"\n\nMalaysian Journal of Pharmacy 2001;1:29-34 Research article\n\n\n\n30\n\n\n\nDevelopment of a High-Performance Liquid\nChromatographic Method for Analysis of\nGlibenclamide from Dissolution Studies\n\n\n\nWan Azman Wan Ismail, Mohamed Ibrahim Noordin, Hadida Hashim*,\nAshok Kumar Narayana\n\n\n\nDepartment of Pharmacy, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur,\nMalaysia.\n\n\n\n*Author for correspondence\n\n\n\nABSTRACT\n\n\n\nA HPLC method for the detection and quantification of glibenclamide, from\ndissolution studies of glibenclamide tablets (5 mg), was developed. The dissolution\ntest employed was the basket method, operating at 100 rpm, using 1000ml\nphosphate buffer pH 7.4 as the dissolution medium. Elution was performed on LC-\n18 reverse phase, SupelcosilTM ODS column (4.6mm x 25cm, 5\u00b5\u00b5\u00b5\u00b5m) using a mobile\nphase consisting of 0.02M monobasic ammonium phosphate in 60%v/v acetonitrile\nin water at a flow rate of 2ml/min, using phenacetin as the internal standard. The\neluent was monitored at 254nm with an UV detector. Retention times of the\nglibenclamide and phenacetin peaks were 3.61 minutes and 1.8 minutes respectively.\n\n\n\nKey words: glibenclamide, dissolution studies, in vitro, HPLC analysis\n\n\n\nINTRODUCTION\n\n\n\nGlibenclamide is the most extensively used\nsulphonylurea in many parts of the world for the\nmanagement of non-insulin-dependent diabetes\nmellitus (NIDDM) (1). A search of the registry of\ndrugs approved for marketing in Malaysia, kept at\nthe Drug Evaluation and Safety Division of the\nNational Pharmaceutical Control Bureau, revealed\na total of 32 glibenclamide preparations registered\nas at July 1999. These included the innovator\nproducts, namely Daonil\uf6da  and Euglucon\uf6da , as well\nas 30 generic preparations, of which 14 were\nimported.\n\n\n\nGlibenclamide is documented to possess low\naqueous solubility (2). Large inter- and intra-\nindividual  responses  following  administration  of\n\n\n\nglibenclamide preparations have also been\nreported (3-5). Such variations are undesirable and\nmay expose susceptible patients to the danger of\nhypoglycaemia or other hazards when changing a\npatient\u2019s therapy from one preparation to another.\n\n\n\nSince 1970, dissolution requirements have been\nadded to tablet and capsule monographs, in\ngeneral, in response to concerns for bioavailability.\nOf equal significance is the recognition of the\nimmense value of dissolution testing as a tool for\nquality control. Thus, equivalence in dissolution\nbehaviour was sought in light of both\nbioavailability and quality control considerations\n(2). The United States Pharmacopoeia (USP) 1995,\nhowever, does not require glibenclamide tablets to\n\n\n\n\n\n\n\n\nResearch article: Analysis of glibenclamide by HPLC\n\n\n\n31\n\n\n\ncomply to the dissolution test (2). Nonetheless,\ndissolution profiles are often used by the industry\nto ascertain the release rates of glibenclamide from\ntablet formulations as a quality assurance tool.\n\n\n\nSignoretti et al (1983) and El-Sayed et al (1989)\nconducted studies to evaluate the physico-chemical\ncharacteristics, including the dissolution profiles,\nof various glibenclamide preparations which might\ncontribute to the unpredictable behaviour of the\ndrug products (6,4). In their studies, Signoretti et\nal (1983) used a method based on ultraviolet\nspectrophotometry to analyze glibenclamide from\ndissolution samples.\n\n\n\nHowever, in terms of sensitivity, precision and\nspecificity, a high-performance liquid\nchromatographic (HPLC) method may offer\nadditional advantages (5,7-9). The USP (1995)\ndocuments a HPLC method for the assay of\nglibenclamide tablets using progesterone as the\ninternal standard (2). The use of an internal\nstandard is required for evaluating system\nsuitability and is not necessary for assays, which\nhave been proven to be accurate, precise, sensitive\nand specific. However, the authors felt that the\nincorporation of a suitable internal standard\nprovides an added value to a HPLC technique, as\nan additional calibration tool, to accommodate any\nchanges in the system and to improve retention\nreproducibility throughout the analytical period\n(10).\n\n\n\nAIM\n\n\n\nThis study aims to develop a HPLC method, with\nthe incorporation of an internal standard, for the\ndetection and quantification of glibenclamide from\ndissolution studies.\n\n\n\nMATERIALS AND METHODS\n\n\n\nMaterials\n\n\n\nTwo of the 5mg glibenclamide tablet preparations\navailable in the Malaysian market namely, Brand\nA (expiry date: August 2002) and Brand B (expiry\ndate: April 2002) were used in the dissolution\nstudies. Glibenclamide RS, progesterone RS and\nphenacetin RS were obtained from the Reference\nStandard Unit, National Pharmaceutical Control\nBureau (NPCB). HPLC-grade acetonitrile and\nmethanol as well as AR-grade monobasic\n\n\n\nammonium phosphate and phosphoric acid were\nused in preparing the mobile phase.\n\n\n\nApparatus\n\n\n\nIn vitro dissolution studies were carried out in a\nErweka\uf6da  DT 70 dissolution apparatus using the\nbasket method, operated at 100 rpm. The HPLC\nsystem consisted of a dual-pump Waters\uf6da  solvent\ndelivery system (Model 600E) a Rheodyne\uf6da  (7725\ni) variable-volume, syringe-loading sample\ninjector, a Waters\uf6da  UV detector (Model 486) set at\n254 nm and Millennium\uf6da  2010 chromatography\nManager, version 2.1 data system as the integrator.\nA stainless steel SupelcosilTM LC-18 ODS (4.6\nmm x 25 cm, 5 \u00b5m) column was used as the\nstationary phase.\n\n\n\nAssay procedures and validation\n\n\n\nStock solutions of 0.05%w/v of glibenclamide RS\nin methanol:phosphate buffer pH7.4 (2:98%v/v),\n0.001%w/v progesterone RS in acetonitrile and\n0.001%w/v of phenacetin RS in phosphate buffer\nwere prepared separately. Standard solutions of\nvarying concentrations of glibenclamide (0.05, 0.1,\n0.2, 0.5, 0.75, 0.8, 1, 1.5, 2 and 5\u00b5g/ml) were\nprepared. This range was selected based on 5\u00b5g/ml\nbeing the maximum concentration of\nglibenclamide in the dissolution medium, upon\ncomplete dissolution of the tablet.\n\n\n\nTo each 1ml aliquot of the standard solutions,\n0.5ml of the internal standard solution (0.001%w/v\nprogesterone or 0.001%w/v phenacetin) was\nadded. 10\u00b5l aliquots of the mixture were then\ninjected into the HPLC (minimum of n=5 for each\nmixture). For the mixtures incorporating\nprogesterone as the internal standard, the following\nmobile phases were used:\na) 0.02M monobasic ammonium phosphate in\n\n\n\nacetonitrile:water (55:45%v/v)\nb) 0.02M monobasic ammonium phosphate in\n\n\n\nacetonitrile:water (60:40%v/v)\nFor each of the mobile phases, the pH was\nadjusted to 5.25 \u00b1 0.10, using phosphoric acid, and\nit was delivered isocratically at 2ml/min. Mobile\nphase (b) was also used for aliquots of mixtures\ncontaining phenacetin as the internal standard.\n\n\n\nFor the assessment of intra-day precision, 10\u00b5l\naliquots of the complete set of glibenclamide\nstandard and the internal standard (phenacetin)\nmixtures were injected (n=3) at 4 different times\nover an 18-hour period, namely in the early\n\n\n\n\n\n\n\n\nResearch article: Analysis of glibenclamide by HPLC\n\n\n\n32\n\n\n\nmorning, noon, mid-evening and night. This was\nrepeated over 3 days to measure inter-day\nprecision.\n\n\n\nTo further validate the accuracy of the assay\ntechnique, the phosphate buffer pH 7.4 used in the\ndissolution experiments was spiked with 3\ndifferent known concentrations of the\nglibenclamide standard (0.65, 1.30 and 1.95\n\u00b5g/ml) and assayed. Phenacetin was used as the\ninternal standard for the assay of the spiked\nsamples.\n\n\n\nApart from measuring the retention times of the\nanalyte peaks, calibration curves of peak area\nratios (PAR) of glibenclamide:internal standard\nversus the known glibenclamide concentrations\nwere also constructed.\n\n\n\nDissolution experiments\n\n\n\n1000 ml of phosphate buffer pH 7.4 @ 37oC was\nused as the dissolution medium. Dissolution of the\ntablets was carried simultaneously in 6 vessels,\nusing the basket method, operating at 100 rpm.\n2ml samples were drawn at 5, 10, 15, 30, 60, 90\nand 120 minutes from the onset of the dissolution\nstudies. Equal volumes of phosphate buffer pH 7.4\npreheated to 37oC, was added into each vessel to\nreplace the withdrawn volumes. The samples were\nfiltered through a 0.45\u00b5m (millipore) membrane\nfilter . To each 1ml aliquot of the samples, 0.5ml\n\n\n\nof 0.01mg/ml phenacetin in phosphate buffer\npH7.4 was added as the internal standard. 10\u00b5l\naliquots of the sample and internal standard\nmixture were then analysed by HPLC (n=3).\n\n\n\nRESULTS AND DISCUSSION\n\n\n\nA mobile phase composing of 0.02M monobasic\nammonium phosphate in 55%v/v acetonitrile in\nwater was initially used, with progesterone as the\ninternal standard, as recommended by the United\nStates Pharmacopoeia (1995). The retention times\nfor the glibenclamide and progesterone peaks were\n4.5 minutes and 7.9 minutes respectively. The\nprolonged retention time of progesterone coupled\nwith its extremely poor aqueous solubility\nrendered it unsuitable as an internal standard for\nthis assay. It was subsequently substituted with\nphenacetin. To reduce the retention time of the\nglibenclamide peak, the composition of the\nacetonitrile in the mobile phase was increased to\n60%v/v. The retention time of phenacetin was\nfound to be 1.8 minutes (Figure 1) while the mean\nretention time for the glibenclamide peaks was\n3.61 minutes with Relative Standard Deviation\n(RSD) values between 0.08% and 1.6% (n=12).\nThe maximum RSD at 1.6% showed that the\nprecision of this method was acceptable.\n\n\n\nThe calibration curve for glibenclamide was linear\nin the concentration range 0.05 to 5 \u00b5g/ml (R2 =\n0.997;  y = 0.1384x + 0.0138).  The  intercept  was\n\n\n\nFigure 1. Retention times for glibenclamide and phenacetin peaks (mobile phase:0.02M\nmonobasic ammonium phosphate in acetonitrile:water, 60:40%v/v)\n\n\n\nphenacetin glibenclamide\n\n\n\nAU\n\n\n\n\n\n\n\n\nResearch article: Analysis of glibenclamide by HPLC\n\n\n\n33\n\n\n\nnot significantly different from zero. However, for\nthe dissolution experiments, preliminary studies\nrevealed that there was incomplete dissolution of\nthe glibenclamide tablets from both Brands A and\nB. Less than 2\u00b5g/ml of glibenclamide was detected\nin the dissolution medium at 120 minutes from the\nonset of the dissolution studies. As such, the\nconcentration range for the calibration curve\nutilized for the dissolution studies was narrowed\ndown to 0.05-2 \u00b5g/ml. The linearity (R2 = 0.9908)\nwas found to be acceptable for this range as\ndisplayed in Figure 2.\n\n\n\nUsing peak area ratios of glibenclamide:phenacetin\n(internal standard), the coefficients of variation for\nboth intra- and inter-day analyses were shown to\nrange from 0.91% to 5.91% and 0.39% to 6.26%\nrespectively for the complete range of\nglibenclamide standards.  As such the intra- and\ninter- day precision of the assay were found to be\nacceptable.\n\n\n\nTable 1 compares the results of the assayed\nconcentrations    (   calculated   from   the  standard\n\n\n\ncurve) of the spiked samples of phosphate buffer\npH 7.4 to the known concentrations of\nglibenclamide added. The differences between the\nknown concentration values and the values\nquantitated from the assay method were not\nsignificant as reflected by the very low values\n(<2%) of the percentage of the [difference \u00f7\nknown concentration].  This further validated the\naccuracy of the assay method.\n\n\n\nFigures 3 and 4 display the dissolution profiles\nfrom the studies conducted on the two commercial\nglibenclamide preparations, Brands A and B, using\nthe HPLC method developed. It was found that the\nHPLC method developed was suitable to measure\nthe low levels of glibenclamide released into the\ndissolution medium.\n\n\n\nFor both brands, dissolution of the tablets were not\ncomplete, even at 120 minutes.  USP (1995)\ngenerally requires that, for an immediate release\ntablet, at least 75% of its active ingredient is\ndissolved within 45 minutes (2).  However, the\npharmacopoeia does not specify dissolution testing\n\n\n\ny = 0.2597x - 0.0038\nR2 = 0.9908\n\n\n\n-0.1\n0\n\n\n\n0.1\n0.2\n0.3\n0.4\n0.5\n0.6\n\n\n\n0.00 0.50 1.00 1.50 2.00 2.50\n\n\n\nConcentrations (ug/ml)\n\n\n\nPe\nak\n\n\n\n A\nre\n\n\n\na \nR\n\n\n\nat\nio\n\n\n\nFigure 2. Calibration curve of glibenclamide for dissolution studies.\n\n\n\nMean \u00b1 SD; n=5\n\n\n\nTable 1. Analysis data of phosphate buffer pH 7.4 spiked with known concentrations of\nglibenclamide.\n\n\n\nKnown concentration\nof glibenclamide\nadded to buffer\n\n\n\nsolutions (\u00b5g/ml)\n[a]\n\n\n\nQuantitated mean\nconcentration of\n\n\n\nglibenclamide from\nHPLC assay (\u00b5g/ml)\n\n\n\n[b]\n\n\n\nDifference between\nknown concentration\nand detected mean\n\n\n\nconcentration (\u00b5g/ml)\n[a]-[b]\n\n\n\nPercentage of difference\nfrom known concentration\n\n\n\n(%)\n[a]-[b] x 100\n\n\n\n               [a]\n\n\n\n0.65 0.65 0 0\n1.30 1.28 0.02 1.54\n1.95 1.93 0.02 1.03\n\n\n\n\n\n\n\n\nResearch article: Analysis of glibenclamide by HPLC\n\n\n\n34\n\n\n\nin the glibenclamide tablet monograph and as such\nthese tablets need not comply to the general\nrequirement. Nonetheless, due to its poor aqueous\nsolubility, glibenclamide tablet formulations may\npotentially face bioavailability problems if its\ndissolution profile is found to be relatively poor.\nThus, the industry does utilize dissolution studies\nas a quality assurance tool.\n\n\n\nCONCLUSION\n\n\n\nA HPLC method for the detection and\nquantification of glibenclamide from dissolution\nstudies had been successfully developed, with\n\n\n\nacceptable retention times of the drug and internal\nstandard peaks, of less than 4 minutes per assay.\nThe HPLC method is able to detect glibenclamide\nconcentrations as low as 0.05\u00b5g/ml with a Relative\nStandard Deviation ranging between 0.08% and\n1.6%.  Apart from the greater precision and\nsensitivity attained using this HPLC method, the\nspecificity offered is undoubtedly another\nadvantage compared to the UV method of analysis.\n\n\n\nACKNOWLEDGEMENTS\n\n\n\nThe authors wish to thank University of Malaya\nR&D Unit for its financial support and Mr. Mohd\nNasir of the Reference Standard Unit, National\n\n\n\nMean \u00b1 SD; n=6\n\n\n\n\n\n\n\n0.00 \n\n\n\n0.50 \n\n\n\n1.00 \n\n\n\n1.50 \n\n\n\n2.00 \n\n\n\n0 20 40 60 80 100 120 140 \n\n\n\nTime (minutes) \n\n\n\nC\non\n\n\n\nce\nnt\n\n\n\nra\ntio\n\n\n\nn \n(u\n\n\n\ng/\nm\n\n\n\nl) \n\n\n\nFigure 4. Dissolution profile of glibenclamide from Brand B\n\n\n\nMean \u00b1 SD; n=6\n\n\n\n\n\n\n\n0.00 \n\n\n\n0.50 \n\n\n\n1.00 \n\n\n\n1.50 \n\n\n\n2.00 \n\n\n\n0 20 40 60 80 100 120 140 \n\n\n\nTime (minutes) \n\n\n\nC\non\n\n\n\nce\nnt\n\n\n\nra\ntio\n\n\n\nn \n(u\n\n\n\ng/\nm\n\n\n\nl) \n\n\n\nFigure 3. Dissolution profile of glibenclamide from Brand A\n\n\n\nMean \u00b1 SD; n=6\n\n\n\n\n\n\n\n\nResearch article: Analysis of glibenclamide by HPLC\n\n\n\n35\n\n\n\nPharmaceutical Control Bureau, Ministry of\nHealth Malaysia for his prompt supply of the\n\n\n\nreference standards.\n\n\n\n*****\nREFERENCES\n\n\n\n1. Lebovitz HE, Melander A. Sulfonylureas: Basic\naspects and clinical uses. In: Alberti KGMM,\nDeFronzo RA, Keen H, Zimmet P, editors..\nInternational textbook of diabetes mellitus.\nEngland: John Wiley & Sons; 1992.\n\n\n\n2. The United States Pharmacopoeia/The National\nFormulary (USP XXIII/ NF XVIII). United States\nPharmacopoeial Convention Inc: USA; 1995.\n\n\n\n3. Coppack SW, Lant AF, McIntosh CS, et al.\nPharmacokinetic and pharmacodynamic studies of\nglibenclamide in non-insulin-dependent diabetes\nmellitus. Br J Clin Pharmac 1990; 29:673-84.\n\n\n\n4. El-Sayed YM, Suleiman MS, Hasan MM, et al.\nComparison of the pharmacokinetics and\npharmacodynamics of two commercial products\ncontaining glibenclamide. Int J Clin Pharmacol\nTher Toxicol 1989; 27: 551-7.\n\n\n\n5. Marchetti P, Navalesi R. Pharmacokinetic-\npharmacodynamic relationships of oral\nhypoglycaemic   agents.  Clin     Pharmacokinetics\n\n\n\n1989; 16: 100-28.\n6. Signoretti EC, Dell\u2019utri A, Cingolani E.\n\n\n\nBioavailability of glibenclamide tablets. Farmaco\n(Prat) 1983; 40: 141-5.\n\n\n\n7. Charles BG, Ravenscroft PJ. Measurement of\ngliclazide in plasma by radial compression\nreversed-phase liquid chromatography. Clin Chem\n1984; 30: 1789-91.\n\n\n\n8. Emilsson H. High-performance liquid\nchromatographic determination of glipizide in\nhuman plasma and urine. J Chromatog 1987; 421:\n319-26.\n\n\n\n9. Raghow G, Meyer MC. High-performance liquid\nchromatographic assay of tolbutamide and\ncarboxytolbutamide in human plasma. J Pharm Sci\n1981; 70: 1166-7.\n\n\n\n10. Smith RM. Retention index scales used in high-\nperformance liquid chromatography.  J Chrom Lib:\nRetention and selectivity in liquid chromatography\n1995; 57:93-144.\n\n\n\n\n\n\n \nTable of Contents\n\n\n \nCenter of Ethics at Georgetown University, Professor Andr\u00e9 Hellegers seized the opportunity to turn bioethics into an academic discipline that reflected the needs of the time. This was rather easily acceptable as bioethics can readily be identified with\n\n\n \nABSTRACT\n\n\n\n\n\n\nINTRODUCTION\n\n\nAIM\n\n\nMATERIALS AND METHODS\n\n\n \n\n\n \n\n\n \nMaterials\n\n\nApparatus\n\n\n\n\nAssay procedures and validation\n\n\nDissolution experiments\n\n\n\n\n\n\nRESULTS AND DISCUSSION\n\n\nThe calibration curve for glibenclamide was linear in the concentration range 0.05 to 5 (g/ml (R2 = 0.997;  y = 0.1384x + 0.0138).  The  intercept  was\n\n\nnot significantly different from zero. However, for the dissolution experiments, preliminary studies revealed that there was incomplete dissolution of the glibenclamide tablets from both Brands A and B. Less than 2(g/ml of glibenclamide was detected in t\n\n\nCONCLUSION\n\n\nACKNOWLEDGEMENTS\n\n\n \n\n\n \n\n\n \n\n\n \n\n\n \nREFERENCES\n\n\n\n\n\n\n\n\n\n\n\n\n\n"
"\n\nMalaysian Journal of Pharmacy Volume 7 Issue 2 (2021) \n \n\n\n\n\n\n\n\n58 \n\n\n\n\n\n\n\n*Correspondence: aisyahsaad@uitm.edu.my \n1Faculty of Pharmacy, Universiti Teknologi MARA, 42300 Puncak Alam, \n\n\n\nSelangor, Malaysia \n \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n Short Communication \n\n\n\n\n\n\n\nFirst Year Pharmacy Students' Perceptions on ODL during the \n\n\n\nCovid-19 Pandemic: A Thematic Analysis \n \n\n\n\nAisyah Saad Abdul Rahim1*, Chee Yan Choo1 \n\n\n\n\n\n\n\n \nArticle Info  \n\n\n\n \nReceived date: 12 Aug 2021  \n\n\n\nAccepted date: 05 Nov 2021 \n\n\n\nPublished date: 31 Dec 2021 \n\n\n\n\n\n\n\nKeywords: First year students, \n\n\n\nonline distance learning, \n\n\n\nCovid-19, teaching presence, \n\n\n\nCommunity of Inquiry. \n\n\n\nABSTRACT  \n\n\n\n\n\n\n\nIntroduction: Following the outbreak of the Covid-19 pandemic in early 2020, the traditional face-\n\n\n\nto-face delivery moved to online distance learning (ODL). New to the university\u2019s online learning \n\n\n\nenvironment are the first-year students. This study explores perceptions and experiences of the first-\n\n\n\nyear undergraduate pharmacy students learning via the ODL mode during the Covid-19 pandemic. \n\n\n\nObjective: This study aims to gain an understanding of the students\u2019 learning issues and concerns \n\n\n\nduring ODL. Method: Students\u2019 responses were collected and analysed using thematic analysis. \n\n\n\nResult: The findings revealed three broad themes of learning issues and concerns during ODL: (1) \n\n\n\nadapting to online distance learning mode, (2) feeling overwhelmed and increased stress, and (3) \n\n\n\nsupport and guidance during online learning. The results indicate the need for enhanced teaching and \n\n\n\nsocial presences during ODL. Conclusion: Adapting to ODL seems to take longer time than expected \n\n\n\nfor the first-year pharmacy students. It appears that they struggled to manage their lives and studies \n\n\n\nin remote learning, thus requiring more support and direct instruction.   \n\n\n\n\n\n\n\n\n\n\n\nINTRODUCTION  \n  \n\n\n\nThe Covid-19 pandemic has caused significant disruptions to \n\n\n\nthe normal operation of on-campus face-to-face educational \n\n\n\ndelivery in higher education institutions worldwide. To reduce \n\n\n\nthe spread of the coronavirus to communities, Malaysia\u2019s \n\n\n\nMinistry of Higher Education instructed temporary closure of \n\n\n\nall universities in Malaysia from April 2020. All physical face-\n\n\n\nto-face (F2F) teaching and learning sessions moved to remote \n\n\n\nteaching, where students resumed their studies, from home, via \n\n\n\nthe online distance learning (ODL) mode [1,2]. \n\n\n\n\n\n\n\nOnline learning can be defined as synchronous or asynchronous \n\n\n\nlearning that takes place in an online environment mediated by \n\n\n\nthe use of the internet in teaching and learning [3-5]. The term \n\n\n\n\u2018online learning\u2019 is evolving in parallel with advances in \n\n\n\ntechnology and media; sometimes, it is used interchangeably \n\n\n\nwith e-learning or considered a subset of e-learning [5,6]. \n\n\n\nOnline learning, however, is not new to many higher education \n\n\n\ninstitutions. Since the rollout of Massive Open Online Courses \n\n\n\n(MOOCs) in 2012, this form of online learning has \n\n\n\ntremendously gained traction, with over 180 million \n\n\n\nenrolments globally in 2020, excluding China [7]. Online \n\n\n\ncourses provide convenience, flexibility and invaluable access \n\n\n\nto free and affordable learning materials to learners. In the \n\n\n\ncontext of pharmacy education, e-learning has been reviewed \n\n\n\nrecently [6,8,9]. The reviews concluded that e-learning is an \n\n\n\naccepted pedagogy with proven short-term effectiveness in \n\n\n\npharmacy education. However, little evidence was found on its \n\n\n\nlong-term effectiveness in improving skills and professional \n\n\n\npractices [6,8].   \n\n\n\n\n\n\n\nIn early 2020, the threat of the coronavirus pandemic \n\n\n\naccelerated the speed and scale of the transition to full ODL at \n\n\n\npharmacy institutions including in the Middle East [10-12] and \n\n\n\nAsia Pacific region [13]. Faculty members had to quickly adapt \n\n\n\nto emergency remote teaching to ensure that educational \n\n\n\ndelivery was not disrupted. Conventional F2F lectures and \n\n\n\npractical laboratory sessions were converted to live lectures and \n\n\n\nvirtual practical, which were conducted synchronously or \n\n\n\nasynchronously using remote meeting apps. Timely response \n\n\n\nto most students\u2019 enquiries helped reduce uncertainties and \n\n\n\nunsettling feelings during online learning. Many students were \n\n\n\nable to cope with online learning and the resulting changes \n\n\n\nthanks to the continuous and unwavering support of institutions \n\n\n\n\n\n\n\n\nAisyah Saad et al. Mal J Pharm 7 (2) 2021, 58-63 \n\n\n\n\n\n\n\n59 \n\n\n\n\n\n\n\nand faculty members. As a result, learning continued with \n\n\n\nminimal interruptions. \n\n\n\n\n\n\n\nWhile we remain convinced of the many advantages of online \n\n\n\nlearning for our Digital Native students, making the full \n\n\n\ntransition to ODL is not always easy [14]. We recognise many \n\n\n\nchallenges faced by the faculty members and students during \n\n\n\nthe transition. Access to stable internet connectivity continues \n\n\n\nto be the main issue for faculty members and students alike \n\n\n\n[2,11,15]. To accommodate students\u2019 limited internet data or \n\n\n\nlow bandwidth, in practice, many synchronous activities or live \n\n\n\nlectures were conducted with students\u2019 webcams and \n\n\n\nmicrophones turned off [16]. Such practices can feel \n\n\n\ndisconcerting to both faculty members and students; for faculty \n\n\n\nmembers, it feels like talking to a wall for the whole lecture \n\n\n\nhour. Thus, the lack of social interactions and social cues, for \n\n\n\ninstance absence of body language, reactions and facial \n\n\n\nexpressions have been identified as one of the most significant \n\n\n\nbarriers in online learning [15,17,18].  \n\n\n\n\n\n\n\nAdditionally, being used to didactic F2F delivery, faculty \n\n\n\nmembers may lack sound pedagogical, facilitation and \n\n\n\ntechnical knowledge in developing online courses. Notably, \n\n\n\ndespite the shift to online delivery, many courses retain the \n\n\n\n\u2018feel\u2019 of F2F instruction [18]. Little design consideration to the \n\n\n\ndesign of an online course is given. An online course typically \n\n\n\nconsists of an ice-breaking activity, netiquette and \n\n\n\ncollaborative activities to engage students in a virtual setting \n\n\n\n[19,20]. \n\n\n\n\n\n\n\nIn the last two decades, Community of Inquiry (COI) \n\n\n\nframework has emerged as a widely researched model for \n\n\n\ndesigning learning experiences in virtual environments [21-\n\n\n\n23]. Based on social constructivist theory, COI \u201crepresents a \n\n\n\nprocess of creating a deep and meaningful learning experience \n\n\n\nthrough the development of three interdependent elements\u2013\n\n\n\nsocial, cognitive and teaching presence\u201d [22]. Central to both \n\n\n\nsocial and cognitive presence is a faculty member\u2019s online \n\n\n\nteaching presence involving course design and providing \n\n\n\nfacilitation and direction to students in achieving common \n\n\n\nlearning outcomes.  \n\n\n\n\n\n\n\nNew to the online learning environment are the first-year \n\n\n\nundergraduate students. It was their first time at the university. \n\n\n\nThey had no face-to-face meeting with faculty members and \n\n\n\ncoursemates, nor did they have experiences in the full ODL \n\n\n\nmode. Hence, this study seeks to explore the first-year \n\n\n\npharmacy students' perceptions on ODL during the first \n\n\n\nsemester, which, to the best of our knowledge, has not been \n\n\n\nstudied in Malaysia. Gaining an understanding of the students' \n\n\n\nlearning issues can serve as an opportunity to re-think aspects \n\n\n\nof an existing course or a programme that may not seem \n\n\n\nobvious to the faculty members. Insights from the study can \n\n\n\nhelp faculty members and administrators to develop \n\n\n\npedagogical interventions and academic support for students. \n\n\n\n\n\n\n\nMETHOD  \n \n\n\n\nThis study seeks to explore perceptions and experiences of the \n\n\n\nfirst-year undergraduate pharmacy students at Universiti \n\n\n\nTeknologi MARA on ODL during the Covid-19 pandemic. To \n\n\n\ngain an understanding of the students\u2019 perceptions, a qualitative \n\n\n\napproach was employed. The pharmaceutical chemistry course \n\n\n\nfor first year undergraduate pharmacy students consists of \n\n\n\ntopics on organic chemistry and stereochemistry that were \n\n\n\ndelivered via synchronous and asynchronous methods of \n\n\n\nremote teaching over a period of 14 weeks. Students' \n\n\n\nperformance in this course were assessed using a combination \n\n\n\nof a quiz (Test 1), virtual laboratory sessions and problem-\n\n\n\nbased learning (PBL) sessions before the final open-book \n\n\n\nexaminations at the end of Week 14.   \n\n\n\n\n\n\n\nIn Week 11, a PBL briefing via Cisco Webex meeting took \n\n\n\nplace and was attended by two faculty members and 107 \n\n\n\nstudents. Mentimeter was employed to facilitate students\u2019 \n\n\n\nsharing their responses to a question when posed on a \n\n\n\nMentimeter slide. The question was: please tell us (in general \n\n\n\nor specific) what are the issues in learning this course. The link \n\n\n\nto the slide was posted in the Webex chat box. A flowing grid \n\n\n\nresponse in Mentimeter was chosen to show the students' \n\n\n\nresponses. The students were allowed to post multiple \n\n\n\ncomments without the need to share their names. The posted \n\n\n\ncomments were not visible to other students during the session. \n\n\n\nThey were informed that their responses would remain \n\n\n\nanonymous. \n\n\n\n\n\n\n\nWe received 56 comments in total on Mentimeter. Their \n\n\n\nresponses were presented (screen-sharing) during the Webex \n\n\n\nmeeting, and this led to informal and unstructured interactive \n\n\n\ndiscussions with the students. Several more students \n\n\n\ncommented further in the Webex chat box\u2013to agree, clarify or \n\n\n\nexplain the situations or issues they had during the ODL \n\n\n\nsession.  \n\n\n\n\n\n\n\nThematic analysis of students' responses was employed as this \n\n\n\nmethodology enabled us to elucidate their perceptions, namely \n\n\n\non ODL learning issues during this unprecedented time. The \n\n\n\nanalysis of students' responses was conducted according to the \n\n\n\nsteps outlined by Braun and Clarke [24,25].  The responses in \n\n\n\nMentimeter, Cisco Webex chat box and Webex meeting \n\n\n\nrecording were transcribed, compiled and categorised \n\n\n\naccording to topics and frequency of responses. Immersion in \n\n\n\nthe data is one of the key steps in thematic analysis; thus, \n\n\n\nfamiliarisation of the data involved several readings of the \n\n\n\ntranscripts. Inductive analysis was conducted on the transcribed \n\n\n\nresponses. An initial list of codes was developed and discussed \n\n\n\nbetween the authors. This led to further refinements and \n\n\n\n\n\n\n\n\nAisyah Saad et al. Mal J Pharm 7 (2) 2021, 58-63 \n\n\n\n\n\n\n\n60 \n\n\n\n\n\n\n\ndevelopment into broader patterns of meanings, or themes \n\n\n\nacross many learning issues highlighted by the first-year \n\n\n\npharmacy undergraduate students in the first semester. \n\n\n\n\n\n\n\nRESULT  \n\n\n\n\n\n\n\nThree themes were developed from the analysis of the \n\n\n\ntranscribed responses in Mentimeter, Cisco Webex chat box \n\n\n\nand Webex meeting recording: (1) Adapting to online learning \n\n\n\nmode; (2) Feeling overwhelmed and increased stress; and (3) \n\n\n\nSupport and guidance during online learning. \n\n\n\n\n\n\n\n3.1 Adapting to online distance learning mode \n\n\n\n\n\n\n\nThe first-year students expressed that they were struggling to \n\n\n\nadapt to online learning, since it is their first time learning via \n\n\n\nthe ODL mode and had no opportunities meeting face-to-face \n\n\n\nwith their peers and lecturers. They highlighted difficulties in \n\n\n\nmanaging time and self with additional family commitments. \n\n\n\n\n\n\n\n\"It is very difficult as we are in ODL for the first time in the \n\n\n\nfirst semester. It is difficult to study (online) in a group and ask \n\n\n\nfriend and lecturers as it has a barrier compare to face-to-face \n\n\n\nlearning. Other than that, at home we have many \n\n\n\nresponsibilities.\" C38 \n\n\n\n\n\n\n\n\"I\u2019m not sure about others but for me, I still struggle in \n\n\n\nadapting with this online learning especially in terms of time \n\n\n\nmanagement. That being said, the source of the problem is \n\n\n\nmyself. I can\u2019t really provide a good reason because the \n\n\n\nproblem is myself.\" C15 \n\n\n\n\n\n\n\n3.2 Feeling overwhelmed and increased stress \n\n\n\n\n\n\n\nStudents shared two main issues that led to the feelings of being \n\n\n\noverwhelmed and increased stress during their online learning. \n\n\n\nThe first issue is on time management and perceived high \n\n\n\nacademic workload, whereas the second concern is about \n\n\n\nworking with problematic group members. \n\n\n\n\n\n\n\n3.2.1 Sub-theme: Feeling overwhelmed and stress managing \n\n\n\nclasses, assignments, deadlines and revisions \n\n\n\n\n\n\n\nThe first-year students felt overwhelmed under the time \n\n\n\npressure of completing multiple individual assignments prior to \n\n\n\nTest 1, thus citing the lack of time for revisions.  \n\n\n\n\n\n\n\n\"I found it hard to revise or catch up with the lectures because \n\n\n\nthere are a lot of assignments that need to be done. The only \n\n\n\ntime that I can actually revise is during test week.\" C16  \n\n\n\n\n\n\n\n\"I stayed home and I need to help my family to do the house \n\n\n\nchores as well. The assignments burden me so bad. The other \n\n\n\nsubjects\u2019 assignments are really hard for me to do it alone. So, \n\n\n\nI really don\u2019t have much time to focus on my study for this \n\n\n\nsubject.\" C12  \n\n\n\n\n\n\n\n3.2.2 Sub-theme: Stress caused by problematic group \n\n\n\nmembers \n\n\n\n\n\n\n\nThe first year\u2019s students voiced a strong desire to have the \n\n\n\noption to choose their own members for group work, instead of \n\n\n\nbeing assigned by lecturers. They were aware of problems \n\n\n\narising from incompatible group members, citing poor work \n\n\n\nattitudes or the lack of commitments during group work.  \n\n\n\n\n\n\n\n\"I hope students can choose their own group members for PBL \n\n\n\nand lab report like the lecturer did for PBL2. As for other \n\n\n\nsubjects, some students experience problems, like not all \n\n\n\nmembers did their work when the group members assigned by \n\n\n\nlecturers.\" C27 \n\n\n\n\n\n\n\n\"It is stressful when we need to do the assignment in groups \n\n\n\nand the marks that will be given also based on the group. I have \n\n\n\nproblems which my certain group mates did not participate \n\n\n\nactively and just did the assignment for only 5%.\" C47 \n\n\n\n\n\n\n\n\"I am thankful for this subject - we can actually choose our \n\n\n\nteam members for all the assignments. But for other subjects, \n\n\n\nthe group members are all picked by lecturers and I need to \n\n\n\nface the same problematic members. I cried a lot because of \n\n\n\nthis.\" C48 \n\n\n\n\n\n\n\n3.3 Support and guidance during online learning \n\n\n\n\n\n\n\nStudents expressed their need for live lectures, recording and \n\n\n\npast-year questions to be made available to support and guide \n\n\n\ntheir studies since this is their first year. They were aware of \n\n\n\nthe isolated feeling of studying online and asked for a more \n\n\n\nresponsive chat group to support their learning. \n\n\n\n\n\n\n\n\"I\u2019m having a problem during a lecturer\u2019s class. Because we \n\n\n\njust discussed what we do not understand instead of going \n\n\n\nthrough the notes given. Not recorded too.\" C29  \n\n\n\n\n\n\n\n\"I think that the one thing that has been so hard on me is that \n\n\n\nfor three weeks - there was no lecture conducted and only Q & \n\n\n\nA sessions. I believe for me, it is really ineffective to study \n\n\n\nchemistry by ourselves.\" C11 \n\n\n\n\n\n\n\n\"There is a problem when someone ask something in the group, \n\n\n\nthere will just \u2018seen\u2019 the chat and no response at all. This makes \n\n\n\nsomeone gives up asking something. And I hope that there will \n\n\n\nbe more (students/lecturers) who want to answer the chat - \n\n\n\nbecause it can make someone (feel) down.\" C28 \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nAisyah Saad et al. Mal J Pharm 7 (2) 2021, 58-63 \n\n\n\n\n\n\n\n61 \n\n\n\n\n\n\n\nDISCUSSION \n \n\n\n\nThis study aims to explore perceptions and experiences of the \n\n\n\nfirst-year undergraduate pharmacy students in the first semester \n\n\n\nof ODL during the Covid-19 pandemic. The loss of a familiar \n\n\n\nroutine and support expected from the traditional, face-to-face \n\n\n\nteaching and learning has disrupted a sense of stability and \n\n\n\ncoherence in the lives of faculty members and students. Many \n\n\n\nhad no choice but to rapidly adapt to the online learning \n\n\n\nenvironment. \n\n\n\n\n\n\n\n1. Adapting to online distance learning mode \n\n\n\n\n\n\n\nThe preliminary findings of this study revealed that the first-\n\n\n\nyear undergraduate pharmacy students still find it difficult \n\n\n\nadapting to ODL\u2013almost three months into the semester. For \n\n\n\nstudents, it is their first time at the university. Navigating \n\n\n\nthrough new courses and meeting new course mates and faculty \n\n\n\nmembers on online platforms can be exciting, awkward, \n\n\n\nnervous and intimidating at the same time. Without prior \n\n\n\nexperience in ODL, we speculate that they were unfamiliar \n\n\n\nwith what to expect and how to behave in an online learning \n\n\n\nenvironment. This is consistent with a recent study on \n\n\n\npharmacy student ODL experience at a college of pharmacy in \n\n\n\nSaudi Arabia [11] that showed the preparatory phase students \n\n\n\nhave lower level of perceived preparedness. It also appears that \n\n\n\neven though students were aware \u201c... the source of the problem \n\n\n\nis myself...\u201d (C15), they were having trouble finding the right \n\n\n\nbalance in managing their time and learning, thus took longer \n\n\n\nthan expected in adapting to ODL. \n\n\n\n\n\n\n\n2. Feeling overwhelmed and increased stress  \n\n\n\n\n\n\n\nOnline learning from home presents many unique and \n\n\n\nunexpected challenges to the first-year students [1,27]. They \n\n\n\nfound themselves having to split their attention, time and \n\n\n\nspaces constantly. Dealing with daily house chores, family \n\n\n\nresponsibilities, negotiating living spaces, the internet and \n\n\n\ndevices with siblings and parents (all learning and working \n\n\n\nfrom home) while attending live lectures, completing \n\n\n\nassignments and studying for tests and exams are amongst the \n\n\n\nrealities of ODL. Coping with the learning environment at \n\n\n\nhome is not limited to pharmacy students; Barrot et al. [28] \n\n\n\nhighlighted similar challenges experienced by college students \n\n\n\nat the National University in the Philippines. \n\n\n\n\n\n\n\nManaging increased responsibilities at home, in addition to \n\n\n\nunfamiliarity and uncertainties in academic activities may have \n\n\n\nresulted in the first-year students feeling stressed and \n\n\n\noverwhelmed in meeting the demands of academic workload \n\n\n\n[2,27,29]. Having regular open and receptive communications \n\n\n\namong faculty members and students could help reduce \n\n\n\nscheduling conflicts, thus easing the stress related to academic \n\n\n\nworkload. \n\n\n\nMoreover, the lack of face-to-face interactions may make it \n\n\n\nmore difficult for the first-year students to develop trust and \n\n\n\nbonds with new group mates and faculty members. Vietnamese \n\n\n\nresearchers found that, in an online learning environment, \n\n\n\nstudents were \u201cmore passive and less motivated to work with \n\n\n\npeople who they did not know in person before.\u201d [18]. Students \n\n\n\nexpressed concerns about working with difficult and \n\n\n\nuncooperative group members, which further added to the \n\n\n\nstress associated with remote learning. Therefore, it is \n\n\n\nunderstandable that they would prefer to choose their own \n\n\n\ngroup members rather than having them assigned by faculty \n\n\n\nmembers. These underscore the need to incorporate teaching \n\n\n\nand social presence in an existing course.  \n\n\n\n\n\n\n\nTeaching and social presence can be illustrated further using \n\n\n\nthe \u201cPhases of Engagement\u201d model which progressively builds \n\n\n\ntrust and understanding between students via collaborative \n\n\n\nassignments, and facilitates faculty members in promoting \n\n\n\nactive learning in an online course [19,20]. For example, to \n\n\n\nactively engage students online, the faculty at D\u2019Youville \n\n\n\nSchool of Pharmacy in the United States used the breakout \n\n\n\nroom feature in Zoom to conduct medicinal chemistry \n\n\n\nassignments in Pharmacotherapeutics IV: Endocrinology \n\n\n\ncourse. The faculty moved from one breakout room to another \n\n\n\nto observe students\u2019 progress and collaborations, and facilitate \n\n\n\ntheir discussions [30]. Such intervention fosters better peer-to-\n\n\n\npeer learning, thus providing support to help reduce stress \n\n\n\nrelated to ODL. \n\n\n\n\n\n\n\n3. Support and guidance during online learning \n\n\n\n\n\n\n\nStudents expressed difficulties studying alone, and being \n\n\n\nwithout much support from peers and faculty members during \n\n\n\nODL. These would consequently lead to negative emotions, \n\n\n\nnamely feeling neglected, isolated and demotivated; these are \n\n\n\nnot uncommon [11,31], considered as barriers in online \n\n\n\nlearning [17], and ways to overcome these feelings have been \n\n\n\nexplored [32]. Students do require on-going contact and \n\n\n\nsupport in order to deal with these negative emotions, which \n\n\n\nare viewed as taboo in Asian cultures and therefore, might be \n\n\n\nleft unspoken. Gradual introduction of collaborative group \n\n\n\nwork in online courses may help mitigate negative emotions \n\n\n\nin constructive ways [20]. \n\n\n\n\n\n\n\nThe crucial role of a faculty member\u2019s teaching presence is \n\n\n\nhighlighted in the comment below: \n\n\n\n\n\n\n\n\"I think that the one thing that has been so hard on me is that \n\n\n\nfor three weeks - there was no lecture conducted and only \n\n\n\nquestion and answer (Q & A) sessions. I believe for me, it is \n\n\n\nreally ineffective to study chemistry by ourselves.\" C11  \n\n\n\n\n\n\n\nBeing new to the topics, the first-year students would find it \n\n\n\ndifficult to learn new concepts on their own. They seem to \n\n\n\n\n\n\n\n\nAisyah Saad et al. Mal J Pharm 7 (2) 2021, 58-63 \n\n\n\n\n\n\n\n62 \n\n\n\n\n\n\n\nexpect faculty members, as subject matter experts, to provide \n\n\n\ndirect instruction on the topics. Garrison et al. [21]asserted the \n\n\n\nimportance of teaching presence as \u2018the binding element\u2019 for \n\n\n\nsocial and cognitive presences in a virtual learning \n\n\n\nenvironment. During the pandemic, a consistent theme in the \n\n\n\nfaculty\u2019s approaches at Monash University\u2019s Faculty of \n\n\n\nPharmacy and Pharmaceutical Sciences was ensuring some \n\n\n\nsynchronous touchpoints to create and sustain community-\n\n\n\nbuilding between students and instructors [33]. For example, \n\n\n\nstudents were sorted into smaller groups for synchronous \n\n\n\nsessions where Zoom\u2019s breakout rooms were used for role-play \n\n\n\npatient counselling [34]. \n\n\n\n\n\n\n\nAdditionally, conducting live lectures could open up learning \n\n\n\nopportunities and correct misconceptions. Although during live \n\n\n\nlectures internet connectivity may be disrupted and students \n\n\n\nattend the live lectures as passive learners, they would still be \n\n\n\nable to \u2018feel\u2019 and hear their peers participating in the virtual \n\n\n\natmosphere. This creates a sense of belonging among the \n\n\n\nstudents, thus promoting social and cognitive presence as \n\n\n\noutlined in the COI framework. The recordings of the live \n\n\n\nsession allowed the students to follow up on the missing parts \n\n\n\nand reflect on the live lecture discussion or activities [33]. All \n\n\n\nthese are important in providing support and guidance to \n\n\n\nstudents. \n\n\n\n\n\n\n\nIn the light of the Covid-19 pandemic and its long-term \n\n\n\nramifications, administrators and faculty members must be \n\n\n\nacutely aware of the first-year students\u2019 learning concerns and \n\n\n\nneeds [13,14,28,33,34]. To address the issues, we suggest the \n\n\n\nfollowing interventions:  \n\n\n\n\n\n\n\na. Conduct briefings to assist students in becoming \n\n\n\nacquainted with the pharmacy programme in the first \n\n\n\nsemester of online learning. \n\n\n\nb. Connect them with their mentors, peers and seniors \n\n\n\nvia virtual ice-breaking sessions. \n\n\n\nc. Introduce programme-wide monitoring of academic \n\n\n\nworkload deadlines to reduce submission conflicts. \n\n\n\nd. Incorporate online collaborative pedagogical \n\n\n\ninterventions e.g., the use of virtual breakout rooms \n\n\n\nwith think-pair-share, jigsaw and escape room \n\n\n\nactivities. \n\n\n\ne. Place greater emphasis on teaching and social \n\n\n\npresence in the first-year courses. \n\n\n\nf. Training of educators on designing online courses and \n\n\n\ntechnology in teaching to achieve the course learning \n\n\n\noutcomes through active learning. \n\n\n\n\n\n\n\nTogether, these could bring about a desirable \u2018snowball effect\u2019 \n\n\n\nthat builds and sustains trust, alleviates academic stress, and \n\n\n\nfosters meaningful online learning experiences for first year \n\n\n\nundergraduate pharmacy students, thus, would be extendable to \n\n\n\nother courses. \n\n\n\nThe results of this study should be interpreted in light of some \n\n\n\nlimitations. The responses were gathered from a group of first \n\n\n\nyear undergraduate pharmacy students who volunteered to \n\n\n\nshare their views and experiences in ODL. The students are \n\n\n\nfrom only one university in Malaysia. This could limit the \n\n\n\ntransferability of the study\u2019s findings. Our research, however, \n\n\n\nhas shed light on students\u2019 online learning issues that are \n\n\n\nconsistent with larger studies [10,11,28,35]. This indicates that \n\n\n\nour findings may be transferable to some extent.   \n\n\n\n\n\n\n\nCONCLUSION  \n \n\n\n\nWe conducted this study to gain some understanding of \n\n\n\nlearning issues encountered by the first-year undergraduate \n\n\n\npharmacy students during the Covid-19 pandemic. Thematic \n\n\n\nanalysis of students\u2019 responses led to three broad themes of \n\n\n\nlearning issues and concerns during ODL: (1) Adapting to \n\n\n\nonline distance learning mode; (2) Feeling overwhelmed and \n\n\n\nincreased stress; (3) Support and guidance during online \n\n\n\nlearning. This study suggests that the first-year students \n\n\n\nexperienced difficulty to adapt and manage their lives and \n\n\n\nstudies during their first semester of ODL. The study also \n\n\n\nhighlights the importance of online teaching presence in \n\n\n\nrealising meaningful outcomes in student learning. The first-\n\n\n\nyear students seem to need direct instruction and institutional \n\n\n\nsupport during ODL. A number of interventions are suggested \n\n\n\nto address the highlighted issues. These will continue to be \n\n\n\nrelevant as the higher education sector re-opens in stages where \n\n\n\nstudents would resume their studies in hybrid and ODL modes. \n\n\n\nFurther research is needed to determine the post-pandemic \n\n\n\nimpact of ODL among pharmacy undergraduate students in \n\n\n\nMalaysia, and perhaps the effect of ODL on the quality of \n\n\n\ngraduates produced. \n\n\n\n\n\n\n\nACKNOWLEDGEMENT  \n \n\n\n\nThe authors would like to thank all first-year undergraduate \n\n\n\npharmacy students who had participated in the survey and the \n\n\n\nCisco Webex session.   \n\n\n\n\n\n\n\nCONFLICT OF INTEREST   \n \n\n\n\nThe authors declare no conflict of interest. This research did \n\n\n\nnot receive any specific grant from funding agencies in the \n\n\n\npublic, commercial or not-for-profit sectors. \n\n\n\n\n\n\n\nREFERENCE   \n \n\n\n\n[1] Sahu P. 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"\n\nMalaysian Journal of Pharmacy Volume 7 Issue 2 (2021) \n \n\n\n\n\n\n\n\n77 \n\n\n\n\n\n\n\n\n\n\n\n*Correspondence: freedathean@winwamedical.com \n1Bachelor of Pharmacy. Product Development, Winwa Medical Sdn. Bhd., \n\n\n\nBukit Mertajam, Pulau Pinang, Malaysia.  \n2Bachelor of Pharmacy. Product Management, Winwa Medical Sdn. Bhd., \n\n\n\nBukit Mertajam, Pulau Pinang, Malaysia. \n3Bachelor of Science (Chemistry). Quality Control, Winwa Medical Sdn. \n\n\n\nBhd., Bukit Mertajam, Pulau Pinang, Malaysia. \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n Original Article \n\n\n\n\n\n\n\nStability Study of an Extemporaneous Isoniazid Oral \n\n\n\nSuspension Prepared using Commercially Available Tablets \n\n\n\nwith X-Temp\u00ae Oral Suspension System   \n \n\n\n\nFreeda Siew Yuin Thean1*, Lian Thye Chan2, Lue See Yeoh3, Rou Chian Ng3 \n\n\n\n\n\n\n\n \nArticle Info  \n\n\n\n \nReceived date: 2 Sept 2021  \n\n\n\nAccepted date: 15 Dec 2021 \n\n\n\nPublished date: 31 Dec 2021 \n\n\n\n\n\n\n\nKeywords: Isoniazid, X-Temp\u00ae \n\n\n\nOral Suspension System, \n\n\n\nExtemporaneous, Stability, \n\n\n\nTuberculosis \n\n\n\n\n\n\n\nABSTRACT  \n\n\n\n\n\n\n\nIsoniazid (INH) is a hydrazine derivative that is routinely used for the treatment of pulmonary and \n\n\n\nextrapulmonary tuberculosis. It is used with other anti-tuberculosis drugs usually in regimes \n\n\n\nincluding rifampicin, ethambutol, and pyrazinamide. As there is no access to commercial oral \n\n\n\nsolution in Malaysia, there is a requirement to prepare this product by extemporaneous compounding. \n\n\n\nThis study is initiated to identify an easy-to-prepare formulation for compounding and to select \n\n\n\nproduct storage condition and establish beyond-use date. INH tablets were used to mix into X-Temp\u00ae \n\n\n\nOral Suspension System to compound the 10 mg per mL and 40 mg per mL solution. For the stability \n\n\n\nstudies, the finished products were packed into amber HDPE bottles and stored at refrigeration (5\u00b0C \n\n\n\n\u00b1 3\u00b0C) or room temperature (30\u00b0C \u00b1 2\u00b0C) for up to 90 days. The samples were evaluated by visual \n\n\n\ninspection, pH measurement, high-performance liquid chromatography (HPLC) assay at \n\n\n\npredetermined testing intervals for 90 days. The samples were submitted for microbiology testing at \n\n\n\neach time point. An HPLC method validation was also carried out to ensure that the system provides \n\n\n\naccurate, precise and reliable analytical data. The results showed that INH suspension at \n\n\n\nconcentration of 10mg/mL and 40mg/mL remained unchanged in physical, chemical and \n\n\n\nmicrobiological evaluations for up to 90 days. The HPLC results demonstrated that all the samples \n\n\n\nretained the drug concentration within the specification. It could be suggested that INH tablet can be \n\n\n\nextemporaneously compounded in X-Temp\u00ae Oral Suspension System at a concentration of between \n\n\n\n10mg/mL to 40mg/mL with the resulting product stable for up to 90 days when packed in HDPE \n\n\n\nbottles and stored at either refrigeration or room temperature. \n\n\n\n\n\n\n\n\n\n\n\nINTRODUCTION  \n  \n\n\n\nTuberculosis (TB) caused by Mycobacterium tuberculosis is a \n\n\n\nserious infectious disease with a potential lethal outcome. In \n\n\n\n2020 alone, an estimated 10 million incident cases of TB were \n\n\n\nreported worldwide resulting in an estimated 1.5 million deaths \n\n\n\n(214,000 deaths involving HIV-infected people). It is a serious \n\n\n\npublic health issue as TB is now recognized as the second most \n\n\n\ndeadly disease caused by a single infectious agent after Covid-\n\n\n\n19 and the leading cause of mortality among the HIV-infected \n\n\n\npeople, which is why effective intervention is urgently needed \n\n\n\n[1]. \n\n\n\n\n\n\n\nTB has devastating effects in children: in 2020, 1.1 million \n\n\n\nchildren became ill with TB [1]. There are about 15% - 20% of \n\n\n\nTB cases involving children in high-burden settings. Those \n\n\n\nsusceptible to infection with M. tuberculosis are young children \n\n\n\n(< 5 years of age) and children with HIV infection. They are at \n\n\n\nmuch higher risk than adults to progress into TB following an \n\n\n\ninfection. More often than not, those that experience severe \n\n\n\n\n\n\n\n\nThean S.Y. et al. Mal J Pharm 7 (2) 2021, 77-84 \n\n\n\n\n\n\n\n78 \n\n\n\n\n\n\n\nforms of TB are more likely to be left severely disabled by the \n\n\n\ndisease, as they are more prone to complex forms of TB such \n\n\n\nas TB meningitis [2]. Hence, safe and effective strategy is \n\n\n\nneeded to protect this vulnerable group from developing TB. \n\n\n\n\n\n\n\nThe first-line agents routinely used in multi-drug regimens for \n\n\n\nthe treatment of TB are Isoniazid (INH), rifampicin (RMP), and \n\n\n\npyrazinamide (PZA). As a single drug, INH can be used for the \n\n\n\nprevention of M. tuberculosis infection and also to prevent \n\n\n\nprogression from latent infection to TB [3]. Therefore, INH is \n\n\n\nregarded highly effective against M. tuberculosis [5]. \n\n\n\n\n\n\n\nINH and RMP are important for their bactericidal activity \n\n\n\nagainst metabolically active M. tuberculosis. After treatment, \n\n\n\nthe sterilising activities of PZA and RMP prevent the relapse of \n\n\n\ndisease. Meanwhile, INH plays an important role in preventing \n\n\n\nthe development of resistance to companion drugs such as \n\n\n\nRMP [4]. \n\n\n\n\n\n\n\nINH is available in 100 mg conventional tablets. Unfortunately, \n\n\n\nthe convenient, ready-to-take liquid dosage form is not \n\n\n\navailable in Malaysian hospitals. Administration of solid \n\n\n\ndosage forms is difficult in patients who are unable to swallow \n\n\n\ntablets or capsules. The lack of liquid pharmaceutical forms for \n\n\n\noral use in the market has become a problem for the \n\n\n\npharmacotherapy of patients that primarily uses liquid \n\n\n\nformulations, such as paediatric patients, the elderly, patients \n\n\n\nwith dysphagia, patients receiving drugs via probe, and patients \n\n\n\nwith dementias, Parkinson\u2019s, or Alzheimer\u2019s disease [7,8]. In \n\n\n\norder to ensure patient\u2019s therapy with such conditions, \n\n\n\nextemporaneous oral preparation is required [9]. \n\n\n\n\n\n\n\nChildren, in particular, pose a challenge for medication \n\n\n\nadministration as do patients that require non-standard doses. \n\n\n\nThis creates a special need in patient groups who are not able \n\n\n\nto swallow solid dosage form especially neonates, infants and \n\n\n\nelderly. For the paediatric population, the commercial tablets \n\n\n\nare usually split, crushed and dispensed in packets to the \n\n\n\npatients to be dispersed in fruit juice or milk. Such situation \n\n\n\ncould create unwanted outcome notably incomplete \n\n\n\ndissolution, improper dosage and further risks of developing \n\n\n\nside effects. Administration of crushed INH tablets with food \n\n\n\nmay be associated with impaired gastrointestinal absorption \n\n\n\n[6]. When the commercial tablets are crushed and mixed with \n\n\n\nsyrup, there are complexities associated with the formulation \n\n\n\nof liquid dosage forms due to various physicochemical factors \n\n\n\n[7]. It could contribute to improper stability and shelf life.  \n\n\n\n\n\n\n\nThus, in order to supply safe and reliable paediatric dosages, \n\n\n\nthere is a need to develop a convenient suspension starting from \n\n\n\nthe available tablets. Tablets are more conveniently obtained in \n\n\n\nthe pharmacy, as compared to the active ingredient powder and \n\n\n\ntherefore, extemporaneous suspension is commonly prepared \n\n\n\nin pharmacy practice from tablets. Even though liquid dosage \n\n\n\nforms of antituberculosis drugs can be prepared \n\n\n\nextemporaneously, the chemical and physical stability of the \n\n\n\nformulations should always be evaluated [6,10]. \n\n\n\n\n\n\n\nThe use of ready-to-use suspending vehicle X-Temp\u00ae Oral \n\n\n\nSuspension System is a suitable resource for compounding \n\n\n\npharmacists as it constitutes a safe and time-saving alternative. \n\n\n\n\n\n\n\nThe study was initiated to assess the stability of INH oral \n\n\n\nsuspension at two different concentrations compounded from \n\n\n\ncommercial tablets using X-Temp\u00ae Oral Suspension System as \n\n\n\nthe vehicle stored in controlled refrigerated (5\u00b0C) and room \n\n\n\ntemperature (30\u00b0C) throughout the study period. \n\n\n\n\n\n\n\nMATERIAL AND METHOD \n \n\n\n\nOral suspension solutions were prepared from commercial \n\n\n\ntablets containing 100 mg of INH (Pharmaniaga Isoniazid \n\n\n\nTablet 100 mg, Malaysia). The commercial suspending system \n\n\n\nused was X-Temp\u00ae Oral Suspension System which was \n\n\n\nmarketed by Pharm-D Sdn. Bhd. (X-Temp\u00ae Oral Suspension \n\n\n\nSystem, Malaysia). X-Temp\u00ae Oral Suspension System is \n\n\n\nregularly used to assist in extemporaneous preparation of oral \n\n\n\nliquid, non-soluble suspended aqueous formulation in the \n\n\n\nhospitals.  \n\n\n\n\n\n\n\nPreparations of INH in X-Temp\u00ae suspension \n\n\n\n\n\n\n\nThe concentrations of INH suspension prepared in this study \n\n\n\nare 10 mg/mL and 40mg/mL, respectively. Twenty bottles of \n\n\n\n100mL for each concentration were prepared in this \n\n\n\ninvestigation.  First, the required volume of X-Temp\u00ae Oral \n\n\n\nSuspension System was measured. Then, INH commercial \n\n\n\ntablets were crushed and pulverised in a mortar.  A small \n\n\n\namount of X-Temp\u00ae Oral Suspension System was added to \n\n\n\nlevigate the powder to form a smooth paste. A small amount of \n\n\n\nX-Temp\u00ae Oral Suspension System was gradually added to the \n\n\n\npaste with continual mixing until a homogeneous liquid is \n\n\n\nformed. The content was then transferred to a graduated \n\n\n\ncontainer. Additional vehicle was used to rinse the remaining \n\n\n\ndrug from the mortar and poured into the graduated container. \n\n\n\nThe final volume was achieved by adding the remaining \n\n\n\nvolume of the required X-Temp\u00ae Oral Suspension System. \n\n\n\nThe bulk liquid was then packed into 20 amber high-density \n\n\n\npolyethylene (HDPE) bottles of 100 mL each and these were \n\n\n\nfitted with white polypropylene (PP) screw caps to simulate the \n\n\n\ndispensing conditions.  \n\n\n\n\n\n\n\nSTABILITY EVALUATION \n \n\n\n\nThe bottles were separated into 2 groups of 10 bottles each and \n\n\n\nkept under room temperature (30\u00b0C \u00b1 2\u00b0C / 75% RH \u00b1 5% RH) \n\n\n\nand refrigeration (5\u00b0C \u00b1 3\u00b0C) conditions respectively to \n\n\n\nsimulate the dispensing conditions. All samples were stored for \n\n\n\n\n\n\n\n\nThean S.Y. et al. Mal J Pharm 7 (2) 2021, 77-84 \n\n\n\n\n\n\n\n79 \n\n\n\n\n\n\n\n3 months. For the stability evaluation, samples of 10 mg/mL \n\n\n\nand 40 mg/mL from each storage condition were collected on \n\n\n\nday 1, first month, second month and third month, respectively. \n\n\n\n\n\n\n\nPhysical Stability \n\n\n\n\n\n\n\nPhysical stability was examined through visual inspection. \n\n\n\nPhysical stability is defined when there is no change in colour, \n\n\n\nodour and clarity of the suspension. The preparation is \n\n\n\nconsidered stable if physical characteristics have remained \n\n\n\nfairly unchanged. The specific gravity at different time points \n\n\n\nwere determined throughout the study period to monitor the \n\n\n\nweights component of the INH in the oral suspension. The \n\n\n\nspecific gravity test was carried out at ambient room \n\n\n\ntemperature (25\u00b0C \u00b1 2\u00b0C) by using a specific gravity bottle. \n\n\n\nThe specific gravity was defined as the relative weight of \n\n\n\nsample corresponded to the weight of water [11]. The \n\n\n\nacceptance criteria for 10 mg/mL and 40 mg/mL were set at \n\n\n\n1.01 - 1.07 g/mL and 1.03 - 1.07 g/mL, respectively according \n\n\n\nto in-house specification. \n\n\n\n\n\n\n\nChemical stability \n\n\n\n\n\n\n\nChemical stability was determined by the mean concentration \n\n\n\nof INH in the samples and pH of the INH oral suspension \n\n\n\nsamples. The concentration of the INH in the samples should \n\n\n\nbe in between 90% and 110% of the stated amount [11] and it \n\n\n\nwas analysed by using high performance liquid \n\n\n\nchromatography (HPLC). The retention time, RT of INH in \n\n\n\nreference standard and samples was compared and the peak \n\n\n\narea of INH was calculated to determine its concentration. The \n\n\n\nconcentration of INH in the oral suspension was calculated as \n\n\n\nthe following formula: \n\n\n\nThe pH values of the samples were measured at each time \n\n\n\npoints and was measured by using a digital pH meter (Metrohm \n\n\n\nModel 913, Metrohm, Switzerland). The samples of 10 mg/mL \n\n\n\nand 40 mg/mL were withdrawn from the storage at their \n\n\n\nrespective studies time points for inspection and stability \n\n\n\nstudies. All results of the studies were recorded accordingly. \n\n\n\n\n\n\n\nAnalytical Method and Equipment \n\n\n\n\n\n\n\nThe quantification of the active pharmaceutical ingredients was \n\n\n\nperformed by high-performance liquid chromatography \n\n\n\n(HPLC) equipped with UV-Vis detector (Agilent Model 1200 \n\n\n\nRRLC, Agilent United States). A reference standard of INH \n\n\n\nwas obtained from British Pharmacopoeia Commission, United \n\n\n\nKingdom. \n\n\n\nHPLC assay method was developed according to the in-house \n\n\n\nHPLC method with reference to the British Pharmacopoeia \n\n\n\n(BP).  The targeted compound was eluted with a mixture of \n\n\n\nMethanol - 0.15 M Sodium Dodecyl Sulphate (pH 2.5) (55 : 45, \n\n\n\nv/v) as mobile phase. The mobile phase served as diluent in the \n\n\n\npreparation of reference standard and test sample. The INH \n\n\n\npeak in samples was compared to the INH peak of the reference \n\n\n\nstandard. In the HPLC assay analysis, the operating conditions \n\n\n\napplied in the analysis are as summarized in Table I. \n\n\n\nMethods were adequately validated in a former short-term \n\n\n\nstability study of extemporaneously prepared INH oral \n\n\n\nsuspension using the above formulation. The validation of the \n\n\n\nanalytical methods included linearity, accuracy, specificity, \n\n\n\nprecision and system suitability.  \n\n\n\n\n\n\n\nIdentification and INH Assay using HPLC \n\n\n\n\n\n\n\nPreparation of Reference Standard \n\n\n\n\n\n\n\nApproximately 32 mg of INH reference standard was dissolved \n\n\n\nwith about 70 mL of diluent in 100 mL amber volumetric flask \n\n\n\nand sonicated for 5 minutes to allow the dissolution of \n\n\n\nreference standard. The reference standard was further diluted \n\n\n\nwith diluent to 100 mL and mixed well. The reference standard \n\n\n\nsolution was filtered through filter paper (Whatman No. 1). 5ml \n\n\n\nof the filtrate was pipetted and further diluted to 50 mL with \n\n\n\ndiluent. The solution was filtered through 0.45 \u03bcm PVDF \n\n\n\nsyringe filter into amber autosampler vial for chromatographic \n\n\n\nanalysis \n\n\n\n\n\n\n\nPreparation of Test Sample \n\n\n\n\n\n\n\nMix a weighed quantity of the INH suspension being examined \n\n\n\ncontaining 32 mg of Isoniazid with 70 mL of diluent. The \n\n\n\nsolution was capped and sonicated in water bath for 5 minutes. \n\n\n\nThe sample solution was further diluted to 100 mL with the \n\n\n\ndiluent. The sample solution was filtered through filter paper \n\n\n\n(Whatman No. 1). 5 mL of the filtrate was further diluted to 50 \n\n\n\nmL with diluent and filtered through a 0.45 \u03bcm PVDF syringe \n\n\n\nfilter into amber autosampler vial for chromatographic \n\n\n\nanalysis. The final concentration of the test sample prepared \n\n\n\nwas 32 \u00b5g/mL. \n\n\n\n\n\n\n\n\n\n\n\n% Assay = \n\n\n\n\n\n\n\nArea for Sample X Concentration of Reference \n\n\n\nstandard X References Standard Purity \n\n\n\nArea for Standard X Concentration of Sample \n\n\n\n\n\n\n\nTable I. HPLC Operating Conditions \n\n\n\n\n\n\n\nInstrumentation Operating Conditions \n\n\n\nType of Column Zorbac Exclipse XDB-C18 \n\n\n\nColumn size 4.6 mm x 150 mm, 5 \u00b5m \n\n\n\nFlow rate 1.0 \n\n\n\nInjection volume 10 \u00b5L \n\n\n\nMobile phase Methanol : 0.015 M Sodium Dodecyl \n\n\n\nSulphate (55 : 45 v/v) \n\n\n\npH 2.5 \n\n\n\n \n\n\n\n\n\n\n\n\nThean S.Y. et al. Mal J Pharm 7 (2) 2021, 77-84 \n\n\n\n\n\n\n\n80 \n\n\n\n\n\n\n\nMicrobiological stability  \n\n\n\n\n\n\n\nThe samples were subjected to microbiological evaluation in \n\n\n\norder to determine whether microbiological attributes of non-\n\n\n\nsterile pharmaceutical are met. The method for the \n\n\n\nmicrobiological test was conducted with slight modification \n\n\n\nwith reference to BP2014. According to BP2014 [11], the \n\n\n\nparameters were set as total aerobic microbial count below 2 X \n\n\n\n102 cfu/g, total combined yeasts / moulds count below 2 X 10 \n\n\n\ncfu/g and absence of Escherichia coli (E. coli) in 1g. Microbial.  \n\n\n\n\n\n\n\nEnumeration Tests \n\n\n\n\n\n\n\nThe spread plate method was used in determining the Total \n\n\n\nAerobic Microbial Count (TAMC) and the Total Combined \n\n\n\nYeasts and Moulds Count (TYMC). 10 g of the sample was \n\n\n\ndiluted in 90 ml buffered sodium chloride-peptone solution pH \n\n\n\n7.0. A one in ten dilution was prepared. Inactivators of \n\n\n\nantimicrobial agents: Polysorbate 80 1% w/v was added to this \n\n\n\nsolution. Further serial tenfold dilutions were prepared using \n\n\n\nthe same diluent, 10-1, 10-2, 10-3 and so on to yield between 25 \n\n\n\n- 250 colonies.  From the sample preparation, 0.5 ml aliquot of \n\n\n\neach dilution was transferred onto two Petri dishes containing \n\n\n\nSoybean-Casein Digest Agar (TSA) and two Petri dishes \n\n\n\ncontaining Sabouraud Dextrose Agar (SDA). The solution was \n\n\n\nspread evenly and the plate was exposed to dry off the surface. \n\n\n\nThe TSA plates were covered, inverted and incubated at 30\u00b0C \n\n\n\n- 35\u00b0C for 3 - 5 days to determine total aerobic of bacteria & \n\n\n\nfungi. Meanwhile, SDA plates were incubated at 20\u00b0C - 25\u00b0C \n\n\n\nfor 5 - 7 days for the determination of yeast and mould. The \n\n\n\nplates were examined for growth of microbial. Negative control \n\n\n\nwas simultaneously performed using sterilized diluent instead \n\n\n\nof sample for each medium.  \n\n\n\n\n\n\n\nTests for Escherichia coli \n\n\n\n\n\n\n\n10 g of INH sample was diluted in 90 ml buffered sodium \n\n\n\nchloride-peptone solution pH 7.0. A one in ten dilution was \n\n\n\nprepared. Inactivators of antimicrobial agents: Polysorbate 80 \n\n\n\n1% w/v was added to this solution. 10 mL (quantity \n\n\n\ncorresponding to 1 g or 1 mL) was used to inoculate 100 mL of \n\n\n\nSoybean-Casein Digest Broth, homogenized and incubated at \n\n\n\n30\u00b0C - 35\u00b0C for 18 - 24 hours. After incubation, the broth bottle \n\n\n\nwas shaken for the content to mix well and 1 mL of the \n\n\n\nSoybean-Casein Digest Broth was transferred to 100 mL of \n\n\n\nMacConkey Broth and incubated at 42\u00b0C - 44\u00b0C for 24 - 48 \n\n\n\nhours. After incubation, the MacConkey broth tube was shaken \n\n\n\nand a loopful streaked on a plate of MacConkey Agar using a \n\n\n\nsterilized inoculating loop. The MacConkey Agar plates were \n\n\n\nincubated at 30\u00b0C - 35\u00b0C for 18 - 72 hours in inverted position. \n\n\n\nGrowth of colonies were examined on the MacConkey Agar \n\n\n\nplates for the presence of red non-mucoid colonies. Isolates \n\n\n\nwere identified using Gram stain and biochemical tests and \n\n\n\nconfirmed with API 20E (bioM\u00e9rieux) identification system. \n\n\n\n\n\n\n\nRESULT AND DISCUSSION \n \n\n\n\nOral liquid suspension of 10 mg/mL and 40 mg/mL were \n\n\n\nprepared from commercially available INH tablets using X-\n\n\n\nTemp\u00ae Oral Suspension System; a commercially available \n\n\n\nsuspending vehicle. Preparation of the suspensions was \n\n\n\nconducted according to current good manufacturing practices \n\n\n\nof pharmaceutical compounding. Method validation for the \n\n\n\nanalysis was performed to investigate its conformity, accuracy, \n\n\n\nprecision and effectiveness of the assay. The method validation \n\n\n\nresult for the assay is tabulated in Table II. It shows that all the \n\n\n\nspecification criteria are fulfilled and the method validation \n\n\n\nfurther confirms the suitability of the analysis studies toward \n\n\n\nINH oral suspension.  \n\n\n\n\n\n\n\nThese two INH in X-Temp\u00ae suspension concentrations were \n\n\n\nstudied to examine the stability of INH at both low dose (10 \n\n\n\nmg/mL) and high dose (40 mg/mL) at room temperature (30\u00b0C \n\n\n\n\u00b1 2\u00b0C) as well as refrigerated condition (5\u00b0C \u00b1 3\u00b0C). From the \n\n\n\nstability studies, INH in X-Temp\u00ae suspension in both low and \n\n\n\nhigh doses were found to be stable under two storage condition \n\n\n\nfor at least 3 months. Figure I. shows the stability of INH in X-\n\n\n\nTemp\u00ae suspension preparation proposed in this study. From \n\n\n\nFigure I, the INH content in the samples was consistent and \n\n\n\ncomplied to the specifications. These findings could be used as \n\n\n\na guideline in the preparation of INH in X-Temp\u00ae suspension \n\n\n\nbased on its stability in both low dose and high dose \n\n\n\nconcentration. \n\n\n\nAs presented in Table III and Table IV, the physical, chemical \n\n\n\nand microbial stability profile of the INH in X-Temp\u00ae \n\n\n\nsuspension (10 mg/mL and 40 mg/mL in two storage \n\n\n\nconditions) over 3 months were summarised and tabulated. The \n\n\n\nassay percentage for 10 mg/mL showed higher content as \n\n\n\ncompared to that of 40 mg/mL. However, both 10 mg/mL and \n\n\n\n\n\n\n\nFigure I. Stability of INH in X-Temp\u00ae Oral Suspension  \n\n\n\nover 3 months (n=1) \n\n\n\n\n\n\n\n\nThean S.Y. et al. Mal J Pharm 7 (2) 2021, 77-84 \n\n\n\n\n\n\n\n81 \n\n\n\n\n\n\n\n40 mg/mL assay results conformed to the specification. The \n\n\n\nassay result range of 10 mg/mL suspension was between 90.3% \n\n\n\nto 100.2% while for 40 mg/mL suspension, the result was from \n\n\n\n90.0% to 92.7%. \n\n\n\n\n\n\n\nTable II. Result of Method Validation \n\n\n\n\n\n\n\nTest Parameter Acceptance Criteria (11) (12) Validation Results \n\n\n\nSpecificity   \n\n\n\n  Identification   \n\n\n\n     Comparison with a known  \n\n\n\n     reference material \n\n\n\nPositive control: Positive \n\n\n\nNegative control: absence of peak at RT 6.9 min \n\n\n\nPositive \n\n\n\nPeak absence at RT 6.9 min \n\n\n\n  Assay   \n\n\n\n     Placebo / Matrix analysis \nNo interfering peak from excipients No interfering peak from excipients were observed \n\n\n\nPlacebo Effect NMT 1.5% Placebo effect = 0.02 % (insignificant) \n\n\n\n\n\n\n\n     Linearity & Range \nr2 \u2265 0.995; 0.016 - 0.064 mg/ml 1 \n\n\n\nY-intercept at 100% working concentration \u2264 2.0% 0.46% \n\n\n\n     Accuracy % Recovery within 95% to 105% Conform \n\n\n\n     Precision (Repeatability) RSD \u2264 2.0% 0.46% \n\n\n\n     Precision (Reproducibility) RSD \u2264 2.0% 0.96% \n\n\n\n     Precision (Intermediate   \n\n\n\n     Precision/ruggedness) \n\n\n\nRSD \u2264 2.0% 0.74% \n\n\n\n\n\n\n\nSystem Suitability   \n\n\n\n     System precision RSD \u2264 2.0% 0.46% \n\n\n\n     Peak performance k\u2019 \u2265 1.5 3.638 \n\n\n\n Resolution > 2 9.302 \n\n\n\n USP Tailing Factor < 2 0.990 \n\n\n\n Column efficiency \u2265 2000 8873 \n\n\n\n\n\n\n\n\n\n\n\nTable III. Stability Profile of Isoniazid in X-Temp\u00ae Oral Suspension 10 mg/mL (n=1) \n\n\n\n\n\n\n\nTest Specifications \nStorage \n\n\n\ncondition \n\n\n\nMonth \n\n\n\n0 1st 2nd 3rd \n\n\n\nVisual \n\n\n\nAppearance \n\n\n\nColour: Light Yellow \n\n\n\nClarity: Opaque \n\n\n\nOdour: Orange \n\n\n\n5\u00b0C \u00b1 3\u00b0C \nLight Yellow & \n\n\n\nOpaque; Orange \n\n\n\nLight Yellow & \n\n\n\nOpaque; Orange \n\n\n\nLight Yellow & \n\n\n\nOpaque; Orange \n\n\n\nLight Yellow & \n\n\n\nOpaque; Orange \n\n\n\n30\u00b0C \u00b1 2\u00b0C \nLight Yellow & \n\n\n\nOpaque; Orange \n\n\n\nLight Yellow & \n\n\n\nOpaque; Orange \n\n\n\nLight Yellow & \n\n\n\nOpaque; Orange \n\n\n\nLight Yellow & \n\n\n\nOpaque; Orange \n\n\n\nPhysical \n\n\n\nProperties \n\n\n\npH: 4.0 - 5.0 \n5\u00b0C \u00b1 3\u00b0C 4.701 4.677 4.681 4.683 \n\n\n\n30\u00b0C \u00b1 2\u00b0C 4.701 4.648 4.697 4.695 \n\n\n\nSpecific gravity: 1.01 \u2013 1.07 \n\n\n\n(g/mL) \n\n\n\n5\u00b0C \u00b1 3\u00b0C 1.0396 1.0385 1.0378 1.0406 \n\n\n\n30\u00b0C \u00b1 2\u00b0C 1.0396 1.0376 1.0377 1.0411 \n\n\n\nAssay 90.0% \u2013 110.0% \n5\u00b0C \u00b1 3\u00b0C 98.6 99.2 99.7 94.9 \n\n\n\n30\u00b0C \u00b1 2\u00b0C 98.6 99.3 98.3 90.3 \n\n\n\nMicrobial \n\n\n\nlimit \n\n\n\nAerobic microbial < 200 cfu/g \n\n\n\nYeasts & moulds < 20 cfu/g \n\n\n\nEscherichia coli: Absent in 1 g \n\n\n\n5\u00b0C \u00b1 3\u00b0C Conforms Conforms Conforms Conforms \n\n\n\n30\u00b0C \u00b1 2\u00b0C Conforms Conforms Conforms Conforms \n\n\n\n\n\n\n\n\n\n\n\nTable IV. Stability Profile of Isoniazid in X-Temp\u00ae Oral Suspension 40 mg/mL (n=1) \n\n\n\n\n\n\n\nTest Specifications \nStorage \n\n\n\ncondition \n\n\n\nMonth \n\n\n\n0 1st 2nd 3rd \n\n\n\nVisual \n\n\n\nAppearance \n\n\n\nColour: Light Yellow \n\n\n\nClarity: Opaque \n\n\n\nOdour: Orange \n\n\n\n5\u00b0C \u00b1 3\u00b0C \nLight Yellow & \n\n\n\nOpaque; Orange \n\n\n\nLight Yellow & \n\n\n\nOpaque; Orange \n\n\n\nLight Yellow & \n\n\n\nOpaque; Orange \n\n\n\nLight Yellow & \n\n\n\nOpaque; Orange \n\n\n\n30\u00b0C \u00b1 2\u00b0C \n\n\n\n\n\n\n\nLight Yellow & \n\n\n\nOpaque; Orange \n\n\n\nLight Yellow & \n\n\n\nOpaque; Orange \n\n\n\nLight Yellow & \n\n\n\nOpaque; Orange \n\n\n\nLight Yellow & \n\n\n\nOpaque; Orange \n\n\n\nPhysical \n\n\n\nProperties \n\n\n\npH: 4.0 - 6.0 \n5\u00b0C \u00b1 3\u00b0C 5.213 5.221 5.218 5.239 \n\n\n\n30\u00b0C \u00b1 2\u00b0C 5.213 5.233 5.252 5.268 \n\n\n\nSpecific gravity: 1.03 - 1.07 \n\n\n\n(g/mL) \n\n\n\n5\u00b0C \u00b1 3\u00b0C 1.0529 1.0525 1.0543 1.0521 \n\n\n\n30\u00b0C \u00b1 2\u00b0C 1.0529 1.0534 1.0530 1.0538 \n\n\n\nAssay 90.0% \u2013 110.0% \n5\u00b0C \u00b1 3\u00b0C 92.7 92.2 90.9 91.8 \n\n\n\n30\u00b0C \u00b1 2\u00b0C 92.7 91.0 91.4 90.0 \n\n\n\nMicrobial \n\n\n\nlimit \n\n\n\nAerobic microbial < 200 cfu/g \n\n\n\nYeasts & moulds < 20 cfu/g \n\n\n\nEscherichia coli: Absent in 1 g \n\n\n\n5\u00b0C \u00b1 3\u00b0C Conforms Conforms Conforms Conforms \n\n\n\n30\u00b0C \u00b1 2\u00b0C Conforms Conforms Conforms Conforms \n\n\n\n \n\n\n\n\n\n\n\n\nThean S.Y. et al. Mal J Pharm 7 (2) 2021, 77-84 \n\n\n\n\n\n\n\n82 \n\n\n\n\n\n\n\nPhysical Stability \n\n\n\n\n\n\n\nOn each study, there were no notable change of colour, odour \n\n\n\nand clarity of suspension detected for 3 months at 2 different \n\n\n\nstorage temperatures (5\u00b0C \u00b1 3\u00b0C and 30\u00b0C \u00b1 2\u00b0C). The specific \n\n\n\ngravity remained fairly unchanged throughout the stability \n\n\n\nstudy period.  \n\n\n\n\n\n\n\nChemical Stability \n\n\n\n\n\n\n\nAll suspensions were assayed throughout the study period, the \n\n\n\nstudies revealed that INH content in both 10 mg/mL and 40 \n\n\n\nmg/mL samples were above 90%. INH is susceptible to \n\n\n\nhydrolysis and oxidation and interacts with excipients, \n\n\n\nparticularly reducing sugars, to form hydrazones [10]. \n\n\n\nHaywood et. al. [10] has also documented incompatibilities of \n\n\n\nINH with lactose, which is commonly found in tablets. \n\n\n\nHowever, from the stability results, there was limited \n\n\n\nsuggestion that the commonly used INH tablet, when mixed \n\n\n\nwith the X-Temp\u00ae Oral Suspension System, causes degradation \n\n\n\nto INH. There was little or no INH loss occurred in both 10 \n\n\n\nmg/mL and 40 mg/mL samples at both storage conditions. The \n\n\n\npH value was fairly stable and remained around 4.7 and 5.2 for \n\n\n\nthe samples of 10 mg/mL and 40 mg/mL respectively. The X-\n\n\n\nTemp\u00ae Oral Suspension System was buffered with the Citric \n\n\n\nAcid\u2013Monosodium Phosphate buffering system. These \n\n\n\nfindings further ensured that the pH of the INH suspension \n\n\n\nremained constant which was favourable towards the stability \n\n\n\nof INH. The excipients used in X-Temp\u00ae Oral Suspension \n\n\n\nSystem, such as Sorbitol and Glycerol were quite inert and they \n\n\n\nwere usually compatible with most active ingredients. Sorbitol \n\n\n\nwas recommended to be used together with INH, according to \n\n\n\nMartindale [5]. Furthermore, X-Temp\u00ae Oral Suspension \n\n\n\nSystem does not contain reducing sugars that could cause \n\n\n\nhydrolysis and oxidation to INH. These characteristics enabled \n\n\n\nX-Temp\u00ae Oral Suspension System to be a suitable carrier for \n\n\n\nINH extemporaneous preparation. INH being a light sensitive \n\n\n\nmaterial [5] was well protected in the HDPE amber bottle with \n\n\n\nPP screw cap.  \n\n\n\n\n\n\n\nThe Extemporaneous Formulation Manual [13] endorsed by \n\n\n\nthe Ministry of Health Malaysia has recommended the use of \n\n\n\ndistilled water and sorbitol solution for the extemporaneous \n\n\n\npreparation of Isoniazid Syrup 10 mg/ml in hospitals. However, \n\n\n\nthis formulation is only stable for 21 days in refrigerated \n\n\n\ncondition, which suggests the limitations faced by healthcare \n\n\n\nproviders in terms of shelf-life and storage temperature. With \n\n\n\nX-Temp\u00ae Oral Suspension System, such limitations can be \n\n\n\n\n\n\n\nFigure II. HPLC Chromatograms of (A) X-Temp\u00ae Oral Suspension System, (B) Isoniazid Standards Reference, (C) Isoniazid in X-Temp\u00ae Oral \n\n\n\nSuspension (10 mg/mL) \n\n\n\n\n\n\n\n\nThean S.Y. et al. Mal J Pharm 7 (2) 2021, 77-84 \n\n\n\n\n\n\n\n83 \n\n\n\n\n\n\n\novercome. Not only a higher concentration of Isoniazid \n\n\n\nSuspension (40 mg/ml) can be prepared, the preparation can be \n\n\n\nstable for up to 3 months stored at room temperature (below \n\n\n\n30\u00b0C) or in refrigerator. \n\n\n\n\n\n\n\nThe chromatograms illustrated below show that the HPLC \n\n\n\nmethod to be selective for the purpose of this study with \n\n\n\nminimal interference from the excipients in the formulation \n\n\n\n(Figure II). The chromatograms of tested samples at the \n\n\n\ndifferent intervals of the stability study period revealed no other \n\n\n\npeak that could be attributed to a possible degradation \n\n\n\ncompound. \n\n\n\n\n\n\n\nMicrobiological Stability \n\n\n\n\n\n\n\nThe samples were subjected to microbiological inspection to \n\n\n\nevaluate and determine if they meet the microbiological \n\n\n\nspecification of non-sterile pharmaceutical products. The \n\n\n\nspecification was set as total aerobic microbial count below 2 \n\n\n\nX 102 cfu/g, total combined yeasts / moulds count below 2 X \n\n\n\n10 cfu/g and absence of E. coli. The findings on microbial limit \n\n\n\nevaluation of the INH in X-Temp\u00ae suspension 10 mg/mL and \n\n\n\nINH in X-Temp\u00ae suspension 40 mg/mL were shown in Table \n\n\n\nIII and Table IV, respectively. \n\n\n\n\n\n\n\nFrom the results, all suspension batches showed no \n\n\n\ndevelopment of microorganism throughout the study period. \n\n\n\nThe microbial examination test indicates the absence of \n\n\n\nmicrobial growth for the total aerobic microbial, the total \n\n\n\ncombined yeasts / moulds and E. coli, complying with official \n\n\n\nquality requirements. This shows that the preserved X-Temp\u00ae \n\n\n\nOral Suspension System is able to ensure the microbial stability \n\n\n\nof the suspension throughout the study period. The pH of the \n\n\n\nsuspensions, which ranges from 4.6 - 5.2 plays important role \n\n\n\nin preservative efficacy and provides an environment that is \n\n\n\nunfavourable towards microbial growth. This is important as \n\n\n\nthe shelf-life of most extemporaneous preparations are limited \n\n\n\nby microbial growth besides the stability of the active \n\n\n\ncomponent itself. \n\n\n\n\n\n\n\nCONCLUSION  \n \n\n\n\nPaediatric oral liquid suspensions consisting 10 mg/mL and 40 \n\n\n\nmg/mL INH were easily prepared from commercially available \n\n\n\ntablets. The compounding showed suitable stability for up to 3 \n\n\n\nmonths, maintaining all quality attributes. With the results, it is \n\n\n\nhypothesized that INH in X-Temp\u00ae suspension in the \n\n\n\nconcentration of between 10 mg/mL and 40 mg/mL is \n\n\n\nphysically, chemically and microbiologically stable under \n\n\n\nrefrigeration and room temperature for up to 3 months when \n\n\n\npacked in amber HDPE bottles with PP screw cap. This \n\n\n\nformulation prepared with X-Temp\u00ae Oral Suspension System \n\n\n\nis an interesting option in terms of efficacy, safety and \n\n\n\nreliability to be prepared by the hospital pharmacy service to \n\n\n\noptimise the paediatric treatment of tuberculosis. \n\n\n\n\n\n\n\nThe results from the stability studies suggested that X-Temp\u00ae \n\n\n\nOral Suspension System may be a stable suspending vehicle for \n\n\n\ncompounding of different active pharmaceutical ingredients for \n\n\n\ndifferent medical usages. Besides offering a stable formulation, \n\n\n\nit possesses additional advantages of alcohol-free, colorant-free \n\n\n\nand sugar-free. These findings and results reported could be \n\n\n\nused as a preliminary result in future research in which the \n\n\n\nfindings showed a promising use of X-Temp\u00ae Oral Suspension \n\n\n\nSystem in isoniazid extemporaneous oral suspension. \n\n\n\n\n\n\n\nACKNOWLEDGEMENT \n  \n\n\n\nThe authors acknowledge the contribution of BioScenergy \n\n\n\nInternational Sdn. Bhd. for supplying the isoniazid tablets, X-\n\n\n\nTemp\u00ae Oral Suspension System and plastic HDPE bottles used \n\n\n\nin this study. \n\n\n\n\n\n\n\nCONFLICT OF INTEREST \n  \n\n\n\nThe authors declare no conflict of interest is involved in the \n\n\n\nwriting of this article.  \n\n\n\n\n\n\n\nREFERENCES \n \n\n\n\n[1] World Health Organization. (2021). \u201cTuberculosis.\u201d  \n\n\n\nhttps://www.who.int/news-room/fact-sheets/detail/tuberculosis \n\n\n\n[2] Marais BJ, Hesseling AC, Gie RP, et al., 2006. The burden of \n\n\n\nchildhood tuberculosis and the accuracy of community-based \n\n\n\nsurveillance data. Int J Tuberc Lung Dis., 10(3), pp 259-63. \n\n\n\nhttps://www.ingentaconnect.com/content/iuatld/ijtld/2006/00000010/\n\n\n\n00000003/art00007 \n\n\n\n[3] Ayieko, J., Abuogi, L., Simchowitz, B., Bukusi, E.A., Smith, A.H. and \n\n\n\nReingold, A., 2014. Efficacy of isoniazid prophylactic therapy in \n\n\n\nprevention of tuberculosis in children: a meta\u2013analysis. BMC \n\n\n\ninfectious diseases, 14(1), pp 91.  \n\n\n\nhttps://doi.org/10.1186/1471-2334-14-91  \n\n\n\n[4] Zvada, S.P., Denti, P., Donald, P.R., Schaaf, H.S., Thee, S., Seddon, \n\n\n\nJ.A., Seifart, H.I., Smith, P.J., Mcllleron, H.M. and Simonsson, U.S., \n\n\n\n2014. Population pharmacokinetics of rifampicin, pyrazinamide and \n\n\n\nisoniazid in children with tuberculosis: in silico evaluation of \n\n\n\ncurrently recommended doses. Journal of Antimicrobial \n\n\n\nChemotherapy, 69(5), pp 1339-1349.  \n\n\n\nhttps://doi.org/10.1093/jac/dkt524 \n\n\n\n[5] Sweetman, S.C., 2009. Martindale: The complete drug reference. 36th \n\n\n\nedition. London, UK: Pharmaceutical Press. \n\n\n\nhttps://vnras.com/wp-content/uploads/2018/04/Martindale-The-\n\n\n\nComplete-Drug-Reference_-36th-Edition.pdf \n\n\n\n[6] Baniasadi S, Shahsavari N, Namdar R, Kobarfard F., 2015. Stability \n\n\n\nassessment of isoniazid and rifampin liquid dosage forms in a national \n\n\n\nreferral center for tuberculosis. IJPSR. 6(4), pp 706-709.  \n\n\n\nhttps://www.ijpsr.info/docs/IJPSR15-06-04-010.pdf \n\n\n\n[7] Haywood, A. and Glass, B.D., 2013. Liquid dosage forms \n\n\n\nextemporaneously prepared from commercially available products\u2013\n\n\n\nConsidering new evidence on stability. Journal of Pharmacy & \n\n\n\nPharmaceutical Sciences, 16(3), pp 441-455.  \n\n\n\nhttps://doi.org/10.18433/J38887 \n\n\n\n\nhttps://www.who.int/news-room/fact-sheets/detail/tuberculosis\n\n\nhttps://www.ingentaconnect.com/content/iuatld/ijtld/2006/00000010/00000003/art00007\n\n\nhttps://www.ingentaconnect.com/content/iuatld/ijtld/2006/00000010/00000003/art00007\n\n\nhttps://doi.org/10.1186/1471-2334-14-91\n\n\nhttps://doi.org/10.1093/jac/dkt524\n\n\nhttps://vnras.com/wp-content/uploads/2018/04/Martindale-The-Complete-Drug-Reference_-36th-Edition.pdf\n\n\nhttps://vnras.com/wp-content/uploads/2018/04/Martindale-The-Complete-Drug-Reference_-36th-Edition.pdf\n\n\nhttps://www.ijpsr.info/docs/IJPSR15-06-04-010.pdf\n\n\nhttps://doi.org/10.18433/J38887\n\n\n\n\n\n\nThean S.Y. et al. Mal J Pharm 7 (2) 2021, 77-84 \n\n\n\n\n\n\n\n84 \n\n\n\n\n\n\n\n[8] Polonini HC, Loures S, Brand\u00e3o MA, Ferreira AO.,2016 Stability of \n\n\n\nAllopurinol, Amitriptyline Hydrochloride, Carbamazepine, \n\n\n\nDomperidone, Isoniazid, Ketoconazole, Lisinopril, Naproxen, \n\n\n\nParacetamol (Acetaminophen), and Sertraline Hydrochloride in \n\n\n\nSyrSpend SF PH4 Oral Suspensions. Int J Pharm Compd. 20(5), pp \n\n\n\n426-434.  \n\n\n\n[9] Benzi JR, Mastroianni PD., 2016 Analysis of extemporaneous oral \n\n\n\nliquid from commercially available drugs in hospital. Brazilian \n\n\n\nJournal of Pharmaceutical Sciences. 52(3), pp 517-525.  \n\n\n\nhttps://doi.org/10.1590/S1984-82502016000300017 \n\n\n\n[10] Haywood A, Mangan M, Grant G, Glass B, 2005. Extemporaneous \n\n\n\nIsoniazid Mixture: Stability Implications. Journal of Pharmacy \n\n\n\nPractice and Research, 35 (3), pp 181 - 182. \n\n\n\nhttps://doi.org/10.1002/j.2055-2335.2005.tb00333.x \n\n\n\n[11] British Pharmacopoeia Commission 2013. British Pharmacopoeia \n\n\n\n2014 Volume IV. Appendix XVIB.  London, The Stationery Office. \n\n\n\n[12] International Conference on Harmonisation of Technical \n\n\n\nRequirements for Registration of Pharmaceuticals for Human Use, \n\n\n\nICH Harmonised Tripartite Guideline, Q2 (R1).  \n\n\n\nhttps://database.ich.org/sites/default/files/Q2%28R1%29%20Guideli\n\n\n\nne.pdf  \n\n\n\n[13] Extemporaneous Formulation, MOH 2015, Pharmaceutical Services \n\n\n\nDivision, Ministry of Health Malaysia, pp 39. \n\n\n\nhttp://www.invotek.com.tr/images2/MOH_Malaysia_Extemporaneo\n\n\n\nus_Formulation.pdf \n\n\n\n\nhttps://doi.org/10.1590/S1984-82502016000300017\n\n\nhttps://doi.org/10.1002/j.2055-2335.2005.tb00333.x\n\n\nhttps://database.ich.org/sites/default/files/Q2%28R1%29%20Guideline.pdf\n\n\nhttps://database.ich.org/sites/default/files/Q2%28R1%29%20Guideline.pdf\n\n\nhttp://www.invotek.com.tr/images2/MOH_Malaysia_Extemporaneous_Formulation.pdf\n\n\nhttp://www.invotek.com.tr/images2/MOH_Malaysia_Extemporaneous_Formulation.pdf\n\n\n\n"
"\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n234 \n\n\n\nThe Study of Alfuzosin and Finasteride in the Treatment of Benign Prostatic \n\n\n\nHyperplasia \n\n\n\n\n\n\n\nLee Sau Yong*, Tan Meng Wah and Wan Noor Hayati \n\n\n\n\n\n\n\nDeaprtment of Pharmacy, Hospital Tuanku Jaafar, Seremban, Negeri Sembilan \n\n\n\n\n\n\n\n* Corresponding Author \nMalaysian Journal of Pharmacy 2008: 1( 6): 234 - 245                                               \n\n\n\n\n\n\n\n\n\n\n\nAbstract \n\n\n\n\n\n\n\nBenign Prostatic Hyperplasia (BPH) is a hyperplasia process where there are an \n\n\n\nincreased number of cells from the transition zone of the gland. The goals of the \n\n\n\nstudy were: (1) to compare the effectiveness of finasteride 5mg (Proscar) versus \n\n\n\nalfuzosin 10mg (Xatral XL) for the treatment of BPH; (2) to compare the \n\n\n\ntreatment costs of both drug; (3) to compare the side-effect profile of both drug.  \n\n\n\nAll patients who have been diagnosed with BPH and have been receiving the \n\n\n\ntreatment in SOPD Hospital Tuanku Ja\u2019afar were reviewed.  The inclusion \n\n\n\ncriteria were: (1) male more than 45 year old; (2) patients who are not suffering \n\n\n\nfrom recurrent or rebound BPH.  Subjects were evaluated using the International \n\n\n\nProstate Symptom Score (IPSS) questionnaire The score and side effects \n\n\n\noccurrence were analysis by SPSS.  Only 66 men were analyzed in the study as 6 \n\n\n\nmen (8.3%) were excluded. 36 of them (55%) are taking Finasteride 5mg once \n\n\n\ndaily whereas the other 30 men (45%) are taking the extended released form of \n\n\n\nAlfuzosin 10mg once daily. The distribution of subject\u2019s age is even. Subjects \n\n\n\nwith Finasteride 5mg have higher score (mean = 22.18) than Alfuzosin 10mg \n\n\n\n(mean = 18.87) (p<0.05). However, the total side effect score of both drug \n\n\n\nshowed no significant different (p>0.05). Finasteride group (mean = 0.52 case) \n\n\n\nhas experienced a slightly more side effect than the Alfuzosin group (mean = \n\n\n\n0.50 case). This study concluded that both Alfuzosin and Finasteride provide \n\n\n\nsymptomatic relief to BPH patients.  Alfuzosin with its faster onset of action \n\n\n\ncould be very useful for patients who were diagnosed with BPH and carry \n\n\n\nmoderate IPSS scores. \n\n\n\n\n\n\n\nKeyword:  Benign Prostate Hyperplasia, Alfuzosin, outcome \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n235 \n\n\n\nIntroduction \n\n\n\n\n\n\n\nBenign Prostatic Hyperplasia (BPH) \n\n\n\nis a hyperplasia process where there \n\n\n\nare an increased number of cells \n\n\n\nfrom the transition zone of the \n\n\n\nprostate gland.  The prevalence of \n\n\n\nthis condition increases with age and \n\n\n\nrequires the presence of testicular  \n\n\n\nandrogens.  About half of men\u2019s \n\n\n\npopulation will develop BPH by the \n\n\n\naverage of 50 years old, due to the \n\n\n\ncomplex stromal-epithelial \n\n\n\ninteractions\n1\n.  The disease can be \n\n\n\nprogressive, showing symptoms \n\n\n\nwhich can be classified into two \n\n\n\ncategories: irritative (frequency, \n\n\n\nnocturia, burning, urgency or urge \n\n\n\nincontinence) and obstructive \n\n\n\n(hesitancy, weak stream, dribbling, \n\n\n\nincomplete voiding or retention).  \n\n\n\nBesides these bothersome lower \n\n\n\nurinary tract symptoms (LUTS), \n\n\n\nthere could also be associated \n\n\n\nanatomic enlargement of the prostate \n\n\n\nleading to the compression of the \n\n\n\nurethra, resulting in compromised \n\n\n\nurinary flow and bladder outlet \n\n\n\nobstruction (BOD). \n\n\n\n\n\n\n\nBPH symptoms manifested could \n\n\n\ninterfere with patient\u2019s daily living \n\n\n\nactivities, causing significant \n\n\n\nimpairment in the quality of life and \n\n\n\nin some cases compromised sexual \n\n\n\nfunctioning.  Serious cases could \n\n\n\nalso subsequently lead to secondary \n\n\n\nchanges of the bladder anatomy and \n\n\n\nfunction, urinary tract infections, \n\n\n\nformation of bladder stones, and \n\n\n\neventually causing the deterioration \n\n\n\nof the upper urinary tract \n\n\n\naccompanied with renal failure. \n\n\n\n\n\n\n\nPatients manifesting with different \n\n\n\nsymptoms should be treated using \n\n\n\ndifferent approaches.   Most patients \n\n\n\nare first assessed by a quantitative \n\n\n\nsymptom score, such as the \n\n\n\nInternational Prostate Symptom \n\n\n\nScore (IPSS) which was further \n\n\n\napplied in the present study.  \n\n\n\nAccording to a study\n2\n, an estimated \n\n\n\n35 percent of elderly males need \n\n\n\neither surgical or medical \n\n\n\nintervention or both for BPH in their \n\n\n\nlifetime.  However, surgical \n\n\n\nintervention was rather radical from \n\n\n\nmost of the patient\u2019 perspective and \n\n\n\nmany of them were reluctant to \n\n\n\nundergo surgery and prefer a less \n\n\n\ninvasive treatment.  Patients are \n\n\n\naware of the availability of effective \n\n\n\npharmacotherapy and also have the \n\n\n\nawareness of the complications of \n\n\n\nsurgery which can include \n\n\n\nsignificant morbidity such as \n\n\n\nirreversible incontinence and loss of \n\n\n\nsexual function.  It is therefore not \n\n\n\nastounding that besides surgery and \n\n\n\nwatchful waiting, medical \n\n\n\nmanagement is generally the first \n\n\n\nrecommendation for patients \n\n\n\nshowing bothersome symptoms, \n\n\n\nalthough many do make it better \n\n\n\nwithout any intervention.   \n\n\n\n\n\n\n\nWhen treating BPH, drug therapy \n\n\n\ncould always be an option to control \n\n\n\nsymptoms and delay the need for \n\n\n\nsurgical intervention. To decide the \n\n\n\nmost appropriate medication to treat \n\n\n\nmoderate to severe BPH, it is often \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n236 \n\n\n\ncrucial that the choice of drug \n\n\n\ndepends on the actual or patient-\n\n\n\nperceived effectiveness of therapy, \n\n\n\nonset of action, adverse effects, \n\n\n\ndosing regimen, potential drug-drug \n\n\n\ninteraction and cost.  The goals of \n\n\n\ndrug therapy are to provide \n\n\n\nsymptomatic relief and to prevent \n\n\n\nany further complications.  Drug \n\n\n\ntherapy for BPH normally begins \n\n\n\nwith a single therapeutic agent, \n\n\n\nusually an alpha-adrenergic \n\n\n\nantagonist.  BPH medication \n\n\n\ntreatment is always indicated for \n\n\n\nlong period.  Therefore, patient \n\n\n\nshould always be advised that \n\n\n\nsymptoms improvement could be \n\n\n\nobserved only when treatment is \n\n\n\ncontinued and good adherence is \n\n\n\nobserved.    \n\n\n\n\n\n\n\nDrug therapy for BPH can be \n\n\n\nclassified into 2 different categories: \n\n\n\nagents that act directly on the \n\n\n\nprostatic smooth muscles and those \n\n\n\nthat interfere with the stimulatory \n\n\n\neffects of testosterone on prostate \n\n\n\nenlargement.  Of the agents, \u03b11 \n\n\n\nadrenergic antagonists such as \n\n\n\nalfuzosin, doxazosin, terazosin relax \n\n\n\nprostatic smooth muscles, whereas \n\n\n\n5-\u03b1 reductase inhibitors such as \n\n\n\nfinastride, selectively inhibit the \n\n\n\nconversion of testosterone to \n\n\n\ndihydrotestosterone.  Both these \n\n\n\nagents are accepted for treatment of \n\n\n\nBPH.  However, the difference in \n\n\n\ntheir mechanisms of action has \n\n\n\nrendered these agents in treating \n\n\n\ndifferent clinical symptoms.  \n\n\n\nFinasteride was found to work best \n\n\n\nwith patients who have a significant \n\n\n\nprostate enlargement of more than \n\n\n\n40g in size.  On the other hand, \n\n\n\n\u03b11adrenergic antagonists are more \n\n\n\neffective in treating patients who \n\n\n\nmanifest with BPH symptoms \n\n\n\ncaused by excessive adrenergic tone \n\n\n\nin the prostatic stroma.  Therefore, \n\n\n\nthese antagonists are often \n\n\n\ncommonly being considered to be an \n\n\n\nappropriate treatment for all patients \n\n\n\nregardless of prostate size. \n\n\n\n\n\n\n\nFDA has currently approved four \u03b1 \n\n\n\nadrenergic antagonists (doxazosin, \n\n\n\nterazosin, tamsulosin and alfuzosin) \n\n\n\nfor lower urinary tract symptoms \n\n\n\nassociated with BPH. These agents \n\n\n\nhowever showed equal benefits and \n\n\n\nall provide modest symptoms relief.  \n\n\n\nThe first generation of \u03b1 blockers \n\n\n\nsuch as doxazosin, terazosin and \n\n\n\nprazosin are associated with \n\n\n\nsignificant vasodilatory actions.  \n\n\n\nThese \u03b1 blockers are always \n\n\n\nassociated with certain degrees of \n\n\n\nvasodilatory side-effects such as \n\n\n\ndizziness and postural hypotension \n\n\n\nand subsequently cause poor \n\n\n\ncompliance to treatment.  \n\n\n\n\n\n\n\nNewer generations of \u03b1 blockers, \n\n\n\nnamely alfuzosin and tamsulosin, \n\n\n\nbind more prominently to the lower \n\n\n\nurinary tract tissues compared to \n\n\n\nvascular tissues.  Reflecting this \n\n\n\ndifferential pattern of tissue binding, \n\n\n\nthese agents have been found to be \n\n\n\nassociated with a lower risk of \n\n\n\nsignificant vascular side-effects \n\n\n\ncompared with the non-uroselective \n\n\n\n\u03b1 inhibitors, despite having a \n\n\n\nsignificant effect in reducing BPH \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n237 \n\n\n\nsymptoms\n3\n.  However, literature has \n\n\n\nrevealed that tamsulosin appears to \n\n\n\nhave a lower probability of causing \n\n\n\npostural hypotension, but higher \n\n\n\nchances of ejaculatory dysfunction \n\n\n\nthan other \u03b1 blockers.   \n\n\n\n\n\n\n\nThe extended release (ER) form of \n\n\n\nalfuzosin (10mg once a day) has \n\n\n\nbeen used and approved by the \n\n\n\nUnited States Food and Drug \n\n\n\nAdministration in 2003 for treating \n\n\n\nsigns and symptoms of BPH based \n\n\n\non clinical improvements of the \n\n\n\nirritative and obstructive urinary \n\n\n\nsymptoms of the disease.  A study \n\n\n\nmentioned in the literature\n3\n had \n\n\n\ndiscussed a meta-analysis of 3 \n\n\n\nclinical trials studying the \n\n\n\nvasodilatory effects of the ER \n\n\n\nalfuzosin compared to placebo.  In \n\n\n\nthese studies, results had shown that \n\n\n\nthe effects were similar to placebo \n\n\n\nand no significant changes in blood \n\n\n\npressure were observed.   \n\n\n\n\n\n\n\nOn the other hand, finasteride, a \n\n\n\nselective 5-\u03b1 reductase inhibitor, acts \n\n\n\nthrogh a different mechanism \n\n\n\ncompared to \u03b1-blockers.  It decreases \n\n\n\nthe conversion of testosterone to \n\n\n\ndihydrotestosterone, a hormone \n\n\n\nprimarily found in the prostate \n\n\n\ngland, testes, hair follicles and \n\n\n\nadrenal glands.  Dihydrotestosterone \n\n\n\nis the primary contributing factor in \n\n\n\nthe development or exacerbation of \n\n\n\nBPH and prostate cancer.  Therefore, \n\n\n\nfinasteride, by selectively inhibiting \n\n\n\ntype II 5-\u03b1 reductase, could \n\n\n\nprogressively delay the development \n\n\n\nof BPH.  Many studies have shown \n\n\n\nthat finasteride, when compared to \n\n\n\nplacebo, has effectively reduced the \n\n\n\nvolume of the prostate and enlarged \n\n\n\nprostate glands in men \n4,5\n\n\n\n. \n\n\n\n\n\n\n\nMethodology \n\n\n\n\n\n\n\nWe conducted a study to compare \n\n\n\ntwo BPH drugs with different \n\n\n\nmechanisms of action.  The aims of \n\n\n\nthe study were: (1) to compare the \n\n\n\neffectiveness of finasteride 5mg \n\n\n\n(Proscar) versus alfuzosin 10mg \n\n\n\n(Xatral XL) for the treatment of \n\n\n\nBPH; (2) to compare the treatment \n\n\n\ncosts of both drug; (3) to compare \n\n\n\nthe side-effect profile of both drug \n\n\n\nSubjects were patients who have \n\n\n\nbeen diagnosed with BPH and have \n\n\n\nbeen receiving the treatment in \n\n\n\nSOPD Hospital Tuanku Ja\u2019afar.  The \n\n\n\ninclusion criteria were: (1) male \n\n\n\nmore than 45 year old; (2) patients \n\n\n\nwho are not suffering from recurrent \n\n\n\nor rebound BPH. On the other hand, \n\n\n\nthe exclusion criteria include: (1) \n\n\n\npatient who has multi-disease prior \n\n\n\nto the study; (2) patient who has \n\n\n\nundergone surgical intervention \n\n\n\nprior to the study; (3) patient who \n\n\n\nwas taking any other traditional or \n\n\n\ncomplementary medicines. \n\n\n\n\n\n\n\nSubjects were evaluated using the \n\n\n\nInternational Prostate Symptom \n\n\n\nScore (IPSS) questionnaire \n\n\n\n(Appendix I).  This instrument \n\n\n\nevaluates the lower urinary tract \n\n\n\nsymptoms for the past one month. \n\n\n\nSubjects were asked seven questions \n\n\n\nassociated with the following \n\n\n\nsymptoms: (1) incomplete emptying \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n238 \n\n\n\nof bladder during urination; (2) \n\n\n\nfrequency of urine in less than 2 \n\n\n\nhours; (3) intermittency that stopped \n\n\n\nand started again when urinated; (4) \n\n\n\nurgency (difficulty to postpone \n\n\n\nurination); (5) weak stream; (6) \n\n\n\nstraining which push to begin \n\n\n\nurination; and (7) nocturia (the \n\n\n\nnumber of times the subject has to \n\n\n\nget up from bed to urinate at night).  \n\n\n\nThe rating ranged from 0 to 5 which \n\n\n\nrepresent the frequency of the above \n\n\n\nsymptoms in the past one month.  \n\n\n\nThe total score of IPSS is calculated \n\n\n\nby sum up the individual scores.  \n\n\n\nBased on the total score of IPSS, 0-7 \n\n\n\nmeans mildly symptoms; 8-19 \n\n\n\nmeans moderately symptoms and \n\n\n\n20-35 means severely symptomatic.  \n\n\n\n\n\n\n\nSubjects were also asked about side-\n\n\n\neffects of the drugs based on the \n\n\n\nestablished side-effects profiles of \n\n\n\nthe drugs.  This was to help the \n\n\n\nresearcher to evaluate the patient\u2019s \n\n\n\nacceptance of the drug therapy.  \n\n\n\nThere was a total score of 10 for this \n\n\n\nquestion.  \n\n\n\n\n\n\n\nThe data were analyzed using SPSS.  \n\n\n\nThe two treatment groups were \n\n\n\ncompared using Student\u2019s t-test.  P-\n\n\n\nvalue less than 0.05 was considered \n\n\n\nstatistically significant.  \n\n\n\n\n\n\n\nResults \n\n\n\n\n\n\n\nA total of 72 men diagnosed with \n\n\n\nBPH were involved in the study.  \n\n\n\nHowever, only 66 men were \n\n\n\nincluded in the analysis.  Of the 72 \n\n\n\npatients, three were taking the \n\n\n\ncombination treatment of finasteride \n\n\n\n5mg and alfuzosin 10mg, 2 other \n\n\n\npatients had just started the \n\n\n\ntreatment for less than 1 week, \n\n\n\nwhereas 1 patient was known to \n\n\n\nhave underlying disease (stroke).  \n\n\n\nTherefore, 8.3% of the total patients \n\n\n\nwere excluded from this study as \n\n\n\nthey did not meet the inclusion \n\n\n\ncriteria. \n \n\n\n\n36 of the subjects (55%) received \n\n\n\nfinasteride 5mg once daily, whereas \n\n\n\nthe rest took the ER alfuzosin 10mg \n\n\n\nonce daily.  The distribution of \n\n\n\npatients included was fairly equal to \n\n\n\nhelp minimize any bias in patient \n\n\n\nselections.  This is the true \n\n\n\ndistribution of patients encountered \n\n\n\nby our hospital out-patient \n\n\n\ndepartment as the stock movements \n\n\n\nof our integrated store were found to \n\n\n\nbe collaborated with our patient \n\n\n\nnumbers. \n\n\n\n\n\n\n\nTable 1 column 2 presents the \n\n\n\ndistribution of the subjects by age \n\n\n\ngroup. Twenty men (30%) were \n\n\n\nfrom 50 to 59 years, 18 men (27%) \n\n\n\nwere from 60-69 years, and 22 men \n\n\n\n(34%) were from 70-79 years. Only \n\n\n\na small proportion of the study \n\n\n\npopulation (9%) was more than 80 \n\n\n\nyears old.   \n \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n239 \n\n\n\nTable 1 Age distribution of patients who received two different therapies for BPH \n\n\n\n\n\n\n\nAge Group N (%) \nName of Drugs \n\n\n\nFinasteride 5mg Alfuzosin 10mg \n\n\n\n50-59 20 (30) 2 (5.56%) 18 (60%) \n\n\n\n60-69 18 (27) 12 (33.3%) 6 (20%) \n\n\n\n70-79 22 (34) 20 (55.6%) 2 (6.67%) \n\n\n\n80-89 4 (6) 2 (5.56%) 2 (6.67%) \n\n\n\n90-99 2 (3) 0 (0%) 2 (6.67%) \n\n\n\n\n\n\n\n\n\n\n\nTable 1 Columns 2 and 3 shows the \n\n\n\ndistribution of patients who received \n\n\n\ntwo different therapies for BPH, by age \n\n\n\ncategories. In the finasteride group, \n\n\n\nabout 33% of the patients were in \n\n\n\nthe range of 60-69 years old, and \n\n\n\nmore than half of the patients were \n\n\n\naged 70-79 years.  Conversely, in the \n\n\n\nalfuzosin group, the majority of the \n\n\n\npatients (80%) were between 50-69 \n\n\n\nyears old.  This shows the trend of \n\n\n\ndrug prescribing in our hospital, \n\n\n\nwhere the younger patients were \n\n\n\nmost probably prescribed with \n\n\n\nalfuzosin and the older patients were \n\n\n\ntreated with finasteride.   \n\n\n\n\n\n\n\nSubjects who received finasteride \n\n\n\n5mg had a significantly higher IPSS \n\n\n\nthan those who received alfuzosin \n\n\n\n10mg (mean IPSS of 22.18\u00b18.06 \n\n\n\nvs.18.87\u00b17.34, respectively; \n\n\n\np=0.001).  This indicates that \n\n\n\npatients who were treated with \n\n\n\nfinasteride were severely \n\n\n\nsymptomatic whereas those who \n\n\n\nreceived alfuzosin were moderately \n\n\n\nsymptomatic (Table 2). \n\n\n\n\n\n\n\n\n\n\n\nTable 2      Statistical results of mean IPSS score for patients on Alfuzosin and \n\n\n\nFinasteride \n  \n\n\n\nDrugs N Mean Std. Deviation P value \n\n\n\n \nFinasteride 5mg \n\n\n\n \n598 \n\n\n\n \n22.18 \n\n\n\n \n8.060 \n\n\n\n0.001 \n \nAlfuzosin 10mg \n\n\n\n \n448 \n\n\n\n \n18.87 \n\n\n\n \n7.337 \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n240 \n\n\n\nTable 3    Mean IPSS scores for patients in different age groups \n\n\n\n\n\n\n\nAge group Mean Total IPSS Score \n\n\n\nFinasteride 5mg Alfuzosin 10mg \n\n\n\n50-59 27 16 \n\n\n\n60-69 21 25 \n\n\n\n70-79 19 3 \n\n\n\n80-89 32 4 \n\n\n\n90-99 n/a 22 \n\n\n\n\n\n\n\n\n\n\n\nThis study compared the mean IPSS \n\n\n\nof different age groups in the two \n\n\n\ntreatment arms.  Student\u2019s t-test \n\n\n\nshows that there was no significant \n\n\n\ndifference in IPSS between the two \n\n\n\ntreatment arms across all age groups. \n\n\n\nMost of the groups obtained a mean \n\n\n\nIPSS of 20 and above, which \n\n\n\nindicates severely symptomatic \n\n\n\npatients (refer to Table 3).   \n\n\n\n\n\n\n\nThe distribution of mean score based \n\n\n\non duration of treatment of both drug \n\n\n\nis shown in the Table 4.  The mean \n\n\n\nscore of finasteride 5mg for less than \n\n\n\nhalf a year was 25; half a year to one \n\n\n\nyear was 11; one year to 1.5 years \n\n\n\nwas 30; and more than 1.5 years was \n\n\n\n20. On the other hand, the mean \n\n\n\nscore of alfuzosin 10mg for less than \n\n\n\nhalf a year was 20; half a year to one \n\n\n\nyear was 21; one year to 1.5 years \n\n\n\nwas 7; and more than 1.5 years was \n\n\n\n10. \n\n\n\n \nTable 4     Mean IPSS scores for patients according to duration of drug therapy \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nMean Total IPSS Scores  \n\n\n\n\n\n\n\nP values \n\n\n\n< 1/2 yr \n\n\n\n0.5 yr to \n\n\n\n1 yr \n\n\n\n1yr to 1.5 \n\n\n\nyr > 1.5 yr \n\n\n\nFinasteride 5mg 25 11 30 20 \n\n\n\n>0.05 \nAlfuzosin 10mg 20 21 7 10 \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n241 \n\n\n\nTable 5: Mean score for the number of adverse events occurred among patients \n\n\n\n\n\n\n\n Incidence of Side-effects  \n\n\n\nDrugs N Mean Std. Deviation p \n\n\n\n\n\n\n\nFinasteride 5mg \n\n\n\n\n\n\n\n598 \n\n\n\n\n\n\n\n0.52 \n\n\n\n\n\n\n\n0.738 \n \n\n\n\n0.639 \nAlfuzosin 10mg 448 0.50 0.745 \n\n\n\n\n\n\n\nTable 5 shows no significant \n\n\n\ndifference in the total side-effects \n\n\n\nscores between the two intervention \n\n\n\ngroups (p=0.693).  Overall, the \n\n\n\nfinasteride group had experienced a \n\n\n\nslightly higher incidence of side-\n\n\n\neffects than the alfuzosin group \n\n\n\n(mean = 0.52 cases vs. 0.50 cases, \n\n\n\nrespectively)  \n\n\n\n\n\n\n\nFigure 1 presents the frequencies of \n\n\n\nindividual side-effects among the \n\n\n\ntreatment groups.  about 16.7% \n\n\n\nsubjects on finasteride complained \n\n\n\nof fatigue and decreased sexual \n\n\n\ndesires 5.6% experienced problems \n\n\n\nrelated to erectile dysfunction.  \n\n\n\nHeadache and dizziness contributed \n\n\n\nto 33.3%of side effects experienced \n\n\n\nby Alfuzosin arm.   \n \n\n\n\nFigure 1: Side effects experienced by patients on finasteride and alfuzosin group \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n242 \n\n\n\nIn comparison of treatment costs \n\n\n\nbetween the two treatments, \n\n\n\nfinasteride 5mg tablet (Proscar) was \n\n\n\nRM 123.00 per pack of 30\u2019s while \n\n\n\nalfuzosin 10mg tablet (Xatral XL) \n\n\n\nwas RM 41.31 per pack of 30\u2019s.  \n\n\n\nTreatment of BPH is often life long \n\n\n\nand effect will only be seen when \n\n\n\nthe treatment is continued.  \n\n\n\nTherefore, to consider a one-month \n\n\n\ntreatment, alfuzosin can reduce cost \n\n\n\nby RM81.969 per month, \n\n\n\ncontributing to RM980.28 every \n\n\n\nyear. \n\n\n\n\n\n\n\nDiscussion \n\n\n\n\n\n\n\nThe most important finding of this \n\n\n\nstudy is that patients taking ER \n\n\n\nalfuzosin 10mg had a significantly \n\n\n\nlower International Prostate \n\n\n\nSymptom Score (IPSS) when \n\n\n\ncompared to patients taking \n\n\n\nfinasteride 5mg.  BPH and its \n\n\n\nconsequent bothersome lower \n\n\n\nurinary tract symptoms can severely \n\n\n\naffect quality of life in older men.  \n\n\n\nOn the basis of this study, we could \n\n\n\ndeduce from the mean IPSS that \n\n\n\nalfuzosin provided a better \n\n\n\nimprovement in the quality of life of \n\n\n\nthese patients. \n\n\n\n\n\n\n\nThe study did not collect patients\u2019 \n\n\n\nbaseline values of the IPSS, \n\n\n\ntherefore it is impossible for us to \n\n\n\ncompare the effect before and after \n\n\n\ntreatment.  However, the finding \n\n\n\nshowed that patients with higher \n\n\n\nIPSS scores (more severe) were \n\n\n\nnormally prescribed finasteride 5mg.  \n\n\n\nThis observation could be seen as \n\n\n\nrational, since BPH is a progressive \n\n\n\nillness and significant prostate \n\n\n\nenlargement of more than 40g is \n\n\n\nnormally a manifestation of the later \n\n\n\nstages of BPH.  Progressive growth \n\n\n\nof the prostate would eventually \n\n\n\novercome the reduction in prostatic \n\n\n\nurethral obstruction achieved by the \n\n\n\nrelaxation of prostatic smooth \n\n\n\nmuscle tone caused by alpha \n\n\n\nblockers even in patients on \n\n\n\ntherapy\n5\n. \n\n\n\n\n\n\n\nOne study which compared \n\n\n\nfinastride with placebo showed \n\n\n\nsymptomatic improvements in men \n\n\n\nwith prostatic enlargement and \n\n\n\nmoderate to severe symptoms\n4\n.  \n\n\n\nTherefore, it would be logical to \n\n\n\nprescribe finasteride to patients who \n\n\n\ndo not respond well with to alfuzosin \n\n\n\nand to minimize the need of surgical \n\n\n\nintervention as it is always an \n\n\n\nattribution to severe enlargement of \n\n\n\nprostate size.  Patients treated with \n\n\n\nfinasteride can eventually have a \n\n\n\nfour-year risk reduction for surgical \n\n\n\nintervention and acute urinary \n\n\n\nretention\n4\n.  The benefit of finasteride \n\n\n\nis slow, which can only be observed \n\n\n\nconservatively at about 4 months \n\n\n\nafter initiation of therapy.  \n\n\n\nConversely, the effects of alfuzosin \n\n\n\ncan be seen within first few days of \n\n\n\ntreatment.  The promptness of action \n\n\n\nof alfuzosin provides benefits of \n\n\n\nquick evaluation without delay and \n\n\n\nminimizes the costly long-term \n\n\n\ntreatment where patients can only be \n\n\n\nre-evaluated after few months of \n\n\n\ninappropriate treatment. \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n243 \n\n\n\nThe overall side effects between \n\n\n\nalfuzosin and finasteride shows no \n\n\n\nsignificant difference, with p>0.05.  \n\n\n\nPatients from both arms shows \n\n\n\ndifferent side-effects profiles, about \n\n\n\n16.7% of patients treated with \n\n\n\nfinastride had experienced fatigue \n\n\n\nand decreased sexual desires. 5.6% \n\n\n\nof them had encountered problems \n\n\n\nrelated to erectile dysfunction.  \n\n\n\nThese side-effects were mostly \n\n\n\nobserved in patients receiving \n\n\n\nfinastride for less than 1 year.  On \n\n\n\nthe other hand the most prominent \n\n\n\nside-effects experienced by patients \n\n\n\ntaking alfuzosin were dizziness and \n\n\n\nheadache.  However, alfuzosin is \n\n\n\ngenerally reported to have only little \n\n\n\neffect on blood pressure when \n\n\n\ncompared to other \u03b1 blockers.  Meta \n\n\n\nanalyses of placebo and randomized \n\n\n\ncontrolled trials have demonstrated \n\n\n\nan extra 5%-20% of dizziness \n\n\n\nincidences reported by normotensive \n\n\n\npatients who underwent treatment \n\n\n\nwith terazosin or doxazosin.  \n\n\n\nHowever, with alfuzosin, the event \n\n\n\nof dizziness reported was \n\n\n\napproximately 5%\n6\n.  In addition, one \n\n\n\nrandomized controlled study found \n\n\n\nthat the occurrence of postural \n\n\n\nhypotension with alfuzosin was at \n\n\n\nplacebo level (estimated at 1%)\n7\n.  \n\n\n\nThis phenomenon is seen as \n\n\n\nalfuzosin is more selective to \n\n\n\nprostatic smooth muscle than \n\n\n\nvascular smooth muscles. \n\n\n\n\n\n\n\nAnother study estimated that about \n\n\n\n30-50% of BPH patients would \n\n\n\ndevelop essential hypertension\n8\n.  \n\n\n\nPatients who are originally on \u03b1-\n\n\n\nblocker as anti-hypertensive \n\n\n\nmedications are more likely to \n\n\n\nexperience cardiovascular adverse \n\n\n\neffects.  Therefore, the second \n\n\n\ngeneration \u03b1-blockers such as \n\n\n\nalfuzosin are more suitable to this \n\n\n\ngroup of patients as they are more \n\n\n\nselective and could minimize the \n\n\n\noccurrence of cardiovascular side \n\n\n\neffects. \n\n\n\n\n\n\n\nConclusion: \n\n\n\n\n\n\n\nFrom the study, it is clear that both \n\n\n\nalfuzosin and finasteride provide \n\n\n\nsymptomatic relief to BPH patients.  \n\n\n\nHowever, the differences in \n\n\n\nmechanisms of actions of the two \n\n\n\ndrugs made them useful to patients \n\n\n\nwith different underlying problems.  \n\n\n\nAlfuzosin with its faster onset of \n\n\n\naction could be very useful for \n\n\n\npatients who are diagnosed with \n\n\n\nBPH and carry moderate IPSS \n\n\n\nscores.  Further studies need to be \n\n\n\nconducted in order to obtain a \n\n\n\nclearer picture of the efficacy and \n\n\n\ntolerability of both drugs. \n\n\n\nReference: \n\n\n\n\n\n\n\n1. E. Darracott Vaughan, Jr., M. D. Medical Management of benign \n\n\n\nProstatic Hyperplasia-Are two Drugs Better Than One N Eng J Med. \n\n\n\n2003 Dec 18; Volume 349:2449-2451 \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n244 \n\n\n\n2. Oesterling JE. Benign prostatic hyperplasia: a review of its histogenesis \n\n\n\nand natural history. Prostate Suppl 1996;6:67-73 \n\n\n\n\n\n\n\n3. Kevin T. McVary. Alfuzoxin for Symptomatic Benign Protatic \n\n\n\nhyperplasia: Long- Term Experience. Available online 12 December 2005 \n\n\n\n\n\n\n\n4. John D. McConnell et al. The Effect of Finasteride on the Risk of Acute \n\n\n\nUrinary Retention and the Need for Surgical Treatment among Men with \n\n\n\nBenign Prostatic Hyperplasia. N Eng J Med. 1998 Feb 26;338(9):612-3 \n\n\n\n\n\n\n\n5. John D. McConnell et al. The Long Term Effect of Doxazosin, \n\n\n\nFinasteride and Combination Therapy on the Clinical Progression of \n\n\n\nbenign Prostatic Hyperplasia. The New England Journal of Medicine \n\n\n\n2003 Dec 18;349(25):2387-98 \n\n\n\n\n\n\n\n6. McKiernan JM, Lowe FC. Side effects of terazosin in the treatment of \n\n\n\nsymptomatic benign prostatic hyperplasia. South Med J. 1997;90:509\u2013\n\n\n\n513. \n\n\n\n\n\n\n\n7. Christopher R. Chapple. A Comparison of Varying \u03b1-Blokers and Other \n\n\n\nPharmacotherapy options for Lower Urinary Tract Symptoms. RevUrol. \n\n\n\n2005; 7(Suppl 4):S22-S30 \n\n\n\n\n\n\n\n8. Alfuzosin Hydrochloride for the Treatment of Benign Prostatic from \n\n\n\nAmerican Journal of Health-System Pharmacy.  Available online: \n\n\n\nwww.medscape,com/viewarticle/458899_13 \n\n\n\n\n\n\n\n9. A. Tejani et al; Clinical practice: Benign Prostatic Hypertrohpy. Available \n\n\n\nonline : www.cfpc.ca/cfp/2006/Sep/vol52-sep-clinical-therapeutics.asp \n\n\n\nAppendix I \n\n\n\nInternational prostate symptom score (IPSS) \n\n\n\n \nName:       Date: \n\n\n\n\n\n\n\nN\no\n\n\n\nt \nat\n\n\n\n a\nll\n\n\n\n\n\n\n\nL\nes\n\n\n\ns \nth\n\n\n\nan\n \n\n\n\n1\n t\n\n\n\nim\ne \n\n\n\nin\n 5\n\n\n\n\n\n\n\nL\nes\n\n\n\ns \nth\n\n\n\nan\n \n\n\n\nh\nal\n\n\n\nf \nth\n\n\n\ne \n\n\n\nti\nm\n\n\n\ne \nA\n\n\n\nb\no\n\n\n\nu\nt \n\n\n\nh\nal\n\n\n\nf \n\n\n\nth\ne \n\n\n\nti\nm\n\n\n\ne \n\n\n\nM\no\n\n\n\nre\n t\n\n\n\nh\nan\n\n\n\n\n\n\n\nh\nal\n\n\n\nf \nth\n\n\n\ne \n\n\n\nti\nm\n\n\n\ne \nA\n\n\n\nlm\no\n\n\n\nst\n \n\n\n\nal\nw\n\n\n\nay\ns \n\n\n\nY\no\n\n\n\nu\nr \n\n\n\nsc\no\n\n\n\nre\n \n\n\n\nIncomplete emptying \nOver the past month, how often have you had a \n\n\n\nsensation of not emptying your bladder completely \n\n\n\nafter you finish urinating? \n\n\n\n0 1 2 3 4 5 \n\n\n\n \n\n\n\n\nhttp://www.medscape,com/viewarticle/458899_13\n\n\nhttp://www.cfpc.ca/cfp/2006/Sep/vol52-sep-clinical-therapeutics.asp\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n245 \n\n\n\nFrequency \nOver the past month, how often have you had to \n\n\n\nurinate again less than two hours after you finished \n\n\n\nurinating? \n\n\n\n0 1 2 3 4 5 \n\n\n\n\n\n\n\nIntermittency \nOver the past month, how often have you found \n\n\n\nyou stopped and started again several times when \n\n\n\nyou urinated? \n\n\n\n0 1 2 3 4 5 \n\n\n\n\n\n\n\nUrgency \nOver the last month, how difficult have you found \n\n\n\nit to postpone urination? \n0 1 2 3 4 5 \n\n\n\n\n\n\n\nWeak stream \nOver the past month, how often have you had a \n\n\n\nweak urinary stream? \n0 1 2 3 4 5 \n\n\n\n\n\n\n\nStraining \nOver the past month, how often have you had to \n\n\n\npush or strain to begin urination? \n0 1 2 3 4 5 \n\n\n\n\n\n\n\n\n\n\n\nN\no\n\n\n\nn\ne \n\n\n\n1\n t\n\n\n\nim\ne \n\n\n\n2\n t\n\n\n\nim\nes\n\n\n\n\n\n\n\n3\n t\n\n\n\nim\nes\n\n\n\n\n\n\n\n4\n t\n\n\n\nim\nes\n\n\n\n\n\n\n\n5\n t\n\n\n\nim\nes\n\n\n\n o\nr \n\n\n\nm\no\n\n\n\nre\n \n\n\n\nY\no\n\n\n\nu\nr \n\n\n\nsc\no\n\n\n\nre\n \n\n\n\nNocturia \nOver the past month, many times did you most \n\n\n\ntypically get up to urinate from the time you went \n\n\n\nto bed until the time you got up in the morning? \n\n\n\n0 1 2 3 4 5 \n\n\n\n\n\n\n\n\n\n\n\nTotal IPSS score \n\n\n\n\n\n\n\n\n\n\n\n \nQuality of life due to urinary symptoms \n \n \n \n D\n\n\n\nel\nig\n\n\n\nh\nte\n\n\n\nd\n \n\n\n\nP\nle\n\n\n\nas\ned\n\n\n\n\n\n\n\nM\no\n\n\n\nst\nly\n\n\n\n\n\n\n\nsa\nti\n\n\n\nsf\nie\n\n\n\nd\n \n\n\n\nM\nix\n\n\n\ned\n \u2013\n\n\n\n\n\n\n\nab\no\n\n\n\nu\nt \n\n\n\neq\nu\n\n\n\nal\nly\n\n\n\n\n\n\n\nsa\nti\n\n\n\nsf\nie\n\n\n\nd\n \n\n\n\nan\nd\n\n\n\n\n\n\n\nd\nis\n\n\n\nsa\nti\n\n\n\nsf\nie\n\n\n\nd\n \n\n\n\nM\no\n\n\n\nst\nly\n\n\n\n\n\n\n\nd\nis\n\n\n\nsa\nti\n\n\n\nsf\nie\n\n\n\nd\n \n\n\n\nU\nn\n\n\n\nh\nap\n\n\n\np\ny\n \n\n\n\nT\ner\n\n\n\nri\nb\n\n\n\nle\n \n\n\n\nIf you were to spend the rest of your life with your \n\n\n\nurinary condition the way it is now, how would \n\n\n\nyou feel about that? \n0 1 2 3 4 5 6 \n\n\n\n \nTotal score: 0-7 Mildly symptomatic; 8-19 moderately symptomatic; 20-35 severely \n\n\n\nsymptomatic. \n\n\n\n\n\n"
"\n\nMalaysian Journal of Pharmacy Volume 7 Issue 2 (2021) \n\n\n\n\n\n\n\n1 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n Obituary \n\n\n\n\n\n\n\n\n\n\n\nProfessor Dr. Mohamed Azmi bin Ahmad Hassali (1974-2021)  \n\n\n\n \nGuat See Ooi 1, Yuet Yen Wong 2 \n\n\n\n \n1Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Minden, Pulau Pinang, Malaysia. \n2Faculty of Pharmacy, Universiti Teknologi MARA, Cawangan Pulau Pinang, Kampus Bertam, 13200 Kepala Batas, Pulau Pinang, Malaysia  \n\n\n\n\n\n\n\n \nThe profession of pharmacy had lost one of its key intellectual \n\n\n\nleaders when Prof. Dr. Mohamed Azmi Ahmad Hassali (Fig.1) \n\n\n\nhad suddenly passed away on 16th of July, 2021. \n\n\n\n\n\n\n\nProf. Dr. Mohamed Azmi Ahmad Hassali was born on the 19th of \n\n\n\nFebruary, 1974 in Penang, Malaysia. He graduated with a \n\n\n\nBachelor\u2019s Degree in Pharmacy from Universiti Sains Malaysia \n\n\n\nin the year 1998, followed soon after with a Master\u2019s Degree in \n\n\n\nthe field of clinical pharmacy from the same university in 2000. \n\n\n\nFor his outstanding performance, he was then selected to receive \n\n\n\nthe \u2018Universiti Sains Malaysia Academic Staff Training \n\n\n\nFellowship (ASTS)\u2019 to pursue his PhD studies in the field of \n\n\n\nsocial pharmacy in Australia in 2002, consequently earning him a \n\n\n\nPhD by the Victorian College of Pharmacy at Monash University \n\n\n\nin Melbourne, Australia. \n\n\n\n\n\n\n\nProf. Dr. Mohamed Azmi Ahmad Hassali joined Universiti Sains \n\n\n\nMalaysia as a lecturer and researcher after obtaining his PhD \n\n\n\ndegree, and he was one of the key academicians and pioneers \n\n\n\ninvolved in setting up the Discipline of Social and Administrative \n\n\n\nPharmacy Department within the School of Pharmaceutical \n\n\n\nSciences, Universiti Sains Malaysia. He was promoted to the \n\n\n\nposition of associate professor and appointed as programme chairman for the Discipline of Social and Administrative Pharmacy in \n\n\n\n2010. In 2012, he was appointed as the deputy dean of student affairs and networking of the School of Pharmaceutical Sciences, \n\n\n\nUniversiti Sains Malaysia. He obtained his professorship in 2014 at the age of 40.  \n\n\n\n\n\n\n\nAs a researcher, Prof Azmi\u2019s main research areas of expertise included the fields of social pharmacy, pharmacoepidemiology, \n\n\n\npharmacy practice research, clinical pharmacoeconomics and clinical pharmacy. He had published over 800 articles in international \n\n\n\npeer-reviewed journals and authored over 250 conference presentations, besides also being recognized by the World Health \n\n\n\nOrganization Pacific Office and WHO Geneva as a leading researcher in the field of generic medicine policy analysis and \n\n\n\nmedication safety. He also made history when his name was recorded in the Malaysia Book of Records (MBR) for \u2018Most Number \n\n\n\nof Medical Research Journals Published\u2019 in 2017 [1]. Prof. Azmi published research books and contributed several book chapters \n\n\n\nwhich are widely utilized among the pharmacy profession to this day. One of the best known of the many books he had published \n\n\n\nis his books about generic medicine [2][3]. As a research supervisor, Prof. Azmi had graduated over 100 postgraduate students. He \n\n\n\nreceived numerous awards in the university and national level.   \n\n\n\n\n\n\n\nProfessionally, Prof. Azmi served as advisory board member for many different journals since the year 2008, including the Journal \n\n\n\n\u2018Pharmacy Practice\u2019, the Journal of Medicine Use in Developing Countries, the American Journal of Pharmaceutical Education, \n\n\n\nSouthern Medicine Review and Archives of Pharmacy Practice, the Journal of Pharmaceutical Health Service Research, the Journal \n\n\n\nof Pharmacy and Alternative Medicine and the American Journal of Pharmaceutical Education as well as the Journal of \n\n\n\nPharmaceutical Technology and Drug Research. He also served as a member of the editorial board for Nepal Journal of \n\n\n\n\n\n\n\nFig.1 Portrait of Professor Dr. Mohamed Azmi Bin Ahmad Hassali \n\n\n\n(1974-2021) \n\n\n\n \n\n\n\n\n\n\n\n\nOoi G.S. and Wong, Y.Y.                                                                                                                        Mal J Pharm 7 (2) 2021, 1-2 \n\n\n\n\n\n\n\n2 \n\n\n\n\n\n\n\nEpidemiology and as an editor for the Journal of Pharma Scientist. Of course, his accomplishments are not limited to black-and-\n\n\n\nwhite journal publications alone, for he had also been invited as a keynote and plenary speaker for various conferences held both \n\n\n\nlocally and internationally, besides also being actively involved in contributing to local community works. Prof. Azmi was also \n\n\n\nwell sought-after as an internal and external examiner as well as an academic reviewer. He had numerous appointments as an \n\n\n\nadjunct lecturer besides also holding positions as honorary and visiting professors in the Middle East and Malaysia.  \n\n\n\n\n\n\n\nDespite his remarkable achievements and contributions to the profession both locally and globally, Prof. Azmi was better known \n\n\n\nfor his role as an academician. Being the friendly, diligent, generous, caring and a much-loved mentor and supervisor that he was, \n\n\n\nhe earned the title of the \u2018Great Guru\u2019 among his students, many of which are now scattered far and wide across the world. \n\n\n\nTherefore, amidst his countless academic accomplishments, his greatest legacy will always be the hundreds and thousands of \n\n\n\npharmacists and students of whom he had impacted, inspired and developed.  \n\n\n\n\n\n\n\n\u201cSome people come into our lives, leave footprints on our hearts, and we are never the same.\u201d  - Unknown \n\n\n\n\n\n\n\n\n\n\n\nREFERENCES  \n \n\n\n\n[1] Mohamed Azmi Cipta Nama Dalam Malaysia Book of Records. Pulau Pinang; 2017. [assessed date 20 July 2021][url: \n\n\n\nhttps://news.usm.my/index.php/berita-mutakhir/5144-mohamed-azmi-cipta-nama-dalam-malaysia-book-of-records] \n\n\n\n[2] Hassali MA. Quality Use of Generic Medicines: What The Healthcare Practitioners and Consumer Should Know. Saarbrucken, Germany; 2010; ISBN: \n\n\n\n978-3-8383-8362-0.  \n\n\n\n[3] Hassali MA, Thambyappa J, Shafie AA. What You Should Know About Generic Medicines (Penerbit USM). Penerbit USM; 2014 Nov 25; ISBN: 978-\n\n\n\n983-861-543-3.  \n\n\n\n\n\n\n\nThe main author, Ooi Guat See was a PhD student under the main supervision of Prof. Dr. Mohamed Azmi Ahmad Hassali and graduated in 2015. She was then \n\n\n\njoined School of Pharmaceutical Sciences, Universiti Sains Malaysia as a lecturer and became a colleague to Prof. Azmi in since 2018. They had been working \n\n\n\nclosely in various research projects as well as teaching and learning related tasks.  \n\n\n\nCorresponding Author: guatsee.ooi@usm.my \n\n\n\n \n\n\n\n\n\n"
"\n\n\n\n\n\n \nPP12684/8/2008 \n\n\n\nVol. 1 Issue 11. Oct 2014 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJOURNAL of PHARMACY \n \n\n\n\nIn this issue: \n\n\n\n\n\n\n\n\uf0b7 Cost-effectiveness analysis of a behavioral risk factor \n\n\n\nreduction program at a worksite: Experience from a public \n\n\n\nuniversity in Malaysia \n\n\n\n\n\n\n\n\uf0b7 Formulation and Stability of Extemporaneously Prepared \n\n\n\nMorphine Oral Suspension \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nSupplement \n\n\n\n\n\n\n\nProceedings of the 25th FAPA Congress 2014 \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nA Publication of the Malaysian Pharmaceutical Society \n\n\n\n                                                                                          M\nA\n\n\n\nL\nA\n\n\n\nY\nS\n\n\n\nIA\nN\n\n\n\n JO\nU\n\n\n\nR\nN\n\n\n\nA\nL\n\n\n\n O\nF\n\n\n\n P\nH\n\n\n\nA\nR\n\n\n\nM\nA\n\n\n\nC\nY\n\n\n\n                                                              V\no\nl . 1\n\n\n\n. Issu\ne 1\n\n\n\n1\n \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy \n Vol.1 Issue 11, October 2014 \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nThe Official Journal of the Malaysian Pharmaceutical Society       \n\n\n\n\n\n\n\n \n Editor-in-Chief: Assoc Prof Dr Asrul Akmal Shafie \n\n\n\n\n\n\n\n Associate Editors: Prof Dr PT Thomas \n\n\n\n  Prof Dr Yuen Kah Hay \n\n\n\n  Assoc Prof Dr Mohamed Azmi Ahmad Hassali \n\n\n\n  Assoc Prof Dr Mohamad Haniki Nik Mohamed \n\n\n\n  Mr Lam Kai Kun \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n Publisher: Malaysian Pharmaceutical Society \n\n\n\n16-2 Jalan OP 1/5, 1-Puchong Business Park \n\n\n\nOff Jalan Puchong \n\n\n\n47160 Puchong \n\n\n\nMalaysia \n\n\n\n  Tel: 6-03-80791861 \n\n\n\nFax: 6-03-80700388 \n\n\n\n  Homepage: www.mps.org.my \n\n\n\nEmail: mspharm@po.jaring.my \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \nThe Malaysian Journal of Pharmacy is a publication of the Malaysian Pharmaceutical Society.  \n\n\n\nEnquiries are to be directed to the publisher at the above address.  The Publisher reserves \n\n\n\ncopyright and renewal on all published materials, and such material may not be reproduced in \n\n\n\nany form without the written permission of the Publisher. \n\n\n\n \n\n\n\n\nhttp://www.mps.org.my/\n\n\nmailto:mspharm@po.jaring.my\n\n\n\n\n\n\nTable of contents \n \n\n\n\nEditorial \n  \n\n\n\nWorking Together for a Robust and Relevant Research \n\n\n\n\n\n\n\n\n\n\n\niii \n\n\n\nResearch Papers \n  \n\n\n\nCost-Effectiveness Analysis of a Behavioral Risk Factor \n\n\n\nReduction Program at a Worksite: Experience From a Public \n\n\n\nUniversity In Malaysia \n\n\n\n\n\n\n\nFormulation and Stability of Extemporaneously Prepared \n\n\n\nMorphine Oral Suspension \n\n\n\n\n\n\n\n\n\n\n\nPage? \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nPage ? \n\n\n\nProceedings of the 25\nth\n\n\n\n FAPA Congress 2014  \n \n\n\n\n\n\n\n\nPlenary Lectures \n\n\n\n\n\n\n\nConcurrent Symposium \n\n\n\n\n\n\n\nOral Presentations \n\n\n\n\n\n\n\n     Hospital and Clinical Pharmacy \n\n\n\n     Community Pharmacy \n\n\n\n     Drug Marketing and Socio-Economic Pharmacy \n\n\n\n     Industrial Pharmacy \n\n\n\n     Scientific \n\n\n\n     Phytopharmacy and Pharmacopeia \n\n\n\n     Pharmacy Education and Student Affairs \n\n\n\n     Pharmaceutical Legislations, Ethics and Regulatory Affairs \n\n\n\n     Emergency Medicine and Others \n\n\n\n\n\n\n\nPoster Presentations \n\n\n\n\n\n\n\n     Hospital and Clinical Pharmacy \n\n\n\n     Community Pharmacy \n\n\n\n     Drug Marketing and Socio-Economic Pharmacy \n\n\n\n     Industrial Pharmacy \n\n\n\n     Scientific \n\n\n\n     Phytopharmacy and Pharmacopeia \n\n\n\n     Pharmacy Education and Student Affairs \n\n\n\n     Pharmaceutical Legislations, Ethics and Regulatory Affairs \n\n\n\n     Emergency Medicine and Others \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nEditorial \n\n\n\nWORKING TOGETHER FOR A ROBUST AND RELEVANT RESEARCH \n\n\n\nAsrul A Shafie \n\n\n\nSchool of Pharmaceutical Science, Universiti Sains Malaysia, 11800 Penang, MALAYSIA \n\n\n\n\n\n\n\nPharmacy research and practice in Malaysia has never been as exciting. The Malaysian \n\n\n\nPharmaceutical Society has co-organized the National MPS Scientific Conference since \n\n\n\n2001, the National Research & Development Conference for eight years running and various \n\n\n\nconferences at state level. Each of the conference highlighted hundreds of researches \n\n\n\nproduced throughout the country covering wide range of themes in pharmacy. This reflects \n\n\n\nthe rapid growth of research and interest in scientific endeavour in the country.  \n\n\n\n\n\n\n\nAn interesting observation in the conferences are the increasing researches conducted in \n\n\n\npharmacy practice setting by practitioners. Whilst this is an encouraging trend, researchers \n\n\n\nneed to be aware of the technical progress made in the field that has push forward the \n\n\n\nsophistication in study methods and design. For example, it is no longer sufficient to infer \n\n\n\nfrom observational study that did not consider confounding factors and biasness in their \n\n\n\nanalysis. In fact, publication are now required to adhere to reporting guidelines specific to its \n\n\n\nstudy design e.g. CONSORT for clinical trial (1), PRISMA for systematic review (2), \n\n\n\nCHEERS for economic evaluation (3). This reflects greater understanding by scientific \n\n\n\ncommunity on the methods limitation and potential risk to its internal validity, and the desire \n\n\n\nto increase generalizability of the results. \n\n\n\n\n\n\n\nIn spite of the interest shown by Malaysian researchers and practitioners in disseminating \n\n\n\ntheir research in conference, the same cannot be said for publishing their research in peer \n\n\n\nreviewed journal. This is a gross missed opportunity as such publication would allow \n\n\n\ndissemination of local pharmacy research to both international and local audience. Hence it is \n\n\n\nnot surprising to observe researchers flogging a dead horse in local conference. In contrast to \n\n\n\nconference that only provides brief and limited exposure of the evidence, journal publication \n\n\n\nis a time tested archive that allow research to be shared over and over again. Thus, allowing \n\n\n\nfuture research and policy to be better informed, and equipped. \n\n\n\n\n\n\n\nHowever, local researchers faced many obstacles in publishing their studies. One of the most \n\n\n\ncommon is the lack of appeal of the research topic as they are frequently limited to specific \n\n\n\npharmacy setting/service. Thus, local researchers need to come out from their silo and expand \n\n\n\ntheir research scope to wider audience in health care. Many research problems are also unique to \n\n\n\nMalaysia setting and might lack appeal to journal based in developed countries. Dispensing separation \n\n\n\nfor example, is a foregone conclusion in many countries with some already moving into \n\n\n\nempowering prescribing role to pharmacist(4) but the issue remain wanting in Malaysia(5). \n\n\n\nThe issues of Government Sales Taxon drugs, impact of health care reform to pharmacy and \n\n\n\ncontinuous point development requirement for pharmacist are some local issues that highly \n\n\n\nrelevant and pharmacist demand their voice to be heard and the issues to be systematically \n\n\n\nexplored.  \n\n\n\n\n\n\n\nHence, the Malaysian Pharmacy Journal (MJP)  has taken a significant step forward to allow \n\n\n\na proper discourse of pertinent issues by introducing letter to editor section that would allow \n\n\n\nintellectual discussion of recently published studies in the journal or current issue in \n\n\n\npharmacy. MJP has also revised the reporting format to conform to international guidelines \n\n\n\nand is working to list the journal in international indexing service.  MJP is committed to \n\n\n\n\n\n\n\n\nfoster local pharmacy research and encourage collaborative research between academic and \n\n\n\npractitioners to improve technical rigor in the researchwhilst at the same time ensuring the \n\n\n\nresearch remain relevant to practice. \n\n\n\n\n\n\n\n\n\n\n\n1. Altman DG, Schulz KF, Moher D, Egger M, Davidoff F, Elbourne D, et al. The revised \n\n\n\nCONSORT statement for reporting randomized trials: explanation and elaboration. Ann \n\n\n\nIntern Med. 2001;134(8):663-94 \n\n\n\n\n\n\n\n2. Liberati A, Altman DG, Tetzlaff J, Mulrow C, G\u00f8tzsche PC, Ioannidis JPA, et al. The \n\n\n\nPRISMA statement for reporting systematic reviews and meta-analyses of studies that \n\n\n\nevaluate healthcare interventions: explanation and elaboration2009 2009-07-21 \n\n\n\n10:46:49. \n\n\n\n\n\n\n\n3. Husereau D, Drummond M, Petrou S, Carswell C, Moher D, Greenberg D, et al. \n\n\n\nConsolidated Health Economic Evaluation Reporting Standards (CHEERS) statement. \n\n\n\nBMC Medicine. 2013;11(1):80. \n\n\n\n\n\n\n\n4. Nissen L. Pharmacist prescribing: What are the next steps? American Journal of \n\n\n\nHealth-System Pharmacy. 2011;68(24):2357-61. \n\n\n\n\n\n\n\n5. Shafie AA, Hassali MA, Azhar S, See OG. Separation of prescribing and dispensing in \n\n\n\nMalaysia: A summary of arguments. Research in Social and Administrative Pharmacy. \n\n\n\n2012;8(3):258-62. \n \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nCost-Effectiveness Analysis of a Behavioral Risk Factor Reduction Program at a \n\n\n\nWorksite: Experience From a  Public University in Malaysia \n \n\n\n\nSiow Yen Liau* BPharm, PhD\n1\n, Asrul A Shafie  BPharm, PhD\n\n\n\n2\n, Mohamed Azmi A Hassali  BPharm, \n\n\n\nPhD\n2\n, Mohamed Izham Mohamed Ibrahim BPharm, PhD\n\n\n\n3 \n\n\n\n \n1\n Pharmacy Department, Hospital Queen Elizabeth 2, Kota Kinabalu, Sabah \n\n\n\n2\n School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia \n\n\n\n3\n Social and Administrative Pharmacy, College of Pharmacy, Qatar University, Doha, Qatar \n\n\n\n\n\n\n\n* Contact for correspondence, please email: siowyenliau@yahoo.com \n\n\n\n\n\n\n\nABSTRACT \nObjectives: The objectives of this study were to determine the cost of a behavioral risk factor \n\n\n\nreduction program at the worksite  and to compare the cost-effectiveness of the program with a \n\n\n\ncontrol group.  Methodology: This was a quasi-experimental study conducted among employees of \n\n\n\nUniversiti  Sains Malaysia. The program targeted five primary risk factors (RF). Participants in the \n\n\n\nintervention program were subjected to schedule individualized counseling and seminars during the 6-\n\n\n\nmonth follow-up. Participants in the control group underwent health screening. Cost-effectiveness \n\n\n\nanalysis was conducted from the payer\u2019s perspective to determine the cost of 1% increase in \n\n\n\nproportion of participants who reach ideal targets for the RF. One-way sensitivity analysis was also \n\n\n\nconducted. Results: A total 136 participants were recruited in this study. At 6-month follow-up, \n\n\n\nsignificantly higher proportion of participants in the intervention group reached target for fruit and \n\n\n\nvegetable intake (P \uf03c 0.001) and physical activity (P = 0.017). The costs of the intervention program \n\n\n\nand control group were estimated to be MYR304.52 (USD92.28) and MYR169.90 (USD51.48)  per \n\n\n\nparticipant respectively. The incremental cost-effectiveness ratio (ICER) of all the RF were lower \n\n\n\nthan the World Health Organization recommendation based on the CHOICE analyses for relative \n\n\n\ncost-effectiveness of an intervention. Body mass index and alcohol consumption reported negative \n\n\n\nICER which indicated control dominant. Sensitivity analyses showed that ICER was reported to be \n\n\n\nmost sensitive to the change in participants\u2019 salary. Conclusion: The proposed health promotion \n\n\n\nprogram was shown to be cost-effective in modifying most of the behavioral RF.  \n\n\n\n\n\n\n\nKeywords: behavioural, cost-effectiveness analysis, risk factors \n \n\n\n\n\n\n\n\nBACKGROUND \nOver the years, the life expectancy of the Malaysian population has increased and coupled with the \n\n\n\nadoption of western lifestyle, the prevalence of cardiovascular risk factors has also increased[1-2]. \n\n\n\nThis increased resulted in an increased in the prevalence of cardiovascular (CV) and its related \n\n\n\ndiseases[3]. Cardiovascular and its related diseases required long-term medical treatment. \n\n\n\n\n\n\n\nModification of risk factors (RFs) is crucial in order to curb the rise of CV disease. In Malaysia, \n\n\n\nnumerous CV prevention program has been initiated by various parties. These included the \n\n\n\nindividualized and community-wide strategies. Community-wide strategies are widely used but its \n\n\n\neffectiveness is questionable. Individualized counseling on RF modification provides personalized \n\n\n\ninformation to individuals and is believed to produce better outcome. However, the implementation in \n\n\n\nreal world scenario of such a program is questionable because individualized health promotion \n\n\n\nprogram is time, manpower and resources consuming.  \n\n\n\n\n\n\n\nThis health promotion program incorporated both behavioral and educational aspects of lifestyle \n\n\n\nmodification strategies, with an emphasis on the five modifiable RF. The aim of the health promotion \n\n\n\nprogram was to correct an array of cardiovascular risk factor behaviors simultaneously. The emphasis \n\n\n\nof this program was empowerment, which aimed to help participants to develop the knowledge, skills, \n\n\n\n\nmailto:siowyenliau@yahoo.com\n\n\n\n\n\n\nattitude and self-awareness required to take up the responsibility for their own health. The \n\n\n\nintervention program included stage-matched motivational and behavioral strategies based on the \n\n\n\nTranstheoretical Model (TTM). These were applied to the five modifiable RFs, namely smoking, \n\n\n\nunhealthy diet, excessive alcohol consumption, physical inactivity, and obesity and being overweight. \n\n\n\nIt was assumed that changes to a primary RF will bring positive changes to the secondary RF. \n\n\n\n\n\n\n\nIn Malaysia, public healthcare sector was heavily subsidized by the government. The rise in CV and \n\n\n\nits related diseases has dramatic impact on healthcare expenses as well as employees\u2019 absenteeism \n\n\n\nfrom work. With the limited resources for healthcare, priority setting is important to identify the \n\n\n\ntreatment (intervention) which gives maximum health gain within a limited budget. Thus evaluation \n\n\n\nof cost and benefit of a health promotion program can support decision-makers in effective budget \n\n\n\ndeployment. Moreover, the cost-effectiveness analysis of the health promotion program provided an \n\n\n\ninsight on the affordability of this program.  \n\n\n\n\n\n\n\nThe objective of this study was to compare the cost-effectiveness of a behavioral RF reduction \n\n\n\nprogram at the worksite versus health screening alone in achieving the ideal target for five primary \n\n\n\ncardiovascular risk factors. \n\n\n\n\n\n\n\nMETHODOLOGY \nThis was a quasi-experimental study carried out from October 2009 to July 2010 at Universiti  Sains \n\n\n\nMalaysia (USM). Participants for the intervention and control group were recruited among the \n\n\n\nemployees of Engineering Campus and main campus of USM respectively.  \n\n\n\n\n\n\n\nThis prospective lifestyle interventional study targeted five primary RF namely smoking, excessive \n\n\n\nalcohol consumption, physical inactivity, inadequate fruit and vegetable intake and \n\n\n\noverweight/obesity. Participants in the intervention group were required to attend scheduled \n\n\n\nindividualized counseling and seminars during the 6-month follow-up. Individualized counseling was \n\n\n\nbased on a standardized and validated (using Delphi method) counseling protocol. The frequencies of \n\n\n\nthe individualized counseling sessions were bimonthly for the first month and monthly thereafter. \n\n\n\nTwo seminars were held during the 6-month program targeted on the two main RF i.e. physical \n\n\n\ninactivity and unhealthy diet. The health educator was trained on providing counseling on RF \n\n\n\nmanagement based on the TTM and motivational interviewing principles. Control group participants \n\n\n\nunderwent health screening and the results of this health screening were mailed to them within one \n\n\n\nweek. No involuntary changes were made to their lifestyle. Figure 1 display the flow of the study. \n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\nFigure 1: Flow of the study \n\n\n\n \nParticipants for both the intervention and control group fulfilled pre-set inclusion and exclusion \n\n\n\ncriteria prior to enrollment into the study. The inclusion criteria were no previous CV disease/events \n\n\n\nand not currently on medication for treatment of hypertension, diabetes or dyslipidemia. Participants \n\n\n\nshould have at least one cardiovascular risk factor. Employees who were pregnant, history of severe \n\n\n\nrenal or liver disease and who were currently enrolled in any other lifestyle changes program were \n\n\n\nexcluded from this study.  \n\n\n\n\n\n\n\nData on current RF status were collected using the WHO STEPS instrument for chronic disease risk \n\n\n\nfactors surveillance questionnaires[4]. Behavioral RF status was self-reported. The same instruments \n\n\n\nand measurements were used throughout the study to reduce variability between the instruments and \n\n\n\nmeasurements made for the various obesity indexes. Physical measurements made included height, \n\n\n\nweight and waist circumference (WC). Height and weight were measured using a stadiometer. Waist \n\n\n\ncircumference was measured using a fiberglass measuring tape taken between the inferior margin of \n\n\n\nthe last rib and the crest of the ilium in a horizontal plane. Hip circumference measurement was taken \n\n\n\naround the pelvis at the point of maximal protrusion of the buttocks while patient stand with feet 25 \n\n\n\ncm to 30 cm apart with weight evenly distributed[5].  \n\n\n\n\n\n\n\n\n\n\n\nUSM \n\n\n\nControl Intervention \n\n\n\nBaseline \n\n\n\nevaluation (n=69) \n\n\n\n3-months \n\n\n\nevaluation (n=53) \n\n\n\n6-months \n\n\n\nevaluation (n=54) \n\n\n\nBaseline \n\n\n\nevaluation (n=67) \n\n\n\nMonthly individualized counseling (based on \n\n\n\nvalidated counseling protocol) by principal \n\n\n\ninvestigator (30-45 min per session) \n\n\n\n6-months \n\n\n\nevaluation (n=54) \n\n\n\nMonthly individualized counseling \n\n\n\nHealthy eating seminar \n\n\n\nby dietician (1.5hr)  \n\n\n\nResults of \n\n\n\nscreening \n\n\n\n(baseline) \n\n\n\nmailed to \n\n\n\nparticipants   \n\n\n\nPhysical activity seminar by \n\n\n\nacademician (1.5 hr)  \n\n\n\n\n\n\n\n\nCost-effectiveness analysis was conducted from the perspective of the university, as payer of \n\n\n\nhealthcare for its employees. Both direct and absenteeism costs were included in the costing analysis. \n\n\n\nResearch-related costs were excluded from the analysis. These included cost for awareness program \n\n\n\nand incentives paid to the participants. Costs of hospital admission and medications were also \n\n\n\nexcluded in the analysis because analysis was done until the day the participants were admitted for \n\n\n\nany CV events or started on medications. Micro-costing was carried out wherever possible. In cases \n\n\n\nwhere micro-costing cannot be done, expert opinion of panel or the closet estimates were used[6]. \n\n\n\n\n\n\n\nResource consumed in health and productivity sector were accounted in the cost as follows (Table 1). \n\n\n\nThe costs of the building (or space) and equipment used during the intervention were annuitized over \n\n\n\nthe useful life of the building (or space) and equipment which was estimated to be between 5 and 20 \n\n\n\nyears at a 5% discount rate. It was assumed that there was no resale value for the equipment after the \n\n\n\nuseful life of the equipment. The estimated \u2018equivalent annual cost\u2019 (EAC) was derived by taking into \n\n\n\naccount the depreciation aspect and the opportunity cost aspect of the capital cost. The costs and \n\n\n\noutcomes of the intervention program were not discounted because only 6-month outcomes were \n\n\n\ntaken into consideration during analysis.  \n\n\n\n\n\n\n\nTable 1. Resource consumed for the behavioral risk factor reduction program at the worksite. \n\n\n\nMeasure Cost  Data source \n\n\n\nActivity 1: Counseling by health educator \n\n\n\nCounseling and \n\n\n\nscreening by \n\n\n\nhealth educator \n\n\n\nDuration of counseling and \n\n\n\nscreening \n\n\n\nDetail recorded during study period. \n\n\n\nSalary of health educator \n\n\n\n(pharmacist) \n\n\n\nBased on Ministry of Health starting salary (excluding \n\n\n\nallowances) for pharmacist (Grade P1T4).  \n\n\n\nSpace for \n\n\n\ncounseling \n\n\n\nBuilding cost  Data obtained from university\u2019s Development Department. \n\n\n\nThe cost was reported as cost per square feet. \n\n\n\nUseful life years Estimated to be 20 years. \n\n\n\nDiscount rate Estimated to be 5%. \n\n\n\nAnnual maintenance Data obtained from Faber Medi Serve cleansing and linen \n\n\n\nservices for Duchess of Kent Hospital, Sandakan, Sabah. The \n\n\n\ncost was divided by two (assuming cost of cleansing and \n\n\n\nlinen services were equally distributed). The cost was \n\n\n\nreported as cost per square feet. \n\n\n\nUtilities Data obtained from monthly electricity bill for Duchess of \n\n\n\nKent Hospital, Sandakan, Sabah. The cost was reported as \n\n\n\ncost per square feet. \n\n\n\nEquipment Purchase price for electronic \n\n\n\nblood pressure machine, \n\n\n\nmeasuring tape, laptop, \n\n\n\nprinter, tables and chairs \n\n\n\nActual acquisition price. \n\n\n\nPurchase price for table, chair Government tender price. \n\n\n\nResale value Assume to be nil at the end of useful life years. \n\n\n\nUseful life years  5 years except for table (10 years)  \n\n\n\nDiscount rate  5%. \n\n\n\n \nMeasure Cost  Data source \n\n\n\nCounseling \n\n\n\nmaterial \n\n\n\nRoad to healthy heart booklet Actual printing cost. \n\n\n\nStationeries (papers and pens) Actual acquisition price. \n\n\n\nPrinting of forms Actual printing cost. \n\n\n\nLaboratory tests Fasting blood glucose and full \n\n\n\nlipid profile \n\n\n\nAverage price quoted by Pro Medic Laboratory Sdn. Bhd. \n\n\n\nOthers Toner for printer Actual acquisition price. \n\n\n\nActivity 2: Seminars \n\n\n\nSpace  Seminar room, utility, one tea \n\n\n\nbreak, audio-visual \n\n\n\nequipment, tables and chairs \n\n\n\nPrice quoted by USAINS Group of Companies for \n\n\n\nconducting seminar. \n\n\n\n\n\n\n\n\nHonorarium for \n\n\n\nspeakers \n\n\n\nTwo speakers Actual amount paid. \n\n\n\nActivity 3: Training of health educator \n\n\n\nSpace  Seminar room, utility, one tea \n\n\n\nbreak, audio-visual \n\n\n\nequipment, tables and chairs \n\n\n\nPrice quoted by USAINS Group of Companies for \n\n\n\nconducting seminar. \n\n\n\nHonorarium  Five speakers Actual amount paid. \n\n\n\nTraveling \n\n\n\nexpenses for \n\n\n\nspeaker \n\n\n\nTaxi fare for airport transfer \n\n\n\nand air fare  \n\n\n\nActual amount paid. \n\n\n\nActivity 4: Loss of productivity \n\n\n\nLoss of \n\n\n\nproductivity \n\n\n\nAbsenteeism from work Number of days absent from work and salary of the \n\n\n\nadministrative clerk.  \n\n\n\n\n\n\n\n \nThe costs of the intervention and control group were summed based on the following equation. \n\n\n\n\n\n\n\nAverage total cost per participant = Average variable cost + Average fixed cost \n\n\n\n\n\n\n\n\n\n\n\nAverage variable cost = \u2211 cost of program per participanti / number of participants \n\n\n\n\n\n\n\n= (\u2211 cost of counselingi / number of participants) + counseling material + [\u2211 \n\n\n\n(laboratory charges x number of testi) / number of participants)] + [\u2211 \n\n\n\n(participant daily salary x days of medical sick leavei) / number of \n\n\n\nparticipants)] \n\n\n\n\n\n\n\n= [\u2211 (cost of health educator per minute + cost of space per minute + cost of \n\n\n\nmaintenance per minute + cost of electricity per minute + cost of \n\n\n\nequipment per minute) x duration of counselingi/ number of \n\n\n\nparticipants] + counseling material + [\u2211 (laboratory charges x \n\n\n\nnumber of testi) / number of participants)] + [\u2211 (participant daily \n\n\n\nsalary x days of medical sick leavei) / number of participants)] \n\n\n\n\n\n\n\nAverage fixed cost  = \u2211 (cost for stationeries + printing charges + seminars + training) / number \n\n\n\nof participants \n\n\n\n\n\n\n\nOne-way sensitivity analysis was conducted by varying the cost of three parameters to test the \n\n\n\nrobustness of the results obtained. These parameters were the salary of health educators, the salary of \n\n\n\nthe participants and cost of renting of seminar room. These parameters were chosen due to the \n\n\n\nestimated costs used in the initial evaluation. In this study, the intervention was conducted by a \n\n\n\npharmacist. However, other healthcare professionals who frequently conduct such programs are \n\n\n\nmedical officers, dieticians or nurses. Therefore, the health educator\u2019s salary was varied between the \n\n\n\nhighest and the lowest salary of these professions, based on the starting salary as quoted by the Public \n\n\n\nService Department, Malaysia. Secondly, the cost of the medical sick leave of the base case analysis \n\n\n\nwas calculated based on the salary of an administrative clerk, which was the occupation of the \n\n\n\nmajority of the participants. However, there were participants of other occupation groups in this \n\n\n\nprogram. Therefore, the highest and the lowest salary of these professions were used in the sensitivity \n\n\n\nanalysis. Finally, the cost of the seminar room and tea break can vary depending on the place \n\n\n\noccupied and the food ordered.  \n\n\n\n\n\n\n\nThe primary outcome measure was to examine the intervention effects in terms of the prevalence of \n\n\n\nindividuals meeting healthy lifestyle recommendations after intervention. Given that there are four \n\n\n\nprimary outcome measures, a range of sample-size estimates based on the intervention effects \n\n\n\nobtained from previous studies was calculated. The required sample size was calculated using the \n\n\n\n \n\n\n\n\n\n\n\n\nformula for finding the sample size for studies about proportions in two groups assuming a Type I \n\n\n\nerror of 0.05 and a power of 80%[7].  \n\n\n\n\n\n\n\nIt was assumed that the achievement of fruit and vegetable intake in the intervention group was 33.0% \n\n\n\nas compared with 13.0% in the control group; physical activity was 90.0% in the intervention group \n\n\n\nas compared with 71.0% in the control group[7]; smoking cessation rates were 17.0% for the \n\n\n\nintervention group as compared with 2.3% in the control group[8] and a higher compliance with \n\n\n\nrecommendations for the control group (30.0% vs 26.0%) was reported for alcohol consumption[7]. \n\n\n\nAfter taking into considerations a 20% drop-out rate, the required sample size was between 58 and \n\n\n\n118 in each group. \n\n\n\n\n\n\n\nPre-determined criterion to define whether a change has successfully reach its target or not, were \n\n\n\nbased on the targets adopted from the Malaysian clinical practice guidelines[5, 9-14]. The outcome \n\n\n\nmeasure for this study was the cost per 1% increase in proportion of participants who reach the ideal \n\n\n\ntargets for the RF. Approval from the Joint Ethics Committee of the School of Pharmaceutical \n\n\n\nSciences, USM-Lam Wah Ee Hospital was obtained prior to the commencement of the study. \n\n\n\n\n\n\n\nAll data were analyzed using statistical software SPSS package version-16. A two-tailed P-value \uf03c \n\n\n\n0.05 was considered statistically significant. Baseline sociodemographic and RF characteristics \n\n\n\nbetween intervention and control groups were reported using simple descriptive statistics. Continuous \n\n\n\nvariables were expressed in mean and standard deviation or median and inter-quartile range for \n\n\n\ncontinuous variables. Discrete variables were expressed in proportion. Differences in the proportion \n\n\n\nof participants reaching target for each RF were compared using chi square test (or Fisher exact test).  \n\n\n\n\n\n\n\nRESULTS \nA total 136 participants were recruited into the study with 69 participants (50.7%) in the intervention \n\n\n\ngroup and 67 participants (49.3%) in the control group. At 6-month follow-up, 78.3% (n = 54) and \n\n\n\n91.1% (n = 61) of the participants completed final evaluation. Majority of the participants were \n\n\n\nfemale and of Malay ethnic origin. The mean age was 36.92 (SD = 9.14) years. There was no \n\n\n\nsignificant difference between intervention and control group in terms of sex and ethnicity. \n\n\n\n\n\n\n\nThe RFs were categorized into reaching target and not reaching target and were compared between \n\n\n\nintervention and control groups (Table 2). At baseline, there was no significant difference in the \n\n\n\nproportion of participants reaching the target for any of the RF. However, at 6-month follow-up, \n\n\n\nsignificantly higher proportion of participants in the intervention group reached the target for fruit and \n\n\n\nvegetable intake (P \uf03c 0.001) and physical activity (P = 0.017).  \n\n\n\n\n\n\n\nA total of 69 participants in the intervention group were entered into the analyses. The cost of the \n\n\n\nintervention program was estimated to be MYR304.52 (USD92.28) per participant.  \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nTable 2. Comparison of proportion of participants reaching risk factors target \n\n\n\nRisk factor Group Baseline \n\n\n\n(n, %) \n\n\n\nP-value 3-month \n\n\n\n(n, %) \n\n\n\nP-\n\n\n\nvalue \n\n\n\n6-month \n\n\n\n(n, %) \n\n\n\nP-\n\n\n\nvalue \n\n\n\n  Yes No  Yes No  Yes No  \n\n\n\nSmoking  Int 65 \n\n\n\n(94.2) \n\n\n\n4  \n\n\n\n(5.8) \n\n\n\n0.743\nb\n 50 \n\n\n\n(94.3) \n\n\n\n3 \n\n\n\n(5.7) \n\n\n\n- 52 \n\n\n\n(96.3) \n\n\n\n2 \n\n\n\n(3.7) \n\n\n\n0.683\nb\n \n\n\n\nControl  62 \n\n\n\n(92.5) \n\n\n\n5  \n\n\n\n(7.5) \n\n\n\n  57 \n\n\n\n(93.4) \n\n\n\n4 \n\n\n\n(6.6) \n\n\n\nAlcohol \n\n\n\nconsumption \n\n\n\nInt 67 \n\n\n\n(97.1) \n\n\n\n2  \n\n\n\n(2.9) \n\n\n\n1.000\nb\n 51 \n\n\n\n(96.2) \n\n\n\n2 \n\n\n\n(3.8) \n\n\n\n- 52 \n\n\n\n(96.3) \n\n\n\n2 \n\n\n\n(3.7) \n\n\n\n0.218\nb\n \n\n\n\nControl  66 \n\n\n\n(98.5) \n\n\n\n1  \n\n\n\n(1.5) \n\n\n\n  61 \n\n\n\n(100.0) \n\n\n\n0 \n\n\n\n(0) \n\n\n\nFruit and \n\n\n\nvegetable intake \n\n\n\nInt 3 \n\n\n\n(4.3) \n\n\n\n66 \n\n\n\n(95.7) \n\n\n\n0.322\nb\n 11 \n\n\n\n(20.8) \n\n\n\n42 \n\n\n\n(79.2) \n\n\n\n- 19 \n\n\n\n(35.2) \n\n\n\n35 \n\n\n\n(64.8) \n\uf03c0.001\n\n\n\na\n \n\n\n\nControl  6 \n\n\n\n(9.0) \n\n\n\n61 \n\n\n\n(91.0) \n\n\n\n  5 \n\n\n\n(8.2) \n\n\n\n56 \n\n\n\n(91.8) \n\n\n\nPhysical activity Int 13 \n\n\n\n(18.8) \n\n\n\n56 \n\n\n\n(81.2) \n\n\n\n0.096\na\n 13 \n\n\n\n(24.5) \n\n\n\n40 \n\n\n\n(75.5) \n\n\n\n- 13 \n\n\n\n(24.5) \n\n\n\n40 \n\n\n\n(75.5) \n\n\n\n0.017\na\n \n\n\n\nControl  6 \n\n\n\n(9.0) \n\n\n\n61 \n\n\n\n(91.0) \n\n\n\n  5 \n\n\n\n(8.2) \n\n\n\n56 \n\n\n\n(91.8) \n\n\n\nBody mass \n\n\n\nindex \n\n\n\nInt 23 \n\n\n\n(33.3) \n\n\n\n46 \n\n\n\n(66.7) \n\n\n\n0.308\na\n 18 \n\n\n\n(34.0) \n\n\n\n35 \n\n\n\n(66.0) \n\n\n\n- 20 \n\n\n\n(37.0) \n\n\n\n34 \n\n\n\n(63.0) \n\n\n\n0.503\na\n \n\n\n\nControl  17 \n\n\n\n(25.4) \n\n\n\n50 \n\n\n\n(74.6) \n\n\n\n  18 \n\n\n\n(31.0) \n\n\n\n40 \n\n\n\n(69.0) \n\n\n\nWaist \n\n\n\ncircumference \n\n\n\nInt 33 \n\n\n\n(47.8) \n\n\n\n36 \n\n\n\n(52.2) \n\n\n\n0.081\na\n 35 \n\n\n\n(66.0) \n\n\n\n18 \n\n\n\n(34.0) \n\n\n\n- 29 \n\n\n\n(54.7) \n\n\n\n24 \n\n\n\n(45.3) \n\n\n\n0.089\na\n \n\n\n\nControl  42 \n\n\n\n(62.7) \n\n\n\n25 \n\n\n\n(37.3) \n\n\n\n  31 \n\n\n\n(53.4) \n\n\n\n27 \n\n\n\n(46.6) \n\n\n\nWaist-hip ratio Int 53 \n\n\n\n(76.8) \n\n\n\n16 \n\n\n\n(23.2) \n\n\n\n0.747\na\n 48 \n\n\n\n(90.6) \n\n\n\n5 \n\n\n\n(9.4) \n\n\n\n- 47 \n\n\n\n(88.7) \n\n\n\n6 \n\n\n\n(11.3) \n\n\n\n0.181\na\n \n\n\n\nControl  53 \n\n\n\n(79.1) \n\n\n\n14 \n\n\n\n(20.9) \n\n\n\n  46 \n\n\n\n(79.3) \n\n\n\n12 \n\n\n\n(20.7) \n\n\n\n\u03b1 value = 0.05; \na\n chi square; \n\n\n\nb\n Fisher Exact test; Int = intervention;  \n\n\n\n\n\n\n\nSimilar estimation and calculation was used to calculate the cost of the control group. The time spent \n\n\n\non screening for baseline and 6-month evaluation was taken into consideration of cost calculation. \n\n\n\nSince no active intervention was provided to the control group, laptop and printer were considered not \n\n\n\nutilized by this group of participant. They were also not provided with the counseling material and \n\n\n\ntherefore its cost was excluded from this analysis for the control group. It was estimated that the \n\n\n\nscreening of the control group used up one ream of A4 paper and one pen with a total cost of \n\n\n\nMYR18.50. The printing cost over the 6-month was MYR356.00 (108 pages for 66 participants at \n\n\n\nMYR0.05 per page). The cost of seminars and training of health educator was also excluded from this \n\n\n\nanalysis. Initially there were 67 participants in the control group. However, three of the participants \n\n\n\nwere transferred to another institution and data on their medical sick leave and 6-month evaluation \n\n\n\nwere not available. Therefore, they were excluded from these analyses giving a total of 64 participants \n\n\n\nin the control group. The cost of screening for the control group was estimated to be MYR169.90 \n\n\n\n(USD51.48) per participant. Therefore, the differences in cost between intervention and control group \n\n\n\nparticipant was MYR134.62 (USD40.79) per participant.  \n\n\n\n\n\n\n\nCost-effectiveness Analysis of Proportion of Participants Reaching Risk Factors Target \n\n\n\nThe summary of the cost-effectiveness ratio (CER) and incremental cost-effectiveness ratio (ICER) \n\n\n\nfor the proportion of participants reaching target for each RF was presented in Table 3. Cost-\n\n\n\neffectiveness ratio provides information on the cost of 1% increase in the proportion of participants \n\n\n\nreaching target for each RF. It can be seen that within the intervention group, alcohol consumption \n\n\n\nworsen with a negative CER. Similarly, three RFs (fruit and vegetable intake, physical activity and \n\n\n\nWC) produced negative CER for the control group.   \n\n\n\n \n\n\n\n\n\n\n\n\nTable 3. Cost-effectiveness ratio and incremental cost-effectiveness ratio for proportion of \n\n\n\nparticipants reaching target for each risk factor \n\n\n\n Intervention Control  \n\n\n\n Baseline \n\n\n\n(a) (%) \n\n\n\n6-\n\n\n\nmonth \n\n\n\n(b) \n\n\n\n(%) \n\n\n\n(b) \u2013 \n\n\n\n(a) \n\n\n\nCER Baseline \n\n\n\n(a) (%) \n\n\n\n6-\n\n\n\nmonth \n\n\n\n(b) \n\n\n\n(%) \n\n\n\n(b) \u2013 \n\n\n\n(a) \n\n\n\nCER ICER \n\n\n\nSmoking   94.2 96.3 2.1 14,500.95 92.5 93.4 0.9 18,877.78 11,218.33 \n\n\n\nAlcohol \n\n\n\nconsumption  \n\n\n\n97.1 96.3 -0.8 -38,065.00 98.5 100.0 1.5 11,326.67 CD \n\n\n\nFruit and \n\n\n\nvegetable \n\n\n\nintake \n\n\n\n4.3 35.2 30.9 985.50 9.0 8.2 -0.8 -\n\n\n\n21,237.50 \n\n\n\n424.67 \n\n\n\nPhysical \n\n\n\nactivity \n\n\n\n18.8 24.5 5.7 5342.46 9.0 8.2 -0.8 -\n\n\n\n21,237.50 \n\n\n\n2071.08 \n\n\n\nBody mass \n\n\n\nindex \n\n\n\n33.3 37.0 3.7 8230.27 25.4 31.0 5.6 3033.93 CD \n\n\n\nWaist \n\n\n\ncircumference \n\n\n\n47.8 54.7 6.9 4413.33 62.7 53.4 -9.3 -1826.88 830.99 \n\n\n\nWaist-hip \n\n\n\nratio \n\n\n\n76.8 88.7 11.9 2558.99 79.1 79.3 0.2 84,950.00 1150.60 \n\n\n\nCD = control dominant; CER = cost-effectiveness ratio; ICER = incremental cost-effectiveness ratio \n\n\n\n\n\n\n\nIncremental cost-effectiveness ratio is defined as the ratio of change in cost of an intervention as \n\n\n\ncompared to the control group to the change in outcomes between the two groups[15]. A negative \n\n\n\nratio indicated that the control group was dominant in increasing the proportion of participants \n\n\n\nreaching target. This was seen with body mass index (BMI) and alcohol consumption. \n\n\n\n\n\n\n\nSensitivity analyses were conducted to test the robustness of the cost-effectiveness model. Three \n\n\n\nparameters were varied between their maximum and minimum values. These were the salary of the \n\n\n\nhealth educator, salary of participants for productivity cost estimation and cost of conducting \n\n\n\nseminars.  \n\n\n\n\n\n\n\nThe cost per participant for the intervention and control groups was recalculated based on the \n\n\n\nvariation of the pre-set parameters in the sensitivity analysis. The incremental costs vary from -\n\n\n\nMYR79.57 (USD24.11) (cost per participant in the control group higher than intervention group) to \n\n\n\nMYR144.49 (USD43.78). This was summarized in Table 4. \n\n\n\n\n\n\n\n\n\n\n\nTable 4. Cost of the program (intervention and control) during sensitivity analysis \n\n\n\n Cost of program / per \n\n\n\nparticipant \n\n\n\n(Intervention) (MYR) \n\n\n\nCost of program \n\n\n\nper participant \n\n\n\n(Control) (MYR) \n\n\n\nIncremental cost \n\n\n\n(intervention \u2013 \n\n\n\ncontrol) (MYR) \n\n\n\nBase case analysis 304.52 169.90 134.62 \n\n\n\nSensitivity analysis 1: health educator \n\n\n\nsalary maximum \n\n\n\n308.47 171.02 137.45 \n\n\n\nSensitivity analysis 2: health educator \n\n\n\nsalary minimum \n\n\n\n288.36 165.28 123.08 \n\n\n\nSensitivity analysis 3: participant \n\n\n\nsalary maximum (for estimation of \n\n\n\nabsenteeism) \n\n\n\n482.76 562.33 -79.57 \n\n\n\nSensitivity analysis 4: participant \n\n\n\nsalary minimum (for estimation of \n\n\n\nabsenteeism) \n\n\n\n296.33 151.84 144.49 \n\n\n\nSensitivity analysis 5: seminar cost \n\n\n\nmaximum \n\n\n\n314.53 169.90 144.63 \n\n\n\n\n\n\n\n\nSensitivity analysis 6: seminar cost \n\n\n\nminimum \n\n\n\n294.53 169.90 124.63 \n\n\n\n\n\n\n\nCost-effectiveness ratio and ICER were calculated for each RF and for each of the parameters which \n\n\n\nwas included in the sensitivity analysis. Subsequently, the percentage change from the base case \n\n\n\nanalysis in the ICER was calculated.  \n\n\n\n\n\n\n\nThe sensitivity of the change in parameters varied. Although the cost of the health educator made up \n\n\n\nof 18% of the total cost of the program, varying this cost to the medical officer\u2019s salary did not affect \n\n\n\nthe results as much as varying it to the salary of the staff nurse. Hence employing staff nurse to \n\n\n\nconduct the intervention is more cost-effective. Secondly, varying the cost of the rental for the \n\n\n\nseminar room did not have much effect on the ICER. In contrast, varying the participants\u2019 salary \n\n\n\nbetween the minimum (salary of general worker) and maximum (lecturer) have tremendous effect on \n\n\n\nthe ICER. This salary was used to calculate the cost of medical sick leave taken by the participants. \n\n\n\nThere was more than 150% change when the participants\u2019 salary was adjusted to the maximum, in \n\n\n\nfavor of the intervention group. When the salary was adjusted to the minimum, the cost difference \n\n\n\nincreased from base case analysis resulting in an increased in percentage change in ICER. This can be \n\n\n\nobserved from the tornado diagram as presented in Figure 2.  \n\n\n\n\n\n\n\n\n\n\n\nFigure 2: Tornado diagram of the percentage change in ICER for proportion of participants reaching \n\n\n\nRF target \n\n\n\n\n\n\n\nSimilarly, ICER was recalculated by varying the two main outcomes, namely physical activity and \n\n\n\nadequate fruit and vegetable intake. It was found that by varying proportion of participants achieving \n\n\n\ntarget RF, the ICER achieved was still less than MYR30,000. \n\n\n\n-8.57 \n\n\n\n-7.42 \n\n\n\n7.33 \n\n\n\n2.10 \n\n\n\n7.44 \n\n\n\n-159.11 \n\n\n\n-180 -160 -140 -120 -100 -80 -60 -40 -20 0 20\n\n\n\nPercentage change in ICER \n\n\n\nP\na\n\n\n\nra\nm\n\n\n\ne\nte\n\n\n\nrs\n v\n\n\n\na\nri\n\n\n\ne\nd\n\n\n\n\n\n\n\nminimum maximum\n\n\n\nParticipant's salary \n\n\n\nCost of seminar \n\n\n\nHealth educator \n\n\n\n\n\n\n\n\nDiscussion \nThe aim of this study was to conduct cost-effectiveness analysis on the effect of a worksite health \n\n\n\npromotion program on achieving RF targets. Significant improvement of the intervention on the \n\n\n\nproportion of participants reaching the targets was found in fruit and vegetable intake and physical \n\n\n\nactivity. Most of the studies reviewed reported significant higher proportion of participants in the \n\n\n\nintervention groups meeting the target for physical activity and fruit and vegetable intake except for \n\n\n\nstudies reported by Jimmy et al. (2005) (physical activity) and Hardcastle et al. (2008) (fruit and \n\n\n\nvegetable intake)[7, 16-19].  \n\n\n\n\n\n\n\nThe effect of health promotion program on the prevalence of smoking was not consistent. Our study \n\n\n\nreported no significant difference between the two groups. This was supported by studies reported \n\n\n\nelsewhere[18, 20-24]. However, the numbers of smokers might be too small to detect any differences \n\n\n\nduring analyses. \n\n\n\n\n\n\n\nThe intervention program was more costly than the control, with a differential cost of MYR134.62 \n\n\n\n(USD40.79) per participant in six months. The differential costs between health promotion program \n\n\n\nand screening along differed widely in existing studies, depending on the duration, intensity and type \n\n\n\nof intervention. It ranged from USD41.09 to EUR430 (USD612.42)[25-27]. \n\n\n\n\n\n\n\nIt is not feasible to compare the CER and ICER calculated from this study to the studies reported \n\n\n\nelsewhere. Most of the studies had modeled the effect of the intervention to final outcomes such as \n\n\n\nlife-years gained and quality-adjusted life years.  \n\n\n\n\n\n\n\nThe ICER of the various obesity indexes produced different results. The disproportionate achievement \n\n\n\nof target RF between BMI, WC and waist-hip ratio (WHR) between intervention and control group \n\n\n\nwas unexpected and was not supported by the studies reviewed. A reduction in body weight is \n\n\n\nfrequently reported to correspond with reduction in abdominal obesity (reported as WC and \n\n\n\nWHR)[28-30]. The only exception was a study by Hassan et al. (2011) which reported a significant \n\n\n\nreduction in WC and hip circumference but not BMI after a 6-month program targeted on diet and \n\n\n\nindividualized physical activity[31].  \n\n\n\n\n\n\n\nDespite the negative ICER for alcohol consumption, the number of participants who achieved targets \n\n\n\nfor alcohol consumption was too small to make any general conclusion on the effect of the program. \n\n\n\n\n\n\n\nThe other RF consistently showed positive ICER for both the outcomes. The calculated ICER were \n\n\n\nmuch lower than the World Health Organization recommendation based on the CHOICE analyses for \n\n\n\nrelative cost-effectiveness of an intervention, whereby an ICER of less than MYR30,000 \n\n\n\n(USD9090.91) is considered cost-effectiveness for public policy intervention in Malaysia[32]. \n\n\n\n\n\n\n\nA review of the literature found numerous economic evaluation which reported positive results from \n\n\n\nthe intervention (including worksite intervention). Smoking cessation program which utilized \n\n\n\nremuneration or nicotine-replacement therapy was more cost-effective than usual counseling \n\n\n\nalone[33]. Sevick et al. (2000) reported the cost-effectiveness of lifestyle intervention as compared \n\n\n\nwith structured program in terms of physical activity, BP and weight[34]. In 2007, Sevick et al (2007) \n\n\n\nreported that it was more cost effective to use printed letters than phone to improve physical activity \n\n\n\nlevel[35]. However, other studies also reported no superiority of intervention on the economic \n\n\n\noutcomes on the RFs[27, 36]. Almost all of the economic evaluation of worksite intervention program \n\n\n\nreported in reduction in absenteeism[27, 37-38]. \n\n\n\n\n\n\n\nThe sensitivity analyses showed that the ICER was most resistant to change in the cost of seminar \n\n\n\n(both minimizing and maximizing the cost) and also maximizing the salary of the health educator. In \n\n\n\ncontrast, the ICER was most sensitive to the participant\u2019s salary, whereby the maximum possible \n\n\n\nsalary resulted in approximately 150% change in ICER as compared to the base case model. These \n\n\n\nresults showed that it is possible to further improve the incremental cost of CER by utilizing a staff \n\n\n\n\n\n\n\n\nnurse trained in conducting this program. Training should be emphasizing in order to ensure \n\n\n\nstandardization of counseling given. More importantly, the sensitivity analyses results also showed \n\n\n\nthat salary of the participants greatly impact the ICER. The participants\u2019 salary in the base model was \n\n\n\nbased on the salary of an administrative clerk. This salary was used to calculate the cost of medical \n\n\n\nsick leave. This can be explained by the fact that the number of medical sick leave days taken by the \n\n\n\nparticipants in the intervention group (n = 1.03 days) was lower than the control group (n = 2.27 days) \n\n\n\neven though this difference did not reach statistical significance (Mann-Whitney test, P = 0.175). A \n\n\n\npublic university consisted of several positions with different salary scheme. If this program is \n\n\n\nconducted in a large scale, involving large number of participants, it is expected to be more cost-\n\n\n\neffective. \n\n\n\n\n\n\n\nThe results from this analysis have to be taken with some caution. This study looked into the \n\n\n\nintermediate outcomes related to the individual RF. Despite not addressing the mortality and \n\n\n\nmorbidity over lifetime, these intermediate outcomes (behavioral changes) were deemed clinically \n\n\n\nrelevant. Numerous studies have reported the correlation between these intermediate outcomes and \n\n\n\nmortality and morbidity[15]. Furthermore, the behavioral RF status was self-reported and is subjected \n\n\n\nto recall bias. Moreover, participation in the program is voluntary and non-random. Therefore, it was \n\n\n\nexpected participants with higher intention to change was enrolled in the program. \n\n\n\n\n\n\n\n\n\n\n\nCONCLUSIONS \n\n\n\nIn conclusion, this program was shown to be cost-effective in modifying most of the behavioral RF, \n\n\n\nmost notable physical activity and fruit and vegetable intake. Cost-effectiveness of the program would \n\n\n\nbe increased with recruitment of high-risk individuals with higher baseline risk. Secondly, by \n\n\n\nrecruiting a higher number of participants into the program, the cost of the intervention can be \n\n\n\nreduced. As such it is recommended that this program be extended throughout the worksite \n\n\n\nparticularly targeted at high-risk individuals. \n\n\n\n\n\n\n\n\n\n\n\nCONFLICT OF INTEREST \nThe authors declared no conflict of interest in conducting and writing this research.  \n\n\n\n\n\n\n\nACKNOWLEDGEMENT \nI would like to thank the staff from the Health Unit of Engineering Campus, USM for their continuous \n\n\n\nsupport during the course of this study. This research was financially supported by Universiti  Sains \n\n\n\nMalaysia Research University [1001/PFARMASI/813018]; and Healthy Campus Grant 2008. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nREFERENCES \n1. Ministry of Health. MyNCDS-1 report.  Putrajaya: Ministry of Health, Malaysia; 2007 [cited \n\n\n\n2008 30 January ]; Available from: www.dph.gov.my/ncd/surveillance/index. \n\n\n\n2. 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AHA dietary guidelines: revision 2000: a statement for \n\n\n\nhealthcare professionals from the Nutrition Committee of the American Heart Association. \n\n\n\nCirculation. 2000;102:2284-99. \n\n\n\n10. Grundy SM, Becker D, Clark LT, et al. Third report of the National Cholesterol Education \n\n\n\nProgram (NCEP) expert panel on detection, evaluation and treatment of high blood cholesterol in \n\n\n\nadults (Adult Treatment Panel III) panel report. Circulation. 2002;106:3143-421. \n\n\n\n11. Mahayiddin HA, Mazlan M, Bakar SA, et al. Clinical practice guidelines on treatment of tobacco \n\n\n\nuse and dependence 2003. Putrajaya: Ministry of Health Malaysia; 2003. \n\n\n\n12. Chan SP, Zain AZM, Ismail IS, et al. Clinical practice guidelines in the management of type 2 \n\n\n\ndiabetes mellitus. Third ed. Sivalal S, Jaudin R, editors. Putrajaya: Ministry of Health Malaysia, \n\n\n\nPersatuan Diabetes Malaysia, Academy of Medicine; 2004. \n\n\n\n13. Chobanian AV, Bakris GL, Black HR, et al. Seventh report of the Joint National Committee on \n\n\n\nprevention, detection, evaluation, and treatment of high blood pressure. Hypertension. \n\n\n\n2003;42:1206-52. \n\n\n\n14. Zambahari R, Jeyamalar R, Rahman ARBA, et al. Clinical practice guidelines on management of \n\n\n\ndyslipidemia. Putrajaya: Ministry of Health Malaysia, Academy of Medicine Malaysia, National \n\n\n\nHeart Association of Malaysia; 2004. \n\n\n\n15. Wagner T, Goldstein MK. Behavioral interventions and cost-effectiveness analysis. Prev Med. \n\n\n\n2004;39:1208-14. \n\n\n\n16. Oldroyd JC, Unwin NC, White M, et al. Randomised controlled trial evaluating the effectiveness \n\n\n\nof behavioural interventions to modify cardiovascular risk factors in men and women with \n\n\n\nimpaired glucose tolerance: outcomes at 6 months. Diabetes Res Clin Pract. 2001;52:29-43. \n\n\n\n17. Jimmy G, Martin BW. Implementation and effectiveness of a primary care based physical \n\n\n\nactivity counseling scheme. Patient Educ Couns. 2005;56:323-31. \n\n\n\n18. Wood DA, Kotseva K, Connolly S, et al. Nurse-coordinated multidisciplinary, family-based \n\n\n\ncardiovascular disease prevention programme (EUROACTION) for patients with coronary heart \n\n\n\ndisease and asymptomatic individuals at high risk of cardiovascular disease: a paired, cluster-\n\n\n\nrandomised controlled trial. Lancet. 2008;371:1999-2012. \n\n\n\n19. Hardcastle S, Taylor A, Bailey M, et al. A randomised controlled trial on the effectiveness of a \n\n\n\nprimary health care-based counselling intervention on physical activity, diet and CHD risk \n\n\n\nfactors. Patient Educ Couns. 2008;70:31-9. \n\n\n\n20. Kreuter MW, Strecher VJ. Do tailored behavior change messages enhance the effectiveness of \n\n\n\nhealth risk appraisal? Results from a randomized trial Health Educ Res. 1996;11:97-105. \n\n\n\n21. Glasgow RE, Terborg JR, Strycker LA, et al. Take Heart II: Replication of a worksite health \n\n\n\npromotion trial. J Behav Med. 1997;20:143-61. \n\n\n\n22. Sorensen G, Stoddard A, Hunt MK, et al. The effects of a health promotion-health protection \n\n\n\nintervention on behavior change: The WellWorks Study. Am J Public Health. 1998 November 1, \n\n\n\n1998;88(11):1685-90. \n\n\n\n23. Emmons K, Linnan LA, Shadel WG, et al. The Working Health Project: A worksite health-\n\n\n\npromotion trial targeting physical activity, diet and smoking. J Occup Environ Med. \n\n\n\n1999;41:545-55. \n\n\n\n24. Harting J, Assema Pv, Limpt Pv, et al. Cardiovascular prevention in the Hartslag-Limburg \n\n\n\nproject: effects of a high-risk approach on behavioral risk factors in a general practice population. \n\n\n\nPrev Med. 2006;43:372-8. \n\n\n\n25. Foote A, Erfurt JC. The benefit of cost ratio of work-site blood pressure control programs. J Am \n\n\n\nMed Assoc. 1991;265:1283-6. \n\n\n\n\n\n\n\n\n26. Pritchard DA, Hyndman J, Taba F. Nutritional counselling in general practice: a cost-\n\n\n\neffectiveness analysis. J Epidemiol Community Health. 1999;53:311-6. \n\n\n\n27. Proper KI, Bruyne MCd, Hildebrandt VH, et al. Costs, benefit and effectiveness of worksite \n\n\n\nphysical activity counseling from the employer's perspective. Scand J Work Environ Health \n\n\n\n2004;30(1):36-46. \n\n\n\n28. Leutholtz BC, Keyser RE, Heusner WW, et al. Exercise training and severe caloric restriction: \n\n\n\nEffect on lean body mass in the obese. Arch Phys Med Rehab. 1995;76(1):65-70. \n\n\n\n29. Slentz CA, Duscha BD, Johnson JL, et al. Effects of the amount of exercise on body weight, \n\n\n\nbody composition, and measures of central obesity: STRRIDE- A randomized controlled study. \n\n\n\nArch Intern Med. 2004 January 12, 2004;164(1):31-9. \n\n\n\n30. Jakicic JM. The effect of physical activity on body weight. Obesity. 2009;17(n3s):S34-S8. \n\n\n\n31. Hassan NE-M, Zak ST, El-Masry S, et al. Impact of balanced caloric diet and physical activity \n\n\n\non body composition and fat distribution of obese Egyptian adolescent girls Maced J Med Sci. \n\n\n\n2011;4:17-24. \n\n\n\n32. World Health Organization. CHOosing Interventions that are Cost Effective (WHO-CHOICE): \n\n\n\nCost-effectiveness thresholds.  Geneva: World Health Organization; 2005 [cited 2011 3rd April]; \n\n\n\nAvailable from: http://www.who.int/choice/costs/CER_thresholds/en/index.html. \n\n\n\n33. Salize HJ, Merkel S, Reinhard I, et al. Cost-effective primary care-based strategies to improve \n\n\n\nsmoking cessation: more value for money. Arch Intern Med. 2009 February 9, 2009;169:230-5. \n\n\n\n34. Sevick MA, Dunn AL, Morrow MS, et al. Cost-effectiveness of lifestyle and structured exercise \n\n\n\ninterventions in sedentary adults: Results of project ACTIVE. Am J Prev Med. [doi: DOI: \n\n\n\n10.1016/S0749-3797(00)00154-9]. 2000;19:1-8. \n\n\n\n35. Sevick MA, Napolitano MA, Papandonatos GD, et al. Cost-effectiveness of alternative \n\n\n\napproaches for motivating activity in sedentary adults: results of Project STRIDE. Prev Med. \n\n\n\n2007;45:54-61. \n\n\n\n36. Salkeld G, Phongsavan P, Oldenburg B, et al. The cost-effectiveness of a cardiovascular risk \n\n\n\nreduction program in general practice. Health Policy 1997;41(2):105-19. \n\n\n\n37. Bertera RL. The effects of workplace health promotion on absenteeism and employment costs in \n\n\n\na large industrial population. Am J Public Health. 1990;80(9):1101-5. \n\n\n\n38. Aldana SG, Merrill RM, Price K, et al. Financial impact of a comprehensive multisite workplace \n\n\n\nhealth promotion program. Prev Med. 2005;40:131-7. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\nhttp://www.who.int/choice/costs/CER_thresholds/en/index.html\n\n\n\n\n\n\n\n\n\n\nFormulation and Stability of Extemporaneously Prepared Morphine Oral \n\n\n\nSuspension  \n \n\n\n\nLian T. Chan*, Lucy Yeoh \n\n\n\n\n\n\n\nWinwa Medical Sdn Bhd, Bukit Mertajam, Pulau Pinang, Malaysia. \n\n\n\n\n\n\n\n* Contact for correspondence, please email: ltchan@winwamedical.com \n\n\n\n\n\n\n\n\n\n\n\nABSTRACT \n\n\n\n \nMorphine taken by mouth is an effective analgesic for most people with moderate or severe cancer \n\n\n\npain. Hospital pharmacists commonly prepare morphine oral liquid extemporaneously for cancer \n\n\n\npatients who require tube feeding or have difficulties in swallowing because it is not available \n\n\n\ncommercially in Malaysia. This study aims to provide the physical, chemical and microbiological \n\n\n\nstability data to determine the shelf-life and storage condition for the extemporaneous preparation of \n\n\n\nmorphine oral suspension (10mg/5ml) using X-Temp Oral Suspension System. The samples were \n\n\n\ndivided into 2 groups and were stored at 4\u00baC (refrigeration) and 30\u00baC / 75%RH (room temperature) \n\n\n\nprotected from light for 12 months. The physical, chemical and microbiological stability were \n\n\n\nexamined at the interval of months 0, 1, 2, 3, 4, 5, 6, 9 and 12. The content of morphine was \n\n\n\ndetermined using HPLC-UV method. The content of morphine remained above 95% of the original \n\n\n\nconcentration throughout the study period. The colour, clarity and odour remained fairly unchanged \n\n\n\nthroughout the study period and the pH values were steady at around pH 4. The extemporaneous \n\n\n\npreparation was not susceptible to microbial contamination. The results from the stability studies \n\n\n\nconfirmed that the new formulation of morphine oral suspension is stable for up to 12 months when \n\n\n\npacked in HDPE bottles with polypropylene caps and stored at both 4\u00baC and 30\u00baC / 75%RH.  \n\n\n\n\n\n\n\n\n\n\n\nINTRODUCTION \n \n\n\n\nMorphine is an opioid analgesic used to relieve severe, acute pain or moderate to severe, chronic pain \n\n\n\nfor patients with cancer, myocardial infarction and surgery (1,2). Morphine taken by mouth is an \n\n\n\neffective analgesic for cancer pain and is considered the drug of first choice for relieving moderate to \n\n\n\nsevere pain (3). Moderate to severe pain in cancer is common and affects 70 to 80% of patients with \n\n\n\nadvanced disease (3). Morphine has remained the first choice for reasons of familiarity, availability \n\n\n\nand cost rather than proven superiority (3). \n\n\n\n\n\n\n\nAccording to the World Health Organization (WHO), morphine is given orally as an aqueous \n\n\n\nmorphine solution or as standard immediate-release tablet every four hours by the clock (4). \n\n\n\nModified-release tablets or capsules are available in both 12 hour and 24 hour release patterns and \n\n\n\nshould be swallowed whole (5). The effective dose may vary from as little as 5mg to more than \n\n\n\n1000mg partly because of individual variations in systemic bioavailability (4). Immediate-release \n\n\n\nformulations (tablet or aqueous solution) are much more flexible than long-acting preparations, both \n\n\n\nin the dose titration period and when the pain is poorly controlled (3). When compared to immediate- \n\n\n\nand modified-release morphine tablets, morphine oral solution has an earlier onset and is easier to \n\n\n\ntake and more convenient for dose titration (6). \n\n\n\n \nThe lack of commercially available oral liquid dosage form is an on-going problem for health care \n\n\n\nproviders in many practice settings. The pharmacist, both in community and hospital pharmacy \n\n\n\npractice, is often challenged with the preparation of a liquid dosage form not available for paediatric \n\n\n\n\n\n\n\n\n\n\n\n\npatients, those adults unable to swallow tablets or capsules and patients who must receive medications \n\n\n\nvia nasogastric or gastrostomy tubes (7). \n\n\n\n\n\n\n\nWhen there is a need to undertake extemporaneous preparation, the accountable pharmacist must \n\n\n\nchoose a validated formula with supporting stability data (8,9). However, when the stability data and \n\n\n\nvalidated formulations are not available, further research should be carried out to validate the \n\n\n\nformulations used in practice whenever possible and then the formulations should be standardized \n\n\n\namong all the hospitals (9).  \n\n\n\n\n\n\n\nMorphine oral liquid is preferred in cancer patients who require tube feeding or have difficulties in \n\n\n\nswallowing (6). Many hospital pharmacists have to prepare morphine oral liquid extemporaneously \n\n\n\nbecause it is not available commercially (9). In Malaysia, pharmacists in major hospital are tasked to \n\n\n\nprepare morphine oral liquids on a weekly basis to supply them to outpatient departments, satellite \n\n\n\npharmacies and wards. Therefore, it is ideal that the morphine oral liquid has longer shelf-life to meet \n\n\n\nthe clinical requirements of the outpatients who are taking this medicine and also to minimize wastage \n\n\n\ndue to short expiry. \n\n\n\n\n\n\n\nExtemporaneous preparation remains one of the highest risks preparative activities carried out in the \n\n\n\npharmacy, as the risks of unlicensed medicines are combined with inherent risks associated with the \n\n\n\npharmaceutical compounding process (8). Formulation failure can occur when a formulation has not \n\n\n\nbeen adequately validated, potentially resulting in either under- or overdose and associated toxicity or \n\n\n\ntherapeutic failure (8). The causes of formulation failure are numerous and can be complex, including \n\n\n\nphysical incompatibilities, drug/excipient binding issue and drug degradation (8). Generally, as the \n\n\n\ncomplexity of the formulation increases so does the risk of problems occurring. Therefore, the \n\n\n\nformulation of the extemporaneous preparation should be designed as simple as possible for these \n\n\n\nreasons (8). \n\n\n\n\n\n\n\nAccording to the USP36-NF31 Chapter <795>, Pharmaceutical Compounding \u2013 Nonsterile \n\n\n\nPreparations (10), an extemporaneous oral liquid has a beyond-use date (BUD) of not more than 14 \n\n\n\ndays shelf-life when stored at controlled cold temperatures if no stability information or supporting \n\n\n\ndata is available. This study will provide the stability data needed to determine the shelf-life and \n\n\n\nstorage condition for the extemporaneous preparation of morphine oral liquid. The results from the \n\n\n\nstability studies are important to validate the formulation and to confirm that the extemporaneous \n\n\n\npreparation remains stable and efficacious during the course of their use.  \n\n\n\n\n\n\n\nAn oral formulation can be prepared from morphine sulfate or hydrochloride salt (4,5). Morphine \n\n\n\nhydrochloride is a colourless, white or almost white, crystalline powder. It is efflorescent in a dry \n\n\n\natmosphere. It is soluble in water, slightly soluble in alcohol and practically insoluble in toluene (2).  \n\n\n\n\n\n\n\nOral liquids are usually formulated as either a suspension or solution. Drugs in solution are more \n\n\n\nsusceptible to chemical degradation than drugs in the solid state and this should be considered when \n\n\n\npreparing a solution (11). Extemporaneous preparation made from tablets contains excipients such as \n\n\n\nbinders and disintegrating agents in addition to the active drug. Insoluble tablet excipients may \n\n\n\ncompromise the product appearance of the suspension whereas soluble tablet excipients may reduce \n\n\n\ndrug stability, for example, by altering the pH of the preparation (11). \n\n\n\n\n\n\n\nWhen considering the suitability of an extemporaneous oral liquid, a number of factors, in addition to \n\n\n\nchemical stability of active pharmaceutical ingredient (API) need to be considered. This includes \n\n\n\nphysical stability, microbial stability, palatability, excipient suitability (e.g. sugar free for diabetic \n\n\n\npatients), interactions with packaging materials, accurate compounding procedures including \n\n\n\ncalculations and cost (12).  \n\n\n\n\n\n\n\nSince sourcing of API for morphine hydrochloride is possible, pure drug substance is preferred over \n\n\n\ncommercially available tablet for compounding of oral liquids. The use of commercially available \n\n\n\nsuspending base is encouraged and is considered an excellent choice for making the extemporaneous \n\n\n\n\n\n\n\n\n\n\n\n\npreparations as simple for the inexperienced pharmacist making one-off preparations (13). \n\n\n\nCommercial vehicles are considered a convenient choice since many practice settings may not stock a \n\n\n\nwide variety of excipients and many of the stability studies in the literature on oral liquids prepared \n\n\n\nextemporaneously utilize these commercial vehicles (12). \n\n\n\n\n\n\n\nMATERIALS AND METHODS \n\n\n\n \nFormulation and Study Design \n\n\n\nThe extemporaneous preparation of morphine oral suspension (10mg/5ml) was prepared by the \n\n\n\npharmacy department of Universiti Kebangsaan Malaysia Medical Centre (UKMMC). The API of \n\n\n\nmorphine hydrochloride BP, PhEur. was sourced from Johnson Matthey / Macfarlan Smith Limited, \n\n\n\nUnited Kingdom and the commercial vehicle, X-Temp Oral Suspension System was supplied by \n\n\n\nPharm-D Sdn Bhd, Malaysia (Figure 1). \n\n\n\n\n\n\n\nFigure 1: Master formula for morphine oral suspension \n\n\n\nIngredient Amount \n\n\n\n Morphine HCl Powder                 10g \n\n\n\n X-Temp Oral Suspension System qs ad 5000ml \n\n\n\n\n\n\n\nThe commercial vehicle chosen contains specialized suspending system formulated to assist in \n\n\n\nextemporaneous preparation of oral liquid, non-soluble (suspended), aqueous dosage form and is an \n\n\n\norange flavoured, sweetened, sugar-free vehicle containing suitable preservatives. The morphine oral \n\n\n\nsuspension was packed into 100ml semi-transparent high-density polyethylene (HDPE) bottles and \n\n\n\nwas fitted with white polypropylene screw caps. \n\n\n\n\n\n\n\nFifty-five bottles of morphine oral suspension were divided into 2 groups and one group was stored at \n\n\n\n4 \u00b1 2\u00baC (refrigeration) and the other was stored at 30 \u00b1 2\u00baC / 75%RH \u00b1 5%RH (room temperature) in \n\n\n\nthe absence of light.  \n\n\n\n\n\n\n\nDrug product stability encompasses chemical, physical, microbiological, therapeutic and toxicological \n\n\n\nstability not only of the drug substance, but when taking into account of the excipients, also the drug \n\n\n\nproduct (14). Stability studies should be performed for desired drug concentration and in real storage \n\n\n\nconditions (storage temperature, duration and type of container). The physical stability is assessed \n\n\n\nfrom changes in appearance, colour or odour, while the chemical stability is determined using an \n\n\n\nadequate analytical method for drug quantification (10). Microbiological stability should be \n\n\n\nconducted in extemporaneous oral formulations containing no or insufficient preservatives and be \n\n\n\nstored at room temperature over an extended period (10,15). This study focuses on the physical, \n\n\n\nchemical and microbiological stabilities and to confirm that the new formulation for the morphine oral \n\n\n\nsuspension is suitable and stable. \n\n\n\n\n\n\n\nAnalytical Method and Equipment \n\n\n\nThe content of morphine hydrochloride in the oral suspension was assayed by high-performance \n\n\n\nliquid chromatography (HPLC) method with reference to the British Pharmacopoeia and the content \n\n\n\nof morphine hydrochloride was set at 90 to 110% of the stated amount (16). The HPLC method for \n\n\n\nthe analysis of morphine in this study was validated in a previous short-term stability study of \n\n\n\nextemporaneously prepared morphine oral suspension using the above formulation. The evaluation of \n\n\n\nthe analytical method validation includes linearity, accuracy and system suitability (Table 1). A range \n\n\n\nperformed on the HPLC system has confirmed the linearity of the method (R\n2 \n= 0.99998) (Figure 2).  \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nTable 1: Results of analytical method validation \n\n\n\nTest Parameter Validation Results Acceptance Limits \n\n\n\nLinearity & Range   \n\n\n\n R\n2\n = 0.99998 R\n\n\n\n2\n: Not less than 0.999 \n\n\n\nIntercept = 0.40% of the response \n\n\n\nof 100% (working) concentration \n\n\n\nIntercept: NMT 2% of the response \n\n\n\nof 100% (working) concentration \n\n\n\nAccuracy   \n\n\n\nSpiking of placebo \n\n\n\n9 determination (3 \n\n\n\nreplicates / 3 \n\n\n\nconcentration) \n\n\n\n99.3%, 99.6%, 99.7%, 98.1%, \n\n\n\n99.0%, 98.7%, 100.4%, 101.1%, \n\n\n\n100.8% \n\n\n\n% recovery: 98 - 102% of label or \n\n\n\nmean from precision \n\n\n\nSystem Suitability   \n\n\n\nSystem Precision RSD of detector response = 0.07% RSD of detector response: NMT \n\n\n\n2%  \n\n\n\n RSD of retention time = 0.08% RSD of retention time: NMT 1% \n\n\n\nPeak Performance  \n\n\n\nk' = 2.215 \n\n\n\nResolution  = 18.167 \n\n\n\nUSP tailing = 1.344 \n\n\n\nN = 5939 \n\n\n\nAnalyte \n\n\n\nk': NLT 1.5 \n\n\n\nResolution: NLT 2 \n\n\n\nUSP tailing: NMT 2 \n\n\n\nN: NLT 2000 \n\n\n\n \nFigure 2: Calibration curve of the HPLC assay method \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \nThe content of morphine hydrochloride was measured by HPLC-UV method after the sample of \n\n\n\nextemporaneous preparation was made throughout the stability study period. Samples were removed \n\n\n\nfrom each individual bottle on months 0, 1, 2, 3, 4, 5, 6, 9 and 12. A working reference standard of \n\n\n\nmorphine hydrochloride was obtained from Johnson Matthey / Macfarlan Smith Limited, United \n\n\n\nKingdom. \n\n\n\n\n\n\n\nThe HPLC system used for the analysis was an Agilent 1200 RRLC instrument with binary pump SL, \n\n\n\nautosampler SL, DAD SL detector, Thermostat Column Compartment SL and chemstation. The \n\n\n\nchromatographic separation used was Zorbax Eclipse XDB-C18 (4.6mm ID x 100mm, 3.5\uf06dm). The \n\n\n\nDAD detector operated at 230nm. The mobile phase consisted of a mixture of 65 volumes of \n\n\n\n0.005M sodium heptanesulfonate buffer adjusted to pH 2.6 with orthophosphoric acid 85% \n\n\n\n\n\n\n\n\n\n\n\n\nand 35 volumes of methanol. The mobile phase was delivered at a flow rate of 1ml/min. Samples \n\n\n\nwere filtered before HPLC analysis and the injection volume as 5\uf06dL. \n\n\n\n\n\n\n\nPhysicochemical Stability  \n\n\n\nThe physical and chemical tests (such as visual appearance, odour, pH and morphine content) were \n\n\n\nassessed at time 0, 1, 2, 3, 4, 5, 6, 9 and 12 months during storage at both temperatures. The morphine \n\n\n\noral suspensions were examined at each sample time for any change in appearance (colour and clarity) \n\n\n\nor odour. The pH was periodically checked during storage at for both temperatures using a pH meter. \n\n\n\nThe extemporaneous preparation is considered stable if physical characteristics have remained fairly \n\n\n\nunchanged and assay of morphine hydrochloride has remained equal or above 90% of the original \n\n\n\nconcentration during the storage period. \n\n\n\n\n\n\n\nMicrobiological Stability \n\n\n\nMicrobiological stability of the morphine oral suspension stored at 4\u00baC and 30\u00baC was studied at the \n\n\n\ninterval of months 0, 1, 2, 3, 4, 5, 6, 9 and 12. The microbial limit test was designed according to the \n\n\n\nBritish Pharmacopoeia for non-sterile products to determine whether the total bacteria, total fungi and \n\n\n\nEscherichia coli (E. coli) in the extemporaneous preparation complies with the established \n\n\n\nspecification for microbiological quality of this type of product (17).  \n\n\n\n\n\n\n\nRESULTS AND DISCUSSION \n\n\n\n \nPhysicochemical Stability \n\n\n\nMorphine degrades in aqueous solutions with the formation of mainly pseudomorphine, to a lesser \n\n\n\nextent morphine-N-oxide and probably apomorphine and discolouration has been observed when \n\n\n\ndegradation products are found in morphine solution (6,18,19). The results of the colour, clarity and \n\n\n\nodour of the morphine oral suspension remained fairly unchanged and no precipitation was observed \n\n\n\nin any of the samples throughout the 12 months at both storage conditions (Table 2). The orange taste \n\n\n\nand sweetness of the morphine oral suspension were quite the same throughout the stability study \n\n\n\nperiod. Morphine salts are sensitive to change in pH and morphine is liable to be precipitated out of \n\n\n\nsolution at alkaline pH (2). Vermeire and Remon (1999) also concluded that the degradation of \n\n\n\nmorphine is accelerated at higher pH of the solution, whereas temperature and light have only a minor \n\n\n\ninfluence on the degradation rate (18). The results from this study confirmed that the pH values of the \n\n\n\nmorphine oral suspension remained fairly constant (pH3.984 \u2013 4.082) at both temperatures (Table 3). \n\n\n\n\n\n\n\nTable 2: Visual appearance and odour of morphine oral suspension \n\n\n\nTime (Months) \n4\u00baC 30\u00baC \n\n\n\nColour Clarity Odour Colour Clarity Odour \n\n\n\n0 Off white Opaque Orange Off white Opaque Orange \n\n\n\n1 Off white Opaque Orange Off white Opaque Orange \n\n\n\n2 Off white Opaque Orange Off white Opaque Orange \n\n\n\n3 Off white Opaque Orange Off white Opaque Orange \n\n\n\n4 Off white Opaque Orange Off white Opaque Orange \n\n\n\n5 Off white Opaque Orange Off white Opaque Orange \n\n\n\n6 Off white Opaque Orange Off white Opaque Orange \n\n\n\n9 Off white Opaque Orange Off white Opaque Orange \n\n\n\n12 Off white Opaque Orange Off white Opaque Orange \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\nTable 3: pH of morphine oral suspension  \n\n\n\nTime (Months) 4\u00baC 30\u00baC \n\n\n\n0 4.075 4.075 \n\n\n\n1 4.080 4.074 \n\n\n\n2 4.073 4.082 \n\n\n\n3 4.074 4.060 \n\n\n\n4 4.070 4.036 \n\n\n\n5 4.068 4.040 \n\n\n\n6 4.082 4.041 \n\n\n\n9 4.036 3.984 \n\n\n\n12 4.050 4.001 \n\n\n\n\n\n\n\nTable 4: Concentration of morphine oral suspension  \n\n\n\nTime (Months) 4\u00baC 30\u00baC \n\n\n\n0 102.8% 102.8% \n\n\n\n1 97.0% 97.0% \n\n\n\n2 99.3% 101.0% \n\n\n\n3 95.1% 95.6% \n\n\n\n4 96.1% 96.6% \n\n\n\n5 101.4% 97.0% \n\n\n\n6 99.5% 96.6% \n\n\n\n9 96.1% 96.0% \n\n\n\n12 95.5% 96.2% \n\n\n\n \nThe morphine hydrochloride content for all tested samples from the morphine oral suspension were \n\n\n\nall above 95% throughout the 12 months period for both temperatures (Table 4). Even though the rate \n\n\n\nof chemical degradation usually increases with temperature (11), there were no significant differences \n\n\n\nin the assay results between the two storage conditions to establish any possibility of degradation \n\n\n\nduring storage.  \n\n\n\n\n\n\n\nThe analytical results of this stability study proved that the HPLC method developed for the analysis \n\n\n\nof morphine content in extemporaneous preparation to be adequate. The chromatograms illustrated \n\n\n\nbelow showed that the HPLC method to be selective for the purpose of this study with minimal \n\n\n\ninterference from the excipients in the formulation (Figure 3). The chromatograms of tested samples \n\n\n\nat the different intervals throughout the stability study period revealed no other peak that could be \n\n\n\nattributed to a possible morphine degradation compound. \n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n \nFigure 3: Chromatograms of morphine standard solution and extemporaneously prepared morphine \n\n\n\noral suspension \n\n\n\n\n\n\n\nMorphine standard solution \n\n\n\n\n\n\n\n\n\n\n\nMorphine oral suspension \n\n\n\n\n\n\n\n \n \nThese results confirmed that the temperature has little effect on the physical and chemical stabilities \n\n\n\nof morphine in the oral suspension and the morphine content is relatively stable at acidic pH. Storage \n\n\n\nin the refrigerator may not be considered necessary. The extemporaneous preparation of morphine \n\n\n\noral suspension remains stable when stored at room temperature in the same container closure system. \n\n\n\nMorphine solutions should preferably be stored at room temperature in order to avoid precipitation at \n\n\n\nlow temperatures and water evaporation at higher temperatures causing increase in morphine \n\n\n\nconcentration when store in polymer reservoirs (18). \n\n\n\n\n\n\n\nMicrobiological Stability \nNo microbial contamination was observed in all samples of morphine oral suspension during the 12 \n\n\n\nmonths study period for both temperatures (Table 5 and 6). The results showed that the microbial \n\n\n\nquality was within the test limits according to the British Pharmacopoeia (17). The total viable aerobic \n\n\n\nbacteria count was kept low and total yeast and mould count was minimal. E. coli was absent \n\n\n\nthroughout the study period. These results shows that the preservatives of the extemporaneous \n\n\n\npreparation were effective against bacteria and fungi and the morphine oral suspension is \n\n\n\nmicrobiologically stable at both temperatures for up to 12 months.  \n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\nTable 5: Microbial results of morphine oral suspension (4\u00baC) \n\n\n\nTime (Months) \n\n\n\nTotal aerobic bacteria \n\n\n\n(Not more than \n\n\n\n200cfu/g) \n\n\n\nTotal yeast & mould \n\n\n\n(Not more than \n\n\n\n20cfu/g) \n\n\n\nE. coli \n\n\n\n(Absence in 1g) \n\n\n\n0 <10cfu/g <10cfu/g Conforms \n\n\n\n1 <10cfu/g <10cfu/g Conforms \n\n\n\n2 <10cfu/g <10cfu/g Conforms \n\n\n\n3 <10cfu/g <10cfu/g Conforms \n\n\n\n4 <10cfu/g <10cfu/g Conforms \n\n\n\n5 <10cfu/g <10cfu/g Conforms \n\n\n\n6 <10cfu/g <10cfu/g Conforms \n\n\n\n9 <10cfu/g <10cfu/g Conforms \n\n\n\n12 <10cfu/g <10cfu/g Conforms \n\n\n\n\n\n\n\nTable 6: Microbial results of morphine oral suspension (30\u00baC) \n\n\n\nTime (Months) \n\n\n\nTotal aerobic bacteria \n\n\n\n(Not more than \n\n\n\n200cfu/g) \n\n\n\nTotal yeast & mould \n\n\n\n(Not more than \n\n\n\n20cfu/g) \n\n\n\nE. coli \n\n\n\n(Absence in 1g) \n\n\n\n0 <10cfu/g <10cfu/g Conforms \n\n\n\n1 <10cfu/g <10cfu/g Conforms \n\n\n\n2 <10cfu/g <10cfu/g Conforms \n\n\n\n3 <10cfu/g <10cfu/g Conforms \n\n\n\n4 <10cfu/g <10cfu/g Conforms \n\n\n\n5 <10cfu/g <10cfu/g Conforms \n\n\n\n6 <10cfu/g <10cfu/g Conforms \n\n\n\n9 <10cfu/g <10cfu/g Conforms \n\n\n\n12 <10cfu/g <10cfu/g Conforms \n\n\n\n \nFormulation Stability \n\n\n\nThe new formulation for extemporaneous preparation chosen for this study is simple and ideal for any \n\n\n\npharmacist in UKMMC to prepare when compared to the old formulation consisting of morphine \n\n\n\npowder, glycerine, lemon oil, alcohol, water and syrup simplex. No published information is available \n\n\n\nto support the stability of the old formulation and to justify the shelf-life. Furthermore, traditional use \n\n\n\nof syrup BP (syrup simplex) as a suspending agent is not recommended as the typical pH of syrup BP \n\n\n\nis approximately 7.5 to 9.5 and does not promote morphine stability (19). \n\n\n\n\n\n\n\nPreechagoon et. al. (2005) have studied the formulation development and stability testing of oral \n\n\n\nmorphine solution using a preformulation approach (20). The study has highlighted that the pH of the \n\n\n\nsolution is a major factor influencing morphine stability and masking of the bitter taste of morphine is \n\n\n\nanother challenge (20). Even though the formulations have been demonstrated to be stable throughout \n\n\n\nthe study period, some may consider the formulations from this study to be too complex for use at \n\n\n\ndispensary level (19). \n\n\n\n\n\n\n\nThe flavour and sweetener from the commercial vehicle, X-Temp Oral Suspension System were \n\n\n\nsufficient to mask the bitter taste of morphine in the extemporaneous preparation. Besides, the \n\n\n\ncommercial vehicle is buffered to a slightly acidic pH (pH~4.4) and this pH helps to reduce the \n\n\n\ndegradation process of morphine in solution. \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\nCONCLUSIONS \n\n\n\n \nThe results from the physical, chemical and microbiological stability studies confirmed that the \n\n\n\nextemporaneous of morphine oral suspension using X-Temp Oral Suspension System is stable for up \n\n\n\nto 12 months when packed in HDPE bottles with polypropylene caps and stored at both 4\u00baC and 30\u00baC. \n\n\n\nThe extemporaneous preparation can now be prepared with ease by compounding pharmacists in the \n\n\n\nhospitals using X-Temp Oral Suspension System with validated stability and proven shelf-life. This \n\n\n\nnew evidence will be made available and the protocol can be standardized in the prescribing and \n\n\n\ncompounding practices among the hospitals to provide a safe, effective and quality morphine oral \n\n\n\nsuspension to the patients. \n\n\n\n\n\n\n\nThis study not only addressed the chemical, physical and microbial stability, it has also dealt into \n\n\n\nother parameters including palatability, excipient suitability (e.g. alcohol free for children, sugar free \n\n\n\nfor diabetic patients) and interactions with packaging materials of an extemporaneous oral liquid. \n\n\n\nVisual appearance, smell, taste and mouth feel all have a big influence on patient acceptance and \n\n\n\ncompliance, especially in the paediatric patients and are as important factor to consider in the \n\n\n\ndevelopment of a suitable extemporaneous preparation (13). \n\n\n\n\n\n\n\nAlthough some of the risks associated with extemporaneous compounding has been addressed, there \n\n\n\nare still other inherent risks in compounding which include using incorrect formulation and \n\n\n\ncalculations, selecting incorrect drugs and using incorrect quantities (8,21). Therefore, proper \n\n\n\nguidelines with focus on quality assurance and quality control practices should be put in place for \n\n\n\nevery compounding pharmacy to deliver consistent, safe and quality products (22). \n\n\n\n\n\n\n\nACKNOWLEDGEMENTS \n\n\n\n \nThe author wished to thank pharmacy department of Universiti Kebangsaan Malaysia Medical Centre \n\n\n\n(UKMMC) for providing the extemporaneous samples and morphine hydrochloride pure drug \n\n\n\nrequired for this study and BioScenergy International Sdn Bhd for its financial support. \n\n\n\n\n\n\n\nREFERENCES \n\n\n\n \n1. McEvoy GK. AHFS: Drug Information. Bethesda, MD: American Society of Health-System \n\n\n\nPharmacists; 2009. \n\n\n\n2. Sweetman SC. Martindale: The Complete Drug Reference. 36\nth\n ed. United Kingdom: \n\n\n\nPharmaceutical Press; 2009. \n\n\n\n3. Caraceni A, Hanks G, Kaasa S, Bennett MI, Brunelli C, Cherny N, Dale O, De Conno F, Fallon \n\n\n\nM, Hanna M, Faksv\u00e5g Haugen D, Juhl G, King S, Klepstad P, Laugsand EA, Maltoni M, \n\n\n\nMercadante S, Nabal M, Pigni A, Radbruch L, Reid C, Sjogren P, Stone PC, Tassinari D, \n\n\n\nZeppetella G. Use of opioid analgesics in the treatment of cancer pain: evidence-based \n\n\n\nrecommendations from the EAPC. Lancet Oncol 2012; 13:e58-68. \n\n\n\n4. World Health Organization. Cancer pain relief. 2\nnd\n\n\n\n ed. Geneva: WHO; 1996. \n\n\n\n5. Wiffen PJ, Wee B, Moore RA. Oral morphine for cancer pain. Cochrane Database of Systematic \n\n\n\nReviews 2013; Issue 7. Art. No.: CD003868. DOI: 10.1002/14651858.CD003868.pub3. \n\n\n\n6. Lin CY, Shen LJ, Huang CF, Yang HL, Chen YJ, Wu FL. Beyond-use date of extemporaneous \n\n\n\nmorphine hydrochloride oral solution. Journal of Food and Drug Analysis 2013; 21(2):142-146. \n\n\n\n7. Glass BD, Haywood A. Stability considerations in liquid dosage forms extemporaneously \n\n\n\nprepared from commercially available products. J Pharm Pharmaceut Sci 2006; 9(3):398-426. \n\n\n\n8. Jackson M, Lowey A. Risk management. Handbook of Extemporaneous Preparation. United \n\n\n\nKingdom: Pharmaceutical Press; 2010. \n\n\n\n9. Lowey AR, Jackson MN. A survey of extemporaneous preparation in NHS trusts in Yorkshire, \n\n\n\nthe North-East and London. Hospital Pharmacist 2008; 15(6):217-219. \n\n\n\n\n\n\n\n\n\n\n\n\n10. United States Pharmacopeia and National Formulary (USP36-NF31). Chapter 795. \n\n\n\nPharmaceutical compounding \u2013 nonsterile preparations. Rockville, MD: United States \n\n\n\nPharmacopeial Convention, Inc.; 2013. \n\n\n\n11. Woods DJ. Extemporaneous formulation of oral liquids \u2013 a guide.  \n\n\n\n12. http://www.pharminfotech.co.nz/manual/Formulation/extemprep.pdf (5 November 2009). \n\n\n\n13. Haywood A, Glass BD. Liquid dosage forms extemporaneously prepared from commercially \n\n\n\navailable products \u2013 considering new evidence of stability. J Pharm Pharmaceut Sci 2013; \n\n\n\n16(3):441-455. \n\n\n\n14. Jackson M, Lowey A. Formulation and stability. Handbook of Extemporaneous Preparation. \n\n\n\nUnited Kingdom: Pharmaceutical Press; 2010. \n\n\n\n15. Haywood A, Glass B. Managing extemporaneous oral liquids in practice. Journal of Pharmacy \n\n\n\nPractice and Research 2007; 37(2):131-133. \n\n\n\n16. Santos S, Sa A, Saiao A, Pecorelli C. Stability of folic acid in extemporaneous oral suspension. \n\n\n\nBiopharmaceuticals Sciences 2005; 3(2):223-232. \n\n\n\n17. British Pharmacopoeia (2012). Volume I & II - Monographs: medicinal and pharmaceutical \n\n\n\nsubstances. London, England: British Pharmacopoeia Commission; 2012. \n\n\n\n18. British Pharmacopoeia (2012). Volume V. Appendix XVI B - Microbiological examination of \n\n\n\nnon-sterile products. London, England: British Pharmacopoeia Commission; 2012. \n\n\n\n19. Vermeire A, Remon JP. Stability and compatibility of morphine. Int J Pharm 1999; 187(1):17-51. \n\n\n\n20. Jackson M, Lowey A. Morphine sulphate oral liquid. Handbook of Extemporaneous Preparation. \n\n\n\nUnited Kingdom: Pharmaceutical Press; 2010. \n\n\n\n21. Preechagoon D, Sumyai V, Tontisirin K, Aumpon S, Pongjanyakul T. Formulation development \n\n\n\nand stability testing of oral morphine solution utilizing preformulation approach. J Pharm \n\n\n\nPharmaceut Sci 2005; 8(2):362-369. \n\n\n\n22. Kairuz TE, Gargiulo D, Bunt C, Garg S. Quality, safety and efficacy in the \u2018off-label\u2019 use of \n\n\n\nmedicines. Current Drug Safety 2007; 2:89-95. \n\n\n\n23. Liva R. Quality assurance issues in compounding pharmacy. Integrative Medicine 2006; 5(5):70-\n\n\n\n72. \n\n\n\n\n\n\n\n\nABSTRACTS FROM THE 25\nth\n\n\n\n FEDERATION OF ASIAN \n\n\n\nPHARMACEUTICAL ASSOCIATIONS CONGRESS 2014 (25\nTH \n\n\n\nFAPA \n\n\n\nCONGRESS 2014)  \n\n\n\n\n\n\n\nExpanding the Pharmacists\u2019 Roles in Wellness and Sustainable Health \n \n\n\n\n9 \u2013 12 October 2014 \n\n\n\nKota Kinabalu, Sabah, Malaysia \n\n\n\n\n\n\n\nJointly organised by the Malaysian Pharmaceutical Society and the Pharmaceutical Services Division \n\n\n\nof the Ministry of Health, with the Sabah Pharmaceutical Society (SPS) as local organiser \n\n\n\n\n\n\n\nSCIENTIFIC COMMITTEE \n\n\n\nProf Dr Syed Azhar Syed Sulaiman (Chairman) \n\n\n\nAssoc Prof Dr Allan Mathews (Vice-Chairman) \n\n\n\nAssoc Prof Dr Chua Siew Siang \n\n\n\nDr Nour Hanah Othman \n\n\n\nMs Syireen binti Alwi \n\n\n\nMs Rita A/P Mohan Dallumal \n\n\n\nMr Lam Kai Kun \n\n\n\nDr Liau Siow Yen \n\n\n\n\n\n\n\n\n\n\n\nReviewers of Abstracts \n\n\n\nProf Dr Syed Azhar Syed Sulaiman \n\n\n\nDr BalamuruganTangiisuran \n\n\n\nProf Dr Chan Kit Lam  \n\n\n\nDr Dzul Azri Mohamed Noor  \n\n\n\nDr Baharudin Ibrahim  \n\n\n\nDr Amir Hayat Khan    \n\n\n\nDr Lee Chong Yew \n\n\n\nDr Nour Hanah Othman \n\n\n\nAssoc Prof Dr Chua Siew Siang \n\n\n\nMs Syireen bint iAlwi      \n\n\n\nProf Dr PT Thomas \n\n\n\nMr Navin Kumar Loganadan \n\n\n\nDr Shaun Lee Wen Huey \n\n\n\nDr Leong Kok Hoong \n\n\n\nMs Lee Hooi Leng \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nTABLE OF CONTENTS \n \n\n\n\nPLENARY LECTURES \n \n\n\n\nNo Presenter Title \n\n\n\nPlenary 1 Dr Salmah Binti Bahri \nPharmacists Today \u2013 Winds of Change Through the \n\n\n\nDecades \n\n\n\nPlenary 2 Mr Ashok Soni \n\n\n\nGlobal Innovative Strategies to Expand Pharmacists\u2019 Roles \n\n\n\nin Wellness and Sustainable Health \u2013 Now or Never: New \n\n\n\nModels of Care \n\n\n\nPlenary 3 \nMdm Abida Haq Binti \n\n\n\nSyed M Haq \n\n\n\nPharmacy Transformation Plan in Malaysia:  Expanding \n\n\n\nPharmacists\u2019 Roles in Wellness and Betterment of Health \n\n\n\nOutcomes \n\n\n\nPlenary 4 Ms Leonila M Ocampo \nChanges In The Community Pharmacy Services In The \n\n\n\nPhilippines : Assurance For Better Sustainability \n\n\n\nPlenary 6 \nProf Dr Chomchin \n\n\n\nChantaraskul \nThe Trend of Pharmacy Profession in Asia \n\n\n\nPlenary 7 \nDr Akhteruzzaman \n\n\n\nSano \n\n\n\nHealth and Environment Changes: The Role of \n\n\n\nPharmacists in Enhancing the Development of Sustainable \n\n\n\nHealth \n\n\n\nPlenary 8 Mr Gerard Stevens \nInnovative Pharmacy Practice Through Cutting Edge \n\n\n\nRobotic Technology \n\n\n\n\n\n\n\n\n\n\n\nCONCURRENT SYMPOSIUM \n\n\n\n\n\n\n\nNo Ishidate Awardees Title \n\n\n\nS1 Dr. Yueh-Ching Chou \nSafety Management in Medication Use System-  \n\n\n\nExperience of a Medical Center in Taiwan \n\n\n\nS2 Prof Wan Gyoon Shin \nApplication of a Drug-interaction Detection Method to the \n\n\n\nKorean National Health Insurance Claims Database \n\n\n\nS2 \nAssoc. Prof Cheung \n\n\n\nHon Yeung \n\n\n\nTrends of Pharmacy Education and Trainings in Asia: \n\n\n\nProper Transformation or Not? \n\n\n\nS4 \nProf Garnpinol C \n\n\n\nRitthidej \n\n\n\nRe-Emerging Role of Industrial Pharmacist on Vaccine \n\n\n\nDelivery \n\n\n\nS5 \nProf Dr Syed Azhar \n\n\n\nSyed Sulaiman \n\n\n\nPharmacy Education and Practices in Asia \u2013 Strategies to \n\n\n\nImprove the Quality and Sustainability in Pharmaceutical \n\n\n\nCare \n\n\n\n\n\n\n\n\n\n\n\nNo Invited Speakers Title \n\n\n\nS6 Ms Lita Chew \nPharmacists and Sustainable Knowledge on Medication \n\n\n\nSafety \n\n\n\nS7 Prof Dr Chan Kit Lam \n\n\n\nA validated NMR-based identification of discriminatory \n\n\n\nurine metabolome of rats with low and high sperm count \n\n\n\nfollowing oral treatment of Eurycomalongifolia extracts \n\n\n\n \n\n\n\n\n\n\n\n\nS8 \n\n\n\nAssoc Prof Dr \n\n\n\nMohamed Azmi \n\n\n\nAhmad Hassali \n\n\n\nSocial Pharmacy Education and Research: The Needs and \n\n\n\nChallenges In Asia \n\n\n\nS10 \nMr Navin Kumar \n\n\n\nLoganadan \n\n\n\nImpact of Medication Therapy Adherence Clinic (MTAC) \n\n\n\nService on Type 2 Diabetes Patients: The Malaysian \n\n\n\nPharmacists' Experience \n\n\n\nS11 Dr Suphat Subongkot \nSelective Cyclooxygenase-2 Inhibition: A Target in Cancer \n\n\n\nPrevention and Treatment \n\n\n\nS12  Prof Dr Yuen Kah Hay \nClinical Studies on the Neuroprotective Effects of Palm \n\n\n\nVitamin E Tocotrienols \n\n\n\nS13 \nCol Dr A Halim Hj \n\n\n\nBasari \n\n\n\nExpanding Pharmacists' Role in the Humanitarian and \n\n\n\nDisaster Relief (HADR) Missions\u2013 Malaysian Military \n\n\n\nPharmacy Perspectives \n\n\n\nS14 \nAssoc Prof Dr Allan \n\n\n\nMathews \nInfusing Quality Into the Pharmaceutical Supply Chain \n\n\n\nS15 \nMdm. Noraini \n\n\n\nMohamad \nClinical Pharmacy in Malaysia: Past, Current and Future \n\n\n\nS16 \nProf Dr Gul Majid \n\n\n\nKhan \n\n\n\nLiposomes Decorated Topical Drug Delivery for the \n\n\n\nTreatment of Cutaneous Leishmaniasis \n\n\n\nS17 Dr Vivian WY Lee \nPharmacy Education for Sustainable Tomorrow \u2013 Asia \n\n\n\nExperience \n\n\n\nS18 \nProf Dr Hashamian \n\n\n\nFarshad \n\n\n\nClinical Pharmacy Services in Iran: Improving Patient\u2019s \n\n\n\nCare \n\n\n\n \n\n\n\n\n\n\n\n\nORAL PRESENTATIONS \n\n\n\nHospital and Clinical Pharmacy \n\n\n\n\n\n\n\nNo Presenting Author Title \n\n\n\nHPO 01 A Ramesh Prospective Evaluation of Clinical Pharmacy Services at a \n\n\n\nSouth Indian HIV Community Care Centre \n\n\n\nHPO 02 AM Ong The Development of a Pharmacy Management Hypertension \n\n\n\nProgram and Opportunities for Pharmaceutical Care \n\n\n\nHPO 03 AH Khan Prevalence and Effect of Smoking on Treatment Outcome \n\n\n\namong Tuberculosis Patients in Malaysia \n\n\n\nHPO 04 JL Quah A Study on Perception of the Need and Time needed to Render \n\n\n\nCritical Ward Services by A Clinical Pharmacist in Neonatal \n\n\n\nIntensive Care Unit (NICU) In Duchess of Kent Hospital, \n\n\n\nSandakan \n\n\n\nHPO 05 D Yodyoi Effectiveness of Hyperosmolar Oral Liquid Medications \n\n\n\nGuideline to Prevent Necrotizing Enterocolitis in Preterm \n\n\n\nNeonates \n\n\n\nHPO 06 F Hashmi Self-medicating Behavior of Urban Pakistani Population \n\n\n\ntowards Psychotropic Agents and its Correlates \n\n\n\nHPO 07 W Utaminingrum Evaluation of Adherence and Haemoglobin Levels of Iron \n\n\n\nTablets Use in Pregnant Women at Public Health Centre in \n\n\n\nPurwokerto \n\n\n\nHPO 08 J Penm Clinical Pharmacy Services that Influence Prescribing in the \n\n\n\nWestern Pacific Region \n\n\n\nHPO 09 IAA Widhiartini Pharmacokinetic of Rifampicin in Urban and Rural Lung \n\n\n\nTuberculosis Patients in Bali Province \n\n\n\nHPO 10 S Kanakarathnam Drug Related Problems (DRPs) among Geriatric Patients in \n\n\n\nPrimary Care Setting \n\n\n\nHPO 11 I Abdul Halim Zaki Risk Factors of Pacemaker Implantation Infection: A Single \n\n\n\nCentre Experience \n\n\n\nHPO 12 FK Hashmi  Statistical Prediction of Risk Frequency for Ischemic Heart \n\n\n\nDisease in Punjab, Pakistan  \n\n\n\nHPO 13 J Suphanklang Prevalence of Comorbidity and Pattern Drug Use among \n\n\n\nChildren with Attention-deficit Hyperactivity Disorder: A \n\n\n\nSingle Center in Thailand \n\n\n\nHPO 14 K Duangmee Study of relationship between trigger tools and adverse drug \n\n\n\nevents at Somdet Phra Sangharaja the 19th hospital, \n\n\n\nKanchanaburi \n\n\n\nHPO 15 LLYeap Slow Carbamazepine Clearance in a Nonadherent Malay \n\n\n\nWoman with Epilepsy and Thyrotoxicosis \n\n\n\nHPO 16 SWH Lee Strategies for a Safer Fasting During Ramadan for Muslim \n\n\n\nPatients with Type 2 Diabetes Mellitus: A Systematic Review \n\n\n\nHPO 17 YP Ng Comparison of Methods for Estimating Glomerular Filtration \n\n\n\nRate in Critically Ill Patients with Unstable Renal Function \u2013 A \n\n\n\nSingle Center Retrospective Study from Malaysia. \n\n\n\nHPO 18 PM Sigua Applicability of a Pharmacy-developed Diary in Patient-\n\n\n\nReported Monitoring of Compliance to Therapeutic \n\n\n\nInterventions \n\n\n\nHPO 19 C Kongkaew Hospital Admissions/Visits Associated with Drug-Drug \n\n\n\nInteractions: A Meta-Analysis \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nHPO 20 Armenia The Interaction Impact of Type of Antihypertension therapy, \n\n\n\nComorbidity and Medical Adherence to the HRQoL on the \n\n\n\nStroke Patients of the National Stroke Hospital, West \n\n\n\nSumatera, Indonesia \n\n\n\nHPO 21 C Wong Development and Implementation of a Career Development \n\n\n\nPathway and Competency Framework at SingHealth: A 7-year \n\n\n\nJourney \n\n\n\nHPO 22 A Rakhman Antibiotic Therapy Profile in Intensive Care Unit (ICU) \n\n\n\nPatients with Ventilator-Associated Pneumonia (VAP) at \n\n\n\nSungai Buloh Hospital \n\n\n\nHPO 23 FV Gamboa Portable Pocket Calendar: Improving Patient Compliance to \n\n\n\nOral Antibiotic Intervention Approach \n\n\n\nHPO 24 B Tangiisuran Factors Associated with Hospital Readmission among Older \n\n\n\nPatients Discharged after Acute Exacerbations of Chronic \n\n\n\nObstructive Pulmonary Disease \n\n\n\nHPO 25 AA Bawadikji Metabolomics and Pharmacometabonomics Approaches for \n\n\n\nDiagnosis of Diseases and Predicting Drug Response \n\n\n\nHPO 26 JES Liew Hyperglycaemia Management in the Intensive Care Unit: An \n\n\n\nEvaluation of Insulin Infusion Protocol \n\n\n\nHPO 27 Lailaturrahmi Relationship between Sociodemographic Characteristics with \n\n\n\nHRQoL in Stroke Patients of the National Stroke Hospital, \n\n\n\nWest Sumatera, Indonesia \n\n\n\nHPO 28 JER Berberabe Specialized Medication Review on Geriatric Patients in a \n\n\n\nPublic Regional Hospital in the Philippines: A Clinical \n\n\n\nPharmacists Perspective \n\n\n\nHPO 29 A Tan  Review of Best Practices for Next-Generation Sengkang \n\n\n\nHealth Pharmacy  \n\n\n\nHPO 30 YL Lo Advanced Age and Antiplatelets Use are Risk Factors of Upper \n\n\n\nGI Bleeding among the Elderly \n\n\n\nHPO 31 DA Perwitasari The Quality of Life Measurement on Hypertension Patients in \n\n\n\na Primary Health Care of Cirebon City Using Time Trade Off \n\n\n\nMethod \n\n\n\nHPO 32 P Pimsi Effects of Warfarin Dose Adjustment on the International \n\n\n\nNormalized Ratio (INR) Target Achievement in Thai Patients: \n\n\n\nA Preliminary Study \n\n\n\nHPO 33 R Adepu Initiation and Evaluation of Patient Reporting ADRs in Out \n\n\n\nPatient Department of a South Indian Tertiary Care Teaching \n\n\n\nHospital \n\n\n\nHPO 34 RR Aniza A Multicentre Analysis on Factors Affecting Anticoagulation \n\n\n\nControl and Adverse Outcomes among Warfarin MTAC \n\n\n\nPatients in MOH Facilities, Malaysia \n\n\n\nHPO 35 IBN Maharjana Medication Review Impact on Medication Appropriateness \n\n\n\nIndex in Hospitalized Balinese Elderly Determined by the \n\n\n\nSTOPP/START Criteria \n\n\n\nHPO 37 S. Prateepjarassaeng Factors Influencing Hospital Formulary Decision-Making: A \n\n\n\nPreliminary Study in Thailand \n\n\n\nHPO 38 P.Tanavij Potentially Inappropriate Medication in Elderly Outpatient \n\n\n\nPrescriptions at a District Hospital in the South of Thailand \n\n\n\nHPO 39 V Sankar Role of Pictograms in Educating Diabetic Patients about \n\n\n\nMedication Use and Lifestyle Modifications \n\n\n\nHPO 40 W Saelim Response to an Initial Dose of Warfarin in Thai Patients \n\n\n\nUndergoing Long-Term Anticoagulant Therapy \n\n\n\nHPO 41 W-K Chou A Preliminary Study of Comprehensive Pharmaceutical Care \n\n\n\namong Hospitalized Elderly Patients \n\n\n\n\n\n\n\n\nHPO 42 Y Lertsrisatit The Prevalence of Febrile Neutropenia due to Etoposide, \n\n\n\nMethotrexate, Actinomycin-d, Cyclophosphamide, Vincristine \n\n\n\n(EMA-CO regimen) among Patients with Gestational \n\n\n\nTrophoblastic Neoplasia: A Report from a Single Medical \n\n\n\nTeaching Hospital in Thailand \n\n\n\nHPO 43 Z Zahari The Relationship of Pain and Sleep Quality in Opioid \n\n\n\nDependent Patients on Methadone Maintenance Therapy \n\n\n\n(MMT) \n\n\n\nHPO 44 Zikria Comparative Study of Changes in Hepatic Profile Induced by \n\n\n\nLiposomal Doxorubicin Versus Conventional Doxorubicin \n\n\n\nBased Regimens in Cancer Patients \n\n\n\nHPO 45 Z-M Lee Evaluation of the Safety of Excipients in Drugs for Infants \n\n\n\nHPO 46 P Juacalla The Geriatric Clinic Care Program: An Approach to \n\n\n\nMaintaining Good Health and Quality of Life \n\n\n\nHPO 47 AM Abd Aziz Medication Administration Errors: An Unsolved Issue of \n\n\n\nPharmaceutical Care \n\n\n\nHPO 48 JGST Aquino The Assessment on the Usage of Complementary and \n\n\n\nAlternative Medicine among People Living with HIV in Metro \n\n\n\nManila \n\n\n\n\n\n\n\n\n\n\n\nCommunity Pharmacy \n\n\n\n\n\n\n\nNo Presenting Author Title \n\n\n\nCPO 01 RP Hananditia Profile Components of Drug Information Service by \n\n\n\nPharmacists for Prescription Service in Pharmacy Klojen \n\n\n\nSubdistrict Malang \n\n\n\nCPO 02 IGB Bacud Consumers Knowledge, Perception and Satisfaction towards \n\n\n\nthe Role of Community Pharmacist as Healthcare Provider in \n\n\n\nBasco, Batanes \n\n\n\nCPO 03 R Illahi Comparing the Onset of Action and Duration of Action of \n\n\n\nAvailable Topical Patches to Ease Muscle Strain in Groups of \n\n\n\nSubjects between 20-40 years old \n\n\n\nCPO 04 GF Galistiani Evaluation of Drug Information Services in Community \n\n\n\nPharmacies using Simulated Patient Method: Amoxicillin \n\n\n\nAntibiotic and Oral Corticosteroid \n\n\n\nCPO 05 LW Raymundo Pharmacists Counselling Advantages on Medication \n\n\n\nAdherence and Non-Pharmacologic Interventions \n\n\n\nCPO 06 I Nahlah Elkudssiah Evaluation of Different Inhalational Delivery Devices \n\n\n\nTechniques among the Community Pharmacists in Urban \n\n\n\nAreas in Selangor, Malaysia \n\n\n\nCPO 07 S Alwi Response of Community Pharmacists to Request for an Oral \n\n\n\nContraceptive \n\n\n\nCPO 08 E Roohi Pharmacists and General Practitioners Collaborative Practice: \n\n\n\nA Survey of Attitudes, Current Practice and Barriers to \n\n\n\nInterprofessional Care \n\n\n\nCPO 09 MFVT Gamboa Caffeine Habit: A survey on the use and effects of caffeine-\n\n\n\ncontaining beverages among university students \n\n\n\nCPO 10 K Hung Community Pharmacy Dispensing Practice of Non-steroidal \n\n\n\nAnti-inflammatory Drugs by Pharmacists and Pharmacy \n\n\n\nAssistants in Manila City \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nCPO 11 A Panaligan A Comparative Analysis of the 8-Item Morisky Medication \n\n\n\nAdherence Scale before and after a Pharmaceutical Care \n\n\n\nProgram among Chronically Hypertensive Elderly Patients \n\n\n\nCPO 12 V Lertjanyakun The Behavioral Intention of Thai Community Pharmacist to \n\n\n\nProvide Medicine Use Review (MUR) \n\n\n\nCPO 13 SS Wong Transforming Malaysian Community Pharmacists\u2019 Role in \n\n\n\nWellness and Health-care \n\n\n\n\n\n\n\n \nDrug Marketing and Socio-Economic Pharmacy \n \n\n\n\nNo Presenting Author Title \n\n\n\nSEO 01 JYH Voo Cost-Effectiveness Analysis (CEA) of Antihypertensive Drugs \n\n\n\nin Patients with Type 2 Diabetes Mellitus in Lahad Datu \n\n\n\nHospital \n\n\n\nSEO 02 IM Tesalona Wellness in Smallness \n\n\n\n\n\n\n\n\n\n\n\nIndustrial Pharmacy \n \n\n\n\nNo Presenting Author Title \n\n\n\nIPO 01 A Buang 'Halal Pharmaceuticals' - A Way Forward \n\n\n\nIPO 02 V Tantishaiyakul Investigation of the Efficiency and Mechanism of Gelation and \n\n\n\nDegelation of Three Positional Isomers of Aminobenzoic Acid \n\n\n\nIPO 03 Y Mutiawati Effect of Vitamin E (D-Tocopheryl Polyethylene Glycol 1000 \n\n\n\nSuccinate) in Enhancing Absorption of Lisinopril 10 mg Tablet \n\n\n\nFormulation \n\n\n\nIPO 04 C Tanakitcharoenpat Development of Multiparticulate Tablet from Alginate \n\n\n\nMicroparticles Prepared By Spray Drying Technique \n\n\n\nIPO 05 V Natekrajangkul Development of Alginate Microparticles using Polymer Blend \n\n\n\nTechnique for Drug Delivery System \n\n\n\n\n\n\n\n\n\n\n\nScientific \n\n\n\nNo Presenting Author Title \n\n\n\nSPO 01 AA Jamil Metabolic Therapy: A New Paradigm for the Management of \n\n\n\nDiabetic Hearts? \n\n\n\nSPO 02 AM Kusuma Acute Toxicity of Calabash Leaves Ethanol Extract in White \n\n\n\nMale Rats \n\n\n\nSPO 03 D Shuwisitkul Effects of Storage Condition and Preparing Processes on \n\n\n\nStability of Recombinant Human Growth Hormone \n\n\n\nSPO 04 EMD Ramos Hypolipidemic Activity of Senna Occidentalis (L.) Link. (Fam. \n\n\n\nFabaceae) Methanolic Extract in Atherogenic Diet Induced \n\n\n\nHyperlipidemia in Sprague-Dawley Rats \n\n\n\nSPO 05 H Ab Hadi Non-Invasive Measurement Method of Skin Conditions by \n\n\n\nusing Dermalab\u00ae Combo \n\n\n\nSPO 06 JM Galang A Study on the Potential of Kappa-carrageenan and \n\n\n\nCarboxymethylcellulose in Extended Release Potassium \n\n\n\nChloride Capsules \n\n\n\nSPO 07 R.Garcia In vivo Study of the Anti-angiogenic Property of the Ethanolic \n\n\n\nExtract of Annona muricata Linne in the Chorioallantoic \n\n\n\nMembrane (CAM) of the Duck Embryo \n\n\n\n\n\n\n\n\nSPO 08 S Mustafa Nevirapine metabolites ratio at steady state in Malaysian \n\n\n\npopulation \n\n\n\nSPO 09 S Surini Diclofenac Sustained Release Tablets using Novel \n\n\n\nCoprocessed Excipients of Crosslinked-Amylose and Xanthan \n\n\n\nGum as Matrix \n\n\n\nSPO 10 S Thubthimthed Research and Development of Weight Loss Product with \n\n\n\nLipase Inhibitory Activity \n\n\n\nSPO 11 RA Rosdi The effect of CYP2C9 polymorphisms: Orang Asli Jahai is \n\n\n\npoor metabolizer to warfarin compared to Malay in Malaysia \n\n\n\nSPO 12 B Gowramma Stability Indicating Chiral HPLC Method for the Estimation of \n\n\n\nZaltoprofen Enantiomers in Pharmaceutical Formulations \n\n\n\n\n\n\n\n\n\n\n\nPhytopharmacy & Pharmacopeia \n \n\n\n\nNo Presenting Author Title \n\n\n\nPPO 01 FV Arce Jr Antioxidant Activity of Philippine Jasmine Jasminum Sambac \n\n\n\nLinn, (1789) Leaf Extract using 2,2-Diphenyl-1-Picrylhydrazyl \n\n\n\n(DPPH) Free Radical Scavenging Assay \n\n\n\nPPO 02 E Sasmito Polysaccharide-Rich Fraction of Noni Fruit (Morinda citrifolia \n\n\n\nL.) as Doxorubicin Co-Chemotherapy: Evaluation on Catalase, \n\n\n\nMacrophage, TCD8+ Lymphocyte, Vero, HeLa and T47D \n\n\n\nCells \n\n\n\nPPO 03 E Lukitaningsih Macronutrients Content, Glycaemic Index and Anti-\n\n\n\nUlcerogenic Effect of Ganyong (Canna edulis Ker.) \n\n\n\nPPO 04 G Subramanian Simultaneous Estimation of Quercetin and Rutin in Aganosma \n\n\n\ndichotoma [Roth] K. Schum by HPLC Method \n\n\n\nPPO 05 S Patil Phytosomes: A Valuable Phyto-Phospholipid Carriers \n\n\n\nPPO 06 P Ahmadi Pirshahid Determination of Cordycepin in Cordyceps militaris (Linn.) \n\n\n\nPPO 07 S Pramono Effect of Piperine, Piperine Free Non-Hexanic Fraction of \n\n\n\nEthanolic Extract of Piper retrofractum Vahl on Sexual \n\n\n\nBehavior, Blood Testosterone Level, and Sperm Quality of \n\n\n\nWistar Male Rats \n\n\n\nPPO 08 GLL See The Anti-Mutagenic Activity of Labanos Raphanus sativus L. \n\n\n\nvar. Longipinatus Vegetable Juice on Male Albino Mice \n\n\n\nPPO 09 S Patil Ethosome: A Versatile Tool for Novel Drug Delivery System \n\n\n\nPPO10 Rumiyati Screening of Ribosome-Inactivating Proteins (Rips) from \n\n\n\nIndonesian Fruits and Vegetables and Effect of Processing on \n\n\n\nits Stability \n\n\n\nPPO 11 SM Florano In Vivo Haemostatic Activity Screening of the Decoction of \n\n\n\nthe Peel of Musa Errans (Blco.) Teod. Var. Botoan Teod. on \n\n\n\nSprague-Dawley Rats \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nPharmacy Education and Student Affairs \n \n\n\n\n\n\n\n\nPharmaceutical Legislation, Ethics and Regulatory Affairs \n\n\n\n\n\n\n\nNo Presenting Author Title \n\n\n\nPLO 01 M Fan Trial Plan for Prescription Release from Primary Care \n\n\n\nPLO 02 NA Mahmood Knowledge, Attitude and Perceptions of Pharmacists in \n\n\n\nGovernment Service Towards Adverse Drug Reaction \n\n\n\nReporting in Kelantan \n\n\n\nPLO 03 XR Tan A Randomized Controlled Study on Compliance towards \n\n\n\nMASA 1956 among Retail Pharmacists in Sabah \n\n\n\nPLO 04 J Jackson The Policy Framework that Supports Community Pharmacists\u2019 \n\n\n\nPractice   \n\n\n\nNo Presenting Author Title \n\n\n\nPEO 01 AN Mariani Cyberjaya University College of Medical Sciences (CUCMS) \n\n\n\nPharmacy Graduates Career Choices \n\n\n\nPEO 02 J Jazul Self-Medication Practice Among Allied and Non-Allied Health \n\n\n\nStudents of the University of Santo Tomas, Manila, Philippines \n\n\n\nPEO 03 SW Lee Enhancing Pharmacy Students Learning with Audiovisual \n\n\n\nEducational Tool on Issues Regarding Generic Medicines \n\n\n\nPEO 04 PN Yeoh Perceptions, General Health Knowledge and Health-seeking \n\n\n\nBehaviour of Outpatients in Two Chinese Medicine Treatment \n\n\n\nCentres in Kuala Lumpur \n\n\n\nPEO 05 RM Elkalmi Design and Evaluation of the Pharmacovigilance Course in a \n\n\n\nPharmacy School (Kulliyyah) In Malaysia \n\n\n\nPEO 06 RAT Oli Curricular Directions for a B. S. Pharmacy Course in Response \n\n\n\nto the K-12 Program \n\n\n\nPEO 07 SQ Jamshed Students\u2019 Views about Problem-Based Learning Facilitators: A \n\n\n\nQualitative Insight \n\n\n\nPEO 08 JML Magno The Relationship of the Pharmacy Licensure Examination \n\n\n\nScores with the University of Santo Tomas Entrance Test \n\n\n\n(USTET) IQ Scores, Course Preference and General Weighted \n\n\n\nAverage (GWA) of Pharmacy Students of the University of \n\n\n\nSanto Tomas Batches 2010 \n\n\n\nPEO 09 J Chai Qualitative Research: Recent Application to Study Patients \n\n\n\nLived-Experience of Using Insulin Treatment to Manage Type \n\n\n\n2 Diabetes Mellitus \n\n\n\nPEO 10 MA Nor Muhammad Causes of Stress and Management Approaches among IIUM \n\n\n\nPharmacy Students \n\n\n\nPEO 11 TV Narayana Pharm.D Programme in India: Changing Scenario of Pharmacy \n\n\n\nand the Pharmacist\u2019s Role \n\n\n\nPEO 12 \n\n\n\n\n\n\n\nT Sottiyotin \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nIntegrating Academic Services into Health Consumer \n\n\n\nProtection Course: A Community-Based Learning at Satit-\n\n\n\nWalailak-Pattana Community for the Fifth-year Pharmacy \n\n\n\nStudents, Walailak School of Pharmacy, Thailand \n\n\n\nPEO 13    \n\n\n\n\n\n\n\nI Kanchanaphibool           Opportunities for pharmaceutical care education in the Greater \n\n\n\nMakong Subregion: A preliminary study \n\n\n\n\n\n\n\n\nEmergency Medicine and Others \n\n\n\n\n\n\n\nNo Presenting Author Title \n\n\n\nEMO 01 A Shaharudin Effectiveness and Tolerability of Hyaluronic Acid for Chronic \n\n\n\nWounds Healing: A Systematic Review \n\n\n\nEMO 02 NJ Chong A Systematic Review of the Efficacy and Tolerability of \n\n\n\nSaccharum officinarum for Hypercholesterolemia \n\n\n\nEMO 03 T Kajsongkram Research and Development of Herbal Cosmeceutical for the \n\n\n\nPrevention of Keloid and Hypertrophics Scars \n\n\n\nEMO 04 F Shipton A Preliminary Survey of the Penetration and Application of \n\n\n\nMobile Health Apps in Malaysia \n\n\n\nEMO 05 A Vijayakumar Systematic Review and Meta Analysis on Brain Derived \n\n\n\nNeurotrophic Factor and Major Depressive Disorder: An \n\n\n\nEvidence-based approach \n\n\n\nEMO 06 Z Aziz Hydroxyethylrutosides for Signs and Symptoms of Chronic \n\n\n\nVenous Insufficiency: A Systematic Review \n\n\n\nEMO 07 WL Tang Efficacy and Tolerability of Micronized Purified Flavonoid \n\n\n\nFractions (MPFF) for Haemorrhoids: A Systematic Review \n\n\n\n \n\n\n\n\n\n\n\n\nPLENARY 1 \n\n\n\n\n\n\n\n \nPharmacists Today \u2013 Winds of Change Through the Decades \n\n\n\n\n\n\n\nDr Salmah Binti Bahri \n\n\n\nDirector of Pharmacy Practice & Development \n\n\n\nPharmaceutical Services Division, Ministry of Health Malaysia \n\n\n\n\n\n\n\nThe pharmacist profession has evolved from product-oriented to patient-oriented over the past decades. \n\n\n\nThe importance of pharmacist roles has been recognized by World Health Organisation (WHO) that led to \n\n\n\nthe resolution of the 47\nth\n World Health Assembly (WHA 47.12). Hence, the Joint International \n\n\n\nPharmaceutical Federation, FIP/WHO Guidelines on Good Pharmacy Practice (GPP)has been published \n\n\n\nto raise standards of pharmacy services and professional practice. The recent 67\nth\n World Health \n\n\n\nAssembly\u2019s resolution addressing access to bio-therapeutics (WHA 67.21) and essential medicines (WHA \n\n\n\n67.22) further highlights the roles and contributions of pharmacists towards achieving health system \n\n\n\ngoals.The main responsibilities where pharmacists\u2019 involvement or supervision is expected by the society \n\n\n\nincludes drug management and distribution, effective medication therapy management, maintain and \n\n\n\nimprove professional performance, and  contribution towards effective health-care system. However, \n\n\n\nthese roles are challenged by varied drug policies among countries, lack of competencies and consensus \n\n\n\nregarding the profession\u2019s goals, as well as resistance to broadening the pharmacist\u2019s responsibilities \n\n\n\nbeyond dispensing functions which includes pharmaceutical care in the treatment and prevention of \n\n\n\ndisease along with promotion of wellness. These challenges are amplified by the increased disease burden \n\n\n\nand escalating health care cost. Therefore, it is pivotal to recognize the priorities and engage \n\n\n\ncollaboratively with other healthcare providers and stakeholders in order to achieve present and future \n\n\n\nsocietal and pharmaceutical health needs. \n\n\n\n\n\n\n\n\n\n\n\nPLENARY 2 \n \n\n\n\n \nGlobal Innovative Strategies to Expand Pharmacists\u2019 Roles in Wellness and Sustainable Health \u2013 \n\n\n\nNow or Never: New Models of Care \n\n\n\n\n\n\n\nMr Ashok Soni OBE  \n\n\n\nPresident, Royal Pharmaceutical Society, Clinical Network Lead, NHS Lambeth Clinical Commissioning \n\n\n\nGroup, London, United Kingdom \n\n\n\n\n\n\n\nThe traditional model of community pharmacy will be challenged as economic austerity in the NHS , a \n\n\n\ncrowded market of local pharmacies, increasing use of technicians and automated technology to \n\n\n\nundertake dispensing, and the use of online and e-prescribing bear down on community pharmacies\u2019 \n\n\n\nincome and drive change. A broader role for pharmacists as caregivers will be central to securing the \n\n\n\nfuture of community pharmacy. \n\n\n\nThe NHS is engaged in an urgent search for ways to provide better standards of care in the face of \n\n\n\nunprecedented pressure on budgets, and justifiably intense scrutiny of quality. Only by adapting to the \n\n\n\nneeds of patients with long-term conditions and preventable illnesses can this be achieved. Pharmacists \n\n\n\nhave a vital role in helping the NHS make the shift from acute to integrated care, and fulfilling the \n\n\n\npressing need to do more for less. \n\n\n\n\n\n\n\n\nSome patients, carers and members of the public have access to a broader range of services and care from \n\n\n\npharmacy than the traditional dispensing and supply of medicines. Pharmacists increasingly provide \n\n\n\nservices that help people stay well and use their medicines to best effect. However, the pace of change \n\n\n\nremains slow, and financial and structural incentives are not sufficiently aligned to support it. \n\n\n\nPharmacists are working more closely with patients and healthcare colleagues in hospitals, outreach \n\n\n\nteams, patients\u2019 homes, residential care, hospices, and general practice, as well as in community \n\n\n\npharmacies. They are helping patients to manage their own conditions, providing health checks, \n\n\n\nsupporting best use of medicines, and detecting early deterioration in patients\u2019 conditions. \n\n\n\nHigh street presence and long opening hours mean that community pharmacy has the potential to play a \n\n\n\ncrucial role in new models of out-of-hours primary and urgent care. Access by pharmacists to integrated \n\n\n\npatient records will be a key enabler of this, as will the active engagement of pharmacists in local primary \n\n\n\ncare federations, networks and super-partnerships. \n\n\n\nDespite its potential, pharmacy \u2013 and particularly community pharmacy \u2013 is marginalised in the health \n\n\n\nand social care system at both local and national level. It is seen by others as a rather insular profession, \n\n\n\nbusy with its own concerns and missing out on debates and decisions in other health and social care \n\n\n\norganisations and the wider world of health policy. \n\n\n\nAlongside this, there is insufficient public awareness of the range of services pharmacists can offer. There \n\n\n\nis a pressing need to de-mystify pharmacy so that patients, the public and the rest of the health service \n\n\n\nunderstand the extent of the role that pharmacists do and can have in providing direct care. \n\n\n\nFocused, outward-looking local and national leadership of pharmacy will be needed to change this. \n\n\n\nLeaders within pharmacy need to work with national and local commissioners and providers of other care \n\n\n\nservices to ensure a shift in the balance of funding, contracts and service provision away from dispensing \n\n\n\nand supply, towards using the professional expertise of pharmacists to enable people to get the most from \n\n\n\ntheir medicines and stay healthy. \n\n\n\nTo enable such a shift, there will be a need for a significant rethink of the models of care through which \n\n\n\npharmacy is delivered, as a prerequisite to developing new approaches to contracting and funding that \n\n\n\ninclude: the possibility of specific contracts with groups of pharmacists to deliver patient services; and \n\n\n\npopulation-based contracts for new larger primary care organisations that include pharmacists in their \n\n\n\nmembership along with GP s, nurses and others. \n\n\n\n\n\n\n\n\n\n\n\nPLENARY 3 \n \n\n\n\n \nPharmacy Transformation Plan in Malaysia:  Expanding Pharmacists\u2019 Roles in Wellness and \n\n\n\nBetterment of Health Outcomes \n\n\n\n\n\n\n\nMdm Abida Haq Syed M Haq \n\n\n\nChief Pharmacist, Kuala Lumpur Hospital, Ministry of Health Malaysia \n\n\n\n\n\n\n\nWhile it is widely acknowledged that Malaysia has a good healthcare system, escalating costs and the \n\n\n\nneed to ensure a sustainable system have necessitated the formulation of a health transformation plan for \n\n\n\nthe future of the country. The Country Health Plan as outlined in the 10th Malaysia Plan 2011-2015 aims \n\n\n\nto create a seamless effective, efficient, fair and high-tech system of health care which will further \n\n\n\nimprove access to various levels of appropriate health care to all Malaysians. Three Key Result Areas \n\n\n\n\n\n\n\n\nhave been identified for the health sector reform which include ensuring Universal Access to Healthcare, \n\n\n\nHealth Awareness & Healthy Lifestyle and Empowerment of the Individual and Community to be \n\n\n\nresponsible for their health. Pharmacists, both in the public and community setting, are well positioned to \n\n\n\ncontribute towards achievement of these goals through a paradigm shift in the role played by pharmacists \n\n\n\ntoday in health care delivery. \n\n\n\n\n\n\n\nPharmacists in Malaysia are actively involved in clinical services, primary care, drug addiction programs, \n\n\n\nsmoking cessation clinics and wellness campaigns. These collaborative and synergistic efforts that \n\n\n\ncompliment physician services have led to evidence based positive health outcomes and better acceptance \n\n\n\nof pharmacists as key players in the health care team. \n\n\n\n\n\n\n\nThis paper will outline findings from local studies and national data which demonstrate the contribution \n\n\n\nof pharmacists in achieving better health outcomes in diabetes management, warfarin clinics, methdone \n\n\n\nreplacement therapy and weight management programs. \n\n\n\n\n\n\n\n\n\n\n\nPLENARY 4 \n \n\n\n\n \nChanges in the Community Pharmacy Services in the Philippines: Assurance for Better \n\n\n\nSustainability \n\n\n\n\n\n\n\nMs Leonila Macuto-Ocampo \n\n\n\nImmediate Past President, Philippine Pharmacists Association, Inc. \n\n\n\nPresident, Asia Pacific Institute for Medication Management, Inc. \n\n\n\n\n\n\n\nCommunity Pharmacy is the most common and the most accessible place for patients and clients who \n\n\n\nneed medicines; the way it serves the patient or client therefore is crucial to allow the optimum outcomes \n\n\n\nof the medicines the patients buy and will take. These Community Pharmacies practically sell the same \n\n\n\nproducts that what can spell the difference between one with the other is the quality of the products and \n\n\n\nthe services that they offer.  \n\n\n\n\n\n\n\nIn the Philippines where there is no law that limits the number of branches a Chain Pharmacy operates, \n\n\n\ncompetition is so stiff and the business is spread widely. Services rendered by majority of the pharmacies \n\n\n\nalso do not demonstrate pharmaceutical care services given to the client or the buying public. The \n\n\n\nPharmacies therefore are perceived to do just plain trading of medicines and people do not expect \n\n\n\nanything more that the Pharmacy nor the Pharmacist is to serve them.  \n\n\n\n\n\n\n\nWith the ASEAN integration fast approaching, Pharmacists and Pharmacy Operators have no choice but \n\n\n\nto think of how they can improve their operations and services. Non-Pharmacists owners are also seeking \n\n\n\nassistance to improve their services. It is on this note that this presentation is prepared; to share some of \n\n\n\nthe changes happening in the country giving particular focus on optimizing health outcomes and patient \n\n\n\nsafety through safe and responsible use of medicines. This too, is to protect and ensure business viability. \n\n\n\nThis is therefore to introduce the idea of Pharmapreneurship and will also tackle the challenges \n\n\n\nencountered as practice changes is undertaken and how these challenges are resolved or addressed. \n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nPLENARY 6 \n \n\n\n\n \nThe Trend of Pharmacy Profession in Asia \n\n\n\n\n\n\n\nProf Dr Chomchin Chantaraskul  \n\n\n\nThailand \n\n\n\n\n\n\n\nThe mission of pharmacy profession is to provide the pharmaceutical care needs of the public.  Pharmacy \n\n\n\nis practiced in a wide range of settings: community pharmacies, hospitals, the pharmaceutical industry, \n\n\n\nmanaged care, and government (Food and Drug Administration, Public  \n\n\n\nHealth Service).Historically, pharmacy profession was very much related to the pharmacy education and \n\n\n\npharmaceutical care requirements. There were a lot of changes in pharmacy education and pharmacy \n\n\n\npractices in the past 40 - 50 years. In the early period, most of the Asian countries had to import finished \n\n\n\nproducts from Europe or U.S.A.  The major roles of pharmacists were, therefore, on the fields of \n\n\n\ncommunity pharmacy and industrial pharmacy.  The curriculum was emphasized on techniqueof \n\n\n\npreparing as well as dispensing drugs and medicines. \n\n\n\n\n\n\n\nAt present, the scope of pharmacy practice includes not only traditional role but also includes more \n\n\n\nmodern services related to health care, including clinical services, reviewing medications for safety and \n\n\n\nefficacy, and providing drug information.  In the future, if we look at the changes in pharmacy education, \n\n\n\nthe trend of pharmacy profession will be mostly on the field of pharmaceutical care.  Pharmacists are \n\n\n\nexpected to become more integral within the health care system and increasingly expected to be \n\n\n\ncompensated for their patient care skills as well. In particular, Medical Therapy  \n\n\n\n\n\n\n\nManagement (MTM) includes the clinical services that pharmacists can provide for their patients.  Other \n\n\n\nnew trends of pharmacy practices may include Nuclear Pharmacy, Internet Pharmacy, and Biopharmacy. \n\n\n\nIn order to cope with this new trend, pharmacists must be competent, trustworthy, care for and about their \n\n\n\npatients. \n\n\n\n\n\n\n\n\n\n\n\nPLENARY 7 \n \n\n\n\n \nHealth and Environment Changes: The Role of Pharmacists in Enhancing the Development of \n\n\n\nSustainable Health  \n\n\n\n\n\n\n\nDr Aktheruzaman Sano \n\n\n\n\n\n\n\nThe impact of climate change on human health has been critically increasing. The human induced \n\n\n\nactivities mainly political issues, deforestation, fragmented development activities, increased population, \n\n\n\nusing chemicals in different levels of activities etc. have been worsening the health environment \n\n\n\nconsiderably.  \n\n\n\n\n\n\n\nEach and every environmentally unfriendly activity is impacting the health situations in different ways. \n\n\n\nThere are some impact human is experiencing directly and there some negative impacts are experiencing \n\n\n\nat different levels. The poor are the highly affected people\u2019s group who are paying for these changes. \n\n\n\n \n\n\n\n\n\n\n\n\nDue to weak and sick health condition, the people\u2019s contribution in sustainable development fields is \n\n\n\nlimited. As a result, the upcoming UN sustainable development goal achievement may face higher \n\n\n\nchallenges.  \n\n\n\n\n\n\n\nIn order to enhance the sustainable development processes, there is a need of sustainable health for all.  \n\n\n\n\n\n\n\nThere are different professionals have been adding value for sustainable health facilities. But the specific \n\n\n\nroles of pharmacists\u2019 are something greater than many great efforts in achieving the sustainable health to \n\n\n\nadd value to the sustainable development processes. \n\n\n\n\n\n\n\nThe presentation \u201cHealth and Environment Change: The Role of Pharmacists in Enhancing Development \n\n\n\nof Sustainable Health\u201d outlines doable mechanism how to make it happen.   \n\n\n\n\n\n\n\n\n\n\n\nPLENARY 8 \n\n\n\n\n\n\n\n \nInnovative Pharmacy Practice through Cutting Edge Robotic Technology \n\n\n\n\n\n\n\nMr Gerard Stevens \n\n\n\n\n\n\n\nMedication compliance is well known to be a major problem with loads of research showing that about \n\n\n\n50% of medications prescribed are no longer being taken as they were prescribed after 6 months. This is a \n\n\n\nstartling figure that also demonstrates that there is much room for improvement and pharmacists are best \n\n\n\nplaced to lead positive action. Services tied to \u2018medication optimisation\u2019, is where pharmacists can make \n\n\n\ntheir greatest contribution to community health. \n\n\n\n\n\n\n\nIt has been said that pharmacists have hard-earned qualifications and skills that are the least utilised when \n\n\n\ncompared to all the professions. Combining that with the fact that pharmacists are the most accessible and \n\n\n\nvisited health professional makes for a potent value proposition.  \n\n\n\n\n\n\n\nIn difficult times and in order to maintain profitability, or even viability, pharmacy needs to extend its \n\n\n\nprofessional and commercial boundaries. \n\n\n\n\n\n\n\nA medication management system such as Webster-pak can help a patient achieve a better health outcome \n\n\n\nthrough compliance with the medication prescribed by the doctor.  Such a system can be labour intensive. \n\n\n\nThe outcome from improved compliance however is improved customer loyalty and better health \n\n\n\noutcomes, with older people able to remain independent and stay at home for longer. \n\n\n\n\n\n\n\nEfforts over time to reduce the workload and yet maintain the full benefits to the consumer have led to \n\n\n\ndevelopment of robotic packing machines to assist in the packing process. These technology advances are \n\n\n\nproving extremely valuable to pharmacy. High accuracy combined with productivity improvements and \n\n\n\nlower risk reduces costs and makes the service more readily available. \n\n\n\n\n\n\n\nThe session today will focus on the development of this new technology that makes robotics and semi-\n\n\n\nautomated systems viable for a community pharmacy as well as hospital pharmacy. \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nSYMPOSIUM S1 \n \n\n\n\n \nSafety Management in Medication Use System- Experience of a Medical Center in Taiwan \n\n\n\n\n\n\n\nDr Yueh-Ching Chou\n \n\n\n\nDirector of Pharmacy, Taipei Veterans General Hospital, Taiwan \n\n\n\nNational Yang-Ming University & Taipei Medical University, Taiwan \n\n\n\n\n\n\n\nThe medication use system holds a complex process comprised of the following components: \n\n\n\nprocurement/storage, prescribing, prescription verification, dispensing/preparation, administration, and \n\n\n\nmonitoring. In recent decades, hospitals in Taiwan actively promote implementation of safeguard systems \n\n\n\nin each stage of the medication use process. Taipei Veterans General Hospital (VGH), a national level \n\n\n\nmedical center, was the first in Taiwan to utilize computerized physician order entry (CPOE) system since \n\n\n\n1983. The presentation will take the safeguard systems of Taipei VGH as an example to describe safety \n\n\n\nfeatures in medication use processes.  \n\n\n\n\n\n\n\nFor medication storage, inventory control is achieved by the computerized bar-code system. We also \n\n\n\nestablish guidelines for high alert/look-alike sound-alike medications. For prescribing, we develop more \n\n\n\nthan 20 error-proofing mechanisms on the CPOE/clinical decision supporting system. We embed useful \n\n\n\ninformation database in CPOE system including formulary, package inserts, drug appearances, drug \n\n\n\nclassification lists, clinical indications, and drug substitution lists for on-time inquiry. In addition, we \n\n\n\nintegrate warning and interception mechanisms including duplications, maximum doses, interactions, \n\n\n\ninappropriate splitting, pregnancy, contraindications, allergies, serious adverse drug reactions, etc. We set \n\n\n\nup electronic medication error and adverse drug reaction reporting systems to detect and correct errors, \n\n\n\nand encourage changes to reduce the potential for future errors. We employ quality management \n\n\n\nindicators to continually improve systems and ensure quality of pharmacy practice. We shall make every \n\n\n\neffort to fulfill our visions of being a world leading center for pharmaceutical care services, education and \n\n\n\nresearch. \n\n\n\n\n\n\n\n\n\n\n\nSYMPOSIUM S2 \n \n\n\n\n \nApplication of a Drug-Interaction Detection Method to the Korean National Health Insurance \n\n\n\nClaims Database \n\n\n\n\n\n\n\nProf Wan Gyoon Shin \n\n\n\nCollege of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, \n\n\n\nSeoul, South Korea \n\n\n\n\n\n\n\nAdverse drug reactions (ADR) are becoming serious problems causing damage to patients even leading to \n\n\n\ndeath. To prevent ADRs, It has been investigated whether the compound causes severe problems to the \n\n\n\npatient and what extent not only during investigation process but after marketing. However, though \n\n\n\nmassive amount of ADR data had been piling up, it was too time-consuming for clinicians to analyze \n\n\n\nevery single ADR report. But with the improved processing power of the computers and their \n\n\n\naccessibility, computers have made it possible to analyze ADR reports. It has been proven that massive \n\n\n\ndata analysis is useful in many different fields, from economics to genetics. The Uppsala Monitoring \n\n\n\nCenter (the UMC) initiated handling ADR reports by using computers. The source of the UMC is the \n\n\n\nreport written when ADRs of a drug occurred in clinical practice. However, we have researched on using \n\n\n\n\n\n\n\n\nadministrative data as a source of detecting ADRs. Studies on the model drugs were done by different \n\n\n\nanalysis methods. It was found that some of the signals of the model drugs were concordant with known \n\n\n\nADRs, but other signals occurred that were not suspected as ADRs let administrative data remain as an \n\n\n\nincomplete ADR source. Further studies on other drugs by different methods are needed to evaluate the \n\n\n\npossibility on utilizing insurance database as a source of detecting ADRs \n\n\n\n\n\n\n\n\n\n\n\nSYMPOSIUM S3 \n \n\n\n\n \nTrends of Pharmacy Education and Trainings in Asia: Proper Transformation or Not? \n\n\n\n\n\n\n\nAssoc Prof Cheung Hon-Yeung\n \n\n\n\nDepartment of Biomedical Sciences, City University of Hong Kong, Kowloon Tong, Hong Kong SAR, \n\n\n\nCHINA \n\n\n\n\n\n\n\nThis talk will go through some important breakthroughs in pharmaceutical research, contemporary trends \n\n\n\nin pharmaceutical education and people\u2019s expectation for tertiary education from the view of local society \n\n\n\nor country in recent years. Some of the major challenges facing the pharmacy trainings and practices will \n\n\n\nbe listed and described. Based on the projection of some changes in the near future, this speaker believes \n\n\n\nthat to be successful in the long run, pharmacy education will need to be slightly different from today in \n\n\n\nthe way that they are offered and operated. By accompanying with well-defined trainings and strategies \n\n\n\nimplemented, it may provide students admitted to the pharmacy program with more competitive strength, \n\n\n\ninfluential role and a more prosperous future in our modern society. \n\n\n\n\n\n\n\n\n\n\n\nSYMPOSIUM S4 \n \n\n\n\n \nRe-Emerging Role of Industrial Pharmacist on Vaccine Delivery \n\n\n\n\n\n\n\nProf Garnpimol C. Ritthidej\n \n\n\n\nDepartment of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmaceutical Sciences, \n\n\n\nChulalongkorn University, Thailand \n\n\n\n\n\n\n\nThe emerging pathogenic diseases have become increasing with alarming rate. The phrase \u201cprevent is \n\n\n\nbetter than cure\u201d is truly applied to vaccination that global vaccine market is rapidly grown and vaccine is \n\n\n\nbecoming an engine for the pharmaceutical industry. The advancement in the knowledge of pathogenic \n\n\n\ndiseases now leads scientists especially biotechnologists to dedicate towards the production of antigens \n\n\n\nwhether as whole (live or killed), subunit, conjugate and DNA/recombinant vector to be used as vaccines \n\n\n\nin order to stimulate immune systems for protection, amelioration or therapy of any disease or infection. \n\n\n\nIn addition, industrial pharmacists especially the R&Ds are becoming to involve in vaccine delivery. Due \n\n\n\nto several disadvantages of parenteral vaccination, new routes of administration are now sought such as \n\n\n\noral, nasal pulmonary and transdermal routes. Because liquid vaccines are prone to instability, lyophilized \n\n\n\nand spray-freeze drying products are under intensive investigation, not only to improve vaccine stability \n\n\n\nbut also preference for distribution and transportation. Since the subunit and DNA/recombinant vector \n\n\n\ntypes of vaccines have lower severe side effects, so is their efficacy. Therefore, adjuvants are incorporated \n\n\n\nto provoke higher immune response. The advanced knowledge on pharmaceutical carriers is of \n\n\n\nadvantages to vaccine delivery. Several nano/microparticulate systems are under investigation as \n\n\n\n\n\n\n\n\nadjuvants and some are already in commercialized vaccines.  Moreover, strict requirement on GMP of \n\n\n\nbiological products has been recently launched from healthcare institutions and called for special \n\n\n\nattention. Thus, the role of pharmacists, both services and industry in this particular field is increasing \n\n\n\nimportant, as vaccines are drug products which are pharmacists\u2019 responsibility. \n\n\n\n\n\n\n\n\n\n\n\nSYMPOSIUM S5 \n \n\n\n\n \nPharmacy Education and Practices in Asia \u2013 Strategies to Improve the Quality and Sustainability \n\n\n\nin Pharmaceutical Care \n\n\n\n\n\n\n\nProf Dr Syed Azhar Syed Sulaiman \n\n\n\nSchool of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia \n\n\n\nPharmacy education has become one of the most top selected professions around the world. Vital changes \n\n\n\nin education system are expected to create the future graduates who are competent, proficient, highly skill \n\n\n\nin communication and IT savvy. Modernization is essential for pharmacy education however it should not \n\n\n\nbe to the extent of losing it basics purpose. In Asia harmonization of pharmaceutical education has to be a \n\n\n\nglobal agenda that will encompass the developments that have taken place in serving the needs and \n\n\n\nexpectations of society.  Certain elements of education structure must be in place to provide quality \n\n\n\npharmaceutical care for the graduates to practice once there are in the healthcare systems. Some of these \n\n\n\nelements are included knowledge, skill, and function of personnel, ability to extract data from the practice \n\n\n\narea for documentation, and transfer of information, efficient work flow processes, excellent \n\n\n\ncommunication skills, and ability to establish quality improvement and assessment procedures.  To \n\n\n\nachieve the goal of Pharmaceutical Care, the education system in each country is expected to fulfil such \n\n\n\nneed in order to optimize the patient's health-related quality of life, and achieve positive clinical \n\n\n\noutcomes, within realistic economic expenditures. Lots of challenges and barriers exist in developing \n\n\n\nsustainability of pharmacy education and practices among the countries in Asia. Variations are to be \n\n\n\nexpected in pharmacy education in various countries around Asia , however it should be at certain \n\n\n\nstandard in order to fulfil the expectation of the public in healthcare system. The educational and research \n\n\n\nactivities should be cultivated among the universities and collaboration with other health is very pertinent \n\n\n\nto create the environment that is conducive for pharmaceutical care to take place. \n\n\n\n\n\n\n\n\n\n\n\nSYMPOSIUM S6 \n \n\n\n\n \nPharmacists and Sustainable Knowledge on Medication Safety  \n\n\n\n\n\n\n\nMs Lita Chew \n\n\n\nChief Pharmacist, Ministry of Health Singapore \n\n\n\n\n\n\n\nMedication Safety is a global concern for both healthcare providers and consumers. Medication error is a \n\n\n\nmajor cause of preventable patient harm. The scale of medication related incidences has been studied in \n\n\n\nmany epidemiologic studies. The Institute of Medicine in the United States reported estimation of 1 \n\n\n\nmedication error per hospitalized patient per day in the United States and 1.5 million preventable adverse \n\n\n\ndrug events per year in the United States.  \n\n\n\n \n\n\n\n\n\n\n\n\nMedication use has become increasingly complex and safe medication use remains a challenge. \n\n\n\nChallenges to current medication safety practice include under-reporting of medication errors and adverse \n\n\n\ndrug reactions, lack of training, lack of communication between providers and patients, and high \n\n\n\nworkloads. Suggestions for improvement include continuous education and competency assessment \n\n\n\nfocusing on medication safety, development of a culture that encourages medication error and adverse \n\n\n\ndrug reactions reporting, use of technology proven to decrease medication errors, and promotion and \n\n\n\nimplementation of national patient safety initiatives. \n\n\n\n\n\n\n\nPharmacists, as health-care workers, have important roles in making medication use safe. As medication \n\n\n\nexperts we are uniquely qualified to serve as medication safety leaders. These roles include leadership in \n\n\n\ninfluencing practice change, development and implementation of proactive error-prevention strategies, \n\n\n\neducation and research. \n\n\n\n\n\n\n\n\n\n\n\nSYMPOSIUM S7 \n \n\n\n\n \nA Validated NMR-Based Identification of Discriminatory Urine Metabolome of Rats with Low and \n\n\n\nHigh Sperm Count Following Oral Treatment Of EurycomaLongifolia Extracts \n\n\n\n\n\n\n\nForough Ebrahimi\n1\n, Baharudin Ibrahim\n\n\n\n1\n, Chin-Hoe Teh\n\n\n\n2\n, Vikneswaran Murugaiyah\n\n\n\n1\n, Kit Lam \n\n\n\nChan\n1\n \n\n\n\n1\nSchool of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia  \n\n\n\n2\nBruker Malaysia Sdn Bhd, Selangor, Malaysia \n\n\n\n\n\n\n\nThe roots of Eurycomalongifolia, locally called Tongkat Ali are traditionally used to improve male libido \n\n\n\nand fertility. The quassinoids indigenously found in E. longifolia have been reported to increase \n\n\n\ntestosterone steroidogenesis and spermatogenesis in rats. Presently, a validated NMR-based spectroscopic \n\n\n\nmethod was applied to analyse the rat urinary metabolome related to the sperm count level. Three groups, \n\n\n\ncomprising six Sprague-Dawley rats each, were administered with E. longifolia water extract (TAW) of 6 \n\n\n\nfold TAF273 concentration, quassinoid-poor extract (TAQP), and quassinoid-rich extract (TAF273), \n\n\n\nwhich were HPLC standardised for eurycomanone, 13,21-dihydroeurycomanone and 13\u03b1(21)-\n\n\n\nepoxyeurycomanone, the major quassinoids. The groups including a control group of six rats given water \n\n\n\nalone were orally administered daily for 48 days. The urine samples of post-treatment were analysed for \n1\nH-NMR, J-res. and HSQC spectroscopies, using a Bruker Avance III 500 MHz spectrometer at probe \n\n\n\ntemperature of 300 K.  At the end of treatment, the animals were sacrificed for sperm count analysis \n\n\n\nfollowing the WHO method. Their urine profiles were categorized into groups of normal and high sperm \n\n\n\ncount. A significant increase (p < 0.05) in sperm count was observed in both TAF273- and TAW-treated \n\n\n\ngroups over those of TAQP-treated and control groups. The OPLS-DA model (R\n2\nX = 0.9516, Q\n\n\n\n2\n= \n\n\n\n0.8247) indicated a clear separation of outliers related to sperm count amongst the urine profiles. The \n\n\n\ndiscriminatory metabolites detected in VIP plot were quantified and showed high concentration of \n\n\n\ntrigonelline and 3-methylhistidine in the urine of TAF273 and TAW-treated groups. In contrast, the \n\n\n\nurinary metabolite, ethanol displayed higher concentration in TAQP-treated and control groups, but lower \n\n\n\nconcentration for TAF273 and TAW-treated groups. In conclusion, the \n1\nH-NMR urine spectral analysis \n\n\n\nmay provide some reliable metabolome markers for non-invasive prediction of male infertility.  \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nSYMPOSIUM S8 \n \n\n\n\n \nSocial Pharmacy Education and Research: The Needs and Challenges in Asia  \n\n\n\n\n\n\n\nAssoc Prof Dr Mohamed Azmi Ahmad Hassali\n \n\n\n\nSchool of Pharmaceutical Sciences, Universiti Sains Malaysia, Minden, Penang, Malaysia. \n\n\n\n\n\n\n\nThe practice of pharmacy, and consequently, the pharmacy curriculum has undergone significant change \n\n\n\nover the years in response to a rapidly changing economic, political and social environment. Within this \n\n\n\ncontext, the role of the pharmacist now includes more direct interaction with the public in terms of the \n\n\n\nprovision of health information and advice on the safe and rational use of medications. In order to carry \n\n\n\nout this function effectively within the society, future pharmacists need to be well prepared on how to \n\n\n\ndeal with patients\u2019 behaviour and psychology. Understanding of patients\u2019 behaviour and psychology are \n\n\n\nparamount in order to achieve good outcomes from medication therapy. The concept of behavioural \n\n\n\nsciences and health psychology are embedded as the fundamental foundation of the field of social \n\n\n\npharmacy and it is imperative that this field need to be taught and nurtured to the future pharmacy \n\n\n\npractitioners. In tandem with the need for future pharmacists to be exposed to issues in social pharmacy, \n\n\n\nmany pharmacy schools around the world had adopted this subject to be part of their standard curriculum. \n\n\n\nSimilarly, in current pharmacy education scenario in Asia Pacific region, the adoption of social pharmacy \n\n\n\nsubjects in pharmacy curriculum is taking it own pace. In Malaysia, efforts had been taken to incorporate \n\n\n\nsocial pharmacy subjects in undergraduate pharmacy education since 1995. Beside undergraduate \n\n\n\neducation, there is a dire need to establish research component in the field social pharmacy in order to \n\n\n\ngenerate evidence based data for advocating health policy changes. As the field continues to grow, there \n\n\n\nis a need to train both local and international postgraduate in the field. In this presentation, the experience \n\n\n\nfrom the Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, \n\n\n\nUniversiti Sains Malaysia (USM) in establishing social pharmacy education and research will be \n\n\n\ndiscussed.  \n\n\n\n\n\n\n\n\n\n\n\nSYMPOSIUM S10 \n \n\n\n\n \nImpact of Medication Therapy Adherence Clinic (MTAC) Service on Type 2 Diabetes Patients: The \n\n\n\nMalaysian Pharmacists' Experience \n\n\n\n\n\n\n\nMr Navin Kumar Loganadan\n \n\n\n\nMinistry of Health, Malaysia\n \n\n\n\n\n\n\n\nType 2 Diabetes Mellitus (T2DM) become a major healthcare burden in the world. According to Ministry \n\n\n\nof Health (MOH), Malaysia in 2011, the prevalence of T2DM among Malaysian adults of over 30 years \n\n\n\nhave increased remarkably from 14.9% in 2006 to 20.8% in 2011. Medication Therapy Adherence Clinic \n\n\n\n(MTAC) conducted by pharmacists in the MOH hospitals and health clinics in Malaysia in collaboration \n\n\n\nwith the physicians. This program which was introduced by the Pharmaceutical Services Division of \n\n\n\nMOH in 2006 is aimed to improve patients\u2019 knowledge of disease and medication taking behaviour to \n\n\n\nimproved clinical outcomes. T2DM patients with poor medication adherence and poor glycemic control \n\n\n\nare enrolled into the clinic and monitored by the MTAC Pharmacists through scheduled follow-ups on an \n\n\n\naverage interval of 2 months. During these visits, the patients receive medication history taking, \n\n\n\nmedication adherence assessment, personalised medication counselling and diabetes education from the \n\n\n\npharmacists as outlined in the MTAC Diabetes Protocol. The diabetes education is also done using 4 \n\n\n\n\n\n\n\n\nstandardised MTAC Diabetes modules which provides patients with knowledge and understanding of \n\n\n\ntheir disease and medications, importance of medication adherence, functions of medications and \n\n\n\ncomplications of diabetes in an easy to understand manner. Regular feedbacks are given to the patients\u2019 \n\n\n\ntreating physicians on patients drug related problems and medication adherence status. A multicentre \n\n\n\nstudy on 155 Type 2 Diabetes patients who underwent pharmacist run MTAC Diabetes clinics in 10 \n\n\n\nMOH hospitals across Malaysia showed improvements in medication adherence and HbA1c reduction of \n\n\n\n1.1% in 6 months. The positive findings from the studies conducted to date suggest that pharmacists play \n\n\n\nan effective and significant role in the diabetes management team comprising doctors and other healthcare \n\n\n\nprofessionals. \n\n\n\n\n\n\n\n\n\n\n\nSYMPOSIUM S11 \n \n \n\n\n\nSelective Cyclooxygenase-2 Inhibition: A Target in Cancer Prevention and Treatment \n\n\n\n\n\n\n\nDr Suphat Subongkot \n\n\n\nClinical Pharmacy Division, Faculty of Pharmaceutical Sciences, Khon Kaen University, Thailand. \n\n\n\n\n\n\n\nA major goal in the area of cancer prevention and treatment is to make rational use of defined molecular \n\n\n\ntargets in order to block carcinogenesis. Studies conducted in experimental animal models for many \n\n\n\nhuman cancers, including those of lung, skin, mammary gland, urinary bladder, colon, and pancreas, have \n\n\n\ndemonstrated that carcinogenesis often may be inhibited by the administration of a highly diverse group \n\n\n\nof biologic and chemical agents. One very promising and well-studied target is cyclooxygenase (COX)-2. \n\n\n\nInterestingly, a number of cancers appear to overexpress the COX-2 enzyme, which may play several \n\n\n\nroles in carcinogenesis. Recent clinical studies have demonstrated the effect of COX-2 inhibitors in the \n\n\n\ntreatment of familial adenomatous polyposis, a genetic disorder that increases the risk for developing \n\n\n\ncolorectal cancer. Ongoing clinical trials with COX-2 inhibitors will increase our understanding and may \n\n\n\ngive us profound insights into the general applicability of this new-targeted approach for cancer control. \n\n\n\n\n\n\n\n\n\n\n\nSYMPOSIUM S12 \n \n\n\n\n \nClinical Studies on the Neuroprotective Effects of Palm Vitamin E Tocotrienols \n\n\n\n\n\n\n\nProf Dr Yuen Kah Hay\n \n\n\n\nSchool of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia \n\n\n\n\n\n\n\nCell and animal studies have convincingly shown the tocotrienols to be neuroprotective. However, many \n\n\n\ncompounds have been proven neuroprotective in pre-clinical studies but none succeeded in human trials. \n\n\n\nSuch failures can be attributed to the use of a wrong disease model, example acute ischemic stroke, which \n\n\n\nhas a short treatment time window. Furthermore, the disrupted blood flow will limit the administered \n\n\n\nagent from reaching the target tissues. The compound should best be given before the stroke event, like in \n\n\n\nthe animal studies. Considering the above, a study was conducted to investigate the neuroprotective \n\n\n\neffects of palm vitamin E tocotrienols using human volunteers with white matter lesions (WMLs). WMLs \n\n\n\nare associated with ischemic small blood vessel disease of the brain leading to bundles of nerve fibers \n\n\n\ndegenerating. The lesions are self-progressive and can be quantified using magnetic resonance imaging \n\n\n\n(MRI). In this study, 121 volunteers with WMLs were randomized 200mg palm tocotrienols or placebo \n\n\n\ntwice daily and imaged at baseline, after 1 year and 2 years of supplementation. Results obtained showed \n\n\n\n\n\n\n\n\nthat the mean WML volume of the treated group remained essentially unchanged after 2 years, whereas \n\n\n\nthe placebo group showed a mark progression. The change in the mean WML volume of the 2 groups was \n\n\n\nsignificantly different (p<0.05) after 2 years. Based on the encouraging results, a second study is being \n\n\n\nconducted on 300 diabetic patients with peripheral neuropathy randomized placebo or 200mg tocotrienols \n\n\n\ntwice daily for one year. To date, about 150 of the patients have completed the one year and a majority \n\n\n\nshowed improvements in their total symptom score (TSS) without unblinding. An interim analysis is \n\n\n\nwarranted and may be performed soon. \n\n\n\n\n\n\n\n\n\n\n\nSYMPOSIUM S13 \n \n\n\n\n \nExpanding Pharmacists' Role in the Humanitarian and Disaster Relief (HADR) Missions\u2013 \n\n\n\nMalaysian Military Pharmacy Perspectives \n\n\n\n\n\n\n\nCol Dr A Halim Hj Basari \n\n\n\nMinistry of Defence, Malaysia \n\n\n\n\n\n\n\nThe framework of the Malaysian Military Pharmacy practice is discussed to demonstrate similarities and \n\n\n\ndissimilarities to the conventional non-military practice.  Is there really any difference?  The peacetime \n\n\n\ninvolvement of military and emergency pharmacists in missions for Humanitarian and Disaster Relief be \n\n\n\nit overseas and/or locally has gone pretty much unnoticed.  Much of their contributions have been very \n\n\n\nunconventional in nature but very important/significant to the nation.  So much so, the experiences \n\n\n\ndeserved to be shared and encouraged to other pharmacists who are in the mainstream arena of pharmacy \n\n\n\npractice.  Managing relief initiatives/missions for example, truly expand the pharmacists' role beyond its \n\n\n\nclassroom knowledge and challenge them to be creative and innovative.  Such roles definitely fit into the \n\n\n\nlong term capacity building of the nation especially so in promoting wellness and rebuilding affected area \n\n\n\nfor sustainable healthcare.  On the other hand, the wartime involvement of military pharmacists reflect \n\n\n\ntheir unique roles in making soldiers healthy and recover quickly when they are injured in pre-, during \n\n\n\nand post-deployment phases. This is n order to maintain the forces' fighting strength to overcome the \n\n\n\nenemy\u2019s initiatives.  The need to create perfect soldiers that will ensure battle success stretches the \n\n\n\nmilitary pharmacists' conventional wisdom and practice in the area of wellness and sustainable health. \n\n\n\n\n\n\n\n\n\n\n\nSYMPOSIUM S14 \n \n\n\n\n \nInfusing Quality into the Pharmaceutical Supply Chain \n\n\n\n\n\n\n\nAssoc Prof Dr Allan Mathews\n \n\n\n\nFaculty of Pharmacy and Heath Sciences, Royal College of Medicine Perak, Malaysia. \n\n\n\n\n\n\n\nThe pertinent quality assurance question to be addressed within the Pharmaceutical Supply Chain starting \n\n\n\nfrom the finished product in a Pharmaceutical Manufacturing is how much of the potency has been lost \n\n\n\ndue to the effect of environmental elements, i.e. temperature and humidity.  There are increasing demands \n\n\n\nfor higher levels of quality including preventive measures to ensure temperatures are maintained 24 hours \n\n\n\na day.  In addition, higher demands for quality now cover 7s (Sort, Simplify, Shine, Standardize, Sustain, \n\n\n\nSafety, Security); preventing trade returns of counterfeits; preventing cross contamination in distribution \n\n\n\ncentres; pest control; electrical audits to prevent fire, system failure, lightning strike; customer care logs \n\n\n\n\n\n\n\n\nto ensure service levels; ensuring one-way-line process flow from stock receiving to stock despatching; \n\n\n\ngreater emphasis on training including written assessment for participants; and proper documentation.   \n\n\n\n\n\n\n\nMost non-cold chain medicines would need a storage temperature of below 25\u00b0C but day-time \n\n\n\ntemperatures in the topics will exceed this temperature throughout the day. Although temperatures in \n\n\n\nmajor storage facilities such as the Manufacturing Facility, Distribution Centres, hospitals are monitored \n\n\n\nand documented, concerns arise during shipments in non-air-conditioned metal containers across sea \n\n\n\nchannels which can last weeks and temperatures excepted to soar when in open sea; storage in the \n\n\n\nwholesaler\u2019s store where temperature and humidity controls may not be monitored on a continuous 24-\n\n\n\nhour basis, or at the pharmacies although air-conditioned there may be inadequate documentation and \n\n\n\ncontinuous monitoring. Transportation by air-conditioned vans without thermostat control cannot ensure \n\n\n\nadherence to the temperature requirement. Some suppliers has taken the step of a non-return policy to \n\n\n\nensure quality of their products especially for cold-chain products. The current emphasis on quality \n\n\n\nappears to be focussed on major storage facilities only and not throughout the supply chain.  Temperature \n\n\n\nmonitoring devices are placed together with the products between these major storage facilities. \n\n\n\n\n\n\n\n\n\n\n\nSYMPOSIUM S15 \n \n\n\n\n \nClinical Pharmacy in Malaysia: Past, Current and Future \n\n\n\n\n\n\n\nMdm Noraini Mohamad \n\n\n\nPharmacy Clinical Unit, Pharmacy Practice & Development Pharmaceutical Services Department, \n\n\n\nMinistry of Health, Malaysia \n\n\n\n\n\n\n\nIn 1990, Hepler and Strand introduced the concept of \"pharmaceutical care\" which defines a new way to \n\n\n\nlook at the responsibilities of the pharmacist and pharmacy services. Since then, the concept has been \n\n\n\nwidely adopted and brings new dimension to the pharmacy practice. Literatures suggested that the \n\n\n\ninvolvement of a pharmacist in the evaluation of a patient's drug therapy regimen improves outcomes.  \n\n\n\n\n\n\n\nIn Malaysia, the 1980s decade already saw a change from product-oriented services to patient-focused \n\n\n\ncare. From the year 2000, the clinical pharmacy has expanded into specialised services which now \n\n\n\ninclude medication therapy adherence clinic (MTAC), critical care, cardiology pharmacy and many more. \n\n\n\nThe transformation is inevitable for pharmacy services in Malaysia to be in line with the current \n\n\n\ndevelopment worldwide. \n\n\n\n\n\n\n\nThe Pharmaceutical Services Division, MOH, is ensuring that the pharmacy services offered achieve the \n\n\n\nrequired standards and not lacking in quality. Among the measures taken include standardisation of \n\n\n\npractise and expertise development programme.  \n\n\n\n\n\n\n\nIn the year 2013, 100% ICU wards and 76.4% medical wards are filled/stationed with at least one full \n\n\n\ntime pharmacist. To ensure smooth running of clinical pharmacy service in the wards, placement of \n\n\n\npharmacist in the critical care units and medical wards of MOH hospitals has been one of the action plans \n\n\n\nset for the year 2014.  \n\n\n\n\n\n\n\nMedication Therapy Adherence Clinic (MTAC) services started in 2004 with the establishment of Renal \n\n\n\nTransplant MTAC. Currently, there are 13 types of MTAC services are offered for diabetes, warfarin, \n\n\n\nretroviral disease, respiratory diseases, nephrology, psoriasis, haemophilia, psychiatry, stroke, rheumatoid \n\n\n\narthritis and geriatrics at 660 MOH hospitals and health clinics. Clinical pharmacists in MOH are also \n\n\n\n\n\n\n\n\nactively involved in research with emphasis given on outcome-based researches which have significant \n\n\n\nimpact towards current or previous practice. \n\n\n\n\n\n\n\nThe transformation of clinical pharmacy in Malaysia continues with the direction focus on obtaining \n\n\n\nsubspecialisation and international recognition which will provide clinical pharmacists with a better \n\n\n\ncareer pathway. \n\n\n\n\n\n\n\n\n\n\n\nSYMPOSIUM S16 \n \n\n\n\n \nLiposomes Decorated Topical Drug Delivery for the Treatment of Cutaneous Leishmaniasis \n\n\n\n\n\n\n\nProf. Gul Majid Khan  \n\n\n\nDepartment of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan \n\n\n\n\n\n\n\nCurrently, several drugs/products are used for the treatment of cutaneous leishmaniasis employing \n\n\n\ndifferent treatment approaches. However, due to some critical undesired factors, including but not limited \n\n\n\nto their associated side effects, unaffordable high costs, development of severe resistance against them, \n\n\n\nregulatory issues and non-availability of such drugs/products, the treatment of this so called \u2018non-curable\u2019 \n\n\n\ndisease still remains as a big challenge. This presentation is meant to show the endeavors and \n\n\n\nachievements of my research group towards addressing of the said challenge, while exploiting the \n\n\n\npotentials of centuries old used indigenous natural products of KPK, Pakistan, alone or in combination \n\n\n\nwith tested synthetic compounds, for development of cheaper but safe and effective topical formulations \n\n\n\ncapable of carrying and retaining suitable concentrations of the target drugs for prolonged local action in \n\n\n\nthe deeper layers of the skin where the leishmanial parasites reside. In this regards, our liposomal drug \n\n\n\ndelivery systems containing curcumin in combination with amphotericin B and/or miltefosine exhibited \n\n\n\ntremendously better results with enhanced antileishmanial activity and significantly shorter duration of \n\n\n\ntreatment, both in animals as well as in human beings. We are hopeful to have a few of them as patents \n\n\n\nand also to translate them into scale-up products before coming into an agreement with a local \n\n\n\npharmaceutical industry based in Peshawar for initiation of regulatory process for large scale production.       \n \n\n\n\n\n\n\n\nSYMPOSIUM S17 \n \n\n\n\n \nPharmacy Education for Sustainable Tomorrow \u2013 Asia Experience \n\n\n\n\n\n\n\nMs Vivian WY Lee\n \n\n\n\nSchool of Pharmacy, Faculty of Medicine, Chinese University of Hong Kong (CUHK) \n\n\n\n\n\n\n\nPharmacy education is important for the training of capable future pharmacists and is crucial for the \n\n\n\nclinical pharmacy development.  We nurture our next generation to be the future leaders of our society, \n\n\n\nand young people learn and grow academically and morally. The impact of university education on the \n\n\n\ndevelopment of students for the future of society cannot be underestimated.  This is the time when they \n\n\n\nlearn how to be independent and reliable individuals.  With the advancement of technology and health \n\n\n\nmanagement, how can we better prepare our students to cope with the rapidly changing pharmacy \n\n\n\npractice?  I am fortunate to discover ways to engage my students in my teaching.  I believe that teaching, \n\n\n\nresearch and service development can co-exist.  As a teacher in the pharmacy profession, my \n\n\n\nresponsibility is to train the new generation of practicing pharmacists.   \n\n\n\n\n\n\n\n\nIn this presentation, the following topics will be discussed: \n\n\n\n1. Illustrate the changing clinical pharmacy practice and the impact on pharmacy curriculum; \n\n\n\n2. Demonstrate effective platform for not only teaching but also research and clinical service \n\n\n\ndevelopment. \n\n\n\n3. Examples of successful teaching platforms will be demonstrated. \n\n\n\n\n\n\n\n\n\n\n\nSYMPOSIUM S18 \n \n\n\n\n \nClinical Pharmacy Services in Iran: Improving Patient\u2019s Care \n\n\n\n\n\n\n\nFarshad Hashemian \nIslamic Azad University, Pharmaceutical Sciences Branch, Clinical Pharmacy Department,  \n\n\n\nTehran, Iran. \n\n\n\n\n\n\n\nIt was in 1922 that a pharmacy division was set up at the school of medicine in Tehran for the first time.  \n\n\n\nFurthermore, discipline of \u201cClinical Pharmacy\u201d has been introduced to Iranian health care system, since \n\n\n\n20years ago. It consists of a post-graduate program directed at developing specialists who provide first-\n\n\n\nclass pharmacotherapy service in areas of developing pharmacotherapy plans for patient-specific \n\n\n\nproblems, evaluating appropriateness of pharmacotherapy including drug choice, dose, route of \n\n\n\nadministration, monitoring possible drug interactions, and etc. Indeed, there have been numerous studies \n\n\n\ninvestigating the effects of clinical pharmacists\u2019 interventions on patients\u2019 outcomes. According to their \n\n\n\nresults, a significant decrease in medication cost and drug-drug interactions have been reported. \n\n\n\nAdditionally, clinical pharmacists\u2019 interventions have been reported to reduce medication errors \n\n\n\nsignificantly. Driven by the aspirations for a larger role of clinical pharmacists in health care system, \n\n\n\nIranian Society of Clinical Pharmacists tries to build inter-professional relationships with other health \n\n\n\ncare professionals with the aim of optimizing patient care and improving patient outcomes.  \n\n\n\n\n\n\n\nIf we want to pause to reflect upon clinical pharmacy services and education in the past decades, we \n\n\n\nrecognize that current level of interprofessional collaboration between clinical pharmacists and physicians \n\n\n\nin most of the cases is beyond expectation and physicians\u2019 society do support clinical pharmacists in a \n\n\n\ngood manner; thus, our momentum is moving us to the right direction.  \n\n\n\n\n\n\n\nEveryone in the pharmacy profession should take pride in the remarkable progress in pharmacy education \n\n\n\nand clinical pharmacy services provided in the last decades in the country. The vision of future would be \n\n\n\nthe ultimate interprofessional collaboration of clinical pharmacists and physicians so that the goal of \n\n\n\nenhanced patient care and outcome through interprofessional collaboration become fully realized. \n\n\n\n \n\n\n\n\n\n\n\n\nHOSPITAL AND CLINICAL PHARMACY \n \nHPO 01 \n\n\n\nFAPA2014000007 (Oral) \n\n\n\n\n\n\n\nProspective Evaluation of Clinical Pharmacy Services at a South Indian HIV Community Care \n\n\n\nCentre \n\n\n\n\n\n\n\nA Ramesh, P Prudhviraju, RVSN Datla, G Parthasarathi, SN Mothi, VT Swamy \n\n\n\n\n\n\n\nThis study was conducted to initiate and evaluate the usefulness of clinical pharmacy services at a \n\n\n\nSouth Indian HIV community care centre. The need and importance of clinical pharmacy services \n\n\n\nwere presented to the practising doctors at the study site and the clinical pharmacy services were \n\n\n\ninitiated. Cipole\u2019s classification was used to categorize the drug-related problems (DRPs) and suitable \n\n\n\nscales were used to assess the causality, severity and preventability of adverse drug reactions (ADRs). \n\n\n\nDuring the study period, 49 drug interaction (DI) queries were received and a majority of the DI \n\n\n\nrequests were made during ward rounds (47%). Most of the queries (63%) were for better patient care; \n\n\n\n41% of the queries were answered immediately (0-30 min) and usually via verbal communication. Of \n\n\n\nthe 65 interventions made during the study period, 32% (n=21) were rated as \u2018minor\u2019, 58% (n=38) as \n\n\n\n\u2018moderate\u2019 and 9% (n=6) as \u2018major\u2019. Drug interactions were the most common DRPs identified which \n\n\n\naccounted for 37% of the total DRPs. The acceptance rate of interventions was 100% and drug \n\n\n\ntherapy was changed in 98% of the cases. During the study period, a total of 176 ADRs were \n\n\n\nobserved which were associated with antiretroviral agents. Of these 176 ADRs, 53.4% were \n\n\n\nconsidered as probable and 46.6% as possible. The severity for a majority of the ADRs (95.5%, \n\n\n\nn=168) was classified as moderate in nature and the rest as mild (4.5%, n=8). Out of the 176 ADRs, \n\n\n\n139 (79.0%) were predictable. Vomiting (19.8%) and anemia (13.6%) were the most commonly \n\n\n\nobserved ADRs. The organ system most commonly affected by ADRs was the gastrointestinal \n\n\n\nsystem. In conclusion, the clinical pharmacy services (which constituted 49 DI queries, 65 \n\n\n\ninterventions, and 176 ADRs) were well accepted by the doctors in the HIV community care centre. \n\n\n\n\n\n\n\n\n\n\n\nHPO 02 \n\n\n\nFAPA2014000227 (Oral) \n\n\n\n\n\n\n\nThe Development of a Pharmacy Management Hypertension Program and Opportunities for \n\n\n\nPharmaceutical Care \n\n\n\n\n\n\n\nAM Ong\n1\n, LE Briones\n\n\n\n1\n, LW Raymundo\n\n\n\n1\n, AE Arcega\n\n\n\n1\n, PM Sigua\n\n\n\n1\n, PB Agregado\n\n\n\n1\n, ZB Corteza\n\n\n\n1\n, \n\n\n\nCG Pablo\n2 \n\n\n\n1\nFaculty of Pharmacy, University of Santo Tomas, Manila, Philippines  \n\n\n\n2\nThe Graduate School, University of Santo Tomas, Manila, Philippines \n\n\n\n\n\n\n\nHypertension (HTN) is a preventable and most important cardiovascular risk factor. According to the \n\n\n\nPhilippine Society of Hypertension, the rapid increase of patients with hypertension was associated \n\n\n\nwith poor diet, exercise and medication adherence. Pharmaceutical care provides drug therapy for the \n\n\n\npurpose of achieving the elimination of such disease. The study aims to improve the patient\u2019s \n\n\n\nlifestyle, medication adherence and knowledge with the aid of a community-based programme and \n\n\n\napplication of pharmaceutical care. The prospective cohort study consisted of five theme activities: \n\n\n\nfirst and last activity was on profiling, quality of life (SF-12) and medication adherence (Morisky \n\n\n\nscale); nutrition/DASH and drug information/interaction were the second, third was an exercise \n\n\n\nseminar and fourth was post intervention. There were 6 stations in each activity: registration, vital \n\n\n\nsigns, eye examination, theme activity, pharmacist\u2019s counselling and dispensing. Opportunities for \n\n\n\npharmaceutical care services were utilized throughout the programme. Thirty respondents (mean age \n\n\n\n= 59.5 years and 43% were males), with mostly 2-3 co-morbidities. Seven percent of the respondents \n\n\n\n\n\n\n\n\nhad normal BP, 60% with pre-HTN, 23%  at stage 1 HTN, and 10% at stage 2 HTN. In addition, 23% \n\n\n\nwere smokers and 37% were alcoholic drinkers. Post intervention showed higher medication \n\n\n\nadherence (51% of the respondents) and most of them showed improvement in physical, social, and \n\n\n\nemotional health. It was also noted that 60% had improved BP, 46% took less or avoided salt intake, \n\n\n\n44% of known alcoholic drinkers reduced alcohol consumption, and continued their active lifestyle. In \n\n\n\nconclusion, the development of a pharmacy-administered hypertension programme has improved the \n\n\n\nquality of life of patients through lifestyle modification and pharmaceutical care. Pharmacist-managed \n\n\n\nhealthcare activities provided health education and medication counselling as well as promoted \n\n\n\nmedication adherence. \n\n\n\n\n\n\n\n\n\n\n\nHPO 03 \n\n\n\nFAPA2014000211 (Oral) \n\n\n\n\n\n\n\nPrevalence and Effect of Smoking on Treatment Outcome among Tuberculosis Patients in \n\n\n\nMalaysia \n\n\n\n\n\n\n\nAH Khan\n1\n, SA Syed Sulaiman\n\n\n\n1\n, O Mateen\n\n\n\n1\n, MA Hassali\n\n\n\n2\n \n\n\n\n1\nDiscipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, \n\n\n\nPenang, Malaysia \n2\nDiscipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti \n\n\n\nSains Malaysia, Penang, Malaysia \n\n\n\n\n\n\n\nSmoking plays a key role in the development of tuberculosis (TB) infection and is also a predictor of \n\n\n\npoor TB treatment outcomes and prognosis. The aim of the present study was to evaluate the \n\n\n\nprevalence of smoking and its influence on treatment success among TB patients. A multicenter \n\n\n\nretrospective study design was adopted from January 2006 to March 2009 in four states of Malaysia \n\n\n\n(Penang, Sabah, Sarawak and Selangor) in order to collect data of TB patients. All adult patients \n\n\n\ndiagnosed with TB were included, whereas patients with missing records were excluded. A validated \n\n\n\ndata collection form was used to record patient demographic and clinical data. All the data was \n\n\n\nanalyzed by using SPSS version 20.0. All relevant ethical considerations were obtained. Out of 9337 \n\n\n\nTB patients, the prevalence of smokers was 4313 (46.2%) while 5024 (53.8%) were non-smokers. \n\n\n\nGender (p< 0.001), marital status (p= 0.005), race (p< 0.001), co-morbidity (p< 0.001) and area of \n\n\n\nresidence (p< 0.001) were significantly associated with smoking habit. Among the smoker group, \n\n\n\nmale gender (OR=1.79, 95% CI 1.64-1.96, p< 0.001), unmarried individuals (OR=1.14, 95% CI 1.04-\n\n\n\n1.24, p= 0.05), Sarawakian indigenous (OR=15.73, 95% CI 0.35-0.70, p< 0.001), presence of co-\n\n\n\nmorbidity (OR=1.85, 95% CI 1.69-2.01, p< 0.001), and urban residents (OR=1.47, 95% CI 1.35-1.60, \n\n\n\np< 0.001) were found statistically significant. Of the total 4313 smoker TB patients, 3236 (75%) were \n\n\n\nsuccessfully treated while 1077 (25%) had treatment failure. Among non-smokers TB group, 4004 \n\n\n\n(79.7%) patients had successful treatment outcome. The treatment failure rate was 1.3 times higher in \n\n\n\nsmoker TB patients as compared to the non-smokers. Smoking had a strong influence on TB and is a \n\n\n\ncontributing factor towards treatment failure (OR=1.30, 95% CI 1.18-1.44, p< 0.001). Therefore, \n\n\n\nproper action should be adopted to stop smoking among TB patients. \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nHPO 04 \n\n\n\nFAPA2014000125 (Oral) \n\n\n\nA Study on Perception of the Need and Time needed to Render Critical Ward Services by a \n\n\n\nClinical Pharmacist in Neonatal Intensive Care Unit (NICU) In Duchess of Kent Hospital, \n\n\n\nSandakan \n\n\n\n\n\n\n\nLM Chu, JL Quah, R Raihan, MAA Nik \n\n\n\nDepartment of Pharmacy, Duchess of Kent Hospital, Sandakan, Sabah, Malaysia \n\n\n\n\n\n\n\nDue to the extensive exposure to medications in NICU and lack of neonate-specific evidence on \n\n\n\npharmacotherapeutic interventions or neonate-specific formulations, neonates are highly vulnerable to \n\n\n\nmedication errors. Participation of clinical pharmacist in ward rounds twice weekly was suggested to \n\n\n\nimprove medication safety in NICU. The objective of the study was to determine the perception of the \n\n\n\nneed and benefits of NICU pharmacy service rendering pharmaceutical care, and to review the time \n\n\n\ncontribution of pharmacist in patient care. An expectation study was carried out, before the clinical \n\n\n\npharmacy service commenced in the NICU, Duchess of Kent Hospital, Sandakan. The questionnaire \n\n\n\nconsisted of eight 4-pointers questions regarding NICU pharmacy service. In addition, the clinical \n\n\n\npharmacist also documented the time and activities in the ward, when the service was started. The \n\n\n\nstudy was carried out on a total of 30 doctors and nurses. Of these participants, 93% expected the \n\n\n\npharmacist to take personal responsibility for resolving any drug-related problem. All of the \n\n\n\nparticipants regarded the pharmacist as a knowledgeable drug therapy expert, and a reliable source of \n\n\n\ndrug information. The clinical pharmacist spent most of the time on checking and documenting the \n\n\n\ndrug chart (41%), followed by drug dosage calculations (21%). Thirteen and seven percent of the time \n\n\n\nwas spent on providing drug information and stock control, respectively. In conclusion, doctors and \n\n\n\nnurses have high perception of the need and expectation towards the role of a pharmacist in the NICU. \n\n\n\nThe time spent by the pharmacist in checking the drug chart and in dosage calculations would \n\n\n\nimprove patient care.   \n\n\n\n\n\n\n\n\n\n\n\nHPO 05 \n\n\n\nFAPA2014000053 (Oral) \n\n\n\n\n\n\n\nEffectiveness of Hyperosmolar Oral Liquid Medications Guideline to Prevent Necrotizing \n\n\n\nEnterocolitis in Preterm Neonates \n\n\n\n\n\n\n\nD Yodyoi  \n\n\n\nDepartment of Pharmacy, Songklanagarind hospital, Songkhla, Thailand.       \n\n\n\n\n\n\n\nThe purpose of the study was to establish the guideline for dilution of  high osmolality oral liquid \n\n\n\nmedications which were administered to preterm neonates. Healthcare professionals\u2019 compliance to \n\n\n\nguideline and incidence of necrotizing enterocolitis (NEC) was monitored for the effectiveness. The \n\n\n\nosmolality of 20 oral liquid medications was measured using the freezing point depression method. \n\n\n\nThe medications with osmolality more than 350 mOsm/kg H20 were classified as hyperosmolar \n\n\n\nmedications. The guideline for dilution of the hyperosmolar medication was established and \n\n\n\ncommunicated to healthcare professionals  by  several methods: oral presentation, attachment of the \n\n\n\nguideline in  patient charts and  at the nursing area for  medication preparations. The incidence of \n\n\n\nnecrotizing enterocolitis in preterm patients was monitored for 1 year, between 1 September 2012 and \n\n\n\n31 August 2013  and  it was compared with the incidence of  1 year before the guideline was \n\n\n\nlaunched.   All of the oral liquid medications used in preterm neonates, except for caffeine solution, \n\n\n\nhad osmolality more than 350 mOsm/kg H2O. These included sildenafil, furosemide, Ursolin\u00ae,and \n\n\n\ndigoxin. Multivitamin drops with 8,512 mOsm/kg H2O was the highest osmolality medication. These \n\n\n\nhyperosmolar medications were put in the guideline and made recommendation to dilute with water \n\n\n\nbefore administrtion to preterm neonates. After the guideline was launched, we found that healthcare \n\n\n\n\n\n\n\n\nprofessionals complied with our guideline for all preterm neonates (95) who got the hyperosmolar \n\n\n\nmedications. The NEC incidence was decreased from 14 cases per year (2 cases were severe NEC \n\n\n\nwith surgical treatment) to 6 cases per year and no severe necrotizing enterocolitis with surgical \n\n\n\ntreatment.  All of the oral liquid medications used in preterm neonate were hyperosmolar except for \n\n\n\ncaffeine solution.  Guideline for dilution of  hyperosmolar oral liquid medications could be an \n\n\n\nalternative for severe necrotizing enterocolitis prevention in preterm neonates. \n\n\n\n\n\n\n\n\n\n\n\nHPO 06 \n\n\n\nFAPA2014000250 (Oral) \n\n\n\n\n\n\n\nSelf-medicating Behavior of Urban Pakistani Population towards Psychotropic Agents and its \n\n\n\nCorrelates \n\n\n\n\n\n\n\nF Hashmi, AR Hassaan, MZ Abdul Sattar, FK Hashmi \n\n\n\nCardiovascular and Renal Physiology Research Laboratory, Universiti Sains Malaysia, Penang, \n\n\n\nMalaysia \n\n\n\n\n\n\n\nThe increasing trend of self-medication, particularly in developing countries is associated with a large \n\n\n\nnumber of complications. Therefore, a cross-sectional study was conducted to investigate self-\n\n\n\nmedication trend in an urban community and its correlates such as educational level, gender and \n\n\n\nbehavior of using psychoactive medicines. A validated questionnaire was used to collect the data from \n\n\n\n110 individuals in different locations of Lahore, the provincial capital of Punjab, Pakistan. The \n\n\n\neducation levels of respondents included 1.82% illiterates, 13.64% primary, 34.55% secondary, \n\n\n\n16.36% higher secondary and 33.64% university level. The respondents consisted of 54.55% males. A \n\n\n\ntotal of 26.36% were found to be using psychoactive agents without consulting a physician. The trend \n\n\n\nof self-medication was 10% higher in individuals with primary education and of lower socio-\n\n\n\neconomic status. Poor medicine accessibility, religious and cultural beliefs, lack of awareness of risks \n\n\n\nof medication use, non-prescription sales and previous medication experience were also found to be \n\n\n\nresponsible for the self-medication behaviour. It is concluded from the results of this study that \n\n\n\nliterate people tend to be involved in self-medication despite knowing the side effects. Moreover, a \n\n\n\nsignificant fraction of the population is using psychotropic drugs without consulting a physician. \n\n\n\n\n\n\n\n\n\n\n\nHPO 07 \n\n\n\nFAPA2014000176 (Oral) \n\n\n\n\n\n\n\nEvaluation of Adherence and Haemoglobin Levels of Iron Tablets Use in Pregnant Women at \n\n\n\nPublic Health Centre in Purwokerto \n\n\n\n\n\n\n\nFD Anggraini, W Utaminingrum, Sudarso \n\n\n\nFaculty of Pharmacy, Muhammadiyah University of Purwokerto \n\n\n\n\n\n\n\nAnaemia in pregnant women is a major cause of morbidity in foetus and infants.  Administration of \n\n\n\noral iron tablets is to prevent iron deficiency anaemia.  Patient adherence of iron tablets can affect \n\n\n\nhaemoglobin levels in pregnant women. The aim of this study was to know the relationship between \n\n\n\nadherence and haemoglobin levels in pregnant women who consumed iron tablets. This study is an \n\n\n\nobservational study conducted by analytic study design at 5 public health centres in Purwokerto. A \n\n\n\ntotal of 66 pregnant women who required antenatal care were included in this study.  Morisky \n\n\n\nMedication Adherence Scale and pill count were used to measure patient adherence while the Sahli \n\n\n\nmethod was used to determine haemoglobin levels after the patient obtained 90 iron tablets. Chi-\n\n\n\nsquare test was used to test the hypotheses. A total of 42.4% of the patients were adherent. Based on \n\n\n\nthe examination of haemoglobin levels, a total of 59.1% were anaemic. Statistical analysis using Chi-\n\n\n\nSquare test showed a relationship between adherence and haemoglobin levels (p = 0.005). There was \n\n\n\n\n\n\n\n\na relationship between adherence and haemoglobin levels of iron tablets use in pregnant women at \n\n\n\npublic health centre in Purwokerto. \n\n\n\n\n\n\n\n\n\n\n\nHPO 08 \n\n\n\nFAPA2014000048 (Oral) \n\n\n\n\n\n\n\nClinical Pharmacy Services that Influence Prescribing in the Western Pacific Region \n\n\n\n\n\n\n\nJ Penm, B Chaar, R Moles \n\n\n\n\n\n\n\nThe Western Pacific Region (WPR) is home to approximately 1.8 billion people, more than one-\n\n\n\nfourth of the world's population. It stretches over a vast area, from China in the north and west, to \n\n\n\nNew Zealand in the south, and French Polynesia in the east. Clinical pharmacy services have recently \n\n\n\nbeen introduced into many of these countries, particularly in Asia. Services that focus on pharmacists\u2019 \n\n\n\ninfluence on prescribing have been of particular interest in this region. The aims of this study were to \n\n\n\nidentify the extent of implementation of clinical pharmacy services that influence prescribing in the \n\n\n\nWPR and also to explore the barriers and facilitators involved in their implementation. The surveys \n\n\n\nwere distributed online to hospital pharmacy directors in the WPR. Reminders were sent to non-\n\n\n\nresponders at one and three weeks after the initial invitation email was sent. Surveys were available in \n\n\n\nEnglish, Japanese, Chinese, Vietnamese, Lao, Khmer, French and Mongolian. In total, 726 responses \n\n\n\nwere received from 31 countries and nations. Nearly all hospitals, 90.6% (658/726), stated that they \n\n\n\nprovided clinical pharmacy services. From those with such services, 28% of their clinical pharmacists \n\n\n\nattended medical rounds regularly. The median percentage of inpatients receiving a medication \n\n\n\nhistory and discharge counselling by a pharmacist was 40% and 30%, respectively. Higher internal \n\n\n\nfacilitator factor scores significantly increased the likelihood to offer clinical pharmacy services and \n\n\n\nhave pharmacists attend medical rounds regularly. Higher environmental facilitator factor scores \n\n\n\nsignificantly increased the percentage of inpatients receiving a medication history, review and \n\n\n\ndischarge counselling by a pharmacist. A large proportion of hospitals in the WPR has implemented \n\n\n\nclinical pharmacy services and is regularly involved in educating prescribers. Although internal \n\n\n\nfacilitators are important for initiating such services, the addition of environmental facilitators is \n\n\n\ncrucial for them to be integrated throughout the hospital. \n\n\n\n\n\n\n\n\n\n\n\nHPO 09 \n\n\n\nFAPA2014000142 (Oral) \n\n\n\n\n\n\n\nPharmacokinetic of Rifampicin in Urban and Rural Lung Tuberculosis Patients in Bali \n\n\n\nProvince \n\n\n\n\n\n\n\nIAA Widhiartini\n1\n, IN Toya Wiartha\n\n\n\n1\n, DM Sukrama\n\n\n\n2\n, H Prawiranata\n\n\n\n3\n, MAG Wirasuta\n\n\n\n3\n \n\n\n\n1\nPharmaceutical Medicine Department, Faculty of Medicine, Udayana University, Bali, Indonesia \n\n\n\n2\nClinical Microbiology Department, Faculty of Medicine, Udayana University, Bali, Indonesia \n\n\n\n3\nSchool of Pharmacy, Udayana University, Bali, Indonesia \n\n\n\n\n\n\n\nMany determinants of rifampicin variability other than urban and rural groupings have been \n\n\n\nevaluated. Pharmacokinetic difference in a group of population can be a determinant of suboptimal \n\n\n\nrifampicin therapy. This study compared the pharmacokinetics of rifampicin plasma level of urban \n\n\n\nand rural tuberculosis patients upon once daily oral antituberculosis fixed dose combination given at \n\n\n\nstandard dose. A cross sectional study was conducted on new tuberculosis urban and rural patients in \n\n\n\nseveral primary health care centres, who used oral antituberculosis category I as a core therapy. \n\n\n\nPlasma samples at 2 and 6 hours after oral administration were collected and analyzed by TLC \n\n\n\ndensitometry method. Comparison of the mean serum levels at 2 and 6 hours from the two groups \n\n\n\nwere carried out using t-test. Eleven urban and nine rural new lung tuberculosis patients participated \n\n\n\nin this study. The participants were between 19 and 55 years old, with IBW between 15.8 kg/m2 and \n\n\n\n\n\n\n\n\n29.5 kg/m2. The mean plasma level at 2 hours were 6.09 mcg/mL and 5.88 mcg/mL in urban and \n\n\n\nrural, while at 6 hours were 4.57 mcg/mL and 4.87 mcg/mL in urban and rural,  respectively. The \n\n\n\nmean plasma levels of rifampicin between the two groups of participants were clinically different but \n\n\n\nnot significantly different at 2 and 6 hours. The results indicate that urban and rural lung tuberculosis \n\n\n\npatients in this study may have similar absorption, distribution, metabolism, and excretion. Further \n\n\n\nstudies on the pharmacokinetic differences in urban and rural tuberculosis patients should be explored \n\n\n\nand more patients should be included. The pharmacokinetic properties of rifampicin in urban and rural \n\n\n\npatients were not significantly different. \n\n\n\n\n\n\n\n\n\n\n\nHPO 10 \n\n\n\nFAPA2014000212 (Oral) \n\n\n\nDrug Related Problems (DRPs) among Geriatric Patients in Primary Care Setting \n\n\n\nS Kanakarathnam\n1\n, SS Chua\n\n\n\n1\n, A Abdullah\n\n\n\n2 \n\n\n\n1\nDepartment of Pharmacy, \n\n\n\n2\nDepartment of Primary Care Medicine, Faculty of Medicine, University \n\n\n\nof Malaya, Kuala Lumpur, Malaysia \n\n\n\nDrug related problems (DRPs) or medication related problems (MRPs) which may lead to poor \n\n\n\nclinical outcomes are common, costly, and often preventable in geriatric population. Geriatric patients \n\n\n\nare particularly vulnerable to DRPs for two major reasons which are age-related physiological \n\n\n\nchanges and multiple co-morbidities with multiple medications. This study was conducted to \n\n\n\ndetermine the incidence and types or nature of DRPs associated with medication use in geriatric \n\n\n\npatients. A retrospective study was conducted using the patient medical records of geriatric patients \n\n\n\nwho seek treatment at the Department of Primary Care in University Malaya Medical Centre \n\n\n\n(UMMC) from January 2014 to April 2014. The assessment and classification of DRPs was based on \n\n\n\nPharmaceutical Care Network Europe Classification (PCNE) of Drug-related Problems tools version \n\n\n\n6.2. Out of 408 geriatric patients included in this study, 142 (34.8%; 95% confidence interval: 39.4; \n\n\n\n30.2%) had at least one DRP, with a total of 177 DRPs. This means 44 DRPs per 100 patients. The \n\n\n\nmost common category of DRPs was adverse events (53.7%) such as muscle ache, gastrointestinal \n\n\n\ndisturbances, cough, hypoglycemia and dizziness, followed by treatment effectiveness problems \n\n\n\n(30%) and non-adherence to medications (9.0%). Drug-drug interactions (27.7%) and inappropriate \n\n\n\ndrugs (27.1%) were the most common causes of DRPs. In conclusion, DRPs are frequently \n\n\n\nencountered by geriatric patients with multi-morbidities and hence, polypharmacy is common. \n\n\n\nInterventions by healthcare providers are essential to resolve such problems and consequently to \n\n\n\nreduce the mortality and morbidity associated with DRPs.  \n\n\n\n\n\n\n\n\n\n\n\nHPO 11 \n\n\n\nFAPA2014000126 (Oral) \n\n\n\n\n\n\n\nRisk Factors of Pacemaker Implantation Infection: A Single Centre Experience \n\n\n\n\n\n\n\n I Abdul Halim Zaki\n1\n, NN Saat\n\n\n\n1\n, N Eyon\n\n\n\n2\n, J Idris\n\n\n\n1\n, N Hussin\n\n\n\n3\n\u00b8 SY Liau\n\n\n\n1,3\n, HB Liew\n\n\n\n2,3\n \n\n\n\n1\nPharmacy Department, Hospital Queen Elizabeth II, Sabah, Malaysia \n\n\n\n2\nCardiology Department, Hospital Queen Elizabeth II, Sabah, Malaysia  \n\n\n\n3\nClinical Research Centre, Hospital Queen Elizabeth II, Sabah, Malaysia \n\n\n\n\n\n\n\nImplantation of permanent pacemaker (PPM) is a device treatment for various brady-arrhythmias. \n\n\n\nSeveral risk factors have been associated with infection of PPM implantation, including peri-\n\n\n\nprocedure antibiotic use. Currently, there is no study published in Malaysia to analyze the risk factors \n\n\n\nof permanent pacemaker infection. This study was conducted to determine the associated factors of \n\n\n\nPPM implantation infection. A retrospective case control study was designed from January 2011 to \n\n\n\nJuly 2013, at a tertiary regional cardiac centre in Hospital Queen Elizabeth II located in Sabah, East \n\n\n\n\n\n\n\n\nMalaysia. A checklist was used for data collection: patient and procedural risk factors, including peri-\n\n\n\nprocedural antibiotic use. Risk factors were analyzed based on clinical surveillance of infection at \n\n\n\ndischarge on Day-10 which was carried out as part of routine practice. Sample size calculation was \n\n\n\ndone using two proportional formulae with the power of the study set at 80%. A total of 112 patients \n\n\n\nwere included: 12(10.7%) with PPM infection and 100 controls (no infection). All patients received \n\n\n\npre-implant prophylactic use of antibiotics, varied at discretion of implanting clinician. Univariate \n\n\n\nanalysis showed post-implant administration of cefoperazone was associated with lower infection rate \n\n\n\n(OR 0.198: 95% CI 0.05, 0.79; p<0.05) and longer procedure duration was associated with higher \n\n\n\ninfection rate (OR 5.158: 95% CI 0.965, 27.564; p<0.05). Multivariable logistic regression showed \n\n\n\nthe post-implant amoxicillin plus clavulanic acid (OR 16.852: 95% CI 1.977, 143.63; p=0.010) and \n\n\n\npost-implant cefazolin (OR 32.50: 95% CI 3.222, 327.774; p=0.003) were independent factors for \n\n\n\nPPM infection. Pre-implant antibiotic choice was not significantly associated with infection rate. In \n\n\n\nconclusion, implant infection could probably be due to different choice of antibiotic use during the \n\n\n\nprocedure. This may be associated with procedural complexity and operator experience, which \n\n\n\ndeserve further study in order to formulate preventive strategy to minimize risk of PPM infections, \n\n\n\nincluding antibiotic policy. \n\n\n\n\n\n\n\n\n\n\n\nHPO 12 \n\n\n\nFAPA2014000248 (Oral) \n\n\n\n\n\n\n\nStatistical Prediction of Risk Frequency for Ischemic Heart Disease in Punjab, Pakistan \n\n\n\n\n\n\n\nFK Hashmi\n1\n, HA Rathore\n\n\n\n1\n, MZ Abdul Sattar\n\n\n\n1\n, H Saeed\n\n\n\n2\n, Zikria\n\n\n\n2\n, Muhammad Islam\n\n\n\n2\n, M \n\n\n\nAhmad\n2\n \n\n\n\n1\nHypertension and Cardiovascular Research Laboratory, School of Pharmaceutical Sciences, \n\n\n\nUniversiti Sains Malaysia, Penang, Malaysia \n2\nUniversity College of Pharmacy, University of the Punjab, Lahore, Pakistan \n\n\n\n\n\n\n\nA case-control interview based survey on the prevalence of IHD risk factors in Pakistani community \n\n\n\nwas conducted. A total of 96 individuals were included in this study of which, 46 were patients and 50 \n\n\n\nwere healthy individuals who served as control. Social and medical factors that either directly or \n\n\n\nindirectly influence the development of IHD were used as factors affecting risk of IHD. These factors \n\n\n\nincluded modifiable risk factors such as hypertension, dyslipidaemia, tobacco smoking, physical \n\n\n\ninactivity, obesity, unhealthy diet and diabetes mellitus, and non-modifiable risk factors such as age, \n\n\n\nfamily history, gender, anxiety and post-menopausal status. Patients with confirmed diagnosis of IHD \n\n\n\nand a history of IHD not more than five years were included. Individuals who had not demonstrated \n\n\n\neven a single symptom of IHD were taken as controls. The IHD risk factors frequency was assessed \n\n\n\nby logistic regression model using SPSS version 17\n\u00ae\n. Overall, high fat-diet intake was the most \n\n\n\nprevalent risk factor (73.91%) followed by age (>50 years) (67.39%). In terms of gender comparison, \n\n\n\nthe most significant difference was observed in hypertension, with more female patients (84.61%) \n\n\n\ncompared to males (39.39%). Similarly, age of patients was found to be the most apparent risk factor \n\n\n\nof IHD, owing to a significant decline in physical activity with advancing age. A probability equation \n\n\n\nwas derived for risk prediction and hypertension was found to be the most significant factor with \n\n\n\nP=0.115, followed by diabetes 0.135 and age 0.148. When the model was tested on pre-observed data, \n\n\n\n81.3% correct prediction was observed. Although the logistic regression model did not produce \n\n\n\nsignificant results, the probability equation was able to predict IHD risk factors with moderate \n\n\n\nprecision.  \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nHPO 13 \n\n\n\nFAPA2014000196 (Oral) \n\n\n\n\n\n\n\nPrevalence of Comorbidity and Pattern Drug Use among Children with Attention-deficit \n\n\n\nHyperactivity Disorder: A Single Center in Thailand  \n\n\n\n\n\n\n\nJ Suphanklang\n1\n, W Santimaleeworagun\n\n\n\n1\n, W Sumret\n\n\n\n2\n, P Maleevech\n\n\n\n3\n \n\n\n\n1\nDepartment of Pharmacy, Faculty of Pharmacy, Silpakorn University, Nakorn Pathom, Thailand \n\n\n\n2\nDivision of Pharmacy, Hua Hin Hospital, Prajuabkirikhan,Thailand \n\n\n\n3\nDepartment of Children and Adolescent Psychiatric Unit, Hua Hin Hospital, Prajuabkirikhan, \n\n\n\nThailand  \n\n\n\n\n\n\n\nAttention-deficit hyperactivity disorder (ADHD) is a common psychiatric disorder in childhood. The \n\n\n\ntreatment of this condition has to include a multi-modal approach, involving parent education, \n\n\n\npsychological interventions, educational intervention, and appropriate medication use. Therefore, this \n\n\n\nstudy aimed to describe the prevalence comorbidity and drug use pattern of ADHD in Thai children. \n\n\n\nA retrospective study was conducted among children (6-12 years old) with ADHD from Psychiatric \n\n\n\nOutpatient Unit during January 2013 to March 2014 at Hua Hin Hospital, Prajuabkirikhan province, \n\n\n\nThailand. Demographic data, underlying disease, comorbidity and medication use were collected and \n\n\n\nanalysed. During study period, 87 patients were included. The first three ranked comorbid diseases \n\n\n\nwere oppositional defiant disorder, ODD (n=28, 32.2%); learning disorder, LD (n=21, 24.1%) and \n\n\n\nanxiety (n=8, 9.2%), respectively. Thirty-five out of 87 patients had underlying diseases. Accidental \n\n\n\ninjury (n=19, 54.3%) and epilepsy (n=9, 25.7%) were common. The pattern of medication use showed \n\n\n\nthat 54.0% of the patients received only methylphenidate (n=47) and combined regimens; \n\n\n\nmethylphenidate plus atypical antipsychotics (n=30, 34.5%), respectively. The mean dosage of \n\n\n\nmethylphenidate and risperidone were 14.9 mg/day and 0.55 mg/day, respectively. The combined \n\n\n\nregimen was used in 53.6% and 33.3% of patients with ODD and LD, respectively but there was no \n\n\n\nstatistical significance. The most comorbidities of ADHD were ODD and LD.  Combined regimens \n\n\n\nwere commonly used in ODD patients but its benefits required further investigations.   \n\n\n\n\n\n\n\n\n\n\n\nHPO 14 \n\n\n\nFAPA2014000174 (Oral) \n\n\n\n\n\n\n\nStudy of relationship between trigger tools and adverse drug events at Somdet Phra Sangharaja \n\n\n\nthe 19th hospital, Kanchanaburi \n\n\n\n\n\n\n\nK Duangmee\n1\n C Phetsai\n\n\n\n1\n, N Sengsoon\n\n\n\n1\n, U Khunthongphet\n\n\n\n1\n, C Jetiyanuwat\n\n\n\n2\n, S Tananonniwat\n\n\n\n2\n , \n\n\n\nNichanok Ngernngam\n2\n, K Tewthanom\n\n\n\n1\n \n\n\n\n1\nFaculty of Pharmacy,  Silpakorn University, NakhonPathom, Thailand \n\n\n\n2\nPharmacy Division,  SomdetPhraSangharaja the 19\n\n\n\nth\n hospital, Kanchanaburi, Thailand \n\n\n\n\n\n\n\nThe purpose of this study was to analyze a relationship between the trigger tools and adverse drug \n\n\n\nevents (ADEs) at Somdet Phra Sangharaja the 19\nth\n hospital. Researchers collected inpatient medical \n\n\n\nrecords from August to September 2013, with existing trigger tools: vitamin K, INR greater than 4, \n\n\n\nnaloxone, calcium polystyrene sulfonate, potassium chloride elixir, serum glucose lower than 50 \n\n\n\nmg/dl, rising serum creatinine due to enalapril and chlorpheniramine (CPM) injection. Data were \n\n\n\ncalculated for positive predictive value (PPV) and the results showed that naloxone has the highest \n\n\n\nvalue (PPV = 1.00). Besides that, INR greater than 4 (PPV = 0.5), rising creatinine due to enalapril \n\n\n\n(PPV = 0.44), potassium choride elixir (PPV = 0.41), CPM injection (PPV = 0.17), calcium \n\n\n\npolystyrene sulfonate (PPV = 0.17) and vitamin K (PPV = 0.09). Sensitivity of potssium chloride \n\n\n\nelixir, CPM injection and calcium polystyrene sulfonate were 0.48, 0.50 and 0.50, respectively. \n\n\n\nFurthermore, chi-square test of potassium chloride elixir showed that it was associated with drug-\n\n\n\ninduced hypokalemia (P-value = 0.001). In conclusion, these trigger tools can be used for detecting \n\n\n\nadverse drug events and planning ADEs prevention scheme. \n\n\n\n\n\n\n\n\nHPO 15 \nFAPA2014000035 (Oral) \n\n\n\n\n\n\n\nSlow Carbamazepine Clearance in a Nonadherent Malay Woman with Epilepsy and \n\n\n\nThyrotoxicosis \n\n\n\n\n\n\n\nLLYeap\n1\n, KS Lim\n\n\n\n2\n, CC Ng\n\n\n\n3\n, AHP Khor\n\n\n\n3\n,YL Lo\n\n\n\n1\n \n\n\n\n1\nDepartment of Pharmacy, Faculty of Medicine; \n\n\n\n2\nDivision of Neurology, Faculty of Medicine; \n\n\n\n3\nInstitute of Biological Sciences, Faculty of Science, University of Malaya, Kuala Lumpur, Malaysia \n\n\n\n\n\n\n\nSlow carbamazepine clearance may be related to genetic polymorphisms of drug metabolizing \n\n\n\nenzymes and transporters. Such altered metabolism can lead to drug toxicity and consequently poor \n\n\n\nadherence, even when small doses of carbamazepine are administered. Drug\u2013drug interactions or \n\n\n\ndrug\u2013disease interactions may also have attributed to the inconsistency in treatment outcome with \n\n\n\ncarbamazepine which inherently has a narrow therapeutic window. Therapeutic drug monitoring \n\n\n\n(TDM) of carbamazepine was carried out on a Malay woman with seizure relapse presented to an \n\n\n\nepilepsy clinic. The patient was recently diagnosed with hyperthyroidism and was treated with \n\n\n\ncarbimazole and propranolol. TDM revealed a slow carbamazepine clearance of 1.45 L.h-1 per 70 kg. \n\n\n\nGenotyping of selected genetic variants in CYP3A4, CYP3A5, EPHX1, ABCB1, and ABCC2 was \n\n\n\ncarried out. The patient has CYP3A5*3/*3 and ABCB1 3435-CC genotypes which have been \n\n\n\nassociated with a higher adjusted mean serum carbamazepine concentration in Chinese and Korean \n\n\n\npatients with epilepsy. The seizure relapse in this patient was assumed to be related to poor \n\n\n\nmedication adherence, possibly due to avoidance of medication adverse effects. Individualization of \n\n\n\ndrug therapy for this patient using pharmacokinetic modeling and simulations of carbamazepine \n\n\n\ndosing regimens was performed. Attending physicians should be vigilant and request TDM service \n\n\n\njudiciously, so that the dosage of CBZ can be adjusted promptly for maximum seizure control with \n\n\n\nminimum adverse effects. Pharmacogenomic studies on CBZ patients of various races may be helpful \n\n\n\nin identifying individual with a slow carbamazepine clearance. \n\n\n\n\n\n\n\n\n\n\n\nHPO 16 \nFAPA2014000041 (Oral) \n\n\n\nStrategies for a Safer Fasting During Ramadan for Muslim Patients with Type 2 Diabetes \n\n\n\nMellitus: A Systematic Review \n\n\n\nJY Lee, SWH Lee  \nSchool of Pharmacy, Monash University Malaysia, Selangor, Malaysia  \n\n\n\nFasting during Ramadan increases the risk of hypoglycaemia in diabetic Muslim patients. Clinical \n\n\n\ninterventions can provide diabetic Muslims a safer fasting period during the month of Ramadan. The \n\n\n\naim of this systematic review was to evaluate the different strategies used to keep diabetic Muslims \n\n\n\nsafe when fasting during the month of Ramadan. A total of seven electronic databases was searched \n\n\n\n(PubMed, Cochrane Central Register of Controlled Trials, AMED, PsycINFO, EMBASE, CINAHL, \n\n\n\nClinicaltrials.gov) for randomized studies that studied the strategies to keep diabetic Muslims safe \n\n\n\nwhen fasting during Ramadan. Seven trials involving 2977 patients were included. Five out of seven \n\n\n\nstudies involved drug interventions with sulphonylureas being used as the most common comparator \n\n\n\ndrug. The average diabetic years among seven studies are 7.9 years while the average duration of the \n\n\n\nstudies was 14.5 weeks. All studies reported hypoglycaemic episode or events, side effects and \n\n\n\nadverse effects. Out of the five studies that confirmed the incidence of hypoglycaemia with \n\n\n\ncorresponding blood glucose value, four studies reported hypoglycaemia event(s) during Ramadan \n\n\n\nand one study reported incidence of severe hyperglycaemia in their fasting group versus non-fasting \n\n\n\ngroup. Hypoglycaemic events were noted with an average of 9.5% in the control group versus 5.8% in \n\n\n\nthe intervention group. In two studies that reported the occurrence of hypoglycaemic episodes, an \n\n\n\naverage of 32% was noted in the control group and 19% in the intervention group. In conclusion, \n\n\n\n\n\n\n\n\nsulphonylureas are associated with higher risk of hypoglycaemia and hyperglycaemic events. Patients \n\n\n\nwishing to fast should consider alternative drugs for their diabetes during Ramadan to reduce the risk \n\n\n\nof hypogylcaemia. \n\n\n\n\n\n\n\nHPO 17 \n\n\n\nFAPA2014000002 (Oral) \n\n\n\n\n\n\n\nComparison of Methods for Estimating Glomerular Filtration Rate in Critically Ill Patients \n\n\n\nwith Unstable Renal Fucntion \u2013 A Single Center Retrospective Study from Malaysia.  \n\n\n\n\n\n\n\nYP Ng\n1\n, CP Chong\n\n\n\n1\n, AN Abdul Shukor\n\n\n\n2\n, I Vaithalingam3, L Ramanathan\n\n\n\n4\n.  \n\n\n\n1Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, \n\n\n\nMinden, Penang, Malaysia  \n\n\n\n2Department of Intensive Care Unit, Taiping Hospital, Perak, Malaysia  \n\n\n\n3Department of Nephrology, Taiping Hospital, Perak, Malaysia  \n\n\n\n4Medical Department, Taiping Hospital, Perak, Malaysia \n\n\n\n\n\n\n\nDosing of drugs is challenging in critically ill patients with unstable kidney function. Equations like \n\n\n\nJellife, Brater and Chiou are options but they are not robustly tested. This study aimed to investigate \n\n\n\nthe mean differences of estimated creatinine clearance (eCrCl) using Cockroft-Gault method compare \n\n\n\nto Jellife, Brater, and Chiou method and the appropriateness of dosing adjustment of renally excreted \n\n\n\ndrugs based on these methods for critically ill patients with unstable kidney function. A total of 120 \n\n\n\npatients admitted to the intensive care unit (ICU) of Taiping Hospital in Perak, Malaysia from year \n\n\n\n2010 to 2012, were reviewed retrospectively. Serum creatinine levels and urine outputs from day 1 to \n\n\n\n7 of admission were collected. The median differences of calculated CrCl based on four different \n\n\n\nmethods were analysed using Friedman-ANOVA test. Spearman rank correlation test was used to \n\n\n\ndetermine the relationship between the calculated CrCl and urine output. Median values of eCrCl \n\n\n\ncalculated were compared using Cockroft-Gault equation versus Jellife, Brater and Chiou. At point of \n\n\n\nacute kidney injury, the calculated median CrCl were 34.70 mL/min (IQR 13.50) with Cockroft-\n\n\n\nGault; 26.00 mL/min (IQR 12.40) with Jellife; 32.70 mL/min (IQR 11.90) with Brater and 27.90 \n\n\n\nmL/min (IQR 14.70) Chiou. At this point, the calculated CrCl was 25% lower with Jellife; 5.76% \n\n\n\nlower with Brater; and 19.60% lower with Chiou compared to using Cockroft-Gault. The two \n\n\n\nsuspected drug toxicity reported was upper/lower gastrointestinal bleeding secondary to antifactor Xa \n\n\n\ninhibitor, fondaparinux and fits secondary to imipenem use. Clinicians and Pharmacists should \n\n\n\nconsider using Jellife, Brater or Chiou equations to estimate CrCl for patients with acute kidney injury \n\n\n\nwith unstable renal functions. \n\n\n\n\n\n\n\n\n\n\n\nHPO  18 \n\n\n\nFAPA2014000036 (Oral) \n\n\n\n\n\n\n\nApplicability of a Pharmacy-developed Diary in Patient-Reported Monitoring of Compliance to \n\n\n\nTherapeutic Interventions \n\n\n\n\n\n\n\nPM Sigua\n1\n, PB Agregado\n\n\n\n1\n, AM Ong\n\n\n\n1\n, LE Briones\n\n\n\n1\n, LW Raymundo\n\n\n\n1\n, AE Arcega\n\n\n\n1\n, ZB Corteza\n\n\n\n1\n, \n\n\n\nCG Pablo\n2\n \n\n\n\n1\nFaculty of Pharmacy, University of Santo Tomas, Manila, Philippines \n\n\n\n2\nThe Graduate School, University of Santo Tomas, Manila, Philippines \n\n\n\n\n\n\n\nPatients compliant to medications had fewer hospitalizations and overall costs that were 23% lower \n\n\n\nthan non-compliant patients. A patient-centered care model has the potential to improve long-term \n\n\n\ncare, manage chronic conditions, and minimize complications. Clinical pharmacy students developed \n\n\n\na hypertension (HTN) diary, a journal to measure patient compliance to pharmaceutics and non-\n\n\n\npharmacologic interventions. Diaries were given to patients (N=66) of an urban community in the \n\n\n\n\n\n\n\n\nPhilippines who attended a five-phased intervention programme. The diary contains education-based \n\n\n\nknowledge on HTN, DASH diet, exercise, and drug information. A calendar was added for patients\u2019 \n\n\n\ndocumentation of daily blood pressure measurement, exercise, sleeping habits and medication intake. \n\n\n\nThe effectiveness of the diary was measured using patient satisfaction survey and modified QQ10 \n\n\n\nquestionnaire. Out of the 66 patients, 94% used the diary. Patients monitored their blood pressure on \n\n\n\nan average of 3-4 times a week (74%) and religiously updated their diary on sleeping habits (71%) \n\n\n\ndiet (70%) and exercise (91%). There was an overall reduction in blood pressure (63%), reduced \n\n\n\nsodium intake (33%) and increased physical activity (93%). Patients (97%) gave positive feedbacks \n\n\n\non the diary use and were highly satisfied with the self-monitoring logbook. In conclusion, the diary \n\n\n\nwas a visible reminder for compliant and subsequent medication intake, reduction in blood pressure, \n\n\n\nsodium intake as well as improved mobility. Health providers can utilize this diary to measure \n\n\n\npatient\u2019s compliance by the completion of the diary itself. The diary showed great potential to \n\n\n\nimprove patient outcomes, focusing on the patient and addressing improved health management. \n\n\n\n\n\n\n\n\n\n\n\nHPO 019 \n\n\n\nFAPA2014000111 (Oral) \n\n\n\n\n\n\n\nHospital Admissions/Visits Associated with Drug-Drug Interactions: A Meta-Analysis \n\n\n\n\n\n\n\nS Dechanont\n1\n, S Maphanta\n\n\n\n1\n, B Butthum\n\n\n\n2\n, C Kongkaew\n\n\n\n1\n \n\n\n\n1\nDepartment of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, \n\n\n\nThailand \n2\nFaculty of Medicine, Naresuan University, Thailand \n\n\n\n\n\n\n\nThe objective of this study was to estimate prevalence of hospital admissions/visits associated with \n\n\n\nactual drug-drug interactions (DDIs) and to examine the effect of study design; population; and \n\n\n\nmethod of detecting DDIs on reported prevalence. PubMed, International Pharmaceutical Abstracts, \n\n\n\nEMBASE, CINAHL and the Cochrane Database of Systematic Reviews up to October 2013 were \n\n\n\nsearched for observational studies examining actual DDIs, in many languages. The outcomes in this \n\n\n\nstudy were DDI prevalence rates in total populations and frequency of each pairs of DDIs. Thirteen \n\n\n\nstudies met our inclusion criteria. The median DDI prevalence rate for hospital admissions was 1.1% \n\n\n\n(367 DDI cases/47,976 patients, IQR 0.4-2.4%) The median DDI prevalence rate for hospital visits \n\n\n\nwas 0.1% (20DDI cases/23,607 patients, IQR 0.0-0.3%). Medical record, interview, drug interaction \n\n\n\nscreening program, adverse reaction report, and electronic medical record were identified as methods \n\n\n\nused for detecting DDIs. Non-steroidal anti-inflammatory drugs (NSAIDs) were most commonly \n\n\n\ninvolved in hospital admission associated DDIs, while warfarin was frequently involved in DDIs \n\n\n\ndetected as hospital visits as outpatients/emergencies. In conclusion, DDIs are a significant cause of \n\n\n\nhospital admissions and hospital visits. Improved DDI information gathering could help to reduce \n\n\n\nsuch adverse effects from DDIs, especially for patients using NSAIDs and warfarin. \n\n\n\n\n\n\n\n\n\n\n\nHPO  20 \n\n\n\nFAPA2014000285 (Oral) \n\n\n\nThe Interaction Impact of Type of Antihypertension therapy, Comorbidity and Medical \n\n\n\nAdherence to the HRQoL on the Stroke Patients of the National Stroke Hospital, West \n\n\n\nSumatera, Indonesia \n\n\n\nArmenia\n1\n, Lailaturrahmi\n\n\n\n1\n, K Armal\n\n\n\n2\n, Akmal\n\n\n\n2\n  \n\n\n\n1\nFaculty of Pharmacy, University of Andalas Padang, West Sumatera, Indonesia \n\n\n\n2\nNational Stroke Hospital, West Sumatera, Indonesia \n\n\n\nHRQoL of the patients is affected by several factors. This study is performed to determine the \n\n\n\nassociation impact of the type of antihypertensive and medical adherence to HRQoL on hypertensive \n\n\n\n\n\n\n\n\nstroke patients with or without other comorbidities. About 155 patients were involved in the research \n\n\n\nthat was conducted between March to May 2014. The HRQoL of the patients were determined by \n\n\n\nusing Stroke the Specific Quality of Life (SSQoL) while the adherence were determined using the \n\n\n\nMorisky Medical Adherence Scale-8 (MMAS-8) questionnaire that has been translated into \n\n\n\nIndonesian. Data of stroke types and durations, and antihypertensive therapies that were received by \n\n\n\nthe patients were collected from patients\u2019 medical records. Analysis of covariance was used to analyse \n\n\n\nthe data, and the 95% confidence interval was taken for the significance. There was no significant \n\n\n\nimpact of type of anti-hypertensions, medical adherence and comorbidities to HRQoL on the stroke \n\n\n\npatients (p>0.1), but there was a three-way interaction among type of anti-hypertension, \n\n\n\ncomorbidities, and medical adherence impact to the HRQoL (p<0.05). The average score of the \n\n\n\npatient\u2019s HRQoL are good (44.83\u00b15.73 with the maximum score of 60),  but stroke patients with \n\n\n\ncomorbidities of hypertension which received combination of calcium channel blocker and \n\n\n\nangiotensin converting enzyme inhibitor with a moderate adherence to this antihypertensive therapy \n\n\n\nhad the highest HRQoL average score among others.  On the other hands, stroke patient with \n\n\n\ncomorbidity of hypertension, diabetes mellitus and dyslipidaemia which received calcium channel \n\n\n\nblocker with a moderate adherence possess the lowest HRQoL average score. In conclusion, type of \n\n\n\nanti-hypertensive therapy, comorbidities, and medical adherence of hypertensive stroke patients \n\n\n\ndetermined their HRQoL score of the stroke patients. HRQoL and medical adherence assessment \n\n\n\nwould be important for the pharmacist intervention plan which may be needed to improve patient\u2019s \n\n\n\nmedical adherence, and thus HRQoL. \n\n\n\n\n\n\n\n\n\n\n\nHPO  21 \n\n\n\nFAPA2014000182 (Oral) \n\n\n\n\n\n\n\nDevelopment and Implementation of a Career Development Pathway and Competency \n\n\n\nFramework at SingHealth: A 7-year Journey \n\n\n\n\n\n\n\nC Wong \n\n\n\nSengkang Health Hospitals and Singapore General Hospital, Singapore \n\n\n\n\n\n\n\nThe healthcare system in Singapore continues to be in a state of evolution with the silver tsunami \n\n\n\nlooming in front of it. There is an increasing prevalence of chronic diseases, polypharmacy and higher \n\n\n\nhospital admission rates. To meet these challenges there is a need to ensure a highly competent \n\n\n\npharmacy workforce in the areas of service, education and research. This presentation aims to share \n\n\n\nthe journey SingHealth took to achieve this. In 2007, the Department of Pharmacy at Singapore \n\n\n\nGeneral Hospital (SGH) (an institution under SingHealth) took lead to develop its Career \n\n\n\nDevelopment Pathway (CDP) and Pharmacy Competency Frameworks. Local and international CDPs \n\n\n\nwere reviewed by the workgroup but none were found suitable and the department had to develop one \n\n\n\nthat would meet the hospital needs. Concurrently, it reviewed the Singapore Competency Standards \n\n\n\n(for entry-to-practice), and the UK CoDEG\u2019s General Level and Advanced Consultant Level \n\n\n\nFrameworks. Then in 2009, after much deliberation by the workgroup and piloting of and soliciting \n\n\n\nfeedback on the frameworks, the revised CDP and frameworks were implemented in SGH. Coupled \n\n\n\nwith this, were the General Level (GLF) and Advanced Level Frameworks (ALF), each with clearly \n\n\n\ndefined competency standards for the various job grades in the respective pathways within the CDP. \n\n\n\nThe criteria were also set for promotion and include the relevant years of experience, postgraduate \n\n\n\neducation, certification and meeting the respective competency standards. Junior pharmacists utilise \n\n\n\nthe GLF to show frequency of demonstrating competencies in the areas of Delivery of Patient Care, \n\n\n\nProblem Solving, and Professional Attributes. They subsequently transit onto the ALF which \n\n\n\ncomprise of 6 domains i.e. Expert Professional Practice, Building Working Relationships, Leadership, \n\n\n\nManagement, Education, Training and Development, and Research and Evaluation, with subdomains \n\n\n\nfurther categorised into Foundational, Excellence and Mastery competency levels. In the same year, \n\n\n\nthe SGH CDP and frameworks were adopted SingHealth-wide and the CDP now encompasses 4 \n\n\n\npathways for a pharmacist to pursue a career in i.e. Professional (administrative), Clinical (including \n\n\n\nspecialists), Education and Research. In conclusion, the CDP and competency frameworks have been \n\n\n\n\n\n\n\n\nimplemented successfully within SingHealth, with the frameworks supporting performance review \n\n\n\nand the identification of competency gaps. The Singapore Ministry of Health too had adopted the \n\n\n\nSGH CDP in 2009 for all of its public institutions and plans are currently underway to implement the \n\n\n\nALF at a national level. \n\n\n\n\n\n\n\n\n\n\n\nHPO  22 \n\n\n\nFAPA2014000305 (Oral) \n\n\n\nAntibiotic Therapy Profile in Intensive Care Unit (ICU) Patients with Ventilator-Associated \n\n\n\nPneumonia (VAP) at Sungai Buloh Hospital \n\n\n\nA Rakhman\n1\n, CK Shin\n\n\n\n2\n , RA Khan\n\n\n\n3 \n\n\n\n1\nClinical Pharmacy Unit, School of Pharmacy, Management & Science University, Malaysia \n\n\n\n2\nUndergraduate student, School of Pharmacy, Management & Science University, Malaysia\n\n\n\n\n\n\n\n3\nDepartment of Pharmacy, Sungai Buloh Hospital, Malaysia \n\n\n\n\n\n\n\nVAP is a lower respiratory tract infection which has been one of the common nosocomial infections \n\n\n\nin ICU worldwide. This study aimed to identify the frequency and distribution of VAP, and the \n\n\n\nantibiotic therapy profile in VAP patients. An observational retrospective study of VAP patients \n\n\n\n(n=43) in ICU was conducted from January to June 2013. The patient\u2019s demographic data, types of \n\n\n\nbacteria, as well as antibiotic therapy profile were collected through the eHIS (electronic Health \n\n\n\nInformation System). The highest number of VAP cases was reported in March and April 2013 \n\n\n\n(25.6%) respectively. Thirty-four (79.1%) male patients were diagnosed with VAP whereas nine \n\n\n\n(20.9%) cases for female patients. Malays (67.4%) were the majority ethnic group compared to the \n\n\n\nChinese (7.0%) and Indian (7.0%). Age group which is most commonly diagnosed with VAP was 13-\n\n\n\n25 years old (30.2%). The most commonly isolated bacteria were Klebsiella pneumoniae, \n\n\n\nPseudomonas aeruginosa, and Acinetobacter sp. The most frequently used antibiotic in the early-\n\n\n\nonset of VAP was Ampicillin/Sulbactam (17.4%); however, in the late-onset of VAP was Ampicillin \n\n\n\n(16%) and Piperacillin/Sulbactam (16%). In conclusion, based on the demographic result, male, \n\n\n\nMalays, and age group between 13 and 25 years old had the highest number of VAP cases. From \n\n\n\nJanuary to June 2013, the highest frequency of VAP cases was documented in March and April. \n\n\n\nPenicillins were the most common group of antibiotic therapy used in treating VAP patients in this \n\n\n\nhospital.   \n\n\n\n\n\n\n\n\n\n\n\nHPO 23 \n\n\n\nFAPA2014000302 (Oral) \n\n\n\n\n\n\n\nPortable Pocket Calendar: Improving Patient Compliance to Oral Antibiotic Intervention \n\n\n\nApproach \n\n\n\n\n\n\n\nFV Gamboa, AR Lundang, M Mallillin, TD Miguel, KN Po, MA Soriano  \n\n\n\nFaculty of Pharmacy, University of Santo Tomas, Manila, Philippines \n\n\n\n\n\n\n\nNoncompliance to antibiotic therapy such as misuse of antibiotics, including failure to complete \n\n\n\ntherapy, skipping of doses, or reuse of leftover antibiotics has led to a significant percentage of \n\n\n\nmedical admissions that were actually deemed preventable. The purpose of this study is to improve \n\n\n\npatient compliance to a 7-day oral antibiotic therapy through the use of a portable pocket calendar. \n\n\n\nSixty outpatients from East Avenue Medical Hospital were used as subjects comprising of 30 patients \n\n\n\nas control groups subjected to the traditional counselling method and 30 patients as test groups given \n\n\n\nthe portable pocket calendar. Patients were assessed through a given set of pre-test and post-test \n\n\n\nquestionnaires to evaluate their compliance. The statistical parameters that were considered in this \n\n\n\nstudy were the patient\u2019s demographic profile, history of health compliance to antibiotics, patient\u2019s \n\n\n\ndrug information (antibiotic prescribed, dose, frequency), patient\u2019s health status (duration of \n\n\n\n\n\n\n\n\ntreatment, healthcare provider, diagnosis, follow-up treatment) and patient\u2019s compliance based on the \n\n\n\nMorisky questionnaire with special questions for the assessment on the usability of the portable \n\n\n\npocket calendar. Tabulation on the Morisky data showed that both the traditional and calendar groups \n\n\n\nwere categorised as low in adherence but upon averaging the scores of people in both groups, the \n\n\n\ncalendar group acquired a lower score (5.53) as compared to the traditional group (6.40) thus \n\n\n\nindicating the former group to have a better adherence than the latter group. \n\n\n\n\n\n\n\n\n\n\n\nHPO 24 \n\n\n\nFAPA2014000254 (Oral) \n\n\n\n\n\n\n\nFactors Associated with Hospital Readmission among Older Patients Discharged after Acute \n\n\n\nExacerbations of Chronic Obstructive Pulmonary Disease  \n\n\n\n\n\n\n\nB Tangiisuran\n1\n, SMHA Aqqad\n\n\n\n1\n, IAH Ali\n\n\n\n2\n, RMNBM Kassim\n\n\n\n3\n, JL Wong\n\n\n\n4\n, TST Ismail\n\n\n\n5 \n \n\n\n\n1\nPusat Pengajian Sains Farmasi, Universiti Sains Malaysia, 11800 Pulau Pinang, Malaysia \n\n\n\n2\nHospital Pulau Pinang, Jalan Residensi, George Town, Pulau Pinang, Malaysia \n\n\n\n3\nHospital Sultanah Bahiyah, Alor Setar, Kedah, Malaysia \n\n\n\n4\nRespiratory Unit, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Selayang, Malaysia \n\n\n\n5\nSarawak General Hospital, Kuching, Sarawak, Malaysia  \n\n\n\n\n\n\n\nChronic obstructive pulmonary disease (COPD) is associated with exacerbation which is the main \n\n\n\ncause of hospitalisations especially among the elderly. The purpose of the study was to identify \n\n\n\npredictors for COPD hospital readmission among older patients discharge after acute exacerbation of \n\n\n\nCOPD (AECOPD). Prospective longitudinal study was conducted in four major hospitals in Malaysia. \n\n\n\nOlder (\u226560 years) patients discharged after AECOPD were recruited. Demographic and clinical \n\n\n\ncharacteristics were extracted during the index hospital admission. Patients were followed up 3-\n\n\n\nmonths after discharge. Eighty one patients were recruited during the one year study period. The \n\n\n\nmedian age was 72 (Inter Quartile Range (IQR) 66.4-78) years. Majority of the cohort was \n\n\n\nrepresenting patients with moderate to severe COPD disease based on the standardised GOLD criteria \n\n\n\nand comprised mainly males (97.5%). Ethnicity distribution representing Chinese (44.4%), followed \n\n\n\nby Malay (42%) and Indian and others (13.6%). Almost a quarter (23.5%) was current smokers. \n\n\n\nHospital admission due to COPD in the previous year was common (59.3%), of which, 42% of the \n\n\n\ncohort had \u2265 2 admission (history of frequent admissions). The most common co-morbidities were \n\n\n\nhypertension (49.4%), diabetes (25.9%) and ischemic heart disease (IHD) (18.5%). The median score \n\n\n\nfor dyspnoea severity among patients was 3 (IQR = 2-4). The median days of hospital stay were 6 \n\n\n\n(IQR 4-9) days. More than one-third (40.7%) of the patients were readmitted at least once during the \n\n\n\nfollow up. History of frequent AECOPD admission (OR=2.87; 95% CI 1.05-7.85, p=0.040) and IHD \n\n\n\n(OR=4.04; 95% CI 1.1-14.6, p=0.032) were identified as factors increased the risk of COPD \n\n\n\nreadmission after discharge. High readmission rate was noticed among the elderly cohort. COPD \n\n\n\nolder patients with IHD and history of frequent exacerbation admissions were at higher risk for \n\n\n\nhospital readmission. Special attention and regular monitoring among those patients are needed.  \n\n\n\n\n\n\n\n\n\n\n\nHPO 25 \n\n\n\nFAPA2014000253 (Oral) \n\n\n\n\n\n\n\nMetabolomics and Pharmacometabonomics Approaches for Diagnosis of Diseases and \n\n\n\nPredicting Drug Response \n\n\n\n\n\n\n\nB Ibrahim, SAS Sulaiman, AA Bawadikji \n\n\n\nSchool of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia \n\n\n\n\n\n\n\nComplexity and heterogeneity of diseases necessitate the need for novel and more accurate diagnostic \n\n\n\nmethods. A simple, convenient and non-invasive technique will provide comfort to both the physician \n\n\n\n\n\n\n\n\nand the patient. Metabolomics, the study of all the metabolites in the body, may be an alternative and \n\n\n\npromising option for diagnosing diseases. Meanwhile, every patient has a unique biology and \n\n\n\npathophysiology and may respond differently to different drugs thus this should be reflected in the \n\n\n\nchoice of pharmacotherapy. Pharmacometabonomic, a branch of metabolomics, focuses on the \n\n\n\ndetection of specific biomarkers in the metabolic profile that are associated with the \n\n\n\npharmacodynamic/response and/or toxicity of a drug. Molecular information obtained from these \n\n\n\nanalyses may lead to a more targeted therapy including dosing adjustment and therefore may reduce \n\n\n\nor prevent drug failure, cost and adverse drug reactions. The aim of this presentation is to \n\n\n\ncomprehensively evaluate some of the metabolomics and pharmacometabonomics researches that \n\n\n\nhave been done in our setting to identify disease biomarkers such as for asthma, COPD, male \n\n\n\ninfertility and alcohol dependence and predicting drug response such as for clopidogrel and warfarin. \n\n\n\nThe outcome from these non-invasive approaches is hopefully can lead to the development of point-\n\n\n\nof-care diagnostics in future and personalized drug treatment. \n\n\n\n\n\n\n\n\n\n\n\nHPO 26 \n\n\n\nFAPA2014000313 (Oral) \n\n\n\n\n\n\n\nHyperglycaemia Management in the Intensive Care Unit: An Evaluation of Insulin Infusion \n\n\n\nProtocol \n\n\n\n\n\n\n\nJES Liew\n1\n, BK Law, VYW Chua \n\n\n\nPharmacy Department, Queen Elizabeth Hospital, Sabah, Malaysia \n\n\n\n\n\n\n\nPhysiological stress experienced by critically ill patients results in hyperglycaemia. Insulin infusion \n\n\n\nprotocols have been suggested however, glucose control has been inconsistent. Our aim was to \n\n\n\nevaluate the effectiveness of current standard insulin infusion protocol in critically ill patients. A \n\n\n\nprospective cohort study was conducted in an adult medical intensive care unit. All adult patients who \n\n\n\nreceived insulin infusion were recruited over 9 month period and followed up throughout ICU stays. \n\n\n\nVariables were collected and glycaemic performance was assessed by percentage of time spent within \n\n\n\npredefined glycaemic range, prevalence of hyperglycaemia and hypoglycaemia. Clinical outcome was \n\n\n\nICU mortality and length of stay. Thirty nine critically ill adult patients with 2799 glucose \n\n\n\nmeasurements were recruited. The percentage (%) of time spent in the < 4.0, 4.1-6.0, 6.1-10.0 and \n\n\n\n>10.0 mmol/L range was 0.6 (0.09-1.1), 9.1 (6.2-12.0), 55.5 (51-60.0) and 32.6 (27.4-37.9), \n\n\n\nrespectively. Hyperglycaemia (% time spent in >10.0 mmol/L) was noted in patient with prior \n\n\n\ndiabetes mellitus (DM) (x=10.658, 95% CI, 0.580-20.736, P< 0.05) and without renal replacement \n\n\n\ntherapy (RRT) (x=12.557, 95% CI, 2.239-22.875, P<0.05). In fact, diagnosis of DM also caused \n\n\n\nlower % time spent 6.1-10.0 mmol/L (x=-10.029, 95% CI, -18.579- -1.479, P<0.05). Moderate \n\n\n\ncorrelation was noted between hyperglycaemia and age (r=-0.326, p<0.05), weight (r=0.365, p <0.05) \n\n\n\nand HbA1C (r=0.575, p<0.05) whereas % time spent in 6.1-10.0 mmol/L was correlated with age \n\n\n\n(r=0.399, p<0.05) and HbA1C (r=-0.512, p<0.05). Prevalence of hyperglycaemia (>10.0 mmol/L) was \n\n\n\n34.7 % as compare to hypoglycaemia (<4.0 mmol/L) 1.4%. No significant different was noted \n\n\n\nbetween glycaemic control and mortality or ICU length of stay. Preliminary result shows an \n\n\n\nacceptable performance (55% of time spent in 6.1-10.0 mmol/L) of the current standard insulin \n\n\n\ninfusion protocol in achieving target glucose control. Glycaemia changes may be influenced by \n\n\n\nunderlying DM, RRT, age, HbA1C and body weight. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nHPO 27 \n\n\n\nFAPA2014000290 (Oral) \n\n\n\n\n\n\n\nRelationship between Sociodemographic Characteristics with HRQoL in Stroke Patients of the \n\n\n\nNational Stroke Hospital, West Sumatera, Indonesia \n\n\n\n\n\n\n\nLailaturrahmi\n1\n, Armenia\n\n\n\n1\n, K Armal\n\n\n\n2\n, Akmal\n\n\n\n2\n \n\n\n\n1\nFaculty of Pharmacy, University of Andalas, Padang, West Sumatera, Indonesia \n\n\n\n2\nNational Stroke Hospital, West Sumatera, Indonesia  \n\n\n\n\n\n\n\nHRQoL is a comprehensive assessment method to understand the disease burden of stroke patients. \n\n\n\nThis study determines the association between sociodemographic characteristics (gender, age, \n\n\n\neducation, and occupation) with HRQoL of the hypertensive stroke patients with or without other \n\n\n\ncomorbidities. The research was conducted between March to May 2014. An amount of 155 patients \n\n\n\nwere participated in this study. The patients were interviewed by using Stroke Specific Quality of Life \n\n\n\n(SSQoL) questionnaire that has been translated to Indonesian to determine the HRQoL score. Data of \n\n\n\npatient\u2019s gender, age, education, and occupation were collected by interviewing the patients who were \n\n\n\nconfirmed by their medical records. T-test and one-way ANOVA were used to analyse the \n\n\n\nrelationship between sociodemographic characteristics of hypertensive stroke patients with their \n\n\n\nHRQoL. The 95% confidence interval was taken for the significance. Results showed that education \n\n\n\nlevel significantly affected the HRQoL score (p<0.05), while gender, age, and occupation were not \n\n\n\nsignificantly influenced the HRQoL score (p>0.1). Patients who have higher level of \n\n\n\neducation possessed higher average score of HRQoL as compared to those with lower level of \n\n\n\neducation. In conclusion, the HRQoL of the stroke patients is determined by their level of education, \n\n\n\nbut not by gender, age, and occupation.  \n\n\n\n\n\n\n\n\n\n\n\nHPO 28 \n\n\n\nFAPA2014000320 (Oral) \n\n\n\nSpecialized Medication Review on Geriatric Patients in a Public Regional Hospital in the \n\n\n\nPhilippines: A Clinical Pharmacists Perspective \n\n\n\nJER Berberabe, MAE Berjamin, MEC Igno, MAJ Navarro, AMC Panaligan, GAO Tang  \n\n\n\nFaculty of Pharmacy, University of Santo Tomas, Manila, Philippines \n\n\n\nGeriatrics in the Philippines accounts for 6.8% of the population in 2010 with a high percentage of \n\n\n\ngeriatric prescription. High-risk for medication misuse are the geriatric patients, due to the critical \n\n\n\nnature of their illnesses, polypharmacy, use of high-risk drugs, and a high frequency of changes in \n\n\n\npharmacotherapy. On-ward participation of a clinical pharmacist can effectively and efficiently \n\n\n\nreduce the number of medication errors and related patient harm. This study aims to conduct a \n\n\n\nspecialised medication review on geriatric patients in a regional public hospital in the Philippines and \n\n\n\nto determine the prevalence of polypharmacy and to identify the most common medications \n\n\n\nprescribed to the geriatric patients including the clinically relevant pharmacotherapeutic \n\n\n\ncomplications presented.  Patient medication profile data were collected from Batangas Medical \n\n\n\nCenter. The patients were aged 65 years old and above, admitted during December 2013. The \n\n\n\nmedication reviews were performed with the required parameters: dose, route of administration, \n\n\n\ndosage form, frequency, administration-techniques, monitoring, occurrence of possible adverse drug \n\n\n\nreaction and drug interactions, and patient compliance. From the accomplished evaluation, the \n\n\n\nidentified errors were categorised based on ASHP types of medication errors. From the 70 medication \n\n\n\nprofiles reviewed, averages of 10-15 drug orders per medication profiles were assessed.  The most \n\n\n\ncommon medications prescribed to geriatric patients were those that are indicated for cardiovascular \n\n\n\ndiseases, namely, beta-blockers, diuretics, and ACE inhibitors, as well as those that are indicated for \n\n\n\ninfections. The most common error found was related to monitoring \u2013 with potential and significant \n\n\n\ndrug interactions. The skills and competencies of the clinical pharmacist promoted positive outlook in \n\n\n\n\n\n\n\n\nthe importance of medication review in determining consequences due to medication errors thus \n\n\n\nproviding a higher standard in terms of regulating safety and efficacy of the medications and \n\n\n\npharmacotherapy.   \n\n\n\n\n\n\n\nHPO 29 \n\n\n\nFAPA2014000186 (Oral) \n\n\n\n\n\n\n\nReview of Best Practices for Next-Generation Sengkang Health Pharmacy  \n\n\n\n\n\n\n\nA Tan\n1,2\n\n\n\n, YF Lai\n1,2\n\n\n\n, LC Wong\n2\n, C Wong\n\n\n\n1,2\n \n\n\n\n1\nSengkang Health Hospitals, Singapore \n\n\n\n2\nSingapore General Hospital, Singapore \n\n\n\n\n\n\n\nThis study aimed to explore and innovate new ways to bring pharmacy practice to a new frontier at \n\n\n\nthe upcoming Sengkang Health Hospitals, through review of current medication use and related \n\n\n\nsupply chain processes (locally and internationally). Through a series of site visits, focus group \n\n\n\ndiscussions and review of evidence with end-users, medical planners and consultants, a range of \n\n\n\noptions were explored. New proposed infrastructural options and workflows were debated on, \n\n\n\nsimulations and test calculations were conducted before fine-tuning into a consensus that was \n\n\n\nacceptable to all stakeholders. The three categories of focus were: 1) medication safety by closed-loop \n\n\n\nmedication management (CLMM) and knowledge-based medication administration (KBMA) 2) \n\n\n\noutpatient medication reconciliation and automation and 3) community centred pharmacy services and \n\n\n\ninfrastructure. For inpatient CLMM, KBMA together with automated medication cabinets, ensure \n\n\n\nmedication safety and timely supply of medications. Medications are prepared by pharmacy and \n\n\n\ndelivered to the wards by Automated Guided Vehicles (AGVs) at night, ready for nurses to serve at \n\n\n\nthe morning administration time. For outpatient medication reconciliation will be conducted within \n\n\n\nclinic floors. This allows for timely pharmacy interventions and ease of collaboration with doctors to \n\n\n\noptimise pharmaceutical care for patients. For community-centred pharmacy services, steps are taken \n\n\n\nto cooperate with community partners to bring about affordable and convenient services, e.g. home \n\n\n\ndelivery of mediations, multi-disciplinary home care and online-ordering of medications. Apart from \n\n\n\nconventional pharmaceutical delivery approaches, we also approached industry partners like Singpost \n\n\n\nto explore possibility of utilising their 100 island-wide POP station systems for self-collection of \n\n\n\nmedication. Discussions are actively ongoing and a pilot has been planned at the Singhealth Sengkang \n\n\n\nPolyclinic. The proposals have been incorporated into the Sengkang Health hospital designs. With \n\n\n\nstrong support from Singhealth and continued innovations, we hope to see a more healthy and vibrant \n\n\n\ncommunity in the North Eastern region of Singapore in 2018. \n\n\n\n\n\n\n\n\n\n\n\nHPO 30 \n\n\n\nFAPA2014000101 (Oral) \n\n\n\n\n\n\n\nAdvanced Age and Antiplatelets Use are Risk Factors of Upper GI Bleeding among the Elderly \n\n\n\n\n\n\n\nYL Lo\n1\n, NA Kamarudin\n\n\n\n1\n, P Poi\n\n\n\n2\n,\n \nSB Kamaruzzaman\n\n\n\n2\n \n\n\n\n1\nDepartment of Pharmacy, Faculty of Medicine, University of Malaya, Malaysia  \n\n\n\n2\nDepartment of Medicine, Faculty of Medicine, University of Malaya, Malaysia \n\n\n\nUpper gastrointestinal bleeding (UGIB) affects a number of elderly patients and results in an \n\n\n\nincreased morbidity and mortality. The objectives of this study were to determine the occurrence of \n\n\n\nUGIB among the elderly, to identify contributing factors, and the clinical outcome of UGIB among \n\n\n\nthese patients. Combined data were collected prospectively and retrospectively from a geriatric \n\n\n\nmedical ward and a surgical ward in a tertiary hospital for a period of 6 months. Of the 766 patients \n\n\n\n(362 males [47%]; mean age 74.3 years) recruited during the study period, 80 (10.4%) patients were \n\n\n\nnoted to develop UGIB. Patients of advanced age (OR 1.72, 95% CI 1.00-2.95; p=0.047) and those \n\n\n\n\n\n\n\n\nwho received antiplatelet drugs therapy (OR 1.8, 95% CI 1.11-2.88; p=0.005) were at a higher \n\n\n\nbleeding risk. Moreover, the odds of UGIB was 2 times higher given aspirin administration compared \n\n\n\nto no aspirin administration (95% CI 1.23-3.30; p=0.005). The duration of antiplatelet agents use, \n\n\n\nhowever, did not contribute significantly to a higher bleeding risk (OR 0.90, 95% CI 0.42-1.94; \n\n\n\np=0.804). Previous history of gastrointestinal diseases was the most common risk factor (46.3%) \n\n\n\npresented in the case subjects. Mortality of patients with UGIB was 15 or 19%. Only 2 deaths or \n\n\n\n13.3% were directly caused by UGIB while the remaining 87% were due to intercurrent illnesses. In \n\n\n\nconclusion, elderly with a previous history of GI diseases and on antiplatelet agents in particular \n\n\n\naspirin, are at a higher risk of developing UGIB. The risk of bleeding may outweigh the benefit in \n\n\n\nsome patients. Therefore, the decision to use antiplatelet agents in particular aspirin among the elderly \n\n\n\nmust be more individualized to reduce the risk of UGIB.  \n\n\n\n\n\n\n\nHPO 31 \nFAPA2014000021 (Oral) \n\n\n\n\n\n\n\nThe Quality of Life Measurement on Hypertension Patients in a Primary Health Care of \n\n\n\nCirebon City Using Time Trade Off Method \n\n\n\n\n\n\n\nR Susilo, DA Perwitasari \n\n\n\nFaculty of Pharmacy, University of Ahmad Dahlan, Yogyakarta, Indonesia \n\n\n\n\n\n\n\nOne of the treatment\u2019s outcomes in hypertension disease is to increase patients\u2019 quality of life during \n\n\n\nthe hypertension treatment. Thus, using the appropriate method to measure patients\u2019 quality of life \n\n\n\nbecame the important issue in hypertension treatment. This study was conducted to understand \n\n\n\nhypertensive patients\u2019 quality of life in a primary health centre using Time Trade Off (TTO) method. \n\n\n\nA cross-sectional study was conducted over two months. Adult hypertensive patients who had been \n\n\n\ntreated with antihypertensive agents for at least for 6 months, were recruited from a Primary Health \n\n\n\nCentre of Cirebon City. Two scenarios of TTO were used: A) patient can live in a very good health \n\n\n\nfor 5 years without medication, followed by death and B) patients can live in a good health for 10 \n\n\n\nyears with medications, followed by death. This design was arranged according to the preliminary \n\n\n\nstudy in hypertensive patients. Besides using TTO, SF-36 questionnaire was used to understand the \n\n\n\npatients\u2019 quality of life according to the TTO. A total of 27 subjects were recruited, with the following \n\n\n\ncharacteristics: 78% were female; 52% were above of 50 years old; 38% were covered by national \n\n\n\nhealth insurance; 72% have complications and 48% were in stage 2 hypertension. More patients \n\n\n\n(67%) choose B of the TTO and the patients in this group had higher quality of life (73.96 \u00b1 13.73) \n\n\n\nthan those who chose A of the TTO. However, there was no significant difference in patients\u2019 quality \n\n\n\nof life between those who chose A or B of the TTO (p value= 0.384). In conclusion, hypertensive \n\n\n\npatients in a primary health centre of Cirebon city preferred to take antihypertensive medications to \n\n\n\nmaintain their health and to achieve a better quality of life. \n\n\n\n\n\n\n\n\n\n\n\nHPO 32 \nFAPA2014000215 (Oral) \n\n\n\nEffects of Warfarin Dose Adjustment on the International Normalized Ratio (INR) Target \n\n\n\nAchievement in Thai Patients: A Preliminary Study  \n\n\n\nP Pimsi, P Boonmuang, D Rungprai, W Santimaleeworagun \nDepartment of Pharmacy, Faculty of Pharmacy, Silpakorn University, Bangkok, Thailand \n\n\n\n\n\n\n\nWarfarin is the standard treatment for thromboembolism. Factors that affect INR were drug - drug \n\n\n\ninteraction, underlying diseases, body weight, adherence and VKORC1 polymorphism which is \n\n\n\nassociated with an individual warfarin dose. The 9\nth\n edition of ACCP guideline for antithrombotic \n\n\n\ntherapy and prevention of thrombosis recommended that warfarin dose should be adjusted by 5% - \n\n\n\n\n\n\n\n\n20% of previous total weekly dose (TWD). Currently, the optimal warfarin dose adjustment in Thai \n\n\n\npatients is still unknown. This study aimed to evaluate the effects of warfarin dose adjustment on INR \n\n\n\ntarget achievement among Thai patients. The present study was a preliminary observational \n\n\n\nretrospective study conducted in Hua-Hin hospital, Thailand. The patients who were included in the \n\n\n\nstudy received warfarin therapy during January 2013 \u2013 July 2014. The INR of these patients were not \n\n\n\naccomplished the target range of 2 \u2013 3. The patients in the present study must not have any factors \n\n\n\nthat affect the INR. INR values and the percent change between the previous TWD and the TWD after \n\n\n\ndose adjustment were observed. Forty-two patients were included in the present study. The mean age \n\n\n\nwas 61.57\u00b116.82 years. 28 patients (66.7%) had atrial fibrillation. More than 90% of the patients \n\n\n\nachieved the target range of INR 2-3. Twenty-six patients (61.9%) received warfarin dose adjusted by \n\n\n\n5% - 20%, 16 patients (61.54%) achieved the target range. Others received warfarin dose adjusted \n\n\n\nmore than 20% (16 patients, 38%), 9 patients (56.25%) achieved the target range. The patients who \n\n\n\nreceived warfarin dose adjusted by 5% - 20% had more opportunity to achieve the expected target \n\n\n\nrange of INR than the other group. The present study is a preliminary study, therefore the further \n\n\n\nprospective study is needed. \n\n\n\n\n\n\n\n\n\n\n\nHPO 33 \nFAPA2014000214 (Oral) \n\n\n\nInitiation and Evaluation of Patient Reporting ADRs in Out Patient Department of a South \n\n\n\nIndian Tertiary Care Teaching Hospital  \n\n\n\nR Adepu, P Gokul Raj, P Verma, UR Rakshith, J Kurian, P Rohith \n\n\n\nIn Post Marketing Surveillance (PMS), patients are key elements in tracking about ADR information. \n\n\n\nStudies have corroborated that sensitization and motivation of patients will increase the reporting of \n\n\n\nsuspected ADRs and increase the knowledge about the potential harm of drugs. The objective of this \n\n\n\nstudy was to initiate and evaluate patient reporting of suspected ADRs in an ambulatory care setting. \n\n\n\nIn this prospective observational study, patients visiting out-patient Medicine department were briefed \n\n\n\nabout study after obtaining their written informed consent. Patients were advised to inform the \n\n\n\ninvestigator in case if they have experienced any unpleasant drug effects. The investigators collected \n\n\n\nall the necessary data on patient\u2019s call and analysed the data for establishing causality, type of \n\n\n\nreaction, outcome and fate of the suspected drug. Descriptive statistics, T-test and Chi Square test \n\n\n\nwere used to perform the analysis of findings. During the study period, 1125 patients were enrolled \n\n\n\nand 128 patients called back and reported 95 ADRs [response rate 8.44%]. The mean age of the study \n\n\n\npopulation was 50.14% +/- 16.39 years. Female patients [54 (57%)] reported more ADRs than males \n\n\n\n[41 (43%)] [P = 0.001]. Patients in the age group of 40-60 [38 (40%)] reported more ADRs. Patients \n\n\n\nwith UG education reported more ADR (38.8%). Majority of the reported ADRs were associated with \n\n\n\nGI [34 (35.78%)] and Skin & Appendages [22 (23.10%)]. A comparison of the Modified Hartwig & \n\n\n\nSiegel plot of patient reported ADRs with that of physician reported ADRs suggest that reports from \n\n\n\nphysician include more of Moderate (57.57%) in nature compared to patient reports which more often \n\n\n\nincluded Mild reactions (66.15%) [T-test (0.986)]. The research findings suggest that patients\u2019 \n\n\n\nsensitization will improve patient reporting of ADRs. This will also strengthen the pharmacovigilance \n\n\n\nactivity of the country and results in safer use of medicines.  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nHPO 34 \n\n\n\nFAPA2014000131 (Oral) \n\n\n\nA Multicentre Analysis on Factors Affecting Anticoagulation Control and Adverse Outcomes \n\n\n\namong Warfarin MTAC Patients in MOH Facilities, Malaysia \n\n\n\nRR Aniza\n1\n, B Nurul Zaidah\n\n\n\n2\n, MS Long\n\n\n\n3\n, EMF Chong\n\n\n\n4\n, S Eezmalina Sazza\n\n\n\n5\n, A Noor Fadzilah\n\n\n\n6\n, \n\n\n\nM. Sahimi\n7\n, Warfarin MTAC Task Force\n\n\n\n8\n \n\n\n\n1\nDepartment of Pharmacy, Hospital Tengku Ampuan Rahimah, Selangor, Malaysia \n\n\n\n2\nDepartment of Pharmacy, Hospital Serdang, Selangor, Malaysia \n\n\n\n3\nDepartment of Pharmacy, Hospital Selayang, Malaysia \n\n\n\n4\nDepartment of Pharmacy, Hospital Kuala Lumpur, Malaysia \n\n\n\n5\nDepartment of Pharmacy, Pharmaceutical Services Division, Ministry of Health, Malaysia   \n\n\n\n6\nDepartment of Pharmacy, Hospital Putrajaya, Malaysia \n\n\n\n7\nDepartment of Pharmacy, Hospital Tengku Ampuan Afzan, Pahang, Malaysia \n\n\n\n8\nCardiology Pharmacy Committee,\n\n\n\n \nPharmaceutical Services Division, Ministry of Health, Malaysia \n\n\n\n\n\n\n\nWarfarin Medication Therapy Adherence Clinic (WMTAC) in Ministry of Health (MOH), Malaysia \n\n\n\nwas first introduced in 2005 with the aim to optimize anticoagulation therapy. Anticoagulation control \n\n\n\nand adverse outcomes have been the main determinants of the effectiveness of long term warfarin \n\n\n\nmanagement in outpatient setting. Thus, it is imperative to recognise patients\u2019 variability that could \n\n\n\nlead to inadequate anticoagulation control and occurrence of adverse outcomes. The objectives of this \n\n\n\nstudy were to explore any differences in weekly dose and anticoagulation control between patients\u2019 \n\n\n\nunmodifiable factors (age, race and indication) and to identify factors associated with bleeding and \n\n\n\nthromboembolic complications in WMTAC patients. Data were collected from 36 MOH facilities. \n\n\n\nPatients were enrolled if they are actively followed up and had been taking warfarin for at least 3 \n\n\n\nmonths prior to January 2012. Patients\u2019 demographics, INR values, bleeding and thromboembolic \n\n\n\nhistory were collected from patients\u2019 medical record or INR booklet. The expanded INR range (\u00b10.2) \n\n\n\nwas used to calculate TTR using Rosendaal linear interpolation method. All relevant variables were \n\n\n\nanalysed against the intended parameters. A total of 1589 patients (mean age; 60 \u00b113.65) were \n\n\n\nincluded in the study. The main indication was atrial fibrillation (67.1%), followed by prosthetic heart \n\n\n\nvalves (23.4%). The youngest patient group (15-30 years old) have the highest mean weekly dose \n\n\n\namong the age groups (p<0.001). Besides, Indians have the highest mean weekly dose whereas \n\n\n\nChinese have the highest TTR compared to other ethnicities (p<0.001). Bleeding events were seen \n\n\n\nmore in patients with inconsistent diet and those taking alternative medicines compared to their \n\n\n\ncounterparts (p<0.001). Additionally, non-compliant patients and those with inconsistent diet have 2.3 \n\n\n\nand 2.9 times the chance to have thromboembolic events respectively compared to their counterparts \n\n\n\n(95% CI=1.11-4.57, p=0.024; 95% CI=1.37-6.18, p=0.006). In conclusion, knowledge on the factors \n\n\n\nthat could compromise anticoagulation control and contribute to adverse outcome would assist on \n\n\n\nimproving the service. \n\n\n\n\n\n\n\n\n\n\n\nHPO 35 \n\n\n\nFAPA2014000318 (Oral) \n\n\n\n\n\n\n\nMedication Review Impact on Medication Appropriateness Index in Hospitalized Balinese \n\n\n\nElderly Determined by the STOPP/START Criteria  \n\n\n\n\n\n\n\nIBN Maharjana\n1\n, T Kuswardhani\n\n\n\n1\n, AP Susilo\n\n\n\n2\n, F Herawati\n\n\n\n3\n \n\n\n\n1\nSanglah General Hospital Bali, Indonesia \n\n\n\n2\nFaculty of Medicine, Mulawarman University, Samarinda, Indonesia \n\n\n\n3\nFaculty of Pharmacy, University of Surabaya, Indonesia \n\n\n\n\n\n\n\nIndonesia has the fourth highest elderly population in the world. Inappropriate prescribing can lead to \n\n\n\nmedication errors in elderly patients. Pharmacists can contribute by conducting medication review in \n\n\n\n\n\n\n\n\npreventing the occurrence of medication errors. STOPP/START can be used as a guide to conduct \n\n\n\nmedication reviews but their effectiveness has not been tested in Indonesian. This study aimed to find \n\n\n\nout if medication review using STOPP/START as a guide can improve the Medication \n\n\n\nAppropriateness Index (MAI), reduce the risk of ADR (gerontonet score), and Length of Stay (LOS) \n\n\n\nin elderly patients. An NRCT was conducted over a 3-month period using consecutive sampling. The \n\n\n\noutcomes measures assessed were MAI, gerontonet score and LOS. A total of 63 patients were \n\n\n\nincluded inthis study: 33 patients in the control and 30 patients in the intervention groups. Both \n\n\n\ngroups were comparable. There were significant differences between the control and intervention \n\n\n\ngroup on measures of MAI (p <0.001), gerontonet score (p = 0.003) and LOS (p = 0.011). MAI mean \n\n\n\nvalues were 9.94 \u00b1 6.14 and 2.97 \u00b1 2.25 after intervention. Gerontonet score mean values were 5.18 \u00b1 \n\n\n\n2.10 and 3.33 \u00b1 2.28 after intervention. LOS mean values were 14.18 \u00b1 9.97 and 7.63 \u00b1 3.00 after \n\n\n\nintervention. Thirteen out of the 33 patients experienced ADRs in the control group and 3 out of 30 in \n\n\n\nintervention group. STOPP / START used as a guide for medication review can improve the \n\n\n\nmedication appropriateness index, and reduce the risk of ADRs and LOS. \n\n\n\n\n\n\n\n\n\n\n\nHPO 37 \nFAPA2014000180 (Oral) \n\n\n\nFactors Influencing Hospital Formulary Decision-Making: A Preliminary Study in Thailand \n\n\n\nS. Prateepjarassaeng\n1\n, S. Hirunrassamee\n\n\n\n2\n, W. Santimaleeworagun\n\n\n\n3 \n\n\n\n1\nFaculty of Pharmaceutical Sciences, Burapha University/ Pharmacy Resident, FAPA-CP Thailand \n\n\n\n2\nPhramongkutklao College of Medicine, Bangkok, Thailand/ Fellow at School of Public Health, \n\n\n\nKunming Medical University, Yunnan, P.R. China \n3\nDepartment of Pharmacy, Faculty of Pharmacy, Silpakorn University, Thailand \n\n\n\nEffective hospital formulary management is a widely accepted mechanism to contain cost and to \n\n\n\nassure rational drug use. In Thailand, limited evidence on decisive factors for the Pharmacy and \n\n\n\nTherapeutics Committee (PTC)\u2019s decision making has been disclosed. The objective was to identify \n\n\n\ndecision-making factors of the PTCs on hospital formulary (HF) inclusion. This preliminary study \n\n\n\nwas conducted using a content analysis of the PTC\u2019s meeting minutes, voice records (if any), during \n\n\n\n2012 \u2013 2013. Two public hospitals were purposively recruited, including a 1,200-bed university \n\n\n\nhospital (UH) and a 305-bed provincial hospital (PH). The justification for selection of new drug \n\n\n\nitems was determined by particular groups of drugs. The total numbers of drug items in the HF were \n\n\n\n2,164 (UH), and 550 (PH). The ratios of drug items in the National List of Essential Medicines (ED) \n\n\n\nand not in this list (NED) were 56:44, and 81:19 respectively. There are 156 new drug items of 2 \n\n\n\nhospitals including 57 ED and 99 NED items. Most of the new drug items were included in the HF \n\n\n\nwith only one reason (61 items, 62.2%). For these drug items were based on cost (36.8%) and \n\n\n\ncompliance (24.6%), indication (24.6%), and others. Only 31 drug items (31.6%) were selected by \n\n\n\ntwo reasons, including cost (58%) with efficacy (25.8%), compliance (12.9%) or other reasons. Me-\n\n\n\nToo drugs that selected were 59.4% and New Chemical drugs (NCs) were 40.3%. %ED:NED of NCs \n\n\n\nwere 25.4:74.6 and Me-Too drugs were 44.1:55.9. The most of the influential factors in NCs were \n\n\n\nefficacy and Me-Too drugs were cost (38%), but cost was the least in NCs (8.9%). In conclusions, \n\n\n\ncost, compliance, and efficacy seems to be the imperative decision-making factors for new drug items \n\n\n\nselection to include in the HF. Further studies are needed to triangulate these findings with other \n\n\n\nsources of information. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nHPO 38 \n\n\n\nFAPA2014000158 (Oral) \n\n\n\nPotentially Inappropriate Medication in Elderly Outpatient Prescriptions at a District Hospital \n\n\n\nin the South of Thailand \n\n\n\nP.Tanavij\n  \n\n\n\nSchool of Pharmacy, Walailak University, Thailand \n\n\n\nThai elderly patients have grown rapidly for decades, as well as, the rise of chronic diseases. \n\n\n\nAccordingly, multiple medications were required that, consequently, caused medication-related \n\n\n\nproblems among those elderly patients. This study aims to know the prevalence of, and to describe \n\n\n\npatient's factors associated with prescribing potentially inappropriate medication (PIM) at a district \n\n\n\nhospital in the South of Thailand. A cross-sectional study with retrospectively prescription data during \n\n\n\nOctober 1, 2011 to September 30, 2012 were retrieved from a district hospital in the South of \n\n\n\nThailand. Participants, as hospital outpatients, aged 65 years or more, who had at least 1 prescribed \n\n\n\nmedication during the study period. 430 out of 5,265 participants were randomised and their 2,128 \n\n\n\nprescriptions were assessed regardless of multiple counts of PIM in each participant. Unconditionally \n\n\n\nBeers criteria 2012 were applied for screening PIM. Of all participants, 39.1% were female; 53.7% \n\n\n\naged 65-74 years; 49.8% had at least 1 PIM. Most PIM prescriptions were observed in mental and \n\n\n\nbehavioral disorders, while lorazepam were frequently prescribed. There were significant differences \n\n\n\nof number of prescribed medications, outpatient visits and diagnoses between PIM users and non \n\n\n\nusers (Chi-square, p<0.001). Futhermore, there was the more likelihood of PIM users increased \n\n\n\nsignificantly when they were prescribed more medications during the study year (Logistic regression, \n\n\n\nB=0.219, 95%CI=1.157-1.339, p<0.001). No statistically significant association of PIM and patient's \n\n\n\ngender, age, number of diagnoses, health insurance schemes, and hospitalizations. Almost 50% of the \n\n\n\nelderly outpatients had at least 1 PIM across 1 year. It is obviously that the number of medications had \n\n\n\na strong association to PIM prevalence. Therefore, all prescribers should weigh benefits to risks of \n\n\n\nmedications prior to prescribe them to elderly patients. To be more specified, however, a country-\n\n\n\nmodified criteria with conditional patient's disease are recommended in order to apply for decision-\n\n\n\nmaking in clinical practice. \n\n\n\n\n\n\n\n\n\n\n\nHPO 39 \n\n\n\nFAPA2014000161 (Oral) \n\n\n\nRole of Pictograms in Educating Diabetic Patients about Medication Use and Lifestyle \n\n\n\nModifications \n\n\n\nV Sankar, K Ramya Krishna, M Narmadha, N Sameer Hussain, VV Krishna Reddy \nDepartment of Pharmacy Practice , PSG College of Pharmacy, Peelamedu, Coimbatore, India \n\n\n\nThe study examined the role of pictograms in educating diabetic patients about proper medication use \n\n\n\nand lifestyle modifications. The prospective-observational comparative study of 6-month duration was \n\n\n\nundertaken with 100 participants for Phase-1 (Survey with discussion; n=100) to select the best \n\n\n\nunderstood pictograms from the 24 pictograms chosen for the study. This set was carried out for \n\n\n\nPhase-2 (one-on-one interview; n=100), which had Guessability and Translucency as its components. \n\n\n\nGuessability study was carried out in 50 diabetic patients and their response to pictograms was \n\n\n\nrecorded in a 3-point Likert scale. Modifications were made to the pictograms based on the \n\n\n\ndifficulties faced by the patients in understanding the pictograms. These modified pictograms were \n\n\n\nused for Translucency study and result was obtained using 5-point Likert scale. Student t-test and Chi-\n\n\n\nSquare test using SPSS 19 were used to analyze the data. The results of this study show that \n\n\n\npictograms are generally well understood by the diabetic patients when the intended meaning of the \n\n\n\npictograms are explained and are accompanied with text. The statistically significant p values were \n\n\n\n\n\n\n\n\nobtained only with levels of education in both Guessability (0.040) and Translucency (0.050). The \n\n\n\noverall Guessability (all pictograms included) was 69.6% and the overall Translucency was 90.9 %.  \n\n\n\n\n\n\n\n\n\n\n\nHPO 40 \n\n\n\nFAPA2014000208 (Oral) \n\n\n\nResponse to an Initial Dose of Warfarin in Thai Patients Undergoing Long-Term Anticoagulant \n\n\n\nTherapy \n\n\n\nW Saelim\n1\n, P Boonmuang\n\n\n\n1\n, W Santimaleeworagun\n\n\n\n1\n, D Rungprai\n\n\n\n1\n, J Suphanklang\n\n\n\n1\n, P Pimsi\n\n\n\n1\n, O \n\n\n\nHongchumpae\n2\n, W Sumret\n\n\n\n2\n,  S Pounghom\n\n\n\n2\n, O Kriangsuwan\n\n\n\n2\n \n\n\n\n1\nDepartment of Pharmacy, Faculty of Pharmacy, Silpakorn University, Bangkok, Thailand \n\n\n\n2\nDepartment of Pharmacy, Hua Hin Hospital, Bangkok, Thailand \n\n\n\n\n\n\n\nIt is important to accomplish a goal of therapeutic international normalized ratio (INR) with warfarin \n\n\n\ntreatment because of the benefit in thromboembolism risk reduction. This study aimed to describe the \n\n\n\nefficacy and safety of initial dosing of warfarin in Thai patients. A retrospective study was conducted \n\n\n\nat Hua Hin Hospital, Thailand. Patients who were at least 18 years old and initiated warfarin therapy \n\n\n\nfrom June 2012 to June 2014 were eveluated. Initial dose of warfarin was adjusted by the physicians. \n\n\n\nPatient demographic data, warfarin dosing, INR values, and drug interactions were collected. The \n\n\n\npatients needed to have 2 follow up visits consecutively which no longer than 12 weeks apart. The \n\n\n\ntarget INR of 2.0-3.0 or 2.5-3.5 was the primary endpoint. Bleeding complication, subtherapeutic or \n\n\n\nsupratherapeutic INR values were the secondary endpoints. Of 55 patients, 28 (50.9%) were males. \n\n\n\nThe mean age and body weight were 61.3+ 13.8 (22.0-85.0 years) and 61.5 + 12.2 (41.0-95.0 kg), \n\n\n\nrespectively. Atrial fibrillation was a majority of indication for warfarin therapy (70.9%). The mean \n\n\n\ninitial dose of warfarin was 2.5 + 0.6 (1.0-3.0 mg). Thirty patients (54.6%) received 3 mg of warfarin \n\n\n\nas the initial dosing of therapy and 30.9% of the patients received 2 mg of warfarin. However, only 13 \n\n\n\npatients (23.6%) were achieved the target INR. Interestingly, the most of patients (76.8%) had INR \n\n\n\nvalues out of the target range; subtherapeutic and supratherapeutic INR values were 63.6% and \n\n\n\n12.7%, respectively. None of the patients had major bleeding, while 3 patients (5.5%) had minor \n\n\n\nbleeding during the follow up period. Although recent evidence suggested that an initial dose of \n\n\n\nwarfarin use as 2 or 3 mg might be relatively less effective, the clinicians should consider patient \n\n\n\nspecific factors prior to making a decision for an initial warfarin dose. \n\n\n\n\n\n\n\n\n\n\n\nHPO 41 \n\n\n\nFAPA2014000063 (Oral) \n\n\n\nA Preliminary Study of Comprehensive Pharmaceutical Care among Hospitalized Elderly \n\n\n\nPatients \n\n\n\nW-K Chou\n1,3\n\n\n\n, C-M Chang\n2,3\n\n\n\n, H-N Tu\n3\n, J-H Kuo\n\n\n\n3\n, P-Y Chang\n\n\n\n1\n, S-M Kao\n\n\n\n1\n, P-Y Liu Yeh\n\n\n\n1\n, H-J \n\n\n\nChang\n1 \n\n\n\n1\nDepartment of Pharmacy, National Cheng Kung University Hospital, Taiwan \n\n\n\n2\nDivision of Geriatrics and Gerontology, Department of Internal Medicine, National Cheng Kung \n\n\n\nUniversity Hospital,Taiwan \n3\nInstitute of Gerontology, College of Medicine, National Cheng Kung University,Tainan,Taiwan \n\n\n\nCurrently, studies of pharmaceutical care focusing on elderly patients with multi-comorbidities and \n\n\n\npolypharmacy are rare and usually fragmentary. The aim of the study was to establish the assessment \n\n\n\nprotocol of comprehensive pharmaceutical care. We enrolled hospitalized patients aged \u2265 65 years in \n\n\n\na geriatric ward from a medical center in southern Taiwan. After interview with patients and \n\n\n\ncaregivers by pharmacists, the drug utilization evaluation was conducted using the assessment form of \n\n\n\n\n\n\n\n\ncomprehensive pharmaceutical care. The following contents of the evaluation were included: 1) \n\n\n\nReasonability of drug utilization; 2) Potential association between medications and geriatric \n\n\n\nsyndrome; 3) Potentially inappropriate medications based on STOPP & START criteria; 4) Patient \n\n\n\neducation and feedback. A total of 60 patients were recruited. The mean age was 82.5\u00b17.5 years, 50% \n\n\n\nwere female. Total number of prescribed medications assessed was 780 and a mean of 13\u00b14.8 \n\n\n\nmedications per patient during hospital stay. The application of comprehensive pharmaceutical care \n\n\n\nidentified consisted of 15 types of 249 medication problems, including crushing the non-crushed \n\n\n\nmedications in 77 (30.9%), potential association of geriatric syndrome and medications in 43 (17.3%), \n\n\n\ndosage adjustment according to renal function in 21 (8.4%), and medication-related abnormal \n\n\n\nlaboratory data to be followed up in 20 (8%). During the hospital stay, 28 (46.7%) patients received \u2265 \n\n\n\none inappropriate medications by STOPP criteria and 15 (25%) medications needed to be added by \n\n\n\nSTART criteria, with a total of 58 medications detected by both criteria. Calcium channel blockers in \n\n\n\n11 (18.3%) patients with chronic constipation were the most common by STOPP criteria. Antiplatelet \n\n\n\ntherapy was used by 7 (11.7%) diabetic patients with co-existing major cardiovascular risks based on \n\n\n\nthe START criteria. The application of comprehensive pharmaceutical care might detect medication \n\n\n\nproblems among hospitalized elderly patients. Further study to clarify the effects of the suggestions by \n\n\n\npharmacists for medication problems is needed. \n\n\n\n\n\n\n\n\n\n\n\nHPO 42 \n\n\n\nFAPA2014000213 (Oral) \n\n\n\nThe Prevalence of Febrile Neutropenia due to Etoposide, Methotrexate, Actinomycin-d, \n\n\n\nCyclophosphamide, Vincristine (EMA-CO regimen) among Patients with Gestational \n\n\n\nTrophoblastic Neoplasia: A Report from a Single Medical Teaching Hospital in Thailand \n\n\n\nY Lertsrisatit\n1\n, W Santimaleeworagun\n\n\n\n2\n, N  Saengsukkasemsak\n\n\n\n3\n, C Ratanatharathorn\n\n\n\n3\n, S \n\n\n\nTherasakvichya\n4 \n\n\n\n1\nThe College of Pharmacotherapy of Thailand, Bangkok, Thailand \n\n\n\n2\nDepartment of Pharmacy, Faculty of Pharmacy, Silpakorn University, Nakhon Pathom, Thailand \n\n\n\n Department of Pharnacy, Siriraj Hospital, Bangkok, Thailand \n4\nDepartment of Obstetrics & Gynaecology, Faculty of Medicine, Siriraj Hospital, Bangkok, Thailand \n\n\n\n\n\n\n\nAccording to a very few reports of febrile neutropenia (FN), this study aimed to determine the \n\n\n\nprevalence of FN among patients treated with the combination of etoposide, methotrexate, \n\n\n\nactinomycin-d, cyclophosphamide and vincristine regimen (EMA-CO regimen). The patients with \n\n\n\ngestational trophoblastic neoplasia who received EMA-CO regimen during January 2010 \u2013 July 2014 \n\n\n\nat Siriraj Hospital, Bangkok, Thailand, were reviewed retrospectively. FN was defined as the patient \n\n\n\nwith absolute neutrophil count below 500 cell/mm\n3\n become febrile (single oral temperature \u226538.3\u00b0C \n\n\n\nor \u226538\u00b0C sustained over 1 hour). During the study period, ten female patients, 78 cycles of \n\n\n\nchemotherapy were evaluated. The patients\u2019 median age was 34.5 years (range 21-49 years). The \n\n\n\nprevalence of FN was 1 of 10 cases (10%) or 1 time of overall 78 cycle (1.3%), respectively. The FN \n\n\n\noccurred in the fifth cycle. Such patient had positive blood culture with Streptococcus pasteurianus, \n\n\n\nKlebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa identified. Neutropenia grade 3 \n\n\n\nand 4 occurred in 70% (7/10) and 50% (5/10), respectively. The FN in patient with EMA-CO regimen \n\n\n\nwas 10%. This number seems to be intermediate risk of FN based on National Comprehensive Cancer \n\n\n\nNetwork (NCCN) criteria. Therefore, the granulocyte-colony stimulating hormone may be used for \n\n\n\nprimary prophylaxis among these patients. \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nHPO 43 \n\n\n\nFAPA2014000042 (Oral) \n\n\n\nThe Relationship of Pain and Sleep Quality in Opioid Dependent Patients on Methadone \n\n\n\nMaintenance Therapy (MMT) \n\n\n\nZ Zahari\n1,2\n\n\n\n, CS Lee\n3\n, N Musa\n\n\n\n2\n, MA Mohd Yasin\n\n\n\n2,4\n,  SC Tan\n\n\n\n2\n, NMohamad\n\n\n\n2,5\n, R Ismail\n\n\n\n2,6 \n\n\n\n1\nDepartment of Pharmacy, Hospital Universiti Sains Malaysia, Kelantan, Malaysia  \n\n\n\n2\nPharmacogenetics and Novel Therapeutics Cluster, Institute for Research in Molecular Medicine \n\n\n\n(INFORMM), Universiti Sains Malaysia, Kelantan, Malaysia \n\n\n\n \n3\nDepartment of Emergency Medicine, School of Medical Sciences, Universiti Sains Malaysia, \n\n\n\nKelantan, Malaysia  \n4\nDepartment of Psychiatry, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, \n\n\n\nMalaysia \n\n\n\n \n5\nPejabat Timbalan Dekan Penyelidikan & Inovasi, Fakulti Perubatan Dan Sains Kesihatan, \n\n\n\nUniversiti Sultan Zainal Abidin, Terengganu, Malaysia.  \n6\nCentre of Excellence for Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia. \n\n\n\n\n\n\n\nOpioid dependent patients on methadone maintenance therapy (MMT) have been reported to \n\n\n\ncomplain about pain and poor quality of sleep. Data on pain intolerant and poor sleep quality among \n\n\n\nMMT patients in our population are largely unavailable. This study investigated pain sensitivity and \n\n\n\nquality of sleep in this group. A total of 168 opioid dependent patients from MMT clinics in Kelantan, \n\n\n\nMalaysia completed the study. Pain tolerance to cold pressor test (CPT) were evaluated at 0 hour and \n\n\n\nat 24 hours after the first CPT. Malay version of the Pittsburgh Sleep Quality Index \u2013 PSQI and the \n\n\n\nsubjective opiate withdrawal scale (SOWS) questionnaires were administered for the evaluation of \n\n\n\nquality of sleep and withdrawal symptoms, respectively. The mean age of the study participants was \n\n\n\n37.2 (range: 25 - 55) years old. The mean daily methadone dose was 76.6 (range: 20 - 360) mg/day. \n\n\n\nThe mean averaged SOWS score was 5.4 (range: 0 \u2013 48). The averaged pain tolerance time ranged \n\n\n\nfrom 7 to 300 seconds with a mean time of 32.2 (SE 2.72) seconds, slightly below a cut-off score of \n\n\n\n37.14 seconds. More specifically, 78.6% (n = 133) of subjects were identified as \u2018pain-sensitive\u2019 \n\n\n\n(averaged pain tolerance time = 37.14 seconds), and 36 (21.4%) had averaged pain tolerance time > \n\n\n\n37.14 seconds, indicating \u2018pain-tolerant\u2019 subjects. The mean global PSQI score was 5.47 (range: 0 \u2013 \n\n\n\n14). The pain-sensitive patients reported poorer sleep quality compared with pain-tolerant patients (t \n\n\n\n(df) = 2.88 (165), p = 0.005). However, the mean SOWS scores were similar in pain-sensitive and \n\n\n\npain-tolerant opioid dependent patients (t (df) = 1.14 (168), p = 0.256). Opioid dependent patients on \n\n\n\nMMT represent a pain-sensitive subset of clinical patients. Results also provide evidence that pain-\n\n\n\nsensitive patient was associated with poorer sleep quality.  \n\n\n\n\n\n\n\n\n\n\n\nHPO 44 \n\n\n\nFAPA2014000237 (Oral) \n\n\n\n\n\n\n\nComparative Study of Changes in Hepatic Profile Induced by Liposomal Doxorubicin Versus \n\n\n\nConventional Doxorubicin Based Regimens in Cancer Patients \n\n\n\n\n\n\n\nZikria\n1\n, M Ahmad\n\n\n\n1\n, FK Hashmi\n\n\n\n1\n, MT Aziz\n\n\n\n2\n, H Saeed\n\n\n\n1\n, SH Kamran\n\n\n\n1\n, M Islam\n\n\n\n1\n \n\n\n\n1\nUniversity College of Pharmacy, University of the Punjab, Allama Iqbal Campus, Lahore, Pakistan \n\n\n\n2\nShaukat Khanum Cancer Hospital and Research Center, Lahore, Pakistan \n\n\n\n\n\n\n\nThe study aimed to compare the liposomal doxorubicin with conventional doxorubicin to see their \n\n\n\nrelative effects on hepatic profiles. In this retrospective observational study, computerized records of \n\n\n\ncancer hospitals were utilized to check patient demographic details, diagnosis, treatment and \n\n\n\nlaboratory findings. Liver functions were assessed by analyzing pre and post drug therapy values \n\n\n\nduring the course of 4 different cycles (cycle 1, cycle 2, cycle 3 and cycle 4). After applying paired t-\n\n\n\ntest through SPSS version 21, overall no significant changes in liver enzymes and proteins in patients \n\n\n\n\n\n\n\n\nreceiving liposomal doxorubicin (p>0.005) were observed. However, a marked increase in liver \n\n\n\nenzymes levels (p<0.005) and a noticeable decrease in total protein and globulin (p<0.005) levels in \n\n\n\npatients receiving conventional doxorubicin were observed \u2013 exasperating liver damage. Doxorubicin \n\n\n\ninduced hepatic dysfunction is more prominent in the elderly patients of age groups ranging from 41-\n\n\n\n68 years. Moreover, it is pertinent to mention that the study outcome has far reaching implications on \n\n\n\ncurrent health practices focusing on cancer therapeutic management, patient disease prognosis and the \n\n\n\npocket friendly management of the finances. \n\n\n\n\n\n\n\n\n\n\n\nHPO 45 \nFAPA2014000043 (Oral) \n\n\n\n\n\n\n\nEvaluation of the Safety of Excipients in Drugs for Infants \n\n\n\n\n\n\n\nZ-M Lee\n1\n, L Wang\n\n\n\n1\n, S-T Deng\n\n\n\n2\n, F-A Chen\n\n\n\n3 \n\n\n\n1\nDepartment of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Taiwan \n\n\n\n2\nDepartment of Pharmacy, Linkou Chang Gung Memorial Hospital, Taiwan \n\n\n\n3\nDepartment of Pharmacy, Tajen University, Pingtung, Taiwan \n\n\n\n\n\n\n\nExcipients are inactive substances formulated alongside a pharmaceutical compound, have long been \n\n\n\nadded to be part of drugs, and considered inert and pharmacologically inactive. However, as infants \n\n\n\nhave immature hepatic and renal function, there have been more and more evidence suggesting that \n\n\n\nsome excipients may not be safe for infants, leading to their accumulation and resultant toxicity. A \n\n\n\nreview of clinical studies was conducted through Medline 2.0 database from 1860 to May 2014, using \n\n\n\nkeywords of \u201cdrug additive\u201d and \u201ctoxicity\u201d; \u201cdrug additive\u201d and \u201cpoison\u201d; \u201cexcipient\u201d and \u201ctoxicity\u201d; \n\n\n\nand \u201cexcipient\u201d and \u201cpoison\u201d, respectively, and found different numbers of journals for each matched \n\n\n\nterm. Abstracts of these journals were reviewed, and excipients which had caused major toxicity, or \n\n\n\nare not recommended for use in infants, were recorded. Benzyl alcohol, propylene glycol, and ethanol, \n\n\n\nas safe excipients in medicines for adults, were noted to have induced major toxicity or even death in \n\n\n\ninfants. Parabens and sodium metabisulphite drew mixed results. A prescriber should be aware of the \n\n\n\npotential adverse reactions caused by excipients. Critically ill infants, especially those receiving \n\n\n\nmedication by continuous infusion are at great risk. Constant observation and evaluation of \n\n\n\nmedication used in infants is essential for drug safety.  \n\n\n\n\n\n\n\n\n\n\n\nHPO 46 \n\n\n\nFAPA2014000296 (Oral) \n\n\n\n\n\n\n\nThe Geriatric Clinic Care Program: An Approach to Maintaining Good Health and Quality of \n\n\n\nLife \n\n\n\n\n\n\n\nY Agapito, J Berberabe, K Cruz, D Dela Cruz, J Go, K Hung, M Igno, P Juacalla, M Lanzona, \n\n\n\nR Lao, D Ledesma, L Lim, T Miguel, A Panaligan, J Tan, Q Yu, P Quilala \n\n\n\nFaculty of Pharmacy, University of Santo Tomas, Manila, Philippines \n\n\n\n\n\n\n\nThe Geriatric Clinic aspires to address the health care needs of the geriatrics through provision of free \n\n\n\nmedical services. We commit to providing the patients with access to free health services and \n\n\n\nmedications, and to promote activities and lifestyle modifications for a better quality of life. The \n\n\n\nGeriatric Clinic advocates proper care to reach out to the elderly and improves overall well-being \n\n\n\nthrough education, diagnosis and prevention of diseases and provision of appropriate management and \n\n\n\nspecific care to ensure the improvement of quality of life. The programme was conducted at the St. \n\n\n\nJohn\u2019s Home for the Elders, Quiapo, Manila, Philippines between September 2013 and January 2014 \n\n\n\nand was divided into four phases. Phase I comprised of patient profiling and consultation. Patient \n\n\n\nprofiling included patient demographic data, patient history, adherence to medication, eye \n\n\n\nexamination, vital signs, SF-12 (a measurement of patient\u2019s limitation of activities), and \n\n\n\n\n\n\n\n\nchronotyping. Doctors assessed patients and recorded their corresponding management. Phase II \n\n\n\nfocused on providing diagnostic tests which included X-ray, ultrasound, and electrocardiogram. Phase \n\n\n\nIII comprised of communicating diagnostic test results and giving management plan for patients, \n\n\n\ntogether with medicines and medication information. Phase IV comprised of follow-up monitoring, \n\n\n\nand seminars on nutrition, exercise, and sleeping habits. Activities which included showcasing of \n\n\n\ntalents, games and activities, and lunch were given to the beneficiaries. Volunteers quantified the \n\n\n\neffect of the interventions. Results showed that medication adherence rate was found to be high \n\n\n\namong patients after an intervention, and poor adherence rate was found to affect BP control. \n\n\n\nHowever, this was found to be inconclusive because of very small population. Patient demographics \n\n\n\nshowed that the population exhibits a high prevalence of hypertension and diabetes. The community \n\n\n\nwas endorsed to Hypertension clinic and Diabetes Clinic. Overall we conclude that the patients\u2019 \n\n\n\nquality of life improved. \n\n\n\n\n\n\n\n\n\n\n\nHPO 47 \nFAPA201400324 \n\n\n\n\n\n\n\nMedication Administration Errors: An Unsolved Issue of Pharmaceutical Care \n\n\n\n\n\n\n\nM Ibrahim\n1\n, MM Manan\n\n\n\n1\n, B Naina\n\n\n\n2\n, AM Abd Aziz\n\n\n\n3\n \n\n\n\n1\nFaculty of Pharmacy, University Teknologi MARA, Puncak Alam, Malaysia \n\n\n\n2\nHospital Tuanku Ampuan Najihah, Kuala Pilah, Negeri Sembilan, Malaysia \n\n\n\n3\nHospital Tuanku Jaafar, Seremban, Negeri Sembilan, Malaysia \n\n\n\n\n\n\n\nThe frequency of medications errors in the medication use cycle based on the Unit of Dose System to \n\n\n\nreduce medication errors is still questionable. This study aimed to determine the incidence, types of \n\n\n\nmedication administration errors in the implementation the Unit Dose System and to identify the \n\n\n\nfrequency and the potential risk factors. This is a prospective disguised observational study of nurses \n\n\n\npreparing and administering drugs in three wards at a 314 bedded district hospital in Negeri Sembilan. \n\n\n\nThe nurses were followed by a clinical pharmacist of three medication rounds on each day for 10 days \n\n\n\nper ward. Main outcome were number, type of errors and associated risk factors. Medication \n\n\n\nadministration error rate was calculated with and without wrong time errors. Relationship between the \n\n\n\noccurrence of errors and potential risk factors were investigated using logistic regression models. The \n\n\n\nmost common type of prescribing and dispensing errors were incomplete prescription (59.6% of all \n\n\n\nerrors) and labelling errors (95.2% of all errors). A total of 1313 opportunities for errors were \n\n\n\nobserved and 398 administrations with one or more errors were detected. This gave a calculated error \n\n\n\nrate of 30.3% if wrong time error is excluded, the error rate reduced to 26.2%. The most common \n\n\n\ntypes of medication administration errors were wrong administration techniques (64.6%; mainly fast \n\n\n\nbolus administrations and wrong-technique errors (dietary restriction). In multivariate analysis, the \n\n\n\noccurrence of errors was associated with day of observation, patient age, administration route, ATC \n\n\n\nmedication class, MOH drug category, and administration time. Medication administration errors are \n\n\n\nfrequent and pharmacist involvement is critical to ensure the desired pharmaceutical care outcome. \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nHPO 048 \n\n\n\n \nFAPA2014000238 (Oral) \n\n\n\n\n\n\n\nThe Assessment on the Usage of Complementary and Alternative Medicine among People \n\n\n\nLiving with HIV in Metro Manila \n\n\n\n\n\n\n\nAXD Gener, LRS Ramos, BCO Saquilayan, JJF Filler, GMP Atienza, SIP Castillo, HA Maini, \n\n\n\nJGST Aquino \n\n\n\nCollege of Pharmacy, Adamson University, Manila Philippines \n\n\n\n\n\n\n\nHIV is a virus that suppresses the immune system of an individual who has the disease which could \n\n\n\nmake them weak and susceptible to other infections. Antiretrovirals are often used as treatment for the \n\n\n\ndisease but with the rising popularity of Complementary and Alternative Medicine (CAM) which is a \n\n\n\ngroup of diverse medical and health care system that are not part of conventional treatment, People \n\n\n\nLiving with HIV(PLHIV) tend to use these systems to help them with their condition. This study aims \n\n\n\nto assess factors that affect the use of CAM by PLHIV. A cross sectional study was conducted and \n\n\n\nparticipants were from non-government organizations which caters PLHIV who gave their approval to \n\n\n\nconduct the study in their respective organisation. In order to assess the factors that may affect their \n\n\n\nuse of CAM, an adapted questionnaire was used to conduct a survey in two NGOs in Metro Manila \n\n\n\nwith total respondents of 91. The survey questionnaire was pre-tested and validated by people with \n\n\n\nexpertise to CAM and HIV/AIDS. Data collected were analysed using SPSS for windows version \n\n\n\n21. Results showed that there is no association with the socio-demographic factors to the use of CAM \n\n\n\nby PLHIV. Level of Benefit and Level of source of Awareness showed a significant effect on the \n\n\n\nreason of CAM use. CAM is used by PLHIV for promoting their health status and boosts their \n\n\n\nimmune system. The level of benefit they get from using CAM specially on alleviating side effects \n\n\n\nfrom the conventional therapy provokes them to make use of this system, also their source of \n\n\n\nawareness to this medications and alternative systems affects their use of CAM while their socio \n\n\n\ndemographic factors does not have a significant effect on why these people resort to using CAM. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nCOMMUNITY PHARMACY \n \nCPO 01 \n\n\n\nFAPA2014000135 (Oral) \n\n\n\n\n\n\n\nProfile Components of Drug Information Service by Pharmacists for Prescription Service in \n\n\n\nPharmacy Klojen Subdistrict Malang \n\n\n\n\n\n\n\nR Atika, S Bambang, RP Hananditia\n \n\n\n\nDepartment of Pharmacy, Medical Faculty, University of Brawijaya, Malang, Indonesia \n\n\n\n\n\n\n\nDrug information service is a service activity that must be performed by pharmacists to provide \n\n\n\naccurate information and consultation. On prescription service, medicines given are not always \n\n\n\naccompanied by a package that includes drug information, so that the role of pharmacists in this \n\n\n\naspect is very important in ensuring the goals of treatment and the correct use of the drug. This study \n\n\n\nwas design to identify the components of drug information services and the existing obstacles in the \n\n\n\nimplementation of drug information service by pharmacists on prescription in the pharmacy services. \n\n\n\nA prospective observational study was conducted at Pharmacy Klojen subdistrict Malang for 2 \n\n\n\nmonths, from February to April 2013. Apothecary that conducts service prescriptions of doctors and \n\n\n\ndentists for at least five sheets of prescription and any pharmacists in the pharmacy at the time of \n\n\n\nprescription service, were eligible for this research. The components of drug information services \n\n\n\ndelivered by most of the pharmacists were the condition of use, duration of treatment, frequency of \n\n\n\ndrug use, and drug dosing. In addition, 70% were related to information on side effects, 50% on \n\n\n\nactivities that should be avoided during therapy, 30% on food and beverages which should be avoided \n\n\n\nduring therapy, 10% on drug storage and contra indications. The most common obstacles in the \n\n\n\nimplementation of drug information services were patient in a hurry (81.8%), educational background \n\n\n\nof patients (63.6%) and patient age (54.5%). In conclusion, a component of drug information services \n\n\n\nprovided by pharmacists on prescriptions has not been fully conveyed in accordance with the existing \n\n\n\nregulations. \n\n\n\n\n\n\n\n\n\n\n\nCPO 02 \nFAPA2014000030 (Oral) \n\n\n\n\n\n\n\nConsumers Knowledge, Perception and Satisfaction towards the Role of Community \n\n\n\nPharmacist as Healthcare Provider in Basco, Batanes \n\n\n\n\n\n\n\nIGB Bacud, GMQ Dela Cruz, AP Zaide, PM Crucis, HA Maini \n\n\n\nCollege of Pharmacy, Adamson University, Manila,Philippines \n\n\n\n\n\n\n\nCommunity pharmacists are the most accessible point in patient-centered healthcare. However, most \n\n\n\nFilipinos have the perception that community pharmacists are merely a vendor of drugs, making them \n\n\n\nas \u201cunderutilized\u201d healthcare professionals. This study sought to determine the perception, satisfaction \n\n\n\nand knowledge of consumers towards the role of community pharmacists as healthcare providers in \n\n\n\nBasco, Batanes, and to compare the performance of the community pharmacists as healthcare \n\n\n\nproviders with the mandated roles by the World Health Organization (WHO). Qualitative and \n\n\n\nquantitative sampling methods were done. Data were collected using self-administered questionnaires \n\n\n\nfrom six selected community pharmacies, 56 consumers and four randomly selected participants in \n\n\n\nthe Focus Group Discussion. The questionnaire used was from a published journal that was translated \n\n\n\ninto Filipino language, validated, pre-tested and reliability tested. The results indicated that \n\n\n\nrespondents\u2019 age, educational attainment and gender did not significantly affect their levels of \n\n\n\nperception, knowledge and satisfaction. The results of the study showed that the consumers in Basco, \n\n\n\nBatanes have an overall positive perception (95%), satisfaction (57%) and knowledge (82%) towards \n\n\n\nthe role of community pharmacists as healthcare providers. However, a majority of the consumers \n\n\n\n\n\n\n\n\nperceived the pharmacist as merely a vendor of drugs. There was also an observed relationship \n\n\n\nbetween knowledge, perception and satisfaction. It can be concluded that despite the geographic \n\n\n\nisolation of Batanes, consumers in Basco had an overall positive knowledge, perception and \n\n\n\nsatisfaction on the role of community pharmacists as healthcare providers. There were no gaps \n\n\n\nbetween the practices in the island with that of the mandated roles by the WHO. Moreover, as the \n\n\n\nconsumers\u2019 knowledge increases, the more their perception increases, therefore satisfaction also \n\n\n\nincreases. Patient-centered approach programmes should be developed to improve consumers\u2019 \n\n\n\nimpression towards the proper utilization of community pharmacists to achieve better health \n\n\n\noutcomes. \n\n\n\n\n\n\n\n\n\n\n\nCPO 03 \nFAPA2014000134 (Oral) \n\n\n\n\n\n\n\nComparing the Onset of Action and Duration of Action of Available Topical Patches to Ease \n\n\n\nMuscle Strain in Groups of Subjects between 20-40 years old \n\n\n\n\n\n\n\nR  Illahi, E Triastuti, E Yunita, H Pramestutie \n\n\n\nPharmacy Department, Faculty of Medicine, Brawijaya University, Malang, Indonesia \n\n\n\n\n\n\n\nThe Indonesian market is flooded with products used to treat or ease muscle strain, and most of them \n\n\n\nare topical including patch. Patch is likely to become the consumer\u2019s choice because it is easy to use \n\n\n\nwith earlier onset and longer duration of use compared with gel or cream. The aim for this study was \n\n\n\nto determine which available analgesic patch with active ingredient capsaicin that has the earliest \n\n\n\nonset and the longest duration of action by a consumer test done to a particular group of subjects.  \n\n\n\nSubjects (n = 237) between 20-40 years old were assigned to three different hot patch groups, patch A \n\n\n\nvs B, A vs C and A vs D. Subjects were chosen randomly and patch was assigned to each subject \n\n\n\nusing double-blinded to minimize bias. Subjects were asked to apply the patches on their back, which \n\n\n\nis a body area that often has muscle strain, and then fill the questionnaire to determine which patch \n\n\n\nhas the earlier onset of action and the longest duration of action. The method has been approved by \n\n\n\nHealth Research Ethic Committee, Medical Faculty of University of Brawijaya. Hypothetical analysis \n\n\n\nusing Mann-Whitney U test showed that there were statistically significant differences between onsets \n\n\n\nof action of hot patches in group A vs B (p=0.012), A vs C (p=0.000) and A vs D (0.006), but there \n\n\n\nwere no significant differences in duration of action for the three groups. There were statistically \n\n\n\nsignificant differences in onset of action of available analgesic patches in the market but there were no \n\n\n\ndifferences in duration of action from a consumer test done to a particular group of subjects. Those \n\n\n\ndifferences can happen due to different formulation of each patch and also different characteristics of \n\n\n\nactive ingredients and excipients from different suppliers. \n\n\n\n\n\n\n\n\n\n\n\nCPO  04 \nFAPA2014000114 (Oral) \n\n\n\n\n\n\n\nEvaluation of Drug Information Services in Community Pharmacies using Simulated Patient \n\n\n\nMethod: Amoxicillin Antibiotic and Oral Corticosteroid \n\n\n\n\n\n\n\nGF Galistiani, A Ardiansyah, NA Wibowo, AM Kusuma \n \nFaculty of Pharmacy, University of Muhammadiyah Purwokerto, Jawa Tengah, Indonesia \n\n\n\n\n\n\n\nDrug information services have become an integral part of community pharmacy practice. In \n\n\n\nproviding information to consumers with prescriptions, pharmacists have to fulfill the minimum \n\n\n\npractice standards, such as information request (questions pharmacists should ask the patients) and \n\n\n\ninformation provision (information on medicine that pharmacists should give to the patients). The aim \n\n\n\nof the research was to measure the quality of drug information services given by the community \n\n\n\npharmacists in amoxicillin antibiotic and oral corticosteroid prescription-based products. The research \n\n\n\n\n\n\n\n\nwas assessed using simulated patient method. Trained simulated patients, instructed to play their roles \n\n\n\naccording to a scenario, visited 55 voluntarily participating community pharmacies in Banyumas \n\n\n\nRegion, Central Java States, Indonesia. They requested a prescription-based product: amoxicillin \n\n\n\nantibiotic and oral corticosteroid. The pharmacists drug information services recorded in audio taped. \n\n\n\nImmediately after each visit, the researcher filled a check list form to measure the quality of drug \n\n\n\ninformation services given by the pharmacists based on simulated patients information recall. The \n\n\n\nevaluation criteria were the information content, where the pharmacist\u2019s information request and \n\n\n\nprovision. The pharmacists rarely asked the simulated patients any questions. The simulated patients \n\n\n\nwere asked what is the symptoms (49,09%), for whom the product was for (23,64%), allergy status \n\n\n\n(9,09%) and the medication they have used before (9,09%). However, information provision was \n\n\n\nmore common. The most frequently provided information was the dosage (92,73%) and antibiotic \n\n\n\ninformation (80,00%). The quality of drug information services given by the pharmacists was good as \n\n\n\nclassified for 28 of the 55 participating pharmacists. The information request was less than provision \n\n\n\ninformation that should be asked by pharmacists to patients. The information of antibiotic amoxicillin \n\n\n\nis more frequently provided by pharmacists than oral corticosteroid.   \n\n\n\n\n\n\n\n\n\n\n\nCPO  05 \nFAPA2014000226 (Oral) \n\n\n\n\n\n\n\nPharmacists Counselling Advantages on Medication Adherence and Non-Pharmacologic \n\n\n\nInterventions \n\n\n\n\n\n\n\nLW Raymundo\n1\n, AE Arcega\n\n\n\n1\n, PM Sigua\n\n\n\n1\n, PB Agregado\n\n\n\n1\n, AM Ong\n\n\n\n1\n, LE Briones\n\n\n\n1\n, ZB Corteza\n\n\n\n1\n, \n\n\n\nCG Pablo\n2\n. \n\n\n\n1\nFaculty of Pharmacy, University of Santo Tomas, Manila, Philippines  \n\n\n\n2\nThe Graduate School, University of Santo Tomas, Manila, Philippines \n\n\n\n\n\n\n\nPatient counselling ensures the safe and effective use of medicines by providing a framework to allow \n\n\n\nan in-depth exploration of the patient experiences, views and medication use. Interventions were \n\n\n\nperformed in a community-based hypertension programme model. The aim of this study was to \n\n\n\nevaluate the effectiveness of face-to-face counselling on medication adherence and lifestyle \n\n\n\nimprovements of patients. The patients were assessed at baseline and at several phases of \n\n\n\ninterventions. Patients\u2019 demographics, family/social history, blood pressure (BP) and medications \n\n\n\nwere noted. Lifestyle interventions (exercise/nutritional seminar) were delivered as well as pharmacy \n\n\n\ncare and counselling. The pharmaceutical care counselling template documented the improvement on \n\n\n\nmedication adherence and patients\u2019 lifestyle. Patient satisfaction survey was conducted. After 5-\n\n\n\nphases intervention, there were a total of 30 patients. Seventeen (57%) patients had significantly \n\n\n\ndecreased BP. Of the 7(23%) known smokers, 4(57%) ceased the habit while the rest continued \n\n\n\nsmoking. Of the 11(37%) known alcoholic drinkers, 5(45%) stopped drinking habits; 10(33%) \n\n\n\npatients lessened salt and oil consumption while 6(37%) patients completely avoided it. Sedentary \n\n\n\nlifestyle was not noted within the community. Based on the Morisky Medication Adherence Scale, \n\n\n\n24(80%) patients adhered to their medication regimen. After counselling, their implementation was \n\n\n\nassociated with improved lifestyle and the modifications were acceptable. Most stated that they have \n\n\n\nadopted the changes.  Pharmacist-led face-to-face counselling had a positive impact on patients\u2019 \n\n\n\nmedication adherence and lifestyle modification. It is effective in controlling BP and improving self-\n\n\n\nefficacy in the management of condition and quality of life.  \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nCPO  06 \nFAPA2014000249 (Oral) \n\n\n\n\n\n\n\nEvaluation of Different Inhalational Delivery Devices Techniques among the Community \n\n\n\nPharmacists in Urban Areas in Selangor, Malaysia \n\n\n\n\n\n\n\nI Nahlah Elkudssiah, A Lokman Hakim, Z Muhammad Khalis, NK Muhammad Anwar\n \n\n\n\nClinical BioPharmaceutics Research Group (CBRG), Faculty of Pharmacy, Universiti Teknologi \n\n\n\nMARA, Puncak Alam Campus, Selangor, Malaysia \n\n\n\n\n\n\n\nThe right inhalational delivery devices techniques are vital to ensure the inhaled drug particles \n\n\n\nreached the targeted site to produce desired therapeutic action. As one of the front-line health \n\n\n\nprofessionals, pharmacists must be able to directly demonstrate and educate correct technique of using \n\n\n\nvarious inhalational delivery devices to patients with respiratory diseases especially asthma and \n\n\n\nchronic obstructive pulmonary disease. This study determined the knowledge level of the community \n\n\n\npharmacists regarding their ability to educate patients on how to use the metered dose inhaler (MDI) \n\n\n\nand dry powder inhalers (DPIs), mainly accuhaler and turbuhaler. Data were collected from January \n\n\n\nuntil May 2013. Post signed consent, the community pharmacists completed the given questionnaires \n\n\n\nwhich consisted of study socio-demographic data. The verbal demonstrations of the respective study \n\n\n\ninhalers were recorded and transferred to inhaler checklist for scoring. Descriptive and inferential \n\n\n\nstatistical analysis using SPSS (version 19) were employed where appropriate with p value of < 0.05 \n\n\n\nas statistically significant. This observational study recruited 81 community pharmacists from various \n\n\n\nurban areas (n = 6) in Selangor, Malaysia. The overall mean (\u00b1SD) scores for MDI, turbuhaler and \n\n\n\naccuhaler were 6.67 (\u00b10.88), 6.40 (\u00b10.73) and 5.79 (\u00b10.83), respectively. These were the mean scores \n\n\n\nfor the inhaler techniques which were answered sequentially. There were significant relationships \n\n\n\nbetween ethnicity and different categories of scores for MDI (p = 0.037) and turbuhaler (p = 0.011). \n\n\n\nThe study showed that the overall level of knowledge in demonstrating inhaler techniques amongst \n\n\n\nurban community pharmacists was moderate (5 \u2013 7 score). Many respondents were unable to obtain \n\n\n\ngood score (8 to 10). Additional training via continuous professional development programmes should \n\n\n\nbe provided to further equip the respondents with proper inhaler techniques for them to demonstrate \n\n\n\nthe best inhaler techniques to the patients. \n\n\n\n\n\n\n\n\n\n\n\nCPO  07 \nFAPA2014000323 (Oral) \n\n\n\n\n\n\n\nResponse of Community Pharmacists to Request for an Oral Contraceptive \n\n\n\n\n\n\n\nAM Yusoff\n1\n, SS Chua\n\n\n\n1\n, SY Yip\n\n\n\n2\n, KK Lam\n\n\n\n3\n, S Alwi\n\n\n\n1\n \n\n\n\n1\nDepartment of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia \n\n\n\n2\nAlychem Pharmacy, Selayang Baru, Kuala Lumpur, Malaysia \n\n\n\n3\nMalaysian Pharmaceutical Society, Kuala Lumpur, Malaysia \n\n\n\n\n\n\n\nOral contraceptive (OC) is one of the common contraception methods used for family planning. It can \n\n\n\nbe purchased at a community pharmacy with proper consultation by community pharmacist to ensure \n\n\n\nits effective and safe usage. Thus, this study aimed to assess the response of community pharmacists \n\n\n\nto request for an oral contraceptive. This study used a stimulated-customer method, conducted at 100 \n\n\n\ncommunity pharmacies located in Klang Valley. The researcher who posed as a customer approached \n\n\n\nthe community pharmacist and requested an OC for her family planning purposes. Consultations were \n\n\n\ndocumented in a pretested data collection form.  In 99% of the consultations, the pharmacist asked at \n\n\n\nleast one question and the most common question asked was the customer\u2019s previous OC usage (85%) \n\n\n\nfollowed by her last menstrual period (22%).  A majority of the pharmacists (95%) provided some \n\n\n\ncounselling to the \u2018customer\u2019. A median of seven counselling elements were addressed out of 22 \n\n\n\nrecommended and they were mainly on the dose (85%), dosing frequency (85%), route of \n\n\n\nadministration (81%) and duration of therapy (79%).  The number of counselling elements addressed \n\n\n\n\n\n\n\n\nwas significantly associated with gender, age of the pharmacist, location of the pharmacy and duration \n\n\n\nof the consultation. Overall, 83% of the consultations ended with the \u2018customer\u2019 buying an OC while \n\n\n\nthe rest referred the \u2018customer\u2019 to a doctor. All OCs recommended were combined oral contraceptive \n\n\n\n(COC). This study showed that extent of information gathering during patient counselling varied \n\n\n\namong the community pharmacists in the Klang Valley.  Community pharmacists should step up \n\n\n\nfurther and portray themselves as a competent first line health educators in providing thorough \n\n\n\nconsultation and counselling to the general public. \n\n\n\n\n\n\n\n\n\n\n\nCPO  08 \nFAPA2014000312 (Oral) \n\n\n\n\n\n\n\nPharmacists and General Practitioners Collaborative Practice: A Survey of Attitudes, Current \n\n\n\nPractice and Barriers to Interprofessional Care \n\n\n\n\n\n\n\nE Roohi, F Hashemian \n\n\n\nDepartment of Clinical Pharmacy, Pharmaceutical Sciences Branch, Islamic Azad University, \n\n\n\nTehran, Iran \n\n\n\n\n\n\n\nInterprofessional collaboration between pharmacists and general practitioners (GPs) has proven to \n\n\n\nenhance patient care and outcomes. Yet, research into factors influencing collaborative practice \n\n\n\nremains limited. The aim of the present study was to investigate collaborative working relationship \n\n\n\nbetween pharmacists and GPs in terms of their attitudes, role perceptions, experiences with \n\n\n\ncollaborative practice, preferred method of communication, areas of current and further collaboration, \n\n\n\nand perceived barriers to interprofessional collaboration in a sample of Iranian population. A total of \n\n\n\n243 surveys were distributed among community pharmacists and GPs attending different continuous \n\n\n\nmedical education programs from all over the country. The survey questions were designed to address \n\n\n\nthe research questions. The study was conducted during winter and spring 2014. Results of each group \n\n\n\nwere analyzed separately, and comparisons between groups were made in order to compare responses \n\n\n\nof both groups. Both groups had positive attitudes towards collaboration. However, the majority of \n\n\n\npharmacists and GPs reported only occasional experience with collaborative practice. For both \n\n\n\ngroups, communication via telephone or face to face communication was preferred. Both groups were \n\n\n\nfound to have different role perceptions regarding perceived roles of a community pharmacist. The \n\n\n\nmost significant perceived barriers to collaborative practice were found to be possible fragmentation \n\n\n\nof patient care due to involvement of multiple health care providers and lack of face to face \n\n\n\ncommunication. The present study suggested that there are different factors contributing to current \n\n\n\nlevel of collaborative practice between community pharmacists and GPs in Iran. Diverse perceptions \n\n\n\nof the roles of community pharmacists in health care settings, and lack of face to face communication \n\n\n\nwere found as possible contributing factors.  Moreover, lack of interprofessional collaboration \n\n\n\neducation and joint programmes for both pharmacy and medicine students were suggested. \n\n\n\n\n\n\n\n\n\n\n\nCPO  09  \n\n\n\nFAPA2014000307 (Oral) \n\n\n\n\n\n\n\nCaffeine Habit: A survey on the use and effects of caffeine-containing beverages among \n\n\n\nuniversity students \n\n\n\n\n\n\n\nMHF Encinas, CJN Gabrito, MFVT Gamboa, JKB Llena, KIS Sison, MPC Valero, KCA \n\n\n\nViray,\n \nJG Apostol \n\n\n\nFaculty of Pharmacy, University of Santo Tomas, Philippines \n\n\n\n\n\n\n\nLike any morning ritual, drinking coffee has been a routine for most students wanting an extra jolt of \n\n\n\nalertness and performance boost to face the day and perform efficiently in academic activities. \n\n\n\nStudents often abuse caffeine, and often than not, they take it lightly. With this mentality, they may \n\n\n\n\n\n\n\n\nactually end up overdosed. Caffeine as a pharmaceutical entity is not safe when abused. Counseling is \n\n\n\nneeded to inform students on safe and effective caffeine use. This study aimed to find which \n\n\n\ncaffeinated beverage is commonly preferred by students; to find the common side effects experienced \n\n\n\nby the students after taking a dose of caffeine into their system; and to know the reasons for drinking \n\n\n\nsuch beverages. The study was conducted on November 2013 at a tertiary education institution. \n\n\n\nRespondents were randomly selected from freshmen taking Bachelor of Science in Pharmacy, \n\n\n\nMedical Technology and Biochemistry. The survey tool consisted of demographics, caffeine source \n\n\n\npreference and any unpleasant effect they experienced after taking caffeinated products. The \n\n\n\nresearchers used percentage to analyze the data. Among the choices of coffee, chocolate drink, milk \n\n\n\ntea, soda and energy drinks, coffee stands as the prime source of caffeine. Among the side effects, the \n\n\n\nsymptoms of nervousness, insomnia and palpitations were experienced by the students and were often \n\n\n\ncomplained as troublesome as it hindered functioning and attention as opposed to the perceived \n\n\n\nbenefit of alertness and endurance. Notably, the main purpose as to why students consumed caffeine \n\n\n\nwas to boost energy during any school works. Surveyed students\u2019 lack of understanding regarding \n\n\n\ncaffeine and its varied side effects and how the irresponsible use of caffeine may lead to various \n\n\n\ncomplications. Consequently, a seminar on proper information dissemination is recommended to \n\n\n\ninform them regarding its rational use. \n\n\n\n\n\n\n\n\n\n\n\nCPO  10 \nFAPA2014000284 (Oral) \n\n\n\n\n\n\n\nCommunity Pharmacy Dispensing Practice of Non-steroidal Anti-inflammatory Drugs by \n\n\n\nPharmacists and Pharmacy Assistants in Manila City \n\n\n\n\n\n\n\nJK Go, S Delos Santos, K Hung, IC Medina, S Ong \n\n\n\nFaculty of Pharmacy, University of Santo Tomas, Manila City, Philippines \n\n\n\n\n\n\n\nIn community pharmacy practice, recommendation of over-the-counter (OTC) Non-Steroidal Anti-\n\n\n\nInflammatory Drugs (NSAIDs) is influenced by several factors: knowledge, attitude and factors that \n\n\n\naffect decision making. The aim of the study is to measure those factors. The popularity and \n\n\n\nincreasing use and demand of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) as over-the-counter \n\n\n\ndrug warrants further surveillance and avoidance of unwanted events. A survey will be conducted on \n\n\n\na sample size of 90 community pharmacies within the 6 districts of Manila city. The respondents will \n\n\n\nbe a pharmacist and a pharmacy assistant, whom will be randomly selected by the researchers, for \n\n\n\neach community pharmacy drugstore. A 95% CI and a 10% margin of error were used in the \n\n\n\ncalculation of the sample size from a population size of 945 community pharmacies within Manila \n\n\n\ncity. The knowledge and the attitude will be measured and correlated using the Pearson Correlation \n\n\n\nMethod, where the researchers will determine if the data has a statistically significant correlation. The \n\n\n\nfactors will be quantitatively analyzed by obtaining the mean and the standard deviation of the result \n\n\n\nthat will be gathered. \n\n\n\n\n\n\n\n\n\n\n\nCPO  11 \n\n\n\nFAPA2014000294 (Oral) \n\n\n\n\n\n\n\nA Comparative Analysis of the 8-Item Morisky Medication Adherence Scale before and after a \n\n\n\nPharmaceutical Care Program among Chronically Hypertensive Elderly Patients \n\n\n\n\n\n\n\nY Agapito, J Berberabe, K Cruz, DD Cruz, J Go, K Hung, M Igno, P Juacalla, M Lanzona, R \n\n\n\nLao, D Ledesma, L Lim, T Miguel, A Panaligan, J Tan, Q Yu, P Quilala \n\n\n\nFaculty of Pharmacy, University of Santo Tomas, Philippines \n\n\n\n\n\n\n\nProblems with non-adherence to treatments are risk factors that highly contribute to total reduction in \n\n\n\nthe control of blood pressure (BP). Adherence to prescribed medication regimens is difficult for all \n\n\n\n\n\n\n\n\npatients and particularly challenging for the elderly. This study aimed to determine the relative \n\n\n\nsignificance of the scores in the 8-item Morisky Medication Adherence Scale (MMAS-8) before and \n\n\n\nafter a pharmaceutical care intervention and its association to BP control of chronically hypertensive \n\n\n\ngeriatric patients. It also aimed to evaluate the effects in adherence and BP control of the intervention \n\n\n\nmade by the Clinical Pharmacy students of the University of Santo Tomas, Philippines. Data were \n\n\n\ncollected from chronically hypertensive geriatric respondents of St. John\u2019s Home for the Elders in \n\n\n\nQuiapo, Manila, Philippines between September 7, 2013 and December 8, 2013. The geriatric patients \n\n\n\nwere subjected to MMAS-8 and measurement of BP before and few weeks after the intervention. The \n\n\n\ndata also included their age, gender, height, weight, and visual acuity. Data from the MMAS-8 were \n\n\n\nanalyzed and scores of more than 2 were recorded as low adherence, 1 or 2 as medium adherence and \n\n\n\na score of 0 as high adherence. 83.33% of the patients were adherent (MMAS-8 = 0) and 16.67% were \n\n\n\nnon-adherent (MMAS-8 >2). One out of three (33.33%) patients with uncontrolled BP did not adhere \n\n\n\nto antihypertensive treatment, while 88.89% with controlled BP were adherent. The effect of the \n\n\n\nintervention to BP control and medication adherence was found to be inconclusive since a small \n\n\n\npopulation was involved in the study. The medication adherence rate was found to be high among \n\n\n\npatients after an intervention. A poor adherence rate was found to affect BP control. The effect of the \n\n\n\nintervention program is necessary to improve adherence and in turn, to improve BP control. \n\n\n\n\n\n\n\n\n\n\n\nCPO  12 \nFAPA2014000235 (Oral) \n\n\n\n\n\n\n\nThe Behavioral Intention of Thai Community Pharmacist to Provide Medicine Use Review \n\n\n\n(MUR) \n\n\n\n\n\n\n\nV Lertjanyakun, K Wattanatraiphop, A Theeraroungchaisri, R Sakulbumrungsil\n  \n \n\n\n\nDepartment of Social and Administrative Pharmacy, Faculty of Pharmaceutical Sciences, \n\n\n\nChulalongkorn University, Thailand  \n\n\n\n\n\n\n\nCommunity pharmacy is the setting that plays a vital role in seamless patient care.  National Health \n\n\n\nSecurity Office (NHSO), Thailand created the standard of primary pharmaceutical care services, \n\n\n\nwhich consists of four types of services - Medicine Use Review (MUR), Prevention & Promotion, \n\n\n\nBehavioral modification, and Health consumer protection. MUR is the first service that was \n\n\n\nintroduced to some communities as an expanded pilot service model. This research was therefore \n\n\n\ncarried out to identify what are the factors that contribute to the behavioral intention of Thai \n\n\n\npharmacists in providing MUR. The sample for this cross-sectional study was all Thai community \n\n\n\npharmacists (n=1,284). The questionnaire was developed based on the Theory of Planned Behavior. \n\n\n\nBesides, we also measure 3 variables - reimbursement, good drugstore image, and self-esteem. \n\n\n\nMultiple linear regression (MRA) was used to predict the behavioral intention. The intention to \n\n\n\nprovide MUR was positive with a mean score of 7.1 \u00b11.9 out of 10. The MRA found the constructs \n\n\n\nof attitude, subjective norm, perceived behavioral control and self-esteem to be significant predictors \n\n\n\nof behavioral intention (P < 0.01). Pharmacists with stronger intention to provide MUR were those \n\n\n\nwho felt they had more control over providing MUR, felt their peers\u2019 approval of engaging in MUR, \n\n\n\nhad a positive attitude towards MUR, and felt self-esteem from providing MUR.  Perceived \n\n\n\nbehavioral control is the strongest predictors (standard coefficient beta = 0.349, adjusted R\n2 \n= 0.613). \n\n\n\nThe 68 percent of respondents expressed that \u201ctime\u201d is an important barrier to provide MUR. Other \n\n\n\nbarriers such as lack of staff, essential skill, knowledge, instrument or technology support, and good \n\n\n\ncorporation were also reported. Therefore, strategies to help pharmacists provide MUR should focus \n\n\n\non increasing the confidence of Thai pharmacists in their potential to provide MUR and finding time \n\n\n\nand support to provide medical use review services.  \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nCPO  13 \nFAPA2014000329 (Oral) \n\n\n\n\n\n\n\nTransforming Malaysian Community Pharmacists\u2019 Role in Wellness and Health-care \n\n\n\n\n\n\n\nSS Wong \n\n\n\nBath Pharmacy, Kuching, Sarawak, Malaysia. \n\n\n\n\n\n\n\nIn the last decade pharmacy profession in Malaysia had transformed, with 155% increase in registered \n\n\n\npharmacists, 300% more local tertiary pharmacy institutions, and there were more public sector \n\n\n\npharmacists than private community pharmacists. Such rapid changes risked disrupting the livelihood \n\n\n\nand future of pharmacy practitioners unless it came with new practice frontiers and a major overhaul \n\n\n\nof the colonial-era health-care delivery system. Overall transformation requires a suitable pharmacy \n\n\n\nlegislative framework, new professional roles for community pharmacists, equitable distribution and \n\n\n\nadequate financing of community pharmacies. Public sector excels in the transformation processes as \n\n\n\nthey are not constrained by legislation, manpower resources and finance consideration. Appropriate \n\n\n\nstrategies to transform the most vulnerable community pharmacy sector include incorporation of \n\n\n\nvarious practice guidelines and standard operating procedures to ensure consistent pharmacy \n\n\n\nprofessionalism to bring greater health-care benefits to the patients and consumers. Successful \n\n\n\ntransformation of Malaysian community pharmacists\u2019 role will contribute immensely to pharmacy \n\n\n\nprofession and the nation. Partnership of the Government and pharmacists is an essential ingredient in \n\n\n\nthe process. Neither party can afford to fail. \n\n\n\n \n\n\n\n\n\n\n\n\nDRUG MARKETING & SOCIO-ECONOMIC PHARMACY \n\n\n\nSEO 01 \n\n\n\nFAPA2014000127 (Oral)  \n\n\n\n\n\n\n\nCost-Effectiveness Analysis (CEA) of Antihypertensive Drugs in Patients with Type 2 Diabetes \n\n\n\nMellitus in Lahad Datu Hospital \n\n\n\n\n\n\n\nJYH Voo\n1\n, B Samsia\n\n\n\n1\n, TY Tang\n\n\n\n2\n \n\n\n\n1\nDepartment of Pharmacy, Lahad Datu Hospital, Lahad Datu, Sabah, Malaysia \n\n\n\n2\nDepartment of Pharmacy, Sabah State Pharmacy Supply Centre, Kota Kinabalu, Sabah, Malaysia \n\n\n\n\n\n\n\nHypertension with type 2 diabetes mellitus (T2DM) is a prevalent non-communicable disease that \n\n\n\nleads to morbidity and mortality. Malaysian Statistics on Medicines reported that RM508 millions \n\n\n\nwere spent on antihypertensive drugs, purchase by public and private sectors in 2008.  There is a need \n\n\n\nfor efficient selection of antihypertensive drugs due to the escalating costs of drugs and scarce \n\n\n\nresources available. This study aimed to determine the cost-effectiveness of different classes of \n\n\n\nantihypertensive drugs and to evaluate adherence to the current Malaysian Clinical Guidelines for \n\n\n\nantihypertensive agents use in diabetes patients. This was a retrospective review, from May 2010 to \n\n\n\nApril 2011, where records of outpatients with T2DM in Lahad Datu Hospital were evaluated. All \n\n\n\nT2DM outpatients who were on antihypertensive agents for more than 3 months were included in the \n\n\n\nstudy. Costing was undertaken from providers\u2019 perspectives.  Direct costs such as drug acquisition \n\n\n\ncosts, laboratory costs and salaries of health professionals were included.  The Incremental Cost-\n\n\n\nEffectiveness Ratio (ICER) was determined by comparing the extra monthly mean cost of two \n\n\n\nantihypertensive alternative groups to the additional proportion of diabetes patients with controlled \n\n\n\nBP. A total of 135 patients were included in the analysis, with 30 and 42 patients who received \n\n\n\nangiotensin converting enzyme inhibitor (ACEI) monotherapy and combination therapy, respectively. \n\n\n\nThis was in concordance with the guidelines. In this population, 63 patients (46.67%) achieved ideal \n\n\n\nBP control of less than 130/80 mmHg.  ACEI monotherapy (RM45) were the most cost-effective \n\n\n\ndrugs to control BP among diabetes patients, followed by calcium channel blockers (CCBs) (RM81).  \n\n\n\nIn addition, ACEIs + diuretics (RM84) and ACEIs + CCBs + beta-blockers (RM120) were the most \n\n\n\ncost-effective double and triple drug combination regimens, respectively. In conclusion, the most \n\n\n\ncost-effective therapies were ACEIs and ACEIs combination therapies. Both utilisation of ACEIs \n\n\n\nmonotherapy and combination in hypertensive patients with T2DM are consistent with evidence-\n\n\n\nbased clinical practice guidelines. \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nSEO 02 \nFAPA2014000105 (Oral) \n\n\n\n\n\n\n\nWellness in Smallness \n\n\n\n\n\n\n\nIM Tesalona \n\n\n\nFine Nutrition Trading International, Quezon City, Philippines \n\n\n\n\n\n\n\nThe buy and sell of one sachet of health supplement is the smallest degree of retail. Even in this \n\n\n\nrepack commerce we can still imbibe wellness. Health supplements in the market are outmoded since \n\n\n\nwe do not move on to a next phase. We have not developed the braveness to discard the obsolete kind \n\n\n\nof mentality. We fear bigness, we fear of moving on. That is why up to this time, the heritage of \n\n\n\nsmallness is very significant. The challenge was not met. Wellness and good health have been well \n\n\n\npromoted. In fact, this is the trend in these modern times. Despite much effort to advocate wellness, \n\n\n\nsmallness prevails because we work on small scale. The challenge to promote wellness is inherent in \n\n\n\nme being a Pharmacist by profession. The depressing fact is the way of thinking - of thinking poor. \n\n\n\nThis clinging to smallness was inherited from our pagan forefathers. We are on a threshold to great \n\n\n\nachievement as we continue to embrace the challenge to promote wellness despite smallness. \n\n\n\nConsumers will be enjoying new launched supplements manufactured in the state of the art \n\n\n\ntechnology which will give not only economic revival but more productive and healthy lives. Today, \n\n\n\nwe should be able to ignore the pagan evidence and have the push towards larger effort. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nINDUSTRIAL PHARMACY \n \nIPO 01 \n\n\n\nFAPA2014000045 (Oral) \n\n\n\n\n\n\n\n'Halal Pharmaceuticals' - A Way Forward \n\n\n\n\n\n\n\nA Buang \n\n\n\nPharmacy Department, University Malaya Medical Centre, Kuala Lumpur, Malaysia \n\n\n\n\n\n\n\nIn terms of achieving concordance in medicine taking, fulfilling the religious needs of a patient is \n\n\n\nparamount. For Muslim patients, the need of \u2018halal pharmaceuticals\u2019 is in accordance to the Syariah \n\n\n\nlaws that requires medicines to be both produced with \u2018Halalan and Toyibban\u2019 principles. At present, \n\n\n\nMalaysia is the only country in the world that provides a standard for the production of halal \n\n\n\npharmaceuticals designated as MS2424:2012 - Halal Pharmaceuticals: General Guidelines. Drug \n\n\n\nmanufacturers that comply with this standard will be given halal certificate and halal Malaysia logo \n\n\n\nby the Department of Islamic Development, Malaysia (JAKIM). The production of halal \n\n\n\npharmaceuticals in this standard follows the Pharmaceutical Inspection Convention and \n\n\n\nPharmaceutical Inspection Co-operation Scheme (jointly referred to as PIC/S). Therefore, it complies \n\n\n\nwith Good Manufacturing Practice (GMP). For products to obtain MS2424:2012, it must first be \n\n\n\nregistered with the National Pharmaceutical Control Bureau under the Drug Control Authority of \n\n\n\nMalaysia. This is followed by an online submission to the Halal Hub Division, JAKIM who will then \n\n\n\ncarry out the halal audit. Upon compliance to the halal audit, the drug manufacturer will then be \n\n\n\nawarded a halal certificate and the usage of the Malaysia halal logo. JAKIM has the capability to audit \n\n\n\ndrug manufacturers in and outside Malaysia. They also have collaboration with about 75 Islamic \n\n\n\ncompetent authorities throughout the world. Halal pharmaceuticals are not only intended for the \n\n\n\nMuslim population but to the entire human population as it upholds the highest quality standard in \n\n\n\ndrug manufacturing process. \n\n\n\n\n\n\n\n\n\n\n\nIPO 02 \nFAPA2014000003 (Oral) \n\n\n\n\n\n\n\nInvestigation of the Efficiency and Mechanism of Gelation and Degelation of Three Positional \n\n\n\nIsomers of Aminobenzoic Acid \n\n\n\n\n\n\n\nV Tantishaiyakul, S Dokmaisrijan, T Sangfai, N Hirun, L Li, S Juntarapet, K Suknuntha \n\n\n\n\n\n\n\nHydrogels produced from small molecules have gained much attention due to their potential use for \n\n\n\nvarious applications including tissue engineering and controlled drug release. Three positional \n\n\n\nisomers of aminobenzoic acid (AB): oAB, mAB and pAB are antimutagenic, oAB is vitamin L and \n\n\n\npAB is part of the vitamin B complex. In this study, the efficiency and mechanism of gelation and \n\n\n\ndegelation of the three positional isomers of AB and melamine (M) were investigated. This may \n\n\n\nprovide a more detailed understanding of the gelation/degelation of different isomers of a compound. \n\n\n\nRheological and DSC methods were used to examine the gelation and degelation of each system. \n\n\n\nFTIR and computational methods were employed to understand the mechanism of gelation/ \n\n\n\ndegelation of the systems. These AB/M systems existed as a gel at low temperature and these gels \n\n\n\nmelted at higher temperatures. Based on the rheological measurements, the gel strength at the lower \n\n\n\ntemperatures was in the order of pAB/M>mAB/M>oAB/M. This agreed with the computational \n\n\n\nanalyses according to the presence of stronger hydrogen bonding and the lower energy of each cluster. \n\n\n\nWhen heated, the sequence of the degelation temperature was in the order of \n\n\n\npAB/M>oAB/M>mAB/M. This degelation temperature was consistent with the DSC measurements \n\n\n\nwhich also revealed the thermoreversibility of these gel systems. It was surprising that the mAB/M \n\n\n\nwhich is a stronger gel than the oAB/M could be more easily converted to a sol than the oAB/M. \n\n\n\n\n\n\n\n\nFTIR demonstrated that during heating, the mAB from the mAB/M changed from the uncharged form \n\n\n\nto the zwitterionic form (mABz). In addition, the computational results pointed out that the hydrogen \n\n\n\nbonding between the mABz and M was much weaker than that between the mAB and M. This may \n\n\n\nresult in the lower degelation temperature of the mAB/M system. \n\n\n\n\n\n\n\n\n\n\n\nIPO 03 \nFAPA2014000139 (Oral) \n\n\n\n\n\n\n\nEffect of Vitamin E (D-Tocopheryl Polyethylene Glycol 1000 Succinate) in Enhancing Absorption \n\n\n\nof Lisinopril 10 mg Tablet Formulation \n\n\n\n\n\n\n\nY Mutiawati\n1,2\n\n\n\n, DD Cahyani \n2\n, T Rusdiana\n\n\n\n1\n, Mutakin\n\n\n\n1\n \n\n\n\n1\nPharmaceutical Department and Pharmacy Technology, Faculty of Pharmacy, University of \n\n\n\nPadjadjaran, Bandung, Indonesia \n2\nResearch and Development Unit of PT, Kimia Farma, Indonesia \n\n\n\n\n\n\n\nLisinopril is a long acting, oral angiotensin converting enzyme (ACE) inhibitor, based on its \n\n\n\nbiopharmaceutical characteristics. Lisinopril has high solubility but low permeability which limit its \n\n\n\nbioavailability. The aim of this study was to develop formulas that could repair its biopharmaceutical \n\n\n\nproperties and increase its permeability with the addition of permeability-enhancing substance such as \n\n\n\nVitamin E TPGS NF (d-tocopheryl polyethylene glycol 1000 succinate), in   various  concentrations. \n\n\n\nThe process used wet granulation method and evaluation of mixture lisinopril and Vitamin E TPGS \n\n\n\ncharacteristics was done using DTA (differential thermal analysis). After all the formulas met the \n\n\n\nrequirements of physics, chemistry and comparison dissolution test against its innovators, one formula \n\n\n\nfollowed pilot bioequivalence test. The research activity was carried out in the Research and \n\n\n\nDevelopment Unit, PT Kimia Farma and PT Equilab in Indonesia. There is a positive correlation \n\n\n\nbetween Vitamin E TPGS as a solubility and absorption enhancer and  lisinopril  (BCS III). Vitamin E \n\n\n\nTPGS is expected to increase the absorption of lisinopril which was seen from the results of the pilot \n\n\n\nbioequivalence test, with an increase in the pharmacokinetic parameters (AUCt, AUCinf, Cmax). The \n\n\n\nconclusion from this study is Vitamin E TPGS in Formula Lisinopril 10 mg tablet, can increase its \n\n\n\nabsorption based on the bioequivalence test parameters. \n\n\n\n\n\n\n\n\n\n\n\nIPO 04 \nFAPA2014000019 (Oral) \n\n\n\n\n\n\n\nDevelopment of Multiparticulate Tablet from Alginate Microparticles Prepared By Spray \n\n\n\nDrying Technique \n\n\n\n\n\n\n\nC Tanakitcharoenpat, J Trissadeerug, S Tanvichien, D Shuwisitkul \n\n\n\nFaculty of Pharmacy, Srinakharinwirot University, Nakornayok, Thailand \n\n\n\n\n\n\n\nThe objectives of the study were to develop multiparticulate tablets from alginate microparticles \n\n\n\nprepared by spray drying technique and to achieve zero order release from the tablets. The influence \n\n\n\nof alginate concentrations, pharmaceutical excipients, model drugs on morphology of microparticles \n\n\n\nand the influence of formulating parameters on drug release from multiparticulate tablets were \n\n\n\ninvestigated. Alginate microparticles were prepared by spray drying technique. Multiparticulate \n\n\n\ntablets from alginates microparticles were fabricated by direct compression with the aid of diluent. 1% \n\n\n\nw/v alginate and the addition of lactose and trehalose led to smooth surface and spherical shape of \n\n\n\nmicroparticles. The good morphology can be explained by higher viscosity and appropriate heat and \n\n\n\nmass transfer. The different direct compression fillers and ratios of alginate microparticles and fillers \n\n\n\nwere studied. Theophylline release from multiparticulate tablets was slow and showed two phase \n\n\n\nrelease manners. The first was fast release followed by the slow release due to gel formation of \n\n\n\nalginate in the acid condition. The second fast release was observed when the tablet was soaked into \n\n\n\n\n\n\n\n\nthe basic medium. A zero order release of theophylline from the multiparticulate tablet was obtained \n\n\n\nfrom the blend of alginate microparticles: Avicel PH 102 in the ratio of 1:1. The difference in the \n\n\n\ndirect compression filler did not affect theophylline release. By contrast, the different properties of \n\n\n\nmodel drugs have an impact on the drug release profile. The drug release from multiparticulate tablet \n\n\n\ncontaining mefenamic acid (low water-soluble model drug with acidic properties) was slower in \n\n\n\ncomparison to theophylline release. A lag time at first few hours in the acid medium was observed. \n\n\n\n\n\n\n\n\n\n\n\nIPO 05 \n\n\n\nFAPA2014000018 (Oral)  \n\n\n\nDevelopment of Alginate Microparticles using Polymer Blend Technique for Drug Delivery \n\n\n\nSystem \n\n\n\nV Natekrajangkul, C Teeraittirat, C Managit, D Shuwisitkul  \nFaculty of Pharmacy, Srinakharinwirot University, Nakornayok, Thailand \n\n\n\nThe aim of this study was to develop alginate microparticles by using polymer blend technique in \n\n\n\norder to enhance encapsulation efficiency and retard drug release from alginate microparticles. \n\n\n\nAlginate microparticles were prepared by cross linked emulsification. Particle size and shape, surface \n\n\n\nmorphology, entrapment efficiency and in vitro drug release were studied. Theophylline and \n\n\n\nmefenamic acid with different solubilities were used as model drugs. Types of polymer blends and the \n\n\n\nblend ratios were independent variables. The results demonstrated that the poorly water-soluble drug \n\n\n\nshowed lower encapsulation efficiency than highly water-soluble drug because of incomplete \n\n\n\nmicroparticles formation and drug dissolution to the external phase. The suitable type of polymer \n\n\n\nblends and polymer blend ratios increased encapsulation efficiency and delayed theophylline release \n\n\n\nfrom microparticles. This can be explained by the higher viscosity of the polymer solution of polymer \n\n\n\nblends. The diffusion of the drug into the external phase was more difficult. In addition to the higher \n\n\n\nviscostiy, the ionic interaction between cationic charge of chitosan and anionic charge of alginate or \n\n\n\ncross linking of pectin with calcium ion can help enhance the properties of polymer blend \n\n\n\nmicroparticles. \n\n\n\n\n\n\n\n\nSCIENTIFIC \n\n\n\n \nSPO 01 \n\n\n\nFAPA2014000319 (Oral) \n\n\n\n\n\n\n\nMetabolic Therapy: A New Paradigm for the Management of Diabetic Hearts? \n\n\n\n\n\n\n\nAA Jamil\n1\n, WS A'laudden\n\n\n\n1\n, M.A Cole\n\n\n\n2\n, LC Heather\n\n\n\n2\n, K Clarke\n\n\n\n2\n \n\n\n\n1\nDepartment of Basic Medical Science, Faculty of Pharmacy, International Islamic University \n\n\n\nMalaysia  \n2\nDepartment of Physiology, Anatomy and Genetics, University of Oxford, United Kingdom \n\n\n\n\n\n\n\nOne of the leading causes of mortality in diabetic patient is cardiovascular heart disease, with growing \n\n\n\nevidence linking abnormal cardiac substrate metabolism to the ensuing diabetic cardiomyopathy. \n\n\n\nDiabetic hearts are metabolically remodelled, with increased fatty acid metabolism at the expense of \n\n\n\nglucose utilisation for energy production. This is associated with increased circulating free fatty acid \n\n\n\nand activation of PPAR\u03b1 - a key nuclear transcription factor modulating fatty acid oxidation. These \n\n\n\nabnormal metabolic changes have been shown to decrease cardiac recovery following ischemia in \n\n\n\ndiabetic patients, with a reduced tolerance to oxygen-limited conditions. Our data have shown that \n\n\n\nwhen healthy mice were exposed to hypoxia (11% oxygen for 3 weeks), their hearts must \n\n\n\nmetabolically adapt by inducing a switch away from fatty acid oxidation towards glycolysis in order \n\n\n\nto maintain ATP production and contractile function. Pharmacological in vitro studies indicated that \n\n\n\nthe adaptive response was concerted by hypoxia inducible factor (HIF)-dependent PPAR\u03b1-\n\n\n\ndownregulation. HIF is the key modulator of the transcriptional responses to changes to oxygen \n\n\n\navailability, by regulating the expression of genes that control cellular adaption to hypoxia, including \n\n\n\na switch from oxidative to glycolytic metabolism, and stimulation of oxygen delivery through \n\n\n\nincreased angiogenesis. In contrast, it was found that isolated hearts in a pre-diabetic mice model of \n\n\n\ndietary induced obesity, achieved by high fat feeding (60% high fat) were unable to suppress fatty \n\n\n\nacid oxidation, which reduced ejection fraction by 9%, determined using in vivo cine-MRI. Moreover, \n\n\n\nhigh fat feeding prevented the accumulation of VEGF, a prominent HIF downstream target, which \n\n\n\nmay have contributed to the maladaptive response to hypoxia in these hearts. Therefore, a therapeutic \n\n\n\napproach aimed at correcting metabolic inflexibilities through manipulations of the HIF pathway \n\n\n\ncould increase hypoxic tolerance of the diabetic heart, providing a promising adjuvant therapy to \n\n\n\nimprove recovery post-myocardial infarction. \n\n\n\n\n\n\n\n\n\n\n\nSPO 02 \nFAPA2014000113 (Oral) \n\n\n\n\n\n\n\nAcute Toxicity of Calabash Leaves Ethanol Extract in White Male Rats \n\n\n\n\n\n\n\nAM Kusuma, S Kaaffah, Susanti \n\n\n\n Faculty of Pharmacy, University of Muhammadiyah Purwokerto, Indonesia \n\n\n\n\n\n\n\nCalabash plant (Crescentia cujete L.) is traditionally and often used to treat various diseases such as \n\n\n\nfever, swelling and wound. Previous research showed that ethanol extract of calabash leaves have \n\n\n\nantibacterial activity, anti-inflammatory and external bleeding cessation. This plant has a large \n\n\n\npotential as an herbal remedy, but there are no reports of research on calabash plant about the safety \n\n\n\nproperties. The method is an experimental method with two kinds of tests. First, sighting study with 2 \n\n\n\ndoses of ethanol extract of calabash leaves 300 mg/kg and 2000 mg/kg for 24 hours with observation \n\n\n\nby counting the number of deaths of the rats. Second, main study with 1% Na - CMC as a control and \n\n\n\nethanol extract of calabash leaves dose 2000 mg/kg treatment was observed for 14 days. Each group \n\n\n\nconsisted of 5 male white rats. As a result, there was no death of test animals in the sighting study. In \n\n\n\nthe main study, there was no significant difference between the treatment and control group (p<0.05) \n\n\n\n\n\n\n\n\non the symptoms of toxic effects, body weight, haematology, blood biochemistry, organ weights and \n\n\n\nhistopathology of liver and kidney. However, the inter-treatment group showed a significant \n\n\n\ndifference in the value of GPT enzyme (p>0.05), because one of the mice showed abnormal values \n\n\n\nand liver histopathology showed fatty degeneration and foki necrosis. \n\n\n\n\n\n\n\n\n\n\n\nSPO 03 \nFAPA2014000222 (Oral) \n\n\n\n\n\n\n\nEffects of Storage Condition and Preparing Processes on Stability of Recombinant Human \n\n\n\nGrowth Hormone \n\n\n\n\n\n\n\nD Shuwisitkul\n1\n, A Tongta\n\n\n\n2\n, S Siriraksophon\n\n\n\n3\n, S Tunvichien\n\n\n\n1\n \n\n\n\n1\nDepartment of Pharmaceutical Technology, Srinakharinwirot University, Thailand  \n\n\n\n2\nDivision of Biotechnology, School of Bioresources and Technology, King Mongkut's University of \n\n\n\nTechnology Thonburi, Thailand \n\n\n\n \n3\nBiochemical engineering department, Pilot Plant Development and Training Institute, King \n\n\n\nMongkut\u2019s University of Technology Thonburi, Thailand \n\n\n\n\n\n\n\nRecombinant human growth hormone (rhGH) is a sensitive therapeutic protein. Many effects can \n\n\n\ninfluence the stability of rhGH. This research objective was to find a suitable storage condition for \n\n\n\nrhGH solution before drying using lyophilization. The effects of dialysis to the different solutions and \n\n\n\npre-freezing conditions were also studied. rhGH was produced using Pichia Pastoris. The rhGH \n\n\n\nsolution in Tris-HCl buffer pH 7.8 was obtained. The rhGH solution in Tris-HCl buffer was storage at \n\n\n\nthe temperature of -20\uf0b0C and then thawing (one cycle). The rhGH solution was dialyzed into distilled \n\n\n\nwater or phosphate buffer pH 7 to find the better solution for rhGH. The pre-freezing in the freezer or \n\n\n\nin the freeze dryer was studied. rhGH was then determined qualitatively and quantitatively using size \n\n\n\nexclusion chromatography, SDS PAGE and native PAGE.  The result showed that rhGH in Tris-HCl \n\n\n\nbuffer pH 7.8 was not stable after 2 cycles of freezing and thawing due to the high pH. The dialysis of \n\n\n\nrhGH from Tris-HCl buffer pH 7.8 to distilled water resulted in the better quality and quantity of \n\n\n\nrhGH than the dialysis to phosphate buffer pH 7. The addition of some excipients helped increase the \n\n\n\nstability of rhGH after the dialysis to distilled water. The pre-freezing in the freezer at the temperature \n\n\n\nof -80\uf0b0C caused the degradation of rhGH, while the pre-freeze in the freeze dryer at the temperature \n\n\n\nof -60\uf0b0C did not affected rhGH. In conclusion, the rhGH solution in Tris-HCl buffer pH 7.8 could be \n\n\n\nstable after freezing at the temperature of -20\uf0b0C and thawing for only one cycle. The dialysis into \n\n\n\nwater and the immediate addition of some excipients were infinitely preferable. The pre-freezing in \n\n\n\nthe freeze dryer at the temperature of -60\uf0b0C was chosen as the process for lyophilization. \n\n\n\n\n\n\n\n\n\n\n\nSPO 04 \nFAPA2014000099 (Oral) \n\n\n\n\n\n\n\nHypolipidemic Activity of Senna Occidentalis (L.) Link. (Fam. Fabaceae) Methanolic Extract in \n\n\n\nAtherogenic Diet Induced Hyperlipidemia in Sprague-Dawley Rats \n\n\n\n\n\n\n\nRRZ Carandang\n1\n, EMD Ramos\n\n\n\n2\n, PM Crucis\n\n\n\n2\n, AN Robes\n\n\n\n2\n, KKB Cruz \n\n\n\n1\nGraduate School of Agricultural and Life Sciences, The University of Tokyo, Bunkyo-ku, Tokyo, \n\n\n\nJapan \n2 \nAdamson University, San Marcelino St. Ermita Manila, Philippines \n\n\n\n\n\n\n\nHyperlipidemia is the greatest risk factor of coronary heart disease. The study focuses on the \n\n\n\nantihyperlipidemic activity of methanolic plant extracts of S. occidentalis (L.) Link. against \n\n\n\natherogenic diet induced hyperlipidemia in rats. The aim of the present study is to evaluate the effect \n\n\n\nof the plant in reducing cholesterol levels of experimentally induced hyperlipidemic rats. Healthy 36 \n\n\n\nmale albino rats were divided into six groups. Group I (normal control) received standard chow diet, \n\n\n\n\n\n\n\n\nGroup II (negative control) received atherogenic diet, Group III (positive control) received \n\n\n\natherogenic diet + atorvastatin (Lipitor), and Group IV-VI (treatment Groups) received atherogenic \n\n\n\ndiet + methanolic extract of S. occidentalis (L.) Link. at doses of 500mg/kg body weight (BW), \n\n\n\n800mg/kg BW and 1000mg/kg BW respectively. The parameters used are the serum lipid profile (TC, \n\n\n\nTG, HDL, LDL) and body weight of rats. The results were statistically analyzed using ANOVA. This \n\n\n\nshowed that the plant extract was exhibiting a hypolipidemic activity in a dose dependent manner. \n\n\n\nThe administration of S. occidentalis (L.) Link. methanolic extracts to the hyperlipidemic rats \n\n\n\nprovides significant reduction in serum level of TC, TG and LDL level. Serum level of HDL was also \n\n\n\nincreased upon administration of the methanolic extract of the plants. S. occidentalis methanolic \n\n\n\nextract is exhibiting a hypolipidemic activity in a dose dependent manner, where 1000 mg/kg body \n\n\n\nweight of the methanolic extract exhibited the highest effect in lowering serum level of TC, TG and \n\n\n\nLDL and highest in increasing HDL level. It can be concluded that the methanolic extract of S. \n\n\n\noccidentalis (L.) Link. is effective against hyperlipidemia and can be a potential hypolipidemic agent. \n\n\n\n\n\n\n\n\n\n\n\nSPO 05 \nFAPA2014000095 (Oral) \n\n\n\n\n\n\n\nNon-Invasive Measurement Method of Skin Conditions by using Dermalab\u00ae Combo \n\n\n\n\n\n\n\nH Ab Hadi, N Mohd Hanif, NFA Md Sidik, MRN Mohd Rani, MS Mohd Suhaimi\n \n\n\n\nKulliyyah of Pharmacy, International Islamic University Malaysia, 25200 Kuantan, Pahang  \n\n\n\n\n\n\n\nSkin is a protective barrier from exogenous substances. The aim of the study was to evaluate the \n\n\n\nreliability of the DermaLab Combo in measuring trans-epidermal water loss (TEWL) and skin \n\n\n\nhydration. Fifty male and 50 female students from the International Islamic University Malaysia \n\n\n\n(IIUM) volunteered to participate in this study. The readings were taken on the volar forearm of the \n\n\n\nvolunteers using TEWL probe and hydration pin probe. A set of questionnaire was also distributed to \n\n\n\nobtain information about the skin care regime and their daily habits. Most students who often use \n\n\n\nmoisturizers have lower TEWL value than those who do not use it. A low TEWL reflects the skin \n\n\n\nbarrier integrity. Skin hydration is also correlated with the use of moisturizers. This is supported by \n\n\n\nRosado et al. (2009) who proved that the application of moisturizers can increase stratum corneum \n\n\n\nhydration. The hydration state of the skin was also higher in volunteers who consumed water of more \n\n\n\nthan 1L per day. It has been reported that fluidity has a positive correlation with stratum corneum \n\n\n\nhydration. This is because water content at tissue level might redistribute up to the stratum corneum \n\n\n\nwhich ultimately hydrates the skin. In this study, it can be concluded that DermaLab\u00ae combo is a \n\n\n\nreliable skin analysis instrument that offers high precision, accuracy and reproducibility on all the \n\n\n\nmeasuring parameters. \n\n\n\n\n\n\n\n\n\n\n\nSPO 06 \nFAPA2014000262 (Oral) \n\n\n\n\n\n\n\nA Study on the Potential of Kappa-carrageenan and Carboxymethylcellulose in Extended \n\n\n\nRelease Potassium Chloride Capsules \n\n\n\n\n\n\n\nJM Galang, ME Apolinario, KS Canlas, GM Gatus, B Genson  \n\n\n\nFaculty of Pharmacy, University of Santo Tomas, Philippines \n\n\n\n\n\n\n\nThe drug of choice in preventing and treating hypokalemia is Potassium chloride (KCl). Extending the \n\n\n\nrelease of KCl is intended to slow down and prolong the release of potassium in order to reduce the \n\n\n\ngastrointestinal irritation brought about by KCl. This study aims to discover the feasibility of an \n\n\n\nextended release KCl capsule formulation using the ideal 1:2 cellulosic ratio of CMC and Kappa-\n\n\n\nCarrageenan obtained from a previous study, Comparative Study of the Cellulosic Ratio of \n\n\n\nCarboxymethylcellulose: Kappa-Carrageenan As A Potential Drug Delivery System (Cruz et. al, \n\n\n\n\n\n\n\n\n2012) by means of compatibility determination, actual formulation of drug product and testing for \n\n\n\ncompliance to monograph specifications for dissolution. The extended release KCl formulation in this \n\n\n\nstudy was prepared by means of microencapsulation, oven drying at 85\no\nC and particle size reduction \n\n\n\nthrough sieving prior to capsule filling. A sample of the granules from the prepared formulation and \n\n\n\nthe chief ingredients (including CMC, KC and KCl) each underwent Differential Scanning \n\n\n\nCalorimetry performed by professionals in RCNAS for compatibility determination. The capsules \n\n\n\nwere tested for dissolution by employing the procedures and specifications of USP for extended \n\n\n\nrelease KCl capsules. The aliquots were diluted for preparation for AAS to determine the absorbance \n\n\n\nof the samples necessary for the computation of sample concentration. The data collected were \n\n\n\nanalyzed by using One-Way ANOVA F test and Pearson r correlation. No significant change was \n\n\n\nseen in the data. It was concluded that the said formulation poorly exhibited extended release \n\n\n\nproperty. \n\n\n\n\n\n\n\n\n\n\n\nSPO 07 \nFAPA2014000224 (Oral) \n\n\n\n\n\n\n\nIn vivo Study of the Anti-angiogenic Property of the Ethanolic Extract of Annona muricata \n\n\n\nLinne in the Chorioallantoic Membrane (CAM) of the Duck Embryo \n\n\n\n\n\n\n\nR.Garcia\n1\n, C Aniversario\n\n\n\n1\n, S Gaspar\n\n\n\n1\n, L Chico\n\n\n\n1\n, H Evasco\n\n\n\n1\n, H Maini\n\n\n\n1\n, S Solano\n\n\n\n2\n \n\n\n\n1\nCollege of Pharmacy, Adamson University \n\n\n\n2\nCollege of Sciences, Adamson University \n\n\n\n\n\n\n\nAngiogenesis, the process of forming new blood vessels, has been the focus for testing numerous \n\n\n\nnatural compounds from plants with underlying angiogenic or anti-angiogenic properties. Annona \n\n\n\nmuricata Linne, locally known as Guyabano, has been given importance for its purported use in \n\n\n\ntreating tumors and various forms of cancers. The present work deals with the evaluation of the anti-\n\n\n\nangiogenic property of A. muricata L. using the Chorioallantoic Membrane (CAM) of the duck \n\n\n\nembryo. Selected mature leaves of A. muricata L. were harvested, air dried and extracted by \n\n\n\npercolation using 50% Ethanol. The crude extract was evaporated of the solvent and was diluted to \n\n\n\n25, 50, 75 and 100% concentrations. The resulting solutions were tested by administering to the egg \n\n\n\nsamples at day 1 of development, wherein anti-angiogenic activity will be observed at days 8, 9, 10, \n\n\n\n11 and 12 of development and compared to the untreated, NSS Control, and positive control \n\n\n\n(Docetaxel). The extracts, importantly the 50% extract concentration, showed a significant anti-\n\n\n\nangiogenic activity due to the decrease in area of the CAM on the samples specifically on Day 9 of \n\n\n\ndevelopment. Thus, these findings showed that the ethanolic extract of the mature leaves of A. \n\n\n\nmuricata L. has a potential anti-angiogenic property. \n\n\n\n\n\n\n\n\n\n\n\nSPO 08 \nFAPA2014000051 (Oral) \n\n\n\n\n\n\n\nNevirapine metabolites ratio at steady state in Malaysian population \n\n\n\n\n\n\n\nS Mustafa\n1\n, WN Wan Yusuf\n\n\n\n1\n, N Badariah Hassan\n\n\n\n1\n, SC Tan\n\n\n\n2\n, M Mustafa\n\n\n\n3\n, AK Abd Rahman\n\n\n\n4\n \n\n\n\n1\nDepartment of Pharmacology, University Sains Malaysia, Malaysia \n\n\n\n2\nINFORMM, University Sains Malaysia \n\n\n\n3\nHospital Raja Perempuan Zainab II. Kota Bharu, Kelantan, Malaysia \n\n\n\n 4\nHospital Sultanah Nur Zahirah, Kuala Trengganu, Malaysia   \n\n\n\n\n\n\n\nNevirapine is extensively metabolized via cytochrome P450 isoenzymes CYP2B6 and CYP3A to 3-\n\n\n\nhydroxy nevirapine (3-OH NVP) and to 2-hydroxy nevirapine (2-OH NVP). The present analyses \n\n\n\naimed to characterize two main nevirapine metabolites: 2-OH and 3-OH nevirapine at steady-state in \n\n\n\n80 HIV-infected Malaysian adults. Nevirapine and the metabolites were extracted from plasma by \n\n\n\n\n\n\n\n\nliquid-liquid extraction method and assayed using high-performance liquid chromatography (HPLC). \n\n\n\nThe metabolite ratio for each metabolite was defined as the ratio of the metabolites area under the \n\n\n\nconcentration-time curve (AUC) to the nevirapine AUC. The metabolites concentrations were much \n\n\n\nlower than the parent nevirapine concentration. The 2-OH NVP was detected in all patients while 3-\n\n\n\nOH NVP was detected in 67 patients. The predominant metabolite at steady state was 2-OH NVP with \n\n\n\nthe AUC of 20 times lower from nevirapine while the 3-OH NVP AUC was 333 times lowers than the \n\n\n\nparent drug. There were positive correlation between nevirapine AUC and the metabolites AUC; \n\n\n\nhowever strong correlation was observed only with 2-OH NVP. Significant differences in AUC of \n\n\n\nboth metabolites between genders were also observed. Concentration of nevirapine was slightly \n\n\n\nhigher in patients\u2019 presence with both metabolites but the difference was not significant. It is maybe \n\n\n\ndue to the small number of patients without 3-OH NVP detected in the study. Consequences of the \n\n\n\nfindings warrant further investigation. \n\n\n\n\n\n\n\n\n\n\n\nSPO 09 \nFAPA2014000261 (Oral) \n\n\n\n\n\n\n\nDiclofenac Sustained Release Tablets using Novel Coprocessed Excipients of Crosslinked-\n\n\n\nAmylose and Xanthan Gum as Matrix \n\n\n\n\n\n\n\nS Surini, L Ariani, Hayun, E Anwar \n\n\n\nFaculty of Pharmacy, Universitas Indonesia, Depok, Indonesia \n\n\n\n\n\n\n\nIn previous study, we produced the novel modified excipients which were coprocessed excipients of \n\n\n\ncrosslinked-amylose and xanthan gum in the ratio of 1:1, 1:2 and 2:1. We obtained 4 excipient types, \n\n\n\nwhich were Co-CLA6-XG, Co-CLA12-XG, CL6-Co-A-XG and CL12-Co-A-XG, each type had 3 \n\n\n\nratio of CLA-XG or A-XG; totally we produced 12 types of new excipients. All the resulted \n\n\n\nexcipients had good swelling index, high viscosity and good gel strength, which are suitable to be \n\n\n\nused as matrix for sustained release tablet dosage form. In this present study, diclofenac sustained \n\n\n\nrelease tablets are formulated using the 12 types of coprocessed excipients of crosslinked-amylose and \n\n\n\nxanthan gum. The produced diclofenac sustained release tablets were studied for the in vitro drug \n\n\n\nrelease, swelling index and others evaluation for tablets within the acceptable standard. The drug \n\n\n\nrelease profile from the diclofenac sustained release tablets using matrix of the Co-CLA6-XG, Co-\n\n\n\nCLA12-XG, CL6-Co-A-XG and CL12-Co-A-XG showed the retarded drug release during 8 hours. \n\n\n\nThe release study revealed that drug release kinetic follow the zero order kinetic. The results \n\n\n\nsuggested that the controlled release matrix tablets could retard drug release up to 16-32 hours. It may \n\n\n\nbe concluded that applying the coprocessed excipients of crosslinked-amylose and xanthan gum as \n\n\n\ncontrolled release matrix can control and retard drug release following the zero order kinetic.       \n\n\n\n\n\n\n\n\n\n\n\nSPO 10 \nFAPA2014000177 (Oral) \n\n\n\n\n\n\n\nResearch and Development of Weight Loss Product with Lipase Inhibitory Activity \n\n\n\n\n\n\n\nS Thubthimthed, S Laovitthayanggoon, P Siriarchavatana, T Kajsongkramand, T Sematong, A \n\n\n\nTantrawong, S Reungpatthanaphong, C Banchonglikitkul \n\n\n\n\n\n\n\nObesity is becoming one of the most important global health problems. The application of a lipase \n\n\n\ninhibitor is a useful medication for the treatment of obesity. In order to find new pancreatic lipase \n\n\n\ninhibitors from natural sources, eighteen selected Thai medicinal plants were extracted with 95% \n\n\n\nethanol and screened for their potential inhibition of lipase activity using the BALB-DTNB method. \n\n\n\nOrlistat, the most common anti-obesity drug, was used as a positive control. In vitro study showed \n\n\n\nthat the extract of Ocimum basillicum Linn., Citrus hystrix DC. and Solanum torvum Sw. have potent \n\n\n\npancreatic lipase inhibition while the extract of Quercus infectoria G. Olivier showed significant \n\n\n\n\n\n\n\n\nreduction in triglyceride concentration in animal study. The weight loss supplement has been \n\n\n\ndeveloped by using Q infectoria extracts. The physical, chemical and biological activities of this \n\n\n\nproduct have also been examined in order to control the quality. The safety evaluation of the product \n\n\n\nwas investigated. Acute oral toxicity showed that LD50 of the product was above 15,000 mg/kg body \n\n\n\nweight. This result confirmed that the product studied is effective and safe for use as another weight \n\n\n\nloss supplement. \n\n\n\n\n\n\n\n\n\n\n\nSPO 11 \nFAPA2014000321 (Oral) \n\n\n\n\n\n\n\nThe effect of CYP2C9 polymorphisms: Orang Asli Jahai is poor metabolizer to warfarin \n\n\n\ncompared to Malay in Malaysia \n\n\n\n\n\n\n\nRA Rosdi, S Yusoff, N Musa, MSN Mohd Yusoff \n1\nSchool of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia \n\n\n\n2\nInstitute for Research inMolecular Medicine (INFORMM), Universiti Sains Malaysia, Kelantan, \n\n\n\nMalaysia \n3\nAdvanced Medical and Dental Institute, Universiti Sains Malaysia, Kelantan, Malaysia \n\n\n\n\n\n\n\nWarfarin therapeutic is characterized by inter-individual variations in dose requirements and a narrow \n\n\n\ntherapeutic index. Accurate dosing is critical for safety patient management on this drug. \n\n\n\nPolymorphisms in CYP2C9 gene have been found to play big role in determining the effect of \n\n\n\nwarfarin therapy on coagulation. However, the information of polymorphisms in CYP2C9 gene \n\n\n\namongst the indigenous populations including in Malaysia is still unclear. The objectives of the study \n\n\n\nwere to determine the main variants of CYP2C9 gene (*2 and *3) in one of the Malaysia's indigenous \n\n\n\npopulations, Orang Asli (OA) Jahai and in ethnic Malays; and compare the alleles\u2019 prevalence \n\n\n\nbetween these two ethnic groups, also with available data from other indigenous populations around \n\n\n\nthe world. This study was approved by the Research and Ethics Committee of Universiti Sains \n\n\n\nMalaysia. 10mL blood of a cohort of 155 OA Jahai and 183 Malays were collected after the informed \n\n\n\nconsents were obtained. The DNA from the bloods was extracted and was genotyped for CYP2C9 \n\n\n\npolymorphisms by using nested multiplex allele-specific polymerase chain reaction technique. The \n\n\n\nsubsets of results were confirmed by DNA direct sequencing. Genotyping results showed CYP2C9*2 \n\n\n\nand CYP2C9*3 in Malays was 0.011 and 0.036 respectively.  However, the variant of CYP2C9*2 was \n\n\n\nabsent in OA Jahai but significantly high in CYP2C9*3 with a frequency of 0.34, making them the \n\n\n\nmost highest carriers of the allele reported thus far in any ethnics in Southeast Asia and other \n\n\n\nindigenous population in the world. It can be concluded that 18% of OA Jahai were poor warfarin \n\n\n\nmetabolisers while 41% were intermediate between extensive and poor metabolisers. It is important to \n\n\n\nreduce dose requirement in poor- or intermediate-metabolisers. Therefore, to ensure better clinical \n\n\n\noutcomes, understanding the genotypes of CYP2C9 alleles amongst ethnics is critical for patients \n\n\n\nreceiving drugs metabolized by the gene.  \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nSPO 12 \nFAPA2014000001 (Oral)  \n\n\n\n\n\n\n\nStability Indicating Chiral HPLC Method for the Estimation of Zaltoprofen Enantiomers in \n\n\n\nPharmaceutical Formulations \n\n\n\n\n\n\n\nB Gowramma\n1\n,\n \nSN Meyyanathan\n\n\n\n2\n, B Babu\n\n\n\n2\n, N Krishnaveni\n\n\n\n2\n \n\n\n\n1\nDepartment of Pharmaceutical Chemistry, J.S.S. College of Pharmacy, Udhagamandalam, \n\n\n\nNilgiris,  Tamilnadu, India \n2\nDepartment of Pharmaceutical Analysis, J.S.S. College of Pharmacy, Udhagamandalam, \n\n\n\nNilgiris,  Tamilnadu, India \n\n\n\n\n\n\n\nA stability indicating chiral high performance liquid chromatographic (HPLC) method was developed \n\n\n\nand validated for the separated (S) and (R) Zaltoprofen in raw material and its determination in the \n\n\n\npresence of degradation products formed during forced degradation studies. In the present study an \n\n\n\nisocratic NP-HPLC method was developed with stationary phase as ACI Cellu 1 (150 x 4.6 mm i.d., 5 \n\n\n\n\u03bc) column and acetonitrile: 25 mM sodium perchlorate (80:20, v/v) as mobile phase. The entire study \n\n\n\nwas performed using 1.0 mL/min as flow rate and the detection wavelength at 254 nm. The \n\n\n\nzaltoprofen (R and S) was exposed to various stress condition such as hydrolytic (acid and base), \n\n\n\nneutral, oxidative and photolytic.  The stressed samples were analyzed by the proposed method. The \n\n\n\ndescribed method was linear over the range of 2 - 4 \u00b5g/mL for S-Zaltoprofen and 3 - 5 \u00b5g/mL for R-\n\n\n\nZaltoprofen. The limit of detection and limit of quantification of S-Zaltoprofen and R-Zaltoprofen \n\n\n\nwere found to be 4.16 \u03bcg/mL and 12.61 \u03bcg/mL respectively. The recovery of S and R-Zaltoprofen \n\n\n\nfrom tablet formulations was around 98.04 %. The method provides good sensitivity and excellent \n\n\n\nprecision and reproducibility. The developed method can be applied in the quality control of drug \n\n\n\nproducts.  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nPHYTOPHARMACY & PHARMACOPEIA \n \nPPO 01 \n\n\n\nFAPA2014000107 (Oral) \n\n\n\n\n\n\n\nAntioxidant Activity of Philippine Jasmine Jasminum Sambac Linn, (1789) Leaf Extract using \n\n\n\n2,2-Diphenyl-1-Picrylhydrazyl (DPPH) Free Radical Scavenging Assay \n\n\n\n\n\n\n\nFV Arce Jr, LMC Jao, AKT Jurial, YC Deliman, GLL See \n\n\n\nDepartment of Pharmacy, University of San Carlos, Cebu City, Philippines \n\n\n\n\n\n\n\nIn the Philippines, heart disease and cancer are the leading causes of death. Among the triggers and \n\n\n\naccelerators of these diseases are the free radicals found in environmental exposures like tobacco \n\n\n\nsmoke and radiation. The use of synthetic antioxidants available in the market such as vitamin C and \n\n\n\nE is not favored by others due to their tendency to cause adverse effects. Philippine Jasmine leaves, \n\n\n\nabundant in the archipelago, have folkloric uses of alleviating various diseases but has no established \n\n\n\nstudies on antioxidant activity. The spectrophotometric DPPH free radical scavenging assay was used \n\n\n\nto establish the antioxidant activity. The study aimed to establish the percent inhibition on DPPH \n\n\n\nmolecule, percent antioxidant activity relative to the positive control and established the median \n\n\n\neffective concentration (EC50) of test solutions of Philippine Jasmine leaves. Another parameter used \n\n\n\nwas the color change from violet to yellow and the decrease of absorbance at 517 nm indicating \n\n\n\nantioxidant activity. The leaf extract was obtained through maceration with 95% alcohol and was \n\n\n\nsubjected to vacufuge to obtain a solvent-free leaf extract. The concentrations of the test solution were \n\n\n\n100% (w/v), 75% (w/v), and 50% (w/v). The positive control was ascorbic acid USP grade (5 \u00b5g/mL), \n\n\n\nand DPPH-ethanol solution (39.43 \u00b5g/mL) as blank. The 100% test solution had the highest decrease \n\n\n\nin absorbance and its antioxidant activity was 78.79%. The median effective concentration (EC50) \n\n\n\nwas 65%. The test solutions exhibited the positive color change from violet to yellow and a decrease \n\n\n\nin absorbance value. The test solutions derived from Philippine jasmine leaf extract indicates \n\n\n\nremarkable potential as a source for antioxidants. The phytochemical screening revealed that leaf \n\n\n\nextract possess flavonoids, phenols, alkaloids and tannins which have antioxidant activity. \n\n\n\n\n\n\n\n\n\n\n\nPPO 02 \nFAPA2014000104 (Oral) \n\n\n\n\n\n\n\nPolysaccharide-Rich Fraction of Noni Fruit (Morinda citrifolia L.) as Doxorubicin Co-\n\n\n\nChemotherapy: Evaluation on Catalase, Macrophage, TCD8+ Lymphocyte, Vero, HeLa and \n\n\n\nT47D Cells \n\n\n\nE Sasmito, T Hertiani, R Tiya Novlita, A Nauval Arrazy, L Brata Jaya, P Wahyu Puji \n\n\n\n\n\n\n\nThis study explored the potency of the polysaccharide-rich fraction of Noni juice (PF) combined with \n\n\n\ndoxorubicin (DOX) against in vivo macrophage activity (MA), including phagocytosis index and \n\n\n\nratio, CD8+ T lymphocyte proliferation (TCD8+P), catalase enzyme concentration (CEC), also in \n\n\n\nvitro Vero, HeLa and T47D cells growth. MA was evaluated with latex bead method, CEC was \n\n\n\nevaluated using commercial assay kit, while TCD8+P was evaluated using flow cytometry method \n\n\n\nfollowing in vivo administration. Thirty six Wistar rats were divided into normal control, negative \n\n\n\ncontrol (DOX i.p. 4.67 mg/kg BW on day 1 and 4); 25, 50, 100, and 200 mg/kg BW of PF p.o. daily \n\n\n\nand DOX i.p. 4.67 mg/kg BW (day 1 and 4) for 7 days. In vitro PF+DOX cytotoxicity assay was \n\n\n\nperformed using MTT reduction method on Vero, HeLa and T47D cells. The data were statistically \n\n\n\nanalyzed at 95% confidence level. PF has been proven to increase TCD8+ cells proliferation in \n\n\n\ncombination with DOX. Phagocytosis index was not altered significantly. Nevertheless, the \n\n\n\nphagocytosis ratio increased on 100 mg/kg BW PF treatment. CEC was significantly increased on the \n\n\n\n\n\n\n\n\nsame dose. PF could increase the cytotoxicity of DOX towards HeLa and T47D cells and less toxic \n\n\n\ntowards Vero cells. Therefore, PF is a potential candidate to be used as DOX co-chemotherapy. \n\n\n\n\n\n\n\n\n\n\n\nPPO 03 \n\n\n\nFAPA2014000241 (Oral) \n\n\n\nMacronutrients Content, Glycaemic Index and Anti-Ulcerogenic Effect of Ganyong (Canna \n\n\n\nedulis Ker.) \n\n\n\nE Lukitaningsih, I Titi Handayani, Rumiyati, I Puspitasari   \n\n\n\nFaculty of Pharmacy, Gadjah Mada University, Indonesia \n\n\n\n\n\n\n\nRhizome of Ganyong or canna rhizome (Canna edulis Ker.) contains higher level of carbohydrate \n\n\n\nthan in rice. Nevertheless, glycaemic index of canna rhizome is relatively low because of the type of \n\n\n\ncarbohydrate content, which is starch. Therefore, canna rhizome can be developed as an anti-\n\n\n\nulcerogenic agent. Analysis of macronutrient content, which included carbohydrate, starch, fiber, \n\n\n\nprotein and lipid, were conducted using chemical reactions according to AOAC procedure. \n\n\n\nGlycemic index was determined by in vivo method. Anti-ulcerogenic effect was determined by \n\n\n\nscoring of ulcers and histopathological studies. Rats induced with aspirin in dose of 200 mg/kg BW \n\n\n\nwere used as models. After inducing, the rats were divided into five groups, i.e. negative control, \n\n\n\npositive control, group I, group II and group III. Each group was given different treatment, that is \n\n\n\nwithout treatment, with sucralfate, ethanolic extract (EE), hot water extract (EAP), cold water extract \n\n\n\n(EAD) with doses of 360, 100.5, 4621.5, 4621.5, 360 mg/kg BW respectively for five days. After \n\n\n\ntreatment, rats were dissected, their stomachs were removed, followed by scoring ulcers and \n\n\n\nhistopathological studies. The results showed that canna rhizome contained reduced carbohydrate, \n\n\n\nunreduced carbohydrate, starch, protein, fiber and lipid in concentration of 3.25 \u00b1 0.04%; 2.55 \u00b1 \n\n\n\n0.01%; 7.32 \u00b1 0.09%; 0.23 \u00b1 0.01%; 3.84 \u00b1 0.34%; a n d  1.01 \u00b1 0.08%, respectively. The \n\n\n\nglycaemic index was 20.8. Therefore, canna rhizome is possible to be used as a carbohydrate source \n\n\n\nfor diabetes mellitus patient. Ethanol, hot water and water extracts of canna rhizome have anti-\n\n\n\nulcerogenic activity, because they can improve ulcers of induced rat models. The water extract was \n\n\n\nthe most potent compared to other extracts.  \n\n\n\n\n\n\n\n\n\n\n\nPPO 04 \nFAPA2014000006 (Oral) \n\n\n\n\n\n\n\nSimultaneous Estimation of Quercetin and Rutin in Aganosma dichotoma [Roth] K. Schum by \n\n\n\nHPLC Method \n\n\n\n\n\n\n\nG Subramanian, SN Meyyanathan, B Gowramma, Y Karthik, DS Palanisamy   \n\n\n\n\n\n\n\nA simple, specific, accurate and precise high performance liquid chromatography method was \n\n\n\ndeveloped for the simultaneous estimation of quercetin and rutin in Aganosma dichotoma. The \n\n\n\nchromatographic separation was achieved by using C18 column, 150 x 4.6mm i.d., 5\u00b5 Hibar \n\n\n\nLichrospher, mobile phase containing acetonitrile:25mM ammonium acetate pH 3 (40:60 v/v). The \n\n\n\nflow rate was 1 ml/min and the absorbance was monitored at 259 nm. The retention time of quercetin \n\n\n\nand rutin was found to be 4.30 min and 1.71 min respectively. The proposed method was validated in \n\n\n\nterms of the analytical parameters such as accuracy, linearity, precision, robustness, limit of detection \n\n\n\n(LOD), limit of quantification (LOQ) and were determined based on the International Conference on \n\n\n\nHarmonization (ICH) guidelines. The detector response was linear in the range of 1-5 \u00b5g/ml, 0.1-0.5 \n\n\n\n\u00b5g/ml for quercetin and rutin respectively. The proposed method was successfully applied for the \n\n\n\nsimultaneous estimation of both constituents in Aganosma dichotoma. This study established a \n\n\n\n\n\n\n\n\nquantitative method for the simultaneous determination of quercetin and rutin from Aganosma \n\n\n\ndichotoma. \n\n\n\n\n\n\n\n\n\n\n\nPPO 05 \nFAPA2014000026 (Oral) \n\n\n\n\n\n\n\nPhytosomes: A Valuable Phyto-Phospholipid Carriers \n\n\n\n\n\n\n\nS Patil, R Patil, S Patil \n\n\n\nDepartment of Pharmaceutics, Ashokrao Mane College of Pharmacy, Peth-vadgaon, Kolhapur, India \n\n\n\n\n\n\n\nA phytosome is a complex between polar polyphenolics and dietary phospholipids that shows definite \n\n\n\nphysicochemical and spectroscopic features. Phytosomes are superior forms of herbal products that \n\n\n\nare better absorbed, utilized and produce better results than conventional herbal extracts due to \n\n\n\nincreased bioavailability. These are formulated by using natural or synthetic phospholipid along with \n\n\n\nactive components. Phytosomes are complexes of phospholipid as phosphatidylcholine and \n\n\n\nphosphatidylethanolamine with polyphenolic component. Polyphenolic component are simple \n\n\n\nflavonoids, with or without natural mixture in aprotic solvent like simple flavonoids, \n\n\n\nphosphatidylserine with polyphenolic component. Phytosome is different from the liposome \n\n\n\naccording to the physicochemical properties giving rise to better absorption than that of liposomes. \n\n\n\nPhytosomes are also superior to liposomes in skin care products. Thus, this article also presents an \n\n\n\noverview of the techniques of preparation of phytosome, characterisation and their applications. \n\n\n\n\n\n\n\n\n\n\n\nPPO 06 \nFAPA2014000178 (Oral) \n\n\n\n\n\n\n\nDetermination of Cordycepin in Cordyceps militaris (Linn.)  \n\n\n\n\n\n\n\nP Ahmadi Pirshahid\n1\n, C Promthong\n\n\n\n2\n, T Hemthanon\n\n\n\n1\n, C Banchonglikitkul\n\n\n\n1\n \n\n\n\n1\nPharmaceutical and Natural Products Department, Thailand Institute of Scientific and \n\n\n\nTechnological Research (TISTR), Thailand \n2\nBio-Science Department, Thailand Institute of Scientific and Technological Research (TISTR), \n\n\n\nThailand \n\n\n\n\n\n\n\nOphicordyceps sinensis (Berk.) Sace. (Cordyceps sinensis) is a medicinal mushroom, naturally \n\n\n\ndistributed in Tibetan Plateau and Bhutan. It was used in traditional Chinese medicine as a tonic, \n\n\n\nimmunomodulator and other medicinal purposes. Due to its natural occurrence, O. sinensis are very \n\n\n\nrare, needed and of high value. Cordyceps militaris (Linn.) is mostly artificially cultivated and was \n\n\n\nclaimed to possess a variety of therapeutic activities. Cordycepin, naturally abundant in O. sinensis, is \n\n\n\nthe main compound and largely responsible for pharmacological effect. The objective of this study \n\n\n\nwas to develop a reversed-phase high performance liquid chromatography method for quality control \n\n\n\nby determination of cordycepin in C. militaris. C. militaris were collected in June 2013 (1\nst\n crop), and \n\n\n\nJan 2014 (2\nnd\n\n\n\n crop) from mushroom farms in Chiang Mai Province, Thailand. Both crops were in the \n\n\n\nsame medium and condition. The separate preparation of C. militaris were extracted with MeOH:H2O \n\n\n\n(1:1) to obtain 2 extracts for cordycepin analysis which were performed by HPLC (Waters, alliance \n\n\n\n2695), equipped with photo-diode array. The methods validation of HPLC were examined in term of \n\n\n\nspecificity, precision, accuracy, limit of detection and limit of quantification. Cordycepin was \n\n\n\nidentified as the main compound of both extracts. The linear equation y = 30216x+11692 and R\n2\n = \n\n\n\n0.9998. The LOD and LOQ were 0.866 and 2.887 \u00b5g/ml. The percentage recovery range was from \n\n\n\n98.0-102.0. The content of cordycepin in both extracts were 0.370 \u00b1 0.002 %w/w and 0.134 \u00b1 0.001 \n\n\n\n%w/w respectively. The analytical method is suitable for quality control of cordycepin in C. militaris. \n\n\n\nThe results of cordycepin content in both crops of C. militaris, which were cultivated from the same \n\n\n\ncondition, are much different in percentage. It should be realized that the cultivation processes must \n\n\n\n\n\n\n\n\nbe improved to get higher content of cordycepin which further can be cultivated for large production \n\n\n\nto meet the world demand and substituted for O. sinensis. \n\n\n\n\n\n\n\n\n\n\n\nPPO 07 \nFAPA2014000223 (Oral) \n\n\n\n\n\n\n\nEffect of Piperine, Piperine Free Non-Hexanic Fraction of Ethanolic Extract of Piper \n\n\n\nretrofractum Vahl on Sexual Behavior, Blood Testosterone Level, and Sperm Quality of Wistar \n\n\n\nMale Rats \n\n\n\n\n\n\n\nS Pramono\n1\n, Sugiyanto\n\n\n\n1\n, S Muslichah\n\n\n\n2\n, F Faramayuda\n\n\n\n3 \n\n\n\n1\nFaculty of Pharmacy, Gadjah Mada University, Yogyakarta, Indonesia \n\n\n\n2\nFaculty of Pharmacy, Jember University, Jember, Indonesia \n\n\n\n3\nFaculty of Pharmacy, Jenderal Achmad Yani University, Bandung, Indonesia  \n\n\n\n\n\n\n\nThe fruits of Piper retrofractum Vahl are traditionally used as aphrodisiac in Indonesia and some \n\n\n\nresearches have been reported. The ethanolic extract had androgenic effect on male chicks and it \n\n\n\nincreased blood testosterone level in male hypogonadism. Non-hexanic fraction of ethanolic extract \n\n\n\nhad aphrodisiac effect, while the hexanic fraction was inactive. Piperine had stimulant, vasodilator \n\n\n\nand antidepressant effects. Based on those researches, it is relevant to observe the aphrodisiac effect \n\n\n\nof piperine and piperine free non-hexanic fraction of ethanolic extract of P. retrofractum fruits. \n\n\n\nTwenty five Wistar male rats aged 2.4 - 3 months were divided into 5 groups. Tested substances were \n\n\n\nandriol (2.88 mg/kg BW), CMC-Na 1%, piperine (1.6 mg/kg BW), piperine free non-hexanic fraction \n\n\n\n(29.1 mg/kg BW) and non-hexanic fraction of ethanolic extract of P. retrofractum fruits (31.72 mg/kg \n\n\n\nBW) given orally once daily for 30 days. Every rat in each group was placed together with female rat \n\n\n\nin individual cage. Sexual behavior including introduction and climbing were observed at day 0, 1, 3, \n\n\n\n5, 7, 11, 15, 19, 23, and 27. At the end of the treatment, the quality of spermatozoa was observed and \n\n\n\nthe blood was collected for testosterone level measurement. The results showed that piperine, piperine \n\n\n\nfree non-hexanic fraction and non-hexanic fraction of ethanolic extract of P. retrofractum fruits, as \n\n\n\nwell as andriol, had significant effect for the frequency of introduction and climbing, but did not \n\n\n\nchange testosterone level compared to CMC-Na group. All tested substances had significant effect on \n\n\n\nthe improvement of quality of spermatozoa including reproductive organ weight, motility, and score \n\n\n\nof spermatozoa. The piperine free non-hexanic fraction had the highest effect in decreasing double \n\n\n\nhead and broken tail sperms, diameter of tubulus seminiferus and on the other hand the enhancement \n\n\n\nof spermatocytes-spermatids thickness.  \n\n\n\n\n\n\n\n\n\n\n\nPPO 08 \nFAPA2014000109 (Oral) \n\n\n\nThe Anti-Mutagenic Activity of Labanos Raphanus sativus L. var. Longipinatus Vegetable Juice \n\n\n\non Male Albino Mice \n\n\n\nGLL See, LL Quisaot, GAU Ecoy, YC Deliman, FV Arce Jr, \n\n\n\nDepartment of Pharmacy, University of San Carlos, Cebu City, Philippines \n\n\n\nCancer is the third leading cause of mortality in the Philippines and studies have shown that people \n\n\n\nwho consume a diet high in fruits and vegetables reduce their risk of cancer. Radish, a crucifer, has \n\n\n\ngained prominence in the field of cancer prevention because it contains many beneficial \n\n\n\nphytochemicals. In this study, Labanos, the Filipino radish, is tested as a functional food and as a \n\n\n\npotent phytomedicine to prevent cancer by studying its anti-mutagenic activity. The anti-mutagenic \n\n\n\nactivity of Labanos was examined through an in vivo micronucleus assay in treatment-free Labanos \n\n\n\ntest juice form. The micronucleus assay detects freshly- induced structural chromosomal damages in \n\n\n\nbone marrow cells and administration of the Labanos test juice is tested for the ability to lower the \n\n\n\n\n\n\n\n\nincidence of induced micronuclei which serve as the index for genetic damage. Mutation was induced \n\n\n\nthrough intraperitoneal administration of Mitomycin C. The Labanos juice was tested using four \n\n\n\ndoses: 1000 mg, 500 mg, 250 mg, and 150 mg doses per 20 g body weight (BW). The untreated group \n\n\n\nwas not administered with the test juice while the negative control was given water for injection. The \n\n\n\nmice given 1000 mg dose developed an average of 81 Micronucleated Polychromatic Erythrocytes \n\n\n\n(MPCEs) per 1000 Polychromatic Erythrocytes (PCEs) translating to a 69.99% reduction of MPCEs. \n\n\n\nAs the dosage further decreased, there was a respective decrease in the percent reduction thus \n\n\n\nshowing a linear, dose-dependent anti-mutagenic activity. The one-way analysis of variance (p > \n\n\n\n0.01) and post-hoc analysis showed that all variables have significant differences. The results suggest \n\n\n\nthat the Labanos test juice is anti-mutagenic, with an ED50 (median Effective Dose) of 510 mg. \n\n\n\nSaponins and phenolics were found in the Labanos test juice in the phytochemical screening through \n\n\n\nthe test tube method. \n\n\n\n\n\n\n\nPPO 09 \nFAPA2014000025 (Oral) \n\n\n\n\n\n\n\nEthosome: A Versatile Tool for Novel Drug Delivery System \n\n\n\n\n\n\n\nS Patil, R Patil, S Patil \n\n\n\nDepartment of Pharmaceutics, Ashokrao Mane College of Pharmacy, Peth-vadgaon, Kolhapur, India \n\n\n\n\n\n\n\nSeveral approaches have been developed for increasing the skin penetration of drugs and many \n\n\n\ncosmetics by the use of vesicular systems, such as liposomes and ethosomes. Ethosomal drug delivery \n\n\n\nsystem is one of the approaches that have various application in pharmaceuticals. Ethosomes were \n\n\n\ndeveloped by Touitou in 1997 as additional novel lipid carriers composed of ethanol, phospholipids \n\n\n\nand water. Ethanol is used as one of the efficient permeation enhancer in ethosomes generally in \n\n\n\nconcentration of 20 - 45%. Ethosomes were prepared by very simple methods such as Hot and Cold \n\n\n\nmethods, the products of which were characterised by vesicular size, entrapment efficiency, transition \n\n\n\ntemperature and vesicle stability. The major advantages of ethosomes were low toxicity and better \n\n\n\nstability than liposomes, as well as better patient compliance. Ethosomes have wide applications in \n\n\n\ndrug delivery in treatment of AIDS and Parkinsonian syndrome and also in diabetes. Ethosomes hold \n\n\n\na promising place in the development of novel improved therapies. \n\n\n\n\n\n\n\n\n\n\n\nPPO 10 \nFAPA2014000183 (Oral) \n\n\n\n\n\n\n\nScreening of Ribosome-Inactivating Proteins (Rips) from Indonesian Fruits and Vegetables and \n\n\n\nEffect of Processing on its Stability \n\n\n\n\n\n\n\nRumiyati, Y Damayanti, GK Mawarni, Sismindari \n\n\n\nFaculty of Pharmacy, Gadjah Mada University, Sekip Utara, Yogyakarta, Indonesia \n\n\n\n\n\n\n\nSome plants are identified to contain Ribosome-inactivating proteins (RIPs) which have been \n\n\n\ndemonstrated to possess activities such as antitumor, anticancer, antivirus and anti-inflammation. \n\n\n\nThere is limited information on the presence of the RIPs of Indonesian local  fruits and vegetables. \n\n\n\nThis research was therefore aimed to screen the presence of the RIPs in the fruits and vegetables and \n\n\n\nto study stability of the proteins during processing. Protein from plant samples was extracted using \n\n\n\nphosphate buffer. This protein extract was then analyzed using activity assay of cleaving of \n\n\n\nsupercoiled double stranded plasmid DNA, in order to identify the presence of RIPs in the extracts. \n\n\n\nStability of the protein after storage for 3 days at room temperature and after boiling for 5 minute was \n\n\n\nthen tested based on the activity. The results demonstrated that there was presence of RIPs in some \n\n\n\nIndonesian vegetable samples such as leunca, Indonesian spinach and kenikir and fruits (banana, \n\n\n\n\n\n\n\n\nguava and apple). Storage of the samples for 3 days at room temperature has a little effect on stability \n\n\n\nof  the RIPs, while boiling prosess has an effect on the protein stability. \n\n\n\n\n\n\n\n\n\n\n\nPPO 11 \nFAPA2014000287 (Oral) \n\n\n\n\n\n\n\nIn Vivo Haemostatic Activity Screening of the Decoction of the Peel of Musa Errans (Blco.) \n\n\n\nTeod. Var. Botoan Teod. on Sprague-Dawley Rats \n\n\n\n\n\n\n\nSM Florano, PMDG Sigua, MJFJ Tabi, AJC Trinidad, IMAM Vergara \n\n\n\nFaculty of Pharmacy, University of Santo Tomas, Manila, Philippines \n\n\n\n\n\n\n\nHaemostasis is important in maintaning homeostasis and preventing systemic damage caused by \n\n\n\nsevere bleeding.  Plant sources have been utilized to promote haemostasis. Thus, the researchers chose \n\n\n\nMusa errans, a species of wild banana endemic to the Philippines, as a target haemostatic agent. This \n\n\n\nstudy aimed to determine the haemostatic potential of Musa errans and devise a way of utilizing \n\n\n\nplants endemic to the country in arresting bleeding. Phytochemical screening, specifically the \n\n\n\nGoldbeater\u2019s Test has proven the presence of tannins in the extract indicating its ability to precipitate \n\n\n\nproteins, contributing to its haemostatic activity. Acute toxicity test following the Up-and-Down \n\n\n\nMethod from OECD guideline was used to determine the LD50. After performing the Limit Test, the \n\n\n\ndecoction was proven to be safe for oral administration. Three groups of five Sprague-Dawley rats \n\n\n\neach were given different amounts of extract (100mg/kg, 199.53 mg/kg, and 398.11mg/kg) and a \n\n\n\ngroup of five rats was administered with distilled water for a period of 10 days. In order to assess the \n\n\n\nhaemostatic potential, bleeding parameters such as Bleeding Time (BT), Clotting Time (CT), \n\n\n\nProthrombin Time (PT) and Activated Partial Thromboplastin Time (aPTT) were measured before \n\n\n\nand after the administration period of the decoction. Statistical analysis has proven that there is a \n\n\n\nsignificant difference from the four different parameters measured before and after decoction \n\n\n\nadministration. The results observed after the administration proves the haemostatic activity of Musa \n\n\n\nerrans, affecting both the platelets, as seen with the decrease in BT and CT, and the Intrinsic and \n\n\n\nExtrinsic Pathway, as seen with the decrease in aPTT and PT, respectively. Further statistical analysis \n\n\n\nalso revealed that there was no significant difference among the three different concentrations \n\n\n\nadministered, thus the effect is not dose-dependent. This study establishes the dose-independent \n\n\n\nhaemostatic activity of Musa errans in Sprague-Dawley rats via various mechanisms. \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nPHARMACY EDUCATION AND STUDENT AFFAIRS \n \nPEO 01 \n\n\n\nFAPA2014000116 (Oral) \n\n\n\n\n\n\n\nCyberjaya University College of Medical Sciences (CUCMS) Pharmacy Graduates Career \n\n\n\nChoices \n\n\n\n\n\n\n\nAN Mariani, A Nur Hafizah, WZW Sazrina, MTA Rashidi \n\n\n\nFaculty of Pharmacy, Cyberjaya University College of Medical Sciences, Cyberjaya, Malaysia \n\n\n\n\n\n\n\nTraditionally, the standard career choices for pharmacists were in the hospital and community \n\n\n\nsettings. However, nowadays career opportunities have expanded. In Malaysia, pharmacy \n\n\n\nliberalization has prompted this by offering pre-registration training in recognized government \n\n\n\nhospitals, private hospitals, government polyclinics, community pharmacies and pharmaceutical \n\n\n\ncompanies. This study aimed to identify preferred future career choices of CUCMS graduates and the \n\n\n\nfactors that influence their career choices. It was a cross-sectional study from June-September 2013, \n\n\n\nconducted among graduates of 2009-2012 (n=67). The questionnaire was adopted and adapted from \n\n\n\n\u201cA Longitudinal Cohort Study of Pharmacy Careers Early Choices Questionnaire\u201d and sent to the \n\n\n\nrespondents via email and social networking. Descriptive statistics were used to describe all \n\n\n\ncategorical data. Chi-square analysis was employed to identify the association between gender and \n\n\n\nethnicity with future career choices. Likert scale quantified the factors influencing their decisions. The \n\n\n\nresults indicated that the respondents were more interested in practicing in the hospital settings \n\n\n\ncompared to other practice settings. The findings also showed an association between gender and \n\n\n\nfuture career choices as females seemed to prefer a more stable environment. An association was \n\n\n\nfound between ethnicity and future career choices as certain ethnic groups were risk averse. The top \n\n\n\nfactors influencing their career choices were their love for sharing their knowledge in related areas, \n\n\n\nexposure to practicals during undergraduate years, desire to investigate new things, implementation of \n\n\n\nliberalization and opportunities for advancement. It is recommended that more interest be created in \n\n\n\nother areas of the pharmacy curricula to encourage career uptake in community pharmacy and \n\n\n\npharmaceutical industry. \n\n\n\n\n\n\n\n\n\n\n\nPEO 02 \nFAPA2014000164 (Oral) \n\n\n\n\n\n\n\nSelf-Medication Practice Among Allied and Non-Allied Health Students of the University of \n\n\n\nSanto Tomas, Manila, Philippines \n\n\n\n\n\n\n\n J Jazul \n1\n, XA Nieto \n\n\n\n2     \n \n\n\n\n1\nDepartment of Pharmacy, University of Santo Tomas, Faculty of Pharmacy \n\n\n\n2\nDepartment of Mathematics, University of Santo Tomas, Faculty of Pharmacy \n\n\n\n\n\n\n\nSelf-medication is presumed to be widely practiced around the world. This can be defined as the use \n\n\n\nof drugs to treat self-diagnosed disorders or symptoms, or the intermittent or continued use of a \n\n\n\nprescribed drug for chronic or recurrent disease or symptoms. High level of education and \n\n\n\nprofessional status has also been mentioned as predictive factors for self-medication. Students from \n\n\n\nthe allied and non-allied health institutions of the University of Santo Tomas were assessed for the \n\n\n\nfactors of self-medication practices. A total of 66 graduating students were asked to complete the \n\n\n\nquestionnaire. To ensure valid responses, the researchers supervised the respondents in completing the \n\n\n\nquestionnaires. Mean and range summarized the age while counts and percentages summarized the \n\n\n\ngender, school, practice of self-medication, therapeutic classes, health conditions, reasons and sources \n\n\n\nof self-medication. A total of 55 reported that they practice self-medication. On the total 66 \n\n\n\nrespondents practicing self-medication is antibiotics, anti-allergic and antihistamine, and \n\n\n\n\n\n\n\n\ndecongestants. The 55 respondents documented headache to be the most self-treated health condition \n\n\n\nfollowed by cough and cold, toothache, muscle pain pimples, back/chest pain, dizziness, and \n\n\n\ndiarrhea/constipation. Significantly greater percentage of females (p=0.038) used antibiotics. \n\n\n\nRespondents with high self-care orientation are self-medicating on antibiotics (p=0.027), anti-allergic \n\n\n\n(p<0.001), and herbal medicine (p=0.001) than respondents with low self-care orientation.  \n\n\n\n\n\n\n\n\n\n\n\nPEO 03 \nFAPA2014000179 (Oral) \n\n\n\n\n\n\n\nEnhancing Pharmacy Students Learning with Audiovisual Educational Tool on Issues \n\n\n\nRegarding Generic Medicines \n\n\n\n\n\n\n\nSW Lee, MA Hassali, AA Shafie \n\n\n\nDiscipline of Social & Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains \n\n\n\nMalaysia \n\n\n\n\n\n\n\nThe use of multimedia such as animated videos/cartoons, in teaching and learning has been stated as \n\n\n\nan effective tool to enhance learning. Many disciplines have been using animated modules to explain \n\n\n\ncomplex subject matters to build interest in the learning process. This study was to test the \n\n\n\neffectiveness of the developed animated educational video regarding issues related to bioequivalence \n\n\n\nof generic medicines. A cross sectional, intervention study was conducted on 111 senior year \n\n\n\npharmacy students of Universiti Sains Malaysia with a valid ethics committee approval. Students \n\n\n\nshowed interest in learning with animated video and significant improvement in the knowledge and \n\n\n\nattitude towards generic medicine and bioequivalence was observed with 95.6% respondents agreeing \n\n\n\nthat the animated video enhanced their understanding of bioavailability and bioequivalence. None of \n\n\n\nthem thought of generic medicines to be less effective than innovator brands after watching the video \n\n\n\ncompared to 3.6% before the intervention. The intervention incremented the knowledge of generic \n\n\n\nmedicine bioequivalence parameters to 91.2% as compared to 0.9% pre-intervention (p<0.05) and \n\n\n\n76.3% as compared to 31.5% (p<0.05) in the confidence of study participants regarding generic \n\n\n\nmedicine substitution. A 31% improvement was also observed in the study respondents\u2019 perception of \n\n\n\nsafety standards for generic medicines after the intervention. It can therefore be concluded that new \n\n\n\nmedia technologies such as animation/cartoon is an effective tool that can be used to bridge different \n\n\n\ncomplex subject matters in pharmacy education. \n\n\n\n\n\n\n\n\n\n\n\nPEO 04 \nFAPA2014000210 (Oral) \n\n\n\n\n\n\n\nPerceptions, General Health Knowledge and Health-seeking Behaviour of Outpatients in Two \n\n\n\nChinese Medicine Treatment Centres in Kuala Lumpur \n\n\n\n\n\n\n\nPN Yeoh\n1\n, MC Leong \n\n\n\n1\n, HX Yong\n\n\n\n1\n and SM Liow\n\n\n\n2\n  \n\n\n\n1\nSchool of Pharmacy, International Medical University, Bukit Jalil, 57000 Kuala Lumpur, Malaysia \n\n\n\n2\nSchool of Health Sciences, Division of Chinese Medicine, International Medical University, Bukit \n\n\n\nJalil, 57000 Kuala Lumpur, Malaysia \n\n\n\n\n\n\n\nTraditional Chinese medicine (TCM) with origin in China is more than 2,000 years\u2019 old. Today TCM \n\n\n\nis practiced in China and almost all countries in the world. In the West, it is viewed as complementary \n\n\n\nand alternative medicine (CAM). In Malaysia, the government has incorporated integrated healthcare \n\n\n\nin many public hospitals since 2006 and has passed the Traditional and Complementary Medicine \n\n\n\n(T&CM) Act in 2012 in order to regulate the training and practice of T&CM. The aim of this study \n\n\n\nwas to evaluate whether outpatients of two TCM treatment centres in Kuala Lumpur: Chinese \n\n\n\nMedicine Aid Department (CMAD) a non-profit organisation and the International Medical \n\n\n\nUniversity Chinese Medicine Centre (IMU CMC), a for-profit organization were different in their \n\n\n\n\n\n\n\n\nperceptions (P) and health-seeking behavior (HSB).  A cross-sectional study was conducted through a \n\n\n\nself-designed questionnaire on 175 patients  from  CMAD and 175 patients  from IMU CMC. Data \n\n\n\nwas analysed with the help of Excel and SPSS.  Perceptions of outpatients among CMAD and IMU \n\n\n\nCMC were not different (P>0.05).  However, perceptions were found to be correlated with patients\u2019 \n\n\n\neducation level and their estimated monthly income in both centres. There was a significant difference \n\n\n\n(P<0.05) in general health knowledge between CMAD and IMU CMC outpatients and this was \n\n\n\ndependent on patients\u2019 age. Health-seeking behaviour of outpatients in CMAD and IMU CMC was \n\n\n\nnot different and was not correlated with gender, age, highest education level and estimated monthly \n\n\n\nincome (P>0.05).  There was a significant difference in general health knowledge of outpatients in \n\n\n\nCMAD compared to IMUCMC.  However, there was no difference between their perceptions and \n\n\n\nhealth seeking behavior. \n\n\n\n\n\n\n\n\n\n\n\nPEO 05 \nFAPA2014000070 (Oral) \n\n\n\n\n\n\n\nDesign and Evaluation of the Pharmacovigilance Course in a Pharmacy School (Kulliyyah) In \n\n\n\nMalaysia \n\n\n\n\n\n\n\nRM Elkalmi\n1\n, OQB Al-lela\n\n\n\n2\n, SQ Jamshed\n\n\n\n3\n, AIJ Awadh\n\n\n\n4, \nAM Alshami\n\n\n\n5\n, MA Hassali\n\n\n\n6\n \n\n\n\n\n\n\n\nDeficiencies in pharmacovigilance education may contribute to low involvement and ADR \n\n\n\nunderreporting among pharmacists. Pharmacy students need to be adequately trained and exposed to \n\n\n\nthe challenges in pharmacovigilance.  The objectives of this study were to describe the development \n\n\n\nand evaluate of new pharmacovigilance course for undergraduate pharmacy program in Malaysia and \n\n\n\nstudents\u2019 evaluation of the course.  Three hours face-to-face lectures and 2 hours tutorial base have \n\n\n\nbeen integrated in required 3 \u2013credited-hours course (research in pharmacy and \n\n\n\npharmacoepidemiology). The training provides hands-on training on adverse drug reactions reporting \n\n\n\nand undertaking causality assessment. An assessment approach using pre- and post-course \n\n\n\nevaluations has been made. Descriptive and inferential statistics using SPSS 20.0 were undertaken.  \n\n\n\nNinety one self-completed questionnaires were returned out of 104 (response rate: 87.6%). the \n\n\n\nmajority of respondents were female (n=67, 73.6%), the mean age of students was 21.9SD+0.43. The \n\n\n\noverall perception of the students regarding the course was positive. All of the respondents believed \n\n\n\nthat the knowledge gained from the course would be required in their future practice of pharmacy \n\n\n\n(n=91, 100%). The majority (n= 81, 89.0%) of the students indicated that they understood the role of \n\n\n\npharmacist in pharmacovigilance on safety of vaccines activities after attending the course. A \n\n\n\npharmacovigilance course was successfully designed and implemented in the BPharm curriculum. \n\n\n\nAdditional and procedural amendments to the course content should be done.  \n\n\n\n\n\n\n\n\n\n\n\nPEO 06 \nFAPA2014000038 (Oral) \n\n\n\n\n\n\n\nCurricular Directions for a B. S. Pharmacy Course in Response to the K-12 Program \n\n\n\n\n\n\n\nRAT Oli\n1\n, GA Reyes\n\n\n\n2\n \n\n\n\n1\nCollege of Pharmacy, Adamson University, Manila, Philippines \n\n\n\n2\nSchool of Natural Sciences, Saint Louis University, Baguio City, Philippines  \n\n\n\n\n\n\n\nIn the Philippines, pharmacy education is governed by the Commission on Higher Education (CHED) \n\n\n\nwhich requires a four-year baccalaureate degree. The Department of Education (DepEd) launched K-\n\n\n\n12 curriculum which will result to the downloading of subjects from CHED to high school that will \n\n\n\naffect the pharmacy course due to the less number of subjects and the number of years a B. S. \n\n\n\nPharmacy course be offered.  Document analysis was performed on K-12 primer, CHED \n\n\n\nMemorandum Orders (CMO), pharmacy curriculum of other countries, and related studies. The result \n\n\n\n\n\n\n\n\nwas provided to population groups, graduating pharmacy students, faculty members, and industry \n\n\n\npartners, in a form of a document before the survey was conducted. The survey was conducted to \n\n\n\ndetermine whether the subjects in the currently existing Pharmacy curriculum in the country should be \n\n\n\nretained, transferred to high school, removed, or replaced, and for professional subjects, either change \n\n\n\nthe number of terms or modifying the number of units, or to trim down the number of years the course \n\n\n\nbe offered in light of the full implementation of K-12. Faculty members and industry partners were \n\n\n\ngiven the opportunity to list down subjects that are deemed necessary to be taken by students but are \n\n\n\nnot yet included in the existing curriculum. Triangulation methodology was used to validate, through \n\n\n\ncross verification, the data obtained in the survey. Except for Chem 1, Ethics, and Statistics, all \n\n\n\ngeneral education subjects, and mandated subjects were considered by the majority of the respondents \n\n\n\nto be transferred to high school. All core and professional subjects are to be retained in college \n\n\n\nwithout alteration in the number of terms and units. Nuclear Pharmacy, Complementary and \n\n\n\nAlternative Medicine, Cosmetic Pharmacy, Pharmbiotechnology, Drug Interactions & Monitoring \n\n\n\nSkills, and Chemical Instrumentations were deemed necessary but are not yet included in the existing \n\n\n\ncurriculum. \n\n\n\n\n\n\n\n\n\n\n\nPEO 07 \nFAPA2014000170 (Oral) \n\n\n\n\n\n\n\nStudents\u2019 Views about Problem-Based Learning Facilitators: A Qualitative Insight \n\n\n\n\n\n\n\nSQ Jamshed, MH Nik Mohamed, NI Nor Mohamed Nazar, SH Shamsudin, SH Bux, N Othman \n\n\n\nDepartment of Pharmacy Practice, Kulliyyah of Pharmacy, International Islamic University \n\n\n\nMalaysia, Kuantan, Pahang, Malaysia \n\n\n\nPharmacy Practice, College of Pharmacy, Taibah University, Madinah, Kingdom of Saudi Arabia \n\n\n\n\n\n\n\nFacilitators in problem-based learning act like a pedestal in strengthening the collaborative learning \n\n\n\napproach of students. The current research aimed to explore the role of facilitators from the students\u2019 \n\n\n\nstandpoint. A qualitative approach was adopted to obtain in depth information from the respondents. \n\n\n\nA purposive sampling approach was used.  Thirteen students were selected from final year class and \n\n\n\nsemi-structured, face to face interviews were conducted with an interview guide. Questions mainly \n\n\n\npertaining to the role of PBL facilitators, their approach towards managing the case and style of \n\n\n\nfacilitation were incorporated in the interview guide. Interviews were conducted till the point of \n\n\n\nsaturation achieved. Thematic content analysis generated three main themes: (i) Lack of punctuality \n\n\n\namong facilitators; (ii) improper facilitation style; (iii) Lack of engagement. Respondents reported that \n\n\n\nthe facilitators were not aware of how to carry on with the discussion among the group. It was also \n\n\n\nreported that generally one PBL which comprises of two sessions with 15-days interval in between the \n\n\n\ntwo sessions was curtailed into one session only. Students also reported that a couple of the \n\n\n\nfacilitators did not utter a single word during whole one session. The current research findings \n\n\n\nreported that facilitators must be trained properly for their roles which in turn improvise the \n\n\n\nintellectual ability and critical reasoning of the students. \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nPEO 08 \nFAPA2014000310 (Oral) \n\n\n\n\n\n\n\nThe Relationship of the Pharmacy Licensure Examination Scores with the University of Santo \n\n\n\nTomas Entrance Test (USTET) IQ Scores, Course Preference and General Weighted Average \n\n\n\n(GWA) of Pharmacy Students of the University of Santo Tomas Batches 2010 \n\n\n\n\n\n\n\nAEA Arcega, LEDC Briones, ZBP Corteza, MRK De Guzman, JML Magno, SC Sy, MA Ngo, \n\n\n\nAQ Carigma, MCC Chua \n\n\n\nFaculty of Pharmacy, University of Santo Tomas, Manila, Philippines \n\n\n\n\n\n\n\nEvery year, a new batch of student graduates takes their respective licensure examinations to acquire a \n\n\n\nlicense to practice their profession and be given the confirmation that they are competent enough to \n\n\n\nperform the duties their profession requires. Although most takers do pass or become top-notchers, \n\n\n\nbut still there are those who unfortunately do not. This study focused on discovering the University of \n\n\n\nSanto Tomas Entrance Test (USTET) IQ scores, Course Preference, and their General Weighted \n\n\n\nAverage (GWA) could serve as determinants of the increase or decrease in the scores of Pharmacy \n\n\n\nLicensure Examination Scores of Pharmacy students and Clinical Pharmacy students of UST Batches \n\n\n\n2010-2013. The acquired data were gathered from the Guidance office (USTET and Course \n\n\n\nPreference), Registrar\u2019s office (GWA) and Dean\u2019s office (Pharmacy Licensure Examination Scores). \n\n\n\nConsequently, the data were encoded and organized in Microsoft Excel and analyzed using Multiple \n\n\n\nLinear Regression in SPSS (Statistical Package for the Social Sciences). Only the correlation \n\n\n\nobserved in batch 2012 was significant for the IQ (p-value = 0.02). As for the course preference, only \n\n\n\nthe batch 2010 was significant (p-value= 0.01). Meanwhile, the GWA in all the batches were \n\n\n\nsignificant except for the Clinical Pharmacy batch 2012 (p-value= 0.06). These results state that the \n\n\n\nmost consistently significant variable was the GWA. This in turn would mean that the GWA can be \n\n\n\nconsidered as a determinant in passing the Pharmacy Licensure Examinations. Since Pharmacy \n\n\n\nLicensure Examinations aim to ensure that every individual who is granted a license to practice the \n\n\n\npharmacy profession is competent enough to perform their tasks as pharmacists, the examination\u2019s \n\n\n\nobserved direct relationship with the GWA would mean that the Pharmacy Licensure examination is \n\n\n\ngreatly dependent on the student\u2019s knowledge and skills acquired and applied through the academic \n\n\n\nprogram. \n\n\n\n\n\n\n\n\n\n\n\nPEO 09 \nFAPA2014000311 (Oral) \n\n\n\n\n\n\n\nQualitative Research: Recent Application to Study Patients Lived-Experience of Using Insulin \n\n\n\nTreatment to Manage Type 2 Diabetes Mellitus \n\n\n\n\n\n\n\nJ Chai\n1\n, C Anderson\n\n\n\n2\n, KT Wong\n\n\n\n1\n, Z Hussein\n\n\n\n3\n \n\n\n\n1\nThe University of Nottingham Malaysia Campus, Semenyih, Selangor, Malaysia \n\n\n\n2\nThe University of Nottingham UK Campus Nottingham, United Kingdom \n\n\n\n3\nPutrajaya Hospital, Putrajaya, Malaysia  \n\n\n\n\n\n\n\nQuantitative research has a long tradition in gathering scientific knowledge, epidemiological \n\n\n\nknowledge, and clinical knowledge on diseases and treatment interventions. However, quantitative \n\n\n\nmethod such as randomised controlled trial or cross-sectional survey has a limited role when trying to \n\n\n\nexplain a social phenomenon or to give an insight of peoples\u2019 experience such as why patients do not \n\n\n\nadhere to their medication. Furthermore, the advancement in medical treatment and exposure of the \n\n\n\npublic to modern technology, subsequently patient expectations of treatment and health outcomes are \n\n\n\nrising. In order to cater for the rising complexity of patients\u2019 experience with different health issue, a \n\n\n\ndifferent approach in conducting research is required to gain deeper understanding of these \n\n\n\nphenomena. This is critical when a piece of research is trying to draw the attention of policy makers, \n\n\n\nwho are looking for evidence such as patients\u2019 views and context in order to make decisions to \n\n\n\n\n\n\n\n\nimprove health services and health outcomes. Malaysian patients\u2019 experience has seldom been \n\n\n\ninvestigated; using quantitative method has a limited role, as there is no firm foundation to build upon \n\n\n\nand over-dependent on the researcher\u2019s assumptions. Pre-determined assumptions therefore would be \n\n\n\nbased on findings in other countries with different cultures; thus they might not be able to reflect the \n\n\n\ncomplexity of health issues faced by Malaysian patients. This study employed qualitative approach to \n\n\n\nexplore patients\u2019 lived-experience of using insulin treatment to manage type 2 diabetes mellitus in \n\n\n\nMalaysia. This study utilised an interpretative phenomenological analysis approach. Purposive \n\n\n\nsampling method was used to select patients for interviews. Interviews were transcribed verbatim and \n\n\n\ncoded using NVivo\u00ae software. Thematic analysis is used to identify and categorise emergent themes. \n\n\n\nThe principle features of grounded theory were adopted particularly in the process of theory \n\n\n\ngeneration, theoretical sampling, and constant comparative method of data analysis.  \n\n\n\n\n\n\n\n\n\n\n\nPEO 10 \nFAPA2014000189 (Oral) \n\n\n\n\n\n\n\nCauses of Stress and Management Approaches among IIUM Pharmacy Students \n\n\n\n\n\n\n\nMA Nor Muhammad, MFK Kasim, I Sumali, AZ Samsul Bahari, PM Ibrahim, N Zulkepli, SS \n\n\n\nMuhammad Ghanisma, IF Othman, NA Adnan, RA Dalim, SQ Jamshed \n\n\n\nKulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang \n\n\n\n  \nStress is one of the psychological problems that affect one\u2019s mental and physical condition. In today\u2019s \n\n\n\nera, students seem to be in stress continuously which affects their academic performance as well as \n\n\n\nparticipation in non-academic activities. The aims of the current research were to explore the different \n\n\n\ncauses of stress among pharmacy students and to identify different ways of managing stress. This is a \n\n\n\ncross-sectional study design in which all the undergraduate pharmacy students of International Islamic \n\n\n\nUniversity Malaysia (IIUM), registered in semester 1, 2013/2014 were recruited. A total of 300 \n\n\n\nstudents from 1\nst\n to 4\n\n\n\nth\n professionals participated in the study. The survey instrument was designed on \n\n\n\nthe basis of previously published research and subjected to face validity and content validity. The \n\n\n\nquestionnaire consists of three main domains; demographics, causes of stress and managing \n\n\n\napproaches towards stress. The data was subjected to International Business Machine Statistical \n\n\n\nPackage for the Social Sciences Statistic version 21 (IBM SPSS) and descriptive and inferential \n\n\n\nstatistics applied. In the current research, a majority of students (n=258; 89%) reported quizzes as the \n\n\n\nmain cause of stress. A significant correlation can be observed between age range (p=0.009) and year \n\n\n\nof study (p=0.006) to quizzes. On the contrary, inadequate support from teachers was stated as the \n\n\n\nminimal cause of stress (n=22; 7.3%). A majority of respondents agreed (210 students; 70%) that \n\n\n\nsleeping is the best way to relief stress. Keeping in view the competitive environment among students, \n\n\n\nmanagement of stress cannot be sidelined. Counseling programmes can be instituted in each semester \n\n\n\nwhich highlight to inculcate managing approaches in daily activities. \n\n\n\n\n\n\n\n\n\n\n\nPEO 11 \nFAPA2014000259 (Oral) \n\n\n\n\n\n\n\nPharm.D Programme in India: Changing Scenario of Pharmacy and the Pharmacist\u2019s Role \n\n\n\n\n\n\n\n TV Narayana, G Sumalatha, KPR Chowdary, TB Vikas, C.Ramesh \n\n\n\nSBD College of Pharmacy, Bangalore, Karnataka, India \n\n\n\n\n\n\n\nThe origin of pharmacy education in India dates back to 1899 with syllabus more focused towards \n\n\n\npharma industry. The UG and PG programmes designed to cater the needs of the industry and become \n\n\n\nsuccessful in making India number 3 in the world and contributed for the development of Pharmacy \n\n\n\nprofession in India. The education system in several countries has undergone major initiatives to \n\n\n\nupdate the Pharmacy programme a more clinical and service oriented programme with practice based \n\n\n\n\n\n\n\n\napproach reflecting the vision for pharmacy practice and education. Though there are more than one \n\n\n\nmillion registered Pharmacists in India, Pharmacist and Pharmacy services were not evident as the \n\n\n\nstudents were not trained in practice oriented areas.. As a major breakthrough in the history of \n\n\n\nPharmacy education in India, a 6 years Pharm.D programme was introduced from 2008 with a vision \n\n\n\nto train the pharmacy students in clinical and practice oriented areas. At present there are 175 \n\n\n\nInstitutions offering Pharm.D programme with intake of 5,250 students in India. Some of the Teachers \n\n\n\nfrom India has undergone training programmes with the help of experts from developed countries like \n\n\n\nU.S, U.K and Australia in practice oriented areas. The value added services provided by Pharm.D \n\n\n\nstudents to the patients started recognizing the role of Pharmacist services which was not seen earlier \n\n\n\nby the physicians and patients. Intervention of Pharm.D students at various capacities proved vital and \n\n\n\nwell accepted by the physicians in India. The first batch of Pharm.D will be completing their \n\n\n\nprogramme in 2014 and going to pave the way to the new generation Pharmacist with new role and \n\n\n\nresponsibility of the future pharmacists of India. \n\n\n\n\n\n\n\n\n\n\n\nPEO 12 \nFAPA2014000157 (Oral) \n\n\n\n\n\n\n\nIntegrating Academic Services into Health Consumer Protection Course: A Community-Based \n\n\n\nLearning at Satit-Walailak-Pattana Community for the Fifth-year Pharmacy Students, \n\n\n\nWalailak School of Pharmacy, Thailand \n\n\n\n\n\n\n\nT Sottiyotin, T Pannoi, S Yongpraderm \n\n\n\nSchool of Pharmacy, Walailak University, Thailand \n\n\n\n\n\n\n\nSchool of Pharmacy (SOP), Walailak University (WU) aims at nurturing a new generation of Thai \n\n\n\npharmacists who work competently in primary care pharmacy service. As an academic blueprint, a \n\n\n\nsix-step competency for WU-SOP students was used as aguide in educating all students with relevant \n\n\n\nknowledge and skills. Regarding that WU-SOP blueprint, results of integration of academic services \n\n\n\ninto Basic Health Consumer Protection course were described. A mixed-method was applied that \n\n\n\ninstructor\u2019s scoring assessment and after action review (AAR) by students were used as data sources.  \n\n\n\nTwo main course activities were assigned by the course director--finding community health problems \n\n\n\nrelated with health products or health needs, planning and then implementing academic services in the \n\n\n\nstudy community. Results showed that students raised 2 health product problems--steroidal \n\n\n\ncontaminated products and harm contamination in food and cosmetics, while, chronic disease \n\n\n\nscreening was a health need from this community. According to health product problems, self-\n\n\n\nsteroidal testing in food and cosmetic, hypertension and diabetes screening, medication counseling \n\n\n\nand health education among chronic ill patients were provided as academic services. Most students \n\n\n\npursued \u201cvery good\u201d level (scored 4.6/5) in integrating data to identify community problems. In \n\n\n\naddition, the value of academic service media are \u201cgood\u201d for people in understanding self-health care \n\n\n\n(scored 3.9/5), as well as, given academic activities were \u201cstrongly interesting\u201d (scored 4.3/5). From \n\n\n\nAAR, all students perceived the roles of consumer protection pharmacist. Over 80 per cent of students \n\n\n\nunderstood the principle of consumer protection, collaborated well with primary health care \n\n\n\nprofessionals, and gained more confidence to work in primary care pharmacy service.  Integrating \n\n\n\nacademic service to health consumer protection course is obviously benefits to the fifth-year WU \n\n\n\npharmacy students in applying knowledge to solve community health problems, which is one of \n\n\n\nrequired competencies declared in the WU-SOP blueprint. \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nPEO 13 \nFAPA2014000187 (oral) \n\n\n\nOpportunities for pharmaceutical care education in the Greater Makong Subregion: A \n\n\n\npreliminary study \n\n\n\nI Kanchanaphibool\n1\n, S Hirunrassamee\n\n\n\n2\n \n\n\n\n1\nFaculty of Pharmacy, Silpakorn University, Nakhon-Pathom, Thailand \n\n\n\n2\nPharmacy Division, Phramongkutklao Hospital and Phramongkutklao College of Medicine, \n\n\n\nBangkok, Thailand \n3\nSchool of Public Health, Kunming Medical University, Yunnan, P.R. China \n\n\n\n\n\n\n\nPharmaceutical care practice has been the worldwide upward trend in the pharmacy profession. \n\n\n\nPreparedness in pharmacy education should be carefully planned to support this globalization. \n\n\n\nCollaboration among countries would be an effective strategy to strengthen and rapidly build up \n\n\n\nprofessional expertise in the pharmacy schools. This approach may be beneficial for the Greater \n\n\n\nMekong Subregion (GMS) countries. Therefore, the objectives of this study were 1) to identify \n\n\n\nessential health care needs of the individual countries, 2) to determine the opportunities in \n\n\n\npharmaceutical care education in this subregion. The documents were reviewed for the 20\u2013year trends \n\n\n\ntoward public health care statistics, including specific population characters and leading causes of \n\n\n\ndeath of each country during 1990\u20132010. Pharmacy education system, number of pharmacy schools, \n\n\n\nand number of registered pharmacists were compared among the countries. The countries with the \n\n\n\nhighest percentage of aging population were Thailand (9.8%), the People's Republic of China (PRC) \n\n\n\n(9.4%), and Vietnam (5.6%). Non-communicable diseases (NCDs) were the causes of death with \n\n\n\nincreasing trends in all six countries. However, communicable diseases (CDs) were still the heavy \n\n\n\nburden in Cambodia, Lao PDR and Myanmar. The most advanced pharmaceutical care education was \n\n\n\nin Thailand, including the 6-year curriculum for the entire country and the pharmacy residency \n\n\n\nprogram while the other countries had various systems and absolutely no residency program. The \n\n\n\nlargest numbers of pharmacy schools and registered pharmacists were in PRC (74 and 200.000), \n\n\n\nThailand (17 and 23,272) and Vietnam (7 and 12,000). On the demand side of the specialty \n\n\n\npharmaceutical care education, PRC and Vietnam exploited the arising opportunities while TH \n\n\n\nexploited on the supply side in providing training the trainers programmes. Specialty residency in \n\n\n\ngeriatric and cardiology has considered the priorities based on population characteristics and causes of \n\n\n\ndeath.  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nPHARMACEUTICAL LEGISLATION, ETHICS AND REGULATORY \n\n\n\nAFFAIRS \n \nPLO 01 \n\n\n\nFAPA2014000264 (Oral) \n\n\n\n\n\n\n\nTrial Plan for Prescription Release from Primary Care \n\n\n\n\n\n\n\nM Fan  \n\n\n\nTaipei Pharmacists Association, Taipei, Taiwan, R.O.C. \n\n\n\n\n\n\n\nThe separation policy of dispensing from prescription has not been adequately implemented especially \n\n\n\nin primary care clinics where the pharmacist, usually only one, is hired. The problem would be caused \n\n\n\nwhen such only one pharmacist would like to take leave.  The aim of this study was to explore ways to \n\n\n\navoid the lack of professional pharmaceutical service that may happen in primary care clinics in \n\n\n\npharmacist\u2019s absence.  The Taipei Pharmacists Association and Taipei Physicians Association joined \n\n\n\ntogether to initiate the trial plan to maintain adequate pharmaceutical service for clinics in \n\n\n\npharmacist\u2019s absence. The methodology of the plan included: clinics release prescription to \n\n\n\ncommunity pharmacies assigned by Taipei Pharmacists Association and the information of drug \n\n\n\nneeded should be provided by clinics in advance.  The conduction of the plan didhelp to solve the \n\n\n\nproblem of lack of professional pharmaceutical service that happened in primary care clinics in the \n\n\n\npharmacist\u2019s absence. The patients\u2019 drug use safety can be secure.  In conclusion, the collaboration \n\n\n\nbetween primary care clinics and community pharmacies has been well established through the trial \n\n\n\nplan will definitely benefit patients, clinics and community pharmacies. \n\n\n\n\n\n\n\nPLO 02 \nFAPA2014000217 (Oral) \n\n\n\n\n\n\n\nKnowledge, Attitude and Perceptions of Pharmacists in Government Service Towards Adverse \n\n\n\nDrug Reaction Reporting in Kelantan \n\n\n\n\n\n\n\n NA Mahmood\n1\n, TW Han\n\n\n\n2\n, AYacob\n\n\n\n3\n, TX Er\n\n\n\n3\n \n\n\n\n1\nKlinik Kesihatan Bandar Kota Bharu, Kelantan, Malaysia,  \n\n\n\n2\nKlinik Kesihatan Chiku 3, Kelantan, Malaysia \n\n\n\n3\nHospital Gua Musang, Kelantan, Malaysia \n\n\n\n\n\n\n\n Medication safety plays an important role in ensuring patient\u2019s therapeutic outcome. Any unwanted, \n\n\n\nnegative consequence after the administration of a medication is termed adverse drug reaction (ADR) \n\n\n\nand the surveillance of ADR is called pharmacovigilance. Pharmacists play an important role in \n\n\n\nensuring ADR is being reported to the Malaysian Adverse Drug Reaction Advisory Committee \n\n\n\n(MADRAC).  The objective of this study was to investigate the knowledge, attitude and practices \n\n\n\n(KAP) of pharmacists in government service in Kelantan regarding adverse drug reaction (ADR) \n\n\n\nreporting.  A cross sectional questionnaire based study was carried out on all government hospital and \n\n\n\nhealth clinics pharmacists between August 2013 and October 2013. All pharmacists in government \n\n\n\nfacilities in Kelantan were included.  Out of 163 questionnaires given out, a total of 102 questionnaires \n\n\n\nwere returned. The majority of pharmacists were female (84.3%) and had below 10 years experience \n\n\n\nin practising pharmacy (88.2%). 56.9% were from hospitals and the remaining from health clinics. \n\n\n\nOnly half of the respondents (54.9%) had reported ADR in the past one year. The overall knowledge \n\n\n\nof ADR reporting for the respondents fell into the high (59.8%) and medium (40.2%) category while \n\n\n\n50% of respondent achieved high score in the attitude section of the questionnaire.The main factor \n\n\n\ninfluencing non-reporting was lack of time to actively look for an ADR and to lodge a report during \n\n\n\nworking hours.  In conclusion, the pharmacists are aware of ADR and the importance of their \n\n\n\nreporting. However, lack of reporting was clearly evident. Creating awareness about ADR reporting \n\n\n\nand making it more convenient may improve the rate of reporting. \n\n\n\n\n\n\n\n\nPLO 03 \nFAPA2014000122 (Oral) \n\n\n\n\n\n\n\nA Randomized Controlled Study on Compliance towards MASA 1956 among Retail \n\n\n\nPharmacists in Sabah \n\n\n\n\n\n\n\nJO Modili,  MF Sahini, S Nair, XR Tan, CC Chew, R Thangatorai, MSJANazir, KY an, KG \n\n\n\nOoi, M Ibrahim, ZNM Ashhar. \n \nPharmaceutical Service Division, Sabah State Health Derpartment, Sabah, Malaysia \n\n\n\n\n\n\n\nThe objective of this study was to evaluate the improvement of compliances towards MASA 1956 \n\n\n\nafter intervention and to determine the correlation between KAP score and noncompliance towards \n\n\n\nMASA\u201956.  This was a randomized controlled study. All retail pharmacies in Sabah with illegal \n\n\n\nadvertisement (n=88) were randomized into the control and intervention after baseline inspection. \n\n\n\nStudy tools included Knowledge, Attitude, Practice (KAP) questionnaire and checklist to quantify \n\n\n\nadvertisements that contravene MASA 1956. The study was conducted from 01\n \nAugust 2013 to 17 \n\n\n\nFebruary 2014. Intervention done included dialogue session, personal coaching and visitation over a \n\n\n\nperiod of 1 month. Second phase study was done 1 month post intervention. Independent t-test was \n\n\n\nused to analyse number of illegal advertisements between groups as well as KAP scores. Chi-square \n\n\n\nwas used to compare offence and no offence between groups. Correlation between KAP and number \n\n\n\nof illegal advertisement was analysed using Pearson correlation.  There was significant improvement \n\n\n\non KAP score of intervention group compared to the control group, p< 0.01.  There was a significant \n\n\n\ndifference in terms of compliance towards MASA\u201956 for the intervention group compared with the \n\n\n\ncontrol group, x\n2\n statistic (df) = 23.768 (1), p< 0.01. There was a mean difference of 4 illegal \n\n\n\nadvertisements between the intervention group (95% CI 2.676, 5.3296, p< 0.01) and the control group. \n\n\n\nPractice score from KAP has moderate negative correlation with the number of illegal advertisement \n\n\n\n(correlation coefficient (r) value of -0.512).  In conclusion, the new form of intervention successfully \n\n\n\nreduced offence of MASA\u201956 as well as number of illegal advertisements. \n\n\n\n\n\n\n\n\n\n\n\nPLO 04 \n\n\n\nFAPA2014000143 (Oral) \n\n\n\n\n\n\n\nThe Policy Framework that Supports Community Pharmacists' Practice \n\n\n\n\n\n\n\nJ Jackson  \n\n\n\nCentre for Medicine Use & Safety, Faculty of Pharmacy & Pharmaceuctial Sciences,  \n\n\n\nMonash University, Australia \n\n\n\n\n\n\n\nThe framework that supports pharmacists' practice consists of numerous interlinked policies, \n\n\n\nregulations and philosophies developed by global and national health agencies, international pharmacy \n\n\n\norganisations, national pharmacists' associations and lead practitioners. Examples that have been \n\n\n\nanalysed for this study include WHO's policy of Universal Health Coverage, various national \n\n\n\nmedicines policies and medicines scheduling regimes, the philosophy of pharmaceutical Care, the \n\n\n\nconcepts of clinical pharmacy, rational use of medicines and medication safety and FIP's Good \n\n\n\nPharmacy Practice Guidelines and Seven Star Pharmacist concept. Understanding the principles and \n\n\n\npurpose of each statement and the relationship between them is critical to their successful \n\n\n\nimplementation. This presentation will describe and map a number of these policies and philosophies \n\n\n\nin relation to community pharmacists' practice and will include discussion of how they either restrict \n\n\n\nor support the advancement of practice. Major issue in contemporary practice including the separation \n\n\n\nof prescribing and dispensing, the supervision of supply by pharmacists and compliance with \n\n\n\nprescription-only supply will be assessed within the context of these policies, regulations and \n\n\n\nphilosophies. \n\n\n\n\n\n\n\n\nEMERGENCY MEDICINE AND OTHERS \n\n\n\n \nEMO 01 \nFAPA2014000124 (Oral) \n\n\n\n\n\n\n\nEffectiveness and Tolerability of Hyaluronic Acid for Chronic Wounds Healing: A Systematic \n\n\n\nReview \n\n\n\n\n\n\n\nA Shaharudin, Z Aziz, NJ Chong \n\n\n\nDepartment of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia \n\n\n\n\n\n\n\nHyaluronic Acid (HA) plays a critical role in maintaining the structure and integrity of the skin as \n\n\n\nwell as in wound healing process. Despite the increasingly used of dressings containing HA and \n\n\n\ntopical HA to treat chronic wounds, the evidence of its effectiveness remains inconclusive. The aim of \n\n\n\nthis study was to examine the effectiveness of HA (either as dressing or topical agent) for promoting \n\n\n\nhealing in chronic wounds through a meta-analysis of the available evidence. Several databases \n\n\n\nincluding the Cochrane Library, CINAHL, Medline, Ovid, Embase and online publishing site were \n\n\n\nsearched to identify relevant studies. The search was supplemented by hand searches of conference \n\n\n\nproceedings and reference lists. Twelve randomised controlled trials (RCTs) involving 985 \n\n\n\nparticipants were included. Compared to the non-HA group, both HA dressings and topical HA \n\n\n\ngroups showed statistically significant reduction in wound area [WMD -3.61; 95% CI -6.62 to -0.61]. \n\n\n\nHowever, in terms of the number of wounds healed, there was no significant difference between the \n\n\n\ntwo groups [RR 1.43; 95% CI 0.93 to 2.22]. Two out of the twelve trials did not provide quantitative \n\n\n\ndata. For the outcome healing time, only one trial showed a significant effect. As for the safety profile \n\n\n\nof HA, only one trial reported its safety. Evidence to guide decisions regarding the use of dressings \n\n\n\ncontaining HA and topical HA to promote wound healing is still limited because the included trials \n\n\n\nwere of moderate quality. More good quality trials are warranted. \n\n\n\n\n\n\n\n\n\n\n\nEMO 02 \nFAPA2014000136 (Oral) \n\n\n\n\n\n\n\nA Systematic Review of the Efficacy and Tolerability of Saccharum officinarum for \n\n\n\nHypercholesterolemia \n\n\n\n\n\n\n\nNJ Chong, Z Aziz\n \n \n\n\n\nDepartment of Pharmacy, Faculty of Medicine, University of Malaya 50603 Kuala Lumpur, Malaysia \n\n\n\n\n\n\n\nSaccharum officinarum commonly known as sugar cane is believed to be useful for \n\n\n\nhypercholesterolemia. Results of several trials assessing the effectiveness of Saccharum officinarum \n\n\n\nfor cholesterol levels are contradictory. The aim of this study was to assess the efficacy and \n\n\n\ntolerability of Saccharum officinarum for hypercholesterolemia. Databases searched included \n\n\n\nCochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Wiley Online Library, and \n\n\n\nAcademic Search Premier. There was no language restrictions. We also conducted hand searches and \n\n\n\nexamined grey literature such as conference proceedings and references lists for additional trials. Two \n\n\n\nreview authors independently selected studies, extracted data and assessed risk of bias. Only \n\n\n\nrandomised control trials involving Saccharum officinarum compared with placebo of at least two \n\n\n\nweeks study duration were included. Weighted mean difference (WMD) was calculated for total \n\n\n\ncholesterol (TC), low density lipoprotein-cholesterol (LDL), high density lipoprotein-cholesterol \n\n\n\n(HDL), and triglyceride (TG). Seven randomised controlled trials involving 508 hypercholesterolemic \n\n\n\npatients were included. Compared to placebo, Saccharum officinarum did not produce any significant \n\n\n\neffect on any of the outcomes examined: TC (WMD = -0.14; 95% CI -1.14, 0.86), LDL (WMD = -\n\n\n\n0.40; 95% CI -1.29, 0.49), HDL (WMD = 0.15; 95% CI -0.14, 0.44), and TG (WMD = 0.08; 95% CI \n\n\n\n0.01, 0.15). Overall, Saccharum officinarum was well tolerated. Current available evidence based on \n\n\n\n\n\n\n\n\ntrials of moderate quality does not support the efficacy of Saccharum officinarum for lowering \n\n\n\ncholesterol levels. Further rigorously conducted trials are needed to confirm the effects of Saccharum \n\n\n\nofficinarum on hypercholesterolemia. \n\n\n\n\n\n\n\n\n\n\n\nEMO 03 \nFAPA2014000159 (Oral) \n\n\n\n\n\n\n\nResearch and Development of Herbal Cosmeceutical for the Prevention of Keloid and \n\n\n\nHypertrophics Scars \n\n\n\n\n\n\n\nT Kajsongkram, P Siriarchawattana, C Thisayakorn, T Sematong, C Banchonglikitkul  \n\n\n\nThailand Institue of Scientific and Technological Research, Pathum Thani, Thailand \n\n\n\n\n\n\n\nLico-scars cream developed in this research was a topical product for external use in the treatment of \n\n\n\nkeloid and hypertropic scars. This product had passed efficacy and safety evaluation with clinical \n\n\n\ntesting for safety.  Research and development of the Lico-scars cream began with selection of \n\n\n\npotential herbal extracts. In vitro studies of a total 30 herbal extracts indicated that Licorice extract \n\n\n\nhad inhibitory activities on the proliferation of keloid fibroblast and the secretion of IL-6. The \n\n\n\ninhibitory activity on keloid fibroblast and IL-6 production was found to be 45.5 and 62.9% at the \n\n\n\nconcentration of 1x 10-4g/mL. The Licrorice extract possessed anti-inflammatory activity that helps \n\n\n\nwound healing and thereby reduction of keloid and hypertrophic scars. In addition, the extract \n\n\n\nexhibited antioxidant activity that aids in skin smoothing and had anti-tyrosinase activity in improving \n\n\n\ntexture of hypertrophic scars. With above mentioned properties of the extract, it was then developed \n\n\n\nto topical cream with subsequent animal test for anti-hypertrophic scars using surgical excision \n\n\n\nmodel. The scar thickness observed in the intervention group (1.56\u00b10.16 mm) was significantly lower \n\n\n\nthan that of the control group (2.17\u00b10.19 mm). Our results showed that the Lico-scars cream was \n\n\n\neffective in reducing hypertrophic scarring in the rabbit ear model which was statistically significant \n\n\n\ncompared with a base cream. The cream was considered safe when evaluated for acute dermal \n\n\n\ntoxicity, acute dermal irritation and skin sensitisation testing. Moreover, in the human volunteer study, \n\n\n\nit revealed that the cream was non-irritating to human skin. According to the questionnaire survey of \n\n\n\nfocus group to the Lico-scars cream, 210 study participants reported the overall product likeness after \n\n\n\ntesting at a high level of satisfaction. \n\n\n\n\n\n\n\n\n\n\n\nEMO 04 \nFAPA2014000291 (Oral) \n\n\n\n\n\n\n\nA Preliminary Survey of the Penetration and Application of Mobile Health Apps in Malaysia \n\n\n\n\n\n\n\nF Shipton, C Chen, MYQ Chai, YF Tan, T-J Khoo \n\n\n\nSchool of Pharmacy, University of Nottingham Malaysia Campus, Semenyih, Selangor, Malaysia \n\n\n\n\n\n\n\nHealthcare related applications (apps) for smartphones provide the general population and healthcare \n\n\n\nprofessionals with a convenient source of information and advice. Some of these apps have been \n\n\n\ndesigned specifically for healthcare professionals, while others are aimed at the general public and can \n\n\n\nrange from reference books to exercise aids. This study aimed to examine how readily accepted these \n\n\n\napps are and to observe any patterns in medical related mobile application usage within Malaysia. A \n\n\n\nsurvey was handed out to members of the general public and healthcare professionals in Malaysia. \n\n\n\nParticipants were asked a total of 33 questions which were centered on the issue of health related \n\n\n\napps, including how and when the apps were used and their opinions of these apps. 175 participants \n\n\n\ncompleted the survey, of which 16% (n=28/175) were healthcare workers and 54% (n=94/175) were \n\n\n\nstudents. Only 4% (n=7/175) of the participants did not own a smartphone. Most of the participants \n\n\n\nhad between 1-5 health related apps on their phone, only 7% (n=18/175) having more than this, of \n\n\n\nwhich 67% (n=12/18) were students or healthcare professionals. Out of the health related apps that \n\n\n\n\n\n\n\n\nparticipants possessed, a significant number had apps relating to drug information and diet. Healthcare \n\n\n\nprofessionals used apps that provide drug information, while students tended to use the calculators \n\n\n\nand diet and exercise related apps. When asked about the negative aspects of health apps, the \n\n\n\nreliability and lack of detailed information provided by apps was the most common complaint. This \n\n\n\nstudy found that a large number of people used health apps and some of this use was casual, \n\n\n\nwhile others used these apps for study or to assist in their work. There is room for the development of \n\n\n\nreliable drug formation apps by people in the pharmacy profession for the general population. \n\n\n\n\n\n\n\n\n\n\n\nEMO 05 \n\n\n\nFAPA2014000199 (Oral) \n\n\n\n\n\n\n\nSystematic Review and Meta Analysis on Brain Derived Neurotrophic Factor and Major \n\n\n\nDepressive Disorder: An Evidence-based approach \n\n\n\n\n\n\n\nA Vijayakumar, T Jacob, MJ Sajar, N Augustine, VS John  \n\n\n\nDepartment of Pharmacy Practice, KMCH College of Pharmacy, Coimbatore, India \n\n\n\n\n\n\n\nThe objective of this study was to perform a systematic review and meta-analysis to assess the role of \n\n\n\nBrain Derived Neurotrophic Factor (BDNF) in Major Depressive Disorder (MDD) patients to \n\n\n\ndetermine the efficacy of antidepressant treatment. We also assessed the impact of antidepressant \n\n\n\ntreatment on Hamilton Rating Scale for Depression (HRSD) in MDD patients.  Meta-analysis was \n\n\n\nperformed using the software \u2018comprehensive meta-analysis\u2019 which gives a thorough summary of \n\n\n\nseveral studies that have been done on the same topic and provides the reader with extensive \n\n\n\ninformation. We conducted search in PUBMED database using key words \u201cBDNF\u201d and \u201cDepression\u201d \n\n\n\nand \u201cAntidepressants\u201d. On the basis of the inclusion and exclusion criteria, studies were filtered and \n\n\n\nfinally shortlisted 6 articles for the study.  Using the random effect model, comparison of serum \n\n\n\nBDNF in Major Depressive Disorder (MDD) patients before and after antidepressant treatment was \n\n\n\nperformed [CI,-1.299 to -0.254; SMD-Standard Mean Difference, -0.776] with p>0.05, which \n\n\n\nindicates that no significant impact of antidepressant on BDNF. The HRSD Score before and after \n\n\n\nantidepressant treatment was also compared by using random effect model [CI= 1.719 to 3.707; \n\n\n\nSMD=2.713] with p <0.05, which reveals significant decrease in HRSD score and thereby it may \n\n\n\nimprove the quality of life. The result shows that antidepressant treatment does not significantly affect \n\n\n\nBDNF levels. In addition the Hamilton Rating Scale for Depression (HRSD) score gets reduced \n\n\n\nsignificantly after antidepressant treatment. This leads to the suggestion that BDNF cannot be used as \n\n\n\na reliable marker for assessing the effect of antidepressant treatment. \n\n\n\n\n\n\n\n\n\n\n\nEMO 06 \nFAPA2014000115 (Oral) \n\n\n\n\n\n\n\nHydroxyethylrutosides for Signs and Symptoms of Chronic Venous Insufficiency: A Systematic \n\n\n\nReview \n\n\n\n\n\n\n\nZ Aziz, NJ Chong, LY Tho \n\n\n\nDepartment of Pharmacy, Faculty of Medicine, University of Malay, Kuala Lumpur, Malaysia. \n\n\n\n\n\n\n\nHydroxyethylrutosides is a standardised mixture of semi-synthetic flavonoids believed to be \n\n\n\nbeneficial for signs and symptoms of chronic venous insufficiency (CVI). However, the evidence is \n\n\n\ninconclusive. The aim of this systematic review was to evaluate the evidence of efficacy and \n\n\n\ntolerability of hydroxyethylrutosides for CVI. We searched electronic databases such as Cochrane \n\n\n\nCentral Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and CINAHL; publisher \n\n\n\ndatabases, conference proceedings and references lists for both English and non-English randomised \n\n\n\ncontrolled trials. We also performed hand searches for additional trials. Two review authors \n\n\n\nindependently selected studies, extracted data and assessed risk of bias of included trials. The search \n\n\n\n\n\n\n\n\nproduced 1466 records. Only 15 trials involving 1648 participants met our inclusion criteria and thus \n\n\n\nincluded in the review. Results of meta-analysis showed that hydroxyethylrutosides was significantly \n\n\n\nsuperior compared to control for reducing the number of oedema (RR 0.69, 95% CI 0.58 to 0.82), \n\n\n\nvenous ulcers (RR 1.7, 95% CI 1.24 to 2.34), pain (SMD -1.07, 95% CI -1.44 to -0.70), swelling (RR \n\n\n\n0.76, 95% CI 0.36 to 1.63) and cramps (SMD -1.07, 95% CI -1.45 to -0.69). No serious adverse effect \n\n\n\ndue to hydroxyethylrutosides was reported. The findings showed beneficial but modest effects of \n\n\n\nhydroxyethylrutosides for improving signs and symptoms of CVI. All the included trials were of \n\n\n\nmoderate quality and therefore better quality trials are still required to make a firm conclusion on the \n\n\n\nusefulness of hydroxyethylrutosides.  \n\n\n\n\n\n\n\n\n\n\n\nEMO 07 \n\n\n\nFAPA2014000137 (Oral) \n\n\n\n\n\n\n\nEfficacy and Tolerability of Micronized Purified Flavonoid Fractions (MPFF) for \n\n\n\nHaemorrhoids: A Systematic Review \n\n\n\n\n\n\n\nWL Tang, Z Aziz \n\n\n\nDepartment of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia \n\n\n\n\n\n\n\nHaemorrhoids are a common condition with estimates suggesting a prevalence of 4% in the adult \n\n\n\npopulation. Reports on the beneficial effects of micronized purified flavonoid fractions (MPFF) in the \n\n\n\nmanagement of haemorrhoidal symptoms are contradictory. The aim of this study was to assess the \n\n\n\nefficacy and tolerability of MPFF in the management of haemorrhoidal symptoms. We included \n\n\n\nrandomized controlled trials evaluating the efficacy and tolerability of MPFF in the management of \n\n\n\nhaemorrhoidal symptoms. Electronic databases such as CENTRAL, CINAHL, EMBASE and \n\n\n\nMEDLINE as well as other publisher databases were searched for eligible trials. No language or \n\n\n\npublication restriction was applied. Two review authors independently selected trials, extracted data \n\n\n\nand assessed the risks of bias of included trials. The quality of the selected trials was assessed using \n\n\n\nthe Cochrane Risk of Bias Assessment Tool. The treatment effects of similar outcomes were pooled \n\n\n\nwhenever appropriate. We included twelve randomized controlled trials involving a total of 1807 \n\n\n\nparticipants. The evidence showed that MPFF was well tolerated with minimal gastrointestinal \n\n\n\neffects. The pooled data showed that MPFF produced beneficial effects on bleeding, pruritis, \n\n\n\nsymptoms recurrence, discharge and overall symptoms improvement. However these effects were not \n\n\n\nstatistically significant between the MPFF and comparator groups. The available evidence based on \n\n\n\ntrials of poor to moderate quality does not support the efficacy of MPFF for managing haemorrhoids \n\n\n\nsymptoms. Further rigorously designed trials with larger sample size are required to confirm the \n\n\n\nbenefits of MPFF for haemorrhoids. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nPOSTER PRESENTATIONS \n \n\n\n\nHospital and Clinical Pharmacy \n\n\n\n\n\n\n\nNo Presenting Author Title \n\n\n\nHPP 01 YC Hung The Antibiotic Resistance among Serogroups of Non-Typhoidal \n\n\n\nSalmonella \n\n\n\nHPP 02 P Phueanpinit Survey of Hospital Pharmacists Monitoring and Assessment of \n\n\n\nAdverse Drug Reactions from Non-Steroidal Anti-\n\n\n\nInflammatory Drugs \n\n\n\nHPP 03 P Plibai Improvement of Repackage Labeling of the Drugs in Pharmacy \n\n\n\nUnit: Somdech Phra Debaratana Medical Center Experience \n\n\n\nHPP 04 NI Penwalla Safety and Efficacy of Basal-Bolus and Premixed Insulin \n\n\n\nIntensification Regimens in the Management of Type 2 \n\n\n\nDiabetes Mellitus: A 13-Year Narrative Review of Literature \n\n\n\nHPP 05 R Pannarunothai Pharmaceutical Care for Children with Type 1 Diabetes, \n\n\n\nBuddhachinaraj Hospital, Phitsanulok, Thailand \n\n\n\nHPP 06 YW Shim Validation of the Simplified Chinese Version of the Malaysian \n\n\n\nMedication Adherence Scale (MALMAS) on Elderly Patient \n\n\n\nHPP 07 RM Dallumal Adherence to Sitagliptin Using Medication Possession Ratio \n\n\n\n(MPR) and Its Effects on Glycaemic Control \n\n\n\nHPP 08 LY Wong Asthma Control of Adults in Public Health Clinics: Preliminary \n\n\n\nResults \n\n\n\nHPP 09 HL Lee Co-Prescribing of Gastroprotective Agents with Nonsteroidal \n\n\n\nAnti-Inflammatory Drugs in a Tertiary Hospital: Preliminary \n\n\n\nResults \n\n\n\nHPP 10 SM Junoh Unclaimed Prescriptions at the Outpatient Pharmacy of a \n\n\n\nTeaching Hospital \n\n\n\nHPP 11 RW Zhang The Analysis of the Different Treating Dosage Regimen of \n\n\n\nInhaled Colistin Methanesulfonate in Treating the \n\n\n\nAcinetobacter Baumanni Pneumonia \n\n\n\nHPP 12 S Ruengsawad The Impact of Imipenem Shortage for the Clinical Utility of \n\n\n\nAnti-Pseudomonal Carbapenems: A Cross Sectional Analysis \n\n\n\nHPP 13 SY Liang Trend of Drug Utilization Pattern with the Anatomical \n\n\n\nTherapeutic Chemical (ATC) Classification in a Tertiary \n\n\n\nTeaching Hospital from 2006 To 2013 \n\n\n\nHPP 14 SF Huang Applying the Quality Control Method to Decrease the \n\n\n\nPrescribing Errors of Emergency Department \n\n\n\nHPP 15 S Wachira Effectiveness of Intervention among Patients with Diabetes and \n\n\n\nHypertension by Pharmacist and Health Care Professionals in \n\n\n\nNongku Primary Care Unit, Sisaket Province, Thailand \n\n\n\nHPP 16 T Sumaporn Pharmacist's Role in the Development of Pharmaceutical \n\n\n\nManagement System under Limited Budget: A Case Study in \n\n\n\nSaraburi Hospital \n\n\n\nHPP 17 TS Wang Evaluation of Clinical Efficacy and Safety of Switching from \n\n\n\nTwice-Daily to Once-Daily Tacrolimus Formulation in Liver \n\n\n\nTransplant Patients \n\n\n\nHPP 18 T Asawutmangkul The Quality of Life of Dementia Caregivers before and after \n\n\n\nPatients Receiving Pharmaceutical Care \n\n\n\n\n\n\n\n\nHPP 19 TH Yeh The Effect of Pharmacists' Interventions in Acute Myocardial \n\n\n\nInfarction Patients as a Part of the Cardiovascular Care Team \n\n\n\nHPP 20 U Wanakamanee Survey of Drug Related Problems Identified from Home \n\n\n\nVisiting by Thai Pharmacists \n\n\n\nHPP 21 WJ Chen A Case Report of Suspected Vinorelbine-Induced Pulmonary \n\n\n\nOedema Worsen \n\n\n\nHPP 22 WH Chen Analysis of the Use of Secondary Prevention Drug Therapy in \n\n\n\nPatients with Acute Myocardial Infarction after Discharge from \n\n\n\nHospital \n\n\n\nHPP 23 W Santimaleeworagun The Measures of Adherence to Antiretroviral Therapy in \n\n\n\nThailand: A Survey Study \n\n\n\nHPP 24 W Warathanakul Save Drug, Save Cost, Save Life \n\n\n\nHPP 25 KZ Zhou Evaluation of the Extent and Impact of Oncology Clinical \n\n\n\nPharmacy Service in a Tertiary Hospital in Hong Kong: First \n\n\n\nTen-Month Experience \n\n\n\nHPP 26 YM Hsu Lenalidomide Treatment for Relapsed/Refractory Multiple \n\n\n\nMyeloma: The Experience from a Medical Centre in Taiwan \n\n\n\nHPP 27 CP Ho The Relationship between Medication Possession Ratio and \n\n\n\nMedication Regimen Complexity among Hypertensive Patients: \n\n\n\nA Population-Based Study \n\n\n\nHPP 28 YC Hung Susceptibility of Ciprofloxacin-Sensitive and Resistant MRSA \n\n\n\nIsolates to Non-Beta-Lactam Antibiotics \n\n\n\nHPP 29 YL Chang Joint Commission International Accreditation Standards for \n\n\n\nHospitals its Impact and Analysis on Hospital Drug Safety Use \n\n\n\nHPP 30 YL Chang Analysis of the Effectiveness of the Quality of Outpatient \n\n\n\nPharmacy Service \n\n\n\nHPP 31 M Noraini Transformation of Clinical Pharmacy Activities in Ministry of \n\n\n\nHealth Hospitals in Malaysia \n\n\n\nHPP 32 CS Zin Effect of a Home Medication Review Program on Medication \n\n\n\nAdherence, HbA1c, Fasting Blood Sugar, Blood Pressure and \n\n\n\nLipid Profiles in Patients with Type 2 Diabetes Mellitus: A \n\n\n\nRandomized Controlled Trial \n\n\n\nHPP 33 N Jangkong The Impact of Pharmacodynamically-Optimized Carbapenems \n\n\n\nDosing for Hospital Acquired Infection Treatment: A Cross \n\n\n\nSectional Analysis \n\n\n\nHPP 34 CL Fang Using Quality Control Circle Analysis to Improve Dispensing \n\n\n\nErrors in an Outpatient Pharmacy \n\n\n\nHPP 35 JY Kao Drug Use Evaluation of Rivaroxaban in Atrial Fibrillation \n\n\n\nHPP 36 J Anansushatgul Antibiotic Use in Upper Respiratory Tract Infections in \n\n\n\nAmbulatory Patients in Tertiary Care Hospital, Thailand \n\n\n\nHPP 38 M Suzuki An Evaluation of Efficacy and Safety of Long-Term Use of \n\n\n\nGeneric Pravastatin Sodium in Hyperlipidaemia \n\n\n\nHPP 39 MT Li A Comprehensive Analysis of Outpatient Duplicate Prescribing \n\n\n\nErrors in a Regional Teaching Hospital \n\n\n\nHPP 40 MW Sung Use of a new chemotherapy-specific CPOE system to improve \n\n\n\nchemotherapy safety? \n\n\n\nHPP 41 MM Manan An Evaluation on the Effects of Vaminolact\u00ae in the Parenteral \n\n\n\nNutrition on Physical Changes of Very Low Birth Weight \n\n\n\nPreterm Neonates \n\n\n\n \n\n\n\n\n\n\n\n\nHPP 42 P Khunsakdeeyodom The Incidence of Severe Cutaneous Adverse Drug Reactions in \n\n\n\nThai Population \n\n\n\nHPP 43 AY Kang Analysis of Dyslipidemia Caused by L-Asparaginase in \n\n\n\nPaediatric Acute Lymphoblastic Lymphoma Patients \n\n\n\nHPP 44 A Tienchairoj Pharmacy Drug Care Center: Beyond Pharmacy Service \n\n\n\nHPP 45 K Areerud Provision Pharmaceutical Care with Sticker Tools Reduced \n\n\n\nIncorrect Dose Problem and Its Root Causes in the Elderly \n\n\n\nHPP 46 B Booddawong Sources and Distribution of Unlawful Medicines in 8 Provinces \n\n\n\nof Thailand: To Inform The Public Policy Change \n\n\n\nHPP 47 CL Chou A Risky Practice of Tablet Splitting: an Example of Drugs with \n\n\n\nNarrow Therapeutic Index \n\n\n\nHPP 48 CW Kuo Drug Utilization Evaluation of ACEI and ARB at the Regional \n\n\n\nHospital in Central Taiwan \n\n\n\nHPP 49 C Veerapong Haematological and Thromboembolic Adverse Events of \n\n\n\nLenalidomide in Siriraj Hospital, Thailand \n\n\n\nHPP 50 CP Hsin Drug Utilization of Rabies Virus Vaccine in Outpatients in a \n\n\n\nMedical Centre of Taiwan \n\n\n\nHPP 51 CY Shih Aflibercept-Induced Hyperpigmentation in Patient with \n\n\n\nMetastatic Colorectal Cancer \n\n\n\nHPP 52 CC Hsu Effectiveness of Computerized Decision Support System in \n\n\n\nPreventing Inappropriate Pill Splitting of Prescription \n\n\n\nMedications \n\n\n\nHPP 53 CK Huang A Case of Improper Treatment Course: Baclofen for Hiccups \n\n\n\nHPP 54 Y Choe Perlis Warfarin Clinic: A Study on the Effects of Evolution in \n\n\n\nthe Model of Care \n\n\n\nHPP 55 SWH Lee Identifying and Evaluating Potential Drug-Related Problems: \n\n\n\nMedication Review in Elderly Residents of a Care Home \n\n\n\nHPP 56 CW Tu Bar-Code Technology Implementation on Paediatric Vaccines \n\n\n\nto Reduce Dispensing Error \n\n\n\nHPP 57 D Raja Evaluation of Beneficial Effect in Adding the Nilavembu \n\n\n\nKudineer Chooranam (Siddha Formulation) to Metformin in \n\n\n\nTreatment of Type 2 Diabetes Mellitus \n\n\n\nHPP 58 H Fahmi A Retrospective Comparison of the Mortality of Critically Ill \n\n\n\nPatients Receiving Prolonged and Standard Infusion of \n\n\n\nMeropenem \n\n\n\nHPP 59 H Rashwan Knowledge, Attitude and Vaccination Status of Influenza \n\n\n\namong Healthcare Workers \n\n\n\nHPP 61 HH Lin Medical Warehouse Room Quality Indicator Management \n\n\n\nMonitoring \n\n\n\nHPP 62 HL Lin Palivizumab Injection Use and Safety Assessment of a Medical \n\n\n\nCentre in Taiwan \n\n\n\nHPP 63 HJ Lin Increment of Grade 3 or 4 Adverse Reaction Reporting Rate \n\n\n\nfrom Chemotherapy Agents \n\n\n\nHPP 64 LT Hsu Simvastatin/Ezetimibe Induced Hand Eczema \n\n\n\nHPP 65 HC Lo A Case Report of Suspected Inflammatory Polyarthritis and \n\n\n\nDelayed Infusion Reaction After TrastuzumabTherapy \n\n\n\nHPP 66 HP Liu Suspect Ceftriaxone-Induced Neurologic Adverse Effects: Case \n\n\n\nReport \n\n\n\nHPP 67 HC Lo Impact of a Pharmacist Intervention on Medication \n\n\n\nDiscrepancies and Clinical Outcome in Home Care \n\n\n\n\n\n\n\n\nHPP 68 IC Chen Analysis of the Styles and Pharmacological Classifications for \n\n\n\nAdverse Drug Reaction in a Medical University Hospital \n\n\n\nHPP 69 J Aporn A Comparative Study of Changing Penfill Insulin to \n\n\n\nConventional Syringe Insulin \n\n\n\nHPP 70 JH Kuo Effectiveness of Clinical Pharmacist Visit among Hospitalized \n\n\n\nElderly Patients \n\n\n\nHPP 71 TH Ke Subcutaneous Versus Intravenous Administration of \n\n\n\nBortezomib in Patients with Multiple Myeloma: A \n\n\n\nRetrospective Review Study \n\n\n\nHPP 72 K Theangjit Drug Related Problems in Geriatric Clinic \n\n\n\nHPP 73 MC Lin Evaluation on the Use of Febuxostat \n\n\n\nHPP 74 N Basariah The Effectiveness of Adult Epilepsy-Medication Therapy \n\n\n\nAdherence Clinic (Epi-MTAC) \n\n\n\nHPP 75 M Chaemchaeng Comparison Haematologic Adverse Effect between R-CHOP, \n\n\n\nCHOP, CVP and ESHAP Regimens in Non - Hodgkin's \n\n\n\nlymphoma Patients at Saraburi Hospital, Thailand \n\n\n\nHPP 76 K Tungtragool Pharmacist-led Home Healthcare Increased Medical \n\n\n\nAppointment Adherence and INR Level \n\n\n\nHPP 77 C Siriwong Drug Use Evaluation of Restricted Antibiotics in Hospitalized \n\n\n\nPatients at Phangnga Hospital \n\n\n\nHPP 78 N Inwan The Prevalence and Types of Prescribing Errors (PE) in the \n\n\n\nOutpatient Pharmacy Unit of an Academic Hospital \n\n\n\nHPP 79 D Ledesma The Geriatric Clinic Care Program: An Approach to \n\n\n\nMaintaining Good Health and Quality of Life \n\n\n\nHPP 80 N Azlean Predictors of Adherence to Calcium Carbonate as Phosphate \n\n\n\nBinder among Dialysis Patients in Hospital Raja Perempuan \n\n\n\nZainab II \n\n\n\nHPP 81 S Rattanawai Risk Factors of Anti-tuberculosis Drugs-Induced \n\n\n\nHepatotoxicity in Central of Chest Institute of Thailand \n\n\n\nHPP 82 SW Kang Using the Quality Control Circle Approach to Reduce Resupply \n\n\n\nRate in Pharmaceutical Inventory Control \n\n\n\nHPP 83 A Irawan Using Comic, Pictograms and Table Sticker to Improve \n\n\n\nKnowledge and Medication Adherence in Children with \n\n\n\nHIV/AIDS \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nCommunity Pharmacy \n\n\n\nNo Presenting Author Title \n\n\n\nCPP 01 A Sermhutthakit The Clinical Effectiveness of Clinical Scoring System for \n\n\n\nPharyngitis Diagnosis Leading to Antimicrobial Selection in \n\n\n\nCommunity Pharmacies  \n\n\n\nCPP 02 E Chang The Projection of Community Pharmacy Service in Diabetes \n\n\n\nCare \n\n\n\nCPP 03 M Fan Build a Supporting System of Drug Supply for Community \n\n\n\nPharmacies by Taipei Pharmacist Association \n\n\n\nCPP 04 E Chang Development Programs of International Meeting Participation \n\n\n\nfor Community Pharmacies of Taipei Pharmacist Association   \n\n\n\nCPP 05 DLC Pradana Correlation of Diabetes Treatment Satisfaction and Quality of \n\n\n\nLife in Outpatient Elderly at RSUP Dr Kariadi Semarang \n\n\n\n\n\n\n\n\nCPP 06 SS Chua Health Supplements used by Pregnant Women \n\n\n\nCPP 07 K Saramunee Unit Cost Analysis of Managing Common Illness in the \n\n\n\nUniversity Health Services \n\n\n\nCPP 08 Moe Hosaka Investigation of Actual Conditions about Mixture of External \n\n\n\nMedicines in Japanese Health Insurance Pharmacy: \n\n\n\nQuestionnaire Survey in Japan \n\n\n\nCPP 09 JN Adilla Hayat Knowledge, Attitude and Practice (KAP) towards Human \n\n\n\nImmunodeficiency Virus (HIV)/ Sexually Transmitted Illnesses \n\n\n\n(STIs) among Secondary School Students in Kota Damansara, \n\n\n\nSelangor \n\n\n\nCPP 10 P Sachinkumar Look Alike Sound Alike (LASA) Medications \n\n\n\nCPP 11 S Yamamura Barriers to Implementing Practice Research in Japanese \n\n\n\nCommunity Pharmacists \n\n\n\nCPP 12 SL Leong Practices of Remote and Modernised Indigenous People \n\n\n\ntowards Minor Illness: A Comparison \n\n\n\nCPP 13 CT Lin Survey of Community Pharmacies conducting Chinese \n\n\n\nMedicine Business in Taichung \n\n\n\nCPP 14 I Siti Nooruhani Knowledge, Attitude and Practices of Contraception among \n\n\n\nRural Women in Banting, Selangor \n\n\n\nCPP 15 S Baadilla Analysis of Factor Affecting Therapy Adherence in Systemic \n\n\n\nLupus Erythematosus (SLE) Patients \n\n\n\nCPP 16 M Fan The Milestone of Pharmaceutical Service in Taiwan ~ Be Part \n\n\n\nof Consumer Protection ~ 2013 Intercity Pharmacy Forum \n\n\n\nCPP 17 CY Ting Awareness on the Use of Medicine and Know Your Medicine \n\n\n\nCampaign by Sarawak Consumers: A Comparison between \n\n\n\nUrban and Rural Population \n\n\n\n\n\n\n\n\n\n\n\nDrug Marketing and Socio-Economic Pharmacy \n\n\n\n\n\n\n\nNo Presenting Author Title \n\n\n\nSEP 01 M Masro A Study on Cost Effectiveness, Reduction in Pack Per Year and \n\n\n\nPeak Flow Analysis of Electronic Cigarette Users in Klang \n\n\n\nValley, Malaysia \n\n\n\nSEP 02 W Chaisiripenpak Cost-effectiveness Analysis of Medication Reconciliation at \n\n\n\nFemale Medical Ward in Chonburi Hospital, Thailand \n\n\n\nSEP 03 A Idha Comparison of Cost Analysis and Usage Effectivity of \n\n\n\nRepacked Meropenem and Non Repacked Meropenem in \n\n\n\nPaediatric Patients \n\n\n\nSEP 04 CC Chew Validation of Questionnaire Assessing General Knowledge \n\n\n\nabout Features of Registered Healthcare Products (VALKORP) \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nIndustrial Pharmacy \n\n\n\n\n\n\n\nNo Presenting Author Title \n\n\n\nIPP 01 BVS Nallamolu Solubility Enhancement and Formulation Development of \n\n\n\nAprepitant Using Self-Micro Emulsifying Drug Delivery \n\n\n\nSystem \n\n\n\nIPP 02 S Rattanakiat The Microbiological Quality of Herbal Cosmetics \n\n\n\nIPP 03 V Senthil Formulation and Characterization of Acyclovir Loaded \n\n\n\nNanostructured Lipids with Polysorbate 80 \n\n\n\nIPP 04 P Boonme Effects of Cosolvent in Water Phase on Microemulsion Regions \n\n\n\nof Nonionic Systems and Antioxidant Efficacy of Topical \n\n\n\nNicotinamide Microemulsion \n\n\n\nIPP 05 AMuhardiansyah Effect of Changes in the Characteristic of the Mixing \n\n\n\nCrystalline Atorvastatin Calcium Directly With Tween 80 (Co-\n\n\n\nCrystal) which can Increase Atorvastatin Tablet Dissolution \n\n\n\nIPP 06 Y Mardianti Effect of Pregabalin Intra and Extra Granular to Comparative \n\n\n\nDissolution Test with its Originator \n\n\n\n\n\n\n\n\n\n\n\nScientific \n\n\n\n\n\n\n\nNo Presenting Author Title \n\n\n\nSPP 01 R Oka The Hospital Formulation of Levetiracetam Suppository and \n\n\n\nEvaluation of the Pharmaceutics \n\n\n\nSPP 02 MIA Lazhari The Impact of High Dose Green Tea Polyphenol Extract and \n\n\n\nVitamin C on Blood Pressure and Renal Haemodynamics in \n\n\n\nCisplatin-Induced Renal Failure in Spontaneously Hypertensive \n\n\n\nRats \n\n\n\nSPP 03 H Amekyeh Using Marker Drugs to Study the Gastrointestinal Transit \n\n\n\nBehavior of Amphotericin B-Containing Solid Lipid \n\n\n\nNanoparticles \n\n\n\nSPP 04 AT Jacinto Comparative Antibacterial Property of the Matured Trunk and \n\n\n\nStem Bark Extract of Tamarindus Indica Linn, Preformulation, \n\n\n\nDevelopment and Quality Control of Cream \n\n\n\nSPP 05 Y Yuliandra The Hypotensive Activity of Defatted Crude Extract, Ethyl \n\n\n\nAcetate and Butanolic Fractions of Cassytha filiformis L. on \n\n\n\nPrednisone-Saline and Prednisone-Saline-L-NAME Induced \n\n\n\nHypertensive Rats: A Comparative Study \n\n\n\nSPP 06 A Ahmad Functional Contribution of \u03b11D Receptors in Renal Vasculature \n\n\n\nof Left Ventricular Hypertrophy Induced by Isoprenaline and \n\n\n\nCaffeine in Wistar Kyoto Rats \n\n\n\nSPP 07 CH Chang NMDA Receptor Antagonism in the Hippocampus Ameliorates \n\n\n\nAcute Stress Potentiation of Aggressive Behaviors in the Post-\n\n\n\nWeaning Isolation-Reared Mice \n\n\n\nSPP 08 E Uemura Improvement of Dispersibility of Fullerene C60 Derivative by \n\n\n\nPluronic F-127 and the Potential to Enhance Anti-inflammatory \n\n\n\nEffect of C60 Derivative \n\n\n\n \n\n\n\n\n\n\n\n\nSPP 09 F Hashemian Investigating Regulatory Role of Prolactin in Parental Behavior \n\n\n\nin Male Parents \n\n\n\nSPP 10 FUD Ahmad Exogenous Hydrogen Sulfide Up-Regulates the NO/eNOS \n\n\n\nSystem in Spontaneously Hypertensive Rats \n\n\n\nSPP 11 M Gazo Acute Toxicity and the In Vitro Determination of the \n\n\n\nContractile Effects on the Locally Administered Ethanolic \n\n\n\nExtract of the Leaves of Strophanthus cumingii (Apocynaceae) \n\n\n\non the Isolated Skeletal Muscle of Female Sprague-Dawley \n\n\n\nRats \n\n\n\nSPP 12 WS Hong Hydrolase Activity of Bacteria Isolated from Pristine Mangrove \n\n\n\nSoil \n\n\n\nSPP 13 HC Hung Learning Induces Sonic Hedgehog Signaling in the Amygdala \n\n\n\nWhich Promotes Neurogenesis and Long-Term Memory \n\n\n\nFormation \n\n\n\nSPP 14 RI Elina Evaluating the Potential of Buprenorphine to Reduce Relapse to \n\n\n\nMorphine/ Methamphetamine Addiction \n\n\n\nSPP 15 K Sagami Anti-Inflammatory Mechanism of C60 Pyrrolidine Tris-Acid \n\n\n\n(C60-P) on Caco-2 Cells \n\n\n\nSPP 16 KB Liew Investigation of Taste Masking Techniques for Drug Causing \n\n\n\nMucosal Irritation \n\n\n\nSPP 17 CH Khiew Effect of Bromelain from Pineapple Fruit Stem on Motility of \n\n\n\nthe Gastrointestinal Tract of the Rat \n\n\n\nSPP 18 K Tanaka Analysis of Neurological Effects After Exposure to Silver \n\n\n\nNanoparticles via Intranasal Route \n\n\n\nSPP 19 JM Muarip Formulation and Evaluation of Extended Release \n\n\n\nMicroencapsulated Mefenamic Acid Using the Oil of Cocos \n\n\n\nnucifera (Coconut Fruit) and Liquid Paraffin (50:50) as Oil \n\n\n\nPhase in Solvent Evaporation Method \n\n\n\nSPP 20 M Rahmani Investigating the Effects of Novel Wound Dressings Based on \n\n\n\nChitosan, Sodium Alginate, and Gelatin \n\n\n\nSPP 21 CW Mai Anticancer Activity and Apoptotic Induction of Chalcones \n\n\n\nagainst TRAIL Resistant Cancer Cells \n\n\n\nSPP 22 M Yamaguchi Size Effects of Gold Nanoparticles on the Tissue Distribution \n\n\n\nand Retention \n\n\n\nSPP 23 N Nishijima Amorphous Silica Nanoparticles Induce Size-Dependent \n\n\n\nInflammation \n\n\n\nSPP 24 OE Puspita Preparation and Characterization of Diclofenac Sodium Loaded \n\n\n\nSolid Lipid Nanoparticle \n\n\n\nSPP 25 PS Rajinikanth Preparation and Characterization of Water-in-Oil \n\n\n\nNanoemulsion of 5-Fluorouracil to Enhance Skin Permeation \n\n\n\nfor Treatment of Skin Diseases \n\n\n\nSPP 26 P Mittal Effects of Black Pepper on Pharmacokinetics of Glimepiride in \n\n\n\nType 2 Diabetic Rats \n\n\n\nSPP 27 VNR Lim Characterisation and Optimisation of Hydrolase-Producing \n\n\n\nBacteria Strains Isolated from Non-Pristine Mangrove Soil \n\n\n\nSPP 28 R Ishimoto The Basic Analysis for the Evaluation of Nanomaterials \n\n\n\nExcretion \n\n\n\nSPP 29 SK Verma Molecular Docking Based Screening of Natural Products as \n\n\n\nPotential Aldose Reductase Inhibitor for the Management of \n\n\n\nDiabetic Complications \n\n\n\n\n\n\n\n\nSPP 30 SA Khan Effect of Renal Denervation on the Sensitivity of \n\n\n\nCardiopulmonary Reflex Mechanism in Cisplatin-Induced \n\n\n\nAcute Renal Failure Rats \n\n\n\nSPP 31 T Mori Optimization of an Immune Method to Shorten Time for \n\n\n\nInducing High-Affinity Antibodies \n\n\n\nSPP 32 T Handa The Correlation Analysis between the Size of Silica \n\n\n\nNanoparticles and Their Acute Toxicity for Making Safer \n\n\n\nNanomaterials \n\n\n\nSPP 33 YF Tan Synthesis and Redox Potentials of Copper Dithiocarbazates \n\n\n\nComplexes as Potential Radiopharmaceuticals \n\n\n\nSPP 34 KY Tye Antimicrobial Activity of Dichloromethane Extract of \n\n\n\nTurbinaria ornate \n\n\n\nSPP 35 YJ Yu AMPA Receptor Endocytosis and NMDA Receptors in the \n\n\n\nAmygdala is Involved in the Destabilization of \n\n\n\nMethamphetamine-Associated Memory \n\n\n\nSPP 36 PP Yen Influence of Tempol and Losartan on Sensitivity of Renal \n\n\n\nVascular Responses to Adrenergic Agonists and Angiotensin II \n\n\n\nin DOCA-Salt Treated Rat Model of Hypertension \n\n\n\nSPP 37 Y Iwahara Depletion of Neutrophil Could Exacerbate Fetal Death Induced \n\n\n\nby Silica Nanoparticles \n\n\n\nSPP 38 Y Namba Transgenerational Effects of Silica Nanoparticles Focused on \n\n\n\nPaternal Exposure \n\n\n\nSPP 39 Y Nishikawa Silver Nanoparticles Induced Inflammatory Response in \n\n\n\nHuman Pulmonary Cells \n\n\n\nSPP 40 Y Takimura Distribution of Gold Nanoparticles to the Breast Milk in Mice \n\n\n\nSPP 41 V Asati Synthesis and Evaluation of Antimicrobial Activity of Some 6-\n\n\n\nChlorobenzothiazole-2-yl-hydrazones Derivatives \n\n\n\nSPP 42 B. Babu Development and Validation of a Stability Indicating RP-HPLC \n\n\n\nMethod of Pemetrexed API from Its Forced Degradation \n\n\n\nProducts \n\n\n\nSPP 43 K Sugibayashi Contribution of Hair Follicular Pathway of Topically Applied \n\n\n\nand Exposed Chemicals for the Total Skin Permeation \n\n\n\nSPP 44 M Liau The Potential of Phyla nodiflora as Chemopreventive Agent in \n\n\n\nHuman Breast Cancer Cell Line, MCF-7 \n\n\n\nSPP 45 N Dwivedi Synthesis of Amino Acid Conjugates of Dopamine for the \n\n\n\nEnhancement of Brain Targeted Delivery of Dopamine \n\n\n\nSPP 46 S Afzal Effect of Peroxisome Proliferator-Activated Receptor (PPAR) \n\n\n\nAgonist, Pioglitazone on Vasopressor Responses to Adrenergic \n\n\n\nAgonists and Angiotensin II in Diabetic and Non-diabetic \n\n\n\nSpontaneously Hypertensive Rats \n\n\n\nSPP 47 WR Wan Rosalina Tracking Cardiovascular Disease (CVD): Development of \n\n\n\nGenotyping Methods for Various Polymorphism Implicated in \n\n\n\nCVD Therapy \n\n\n\nSPP 48 YH Hsiao Social Interaction with a Helper Rescues Memory Deficit in an \n\n\n\nAnimal Model of Alzheimer\u2019s Disease by Increasing BDNF-\n\n\n\ndependent Hippocampal Neurogenesis \n\n\n\nSPP 49 SC Yang Palladium-Catalyzed Allylation of Indoles with Allylic \n\n\n\nAcetates in PEG-Water System \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nSPP 50 HJ Oh Hydrochlorothiazide and Candesartan Treatment Improves \n\n\n\nBlood Pressure, Renal Haemodynamics and Renal Function in \n\n\n\nSpontaneously Hypertensive Rats \n\n\n\n\n\n\n\n\n\n\n\nPhytopharmacy & Pharmacopeia \n \n\n\n\nNo Presenting Author Title \n\n\n\nPPP 01 CT Kumarappa Inhibitory Effects of Polyphenolic Extract of Ichnocarpus \n\n\n\nfrutescenes on Carbohydrate Digestive Enzymes \n\n\n\nPPP 02 CC Chang Acylated Flavonoids as \u03b1-Glucosidase Inhibitors from \n\n\n\nTinospora crispa Leaf \n\n\n\nPPP 03 M Taher Antinociceptive Effects of Alkaloids Rich Fraction of Aidia \n\n\n\ndensiflora in Mice \n\n\n\nPPP 04 J Wannachot Inhibitory Effect of Some Herbal Extracts against \n\n\n\nStreptococcus mutans \n\n\n\nPPP 05 H Balakrishnan In vitro Antibacterial Effects of Alteranthera sessilis Leaves \n\n\n\nExtracts on Common Bacteria Associated with Wound \n\n\n\nInfections with Emphasis on Methicillin-Resistant \n\n\n\nStaphylococcus aureus \n\n\n\nPPP 06 MJ Siddiqui Chemometric Analysis of Labisa pumila (Kacip Fatimah) \n\n\n\nVariants by Fourier Transform Infrared (FT-IR) Spectroscopy \n\n\n\n\n\n\n\n\n\n\n\nPharmacy Education and Student Affairs \n \n\n\n\nNo Presenting Author Title \n\n\n\n\n\n\n\nPEP 01 A Hidayati Analysis of Student Satisfaction on Service Quality in the \n\n\n\nFaculty of Pharmacy Universitas Ahmad Dahlan Yogyakarta \n\n\n\nPEP 02 E Chang Fun Competition of Public Education on Drug Use Safety \n\n\n\nPEP 03 S.Karthiyayini Breat Cancer Knowledge and Attitude, Self-efficacy and \n\n\n\nPractice of Screening Methods Among Female Students in a \n\n\n\nPrivate University \n\n\n\nPEP 04 ML Tsai Student's Perception of Objective Structured Clinical \n\n\n\nExamination (OSCE) among Taiwan Pharmacy Students \n\n\n\nPEP 05 P Boonmuang Needlestick Injuries among Six-Year Pharm D Students during \n\n\n\nPharmaceutical Care Clerkships: A Survey Study \n\n\n\nPEP 06 WZW Sazrina The Roles of Clinical Pharmacists: Knowledge and Perceptions \n\n\n\nof Malaysian Medical Students Receiving Education in Various \n\n\n\nCountries \n\n\n\nPEP 07 MTA Rashidi  Knowledge about Sexual Transmitted Disease (STD) Among \n\n\n\nCUCMS Medical and Pharmacy Students and in Comparison \n\n\n\nwith Public in Putrajaya and Cyberjaya \n\n\n\nPEP 08 PI Chen The Analysis of the Training Effectiveness of Professional \n\n\n\nSeminar Performed By Post-Graduated Year Pharmacists \n\n\n\nPEP 09 AK Mohd Tahir Dispensing Separation Policy:  Attitudes of Future Physicians \n\n\n\nand Pharmacists For Inter-Professional Collaboration \n\n\n\n\n\n\n\n\nPEP 10 MZ Baharuddin To Validate the Scale of Attitudes Towards Physician-\n\n\n\nPharmacist Collaboration (SATP2C) Questionnaire on Medical \n\n\n\nand Pharmacy Students   \n\n\n\nPEP 11 F Muthalib The Impact of Facebook on the Academic Performance among \n\n\n\nPharmacy Students of International Islamic University \n\n\n\nMalaysia Kuantan \n\n\n\nPEP 12 H-C Chou Continuing Education for Young Pharmacists in Taiwan: the \n\n\n\nExperience from Taiwan Young Pharmacists\u2019 Group \n\n\n\nPEP 13 S Simansalam Integrated Behaviour Model and Pharmacy Students Intention \n\n\n\nto Provide Smoking Cessation Counselling \n\n\n\n\n\n\n\n\n\n\n\nPharmaceutical Legislation, Ethics and Regulatory Affairs \n  \n\n\n\nNo Presenting Author Title \n\n\n\nPLP 01 N Jinachai ASEAN Harmonisation; Compliance of Cosmetics Regulatory \n\n\n\nScheme in Thailand within 5 Years  \n\n\n\nPLP 02 YT Hong Reducing Medication Supplementing Errors by a Quality \n\n\n\nImprovement Program \n\n\n\nPLP 03 CYS Ting Public Accessibility and Preference Towards Media Channels \n\n\n\nin Delivering Drug-Related Information:  Comparison of Urban \n\n\n\nand Rural Pupulation in Sarawak \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nEmergency Medicine and Others \n \n\n\n\nNo Presenting Author Title \n\n\n\nEMP 01 MA Adnan The Haiyan Super Typhoon in Philippines: Malaysian \n\n\n\nMilitary Pharmacist Experience \n\n\n\n \n\n\n\n\n\n\n\n\nHOSPITAL AND CLINICAL PHARMACY \n \nHPP 01 \n\n\n\nFAPA2014000067 (Poster) \n\n\n\n\n\n\n\nThe Antibiotic Resistance among Serogroups of Non-Typhoidal Salmonella \n\n\n\n\n\n\n\nPI Chen\n1, 3\n\n\n\n, SC Ke\n2\n, YC Hung\n\n\n\n1, 3\n, CM Chen\n\n\n\n2\n \n\n\n\n1\nPharmacy Department of Tungs\u2019 Taichung MetroHarbor Hospital, Taichung, Taiwan  \n\n\n\n2\nInfection Control Committee of Tungs\u2019 Taichung MetroHarbor Hospital, Taichung, Taiwan  \n\n\n\n3\nTaichung County Pharmacist Association, Taiwan \n\n\n\n\n\n\n\nThe salmonella are divided into over 50 serogroups based on somatic (O) antigens present. The most \n\n\n\ncommon O-antigen serogroups are A, B, C, D and E. Strains in these serogroups cause approximately \n\n\n\n99% of salmonella infections in humans. The earlier drugs chloramphenicol, trimethoprim-\n\n\n\nsulfamethoxazole and ampicillin could be used for salmonellosis treatment. However, resistance to \n\n\n\nthese drugs has increased significantly in recent years. Fluoroquinolones have been recommended for \n\n\n\nthe treatment of salmonella infections for adults and third generation cephalosporins are the drugs of \n\n\n\nchoice to treat very young patients or when fluoroquinolone resistance is present. The present study \n\n\n\ndescribes the antibiotic resistance of ciprofloxacin, ceftriaxone and other commonly used antibiotics \n\n\n\namong serogroups of non-typhoidal Salmonella isolates. During 2010 to 2013, the non-duplicated \n\n\n\nnon-typhoidal Salmonellas were isolated from the patients. Antibiotic susceptibility was performed by \n\n\n\nthe disc diffusion method according to the criteria of NCCLS. Statistical analysis for comparison of \n\n\n\ndata on resistance was done by the Chi-square and Fisher`s test. Of 458 strains of non-typhoidal \n\n\n\nSalmonella were isolated from the patients. Overall antibiotic resistance among the strains belonging \n\n\n\nto serogroup B(72.5%) was significantly higher than serogroup C1(46.9%), serogroup non-\n\n\n\nC1(26.4%), serogroup D1(42.0%) and serogroup F or G(28.0%) (P\u22640.007). All the resistance trains to \n\n\n\nciprofloxacin were belonging to serogroup B. Resistance to nalidixic acid were significantly more \n\n\n\ncommon among the strains belonging to serogroup B and non-C1. It is demonstated that the \n\n\n\nassociation between nalidixic acid-resistance and reduced susceptibility to ciprofloxacin among the \n\n\n\nSalmonella Typhi isolates, and nalidixic acid-resistance might be an indication of decreased \n\n\n\nsusceptibility to ciprofloxacin. In our study the resistance rate of serogroups B to ciprofloxacin was \n\n\n\n8.8% but to nalidixic acid was 29.4%. Obviously, the resistance of salmonella strains to ciprofloxacin \n\n\n\nhas been underestimated. \n\n\n\n\n\n\n\n\n\n\n\nHPP 02 \n\n\n\nFAPA2014000083 (Poster) \n\n\n\n\n\n\n\nSurvey of Hospital Pharmacists Monitoring and Assessment of Adverse Drug Reactions from \n\n\n\nNon-Steroidal Anti-Inflammatory Drugs  \n\n\n\n\n\n\n\nP Phueanpinit\n1\n, N Jarernsiripornkul\n\n\n\n1\n, J Pongwecharak\n\n\n\n2\n, J Krska\n\n\n\n3 \n\n\n\n1\nDepartment of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Khon Kaen University, Khon \n\n\n\nKaen, Thailand \n2\nFaculty of Pharmacy, Thammasat University, Rangsit Center, Pathumthani, Thailand \n\n\n\n3\nMedway School of Pharmacy, Universities of Greenwich and Kent, Kent, United Kingdom \n\n\n\n\n\n\n\nMonitoring and assessment of potential adverse drug reactions (ADRs) are important keys in \n\n\n\nevaluating the safety and benefit of drug treatment. The present study aimed to explore the roles of \n\n\n\nhospital pharmacists in ADR monitoring, including methods used and information sources for ADR \n\n\n\nassessment. This study was a cross-sectional survey. A total of 761 pharmacists, working in 287 \n\n\n\nhospitals in North-eastern Thailand, were selected by stratified random sampling in general hospitals \n\n\n\nand community hospitals, but all tertiary hospitals were included. Self-administered questionnaires \n\n\n\n\n\n\n\n\nwere sent by post, followed by postcard reminders to nonrespondents. The response rate was 54.8% \n\n\n\n(n=417). Pharmacists commonly reported patients\u2019 experiences of gastrointestinal irritation (71.5%) \n\n\n\nfor gastrointestinal system, high blood pressure (35.9%) for cardiovascular system, and renal \n\n\n\nimpairment (39.3%) for renal system. The common methods of ADR detection and assessment by \n\n\n\npharmacists were as followed: asking patients whether they experienced any ADR symptoms \n\n\n\n(98.8%), checking patients\u2019 physical examination (24.5%), and their levels of serum creatinine \n\n\n\n(19.9%) from medical records. Most pharmacists (95.0%) assessed ADRs by themselves, in which the \n\n\n\nNaranjo\u2019s algorithm was frequently used (85.8%). However, some pharmacists referred their patients \n\n\n\nto doctors for check-up (46.6%) or to ADR specialised pharmacists for further evaluation (35.8%). \n\n\n\nPharmacists working in community hospitals were more likely to ask patients (98.7% vs 89.3%, \n\n\n\np<0.001) and refer them to doctors (58.3% vs 36.9%, p=0.004) than those in tertiary hospitals. \n\n\n\nRegarding ADR assessment, the Drug Information Handbook (94.2%) and Micromedex (31%) were \n\n\n\nthe most frequently used sources of information. Hospital pharmacists often screened potential ADRs \n\n\n\nby asking patients about ADR symptoms experienced. Further investigations through the use of \n\n\n\nclinical parameters were uncommon. ADR assessment was commonly performed by using \n\n\n\nstandardized assessment tools and reliable information sources. \n\n\n\n\n\n\n\n\n\n\n\nHPP 03 \n\n\n\nFAPA2014000242 (Poster) \n\n\n\n\n\n\n\nImprovement of Repackage Labeling of the Drugs in Pharmacy Unit: Somdech Phra \n\n\n\nDebaratana Medical Center Experience \n\n\n\n\n\n\n\nP Supapsophon, S Noikaew, P Plibai \n\n\n\nPharmacy services, Somdech Phra Dhebaratana Medical Center, Thailand \n\n\n\nFaculty of Medicine, Ramathibodi hospital, Bangkok, Thailand \n\n\n\nAt present many drugs from manufacturers are available in bulk bottles. Repacking into smaller \n\n\n\nquantity is a big job in pharmacy unit of busy hospital. Repack and labelling in advance will shorten \n\n\n\npatient waiting time. In the past, the labelling process was done by using handlabeler. This caused \n\n\n\nseveral disadvantages such as no lot number indicated, and error in drug name and expiry date. The \n\n\n\naim of this study is to find out the better labelling process. Present study was conducted at outpatient \n\n\n\npharmacy unit of SDMC. We design software for make the right and limit number of labels, and \n\n\n\ncontain essential information according to good practice standard. The contents in repackage labelling \n\n\n\nsticker are drug name, strength, Lot No., quantity, packing date, expiry date, and location. The \n\n\n\nsoftware produces summary report daily and monthly. We started to use this program from early \n\n\n\n2012. Since 2012-2013, 57 items of drugs were repacked. The number of drug under repacking and \n\n\n\nlabelling process was over 48 million tablets. No error on the labelled description produced by the \n\n\n\nsoftware was founded. The new label process has many advantages including 1) eliminate errors in \n\n\n\ndrug name and expiry date labelling, 2) produce complete label and report, 3) help detect counting \n\n\n\nmachine defects, 4) reduce working time, 5) be able to indicate dispensary room, and 6) be able to \n\n\n\ntrace back if the medicine is reported product problem. The new labelling process achieves more \n\n\n\nquality and safety of drug used. The process has been expanded to the nearby pharmacy units. In the \n\n\n\nfuture, we plan to expand to hospital production unit. \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nHPP 04 \n\n\n\nFAPA2014000247 (Poster) \n\n\n\n\n\n\n\nSafety and Efficacy of Basal-Bolus and Premixed Insulin Intensification Regimens in the \n\n\n\nManagement of Type 2 Diabetes Mellitus: A 13-Year Narrative Review of Literature. \n\n\n\n\n\n\n\nNI Penwalla\n1\n, O Noordin\n\n\n\n2\n, MN Norilyani\n\n\n\n1\n, NN Fatnoon\n\n\n\n3\n \n\n\n\n1\nKulliyyah of Pharmacy, International Islamic University Malaysia  \n\n\n\n2\nDepartment of Clinical and Hospital Pharmacy, College of Pharmacy, Taibah University, Saudi \n\n\n\nArabia \n3\nKulliyyah of Medicine, International Islamic University Malaysia \n\n\n\nType 2 Diabetes Mellitus (T2DM) is a chronic condition due to insulin resistance or relative insulin \n\n\n\ndeficiency. Although insulin intensification regimens are commonly prescribed for the management \n\n\n\nof T2DM, there is uncertainty regarding their optimal use. We conducted a 13 Year narrative review \n\n\n\nto compare outcomes of these regimens in the treatment of T2DM.  We searched electronic databases \n\n\n\n(PubMed, Scopus, Proquest and Google Search), and \u201cgrey literature\u201d from January 2000 to \n\n\n\nDecember 2013 to identify studies comparing insulin intensification regimens. Out of 17 studies \n\n\n\nidentified, we only included 10 studies specifically comparing Basal-Bolus regimens (BB) versus \n\n\n\nPremixed Insulin Regimens (PM). Seven trials comparing regimens other than the studied regimens; \n\n\n\nwith study duration lesser than 12 weeks; or involving Type 1 diabetes mellitus patients were \n\n\n\nexcluded. The outcomes measured were divided into safety and efficacy parameters. Among the \n\n\n\nsafety parameters measured were Hypoglycaemia, Weight Gain, Quality of Life (QoL), and other \n\n\n\nAdverse Events (AE). Whereas, efficacy parameters measured were Glycosylated Haemoglobin \n\n\n\n(HbA1c), Fasting Plasma Glucose, Daily Plasma Glucose, Post Prandial Plasma Glucose, Carotid \n\n\n\nIntima Media Thickness (IMT), Adinopectin Level, 1,5-anhydroglucitol (1,5-AG), Total Daily Insulin \n\n\n\n(TDI) Dose and Cost. Mixed results were discovered among all the parameters measured favouring in \n\n\n\nbetween BB and PM regimens. We found that BB regimens showed better glycaemia control \n\n\n\nespecially in terms of primary endpoint of HbAlc but at the expanse of significantly higher TDI dose, \n\n\n\nweight gain, and further increase in cost of treatment. Whereas, all other parameters measured were \n\n\n\ncomparable between regimens. Locally, conventional human insulin is still the mainstay of therapy in \n\n\n\nhealth facilities nationwide. Yet, none of the reviewed studies were fully conducted locally nor \n\n\n\ncompared human insulin in both arms. Thus, this review highlights the need and relevancy of future \n\n\n\nresearches comparing non-analogue insulin intensification regimens, locally. \n\n\n\n\n\n\n\n\n\n\n\nHPP 05 \n\n\n\nFAPA2014000108 (Poster) \n\n\n\nPharmaceutical Care for Children with Type 1 Diabetes, Buddhachinaraj Hospital, \n\n\n\nPhitsanulok, Thailand \n\n\n\nR Pannarunothai, K Nakariyakul \n\n\n\nDepartment of Pharmacy, Buddhachinaraj Hospital, Phitsanulok, Thailand \n\n\n\nType 1 diabetes is a long-term condition requiring intensive daily self-management, high-quality \n\n\n\neducation and training is essential. Among children with established type 1 diabetes, ketoacidosis and \n\n\n\nsevere hypoglycaemia are potentially avoidable if exogenous insulin is administered appropriately. \n\n\n\nProviding pharmaceutical care for children with type 1 diabetes includes comprehensive diabetic care, \n\n\n\nindividual counselling concerning motivational aspects, psychosocial problems, coping strategies and \n\n\n\npatient education camp could help children manage their diabetes and live better. Aim of the study \n\n\n\nwas to determine the impact of providing pharmaceutical care on glycaemia control and hospital \n\n\n\nadmission with acute complication (ketoacidosis and severe hypoglycaemia)  in children with type 1 \n\n\n\ndiabetes. A twelve-month prospective study was conducted from October 2012 to September 2013. \n\n\n\n\n\n\n\n\nThirty-six patients with type 1 diabetes were included in present study. The mean age at diagnosis was \n\n\n\n9.2+3.3. Mean HbA1c was 9.56+2.3 and only 8 children had HbA1c close to target. In study period \n\n\n\n(Oct1, 2012-Sept 30, 2013), three cases of hospital admission were found, one from ketoacidosis and \n\n\n\ntwo from severe hypoglycaemia.  All patients could correctly use insulin injection and do home \n\n\n\nmonitoring blood glucose. Twenty- two patients with their families had participated in yearly \n\n\n\neducation camp. In conclusion, this study demonstrates providing pharmaceutical care for children \n\n\n\nwith type 1 diabetes could help patients and their families understand how to self-manage their \n\n\n\ndiabetes. However, the way to control glucose level should be improved. \n\n\n\n\n\n\n\nHPP 06 \nFAPA2014000106 (Poster) \n\n\n\n\n\n\n\nValidation of the Simplified Chinese Version of the Malaysian Medication Adherence Scale \n\n\n\n(MALMAS) on Elderly Patient  \n\n\n\n\n\n\n\nYW Shim\n1,2\n\n\n\n, SS Chua\n2\n, YC Siow \n\n\n\n3  \n\n\n\n1\nDepartment of Pharmacy, Duchess of Kent Hospital, Sandakan, Sabah, Malaysia \n\n\n\n2\nDepartment of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia \n\n\n\n3\nDepartment of Palliative Medicine, Selayang Hospital, Selangor, Malaysia \n\n\n\n\n\n\n\nPoor medication adherence is a common concern among elderly patients. However, there is currently \n\n\n\nno gold standard for assessing medication adherence. Therefore, this study aimed to examine the \n\n\n\npsychometric properties of the Simplified Chinese version of the Malaysian Medication Adherence \n\n\n\nScale (MALMAS). MALMAS consists of 8 items which measures one domain. It was translated into \n\n\n\nSimplified Chinese version and validated on a convenience sample of 100 elderly outpatients in a \n\n\n\npublic hospital in East Malaysia. Data was collected from April to June 2013. Internal consistency of \n\n\n\nthe MALMAS was evaluated based on Cronbach\u2019s alpha value. A retest was conducted a month later \n\n\n\nto assess its stable reliability. Validity was assessed using convergent validity by comparing \n\n\n\nMALMAS to the Simplified Chinese translation of Morisky Medication Adherence Scale (MMAS-8) \n\n\n\nand criterion validity was confirmed by comparing the levels of medication adherence measured using \n\n\n\nMALMAS with pill count. MALMAS has an acceptable internal consistency with Cronbach\u2019s alpha \n\n\n\nof 0.586 and a test-retest correlation of 0.405 (p<0.001), indicating fair correlation. A good correlation \n\n\n\nbetween MALMAS and the Simplified Chinese version of MMAS-8 was found (Spearman\u2019s rho = \n\n\n\n0.717; p<0.001). A significant association between levels of medication adherence based on the \n\n\n\nMALMAS and pill count was observed (p=0.011). The MALMAS has a sensitivity and specificity of \n\n\n\n80% and 67.3%, respectively, with positive and negative predictive values of 33.3% and 94.3%, \n\n\n\nrespectively. The Simplified Chinese version of MALMAS is a reliable and valid instrument for \n\n\n\nmeasuring the medication adherence of elderly patient with good sensitivity and specificity. \n\n\n\n\n\n\n\n\n\n\n\nHPP 07 \n\n\n\nFAPA2014000117 (Poster) \n\n\n\nAdherence to Sitagliptin Using Medication Possession Ratio (MPR) and Its Effects on \n\n\n\nGlycaemic Control \n\n\n\n\n\n\n\nRM Dallumal\n1\n, SS Chua\n\n\n\n1\n, DWB Chia\n\n\n\n2\n, SRD Benjamin\n\n\n\n3 \n\n\n\n1\nDepartment of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia \n\n\n\n2\nSchool of Pharmacy, Monash University Sunway Campus, Subang Jaya, Malaysia \n\n\n\n3\nDepartment of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia \n\n\n\n\n\n\n\nThis study was conducted to assess the adherence and one-year persistence of type 2 diabetes patients \n\n\n\nto sitagliptin, and its association with glycaemic levels. This retrospective study was conducted in a \n\n\n\nmajor teaching hospital in Malaysia. Medication refill data were obtained from the pharmacy \n\n\n\n\n\n\n\n\ninformation system for a one-year period and both patients\u2019 persistence and adherence was calculated \n\n\n\nfor the first six months and the next 7 to 12 months. Patients with medication possession ratio (MPR) \n\n\n\nof at least 80% were deemed to be adherent. Possible association between adherence to sitagliptin and \n\n\n\npatients\u2019 glycated haemoglobin (HbA1c) values was analysed for the same period of time. Amongst \n\n\n\nthe 420 patients included in this study, 73.1% were persistence on sitagliptin for at least one year. \n\n\n\nHowever, only 55.5% of the patients were adherent to sitagliptin during this one year. A higher \n\n\n\npercentage of patients achieved the targeted MPR of 80% or more during the first six months (62.1%) \n\n\n\nthan the latter six months (50.5%). A significant association was found between adherence to \n\n\n\nsitagliptin and the achievement of target HbA1c of less than 7% (p=0.008). Patients who were adherent \n\n\n\nwere two times more likely to achieve HbA1c of less than 7% compared to patients who were non-\n\n\n\nadherent (Odds ratio, OR=2.11; 95% confidence interval, CI = 1.21-3.68). Only 50% of the patients \n\n\n\nwere adherent to sitagliptin although more than 70% were persistent over a one-year period. Poor \n\n\n\nmedication adherence was significantly related to lower achievement of HbA1c less than 7%. \n\n\n\n\n\n\n\n\n\n\n\nHPP 08 \n\n\n\nFAPA2014000198 (Poster) \n\n\n\n\n\n\n\nAsthma Control of Adults in Public Health Clinics: Preliminary Results  \n\n\n\n\n\n\n\n LY Wong\n1,2\n\n\n\n, SS Chua\n1\n, A Hanisah\n\n\n\n3\n, B Noor Azwin\n\n\n\n4\n, PP Cher\n\n\n\n3 \n\n\n\n1\nDepartment of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia \n\n\n\n2\nMaharani Health Clinic, Muar, Johor, Malaysia \n\n\n\n3\nBakri Health Clinic, Muar, Johor, Malaysia \n\n\n\n4\nPayamas Health Clinic, Ledang, Johor, Malaysia \n\n\n\n\n\n\n\nAlthough guidelines are available for the management of asthma worldwide, this disease is still poorly \n\n\n\nmanaged in many countries. Several studies showed high prevalence of symptoms and low level of \n\n\n\nasthma control among patients in Europe, the United States, Australia and Asia Pacific region. The \n\n\n\naim of this study was to assess the level of asthma control in adults. This study constituted the \n\n\n\nbaseline data obtained from a randomised controlled trial (RCT) on a Pharmacy Management Service \n\n\n\nprovided to asthma patients. Participants were recruited from April 2014 to July 2014. Two \n\n\n\ngovernment health clinics from Muar and another two from Ledang were selected as the study sites by \n\n\n\nusing proportionate stratified randomisation based on patient workload. Participants were recruited \n\n\n\nbased on convenience sampling. Any asthma patient who seek treatment at the study sites and met the \n\n\n\ninclusion criteria, was recruited. Asthma control was assessed using the Asthma Control Test (ACT) \n\n\n\nwhile the medication adherence was evaluated using the Malaysian Medication Adherence Scale \n\n\n\n(MALMAS). A total of 91 participants were recruited. Only 31.9% of the participants have controlled \n\n\n\nasthma, while partly controlled and uncontrolled asthma accounted for 34.05% and 34.05%, \n\n\n\nrespectively. The mean (standard deviation, SD) inhaler technique score was 3.8 (1.5), which is \n\n\n\nconsidered as incorrect technique. The mean (SD) medication adherence score was 4.9 (1.7), which \n\n\n\nindicates low adherence while the mean (SD) knowledge score was 55.6 (22.0)%. In addition, the \n\n\n\nmean (SD) PEFR was 269.8 (91.64), which seemed much lower than the expected PEFR. In \n\n\n\nconclusion, the baseline results show that asthma is poorly managed in both districts. The asthma \n\n\n\ncontrol level, inhaler techniques and medication adherence of asthma patients were low, with poor \n\n\n\nknowledge of asthma medications. Further research is warranted to investigate the effects of a \n\n\n\npharmacy management service on asthma patients. \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nHPP 09 \n\n\n\nFAPA2014000243 (Poster) \n\n\n\nCo-Prescribing of Gastroprotective Agents with Nonsteroidal Anti-Inflammatory Drugs in a \n\n\n\nTertiary Hospital: Preliminary Results \n\n\n\nHL Lee\n1\n, SS Chua\n\n\n\n1\n, S Mahadeva\n\n\n\n2\n \n\n\n\n1\nDepartment of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia \n\n\n\n2\nDepartment of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia \n\n\n\n\n\n\n\nThe need for gastroprotective agents (GPAs) in managing nonsteroidal anti-inflammatory drug \n\n\n\n(NSAID)-induced gastrointestinal adverse effects has been widely recommended in clinical \n\n\n\nguidelines. However, the utilization of GPAs is still suboptimal in most countries. Therefore, the \n\n\n\npresent study aimed to investigate the co-therapy of GPAs with NSAIDs in Malaysia. A prospective \n\n\n\ncohort study was conducted in the outpatient pharmacy of University Malaya Medical Centre. Patients \n\n\n\nwho filled their NSAID prescriptions to be taken on a regular basis, for a minimum of two weeks, \n\n\n\nwere recruited via convenience sampling. Data was collected via interviews and the occurrence of \n\n\n\ndyspepsia was assessed using the Modified Leeds Dyspepsia Questionnaire. Participants were \n\n\n\nfollowed-up via telephone interviews for the duration of their prescribed NSAIDs or up to three \n\n\n\nmonths. By July 2014, 205 patients had been recruited. The mean age (standard deviation) of the \n\n\n\nparticipants was 51.5 (14.4) years, and comprised of 58.5% females. In terms of ethnicity, there were \n\n\n\nMalays (46.3%), Indian (32.7%), Chinese (19.5%) and others (1.5%). In addition, 18% of the \n\n\n\nparticipants were found to have dyspepsia at baseline. The most common NSAIDs prescribed were \n\n\n\ndiclofenac sodium (98 participants; 47.8%), followed by celecoxib (63 participants; 30.7%), \n\n\n\nmeloxicam (29 participants; 14.1%) and etoricoxib (13 participants; 6.3%). Two of the participants \n\n\n\nreceived a combination of two NSAIDs: diclofenac sodium plus meloxicam, and diclofenac sodium \n\n\n\nplus indomethacin. The co-prescription of GPAs was low (10.2%), with mainly standard-dose \n\n\n\nranitidine and omeprazole. There were also two prescriptions with magnesium trisilicate. Of those co-\n\n\n\nprescribed with GPAs, 19% did not cover the entire duration of the NSAID use.  In conclusion, the \n\n\n\nrate of co-prescribing of GPAs with NSAIDs was low. However, further study should also assess the \n\n\n\nrisk factors of the patients on NSAIDs to ensure that GPAs are used appropriately. \n\n\n\n\n\n\n\n\n\n\n\nHPP 10 \n\n\n\nFAPA2014000244 (Poster) \n\n\n\n\n\n\n\nUnclaimed Prescriptions at the Outpatient Pharmacy of a Teaching Hospital  \n\n\n\n\n\n\n\nSM Junoh\n1\n, SS Chua\n\n\n\n1\n, A Aris\n\n\n\n2\n, KS Law\n\n\n\n2\n, SL Lim\n\n\n\n2\n \n\n\n\n1\nDepartment of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia \n\n\n\n2\nPharmacy Department, University Malaya Medical Centre, Kuala Lumpur, Malaysia   \n\n\n\n\n\n\n\nNon-adherence to medications is a common phenomenon that limits the effectiveness of prescription \n\n\n\nmedications. Most studies focused on secondary non-adherence where the prescriptions were not \n\n\n\nrefilled on time or when patients discontinued their medications whereas, primary non-adherence \n\n\n\noccurred when filled prescriptions were not claimed by the patients. Primary non-adherence is not \n\n\n\ncommonly studied and hence, the aim of this study was to investigate the incidence of unclaimed \n\n\n\nprescriptions at the pharmacy of a teaching hospital. This prospective study was conducted from April \n\n\n\nto May 2014 at the Outpatient Pharmacy of University Malaya Medical Centre. All unclaimed \n\n\n\nelectronic prescriptions were screened at the end of each working day. Patients\u2019 particulars were \n\n\n\nobtained from the prescriptions, as well as from the pharmacy information system (PIS) and electronic \n\n\n\nHealth Records (eHR). Unclaimed prescriptions were classified into two groups: prescriptions for \n\n\n\nacute and chronic conditions. A total of 15,765 electronic prescriptions were received by the \n\n\n\npharmacy for a 38-day working days. A total of 500 prescriptions (3.2%) were not claimed that is, an \n\n\n\naverage of 13.2 unclaimed prescriptions per day. Females comprised of 54.8% of those who did not \n\n\n\n\n\n\n\n\nclaim their prescriptions. The unclaimed prescriptions comprised of 59.8% acute medications and an \n\n\n\naverage of 2.4 medications per prescription. Further studies should determine the reasons for patients \n\n\n\nnot claiming their prescription so that appropriate strategies can be implemented to address or \n\n\n\nminimise such problem. \n\n\n\n\n\n\n\n\n\n\n\nHPP 11 \n\n\n\nFAPA2014000278 (Poster) \n\n\n\n\n\n\n\nThe Analysis of the Different Treating Dosage Regimen of Inhaled Colistin Methanesulfonate in \n\n\n\nTreating the Acinetobacter Baumanni Pneumonia \n\n\n\n\n\n\n\nRW Zhang\n1,2\n\n\n\n, PI Chen\n1,2\n\n\n\n, PL Chen\n1,2 \n\n\n\n1\nPharmacy Department of Tungs\u2019 Taichung MetroHarbor Hospital, Taichung, Taiwan  \n\n\n\n2\nTaichung County Pharmacist Association, Taiwan \n\n\n\n\n\n\n\nAcinetobacter baumanii (AB) and Multidrug-resistant Acintobacter baumanni (MDRAB) from the \n\n\n\nrespiratory secretions posed a great challenge for infection control. Colistin mehanesulfonate (CMS) \n\n\n\nwas the drug of choice of MDRAB. To maximize target concentration, we tried to find the least toxic \n\n\n\nand the most effect dosage of inhaled CMS to treat MDRAB pneumonia. Patients who were admitted \n\n\n\nduring January to August 2011 and had sputum culture of AB or MDRAB and treated with inhaled \n\n\n\nCMS were included. People who received intravenous CMS only and those who received CMS \n\n\n\ninhalation < 3 days were excluded. We defined the day of first isolation of AB or MDRAB as index \n\n\n\nday and at least 2 consecutive cultures revealed no growth in 7 days as early eradication. Clinical \n\n\n\noutcomes were assessed by SPSS. We enrolled 113 cases (79 men and 34 women) including 16 cases \n\n\n\nof 2 million international units (IU) (=160 mg CMS) daily, 94 cases of 4 IU daily and 6 cases of 6 IU \n\n\n\ndaily. The early eradication rates of the three groups were 81.25%, 91.49% and 33.33%. We traced \n\n\n\none month from the index day to record as the recurrence rate. The recurrence rates of the three \n\n\n\ngroups were 25%, 11.70% and 66.67%. The MDRAB rates were 93.75%, 90.43%, and 66.6%. The \n\n\n\nrenal failure cases during drug usage time were only recorded 2 cases in 2 IU group and 6 cases in 4 \n\n\n\nIU group. No neurotic adverse effect was recorded. We analyze 2 IU and 4 IU groups by Chi-Square \n\n\n\nanalysis and there no significant between these two groups. We found the inhaled CMS might be \n\n\n\nanother choice of eradication AB pneumonia. However, inhaled daily CMS dosage of 4 IU might \n\n\n\nhave lower recurrence rate. \n\n\n\n\n\n\n\n\n\n\n\nHPP 12 \nFAPA2014000195 (Poster) \n\n\n\n\n\n\n\nThe Impact of Imipenem Shortage for the Clinical Utility of Anti-Pseudomonal Carbapenems: \n\n\n\nA Cross Sectional Analysis \n\n\n\n\n\n\n\nS Ruengsawad, N Jangkong\n \n\n\n\nDepartment of Pharmacy, Ratchaburi Hospital, Thailand \n\n\n\n\n\n\n\nAnti-pseudomonal carbapenem, imipenem and meropenem, have played an important role in \n\n\n\nnosocomial infection treatment. To improve the use of carbapenems, several initiatives should be \n\n\n\nconsidered, increase awareness about appropriate treatment and cost containment issues. In our \n\n\n\nsetting, meropenem is more economical than imipenem and imipenem was withdrawn from the \n\n\n\nhospital formulary and replaced by generic meropenem. Thus, this study is to assess the impact of the \n\n\n\nimipenem shortage on the clinical use and costs of alternative anti-pseudomonal carbapenem \n\n\n\nantibiotics. A retrospective cohort study of critically ill patients with infections diagnosed in medical \n\n\n\nwards, Ratchaburi Hospital, between May 2012 - May 2014 was undertaken.  The mortality and \n\n\n\nbacteriological eradication rate was evaluated over the first 14 days of treatment in comparable \n\n\n\nbetween those receiving imipenem and meropenem treatment. Cost containment of anti-pseudomonal \n\n\n\n\n\n\n\n\nin medical ward between 2 periods was compared. For clinical evaluation, the treatment of 112 was \n\n\n\nevaluable for clinical and bacteriological efficacy. The duration of antibiotic treatment was 13.19 +/- \n\n\n\n5.9 days and 11.3 +/- 4.74 days (mean +/- SD) for meropenem and imipenem respectively. 26 \n\n\n\n(46.42%) and 30 (53.5%) patients were receiving assisted ventilation and innotropic agents for \n\n\n\nmeropenem and imipenem. Among patients who survived to 14 days, survival rate were similar, \n\n\n\n98.2% vs 94.6% for meropenem and imipenem respectively but bacteriological rate were significantly \n\n\n\ndifference, 78.5% for meropenem and 92% for imipenem. For economical issues, there was \n\n\n\ndramatically significant increase in the consumption of meropenem in medical ward with definitive \n\n\n\ninterruption of imipenem supply. These shifts were associated with significantly higher overall costs, \n\n\n\n4,008,691 vs 5,754,112 Bath, before and after imipenem withdrawal respectively. Imipenem shortage \n\n\n\nhad no impact for clinical outcomes.  For cost containment issues, an interruption of medication \n\n\n\nshould be use with caution as alternative policy. \n\n\n\n\n\n\n\n\n\n\n\nHPP 13 \n\n\n\nFAPA2014000269 (Poster) \n\n\n\n\n\n\n\nTrend of Drug Utilization Pattern with the Anatomical Therapeutic Chemical (ATC) \n\n\n\nClassification in a Tertiary Teaching Hospital from 2006 To 2013 \n\n\n\n\n\n\n\nSY Liang, YJ Hung, MF Lin \n\n\n\nDepartment of Pharmacy, E-Da Hospital, Taiwan \n\n\n\n\n\n\n\nIn facing medical progress and finial imbalance of National Health Insurance (NHI), controlling the \n\n\n\ngrowth of pharmaceutical expenditures is a major challenge issue. In this study, we aim to know the \n\n\n\ntrends of drug utilization pattern with the anatomical therapeutic chemical classification in a tertiary \n\n\n\nteaching hospital in southern Taiwan. We evaluate the percentage of cost of drugs in total medical \n\n\n\ncost 2006 to 2013. And we use the anatomical therapeutic chemical classification to know the trend of \n\n\n\ndrug utilization in the study period. The proportion of NHI expenses on pharmaceuticals was \n\n\n\nincreased from 24.2% (820 million TWD) to 29.2% (152 million TWD) (P<.001). The proportion of \n\n\n\nself-paid drug expenses was changed from 11.0% (70 million TWD) to 8.6% (100 million TWD) \n\n\n\n(P=0.112) The 3 highest expenses on pharmaceuticals in ATC subgroups (therapeutic subgroup) were \n\n\n\ndetermined in 2013. Antineoplastic agents was highest (23.1%), followed by antibacterial agents \n\n\n\n(9.8%) and antiviral agents (7.5%).The trend of expenses of antineoplastic agents significantly \n\n\n\nincreased between 2006 and 2013 (P<.001). Using ATC code (chemical substance), the 3 highest \n\n\n\nexpenses on pharmaceuticals was sorafenib (3.0%), gefitinib (2.1%) and piperacillin/tazobactam \n\n\n\n(1.9%). Among expenses on pharmaceuticals in antineoplastic agents in 2013, protein kinase \n\n\n\ninhibitors was highest (33.7%), followed by monoclonal antibodies (16.2%) and taxanes (10.8%). \n\n\n\nAnd the trend of expenses of protein kinase inhibitors and monoclonal antibodies significantly \n\n\n\nincreased between 2006 and 2013 (P<.001). The findings related to antineoplastic agents were \n\n\n\nconsistent with global prevalence of cancer and payment approval for cancer targeted therapy by \n\n\n\nTaiwan NHI. Although very high drug expense, oral targeted therapy had the advantage of cost \n\n\n\nsavings on total inpatient expenditures and other medication costs due to quality of life improvement. \n\n\n\nFurther cost-effectiveness assessment of targeted therapy such as protein kinase inhibitors and \n\n\n\nmonoclonal antibodies is needed. \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nHPP14 \nFAPA2014000057 (Poster) \n\n\n\n\n\n\n\nApplying the Quality Control Method to Decrease the Prescribing Errors of Emergency \n\n\n\nDepartment \n\n\n\n\n\n\n\nSF Huang \nDepartment of Pharmacy, Hospital Chi Mei, Chiali, Taiwan  \n\n\n\n\n\n\n\n\"Patient safety\" is the fundamental quality of patient care. The Association For Healthcare Quality, \n\n\n\nTaiwan regularly announced the hospital patient safety goals, strategies, principles and suggested \n\n\n\npractice, reference to the annual target and strategies of Joint Commission on Accreditation of \n\n\n\nHealthcare Organizations (JCAHO). \u201cTo elevate medication safety\u201d is the first goal. Prescribing \n\n\n\nerrors are the most common type of medication error and are often preventable. Computerized \n\n\n\nphysician order entry (CPOE) system has been used in almost all hospitals in Taiwan to reduce \n\n\n\ntranscription errors by nonprofessional technicians. The prescribing error rates and types were \n\n\n\ncollected by the pharmacist responsible for monitoring, and THIS (Taiwan Healthcare Indicator \n\n\n\nSeries) indicator was calculated. If prescribing error rate is higher than the peer value in the same \n\n\n\nlevel of hospitals, we would try to improve the original cause. The prescribing error of emergency \n\n\n\ndepartment (0.43%) was noticed higher than the peer value (0.19%) in November 2012. The causes \n\n\n\nwere evaluated and 85.7% was related to wrong dosage form, as acetaminophen tablet was prescribed \n\n\n\nas syrup. In order to distinguish between the upper and lower rows of confusing medicines, changing \n\n\n\nthe colour of certain dosage of medicine were discussed, resolved and developed. After that \n\n\n\nimprovement, prescribing error of emergency department decreased to 0.05% in April 2014, lower \n\n\n\nnearly 8.6 times than in November 2012. Even CPOE could reduce transcription errors by non-\n\n\n\nprescribers, but \u201cTo Err is Human\u201d, it still can be improved continually to reduce self-input errors. In \n\n\n\naddition, pharmacist\u2019s cognitive service remains essential to protect patient safety. \n\n\n\n\n\n\n\n\n\n\n\nHPP 15 \n\n\n\nFAPA2014000128 (Poster) \n\n\n\nEffectiveness of Intervention among Patients with Diabetes and Hypertension by Pharmacist \n\n\n\nand Health Care Professionals in Nongku Primary Care Unit, Sisaket Province, Thailand \n\n\n\nS Wachira\n1\n, C Hatahirat\n\n\n\n2\n, D Thanachot\n\n\n\n3\n \n\n\n\n1 \nDepartment of Pharmacy, Sisaket Hospital Thailand \n\n\n\n2 \nPrimary care unit Nongku , Sisaket Thailand \n\n\n\n3 \nPrimary care unit Nongku, Sisaket Thailand \n\n\n\n\n\n\n\nThe Sisaket Hospital team provides services for all patients attending the primary care unit. The \n\n\n\nnumber of patients suffering from diabetes and hypertension in Nongku primary care unit increases \n\n\n\nfrom 241 in 2008 to 304 in 2013. Although the team provided the adequate knowledge and advices, \n\n\n\nthere were still several uncontrolled blood glucose and/or blood pressure levels. Seven colours ping-\n\n\n\npong model was introduced to motivate the patients in controlling their diseases and self-care. The \n\n\n\nobjective of the study was to assess the effectiveness of intervention, using 7 colours ping-pong model \n\n\n\nby Pharmacist and other health care professionals on blood glucose levels and blood pressure levels. \n\n\n\nDescriptive study consists of 156 diabetic or/and hypertensive patients were selected using purposive \n\n\n\nsampling. Comparison of blood glucose levels and blood pressure levels before and after the \n\n\n\nintervention were performed. Data were analyzed using percentage, mean, standard deviation, Paired \n\n\n\nsample t-test and Wilcoxon signed-rank test. The percentage of patients with diabetes, hypertension \n\n\n\nand diabetes with hypertension were 38.22, 36.94 and 24.20 respectively. Mostly were female \n\n\n\n(64.70%).The average age was 61 years. After intervention, the numbers of patients who can control \n\n\n\nblood sugar levels increased from 25.51% to 35.71%. The results revealed that fasting blood sugar \n\n\n\ndecreased from 166\u00b175 mg/dl to 149\u00b1 57 mg/dl, significantly (p <0.01). The numbers of patient who \n\n\n\n\n\n\n\n\ncan control blood pressure have increased from 82.05% to 84.62%. Blood pressure decreased from \n\n\n\n127\u00b1 16 mmHg to 126\u00b1 16 mmHg. (p = 0.049). The intervention provided to patients with diabetes \n\n\n\nand hypertension by Pharmacist and other health care professionals was effective in improving the \n\n\n\nprocess of care. The patients\u2019 blood glucose and blood pressure levels decreased significantly. \n\n\n\n\n\n\n\n\n\n\n\nHPP 16 \nFAPA2014000094 (Poster) \n\n\n\n\n\n\n\nPharmacist's Role in the Development of Pharmaceutical Management System under Limited \n\n\n\nBudget: A Case Study in Saraburi Hospital \n\n\n\n\n\n\n\nT Sumaporn \n\n\n\nDepartment of Pharmacy, Saraburi Regional Hospital, Thailand \n\n\n\n\n\n\n\nPharmaceutical management is one of the most important jobs under the responsibility of pharmacist \n\n\n\nwhich includes drug selection, procurement and distribution in order to promote reasonable use of \n\n\n\npharmaceutical products. Pharmaceutical cost is the second highest in hospital, thus reducing it can \n\n\n\nsignificantly affect the quality of service, especially under limited budget. This was a descriptive \n\n\n\nstudy comparing the drug management data of Saraburi Hospital during budget years 2012 and 2013. \n\n\n\nAs compared with budget year 2012, the cost of drug procurement dropped by 120,638,484.02 baht \n\n\n\n(22.26%) and drug stock was reduced by 59,123,334.74 baht (14.92%) with no negative impact on the \n\n\n\nquality of patient care. Pharmacist negotiated with related suppliers to reduce drug prices below the \n\n\n\nstandard prices issued by Ministry of Public Health. Saraburi Hospital saved the drug cost by \n\n\n\n3,665,734.77 baht, compared to the cost reduction in previous budget year 2013, 472,812 baht \n\n\n\n(14.81%). Pharmacist as a member in the Pharmacy Therapeutic Committee (PTC) helped define \n\n\n\nhospital drug-related policies which promoted reasonable use of pharmaceutical products. After the \n\n\n\nimplementation of the policies, the use of carbapenems in fiscal year 2013 dropped by 17.25%, saving \n\n\n\nthe cost of 24,249,809 baht (49.50%). Efficient pharmaceutical management not only guarantees \n\n\n\nquality, reasonable use and sufficiency of drugs, it can also give positive impact to hospital financial \n\n\n\nstatus especially under limited budget. Pharmacist's role is also important in the development of \n\n\n\nefficient pharmaceutical management system under regulations, good governance, transparency and \n\n\n\naccountability. \n\n\n\n\n\n\n\n\n\n\n\nHPP 17 \nFAPA2014000219 (Poster) \n\n\n\n\n\n\n\nEvaluation of Clinical Efficacy and Safety of Switching from Twice-Daily to Once-Daily \n\n\n\nTacrolimus Formulation in Liver Transplant Patients \n\n\n\n\n\n\n\nTS Wang, TY Wei, TH Yeh, MS Wang, SH Sun \n\n\n\nDepartment of Pharmacy, Far Eastern Memorial Hospital, Taiwan \n\n\n\n\n\n\n\nImmunosuppressant non-adherence has contributed to a major problem in transplantation which leads \n\n\n\nto rejection and graft loss. In the previous studies, conversion to tacrolimus once daily in liver \n\n\n\ntransplant patients seemed to be effective, safe, and improved adherence. In our hospital, we tried to \n\n\n\nswitch from twice daily tacrolimus regimen to once daily in liver transplant patients in 2013. The aim \n\n\n\nof this study was to assess the efficacy and safety in liver transplant patients converted from twice-\n\n\n\ndaily to once-daily tacrolimus. This was an observational study conducted from January 2013 to June \n\n\n\n2014. Conversion from twice-daily to once-daily tacrolimus was based on a 1:1 mg proportion. All \n\n\n\nliver transplant patients with conversion formulation were eligible for the study. No monitoring \n\n\n\nprocedures other than those required in the course of current clinical practice were applied to the liver \n\n\n\ntransplant patients. The clinical practice included to evaluate tacrolimus trough level, liver and renal \n\n\n\nfunction, glucose, lipid, blood pressure, rejection episodes, and any adverse event at pre-conversion, \n\n\n\n\n\n\n\n\nmonths 1, 3, and 6 after conversion. Eight patients were enrolled in the study (mean age 52\u00b18 years). \n\n\n\nMedian time since liver transplant was 23 months (range: 8 to 31 months). Mean conversion \n\n\n\nformulation time was 13\u00b16 months after liver transplantation. Mean tacrolimus level concentration \n\n\n\nwas 4.1\u00b12.1 ng/ml at baseline, and tended to equal during follow-up (month 6: 3.7\u00b12.0 ng/ml, P = \n\n\n\n0.711). Liver function, glucose, lipid and blood pressure remained stable during the study. No \n\n\n\nrejection episodes or adverse events were occurred. There was no significant difference in renal \n\n\n\nfunction (calculated by MDRD equation) before conversion and at month 6 post-conversion \n\n\n\n(77.6\u00b140.6 ml/min vs. 82.0\u00b144.8 ml/min, P = 0.856). Conversion from twice-daily to once-daily \n\n\n\ntacrolimus in liver transplant patients is equivalent efficacy, adequate safety, and maintained stable \n\n\n\nrenal function.  \n\n\n\n\n\n\n\n\n\n\n\nHPP 18 \nFAPA2014000034 (Poster) \n\n\n\n\n\n\n\nThe Quality of Life of Dementia Caregivers before and after Patients Receiving Pharmaceutical \n\n\n\nCare \n\n\n\n\n\n\n\nT Asawutmangkul \n\n\n\nPharmacy Department, Prasat Neurological Institute, Bangkok, Thailand \n\n\n\n\n\n\n\nThis study was aimed to investigate the quality of life of dementia caregivers and the changes in the \n\n\n\ncaregivers\u2019 quality of life after providing pharmaceutical care for the patient. The studies were \n\n\n\nperformed on the outpatient dispensary unit at the pharmacy department, Prasat Neurological \n\n\n\nInstitute. The study was focused on caregivers who care for patients with moderate to severe dementia \n\n\n\nfor at least 6 months. The quality of life of the caregivers was assessed using the SF-12 version 2 to \n\n\n\nevaluate their quality of life before and after providing pharmaceutical care. The research period was \n\n\n\nfrom October 2012 to September 2013. The results showed that the overall average qualities of life \n\n\n\nlevels for caregivers both before and after providing pharmaceutical care are higher than the United \n\n\n\nStates criteria 62.78\u00b112.94 and 59.51\u00b111.46, respectively, which indicated that the dementia \n\n\n\ncaregivers have a good quality of life. A comparative study on the quality of life of the caregivers \n\n\n\nboth before and after providing pharmaceutical care were done, and according to the result in terms of \n\n\n\nphysical health, the score of caregivers with a lower quality of life reflects that they had cared for \n\n\n\ndementia patients for a long time. This shows an increase in the caregivers\u2019 physical burden. As for \n\n\n\ntheir mental health, the caregivers have a higher quality of life score after providing pharmaceutical \n\n\n\ncare. The result also indicated that the caregivers whose status is the spouse of a patient will make the \n\n\n\npatient respond to the medication more effectively. \n\n\n\n\n\n\n\n\n\n\n\nHPP 19 \nFAPA2014000093 (Poster) \n\n\n\n\n\n\n\nThe Effect of Pharmacists' Interventions in Acute Myocardial Infarction Patients as a Part of \n\n\n\nthe Cardiovascular Care Team \n\n\n\n\n\n\n\nTH Yeh, T Pan, YZ Wang, MJ Chien, FS Wu  \n\n\n\nDepartment of pharmacy, Far Eastern Memorial Hospital, New Taipei, Taiwan \n\n\n\n\n\n\n\nThe ratio of male and female patients with acute myocardial infarction (AMI) at Far Eastern \n\n\n\nMemorial Hospital is 4:1, 32.5% of patients between 51-60 years of age. 13.2% patients may be \n\n\n\nreadmitted due to another episode of MI or stent thrombosis. The pharmacists play an important role \n\n\n\nto ensure that MI patients receive the appropriate treatment including antiplatelet agents. Quality \n\n\n\nimprovement indicators were created to ensure that patients received medication education prior to \n\n\n\ndischarge and comprehensive care. The \"cardiovascular care team\" was established in 2011 to ensure \n\n\n\nthat patients received comprehensive treatment and medication education. 12 items of quality \n\n\n\n\n\n\n\n\nimprovement indicators were created. For example, ensure dual antiplatelet agents were prescribed to \n\n\n\nappropriate patients. Pharmacists were invited to be part of the cardiovascular care team in the third \n\n\n\nquarter of 2011 to help to ensure that all patients received medication education prior to discharge \n\n\n\nfrom hospital. In the fourth quarter of 2012, pharmacists further improved comprehensive care by \n\n\n\nfollowing up patients at least twice within six months of discharge. Patients\u2019 understanding of \n\n\n\nmedication was calculated with the use of a questionnaire. Only 52.9% of AMI patients received \n\n\n\nmedication-related education prior to discharge in 2011. This rose to 90.9% in 2012 with the use of \n\n\n\ncomputer software to identify all patients that require medication education. In drug awareness \n\n\n\nquestionnaire, 70% of patients received full marks on medication storage, dosage and indication. \n\n\n\nDuring the first follow up, 57.1% of patients received full marks on NTG use on questionnaire as \n\n\n\ncompared to 85.7% of patients in the second follow up. This shows that education helps with patient\u2019s \n\n\n\nNTG use. With the assistance of computer software and modifications in the standard operating \n\n\n\nprocedures, nearly all AMI patients received medication education prior to discharge. NTG using \n\n\n\ncognitive scores improved 1.5 times.  \n\n\n\n\n\n\n\n\n\n\n\nHPP 20 \nFAPA2014000197 (Poster) \n\n\n\n\n\n\n\nSurvey of Drug Related Problems Identified from Home Visiting by Thai Pharmacists \n\n\n\n\n\n\n\nU Wanakamanee\n1\n, T Ningsanon\n\n\n\n2\n, P Pinyowatayakorn\n\n\n\n2\n, J Thongim\n\n\n\n3\n, C Wisedsorn\n\n\n\n4  \n \n\n\n\n1\nPrince of Songkla University (PSU), Thailand \n\n\n\n2\nThe Association of Hospital Pharmacy, Thailand \n\n\n\n3\nHealth Center 51 Department of Health, Bangkok Metropolitan Administration (BMA), Thailand \n\n\n\n4\nKuchinarai Crown Prince Hospital, Kalasin, Thailand \n\n\n\n\n\n\n\nPatients with chronic diseases have higher risk to get drug related problems (DRPs) since majority of \n\n\n\nthem need to take many medications. In addition, some of these medication regimens are complex. In \n\n\n\nThailand, home pharmaceutical care has been provided for these patients for approximately 10 years. \n\n\n\nThe aim of this study was to detect DRPs, their causes and problem management by home \n\n\n\npharmaceutical care. This descriptive study was conducted in 28 home health care settings in \n\n\n\nThailand, from July to December 2013. Information on each possible DRPs detected were recorded \n\n\n\nusing structured questionnaire and observation during pharmacist home visiting. Prevalence, pattern, \n\n\n\ncauses of DRPs and problem management/prevention were analyzed. A total of 743 DRPs were \n\n\n\nidentified in 717 patients. The most common types of DRPs were failure to receive medication (212, \n\n\n\n28.53%), followed by untreated indication (102, 13.73%) and adverse drug reactions (53, 7.13%). The \n\n\n\nmajor cause of these problems was inadequate knowledge of patients and their caregivers. Most \n\n\n\npatients and their caregivers did not understand the reason for taking medications continuously. \n\n\n\nIndividual medication counselling and medication reconciliation should be given to every patient and \n\n\n\ntheir caregivers. Multidisciplinary coordination should be able to solve and reduce preventable DRPs. \n\n\n\nPattern of DRPs was similar to previous studies in home care settings. These findings would guide to \n\n\n\npromote pharmaceutical care in primary care settings to improve medication management including \n\n\n\nadherence and DRPs prevention. \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nHPP 21 \nFAPA2014000062 (Poster) \n\n\n\n\n\n\n\nA Case Report of Suspected Vinorelbine-Induced Pulmonary Oedema Worsen \n\n\n\n\n\n\n\nWJ Chen, CL Hu \n\n\n\nDepartment of Pharmacy, Tainan Municipal Hospital, Taiwan \n\n\n\n\n\n\n\nWe display a case report of vinorelbine induced pulmonary oedema and probe the causes of \n\n\n\npulmonary oedema and relevant clinical matters. A 56-years-old woman have been diagnosed with \n\n\n\nright breast cancer stage A, pT2N0M0, ER, PR (-), HER/neu (-) and underwent modified radical \n\n\n\nmastectomy. She received D1 cisplatin 60mg/m\n2\n, vinorelbine 35mg/m\n\n\n\n2\n , D8 vinorelbine 35mg/m\n\n\n\n2\n \n\n\n\ntherapy. After received second cycle chemotherapy, the patient presented with shortness of breath. \n\n\n\nChest X-ray showed pulmonary oedema and left ventricular ejection fraction (LVEF) was 51% by \n\n\n\nechocardiography examination. After treatment, pulmonary oedema was resolved. When she accepted \n\n\n\nthird cycle chemotherapy, the patient suddenly became dyspnoea after 30 minutes of IV infusion \n\n\n\nvinorelbine. Follow-up by echocardiography, the LVEF rate decreased to 36.1%. Oxygen support \n\n\n\nwith mechanical ventilator and furosemide 20mg Q8H was given, she was discharged after 3 days. \n\n\n\nBased on the presentation of this patient, vinorelbine-induced pulmonary oedema was suspected \n\n\n\n(Naranjo score is 4). Vinorelbine has more high lipophilic properties compared with others Vinca \n\n\n\ndrugs, approximately 300 and 100 times more concentrated in heart and lungs, respectively, than in \n\n\n\nserum. The direct enhancing effects of the alkaloids on the coagulation mechanism lead to arterial \n\n\n\nocclusion. The other effects on the myocardium induce to cellular anoxia. These may lead to heart \n\n\n\nfailure be exacerbated and induce clinical symptoms of pulmonary oedema. Cancer patient have heart \n\n\n\nfailure combined with receiving vinorelbine should be closely monitored. \n\n\n\n\n\n\n\n\n\n\n\nHPP 22 \nFAPA2014000065 (Poster) \n\n\n\n\n\n\n\nAnalysis of the Use of Secondary Prevention Drug Therapy in Patients with Acute Myocardial \n\n\n\nInfarction after Discharge from Hospital  \n\n\n\n\n\n\n\nWH Chen\n1\n, YY Chu\n\n\n\n2\n, BT Wu\n\n\n\n2\n, YL Lee\n\n\n\n1,3\n, YL Chang\n\n\n\n1,3\n, PL Chen\n\n\n\n1,3 \n\n\n\n1\nPharmacy Department of Tungs\u2019 Taichung MetroHarbor Hospital, Taichung, Taiwan \n\n\n\n2\nInternal Medicine Department of Tungs\u2019 Taichung MetroHarbor Hospital, Taichung, Taiwan \n\n\n\n3\nTaichung Country Pharmacist Association, Taiwan \n\n\n\n\n\n\n\nAcute myocardial infarction (AMI) patients still show high recurrence rate even after treatment. AMI \n\n\n\npatients after discharge from hospital are required to continue taking dual anti-platelet agents, oral \u03b2-\n\n\n\nblockers, statin drugs and an angiotensin II converting enzyme-inhibitor (ACEi) or angiotensin II \n\n\n\nreceptor blocker (ARB) as secondary prevention of acute coronary event. We tried to follow-up the \n\n\n\ncondition of these patients after physicians stopped prescribing \u03b2-blockers, statin and ACEi or ARB.  \n\n\n\nA total of 98 patients were enrolled. After their discharge we checked their medications on the first, \n\n\n\nthird and six months at our cardiovascular clinic (McNemar test). The most common drug that \n\n\n\nphysician did not prescribed was ACEi/ARB followed by \u03b2-blocker and statin. Comparing drugs \n\n\n\ngiven at the time of discharge and during their visit at CV clinic, statin drug came in first (18.4%, \n\n\n\n26.6% and 32.7%) (p <0.001), followed by the ACEI / ARB (17%, 19.1% and 18.1%) (p <0.001), and \n\n\n\n\u03b2-blocker (5.1%, 15.4% and 14.4%). Reason for not prescribing ACEI/ARB was due to its dry cough, \n\n\n\nelevated creatinine level, hypotension and intolerance. For \u03b2-blockers if patient developed bradycardia \n\n\n\nor asthma. For statin, a small number of patients complain of myalgia, elevated liver enzymes or the \n\n\n\nprice of the drug but mostly the reason is not known. AMI patient stopping these drugs should be \n\n\n\nunder the physician discretion. We also considered the recommendations from the latest treatment \n\n\n\nguidelines. Another reason is that government-run national health insurance system can also \n\n\n\ninfluenced the physician\u2019s decision on prescribing drugs. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nHPP 23 \n\n\n\nFAPA2014000207 (Poster) \n\n\n\n\n\n\n\nThe Measures of Adherence to Antiretroviral Therapy in Thailand: A Survey Study \n\n\n\n\n\n\n\nW Santimaleeworagun\n1, \n\n\n\nS Pattarachayakul\n2\n \n\n\n\n1\nDepartment of Pharmacy, Faculty of Pharmacy, Silpakorn University, Thailand \n\n\n\n2\nDepartment of Clinical Pharmacy, Faculty of Pharmaceutical Science, Prince of Songkla University, \n\n\n\nThailand   \n\n\n\n\n\n\n\nA good adherence to antiretroviral therapy is an important issue to sustain HIV suppression, reduce \n\n\n\nrisk of opportunistic infection and improve overall survival in HIV patients. Thus, the measures were \n\n\n\nwidely used for adherent assessment. This study aimed to survey the type and number of adherent \n\n\n\ntools used by pharmacist at HIV/AIDS care clinic. This study was a survey study among the \n\n\n\npharmacists by using a self-reporting questionnaire. We include the pharmacist participating in \n\n\n\nHIV/AIDS conference by PIPHAT group (Pharmacist Initiative for Patients Living with HIV/AIDS \n\n\n\nThailand) in Bangkok, Thailand on the 11\nth\n- 15\n\n\n\nth\n February 2013. All interviewed pharmacists worked \n\n\n\nat HIV/AIDS care clinic or ambulatory care clinic and have used the measures of adherence to \n\n\n\nantiviral therapy. Out of 42 participants, 7 (16.7%) were males. 19 (45.2%) and 14 (33.3%) of the \n\n\n\nsurveyed pharmacists worked in the community and general hospital, respectively. Most of them \n\n\n\n(n=27 participants, 64.3%) counselled their patient at HIV/AIDS care clinic. The use of mono-, dual-, \n\n\n\nand triple tools by pharmacist for adherent assessment was 42.9, 50 and 7.1%, respectively (n=18, 21 \n\n\n\nand 3 cases, respectively). With 18 pharmacists using 1 tool, they selected either the patient self-\n\n\n\nreport or pill count for measurement (n=9; 50% and n=9; 50%, respectively). Patient self-report in \n\n\n\ncombination with pill count was the most used method among 21 pharmacists using 2 tools (n=13; \n\n\n\n61.9%). Most of interviewed pharmacists use more than 2 tools for adherent assessment. It seems to \n\n\n\nbe an appropriate strategy to confirm the patient adherence by a different method. However, the \n\n\n\nnationwide survey is necessary for revealing the real situation on the use of adherent tools in \n\n\n\nThailand. \n\n\n\n\n\n\n\n\n\n\n\nHPP 24 \nFAPA2014000044 (Poster) \n\n\n\n\n\n\n\nSave Drug, Save Cost, Save Life \n\n\n\n\n\n\n\nW Warathanakul, C Prakobkit  \n\n\n\nDepartment of Pharmacy, Hospital Vachiraphuket , Phuket , Thailand \n\n\n\n\n\n\n\nThis study aimed to explore groups, items and values of leftover medicines of patients in \n\n\n\nVachiraphuket Hospital, and to identify the cause and ways to reduce leftover medication cost. We \n\n\n\nanticipate the result of preventing any adverse drug events from leftover medication in patients. Data \n\n\n\nwere collected during 2 years period from April 2012 to March 2014. The overall value of leftover \n\n\n\nmedicines was 2,920,248 baht. The value of expired or deteriorate medicines was 458,114 baht.  The \n\n\n\nhighest value of returned medicines according to pharmacological group were central nervous system \n\n\n\nwith 387,1670 baht, cardiovascular system 119,416 baht and nutrition and blood 117,642 baht. The \n\n\n\nhighest amount of returned medicines according to pharmacological group were antidiabetic drugs \n\n\n\n103,503 tablets, followed by vasodilator antihypertensive drugs 78,991 tablets and minerals 42,266 \n\n\n\ntablets. From 588,683 tablets of returned medicines, the top three drugs of highest amount were \n\n\n\nmetformin 500 mg 63,533 tablets (10.79%), glipizide 5 mg 31,500 tablets (5.35%) and calcium \n\n\n\ncarbonate 600 mg 31,187 tablets (5.29%). Whereas, the top three drugs of highest value were Keppra \n\n\n\n500 mg tablet with a value of 93,580 baht, apresoline 25 mg tablet 89,653 baht and morphine 20 mg \n\n\n\ncapsule 84,434 baht. Most of the leftover medicines were found in chronic disease. Reasons were \n\n\n\n\n\n\n\n\nfound to be overprescribing and overused medication by the physicians, patients forgot to take \n\n\n\nmedicines, patient misunderstanding, physicians changed the treatment regimens and patients were \n\n\n\ntransferred to other hospital. These results revealed the drug related problems especially in the \n\n\n\ndiabetic group patients and lead to the intervention in patient education program among these patients. \n\n\n\nEspecially the need for better care from pharmacists and healthcare practitioners in order to improve \n\n\n\nthe patients\u2019 knowledge and understanding in rational use of medicines and to improve the medication \n\n\n\nutilization in hospital. \n\n\n\n\n\n\n\n\n\n\n\nHPP 25 \nFAPA2014000023 (Poster) \n\n\n\nEvaluation of the Extent and Impact of Oncology Clinical Pharmacy Service in a Tertiary \n\n\n\nHospital in Hong Kong: First Ten-Month Experience \n\n\n\nWT Cheung, YY Wong, KZ Zhou, KH So, SC Lee \n\n\n\nOncology pharmacist counselling service was launched at the Prince of Wales Hospital (PWH) since \n\n\n\nthe end of 2011 for all patients who are newly starting on chemotherapy or other anti-cancer agents. \n\n\n\nThis study aims to evaluate the extent and impact of pharmacists' intervention and to recognize the \n\n\n\npotential risk factors of DRPs in a local tertiary hospital. A retrospective review was carried out. \n\n\n\nInformation regarding the service between February 2012 and December 2012 were collected. Drug \n\n\n\nRelated Problems (DRPs) identified were classified according to the PCNE Classification V6.2. An \n\n\n\nindependent oncology pharmacist was responsible for evaluating the clinical significance of \n\n\n\nindividual DRPs. Potential risk factors leading to the occurrence of a pharmacist\u2019s intervention were \n\n\n\nalso analyzed. A total of 842 patients were included in this study. DRPs were identified in 255 \n\n\n\n(30.3%) patients. Common problems identified fall under the \u201cTreatment Effectiveness\u201d and \n\n\n\n\u201cAdverse Reactions\u201d categories. Common causes of DRPs include concomitant drug-food \n\n\n\ninteractions, inappropriate combination of drugs, and non-compliance issue of patients. There were \n\n\n\n356 interventions performed at prescriber, patient/carer and drug levels. The majority (95.3%) of \n\n\n\nDRPs were \"somewhat significant\" or \"significant\" and the average Intervention Ranking Score was \n\n\n\n3.13 (S.D=0.45). One or more concomitant diseases (p<0.001), hypertension (p=0.026), \n\n\n\npolypharmacy (p=0.027), type of treatment (p=0.006), and lung carcinoma (p<0.001) were found be \n\n\n\nsignificant positive risk factors to the occurrence of intervention in univariate analysis. In conclusion, \n\n\n\nthe service was shown to be beneficial to patients as pharmacist was able to identify drug related \n\n\n\nproblems to optimize drug therapy as a whole. Further studies are required to build a more \n\n\n\ncomprehensive model of risk factors. Awareness of the various DRPs and the possible risk factors of \n\n\n\nthe DRPs should be the key to a high-standard drug therapy. \n\n\n\n\n\n\n\nHPP 26 \nFAPA2014000088 (Poster) \n\n\n\n\n\n\n\nLenalidomide Treatment for Relapsed/Refractory Multiple Myeloma: The Experience from a \n\n\n\nMedical Centre in Taiwan \n\n\n\n\n\n\n\nYM Hsu, LJ Hsu, SY Chien \n\n\n\nDepartment of Pharmacy, Changhua Christian Hospital, Changhua, Taiwan \n\n\n\n\n\n\n\nLenalidomide is an immunomodulatory drug derived from thalidomide which has been used for the \n\n\n\ntreatment of relapsed/refractory multiple myeloma (RRMM). We evaluated the efficacy and safety of \n\n\n\nlenalidomide in patients with RRMM at a medical center in Taiwan. We conducted a retrospective \n\n\n\nanalysis of lenalidomide in patients with RRMM who were treated in Changhua Christian Hospital in \n\n\n\nTaiwan. Data was collected from electronic patient record which includes demographic data, \n\n\n\n\n\n\n\n\nmyeloma (M) protein levels, hospital admissions record and incidence of adverse events. A total of 15 \n\n\n\npatients (F:M ratio 2:3) included during Jan 2013 to May 2014. The average age was 63.7\u00b110.2 \n\n\n\nyears.  The median time from diagnosis to lenalidomide treatment was 38.8 months (0.3 -100.9). \n\n\n\nAmong these patients, 14 patients relapsed or progressed after two prior therapies, including \n\n\n\nbortezomib (100%) and thalidomide (85.7%). With an average time of 6.7 months after starting \n\n\n\nlenalidomide, the partial response (defined as a reduction in M protein levels of at least 15 percent) \n\n\n\nwas observed in 10 (66.7%) patients. However, there were still 4 patients converted to other \n\n\n\nchemotherapy due to lenalidomide failure, and 3 patients died. During the study period, hospital \n\n\n\nadmissions were observed in 7 patients, mostly because of infection problem. The most common \n\n\n\nadverse drug reactions were thrombocytopenia (40%), neutropenia (33%), leukocytes (20%), skin \n\n\n\nrash (13%), and fatigue (6%), all with mild degree. It seems that lenalidomide is effective and less \n\n\n\ntoxic for RRMM in our patients. However, with the limitation of population size and follow-up \n\n\n\nperiod, we need more data to confirm the appropriate treatment regimens about lenalidomide until \n\n\n\ndisease progression. \n\n\n\n\n\n\n\n\n\n\n\nHPP 27 \n\n\n\nFAPA2014000204 (Poster) \n\n\n\n\n\n\n\nThe Relationship between Medication Possession Ratio and Medication Regimen Complexity \n\n\n\namong Hypertensive Patients: A Population-Based Study \n\n\n\n\n\n\n\nCP Ho\n1,2\n\n\n\n, SH Wen\n3\n, TJF Lee\n\n\n\n4,5,6\n   \n\n\n\n1\nDepartment of Pharmacy, Buddhist Tzu Chi General Hospital, Hualien, Taiwan \n\n\n\n2\nInstitute of Medical Sciences, Tzu Chi University, Hualien, Taiwan    \n\n\n\n3\nDepartment of Public Health, Tzu Chi University, Hualien, Taiwan \n\n\n\n4\nDepartment of Medical Research, Buddhist Tzu Chi General Hospital, Hualien, Taiwan             \n\n\n\n5\nDepartment of Life Sciences, Tzu Chi University, Hualien, Taiwan \n\n\n\n6\nDepartment of Pharmacology, Southern Illinois University School of Medicine, Springfield, IL,   \n\n\n\n USA \n\n\n\nStudies focusing on the relationship between the medication possession ratio (MPR) and medication \n\n\n\nregimen complexity index (MRCI) have not been adequately described. This study aimed to explore \n\n\n\nthe relationship between MPR and MRCI among hypertensive patients in Taiwan. A total of 10 \n\n\n\ndescriptive statistics were performed for all measures as appropriate. The MPR was further divided \n\n\n\ninto high (\u226580%), medium (<80-60%), and low (<60%) groups, and Chi-Square test and analysis of \n\n\n\nvariance were performed for comparisons of demography. A total of 598 hypertensive patients were \n\n\n\nselected from 800,000 random samples of the National Health Insurance Research Database (NHIRD) \n\n\n\nin Taiwan. The MPR and MRCI were analyzed using correlation coefficient. Multiple regression \n\n\n\nanalysis was used to examine the relationship between MPR and MRCI with controlling for potential \n\n\n\nconfounding factors. All data were analyzed using SAS 9.3 statistical analysis software. Among the \n\n\n\ntotal patients from 2007 to 2008, those who took antihypertensive medications had a mean number of \n\n\n\ntaking 2.6 different kinds of antihypertensive drugs. The mean MPR was 36.83 (standard deviation, \n\n\n\nSD=28.43), with 1136 (10.7%), 1667 (15.7%), and 7795 (73.6%) in high, medium, and low MPR \n\n\n\ngroups, respectively. The mean MRCI was 26.43 (SD=26.18). Significant difference was found \n\n\n\namong three groups according to age, gender, number of medical providers, comorbidities and MRCI. \n\n\n\nThe MPR was positively correlated with MRCI (r=0.55, p=0.00). The R2 for the multiple regression \n\n\n\nanalysis was 0.32, indicating that 32% of the variance in MPR was accounted for by MRCI. The \n\n\n\nMRCI was observed to be a reliable predictor of MPR (\u03b2=0.58, p=0.00). The MRCI is a useful \n\n\n\npredictor for the MPR of the hypertensive patients in Taiwan. \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nHPP 28 \nFAPA2014000060 (Poster) \n\n\n\n\n\n\n\nSusceptibility of Ciprofloxacin-Sensitive and Resistant MRSA Isolates to Non-Beta-Lactam \n\n\n\nAntibiotics \n\n\n\n\n\n\n\nYC Hung\n1 3\n\n\n\n, PI Chen\n1 3\n\n\n\n, SC Ke\n2\n, PL Chen\n\n\n\n1 3\n, CM Chen\n\n\n\n2\n  \n\n\n\n1\nPharmacy Department of Tungs\u2019 Taichung MetroHarbor Hospital, Taichung, Taiwan  \n\n\n\n2\nInfection Control Committee of Tungs\u2019 Taichung MetroHarbor Hospital, Taichung, Taiwan  \n\n\n\n3\nTaichung County Pharmacist Association, Taichung, Taiwan \n\n\n\n\n\n\n\nMRSA was first detected in 1961, and has been regarded as a hospital-acquired bacterium, namely \n\n\n\nHA-MRSA. Since the mid-1990s there have been individuals who were without any recent contact \n\n\n\nwith the health care system began presenting with MRSA infections. This new MRSA strains often \n\n\n\ncalled CA-MRSA. CA-MRSA strains have been distinguished from HA-MRSA by molecular means. \n\n\n\nHA-MRSA strains carry SCCmec type I, II, or III and are usually resistant to beta-lactam antibiotics \n\n\n\nand many classes of non-beta-lactam antibiotics. CA-MRSA isolates carry SCCmec type IV or V and \n\n\n\nare more susceptible to non-beta-lactam antibiotics. In 2008, Otter et al indicated that 82% of the \n\n\n\nciprofloxacin-sensitive MRSA isolates were found to be SCCmec IV positive. So, ciprofloxacin \n\n\n\nsusceptibility may be used as a screening marker to select isolates likely to be CA-MRSA. Our study \n\n\n\nis to investigate the differences of the non-beta-lactam antibiotics susceptibility between \n\n\n\nciprofloxacin-sensitive and -resistant MRSA isolates. Total of 1359 MRSA isolates were collected \n\n\n\nfrom patients during 2012 to 2013. The resistances of non-beta-lactam antibiotics were determined by \n\n\n\ndisc diffusion method. Statistical analysis was done by using the Chi-square and Fisher`s test. The \n\n\n\nresistance of MRSA isolates to ciprofloxacin, TMP/SMX, clindamycin, rifampicin, and erythromycin \n\n\n\nis 68.7%, 51.5%, 92.3%, 24.4%, and 92.5 %, respectively. There were statistically significant \n\n\n\ndifferences among all antibiotics (P=0.000) except between clindamycin and erythromycin. The \n\n\n\nresistance of ciprofloxacin-sensitive MRSA to TMP/SMX and rifampicin were lower than \n\n\n\nciprofloxacin-resistance isolates (5.2% vs 72.6%, p=0.000 and 3.3% vs 34.0%, p=0.000, \n\n\n\nrespectively). Although ciprofloxacin-sensitive MRSA isolates showed low resistance to TMP/SMX \n\n\n\nand rifampicin, they are highly resistance to clindamycin and erythromycin (82.8% and 83.1% \n\n\n\nrespectively). Can the susceptibility of ciprofloxacin be used as a definitive marker to spark initial \n\n\n\nsuspicion of CA-MRSA? We need further investigation in gene typing of these MRSA isolates to \n\n\n\nprove it. \n\n\n\n\n\n\n\n\n\n\n\nHPP 29 \nFAPA2014000059 (Poster) \n\n\n\n\n\n\n\nJoint Commission International Accreditation Standards for Hospitals its Impact and Analysis \n\n\n\non Hospital Drug Safety Use \n\n\n\n\n\n\n\nYL Chang\n1,2\n\n\n\n, PI Chen\n1,2\n\n\n\n, WH Chen\n1,2\n\n\n\n, YL Lee \n1,2\n\n\n\n, PL Chen \n1,2\n\n\n\n \n1\nPharmacy Department of Tungs\u2019 Taichung MetroHarbor Hospital, Taichung, Taiwan \n\n\n\n2\nTaichung Country Pharmacist Association, Taichung, Taiwan \n\n\n\n\n\n\n\nAccording to the Joint Commission International [JCI] Accreditation Standards for Hospitals, patient \n\n\n\nsafety and medication management is one of the key goals in the accreditation program. From a \n\n\n\nforeign accreditation system viewpoint we hope can help us improved our pharmacy department by \n\n\n\ndoing a comprehensive investigation on our pharmacists\u2019 workflow and medication quality system. In \n\n\n\n2008, our hospital participated in the JCI accreditation program. This program includes organization \n\n\n\nand management survey, drug selection and procurement, storage, ordering and transcribing, \n\n\n\npreparing and dispensing, administration and monitoring, and international patient safety goals for \n\n\n\nforeigners included here are patient identification and drug safety and warnings. In the 2006 to 2008 \n\n\n\nbefore the accreditation program we had a higher near miss rate, ratio than after the accreditation \n\n\n\n\n\n\n\n\nprogram in Dispensary Department (p<0.001, 95% C.I. 0.039%~0.0521%). However in medication \n\n\n\nerror we found a higher number of cases after the accreditation (this is due to increase awareness and \n\n\n\nreporting). No significant difference [p=0.245] regarding inappropriate prescription ordered by \n\n\n\nphysician but the number of cases reported after the program was significantly reduced. Surveillance \n\n\n\nof the expiration date of drugs, items requiring refrigeration and parenteral nutrition were within \n\n\n\nthreshold range. No difference was noted before and after the evaluation. From the accreditation \n\n\n\nprogram evaluation to our analysis, we found there is difference from our usual practice and the \n\n\n\nstandard sets by the JCI with regards to drug safety issues. These includes patient identification , high \n\n\n\nalert medications and drug safety and management , proper use of medications with clear labelled \n\n\n\ninformation for patient\u2019s use and continue care. All these needs improvement and upgrade to conform \n\n\n\nto the standard set by the JCI. We hope with proper efforts we can improve our system in line with \n\n\n\ninternational standards. \n\n\n\n\n\n\n\n\n\n\n\nHPP 30 \nFAPA2014000066 (Poster) \n\n\n\n\n\n\n\nAnalysis of the Effectiveness of the Quality of Outpatient Pharmacy Service \n\n\n\n\n\n\n\nYJ Lee\n1,2\n\n\n\n, WH Chen\n1,2\n\n\n\n, SL Shang\n1\n, YL Lee\n\n\n\n1,2\n, YL Chang\n\n\n\n1,2\n, PL Chen\n\n\n\n1\n \n\n\n\n1\nPharmacy Department of Tungs\u2019 Taichung MetroHarbor Hospital, Taichung, Taiwan \n\n\n\n2\nTaichung Country Pharmacist Association, Taichung, Taiwan \n\n\n\n\n\n\n\nTaiwan has not fully implemented the policy of separation of drug prescribing and dispensing, leading \n\n\n\nto an increase in the workload of the Department of Pharmacy in the Outpatient of the hospital. We \n\n\n\nare hoping that an information system can be created in order to assist the delivery more efficiently \n\n\n\nand improve the quality of the service in the pharmacy department. Information was collected at our \n\n\n\noutpatient pharmacy data quality monitoring indicators system from 2012-01 to 2013-12. These \n\n\n\nincludes improvement measures regarding pharmacist can immediate dispensing after doctor \n\n\n\nprescribed medications before patients going to the cashier , if the waiting time is more than 15 \n\n\n\nminutes for patient to collect their medicines, computer will send texts message to the head of the \n\n\n\ndepartment to management. There is a computerized voice message reminding the patient to show \n\n\n\ntheir insurance card for identification purpose. A computer monitor shows drug images for both the \n\n\n\npharmacist and patient for double checking the dispensed drugs. In this study, the waiting time was < \n\n\n\n15 min (p=0.73), if shortened to about 5-10 minutes, satisfaction or acceptable rate increased from \n\n\n\n34.58% to 56.68%. Satisfaction rate survey also increased from 39.84% to 44.42%. Prescribe near \n\n\n\nmiss rate (<0.05%, p=0.912) and patient\u2019s satisfaction survey regarding pharmacist checking their \n\n\n\nidentification prior to handling their medications increased from 40.13% to 90.11%. Use of \n\n\n\ncomputerized information systems can improve the outpatient pharmacy operation, not only, it can \n\n\n\nreduce the workload of pharmacists , shortened the waiting time for patient to collect their \n\n\n\nmedications , upgrade drug safety , minimize medication errors and increase patient\u2019s satisfaction \n\n\n\nregarding pharmacy service but also improve patient\u2019s identifications accurateness prior to handling \n\n\n\nthem their medications. No complained was noted from patients or family while checking their \n\n\n\nidentification before giving them their drugs. \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nHPP 31 \nFAPA2014000138 (Poster) \n\n\n\n\n\n\n\nTransformation of Clinical Pharmacy Activities in Ministry of Health Hospitals in Malaysia \n\n\n\n\n\n\n\nM Noraini, H Hazimah, NAN Nuradlina, MW Tan, SS Eezmalina \n\n\n\nPharmaceutical Services Division, Ministry of Health Malaysia \n\n\n\n\n\n\n\nBefore the year 2000, clinical pharmacy in Malaysia mainly involves medication counselling, clinical \n\n\n\npharmacokinetics service, parenteral nutrition and cytotoxic drug reconstitution. Entering the new \n\n\n\nmillennium, efforts were made to expand the services from product-oriented to a more patient-centric \n\n\n\napproach with adoption of pharmaceutical care concept. To date, it has evolved into specialised \n\n\n\nclinical services such as Medication Therapy Adherence Clinic (MTAC), critical care and cardiology \n\n\n\npharmacy. The transformation of the clinical services is essential in fulfilling the nation's need and in \n\n\n\nline with the dynamic development of the pharmacy profession. The Clinical Unit in the \n\n\n\nPharmaceutical Services Division, Ministry of Health Malaysia is entrusted to lead this \n\n\n\ntransformation. The responsibilities include development of guidelines and standards of practice, \n\n\n\nfacilitate local and overseas training, identify appropriate personnel for clinical pharmacy training \n\n\n\nprogrammes and continuous monitoring of the progress. Currently, there are 13 types of MTAC \n\n\n\nservices (diabetes, warfarin, retroviral disease, respiratory diseases, nephrology, psoriasis, \n\n\n\nhaemophilia, psychiatry, stroke, rheumatoid arthritis and geriatrics) with established protocols offered \n\n\n\nin ambulatory care setting at 660 MOH facilities. For inpatient setting, 100% ICU wards and 76.4% \n\n\n\nmedical wards were filled/stationed with at least one full time pharmacist. 380,558 of the total \n\n\n\ninpatient prescriptions were intervened in 2013, which comprises of incomplete prescriptions \n\n\n\n(27.6%), prescriptions with inappropriate regimens (54.4%) and others (18.0%). 210,520 discharge \n\n\n\ncounselling, 185,501 bedside counselling and 1,582 group counselling sessions (6,697 patients) were \n\n\n\nconducted in the entire inpatient settings. For continuity of care, 7,712 home medication review visits \n\n\n\n(5,336 patients) were conducted. This transformation has open up a better career pathway for clinical \n\n\n\npharmacists and future trend of development will focus more on specialised services with \n\n\n\ninternational recognition.  \n\n\n\n\n\n\n\n\n\n\n\nHPP 32 \n\n\n\nFAPA2014000188 (Poster) \n\n\n\n\n\n\n\nEffect of a Home Medication Review Program on Medication Adherence, HbA1c, Fasting Blood \n\n\n\nSugar, Blood Pressure and Lipid Profiles in Patients with Type 2 Diabetes Mellitus: A \n\n\n\nRandomized Controlled Trial. \n\n\n\n\n\n\n\nNE Alias\n1\n, CS Zin\n\n\n\n1\n, PA Ball\n\n\n\n2\n \n\n\n\n1\nKulliyyah of Pharmacy International Islamic University Malaysia, Kuantan, Malaysia \n\n\n\n2\nFaculty of Engineering, Health, Science & the Environment (EHSE), Charles Darwin University, \n\n\n\nDarwin, Australia \n\n\n\nPoor medication adherence diminishes the health benefits of pharmacotherapies. Patients with Type 2 \n\n\n\nDiabetes Mellitus (T2DM) require treatment with multiple medications, placing them at increased risk \n\n\n\nfor nonadherence. This study aimed to investigate the efficacy of a home medication review program \n\n\n\nconducted by a pharmacist to improve medication adherence and its associated effects on HbA1c, \n\n\n\nfasting blood sugar (FBS), blood pressure (BP), and lipid profiles. Adult patients with T2DM \n\n\n\nattending health clinics in rural area of Pahang, Malaysia were recruited into this six months \n\n\n\nrandomized-controlled study.  Patients were taking medications for diabetes for at least two years, \n\n\n\nwith HbA1c>8%. The intervention group received three home visits by a pharmacist (at baseline, 3 \n\n\n\nmonths and at 6 months) in addition to the standard medical care. Counselling on medication and \n\n\n\ndisease was provided during the visit. Control group patients only received standard medical care. \n\n\n\nOutcome measures include medication adherence using Modified Morisky Adherence Scale, HbA1c, \n\n\n\nfasting blood sugar (FBS), blood pressure (BP) and lipid profiles. Total of 73 patients were recruited \n\n\n\n\n\n\n\n\nand randomized into the intervention group (38) and the control group (35), with no significant \n\n\n\ndifference identified in baseline parameters. There was significant improvement in medication \n\n\n\nadherence from baseline to 6 months in the intervention group (mean difference (MD)=-2.19, 95% \n\n\n\nCI[-2.73,-1.65], p<0.001) and was associated with significant improvements in HbA1c (mean \n\n\n\ndifference (MD) = 1.57, 95% CI[0.88, 2.26], p<0.001); FBS (MD=2.76, 95% CI[0.59,4.94], p=0.009); \n\n\n\nsystolic BP (MD=6.56, 95% CI[0.75,12.36], p=0.022); diastolic BP (MD=4.44, 95% CI[1.11,7.78], \n\n\n\np=0.006); and triglycerides (MD=0.59, 95% CI[0.24,0.93], p<0.001). The control group showed no \n\n\n\nsignificant changes in medication adherence (MD=-0.29, 95% CI [-0.89, 0.32], p=0.342) and other \n\n\n\nassociated measures. A HMR program conducted by a pharmacist provided significant improvement \n\n\n\nin medication adherence and its associated measures amongst patients with Type 2 diabetes. \n\n\n\n\n\n\n\n\n\n\n\nHPP 33 \nFAPA2014000190 (Poster) \n\n\n\n\n\n\n\nThe Impact of Pharmacodynamically-Optimized Carbapenems Dosing for Hospital Acquired \n\n\n\nInfection Treatment: A Cross Sectional Analysis \n\n\n\n\n\n\n\nN Jangkong, S Ruengsawad \n\n\n\nDepartment of Pharmacy, Ratchaburi Hospital, Thailand  \n\n\n\n\n\n\n\nMeropenem and imipenem are often employed as the rescuer therapy for patients with nosocomial \n\n\n\ninfections. Consideration of pharmacodynamic principles in dosage regimens for these agents can \n\n\n\nmaximize their antibacterial effectiveness and clinical outcomes. The dosage scheme for these \n\n\n\ncarbapenems may be modified to maximize the percentage of the dosage interval that drug \n\n\n\nconcentrations remain above the minimum inhibitory concentration, an important parameter related to \n\n\n\nthe bacterial eradication. Clinically, optimized pharmacodynamics regimen of carbapenems (OPC) \n\n\n\nmay be a suitable alternative and possibly more effective than recommended regimen of carbapenems \n\n\n\n(RRC) which is available in the medical textbook. This study aimed to assess application of \n\n\n\npharmacodynamics principle for carbapenems on clinical utility among nosocomial infection. \n\n\n\nProtocol of OPC was developed by infectious disease pharmacy specialist and approved by infectious \n\n\n\ndisease physician. This treatment protocol was used as guidance for physician in medical wards. \n\n\n\nRelevant information was identified through an electronic search of hospital data base for meropenem \n\n\n\nand imipenem use in medical ward during July 2013-June 2014. According to our protocol, \n\n\n\nmeropenem and imipenem regimen was classified as OPC and RRC. Clinical and bacteriological \n\n\n\noutcomes were analyzed in comparable. The 112 patients with nosocomial infection were assessable. \n\n\n\nOverall mortality on day 14 significantly difference between the OPC (94.6%) and RRC (98.2%). \n\n\n\nAmong patients who survived to 14 days, eradication rates of bacteria were both 85.7% for OPC and \n\n\n\nRRC but duration of treatment for OPC was significantly shorter than RRC (11.25 days vs 13.21 \n\n\n\ndays). There was no adverse drug reaction that resulted in treatment discontinuation, including \n\n\n\nnervous system disorders such as convulsion for both regimens.  The results show that monotherapy \n\n\n\nof ORC was effective and well tolerated in adult patients. Pharmacodynamic principles can be applied \n\n\n\nto dosage strategies for imipenem and meropenem for better clinical outcomes. \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nHPP 34 \nFAPA2014000200 (Poster) \n\n\n\n\n\n\n\nUsing Quality Control Circle Analysis to Improve Dispensing Errors in an Outpatient \n\n\n\nPharmacy \n\n\n\nCL Fang, Y Zhao, YJ Lou   \n\n\n\nDepartment of Pharmacy, Taipei City Hospital, Taiwan \n\n\n\n\n\n\n\nPatient safety is an important issue of pharmaceutical patient care. To prevent dispensing error is an \n\n\n\napproach that can guarantee patient safety more effectively. The purpose of this study was to explore \n\n\n\nthe results of quality control circle (QCC) project for reducing dispensing errors at a regional teaching \n\n\n\nhospital in Taiwan. We applied a retrospective analysis with prescription dispensing errors in \n\n\n\noutpatient pharmacy from April 9, 2012 to November 30, 2012. The study design was divided into \n\n\n\nthree stages. Stage 1: We collected the near-missed dispensing cases and applied pareto principle to \n\n\n\nanalyse the major causes of these errors. Stage 2: According to the major causes, we developed and \n\n\n\nimplemented reasonable plans to improve the dispensing process. Stage 3: After the quality control \n\n\n\nproject interventions, we calculated the rate of dispensing errors and compared with that before QCC \n\n\n\nproject. Also, a questionnaire survey of the outpatient pharmacy was conducted to observe the service \n\n\n\nsatisfaction. Before performing the QCC project, the average rate of dispensing errors was 0.548% the \n\n\n\nmajor cause dispensing errors were wrong medicines (45.4%) and counting errors (37.2%). The target \n\n\n\nwas 50% reduction of dispensing errors. After the initial interventions, wrong medicines and counting \n\n\n\nerrors were reduced by 64% and 46%, and average rate of all dispensing errors was reduced to \n\n\n\n0.258%. To achieve more reduction in counting errors, we implemented other strategies to improve \n\n\n\nthe counting errors. Finally, the rate of all dispensing errors was below 0.2%. Moreover, the \n\n\n\nquestionnaire survey revealed the time of outpatient waiting for receiving medicine was shortened and \n\n\n\nthe service satisfaction of the outpatient pharmacy was improved after implementing the QCC project. \n\n\n\nThrough QCC activities was not only improve dispensing process, working environment, but also \n\n\n\nreduce dispensing errors and enhance the service satisfaction of the outpatient pharmacy. \n\n\n\n\n\n\n\nHPP 35 \nFAPA2014000270 (Poster) \n\n\n\n\n\n\n\nDrug Use Evaluation of Rivaroxaban in Atrial Fibrillation  \n\n\n\n\n\n\n\nJY Kao, LC Chien, MF Lin \n\n\n\n\n\n\n\nAtrial fibrillation (AF) is a common cardiac arrhythmia disease. AF significantly increases the risk of \n\n\n\nischemic stroke by thrombus formation. In pass, warfarin is only one oral anticoagulant agent to \n\n\n\nprevent stroke. The use of vitamin K antagonists is highly effective for stroke prevention in patient \n\n\n\nwith nonvalvular atrial fibrillation. However, drug and drug interaction or food and food interactions \n\n\n\nnecessitate frequent INR monitoring, and drug induce bleeding adverse reaction is highly, \n\n\n\nrequirements that make it difficult for many patients to use such drug in clinical practice. Rivaroxaban \n\n\n\nis a new oral anticoagulant agent. It is a directed and reversible Xa inhibitor to prevent thrombus \n\n\n\nformation and not necessitate laboratory monitor. We hypothesised that patients received rivaroxaban \n\n\n\nwill prevention stroke event and reduce bleeding adverse reaction. A retrospective evaluation that \n\n\n\npatients who first-time received rivaroxaban and include those patients who had a diagnosis for AF at \n\n\n\na medical centre in southern Taiwan from October 2013 to May 2014. We were assessed the \n\n\n\nincidence of stroke or thrombus formation, and rivaroxaban complications after patients were treated \n\n\n\nsix months. Data from 168 patients and electronic patient chart review. The mean age (\u00b1SD) was \n\n\n\n75.3\u00b19.9 years. 1 (0.60%) of the participants had diagnosis of recurred thrombus within receiving \n\n\n\nrivaroxaban. The incidence of adverse reaction is 5.95%, include 2.40% of bleeding complications \n\n\n\nand 2.40% of skin associated reaction (such as rash, urticaria). The more bleeding complications in \n\n\n\nolder patients (mean age 77.8 years), and 50.0% of patients combined other antiplatelet agent. In \n\n\n\n\n\n\n\n\nconclusion, rivaroxaban has prevention thrombus formation and be lower risk of bleeding, especially \n\n\n\nolder patients. Nevertheless, in case of bleeding is not antidote to treatment. Pharmacists should be \n\n\n\nprovided to patients who receive rivaroxaban the education and counselling. \n\n\n\n\n\n\n\n\n\n\n\nHPP 36 \nFAPA2014000181 (Poster) \n\n\n\nAntibiotic Use in Upper Respiratory Tract Infections in Ambulatory Patients in Tertiary Care \n\n\n\nHospital, Thailand \n\n\n\nJ Anansushatgul\n1\n, U Kittiwongsunthorn\n\n\n\n1\n, C Thanee\n\n\n\n2\n, P Kanjanawat\n\n\n\n1\n, T Tumsen\n\n\n\n1\n, TR \n\n\n\nVivian\n3                                                           \n\n\n\n1\nDepartment of Pharmacy, Sunpasitthiprasong Hospital, Thailand  \n\n\n\n2\nDepartment of Pediatrics, Sunpasitthiprasong Hospital, Thailand  \n\n\n\n3\nDepartment of Kinesiology, West Chester University, USA \n\n\n\nMultidrug resistant organisms (MDRO) are emerging and challenging in Thailand. The misuse and \n\n\n\noveruse of antibiotics has been documented as the major cause of the development of antibiotic \n\n\n\nresistance. Intensifying the monitoring of antibiotic use in ambulatory patients is the one mission of \n\n\n\nthe Ministry of Public Health of Thailand. The objective of this study was to determine the clinical \n\n\n\ndecision and cost expenditure of antibiotic prescriptions in Upper Respiratory Tract Infections. \n\n\n\nMedical records of URI in ambulatory patients at Sunpasitthiprasong Hospital were reviewed for one \n\n\n\nyear (October 2012 - September 2013). The clinical decision was determined by an infectious disease \n\n\n\nphysician and the Thailand antibiotic use guideline. Cost expenditure was analysed per visit. 14,731 \n\n\n\npatients with URI were reviewed. Total antibiotic cost was $43,316 and 794 cases (5%) involved \n\n\n\nmisuse or overuse of antibiotic prescriptions. Most of them were children under 10 years old (30%) \n\n\n\nand above 50 years old (20%). The cost expenditure of antibiotic prescriptions ranged between $2.00 \n\n\n\nand $7.50 per visit. The Civil Servant Medical Benefit Scheme (CSMBS) was two times more \n\n\n\nexpensive than the Universal Coverage Scheme (USC). The highest cost expenditure was otitis media \n\n\n\n(78.2%, $2,748), followed by the common cold (16.3%, $ 74) and acute bronchiolitis (2.5%, $90). \n\n\n\nThe two most prescribed antibiotics were amoxicillin and clarithromycin. The highest cost \n\n\n\nexpenditure was found in amoxicillin-clavulanate prescriptions ($1,638) and mostly used in the \n\n\n\nDepartment of Otolaryngology. In conclusion, with the emergence of MDRO, antibiotic use should be \n\n\n\nanalysed to determine the cost expenditure and the clinical decision. Implementation of a rational \n\n\n\nantibiotic use policy would not only control costs for hospital but also reduce drug resistance among \n\n\n\npatients. \n\n\n\n\n\n\n\n\n\n\n\nHPP 38 \nFAPA2014000209 (Poster) \n\n\n\n\n\n\n\nAn Evaluation of Efficacy and Safety of Long-Term Use of Generic Pravastatin Sodium in \n\n\n\nHyperlipidaemia \n\n\n\n\n\n\n\nM Suzuki, M Kanamori, T Hashimoto, T Sasaki \n\n\n\nDepartment of Pharmacy, Kameda Medical Center, Japan \n\n\n\n\n\n\n\nIn Japan, the wider use of generic drugs is expected to reduce the growing healthcare spending. \n\n\n\nHowever, the share of generic drugs remains still low compared to the European and U.S. countries. \n\n\n\nOne of the reasons for the low share is reported because many people are worried about using generic \n\n\n\ndrugs. To solve this problem, we retrospectively evaluated the efficacy and safety of long-term use of \n\n\n\ngeneric pravastatin sodium. Study period was from January 2008 to December 2011. Those patients \n\n\n\ntaking generic pravastatin sodium for 15 months or greater were defined as long-time users and \n\n\n\nincluded in this study. Assessment of efficacy was conducted to observe TC (total cholesterol), TG \n\n\n\n(triglyceride), HDL (high-density lipoprotein cholesterol) and LDL (low-density lipoprotein \n\n\n\n\n\n\n\n\ncholesterol). On the other hand, assessment of safety was conducted to observe AST (aspartate \n\n\n\naminotransferase), ALT (alanine aminotransferase), CPK (creatinine phosphokinase), \u03b3-GT (gamma-\n\n\n\nglutamyl transferase), ALP (alkaline phosphatase), LDH (lactate dehydrogenase), T-Bil (total-\n\n\n\nbilirubin), BUN (blood urea nitrogen), SCr (serum creatinine) and HbA1c (haemoglobin A1c) based \n\n\n\non laboratory data and we researched discontinued patients about the reasons by electrical medical \n\n\n\nrecord. We enrolled 1,337 patients. As a result, there is no significant difference between short-term \n\n\n\nand long-term laboratory data except for ALT. For ALT, long-term laboratory data was significantly \n\n\n\nlower than short-term laboratory data and liver dysfunction did not occur and we considered long-\n\n\n\nterm use did not effect on safety. Although 37 patients discontinued possibly due to drug related \n\n\n\nadverse events, we considered those adverse events were not due to the generic version of pravastatin \n\n\n\nsodium. In conclusion, this study showed that a long term use of generic pravastatin sodium was \n\n\n\neffective and safe; it would be helpful to relieve the people\u2019s fears of generic drugs. \n\n\n\n\n\n\n\n\n\n\n\nHPP 39 \nFAPA2014000206 (Poster) \n\n\n\n\n\n\n\nA Comprehensive Analysis of Outpatient Duplicate Prescribing Errors in a Regional Teaching \n\n\n\nHospital \n\n\n\n\n\n\n\nMT Li, Y Zhao, YJ Lou \n\n\n\nDepartment of Pharmacy, Taipei City Hospital, Taiwan \n\n\n\n\n\n\n\nSince National Health Insurance system and specialized medical services are well-prepared in \n\n\n\nTaiwan, patients may have duplicate medical treatment in the same or different medical \n\n\n\ndepartments. Duplicate prescribing is one of the most common types of medication errors which \n\n\n\nare hazardous and costly. The objective of this study is to analyse the frequency and patterns \n\n\n\nof duplicate prescribing errors in our hospital outpatient department services. This study \n\n\n\nretrospectively collected and analysed the prescriptions in our hospital outpatient department services \n\n\n\nfrom Jan. 1\nst\n 2014 to Jan. 31\n\n\n\nst\n 2014. In our study, there were 25483 patients visited our \n\n\n\nhospital outpatient department during this period. This study included 33814 prescriptions, with the \n\n\n\noverall duplicate prescribing error rate being 0.33%. 88.79% of duplicate prescribing errors were \n\n\n\noriginated from different prescriptions. 37.4% of the inappropriate prescriptions were classified as \n\n\n\nsame ingredients while the others were duplicate pharmacological mechanism. The most common \n\n\n\ndrug classification of these prescribing errors was non-steroidal anti-inflammatory drugs (34.58%), \n\n\n\nfollowed by antihistamines (14.02%). In conclusion, we found that duplicate prescribing errors are \n\n\n\nsignificantly more serious in patients with multi-specialties visit. The implementation of pharmacists\u2019 \n\n\n\ncognitive services has made a positive impact on reducing duplicate prescribing errors in the same \n\n\n\nprescription. However, pharmacists have been slow to expand cognitive services roles \n\n\n\nto reducing duplicate prescribing errors between different prescriptions. It is suggested to integrate \n\n\n\npatient\u2019s drug profiles into the Hospital Information System (HIS) and barcode check system to \n\n\n\nenhance the efficiency and effectiveness of pharmacists\u2019 cognitive services.  \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nHPP 40 \n\n\n\nFAPA2014000147 (Poster) \n\n\n\n\n\n\n\nUse of a new chemotherapy-specific CPOE system to improve chemotherapy safety?  \n\n\n\n\n\n\n\nTC Ko\n1\n, SH Hsu\n\n\n\n1\n, PC Wang\n\n\n\n2\n, MW Sung\n\n\n\n3\n \n\n\n\n1\nDepartment of Pharmacy, Mackay Memorial Hospital Hsinchu branch, Hsinchu, Taiwan \n\n\n\n2\nDivision of Gastroenterology, Mackay Memorial Hospital Hsinchu branch, Hsinchu, Taiwan \n\n\n\n3\nTaichung couty pharmacists association, Taichung, Taiwan \n\n\n\n\n\n\n\nWe designed a new chemotherapy-specific CPOE system aimed to reduce the number of prescribing \n\n\n\nerrors. We also evaluated the clinical impacts of prescribing errors about this new system in a \n\n\n\nteaching hospital at Taiwan. We designed a new CPOE system since 1st July, 2012 and we held a \n\n\n\nseries of education sessions to discuss the current practices of chemotherapy ordering for 6 months. \n\n\n\nThe prescribing errors were collected and identified by pharmacists for one year period starting 1st \n\n\n\nJuly, 2011 until 30th Jun, 2012 before implementing a new CPOE system (stage one), compared with \n\n\n\none year period starting from 1st January to 31st December, 2013 after implementing new system \n\n\n\n(stage two). The causes of prescribing errors were analysed. Approximately 38 (0.92%) prescribing \n\n\n\nerrors were detected out of 4141 medication orders during stage one. The most common errors of the \n\n\n\nprescribed drugs were wrong dose and wrong time, which were 47% and 39% respectively. After \n\n\n\nimplementation of the new system (stage two), 23 (0.57%) prescribing errors were detected out of \n\n\n\n4036 medication orders. The most common errors of the prescribed drugs were wrong route and \n\n\n\nwrong combination, which were 29% and 23% respectively. Other errors such as wrong frequency, \n\n\n\nwrong drug, and wrong patient were also encountered with different degree of severity. Technology in \n\n\n\nprescribing process will support the practitioner to reduce the incidence of these errors. Although the \n\n\n\nuse of new CPOE system could lead to new error types, it reduced the number of prescribing errors. \n\n\n\nOur study demonstrated the fact that new CPOE system could be used as a tool for reducing the \n\n\n\nprescribing errors and improving the chemotherapy safety. \n\n\n\n\n\n\n\n\n\n\n\nHPP 41 \nFAPA2014000079 (Poster) \n\n\n\n\n\n\n\nAn Evaluation on the Effects of Vaminolact\u00ae in the Parenteral Nutrition on Physical Changes \n\n\n\nof Very Low Birth Weight Preterm Neonates \n\n\n\n\n\n\n\nNA Kamaruddin\n1\n, MM Manan\n\n\n\n2\n, S Mohd. Ali\n\n\n\n3\n \n\n\n\n1\nDepartment of Pharmacy, Hospital Sultanah Aminah, Johor, Malaysia \n\n\n\n2\nFaculty of Pharmacy, Universiti Teknologi MARA, Puncak Alam Campus, Selangor, Malaysia \n\n\n\n3\nFaculty of Pharmacy, MAHSA University, Kuala Lumpur, Malaysia \n\n\n\n\n\n\n\nCurrently, there is a lack of studies available which focus on administration of Vaminolact\u00ae in \n\n\n\nparenteral nutrition (PN) in local hospital setting. This study was conducted to evaluate the effects of \n\n\n\nVaminolact\u00ae in PN on the physical changes of very low birth weight (VLBW) infants in Hospital \n\n\n\nSultanah Aminah, Johor Bahru. A retrospective medical chart review was performed of VLBW \n\n\n\ninfants receiving PN support in 2012. The subjects were classified into three groups of gestational \n\n\n\nage. The outcome measured was physical changes, assessed by weight, length and head circumference \n\n\n\ngrowth. Analyses were performed to evaluate differences in physical changes between the groups. A \n\n\n\ntotal of 100 VLBW premature infants were taken as the subjects in this study.  The majority of the \n\n\n\nsubjects were Malays, followed by other races. The average gestational age was obtained to be 28.91 \n\n\n\n\u00b1 2.72 weeks. Vaminolact\u00ae in PN was initiated at an average age of 4.25 \u00b1 2.54 days, with a median \n\n\n\ndose of 1 g/kg/day. The median duration of PN was found to be 13 days. Only 33% of the study \n\n\n\nsample achieved the minimum standard nutritional goal of 100 kcal/kg/day by PN. The overall mean \n\n\n\npercentage of weight gain per day, median percentage of length growth per week and median \n\n\n\npercentage of head circumference growth per week in this study was 0.30 \u00b1 0.82% g, 0.89 (2.25)% \n\n\n\n\n\n\n\n\ncm and 0.00(1.42)% cm, respectively. This was less compared to the standard recommendation. It was \n\n\n\nobserved that there were no significant differences in the percentage of weight gain, length and head \n\n\n\ncircumference growth between the groups (p > 0.05). The study findings showed evidences that the \n\n\n\nphysical changes in the VLBW infants during the period of PN administration were inadequate to \n\n\n\nachieve the standard growth recommendation. This showed that the current practice of PN \n\n\n\nadministration needs to be reviewed in order to optimize the outcomes. \n\n\n\n\n\n\n\n\n\n\n\nHPP 42 \nFAPA2014000203 (Poster) \n\n\n\n\n\n\n\nThe Incidence of Severe Cutaneous Adverse Drug Reactions in Thai Population \n\n\n\n\n\n\n\nP Khunsakdeeyodom \nPharmacy Department, Mahidol University, Bangkok, Thailand \n\n\n\n\n\n\n\nThe severe cutaneous adverse reactions (SCARs) consist of Stevens-Johnson syndrome (SJS), toxic \n\n\n\nepidermal necrolysis (TEN), drug rash with eosinophilia and systemic symptoms (DRESS)/drug-\n\n\n\ninduced hypersensitivity syndrome (DIHS) and acute generalized exanthematous pustulosis (AGEP) \n\n\n\nare caused by various drugs and their incidence are vary among different ethnicities. Aim of the study \n\n\n\nwas to determine the incidence of SCARs reported among Thai population. In a retrospective study, \n\n\n\nreports of SCARs were retrieved from adverse drug reaction (ADR) database of ADR centre, Siriraj \n\n\n\nHospital during January 2011 to June 2014. Data were analyzed regarding demographic data of \n\n\n\npatients, type of skin reactions and causative drugs.  \n\n\n\nOf the 160 reports of SCARs from 126 Thai patients, the reactions were observed in 69 females \n\n\n\n(55.80%). No significant difference between male and female. A mean age was 46 years (range 1-92 \n\n\n\nyears). The most frequent type of SCARs were DRESS/DIHS (66 reports, 41.25%), SJS (72 reports, \n\n\n\n45.00 %), and TEN (15 reports, 9.38 %). Focus on causative drugs, phenytoin (10 reports), allopurinol \n\n\n\n(10 reports), and cotrimoxazole (6 reports) were the most common culprit drugs related with \n\n\n\nSJS/TEN. Phenytoin (25 reports) and allopurinol (9 reports) were mainly associated with \n\n\n\nDRESS/DIHS whereas AGEP was mainly caused by antibiotics such as amoxicillin and clindamycin. \n\n\n\nEye complications including dry eye and eye irritation were found in 16 patients after resolving SJS \n\n\n\nand TEN (13 SJS and 3 TEN), moreover two patients were dead from TEN. Current study shows that \n\n\n\nSCARs rarely occurred conditions induced by various drugs such as phenytoin, allopurinol, and \n\n\n\ncotrimoxazole among Thai patients. Therefore, patient\u2019s education about signs and symptoms of \n\n\n\nSCARs was important when initiating these drugs. \n\n\n\n\n\n\n\n\n\n\n\nHPP 43 \nFAPA2014000118 (Poster) \n\n\n\n\n\n\n\nAnalysis of Dyslipidemia Caused by L-Asparaginase in Paediatric Acute Lymphoblastic \n\n\n\nLymphoma Patients \n \n\n\n\nAY Kang\n1\n, JY Cho\n\n\n\n1\n, MW Lee\n\n\n\n2\n, G Jung\n\n\n\n1\n, HL Ahn\n\n\n\n1\n, JY Yoon\n\n\n\n1\n, DG Lee\n\n\n\n3\n, OY Han\n\n\n\n1\n, HO La\n\n\n\n1,4\n \n\n\n\n1\nDepartment of Pharmacy, Seoul St. Mary\u2019s Hospital, Seoul, Korea \n\n\n\n2\nRegional Pharmacovigilance Center, Seoul St. Mary\u2019s Hospital, Seoul, Korea \n\n\n\n3\nDivision of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic \n\n\n\nUniversity of Korea, Seoul, Korea \n4\nDepartment of Pharmacology, College of Medicine, The Catholic University of Korea, Seoul, Korea \n\n\n\n\n\n\n\nL-asparaginase is an important antileukaemia agent used in first-line therapy of paediatric acute \n\n\n\nlymphoblastic lymphoma (ALL). Hyperglycemia, hepatotoxicity and acute pancreatitis have \n\n\n\ncommonly been reported to occur with L-asparaginase treatment. Dyslipidaemia has also long been \n\n\n\nrecognized as an important L-asparaginase-related complication, but has not been mentioned in insert \n\n\n\n\n\n\n\n\npaper. We analyzed the characteristics of dyslipidaemia in paediatric patients with ALL, receiving L-\n\n\n\nasparaginase. We studied retrospectively 39 patients with ALL who were admitted to the Paediatric \n\n\n\nwards in Seoul St. Mary\u2019s Hospital, from January 1, 2011 to July 31, 2013 and were treated with L-\n\n\n\nasparaginase during the induction phase. For these patients, all total cholesterol (TC) and triglyceride \n\n\n\n(TG) levels were obtained from the electronic medical records. The degree of causality and \n\n\n\nseriousness for each case of adverse drug reaction was determined using WHO-UMC causality \n\n\n\ncategory and CTCAE version 4.0. Of the 39 patients, 18 patients had dyslipidaemia. Baseline \n\n\n\ncharacteristics which included the number of L-asparaginase administration, were not different \n\n\n\nbetween the two groups. The dyslipidemia group were checked for hypercholesterolemia (N=14) and \n\n\n\nhypertriglyceridemia (N=13). The mean TC level of dyslipidaemia group was significantly higher \n\n\n\nthan the normal group (223.4\u00b169.0mg/dl vs 168.3\u00b119.8mg/dl, p<.0001). The mean TG level of the \n\n\n\ndyslipidaemia group was significantly higher than the normal group. (448.6\u00b1477.5mg/dl vs \n\n\n\n143.9\u00b142.7mg/dl, p<.0001). WHO-UMC causality category of each case is possible or probable. L-\n\n\n\nasparaginase was discontinued for one case with serious hyperlipidaemia. L-asparaginase induced \n\n\n\ndyslipidaemia diagnosed in 18 patients (46.2%). We recommend that blood lipid level mornitoring \n\n\n\nshould be conducted in L-asparaginase therapy. \n\n\n\n\n\n\n\n\n\n\n\nHPP 44 \nFAPA2014000144 (Poster) \n\n\n\nPharmacy Drug Care Center: Beyond Pharmacy Service \n\n\n\nA Tienchairoj, P Tangsomboon, L Virojawanich  \n\n\n\n\n\n\n\nThis study aimed to increase both effectiveness of pharmacy diagnostic problems and compliance in \n\n\n\nnon-communicable diseases out-patients, and to reduce drug cost for our hospital. Data were collected \n\n\n\nfrom all pharmacy drug care center patients from 1\nst\n Oct 2012 until 28\n\n\n\nth\n Feb 2013. Descriptive data \n\n\n\nwas analyzed from intervention by pharmacist. Cost-saving values were calculated from patient \n\n\n\nmedication reconciliation record. Overall, there were a total of 13,553 patients who used the \n\n\n\npharmacy drug care center with an average of 39.17 patients daily (max 132 patients daily). Almost \n\n\n\nall of the drug related problems were non-compliance for drug use (83.50%). Non-compliance for \n\n\n\ndrug use consists of inconsistency of taking the drug (63%) and wrong drug use (37%). Eighty percent \n\n\n\nof physician accepted the pharmacist intervention. The hospital was saved 8,376,205.60 baht from this \n\n\n\ncenter. This study found that the pharmacy drug care center was a new strategy to solve medication \n\n\n\nreconciliation problem in out-patient. Pharmacist diagnosed drug related problem and wrote \n\n\n\nrecommendation to physician before patients met. Comparison of drug history and present drug \n\n\n\nbetween the patient medication reconciliation record and prescription made patients to receive \n\n\n\ncomplete drug use, increase compliance and save cost. \n\n\n\n\n\n\n\n\n\n\n\nHPP 45 \nFAPA2014000171 (Poster) \n\n\n\n\n\n\n\nProvision Pharmaceutical Care with Sticker Tools Reduced Incorrect Dose Problem and Its \n\n\n\nRoot Causes in the Elderly \n\n\n\n\n\n\n\nK Areerud  \n\n\n\nDepartment of Pharmacy, Hospital Phatthalung, Thailand \n\n\n\n\n\n\n\nProviding pharmaceutical care for the patients at the elderly clinics during 2012-2013 identified \n\n\n\n88.98% patients as non-compliance. Of these, 41.67% was taking improper dose of medication. The \n\n\n\nobjective of this study was to reduce the problem of taking wrong dose of medication in the elderly \n\n\n\npatients. Sticker tools, a supplement label, were designed and developed in stepwise approach with \n\n\n\ncontinuous quality improvement (CQI) concept to manage DRPs and their root causes. In phase I, \n\n\n\n\n\n\n\n\nsticker tool with specific color and bigger fonts was designed and used to help the patients identify the \n\n\n\nmedication of which the prescribed dose was changed and those with visual problem. In phase II, new \n\n\n\npictogram-contained sticker tools were developed and used to help the patients who are illiterate. In \n\n\n\nphase III, new sticker tools were redesigned to prevent them from peeling off the medication \n\n\n\ncontainers/package and three different colors were used to differentiate the dose of medication, time \n\n\n\nof administration, before/after meal. Non-compliance was measured by interviewing the patients with \n\n\n\nthe validated questionnaire and was collected before phase I and during each phase when the sticker \n\n\n\ntools were systematically implemented in the elderly clinic. Before phase I, 41.67% of the patients \n\n\n\ntook incorrect dose of medication. After using sticker tools in phase I and phase II, 37.47% and \n\n\n\n35.29% of the patients still have this DRP respectively. The top three root causes of the remaining \n\n\n\nDRP were the label peeling off (23.14%), getting confused from polypharmacy (14.39%) and the \n\n\n\nunused medications at home (9.25%). After using the new sticker tools developed in phase III, the \n\n\n\nincorrect dose problem decreased to 16.73%. In conclusion, provision pharmaceutical care to the \n\n\n\nelderly patients who administered improper dose of medication by using sticker tools developed for \n\n\n\nspecific DRPs and their root causes can diminish this DRP. \n\n\n\n\n\n\n\n\n\n\n\nHPP 46 \nFAPA2014000165 (Poster) \n\n\n\n\n\n\n\nSources and Distribution of Unlawful Medicines in 8 Provinces of Thailand: To Inform The \n\n\n\nPublic Policy Change \n \n\n\n\nB Booddawong\n1\n, K Wanleepong\n\n\n\n2\n, L Boonmanus\n\n\n\n2\n, O Kadsomboon\n\n\n\n2\n, J Dokbua\n\n\n\n2\n, J Pratomnam\n\n\n\n2\n, \n\n\n\nC Booncherd\n2\n, S Plengchai\n\n\n\n2\n, PS Thamasorn\n\n\n\n2\n, K Pentongdee\n\n\n\n2\n, NK Angsulee\n\n\n\n2 \n\n\n\n1\nNonkhon Hospital, Sisaket Provincial Public Health Office, Thailand \n\n\n\n2\nDrug System Monitoring Mechanism Development Program (DMD), Thailand  \n\n\n\n\n\n\n\nAccording to the current law governing the medicines in Thailand (Thailand Drug Act, B.E 2510), \n\n\n\nselling medicines outside of registered pharmacies is not allowed except Over The Counter (OTC) \n\n\n\nmedicines which have been approved for general distribution. Despite this law, general distribution of \n\n\n\nrestricted medicines is occurring. This activity is of concern because of the increased possibility of \n\n\n\nharm. Data from 8 hospitals showed that 18 % of adverse drug reactions (ADRs) cases were from \n\n\n\nunlawfully medicines. This survey was conducted to track original sources of medicines and \n\n\n\ndistribution routes from 613 stores in 8 provinces of Thailand. We also interviewed patients who have \n\n\n\nbeen affected by ADRs. After investigating non-pharmacy stores, several type of drug were found. \n\n\n\nThese types include dangerous drugs (30.9%), common household drugs (21.8 %), ready packed \n\n\n\nmodern drugs (20.3%), Thai traditional drugs (13.6 %), mixed medicines packaged in a set with \n\n\n\nsteroid drugs (4.4 %) and others (7.7 %). Further investigation showed that these stores received their \n\n\n\nsupplies from five sources. There were drug stores (46.0 %), wholesale dealers (24.6 %), grocery \n\n\n\nstores (11.1%), food truck (9.1%), department store (7.7 %) and others (1.5%). Routes of distribution \n\n\n\nwere direct delivery, postal service and medicine trucks, and the trucks that travel to village and \n\n\n\nentertain villagers with various shows, i.e. animal shows or movies. At the end of the shows, seller \n\n\n\nwill sell medicines to audiences. Additionally, in household we found stockpile of medicines waiting \n\n\n\nto be distributed. Findings have been forwarded to 8 Provincial Public Health Offices, the FDA, the \n\n\n\nDrug System Monitoring Mechanism Development Program (DMD) and the Regional Medical \n\n\n\nScience Center. The data gathered will be use to inform policy changes, improve drug distribution \n\n\n\nchannels and protect community by limiting access to potentially harmful medicines without \n\n\n\nprofessional medical consultation and authorization. \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nHPP 47 \nFAPA2014000266 (Poster) \n\n\n\nA Risky Practice of Tablet Splitting: an Example of Drugs with Narrow Therapeutic Index \n\n\n\nCL Chou\n 1\n, CC Hsu \n\n\n\n1\n, YL Chang \n\n\n\n1\n, TJ Chen \n\n\n\n2\n, YC Chou \n\n\n\n1\n \n\n\n\n1\nDepartment of Pharmacy, Taipei Veterans General Hospital, Taiwan \n\n\n\n2\nDepartment of Family Medicine, Taipei Veterans General Hospital, Taiwan \n\n\n\n\n\n\n\nTablet splitting is common in daily medical practice. Previous research investigated the \n\n\n\nappropriateness of tablet splitting with a focus on drug formulation and the content uniformity of split \n\n\n\ntablets. However, inaccurate splitting of drugs with narrow therapeutic index (NTI) may lead to \n\n\n\nunwanted toxicity. In this study, we aimed to investigate the frequency of prescribing split NTI drugs \n\n\n\nat ambulatory setting in Taiwan.  The details of prescriptions containing NTI drugs at ambulatory \n\n\n\nsetting were extracted by using the National Healthcare Insurance Research Database in 2010. We \n\n\n\nadopted the definition of NTI drugs by the North Carolina Board of Pharmacy in 2012. The \n\n\n\ntherapeutic categories of NTI drugs, dosage form, patient age and status of pill splitting were further \n\n\n\nstratified and analyzed.  Based on the definition of NTI drugs by the North Carolina Board of \n\n\n\nPharmacy, 133 NTI drug items had been prescribed for oral use in the cohort datasets in 2010. A total \n\n\n\nof 512,398 prescriptions containing NTI drugs were prescribed to 148,548 patients and 41.8% of \n\n\n\npatients had received NTI drugs in form of splitting. Only 3 kinds of NTI drugs existed liquid-form \n\n\n\nproducts. Splitting was prevalent among the elderly with prescriptions of digoxin (82.4%) and \n\n\n\nwarfarin (84.5%). The results of this study showed that NTI drugs were frequently prescribed to be \n\n\n\nsplit in Taiwan. This kind of potentially inappropriate medications was frequently seen in digoxin and \n\n\n\nwarfarin prescriptions to the elderly. The lack of wide spectrums of strengths and formulations of NTI \n\n\n\ndrugs may be the major cause. Further studies are needed to evaluate the outcome of inappropriate \n\n\n\nsplitting of NTI drugs. \n\n\n\n\n\n\n\n\n\n\n\nHPP 48 \nFAPA2014000097 (Poster) \n\n\n\nDrug Utilization Evaluation of ACEI and ARB at the Regional Hospital in Central Taiwan \n\n\n\nCW Kuo\n1,2,3\n\n\n\n, YC Ying\n1\n, MJ Pan\n\n\n\n1\n, SJ Chung\n\n\n\n1\n, JC Lien\n\n\n\n3\n, MJ Hour\n\n\n\n3 \n\n\n\n1\nDepartment of Pharmacy, Jen-Ai Hospital, Taichung, Taiwan \n\n\n\n2\nTaichung County Pharmacists Association, Taichung, Taiwan  \n\n\n\n3\nSchool of Pharmacy, China Medical University, Taichung, Taiwan \n\n\n\n\n\n\n\nACEI (Angiotensin converting enzyme inhibitors) and ARB (Angiotensin receptor blocker) is the role \n\n\n\nof the antihypertensive drugs in the RAA (Renin-angiotensin) drugs. ACEI/ARB effect is to reduce \n\n\n\nglomerular vascular pressure, reduce urinary protein excretion and help maintain kidney function. \n\n\n\nClinical widely used to reduce the amount of urinary protein loss filtration, slow the rate of \n\n\n\ndeterioration of renal function. Recent studies have found that blocking the RAA to reduce urinary \n\n\n\nprotein, renal function may not be protected but no longer deteriorating. This study evaluated a \n\n\n\nregional hospital currently ACEI, ARB's usage to alert medical personnel to note the patient's kidney \n\n\n\nfunction. Retrospective data collection was 102 in January to 103 in June using ACEI/ARB \n\n\n\nprescription drugs in the case of a regional hospital. Analysis of patient demographic distribution, \n\n\n\ntreatment divisions, physicians age, the number of days prescribed, liver function tests and renal \n\n\n\nfunction tests. The results showed that drug use to Exforge, followed by Diovan, Blopress; using one \n\n\n\nkind of ACEI or ARB drugs was 95.46%, the use of two or more is 3.45%; Division usage in \n\n\n\ncardiology accounted for 55.69%, followed by endocrinology 14.48%, 12.23% neurology. Some \n\n\n\npatients with renal insufficiency continue to use ACEI/ARB combination therapy, there is a small part \n\n\n\nof the liver is not functioning properly. ACEI and ARB therapy in hypertensive patients with poor \n\n\n\n\n\n\n\n\nkidney function, the maximum effective to reduce urinary protein in patients. Now study shows \n\n\n\npatients are the fastest reduced eGFR. So, the better the performance of RAA blocking drugs more \n\n\n\ncan reduce urinary protein, but has failed to synchronize renal function deterioration is no longer \n\n\n\nprotected; therefore clinical use ACEI / ARB in patients with poor kidney function, renal function \n\n\n\nshould be aware of changes. Therapeutic effect achieved while ensuring drug safety. \n\n\n\n\n\n\n\nHPP 49 \nFAPA2014000173 (Poster) \n\n\n\nHaematological and Thromboembolic Adverse Events of Lenalidomide in Siriraj Hospital, \n\n\n\nThailand \n\n\n\nC Veerapong \n\n\n\nPharmacy Department, Siriraj Hospital, Mahidol University, Bangkok, Thailand \n\n\n\n\n\n\n\nLenalidomide is an analogue of thalidomide approved in 2004. It is used as an effective agent in \n\n\n\nmultiple myeloma (MM) whereas safety profiles should be concerned. Haematological and \n\n\n\nthromboembolic adverse effects (AEs) commonly present during treatment with lenalidomide. Thus, \n\n\n\nthis study is to examine haematological and thromboembolic AEs reported during treatment with \n\n\n\nlenalidomide in MM and to assess the severity of the AEs. \n\n\n\nThe study design was a retrospective analysis of reports of haematological AEs during MM therapy \n\n\n\nwith lenalidomide reported to the Adverse Drug Reaction Centre, Siriraj Hospital during January \n\n\n\n2013 to June 2014. Data were presented in terms of descriptive statistics such as percentage, \n\n\n\nfrequency and median. The severity of haematological adverse effects was graded by using Common \n\n\n\nTerminology Criteria for Adverse Events (CTACE) criteria. There were 17 patients with a median age \n\n\n\n64 years using lenalidomide for MM. A median dose of lenalidomide was 25 mg daily. Fourteen \n\n\n\n(82.35%) of them were male. We found anemia in 10 patients (58.82%), neutropenia in 8 patients \n\n\n\n(47.06%) and thrombocytopenia in 6 patients (35.30%). Grade-3 neutropenia was reported in 4 \n\n\n\npatients on 2\nnd\n\n\n\n \u2013 5\nth\n months whereas grade-3 thrombocytopenia was found in one patient after \n\n\n\ninitiating lenalidomide for 4 months. For anemia event, it was found only grade 1-2 in 10 patients \n\n\n\nduring 2\nnd\n\n\n\n \u2013 3\nrd\n\n\n\n months of lenalidomide therapy. None of thromboembolic event was observed. \n\n\n\nIn conclusion, haematologic AEs were common adverse effect during treatment with lenalidomide. \n\n\n\nThey occured in 30-60% and the severity was graded as level 1 to level 3. No thromboembolic event \n\n\n\nwas observed.  Regarding the results, complete blood counts should be especially monitored every \n\n\n\nweek for the first 2 months during treatment with lenalidomide. \n\n\n\n\n\n\n\n\n\n\n\nHPP 50 \nFAPA2014000273 (Poster) \n\n\n\nDrug Utilization of Rabies Virus Vaccine in Outpatients in a Medical Centre of Taiwan \n\n\n\nCP Hsin, CF Chen, ML Yao, WY Lee \n\n\n\nDepartment of Pharmacy, Mackay Memorial Hospital, Taipei, Taiwan \n\n\n\n\n\n\n\nThere was rabies-free status for several decades of Taiwan until July, 2013. The experience for proper \n\n\n\nhandling of rabies vaccines is a lacked of new staff for years. This study aimed to assess the clinical \n\n\n\nrabies vaccines usages in a medical centre of Taiwan. This retrospective study analyzed the \n\n\n\ndemographic data of patients who received rabies vaccination from July 2013 to January 2014. Data \n\n\n\ncollected include the age, gender, racial group, medical visit department, visiting times, exposure \n\n\n\nstatus and vaccination dosage. A total of 755 cases were included, female vs. male was 39.1% vs. \n\n\n\n60.9% and 42.5% self-payment cases involved. The age structure of population were 1-20 \n\n\n\nyears  (7.5%), 21-40 years (43.3%), 41-64 years (42.1%) and 65-96 years (7.9%). 34% (257/755) of \n\n\n\ncases were used for pre-exposure immunization. 81.7% clinical application fit the WHO guidelines. \n\n\n\n\n\n\n\n\n54.1% cases were prescribed for pre-exposure immunization, like veterinarians, animal control \n\n\n\nspecialists, etc. Self-protection issues were 36.5% and traveler 4.7%. Completed standard \n\n\n\nvaccinations were 46.6% cases. The majority of cases with post-exposure prophylaxis were bitten by \n\n\n\ndogs (62.8%). Another animals included cats (18.2%), mice and rats (14.2%), squirrels (2.2%), ferret \n\n\n\nbadgers (0.8%), monkeys (0.8%), miscellaneous (0.8%) and unknown (0.2%). Only 4 cases without \n\n\n\nfit the WHO guidelines because their bite wound were classified as level one.  In conclusion, this \n\n\n\nstudy presented that most cases fit the guidelines for rabies vaccinations. These evidence data reveal \n\n\n\nwithout any psychological impact of fear in Taiwan. \n\n\n\n\n\n\n\n\n\n\n\nHPP 51 \nFAPA2014000064 (Poster) \n\n\n\nAflibercept-Induced Hyperpigmentation in Patient with Metastatic Colorectal Cancer \n\n\n\nCY Shih\n1\n, CL Hu\n\n\n\n2\n, CK Huang\n\n\n\n3\n  \n\n\n\n1,2\nDepartment of Pharmacy, Tainan Municipal Hospital, Taiwan \n\n\n\n3\nDirector, Department of Pharmacy, Tainan Municipal Hospital, Taiwan \n\n\n\n\n\n\n\nThis paper is to report a case of hyperpigmentation associated with Aflibercept. The 45-year-old \n\n\n\nwoman with colon cancer, cTxNxM1, stage IV. The patient was treated with targeted cancer therapy \n\n\n\n(bevacizumab or cetuximab) in combination with traditional chemotherapy for five years and did not \n\n\n\nnotice any adverse effect. Due to tumor marker elevated and the doctor changed regimen to \n\n\n\naflibercept (5 mg/kg) in combination with FOLFIRI (irinotecan 180mg/m\n2\n, folinic acid 400mg/m\n\n\n\n2\n and \n\n\n\nfluorouracil 2600mg/m\n2\n) biweekly. After the third chemotherapy cycle, she noticed extensive \n\n\n\npigmental changes, cracked and flaking on the palms and the soles. Topical urea and mometasone \n\n\n\ncream was given for symptom relief and the patient still follow up in our OPD. Cutaneous \n\n\n\nhyperpigmentation is a common drug induced adverse effect on targeted cancer therapy such as \n\n\n\nepidermal growth factor receptor (EGFR) inhibitors but it is rare in vascular endothelial growth factor \n\n\n\nreceptor (VEGFR) inhibitor. Aflibercept is a VEGFR antagonist, and the most frequent adverse events \n\n\n\nwere hypertension, proteinuria, and headache. The mechanism of drug-induced hyperpigmentation is \n\n\n\nunclear, but it may to be interference of EGFR signaling in the skin. We speculate that EGFR-VEGFR \n\n\n\npathway cross-talk may contribute to aflibercept induced hyperpigmentation. In addition, the patient \n\n\n\nwas administered FOLFIRI before and wasn\u2019t noticed of any skin adverse effect. Using of the \n\n\n\nNaranjo probability scale in this patient, there is a probable relationship (Naranjo score= 4) between \n\n\n\naflibercept use and the skin adverse reaction. In conclusion, clinically, we need to rely on anecdotal \n\n\n\ncase reports, and postmarketing surveillance data to assess the incidence of rare adverse drug reaction. \n\n\n\nWe expect new diagnosis and treatment could provide more precisely to relieve the drug induced skin \n\n\n\nadverse reaction. \n\n\n\n\n\n\n\n\n\n\n\nHPP 52 \nFAPA2014000276 (Poster) \n\n\n\nEffectiveness of Computerized Decision Support System in Preventing Inappropriate Pill \n\n\n\nSplitting of Prescription Medications \n\n\n\n CC Hsu\n1\n, CL Chou\n\n\n\n1\n, CC Ho\n\n\n\n1\n, CY Li\n\n\n\n2\n, YC Chou\n\n\n\n1\n \n\n\n\n1\nDepartment of Pharmacy, Taipei Veterans General Hospital, Taipei, Taiwan \n\n\n\n2\nComputer center, Taipei Veterans General Hospital, Taipei, Taiwan \n\n\n\n\n\n\n\nTo reduce inappropriate pill splitting, we developed an automatic interruptive alert system linked to a \n\n\n\ncomputerized physician order entry (CPOE) system for special oral formulation drugs in outpatient \n\n\n\nsettings. In this study, our aim is to examine the impact of the alert system in the prescribing process \n\n\n\n\n\n\n\n\nand the effect of the warnings of inappropriate pill splitting. All prescriptions from the CPOE system \n\n\n\nwere collected and used as a retrospective before-and-after design to analyze the ambulatory \n\n\n\nprescriptions from January 1, 2010 through May 31, 2010 (baseline period) and from June 1, 2010 \n\n\n\nthrough August 31, 2011 (intervention period). During the intervention period, any change in a \n\n\n\nprescription in response to an alert would be logged and analyzed. There were 34 different drugs with \n\n\n\nspecial oral formulations in this study. During the 15-month intervention period, 909 alerts for 26 \n\n\n\nkinds of drugs were triggered. We observed a rapid and sustained decrease in the monthly alert rates \n\n\n\nof inappropriate splitting after the implementation of this alert system. The rate of inappropriate \n\n\n\nprescriptions dropped from 0.61% (703/116,088) in the baseline period to 0.16% (186/114,637) in the \n\n\n\nlate post-implementation period (incidence rate ratio 0.27, 95% CI 0.23-0.31, P<0.001). Of the \n\n\n\nprescriptions which triggered alerts, 24.6% (224/909) were prescribed by cardiologists, 15.5% \n\n\n\n(125/909) by psychiatrists and 11.9% (108/909) by endocrinologists. The three drugs with the highest \n\n\n\nnumber of alerts were alprazolam ER tab 0.5 mg (22.2%, 202/909), fluvastatin ER tab 80 mg (18.8%, \n\n\n\n171/909) and paliperidone ER tab 3 mg (6.9%, 63/909). In conclusion, we showed that a \n\n\n\ncomputerized decision support intervention can be highly effective in reducing the number of \n\n\n\nprescriptions with inappropriate pill splitting. We encourage the establishing of such a warning \n\n\n\nsystem with specified targets and straightforward alerts in order to prevent inappropriate pill splitting \n\n\n\nin CPOE systems. \n\n\n\n\n\n\n\n\n\n\n\nHPP 53 \nFAPA2014000056 (Poster) \n\n\n\nA Case of Improper Treatment Course: Baclofen for Hiccups \n\n\n\nCK Huang\n1\n, YN Lin\n\n\n\n2\n \n\n\n\n1\nDirector Department of Pharmacy, Tainan Municipal Hospital Taiwan \n\n\n\n2\nDepartment of Pharmacy, Tainan Municipal Hospital Taiwan \n\n\n\n\n\n\n\nBaclofen is generally used as a muscle relaxant, and used for hiccups is an off-label indication. It \n\n\n\ndoesn\u2019t often think that it can be used to treat hiccups at first sight and there is no alertness for long-\n\n\n\nterm use. A 87-year-old male was treated with baclofen for hiccups (2.5mg three times daily from \n\n\n\nOctober 8, 2012). He didn\u2019t take any drug associated with hiccups such as corticosteroids or \n\n\n\nbenzodiazepines, but had many potential causes of hiccups: esophagus ulcer, gastroesophageal reflux \n\n\n\ndisease and nasogastric feeding. The physician could not ensure the cause and prescribed baclofen for \n\n\n\nabout one year. However, a pharmacist visit showed the frequency of hiccups already reduced and \n\n\n\ndidn\u2019t affect the sleep quality as well as nutrition. Even no considerable adverse drug effects, the \n\n\n\nphysician accepted our suggestion to discontinue baclofen on October 4, 2013. Short bouts of hiccups \n\n\n\n(\u226448 hours) don\u2019t require a medical evaluation. Persistent (>48 hours and \u22641 month) and intractable \n\n\n\n(>1 month) hiccups may necessitate a medical evaluation. Baclofen, an analog of \u03b3-aminobutyric acid \n\n\n\n(GABA), can decrease the excitability and inhibits the hiccup reflex. However, the symptomatic \n\n\n\ntreatment should not be long-term used even though there is no definitive treatment course. To \n\n\n\nconclude, not only baclofen, many drugs such as metoclopramide used for hiccups is an off-label use; \n\n\n\neven if chlorpromazine is approved by Food and Drug Administration (FDA), it may also be thought \n\n\n\nof as sleep aids or antipsychotics. This case has been published on Taiwan Pharmacist\u2019s Weekly \n\n\n\nNews to arouse the attention of all pharmacists. \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nHPP 54 \nFAPA2014000112 (Poster) \n\n\n\nPerlis Warfarin Clinic: A Study on the Effects of Evolution in the Model of Care \n\n\n\nY Choe, AH Baharudin, HC Harun, UA Halim, HY Lim, S Ismail, MI Ismorning, N Rohani, \n\n\n\nJSK Wong, KLF Wee, A Hashim \nDepartment of Pharmacy, Hospital Tuanku Fauziah, Perlis, Malaysia \n\n\n\n\n\n\n\nManagement of oral anticoagulation therapy was previously done by doctors (usual medical warfarin \n\n\n\nclinic, UMWC). In 2008, pharmacist assisted warfarin clinic (PAWC) was initiated in Hospital \n\n\n\nTuanku Fauziah which then evolved to pharmacist managed warfarin clinic (PMWC) in 2011. This \n\n\n\nstudy was to compare the effectiveness of evolution in model of care initiated by the pharmacists in \n\n\n\ntime in therapeutic range (TTR), international normalised ratio (INR) control and time in high risk \n\n\n\nINR. This retrospective cohort study recruited 64 patients on warfarin therapy who were managed \n\n\n\nthrough three different models of care (UMWC, PAWC and PMWC). Medical records and \n\n\n\nMedication Therapy Adherence Clinic Warfarin Follow-up Visit Forms were reviewed to investigate \n\n\n\nthe INR amongst the patients over five years (2007-2012). The primary endpoints were TTR, INR \n\n\n\ncontrol (poor = TTR <60%, moderate = TTR 60-75% and good = TTR >75%) and time in high risk \n\n\n\nINR (INR <1.5 and INR >4.5). ANOVA test was used for numerical data while Chi-square test was \n\n\n\nused for categorical data. Post-hoc tests were done for significant results. Results showed that the \n\n\n\nmean TTR of the two new models (PAWC =56.65%; PMWC =59.12%) were higher than UMWC \n\n\n\n(34.18%) (p <0.001 for all). However, there was no significant difference between PAWC and \n\n\n\nPMWC in mean TTR. There were significant association between INR control and model of care \n\n\n\n(p=0.023). UMWC had more patients in poor INR control (78.13%) than PAWC (54.69%) and \n\n\n\nPMWC (57.81%) (p<0.05 for all). There were no significant difference in time in INR >4.5 among \n\n\n\nthe three models. However, UMWC had significantly higher percentage of time in INR <1.5 as \n\n\n\ncompared to PAWC and PMWC (p<0.001). Two new models were more effective than UMWC. \n\n\n\nHowever, PMWC was no superior to PAWC which might be due to other factors that were not \n\n\n\ncontrolled in the practice. \n\n\n\n\n\n\n\n\n\n\n\nHPP 55 \nFAPA2014000240 (Poster) \n\n\n\n\n\n\n\nIdentifying and Evaluating Potential Drug-Related Problems: Medication Review in Elderly \n\n\n\nResidents of a Care Home \n\n\n\n\n\n\n\nCS Chong, D Chong, SWH Lee \n\n\n\nSchool of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia \n\n\n\n\n\n\n\nElderly patients are vulnerable to medication misadventure from risks including inappropriate \n\n\n\nprescribing, polypharmacy, frailty, cognitive and physical disability. Periodic medication review has \n\n\n\nsignificant impact on identifying and improving patient outcomes, but data on its impact is relatively \n\n\n\nscarce in Malaysia. The Beers criteria have been used to promote safer prescribing in the elderly, \n\n\n\nwhilst various screening criteria are used to guide medication review. The aim of this pilot study was \n\n\n\nto compare the performance of the Screening Tool of Older Person\u2019s potentially inappropriate \n\n\n\nPrescription (STOPP) and the Beer\u2019s Criteria in detecting potentially inappropriate medicines (PIMs) \n\n\n\nand related adverse drug events (ADEs) in elderly residents of a care home. Medication review was \n\n\n\nundertaken for 20 residents at a residential home. Medication related problems were identified using \n\n\n\nthe STOPP and Beer\u2019s criteria. PIMs with clear causal correlations or contribution to the principal \n\n\n\nreason were documented. The mean age of study subjects was 64 years (range 48-85). The total \n\n\n\nnumber of prescribed medications was 96.  More than two thirds of subjects had two or more \n\n\n\ndocumented co-morbidities. The STOPP criteria identified 16 PIMs affecting 13 subjects. The most \n\n\n\nfrequently encountered PIM was the use of anti-cholinergics to treat extrapyramidal side effects of \n\n\n\n\n\n\n\n\nneuroleptic drugs. The Beers\u2019 criteria identified 22 PIMs in 11 subjects, and the most frequently \n\n\n\nencountered PIM was short-acting benzodiazepines. A high proportion of study subjects were \n\n\n\nprescribed at least one potentially inappropriate medicine.  As the tools use different criteria, they can \n\n\n\nbe used in a complementary manner, but may also be synthesized and tested in the Malaysian setting, \n\n\n\nwith a view to informing prescribing practice for the elderly. \n\n\n\n\n\n\n\n\n\n\n\nHPP 56 \nFAPA2014000274 (Poster) \n\n\n\nBar-Code Technology Implementation on Paediatric Vaccines to Reduce Dispensing Error \n\n\n\nCW Tu, ML Yao, CF Chen, WY Lee  \n\n\n\nDepartment of Pharmacy, Mackay Memorial Hospital Taipei, Taiwan \n\n\n\n\n\n\n\nThe management of paediatric medications is important and crucial for the patient safety in the \n\n\n\nclinical practice. To collect the administration record, clarify with similar packaging with different \n\n\n\nmedications and distinguish the paediatric vaccine with different drug are major jobs for pharmacists. \n\n\n\nImplement the information technology on pharmaceutical practice may reduce the medication error. \n\n\n\nUnfortunately, some drugs did not have bar-code label in Taiwan. This study implements the bar-code \n\n\n\ninto the paediatric vaccine which did not have bar-code label to prevent medication errors. We build \n\n\n\nlabel sticker with bar-code to assist the paediatric vaccines in medication dispersion in Mackay \n\n\n\nMemorial Hospital. The labels would stick on the package and the bar-code information includes the \n\n\n\nproduct code, batch number and expiry date. During the dispensing process, pharmacist could scan the \n\n\n\nbar-code on the vaccine drug bag printed by the order and then scan the bar-code label sticker on the \n\n\n\ndispensing vaccine to determine if bar-code matches. The delivery rate progressively increased from \n\n\n\n2013 April (61%) till December (89.7%). There is no medication error in paediatric vaccine since the \n\n\n\nbar-code technology implemented. In addition, nurse can record the batch number by bar-code system \n\n\n\nfor the vaccine to be injected. The bar-code system not only records the required information \n\n\n\nefficiently but also reduces the dispensing error. This study found that no medication error since the \n\n\n\nsystem was introduced. The bar-code system also saves the time for medications checking. It \n\n\n\ndecreased the risk of medication delivery error. In addition, the pharmacists may manage some \n\n\n\nadministration data easier. This system decreased medication error and improved patient safety. \n\n\n\n\n\n\n\n\n\n\n\nHPP 57 \nFAPA2014000185 (Poster) \n\n\n\nEvaluation of Beneficial Effect in Adding the Nilavembu Kudineer Chooranam (Siddha \n\n\n\nFormulation) to Metformin in Treatment of Type 2 Diabetes Mellitus \n\n\n\nD Raja\n1\n, PRA Vijaykumar\n\n\n\n1\n, A Jose\n\n\n\n1\n, ES Abhraham\n\n\n\n1\n, C Oommen\n\n\n\n1\n, P Baby\n\n\n\n1\n, P Vijayan\n\n\n\n2  \n \n\n\n\n1\nDepartment of Pharmacy Practice, JSS College of Pharmacy, Ooty (A Constituent college of JSS \n\n\n\nUniversity, Mysore), India \n2\nDepartment of Pharmaceutical Biotechnology, JSS College of Pharmacy, Ooty, (A Constituent \n\n\n\nCollege of JSS University, Mysore), India \n\n\n\n\n\n\n\nThe guidelines for the management of type 2 diabetes given by the Indian Council for Medical \n\n\n\nResearch, strongly recommend research and careful evaluation of indigenous system and the \n\n\n\npossibility of drug\u2013herb interaction. Similarly, the American Diabetes Association (ADA) currently \n\n\n\ndoes not have any specific guidelines for the use of Complementary and Alternative Medicine (CAM) \n\n\n\nin patients with diabetes but has acknowledged its use in lieu of patients\u2019 interest.  Nilavembu \n\n\n\nKudineer Chooranam (NKC) (ingredients: each 100 g contains: Andropraghis paniculata 11.1g, \n\n\n\nVetiveria zizanoides 11.1g, Coleus ambonicus 11.1g, Santalum album 11.1g, Tricosanthes \n\n\n\n\n\n\n\n\ncucumerina 11.1g, Cyperus rotundus 11.1g, Zingiber offcinale 11.1g, Piper nigrum 11.1g, Mollugo \n\n\n\ncerviana 11.2 g) is one of the Siddha formulation available at Siddha unit which is used in treating \n\n\n\ntype 2 diabetes patients at government hospitals in Tamilnadu, India. There are no reports available on \n\n\n\nthe pharmacodynamic effects of NKC when given alone and along with metformin. A prospective \n\n\n\nopen label study was performed at the Government District Headquarters hospital, Ooty, Tamilnadu, \n\n\n\nIndia. The fasting plasma glucose, postprandial plasma glucose, lipid profiles, blood pressure, HbA1c, \n\n\n\nserum creatinine and urine albumin levels were measured at baseline and at regular intervals for a \n\n\n\nperiod of 3 months.  Results showed that during the follow-up periods, the NKC exhibited statistically \n\n\n\nand clinically significant antidiabetic effect by reducing the HbA1c levels. This was comparable with \n\n\n\nthe effect of metformin. Similarly the NKC + metformin combination caused significant HbA1c \n\n\n\nreduction as that of metformin + glibenclamide group. The serum creatinine, urine albumin levels \n\n\n\nremained unchanged significantly.  In conclusion, the nilavembu kudineer chooranam was found to be \n\n\n\neffective as an antidiabetic agent and can be used in combination with metformin for treating type 2 \n\n\n\ndiabetes. \n\n\n\n\n\n\n\n\n\n\n\nHPP 58 \nFAPA2014000119 (Poster) \n\n\n\nA Retrospective Comparison of the Mortality of Critically Ill Patients Receiving Prolonged and \n\n\n\nStandard Infusion of Meropenem  \n\n\n\nH Fahmi\n1\n, AA Noorizan\n\n\n\n2\n, H Yahaya\n\n\n\n2\n \n\n\n\n1\nPharmaceutical Services Division, Ministry of Health, Malaysia \n\n\n\n2\nFaculty of Pharmacy, Department of Pharmacy Practice, Universiti Teknologi MARA, Malaysia \n\n\n\n\n\n\n\nMeropenem is one of the most widely used antibiotics for treatment of serious bacterial infection in \n\n\n\nseptic patients. Since meropenem is a beta-lactam antibiotic, it exhibits the bactericidal effect with \n\n\n\ntime-dependent activity. Theoretically, the longer the infusion time, the longer the concentration of \n\n\n\nmeropenem will remain above a pathogen\u2019s minimum inhibitory concentration (MIC) thus increasing \n\n\n\nthe efficacy of the drug. Thus, the objective of this study is to compare the mortality rate of critically \n\n\n\nill patients with sepsis receiving 30 minutes and 3-hour meropenem infusion. A retrospective cohort \n\n\n\nand cross-sectional study was conducted among septic patients treated with meropenem infusion in \n\n\n\nIntensive Care Unit of three hospitals in Malaysia. Patients included in the study received either 30 \n\n\n\nminutes or 3-hour infusion of meropenem as per practice of individual settings. Outcomes and clinical \n\n\n\ndata were retrospectively collected from the electronic databases and patients\u2019 file from the record \n\n\n\ndepartments of individual settings. A total of 1975 patients received meropenem infusion during their \n\n\n\nadmission in the ICUs. 11.4% of the selected samples met the inclusion criteria of the study and were \n\n\n\nincluded in the analysis. From the 225 subjects, 108 patients received 3-hour infusion of meropenem \n\n\n\nwhile the remaining 117 patients received 30-minute infusion of meropenem. Patients receiving the \n\n\n\nprolonged infusion of meropenem were found to have lower mortality rate compared to those \n\n\n\nreceiving the standard infusion of meropenem (64.1% vs. 49.1%, p=0.16). Regression analysis of the \n\n\n\ndata showed that infusion time and patients\u2019 age significantly confounded the mortality outcome of \n\n\n\nthe studied patients. This study would be able to strengthen the evidence in using prolonged infusion \n\n\n\nof meropenem as a standard practice in critical care settings in Malaysia. Prolonged infusion of \n\n\n\nmeropenem seems to have equal efficacy if not superior to the standard infusion of meropenem. \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nHPP 59 \nFAPA2014000084 (Poster) \n\n\n\nKnowledge, Attitude and Vaccination Status of Influenza among Healthcare Workers \n\n\n\nH Rashwan\n1\n, I Isahak\n\n\n\n2\n \n\n\n\n1\nFaculty of Pharmacy, Universiti Teknologi MARA, Malaysia \n\n\n\n2\nFaculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Nilai, Malaysia  \n\n\n\n\n\n\n\nHealth care workers play an important role in providing health care directly to the patient. Thus \n\n\n\nvaccination of influenza by the health care workers is essential to prevent spreading of the disease to \n\n\n\nthem and also to patients. The objectives of this study were to evaluate the level of knowledge, \n\n\n\nattitude towards work practices and influenza vaccination status among healthcare workers. This \n\n\n\ncross-sectional survey was conducted in March and April 2004. It involved 800 respondents among \n\n\n\nhealthcare workers in Hospital University Kebangsaan Malaysia (HUKM) in Kuala Lumpur. Results \n\n\n\nrevealed low level of knowledge about influenza among healthcare workers with average score of \n\n\n\n63.2%. There was no correlation (p>0.05) between level of knowledge and gender, but there was \n\n\n\nsignificant difference (p<0.05) based on age, level of education, and occupations. Attitude of health-\n\n\n\ncare workers towards work practices and the risk of influenza infection were at low levels with \n\n\n\naverage score of 56.3%. There were significant differences (p<0.05) between attitude among \n\n\n\nhealthcare workers with occupations, and level of knowledge about influenza. The overall influenza \n\n\n\nvaccination rate among health-care workers was low, only 264 (33.0%) of respondents had received \n\n\n\ninfluenza vaccination. Influenza vaccination was highest among healthcare workers with high level of \n\n\n\nattitude (72.8%). In conclusion, more educational programs on influenza and its preventive measures \n\n\n\nincluding infection control measures and importance of annual vaccination need to be introduced to \n\n\n\nincrease the level of knowledge among healthcare workers.    \n\n\n\n\n\n\n\n\n\n\n\nHPP 61 \nFAPA2014000068 (Poster) \n\n\n\nMedical Warehouse Room Quality Indicator Management Monitoring \n\n\n\nHH Lin\n1, 2\n\n\n\n, WH Chen\n1, 2\n\n\n\n, YY Chu\n3\n, YL Lee\n\n\n\n1, 2\n, YC Hung\n\n\n\n1, 2\n, PL Chen\n\n\n\n1, 2 \n\n\n\n1\nPharmacy Department of Tungs\u2019 Taichung MetroHarbor Hospital, Taichung, Taiwan \n\n\n\n2\nTaichung Country Pharmacist Association, Taiwan \n\n\n\n3 \nInternal Medicine Department of Tungs\u2019 Taichung MetroHarbor Hospital, Taichung, Taiwan \n\n\n\n\n\n\n\nMedical warehouse room management system is related to hospital business operation due to the \n\n\n\ncompetitiveness in our healthcare system. Using indicators management approach that allow the \n\n\n\nadministrators to control and regulate drug inventory, ensure the normal supply of medicines to \n\n\n\nprevent the pile-up of excess and unnecessary stocks or expired medications that affect safety of the \n\n\n\npatient. The purpose of this study is to determine the necessary basic indicators then 2 year \n\n\n\ncomparison evaluate their effectiveness and their threshold (independent T-test). Data were collected \n\n\n\nfrom January 2012 to December 2013. These include monthly inventory indicator management and \n\n\n\nmonitoring thresholds in each month. As a result, six indicators were identified and these are: 1. \n\n\n\ndelayed in supply by manufacturers rate, 2. shortage of drug products from manufacturers rate, 3. \n\n\n\ninventory error rate, 4. narcotic drugs turnover ratio, 5. drug warehouse turnover ratio and 6. lending \n\n\n\ndrugs from medical warehouse room in out-patient and in-patient department pharmacy. All the \n\n\n\nresults of these indicators are within the threshold range. However, in one occasion where ratio of \n\n\n\nlending drugs in between out-patient and in-patient department pharmacy was noted to have exceeded \n\n\n\nthe threshold range. Comparing the year 2012 and 2013 there is a significant difference [p=0.002], \n\n\n\nmean 2.115 (95% CI-1.0395-0.2689) in delay in drug delivery rate. Problems the administrator needs \n\n\n\nto face are higher rates of drug shortage during Chinese New Year festival, excessive use of some \n\n\n\n\n\n\n\n\nrestricted drugs with limited supply and long holidays when most pharmaceutical companies were \n\n\n\nclosed. Another problem facing the medical warehouse unit is the government-owned national health \n\n\n\ninsurance which control and regulate the price of the medicines that can affect the budget of the \n\n\n\nhospital. Most hospitals will do the necessary adjustments to negotiate with the drug companies to \n\n\n\nreduce the cost of medicines. \n\n\n\n\n\n\n\n\n\n\n\nHPP 62 \nFAPA2014000087 (Poster) \n\n\n\nPalivizumab Injection Use and Safety Assessment of a Medical Centre in Taiwan \n\n\n\nHL Lin, LJ Hsu, SP Ng, SY Chien \nDepartment of Pharmacy, Changhua Christian Hospital, Changhua, Taiwan \n\n\n\n\n\n\n\nRespiratory syncytial virus (RSV) is the leading cause of lower respiratory tract infections in infants \n\n\n\nand young children, especially in children under 2 years. Currently there is no specific treatment for \n\n\n\nRSV infection, mainly with supportive therapy. Palivizumab is a humanized monoclonal antibody \n\n\n\n(IgG1) which inhibits RSV activity, indicated for prevention of serious lower respiratory tract disease \n\n\n\ncaused by RSV. Taiwan's Ministry of Health and Welfare has approved palivizumab for prophylaxis \n\n\n\nin high-risk infants, which included infants with bronchopulmonary dysplasia (BPD), premature \n\n\n\ninfants (\u226435 weeks\u2019 gestation) and hemodynamically significant congenital heart disease (CHD). We \n\n\n\nretrospectively analyzed the efficacy and safety of palivizumab use in our hospital. We selected \n\n\n\ninfants born during July 2011 to April 2014 and have completed 6 doses of palivizumab. We extracted \n\n\n\ndata for 24 months for each infant. Data was collected from electronic patient record on demographic, \n\n\n\nreadmission indication, length of stay (LOS) and side-effects. A total of 41 premature infants (21 male \n\n\n\nand 20 female) were included. 39 (95%) infants were \u226428 weeks\u2019 gestation, among them, 17 (44%) \n\n\n\ninfants associated with chronic lung disease (CLD). Two (5%) infants were \u226435 weeks\u2019 gestation \n\n\n\nconcomitant with CLD. All of our cases were without CHD. The readmission was 47 patient visit, the \n\n\n\naverage of 1.1 patient visit. Readmission related to respiratory disease was 25 patient visit (53%), the \n\n\n\naverage LOS was 6.2 days, unrelated to respiratory disease was 22 patient visit (47%) with the \n\n\n\naverage LOS 5.5 days. The survival rate within 24 months was 100%. The main side effects of \n\n\n\npalivizumab were injection side reaction and mild fever.  Palivizumab is currently the only medication \n\n\n\nused to prevent serious lower respiratory tract disease caused by RSV infection. Our results show that \n\n\n\npalivizumab is safe and effective in preventing RSV infection in high risk patients.  \n\n\n\n\n\n\n\n\n\n\n\nHPP 63 \nFAPA2014000089 (Poster) \n\n\n\nIncrement of Grade 3 or 4 Adverse Reaction Reporting Rate from Chemotherapy Agents \n\n\n\nHJ Lin, CH Lee, LT Peng, YC Su, MH Chuang \n\n\n\nDalin Tzu Chi General Hospital, Chiayi Country, Taiwan \n\n\n\n\n\n\n\nAdverse drug reaction (ADR) monitoring is often as one of the hospital's risk management program. \n\n\n\nAccording to previous literature, chemotherapy induced Grade 3 or 4 ADRs of hematologic toxicity \n\n\n\nwas approximately 16%. However, the same reporting rate was only 0.08% at a regional teaching \n\n\n\nhospital in Southern Taiwan. Chemotherapy induced grade 3 or 4 ADRs were defined by the NCI \n\n\n\nCommon Terminology Criteria. Data was collected retrospectively from ADR reporting system from \n\n\n\nJanuary to December 2012. Some interventions were conducted based on the reasons of unwilling \n\n\n\nreporting tendency from the health care professionals. The informative systems integrated the \n\n\n\ncommunication between doctors and pharmacists. Physicians can actively assess patients\u2019 conditions \n\n\n\nthrough the CPOE system based on NCI criteria. After completion the evaluation from physicians, the \n\n\n\n\nhttp://www.rxlist.com/script/main/art.asp?articlekey=4425\n\n\nhttp://www.rxlist.com/script/main/art.asp?articlekey=4425\n\n\nhttp://www.rxlist.com/script/main/art.asp?articlekey=6568\n\n\n\n\n\n\nCPOE system will then automatically send the informed messages over circular note system to \n\n\n\npharmacists. In addition, an e-Learning program was established as the pharmacist training courses by \n\n\n\nMoodle platform. Moreover, a standard detection process of abnormal clinical laboratory value was \n\n\n\ndesigned for pharmacists. Grade 3 or 4 ADRs reporting rate were studied before and after the \n\n\n\ninterventions. Six months after interventions, 149 ADRs were reported; 149 reports were submitted to \n\n\n\nTFDA. During the study period, physicians and pharmacists voluntarily reported 149 ADRs detected \n\n\n\nusing this automated system. Compared with before, only 21 ADRs was identified using traditional \n\n\n\ndetection methods. The Grade 3 or 4 ADR reporting rate of chemotherapy agents was significantly \n\n\n\nincreased from 0.08% to 0.87% (p=0.0000003). The integration system enables automated detection \n\n\n\nof ADRs during clinical practice stage. In this study, the physician ADR reporting rate was \n\n\n\nsuccessfully increased. In the future, pharmacist circular note system will combine with the nurse \n\n\n\nassessment system to increase the whole reporting rate. \n\n\n\n\n\n\n\n\n\n\n\nHPP 64 \nFAPA2014000058 (Poster) \n\n\n\n\n\n\n\nSimvastatin/Ezetimibe Induced Hand Eczema \n\n\n\n\n\n\n\nLT Hsu\n1\n, CK Huang\n\n\n\n1\n, SF Huang\n\n\n\n2\n \n\n\n\n1\nDepartment of Pharmacy, Tainan Municipal Hospital, Taiwan \n\n\n\n2\nDepartment of Pharmacy, Chi Mei Hospital, Chiali, Taiwan \n\n\n\n\n\n\n\nThe combination of a statin with ezetimibe, acting as a dual inhibition mechanism against the \n\n\n\nsynthesis and absorption of cholesterol, reduces LDL-cholesterol significantly more than treatment \n\n\n\nwith a statin in monotherapy. A drug combination comprising ezetimibe 10 mg and simvastatin 20mg \n\n\n\nhas been introduced into the market in Taiwan. Ezetimibe and simvastatin had proven to be a well-\n\n\n\ntolerated, effective lipid-lowering drug combination. In addition to rash, adverse effects about \n\n\n\ndermatologic had rarely been mentioned. Eczema was a common skin disease which had a variety of \n\n\n\netiology and morphology. Medication were unusually been suspected the etiology of eczema. This \n\n\n\ncase is about ezetimibe/simvastatin suspected the cause of hand eczema. This case is a 60-year-old \n\n\n\nwoman, with a history of hypertensive cardiovascular disease, dyslipidemia and carotid stenosis, had \n\n\n\nlong-term medication control with 6 items of cardiovascular medication including valsartan, \n\n\n\nfelodipine. Physicians started prescription rosuvastatin 10mg for hypercholesterolemia from 9 July \n\n\n\n2010 and then changed to ezetimibe/simvastatin 10/20mg for meeting the target of LDL in 22 July \n\n\n\n2012. After taking about four weeks, the patient\u2019s eyes and fingers became to swelling; then fingers \n\n\n\npeeled repeatedly. Contact dermatitis was diagnosed by dermatology physicians in LMD and \n\n\n\nhospitals. Multiple medications were prescribed but there were no significant improvement. Until Jun \n\n\n\n2013, she discontinued taking the suspected medication because of her friend\u2019s advice to medications \n\n\n\nmight be the cause. After ezetimibe/simvastatin was discontinued by herself, the symptoms of eyes \n\n\n\nand hands improved gradually. Though eczema was not life-threatening, it significantly affected the \n\n\n\npatient's quality of life and spends extra time and money. The patient found finally the true etiology \n\n\n\nunder the friend\u2019s reminder. So we suggested that the dermatologic symptom might be considered by \n\n\n\nmedications early, if it was not improved after standard therapy. \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nHPP 65 \nFAPA2014000069 (Poster) \n\n\n\nA Case Report of Suspected Inflammatory Polyarthritis and Delayed Infusion Reaction After \n\n\n\nTrastuzumabTherapy \n\n\n\nHC Lo\n1\n, CL Hu\n\n\n\n1\n, YC Lee\n\n\n\n2\n \n\n\n\n1\nDepartment of Pharmacy, Tainan Municipal Hospital, Taiwan \n\n\n\n2\nDivision of Hemato-Oncology, Department of Internal Medicine, Tainan Municipal Hospital, Taiwan \n\n\n\n\n\n\n\nWe describe a case report of suspected trastuzumab-induced inflammatory polyarthritis and delayed \n\n\n\ninfusion reaction. 46 year-old female was diagnosed with breast cancer in 2012. She received right \n\n\n\nmodified radical mastectomy, which demonstrated right breast invasive ductal carcinoma, pT2N2, \n\n\n\nstage IIA, ER, PR (+), HER2/neu=3+. She received adjuvant chemotherapy docetaxel plus epirubicin \n\n\n\nand cyclophosphamide in 6 cycles and followed by tamoxifen 10mg bid daily and trastuzumab \n\n\n\n(4mg/kg) therapy per 3 weekly. After seventh trastuzumab treatment, she developed fever with diffuse \n\n\n\narthralgia the next day. The symptom accompanied with chills, skin rash over her abdominal and \n\n\n\nback, dizziness and conjunctivitis (bilateral red eyes). The laboratory data were generally within \n\n\n\nnormal range except elevated white count, CRP and ESR. Bilateral hand, cervical spine X-ray showed \n\n\n\nnegative finding. Peripheral blood and Port-A blood culture were negative. Whole body CT didn't \n\n\n\ndiscover any obscured infection source. Echocardiography examination didn't support infection \n\n\n\nendocarditis. Systemic steroid had been prescribed and the fever, skin rash, arthragia and conjuntivitis \n\n\n\nsubsided. Due to no evidence of infection or tumor recurrent, we suspect the symptoms are \n\n\n\ntrastuzumab adverse effect related. (Naranjo score = 5). The mechanism of trastuzumab-induced \n\n\n\ninflammatory polyarthritis and delayed infusion reaction is unknown. According to patient\u2019s \n\n\n\ncondition, we guess it may be some factors induce these reactions, include antichimeric antibody \n\n\n\nproduced or a concomitant viral infection. Our opinion is that a relationship between trastuzumab and \n\n\n\nthe onset of inflammatory polyarthritis and delay infusion reaction is possible. Clinicians should be \n\n\n\nalert to the possibility of such adverse reactions. \n\n\n\n\n\n\n\n\n\n\n\nHPP 66 \nFAPA2014000268 (Poster) \n\n\n\nSuspect Ceftriaxone-Induced Neurologic Adverse Effects: Case Report \n\n\n\nHP Liu, MF Lin \n\n\n\nDepartment of Pharmacy, E-DA Hospital, Kaohsiung, Taiwan \n\n\n\n\n\n\n\nCeftriaxone is a third-generation cephalosporin commonly used in serious gram-negative infections. \n\n\n\nNeurological adverse effects resulted from cephalosporins include wide ranges of clinical \n\n\n\nmanifestations, such as a change in mental status or encephalopathy, and seizures. We describe a case \n\n\n\nthat developed encephalopathy and seizures after the use of ceftriaxone. A 74 year-old woman was \n\n\n\ndiagnosed with hypertension, chronic kidney disease and stroke with mild sequela. She suffered from \n\n\n\nshortness of breath for one week and admitted to ward under the impression of lung pneumonia on \n\n\n\nMarch 28, 2014. Ceftriaxone was administered intravenously 1g Q12H plus Azithromycin 500mg \n\n\n\nQD. She was transferred to ICU according to deterioration of respiratory function on March 29. Under \n\n\n\nrelatively stable condition, she was transferred to ward on April 1. Obvious involuntary movements of \n\n\n\nfour limbs, altered state of consciousness occurred since April 6. Under the suspicion of \n\n\n\nencephalopathy induced by ceftriaxone, antibiotic was shifted to ciprofloxacin 200mg Q12H. \n\n\n\nPsychiatrist recommended quetiapine 25-50mg PO before sleep and olanzapine 5mg injection as \n\n\n\nneeded. Generalized seizures occurred on April 9 and valproic acid 400mg was injected Q8H under \n\n\n\nthe suggestion of neurologist. Based on literature search, time-series association, only ceftriaxone has \n\n\n\npossibility to induce neurotoxicity. The patient's consciousness gradually improved on April 12. She \n\n\n\n\n\n\n\n\ndischarged on May 1 under relatively stable condition. Encephalopathy is a rare side effect of a third-\n\n\n\ngeneration cephalosporin. This adverse effect is common in the initial 10 days of ceftriaxone use, and \n\n\n\nalleviation within 2-7 days after discontinuation. In this case, state of consciousness was recovered \n\n\n\nand seizures were under control 6 days after discontinuation of ceftriaxone. This case reminds medical \n\n\n\nprofessionals to be aware of unusual behaviors followed by ceftriaxone use, in order to reduce the \n\n\n\npossible neurotoxicity. \n\n\n\n\n\n\n\n\n\n\n\nHPP 67 \nFAPA2014000061 (Poster) \n\n\n\nImpact of a Pharmacist Intervention on Medication Discrepancies and Clinical Outcome in \n\n\n\nHome Care \n\n\n\nHC Lo  \n\n\n\nDepartment of Pharmacy, Tainan Municipal Hospital, Taiwan \n\n\n\n\n\n\n\nMedication discrepancies are common among elderly patients using multiple drugs for the treatment \n\n\n\nof chronic diseases. The aim of this study was to investigate the occurrence of medication \n\n\n\ndiscrepancies in this population. An observational study involving 35 patients aged over 65 years at \n\n\n\nleast five prescriptions drugs and received home care service was conducted. A pharmacist faced to a \n\n\n\npatient or caregivers to discuss medication discrepancies. The mean (\u00b1 S.D.) number of medication \n\n\n\ndiscrepancies in this group was 1.5 (\u00b10.7). The discrepancy rate was 62.9 % and resolution rate was \n\n\n\n77.2 %. Medication discrepancies found using the medication discrepancy tool (MDT) were not to \n\n\n\nneed prescription (20%), financial barrier (5.7%), fear of adverse drug effects or knowledge \n\n\n\ndeficit (17.2%) and incorrect dosage (20%). The findings indicate that a pharmacist was effective in \n\n\n\nresolving medication discrepancies and potential preventing drug-related problems. An important task \n\n\n\nfor pharmacists is to identify, resolve, monitor, and prevent the occurrence of medication \n\n\n\ndiscrepancies among this patient group. Early interventions will have the best effects. \n\n\n\n\n\n\n\n\n\n\n\nHPP 68 \nFAPA2014000055 (Poster) \n\n\n\nAnalysis of the Styles and Pharmacological Classifications for Adverse Drug Reaction in a \n\n\n\nMedical University Hospital \n\n\n\nIC Chen, ML Tsai, YH Huang  \n\n\n\nDepartment of Pharmacy, Chung Shun Medical University Hospital, Taichung City, Taiwan \n\n\n\n\n\n\n\nADRs not only increase the cost of healthcare but also are one of the reasons causing high morbidity \n\n\n\nand mortality. In order to avoid the recurrence, ADRs were analyzed by seasons in Chung Shan \n\n\n\nMedical University Hospital (CSMUH). This study aimed to warn medical care staff of the ADRs, \n\n\n\npromote the safety of using drugs and prevent the occurrence toward ADRs. Pharmacists collected the \n\n\n\nADRs information then evaluated the relevance to drugs according to Naranjo Probability Score, \n\n\n\nchecked patients\u2019 medical histories, interviewed patients on the phone and discussed with medical \n\n\n\ncare staff. We divided ADRs into 15 styles according to the adverse effects, which were dermatologic, \n\n\n\nneurologic, gastrointestinal, cardiovascular, musculoskeletal, respiratory, haematologic, immunologic, \n\n\n\nhepatic, endocrine/metabolic, ophthalmic, psychiatric, renal, genitourinary and others. The 13 \n\n\n\npharmacology drug classifications for ADRs were anti-infective, muscular-skeletal, nervous, \n\n\n\nrespiratory, and cardiovascular system, alimentary tract and metabolism, blood and blood forming \n\n\n\norgans, anti-neoplastic and immune-modulating agents, genitourinary system and sex hormones, \n\n\n\nsystemic hormonal preparations, anti-parasitic products, sensory organs, and dermatologicals. A total \n\n\n\nof 427 ADR cases were identified from January to December in 2013. The final statistical results \n\n\n\n\n\n\n\n\nshowed the most common ADRs styles were dermatologic (235, 51%), neurologic (85, 19%) and \n\n\n\ngastrointestinal (45, 10%); the most common pharmacological classifications related to ADRs were \n\n\n\nanti-infective for systemic use (91, 21%), muscular-skeletal system (81, 18%) and nervous system \n\n\n\n(69, 16%). We can provide statistical analysis for medical care staff and set individual pharmaco-\n\n\n\nvigilance in medical order system to prevent patients from taking the same drug again. By the way of \n\n\n\npreventable ADRs through monitoring the high dangerous drugs, we elevate the quality of \n\n\n\npharmaceutical care, promote the usage of appropriate economic medicines and reduce the ADR-\n\n\n\nrelated hospitalizations. Our ultimate goal is to enhance drug safety and quality of life in order to \n\n\n\npromote public health. \n\n\n\n\n\n\n\n\n\n\n\nHPP 69 \nFAPA2014000202 (Poster) \n\n\n\nA Comparative Study of Changing Penfill Insulin to Conventional Syringe Insulin \n\n\n\nJ Aporn, J Nantikorn,  S Thanatcha \n\n\n\nDepartment of Pharmacy and Consumers Protection, Warinchumrab Hospital, Ubonratchathani, \n\n\n\nThailand \n\n\n\n\n\n\n\nDiabetes Mellitus (DM) is the health problem in Thailand. Patients with DM have to use insulin \n\n\n\ninjection lifelong although insulin injection is expensive. To reduce the direct medical costs, changing \n\n\n\nfrom penfill insulin injection (PII) to conventional syringe insulin (CSI) is very practical. This study \n\n\n\naimed to compare the blood glucose level and direct medical costs before and after changing from PII \n\n\n\nto CSI. This action research used before and after design. DM patients received PII during June to \n\n\n\nSeptember 2012 (Phase I) and changed to CSI during October 2012 to January 2013 (Phase II). The \n\n\n\ninclusion criteria were DM patients who received insulin injection for more than 1 year, had no \n\n\n\nlimitation of insulin injection, received counseling from pharmacist and had at least 2 blood sugar \n\n\n\nlevel tests before and after changing insulin injection. Only insulin injection cost was included. \n\n\n\nDuring phase I, 713 of 855 DM patients received PII (83.39%). The approximate time of disease was \n\n\n\n2.19 years and had insulin injection twice daily. During phase II, 720 DM patients received insulin \n\n\n\ntreatment. Of these, 364(50.56%) patients received PII and 114(15.83%) of these changed to CSI. \n\n\n\nAlthough the total amount of insulin unit increased from 1,551,400 units (15.12 units/patient/day) to \n\n\n\n2,868,900 units (33.20 units/patient/day), the total cost of insulin treatment decreased from 542,990 \n\n\n\nbaht in phase I (0.35 baht/unit) to 429,729.83 baht in phase II (0.15 baht/unit) which gives rise to a \n\n\n\ntotal cost saving of 113,260.17 baht. The average cost decreased from 158.79 to 149.40 \n\n\n\nbaht/patient/month. Fifty one DM patients were monitored and blood glucose level was compared \n\n\n\nbetween phases I and II. The results revealed that blood glucose level decreased statistically \n\n\n\nsignificantly from 204 mg% to 117 mg% (paired t-test, P=0.0388). In conclusion, changing PII to CSI \n\n\n\ndecreased direct treatment cost and blood glucose level also decreased. It is possible that calibration is \n\n\n\nneeded for penfill injection. \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nHPP 70 \nFAPA2014000277 (Poster) \n\n\n\nEffectiveness of Clinical Pharmacist Visit among Hospitalized Elderly Patients \n\n\n\nJH Kuo\n1\n, CM Chang\n\n\n\n1,2\n, WK Chou\n\n\n\n1,3\n \n\n\n\n1\nInstitute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan \n\n\n\n2\nDivision of Geriatrics and Gerontology, Department of Internal Medicine, National Cheng Kung \n\n\n\nUniversity Hospital, Taiwan \n 3\nDepartment of Pharmacy, National Cheng Kung University Hospital, Taiwan \n\n\n\n\n\n\n\nPharmaceutical care on elderly patients is complex because of multi-comorbidities, polypharmacy. \n\n\n\nThe aims of this study is to identify medication problems and suggestions in elderly patients visited \n\n\n\ndirectly by geriatric pharmacists. From March 2014 to June 2014, a case-control study, matched by \n\n\n\nage and gender, was conducted at a medical center in southern Taiwan. Cases were hospitalized \n\n\n\npatients aged 65 years in geriatric wards and received comprehensive pharmaceutical care, 1) \n\n\n\nReasonability of drug utilization by clinical visit; 2) Patient education and suggestions; 3) To assess \n\n\n\nthe prevalence of potentially inappropriate medications based on STOPP & START criteria. \n\n\n\nControlled cases were those in general medical wards and received routine pharmaceutical \n\n\n\nconsultation and suggestions. The requirements of pharmaceutical suggestions in controlled cases \n\n\n\nwere retrospectively reviewed. A total number of 120 cases were enrolled, with 50% were female. \n\n\n\nThe mean ages of case and control group were 82.5\u00b17.5 and 82.5\u00b17.4, respectively. Mean numbers of \n\n\n\ndiseases per patient were 3.58 and 3.53. Mean numbers of medications per patient were 13.0 \u00b1 4.8 and \n\n\n\n10.7\u00b13.8. A total number of medications required education by pharmacist is 78 and 103, and the \n\n\n\nnumbers of crushing ungrindable medications is 62 and 67. Number of potentially inappropriate \n\n\n\nmedications defined by STOPP criteria is 40 and 27, while medications defined by START criteria \n\n\n\nare 18 vs 14. After visit by geriatric pharmacists in the case group, all patients with 78 medication \n\n\n\nproblems received education, and the crushing ungrindable medications decreased from 62 to 51. \n\n\n\nMedications problems defined by STOPP and START criteria in the case group decreased from 40 \n\n\n\nand 18 to 27 and 10, respectively. Geriatric pharmaceutical care visited directly by pharmacists could \n\n\n\ndetect more medication problems and practical education might be provided to those hospitalized \n\n\n\nelderly patients. \n\n\n\n\n\n\n\n\n\n\n\nHPP 71 \nFAPA2014000220 (Poster) \n\n\n\nSubcutaneous Versus Intravenous Administration of Bortezomib in Patients with Multiple \n\n\n\nMyeloma: A Retrospective Review Study \n\n\n\nTH Ke, TH Yeh, MS Wang, SH Sun \n\n\n\nDepartment of Pharmacy, Far Eastern Memorial Hospital, Taiwan \n\n\n\n\n\n\n\nIntravenous (IV) bolus is the standard administration route of bortezomib, however, subcutaneous \n\n\n\n(SC) administration is an important alternative route. Bortezomib induced peripheral neuropathy in \n\n\n\nmultiple myeloma (MM) patients is a common and serious side effect. Currently, it has been reported \n\n\n\nthat SC administration of bortezomib decreases the incidence of peripheral neuropathy as compared to \n\n\n\nIV bolus injection without any differences in efficacy. We compared the efficacy and safety of SC vs. \n\n\n\nIV bortezomib in patients with multiple myeloma (MM). This study was designed to retrospective \n\n\n\nreview the medical records of patients with MM, who were treated with bortezomib-based regimen \n\n\n\nbetween January 2012 and November 2013 at the medical center in Taiwan. Twelve MM patients \n\n\n\nwere average 66 years; had received one to three lines of therapy. Patients were received bortezomib \n\n\n\nby standard SC (n=6) or IV bolus (n=6) at the recommended dose and schedule (1.3 mg/m\u00b2 dose twice \n\n\n\na week to once a week). Twelve patients were evaluated (IgG: light chain: IgA type=6:5:1; Male: \n\n\n\n\n\n\n\n\nFemale=7:5). The number of treatment cycles was 7 (range 2\u201321). The mean cumulative bortezomib \n\n\n\ndose was 21.5 mg/m\u00b2 (range 7.8\u201344.2). The most common of adverse events were reported \n\n\n\nthrombocytopenia (3 [50%] vs. 4 [67%]), peripheral neuropathy of any grade (1 [17%] vs. 3 [50%]) \n\n\n\nwith SC vs. IV bortezomib. Patients with peripheral neuropathy of any grade, where the average \n\n\n\ncumulative bortezomib dose was 17 mg, were treated by medication including duloxetine, pregabalin, \n\n\n\nand methylcobalamin. In conclusion, SC administration is a promising alternative to IV \n\n\n\nadministration, particularly in patients with poor venous access or at increased risk of side effects. \n\n\n\nDecreased incidence of grade 3 or higher adverse events were observed with SC administration. \n\n\n\nFurther studies in larger populations are warranted to confirm preliminary efficacy and safety data. \n\n\n\n\n\n\n\n\n\n\n\nHPP 72 \nFAPA2014000260 (Poster) \n\n\n\nDrug Related Problems in Geriatric Clinic \n\n\n\nK Theangjit\n1\n, K Puttipokin\n\n\n\n2\n, P Rerkchaimongkol\n\n\n\n2\n, P Bunupuradah\n\n\n\n2\n \n\n\n\n1\nPharmacy Services, Somdech Phra Debaratana Medical Center (SDMC), Faculty of Medicine, \n\n\n\nRamathibodi Hospital, Mahidol University, Bangkok, Thailand \n2\nDepartment of Pharmacy, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, \n\n\n\nThailand \n\n\n\n\n\n\n\nDrug related problems (DRPs) are common in the elderly patients.  Apart from chronic illness many \n\n\n\nelderly patients also suffered from mental and memory problems.  They use more drugs than the \n\n\n\nyounger patients.  The objective of this study was to investigate the prevalence of DRPs among the \n\n\n\nelderly patients. The study was conducted at a geriatric clinic of SDMC, which is the academic \n\n\n\nhospital that belongs to the Faculty of Medicine, Ramathibodi Hospital.  Pharmacists collected the \n\n\n\ninformation by reviewing patients\u2019 medication profiles and interviewing the patients or caregivers to \n\n\n\nfind out DRPs.  The study period was from December 2006 to April 2013. Data from 1,187 visits of \n\n\n\n615 patients were collected and analyzed.  DRPs were found in 892 visits (75.15%). The most \n\n\n\ncommon type of DRPs was patient drug use process.  In this study half of the problem was non-\n\n\n\ncompliances (54.23%) which included taking medication irregularly (43.70%), self-discontinuing \n\n\n\nmedication (29.40%), do not follow the prescribed direction (22.30%), and self- medication or dietary \n\n\n\nsupplement (4.60%). Other common DRPs founded were adverse drug reactions (19.22%), \n\n\n\ninappropriate drug selection (5.72%), drug interaction (5.26%), untreated condition (4.80%), \n\n\n\nduplicated medication (4.03%), dosage too high/too low (3.31%), over use/no indication (2.63%), and \n\n\n\nneed additional drugs therapy (0.80%). In conclusion, DRPs are common especially in elderly.  Non-\n\n\n\ncompliance was the most prevalence.  These events may lead to considerable patient morbidity and \n\n\n\nmortality.  Pharmacists have major roles in the prevention and resolving of DRPs.  More \n\n\n\ncomprehensive systemic approaches are needed to resolve these problems. \n\n\n\n\n\n\n\n\n\n\n\nHPP 73 \nFAPA2014000275 (Poster) \n\n\n\nEvaluation on the Use of Febuxostat \n\n\n\nMC Lin\n1\n, TW Lung\n\n\n\n1\n, SW Kang\n\n\n\n1,2\n \n\n\n\n1\nDepartment of Pharmacy, St. Joseph's Hospital Yunlin, Taiwan \n\n\n\n2\nGraduate Institute of Health Industry Management, National Yunlin University of Science & \n\n\n\nTechnology, Yunlin, Taiwan  \n\n\n\n\n\n\n\nFebuxostat, an xanthine oxidase inhibitor (XOI), is commonly used for treatment of hyperuricemia in \n\n\n\npatients with gout. This drug is recommended for use as first-line therapy, or use post failure of \n\n\n\n\n\n\n\n\ntreatment with allopurinol and benzbromarone. This study was undertaken to gather relevant data and \n\n\n\nevaluate the results to understand the efficacy of a new drug at our hospital. This is a retrospective \n\n\n\nstudy. We collected data from October 2012 to March 2013, using febuxostat and ICD-9 diagnosis \n\n\n\ncode 274.0-274.9 (gout). We included patients whose uric acid> 6 mg/dL and recorded the dose, \n\n\n\nserum uric acid levels pre- and post- treatment, improvement rates in clinical symptoms. SPSS17.0 \n\n\n\nwas used to for statistical analysis. In total 48 patients were included in this study, of whom 42 were \n\n\n\nmales, 6 females. The ratio of male to female is 8.8:1.2, and the average age is 57 (34-88) years old. \n\n\n\nComplications occurred as hypertension: 66.7%; high cholesterol: 62.5%; diabetes: 12.5%; liver and \n\n\n\nrenal dysfunctions were approximately 12.5%. Ratios of the daily maintenance dose of febuxostat as \n\n\n\n20mg, 40 mg and 80 mg are 12.5%, 68.75% and 18.75% respectively. The average uric acid levels \n\n\n\npre- and post- treatments were 8.9 (6.2-11.5) mg/dL and 5.5 (4.6-8.8) mg/dL. Of which, 64.6% of \n\n\n\npatients whose uric acid levels were reduced to below 6 mg/dL, and ten patients improved either in \n\n\n\nepisodes of gouts attack or relief of symptoms. In this study, we found febuxostat can effectively \n\n\n\nreduce serum uric acid, gout episodes or improve symptoms. Although no serious adverse reactions \n\n\n\noccurred, we still need to monitor liver functions, gastrointestinal symptoms, rashes, etc., to further \n\n\n\nenhance patient medication safety. Issues related to combination therapy with anti-inflammatory \n\n\n\ndrugs (such as NSAID and steroids) are left for further study. \n\n\n\n\n\n\n\n\n\n\n\nHPP 74 \nFAPA2014000230 (Poster) \n\n\n\nThe Effectiveness of Adult Epilepsy-Medication Therapy Adherence Clinic (Epi-MTAC)  \n\n\n\nM Adibah, K Laisan, N Basariah \n\n\n\nHospital Tuanku Ampuan Najihah, Kuala Pilah, Negeri Sembilan, Malaysia \n\n\n\n\n\n\n\nProvision of pharmaceutical care in epilepsy patients has contributed in improvement of their anti-\n\n\n\nepileptics adherence, seizure frequency, and management of their disease. In HTAN, adult Epi-\n\n\n\nMTAC has been operated since May 2011. A retrospective study was conducted with data collection \n\n\n\nfrom 2010 to 2013. The objective is to evaluate the effectiveness of adult Epi-MTAC in HTAN. \n\n\n\nSubjects involved had at least 3 visits and 6 months follow-up. Data for pre- and post-Epi-MTAC \n\n\n\nrecruitment of subjects\u2019 anti-epileptic adherence, seizure frequency, and prescriber\u2019s acceptance of \n\n\n\npharmacists\u2019 intervention were collected from the Medical Out-Patient Department (MOPD) files and \n\n\n\nMTAC files. Therapeutic Drug Monitoring (TDM) data of subjects was obtained from TDM unit. The \n\n\n\nquestionnaire-evaluated subjects\u2019 quality of life (QOL) and satisfaction towards MTAC service were \n\n\n\nobtained from MTAC unit. From 54 subjects recruited, significant (p<0.05) improvements were found \n\n\n\nin post-Epi-MTAC recruitment for anti-epileptics adherence and mean seizure frequency per month. \n\n\n\nA self-rating by Epi-MTAC pharmacists showed some short-comings in Epi-MTAC service, leading \n\n\n\nto implementation of a new intervention, which was provision of epilepsy tool kit. Subjects were \n\n\n\nfound to be satisfied with the Epi-MTAC services; though there was no significant increase in mean \n\n\n\nsatisfaction score even after the new intervention (epilepsy tool kit) was provided. There was a small \n\n\n\nimprovement in subjects\u2019 QOL between 0-month and after at least 6 months in Epi-MTAC. High \n\n\n\nacceptance by the prescribers of Epi-MTAC pharmacists\u2019 interventions was achieved. A positive \n\n\n\noutcome was seen from the impact of Epi-MTAC pharmacists\u2019 interventions in TDM request. In \n\n\n\nconclusion, by collaborating with the prescribers and with active participation from patients, Epi-\n\n\n\nMTAC plays an important role in ensuring the quality of drug and disease management in epilepsy \n\n\n\npatient and was shown to be effective. \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nHPP 75 \nFAPA2014000100 (Poster) \n\n\n\nComparison Haematologic Adverse Effect between R-CHOP, CHOP, CVP and ESHAP \n\n\n\nRegimens in Non - Hodgkin's lymphoma Patients at Saraburi Hospital, Thailand \n\n\n\nM Chaemchaeng, CM Unprom\n     \n\n\n\nDepartment of Pharmacy, Saraburi Hospital, Thailand\n \n\n\n\n\n\n\n\nThe incidence of diffuse large B-cell lymphoma has increased at Saraburi Hospital. There were \n\n\n\nmany chemotherapy regimens to treat such as R-CHOP (Rituximab, Cyclophosphamide, Doxorubicin, \n\n\n\nVincristine and Prednisolone), CHOP (Cyclophosphamide, Doxorubicin, Vincristine and \n\n\n\nPrednisolone), CVP (Cyclophosphamide, Vincristine and Prednisolone) and ESHAP (Etoposide, \n\n\n\nCisplatin, Cytarabine and Prednisolone). Many patients have suffered serious hematologic adverse \n\n\n\neffect until non compliance to treat with chemotherapy in the next cycle and this in turn, decreased \n\n\n\nquality of life. Thus, this study aimed to analyze hematologic adverse effect and 5-years survival of \n\n\n\nthese regimens. This study was descriptive research and retrospective study. Data were collected since \n\n\n\nJanuary 1, 2008 to December 31, 2013 from medical records of adults Non - Hodgkin's lymphoma \n\n\n\npatients at Saraburi Hospital. The results were analyzed using Kruskal Wallis Test statistics in SPSS \n\n\n\nProgram. The mean age of 190 patients in Non-Hodgkin's lymphoma was 54.7 years old. There \n\n\n\nwere 1,124 hematologic adverse effects such as anemia, hypokalemia, neutropenia \n\n\n\nand thrombocytopenia. All of four regimens R-CHOP, CHOP, CVP and ESHAP were happened \n\n\n\nanemia most 28.0%, 25.4%, 22.4% and 24.2% respectively, hypokalemia were happened 27.2%, \n\n\n\n24.5%, 21.5 % and 24.0% respectively, neutropenia were happened 27.9%, 23.8%, 21.7% and 23.8% \n\n\n\nrespectively. This difference was significant in statistic P=0.04. In 5-years survival found that CVP \n\n\n\nregimen was the most rate 52.6 %. In medical treatment expense founded that R-CHOP was the most \n\n\n\nexpensive ,more than CVP regimen 7 times, CHOP regimen 5 times and ESHAP regimen 4 times. \n\n\n\nThe average times of hematologic adverse effect per one patient found that CVP regimen was less \n\n\n\nthan other regimen 2.8 times. In conclusion, CVP regimen has the best 5-years survival, less medical \n\n\n\ntreatment expense and less hematologic adverse effect. \n\n\n\n\n\n\n\n\n\n\n\nHPP 76 \nFAPA2014000169 (Poster) \n\n\n\nPharmacist-led Home Healthcare Increased Medical Appointment Adherence and INR Level \n\n\n\nK Tungtragool, A Jaturapattarawong, C Karin \n\n\n\nWarinchumrab Hospital, Ubon Ratchathani, Thailand  \n\n\n\n\n\n\n\nNon-adherence to medical appointment in patients who received medical care at Warfarin Clinic from \n\n\n\nOctober 2012 through March 2013 was 8.70 %.  It was higher than the quality control criteria (5%) \n\n\n\nfrom The National Health Security Office, Thailand. Thus, the purpose of this study was to decrease \n\n\n\nthe appointment non-adherence of patients in Warfarin Clinic, to monitor side effects of warfarin and \n\n\n\nto identify and decrease drug-related problems. Forty-two patients were included in this study. This \n\n\n\nstudy was an action research using before and after design conducted at Warfarin Clinic, \n\n\n\nWarinchumrab Hospital.  INR level and drug-related problems (DRPs) during October 2012 through \n\n\n\nMarch 2013 were retrospectively reviewed and collected from electronic and paper-based medical \n\n\n\nrecords. Pharmacist-led home healthcare visit were initially implemented in April 2013 to identify \n\n\n\nbarriers and problems of medical care services in these patients.  During home healthcare visit, health \n\n\n\neducation and pharmaceutical care were provided to each patient to identify and properly manage \n\n\n\nthose DRPs and improper health behaviors. The result revealed that the appointment non-adherence \n\n\n\nrate statistically decreased from 8.70% to 2.90% (McNemar\u2019s chi-squared, P=0.028) after pharmacist-\n\n\n\nled home healthcare visit.  Achievement of INR level statistically increased from 52.22% to 63.73% \n\n\n\n\n\n\n\n\n(Pair t-test, P=0.016). DRPs including improper dose of warfarin, non-compliance, bleeding, drug \n\n\n\ninteraction also statistically decreased from 56.52% to 42.02% (McNemar\u2019s chi-squared, \n\n\n\nP=0.001).  In conclusion, pharmacist-led home healthcare visit has reduced appointment non-\n\n\n\nadherence, DRPs and increased achievement of INR level significantly. \n\n\n\n\n\n\n\n\n\n\n\nHPP 77 \nFAPA2014000085 (Poster) \n\n\n\nDrug Use Evaluation of Restricted Antibiotics in Hospitalized Patients at Phangnga Hospital \n\n\n\nN Toopsompong\n1\n, C Siriwong\n\n\n\n2\n \n\n\n\n1\nSenior Pharmacist, Professional Level, Pharmacy Department, Phangnga Hospital, Thailand \n\n\n\n2\nPharmacist, Professional Level, Pharmacy Department, Phangnga Hospital, Thailand \n\n\n\n\n\n\n\nDrug Use Evaluation (DUE) studies are designed to assess drug use appropriateness. We aimed to \n\n\n\nevaluate drug utilization of 5 restricted antibiotics (imipenem/cilastatin, meropenem, vancomycin, \n\n\n\ncefoperazon/sulbactam and ampicillin/sulbactam), the broad spectrum antibiotics that consume a \n\n\n\nsignificant proportion of our hospital outlay, under the Pharmacy and Therapeutic Committee (PTC) \n\n\n\nregulation. Data was collected prospectively from January 2013 to September 2013. Demographic and \n\n\n\ndrug use details were recorded on special forms. Appropriateness was assessed if met criteria and \n\n\n\nutilization was measured in ATC/DDD index (defined daily dose (DDD)/100 patient-days). Overall, \n\n\n\n120 patients received 225 courses with one of these antibiotics. The appropriate rate of restricted \n\n\n\nantibiotics prescription was 83.63% (189 courses). The total 5.75%, 38.94% and 55.31% of 226 \n\n\n\ncourses was prescribed documented, empirical and specific therapy respectively. The DDD/100 \n\n\n\npatient-days of the study was 0.33 in imipenem/cilastatin, 4.64 in meropenem, 1.10 in vancomycin, \n\n\n\n1.22 in cefoperazon/sulbactamand 2.71 in ampicillin/sulbactam. The final clinical outcomes of \n\n\n\npatients were 80.97% therapeutic response and 19.03% therapeutic failure. Only 65.04% of cultures \n\n\n\nreports were found multi-drug resistant (MDR) organisms. In conclusion, the majority of courses with \n\n\n\nrestricted antibiotics were empirically. The appropriateness of drug use was acceptable. However, \n\n\n\nalmost 20% of courses still concerned irrational use. Educational interventions, intensive PTC \n\n\n\nregulation and empowerment of adherence to a strict antibiotic prescribing policy can help \n\n\n\nsignificantly to overcome this problem. \n\n\n\n\n\n\n\nHPP 78 \nFAPA2014000163 (Poster) \n\n\n\nThe Prevalence and Types of Prescribing Errors (PE) in the Outpatient Pharmacy Unit of an \n\n\n\nAcademic Hospital \n\n\n\nN Inwan, A Aim-Oat, N Roatputtikul, T Naratreekoon, A Sanoh, S Amornpatchara \n\n\n\nPharmacy services, Somdech Phra Debaratana Medical Center (SDMC) Faculty of Medicine, \n\n\n\nRamathibodi Hospital, Bangkok, Thailand \n\n\n\n\n\n\n\nMedication prescribing is an important process of pharmacy services in the hospital. The unclear and \n\n\n\nerrors in prescribing cause several untoward consequences.  The aim of this study was to identify the \n\n\n\nprevalence and types of PE in the outpatient pharmacy services. The prescriptions at outpatient \n\n\n\npharmacy services (Orthopedics, Surgery, Skin, and Ear Nose throat department) during Jan \u2013 Dec \n\n\n\n2013 were studied.  SDMC is one of the 3 hospitals belong to the Faculty of Medicine, Ramathibodi \n\n\n\nHospital.  Physicians prescribed by handwritten before sending to the pharmacy unit. The total of \n\n\n\n313,217 prescriptions was analyzed.  Prescribing errors were found in 1,937 prescriptions (0.62% of \n\n\n\ntotal prescriptions).  The most frequent errors were omitted and unclear drug strength (46.61%). These \n\n\n\nwere followed by prescribing drug which patients has documented history of allergy (16.42%), \n\n\n\ninappropriate dosage (11.10%), incorrect dosage schedule (10.37%), unclear drug name or unclear \n\n\n\n\n\n\n\n\nhandwritten prescription (7.64%), inappropriate route of administration (3.36%), omission of the \n\n\n\nprescriber\u2019s signature (2.48%), prescribing two drugs which have the same pharmacologic mechanism \n\n\n\nor significant drug interaction (1.34%) and use of non-internationally accepted abbreviated drug name \n\n\n\n(0.67%).  All unclear prescriptions were sent back to physicians and 96.26% were corrected. In \n\n\n\nconclusion, PE is still common in everyday clinical practice.  Computerized Physician Order Entry \n\n\n\nwill be soon implemented which may partly reduce PE. Pharmacist intervention will significantly \n\n\n\nreduce PE.  More epidemiological studies to identify the key factors affecting PE are needed. \n\n\n\n\n\n\n\nHPP 79 \nFAPA2014000296 (Poster) \n\n\n\nThe Geriatric Clinic Care Program: An Approach to Maintaining Good Health and Quality of \n\n\n\nLife \n\n\n\nP Juacalla, Y Agapito, J Berberabe, K Cruz, DD Cruz, J Go, K Hung, M Igno, M Lanzona, R \n\n\n\nLao, D Ledesma, L Lim, T Miguel, A Panaligan, J Tan, Q Yu, P Quilala\n \n\n\n\nFaculty of Pharmacy, University of Santo Tomas, Manila, Philippines \n\n\n\n\n\n\n\nThe Geriatric Clinic aspires to address the health care needs of the geriatric population through \n\n\n\nprovision of free medical services. We commit to providing the patients with access to free health \n\n\n\nservices and medications, and to promote activities and lifestyle modifications for a better quality of \n\n\n\nlife. The Geriatric Clinic advocates proper care for the elderly to improve their overall well-being \n\n\n\nthrough education, diagnosis and prevention of diseases as well as the provision of appropriate \n\n\n\nmanagement and specific care to ensure improvement in quality of life. The programme was \n\n\n\nconducted at the St. John\u2019s Home for the Elders, Quiapo, Manila, Philippines, between September \n\n\n\n2013 and January 2014, and was divided into four phases. Phase I comprised of patient profiling and \n\n\n\nconsultation. Patient profiling included demographic characteristics, patient medical history, \n\n\n\nadherence to medication, eye examination, vital signs, SF-12 (a measurement of patient\u2019s limitation of \n\n\n\nactivities), and chronotyping. Doctors assessed patients and recorded their corresponding \n\n\n\nmanagement. Phase II focused on providing diagnostic tests which included X-ray, ultrasound and \n\n\n\nelectrocardiogram. Phase III comprised of communicating diagnostic test results and giving \n\n\n\nmanagement plan for patients, together with their medicines and medication information. Phase IV \n\n\n\ncomprised of follow-up monitoring, and seminars on nutrition, exercise, and sleeping habits. \n\n\n\nActivities provided included showcasing of talents, games and lunch to the beneficiaries. Volunteers \n\n\n\nquantified the effect of the interventions. The results showed that medication adherence rate was high \n\n\n\namong patients after the intervention, and poor adherence rate was found to affect blood pressure \n\n\n\ncontrol. However, this was found to be inconclusive because of the very small population involved. \n\n\n\nThe study population also exhibited a high prevalence of hypertension and diabetes. The community \n\n\n\nwas endorsed to the Hypertension Clinic and Diabetes Clinic. Overall we conclude that the patients\u2019 \n\n\n\nquality of life has improved. \n\n\n\n\n\n\n\n\n\n\n\nHPP 80 \n\n\n\nFAPA2014000225 (Poster) \n\n\n\nPredictors of Adherence to Calcium Carbonate as Phosphate Binder among Dialysis Patients in \n\n\n\nHospital Raja Perempuan Zainab II \n\n\n\nN Azlean\u00b9, AR Sudarwaty\u00b2, SA Nasriq\u00b2, N Husna\u00b2 \n\n\n\n\u00b9Department of Pharmacy, Hospital Tanah Merah, Kelantan, Malaysia \n\n\n\n\u00b2Department of Pharmacy, Hospital Raja Perempuan Zainab II, Kelantan, Malaysia \n\n\n\n\n\n\n\nPatients with end stage-renal disease (ESRD) are at risk of cardiovascular disease and bone disorder \n\n\n\ndue to hyperphosphatemia. Treatment with phosphate binders is associated with improves survival \n\n\n\n\n\n\n\n\namong hemodialysis patients. However, poor adherence is common in these patients which can lead \n\n\n\nto inadequate control of serum phosphorus concentrations. Thus, this study aimed to determine the \n\n\n\npredictors of adherence on calcium carbonate as phosphate binder among haemodialysis patients in \n\n\n\nHRPZ II. A cross sectional study was conducted at hemodialysis unit of HRPZ II targeting only on \n\n\n\npatients taking calcium carbonate as phosphate binder. All responders were assessed based on their \n\n\n\nadherence to the medication using Modified Morisky scale. Twenty one out 44 patients (48.0%) \n\n\n\nreported non-adherence towards calcium carbonate. Mean phosphate level was significantly low in \n\n\n\npatients with good adherence (p= 0.034) as compared to patients with poor adherence. Gender, \n\n\n\neducation level, and marital status did not significantly influence medication adherence. However, \n\n\n\nunemployed or pensioner patients show more compliance compared to employed patients (p= 0.027). \n\n\n\nMean pill burden and duration of hemodialysis were not significantly differently between adherence \n\n\n\nand non-adherence group. There was significantly difference between mean age of adherence to non-\n\n\n\nadherence patients (p=0.004). In conclusion, the employment status, age and phosphate level of the \n\n\n\npatients were the predictors of adherence on calcium carbonate as phosphate binder among \n\n\n\nhaemodialysis patients in HRPZ II. Unemployed or pensioner and older patients showed more \n\n\n\nadherence towards their medications. \n\n\n\n\n\n\n\nHPP 81 \nFAPA2014000228 (Poster) \n\n\n\nRisk Factors of Anti-tuberculosis Drugs-Induced Hepatotoxicity in Central of Chest Institute of \n\n\n\nThailand \n\n\n\nS Rattanawai \n\n\n\nCentral of Chest Institute of Thailand, Thailand \n\n\n\n\n\n\n\nThe purpose of this research was to determine the rate and risk factors of drug-induced hepatotoxicity \n\n\n\nin tuberculosis patients treated at Central of Chest Institute of Thailand. The study was a three-year \n\n\n\nretrospective study with data collected from the patient charts between January 2008 and December \n\n\n\n2010. Two hundred and twenty seven patients were selected from four hundred and forty seven drug-\n\n\n\ninduced hepatotoxic tuberculosis patients based on the inclusion criteria, calculated as 50.78%. The \n\n\n\npercentage of tuberculosis patients in Central of Chest Institute of Thailand (3,482) having drug-\n\n\n\ninduced hepatotoxicity was 6.52. The result showed that the mean \u00b1 SD for onset of hepatotoxicity in \n\n\n\npatients who received H300:R600:Z1500:E1000 regimen was higher than the patients who \n\n\n\nreceived H300:R450:Z1000:E800 regimen. As for the patient\u2019s weight, there is a greater risk of \n\n\n\nhepatotoxicity in patients with less than 45 kilograms (OR = 1.49, 95% CI: 1.14 \u2013 1.95, p = 0.0037). \n\n\n\nAccording to the research, patient\u2019s weight is the second risk factor for hepatotoxicity. Gender was \n\n\n\nalso found to be associated with hepatotoxicity from anti-tuberculosis drugs as the research found that \n\n\n\nmale has more risk than female (OR = 1.73, 95% CI : 1.32 \u2013 2.27, Z statistic = 3.930, p = 0.001).  \n\n\n\n\n\n\n\nHPP 82 \n\n\n\nFAPA2014000271 (Poster) \n\n\n\nUsing the Quality Control Circle Approach to Reduce Resupply Rate in Pharmaceutical \n\n\n\nInventory Control \n\n\n\nSW Kang\n1\n, CY Huang\n\n\n\n1\n, ST Ching\n\n\n\n2\n, HL Chou\n\n\n\n3\n, HT Chow\n\n\n\n3\n, MC Lin\n\n\n\n1\n \n\n\n\n1\nDepartment of Pharmacy, St. Joseph\u2019s Hospital, Kaohsiung, Taiwan \n\n\n\n2\nDepartment of General Affairs, St. Joseph\u2019s Hospital, Kaohsiung, Taiwan \n\n\n\n3\nInformation Center, St. Joseph\u2019s Hospital, Kaohsiung, Taiwan \n\n\n\n\n\n\n\nGood inventory control makes ordering and pharmaceutical management easier.  Essential medicine \n\n\n\nprograms place a high priority on improving inventory control to ensure a reliable supply of all \n\n\n\npharmaceutical products at health facilities. To achieve this aims, we carry out the quality control \n\n\n\n\n\n\n\n\ncircle approach in improving pharmaceutical inventory control in our hospital. Our end point is to \n\n\n\nimprove patient pharmaceutical services and to obtain a better pharmaceutical management.  The \n\n\n\nstudy was carried out in 2013 year from March to October; we used the quality control (QC) \n\n\n\ntechniques (i.e., Gantt charts, Plato, QC STORY decision tables, etc.). We analyzed the distribution \n\n\n\nprocedure from the warehouse to our pharmacy, drug shortage rate, drug deficiency rate, the resupply \n\n\n\nrate, stock-out rate. We used the Pareto principle (80/20 rule) to improve the event and improve the \n\n\n\nrate of drug resupply rate.  Before QC technique was implemented, the event of resupply event rate \n\n\n\nwas 7.79%. Our implementation to improve the event includes; setting the pharmacy inventory IT \n\n\n\nsystem, individual staff to manage the inventory management system, setting the provisional \n\n\n\nprocurement application form, drugs status reminds/warning, etc. A 4.4% improvement result was \n\n\n\nobtained; with a decreased of 0.58% resupply rate; main target is 1.35%; overall target achievement \n\n\n\nrate is 112%.   QC circle activity provides an excellent method in improving the quality control of \n\n\n\npharmaceutical inventory management. A good inventory management balances the service level and \n\n\n\nsafety stock. A regular and accurate stock count and standard method for valuing are needed to \n\n\n\ndetermine the base of inventory value. \n\n\n\n\n\n\n\nHPP 83 \n\n\n\nFAPA2014000315 (Poster) \n\n\n\n\n\n\n\nUsing Comic, Pictograms and Table Sticker to Improve Knowledge and Medication Adherence \n\n\n\nin Children with HIV/AIDS  \n\n\n\n\n\n\n\nA Irawan\n1\n, KDK Wati\n\n\n\n2\n, AP Susilo\n\n\n\n3\n, F Herawati\n\n\n\n1\n \n\n\n\n1\nFaculty of Pharmacy, University of Surabaya, Surabaya, Indonesia \n\n\n\n2\nDepartment of Child Health, Sanglah General Hospital, Bali, Indonesia \n\n\n\n3\nFaculty of Medicine, Mulawarman University, Samarinda, Indonesia \n\n\n\n\n\n\n\nAdherence to treatment of chronic diseases is one of the main things to ensure the success of therapy. \n\n\n\nChildren with chronic disease, often not adhere to their treatment. The problem of non-adherence is \n\n\n\ndue to the lack of information which given to the children about their treatment. This study aims to \n\n\n\ndetermine the effectiveness of education to improve knowledge and adherence in children with \n\n\n\nchronic illness. This before-after study test the effectiveness of illustrated booklet (comic), pictograms \n\n\n\nand table stickers on 22 outpatient children with HIV/AIDS in Sanglah Hospital Denpasar-Bali. We \n\n\n\nused a validated pre-test and post-test questionnaire to measure their knowledge about HIV/AIDS \n\n\n\nmedication. We used \u2018pill count\u2019 to measure the improvement of the medication adherence. In this \n\n\n\nstudy, comic; pictograms and table stickers would be given to all children after they filled the \n\n\n\nquestionnaire (pre-test). Results showed that their knowledge\u2019s score after study was higher than \n\n\n\nbefore study (p < 0.001). The level of adherence, at the beginning (before the study), is already high \n\n\n\n(pill count 100%), there was no significant difference \u2018pill count\u2019 between before and after the \n\n\n\nadministration of education (p = 1,000). In conclusion, comic, pictograms, and table stickers can \n\n\n\nincrease the knowledge of children with HIV/AIDS. Children\u2019s knowledge of the disease and \n\n\n\ntreatment is needed to maintain medication adherence, particularly when the children grow up, as \n\n\n\nteenager or adolescent. \n\n\n\n \n\n\n\n\n\n\n\n\nCOMMUNITY PHARMACY \n \nCPP 01 \nFAPA2014000098 (Poster) \n\n\n\n\n\n\n\nThe Clinical Effectiveness of Clinical Scoring System for Pharyngitis Diagnosis Leading to \n\n\n\nAntimicrobial Selection in Community Pharmacies  \n\n\n\n\n\n\n\nA Sermhutthakit\n \n\n\n\nDepartment of Pharmacy, Hospital Kasemrad Bangkhae, Bangkok, Thailand \n\n\n\n\n\n\n\nThe objective of this study was to determine the clinical effectiveness of clinical scoring system for \n\n\n\npharyngitis diagnosis leading to antimicrobial selection in community pharmacies. The clinical \n\n\n\nscoring system is based on 4 clinical criteria for predicting risk of infection from group A streptococci \n\n\n\n(GAS), namely fever (the body temperature > 37.8 \nO\nC), absence of cough, cervical lymphadenopathy \n\n\n\nand tonsillopharyngeal exudates. Patients with less than 3 criteria were unnecessary treated with \n\n\n\nantimicrobial drugs. The study constituted a quasi-experimental design with parallel groups to \n\n\n\ncompare clinical effectiveness at 7 and 14 days after pharyngitis treatment between study groups, \n\n\n\ndiagnosed by using clinical scoring system, who did not receive antimicrobial drugs (n = 37), and \n\n\n\ncontrol group with unnecessary antimicrobial treatment (n = 37). Both groups were suspected to have \n\n\n\nviral pharyngitis based on the clinical score 0 - 2. The results showed that antimicrobial drug usage \n\n\n\nwas statistically significantly decreased from 97.7% in control group to 7.5% in study group (p < \n\n\n\n0.001). At day 7 and day 14 after treatment, clinical response, defined as clinical improvement and \n\n\n\ncomplications in both groups were not significantly different. The receiving of antimicrobial drugs \n\n\n\nwas not related to the clinical response (p = 0.327 at day 7 and 0.282 at day 14). In conclusion, this \n\n\n\nclinical scoring system is effective in promoting appropriate diagnosis, differentiating between viral- \n\n\n\nand bacterial- infected pharyngitis, and antimicrobial selection in community pharmacies. \n\n\n\n\n\n\n\n\n\n\n\nCPP 02 \nFAPA2014000281 (Poster) \n\n\n\n\n\n\n\nThe Projection of Community Pharmacy Service in Diabetes Care  \n\n\n\n\n\n\n\n E Chang \n\n\n\nCommunity Pharmacy, Taipei Pharmacists Association, Taipei, Taiwan, R.O.C. \n\n\n\n\n\n\n\nDiabetes has become the highest population among chronic diseases in Taiwan. However, the public \n\n\n\nknowledge about diabetes care has not been well established, especially the awareness and \n\n\n\nmanagement of complications. The aim of this study was to provide pharmacy care for diabetes \n\n\n\npatients in the community in order to better control complications and reduce medical cost.  The \n\n\n\ncounselling desk specific for diabetes care was established in community pharmacy, where primary \n\n\n\ncare such as blood pressure and glucose measuring, drug use counselling, education for quit smoking \n\n\n\nand dietary recommendation through dietician were conducted.  According to statistical analysis on \n\n\n\nthe Q & A results, almost all the diabetes patients agreed that pharmacy care was satisfactory. The \n\n\n\nhealth education and drug use counselling for diabetes patients did reduce the occasion of falling \n\n\n\ndown caused by low blood glucose. The pharmacy care for diabetes in community is helpful to \n\n\n\ncontrol complications. The patient\u2019s quality of life and the confidence can be secured through \n\n\n\ncommunity pharmacy care. \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nCPP 03 \nFAPA2014000279 (Poster) \n\n\n\n\n\n\n\nBuild a Supporting System of Drug Supply for Community Pharmacies by Taipei Pharmacist \n\n\n\nAssociation  \n\n\n\n\n\n\n\nWC Chang, M Fan \n\n\n\nTaipei Pharmacists Association, Taipei, Taiwan, R.O.C. \n\n\n\n\n\n\n\nThe situation on shortage of drugs, rare-use or purchasing price higher than reimbursement happened \n\n\n\nto community pharmacies. This is caused by inadequately implemented separation policy of \n\n\n\ndispensing from prescribing. The aim of this study was to solve the drug supply problem and provide \n\n\n\nthe drug use convenience to the general public as well as better management of community \n\n\n\npharmacies. The Taipei Pharmacists Association established the website of platform for drug supply \n\n\n\nlisting which allowed community pharmacies in Taipei to list drugs needed or drugs to be shared. \n\n\n\nMoreover, the policy allowing Taipei Pharmacists Association to be a drug supplier for Taipei City \n\n\n\nHospital Tender is under investigation. The website of platform for drug supply listing is satisfactory \n\n\n\nto solve the problem mentioned above. Furthermore, the information obtained from the platform has \n\n\n\nbeen statistically analyzed and investigated to be a valuable reference for better health and pharmacy \n\n\n\ncare service. All the community pharmacies and citizens in Taipei enjoy the convenience and benefits \n\n\n\nfrom the website of platform for drug supply listing. It is a milestone for pharmaceutical services \n\n\n\nespecially for the current status of separation of dispensing from prescribing. \n\n\n\n\n\n\n\n\n\n\n\nCPP 04 \n\n\n\nFAPA2014000282 (Poster) \n\n\n\n\n\n\n\nDevelopment Programs of International Meeting Participation for Community Pharmacies of \n\n\n\nTaipei Pharmacist Association   \n\n\n\n\n\n\n\n B Chen B\n1\n, E Chang\n\n\n\n2\n \n\n\n\n 1\nInternational Affairs Committee, Taipei Pharmacists Association, Taipei, Taiwan, R.O.C. \n\n\n\n \n2\nCommunity Pharmacy, Taipei Pharmacists Association, Taipei, Taiwan, R.O.C. \n\n\n\n\n\n\n\nMore than half of the member pharmacists of Taipei Pharmacist Association (TPA) are from \n\n\n\ncommunity pharmacies. However, very few of them have experience of participating in international \n\n\n\nmeetings while participants are mostly from hospitals or academy. It might be one of the reasons they \n\n\n\nare not familiar with the international pharmacy meetings.  In order to elevate the quality of \n\n\n\ncommunity pharmacies, expand the viewpoint of community pharmacists, and encourage participation \n\n\n\nin international meetings, a series of workshops were sponsored by the International Affairs \n\n\n\nCommittee of TPA during October, November, and December 2013. Three lecturers from pharmacy \n\n\n\nschools and hospital pharmacy were invited to introduce their experience of participating in FIP and \n\n\n\nFAPA, how to write an abstract, and how to prepare a poster at international meetings. A total of 22 \n\n\n\nmember pharmacists of TPA joined the workshops and practiced writing an abstract with individual \n\n\n\ncounselling from lecturers at the workshops. In addition, two classes of etiquette and table manners \n\n\n\nwere given by another lecturer. An exercise dinner was held at an elegant restaurant after the classes. \n\n\n\nParticipants who complete the programmes were awarded certain credits for the pharmacist \n\n\n\ncontinuing education as well. Every participant completed his/her own essay and would love to \n\n\n\nsubmit their abstract to FIP 2014 in Bangkok or FAPA 2014 in Malaysia, and enjoyed the programme \n\n\n\nvery much. The workshops were well accepted and welcomed. Participants learned about the \n\n\n\ninternational meetings and how to write an abstract at limited period of time. Outstanding participants \n\n\n\nwere identified to assist at future workshops. \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nCPP 05 \nFAPA2014000032 (Poster) \n\n\n\n\n\n\n\nCorrelation of Diabetes Treatment Satisfaction and Quality of Life in Outpatient Elderly at \n\n\n\nRSUP Dr Kariadi Semarang \n\n\n\n\n\n\n\nDLC Pradana\n1\n, TM Andayani\n\n\n\n2\n, IDP Pramantara S\n\n\n\n3 \n\n\n\n1\nPharmacy Department, Jambi University, Indonesia  \n\n\n\n2\nPharmacy Department, Gadjah Mada University, Indonesia \n\n\n\n3\nRSUP Dr Sardjito,Yogyakarta, Indonesia \n\n\n\n\n\n\n\nThere is a need for normative data to improve the quality of life for elderly patients with measuring \n\n\n\ndiabetes treatment satisfaction and quality of life. The study was conducted on 106 outpatient elderly \n\n\n\nwith type 2 diabetes mellitus at the Paviliun Lanjut Usia RSUP dr Kariadi Semarang during \n\n\n\nSeptember-November 2012. The study design was a cross sectional study. Diabetes Medication \n\n\n\nSatisfaction Tool Scale (DMSAT) was used to measure treatment satisfaction and the Euro Quality of \n\n\n\nLife 5D is used to measure the quality of life of patients. The primary outcome measure was treatment \n\n\n\nsatisfaction, quality of life and correlation of treatment satisfaction and quality of life of elderly \n\n\n\npatients with diabetes mellitus type 2. Statistical analysis using pearson correlation test. Overall \n\n\n\ndiabetes treatment satisfaction mean score patient was include quite satisfied category (5.42 \u00b1 0.12) \n\n\n\nand the EQ VAS quality of life mean 72.92 \u00b1 10.14. On the quality of life measure with EQ-5D have \n\n\n\nextreme problems on mobility domain 1.9% patients, self-care 2.8%, usual  activities 2.8%, \n\n\n\ndepression 0.9%. There are significant differences between age, education level, and Charlson \n\n\n\ncomorbidity index scores in patients with quality of life. Based on the Pearson test, there is no \n\n\n\nsignificant correlation between treatment satisfaction and quality of life of patients (P > 0.05). \n\n\n\n\n\n\n\n\n\n\n\nCPP 06 \nFAPA2014000245 (Poster) \n\n\n\n\n\n\n\nHealth Supplements Used by Pregnant Women  \n\n\n\n\n\n\n\nLL Goh\n1\n, SS Chua\n\n\n\n1\n, SZ Omar\n\n\n\n2 \n \n\n\n\n1\nDepartment of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia  \n\n\n\n2\nDepartment of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia  \n\n\n\n\n\n\n\nHealth supplements are commonly used in pregnancy but information on the extent and types used are \n\n\n\nscarce. A cross-sectional study was conducted on pregnant women who were at least in the second \n\n\n\ntrimester of pregnancy, and who attended the antenatal clinic in the University of Malaya Medical \n\n\n\nCentre, from January to April 2013. The aim of this study was to investigate the safety of common \n\n\n\nhealth supplements used by pregnant women especially during the first trimester of pregnancy. Data \n\n\n\nwas collected via face to face interviews using a structured questionnaire.  A total of 1376 health \n\n\n\nsupplements were used by 491 out of 500 pregnant women (98.2%) who participated in this study. \n\n\n\nMore than half (54.3%) of the health supplements were started during the first trimester of pregnancy. \n\n\n\nThe commonly used health supplements were Obimin\u00ae (82.8%), folic acid (70.0%), calcium (51.6%) \n\n\n\nand iron (16.6%) supplements, and vitamin C (11.0%). A majority of the respondents (85.2%) used \n\n\n\nmore than one type of supplements without knowing that they were consuming much higher than the \n\n\n\nRecommended Daily Allowance (RDA) for pregnant women. These include the mean dosages of folic \n\n\n\nacid, vitamin A and vitamin D. The findings of this study indicate a lack of awareness concerning the \n\n\n\nsafety of health supplements hence, women of child-bearing age should be counselled on this issue as \n\n\n\nexcessive use of some supplements such as vitamin A, may have deleterious effect on the foetus and \n\n\n\nmother. \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nCPP 07 \nFAPA2014000014 (Poster) \n\n\n\n\n\n\n\nUnit Cost Analysis of Managing Common Illness in the University Health Services \n\n\n\n\n\n\n\nK Saramunee\n1\n, C Ploylearmsang\n\n\n\n1\n, S Chaiyasong\n\n\n\n1\n, W Phimarn\n\n\n\n2\n, P Sookaneknun\n\n\n\n3\n, T \n\n\n\nSirithanawutichai\n4\n, T Kaenphukhieo\n\n\n\n1\n, T Supattarachaikun\n\n\n\n1\n, I Loakhom\n\n\n\n1\n, T Saman\n\n\n\n1\n,  \n\n\n\n1\n Social Pharmacy Research Unit, Faculty of Pharmacy, Mahasarakham University, Thailand  \n\n\n\n2 \nClinical Pharmacy Research Unit, Faculty of Pharmacy, Mahasarakham University, Thailand  \n\n\n\n3\n Primary Care Practice Research Unit, Faculty of Pharmacy, Mahasarakham University, Thailand  \n\n\n\n4\n Faculty of Medicine, Mahasarakham University, Thailand \n\n\n\n\n\n\n\nMahasarakham University (MSU) medical centre provides health services to students, free-of-charge, \n\n\n\nsupported by the Thai government. The Pharmacy (UniPharm) also serves numerous students who \n\n\n\nsuffered from common illnesses, but out-of-pocket. Both places should be incorporated into one \n\n\n\nsystem. Cost of services is, therefore, essential to design a payment method between them. This study \n\n\n\nwas to examine the proportion of the student visits of both settings regarding common illnesses \n\n\n\n(covering eight systems: upper-respiratory, gastrointestinal, urinary tract, reproductive health, pain, \n\n\n\neye/ear, skin, and helminths), and to perform unit cost analysis. Patient visits were observed during \n\n\n\nAugust to October 2013. Labour (LC) and material costs (MC) related to the focal activity were \n\n\n\nrecorded. Total cost divided by total patient visits determined the unit cost. Patients were followed up \n\n\n\nafter 3-14 days of pharmacy visit to examine the effectiveness. Sensitivity analysis was performed by \n\n\n\nvarying direct medical cost at \u00b110%. Managing common illness at the medical centre involved nurse \n\n\n\nassistants, nurses, doctors and pharmacists. Of 6,701 patients, 1,454 (21.7%) visited regarding \n\n\n\naforementioned illnesses, 904 were students (13.5%). Upper respiratory disorders were the most \n\n\n\ncommon, 53.0% (771/1,454). Unit cost of treatment ranged from 85.39 baht (eye/ear) to 245.93 baht \n\n\n\n(sexual health). At the UniPharm, community pharmacist performed multiple tasks including \n\n\n\nassessing patient, choosing appropriate treatment and dispensing. Of the 9,141 customers, 755 were \n\n\n\nstudents seeking help regarding common illnesses (8.5%). Upper respiratory disorders were also \n\n\n\nfound to be the highest 41.9% (325/755). Unit cost of treatment ranged from 54.16 baht (pain) to \n\n\n\n82.71 baht (skin problems). Two-thirds (70.1%, 543/699) reported completely recovered. Varied \n\n\n\ndirect medical cost affected the unit cost change for approximately 4.3-7.3% in both places. Managing \n\n\n\ncommon illnesses at the UniPharm shows satisfactory effectiveness with lower unit cost, thus its \n\n\n\npotential to be a sub-contractor of the university health system.  \n\n\n\n\n\n\n\n\n\n\n\nCPP 08 \nFAPA2014000012 (Poster) \n\n\n\nInvestigation of Actual Conditions about Mixture of External Medicines in Japanese Health \n\n\n\nInsurance Pharmacy: Questionnaire Survey in Japan \n\n\n\nMoe Hosaka\u00b9, Hisashi Iijima\u00b2, Eriko Kobayashi\u00b9, Nobunori Satoh\u00b9 \n\n\n\n\u00b9Department of Clinical Education and Research, Graduate School of Pharmaceutical Sciences, \n\n\n\nChiba University, Japan \n\n\n\n\u00b2Drug Information Center, Chiba Pharmaceutical Association, Japan \n\n\n\nAs a dermatological therapy in Japan, two or more kinds of external medicines are mixed depending \n\n\n\non patients\u2019 symptoms to improve their compliance. However, several problems exist when mixing \n\n\n\nexternal medicines, such as separation of mixed medicines due to an incompatible match. In this \n\n\n\nsurvey, we investigated the attitude of pharmacists toward mixing external medicines in Japan. A \n\n\n\nquestionnaire survey was conducted in order to explore the pharmacists\u2019 attitude and experiences \n\n\n\ntoward mixing external medicines. The subjects of the survey were the pharmacists who work at the \n\n\n\npharmacies belonging to Chiba Pharmaceutical Association (1931 pharmacies). The response rate was \n\n\n\n19.2%. A quarter (25.4%) of the respondents had positive opinions about mixing external medicines. \n\n\n\n\n\n\n\n\nAs patients benefit from the mixed external medicines, the respondents who had positive opinions \n\n\n\nabout mixing external medicines indicated that reduced side effects, improved usage impression, and \n\n\n\nincreased effect of medicines more than those who did not (p<0.01). Furthermore, the respondents \n\n\n\nwho did not have positive opinion had never had problems and questions about mixing external \n\n\n\nmedicines more than those who did (p=0.023). Those problems they indicated were related to the \n\n\n\ncomplaints from patients and the prescription questions to doctors. The survey revealed pharmacists\u2019 \n\n\n\nexperiences of having problems and questions were associated to their attitudes toward mixing \n\n\n\nexternal medicines. Since the problems the respondents had about mixing external medicines \n\n\n\ncorresponded to the complaints from patients and their prescription questions to doctors, solving their \n\n\n\nproblems and questions may reduce the complaints from patients and the prescription questions to \n\n\n\ndoctors. Since external medicines should be originally used alone, currently not much information on \n\n\n\nmixing external medicines is described in drug labeling in Japan. In order to reduce the complaints \n\n\n\nfrom patients and the prescription questions to doctors, the tools that pharmacists can easily extract \n\n\n\nthe information on mixing of external medicines should be developed. \n\n\n\n\n\n\n\nCPP 09 \n\n\n\nFAPA2014000110 (Poster) \n\n\n\nKnowledge, Attitude and Practice (KAP) towards Human Immunodeficiency Virus (HIV)/ \n\n\n\nSexually Transmitted Illnesses (STIs) among Secondary School Students in Kota Damansara, \n\n\n\nSelangor. \n\n\n\nJN Adilla Hayat, AJN. Amaliya Wafiya, A B Semira\n \n\n\n\n\n\n\n\nDepartment of Clinical Pharmacy, Faculty of Pharmacy, Cyberjaya University College of Medical \n\n\n\nSciences, Selangor, Malaysia. \n\n\n\nSexual and reproductive health of young people has become a major health problem in recent \n\n\n\ndecades. Recently, WHO revealed that adolescents who were infected with STIs including HIV \n\n\n\naccounted for an estimated 40% of all new HIV infections among adults worldwide in 2009. In \n\n\n\ncomparison to that, about 26% of reported HIV infections in Malaysia are amongst young people aged \n\n\n\nbetween 13-29 years old. Recent and rapidly increasing HIV rates show an urgent need for prevention \n\n\n\ninterventions in Malaysia. This study aimed to evaluate the knowledge, attitude and practice of \n\n\n\nsecondary school students with regard to HIV/STIs. A cross-sectional study was conducted between \n\n\n\nJanuary - December 2013. A total of 312 secondary school students in Kota Damansara, Selangor \n\n\n\ncompleted anonymous self-administered questionnaires in supervised classroom settings. Data in the \n\n\n\nstudy demonstrated an overall low level of knowledge of HIV/STIs (35.5%), which was influenced by \n\n\n\ngender, age and academic streams of the subjects (p<0.05). There were some misconceptions \n\n\n\nidentified, mostly regarding ability to cure HIV and that usage of antibiotic and vaccine was believed \n\n\n\ncould prevent or stop the infections. Analysis showed a negative attitude among the subjects towards \n\n\n\nHIV/STIs and people living with HIV (PLHIV), which was also influenced by age and academic \n\n\n\nstream (p<0.05). Subjects were found to have engaged in risky practices that could lead to the \n\n\n\ncontraction of HIV/STIs. Study observed that subjects with higher knowledge level have better \n\n\n\nattitude towards the disease and PLHIV (r= 0.583, p<0.001). Yet knowledge and good attitude are not \n\n\n\nsufficient to prevent them from getting involved in risky practices. The most common source of \n\n\n\ninformation on HIV/STIs was TV/radio advertisements. Knowledge inadequencies and negative \n\n\n\nattitude among subjects require more emphasis in the curricula and education campaign on the \n\n\n\ndiseases. \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nCPP 10 \nFAPA2014000024 (Poster) \n\n\n\n\n\n\n\nLook Alike Sound Alike (LASA) Medications \n\n\n\n\n\n\n\nP Sachinkumar, K Atul, P Shitalkumar  \n\n\n\nDepartment of Pharmaceutics, Ashokrao Mane College of Pharmacy Peth Vadgaon, India \n\n\n\n\n\n\n\nLook Alike Sound Alike (LASA) medications involve medications that are visually similar in \n\n\n\nphysical appearance or packaging and names of medications that have spelling similarities and/or \n\n\n\nsimilar phonetics. As more medicines and new brands are being marketed in addition to the thousands \n\n\n\nalready available, many of these medication names may look or sound alike. Confusing medication \n\n\n\nnames and similar product packaging may lead to potentially harmful medication errors. Emphasis on \n\n\n\npatient safety in the naming of medicines is now undertaken by national and international regulatory \n\n\n\nand advisory boards. The World Health Organization\u2019s International Non-proprietary Names Expert \n\n\n\nGroup works to develop international non-proprietary names for pharmaceutical medicinal substances \n\n\n\nfor acceptance worldwide. Healthcare organizations need to institute risk management strategies to \n\n\n\nminimize adverse events with LASA medications and enhance patient safety. Therefore, it is \n\n\n\nnecessary to study the common risk factors associated with LASA medications, Strategies to avoid \n\n\n\nerrors with Look Alike Sound Alike Medications Prescribing procedure, Patient Education and roles \n\n\n\nof typography in differentiating the Look Alike Sound Alike Medications. \n\n\n\n\n\n\n\n\n\n\n\nCPP 11 \nFAPA2014000145 (Poster) \n\n\n\n\n\n\n\nBarriers to Implementing Practice Research in Japanese Community Pharmacists \n\n\n\n\n\n\n\nS Yamamura\n1\n, M Fujii\n\n\n\n1\n, A Hirano\n\n\n\n1\n, R Hirokawa\n\n\n\n1\n, Y Sawada\n\n\n\n1,2\n, R Takehira\n\n\n\n1\n \n\n\n\n1\nFaculty of Pharmaceutical Sciences, Josai International University, Japan \n\n\n\n2\nWelcia Kanto Co., Ltd., Japan \n\n\n\n\n\n\n\nTo expand the professional roles of pharmacists in the community, they should clarify themselves that \n\n\n\nthey can improve patients\u2019 outcomes through practice researches. There would be some barriers to \n\n\n\nconduct a practice research by community pharmacists in Japan. The purpose of this research is to \n\n\n\nreveal the barriers to conduct a research in Japanese community pharmacists. Community pharmacists \n\n\n\n(n=478) who gave a presentation in three major pharmacy related conferences in last 2 years were \n\n\n\nasked on barriers to conduct a practice research in their setting. We also explored their level of \n\n\n\nunderstanding of technical terms using in protocols of practice researches. A questionnaire was \n\n\n\nmailed to the pharmacists directly and the response was returned by mail. We obtained 229 responses \n\n\n\nfrom community pharmacists (47.9%). From the responses, the barriers to conduct a practice research \n\n\n\nin Japanese community pharmacists: 1) they can\u2019t find enough time to research because of busy tasks, \n\n\n\n2) no supervisor for research in community pharmacy setting and 3) a lack of understand the \n\n\n\nimportance of practice research in other community pharmacists. Many community pharmacists \n\n\n\nwould have knowledge about statistical analysis, but are not good for the study designs of practice \n\n\n\nresearch. We identified 3 major potential barriers to the development of practice research of \n\n\n\ncommunity pharmacists in Japan. To overcome the barriers, the development of a collaborative \n\n\n\nrelationship among pharmacists to make time for practice research and the establishment of \n\n\n\ncollaboration between universities or research institutes and community pharmacists would be a \n\n\n\nchallenge to implementing practice research in Japanese community pharmacists.  \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nCPP 12 \nFAPA2014000103 (Poster) \n\n\n\n\n\n\n\nPractices of Remote and Modernised Indigenous People towards Minor Illness: A Comparison \n\n\n\n\n\n\n\nSL Leong, N Jamil, YL Tan, TK Leong \n\n\n\nFaculty of Pharmacy, Cyberjaya University College of Medical Sciences, Kuala Lumpur, Malaysia \n\n\n\n\n\n\n\nTo improve the health conditions of indigenous population, the government provides them with \n\n\n\nconvenient healthcare services, free education and mass media exposure. However, how much this \n\n\n\nmodernisation has changed our Orang Asli practice in managing and prevention of minor illness is \n\n\n\nstill doubtful. Thus, this study is aimed to compare the practice between the remote and modernised \n\n\n\nindigenous people towards minor illness which the result could be useful to the authority in designing \n\n\n\nfuture healthcare promotion programme for the similar population. Cross-sectional surveys using pre-\n\n\n\ntested questionnaire were carried out at a remote Orang Asli settlement (Kampung Pos Piah, Sungai \n\n\n\nSiput, Perak) and modernised Orang Asli settlements (Kampung Tadom, Kampung Paya Rumput and \n\n\n\nKampung Mutus Tua, Banting, Selangor), according to Jabatan Kemajuan Orang Asli Malaysia. A \n\n\n\ntotal of 141 and 103 indigenous adults were conveniently sampled from remote and modernised \n\n\n\nsettlements respectively. Public healthcare centre were preferred by most remote population while in \n\n\n\nmodernised settlement, both public and private healthcare centre were almost equally preferred. \n\n\n\nFever, cough and common cold were the top three minor illnesses that made both populations to seek \n\n\n\ntreatment from modern medicine. In remote settlement, reachability is the main barrier in seeking \n\n\n\ntreatment from modern medicine. Both populations will advise and assist ill family member to seek \n\n\n\ntreatment and take care of them. In remote population there is a significance number of them will \n\n\n\ndistance themselves from (n = 54), lock up (n = 33) and disown (n = 20) the ill family member, which \n\n\n\nmight be due to misconception on minor illnesses. There was significantly more people in remote \n\n\n\nsettlement prevent minor illness by visiting \u2018bomoh\u2019 regularly. The difference in practice towards \n\n\n\nminor illnesses between the two populations which could be due to different exposure and facilities \n\n\n\navailability in the neighbourhood. \n\n\n\n\n\n\n\n\n\n\n\nCPP 13 \nFAPA2014000039 (Poster) \n\n\n\n\n\n\n\nSurvey of Community Pharmacies conducting Chinese Medicine Business in Taichung \n\n\n\n\n\n\n\nWW Liu\n1\n, CT Lin\n\n\n\n1\n, FC Pan\n\n\n\n2\n  \n\n\n\n1\nDepartment of Healthcare Administration, Central Taiwan University of Science and Technology, \n\n\n\nTaiwan \n2\nDepartment of Hospitality Management, Tajen University, Taiwan \n\n\n\n\n\n\n\nThe aim of the study was to reveal the problems and accordingly attempt to figure out alternative \n\n\n\nsolutions as reliable references to the authorities and associated organizations in promoting Chinese \n\n\n\nmedicines. This survey investigated the general perceptions of pharmacists working in community \n\n\n\npharmacies towards conducting the captioned business in Taichung. There were 213 pharmacies, that \n\n\n\nis 28.8% of the 739 in the entire city, which offered products associated with Chinese medicines. \n\n\n\nAmple room for such business remained. The survey results showed that the respondents lacked faith \n\n\n\nto be involved in Chinese medicines in the present business, and generally believed that education on \n\n\n\nthis particular business is sufficient, whereas the incentive or additional training offered by the \n\n\n\ngovernment and occupational associations were not. The survey indicated that there were three types \n\n\n\nof business model in the current market. The first type is a business model that fully embraced all \n\n\n\nkinds of Chinese medicines. Products offered by this type may range from prepared decoction, herbs, \n\n\n\nprocessed medicines (scientific Chinese medicines), medicinal cuisine, and regime teas to medicines \n\n\n\nthat may alleviate gastrointestinal and vascular diseases or disorders, including products that \n\n\n\nempowered immunity and that helped body shaping for both retail and wholesale markets. The second \n\n\n\n\n\n\n\n\ntype of pharmacy was those which barely offered processed Chinese medicines to accompany western \n\n\n\nmedicines. The last type was certified as licensed sellers, and offered the requested Chinese medicines \n\n\n\nin response to the customers\u2019 demand. The survey results indicated that over 70% of the community \n\n\n\npharmacies lacked faith in the Chinese medicine business. The authors suggested that the pharmacist \n\n\n\nassociations and the associated authorities should make sufficient endeavors to ease the suspicious \n\n\n\ntowards this business, and provide education and training programmes to encourage and improve \n\n\n\nmore involvement of pharmacists in this business. The consumers can have more choices, and may \n\n\n\nincrease their overall satisfaction towards the medication services. \n\n\n\n\n\n\n\n\n\n\n\nCPP 14 \nFAPA2014000229 (Poster) \n\n\n\n\n\n\n\nKnowledge, Attitude and Practices of Contraception among Rural Women in Banting, Selangor \n\n\n\n\n\n\n\nAKJ Nurul Atiqah, M Alini, I Siti Nooruhani \n\n\n\nCyberjaya University College of Medical Sciences, Cyberjaya, Selangor, Malaysia \n\n\n\n\n\n\n\nModern contraceptive practice in Malaysia is low. Only 30% of married women aged between 15-49 \n\n\n\nyears make use of modern contraceptive methods. The government however has been promoting \n\n\n\nfamily planning since 1967, implying that contraception would by now be a household use. This study \n\n\n\nwas conducted to determine the knowledge, attitude and practice (KAP) of contraception among rural \n\n\n\nwomen, forty five years after the introduction of modern contraception in Malaysia. This survey was \n\n\n\ncarried out in Banting, Selangor. A total of 250 married women were enrolled in this study using \n\n\n\nconvenient sampling. Respondents were interviewed using a questionnaire. Their demographic and \n\n\n\nsocioeconomic information were recorded and data on contraceptive KAP were collected from \n\n\n\nmarried women in the age group of 15 to 49 years. Of the respondents (n=250), 88% indicated that \n\n\n\nthey had knowledge regarding contraceptive methods, 48.8% were practising contraception and \n\n\n\n52.4% had good attitude towards contraception. Both demographic data and socioeconomic \n\n\n\nfactors influenced the contraceptive practices. The analysis showed that women with lower education \n\n\n\nwere more likely to practise contraception compared to women with higher education. Women who \n\n\n\nwere working, having less than two children and who were in the higher income status were more \n\n\n\nlikely to practise contraception. Women who had higher knowledge regarding contraception and \n\n\n\nwomen who were practising contraception were more likely to develop good attitude towards \n\n\n\ncontraception (p<0.001). This suggests that awareness on contraception is reasonably good among \n\n\n\nrural women. Efforts to promote contraceptive use among Malaysian women especially those in rural \n\n\n\nareas should continue and be strengthened. \n\n\n\n\n\n\n\n\n\n\n\nCPP 15 \nFAPA2014000309 (Poster) \n\n\n\n\n\n\n\nAnalysis of Factor Affecting Therapy Adherence in Systemic Lupus Erythematosus (SLE) \n\n\n\nPatients \n\n\n\n\n\n\n\nS Baadilla\n1\n, A Rahem\n\n\n\n2\n, R Yulia\n\n\n\n1\n \n\n\n\n1\nFaculty of Pharmacy, University of Surabaya, Surabaya, Indonesia \n\n\n\n2\nFaculty of Pharmacy, Airlangga University, Surabaya, Indonesia \n\n\n\n\n\n\n\nMedication adherence in chronic diseases such as Systemic Lupus Erythematosus (SLE) has been \n\n\n\nshown to improve clinical outcomes and prevent exacerbations and maintain SLE in a stable state. \n\n\n\nHowever, patient adherence remains a problem in the treatment of SLE. Various studies suggest that \n\n\n\npatient adherence in the treatment of SLE is still quite low. This study is an observational study with \n\n\n\ndescriptive and analytical design. The samples in this study were 37 patients with SLE who were \n\n\n\nenrolled as members of the Syamsidhuha foundation. Adherence levels measured with validated \n\n\n\n\n\n\n\n\nquestionnaires, MMAS-8 item and factors affecting adherence searched in-depth interviews. \n\n\n\nAdherence factors were classified into patient factors, treatment factors, disease factors, health service \n\n\n\nfactors and socioeconomic factors. These factors were analyzed using logistic regression to look for \n\n\n\neffects on the level of adherence. This study showed that 65% of patients adhere to treatment. \n\n\n\nDifferent factors were significant patient factors (p = 0.039) and socioeconomic factors (p = 0.045). \n\n\n\nFactors that significantly affect patient adherence are patient factors, health service factors, and \n\n\n\nsocioeconomic factors. \n\n\n\n\n\n\n\n\n\n\n\nCPP 16 \n\n\n\nFAPA2014000280 (Poster) \n\n\n\nThe Milestone of Pharmaceutical Service in Taiwan ~ Be Part of Consumer Protection ~ 2013 \n\n\n\nIntercity Pharmacy Forum \n\n\n\nWN Yu, M Fan \n\n\n\nTaipei Pharmacists Association, Taipei, Taiwan, R.O.C. \n\n\n\nThe demands of drug use safety and convenience have been progressively increasing. Facing the \n\n\n\nneeds of upgrading qualities and convenience of pharmacy professional service, Taipei Pharmacists \n\n\n\nAssociation believed that we should learn more from the other countries. In order to evaluate the \n\n\n\npolicy for separation of dispensing from prescribing, to deliberate the strategy of pharmacy care, and \n\n\n\nto find out the better practice environment to secure people\u2019s well-being of healthcare through \n\n\n\n\"responsible self-medication\", Taipei Pharmacists Association and Taipei City Government jointly \n\n\n\nheld 2013 Intercity Pharmacy Forum. We invited pharmacist leaders from Tokyo, Seoul, Beijing, \n\n\n\nShanghai, FIP, FAPA, the Pharmaceutical Society of Singapore and Malaysia. We exchanged views \n\n\n\nin promoting the policies of the pharmacy service deemed helpful to the country to overcome \n\n\n\ndifficulties in the next decade. The target of 440 participants was achieved. The current issues were \n\n\n\nthoroughly discussed and the view exchange among participants was wonderfully communicated. The \n\n\n\nROC President, Ma Ying-Jeou, declared the core value of the Forum: To implement medical \n\n\n\ndiversion and pharmacist professional service to ensure drug safety is the existing policy and patient-\n\n\n\noriented pharmacy services not only reduce medical wastage but also lower expenditure of health \n\n\n\ninsurances. The cross-strait platform to assist the Government in promoting the development of cross-\n\n\n\nstrait medicine and health was built. The pharmacists in Taiwan actively promote the value \n\n\n\nof pharmacy service currently. The Health Bureau of Taipei City increased the budget and activities \n\n\n\nfor promoting the role of pharmacy practice in the community. The Taipei citizens gave high marks to \n\n\n\npharmacist providing professional service and 78.4% expressed that they do need \n\n\n\npharmacist\u2019s professional consultation. \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nCPP 17 \nFAPA2014000308 (Poster) \n\n\n\n\n\n\n\nAwareness on the Use of Medicine and Know Your Medicine Campaign by Sarawak \n\n\n\nConsumers: A Comparison between Urban and Rural Population \n\n\n\n\n\n\n\nTHR Tan, CY Ting \n\n\n\nPharmacy Enforcement, Sarawak State Health Department, Ministry of Health Malaysia \n\n\n\n\n\n\n\n\u201cKnow Your Medicine\u201d (KYM) Campaign was launched in tandem with the Malaysian National \n\n\n\nMedicines Policy which stresses the importance of the Quality Use of Medicine (QUM) among \n\n\n\nconsumers. It is essential to understand how consumers use their medicines and their awareness \n\n\n\ntowards the campaign so that the authorities could plan effective strategies to enhance consumers\u2019 \n\n\n\nunderstanding on the concept of QUM. The study was conducted to explore the awareness on the use \n\n\n\nof medicines and towards KYM campaign by Sarawak consumers with comparison between urban \n\n\n\nand rural population. A cross-sectional study was carried out from September to November 2013 by \n\n\n\nusing self-administered questionnaire. 26 data collectors were appointed and trained in data \n\n\n\ncollection. Multiple stages sampling was carried out to pick 385 respondents from the whole of \n\n\n\nSarawak. Research data were analyzed with non-parametric tests with significance level p<0.05. A \n\n\n\ntotal of 189 respondents were recruited from each urban and rural area. Rural respondents were less \n\n\n\naware that medicines approved by the Ministry of Health must have MAL Registration Number and \n\n\n\nHologram Meditag\nTM\n\n\n\n sticker. Rural respondents had difficulties in reading medicines\u2019 label supplied \n\n\n\nby private healthcare institutions. They also perceived that controlled medicines can be obtained from \n\n\n\nthe grocery shops. In terms of disposing defect or expired medications, more respondents from rural \n\n\n\nwould return them to the pharmacist in Government health institutions. Urban respondents were less \n\n\n\naware of KYM campaign. Both urban and rural respondents were aware of side effects and drug \n\n\n\ninteractions of their medication. The study revealed the current scenario on the use of medicines and \n\n\n\nawareness towards KYM campaign among the urban and rural population in Sarawak. This serves as \n\n\n\na yardstick for future strategy development by Sarawak Pharmaceutical Services Division in \n\n\n\nenhancing consumers\u2019 understanding on the concept of QUM. \n\n\n\n\n\n\n\n\nDRUG MARKETING & SOCIO-ECONOMIC PHARMACY \n\n\n\nSEP 01 \n\n\n\nFAPA2014000121 (Poster) \n\n\n\n\n\n\n\nA Study on Cost Effectiveness, Reduction in Pack Per Year and Peak Flow Analysis of Electronic \n\n\n\nCigarette Users in Klang Valley, Malaysia \n\n\n\n\n\n\n\nM Masro, M Mazlin-Eliani \n\n\n\nFaculty of Pharmacy, Cyberjaya University College of Medical Sciences (CUCMS), Cyberjaya, Selangor, \n\n\n\nMalaysia \n\n\n\n\n\n\n\nElectronic cigarette (EC) is a battery-powered device that imitates the feel and experiences of smoking a \n\n\n\nconventional cigarette. It is a novel product emerging in the market just a couple of years ago and \n\n\n\ntherefore, there are only few scientific studies on the effectiveness of this product and its health \n\n\n\nimplications. The aims of this study were to compare the estimated costs spent on conventional cigarettes \n\n\n\n(pre-EC) with that of the estimated costs after shifting to EC (post-EC), to calculate the reduction of pack \n\n\n\nper year after shifting to EC and to measure the peak flow reading of the EC users in the Klang Valley, \n\n\n\nMalaysia. This study was conducted at an electronic cigarette stall in Downtown Night Market, Cheras, \n\n\n\nKuala Lumpur. Questionnaires were given to 73 respondents who fulfilled both the inclusion and \n\n\n\nexclusion criteria. After answering the questionnaires, a peak flow meter test was carried out on each of \n\n\n\nthe respondents. In addition, the peak flow meter test was also carried out on the same number of \n\n\n\nconventional cigarette smokers to compare the readings with that of the EC users. Findings from this \n\n\n\nstudy suggested that EC is a cost effective device which showed a significant reduction in average \n\n\n\nmonthly expenditure. In addition, the results also showed that electronic cigarette helped in the reduction \n\n\n\nof pack per year. There is also a significant difference between the peak flow readings of the EC users \n\n\n\nwith that of the peak flow meter readings of the conventional cigarette smokers. In conclusion, EC may \n\n\n\nbe considered as an alternative to the current nicotine replacement therapy (NRT) in an attempt to quit \n\n\n\nsmoking.  \n\n\n\n\n\n\n\n\n\n\n\nSEP 02 \nFAPA2014000167 (Poster) \n\n\n\n\n\n\n\nCost-effectiveness Analysis of Medication Reconciliation at Female Medical Ward in Chonburi \n\n\n\nHospital, Thailand \n\n\n\n\n\n\n\nW Chaisiripenpak, S Soontaros, K Chaisiri \n\n\n\nChonburi Hospital, Thailand \n\n\n\n\n\n\n\nMedication reconciliation (MR) is an important process in medication management system to improve \n\n\n\nquality of care. However, the economic outcome of MR in Chonburi Hospital has not been disclosed. \n\n\n\nCost-effectiveness analysis of this process is needed for decision making of the hospital director to \n\n\n\nimplement this activity throughout the hospital. This study aimed to assess the incremental cost \n\n\n\neffectiveness ratio (ICER) of the medication reconciliation process. The ICER was carried out from the \n\n\n\nprovider perspective.  This retrospective study included patients admitted to the female medical ward, \n\n\n\nChonburi Hospital from October 1, 2012, to December 25, 2012. Patients with the same ICD-10 diagnosis \n\n\n\ncodes were assigned to the MR implemented group (MR group) and the non-MR implemented group \n\n\n\n(non-MR group). The direct costs associated with the MR process were determined, including material \n\n\n\nand labour costs. The effectiveness was defined as the length of stay in the hospital and the cost saving of \n\n\n\n\n\n\n\n\nthe reusable medicines. The number of patients in each group was 21. The average time to complete \n\n\n\nmedication reconciliation process was 103 minutes per patient. The average labour cost per patient of the \n\n\n\nMR group was 8.84 USD higher than of the non-MR group. The average reduced length of stay per \n\n\n\npatient per day was 1.6 days for the MR-group which accounted for 99.22 USD. The reusable medicine \n\n\n\nsaving cost was 5.13 USD per patient. The overall effectiveness was 104.34 US per patient. The \n\n\n\nincremental cost effectiveness ratio of the MR process in Chonburi hospital was 11.8. The implication is \n\n\n\nthat for every 1,000 USD of the MR costs, the return is 11,800 USD of the effectiveness outcomes.  \n\n\n\n\n\n\n\n\n\n\n\nSEP 03 \nFAPA2014000028 (Poster) \n\n\n\nComparison of Cost Analysis and Usage Effectivity of Repacked Meropenem and Non Repacked \n\n\n\nMeropenem in Paediatric Patients  \n\n\n\nA Idha, S Chasanah \nDepartment of Pharmacy, Saiful Anwar General Hospital, Malang, Indonesia \n\n\n\n\n\n\n\nHigh cost of antibiotic remains a health problem in developing countries, such as Indonesia. The use of \n\n\n\nmeropenem in paediatric patients, at Saiful Anwar General Hospital, reached 70% in definitive therapy of \n\n\n\ninfection cases. Due to unavailability of paediatric dosage form, patients have to buy the standard pack \n\n\n\nmeropenem 1 g/vial even if the required dose are less than that.  Low stability after reconstitution, low \n\n\n\ndoses used by paediatric patients, and left-over of injection, it based the pharmacist to make a repacking \n\n\n\nof meropenem. The purpose of this study is to analyze effectivity and usage cost in repacked meropenem, \n\n\n\ndone by observational analysis and taken by secondary data in medical records. The amounts of samples \n\n\n\nare 60 pediatric patients, divided by 30 paediatric patients using repacked meropenem and 30 pediatric \n\n\n\npatients using non-repacked meropenem. The effectiveness will be evaluated by observed the clinical \n\n\n\nimprovement, such as pulse, temperature and respiration rate for 3 to 7 days, then calculating the score of \n\n\n\neffectiveness and processed by SPSS with Mann Whitney method. The fastest clinical improvement was \n\n\n\npatient using repacked meropenem (4 days), while the score of effectiveness in patient using repacked \n\n\n\nmeropenem (pulse score 6.87; temperature score 6.80; RR score 6.70) was bigger than non-repacked \n\n\n\nmeropenem (pulse score 6.80; temperatures score 6.60; RR score 6.57). Cost data processing using ACER \n\n\n\nmethod, the obtained by usage of repacked meropenem is cheaper than non-repacked meropenem. The \n\n\n\nconclusion of this study are repacked meropenem is more effective and low price than non-repacked \n\n\n\nmeropenem. \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nSEP 04 \n\n\n\nFAPA2014000123 (Poster) \n\n\n\n\n\n\n\nValidation of Questionnaire Assessing General Knowledge about Features of Registered Healthcare \n\n\n\nProducts (VALKORP) \n\n\n\n\n\n\n\nCC Chew,  XR Tan, LY Hii, PK Chia, AN Ahmad Afandi, SM Wong, R Thangatorai, S Setan, AK \n\n\n\nMohd Tahir \n\n\n\nPharmacy Enforcement Branch, Pharmaceutical Services Division, Sabah State Department of Health, \n\n\n\nMinistry of Health, Kota Kinabalu, Sabah, Malaysia \n\n\n\n\n\n\n\nAwareness of registered healthcare products is highly important for society. Aim of the current study was \n\n\n\nto develop and validate a questionnaire to assess and to measure general knowledge about registered \n\n\n\nhealthcare products. This was a cross-sectional study conducted from August till December 2013 among \n\n\n\nemployees at government departments located at KWSP building and Federal House, Kota Kinabalu, \n\n\n\nSabah. A Malay language, non-validated self-administered questionnaire was modified into 2 domains \n\n\n\nconsisted of 13 items and proof read by Malaysian Institute of Translation & Books (ITBM). A total of 86 \n\n\n\ngovernment servants were requested to participate through convenient sampling. Re-test was conducted \n\n\n\nafter 2 weeks and 84 responded. Descriptive analysis, internal consistency, intraclass correlation and \n\n\n\nfactor analysis were done. Internal consistency with Cronbach's Alpha of 0.877 and intraclass correlation \n\n\n\ncoefficient of 0.745 showed sufficient reliability. Factor analysis indicated 2 main factors. This result was \n\n\n\nsimilar to our initial intention where questionnaire was modified into 2 domains. However, loading factor \n\n\n\nof item-4 was low (0.384). This was increased to >0.4 when 3 factors were extracted. Loading factors of \n\n\n\nitem-13 were 0.499 and 0.634 for each factor respectively and this suggested item-13 correlated better \n\n\n\nwith the first three items. Decision of content expertise was to remove item-4 and move item-13 to be the \n\n\n\nfirst item. Final Cronbach\u2019s Alpha was 0.879. This validated questionnaire was used to assess general \n\n\n\nknowledge of registered healthcare products and can be used for further validation of English version. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nINDUSTRIAL PHARMACY \n \nIPP 01 \nFAPA2014000052 (Poster) \n\n\n\n\n\n\n\nSolubility Enhancement and Formulation Development of Aprepitant Using Self-Micro \n\n\n\nEmulsifying Drug Delivery System \n\n\n\n\n\n\n\nBVS Nallamolu\n1\n, J Vijayaratna\n\n\n\n2\n, JM Rathbone\n\n\n\n3\n, C Mallikarjun\n\n\n\n1\n \n\n\n\n1\nDepartment of Pharmaceutical Technology, International Medical University, Malaysia. \n\n\n\n2\nAU College of Pharmaceutical Sciences, Andhra University, India. \n\n\n\n3\nSchool of Pharmacy, International Medical University, Malaysia. \n\n\n\n\n\n\n\nAprepitant is a nerokinin-1 receptor antagonist which is indicated for the prevention of acute and delayed \n\n\n\nnausea and vomiting associated with initial and repeat courses of highly emetogenic cancer \n\n\n\nchemotherapy. Aprepitant is one of the prototypical BCS class II model compound which has poor \n\n\n\nsolubility and poor permeability characteristics. The delivery of aprepitant is also fraught with inter-\n\n\n\npatient variability when delivered as a tablet formulation, thereby requiring a nanoparticulate capsule-\n\n\n\nbased composition. To overcome this problem, the solubility of drug was improved by using self-micro \n\n\n\nemulsifying drug delivery system in various vehicles viz. oils, surfactants and co-surfactants. A pseudo \n\n\n\nternary phase diagram was constructed to identify the self-micro emulsification region using water \n\n\n\ntitration method. The in vitro self-micro emulsification properties and droplet size analysis of SMEDDS \n\n\n\nwere studied following their addition to water under mild agitation. The resultant formulations were \n\n\n\ninvestigated for clarity, phase separation, globule size, effect of pH (SGF, SIF) and effect of dilution \n\n\n\n(1:100, 1:500, and 1:1000), dissolution, emulsification time and freeze \u2013 thaw stability. The optimized \n\n\n\nformulation, SMEDDS used for in vitro dissolution contained oil (Capryol 90), surfactant (Cremophor-\n\n\n\nEL) and co-surfactant (Transcutol \u00aeHP). The self-micro emulsifying drug delivery system developed was \n\n\n\nfound to be a good model for enhancing the solubility of poorly water soluble drugs and the formulation \n\n\n\ndevelopment of aprepitant was found to be good, which gave promising results in terms of zeta size, \n\n\n\neffect of dilution, pH, freeze thaw, stability, dissolution, emulsification time and others. The formulation \n\n\n\nAPT7 was found to be good, in terms of solubility and dissolution. \n\n\n\n\n\n\n\n\n\n\n\nIPP 02 \nFAPA2014000015 (Poster) \n\n\n\n\n\n\n\nThe Microbiological Quality of Herbal Cosmetics \n\n\n\nS Rattanakiat, N Phromchai, N Jitnamkorn  \n\n\n\nPharmaceutical Chemistry and Natural Products Research Unit, Faculty of Pharmacy, Mahasarakham \n\n\n\nUniversity, Kantarawichai, Maha Sarakham, Thailand. \n\n\n\nHerbal cosmetics have become popular in recent years; thus products are diverse in the market. However, \n\n\n\nmicrobial contamination is a major concern because of contaminated raw materials and unhygienic or \n\n\n\nsuboptimal production process. This study was to examine microbiological quality of herbal cosmetics \n\n\n\nwhich were commercially available in Maha Sarakham, Thailand. Thirty herbal cosmetics in three forms; \n\n\n\npowder, aqueous- and oil-based preparations, were convenience sampled from different sources. \n\n\n\nAssessment of microbiological quality included (1) the enumeration of microorganisms - total aerobic \n\n\n\nmicrobial count (TAMC) and (2) the detection of specific pathogenic bacteria including Staphylococcus \n\n\n\naureus, Pseudomonas aeruginosa, Candida albicans and Clostridium spp., as per the Thai Industrial \n\n\n\n\n\n\n\n\nStandard, TIS 152-1996. Total yeast and mold count (TYMC) was additionally carried out. Of the 30 \n\n\n\nsamples, 16 (7 powder, 5 aqueous-based, and 4 oil-based preparations) did not meet the TIS standard due \n\n\n\nto the exceeded amount of TAMC (> 1x10^3 CFU per g or mL). S. aureus was found in one aqueous-\n\n\n\nbased product, while Ps. aeruginosa was found in one oil-based, and Clostridium spp. was found in three \n\n\n\nbrands of powder form and one aqueous-based product. C. albicans was not detected in any of the \n\n\n\nsamples. TYMC more than 1x10^3 CFU per g or mL was found in 14 samples (7 powder, 4 aqueous-\n\n\n\nbased and 3 oil-based products). This study identified poor microbiological quality of some herbal \n\n\n\ncosmetics available in Maha Sarakham. Producers should pay more attention to good manufacturing \n\n\n\npractices and adhere to guidelines given by relevant government authorities. Several measures, including \n\n\n\nmonitoring programmes and post-marketing surveillance may be imposed further to reduce the level of \n\n\n\nmicrobial contamination of herbal products. \n\n\n\n\n\n\n\n\n\n\n\nIPP 03 \n\n\n\nFAPA2014000092 (Poster) \n\n\n\nFormulation and Characterization of Acyclovir Loaded Nanostructured Lipids with Polysorbate 80 \n\n\n\nV Senthil, N Aniruth, N Jawahar \n\n\n\nDepartment of Pharmaceutics, JSS College of Pharmacy, Tamil Naidu, India \n\n\n\n\n\n\n\nAcyclovir is used to treat brain encephalitis caused by herpes virus. Acyclovir being a hydrophilic drug, \n\n\n\nhas poor oral bioavailability (15% - 30%) and its blood plasma to cerebrospinal fluid ratio is 10:1. The \n\n\n\nnanostructured lipids are formulated using polysorbate 80 for targeting the brain so that the concentration \n\n\n\nof drug in the brain can be increased and the dose of drug can be reduced. Hallucinations and \n\n\n\nnephrotoxicity have been reported with high doses of acyclovir. NLCs are prepared by emulsification \n\n\n\nmethod. The formulation was optimized by changing different parameters like stirring time, stirring speed \n\n\n\nand liquid-lipid content. The prepared NLCs were evaluated for entrapment efficiency, percentage of drug \n\n\n\nloading, particle size, zeta potential and also studied for in-vitro dissolution as well as in-vivo bio-\n\n\n\ndistribution. Selected lipids were found to be compatible with acyclovir based on IR peak matching \n\n\n\nmethod as there is no peak interference or shift in the mixture. Partitioning studies indicate that glyceryl \n\n\n\ndibehenate has a higher partition coefficient for acyclovir compared to tristearin. The entrapment \n\n\n\nefficiency and drug loading were found to be higher in NLC prepared with 25% liquid-lipid with 300 mg \n\n\n\nweight compared to 12.5% liquid-lipid with 150 mg weight. In vitro studies revealed that NLC (25% \n\n\n\nliquid-lipid) released the maximum drug over a period of 12 hours, followed by 12.5% liquid-lipid. \n\n\n\nHaemocompatibility studies showed that with increasing concentration from 40 \u03bcg/mL to 200 \u03bcg/mL, \n\n\n\nthere was no significant increase in % of haemolysis, and did not produce any toxic effects. Bio-\n\n\n\ndistribution studies indicate that the nanoparticles reached the brain 6.8 times more in the case of \n\n\n\nnanostructured lipids with 12.5% liquid-lipid whereas, 8.2 times more in the case of nanostructured lipids \n\n\n\nwith 25% liquid-lipid when compared to the pure drug. \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nIPP 04 \n\n\n\nFAPA2014000005 (Poster)  \n\n\n\nEffects of Cosolvent in Water Phase on Microemulsion Regions of Nonionic Systems and \n\n\n\nAntioxidant Efficacy of Topical Nicotinamide Microemulsion \n\n\n\nP Boonme\n1,2\n\n\n\n, C Boonthongchuay\n1,2\n\n\n\n, T Limsuwan\n1\n, T Amnuaikit\n\n\n\n1\n, W Wongpoowarak\n\n\n\n1\n \n\n\n\n1\nDepartment of Pharmaceutical Technology, Prince of Songkla University, Songkhla, Thailand \n\n\n\n2\nDrug Delivery System Excellence Center, Faculty of Pharmaceutical Sciences, Prince of Songkla \n\n\n\nUniversity, Songkhla, Thailand \n\n\n\n\n\n\n\nMicroemulsions are widely studied for cosmetic formulation development. Generally, microemulsion \n\n\n\nregions are constructed for blank (without active) systems. Therefore, enough large microemulsion \n\n\n\nregions are necessary to still obtain microemulsions after the active addition. In this study, effects of \n\n\n\nvarious amounts of isopropanol (IPA) in water phase on microemulsion regions of systems containing 1:1 \n\n\n\nTween80:Span80 as surfactant blend and isopropyl palmitate (IPP) as oil phase was investigated. \n\n\n\nAfterwards, a microemulsion formulation was selected to incorporate with nicotinamide and then the \n\n\n\nantioxidant efficacy of the obtained nicotinamide microemulsion was determined via penetration and \n\n\n\nretention in newborn pig skin by using 2,2-diphenylpicrylhydrazyl (DPPH) method. It was found from \n\n\n\npseudoternary phase diagram construction by titration method that appropriate fractions of IPA \n\n\n\n(water:IPA = 1:1, 2:1 and 3:1) could enlarge microemulsion regions comparing with the cosolvent-free \n\n\n\nsystem. Relation between dielectric constants of water:IPA mixtures and microemulsion regions could be \n\n\n\nobserved. It may explain that IPA molecules resided in the water could reduce polarity of the water phase. \n\n\n\nNevertheless, water itself could provide larger microemulsion region than some water:IPA mixtures (4:1 \n\n\n\nto 9:1) with lower dielectric constants. The reason was unclear. It might be due to interaction among \n\n\n\nwater, IPA and surfactant blend. Formulation containing 20% w/w IPP, 50% w/w 1:1 Tween80:Span80, \n\n\n\n27% w/w 2:1 water:IPA and 3% w/w nicotinamide was chosen for further study. The free radical-\n\n\n\nscavenging activity of topical nicotinamide microemulsion penetrated through newborn pig skin into \n\n\n\nreceptor fluids of modified Franz diffusion cells could not be detected by UV measurement of the DPPH \n\n\n\nmethod while that of the skin extract samples could be somewhat noticed. Although low antioxidant \n\n\n\nefficacy was detected, the results suggested that nicotinamide microemulsion could retain in the skin \n\n\n\nmembranes higher than pass into the receptor fluids, representative of the blood circulation. Therefore, \n\n\n\nthis microemulsion system should be proper for cosmetic purpose. \n\n\n\n\n\n\n\n\n\n\n\nIPP 05 \nFAPA2014000140 (Poster) \n\n\n\n\n\n\n\nEffect of Changes in the Characteristic of the Mixing Crystalline Atorvastatin Calcium Directly \n\n\n\nWith Tween 80 (Co-Crystal) which can Increase Atorvastatin Tablet Dissolution \n\n\n\n\n\n\n\nAMuhardiansyah, L Nurul  \n\n\n\n\n\n\n\nAtorvastatin is a drug anti hyperlipidemia are currently widely used by people with hyperlipidaemia as an \n\n\n\nadjunctive therapy to diet to reduce elevated total cholesterol, LDL cholesterol, and triglycerides in \n\n\n\npatients with primary hypercholesterolemia. Currently on the market are in the form of atorvastatin coated \n\n\n\ntablet. Atorvastatin is a substance that is poorly soluble in water but highly permeability \n\n\n\n(biopharmaceutical classification system 2). Substance used in the study is atorvastatin calcium \n\n\n\ncrystalline type 1 according to the origin of Lipitor. In the experiments conducted, atorvastatin interaction \n\n\n\nis mixed or used with Tween 80 with rapid stirring using a super mixer for 2 minutes operations. This is a \n\n\n\nsimple method to make co-crystal of atorvastatin to change its physical characteristics. The change in the \n\n\n\n\n\n\n\n\nphysical characteristics of the initial or hygroscopic particles which attract each other between \n\n\n\natorvastatin was reduced, thus increasing its solubility. From these results, further formulation into a \n\n\n\ntablet dosage form by using a standard formula which then used wet granulation method to produce \n\n\n\ncoated tablets. The dissolution method standard is from the Indonesian Pharmacopoeia. From the results \n\n\n\nof the dissolution with the same formula, the results are mixed or atorvastatin in the first interaction with \n\n\n\nTween 80 higher than when Tween 80 was added while mixing with other additives as a wetting agent in \n\n\n\nexcipient. The conclusion is co-crystal atorvastatin can make dissolution tablet tester higher with same \n\n\n\nformula. \n\n\n\n\n\n\n\n\n\n\n\nIPP 06 \nFAPA2014000233 (Poster) \n\n\n\n\n\n\n\nEffect of Pregabalin Intra and Extra Granular to Comparative Dissolution Test with its Originator \n\n\n\n\n\n\n\nY Mardianti, Very Bambang EBAA \n\n\n\n\n\n\n\nPregabalin is a gamma-amino-butyric acid (GABA) analog that works as an anti-anticonvulsant, \n\n\n\nanxiolytic, and also has sleep-modulating activity. The study was conducted with limited equipment \n\n\n\ncausing the capsule weight between the originator, Pregabalin (Lyrica ex Pfizer) with Pregabalin capsules \n\n\n\nthat we want to be different. So the challenge is how to make a product that has a Comparative \n\n\n\nDissolution Test which conforms to the originator, but has good flow properties and homogeneity. The \n\n\n\nstudy was conducted by using a dry mix of excipients with good flow properties, dry granulation using a \n\n\n\nroller compactor (intra and extra granular) and wet granulation (extra and intra-granular). Of the five \n\n\n\nexperiments, the results conform to the originator in terms of Comparative Dissolution Test at 3 pH media \n\n\n\n(pH 1.0 \u2013 1.5 ; pH 4.0 \u2013 4.5 and pH 6.0 \u2013 6.8 ) is when Pregabalin located outside the granules (extra \n\n\n\ngranular). \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nSCIENTIFIC  \n \nSPP 01 \n\n\n\nFAPA2014000009 (Poster) \n\n\n\n\n\n\n\nThe Hospital Formulation of Levetiracetam Suppository and Evaluation of the Pharmaceutics \n\n\n\n\n\n\n\nR Oka\u00b9, M Musya\u00b9, K Kuwabara\u00b2, T Sakurada\u00b9, E Kobayashi\u00b9, N Satoh\u00b9 \n\n\n\n\u00b9Department of Clinical Education and Research, Graduate School of Pharmaceutical Sciences,    \n\n\n\nChiba University, Japan \n\n\n\n\u00b2Chiba Cancer Center Pharmacy, Chiba University, Japan \n\n\n\n\n\n\n\nLevetiracetam, a drug used for a combination therapy in Japan for a partial epilepsy attack, acts by \n\n\n\ncombining with synaptic vesicle protein 2A of the nerve ending. Its action mechanism is different from \n\n\n\nthe existing antiepileptic drugs. However, it cannot be used for patients who cannot take drugs orally \n\n\n\nbecause levetiracetam in Japan is only available as an orally administered drug. Therefore, this study was \n\n\n\nundertaken to formulate levetiracetam as a suppository which is a parenteral administrative dosage form. \n\n\n\nLevetiracetam suppositories using E Keppra\u00ae Tablets and vosco H-15 or vosco S-55 as the suppository \n\n\n\nbase were prepared. Mixture ratio of vosco H-15 and vosco S-55 were (1) H-15:S-55=100%:0%, (2) H-\n\n\n\n15:S-55=75%:25%, (3) H-15:S-55=50%:50%, (4) H-15:S-55=25%:75%, (5) H-15:S-55=0%:100%. A \n\n\n\ncontent uniformity test and a dissolution test were performed. For the content uniformity test, we \n\n\n\nfollowed the 16th edition of Japanese Pharmacopoeia to measure the average value of the contents of ten \n\n\n\nsuppositories for each suppository base, and assessed conformity when the determination value of ten \n\n\n\nsamples was less than 15%. In the dissolution test, we measured the average value of the accumulative \n\n\n\namount of dissolution (AD) and the dissolution time of four suppositories for each suppository base. A \n\n\n\nsuppository was put in a dialysis membrane, being moved vertically in a testing liquid and samples were \n\n\n\ncollected over time to measure the levetiracetam content. In all the mixtures, determination value of \n\n\n\ncontent uniformity tests was less than 15%, and the average of the AD was over 90% within 60 minutes. \n\n\n\nIn this study, the uniformity of the content was high and the dissolution behaviour was good in the \n\n\n\nlevetiracetam suppositories for all mixture ratios. Therefore, we were able to establish a method to make \n\n\n\nlevetiracetam suppositories for a useful clinical application from the viewpoint of drug formulation. \n\n\n\n\n\n\n\n\n\n\n\nSPP 02 \n\n\n\nFAPA2014000075 (Poster) \n\n\n\nThe Impact of High Dose Green Tea Polyphenol Extract and Vitamin C on Blood Pressure and \n\n\n\nRenal Haemodynamics in Cisplatin-Induced Renal Failure in Spontaneously Hypertensive Rats \n\n\n\nMIA Lazhari\n1\n,  MZA Sattar\n\n\n\n1\n,  A Hassaan\n\n\n\n1\n,  S Afzal\n\n\n\n1\n,  A Ahmad\n\n\n\n1\n, MH Abdulla\n\n\n\n3\n, SF Faisal, F \n\n\n\nAhmad\n1\n, S Akhtar\n\n\n\n1\n, HJ Oh\n\n\n\n1\n, PP Yen\n\n\n\n1\n, JL Khoo\n\n\n\n1\n, NA Abdullah\n\n\n\n2\n, EJ Johns\n\n\n\n3 \n\n\n\n1\nCardiovascular and Renal Laboratory of Physiology, School of Pharmaceutical Sciences, University \n\n\n\nSains Malaysia. \n2\nDepartment of Pharmacology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia. \n\n\n\n3\nDepartment of Physiology, University College Cork, Cork, Ireland \n\n\n\n\n\n\n\nThis study evaluated the potential benefits of natural and synthetic antioxidants (green tea and vitamin C) \n\n\n\non blood pressure and renal haemodynamics in renal failure hypertensive model. Renal failure was \n\n\n\ninduced by cisplatin injection (5 mg/kg i.p.). After 7 days, the rats received either a vehicle (control), a \n\n\n\nhigh dose vitamin C (1000 mg/kg/day) or a high dose green tea polyphenol extract (1000 mg/kg/day) via \n\n\n\n\n\n\n\n\noral gavages for 21 days (n=6 rats per group). Tail cuff blood pressure was measured on days 0, 7 and 28 \n\n\n\nof the study. On day 29, rats were anaesthetized with sodium pentobarbitone (60 mg/kg i.p.) and renal \n\n\n\ncortical blood perfusion was measured using laser Doppler flow probe positioned at the surface of the left \n\n\n\nkidney. Renal failure SHR group had higher kidney index compared to control SHR group (0.37 \u00b1 0.01 \n\n\n\nvs. 0.29 \u00b1 0.01%, p<0.05). Vitamin C high dose treatment reduced systolic blood pressure by 9% when \n\n\n\ncompared with control SHR group (140 \u00b1 2 vs. 155 \u00b1 7 mmHg, p<0.05). The renal cortical blood \n\n\n\nperfusion in the group treated with high dose green tea was higher by 11% compared to the control SHR \n\n\n\ngroup (167 \u00b1 5 vs. 150 \u00b1 2 bpu, p<0.05). These data indicate that high dose of vitamin C but not green tea \n\n\n\nhas a significant blood pressure lowering effect while high dose green tea showed significant vasodilatory \n\n\n\neffect in cisplatin-induced renal failure SHR. The results suggest an important role played by free radicals \n\n\n\nin this model of renal impairment.  \n\n\n\n\n\n\n\n\n\n\n\nSPP 03 \nFAPA2014000317 (Poster) \n\n\n\n\n\n\n\nUsing Marker Drugs to Study the Gastrointestinal Transit Behavior of Amphotericin B-Containing \n\n\n\nSolid Lipid Nanoparticles \n\n\n\n\n\n\n\nH Amekyeh\n1\n, N Billa\n\n\n\n1\n, KH Yuen\n\n\n\n2\n, SLS Chin\n\n\n\n2\n \n\n\n\n1 \nSchool of Pharmacy, University of Nottingham, Malaysia Campus, Selangor, Malaysia  \n\n\n\n2\n School of Pharmaceutical Sciences, Universiti Sains Malaysia, Minden, Penang, Malaysia \n\n\n\n\n\n\n\nThe objective of the study was to investigate the gastrointestinal (GI) transit behaviour of an amphotericin \n\n\n\nB (AmB) solid lipid nanoformulation (SLN), as well as the absorption of AmB in rats using paracetamol \n\n\n\n(PAR) and sulfasalazine (SSZ) as marker drugs. AmB, PAR and SSZ similarly formulated into SLNs and \n\n\n\nhave comparable characteristics would likely behave in a similar fashion in the GI tract when all three \n\n\n\nSLNs are simultaneously administered via the oral route. PAR SLN and SSZ SLN would therefore be \n\n\n\nuseful as marker drugs for estimating the gastric emptying and caecal arrival times of AmB SLN \n\n\n\nrespectively. The three types of SLNs were formulated similarly using beeswax and theobroma oil as the \n\n\n\nlipid matrix. These were then characterized with regards to size, morphology, viscosity, relative density \n\n\n\nand migration propensity in agarose gel. In vitro drug release and in vivo studies were carried out using \n\n\n\nhigh performance liquid chromatography (HPLC). All three types of SLNs exhibited identical properties \n\n\n\nwith regards to z-average, viscosity, relative density and migration propensity in agarose gel. PAR was \n\n\n\nabsorbed rapidly from the small intestine following its emptying from the stomach and reached its Tmax in \n\n\n\n1 hour. The Tmax of AmB was 8 hours. Sulfapyridine (SP) was absorbed after its release from microbial \n\n\n\ndegradation of SSZ from SLN in the colon with a lag time of 2 hours post administration. The caecal \n\n\n\narrival time of the SLNs was found to be about 2 hours, as estimated from the initial detection of SP in \n\n\n\nthe plasma. AmB, PAR and SSZ SLNs were successfully formulated with matching physical \n\n\n\ncharacteristics. AmB from its SLN was favorably but slowly absorbed from the small intestine, \n\n\n\npresumably through uptake of the SLN by Peyer\u2019s patches followed by emptying into the systemic \n\n\n\ncirculation.  \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nSPP 04 \n\n\n\nFAPA2014000072 (Poster) \n\n\n\n\n\n\n\nComparative Antibacterial Property of the Matured Trunk and Stem Bark Extract of Tamarindus \n\n\n\nIndica Linn, Preformulation, Development and Quality Control of Cream \n\n\n\n\n\n\n\nAT Jacinto\n1\n, MO Osi\n\n\n\n2\n \n\n\n\n1\nCollege of Pharmacy, University of Perpetual Help System DALTA, Las Pi\u00f1as City, Philippines \n\n\n\n2\nGraduate School, University of Santo Tomas, Manila, Philippines \n\n\n\n\n\n\n\nStudies on Tamarindus indica showed that it is rich in tannin which is responsible for its antibacterial \n\n\n\nproperty. Thus, the objective of this study was to compare the antibacterial activity of the bark of trunk \n\n\n\nand stem using the acetone extract of the barks. Powdered barks (225 g each) were extracted by soxhlet \n\n\n\nmethod using 70% acetone as solvent for the tannin. Trunk bark produced a yield of 2.6% extract and \n\n\n\n2.1% for stem bark. Results showed that the trunk bark was more sensitive than the stem bark to \n\n\n\norganisms such as Staphylococcus aureus, Corynebacterium minutissimum, and Streptococcus sp. Dermal \n\n\n\nsensitization test on rabbits using 100, 40, and 20 mg/mL of extract showed that tamarind has no irritating \n\n\n\nproperty and therefore, is safe for formulation as an antibacterial cream. The extract from trunk bark has \n\n\n\nhigher contents than that of stem bark when tested for compendia requirements such as foreign matter \n\n\n\n(1.35% and 1.21%), total ash (10.16% and 8.27%) and water determination (11.81% and 7.28%). \n\n\n\nPreformulation data showed that both extracts had the same solubility in water, 80% ethanol, ether and \n\n\n\nchloroform. A 1% aqueous solution of the extracts exhibited a pH 8.38 (trunk bark) and 8.17 (stem bark). \n\n\n\nDensity by displacement method was 0.92 (trunk bark) and 0.91 (stem bark). Both extracts were stable to \n\n\n\ndirect sunlight and efflorescent. Excipients for manufacture of cream such as methyl paraben, propyl \n\n\n\nparaben, sodium lauryl sulfate, stearyl alcohol and white petrolatum subjected to differential scanning \n\n\n\ncalorimetry were found to be compatible with the extracts except for sodium lauryl sulfate where \n\n\n\npolymorphism was exhibited at higher temperature. Thus, a dark-brown smooth cream which passed \n\n\n\nmicrobial, sensitivity and antibacterial tests was developed as the final output of this study. \n\n\n\n\n\n\n\n\n\n\n\nSPP 05 \nFAPA2014000306 (Poster) \n\n\n\n\n\n\n\nThe Hypotensive Activity of Defatted Crude Extract, Ethyl Acetate and Butanolic Fractions of \n\n\n\nCassytha filiformis L. on Prednisone-Saline and Prednisone-Saline-L-NAME Induced Hypertensive \n\n\n\nRats: A Comparative Study \n\n\n\n\n\n\n\nY Yuliandra\n1\n, Armenia\n\n\n\n1\n, MZA Sattar\n\n\n\n2\n \n\n\n\n1\nFaculty of Pharmacy, University of Andalas, Padang, Indonesia \n\n\n\n2\nSchool of Pharmacy, Universiti Sains Malaysia, Pulau Pinang, Malaysia \n\n\n\n\n\n\n\nA comparative study of the hypotensive activity of defatted crude ethanolic extract of Cassytha filliformis \n\n\n\nL. and its ethyl acetate and butanolic fractions has been carried out on the anaesthetized hypertensive-\n\n\n\ninduced rats. An amount of 30 Sprague-Dawley rats were divided into two subdivisions: prednisone-\n\n\n\nsaline-induced (PN) and prednisone-saline-L-NAME-induced (PNL) hypertensive rats. Each subdivision \n\n\n\nrats were divided into 5 groups. Group 1 was treated as control; group 2, 3 and 4 were treated with \n\n\n\ndefatted crude ethanolic extract, ethyl acetate and butanolic fractions of the plant at the dose of 5 mg/kg; \n\n\n\nwhile group 5 was treated with tempol 100 \u00b5mol/kg. The doses were commenced in 3 consecutive \n\n\n\nintravenous administrations every one hour interval. The systolic (SBP), diastolic (DBP), mean arterial \n\n\n\npressures (MAP) and heart rate (HR) of the animals were measured (Biopac\n\u00ae\n MP 150 Data Acquisition \n\n\n\nSystem). Data were presented as the percentage changes of those parameters and analyzed by three way \n\n\n\n\n\n\n\n\nANOVA followed by Duncan\u2019s Multiple Range Test. Results showed that the ethanolic extract and \n\n\n\ntempol decreased animal SBP, DBP, MAP and HR significantly (p<0.05) while ethyl acetate and \n\n\n\nbutanolic fractions did not (p>0.1). The average percentage decrease of animal SBP and MAP on PNL \n\n\n\nrats were higher (p<0.05) as compared to those on PN rats, while DBP and HR of those groups of animal \n\n\n\nwere not significantly different (p>0.1). Repeated dose of all samples tended to decrease animal SBP and \n\n\n\nHR (p<0.1) but not in DBP and MAP (p>0.1). These results indicate that the defatted ethanolic extract of \n\n\n\nCassitha filliformis exhibits more hypotensive effect compared to its ethyl acetate and butanolic fractions. \n\n\n\nThis hypotensive effect is greater on oxidative stress related hypertensive rats. \n\n\n\n\n\n\n\n\n\n\n\nSPP 06 \nFAPA2014000073 (Poster) \n\n\n\n\n\n\n\nFunctional Contribution of \u03b11D Receptors in Renal Vasculature of Left Ventricular Hypertrophy \n\n\n\nInduced by Isoprenaline and Caffeine in Wistar Kyoto Rats \n\n\n\n\n\n\n\nA Ahmad\n1\n, MA Sattar\n\n\n\n1\n, HA Rathore\n\n\n\n1\n, SA Khan\n\n\n\n1\n, S Afzal\n\n\n\n1\n, MI Lazhari\n\n\n\n1\n, PP Yen\n\n\n\n1\n, HJ Oh\n\n\n\n1\n, YC Tan\n\n\n\n1\n, \n\n\n\nJL Khoo\n1\n, NA Abdullah\n\n\n\n2\n, EJ Johns\n\n\n\n3    \n \n\n\n\n1\nSchool of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia \n\n\n\n2\nDepartment of Pharmacology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia \n\n\n\n3\nDepartment of Physiology, University College Cork, Cork, Ireland \n\n\n\n\n\n\n\nThis study investigated the role of \u03b11D-adrenoceptor in the modulation of renal haemodynamics in rats \n\n\n\nwith left ventricular hypertrophy (LVH). LVH was established in Wistar Kyoto (WKY) rats using \n\n\n\nisoprenaline (5 mg/kg s.c. every 72 hr) and caffeine (62 mg/L in drinking water) for 14 days. Renal \n\n\n\nvasoconstrictor responses were measured for noradrenaline (NA), phenylephrine (PE) and methoxamine \n\n\n\n(ME) before and after low or high dose intrarenal infusions of BMY 7378, a selective \u03b11D-adrenoceptor \n\n\n\nblocker. LVH group had a significantly higher mean arterial blood pressure but lower renal cortical blood \n\n\n\nperfusion as compared to the control (all p<0.05). The magnitude of the renal vasoconstrictor response to \n\n\n\nME but not to NA or PE in LVH group was blunted (p<0.05) in comparison with the control group (LVH \n\n\n\nvs. C, 38 vs. 50%). The magnitude of the drop in the vasoconstrictor responses to NA, PE and ME in the \n\n\n\npresence of a higher dose of BMY7378 was significantly greater in the LVH compared to the control \n\n\n\n(LVH vs. C, 45 vs. 25%, 52 vs. 33%, 66 vs. 53%, all p<0.05). These findings indicate attenuated renal \n\n\n\nvasoconstrictor responses during LVH. In addition, \u03b11D-adrenoceptor subtype is playing a key role in the \n\n\n\nmodulation of vascular responses in this diseased state. \n\n\n\n\n\n\n\n\n\n\n\nSPP 07 \nFAPA2014000047 (Poster) \n\n\n\n\n\n\n\nNMDA Receptor Antagonism in the Hippocampus Ameliorates Acute Stress Potentiation of \n\n\n\nAggressive Behaviors in the Post-Weaning Isolation-Reared Mice \n\n\n\n\n\n\n\nCH Chang, PW Gean\n   \n\n\n\n\n\n\n\nDespite epidemiological evidence showing that early life events have long-term effects on the \n\n\n\nsusceptibility to subsequent stress exposure during adulthood, there has been very little work examining \n\n\n\nthe underlying cellular mechanism. We used post-weaning social isolation mice as an animal model of \n\n\n\nearly life adversities to test the action of NMDA receptor antagonists on acute stress-induced \n\n\n\nexaggeration of aggressive behaviors in the social isolated (SI) mice. Synaptic protein levels of NMDA \n\n\n\nreceptors were measured using synaptosomal preparation. Acute stress giving before test markedly \n\n\n\n\n\n\n\n\nexacerbated offensive behaviors and attack number in the SI mice. Post-weaning social isolation \n\n\n\nincreased hippocampal surface expression of NR2A and NR2B without affecting NR1 subunit of NMDA \n\n\n\nreceptors, PSD-95 and a2 subunit of GABAA receptors. Bilateral hippocampal injection of NMDA \n\n\n\nantagonists reversed acute stress-induced exaggeration of aggressive behaviors in the SI mice. Acute \n\n\n\nstress induced phosphorylation of eukaryotic elongation factor-2 (eEF2) which was abrogated by NMDA \n\n\n\nantagonist. Furthermore, eEF2 kinase inhibitors reversed acute stress-induced exaggeration of aggressive \n\n\n\nbehaviors and exhibited anti-depressant effect in the SI mice. These results suggest the involvement of \n\n\n\nNMDA receptors and eEF2 kinase in the isolation-induced alterations of behavioral phenotypes and \n\n\n\nNMDA receptor antagonists may be useful to ameliorate child neglect-induced exacerbation of aggressive \n\n\n\nbehaviours. \n\n\n\n\n\n\n\n\n\n\n\nSPP 08 \nFAPA2014000146 (Poster) \n\n\n\n\n\n\n\nImprovement of Dispersibility of Fullerene C60 Derivative by Pluronic F-127 and the Potential to \n\n\n\nEnhance Anti-inflammatory Effect of C60 Derivative \n\n\n\n\n\n\n\nE Uemura\n1\n, Y Yoshioka\n\n\n\n1,2\n, T Hirai\n\n\n\n1\n, H Takahashi\n\n\n\n1\n, K Sagami\n\n\n\n1\n, S Tsunoda\n\n\n\n2,3\n, T Ohe\n\n\n\n4\n, T Mashino\n\n\n\n4\n, H \n\n\n\nAoshima\n5\n, K Kokubo\n\n\n\n6\n, T Oshima\n\n\n\n6\n, K Higashisaka\n\n\n\n1,2\n, Y Tsutsumi\n\n\n\n1,3 \n\n\n\n1\nLaboratory of Toxicology and Safety Science, Graduate School of Pharmaceutical Sciences, Osaka \n\n\n\nUniversity, Japan \n2\nLaboratory of Biopharmaceutical Research, National Institute of Biomedical Innovation, Japan \n\n\n\n3\nThe Center for Advanced Medical Engineering and Informatics, Osaka University, Japan \n\n\n\n4\nDepartment of Biochemistry, Faculty of Pharmacy, Keio University, Japan \n\n\n\n5\nVitamin C60 BioResearch Corporation, Japan \n\n\n\n6\nDivision of Applied Chemistry, Graduate School of Engineering, Osaka University, Japan \n\n\n\n\n\n\n\nFullerene C60 (C60) is consisted of 60 carbon atoms and is known as a strong anti-oxidant. As a strong \n\n\n\nanti-oxidant, C60 is believed to be capable of absorbing free radicals in organisms; therefore, we are \n\n\n\ncurrently aiming to apply C60 as a nano-medicine for inflammatory diseases, which are often closely \n\n\n\nrelated to oxidative stresses. However, aggregability of C60 is one of the hurdles for its application in \n\n\n\nmedicinal field because agglomerates often hinder its original anti-inflammatory effect and can also \n\n\n\nreversely cause inflammation. Our group has successfully formulated C60 pyrrolidine tris-acid (C60-P), \n\n\n\nwhich is one of C60 derivatives with higher dispersibility and higher anti-inflammatory effect. \n\n\n\nAdditionally, other groups have reported that dispersibility of C60 was significantly improved when a \n\n\n\npoloxamer compound, Pluronic F-127 (F127) co-existed in the solution. In this study, we attempted to \n\n\n\napply F127 for C60-P to enhance the anti-inflammatory effect by increasing its dispersibility. We first \n\n\n\nmeasured the diameters of C60-P particles prepared with F127. As a result, it significantly increased C60-P \n\n\n\ndispersibility and regulated their particle size. To determine the anti-inflammatory effect of C60-P with \n\n\n\nF127, we measured the amount of IL-8 produced by Caco-2 cells after IL-1\u03b2 stimulation. However, C60-P \n\n\n\ndispersed with F127 did not show enhanced anti-inflammatory effect against stimulated Caco-2. Our \n\n\n\ninterest now is in whether F127 can decrease pro-inflammatory effect induced by agglomerates of C60-P. \n\n\n\nFurther studies with other dispersant on the relationship between C60-P dispersal and its anti-inflammatory \n\n\n\neffect need to be conducted to maximize the potential of C60-P as a nano-medicine. We also believe that \n\n\n\nthis study will also contribute to understand the dynamics of nanomaterials used in various products. \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nSPP 09 \nFAPA2014000314 (Poster) \n\n\n\n\n\n\n\nInvestigating Regulatory Role of Prolactin in Parental Behavior in Male Parents \n\n\n\n\n\n\n\nF Hashemian, E Roohi, F Shafigh\n \n\n\n\nDepartment of Clinical Pharmacy, Pharmaceutical Sciences Branch, Islamic Azad University, Tehran, \n\n\n\nIran \n\n\n\n\n\n\n\nIn all mammalian species, a combination of neuroendocrine and experiential factors contributes to the \n\n\n\nemergence of remarkable behavioral changes observed in parental behavior. However, paternal behavior \n\n\n\nis rare and is observed in only 6% of mammalian species including humans. Our understanding of \n\n\n\nneuroendocrine bases of paternal behavior in humans is still preliminary and more research is needed in \n\n\n\nthis area. The researchers reviewed available laboratory and clinical data regarding hormonal bases of \n\n\n\nparental behavior in human and non-human mammals. Literature searches were conducted on electronic \n\n\n\ndatabases, and the following MeSH terms were used: Behavior Endocrinology, Fathering Behavior, \n\n\n\nHormone of Paternity, Hormones and Behavior, Mammalian Fathers, Mammalian Paternal Behavior, \n\n\n\nMaternal Care, Neurobiological bases of Fathering, Neurobiology of Parental Brain, Parental Behavior, \n\n\n\nParental Care, Parental Responsiveness, Parent-infant Behavior, Parenting and Plasticity, Parenting Brain, \n\n\n\nPaternal Behavior, Paternal Care, Paternal Hormonal Effects, Paternal Prolactin Level, and Prolactin. A \n\n\n\npositive relationship between prolactin and regulation of paternal behavior in mammalian species \n\n\n\nshowing biparental behavior and humans were observed. Currently available data suggest that the \n\n\n\nexpression of parental behavior involves neuroendocrine circuits in both male and females. There is \n\n\n\nprobably a positive relationship between prolactin and paternal behavior in humans. Elevated prolactin \n\n\n\nlevels in newly fathers most probably contribute to child caring behavior and facilitate behavioral and \n\n\n\nemotional states attributed to child care. Moreover, elevated paternal prolactin levels after childbirth \n\n\n\ndecrease the parents\u2019 libidos so that they invest more in parental care than in fertility behavior. \n\n\n\n\n\n\n\n\n\n\n\nSPP 10 \n\n\n\nFAPA2014000080 (Poster) \n\n\n\nExogenous Hydrogen Sulfide Up-Regulates the NO/eNOS System in Spontaneously Hypertensive \n\n\n\nRats \n\n\n\nFUD Ahmad\n1\n, MA Sattar\n\n\n\n1\n, HA Rathore\n\n\n\n1\n, JL Khoo\n\n\n\n1\n, PP Yen\n\n\n\n1\n, HJ Oh\n\n\n\n1\n, YC Tan\n\n\n\n1\n, A Ahmad\n\n\n\n1\n, S \n\n\n\nAfzal\n1\n, S Akhtar\n\n\n\n1\n, MA Lazhari\n\n\n\n1\n, NA Abdullah\n\n\n\n2\n, EJ Johns\n\n\n\n3 \n\n\n\n1\nSchool of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia\n\n\n\n\n\n\n\n2\nDepartment of Pharmacology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia \n\n\n\n3\nDepartment of Physiology, Western Gateway Building, University College Cork, Cork, Ireland \n\n\n\nThis study investigated the effects of exogenous H2S on NO/NOS system in SHR. Eighteen SHR rats \n\n\n\nwere divided into two groups (n=9 in each group, 1-6 for in vivo,7-9 for CSE and eNOS expression), viz:- \n\n\n\nSHR, SHR + NaHS (56 \u00b5mol/kg i.p. for four weeks). WKY rats served as control. In in vivo study, blood \n\n\n\npressure, plasma H2S and NO were performed at the end of treatment. For CSE and eNOS expression, \n\n\n\nreverse transcribed cDNA was amplified using TaqMan Fast PCR Master mix on a Step One Plus qPCR. \n\n\n\nCycle number at which the transcripts were detectable was normalized to the cycle number of \u00df-actin \n\n\n\ngene. Relative changes in expression levels were determined using the 2\n-\u0394\u0394CT\n\n\n\n method. In vivo data, mean \n\n\n\n\u00b1 SEM, was analyzed by one way ANOVA followed by Bonferroni post hoc test with significance at 5%. \n\n\n\nSHR rats had higher mean arterial blood pressure, lower plasma H2S and NO (all p<0.05) along with \n\n\n\n\n\n\n\n\n64.2% and 41.2% decreased expression of aortic CSE and eNOS respectively as compared to WKY \n\n\n\ncontrol. Exogenous H2S decreased the mean arterial blood pressure and increased the plasma H2S and NO \n\n\n\nlevels as compared to SHR (all p<0.05). Moreover, SHR + NaHS had 475.9% and 228.2% higher \n\n\n\nexpression of aortic CSE and eNOS respectively as compared to SHR. The results obtained suggested that \n\n\n\nexogenous administration of H2S not only up-regulated the H2S/CSE system but also the NO/eNOS \n\n\n\npathway. An increased NO production is suggested to mediate the antihypertensive vascular effects of \n\n\n\nH2S in spontaneous hypertension. \n\n\n\n\n\n\n\n\n\n\n\nSPP 11 \nFAPA2014000295 (Poster) \n\n\n\n\n\n\n\nAcute Toxicity and the In Vitro Determination of the Contractile Effects on the Locally \n\n\n\nAdministered Ethanolic Extract of the Leaves of Strophanthus cumingii (Apocynaceae) on the \n\n\n\nIsolated Skeletal Muscle of Female Sprague-Dawley Rats \n\n\n\n\n\n\n\nM Gazo, K Visco, H Encinas, E Matammu, J Nodado, K Sison, L Raymundo, A Ong\n \n \n\n\n\nFaculty of Pharmacy, University of Santo Tomas, Manila, Philippines \n\n\n\n\n\n\n\nStrophanthus cumingii (Apocynaceae), locally known as Abuhab-baging, produce toxic alkaloids and \n\n\n\ncardiac glycosides from the thickened sap of the bark.  Strophanthin is a muscle poison that increases the \n\n\n\ncontractile power of all striated muscles. The study aims to establish acute toxicity by determining the \n\n\n\nmedian lethal dose, and the in vitro determination of the contractile effects on the locally-administered \n\n\n\nethanolic extract of the leaves of S. cumingii on the isolated gastrocnemius muscle of female Sprague-\n\n\n\nDawley rats; concentration which exhibits the most favorable skeletal muscle contraction; and the \n\n\n\nsignificant difference between the skeletal muscle contraction under normal physiologic conditions and \n\n\n\nupon administration of the ethanolic extract of the leaves of S. cumingii. As confirmed by TLC, G-\n\n\n\nstrophanthin is present in the ethanolic extract of S. cumingii leaves. The median lethal dose of the \n\n\n\nethanolic extract of S. cumingii leaves administered intramuscularly is 550mg/kg through the Up-and-\n\n\n\nDown Method under the Main Test. There is a significant difference between the skeletal muscle \n\n\n\ncontraction under normal physiologic conditions and upon administration of the test extract. In the \n\n\n\ndetermination of which concentration exhibits the most favorable skeletal muscle contraction, the \n\n\n\nethanolic extract of the different controls of Strophanthus cumingii having doses of 0.075 mg/ml, 0.225 \n\n\n\nmg/mL, and 0.75 mg/mL shows that there is a significant difference produced among the controls \n\n\n\ntogether with negative and positive control with its F value of 3.30 greater than its F critical value of 2.46. \n\n\n\nThe dose of 0.075 mg/mL gave the most favorable amplitude reading compared to the other controls. \n\n\n\n\n\n\n\n\n\n\n\nSPP 12 \nFAPA2014000193 (Poster) \n\n\n\n\n\n\n\nHydrolase Activity of Bacteria Isolated from Pristine Mangrove Soil \n\n\n\n\n\n\n\nWS Hong\n1\n, SHE Lim\n\n\n\n2\n, CW Mai\n\n\n\n1\n, CW Chong\n\n\n\n1\n, KSI Yap\n\n\n\n1\n, KW Cheong\n\n\n\n1\n  \n\n\n\n1\nSchool of Pharmacy, International Medical University, Bukit Jalil, Kuala Lumpur, Malaysia    \n\n\n\n2\nPerdana University, Serdang, Selangor Darul Ehsan, Malaysia \n\n\n\n\n\n\n\nMangroves are coastal forests that have unique characteristics which represent a dynamic, productive and \n\n\n\nbiological important ecosystem. Malaysia, being one of the megadiverse countries, harbour a wide variety \n\n\n\nof natural habitats for the prospecting of extremophiles especially the pristine mangrove soil. This \n\n\n\necosystem is different compared to dry land environment because of periodic inundation of saline water \n\n\n\n\n\n\n\n\nand sometimes freshwater.  Pristine mangrove soil has lesser human contact than impaired mangrove soil, \n\n\n\nthus it could be spared from human contamination. Pristine mangroves soil may have significant different \n\n\n\nmicrobial communities which could potentially harbour different valuable enzymatic activities. Although \n\n\n\nhydrolase has emerged as an important class of biocatalysts for industrial applications, very few hydrolase \n\n\n\nproducing bacteria have been characterised. Thus, the research was undertaken to isolate hydrolase \n\n\n\nproducing bacteria from pristine mangrove soil. The hydrolase activity of these bacteria was confirmed \n\n\n\nusing tributyrin agar plates. The optimum condition for hydrolase production of these bacteria were \n\n\n\noptimised. Several colonies with potential hydrolase activities were successfully isolated and \n\n\n\ncharacterised. Further study is warranted for additional investigations.  \n\n\n\n\n\n\n\n\n\n\n\nSPP 13 \nFAPA2014000050 (Poster) \n\n\n\n\n\n\n\nLearning Induces Sonic Hedgehog Signaling in the Amygdala Which Promotes Neurogenesis and \n\n\n\nLong-Term Memory Formation \n\n\n\n\n\n\n\nHC Hung\n1\n, YH Hsiao\n\n\n\n2\n, PW Gean\n\n\n\n1,2  \n \n\n\n\n1\nInstitute of Basic Medical Sciences, National Cheng-Kung University, Tainan, Taiwan \n\n\n\n2\nDepartment of Pharmacology, College of Medicine, National Cheng-Kung University, Tainan, Taiwan \n\n\n\n\n\n\n\nIt is known that neurogenesis occurs throughout the life mostly in the subgranular zone (SGZ) of the \n\n\n\nhippocampus and the subventricular zone (SVZ) of the lateral ventricle. Here we investigated whether \n\n\n\nneurogenesis occurred in the amygdala and its function in fear memory formation. Mice were injected \n\n\n\nintraperitoneally with 5-bromo-2'-deoxyuridine (BrdU) 2 h before receiving 15 tone\u2013footshock pairings. \n\n\n\nThe number of BrdU+/DCX+ and BrdU+/NeuN+ cells was significantly higher in the conditioned mice \n\n\n\nsuggesting that association of tone with footshock induced neurogenesis. To determine the relationship \n\n\n\nbetween neurogenesis and memory formation, mice were given cell proliferation inhibitor \n\n\n\nmethylazoxymethanol acetate (MAM). MAM markedly reduced neurogenesis and impaired fear memory \n\n\n\nformation. Similarly, intra-amygdala infusion of cytosine arabinoside (Ara-C) which interferes with DNA \n\n\n\nsynthesis decreased freezing responses. Sonic hedgehog (Shh), its receptor patched1 (Ptc1) and \n\n\n\ntranscription factor Gli1 protein levels increased at 1 day and returned to baseline at 7 days after fear \n\n\n\nconditioning. Immunohistochemistry confirmed that Shh+ cells increased after conditioning. Silencing \n\n\n\nShh gene expression with small hairpin interfering RNA (shRNA) by means of a retrovirus vector \n\n\n\nencoding Shh shRNA (Retro-Shh-shRNA) which allowed us to knockdown Shh specifically in the mitotic \n\n\n\nneurons reduced the number of BrdU+/NeuN+ cells and decreased freezing responses. These results \n\n\n\nsuggest that fear learning induces Shh signaling activation in the amygdala which promotes neurogenesis \n\n\n\nand long-term memory formation. \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nSPP 14 \nFAPA2014000096 (Poster) \n\n\n\n\n\n\n\nEvaluating the Potential of Buprenorphine to Reduce Relapse to Morphine/ Methamphetamine \n\n\n\nAddiction \n\n\n\n\n\n\n\nRI Elina\n1\n, SM Saadah\n\n\n\n1\n, MA Halim\n\n\n\n1\n, KA Razak\n\n\n\n1\n, MNN Ilyani\n\n\n\n1\n, H Ridzwan\n\n\n\n2\n, SA Affandy\n\n\n\n3\n, SMFSM \n\n\n\nSyahmi\n1    \n\n\n\n1\nKulliyyah of Pharmacy, International Islamic University Malaysia, Malaysia \n\n\n\n2\nKulliyyah of Allied Health Sciences, International Islamic University Malaysia, Malaysia \n\n\n\n3\nKulliyyah of Sciences, International Islamic University Malaysia, Malaysia \n\n\n\n\n\n\n\nThere is growing evidence of methamphetamine abuse among methadone users which might affect the \n\n\n\nsuccess rate of methadone maintenance treatment (MMT) programme. Buprenorphine has been proven to \n\n\n\nreduce dopamine level in brain following methamphetamine dependence and to reduce relapse to cocaine, \n\n\n\nwhich suggest the potential of buprenorphine treatment for psychostimulant addiction. Therefore, the aim \n\n\n\nof this study is to evaluate the potential of buprenorphine to reduce relapse in opioid addicts that used \n\n\n\nmethamphetamine concurrently (dual dependencies). Initially, tail-withdrawal test (T=52\no\nC) is used to \n\n\n\nevaluate the mu-opioid receptor properties of buprenorphine and methamphetamine (n=6 for each group). \n\n\n\nLater, using a conditioned place preference (CPP) paradigm, the morphine/methamphetamine dependence \n\n\n\nmodel is developed in mice. The mice were divided into two major groups, morphine and \n\n\n\nmorphine/methamphetamine dependent groups (n=8-12 for each group). Dependence was induced using \n\n\n\nvariable dose of morphine (3.0-5.0 mg/kg, i.p.) and methamphetamine (1.0 mg/kg, i.p.). Following \n\n\n\nabstinence, a priming dose of morphine or and/or methamphetamine is given. The ability of \n\n\n\nbuprenorphine (0.3 mg/kg, i.p.) to reduce relapse in these dual dependencies is investigated. From the tail-\n\n\n\nwithdrawal test, 1 mg/kg naltrexone significantly blocked the mu-agonist properties of 0.3 mg/kg \n\n\n\nbuprenorphine (P<0.05), while 1 mg/kg methamphetamine failed to activate the mu-opioid receptors. \n\n\n\nInitial findings in CPP paradigm show that 0.3 mg/kg buprenorphine produced Straub's tail effect (60-90\no\n) \n\n\n\nand stereotype behaviour (45-60 minutes) in morphine/methamphetamine dependent mice after complete \n\n\n\nabstinence (n=6-8), which suggest the activation of dopamine system after complete abstinence which \n\n\n\nwas not reported with cocaine. Interestingly, the Straub's tail effect is abolished when the mice were \n\n\n\ntreated with naltrexone (n = 5). The studies to investigate the responsible receptor(s) that can reduce \n\n\n\nsensitization to morphine and/or methamphetamine are currently ongoing in order to identify the potential \n\n\n\ndrug targets to reduce relapse to these dual dependencies. \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nSPP 15 \nFAPA2014000152 (Poster) \n\n\n\n\n\n\n\nAnti-Inflammatory Mechanism of C60 Pyrrolidine Tris-Acid (C60-P) on Caco-2 Cells  \n\n\n\n\n\n\n\nK Sagami\n1\n, Y Yoshioka\n\n\n\n1,2\n, T Hirai\n\n\n\n1\n, H Takahashi\n\n\n\n1\n, E Uemura\n\n\n\n1\n, S Tsunoda\n\n\n\n2,3\n, T Ohe\n\n\n\n4\n, T Mashino\n\n\n\n4\n, H \n\n\n\nAoshima\n5\n, K Kokubo\n\n\n\n6\n, T Oshima\n\n\n\n6\n, K Higashisaka\n\n\n\n1\n, Y Tsutsumi\n\n\n\n1,3 \n  \n\n\n\n1\nLaboratory of Toxicology and Safety Science, Graduate School of Pharmaceutical Sciences, Osaka \n\n\n\nUniversity, Japan \n2\nLaboratory of Biopharmaceutical Research, National Institute of Biomedical Innovation, Japan \n\n\n\n3\nThe Center for Advanced Medical Engineering and Informatics, Osaka University, Japan \n\n\n\n4\nDepartment of Biochemistry, Faculty of Pharmacy, Keio University, Japan \n\n\n\n5\nVitamin C60 BioResearch Corporation, Japan \n\n\n\n6\n Department of Applied Chemistry, Graduate School of Engineering, Osaka University, Japan \n\n\n\n\n\n\n\nWith the development of nanotechnology, many nanomaterials with innovative functions have been \n\n\n\ncreated. The fullerene C60 is one of the most promising nanomaterials because of their unique chemical \n\n\n\nand physical properties. It has been reported that the fullerene C60 has antioxidant effect, and so it is \n\n\n\ncalled as a \u201cradical sponge\u201d. For this character, the fullerene C60 is expected to be applied as \n\n\n\nnanomedicine for inflammatory disease which is related to oxidative stress. However, because the \n\n\n\nfullerene C60 has poor solubility, it is difficult to be applied as medicine. In order to improve the \n\n\n\nsolubility, we have used various fullerene C60 derivatives and evaluated anti-oxidant and anti-\n\n\n\ninflammatory effect of each fullerene C60 derivatives. Previously, we have found that C60 pyrrolidine tris-\n\n\n\nacid (C60-P) had high solubility and strongly inhibited inflammatory cytokine (IL-8) production on Caco-\n\n\n\n2. Furthermore, we revealed that this anti-inflammatory effect was independent of anti-oxidant effect. \n\n\n\nHere, to clarify this newly discovered anti-inflammatory mechanism, we examined the effects of C60-P on \n\n\n\nMitogen-Activated Protein Kinase (MAPK), which is one of pathways in IL-8 production. After treatment \n\n\n\nwith C60-P for 30 minutes, Caco-2 was stimulated with IL-1\u03b2. Subsequently, by using western blotting, \n\n\n\nwe analyze phosphorylation of MAPK (p38, ERK, JNK) as an index of activation. C60-P did not suppress \n\n\n\nphosphorylation of p38, ERK, and JNK in Caco-2. Next, we examined the effects of C60-P on IL-8 \n\n\n\nmRNA production after stimulation with IL-1\u03b2 by using realtime-PCR. Although stimulation with IL-1\u03b2 \n\n\n\nincreased the production of IL-8 mRNA, C60-P did not suppress IL-8 mRNA production. These results \n\n\n\nsuggest that C60-P-mediated anti-inflammatory effect is independent of MAPK phosphorylation and \n\n\n\nmRNA production. Therefore, we consider that C60-P effect on downstream of these pathways, such as \n\n\n\ninhibition of secretion or translation. We believe that our findings might provide useful information for \n\n\n\napplication of fullerene C60 to nanomedicine. \n\n\n\n\n\n\n\n\n\n\n\nSPP 16 \nFAPA2014000133 (Poster) \n\n\n\n\n\n\n\nInvestigation of Taste Masking Techniques for Drug Causing Mucosal Irritation \n\n\n\n\n\n\n\nKB Liew, KK Peh   \n\n\n\nSchool of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia \n\n\n\n\n\n\n\nTaste masking techniques for drug causing mucosal irritation was investigated. The objective of the study \n\n\n\nwas to investigate and compare the effectiveness of various taste masking techniques for Dapoxetine HCl, \n\n\n\na drug causing oral mucosal irritation. Taste masked granules of dapoxetine HCl were prepared via \n\n\n\ndifferent taste masking techniques, namely, ion exchange using Kyron T-134 resin, coating with a \n\n\n\nhydrophilic polymer Carbopol, inclusion complexation with hydroxypropyl beta-cyclodextrin, chemical \n\n\n\n\n\n\n\n\nmodification via reaction with sodium bicarbonate and addition of sweetener and flavoring agent \n\n\n\n(sucralose and green apple flavor) were investigated and compared. Coating with Carbopol, inclusion \n\n\n\ncomplexation and addition of sweetener and flavouring agent, did not satisfactorily circumvent the oral \n\n\n\nmucosal irritation and unpleasant taste of dapoxetine HCl. On the contrary, ion exchange and chemical \n\n\n\nmodification techniques were found to be effective. The dissolution of the drug was not affected in 0.1 N \n\n\n\nHCl medium (80% drug released within 45 minute). Kyron formed a resin complex with dapoxetine \n\n\n\nHCL, while sodium bicarbonate converted dapoxetine HCl into non-soluble dapoxetine base. The resin-\n\n\n\ndrug complex and dapoxetine were not soluble in the pH of oral cavity. The drug released in acidic pH of \n\n\n\n0.1M HCl. The SEM showed the formation of drug-resin complex. The FTIR spectra showed that there \n\n\n\nwas no chemical interaction involving the major functional groups of the drug for the two methods. The \n\n\n\ndrug was stable at 40\u00b0C for 6 months. Ion exchange and chemical modification were effective taste \n\n\n\nmasking techniques that could be used to resolve the oral mucosal irritation and improve the palatability \n\n\n\nof dapoxetine HCl in orally disintegrating tablets. \n\n\n\n\n\n\n\n\n\n\n\nSPP 17 \nFAPA2014000201 (Poster) \n\n\n\n\n\n\n\nEffect of Bromelain from Pineapple Fruit Stem on Motility of the Gastrointestinal Tract of the Rat \n\n\n\n\n\n\n\nCH Khiew\n1\n, PN Yeoh\n\n\n\n1\n, JW Mak\n\n\n\n2\n, J Chellian\n\n\n\n1 \n \n\n\n\n1\nSchool of Pharmacy, International Medical University, Bukit Jalil, Kuala Lumpur, Malaysia \n\n\n\n2\nSchool of Medical Sciences, International Medical University, Bukit Jalil, Kuala Lumpur, Malaysia \n\n\n\n\n\n\n\nBromelain from pineapple fruit stem (PSJ) is a glycosylated single-chain cysteine endopeptidase with \n\n\n\ninhibitory effects on intestinal motility, secretion and inflammation. An anecdotal account claimed that \n\n\n\nbromelain could cure gastroesophageal reflux disease (GERD) but evidence pertaining to its effects on \n\n\n\ngastroesophageal motility and secretion are scarce. This investigation looked at the effect of chronic stem \n\n\n\nbromelain treatment (PSJ) on the response of oesophagus, stomach, ileum and colon of rats to \n\n\n\nacetylcholine, histamine and their antagonists. Five groups of male albino rats were fed either with \n\n\n\nnormal saline (control), 3 different concentrations of PSJ or bromelain via oral tube for 21 days. On day \n\n\n\n23, segments of oesophagus, stomach, ileum and colon were removed for isolated organ bath \n\n\n\nexperiments. Effects of different doses of acetylcholine, histamine and their antagonists on tissue \n\n\n\ncontractility were recorded via Powerlab\nTM\n\n\n\n. Dose response curves for acetylcholine and histamine with \n\n\n\ntheir EC50s were obtained alone and in the presence of their antagonists, atropine, mepyramine, \n\n\n\nrespectively and in the presence of PSJ. The mean SEM of the EC50 of treatment groups were compared \n\n\n\nagainst the control group by ANOVA and Student\u2019s t-test. The dose response curves for acetylcholine and \n\n\n\nhistamine alone and in the presences of either atropine or mepyramine in the control rats were compared \n\n\n\nwith those of the treated rats. The results from the oesophagus, stomach, ileum and colon were analysed. \n\n\n\nA shift to the left of the dose-response curves to agonists of treated compared to the control rats would \n\n\n\nshow an increase in responsiveness, while a shift to the right would show a decrease in responsiveness. If \n\n\n\nPSJ shifts the dose-response curves of acetylcholine / histamine of the control rats to the right, then PSJ \n\n\n\nwould have antagonistic effect on muscarinic and histamine H1 receptors. \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nSPP 18 \nFAPA2014000151 (Poster) \n\n\n\n\n\n\n\nAnalysis of Neurological Effects After Exposure to Silver Nanoparticles via Intranasal Route \n\n\n\n\n\n\n\nK Tanaka\n1\n, K Higashisaka\n\n\n\n1,2\n, Y Iwahara\n\n\n\n1\n, S Tsunoda\n\n\n\n2,3\n, Y Yoshioka\n\n\n\n1,2\n, Y Tsutsumi \n\n\n\n1,3\n \n\n\n\n1\nLaboratory of Toxicology and Safety Science, Graduate School of Pharmaceutical Sciences, Osaka \n\n\n\nUniversity, Japan \n2\nLaboratory of Biopharmaceutical Research, National Institute of Biomedical Innovation, Japan\n\n\n\n 3\nThe \n\n\n\nCenter for Advanced Medical Engineering and Informatics, Osaka University, Japan \n\n\n\n\n\n\n\nThe development of nanotechnology enhances the prevalence of ultrafine particles, called nanoparticles \n\n\n\n(1-100 nm). For example, silver nanoparticles (nAg) have been widely used in daily commodities because \n\n\n\nthey can be easily applied to products compared with silver ions previously used as an anti-bacterial \n\n\n\nagent. Thus, we have more opportunities to expose nAg routinely. Considering some recent studies report \n\n\n\nthat the inhalation exposure of airborne ultrafine particles may be related to brain diseases, information \n\n\n\nabout bio-distribution and biological effects of nAg on brain is indispensable for safety use and the \n\n\n\npromotion of health. In this study, we assessed distribution of nAg to brain following nasal administration \n\n\n\nand their neurological effects by comparing with silver ions. C57BL/6 mice were treated with nAg (10 \n\n\n\nnm) or silver ions by nasal administration for 28 consecutive days. Silver content of each brain sub-region \n\n\n\nwas measured by ICP-MS. ICP-MS analysis showed that silver content of brain in nAg treated group was \n\n\n\nlower than that in silver ions treated group, and that silver content was highest in olfactory bulbs (OB). In \n\n\n\norder to clarify their influence on OB, the expression of tyrosine hydroxylase (TH), which is a marker of \n\n\n\ndopaminergic neurons playing a major role in OB, was evaluated by Western blot. As a result, TH amount \n\n\n\nof the OB in nAg treated group was reduced by approximately 10%, though TH in silver ions treated \n\n\n\ngroup was significantly decreased by approximately 50%. In other words, nAg may have less \n\n\n\nneurological effects on OB than silver ions after nasal exposure. With the aim of elucidating various \n\n\n\neffects of nAg on brain including OB, we are currently performing neurobehavioral tests. \n\n\n\n\n\n\n\n\n\n\n\nSPP 19 \nFAPA2014000288 (Poster) \n\n\n\n\n\n\n\nFormulation and Evaluation of Extended Release Microencapsulated Mefenamic Acid Using the \n\n\n\nOil of Cocos nucifera (Coconut Fruit) and Liquid Paraffin (50:50) as Oil Phase in Solvent \n\n\n\nEvaporation Method \n\n\n\n\n\n\n\nK Allarde, LM Antonio, DD Castro, MD Montaos, JM Muarip  \n\n\n\nFaculty of Pharmacy, University of Santo Tomas, Manila, Philippines \n\n\n\n\n\n\n\nMefenamic acid is a non-steroidal anti-inflammatory drug that could cause adverse reactions and drug \n\n\n\ninteractions if the medication would be taken unmonitored. To prevent further occurrences of these events \n\n\n\nand better patient compliance, an extended release formulation of mefenamic acid was prepared in this \n\n\n\nstudy through microencapsulation using solvent evaporation method. The potential of virgin coconut oil \n\n\n\n(VCO) as an oil phase was tested by using 50:50 ratio of VCO and liquid paraffin in the experimental \n\n\n\ngroup and utilizing liquid paraffin alone in the control. The resulting microspheres were employed under \n\n\n\nFourier Transform Infrared Spectroscopy, Scanning Electron Microscopy (SEM), Differential Scanning \n\n\n\nCalorimetry (DSC), and Dissolution Test to confirm the presence of mefenamic acid, identify its \n\n\n\nmorphology, determine the compatibility of excipients with the drug and verify the extended release of \n\n\n\nthe medication. The change in endothermic peak in DSC thermograms suggested that the mefenamic acid \n\n\n\nin VCO:liquid paraffin formulation reacted with VCO or was lost during formulation. Infrared spectra \n\n\n\n\n\n\n\n\nresults also implied the absence of mefenamic acid in both formulations. SEM images of VCO:paraffin \n\n\n\nformulation showed crystal shaped, collapsed microcapsules with smooth edges, which implied that \n\n\n\nmicrocapsules were not formed. However, the dissolution test revealed that the incorporation of VCO to \n\n\n\nliquid paraffin as the oil phase was superior compared to liquid paraffin in extended release preparations. \n\n\n\nThis was validated by the testing of significance using Independent Sample T-test at 95% Confidence \n\n\n\nInterval. Statistics showed that the differences from 30 minutes down to 2 hours were all found to \n\n\n\nstatistically significant, given p-values less than alpha 0.05 (mean p-value=0.01034). Therefore, the 50:50 \n\n\n\nratio of VCO:liquid paraffin is incompatible with mefenamic acid. Nevertheless, it is more effective as an \n\n\n\noil phase when compared to pure liquid paraffin in terms of delaying release of the drug from the \n\n\n\npreparation. \n\n\n\n\n\n\n\n\n\n\n\nSPP 20 \nFAPA2014000316 (Poster) \n\n\n\nInvestigating the Effects of Novel Wound Dressings Based on Chitosan, Sodium Alginate, and \n\n\n\nGelatin \n\n\n\nM Rahmani\n1\n, F Hashemian\n\n\n\n1\n, SK Sajadi\n\n\n\n2\n \n\n\n\n1 \nDepartment of Clinical Pharmacy, Pharmaceutical Sciences Branch, Islamic Azad University, Tehran, \n\n\n\nIran \n2\n Department of Pharmaceutics, Pharmaceutical Sciences Branch, Islamic Azad University, Tehran, Iran \n\n\n\n\n\n\n\nChronic nonhealing ulcers are a critical problem in clinical practice. Slow healing, difficulty in providing \n\n\n\nproper healing support or treatment methods, and patient suffering are great challenges for modern \n\n\n\nmedicine. Chitosan has been proven to have desirable qualities, such as hemostasis, bacteriostasis, \n\n\n\nbiocompatibility, and biodegradability properties. One of the most interesting effects of chitin and \n\n\n\nchitosan on wound healing is formation of granulation tissue with angiogenesis. Chitin and chitosan \n\n\n\ninduce fibroblasts to release interleukin-8, which is involved in migration and proliferation of fibroblasts \n\n\n\nand vascular endothelial cells. The aim of this study was to prepare and evaluate a novel wound dressing \n\n\n\nbased on chitosan, sodium alginate, and gelatin. For this purpose, two different formulations of films were \n\n\n\nprepared. One formulation contained gelatin and chitosan and the other one consisted of chitosan and \n\n\n\nsodium alginate. Required properties for successful wound dressings such as thickness, water vapor \n\n\n\npermeability and oxygen penetration were examined. Then the best film from each formulation was \n\n\n\nidentified by Design-Expert\n\u00ae\n software. A water-soluble pressure-sensitive adhesive was prepared. The \n\n\n\nselected films were covered by a thin layer of adhesive. Animal studies were performed on female albino \n\n\n\nrabbits and wound areas were measured on days 0, 3, 6, and 9. Healing of the wounds treated with \n\n\n\nchitosan-alginate dressing was more rapid than control. With the chitosan-alginate dressing the rate of \n\n\n\nhealing showed statistically significant difference (p value <0.05) from day 3 onwards. With the chitosan-\n\n\n\ngelatin dressing, the rate of healing showed statistically significant difference (p value <0.05) from day 9. \n\n\n\nThe results showed that wound dressing based on chitosan, sodium alginate, and gelatin accelerates the \n\n\n\nhealing process. In addition, permeability studies illustrated that both chitosan-alginate and chitosan-\n\n\n\ngelatin films allowed higher oxygen penetration compared with the pure chitosan film. \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nSPP 21 \nFAPA2014000040 (Poster) \n\n\n\nAnticancer Activity and Apoptotic Induction of Chalcones against TRAIL Resistant Cancer Cells \n\n\n\nCW Mai\n1\n, M Yaeghoobi\n\n\n\n2\n, N A-Rahman\n\n\n\n2\n, YB Kang\n\n\n\n1\n, MR Pichika\n\n\n\n1\n  \n\n\n\n1\nDepartment of Pharmaceutical Chemistry, School of Pharmacy and Health Sciences, International \n\n\n\nMedical University, Bukit Jalil, Kuala Lumpur, Malaysia \n2\nDrug Design and Development Research Group, Department of Chemistry, University of Malaya, Kuala \n\n\n\nLumpur, Malaysia \n\n\n\nIn the present study, a series of 46 chalcones were synthesised and evaluated for antiproliferative \n\n\n\nactivities against the human TRAIL-resistant breast (MCF-7, MDA-MB-231), cervical (HeLa), ovarian \n\n\n\n(Caov-3), lung (A549), liver (HepG2), colorectal (HT-29), nasopharyngeal (CNE-1), \n\n\n\nerythromyeloblastoid (K-562) and T-lymphoblastoid (CEM-SS) cancer cells. The chalcone 38 containing \n\n\n\nan amino (-NH2) group on ring A was the most potent and selective against cancer cells. The effects of \n\n\n\nthe chalcone 38 on regulation of 43 apoptosis-related markers in HT-29 cells were determined. The \n\n\n\nresults showed that 20 apoptotic markers (Bad, Bax, Bcl-2, Bcl-w, Bid, Bim, CD40, Fas, HSP27, IGF-1, \n\n\n\nIGFBP-4, IGFBP-5, Livin, p21, Survivin, sTNF-R2, TRAIL-R2, XIAP, caspase-3 and caspase-8) were \n\n\n\neither up regulated or down regulated. \n\n\n\n\n\n\n\nSPP 22 \nFAPA2014000166 (Poster) \n\n\n\n\n\n\n\nSize Effects of Gold Nanoparticles on the Tissue Distribution and Retention \n\n\n\n\n\n\n\nM Yamaguchi\n1\n, Y Yoshioka\n\n\n\n1,2\n, H Takahashi\n\n\n\n1\n, T Hirai\n\n\n\n1\n, F Yamashita\n\n\n\n3\n, S Tsunoda\n\n\n\n2,4\n, M Hashida\n\n\n\n3\n, K \n\n\n\nHigashisaka\n1,2\n\n\n\n, Y Tsutsumi\n1,4\n\n\n\n \n1\nLaboratory of Toxicology and Safety Science, Graduate School of Pharmaceutical Sciences, Osaka \n\n\n\nUniversity, Japan \n2\nLaboratory of Biopharmaceutical Research, National Institute of Biomedical Innovation, Japan \n\n\n\n3\nDepartment of Drug Delivery Research, Graduate School of Pharmaceutical Sciences, Kyoto University, \n\n\n\nJapan \n4\nThe Center for Advanced Medical Engineering and Informatics, Osaka University, Japan \n\n\n\n\n\n\n\nWith the recent development of nanotechnology, the application of nanomaterials (\u2264 100 nm) in \n\n\n\nbiomedicine has attracted much attention. However, the increasing use of nanomaterials has raised \n\n\n\nconcerns over their safety for human health. Collecting information between physical properties of \n\n\n\nnanomaterials and their unique biodistribution is important to produce safer forms of nanomaterials. In \n\n\n\nthis study, we investigated the influence of particle size on the in vivo tissue distribution of gold \n\n\n\nnanoparticles, which are promised diagnostic or anticancer drug. Gold nanoparticles with 10, 30, 50, 70, \n\n\n\nand 90 nm in diameter were injected in BALB/c mice via tail vein. The gold contents in liver, kidneys, \n\n\n\nand spleen were determined by the inductively coupled plasma mass spectrometry at 1, 14, and 28 days \n\n\n\nafter the administration. Regardless of particle size, the percentage of the injected dose in kidneys and \n\n\n\nspleen was from 0.5 to 4 % at day 1 after the administration and gradual decrease was observed at day 14 \n\n\n\nand 28. On the other hand, the percentage of the injected dose in the liver of mice treated with each gold \n\n\n\nnanoparticles was from 50 to 90 % at day 1 after the administration. Furthermore, the gold content in liver \n\n\n\ndid not decrease even at 28 days after administration. Thus, little difference in tissue distribution tested \n\n\n\nwas observed between each particles size. However, evaluating the accumulation mechanisms of gold \n\n\n\n\n\n\n\n\nnanoparticles in liver is critical for ensuring the safety of nanomedicine. We believe that our study is \n\n\n\nuseful in designing a new drug of nanoparticles with high safety and efficacy. \n\n\n\n\n\n\n\n\n\n\n\nSPP 23 \nFAPA2014000191 (Poster) \n\n\n\n\n\n\n\nAmorphous Silica Nanoparticles Induce Size-Dependent Inflammation \n\n\n\n\n\n\n\nN Nishijima\n1\n, Y Yoshioka\n\n\n\n1,2\n, T Hirai\n\n\n\n1\n, T Handa\n\n\n\n1\n, N Izumi\n\n\n\n1\n, H Takahashi\n\n\n\n1\n, S Tsunoda\n\n\n\n2,3\n, K \n\n\n\nHigashisaka\n1,2\n\n\n\n, Y Tsutsumi\n1,3\n\n\n\n \n1\nLaboratory of Toxicology and Safety Science, Graduate School of Pharmaceutical Sciences, Osaka \n\n\n\nUniversity, Japan \n2\nLaboratory of Biopharmaceutical Research, National Institute of Biomedical Innovation, Japan \n\n\n\n3\nThe Center for Advanced Medical Engineering and Informatics, Osaka University, Japan \n\n\n\n\n\n\n\nExposure to particulate matters (PM) in environment, such as yellow dust and crystalline silica induce \n\n\n\ninflammatory disease such as allergy and silicosis. Recently it has been reported that nano-sized particles \n\n\n\nin PM play a pivotal role in these influences. On the other hand, by the development of nanotechnology, \n\n\n\nbroad applications and prevalence of nanomaterials (less than 100 nm in diameter) are expanding. \n\n\n\nBecause of their ultra-fine size, nanomaterials have a lot of helpful abilities such as high tissue \n\n\n\npermeability, which are expected to be applied to efficient Drug Delivery Systems. Although it is \n\n\n\nconcerned that the characteristic of nanomaterials as particles might have the possibility of the similar \n\n\n\ninflammatory effects to PM, their potential inflammatory effects have not been fully understood. In this \n\n\n\nstudy, we evaluated the correlation between the size of particles and inflammatory activity using \n\n\n\namorphous silica nanoparticles (nSP). THP-1 cells were treated with each nSP and submicron-sized silica \n\n\n\nparticle (the diameter of 10, 30, 50, 70, 100, 300, and 1000 nm; nSP10, nSP30, nSP50, nSP70, nSP100, \n\n\n\nnSP300, and mSP1000) and IL-1\u03b2 production in the culture supernatants were measured. Although \n\n\n\nsmaller particles induced higher IL-1\u03b2 secretion between mSP1000 and nSP50 in culture supernatant, \n\n\n\nnSP30 and nSP10 induced less secretion than that of nSP50. Thus nSP50 would have the highest \n\n\n\ninflammatory potential. Next, we evaluated the inflammatory effects of nSP in vivo. C57BL/6 mice were \n\n\n\ntreated intraperitoneally with each size of nSP. After 24 h, whole peritoneal cavity lavage fluid (PCLF) \n\n\n\nwas collected. nSP50 induced the highest increase of total cell numbers in PCLF. These results suggest \n\n\n\nthat inflammation induced by nSP is size dependent in vivo. We are now trying to investigate the effects \n\n\n\nof particles size on cellular uptake or intracellular distribution, and clarify why nSP50 induces the strong \n\n\n\nIL-1\u03b2 secretion. \n\n\n\n\n\n\n\n\n\n\n\nSPP 24 \nFAPA2014000141 (Poster) \n\n\n\n\n\n\n\nPreparation and Characterization of Diclofenac Sodium Loaded Solid Lipid Nanoparticle \n\n\n\n\n\n\n\nOE Puspita \n\n\n\nDepartment of Pharmacy, Faculty of Medicine, Brawijaya University, Malang, Indonesia \n\n\n\n\n\n\n\nThe possibility of using Solid Lipid Nanoparticles (SLN) for topical use is an interesting feature. This \n\n\n\nsystem has occlusive properties on the skin surface, therefore enhancing the penetration of drugs through \n\n\n\nthe stratum corneum by increased hydration. This advantage can be used to enhance the drug penetration \n\n\n\nof topical delivery such as diclofenac sodium for the relief of signs and symptoms of osteoarthritis, \n\n\n\nrheumatoid arthritis and ankylosing spondylitis. The purpose of this study was focused on the preparation \n\n\n\n\n\n\n\n\nand physical characterization of Diclofenac sodium loaded SLN (D-SLN). D-SLN were prepared by hot \n\n\n\nhomogenization followed by ultrasonication technique. Since the occlusion factor of SLN is related to its \n\n\n\nparticle size, two formulations different in its surfactant contents were prepared to investigate the \n\n\n\ndifference of the particle size resulted. Surfactants selected for preparation of formulation A (FA) were \n\n\n\nlecithin soya and Tween 80 whereas formulation B (FB) were lecithin soya, Tween 80, and Sodium \n\n\n\nLauryl Sulphate. D-SLN were characterized for particle size and distribution, polydispersity index (PI), \n\n\n\nzeta potential using Beckman-Coulter Delsa\u2122 Nano. Overall, the particle size obtained from FA was \n\n\n\nlarger than FB. FA has 90% of the particles above 1000 nm, whereas FB has 90% below 100 nm. \n\n\n\n\n\n\n\n\n\n\n\nSPP 25 \nFAPA2014000120 (Poster) \n\n\n\nPreparation and Characterization of Water-in-Oil Nanoemulsion of 5-Fluorouracil to Enhance \n\n\n\nSkin Permeation for Treatment of Skin Diseases \n\n\n\nPS Rajinikanth\n1\n, S Mariappan\n\n\n\n2\n  \n\n\n\n1\nDepartment of Pharmaceutical Technology, School of Pharmacy, Taylors University, Subang Jaya, \n\n\n\nMalaysia \n2\nDepartment of Pharmaceutical Technology, School of Pharmacy, International Medical University, \n\n\n\nKuala Lumpur, Malaysia \n\n\n\nThe objective of the study was to prepare and characterize a water-in-oil nanoemulsion of 5-Fluorouracil \n\n\n\n(5-FU) to enhance the skin penetration. The present study describes a nanoemulsion of 5-FU using \n\n\n\nCapyrol PGMC, Transcutol HP and PEG 400 as oil, surfactant and co-surfactant, respectively. The \n\n\n\noptimized formulations were further evaluated for heating cooling cycle, centrifugation studies, freeze \n\n\n\nthaw cycling, particle size distribution and zeta potential in order to confirm the stability of the optimized \n\n\n\nnanoemulsions. The in vitro characterization results showed that the droplets of prepared formulation \n\n\n\nwere ~100 nm with \u00b1 15 zeta potential. In vitro skin permeation studies were conducted in albino mice \n\n\n\nskin. Significant increase in permeability parameters was also observed in nanoemulsion formulations (p \n\n\n\n< 0.05). The steady-state flux (Jss), enhancement ration and permeability coefficient (Kp) for optimized \n\n\n\nnanoemulsion formulation (FU2, FU1, 1:1 S mix were found to be 24.21 \u00b1 2.45 \u00b5g/cm\n2\n/h, 3.28 \u00b1 0.87 & \n\n\n\n19.52 \u00b1 1.87 cm/h, respectively), which were significant compared with conventional gel. The in vitro \n\n\n\nand in vivo skin deposition studies in rat indicated that the amount of drug deposited from the \n\n\n\nnanoemulsion (292.45 \u00b5g/cm\n2\n) in skin was significant (p < 0.05), an increased as compared to a \n\n\n\nconventional 5FU gel (121.42 \u00b5g/cm\n2\n). The skin irritation study using rat skin showed that the mean \n\n\n\nirritation index of the nanoemulsion reduced significantly (p < 0.05) as compared with conventional gel \n\n\n\ncontaining 1% 5-FU. The results from this study suggest that a water-in-oil nanoemulsion could be safely \n\n\n\nused to promote skin penetration of 5-FU following topical application. \n\n\n\nSPP 26 \n\n\n\nFAPA2014000246 (Poster) \n\n\n\nEffects of Black Pepper on Pharmacokinetics of Glimepiride in Type 2 Diabetic Rats \n\n\n\nP Mittal\n1\n, V Juyal\n\n\n\n2\n \n\n\n\n1\nDepartment of Pharmacy Practice, International Medical University, Kuala Lumpur, Malaysia \n\n\n\n2\nDepartment of Pharmaceutical Sciences, Kumaun University, Nainital, India \n\n\n\nThe relationships and interaction between foods, dietary supplements and drugs are gaining recognition in \n\n\n\nthe healthcare and medical fields. An estimated 12-45% of individuals using supplements with \n\n\n\n\n\n\n\n\nprescription drugs are at risk of interactions. Glimepiride is a third generation sulfonylurea which \n\n\n\nstimulates insulin release from pancreatic beta cells and may acts via extra- pancreatic mechanisms. \n\n\n\nGlimepiride is metabolized by CYP2C9. This should be taken into account when glimepiride co-\n\n\n\nadministered with inducers, inhibitors and substrate of CYP2C9. Black pepper alone accounts for about \n\n\n\n35% of the world\u2019s total spice trade and considered as \"King of Spices\". It has been used medicinally for \n\n\n\ncenturies. In addition, the CYP450 inhibitory and bioenhancing properties of black pepper had been \n\n\n\nproved. This study was designed to explore the effect of black pepper on pharmacokinetics of glimepiride \n\n\n\nas no studies are available to address this interaction. Type 2 diabetes was induced in overnight fasted rats \n\n\n\nby streptozotocin and nicotinamide. Glimepiride (1mg/kg) and aqueous black pepper extract (250 mg/kg) \n\n\n\nwere administered to diabetic rats and blood samples were collected at time intervals of 0.5, 1, 2, 4 and 8 \n\n\n\nhours after drug administration and analysed with HPLC to estimate glimepiride concentration in serum. \n\n\n\nThe Cmax, tmax, AUC, t1/2 and MRT of glimepiride were calculated with Kinetica software. In type 2 \n\n\n\ndiabetic rats, the Cmax, tmax and AUC of glimepiride were significantly increased in glimepiride and \n\n\n\naqueous black pepper extract treated rats. The values of t1/2 and MRT were decreased. The glimepiride \n\n\n\nconcentration increased two times and t1/2, AUC increased as well. The CYP2C9 inhibitory and \n\n\n\nbioenhancing properties of black pepper has been proven and documented and responsible for this \n\n\n\npharmacokinetic activity. The present study revealed that black pepper significantly altered the \n\n\n\npharmacokinetics of glimepiride and may potentiate the risk of hypoglycaemia. \n\n\n\n\n\n\n\nSPP 27 \n\n\n\nFAPA2014000194 (Poster) \n\n\n\nCharacterisation and Optimisation of Hydrolase-Producing Bacteria Strains Isolated from Non-\n\n\n\nPristine Mangrove Soil  \n\n\n\nVNR Lim\n1\n, SHE Lim\n\n\n\n2\n, CW Mai\n\n\n\n1\n, CW Chong\n\n\n\n1\n, KSI Yap\n\n\n\n1\n, KW Cheong\n\n\n\n1  \n\n\n\n1\nSchool of Pharmacy, International Medical University, Kuala Lumpur, Malaysia.                 \n\n\n\n2\nPerdana University, Serdang, Selangor, Malaysia. \n\n\n\nMangroves are reported to be one of the most productive and biologically important environments. It is \n\n\n\nusually found at the transition zone between land and sea in the tropical regions. This ecosystem varies in \n\n\n\nterms of its salinity, water levels and nutrient availability during the seasons which are responsible for the \n\n\n\nhigh level of diversity of microorganisms. These microorganisms known as extremophiles have \n\n\n\ndeveloped unique properties to survive under extreme conditions of mangrove soil and may produce \n\n\n\neffective enzymes which function optimally under extreme conditions, making them potential biocatalysts \n\n\n\nused in harsh industrial processes. Although halophilic hydrolases were found to be an excellent \n\n\n\nalternative in industrial applications, very few hydrolases from halophiles have been characterised and \n\n\n\nthere was a lack of research being conducted on isolation of hydroalse-producing bacteria from local \n\n\n\nMalaysia mangroves. In addition, literature search using ScienceDirect and Pubmed did not reveal any \n\n\n\nhydrolases isolated from local Malaysia mangroves. Thus, the research was undertaken to isolate and \n\n\n\nidentify hydrolase producing bacteria from non-pristine mangrove soil. Colonies were screened for \n\n\n\nhydrolase activities on tributyrin agar plates and colonies with distinct morphologies were selected for \n\n\n\ndereplication based on repetitive element polymerase chain reaction (rep-PCR) fingerprinting. Parameters \n\n\n\naffecting hydrolase production, such as media, incubation time, temperature and agitation speed were \n\n\n\nconducted. In addition, the effect of pH, temperature, metal ions and concentrations of sodium chloride on \n\n\n\nthe stabilities and activities of hydrolases was also studied. Few hydrolase-producing bacteria strains were \n\n\n\nsuccessfully isolated. Further studies are warranted for additional investigations. \n\n\n\n \n\n\n\n\n\n\n\n\nSPP 28 \nFAPA2014000149 (Poster) \n\n\n\n\n\n\n\nThe Basic Analysis for the Evaluation of Nanomaterials Excretion \n\n\n\n\n\n\n\nR Ishimoto\n1\n, Y Yoshioka\n\n\n\n1,2\n, M Aoyama\n\n\n\n1\n, S Tsunoda\n\n\n\n2,3\n, K Higashisaka\n\n\n\n1,2\n, Y Tsutsumi\n\n\n\n1,3\n \n\n\n\n1\nLaboratory of Toxicology and Safety Science, Graduate School of Pharmaceutical Sciences, Osaka \n\n\n\nUniversity, Japan \n2\nLaboratory of Biopharmaceutical Research, National Institute of Biomedical Innovation, Japan \n\n\n\n3\nThe Center for Advanced Medical Engineering and Informatics, Osaka University, Japan \n\n\n\n\n\n\n\nNanomaterials have been utilized in an increasing number of applications such as medicine, cosmetics, \n\n\n\nand foods. It is because nanomaterials have unique character and useful function by the decrease of the \n\n\n\nparticle size to the nanoscale. On the other hand, it is concerned that these materials have potential health \n\n\n\nrisks attributed to their unique properties. Therefore, it is necessary to assess risk of nanomaterials from \n\n\n\nthe point of view about kinetic analysis and the hazard analysis. In the recent studies, while the cellular \n\n\n\nuptake mechanisms of nanomaterials have been reported extensively, there is little known about excretion \n\n\n\nof nanomaterials from the cells. A greater understanding of the nanomaterials\u2019 excretion may provide \n\n\n\nuseful information about their safety relating the accumulation and ADME (absorption, distribution, \n\n\n\nmetabolism and excretion) of nanomaterials. In this study, to evaluate the nanomaterials\u2019 excretion, we \n\n\n\nanalyzed the quantity of the intracellular nanomaterials. We treated fluorescence labeled silica \n\n\n\nnanoparticles with a diameter of 70 nm (nSP70) to human alveolar adenocarcinoma cell line (A549) for 2 \n\n\n\nhours. The cells were washed with phosphate buffered saline before changing to fresh growth medium for \n\n\n\nfurther incubation. Then, we analyzed the intensity of fluorescent nSP70 inside the cells by flow \n\n\n\ncytometry. As a result, the level of the fluorescence inside the cells increased after incubation with nSP70 \n\n\n\nfor 2h due to nanomaterials uptake, but this level of the fluorescence decreased after 6h. These results \n\n\n\nsuggest that the particles had excreted from the cells. It has been already reported that foreign substances \n\n\n\nand secretory protein are excreted through various organelle such as lysosome and the Golgi apparatus. \n\n\n\nTherefore, we are investigating through which pathway the nanomaterials inside the cells might be \n\n\n\nexcreted. We believe that these data will contribute to risk analysis of nanomaterials. \n\n\n\n\n\n\n\n\n\n\n\nSPP 29 \nFAPA2014000017 (Poster) \n\n\n\n\n\n\n\nMolecular Docking Based Screening of Natural Products as Potential Aldose Reductase Inhibitor \n\n\n\nfor the Management of Diabetic Complications \n\n\n\n\n\n\n\nSK Verma, S Thareja  \n\n\n\nInstitute of Pharmaceutical Sciences, Guru Ghasidas Central University, Bilaspur, India \n\n\n\n\n\n\n\nDiabetes mellitus is a chronic multifactorial metabolic disease resulting from insulin deficiency or insulin \n\n\n\nresistance. Complications due to diabetes such as neuropathy, nephropathy and retinopathy are the major \n\n\n\ncause of disability, which reduces quality of life. Aldose reductase (AR, ALR2), the first enzyme of the \n\n\n\npolyol metabolic pathway that catalyzes the NADPH-dependent reduction of glucose to sorbitol, has been \n\n\n\nfound to be implicated in the etiology of the long-term diabetic complications. AR inhibition is the most \n\n\n\nwidely used strategy to prevent and delayed diabetic complications. Natural products, containing \n\n\n\ninherently vast structural diversity than synthetic compounds, have been the major sources of bioactive \n\n\n\nagents and will continually play as protagonists for discovering new drugs. Phytochemicals are \n\n\n\nconsidered privileged structures as they have the diversity space in which chemical scaffolds embody \n\n\n\ncharacteristics that promote binding to multiple protein targets. Therefore, natural products are considered \n\n\n\n\n\n\n\n\nimportant sources for new drugs or lead optimization of AR inhibitors for the management of diabetic \n\n\n\ncomplications. In the present study, a library of natural compounds with different scaffolds was employed \n\n\n\nfor the screening of the compounds against AR. Molegro Virtual Docker (MVD 2013.6.0.0 version) was \n\n\n\nused to perform the screening studies. The structure of AR was taken from the protein data bank and the \n\n\n\nPDB entry was 1AH3. Mol-Dock score along with re-rank score was the criteria for measuring the \n\n\n\naffinity of screened compounds with AR enzymes. The binding information obtained from the present \n\n\n\nstudies can be mapped which will be helpful in studying the structural features relating to the trends in \n\n\n\nactivities of the different compounds. The result of present study will provide a new approach for \n\n\n\nthe potential use of these natural compounds as novel selective inhibitors of AR in the management of \n\n\n\ndiabetic complications. \n\n\n\n\n\n\n\n\n\n\n\nSPP 30 \nFAPA2014000078 (Poster) \n\n\n\n\n\n\n\nEffect of Renal Denervation on the Sensitivity of Cardiopulmonary Reflex Mechanism in Cisplatin-\n\n\n\nInduced Acute Renal Failure Rats \n\n\n\n\n\n\n\nSA Khan\n1\n, MZA Sattar\n\n\n\n1\n, HA Rathore\n\n\n\n1\n, PP Yen\n\n\n\n1\n, HJ Oh\n\n\n\n1\n,  JL Khoo\n\n\n\n1\n, A Ahmad\n\n\n\n1\n, F din Ahmad\n\n\n\n1\n, S \n\n\n\nAfzal\n1\n, MI Lazhari, NA Abdullah\n\n\n\n2\n, EJ Johns\n\n\n\n3\n \n\n\n\n1\nSchool of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia \n\n\n\n2\nDepartment of Pharmacology, Faculty of Medicine, University Malaya, Malaysia \n\n\n\n3\nDepartment of Physiology, University College Cork, Cork, Ireland \n\n\n\n\n\n\n\nThe present study investigated the mechanisms underlying the suppressed low pressure cardiopulmonary \n\n\n\nbaroreflex mediated control of renal sympathetic nerve activity and heart rate in cisplatin induced renal \n\n\n\nfailure. Renal failure was induced using cisplatin (5mg kg\n-1\n\n\n\n, i.p.) and the rats were used seven days later. \n\n\n\nGroups of rats were anaesthetized with chloralose\u2013urethane and prepared for measurement of renal \n\n\n\nsympathetic nerve activity and heart rate. Acute unilateral or bilateral renal denervation was performed by \n\n\n\n10 % phenol and the cardiopulmonary receptors were stimulated using an acute saline volume load (0.25 \n\n\n\n% body weight) for 30 min. Cisplatin administration reduced (P<0.05) body weight by 12.5%, creatinine \n\n\n\nclearance by 27% and increased urine volume and water intake, by 27% and 9% respectively (P<0.05). \n\n\n\nFractional excretion of sodium was increased by four folds as compared to control rats and increased \n\n\n\n(P<0.05) plasma creatinine and kidney index by 39% and 30% respectively compared to the control \n\n\n\nrats.  Volume expansion reduced (P < 0.05) renal sympathetic nerve activity by 34% in control rats but \n\n\n\nremained unchanged in the renal failure rats. Unilateral and bilateral renal denervation progressively \n\n\n\nrestored the volume-expansion induced renal sympatho-inhibition to control values. These findings \n\n\n\ndemonstrated a significant role of the renal sensory innervation in cisplatin damaged kidneys which \n\n\n\nblunted the normal baroreflex control of sympathetic outflow to the kidney.  \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nSPP 31 \nFAPA2014000150 (Poster) \n\n\n\n\n\n\n\nOptimization of an Immune Method to Shorten Time for Inducing High-Affinity Antibodies \n\n\n\nT Mori\n1\n, Y Mukai\n\n\n\n1\n, K Higashisaka\n\n\n\n1,2\n, Y Yoshioka\n\n\n\n1,2\n, K Nagano\n\n\n\n1\n, H Kamada\n\n\n\n1,3\n, S Tsunoda\n\n\n\n1,3\n, Y \n\n\n\nTsutsumi\n1,2,3\n\n\n\n \n1\nLaboratory of Biopharmaceutical Research, National Institute of Biomedical Innovation, Japan \n\n\n\n2\nLaboratory of Toxicology and Safety Science, Graduate School of Pharmaceutical Science, Osaka \n\n\n\nUniversity, Japan \n3\nThe Center for Advanced Medical Engineering and Informatics, Osaka University, Japan \n\n\n\nProtein functions are regulated depending on their domains functions; therefore high-affinity monoclonal \n\n\n\nantibodies (mAbs) that block specific domains of proteins can accelerate the functional analysis of \n\n\n\nproteins. Because immunization is the best method to induce high-affinity mAbs, it is widely used for \n\n\n\nisolating mAbs. Lymph node cells are currently focused as antibody sources because antibody-producing \n\n\n\ncells in lymph node are induced in early stage of immunization. The early induction of antibody-\n\n\n\nproducing cells in lymph node is expected as a method to shorten period for establishing mAbs, compared \n\n\n\nwith general method that uses spleen-derived antibody-producing cells. However, immunization protocol \n\n\n\ninducing antibody-producing cells in the shortest period has not been clarified yet. Here, we tested four \n\n\n\ndifferent sites of immunization, then analyzed hypertrophies of five different lymph nodes, to optimize \n\n\n\nthe protocol for immunization. Emulsion for immunization was prepared with titer max gold adjuvant and \n\n\n\novalbumin (OVA), as a model antigen. BALB/c mice were administered with emulsion subcutaneously or \n\n\n\nintramuscularly (back, footpads or thighs, tail base). We measured the weight of cervical, axillary, \n\n\n\ninguinal, iliac, popliteal lymph nodes 3, 7, 14 days after immunization. Differences in hypertrophies of \n\n\n\nlymph nodes were observed within 14 days in each immunization site. For example, popliteal lymph \n\n\n\nnodes were enlarged remarkably in mice immunized subcutaneously in footpads. Meanwhile, iliac and \n\n\n\npopliteal lymph nodes were enlarged in mice immunized intramuscularly in thighs, tail base. These results \n\n\n\nclearly showed that antibody-producing cells were induced in different lymph nodes depending on the site \n\n\n\nof immunizations.  Then, it also suggested that efficiency of affinity maturation might be different \n\n\n\nbetween each immunization. We expect that the immunization protocol will be optimized for rapid \n\n\n\nisolation of mAbs, by further analysis such as comparing antibody repertoires induced in different lymph \n\n\n\nnodes. \n\n\n\n\n\n\n\nSPP 32 \n\n\n\nFAPA2014000168 (Poster) \n\n\n\nThe Correlation Analysis between the Size of Silica Nanoparticles and Their Acute Toxicity for \n\n\n\nMaking Safer Nanomaterials \n\n\n\nT Handa\n1\n, Y Yoshioka\n\n\n\n1,2\n, T Hirai\n\n\n\n1\n, K Ichihashi\n\n\n\n1\n, T Mori\n\n\n\n1\n, N Nishijima\n\n\n\n1\n, M Yamaguchi\n\n\n\n1\n, S \n\n\n\nTsunoda\n2,3\n\n\n\n, K Higashisaka\n1,2\n\n\n\n, Y Tsutsumi\n1,3\n\n\n\n \n1\nLaboratory of Toxicology and Safety Science, Graduate School of Pharmaceutical Sciences, Osaka \n\n\n\nUniversity, Japan \n2\nLaboratory of Biopharmaceutical Research, National Institute of Biomedical Innovation, Japan \n\n\n\n3\nThe Center for Advanced Medical Engineering and Informatics, Osaka University, Japan \n\n\n\nNanomaterials, which are particles with a diameter smaller than 100 nm, are widely applied to drugs as \n\n\n\ndrug delivery system carriers and base compounds. Therefore, it is necessary for us not only to evaluate \n\n\n\n\n\n\n\n\ntheir safety, but also to collect information to make safe forms of nanomaterials. However, it is reported \n\n\n\nthat shrinking the particles down to nanosize changes their biodistribution and hazards. Thus, it is \n\n\n\nessential to reveal the relationship among physical property, efficacy, and safety because it allows us to \n\n\n\nestablish methodology for making valuable and safe nanomaterials. We have elucidated that \n\n\n\nadministration of excessive amounts of amorphous silica nanoparticles (nSPs) induced a drop in rectal \n\n\n\ntemperature, and decrease in a number of platelets. Here, we investigated the effects of the particle size on \n\n\n\nnSPs-induced hazard to develop efficient and safe nanomaterials. C3H/HeN mice were treated with each \n\n\n\nsize of nSP (10, 30, 50, 70, 100, 300, and 1000 nm) and PBS (control) by intravenous injection. As a \n\n\n\nresult of analyzing the rectal temperature after administration, the mice treated with nSP with a diameter \n\n\n\n50 nm showed the maximum drop in rectal temperature among the other treated mice with smaller and \n\n\n\nlarger nSPs. On the other hand, nSPs size-dependently decreased the number of platelet, and nSP with a \n\n\n\ndiameter 10 nm showed marked decrease. These results suggest that nSPs might induce size-dependent \n\n\n\nand also size-specific hazards. Therefore, some of their hazards might be preventable through strictly \n\n\n\ncontrolling the size. Now, we try to reveal each mechanism include size-dependent and the size-specific \n\n\n\nhazard focused on the blood coagulation system which is associated with platelets and on the \n\n\n\ncomplements which can induce a drop in rectal temperature.  \n\n\n\n\n\n\n\nSPP 33 \n\n\n\nFAPA2014000258 (Poster) \n\n\n\nSynthesis and Redox Potentials of Copper Dithiocarbazates Complexes as Potential \n\n\n\nRadiopharmaceuticals \n\n\n\nYF Tan\n1\n, E Goh\n\n\n\n2\n, A Morris\n\n\n\n1\n, TJ Khoo\n\n\n\n1\n \n\n\n\n1\nSchool of Pharmacy, Faculty of Science, University of Nottingham Malaysia Campus, Malaysia \n\n\n\n2\nSchool of Science, Monash University Malaysia Campus, Malaysia \n\n\n\nDithiocarbazates bear resemblance in their chemical structures to thiosemicarbazones which have found \n\n\n\napplication in radiopharmaceutical metal-ligand complexes as hypoxia imaging agents. Schiff base \n\n\n\nligands derived from dithiocarbazates and their complexes have been widely studied for their biological \n\n\n\nactivities e.g. antimicrobial and antitumour. The literature search by our team has revealed that there is \n\n\n\nlittle effort hitherto in exploring Dithiocarbazates derivatives as potential radiopharmaceuticals. It is \n\n\n\ntherefore the aim of this project to synthesize a series of Dithiocarbazate derived Schiff Base ligands and \n\n\n\ntheir copper complexes and characterize their suitability for further development as radiopharmaceuticals. \n\n\n\nWe used electrochemistry to measure their reduction potentials and the stability of the generated Cu (I) \n\n\n\ncomplexes. The redox potentials of these Copper complexes are expected to be tunable by judicious \n\n\n\nchoice of substituents on the diimine backbones. We managed to synthesize 7 Copper (II) complexes with \n\n\n\nvarious redox potentials. Results obtained thus far are encouraging and that this class of compounds \n\n\n\nwarrants further research as radiopharmaceuticals. This work provides a platform for a new research \n\n\n\navenue for Dithiocarbazate derivatives.  \n\n\n\n \n\n\n\n\n\n\n\n\nSPP 34 \n\n\n\nFAPA2014000221 (Poster) \n\n\n\n\n\n\n\nAntimicrobial Activity of Dichloromethane Extract of Turbinaria ornata \n\n\n\nKY Tye\n1\n, SHE Lim\n\n\n\n2\n, SY Gan\n\n\n\n1\n \n\n\n\n1\nSchool of Pharmacy, International Medical University, Bukit Jalil, Kuala Lumpur, Malaysia \n\n\n\n2\nPerdana University, Serdang, Selangor, Malaysia \n\n\n\nAntimicrobial resistance is a worldwide hazard and new resistance mechanisms have been emerging and \n\n\n\nspreading globally. One of the ways to tackle the issue of antimicrobial resistance is to actively encourage \n\n\n\ninnovations and development of new antimicrobials. Marine natural products have been increasingly \n\n\n\nfound to be a promising source of drug candidates for fighting human diseases. There is great potential of \n\n\n\nsourcing antimicrobials from seaweeds. Malaysia with its extensive coastline has more than 380 taxa of \n\n\n\nseaweeds. Seaweeds biosynthesizes compounds called secondary metabolites in order to adapt to \n\n\n\nsurrounding environment, protect against predators as well as guard against pathogens. Extracts from red, \n\n\n\nbrown and green seaweeds are found to possess various biological properties including antioxidant, anti-\n\n\n\ninflammatory, antitumor, antibacterial and anticoagulant\n \nactivities. In this study, a marine brown seaweed \n\n\n\nbelonging to the family Sargassaceae, Turbinaria ornata was assessed for its antimicrobial properties. \n\n\n\nDichloromethane extract of Turbinaria ornata was tested against 21 microorganisms including gram \n\n\n\npositive, gram negative bacteria, yeasts and fungi. \n\n\n\n\n\n\n\n\n\n\n\nSPP 35 \n\n\n\nFAPA2014000049 (Poster) \n\n\n\nAMPA Receptor Endocytosis and NMDA Receptors in the Amygdala is Involved in the \n\n\n\nDestabilization of Methamphetamine-Associated Memory \n\n\n\nYJ Yu\n1\n, PW Gean\n\n\n\n2\n  \n\n\n\n1\nInstitute of Basic Medical Sciences, National Cheng-Kung University, Tainan, Taiwan \n\n\n\n2\nInstitute of Basic Medical Sciences and Department of Pharmacology, National Cheng-Kung University, \n\n\n\nTainan, Taiwan \n\n\n\nDrug addiction is a chronically relapsing disorder characterized by compulsive drug-seeking behavior. \n\n\n\nAddicts is easy to relapse drug withdrawal process, the main factor is addicts re-exposure to \n\n\n\nenvironmental cues of drug intake and thus causing animal drug craving. When drug-related memory is \n\n\n\nreactivated, the memory is thought to become destabilized such that it is susceptible to disruption by \n\n\n\namnestic agents. Previous researches showed that NMDA receptors are involved in the destabilization of \n\n\n\nmemory reconsolidation. Here, we used a conditioned place preference (CPP) procedure in mice to \n\n\n\nexamine the role of AMPA receptor endocytosis and NMDA receptors in the amygdala in the \n\n\n\ndestabilization of methamphetamine (MeAM) memory. Conditioning MeAM (2 mg/kg, i.p.) for 3 days in \n\n\n\nmice could induce a significant rewarding effect. Mice injected with anisomycin 1 hour after CPP test did \n\n\n\nnot exhibited CPP for the previously MeAM-paired chamber. In addition, anisomycin treatment prevented \n\n\n\nMeAM priming-induce reinstatement of CPP suggesting the disruption of MeAM memory \n\n\n\nreconsolidation. Anisomycin had no effect on the CPP when CPP test was omitted. Bilateral injection of \n\n\n\nTat-GluR23Y, a synthetic peptide that blocked AMPA receptor endocytosis, into the BLA prevented \n\n\n\nanisomycin-induced disruption of MeAM memory reconsolidation. In addition, Tat-GluR23Y could \n\n\n\nreverse MeAM-induced increase in surface expression of AMPA receptor in the BLA. Furthermore, we \n\n\n\nbilaterally injected NMDA receptor antagonist into the amygdala before CPP test, resulting in disrupting \n\n\n\n\n\n\n\n\nanisomycin-induced MeAM memory impairment. According to these results, we could suggest that \n\n\n\nAMPA receptor and NMDA receptors might be involved in the destabilization of MeAM memory \n\n\n\nreconsolidation. \n\n\n\n\n\n\n\nSPP 36 \nFAPA2014000076 (Poster) \n\n\n\n\n\n\n\nInfluence of Tempol and Losartan on Sensitivity of Renal Vascular Responses to Adrenergic \n\n\n\nAgonists and Angiotensin II in DOCA-Salt Treated Rat Model of Hypertension \n\n\n\n\n\n\n\nPP Yen\n1\n, MZA Sattar\n\n\n\n1\n, HA Rathore\n\n\n\n1\n, S Akhtar\n\n\n\n1\n, HJ Oh\n\n\n\n1\n, JL Khoo\n\n\n\n1\n, YC Tan\n\n\n\n1\n, FUD Ahmad\n\n\n\n1\n, S \n\n\n\nAfzal\n1\n, M Lazhari\n\n\n\n1\n, A Ahmad\n\n\n\n1\n, NA Abdullah2, EJ Johns3  \n\n\n\n1\nSchool of Pharmaceutical Sciences, Universiti Sains Malaysia, Minden, Penang, Malaysia  \n\n\n\n2\nDepartment of Pharmacology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia   \n\n\n\n3\nDepartment of Physiology, Western Gateway Building, University College Cork, Cork, Ireland \n\n\n\n\n\n\n\nThe effect of tempol, losartan and combination of tempol with losartan were investigated by examining \n\n\n\nthe adrenergic receptors and AT1-receptors responsiveness in DOCA-salt treated rats. DOCA-salt (D-\n\n\n\nControl), tempol treated DOCA group (3mmol/l) (D-Tempol), losartan treated DOCA group (10mg/kg, \n\n\n\nlast 7 days) (D-Losartan) and DOCA group with combination treatment of tempol & losartan (D-\n\n\n\nTempol+Losartan) were studied. On day 43, the animals were anaesthetized with intraperitoneal \n\n\n\npentobarbitone for renal haemodynamic studies.  Mean arterial blood pressure (MAP) and renal vascular \n\n\n\nresponsiveness (using laser Doppler flowmetry) to noradrenaline (NA), phenylephrine (PE), methoxamine \n\n\n\n(ME) and angiotensin II (AngII) were investigated. All data were analyzed using repeated measures one-\n\n\n\nway and two-way ANOVA followed by Bonferroni post hoc test with 95% confidence and expressed as \n\n\n\nmean \u00b1 SEM. D-Tempol showed 9% decreased MAP as compared to D-Control. D-Tempol+Losartan \n\n\n\ngroup showed higher responsiveness to NA by 59% and PE by 159% in decreasing renal cortical blood \n\n\n\nperfusion in comparison to D-Losartan. Decreased responsiveness to PE was observed in D-Losartan by \n\n\n\n53% as compared to D-Control. The responsiveness to ME in D-Tempol+Losartan was higher than D-\n\n\n\nControl by 188%, D-Tempol by 102% and D-Losartan by 217%. D-Losartan and D-Tempol+Losartan \n\n\n\ngroups showed 61% and 41%, respectively, decreased responses to AngII as compared to D-Control. D-\n\n\n\nTempol+Losartan showed 50% greater responsiveness to AngII than D-Losartan. In contrast, D-\n\n\n\nTempol+Losartan showed 28% lower responsiveness to AngII compared to D-Tempol. This suggests that \n\n\n\nthe combination of tempol with losartan improves the responsiveness of renal vasculature responses to \n\n\n\nadrenergic agonists and AngII in DOCA-salt treated rat model of hypertension. \n\n\n\n\n\n\n\n\n\n\n\nSPP 37 \nFAPA2014000175 (Poster) \n\n\n\n\n\n\n\nDepletion of Neutrophil Could Exacerbate Fetal Death Induced by Silica Nanoparticles \n\n\n\n\n\n\n\nY Iwahara\n1\n, K Higashisaka\n\n\n\n1,2\n, K Tanaka\n\n\n\n1\n, S Tsunoda\n\n\n\n2,3\n, Y Yoshioka\n\n\n\n1,2\n, Y Tsutsumi\n\n\n\n1,3 \n\n\n\n1\nLaboratory of Toxicology and Safety Science, Graduate School of Pharmaceutical Sciences, Osaka \n\n\n\nUniversity, Japan \n2 \nLaboratory of Biopharmaceutical Research, National Institute of Biomedical Innovation, Japan \n\n\n\n3\nThe Center for Advanced Medical Engineering and Informatics, Osaka University, Japan \n\n\n\n\n\n\n\nWith the recent development of nanotechnology, nanomaterials with innovative functions have been used \n\n\n\nin various fields such as foods, cosmetics, and medicines. On the other hand, biological effects of \n\n\n\n\n\n\n\n\nnanomaterials have been a concern. As we could be increasingly exposed to nanomaterials, it is urgent to \n\n\n\nensure the safety of nanomaterials. Especially, assessment of effects on pregnancy is essential because \n\n\n\neffects of exposure to adults extend to fetuses, which are more sensitive to environmental chemicals than \n\n\n\nadults. In our previous study, we demonstrated that silica nanoparticles with a diameter of 70 nm (nSP70) \n\n\n\ncould induce pregnancy complication such as intrauterine growth retardation and fetal death. Although \n\n\n\nthe mechanism of these phenomena induced by nSP70 has not been well understood, it is reported that \n\n\n\nneutrophils might relate to pregnancy complication. In this regard, we previously showed that proportion \n\n\n\nof neutrophil fraction was elevated in peripheral blood in nSP70 treated mice. In this study, we \n\n\n\ninvestigated the contribution of nSP70-induced neutrophilia to pregnancy complication induced by \n\n\n\nnSP70. Pregnant BALB/c mice were treated with anti-Ly-6G antibody (150 \u00b5g/mouse), which deplete \n\n\n\nneutrophils specifically, or PBS intraperitoneally at gestational day 15. The next day, they were \n\n\n\nintravenously injected with nSP70 (0.8 mg/mouse) or saline (control) via tail vein. At gestational day 17, \n\n\n\nas we previously reported, maternal body weight declined in nSP70 treated mice. Moreover, in anti-Ly-\n\n\n\n6G antibody pre-treated mice, nSP70 induced a sharply dropping of maternal body weight and significant \n\n\n\ndepression of fetus number compared with mice treated with nSP70 without anti-Ly6G antibody. As we \n\n\n\nconfirmed that anti-Ly-6G antibody depleted plasma number of neutrophils, these results suggest that \n\n\n\nneutrophils might correlate with nSP70-induced fetal death. Our previous reports demonstrated that \n\n\n\nnSP70 might cause damage to placenta. Therefore, it is conceivable that neutrophils could protect from \n\n\n\nnSP70-induced cytotoxicity in placenta. \n\n\n\n\n\n\n\nSPP 38 \nFAPA2014000160 (Poster) \n\n\n\nTransgenerational Effects of Silica Nanoparticles Focused on Paternal Exposure \n\n\n\nY Namba\n1\n, Y Yoshioka\n\n\n\n1,2\n, Y Morishita\n\n\n\n1\n, Y Takimura\n\n\n\n1\n, Y Shimizu\n\n\n\n1\n, Y Ago\n\n\n\n1\n, K Takuma\n\n\n\n1\n, T \n\n\n\nMatsuda\n1\n, S Tsunoda\n\n\n\n2,3\n, K Higashisaka\n\n\n\n1,2\n, Y Tsutsumi\n\n\n\n1,3\n \n\n\n\n1\nLaboratory of Toxicology and Safety Science, Graduate School of Pharmaceutical Sciences, Osaka \n\n\n\nUniversity, Japan \n2\nLaboratory of Biopharmaceutical Research, National Institute of Biomedical Innovation, Japan \n\n\n\n3\nThe Center for Advanced Medical Engineering and Informatics, Osaka University, Japan \n\n\n\nEnvironmental factors, such as living habits and exposure to chemicals, can influence human health. It is \n\n\n\nalso known that parental environmental factors could effect on their children. To reveal the mechanism of \n\n\n\nthis phenomenon, many research have focused on maternal environmental factors because fetus spends a \n\n\n\nlong term in uterus. On the other hand, recent epidemiological researches have suggested that not only \n\n\n\nmaternal but paternal environmental factors could cause problems to child\u2019s health. However, there is still \n\n\n\nlittle information of transgenerational effects through father. Therefore, we have been promoting a study \n\n\n\nof transgenerational effects of chemicals through father, especially focused on nanomaterials. \n\n\n\nNanomaterials have been developed with recent progress of nanotechnology. With their useful functions, \n\n\n\nnanomaterials have already been used in various fields including medicines. We have revealed that \n\n\n\namorphous silica nanoparticles (nSP) which is used in medicines as assistant can be distributed to male \n\n\n\nreproductive organs including testis and sperm. Therefore, transgenerational effects of nSP through father \n\n\n\nare considered to be important. In this study, we examined potential for nSP to cause transgenerational \n\n\n\neffects. Male mice were intravenously treated with nSP with a diameter of 30 nm (nSP30) every other day \n\n\n\nfor a total 4 administrations. After 35 days from first administration, a part of male mice were dissected. \n\n\n\nOthers were crossed to female mice. As for male mice which were administrated nSP30, there was no \n\n\n\nsignificant difference in body weight, weight of reproductive tissues, and survival rate of sperm compared \n\n\n\nto control mice. In addition, mating rate, litter size per dams, and male/female ratio of pups did not \n\n\n\nchange between nSP30-treated group and control group. These results suggest that exposure to nSP30 in \n\n\n\n\n\n\n\n\nthis condition did not affect male reproductive functions and birth of neonates. We will examine effects to \n\n\n\nmatured young mice through male parents. \n\n\n\nSPP 39 \n\n\n\nFAPA2014000148 (Poster) \n\n\n\nSilver Nanoparticles Induced Inflammatory Response in Human Pulmonary Cells \n\n\n\nY Nishikawa\n1\n, K Higashisaka\n\n\n\n1,2\n, A Maki\n\n\n\n1\n, S Tsunoda \n\n\n\n2,3\n, Y Yoshioka\n\n\n\n1,2\n, Y Tsutsumi\n\n\n\n1,3\n \n\n\n\n1\nLaboratory of Toxicology and Safety Science, Graduate School of Pharmaceutical Sciences, Osaka \n\n\n\nUniversity, Japan \n2\nLaboratory of Biopharmaceutical Research, National Institute of Biomedical Innovation, Japan \n\n\n\n3\nThe Center for Advanced Medical Engineering and Informatics, Osaka University, Japan \n\n\n\nIt is widely known that the exposure to particulate matter (PM), such as diesel exhaust or yellow dust, \n\n\n\nexacerbates inflammatory bronchi or lung diseases. In these days, it is suggested that nanometer-scale \n\n\n\nparticles in PM are major factor contributing to these adverse health effects. Under these circumstances, \n\n\n\nthe increasing use of engineered nanoparticles has raised public concern about biological effects of \n\n\n\nnanoparticle exposure on human health. Therefore, it is indispensable for safety use of engineered \n\n\n\nnanoparticles to analyze the correlation between their characteristics and the biological effects. However, \n\n\n\nthere are few studies analyzing the effects in terms of long term exposure. In this study, we evaluated the \n\n\n\nbiological effects focused on the inflammatory responses after daily exposure to silver nanoparticles, \n\n\n\nwhich are frequently used in our life, toward assessment of long term effects. A549, human pulmonary \n\n\n\ncells, were treated with silver nanoparticles (10, 50, and 100 nm) for 3 consecutive days. And we \n\n\n\nevaluated the cell viability and the production level of IL-8, pro-inflammatory cytokine, in the culture \n\n\n\nsupernatant. As a result, we confirmed that 10 nm silver nanoparticles induced a slight decrease in cell \n\n\n\nviability though the other nanoparticle size induced no significant cytotoxic effect. In addition, 10 nm \n\n\n\nsilver nanoparticles induced daily, markedly IL-8 increase. Furthermore, 10 nm silver nanoparticles \n\n\n\ninduced IL-8 production only after exposure for three days though LPS induced the elevation after for one \n\n\n\nday. These results suggest that silver nanoparticles induced size-dependent cellular response and that their \n\n\n\ninduced-inflammatory responses showed gradual changes. To elucidate the inflammatory response \n\n\n\ninduced by silver nanoparticles, we are currently investigating the detailed inflammatory mechanisms or \n\n\n\nexhaustive analysis of other pro-inflammatory markers. \n\n\n\n\n\n\n\nSPP 40 \n\n\n\nFAPA2014000153 (Poster) \n\n\n\nDistribution of Gold Nanoparticles to the Breast Milk in Mice \n\n\n\nY Takimura\n1\n, Y Yoshioka\n\n\n\n1,2\n, Y Morishita\n\n\n\n1\n, Y Namba\n\n\n\n1\n, Y Shimizu\n\n\n\n1\n, F Yamashita\n\n\n\n3\n, S Tsunoda\n\n\n\n2,4\n, M \n\n\n\nHashida\n3\n, K Higashisaka\n\n\n\n1,2\n, Y Tsutsumi\n\n\n\n1,4\n \n\n\n\n1\nLaboratory of Toxicology and Safety Science, Graduate School of Pharmaceutical Sciences, Osaka \n\n\n\nUniversity, Japan \n2 \nLaboratory of Biopharmaceutical Research, National Institute of Biomedical Innovation, Japan \n\n\n\n3 \nDepartment of Drug Delivery Research, Graduate school of Pharmaceutical Sciences, Kyoto University, \n\n\n\nJapan \n4 \nThe Center for Advanced Medical Engineering and Informatics, Osaka University, Japan \n\n\n\nNanomaterials have already been applied in many fields because of their various useful functions. \n\n\n\nNanomaterials are especially expected to be used for medicines. On the other hand, it is known that, in the \n\n\n\n\n\n\n\n\ncase of medication use during lactation, medicines might transfer into milk and induce negative biological \n\n\n\ninfluences on infants. Therefore, for safety use of medicines in lactation, evaluation of distribution to milk \n\n\n\nis important. However, there is almost no information about distribution of nanomaterials to milk. In this \n\n\n\nstudy, we evaluated the distribution to milk of two nanomaterials for the purpose of evaluating changes of \n\n\n\ndistribution by difference of composition. Here, silver nanoparticles (nAg), which have the highest degree \n\n\n\nof commercialization among all nanomaterials, and gold nanoparticles (nAu), which are expected to be \n\n\n\nused as DDS formulation, were used. Lactating dams were intravenously treated with 500 ng/kg of nAg \n\n\n\nwith a diameter of 10 nm (nAg10) or 4000 ng/kg of nAu with a diameter of 10 nm (nAu10) in postnatal \n\n\n\nday 3. After 1, 2, 4, 8, and 12 hours from treatment, Ag and Au concentration in blood and milk were \n\n\n\nmeasured by inductively coupled plasma-mass spectrometry. As a result, Ag was detected in blood and \n\n\n\nmilk of nAg10-treated mice. The Ag concentration in milk of nAg10-treated mice reached a peak at 8 h \n\n\n\npost-treatment, and 0.73 % of administrated Ag was detected at the time. On the other hand, Au was \n\n\n\ndetected in blood but not detected in milk of nAu10-treated mice. These results suggest that the \n\n\n\ncomposition of nanomaterials is important for their distribution to milk and nAg10 are easy to transfer \n\n\n\ninto milk compared with nAu10. Now, we are collecting more detailed information about distribution of \n\n\n\nnanomaterials to milk focused on the difference of size and surface modification. \n\n\n\n\n\n\n\nSPP 41 \n\n\n\nFAPA2014000013 (Poster) \n\n\n\n\n\n\n\nSynthesis and Evaluation of Antimicrobial Activity of Some 6-Chlorobenzothiazole-2-yl-hydrazones \n\n\n\nDerivatives  \n\n\n\n\n\n\n\nV Asati, SK. Bharti \n\n\n\nGuru Ghasi Das University, Bilashpur (Chhatishgarh), India \n\n\n\n\n\n\n\nBenzothiazoles are bicyclic ring system with multiple applications. In the 1950s, a number of 2-\n\n\n\naminobenzothiazoles was intensively studied as central muscle relaxants. Since then medicinal chemists \n\n\n\nhave not taken active interest in this chemical family. Biologist\u2019s attention was drawn to this series when \n\n\n\nthe pharmacological profile of Riluzole was discovered. Riluzole (6-trifluromethoxy-2-\n\n\n\nbenzothiazolamine, PK-26124, RP-54274, Rukytej) was found to interfere with glutamate \n\n\n\nneurotransmission in biochemical, electrophysiological and behavioral experiments. After that \n\n\n\nbenzothiazole derivatives have been studied extensively and found to have diverse chemical reactivity \n\n\n\nand broad spectrum of biological activity. Benzothiazole was long known to be effective as bacteriostatic, \n\n\n\ntuberculostatic, fungistatc and molluscicidal agent. The present work describes the synthesis of new 2-\n\n\n\nbenzothiazole derivatives with potential bacteriostatic and fungistatic activity. A series of 1,3-\n\n\n\nbenzothiazole-2-yl-hydrazones were prepared in satisfactory yield and evaluated for their antibacterial, \n\n\n\nantifungal study. All the synthesized compounds were in good agreement with elemental and spectral \n\n\n\ndata. 6-chloro-2-benzothiazolamine prepared by interaction of p-chloroaniline with potassium thiocyanate \n\n\n\nin the presence of bromine. 2-benzothiazolamine was then refluxed with hydrazine hydrate to yield \n\n\n\nhydrazine derivative, 6-Chloro-2-benzothiazol-2-yl-hydrazine. The final compounds were synthesized by \n\n\n\nthe reaction of hydrazine benzothiazole with appropriate ketones and aldehydes. The compounds were \n\n\n\nevaluated for their anti-bacterial activity against Bacillus subtilis [MTCC 441], Escherichia coli [MTCC \n\n\n\n43], Klebsiella pneumoniae [MTCC 432], and Pseudomonas alkaligenes [MTCC 493] with norfloxacin \n\n\n\nas standard and for antifungal activity against Aspergillus niger [MTCC-554], Candida albicans [MTCC-\n\n\n\n183], Rhizopus oryzae [MTCC-262], using ketoconazole as standard. Compounds 3a and 3b were found \n\n\n\nto be highly active against Bacillus subtilis and Compound 3a was found to have good activity against \n\n\n\nCandida albicans. \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nSPP 42 \nFAPA2014000011 (Poster) \n\n\n\n\n\n\n\nDevelopment and Validation of a Stability Indicating RP-HPLC Method of Pemetrexed API from \n\n\n\nIts Forced Degradation Products \n\n\n\n\n\n\n\nB Babu\n1\n, SN Meyyanathan\n\n\n\n1\n, B Gowramma\n\n\n\n2\n, N Krishnaveni\n\n\n\n1\n   \n\n\n\n1\nDepartment of Pharmaceutical Analysis, Faculty of Pharmacy, J.S.S.College of Pharmacy  Rock lands, \n\n\n\nUdagamandalam, India. \n2\nDepartment of Pharmaceutical Chemistry, Faculty of Pharmacy, J.S.S.College of Pharmacy Rock lands, \n\n\n\nUdagamandalam, India. \n\n\n\n\n\n\n\nThe aim of the present study was to develop and validate a stability indicating Reverse Phase High \n\n\n\nPerformance Liquid Chromatographic (HPLC) method for the separation and determination of \n\n\n\nPemetrexed in Active pharmaceutical material from its degradation products. Pemetrexed is an metastatic \n\n\n\nnonsquamous drug used in the treatment of non small cell lung cancer. The method was validated by \n\n\n\nsubjecting Pemetrexed under various stress condition such as acid, alkali, water hydrolysis and oxidation. \n\n\n\nThe drug componentent was simultaneously estimated by simple reverse phase method using Jones C18 \n\n\n\n(150 x 4.6 mm i.d., 5\u00b5) as stationary phase and 0.1% formic acid : Acetonitrile as mobile phase with flow \n\n\n\nrate of 1.0 mL min-1. The determination was carried out at the wavelength of 230 nm. The stressed \n\n\n\nsamples were assayed using the developed LC method and thus proving its stability-indicating power. \n\n\n\nThe developed method was validated with respect to linearity, accuracy, precision and robustness. The \n\n\n\ndeveloped method was validated and can be used in estimation of pemetrexed marketed formulation and \n\n\n\nin various pharmaceutical developments. \n\n\n\n\n\n\n\n\n\n\n\nSPP 43 \nFAPA2014000325 (Poster) \n\n\n\n\n\n\n\nContribution of Hair Follicular Pathway of Topically Applied and Exposed Chemicals for the Total \n\n\n\nSkin Permeation \n\n\n\n\n\n\n\nF Asmani\n1\n, H Todo\n\n\n\n2\n, M Yoshimoto\n\n\n\n2\n, E Yusuf\n\n\n\n1\n, K Sugibayashi\n\n\n\n2\n \n\n\n\n1\nSchool of Pharmacy, Management & Science University, Shah Alam, Selangor, Malaysia \n\n\n\n2 \nFaculty of Pharmaceutical Sciences, Josai University, Saitama, Japan \n\n\n\n\n\n\n\nGenerally, blood and skin concentration profiles and steady-state skin concentration of topically applied \n\n\n\nor exposed chemicals can be calculated from in vitro skin permeation profile. However, these calculation \n\n\n\nmethods can be applicable especially for chemicals of which the main pathway route is in the stratum \n\n\n\ncorneum.  When hair follicle contribution against the total skin permeation of chemicals could be \n\n\n\nobtained in detail, their blood and skin concentrations would be more precisely predicted. In the present \n\n\n\nstudy, contribution of hair follicle pathway to the skin permeation of topically applied or exposure \n\n\n\nchemicals was calculated from a difference between their permeability coefficients through skin with and \n\n\n\nwithout hair follicle plugging using in vitro skin permeation experiment. The obtained result revealed that \n\n\n\nthe contribution of hair follicle pathway could be predicted by their lipophilicities. In a hydrophilic region \n\n\n\nof chemicals (logKo/w < 0), a higher reduction ratio by hair follicle plugging was observed compared \n\n\n\nwith lipophilic chemicals (logKo/w \u2265 0).  In addition, the reduction ratio was decreased with an increase \n\n\n\nin the logKo/w. This consideration on the hair follicle pathway would be helpful to investigate usefulness \n\n\n\nand safety of chemicals after their topical application and exposure, because skin permeation and \n\n\n\ndisposition must be changed at different sites of skin due to different site and densities of hair follicles.   \n\n\n\n \n\n\n\n\n\n\n\n\nSPP 44 \nFAPA2014000326 (Poster) \n\n\n\n\n\n\n\nThe Potential of Phyla nodiflora as Chemopreventive Agent in Human Breast Cancer Cell Line, \n\n\n\nMCF-7 \n\n\n\n\n\n\n\nM Liau, BE Cheong, PL Teoh \n\n\n\nBiotechnology Research Institute, Universiti Malaysia Sabah, Kota Kinabalu, Sabah \n\n\n\n\n\n\n\nBreast cancer is one of the most prominent diseases that cause major death in women. Currently there are \n\n\n\na lot of researcher focuses on finding of new chemopreventive agents from natural sources. In this study, \n\n\n\nthe ability of Phyla nodiflora to be used as chemopreventive agent was investigated. Phyla nodiflora \n\n\n\nextracts were obtained from different parts of plants such as leave (LMPN, LEPN, LCPN, LDPN, \n\n\n\nLHPN), root (RMPN), fruit (FMPN) and stem (SMPN, SEPN, SCPN, SDPN, SHPN) through soxhlet \n\n\n\nextraction and liquid-liquid partition using five different solvents such as methanol, ethyl acetate, \n\n\n\nchloroform, distilled water and hexane. From the antioxidant assays, we found that the total phenolic and \n\n\n\nflavonoid contents of these extracts were correlated to their antioxidant activity. To examine whether \n\n\n\nPhyla nodiflora extracts prevent the proliferation of MCF-7 cell line, MTT assay was performed.  Our \n\n\n\nresults showed that only certain extracts (RMPN, FMPN, LEPN, LDPN, LCPN, SMPN, SEPN and \n\n\n\nSCPN) were capable to inhibit the cell growth of MCF-7. To understand their mechanistic action, SEPN, \n\n\n\nLEPN, SMPN and RMPN were chosen based on IC50 value for apoptosis study. Among the four extracts, \n\n\n\nonly LEPN and SEPN treated cells showed DNA laddering pattern at the range of 200 bp to 700 bp \n\n\n\nindicating the occurrence of DNA fragmentation upon treatment. Therefore, Phyla nodiflora extracts \n\n\n\ninhibit the cancer cells growth through apoptosis or other mechanisms. In conclusion, Phyla nodiflora has \n\n\n\nthe potential to be developed into chemopreventive agent. \n\n\n\n\n\n\n\n\n\n\n\nSPP 45 \nFAPA2014000008 (Poster) \n\n\n\nSynthesis of Amino Acid Conjugates of Dopamine for the Enhancement of Brain Targeted Delivery \n\n\n\nof Dopamine \n\n\n\nN Dwivedi, J Shah \n\n\n\nDepartment of Pharmacy, Nirma University, Ahmdabad, Gujrat, India \n\n\n\nThis study aimed to assess the synthesis and characterization of various conjugates of amino acids like \n\n\n\nphenylalanine, valine, leucine, tyrosine and dopamine to determine which indicate increase of \n\n\n\nbioavailability by enhancement of permeability to brain and lower rate of clearance by reduction of \n\n\n\nmetabolism and elimination of undesirable effects. Synthesized dopamine-amino acid conjugates were \n\n\n\ncharacterized by infrared spectroscopy. The partition coefficient of dopamine and dopamine conjugates \n\n\n\nwere determined in n-octanol and phosphate buffer saline of pH 7.4, in which conjugates exhibit 8 to 12 \n\n\n\nfold increase in their partition coefficient. While the synthesized conjugates have less protein binding \n\n\n\ncapacity as compared to dopamine and in vitro hydrolysis, the study revealed that dopamine-amino acid \n\n\n\nconjugates have long duration of action due to slow rate of hydrolysis. The dopamine-amino acid \n\n\n\nconjugates have reduced chlorpromazine-induced catatonia more than as compared with plain dopamine \n\n\n\nand combination of levodopa and carbidopa. All the synthesized conjugates of dopamine-amino acids \n\n\n\nhave an effective antiparkinson activity due to higher partition coefficient of the compounds. This lead to \n\n\n\nhigher lipophilicity which also improved the ability of drug to cross BBB, with hydrolysis of conjugates \n\n\n\n\n\n\n\n\nin brain producing corresponding amino acid and dopamine. All synthesized conjugates have prolonged \n\n\n\nduration of action due to slow rate of hydrolysis and less plasma protein binding ability of conjugates. \n\n\n\n\n\n\n\nSPP 46 \n\n\n\nFAPA2014000074 (Poster)  \n\n\n\nEffect of Peroxisome Proliferator-Activated Receptor (PPAR) Agonist, Pioglitazone on Vasopressor \n\n\n\nResponses to Adrenergic Agonists and Angiotensin II in Diabetic and Non-diabetic Spontaneously \n\n\n\nHypertensive Rats \n\n\n\nS Afzal\n1\n, MA Sattar\n\n\n\n1\n, HA Rathore\n\n\n\n1\n, A Ahmad\n\n\n\n1\n, F Ahmad\n\n\n\n1\n, S Akhtar\n\n\n\n1\n, SF Faisal\n\n\n\n1\n, PP Yen\n\n\n\n1\n, JL \n\n\n\nKhoo\n1\n, OH Jin\n\n\n\n1\n, M Ibharim\n\n\n\n1\n, MAI Lazhari\n\n\n\n1\n, NA Abdullah\n\n\n\n2\n, EJ Johns\n\n\n\n3 \n\n\n\n1\nSchool of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia \n\n\n\n2\nDepartment of Pharmacology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia \n\n\n\n3\nDepartment of Physiology, University College Cork, Cork, Ireland \n\n\n\nHypertension is common in type 2 diabetes; hence, hypertensive patients are subjected to combination \n\n\n\ntherapy of antihypertensives and antidiabetics. Pioglitazone, a PPAR-\u03b3 agonist, is an useful agent for \n\n\n\ndiabetes. This study compared the vasopressor responses to intravenous administration of angiotensin II \n\n\n\n(Ang II) and alpha adrenergic agonists to investigate the interaction between PPPAR-\u03b3 and pioglitazone. \n\n\n\nDiabetes was induced with a single i.p injection of STZ (40 mg kg\n\u22121\n\n\n\n). Two diabetic (1 & 2) and two \n\n\n\nnormal groups (3 & 4) of rats were used. Group 1 and 3 received pioglitazone (10mg/kg) orally for 21 \n\n\n\ndays. On day 29, animals were anaesthetized with Na pentobarbitone (60mg/kg) i.p. Dose-response \n\n\n\nrelationships of mean arterial blood pressure in response to intravenous injection of noradrenaline (NA), \n\n\n\nphenylephrine (PE), methoxamine (ME), and Ang II were determined. Data (mean\u00b1SEM) was analysed \n\n\n\nby using two way ANOVA with significance at p<0.05. The responses (%) to NA, PE, ME and Ang II in \n\n\n\nnon-diabetic rats were significantly lower than diabetic SHRs (DBTC vs C, 45% vs 37, 48% vs 40, 30 % \n\n\n\nvs 24 and 49 % vs 37%). Pioglitazone treatment significantly decreased responses to NA, PE, ME in non-\n\n\n\ndiabetic rats (PIO vs DBTC, 27% vs 45%, 32% vs 48%, 19% vs 30%). The responses to Ang II were \n\n\n\nsignificantly accentuated (PIO vs DBTC, 55% vs 49%). Therefore, PPAR-\u03b3 plays role in systemic \n\n\n\nhaemodynamics in diabetic model and cross-talk exists between PPAR-\u03b3 and \u03b11-adrenoceptors and Ang II \n\n\n\nin systemic vasculature of diabetic and non-diabetic SHRs. \n\n\n\n\n\n\n\nSPP 47 \n\n\n\nFAPA2014000010 (Poster)  \n\n\n\n\n\n\n\nTracking Cardiovascular Disease (CVD): Development of Genotyping Methods for Various \n\n\n\nPolymorphism Implicated in CVD Therapy \n\n\n\n\n\n\n\nWR Wan Rosalina, MT Ahmad Rashidi, D Afendi, I Siti Nooruhani, A Mohamed \n\n\n\nFaculty of Pharmacy, Cyberjaya University College of Medical Sciences, Cyberjaya, Malaysia \n\n\n\nCardiovascular disease (CVD) is a serious issue in Malaysia as it is the cause for 32% of deaths across all \n\n\n\nages according to NCD Country Profile published by WHO. CVD accounted for 147,843 admissions or \n\n\n\nabout 6.91% of total admissions in Ministry of Health (MOH) hospitals in year 2009 and in 2010. CVD \n\n\n\nwere the cause for 24.5% of death in government hospitals in year 2010. In light of this, strategies to \n\n\n\noptimize therapeutic efficacy and minimize the potential for toxicity in the process of guiding the \n\n\n\ncardiovascular drug development and selection would aid in the management of the disease.  \n\n\n\n\n\n\n\n\nDevelopment of molecular diagnostic tools that could aid clinicians to tailor CVD therapy suited for \n\n\n\nindividual patients would be highly beneficial. This study was designed to develop PCR\u2013based diagnostic \n\n\n\nmethods for CYP2C19*3, CYP2C9*3, ACE and ALDH which were selected based on their relevance to \n\n\n\nCVD. Allele-specific primers were designed for this each polymorphism and optimization of the run \n\n\n\nprofile parameters was carried out to determine the optimum annealing temperature, primer concentration \n\n\n\nand MgCl2 concentration. The results were assayed using 1.5% agarose gel electrophoreses. The \n\n\n\ngenotyping methods were then validated via gene sequencing. Genotyping methods for five gene \n\n\n\npolymorphisms have been successfully developed and validated. These genotyping methods could be \n\n\n\nutilized to aid in optimizing therapy for CVD patients. \n\n\n\n\n\n\n\nSPP 48 \n\n\n\nFAPA2014000272 (Poster)  \n\n\n\nSocial Interaction with a Helper Rescues Memory Deficit in an Animal Model of Alzheimer\u2019s \n\n\n\nDisease by Increasing BDNF-dependent Hippocampal Neurogenesis \n\n\n\nYH Hsiao\n1\n, HC Hung\n\n\n\n2\n, SH Chen\n\n\n\n3\n, PW Gean\n\n\n\n1, 2\n \n\n\n\n1\nDepartment of Pharmacology, National Cheng Kung University, Tainan, Taiwan \n\n\n\n2\nInstitute of Basic Medical Science, National Cheng Kung University, Tainan, Taiwan \n\n\n\n3\nDepartment of Microbiology and Immunology, National Cheng Kung University, Tainan, Taiwan \n\n\n\nIt has been recognized that the risk of cognitive decline during aging can be reduced if one maintains \n\n\n\nstrong social connections, yet the neural events underlying this beneficial effect have not been vigorously \n\n\n\nstudied. Here, we show that Amyloid precursor protein (APP) and presenilin 1 (PS1) double-transgenic \n\n\n\n(APP/PS1) mice improved memory after co-housing with wide-type (WT) mice. The improvement was \n\n\n\nassociated with increased protein and mRNA levels of BDNF in the hippocampus. Concomitantly, the \n\n\n\nnumber of BrdU+/NeuN+ cells in the hippocampal dentate gyrus was significantly elevated after co-\n\n\n\nhousing. Methylazoxymethanol acetate (MAM), a cell proliferation blocker, markedly reduced BrdU- and \n\n\n\nBrdU/NeuN-positive cells and abolished the companion effect. Selective ablation of mitotic neurons \n\n\n\nusing diphtheria toxin (DT) and retrovirus vector encoding DT receptor (DTR) system abolished the \n\n\n\nbeneficial effect of company. Knockdown of BDNF by shRNA transfection blocked while overexpression \n\n\n\nof BDNF mimicked the memory improving effect. A tropomyosin-related kinase B (TrkB) agonist, 7,8-\n\n\n\ndihydroxyflavone (7,8-DHF), occluded the companion effect. These results provide the first evidence that \n\n\n\nincreased BDNF expression and neurogenesis in the hippocampus underlie the reversal of memory deficit \n\n\n\nby co-housing in APP/PS1 mice. \n\n\n\n\n\n\n\nSPP 49 \n\n\n\nFAPA2014000265 (Poster)  \n\n\n\n\n\n\n\nPalladium-Catalyzed Allylation of Indoles with Allylic Acetates in PEG-Water System \n\n\n\n\n\n\n\nYT Huang\n1\n, BJ Peng\n\n\n\n1\n, SC Yang\n\n\n\n1,2\n \n\n\n\n1\nSchool of Pharmacy, College of Pharmacy, Kaohsiung Medical University, Kaohsiung,   Taiwan  \n\n\n\n2\nDepartment of Fragrance and Cosmetic Science, College of Pharmacy, Kaohsiung Medical University, \n\n\n\nKaohsiung, Taiwan \n\n\n\nThe palladium-catalyzed allylation is a powerful tool for C-C, C-N, and C-O bond formation, which has \n\n\n\nbeen widely applied to organic chemistry. The processes have been shown to proceed by attack of \n\n\n\n\n\n\n\n\nnucleophiles on intermediate \u03b73-allylpalladium (II) complexes generated by oxidative addition of allylic \n\n\n\ncompounds including halides, esters, carbonates, carbamates,        phosphates, and related derivatives to a \n\n\n\nPd(0) complex. Indoles and indole-derived heterocycles are prevalent structural motifs in natural \n\n\n\nproducts, medicinal compounds, and organic materials. Utilizing the prevalence of indole nucleus in \n\n\n\nbiologically active compounds, the direct C3-functionalization or N-functionalization of indoles represent \n\n\n\nan important problem. With green chemistry processes and the concerns over the environmental impacts \n\n\n\nof using volatile organic solvents, the promising potentials of water and other non-conventional solvents \n\n\n\nhave become highly noteworthy in designing organic syntheses. Water has become a highly \n\n\n\nrecommended solvent for organic reactions in terms of cost, safety, availability, and more friendly to \n\n\n\nenvironmental concerns. In this study, the palladium-catalyzed indoles with allylic acetates in PEG-water \n\n\n\nwas investigated under various conditions. \n\n\n\n\n\n\n\nSPP 50 \nFAPA2014000077 (Poster) \n\n\n\n\n\n\n\nHydrochlorothiazide and Candesartan Treatment Improves Blood Pressure, Renal \n\n\n\nHaemodynamics and Renal Function in Spontaneously Hypertensive Rats \n\n\n\n\n\n\n\nHJ Oh\n1\n, MA Sattar\n\n\n\n1\n, HA Rathore\n\n\n\n1\n, FD Ahmad\n\n\n\n1\n, YC Tan\n\n\n\n1\n, MIA Lazhari\n\n\n\n1\n, PP Yen\n\n\n\n1\n, S Akhtar\n\n\n\n1\n, A \n\n\n\nAhmad\n1\n, JL Khoo\n\n\n\n1\n, S Afzal\n\n\n\n1\n, NA Abdullah\n\n\n\n2\n, EJ Johns\n\n\n\n3 \n\n\n\n1\nSchool of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia. \n\n\n\n2\nDepartment of Pharmacology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia. \n\n\n\n3\nDepartment of Physiology, Western Gateway Building, University College Cork, Cork, Ireland. \n\n\n\n\n\n\n\nThis study aimed to explore the impact of hydrochlorothiazide and candesartan alone or in combination \n\n\n\non cardiovascular and renal haemodynamics in spontaneously hypertensive rats (SHR). SHR (n = 6 each \n\n\n\ngroup) were treated for 1 week either with hydrochlorothiazide (SHR-HCTZ), candesartan (SHR-CST), \n\n\n\nor hydrochlorothiazide plus candesartan (SHR-HCTZ + CST) while two groups that is, one SHR and one \n\n\n\nWKY that received vehicle served as controls. Non-invasive blood pressure and metabolic studies were \n\n\n\nperformed on days 0, 21, and 28, after which the animals were anaesthetized with 60 mg/kg \n\n\n\npentobarbitone i.p to measure cardiovascular and renal parameters and pulse wave velocity. Treatment \n\n\n\nwith HCTZ or with CST alone reduced blood pressure and improved renal haemodynamics and excretory \n\n\n\nfunction in comparison to untreated SHR. Combination treatment with HCTZ and CST in SHR rats \n\n\n\nresulted in a significant attenuation in blood pressure, increase in creatinine clearance, urinary sodium \n\n\n\nexcretion and fractional sodium excretion and also renal cortical blood perfusion compared to HCTZ or \n\n\n\nCST alone (all P < 0.05). In summary, these findings suggested that HCTZ and CST given together \n\n\n\npotentiated the reduction in blood pressure, normalization of kidney function and renal hemodynamics \n\n\n\ncompared to either compound alone. These data suggested that a combination therapy of HCTZ and CST \n\n\n\nmay be a potential option for the treatment of hypertension in renal failure. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nPHYTOPHARMACY & PHARMACOPEIA \n \nPPP 01 \n\n\n\nFAPA2014000130 (Poster) \n\n\n\nInhibitory Effects of Polyphenolic Extract of Ichnocarpus frutescenes on Carbohydrate \n\n\n\nDigestive Enzymes \n\n\n\nCT Kumarappa\n1\n, KT Manisenthil\n\n\n\n2\n, SC Mandal\n\n\n\n3\n \n\n\n\n1\nSchool of Pharmacy, Taylor\u2019s University, Malaysia \n\n\n\n2\nFaculty of Pharmaceutical Technology, Jadavpur University, India \n\n\n\n3\nDepartment of Pharmacology, KMCH College of Pharmacy, India \n\n\n\n\n\n\n\nInhibition of \u03b1-glucosidase diminishes glucose absorption and prostprandial hyperglycemia. Recently, \n\n\n\nthere has been an enormous interests in the development of alternative medicines for Type II diabetes \n\n\n\nmellitus, specifically screening for phytochemicals with the ability to delay or prevent glucose \n\n\n\nabsorption. This study focused on evaluation of total polyphenolic content, pancreatic \u03b1- amylase \n\n\n\ninhibition, rat serum \u03b1-amylase inhibition and rat intestinal \u03b1-glucosidase inhibition of polyphenolic \n\n\n\nextract (PPE) of Ichnocarpus frutescens by in vitro. PPE shows appreciable pancreatic \u03b1-amylase \n\n\n\ninhibitory activity in vitro. The extract also showed appreciable \u03b1-glucosidase inhibitory effect in a \n\n\n\nconcentration-dependent manner with a moderate \u03b1-amylase inhibitory activity. The in vitro \n\n\n\nexamination of the inhibitory effect of PPE on maltase and sucrase activities revealed that PPE \n\n\n\ninhibited rat small intestine disaccharidase (\u03b1-glucosidase) activity. Taken together, these results \n\n\n\nsuggest that inhibitory effect of PPE on \u03b1- amylase and \u03b1-glucosidase activities might contribute to \n\n\n\ndelay in carbohydrate digestion and absorption and subsequent lowering of blood glucose level \n\n\n\nleading to prevention of postprandial hyperglycemia in diabetes and its complication. \n\n\n\nPPP 02 \n\n\n\nFAPA2014000234 (Poster) \n\n\n\n\n\n\n\nAcylated Flavonoids as \u03b1-Glucosidase Inhibitors from Tinospora crispa Leaf \n\n\n\n\n\n\n\nCC Chang, SS Lee \n\n\n\nSchool of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan \n\n\n\nTinospora crispa Miers (Menispermaceae) is widely distributed in tropical and subtropical Asia, \n\n\n\nincluding Philippines, Indonesia, Malaysia, Thailand, India and Vietnam. The dried vines of this plant \n\n\n\nhave been used as a folk medicine to treat fever, hypertension, inflammation and diabetes. A \n\n\n\npreliminary study indicated that the ethanolic extract of T. crispa leaf was active against \u03b1-\n\n\n\nglucosidase, whose inhibitors such as acarbose have been used to treat diabetes. Thus, the aim of this \n\n\n\nstudy was to investigate the active constituents from this part. To achieve this goal, bioassay-guided \n\n\n\nfractionation and separation works were applied. The ethanolic extract (205.6 g) of T. crispa leaf was \n\n\n\ndivided into water, n-BuOH and chloroform soluble parts. The n-BuOH soluble fraction (43.6 g), \n\n\n\nwhich displayed a better inhibitory activity against \u03b1-glucosidase, was separated by a Sephadex LH-\n\n\n\n20 column with 100% MeOH to give 14 fractions. The fraction 10 (13 mg) showed the highest \n\n\n\ninhibition compared to the others. However, due to its limited amount, this minor fraction was \n\n\n\nanalyzed by the combination of HPLC-DAD-SPE-NMR and HPLC-HR-MS techniques. Sixteen \n\n\n\nflavonoids were identified from the fraction 10 on the basis of spectroscopic analyses (NMR & HR-\n\n\n\nMS spectra). Among them, five new compounds were elucidated as apigenin-6-C-\u03b1-altroside(6), \n\n\n\nisoorientin-2'-O-(E)-sinapate(7), isovitexin-2'-O-(E)-p-coumarate(9), cosmosiin-6'-O-(E)-ferulate (10) \n\n\n\nand cosmosiin-6'-O-(E)-cinnamate (16), respectively. Bioassay of the isolated compounds against \u03b1-\n\n\n\nglucosidase indicated that 9 possessed highest inhibitory activity with an IC50 value of 4.3\u00b11.4 \u03bcM. \n\n\n\nOther related acylflavonoids including cosmosiin-6'-O-(E)-ferulate (10, 8.8\u00b12.9 \u03bcM), cosmosiin-6'-O-\n\n\n\n\n\n\n\n\n(E)-p-coumarate(11, 14.6\u00b14.8 \u03bcM), cosmosiin-6'-O-(Z)-p-coumarate (12, 10.1\u00b13.5 \u03bcM) and \n\n\n\ncosmosiin-6'-O-(E)-cinnamate (16, 11.3\u00b12.0 \u03bcM) exhibited similar inhibitory activity. In conclusion, \n\n\n\nthe acylated flavonoids as \u03b1-glucosidase inhibitors may contribute to parts of anti-diabetic activity for \n\n\n\nT. crispa leaf. \n\n\n\n\n\n\n\nPPP 03 \n\n\n\nFAPA2014000132 (Poster) \n\n\n\nAntinociceptive Effects of Alkaloids Rich Fraction of Aidia densiflora in Mice \n\n\n\nHH Soib\n1\n, MWA Wan Sulaiman\n\n\n\n2\n, D Susanti\n\n\n\n3\n, TMFS Tg Zakaria\n\n\n\n2\n, K Edueng\n\n\n\n2\n, M Taher\n\n\n\n2\n \n\n\n\n1\nDepartment of Biomedical Science, Faculty of Allied Health Science, International Islamic \n\n\n\nUniversity Malaysia, Kuantan, Pahang, Malaysia \n2\nDepartment of Pharmaceutical Technology, Faculty of Pharmacy, International Islamic University \n\n\n\nMalaysia, Kuantan, Pahang, Malaysia \n3\nDepartment of Chemistry, Faculty of Science, International Islamic University Malaysia, Kuantan, \n\n\n\nPahang, Malaysia \n\n\n\nPain sensation is the major problem worldwide which may affect human health and lifestyle. The \n\n\n\nsearch for pain relieving agents continued to rise over time. Alkaloid is believed to stimulate analgesic \n\n\n\nactivity via blocking transmission of pain stimuli on both central and peripheral pain. The study aimed \n\n\n\nto investigate the antinociceptive effects of alkaloids rich fraction of Aidia densiflora (AD) in albino \n\n\n\nICR mice via acetic acid-induced writhing and the hot plate tests, which was reversed by aspirin. Four \n\n\n\ngroups of mice were separated and treated with alkaloids extract from AD at increasing doses of 100, \n\n\n\n200, 500, 1000 mg/kg. In writhing test, subcutaneously administered AD extract was reported to \n\n\n\nmaximally block abdominal contraction by 71.1% at 1000 mg/kg (p<0.05) as compared to lower \n\n\n\ndoses. Meanwhile, the hot plate test (55 C) revealed that intraperitoneally administered AD showed \n\n\n\nthat there was no significant difference between lower doses which corresponded to 100 and 200 \n\n\n\nmg/kg AD. However, higher doses of 500 and 1000 mg/kg were statistically significant (p<0.05). \n\n\n\nTherefore, the results suggested that the alkaloid extract possessed potential analgesic activities which \n\n\n\ndemonstrated to act through both peripheral and central mechanisms of pain. Despite safety and \n\n\n\neffectiveness profile of the extract, the present data may serve as the basis for the rational utilization \n\n\n\nof AD in alleviating symptoms including pain. \n\n\n\n\n\n\n\n\n\n\n\nPPP 04 \n\n\n\nFAPA2014000016 (Poster) \n\n\n\nInhibitory Effect of Some Herbal Extracts against Streptococcus mutans \n\n\n\nJ Wannachot\n1\n, S Rattanakiat\n\n\n\n2\n \n\n\n\n1\nPharmaceutical Chemistry and Natural Products Research Unit, Faculty of Pharmacy, \n\n\n\nMahasarakham University, Kantarawichai, Maha Sarakham, Thailand  \n2\nKutchum Hospital, Kutchum, Yasothon, Thailand \n\n\n\nHealth industries, including dental care business, have contributed huge effort on production of \n\n\n\nnatural substances since consumers mostly have a concern of adverse effects caused by chemical \n\n\n\nagents. Dental caries is an infectious disease associated with Streptococcus spp., mainly Streptococcus \n\n\n\nmutans. This study was to investigate the inhibitory effect on S. mutans in vitro of the 95% ethanol \n\n\n\nextracts from five herbs, Psidium guajava L., Momordica cochinchinensis Spreng., Glycyrrhiza \n\n\n\nglabra L., Syzygium aromaticum L. and Piper retrofractum Vahl. Antimicrobial activity was \n\n\n\nprimarily tested using disc diffusion method. A two-fold broth dilution method was then used to \n\n\n\ndetermine the minimum inhibitory concentration (MIC) of the extracts. All the extracts showed \n\n\n\n\n\n\n\n\nactivity against S. mutans. The largest mean diameter of inhibition zone was 16.7\u00b10.5 mm produced \n\n\n\nby the S. aromaticum extract. G. glabra extract showed the lowest MIC (0.195 mg/ml) and minimum \n\n\n\nbactericidal concentration (MBC) (3.125 mg/ml). The combination inhibitory effects of extracts \n\n\n\nagainst S. mutans were determined using checkerboard assay. A combined extract of S. aromaticum \n\n\n\n(0.195 mg/ml) and P. guajava (0.195 mg/ml) showed a synergistic effect (FICI 0.25) in inhibiting the \n\n\n\ngrowth of S. mutans. The results showed that these herbal extract may be potential candidates for the \n\n\n\nprevention and management of dental caries. \n\n\n\n\n\n\n\nPPP 05 \n\n\n\nFAPA2014000257 (Poster) \n\n\n\n\n\n\n\nIn vitro Antibacterial Effects of Alteranthera sessilis Leaves Extracts on Common Bacteria \n\n\n\nAssociated with Wound Infections with Emphasis on Methicillin-Resistant Staphylococcus \n\n\n\naureus  \n\n\n\n\n\n\n\nK Kulasingamn, AS Buru, H Balakrishnan, SR Sagineedu, MR Pichika \n\n\n\n\n\n\n\nAlteranthera sessilis  is an aquatic plant known by several common names, including sessile joywead. \n\n\n\nA decoction of A. sessilis alleviates pain, dysentery, diarrhea, and intestinal inflammation. Also, A. \n\n\n\nsessilis is a febrifuge, and it can be used to treat kidney diseases as well. It is often consumed as \n\n\n\nvegetable in India. Several therapeutic benefits of the wild (green) A. sessilis have been investigated \n\n\n\nwhich include anti-inflammatory effect, the nootropic activity, cytotoxic effect towards pancreatic \n\n\n\ncancer cell lines, and the free radical-scavenging ability. The aim of this study was to evaluate the \n\n\n\nantibacterial effects of hexane, ethylacetate, methanol and water extracts of A. sessilis leaves against \n\n\n\ncommon bacteria found in wound infections with primary focus on methicillin-resistant \n\n\n\nStaphylococcus aureus (MRSA). The extracts from A. sessilis leaves were obtained using sequential \n\n\n\nextraction with hexane, ethyl acetate, methanol and water. The antibacterial activities of extracts were \n\n\n\ninvestigated using disk diffusion assays and broth microdilution assays. The ethyl acetate extract of \n\n\n\nleaves showed significant antibacterial activity against wide range of gram positive and gram negative \n\n\n\nbacteria including MRSA. The extract produced the largest inhibition zone of 21.0 mm against MRSA \n\n\n\nwhile its inhibition zone against MRSA was only 8.5 mm. Its minimum inhibitory concentration \n\n\n\n(MIC) was 19.5 \uf06dg mL\n-1\n\n\n\n and minimum bactericidal concentration (MBC) was 39.0 \uf06dg mL\n-1\n\n\n\n against \n\n\n\nMRSA.  \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nPPP 06 \nFAPA2014000156 (Poster) \n\n\n\nChemometric Analysis of Labisa pumila (Kacip Fatimah) Variants by Fourier Transform \n\n\n\nInfrared (FT-IR) Spectroscopy \n\n\n\nMJ Siddiqui\n1\n, LL Hoe\n\n\n\n2\n, S Ramamurthy\n\n\n\n3\n, MR Hamdan\n\n\n\n4\n, Z Ismail\n\n\n\n4\n  \n\n\n\n1\nKulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang, Malaysia \n\n\n\n2\nHospital Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia \n\n\n\n3\nSchool of Pharmacy, International Medical University, Kuala Lumpur, Malaysia \n\n\n\n4\nSchool of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia \n\n\n\n\n\n\n\nLabisia pumila, better known as Kacip Fatimah is a traditional herb commonly used as post-partum \n\n\n\nmedication to regain the body shape, strength and toning the body muscles in Malay women. \n\n\n\nRecently, there is an influx of Kacip Fatimah products in Malaysian market to gain energy and libido, \n\n\n\nas well as to treat many other ailments. Despite high commercialization potential, there is dire need of \n\n\n\nrapid authentication for the use of quality control and standardization of these products. This study \n\n\n\nwas conducted to investigate the chemometric analysis of L. pumila varients by infrared spectroscopy \n\n\n\nprecisely using principle component analysis (PCA) for the discriminate analysis of three closely \n\n\n\nassociated varieties of L. pumila. A total of 171 samples were used consisting of 63 each for L. pumila \n\n\n\nvar. alata and L. pumila var. pumila while 45 samples were of L. pumila var. lanceolata collected \n\n\n\nacross 19 locations in Peninsular Malaysia. Infrared (IR) analysis revealed a total of 16 peaks that \n\n\n\nwere present in Labisia pumila. A total of 15 PCA scores plots were generated, with 3 PCA scores \n\n\n\ninvolving samples that are originated from the same location, showing 3 clusters that corresponded to \n\n\n\neach individual variants of Labisia pumila (var. alata, var. pumila and var. lanceolata). Chemometric \n\n\n\nanalysis is able to discriminate between samples of Labisia pumila with different secondary metabolic \n\n\n\nprofile that arises due to different variants, geographical location origin and parts of the plant. These \n\n\n\nfindings may be useful for a non-destructive analysis as an alternative methodology to implement \n\n\n\nQbD aspects for the evaluation of herbal related products or raw materials.  \n\n\n\n\n\n\n\n\nPHARMACY EDUCATION AND STUDENT AFFAIRS \n \nPEP 01 \n\n\n\nFAPA2014000022 (Poster) \n\n\n\n\n\n\n\nAnalysis of Student Satisfaction on Service Quality in the Faculty of Pharmacy Universitas Ahmad \n\n\n\nDahlan Yogyakarta \n\n\n\n\n\n\n\nA Hidayati\n1\n, A Fudholi\n\n\n\n 2\n, Sumarni\n\n\n\n3\n \n\n\n\n1\nFaculty of Pharmacy, University of Ahmad Dahlan Yogyakarta, Indonesia \n\n\n\n2\nFaculty of Pharmacy, University of Gadjah Mada Yogyakarta, Indonesia \n\n\n\n3 \nDepartment of Psychiatry, Sardjito Hospital, Yogyakarta, Indonesia \n\n\n\n\n\n\n\nFaculty of Pharmacy, University of Ahmad Dahlan, Yogyakarta is one of the private moslem institution \n\n\n\nthat organizes educational services. Thus, this institution should improve its services to get better student \n\n\n\nquality. The objective of this study was to find a description about the students\u2019 satisfaction and to \n\n\n\nunderstand the ratings of student satisfaction gap arising from several dimensional measurements.  \n\n\n\nStudent satisfaction measurement was done with populative observation and data collection prospectively \n\n\n\nat the fourth level students of the Faculty of Pharmacy, University of Ahmad Dahlan in Yogyakarta. The \n\n\n\ndata was collected using satisfaction questionnaire. We recruited 212 students, which consisted of 22.16 \n\n\n\n% male students and 77.84% female students. The value gap that appeared on the dimensions of \n\n\n\nresponsiveness, empathy, reliability, assurance and tangibles were -0.70, -0.70, -0.80 , -0.70  and -1.00, \n\n\n\nrespectively. Each statement item used as a known valuation, was significantly different from students\u2019 \n\n\n\nexpectations (p < 0.005).  In general, the service elements in the Faculty of Pharmacy, have not fulfilled \n\n\n\nthe students\u2019 expectations which was characterized by an absence of positive value or close to zero for a \n\n\n\nrange of each gap values. \n\n\n\n\n\n\n\n\n\n\n\nPEP 02 \nFAPA2014000283 (Poster) \n\n\n\n\n\n\n\nFun Competition of Public Education on Drug Use Safety \n\n\n\n\n\n\n\nHY Huang, E Chang \n\n\n\nCommunity Pharmacy, Taipei Pharmacists Association, Taipei, Taiwan, R.O.C. \n\n\n\n\n\n\n\nThe pharmacists play an important role in ensuring the drug use safety. However, the public awareness in \n\n\n\nthis regard is still far behind the existing profession of pharmaceutical service provided by \n\n\n\npharmacists. The aim of this study was to lift the public awareness on drug use safety and promote the \n\n\n\npartnership between pharmacists and the public in terms of consumer protection. Taipei Pharmacists \n\n\n\nAssociation launched a public education project in 2013 under the collaboration with Health Bureau and \n\n\n\nEducation Bureau of Taipei City Government. The methodology of the project was to conduct fun \n\n\n\ncompetition of drug use safety in primary schools in Taipei and select 8 winners for advanced \n\n\n\ncompetition.  The fun competition of drug use safety attracted very much the students of primary schools. \n\n\n\nThe information on drug use safety has been easily digested by all the participants. Almost all the \n\n\n\nparticipating schools anticipated continuously to join the fun competition in future.  In conclusion, the \n\n\n\nconcept education is important to kids. The impressive information on drug use safety will be helpful to \n\n\n\nthe participating kids over their life time and also of benefits to their families and the society. \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nPEP 03 \nFAPA2014000192 (Poster) \n\n\n\n\n\n\n\nBreat Cancer Knowledge and Attitude, Self-efficacy and Practice of Screening Methods Among \n\n\n\nFemale Students in a Private University \n\n\n\n\n\n\n\n S.Karthiyayini \n\n\n\nFaculty of Pharmacy, Asia Metropolitan University, Malaysia \n\n\n\n\n\n\n\nBreast cancer is the most common cancer in women of both developed and developing countries and the \n\n\n\nleading cause of cancer deaths among women, accounting for more than half a million deaths in 2012. In \n\n\n\nMalaysia, breast cancer tops the most frequent cancer in all ethnic groups with 3,242 new cases in 2007. \n\n\n\nBesides, women between 20-29 years experienced 72.4% mortality rate due to lack of breast cancer \n\n\n\nawareness among young women. Several studies reported inadequate knowledge towards risk factors \n\n\n\nawareness and screening methods, including among educated women and healthcare providers. \n\n\n\nFurthermore, it was reported that women with a positive attitude and self-efficacy towards BSE have \n\n\n\ngreater tendency to practice BSE. Therefore, this study aimed to determine the knowledge, attitude, self-\n\n\n\nefficacy and practice associated with breast cancer among different courses of health sciences female \n\n\n\nundergraduate students in AMU Cheras, Malaysia. A cross sectional study was conducted from June to \n\n\n\nJuly 2014 using self administered questionnaire among 180 students. The 49-item questionnaire included \n\n\n\n10 socio-demographic, 16 knowledge of breast cancer and screening methods, 12 attitude, 6 self-efficacy \n\n\n\nand 5 practice pertaining to breast cancer screening methods. The response rate was 91.67% and the mean \n\n\n\nage of respondents was 23.5 years old. About 55% of respondents claimed they practice BSE with 35% \n\n\n\nperforming it at correct frequency as recommended by guidelines. Although 82% knew that breast cancer \n\n\n\nis the leading cause of death among Malaysian women, and were aware of its signs and symptoms, only \n\n\n\n52% knew its risk factors. Significant positive correlation were found between practice and other \n\n\n\nvariables, namely, knowledge, r =0.29 (p< 0.05), self-efficacy, r =0.37 (p< 0.01) and attitude, r =0.52 (p< \n\n\n\n0.01). Since attitude has a strong correlation with practice, efforts should be taken to educate these \n\n\n\nstudents focusing on breast health awareness and positive attitudes. \n\n\n\n\n\n\n\n\n\n\n\nPEP 04 \nFAPA2014000054 (Poster) \n\n\n\n\n\n\n\nStudent's Perception of Objective Structured Clinical Examination (OSCE) among Taiwan \n\n\n\nPharmacy Students \n\n\n\n\n\n\n\n ML Tsai \n1,2\n\n\n\n, YR Lai \n1\n, PY Chi\n\n\n\n 1\n, IC Chen \n\n\n\n1\n, HC Lee \n\n\n\n1\n \n\n\n\n1 \nDepartment of Pharmacy, Chung Shun Medical University Hospital, Taiwan \n\n\n\n2 \nInstitute of Medicine, Chung Shan Medical University, Taiwan \n\n\n\n\n\n\n\nThe use of objective structured clinical examination (OSCE) for formative assessment has great potential \n\n\n\nto develop clinical competencies for students. An 8-station OSCE was designed and applied to assess the \n\n\n\nclinical skills for final-year undergraduate pharmacy students, learned during their internship in 2013-\n\n\n\n2014. The main objective of this study was to evaluate students' consciousness about OSCE. All students \n\n\n\nwere divided into 4 groups. Students were asked to finish a questionnaire immediately when their group \n\n\n\ncompleted the examination. The questionnaire contained 5 items, difficulty of the tasks, adequate duration \n\n\n\nof each station, perceived degree of learning gained and needed, the suitability of the references or \n\n\n\nliterature resources provided, and overall satisfaction of the test. For each item, there were five ordered \n\n\n\nresponse levels which were strongly disagree, disagree, neither agree nor disagree, agree and strongly \n\n\n\nagree.  Thirty eight (38) pharmacy undergraduate students who completed the OSCE were included. All \n\n\n\n\n\n\n\n\nof the students felt satisfied with the test and substantial proportions of students (97%) reported that the \n\n\n\nreferences and literature resources provided were suitable. 18(47%) perceived that the duration of station \n\n\n\nwas adequate. Moreover, 28(74%) of the students felt that a higher degree of learning was needed to \n\n\n\naccomplish the tasks and 3(8%) of the students reported difficulties with the task.  In conclusion, the \n\n\n\noverall student's evaluation of OSCE was very positive and encouraging. However, some students felt the \n\n\n\ntasks required in some stations required a higher degree of learning than they had achieved. This may \n\n\n\nindicate deficiencies in the students\u2019 learning abilities. Therefore, improvements of the course curriculum \n\n\n\nand the OSCE station design should be included in future efforts. \n\n\n\n\n\n\n\n\n\n\n\nPEP 05 \nFAPA2014000205 (Poster) \n\n\n\n\n\n\n\nNeedlestick Injuries among Six-Year Pharm D Students during Pharmaceutical Care Clerkships: A \n\n\n\nSurvey Study  \n\n\n\n\n\n\n\n P Boonmuang, W Santimaleeworagun \n\n\n\nDepartment of Pharmacy, Faculty of Pharmacy, Silpakorn University, Nakhon Pathom, Thailand \n\n\n\n\n\n\n\nNeedlestrick injuries are burden of healthcare workers. We conducted the study to evaluate the prevalence \n\n\n\nof needlestick injuries and the activity related to needlestick injuries among Thai pharmacy students in the \n\n\n\nDoctor of Pharmacy program.  The subjects were the 6\nth\n year pharmacy students in Faculty of Pharmacy, \n\n\n\nSilpakorn University, Thailand. Pharmacy students are trained in pharmaceutical care clerkships which \n\n\n\nare core subjects in the last year of Pharm D programme from February to May 2014. Data from students \n\n\n\nwere gathered by a self-administrating questionnaire.  Forty participants with 120 rotations, in the \n\n\n\nacademic year 2014 were included this study. Of the 40 students, 6 cases (15%) experienced the actual \n\n\n\nevents of needlestick injuries and the prevalence of needlestick injuries per rotation was estimated to be \n\n\n\n5% (n=120) The clerkships without activity related to needlesticks were 113 rotations and there were 7 \n\n\n\nrotations associated with needlesticks. Among 7 rotations, 3 activities were classified as activities with \n\n\n\nhigh risk of bloodborne disease (2.5%), including a fingerprick capillary blood glucose monitoring (n=2) \n\n\n\nand insulin injection demonstration (n=1). Among the 40 participants, fourteen students (35%) reported \n\n\n\nthat they had knowledge of needlestick injury obtained from literature or preceptor education before \n\n\n\ntraining. In conclusion, this study showed the activities of fingerprick capillary blood glucose monitoring \n\n\n\nand insulin administration related to needlestick injury. This issues need to be part of the education and \n\n\n\ntraining for pharmacy students prior to practice. \n\n\n\n\n\n\n\n\n\n\n\nPEP 06 \nFAPA2014000082 (Poster) \n\n\n\n\n\n\n\nThe Roles of Clinical Pharmacists: Knowledge and Perceptions of Malaysian Medical Students \n\n\n\nReceiving Education in Various Countries \n\n\n\n\n\n\n\n WZW Sazrina, N Fathin, AR Suraiya, AN Mariani, J Aslinda, MT Rashidi  \n\n\n\n Faculty of Pharmacy, Cyberjaya University College of Medical Sciences, Cyberjaya, Malaysia \n\n\n\n\n\n\n\nPhysicians and clinical pharmacists are the healthcare team. Harmonizing the medical \n\n\n\nstudents' knowledge and understanding on the clinical pharmacist\u2019s role is necessary. The aim of this \n\n\n\nstudy was to measure and determine the knowledge and perception of Malaysian medical students \n\n\n\npertaining to the roles of clinical pharmacists and to investigate whether there were significant differences \n\n\n\nin the knowledge and perception on the roles of clinical pharmacists among Malaysian medical students \n\n\n\n\n\n\n\n\nstudying in Malaysia and other countries abroad; the United Kingdom, Republic of Ireland, Australia, \n\n\n\nCzech Republic, Egypt, India, Indonesia, Jordan, New Zealand, and Russia. The questionnaire was \n\n\n\ndistributed via online and in person. Close-ended questions and Likert scales were used to quantify the \n\n\n\nresults. Descriptive, Pearson's correlation and One-Way-Anova analysis were used, accordingly. A total \n\n\n\nof 146 respondents responded. The results revealed that the Malaysian medical students possessed \n\n\n\naverage knowledge regarding the roles of clinical pharmacists. There were no significant differences in \n\n\n\nthe knowledge scores among Malaysian medical students studying or have studied in in Malaysia and \n\n\n\nother countries abroad. Malaysian medical students had strong awareness towards the roles of clinical \n\n\n\npharmacists.  There were no significant differences in the perception scores among Malaysian medical \n\n\n\nstudents studying or have studied in in Malaysia and other countries abroad. There was a positive \n\n\n\ncorrelation between the knowledge and the perception of the Malaysian medical students on the roles of \n\n\n\nclinical pharmacists. As a conclusion, Malaysian medical students have corresponding positive \n\n\n\nknowledge and perceptions regarding the roles of clinical pharmacists, regardless of the countries of study \n\n\n\nand increasing the medical students\u2019 knowledge regarding the roles of clinical pharmacist will enhance \n\n\n\ntheir awareness pertaining the matter. Further studies are needed to define optimal strategies for \n\n\n\nimproving the medical students' knowledge on the roles of clinical pharmacists.  \n\n\n\n\n\n\n\n\n\n\n\nPEP 07 \nFAPA2014000081 (Poster) \n\n\n\n\n\n\n\nKnowledge about Sexual Transmitted Disease (STD) Among CUCMS Medical and Pharmacy \n\n\n\nStudents and in Comparison with Public in Putrajaya and Cyberjaya \n\n\n\n\n\n\n\nWZW Sazrina, ABN Farhana, MTA Rashidi, J Aslinda, AR Suraiya, AN Mariani \n\n\n\nFaculty of Pharmacy, Cyberjaya University College of Medical Sciences, Cyberjaya, Malaysia \n\n\n\n\n\n\n\nSexual transmitted disease (STD) rank among the most important health issue for the people especially \n\n\n\nthe young adults worldwide. However, there are limited findings and evidence that focus on the \n\n\n\nknowledge regarding sexual transmitted disease (STD) in Malaysia. A study was conducted in Cyberjaya \n\n\n\nand Putrajaya, Malaysia to gather the baseline information about student and general public level of \n\n\n\nknowledge on STD to help establish control and education programmes. A total of 575 respondents were \n\n\n\nsurveyed, with 215 respondents from Cyberjaya University College Medical Science (CUCMS) and \n\n\n\nanother 360 respondents from the general public in Putrajaya and Cyberjaya. A convenient sampling \n\n\n\ntechnique was employed. The questionnaire consists of two sections which were demographic data and \n\n\n\nknowledge regarding STD. Mean age of respondents surveyed was 22.6 years for the students and 23.7 \n\n\n\nyears for the general public. More than 60% of both groups of respondents were female. Results showed \n\n\n\nthat the student respondents had moderate level of knowledge regarding STD (mean = 21.88) and public \n\n\n\nrespondents had low level of knowledge regarding STD (mean = 12.61). There was significant difference \n\n\n\n(p = 0.001) in level of knowledge regarding STD between students and the general public. Furthermore, \n\n\n\nthere was significant difference (p = 0.027) between gender of student respondents and level of \n\n\n\nknowledge regarding STD. The results also showed that there was significant difference (p = 0.008) \n\n\n\nbetween education level of public respondents and level of knowledge regarding STD. This study showed \n\n\n\nthat level of knowledge regarding STD was influenced by gender and level of education. Future research \n\n\n\nand interventions in this area are acquired to help the public increase their knowledge and awareness \n\n\n\nabout STD. \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nPEP 08 \nFAPA2014000267 (Poster) \n\n\n\nThe Analysis of the Training Effectiveness of Professional Seminar Performed By Post-Graduated \n\n\n\nYear Pharmacists \n\n\n\nYL Chang\n1,2\n\n\n\n, PI Chen\n1,2\n\n\n\n, PL Chen\n1,2\n\n\n\n \n1\nPharmacy Department of Tungs\u2019 Taichung MetroHarbor Hospital, Taichung, Taiwan  \n\n\n\n2\nTaichung County Pharmacist Association, Taichung, Taiwan \n\n\n\n To improve the communication skills of Post-graduated Year(PGY) pharmacists. In the \u201cPharmacists \n\n\n\ntwo-year training program\u201d, we planned training courses of the professional seminar performance \n\n\n\ncapabilities. Every once a year, we assessed the training effectiveness of the course by 3 main items: \n\n\n\nknowledge, attitudes and skills. From January 2012 to May 2014, the clinical teachers assessed the \n\n\n\nperformance of seminar according to the criteria of \u201cAssessment score sheet\u201d. The following were the 3 \n\n\n\nmain items of assessment: (1) the knowledge: scoring items included \u201cMeet the topic\u201d, \u201cEasily \n\n\n\nunderstood\u201d, \u201cThe contents is complete\u201d and \u201cThe summary\u201d; (2) the attitude: \u201cBody language\u201d, \n\n\n\n\u201cInteractive teaching\u201d and \u201cSpeech without notes\u201d; (3) the skills: \u201cTriggered the learning motivation\u201d, \n\n\n\n\u201cTime control\u201d and \u201cThe usage of teaching tool\u201d. The score of each item is 6-10 points. Statistical \n\n\n\nanalysis was done by the Compare Means method. There were 17 PGY1 and 15 PGY2 pharmacists \n\n\n\nparticipated in the assessment. Between the overall score of the items, the score of \u201cMeet the topic\u201d was \n\n\n\nthe highest(9.28\u00b10.17) followed by \u201cEasily understood\u201d(9.18\u00b10.22) and the score of \u201cInteractive \n\n\n\nteaching\u201d was the lowest(8.85\u00b10.26), there were statistically significant differences among the three \n\n\n\nitems(P=0.00). The average total score of PGY2 was higher than PGY1, the score is 91.75\u00b11.89 and \n\n\n\n90.99\u00b11.55 respectively (P=0.22). In the item of \u201cTriggered the learning motivation\u201d, the performance of \n\n\n\nPGY2 is better than PGY1 (9.13\u00b10.21 vs 8.98\u00b10.17; P=0.03). In the other items, there were no \n\n\n\nstatistically significant differences between PGY2 and PGY1. The training effectiveness of the \n\n\n\nknowledge was the best among 3 main items of assessment. All PGY pharmacists need to practice more \n\n\n\nin the item of \u201cInteractive teaching\u201d. And PGY1 pharmacists need to improve the skill of \u201cTriggered the \n\n\n\nlearning motivation\u201d. \n\n\n\n\n\n\n\nPEP 09 \nFAPA2014000327 (Poster) \n\n\n\n\n\n\n\nDispensing Separation Policy:  Attitudes of Future Physicians and Pharmacists For Inter-\n\n\n\nProfessional Collaboration  \n\n\n\n\n\n\n\nNA Zainuddin\n1\n, MM Manan\n\n\n\n1\n, AA Shafie\n\n\n\n2\n, AK Mohd Tahir\n\n\n\n3 \n\n\n\n1\nFaculty of Pharmacy, University Teknologi MARA, Malaysia \n\n\n\n2\nSchool of Pharmacy, Univeristi Sains Malaysia, Penang, Malaysia \n\n\n\n3\nEnforcement Division, Sabah State Health Department, Malaysia \n\n\n\n\n\n\n\nCollaboration between physicians and pharmacists is one of the strategies for improving healthcare \n\n\n\ndelivery. Strong working relationships are believed to improve patient outcomes. There appears to be \n\n\n\nlittle to no collaborative working relationship between physicians and pharmacists in the private, as well \n\n\n\nas public sector, hence it is crucial to develop an understanding of the determinants in developing \n\n\n\nnecessary collaborations. Supposing structural system is hard to overcome, changing negative attitudes \n\n\n\namong future practitioners might be equally difficult. This study aimed to examine attitudes toward \n\n\n\ncollaboration; inter-professional learning and dispensing separation policy among pharmacy and medical \n\n\n\n\n\n\n\n\nstudents. Three sets of questionnaires, demographic characteristics, Scale of Attitudes Toward Physician-\n\n\n\nPharmacist Collaboration (SATP\n2\nC), Multiprofessional Shared Learning Questionnaire (MSLQ), were \n\n\n\nconvenient sample and self-administered by the final year medical and pharmacy students in Universiti \n\n\n\nTeknologi MARA, Malaysia. A total of 255 completed questionnaires were returned from 108 medical \n\n\n\nstudents and 147 pharmacy students. The factor analysis confirmed the validity of the Scale of Attitudes \n\n\n\nTowards Physician-Pharmacist Collaboration (SATP\n2\nC). The majority of students reported positive \n\n\n\nattitudes towards shared learning from Multiprofessional Shared Learning Questionnaire (MSLQ) and \n\n\n\ndivergent agreement regarding dispensing separation policy. The findings showed that there were \n\n\n\ninconsistent attitudes among the two groups of future professionals regarding the policy. Effort on \n\n\n\ncollaboration between physicians and pharmacists may be affected by these differences and thus justify \n\n\n\nfor an interdisciplinary education system to be formulated. \n\n\n\n\n\n\n\n\n\n\n\nPEP 10 \nFAPA2014000328 (Poster) \n\n\n\n\n\n\n\nTo Validate the Scale of Attitudes Towards Physician-Pharmacist Collaboration (SATP\n2\nC) \n\n\n\nQuestionnaire on Medical and Pharmacy Students   \n\n\n\n\n\n\n\nNA Zainuddin\n1\n, MM Manan\n\n\n\n1\n, AA Shafie\n\n\n\n2\n, MZ Baharuddin\n\n\n\n3 \n\n\n\n1\nFaculty of Pharmacy, University Teknologi MARA, Malaysia \n\n\n\n2\nSchool of Pharmacy, Univeristi Sains Malaysia, Penang, Malaysia \n\n\n\n3\nEnforcement Division, Sabah State Health Department, Malaysia \n\n\n\n\n\n\n\nCollaboration between physicians and pharmacists is vital. However, positive attitudes of medical and \n\n\n\npharmacy students towards collaboration can be a determinant for its success at practice level. This study \n\n\n\naimed to examine and validate the SATP\n2\nC questionnaire among pharmacy and medical students. \n\n\n\nStudents were conveniently sampled. The questionnaire was distributed and self-administered by the final \n\n\n\nyear medical and pharmacy students in Universiti Teknologi MARA, Malaysia. A total of 255 completed \n\n\n\nquestionnaires were returned from 108 medical students and 147 pharmacy students. The validity and \n\n\n\nreliability assessment of SATP\n2\nC were determined by estimating the Underlying Construct Item-Total \n\n\n\nScore Correlations and the Reliability Coefficients. Kaiser\u2019s measure of sampling adequacy was used \n\n\n\nprior to factor extraction which resulted in an overall index of 0.91, which confirmed the adequacy of data \n\n\n\nfor factor analysis. Bartlett\u2019s test for sphericity showed that the intercorrelation matrix was factorable \n\n\n\n(x\n2\n\n\n\n(120) = 1381.7, p<0.001). The mean score for the total sample was 55.2, median of 56, and the standard \n\n\n\ndeviation of 5.5. The Cronbach reliability coefficient alpha for the entire sample was r = 0.88 while the \n\n\n\nscore of 0.84 and 0.89 were obtained for the pharmacy and medical students. The reliability coefficient \n\n\n\nfor factor 1 were r = 0.78, 0.75, 0.77 for the entire sample, pharmacy and medical students, respectively. \n\n\n\nResults for factor 2 were r = 0.77, 0.71 and 0.77 respectively. As for factor 3, r = 0.74, 0.67 and 0.80 were \n\n\n\nobtained. These findings showed support of the significant contribution of each item to the total score, \n\n\n\nand the internal consistency reliability of the instrument. The findings confirmed the validity of the \n\n\n\nSATP\n2\nC questionnaire as a tool to assess the attitudes of medical and pharmacy students towards \n\n\n\ncollaboration. \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nPEP 11 \nFAPA2014000184 (Poster) \n\n\n\n\n\n\n\nThe Impact of Facebook on the Academic Performance among Pharmacy Students of International \n\n\n\nIslamic University Malaysia Kuantan \n\n\n\n\n\n\n\nF Muthalib\n1\n, N Syafinaz\n\n\n\n2\n, N Othman\n\n\n\n3\n \n\n\n\n1\nKuliyyah of Pharmacy, International Islamic University Malaysia, Pahang, Malaysia \n\n\n\n2\nDepartment of Pharmacy Practice, International Islamic University Malaysia, Pahang, Malaysia  \n\n\n\n3\nDepartment of Clinical and Hospital Pharmacy, Taibah University, Al-Madinah Al-\n\n\n\nMunawwarah, Taiyibah, Madinah, Saudi Arabia \n\n\n\n\n\n\n\nNowadays, Facebook becomes one of the most important communication mediums in our daily life. The \n\n\n\nexistense of Facebook is aimed to maximize the connection between people globally, information sharing, \n\n\n\nbusiness promotion, academic, leisure chatting and many more. Many research claimed that Facebook has \n\n\n\nadvantages and also disadvantages towards students\u2019 academic performance. There are many opinions \n\n\n\nand views of the researchers regarding the effects of Facebook on the academic performance of the \n\n\n\nstudents in the whole world. Some studies stated that Facebook can become a good learning tool in order \n\n\n\nto improve students\u2019 academic performance while some studies stated that Facebook can cause addiction \n\n\n\nand misleading to the students from the academic pathway and will result in the drop of their academic \n\n\n\nperformance. The objectives of this study were to examine the impact of Facebook on the academic \n\n\n\nperformance among the Pharmacy students of International Islamic University Malaysia (IIUM) Kuantan. \n\n\n\n\n\n\n\n\n\n\n\nPEP 12 \nFAPA2014000330 (Poster) \n\n\n\n\n\n\n\nContinuing Education for Young Pharmacists in Taiwan: the Experience from Taiwan Young \n\n\n\nPharmacists\u2019 Group \n\n\n\n\n\n\n\nH-C Chou\n1,2\n\n\n\n, Y-H Chen\n1\n, I-H Lee\n\n\n\n1\n, K-C Wang\n\n\n\n1\n, H-TA Ou\n\n\n\n1,3\n \n\n\n\n1 \nTaiwan Young Pharmacists\u2019 Group, Taiwan \n\n\n\n2\n School of Pharmacy, National Defense Medical Center, Taiwan \n\n\n\n3\n Institute of Clinical Pharmacy and Pharmaceutical Sciences, National Cheng Kung University, Taiwan  \n\n\n\n\n\n\n\nAs a bridge between pharmacy students and young pharmacists, the aim of Taiwan Young Pharmacists\u2019 \n\n\n\nGroup (TYPG) is to facilitate smooth transition into the practice and to help the young generation of \n\n\n\npharmacists in Taiwan develops their career pathway. Additionally, the TYPG is aimed to serve as a \n\n\n\nplatform for Taiwan\u2019s young pharmacists to share innovative ideas and network worldwide. Pharmacists\u2019 \n\n\n\ncontinuing education in Taiwan typically focuses on the development of specific professional knowledge \n\n\n\nand skills which may only be applicable to certain fields of pharmacy practice (that is, hospital). As \n\n\n\nrecognizing the diversity of pharmacy practice, the TYPG organized a series of career development \n\n\n\nsections, which emphasized career planning across different ages (for example, 25, 35 and 45 years old) \n\n\n\nand settings (for example,  hospital, community, industry). The sections consisted of various workshops \n\n\n\nand senior pharmacists were invited to share their experiences in career life. To understand the motivation \n\n\n\nand outcomes of the participants in the career development sections, a satisfaction questionnaire was \n\n\n\ndelivered which help gain the insights of future needs of young pharmacists. The pharmacist participants \n\n\n\nrevealed higher satisfactory to the career development sections and looked forward to further workshops \n\n\n\nand experiential sharing. \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nPEP 13 \nFAPA2014000155 (Poster) \n\n\n\n\n\n\n\nIntegrated Behaviour Model and Pharmacy Students Intention to Provide Smoking Cessation \n\n\n\nCounselling \n\n\n\n\n\n\n\nS Simansalam\n1,2\n\n\n\n, MHN Mohamed\n2 \n, J Brewster\n\n\n\n3 \n \n\n\n\n1\nFaculty of Pharmacy, Asia Metropolitan University, Cheras, Selangor, Malaysia  \n\n\n\n2\nKulliyyah of Pharmacy, International Islamic University of Malaysia, Kuantan, Malaysia \n\n\n\n3\nDalla Lana School of Public Health, University of Toronto, Canada \n\n\n\n\n\n\n\nThe main objective was to assess smoking cessation counselling competency among pharmacy students in \n\n\n\na private institution.  The role of prior exposure to tobacco-related topics and relationships between \n\n\n\nconstructs were also explored. A 69-item questionnaire was developed, pilot-tested and administered to \n\n\n\n140 pharmacy undergraduates to assess their knowledge, self-efficacy, attitudes, perceptions of ideal \n\n\n\npharmacists\u2019 role and practice pertaining to smoking cessation counseling. The mean, standard deviation \n\n\n\nand bivariate correlation for practice and other smoking cessation counselling competency-related \n\n\n\nconstructs were determined. Independent samples t-test was performed to examine differences between \n\n\n\nstudents who had previous exposure to tobacco-related topics and the students which did not have any \n\n\n\nsuch exposure. The questionnaire was completed by 137 students, yielding about 98% response \n\n\n\nrate.  Students who had prior exposure to tobacco-related topics had significantly higher self-efficacy. \n\n\n\nGenerally, low scores were obtained for practice activities and knowledge. Self-efficacy was positively \n\n\n\nand significantly correlated with practice and knowledge constructs. Ideal pharmacists\u2019 role perception \n\n\n\nwas positively and significantly correlated with practice and positive attitudes while negative attitudes \n\n\n\nwere negatively and significantly correlated with positive attitudes and ideal pharmacists\u2019 role perception. \n\n\n\nThere is scope for improvement in terms of tobacco-related and smoking cessation counselling \n\n\n\nknowledge and continuous emphasis on the importance of tobacco-related and smoking cessation \n\n\n\ncounselling training should be placed throughout the undergraduate training program. Opportunities to \n\n\n\ndevelop competency as well as to practice smoking cessation counselling should be provided to students \n\n\n\nat higher education institutions and other possible settings during community attachment and hospital \n\n\n\nclerkships. \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nPHARMACEUTICAL LEGISLATION & ETHICS \n \nPLP 01 \n\n\n\nFAPA2014000027 (Poster) \n\n\n\n\n\n\n\nASEAN Harmonisation; Compliance of Cosmetics Regulatory Scheme in Thailand within 5 \n\n\n\nYears \n\n\n\n\n\n\n\nN Jinachai, P Anantachoti \n\n\n\nSocial and Administrative Pharmacy (International Program), Faculty of Pharmaceutical Sciences, \n\n\n\nChulalongkorn University, Bangkok, Thailand \n\n\n\n\n\n\n\nThe ASEAN Harmonisation was aimed to stabilise politics, and improve economic, social, and \n\n\n\ncultural aspects of the region. In the healthcare sector, cosmetics was the first to be harmonised and \n\n\n\ncommitted to implement the ASEAN Harmonised Cosmetics Regulatory Scheme (AHCRS) in January \n\n\n\n2008, with full implementation expected in January 2011. This study was conducted to determine \n\n\n\nwhether Thailand has complied with ASEAN Cosmetic Directive (ACD) after 5 years of \n\n\n\nimplementation in 2012. Thai cosmetics Act B.E. 2535 and ACD were compared in 2008, and in \n\n\n\n2012. Content analysis and in-depth interviews were performed. The study revealed that Thailand \n\n\n\nhas  highly complied with ACD in all regulated areas; (i) definition and scope of cosmetics products \n\n\n\n(ii) ingredients\u2019 listing (iii) labelling (iv) product claims and (v) good manufacturing practice.  To \n\n\n\nofficially implement ACD, the Thai regulator has to transpose the directive into local law. During the \n\n\n\nlegal process, one might notice discrepancy between these two laws. Although the country regulator \n\n\n\nintended to fully harmonize, some minor issues such as the ingredients\u2019 listing and labelling, these \n\n\n\ncannot be implemented all at once. In summary, it can be concluded that the main objectives of \n\n\n\nAHCRS have been achieved. Harmonization in Thailand happened in an ASEAN way. \n\n\n\n\n\n\n\n\n\n\n\nPLP 02 \nFAPA2014000090 (Poster) \n\n\n\n\n\n\n\nReducing Medication Supplementing Errors by a Quality Improvement Program \n\n\n\n\n\n\n\nYT Hong, M Chen, CH Lee, MH Chuang \n\n\n\nPharmacy Department, Dalin Tzu Chi General Hospital, Chiayi Country, Taiwan \n\n\n\n\n\n\n\nDispensing errors can directly harm patient safety, and it can be occurred due to the medication \n\n\n\nsupplementing process at the beginning of dispensing. Supplementing errors may cause the different \n\n\n\nlevels of injury to patients. Notably, this type of error is usually hard to detect and track. In this study, \n\n\n\nthe occurrence rate of medication supplementing error was defined by the quality control circle (QCC) \n\n\n\nteam from September to October of 2013 at a regional teaching hospital in southern Taiwan. Seven \n\n\n\nbasic quality tools and the four steps of the Deming cycle (plan-do-check-act, PDCA) were used by \n\n\n\nthe QCC team to analyze and solve problems systematically.  Data was collected retrospectively and \n\n\n\ninterventions were conducted based on the identified reasons from the occurred errors. A total 24 week \n\n\n\nperiod of data was further collected.  Four major interventions were applied including improving the \n\n\n\nformat of storage label posted on automated drug dispensing machines, improving the medication \n\n\n\nstorage space, establishing the standard steps of triple check during supplementing, and improving the \n\n\n\nattitudes and behavior of pharmacist operating the medication supplementing.  After 24 weeks of \n\n\n\ninterventions, the incidence rate of the medication supplementing error was significantly decreased \n\n\n\nfrom 8.1 ppm to 0.0 ppm.  In conclusion, reducing medication supplementing errors by a quality \n\n\n\nimprovement program such as QCC activities can provide a safer medication use to patients. \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nPLP 03 \nFAPA2014000263 (Poster) \n\n\n\n\n\n\n\nPublic Accessibility and Preference Towards Media Channels in Delivering Drug-Related \n\n\n\nInformation:  Comparison of Urban and Rural Pupulation in Sarawak \n\n\n\n\n\n\n\n CYS Ting, THR Tan \n\n\n\nSarawak Pharmacy Enforcement, Sarawak State Health Department, Ministry of Health Malaysia \n\n\n\n\n\n\n\nMedia channels are tools for the transfer of information and concepts to audiences especially \n\n\n\nsophisticated societies in delivering health information. However, health promotion through media \n\n\n\nchannels can be counterproductive and not cost-effective if they are not suitable with the niche of the \n\n\n\naudience.  This cross sectional study determined the public accessibility and preferences toward types \n\n\n\nof media channel in delivering drug related information in urban and rural areas of Sarawak.  A self-\n\n\n\nadministered questionnaire was developed through panel of experts to explore public accessibility \n\n\n\ntowards media channels, trend of media utility, preference toward media channels in delivering drug \n\n\n\nrelated information and the perceived most credible media channel in delivering drug related \n\n\n\ninformation.  A total of 228 respondents with proportionate cluster sampling from urban area and 212 \n\n\n\nrespondents from rural area were recruited. The ranking of most accessible media channels in urban \n\n\n\narea are television (87.3 %), internet (75.4%) and followed by newspaper (68.9%) while in rural area \n\n\n\nthere are television (90.1%), radio (73.6%) and followed by newspapers (68.4%).Study also revealed \n\n\n\nthat urban respondents mostly obtain drug related information from the internet (69.7%) while rural \n\n\n\nrespondents mostly obtain it from the television (73.6%). Meanwhile, both urban and rural \n\n\n\nrespondents perceived that television has the highest credibility in delivering drug related information. \n\n\n\nIn conclusion, this study reveals social media of choice for people in Sarawak. These data is important \n\n\n\nfor relevant agencies in the planning interventions in disseminating drug related information to the \n\n\n\npeople in Sarawak. \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nEMERGENCY MEDICINE AND OTHERS \n \nEMP 01 \n\n\n\nFAPA2014000172 (Poster) \n\n\n\nThe Haiyan Super Typhoon in Philippines: Malaysian Military Pharmacist Experience \n\n\n\nMA Adnan \n\n\n\nDepartment of Pharmacy, Tuanku Mizan Armed Forces Hospital, Kuala Lumpur, Malaysia \n\n\n\nDisaster is a challenging scenario for healthcare workers. In late 2013, the strongest typhoon hit the \n\n\n\nPhilippines and claimed more than 6,300 lives. Malaysian National Security Council established and \n\n\n\ndeployed a disaster relief team to provide medical aid to the survivors. Pharmacist(s) was/were \n\n\n\ninvolved in this mission from day 5 to day 18 of the disaster in Tacloban district. The objectives were \n\n\n\nto document common diseases after typhoon, to list essential medications and to share experience \n\n\n\nduring the mission. The top 3 clinical diseases were upper and lower respiratory infections (55%), \n\n\n\ninfected wounds and lacerations (14%) and acute gastroenteritis (10%). Top 2 age groups treated were \n\n\n\n18-65 years old (55%) and 1-12 years old (33%). The top three fast-moving medicines were \n\n\n\ndiphenhydramine expectorant, oral rehydration salt and cloxacillin capsule. Typhoon took away all \n\n\n\nmedicines especially from survivors with chronic diseases and majority cannot remember their \n\n\n\nmedicines. Therefore, learning common local words made dispensing and counselling easier, \n\n\n\nespecially to elderly survivors. Extreme tropical weather contributed to not only high respiratory \n\n\n\nillnesses but created logistics issues, especially during outreach program. Thus, waterproof tents, \n\n\n\ncontainers and pallets usage were vital to minimize damage from heavy rain during storing and \n\n\n\ntransporting of medicines. Communicable diseases such as leptospirosis and dengue amplified 2 \n\n\n\nweeks after disaster. Survivors had to live in area without clean water supply and poor sanitation. \n\n\n\nPharmacist involved in supplying clean and safe drinking water by using Malaysian invention of Field \n\n\n\nWater Purification System known as JERNIH. In conclusion, for water-based disaster, an increase in \n\n\n\npatients presenting with infected wounds and lacerations should be expected. Pharmacist can \n\n\n\nstrategize to prepare sufficient pharmacological support. As pharmacists, our responsibility can go \n\n\n\nbeyond providing safe and effective medicine during this kind of mission. Networking with other \n\n\n\npharmacists, local health authorities and other volunteers helped in coordinating and sustaining \n\n\n\nmedical logistics. \n\n\n\n \n\n\n\n\n\n"
"\n\nMalaysian Journal of Pharmacy Volume 8 Issue 1 (2022) \n \n\n\n\n\n\n\n\n26 \n \n\n\n\n*Correspondence: laura_soon@hotmail.com 1 Hospital Queen Elizabeth II. Sabah, Luyang Commercial Centre, 88300 \nKota Kinabalu, Sabah, Malaysia \n \n\n\n\n\n\n\n\nMALAYSIAN \nJournal of \nPharmacy \n\n\n\n Original Article \n \n\n\n\nMedication Administration via Enteral Feeding Tubes: A \nSurvey of Nurses\u2019 Knowledge and Practice  \n \nLaura Soon1*, Pay Chyi Tong1, Le Jun Chung1, Qing Liang Goh1, Sze Ling Tan1  \n \n\n\n\n \nArticle Info  \n \nReceived date: 01 Aug 2021 \nAccepted date: 03 Mar 2022 \nPublished date: 30 Jun 2022 \n \nKeywords: Enteral feeding \ntubes, medication \nadministration, nurse. \n\n\n\nABSTRACT  \n  \nIntroduction: Enteral feeding is a type of nutritional support for critically ill patients who are unable \nto tolerate oral feeding. It is vital to ensure that nurses practise proper administration techniques via \nenteral feeding tubes (EFT) to ensure that medications can be delivered safely and effectively.  \nObjective: This study aims to assess the knowledge and practice of nurses on medication \nadministration through EFT. The association between demographics and knowledge was also \nexplored. Method: This study is a cross-sectional, self-administered, content-validated, pre-tested \nquestionnaire survey involving all nurses who worked in the ward setting at Hospital Queen Elizabeth \nII from August to December 2020. Result: A total of 409 questionnaires were sent out with 252 \nresponses received. The majority of respondents were female (n = 240, 95.6%) with a median \nworking experience of 84 months (interquartile range of 44 months). Most nurses knew that the \nimmediate-release dosage forms (n = 237, 94.4%) may be crushed and administered through EFT. \nSimilarly, most nurses were aware that sublingual nitroglycerin (GTN) tablets should not be crushed \n(n = 232, 92.8%) and that nystatin suspension should not be administered via EFT (n = 212, 85.1%). \nHowever, about half of the nurses responded incorrectly when questioned about the particulars of \nEFT involving the administration of sustained-release medications (n = 152, 60.6%), soft gelatin \ncapsules (n = 111, 44.4%) and hard gelatin capsules (n = 102, 40.6%). Meanwhile, in terms of \npractice, a majority of the nurses would correctly routinely flush the EFT before (n = 226, 90.4%) \nand after (n = 245, 98.8%) the administration of medications. However, only a small proportion of \nnurses (n = 43, 17.3%) demonstrated the appropriate practice of administering all medications \nseparately all the time. Furthermore, it was also worth noting that for some specific knowledge-based \nquestions, nurses from the intensive care setting had more correct responses when compared to those \nfrom the general ward setting (p < 0.05). Conclusion: The knowledge gap and inconsistencies in \npractices amongst nurses related to the use of EFT may lead to suboptimal delivery of medications, \nwhilst potentially compromising patient outcomes. Hence, continuous educational programs should \nbe carried out to ensure safe and effective drug administration through EFT. \n \n\n\n\n \nINTRODUCTION  \n  \nIn the hospital setting, enteral feeding is a type of nutritional \nsupport for critically ill patients who are unable to tolerate oral \nfeeding as a result of certain diseases or treatment modes. \nEnteral feeding plays an important role in providing adequate \nnutrition and preserving the function of the gastric mucosa in \nsuch patients. However, many factors must be considered when \n\n\n\nserving medications through enteral feeding tubes (EFT). \nIncorrect administration techniques may lead to several \ncomplications, including the clogging of EFT, reduced drug \neffectiveness and increased risk of adverse effects. \nAdditionally, certain precautions should also be taken for \ncertain drug formulations when given through the EFT, \nparticularly, extended-release formulations and enteric-coated \npills. Indeed, several cases have been reported whereby  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nSoon L.et al. Mal J Pharm 8 (1) 2022, 26-31 \n \n\n\n\n29 \n \n\n\n\nimproper administration of medications through EFT \ncontributed to patient fatality and ineffective therapy [1,2].     \n \nNurses are hugely responsible for the administration of \nmedications for warded patients; hence they should be \nequipped with the knowledge and skills related to proper \nadministration techniques with regards to EFT. Several studies \nhave reported that nurses have insufficient knowledge related \nto this mode of administration, whilst also conducting \nnumerous practices that diverge from standard guidelines [3,4]. \nincluding the administration of inappropriate dosage forms via \nEFT as well as the lack of tube flushing, where required. \nInevitably, the lack of knowledge as well as the improper \npractices in administering medication through EFT may lead to \ncomplications, and eventually, compromised patient care. \n \nTo date, studies conducted locally to address this issue are few \nin number, while also being limited to West Malaysia. Indeed, \nthe findings from those studies seem to indicate that there were \ndiscrepancies between nurses\u2019 practice and standard guidelines \non medication administration via EFT [3]. This study aims to \nprovide an overview of nurses\u2019 knowledge and practice on drug \nadministration through EFT in Hospital Queen Elizabeth II \n(HQE2). This study also explores the preferred way by which \nnurses improve on their knowledge and practice relating to \nEFT. It is believed that the results of this research would prove \nto be beneficial in providing information towards the designing \nof future educational programs to improve the knowledge and \npractices of medication administration through EFT, with \nhopes of ultimately ensuring safer and more effective patient \ncare. \n \nMETHOD \n \nStudy methods \n \nThis study was a cross-sectional study incorporating a self-\nadministered questionnaire that involved ward-based nurses \nsampled by convenience sampling, with the experiment being \nconducted across the span of a few months from August to \nDecember 2020. It was conducted in Hospital Queen Elizabeth \nII, a 300-bedded tertiary centre that is capable of catering to \nboth intensive and general ward patients. There is no sample \nsize calculated as all the eligible nurses were invited to \nparticipate in this study. All ward-based nurses working in \nHQE2 were approached to participate in this study via text \nmessages. The questionnaires were then distributed to all ward \nnurses respectively. Prior to answering the questionnaires, all \nparticipants gave their consent by signing the consent form. \nSubsequently, each ward would receive phone call reminders \non the submission of completed questionnaires prior to the \ndeadline given. The study was approved by the Medical \nResearch and Ethics Committee with the identification code \nNMRR-20-2416-56357. \n\n\n\nInstrument \n \nThe questionnaire was developed by the authors based on \nprevious studies [3,4] and recommendations by the guidelines \n[5,6] on medication administration via EFT. With \nconsideration of the skills and practice relating to the use of \nEFT, the questionnaire concisely included: \n \n\n\n\nI. 6 questions on socio-demographic information (age, \ngender, ward, highest education level, duration of \nservice, frequency of dealing with EFT) \n\n\n\nII. 10 knowledge-based questions on the medications \nthat can be administered through EFT and their \nspecific administration method. The participants \nwere given three options to choose from: \u201cYes\u201d, \n\u201cNo\u201d, and \u201cI don\u2019t know\u201d. \n\n\n\nIII. 9 practice-based questions on each stage of the \nmedication administration using EFT and tube \nflushing. A four-point Likert scale was used to \nmeasure the frequency of such practices, ranging \nfrom \u201cAll the time\u201d to \u201cNever\u201d. \n\n\n\nIV. An open-ended question on the participants\u2019 preferred \nway of improving their knowledge and practice \nrelating to EFT \n\n\n\n \nThe questionnaire was appraised and subsequently content-\nvalidated by a team of pharmacists with expertise in survey \ndesign and clinical practice. Subsequently, a pre-test was \nconducted in July 2020 to undergo face-validation with five \nrandom ward nurses from different wards.  Each of the pre-\ntested study participants was interviewed to obtain feedback on \nthe comprehensibility, relevance and overall questionnaire. The \nfeedback confirmed the face validity and user-friendliness of \nthe questionnaire as no extra amendment was required. Since \nall the questions are being presented as individual responses, \nfurther validity and reliability tests were not carried out.  \n \nData analysis \n \nAll the information collected was analysed using SPSS version \n22.0. Continuous variables were presented as means (with \nstandard deviation, SD) or medians (with interquartile range, \nIQR) depending on the normality of data distribution. \nCategorical data were presented as frequency and percentage. \nDescriptive analysis, i.e., number and percentages, was \nemployed to describe nurses\u2019 knowledge and practice on \nmedication administration through EFT based on their \nresponses. There is no score calculated for knowledge. The \nassociation between the nurses\u2019 frequency of dealing with EFT, \nward setting and their knowledge of EFT medication \nadministration were tested using the Chi-square test. The \nresponses for frequency of dealing with EFT were merged into \n2 outputs: \u201cAll the time\u201d and \u201cNot all the time\u201d (from \u201cOften\u201d,  \n\n\n\n\n\n\n\n\nSoon L.et al. Mal J Pharm 8 (1) 2022, 26-31 \n \n\n\n\n30 \n \n\n\n\n\u201cSometimes\u201d and \u201cNever\u201d) for ease of analysis. The \nassociation between the median duration of service and \nknowledge was also explored using the Mann-Whitney U test. \nA p-value of <0.05 was considered to be statistically \nsignificant.   \n \n\n\n\nRESULTS \n \n\n\n\nDemographic \n \nA total of 252 ward nurses participated in this study, which \naccounted for an estimated response rate of 61%. The \ndemographic data of all respondents are presented in Table I. \nThe median age of participating ward nurses was 31 years (IQR \n= 6), whereas the median duration of service was 84 months \n(IQR = 44). The majority of the participants were female \n(95.6%) and positioned as staff nurses (93.1%). Most of the \nward nurses (99.2%) had experience in conducting medication \nadministration via EFT, of which 28% claimed that they dealt \nwith it all the time.  \n\n\n\nKnowledge on medication administration through EFT \n \nThe proportion of nurses that answered correctly in the \nknowledge-based questions are shown in Table II. In terms of \nthe administration through EFT, knowledge related to the \nproper administration of immediate-release dosage forms and \nGTN tablets were known best by the nurses, with 94.4% and \n92.8% correct responses respectively. In contrast, knowledge \nrelated to the proper administration of the following two types \nof medication; sustained-release formulations and cytotoxic \nmedications, were found to be the lowest with 39.4% and \n49.8% of nurses answering with correct responses respectively. \nPractice of medications administration via EFT \n\n\n\n \nThe data gathered pertaining to the practice of medication \nadministration via EFT are shown in Table III. Most of the \nnurses claimed that they flush the EFT routinely before (90.4%) \nand after (98.8%) medication administration. The majority of \nnurses (92.8%) also claimed to prop up their patients all the \ntime when administering medications to patients via EFT. \nHowever, only a small proportion of nurses (17.3%) responded \nthat they, appropriately, administer different medications \nseparately and flush between each administration all the time. \nAdditionally, only half of the nurses (53.2%) would stop \nenteral feeding when it is time to administer medications via \nEFT. \n \n \n\n\n\nTable I. General characteristics of respondents (n = 252) \n \n\n\n\nCharacteristics n % Median \n(IQR) \n\n\n\nAge of respondent in years   31 (6) \nDuration of service in months   84 (44) \nGender of respondents    \n   Male 11 4.4  \n   Female 240 95.6  \nFrequency of dealing with EFT    \n   All the time 69 28.0  \n   Often 70 28.5  \n   Sometimes 105 42.7  \n   Never 2 0.8  \nWard of practice    \n   Cardiology 40 15.8  \n   Cardiothoracic 24 9.6  \n   Intensive Care Unit 29 11.5  \n   Medical 39 15.5  \n   Orthopaedic 44 17.4  \n   Paediatrics Cardiology 25 10.0  \n   Surgery 51 20.3  \nType of practice    \n   General 159 63.1  \n   Intensive  93 36.9  \nPosition of respondent    \n   Staff nurse 229 93.1  \n   Sister / Matron 17 6.9  \nHighest education level    \n   Diploma 239 96  \n   Degree 10 4.0  \nPost basic education    \n   Yes 50 20.1  \n   No 199 79.9  \n\n\n\n\n\n\n\nTable II. The proportion of correct responses in the knowledge-based \nquestions \n \n\n\n\nCode  Question  n (%) \n\n\n\nK1 Should immediate-release dosage forms be crushed and \nadministered through EFT? \n\n\n\n237 \n(94.4) \n\n\n\nK2 Should sustained-release dosage forms be crushed and \nadministered through EFT? \n\n\n\n99 \n(39.4) \n\n\n\nK3 Should enteric-coated dosage forms be crushed and \nadministered through EFT? \n\n\n\n203 \n(80.9) \n\n\n\nK4 Should teratogenic/carcinogenic medications be crushed \nand administered through EFT? \n\n\n\n139 \n(55.4) \n\n\n\nK5 Should cytotoxic medications be crushed and \nadministered through EFT?  \n\n\n\n125 \n(49.8) \n\n\n\nK6 Should tablet glyceryl trinitrate (GTN) be crushed and \nadministered through EFT? \n\n\n\n232 \n(92.8) \n\n\n\nK7 Should nystatin suspension, indicated for oropharyngeal \ncandidiasis, be administered through EFT? \n\n\n\n212 \n(85.1) \n\n\n\nK8 Should enteral feeding be stopped 1-2 hours prior to the \nadministration of phenytoin capsule?  \n\n\n\n128 \n(51.2) \n\n\n\nK9 When administering hard gelatin capsules through EFT, \nshould the capsules be opened and its content mixed \nwith water? \n\n\n\n149 \n(59.4) \n\n\n\nK10 When administering soft gelatin capsules through EFT, \nshould the capsules be pierced and its content squeezed \nout? \n\n\n\n139 \n(55.6) \n\n\n\n \n\n\n\n\n\n\n\n\nSoon L.et al. Mal J Pharm 8 (1) 2022, 26-31 \n \n\n\n\n31 \n \n\n\n\nAssociation of demographic and knowledge \n \nOur study revealed that nurses from the intensive care setting \nhad more correct responses to particular knowledge-based \nquestions as compared to those from the general ward setting \n(p < 0.05) as shown in Table IV. Such a finding may not be \nunexpected on account of the fact that a higher proportion of \nnurses in the intensive care setting reportedly deal with patients \nrequiring EFT all the time (42.9%) as compared to those in the \ngeneral setting (19.4%). Nevertheless, the duration of services \n\n\n\nand frequency of handling EFT did not seem to be significantly \nassociated with their level of knowledge (refer Table IV). \n \nPreferred way of improving their knowledge and practice \nrelating to EFT \n \nMost of the nurses stated that their most preferred way of \nimproving EFT techniques was through online educational \nprograms, followed by reading materials and bedside teaching. \n \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nTable III. The proportion and percentage of nurses in terms of practice in medication administration through EFT \n\n\n\n\n\n\n\nPractice in medication administration through EFT \nAll the time Often Sometimes Never \n\n\n\nn (%) n (%) n (%) n (%) \n\n\n\nBefore administering the medications, do you routinely flush the enteral feeding tube?  226 (90.4)  6 (2.4)  4 (1.6)  14 (5.6)  \nAfter administering the medications, do you routinely flush the enteral feeding tube?  245 (98.8)  3 (1.2)  0 (0)  0 (0)  \nWhen medications need to be administered through the enteral feeding tube, do you stop \nthe enteral feeding prior to administration?  \n\n\n\n132 (53.2)  25 (10.1)  28 (11.3)  63 (25.4)  \n\n\n\nWhen administering medications through enteral feeding tube, do you add the medications \ninto the enteral feed?  \n\n\n\n32 (12.8)  21 (8.4)  79 (31.6)  118 (47.2)  \n\n\n\nWhen multiple drugs are due at the same time, do you administer the medications separately \nand flush between each administration?  \n\n\n\n43 (17.3)  30 (12.1)  82 (33.1)  93 (37.5)  \n\n\n\nFor medications that should be administered empty stomach, do you stop the feeding 30 \nminutes before and after dosing?  \n\n\n\n158 (63.5)  53 (21.3)  21 (8.4)  17 (6.8)  \n\n\n\nWhen administering medications through enteral feeding tube, do you prop up the patient \nat an angle of 30-45 degrees?  \n\n\n\n231 (92.8)  2 (0.8)  10 (4.0)  6 (2.4)  \n\n\n\nWhen the enteral feeding tube is clogged, do you flush it with 15-30mL of water using a \n50mL syringe?  \n\n\n\n95 (38.0)  32 (12.8)  31 (12.4)  92 (36.8)  \n\n\n\nWhen flushing of tube is required, do you flush the tube with enteral feed? 46 (18.5)  8 (3.2)  18 (7.2)  177 (71.1)  \n \n \nTable IV. The proportion of nurses with correct responses according to ward setting (a) and frequency of dealing with EFT (b); (c) shows the median \nduration of service based on correct and wrong responses \n \n\n\n\nCode \n(a) Ward setting, \n\n\n\nn (%) p value* \n(b) Frequency of dealing with EFT, \n\n\n\nn (%) p value* \n(c) Duration of service in months, \n\n\n\nmedian (IQR) p value* \nGeneral Intensive care All the time Not all the time Correct response Wrong response \n\n\n\nK1 146 91 0.069 64 (92.8) 169 (96.0) 0.286 84 (47) 100 (85) 0.071 \n\n\n\nK2 53 (33.5) 46 (49.5) 0.013 35 (50.7) 71 (40.3) 0.062 84 (48) 85 (36) 0.675 \n\n\n\nK3 131 (82.9) 72 (77.4) 0.285 53 (76.8) 144 (81.8) 0.374 85 (44) 77 (40) 0.054 \n\n\n\nK4 82 (51.9) 57 (61.3) 0.148 35 (50.7) 98 (55.7) 0.484 88 (51) 84 (38) 0.130 \n\n\n\nK5 68 (43.0) 57 (61.3) 0.005 36 (52.2) 85 (48.3) 0.585 85 (54) 84 (35) 0.968 \n\n\n\nK6 145 (92.4) 87 (93.5) 0.725 63 (91.3) 163 (93.1) 0.612 84.5 (19) 84 (46) 0.986 \n\n\n\nK7 125 (79.6) 87 (94.6) 0.001 56 (81.2) 150 (86.2) 0.323 85 (44) 84 (30) 0.378 \n\n\n\nK8 76 (48.1) 52 (56.5) 0.199 39 (57.4) 85 (48.3) 0.204 84 (45) 85 (41) 0.157 \n\n\n\nK9 104 (65.8) 45 (48.4) 0.007 35 (50.7) 110 (62.5) 0.092 84 (48) 84 (54) 0.387 \n\n\n\nK10 84 (53.2) 55 (59.8) 0.310 36 (52.2) 100 (57.1) 0.482 84 (42) 87 (44) 0.061 \n\n\n\n \n*p value for chi-square test; no cell have expected count less than 5 \n\n\n\n\n\n\n\n\nSoon L.et al. Mal J Pharm 8 (1) 2022, 26-31 \n \n\n\n\n30 \n \n\n\n\nDISCUSSION \n \nOverall, the sample of nurses in this study demonstrated a good \nunderstanding of proper EFT administration of commonly \nencountered medications. However, our findings also \nidentified instances of lack of compliance in their knowledge \nand practice compared to current guidelines. Notably, there was \na lack of awareness in two facets; the fact that sustained-\nrelease/modified-release formulations should not be crushed, \nand the unfamiliarity with the proper administration method of \nteratogenic/carcinogenic medications, and indeed, similar \nfindings are reported in previous studies [3,4]. Incognizance of \nthe former can be alarming because adverse events and fatality \ndue to crushed sustained-release medications have previously \nbeen reported [1,2]. In theory, crushing such formulations may \naffect the pharmacokinetic profile of the drug, resulting in \nexcessive peak plasma concentrations and side effects [5]. \nMeanwhile, the correct administration method of \nteratogenic/carcinogenic medications should be reinforced so \nas to avoid the exposure of nurses themselves to the teratogenic \neffects of the medications. [6]. It is highly encouraged for \nnurses to be familiar with the types of medications for which \nfeeding needs to be stopped for 1-2 hours prior to \nadministration to avoid potential drug-feeding interactions.  \n[7].  \n \nIn terms of practice, most nurses in this study were also \nreported to have demonstrated good practice when it comes to \nthe routine flushing of EFT before and after medication \nadministration. Despite that, in situations where multiple \ndifferent medications are to be administered, only a few nurses \nwould flush between medications and administer them \nseparately all the time. These findings are congruent with a \nprevious study conducted in Malaysia [3], whereby more than \nhalf of the nurses reportedly add the medications into the \nenteral formula during administration, while unfortunately \nadministering multiple drugs at the same time. A small number \nof nurses even claimed that they would flush the EFT with \nenteral formula. Such practices are highly discouraged by \ncurrent guidelines due to the risks of drug-nutrient and drug-\ndrug interactions. [6]. Although adverse events were rarely \nreported due to administering multiple medications \nconcurrently through EFT, it cannot be denied that drug-drug \ninteractions and disruption in drug absorption may occur, \nleading to either adverse effects or poor treatment outcomes \n[8]. Meanwhile, drug-nutrient interactions could potentially \ncontribute to tube clogging, hindering the delivery of \nmedications and ultimately leading to suboptimal treatment \n[9,10]. Flushing of EFT with enteral formula also provides a \nfavourable environment for bacterial growth that may increase \nthe risk of infection [9,10]. Hence, good practice in EFT \nmedication administration is crucial in maintaining the patency \nand hygiene of the EFT for its safe and effective use.  \n \n\n\n\nNurses in the intensive care practice have a higher tendency to \nknow that sustained-release formulations, cytotoxic \nmedications and Nystatin suspension should not be crushed or \nserved through EFT. This is possibly due to a more frequent \nexposure to the handling of EFT in the intensive care setting; a \nhigher number of nurses in the intensive care practice reported \nthat they handle EFT all the time compared to those in general \ncare. [3,4]. \n \nIn our study, the most preferred way of improving EFT \ntechniques by nurses would be through online educational \nprograms, possibly due to the convenience it offers, which can \nespecially be true during the pandemic period. On the other \nhand, previous studies have demonstrated that education \nprograms given through evidence-based booklets and teaching \nsessions have been successful in improving nurses\u2019 knowledge \nand practice [11-15]. Specifically, a study by Chen CJ et. al. \nreported that after an educational program was carried out, the \nordinary drug delivery error rate fell significantly from 60.83% \nto 2.42% [11]. \n \nThe main limitation of this research is that it was a single-centre \nstudy. Another limitation is that the assessment of nurses\u2019 \npractice was solely based on a questionnaire, rather than by \ndirect observation. Our suggestion for future studies would be \nto incorporate direct observation as part of the assessment, \nbesides also including an intervention such as the education on \nEFT medication administration. \n \nCONCLUSION \n \nThe knowledge gaps and inconsistencies in practices may \naffect the delivery of medications through enteral feeding, and \nmay potentially compromise patient outcomes. Hence, \ncontinuous educational programs should be carried out to \nensure that the practice of nurses related to enteral feeding is \nsafe, effective and up to date. \n \nACKNOWLEDGEMENT \n  \nThe authors would like to thank the Director-General of Health \nMalaysia for his permission to publish this article. \n \nCONFLICT OF INTEREST \n  \nThe authors declare no conflict of interest. This case report did \nnot receive any specific grant from funding agencies in the \npublic, commercial or not-for-profit sectors. \n \nREFERENCE \n \n[1] Cornish P. \u201cAvoid the crush\u201d: hazards of medication administration \n\n\n\nin patients with dysphagia or a feeding tube. CMaj. 2005; 172 (7): \n871-872. https://doi.org/10.1503/cmaj.050176  \n\n\n\n\n\n\n\n\nSoon L.et al. Mal J Pharm 8 (1) 2022, 26-31 \n \n\n\n\n31 \n \n\n\n\n[2] Schier JG, Howland MA, Hoffman RS, Nelson LS. Fatality from \nadministration of labetalol and crushed extended-release nifedipine. \nAnn Pharmacother. 2003 Oct;37(10):1420-3. \nhttps://doi.org/10.1503/cmaj.050176   \n\n\n\n[3] Oh PY, Lai WM, Hoo FK, Boo YL, Ramachandran V, Ching SW. \nTechniques of medications administration through enteral feeding \ncatheters in a tertiary care hospital, Malaysia. Rawal Med J. 2016; 41: \n225-229.  \n\n\n\n[4] Phillips NM, Endacott R. Medication administration via enteral tubes: \na survey of nurses' practices. J Adv Nurs. 2011 Dec;67(12):2586-92. \nhttps://doi.org/10.1111/j.1365-2648.2011.05688.x  \n\n\n\n[5] Critical Care Pharmacy Handbook 2013. Malaysia: Pharmaceutical \nDivision, Ministry of Health Malaysia. 1st edition. 2013. \nhttps://www.pharmacy.gov.my/v2/sites/default/files/document-\nupload/critical-care-handbook-2013.pdf  \n\n\n\n[6] White R, Bradnam V. Handbook of Drug Administration via Enteral \nFeeding Tubes. 3rd edition. 2015.  \n\n\n\n[7] Au Yeung SC, Ensom MH. Phenytoin and enteral feedings: does \nevidence support an interaction? Ann Pharmacother. 2000 \nJulAug;34(7-8):896-905. https://doi.org/10.1345/aph.19355  \n\n\n\n[8] Ferreira Silva R, Rita Carvalho Garbi Novaes M. Interactions between \ndrugs and drug-nutrient in enteral nutrition: a review based on \nevidences. Nutr Hosp. 2014 Sep 1;30(3):514-8. \nhttps://doi.org/10.3305/nh.2014.30.3.7488  \n\n\n\n[9] Best C. Enteral tube feeding and infection control: how safe is our \npractice? Br J Nurs. 2008 Sep 11-24;17(16):1036, 1038-41. \nhttps://doi.org/10.12968/bjon.2008.17.16.31069  \n\n\n\n[10] Malhi H. Enteral tube feeding: using good practice to prevent \ninfection. Br J Nurs. 2017 Jan 12;26(1):8-14.  \nhttps://doi.org/10.12968/bjon.2017.26.1.8  \n\n\n\n[11] Chen CJ, Lee HF, Fang YC, et al. Improving Nurse Skill of \nMedication Administration via Enteral Feeding Tube. Nur Primary \nCare. 2018; 2(5): 1-5. https://doi.org/10.33425/2639-9474.1078 \n\n\n\n[12] Dashti-Khavidaki S, Badri S, Eftekharzadeh SZ, Keshtkar A, Khalili \nH. The role of clinical pharmacist to improve medication \nadministration through enteral feeding tubes by nurses. Int J Clin \nPharm. 2012 Oct;34(5):757-64.  \nhttps://doi.org/10.1007/s11096-012-9673-8  \n\n\n\n[13] Hossaini Alhashemi S, Ghorbani R, Vazin A. Improving knowledge, \nattitudes, and practice of nurses in medication administration through \nenteral feeding tubes by clinical pharmacists: a case-control study. \nAdv Med Educ Pract. 2019; 10: 493-500. \nhttps://doi.org/10.2147/AMEP.S203680  \n\n\n\n[14] Abu Hdaib N, Albsoul-Younes A, Wazaify M. Oral medications \nadministration through enteral feeding tube: Clinical pharmacist-led \neducational intervention to improve knowledge of Intensive care units' \nnurses at Jordan University Hospital. Saudi Pharm J. 2021;29(2):134- \n142. https://doi.org/10.1016/j.jsps.2020.12.015  \n\n\n\n[15] Dashti-Khavidaki S, Badri S, Eftekharzadeh SZ, Keshtkar A, Khalili \nH. The role of clinical pharmacist to improve medication \nadministration through enteral feeding tubes by nurses. Int J Clin \nPharm. 2012 Oct;34(5):757-64.  \nhttps://doi.org/10.1007/s11096-012-9673-8  \n \n\n\n\n\n\n"
"\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n \nMALAYSIAN \nJOURNALofPHARMACY \n \n\n\n\nSupplement: \nProceedingsofthe9th National Pharmacy R&D \nConference 2016 \n\n\n\n\n\n\n\n\n\n\n\n \n \n \n \nAPublicationoftheMalaysianPharmaceuticalSociety \n\n\n\n \n \n \n \n \nEDITORIAL BOARD \n \n\n\n\nVol. 2 Issue 2. August 2016 \n\n\n\n\n\n\n\nVol.4 Issue 1. July 2018 \n\n\n\n MALAYSIAN \n JOURNAL of PHARMACY \n\n\n\n      In this issue: \n\n\n\n\uf0b7 Serial Drama: Seven Steps to Avoid Falling Foul of  \nFalsified Medicines Directive (FMD) \n \n\n\n\n\uf0b7 Management of Mild Valproic Acid Toxicity with \nHemodialysis \u2013 A Case Report \n\n\n\n\uf0b7 Stability of Extemporaneously Compounded \nChloral Hydrate Oral Solution  \n \nSupplement \n\n\n\nProceedings of the 10th National Pharmacy  \nR&D Conference 2018 \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \nA Publication of the Malaysian Pharmaceutical Society \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy \nVol.4 Issue 1, July 2018 \n___________________________________________________________________ \n \nThe Official Journal of the Malaysian Pharmaceutical Society \n \nEditor-in-Chief:   Assoc. Prof. Dr. Asrul Akmal Shafie \n \nManaging Editor:   Mr. Ho Rhu Yann \n \nInternational Advisory Board: Assoc. Prof. Dr. Chua Siew Siang \n\n\n\nProf. Dr. Mohd Baidi Bahari   \n \nAssociate Editors:   Mr. Lam Kai Kun \n     Prof. Dr. Mohamed Azmi Ahmad Hassali \n     Assoc. Prof. Dr. Mohamad Haniki Nik Mohamed \n     Ms. Syireen Alwi \n     Prof. P T Thomas \n     Dr. Wong Tin Wui \n     Assoc. Prof. Dr. Vikneswaran a/l Murugaiyah \n     Prof. Dr. Yuen Kah Hay \n \n \nPublisher: \n \nMalaysian Pharmaceutical Society  \n16-2 Jalan OP 1/5, 1-Puchong Business Park \nOff Jalan Puchong \n47160 Puchong \nMalaysia \nTel: 6-03-80791861 \nFax: 6-03-80700388 \nHomepage: www.mps.org.my \nEmail: mps.online@gmail.com \n \n\n\n\n\n\n\n\n \nThe Malaysian Journal of Pharmacy is a publication of the Malaysian Pharmaceutical Society. \nEnquiries are to be directed to the publisher at the above address. The Publisher reserves copy- \nright and renewal on all published materials, and such material may not be reproduced in any \nform without the written permission of the Publisher. \n \n\n\n\n\n\n\n\n\n\n\n\n \n \nISSN 1675-3666 \n9 771675 366005 \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nTable of Contents \n \nEditorial \n \nResearch papers \n\uf0b7 Serial drama: seven steps to avoid falling foul of falsified medicines \n\n\n\ndirective (FMD) \n\uf0b7 Management of mild valproic acid toxicity with hemodialysis \u2013 a case report \n\uf0b7 Stability of extemporaneously compounded chloral hydrate oral solution \n\n\n\n\n\n\n\nAcknowledgement \n \n\n\n\n\n\n\n\nReviewers of abstracts \n \n\n\n\n\n\n\n\nList of oral presentations  \n\n\n\nAbstracts of oral presentations  \n\n\n\nList of poster presentations  \n\n\n\nAbstracts of poster presentations  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nEditorial  \n\u00a0\n\n\n\nENHANCING ACCESS TO MEDICINES THROUGH VALUE-BASED \nAPPROACHES \n \nAbdul Haniff b Mohamad Yahaya, PhD \nDepartment of Pharmacy, Hospital Teluk Intan, Perak, Ministry of Health Malaysia \n \nIn the last decade, value has played a key role in healthcare system. The value-based approach \nrefers to a personalized care, where patient\u2019 expectations and needs are included in a holistic \napproach of medicine that considers physical, mental, and spiritual well-being1. Nowadays, the \nparadigm has shifted from evidence-based medicine (EBM) to value-based medicines (VBM). \nThe term \u201cvalue-based\u201d was first introduced by Brown et al as \u201cthe practice of medicines \nincorporating the highest level of evidence-based data with patient perceived value conferred \nby healthcare interventions for the resource expended\u201d2. The aim of introduction of VBM is to \nimprove the quality of healthcare by efficient utilization of resources.  \n\n\n\nThe key principle in VBM is the integration between best clinical evidence and patient \npreferences in the decision making process. Therefore, there are needs for changes in point of \nviews between healthcare providers and patients. As healthcare management is clearly moving \ntowards patient-centered system, we should emphasize on the patients\u2019 empowerment. This \nenables the patients to be an active and effective participant in their own process of care and to \nbe part of the decision. Thus, the utilization of healthcare especially the access to medicines \ncould be enhanced.  \n\n\n\nOur National Medicines Policy (2012) emphasizes on the improvement of access to medicines \nfor the patients. The equitable access and rational use of safe, effective and affordable good \nquality essential medicines to improve health outcomes of the population are the main objective \nof the policy. In addition, it emphasizes the quality use of medicines by patients\u2019 empowerment \non the information. This indirectly sets up a platform to initiate the implementation of VBM.  \n\n\n\nHowever, the resources are still lacking in terms of research especially this country, to enable \nthe success of the implementation of VBM.  Research in patients\u2019 preferences coupled with \nclinical expertise is fundamental towards a value-based system. The current emerging trend in \nresearch has captivated pharmacy profession to shift their focus to \u201cEnhancing Access to \nMedicines through Value-based Approaches\u201d.  \n\n\n\nThis issue of Malaysian Journal of Pharmacy encompasses the collection of abstract \nproceedings that is presented either as oral or poster presentation at the 10th National Pharmacy \nR&D Conference on 9 \u2013 11 July 2018. On behalf of the scientific committee, I would like to \nexpress my sincerest gratitude to all pharmacist researchers who have shown immense passion \nby submitting their interesting research findings for us. \n\n\n\n\n\n\n\n                                                 \n1Marzorati C, Pravettoni G. Value as a concept in the health care system. Journal of Multidisciplinary Healthcare \n2017;10: 101-106 \n2Brown MM, Brown GC, Sharma S. Evidence-based to value-based medicine. Chicago: AMA Press; 2005, p. 5-\n7, 125-149, 151-181, 193-217, 267-279, 319-324 \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nSERIAL DRAMA: SEVEN STEPS TO AVOID FALLING FOUL OF FALSIFIED \nMEDICINES DIRECTIVE (FMD) \n\n\n\nDavison M* \n\n\n\nrfxcel Corporation, 12667 Alcosta Boulevard, Suite 375, San Ramon, California 94583, the \nUnited States of America. \n*Author for correspondence \n\n\n\nINTRODUCTION \n\n\n\nThe Falsified Medicines Directive (FMD) imposes strict serialisation requirements on \npharmaceutical manufacturers, distributors and dispensers. This article outlines everything you \nneed to know and what you need to do for a seamless serialisation process \u2013 before regulators \nremove your right to trade. \n\n\n\nPharmaceutical manufacturers are currently the main actors in a serial drama where getting \ntheir lines right is paramount. Well, four lines of data, to be precise; in (and next to) DataMatrix \nbarcodes applied to every pack of prescription medicines. The introduction of serialisation, \ndesigned to ensure the authenticity and traceability of individual medicines, promises to \nimprove patient safety and create exciting opportunities for digital health. But there is a twist \nin the plot. Failure to comply with the EU regulation that mandates it means you cannot legally \nship your product. No barcode, no trade. That is when a serial drama turns into a tragedy. And \ntime is running out to be ready. \n\n\n\nThe unfolding story of the Falsified Medicines Directive (FMD), which was first introduced in \n2011, is into its final episodes. The denouement arrives on February 9, 2019, when the \nDirective is fully enforced and the penalties for non-compliance officially come into play. FMD \nis an attempt to prevent inauthentic, substandard or harmful medicines entering the supply \nchain. It imposes strict serialisation, traceability and verification requirements on \npharmaceutical manufacturers and their associated wholesalers, distributors and contract \nmanufacturers. In particular, it mandates companies to print a unique identifier on the \npackaging of prescription medicines. Furthermore, companies are not just responsible for the \ndata that goes on the packaging, they are responsible for submitting it to the central data hub \nthat will enable pharmacists to authenticate products before they dispense them. It is a complex \nundertaking that could be easily underestimated - but not if you understand some key steps.  \n\n\n\nThe implementation of serialisation is not an overnight task \u2013 it encompasses processes that \nhave multiple touch-points across global organisations, partner networks and the wider supply \nchain. Yet despite this \u2013 and despite the enormous implications of getting it wrong \u2013 many \ncompanies are still some distance from being fit for purpose. Indeed, in some organisations, \nthe Directive has not yet hit their radar. It needs to \u2013 because the clock is ticking. But all is not \nlost. Here are seven steps to successful serialisation. \n\n\n\n1: GET EXECUTIVE BUY-IN \n\n\n\nThe significance of serialisation is often underestimated. It is typically considered a production \nissue and punted to manufacturing as an operational challenge. Yet serialisation is a board level \nissue, with ramifications that could directly affect business performance. Indeed, it is not a \nmanufacturing cost \u2013 it is a business continuity risk that touches every aspect of an \norganisation. So the first step towards serialisation \u2013 one that is often overlooked \u2013 is to appoint \nan executive sponsor, ideally with board level oversight, to lead a holistic strategy. \nImplementation will naturally be delegated to project teams, but executive leadership will be \ncrucial to making things happen quickly. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n2: ASSEMBLE A MULTI-DISCIPLINARY TEAM \n\n\n\nMulti-disciplinary engagement is essential. Many organisations do not understand all their \nbusiness processes in sufficient detail to overlay serialisation. It is therefore vital that a multi-\ndisciplinary team (MDT) is convened at the earliest opportunity to map the process flow of the \nbusiness and establish a roadmap of how serialisation can be applied across multiple \norganisational boundaries. An MDT should actively engage representatives from \nmanufacturing, supply chain, information technology, legal/regulatory and partner/contract \nmanagement. \n\n\n\n3: ESTABLISH LONG-TERM USER REQUIREMENTS TO ENSURE YOU RE \n\u2018FUTURE READY\u2019 \n\n\n\nThe next step is to define your user requirements and establish a template for the solution that \nwill help ensure you are compliant. You must consider immediate and long-term factors. For \nexample, which markets do you currently ship product to and which do you plan to target in \nthe future? Which products in both your portfolio and your pipeline will need to be coded? Is \nthere a potential future requirement to be able to track and trace products as they journey \nthrough the supply chain? Regulations, from FMD to the US Drug Supply Chain Security Act \n(DSCSA), differ from country to country and are constantly evolving. Take the opportunity to \nbecome \u2018future ready\u2019 by creating a design template that does not just focus on FMD but is \nflexible enough to be interoperable and implementable between national systems and provides \nthe flexibility to adapt to change as it happens. \n\n\n\n4: UNDERSTAND THE DATA IMPLICATIONS OF FMD \n\n\n\nThe barcodes required for FMD must include 4 lines of data; Global Trade Item Number \n(GTIN), serial number, batch number and expiry date. Some countries require a fifth element, \nusually for national reimbursement purposes. These datasets often live in disparate systems \nwithin organisations. The master data \u2013 including GTINs \u2013 is fixed information that is \ncommonly stored in an enterprise resource planning (ERP) system. Although that data does not \nchange, it still requires attention to ensure it is clean and accurate when uploaded to the \nrepositories. In terms of variable data, the processes required to generate serial numbers, \ntransfer them to production and ensure they are used appropriately are complex. Managing that \nimmensity of numbers throughout the supply chain lifecycle is hugely important; mistakes can \nlead to expensive delays, medicines shortages and loss of revenue. Serialisation software is \ntherefore an essential requirement to help you maintain control of all aspects of fixed and \nvariable data. \n\n\n\n5: CHOOSE THE RIGHT SOFTWARE \n\n\n\nThere are numerous factors to consider when selecting software: \n\n\n\nQuality \n\n\n\nSerialisation should not be divorced from the founding principle of Good Manufacturing \nPractice (GMP) \u2013 quality. GMP guidelines, as well as data integrity advice from regulators \nsuch as the UK MHRA, state that users of computer systems must always be in control. \nHowever, multi-tenant serialisation solutions (where multiple independent entities share the \nsame instance of a software solution) can sometimes impose software updates without prior \ndialogue, leaving users out of control. The potential impact on quality is significant. Passive \nacceptance of change is not an option. Multi-tenant solutions require license-holding \ncompanies to ensure that risk assessment processes are in place to monitor and adapt to change. \nBy contrast, the most effective solutions allow users to maintain control of their specific \nsoftware instance and to dictate the timing, relevance and nature of upgrades. \n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nData Validation \n\n\n\nAn effective solution will focus on both connectivity and data integrity. Some systems \nconcentrate on enabling a connection and flow of data across and between organisations but \nare blind to data quality. Companies should never assume that the data entering, or generated \nwithin, their systems is clean, tidy and accurate. Internal data checks are essential. The best \nsolutions routinely monitor data to detect human error, inaccuracy and duplication. Smart \nsolution providers validate data flowing through a system \u2013 in some cases up to 70 data \nvalidation checks on incoming records to ensure its integrity - essentially preventing bad data \nentering the EU hub. \n\n\n\nNetwork connectivity \n\n\n\nIt is not enough to ensure your own business is ready: your partners must be ready too. With \noutsourcing now common across the industry, it is important that the software you use connects \nall parties to a single version of the truth. The most effective solution providers connect your \nentire partner network as standard. This means more than just having a potential connection \u2013 \nit means working with you and your partners to make sure that data really flows.  \n\n\n\n6: CHOOSE THE RIGHT PARTNER \n\n\n\nIt is important to find a vendor that can partner with you to design responsive solutions that go \nbeyond technology. Certification of your vendor by the European Medicines Verification \nOrganisation (EMVO) is a pre-requisite if you want to be compliant. In addition, a partner \nshould be a recognised provider with experience, credibility and evidence that shows it can \nimplement effectively within tight timeframes. A good partner will be committed to your \nsuccess, keeping you abreast of fluctuating global regulations, and collaborating with you to \ncustomise solutions that adapt to changes in your business and the wider marketplace. \n\n\n\n7: ACT NOW \n\n\n\nThe complexities of serialisation mean that a failure to act now could make it extremely \ndifficult to complete implementation in time for the FMD deadline. Moreover, with the fees \nfor registering with EMVO and other affiliate repositories set to increase in June, the internal \ncosts of your project will inevitably rise if you wait. However, the biggest price of non-\ncompliance will be your inability to ship product. So why risk it?  \n\n\n\nAct now and you can prevent your serial drama becoming a tragedy. \n\n\n\nCONFLICT OF INTEREST \n\n\n\nThe author is the Head of Operations in the European Union (EU) for rfxel Corporation.  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nMANAGEMENT OF MILD VALPROIC ACID TOXICITY WITH \nHEMODIALYSIS \u2013 A CASE REPORT \n\n\n\nChow NK*, Heng LM \n\n\n\nDepartment of Pharmacy, Hospital Kulim, Jalan Mahang, 09000 Kulim, Kedah, Malaysia. \n*Author for correspondence \n\n\n\nABSTRACT \n\n\n\nThe management of Valproic Acid (VPA) toxicity is mainly supportive treatment. Invasive \nmanagement such as hemodialysis (HD) and hemoperfusion were only used in isolated cases \nwhere patient is highly VPA toxic, which results in coma. We described a case of mild VPA \ntoxicity (VPA serum concentration 326.42mcg/mL), where the patient was successfully treated \nwith two hours of low-flux HD with no complication. While the guideline of indication of HD \nin VPA toxicity has yet to be published, low-flux HD can be an effective treatment in cases of \nmild VPA toxicity, if other supportive measures failed or not available. \n\n\n\nKEYWORDS: Valproic acid toxicity; hemodialysis; therapeutic drug monitoring; \npharmacokinetic \n\n\n\nINTRODUCTION \n\n\n\nValproic acid (2-propylpentanoic acid; VPA) is widely prescribed for the treatment of epilepsy, \nbipolar mood disorder (BMD), and for migraine prophylaxis. VPA toxicity is an uncommon \nproblem seen in clinical practice. However, due to its increased usage, accidental and \nintentional overdose can occur. Serious VPA toxicity may lead to coma, confusion, \nsomnolence, hallucinations, cerebral edema and even death. Currently, the VPA toxicity \nmanagement recommended include initial stabilization and resuscitation, decontamination, \npharmacologic therapy, hemodialysis (HD) or hemoperfusion. There are isolated case reports \nand systematic review regarding management of VPA toxicity, yet, a consensus guideline or \nprotocol is still not available. Hereby, we report a case of VPA toxicity successfully treated \nwith two hours of low-flux HD, resulting in a marked reduction of VPA serum concentration \nand toxicity symptoms subsided. \n\n\n\nCASE PRESENTATION \n\n\n\nA 30-year-old woman presented to the Emergency Department at 4.30am due to vomiting and \nexcessive drowsiness after multiple medications ingestion at around 2.30am. The empty \nmedications strips include missing of eight tablets paracetamol, ten tablets chlorpheniramine \nmaleate, ten tablets sodium valproate (Epilim\u00ae), and twenty tablets gabapentin. Patient has no \nunderlying epilepsy or psychiatric related illness, and denied high risk behaviour or history of \nsubstance abuse. The medications ingested were taken from her uncle who has BMD. Upon \nadmission, patient was not responding to call and pupils sluggish bilaterally (2mm/2mm). Vital \nsigns were normal with oxygen saturation 100% and blood glucose 5.7mmol/L.  \n\n\n\nMANAGEMENT AND OUTCOME \n\n\n\nPatient was given 50g oral activated charcoal (AC) at 6.45am but could only tolerate 25g. She \nwas then sent for brain computed tomography (CT) scan. The serum VPA concentration taken \nat 5 hours post ingestion for Therapeutic Drug Monitoring (TDM) measured by fluorescent \npolarization (Cobas Integra 400 plus analyzer, Roche Diagnostics (M) Sdn. Bhd.) was \n326.42mcg/mL (therapeutic range 50-100mcg/mL). Paracetamol, salicylic acid, phenytoin and \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\ncarbamazepine toxicity had also been ruled out. After CT scan, patient was noted to be drowsier \nwith Glasgow Coma Score (GCS) of 12/15, laboured breathing and was not respond to pain \nstimuli. The patient was then intubated, ventilated and sedated and was admitted to the \nintensive care unit. All the blood investigations were normal. Low-flux HD (via a right femoral \nvenous catheter) was performed for two hours with blood flow rate 150 mL/min and was \nuneventful. On the next day, the second TDM result (12 hours post HD) showed a marked \ndecrease in VPA level to 37.14mcg/mL (non-toxic). Patient had regained full GCS with normal \narterial blood gas (ABG) result. She was then extubated and referred to psychiatrist and allowed \nto discharge two days later with no complication. \n\n\n\nDISCUSSION \n\n\n\nThe classification of VPA toxicity is dose dependent. Mild: Dose >200mg/kg and having risk \nof CNS depression; moderate: >400mg/kg and having risk of multi-organ system toxicities; \nsevere: >750mg/kg and is potentially lethal. Maximum therapeutic dose is 60mg/kg/day.1 Since \nthe exact quantity of VPA ingested by the patient might not be accurate, we can only categorize \npatient based on the symptoms of CNS depression, which is mild toxicity. \n\n\n\nOverdose of gabapentin and chlorpheniramine maleate can cause subtle mental status changes \nand drowsiness too. However, only mild clinical effects have been documented following \nsignificant overdose of gabapentin and chlorpheniramine due to their benign side-effect profile. \nVPA has neither significant interaction nor synergism effect with both gabapentin and \nchlorpheniramine. \n\n\n\nThe time for the enteric-coated sodium valproate tablet to reach maximum concentration (Tmax) \nnormally occurs within 3-7 hours. In this case, deterioration of patient condition happened at \naround 5 hours post ingestion might be due to the high serum VPA concentration at Tmax. \n\n\n\nDecontamination with activated charcoal is best to be administered within 0.5-1 hour of VPA \ningestion for maximum effect. AC may still be indicated after one hour post ingestion for \nenteric coated preparation due to the potentially delayed absorption. As this patient was \nadmitted two hours post ingestion and could not tolerate AC, other modes of treatment are \nrequired. \n\n\n\nSome literatures had documented naloxone for the reversal of sedation and coma at VPA level \nof 487.8mcg/mL and in cases of opioid co-ingestion.2 Since this patient\u2019s condition was \nmanageable after intubation, naloxone was not given. On the other hand, L-carnitine is also \nsuggested for hyperammonemia associated with carnitine deficiency caused by long-term or \nhigh-dose VPA use. L-carnitine is not available in our setting and this patient had normal liver \nfunction tests with no hyperammonemia.  \n\n\n\nTherefore, the modes of treatment left to enhance elimination of VPA from the body available \nin our setting were HD and hemoperfusion. Despite the benefit of extracorporeal elimination \ntechniques is undeniable, the clear indication and method of the techniques in VPA toxicity is \nstill undefined. Charcoal hemoperfusion is proved to be more superior in clearing protein-\nbound and lipid soluble drugs, with equal effectiveness in clearing water soluble and small \nmolecule drugs if compared to HD.3 Since VPA is poorly water soluble (solubility in water \n1.3mg/mL at room temperature), charcoal hemoperfusion seems to be more eligible treatment \noption. However, it has limitation in terms of complications, such as thrombocytopenia, \nelectrolyte imbalance, disturbances in coagulation and technically and logistically more \ncomplicated. 3, 4 \n\n\n\nOn the other hand, VPA is a small molecule (MW 144.2) with about 90% plasma protein \nbinding. At supratherapeutic level, the binding sites may become saturated, causing the amount \nof free drug to increase rapidly.4 Low molecular weight and decreased protein binding during \ntoxicity make it ideal for removal through HD. With 2 hours of low-flux HD conducted, the \nVPA serum concentration was able to reduce by 88.6%.  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nRebound phenomenon was reported by a few studies, where a slight increase in VPA levels \nnoted after termination of HD.4, 5 This suggests that VPA may not follow single compartment \nkinetics at toxic concentration and redistribution from other body compartments may occur. In \norder to avoid rebound concentration of VPA after HD, repeated TDM level of VPA was \nscheduled at 12 hours post HD. \n\n\n\nCONCLUSION \n\n\n\nWe have shown in our patient that HD is effective to eliminate excess VPA concentration in \nacute poisoning case when supportive measures failed or not available. More studies are \nrequired to identify the recommended indication for HD based on VPA serum concentration \nand also weighing the risk and benefit of HD or hemoperfusion in different clinical situation. \nMore evidences are also needed regarding the TDM sampling time of VPA serum \nconcentration in acute toxicity cases, including the initial post ingestion sampling time and also \npost dialysis sampling time, by taking the rebound phenomenon into consideration. \n\n\n\nACKNOWLEDGEMENT \n\n\n\nThe authors would like to thank the Director General of Health Malaysia for his permission to \npublish this article. \n\n\n\nCONFLICT OF INTEREST \n\n\n\nThe authors affirm that this case report is original and have no conflict of interest to disclose. \n\n\n\nREFERENCES \n\n\n\n1. Truven Health Analytics. Micromedex Drug Information. Michigan: Truven Holding Corp; \n2017. \n\n\n\n2. Thanacoody HKR. Chronic valproic acid intoxication: reversal by naloxone. Emerg Med J \n2007; 24: 677\u2013678. \n\n\n\n3. Winchester JF. Hemoperfusion. In: Drukker W, Parsons FM, Maher JF, editors. \nReplacement of renal function by dialysis: a textbook of dialysis. Netherlands: Springer; \n1983: 305-322. \n\n\n\n4. Meek MF, Broekroelofs J, Yska JP, Egbers PHM, Boerma EC, van der Voort PHJ. Valproic \nacid intoxication: sense and non-sense of haemodialysis. The Journal of Medicine, \nNetherlands, October 2004; 62 (9): 333-336. \n\n\n\n5. Van der Wouden EA, Dekkers A, Kruis HME, van Geijlswijk IM, Tjan DHT, Feith GW. \nExtracorporeal elimination in acute valproate intoxication. BMJ Case Reports 2009. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nSTABILITY OF EXTEMPORANEOUSLY COMPOUNDED CHLORAL \nHYDRATE ORAL SOLUTION  \n\n\n\nFreeda Thean1*, Chan LT2, Lucy Yeoh3, Yeap PC4 \n\n\n\n1Product Development, Winwa Medical Sdn. Bhd., Bukit Mertajam, Pulau Pinang, Malaysia. \n2Product Management, Winwa Medical Sdn. Bhd., Bukit Mertajam, Pulau Pinang, Malaysia. \n3Quality Control, Winwa Medical Sdn. Bhd., Bukit Mertajam, Pulau Pinang, Malaysia. \n4Product Development, BioScenergy International Sdn. Bhd., Kuala Lumpur, Wilayah \nPersekutuan, Malaysia. \n*Author for correspondence at freedathean@winwamedical.com \n\n\n\nABSTRACT \n\n\n\nThe objective of this study is to look into the stability of Chloral Hydrate 40 mg per ml \nformulated as oral solution in X-temp Oral Suspension System in order to select proper storage \nconditions and establish beyond-use date. X-temp is a novel oral, flavoured sugar-free \nextemporaneous compounding vehicle to assist in the preparation of extemporaneous dosage \nforms.  \n\n\n\nThe compounded solution of 40 mg/ml was prepared by dissolving chloral hydrate powder in \nX-temp vehicle. The solution was then packed in amber HDPE containers, and were stored at \nrefrigeration 5 \u00b1 3\u00b0C and room temperature 30\u00b0C. Physical, chemical and microbiological \nparameters were evaluated at predetermined time-points up to 180 days. Samples were tested \nusing a validated stability\u2013indicating assay. Chloral hydrate concentration was assayed by \nhigh-performance liquid chromatography (HPLC). \n\n\n\nThe stability results indicated that the solution remained unchanged in visual appearance or pH \nat both refrigeration and room temperature for up to 180 days. The HPLC results showed that \nall the stability studies maintained 90 \u2013 100% of initial drug concentration. There was no \nsubstantial changes in the microbiological stability. \n\n\n\nChloral hydrate solution prepared in X-temp Oral Suspension System was stable for up to 180 \ndays when stored at room temperature and refrigeration conditions. These results demonstrated \nthat X-temp is a suitable vehicle for extemporaneous compounding for chloral hydrate.  \n\n\n\nINTRODUCTION \n\n\n\nExtemporaneous preparation refers to a limited amount of a custom-made product prepared for \nan individual when medications and formulations are not commercially available in a suitable \ndosage that meet fully the clinical needs of a particular patient1. Extemporaneously prepared \ndrug formulation is essential to provide optimal pharmaceutical care to special patient \npopulations. \n\n\n\nThese include paediatric patients, patients who are unable to swallow solid dosage forms, \npatients who must receive medications via nasogastric or gastrostomy tubes and patients who \nrequire non-standard doses that are more easily and accurately measured by using a liquid \nformulation that allows for the dose to be reliable and reproducibly measured2. \n\n\n\nChildren, especially the younger age groups, may require age-appropriate formulations \nallowing for both safe and accurate dose administration. The most acceptable drug forms in \npaediatric population are oral liquids. Often, liquid formulation forms are not commercially \navailable due to many factors including small market size and physicochemical factors2. \n\n\n\nDue to convenience and availability of ingredients, commercially available tablets or capsules \nfor adults are often used to prepare extemporaneously oral liquids for children. Hence there \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nmay be potential interactions between the drug and the excipients of the solid dosage in the \nprepared oral liquid3. \n\n\n\nIn many practice setting, there is a lack of choice or availability of excipients such as \nsuspending agents, sweeteners, flavours and preservatives necessary for compounding \nextemporaneous solutions. Hence, pharmacists use commercial dispersing media to compound \nsyrups from an active substance or from tablets available on the market. Commercial vehicles \nare considered an excellent and convenient choice for compounding extemporaneous solutions \nas they contain a combination of suspending agents, sweeteners and flavours, stabilised with \npreservatives. \n\n\n\nCHLORAL HYDRATE \n\n\n\nUses and Administration \n\n\n\nChloral hydrate is a hypnotic and sedative. The active metabolite of chloral hydrate, \ntrichloroethanol enhances the GABA (gamma-amino-butyric acid) receptor complex to \nproduce its pharmacological effect4 and therefore has properties similar to those of the \nbenzodiazepines, non-benzodiazepines and barbiturates.  \n\n\n\nChloral hydrate is a widely used oral sedative hypnotic drug in paediatrics for the short term \nmanagement of insomnia. It has been used for sedation and as a sedative for premedication. \nDespite the availability of other sedatives such as midazolam and pentobarbital, it is one of the \nmost commonly used sedatives in the clinical setting5. It is easily administered with high \nsuccess rate and low prevalence of adverse reactions5. It is used especially to administer to \nchildren before diagnostic procedures such as computerised axial tomography scan and \nmagnetic resonance imaging that require patient immobility. It is also used in intensive care \nunits, paediatric emergency departments and dental surgery to reduce anxiety and stress \nprovoked by technological procedures, light and sound levels and the presence of strangers. It \nis a cheap, effective and safe drug that can be easily handled and administered when performing \nnasofibroscopy6. \n\n\n\nChloral hydrate is more effective than midazolam when it is used as a sleep inductor for \nelectroencephalogram recordings in children age one to five years old. A deeper level of \nsedation can be achieved compared with other sedative agents and children remain calmer \nwhen undergoing echocardiography6. Other traditional sedative agents (such as midazolam, \npropofol and ketamine) can produce untoward effects on the respiratory drive or can have \ncardiovascular side effects. These characteristics of chloral hydrate make it potentially useful \nin the treatment of infants who require sedation in a Paediatric Cardiac Intensive Care Unit \n(PCICU)5. \n\n\n\nFormulation \n\n\n\nAt present, there is no commercially available liquid formulation of chloral hydrate. Because \nof this shortage, it is prepared as an extemporaneous formulation in hospital pharmacies. The \n10% oral solution of chloral hydrate is found in the United States Pharmacopeia 30th edition \n(USP) while the Argentine Pharmacopeia (6th edition) has documented the 7% chloral hydrate \nsyrup. Flavoured syrups are widely preferred by paediatric patients because it can effectively \nmasks unpleasant taste and has good texture and palatability6. \n\n\n\nChloral hydrate (Figure 1) is a colorless, transparent or white crystals with an aromatic, \npenetrating and slightly acrid odour. It is very soluble in water and in olive oil. It is freely \nsoluble in alcohol, chloroform and ether.  \n\n\n\nIt volatilises slowly on exposure to air and melts at about 55\u00b0C. It is light sensitive, \ndecomposing upon exposure and has to be stored in air tight containers. A 10% solution in \nwater has a pH of 3.5 to 5.5.  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nFigure 1: Molecular Formula of Chloral Hydrate \n\n\n\n\n\n\n\nChloral hydrate has an unpleasant, caustic bitter taste and is corrosive to skin and mucous \nmembrane. The most frequent adverse effect is gastric irritation, abdominal distension and \nflatulence. Chloral hydrate is given by mouth as an oral liquid or as a gelatine capsule with \nchloral hydrate dissolved in a suitable vehicle. It should not be given as tablets because of the \nrisk of damage to the mucus membrane of the alimentary tract. Oral dosage forms should be \ntaken well diluted or with plenty of water or milk. Because of its unpleasant taste and its irritant \naction on the gastric mucosa, oral dosage is best avoided in gastritis7. \n\n\n\nFew stability studies of chloral hydrate liquid preparation have been conducted. Based on the \npH evaluation and decomposition products by capillary electrophoresis, Kakehi et. al.8 reported \nthat the content of chloral hydrate in syrup at room temperature of 30\u00b0C and 60\u00b0C, did not \nshow any substantial change over 3 months at both storage conditions. Stability study of chloral \nhydrate 40 mg/ml formulated in 50% simple syrup with pineapple flavour was reported by \nTaguchi et. al.9 The chloral hydrate concentration was found to be stable for at least 14 days \nwhen stored at cold and dark conditions but there was a loss of colour during the storage \nduration10. \n\n\n\nHence there is a need to develop a convenient liquid formulation in order to supply safe and \nreliable dosage for paediatrics. In this context, the objective of this work is to evaluate the \nphysical, chemical and microbiological stability of chloral hydrate compounded in a suitable \nliquid vehicle both under room and refrigeration conditions in plastic bottles to provide the \ninformation and data to assist the pharmacist to determine the shelf life of the chloral hydrate \nextemporaneously prepared in the hospital.  \n\n\n\nMATERIALS AND METHODS  \n\n\n\nFormulation and Study Design \n\n\n\nCurrently there is no commercially available liquid formulation of chloral hydrate. The \npreparation was prepared from the active pharmaceutical ingredient in powder sourced from \nFischer Scientific, Malaysia.  The commercial vehicle X-temp Oral Suspension system \nmarketed by Pharm-D Sdn. Bhd. Malaysia was selected to compound this preparation. The \ncommercial vehicle is formulated specifically to assist in extemporaneous preparation of oral \nliquid; syrup or non-soluble (suspended) aqueous dosage form. It is sweetened, orange flavour, \nsugar-free vehicle with suitable preservatives.  \n\n\n\nPreparation of Chloral Hydrate Oral Solution \n\n\n\nThe following procedure was performed for the preparation of chloral hydrate oral solution 40 \nmg per ml compounded from pure drug powder. A mortar and pestle was used for \ncompounding. First, the quantity of vehicle required was measured. The amount of chloral \nhydrate required is measured and placed into a mortar. A small amount of X-temp was used to \nlevigate the powder to form a smooth and uniform paste.   Under constant mixing, small amount \nof vehicle was gradually added to the paste to form a liquid. The blend was transferred to a \ngraduated container. Some vehicle was added to rinse the remaining drug from the mortar and \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\ntransferred to the graduated container. The remaining X-temp vehicle was incorporated to the \ngraduated container to achieve the final volume. \n\n\n\nThe chloral hydrate oral solution was bottled into 100 ml semi-transparent high-density \npolyethylene (HDPE) containers and was fitted with white polypropylene (PP) screw caps.  \n\n\n\nThirty two bottles of the oral solution were prepared. These are kept under two- predetermined \nconditions to simulate the dispensing conditions:  one group was stored at 5 \u00b1 3oC \n(refrigeration) and the rest of the samples was stored at 30 \u00b1 2oC / 75% RH \u00b1 5% RH (room \ntemperature) in the absence of light. All samples were labeled and kept for 180 days. \n\n\n\nSTABILITY EVALUATION  \n\n\n\nStability evaluation of a formulation should take into account its physical, chemical and \nmicrobiological stability. \n\n\n\nSamples of each storage condition were collected at intervals of 1, 14, 28, 60, 90, 120, 150 and \n180 days. Before taking the samples for analysis, the bottles were manually shaken for a few \nseconds.   \n\n\n\nPhysical Stability \n\n\n\nAt each time point, all samples were examined for obvious changes in colour, odour and clarity. \nPhysical stability was assessed by visual examination and defined as the absence of any change \nin appearance, colour, odour and visible particulate matters.  \n\n\n\nPhysical stability also includes compliance of the specific gravity according to in-house \nspecification of 1.02 \u2013 1.08 g/ml.  \n\n\n\nThe extemporaneous preparation is considered stable if physical characteristics have remained \nfairly unchanged. \n\n\n\nChemical Stability \n\n\n\nChemical stability was evaluated by high-performance liquid chromatography  (HPLC)  \nquantification and pH measurement. Chemical stability was determined following the \nconcentration of chloral hydrate in the samples. To be considered stable, the preparation had \nto retain a minimum of 90% of its initial drug dose and a pH value between 3.8 and 4.8.   \n\n\n\nAnalytical Method and Equipment \n\n\n\nChloral hydrate concentration was assayed using HPLC. The assay method was developed \naccording to the in-house HPLC method with reference to the British Pharmacopoeia (BP) \n201411. The HPLC system used for the analysis was an Agilent 1200 RRLC instrument with \nbinary pump SL, autosampler SL, DAD SL detector, Thermostat Column Compartment SL \nand chemstation. The chromatographic separation used was Zorbax Eclipse XDB-C18 (4.6 mm \nID x 150 mm, 5 \uf06dm). The DAD detector operated at 220 nm. The mobile phase consisted of a \nmixture of 80 volumes of 0.02M potassium dihydrogen phosphate (KH2PO4) phosphate buffer \nadjusted to pH 8.00 with orthophosphoric acid 85% or 10M potassium hydroxide (KOH) and \n20 volumes of acetonitrile. The mobile phase was delivered at a flow rate of 1ml/min.  \n\n\n\nAbout 2.5 ml of sample were prepared in duplicate and dissolved in 100 ml of mobile phase \nand further diluted to obtain final concentration of chloral hydrate 0.1 mg per ml. Equivalent \nstandard concentration of 0.1 mg per ml was prepared using same mobile phase. Both solutions \nwere filtered through 0.45 \uf06dm syringe filter before HPLC analysis and the injection volume as \n100 \uf06dL. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nThe HPLC method for the analysis of chloral hydrate in this study was validated in a former \nshort-term stability study of extemporaneously prepared chloral hydrate oral solution using the \nabove formulation. The validation of the analytical methods includes linearity, accuracy, \nspecificity, precision and system suitability (Table 1).  \n\n\n\nA range performed on the HPLC system has confirmed the linearity of the method \n(R2=0.99988) (Figure 2).  \n\n\n\nTable 1: Results of Analytical Method Validation \n\n\n\nTest Parameter Validation Results Acceptance Limits \n\n\n\nSpecificity \nIdentification  \nComparison with a known \nreference material \n \n \nAssay \nPlacebo/Matrix analysis \n\n\n\n \n \n\uf0a7 Positive result \n \n\uf0a7 No peaks at RT 3.7 min \n\n\n\n\n\n\n\n\uf0a7 No interfering peaks from \nexcipients were observed \n\n\n\n\uf0a7 Placebo effect = - 0.50% \nThe placebo effects were \nfound to be insignificant\n\n\n\n \n \n\uf0a7 Positive control: \n\n\n\nPositive result.  \n\uf0a7 Negative control: \n\n\n\nAbsence of peak at  \nRT 3.7 min \n\n\n\n\uf0a7 No interference from \nexcipients \n\n\n\n\uf0a7 Placebo Effect NMT \n1.5% \n\n\n\nLinearity & Range  \uf0a7 r2 = 0.9998810 \n\uf0a7 Y-Intercept at 100% \n\n\n\nworking  concentration = \n1.18%  \n\n\n\n\uf0a7 r\u00b2  \u2265 0.995 \n\uf0a7 Y-Intercept at 100% \n\n\n\nworking  concentration \n\u2264 2% \n\n\n\nAccuracy  \n9 determinations (3 \nreplicates/3 concentrations) \n\n\n\n \n\uf0a7 97.0%, 100.3%, 99.3%, \n\n\n\n98.3%, 97.6%, 97.0%, \n98.3%, 97.8%, 97.5% \n\n\n\n \n\uf0a7 % recovery within \n\n\n\n95%  to 105% \n\n\n\nPrecision (Repeatability) \n6 determinations at 100% \nworking concentration \n\n\n\n \n\uf0a7 RSD = 0.68% \n\n\n\n\n\n\n\n \n\uf0a7 RSD \u2264 2.0%  \n\n\n\nPrecision (Reproducibility) \n6 determinations at 100% \nworking concentration \n\n\n\n \n\uf0a7 RSD = 0.82% \n\n\n\n\n\n\n\n \n\uf0a7 RSD \u2264 2.0%  \n\n\n\nPrecision  \n(Intermediate Precision/ \nRuggedness) \n\n\n\n \n\uf0a7 RSD = 0.86% \n\n\n\n \n\uf0a7 RSD \u2264 2.0%  \n \n\n\n\nSystem Suitability  \na. System Precision \n \n\n\n\nb. Peak Performance \n\n\n\n \n\uf0a7 RSD = 0.90% \n \n\uf0a7 k' = 2.689 \n\uf0a7 Resolution > 2 \n\uf0a7 USP tailing factor = 1.414 \n\uf0a7 Column efficiency = 5205 \n\n\n\n \n\uf0a7 RSD  \u2264 2% \n \n\uf0a7 k' \u2265 1.5 \n\uf0a7 Resolution >2 \n\uf0a7 USP tailing factor < 2  \n\uf0a7 Column efficiency \u2265 \n\n\n\n2000 \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \nMicrobiological Stability \n\n\n\nMicrobiological stability of the chloral hydrate oral solution stored at 5\u00b0C and 30\u00b0C was carried \nout on day 1, 14, 28, 60, 90, 120, 150 and 180 to determine if they comply with the microbial \nattributes of non-sterile pharmaceutical products according to the BP 2014. The \nmicrobiological evaluation was determined based on total aerobic microbial count below 2 X \n102 cfu/g, total combined yeasts & moulds count below 2 X 10 cfu/g and absence of \nEscherichia coli (E. coli).  \n\n\n\nRESULTS AND DISCUSSION \n\n\n\nPhysicochemical Stability \n\n\n\nThroughout the study period, the results of the visual appearance and odour of the chloral \nhydrate oral solution remained unchanged at both temperatures (Table 2). Also, there were no \nnotable changes in pH and the specific gravity of the extemporaneous preparations at both \ntemperatures (Table 3). In fact, visual appearance, smell, taste and mouth feel are factors that \ncan influence patient acceptance and compliance, specifically in the paediatric patients and are \nimportant factors to consider in the development of a suitable extemporaneous preparation.  \n\n\n\n\n\n\n\nFigure 2 : Calibration Curve of the LC Assay Method \n\n\n\n-100\n\n\n\n0\n\n\n\n100\n\n\n\n200\n\n\n\n300\n\n\n\n0.10 0.20\n\n\n\n [mAU]\n\n\n\n [mg/ml]\n\n\n\n  y = 970.0758x + 1.1501\n\n\n\n  Conf(0)=[-0.7292 ; 3.0293]\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nTable 2: Visual Appearance and Odour of Chloral Hydrate Oral Solution \n\n\n\nVisual Appearance (Colour and Clarity) \n\n\n\nTime \n(Days) \n\n\n\n1 14 28 60 90 120 150 180 \n\n\n\n5\u00baC \nWhite to off-\n\n\n\nwhite & \nopaque \n\n\n\n\u221a \u221a \u221a \u221a \u221a \u221a \u221a \n\n\n\n30\u00baC \nWhite to off-\n\n\n\nwhite & \nopaque \n\n\n\n\u221a \u221a \u221a \u221a \u221a \u221a \u221a \n\n\n\nOdour \n\n\n\nTime \n(Days) \n\n\n\n1 14 28 60 90 120 150 180 \n\n\n\n5\u00baC Orange \u221a \u221a \u221a \u221a \u221a \u221a \u221a \n\n\n\n30\u00baC Orange \u221a \u221a \u221a \u221a \u221a \u221a \u221a \n\n\n\n\u221a = Conforms to Specification \n \n\n\n\nTable 3: pH and Specific Gravity of Chloral Hydrate Oral Solution \n\n\n\npH \n\n\n\nTime \n(Days) \n\n\n\n1 14 28 60 90 120 150 180 \n\n\n\n5\u00baC 4.086 4.100 4.092 3.960 4.137 4.118 4.142 4.093 \n\n\n\n30\u00baC 4.086 4.064 4.051 3.850 3.999 3.994 4.053 3.905 \n\n\n\nSpecific Gravity \n\n\n\nTime \n(Days) \n\n\n\n1 14 28 60 90 120 150 180 \n\n\n\n5\u00baC 1.0534 1.0540 1.0532 1.0531 1.0506 1.0531 1.0534 1.0611 \n\n\n\n30\u00baC 1.0534 1.0559 1.0522 1.0511 1.0506 1.0535 1.0516 1.0522 \n\n\n\nThe analytic results indicated that the chloral hydrate content in all samples assayed was above \n99% throughout the 180 days period for both temperatures (Table 4). During the study, little \nor no chloral hydrate loss occurred in the samples for both storage conditions (Figure 3).  \n\n\n\nTable 4: Percentage of Original Concentration of Chloral Hydrate Oral Solution \n\n\n\nAssay  \n\n\n\nTime \n(Days) \n\n\n\n1 14 28 60 90 120 150 180 \n\n\n\n5\u00baC 101.2% 101.1% 101.3% 101.4% 100.9% 100.1% 99.5% 100.7% \n\n\n\n30\u00baC 101.2% 102.2% 100.7% 101.1% 100.4% 99.0% 99.0% 100.7% \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nChloral hydrate is easily decomposed in alkaline solution yielding mostly chloroform and \nformic acid. Chloral hydrate is also known to be a light sensitive material. The stability of the \npreparation is due to the compatibility of chloral hydrate with the X-Temp vehicle and also the \nprotective nature of the amber plastic container which prevents light degradation. The X-temp \nvehicle has an average pH of 4.1 (slightly acidic) and is buffered with the Citric Acid \u2013 \nMonosodium Phosphate buffering system. The nature of the X-temp vehicle ensures that the \npH of the chloral hydrate solution remains slightly acidic and constant which is favourable \ntowards the stability of chloral hydrate.  \n\n\n\nThe pH remained within the range of 3.8 to 4.1, which suggests minimal or no chemical \ndegradation (Figure 4). This claim is further cemented by the relatively stable assay results \nthroughout the study period of 180 days.  \n\n\n\nFigure 3: Percentage of Original Concentration of Chloral Hydrate Oral Solution \n\n\n\nFigure 4: pH of Chloral Hydrate Oral Solution \n\n\n\n95\n\n\n\n96\n\n\n\n97\n\n\n\n98\n\n\n\n99\n\n\n\n100\n\n\n\n101\n\n\n\n102\n\n\n\n103\n\n\n\n104\n\n\n\n105\n\n\n\n1 14 28 60 90 120 150 180\n\n\n\nC\nhl\n\n\n\nor\nal\n\n\n\n H\nyd\n\n\n\nra\nte\n\n\n\n (\n%\n\n\n\n)\n\n\n\nTime (Days)\n\n\n\n5\u00baC 30\u00baC\n\n\n\n3.00\n\n\n\n4.00\n\n\n\n5.00\n\n\n\n1 14 28 60 90 120 150 180\n\n\n\npH\n\n\n\nTime (Days)\n\n\n\n5\u00baC 30\u00baC\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nMicrobiological Stability \n\n\n\nMicrobiological tests were negative in all samples throughout the study period. The microbial \nexamination test denoted the absence of microbial growth for the total viable aerobic count, \ntotal yeasts & moulds and the specific E. coli complying with official quality requirements. \nThe microbiological stability study showed that the microbial quality of the chloral hydrate \nsolution was within the established specifications during the 6 months study period for both \ntemperatures (Table 5 and 6). \n\n\n\nNo microbial contamination was observed in all samples. The total viable aerobic count was \nkept low and total yeasts & moulds count was minimal. E. coli was absent throughout the 180 \ndays period.  \n\n\n\nThese results revealed that the preservatives of the extemporaneous preparation were effective \nagainst microbes and the chloral hydrate oral solution remained microbiologically stable at \nboth temperatures. \n\n\n\nTable 5: Microbial Results of Chloral Hydrate Oral Solution (5\u00baC) \n\n\n\nTime (Days) \nTotal aerobic bacteria \n\n\n\n(NMT 200 cfu/g) \nTotal yeasts & moulds \n\n\n\n(NMT 20 cfu/g) \nE. coli \n\n\n\n(Absence in 1 g)\n1 < 10 cfu/g < 10 cfu/g Conforms \n14 < 10 cfu/g < 10 cfu/g Conforms \n28 < 10 cfu/g < 10 cfu/g Conforms \n60 < 10 cfu/g < 10 cfu/g Conforms \n90 < 10 cfu/g < 10 cfu/g Conforms \n120 < 10 cfu/g < 10 cfu/g Conforms \n150 < 10 cfu/g < 10 cfu/g Conforms \n180 < 10 cfu/g < 10 cfu/g Conforms \n\n\n\n\n\n\n\nTable 6: Microbial Results of Chloral Hydrate Oral Solution (30\u00baC) \n\n\n\nTime (Days) \nTotal aerobic bacteria \n\n\n\n(Not more than 200 cfu/g) \nTotal yeasts & moulds \n\n\n\n(NMT 20 cfu/g) \nE. coli \n\n\n\n(Absence in 1 g)\n\n\n\n1 < 10 cfu/g < 10 cfu/g Conforms \n\n\n\n14 < 10 cfu/g < 10 cfu/g Conforms \n\n\n\n28 < 10 cfu/g < 10 cfu/g Conforms \n\n\n\n60 < 10 cfu/g < 10 cfu/g Conforms \n\n\n\n90 < 10 cfu/g < 10 cfu/g Conforms \n\n\n\n120 < 10 cfu/g < 10 cfu/g Conforms \n\n\n\n150 < 10 cfu/g < 10 cfu/g Conforms \n\n\n\n180 < 10 cfu/g < 10 cfu/g Conforms \n \n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nCONCLUSION \n\n\n\nChloral hydrate oral solution 40 mg per ml was easily prepared from the active ingredient and \ncommercial compounding vehicle. According to serial qualitative assessment, the \ncompounding support the stability for at least 180 days, maintaining all quality attributes \nrequired. Chloral hydrate oral solution is physically, chemically and microbiologically stable \nunder refrigeration and room temperature for up to 180 days when packed in amber HDPE \nbottles with plastic screw cap. \n\n\n\nThe results from the stability studies showed that X-temp is a suitable compounding vehicle \nfor preparing extemporaneous liquid formulation of chloral hydrate. Besides offering a stable \nformulation, it has added advantage of alcohol-free, colorant-free and sugar-free.  \n\n\n\nThe extemporaneous preparation of chloral hydrate can now be conveniently prepared by \npharmacists in the hospital setting by using X-temp Oral Suspension System. It is supported \nby stability data and proven shelf life.  \n\n\n\nACKNOWLEDGEMENT \n\n\n\nThe authors wished to thank BioScenergy International Sdn. Bhd. for its financial support. \n\n\n\nREFERENCES \n\n\n\n1. Aquilina, A., 2013. The extemporaneous compounding of paediatric medicines at Mater \nDei Hospital. Journal of the Malta College of Pharmacy Practice 19 pp 28-30. \n\n\n\n2. Haywood, A. and Glass, B., 2007. Managing extemporaneous oral liquids in practice. \nJournal of Pharmacy Practice and Research, 37(2), pp 131-133. \n\n\n\n3. Haywood, A. and Glass, B.D., 2013. Liquid dosage forms extemporaneously prepared from \ncommercially available products\u2013Considering new evidence on stability. Journal of \nPharmacy & Pharmaceutical Sciences, 16(3), pp 441-455. \n\n\n\n4. Lu, J. and Greco, M.A., 2006. Sleep circuitry and the hypnotic mechanism of GABA A \ndrugs. Journal of Clinical Sleep Medicine, 2(2), pp S19-S26. \n\n\n\n5. Chen, M.L., Chen, Q., Xu, F., Zhang, J.X., Su, X.Y. and Tu, X.Z., 2017. Safety and efficacy \nof chloral hydrate for conscious sedation of infants in the pediatric cardiovascular intensive \ncare unit. Medicine, 96(1): e5842. \n\n\n\n6. Bustos-Fierro, C., Olivera, M.E., Jim\u00e9nez-Kairuz, \u00c1.F. and Manzo, P.G., 2013. Stability \nevaluation of 7% chloral hydrate syrup contained in mono and multi-dose bottles under \nroom and refrigeration conditions. Farm Hosp, 37 (1) pp 4-9. \n\n\n\n7. Sweetman, S.C., 2009. Martindale: The complete drug reference. 36th edition. London, \nUK: Pharmaceutical Press. \n\n\n\n8. Kakehi, K., Nakano, M., Nishiura, S., Tachibana, S., Ishida, S. and Taneda, M., 1999. \nExamination of the stability of chloral hydrate and its preparation by capillary \nelectrophoresis. Yakugaku Zasshi. Journal of the Pharmaceutical Society of Japan, 119(5), \npp 410-416. \n\n\n\n9. Taguchi, M., Horiuchi, T., Mimura, Y. and Adachi, I., 1999. Studies on Hospital \nPreparation, \u00abChloral Hydrate Syrup\u00bb. Jap J Hosp Pharm, 25, pp 546-551. \n\n\n\n10. Trissel L.A., 2009. Trissel\u2019s Stability of Compounded Formulations. 4th ed. Washington, \nDC: American Pharmaceutical Association, pp 118-119. \n\n\n\n11. British Pharmacopoeia Commission 2013. Microbiological examination of non-sterile \nproducts. In British Pharmacopoeia 2014 Vol IV. Appendix XVIB \u2013 London, The \nStationery Office.  \n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nABSTRACT OF THE 10th NATIONAL PHARMACY RESEARCH & \nDEVELOPMENT CONFERENCE 2018 \n \nAcknowledgements \n \nThe editorial board would like to thank the Director General of Health, Malaysia for permission \nto publish abstracts in this journal. \n \nEnhancing Access to Medicines through Value-based Approaches  \nDate: 9-11th July 2018 \n \nReviewers of Abstracts \n \n\n\n\nDr. Lawrence ak Anchah \nDr. Abdul Haniff bin Mohamad Yahaya \nDr. Norkasihan binti Ibrahim \nDr. Liau Siow Yen \nDr. Yvonne Khoo Siew Khoon \nDr. Wardati binti MazlanKepli \nDr. Janattul Ain binti Jamal \nHj. Ridhwan bin Abdullah  \nSahimi binti Mohamad \nEzatul Rahayu binti Anuar \nHazlinda binti Abu Hassan \nSiti Hir Huraizah binti Md Tahir \nShamala a/p Ayadurai \nFajaratunur binti A. Sani \nThong Kah Shuen \nHazimah binti Hashim \nFarahwahida binti Mohd Kasim \nNorhalina binti Sulaiman \nTeoh Chee Jia \nNoraniza binti Mohamad Zalik \nKamaruddin bin Ahmad \nNorazila binti Abdul Ghani \nLimata @ Monalita binti Othman \nMohd Dziehan bin Mustapa \nNorirmawath binti Saharuddin \nAlia Hayati binti Baharudin \nNoorazlinda binti Yacob \nMarzirah binti Ibrahim \nAslina binti Ashaari \nJerry Liew Ee Siung \n\n\n\n\n\n\n\nStephanie Soon Hooi Cheng \nWong Shui Ling \nTay Eek Poei \nRosdi bin Md Zin \nSiti Zainora binti Mohd Zulkefli \nTang Woan Torng \nMohd Farizh bin Che Pa \nNur Liyana binti Zainal Bahrin \nMuhammad Faizal bin Ma\u2019arof \nMohd Shahril bin Mat Nordin \nMohd Radzi bin Abdul Aziz \nSoo Bee Kuan \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nLIST OF ORAL PRESENTATIONS \n \nNo Presenting Author Title \n\n\n\nOP-01 Choo Shea Jiun A Cross Sectional Study On Public Beliefs, Knowledge And \nPractices Towards Antibiotic Use In The State Of Perak, \nMalaysia \n\n\n\nOP-02 Tok Yu Chin An Evaluation Of Pharmaceutical Calculation Skills Among \nHospital Pharmacists At Queen Elizabeth Hospital In \nMalaysia: A Cross Sectional Study (PCAP-QEH) \n\n\n\nOP-03 Nadzirah Ishak Study On The Impact Of Pharmacist Counselling On Proper \nEye Drop Instillation Technique Among Patients On Topical \nIntraocular Pressure Lowering Agents (IPLA) \n\n\n\nOP-04 Ching Min Wei Impact Of Pharmacist\u2019S Re-Education On Insulin Injection \nSite Lipohypertrophy Among Type 2 Diabetics In Primary \nHealthcare \n\n\n\nOP-05 Norhidayah Binti Kasiman @ \nKamisan \n\n\n\nDrug-Related Problems Among Home Medication Review \nPatients In Hospital Sultanah Nora Ismail \n\n\n\nOP-06 Choo Mun Yee The Use Of Complementary And Alternative Medicine \n(CAM) Among Breast Cancer Patients In Hospital Pulau \nPinang \n\n\n\nOP-08 Lim Kah Von Physicians\u2019 Knowledge, Attitude And Practices Regarding \nManagement Of Medications During Ramadan In Hospital \nTuanku Ampuan Najihah, Kuala Pilah. \n\n\n\nOP-09 Leow Hui Yi The Causes Of Prescribing Errors In Medical Outpatient \nDepartment (MOPD), Hospital Tuanku Ampuan Najihah: A \nQualitative Study \n\n\n\nOP-10 Lee Cheng Ying A Randomized, Open-Label Study To Evaluate Medication \nComprehension Of Elderly Patients With Illustrated \nMedication Labels At A Public Hospital, Penang \n\n\n\nOP-11 Lee Fei Yee Dose Conversion From Prograf\u00ae To Advagraf\u00ae For Kidney \nTransplant Recipients And Associated Costs: Do Malaysians \nDiffer? \n\n\n\nOP-12 Cheah Kit Yee Single-Dose, Open-Label, Randomized, 2-Treatment, 2-\nSequence, 2-Period Crossover Bioequivalance Study Of Two \nOmeprazole Capsule Preparations In Healthy Male \nVolunteers Under Fasted Condition \n\n\n\nOP-13 King Teck Long Effect Of Dual Antiplatelet Therapy (DAPT) On Platelet \nReactivity In Coronary Artery Bypass Grafting (CABG) \nPatients \n\n\n\nOP-14 Kong Lai San Correlation Of Antibiotic Consumption And Multidrug-\nResistant Infections In Hospital Tuanku Ampuan Najihah \n(HTAN) \n\n\n\nOP-15 Toh Yi Siang A Retrospective Study: Comparison Of Two Extended-\nInterval Gentamicin Dosing Guidelines In Achieving \nTherapeutic Concentration In Neonates \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nOP-16 Mahfuzah Binti Ishak Comparative Evaluation Of International Normalized Ratio \n(INR) Monitoring Between Point-Of-Care And Laboratory-\nBased Testing Method In Patients Receiving Warfarin \nTherapy In Hospital Sultanah Nur Zahirah \n\n\n\nOP-17 Mohd Naqib Bin Zainal Abidin Gefitinib Versus Erlotinib For Non-Small-Cell Lung Cancer \nWith Mutated EGFR \n\n\n\nOP-18 Nor Haizan Binti Ibrahim @ \nGhazali \n\n\n\nEffectiveness Of Smoking Cessation Interventions In \nPrimary Health Care \n\n\n\nOP-19 Tang Woan Torng Knowledge, Perception And Attitude Of Healthcare \nProfessionals Towards The Use Of Generic Medicines In \nHospital Tengku Ampuan Afzan (HTAA) \n\n\n\nOP-20 Tang Kai Lun Perceptions And Knowledge On Antibiotic Use And \nResistance: A Cross Sectional Multicenter Survey Among \nPharmacists In Malaysian Public Hospitals \n\n\n\nOP-21 Tan Zhi Shan, Sujata The Level Of Understanding Among Various Groups Of \nGovernment Healthcare Personnel In F.T. Labuan Towards \nRegistered Products And Notified Cosmetics \n\n\n\nOP-22 Teng Sook Yee A Review On The Use Of Oral N-Acetylcysteine (NAC) In \nPreventing Contrast Induced Nephropathy (CIN) \n\n\n\nOP-23 Nur Afifah Binti Shuhardi Return Medication Programme Among Patients At \nOutpatient Setting In Hospital Tuanku Ampuan Najihah: A \nCross-Sectional Study \n\n\n\nOP-24 Wong Kar Loon A Prospective Study To Evaluate The Frequency Of \nAntibiotic De-Escalation Practice In Culture Positive Result \nAmong Physicians And The Impact Of This Strategy In \nMedical Ward Of Penang General Hospital \n\n\n\nOP-25 Choe Jiun Yi A Qualitative Research On Factors Affecting Compliance \nTowards Deferoxamine Among Adult Transfusion-\nDependent Thalassemia Patients In Hospital Pulau Pinang \n\n\n\nOP-26 Azza Binti Mohd. Ghazali Knowledge And Perception Of Medical Staffs On The Use \nOf High Alert Medications In Hospital Permai Johor Bahru \n\n\n\nOP-27 Noor Hafizah binti Tajudin Pain Belief And Adherence To Pain Medications In Patients \nWith Neuropathic Pain In Hospital Rehabilitasi Cheras \n\n\n\nOP-28 Ting Chuo Yew Effectiveness Of \"Know Your Medicine - Take It For \nHealth\" (MEDIHEALTH) Program In Improving \nMedication Adherence Among Type 2 Diabetes Mellitus \nPatients In Sarawak: A Randomized Controlled Trial \n\n\n\nOP-29 Cho Yet Tyng Perception Of The Quality, Safety And Efficacy Of \nTraditional And Complementary Medicine (TCM) Among \nYoung Aduts In Malaysia \n\n\n\nOP-30 Tan Meng Hsiung A Cross Sectional Study On The Awareness Towards \nPharmaceutical Products Registration Among Medical \nPractitioners And Pharmacists In A Tertiary Hospital Of \nMalaysia \n\n\n\nOP-31 Ting Huong Touh A Retrospective Cross-Sectional Study On Drug Utilization \nPatterns In Emergency And Trauma Department (ETD) At \nSibu Hospital \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nOP-32 Sherene Tan Su Ann Knowledge, Attitude, and Practices (KAP) Concerning \nPrescription Drug Abuse among Patients in Hospital Pulau \nPinang \n\n\n\nOP-33 Selvakumari A/P Selvadurai Impact of Insulin Injection Technique Re-Education on \nPerception of Insulin Therapy Among Urban-Dwelling Type \n2 Diabetes Mellitus Patients in Health Clinics in Kuala \nLumpur \n\n\n\nOP-34 Tan Rou Wei NSAIDs Avoidance Education for Heart Failure Patients in \nRegional Referral Hospital \n\n\n\nOP-35 Ahmad Aizat Zaini Scheduled Substances as aCause Leading to Dangerous Drug \nAbuse. \n\n\n\nOP-36 Allah Bukhsh Effectiveness of Pharmacist-Led Educational Interventions \non Self-Care Activities And Glycemic Control Of Type 2 \nDiabetes Patients: A Systematic Review and Meta-Analysis \n\n\n\nOP-37 Khalidah Maruan T2DM Patients' Adherence To Refills And Medication: A \nComparison Between Telephone And Collect Service And \nConventional Counter Service In A Health Clinic \n\n\n\nOP-38 Tai Siew Yin The Most Effective Reminder Method To Reduce Defaulter \nRate In Drive-Through Pharmacy Service In Hospital \nMelaka \n\n\n\nOP-39 Hanisah Kamarudin A Survey On Type 2 Diabetes Patients Knowledge And \nPractices On Insulin Injection Techniques In Primary Health \nCare  \n\n\n\nOP-40 Wong Sin Wei Perception Of Healthcare Professional On Drug Shortage \nImpact In A Malaysian District Hospital \n\n\n\nOP-41 Wan Nur Asyiken Binti Wan \nAb. Rahman \n\n\n\nA Qualitative Study On Healthcare Professionals \nPerspectives On Pharmacists\u2019 Role In Managing \nAntipsychotic Medications In Hospital Kajang \n\n\n\nOP-42 Devi Shantini Assessment Of Cost And Adherence Of Insulin Penfill \nExchange Program: A Pilot Study \n\n\n\nOP-43 Ang Wei Chern Exploring The Healthcare Professionals\u2019 Experience Of \nInterdisciplinary Collaboration In Medical Department, \nHospital Tuanku Fauziah (HTF): A Qualitative Study \n\n\n\nOP-44 Tan Wan Chin The Effect Of Education Counseling On Knowledge Of \nHormonal Therapy (HT) \n\n\n\nOP-45 Tan Xiu Quan Perception And Experience Of Early-Stage Breast Cancer \nPatient Regarding Chemotherapy: A Qualitative Study \n\n\n\nOP-46 Lau Boon Tiang Efficacy, Acceptance And Tolerability Of Split-Dose Versus \nSame-Day Aqueous Sodium Phosphate Regimes For \nColonoscopy Bowel Cleansing In Port Dickson Hospital \n\n\n\nOP-47 Lee Fei Yee Therapeutic Drug Monitoring Of Intraperitoneal Gentamicin \nIn Peritoneal Dialysis Patients With Peritonitis: A Single \nCenter Study In Malaysia \n\n\n\nOP-48 Faridah Yusof Antibiotic De-Escalation: The Prevalence, Clinical Impact \nAnd Factors Associated With The Practice In General \nCritical Ward Hospital Sultanah Bahiyah Kedah \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nOP-49 Ng Siew Yen Patients\u2019 Perceptions On Necessity And Concern Of \nAntidiabetic Medications In Ampangan Health Clinic \n\n\n\nOP-50 Azmi Nor Mohd Farez bin \nAhmat \n\n\n\nFirst-Line Pazopanib In Metastatic Renal Cell Carcinoma: A \n\u201cReal-World\u201d Experience At National Cancer Institute \n\n\n\nOP-51 Puvaneswari A/P \nNitamakwuavan \n\n\n\nDyslipidemia Among Hiv Adult Patients On Antiretroviral \nTreatment (ART) In Hospital Tunaku Ampuan Najihah \n(HTAN), Kuala Pilah \n\n\n\nOP-52 Tan Siew Hua Study On The Medication Knowlegde Of Patients From \nMtac Geriatrics \n\n\n\nOP-53 Saratha Thevi A/P Ponusamy Hemodialysis Catheter-Related Blood Stream Infection \n(CRBSI) In Hospital Tuanku Ampuan Najihah (HTAN): A \nRetrospective Study \n\n\n\nOP-54 Muhammad Nasri Bin Yusoff An Observational Study On Abvd And Escalated Beacopp \nRegimens Among Patients With Hodgkin\u2019S Lymphoma. \n\n\n\nOP-55 Chan Huan Keat Effectiveness And Economic Evaluation Of Nausea And \nVomiting Management For Moderately And Highly \nEmetogenic Chemotherapy In Malaysia: A Multicenter \nCohort Study \n\n\n\nOP-56 Mohd Fathi Bin Abdul Wahab The Stability Study Of Extemporaneous Preparations \nPrepared In The Outpatient Pharmacy Of Hospital Tuanku \nFauziah (HTF) Stored Based On Patient\u2019S Setting \n\n\n\nOP-57 Robin Tan Tiow Heng Medicinal Products And Services Advertising: A Cross-\nSectional Assessment Of Knowledge And Attitude Among \nPharmacists In Melaka (Meps-Pham Study) \n\n\n\nOP-58 Tan Yui Ping Exploring The Cost Of Stage C Heart Failure In Hospital \nQueen Elizabeth II, Kota Kinabalu, Sabah \n\n\n\nOP-59 Wong Shui Ling Availability, Medicine Prices And Affordability Of Selected \nMedicines In Malaysia \n\n\n\nOP-60 Siti Khuzaimah Binti Maarof Effect Of Indomethacin\u2019S Duration Of Administration As A \nPositive Control In Carrageenan-Induced Paw Edema In Rat \nModels \n\n\n\nOP-61 Josephine A/P Henry Basil Development And Validation Of The Childhood Vaccination \nAttitudes And Beliefs Scale (CABS) \n\n\n\nOP-63 Seah Xin Qian An Assessment Of Parent\u2019S Knowledge, Attitude And \nPractice (KAP) On Antibiotic Use Among Children In \nHospital Bukit Mertajam \n\n\n\nOP-64 Ahmad Najib Bin Ahmad \nAfandi \n\n\n\nDevelopment And Validation Of Entry-Point Checklist To \nEnsure Consistency Of Decisions Made Amongst Officers \nOn Duty \n\n\n\nOP-65 Siti Rabi'Atul 'Adawiyah Binti \nNasri \n\n\n\nA Prospective Interventional Study Of Smartphone \nMedication Adherence Application And Its Potential \nBenefits To Retroviral Disease (RVD) Patients: Preliminary \nStudy \n\n\n\nOP-66 Lee Jiong Tatt Investigating The Reason For Unclaimed Medication In \nFlexy Service At Hospital Banting \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nOP-67 Ruzmayuddin Bin Mamat Prevalence Use Of Amphetamine-Type-Stimulants (ATS) \nAnd Hiv Risk Behaviours Among Clients In Government \nAnd Private Methadone Maintenance Treatment (MMT) \nPrograms In Kuantan, Pahang \n\n\n\nOP-68 Fong Chui Wei The Impact Of Pharmacist Intervention On Anemia \nManagement In Continuous Ambulatory Peritoneal Dialysis \n(CAPD) Patients \n\n\n\nOP-69 Gan Eon Tat The Cross-Sectional Study Of Elderly Patients' Adherence \nAnd Knowledge Towards Their Medication Regimes In \nKuala Lipis Hospital \n\n\n\nOP-70 Revathy Kanasin Nurses\u2019 Knowledge, Attitude And Practices In The \nPreparation And Administration Of Intravenous Medications \nIn Putrajaya Hospital \n\n\n\nOP-71 Anisah Muhammad Medical Information Resources On Mobile Phone Among \nHealthcare Professionals: A Cross-Sectional Survey \n\n\n\nOP-72 Chua Peck Wei Inpatient Anticoagulation Service: The Next Frontier In \nAnticoagulant Therapy \n\n\n\nOP-73 Muhammad Syafiq Ikhwan Bin \nSalleh \n\n\n\nA 6-Year Review Of The Methadone Maintenance Program \nAmong Registered Patients In Perak \n\n\n\nOP-74 Nurfardilla Binti Ferdaos Evaluation Of Pharmaceutical Care Issues In Paediatric \nCritical Care Of A Tertiary Referral Hospital In Perak, \nMalaysia: A Cross Sectional Study \n\n\n\nOP-75 Zalina binti Zahari Knowledge, Attitude And Perception Towards Allergic \nReactions Of Paracetamol Among General Public In \nKelantan, Malaysia \n\n\n\nOP-76 Kho Boon Phiaw  Provision Of Professional Pharmacy Services By \nCommunity Pharmacies: Findings From A Cross-Sectional \nStudy In The State Of Sarawak, Malaysia \n\n\n\nOP-77 Asilah binti Che Ayub Factor Affecting Medication Adherence And \nAnticoagulation Control In Patients Taking Warfarin \n\n\n\nOP-78 Shamini a/p Kanakarathnam A Review Of Long Term Oral Proton Pump Inhibitor (PPI) \nUse In A Tertiary Hospital \n\n\n\nOP-79 Liew Ying Hsi Knowledge Regarding Serious Side Effects Of Clozapine \nAmong Registered Nurses And Assistant Medical Officers \n(AMOS) In Hospital Permai Johor Bahru \n\n\n\nOP-80 Nik Suraima Binti N Mustapha Study On Public Knowledge And Attitude Towards \nAntibiotic Use Among Community At Bachok District \n\n\n\nOP-81 Taye Zhi Yun A Prospective Study On The Usage Of Intravenous \nVancomycin In Adult Patients, Selayang Hospital \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \nOP-01 (Oral) \nA CROSS SECTIONAL STUDY ON PUBLIC BELIEFS, KNOWLEDGE AND PRACTICES TOWARDS \nANTIBIOTIC USE IN THE STATE OF PERAK, MALAYSIA \n \nChoo SJ1, Chang CT2, Raj JD1, Lee CY3, Munisamy V1, Thong KS4, Tan CK1, Shafie AA5 \n\n\n\n \n1Department of Pharmacy, Hospital Taiping, Ministry of Health Malaysia,2Clinical Research Centre, Hospital Raja Permaisuri \nBainun, Ministry of Health Malaysia, 3Pharmaceutical Services Division Perak, Ministry of Health Malaysia,4Department of \nPharmacy, Hospital Raja Permaisuri Bainun, Ministry of Health Malaysia,5School of Pharmaceutical Sciences, Universiti \nSains Malaysia \n \nINTRODUCTION: Inappropriate use of antibiotics has led to antimicrobial resistance, a major public health challenge \nworldwide. \nOBJECTIVES: This study aimed to explore beliefs, knowledge, and practice on antibiotic use among the general public in \nPerak. \nMETHOD: A cross-sectional study was conducted at 13 hospitals and 44 primary health clinics in Perak from May to July \n2017. Adults above 18 years of age, literate and have experience in usingantibiotics were selected. Data was collected using a \nself-administered questionnaire with 3 domains i.e. belief: 6 item Likert-scale; knowledge: 12 item Likert-scale; practice: 12 \nitem yes/no question. The subjects were selected via systematic random sampling. The questionnaire was pilot tested on 30 \nsubjects.  \nRESULTS: Out of 2773 distributed questionnaires distributed, 2632 were included for analysis. The mean age of the \nrespondents was 39.7\u00b114.5 years old. Most participants were female (58.6%), Malay (74.7%) and underwent upper secondary \nschool (45.6%). Mean score were generated for each domain with belief: 5.87\u00b13.00 (total score: 12), knowledge: 15.82\u00b13.85 \n(total score: 24), practice: 6.91\u00b12.07 (total score: 12). In the belief domain, 63.2% of respondents believed that antibiotics help \nthem to recover faster. In the knowledge domain, 52.7% of respondents inappropriately thought that antibiotics could work on \nviral infections. In the practice domain, 70% of respondents expected doctors to prescribe antibiotics if suffered from \nsymptoms.  \nCONCLUSION: This study acknowledged the inappropriate knowledge, belief and practice among public. The areas of \nlacking knowledge have been identified and may aid in providing information for public health education in the future. \n \nKEYWORDS: impact of pharmacy services, Perak, antibiotics, beliefs, knowledge, practices \nNMRR ID: NMRR-14-1940-23309 \n \n \nOP-02 (Oral) \nAN EVALUATION OF PHARMACEUTICAL CALCULATION SKILLS AMONG HOSPITAL PHARMACISTS AT \nQUEEN ELIZABETH HOSPITAL IN MALAYSIA: A CROSS SECTIONAL STUDY (PCAP-QEH) \n \nTok YC1, Loh BCC1, Tea YY1, Tong SN1, Lim CH1, Ling CR1, Jerry ES Liew1 \n\n\n\n \n1Clinical Pharmacy Department, Queen Elizabeth Hospital, Ministry of Health Malaysia \n \nINTRODUCTION: Questions that require pharmaceutical calculation is commonly encountered by pharmacist. Any \ncalculation performed especially during counter-checking process needs to be accurate to ensure correct dose and method of \nadministration delivered to patient. Inaccurate pharmaceutical calculation leads to life-threatening errors and jeopardises \npatient's safety.  \nOBJECTIVES: To evaluate the capability of Hospital Queen Elizabeth (HQE) pharmacist in performing pharmaceutical \ncalculation. \nMETHOD: A cross sectional study was conducted on pharmacist at HQE from March to July 2017. All pharmacists underwent \na 1 hour-theory lecture and 1.5 hour-hands-on training in pharmaceutical calculations. This was followed by a 20 minute-short \nanswer question assessment. The accuracy of the answers was evaluated by the researchers. The primary outcome was \nexpressed as percentage of pharmacists who passed (>70%) the assessment. \nRESULTS: A total of 82 pharmacists were recruited with mean aged of 28.65\u00b13.97 years, 70% were female, 58 of them were \nFully Registered Pharmacists (FRP) with average working experience of 50.91\u00b141.22 months. From the assessment, 65% of \nthe pharmacists passed the assessment. The percentage of pharmacists who passed was found to be higher among those with \nlonger working experience [24 (45.2%), >60 months, 21 (39.6%), 13-60 months vs 8 (15.1%), <13 months, p=<0.001, \nrespectively]. Sixteen pharmacists with clinical experience (94%) passed the assessment (\u03c72(1)=8.15, p=0.004). The areas of \nweakness observed (performance expressed in median and interquartile range) were questions related to supply (58.3% \n[0,100]), preparation (75% [60, 87.5]), administration (79.2%, [62.5,100]) and compatibility (83.3%, [0,100]). \nCONCLUSION: Almost 65% of pharmacists passed the assessment for pharmaceutical calculation. The capability of \npharmaceutical calculation thrived with working experience. Pharmacist with clinical experience will have a better \nperformance. More emphasis should be put into calculations related to supply, preparation, administration and compatibility \nin order to address the weaknesses. \n \nKEYWORDS: impact of pharmacy services, Sarawak, pharmacist, calculation skills \nNMRR ID: NMRR-17-1495-36701  \n  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nOP-03 (Oral) \nSTUDY ON THE IMPACT OF PHARMACIST COUNSELING ON PROPER EYE DROP INSTILLATION \nTECHNIQUE AMONG PATIENTS ON TOPICAL INTRAOCULAR PRESSURE LOWERING AGENTS (IPLA) \n \nTan JL1, Loo SY1, Anbalagan MJ1, Lam MH1, Ishak N1, Tay EP1 \n\n\n\n \n1Department of Pharmacy, Hospital Melaka, Ministry of Health Malaysia \n \nINTRODUCTION: Proper eye drop instillation technique is crucial in the management of glaucoma. The role of pharmacist \nin maximizing treatment care for glaucoma patients has yet to be fully illustrated.  \nOBJECTIVES: This study aims to investigate the impact of pharmacist counselling on eye drop instillation technique which \nmay be directly translated to the rate of intraocular pressure (IOP) lowering among patients on topical IPLA and to identify \nthe most common error with eye drop instillation technique. \nMETHOD: This research was conducted from August 2015 until December 2016. Proper eye drop administration technique \nwas based on the steps outlined by The Glaucoma Research Foundation. The score for administration technique, together with \ndifference in intraocular pressure (IOP) was compared before and after pharmacist counseling, during next clinic follow up. \nCommon errors with eye drop instillation technique were also described. Student\u2019s t-test or Mann-Whitney test and Wilcoxon \nsigned rank test was used to analyze the parametric and nonparametric data, respectively. \nRESULTS: Median IQR for the score of eye drop instillation technique improves significantly from 2 to 3 (p<0.001). \nHowever, our results did not show any significant difference in IOP and IOP reduction before and after counselling. The most \ncommon error identified with eye drop instillation technique was drops falling on the cheek (n=18, 56.3%) followed by too \nmany eye drops coming out (n=9, 28.1%). \nCONCLUSION: Our data showed significant improvements in patients\u2019 eye drop administration technique after counselling \nby pharmacist. The most common error identified with eye drop instillation technique is drops falling on the cheek. Future \nstudy is needed in order to illustrate on how to best integrate pharmacist in the management of glaucoma patients.  \n \nKEYWORDS: impact of pharmacy services, Malacca, counselling, glaucoma, eye drops \nNMRR ID: NMRR-15-745-25722 \n \n \nOP-04 (Oral) \nIMPACT OF PHARMACISTS\u2019 RE-EDUCATION ON INSULIN INJECTION SITE LIPOHYPERTROPHY \nAMONG TYPE 2 DIABETICS IN PRIMARY HEALTHCARE \n \nChing MW1, Kamaruddin H1, Mohd Ali LM1, Selvadurai S1, Lee XY1, Lee XH1, Ngajidin RM1, Cheah KY2 \n\n\n\n \n1Pharmacy Division, Health Department of Federal Territory of Kuala Lumpur and Putrajaya, Ministry of Health Malaysia, \n2Clinical Trial Unit, National Clinical Research Centre (CRC) Ministry of Health Malaysia \n \nINTRODUCTION: Lipohypertrophy (LH) is an abnormal accumulation of fat scar tissue in the subcutaneous layer, caused \nby repeated insulin injections in the same location. Injection into this site leads to variability of insulin absorption and thus \nerratic glycemic control. \nOBJECTIVES: The study aimed to determine the prevalence of LH and insulin injection practices among insulin users and \nthe impact of pharmacist\u2019s monthly re-education on injection site rotation in preventing LH. \nMETHOD: A total of 160 type 2 diabetics who self-injected insulin for at least one year with HbA1c above 8% were recruited \nfrom 15 health clinics. The patients were randomly assigned to control and intervention groups. Intervention group received \nmonthly re-education on LH and injection technique assessment for 4 visits. Control group received standard pharmacist \ncounseling only on the first visit. Assessment on injection site rotation practices and presence of LH was performed on first \nand fourth visit. \nRESULTS: Approximately 25.6% (n=41) patients had LH in the injection site. 10% admitted having injected into the lump. \n1.9% did not rotate their injection site. 35.7% reused their needles more than 3 times. Only 5.7% had their injection site \nchecked by healthcare professional at least once a year. There was significant difference on presence of LH pre and post re-\neducation in the intervention group (30.0% vs 18.9%; p=0.002) compared to control (21.3% vs 13.9%; p=0.07). Gender \n(p=0.035), method of rotation (p=0.013) and size of injection site (p=0.049) were found to be associated with development of \nLH. The patients with improvement in LH had HbA1c reduction of 0.95% compared to 0.51% in non-improvement patients. \nThus, reduction of HbA1c was significantly associated with improvement in LH (p=0.042). \nCONCLUSION: Pharmacist assessment and re-education on insulin injection site rotation played a role in preventing \nlipohypertrophy. Monthly re-education is more effective in preventing LH compared to standard counseling. \n \nKEYWORDS: impact of pharmacy services, Kuala Lumpur, insulin, lipodystrophy, pharmacists\u2019 re-education \nNMRR ID: NMRR-16-1591-28767 \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nOP-05 (Oral) \nDRUG-RELATED PROBLEMS AMONG HOME MEDICATION REVIEW PATIENTS IN HOSPITAL \nSULTANAH NORA ISMAIL \n \nNorhidayah K1, Nurul Syuhada H1, Norhanizah H1, Ilyana M1, Aminuddin AAT1 \n\n\n\n \n1Department of Pharmacy, Hospital Sultanah Nora Ismail, Ministry of Health Malaysia \n \nINTRODUCTION: Home Medications Review (HMR) is relatively new service provided by the Ministry of Health Malaysia. \nThis services aims to identify, resolve and prevent drug-related problems (DRPs) among patients. DRPs lead to substantial \nmorbidity and mortality and are significantly related to the clinical outcomes, healthcare costs, and quality of life. \nOBJECTIVES: The aim of this study was to identify DRPs among HMR patients in Hospital Sultanah Nora Ismail (HSNI). \nMETHOD: A prospective cross-sectional study involving 80 patients participated in HMR was conducted from March 2016 \nuntil August 2016. The pharmacists interviewed the patients and reviewed all medications during HMR visit. Potential DRPs \nwere identified based on patient's medications and personal records. The identified potential DRPs were classified using \nPharmaceutical Care Network Europe (PCNE) Version 6.2 classifications. \nRESULTS: A total of 114 potential DRPs were identified in 69 patients. The overall incidence of DRPs was 86% of which \nthe mean + standard deviation of DRPs was 1.43 + 0.9 per patient. Treatment effectiveness (70.1%) was the most frequently \nreported problems among HMR patients followed by treatment costs(17.5%) and adverse drug reactions (12.4%). The common \ncauses of DRPs were patient's own problem (38.5%), followed by drug use process (29.6%), inappropriate drug selection \n(16.3%), logistic issues (5.9%), others (4.4%), dose selection (3.7%) and drug form (0.7%). Most of the identified DRPs were \nintervened at patient/carer level (89.2%) followed by at drug level (1.6%) and at prescriber level (0.8%). None of the \nindependent factor was associated with incidence of DRPs. \nCONCLUSION: The findings reveal the existence of DRPs among HMR patients. HMR can be used as a method to identify \nDRPs among patients; hence it helps to expand pharmacy service to provide better pharmaceutical care to the community. \n \nKEYWORDS: impact of pharmacy services, Johor, home medication review, drug-related problem \nNMRR ID: NMRR-16-2506-32088 \n \n \nOP-06 (Oral) \nTHE USE OF COMPLEMENTARY AND ALTERNATIVE MEDICINE (CAM) AMONG BREAST CANCER \nPATIENTS IN HOSPITAL PULAU PINANG \n \nValerine Beh JN1, Choo MY1, Abdul Basir NFS1, Adrian Chow TC1, Zahir ME1 \n\n\n\n \n1Department of Pharmacy, Hospital Pulau Pinang, Ministry of Health Malaysia \n \nINTRODUCTION: Breast cancer is the most common cancer among females in Malaysia. Conventional cancer therapies \nhave many adverse effects which cause many patients to avoid treatment and opt for complementary and alternative medicine \n(CAM) use.  \nOBJECTIVES: The objective of this study was to determine the prevalence of CAM use among breast cancer patients in \nHospital Pulau Pinang (HPP). \nMETHOD: A cross sectional survey was performed and data was collected over 3 months among female breast cancer patients \nwho followed up at HPP oncology daycare, clinic, surgical ward and oncology ward. Participants were required to fill up \nquestionnaires about demographic, disease, treatment characteristics, CAM use, as well as reasons and perceived helpfulness \nof CAM use. Prayer-for-health was excluded from CAM modality in the data analysis to prevent inflating the statistics of \nCAM use. \nRESULTS: A total of 206 participants were recruited. The use of CAM was prevalent among breast cancer patients in HPP, \nwith 127 (61.7%) patients were identified as CAM users, and 79 (38.3%) patients were non-CAM users. Advanced disease \nstaging was the strongest predictor of CAM use (OR 10.458, n = 206, p < 0.05, 95% CI 4.022 to 27.190). Age, especially \nyounger patients (OR 0.964, n = 206, p < 0.05, 95% CI 0.932 to 0.997) and Malay ethnicity (OR 2.605, n = 206, p < 0.05, \n95% CI 1.224 to 5.548) were also found to be significantly associated with CAM use. Majority of CAM users had taken \nvitamin and mineral supplements and they perceived that CAM might help to improve their physical well-being. \nCONCLUSION: Patient education regarding CAM therapies is important in view of high prevalence of CAM use. CAM, \nwith unproven efficacy, may pose harm to patients' health and future studies focusing on safety issues of CAM use is essential. \n \nKEYWORDS: quality use of medicines, Penang, complementary and alternative medicine, breast cancer \nNMRR ID: NMRR-15-2279-27245 \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nOP-08 (Oral) \nPHYSICIANS\u2019 KNOWLEDGE, ATTITUDE AND PRACTICES REGARDING MANAGEMENT OF \nMEDICATIONS DURING FASTING IN RAMADAN AT HOSPITAL TUANKU AMPUAN NAJIHAH (HTAN), \nKUALA PILAH \n \nMuhammad Faizal M, Lim KV, Nur Aqilah Z \n\n\n\n \nDepartment of Pharmacy, Hospital Tuanku Ampuan Najihah, Ministry of Health Malaysia \n \nINTRODUCTION: Healthy Muslims are required to fast from sunrise to sunset in Ramadan month. Although patients with \nserious illnesses are exempted from fasting during Ramadan, most Muslims prefer to fast. There are guidelines that can help \nphysicians to address the concerns of patients fasting during Ramadan. However, there is limited data regarding knowledge, \nattitudes and practices (KAP) of physicians about management of medications during Ramadan in Malaysia. \nOBJECTIVES: This study aimed toassess physicians\u2019 KAP regarding management of medications during Ramadan in \nHTAN. \nMETHOD: A cross-sectional survey, involving 111 respondents who worked in Hospital Tuanku Ampuan Najihah, was \nconducted using a validated questionnaire. The survey was distributed during Ramadan and Syawal month, 25 May 2017 to \n31 July 2017.  \nRESULTS: The response rate of this study is 85.4%. Majority (n=86, 77.5%) of the respondents had a low level of knowledge, \n(n=22, 19.8%) had a moderate level of knowledge, and (n=3, 2.7%) had a high level of knowledge.Physicians\u2019 knowledge \nabout the management of medications in Ramadan was generally poor with overall score of 9.51 (SD\u00b12.91) out of a total of \n21. The physician\u2019s attitude in concordance with the Islamic principles had overall score of 7.33 (SD\u00b12.03) out of a total of \n10. For physicians\u2019 practice, the overall score was 16.32 (SD\u00b12.7) out of a total of 22. There were no significant differences \nin physician\u2019s religion, current position and department associated with physicians\u2019 KAP regarding management of \nmedications during Ramadan. \nCONCLUSION: The study revealed that there was lack of knowledge among physicians towards the proper management of \nmedications during Ramadan. Continuous medical education is suggested to be held before the fasting month to improve \nphysician\u2019s knowledge and practice regarding management of medications, as well as collaboration of physicians-pharmacist \nin pharmaceutical care issues, in an attempt to improve the quality of life of patients. \n \nKEYWORDS: quality use of medicines, Negeri Sembilan,knowledge, attitude, practice, fasting, medications \nNMRR ID: NMRR-17-2190-36162 \n \n \nOP-09 (Oral) \nTHE CAUSES OF PRESCRIBING ERRORS IN MEDICAL OUTPATIENT DEPARTMENT (MOPD), HOSPITAL \nTUANKU AMPUAN NAJIHAH: A QUALITATIVE STUDY \n \nLeow HY1, Danaraj T1, Muhammad Fitri BT1, Gan XY1 \n\n\n\n \n1Department of Pharmacy, Hospital Tuanku Ampuan Najihah, Ministry of Health Malaysia \n \nINTRODUCTION: Prescribing errors are the most common type of error in the medication use process. However, there is a \npaucity of literature regarding the causes of prescribing errors in Malaysia. \nOBJECTIVES: To explore and understand the causes of prescribing errors at Medical Outpatient department. \nMETHOD: A qualitative study using in-depth interviews of 23 prescribers in Medical Outpatient Department (MOPD), from \nMay 2017 to June 2017 was conducted for this study. Prescriptions with errors from MOPD were collected and prescribers \ninvolved in the errors were interviewed within 12 hours after prescribing errors had occurred. The interviews were audiotaped \nand transcribed verbatim. The responses were analysed by using framework approach of Reason\u2019s Model of Error Causation.  \nRESULTS: Responses from the doctors suggested that knowledge-based mistakes are more commonly occurred. Prescribers \nmentioned various errors producing conditions of prescribing errors including work environment, communication issue, \nphysical and mental well-being, and lack of knowledge contributed to the mistakes. Latent factors comprising of inadequate \ntraining, inappropriate prescribing practice, informal hierarchy culture, and an absence of self-awareness of errors were also \nidentified. Defences against error such as other prescribers and guidelines were absent or deficient, and supervision was \ninadequate. Pharmacists were identified as the main defence before errors reached patient. \nCONCLUSION: Prescribing errors could be minimized by training, improved communication skills, adherence to existing \nsystems of work, and through the introduction of new working practices. Prescribers should aware of error producing \nconditions and formally review interventions made by pharmacists despite practice proper documentation when prescribing.  \n \nKEYWORDS: quality use of medicines, Negeri Sembilan,prescribing errors, causes, qualitative, human error theory \nNMRR ID: NMRR-17-2825-36264 \n  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nOP-10 (Oral) \nA RANDOMIZED, OPEN-LABEL STUDY TO EVALUATE MEDICATION COMPREHENSION OF ELDERLY \nPATIENTS WITH ILLUSTRATED MEDICATION LABELS AT A PUBLIC HOSPITAL, PENANG \n \nLee CY1, Zahid MA1, Lim JN1, Khoo TY1, Sethuraman N1, Ng SQ1, Tamizi AA1, Wong MF1 \n\n\n\n \n1Department of Pharmacy,Hospital Seberang Jaya, Ministry of Health Malaysia \n \nINTRODUCTION: The difficulty in reading and understanding medication labels is highly prevalent among elderly patients, \nand likely to cause medication error and less effective treatment. Evidence suggests that specific content and format of \nmedication labels may facilitate the acquisition and comprehension among the elderly population.  \nOBJECTIVES: To investigate the impact of newly designed illustrated medication label (IML) in elderly patients\u2019 medication \ncomprehension at a tertiary public hospital of Penang, Malaysia. \nMETHOD: Elderly patient diagnosed with cardiovascular-related diseases visiting outpatient pharmacy of Hospital Seberang \nJaya to refill prescription were randomized to either standard medication labels (SML) group (control) or IML group \n(intervention) after screening. Patients\u2019 comprehension of the prescribed medication was assessed at four weeks of interval in \nboth groups. Patient characteristics include age, gender, duration of education years, disease length and pill burden was \nobtained. Descriptive and inferential statistics used to analyze data with statistical significant determine at p<0.05. \nRESULTS: Of 172 patient, 110 underwent follow-up (IML group: 56 patients; SML group: 54 patients). The mean(SD) \nmedication comprehension scores for IML was 3.89 (0.24), with minimum and maximum score was (2.89,4.00), for SML was \n3.82(0.37) with (1.78,4.00). Medication comprehension on dosage, frequency, and administration based on food intake showed \nhigher mean score in the IML group than SML group. Only patients\u2019 pill burden was found to significantly influence their \nmedication comprehension in the IML group (p=0.02), while none of the patient factors affect medication comprehension in \nSML group \nCONCLUSION: Introduction of IML has influence elderly patients\u2019 medication comprehension particularly with significant \ndifferences with their pill burden. Thus, IML can be used in specific subgroups of elderly patients to assist their medication \ncomprehension.  \n \nKEYWORDS: quality use of medicines, Penang, illustrated medication label; elderly; comprehension \nNMRR ID: NMRR-15-1059-25463 \n \n \nOP-11(Oral) \nDOSE CONVERSION FROM PROGRAF\u00ae TO ADVAGRAF\u00ae FOR KIDNEY TRANSPLANT RECIPIENTS AND \nITS ASSOCIATED COSTS: DO MALAYSIANS DIFFER? \n \nLee FY1, Wong HS1,2, Hajar AR1, Dheepa R2 \n\n\n\n \n1Clinical Research Centre, Hospital Selayang,Ministry of Health Malaysia, 2Nephrology Department, Hospital Selayang, \nMinistry of Health Malaysia \n \nINTRODUCTION: Miligram-to-miligram dose conversion from standard-release tacrolimus (Prograf\u00ae) to prolonged-\nrelease tacrolimus (Advagraf\u00ae) among kidney transplant recipients (KTRs) is currently recommended and translated to lower \ndrug costs and better compliance. However, there are suggestions that Asians require higher dose post-conversion, as our initial \nexperience suggested that higher Advagraf\u00ae dose might be required to achieve similar target blood tacrolimus trough \nconcentration (TacC0). \nOBJECTIVES: To determine dose-conversion ratio from Prograf\u00ae to Advagraf\u00ae among Malaysian KTRs and its impact on \ndrug costs. \nMETHOD: This retrospective cohort study screened all stable KTR transplanted at our centre between 1st January 2000 to \n31st December 2017 and converted from Prograf\u00ae to Advagraf\u00ae. KTR with completed database were recruited. Relevant \nclinical data, tacrolimus dosage and TacC0 were collected from hospital electronic medical records. Average TacC0 at steady \nstate adjusted for tacrolimus dose were compared pre and post-conversion via SPSS Version 23.0.  \nRESULTS: Of 23 KTRs who converted from Prograf\u00ae to Advagraf\u00ae, mean TacC0 was reduced from 4.19\u00b13.07ng/mL/mg \ntacrolimus to 3.62\u00b13.31ng/mL/mg tacrolimus after conversion with 1:1.13 dose-conversion ratio(p=0.062). This implied \nadditional cost of RM1539.57 per year incurred among these KTRs to achieve equivalent TacC0. KTRs with concomitant \ndiltiazem use as tacrolimus-sparing agent (n=12) demonstrated significant reduction of mean TacC0 post-conversion from \n3.32\u00b11.74ng/mL/mg tacrolimus to 2.49\u00b11.77ng/mL/mg tacrolimus(p=0.037). Mean TacC0 among KTRs without diltiazem co-\nadministration (n=11) declined insignificantly from 5.13\u00b13.94ng/mL/mg tacrolimus to 4.86\u00b14.18ng/mL/mg \ntacrolimus(p=0.572). Greater Advagraf\u00ae dose requirement is more pronounced among patients with diltiazem co-\nadministration, who are possibly rapid tacrolimus metabolisers with CYP3A5 polymorphism, which is associated with \ndiltiazem\u2019s tacrolimus-sparing mechanism. \nCONCLUSION: There is a projected 13% increase of tacrolimus dose among Malaysian KTRs to maintain equivalent TacC0 \nafter conversion from Prograf\u00ae to Advagraf\u00ae, which translated to additional drug cost incurred, instead of cost-saving as \nsuggested by previous studies. Further studies are required to verify the impact of pharmacogenomic variability on \nPrograf\u00ae:Advagraf\u00ae dose-conversion ratio. \n \nKEYWORDS: clinical research, Selangor,tacrolimus, conversion, cost-saving \nNMRR ID: NMRR-17-820-35750 \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nOP-12 (Oral) \nSINGLE-DOSE, OPEN-LABEL, RANDOMIZED, 2-TREATMENT, 2-SEQUENCE, 2-PERIOD CROSSOVER \nBIOEQUIVALANCE STUDY OF TWO OMEPRAZOLE CAPSULE PREPARATIONS IN HEALTHY MALE \nVOLUNTEERS UNDER FASTED CONDITION \n \nCheah KY1, Mah KY1, Pang LH1, Wong JW2, Tan SS2, Chin SK2, Yuen KH2, Damenthi N1 \n\n\n\n \n1Clinical Research Ward, Clinical Trial Unit, Hospital Ampang, Ministry of Health Malaysia,2Pharmacy-Attest Research Sdn \nBhd BA/BE Centre, Universiti Sains Malaysia, Pulau Pinang \n \nINTRODUCTION: Omeprazole is a substituted benzimidazole derivative and the first of the group of drugs, proton pump \ninhibitors (PPI) that suppress gastric acid secretion. It is acid labile and is administered orally as enteric-coated pellets or \ngranules in capsules or tablets.  \nOBJECTIVES: To investigate the relative bioavailability and bioequivalence between two omeprazole capsule preparations \nunder fasted condition for marketing authorization.  \nMETHOD: The study was conducted in a single-center, single-dose, open-label, randomized, 2-treatment, 2-sequence, 2-\nperiod crossover study in healthy, adult male subjects with a washout period of 7 days. Omeprazole drug products were \nadministered after a 10-hour fast. Standardized meals were served during both study periods. Blood samples for \npharmacokinetic analysis were collected at 0 (predose), 20 minutes, 40 minutes, 1, 1.5, 2, 2.5, 3, 3.5, 4, 5, 6, 7, 8, 9, 10 and 12 \nhours. Blood samples were centrifuged, and plasma separated to cyrovials containing sodium carbonate and kept frozen (-\n15\u00b0C to -25\u00b0C) until analysis. Plasma concentrations of omeprazole were quantified using high performance liquid \nchromatography with UV detector. Bioequivalence was assessed according to the ASEAN guideline acceptance criteria for \nbioequivalence which is the 90% confidence intervals of AUC0-\u221e , AUC0-t and Cmax must be within the range of 80.00 \u2013 \n125.00%.  \nRESULTS: 28 healthy subjects were enrolled in this study and only 26 subjects completed the trial. There were no significant \ndifferences observed between the AUC0-\u221e , AUC0-t and Cmax of the two omeprazole preparations in fasted condition. The 90% \nconfidence intervals for the ratio of AUC0-t (0.9107-1.0775), AUC0-\u221e (0.9237-1.0814) and Cmax (0.8420-1.0498) for the test \npreparation over reference preparation were all within acceptable range of 0.8000-1.2500.  \nCONCLUSION: The test preparation is bioequivalent to the reference preparation under fasted condition in healthy adult \nmales.  \n \nKEYWORDS: clinical research, Selangor, omeprazole, bioequivalence, fasting \nNMRR ID: NMRR-15-433-25317 \n \n \nOP-13 (Oral) \nEFFECT OF DUAL ANTIPLATELET THERAPY (DAPT) ON PLATELET REACTIVITY IN CORONARY \nARTERY BYPASS GRAFTING (CABG) PATIENTS \n \nKing TL1,2, Ku MY1,2, Tan CSY1,2, Soon SY3, Jong YH3, Fong AYY2,4, Chan JKM5 \n1Department of Pharmacy, Sarawak General Hospital, Ministry of Health Malaysia,2Clinical Research Centre, Sarawak \nGeneral Hospital, Ministry of Health Malaysia,3Department of Cardiothoracic Surgery, Sarawak Heart Centre, Ministry of \nHealth Malaysia,4Department of Cardiology, Sarawak Heart Centre, Ministry of Health Malaysia,5Gleaneagles Hospital, \nKuala Lumpur \n \nINTRODUCTION: Addition of clopidogrel to aspirin in post-CABG antiplatelet treatment is thought to induce more potent \nplatelet inhibition thus to prevent early graft failure and improve graft patency.  \nOBJECTIVES: This study aimed to investigate the effect of post-operative DAPT with aspirin and clopidogrel in CABG \npatients as compared to their aspirin monotherapy on platelet reactivity using whole blood platelet aggregometry.  \nMETHOD: Patients who were scheduled for CABG and taking aspirin monotherapy were recruited from Sarawak Heart \nCentre. Clopidogrel was added to aspirin monotherapy after CABG for 6 weeks as the standard practice. ASPItest (arachidonic \nacid, AA) for aspirin was done before operation while taking aspirin only and six weeks after postoperative DAPT. ADPtest \n(adenosine diphosphate, ADP) for clopidogrel was only done at six-week of DAPT. High on-treatment platelet reactivity \n(HOTPR) were defined as platelet reactivity more than 300 and 468 AU*min for aspirin and clopidogrel respectively \nRESULTS: Thirty-three patients were included. Mean ASPItest level during aspirin monotherapy before CABG was \n276.6\uf0b191.5 AU*min and it was reduced significantly to 222.0\uf0b172.5 AU*min (p=0.002) after six weeks of postoperative \nDAPT. 27.3% of the patients (n=9) were found to have HOTPR with aspirin before CABG and more than half (n=5) were \nsuccessfully converted to low on-aspirin platelet reactivity after 6 weeks of DAPT. Mean ADPtest level was 371.1\uf0b1200.3 \nAU*min and 21.2% (n=7) of the patients were found to have HOTPR with clopidogrel after 6 weeks of DAPT. No factors \nwere found to be associated with the effect of DAPT on platelet reactivity. \nCONCLUSION: Inhibition on platelet reactivity was improved after CABG with DAPT than aspirin monotherapy. Addition \nof clopidogrel to aspirin was shown to have additive effect on AA-mediated platelet function inhibition besides inhibiting ADP \npathway. A larger, randomised, and controlled study is however warranted.  \n \nKEYWORDS: clinical research, Sarawak,coronary artery bypass grafting, dual antiplatelet therapy, platelet function test  \nNMRR ID: NMRR-15-304-25000 \n  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nOP-14 (Oral) \nCORRELATION OF ANTIBIOTIC CONSUMPTION AND MULTIDRUG-RESISTANT INFECTIONS IN \nHOSPITAL TUANKU AMPUAN NAJIHAH (HTAN) \n \nKong LS1, Wan Ruzana WJ1, Tan JY1 \n\n\n\n \n1Department of Pharmacy, Hospital Tuanku Ampuan Najihah, Ministry of Health Malaysia \n \nINTRODUCTION: The increasing trend of multidrug-resistant (MDR) infection has become main concern because it will \nlead to increasing healthcare cost, failure of antibiotic treatment and increasing mortality rate. \nOBJECTIVES: To assess the trend and correlation of antibiotic consumption and multidrug-resistant infection in HTAN from \n2014 to 2016.  \nMETHOD: A retrospective study was conducted. Antibiotic consumption data was expressed as defined daily dose \n(DDD)/1000 inpatients-day every 6 months while multidrug-resistant infection was expressed as number of ESBL and MDR \nAcinetobacter cases every 6 months. Individual trends were determined by linear regression while correlation of antibiotic \nconsumption and multidrug-resistant infection was evaluated via Pearson\u2019s correlation coefficient or Spearman rank-order \ncorrelation. \nRESULTS: All the antibiotic consumption reduced from 2014 to 2016 and were significant for ciprofloxacin (p=0.028), \nmoxifloxacin (p=0.026), ceftriaxone (p=0.015), imipenem (p=0.004) and meropenem (p=0.031). Total ESBL infections \nincreased significantly from 2014 to 2016 (p=0.001) and sub-analysis showed that significant increment was only seen in \nsurgical discipline (p=0.024). Overall, all the antibiotic consumption was negatively correlated with ESBL infections. \nHowever, positive moderately strong correlations were found between ESBL infections and consumption of ceftazidime \n(r=0.656, p=0.157), cefepime (r=0.654, p=0.159) and cefoperazone/sulbactam (r=0.556, p=0.525) in surgical discipline. While \nfor MDR Acinetobacter infections, there was no significant increment in total and in individual disciplines. Most of the MDR \nAcinetobacter infections were from ICU/CCU discipline (76%). There were positive strong correlation for the consumption \nof piperacllin/tazobactam (r=0.839, p=0.037) and positive moderately strong correlation for the consumption of \nampicillin/sulbactam (r=0.560, p=0.248) with MDR Acinetobacter infections in ICU/CCU. \nCONCLUSION: Our study revealed that only consumption of certain antibiotics in certain disciplines was positively \ncorrelated with MDR infections in HTAN. Further study is necessary to identify other possible factors contributing to the \nemergence of MDR infections. \n \nKEYWORDS: clinical research, Negeri Sembilan,antibiotics, multiple drug resistance, defined-daily-dose  \nNMRR ID: NMRR-17-2843-36243 \n \n \nOP-15 (Oral) \nA RETROSPECTIVE STUDY: COMPARISON OF TWO EXTENDED-INTERVAL GENTAMICIN DOSING \nGUIDELINES IN ACHIEVING THERAPEUTIC CONCENTRATION IN NEONATES \n \nToh YS1, Toh CC1, Ali NA1, Hashim SA1 \n\n\n\n \n1Department of Pharmacy, Hospital Sultanah Nur Zahirah, Ministry of Health Malaysia \n \nINTRODUCTION: Extended-interval gentamicin dosing by Drug Doses (DD) and Neofax (NF) are two established \nmainstream guidelines in neonates. At current, there is no head to head comparison of safety and efficacy that suits Malaysia \nlocal population. In 2015, 10.38% (127 out of 1223) of gentamicin in HSNZ neonatal cases required dosage adjustment with \nhigh trough level (>1 \u03bcg/mL) which at risk of nephrotoxicity. \nOBJECTIVES: To evaluate the level and safety of gentamicin dosing in neonatal population based on Drug Doses by Frank \nShann and Neofax in a Malaysian hospital. \nMETHOD: This study was designed as retrospective, and sample was selected based on inclusion and exclusion criteria via \ndata retrieval from Hospital Information System (HIS). All neonates \u226430 days of life received intravenous gentamicin \ntreatment [according to Drug Doses (DD) or Neofax (NF) guidelines] in NICU/SCN/MAC were included in the study. \nGestational age, body weight, serum creatinine concentration, gentamicin dose/interval, serum peak and trough concentrations \nwere evaluated. Data was analysed using descriptive and non-parametric tests (SPSS v22) with p-value <0.05 was considered \nas statistical significant. \nRESULTS: Of total 407 subjects included, 83.5% (n=340) achieved therapeutic concentration. These subjects achieved \ntherapeutic trough concentration of <1 \u00b5gmL-1 and therapeutic peak concentration of 4-10 \u00b5gmL-1. There was a significant \nfinding of overall toxicity cases between Drug Doses group and Neofax group [95% CI, DD 21.8% (n=44); NF 11.2% (n=23); \np-value 0.008]. There was no significant difference were found between the percentages of toxicity cases based on gestational \nage (GA) or body weight (BW). \nCONCLUSION: The large percentage of toxicity cases in overall Drug Doses group revealed that Neofax regime appears to \nbe a promising safer option regime with less incidence of toxicity. \n \nKEYWORDS: clinical research, Terengganu,gentamicin, neonates, safety \nNMRR ID: NMRR-16-1185-29757 \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nOP-16 (Oral) \nCOMPARATIVE EVALUATION OF INTERNATIONAL NORMALIZED RATIO (INR) MONITORING \nBETWEEN POINT-OF-CARE AND LABORATORY-BASED TESTING METHOD IN PATIENTS RECEIVING \nWARFARIN THERAPY IN HOSPITAL SULTANAH NUR ZAHIRAH \n \nMuhammad NN1, Abdul Razak R1, Fong CW1, Othman SR1, Ishak M1, Yaakub MAA1, Sidek NN2, AhamadFouzi L2 \n\n\n\n \n1Pharmacy Department, Hospital Sultanah Nur Zahirah,Ministry of Health Malaysia,2Clinical Research Centre, Hospital \nSultanah NurZahirah, Ministry of Health Malaysia \n \nINTRODUCTION: Monitoring of patients receiving warfarin therapy is either by using POC-T or laboratory method. \nHowever, there was a greater variation at the higher INR value claimed by POC-T device provider. Data retrieved from \nSeptember to December 2016, 31.5% of patients with POC-T INR \u22654 showed INR within therapeutic range after confirmatory \nresult with laboratory method.  \nOBJECTIVES: The study aimed 1) To compare the INR results obtained between POC-T and laboratory based method, and \n2) To determine the cut-off point for high INR values generated by POC-T device should mandate confirmatory testing with \nlaboratory method. \nMETHOD: A retrospective cross-sectional study involved patients attending INR clinic was conducted from 1st June 2016 \nuntil 30th May 2017. The two (2) INR values were analysed using POC-T method and laboratory method on the same day. \nThe INR results were compared using Bland-Altman plot. Data was analyzed using SPSS v.20 with p<0.05 was considered \nstatistically significant.  \nRESULTS: A total of 118 patients with INR readings were included in this study. There was a significant difference between \nmean INR (mean\u00b1standard deviation) obtained by the POCT (3.87\u00b11.71) and laboratory testing method (2.89\u00b11.11). The INR \nof POC-T method were significantly correlated to the laboratory method (r = 0.875, p<0.01). INR measured by POC-T exhibit \npositive bias as INR increase, particularly when INR >4.0. \nCONCLUSION: A significant correlation between two METHOD suggested that POC device is a reliable tool for INR <4.0. \nINR values generated by POC-T device exhibit bias at the high INR range thus a repeat test using laboratory method must be \nconsidered when INR \u22654.0. \n \nKEYWORDS: clinical research, Terengganu, warfarin, international normalized ratio, point-of-care \nNMRR ID: NMRR-17-1158-34535 \n \n \nOP-17 (Oral) \nGEFITINIB VERSUS ERLOTINIB FOR NON-SMALL-CELL LUNG CANCER WITH MUTATED EGFR \n \nAhmat ANMF1, Nik-Adnan NN1, Badarudin NS1, Zainal-Abidin MN1, Lee LS1, Tang SL2, Gerard LCC2, Mohamad R1 \n\n\n\n \n1Department of Pharmacy, National Cancer Institute, Ministry of Health Malaysia,2Department of Radiotherapy and \nOncology, National Cancer Institute, Ministry of Health Malaysia \n \nINTRODUCTION: Non-small-cell lung cancer (NSCLC) with sensitive epidermal growth factor receptor (EGFR) mutations \nis highly responsive to EGFR tyrosine kinase inhibitors such as gefitinib and erlotinib, but little is known on its efficacy and \nsafety profile in our population.  \nOBJECTIVES: This prospective study was designed to evaluate the treatment outcomes and safety profile of gefitinib and \nerlotinib in EGFR mutated advanced NSCLC for Malaysian population. \nMETHOD: Patients in Institut Kanser Negara prescribed with gefitinib and erlotinib between June 2015 and June 2017 were \nrecruited and followed up for 2-years or till death. Progression-free survival and overall survival were evaluated using Kaplan-\nMeier survival analysis and log rank test was performed.  \nRESULTS: Fifty-four patients were treated with gefitinib (n=36) and erlotinib (n=18). The median PFS for gefitinib and \nerlotinib were 11.7 months for both drugs (p=0.322). The median OS was 16.8 months for gefitinib and 22.2 months for \nerlotinib (p=0.309). In multivariate analysis, no significant difference for median PFS and OS whether patients receiving \nEGFR-TKI in first or second line setting. In terms of safety, all patients experienced at least one adverse event. Three patients \nexperienced grade 4 toxicities in gefitinib arm while none in erlotinib arm. Grade 3 toxicities occurs more common in erlotinib \narm (94.4% vs 44.4%). The most common toxicities (all grade) for erlotinib and gefitinib arm respectively were aneroxia \n(66.7% vs. 36%), increased blood bilirubin (61% vs. 30.6%), hand-foot syndrome (94.4% vs. 75%), and rash acnieform (72.2% \nvs. 41.7%). In this study, pneumonitis was only observed in gefitinib arm (11.1%). \nCONCLUSION: In NSCLC with mutated EGFR, treatment as first or second-line setting with either gefitinib or erlotinib will \ngive similar PFS and OS. In terms of safety, gefitinib are more tolerable than erlotinib.  \n \nKEYWORDS: clinical research, Putrajaya, non-small-cell lung carcinoma, gefitinib, erlotinib \nNMRR ID: NMRR-15-831-25773 \n  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nOP-18 (Oral) \nEFFECTIVENESS OF SMOKING CESSATION INTERVENTIONS IN PRIMARY HEALTH CARE \n \nIbrahim@Ghazali NH1, Neoh CF2, Ismail H2 \n\n\n\n \n1Kuala Lumpur Health Clinic, Ministry of Health Malaysia, 2Faculty of Pharmacy, Universiti Teknologi MARA (UiTM) \n \nINTRODUCTION: Whilst overall effectiveness of a smoking cessation service in Malaysian primary care setting has been \npreviously reported, however, none of these studies assessed the effectiveness of each smoking cessation intervention.  \nOBJECTIVES: This study aimed to evaluate the effectiveness of each smoking cessation intervention that was available in \nthe primary care setting in Malaysia, measured as 6-month abstinence rate and also to determine the predictors of smoking \ncessation. \nMETHOD: A multi-centre, retrospective cohort study was conducted. Medical records of participants who attended quit \nsmoking clinics in Kuala Lumpur and Putrajaya from August 2015 to November 2016 were retrieved. Information on social \ndemographics, smoking history, quit attempts and intervention types were collected, using a standardised data collection form. \nThe primary outcome was abstinence at 6-month follow-up, confirmed by expired air carbon monoxide. Data were then \nanalysed using SPSS version 24.0.  \nRESULTS: Three hundred and thirty four participants who fulfilled the inclusion criteria were included in this study. Overall \n6-month abstinence rate was reported at 23.1%. Participants treated with counselling and varenicline achieved 32.1% of 6-\nmonth abstinence rate, followed by the group of counselling and nicotine replacement therapy (NRT) (20.8%), counselling \nonly (15.0%) and the group of counselling, varenicline and NRT (13.0%). The predictors for smoking cessation were number \nof visit and intervention types. \nCONCLUSION: In the Malaysian setting, counselling with varenicline appeared to be the most effective option in smoking \ncessation. \n \nKEYWORDS: clinical research, Kuala Lumpur, smoking cessation, , varenicline, nicotine replacement therapy \nNMRR ID: NMRR-17-2086-37463 \n \n \nOP-19 (Oral) \nKNOWLEDGE, PERCEPTION AND ATTITUDE OF HEALTHCARE PROFESSIONALS TOWARDS THE USE \nOF GENERIC MEDICINES IN HOSPITAL TENGKU AMPUAN AFZAN (HTAA) \n \nLaow KY1, Tang WT1, Liew ZH1, Shuhaimi RN1, Ngoh YL 1, Yamin A1, Rizdiana NE1 \n\n\n\n \n1Department of Pharmacy, Hospital Tengku Ampuan Afzan, Ministry of Health Malaysia \n \nINTRODUCTION: The rising of healthcare expenditure has led to introduction of Generic Drug Policy in government \nhospitals to ensure quality healthcare affordable. Therefore, knowledge, perception and attitude of healthcare professionals \nwill influence the use of generic medicines in government hospital. \nOBJECTIVES: This study aimed to explore the knowledge, perception and attitude of healthcare professionals towards the \nuse of generic medicines in Hospital Tengku Ampuan Afzan (HTAA). \nMETHOD: An observational, cross-sectional study was conducted in HTAA among pharmacists and doctors using validated \nquestionnaires, which consist of 4 domains (demographic data, 10 knowledge related questions, 12 perceptions and 5 attitude \nrelated statements). \nRESULTS: A total of 269 healthcare professionals consist of 208 doctors and 61 pharmacists participated in the study. The \noverall knowledge score was 60.30 \u00b1 19.39. Pharmacists achieved higher mean score (73.77) than doctors (56.35) (mean \ndifference 17.42; 95% CI 12.79 to 22.05; p=0.022). More doctors believed that they need a standard guideline on brand \nsubstitution (p=0.003) and more information about the safety and efficacy of generic medicines (p=0.029) compared with \npharmacists. In contrary to pharmacists\u2019 perception, more doctors believed that generic medicines are made in substandard \nfacilities (p<0.001) and multinational products are of good quality than local products (p=0.037). In terms of attitude, most \ndoctors are not comfortable if pharmacists performing any generic substitution without their permission (p<0.001). \nCONCLUSION: Our findings suggested that there is a need to improve healthcare professionals\u2019 knowledge on safety, \nefficacy and quality of generic medicines. Besides, a standard guideline on brand substitution process is needed to improve \nthe use of generic medicines.  \n \nKEYWORDS: quality use of medicines, Pahang, generic medicines, knowledge, attitude, perception \nNMRR ID: NMRR-17-1365-35679 \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nOP-20 (Oral) \nPERCEPTIONS AND KNOWLEDGE ON ANTIBIOTIC USE AND RESISTANCE: A CROSS SECTIONAL \nMULTICENTER SURVEY AMONG PHARMACISTS IN MALAYSIAN PUBLIC HOSPITALS \n \nTang KL 1, Ooi TT1, Ong SY1, Lim PP2, Sarah AK3, Choong YC4, Foong WS5, Sunitha G6 \n\n\n\n \n1Department of Pharmacy, Hospital Seberang Jaya, Ministry of Health Malaysia,2Department of Pharmacy, Hospital Kepala \nBatas, Ministry of Health Malaysia,3Department of Pharmacy, Hospital Pulau Pinang, Ministry of Health \nMalaysia,4Department of Pharmacy, Hospital Bukit Mertajam, Ministry of Health Malaysia,5Department of Pharmacy, \nHospital Balik Pulau, Ministry of Health Malaysia,6Department of Pharmacy, Hospital Sungai Bakap, Ministry of Health \nMalaysia \n \nINTRODUCTION: Antibiotic Stewardship Programme (ASP) is an important measure to contain the spread of antibiotic \nresistance. ASP has been implemented in several major government hospitals in Malaysia with pharmacists working \ncollaboratively with other healthcare professionals in ensuring appropriate use of antibiotics. \nOBJECTIVES: This survey aimed to assess the practices, perceptions and knowledge of government hospital pharmacists on \nantibiotic use and resistance. \nMETHOD: A cross-sectional survey involving pharmacists from 6 public hospitals in Penang was conducted using self-\nadministered validated questionnaire in January 2017. The survey was distributed by Research & Development coordinator of \nthe selected hospitals. The main outcomes were pharmacists' antibiotic utilization knowledge, perceptions, and practices. \nRESULTS: The overall response rate was 88% (n=295). A total of 65% (n=192) respondents demonstrated good level of \nknowledge on antibiotic use and resistance (Mean knowledge score: 10.1 out of maximum score of 13.0 [95% confidence \ninterval 9.95-10.31]). Pharmacists from in-patient and ward pharmacy units have significant better antibiotic knowledge \ncompared the others (p<0.001). Years of practice in hospital was not significantly associated with antibiotic knowledge. A \nmajority of the pharmacists perceived that polypharmacy (85%, n=252) and overuse of broad-spectrum antibiotics (92%, \nn=270) can lead to antibiotic resistance, and that ensuring rational use of antibiotics is a shared responsibility between \nclinicians and pharmacists (94%, n=278). The respondents (90%, n=266) were positive that ASP helps promote rational use \nof antibiotics and they (93%, n=273) perceived that a formal training in infectious diseases should be given before their \ninvolvement in ASP. Majority (81%, n=234) of the pharmacists were concerned about variability in types and availability of \nantibiotics in hospital as compared to only 15.1% of them who felt that the use of generic/innovator brand influenced their \nrecommendations. \nCONCLUSION: This study has identified the antibiotic knowledge gap among hospital pharmacists in the state of Penang. \nHospital pharmacists are generally supportive of ASP. \n \nKEYWORDS: quality use of medicines, Penang, antibiotics, perceptions, knowledge, hospital pharmacists \nNMRR ID: NMRR-16-2299-2875 \n \n \nOP-21 (Oral) \nTHE LEVEL OF UNDERSTANDING AMONG VARIOUS GROUPS OF GOVERNMENT HEALTHCARE \nPERSONNEL IN F.T. LABUAN TOWARDS REGISTERED PRODUCTS AND NOTIFIED COSMETICS \n \nTan ZSS1, Law KE1, Omar WA1, Tan CH1, A Riza ZY1, Ong ST1, Kuan SH1 \n\n\n\n \n1Pharmaceutical Services Division, Labuan State Health Department, Ministry of Health Malaysia \n \nINTRODUCTION: All medicinal and pharmaceutical products in Malaysia must be registered with the Drug Control \nAuthority (DCA) whereas cosmetics must be notified with the National Pharmaceutical Regulatory Agency (NPRA). \nAvailability of unregistered products and unnotified cosmetics in the market are longstanding issues affecting public safety \nand health. It is vital that all government healthcare personnel (GHP) as the front liners are equipped with the knowledge to \nproperly advise the public on this issue. \nOBJECTIVES: This study aims to determine the level of understanding towards registered products and notified cosmetics \namong various groups of government healthcare personnel under the Ministry of Health facilities in Labuan. \nMETHOD: This was a cross-sectional study performed from August to November 2017 using a validated 12 question \nquestionnaire originally designed by Sabah State Pharmacy Enforcement Branch. Respondents were divided into 4 groups and \nresults between different groups were analysed using SPSS Ver. 18. Respondent\u2019s knowledge was given score and those who \nscored 9 marks and above were considered to have good understanding. Those who scored 8 marks and below were considered \nto have poor understanding. \nRESULTS: 219 out of 250 questionnaires were filled and returned with response rate of 87.6%. Pharmacists have the highest \nscore of good understanding on registered products and notified cosmetics at 81.8% (n=18). The level of good understanding \namong allied health professionals (AHP) stood at 42.9% (n=21), 36.4% of nurses (n=43) and 20% of doctors (n=6). The level \nof understanding among GHP are significantly different (p<0.001). Main factor that affect the level of understanding is the \ninability of the respondent to correctly answer a question on cosmetics. \nCONCLUSION: This study shows that the level of understanding among government healthcare personnel varies between \ngroups of profession. More strenuous efforts and continuous education should be undertaken to properly address this situation. \n \nKEYWORDS: quality use of medicines, Labuan, registered products, notified cosmetics, government healthcare personnel,  \nNMRR ID: NMRR-17-541-34803 \n  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nOP-22 (Oral) \nA REVIEW ON THE USE OF ORAL N-ACETYLCYSTEINE (NAC) IN PREVENTING CONTRAST INDUCED \nNEPHROPATHY (CIN) \n \nNurhamizah R1, Nurul Amira A1, Teng SY1, Sarmilah A1, Haifak Z1, Atiqah M1 \n\n\n\n \n1Department of Pharmacy, Hospital Putrajaya, Ministry of Health Malaysia \n \nINTRODUCTION: Contrast-induced nephropathy (CIN) has become the third most common cause of hospital-acquired \nacute kidney injury after hypotension and surgery. CIN is reported to increase from 20% to 40% in high-risk patients following \nthe administration of a contrast agent. \nOBJECTIVES: This study was aimed to identify characteristics of patients who received oral NAC for CIN prevention and \nto determine the outcome of oral NAC in preventing CIN besides identifying the risk factor(s) associated with CIN. \nMETHOD: This was a retrospective, observational study conducted in HPJ. A total of 389 patients who received oral NAC \nduring 2015 and 2016 were included according to inclusion and exclusion criteria. A paired-t test was conducted to evaluate \nthe impact of the NAC on preventing CIN. Data was analyzed using SPSS Version 21. \nRESULTS: A total of 336 patients were included. Only 96 of the patients fulfilled the criteria while the rest were excluded \ndue to no pre or post procedure renal profile (60.4%), ESRF (5.7%) and cancellation of procedure (5.4%). The results showing \nno significant decrease in eGFR post procedure( mean eGFR 46.7\u00b1 25.0 ml/min) to eGFR pre procedure (mean eGFR 43.2 \u00b1 \n25.0 ml/min) at p >0.05. Study showed both Diabetes Mellitus and hydration were significant variables associated with \nincidence of CIN using Simple Linear Regression (SLR) at p<0.25. Hydration was identified as significant risk factor \nassociated with the incidence of CIN via Multiple Linear Regression at p<0.05. \nCONCLUSION: About 28.5% of the patients who received oral NAC were monitored for pre & post contrast procedure for \nCIN. Most patients (85.5%) who received oral NAC did not show any significant decrease in eGFR post contrast procedure. \nHydration status was identified as a significant risk factor associated with CIN. \n \nKEYWORDS: quality use of medicines, Putrajaya, contrast induced nephropathy, oral N-acetylcystiene,  \nNMRR ID: NMRR-17-2651-36798 \n \n \nOP-23 (Oral) \nRETURN MEDICATION PROGRAMME AMONG PATIENTS AT OUTPATIENT SETTING IN HOSPITAL \nTUANKU AMPUAN NAJIHAH: A CROSS-SECTIONAL STUDY \n \nHannah M1, Lin MT1, Nur Afifah S1, Vignishwary SP1 \n\n\n\n \n1Department of Pharmacy, Hospital Tuanku Ampuan Najihah, Ministry of Health Malaysia \n \nINTRODUCTION: Previous study showed that 89.1% patients have unused medications at home. Patients may not use all \nthe medications given to them due to numerous reasons. The unused medication can lead to problems such as ineffective \ntreatment, health risks, medicine resistance, excessive spending on pharmaceuticals and wastage of financial resources. \nOBJECTIVES: To identify the awareness of Return Medication Programme, reasons of patient returning medication among \npatients and to assess patient medication disposal method. \nMETHOD: A cross-sectional study was carried out once a week within September 2017, using self-administered validated \nquestionnaire. Patients included were patients from the medical outpatient clinic, surgical outpatient clinic, obstetrics and \ngynaecology clinic, dental clinic, psychiatric clinic, ear, nose & throat clinic. Patients from eye clinic and skin clinic were \nexcluded.  \nRESULTS: A total of 171 questionnaires were distributed respectively and from which 148 responses were obtained (86.5%). \n64.3%(n=95) respondents were aware of the medication return programme. Majority of the respondents returned medication \ndue to having extra medications (n=37, 25%), discontinued due to self-taking supplements (n=24, 16.2%) and medications \nwere expired (n=20, 13.5%). A total of 62.8% (n=93) respondents knew that improper disposal of medication can harm the \nenvironment. Percentage of respondents who had return medications in Hospital Tuanku Ampuan Najihah was 72.3% (n=107). \nCONCLUSION: Patients can be educated with the proper method to handle extra medications and disposal method. \nAwareness programme to educate patient on medication return programme can be organized to increase awareness and \nunderstanding of patient towards the programme. \n \nKEYWORDS: quality use of medicines, Negeri Sembilan, return medication, awareness, reason, disposal  \nNMRR ID: NMRR-17-1379-36239 \n  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nOP-24 (Oral) \nA PROSPECTIVE STUDY TO EVALUATE THE FREQUENCY OF ANTIBIOTIC DE-ESCALATION PRACTICE \nIN CULTURE POSITIVE RESULT AMONG PHYSICIANS AND THE IMPACT OF THIS STRATEGY IN \nMEDICAL WARD OF PENANG GENERAL HOSPITAL \n \nWong KL1, Chong ZK1, Wong ML1, Chee SH1, Wan Sakinah1, Siva Malar1, Chow TS, Leong KN, Wong PS2, Ch'ng WC3 \n\n\n\n \n1Department of Pharmacy, Hospital Pulau Pinang, Ministry of Health Malaysia,2Infectious Disease Unit, Hospital Pulau \nPinang, Ministry of Health Malaysia,3Pathology Department, Hospital Pulau Pinang, Ministry of Health Malaysia \n \nINTRODUCTION: The increasing of antimicrobial resistance (AMR) rate is a burden to the country due to the high treatment \ncost and increased mortality rate. One of the strategies to reduce AMR developed by Antimicrobial Stewardship (ASP) to \nreduce AMR was Antibiotic de-escalation (ADE).  \nOBJECTIVES: The aim of the study is to assess the frequency of antibiotic de-escalation and factors associated with antibiotic \nnon-de-escalation among physicians in the medical ward of Penang General Hospital. \nMETHOD: This prospective study was carried out in Medical ward (C5, C6 and C7) of Penang General Hospital for three \nmonths. The frequency of de-escalation and the factors associated with non-de-escalation were determined. \nRESULTS: Among 99 patients included in this study, antibiotics were de-escalated in 86(86.9%) patients. Reasons for non \nde-escalation included clinical deterioration(28%), fear of de-escalation in complicated patients (20%), and \nimmunocompromised patients (12%). There were no significant differences in length of hospitalization between the antibiotic \nde-escalation and non de-escalation group. \nCONCLUSION: The percentage of antibiotic de-escalation in medical wards of Penang General Hospital is high. Thus, this \nstudy serves as a precedent to introduce ASP with antibiotic de-escalation to other disciplines (i.e. surgical, O&G, and etc) to \nhelp tackle the increasing AMR rate. \n \nKEYWORDS: quality use of medicines, Penang, antibiotic, de-escalation, antimicrobial stewardship \nNMRR ID: NMRR-17-857-35440 \n \n \nOP-25 (Oral) \nA QUALITATIVE RESEARCH ON FACTORS AFFECTING COMPLIANCE TOWARDS DEFEROXAMINE \nAMONG ADULT TRANSFUSION-DEPENDENT THALASSEMIA PATIENTS IN HOSPITAL PULAU PINANG \n \nChoe JY1, Chew YK1, Liew ZH1, Nurul AAH1, Chwee RCP1 \n\n\n\n \n1Department of Pharmacy, Hospital Pulau Pinang, Ministry of Health Malaysia \n \nINTRODUCTION: Deferoxamine is a well-established iron chelating agent used in managing iron overload in thalassemia \npatients. However, its treatment efficacy and success rates are highly dependent on patients\u2019 compliance. \nOBJECTIVES: This study aims to explore patients\u2019 opinions on factors affecting their compliance towards Deferoxamine. \nMETHOD: A qualitative study was carried out from Mei to December 2015 in Hematology Clinic, Hospital Pulau Pinang. \n10 adult patients who were undergoing or had undergone Deferoxamine therapy were interviewed with guided questions. The \ninterviews were audio-taped, transcribed and interpreted. \nRESULTS: Patients reported that their compliance was affected by personal factors, the treatment factors, environmental \nfactors, and healthcare policies. Personal factors including the desire to get better or fear of worsening of condition affected \npatients\u2019 attitude toward the treatment for most patients in the study group. A positive attitude encouraged them to gain more \nknowledge about their condition and relevant treatments. 60% of patients reported reduced compliance when they were \ndistracted with personal matters, family problems, and work-related issues. Some patients felt that females were more \ncompliant to their treatment. The route of administration of deferoxamine was an important factor as well. This included the \ninconvenience prior to injecting, the duration of infusion, pain and swelling at injection site, and preference of patients for oral \ntablets over the subcutaneous route of treatment. A supportive environment was also important to improving patient \ncompliance. This includes motivation from their family, friends and other support groups. Higher levels of acceptance and \nknowledge of their caregivers were conducive to improving their compliance. Healthcare policies in terms of subsidies and \nenforcement of patient education affected their compliance to a smaller degree. \nCONCLUSION: In conclusion, compliance is not solely dependent on personal factors. Treatment choice and the support \nefforts from all stakeholders will also affect the patients\u2019 compliance towards the treatment. \n \nKEYWORDS: quality use of medicines, Penang, deferoxamine, compliance, thalassemia \nNMRR ID: NMRR-15-2243-27011 \n  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nOP-26 (Oral) \nKNOWLEDGE AND PERCEPTION OF MEDICAL STAFF ON THE USE OF HIGH ALERT MEDICATIONS IN \nHOSPITAL PERMAI JOHOR BAHRU \n \nAzza MG1, Ali Umar I1, Noor Ratna N1, Vikneswari S1 \n\n\n\n \n1Department of Pharmacy, Hospital Permai, Ministry of Health Malaysia \n \nINTRODUCTION: High-alert medications (HAMs) are drugs that bear a heightened risk of causing significant patient harm \nwhen they are used in error, and hence it is vital to have adequate knowledge, education and training when handling with these \nmedications. Previous studies have shown that errors involving high alert medications can be detrimental or even fatal to \npatients.  \nOBJECTIVES: To assess and compare knowledge of doctors, pharmacists, registered nurses, pharmacist assistants, and \nmedical assistants in HPJB and their perceptions regarding high alert medications in HPJB. \nMETHOD: A 35-item questionnaire-based cross-sectional study carried out in HPJB. Assessment of knowledge between \nprofessions are compared using the ANOVA test with a significant p-value of \u22640.05 \nRESULTS: In the 109 respondents, 37% were nurses, 25% medical assistants, 15% pharmacists, 13% pharmacist assistants \nand, 10% doctors. Overall, the mean score of knowledge of medical staff is 6.42 which is considered as good knowledge. \nPharmacists scored the highest with 7.44 point and medical assistants scored the lowest with 5.33 points. There is a statistical \ndifference with p = 0.000 between medical professions and their knowledge scores regarding HAMs. Awareness on the practice \nof 5 Right of medication showed that interruption is the leading cause of 5 Rights being inconsistently done. \nCONCLUSION: This study proves that there is a significant association between the knowledge on the use of high-alert \nmedications among medical staffs in HPJB especially when comparing the knowledge scores of medical staffs with other \nprofessions. Each different profession also has a different perception regarding high alert medications and errors involved \nwhen handling high-alert medications. A total of 64% of respondents choose to be educated on HAMs through Continuing \nMedical Education (CME). This provides a valuable input when considering METHOD to educate medical staffs regarding \nhigh-alert medications in HPJB. \n \nKEYWORDS: quality use of medicines, Johor, high alert medications, knowledge, perception \nNMRR ID: NMRR-17-1620-34658 \n \n \nOP-27 (Oral) \nPAIN BELIEF AND ADHERENCE TO PAIN MEDICATIONS IN PATIENTS WITH NEUROPATHIC PAIN IN \nHOSPITAL REHABILITASI CHERAS \n \nMokhtar J1, Tajudin NH1, Md Yusof NY1, Foong LY1, Muhamad Yunus Y1 \n\n\n\n \n1Pharmacy, Hospital Rehabilitasi Cheras, Ministry of Health Malaysia \n \nINTRODUCTION: Patients\u2019 beliefs about their pain are thought to play a prominent role in pain perception, function and \nresponse to treatment. \nOBJECTIVES: This study was aimed to determine pain belief and medication belief in patients with neuropathic pain, to \ncompare the belief between different neuropathic pain medications prescribed and to determine the correlation between beliefs \nand medication adherence in patient with neuropathic pain. \nMETHOD: A cross-sectional survey using researcher assisted questionnaire was conducted in Outpatient Pharmacy involving \nall patients prescribed with neuropathic pain medications (Pregabalin, Gabapentin and Amitryptyline) from August 2015 \u2013 \nMay 2016. Data was analysed using SPSS Version 21. \nRESULTS: This study included 30 patients with a mean age of 51 \u00b1 15 years. Most of them were Malay (66.7%) and not \nworking (56.7%). Pain duration was 28.0 \u00b1 35.8 months. A total of 63.3% of patients received Gabapentin as monotherapy. \n83.3% of them experienced constants pain with a pain score of 4.9 \u00b1 2. Finding showed no statistical difference when compare \npain belief and medication belief between medications (p=0.970 and p=0.288). This study also found that medication \nadherence has significant correlation with pain belief(r=0.446, p=0.014) but not with medication belief(r=0.150, p=0.429).  \nCONCLUSION: This study showed that pain belief and medication belief does not specific to any drug and medication \nadherence has significant correlation with pain belief but not with medication belief. Further research is needed to elucidate \nthe relationship between pain belief and patient medication adherence, which can help to optimize the treatment and the \nadherence towards the medication. \n \nKEYWORDS: quality use of medicines, Kuala Lumpur, pain, belief, adherence, neuropathic pain  \nNMRR ID: NMRR-15-858-25185 \n  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nOP-28 (Oral) \nEFFECTIVENESS OF \"KNOW YOUR MEDICINE - TAKE IT FOR HEALTH\" (MEDIHEALTH) PROGRAM IN \nIMPROVING MEDICATION ADHERENCE AMONG TYPE 2 DIABETES MELLITUS PATIENTS IN \nSARAWAK: A RANDOMIZED CONTROLLED TRIAL \n \nTing CY1,2, Ahmad Zaidi Adruce S2, Hassali MA3, Morisky DE4, Ting H5, Ting R6, Lim CJ7, Abd Jabar AHA8, Osman NA9, \nTalin BA1, Ngau E10, Shuib IS1, Loo SC1, Sim ST1, Lim SE9, Selbi SF10, Awang Mahrup DF10, Kifli SN11, Iskandar NA11, \nSaid LN1 \n\n\n\n\n\n\n\n1Pharmacy Enforcement Division, Kuching, Sarawak, Ministry of Health Malaysia,2Institute of Borneo Studies, Universiti \nMalaysia Sarawak, Kota Samarahan, Sarawak, 3Social and Administrative Pharmacy, School of Pharmaceutical Sciences, \nUniversiti Sains Malaysia, Penang, 4Department of Community Health Sciences, UCLA Fielding School of Public Health, Los \nAngeles, California, United States of America, 5Sarawak Research Society, Kuching, Sarawak, 6Monash University, Jeffrey \nCheah School of Medicine and Health Sciences, Selangor, 7Clinical Research Center, Sarawak General Hospital, Ministry of \nHealth Malaysia, 8Pharmaceutical Services Division, Kuching, Sarawak, Ministry of Health Malaysia, 9Pharmacy Practice and \nDevelopment Division, Kuching, Sarawak, 10Department of Pharmacy, Klinik Kesihatan Petra Jaya, Ministry of Health \nMalaysia, 11Department of Pharmacy, Klinik Kesihatan Kota Samarahan, Ministry of Health Malaysia \n \nINTRODUCTION: Sarawak Pharmaceutical Services Division had developed a pharmacist-led, theoretical grounded, \nculturally sensitive and structured group-based program \u201cKnow Your Medicine \u2013 Take it for Health\u201d (MEDIHEALTH), \nto improve medication adherence (MA) among T2DM patients. \nOBJECTIVES: This study aimed to evaluate the effectiveness of the MEDIHEALTH in improving MA among Malay \npatients and to identify the factors associated with its effectiveness. \nMETHOD: The randomized controlled trial was conducted at Health Clinic Petra Jaya and Samarahan. Malay T2DM patients \nwho had poor MA (8 items Morisky Medication Adherence Scale Malaysian specific score < 6) were randomly assigned to \nintervention group (IG) and control group (CG). The outcomes are the MA level (primary) and the attitude, subjective norms \n(SN), perceived behavioural control (PBC), intention and knowledge that are related to MA (secondary), at the baseline, 1 and \n6 months of post-intervention. Quantitative results were triangulated by the findings from semi-structured interviews (SSI) \nconducted upon 1 month after the intervention.  \nRESULTS: A total of 131 participants completed follow-up measures with 68 and 63 for IG and CG, respectively. Participants \nin IG had significantly greater MA level at post 1 (p<0.01, 95% CI: 0.115, 0.543) and 6 months as compared to those in CG \n(p<0.01, 95% CI:0.105, 0.523). Path analysis found that the effectiveness of the Program was significantly associated with \nPBC (p<0.05, 95% CI:0.019, 0.213) and knowledge (p<0.01, 95% CI:0.123, 0.325), not attitude, SN or intention related to \nMA. Such associations were further supported by the qualitative results. \nCONCLUSION: MEDIHEALTH was found to be effective in improving MA among Malay T2DM patients, through \nmediating effects of PBC and knowledge related to MA. \nKEYWORDS: quality use of medicines, Sarawak, type 2 diabetes mellitus, medication adherence, structured group-based \neducational program, randomized controlled trial \nNMRR ID: NMRR-17-925-35875 \n \n \nOP-29 (Oral) \nPERCEPTION OF THE QUALITY, SAFETY AND EFFICACY OF TRADITIONAL AND COMPLEMENTARY \nMEDICINE (TCM) AMONG YOUNG ADUTS IN MALAYSIA \n \nMohd NA1, Cho YT1, Lambak UK2, Sobri NAH3, Ismail NF4, Khauli T1 \n\n\n\n \n1Pharmaceutical Services Division, Melaka State Health Department, Ministry of Health Malaysia,2Pharmacy Department, \nHospital Melaka, Ministry of Health Malaysia,3Pharmacy Department, Hospital Jasin, Ministry of Health Malaysia,4Pharmacy \nDepartment, Klinik Kesihatan Merlimau, Ministry of Health Malaysia \n \nINTRODUCTION: Traditional and Complementary Medicine (TCM) is an important and often underestimated part of \nhealthcare. Understanding the perception of young adults in Malaysia regarding the quality, safety and efficacy of TCM is \ncrucial as the demand for T&CM therapy is increasing and incorrect use of this therapy can have fatal outcomes.  \nOBJECTIVES: To study the use of Traditional and Complementary Medicine (TCM) among young adults as well as their \nperceptions towards its quality, safety and efficacy.  \nMETHOD: A cross-sectional study was conducted through social media Facebook and Twitter accounts for 30 days; targeting \nrespondents aged 15-40. A validated, self-administered questionnaire comprised of four sections was used. Analysis was done \nusing descriptive statistics and chi square tests.  \nRESULTS: 350 respondents were recruited in this study. Overall, 64.3% of the respondents have used TCM at least once in \nthe past. 31.7% of the respondents believed in the quality of TCM while 36.9% of them perceived TCM safe to use. 22.9% of \nthe respondents believed that TCM does not have side effects while more than a quarter (27.1%) perceived it to have less side \neffects as compared to conventional treatments. Less than half of the respondents (40.9%) believed that TCM is effective while \nonly 8.3% perceived it to be more effective than conventional treatments. The respondents\u2019 perception towards the quality, \nsafety and efficacy of TCM was significantly associated with their experience of using TCM  \nCONCLUSION: The study revealed the current scenario on the use of TCM among young adults and their perceptions \ntowards its quality, safety and efficacy. This serves as a yardstick for the development of new strategies and action plans in \neducating young adults in Malaysia regarding the quality use of TCM.  \nKEYWORDS: quality use of medicines, Malacca, traditional and complementary medicine, perception, young adults \nNMRR ID: NMRR-17-2926-38994 \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nOP-30 (Oral) \nA CROSS SECTIONAL STUDY ON THE AWARENESS TOWARDS PHARMACEUTICAL PRODUCTS \nREGISTRATION AMONG MEDICAL PRACTITIONERS AND PHARMACISTS IN A TERTIARY HOSPITAL OF \nMALAYSIA \n \nTan MH1, Chong CM2, Yii EM1, Lim YS3 \n\n\n\n \n1Pharmacy Enforcement Branch (Bintulu), Sarawak, Ministry of Health Malaysia, 2Pharmacy Enforcement Branch (Limbang), \nSarawak, Ministry of Health Malaysia, 3Pharmacy Enforcement Branch (Miri), Sarawak, Ministry of Health Malaysia \n \nINTRODUCTION: Unregistered pharmaceutical products are becoming rampant and easily accessed by public despite \nstringent surveillance and enforcement efforts. Public generally do not have comprehensive understanding about \npharmaceutical products and tend to consult medical practitioners or pharmacists in government settings for such issues. Good \nunderstandings on the pharmaceutical products registration among these professionals are essential to deliver accurate \ninformation to the public. \nOBJECTIVES: To study the awareness of medical practitioners and pharmacists working in Miri General Hospital (a tertiary \ngovernment hospital) towards pharmaceutical products registration. \nMETHOD: A self-administered questionnaire was developed based on previous study and review on relevant Acts. The \nquestionnaire was pre-tested and reviewed by 3 senior enforcement officers. Pilot study was adopted to determine the reliability \nand validity of the developed questionnaire. Universal sampling was employed to recruit medical practitioners and pharmacists \nworking in Miri General Hospital. Permission to collect data and ethics approval were obtained prior to data collection. \nDescriptive analysis, independent T test and Pearson correlation were used to analyse the results obtained.  \nRESULTS: A total of 50 pharmacists and 70 medical practitioners were sampled (75% response rate). The overall mean score \nfor pharmacists and medical practitioners is 7.66 (\u00b1SD 2.61) and the individual mean scores are 9.40(\u00b1SD 1.95) and 6.41 (\u00b1SD \n2.3) respectively. The awareness of the pharmacists towards pharmaceutical products registration are significantly higher than \nthe medical practitioners (p<0.05). There is a weak correlation between level of awareness and years of servicing (r= 0.273, \np<0.05). \nCONCLUSION: This study reveals that there is difference in level of awareness towards pharmaceutical products registration \nbetween pharmacists and medical practitioners, in which the mean scores denote \u2018good\u2019 and \u2018moderate\u2019 awareness \nrespectively. Continuous professional development (CPD) courses for both professions are imperative to reinforce their \nunderstanding and subsequently delivering updated information to the public.  \n \nKEYWORDS: quality use of medicines, Sarawak, awareness, pharmaceutical products, registrationNMRR ID: NMRR-17-\n1390-35163 \n \n \nOP-31 (Oral) \nA RETROSPECTIVE CROSS-SECTIONAL STUDY ON DRUG UTILIZATION PATTERNS IN EMERGENCY \nAND TRAUMA DEPARTMENT (ETD) AT SIBU HOSPITAL \n \nTing HT1, Bryan LKZ1, Ting SR1, Annie SYJ1, Peggy WBC1, Ting HK1 \n\n\n\n \n1Department of Pharmacy, Hospital Sibu, Ministry of Health Malaysia \n \nINTRODUCTION: The drugs usage of ETD has increased over years which may lead to irrational drug utilization. \nOBJECTIVES: This study aimed to identify the medication prescribing patterns and cost of drugs in patients discharged from \nETD, Sibu Hospital according to WHO prescribing indicators. \nMETHOD: This was a cross-sectional study in which ETD prescriptions received by pharmacy, Sibu Hospital between \nJanuary and February 2017 were screened for inclusion criteria. All information from the prescriptions was entered into data \ncollection forms and analyzed using SPSS.  \nRESULTS: The study findings showed that ETD prescribing deviated from the WHO prescribing indicators. The average \nnumber of drugs per prescription was 2.88\u00b1 1.256 (WHO standard 1.6-1.8), 90.53% were prescribed in generic names (WHO \nstandard: 100%), 28.5% of the prescriptions contained antibiotics (WHO standard 20.0-26.8%) and 80.34% were prescribed \nfrom NEML list (WHO standard 100%). Top 5 prescribed List A drugs were oral Tramadol (12.9%), Amoxycillin-Clavulanate \n(8.1%), Cefuroxime (2.7%), Omeprazole (1.6%), and Pantoprazole (1.5%). List B analgesics (RM0.23\u00b10.15) has significantly \nlower cost (p=0.0001) compared to List A (RM1.57\u00b1 4.22) or co-prescribing of List A&B analgesics (RM1.81\u00b14.25). List A \ngastroprotective drugs (RM1.81\u00b10.77) has significantly lower cost (p=0.0001) than List B (RM4.08\u00b11.89) or co-prescribing \nof List A& B gastroprotective drugs (RM6.38\u00b10.89). Co-prescribing of List A&B antibiotics (RM48.36\u00b117.28) was \nsignificantly more costly (p=0.003) than either List A (RM42.31\u00b112.54) or List B antibiotics alone (RM14.03\u00b117.28). Thirty-\neight drugs were prescribed outside of the ETD pharmacy list and 3.9% of the antibiotics prescribed were not in accordance \nto national antibiotic guideline 2014. \nCONCLUSION: Our study found prescribing deviation in ETD, Sibu Hospital according to WHO prescribing indicators. A \nrevision on the prescribing policy in ETD is recommended to ensure that our practice is cost-effective and in accordance with \nWHO standard. \n \nKEYWORDS: quality use of medicine, Sarawak, prescribing pattern, emergency and trauma department \nNMRR ID: NMRR-16-2184-33152 \n  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nOP-32 (Oral) \nKNOWLEDGE, ATTITUDE, AND PRACTICES (KAP) CONCERNING PRESCRIPTION DRUG ABUSE AMONG \nPATIENTS IN HOSPITAL PULAU PINANG \n \nTan SSA1, Ong SE1, Farah IAM1, Vikneswary U2, Nazariah KS3 \n \n\n\n\n1Department of Pharmacy, Hospital Pulau Pinang, Ministry of Health Malaysia, 2Department of Pharmacy, Klinik Kesihatan \nBandar Baru Air Itam, Ministry of Health Malaysia, 3Department of Pharmacy, Klinik Kesihatan Sungai Dua, Ministry of \nHealth Malaysia \n \nINTRODUCTION: Prescription Drug Abuse refers to use of medication without a prescription in a way other than prescribed \nor for the experience or feelings elicited. Prescription drug abuse has profound health, economic, and social consequences.  \nOBJECTIVES: The objective of this study is to assess the knowledge, attitude and practice (KAP) concerning prescription \ndrug abuse among patients in Hospital Pulau Pinang. \nMETHOD: This is a cross-sectional survey carried out in Ambulatory Care Centre (ACC) Pharmacy of Hospital Pulau Pinang \nin March 2015. Patients aged more than 18 years old, able to read Bahasa Malaysia or English, who received more than one \nmonth supply of medications and were willing to give consent were interviewed using a face-validated questionnaire. \nKnowledge, attitude and practice were assessed using a scoring system. Positive attitude was defined as acceptance of \nprescription drug abuse while negative attitude was defined as non-acceptance. Patients who achieved 100 % score for the \npractice were considered \u201csafe\u201d while others were categorized as \u201crisky\u201d. \nRESULTS: A total of 137 patients completed the interview. The percentage of respondents with good level of knowledge \nabout prescription drugs was 47%, the percentage of respondents with positive attitude regarding prescription drug abuse was \n28%, and the percentage of respondents with a safe practice of using prescription drugs was 47%. The most commonly abused \nclass of prescription drugs were painkillers (40%), followed by tranquillizers (14%), and then lastly, stimulants (7%). Analysis \non marital status (p<0.001) and education (p=0.019) showed significantly better knowledge of prescription drug abuse. \nEducation level (p<0.001) was significantly associated with negative attitudes towards prescription drug abuse.  \nCONCLUSION: Level of education plays a vital role to enhance knowledge and negative attitudes towards prescription drug \nabuse. Therefore, in the effort to reduce prescription drug abuse, strategies involving the young should be implemented.  \n \nKEYWORDS: quality use of medicine, Penang, prescription drug abuse, knowledge, attitude and practice \nNMRR ID: NMRR-15-2500-28388 \n \n \nOP-33 (Oral) \nIMPACT OF INSULIN INJECTION TECHNIQUE RE-EDUCATION ON PERCEPTION OF INSULIN THERAPY \nAMONG URBAN-DWELLING TYPE 2 DIABETES MELLITUS PATIENTS IN HEALTH CLINICS IN KUALA \nLUMPUR \n \nCheah KY1, Lee XY2, Ching MW2, Selvadurai S2, Mardhiyah R2, Lee XH2, Lina M2, Hanisah bt K2 \n\n\n\n \n1Clinical Trial Unit, National Clinical Research Centre, 2Pharmacy Division, Health Department of Federal Territory of Kuala \nLumpur and Putrajaya, Ministry of Health Malaysia \n \nINTRODUCTION: Glycaemic control of diabetic patients can be influenced by many factors such as insulin technique, \ncompliance, patient perception, diet and lifestyle factors. Patient perception towards insulin therapy may affect their \ncompliance and subsequently glycaemic control. \nOBJECTIVES: To investigate the impact of insulin injection technique re-education on the perception of insulin therapy of \npatients with T2DM.  \nMETHOD: This was an unblinded randomized control trial, that recruited patients up to 4 months follow-up. From 160 \npatients recruited, 80 patients were randomized to the control group and received standard care comprising of insulin injection \ntechnique counselling upon the first visit. 80 patients in the intervention arm received monthly insulin injection technique \ncounselling for 4 visits. Patient\u2019s insulin perception was measured uring the validated Insulin Treatment Appraisal Scale \n(ITAS) on first and 4th visit. Higher ITAS scores indicate a higher negative perception on insulin.  \nRESULTS: There were no significant differences between the ITAS score of the control group pre and post intervention \n(50.88 [10.75] vs 51.29 [10.54]; p = 0.409). However, the ITAS score of the intervention group post intervention were \nsignificantly lower than pre intervention, (51.98 [8.21] vs 49.84 [8.28]; P = 0.007), suggesting a more positive perception \ntowards insulin therapy. The mean ITAS score difference in the intervention group (-2.10 [6.50]) showed a reduction , \ncompared to the mean ITAS score difference in the control group (0.42 [4.26]), suggesting patients who received monthly \ninsulin injection technique counselling had a more positive perception towards insulin therapy after 4 visits. Significant \ncorrelation between the changes in ITAS scores and HbA1c values pre and post-intervention in the intervention group was \nalso observed (Spearman\u2019s rho = 0.242; p = 0.049).  \nCONCLUSION: Insulin injection technique re-education can modify patients' existing insulin perception to be more positive.  \n \nKEYWORDS: impact of pharmacy services, Kuala Lumpur,insulin injection technique, Insulin Treatment Appraisal Scale \n(ITAS), perception \nNMRR ID: NMRR-16-1591-28767 \n  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nOP-34 (Oral) \nNSAIDS AVOIDANCE EDUCATION FOR HEART FAILURE PATIENTS IN REGIONAL REFERRAL \nHOSPITAL \n \nChoong LY1, Lew PC1, Doris G1, Leow KH1, Tan RW1 \n\n\n\n \n1Department of Pharmacy, Hospital Raja Permaisuri Bainun, Ministry of Health Malaysia \n \nINTRODUCTION: Non-steroidal anti-inflammatory drugs (NSAIDs) uses in heart failure patients are associated with a range \nof potential adverse effects, including an increased risk of cardiovascular effects. \nOBJECTIVES: To evaluate effectiveness of an in-patient education program in increasing the awareness of safety issues \nassociated with the use of NSAIDs among hospitalized heart failure patients. \nMETHOD: The quasi experimental study was carried out using self-developed and self- administered questionnaires to \nevaluate patient knowledge on NSAIDs before and after counselling by pharmacist. Patient knowledge questionnaire (PKQ) \ncontain 5 questions were completed by patients before intervention. Each correct answers will be given 1 marks. The \ninterventions consist of self-developed educational leaflets together with 10 minutes standard verbal counselling by \npharmacist. Then, post-counselling PKQ was completed by patients. Having 3 marks and above was equated with adequate \nknowledge on safety uses of NSAIDs. Data was analyzed using Wilcoxon signed ranked test. \nRESULTS: A total of 31 participants (61% female) completed both pre-and post-intervention questionnaires; median age was \n68 (IQR=22). 13% reported long term uses of NSAIDs and only 1% reported use of NSAIDs a week before admission. Median \npost-test scores 3 (IQR=2) was statistically significantly higher than median pre-test scores 1 (IQR=2). 87% found the \neducation program were useful to avoid future NSAIDs uses. \nCONCLUSION: Our findings suggest patients with underlying heart failure had inadequate knowledge on safety issues with \nNSAIDs uses. Pharmacist's counselling together with educational leaflet improved patients awareness on NSAIDs uses. \n \nKEYWORDS:  impact of pharmacy services, Perak, NSAIDs, education, heart failures \nNMRR ID: NMRR-14-1895-21338 \n \n \nOP-35 (Oral) \nSCHEDULED SUBSTANCES AS A CAUSE LEADING TO DANGEROUS DRUG ABUSE  \n \nZaini AA1, Mustafa MH1, Azimee A1, Noor ZH1, Chan YM1, Manoharan VM1, Lim JJ1, Che Harun SF1 \n\n\n\n \n1Pharmacy Enforcement Branch, Division of Pharmaceutical Services, Penang, Ministry of Health Malaysia \n \nINTRODUCTION: Products containing scheduled substances such as psychotropic pills, cough medicines and Mitragyna \nSpeciosa (ketum) had been frequently abused, mainly due to their addictive potential. The widespread abuse of products \ncontaining scheduled substances often perceived as less threatening compared to the pandemic issue of illicit dangerous drugs \nuse. \nOBJECTIVES: This study aims to qualitatively investigate the issues surrounding the abuse of products containing scheduled \nsubstances and the relationship between the abuse of these products and the illicit use of dangerous drugs among the clients in \nCure & Care Clinic Karangan, Kedah. \nMETHOD: Direct interview sessions were simultaneously held by four interviewers, involving a total of thirty clients at the \nCure & Care Clinic Karangan, Kedah. Convenience sampling method was used. Interviewers were given a set of questions as \nreference points. Interviews were done until the data saturation point was achieved. Interviews were audio-recorded, \ntranscribed verbatim, and the data was analysed into themes.  \nRESULTS: The thematic analysis grouped the data into five themes, namely the factors triggering scheduled substance abuse, \naccessibility and affordability of the abuse scheduled substances, the types of scheduled substances abused and illicit use of \ndangerous drugs, dependence or habit-forming effects, and the ramification of substance addiction. Two main products \ncontaining scheduled substances; cough preparations and ketum  had been identified as the popular choice for abuse among \nthe clients. The thematic analysis of the data showed that the abuse of these products were driven by several socioeconomic \nfactors and catalysed by the ubiquity of these products. \nCONCLUSION: The abuse of scheduled substances plays a role in prompting the subsequent illicit use of dangerous drugs \namong the clients in Cure & Care Clinic in Karangan, Kedah, mainly due to the ease of access to the scheduled substances \nsuch as ketum and cough preparations in the market. \n \nKEYWORDS: impact of pharmacy services, Penang, schedules substances abuse, ketum (Mitragyna Speciosa), cough \nmedicine, illicit use of dangerous drugs \nNMRR ID: NMRR-16-1088-31354 \n \n \n \n \n \n \n \n \n \n \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nOP-36 (Oral) \nEFFECTIVENESS OF PHARMACIST-LED EDUCATIONAL INTERVENTIONS ON SELF-CARE ACTIVITIES \nAND GLYCEMIC CONTROL OF TYPE 2 DIABETES PATIENTS: A SYSTEMATIC REVIEW AND META-\nANALYSIS \n \nAllah B1, Shaun WHL1, Tahir MK1 \n\n\n\n \n1School of Pharmacy, Monash University, Selangor, Malaysia \n \nINTRODUCTION: Effectiveness of pharmacist-led educational interventions on self-care activities and glycaemic control \nof type 2 diabetes patients is vague. \nOBJECTIVES: The purpose of this review is to appraise the effect of pharmacist-led diabetes educational interventions in \ntype 2 diabetes patients. \nMETHOD: According to PRISMA guidelines five electronic databases were searched from date of database inception to \nSeptember 2017. Randomized clinical trials examining the effectiveness of pharmacist led-interventions, directed at type 2 \ndiabetes patients only, were included for in this study. The study protocol is available with PROSPERO (CRD42017078854). \nRESULTS: Eleven studies, involving 1544 type 2 diabetes patients, were included in this systematic review. Meat-analysis \ndemonstrated that pharmacist-led interventions had a significant effect on lowering of glycosylated hemoglobin (-0.66; 95%CI \n[-0.83, -0.50]; I2=58.3%), in comparison to usual care. Self-care activities were assessed by using Summary of Diabetes Self-\ncare Activities (SDSCA) tool in eight studies. Overall meta-analysis of self-care activities of these studies (n=8) demonstrated \na significant effect of pharmacist-led interventions on self-monitoring of blood glucose (1.62; 95% CI [0.92-2.32]; I2=70.5%), \nfoot care (1.20; 95% CI [0.49, 1.90]; I 2=95.0%) and overall diet (1.16; 95% CI, [0.38-1.93]; I 2=64.2%), except for specific \ndiet (0.05; 95%CI [-0.58,0.69]; I 2 = 79.2%).  \nCONCLUSION: The findings of this review demonstrate that the involvement of pharmacist in diabetes educational \nprograms, results in significant improvements in self-care practices and glycaemic control of type 2 diabetes patients.  \n \nKEYWORDS: impact of pharmacy services, Selangor, self-care, HbA1c, pharmaceutical care, glycaemic control \nResearch ID: 12794 \n \n \nOP-37 (Oral) \nT2DM PATIENTS' ADHERENCE TO REFILLS AND MEDICATION: A COMPARISON BETWEEN \nTELEPHONE AND COLLECT SERVICE AND CONVENTIONAL COUNTER SERVICE IN A HEALTH CLINIC \n \nKhalidah M1, Mahmathi K2, Khairil AMI3, Norharlina S1 \n\n\n\n \n1Department of Pharmacy, Klang District Health Office, Ministry of Health Malaysia, 2Department of Pharmacy Practice, \nFaculty of Pharmacy, Universiti Teknologi MARA (UiTM), Puncak Alam, Selangor, 3Department of Management Sciences, \nFaculty of Health Sciences, Universiti Teknologi MARA (UiTM), Puncak Alam, Selangor  \n \nINTRODUCTION: Pharmacy Value Added Services (PVAS) has been implemented in Malaysian public healthcare to \nimprove patients' accessibility to follow-up medication supplies, hence improve adherence. Studies have shown that PVAS \nincrease patient satisfaction and reduce waiting time in pharmacy outpatient but no study investigated the adherence status of \npatients using PVAS, which is an important indicator to measure the effectiveness of this service in terms of patient outcome. \nOBJECTIVES: To compare refill and medication adherence score and HbA1c level in type-2 diabetes mellitus (T2DM) \npatients collecting refill medication through conventional counter service (CCS) and Telephone and Collect (T&C) Service \nusing Adherence to Refills and Medication Scale (ARMS).  \nMETHOD: A comparative cross-sectional, single centered, self-administered based survey was conducted at of one clinic \nunder Klang District. Patients attending the outpatient pharmacy, dispensed with at least one type of T2DM medication for at \nleast 6 months were conveniently selected. The instrument, adopted from a previous study, contained 28 items to assess \ndemographic characteristics, medication refill supply and collection and ARMS. Lower ARMS score indicates better \nadherence. Data was also collected through patients record for HbA1c and was analyzed using SPSS software version 24. \nRESULTS: T&C group shown better ARMS score mean (14.47\u00b12.37) compared to CCS group (16.67\u00b14.44) (p<0.001). \nPatients in T&C group had significantly lower HbA1c  readings with a mean of 7.52\u00b11.47 compared to patients in CCS group \n(8.73\u00b12.09) (p<0.001). \nCONCLUSION: Patients from T&C group demonstrated significantly better adherence to medication and refills score and \nbetter glycaemic control showing that PVAS could be an effective option. Further work is needed to assess other chronic \ndiseases and  various  types of healthcare settings in Malaysia. \n \nKEYWORDS: impact of pharmacy services, Selangor, adherence, refill prescription, Pharmacy Value Added Services \n(PVAS) \nNMRR ID: NMRR-17-2113-37731 \n  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nOP-38 (Oral) \nTHE MOST EFFECTIVE REMINDER METHOD TO REDUCE DEFAULTER RATE IN DRIVE-THROUGH \nPHARMACY SERVICE IN HOSPITAL MELAKA \n \nTai SY1, Tan RC1, Razali N1, Mohmed AMS 1 \n\n\n\n \n1Department of Pharmacy, Hospital Melaka, Ministry of Health Malaysia \n \nINTRODUCTION: Drive-Through Pharmacy (DTP) Service provides a convenient way of collecting medicine at the \npharmacy as this service solves common problems encountered by patients at Hospital Melaka. \nOBJECTIVES: The objectives are to determine the most effective reminder method to reduce the defaulter rate; to compare \nthe number of defaulters and to evaluate the cost between the three methods of reminder in DTP service. \nMETHOD: The study was a one month randomized controlled study starting from early of August 2017 until early of \nSeptember 2017. Late comers were randomly assigned into three groups; pre SMS reminder (group A), pre and post SMS \nreminder (group B) and pre SMS plus telephone reminder (group C). Defaulter rate in each group was calculated. Chi square \ntest was used to compare the difference in the number of defaulters among three groups. SPSS version 20 was used for data \nanalysis. The costs of reminders were calculated based on researcher salary and telecommunication (SMS and telephone). A \nsimple linear regression test was run to compare correlation between the ratio of total cost per attendance and the success rate \namong the three groups. \nRESULTS: Group C has the least defaulter numbers (n=3; 2.9%) as compared to that of in group A (n= 18; 17.8%) and group \nB (n=12; 11.7%) where P value < 0.005. A simple linear regression test found that the ratio of total cost per attendance was \nstrongly correlated (r=0.857) with the rate of latecomers collecting medicines via DTP service among the three groups, but the \nresult is insignificant (p-value = 0.345). \nCONCLUSION: SMS plus telephone reminders appear to be the most effective reminder tools to keep patients adhere to DTP \nservice . However, cost per attendance does not reduce the defaulter rate. \n \nKEYWORDS: impact of pharmacy services, Malacca, drive-through, defaulter, late comer, reminder \nNMRR ID: NMRR-17-1366-35782 \n \n \nOP-39 (Oral) \nA SURVEY ON TYPE 2 DIABETES PATIENTS KNOWLEDGE AND PRACTICES ON INSULIN INJECTION \nTECHNIQUES IN PRIMARY HEALTH CARE  \n \nSelvadurai S1, Ngajidin RM1, Lee XY1, Kamaruddin H1, Lee XH1, Mohd Ali LM1, Ching MW1, Cheah KY2 \n\n\n\n \n1Pharmacy Division, Health Department of Federal Territory of Kuala Lumpur and Putrajaya,  Clinical Trial Unit, 2National \nClinical Research Centre (CRC),Ministry of Health Malaysia \n \nINTRODUCTION: Patient\u2019s knowledge and practices on insulin injection technique (IT) played important role in the diabetes \nmanagement and thus affecting their glycaemic control. \nOBJECTIVES: Our study aimed to survey the knowledge and practices on insulin IT among self-injecting type 2 diabetics \nin the primary health care. \nMETHOD: This is a cross sectional study where 160 type 2 diabetics who self-injected insulin for at least one year and had \npoor IT with HbA1c above 8% were recruited from 15 health clinics. Consented patients were required to answer a pharmacist-\nassisted validated questionnaire, adapted from Insulin Technique Questionnaire (ITQ) by Anders, et al. to determine their \nknowledge and practices on insulin injection. \nRESULTS: 27.5% of the patients reported that there is bleeding or bruising on the site of injection while 21.3% reported fluid \nleakages from the injection sites. 42.5% of the patients incorrectly tipped or mixed the insulin (<10 times) and another 8% has \nnever tipped or mixed the insulin before injection. 54% of the patients were not compliant to insulin injection regime and the \nmain reasons were forgotten to inject (57.5%), did not bring insulin along when they were travelling (19%) and skipping meals \n(8%). 38% of the patients did not keep track of the expiry dates of the insulin and 4% claimed to have used expired insulin. \nMajority of the patients (62.5%) disposed used needles into the garbage bin with the caps on, whereas 6.3% of the patients \ndisposed the needles without recapping. 21% of the patients admitted that they needed some assistance due to episodes of \nhypoglycemia and 15% had previous hospital visits due to hypoglycemia.  \nCONCLUSION: Majority of the patients were found to have poor IT. There is a need for re-education sessions on IT to \nachieve good practices and a good glycaemic control. \n \nKEYWORDS: impact of pharmacy services, Kuala Lumpur, knowledge and practices on insulin injection technique, Insulin \nTechnique Questionnaire (ITQ) \nNMRR ID: NMRR-16-1591-28767 \n  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nOP-40 (Oral) \nPERCEPTION OF HEALTHCARE PROFESSIONAL ON DRUG SHORTAGE IMPACT IN A MALAYSIAN \nDISTRICT HOSPITAL \n \nWong SW1, Abdullah NZL1, Azmi AN1 \n\n\n\n \n1Department of Pharmacy, Hospital Enche\u2019 Besar Hajjah Khalsom, Ministry of Health Malaysia \n \nINTRODUCTION: Drug shortage is a problem that entangles health system. Not only is the patient care compromised, but \nhealthcare team is also perplexed under the stress of insufficient supplies.  \nOBJECTIVES: This study aimed to understand the healthcare professionals' perspectives towards the drug shortages problem \nand its impact to the healthcare system. \nMETHOD: A validated questionnaire was distributed to 150 prescribers and pharmacists  in Hospital Enche\u2019 Besar Hajjah \nKhalsom, Kluang from September to October 2017. \nRESULTS: 130 respondents were stratified sampled forming a response rate 86.67%. Majority of  the respondents (64.6%) \nwere female with  mean age of 29.64 years (SD+3.932). More than half of  them  perceived to encounter less than 10 \nprescriptions with drug  shortage  issues and spent  less  than 15 minutes to deal  with  it. From this survey, 41.5% perceived \nthat they  rarely received an  advance notice of drug  shortage and  51.5% of them  perceived  that  they  rarely  received  an \nadvance  notification of shortage duration.  About  half  of  the respondents (45.4%) reported that  more waiting time and \nhospital visits required by patients. Majority  of  the respondents  indicated  an  increase in their  work load (n= 62, 47.7%) \nbecause of the  shortages. Providing  in service education for medical staffs on alternatives to counteract short supply was the \nmost favorable strategy among respondents. In contrary, allocating budgets to encounter drug shortages was the less favorable \nstrategy.  \nCONCLUSION: Drug shortages in Hospital Enche\u2019 Besar Hajjah Khalsom cause  heavy workloads and it is time consuming. \nThe healthcare professionals need to work together to formulate strategies to ensure the availability and continuity of drug \nsupplies. \n \nKEYWORDS: impact of pharmacy services, Johor, impact of drug shortage, survey \nNMRR ID: NMRR-17-1208-35533 \n \n \nOP-41 (Oral) \nA QUALITATIVE STUDY ON HEALTHCARE PROFESSIONALS PERSPECTIVES ON PHARMACISTS\u2019 ROLE \nIN MANAGING ANTIPSYCHOTIC MEDICATIONS IN HOSPITAL KAJANG \n \nWan ARWA1, Shafie SD1, Gnanasan S2 \n\n\n\n \n1Department of Pharmacy, Hospital Kajang,Ministry of Health Malaysia,2Faculty of Pharmacy, Universiti Teknologi MARA, \nSelangor \n \nINTRODUCTION: Mental illness requires acute and long term treatment management, thus adherence to medication is an \nimportant aspect.  \nOBJECTIVES: This qualitative study explored the perspective of the healthcare professionals towards pharmacist's role in \nimproving patient's adherence in Hospital Kajang \nMETHOD: Thirteen one to one, semi structured interview sessions were conducted with doctors and nurses to explore their \nexperience working with pharmacists and suggestions to improvise pharmacists' role to enhance medication adherence. \nInterviews were audio recorded, transcribed verbatim and thematically analysed using constant comparison approach. \nRESULTS: The findings showed that healthcare professionals recognized pharmacists' role in managing antipsychotic \nmedications. The services that were highlighted include Therapeutic Drug Monitoring (TDM), controlling the quota for list A \nmedications, answering their enquiries such as drug-drug interactions and so on. Nevertheless, pharmacists' involvement in \nclozapine clinic, Community Psychiatric Unit (CPU) and Home Medication Review (HMR) may help patients in managing \ntheir antipsychotic medicines. Pharmacists may help to clarify patients' and caregivers' doubts and concerns by giving \nappropriate education. Collaboration of pharmacist with other healthcare professionals is an essential component to maximize \nadherence by developing care plans and follow up, reduce inappropriate use of psychotropic medicines, polypharmacy and \ninvolvement in patient centered care. \nCONCLUSION: The lack of collaboration and shared understanding between healthcare professionals will be an important \nfactor that could impact the continuity of care. All respondents agreed that mutual collaboration may foster greater patient \nsatisfaction, reduce risks of non adherence and improve patient's health outcomes. In conclusion, pharmacists should be \nintegrated within the healthcare team and need to be well trained to improve antipsychotic medication adherence in Hospital \nKajang \n \nKEYWORDS: impact of pharmacy services, Selangor, antipsychotic medications, pharmacist's role, healthcare professionals' \nperspectives \nNMRR ID: NMRR-16-1776-32364 \n  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nOP-42 (Oral) \nASSESSMENT OF COST AND ADHERENCE OF INSULIN PENFILL EXCHANGE PROGRAM: A PILOT STUDY \n \nDevi SRM1, Josephine HB1, Nethiyakalyani S1 \n\n\n\n \n1Department of Pharmacy, Hospital Shah Alam, Ministry Of Health Malaysia \n \nINTRODUCTION: The expansion of public health services in recent years and the rising number of patients visiting \ngovernment health facilities has caused an increase in health expenditure for the government. With the increase in economic \nburden, unused medicines are regarded as a problem and strategies should be devised to minimize drug wastage. In Hospital \nShah Alam, 68.7% of the endocrine drugs returned to the pharmacy were insulin penfills. To curb this issue, he Insulin Penfill \nExchange Program was initiated. \nOBJECTIVES: To compare the cost of insulin pen fills supplied to patients who are randomized to the Insulin Penfill \nExchange Group (IP) group or the usual dispensing group (UD). Additionally, patient adherence to insulin was also measured. \nMETHOD: 24 patients were randomly selected and divided equally into 2 arms, IP and UD. Patients, in the IP arm, were \nrequired to return the empty insulin penfills for further supply. They were otherwise supplied only one penfill during each \nvisit. Patients in the UD arm were supplied with insulin penfills according to the standard dispensing policy. Cost analysis, \nwhere cost for individual subjects was based upon average daily drug administered during study period, was calculated. \nMedication adherence of patients was measured using the Proportion of Days Covered (PDC) formulae.  \nRESULTS: The average daily cost of treatment was RM 0.89 (0.35) for the IP arm and UD RM 1.59(1.07) for the UD arm. \nCost analysis demonstrated significant cost savings (p=0.05) in the IP arm. Mean PDC value for the IP arm was at 0.33(0.49) \nwhile the UD arm had a value of 0.58(0.52). There was no significant difference in adherence between patients in both arms \n(p= 0.24) \nCONCLUSION: This program is cost-saving and patient adherence in the intervention group was not affected by this \nprogramme.  \n \nKEYWORDS: impact of pharmacy services, Selangor, cost, adherence, insulin, minimize wastage \nNMRR ID: NMRR-17-2758-37232 S3R1 \n \n \nOP-43 (Oral) \nEXPLORING THE HEALTHCARE PROFESSIONALS\u2019 EXPERIENCE OF INTERDISCIPLINARY \nCOLLABORATION IN MEDICAL DEPARTMENT, HOSPITAL TUANKU FAUZIAH (HTF): A QUALITATIVE \nSTUDY \n \nAng WC1,2, Abd Rahim SN1, Muhamad Shukri N1, Abd Rahman NF1, Ng SC3, Rokimi WR4 \n\n\n\n \n1Pharmacy Department, Hospital Tuanku Fauziah, Ministry of Health Malaysia, 2Clinical Research Centre, Hospital Tuanku \nFauziah, Ministry of Health Malaysia, 3Medical Department, Hospital Tuanku Fauziah, Ministry of Health Malaysia, 4Nursing \nUnit, Hospital Tuanku Fauziah, Ministry of Health Malaysia \n \nINTRODUCTION: To cater for the complex healthcare demands in Malaysian public hospitals, different healthcare \nprofessionals (HCPs) especially doctors, nurses and pharmacists need to have good interdisciplinary collaboration. To date, \nthere is a lack of studies regarding this collaboration in Malaysia. \nOBJECTIVES: This study aimed to explore the experience of interprofessional collaboration among doctors, nurses and  \npharmacists at Medical Department, HTF, specifically on role clarity, adequacy, barriers and factors to facilitate effective \ncollaboration and awareness of pharmacist-led medication therapy adherence clinic (MTAC) services. \nMETHOD: Four focus group discussions (FGDs) were conducted in May 2017 to explore participants\u2019 knowledge and \nexperiences. Each FGDs is consisting of a medical specialist, a medical officer, a senior clinical pharmacist, a junior clinical \npharmacist, a matron/sister and a staff nurse. Participants were recruited using purposive sampling (nomination by heads of \ndepartment). FGDs were carried out in English but responses in Malay language were accepted and then translated into English. \nAll FGDs were audio-recorded, transcribed and subjected to inductive thematic analysis. \nRESULTS: In the theme of role clarity, most participants agreed that the doctors are the team leader in patient management, \nwhile the nurses are responsible to monitor, ambulate, and educate patients and drug administration. However, some \nparticipants did not know the roles of pharmacists in details. Most participants claimed effective collaboration did exist but \nwas inadequate. Barriers to effective collaboration were lack of time, staff, communication and communication skills. \nInterprofessional collaboration might be facilitated with regular discussions between different departments. All participants \nwere aware of the MTAC provided by the pharmacists but did not know much about it. \nCONCLUSION: The roles and services provided by pharmacists should be actively promoted among other HCPs to prevent \noverlapping of tasks and human resource wastage. \n \nKEYWORDS: impact of pharmacy services, Perlis, qualitative research; focus groups; intersectoral collaboration \nNMRR ID: NMRR-17-628-34168 \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nOP-44 (Oral) \nTHE EFFECT OF EDUCATION COUNSELING ON KNOWLEDGE OF HORMONAL THERAPY (HT) \n \nTan WC, Khairunnadiah MS, Rosdi MZ1, See CS, Nurshazlien HAH \n\n\n\n \nDepartment of Pharmacy, Hospital Melaka, Ministry of Health Malaysia \n \nINTRODUCTION: Hormonal pills usually taken by women to relieve menopausal symptoms, contraception plan or treatment \nof gynaecological condition. However, non-compliance and self discontinuation of hormonal pills can result minimal effect of \nthe drugs or unwanted pregnancy if hormonal pills are used as contraception. The reasons of poor compliance are because \npatients suffered from side effects and fear of side effects.  \nOBJECTIVES: The objective of this study was to assess the effect of education counselling on knowledge of hormonal \ntherapy among patients in Hospital Melaka  \nMETHOD: A cross-sectional study was conducted during 6 months period among patients who seek for their treatment at \nMedical Specialist Clinic, Hospital Melaka. The study involved 42 participants where 36 of them completed pre and post \nquestionnaire. The data was collected using questionnaire and were analyzed using Wilcoxon Signed Ranked Test through \nIBM SPSS statistic software. P value < 0.05 considered statistically significance. Ethical approval of the study was sought \nfrom CRC and the informed consent was ensured prior participation to the study  \nRESULTS: There is a significant different between the knowledge score pre and post counselling session \n(p=0.00). Participants who experienced side effects (n=13) (7.00, IqR 1.00) have significantly higher knowledge score pre \ncounselling session than those who did not experience side effects (6.00, IqR 2.00) after taking hormone pills \nCONCLUSION: Overall, the patients\u2019 knowledge were improved after the counselling session. The results obtained will be \nbeneficial in formulating an appropriate HT counselling.  \n \nKEYWORDS: impact of pharmacy services, Melaka, knowledge, compliance, counselling, Hormonal Therapy (HT) \nNMRR ID: NMRR-16-1918-32025 \n \n \nOP-45 (Oral) \nPERCEPTION AND EXPERIENCE OF EARLY-STAGE BREAST CANCER PATIENTS REGARDING \nCHEMOTHERAPY: A QUALITATIVE STUDY \n \nTan XQ1, Ahmad NS2, Teh KS3 \n\n\n\n \n1Hospital Tuanku Fauziah, Ministry of Health Malaysia,2Klinik Kesihatan Lunas, Ministry of Health Malaysia3Hospital Pulau \nPinang, Ministry of Health Malaysia \n \nINTRODUCTION: Breast cancer is the most common form of cancer affecting women in Malaysia and chemotherapy is one \nof the treatment options. Side effects of chemotherapy have been well-characterized. Therefore, effective management of \nchemotherapy-induced adverse effects is essential to improve quality of life of patients. This may have an impact in their \nwillingness to complete the treatment in the long run. \nOBJECTIVES: To explore the perception and experience of early-stage breast cancer patients regarding chemotherapy \nMETHOD: Individual in-depth interviews were conducted in an isolated room through purposive sampling method. The study \nwas conducted from October 2015 to January 2016. Participants were interviewed before and after the first cycle of \nchemotherapy. Semi-structured interviews were audio recorded with consent from the participants. Each interviews was \ntranscribed verbatim independently by 2 different authors. Transcripts were compared repeatedly to identify and list out \nimportant and recurrent themes. Interviewing stopped when data saturation occurred.  \nRESULTS: Seven Malay women and one Indian woman aged between 41 to 68 years were interviewed. Two themes emerged \nfrom pre-chemotherapy interviews that describe the women's perception: Factors affecting decision making and acceptance of \nchemotherapy. Another two themes emerged after their first cycle of chemotherapy: Changes they experienced and \ncontinuation of treatment. Their friend's experiences played the biggest role in influencing patients' decision making. Majority \nof the women were anxious and worried about the chemotherapy-related side effects. However, their decision to continue the \ntreatment were not affected by the side effects. \nCONCLUSION: This study provides some important information on chemotherapy counselling to assist patient's decision \nmaking on the choice of treatment. Cancer survivor's experiences should be highlighted. To ensure all patients receive \nconsistent and continuous chemotherapy information, each healthcare facility is recommended to develop a chemotherapy \ncounselling checklist.  \n \nKEYWORDS: clinical research, Perlis, Perak and Penang, perception, experience, breast cancer, qualitative \nNMRR ID: NMRR-15-2130-27222 \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nOP-46 (Oral) \nEFFICACY, ACCEPTANCE AND TOLERABILITY OF SPLIT-DOSE VERSUS SAME-DAY AQUEOUS SODIUM \nPHOSPHATE REGIMES FOR COLONOSCOPY BOWEL CLEANSING IN PORT DICKSON HOSPITAL \n \nNatasya-Amanina MR1, Lau BT1, Chai FYP1, Nurul-Farahain I1, Rashidah MK2, Ng SY3 \n\n\n\n \n1Department of Pharmacy, Hospital Port Dickson, Ministry of Health Malaysia,2Department of Surgical, Hospital Port \nDickson, Ministry of Health Malaysia,3Klinik Kesihatan Ampangan, Ministry of Health Malaysia \n \nINTRODUCTION: An ideal bowel preparation regime should be effective, tolerable, convenient, and safe. \nOBJECTIVES: This study aimed to compare the efficacy, acceptance and tolerability of split-dose versus same-day aqueous \nsodium phosphate (NaP) regimes for outpatients scheduled for colonoscopy. \nMETHOD: This was a prospective cohort study conducted in the Surgical Outpatient Department of Port Dickson Hospital, \nNegeri Sembilan, Malaysia, from April 2017 to January 2018. Patients aged between 18 to 65 years old prescribed with one \nof the NaP regimes were recruited as study subjects and counselled by pharmacists according to the pre-specified counselling \nchecklists. Validated questionnaires were used to assess the efficacy, acceptance and tolerability of the aforementioned \ncolonoscopy bowel cleansing regimes on the day of colonoscopy. \nRESULTS: There were 31 (54.4%) and 26 (45.6%) study subjects in the split-dose and same-day NaP groups, respectively. \nThe consumption rates were not significantly different between these two groups (P=1.000). Split-dose NaP was significantly \nmore efficacious than same-day NaP, with a rate of \u201cgood\u201d or \u201cexcellent\u201d on Boston Bowel Preparation Scale in 100% of \nstudy subjects in the split-dose NaP group versus 74.2% in the same-day NaP group (P=0.006). However, there were no \nsignificant difference in the acceptance and tolerability aspects between these two groups (P=1.000 and P=0.582, respectively). \nPatients\u2019 willingness to take the same preparation in the future was 80.8% in the split-dose NaP group compared to 83.9% in \nthe same-day NaP group (P=1.000). The incidence of adverse events was comparable between these two groups. Notably, \n53.8% of the study subjects in the split-dose NaP group reported presence of incontinence prior to colonoscopy procedure \ncompared to 16.1% in the same-day NaP group (P=0.004). \nCONCLUSION: Split-dose NaP was more efficacious compared to same-day NaP, even though acceptance, tolerability and \nother aspects between two groups were comparable. \n \nKEYWORDS: clinical research, bowel cleansing, Negeri Sembilan, Aqueous Sodium Phosphate, efficacy, acceptance, \ntolerability \nNMRR ID: NMRR-17- 490-34840 \n \n \nOP-47 (Oral) \nTHERAPEUTIC DRUG MONITORING OF INTRAPERITONEAL GENTAMICIN IN PERITONEAL DIALYSIS \nPATIENTS WITH PERITONITIS: A SINGLE CENTER STUDY IN MALAYSIA \n \nLau SY1, Lee FY2, Mohd Zaki ZJ1, Roslan NI1, Kuppusamy SK1, Bakhtiarlili MS1, Bee BC3, Wong HS3 \n\n\n\n \n1Department of Pharmacy, Hospital Selayang, Ministry of Health Malaysia,2Clinical Research Centre, Hospital Selayang, \nMinistry of Health Malaysia,3Department of Nephrology, Hospital Selayang, Ministry of Health Malaysia \n \nINTRODUCTION: There is limited evidence regarding the role of monitoring serum gentamicin concentrations to mitigate \ntoxicity risk among Malaysian peritoneal dialysis (PD) patients receiving this antibiotic via intraperitoneal (IP) route for PD-\nrelated peritonitis.  \nOBJECTIVES: To investigate the role of Therapeutic Drug Monitoring (TDM) for IP gentamicin with dosage as per \nInternational Society of Peritoneal Dialysis (ISPD) guideline, and to determine the predictors of toxic serum gentamicin levels. \nMETHOD: This prospective cohort study recruited 128 patients diagnosed with PD-related peritonitis at Selayang Hospital \nbetween 1st February 2016 and 30th June 2017, who received ISPD-recommended dosage of IP gentamicin. TDM was \nperformed every other day throughout the duration of gentamicin therapy (two weeks). Demographic data and TDM levels \nwere retrieved from Hospital Laboratory Management System. The predictors for toxic gentamicin levels were examined using \nunivariate and multivariate logistic regression via R version 3.3.2. \nRESULTS: TDM of IP gentamicin reflected an upward trend of toxic serum gentamicin levels of >2mg/L throughout the \ntreatment regime, from 16 out of 103 samples (15.5%) at Day 4 to 26 subjects out of 78 samples (33.3%) at final day of \ngentamicin therapy (p=0.052). The significant predictors of toxic serum gentamicin levels were body weight of 65kg and \nbelow (OR:3.02, 95% CI:1.13, 8.07), and absence of residual renal function (OR:4.78, 95% CI:1.66, 13.68). However, absence \nof residual renal function was the only predictor of toxic serum gentamicin levels after adjustment for other factors through \nmultivariate logistic regression (adjusted OR:3.70, 95% CI:1.21, 11.32).  \nCONCLUSION: ISPD-recommended dosage of IP gentamicin resulted in systemic accumulation of this antibiotic among \nMalaysian PD patients. Serum gentamicin TDM is essential to mitigate risk of toxicity, especially among PD-related peritonitis \npatients without residual renal function. Further studies are needed to ascertain the impact of toxic serum gentamicin levels on \nresidual renal function among patients with PD-related peritonitis. \n \nKEYWORDS: clinical research, Selangor,therapeutic drug monitoring, gentamicin, peritonitis, peritoneal dialysis \nNMRR ID: NMRR-15-2189-28501 \n  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nOP-48 (Oral) \nANTIBIOTIC DE-ESCALATION: THE PREVALENCE, CLINICAL IMPACT AND FACTORS ASSOCIATED \nWITH THE PRACTICE IN GENERAL CRITICAL WARD HOSPITAL SULTANAH BAHIYAH, KEDAH \n \nYusof F1, Hashim K2, Mohd Noor DA3 \n\n\n\n \n1Pharmacy Department, Hospital Sultanah Bahiyah, Ministry of Health Malaysia,2Pharmacy Department, Hospital Sibu, \nMinistry of Health Malaysia, 3School of Pharmaceutical Science, Universiti Sains Malaysia \n \nINTRODUCTION: Uncontrolled used of broad spectrum antibiotic will result in resistant organism. One of the control \nmeasures is by practising antibiotic de-escalation. \nOBJECTIVES: This observational study was aimed to assess the prevalence of de-escalation, to compare the clinical success \nrate within de-escalation and no de-escalation and to identify factors associated with de-escalation. \nMETHOD: All adult patient started with empiric antibiotic therapy in ICU/HDW within January to June 2015 were included. \nAntibiotic was counted as de-escalated if it had been streamlined or switched to a narrower spectrum that is driven by \nmicrobiological result, discontinued empiric therapy if testing unable to demonstrate evidence of infection or discontinued \ndual antimicrobial therapy if there is overlapping in the spectrum activity. Independent variables associated with de-escalation \nand the clinical success rate were assessed by using Chi-squared Test or Fisher\u2019s Exact Test for categorical data, and Mann \nWhitney Test for continuous data, where appropriate. \nRESULTS: A total of 195 patients were studied. Antibiotic de-escalation was performed in 114 patients (58.5%). Most of the \nde-escalation case was carried out by streamlining antibiotics based on the culture and sensitivity (n=61, 53.5%). De-escalation \nwas observed to lower all-cause mortality (34.2% versus 55.6%, p=0.003) without affecting ICU and hospital stay. Underlying \nCVD (p=0.017) and the use of meropenem (p=0.019) were the only independent variables linked with de-escalation. There \nwere no association in term of severity of illness, reason for ICU/HDW admission, history of hospitalization, antibiotic \nstewardship program, appropriate empiric therapy, culture and sensitivity result and site of infection. \nCONCLUSION: This study suggest de-escalation strategy is safe as part of managing empiric antibiotic and practicable in \nmost cases without compromising clinical outcome even in critically ill patient.  \n \nKEYWORDS: clinical research, Kedah, antibiotic, de-escalation, , critically ill \nNMRR ID: NMRR-15-1960-27714 (IIR) \n \n \nOP-49 (Oral) \nPATIENTS\u2019 PERCEPTIONS ON NECESSITY AND CONCERN OF ANTIDIABETIC MEDICATIONS IN \nAMPANGAN HEALTH CLINIC \n \nNg SY1, Nurul Iman N1, Hasnita J2, Lim XL1, Mohd Zulhilmi AR1 \n\n\n\n \n1Pharmacy Unit, Klinik Kesihatan Ampangan, Ministry of Health Malaysia,2Pharmacy Unit, Klinik Kesihatan Senawang, \nMinistry of Health Malaysia \n \nINTRODUCTION: According to NHMS 2015 the prevalence of diabetes mellitus in Malaysia was 17.5%. Studies showed \nthat 53% of diabetics in Malaysia were not compliant to their medications and 73% of the diabetic-related healthcare costs \nwere due to poor glucose control. Therefore, immediate actions should be taken to improve patients\u2019 adherence towards \nmedication and patients\u2019 belief about medicines were shown to influence their adherence.  \nOBJECTIVES: This study was conducted to determine patients\u2019 belief about diabetic medications and to relate patients\u2019 \nbelief with the control of the disease. \nMETHOD: This cross-sectional study was conducted in Ampangan Health Clinic from January till May 2017. Convenient \nsampling was conducted whereby validated, self-administered questionnaires were distributed to eligible patients.  \nRESULTS: A total of 84 subjects (response rate 76.3%) participated in this study. Majority of the respondents were Malay \n(97.6%), female (63.1%) and married (88.1%). The mean age and mean HbA1C of subjects were 52.3 \u00b1 5.4 years and 9.0 \u00b1 \n2.51 mmol/L respectively. Mean specific-necessity score and mean specific-concern score were 2.82 \u00b1 0.64 and 2.71\u00b1 0.54 \nrespectively. There was fair negative correlation between subjects\u2019 specific-necessity score and number of medications (r=-\n0.356, p= 0.001) as well as their HbA1c (r=-0.278, p=0.01). Subjects\u2019 specific-concern of medications was shown to correlate \nwith the duration of the disease (r=0.262, p=0.016). In multivariable analysis, subjects\u2019 specific-necessity score were found to \nbe associated with HbA1C (adjusted OR -0.278, 95% CI: -0.33 - -0.04). \nCONCLUSION: Patients with higher specific-necessity score showed better diabetes control while patients with longer \nduration of DM were more concern of diabetes medication adverse effects. \n \nKEYWORDS: clinical research, Negeri Sembilan, anti-diabetic medications, perceptions, belief \nNMRR ID: NMRR-16-2627-32366 \n  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nOP-50 (Oral) \nFIRST-LINE PAZOPANIB IN METASTATIC RENAL CELL CARCINOMA: A \u201cREAL-WORLD\u201d EXPERIENCE \nAT NATIONAL CANCER INSTITUTE \n \nAhmat ANMF1, Nik-Adnan NN1, Badarudin NS1, Zainal-Abidin MN1, Lee LS1, Tang SL2, Gerard LCC2, Mohamad R1 \n1Department of Pharmacy, National Cancer Institute, Ministry of Health Malaysia,2Department of Radiotherapy and \nOncology, National Cancer Institute, Ministry of Health Malaysia \n \nINTRODUCTION: In recent years, inexorable march towards the widespread use of targeted treatments especially of the \nsubclass of tyrosine kinase inhibitors (TKI) in the treatment of metastatic RCC was observed. However, strict eligibility criteria \nof previous studies provide limited data on performance status, organ function and Asian counterparts. Decision on the use of \nTKI in daily practice becomes a clinical challenge when patients\u2019 outcomes are poorly characterized notably in terms of safety \nand efficacy \nOBJECTIVES: To evaluate treatment and safety outcomes of pazopanib in unselected mRCC populationsin Malaysia. \nMETHOD: This is a mono-institutional, observational, prospective study, which was carried out in a cancer hospital. Patients \nwith mRCC, treated with pazopanib, in first-line, from June 2015 to June 2017 were recruited and followed up for 2-years or \ntill death. Progression-free survival (PFS) and overall survival (OS) were evaluated using Kaplan-Meier survival analysis. \nRESULTS: 27 patients were treated with pazopanib including those with nonclear cell histology (11%). Based on Memorial \nSloan Kettering Cancer Center (MSKCC) criteria, 11 patients (41%) were categorized as poor risk group and the rest were \nintermediate risk. All patients experienced at least one adverse event. The most common were cutaneous toxicity (92%) \nfollowed by proteinuria (48%), hypertension (41%), diarrhoea (37%) and mucositis (33%). The median PFS and OS were 9.57 \nmonths and 15.5 months, respectively. In multivariate analysis, MSKCC risk score demonstrated strong predictive treatment \noutcome. The median PFS was 14.5 months in intermediate risk and 3.96 months in poor risk (HR: 0.2, p<0.001). However, \nthe median OS data are not yet mature where 63% of intermediate risk group is still alive at 2-years follow-up. \nCONCLUSION: Pazopanib appears to be effective in intermediate risk group mRCC patients. Consistent with other \nnaturalistic observational studies, the treatment-associated adverse events were manageable and mild to moderate in severity. \n  \nKEYWORDS: clinical research, Putrajaya, pazopanib, metastatic renal cell carcinoma \nNMRR ID: NMRR-15-831-25773 \n \n \nOP-51 (Oral) \nDYSLIPIDEMIA AMONG HIV ADULT PATIENTS ON ANTIRETROVIRAL TREATMENT (ART) IN HOSPITAL \nTUANKU AMPUAN NAJIHAH (HTAN), KUALA PILAH \n \nPuvaneswari N1, Adibah M1, Nurul Hanani M1 \n\n\n\n \n1Pharmacy Department, Hospital Tuanku Ampuan Najihah, Ministry of Health Malaysia \n \nINTRODUCTION: The occurrence of one or more lipid abnormalities is known as dyslipidaemia and it is one of the \nmetabolic disorders known to be related to Human Immunodeficiency Virus (HIV) and subsequent usage of antiretroviral \ntreatment (ART). Previous study has shown that dyslipidaemia is common among HIV patients on ART in Malaysia. \nOBJECTIVES: To determine the prevalence of dyslipidemia and potential factors that can be associated with lipid levels \namong HIV adult patients on ART in HTAN. \nMETHOD: This retrospective study was conducted in Infection Disease (ID) Clinic of HTAN from May 2012 until December \n2017. Convenience sampling was applied and 72 subjects were included. Data of demography and factors that can affect lipid \nprofile were collected from medical records using a data collection form. Data were analyzed via SPSS with application of \nChi-Square and Fisher\u2019s Exact tests to identify the potential associated factors. \nRESULTS: 58.3% of the subjects had dyslipidemia. The percentage of subjects with abnormal high density lipoprotein (HDL), \nabnormal low density lipoprotein (LDL), abnormal total cholesterol (TC) and abnormal triglyceride (TG) were 38.9%, 23.6%, \n22.2% and 33.3% respectively. HDL, LDL levels and diabetes mellitus status were significantly associated with TG level \n(p<0.05). Hypertension status and TG level had association with LDL level (p<0.05) while there were associations of TG \nlevels and gender with HDL outcome (p <0.05). However, unlike most other studies, protease inhibitors (PI) exposure, viral \nload, and CD4 count were not significantly associated with all lipid levels in this population. \nCONCLUSION: More than half of HIV patients on ART in HTAN had dyslipidemia. Identified associated factors included \nlipid levels, diabetes mellitus status, gender, and hypertension status. Identifying contributing risk factor of dyslipidemia would \nhelp in preventing cardiovascular disease development in HIV population. \n \nKEYWORDS: clinical research, Negeri Sembilan, dyslipidemia, , HIV, antiretroviralNMRR ID: NMRR-17-2900-36289 \n  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nOP-52 (Oral) \nSTUDY ON THE MEDICATION KNOWLEGDE OF PATIENTS FROM MTAC GERIATRICS \n \nTan SH, Phang EL, Lim SS, Chong TW, Diyanadalila J \n\n\n\n \nDepartment of Pharmacy, Hospital Banting, Ministry of Health Malaysia \n \nINTRODUCTION: Good medication knowledge is important to ensure maximum benefits of medication are obtained. \nOBJECTIVES: This study aim to assess the medication knowledge among geriatric MTAC patients.  \nMETHOD: A prospective, cross sectional study was carried out among patients from Geriatric Medication Adherence Clinic \n(MTAC), Hospital Banting. The study was carried out for 2 months from April to May 2016. A total of 100 patients were \nenrolled in this study for interview by questionaire and consent was taken. The questionnaire consists of three sections: \npatients\u2019 demographic data, medication factors, and medication knowledge. All data was analyzed by using Statistical Package \nfor Social Science (SPSS) version 22.0.  \nRESULTS: A total of 100 patients were included (male 51%, median age 67 years). The average medication knowledge score \n(mean \u00b1 SD) was 8.04 \u00b1 3.24 out of 12 as a total score. Most of the patients had highest knowledge on dose of medication \n(2.79 \u00b1 0.61) and lowest medication knowledge on the method of administration (1.11 \u00b1 1.46) (p<0.05). Patients with \nuniversity education level were reported to have the highest medication knowledge compared to other group of patients \n(p<0.05). Patients were more able to demonstrate their medication knowledge by showing the physical product of medication \nwith the mean score of 91.15%. \nCONCLUSION: The medication knowledge score among Geriatric MTAC is 8.04. They showed low knowledge on the \nmethod of administration of medication. An assessment on medication adherance among Geriatric MTAC was suggested for \nfurther study. \n \nKEYWORDS: clinical research, Selangor, geriatrics, , medication therapy adherence clinic, medication \nNMRR ID: NMRR-17-665-34552 \n \n \nOP-53 (Oral) \nHEMODIALYSIS CATHETER-RELATED BLOOD STREAM INFECTION (CRBSI) IN HOSPITAL TUANKU \nAMPUAN NAJIHAH (HTAN): A RETROSPECTIVE STUDY \n \nMarzirah I, Saratha Thevi P, Kong LS, Muhammad Faizal M, Shamini M, Dinoshaa RN \n\n\n\n \nDepartment of Pharmacy, Hospital Tuanku Ampuan Najihah, Ministry of Health Malaysia \n \nINTRODUCTION: Hemodialysis catheter-related blood stream infection (CRBSI) is a major complication of catheter use in \nhemodialysis patients, which ultimately lead to morbidity and mortality. The cause is multifactorial ranging from patient's \nfactors to catheter's factors in different hemodialysis centers. \nOBJECTIVES: This study aimed to determine the incidence of CRBSI cases among hemodialysis patients in HTAN, as well \nas association between CRBSI cases with hemodialysis centers. \nMETHOD: A retrospective study was conducted. Hemodialysis CRBSI cases were identified from 982 hospitalized \nhemodialysis cases in HTAN between January to December 2017. Case information was obtained from hemodialysis unit \nregistry and hospital online record system (Casemix); while blood culture and sensitivity data were traced from the \nmicrobiology lab. \nRESULTS: 157 CRBSI cases were detected with an incidence rate of 0.75 per 1000 patient-days. 84.7% (n=133) of cases \nwere from private hemodialysis centers while another 15.3% (n=24) were from government hemodialysis center. There was a \nsignificant association between haemodialysis centres and CRBSI cases (p=0.002). Among 11 private haemodialysis centres \ninvolved, Center 1 showed the highest CRBSI cases (n=78, 58.6%), followed by Center 2 (n=33, 24.8%) and Center 3 (n=13, \n9.77%). The most common pathogens causing CRBSI were Staphylococcus aureus (n=40, 25.3%) and followed by (n=21, \n13.3%) methicillin-resistant Staphylococcus aureus infection. \nCONCLUSION: Incidence of hemodialysis CRBSI in HTAN was lower, compared to other studies. Most hemodialysis \nCRBSI cases were from private hemodialysis centers, which warranted further investigation on the contributing factors \ninvolved. This finding would aid in formulating remedial actions to reduce and prevent hemodialysis CRBSI. \n \nKEYWORDS: clinical research, Negeri Sembilan, catheter-related infection, , hemodialysis \nNMRR ID: NMRR-18-101-39879 \n  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nOP-54 (Oral) \n \nAN OBSERVATIONAL STUDY ON ABVD AND ESCALATED BEACOPP REGIMENS AMONG PATIENTS \nWITH HODGKIN\u2019S LYMPHOMA \n \nYusoff MN1, Ashim EA1, Saiful Suhardi MA2, Kori AN3 \n\n\n\n \n1Department of Pharmacy, Hospital Tengku Ampuan Afzan, Ministry of Health Malaysia,2Kulliyyah of Medicine, \nInternational Islamic University of Malaysia, Kuantan, Pahang,3Department of Medicine, Hospital Tengku Ampuan Afzan, \nMinistry of Health Malaysia \n \nINTRODUCTION: ABVD regimen is a standard regimen for Hodgkin\u2019s Lymphoma, proven to be superior and less toxic \ncompared to alternative regimens. BEACOPP is one of the treatment options in advanced Hodgkin\u2019s Lymphoma with escalated \nBEACOPP reported to be significantly better than baseline BEACOPP. \nOBJECTIVES: Primary outcome measured was complete response (CR) rate, and secondary outcomes were disease-free \nsurvival (DFS), progression-free survival (PFS) and overall survival (OS) in patients who received either ABVD or escalated \nBEACOPP. \nMETHOD: An observational, retrospective cohort study was done in Hospital Tengku Ampuan Afzan (HTAA), involving \npatients who diagnosed with early unfavourable and advanced Hodgkin\u2019s Lymphoma from 2013 until January 2018.  \nRESULTS: A total of 28 patients were enrolled, ABVD (n =22) and escalated BEACOPP (n=6). The median age was 28 \nyears old, with majority were Malay (89.3%). Based on the International Prognostic Score (IPS), 25% of them scored IPS \u22654 \nwith 39.3% were on stage IV and 17.9% presented with \u201cB\u201d symptoms. The median follow-up was 34 months and complete \nremission (CR) rate was similar in both arms, 54.5% versus 83.3% respectively (p=0.36). At 63 months the DFS and PFS \nbetween ABVD and escalated BEACOPP were 54.5% versus 83.3% (p=0.26) and 54.5% versus 83.3% (p=0.36) respectively. \nThe OS rate was 81.8% versus 100% (p=0.33) respectively. \nCONCLUSION: ABVD and escalated BEACOPP showed similar outcomes in CR, DFS, PFS and OS in early unfavourable \nand advanced Hodgkin\u2019s Lymphoma. Median follow-up was short particularly in patients who received escalated BEACOPP. \nFurther follow up is required to identify the median of DFS, PFS and OS. These results act as a preliminary data for further \ninvestigations.  \n \nKEYWORDS: clinical research, Pahang, Hodgkin Lymphoma, ABVD, BEACOPPNMRR ID: NMRR-17-2477-34798 (IIR) \n \n \nOP-55 (Oral) \nEFFECTIVENESS AND ECONOMIC EVALUATION OF NAUSEA AND VOMITING MANAGEMENT FOR \nMODERATELY AND HIGHLY EMETOGENIC CHEMOTHERAPY IN MALAYSIA: A MULTICENTER \nCOHORT STUDY \n \nChan HK1, Mohammed NS1, Hassan MRA1, Tan XQ2, Lim YM3, Phua G3, Yeb LF4, Kirubakaran R4, Wong YH5, Sapli NSM5, \nJayaraman MS6, Nor IM6 \n \n1Clinical Research Centre, Hospital Sultanah Bahiyah, Ministry of Health Malaysia, 2Department of Pharmacy, Hospital \nTuanku Fauziah, Ministry of Health Malaysia, 3Department of Pharmacy, Hospital Sultanah Bahiyah, Ministry of Health \nMalaysia, 4Department of Pharmacy, Hospital Abdul Halim, Ministry of Health Malaysia, 5Department of Pharmacy, Hospital \nSultan Ismail, Ministry of Health Malaysia, 6Department of Radiotherapy and Oncology, Hospital Kuala Lumpur, Ministry of \nHealth Malaysia \n \nINTRODUCTION: While chemotherapy-induced nausea and vomiting (CINV) have been shown to be prevalent, their \nmanagement is still noticeably conservative in Malaysia.  \nOBJECTIVES: To evaluate the effectiveness of the CINV management in Malaysia, and to determine the cost-effectiveness \nof all the commonly used antiemetic regimens.  \nMETHOD: This prospective cohort study was undertaken in five public hospitals. Cancer patients who received 1-day \nmoderately and highly emetogenic chemotherapy (MEC and HEC) were randomly sampled and required to record their 5-day \nCINV experience in a diary. The rate of overall uncontrolled CINV (nausea score \u22655 and emesis \u22651 episode), was used as the \nefficacy endpoint. The total cost incurred by the drug and medical resource utilization and the incremental cost-effectiveness \nratio (ICER) of each antiemetic regimen were computed. One-way sensitivity analysis was also performed to assess the \nrobustness of the results. \nRESULTS: Of the 211 patients recruited, the majority had breast cancer (70.1%), were in the late stages (III/ IV) of the disease \n(54.1%), and received HEC (73.9%). The rates of the post-chemotherapy nausea and vomiting were 56.9% and 36.0% \nrespectively, yielding a rate of overall uncontrolled CINV of 59.7%. As similar antiemetic regimens were used for both the \nMEC and HEC, the latter, expectedly led to a higher risk of uncontrolled CINV (adjusted OR: 2.29; 95% CI: 1.20, 4.39). \nAlthough the ondansetron-based antiemetic regimen was shown to be more effective (adjusted OR: 0.48; 95% CI: 0.25, 0.91) \nthan the granisetron-based regimen, it appeared to be less cost-effective (ICER: MYR22.17 per additional CINV-free patient). \nThe ICER was also considerably affected by the dosage and brand of antiemetics used.  \nCONCLUSION: The findings indicate that the CINV management in Malaysia is generally suboptimal. Hence, a revision of \nthe current practice is warranted, preferably to be supplemented by the evidence from the economic evaluation.  \n \nKEYWORDS: health economics, West Malaysia, antiemetics, chemotherapy, cost-effectiveness analysis \nNMRR ID: NMRR-15-2480-25897 \n \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nOP-56 (Oral) \nTHE STABILITY STUDY OF EXTEMPORANEOUS PREPARATIONS PREPARED IN THE OUTPATIENT \nPHARMACY OF HOSPITAL TUANKU FAUZIAH (HTF) STORED BASED ON PATIENT\u2019S SETTING \n \nAbdul Wahab MF1, Amir A1, Md Razi SS1, Ramli N1 \n\n\n\n \n1Department of Pharmacy, Hospital Tuanku Fauziah, Ministry of Health Malaysia \n \nINTRODUCTION: Extemporaneous preparation is defined as the preparing, mixing, assembling, packaging and labeling of \nmedicinal products based on a prescription order from a licensed practitioner for the individual patient. However, there are \nquestions remain in terms of stability of the extemporaneous preparation after being dispensed and stored by patients. \nOBJECTIVES: This study was to investigate the stability of five extemporaneous syrups prepared using both simple syrup \nand X-temp\u00ae Syrup in the outpatient pharmacy of HTF when stored in different conditions.  \nMETHOD: The materials used were simple syrup, X-temp syrup, Baclofen 10mg, Propranolol 40mg, Frusemide 40mg, \nClonazepam 2mg and Spironolactone 25mg tablets were obtained from outpatient pharmacy of HTF. All extemporaneous \npreparations were prepared according to standardized METHOD in the Ministry of Health (MOH) Extemporaneous \nFormulation 2015. The prepared syrups were then stored in either household cupboards or inside the domestic fridge in sets \nof two separate bottles. For each set, one was stored for 14 days while the other was stored for a period of 30 days. At the end \nof each duration, the syrups were assessed in terms of visual and odour, pH level and sterility. The syrups were considered \nstable if no changes detected in each criteria. \nRESULTS: All extemporaneous syrups prepared using X-temp\u00ae were stable up to 30 days when stored in both conditions \nexcept for Propranolol syrup. As for preparations prepared using simple syrup, all except Baclofen syrup were stable up to 30 \ndays when stored in both conditions. \nCONCLUSION: Extemporaneous preparations usingeither vehicle if stored in 2 \u2013 8\u00b0C would maintain their stability for up \nto 30 days. Caregivers are to be advised to always keep their extemporaneous syrup medication in the fridge. \n \nKEYWORDS: quality use of medicines, Perlis, extemporaneous preparation, stability, outpatient \nNMRR ID: NMRR-16-296-29084 \n \n \nOP-57 (Oral) \nMEDICINAL PRODUCTS AND SERVICES ADVERTISING: A CROSS-SECTIONAL ASSESSMENT OF \nKNOWLEDGE AND ATTITUDE AMONG PHARMACISTS IN MELAKA (MEPS-PHAM STUDY) \n \nZainal MS1, Tan RTH1, Low CF1, Manshor M1, Soh ATC2, Ahmad AH3, Mohd-Ramli AF4, Ahlan A1 \n\n\n\n \n1Pharmacy Enforcement Division, Melaka State Health Department, Ministry of Health Malaysia,2Hospital Jasin, Ministry of \nHealth Malaysia,3Hospital Alor Gajah, Ministry of Health Malaysia,4Hospital Putrajaya, Ministry of Health Malaysia \n \nINTRODUCTION: In 2014, 46.6% of advertisements in pharmacies in Melaka were found to be violating Medicines \n(Advertisement and Sale) Act 1956, ranking the highest in Malaysia and should be a cause for concern. False, incompliance \nand misleading advertisements create unrealistic expectations about the benefits and safety of such products and services, with \npotential adverse consequences to the consumers.  \nOBJECTIVES: This study aimed to assess knowledge and attitude on medicinal products and services advertising among \npharmacists in Melaka, Malaysia. \nMETHOD: A cross-sectional study was carried out using validated self-administered questionnaire. All analyses were \nperformed using IBM SPSS version 20.0. Descriptive statistics were used to illustrate demographic characteristics and mean \nscores for knowledge and attitude. Inferential statistics (independent t-test and one-way ANOVA) were used to establish \nassociation between study variables. Pearson\u2019s correlation was used to identify the association between the knowledge and \nattitude scores.  \nRESULTS: Out of 228 pharmacists participated in the study, 153 (67.1%) were from Government sector, with the majority \n(111, 72.5%) in the age group of 20-30 years while 75 (32.9%) were from private sector, with the majority (28, 37.3%) in the \nage group of 31-40 years. Mean (SD) scores for knowledge and attitude were 12.0(2.04) and 9.1(1.76) respectively. Age, \ngender, occupational sector and years of experience as pharmacist were significantly associated with attitude score. There was \nno correlation between knowledge and attitude. \nCONCLUSION: Pharmacists in Melaka have good knowledge, but negative attitude towards medicinal products and services \nadvertising. This study serves as a stepping-stone for further research in the field of medicinal products and services advertising \nin Malaysia. It also provides an insight to the authority and policy maker to strengthen future advertisement control strategies \nand awareness programs on legal advertising among pharmacists. \n \nKEYWORDS: quality use of medicines, Melaka, advertisement, medicinal product and service, knowledge, attitude, \npharmacist \nNMRR ID: NMRR-15-2046-28643  \n  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nOP-58 (Oral) \nEXPLORING THE COST OF STAGE C HEART FAILURE IN HOSPITAL QUEEN ELIZABETH II, KOTA \nKINABALU, SABAH \n \nShafie AA1, Tan YP2, Liau SY3, Yang SL3, Liew HB3,4 \n\n\n\n \n1Discipline of Social & Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, \nPenang,2Pharmacy Department, Hospital Tawau, Ministry of Health Malaysia,3Clinical Research Centre, Hospital Queen \nElizabeth II, Ministry of Health Malaysia,4Cardiology Department, Hospital Queen Elizabeth II, Ministry of Health Malaysia \n \nINTRODUCTION: Numerous cost-of-illness studies of heart failure (HF) have been published in developed countries but \nsuch knowledge is lacking in Malaysia. This makes it harder for the healthcare decision makers to determine research and \nfunding priorities by highlighting areas where inefficiencies may exist. \nOBJECTIVES: This study aimed to estimate the mean annual healthcare cost of Stage C HF in Hospital Queen Elizabeth II \n(HQEII). \nMETHOD: This study adopted an activity-based costing approach from Ministry of Health\u2019s perspective. Data of types and \nquantities of healthcare components utilized when patients were treated in HQEII between 2013 and 2015 were abstracted \nretrospectively from the medical records. Unit costs of each component were valued based on published studies and \ngovernment full-pay tariff. The categorical variables were presented as percentage whereas continuous variable were presented \nas means with standard deviations (SD). The mean annual cost of HF was expressed in Malaysia Ringgit (MYR) 2014 with \n95% confidence interval (CI). \nRESULTS: The mean follow up period was 629 (SD 320) days. Ninety-two patients with 85.9% male and mean age 59 (SD \n3.5) years were included in this study. During the study period there were 451 outpatient clinic visits and 44 admissions with \nmean length of stay of 5.2 (SD 6.0) days. The mean annual cost of heart failure was RM 15,071.00, 95% CI (14,746, 15,396) \nin 2014. Inpatient cost accounted for 90.6% of the total cost which was mainly attributed by percutaneous coronary intervention \n(PCI) procedures and hospitalization. \nCONCLUSION: Cost of PCI procedures and cost of hospitalization were themain cost drivers of HF. Cost saving can be \nachieved by providing efficient clinical management at outpatient setting to prevent worsening of HF which requires frequent \nhospitalization. Caution needed when attempting to apply the cost estimates reported by this study to other hospital settings in \nMalaysia due to generalizability concern.  \n \nKEYWORDS: health economics, Sabah, cost-of-illness, , heart failure \nNMRR ID: NMRR-15-1661-27979 \n \n \nOP-59 (Oral) \nAVAILABILITY, MEDICINE PRICES AND AFFORDABILITY OF SELECTED MEDICINES IN MALAYSIA \n \nWong SL, Saliza I, Norazlin AK, Salbiah MS \n\n\n\n \nPharmacy Practice and Development Division, Ministry of Health Malaysia \n \nINTRODUCTION: High medicine prices and catastrophic out-of-pocket spending are barriers to treatment access. Unfair \nprices impose a great burden to the nation in sustainable healthcare provision and render treatment unaffordable for the people. \nOBJECTIVES: To generate reliable availability, medicine price and affordability information of selected important \nmedicines in Malaysia\u2019s public and private sectors. \nMETHOD: The study adapted the validated methodology developed by the World Health Organization/Health Action \nInternational. A nationwide cross sectional survey with a total of 87 facilities was conducted. Trained data collectors recorded \ndata for the specified dosage forms and strengths of the selected 50 medicines. When available, procurement and patient prices \nwere collected for originator brand and lowest-priced generic equivalent of each medicine.  \nRESULTS: Overall, average medicines availability was high in the public sector (83.0%) and fairly high (66.7%) in the private \nsector. In the public sector, average availability of generics (74.8%) was higher than originators (19.4%). However, in the \nprivate sector, originators (52.2%) had higher availability compared to generics (49.1%). Comparison of median prices \nrevealed that private sector procured medicines at higher prices as compared to the public sector, whereas private hospitals \nsold medicines at higher prices compared to retail pharmacies. Compared to International Reference Price (IRP), procurement \nmedian price ratio (MPR) of originator brands was much higher in the private sector than the public sector (8.6 vs 1.2), whereas \nMPR of lowest-priced generics in the private sector was slightly higher than the public sector (2.5 vs 1.6). Generic products \nwere affordable but originators were not affordable for the low-income population.  \nCONCLUSION: The high availability of generics in the public sector is parallel with the National Medicines Policy (DUNas). \nOverall public procurement was efficient but pricing policies in the private sector are needed. Sustainable financing for \nexpensive medicines should be considered to safeguard medicines access and affordability. \n \nKEYWORDS: health economics, Selangor, availability, affordability, medicine price, median price ratio (MPR) \nNMRR ID: NMRR-16-2476-33791 \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nOP-60 (Oral) \nEFFECT OF INDOMETHACIN\u2019S DURATION OF ADMINISTRATION AS A POSITIVE CONTROL IN \nCARRAGEENAN-INDUCED PAW EDEMA IN RAT MODELS \n \nNorzahirah A1, Siti Khuzaimah M1, Teh BP1, Mohd Ridzuan MAR1, Nor Azrina N1, Nor Azlina Z1, Umi Rubiah Z1, Azlina \nZ1 \n\n\n\n \n1Herbal Medicine Research Centre, Institute for Medical Research, Ministry of Health Malaysia \n \nINTRODUCTION: Indomethacin has often referenced as the positive control in carrageenan-induced anti-inflammtory \nstudies in rats. However, its duration of administration prior to carrageenan-induction and how this affects the rat model is \nscarcely reported in the literature. \nOBJECTIVES: This study aims at evaluating the effect of indomethacin as positive control in carrageenan-induced paw \nedema in rat models used in anti-inflammatory studies. \nMETHOD: Male Wistar rats were divided into four groups (n=6); vehicle-control (C), negative-control (NC), indomethacin-\nD3 (ID-3), and indomethacin-D1 (ID-1). Both C and NC groups received distilled water (10mL/kg body weight) for three \ndays, while group ID-3 and ID-1 received indomethacin at 10mg/kg body weight for three days and one day, respectively. \nCarrageenan in saline (1%, 0.2mL/paw) were injected into the sub-plantar region of the rat's hind paw to induce edema in \ngroups NC, ID-3 and ID-1. Paw volume was measured at time points 0, 1, 3, 6, and 24-hours post-induction using a digital \nwater plethysmometer. At 24-hours post-induction, the rats undergo necropsy and whole blood was collected into EDTA tubes \nfor hematological analysis and blood smear count.  \nRESULTS: At 3-hours, the paw volume in both indomethacin-treated groups was significantly reduced compared to NC group \n(p<0.05). Simultaneously at the same time point, the edema effect induced by carrageenan reached its maximum in the NC \ngroup which indicated the presence of prostaglandins and other inflammatory mediators. At 6-hours and 24-hours, the paw \nvolume was apparently reduced in both indomethacin-treated groups. The hematological profile analysis showed that the \nhematocrit, hemoglobin and red blood cell parameters of ID-3 group were significantly lower compared to both control groups, \nwhile hemoglobin of ID-3 was significantly lower when compared to ID-1 (p<0.05). \nCONCLUSION: In conclusion, rat models dosed with indomethacin for one day prior to carrageenan injection showed \nsufficient reduction in paw inflammation while minimizing indomethacin's effect on the rats' physiology. \n \nKEYWORDS: research tools, Kuala Lumpur, indomethacin, , inflammation, carrageenan, plethysmometer \nNMRR ID: NMRR-17-507-35387 \n \n \nOP-61 (Oral) \nDEVELOPMENT AND VALIDATION OF THE CHILDHOOD VACCINATION ATTITUDES AND BELIEFS \nSCALE (CABS) \n \nJosephine HB1, Devi SRM1, Salihah NY1, Yee JTH1 \n \n\n\n\n1Department of Pharmacy, Hospital Shah Alam, Ministry of Health Malaysia \n \nINTRODUCTION: There has been an increasing trend in vaccine hesitancy among parents and vaccine preventable disease \noutbreaks in the nation. As parents\u2019 attitudes and beliefs are affected by social, cultural, and political background, therefore it \nis fundamental to design a survey with local elements and scenario. \nOBJECTIVES: To develop and validate the Health Belief Model (HBM) based survey to assess parents\u2019 attitudes and beliefs \ntowards childhood vaccination. \nMETHOD: The survey designed was content validated by an expert panel for its representativeness and clarity. Cognitive \ndebriefing interviews were then conducted to explore the understanding and relevance of the items. Exploratory factor analysis \n(EFA) was employed to analyze the factor structure of the items while internal reliability was analyzed with Cronbach\u2019s alpha.  \nRESULTS: The content validity index (S-CVI/Ave) was 0.9. Hence, the Childhood Vaccination Attitudes and Beliefs Scale \n(CABS) is highly valid content. A total of 290 subjects were recruited for construct validity. The EFA provided support for \nthe existence of six factors as proposed in the HBM, which accounted for 63.7% of the total variance for the total of 27 items. \nKaiser-Meyer-Olkin Index of 0.83 verified the sampling adequacy for the analysis. Barlett\u2019s test of sphericity was statistically \nsignificant (p < 0.05) (x2 = 4165, df = 351, Sig. = 0.000) indicating correlations between items were sufficiently large for the \nanalysis. Cronbach\u2019s alpha coefficient for the six subscales ranged between 0.52 and 0.89. CONCLUSION: TheCABS is a \nvalid and reliable instrument for assessing parents\u2019 attitudes and beliefs towards childhood vaccination. \n \nKEYWORDS: research tools, Selangor, exploratory factor analysis, health belief, vaccination, immunization \nNMRR ID: NMRR-16-1462-32031 (IIR) \n  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nOP-63 (Oral) \nAN ASSESSMENT OF PARENT\u2019S KNOWLEDGE, ATTITUDE AND PRACTICE (KAP) ON ANTIBIOTIC USE \nAMONG CHILDREN IN HOSPITAL BUKIT MERTAJAM \n \nPrevena R1, Seah XQ1, Tan WY1, Eng JY2, Norhazrina 3, Ruzaini WN4, Chuah CE5, Boon KY6 \n\n\n\n \n1Department of Pharmacy, Hospital Bukit Mertajam, Ministry of Health Malaysia, 2Department of Pharmacy, Klinik Kesihatan \nJuasseh, Ministry of Health Malaysia, 3Department of Pharmacy, Hospital Kuala Lumpur, Ministry of Health Malaysia, \n4Department of Pharmacy, Hospital Pulau Pinang, Ministry of Health Malaysia, 5Department of Pharmacy, Klinik kesihatan \nBandar Tasek Mutiara, Ministry of Health Malaysia, 6Department of Pharmacy, Klinik Kesihatan Bandar Baru Air Itam, \nMinistry of Health Malaysia  \n \nINTRODUCTION: Parent\u2019s expectations are shown to have impacted physician\u2019s prescribing attitude since parents expect \ntheir child to be treated with antibiotic for each and every illness. Parental KAP on antibiotic use for their children is important \nto be assessed in order to avoid wastage of healthcare resources and emergence of bacterial resistance. \nOBJECTIVES: The objective of the study was to assess the parent\u2019s knowledge, attitude and practice on antibiotic use among \nchildren in Hospital Bukit Mertajam. \nMETHOD: A cross-sectional study was carried out using self-reporting validated questionnaires from April to June 2016 at \noutpatient pharmacy in Hospital Bukit Mertajam. Convenient sampling method was used in this study, where parents visiting \nthe pharmacy with prescription for antibiotics for their children were recruited. \nRESULTS: Out of 103 respondents, noted most of the respondents still believe that antibiotics could cure viral infection \n(85%), antibiotics should be given to kids once having fever (60%), antibiotics should be withdrawn once symptoms \ndisappeared (54%). 40% of the parents agreed that antibiotics do not have side effects. Education and age was significantly \nassociated with parents knowledge (p<0.05). 43.7% of the parents agreed that their child should take antibiotics as prevention, \nonce other children around infected. 91.3% of the parents never practice purchasing antibiotics without physicians\u2019 \nprescription. However, 62% of the parents do request antibiotics from physicians, 24% of the parents practices storing \nantibiotics at home for future needs, and 25% of the parents reduces antibiotics dosage deliberately in consideration of safety \nof their children. \nCONCLUSION: This study has demonstrated that parents\u2019 knowledge, attitudes and practices on antibiotics are still lacking. \nHence, more steps such as patient-physicians time/ patient-pharmacist times, educational/awareness programs should be held \nto ensure quality antibiotics use and to reduce the emergence of bacterial resistance. \n  \nKEYWORDS: quality use of medicines, Penang, antibiotic use, knowledge, attitude, practice, parent \nNMRR ID: NMRR-16-1274-29579 \n \n \nOP-64 (Oral) \nDEVELOPMENT AND VALIDATION OF ENTRY-POINT CHECKLIST TO ENSURE CONSISTENCY OF \nDECISIONS MADE AMONGST OFFICERS ON DUTY \n \nChia PK1, Doreen L1, Ahmad Afandi AN1, Shahari AF1, Syed Abdul Nasir SN1, Foo JY1, Palaniyappan S1, Mohamed Kamil \nN1 \n\n\n\n \n1Cawangan Penguatkuasa Farmasi Sabah, Ministry of Health Malaysia \n \nINTRODUCTION: Pharmacy enforcement officers play vital role in ensuring pharmaceutical products sold in Malaysia \ncomply with National Pharmaceutical Regulatory Agency. The ability of officers to verify compliance criteria and making \nconsistent judgement to endorse importation of consignment is important. Cognitive aid in the form of checklist is proposed \nas a tool to ensure consistent decision made among Sabah entry-point officers. \nOBJECTIVES: To develop and validate a checklist that served to ensure consistency in decision making among officers \nwhen endorsing consignments at Sabah entry-points. \nMETHOD: This was a mixed method study involving qualitative and quantitative approaches. A qualitative approach using \nDelphi method was conducted between 3.6.2016 to 7.4.2017 at CPF Sabah. A preliminary checklist was drafted with 9 domains \nfocusing on \u201cpharmaceutical products\u201d and 4 domains focusing on \u201centry-points\u201d. 8 experts with experience in entry-point \n(\u22658 years) were invited to confirm content validity. Face validity was performed among 10 officers to ensure readability and \nunderstanding. Concurrent validity (quantitative approach) was then carried out. A set of consignment forms endorsed in 2016-\n2017 were sampled to test against criteria in the checklist. 15 officers were required to use the checklist to endorse these \nconsignments. Decisions for these endorsement were censored. The decisions were then compared against the true decision. \nA sensitivity and specificity analysis was performed to confirm concurrent validity. \nRESULTS: Delphi method was applied for three cycles before an absolute concordance was achieved among the experts. \nContent and face validity was conducted. In sensitivity test, there was a significant difference between standard compliance \nanswer and checklist answer. The percentage by using the checklist is higher than standard compliance answer. This prove \nthat the usage of checklist has 100% sensitivity & specificity. \nCONCLUSION: The checklist was validated and it could be served as a tool to improve the consistency in decision making \namong officers on duty at entry-point. \n \nKEYWORDS: research tools, Sabah, checklist, consistence, validation \nNMRR ID: NMRR-17-1005-35965 \n \n \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nOP-65 (Oral) \nA PROSPECTIVE INTERVENTIONAL STUDY OF SMARTPHONE MEDICATION ADHERENCE \nAPPLICATION AND ITS POTENTIAL BENEFITS TO RETROVIRAL DISEASE (RVD) PATIENTS: \nPRELIMINARY STUDY \n \nSiti Rabiatul Adawiyah N1, Nurhayati AS1, Basariah N1, Kok KC2, Afiqah A1, Chan YJ1 \n\n\n\n \n1Department of Pharmacy, Hospital Tuanku Jaafar, Ministry of Health Malaysia, 2Department of Medicine, International \nMedical University, Negeri Sembilan \n \nINTRODUCTION: Adherence remains a significant problem for those who have been prescribed with Antiretroviral Therapy \n(ART). Patients\u2019 knowledge about the disease and treatment may influence their adherence to the treatment plan. Smartphone \napplication is a new approach in improving adherence and patient behaviour, as it is constantly accessible, involving and \neducating the patient, and offers a source for patient- and medication-specific information. \nOBJECTIVES: To determine the percentage of improvement in patient adherence and knowledge after using the iStayhealthy \napplication. \nMETHOD: A prospective interventional study was conducted at RVD Clinic in HTJS. 33 RVD patients were evaluated from \nJuly 2017 to September 2017. Eligible patients were those aged \u226518 years old, on ART medications, CD4 count <500 during \nenrolment and each owns a smartphone. The iStayHealthy application was downloaded from Android Playstore or Apple \nApplication Store. Information such as missed medications, side effects and illness were recorded in the application. \nAdherences of the patients were assessed using validated questionnaires from AIDS Clinical Trial Group (ACTG) \nquestionnaires while patients\u2019 knowledge were assessed using validated questionnaires. Patients were interviewed using these \nquestionnaires on their first and follow up visits after a month. Data were analyzed using descriptive statistics and Paired T-\ntest. \nRESULTS: Of the 33 respondents, 85% (n=28) aged between 20-40 years old and 75% (n=27) of respondents were on ART \ntreatment between 1-5 years. There was a statistically significant increase in adherence and knowledge mean score, which is \n31.8% (p=0.001) and 14.2% respectively (p=0.037). \nCONCLUSION: Adherence and knowledge scores among patient has increased after using the application in this study. Based \non our findings, this application may have potential to be used for younger patients and those who were newly started on ART \ntreatment. However, due to limited samples, the results must be interpreted with caution. \n \nKEYWORDS: health informatics, Negeri Sembilan smartphone application, adherence, antiretroviral  \nNMRR ID: NMRR-17-1152-36246 \n \n \nOP-66 (Oral) \nINVESTIGATING THE REASON FOR UNCLAIMED MEDICATION IN FLEXY SERVICE AT HOSPITAL \nBANTING \n \nSubha P1, Koh CP1, Nur LA1, Lee JT1 \n\n\n\n \n1Hospital Banting, Ministry of Health Malaysia \n \nINTRODUCTION: FLEXY is a dispensing system where the refill medications are prepared in advance. On the appointment \ndate, patient will be able to collect their supply faster at the pharmacy counter. However, there are patients who dropout from \nthe system and the reasons needs to be investigated  \nOBJECTIVES: This study aimed to evaluate the reason for unclaimed medication among dropouts\u2019 that register in FLEXY \nservice.  \nMETHOD: : A retrospective study was conducted from October 2016 to March 2017 via phone call on 360 patients or \ncaregivers which recruited from patients among patients who had joined FLEXY service, but failed to claim their medications \nafter one week from their appointment. The questionnaire was validated through a pilot study. It comprised common socio-\ndemographic and three domains question; to verify patient understands on FLEXY service, the reason patients failed to claim \ntheir medications and how to improve the service.  \nRESULTS: The majority of respondents was male 65.4% with age more than 55 years,69.1%. Among the top reason for \nunclaimed medicine, 22.1% claimed they are busy, 20.6% claimed forget to collect their medicine, followed by 18.0% claimed \noutside of the area, and 17.3% with the reason that they still had supplies of medication at home. Only 12.1% claimed they \nhave no transport to collect their medicines.  \nCONCLUSION: The results suggest that patients aged more than 55 years old tends to forget to collect the medicines. FLEXY \nservice can be improved with various means such as sending notification using short message service (SMS), prolong the TCA \ndate, using POS Laju and also create awareness about this system  \n \nKEYWORDS: impact of pharmacy services, Selangor, unclaimed medication, medication refill \nNMRR ID: NMRR-17-738-34883 \n \n \n \n \n \n \n \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nOP-67 (Oral) \nPREVALENCE USE OF AMPHETAMINE-TYPE-STIMULANTS (ATS) AND HIV RISK BEHAVIOURS AMONG \nCLIENTS IN GOVERNMENT AND PRIVATE METHADONE MAINTENANCE TREATMENT (MMT) \nPROGRAMS IN KUANTAN, PAHANG \n \nRuzmayuddin M1, Singh D2, Vicknasingam. B2 \n\n\n\n \n1Pejabat Kesihatan Daerah Kuantan, Ministry of Health Malaysia, 2Centre for Drug Research, Universiti Sains Malaysia \n \nINTRODUCTION: Methadone Maintenance Treatment (MMT) is proven to reduce HIV infection among opiate drug users. \nStudies investigating the use of ATS and HIV risk behaviours among clients in MMT programs are still limited \nOBJECTIVES: This study aimed to determine the prevalence of ATS use and HIV risk behaviours among clients in \ngovernment and private MMT programs in Kuatan, Pahang \nMETHOD: A total of 237 current methadone users were non-randomly recruited through snowball sampling from four \ngovernment (n=129) and two private (n=108) MMT programs in Kuantan, Pahang. On-site urine tests were done to confirm \nrespondents opiate and ATS use status. A self-report questionnaire was used to collect data \nRESULTS: Respondents mean age in this study was 37.70 years (SD=8.49), and mean age of first methadone use was 32.81 \nyears (SD=6.80). The samples average methadone treatment duration was 48.86 months, and average daily dose of methadone \nwas 52.78mg.Patients in private MMT program were used lower dose of methadone than patients in government MMT \nprogram (OR: 1.8: 1.09-3.09: p<.026).There are significant differences between patients in private and government MMT \nprograms. Private MMT patients were not satisfied with their methadone program (OR: 2.8: 1.49-5.39: p<.002) and methadone \ndose (OR: 2.9: 1.61-5.21: p<.001), more likely to use illicit opiates (OR: 4.3: 2.47-7.64: p<.001) and methamphetamine (OR: \n1.7: 1.01-2.85: p<.050) in the last 30 days, use less than 50mg of methadone daily (OR: 1.8: 1.09-3.09: p<.026) and used other \nIDUs injecting equipments in the last 12 months (OR: 2.2: 1.02-4.54: p<.040), compared to patients in government MMT \nprograms \nCONCLUSION: Our findings showed that there is concomitant use of illicit substances among clients undergoing MMT \ntreatment. The use of illicit opiates could be attributed to the insufficient dose of methadone, but the use of ATS among MMT \npopulation needs to be investigated further. \n \nKEYWORDS: impact of pharmacy services, Pahang, methadone, amphetamine, HIV risk behaviour \nNMRR ID: NMRR-15-2448-26899 \n \n \nOP-68 (Oral) \nTHE IMPACT OF PHARMACIST INTERVENTION ON ANEMIA MANAGEMENT IN CONTINUOUS \nAMBULATORY PERITONEAL DIALYSIS (CAPD) PATIENTS \n \nFong CW1, Wan Mokthar WM1, Mamat NKM1, Sattar MZ1, Tg Abd Kadir TNI1 \n\n\n\n \n1Pharmacy Department, Hospital Sultanah Nur Zahirah, Ministry of Health Malaysia \n \nINTRODUCTION: Anemia management in (CAPD) patients who received erythropoeitin stimulating agent (ESA) have \ndemonstrated favorable impacts on clinical and economic outcomes. Pharmacist-managed anaemia in assisting physician may \nprovide better haemoglobin (Hb) target. This may improve patients\u2019 quality of life and decrease healthcare cost. \nOBJECTIVES: This study was aimed to study outcome of Hb level after implementation of ESA card and counselling. \nMETHOD: A prospective, randomized controlled study involved patients attending dialysis clinic was conducted from March \nto October 2017. Fulfilled inclusion criteria patients were randomized into usual care group (n=94) and pharmacist intervention \ngroup (n=50). Intervention group received ESA injection counselling based on validated checklist and card while usual care \ngroup received standard care. Hb outcome was evaluated pre-and post-intervention. Data was analysed using descriptive and \nparametric test (SPSSv.22) with p<0.05 considered as statistical significant. \nRESULTS: A total of 144 patients with median age of 53 (IQR 41-61) years old were included and 52 % of them were male. \nMean baseline Hb of in usual care group and intervention group were 9.9\u00b11.9 and 9.7\u00b11.7g/dL respectively in usual care group \nand intervention group. Mean Hb was found to be significantly increased post 3 months of monitoring (p<0.01) in which mean \nHb of both groups were 10.5\u00b12.1 g/dL (usual care), vs 10.4\u00b11.9g/dL (intervention). Intervention group had higher percentage \nof increase in mean Hb (7.1% vs 6.8%) in comparison with usual care group. However, mean Hb did not differ significantly \nbetween intervention and usual care group. Significance difference was found in mean Hb between adherence in which patients \nwho adhere to ESA significantly contribute to increased Hb (p=0.01) \nCONCLUSION: This study suggested that pharmacist interventions including ESA card and counselling are vital in view of \nthe favourable impact on the haemoglobin level. \n \nKEYWORDS: impact of pharmacy services, Terengganu, anemia, continuous ambulatory peritoneal dialysis, pharmacist \nintervention \nNMRR ID: NMRR-17-1038-34514 \n \n \n \n \n \n \n \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nOP-69 (Oral) \nTHE CROSS-SECTIONAL STUDY OF ELDERLY PATIENTS' ADHERENCE AND KNOWLEDGE TOWARDS \nTHEIR MEDICATION REGIMES IN KUALA LIPIS HOSPITAL \n \nE.T.Gan1, J.X.Yap1, K.S.Kwong1 \n\n\n\n \n1Department of Pharmacy, Hospital Kuala Lipis, Ministry of Health Malaysia \n \nINTRODUCTION: Elderly patients often have problem to adhere to their prescribed medications due to various reasons such \nas complexity of regimen, polypharmacy, a decrease in cognitive and physical functions, and low literacy level. \nOBJECTIVES: To determine the adherence and knowledge scores of geriatric patients towards their medication regimen. \nMETHOD: A cross-sectional observation study was conducted in Outpatient Pharmacy Department (OPD) at Kuala Lipis \nHospital, Pahang. The adherence scores were collected via the self-reporting questionnaire whereas patients\u2019 knowledge scores \nwere assessed using knowledge assessment form. Data was collected from February 2015 till October 2015 (9 months). \nRESULTS: A total of 193 patients were recruited in the study. Generally, the geriatric patients in Kuala Lipis Hospital \ndemonstrated good understanding towards their medications with knowledge score of 90.23% \u00b1 12.82. There was a significant \ndifference in knowledge score across three different age groups of patients (<65 years old, 65 -74 years old and \u2265 75years \nold), p =0.018, where age < 65 years old had the highest score. There was also a significant association between knowledge \nscore and the number of medication taken by patients, p=0.001. Besides, this study reported high medication adherence level \n(86%) among the patients, which was not affected by their demographic characteristics. There was a positive correlation \nbetween knowledge score and adherence score, (r=-0.142, p =0.046). \nCONCLUSION: High adherence (86%) and high knowledge (90.2%) scores indicated a satisfactory understanding among \ngeriatric patients towards their medications and hence, a better adherence. Higher knowledge score showed significant \ncorrelation with higher adherence level. \n \nKEYWORDS: impact of pharmacy services, Pahang, geriatric, adherence, knowledge, medication \nNMRR ID: NMRR-15-100-24068 \n \n \nOP-70 (Oral) \nNURSES\u2019 KNOWLEDGE, ATTITUDE AND PRACTICES IN THE PREPARATION AND ADMINISTRATION OF \nINTRAVENOUS MEDICATIONS IN PUTRAJAYA HOSPITAL \n \nKanasin R1, Ismail IS1, Jamaludin FF1, Sundra Raja M1, Suhaimi S1, Ariffin NF1 \n\n\n\n \n1Department of Pharmacy, Hospital Putrajaya, Ministry of Health Malaysia \n \nINTRODUCTION: Medication safety has long been recognized to be important in the provision of patient care. \nOBJECTIVES: Study aimed to determine knowledge, attitude and practice levels of nurses regarding the preparation and \nadministration of intravenous (IV) medications and factors influence.  \nMETHOD: In this descriptive cross-sectional study conducted in HPJ from July to August 2017, all nurses working in the \nwards regardless of status or shift were included via convenience sampling. A validated questionnaire was used to collect data \nin this study. Data was analysed statistically using SPSS Version 21. \nRESULTS: A total of 205 respondents were included of which 0.8% was nurse supervisor, 3.9% was head nurse and 95.3% \nwas staff nurse. Result showed that respondents\u2019 had average level of knowledge (mean score 9.1 \u00b1 SD 3.14), attitude (mean \nscore 29.28 \u00b1 SD2.58) and good level of practice (mean score 26.7 \u00b1 SD 3.04) in administering IV medications. Less than \n50% of respondents obtained correct answers for calculation and dosing of IV medications.Furthermore, this study found that \npractice of preparing and administering IV medications was influenced by experience (p = 0.026) while attitude was influenced \nby gender (p= 0.038). \nCONCLUSION: Nurses in Putrajaya Hospital had an average level of knowledge, attitude and good level of practice in \nadministering IV medications. Therefore, intensive regular training programs need to be carried out for nurses to improve their \nknowledge. \n \nKEYWORDS: impact of pharmacy services, Putrajaya knowledge, attitude, practice, intravenous medication \nNMRR ID: NMRR-17-1205-36101 \n \n \n \n \n \n \n \n \n \n \n \n \n \n \nOP-71 (Oral) \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nMEDICAL INFORMATION RESOURCES ON MOBILE PHONE AMONG HEALTHCARE PROFESSIONALS: A \nCROSS-SECTIONAL SURVEY \n \nMuhammad A1, Abdul Ghani F1, Sulaiman R1, Wan Ismail WA1, Nasrun NA1, Faisal N1 \n\n\n\n \n1Department of Pharmacy, Hospital Tengku Ampuan Afzan, Ministry of Health Malaysia \n \nINTRODUCTION: Medical information resources (MIR) on smartphone has been widely used among healthcare \nprofessionals (HP), assisting in decision making of pharmacotherapy management. The benefit and its utilization in clinical \npractice among Malaysian HP are unknown. \nOBJECTIVES: This study aimed to evaluate the utilization of MIR among Malaysian HP and factors that influenced HP\u2019s \npreference upon installing a MIR on any devices. \nMETHOD: A survey was sent to HP working in pharmacy, ward and clinic at a tertiary hospital in Pahang. A total of 1000 \nquestionnaires consisted of 22 questions were distributed. The questionnaire sought information on HPs\u2019 background and \ndetailed information regarding the use of MIR in their clinical practice. \nRESULTS: A total of 532 HP responded to the survey (response rate = 49.7%), with 72.7% (n=109) were pharmacists, 52.2% \n(n=227) nurses and 46.1% (n=196) doctors. Among these, 99.6% were aware of availability of medical smartphone application \n(MSA) while 96.4% were aware of medical online database (MOD). Majority of them (95.6%) utilised MSA in their clinical \npractice with MSA and internet were the most preferred method for searching information. Epocrates is the most preferred \nMSA used among doctors and pharmacists (14% and 14.1% respectively) while nurses preferred to use MIMS as their source \nof reference (29.3%). The most preferred MOD among HP were Embase (25.6%), Medline (17.3%), Pubmed (14.9%) and \nOvid (14.9%). Among factors that influenced HP preference on MIR were immediate reference, trusted information and easy \nto understand information. \nCONCLUSION: MIR on devices are widely used among HP in Malaysia. Both MSA and MOD are equally utilised, \nparticularly those without registration fee. The use of local government-sponsored MSA such as Micromedex is under-utilised \nthus promotion used of this application is required. \n \nKEYWORDS: impact of pharmacy services, Pahang, mobile application, healthcare professional, medical information, \nNMRR ID: NMRR-17-445-34643 (IIR) \n \n \nOP-72 (Oral) \nINPATIENT ANTICOAGULATION SERVICE: THE NEXT FRONTIER IN ANTICOAGULANT THERAPY \n \nChua Peck Wei1, Sahimi Mohamed1, Dr Darshini A/P Chandrasakaranpillay2, Dr Ahlam Naila binti Kori2 \n\n\n\n \n1Department of Pharmacy, Hospital Tengku Ampuan Afzan, Ministry of Health Malaysia, 2Department of Medicine, Hospital \nTengku Ampuan Afzan, Ministry of Health Malaysia \n \nINTRODUCTION: Anticoagulants are extensively used for the prevention and treatment of venous and arterial thrombosis \n(VTE) and they are high-risk medications associated with a significant rate of medication errors among hospitalized patients. \nThe pharmacy department in collaboration with Medical Department in Hospital Tengku Ampuan Afzan (HTAA) is seeking \nto expand anticoagulation services by implementing an Inpatient anticoagulant service (IPACs) providing daily surveillance \nand dosing consultation for patients receiving anticoagulant. \nOBJECTIVES: To identifying the referral reasons to IPACs, percentage of patient with acute VTE received VTE prophylaxis \nand describing the issues identified by the IPACs in the management of anticoagulant therapy (ACT).  \nMETHOD: A cross sectional, descriptive study conducted in HTAA. All adult patients who referred to IPACs team were \nrecruited. \nRESULTS: Of 157 patients seen by IPACs team, 54% are newly started on ACT, 20% are referred for anticoagulant reversal, \n8% for bridging therapy, 10% switching of anticoagulant, and 9% for warfarin titration. Nearly 60% patients (n=81) referred \nfor acute VTE with 85% had high risk but only 33% received VTE prophylaxis. Inappropriate dose of IV vitamin K and \nunderutilisation of prothrombin complex concentrate for overwarfarinization as well as doing daily INR leading to improper \ntitration of warfarin were the most problems seen in IPACs.  \nCONCLUSION: With the clinical experience of IPACs, we create the awareness of VTE prophylaxis and address the issues \nthat related to ACT. IPACs appear to enhance quality of patient care in anticoagulant management. Further research will be \nconducted in future to determine the impact IPACs. \n \nKEYWORDS: impact of pharmacy services, Pahang, anticoagulation, inpatient \nNMRR ID: NMRR-17-2456-36172 \n \n \n \n \n \n \n \n \n \n \nOP-73 (Oral) \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nA 6-YEAR REVIEW OF THE METHADONE MAINTENANCE PROGRAM AMONG REGISTERED PATIENTS \nIN PERAK \n \nSanusi NA1, Abdul Rahman HI2, Salleh MSI3, Ng Yoon Yeen4, Mohd Jobran IA5, Mohd Hasan NS6, Aminah Zainal Bahri \nSNU7 \n\n\n\n \n1Bahagian Perkhidmatan Farmasi, Jabatan Kesihatan Negeri Perak, Ministry of Health Malaysia, 2Kompleks Survelan, Pejabat \nKesihatan Kinta, Ministry of Health Malaysia, 3Unit Farmasi, Hospital Taiping, Ministry of Health Malaysia, 4Bahagian \nPerubatan, Jabatan Kesihatan Negeri Perak, Ministry of Health Malaysia, 5Unit Farmasi, Pejabat Kesihatan Daerah Batang \nPadang, Ministry of Health Malaysia, 6Unit Farmasi, Pejabat Kesihatan Daerah Kuala Kangsar, Ministry of Health Malaysia, \n7Unit Farmasi, Pejabat Kesihatan Daerah Perak Tengah, Ministry of Health Malaysia \n \nINTRODUCTION: People who inject drugs are at high risk of contracting HIV, Hepatitits B (HBV), and Hepatitis C (HCV) \ndue to risky injections and sexual behaviours. The Ministry of Health Malaysia introduced the Methadone Maintenance \nTherapy (MMT) program in 2005 to reduce opioid addiction and disease transmission. \nOBJECTIVES: This study examined time to seroconversion and predictors of HIV, HBV, and HCV infections among MMT \nregistered patients in Perak. \nMETHOD: A retrospective cohort study was conducted among patients registered between 1st January 2010 and 31st \nDecember 2015 at six methadone clinics in major hospitals and health clinics. A questionnaire was used to collect socio-\ndemographic data, sexual and drug use history. Test results for HIV, HBV, and HCV were also retrieved from medical records. \nKaplan-Meier analyses were performed to determine time to HIV, HBV, and HCV seroconversion. Cox regression analyses \nwere used to examine predictors of seroconversion. \nRESULTS: A total of 212 patient records were reviewed. Median survival for HIV, HBV and HCV were 59 (IQR: 40 - 74), \n59 (IQR: 40 - 72) and 0 (IQR: 0 - 54) months respectively. Results also showed that infrequent Direct Observation Therapy \n(HR 10.44, 95% CI: 1.59 \u2013 68.77) and non-usage of condoms (HR 5.92, 95% CI: 1.11 \u2013 31.47) during sexual intercourse \npredicted HIV seroconversion whilst registration into the MMT program at a later age (HR 1.04, 95% CI: 1.02 \u2013 1.06) predicted \nHCV seroconversion. \nCONCLUSION: This study showed that the usage of condoms, supervised Methadone consumption, and early enrolment are \nimportant predictors to seroconversion. \n \nKEYWORDS: impact of pharmacy services, Perak, Methadone therapy, seroconversion, Cox regression analysis \nNMRR ID: NMRR-16-474-29613 \n \n \nOP-74 (Oral) \nEVALUATION OF PHARMACEUTICAL CARE ISSUES IN PAEDIATRIC CRITICAL CARE OF A TERTIARY \nREFERRAL HOSPITAL IN PERAK, MALAYSIA: A CROSS SECTIONAL STUDY \n \nNurfardilla F1, Rosnani H2, Nurul AHJ2, Amar-Singh HSS3, Chew CC4, Khoo SN1 \n\n\n\n \n1Department of Pharmacy, Hospital Raja Permaisuri Bainun, Ministry of Health Malaysia, 2Faculty of Pharmacy, Cyberjaya \nUniversity College Medical Siences, Cyberjaya, Selangor, 3Department of Paediatric, Hospital Raja Permaisuri Bainun, \nMinistry of Health Malaysia, 4Clinical Research Centre (CRC) Perak, Ipoh, Perak Ministry of Health Malaysia \n \nINTRODUCTION: Patients in the Paediatric Intensive Care Unit (PICU) have a higher risk of encountering pharmaceutical \ncare issues (PCIs) because they are critically ill, and prescribed more medications compared to other children. Studies from \nother countries found that 28.8% to 42.7% of drug-related problems in PICU were due to dosing problems, but local data are \nlimited.  \nOBJECTIVES: To investigate the prevalence, types of PCIs encountered and the associated factors in the PICU of a tertiary \nreferral hospital in Perak and the acceptance rate of recommendations made by pharmacists in relation to PCIs that were \nidentified.  \nMETHOD: Observational and prospective study in paediatric patients in PICU between March till May 2017. Subjects were \nconveniently sampled according to the inclusion and exclusion criteria.  \nRESULTS: 150 patients were admitted to the PICU. Of these, 27 were excluded due to incomplete medical records (n=7) and \nshort length of stay (n=20), leaving 123 patients for review. Most patients were Malay (68%) boys (59%) aged between 2 and \n12 years old (51%). Of the 123 patients, 61% had at least one PCI, with a total of 237 PCIs. Most PCIs (79%) were classified \nas drug-related problems, 4% as patient-related problems, and 17% as other problems. Out of 188 DRPs detected, inappropriate \ndosing (44%) was most common, followed by inappropriate drug selection (22%) and inappropriate drug administration (15%). \nA total of 237 recommendations were proposed by the pharmacist, of which 230 (97%) were accepted by the clinician. Patients \nprescribed 6 or more medications (OR=18.90; 95% CI: 5.25-68.02; p \nCONCLUSION: Approximately 61% of PICU patients had at least one PCI. Most PCIs were due to DRPs, of which \ninappropriate dosing was the most common cause.  \n \nKEYWORDS: impact of pharmacy services, Perak, paediatric, critical care, clinical pharmacist \nNMRR ID: NMRR-17-451-34485 \n \n \n \n \nOP-75 (Oral) \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nKNOWLEDGE, ATTITUDE AND PERCEPTION TOWARDS ALLERGIC REACTIONS OF PARACETAMOL \nAMONG GENERAL PUBLIC IN KELANTAN, MALAYSIA \n \nDellemin NA1, Zahari Z2, Hassali MA3, Rashid S1 \n\n\n\n \n1Department of Community & Pharmacy Practice, Faculty of Pharmacy, Cyberjaya University College of Medical Sciences, \nCyberjaya, Selangor, 2Faculty of Pharmacy, Universiti Sultan Zainal Abidin (UniSZA), Besut, Terengganu, 3Social and \nAdministrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang \n \nINTRODUCTION: Recent years, the prevalence of paracetamol allergy in Malaysia becomes great concerns. In Malaysia, \nthe Adverse Drug Reactions (ADR) report 2014 stated that paracetamol is one of the top analgesics as suspected drugs with \n213 reports that cause the adverse effect. \nOBJECTIVE: We investigated knowledge, attitude, and perception towards allergic reactions of paracetamol (KAP-ARP) \namong general public in Kota Bharu, Kelantan, Malaysia. \nMETHOD: A cross-sectional survey was conducted using a validated self-administered questionnaire among the general \npopulation. A total of 177 respondents participated in this study. \nRESULTS: The mean percentage scores for knowledge, attitude and perception towards allergic reactions of paracetamol \nwere 31.7% (SD 23.6), 53.1% (SD 19.2) and 53.3% (SD 23.9), respectively. This study revealed that respondents demonstrated \na poor level of knowledge, a fair level of attitude and negative perception towards allergic reactions of paracetamol. \nCONCLUSION: Information campaigns are essential to adjust people\u2019s current line of thought regards to allergic reactions \nof paracetamol. \n \nKEYWORDS: quality use of medicines, Kelantan, knowledge, attitude, perception, allergic reaction, paracetamol \nResearch ID: CUCMS/CRERC/ER/020 \n \n \nOP-76 (Oral) \nPROVISION OF PROFESSIONAL PHARMACY SERVICES BY COMMUNITY PHARMACIES: FINDINGS \nFROM A CROSS-SECTIONAL STUDY IN THE STATE OF SARAWAK, MALAYSIA \n \nKho BP1,2, Hassali MA2, Lim CJ2, Saleem F3 \n\n\n\n \n1Hospital Umum Sarawak, Ministry of Health Malaysia,2Discipline of Social and Administrative Pharmacy, Universiti Sains \nMalaysia, Penang, 3Faculty of Pharmacy and Health Sciences, University of Baluchistan, Pakistan \n \nINTRODUCTION: Professional pharmacy service provision is fast becoming a mainstay of community pharmacy practice, \nfacilitating appropriate use of medicines and management of chronic diseases. Community pharmacies in Malaysia are \nexpected to provide professional pharmacy services, despite the lack of remuneration frameworks.  \nOBJECTIVES: The aim of this study is to characterise the professional pharmacy services landscape in Sarawak, Malaysia, \nincluding reimbursement for these services and barriers faced. \nMETHOD: A questionnaire survey was sent by post to 184 eligible community pharmacies in Sarawak, Malaysia early 2017. \nReplies were received via postage-paid return mail or collected by hand and analysed. \nRESULTS: 80 responses were received (response rate: 44%). 98% of respondents offered at least a single type of professional \npharmacy service. However, there is a lack of variety in the types of services offered, which was mainly confined to health \nscreening tests including blood pressure (95%) and blood glucose monitoring (91%). Only about a quarter of respondents \nprovided smoking cessation and weight management services. Most health screening tests incur out-of-pocket payments, \nwhereas other services are largely delivered free of charge. Lack of remuneration (73%), manpower (60%) and customer \ndemand (54%) were the main barriers noted.  \nCONCLUSION: A vibrant service provision landscape is mutually beneficial for both community pharmacists and their \nconsumers. Development of a proper framework for more services as well as broad-based remuneration scheme will be \nbeneficial to drive this agenda forward.  \n \nKEYWORDS: impact of pharmacy services, Sarawak, community pharmacy practice, reimbursement, barriers. \nNMRR ID: NMRR-15-1806-28351 \n  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nOP-77 (Oral) \nFACTOR AFFECTING MEDICATION ADHERENCE AND ANTICOAGULATION CONTROL IN PATIENTS \nTAKING WARFARIN \n \nFahmishukran Amir A1, Hamiza A1, Asilah CA1, H Yee Yee1, T Shea Nee1 \n\n\n\n \n1Department of Pharmacy, Hospital Putrajaya, Ministry of Health Malaysia \n \nINTRODUCTION: Medication adherence is the key for treatment successful in chronic diseases. Warfarin has been widely \nused to prevent stroke and thrombus formation despite its narrow therapeutic range and fatal adverse reactions. Poor adherence \nto warfarin may be one of the common barriers to obtain favourable anti-coagulation outcomes. \nOBJECTIVES: To examine medication adherence rate and its contributing factors among patients taking warfarin in Hospital \nPutrajaya, and the correlation between knowledgeon warfarin and medication adherence towards anti-coagulation control.  \nMETHOD: This is a cross-sectional study, enrolled patients who were on warfarin and attended the Medical Specialist Clinic \nat Putrajaya Hospital from November to December 2017, using a self-administered questionnaire. Adherence was measured \nusing 4 items,comprises offrequency, dosage, time, and precautions when taking warfarinfollowing medical \nadvice.Adherence was defined if patients scored 0 as total scores of 4 items. The factors that may influence patients\u2019 adherence \nwere modelled using binary logistic regression. Good anti-coagulation control measured by 70% INR level within therapeutic \nrange. Correlation between medication adherence and anti-coagulation control were measured using chi square test. \nRESULTS: A total of 163 patients were included in the study. Good medication adherence were observed in 150 (92%) of \nthe enrolled patients. Gender, race and education background significantly influenced patients\u2019 adherence to medication. \nPatients who were adhered had greater understanding about warfarin (79.1%) compared to non-adherent patients. However, \nthere were no correlation observed between warfarin adherence and knowledge towards good anti-coagulation control. \nCONCLUSION: Knowledge of medication exerts significant influence on medication adherence in patients taking warfarin. \nHowever, being adherent to medications does not correlate to good anti-coagulation control. Future study may consider \nevaluating modifiable risk factors that can exert better anticoagulation and health outcomes. \n \nKEYWORDS: impact of pharmacy services, Putrajaya, adherence rate, warfarin, anticoagulation \nNMRR ID: NMRR-17-2915-38441 \n \n \nOP-78 (Oral) \nA REVIEW OF LONG-TERM ORAL PROTON PUMP INHIBITOR (PPI) USE IN A TERTIARY HOSPITAL \n \nOng GT1, Saik HL 1, Kanakarathnam S1, Abd Razak AA1, Ching MW1, Lee AL1, Nik@Besar NH1 \n\n\n\n \n1Hospital Putrajaya, Ministry of Health Malaysia \n \nINTRODUCTION: Long-term use of proton-pump inhibitors (PPIs) could lead to unwanted adverse effects, namely \nhypomagnesemia, increase risk of myocardial infarction, osteoporosis/bone fracture and worsening of renal function \nOBJECTIVES:  \nThis study aimed to evaluate the long-term use of oral PPIs, to identify the appropriateness of monitoring parameters and long-\nterm adverse complications in patients treated with PPIs in Hospital Putrajaya. \nMETHOD: This was a retrospective cohort study enrolled patients aged 18 years and above, who were prescribed with oral \nPPIs in Hospital Putrajaya for more than 6 months, in year 2016. Patients who had PPI initiated from other healthcare facilities \nwere excluded. \nRESULTS: A total of321 patients were recruited, mean duration of PPIs prescribed was 31.1 \u00b1 29.9 months. General Medicine \ndiscipline prescribed the most PPIs (51.4%), followed by Surgical (32.1%) and Rheumatology (7.2%). The indication of long-\nterm use of oral PPI as decided in the Drug Therapeutic Committee (DTC) was for gastroesophageal reflux disease (GERD), \nendoscopic-proven ulcer and prophylaxis for dual anti-platelet therapy. It was found that 67% of the long-term PPIs uses were \nnot prescribed according to the DTC decision. Monitoring on long-term adverse effects was found to be lacking. Only 86% of \nlong-term patients had renal profile, 26% calcium level, 19% magnesium level and 3% bone mineral density (BMD) done \nperiodically. Chronic kidney disease (CKD) or worsening CKD was observed in 2.1% patients (n=6/277), 22.2% (n=2/9) had \nosteoporosis/fracture and 1.6% (n=1/61) patients developed hypomagnesemia after long-term use. \nCONCLUSION: Majority of the prescriptions for PPIs were not indicated for long-term use as per local clinical pathway. \nMonitoring parameters such as BMD, calcium, magnesium level, renal profile and electrocardiogram should be performed \nperiodically when long-term PPIs therapy is indicated. \n \nKEYWORDS: quality use of medicines, Putrajaya, proton pump inhibitor, prescribing practice, complication. \nNMRR ID: NMRR-16-2635-32227 \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nOP-79 (Oral) \nKNOWLEDGE REGARDING SERIOUS SIDE EFFECTS OF CLOZAPINE AMONG REGISTERED NURSES AND \nASSISTANT MEDICAL OFFICERS IN HOSPITAL PERMAI JOHOR BAHRU \n \nLiew YH1, They CH1, Noor Ratna N1, Vikneswari S1 \n\n\n\n \n1Department of Pharmacy, Hospital Permai, Ministry of Health Malaysia \n \nINTRODUCTION: Clozapine is a second-generation antipsychotic that is used in patients with treatment-resistant \nschizophrenia and uncontrolled suicide thoughts. Despite its superior efficacy over other antipsychotics, its use has been \nlimited due to some of its potentially life-threatening side effects. Medical staffs such as nurses and assistant medical officers \n(AMOs) play an important role in the long-term management of psychotic patients.  \nOBJECTIVES: To assess the knowledge of psychiatric nurses and AMOs regarding the serious side effects of clozapine  \nMETHOD: Cross-sectional study using a validated questionnaire developed based on 3 experts\u2019 opinion. Participants were \nselected using systematic random sampling.  \nRESULTS: A total of 103 nurses and 37 AMOs completed the questionnaire with mean total scores of 8.4 and 6.6, out of a \npotential maximum score of 18, for nurses and AMOs respectively. Generally, nurses performed better than AMOs, with \n47.6% of nurse and 10.8% of AMOs passing the questionnaire (\u226550% correct answers). Based on multiple regression analysis, \npersonnel who claimed to have received adequate information during training were more likely to score badly in the test \n(p=0.008). There was a trend that personnel who has higher education level was more likely to pass the test (p=0.103).  \nCONCLUSION: There is a large gap in the basic knowledge among psychiatric nurses and AMOs about clozapine and its \nside effects, where it is more significant among the AMOs. Nurses and AMOs who had no knowledge in clozapine should \nreceive adequate training before handling patient who receiving clozapine. Periodic assessment such as using tests or \nquestionnaires could help to identify personnel who required training on handling patient who receiving clozapine. \n \nKEYWORDS: quality use of medicines, Johor Bahru, antipsychotic, knowledge, side effects \nNMRR ID: NMRR-17-952-35066 \n \n \nOP-80 (Oral) \nSTUDY ON PUBLIC KNOWLEDGE AND ATTITUDE TOWARDS ANTIBIOTIC USE AMONG COMMUNITY \nAT BACHOK DISTRICT \n \nNik Suraima NM1, Nur Nadia Suraya S2, Khadijah WH3, Tengku Zharif TZ4, Nik Mohd Hafiz MF5, Zawiyah D5 \n\n\n\n \n1Klinik Kesihatan Balai, Ministry of Health Malaysia,2Klinik Kesihatan Gunong, Ministry of Health Malaysia, 3Klinik \nKesihatan Bachok, Ministry of Health Malaysia, 4Klinik Kesihatan Mahligai, Ministry of Health Malaysia,5Bachok District \nHealth Office, Ministry of Health Malaysia \n \nINTRODUCTION: Antibiotic compliance is a major concern in ensuring optimal pharmacotherapy as poor compliance will \nlead to antimicrobial resistance. Limited information regarding public knowledge and attitudes towards antibiotic particularly \nat Bachok district, Kelantan. \nOBJECTIVES: This study aims to assess the level of knowledge, attitudes and its associated factors among community in \nBachok, Kelantan. \nMETHOD: A cross sectional prospective study using a validated questionnaire was conducted from June 2016 until July \n2017, in four randomly chosen health care clinics under Bachok District Health Office. Data were entered and analysed using \nIBM Statistical Program for Social Sciences (SPSS) version 22. The descriptive METHOD and multiple logistic regressions \nwere applied to answer the objectives of the study.  \nRESULTS: A total of 360 respondents was involved, with prevalence of good knowledge was 22.8% (95% confidence \nintervals [CI]: 18.75, 27.39) and good attitude was 57.5% (95% CI: 52.34, 62.50). Multiple logistic regressions showed that \noccupation related to health sector (adjusted odds ratio [OR]: 4.96; 95% CI: 2.51, 9.78; p<0.001) and good attitude (adjusted \nOR: 20.97; 95% CI: 7.37, 59.66; p<0.001) were significantly associated with good knowledge. While age (adjusted OR: 4.84; \n95% CI: 2.42, 9.71; p<0.001) and good knowledge (adjusted OR: 22.51; 95% CI: 7.90, 64.15; p<0.001) were significantly \nassociated with good attitude.  \nCONCLUSION: Poor knowledge and attitude towards antibiotic use show that awareness were still low among community \nin Bachok. It was also noted that both good knowledge and good attitude were related to each other. Increasing awareness \ntowards the importance and compliance of antibiotic use is vital in order to prevent antibiotic resistance and also financial \nwastage.  \n \nKEYWORDS: impact of pharmacy services, Kelantan, knowledge, attitude, antibiotic use \nNMRR ID: NMRR-17-2829-35614 \n  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nOP-81 (Oral) \nA PROSPECTIVE STUDY ON THE USAGE OF INTRAVENOUS VANCOMYCIN IN ADULT PATIENTS AT \nSELAYANG HOSPITAL \n \nTaye ZY1, Ignatius Leon1, Sarnilla K1, Soo BH 1, Yau PW1, Anuradha PR2 \n\n\n\n \n1Department of Pharmacy, Hospital Selayang Ministry of Health Malaysia,2Department of Medical (Infectious Disease), \nHospital Selayang Ministry of Health Malaysia \n \nINTRODUCTION: Increased in resistant of gram-positive bacteria has caused a surge in the usage of vancomycin which \nleads to substantial misuse of empirical vancomycin treatment, which eventually caused the emergence of vancomycin-\nresistant Enterococcus sp (VRE) especially in Asian countries. This antibiotic resistance leads to consequences such as urgent \nneed of new antibiotic development, prolonged hospitalization and higher cost of treatment. \nOBJECTIVES: This study aimed to evaluate the appropriateness of vancomycin usage based on Centers for Disease Control \nand Prevention (CDC) criteria at 0-hour and 72-hour, and the risk factors associated with vancomycin misuse.  \nMETHOD: This is a prospective study performed on adult patients who were started with intravenous vancomycin at Selayang \nHospitalfrom April 2017 to September 2017. Data were prospectively obtained via drug utilization record and patients\u2019 data \nwere acquired using electronic medical record. All patients were followed up until death or hospital discharge.  \nRESULTS: At 0-hour, majority of the vancomycin cases started empirically were inappropriate. From all the empirical cases, \nonly 10 cases of vancomycin were de-escalated according to the final culture. The study also found out that 31 cases of \nvancomycin therapy were continued empirically after 72 hours; in Nephrology (n=17), Anesthesiology (n=7), Medical (n=4), \nSurgical (n=1), Orthopedic (n=1), and Hepatology (n=1) disciplines, even without substantial evidence from final \nmicrobiological results. Out of 126 cases, only 35 cultures isolated showed sensitivity to vancomycin. Inappropriate usage of \nvancomycin was associated with patient\u2019s age <60 years old, presence of mechanical ventilation and presence of central venous \ncatheter.  \nCONCLUSION: In conclusion, there is a need of hospital policy in guiding vancomycin initiation especially in patient\u2019s age \n<60 years old, with the presence of central venous catheter and mechanical ventilation, in order to reduce the misuse of \nvancomycin.  \n \nKEYWORDS: quality use of medicines, Selangor, vancomycin, appropriateness, risk factors \nNMRR ID: NMRR-17-1600-34959 \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nLIST OF POSTER PRESENTATIONS \n \nNo Presenting Author Title \n\n\n\nPP-01 Ting Chuo Yew Awareness On Know Your Medicine Campaign And The \nAppropriate Use Of Medicines Among Sarawak Consumers \n\n\n\nPP-02 Ting Chuo Yew Knowledge And Practice Of Beauty Salon Personnel \nTowards Regulations Of Cosmetics: Preliminary Findings \nFrom The State Of Sarawak, Malaysia \n\n\n\nPP-03 Khairulanwar Bin Burhanuddin Predicting Oral Drug Absorption In The Older Population: \nAn In-Vitro-In-Vivo Correlation (IVIVC) Approach \n\n\n\nPP-04 Lau Boon Tiang Prevalence Of Potentially Inappropriate Medication (PIM) \nAmong Elderly Patients In A District Hospital: A Cross-\nSectional Study \n\n\n\nPP-05 Tan Guo Hong Antibiotic Prescribing Practice For Paediatric Outpatients \nAcross Non-Specialised Regional Hospitals In Kedah State, \nMalaysia \n\n\n\nPP-06 Wan Nurul Huda Binti W. Hasan Topical Treatment Adherence Amongpsoriatic Patients: A \nSingle Center Study \n\n\n\nPP-07 Rosdi Md Zin Incidence Of Error Before Dispensing At Outpatient \nPharmacy, Hospital Melaka \n\n\n\nPP-08 Hamiza Aziz Qualitative Exploration Of Factors For Medication \nAdherence Among Subsidized And Self-Paying Patients In \nMalaysia \n\n\n\nPP-10 Nur Hazalina Md Salleh Trends And Patterns Of Strong Opioid Prescribing In Cancer \nPain \n\n\n\nPP-11 Syazzana Bt Dzulkifli Retrospective Audit On Carbapenem And Cephalosporin \nAntibiotics Usage In Hospital Rehabilitasi Cheras \n\n\n\nPP-12 Mohamad Syafuan Bin Fadzil The Use Of Complementary And Alternative Medicines \nAmong Type 2 Diabetes Mellitus Patients In Hospital \nTuanku Fauziah \n\n\n\nPP-13 Mohammad Rizalmazli Bin \nSalim \n\n\n\nQuantitative Analysis Of Illegal Sex Stimulant Products \nContaining Sildenafil Distributed In Klang Valley Using \nUltra-High-Performance Liquid Chromatography (UHPLC) \n\n\n\nPP-14 Ganesh Sritheran Paneerselvam Health Related Quality Of Life Among Patients With Skin \nDisorders \n\n\n\nPP-15 Nur Amalina Binti Dellemin Development And Validation Of A Questionnaire On \nKnowledge, Attitude And Perception Towards Allergic \nReactions Of Paracetamol \n\n\n\nPP-16 Aiza Adlina Abdullah Predicting Pharmacokinetics Of Biomolecules (Monoclonal \nAntibodies) \n\n\n\nPP-17 Aslina Binti Ashaari Efficacy And Safety Of Warfarin In Geriatric Patient With \nNonvalvular Atrial Fibrillation In Hospital Tuanku Ja\u2019Afar \nSeremban \n\n\n\nPP-18 Tang Kah Wong Study Of The Efficacy Of Local Application Of Gentamicin \nIn The Prevention Of Catheter-Related Infections Among \nHaemodialysis Patients \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nPP-19 Teo Kui Yuan Knowledge, Attitude, And Practice (KAP) Of Nurses In The \nPreparation And Administration Of Intravenous (IV) \nMedications: Linguistic Validation Of Questionnaire In \nMalay Version \n\n\n\nPP-20 Siti Nuraidah Binti Mamat Evaluation On Effectiveness Of Clinical Pharmacist-Led \nEducational Program In Intensive Care Nurses\u2019 Knowledge \nAnd Practices Regarding Medication Administration \nThrough Enteral Tubes \n\n\n\nPP-21 Tew Mei Mei Pharmacist-Managed Diabetes Clinic In Malaysia - Does \nThe Number Of Follow-Up Visits Really Matter? \n\n\n\nPP-22 Mohd Farizh B Che Pa Comparing The Clinical Effectiveness Of Levothyroxine \nIntake Before Breakfast Versus At Bedtime In Patient With \nHypothyroidism \n\n\n\nPP-23 Aishah Binti Mohd Shah Study Of Workload Among Clinical Pharmacists In The \nMedical Wards In The Form Of Standard Minimum \nRequirement In Hospital Tuanku Ja\u2019Afar Seremban \n\n\n\nPP-24 Ang Ju Ying Inadequate Self-Care Behaviors Among Malaysian Diabetic \nPatients: The Need For Action By Hospital Pharmacists \n\n\n\nPP-25 Ignatius Leon Using Local Microbiological Data To Determine \nSusceptibility Pattern For Treatment Of Hospital-Acquired \nPneumonia \n\n\n\nPP-26 Lee Chee Ming Pattern Of Acute Poisoning And The Antidote Usage; A \nRetrospective Study At Emergency Department Hospital \nSelayang In 2015 \n\n\n\nPP-27 Poh Wen Tsin Implementation Of Crispr-Cas9 System To Modify Genes In \nYeast \n\n\n\nPP-29 Norazila Abdul Ghani Returned Medication In Outpatient Pharmacy Of Hospital \nSultanah Bahiyah \n\n\n\nPP-30 Mumtaz Binti Mohamad \nGhausillah \n\n\n\nPublic Knowlegde And Attitudes Towards Antibiotics Usage \nIn Perlis: A Cross Sectional Study \n\n\n\nPP-31 Sharini Sha\u2019Ari Assessment Of Vancomycin Initial Dosing And Subsequent \nTrough Concentration In Paediatric Patients In Hospital \nTuanku Ja\u2019Afar Seremban \n\n\n\nPP-32 Nor Adilah Binti Nooree Predicting Pharmacokinetics Of Drugs In Pregnant And \nNon-Pregnant Women \n\n\n\nPP-33 Hoo Yee Yin Prior Antiplatelet Use And Clinical Outcomes In Those \nUndergoing Percutaneous Coronary Intervention \n\n\n\nPP-34 Lim Ern Sze The Impacts Of Pictorial And Conventional Labelled Topical \nMedication On The Patient\u2019S Understanding \n\n\n\nPP-35 Nurhanna Syahida Binti Shukran A Qualitative Study In Tablet Splitting: Exploring Patient \nExperiences At Hospital Tuanku Fauziah (HTF) \n\n\n\nPP-36 Nur Mardhiya Binti Darnalis Evaluation Of Initial Vancomycin Weight-Based Loading \nDose In End Stage Renal Failure Patients \n\n\n\nPP-37 Jasmin Mohamed Ariff Supply, Demand And Need Of Pharmacist In Malaysia; \nProjections Until 2030 \n\n\n\nPP-38 Norazila Abdul Ghani Risk Factors In Type 2 Diabetes Mellitus (T2Dm) Among \nAdolescents In The State Of Kedah, Malaysia: A Cross-\nSectional Pilot Study \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nPP-39 Ruzmayuddin Bin Mamat Reasons For Amphetamine-Type-Stimulant (Ats) Use \nAmong Clients In Government And Private Methadone \nMaintenance Treatment (Mmt) Programs In The District Of \nKuantan, Pahang \n\n\n\nPP-40 Nuwairoh Bt Mohamed Nasir Assessment Of Public Knowledge And Perception Towards \nChildhood Vaccination In Perlis, Malaysia \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nPP-01 (Poster) \nAWARENESS ON KNOW YOUR MEDICINE CAMPAIGN AND THE APPROPRIATE USE OF MEDICINES \nAMONG SARAWAK CONSUMERS \n \nTing CY1,2, Ang WC3, Ahmad K4, Abd Jabar AHA5 \n\n\n\n \n1Pharmacy Enforcement Division, Kuching, Sarawak, Ministry of Health Malaysia,2Institute of Borneo Studies, Universiti \nMalaysia Sarawak, Kota Samarahan, Sarawak, 3Clinical Research Centre, Hospital Tuanku Fauziah, Ministry of Health \nMalaysia, 4Department of Pharmacy, Hospital Miri, Ministry of Health Malaysia,5Pharmaceutical Services Division, Kuching, \nSarawak, Ministry of Health Malaysia \n \nINTRODUCTION: Inappropriate use of medicine is a serious public health issue. Malaysia has launched Know Your \nMedicine (KYM) campaign in 2007 to promote appropriate use of medicines (AUOM). However, little studies are done to \nevaluate the extent of awareness level towards the KYM campaign and AUOM among Sarawak population. \nOBJECTIVES: To explore the awareness level of consumers on the KYM campaign and on AUOM in the state of Sarawak, \nMalaysia. \nMETHOD: A cross-sectional survey was conducted from 1st June to 31st August 2015 using a structured self-administered \nquestionnaire adapted from the National Survey on the Use of Medicines III. Multi-stage sampling was employed in which \nstratified sampling was done to confine similar sample size between urban and rural areas. Pearson\u2019s chi-square test was \nconducted to detect statistical significance between urban and rural respondents with SPSS v21.0. \nRESULTS: A total of 267 respondents, with 49.1% and 50.9% from urban and rural population respectively. Only 32.8% and \n19.9% of respondents from urban and rural respectively had attended the KYM activities (p<0.05). From the awareness of the \nAUOM, urban respondents had a significant higher proportion of recognising generic and brand name of medicine (73.3% vs \n39.7%, p<0.001). However, both groups reported poor awareness on proper disposal of medicines (<25%) and availability of \nMeditagTM hologram stickers as anti-counterfeiting measure (<50%). \nCONCLUSION: The results of this study provide insights on the extent knowledge gap of KYM Campaign and AUOM \namong Sarawak population. Efforts to increase such awareness need to be perpetuated and be periodically evaluated. \n \nKEYWORDS: quality use of medicines, Sarawak, awareness, Know Your Medicine Campaign, appropriate use of medicines \nNMRR ID: NMRR-16-2304-33382 \n \n \nPP-02 (Poster) \nKNOWLEDGE AND PRACTICE OF BEAUTY SALON PERSONNEL TOWARDS REGULATIONS OF \nCOSMETICS: PRELIMINARY FINDINGS FROM THE STATE OF SARAWAK, MALAYSIA \n \nTing CY1, Loo SC1, Tee EC2, Ang WC3, Ting H4, Abd Jabar AHA5, Talin BA1 \n\n\n\n \n1Pharmacy Enforcement Division, Kuching, Sarawak, Ministry of Health Malaysia,2Pharmacy Enforcement Division, Johor, \nMinistry of Health Malaysia,3Clinical Research Centre, Hospital Tuanku Fauziah, Ministry of Health Malaysia,4Sarawak \nResearch Society, Kuching, Sarawak, 5Pharmaceutical Services Division, Kuching, Sarawak, Ministry of Health Malaysia \n \nINTRODUCTION: Malaysia regulates all cosmetics in the market to ensure its safety and quality through enforcing \nnotification of cosmetics under Control of Drugs and Cosmetics Regulations 1984.  \nOBJECTIVES: This study investigated the knowledge and practice of beauty salon personnel (BSP) towards the regulation \nof cosmetics. \nMETHOD: A cross-sectional survey was conducted in four major cities of Sarawak from 13th to 31th March 2016. Sampling \nframe through the search of website using key terms was obtained and only those with clear location address stated were \nselected. Universal sampling was employed to select all 86 beauty salons throughout the four cities. A structured questionnaire \nwas developed and pre-tested to measure the knowledge and practice of BSP towards the regulations of cosmetics. \nRESULTS: Due to the sensitivity of the study topic, only 31 of the BSP (36.0%) provide written consent to participate. \nNotwithstanding 71% of BSP were aware that every cosmetic in Malaysia needs to have notification number issued by Ministry \nof Health, only 19.4% of them were aware of how the cosmetic notification number looks like, and almost all of them (96.8%) \ndid not know how to apply for it. Moreover, only 38.7% of them would verify notification status of cosmetics before selling. \nFurthermore, a mere 6.5% of the BSP would apply for the notification number when they imported cosmetics. \nCONCLUSION: The findings alert the relevant authorities about the extant knowledge and practical level of BSP on \nregulations of cosmetics. It highlights the need for more comprehensive studies with remedial interventions in the future to \nimprove the current situation. \n \nKEYWORDS: quality use of medicines, Sarawak, cosmetic regulation, knowledge, practice \nNMRR ID: NMRR-16-2221-33483  \n  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nPP-03 (Poster) \nPREDICTING ORAL DRUG ABSORPTION IN THE OLDER POPULATION: AN IN-VITRO-IN-VIVO \nCORRELATION APPROACH \n \nBurhanuddin K1, Badhan RKS1 \n\n\n\n \n1Pharmacy Department, School of Life and Health Sciences, Aston University, Aston Triangle, Birmingham, B4 7ET, United \nKingdom \n \nINTRODUCTION: The world population is undergoing an ageing phenomenon, with population aged > 65 years projected \nto be >2 billion (2050). On average, this population takes >5 medications daily (mostly oral) for multiple comorbidities. Thus, \nthere is a need to investigate oral absorption in this population. \nOBJECTIVE: To investigate oral absorption in the elderly population using in-vitro dissolution tests in suitable media, \nintegrated with the physiologically based pharmacokinetic (PBPK) model. \nMETHOD: The oral absorption of the geriatric population was simulated using the SimCYP software. Steps involved: (1) \nestablishment of in-vitro-in-vivo correlation (IVIVC) models with paracetamol, warfarin and isoniazid for internal validation, \nand modified-release metoprolol for external validation, (2) development of paracetamol and isoniazid geriatric IVIVC \nmodels; and (3) prediction of geriatric plasma concentration using dissolution profiles in the developed model for comparison \nacross different age groups and gastrointestinal pH conditions.  \nRESULTS: Geriatric IVIVC models for paracetamol and isoniazid were developed and validated internally and externally. \nFor paracetamol, correlation between in-vivo deconvoluted dissolution from geriatric plasma concentration profile and in-vitro \ndissolution performed with phosphate buffer, demonstrate point-to-point correlation with prediction error (PE) of -2.75 for \narea under the curve (AUC) and 7.68 for maximum plasma-concentration (Cmax). The isoniazid geriatric IVIVC demonstrate \nthe best correlation in hydrochloric acid, with PE=0.05 for AUC and -7.25 for Cmax. For both paracetamol and isoniazid, \ncomparison of predicted geriatric pharmacokinetics parameters showed significant differences (p<0.05) in AUC, Cmax, \nelimination rate constant (Kel), volume of distribution (Vd) and clearance (CL) between adult and different geriatric age groups \nbut did not show any difference between stomach and duodenum pH in 85-98 years age population.  \nCONCLUSION: The results show that the pharmacokinetic changes in the elderly population are more pronounced in the \ndistribution, metabolism and elimination than the absorption phase, specifically for paracetamol and isoniazid compounds.  \n \nKEYWORDS: research tools, Birmingham, geriatric, physiologically based pharmacokinetic model, oral, absorption \nNMRR ID: NMRR-18-507-40904 \n \n \nPP-04 (Poster) \nPREVALENCE OF POTENTIALLY INAPPROPRIATE MEDICATION AMONG ELDERLY PATIENTS IN A \nDISTRICT HOSPITAL: A CROSS-SECTIONAL STUDY \n \nMuhammad-Azmin KA1, Lau BT1 \n\n\n\n \n1Department of Pharmacy, Hospital Port Dickson, Ministry of Health Malaysia \n \nINTRODUCTION: Medication-related problems are common and often preventable among elderly patients. \nOBJECTIVES: This study aimed to investigate the prevalence of potentially inappropriate medication (PIM) prescribed for \nelderly patients and the factors associated with PIM. \nMETHOD: This was a cross- sectional study conducted in a district-level hospital of Malaysia. The admission medication \nhistories of patients aged 60 years old and older were assessed by clinical pharmacists between June and December 2015. The \npresence of PIM was screened using American Geriatrics Society 2015 updated Beers criteria and additional clinical histories \nwere retrieved via electronic medical record. \nRESULTS: Of 218 medication histories obtained, 61.9% of elderly patients were found being prescribed with at least one \nPIM. The top three PIM to avoid were proton-pump inhibitor (13.8%), prazosin (9.2%) and metformin/glibenclamide (7.8%). \nOn the other hand, the most common PIM to be used with caution in older adults detected was diuretic (loop diuretic 14.7%, \nthiazides 13.8%, potassium\u2013sparing diuretic 6.4%). Factors associated with PIM were older age (p=0.031), presence of more \nco-morbidities (p<0.001), and higher number of medications (p=0.010). Of all co-morbidities, ischemic heart disease and heart \nfailure were found to be associated with PIM (p=0.008 and p=0.011, respectively). \nCONCLUSION: The prevalence of PIM detected in this district-level hospital was high. Efforts should be taken to reduce \nthe number of PIM prescribed for older adults in the future. \n \nKEYWORDS: quality use of medicines, Negeri Sembilan, elderly, potentially inappropriate medication, risk factors \nNMRR ID: NMRR-16-2689-31499 \n  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nPP-05 (Poster) \nANTIBIOTIC PRESCRIBING PRACTICE FOR PAEDIATRIC OUTPATIENTS ACROSS NON-SPECIALISED \nREGIONAL HOSPITALS IN KEDAH STATE, MALAYSIA \n \nTan GH1, Chan HK2, Linda MJ3, Muhamad Hazwan H3, Yap YT4, Oi AC4, Khoo YH5 \n\n\n\n \n1Department of Pharmacy, Hospital Sik, Ministry of Health Malaysia,2Clinical Research Centre, Sultanah Bahiyah Hospital, \nMinistry of Health Malaysia, 3Department of Pharmacy, Hospital Yan, Ministry of Health Malaysia,4Department of Pharmacy, \nHospital Baling, Ministry of Health Malaysia,5Department of Pharmacy, Hospital Kuala Nerang, Ministry of Health Malaysia \n \nINTRODUCTION: Inappropriate and excessive use of antibiotics is common in both adults and children worldwide. In \nresponse to the increasingly severe antimicrobial resistance, the National Antibiotic Guidelines (NAG) was revised by the \nMinistry of Health, Malaysia, in 2014, and was since then used as the main reference to guide antibiotic prescribing practices \nin public healthcare facilities. \nOBJECTIVES: To explore the patterns of antibiotic utilisation in paediatric patients at the outpatient department, and to \nassess the adherence level of antibiotic prescribing to NAG. \nMETHOD: A cross-sectional study was undertaken at four non-specialised regional hospitals in Kedah State, Malaysia. All \nprescriptions with at least one oral antibiotic, prescribed for outpatients below 13 years of age, between 1st January and 31st \nMarch 2017, were reviewed. Information which includes patient\u2019s age, weight, diagnosis, and type and dosage of antibiotics \nprescribed were recorded. Prescribed antibiotic regimens were then compared to NAG recommendations. \nRESULTS: Of 3,359 paediatric prescriptions reviewed, 1,194 (35.5%) contained at least one oral antibiotic. The patients were \nmostly male (53.1%), with a mean age of 5.52\u00b13.44 years. Antibiotics were most commonly prescribed for \notorhinolaryngology infections (73.6%), followed by skin and soft tissue infections (13.1%), and lower respiratory tract \ninfections (4.6%). The most frequently prescribed antibiotics were amoxicillin (34.9%), phenoxymethylpenicillin (25.6%), \nand cloxacillin (15.3%). Non-adherence to the NAG\u2019s recommendations was found in 71.8% (653) of the prescriptions, \nparticularly in the drug selection (35.8%) and the dosage used (64.1%). \nCONCLUSION: Vast majority of the antibiotics prescribed were not in line with the NAG recommendations, suggesting of \npotential inappropriate antibiotic use. This warrants a well-planned approach to improve the paediatric antibiotic prescribing \npractice among the non-specialised hospitals in Kedah State, Malaysia. \n \nKEYWORDS: pharmacoepidemiology, Kedah, antibiotic prescribing, outpatient paediatric, adherence \nNMRR ID: NMRR-17-910-35784 \n \n \nPP-06 (Poster) \nTOPICAL TREATMENT ADHERENCE AMONG PSORIATIC PATIENTS: A SINGLE CENTER STUDY \n \nWan Nurul Huda WH1, Nur Hazirah A1, Khor SH1, Wong PY1, Nursuaidah R1 \n\n\n\n \n1Department of Pharmacy, Hospital Serdang, Ministry of Health Malaysia \n \nINTRODUCTION: There have been few studies of treatment adherence towards topical products in Asian, specifically in \nMalaysian population with psoriasis. Understanding towards medication adherence is important to have better treatment \noutcomes. \nOBJECTIVE: This study aimed to determine patient\u2019s knowledge on disease and topical treatment; and factors associated \nwith adherence toward topical treatment among psoriatic patients in Dermatology Clinic, Hospital Serdang. \nMETHOD: A cross-sectional study was conducted from April to October 2017 among psoriatic patients in Hospital Serdang \nusing a validated 35-structured questionnaire. The questionnaire assessed patient\u2019s knowledge on disease, adherence and \nsatisfaction towards topical treatment of psoriasis. Adult patients ageing from 18 years old, diagnosed with psoriasis and \ncurrently receiving psoriatic topical treatment in Hospital Serdang were recruited. The association between adherence and \nsatisfaction, knowledge on disease and on topical treatment were examined using Pearson's chi-squared test. \nRESULTS: A total of 132 patients participated in this study. Out of these patients, 36 (27.5%) complied with treatment, 61 \n(46.6%) moderately adhere and 34 (26.0%) did not adhere to topical treatment. The three major reasons for non-adherence \nwere the topical treatment that are oily to use (49.5%), inconvenient to use (40%) and patients have no time to use(26%). There \nwas no association observed between adherence and patient\u2019s satisfaction (p=0.057). Similarly, there was no association \nobserved between patient\u2019s knowledge and adherence on topical treatment (p=0.484). \nCONCLUSION: This study findings suggest that majority of psoriatic patients moderately adhered towards topical treatment. \nTherefore, a simplified and individualized topical regimen should be taken into account. \n \nKEYWORDS: quality use of medicines, Selangor, topical treatment, adherence, psoriatic patients \nNMRR ID: NMRR-17-2755-38853 \n  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nPP-07 (Poster) \nINCIDENCE OF ERROR BEFORE DISPENSING AT OUTPATIENT PHARMACY, HOSPITAL MELAKA \n \nTay SF1, Amirtha R2, Roshwini EM1, Siti Fatimah AK2, Md Zin R2 \n\n\n\n \n1Outpatient Pharmacy Satelite, Department of Pharmacy, Hospital Melaka, Ministry of Health Malaysia,2Outpatient Specialist \nPharmacy, Department of Pharmacy, Hospital Melaka, Ministry of Health Malaysia  \n \nINTRODUCTION: Dispensing error may result in significant effect to patient. Study in error before dispensing, types of \nerror and factors associated may help in minimizing errors in the future.  \nOBJECTIVES: To study the incidence of errors before dispensing, types of error and factors associated with error at \nOutpatient Pharmacy of Hospital Melaka.  \nMETHOD: A cross sectional study focusing on number and types of detected errors before dispensing medication and \ncontributing factors during office hours. Data was recorded in a designated form provided at Outpatient Pharmacy. Results \nwere analyzed using descriptive statistics via SPSS programme analysis.  \nRESULTS: Out of 19,820 prescriptions filled, 219 prescriptions (1.1%) had error before dispensing that were detected and \nrecorded. Incorrect quantity of medication supplied was the most popular type of error, with 24.54% recorded, whilst expired \nmedication and labelling error with wrong patient information was cited as the least popular, with 0% occurrence. Key \nperformance indicator (KPI) of waiting time was the highest contributing factor for errors at 24.66% whilst feeling unwell, \nunclear TCA and inexperience, which made up \u201cother\u201d factors, were cited as the least popular at 3.65%. Another contributing \nfactor was prescriptions with nine or more items which made up of 52.6% of errors as opposed to those with less than nine \nitems.  \nCONCLUSION: Study found that the incidence of error before dispensing was 1.1%, with incorrect quantity, missing out \ndrugs and wrong medication supplied were the most popular types of error. KPI of waiting time and being understaffed were \nthe biggest contributing factors to errors before dispensing. The need for more thorough counter checking before medications \nare dispensed is important to reduce errors.  \n \nKEYWORDS: impact of pharmacy services, Malacca, outpatient pharmacy, dispensing errors, factors \nNMRR ID: NMRR-16-2579-33106 \n \n \nPP-08 (Poster) \nQUALITATIVE EXPLORATION OF FACTORS FOR MEDICATION ADHERENCE AMONG SUBSIDIZED AND \nSELF-PAYING PATIENTS IN MALAYSIA \n \nHamiza A1, Ernieda H2, Mohd MB2 \n\n\n\n \n1Pharmacy Department, Hospital Putrajaya, Ministry of Health Malaysia 2Faculty of Pharmacy, Universiti Kebangsaan \nMalaysia \n \nINTRODUCTION: Numerous studies have evaluated factors for medication adherent among patients with chronic diseases. \nHowever, the factors influencing medication adherence among subsidized patients with chronic diseases, for whom medication \ncosts may not be a constraint, remain unexplored.  \nOBJECTIVES: To explore potential factors that may influence subsidized and non-subsidized (self-paying) patients\u2019 \nadherence to medication. \nMETHOD: Subsidized and self-paying patients were identified at public and private healthcare institutions in three states of \nMalaysia. Patients were then purposively selected for semi-structured, face-to-face interviews according to their medication \nadherence status (including adherent and non-adherent patients), which was measured using the Medication Event Monitoring \nSystem (MEMS). Adherence was defined if patients had 80% and more of the percentage of days in which dose regimen was \nexecuted as prescribed. During the interviews, patients were asked to provide reasons for their medication adherence or non-\nadherence as well as their predicted medication-taking behavior if they were required to pay for the National Health Insurance \nScheme. The patient interviews were audio recorded and transcribed verbatim. Data were analyzed using thematic analysis \nwith NVivo 11 software \nRESULTS: Thirteen subsidized and 12 self-paying patients were interviewed. The themes found in both groups were similar. \nThe factors that influenced adherence to medication include the \u201cperceived importance of quality of life\u201d and \u201cperceived \nbenefitorvalue of the medications.\u201d A unique factor reported by patients in this study included \u201cperceived value of the money \nspent on medications\u201d; more specifically, patients adhered to their medications because they valued the money spent to \nbuy/receive the medications. Patients perceived that paying for the proposed national health insurance scheme might have led \nto medication non-adherence. \nCONCLUSION: Medication adherence among subsidized and self-paying patients was influenced by many factors. A unique \nfactor for medication adherence among these patients includes perceptions of the value of money spent on medications. \n \nKEYWORDS: quality use of medicines, Putrajaya, medication adherence, subsidized medication, self-paying,  \nNMRR ID: NMRR-14-1255-2247 \n  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nPP-10 (Poster) \nTRENDS AND PATTERNS OF STRONG OPIOID PRESCRIBING IN CANCER PAIN \n \nNurhazalina MS1, Thai RW1, Farah AT1, Izzureen S1 \n\n\n\n \n1Department of Pharmacy, Hospital Sultan Ismail, Ministry of Health Malaysia \n \nINTRODUCTION: Drug therapy with opioid is the mainstay of cancer pain management, where strong opioid being the first-\nline treatment for moderate to severe pain. In local setting, the utilisation of weak opioid are common compared to strong \nopioid. Limited data is available describing in details on opioid prescribing pattern, especially in cancer pain management, in \nlocal setting. \nOBJECTIVES: To describe the trends of the commonly prescribed strong opioids for cancer pain in an outpatient care setting. \nMETHOD: This is a cross sectional study, conducted in Out-patient Pharmacy, Hospital Sultan Ismail Johor Bahru. \nPrescriptions of morphine, oxycodone, and fentanyl issued for the period of 2008 to 2015 were reviewed. Annual number of \nprescriptions and patients, oral morphine equivalent (OMEQ) dose and defined daily dose (DDD) / 1000 patients per day were \nmeasured in repeated cross-sectional estimates. \nRESULTS: A total of 3,618 prescriptions of the three strong opioid analgesics were prescribed in 1,557 patients, consisting \nof 57.5% female patients with mean age of 55.68\u00b113.11 years, during the 8-year study period. Morphine was the most \nfrequently prescribed opioid in cancer pain (69.8%), followed by oxycodone (25.7%) and fentanyl (4.4%). The greatest \nincreased in annual number of prescriptions was observed for oxycodone (10,880%). Early in 2008, morphine was the \ndominating opioids and over the eight years its usage has been declined to two-folds from 0.13 to 0.07 of DDD / 1000 patients \nper day. In contrast, oxycodone prescribing rose tremendously from 0.01 in 2010 to 0.20 of DDD / 1000 patients per day in \n2015. \nCONCLUSION: There has been a huge increase in strong opioid prescribing and changes in pattern of opioid prescribing in \ncancer pain management over the study period. Morphine was the most frequently prescribed, but the utilization of oxycodone \nincreased markedly over time. \n \nKEYWORDS: pharmacoepidemiology & drug safety, Johor, prescribing pattern, strong opioid, cancer pain \nNMRR ID: NMRR-16-1907-31595 \n \n \nPP-11 (Poster) \nRETROSPECTIVE AUDIT ON CARBAPENEM AND CEPHALOSPORIN ANTIBIOTICS USAGE IN HOSPITAL \nREHABILITASI CHERAS \n \nDzulkifli S1, Tajuddin NH1, Wong ST1, Jaganathan D1, Muhamad Yunus Y1 \n\n\n\n \n1Hospital Rehabilitasi Cheras, Ministry of Health Malaysia \n \nINTRODUCTION: Antibiotic resistance is a critical problem faced worldwide. In view of increasing consumption of \ncarbapenem and cephalosporin antibiotic in Hospital Rehabilitasi Cheras, an audit has been conducted to determine the usage \nand the rationale use of these antibiotics comparing to National Antibiotic Guideline 2014 (NAG 2014). \nOBJECTIVES: This study aimed to determine the usage and the rationale use of carbapenam and cephalosporin in HRC. \nMETHOD: All adult patients who had started carbapenem and cephalosporin antibiotics in the ward from June 2014 to June \n2016 were included. Patients with incomplete medical records or transferred out during the course of antibiotic were excluded. \nRESULTS: There were 64 cases of which carbapenem and cephalosporin antibiotics were prescribed. Majority of the patients \n(52%) were male with mean age of 46years old. Meropenem was the most preferred carbapenem antibiotic for all of the ESBL \ninfection (35%) and Ceftazidime was the most prescribed cephalosporin antibiotics (47%) detected in the ward. The antibiotics \nwere prescribed mostly as a definitive treatment (45%) and only 17% was given as an empirical treatment. Urinary tract \ninfection (UTI) was the most common infection (49%), followed by 38% as a prophylaxis for urodynamic studies (UDS) and \npneumonia (7%). Majority of the antibiotics (51%) were prescribed in concordance to the NAG 2014. However, Ceftazidime \nof which 80% was given as a prophylaxis for UDS was not concordance to the guideline. \nCONCLUSION: In conclusion, majority of the antibiotics prescribed in HRC were in concordance to the National Antibiotic \nGuidelines (NAG). Meropenem was the most preferred carbapenem antibiotic for all of the ESBL infection and ceftazidime \nwas the most prescribed cephalosporin antibiotics.prophylaxis for urodynamic studies (UDS). Concerted effort such as \nAntibiotic Stewardship Program should be taken to ensure the rational use of antibiotics for all the patients.  \n \nKEYWORDS: impact of pharmacy services, Kuala Lumpur, antibiotics, carbapenem, cephalosporin \nNMRR ID: NMRR-16-1317- 31340 \n \n \n \n \n \n \n \n \n \nPP-12 (Poster) \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nTHE USE OF COMPLEMENTARY AND ALTERNATIVE MEDICINES AMONG TYPE 2 DIABETES MELLITUS \nPATIENTS IN HOSPITAL TUANKU FAUZIAH \n \nNordin NA1, Thanabal S1, Rohani N1, Hashim A1, Baharudin AH1, Fadzil MS1 \n\n\n\n \n1Department of Pharmacy, Hospital Tuanku Fauziah, Ministry of Health Malaysia \n \nINTRODUCTION: The cause of diabetes is a mystery, although both genetics and environment appear to play roles. \nComplementary and Alternative Medicine (CAM) is defined as a group of diverse medical and healthcare systems, practices, \nand products that are not generally considered part of conventional Western medicine. Nowadays, majority of patients used \nCAM because they needed more control on their diabetes. \nOBJECTIVES: To understand the prevalence, types, expenditures, attitudes, beliefs, and perceptions of CAM use among \npatients with type 2 diabetes mellitus (T2DM) in this hospital. \nMETHOD: This is a descriptive, cross-sectional study involving 111 T2DM patients at HTF. This study was conducted from \nFebruary to April 2016. All patients were interviewed with a questionnaire adapted from a previous study conducted by Siew \net al. Data analysis was done using SPSS v.20 to identify predictors of CAM use. \nRESULTS: The prevalence of CAM use was 50.5 percent. Females (67.9%) were the most frequent CAM users compared to \nmales (32.1%). Majority of the users were Malays (98.2%). Diet supplement (48.2%) were the most widely used, followed by \nspiritual/religion master therapy (32.1%), massage therapy (17.9%) and reflexology (7.1%). The median of the expenditure on \nCAM usage was RM0.00(30.00) per month. Age group of 35-60 years old was 3.21 times more likely to use CAM compared \nto the other group (OR 3.21; 95%CI 1.47,7.01; p=0.003). \nCONCLUSION: The highest prevalence use of CAM was among the Malay females. Majority of them used CAM primarily \ndue to recommendations by their friends without disclosing their use towards their respective physicians. Apart from that, most \nof these patients had been a keen user of herbal supplements as they were more affordable and easily available. \n \nKEYWORDS: quality use of medicines, Perlis, attitude, complementary alternative medicine, diabetes mellitus \nNMRR ID: NMRR-16-365-29692 \n \n \nPP-13 (Poster) \nQUANTITATIVE ANALYSIS OF ILLEGAL SEX STIMULANT PRODUCTS CONTAINING SILDENAFIL \nDISTRIBUTED IN KLANG VALLEY USING ULTRA-HIGH-PERFORMANCE LIQUID CHROMATOGRAPHY \n(UHPLC) \n \nMohammad RS1, Mazlan I1, 'Afif AFMT1, Khairul AAK1, Ruhaya MR1, Mohd TD1, Rahmah A1 \n\n\n\n \n1Pharmaceutical Forensic Branch, Pharmaceutical Enforcement Division, Ministry of Health Malaysia \n \nINTRODUCTION: Illegal sex stimulants were sold widely and cause noticeable problem in Malaysia. Despite the problem \nappears to be non-resolving, there is no report of the concentration of the phosphodiesterase type 5 enzyme inhibitor (PDE-5i) \nSildenafil in illegal sex stimulants distributed in Malaysia. Quantitation of sildenafil content in the illegal sex stimulant can \ngive valuable information for consumer education and enforcement activities. \nOBJECTIVES: This study aimed to quantify amount of sildenafil in illegal sex stimulants using validated Ultra-High-\nPerformance Liquid Chromatography(UHPLC) method. \nMETHOD: The chromatographic separation of sildenafil compound was performed on a Purospher\u00ae STAR RP-18 endcapped \ncolumn (50 mm x 2.1 mm i.d., 2\u00b5m particle size), at 30 \u00baC. The isocratic mobile phase was acetonitrile:water (35:65; v/v) with \n0.1% trifluoroacetic acid at a flow rate of 0.2 mL/min. The reading of sildenafil was taken using Shimadzu LC-20AT at 245 \nnm. Samples were prepared with acetonitrile:water (50:50;v/v) and the volume injected was 0.1 \u00b5L. The method was validated \naccording to International Conference on Harmonization (ICH) guidelines. Ten (10) illegal sex stimulants were used for the \nquantification.  \nRESULTS: The retention time of sildenafil was 2.65 min. This developed method showed good specificity and linearity \n(>0.999) over concentration of 1 to 100 \u00b5g/mL. The LOD and LOQ values were determined to be 0.816 \u00b5g/mL and 2.473 \n\u00b5g/mL, respectively. The precision and accuracy of the method were within acceptance range. The developed method was \nthen applied to determine the amount of sildenafil in the illegal sex stimulants. All of the samples tested positive with sildenafil \nand the content range were found to be from 45.53 mg to 147.69 mg. \nCONCLUSION: The amount of sildenafil in illegal sex stimulants were successfully quantified using UHPLC. The present \nmethod is reliable and offers advantages in term of speed and low cost of reagents. \n \nKEYWORDS: research tools, Kuala Lumpur, sildenafil, illegal sex stimulants, UHPLC \nNMRR ID: NMRR-17-3183-38997 \n \n \n \n \n \n \n \n \nPP-14 (Poster) \nHEALTH RELATED QUALITY OF LIFE AMONG PATIENTS WITH SKIN DISORDERS \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \nDr Kassab YW1, Paneerselvam GS1, Muhamad SA1 \n\n\n\n \n1Faculty of Pharmacy, Cyberjaya University College of Medical Sciences (CUCMS), Selangor \n \nINTRODUCTION: Skin diseases are worldwide common problem. It affected every aspect of patients\u2019 quality of life (QOL) \nincluding physically, socially and psychologically.  \nOBJECTIVES: The purpose of this study was to assess QOL in skin diseases patients using Dermatology Life Quality Index \n(DLQI) questionnaire and to identify factors associated with it.  \nMETHOD: A cross-sectional design was conducted in outpatient dermatology clinic of tertiary hospital between July to \nOctober 2017. Acne, psoriasis and atopic dermatitis (AD) patients (n=145) were selected using convenience sampling and \nwere interviewed using DLQI questionnaire during their scheduled follow-up appointments in dermatology clinic.  \nRESULTS: Out of three skin diseases, psoriasis patients had the highest prevalence with 39.3% followed by AD (34.5%) and \nacne (26.2%). Patients\u2019 QOL was largely impacted with mean score 10.5 especially on work/school domain. Furthermore, we \nidentified several factors; namely age, working environment, concurrent skin diseases, usage of supplement for their skin \ndisease and type of food as aggravating factors, that may influence patients\u2019 QOL impairment.  \nCONCLUSION: Our findings revealed skin disease had negatively affected individual QOL with different level of aspects. \nAmong the three diseases, patients with AD had the worst impact on QOL. Significant predictors of QOL did not related  \nsolely to skin diseases but also other factors such as type of food and working environment. \n \nKEYWORDS: clinical research, Selangor, dermatology, quality of life, skin disease \nNMRR ID: NMRR-1773935268 \n \n \nPP-15 (Poster) \nDEVELOPMENT AND VALIDATION OF A QUESTIONNAIRE ON KNOWLEDGE, ATTITUDE AND \nPERCEPTION TOWARDS ALLERGIC REACTIONS OF PARACETAMOL \n \nDellemin NA1, Zahari Z2, Hassali MA 3, Rashid S1 \n\n\n\n \n1Department of Community & Pharmacy Practice, Faculty of Pharmacy, Cyberjaya University College of Medical Sciences, \nCyberjaya, Selangor, 2Faculty of Pharmacy, Universiti Sultan Zainal Abidin (UniSZA), Besut, Terengganu, 3Social and \nAdministrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang \n \nINTRODUCTION: National Pharmaceutical Regulatory Agency (NPRA), Ministry of Health Malaysia has received 1018 \nadverse drug reactions reports related to paracetamol with 1972 adverse events from year 2000 to February 2015. Serious skin \nreactions including Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis and acute generalised exanthematous \npustulosis (AGEP) may be developed as a result of allergic reactions of paracetamol.  \nOBJECTIVES: This study aimed to develop and validate a questionnaire regarding Knowledge, Attitude and Perception \ntowards Allergic Reactions of Paracetamol (KAP-ARP) among general population. \nMETHOD: Content and face validity of the KAP-ARP were determined by four experts and 20 respondents, respectively. A \nquestionnaire with 36 items consisted of 16 Knowledge, 9 Attitude and 11 Perception items was distributed to 177 respondents. \nExploratory factor analysis (EFA) was performed for construct validity. Cronbach\u2019s alpha was used to determine reliability of \nthe questionnaire. \nRESULTS: EFA constructed 13 Knowledge, 8 Attitude and 8 Perception items. The final KAP-ARP questionnaire is reliable \nbased on its internal consistency reliability (Knowledge: \u03b1 = 0.78; Attitude: \u03b1 = 0.63; Perception: \u03b1 = 0.70). \nCONCLUSION: A valid and reliable questionnaire which is useful for measuring KAP-ARP among general population has \nbeen developed. \n \nKEYWORDS: research tools, Malaysia, validation, knowledge, attitudes, practice, allergic reaction \nResearch ID: CUCMS/CRERC/ER/020 \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \nPP-16 (Poster) \nPREDICTING PHARMACOKINETICS OF BIOMOLECULES (MONOCLONAL ANTIBODIES) \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \nAbdullah AA1, Badhan RKS2 \n\n\n\n \n1National Pharmaceutical Regulatory Agency (NPRA), Ministry of Health Malaysia, 2Pharmacy Department, School of Life \nand Health Sciences, Aston University, Aston Triangle, Birmingham, B4 7ET, United Kingdom \n \nINTRODUCTION: Monoclonal antibodies (mAbs) are considered a large molecules and exhibit complex pharmacokinetics \n(PK) and pharmacodynamics (PD) behaviour. Physiologically based pharmacokinetic (PBPK) models, with the integration of \nthe structural and physicochemical data of drugs, and the body physiology, can provide a realistic characterisation of the \nsystemic disposition of mAbs. \nOBJECTIVES: To predict pharmacokinetic parameters of mAbs in different populations and to identify causes of population \nvariability, by using virtual clinical trials. \nMETHOD: A simulator software (Simcyp\u00ae) was used as a population-based simulator for drug modelling and simulation of \nPBPK models for virtual populations. The model was validated using a small molecule compound (quetiapine). Subsequently, \npopulation pharmacokinetics prediction were conducted and validated for mAbs (adalimumab and etanercept). \nRESULTS: Validation of quetiapine, adalimumab and etanercept was successful with all observed data found to be within the \n5th (lower) and 95th (upper) centile of the simulated results. Simulation of adalimumab and etanercept pharmacokinetics, \nparticularly in the geriatric population have demonstrated an increase in Cmax and area under the curve (AUC) (p<0.05). An \nincrease in cardiac output as well as a decrease in tissue blood flow and endogenous IgG were associated with the \npharmacokinetics changes. A similar trend of Cmax and AUC were seen in the pregnancy population with an associated increase \nin cardiac output. In contrast, the cirrhotic population had decreased Cmax and AUC (p<0.05), which were related to an increase \nin endogenous IgG. For the obese population, pharmacokinetics was affected (decreased Cmax and AUC) only in etanercept \nadministered via a subcutaneous route. Related changes include increased body mass index and reduced cardiac output.  \nCONCLUSION: Pharmacokinetic prediction based on PBPK models shows that pharmacokinetics parameters of etanercept \nand adalimumab vary across different populations. \n \nKEYWORDS: cinical research, physiologically based pharmacokinetic, monoclonal antibodies, Simcyp\u00ae \nNMRR ID: NMRR-40923 \n \n \nPP-17 (Poster) \nEFFICACY AND SAFETY OF WARFARIN IN GERIATRIC PATIENT WITH NONVALVULAR ATRIAL \nFIBRILLATION IN HOSPITAL TUANKU JA\u2019AFAR SEREMBAN \n \nAslina A1, Basariah N 1, Noorizan AZ2 \n\n\n\n \n1Department of Pharmacy,Hospital Tuanku Ja'afar, Ministry of Health Malaysia,2School of Pharmacy, Management and \nScience University \n \nINTRODUCTION: Nonvalvular atrial fibrillation patients need long-term oral anticoagulant. Warfarin has a narrow \ntherapeutic index, high potential for interaction with food, drugs and can cause bleeding. Geriatric patients are at risk of \nbleeding. \nOBJECTIVES: In this study, the efficacy and safety of warfarin and their relationship with other factors have been studied \nin geriatric of warfarin clinic. \nMETHOD: Patient's data were retrieved from the hospital medical record, and hospital computerized system. Warfarin \ntherapy is normally presented with the fluctuation of TTR values. TTR values were calculated by Rosendaal and Traditional \nMETHOD. Statistical analysis tests used were chi-square, t-test, ANOVA, correlation and regression when appropriate with \np-value <0.025 (2 tails) is considered significant. Efficacy is defined as good when TTR>65% and the safety assessment \ndefined as INR>3 which related risk of bleeding.  \nRESULTS: There were 84 patients met the inclusion criteria. In term of efficacy, only 44% achieved TTR >65%.The mean \nTTR for the one year period was 60.1% \u00b119.6% (Rosendaal method) and 51.9% \u00b118.6% (Traditional method). In term of \nsafety, from 1073 INR readings, INR>3 was 17.39% of total INR. There were 8 patients admitted due to over-warfarinization \nwhich representing 9.4% of total admissions with mean INR 5.4 \u00b1 1.58 while mean weekly dosing was 13.6 mg and mean \nTTR was 50.6%. There were three predictors of efficacy, number of missed dose, number of concurrent medication, number \nof visited warfarin clinic can explain 6.8%, 2.1% and 36.3% of the variance in TTR values (p-value<0.025). \nCONCLUSION: A majority of geriatric patients did not achieve efficacy, and a few of them had a risk of bleeding. Thus, in \norder to increase majority of geriatric patients achieve efficacy and safety of warfarin therapy, more efforts and appropriate \nstrategies are needed. \n \nKEYWORDS: clinical research, Negeri Sembilan, geriatric, warfarin, efficacy \nNMRR ID: NMRR-16-1650-32282 \n \n \n \n \nPP-18 (Poster) \nSTUDY OF THE EFFICACY OF LOCAL APPLICATION OF GENTAMICIN IN THEPREVENTION OF \nCATHETER-RELATED INFECTIONS AMONG HAEMODIALYSIS PATIENTS \n \nTang KW 1, Leong CM 2, Aziz AA 1, Jaya Ramadoo J3 \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n1Department of Pharmacy, Hospital Kulim, Ministry of Health Malaysia, 2Department of Nephrology, Hospital Kulim, \nMinistry of Health Malaysia, 3Department of Pharmacy, University Sains Malaysia, Pulau Pinang \n \nINTRODUCTION: The use of local application of antibiotic has a beneficial effect on CRBSI. However, some study shows \nprolonging antibiotic ointment application probably offers no advantage. \nOBJECTIVES: To determine efficacy of local gentamicin cream in the prevention of catheter-related infections in \nhaemodialysis patients. \nMETHOD: A cross sectionalstudy involved 60 patients with insertion of non-tunnelled internal jugular venous catheters (IJC) \nin Hospital Kulim. 30 patients randomly prescribed with local gentamicin cream while the other 30 patients were not given \nafter insertion of IJC. Patients were follow up within 6 months after the IJC insertion.  \nRESULTS: The study found 21 patients in gentamicin group been reported with CRBSI while 19 patients in the other group. \nThere are no significant relationship between the use of local gentamicin application in preventing CRBSI (p = 0.785).  \nHowever, our study found, patient\u2019s education level (p = 0.001) and type of occupation (p < 0.001) affect the rate of CRBSI \nincidence.  \nCONCLUSION:Among haemodialysis patients with non-tunnelled IJC, local application of gentamicin cream shows no \nadditional effect on preventing CRBSIs. Improvement on patient education on IJC care will have beneficial effect in preventing \nCRBSI.  \n \nKEYWORDS: clinical research, Kedah, catheter-related infections, gentamicin cream, non-tunnelled internal jugular \ncatheters \nNMRR ID: NMRR-16-2145-31594 \n \n \nPP-19 (Poster) \nKNOWLEDGE, ATTITUDE, AND PRACTICE (KAP) OF NURSES IN THE PREPARATION AND \nADMINISTRATION OF INTRAVENOUS (IV) MEDICATIONS: LINGUISTIC VALIDATION OF \nQUESTIONNAIRE IN MALAY VERSION \n \nAsiah A1, Teo KY1, Liow HT1 \n\n\n\n \n1Department of Pharmacy, Hospital Tuanku Ampuan Najihah, Ministry of Health Malaysia \n \nINTRODUCTION: Nurses are among the healthcare providers who mostly involved in IV medication administration in \nhospital. To our knowledge, there is limited of validated questionnaire in Malay version that can be used to assess the KAP of \nnurses in the preparation and administration of IV medications in Malaysia. \nOBJECTIVES: This linguistic validation is aimed to produce a translated version of questionnaire on KAP of nurses in the \npreparation and administration of IV medications in Malay version, for use in research and clinical practice. \nMETHOD: Permission was taken from the authors of the original validated questionnaire. A five-member translation team \nconducted the translation using the following process: production of two independent forward translations, comparison and \nreconciliation of the translations, backward translation of the first reconciled version, comparison with the original \nquestionnaire and the backward version, producing the second reconciled version, pilot testing and review of translation, and \nfinalization. The reliability and validity of the Malay version were evaluated based on the data collected from 30 nurses \nworking in wards of Hospital Tuanku Ampuan Najihah. Cronbach\u2019s alpha coefficient calculation and face validity was used \nto assess the reliability and validity respectively. \nRESULTS: Linguistic equivalence and psychometric properties were checked to ensure optimal transfer of original message \nfrom English to Malay. During cognitive debriefing and review processes, the translated Malay version of questionnaire was \nfound to be easily comprehensible and appropriate for the KAP to be measured. Face validity was confirmed by the nurses \ninvolved. Evaluation of reliability measured by Cronbach\u2019s alpha coefficient calculation had produced a result of 0.725 (>0.7). \nCONCLUSION: The translated questionnaire in Malay version is a reliable and valid measure of nurses\u2019 KAP in the \npreparation and administration of IV medications, which can be applied for researches in Malaysia. \n \nKEYWORDS: research tools, Negeri Sembilan, Malay language, linguistic validation, intravenous medications \nNMRR ID: NMRR-18-118-39858 \n \n \n \n \n \n \n \n \n \n \nPP-20 (Poster) \nEVALUATION ON EFFECTIVENESS OF CLINICAL PHARMACIST-LED EDUCATIONAL PROGRAM IN \nINTENSIVE CARE NURSES\u2019 KNOWLEDGE AND PRACTICES REGARDING MEDICATION \nADMINISTRATION THROUGH ENTERAL TUBES \n \nRazali SH1, Mamat SN1, Azman A1, Rahman B1, Sidek NN2 \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n1Department of Pharmacy, Hospital Sultanah Nur Zahirah, Ministry of Health Malaysia, 2Clinical Research Center, Hospital \nSultanah Nur Zahirah, Ministry of Health Malaysia \n \nINTRODUCTION: Nurses play a major role in preparing, monitoring, and administrating medication to patients. \nInappropriate medication administration through enteral feeding tube may lead to reduction of drug efficacy and increased \nadverse effects as well. There is no standard guideline or protocol regarding this special administration, hence, the nurses\u2019 \nknowledge and may differ from hospital to another.  \nOBJECTIVES: The objectives of this study were to evaluate effectiveness of clinical pharmacist-led educational program in \nprogressing nurses\u2019 knowledge and practices regarding medication administration through enteral tube. \nMETHOD: This interventional study was conducted from May to September 2016, involving all intensive care nurses of \nHospital Sultanah Nur Zahirah (HSNZ). The self-administered questionnaire and nurse\u2019s observational checklist were used as \na study instruments. The questionnaire was filled by all nurses during pre-interventional phase. A series of continuous medical \neducation and drug booklet were provided to all nurses by a clinical pharmacist during interventional phase. Nurses were \nevaluated again after 2 months. At pre and post-intervention phases nurses were observed regarding their practice to administer \ndrugs via enteral tubes as well. \nRESULTS: From our study, age (r=0.392, p=0.005, 95% CI 0.025, 0.134), (r=0.601, p=<0.001, 95%CI 0.028, 0.064) and \nworking experience (r= 0.395, p=0.005, 95% CI 0.032, 0.167), (r=0.603, p<0.001, 95% CI 0.035, 0.079) were the significant \npredictors for nurses knowledge and practice, respectively.The knowledge and practice of the nurses also found to be \nsignificantly different before and after clinical pharmacist-led educational program (p<0.001, 95% CI 0.000, 0.058) and \n(p=0.013, 95% CI 0.000, 0.059) respectively. \nCONCLUSION: The knowledge and practices of nurses were associated with age and working experience. There was a \nsignificantly different in term of knowledge and practice among nurses in Intensive care unit after our program. \n \nKEYWORDS: impact of pharmacy services, Terengganu, knowledge and practices, medication administration, enteral tubes \nNMRR ID: NMRR-16-1489-29896 \n \n \nPP-21 (Poster) \nPHARMACIST-MANAGED DIABETES CLINIC IN MALAYSIA - DOES THE NUMBER OF FOLLOW-UP \nVISITS REALLY MATTER? \n \nTew MM1, Abdullah MJ2, Tan PH3, Koh JH3, Md Osman N3, Chan HK4 \n\n\n\n \n1Clinical Research Centre, Hospital Sultan Abdul Halim, Ministry of Health Malaysia,2Hospital Yan, Ministry of Health \nMalaysia. 3Department of Pharmacy, Hospital Sultan Abdul Halim, Ministry of Health Malaysia,4Clinical Research Centre, \nHospital Sultanah Bahiyah, Ministry of Health Malaysia \n \nINTRODUCTION:Since the past decade, the pharmacist-managed Diabetes Medication Therapy Adherence Clinic \n(DMTAC) has been introduced across public healthcare settings in Malaysia and was shown to improve the medication \nadherence and glycemic control of diabetic patients. However, no studies had examined the impact of the number of follow-\nup visits on the glycemic control. \nOBJECTIVES: To identify the relationship between the number of follow-up visits and the glycemic control and to assess \nthe effectiveness of the DMTAC in optimizing the glycemic control of diabetic patients. \nMETHOD: Retrospective cohort study. All type 2 diabetes mellitus patients, made at least four follow-up visits to the \npharmacist-managed DMTAC during May 2014 and April 2016, and had their HbA1C levels tested once each before enrolled \nin the DMTAC and within the same month of the last follow-up visit, were included. \nRESULTS: A total of 53 patients (28 male and 25 female) with a median age of 57 years were included in the study. \nIrrespective of the number of follow-up visits, the HbA1c and FBS of the patients were found to reduce by 1.3% (p<0.001) \nand 2.8mmol/L (p<0.001), respectively. However, only 21% of them managed to achieve the targeted HbA1c level. Of all the \npatients who failed to achieve the targeted HbA1c level, more than half had made at least 8 follow-up visits to the DMTAC. \nHigher baseline HbA1c (OR: 2.34; 95% CI: 1.14, 4.79) and FBS (OR: 1.41; 95% CI: 1.02, 1.95) levels were more likely to \nlead to a non-optimized HbA1c level. \nCONCLUSION: Despite the effectiveness of the DMTAC in improving the glycemic control, majority of the patients did not \nachieve targeted level. Number of follow-up visits to the DMTAC is not a determinant of the targeted outcome, and should \nnot be used as discharging criteria in DMTAC.  \n \nKEYWORDS: impact of pharmacy services, Kedah, DMTAC, pharmacist, diabetes mellitus \nNMRR ID: NMRR-16-488-30164 \n \n \n \n \nPP-22 (Poster) \nCOMPARING THE CLINICAL EFFECTIVENESS OF LEVOTHYROXINE INTAKE BEFORE BREAKFAST \nVERSUS AT BEDTIME IN PATIENT WITH HYPOTHYROIDISM \n \nChe Pa MF1, Gurnam Singh SK1, Yaacob S1, Naina B1, Adam N2 \n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n1Department of Pharmacy, Hospital Tuanku Ja\u2019afar, Ministry of Health Malaysia,2Department of Medical, Hospital Tuanku \nJa\u2019afar, Seremban,Ministry of Health Malaysia \n \nINTRODUCTION: Levothyroxine absorption following oral administration is the lowest when taken with food. Several \nstudies have suggested that the administration of levothyroxine at bedtime as an alternate in comparison to the conventional \nbefore breakfast dosing. \nOBJECTIVES: The study objective was to compare the clinical effectiveness of levothyroxine administration, either in the \nmorning or at bedtime on serum TSH and T4 levels and to determine the effect of administration time of levothyroxine on \npatient\u2019s quality of life (QoL). \nMETHOD: A prospective, interventional study was conducted at the Endocrinology Clinic, Hospital Tuanku Ja'afar, \nSeremban from May to November 2017. Hypothyroid patients were assigned to either before breakfast or at bedtime regime \nthrough convenient sampling. After 12 weeks, serum thyroid hormones were tested and QoL variables were assessed using \nthe 36-Item Short Form Health Survey and compared with baseline. Primary outcome measured were the changes in TSH and \nT4 whereas the secondary outcome were QoL, serum creatinine, liver function, BMI, heart rate and blood pressure. \nRESULTS: 35 patients completed the 12 weeks study period and were available for data analysis. The serum TSH and T4 \nlevel showed improvement in bedtime regime group compared to morning group, in which the mean TSH level reduced from \n2.46 \u00b1 1.34 mIU/L to 1.79 \u00b1 0.99 mIU/L (p = 0.13) while the mean T4 level increased from 15.25 \u00b1 2.65 pmol/L to 15.73 \u00b1 \n3.28 pmol/L (p = 0.51). Secondary outcomes such as quality of life assessment, blood pressure, heart rate and laboratory results \n(albumin, ALP and ALT) showed no significant difference between morning and bedtime groups. \nCONCLUSION: Our study showed the bedtime administration of levothyroxine is non \u2013 inferior in improving serum TSH \nand T4 in hypothyroid patients in comparison to the morning regime. However, no marked improvements were found in the \nquality of life variables in both administration times. \n \nKEYWORDS: clinical research, Negeri Sembilan, levothyroxine, TSH, T4, bedtime \nNMRR ID: NMRR-17-1179-36125 \n \n \nPP-23 (Poster) \nSTUDY OF WORKLOAD AMONG CLINICAL PHARMACISTS IN THE MEDICAL WARDS IN THE FORM OF \nSTANDARD MINIMUM REQUIREMENT IN HOSPITAL TUANKU JA\u2019AFAR SEREMBAN \n \nAishah MS1, Ng CD 1, Vigneswary PS1, Aflyn F1, Aslina A1, Basariah N1 \n\n\n\n \n1Department of Pharmacy, Hospital Tuanku Ja'afar, Ministry of Health Malaysia \n \nINTRODUCTION: Clinical pharmacist dealing with many tasks. Workload of clinical pharmacist divided into three parts: \nclinical activities in the ward, non-ward activities and others. \nOBJECTIVES: To evaluate time related workload of clinical pharmacist in medical wards in Hospital Tuanku Ja\u2019afar, \nSeremban \nMETHOD: The study was conducted by self-reporting of six clinical pharmacists through filling in data collection form \nbetween Monday to Friday from 8.00am to 5.00pm which accounts 8 hours of working process for a month . \nRESULTS:The data reveals that the pharmacist spent 38.6% of their total time in the ward. The main activities in the ward \nwere ward rounds which signifies 34.5% followed by 31.5% of combination activities such as preparing CP2, CP1 or \ncounselling during ward round. The pharmacists spent 13.6% in non ward activities where the main activity were \ndocumentations 37.2% followed by medication therapy adherence clinic 23%, quality assurance 20.1%, provisionally \nregistered pharmacist presentation 15.36% . Balance 38.1% of time was spent in other activities such as course work, time-\noff, annual leave and public holiday. 9.7% of time was not recorded by the pharmacists. The result showed that only 62.2% of \nCP1 and 68.9% of CP2 were done by clinical pharmacists involved. \nCONCLUSION: In summary, other activities and non ward activities affect the workload of the pharmacist which led to not \nachieve minimal requirement in the ward activities. Thus, in order to increase the minimum requirement, more pharmacists \nshould be place in the ward. \n \nKEYWORDS: impact of pharmacy services, Negeri Sembilan, clinical pharmacist, workload \nNMRR ID: NMRR-17-2315-37940 \n \n \n \n \n \n \n \n \n \n \nPP-24 (Poster) \nINADEQUATE SELF-CARE BEHAVIORS AMONG MALAYSIAN DIABETIC PATIENTS: THE NEED FOR \nACTION BY HOSPITAL PHARMACISTS \n \nJu-Ying A1,2, Jie-Shi L1, Doris-George1, Chan HK3 \n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n1Department of Pharmacy, Hospital Raja Permaisuri Bainun, Ministry of Health Malaysia,2Clinical Research Centre, Hospital \nRaja Permaisuri Bainun, Ministry of Health Malaysia,3Clinical Research Center, Hospital Sultanah Bahiyah, Ministry of \nHealth Malaysia \n \nINTRODUCTION: Self-care behaviors are strongly associated with clinical outcomes of diabetes management.  \nOBJECTIVES: This study aimed to determine the prevalence and risk factors of inadequate self-care behaviors among \npatients with type 2 diabetes mellitus (T2DM) through screening by hospital pharmacists. \nMETHOD: A cross-sectional study was undertaken for nine months at a public tertiary care center in Perak. Self-care \nbehaviors of 103 patients with T2DM were evaluated using the 16-item Diabetes Self-Management Questionnaire (DSMQ), \nand the scores were dichotomized to represent \u201cadequate\u201d (\u22656 out of 10) and \u201cinadequate\u201d (<6 out of 10) self-care behaviors. \nThe risk factors for inadequate self-care behaviors were identified using logistic regression analysis. \nRESULTS: The participants recorded a mean DSMQ score of 7.48\u00b11.32, and 16 (15.5%) of them were found to have \ninadequate self-care behaviors. Among the four subscales assessed, the \u201cHealth-Care Use\u201d had the highest score (8.36\u00b11.99), \nwhile the \u201cPhysical Activity\u201d had the lowest score (6.82\u00b12.56). Patients with a duration of T2DM less than one year (OR: \n12.00; 95%CI: 1.80, 80.05; p=0.010) and between six to ten years (OR: 7.11; 95% CI: 1.36, 37.31; p=0.020) were found more \nlikely to have inadequate self-care behaviors, as compared with those with a disease duration greater than 10 years. \nCONCLUSION: Noticeable proportions of patients with T2DM in Perak had inadequate self-care behaviors, and were found \nto be associated with the disease duration. This study suggests a more active role for hospital pharmacists in monitoring and \nimproving the diabetes management of patients. \n \nKEYWORDS: impact of pharmacy services, Perak, self-care, diabetes mellitus. \nNMRR ID: NMRR-15-1193-24276 \n \n \nPP-25 (Poster) \nUSING LOCAL MICROBIOLOGICAL DATA TO DETERMINE SUSCEPTIBILITY PATTERN FOR \nTREATMENT OF HOSPITAL-ACQUIRED PNEUMONIA \n \nIgnatius L1, Tong JS1, Wong FY1, Lina H1, NorIdha L1, Laila K2 \n\n\n\n \n1Department of Pharmacy, Hospital Selayang, Ministry of Health Malaysia,2Department of Anaestesiology, Hospital \nSelayang, Ministry of Health Malaysia \n \nINTRODUCTION: Hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) are the second most \ncommon causes of nosocomial infection in hospital and reported as the highest mortality rate compared to other hospital \nacquired infection. Different regions have different rate of antimicrobial resistance and pathological pattern.  \nOBJECTIVES: This study aims to establish HAP and VAP pathogens' microbiologal data and its susceptibility towards \nempirical antibiotics in intensive care unit (ICU) settings, Selayang Hospital. \nMETHOD:A retrospective observational study of ICU patients (age \u2265 18 years) with positive bacterial respiratory culture \nadmitted from January to December 2015 was included in the study. \nRESULTS: Out of 80 isolates, 78 were gram-negative pathogens and two were gram-positive pathogens, with total of 76 \ncases of pneumonia. The most common pathogens were Acinetobacter baumannii, Pseudomonas aeruginosa, and Klebsiella \npneumoniae which were associated with 51%, 20% and 11% of pneumonia respectively. Among the empirical antibiotics \nstarted, carbapenems was the most frequent (42%), followed by cephalosporins (20%) and anti-pseudomonal penicillins (19%). \nWhen data from multi-drug resistant A. baumannii were excluded, empirical antibiotic did not provide susceptible \nantimicrobial coverage in 65%of all isolates. Of those isolates, 37.5% were not appropriate due to empirical use of non-\nsusceptible cephalosporins and aminopenicillins. A. baumannii were only found in late onset HAP and VAP (p = 0.001) \nwhereas P. aeruginosa can be found equally in both early onset and late onset. \nCONCLUSION: This study was able to determine common pathogens and its susceptibility data in our setting. Guidelines \ncomplemented with local microbiological data provide better coverage compared to treatment based on guidelines alone. The \nresult of this study recommends the use of dual antibiotic therapy only in late onset pneumonia without positive culture. \n \nKEYWORDS: clinical research, Selangor, antibiotic resistance, microbiological, nosocomial pneumonia \nNMRR ID: NMRR-15-2440-25828 \n \n \n \n \n \n \n \n \n \n \nPP-26 (Poster) \nPATTERN OF ACUTE POISONING AND THE ANTIDOTE USAGE; A RETROSPECTIVE STUDY AT \nEMERGENCY DEPARTMENT HOSPITAL SELAYANG IN 2015 \n \nZulkupli MZ1, Lee CM1, Mat Aris NA1, Abd Rahman MA2, Yeap HH2 \n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n1Department of Pharmacy, Hospital Selayang, Ministry of Health Malaysia, 2Emergency and Trauma Department, Hospital \nSelayang, Ministry of Health Malaysia \n \nINTRODUCTION: Acute poisoning is a significant health problem all over the world. In Malaysia, nationwide data on \npoisoning pattern is infrequent and lacking.  \nOBJECTIVE: The aim of the study was to evaluate the pattern of acute poisoning in patients attending Emergency and \nTrauma Department, Hospital Selayang, Selayang, Selangor in 2015.  \nMETHOD: The study was a retrospective case reviewof all poisoned patients admitted to Hospital Selayang in 2015. Data \ncollected were concerning demographic parameters of the patients, information about the agent(s) implicated and approach in \nacute poisoning management.  \nRESULTS: There were 319 poisoning incidents recorded. Males outnumbered females throughout the poison cases \n(n=164,51.4%). The predominant mode of poisoning was accidental poisoning (n=216, 67.7%). Patients between 16 to 30 \nyears constituted (n=139, 43.6%) of all cases. Animal and plant toxins were the predominant agents implicated (n=180, 56.4%). \nA higher rate of poisoning involving animal and plant toxin was seen among Chinese ethnic group (n=47, 58%) and Malay \nethnic groups (n=90, 73.2%). On the other hand, a higher rate of poisoning associated to drugs (n=34, 38.6%), household \nproducts (n=15,17%) and pesticides (n=8, 9.1%) was seen among Indian ethnic group. The most commonly used antidote was \nN-acetylcysteine as part of the treatment for the poisoning caused by drugs (n=22, 78.58%). \nCONCLUSION: Pattern of acute poisoning admissions in Emergency and Trauma Department, Hospital Selayang were \nassociated with a higher percentage of Malay ethnic group, male subjects, accidental in nature and involving animal and plant \ntoxins. \n \nKEYWORDS: pharmacoepidemiology & drug safety, Selnagor, acute poisoning, antidote, emergency department \nNMRR ID:NMRR-16-1479-30545 \n \n \nPP-27 (Poster) \nIMPLEMENTATION OF CRISPR-CAS9 SYSTEM TO MODIFY GENES IN YEAST \n \nPoh WT1,2, Brogna S1 \n\n\n\n \n1University of Birmingham,2National Pharmaceutical Regulatory Agency, Ministry of Health Malaysia \n \nINTRODUCTION: The discovery of Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR)-associated \nprotein (Cas) system represents a breakthrough in gene editing. CRISPR-Cas9 enables genome targeting by means of inducing \ndouble-strand break (DSB) in the genome and using cellular DNA repair process. CRISPR-associated endonuclease Cas9 has \nshown successful site-specific genomic loci targeting in the presence of a single guide RNA (sgRNA) which consist of CRISPR \nRNA (crRNA) and trans-activating RNA (tracrRNA). The specificity of the DNA cleavage is achieved by complementary \nsequence binding of crRNA to the DNA sequence of interest that has a protospacer adjacent motif (PAM) located next to it. \nOBJECTIVES: To optimise the transformation of Schizosaccharomyces pombe (S. pombe) and to use CRISPR/Cas9 toolset \nto mutagenise the ade6 gene in a wild type strain of S. pombe. \nMETHOD: The wild type strain is first-transformed with a plasmid vector expressing Cas9 from an adh1 promoter. The \nsecond transformation is followed, using a plasmid expressing the sgRNA construct from rrk1 promoter and homologous \ntemplate that contains ade6-M210 mutation. The constructed sgRNA has ade6 sequence which drives Cas9 to this locus. \nTherefore, Cas9 cleaves the ade6 gene and this double-strand break is repaired by homologous recombination (HR) using the \ntemplate DNA carrying the ade6-M210 mutation. Adenine mutants can be identified because the resulting colonies are red in \nEdinburgh Minimal Media Glutamate (EMM-G) media with low adenine.  \nRESULTS: The first transformation to produce pMZ222 Cas9 expressing plasmid was successful. However, failed to observe \nthe red colonies in EMM-G media with low adenine in the second transformation. \nCONCLUSION: The yeast transformation protocol is optimal, whereby Cas9 expressing plasmid was obtained successfully. \nHowever, optimising the ade6-M210 HR cassette synthesis in introducing the ade6-M210 mutation warrants further research. \n \nKEYWORDS: research tools, Selangor, Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR)/Cas9; \nGenome Editing; NMRR ID: NMRR-40840 \n \n \n \n  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nPP-29 (Poster) \nRETURNED MEDICATION IN OUTPATIENT PHARMACY OF HOSPITAL SULTANAH BAHIYAH \n \nGhani NA1, Ismail AF2, Hashim Z2 \n\n\n\n \n1Department of Pharmacy, Hospital Sultanah Bahiyah, Ministry of Health Malaysia,2Faculty of Pharmacy, Universiti \nTeknology MARA \n \nINTRODUCTION: Returned medication not only can reduce drugs wastage but it can also prevent drug abuse, drug \npoisoning incident, as well as reduce environmental pollution. Hence, this returned medication could represent financial loss, \npossible treatment failure and/or over prescription. \nOBJECTIVE: This study was conducted in analyzing medications that have been returned according to their pharmacological \ngroups and estimated cost as well as evaluating the relationship between patient characteristic with factor that contribute to \nreturned medications. \nMETHOD: This study was being carried out at Outpatient Pharmacy, Hospital Sultanah Bahiyah by using hospital database \nand data collection form that were distributed to patient who came to the Outpatient Pharmacy Department to return their \nunused or expired medication from January 2016 to June 2016. \nRESULTS: 301 patients return their medication during study period with 55.5% patients were female; mean age of 55 years \nold and 52.5% patients was Malay. Cardiovascular drugs is the most common pharmacological group of drug that frequently \nbeing returned by patient (161,783 tablets, 36.64%) followed by nutrition and blood disorder drugs (129,216 tablets, 31%). \nThe total cost involved estimated as RM 129,374.72 for 6 month returned medications. Besides, the most common factors that \ncontribute to returned medication were because of change in medication therapy, extra medications and patients\u2019 non-\ncompliance. There was a non-significant relationship between patients\u2019 characteristic and the cost and total number of returned \nmedications. \nCONCLUSION: This study finding may help for the improvement of patient care as well as a reference for policy makers to \nreview back the two month supply prescribing policy in order to reduce financial loss. \n \nKEYWORDS: quality use of medicines, Kedah, medicines disposal, unused medicines, outpatient pharmacy \nNMRR ID: NMRR-34003 \n \n \nPP-30 (Poster) \nPUBLIC KNOWLEGDE AND ATTITUDES TOWARDS ANTIBIOTICS USAGE IN PERLIS: A CROSS \nSECTIONAL STUDY \n \nMohamad Ghausillah M1, Maidin JD1, Othman N1, Ahmad Zaini S1 \n\n\n\n \n1Department of Pharmacy, Hospital Tuanku Fauziah, Ministry of Health Malaysia \n \nINTRODUCTION: Antibiotic resistance is increasing worldwide.Prevalence of bacterial resistance varies in different \ngeographical areas, and it was correlated with the utilization of antibiotics in the general population. \nOBJECTIVE: This study was conducted to assess public knowledge and attitudes towards antibiotic usage in Perlis, Malaysia. \nMETHOD: A validated self-administered questionnaire survey was distributed among public in three main parliament areas \nof Perlis using quota sampling method, from August to October 2017. The questionnaire from previous study by Lim et al. \nwas used with permission and the data was analyzed using SPSS version 20.0. \nRESULTS: A total of 384 completed questionnaires were collected. 51% respondents were found to have good knowledge \n(score \u22656) and 45.1% have good attitude (score\u22656). The mean knowledge score was 5.01 (SD=2.19)and mean attitude score \nwas 5.60 (SD=3.00). As for knowledge, majority of respondents still perceived that antibiotics would work on viral infections \nin common colds and coughs. In terms of attitude, 74% of the study population expected antibiotics for treatment of coughs \nand colds while 65.1% of the respondents expected that taking antibiotics would improve recovery. 53.6% of the respondents \nwill stop taking antibiotic when they start feeling better. Age and employment sector were found to be significantly associated \nto both knowledge and attitude. There was a positive correlation (r=0.581) between knowledge and attitude scores. \nCONCLUSION: This study has identified people with better knowledge would have appropriate attitude regarding antibiotics \nusage. Hence, educational programme such as antibiotic awareness campaigns and patient counselling are very important in \norder to promote appropriate utilization of antibiotics among public in Perlis. \n \nKEYWORDS: quality use of medicines, Perlis, antibiotic, attitude, knowledge, Malaysia, public, survey \nNMRR ID: NMRR-17-2853-38768 \n  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nPP-31 (Poster) \nASSESSMENT OF VANCOMYCIN INITIAL DOSING AND SUBSEQUENT TROUGH CONCENTRATION IN \nPAEDIATRIC PATIENTS IN HOSPITAL TUANKU JA\u2019AFAR SEREMBAN \n \nSha\u2019ari S1, Chan KH1, Samad NA.1 \n\n\n\n \n1Department of Pharmacy, Hospital Tuanku Ja\u2019afar Seremban, Ministry of Health Malaysia \n \nINTRODUCTION: Vancomycin has a narrow therapeutic index and age-dependent pharmacokinetics. Staphylococcus \naureus exposure to trough level of \nOBJECTIVE: This study aims to evaluate the initial vancomycin dosing and the resultant trough concentration in paediatric \npatients.  \nMETHOD: In this retrospective observational study, universal sampling was used. All therapeutic drug monitoring (TDM) \nrecords of paediatric patients admitted to Hospital Tuanku Ja\u2019afar Seremban (HTJS) between January 2014 and May 2016 \nwere analysed. All 30 patients treated with intravenous vancomycin without documented renal disease were included in the \nstudy.  \nRESULTS: 56% (n=16) were neonates and 44% (n=14) were infants. All of the patients were from the neonatal intensive care \nunit. The most common clinical indication of vancomycin was for nosocomial infection (80%; n=24). The mean weight for \nneonates and infants were 1.72\u00b11kg and 1.88\u00b10.94kg respectively. The five initial dosing regimen recognized were \n45mg/kg/day (60%; n=18), 30mg/kg/day (16.7%; n=5), 40mg/kg/day (13.3%; n=4), 60mg/kg/day (6.7%; n=2), and \n65mg/kg/day (3.3%; n=1). The proportions of those achieving therapeutic range (10-20mg/L) was 56.7% (n=17), sub-\ntherapeutic (20mg/L) was 16.7% (n=5). The distribution of trough level was significantly different between those who received \n=45mg/kg/day and >45mg/kg/day (p=0.045). The proportion of those who achieved the target therapeutic range (10-20mg/L) \nin the 2 dosing groups were 59.3% (n=16) and 33.3% (n=1) respectively.  \nCONCLUSION: This study shows that initial dosing of =45mg/kg/day is more likely to achieve the targeted therapeutic range \nof 10-20mg/L compared to initial dosing of >45mg/kg/day.  \n \nKEYWORDS: clinical research, Negeri Sembilan, vancomycin, trough concentration, paediatric \nNMRR ID: NMRR-16-2343-33139 \n \n \nPP-32 (Poster) \nPREDICTING PHARMACOKINETICS OF DRUGS IN PREGNANT AND NON-PREGNANT WOMEN \n \nNooree NA1, Badhan RK2 \n\n\n\n \n1National Pharmaceutical Regulatory Agency, Ministry of Health Malaysia, 2Aston University, Birmingham, United Kingdom \n \nINTRODUCTION: Pregnant women are typically exempted from any actual studies due to various reasons. Due to the \nmedico-legal and ethical reasons, pharmaceutical industries reluctant to include this group during drug development studies. \nOBJECTIVE: This study aimed to investigate the pharmacokinetics of pregnant group compared to the non-pregnant group \nusing Physiologically-Based Pharmacokinetic (PBPK) Model. \nMETHOD: Simulation study done by using Simcyp software. Three steps were involved in the simulation; 1) Validation of \nSimcyp by using a selected small molecular weight compound which is Quetiapine, 2) identification of in-vivo \npharmacokinetic model for selected compounds used in pregnancy in various studies and 3) prediction of the pharmacokinetics \nfor pregnant women in various gestational stage, changes of phenotyping and genotyping being studied. \nRESULTS: Comparison of predicted pregnant pharmacokinetics parameters for Metoprolol showed significant differences \n(p<0.05) in AUC, Cmax, and clearance (CL) between pregnant and non-pregnant population. However, there was no \npharmacokinetics difference between this two populations in Darunavir. The clearance profile of metoprolol is more \npronounced in pregnant group compared to non-pregnant group while vice versa for Darunavir. In term of genotyping, Chinese \npregnant population demonstrated the slowest metabolizer for Metoprolol while Japanese pregnant population is the fastest \nmetabolizer. However, in Darunavir, the pharmacokinetic profile shown similar between all ethnicity. Last but not least, with \nregards to phenotyping, poor metabolizer shows higher AUC, Cmax compared to extensive metabolizer for metoprolol while \nin Darunavir the results is not statistically significant difference (p<0.001). \nCONCLUSION: The changes in pregnancy population were more pronounced in clearance compared to other \npharmacokinetics parameters specifically for Metoprolol and Darunavir compounds. Therefore it is suggested that dose \nadjustment should be done during pregnancy.  \n \nKEYWORDS: clinical research, Birmingham, pregnant, metoprolol, darunavir, pharmacokinetics \nNMRR ID: NMRR-18-510-40710 \n  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nPP-33 (Poster) \nPRIOR ANTIPLATELET USE AND CLINICAL OUTCOMES IN THOSE UNDERGOING PERCUTANEOUS \nCORONARY INTERVENTION \n \nHoo YY1, Tai JY1, Wardati MK1, Abdul-Muizz AM2, Seah YZ1, Yap PQ3, Fiqri R1, Maisarah AA1 \n \n\n\n\n1Department of Pharmacy, Hospital Serdang, Ministry of Health Malaysia,2Department of Cardiology, Hospital Serdang, \nMinistry of Health Malaysia,3Klinik Kesihatan Sepang, Ministry of Health Malaysia \n \nINTRODUCTION: Antiplatelets are used as primary prevention in patients with high cardiovascular risk, in secondary \nprevention as well as treatment of acute coronary syndrome (ACS). Studies have assessed the benefits of prior antiplatelet use \nin reducing all-cause mortality or coronary artery disease readmissions; however, there is lack of data on the impact of prior \nantiplatelet use on the successfulness of and development of complications during hospitalization post primary percutaneous \ncoronary intervention (PPCI). \nOBJECTIVE: To evaluate whether prior antiplatelet use is associated with better clinical outcomes than non-prior antiplatelet \nuse. \nMETHOD: Patients were identified from the PPCI patients\u2019 list in Hospital Serdang between May 2015 and November 2016. \nData were collected via the electronic Hospital Information System (eHIS). Patients were grouped according to whether they \nwere prior antiplatelet (PAP) users or non-antiplatelet (NAP) users. PAP users are defined as those who use antiplatelet agents \nwithin 30 days before admission (not immediately before PPCI). Outcome measures (cardiovascular (CV) events and \nbleedings) during hospitalization were compared using logistic regression analysis adjusted for important clinical factors. \nCardiovascular events include ACS, stroke, stent thrombosis and death. \nRESULTS: A total of 227 patients [male 89%, median age 54 years] were included. Of these, 25.6% were PAP users and \n72.2% were NAP users. During hospitalization, CV events for PAP and NAP were 5.2% vs 4.3% respectively (adjusted \nOR=1.22; 95% CI 0.30-4.94; p=0.774). On the other hand, bleeding complication was 5.2% for PAP users and 4.3% for NAP \nusers (adjusted OR=1.33; 95% CI 0.32-5.58; p=0.695). \nCONCLUSION: Prior antiplatelet use before PPCI was not associated with lower risk of CV events and bleeding \ncomplications during hospitalization in patients who had PPCI after adjustment for common factors. However, this is a small \nretrospective analysis and need exploring in future studies. \n \nKEYWORDS: clinical research, Selangor, prior antiplatelet use, percutaneous coronary intervention \nNMRR ID: NMRR-17-1166-35048 \n \n \nPP-34 (Poster) \nTHE IMPACTS OF PICTORIAL AND CONVENTIONAL LABELLED TOPICAL MEDICATION ON THE \nPATIENT\u2019S UNDERSTANDING \n \nLim ES1, Abdullah NW2, Lim JY3 \n\n\n\n \n1Hospital Sultanah Bahiyah, Ministry of Health Malaysia,2Klinik Kesihatan Kuah, Ministry of Health Malaysia,3Klinik \nKesihatan Tanjung Piandiang, Ministry of Health Malaysia \n \nINTRODUCTION: An effective topical treatment is highly dependent on patients\u2019 understanding on the instruction printed \non the labels. \nOBJECTIVE: This study aimed to compare the patients\u2019 understanding on pictorialand conventional labels in topical therapy, \nand to evaluate patients\u2019 opinion towards both comparing groups. \nMETHOD: This study was conducted by interviewing the patients using a content validated structured questionnaire, which \nincludes indication, site, sequence, frequency, time and duration. Patients were selected using convenient sampling, and were \nassigned into control group (conventional label), and interventional group (pictorial label) using simple randomization. The \ndata were then be analyzed by using chi-square analysis and Fisher exact test. Mann-Whitney test was used to correlate the \ntotal understanding across the groups, genders, ethnics, and education levels. \nRESULTS: 100 patients were recruited into this study. The results showed that patients in interventional group have better \nunderstanding compared with patients in control group (p<0.001). The comprehension p-values of patients in interventional \ngroup (n=53) are indication (n=52, p<0.001), site (n=53, p<0.001), sequence (n=51, p<0.001), frequency (n=51, p<0.001), \ntime (n=53, p<0.001), duration (n=53, p<0.001). However, there are no significant different in correlation of the genders, \nethnics, and education levels, with the comprehension scores.  \nCONCLUSION: Pictorial label has improved patient\u2019s understanding on drug instruction compared to conventional label. \nPatients recommend to include pictorial label in all types of medication to improve patient\u2019s understanding.  \n \nKEYWORDS: impact of pharmacy services, Kedah, pictogram, conventional labelling, topical medication \nNMRR ID: NMRR-16-2491-32537 \n  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nPP-35 (Poster) \nA QUALITATIVE STUDY IN TABLET SPLITTING: EXPLORING PATIENT EXPERIENCES AT HOSPITAL \nTUANKU FAUZIAH (HTF) \n \nShukran NS1, Kong LH1, Ahmad Sabri AM1 \n\n\n\n \n1Department of Pharmacy, Hospital Tuanku Fauziah, Ministry of Health Malaysia \n \nINTRODUCTION: Tablet splitting is a practice where tablets of higher strengths are broken into halves, or quarters to provide \nthe patient with the prescribed dose. However, there are problems associated with this process. The accuracy of dividing the \ntablets will depend on the patients, tablets, device and technique used. \nOBJECTIVE: The main purpose of this study was to assess patients\u2019 experience towards tablet splitting. \nMETHOD: This was a qualitative study that explored 30 patients\u2019 experience on tablet splitting from September 2015 to \nJanuary 2016. The subjects were among the outpatients and inpatients of HTF recruited using purposive sampling METHOD. \nSemi-structured interviews were conducted to consented patients until saturation was achieved. The data was then analyzed \nby thematic analysis \nRESULTS: The study showed that most of the patients splitted the tablets by themselves while others required assistance \nfrom family members. Interviews revealed that most of the subjects splitted the tablet by hand. Most of the subjects also \nclaimed that they were compliant to the split dose prescribed while some still missed their doses due to various reasons. \nMajority of the subjects split the tablets prior to consumption and a few of them split the tablets days before consuming. Half \nof the subjects agreed that there were no problem for them to split the tablets. \nCONCLUSION: Patients in this study split the tablets by hands or other devices but are unsure about the proper method to \nprevent the tablets from getting crushed. There was no clear impact that tablet splitting affected compliance. \n \nKEYWORDS: quality use of medicines, Perlis, qualitative study, tablet splitting, compliance \nNMRR ID: NMRR-15-2237-28449 \n \n \nPP-36 (Poster) \nEVALUATION OF INITIAL VANCOMYCIN WEIGHT-BASED LOADING DOSE IN END STAGE RENAL \nFAILURE PATIENTS \n \nDarnalis NM1, Husain NF1, Chang E2 \n\n\n\n \n1Department of Pharmacy, Hospital Sultan Abdul Halim, Ministry of Health Malaysia, 2Department of Medical, Hospital \nSultan Abdul Halim, Ministry of Health Malaysia \n \nINTRODUCTION: Appropriate dosing of antibiotic may reduce the development of antimicrobial resistance. There are many \nreferences of vancomycin dose in end stage renal failure (ESRF) patients. In our local setting the current practice is to give \nvancomycin dose of 20mg/kg as initial loading dose. \nOBJECTIVES: This study aimed to determine the adequacy of current initial vancomycin dose by reviewing the resultant \ntrough level. \nMETHOD: This observational study was conducted from December 2016 until December 2017. All ESRF patients who \nstarted with intravenous vancomycin, on high flux dialyzer if haemodialysis is done, and sampling time on day 3 after initiation \nof vancomycin were included. Descriptive statistics were used to depict the demographic data and proportions of patients \nachieving therapeutic range and those not achieving therapeutic range. Percentage of patients that achieved subtherapeutic \n(<15 mg/L), therapeutic (15.1 \u2013 20.0 mg/L) and supratherapeutic level (>20.1 mg/L) were calculated. \nRESULTS: Out of 35 patients, majority achieved therapeutic level (n=18, 51.4%) followed by subtherapeutic level (n=15, \n42.9 %) and only 5.7% (n=2) achieved supratherapeutic level. The overall mean \u00b1 SD serum vancomycin concentration is 15.3 \n\u00b1 3.6 (95% CI, 14.1 to 16.5 mg/L).However, no associations between age, race, urine output, gender and dialysis with \nvancomycin level were identified. \nCONCLUSION: This study revealed that initial vancomycin weight based loading dose of 20mg/kg is adequate to be used in \nESRF patients. Nevertheless, further study with larger sample size is needed to evaluate other factors that may affect \nvancomycin level. \n \nKEYWORDS: clinical research, Kedah, vancomycin, end stage renal failure, Methicillin-Resistant Staphylococcus Aureus \nNMRR ID: NMRR-16-1783-32736 \n  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nPP-37 (Poster) \nSUPPLY, DEMAND AND NEED OF PHARMACIST IN MALAYSIA; PROJECTIONS UNTIL 2030 \n \nAzhar K4, Jasmin MA1, Mahani AH1, Mastura MT1, Mohammad ID3, Nordin S2, Rahayu S1, Rohaizat Y1 \n\n\n\n \n1Planning Division, Ministry of Health, Putrajaya, 2Sarawak State Health Department, Kuching, Ministry of Health Malaysia, \n3University Teknikal Malaysia, Melaka (UTeM), 4University Malaysia Pahang (UMP) \n \nINTRODUCTION: A situational analysis of Human Resource for Health (HRH) in Malaysia was conducted for 2016-2030. \nIn developing a strategic vision and plan, it is crucial to have an optimal number workforce to ensure the aim Universal Health \nCoverage (UHC) is achieved.  \nOBJECTIVE: This study focuses on the Supply, Demand and Need of pharmacist in Malaysia until 2030 to assist policy \nmakers identify future need of pharmacist based on current production trends.  \nMETHOD: System Dynamic using Vensim software as a tool was used to project the supply of pharmacist until 2030 as this \nmethod is able to simulate the dynamic behaviour of complex healthcare services.The models analyse the number based on \nprevious trends of employment. The Need in the model refers to 100 percent requirement of pharmacist to attend to all direct \npatients care services, enforcement, regulatory and administrative duty. Demand refers to the requirement of pharmacist using \nretrospective utilization data. Gap analysis is done by comparing between projected Supply versus Demand and Need.  \nRESULTS: The study shows the projected supply of pharmacist will meet the Demand by 2029. However, the projected \nSupply will not meet the Need even by 2030. In 2016, the actual number of pharmacist was 10,508 and to achieve the Need \nanother 37,773 newly registered pharmacist are needed. The projected density Need for pharmacist in Malaysia in 2017 is 4.8 \nper 10,000 population and goes up to 11.7 per 10,000 population in 2030, which is lower than average OECD countries 10 -\n11 per 10,000 population.  \nCONCLUSION: With the current student intake estimated 2,000 per year for local intake and 200 per year for overseas \ngraduate, Malaysia will be able to meet the Need somewhere beyond 2030. Thus, a coordinated feedback mechanism is \nrequired to balance the country\u2019s pharmacist supply and demand and need. \n \nKEYWORDS: health informatics, Putrajaya, pharmacist, projections, human resource, Malaysia \nNMRR ID: NMRR-14-903-21795 \n \n \nPP-38 (Poster) \nRISK FACTORS IN TYPE 2 DIABETES MELLITUS (T2DM) AMONG ADOLESCENTS IN THE STATE OF \nKEDAH, MALAYSIA: A CROSS-SECTIONAL PILOT STUDY \n \nAbdul Ghani N1, Mohd Mansor N1, Syed Hassan SNF1, Ahmad MH2 \n\n\n\n \n1Department of Pharmacy, Hospital Sultanah Bahiyah, Ministry of Health Malaysia,2Department of Pharmacy, Hospital \nSelama, Ministry of Health Malaysia \n \nINTRODUCTION: Type 2 Diabetes Mellitus (T2DM) is currently considered one of the main chronic diseases affecting \nsociety, in all biological and economy-social stages. T2DM was considered rare among adolescents: however various authors \nhave reported increased incidence among adolescents in recent years. \nOBJECTIVE: This study aimed to identify risk factors for T2DM among adolescents in Kedah and assessing their knowledge \non obesity and risk of diabetes mellitus. \nMETHOD: Questionnaires were distributed to probe the sociodemographic, sedentary and dietary lifestyle and physiological \naspects. Biochemical evaluation was conducted in assessing BMI and blood glucose level. \nRESULTS: Approximately 38.7% of the participants were overweight and 82.25% were sedentary. About 48.4% of the \nparticipants have at least two risk factors of T2DM which were in looming condition. Overall knowledge score was poor; \nmean\u00b1SD total score was 25.97\u00b119.45 which suggested the participants were not being exposed or acknowledged on obesity \nand the risk factors of diabetes mellitus. \nCONCLUSION: A comprehensive strategy and approach need to be established by the Malaysian healthcare system to \nimprove prevention and control of T2DM among adolescents. \n \nKEYWORDS: clinical research, Kedah, risk factors, diabetes mellitus, obesity, adolescents \nNMRR ID: NMRR-16-2093-32627 \n  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nPP-39 (Poster) \nREASONS FOR AMPHETAMINE-TYPE-STIMULANT (ATS) USE AMONG CLIENTS IN GOVERNMENT AND \nPRIVATE METHADONE MAINTENANCE TREATMENT (MMT) PROGRAMS IN THE DISTRICT OF \nKUANTAN, PAHANG \n \nRuzmayuddin M1, Singh D2, Vicknasingam B2 \n\n\n\n \n1Pejabat Kesihatan Daerah Kuantan, Ministry of Health Malaysia, 2Centre for Drug Research, Universiti Sains Malaysia \n \nINTRODUCTION: The use of amphetamine-type-stimulants (ATS) during methadone maintenance treatment (MMT) \nprogram can adversely affect treatment adherence and fuel HIV spread. \nOBJECTIVE: This study aims to investigate the reasons for ATS use among clients in MMT program. \nMETHOD: 237 current methadone users participated in this cross-sectional study. Respondents were recruited through \nsnowball sampling from four government (n=129) and two private (n=108) MMT facilities in Kuantan, Pahang. All the surveys \nwere conducted via face-to-face interviews, and respondents were also screened for illicit drug use. \nRESULTS: The respondents mean age in this study was 37.7 years. Half (50%, n=118/237) were above 38 years old, majority \nMalays (96%, n=228/237) and only 17% (n=39/237) were unemployed.The clients average daily methadone dose in this study \nwas 52.78mg. Fifty-five percent (n=130/237) used less than 50mg of methadone dose daily, while 45% (n=107/237) used \n>51mg of methadone. More than one-third (35%, n=86/147) self-reported using ATS 1 to 3 days a week, while 26% \n(n=61/147) used ATS >4 days a week. Seventy-five percent (n=179/237) have current methamphetamine and amphetamine \nuse history (90%, n=214/237). The main reasons given for using ATS include to improve work productivity (85%, n=202/237), \nto increase energy (83%, n=196/237), to feel happy (72%, n=170/237), to increase self-confidence (67%, n=158/237), to \nreduce methadone dependence (51%, n=120/237), to ease methadone side-effects (40%, n=95/237), to ease psychological \nproblems (39%, n=92/237), to increase sex performance (37%, n=87/237), and as a sex stimulant (32%, n=77/237).  \nCONCLUSION: Our results provide an insight on the high occurrences of ATS use among clients in MMT program in \nMalaysia. Perhaps, the use of ATS could be attributed to the insufficient dose of methadone, as well as treatment \nmisconceptions. Future studies must make an attempt to determine the HIV risk behaviours of ATS users in MMT program.  \n \nKEYWORDS: impact of pharmacy services, Pahang, amphetamine, Methadone Maintenance Treatment (MMT),. \nNMRR ID: NMRR-15-2448-26899 \n \n \nPP-40 (Poster) \nASSESSMENT OF PUBLIC KNOWLEDGE AND PERCEPTION TOWARDS CHILDHOOD VACCINATION IN \nPERLIS, MALAYSIA \n \nNasir N1, Ghazali II1, Zainun WNA1, Tan KY1 \n\n\n\n \n1Department of Pharmacy, Hospital Tuanku Fauziah, Ministry of Health Malaysia \n \nINTRODUCTION: Childhood vaccination protects children from a variety of serious communicable diseases. However, in \nMalaysia there are growing numbers of parents questioning the safety and necessity of routine childhood vaccination, hence \nrefusing immunization. This increases the risk of vaccine preventable diseases. \nOBJECTIVE: Our study aimed to assess knowledge and perception of the public towards childhood vaccination and their \nassociations with demographic factors.  \nMETHOD: A cross-sectional study was conducted from August to December 2017 in Perlis. Through convenient sampling, \nvalidated questionnaires were distributed to Perlis citizens aged above 18 year-old. The data was analyzed using SPSS v20.0. \nRESULTS: Of 387 participants included in the study, majority (n=229, 59.2%) of the respondents were female, university \ngraduates (n=271, 70%), and Muslims (n=347, 89.7%). The results revealed that (n=252, 65.1%) of the public have good \nknowledge while (n=254, 65.6%) of the public have good perception towards childhood vaccination. Most of them (n=227, \n58.7%) obtained the information from social network, followed by healthcare provider (n=226, 58.4%) and television (n=211, \n54.5%). There is a significant association between gender, age, educational background, occupation and income with the level \nknowledge and perception towards vaccination (p<0.05). Marital status and children also has significant association with \nperception.  \nCONCLUSION: The study showed that citizen in Perlis has acceptable knowledge and perception on some aspects related to \nchildhood vaccination. Educational interventions should be focused on lower income group of the society in improving the \npublic knowledge and perception on the childhood vaccination.  \n \nKEYWORDS: pharmacoepidemiology & drug safety, Perlis, knowledge, perception, childhood, vaccination \nNMRR ID: NMRR-17-2641-37868 \n \n \n \n \n \n \n \n \n \n\n\n\n\n\n"
"\n\n12\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\n\n\n\n\nStability of an Extemporaneously Prepared Alcohol-Free Phenobarbitone \nOral Suspension \n \nLian T. Chan*, Lucy Yeoh \n \nWinwa Medical Sdn Bhd, Bukit Mertajam, Pulau Pinang, Malaysia. \n \n* Contact for correspondence, please email: ltchan@winwamedical.com \n \n \n \nABSTRACT \n \nMany drugs used in paediatric are often not available in suitable dosage forms and have to be \nextemporaneously prepared by pharmacists to make them suitable for the body weight, body \nsurface area, or age of the children. Phenobarbitone is the main anti-epileptic drug (AED) for \nthe treatment of seizure in paediatric patients. The objective of this study is to evaluate the \nphysicochemical and microbiological stability of an extemporaneously prepared \nPhenobarbitone Oral Suspension using commercially available tablets and X-temp Oral \nSuspension System. The Phenobarbitone Oral Suspension (10mg/ml) was stored at 4\u00baC and \n30\u00baC / 75%RH protected from light and were examined at the interval of 0, 1, 2, 3 and 6 \nmonths. The content of Phenobarbitone was determined using a validated high-performance \nliquid chromatography (HPLC) method. The visual appearance, odour, pH and specific \ngravity remained fairly unchanged throughout the study period and the content of \nPhenobarbitone remained above 98% of the original concentration throughout the course of \nthe study for both temperatures. The extemporaneous preparation was not susceptible to \nmicrobial contamination. The results from the stability studies confirmed that X-temp Oral \nSuspension is a suitable suspending vehicle for preparing extemporaneous liquid formulation \nof Phenobarbitone Oral Suspension with the added advantage of alcohol-free, colourant-free \nand sugar-free. Based on the data collected, the shelf-life of this liquid formulation is at least \n6 months when stored at 4\u00baC (refrigeration) and 30\u00baC / 75%RH (room temperature).  \n \n \n\n\n\n \nINTRODUCTION \n \nThe pharmaceutical industry supplies oral solid dosage forms that are generally inadequate \nfor paediatric needs. Most licensed oral medicines are intended for adults and are presented \nas tablet or capsule formulations, often in a unit intended as a single adult dose. Some are \navailable as liquids, but have a concentration unsuitable for measuring the dose and \nadministering to the infant or young children (1).   \n \nMany drugs used in paediatrics are often not available in suitable dosage forms and have to \nbe extemporaneously prepared by pharmacists to make them suitable for the body weight, \nbody surface area, or age of the children. Paediatric patients are also more vulnerable to the \neffects of a medication error and may experience a more serious adverse drug reaction than \nan adult, due to the differences in weight or body surface area and because of the varying \nability to metabolize and excrete medications (2). \n \nPharmacists are often required to prepare the extemporaneous preparation and they also face \nthe challenge to choose an appropriate formula. Ideally, the pharmacist should choose \nformulation used for extemporaneous preparation with validated stability and proven shelf-\n\n\n\n\n\n\n\n\n13\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\n\n\n\n\nlife. However, the information related to the extemporaneous formulations and the stability of \nthe final products are lacking (3,4). When the stability data and validated formulations are not \navailable, further research should be carried out to validate the formulations used in practice \nwhenever possible and then the formulations should be standardized among all the hospitals \n(5).  \n \nPhenobarbitone is highly effective for all forms of epilepsy except typical absences in \npatients of all ages, including neonates. It is still a main anti-epileptic drug (AED) for \nneonatal and febrile seizures (if treatment is needed) and established convulsive status \nepilepticus. It is the main monotherapy AED in resource-poor countries (6).  \n \nPhenobarbitone exerts its anti-epileptic activity through multiple modes of action. Its primary \neffect is probably through its post-synaptic binding to GABAA receptors. It also blocks \nvoltage-sensitive sodium and potassium channels, reduces presynaptic calcium influx and \npossibly inhibits glutamate-mediated currents (6).  \n \nPhenobarbitone (Figure 1) is a white, odourless, glistening, small crystals or a white \ncrystalline powder. It may exhibit polymorphism. Soluble 1 in 1000 of water and 1 in 10 of \nalcohol; sparingly soluble in chloroform; soluble in ether and in solutions of fixed alkali \nhydroxides and carbonates. A saturated solution in water has a pH of about 5 (7). \n \n\n\n\nFigure 1: Phenobarbitone \n\n\n\n \n \nSince licensed medicines represent the \u2018gold standard\u2019 for quality, safety and efficacy, the \nunderlying general rule is that a licensed preparation is always preferable to a compounded \none (8). However, the currently available commercial oral liquid formulation of \nPhenobarbitone contains 14% (v/v) alcohol. The American Academy of Pediatrics (AAP) has \nraised the concern with regard to the alcohol content of various medications. AAP \nrecommended that nonprescription oral liquid preparations contain no more than 5% (v/v) \nalcohol because of the risk of harmful central nervous system adverse effects (9). \n \nPhenobarbitone Oral Suspension was prepared in hospital practice for the treatment of seizure \nin paediatric patients. Phenobarbitone has poor solubility (1 mg/ml) but it is freely soluble in \nethanol (100 mg/ml). Therefore, for this reason alcohol is often used in Phenobarbitone \nsolutions. For neonates, as well as for children who use Phenobarbitone for the treatment and \nprevention of seizures, there is a need for an easy to administer liquid oral dosage form of \nPhenobarbitone without alcohol (10, 11). In order to increase the solubility of \nPhenobarbitone, a cosolvent system without alcohol should be created using mixtures of \nvarious oral cosolvents. Sorbitol, glycerin, propylene glycol, and several polyethylene glycol \npolymers are cosolvents that are both useful and acceptable in the formulation of oral liquids \n(10). \n \nTo address this problem, a liquid formulation has to be developed whose suitability and \nstability must be optimized and shelf-life determined. This present study intends to provide \n\n\n\n\n\n\n\n\n14\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\n\n\n\n\nthe information and data to help the pharmacist to determine the shelf-life of the \nextemporaneous preparation of Phenobarbitone commonly prepared in the hospital.  \n \nThe use of commercially and universally available suspending bases is encouraged, \nparticularly where information on the stability of such bases is available in the literature (12). \nCommercial available oral liquid vehicles, such as X-temp Oral Suspension System are a \nconvenient choice for pharmacists, since many practice settings may not stock a wide variety \nof excipients and many of the stability studies in the literature on oral liquids prepared \nextemporaneously utilize these commercial vehicles (13). \n \nThe objective of this study is to evaluate the physicochemical and microbiological stability of \nextemporaneously prepared Phenorbarbitone Oral Suspension and to determine the shelf-life \nand storage condition of the extemporaneous preparation. This information is important to \nensure that the extemporaneous preparation remains stable and efficacious during the course \nof their use. \n \nMATERIALS AND METHODS \n \nCommercial Drug and Vehicle \nThe commercially available tablet, Phenobarbitone 30mg Tablet (in blister pack) \nmanufactured by Idaman Pharma Sdn Bhd was sourced for this study. X-temp Oral \nSuspension System marketed by Pharm-D Sdn Bhd was selected for this extemporaneous \npreparation. X-temp Oral Suspension System is an oral suspending system specially \nformulated to assist in extemporaneous preparation of oral liquid, non-soluble (suspended), \naqueous dosage forms. It is an orange flavoured, sweetened, alcohol-free, colourant-free, \nsugar-free vehicle containing suitable preservatives. Furthermore, it also contains cosolvents \n(sorbitol and glycerin) which is useful for this liquid formulation to increase the solubility of \npoorly water-soluble substances (10).  \n \nSample Preparation \nPhenobarbitone Oral Suspension containing 10mg/ml was prepared using the commercial \navailable tablets. The required numbers of tablet were grounded to a fine powder in a mortar \nwith a pestle. A portion of the vehicle was used to levigate the fine powder to form a uniform \npaste. Additional vehicle was added to the mortar in small portions and then transferred to a \ngraduated container and more vehicle was added to make the total volume required. \n \nThirty bottles of Phenobarbitone Oral Suspension (10mg/ml) were packed into 100ml amber \nhigh-density polyethylene (HDPE) plastic bottles and were fitted with white polypropylene \n(PP) screw caps. Twelve bottles were stored at 4 \u00b1 2\u00baC (refrigeration) and the other eighteen \nbottles at 30 \u00b1 2\u00baC / 75 \u00b1 5%RH (room condition) in the absence of light.  \n \nAnalytical Method and Equipment \nThe Phenobarbitone content in the oral suspension was assayed throughout the course of the \nstudy (0, 1, 2, 3 and 6 months) according to the in-house HPLC method with reference to the \nBritish Pharmacopoeia 2014. The analysis was performed using Agilent 1200 RRLC \ninstrument with UV/VIS detector and the content of Phenobarbitone was set at 90 to 110% of \nthe stated amount (14). The HPLC method for the analysis of Phenobarbitone in this study \nwas validated in another study for its specificity, linearity, accuracy, precision and system \nsuitability (Table 1). A range performed on the HPLC system has confirmed the linearity of \nthe method (R2 = 0.99999) (Figure 2).  \n \n\n\n\n\n\n\n\n\n15\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\n\n\n\n\nTable 1: Results of analytical method validation \nTest Parameter Validation Results Acceptance Limits \n\n\n\n \nSpecificity \nIdentification  \nComparison with a known \nreference material \n \nAssay \nPlacebo/Matrix analysis \n\n\n\n\t\n\t\n\u00a7 Positive result \n\u00a7 No peaks at RT 4 min \n\n\n\n\n\n\n\n\u00a7 No interfering peaks from diluent \nand placebo were observed \n\n\n\n\u00a7 Placebo effect = 0.43% \n\u00a7 The placebo effects were found to \n\n\n\nbe insignificant\t\n\t\n\n\n\n\t\n\t\n\u00a7 Positive control: Positive result \n\u00a7 Negative control: Absence of \n\n\n\npeak at RT 4 min \n \n\u00a7 No interference from \n\n\n\nexcipients \n\u00a7 Placebo effect NMT 1.5%\t\n\n\n\n \nLinearity & Range  \n\n\n\n \n\u00a7 r2 = 0.9999982 \n\u00a7 Intercept = 0.35% of the response \n\n\n\nof 100% working concentration\t\n\t\n\n\n\n \n\u00a7 r\u00b2 \u2265 0.995 \n\u00a7 Y-Intercept at 100% working \n\n\n\nconcentration \u2264 2%\t\n\n\n\n \nAccuracy  \n9 determination (3 \nreplicates/3 concentrations) \n\n\n\n\t\n\u00a7 98.1%, 98.2%, 98.7%, 98.5%, \n\n\n\n99.0%, 98.5%, 98.9%, 100.5%, \n99.1% \n\n\n\n\n\n\n\n\t\n\u00a7 % Recovery within 95% to \n\n\n\n105% \n\n\n\n \nPrecision (Repeatability) \n6 determinations at 100% \nworking concentration \n \n\n\n\n\t\n\u00a7 RSD = 0.66% \n\n\n\nCI = \u00b1 0.70% assayed \n\t\n\n\n\n\t\n\u00a7 RSD \u2264 2.0% & CI \n\n\n\n\n\n\n\n \nPrecision (Reproducibility) \n6 determinations at 100% \nworking concentration \n \n\n\n\n \n\u00a7 RSD = 0.50% \n\n\n\nCI = \u00b1 0.52% assayed \n \n\n\n\n \n\u00a7 RSD \u2264 2.0% & CI \n\n\n\n \nPrecision  \n(Intermediate Precision/ \nRuggedness) \n\n\n\n \n\u00a7 RSD in case of comparison = \n\n\n\n0.58% \n\u00a7 Mean difference = 0.34% \n \n\n\n\n \n\u00a7 RSD \u2264 2.0% & CI \n \n\u00a7 Mean difference \u00b1 2% & CI \n\n\n\n \nDetection Limit (LOD) \n \n\n\n\n \n\u00a7 LOD = 0.000225 mg/ml \n \n\n\n\n- \n\n\n\n \nQuantitation Limit (LOQ) \n \n \n\n\n\n \n\u00a7 LOQ = 0.000824 mg/ml \n \n\n\n\n- \n\n\n\n \nSystem Suitability  \na) System precision \n \n \nb) Peak performance \n\n\n\n \n \n\u00a7 RSD for peak response = 0.07% \n\u00a7 RSD for peak retention time = \n\n\n\n0.06% \n\u00a7 k' = 1.712 \n\u00a7 Resolution = 26.910 \n\u00a7 USP tailing factor = 1.017 \n\u00a7 Column efficiency, N = 13525 \n \n\n\n\n \n \n\u00a7 RSD \u2264 2% \n\n\n\n\n\n\n\n\u00a7 k' \u2264 1.5 \n\u00a7 Resolution >2 \n\u00a7 USP tailing factor < 2  \n\u00a7 Column efficiency, N \u2265 2000 \n\n\n\n\n\n\n\n\n\n\n\n\n\n16\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\n\n\n\n\nFigure 2: Calibration Curve of the LC assay method \n \n \n\n\n\n\n\n\n\n \nThe content of Phenobarbitone was measured by HPLC-UV method after the sample of \nextemporaneous preparation was made throughout the stability study period. Samples were \nremoved from each individual bottle on 0, 1, 2, 3 and 6 months. A working reference \nstandard of Phenobarbitone was obtained from British Pharmacopoeia Commission, United \nKingdom. \n \nThe HPLC system used for the analysis was an Agilent 1200 RRLC instrument with binary \npump SL, autosampler SL, DAD SL detector, Thermostat Column Compartment SL and \nchemstation. The chromatographic separation used was Zorbax Eclipse XDB-C18 (4.6mm ID \nx 150mm, 5\ufffdm). The DAD detector operated at 230nm. The mobile phase consisted of a \nmixture of 72 volumes of a mixture of 0.1M disodium hydrogen phosphate (Na2HPO4) and \n0.026M potassium dihydrogen phosphate (KH2PO4) phosphate buffer adjusted to pH 7 with \n10% (v/v) orthophosphoric acid 85% and 28 volumes of acetonitrile. The mobile phase was \ndelivered at a flow rate of 1ml/min. Samples were filtered before HPLC analysis and the \ninjection volume as 5\ufffdL. \n \nPhysicochemical Stability \nThe analyses of physical and chemical testing (such as visual appearance, odour, pH, specific \ngravity and active content) which could possibly change during storage were assessed at 0, 1, \n2, 3 and 6 months. Prior to sample removal, the bottles were agitated on a rotating mixer for \n30 minutes. The oral suspension was examined at each sample time for any change in \nappearance (colour and clarity) or odour. The pH was determined using a pH meter at initial \nand 1, 2, 3 and 6 months during storage for both temperatures. The preparation is considered \nstable if physical characteristics have remained fairly unchanged and the assay of \nPhenobarbitone content has remained equal or above 90% of the original concentration \nduring the study period. \n \n \n \n\n\n\n\n\n\n\n\n17\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\n\n\n\n\nMicrobiological Stability \nMicrobiological stability of the Phenobarbitone Oral Suspension stored at the two different \nstorage conditions (4\u00baC and 30\u00baC) was studied at the interval of 0, 1, 2, 3 and 6 months. The \nmicrobial limit test was designed according to the British Pharmacopoeia 2014 for non-sterile \nproducts to determine whether the total bacteria, total fungi and Escherichia coli (E. coli) in \nthe extemporaneous preparation complies with the established specifications for \nmicrobiological quality of this type of product (15). \n \nRESULTS AND DISCUSSION \n \nPhysicochemical Stability \nThe visual appearance and odour of the Phenobarbitone Oral Suspension remained the same \nthroughout the 6 months at 4\u00baC and 30\u00baC and no precipitation was observed in any of the \nsamples (Table 2). The results from this study also confirmed that the pH values and the \nspecific gravity of the extemporaneous preparations remained fairly constant at both \ntemperatures (Table 3).  \n \n\n\n\nTable 2: Visual appearance and odour of Phenobarbitone Oral Suspension \n\n\n\nVisual Appearance (Colour and Clarity) \nTime (Month) 0 1 2 3 6 \n\n\n\n4\u00baC White to off-\nwhite & opaque \n\n\n\nWhite to off-\nwhite & opaque \n\n\n\nWhite to off-\nwhite & opaque \n\n\n\nWhite to off-\nwhite & opaque \n\n\n\nWhite to off-\nwhite & opaque \n\n\n\n30\u00baC White to off-\nwhite & opaque \n\n\n\nWhite to off-\nwhite & opaque \n\n\n\nWhite to off-\nwhite & opaque \n\n\n\nWhite to off-\nwhite & opaque \n\n\n\nWhite to off-\nwhite & opaque \n\n\n\nOdour \nTime (Month) 0 1 2 3 6 \n\n\n\n4\u00baC Orange Orange Orange Orange Orange \n30\u00baC Orange Orange Orange Orange Orange \n\n\n\n \nTable 3: pH and specific gravity of Phenobarbitone Oral Suspension  \n\n\n\npH \nTime (Month) 0 1 2 3 6 \n\n\n\n4\u00baC 4.115 4.145 4.061 4.182 4.128 \n30\u00baC 4.115 4.159 4.151 4.182 4.105 \n\n\n\nSpecific Gravity \nTime (Month) 0 1 2 3 6 \n\n\n\n4\u00baC 1.0322 1.0284 1.0393 1.0427 1.0426 \n30\u00baC 1.0322 1.0323 1.0294 1.0423 1.0406 \n\n\n\n \nThe Phenobarbitone content in all the samples were above 98% throughout the 6 months for \nboth temperatures (Table 4) and were relatively stable in acidic pH. There were no \nsignificant differences in the assay results between the two storage conditions to establish any \npossibility of degradation during storage even though the rate of chemical degradation \nusually increases with temperatures (16). The chromatograms illustrated below showed that \nthe HPLC method to be selective for the purpose of this study with minimal interference from \nthe excipients in the formulation (Figure 3). The chromatograms of tested samples at the \ndifferent intervals throughout the stability study period revealed no other peak that could be \nattributed to a possible degradation compound. \n \n \n\n\n\n\n\n\n\n\n18\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\n\n\n\n\nTable 4: Concentration of Phenobarbitone Oral Suspension  \nAssay  \n\n\n\nTime (Month) 0 1 2 3 6 \n4\u00baC 98.5% 98.2% 98.8% 101.5% 102.2% \n\n\n\n30\u00baC 98.5% 99.9% 100.0% 100.7% 101.3% \n \n\n\n\nFigure 3: Chromatograms of Phenobarbitone standard solution and  \nPhenobarbitone Oral Suspension \n\n\n\n \nPhenobarbitone standard solution \n\n\n\n\n\n\n\n\n\n\n\nPhenobarbitone Oral Suspension \n \n\n\n\n\n\n\n\n \nThe above results confirmed that the temperature has little effect on the physical and \nchemical stabilities of the active content in the Phenobarbitone Oral Suspension. Storage in \nthe refrigerator may not be considered necessary.  \n \nMicrobiological Stability \nNo microbial contamination was observed in all samples of Phenobarbitone Oral Suspension \nduring the 6 months study period for both temperatures (Table 5) and the results confirmed \nthat the microbial quality was within the established test limits according to the British \nPharmacopoeia. The total viable aerobic bacteria count was kept low and total yeast and \nmould count was also low. E. coli was absent throughout the study period. These results \nshowed that the preservatives of the extemporaneous preparation were effective against \nbacteria and fungi and the Phenobarbitone Oral Suspension is microbiologically stable at both \ntemperatures for up to 6 months.  \n \n \n\n\n\n\n\n\n\n\n19\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\n\n\n\n\nTable 5: Microbial results of Phenobarbitone Oral Suspension \n\n\n\nMicrobial Limit (4\u00baC) \nTime (Month) 0 1 2 3 6 \n\n\n\nTotal aerobic \nmicrobial count <10cfu/g <10cfu/g <10cfu/g <10cfu/g <10cfu/g \n\n\n\nTotal yeast & \nmoulds count <10cfu/g <10cfu/g <10cfu/g <10cfu/g <10cfu/g \n\n\n\nEscherichia coli Conforms Conforms Conforms Conforms Conforms \n\n\n\nMicrobial Limit (30\u00baC) \nTime (Month) 0 1 2 3 6 \n\n\n\nTotal aerobic \nmicrobial count <10cfu/g <10cfu/g <10cfu/g <10cfu/g <10cfu/g \n\n\n\nTotal yeast & \nmoulds count <10cfu/g <10cfu/g <10cfu/g <10cfu/g <10cfu/g \n\n\n\nEscherichia coli Conforms Conforms Conforms Conforms Conforms \n\n\n\n \nCONCLUSIONS \n \nAn extemporaneously prepared Phenobarbitone Oral Suspension using X-temp Oral \nSuspension System is stable for at least 6 months when packed in amber HDPE bottle with \nplastic screw cap at 4\u00baC (refrigeration) and 30\u00baC / 75%RH (room condition). This liquid \nformulation is also microbiologically stable throughout the course of the study which is \ncritical for the safe use of extemporaneous preparations in paediatric patients. The results \nfrom the stability studies confirmed that X-temp Oral Suspension is a suitable suspending \nvehicle for preparing extemporaneous liquid formulation of Phenobarbitone Oral Suspension. \nThis formulation is not only stable but has the added advantage of alcohol-free, colourant-\nfree and sugar-free.  \n \nThe extemporaneous preparation of Phenobarbitone Oral Suspension can now be prepared \nwith ease by pharmacists in the hospital practice by using X-temp Oral Suspension System \nsupported by stability data and proven shelf-life. \n \nACKNOWLEDGEMENTS \n \nThe author wished to thank Pharm-D Sdn Bhd for its support in providing the commercial \nproducts required for this stability study and BioScenergy International Sdn Bhd for its \nfinancial support. \n \nREFERENCES \n \n1. Nunn AJ. Making medicines that children can take. Arch Dis Child 2003; 88:369-371. \n2. Benavides S, Huynh D, Morgan J, Briars L. Approach to the pediatric prescription in a \n\n\n\ncommunity pharmacy. J Pediatr Pharmacol Ther 2011; 16(4):298-307. \n3. Brion F, Nunn AJ, Rieutord A. Extemporaneous (magistral) preparation of oral medicines \n\n\n\nfor children in European hospitals. Acta Paediatrica 2004; 92:486-490. \n4. Flores-Perez QAC, Flores-Perez J, Juarez-Olguin H, Barranco-Garduno LM. Frequency \n\n\n\nof drug consumption and lack of pediatric formulations. Acta Pediatrica de Mexico 2008; \n29(1):16-20. \n\n\n\n5. Lowey AR, Jackson MN. A survey of extemporaneous preparation in NHS trusts in \nYorkshire, the North-East and London. Hospital Pharmacist 2008; 15(6):217-219. \n\n\n\n\n\n\n\n\n20\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\n\n\n\n\n6. Panayiotopoulos CP. A clinical guide to epileptic syndromes and their treatment. 2th ed. \nUnited Kingdom: Springer Healthcare Ltd; 2010. \n\n\n\n7. Sweetman SC. Martindale: The Complete Drug Reference. 36th ed. United Kingdom: \nPharmaceutical Press; 2009. \n\n\n\n8. Aquilina A. The extemporaneous compounding of paediatric medicines at Mater Dei \nHospital. Journal of the Malta College of Pharmacy Practice 2013: 19:28-30. \n\n\n\n9. Cober MP, Johnson CE. Stability of an extemporaneously prepared alcohol-free \nphenobarbital suspension. Am J Health-Syst Pharm 2007; 64(6):644-646. \n\n\n\n10. Jelveghari M, Nokhodchi A. Development and chemical stability studies of alcohol-free \nphenobarbital solution for use in paediatrics: a technical note. AAPS PharmSciTech 2008; \n9(3):939-943. \n\n\n\n11. Yska JP, Essink GW, Bosch FH, Lankhaar G, van Sorge AA. Oral bioavailability of a \nphenobarbital: a comparison of a solution in Myvacet 9-08, a suspension, and a tablet. \nPharm World Sci 2000; 22(2):67-71. \n\n\n\n12. Jackson M, Lowey A. Handbook of Extemporaneous Preparation. United Kingdom: \nPharmaceutical Press; 2010. \n\n\n\n13. Haywood A, Glass BD. Liquid dosage forms extemporaneously prepared from \ncommercially available products \u2013 considering new evidence of stability. J Pharm \nPharmaceut Sci 2013; 16(3):441-455. \n\n\n\n14. British Pharmacopoeia (2014). Volume I & II - Monographs: medicinal and \npharmaceutical substances. London, England: British Pharmacopoeia Commission; 2014. \n\n\n\n15. British Pharmacopoeia (2014). Volume V. Appendix XVI B - Microbiological \nexamination of non-sterile products. London, England: British Pharmacopoeia \nCommission; 2014. \n\n\n\n16. Woods DJ. Extemporaneous formulation of oral liquids \u2013 a guide. \nhttp://www.pharminfotech.co.nz/manual/Formulation/extemprep.pdf (5 November 2009). \n\n\n\n\n\n"
"\n\n\n\n\n\n\n\n\n\nPROCEEDINGS of \n\n\n\n28th Federation of Asian \n\n\n\nPharmaceutical Associations, MPS-\n\n\n\nNational Pharmacists Convention \n\n\n\n2022 \n\n\n\n\n\n\n\n10th - 12th November 2022 \n \nVenue: Kuala Lumpur Convention Centre, Malaysia \n\n\n\nTheme: Pharmacists Building a Better Healthcare \n\n\n\nSystem \n\n\n\n\n\n\n\nEditors \n \n\n\n\nChan Siok Yee \n\n\n\nMai Chun Wai  \n\n\n\nChua Siew Siang \n\n\n\nGan Siew Hua \n\n\n\nMohamad Haniki bin Nik Mohamed \n\n\n\nMohd Zulkefeli bin Mat Jusoh \n\n\n\nMohd bin Makmor Bakry \n\n\n\nParaidathathu Thomas A/L P.G. Thomas \n\n\n\n\n\n\n\nPublisher:  \n\n\n\n\n\n\n\nMalaysian Pharmacists Society  \n\n\n\n16-2 Jalan OP 1/5, 1-Puchong Business Park  \n\n\n\nOff Jalan Puchong, 47160 Puchong, Malaysia  \n\n\n\n \n\u00a9 Malaysian Journal of Pharmacy \n\n\n\n\n\n\n\n\n\n\n\nISSN 1675-3666 \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n47 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\n\n\n\n\nOral Presentation  \n \n\n\n\n\n\n\n\nCommunity Pharmacy  \n\n\n\n \nAbstract 001 \n\n\n\nPharmacists\u2019 Perceptions on Future Implementation of A Medication Review Service \n\n\n\nModel in Community Settings: A Qualitative Study Utilising the Consolidated \n\n\n\nFramework for Implementation Research (CFIR) and the Expert Recommendations for \n\n\n\nImplementing Change (ERIC) strategy tool \nMaali Mujahid, Ernieda Hatah*, Mohd Makmor-Bakry \n\n\n\n\n\n\n\nAbstract 002 \n\n\n\nRole of Community Pharmacist in Cardiovascular Diseases-Related Health Promotion \n\n\n\nand Dyslipidemia Management in Malaysia: A Cross-Sectional Study \n\n\n\nFarhana Fakhira Ismail, Adyani Md Redzuan*, Chong Wei Wen \n\n\n\n\n\n\n\nAbstract 003 \n\n\n\nA Survey of the Adoption and Perception of Mobile Health Applications Among \n\n\n\nCommunity Pharmacists in Malaysia \n\n\n\nHui Leng Ng, Jason Siau Ee Loo*, Renukha Sellappans \n\n\n\n\n\n\n\nAbstract 004 \n\n\n\nInvestigating Pharmacy Value-Added Services (PVAS) in Community Pharmacies: A \n\n\n\nStudy in Urban and Suburban Areas of Perak, Malaysia \nZaswiza Mohamad Noor*, Nik Nur \u2018Alya Nik Pa \n\n\n\n\n\n\n\n\n\n\n\nHospital Pharmacy  \n \n\n\n\nAbstract 005 \n\n\n\nEvaluation of Anticoagulation Control in Patients with Atrial Fibrillation \nAdyani Md Redzuan*, Azeta Abdullah, Chandini Menon A/P Premakuma, Farah Waheeda  Tajurudin \n\n\n\n\n\n\n\nAbstract 006 \n\n\n\nPrediction of Aspirin Induced Gastric Toxicity and Resistance in Rats Using NMR-Based \n\n\n\nPharmacometabonomics \n\n\n\nIbrahim B*, Sha\u2019aban A, Zainal H \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n48 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 007 \n\n\n\nA Study on Adverse Effect Induced by Chemotherapy Drug Used For Colorectal Cancer \n\n\n\nand Their Management in Nepal Cancer Hospital and Research Center \n\n\n\nShrestha BM*, Bista D, Shakya R \n\n\n\n\n\n\n\nAbstract 008 \n\n\n\nAssessment of Patient Safety Culture among Healthcare Providers in A Tertiary Hospital \n\n\n\nat Johor Bahru, Malaysia \n\n\n\nSok May Cheong*, Palanisamy Sivanandy, Pravinkumar Vishwanath Ingle \n\n\n\n\n\n\n\nAbstract 009 \n\n\n\nHerbal Medicine Tool: Identifying Herbal Users among Malaysian Women \n\n\n\nFarida Tengku Azlan Shah Tengku Mohamad, Jamia Azdina Islahudin*, Malina Jasamai Jamal \n\n\n\n\n\n\n\nAbstract 010 \n\n\n\nPharmacists\u2019 Virtual Consultations for Diabetes Patients in Malaysia: Impact on \n\n\n\nMedication Adherence and Glycaemic Control \nLoganadan NK*, Tse Yeen Soong, Wai Han Lee, Hui Ling Tong, Phei Ching Lim, Sin YeNg, Nur Diniah \n\n\n\nShaharum, Wan Ruwaida Wan Mokhtar, Siong Hung Ting, Aziani Yacob, Wai Yin Yong, Kai Yin Go, \n\n\n\nRodhiah Abd Rahman, Shamala Ayadurai, Huay Sin Tan \n \n\n\n\nAbstract 011 \n\n\n\nThe Impact of Pharmacist-Managed Titration Clinic (PMTC): A Pilot Study \n\n\n\nPoh Lee Geetha Ng*, Syafiqah Abdul Jalil, Nurish Ezzantie Mishan, Nur Asyikin Mohd Yunus, Michelle \n\n\n\nMaryanne Tan, Nik Qistina Nik Ramli, Norhawani Mansor, Kok Han Chee, Nor Aziah Abdullah \n\n\n\n\n\n\n\nAbstract 012 \n\n\n\nComparison of Eight Methods for Estimation of Creatinine Clearance in Patients with \n\n\n\nUnstable Kidney Function \u2013 A Multi-center, Prospective, Observational Study from \n\n\n\nMalaysia. \nYen Ping Ng*, Chee Ping Chong, Ee Siung Liew, Shye Ling Teoh, Cheng Hoon Yap \n\n\n\n\n\n\n\nAbstract 013 \n\n\n\nExposure to Potentially Harmful Excipients in Medications among Neonates at A State \n\n\n\nHospital in Malaysia \n\n\n\nNoraida Mohamed Shah*, Shien Woan Wong, Soo PiingChew, Siti Azdiah Abdul Aziz \n\n\n\n\n\n\n\nAbstract 014 \n\n\n\nAntiseizure Medication Prescribing: A Glimpse of Current Practice in A Ministry of \n\n\n\nHealth Tertiary Care Centre \n\n\n\nRusli RA*, Makmor Bakry M, Mohamed Shah N, Hung KY, Loo XL \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n49 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 015 \n\n\n\nAssessment of Anticoagulation Control, Bleeding, and Thromboembolic Complications \n\n\n\nin Anticoagulation Medication Therapy Adherence Clinic (ACMTAC) Service in \n\n\n\nMalaysia \n\n\n\nSahimi Mohamed, Wardati Mazlan Kipli, Nik Azlean Nik Ismail, Jivanraj R Nagarajah \n\n\n\n\n\n\n\nAbstract 016 \n\n\n\nAssessment of Psychological Health among PLWH during COVID-19 and Its Association \n\n\n\nwith Antiretroviral Therapy Adherence \n\n\n\nAbdul-Aziz SA, Islahudin F, Shukri AH \n\n\n\n\n\n\n\nAbstract 017 \n\n\n\nRole of Pharmacist in Providing Pharmaceutical Care to Tuberculosis Patients in Tertiary \n\n\n\nCare Paediatric Hospital \nFaraz Ashraf \n \n\n\n\n\n\n\n\nIndustrial Pharmacy and Marketing \n \n\n\n\nAbstract 018 \n\n\n\nImpact of a Communication Skills Training Program on Malaysian Hospital Pharmacists\u2019 \n\n\n\nPatient-Centred Communication Attitudes and Behaviours \n\n\n\nYew Keong Ng, Noraida Mohamed Shah, Timothy F Chen, Navin Kumar Loganadan, Shue Hong Kong, Yi \n\n\n\nYun Cheng, Siti Shahida Md Sharifudin, Wei Wen Chong \n\n\n\n\n\n\n\nAbstract 019 \n\n\n\nRapid Quantitative Estimation of Favipiravir in Rat Plasma by Liquid Chromatography-\n\n\n\nTandem Mass Spectroscopy and its Application to Pharmacokinetic Studies \n\n\n\nP D Sri Lakshmi*, G Venkateswarulu, D Srinivasa Sumalatha, P Geetha Bhavani Sastry \n\n\n\n\n\n\n\nAbstract 020 \n\n\n\nTreatment Burden, Medication Adherence and Health Literacy in Elderly with \n\n\n\nMultimorbidity \n\n\n\nSelvakumar D*, Sivanandy P, Ingle PV, Theivasigamani K, Kumar S, Shanmugham S \n\n\n\n\n\n\n\nAbstract 021 \n\n\n\nPrEP Talk: A Multivariate Analysis Exploring the Awareness, Attitude, and Preference \n\n\n\nof Filipino University Students in Metro Manila toward Human Immunodeficiency \n\n\n\nVirus (HIV) Pre-Exposure Prophylaxis (PrEP) \nErnest Van Rito*, Danica Jane Rubi, Mila Iloiza Sangcap, Alicia Alaine Descargar, Kenneth Domdom, Renz \n\n\n\nMarion Ricafrente, Zedierick Tanjista \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n50 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 022 \n\n\n\nRisk of Haemorrhagic Stroke due to Methamphetamine Abuse - A Case Series \n\n\n\nJ John Kirubakaran*, Mina Jafarnia, Farzaneh Raveshi \n\n\n\n\n\n\n\nAbstract 023 \n\n\n\nKnowledge, Attitude, and Practices among Filipinos towards Vitamin D \n\n\n\nSupplementation amidst the Pandemic \n\n\n\nJoseph Samuel S. Anthony*, Earrol Jem R. Berdos, Swituel S. Guevarra, Daniella G. Tulabut, Elvira V. De \n\n\n\nLeon. \n\n\n\n\n\n\n\nAbstract 024 \n\n\n\nTherapeutic Effects and Possibilities of Citrus maxima (Pomelo) Leaves Aqueous Extract \n\n\n\nof a Commercial Product \nJia Rou Khor, Siok Yee Chan* \n\n\n\n\n\n\n\nAbstract 025 \n\n\n\nKnowledge, Attitude, and Practice of the Medical Practitioners towards Adverse Drug \n\n\n\nReactions Reporting \n\n\n\nKirthikaa Gopal Krishnan*, Palanisamy Sivanandy, Nafeeza Bt Hj Mohd Ismail \n\n\n\n\n\n\n\nAbstract 026 \n\n\n\nAdoption of Machine Learning Algorithms in Predicting Vaccine Hesitancy: A Narrative \n\n\n\nReview \n\n\n\nMunaver Ahmad Nazir Ahmad*, Nour Hanah Othman, Irraivan Elamvazuthi, Zaswiza, Mohamad Noor \n\n\n\n\n\n\n\nAbstract 027 \n\n\n\nKnowledge, Attitude, and Acceptance on Coronavirus Disease (COVID-19) Vaccination \n\n\n\nAmong Non-allied Health Individuals in the Greater Manila Area (Metro Manila, \n\n\n\nBulacan, Cavite, Laguna, and Rizal), Philippines \n\n\n\nRose Anne Chua*, Asia Nykyle Stefanie Abello, Samantha Jillian Araneta, Paolo Jose De Los Santos, Kim \n\n\n\nShekinah Mei Hosena, Mary Patricia Joson, Christine Janelle Mataga, Gizelle Parado, Jennie Wong \n\n\n\n\n\n\n\nAbstract 028 \n\n\n\nThe Interaction between Herbal Extract and Eudragit Polymer Blend on Physicochemical \n\n\n\nand Mechanical Characteristics of Core/shell Composite Orodispersible Films \n\n\n\nSiew Mei Tan, Siok Yee Chan* \n\n\n\n\n\n\n\nAbstract 029 \n\n\n\nRemoving Communication Barrier between Pharmacy and Deaf Patients \n\n\n\nNur Azrida Azhari Wasi, Ching Wern Chong, Yoshnni M Navaneethan*, Muhammad Fikree Ahmad, Siti \n\n\n\nNur-Hussaini Mohamad Termizi, Umi Aqilah Amir, Mohd Firdaus Abdullah, Sharmili Retnam, Yuan Wah \n\n\n\nLoo, Farid Ahmad Nasir, Siti Rahimah Mohd Radzi, Suhaila Mustaffa, Noor Azwani Abd Samad, Narian \n\n\n\nSingh Sadu Singh \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n51 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\n\n\n\n\nPharmacy Education \n \n\n\n\nAbstract 030 \n\n\n\nDigital Health Perception among the Pharmacy Students of Asian Countries \n\n\n\nAbdishakur Hassan Mohamed*, Rohit Kumar Verma, Palanisamy Sivanandy, Manisha Pandey, Jayashree \n\n\n\nMayuren \n\n\n\n\n\n\n\nAbstract 031 \n\n\n\nAcademic Restructuring towards Flexible Learning in Philippine Pharmacy Education \n\n\n\nAleth Therese L. Dacanay, Maria Fay Nenette M. Cariaga*, Vina Rose D. Talan, Shiela DV Miranda, Ellen \n\n\n\nMae P. Abiqui \n\n\n\n\n\n\n\nAbstract 032 \n\n\n\nA Shared Culture of Caring in the Time of the COVID-19 Pandemic: The Essence of \n\n\n\nInterprofessional Collaboration as Perceived by Pharmacy and Medical \n\n\n\nTechnology/Medical Laboratory Science Students \n\n\n\nLangit MRD*, Abesamis RAS, Adonis LD , Agustin AJR, Amoy NNT, Aquino GRM, Archog XMGD, Ayeo \n\n\n\nSS, Baladad AGB, Balocating JLZ, Baquir AMG \n\n\n\n\n\n\n\nAbstract 033 \n\n\n\nKnowledge, Awareness, Acceptability, and Perceived Research Misconduct among the \n\n\n\nSchools of Pharmacy in Malaysia \n\n\n\nWan Ping Ng, Khong Yun Pang, Pei Boon Ooi, Chia Wei Phan* \n\n\n\n\n\n\n\nAbstract 034 \n\n\n\nSmoking Cessation Problem-based Learning: Virtual Experience \n\n\n\nSoraya Ismail*, Mohamad Haniki Nik Mohamed \n\n\n\n\n\n\n\nAbstract 035 \n\n\n\nContinuing Professional Development: A Need Assessment among Pharmacists in \n\n\n\nMalaysia \n\n\n\nSyireen Alwi*, Siew Siang Chua, May Hoi Lee, Mei Hui Tang \n\n\n\n\n\n\n\n\n\n\n\nSocial and Administrative Pharmacy  \n \n\n\n\nAbstract 036 \n\n\n\nPotential Roles of Pharmacists in HIV/AIDS Care Delivery in Nepal: A Qualitative Study \n\n\n\nAyushma Shahi, Sweta Shrestha, Badri K.C, Khagendra Acharya, Sait Kumar Pradhan \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n52 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 037 \n\n\n\nAssessing Health Literacy among The Newly Diagnosed Type 2 Diabetes and Pre-\n\n\n\ndiabetes Patients in Malaysia \n\n\n\nAzrina Ely Ahmad Azhari, Jim Chai, Claire Anderson \n\n\n\n\n\n\n\nAbstract 038 \n\n\n\nPerspectives and Challenges Managing Older Adults: A Qualitative Study with Primary \n\n\n\nHealth General Practitioners and Pharmacists In Penang, Malaysia \n\n\n\nChristina Malini Christopher*, Ali Qais Blebil, Bhuvan KC, Deepa Alex, Mohamed Izham Ibrahim \n\n\n\n\n\n\n\nAbstract 039 \n\n\n\nKnowledge, Attitude and Practice of Filipinos on Sunscreen Utilisation \n\n\n\nAndrea Gail A. Cunanan, Ryah Monique C. Fernandez, Jermie Anne S. Li,Christine Marie S. Terrado \n\n\n\n\n\n\n\nAbstract 040 \n\n\n\nA Strategy to Strengthen Halal Pharmamedlog Initiatives by Malaysian Armed Forces - \n\n\n\nFirst Government Agency in the World \n\n\n\nNur Hidayah AR, Muhammad Najhan MB, Mohd Azrizal MR, Mohd Adlan A, A Halim B \n\n\n\n\n\n\n\nAbstract 041 \n\n\n\nThe Stress, Satisfaction, and Fulfilment of Early Career Pharmacists \u2013 A Qualitative \n\n\n\nStudy of their Professional and Personal Lives \n\n\n\nPY Chee, LV Tan, CCW Lee, BBN Choo, WL Cheong \n\n\n\n\n\n\n\nAbstract 042 \n\n\n\nHealth Care Team Patterns through Perception of Interprofessional Interaction Between \n\n\n\nPharmacists and Medical Technologists in a City in Northern Philippines \n\n\n\nLangit MRD, Estacio BRB, Estrella JIOV, Galicio FIF, Gamino CDR, Gloria JAA, Gomez PNC, Hamadain \n\n\n\nSKIL, Hulipas LEM, Jamandre CAD, Lababit AMM \n\n\n\n\n\n\n\nAbstract 043 \n\n\n\nFoundation and Advanced Competencies of Community and Hospital Pharmacists in \n\n\n\nNorthern Philippines \n\n\n\nLangit MRD, Aum RVD, Balaki BKT, Barroga, DAF, Bete CD, Cari\u00f1o NJP, Lim AGP, Mangubat NSJ, \n\n\n\nObedoza CDL, Umagat JM \n\n\n\n\n\n\n\nAbstract 044 \n\n\n\nThe Pharmacist\u2019s Contribution During the COVID 19 Pandemic: Medicine Delivery \n\n\n\nServices \nMohamad Aizuddin Mohamad Noor, Zaswiza Mohamad Noor \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n53 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 045 \n\n\n\nA Narrative Review of Vaccine Hesitancy in Childhood Immunisation in Malaysia. \nNour Hanah Othman*, Munaver Ahmad Nazir Ahmad, Mohammed Tahir Ansari \n\n\n\n\n\n\n\nAbstract 046 \n\n\n\nElectronic Prescription Services Trends across Community Pharmacies in Malaysia \n\n\n\nHui Yin Yow, Jason Siau-Ee Loo, Yi Yang Ten, Megat Helmi Mohd Zubairi, Nusaibah Abdul Rahim* \n\n\n\n\n\n\n\nAbstract 047 \n\n\n\nImproving Knowledge, Attitude, and Perception of Falls among the Geriatric Population \n\n\n\nthrough Educational Intervention \n\n\n\nPriya Manirajan*, Palanisamy Sivanandy, Pravinkumar Vishwanath Ingle \n\n\n\n\n\n\n\n\n\n\n\nScientific  \n \n\n\n\nAbstract 048 \n\n\n\nMussel-inspired Mucoadhesive Gelatine Film Loaded with Cetylpyridinium Chloride \n\n\n\nAmina Ahmady, Nor Khaizan Anuar, Siti Alwani Ariffin, Nor Hayati Abu Samah* \n\n\n\n\n\n\n\nAbstract 049 \n\n\n\nDesign of Degenerate, Universal Primers for Multiplex PCR Determination of Biofilm-\n\n\n\nFormation in Staphylococcus aureus, Pseudomonas aeruginosa, Klebsiella pneumoniae, \n\n\n\nand Escherichia coli \nClodualdo F. Narciso III, Deo Raphael A. Paloma, Dan Ira King M. Tuatis, Sigfredo B. Mata* \n\n\n\n\n\n\n\nAbstract 050 \n\n\n\nIn vitro Anticancer Activity of Myriostachya wightiana Whole Plant Methanolic Extract \n\n\n\non Breast, Hepatocellular and Colorectal Cancer Cell Lines \n\n\n\nAnupama Dasi*, Y. Indira Muzib3 \n\n\n\n\n\n\n\nAbstract 051 \n\n\n\nInvestigation of Pittosporum molucannum Plant Extracts as Potential Source of Natural \n\n\n\nBiopesticides \n\n\n\nMelissa June Paderog*, Remi Charlene Salvilla \n\n\n\n\n\n\n\nAbstract 052 \n\n\n\nDocking Study Using Vina for Phytochemicals from Mangifera zeylanica to Treat \n\n\n\nDengue \n\n\n\nMohamed Jiffry Ifran, Mohamed Jaffry Rizzaly, Mudalige Heshani, Perera Ominda \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n54 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 053 \n\n\n\nSynergistic Killing of Polymyxin B Combinations with Chloramphenicol Derivatives \n\n\n\nagainst Multidrug Resistant (MDR) Klebsiella pneumoniae \n\n\n\nNurulain Idris, Nusaibah Abdul Rahim*, Kok Hoong Leong, Eng Hwa Wong \n\n\n\n\n\n\n\nAbstract 054 \n\n\n\nEffect of B. hispida Seed Extract towards Protein Expression of AHR, OVOL-1 and \n\n\n\nCYP1A1 \n\n\n\nRamli RZ, Hadi H \n\n\n\n\n\n\n\nAbstract 055 \n\n\n\nEffect of Retinoic Acid Loaded Nanosponge Gel-cream Formulation vs Commercial \n\n\n\nFormulation in Animal Model \nSyed Omar SS, Hadi H, Doolanea AA \n\n\n\n\n\n\n\nAbstract 056 \n\n\n\nGenotyping of SNPs in ABCB1 (rs1045642, rs1128503) and OPRM1 (rs1799971, rs9479757) \n\n\n\nAssociated with Pain Control and Adverse Effects of Morphine among Cancer Pain \n\n\n\nPatients in Malaysia \nShobha Elizabeth Satkunananthan, Sabrina Anne Stephen, Hui Yin Yow, Vijayaprakash Suppiah, Fauziah \n\n\n\nAb Aziz, Hasriza Hashim, Gaik-Theng Toh* \n\n\n\n\n\n\n\nAbstract 057 \n\n\n\nEvaluation of the CYP1A2, CYP2D6, and CYP3A4 Inhibition by the Ten DOH-Approved \n\n\n\nPhilippine Medicinal Plants using Enzyme-Specific Fluorometric Substrates in Pooled \n\n\n\nHuman Liver Microsomes \n\n\n\nSigfredo B. Mata*, Hadiyya Mary Glenn A. Paraiso, Alicia P. Catabay \n\n\n\n\n\n\n\nAbstract 058 \n\n\n\nNeuroprotective Effects of Palm Oil Derived Tocotrienol-Rich Fraction in Aluminium \n\n\n\nChloride Induced Vascular Dementia Rats \n\n\n\nShaikh Sohrab A., Muthuraman Arunachalam*, Rajavel Varatharajan \n\n\n\n\n\n\n\nAbstract 059 \n\n\n\nPharmacokinetics of Loratadine after Intranasal Application of Its Gel Formulation \n\n\n\nSophia S. Pagaran*, Bea May I. Remedio, Gerard Lee L. See \n\n\n\n\n\n\n\nAbstract 060 \n\n\n\nAnomalous Dissolution Enhancement of Aged Supersaturated Electrospun Solid \n\n\n\nDispersion System \n\n\n\nXin Yi Teoh, Siok Yee Chan* \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n55 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\n\n\n\n\nAbstract 061 \n\n\n\nPhytochemical Investigation and Antioxidant Activity Determination using ORAC \n\n\n\nAssay of the Dried Bark and Fresh Leaves of Pterocarpus indicus Willd. (Fam. Fabaceae) \nBengala, TJL, Mata, SB, Catabay, AP \n\n\n\n\n\n\n\n\n\n\n\nPoster Presentation \n \n\n\n\n\n\n\n\nCommunity Pharmacy  \n \n\n\n\nAbstract 062 \n\n\n\nPharmacist\u2019s Preferences, Evaluation and Perceptions of Telepharmacy Application \n\n\n\nServices: A Pilot Study \n\n\n\nAdelin Suraya Mokhtar, Ezlina Usir, Munaver Ahmad Nazir Ahmad \n\n\n\n\n\n\n\nAbstract 063 \n\n\n\nRole of Pharmacist during the COVID-19 Pandemic in Taiwan: A Scoping Review \n\n\n\nBen Chen \n\n\n\n\n\n\n\nAbstract 064 \n\n\n\nEvaluation of the Efficacy of Valproic Acid used in Residents of A Long-term Care \n\n\n\nInstitution \n\n\n\nYC Chen, JY Huang, CY Wu, KP Chen, ZA Peng \n\n\n\n\n\n\n\nAbstract 065 \n\n\n\nPatients\u2019 Perspective on Community Pharmacy Services of a Ward (10) of Kathmandu \n\n\n\nMetropolitan \n\n\n\nDurga Bista*, Ankita Ojha, Badri K.C \n\n\n\n\n\n\n\nAbstract 066 \n\n\n\nPeace, Love and Care of Medicine on Radio Broadcasts \n\n\n\nYP Hsiang*, CL Tai, CF Chiang, MT Cheng, FS Hong, LC Liu \n\n\n\n\n\n\n\nAbstract 067 \n\n\n\nEffectiveness of Individualized Health Education Provided by Volunteer Pharmacists on \n\n\n\nTier C Local Stations \n\n\n\nYN Hsieh*, CM Hsiao, CS Chen, ML Chen, SL Lee, CP Hsu \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n56 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 068 \n\n\n\nExploring the Role of Pharmacy as A Community Drug Addiction Counselling Centre \n\n\n\nJungkeun Lee*, Seungwan Moon, Jungwha Yoon \n\n\n\n\n\n\n\nAbstract 069 \n\n\n\nEstablishment of the Betel Nut-free Environment by Community Pharmacists: A Pilot \n\n\n\nStudy in Taiwan \n\n\n\nI-Hsuan Lee*, Yu-Chieh Cheng, Tzu-Chun (Frank) Chou, Hung-Chang (Ivan) Chou* \n\n\n\n\n\n\n\nAbstract 070 \n\n\n\nDirect Selling of Nootropic Drugs in An E-commerce Platform in the Philippines \n\n\n\nGwyne Kylie P. Gumapac, Jonas L. Miranda, Beryll N. Nacar, Sigfredo B. Mata* \n\n\n\n\n\n\n\nAbstract 071 \n\n\n\nPharmacists Approach to Specialty Care Facilities for People who have Parkinson\u2019s \n\n\n\nDisease \n\n\n\nHashimoto M*, Shogen T., Sugita N. \n\n\n\n\n\n\n\nAbstract 072 \n\n\n\nExploring the Lived Experiences of Community Pharmacists\u2019 on Pharmacy-Based \n\n\n\nImmunization: A Phenomenological Study \n\n\n\nKarl Kirby Z. Costales, Maureen Canda-Borcelas*, Hazel Joy B. Da-anton, Raye Marie P. Damole, Ruby \n\n\n\nFelina D. Mahinay \n\n\n\n\n\n\n\nAbstract 073 \n\n\n\nCurrent Contributions and Future Opportunities for Community Pharmacists during the \n\n\n\nCOVID-19 pandemic in Taiwan \n\n\n\nNai-Hwa Mei* \n\n\n\n\n\n\n\nAbstract 074 \n\n\n\nKnowledge, Attitude and Barriers to Compliance for the Pharmacy Support Workforce \n\n\n\nRequirements and Responsibilities on the Philippine Pharmacy Act \nNoelle Marie H. Fontanilla*, Nimfa B. Gambalan, Vieno Gino Cruz, Mark Harvey B. Adamson \n\n\n\n\n\n\n\nAbstract 075 \n\n\n\nKnowledge, Attitude and Perception of Community Pharmacists on Teleconsultation \n\n\n\nNoor Batrisyia Auni Zaidisam*, Mathumalar Loganathan, Munaver Ahmad Nazir Ahmad, Ezlina Usir, \n\n\n\nAdelin Suraya Mokhtar \n\n\n\n\n\n\n\nAbstract 076 \n\n\n\nAnalysis on the Effectiveness of Education Program for Improving Accessibility of \n\n\n\nPharmacy Involvement in HIV Care \nShao Ti Hsu*, Ling Chun Liao, Yu Chen Wang, I-Hsuan Lee, Tzu-Chun Chou \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n57 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 077 \n\n\n\nUnderstanding the Influencing Factors of Telepharmacy Implementation in Taiwan: A \n\n\n\nQualitative Study \n\n\n\nWen Hsiu Lin*, I-Hsuan Lee  \n\n\n\n\n\n\n\nHospital Pharmacy  \n \n\n\n\nAbstract 078 \n\n\n\nAnalysis of the Effectiveness of OSCE Applied to Hospital Pharmacy Training \n\n\n\nWJ Chen, CK Huang, SF Huang \n\n\n\n\n\n\n\nAbstract 079 \n\n\n\nUsing Beers Criteria for Older Inpatients to Assess Rational Drug Use at A Public \n\n\n\nHospital in Taiwan \n\n\n\nCT Chen, MS Li \n\n\n\n\n\n\n\nAbstract 080 \n\n\n\nOptimising the Evaluation Efficiency of Integrated Outpatient Clinic Prescriptions \n\n\n\nCW Chang, JF Chen \n\n\n\n\n\n\n\nAbstract 081 \n\n\n\nAnti-COVID-19 Drugs Induced Elevated Liver Enzymes: A Case Series \n\n\n\nKuang-Yu Chou, Yi-Ping Hsiang \n\n\n\n\n\n\n\nAbstract 082 \n\n\n\nDose-related Study of Opioid Use in Critically Ill Patients Receiving Extracorporeal \n\n\n\nMembrane Oxygenation Maintenance System \n\n\n\nChu-Chen Cheng, Wen-Hwang Chen \n\n\n\n\n\n\n\nAbstract 083 \n\n\n\nUtilisation of Cardiovascular Drugs among Pulmonary Hypertension with Valvular \n\n\n\nHeart Disease Patients before Valve Surgery \n\n\n\nFarizan Abdul Ghaffar*, Adyani Md Redzuan, Mohd Makmor-Bakry \n\n\n\n\n\n\n\nAbstract 084 \n\n\n\nAn Evidence-based Therapy of Secondary Hyperparathyroidism \n\n\n\nFU YU Yang, Wen Jin Tung \n\n\n\n\n\n\n\nAbstract 085 \n\n\n\nStatistical Analysis on Outpatient\u2019s Referral for Individual Medication Guidance by \n\n\n\nPharmacists \n\n\n\nYP Hsiang*, YT Chiu, YC Kuo \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n58 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\n\n\n\n\nAbstract 086 \n\n\n\nEfficiency of Pharmacists\u2019 Pre-intervention for Elderly Outpatients with Polypharmacy \n\n\n\nHsin-Yi Chou, Chiou-Maan Lin, Yuk-Ying Chan, Shin-Tarng Deng \n\n\n\n\n\n\n\nAbstract 087 \n\n\n\nAnalysis of Severe Cases Risk Factors and Potential Drug-drug Interactions (DDIs) in \n\n\n\nPatients Receiving Oral Anti-COVID-19 Virus Drugs \n\n\n\nYC Hsu*,   YP Hsiang \n\n\n\n\n\n\n\nAbstract 088 \n\n\n\nAnalysis Potential Drug-drug Interactions (DDIs) and Risk Factors in COVID-19 Patients \n\n\n\nReceiving Oral Anti-Virus Drugs Paxlovid\u00ae and Molnupiravir \n\n\n\nYC Hsu*, YP Hsiang \n\n\n\n\n\n\n\nAbstract 089 \n\n\n\nThe Evaluation of Inpatient Oral COVID-19 Medication Utilisation in Medical Centers \n\n\n\nof Southern Taiwan \n\n\n\nYu Ci Lai*, Yi Ping Hsiang, Hsiu Ling  Chang, Lei Yu Chang \n\n\n\n\n\n\n\nAbstract 090 \n\n\n\nRetrospective Study of Drug Use Assessment for Plerixafor \n\n\n\nWen-Ling Lin*, Yow-Wen Hsieh \n\n\n\n\n\n\n\nAbstract 091 \n\n\n\nCase Report of Suspect Adverse Effects of Piperacillin/Tazobactam Induced Drug Fever \n\n\n\nHP Liu, YC Hsu, YP Hsing \n\n\n\n\n\n\n\nAbstract 092 \n\n\n\nInnovation and Evaluation of the Outdoor Outpatient Pharmacy in Response to COVID-\n\n\n\n19 Epidemic: A Pilot Study at A Regional Hospital in Southern Taiwan \n\n\n\nTsun-Pin Liu, Wen-Jun Wong, Heng-Jung Chen2, Yaw-Bin Huang* \n\n\n\n\n\n\n\nAbstract 093 \n\n\n\nDrug Utilization Evaluation of Remdesivir in A Regional Teaching Hospital in Southern \n\n\n\nTaiwan \n\n\n\nBJ Lyu*, YCHsu, YP Hsiang \n\n\n\n\n\n\n\nAbstract 094 \n\n\n\nSurvival Analysis of COVID-19 Patients Admitted in a Tertiary Government Hospital in \n\n\n\nNueva Ecija: A Preliminary Report on the Compassionate Use of Remdesivir \n\n\n\nLapuz, Huberto F., Estolano, Melvin R., Magno, Jem Marie L., De Guzman, Reina Elizabeth L., Gustilo, \n\n\n\nLailanie M., Arriola, Lordel M., Pascual, Marilou* \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n59 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 095 \n\n\n\nThe Prevalence of Pill Dysphagia Among Adult Hospitalised Patients in Hospital \n\n\n\nAngkatan Tentera Tuanku Mizan (HATTM) \nNorlizawati Moktar*, Rosman Ab Rahman, Nurul Amirah Daud, Rosmaliah Alias, Mohd Shahezwan Abd \n\n\n\nWahab, Mohammad Halif Mohamad Yusof, Mohd Adlan Adnan, A Halim Hj Basari \n\n\n\n\n\n\n\nAbstract 096 \n\n\n\nStandardization of Medication Bin Labelling with Quick Reference Information to \n\n\n\nReduce Medication Error and Improve Caller Waiting Time \n\n\n\nNursyafiqah Moideen, Norfaizah Bachok \n\n\n\n\n\n\n\nAbstract 097 \n\n\n\nDisaster Management Zone (DMZ): Military Pharmacists\u2019 Unconventional Innovation in \n\n\n\nResponding to Health Threats \n\n\n\nNurul Amirah Daud, Norlizawati Moktar, Mohammad Halif Mohamad Yusof, Mohd Adlan Adnan, A \n\n\n\nHalim Hj Basari \n\n\n\n\n\n\n\nAbstract 098 \n\n\n\nPrescription Error in Tertiary Military Hospital \u2013 Prevalence and Pattern \n\n\n\nNurul Amirah Daud, Norlizawati Moktar, Mohammad Halif Mohamad Yusof, Mohd Adlan Adnan, A \n\n\n\nHalim Hj Basari \n\n\n\n\n\n\n\nAbstract 099 \n\n\n\nSystematic Review on Questionnaires to Measure Medication Knowledge in Post Kidney \n\n\n\nTransplant Recipients \n\n\n\nNurul Syazfeeza Samsudin*, Nurkasihan Ibrahim, Mohd Shahezwan Abd Wahab, Jasmine Shan Lii Ching, \n\n\n\nMohd Adlan Adnan, A Halim Hj Basari \n\n\n\n\n\n\n\nAbstract 100 \n\n\n\nRelationship of Nutritional Status and Sepsis Mortality \n\n\n\nRoongthip Tangsaghasaksri \n\n\n\n\n\n\n\nAbstract 101 \n\n\n\nApplying Quality Control Tool Improves the Conformance Rate of Microbial Monitoring \n\n\n\nPerformed by Chemotherapy Pharmacists \nShu-Chuan Pi*, Yi-Ping Hsiang, Li-Ching Chang \n\n\n\n\n\n\n\nAbstract 102 \n\n\n\nThe Role of High Serum Uric Acid Levels in Androgenic and Non-Androgenic Polycystic \n\n\n\nOvarian Syndrome Patients \n\n\n\nSrinivasa Babu Puttagunta, Ranakishor Pelluri, Srikanth Kongara \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n60 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 103 \n\n\n\nLow-dose Cefepime Efficacy Evaluation Using Real-world Data \n\n\n\nTY Yi, AJ Wu \n\n\n\n\n\n\n\nAbstract 104 \n\n\n\nIncidence of Liver Injury in Patients Initiated with Antiretroviral Therapy in Primary \n\n\n\nCare Clinics \n\n\n\nKausalya Nawaratnam, Siow Chia Tay, Sumayyah Shafifi A Karim, Nur Khalidah Mohd Mus \n \n\n\n\nAbstract 105 \n\n\n\nEvaluation of Chinese Herbal Extracts on Eczema Skin \n\n\n\nSC Tseng, JS Wang, MM Lee \n\n\n\n\n\n\n\nAbstract 106 \n\n\n\nInterprofessional Collaborative Practice in HIV Patient: Role of Pharmacist in A Regional \n\n\n\nHospital \nTsung Wei Chang*, Chun-Ya Huang, Wen-Jin Tung \n\n\n\n\n\n\n\nAbstract 107 \n\n\n\nThe Prevalence of Major Drug\u2013drug Interactions in Patients Treated with Nirmatrelvir \n\n\n\nplus Ritonavir: A Retrospective Study \n\n\n\nTu Po-Yang*, Liu Min-Li, Hsu Yung-Chia, Hsiang Yi-Ping \n\n\n\n\n\n\n\nAbstract 108 \n\n\n\nUsing Plan-Do-Check-Action Management Methods to Improve Medication Errors in \n\n\n\nTaiwan Hospital \nYih-Dih Cheng2*, Wei-Ning Yu, Sonia Chen, Chun-Ju Kuo, Yo-Wen Hsieh \n\n\n\n\n\n\n\nAbstract 109 \n\n\n\nEvaluation of the Appropriateness of Antibiotics Doses in Critically Ill Patients \n\n\n\nReceiving Extracorporeal Membrane Oxygenation System [ECMO] \nWen-Hwang Chen, Chu-Chen, Cheng \n\n\n\n\n\n\n\nAbstract 110 \n\n\n\nReal-world Efficacy of Low-dose Cefepime: a Retrospective Study \n\n\n\nKR Yang, TY Yi, TR Peng, AJ Wu \n \n\n\n\nAbstract 111 \n\n\n\nThe Effectiveness of Pharmacist Intervention in Heart Failure Integrated Clinic \n\n\n\nYi-Fang Weng, Kai-Ruei Yang, Jui-Mei Tsuo, An-Jan Wu, Tzu-Rong Peng* \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n61 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 112 \n\n\n\nTopiramate May Not Increase Risk of Age-related Macular Degeneration: A Population-\n\n\n\nbased Cohort Study in Taiwan \u2013 A Preliminary Report \nSonia Chen, Ying-Shu You, Yih-Dih Cheng*, Yo-Wen Hsieh, Chien-Ying Lee, Kuang-Hua Huang \n\n\n\n\n\n\n\nAbstract 113 \n\n\n\nOptimisation of Medications by Pharmacists in A Respiratory Care Ward \u2013 The \n\n\n\nExperience from A Regional Hospital in Northern Taiwan \nCY Yu, SH Hsu \n\n\n\n\n\n\n\nAbstract 114 \n\n\n\nPrescription Patterns for Acute Myocardial Infarction (AMI) Patients in Secondary \n\n\n\nPrevention \n\n\n\nYun-Hsin Yang \n\n\n\n\n\n\n\nAbstract 115 \n\n\n\nManagement of COVID-19 Infection Combined with Bacteremia Pneumonia in Cancer \n\n\n\nPatients with Neutropenia: A Case Report and Literature Review \n\n\n\nChing- Chih, Huang, Chu-Chen, Cheng \n\n\n\n\n\n\n\n\n\n\n\nIndustrial Pharmacy and Marketing \n \n\n\n\nAbstract 116 \n\n\n\nAcetic Acid Derivatives Improve Cardiovascular Disease in Patients with Dyslipidemia \n\n\n\nChen-Sheng Chen, Bo-Yi Pan, Yu-Ting Hsu, Fang-Yu Chen, Wen-Chin Yang, Ming-Yi Shen* \n\n\n\n\n\n\n\nAbstract 117 \n\n\n\nAnalysis of Patient Self-administered Satisfaction Questionnaires in Psychiatric \n\n\n\nSpecialized Hospital \nChia chang Hsu*, Ting Luo, Tsung-Han Lin, Kuan-Yu Lin, Kuo-Tung Chiang, Szu-Nian Yang \n\n\n\n\n\n\n\nAbstract 118 \n\n\n\nDeveloping the Medication Reminder App to Improve Medication Adherence \n\n\n\nChin-Ju Chuang, Ya-Hsin Hsueh, Cheng-Ying Hsieh, Chiu-Yi Wu, Yi-Pin Chen, Pei-Ling Tsai, Yung-Cheng \n\n\n\nHuang, Shu-Chen Lin, Ying-Chun Chen, Yu-Chen Li, Zhi-Yu Tu, Ling-Chiao Liao* \n\n\n\n\n\n\n\nAbstract 119 \n\n\n\nDeterminants and Perceived Effectiveness of Self-Medication Practices for the \n\n\n\nPrevention or Treatment of COVID-19 Symptoms among Adults in Cavite \n\n\n\nNicole Allyson Carabeo, Nyah Grenadine Cortez, Heather Scarllette Manalo, Cyan Meniado, Francesca \n\n\n\nMarie Manansala, Diana Dalisay Orolfo* \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n62 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 120 \n\n\n\nKnowledge and Perception of the General Public in Cavite, Philippines on Counterfeit Medicines \n\n\n\nHannah Kristnel DV. Mesa, Danielle Marie J. Garduce, Alvin A. Vibar, Mirava A. Villamin, Katrice L. Binos* \n\n\n\n\n\n\n\nAbstract 121 \n\n\n\nCombined SGLT2 and ARNI Therapy to Reduce the Risk of Cardiovascular Disease in \n\n\n\nType II Diabetes: A Nationwide Population-base Cohort Study \n\n\n\nMing-Chi Hung, Chiu-Lan Chen ,Che- huei Lin*, Ming-hung Lin* \n\n\n\n\n\n\n\nAbstract 122 \n\n\n\nThe Impact of Service Marketing Mix toward Customer Purchase Behavior from \n\n\n\nPharmacy Services Online \n\n\n\nXue Min Ng*, Mei Teh Goi \n\n\n\n\n\n\n\nAbstract 123 \n\n\n\nPrediction of in vivo Performance of Dabigatran Capsules Produced in Nepal from in \n\n\n\nvitro (Dissolution) data Using Numerical Convolution Method \n\n\n\nKhanal,N, Budhathoki U, Bista D \n\n\n\n\n\n\n\nAbstract 124 \n\n\n\nThe Study of Drug Interactions between Herbal Medicine and Drugs \n\n\n\nYung-Huei Fu, Li-Heng Pao \n\n\n\n\n\n\n\n\n\n\n\nPharmacy Education \n \n\n\n\nAbstract 125 \n\n\n\nVarying Approaches for Modelling CPD \u2014 A Retrospective Review by Indonesian \n\n\n\nYoung Pharmacists Group \n\n\n\nAnggun P. Wardhani, Dwi P. Rahmawati, Rabella Mufti S, R. Aldizal Mahendra, I Made Bayu Anggriawan \n\n\n\n\n\n\n\nAbstract 126 \n\n\n\nAssessing the Clinical Competence of Entry-to Advanced-level Pharmacists using Case-\n\n\n\nbased Discussions in Japan \n\n\n\nKanayuki Kitahara, Yukari Kataoka, Tatsuya Isezaki, Yasuaki Yokoyama, Asami Funaki, Ryohkan \n\n\n\nFunakoshi \n\n\n\n\n\n\n\nAbstract 127 \n\n\n\nThe Development of Teaching Method and Game-Based Materials for Medication-use \n\n\n\nSafety Modular Course \n\n\n\nLing-Chiao Liao, Yung-Ching Hsu, Ai-Tzu Li, Jou-Wei Lin, Cheng-Ying Hsieh, Yung-Cheng Huang, Yu-\n\n\n\nChen Li, Chin-Ju Chuang* \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n63 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 128 \n\n\n\nA New Platform to Advance Pharmacy Workforce Education \n\n\n\nMd. Mirajul Islam, Mohammad Abusyed, Mandip Pokharel, Sovanrith Phalla, Tammy Allen \n\n\n\n\n\n\n\nAbstract 129 \n\n\n\nDrug-related problems (DRP) Identified by Pharmacy Students during Telepharmacy \n\n\n\nSessions \nNor Elyzatul Akma Hamdan1*, Mahmathi Karuppannan, Munaver Ahmad Nazir Ahmad, Ezlina Usir, \n\n\n\nKamaliah Md. Saman, and Siti Norlina Md. Said \n\n\n\n\n\n\n\nAbstract 130 \n\n\n\nConsultation and Education of Doping Among Athletes and Their Logistics Staff \n\n\n\nHung-Chang Chou, Wei Ho, Tzu-Chun Chou \n\n\n\n\n\n\n\nAbstract 131 \n\n\n\nHybrid learning to answer the adjustment of learning models after the pandemic \n\n\n\nArde Toga Nugraha \n\n\n\n\n\n\n\n\n\n\n\nSocial and Administrative Pharmacy  \n \n\n\n\nAbstract 132 \n\n\n\nNew Drug Budget and Reimbursement Policy in Taiwan \n\n\n\nYY Chan, ZF Lu, CN Hsu, YC Pan, WN Weng \n\n\n\n\n\n\n\nAbstract 133 \n\n\n\nDevelopment of a Searching Program of Nutrient Information for Patients who have \n\n\n\nDiabetes or Hypertension \n\n\n\nGyeongil Jang, Kwang Joon Kim, Dongmun Ha \n\n\n\n\n\n\n\nAbstract 134 \n\n\n\nDevelopment of a Computerized Pharmacy Management System Called PM+20 for the \n\n\n\nIT-based Community Pharmacy Practices in South Korea \n\n\n\nHyuntai, K, Jeehye M \n\n\n\n\n\n\n\nAbstract 135 \n\n\n\nKnowledge, Attitudes, and Practices on the Use of Antibiotics among the Residents in \n\n\n\nSilago, Southern Leyte, Philippines: Basis for Antimicrobial Stewardship Program for \n\n\n\nPrimary Health Care \n\n\n\nKim Ann Pere, Vieno Gino Cruz, Nimfa B. Gambalan, Mark Harvey B. Adamson, Elvira V. De Leon \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n64 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 136 \n\n\n\nAssociated Factors Related to Influenza Vaccine Acceptance among Adults in Cavite \n\n\n\nDuring the COVID-19 Pandemic \n\n\n\nPaola Allison B. Ara\u00f1o, Ma. Bernadette A. Cirilos, Christine Kate G. Conding, Hazel Mae C. Equiza, Louie \n\n\n\nFernand D. Legaspi \n\n\n\n\n\n\n\nAbstract 137 \n\n\n\nMilitary Pharmacist Involvement in COVID-19 Vaccination Outreach Programme \n\n\n\nKhan ARK, Baharuddin F, Adnan MA, Basari AH \n\n\n\n\n\n\n\nAbstract 138 \n\n\n\nMilitary Pharmacist Involvement in Greater Klang Valley Special Task Force (GKVSTF) \n\n\n\n\u2013 Medical and General Logistics Cluster (MedGenLog Cluster) \nMej Muhammad Najhan bin Md Bohari, Lt Kol Mohamad Halif bin Mohamad Yusof, Kol Mohd Adlan bin \n\n\n\nAdnan, Brig Jen Dato\u2019 Dr A. Halim bin Basari \n\n\n\n\n\n\n\nAbstract 139 \n\n\n\nThe Flying Pharmacist: Military Pharmacist\u2019s Experiences and Roles in Managing \n\n\n\nCOVID-19 Vaccine Logistics Using Royal Malaysian Airforce (RMAF) Aircraft \nMAE Zamri, MA Adnan, AH Basari, MA Rahim, MH Haron \n\n\n\n\n\n\n\nAbstract 140 \n\n\n\nCustomer Satisfaction towards Logistic Pharmacy Services in HTJS \n\n\n\nSalihah bt Aidit, Rekarani a/p Rajantharan, Nurfikriah Husna bt Mohamad Radz*, Nur Athirah bt \n\n\n\nMuhammad Fairuz \n\n\n\n\n\n\n\nAbstract 141 \n\n\n\nPatient Characteristics and Factors Associated with Defaulters among Drive-through \n\n\n\nPatients in Hospital Tuanku Ja\u2019afar Seremban \n\n\n\nNursyafiqah. Md Tahir, Nurshazlien. Abd.Halim, Jayasir Elengko \n\n\n\n\n\n\n\nAbstract 142 \n\n\n\nAssessment of Public Satisfaction on National COVID-19 Immunization Services among \n\n\n\nthe Malaysian Population \n\n\n\nWan Xin Soo Toh, Yoon Fong Hoo* \n\n\n\n\n\n\n\nAbstract 143 \n\n\n\nPerceptions, Attitude, and Barriers of PAPPI Regulatory Pharmacists Towards \n\n\n\nRegulatory Pharmacy Experiential Practice: A Basis for Capacity Programs \n\n\n\nRosita S. Ignacio, Nimfa B. Gambalan\uff0cVieno Gino Cruz*\uff0c Mark Harvey B. Adamson \n\n\n\n\n\n\n\nAbstract 144 \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n65 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nExploratory Factor Analysis of A Patient-reported Outcome Measure: A Newly \n\n\n\nDeveloped Medication Adherence Measurement Tool for the Elderly in Malaysia \n\n\n\nKamaliah Md Saman*, Nurfatiha Zulkarnain Helmi, Khairil Anuar Md Isa, Mathumalar Loganathan  Fahrni \n\n\n\n\n\n\n\n\n\n\n\nScientific  \n \n\n\n\nAbstract 145 \n\n\n\nTransethosomal Gels as Nanocarriers for the Transdermal Delivery of Tamoxifen: \n\n\n\nStatistical Optimization, Characterization, and Ex vivo Evaluation \n\n\n\nReem Abou Assi1,2, Siok Yee Chan 1* \n\n\n\n\n\n\n\nAbstract 146 \n\n\n\nViability Assay of Essential Fatty Acids from the Benincasa hispida Seed Extract in \n\n\n\nKeratinocytes \n\n\n\nRamli RZ, Hadi H \n\n\n\n\n\n\n\nAbstract 147 \n\n\n\nThe Development and Characterisation of Retinoic Acid Loaded Nanosponge \n\n\n\nSyed Omar SS, Hadi H, Doolanea AA \n\n\n\n\n\n\n\nAbstract 148 \n\n\n\nFormulation and Evaluation of Voriconazole Gastro Retentive Floating Tablets \n\n\n\nD Srinivasa Sastry*, S. Jahnavi Purna, G Sumalatha, D Srilakshmi \n\n\n\n\n\n\n\nAbstract 149 \n\n\n\nIn vitro Mammalian \u03b1-Glucosidase Inhibitory Activity of Hylocereus polyrhizus \n\n\n\nChristian M. Miranda, Vieno Gino Cruz, Nimfa B. Gambalan, Jover D. Francisco, Rizza Caluag \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n66 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 001 \n\n\n\n\n\n\n\nPharmacists\u2019 Perceptions on Future \n\n\n\nImplementation of A Medication Review \n\n\n\nService Model in Community Settings: A \n\n\n\nQualitative Study Utilising the \n\n\n\nConsolidated Framework for \n\n\n\nImplementation Research (CFIR) and the \n\n\n\nExpert Recommendations for \n\n\n\nImplementing Change (ERIC) strategy tool \n\n\n\n\n\n\n\nMaali Mujahid, Ernieda Hatah*, Mohd \n\n\n\nMakmor-Bakry \n \n\n\n\nFaculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda \n\n\n\nAbd Aziz, 50300 Kuala Lumpur, Malaysia. \n\n\n\n* Corresponding author \n\n\n\nEmail: ernieda@ukm.edu.my \n\n\n\n\n\n\n\nBackground and Objectives:  Pharmacists' roles have been \n\n\n\nevolving to include more patient-centred care services such \n\n\n\nas medication reviews that help patients receive the most \n\n\n\nbenefits from their medications. In Malaysia, medication \n\n\n\nreview service is yet to be widely implemented in the \n\n\n\ncommunity pharmacy settings for several reasons, including \n\n\n\nthe non-dispensing separation healthcare system. To \n\n\n\nimplement a feasible medication review service model in \n\n\n\nMalaysia, it is important to gather community pharmacists\u2019 \n\n\n\nperspectives on such services. Therefore, the present study \n\n\n\nwas conducted to explore community pharmacists\u2019 \n\n\n\nperceptions of barriers, facilitators, and strategies for the \n\n\n\nimplementation of a medication review service model in \n\n\n\nMalaysia. Methods: A focus group discussion followed by \n\n\n\nsemi-structured interviews were conducted among \n\n\n\npurposively sampled community pharmacists with interest in \n\n\n\nmedication review service. A deductive approach was used \n\n\n\nto generate and analyse the data according to the consolidated \n\n\n\nframework for implementation research (CFIR). After data \n\n\n\nmapping, the CFIR-ERIC matching tool was used to generate \n\n\n\nappropriate strategies according to the barriers identified. \n\n\n\nResults and Discussion: Twenty community pharmacists \n\n\n\nparticipated in this study. Several barriers and facilitators to \n\n\n\nservice implementation were identified based on the \n\n\n\nrespondents\u2019 feedback. The CFIR-ERIC strategies matching \n\n\n\ntool analysis reported potential plans that can mitigate the \n\n\n\nbarriers such as: identify and prepare champions, conduct \n\n\n\nlocal consensus discussions, conduct educational meetings, \n\n\n\nalter incentive/allowance structures, and develop a formal \n\n\n\nimplementation blueprint. Conclusion: The findings will \n\n\n\nguide the development of a medication review service model \n\n\n\nthat is tailored for implementation in community pharmacy \n\n\n\nsettings in Malaysia. \n\n\n\nAbstract 002 \n\n\n\n\n\n\n\nRole of Community Pharmacist in \n\n\n\nCardiovascular Diseases-Related Health \n\n\n\nPromotion and Dyslipidemia Management \n\n\n\nin Malaysia: A Cross-Sectional Study  \n\n\n\n\n\n\n\nFarhana Fakhira Ismail1,2, Adyani Md \n\n\n\nRedzuan1*, Chong Wei Wen1  \n \n1 Centre for Quality Management of Medicine, Faculty of Pharmacy, \n\n\n\nUniversiti Kebangsaan Malaysia, Kuala Lumpur, 50300, Malaysia  \n2 Department of Clinical Pharmacy, Faculty of Pharmacy, Universiti \n\n\n\nTeknologi MARA, Selangor, 42300, Malaysia.  \n\n\n\n* Corresponding author \n\n\n\nEmail: farhanafakhira.288@gmail.com \n\n\n\n\n\n\n\nBackground and Objectives: In Europe, cardiovascular \n\n\n\ndisease (CVD) is the primary cause of morbidity and \n\n\n\nmortality. It is connected to a heavy clinical and financial \n\n\n\nburden. Similarly in Malaysia, it is found that 64% of \n\n\n\nMalaysia adults had elevated total cholesterol (TC) and 56.7% \n\n\n\nwith elevated low density lipoprotein cholesterol (LDL-C). \n\n\n\nPharmacists in the community are well-positioned to assist \n\n\n\npatients who have CVD or who are at risk of developing this. \n\n\n\nTherefore, the purpose of this study was to investigate the \n\n\n\ncurrent involvement of community pharmacists (CPs) in \n\n\n\nMalaysia specifically in dyslipidemia management. Their \n\n\n\nperceived barriers in providing CVD and dyslipidemia \n\n\n\nservices are explored in depth. Methods: A self-administered \n\n\n\nsurvey was sent to all CPs in Malaysia using convenience \n\n\n\nsampling. The survey was conducted online and being shared \n\n\n\nin relevant groups involving CPs in Facebook, Whatsapp and \n\n\n\nTelegram platforms. The data was analysed using descriptive \n\n\n\nand inferential statistics. Results and Discussion: A total of \n\n\n\n312 CPs took part in the study. Chinese population, CPs with \n\n\n\npremises located in the urban area, more than one pharmacist \n\n\n\navailable at one shift and completion of dyslipidemia training \n\n\n\nshow significantly higher practice. For CVD-related health \n\n\n\npromotional activities, more than 50% of the respondents \n\n\n\nopted for never or rarely in providing educational materials, \n\n\n\nconducting the risk assessment score and collaborating with \n\n\n\nother healthcare professionals. For dyslipidemia \n\n\n\nmanagement, lack of practice was seen in counselling of \n\n\n\nantiplatelet therapy, referral of patients to dietitians and \n\n\n\nreview of patients\u2019 drug history. Lack of access to medical \n\n\n\nrecords (71.2%) was the highest perceived barrier \n\n\n\nencountered by CPs, followed by lack of CVD-related \n\n\n\neducational materials (70.8%). Conclusion: Current \n\n\n\ninvolvement of CPs in Malaysia is found to be satisfactory \n\n\n\nand can be improved. Support and strategies can be \n\n\n\nimplemented effectively in the near future to increase the \n\n\n\ninvolvement of CPs in CVD prevention. \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:ernieda@ukm.edu.my\n\n\nmailto:farhanafakhira.288@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n67 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 003 \n\n\n\n\n\n\n\nA Survey of the Adoption and Perception \n\n\n\nof Mobile Health Applications Among \n\n\n\nCommunity Pharmacists in Malaysia  \n\n\n\n\n\n\n\nHui Leng Ng, Jason Siau Ee Loo*, Renukha \n\n\n\nSellappans \n \n\n\n\nSchool of Pharmacy, Faculty of Health and Medical Sciences, Taylor\u2019s \n\n\n\nUniversity, No.1, Jalan Taylor\u2019s, 47500 Subang Jaya, Selangor, Malaysia  \n\n\n\n* Corresponding author \n\n\n\nEmail: huileng1999@gmail.com \n\n\n\n\n\n\n\nBackground and Objectives: Mobile health applications are \n\n\n\none of the most accessible health technologies that will play \n\n\n\nan integral role in the future of healthcare. Community \n\n\n\npharmacists are key stakeholders in promoting mHealth \n\n\n\napplications among the general public, therefore \n\n\n\nunderstanding their adoption and perception of these \n\n\n\napplications is key in shaping the integration of these \n\n\n\ntechnologies into healthcare systems. In this study, we \n\n\n\ndetermine the adoption and perception towards mHealth \n\n\n\napplications of community pharmacists in Malaysia. \n\n\n\nMethods: A cross-sectional survey was conducted with 300 \n\n\n\ncommunity pharmacists practising in the Klang Valley, \n\n\n\nMalaysia using a stratified sampling approach and a self \n\n\n\nadministered questionnaire. The questionnaire included three \n\n\n\nsections: demographic characteristics, adoption of mHealth \n\n\n\napplications, and perception towards mHealth applications. \n\n\n\nDescriptive and inferential statistics together with factor \n\n\n\nanalysis were utilised for data analysis. Results and \n\n\n\nDiscussion: The adoption of mHealth applications among \n\n\n\nrespondents overall was high at 79.7%. However, among \n\n\n\nthese mHealth application users only 65.7% recommended \n\n\n\nthem to their patients. Respondents showed a higher usage of \n\n\n\nmHealth applications in the literature category, followed by \n\n\n\npatient monitoring and personal care. Respondents mainly \n\n\n\nrecommended applications in the personal care and \n\n\n\ncommunication with healthcare professionals category to \n\n\n\npatients. Factor analysis revealed the most influential factor \n\n\n\ndriving mHealth application adoption was positive \n\n\n\nperception towards mHealth applications aspects related to \n\n\n\nprofessional practice. This was significantly higher than \n\n\n\nperception towards other aspects of mHealth such as patient \n\n\n\ncare, mHealth application features, and reliability of mHealth \n\n\n\napplications. Conclusion: The overall adoption of mHealth \n\n\n\napplications is high among community pharmacists. \n\n\n\nHowever, community pharmacists are more likely to utilise \n\n\n\nmHealth applications for their own professional practice and \n\n\n\nless likely to recommend them to patients. Improving the \n\n\n\nperception of mHealth applications in aspects of patient care \n\n\n\nand reliability may help improve community pharmacists\u2019 \n\n\n\npromotion of mHealth applications among the general public. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 004 \n\n\n\n\n\n\n\nInvestigating Pharmacy Value-Added \n\n\n\nServices (PVAS) in Community \n\n\n\nPharmacies: A Study in Urban and \n\n\n\nSuburban Areas of Perak, Malaysia \n\n\n\n\n\n\n\nZaswiza Mohamad Noor*, Nik Nur \u2018Alya Nik \n\n\n\nPa \n \n\n\n\nDepartment of Pharmacy, Faculty of Pharmacy and Health Sciences, Royal \n\n\n\nCollege of Medicine Perak, Universiti Kuala Lumpur, 30450 Ipoh, Perak, \n\n\n\nMalaysia \n\n\n\n* Corresponding author \n\n\n\nEmail: zaswiza@unikl.edu.my \n\n\n\n\n\n\n\nBackground and Objectives: Community pharmacies \n\n\n\nmonitor and deliver health services to the community, apart \n\n\n\nfrom dispensing medications. PVAS are extended services \n\n\n\nprovided to enhance pharmaceutical care. At present, digital \n\n\n\ntechnology is also needed as a platform for PVAS. This study \n\n\n\nwas conducted to investigate the PVAS available in \n\n\n\ncommunity pharmacies, to identify the practice differences in \n\n\n\nurban and suburban areas, and to identify the pharmacists\u2019 \n\n\n\nreadiness to use digital technology. Methods: This cross-\n\n\n\nsectional study was conducted face-to-face and via online. \n\n\n\nValidated-questionnaire consisted of three-parts, was \n\n\n\ndistributed to community pharmacists (CPs) in urban and \n\n\n\nsuburban areas of Perak. Survey-link was provided either via \n\n\n\nemail or posted to social media. Paper-based survey was \n\n\n\ngiven to the CPs at the premise. Sample size was calculated \n\n\n\nusing Raosoft Software. Data were analysed using SPSS \n\n\n\nV.20 descriptively. Results and Discussion: Sixty-one \n\n\n\n(N=61) CPs responded; female (57%), age 36-40 years-old \n\n\n\n(29%), and Malays (44%). The most provided PVAS are \n\n\n\nhealth screening (100%), supplement-TCM consultation \n\n\n\n(79%), and diet-lifestyle counselling (77%). CPs also provide \n\n\n\ncounselling for smoking cessation (36%) and weight \n\n\n\nmanagement (44%). Eighty-five percent of CPs in urban \n\n\n\nareas used digital technology as a platform for PVAS. For \n\n\n\nreadiness to use technology, only 49% of the CPs were ready. \n\n\n\nHome delivery (51%) and mobile pharmacy (40%) were \n\n\n\nchosen as the most appropriate PVAS. Conclusion: No \n\n\n\nsignificant difference was found between PVAS provided by \n\n\n\nurban and suburban pharmacies. Although the CPs in urban \n\n\n\nareas prefer digital technology for certain PVAS, most of the \n\n\n\nCPs are already prepared with knowledge and budget for new \n\n\n\nfuture-PVAS. \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:huileng1999@gmail.com\n\n\nmailto:zaswiza@unikl.edu.my\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n68 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 005 \n\n\n\n\n\n\n\nEvaluation of Anticoagulation Control in \n\n\n\nPatients with Atrial Fibrillation  \n\n\n\n\n\n\n\nAdyani Md Redzuan*, Azeta Abdullah, \n\n\n\nChandini Menon A/P Premakuma, Farah \n\n\n\nWaheeda  Tajurudin \n \n1 Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda \n\n\n\nAbdul Aziz, 50300 Kuala Lumpur \n\n\n\n* Corresponding author \n\n\n\nEmail: adyani@ukm.edu.my \n\n\n\n\n\n\n\nBackground and Objectives: Time in therapeutic range \n\n\n\n(TTR) measures the stability of the international normalized \n\n\n\nratio (INR) in patients on warfarin therapy. Low values are \n\n\n\nassociated with poor outcome. This study aims to evaluate \n\n\n\nthe warfarin treatment for atrial fibrillation (AF) by \n\n\n\ndetermining the TTR and the significant predictors that affect \n\n\n\nthe TTR control. Methods: In a retrospective observational \n\n\n\nstudy, all patients with AF attending follow-up in Warfarin \n\n\n\nClinic, UKM Medical Centre from January 2020 until June \n\n\n\n2021 were reviewed. The collected data includes patients\u2019 \n\n\n\ndemographics and their clinical characteristics which were \n\n\n\nretrieved from INR\u2019s booklet and electronic medical record \n\n\n\n(C-HEtS, Medipro\u00ae). Results and Discussion: Seventy-\n\n\n\nthree patients who met the inclusion criteria were included in \n\n\n\nthis study. Binary logistic regression was carried out to \n\n\n\nidentify the significant predictors of TTR. The calculated \n\n\n\nmean TTR were 52%, (SD 24.97%). Of the included patients, \n\n\n\n60.3% (n=44) were in the poor control category. The results \n\n\n\nof binary logistic regression revealed that the significant \n\n\n\npredictors of TTR control were age (OR 0.92; 95% CI: 0.86-\n\n\n\n0.99; p = 0.024) and number of medications (OR: 1.17; 95% \n\n\n\nCI: 1.02-1.35; p = 0.025). Younger age and increased number \n\n\n\nof medications leading to poor TTR values presumably due \n\n\n\nto poor adherence. Conclusion: Since majority of patients \n\n\n\nunder Warfarin Clinic follow-up had poor TTR control, it is \n\n\n\nnecessary for patients to be well-educated and understand the \n\n\n\nimportance of adherence through counselling in order to \n\n\n\nmaintain good INR control. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 006 \n\n\n\n\n\n\n\nPrediction of Aspirin Induced Gastric \n\n\n\nToxicity and Resistance in Rats Using \n\n\n\nNMR-Based Pharmacometabonomics \n\n\n\n\n\n\n\nIbrahim B1*, Sha\u2019aban A2, Zainal H2 \n\n\n\n\n\n\n\n1 Faculty of Pharmacy, Universiti Malaya, 50603 Kuala Lumpur, Malaysia \n2 School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 \n\n\n\nPenang, Malaysia \n\n\n\n* Corresponding author \n\n\n\nEmail: baharudin.ibrahim@um.edu.my \n\n\n\n\n\n\n\nBackground and Objectives: Low Dose Aspirin (LDA) is \n\n\n\nthe cornerstone of secondary prevention in coronary artery \n\n\n\ndisease (CAD). Despite its established efficacy, it suffers a \n\n\n\nmajor setback of causing gastrointestinal toxicity. In addition, \n\n\n\nsome patients still experience atherothrombotic events while \n\n\n\non aspirin secondary prophylaxis, a term known as aspirin \n\n\n\nresistance. The aim of this project was to evaluate the use of \n\n\n\npharmacometabonomics, in finding metabolites that can \n\n\n\npredict aspirin-induced gastric toxicity and aspirin resistance \n\n\n\nin rats. Methods: Pre-dose models were developed using H-\n\n\n\nNMR spectroscopic data from the biofluids of Sprague \n\n\n\nDawley (SD) rats and the respective class identities of the rats. \n\n\n\nThe class identities were either gastric toxic versus non-\n\n\n\ngastric toxic or aspirin resistant versus aspirin sensitive. \n\n\n\nApproximately, 300 \u00b5l of rat serum and an equal volume of \n\n\n\nphosphate buffer were mixed and analysed using nuclear \n\n\n\nmagnetic resonance (NMR) spectroscopy. The spectra were \n\n\n\nsubjected to multivariate statistical analysis including \n\n\n\nprincipal component analysis and orthogonal-partial least \n\n\n\nsquare discriminant analysis and the discriminating \n\n\n\nmetabolites were identified using metabolomics database. \n\n\n\nResults and Discussion: The multivariate statistical analysis, \n\n\n\nfrom which the models were developed, showed a significant \n\n\n\nseparation between the two classes in each case. Pre-dose \n\n\n\npharmacometabonomic serum analysis identified valine, \n\n\n\nlactate, acetoacetate and pyruvate as biomarkers for aspirin-\n\n\n\ninduced gastric toxicity. Meanwhile, lactate, trimethylamine \n\n\n\nN-oxide and 4-hydroxyphenylacetate were identified as \n\n\n\nbiomarkers for aspirin resistance. The AUROC were 0.988 \n\n\n\nand 0.874 respectively for gastric toxicity and resistance \n\n\n\ndiscriminations. Conclusion: NMR-based \n\n\n\npharmacometabonomics has good potential to identify \n\n\n\nbiomarkers to predict aspirin induced gastric toxicity and \n\n\n\naspirin resistance. This technology known as precision \n\n\n\nmedicine can be used to predict aspirin response on different \n\n\n\nindividuals even before starting the therapy. \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:adyani@ukm.edu.my\n\n\nmailto:baharudin.ibrahim@um.edu.my\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n69 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstrat 007 \n\n\n\n\n\n\n\nA Study on Adverse Effect Induced by \n\n\n\nChemotherapy Drug Used For Colorectal \n\n\n\nCancer and Their Management in Nepal \n\n\n\nCancer Hospital and Research Center \n \n\n\n\n Shrestha BM1*, Bista D 1, Shakya R1  \n \n1 Department Pharmacy, School of Science, Kathmandu University, \n\n\n\nDhulikhel, Kavre, Nepal   \n\n\n\n* Corresponding author \n\n\n\nEmail: aoki.shrestha593@gmail.com \n \n\n\n\nBackground and Objectives: Colorectal Cancer (CRC) is \n\n\n\nthe third most common malignancy and second most leading \n\n\n\ncause of death globally. The main objective of this study was \n\n\n\nto study various types of adverse drug reactions (ADRs) \n\n\n\nassociated with chemotherapy administered in CRC in one of \n\n\n\nthe cancer hospitals of Nepal. Methods: A retrospective \n\n\n\nobservational study was conducted at the Nepal Cancer \n\n\n\nHospital and Research Centre in patients who visited from \n\n\n\nJanuary 2020 to December 2021 for the treatment of \n\n\n\ncolorectal cancer. Patient who met the study criteria were \n\n\n\nenrolled in the study and the data was collected from their \n\n\n\ncase records. The ADRs reported were noted down and \n\n\n\nmanagement of such ADRs were taken into account.  Results \n\n\n\nand Discussion: A total of 90 patient received \n\n\n\nchemotherapy, out of which ADRs were observed in 90% \n\n\n\n(n=81). There were in total 381 ADRs recorded among them. \n\n\n\nCommon regimen administered for treatment of CRC were \n\n\n\n5FU/LV, FOLFOX, CAPOX and Oral Capecitabine. \n\n\n\nInfection (55.6%) and diarrhea (51.9%) were the most \n\n\n\nprevalent ADRs in CRC patients receiving chemotherapy. \n\n\n\nOlder population showed more ADRs compared to younger \n\n\n\n(P=0.05) and oral capecitabine reported less ADRs when \n\n\n\ncompared to other chemotherapy regimen. Severe ADRs \n\n\n\nwere seen in 38.3% (n=31) patients that included mainly \n\n\n\ndiarrhea (n=14) and sepsis (n=9). Most of the severe ADRs \n\n\n\nled to prolonged hospitalization. Majority of the ADRs were \n\n\n\nmanaged symptomatically and only in severe or \n\n\n\nhypersensitivity cases the chemotherapy regimen was \n\n\n\nchanged or stopped. Conclusion: ADRs are inevitable with \n\n\n\nchemotherapy administered. Health care professionals \n\n\n\nincluding pharmacists can play an important role in detection \n\n\n\nand management of ADRs. Proper monitoring of patients on \n\n\n\nchemotherapy, timely detection and prevention of ADRs can \n\n\n\nbe critical step in enchancing quality of life of CRC patients. \n\n\n\nInterventional studies aiming to improve detection and \n\n\n\nreporting of such ADRs is recommended.  \n\n\n\n\n\n\n\n\n\n\n\nAbstrat 008 \n\n\n\n\n\n\n\nAssessment of Patient Safety Culture \n\n\n\namong Healthcare Providers in A Tertiary \n\n\n\nHospital at Johor Bahru, Malaysia \n \n\n\n\nSok May Cheong1*, Palanisamy Sivanandy2, \n\n\n\nPravinkumar Vishwanath Ingle2 \n \n1 School of Postgraduate Studies, International Medical University, Kuala \n\n\n\nLumpur, Malaysia \n2 Department of Pharmacy Practice, School of Pharmacy, International \n\n\n\nMedical University, Kuala Lumpur, Malaysia \n\n\n\n* Corresponding author \n\n\n\nEmail: 00000033167@student.imu.edu.my \n\n\n\n\n\n\n\nBackground and Objectives: Patient safety culture is the \n\n\n\ncombination of attitudes and behaviors toward patient safety \n\n\n\nthat are addressed when a patient walks into a healthcare \n\n\n\ninstitution. The objectives of the study were to identify the \n\n\n\ncurrent status of patient safety culture and to evaluate and \n\n\n\ncorrelate the healthcare providers (HCPs) knowledge, \n\n\n\nattitude, and perception of patient safety culture in tertiary \n\n\n\nhospital settings. Methods: A cross-sectional study was \n\n\n\ncarried out among the HCPs of a tertiary hospital in Medini \n\n\n\nJohor. A structured validated questionnaire which includes \n\n\n\nHospital Survey On Patient Safety Culture (HSOPSC) was \n\n\n\nused in this study to analyse the level of patient safety culture \n\n\n\nin the study settings. Results and Discussion: A total of 100 \n\n\n\nHCPs were approached and only half of them (50%) \n\n\n\nresponded to this online survey and the response rate was \n\n\n\n50%. The overall patient safety grade was rated as very good \n\n\n\nor excellent by 31 (62%) respondents. Around 42% (n=21) \n\n\n\nof the respondents believed that the staff in the unit worked \n\n\n\nmore hours than was ideal for patient care. The study \n\n\n\nrevealed that feedback and communication about errors were \n\n\n\ngood in this study setting, whereas staffing and non-punitive \n\n\n\nresponse to error require improvement in terms of patient \n\n\n\nsafety culture. Conclusion: HCPs in this study setting had \n\n\n\nfavourable attitudes toward the culture of patient safety in \n\n\n\ntheir organization. Every healthcare organization should \n\n\n\naddress the issue of safety culture holistically. \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\nmailto:aoki.shrestha593@gmail.com\n\n\nmailto:00000033167@student.imu.edu.my\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n70 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 009 \n\n\n\n\n\n\n\nHerbal Medicine Tool: Identifying Herbal \n\n\n\nUsers among Malaysian Women \n\n\n\n\n\n\n\nFarida Islahudin,  Tengku Mohamad Tengku \n\n\n\nAzlan Shah, Lay Yan Ling, Jamia Azdina \n\n\n\nJamal*, Malina Jasamai  \n \n\n\n\nFaculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda \n\n\n\nAbdul Aziz, 50300 Kuala Lumpur, Malaysia.  \n\n\n\n* Corresponding author \n\n\n\nEmail: faridaislahudin@ukm.edu.my \n\n\n\n\n\n\n\nBackground and Objectives: The use of herbal medicine is \n\n\n\ngaining popularity among women to prevent and manage \n\n\n\ndiseases. Many believe herbal medicines are safe but are \n\n\n\nreluctant to disclose its use to their healthcare professionals. \n\n\n\nWith the lack of disclosure, appropriate herbal counselling by \n\n\n\nhealthcare professionals remains challenging. Therefore, the \n\n\n\ncurrent work aims to develop and validate a tool to predict \n\n\n\nherbal users among adult Malaysian women.  Methods: The \n\n\n\nquestionnaire-based study was performed among adult \n\n\n\nwomen who understood either Malay or English to assess \n\n\n\nsociodemographic data and characteristics of herbs used. \n\n\n\nIncomplete questionnaires were excluded. A simple and \n\n\n\nmultiple logistic regression was performed on two-thirds of \n\n\n\nthe data. Score-values were then assigned based on \n\n\n\nsignificant factors. Score-values were then compared with \n\n\n\nlogistic regression-values in the remaining one-third of the \n\n\n\ndata for validation. Result and Discussion: A total of 1435 \n\n\n\nrespondents were included. The most common herbal \n\n\n\nmedicines used were raw herbs (n=439, 65.4%), followed by \n\n\n\ncommercial herbs (n=220, 32.8%). The developed model \n\n\n\nbased on two-thirds of the data (n=957, 66.7%) demonstrated \n\n\n\nthat Malays, married women, employed and a monthly \n\n\n\nincome of less than MYR3000 was associated with herbal use \n\n\n\n(\u03c7\u00b2=235.9, df=6, p<0.001), in which beta-values were used to \n\n\n\nassign scores. The developed score-values of the significant \n\n\n\nfactors demonstrated an area under the receiving operator \n\n\n\ncurve (ROC) of 0.751. Validation of score-values on one-\n\n\n\nthird of the data (n=478, 33.3%) demonstrated an area under \n\n\n\nthe ROC of 0.765. It was demonstrated there was no \n\n\n\nsignificant difference between the two models (p=0.302), \n\n\n\ndemonstrating that the model was acceptable. Conclusion: \n\n\n\nThe tool predicts high risk herbal users among Malaysian \n\n\n\nwomen. Healthcare professionals, in particular pharmacists, \n\n\n\nmay find the tool easy to use and may facilitate appropriate \n\n\n\neducation of herbal medicine, better coordination of care, \n\n\n\nreduce unwanted adverse effects and lead to better patient \n\n\n\noutcomes. \n\n\n\n\n\n\n\nAbstract 010 \n\n\n\n\n\n\n\nPharmacists\u2019 Virtual Consultations for \n\n\n\nDiabetes Patients in Malaysia: Impact on \n\n\n\nMedication Adherence and Glycaemic \n\n\n\nControl \n \n\n\n\nLoganadan NK1,2*, Tse Yeen Soong2, Wai Han \n\n\n\nLee2, Hui Ling Tong2, Phei Ching Lim2, Sin \n\n\n\nYeNg2, Nur Diniah Shaharum2, Wan Ruwaida \n\n\n\nWan Mokhtar2, Siong Hung Ting2, Aziani \n\n\n\nYacob2, Wai Yin Yong2, Kai Yin Go2, Rodhiah \n\n\n\nAbd Rahman2, Shamala Ayadurai2, Huay Sin \n\n\n\nTan2 \n \n1Pharmacy Unit, Endocrine Institute, Putrajaya Hospital, 62250 Putrajaya, \n\n\n\nMalaysia \n2Pharmacy Practice and Development Division, Ministry of Health, Lot 36, \n\n\n\nJalan Universiti, 46200 Petaling Jaya, Selangor, Malaysia \n\n\n\n* Corresponding author \n\n\n\nEmail: pharmnavin@gmail.com \n\n\n\n\n\n\n\nBackground and Objectives: Virtual consultation is an \n\n\n\nalternative platform for providing pharmaceutical care for \n\n\n\nchronic disease patients mainly during the COVID-19 \n\n\n\npandemic where physical visits to healthcare facilities were \n\n\n\nrestricted. This study investigated the outcomes of virtual \n\n\n\nconsultations by pharmacists on diabetes patients undergoing \n\n\n\nthe Diabetes Medication Therapy Adherence Clinic \n\n\n\n(DMTAC) follow-up. Methods: This was a prospective \n\n\n\nstudy involving 17 hospitals from all the states in Malaysia \n\n\n\nfrom April to September 2020. Type 2 diabetes (T2DM) \n\n\n\npatients attending the DMTAC clinic for more than one year \n\n\n\nand having either a telephone or mobile phone were included. \n\n\n\nThose with poor phone line connectivity, language barrier, \n\n\n\nand unconducive environment for virtual consultation were \n\n\n\nexcluded. Pharmacists provided virtual consultations at least \n\n\n\ntwice between physical visits at baseline and six months. \n\n\n\nData were analyzed using SPSS Version 26.0. Results and \n\n\n\nDiscussion: The 65 subjects included had a median age of \n\n\n\n58.0 [48.0\u201365.5] years. Poor medication adherence (21.2%), \n\n\n\npoor understanding of medication instructions (18.2%), and \n\n\n\ninability to adjust insulin doses (16.7%) were the main \n\n\n\npharmaceutical care issues that warranted pharmacists\u2019 \n\n\n\ninterventions. The Malaysia Medication Adherence \n\n\n\nAssessment Tool (MyMAAT) score improved significantly \n\n\n\nfrom 51.0 [45.5\u201357.8] at baseline to 54.0 [52.0\u201357.0] after \n\n\n\nsix months (p<0.05). This translated into significant \n\n\n\nimprovements in glycaemic control indicated by an HbA1c \n\n\n\nreduction of 1.3% from 9.2% [7.8-10.4] at baseline to 7.9% \n\n\n\n[7.5\u20139.6] after six months (p<0.05). Hypoglycaemia present \n\n\n\nat baseline were resolved in majority (83.7%) of the patients \n\n\n\nat 6th month. Conclusion: The virtual consultations by \n\n\n\nDMTAC pharmacists improved medication adherence and \n\n\n\nglycaemic control for T2DM patients. This approach should \n\n\n\n\nmailto:faridaislahudin@ukm.edu.my\n\n\nmailto:pharmnavin@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n71 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nbe adopted to complement physical pharmacist follow-ups to \n\n\n\nensure a sustained pharmaceutical care delivery. \n\n\n\nAbstract 011 \n\n\n\n\n\n\n\nThe Impact of Pharmacist-Managed \n\n\n\nTitration Clinic (PMTC): A Pilot Study \n\n\n\n\n\n\n\nPoh Lee Geetha Ng1*, Syafiqah Abdul Jalil1, \n\n\n\nNurish Ezzantie Mishan1, Nur Asyikin Mohd \n\n\n\nYunus2, Michelle Maryanne Tan2, Nik Qistina \n\n\n\nNik Ramli2, Norhawani Mansor2, Kok Han \n\n\n\nChee3, Nor Aziah Abdullah1 \n \n1 Department of Pharmacy Tengku Ampuan Rahimah Klang Hospital \n2 Department of Medicine Tengku Ampuan Rahimah Klang Hospital \n3 Department of Medicine University Malaya Medical Centre \n\n\n\n* Corresponding author \n\n\n\nEmail: poohdini19@yahoo.com \n\n\n\n\n\n\n\nBackground and Objectives: The key to reduce morbidity \n\n\n\nand mortality of cardiovascular disease is by having an ACE \n\n\n\ninhibitor (ACE-I) or Angiotensin Receptor Blocker (ARB) \n\n\n\nand beta-blockers commenced promptly in the treatment \n\n\n\nmanagement. Nonetheless, these drugs are often not \n\n\n\nprescribed, or doses are not optimized. One strategy to \n\n\n\nimprove this is by involving the pharmacist to optimize the \n\n\n\nmedication management. The aim of this study was to \n\n\n\nevaluate the impact by determining the proportion of patients \n\n\n\non target or maximum tolerated ACE-I (perindopril) and \n\n\n\nbeta-blocker (bisoprolol) doses, their blood pressure and \n\n\n\nheart rate in the Pharmacist-Managed Titration Clinic \n\n\n\n(PMTC) versus General Medical Clinic (GMC) managed by \n\n\n\nthe physician. Methods: This was a prospective study \n\n\n\ninvolving patients who attended the clinic from May 2019 \n\n\n\nuntil March 2020. 16 patients are screened in the ward during \n\n\n\ntheir admission due to cardiovascular disease by the \n\n\n\npharmacist. Patients must at least be on 2 doses of perindopril \n\n\n\nand bisoprolol and doses are not yet maximized. They are \n\n\n\ncompared to 16 patients who attended the GMC through \n\n\n\nsimple random sampling. Results and Discussion: At \n\n\n\nbaseline, mean blood pressure systolic, diastolic, heart rate, \n\n\n\ndoses of beta-blocker and ACE-I/ARB in both groups were \n\n\n\nsimilar. In PMTC, mean blood pressure systolic was \n\n\n\n118\u00b117.4 mmHg compared to 135\u00b115.3 mmHg for GMC \n\n\n\n(p<0.05). Mean diastolic blood pressure for PMTC was \n\n\n\n74\u00b112.6 mmHg compared 81\u00b111.6 mmHg (p>0.05). Mean \n\n\n\nheart rate was 69\u00b110.5 bpm in PMTC versus 78\u00b15.9 bpm in \n\n\n\nGMC (p<0.05). Mean dose for bisoprolol was 5\u00b13.3 mg in \n\n\n\nPMTC versus 2.7\u00b11.72 mg in GMC (p<0.05). Mean dose for \n\n\n\nperindopril was 4\u00b12.7 mg in PMTC versus 2.8\u00b12.1 mg in \n\n\n\nGMC (p>0.05). Conclusion: This study demonstrates the \n\n\n\nbeneficial impact of PMTC in terms of improvement of blood \n\n\n\npressure, heart rate and optimisation doses of ACE-I/ARB \n\n\n\nand beta-blocker for cardiovascular disease medication \n\n\n\nmanagement. \n\n\n\n\n\n\n\nAbstract 012 \n\n\n\n\n\n\n\nComparison of Eight Methods for \n\n\n\nEstimation of Creatinine Clearance in \n\n\n\nPatients with Unstable Kidney Function \u2013 \n\n\n\nA Multi-center, Prospective, Observational \n\n\n\nStudy from Malaysia. \n\n\n\n\n\n\n\nYen Ping Ng1*, Chee Ping Chong2, Ee Siung \n\n\n\nLiew3, Shye Ling Teoh4, Cheng Hoon Yap5 \n\n\n\n\n\n\n\n1 Clinical Pharmacy Unit, AIMST University, 08100 Bedong, Kedah, \n\n\n\nMalaysia. \n2 Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, \n\n\n\nUniversiti Sains Malaysia (USM), 11800 Minden, Penang, Malaysia. \n3 Intensive Care Unit, Queen Elizabeth Hospital, Sabah, Malaysia. \n4 Intensive Care Unit, Sultan Abdul Halim Hospital, Sungai Petani, Kedah, \n\n\n\nMalaysia. \n5 Pharmacist, Klinik Kesihatan Butterworth, Ministry of Health Malaysia, \n\n\n\nPenang, Malaysia. \n\n\n\n* Corresponding authors \n\n\n\nEmail: yenpingng@hotmail.com \n\n\n\n\n\n\n\nBackground and Objectives: Estimation of creatinine \n\n\n\nclearance (Clcr) has long been a problem in critically ill \n\n\n\npatients with unstable kidney function. The commonly used \n\n\n\nmethods like Cockcroft-Gault method requires a stable \n\n\n\nkidney function. A reliable and more accurate tool is needed \n\n\n\nin the estimation of Clcr to guide drug dosage adjustment. \n\n\n\nThe study aimed to compare the eight methods to estimate \n\n\n\nClcr with measured Clcr. In addition, the study also aimed to \n\n\n\ndetermine the agreement between estimated Clcr with \n\n\n\nmeasured Clcr. Methods: This was a multicentre, \n\n\n\nprospective, observational study. Three intensive care units \n\n\n\nin Malaysia tertiary public hospitals. Two serum creatinine \n\n\n\nsamples over 24 hours apart and simultaneously 24 hours \n\n\n\nurine collection. This study was approved by the Malaysian \n\n\n\nmedical research ethical committee (MREC) \u2013 NMRR-16-\n\n\n\n736-29621 (IIR). Results and Discussion: A total of 43 \n\n\n\npatients were recruited. During the early phase of unstable \n\n\n\nkidney functions (regardless of acute deteriorating or acute \n\n\n\nimproving), only the modified Cockcroft-Gault method \n\n\n\nshowed non-significant different with the measured Clcr (p = \n\n\n\n0.741).  A sub-set analysis on 23 patients with acute \n\n\n\ndeteriorating kidney functions was performed. Only the \n\n\n\nmodified Cockcroft-Gault revealed non-significant different \n\n\n\nwith the measured Clcr (p = 0.843).  Sub-set analysis \n\n\n\nperformed on 20 patients with rapid improving kidney \n\n\n\nfunctions, the Chiou method greatly underestimated the Clcr \n\n\n\nby approximately 34%, p < 0.001. Bland-Altman analysis \n\n\n\nrevealed that Clcr estimated with modified Cockcroft-Gault \n\n\n\nmethod showed agreement to measured Clcr, p > 0.05. \n\n\n\nConclusion: Owing to the precision of estimation and the \n\n\n\nconsistency (reproducibility) as well as the simplicity of \n\n\n\nmodified Cockcroft-Gault method, it should be the reliable \n\n\n\n\nmailto:poohdini19@yahoo.com\n\n\nmailto:yenpingng@hotmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n72 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nmethod to assess renal function in critically ill patients with \n\n\n\nunstable kidney function. \n\n\n\n\n\n\n\nAbstract 013 \n\n\n\n\n\n\n\nExposure to Potentially Harmful Excipients \n\n\n\nin Medications among Neonates at A State \n\n\n\nHospital in Malaysia \n\n\n\n\n\n\n\nNoraida Mohamed Shah1*, Shien Woan Wong \n1,2, Soo PiingChew2, Siti Azdiah Abdul Aziz1 \n \n\n\n\n1 Centre for Quality Management of Medicines, Faculty of Pharmacy, \n\n\n\nUniversiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia \n2 Pharmacy Department, Hospital Melaka, Melaka, Malaysia \n\n\n\n* Corresponding author \n\n\n\nEmail: noraida_mshah@ukm.edu.my \n \n\n\n\nBackground and Objectives: Medicines may contain \n\n\n\npotentially harmful excipients (PHE) which are toxic to \n\n\n\nneonates. The extent of PHE exposure among neonates in \n\n\n\nMalaysia remains unknown. This study aimed to determine \n\n\n\nthe incidence, types and predictors of PHE exposure among \n\n\n\nhospitalized neonates. Methods: A prospective \n\n\n\nobservational study was conducted from March to April 2022 \n\n\n\nin neonatal wards at Hospital Melaka. All neonates receiving \n\n\n\nat least one medication were randomly selected. Medical and \n\n\n\nmedication related data were retrieved from patients\u2019 medical \n\n\n\nrecords. The PHEs of interest were aspartame, benzalkonium \n\n\n\nchloride, benzyl alcohol, benzoic acid or benzoates, ethanol, \n\n\n\nparabens, polysorbate 80, propylene glycol, saccharin \n\n\n\nsodium, sorbitol and sulphites. Product information leaflets \n\n\n\n(PILs) and summaries of product characteristics (SPCs) were \n\n\n\nreferred to obtain information on active pharmaceutical \n\n\n\ningredient, strength, trade name as well as type and amount \n\n\n\nof the excipients.  Results and Discussion: A total of 108 \n\n\n\nneonates were recruited and 97.2% of them were exposed to \n\n\n\nat least one PHE. The high incidence of PHE exposure in \n\n\n\nneonates is similarly seen in other countries worldwide. \n\n\n\nParabens (47.2%) and sulphites (27.5%) were the two most \n\n\n\ncommonly administered PHEs. Benzyl alcohol is \n\n\n\ncontraindicated in neonates but was administered to 8% of \n\n\n\nneonates in this study. The median daily dose of ethanol \n\n\n\n(24.11 mg/kg/day, IQR 19.73, 28.49) exceeded the \n\n\n\nacceptable daily intake (ADI) by four times. However, the \n\n\n\ndose was not available for all PHEs as this information is not \n\n\n\nalways available in the PIL or SPC. Administration of \n\n\n\ncardiovascular drugs was associated with a higher risk of \n\n\n\nexposure to any PHE (OR 6.38, CI 2.75, 14.79, p-value < \n\n\n\n0.001). Conclusion: The exposure of PHE among neonates \n\n\n\nin this study is high with certain PHEs exceeding the ADI. It \n\n\n\nhighlights the need for certain strategies to be implemented \n\n\n\nto reduce such exposure in neonates. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 014 \n\n\n\n\n\n\n\nAntiseizure Medication Prescribing: A \n\n\n\nGlimpse of Current Practice in A Ministry \n\n\n\nof Health Tertiary Care Centre \n\n\n\n\n\n\n\nRusli RA1*, Makmor Bakry M1, Mohamed \n\n\n\nShah N1, Hung KY2, Loo XL3 \n\n\n\n \n1 Centre of Quality Management of Medicines, Faculty of Pharmacy, \n\n\n\nUniversiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.   \n2 Aeromedical Unit, Department of Medical, Hospital Tengku \n\n\n\nAmpuan Rahimah, Selangor, Malaysia  \n3 Department of Pharmacy, Hospital Tengku Ampuan Rahimah, \n\n\n\nSelangor, Malaysia \n\n\n\n* Corresponding author \n\n\n\nEmail: roseanizar@gmail.com \n\n\n\n\n\n\n\nBackground and Objectives: Antiseizure medication (ASM) \n\n\n\nis the mainstay of treatment for epilepsy patients. Throughout \n\n\n\nthe years, new ASMs were approved to be registered by \n\n\n\nMinistry of Health, Malaysia. This study aims to determine \n\n\n\nthe current prescribing practice of ASM in a tertiary care \n\n\n\ncentre. Methods: All prescriptions containing at least one \n\n\n\nASM from 1 January 2019 to 31 December 2021 were \n\n\n\npreliminary screened for eligibility. Samples were \n\n\n\nrandomised using stratified sampling method according to \n\n\n\nthe portion of ASM usage. Each of the subject\u2019s follow up \n\n\n\ncard was retrospectively review and all relevant data was \n\n\n\nrecorded. Result and Discussion: A total number of 260 \n\n\n\npatients were included for analysis. The commonly \n\n\n\nprescribed ASM monotherapy for initial management of \n\n\n\nepilepsy was sodium valproate (50.4%), followed by \n\n\n\ncarbamazepine (8.1%), phenytoin (8.1%) and levetiracetam \n\n\n\n(4.6%) across all seizure types. For initial management, \n\n\n\nsodium valproate and phenytoin (7.7%) was the most \n\n\n\ncommon ASM combination followed by sodium valproate \n\n\n\nand carbamazepine (4.2%). At maintenance, polytherapy \n\n\n\n(54.6%) was prescribed more often compared to \n\n\n\nmonotherapy (45.6%) with the combination of sodium \n\n\n\nvalproate and levetiracetam tops the polytherapy prescribing \n\n\n\n(10%). Majority (95.4%) have at least one concurrent \n\n\n\nmedications with 38.5% of the patients have only folic acid \n\n\n\ntablet being co-prescribed. Half of the patients (50.6%) have \n\n\n\ntheir ASM being monitored for serum concentration within \n\n\n\nthe recent period. Conclusion: Sodium valproate remains the \n\n\n\ndrug of choice as initial as well as maintenance therapy for \n\n\n\nmost seizure types. The role of levetiracetam in the treatment \n\n\n\nof epilepsy whether as mono- or polytherapy has become \n\n\n\nmore prominent in line with its approval by Ministry of \n\n\n\nHealth over the last decade. Newer agent such as zonisamide \n\n\n\nis still being sparingly prescribed. A nationwide study is \n\n\n\nwarranted for better insights into overall ASM prescribing in \n\n\n\ngovernment healthcare centres. \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:noraida_mshah@ukm.edu.my\n\n\nmailto:roseanizar@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n73 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 015 \n\n\n\n\n\n\n\nAssessment of Anticoagulation Control, \n\n\n\nBleeding, and Thromboembolic \n\n\n\nComplications in Anticoagulation \n\n\n\nMedication Therapy Adherence Clinic \n\n\n\n(ACMTAC) Service in Malaysia  \n \n\n\n\nSahimi Mohamed2*, Wardati Mazlan Kipli1, \n\n\n\nNik Azlean Nik Ismail3, Jivanraj R \n\n\n\nNagarajah4 \n \n1 Department of Clinical Pharmacy & Pharmacy Practice, Faculty of \n\n\n\nPharmacy, University of Malaya, 50603 Kuala Lumpur, Malaysia.  \n2 Department of Pharmacy, Hospital Serdang, Ministry of Health Malaysia, \n\n\n\nJalan Puchong, 43000 Kajang, Selangor, Malaysia.  \n3 Department of Pharmacy, Hospital Raja Perempuan Zainab II, Ministry of \n\n\n\nHealth Malaysia, Jalan Hospital, 15200 Kota Bharu, Kelantan, Malaysia.  \n4 Department of Pharmacy, Hospital Kuala Lumpur, Ministry of Health \n\n\n\nMalaysia, Jalan Pahang, 50586 Kuala Lumpur, Malaysia.  \n\n\n\n* Corresponding author \n\n\n\nEmail: sahimimohd@gmail.com \n\n\n\n\n\n\n\nBackground and Objectives:  The risk of thromboembolic \n\n\n\nevents and bleeding must be balanced while using warfarin \n\n\n\nas an anticoagulant. Time in therapeutic range (TTR) is an \n\n\n\nimportant assessment for the quality of anticoagulation \n\n\n\ntreatment as it has been proven to be associated with bleeding \n\n\n\nand thromboembolic events. In Malaysia, the pharmacist-\n\n\n\nmanaged Anticoagulation Medication Therapy Adherence \n\n\n\nClinic (ACMTAC) follow-up and monitor the dosage of \n\n\n\nwarfarin. This study aimed to evaluate the degree of \n\n\n\nanticoagulation control, bleeding complications and \n\n\n\nthromboembolic events under ACMTAC service. Methods: \n\n\n\nThis multicentre and cross-sectional study included patients \n\n\n\ntreated with warfarin from 1st Jan 2019 to 31st December \n\n\n\n2021 under ACMTAC in Malaysia. A multistage sampling \n\n\n\nwas used to select facilities with ACMTAC and systematic \n\n\n\nsampling was used to select patients from each facility. The \n\n\n\nTTR value was calculated using Rosendaal\u2019s method and \n\n\n\nTTR \u226565% was defined as a good control. Results and \n\n\n\nDiscussion: Of 1464 patients from 49 facilities, the mean age \n\n\n\nwas 60.3 (13.1) years and 732 (50%) were female. The main \n\n\n\nindications for warfarin treatment were atrial fibrillation \n\n\n\n(65.7%) and valve replacement (23.1%). The annual mean \n\n\n\nTTR for all patients in 2019, 2020 and 2021 were \n\n\n\n63.1(24.5)%, 64.0(25.0)% and 64.1(26.3)% respectively. \n\n\n\nThe percentage of ACMTACs with good anticoagulant \n\n\n\ncontrol over three consecutive years was 49.5, 55.1 and 53.4. \n\n\n\nThromboembolic events occurred in 15 (1.0%) while events \n\n\n\nof stroke and TIA in 12 (0.8%). Bleeding events occurred in \n\n\n\n227 (15.5%), bruises in 87 (5.9%) and  gum bleeding in 40 \n\n\n\n(2.7%). Conclusion: Overall, there was a moderate quality \n\n\n\nof anticoagulation control in warfarin-treated patients under \n\n\n\nACMTAC. Nearly half of the patients achieved the \n\n\n\nminimally recommended TTR of 65%. Bleeding and \n\n\n\nthromboembolic events in this study were low. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 016 \n\n\n\n\n\n\n\nAssessment of Psychological Health among \n\n\n\nPLWH during COVID-19 and Its \n\n\n\nAssociation with Antiretroviral Therapy \n\n\n\nAdherence  \n\n\n\n\n\n\n\nAbdul-Aziz SA*, Islahudin F, Shukri AH \n \n\n\n\nCenter for Quality Management of Medicines, Faculty of Pharmacy, \n\n\n\nUniversiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.  \n\n\n\n* Corresponding author \n\n\n\nEmail: sitiazdiah@ukm.edu.my \n\n\n\n\n\n\n\nBackground and Objectives: COVID-19 not only affects \n\n\n\nphysiological health but also impairs psychological health of \n\n\n\nthe global population. This includes individuals on chronic \n\n\n\ntreatment such as people living with HIV (PLWH) infection. \n\n\n\nThe impact can cause non-adherence towards highly active \n\n\n\nantiretroviral therapy, which will lead to unsuccessful \n\n\n\ntreatment outcomes leading to progression to AIDS and death. \n\n\n\nHowever, investigations on this issue are still limited among \n\n\n\nlocal HIV infected population. This study aims to determine \n\n\n\nthe impact of COVID-19 on PLWH related to psychological \n\n\n\nhealth and adherence towards antiretroviral therapy. \n\n\n\nMethods: A cross-sectional survey was conducted in two \n\n\n\nhospital-based Infectious Disease (ID) clinics in Pahang state. \n\n\n\nPLWH who met inclusion and exclusion criteria were \n\n\n\nconveniently recruited in this study. Data was collected \n\n\n\nbetween 1st April 2022 until 31st July 2022. Psychological \n\n\n\nhealth was assessed by using Impact of Event Scale-Revised \n\n\n\n(IES-R Malay version) and antiretroviral therapy adherence \n\n\n\nlevel was assessed by using the Malaysia Medication \n\n\n\nAdherence Assessment Tool (MyMAAT). Spearman\u2019s rank \n\n\n\ncorrelation test was utilised to analyse correlation between \n\n\n\npsychological health and antiretroviral therapy adherence \n\n\n\nlevel. Results and Discussion: Of 59 participants, mean age \n\n\n\nwas 38.02 (\u00b111.02) years old. One-fourth (n=15, 25.4%) of \n\n\n\nthe patients had psychological stress of median (IQR) score \n\n\n\nof, 6 (1 - 14.5) and more than one-third (n=21, 35.6%) had \n\n\n\nbehavioural stress with a median (IQR) score of 4 (0 to 10) \n\n\n\nduring the COVID-19 phase in Malaysia. For antiretroviral \n\n\n\ntherapy adherence, majority of patients had good adherence \n\n\n\ntowards antiretroviral therapy (n=49, 83.1%). A significant \n\n\n\nnegative correlation was associated between psychological \n\n\n\nand behaviour domain with adherence (r= -0.359, p <0.05 \n\n\n\nand r=- 0.344, p <0.05 respectively). Conclusion: Despite \n\n\n\nthe fact that the nation is entering a \u2018transition to endemic\u2019 \n\n\n\nCOVID-19 phase, psychological health impairment was still \n\n\n\nreported among PLWH. Our findings found a negative \n\n\n\ncorrelation between poor psychological health and \n\n\n\nantiretroviral therapy adherence level.  \n\n\n\n\nmailto:sahimimohd@gmail.com\n\n\nmailto:sitiazdiah@ukm.edu.my\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n74 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 017 \n\n\n\n\n\n\n\nRole of Pharmacist in Providing \n\n\n\nPharmaceutical Care to Tuberculosis \n\n\n\nPatients in Tertiary Care Paediatric \n\n\n\nHospital \n\n\n\n\n\n\n\nFaraz Ashraf* \n \n\n\n\nThe University of Child Health Sciences & The Children\u2019s Hospital, \n\n\n\nLahore, Pakistan. \n\n\n\n*Corresponding author \n\n\n\nEmail: drfarazashraf@gmail.com  \n\n\n\n\n\n\n\nBackground and Objectives: Pharmacist\u2019s role shifts from \n\n\n\ndispensing to bedside care, resulting better patient health \n\n\n\noutcomes. Pharmacists in developed countries ensure \n\n\n\nrational drug use, improve clinical outcomes, and promote \n\n\n\nhealth status by working as part of a multidisciplinary team \n\n\n\nof healthcare professionals. However, clinical pharmacist \n\n\n\nservices on healthcare utilization in low-and middle-income \n\n\n\ncountries (LMICs) like Pakistan are unclear. Pharmacists can \n\n\n\nimprove the implementation of critical pathways by \n\n\n\ndocumenting processes and out- comes, ensuring proper \n\n\n\npatient selection and medication use, monitoring patients for \n\n\n\ndrug efficacy and adverse effects, and providing for \n\n\n\ncontinuity of care. Objective of this study is to assess the role \n\n\n\nof a clinical pharmacist-directed patient education on the \n\n\n\ntherapy adherence of paediatric TB patients and to identify \n\n\n\nthe major pharmaceutical care needs. Methods: Data was \n\n\n\ncollected by using questionnaire designed to collect \n\n\n\ndemographic variables as well as knowledge, attitude, and \n\n\n\nadherence to the treatment. This study includes all patients \n\n\n\nwho enrolled from Jan 2019 to June 2019. Results and \n\n\n\nDiscussion: In this study, 58.47% of the respondents were \n\n\n\nmale and 41.53% were female. It was found that 64.98% of \n\n\n\nthe respondents appreciated the role of pharmacist in TB \n\n\n\nclinic and agreed that their medication outcome and \n\n\n\nsatisfaction has increased with pharmacist interaction. \n\n\n\nResults showed that 23.88% patients needed extra \n\n\n\npharmaceutical care, and all agreed to receive the guidance \n\n\n\nfrom the Pharmacist. Approximately 11.14% \n\n\n\npatients/attendants refused to receive pharmaceutical care \n\n\n\nand guidance from the pharmacist and did not show consent \n\n\n\nfor follow-up. Many patients faced side effects of drugs. \n\n\n\nAmong them, 64.13% patients were satisfied with the \n\n\n\nguidance provided by the Pharmacist to manage and \n\n\n\nunderstand side effects. Conclusion: Patients' adherence to \n\n\n\nTB treatment improved when a pharmacist provided patient \n\n\n\neducation on medication use and addressed patients' \n\n\n\npharmaceutical care issues. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 018 \n\n\n\n\n\n\n\nImpact of a Communication Skills Training \n\n\n\nProgram on Malaysian Hospital \n\n\n\nPharmacists\u2019 Patient-Centred \n\n\n\nCommunication Attitudes and Behaviours \n\n\n\n\n\n\n\nYew Keong Ng1, Noraida Mohamed Shah1, \n\n\n\nTimothy F Chen2, Navin Kumar Loganadan3, \n\n\n\nShue Hong Kong4, Yi Yun Cheng5, Siti \n\n\n\nShahida Md Sharifudin6, Wei Wen Chong1* \n\n\n\n \n1 Centre of Quality Management of Medicines, Faculty of Pharmacy, \n\n\n\nUniversiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia \n2 School of Pharmacy, Faculty of Medicine and Health, The University of \n\n\n\nSydney, NSW, Australia. \n3 Department of Pharmacy, Hospital Putrajaya, Ministry of Health, \n\n\n\nPutrajaya, Malaysia. \n4 Department of Pharmacy, Universiti Kebangsaan Malaysia Medical Centre, \n\n\n\nKuala Lumpur, Malaysia \n5 Department of Pharmacy, Hospital Ampang, Ministry of Health, Selangor, \n\n\n\nMalaysia \n6 Department of Pharmacy, Hospital Kuala Lumpur, Ministry of Health, \n\n\n\nKuala Lumpur, Malaysia \n\n\n\n* Corresponding author \n\n\n\nEmail: weiwen@ukm.edu.my \n\n\n\n\n\n\n\nBackground and Objectives: Effective communication is \n\n\n\nintegral in the process of providing patient-centred care in \n\n\n\nhealth encounters. Communication skills training (CST) \n\n\n\nprograms have been proposed to improve patient-centred \n\n\n\ncommunication among pharmacists. This study aimed to \n\n\n\nevaluate the effects of a CST program on patient-centred \n\n\n\ncommunication scores, communication self-efficacy, and \n\n\n\nattitudes toward concordance among pharmacists providing \n\n\n\nmedication therapy adherence clinic (MTAC) services in \n\n\n\npublic hospitals. Methods: A CST program for pharmacists \n\n\n\nbased on a patient-centred communication framework (the \n\n\n\nFour Habits Model) and motivational interviewing \n\n\n\ntechniques was developed and implemented. A pre-test/post-\n\n\n\ntest quasi-experimental design was used to evaluate the \n\n\n\neffects of this CST program. Pharmacists underwent pre-\n\n\n\ntest/post-test audiotaped simulated consultations and \n\n\n\ncompleted the Revised United States\u2013Leeds Attitudes \n\n\n\ntowards Concordance scale and communication self-efficacy \n\n\n\nscale. The Four Habits Coding Scheme (FHCS) was used to \n\n\n\nevaluate patient-centred communication scores from the \n\n\n\naudiotapes. Results and Discussion: A total of 38 \n\n\n\npharmacists from four tertiary hospitals participated in the \n\n\n\ntraining program. However, only 23 pharmacists completed \n\n\n\nboth pre- and post-intervention simulated consultations. \n\n\n\nImprovements were noted in the FHCS scores, including \n\n\n\nexploring patients\u2019 concerns (pre-test median = 3, post-test \n\n\n\nmedian = 4, Z = -2.73; p < 0.05), acceptability (pre-test \n\n\n\nmedian = 3, post-test median = 4, Z = -2.58; p < 0.05), and \n\n\n\nbarriers to treatment (pre-test median = 3, post-test median = \n\n\n\n4, Z = -2.86; p < 0.05). However, there were no significant \n\n\n\n\nmailto:drfarazashraf@gmail.com\n\n\nmailto:weiwen@ukm.edu.my\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n75 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nimprovement in scores regarding involving patients in \n\n\n\ndecision-making but there was an improvement in \n\n\n\nrecognising patients\u2019 needs and potential medication \n\n\n\nuncertainty. Conclusion: CST may help increase the \n\n\n\nadoption of patient-centred communication behaviours in \n\n\n\npharmacists\u2019 consultations with patients and improve \n\n\n\npharmacists\u2019 attitudes towards concordance and \n\n\n\ncommunication self-efficacy. Future CST studies may \n\n\n\nconsider incorporating tools to enhance patient involvement \n\n\n\nin decision-making. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 019 \n\n\n\n\n\n\n\nRapid Quantitative Estimation of \n\n\n\nFavipiravir in Rat Plasma by Liquid \n\n\n\nChromatography-Tandem Mass \n\n\n\nSpectroscopy and its Application to \n\n\n\nPharmacokinetic Studies \n\n\n\n\n\n\n\nP D Sri Lakshmi1*, G Venkateswarulu2, D \n\n\n\nSrinivasa Sumalatha2, P Geetha Bhavani \n\n\n\nSastry2 \n\n\n\n\n\n\n\n1 Department of Pharmaceutical Chemistry, Vikas Institute of \n\n\n\nPharmaceutical Sciences, Rajahmundry, AP \n2 Department of Pharmaceutical Analysis, Vikas Pharmacy College, \n\n\n\nVissanapet, AP. \n\n\n\n* Corresponding author \n\n\n\nEmail: dsrilakshmi83@gmail.com \n \n\n\n\nBackground and Objectives: To validate bio-analytical \n\n\n\nLCMS/MS method for the estimation of favipiravir in bulk \n\n\n\nand pharmaceutical drugs in rat plasma. To develop a simple, \n\n\n\nrapid and specific LCMS/MS bio-analytical method for the \n\n\n\nestimation of Favipiravir in bulk and combined \n\n\n\npharmaceutical dosage forms. To validate the proposed \n\n\n\nmethods in accordance with the analytical parameters \n\n\n\nmentioned in the ICH guidelines, such as system suitability, \n\n\n\naccuracy, precision, specificity, linearity, recovery, matrix \n\n\n\nfactor, stability, LOD and LOQ. Methods: Chromatographic \n\n\n\nseparation of favipiravir was achieved on Waters Alliance-\n\n\n\ne2695, by using X-bridge phenyl, 150x4.6mm, 3.5\u00b5m \n\n\n\ncolumn and the mobile phase containing 0.1% formic acid & \n\n\n\nACN in the ratio of 40:60% v/v. The flow rate was 1.0 \n\n\n\nmL/min; detection was carried out by using a photodiode \n\n\n\narray detector at ambient temperature. Results and \n\n\n\nDiscussion: The number of theoretical plates and tailing \n\n\n\nfactor for favipiravir were NLT 2000 and should not more \n\n\n\nthan 2 respectively. Percentage relative standard deviation of \n\n\n\npeak areas of all measurements always less than 2.0. The \n\n\n\nproposed method was bio-analytical validated according to \n\n\n\nUSFDA guidelines. Conclusion: The method was found to \n\n\n\nbe simple, economical, suitable, precise, accurate & stable \n\n\n\nmethod for pharmacokinetics analysis of favipiravir and \n\n\n\nstudy of its stability. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 020 \n\n\n\n\n\n\n\nTreatment Burden, Medication Adherence \n\n\n\nand Health Literacy in Elderly with \n\n\n\nMultimorbidity \n\n\n\n\n\n\n\nSelvakumar D1*, Sivanandy P2, Ingle PV2, \n\n\n\nTheivasigamani K3, Kumar S2, Shanmugham \n\n\n\nS2 \n \n\n\n\n1 School of Postgraduate Studies, International Medical University, Kuala \n\n\n\nLumpur, Malaysia \n2 Department of Pharmacy Practice, School of Pharmacy, International \n\n\n\nMedical University, Kuala Lumpur, Malaysia \n3 Department of Pharmacy Practice, Nandha College of Pharmacy, Erode, \n\n\n\nIndia. \n\n\n\n* Corresponding author \n\n\n\nEmail: 00000034565@student.imu.edu.my \n\n\n\n\n\n\n\nBackground and Objectives: Many chronic health \n\n\n\nconditions occur outside healthcare institutions in the form of \n\n\n\nself-management routines that the elderly perform on their \n\n\n\nown at home. Elderly people who have poor health literacy \n\n\n\nand are burdened with their treatment regimen may struggle \n\n\n\nwith adhering to their medication plans.  The prospective \n\n\n\nstudy aims to explore quantitatively how treatment burden \n\n\n\nand health literacy affect medication adherence in elderly \n\n\n\nliving with multimorbidity. Methods: Face-to-face \n\n\n\nstructured interviews were conducted in 10 general \n\n\n\npractitioners (GP) clinics in Selangor among elderly \n\n\n\naged >60 years to collect the data comprising of (1) \n\n\n\ndemographic details, (2) treatment burden assessed using the \n\n\n\nBurden of Treatment Questionnaire (TBQ-15), (3) health \n\n\n\nliteracy of participants assessed using the Short Form Health \n\n\n\nLiteracy Questionnaire (HLS-SF12) and (4) medication \n\n\n\nadherence level of participants assessed using the Malaysia \n\n\n\nMedication Adherence Assessment Tool (MyMAAT). \n\n\n\nResults and Discussion: The preliminary data collected for \n\n\n\nthis study included 36 elderly aged 60 years and above with \n\n\n\n2 or more chronic conditions. The mean score for treatment \n\n\n\nburden, health literacy, and medication adherence for the \n\n\n\nparticipants was 53.9 (SD = 29.7), 20.6 (SD = 9.0), and 36.0 \n\n\n\n(SD =18.9). All the participants (100%) in this study had a \n\n\n\nhigh treatment burden and showed low medication adherence \n\n\n\n(p<0.05) and 72.4% of participants with limited health \n\n\n\nliteracy had low medication adherence (p<0.05). The \n\n\n\nfindings of this study indicate that elderly with \n\n\n\nmultimorbidity who have a high treatment burden and low \n\n\n\nhealth literacy significantly are less adherent to their \n\n\n\nmedications. Conclusion: Low health literacy and high \n\n\n\ntreatment burden significantly affected the elderly with \n\n\n\nmultimorbidity and hurt their health outcomes. \n\n\n\n\nmailto:dsrilakshmi83@gmail.com\n\n\nmailto:00000034565@student.imu.edu.my\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n76 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 021 \n\n\n\n\n\n\n\nPrEP Talk: A Multivariate Analysis \n\n\n\nExploring the Awareness, Attitude, and \n\n\n\nPreference of Filipino University Students \n\n\n\nin Metro Manila toward Human \n\n\n\nImmunodeficiency Virus (HIV) Pre-\n\n\n\nExposure Prophylaxis (PrEP)  \n\n\n\n\n\n\n\nErnest Van Rito*, Danica Jane Rubi, Mila \n\n\n\nIloiza Sangcap, Alicia Alaine Descargar, \n\n\n\nKenneth Domdom, Renz Marion Ricafrente, \n\n\n\nZedierick Tanjista \n \n\n\n\nCollege of Pharmacy, Our Lady of Fatima University, Quezon City, \n\n\n\nPhilippines  \n\n\n\n* Corresponding author \n\n\n\nEmail: ecrito@student.fatima.edu.ph \n\n\n\n\n\n\n\nBackground and Objectives: Pre-Exposure Prophylaxis \n\n\n\n(PrEP) acts as an additional preventive choice in the sexual \n\n\n\ntransmission of the virus has been emerging in popularity in \n\n\n\nthe Philippines. To date, the country\u2019s implementation of \n\n\n\nPrEP is still under pilot testing, thus there are no available \n\n\n\ndetailed-reports. The purpose of the study is to assess the use \n\n\n\nof PrEP among Filipino university students by identifying \n\n\n\ntheir awareness, attitude, and preference. Methods: Primary \n\n\n\ndata was obtained from an anonymous online survey \n\n\n\nconducted among 300 Filipino university students in Metro \n\n\n\nManila. Multivariate analysis of the survey data was \n\n\n\nemployed to identify the factors that affect their attitude and \n\n\n\npreference, and to establish their knowledge and awareness \n\n\n\nto the medication. Results and Discussion: Three factors \n\n\n\nthat explain preference over an HIV prevention were \n\n\n\nidentified using factor analysis, namely, familiarity, social \n\n\n\nImpact, and sexual lifestyle. Consequently, the study \n\n\n\nexplored the effects of these factors on different clusters that \n\n\n\nresulted from cluster analysis. These clusters were sexually \n\n\n\nactive, sexually informed, and sexually inactive. \n\n\n\nConsiderably low knowledge and awareness scores were \n\n\n\nrecorded across all clusters, with an overall 51.4% average \n\n\n\ncorrect response. In spite of that, respondents demonstrated \n\n\n\nfavorable attitudes and high interest in PrEP, with 67% (201) \n\n\n\nsaying that they would use the medication. Conclusion: The \n\n\n\npositive response and high levels of interest recorded, despite \n\n\n\ntheir low knowledge and awareness, highlights its \n\n\n\nimportance in promoting PrEP uptake to the key populations. \n\n\n\nMoreover, the three identified factors could serve as \n\n\n\ninstrumental figures in influencing strategies that the public \n\n\n\nand private sectors may take on for advancing PrEP in the \n\n\n\ncountry. These sectors can tailor fit their actions based on the \n\n\n\ncharacteristics of different groups of people as described by \n\n\n\nthe cluster analysis. Overall, the key insights from the study \n\n\n\nmay serve as guides in improving awareness, preference, and \n\n\n\nutilization of PrEP in the Philippines. \n\n\n\n\n\n\n\nAbstract 022 \n\n\n\n\n\n\n\nRisk of Haemorrhagic Stroke due to \n\n\n\nMethamphetamine Abuse - A Case Series  \n\n\n\n\n\n\n\nJ John Kirubakaran1*, Mina Jafarnia2, \n\n\n\nFarzaneh Raveshi3 \n \n1 Vikas Institute of Pharmaceutical Sciences, Rajahmundry, East Godavari \n\n\n\nDt, AP, India. \n2 Dr Ramezanpour Pharmacy, Garms\u0101r, Semnan, Iran. \n3 Delfinado Pharmacy, Qom, Iran \n\n\n\n* Corresponding author \n\n\n\nEmail: john.mpharm@gmail.com \n\n\n\n\n\n\n\nBackground and Objectives: Drug abuse is the biggest \n\n\n\nissue in the western world and even a major part of the world \n\n\n\nis facing. Irrespective of age groups, everyone is being \n\n\n\nvictims to that. Methamphetamine is one among those which \n\n\n\nis a common form of abuses seen in the western world. \n\n\n\nCerebrovascular complications show a worse effect on the \n\n\n\nvictim's quality of life. Hence, the present study is \n\n\n\nconcentrated on the adverse cerebrovascular outcomes due to \n\n\n\nmethamphetamine abuse. Methods: A systematic review is \n\n\n\ndone by taking case reports and case series between a \n\n\n\ntimeline of 2000-2019. The collection of studies was done \n\n\n\nfrom EMBASE, MEDLINE and PUBMED. The quality of \n\n\n\neach study is assessed by using the new castle-Ottawa scale. \n\n\n\nThe inclusion criteria were Case reports, Case series with \n\n\n\npatients having a history of methamphetamine use. Patients \n\n\n\nwho stopped use of methamphetamine one year back and \n\n\n\nstudies which involve abuse of other illegal drugs were \n\n\n\nexcluded from the study. We evaluated for the stroke which \n\n\n\nshow an absolute involvement of methamphetamine as risk \n\n\n\nfactor. Results and Discussion: Following the exclusion and \n\n\n\ninclusion criteria, articles were collected from 25 case reports \n\n\n\nand being assessed for the occurrence of stroke in subjects \n\n\n\nwho were consuming methamphetamine. Of the 25 cases \n\n\n\nbeing collected, hemorrhagic stroke comprises of 13 (52%) \n\n\n\ncases, ischemic stroke comprises of 9 (36%) cases, \n\n\n\ncardiogenic shock 1(4%), hypovolemic shock 1(4%) and \n\n\n\nanterograde amnesia 1(4%). All the cases show that chronic \n\n\n\nuse of methamphetamine led to stroke. All the cases were \n\n\n\nstrongly evidenced by the confirmatory diagnosis as \n\n\n\nmethamphetamine being the cause for the cerebrovascular \n\n\n\nevents. CT scan was the diagnostic technique used as the \n\n\n\nconfirmatory diagnosis. Thereby, the study strongly \n\n\n\ninterprets that methamphetamine use can cause stroke even \n\n\n\nin healthy individuals. Conclusion: There data can be \n\n\n\ninterpreted as methamphetamine abuse may lead to stroke. \n\n\n\nBased on this study, it can be interpreted that chronic abuse \n\n\n\nof methamphetamine may lead to cerebrovascular \n\n\n\ncomplications of which stroke is the most common \n\n\n\n\nmailto:ecrito@student.fatima.edu.ph\n\n\nmailto:john.mpharm@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n77 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\ncomplications. The risk of hemorrhagic stroke is more than \n\n\n\nischemic stroke.  \n\n\n\n\n\n\n\nAbstract 023 \n\n\n\n\n\n\n\nKnowledge, Attitude, and Practices among \n\n\n\nFilipinos towards Vitamin D \n\n\n\nSupplementation amidst the Pandemic  \n\n\n\n\n\n\n\nJoseph Samuel S. Anthony*, Earrol Jem R. \n\n\n\nBerdos, Swituel S. Guevarra, Daniella G. \n\n\n\nTulabut, Elvira V. De Leon.  \n \n\n\n\nManila Central University \n\n\n\n* Corresponding author \n\n\n\nEmail: samanthony652@gmail.com \n\n\n\n\n\n\n\nBackground and Objectives: Vitamin D has been recently \n\n\n\nstudied to have immune enhancing effects, especially \n\n\n\ntowards respiratory illness prevention and recovery. \n\n\n\nHowever, it is not commonly viewed as a preventive measure \n\n\n\nfor Covid19 and other respiratory tract infections such as \n\n\n\nasthma, TB, and COPD. The aim of this study is to determine \n\n\n\nthe knowledge, attitude, and practice of Filipinos aged 20-50 \n\n\n\nyears old residing in Quezon City towards vitamin D \n\n\n\nsupplementation during the pandemic. Methods: The survey \n\n\n\ntool was developed using statements from other references \n\n\n\nand was validated to ensure credible data gathering. It was \n\n\n\nposted on social media platforms accompanied by a poster \n\n\n\nindicating the inclusion criteria for eligible participants. \n\n\n\nResults and Discussion: The questionnaire garnered results \n\n\n\nstating that the Filipino consumers in Quezon City have high \n\n\n\nlevels of knowledge, attitude, and practice proper vitamin D \n\n\n\nintake wherein females (60.69%) were the more common \n\n\n\nparticipants in the age group of 20-29 years\u2019 old (86%). It \n\n\n\nwas also noted that the prevalence of Covid-19 symptoms \n\n\n\ncontributed to the increase in vitamin D supplementation \n\n\n\nbased on supplement sale increase in 2020. The study also \n\n\n\nfound out that knowledge, attitude, and practices have \n\n\n\npositive correlations with each other when it comes to \n\n\n\nvitamin D supplementation amidst the pandemic. \n\n\n\nConclusion: The relationship exists between knowledge and \n\n\n\nattitude, knowledge and practice, and attitude and practice of \n\n\n\nFilipinos towards vitamin D supplementation amidst the \n\n\n\npandemic. It shows positive significant correlations with \n\n\n\neach other. This means that higher levels of knowledge are \n\n\n\nassociated with a higher level of attitude and frequent proper \n\n\n\npractice of vitamin D supplement intake. A higher level of \n\n\n\nattitude implies a high level of knowledge and frequent \n\n\n\nproper practice of vitamin D supplement intake. It is \n\n\n\nrecommended for pharmacist to continue proper education \n\n\n\nand information regarding vitamin D supplementation.  \n\n\n\n\n\n\n\n\n\n\n\nAbstract 024 \n\n\n\n\n\n\n\nTherapeutic Effects and Possibilities of \n\n\n\nCitrus maxima (Pomelo) Leaves Aqueous \n\n\n\nExtract of a Commercial Product \n\n\n\n\n\n\n\nJia Rou Khor, Siok Yee Chan* \n\n\n\n\n\n\n\nDiscipline of Pharmaceutical Technology, School of Pharmaceutical \n\n\n\nSciences, Universiti Sains Malaysia (USM), 11800 Gelugor, Penang, \n\n\n\nMalaysia \n\n\n\n* Corresponding author \n\n\n\nEmail: sychan@usm.my \n\n\n\n\n\n\n\nBackground and Objectives: For thousands of years, \n\n\n\npopulation in rural and tribal areas has relied primarily on \n\n\n\nCitrus maxima leaves as a natural traditional medicine. In \n\n\n\norder to find natural items that can be utilised in addition to \n\n\n\nconventional medicine, our study would want to gain a \n\n\n\ngreater understanding of the therapeutic characteristics of \n\n\n\nCitrus maxima leaves of  a commercial product. Methods: \n\n\n\nPhytochemical analysis was performed to identify and screen \n\n\n\nfor bioactive chemical elements in medicinal plant. The \n\n\n\nneutralisation effect and capacity of fresh and dry leaves of \n\n\n\nyoung and old leaves were experimentally evaluated. To \n\n\n\nmeasure the anti-inflammatory efficacy and antioxidant \n\n\n\nactivity of all four-leaf extracts, egg albumin denaturation \n\n\n\nassay and DPPH radical scavenging assay were carried out. \n\n\n\nResults and Discussion: Screening assays for \n\n\n\nphytochemicals identified the classes of active \n\n\n\nphytochemicals as flavonoids, steroids, tannins, and cardiac \n\n\n\nglycoside. The outcome demonstrated that the dried old leaf \n\n\n\nextract had an excellent neutralizing effect by raising the pH \n\n\n\nof the artificial gastric juice from its initial pH of 1.2 to 4.16 \n\n\n\n\u00b1 0.04 with the preeminent consumption of 89.85 \u00b1 0.08 mL \n\n\n\nof artificial gastric juice and 5.669 \u00b1 0.005 moles of H+ ions, \n\n\n\nrespectively. Fresh old leaf extract displayed appreciable \n\n\n\nactivity preventing the denaturation of egg albumin with \n\n\n\n71.10 \u00b1 0.62% inhibition. The maximum potential of anti-\n\n\n\noxidant was seen in fresh young leaf extract with 76.91 \u00b1 \n\n\n\n1.197% inhibition. Conclusion: All the assays evidenced the \n\n\n\nneutralising, anti-inflammatory and anti-oxidant effect of \n\n\n\nCitrus maxima leaves, with dried old leaves, fresh old leaves \n\n\n\nand fresh young leaves being the most prominent. Our study's \n\n\n\npertinent findings will pave the way for the discovery of \n\n\n\nnatural remedies that may be utilised in conjunction with \n\n\n\nconventional medicine. \n\n\n\n \n\n\n\n\nmailto:samanthony652@gmail.com\n\n\nmailto:sychan@usm.my\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n78 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 025 \n\n\n\n\n\n\n\nKnowledge, Attitude, and Practice of the \n\n\n\nMedical Practitioners towards Adverse \n\n\n\nDrug Reactions Reporting \n\n\n\n\n\n\n\nKirthikaa Gopal Krishnan1*, Palanisamy \n\n\n\nSivanandy2, Nafeeza Bt Hj Mohd Ismail3  \n \n1 School of Postgraduate Studies, International Medical University, Kuala \n\n\n\nLumpur, Malaysia \n2 Department of Pharmacy Practice, School of Pharmacy, International \n\n\n\nMedical University, Kuala Lumpur, Malaysia \n3 Faculty of Medicine, Universiti Teknologi MARA, Selangor, Malaysia  \n\n\n\n* Corresponding author \n\n\n\nEmail: kirthikaagopalkrishnan@gmail.com \n\n\n\n\n\n\n\nBackground and Objectives: In Malaysia, the rate of \n\n\n\nadverse drug reaction (ADR) reporting among private \n\n\n\npractitioners is exceptionally low, with only 5.26% reporting. \n\n\n\nThe failure to report ADRs increases the likelihood of ADR \n\n\n\ncases significantly and reduces the quality of life of patients. \n\n\n\nThis study was aimed to analyse medical practitioners' \n\n\n\nknowledge, attitudes, and practices (KAP) on \n\n\n\npharmacovigilance and the ADR reporting system and to \n\n\n\nidentify the factors that influence ADR underreporting. \n\n\n\nMethods: A cross-sectional survey of 600 private and public \n\n\n\nmedical practitioners in Kuala Lumpur and Selangor was \n\n\n\nundertaken. A structured validated questionnaire was used to \n\n\n\ncollect demographic data, medical practitioners\u2019 KAP of \n\n\n\nADRs and reporting system. Results and Discussion: This \n\n\n\nsurvey included 600 private and public medical practitioners. \n\n\n\nAround 78.3% of respondents believed that reporting ADRs \n\n\n\nhelped to discover safe pharmaceuticals, and 82% said that it \n\n\n\nhelped to gauge the occurrence of ADRs. In terms of practice, \n\n\n\n68.9% of respondents said they would only report an event if \n\n\n\nthey were certain the reaction was an ADR. In terms of \n\n\n\nattitudes, 84%, 62.4%, and 26.5% of people were complacent, \n\n\n\nignorant, or indifferent. Conclusion: Half of the participants \n\n\n\nin this survey showed medium to moderate understanding, \n\n\n\nattitudes, beliefs, and practice of ADR reporting. ADRs were \n\n\n\nunderreported at all levels of practice, academic, and \n\n\n\nprofessional experience. A well-structured periodic \n\n\n\nintervention programme is required to address the \n\n\n\nfundamental cause and raise the rate of ADR reporting. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 026 \n\n\n\n\n\n\n\nAdoption of Machine Learning Algorithms \n\n\n\nin Predicting Vaccine Hesitancy: A \n\n\n\nNarrative Review  \n\n\n\n\n\n\n\nMunaver Ahmad Nazir Ahmad1*, Nour \n\n\n\nHanah Othman2, Irraivan Elamvazuthi3, \n\n\n\nZaswiza, Mohamad Noor4 \n \n\n\n\n\u00b9 Faculty of Pharmacy and Health Sciences, Royal College of Medicine \n\n\n\nPerak, Universiti Kuala Lumpur, Malaysia.  \n\n\n\n\u00b2 Faculty of Pharmacy and Health Sciences, Royal College of Medicine \n\n\n\nPerak, Universiti Kuala Lumpur, Malaysia.  \n\n\n\n\u00b3 Dept of Electrical & Electronic Engineering, Universiti Teknologi \n\n\n\nPETRONAS, Malaysia.  \n\n\n\n\u2074 Faculty of Pharmacy and Health Sciences, Royal College of Medicine \n\n\n\nPerak, Universiti Kuala Lumpur, Malaysia. \n\n\n\n* Corresponding author \n\n\n\nEmail: munavernazirrcmp@gmail.com \n\n\n\n\n\n\n\nBackground and Objectives: The alarming increase of \n\n\n\nvaccine hesitancy (VH) cases among Malaysian parents has \n\n\n\nled to a resurgence of vaccine preventable diseases (VPD) \n\n\n\nand mortalities among children in the last 10 years. \n\n\n\nNumerous studies have assessed various factors of vaccine \n\n\n\nhesitancy. However, less research has been conducted on \n\n\n\nhow well these factors perform in predicting vaccine \n\n\n\nhesitancy. Recently, machine learning algorithms (MLA) \n\n\n\nhave been used to predict vaccine hesitancy accurately. \n\n\n\nTherefore, the objective of this study is to review the use of \n\n\n\nmachine learning algorithms to predict vaccine hesitancy.  \n\n\n\nMethods: A narrative review of existing literature using a \n\n\n\nnon-systematic search for original articles was conducted \n\n\n\nthrough online search databases, namely Pubmed, DOAJ \n\n\n\nOpen Access, and Google Scholar from 2018 to 2022, on \n\n\n\nmachine learning algorithms to predict vaccine hesitancy \n\n\n\n(VH). Fifteen (15) articles were then included in this review. \n\n\n\nKey words used to conduct the search were \u201cmachine \n\n\n\nlearning algorithms\u201d, \u201cvaccine hesitancy\u201d, \u201crefusal\u201d, \n\n\n\n\u201cimmunisation\u201d, \u201cartificial intelligence\u201d, \u201cadopting\u201d, and \n\n\n\n\u201cpredicting\u201d. Results and Discussion: The findings \n\n\n\nhighlighted the increasing roles played by machine learning \n\n\n\nalgorithms in predicting vaccine hesitancy, across various \n\n\n\nsocioeconomic and demographic profiles in low-, middle- \n\n\n\nand high-income countries. The phases of development, \n\n\n\nvalidation, and performance analysis of a battery of machine \n\n\n\nlearning models predicting vaccine hesitancy was also \n\n\n\ndocumented. Strategies to develop parsimonious models to \n\n\n\nprovide health workers and policymakers with interpretable \n\n\n\nmodel that can be easily explained was also provided.  \n\n\n\nConclusion: This review has found that MLA is an objective \n\n\n\nmethod to predict VH and can be used by policy makers to \n\n\n\nincrease vaccination uptake among the population. \n\n\n\n \n\n\n\n\nmailto:kirthikaagopalkrishnan@gmail.com\n\n\nmailto:munavernazirrcmp@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n79 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 027 \n\n\n\n\n\n\n\nKnowledge, Attitude, and Acceptance on \n\n\n\nCoronavirus Disease (COVID-19) \n\n\n\nVaccination Among Non-allied Health \n\n\n\nIndividuals in the Greater Manila Area, \n\n\n\nPhilippines \n\n\n\n\n\n\n\nRose Anne Chua*, Asia Nykyle Stefanie \n\n\n\nAbello, Samantha Jillian Araneta, Paolo Jose \n\n\n\nDe Los Santos, Kim Shekinah Mei Hosena, \n\n\n\nMary Patricia Joson, Christine Janelle \n\n\n\nMataga, Gizelle Parado, Jennie Wong \n \n\n\n\nDepartment of Preventive, Family, and Community Medicine and \n\n\n\nResearch. College of Medicine. Chinese General Hospital Colleges. \n\n\n\nManila, Philippines \n\n\n\n* Corresponding Author \n\n\n\nEmail: rose.chua@cghc.edu.ph /rose.anne.v.chua@gmail.com  \n\n\n\n\n\n\n\nBackground and Objectives: The Coronavirus Disease \n\n\n\n2019 (COVID-19) pandemic wreaked havoc on healthcare \n\n\n\nsystems, posing novel problems. Vaccination is considered \n\n\n\nthe best hope for a long-term solution. However, this has to \n\n\n\nbe accepted by a majority of the population to achieve herd \n\n\n\nimmunity. The aim of the study was to assess the knowledge, \n\n\n\nattitude, and acceptance (KAA) of COVID-19 vaccination \n\n\n\namong non-allied health individuals and determine their \n\n\n\nrelationship to demographic profiles. Methods: An online \n\n\n\nself-administered questionnaire was developed through \n\n\n\nliterature review and modified, undergone expert \n\n\n\nevaluation/validation, translation and back translation, and \n\n\n\npre-testing. The instrument was distributed to respondents \n\n\n\nresiding in the Greater Manila Area: GMA (Metro Manila, \n\n\n\nBulacan, Cavite, Laguna, and Rizal), Philippines. Data \n\n\n\ncollection was conducted in June 2022. Descriptive and \n\n\n\ninferential statistics were generated using Microsoft Excel \n\n\n\n2020 and R/Python version 4.2.0 2022. Results and \n\n\n\nDiscussion: Most of the respondents were young adults \n\n\n\n(54%), male (50%), single (67%), with tertiary education \n\n\n\n(54%), and belonging to the middle class (39%). Age \n\n\n\n(0.02546), educational background (0.0002017), monthly \n\n\n\nhousehold income (0.002824), and internet signal (0.02266) \n\n\n\nwere found to significantly influence knowledge. Those \n\n\n\nsignificantly affected attitude were: age (0.01767), \n\n\n\neducational background (0.0003589), monthly household \n\n\n\nincome (0.0006069), internet Signal (0.0359), time spent on \n\n\n\nsocial media (0.01968), and political stance (0.001231). \n\n\n\nThose that showed significant association with acceptance \n\n\n\nwere educational background (0.02556), monthly household \n\n\n\nincome (0.00002606), and internet signal (0.005458). \n\n\n\nConclusion: This study offers insight into the KAA of \n\n\n\nCOVID-19 vaccination among non-allied health individuals \n\n\n\nin the GMA. Demographics such as educational \n\n\n\nbackground, monthly household income, internet signal, and \n\n\n\ntime spent on social media influenced the KAA. \n\n\n\n\n\n\n\nAbstract 028 \n\n\n\n\n\n\n\nThe Interaction between Herbal Extract and \n\n\n\nEudragit Polymer Blend on \n\n\n\nPhysicochemical and Mechanical \n\n\n\nCharacteristics of Core/shell Composite \n\n\n\nOrodispersible Films \n\n\n\n\n\n\n\nSiew Mei Tan, Siok Yee Chan* \n \n\n\n\nThoughts Formulation Lab, Discipline of Pharmaceutical Technology, \n\n\n\nSchool of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang \n\n\n\n11800, Malaysia  \n\n\n\n* Corresponding author \n\n\n\nEmail: sychan@usm.my \n\n\n\n\n\n\n\nBackground and Objectives: Orodispersible fibre film with \n\n\n\ncore/shell composite is a promising drug dosage form to \n\n\n\novercome the bitter taste drawback of herbal extracts using \n\n\n\ncoaxial electrospun technology. However, the interaction \n\n\n\nbetween the core and the shell layer are not fully \n\n\n\ncomprehended. This research aims to reveal the interaction \n\n\n\neffects of different ratios of Eudragit polymer blends (shell) \n\n\n\nand Carica papaya leaf extract (core) on the physicochemical \n\n\n\nand mechanical characteristics of core/shell composite \n\n\n\norodispersible fibre films. Methods: The orodispersible fibre \n\n\n\nfilms were formulated using the coaxial electrospinning \n\n\n\nmethod with Eudragit L100-55 and Eudragit L100 polymer \n\n\n\nblends in the ratio of 1:0, 1:1, 1:3, 1:5, and 0:1 respectively. \n\n\n\nBlank formulations were prepared to compare with those \n\n\n\nloaded with the Carica papaya leaf extract. The developed \n\n\n\nformulations were characterised for their film thickness, \n\n\n\nmoisture content, swelling properties, mechanical strength, \n\n\n\nand film disintegration (wetting time). ATR-FTIR analysis \n\n\n\nwas conducted to study the drug-excipient compatibility. \n\n\n\nResults and Discussion: The employed polymers in coaxial \n\n\n\nelectrospun manner successfully produced homogenous and \n\n\n\nadequate flexibility fibre films, with a uniform green color \n\n\n\nfrom the inside and off-white color from the outside. The \n\n\n\ndeveloped orodispersible films offered an immediate \n\n\n\ndisintegration profile in simulated human saliva (pH 6.8), \n\n\n\nshowing the potential production of oral formulation. ATR-\n\n\n\nFTIR analysis showed the compatibility between the shell \n\n\n\nand core layer. Conclusion: The coaxial electrospinning was \n\n\n\nsuccessfully used in developing orodispersible films as a \n\n\n\npharmaceutical dosage form for the oral delivery of Carica \n\n\n\npapaya leaf extract with the abilities to overcome the bitter \n\n\n\ntaste. This study elucidates the relationship between polymer \n\n\n\ncarrier and herbal extract in affecting the physicochemical \n\n\n\nand mechanical behaviours of the orodispersible films at \n\n\n\ndifferent ratios of polymer blends.  \n\n\n\n \n\n\n\n\nmailto:rose.chua@cghc.edu.ph\n\n\nmailto:/rose.anne.v.chua@gmail.com\n\n\nmailto:sychan@usm.my\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n80 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 029 \n\n\n\n\n\n\n\nRemoving Communication Barrier between \n\n\n\nPharmacy and Deaf Patients \n\n\n\n\n\n\n\nNur Azrida Azhari Wasi, Ching Wern Chong, \n\n\n\nYoshnni M Navaneethan*, Muhammad \n\n\n\nFikree Ahmad, Siti Nur-Hussaini Mohamad \n\n\n\nTermizi, Umi Aqilah Amir, Mohd Firdaus \n\n\n\nAbdullah, Sharmili Retnam, Yuan Wah Loo, \n\n\n\nFarid Ahmad Nasir, Siti Rahimah Mohd \n\n\n\nRadzi, Suhaila Mustaffa, Noor Azwani Abd \n\n\n\nSamad, Narian Singh Sadu Singh \n \n\n\n\nDepartment of Pharmacy, University of Malaya Medical Centre, Kuala \n\n\n\nLumpur, Malaysia \n\n\n\n* Corresponding Author \n\n\n\nEmail: yoshnni@ummc.edu.my \n\n\n\n\n\n\n\nBackground and Objectives: Deaf community in Malaysia \n\n\n\nuses Malaysian Sign Language in communication. In the \n\n\n\nUniversity of Malaya Medical Centre (UMMC), however, \n\n\n\nthe Pharmacy Department uses either Malay or English for \n\n\n\nmedication instruction on the labels as well as when \n\n\n\ndispensing medication to patients. This communication \n\n\n\nbarrier can compromise deaf patient\u2019s safety when using \n\n\n\nmedications. Methods: A survey was conducted in 2020 \n\n\n\nacross the hospital to assess the current practice in delivering \n\n\n\ncare towards deaf patients. Following the survey, an \n\n\n\nimprovement was initiated in 2021 in collaboration with the \n\n\n\nMalaysia Federation of the Deaf (MFD) to create 75 \n\n\n\nmedication instruction videos in Malaysian Sign Language. \n\n\n\nEach video is linked to a QR code that is printed and stuck \n\n\n\non the medication upon dispensing to deaf patients. Patients \n\n\n\nwill scan the QR codes to access the videos.  Results and \n\n\n\nDiscussion: Pre-improvement survey (N=275) which \n\n\n\nincludes 64 pharmacy staff found that most (97%) staff are \n\n\n\nnot equipped to cater to deaf patients given the existing \n\n\n\ncommunication barrier. Engagement with the deaf \n\n\n\ncommunity via MFD creates a library of medication \n\n\n\ninstructions in Malaysian Sign Language that is verified for \n\n\n\ndeaf community use. A post-improvement survey among \n\n\n\nPharmacy frontliners (N=111) showed that 96.3% feels that \n\n\n\nthis standardized approach eases communication with deaf \n\n\n\npatients.  Conclusion: Providing QR code labels with \n\n\n\nembedded medication instructions in sign language removes \n\n\n\ncommunication barriers in the dispensing process and creates \n\n\n\nan inclusive system for ensuring safe and correct medication \n\n\n\nuse by deaf patients. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 030 \n\n\n\n\n\n\n\nDigital Health Perception among the \n\n\n\nPharmacy Students of Asian Countries \n\n\n\n\n\n\n\nAbdishakur Hassan Mohamed1*, Rohit \n\n\n\nKumar Verma2, Palanisamy Sivanandy2, \n\n\n\nManisha Pandey2, Jayashree Mayuren2 \n \n\n\n\n1 School of Postgraduate Studies, International Medical University, Kuala \n\n\n\nLumpur, Malaysia \n2 Department of Pharmacy Practice, School of Pharmacy, International \n\n\n\nMedical University, Kuala Lumpur, Malaysia \n\n\n\n* Corresponding author \n\n\n\nEmail: abdishakurmoha2030@gmail.com \n\n\n\n\n\n\n\nBackground and Objectives: In the recent decade, there has \n\n\n\nbeen a gradual uptake and adoption of digital health in the \n\n\n\nhealthcare industry. The utilisation of digital health tools at \n\n\n\nhealthcare facilities has greatly improved patient-related \n\n\n\noutcomes, supported healthcare staff by reducing their \n\n\n\nworkload and improved care coordination. Hence, it is \n\n\n\nimperative for healthcare professionals to be well-acquainted \n\n\n\nwith digital health literacy and are competent-level digital \n\n\n\nskills. Therefore, institutions/universities must implement \n\n\n\ndigital health literacy competencies in the curriculum to \n\n\n\nprepare future healthcare professionals to leverage the \n\n\n\npotential of digital technologies to improve patient health. \n\n\n\nThe study aimed to evaluate the perceptions of Asian \n\n\n\npharmacy students on digital health. Methods: It was a \n\n\n\nmixed-methods study conducted online through an \n\n\n\nanonymous and self-administered survey targeted toward \n\n\n\npharmacy students in Asian countries. The online survey \n\n\n\nquestionnaire has both qualitative and quantitative items. The \n\n\n\npharmacy students from approved universities in Asian \n\n\n\ncountries willing to participate in this survey were included. \n\n\n\nA total of 44 approved universities were included from India \n\n\n\n(22), Malaysia (6), Thailand (3), Indonesia (4), Bangladesh \n\n\n\n(3), Philippines (3), Pakistan (1), Sri Lanka (1), and South \n\n\n\nKorea (1). Results and Discussions: The study survey \n\n\n\nreceived 304 responses. More than three-fourths of the \n\n\n\nrespondents understood and were familiar with eHealth \n\n\n\n(n=226, 74.34%). In addition to that, the majority of the \n\n\n\nrespondents saw the advantage of the use of \"Big data\", \n\n\n\n\"Telehealth\", and \"mHealth\" in the future. In terms of the \n\n\n\nimplementation of eHealth in the pharmacy curriculum, \n\n\n\n80.59% (n=245) of the respondents were in favour since \n\n\n\nnearly 80% of respondents had received less than 5 hours of \n\n\n\neHealth training. Conclusion: The findings in this study have \n\n\n\ndemonstrated that digital health-related components in the \n\n\n\npharmacy curriculum and perceived digital health literacy \n\n\n\namong Asian pharmacy students ranged from acceptable to \n\n\n\nreasonable levels. Furthermore, the majority of students \n\n\n\nfavour and anticipate the implementation of eHealth \n\n\n\neducation in the pharmacy curriculum. \n\n\n\n \n\n\n\n\nmailto:yoshnni@ummc.edu.my\n\n\nmailto:abdishakurmoha2030@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n81 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 031 \n\n\n\n\n\n\n\nAcademic Restructuring towards Flexible \n\n\n\nLearning in Philippine Pharmacy Education \n\n\n\n\n\n\n\nAleth Therese L. Dacanay, Maria Fay Nenette \n\n\n\nM. Cariaga*, Vina Rose D. Talan, Shiela DV \n\n\n\nMiranda, Ellen Mae P. Abiqui \n\n\n\n\n\n\n\nPhilippine Association of Colleges of Pharmacy, Manila, Philippines \n\n\n\n*Corresponding author \n\n\n\nEmail: pacoppresident@gmail.com \n\n\n\n\n\n\n\n\n\n\n\nBackground and Objectives: Due to Covid-19, schools \n\n\n\nphysically shut down in 2020, which led to the \n\n\n\nimplementation of flexible learning in pharmacy education. \n\n\n\nThe first phase of this study sought to determine the stage \n\n\n\nwhere schools are from the continuum of pre-emerging to \n\n\n\nempowering, forming the basis of the creation of the ACTS \n\n\n\n(Assess, Cope, Transition, Synergize) framework; Philippine \n\n\n\nAssociation of Colleges of Pharmacy [PACOP] \n\n\n\nRecommending Guidelines on Academic Restructuring \n\n\n\ntowards Flexible Learning and action plan in serving all \n\n\n\nschools of pharmacy during the height of the pandemic. The \n\n\n\nsecond phase determined the stage two years after integrated \n\n\n\naction plan implementation, with the adopted 2021 \n\n\n\nframework, AAT (Absorptive Adaptive Transformative)-\n\n\n\nResilience Capacities or ARTS (Adaptation Resilience \n\n\n\nTransformative Synergy).  Methods: Survey research using \n\n\n\nan adapted tool was employed. Eighty-seven and fifty-three \n\n\n\nschools, represented by the deans or heads, participated in the \n\n\n\nfirst and second phase, respectively, out of 124 schools. \n\n\n\nQualitative inputs were used to supplement the discussion of \n\n\n\nfindings. Data were analysed using descriptive statistics and \n\n\n\nthematic analysis.  Results and Discussion: Along areas of \n\n\n\ncourse plan modification, lecture, laboratory, research, \n\n\n\nexperiential pharmacy practice (EPP) and health and \n\n\n\nwellness; and specific domains like mode of delivery, \n\n\n\ngradable assessments, and grading system, results in 2020 \n\n\n\nshowed that schools were mostly on the pre-emerging \n\n\n\n(42.35%) to emerging phase (34.12%). Now in 2022, schools \n\n\n\nhave migrated to engaging (37.74%), extending (35.8%) and \n\n\n\nempowering (18.9%) stages. Best practices\u2019 themes were \n\n\n\nborderless integration of industry experts and practitioners in \n\n\n\nthe [FLO] delivery; resilience of schools and industry/ \n\n\n\norganization partners 3) stronger collaboration with all \n\n\n\nstakeholders; hybrid/ hyflex mode as main recovery plan \n\n\n\nstrategy. Conclusion: Moving forward, there is still a need \n\n\n\nfor recovery interventions, revision of existing \n\n\n\nrecommending guidelines, measures of sustainability and \n\n\n\nCQI, and official guidelines for EPP delivery. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 032 \n\n\n\n\n\n\n\nA Shared Culture of Caring in the Time of \n\n\n\nthe COVID-19 Pandemic: The Essence of \n\n\n\nInterprofessional Collaboration as \n\n\n\nPerceived by Pharmacy and Medical \n\n\n\nTechnology/Medical Laboratory Science \n\n\n\nStudents \n\n\n\n\n\n\n\nLangit MRD1,3,4*, Abesamis RAS2, Adonis \n\n\n\nLD2 , Agustin AJR2, Amoy NNT2, Aquino \n\n\n\nGRM2, Archog XMGD2, Ayeo SS2, Baladad \n\n\n\nAGB2, Balocating JLZ2, Baquir AMG2 \n \n1 Department of Pharmacy,  \n2 Department of Medical Laboratory Science, School of Natural Sciences, \n\n\n\nSaint Louis University, Baguio City, Philippines \n\n\n\n3 The Graduate School, University of Santo Tomas, Sampaloc, Manila, \n\n\n\nPhilippines \n4 Executive Secretary, Philippine Pharmacists Association, Manila, \n\n\n\nPhilippines \n\n\n\n* Corresponding author \n\n\n\nEmail address: mrdlangit@slu.edu.ph ; secretary.ppha@gmail.com \n\n\n\n\n\n\n\nBackground and Objectives: COVID-19 pandemic has \n\n\n\naffected an unimaginable number of lives. Healthcare \n\n\n\nproviders have played an essential role in battling the \n\n\n\npandemic with strategies which organised the healthcare \n\n\n\nsystem to reduce the current issues or challenges. This study \n\n\n\nsought to assess the perception, attitude, and perceived view \n\n\n\nof medical laboratory science and pharmacy students on \n\n\n\ninterprofessional collaboration during the COVID-19 \n\n\n\npandemic. Methods: A 30-item questionnaire was \n\n\n\ndistributed randomly using google forms, to the Third and \n\n\n\nFourth-Year students taking either BS Pharmacy (BSPharm) \n\n\n\nor BS Medical Laboratory Science (BSMLS) at a private \n\n\n\nuniversity in Northern Philippines. A total of 198 \n\n\n\nrespondents returned the questionnaire. t-test and chi-square \n\n\n\nwere used to compare the mean values of dependent and \n\n\n\nindependent variables to determine their statistical \n\n\n\nrelationship. Results and Discussion: Interaction between \n\n\n\nBSPharm and BSMLS students was observed to be high \n\n\n\n(\u201cRegularly\u201d= 35.90%; \u201cQuite a lot\u201d= 18.70%; \n\n\n\n\u201cSomewhat\u201d= 35.90%; \u201cNot at all\u201d= 9.60%), but \n\n\n\ncollaboration showed the opposite (\u201cRegularly\u201d= 27.60%; \n\n\n\n\u201cQuite a lot\u201d= 26.00%; \u201cSomewhat\u201d= 22.40%; \u201cNot at all\u201d= \n\n\n\n24.00%). There is a lack of collaboration between student-\n\n\n\nprofessionals and student-medical technologists in general. \n\n\n\nNevertheless, they understand the responsibilities of their \n\n\n\nown department and see interprofessional collaboration as \n\n\n\nan important factor in providing quality service in patient \n\n\n\ncare. Conclusion: The results showed that interprofessional \n\n\n\neducation and collaborative experience is essential in \n\n\n\nenhancing students\u2019 patient-centeredness, teamwork and \n\n\n\ncollaboration, especially in times of pandemic. Therefore, \n\n\n\n\nmailto:pacoppresident@gmail.com\n\n\nmailto:mrdlangit@slu.edu.ph\n\n\nmailto:secretary.ppha@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n82 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nmore effort should be made in interacting and collaborating \n\n\n\nwith other student professionals.  \n\n\n\nAbstract 033 \n\n\n\n\n\n\n\nKnowledge, Awareness, Acceptability, and \n\n\n\nPerceived Research Misconduct among the \n\n\n\nSchools of Pharmacy in Malaysia \n\n\n\n\n\n\n\nWan Ping Ng1, Khong Yun Pang2, Pei Boon \n\n\n\nOoi3, Chia Wei Phan1,4* \n \n\n\n\n1 Department of Pharmaceutical Life Sciences, Faculty of Pharmacy, \n\n\n\nUniversiti Malaya, 50603 Kuala Lumpur, Malaysia. \n2 Psychology Department, Faculty of Social Science & Liberal Arts, UCSI \n\n\n\nUniversity, 56000 Cheras, Malaysia. \n3Department of Medical Sciences, School of Medical & Life Sciences, \n\n\n\nSunway University, Bandar Sunway, 47500 Petaling Jaya, Selangor, \n\n\n\nMalaysia. \n4 Clinical Investigation Centre (CIC), University Malaya Medical Centre, \n\n\n\n59100 Kuala Lumpur, Malaysia. \n\n\n\n* Corresponding author \n\n\n\nEmail: phancw@um.edu.my \n\n\n\n\n\n\n\nBackground and Objectives: Research misconduct is a \n\n\n\ngrowing issue which needs more attention. The higher \n\n\n\nprevalence of research misconduct in health-related \n\n\n\nresearch as compared to research in other fields negatively \n\n\n\ninfluences the healthcare sector. Factors which might \n\n\n\ninfluence research practice include level of knowledge and \n\n\n\nawareness regarding research misconduct, as well as \n\n\n\nacceptability to unethical research practices. This study \n\n\n\naimed to investigate the relationship between research \n\n\n\nmisconduct and its knowledge, awareness, and \n\n\n\nacceptability with focus on Malaysia pharmacy education \n\n\n\ncommunity, i.e., the educators and students. Methods: \n\n\n\nEthics approval was obtained from the Universiti Malaya \n\n\n\nEthics Committee (UMREC). A cross-sectional study \n\n\n\nusing an online questionnaire was conducted. A total of \n\n\n\n393 pharmacy students and pharmacy academicians in \n\n\n\nMalaysia were involved. Data was analysed using PLS-\n\n\n\nSEM to assess the proposed hypotheses.  Results and \n\n\n\nDiscussion: A statistically significant positive relationship \n\n\n\nwas found between awareness of terminologies regarding \n\n\n\nresearch misconduct and perceived research misconduct in \n\n\n\nthe workplace. However, acceptability of unethical \n\n\n\npractices in research demonstrated a negative correlation \n\n\n\nwith perceived research misconduct. Knowledge and \n\n\n\nawareness regarding research misconduct have no \n\n\n\nsignificant relationship with perceived research \n\n\n\nmisconduct. Both awareness on terminologies and \n\n\n\nacceptability to unethical practices explained 10.8% of \n\n\n\nvariance in perceived research misconduct. Conclusion: \n\n\n\nThe study indicates that awareness, knowledge, and \n\n\n\nacceptability of research misconduct might not be the main \n\n\n\npredictors to questionable conduct of research among the \n\n\n\npharmacy academicians and students. Future study on \n\n\n\nother factors which might contribute to research \n\n\n\nmisconduct is highly recommended to investigate the \n\n\n\nsignificant contributing factors of irresponsible conduct of \n\n\n\nresearch. \n\n\n\n\n\n\n\nAbstract 034 \n\n\n\n\n\n\n\nSmoking Cessation Problem-based \n\n\n\nLearning: Virtual Experience \n\n\n\n\n\n\n\nSoraya Ismail1*, Mohamad Haniki Nik \n\n\n\nMohamed2 \n\n\n\n \n1 Department of Basic Medical Sciences, Kulliyyah (Faculty) of Medicine, \n\n\n\nInternational Islamic University Malaysia \n2 Department of Pharmacy Practice, Kulliyyah (Faculty) of Pharmacy, \n\n\n\nInternational Islamic University Malaysia \n\n\n\n* Corresponding author \n\n\n\nEmail: dr_soraya@iium.edu.my \n\n\n\n\n\n\n\nBackground and Objectives: Problem-based learning (PBL) \n\n\n\nis a student-centred teaching and learning methodology \n\n\n\nwhere students collaboratively address specific issues. \n\n\n\nTobacco use is a major health issue globally. Health \n\n\n\nprofessions and students need to have knowledge and skills \n\n\n\nto facilitate smoking cessation.  The objective of this study is \n\n\n\nto assess feasibility of PBL during a virtual attachment \n\n\n\ninvolving institutions from Malaysia and the USA. Methods: \n\n\n\nA 4-week smoking cessation virtual attachment was \n\n\n\nconducted for three third-year University of Pittsburgh, USA \n\n\n\npharmacy students. Malaysian smoking cessation experts \n\n\n\ndesigned and facilitated a PBL smoking cessation module. It \n\n\n\nwas split into two 2-hour sessions with 3 triggers; Trigger 1: \n\n\n\n\u2018Chief Presentation\u2019, Trigger 2: \u2018History & Motivational \n\n\n\nInterview\u2019, and Trigger 3: \u2018Brief 5A\u2019s Intervention\u2019.  \n\n\n\nStudents received Trigger 1 a day earlier and discussed \n\n\n\namongst themselves. In session 1, Triggers 1-3 were given \n\n\n\nsequentially and discussed after completing all tasks from \n\n\n\neach trigger. In session 2 one-week later, facilitators gave \n\n\n\nformative assessment and students provided reflection \n\n\n\nregarding the PBL session. Upon completing the four-week \n\n\n\nvirtual attachment, students provided feedback and \n\n\n\nfacilitators graded the students. Result and Discussion:  A \n\n\n\ncomprehensive and interactive PBL session was successfully \n\n\n\nconducted virtually. Based on the clinical practice guidelines \n\n\n\nof both countries, there were differences in terms of \n\n\n\navailability and use of cessation medications, but the general \n\n\n\nprinciples of smoking cessation consultation and \n\n\n\ninterventions were similar. Students were able to discuss the \n\n\n\ncase openly, putting forth ideas and questions in both \n\n\n\nsessions. All students provided positive feedbacks regarding \n\n\n\nthe PBL. Conclusion:  With the extensive development of \n\n\n\nonline platforms connecting the world over, student virtual \n\n\n\nattachment and mobility programmes can be easily \n\n\n\nconducted with minimal cost.  A suitable module embedding \n\n\n\nPBL can be designed and conducted to best suit the online \n\n\n\nplatform and the intended students.    \n\n\n\n \n\n\n\n\nmailto:phancw@um.edu.my\n\n\nmailto:dr_soraya@iium.edu.my\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n83 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 035 \n\n\n\n\n\n\n\nContinuing Professional Development: A \n\n\n\nNeed Assessment among Pharmacists in \n\n\n\nMalaysia \n\n\n\n\n\n\n\nSyireen Alwi1*, Siew Siang Chua2, May Hoi \n\n\n\nLee3, Mei Hui Tang3 \n\n\n\n \n1 Department of Clinical Pharmacy and Pharmacy Practice, Faculty of \n\n\n\nPharmacy, Universiti Malaya, Malaysia \n2 Malaysian Academy of Pharmacy, Malaysia \n3 Faculty of Pharmacy, Universiti Malaya, Malaysia \n\n\n\n* Corresponding author \n\n\n\nEmail: syireen@um.edu.my \n\n\n\n\n\n\n\nBackground and Objectives: Continuing Professional \n\n\n\nDevelopment (CPD) is a lifelong learning model to maintain \n\n\n\nand enhance pharmacists\u2019 competencies. As the practice of \n\n\n\npharmacy is advancing, it is essential to keep pharmacists \n\n\n\nupdated and ultimately improve patient care. This study \n\n\n\naimed to assess the needs of pharmacists to fulfil the CPD \n\n\n\nrequirements. Methods: A cross-sectional survey was \n\n\n\ncarried out using an online, validated semi-structured \n\n\n\nquestionnaire. The questionnaire was shared with \n\n\n\npharmacists on social media and through pharmacists\u2019 \n\n\n\nWhatsApp groups. Results and Discussion: A total of 557 \n\n\n\nresponses were obtained, of which 57% were from hospital \n\n\n\npharmacy background. Continuing pharmacy education \n\n\n\n(CPE) sessions (93.2%), structured activities such as seminar \n\n\n\n(91.4%) and workshops (87.6%) were the most preferred \n\n\n\nCPD activities. This finding is consistent with other studies \n\n\n\nthat showed most of the respondents preferred directed \n\n\n\nlearning more than non-directed learning. Nutrition and diet \n\n\n\n(95.4%) and pharmacotherapy of geriatric population (90.8%) \n\n\n\nwere the most preferred CPD topic and area of specialisation \n\n\n\namong respondents with community pharmacy background \n\n\n\nwhilst infectious diseases (85.5%) and pain management \n\n\n\n(83.9%) for respondents with hospital pharmacy background \n\n\n\nas these are common areas encountered by them during their \n\n\n\npractice. The main barriers to CPD participation were cost of \n\n\n\nparticipation (83.5%), time constraints (83.1%) and \n\n\n\naccessibility to CPD venue (81.1%). Out-of-pocket payment \n\n\n\nand high workload could be the main reasons for these \n\n\n\nbarriers. Improved range of CPD topics (94.8%) and more \n\n\n\nfrequent CPD activities (92.3%) were the top two motivators \n\n\n\nto CPD involvement. Thus, reduced cost, better timing of \n\n\n\nCPD activities, improved relevance of topics and increased \n\n\n\naccessibility would lead to increase CPD participation. \n\n\n\nConclusion: These findings have also enabled CPD \n\n\n\nproviders to develop modalities to improve CPD \n\n\n\nprogrammes to meet the needs of pharmacists.  \n\n\n\n\n\n\n\nAbstract 036 \n\n\n\n\n\n\n\nPotential Roles of Pharmacists in \n\n\n\nHIV/AIDS Care Delivery in Nepal: A \n\n\n\nQualitative Study \n\n\n\n\n\n\n\nAyushma Shahi1*, Sweta Shrestha1, Badri \n\n\n\nK.C1, Khagendra Acharya2, Sait Kumar \n\n\n\nPradhan3 \n \n\n\n\n1 Department of Pharmacy, School of Science, Kathmandu University, \n\n\n\nDhulikhel, Kavre, Nepal \n2 Department of Management Informatics and Communication, School of \n\n\n\nManagement, Kathmandu University, Dhulikhel, Kavre, Nepal \n3 Department of Clinical Physiology, Maharajgunj Medical Campus, \n\n\n\nInstitute of Medicine, Nepal \n\n\n\n* Corresponding author \n\n\n\nEmail: ayushmas4@gmail.com \n\n\n\n\n\n\n\nBackground and Objectives: Nepal is facing escalating \n\n\n\ninfection rates of HIV/AIDS, a major global public health \n\n\n\nthreat. Continuum of services is an identified strategic \n\n\n\ncomponent of the Joint United Nations Programme on \n\n\n\nHIV/AIDS (UNAIDS) commitment to end this public health \n\n\n\ncrisis by 2030 and achieve the Sustainable Development \n\n\n\nGoal 6. Pharmacists are integral members of the continuum \n\n\n\nof care in HIV/AIDS hence, this study aimed to gain an \n\n\n\ninsight into the views of stakeholders on the roles of \n\n\n\npharmacists in this arena.  Methods:  A qualitative approach \n\n\n\nwas used where 15 key informants were interviewed using a \n\n\n\nsemi-structured interview protocol. Participants were \n\n\n\nselected through a sequence of purposive sampling and \n\n\n\nsnowball sampling technique. The interviews were \n\n\n\nconducted, transcribed verbatim and analyzed using thematic \n\n\n\nanalysis. Results and Discussion:  Potential roles of \n\n\n\npharmacists reside in adherence monitoring, \n\n\n\npharmacovigilance, provincial and district level ART centers. \n\n\n\nPharmacists and other stakeholders held divergent views on \n\n\n\nthe pharmacist's role in dispensing and counseling \n\n\n\nantiretroviral medications. Barriers to the pharmacists' \n\n\n\ninvolvement were lack of workforce, advocacy and \n\n\n\ngovernment support, frailty of professional organizations, \n\n\n\nself-limited scope, policy constraints, structural limitations, \n\n\n\nbiasedness, and societal unawareness. Pharmacists \n\n\n\nthemselves and organizations such as National Government \n\n\n\nOrganizations (NGOs) and International Government \n\n\n\nOrganizations (INGOs) were identified as the facilitators. \n\n\n\nConclusion:  Stakeholders are willing to expand the role of \n\n\n\npharmacists in HIV/AIDS care in Nepal. Nevertheless, some \n\n\n\ncrucial impediments exist. Primarily, an aggressive and \n\n\n\nassertive advocacy is needed from pharmacists themselves \n\n\n\nand their professional organizations to establish their roles in \n\n\n\nHIV/AIDS care delivery. Additionally, unearthing potential \n\n\n\nof pharmacists as contributors in HIV/AIDS care delivery or \n\n\n\nany other chronic disease management equally demands a \n\n\n\nstrong support from the government officials as well as the \n\n\n\nother health care professionals. \n\n\n\n\nmailto:syireen@um.edu.my\n\n\nmailto:ayushmas4@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n84 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\n\n\n\n\nAbstract 037 \n\n\n\n\n\n\n\nAssessing Health Literacy among The \n\n\n\nNewly Diagnosed Type 2 Diabetes and Pre-\n\n\n\ndiabetes Patients in Malaysia  \n\n\n\n\n\n\n\nAzrina Ely Ahmad Azhari1*, Jim Chai1, Claire \n\n\n\nAnderson2 \n \n1 School of Pharmacy, University of Nottingham Malaysia, Semenyih, \n\n\n\nSelangor, Malaysia \n2 Division of Pharmacy Practice and Policy, School of Pharmacy, University \n\n\n\nof Nottingham, Nottingham, United Kingdom \n\n\n\n* Corresponding author \n\n\n\nEmail: hyxaa1@nottingham.edu.my \n\n\n\n\n\n\n\nBackground and Objectives: Health literacy refers to the \n\n\n\nability of an individual to access, understand, appraise, and \n\n\n\napply health information and services. In Malaysia, one in \n\n\n\nthree adults have low health literacy. Low health literacy is \n\n\n\nassociated with poorer diabetes knowledge and self-care \n\n\n\nmanagement. We aimed to assess the health literacy of newly \n\n\n\ndiagnosed type 2 diabetes and pre-diabetes patients to \n\n\n\nidentify their strengths and limitations in health literacy. \n\n\n\nMethods: The Health Literacy Questionnaire (HLQ) which \n\n\n\nexamines the 9 scales of health literacy was used. 28 \n\n\n\nparticipants who were recruited from online platforms and \n\n\n\ntwo public clinics for qualitative interview were invited to fill \n\n\n\nin the questionnaire. Data were collected using self-\n\n\n\nadministered questionnaires which were available online and \n\n\n\npaper based. Descriptive statistics was used to summarise the \n\n\n\nresponses to the questionnaire questions. Data from the semi-\n\n\n\nstructured interviews were coded and categorised into themes \n\n\n\nusing thematic analysis. Results and Discussion: The HLQ \n\n\n\nprovided 9 separate scores to indicate a person\u2019s strengths \n\n\n\nand limitations in their health literacy and the strengths and \n\n\n\nlimitations of the sample population can be explained in \n\n\n\nterms of the number of participants with a lower or higher \n\n\n\nlevel of health literacy for each scale. In this study, among \n\n\n\nthe 9 scales of the HLQ, the lowest score was found for scale \n\n\n\n7 \u2018Navigating the healthcare system\u2019 and the highest score \n\n\n\nwas scale 5 \u2018Appraisal of health information\u2019. Conclusion: \n\n\n\nThe limitations in health literacy among the newly diagnosed \n\n\n\ntype 2 diabetes and pre-diabetes patients were identified. The \n\n\n\nresults were consistent with the themes identified from the \n\n\n\ninterview data. Improving accessibility of health information \n\n\n\nand services for diabetes patients are needed to increase \n\n\n\npatients\u2019 knowledge and empower self-care behaviours.  \n\n\n\nAbstract 038 \n\n\n\n\n\n\n\nPerspectives and Challenges Managing \n\n\n\nOlder Adults: A Qualitative Study with \n\n\n\nPrimary Health General Practitioners and \n\n\n\nPharmacists In Penang, Malaysia \n\n\n\n\n\n\n\nChristina Malini Christopher1*, Ali Qais \n\n\n\nBlebil1, Bhuvan KC2, Deepa Alex3, Mohamed \n\n\n\nIzham Ibrahim4 \n\n\n\n \n 1 School of Pharmacy, Monash University Malaysia, Subang Jaya, \n\n\n\nSelangor, Malaysia     \n2 Faculty of Pharmacy and Pharmaceutical Sciences, Monash \n\n\n\nUniversity Parkville Campus, Melbourne, Australia \n3Jeffrey Cheah School of Medicine and Health Sciences, Monash \n\n\n\nUniversity Malaysia, Subang Jaya, Selangor, Malaysia \n4 Clinical Pharmacy and Practice Department, College of Pharmacy, \n\n\n\nQU Health, Qatar University, Doha, Qatar \n\n\n\n* Corresponding author \n\n\n\nEmail: christina.christopher@monash.edu \n\n\n\n\n\n\n\nBackground and Objectives: There has been an increase in \n\n\n\nthe older adult demographic, and there is a need to prioritize \n\n\n\nhealthy ageing to suit their needs. Primary care facilities, due \n\n\n\nto their accessibility and use, seem to be the first choice for \n\n\n\nhealthcare services for older adults. This study aims to \n\n\n\nunderstand the health care providers' perspectives on older \n\n\n\nadults' medication use problems at the primary care level. \n\n\n\nMethods: The study used a qualitative methodology \n\n\n\ncomprising 30 in-depth interviews among general \n\n\n\npractitioners and pharmacists in Penang, Malaysia, in public \n\n\n\nand private primary care settings. Participants were recruited \n\n\n\nbased on purposive sampling. Interviews were transcribed \n\n\n\nverbatim, and data were coded based on the principles of \n\n\n\nthematic analysis in NVivo.  Results and Discussion: \n\n\n\nFindings reported on the perspectives of professional \n\n\n\nhealthcare providers in providing healthcare services to older \n\n\n\nadults. Three themes emerged from the study. Theme one \n\n\n\nhighlighted aligning health systems with the needs of older \n\n\n\npopulations. Theme two explored feedback on shared \n\n\n\ndecision-making among health care providers. The final \n\n\n\ntheme delineated the challenges of medication use and \n\n\n\nfacilities among older adults. Conclusion: This study \n\n\n\nidentified various challenges faced by primary care providers \n\n\n\nin responding to older adults' medication-related problems at \n\n\n\nthe primary care level. Inputs from the primary health care \n\n\n\nsystem frontier are essential to reduce the challenges and \n\n\n\nuplift the quality of ageing populations' healthcare in \n\n\n\nMalaysia. \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:hyxaa1@nottingham.edu.my\n\n\nmailto:christina.christopher@monash.edu\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n85 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 039 \n\n\n\n\n\n\n\nKnowledge, Attitude and Practice of \n\n\n\nFilipinos on Sunscreen Utilisation  \n\n\n\n\n\n\n\nAndrea Gail A. Cunanan*, Ryah Monique C. \n\n\n\nFernandez, Jermie Anne S. Li,Christine Marie \n\n\n\nS. Terrado \n \n\n\n\nManila Central University, University in Caloocan, Philippines \n\n\n\n* Corresponding author \n\n\n\nEmail: andreagailcunanan1701@gmail.com \n \n\n\n\nBackground and Objectives:  Non-melanoma skin cancer \n\n\n\nis a type of cancer that is mainly caused by overexposure to \n\n\n\nultraviolet (UV) light and recent study shows the increasing \n\n\n\nnumber of people at risk of this cancer were Filipinos. This \n\n\n\nstudy aims to identify the knowledge, attitude, and practices \n\n\n\nof Filipinos in Brgy. Catmon, Malabon City on sunscreen \n\n\n\nutilization.  Methods:  By using the snowball sampling \n\n\n\ntechnique, the researchers were able to gather 100 \n\n\n\nrespondents online. Pearson-R was used to determine if there \n\n\n\nis a significant relationship between the knowledge, attitudes, \n\n\n\nand practices on sunscreen utilisation.  T-test and Analysis of \n\n\n\nVariance was used to determine if there was a difference \n\n\n\nbetween the respondent\u2019s knowledge, attitudes, and practices \n\n\n\non sunscreen utilization when grouped according to their \n\n\n\nprofile.  Results and Discussion: The study revealed that \n\n\n\nrespondents\u2019 knowledge, attitude, and practices on sunscreen \n\n\n\nutilization have a moderately high positive relationship.  The \n\n\n\nstudy also revealed that the respondents\u2019 knowledge, attitude, \n\n\n\nand practices on sunscreen utilisation have a significant \n\n\n\ndifference when grouped according to their socio-\n\n\n\ndemographic profile, specifically the respondents\u2019 gender. \n\n\n\nThis indicates that other demographic profiles such as age, \n\n\n\neconomic status, field of work, and their skin type does not \n\n\n\ndiffer in their knowledge, attitude, and practices on sunscreen \n\n\n\nutilization. Conclusion:  The results of this study can be used \n\n\n\nto encourage health professionals on better education and \n\n\n\ncounselling on the harmful effects of sun exposure, \n\n\n\nnecessitating the daily use of sunscreen to aid in preventing \n\n\n\nskin cancer, for better skin care, and better health. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 040 \n\n\n\n\n\n\n\nA Strategy to Strengthen Halal \n\n\n\nPharmamedlog Initiatives by Malaysian \n\n\n\nArmed Forces - First Government Agency \n\n\n\nin the World \n\n\n\n\n\n\n\nNur Hidayah AR1*, Muhammad Najhan MB1, \n\n\n\nMohd Azrizal MR1, Mohd Adlan A2, A Halim \n\n\n\nB2  \n \n1 Malaysian Armed Forces Medical & Dental Depot, Kuala Lumpur, \n\n\n\nMalaysia  \n2 Malaysian Armed Forces Headquarters, Health Services Division, Kuala \n\n\n\nLumpur, Malaysia \n\n\n\n* Corresponding author \n\n\n\nEmail: mjhidayahrahim@gmail.com \n\n\n\n\n\n\n\nBackground and Objectives:  Malaysian government aims \n\n\n\nto be the most competitive country in the global halal \n\n\n\nindustry. Halal Pharmamedlog refers to management of \n\n\n\npharmaceuticals and medical logistics (Pharmamedlog) \n\n\n\nitems under circumstances of Islamic Law. Previously, there \n\n\n\nwas no JAKIM halal certified Pharmamedlog warehouse in \n\n\n\nMalaysia. 93 Medical and Dental Depot Malaysian Armed \n\n\n\nForces (93 MDDMAF) took the challenge to obtain halal \n\n\n\nrecognition in order to support MAF Health Services Action \n\n\n\nPlan 2030 which contains Syariah Compliance Pharmacy \n\n\n\nPractice (SCPP) of Pharmamedlog activities. Methods:  A \n\n\n\ndescriptive study was carried out from November 2020 to \n\n\n\nMarch 2022 in 7 stores of 93 MDDMAF which handled \n\n\n\nPharmamedlog items. Halal Pharmaceutical Decision Tree \n\n\n\n(HPDT) was a novel halal assessment tool and was developed \n\n\n\nwith the consensus of Halal Subject Matter Experts. HPDT \n\n\n\nanalysed sources of active ingredients and excipients that \n\n\n\npotentially originated from animals and substances forbidden \n\n\n\nto Muslims. Colour coding of green (permissible), grey \n\n\n\n(doubtful) and red (forbidden) were used to describe product \n\n\n\nhalal category. Halal Critical Points (HCPs) were then \n\n\n\nidentified and controlled to guarantee halal integrity of \n\n\n\nproducts and processes. Results and Discussion:  \n\n\n\nAssessment of 1465 Pharmamedlog items showed that 94% \n\n\n\nof the health products were categorized as green items, 4% as \n\n\n\ngrey, and 2% as red. Clear process of segregations needed to \n\n\n\nbe shown to preserve halal integrity during the management \n\n\n\nof Pharmamedlog. 13 HCPs were identified and strictly \n\n\n\nmonitored through Halalan Thoyyiban Risk Management \n\n\n\nPlan. After thorough audit, 7 stores of the 93 MDDMAF have \n\n\n\nbeen certified halal by JAKIM on 16th April 2022. This \n\n\n\nrecognition is the first in the world received by a government \n\n\n\nagency. Conclusion:  MAF is committed to ensure all health \n\n\n\nfacilities and supply chain partners adapt and cultivate Halal \n\n\n\nSupply Chain Management System through SCPP Plan-Do-\n\n\n\nCheck-Act cycles to ensure safety, quality and efficacy of \n\n\n\nPharmamedlog items in MAF. \n\n\n\n\nmailto:andreagailcunanan1701@gmail.com\n\n\nmailto:mjhidayahrahim@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n86 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 041 \n\n\n\n\n\n\n\nThe Stress, Satisfaction, and Fulfilment of \n\n\n\nEarly Career Pharmacists \u2013 A Qualitative \n\n\n\nStudy of their Professional and Personal \n\n\n\nLives \n\n\n\n\n\n\n\nPY Chee, LV Tan, CCW Lee, BBN Choo, WL \n\n\n\nCheong* \n \n\n\n\nSchool of Pharmacy, Monash University Malaysia, Bandar Sunway, \n\n\n\nMalaysia \n\n\n\n* Corresponding author \n\n\n\nEmail: cheong.wingloong@monash.edu \n\n\n\n\n\n\n\nBackground and Objectives:  Early career pharmacists are \n\n\n\nreportedly highly stressed and burnt out. Developing \n\n\n\ninterventions to support their well-being requires an \n\n\n\nunderstanding of the factors that affect their stress, \n\n\n\nsatisfaction, and fulfilment. This study aims to examine and \n\n\n\ndevelop a better understanding of: 1) the factors that affect \n\n\n\nthe stress of both their professional and personal lives, 2) the \n\n\n\naspects of professional and personal life that affect their \n\n\n\nsatisfaction and fulfilment, and 3) what they need to achieve \n\n\n\nsatisfaction and fulfilment in their professional and personal \n\n\n\nlives. Methods:  A cross-sectional study using a \n\n\n\nquestionnaire was developed. The questionnaire contained 8 \n\n\n\nquestions designed to collect qualitative data on the factors \n\n\n\naffecting the stress, satisfaction, and fulfilment in the \n\n\n\nprofessional and personal lives of early career pharmacists. \n\n\n\nQuestionnaire responses were analysed using a qualitative \n\n\n\ncontent analysis approach and themes describing influential \n\n\n\nfactors were developed. Results and Discussion:  Some of \n\n\n\nthe factors that contribute to the stress, satisfaction and \n\n\n\nfulfilment of early career pharmacists were identified. The \n\n\n\nstressors identified include the workplace environment and \n\n\n\nrelationships with colleagues, the demands of a pharmacist \n\n\n\ncareer, the lack of career advancement pathways, job \n\n\n\ninsecurity, relationships, and their weaknesses. Factors \n\n\n\ncontributing to satisfaction and fulfilment included \n\n\n\nsupportive work environments and relationships, being \n\n\n\nappreciated and making a difference, growth, supportive \n\n\n\nrelationships, and self-care. Conclusion:  Supporting the \n\n\n\nwell-being of early career pharmacists is important for a \n\n\n\nresilient, engaged, and effective pharmacy workforce. Key \n\n\n\ninterventions include eliminating job insecurity, establishing \n\n\n\nclear career pathways, improving work environments and \n\n\n\nrelationships, and investing in skills development. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 042 \n\n\n\n\n\n\n\nHealth Care Team Patterns through \n\n\n\nPerception of Interprofessional Interaction \n\n\n\nBetween Pharmacists and Medical \n\n\n\nTechnologists in a City in Northern \n\n\n\nPhilippines \n\n\n\n\n\n\n\nLangit MRD1,3,4*, Estacio BRB2, Estrella \n\n\n\nJIOV2, Galicio FIF2, Gamino CDR2, Gloria \n\n\n\nJAA2, Gomez PNC2, Hamadain SKIL2, \n\n\n\nHulipas LEM2, Jamandre CAD2, Lababit \n\n\n\nAMM2 \n\n\n\n \n1 Department of Pharmacy, 2 Department of Medical Laboratory Science, \n\n\n\nSchool of Natural Sciences, Saint Louis University, Baguio City, \n\n\n\nPhilippines \n\n\n\n \n3 The Graduate School, University of Santo Tomas, Sampaloc, Manila, \n\n\n\nPhilippines \n4Executive Secretary, Philippine Pharmacists Association, Manila, \n\n\n\nPhilippines \n\n\n\n* Corresponding author \n\n\n\nEmail: mrdlangit@slu.edu.ph \n \n\n\n\nBackground and Objectives: Interprofessional \n\n\n\ncollaboration in healthcare is a crucial factor in delivering \n\n\n\nquality health and patient care. The aim of this study was to \n\n\n\ninvestigate healthcare team patterns involving \n\n\n\ninterprofessional collaboration between medical \n\n\n\ntechnologists and pharmacists. Methods: A quantitative, \n\n\n\ndescriptive cross-sectional design study wherein, a 30-item \n\n\n\nquestionnaire was distributed through physical \n\n\n\nquestionnaires and Google Forms to pharmacists and medical \n\n\n\ntechnologists working at four tertiary hospitals in a city in \n\n\n\nNorthern Philippines. A total of 105 respondents were \n\n\n\nrecruited, with a response rate of 64.7%. This study utilized \n\n\n\nsimple random sampling. All consenting medical \n\n\n\ntechnologists and pharmacists with at least six-month \n\n\n\nhospital experience were included in the study. Results and \n\n\n\nDiscussion: Interprofessional interactions between medical \n\n\n\ntechnologists and pharmacists is infrequently observed, \n\n\n\ncompared to interprofessional interactions between other \n\n\n\nhealthcare professionals. The ranking of interaction with \n\n\n\npharmacists is significantly negatively correlated with the \n\n\n\nranking of interaction with medical technologists (rs=-0.895; \n\n\n\nP-value=0.001) indicating that those who interact more with \n\n\n\npharmacists interact less with medical technologists. \n\n\n\nEvidence suggests a significant difference between the mean \n\n\n\nindex on \u201cTeamwork and Collaboration\u201d, and \u201cPatient-\n\n\n\nCenteredness\u201d of the two professions (P-value=0.001; P-\n\n\n\nvalue=0.014). This indicates that pharmacists exhibit greater \n\n\n\npositive attitude towards \u201cTeamwork and Collaboration\u201d and \n\n\n\n\u201cPatient-Centeredness\u201d than medical technologists. However, \n\n\n\nboth professions showed readiness for interprofessional \n\n\n\n\nmailto:cheong.wingloong@monash.edu\n\n\nmailto:mrdlangit@slu.edu.ph\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n87 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nlearning. Conclusion: There is a lack of established \n\n\n\ninterprofessional interactions and collaboration between \n\n\n\npharmacists and medical technologists despite existence calls \n\n\n\nfor the creation of interactive and collaborative opportunities. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 043 \n\n\n\n\n\n\n\nFoundation and Advanced Competencies \n\n\n\nof Community and Hospital Pharmacists in \n\n\n\nNorthern Philippines \n\n\n\n\n\n\n\nLangit MRD1,2,3*, Aum RVD1, Balaki BKT1, \n\n\n\nBarroga, DAF1, Bete CD1, Cari\u00f1o NJP1, Lim \n\n\n\nAGP1, Mangubat NSJ1, Obedoza CDL1, \n\n\n\nUmagat JM1 \n\n\n\n \n1 Department of Pharmacy, School of Nursing, Allied Health and \n\n\n\nBiological Sciences, Saint Louis University, Baguio City, Philippines \n2 The Graduate School, University of Santo Tomas, Sampaloc, Manila, \n\n\n\nPhilippines \n3 Philippine Pharmacists Association, Manila, Philippines \n\n\n\n*Corresponding author  \n\n\n\nEmail: mrdlangit@slu.edu.ph \n\n\n\n\n\n\n\nBackground and Objectives: In most developed countries, \n\n\n\na competency framework specific to the practice of pharmacy \n\n\n\nin the community is well\u2013established and recognized as a \n\n\n\nmeans to facilitate individual continuing professional \n\n\n\ndevelopment and assist with performance review, thus \n\n\n\nprogress could be seen in the provision of pharmaceutical \n\n\n\ncare. However, such is not yet in place in certain developing \n\n\n\ncountries including the Philippines.  This study aimed to \n\n\n\ndetermine the awareness and preparedness of pharmacists to \n\n\n\ncareer progression and specialization through assessing their \n\n\n\nactual and perceived level of practice and to determine the \n\n\n\ncorrelation between the current level of practice of \n\n\n\ncommunity and hospital pharmacists to the length of \n\n\n\nexperience in their current practice areas. Methods: A \n\n\n\nquestionnaire was developed using the Philippines Practice \n\n\n\nStandards for Pharmacists. Seventy community and hospital \n\n\n\npharmacists were selected via non-probability convenience \n\n\n\nsampling. Results and Discussion: Perceived level of \n\n\n\npractice of community and hospital pharmacists showed an \n\n\n\nadvanced level on all standards. The actual level of hospital \n\n\n\npharmacists under Business Sustainability Assurance \n\n\n\nresulted as advanced and the rest were expert. For community \n\n\n\npharmacists, all were advanced except for Providing Quality \n\n\n\nMedicines and Patient Needs which was expert. The \n\n\n\ncorrelation of actual level vs. perceived level demonstrated \n\n\n\nsignificant positive correlation for both pharmacists in all \n\n\n\ncompetency standards except for Business Sustainability \n\n\n\nAssurance which only showed significant correlation. The \n\n\n\nlength of practice in hospital pharmacy was correlated with \n\n\n\nProviding Quality Medicines and Patient Needs and the rest \n\n\n\nwere not correlated. Conclusion: There is a current \n\n\n\nrecognition of pharmacy practice, particularly the role of \n\n\n\neach pharmacist to ensure patient safety. The advancement of \n\n\n\ncompetencies proves the strong sense of responsibility \n\n\n\namong Filipino Pharmacists to continually improve, and thus \n\n\n\nprovide better quality services to the clients and patients. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 044 \n\n\n\n\n\n\n\nThe Pharmacist\u2019s Contribution During the \n\n\n\nCOVID 19 Pandemic: Medicine Delivery \n\n\n\nServices  \n\n\n\n\n\n\n\nMohamad Aizuddin Mohamad Noor 1*, \n\n\n\nZaswiza Mohamad Noor2  \n \n1 School of Pharmacy, University of Kuala Lumpur, Malaysia.  \n2 Department of Pharmacy Practice, School of Pharmacy, University of \n\n\n\nKuala Lumpur, Malaysia.  \n\n\n\n*Corresponding author  \n\n\n\nEmail: aizuddin.mnoor@gmail.com \n\n\n\n\n\n\n\nBackground and Objectives: SARS-CoV-2 (COVID 19) \n\n\n\nwas a global pandemic which changed the socioeconomic of \n\n\n\nevery nation. Malaysia also was not excluded and \n\n\n\nimplemented various strategies to counter the pandemic such \n\n\n\nas the execution of Movement Control Order (MCO) that \n\n\n\nrestricted the movement of people, which affected and \n\n\n\nlimited access to healthcare services. Pharmacists as the \n\n\n\nmedication expert and one of the frontliners in the healthcare \n\n\n\nsector play roles, in many aspects of its profession,to cater \n\n\n\nthe needs of society and ensure the accessibility to medicines \n\n\n\nthroughout the pandemic. The objective of this research was \n\n\n\nto assess the pharmacists\u2019 roles in medicine delivery during \n\n\n\nthe Movement Control Order (MCO) during the COVID-19 \n\n\n\npandemic and in particular to ensure the access to medicines \n\n\n\nand promotion of quality use of medicines. Methods: The \n\n\n\nparticipants were chosen from an online form offered during \n\n\n\nmedicine delivery service during MCO and involved repeat \n\n\n\nprescriptions from the nearby government healthcare \n\n\n\nfacilities. Participants were interviewed through phone calls \n\n\n\nafter the medicines were delivered. The responses were \n\n\n\nrecorded and analysed. Results and Discussion: A total of \n\n\n\n80 participants were involved in this study. All participants \n\n\n\nagreed that pharmacy delivery medicines services helped \n\n\n\nthem to collect the medications. Majority of the participants \n\n\n\npreferred the pharmacists to deliver the medicine as the \n\n\n\npharmacist could also  provide counselling on the usage of \n\n\n\nmedication. Furthermore, the majority of the participants \n\n\n\nwere willing to continue the services after the MCO. \n\n\n\nConclusion: Pharmacists help access to medicines and \n\n\n\nquality use of medicines. The medicines delivery services \n\n\n\nshould be expanded as pharmacy value-added services that \n\n\n\ninvolve both government and private sectors. \n\n\n\n\nmailto:mrdlangit@slu.edu.ph\n\n\nmailto:aizuddin.mnoor@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n88 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 045 \n\n\n\n\n\n\n\nA Narrative Review of Vaccine Hesitancy \n\n\n\nin Childhood Immunisation in Malaysia \n\n\n\n\n\n\n\nNour Hanah Othman1*, Munaver Ahmad \n\n\n\nNazir Ahmad1, Mohammed Tahir Ansari2 \n\n\n\n \n1 Department of Pharmaceutical Sciences, Faculty of Pharmacy and Health \n\n\n\nSciences, Universiti Kuala Lumpur, Royal College of Medicine. \n2 School of Pharmacy, University of Nottingham Malaysia \n\n\n\n* Corresponding author \n\n\n\nEmail: nourhanah@unikl.edu.my \n\n\n\n\n\n\n\nBackground and Objectives: Vaccination has been known \n\n\n\nto be the most effective strategy in the prevention of many \n\n\n\ncommunicable diseases. In Malaysia, since 2013 there has \n\n\n\nbeen a resurgence in vaccine preventable diseases in children. \n\n\n\nThe aim of this study was to examine the prevalence of \n\n\n\nvaccine hesitancy (VH) in Malaysia and the factors that \n\n\n\ncontribute towards vaccine hesitancy. Methods: Relevant \n\n\n\narticles on vaccine hesitancy in childhood immunisation in \n\n\n\nMalaysia were searched using Google Scholar, PubMed and \n\n\n\nMendeley databases. The search was restricted for articles \n\n\n\npublished in the English language from 2015 \u2013 2022. Studies \n\n\n\ngiving insight into vaccine hesitancy, refusal, defaulters, and \n\n\n\nhighlighted factors contributing to these parameters were \n\n\n\nincluded.  Results and Discussion: VH includes those who \n\n\n\nrefuse or delayed getting their child immunised. A total of 10 \n\n\n\npapers were included in the review which varied in terms of \n\n\n\nmethodology, vaccine hesitancy measurement methods, \n\n\n\nsettings and participants. The prevalence of vaccine \n\n\n\nhesitancy from 3 studies was in the range of 6.8% to 11.6%. \n\n\n\nThe range of defaulters is much wider whereby the \n\n\n\npercentage of mothers or parents who defaulted is between \n\n\n\n0.03% - 20.7%. Parents or mothers who refused childhood \n\n\n\nvaccination accounted for a very small percentage (0.08% - \n\n\n\n0.47%). Common reasons for VH are low education level, \n\n\n\ndoubts about vaccine content and religion. Interestingly, VH \n\n\n\nis more common among non-Muslims in the urban areas, but \n\n\n\nmore Muslims mothers are vaccine-hesitant in rural states. \n\n\n\nConclusion: Vaccine hesitancy (VH) is complex and \n\n\n\ndepends on various settings that include time, place and \n\n\n\nvaccines. Factors that are associated with VH are also wide \n\n\n\nranging. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 046 \n\n\n\n\n\n\n\nElectronic Prescription Services Trends \n\n\n\nacross Community Pharmacies in Malaysia \n\n\n\n\n\n\n\nHui Yin Yow1, Jason Siau-Ee Loo2, Yi Yang \n\n\n\nTen3, Megat Helmi Mohd Zubairi4, Nusaibah \n\n\n\nAbdul Rahim3* \n \n1 Department of Pharmaceutical Life Sciences, Faculty of Pharmacy, \n\n\n\nUniversiti Malaya, Kuala Lumpur, Malaysia. \n2 School of Pharmacy, Faculty of Health and Medical Sciences, Taylor\u2019s \n\n\n\nUniversity, Selangor, Malaysia. \n3 Department of Clinical Pharmacy & Pharmacy Practice, Faculty of \n\n\n\nPharmacy, Universiti Malaya, Kuala Lumpur, Malaysia. \n4 DOC2US, Heydoc International Sdn Bhd, Selangor, Malaysia. \n\n\n\n*Corresponding author  \n\n\n\nEmail: nusaibah.abdulrahim@um.edu.my \n\n\n\n\n\n\n\nBackground and Objectives: Telehealth services have \n\n\n\nincreased exponentially, particularly during Covid-19 \n\n\n\npandemic. E-prescribing is the direct transmission of \n\n\n\nelectronic prescriptions (e-prescriptions) from prescribers to \n\n\n\ncommunity pharmacies via digital devices. To date, there is \n\n\n\na lack of studies investigating e-prescription services in \n\n\n\nMalaysia. Thus, the study aims to investigate usage of e-\n\n\n\nprescription services in community pharmacies and \n\n\n\ndetermine trends of most common medication classes \n\n\n\nprescribed. Methods: A retrospective observational study \n\n\n\nwas conducted by retrieving records from a telemedicine \n\n\n\ndatabase used among community pharmacies in Malaysia. \n\n\n\nThe e-prescribing records from January 2019 to December \n\n\n\n2021 were extracted using a designated data collection form. \n\n\n\nData cleaning, standardization and data analysis were \n\n\n\nperformed using Python v3.9. The diagnoses and medicines \n\n\n\nwere classified according to the International Classification \n\n\n\nof Disease (ICD-11) and Anatomical Therapeutic Chemical \n\n\n\n(ATC) system, respectively. The usage of the service across \n\n\n\ntime, demographic profile of users and the most common \n\n\n\nmedication classes prescribed were identified. Results and \n\n\n\nDiscussion: A total of 743,542 records were included, \n\n\n\nincluding 109,664 (14.7%), 206,262 (27.7%) and 427,616 \n\n\n\n(57.5%) records, respectively for 2019, 2020 and 2021. There \n\n\n\nwere 207,024 (27.8%) unique users and 536,548 (72.2%) \n\n\n\nrepeated users over the 3 years. The user population \n\n\n\ncomprised of 59.7% female and 40.3% male, with a mean age \n\n\n\nof 51 \u00b1 21 years and primarily Malaysians (97.3%). The most \n\n\n\ncommonly prescribed medication classes were for \n\n\n\ncardiovascular system (52.7%), alimentary tract and \n\n\n\nmetabolism (21.1%), musculoskeletal system (7.2%), blood \n\n\n\nand blood-forming organs (5.2%) and nervous system (2.9%).   \n\n\n\nConclusion: This study concludes that the increase in usage \n\n\n\nof e-prescription services and its potential to remain as a \n\n\n\nfeature of the health care system in community pharmacies. \n\n\n\nFurther investigation on its role in prescribing and dispensing \n\n\n\npractices and impact on medication safety, quality and health \n\n\n\ncare delivery are warranted.  \n\n\n\n\nmailto:nourhanah@unikl.edu.my\n\n\nmailto:nusaibah.abdulrahim@um.edu.my\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n89 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 047 \n\n\n\n\n\n\n\nImproving Knowledge, Attitude, and \n\n\n\nPerception of Falls among the Geriatric \n\n\n\nPopulation through Educational \n\n\n\nIntervention \n\n\n\n\n\n\n\nPriya Manirajan1*, Palanisamy Sivanandy2, \n\n\n\nPravinkumar Vishwanath Ingle2 \n \n1 School of Postgraduate Studies, International Medical University, Kuala \n\n\n\nLumpur, Malaysia \n2 Department of Pharmacy Practice, School of Pharmacy, International \n\n\n\nMedical University, Kuala Lumpur, Malaysia \n\n\n\n* Corresponding author \n\n\n\nEmail: priyamanirajan28@gmail.com \n\n\n\n\n\n\n\nBackground and Objectives: As the global elderly \n\n\n\npopulation grows, especially in Southeast Asia, fall \n\n\n\nincidences are predicted to increase dramatically in the future. \n\n\n\nElderly people who experience falls suffer from lower quality \n\n\n\nof life and incur more medical expenses as a result of \n\n\n\ntreatment for their injuries. As one of the main factors in \n\n\n\nincreasing the risk of falls, numerous research has been \n\n\n\nconducted in recent years to determine the relationship \n\n\n\nbetween drugs and falls. This study was aimed to assess the \n\n\n\nknowledge, attitude, and perception (KAP) of falls among the \n\n\n\ngeriatric population in a primary care Malaysian clinic setting, \n\n\n\nreview the fall risk-increasing drugs (FRIDs) and provide \n\n\n\neducational intervention to improve the awareness of falls \n\n\n\nand FRIDs and analyse the effectiveness of the educational \n\n\n\nintervention. Methods: This interventional study was carried \n\n\n\nout in a primary care setting using a validated structured \n\n\n\nquestionnaire to assess the KAP of falls. Elderly patients who \n\n\n\nwere 65 years and above, seeking medical treatment in the \n\n\n\nprimary care setting, and able to read, understand, and \n\n\n\nrespond to the study questionnaire and educational \n\n\n\ninterventional materials were included in the study. Results \n\n\n\nand Discussion: In a total of 310 respondents, 74% of them \n\n\n\nhad obtained primary level education, and 46% of them were \n\n\n\nliving alone or with their partner/caregiver. The percentage \n\n\n\nof elderly patients who experienced falls after the age of 65 \n\n\n\nyears was 31%. The study showed that the participants\u2019 KAP \n\n\n\nof falls and FRIDS improved significantly (p<0.05) after the \n\n\n\npharmacist-led educational intervention. Conclusion: The \n\n\n\neducational intervention provided to the elderly population in \n\n\n\nthe rural region improved the knowledge of the elderly \n\n\n\npopulation in the primary care clinical settings. Health policy \n\n\n\nfocusing on prevention measures needs to be curated in the \n\n\n\nfuture to meet the demands of the ageing population. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 048 \n\n\n\n\n\n\n\nMussel-inspired Mucoadhesive Gelatine \n\n\n\nFilm Loaded with Cetylpyridinium \n\n\n\nChloride \n\n\n\n\n\n\n\nAmina Ahmady1, Nor Khaizan Anuar1,2, Siti \n\n\n\nAlwani Ariffin1,3, Nor Hayati Abu Samah1,3* \n \n1 Faculty of Pharmacy, Universiti Teknologi MARA (UiTM), Puncak Alam \n\n\n\nCampus, Selangor, Malaysia;  \n2 Non-Destructive Biomedical and Pharmaceutical Research Centre, Smart \n\n\n\nManufacturing Research Institute, UiTM, Selangor, Malaysia.  \n3 Marine Pharmaceutical Research Group (MaREG), UiTM, Puncak Alam \n\n\n\nCampus, Selangor, Malaysia  \n\n\n\n* Corresponding author \n\n\n\nEmail: aminaahmady8@gmail.com \n\n\n\n\n\n\n\nBackground and Objectives: Mouthwashes containing \n\n\n\nantiseptic agents are commonly used to prevent or treat oral \n\n\n\ncavity health issues. Recently their use has been suggested to \n\n\n\nreduce the severity and transmission rate of COVID-19 \n\n\n\ndisease. However, mouthwashes have low retention times in \n\n\n\nthe oral cavity. This study aimed to formulate buccal films \n\n\n\ncontaining an antiseptic agent with enhanced retention time \n\n\n\nin the oral cavity. Methods: A series of films made of bovine \n\n\n\ngelatine cross-linked by tannic acid (GelTA) were prepared \n\n\n\nby solvent evaporation and loaded with cetylpyridinium \n\n\n\nchloride (CPC), followed by physical and functional \n\n\n\ncharacterisation. Results and Discussion: The GelTA films \n\n\n\nmass and thickness were in the range of 16.4\u201323.0 mg and \n\n\n\n89.9\u2013103.3 \u00b5m, respectively. The cross-linking of gelatine \n\n\n\nusing tannic acid notably increased the films\u2019 dissolution \n\n\n\ntimes. The miscibility of CPC in BG-TA5-GLY20-7  was \n\n\n\nhigher by 3-fold than in the control film . Reduced film \n\n\n\nsolubility, swelling ratio, pH and contact angle were \n\n\n\nobserved in CPC-loaded films compared to blank film. \n\n\n\nMoreover, the release of CPC from the GelTA film prepared \n\n\n\nat pH 7 was significantly extended (6 h) compared with the \n\n\n\ncontrol film (1 h). There was a positive correlation (R=0.865, \n\n\n\np=0.00) between the erosion of GelTA films and CPC release. \n\n\n\nFurthermore, the BG-TA5-GLY20-7 film demonstrated \n\n\n\nantimicrobial activities against S. aureus in agar disc \n\n\n\ndiffusion studies with the ZOI  of 6.8 \u00b1 0.8 and 11.0 \u00b1 0.9 for \n\n\n\nthe blank and CPC loaded films (20% CPC), respectively. \n\n\n\nConclusion: GelTA film prepared at pH 7 has potential \n\n\n\napplications as a buccal film matrix considering its functional \n\n\n\nproperties and extended dissolution and release of CPC. \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:priyamanirajan28@gmail.com\n\n\nmailto:aminaahmady8@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n90 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 049 \n\n\n\n\n\n\n\nDesign of Degenerate, Universal Primers \n\n\n\nfor Multiplex PCR Determination of \n\n\n\nBiofilm-Formation in Staphylococcus \n\n\n\naureus, Pseudomonas aeruginosa, Klebsiella \n\n\n\npneumoniae, and Escherichia coli \n\n\n\n\n\n\n\nClodualdo F. Narciso III, Deo Raphael A. \n\n\n\nPaloma, Dan Ira King M. Tuatis, Sigfredo B. \n\n\n\nMata* \n \n\n\n\nDr. Mariano Que College of Pharmacy, De La Salle Medical and Health \n\n\n\nSciences Institute, Cavite, Philippines \n\n\n\n* Corresponding author \n\n\n\nEmail: sbmata@dlshsi.edu.ph \n\n\n\n\n\n\n\nBackground and Objectives: Biofilm-forming pathogens \n\n\n\nStaphylococcus aureus, Pseudomonas aeruginosa, \n\n\n\nKlebsiella pneumoniae, and Escherichia coli are responsible \n\n\n\nfor a significant proportion of nosocomial infections. \n\n\n\nMultiplex polymerase chain reaction (PCR) using degenerate \n\n\n\nprimers has potential for simultaneous detection of multiple \n\n\n\nbacterial species. This study aimed to design degenerate, \n\n\n\nuniversal primers for multiplex PCR determination of \n\n\n\nbiofilm formation in S. aureus, P. aeruginosa, K. \n\n\n\npneumoniae, and E. coli. Methods: FASTA gene sequences \n\n\n\nof clinically significant biofilm-forming bacterial strains \n\n\n\nwere collected from NCBI Nucleotide database. Consensus \n\n\n\nsequences were generated from chosen genes using multiple \n\n\n\nsequence alignment (MSA). These sequences were used to \n\n\n\ngenerate primers, which were characterized, validated, and \n\n\n\nsubjected to principal component analysis (PCA) to \n\n\n\ndetermine significant degenerate primer sequences. Primer \n\n\n\nselection followed by post-validation was performed to all \n\n\n\ncollected genes to determine hallmark nucleotide bands. \n\n\n\nFinally, a touchdown multiplex PCR method was proposed. \n\n\n\nResults and Discussion: From the six clinically significant \n\n\n\nbiofilm-forming bacterial strains, 96 genes were associated \n\n\n\nwith biofilm-forming activity. There were three MSA \n\n\n\nprofiles generated: first, for the S. aureus rqcH gene \n\n\n\nproducing fibrinogen-binding protein (SAOUHSC_01175) \n\n\n\nand P. aeruginosa pslE gene; and second, for enterococcal \n\n\n\nHha toxicity modulator, tomB gene; and third, for hemolysin \n\n\n\nexpression-modulating hha gene. From these, two degenerate \n\n\n\nconsensus sequences were used to generate 60 primers. A \n\n\n\ntotal of 13 primers for the first consensus sequence, and ten \n\n\n\nprimers for the second consensus sequence were determined \n\n\n\nas significant degenerate primers. Two primer pairs having \n\n\n\nsatisfactory characteristics were selected for design of a \n\n\n\ntouchdown multiplex PCR. Conclusion: Degenerate \n\n\n\nuniversal primers were designed to produce hallmark bands \n\n\n\nfor clinically significant biofilm-forming strains of chosen \n\n\n\nbacterial species. Actual PCR using the proposed method \n\n\n\nwill be performed to determine effectiveness of these \n\n\n\ndegenerate primers in detecting these biofilm-forming \n\n\n\nstrains. \n\n\n\nAbstract 050 \n \n\n\n\nIn vitro Anticancer Activity of \n\n\n\nMyriostachya wightiana Whole Plant \n\n\n\nMethanolic Extract on Breast, \n\n\n\nHepatocellular and Colorectal Cancer Cell \n\n\n\nLines \n\n\n\n\n\n\n\nAnupama Dasi1,2*, Y. Indira Muzib3 \n\n\n\n \n1 Research Scholar, Sri Padmavathi Mahila Viswavidyalayam, Tirupati;  \n2 Vikas Institute of Pharmaceutical Sciences, Rajahmundry. \n3 Professor,Institute of Pharmaceutical technology, Sri Padmavathi \n\n\n\nMahilaViswavidyalayam, Tirupati. \n\n\n\n* Corresponding author \n\n\n\nEmail: 99anupama@gmail.com \n\n\n\n\n\n\n\nBackground and Objectives: Cancer is an evil spirit that \n\n\n\ncauses alarming symptoms of death owing to the disease's \n\n\n\nglobal growth and is estimated to have caused 9.6 deaths \n\n\n\nglobally in 2018. Myriostachya wightiana, (Poaceae) a grass \n\n\n\nplant of mangroves are of tremendous ecological importance \n\n\n\nsince they are rich in potential bioactive chemicals. The \n\n\n\nobjective of the study was to evaluate the Anti-cancer activity \n\n\n\nof methanolic extract of Myriostachya wightiana whole plant. \n\n\n\nThe extract was subjected to preliminary phytochemical \n\n\n\nscreening with aim to study in-vitro cytotoxic activity in \n\n\n\ndifferent cell lines followed by docking studies and in-vivo \n\n\n\nanimal studies. Methods: The crude flour from the entire \n\n\n\nplant was extracted in succession of polar solvents with \n\n\n\nincreasing polarity. The extract was dried and weighed after \n\n\n\nbeing evaporated to dryness. The extract was screened for \n\n\n\nflavonoids, alkaloids, carbohydrates, tannins, and other \n\n\n\nphytochemicals. In-vitro cytotoxic study was performed on \n\n\n\nthe human breast cancer cell-line MCF-7, human colorectal \n\n\n\ncancer cell line CACO-2 and hepatocellular cancer cell line \n\n\n\nHEPG-2 using 3-(4,5-dimethythiazol- 2-yl)-2,5-diphenyl \n\n\n\ntetrazolium bromide (MTT) assay. Results and Discussion: \n\n\n\nMyriostachya wightiana Methanolic extract was found to be \n\n\n\neffective with IC50 values103.47 \u00b5g/ml ,110.22 \n\n\n\n\u00b5g/ml,110.85 \u00b5g/ml on MCF-7, HEPG-2,CaCO 2 with the \n\n\n\nstandard drug Vinblastine sulphate respectively. Conclusion: \n\n\n\nThe study indicated that methanolic extract of Myriostachya \n\n\n\nwightiana was active with IC50 against human breast cancer \n\n\n\ncell line MCF 7, colorectal cancer cell line CACO 2 & \n\n\n\nhepatocellular cancer cell line HEPG 2. There is an urgent \n\n\n\nneed for more research into this plant in order to uncover and \n\n\n\nisolate its active anticancer components. \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\nmailto:99anupama@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n91 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 051 \n\n\n\n\n\n\n\nInvestigation of Pittosporum molucannum \n\n\n\nPlant Extracts as Potential Source of \n\n\n\nNatural Biopesticides \n\n\n\n\n\n\n\nMelissa June Paderog*, Remi Charlene \n\n\n\nSalvilla \n  \nDepartment of Pharmacy, College of Pharmacy and Medical Technology, \n\n\n\nUniversity of San Agustin, Gen. Luna St., Iloilo City, Philippines 5000. \n\n\n\n* Corresponding author \n\n\n\nEmail: mpaderog@usa.edu.ph \n\n\n\n\n\n\n\nBackground and Objectives: Unintentional pesticide \n\n\n\npoisoning (UPP) in humans has been an inherent public \n\n\n\nhealth problem most developing and agricultural countries, \n\n\n\nfaces since the 1960\u2019s. Pesticides are substances that are used \n\n\n\nto kill or repel plants and animals considered to be pests. \n\n\n\nHowever, despite its benefits, pesticides poses health risks. \n\n\n\nPittosporum moluccanum locally known as \u201cbuyo-buyo\u201d was \n\n\n\ntraditionally used as herbal pesticides although no further \n\n\n\nscientific findings support this claim. Thus, this study aims to \n\n\n\nprovide initial findings on the plant\u2019s potential as a source of \n\n\n\nnatural biopesticides. Methods: In this study, extracts were \n\n\n\nobtained through maceration of the plant\u2019s leaves, fruits, and \n\n\n\nbarks in ethanol, followed by filltration, and finally \n\n\n\nconcentration using rotary evaporator. The extracts were \n\n\n\nchemically profiled through thin-layer chromatographic \n\n\n\nprinciples and toxicity was screened using brine shrimp \n\n\n\nlethality assay and MTT cytotoxicity assay. Herbicidal \n\n\n\nactivity was determined using phototoxicity assay and \n\n\n\nactivity was compared to glyophosate (positive control) and \n\n\n\nwater (growth control). Results and Discussion: TLC \n\n\n\nexperiment results suggest that the leaves, fruits and barks \n\n\n\ncontain semipolar compounds that are UV active at 365nm \n\n\n\nand 254nm wavelengths. Alkaloids and flavonoids were \n\n\n\nfound on the three plant extracts, phenolics were found in \n\n\n\nleaves and fruits, and tannins was found only on leaves. \n\n\n\nFurthermore, toxicity profiling suggests an LC50 of 0.098 \n\n\n\nmg/mL for leaves extract and 3.125 mg/mL for barks and \n\n\n\nfruits extracts. In addition, the fruits extract was found to be \n\n\n\ncytotoxic (CC50) at 0.39 ug/mL while both the leaves and \n\n\n\nbarks at 0.2 ug/mL. Herbicidal assay suggests that the \n\n\n\nextracts totally inhibit seed germination (100 % + SD 0.00) \n\n\n\nat 2 ug/mL while the positive control (13.5 ug/mL \n\n\n\nglyophosate) only exhibited 92.34 % + 0.47) inhibition. \n\n\n\nConclusion: Findings of this study suggests that \n\n\n\nP.molucannum plant contains UV active compounds that \n\n\n\ncould be a potential source of biopesticides specifically \n\n\n\nagainst weeds. \n\n\n\nAbstract 052 \n\n\n\n\n\n\n\nDocking Study Using Vina for \n\n\n\nPhytochemicals from Mangifera zeylanica \n\n\n\nto Treat Dengue  \n\n\n\n\n\n\n\nMohamed Jiffry Ifran*, Mohamed Jaffry \n\n\n\nRizzaly, Mudalige Heshani, Perera Ominda \n \n\n\n\nSchool of Science, BMS, Colombo-6, Sri Lanka \n\n\n\n*Corresponding author  \n\n\n\nEmail: mohamedifran1999@gmail.com \n\n\n\n\n\n\n\nBackground and Objectives: Dengue has emerged as a \n\n\n\nglobal public health challenge which unmet specific drug \n\n\n\ntreatment or vector control has become a threat to the world \n\n\n\ndue to increased morbidity rate. The current unavailability of \n\n\n\ndrugs has urged the need for novel antiviral drugs. NS3 \n\n\n\nprotease (PDB ID: 2FOM) is known for its viral replication \n\n\n\nof the dengue virus type II is used in this study. This study \n\n\n\nexplores the possibility of phytochemical compounds as NS3 \n\n\n\nprotease antagonists by detecting the common amino acid \n\n\n\nresidues in the binding pocket. Methods: 2OFM, which is a \n\n\n\nprimary target protein to treat dengue, was retrieved from \n\n\n\nRCSB PDB. In this study, docking of phytochemicals which \n\n\n\nwere downloaded from NCBI PubChem from the source, \n\n\n\nMangifera zeylanica was carried out in a single config.txt file \n\n\n\nusing AutoDock vina 1.2.6 with FDA-approved drug as \n\n\n\ncontrol ligand to find the antagonist candidate of NS3. All the \n\n\n\nligands were docked at a time by generating and executing \n\n\n\nthe *.BAT file through vina.exe and ligands (*. pdbqt files) \n\n\n\nfolder pathways. BIOVIA discovery studio was utilized to \n\n\n\nvisualize the interactions between protein and ligand. \n\n\n\nPotential drug candidates against dengue were assessed using \n\n\n\nSwiss-ADME webtool based on Lipinski\u2019s rule of five, \n\n\n\nblood-brain barrier permeability and GI absorption for oral \n\n\n\nadministration. Results and Discussion: Phytochemical, \n\n\n\nlupeol showed the lowest binding energy (-8.9 kcal/mol) \n\n\n\nwhile it does not obey Lipinski\u2019s rule. Epicatechin showed -\n\n\n\n8.5 kcal/mol and acceptance for Lipinski\u2019s rule. Other \n\n\n\nphytochemicals\u2019 binding affinities range from -5.1 to -8.6 \n\n\n\nkcal/mol. Conclusion: Epicatechin can be selected as a \n\n\n\npotential drug candidate. LEU149 was detected as a common \n\n\n\namino acid with respect to hydrogen bond and LEU76 and \n\n\n\nILE165 were identified as the common amino acid residue \n\n\n\ncorresponding to hydrophobic interaction. Further, in-vitro \n\n\n\nand in-vivo experiments can be persuaded. \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:mpaderog@usa.edu.ph\n\n\nmailto:mohamedifran1999@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n92 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 053 \n\n\n\n\n\n\n\nSynergistic Killing of Polymyxin B \n\n\n\nCombinations with Chloramphenicol \n\n\n\nDerivatives against Multidrug Resistant \n\n\n\n(MDR) Klebsiella pneumoniae \n\n\n\n\n\n\n\nNurulain Idris1, Nusaibah Abdul Rahim1*, \n\n\n\nKok Hoong Leong2, Eng Hwa Wong3 \n \n1 Department of Clinical Pharmacy and Pharmacy Practice,  \n2 Department of Pharmaceutical Chemistry, Faculty of Pharmacy, \n\n\n\nUniversiti Malaya, Kuala Lumpur, Malaysia. \n3 School of Medicine, Faculty of Health and Medical Sciences, Taylor\u2019s \n\n\n\nUniversity Lakeside Campus, Selangor, Malaysia. \n\n\n\n* Corresponding author \n\n\n\nEmail: nusaibah.abdulrahim@um.edu.my  \n \n\n\n\nBackground and Objectives: Combination antibiotics is \n\n\n\na treatment strategy to achieve synergistic killing against \n\n\n\nmultidrug resistant (MDR) Klebsiella pneumoniae. \n\n\n\nCombination interactions can be classified into synergy \n\n\n\n(\u22652 log10 CFU/mL), additive (1-2 log10 CFU/mL), and \n\n\n\nindifferent activity (<2 log10 CFU/mL) of bacterial killing \n\n\n\nwhen compared to the most active monotherapy. This \n\n\n\nstudy aimed to determine the antimicrobial \n\n\n\npharmacodynamics of polymyxin B combination with \n\n\n\nchloramphenicol and its less cytotoxic derivatives \n\n\n\n(thiamphenicol and florfenicol) against MDR K. \n\n\n\npneumoniae. Methods: Broth microdilution was used to \n\n\n\ndetermine the minimum inhibitory concentration (MIC) \n\n\n\nagainst Acinetobacter baumanii 19606 and MDR K. \n\n\n\npneumoniae, ATCC 700603, BAA-2146, and 700721 \n\n\n\nisolates. Time kill assay was used to assess the bacterial \n\n\n\nkilling of polymyxin B (20mg/L) in combination with \n\n\n\nchloramphenicol (160mg/L), thiamphenicol (64mg/L) and \n\n\n\nflorfenicol (64mg/L) against MDR. K. pneumoniae isolates. \n\n\n\nViable cell count was done to determine the antimicrobial \n\n\n\npharmacodynamic effect of antibiotics alone and in \n\n\n\ncombination expressed as bacterial burden (log10 CFU/mL) \n\n\n\nat 1, 4 and 24h. Results and Discussion: All isolates were \n\n\n\nsusceptible to polymyxin B and resistant to \n\n\n\nchloramphenicol, thiamphenicol and florfenicol. \n\n\n\nMonotherapy polymyxin B showed a regrowth of bacteria \n\n\n\nafter 24h for all isolates. Chloramphenicol, thiamphenicol \n\n\n\nand florfenicol were ineffective against all isolates when \n\n\n\ntreated alone. The combination of polymyxin B with \n\n\n\nchloramphenicol exhibited synergistic activity against all \n\n\n\nisolates. Treatment of polymyxin B and florfenicol \n\n\n\ndemonstrated synergistic and additive killing of all isolates \n\n\n\nand combination of polymyxin B with thiamphenicol \n\n\n\nshowed indifferent and additive killing of bacteria. The \n\n\n\nsynergistic activity combination of polymyxin B with \n\n\n\nchloramphenicol against MDR K. pneumoniae were \n\n\n\nsimilar as previous study. Conclusion: The combination of \n\n\n\npolymyxin B with florfenicol and thiamphenicol \n\n\n\ndemonstrated synergistic and additive killing against MDR \n\n\n\nK. pneumoniae isolates. Further investigation assessing the \n\n\n\ncytotoxic effect of polymyxin B combination with \n\n\n\nthiamphenicol and florfenicol at clinically relevant \n\n\n\nconcentrations are warranted. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 054 \n \n\n\n\nEffect of B. hispida Seed Extract towards \n\n\n\nProtein Expression of AHR, OVOL-1 and \n\n\n\nCYP1A1 \n\n\n\n\n\n\n\nRamli RZ*, Hadi H \n \n\n\n\nDermatopharmaceutics Research Group, Department of Pharmaceutical \n\n\n\nTechnology, Kuliyyah of Pharmacy, International Islamic University \n\n\n\nMalaysia, Kuantan, Pahang, Malaysia \n\n\n\n* Corresponding author \n\n\n\nEmail: rizal.zaim@yahoo.com \n\n\n\n\n\n\n\nBackground and Objectives: Atopic dermatitis (AD) is skin \n\n\n\ndisease which can be characterized by pruritic and \n\n\n\neczematous dermatitis that can be chronically varied through \n\n\n\nremissions and relapses. Primarily, AD is caused by the skin \n\n\n\nbarrier dysfunction while the skin sensitization to allergens \n\n\n\ncould also contributed to the severity of the skin disease. This \n\n\n\nstudy aims to discover the skin barrier repair functions of the \n\n\n\nBenincasa hispida seed extract (BHSE) which mainly \n\n\n\nconsists of polyunsaturated fatty acids (PUFAs) towards the \n\n\n\nskin barrier proteins which usually were downregulated in \n\n\n\nAD. Methods: The methods that were implemented in this \n\n\n\nstudy were the immunoblotting including Sodium Dodecyl \n\n\n\nSulphate Polyacrylamide Gel Electrophoresis (SDS-PAGE) \n\n\n\nto study the upregulations of three main skin barrier proteins \n\n\n\nwhich are Filaggrin, Loricrin and Involucrin and the \n\n\n\nreceptors and other proteins (Aryl Hydrocarbon Receptors, \n\n\n\nOvo Like Transcriptional Repressor 1 and Cytochrome P450 \n\n\n\nFamily 1 Subfamily A Member 1) which were involved in \n\n\n\nthe upregulations of the mentioned skin barrier proteins. The \n\n\n\nprocedures started with the SDS-PAGE to separate the \n\n\n\nprotein mixture of HaCaT lysate according to their respective \n\n\n\nmolecular weight, followed by protein transfer or blotting \n\n\n\ntowards the polyvinylidene fluoride membrane and lastly, the \n\n\n\nblocking steps of primary and secondary antibody before \n\n\n\nchemiluminiscent visualization. Results and Discussion: \n\n\n\nThis study found that the BHSE was able to upregulate all of \n\n\n\nthe proteins involved in the skin barrier restoration in dose \n\n\n\ndependent manner of the selected concentrations of 250 \n\n\n\n\u00b5g/mL, 125 \u00b5g/mL and 62.5 \u00b5g/mL. Conclusion: Based on \n\n\n\nthis finding, it can concluded that there were upregulations \n\n\n\non the protein expressions in most of the interested proteins \n\n\n\nwhich each one of them plays a crucial role in restoring the \n\n\n\nskin barrier dysfunction and therefore, suggesting the ability \n\n\n\nof the BHSE in the treatment for AD through the restoration \n\n\n\nof skin barrier dysfunction.   \n\n\n\n\nmailto:nusaibah.abdulrahim@um.edu.my\n\n\nmailto:rizal.zaim@yahoo.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n93 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 055 \n \n\n\n\nretracted \n\n\n\n\n\n\n\nAbstract 056 \n\n\n\n\n\n\n\nGenotyping of SNPs in ABCB1 (rs1045642, \n\n\n\nrs1128503) and OPRM1 (rs1799971, \n\n\n\nrs9479757) Associated with Pain Control \n\n\n\nand Adverse Effects of Morphine among \n\n\n\nCancer Pain Patients in Malaysia \n\n\n\n\n\n\n\nShobha Elizabeth Satkunananthan1, Sabrina \n\n\n\nAnne Stephen1, Hui Yin Yow2, Vijayaprakash \n\n\n\nSuppiah3, Fauziah Ab Aziz4, Hasriza Hashim4, \n\n\n\nGaik-Theng Toh5* \n \n1School of Pharmacy, Faculty of Health & Medical Sciences, Taylor\u2019s \n\n\n\nUniversity, Selangor, Malaysia \n2Department of Pharmaceutical Life Sciences, Faculty of Pharmacy, \n\n\n\nUniversiti Malaya, Kuala Lumpur, Malaysia. \n3Clinical and Health Sciences, University of South Australia, Adelaide, \n\n\n\nAustralia \n4Department of Palliative Medicine and Supportive Care, National Cancer \n\n\n\nInstitute, Wilayah Persekutuan Putrajaya, Malaysia \n5School of Medicine, Faculty of Health & Medical Sciences, Taylor\u2019s \n\n\n\nUniversity, Selangor, Malaysia \n\n\n\n* Corresponding author \n\n\n\nEmail: gaiktheng.toh@taylors.edu.my  \n\n\n\n\n\n\n\nBackground and Objectives: Single nucleotide \n\n\n\npolymorphisms (SNPs) affect treatment outcomes in opioid-\n\n\n\ntreated patients with evidence predominantly from Caucasian \n\n\n\npopulations. The association of SNPs with cancer pain \n\n\n\ntreatment outcomes within multi-ethnic Malaysian \n\n\n\npopulation remains unknown. This study aimed to investigate \n\n\n\nthe relationship of SNPs in ABCB1 and OPRM1 genes on \n\n\n\nmorphine pharmacodynamic parameters (pain control, dose \n\n\n\nrequirement, and adverse effects) and non-genetic \n\n\n\npharmacodynamics of morphine (gender, ethnicity, ECOG \n\n\n\nscores and cancer stage). Methods: 66 Malaysian solid \n\n\n\ntumour cancer patients treated with morphine were recruited \n\n\n\nfrom National Cancer Institute. Data (demographic and \n\n\n\nclinical) and saliva samples were collected from all \n\n\n\nparticipants. Patients\u2019 pain severity was evaluated by using \n\n\n\nBrief Pain Inventory. Incidence of adverse effects were \n\n\n\ndetermined through a questionnaire. Both questionnaires \n\n\n\nused Likert scales and were available in English and Malay. \n\n\n\nDue to COVID-19 restrictions, 38 out of 66 subjects \n\n\n\ncompleted the questionnaires. DNA extracted from saliva \n\n\n\nsamples were genotyped for SNPs in ABCB1 (rs1045642, \n\n\n\nrs1128503) and OPRM1 (rs1799971, rs9479757). Statistical \n\n\n\nanalyses were performed to determine the associations \n\n\n\nbetween genetic and non-genetic factors with morphine. \n\n\n\nResults and Discussion: The AA genotype in ABCB1 \n\n\n\nrs1128503 SNP had the highest pain score in the last 24 hours \n\n\n\n(p=0.043). ABCB1 (rs1045642, rs1128503) and OPRM1 \n\n\n\n(rs1799971, rs9479757) SNPs were associated with several \n\n\n\nadverse effects incidence (p<0.05). Ethnicity was associated \n\n\n\nwith the incidence of hallucination (p=0.041) in patients. \n\n\n\nECOG scores and cancer stages were also associated with \n\n\n\nseveral adverse effects incidence (p<0.05). However, \n\n\n\nmorphine dose was not associated with genetic or non-\n\n\n\ngenetic factors. Conclusion6U6Y The association between \n\n\n\ngenetic and non-genetic factors with pain severity and \n\n\n\nadverse effects incidence was seen in this study, but not with \n\n\n\ndose requirement. This pilot study should be validated in \n\n\n\nfuture genetic association studies on larger cohorts to \n\n\n\nelucidate the role of pharmacogenomics in treating cancer \n\n\n\npain in Asian patients. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 057 \n \n\n\n\nEvaluation of the CYP1A2, CYP2D6, and \n\n\n\nCYP3A4 Inhibition by the Ten DOH-\n\n\n\nApproved Philippine Medicinal Plants \n\n\n\nusing Enzyme-Specific Fluorometric \n\n\n\nSubstrates in Pooled Human Liver \n\n\n\nMicrosomes \n\n\n\n\n\n\n\nSigfredo B. Mata*, Hadiyya Mary Glenn A. \n\n\n\nParaiso, Alicia P. Catabay \n \n\n\n\nDr. Mariano Que College of Pharmacy, De La Salle Medical and Health \n\n\n\nSciences Institute, Cavite, Philippines \n\n\n\n* Corresponding author \n\n\n\nEmail: sbmata@dlshsi.edu.ph \n\n\n\n\n\n\n\nBackground and Objectives: Herb-drug interaction is a \n\n\n\nsafety concern in using herbal medicines and plant-based \n\n\n\ndietary supplements. Cytochrome P450 enzymes (CYP) \n\n\n\nconstitute the major enzyme family known for oxidative \n\n\n\nbiotransformation of most drugs and other lipophilic \n\n\n\nsubstrates. CYP inhibition can result in high levels of \n\n\n\nunmetabolized drug molecule possibly eliciting toxic effects. \n\n\n\nThis study aimed to determine the inhibition of CYP1A2, \n\n\n\nCYP2D6, and CYP3A4 by the ten Philippine herbal \n\n\n\nmedicines approved by Philippine Department of Health \n\n\n\n(DOH). Methods: CYP inhibition in pooled human liver \n\n\n\nmicrosomes was determined using a spectrofluorometric \n\n\n\ntechnique that involved isoform-specific substrates: 7-\n\n\n\nmethoxyresorufin (7-MR), 7-benzyloxy-4-\n\n\n\ntrifluoromethylcoumarin (BFC), and 7-benzyloxyquinoline \n\n\n\n(BQ) monitoring the activity of CYP1A2, CYP2D6, and \n\n\n\nCYP3A4, respectively. The substrates at Km were incubated \n\n\n\nwith microsomes, phosphate buffer (pH 7.4), and NADPH \n\n\n\nwith or without methanolic extracts of each plant. \n\n\n\nMicrosome-substrate mixtures were pre-incubated before \n\n\n\n\nmailto:gaiktheng.toh@taylors.edu.my\n\n\nmailto:sbmata@dlshsi.edu.ph\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n94 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nadding NADPH, which initiated CYP activity. After \n\n\n\nincubation, microsomal protein was separated from \n\n\n\nsupernatant. Fluorescence intensity of supernatant at \n\n\n\nfluorophore-specific emission and excitation wavelengths \n\n\n\nshowed O-demethylation by CYP1A2 and O-dealkylation by \n\n\n\nCYP2D6 and CYP3A4. Percentage mean inhibition values \n\n\n\nwere determined based on fluorescence intensity of \n\n\n\nuninhibited substrates. Extracts showing at least 50% \n\n\n\ninhibition at Km were considered as having inhibitory effect \n\n\n\non enzymes. Results and Discussion: Ehretia microphylla, \n\n\n\nQuisqualis indica, Blumea balsamifera, and Cassia alata \n\n\n\nexhibited high CYP1A2 inhibition values: 82.98%, 64.81%, \n\n\n\n63.75%, and 60.58%, respectively, at 50 \u00b5g\u00b7mL-1. Only Q. \n\n\n\nindica showed more than 50% inhibition at 25 \u00b5g\u00b7mL-1. \n\n\n\nCYP2D6 and CYP3A4 inhibitions were not observed even at \n\n\n\nthe highest extract concentration (72 \u00b5g\u00b7mL-1). Nonetheless, \n\n\n\nAllium sativum at 14.6 \u00b5g\u00b7mL-1 showed mean CYP3A4 \n\n\n\ninhibition above 50%. Conclusion: CYP1A2, CYP2D6, and \n\n\n\nCYP3A4 have broad substrate specificity and clinical \n\n\n\nrelevance. Due to possible CYP inhibitory action of some \n\n\n\nPhilippine medicinal plants, their concomitant use with \n\n\n\ncertain drugs should be considered with caution. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 058 \n \n\n\n\nNeuroprotective Effects of Palm Oil \n\n\n\nDerived Tocotrienol-Rich Fraction in \n\n\n\nAluminium Chloride Induced Vascular \n\n\n\nDementia Rats \n\n\n\n\n\n\n\nShaikh Sohrab A., Muthuraman \n\n\n\nArunachalam*, Rajavel Varatharajan \n \n\n\n\nPharmacology Unit, Faculty of Pharmacy, AIMST University, Semeling, \n\n\n\n08100 Bedong, Kedah, Malaysia. \n\n\n\n* Corresponding author \n\n\n\nEmail: shaikh.sohrab@aimst.edu.my \n\n\n\n\n\n\n\nBackground and Objectives: Vascular dementia (VaD) is a \n\n\n\ncommon type of dementia and can be caused by aluminium \n\n\n\nexposure. Available medicines for the management of VaD \n\n\n\nare limited. Palm oil derived tocotrienol rich fraction (TRF) \n\n\n\nis known to produce neuroprotective actions in neurological \n\n\n\nconditions, however, its effect on VaD is not explored. Hence, \n\n\n\nthe objective was to evaluate the neuroprotective effects of \n\n\n\nTRF in aluminum chloride (AlCl3) induced VaD rats. \n\n\n\nMethods: AlCl3 (150 mg/kg; i.p.) was administered daily for \n\n\n\n7 days to rats for inducing VaD and later rats were treated \n\n\n\nwith TRF 30, 60, and 120 mg/kg; p.o. for 21 days. VaD \n\n\n\ninduced memory loss was assessed by Morris water maze test. \n\n\n\nBiochemical markers like plasma homocysteine, brain \n\n\n\nacetylcholinesterase (AChE) activity, reduced glutathione \n\n\n\n(GSH), and superoxide dismutase (SOD) levels were \n\n\n\nestimated. Brain coronal sections were stained with \n\n\n\nhematoxylin and eosin for histopathological analysis. \n\n\n\nResults and Discussion: VaD in AlCl3 treated rats was \n\n\n\nconfirmed by significant increase in the plasma \n\n\n\nhomocysteine levels (9.61 \u00b1 1.00 umol/L) and brain AChE \n\n\n\nactivity (6.16 \u00b1 0.24 umol/min/gm of tissue), decrease in \n\n\n\nGSH (4.67 \u00b1 0.29 uM/mg of protein), and SOD (4.78 \u00b1 0.86 \n\n\n\nU/mg of protein) levels as compared to normal rats. However, \n\n\n\ntreatment with TRF 60 in VaD rats significantly decreased \n\n\n\nthe levels of plasma homocysteine (5.50 \u00b1 0.37 umol/L) and \n\n\n\nbrain AChE activity (3.81 \u00b1 0.19 umol/min/gm of tissue), \n\n\n\nincreased GSH (7.15 \u00b1 0.48 uM/mg of protein), and SOD \n\n\n\n(8.87 \u00b1 0.68 U/mg of protein) levels as compared to AlCl3 \n\n\n\ntreated rats. Furthermore, neurodegeneration and memory \n\n\n\nloss were also significantly protected by TRF. Moreover, \n\n\n\nTRF 60 and 120 effects were found to be equipotent. \n\n\n\nConclusion: This study exhibits the neuroprotective role of \n\n\n\nTRF in VaD rats and hence provides new knowledge to \n\n\n\nunderstand TRF effectiveness in the management of VaD. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 059 \n\n\n\n \nPharmacokinetics of Loratadine after \n\n\n\nIntranasal Application of Its Gel \n\n\n\nFormulation \n\n\n\n\n\n\n\nSophia S. Pagaran1*, Bea May I. Remedio1, \n\n\n\nGerard Lee L. See2 \n \n1Department of Pharmacy, School of Health Care Professions, University \n\n\n\nof San Carlos, Cebu, the Philippines \n2Pharmaceutical Research and Drug Development Laboratories, \n\n\n\nDepartment of Pharmacy, School of Health Care Professions, University of \n\n\n\nSan Carlos, Cebu, the Philippines \n\n\n\n* Corresponding author \n\n\n\nEmail: 17100131@usc.edu.ph \n\n\n\n\n\n\n\nBackground and Objectives: Loratadine is a second-\n\n\n\ngeneration antihistamine administered orally to treat allergic \n\n\n\nrhinitis and urticaria. However, its oral administration can \n\n\n\ncause several side effects such as headache, dizziness, fatigue, \n\n\n\nand nausea. To address these issues, intranasal drug delivery \n\n\n\nis considered due to avoidance of the first-pass effect and \n\n\n\nimproved bioavailability. In situ nasal gel formulation, in \n\n\n\nparticular, is advantageous due to its sustained and controlled \n\n\n\nrelease of drugs. Methods: In this study, an in situ gel \n\n\n\nformulation was evaluated for its pharmacokinetic \n\n\n\nparameters through an in vivo experiment in rabbits and was \n\n\n\ncompared with that of loratadine administered as intravenous \n\n\n\nand intranasal solutions. Results and Discussion: The in situ \n\n\n\ngel exhibited the highest mean residence time when \n\n\n\ncompared with intravenous and intranasal solution which \n\n\n\nindicates the accumulation of loratadine in a specific tissue \n\n\n\nfor a longer period of time and exhibits its therapeutic \n\n\n\nefficacy. The pH of the formulation was within the \n\n\n\nphysiological range (pH = 6.60 \u00b1 0.13). Drug plasma \n\n\n\n\nmailto:shaikh.sohrab@aimst.edu.my\n\n\nmailto:17100131@usc.edu.ph\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n95 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nconcentration significantly increased 6 to 8 hours after \n\n\n\nadministration of gel (p < 0.05). The fraction of dose \n\n\n\nabsorbed for the in situ nasal gel (F = 0.83) was 2.3-fold \n\n\n\nhigher than that of the intranasal solution (F = 0.36). \n\n\n\nConclusion: Based on the results, the rise in drug plasma \n\n\n\nconcentration from the in situ gel formulation appeared to be \n\n\n\nslower and more gradual compared to the intravenous and \n\n\n\nintranasal solutions. The incorporation of loratadine into in \n\n\n\nsitu nasal gels may be beneficial for patients suffering from \n\n\n\ndiseases affecting the nasal mucosa, such as allergic rhinitis, \n\n\n\ndue to its improved bioavailability, convenient dosing, and \n\n\n\neasy administration. \n\n\n\n\n\n\n\n\n\n\n\n Abstract 060 \n \n\n\n\nAnomalous Dissolution Enhancement of \n\n\n\nAged Supersaturated Electrospun Solid \n\n\n\nDispersion System \n\n\n\n\n\n\n\nXin Yi Teoh, Siok Yee Chan* \n \n\n\n\nThoughts Formulation Laboratory, Discipline of Pharmaceutical \n\n\n\nTechnology, School of Pharmaceutical Sciences, Universiti Sains \n\n\n\nMalaysia, 11800 Penang, Malaysia \n\n\n\n* Corresponding author \n\n\n\nEmail: sychan@usm.my  \n\n\n\n\n\n\n\nBackground and Objectives: Supersaturation was \n\n\n\nintroduced as part of the strategy for improving the \n\n\n\ndissolution profile of the amorphous solid dispersion (ASD) \n\n\n\nsystem. However, supersaturation stability over time remains \n\n\n\nthe main hurdle for a sustainable dissolution enhancement. \n\n\n\nWorse still, physical stability, particularly ageing and \n\n\n\nrecrystallisation persist as the challenges which restrict the \n\n\n\ndevelopment of ASD. Therefore, this study aims to \n\n\n\ninvestigate the effect of storage conditions on the physical \n\n\n\nstability of the supersaturated electrospun system, \n\n\n\nparticularly the sustainability of dissolution enhancement and \n\n\n\ninhibition of solution-mediated recrystallisation. Methods: \n\n\n\nElectrospun samples were stored in two distinctive \n\n\n\nconditions, i.e., 75% RH, 40\u00b0C and 0% RH, 25\u00b0C for 3 \n\n\n\nmonths and 12 months respectively. Physical characteristics \n\n\n\nof aged electrospun samples were tested with polarised light \n\n\n\nmicroscopy, Differential Scanning Calorimetry and \n\n\n\nAttenuated Total Reflectance-Fourier Transform Infrared. \n\n\n\nDrug content assay was conducted to identify drug stability \n\n\n\nafter storage. Dissolution studies were carried out in a non-\n\n\n\nsink condition to assess the release stability across \n\n\n\nrecrystallisation tendency. Results and Discussion: In the \n\n\n\nhighly humid and relatively high temperature condition, the \n\n\n\naged electrospun sample has recrystallised and lost the \n\n\n\nadvantage of an ASD system in achieving supersaturation, \n\n\n\nresembling the dissolution profile of its crystalline \n\n\n\ncounterpart. In contrast, electrospun sample stored in dry and \n\n\n\ntemperate conditions has remained sample amorphicity and \n\n\n\nunexpectedly showed inhibition towards solution-mediated \n\n\n\nrecrystallisation, hence sustaining the dissolution \n\n\n\nenhancement. Such positive transformation in the aged \n\n\n\nelectrospun sample could be due to the achievement of an \n\n\n\nequilibrium glassy state by structural relaxation during the \n\n\n\nageing process. Conclusion: Structural relaxation was \n\n\n\nproposed to exert a stabilising effect on ASD which inhibit \n\n\n\nsolution-mediated recrystallisation. The presented result \n\n\n\nsuggested ageing improves the sustainability of dissolution \n\n\n\nenhancement in the ASD system which was not previously \n\n\n\nstabilised through a formulation design.  \n\n\n\n\n\n\n\n\n\n\n\nAbstract 061 \n \n\n\n\nPhytochemical Investigation and \n\n\n\nAntioxidant Activity Determination using \n\n\n\nORAC Assay of the Dried Bark and Fresh \n\n\n\nLeaves of Pterocarpus indicus Willd. (Fam. \n\n\n\nFabaceae) \n\n\n\n\n\n\n\nBengala, TJL*, Mata, SB, Catabay, AP \n \n\n\n\nDr. Mariano Que College of Pharmacy, De La Salle Medical and Health \n\n\n\nSciences Institute, Dasmari\u00f1as City, Philippines \n\n\n\n* Corresponding author  \n\n\n\nEmail: tlbengala@dlshsi.edu.ph  \n\n\n\n\n\n\n\nBackground and Objectives: The study aimed to look at the \n\n\n\neffects of different drying and processing protocols (DPPs) \n\n\n\non selected parameters: IR peaks, Moisture Content (MC), \n\n\n\nTotal Extractives (TE), Phytochemical Tests (PCS), and \n\n\n\nORAC Score. The different DPPs can cause post-harvest \n\n\n\nmodifications resulting to changes in the kind and amount of \n\n\n\nphytochemicals in each sample. Methods: The samples were \n\n\n\nmacerated in ethanol and the extract was vacuum evaporated. \n\n\n\nThe extracts were then used for phytochemical screening and \n\n\n\nFTIR analysis. The collected peaks were binned and were \n\n\n\nanalyzed with Hierarchical Clustering and Principal \n\n\n\nComponent Analysis using R. Results and Discussion: The \n\n\n\nPCS revealed that the DPPs with significant air-drying time \n\n\n\n(DPPs 1 and 2) tested positive for polyphenols and flavonoids. \n\n\n\nThe combination of air- and oven-drying (DPP 2) may have \n\n\n\nled to some metabolite decomposition as evidence by a \n\n\n\ndecrease in TE. Oven-drying only (DPP 4) resulted in a lower \n\n\n\ndegree of variety in the metabolites present. The absence of \n\n\n\nany form of drying (DPP 3) resulted in a product that did not \n\n\n\nhave any of the desired metabolites. The PCA and HCA \n\n\n\nanalysis have revealed that clustering was observed on \n\n\n\nproducts from DPPs 3, 6, and 7 (air-drying only); DPPs 1, 2 \n\n\n\nand 5 (both air- and oven drying); lastly DPP 4 (oven-drying \n\n\n\nonly). The ORAC score of DPPs 2,4, and 5 (all belonging to \n\n\n\ndifferent clusters) were not significantly different to one \n\n\n\nanother; the highest score was reported on DPP 5 (H-ORAC \n\n\n\n= 24627.7). Conclusion: There may be an optimum \n\n\n\ncombination of air- and oven-drying that will ensure the \n\n\n\n\nmailto:sychan@usm.my\n\n\nmailto:tlbengala@dlshsi.edu.ph\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n96 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nhighest amount and activity of antioxidant compounds for the \n\n\n\nprocessed Narra bark. The methods used in this study may be \n\n\n\nused for the quality control of dietary supplements and herbal \n\n\n\nmedicines. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 062 \n\n\n\n\n\n\n\nPharmacist\u2019s Preferences, Evaluation and \n\n\n\nPerceptions of Telepharmacy Application \n\n\n\nServices: A Pilot Study  \n\n\n\n\n\n\n\nAdelin Suraya Mokhtar1*, Ezlina Usir1, \n\n\n\nMunaver Ahmad Nazir Ahmad2 \n \n1 Department of Clinical Pharmacy, Faculty of Pharmacy, Universiti \n\n\n\nTeknologi MARA Cawangan Selangor, 42300 Bandar Puncak Alam, \n\n\n\nSelangor, Malaysia. \n2 Rhazes Telehealth, Rhazes Consultancy Services Sdn Bhd, Nucleus Tower,  \n\n\n\nMutiara Damansara, 47800 Subang Jaya, Selangor, Malaysia \n\n\n\n* Corresponding author \n\n\n\nEmail: adelinsuraya29@gmail.com  \n\n\n\n\n\n\n\nBackground and Objectives: Information on the evaluation \n\n\n\nand opinions of telepharmacy application systems among \n\n\n\npharmacists is needed to facilitate the adoption of \n\n\n\ntelepharmacy services. The purpose of this study were to \n\n\n\ndetermine the i) preferences, evaluation, and perceptions of \n\n\n\npharmacist towards the telepharmacy systems and ii) \n\n\n\nrelationship between the demographic background and their \n\n\n\npreferences on telepharmacy application system services. \n\n\n\nMethods: Self-administration survey was conducted via an \n\n\n\nonline and face-to-face survey from April to May 2022. The \n\n\n\ntarget population was community pharmacists who work in \n\n\n\ncommunity pharmacies in Klang Valley. An invitation link \n\n\n\nwas sent via Gmail and Whatsapp platform to a list of \n\n\n\ncommunity pharmacies. Data collected were analysed using \n\n\n\ndescriptive statistics, Kruskal-Wallis and Mann-Whitney U \n\n\n\ntest. Results and Discussion: A total of 24 respondents met \n\n\n\nthe inclusion criteria, with 14 (58.3%) had 1-5 years of \n\n\n\nworking as a pharmacist, and two-third (66.6%) showed \n\n\n\ninterest in using telepharmacy. Aspects to consider in using \n\n\n\ntelepharmacy are ease of use and the ability to use \n\n\n\ntelepharmacy application and conduct consultation from the \n\n\n\nsmartphone. The pharmacists disagree to the statement \u2018I \n\n\n\nfound no difference between how I conducted face-to-face \n\n\n\nconsultation and how I provided consultation via \n\n\n\ntelepharmacy\u2019. Conclusion: Despite the growing recognition \n\n\n\nof telepharmacy, its implementation and utilization of \n\n\n\ntelepharmacy by pharmacists in Klang Valley is still quite \n\n\n\nlow. Nevertheless, our study provides a current view of the \n\n\n\ntelepharmacy setting, which will aid future development and \n\n\n\napplication of telepharmacy by pharmacists, professional \n\n\n\norganizations, and government officials. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 063 \n\n\n\n\n\n\n\nRole of Pharmacist during the COVID-19 \n\n\n\nPandemic in Taiwan: A Scoping Review  \n\n\n\n\n\n\n\nBen Chen* \n \n\n\n\nThe Federation of Taiwan Pharmacists Associations \n\n\n\n* Corresponding author \n\n\n\nEmail: ben.chenshunjen@gmail.com  \n\n\n\n\n\n\n\nBackground and Objectives: Since the start of the \n\n\n\nnew Coronavirus (COVID-19) outbreak in December 2019, \n\n\n\npharmacists in Taiwan are playing a key role adopting \n\n\n\ninnovative strategies to minimize the adverse impact of the \n\n\n\npandemic. It is the objective to identify and describe core \n\n\n\nservices provided by the pharmacist in Taiwan during the \n\n\n\nCOVID-19 pandemic. Methods: A literature search was \n\n\n\nperformed in Google Scholar for studies published between \n\n\n\nDecember 1st, 2019 and August 20th, 2022 in English.  \n\n\n\nStudies that reported services provided by pharmacists \n\n\n\nduring the COVID-19 pandemic in Taiwan were included. \n\n\n\nResults and Discussion: A total of 3980 records were \n\n\n\nidentified, of which 16 studies fully met the eligibility criteria. \n\n\n\nMost of them were conducted in Taiwan. The most common \n\n\n\ntype of publication were literatures describing the workplace \n\n\n\nof the pharmacist in community and hospitals. These findings \n\n\n\nshowed the different roles of pharmacists during the COVID-\n\n\n\n19 pandemic, such as disease prevention and infection \n\n\n\ncontrol, adequate storage and drug supply, patient care and \n\n\n\nsupport for healthcare professionals. Pharmacists' \n\n\n\ninterventions were mostly conducted for healthcare \n\n\n\nprofessionals and patients, through one-to-one contact, \n\n\n\ntelephone or video conference. The pharmacists' main \n\n\n\nresponsibility was to provide drug information for healthcare \n\n\n\nprofessionals as well as patient counselling. Yet, pharmacists \n\n\n\ndeliver medicine to patients at home under quarantine. \n\n\n\nConclusion: A reasonable number of studies that described \n\n\n\nthe role of the pharmacists during the COVID-19 pandemic \n\n\n\nwere found. All studies reported actions taken by pharmacists, \n\n\n\nalthough without providing a satisfactory description. Thus, \n\n\n\nfuture research with more detailed description as well as an \n\n\n\nevaluation of the impact of pharmacist intervention is needed \n\n\n\nin order to guide future actions in this and/or other pandemic. \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:adelinsuraya29@gmail.com\n\n\nmailto:ben.chenshunjen@gmail.com\n\n\nhttps://www.sciencedirect.com/topics/pharmacology-toxicology-and-pharmaceutical-science/coronavirinae\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n97 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 064 \n\n\n\n\n\n\n\nEvaluation of the Efficacy of Valproic Acid \n\n\n\nused in Residents of A Long-term Care \n\n\n\nInstitution \n\n\n\n\n\n\n\nYC Chen1,2*, JY Huang1,2, CY Wu1,2, KP \n\n\n\nChen1,2, ZA Peng1,2  \n \n\n\n\n1 Chih-Ta Community Pharmacy, Taiwan \n2 New Taipei City Pharmacists Association, Taiwan \n\n\n\n* Corresponding author \n\n\n\nEmail: chenyichi2005@gmail.com  \n\n\n\n \nBackground and Objectives: Drug use evaluation is rarely \n\n\n\npracticed in long-term care (LTC) institutions in Taiwan. Our \n\n\n\nstudy looked at the efficacy of valproic acid by analysing \n\n\n\nprescriptions, test values and clinical effects, and assessment \n\n\n\nof the rationale of the medicines in LTC institutions to ensure \n\n\n\npatient safety. Methods: This was a retrospective study of \n\n\n\nresidents, diagnosed with epilepsy and taking valproic acid \n\n\n\nin a private LTC institution in New Taipei City from January \n\n\n\n1, 2017, to July 31, 2020, by regular tracking drug \n\n\n\nconcentration, drug interaction, liver damage index, platelet \n\n\n\nvalues, and clinical effects. Results and Discussion: We \n\n\n\ncollected 56 medicine concentration data from total 19 \n\n\n\nresidents, 31 cases were between the normal value of the \n\n\n\nvalproic acid concentration, 23 cases were lower than the \n\n\n\ntreatment range, 2 cases were higher than the treatment range, \n\n\n\nthe symptoms of most residents were well control. We \n\n\n\nobserved that residents\u2019 plasma concentration and the clinical \n\n\n\nefficacy of epilepsy treatment did not have an absolute \n\n\n\nrelation, which was roughly the same as the results in \n\n\n\npublished research literature. There were 4 pharmacy \n\n\n\nrecommendations for dose adjustment of valproic acid, 1 for \n\n\n\ndrug interaction, 1 for adverse reaction that occurs after \n\n\n\ntaking the medicine, 2 for excessive dosage, 3 were for \n\n\n\nabnormal liver damage indicators, and 5 cases were platelet \n\n\n\nabnormalities. There were limited indicators that could be \n\n\n\ntracked regularly in the LTC institution, so the observed \n\n\n\nincrease in liver injury indicators was not significantly \n\n\n\nassociated with oral valproic acid. Conclusion: Most LTC \n\n\n\ninstitutions had limited resources in Taiwan, so we must \n\n\n\ncooperate and re-educate all staffs in LTC to assess the \n\n\n\neffectiveness of treatment correctly to improve the safety of \n\n\n\nmedication for residents. \n\n\n\n\n\n\n\nAbstract 065 \n\n\n\n\n\n\n\nPatients\u2019 Perspective on Community \n\n\n\nPharmacy Services of a Ward (10) of \n\n\n\nKathmandu Metropolitan  \n\n\n\n\n\n\n\nDurga Bista*, Ankita Ojha, Badri K.C \n\n\n\n\n\n\n\nDepartment of Pharmacy, Kathmandu University, Dhulikhel, Nepal \n\n\n\n* Corresponding author \n\n\n\nEmail: durga.bista@ku.edu.np  \n\n\n\n\n\n\n\nBackground and Objectives: The patient-centered role of \n\n\n\npharmacists is undervalued as  the public are not aware about \n\n\n\nthe roles of pharmacists. This research aimed to identify \n\n\n\npatients\u2019 perception and satisfaction towards pharmaceutical \n\n\n\ncare service and factors affecting their preferences for \n\n\n\ncommunity pharmacy. Methods: A cross\u2010sectional and mix \n\n\n\nmethod study. Quantitative study was done using a validated \n\n\n\nquestionnaire and Q methodology study was done using a \n\n\n\nnormal distribution grid and Q statements which is \n\n\n\nconsidered as both quantitative and qualitative study. Q \n\n\n\nmethodology was used to collect the perception towards \n\n\n\ncommunity pharmacists through the Q method software. \n\n\n\nResults and Discussion: Out of 406 participants, 30.5% \n\n\n\nrespondents perceived balance between business and health \n\n\n\naspects of pharmacy practices, some as drug experts while \n\n\n\nothers viewed pharmacists as being more concerned with \n\n\n\nbusiness. In addition, 43.8% of the participants were found to \n\n\n\ndiscuss their drug related queries with pharmacists, may be \n\n\n\ndue to the low cost of treatment. More than 70% of the \n\n\n\nrespondents had no hesitancy when contacting pharmacists \n\n\n\nfor health-related information regarding mild illnesses \n\n\n\nbecause they believed that pharmacists are sufficiently \n\n\n\nqualified to address drug-related questions. A high level of \n\n\n\nsupport (88.1%) was for the role of pharmacists to counsel \n\n\n\nthe patient about the directions for use of medications. Level \n\n\n\nof satisfaction indicated that 72.4% were satisfied and highly \n\n\n\nsatisfied with the service. They were also confident about \n\n\n\npharmacists' ability to protect the privacy of their medical \n\n\n\nrecords and felt at ease to discuss their health with them. Out \n\n\n\nof 52 participants in Q methodology, a majority perceived \n\n\n\npharmacists were competent to advise on good quality drug \n\n\n\nusage and monitor their health, providing sufficient \n\n\n\ncounselling time. Conclusion: Pharmacists were regarded as \n\n\n\nthe most trusted personnel to contact. However, in order to \n\n\n\nfacilitate the expansion of pharmaceutical care services, the \n\n\n\npublic should be made aware about their distinctive \n\n\n\nprofessional talents. \n\n\n\n\nmailto:chenyichi2005@gmail.com\n\n\nmailto:durga.bista@ku.edu.np\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n98 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 066 \n\n\n\n\n\n\n\nPeace, Love and Care of Medicine on Radio \n\n\n\nBroadcasts \n\n\n\n\n\n\n\nYP Hsiang1,2*, CL Tai 1, CF Chiang1, MT \n\n\n\nCheng1, FS Hong1, LC Liu1  \n \n1 Kaohsiung First Pharmacists Association, Taiwan, R.O.C. \n2 Department of Pharmacy, E-DA Hospital, Taiwan, R.O.C. \n\n\n\n* Corresponding author \n\n\n\nEmail: ed108228@edah.org.tw  \n \n\n\n\nBackground and Objectives: Kaohsiung First Pharmacists \n\n\n\nAssociation (KFPA) cooperated with the Taiwan Drug Relief \n\n\n\nFoundation to promote peace, love and care of medicine on \n\n\n\nKaohsiung Broadcasting Station. People can learn more \n\n\n\nabout healthy information through radio broadcasts, and \n\n\n\nenjoy better medication environment under COVID-\n\n\n\npandemic. Methods: From January to December 2021, a \n\n\n\ntotal 30-minute topic was conducted on the first Thursday of \n\n\n\neach month. KFPA planned health themes and provided \n\n\n\naudiences with accurate medical information and health care \n\n\n\nknowledge. Results and Discussion: In 2021, the KFPA \n\n\n\nhold a total of 7 broadcasts on Kaohsiung Broadcasting \n\n\n\nStation. The topics were women disease, drug side effect, \n\n\n\nophthalmology, depression, hyperglycemia, and antibiotic \n\n\n\nmanagement. These sharing were specially selected by the \n\n\n\nKFPA for community pharmacists and hospital pharmacists. \n\n\n\nRadio programs can use the official website of the TDRF and \n\n\n\nFacebook page of \"Smart Drugs and Healthy Eating\" to \n\n\n\nrelease the program preview information before the \n\n\n\nbroadcast, and provided the link to audience. Such radio \n\n\n\nprograms can be listened at anywhere, regardless of location \n\n\n\nand space. It\u2019s a very worth promotion during the COVID-19 \n\n\n\npandemic. Conclusion: The broadcast and network \n\n\n\ntransmission speed are too fast, and the audience has no field \n\n\n\nand movement restrictions. In the COVID-pandemic \n\n\n\nprevention policy, broadcasting activities is an excellent \n\n\n\nmethod to promote community health education. KFPA had \n\n\n\nlong cooperated with national and local health authorities, \n\n\n\nthrough the monthly radio program \"Peace, Love and Care of \n\n\n\nMedicine\", it can increase the public's correct concept of drug \n\n\n\nuse, and also enhance the professional image of pharmacists \n\n\n\nregardless of the pandemic.  \n\n\n\n\n\n\n\nAbstract 067 \n\n\n\n\n\n\n\nEffectiveness of Individualized Health \n\n\n\nEducation Provided by Volunteer \n\n\n\nPharmacists on Tier C Local Stations \n\n\n\n\n\n\n\nYN Hsieh1, 2*, CM Hsiao1, CS Chen1, ML \n\n\n\nChen1, SL Lee1, CP Hsu1 \n\n\n\n \n1 Taichung City Pharmacists Association, Taichung, Taiwan, ROC  \n2 Department of Pharmacy, Hong En Hospital, Taichung, Taiwan, ROC \n\n\n\n* Corresponding author \n\n\n\nEmail: pu068704@hotmail.com  \n\n\n\n\n\n\n\nBackground and Objectives: In Taiwan, pharmacists have \n\n\n\nbecome increasingly involved in community practice and \n\n\n\nlong-term care institutions. This study combines \n\n\n\nthe Taichung City Office of Food and Drug Safety with the \n\n\n\npower of the community by instructing volunteer \n\n\n\npharmacists from the Taichung City Pharmacists \n\n\n\nAssociation to provide a wide range of pharmaceutical care \n\n\n\nservices and improve medication use among the community \n\n\n\npopulation with support from the health resources of tier C \n\n\n\nlocal service stations. Methods: Participants aged 45 years \n\n\n\nor older were recruited in this cross-sectional study from tier \n\n\n\nC local service stations in Taichung City, during September \n\n\n\n2019 to November 2019. A single group pretest and posttest \n\n\n\ntrial was conducted. Repeated attendees of activities \n\n\n\norganized by four tier C local service stations were eligible. \n\n\n\nThe short-term effectiveness of educational medication \n\n\n\nsafety lectures on health promotion in the tier C long-term \n\n\n\ncare stations was assessed. Results and Discussion: The \n\n\n\nvolunteer pharmacists conducted 12 medication safety and \n\n\n\nhealth promotion events at four tier C local service stations \n\n\n\nin Taichung City. A total of 190 questionnaires were \n\n\n\ndistributed to assess the efficacy of the program. All single \n\n\n\nitems exhibited significant improvements 3 months after the \n\n\n\neducational medication safety lectures. We also designed a \n\n\n\ngamified intervention, namely \u201cA Healthy Monopoly,\u201d that \n\n\n\naimed to motivate participants to increase their medication \n\n\n\nknowledge through the game. Conclusions: These results \n\n\n\ndemonstrated that volunteer pharmacists can play a valuable \n\n\n\nrole in community health care and that pharmaceutical care \n\n\n\ninterventions can improve the safety of the environment in \n\n\n\nTaiwan. \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:ed108228@edah.org.tw\n\n\nmailto:pu068704@hotmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n99 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 068 \n\n\n\n\n\n\n\nExploring the Role of Pharmacy as A \n\n\n\nCommunity Drug Addiction Counselling \n\n\n\nCentre \n\n\n\n\n\n\n\nJungkeun Lee*, Seungwan Moon, Jungwha \n\n\n\nYoon \n \nGyeonggi Branch, Korean Association Against Drug Abuse, Suwon, Korea \n\n\n\n* Corresponding author \n\n\n\nEmail: fourkidspapa@hotmail.com  \n\n\n\n\n\n\n\nBackground and Objectives: Pharmacy is a valuable local \n\n\n\nresource that provides not only medication counseling in the \n\n\n\nusual sense, but also counseling on narcotics and drug \n\n\n\naddiction. The present study was conducted to explore the \n\n\n\nrole of pharmacy as a community drug addiction counselling \n\n\n\ncentre. Methods: As a member of Gyeonggi Pharmaceutical \n\n\n\nAssociation, 46 \u2018Magmi Pharmacies\u2019 were selected to \n\n\n\nparticipate in the pilot project centering on pharmacies that \n\n\n\nshare the common awareness on safe and correct use of legal \n\n\n\nnarcotic drugs. The Project was carried out for two months \n\n\n\nfrom Oct .2021, and an 8-item questionnaire was used to \n\n\n\nsurvey the local residents who received the service.  Results \n\n\n\nand Discussion: We distributed promotional materials and \n\n\n\nbrochures on drug abuse and addiction to more than 10,000 \n\n\n\nlocal residents. We also performed detailed information \n\n\n\nprovision and counseling service on a total of 325 \n\n\n\nmedications. Psychotropic drugs accounted for most of the \n\n\n\ndrug counselling with 262 cases, as well as 2 narcotics and \n\n\n\n26 non-narcotic prescription drugs and 35 over-the-counter \n\n\n\ndrugs. When local residents were surveyed, the need for \n\n\n\nMagmi Pharmacy service and satisfaction with the \n\n\n\ncounseling service were high regardless of gender, age, and \n\n\n\noccupation. The overall service was satisfactory, such as the \n\n\n\nexpertise of the information obtained, and the reinforcement \n\n\n\nof the motivation to change through the service. Conclusion: \n\n\n\nIn order for pharmacies to function as community drug \n\n\n\ncounselling centres, pharmacists must not only remain as \n\n\n\nexperts in drugs, but also develop competence as \u2018counsellors\u2019 \n\n\n\nso that they can intervene in psychological and behavioral \n\n\n\ntherapy as well as drug counselling. The Magmi Pharmacy \n\n\n\nproject demonstrated that pharmacies have considerable \n\n\n\npotential and roles as local drug addiction counselling centres \n\n\n\nthat can reinforce the correct use of drugs and prevention of \n\n\n\ndrug misuse, ultimately contributing to public health \n\n\n\npromotion through an integrated drug counselling process. \n\n\n\n\n\n\n\nAbstract 069 \n\n\n\n\n\n\n\nEstablishment of the Betel Nut-free \n\n\n\nEnvironment by Community Pharmacists: \n\n\n\nA Pilot Study in Taiwan \n\n\n\n\n\n\n\nI-Hsuan Lee1,2*, Yu-Chieh Cheng2, Tzu-Chun \n\n\n\n(Frank) Chou2, Hung-Chang (Ivan) Chou1,2,3* \n\n\n\n\n\n\n\n1 Federation of Taiwan Pharmacists Associations, Taiwan \n2 Taiwan Young Pharmacist Group, Taiwan \n3 Department of Pharmacy and Master Program, Tajen University, Taiwan \n\n\n\n* Corresponding author \n\n\n\nEmail: heyman1799@gmail.com  \n\n\n\n\n\n\n\nBackground and Objectives: Regarding the hazards of \n\n\n\nbetel nut, the International Agency for Research on Cancer \n\n\n\nconcluded from various research outcomes that \"chewing \n\n\n\nbetel nut containing tobacco\" or \"simultaneous smoking and \n\n\n\nchewing betel nut\" are harmful to humans. From the latest \n\n\n\ncancer registration data and cause of death statistics, over \n\n\n\n8,000 new cases of oral cancer are diagnosed each year, and \n\n\n\n3,300 people passed away from oral cancer, one of the \n\n\n\nleading cancers in Taiwanese male. To reduce the prevalence \n\n\n\nrate of betel nut chewing, the establishment of a base to \n\n\n\ncontrol and eliminate betel nuts at community pharmacy is \n\n\n\nvital. Methods: This study was performed from September \n\n\n\n1st in 2021 to July 31st in 2022 in Taiwan. The lectures on \n\n\n\nbetel nuts and cancer prevention were held in Eastern Taiwan \n\n\n\nfor pharmacists to update their clinical regulation and \n\n\n\nknowledge. Surveys were conducted pre- and post-course. \n\n\n\nThe pharmacists provided consultation and education to \n\n\n\npotential patients and held numerous events on health \n\n\n\neducation in the community to improve the public health \n\n\n\nliteracy. Results and Discussion: The average accurate rate \n\n\n\nof examination for pharmacist professional education \n\n\n\nincreases from 83.3 \u00b1 20.6% to 90.5 \u00b1 14.9% (n = 83, p < \n\n\n\n0.01). After the courses, pharmacists in 15 community \n\n\n\npharmacies participated in the consultation and education to \n\n\n\nthe public. The consultations were raised by patients (n = 42, \n\n\n\n60.9%) or their families (n = 27, 39.1%). The majority of \n\n\n\npatients were elderly, male and blue-collar workers. The \n\n\n\nreduction in betel nuts chewing was observed, and the \n\n\n\npercentage of complete abstinence from betel nuts was 28.1% \n\n\n\n(n = 9). Conclusion: With this pilot study, the community \n\n\n\npharmacy as a base for the prevention and control of betel \n\n\n\nnuts was successfully established, and this project would be \n\n\n\nfurther extended in Taiwan. \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:fourkidspapa@hotmail.com\n\n\nmailto:heyman1799@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n100 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 070 \n\n\n\n\n\n\n\nDirect Selling of Nootropic Drugs in An E-\n\n\n\ncommerce Platform in the Philippines \n\n\n\n\n\n\n\nGwyne Kylie P. Gumapac1, Jonas L. \n\n\n\nMiranda1*, Beryll N. Nacar1, Sigfredo B. \n\n\n\nMata2* \n \n\n\n\nDr. Mariano Que College of Pharmacy, De La Salle Medical and Health \n\n\n\nSciences Institute, Cavite, Philippines \n\n\n\n* Corresponding author \n\n\n\nEmail: miranda.jonaslegaspi@gmail.com  \n \n\n\n\nBackground and Objectives: Availability of prescription \n\n\n\nand controlled substances, including nootropics, in e-\n\n\n\ncommerce platforms has become a growing concern with an \n\n\n\nincrease of Internet and social media users. Despite FDA \n\n\n\nrestrictions, there is evidence of poor digital surveillance of \n\n\n\nregulated drugs. The objective of this study was to evaluate \n\n\n\nthe regulatory issues on direct selling of nootropic (\u201cbrain \n\n\n\nboosting\u201d) drugs on an e-commerce platform in the \n\n\n\nPhilippines. Methods: Search terms and other terms \n\n\n\nassociated with nootropics were collected from an e-\n\n\n\ncommerce website and Google. The nootropics found were \n\n\n\ninitially filtered using the inclusion and exclusion criteria, \n\n\n\nand classified according to seller\u2019s name and pertinent \n\n\n\nproduct information. Subsequently, duplicated items (same \n\n\n\nproduct and seller) were eliminated. Data validation was \n\n\n\ndone while excluding ineligible data. Data were reviewed \n\n\n\nindependently before characterization based on product \n\n\n\ncategory [over-the-counter (OTC) drug, prescription drug or \n\n\n\nfood supplement], country/region of origin, popularity \n\n\n\n(number sold, ratings, reviews, and products sold), and FDA \n\n\n\nregistration based on Philippines FDA Verification Portal \n\n\n\nand Indonesian BADAN-POM database. Final data were \n\n\n\nfiltered using the eligibility criteria. Then, these were sorted \n\n\n\nand analysed. Results and Discussion: A total of 96 unique \n\n\n\nnootropics products, of which 33 contained prescription and \n\n\n\ncontrolled drugs, were found in the e-commerce website. An \n\n\n\nexamination of their registration status in their countries of \n\n\n\norigin confirmed that only products containing citicoline \n\n\n\n(24.2%) were registered; the rest were unregistered (75.8%). \n\n\n\nEven though citicoline products are registered, they require a \n\n\n\nprescription and these should not be sold direct-to-consumer. \n\n\n\nOf the unregistered nootropic drugs, two are categorized as \n\n\n\ncontrolled substances: namely, modafinil (27.3%)  and \n\n\n\narmodafinil (15.2%). Both are popular in terms of the number \n\n\n\nsold, ratings, and reviews. Conclusion: Unregistered drugs \n\n\n\ncontaining controlled substances were available and highly \n\n\n\naccessible direct-to-consumer showing lack of regulatory \n\n\n\ncompliance among online sellers and the e-commerce \n\n\n\nplatform. Direct-to-consumer regulatory policies need to be \n\n\n\nreviewed to strengthen digital surveillance of the online \n\n\n\npharmaceutical marketplace. \n\n\n\n\n\n\n\nAbstract 071 \n \n\n\n\nPharmacists Approach to Specialty Care \n\n\n\nFacilities for People who have Parkinson\u2019s \n\n\n\nDisease \n\n\n\n\n\n\n\nHashimoto M1*, Shogen T.2, Sugita N.3 \n\n\n\n \n1 Spatel, Kanazawa, 2Temarikobu Pharmacy, 3Drug Information Office, \n\n\n\nSpatel, Kanazawa, Japan \n\n\n\n* Corresponding author \n\n\n\nEmail: hashimoto@temariyakkyoku.com  \n \n\n\n\nBackground and Objectives: The treatment of people who \n\n\n\nhave Parkinson\u2019s disease should be customized for each \n\n\n\nindividual. The Temari Group attempted to provide optimal \n\n\n\ncare by assembling a team of healthcare professionals \n\n\n\nincluding physical therapists, nurses, care workers, \n\n\n\noccupational therapists, and speech therapists. Methods: The \n\n\n\nway the Temari Group approached this was to first gather \n\n\n\ninformation about the people who have Parkinson\u2019s disease \n\n\n\nand survey them to know what medications each individual \n\n\n\nhad been taking. Further research was done to know the \n\n\n\nadherence to their daily medicine schedule, the effectiveness \n\n\n\nof the medicine, and to what extent people suffered from side \n\n\n\neffects. At the specialty care facility, we led a meeting about \n\n\n\npharmaceutical care for patients with Parkinson\u2019s disease. \n\n\n\nWe held monthly meetings with all healthcare professionals \n\n\n\nto discuss the care of people with Parkinson\u2019s disease, the \n\n\n\neffectiveness of their medicine, side effects, and so on. After \n\n\n\none year, we met again to identify any issues we had and how \n\n\n\nthey could be improved. Results and Discussion: We were \n\n\n\nable to know about the patients who suffer from Parkinson\u2019s \n\n\n\nmedicine intake, schedule, effectiveness of the medicine, and \n\n\n\nfinally, the side effects. Furthermore, all healthcare \n\n\n\nprofessionals got together to share their thoughts, opinions, \n\n\n\nand information, so as to improve patient care in \n\n\n\nfuture.Conclusion: We can see that the collaboration of \n\n\n\nhealthcare professionals has contributed to and improved the \n\n\n\nactivities of daily life and quality of life of those with \n\n\n\nParkinson\u2019s disease. We continue to see pharmacists play an \n\n\n\nimportant role in the collaborative treatment of patients with \n\n\n\nParkinson\u2019s disease, now and in future.  \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:miranda.jonaslegaspi@gmail.com\n\n\nmailto:hashimoto@temariyakkyoku.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n101 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 072 \n\n\n\n\n\n\n\nExploring the Lived Experiences of \n\n\n\nCommunity Pharmacists\u2019 on Pharmacy-\n\n\n\nBased Immunization: A Phenomenological \n\n\n\nStudy \n\n\n\n\n\n\n\nKarl Kirby Z. Costales, Maureen Canda-\n\n\n\nBorcelas*, Hazel Joy B. Da-anton, Raye Marie \n\n\n\nP. Damole, Ruby Felina D. Mahinay \n \n\n\n\nUniversity of the Immaculate Conception, College of Pharmacy and \n\n\n\nChemistry, Davao City, Philippines \n\n\n\n* Corresponding author \n\n\n\nEmail: mcanda@uic.edu.ph  \n \n\n\n\nBackground and Objectives: Increasing levels of vaccine \n\n\n\nhesitancy and the recent COVID-19 pandemic have \n\n\n\nnecessitated the implementation of pharmacy-based \n\n\n\nimmunization in the Philippines. Previous researches has \n\n\n\nprimarily employed quantitative methods. This \n\n\n\nphenomenological study aimed to explore the lived \n\n\n\nexperiences of community pharmacists on pharmacy-based \n\n\n\nimmunization among the three districts of Davao City. \n\n\n\nMethods: This study employed a phenomenological \n\n\n\nqualitative research design using purposive sampling. Data \n\n\n\nwas gathered through in-depth interviews with validated \n\n\n\nsemi-structured questionnaires, with four participants per \n\n\n\ndistrict. Consent was sent through their emails and Google \n\n\n\nMeet platform was utilized. Data was duly analysed through \n\n\n\nthematic analysis to identify recurring concepts and, \n\n\n\neventually, themes. Results and Discussion: Nine themes \n\n\n\nwere generated: Positive experience, accessibility and \n\n\n\nconvenience, enhanced trust and therapeutic relationship, \n\n\n\nadvancing public health, insufficient manpower and more \n\n\n\nworkload, unsuitable setting and inadequate training for \n\n\n\nvaccination and emergencies, lack of motivation and \n\n\n\nexperience, top-down support for effective pharmacy-based \n\n\n\nimmunization, and increased sales and improved brand \n\n\n\nreputation. Younger participants were more open to the \n\n\n\nconcept of administering vaccines in their pharmacies. \n\n\n\nPharmacy-based immunization is beneficial because it \n\n\n\ncapitalizes on the patients\u2019 preference for pharmacies over \n\n\n\nhospitals and other vaccination sites. The major downside is \n\n\n\nthe lack of manpower, resulting in negative impacts on the \n\n\n\nquality of work. Conclusion: Based on the results, effective \n\n\n\nimplementation of pharmacy-based immunization required \n\n\n\nthat the challenges are resolved and issues mitigated. \n\n\n\nCommunity pharmacists support pharmacy-based \n\n\n\nimmunization. Relevant stakeholders (pharmacy \n\n\n\norganizations and drug store owners) could utilize this study \n\n\n\nto address concerns of community pharmacists, resulting in \n\n\n\nimproved immunization services. Through the use of online \n\n\n\nplatforms and heads of pharmacy organizations, this could \n\n\n\nhelp improve awareness of the program, educate the \n\n\n\nstakeholders, and create better guidelines. \n\n\n\n\n\n\n\nAbstract 073 \n \n\n\n\nCurrent Contributions and Future \n\n\n\nOpportunities for Community Pharmacists \n\n\n\nduring the COVID-19 pandemic in Taiwan \n\n\n\n\n\n\n\nNai-Hwa Mei1,2* \n\n\n\n \n1 International Health Program, Institute of Public Health, National Yang \n\n\n\nMing Chiao Tung University, Taipei, Taiwan \n2 Guandu Song Community Pharmacy, Taipei, Taiwan \n\n\n\n* Corresponding author \n\n\n\nEmail: meit014828@gmail.com  \n\n\n\n\n\n\n\nBackground and Objectives: The global spread of COVID-\n\n\n\n19 continues to place unprecedented demands on healthcare \n\n\n\nservices. In this time of crisis, innovative and adaptive \n\n\n\nmethods of practicing will be required across all health \n\n\n\nprofessions. Community pharmacists in Taiwan have since \n\n\n\nplayed a vital role in response to the current pandemic. As \n\n\n\ntheir scope of practice extends to the optimization of chronic \n\n\n\nmedication use, evidence-based health advice, rationing of \n\n\n\npersonal protective equipment, and medication home \n\n\n\ndeliveries, their expertise is undoubtedly still underutilized. \n\n\n\nTherefore, this study was to highlight the roles and activities \n\n\n\nthat community pharmacists have taken to aid in relieving \n\n\n\npressure on other healthcare services and government \n\n\n\nofficials. The results of this study will act as a roadmap for \n\n\n\npolicymakers when restructuring existing and expanding \n\n\n\nfuture health services provided by pharmacists in response to \n\n\n\npublic health crises such as COVID-19. Methods: Data from \n\n\n\nMarch 2020 to June 2022 was collected from Guandu Song \n\n\n\nCommunity Pharmacy\u2019s electronic database and further \n\n\n\nanalysed through software data, Microsoft Excel and STATA. \n\n\n\nResults and Discussion: Pharmacists performed an average \n\n\n\nof 50 daily medication reviews among the 10 participating \n\n\n\nlong-term care (LTC) facilities. Overall, 99 drug-related \n\n\n\nproblems (DRPs) and potentially inappropriate medication \n\n\n\n(PIM) were documented. This included suggestions to \n\n\n\nchange an \u201cinappropriate drug of choice\u201d, \u201cno indication of \n\n\n\ndrug use\u201d, and \u201cduplicate medication\u201d. The acceptance rate \n\n\n\nfrom physicians was 91%. Whereas, the daily average of \n\n\n\nindividual COVID-19 rapid test kits distributed was 410. In \n\n\n\naddition, pharmacists handed out more than 200 surgical \n\n\n\nmasks per day in accordance with the government\u2019s rationing \n\n\n\nscheme. Conclusion: This study suggests that community \n\n\n\npharmacists have significantly contributed during a public \n\n\n\nhealth crisis by ensuring continuity of pharmaceutical \n\n\n\nservices and providing novel services. Their vital role within \n\n\n\na community during the COVID-19 health crisis further \n\n\n\nillustrates that they are an essential team player in the \n\n\n\nmanagement of emerging infectious diseases. \n\n\n\n\nmailto:mcanda@uic.edu.ph\n\n\nmailto:meit014828@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n102 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 074 \n \n\n\n\nKnowledge, Attitude and Barriers to \n\n\n\nCompliance for the Pharmacy Support \n\n\n\nWorkforce Requirements and \n\n\n\nResponsibilities on the Philippine \n\n\n\nPharmacy Act  \n\n\n\n\n\n\n\nNoelle Marie H. Fontanilla1*, Nimfa B. \n\n\n\nGambalan2, Vieno Gino Cruz1, Mark Harvey \n\n\n\nB. Adamson1 \n\n\n\n \n1 School of Pharmacy, Graduate studies, Philippine Women\u2019s University, \n\n\n\nManila, Philippines \n2 Department of Pharmacy, College of Allied Health, National University, \n\n\n\nManila, Philippines \n\n\n\n* Corresponding author \n\n\n\nEmail: vcruz@pwu.edu.ph, nbgambalan@national-u.edu.ph, \n\n\n\nnoellemariefontanilla@gmail.com  \n\n\n\n\n\n\n\nBackground and Objectives: The New Philippine \n\n\n\nPharmacy Act revolutionize Community Pharmacy practice \n\n\n\nwhich requires training and define specific roles for \n\n\n\nPharmacy Support Workforce (PSW). The study assessed the \n\n\n\nknowledge, attitude, and barriers (KAB) in compliance to \n\n\n\nresponsibilities and requirements on PSW among \n\n\n\nindependent drug stores in Rodriguez, Rizal, Philippines \n\n\n\nMethods:  This quantitative, cross-sectional study used a \n\n\n\ndescriptive research design that utilized a validated and \n\n\n\npretested structured questionnaire administered face-to-face \n\n\n\namong all consented independent drug store where \n\n\n\nrespondents include pharmacy owners and PSW such as \n\n\n\npharmacy technicians, pharmacy assistants, and pharmacy \n\n\n\naides. Statistical Package for Social Sciences (SPSS) was \n\n\n\nused to perform all descriptive statistics for summarizing \n\n\n\nKAB scores and non-parametric inferential statistics such as \n\n\n\nMann-Whitney, Kruskal-Wallis, and Spearman\u2019s Correlation. \n\n\n\nResults and Discussion: Owners (88.1%) and PSW (77.4%) \n\n\n\nhad \u2018poor knowledge\u2019 but with \u2018positive attitude\u2019 towards \n\n\n\ncompliance. Most are hesitant to finance their training. \n\n\n\nInaccessibility of training site is a moderate barrier to \n\n\n\ncompliance. KAB between owners and PSW did not \n\n\n\nsignificantly differ.  Level of knowledge (LOK) significantly \n\n\n\ndiffered with training attendance (\ud835\udc5d < 0.001) for owners and \n\n\n\nPSW and with the highest educational attainment (\ud835\udc5d = 0.018) \n\n\n\nand length of employment (LOE) (\ud835\udc5d = 0.0403) for PSW.  \n\n\n\nPSW\u2019s attitude differed with LOE (\ud835\udc5d = 0.049). Owner\u2019s LOK \n\n\n\nis positively associated with administrative barriers (\ud835\udc5f = 0.32) \n\n\n\nand owner\u2019s and PSW\u2019s attitude is negatively associated with \n\n\n\npersonal barriers (\ud835\udc5f\ud835\udc60 = \u22120.39 and \ud835\udc5f\ud835\udc60 = \u22120.53, \ud835\udc5d < 0.01). \n\n\n\nFurther PSW\u2019s attitude is negatively associated with \n\n\n\nadministrative barriers (\ud835\udc5f\ud835\udc60 = \u22120.45, \ud835\udc5d = 0.001). Conclusion:  \n\n\n\nBased on the results obtained, accessible and affordable \n\n\n\ntraining should be provided to owners and PSW to enhance \n\n\n\ntheir competencies and comply with requirements. \n\n\n\nAbstract 075 \n \n\n\n\nKnowledge, Attitude and Perception of \n\n\n\nCommunity Pharmacists on \n\n\n\nTeleconsultation \n\n\n\n\n\n\n\nNoor Batrisyia Auni Zaidisam1,2*, \n\n\n\nMathumalar Loganathan1, Munaver Ahmad \n\n\n\nNazir Ahmad1, Ezlina Usir1, Adelin Suraya \n\n\n\nMokhtar1 \n \n1 Faculty of Pharmacy, Universiti Teknologi MARA (UiTM), Selangor, \n\n\n\nMalaysia \n2 Rhazes Consultancy Services Sdn Bhd, Selangor, Malaysia \n\n\n\n* Corresponding author \n\n\n\nbatrisyiaauni@gmail.com  \n\n\n\n\n\n\n\nBackground and Objectives: Teleconsultation was \n\n\n\nincreasingly used to communicate with patients, particularly \n\n\n\nduring the COVID-19 outbreak. Most of the healthcare \n\n\n\nproviders showed a positive attitude and perception of \n\n\n\nteleconsultation however, community pharmacists receive \n\n\n\nscant attention in the literature. This study was conducted to \n\n\n\nassess community pharmacists' knowledge, attitude and \n\n\n\nperception of teleconsultation. Methods: A semi-structured \n\n\n\ninterview was done with community pharmacists servicing in \n\n\n\nthe Klang Valley, Malaysia. A selected number of \n\n\n\ncommunity pharmacists were introduced to a video on \n\n\n\nconsultation services provided by a telehealth provider and \n\n\n\nanswered a set of questionnaires. Results and Discussion: A \n\n\n\ntotal of 27 community pharmacists participated in the semi-\n\n\n\nstructured interview and 13 community pharmacists were \n\n\n\nselected for the video demonstration and were asked to \n\n\n\nanswer a set of questionnaires. The themes which emerged \n\n\n\nfrom the interview were knowledge of teleconsultation, \n\n\n\nattitude and perceptions of teleconsultation application and \n\n\n\nbarriers to teleconsultation. As for the demonstration, 69.2% \n\n\n\nshowed good knowledge scores while 53.8% showed \n\n\n\nmoderate scores in their attitude and 53.8% and 61.5% \n\n\n\nshowed poor perception scores on usefulness and practicality, \n\n\n\nrespectively. There are no statistically significant differences \n\n\n\nbetween the attitude scores of the participants with \u201cgood \n\n\n\nknowledge\u201d and \u201cmoderate knowledge\u201d (Kruskal-Wallis, H \n\n\n\n= 0.032, p = 0.859). There is a weak and positive correlation \n\n\n\nbetween overall knowledge scores and perception. At the \n\n\n\nsame time, there is a strong and positive correlation between \n\n\n\noverall attitude scores and perception. Conclusion: \n\n\n\nCommunity pharmacists were aware and knowledgeable \n\n\n\nabout teleconsultation but their attitude and perception can be \n\n\n\nimproved. As community pharmacists will be the ones to \n\n\n\nprovide such services, efforts must be taken to improve their \n\n\n\nattitude and perception so they can provide good quality \n\n\n\nservices in the near future. \n\n\n\n\nmailto:vcruz@pwu.edu.ph\n\n\nmailto:nbgambalan@national-u.edu.ph\n\n\nmailto:noellemariefontanilla@gmail.com\n\n\nmailto:batrisyiaauni@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n103 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 076 \n\n\n\n\n\n\n\nAnalysis on the Effectiveness of Education \n\n\n\nProgram for Improving Accessibility of \n\n\n\nPharmacy Involvement in HIV Care \n\n\n\n\n\n\n\nShao Ti Hsu1*, Ling Chun Liao1,2, Yu Chen \n\n\n\nWang1, I-Hsuan Lee1, Tzu-Chun Chou1 \n\n\n\n \n1 Taiwan Young Pharmacists' Group, Taiwan \n2 Department of Pharmacy, National Taiwan University Hsin-Chu Hospital \n\n\n\n* Corresponding author \n\n\n\nEmail: a0989909181@gmail.com  \n\n\n\n\n\n\n\nBackground and Objectives: The number of community \n\n\n\npharmacies in Taiwan joining the professional system of \n\n\n\nAIDS care continues to increase, from 17 to 56 between the \n\n\n\nyears 2017 and 2021. Advanced knowledge of pharmacists \n\n\n\nto care for HIV- infected patients and their intention to \n\n\n\nprovide public health services for prevention and treatment \n\n\n\nhave to be evaluated, promoted and strengthened. In 2021, \n\n\n\nTaiwan Young Pharmacists Group hosted two educational \n\n\n\ntraining courses for pharmacists, supported by Taiwan CDC. \n\n\n\nTwo courses were held in eastern and northern Taiwan, \n\n\n\nincluding online and on-site courses. This study was \n\n\n\nconducted to evaluate the effectiveness of the education and \n\n\n\ntraining courses. Methods: Pre-test and post-test \n\n\n\nquestionnaire data of trainees were collected and analysed for \n\n\n\nany differences in the training pharmacists\u2019 HIV prevention \n\n\n\nknowledge, attitude and behavior intention in the HIV \n\n\n\neducation program. The questionnaire consists of five true or \n\n\n\nfalse questions and five multiple-choice questions, each with \n\n\n\nfour options. The proportion of responses before and after the \n\n\n\ncourse were analysed using McNemar's test. The attitude and \n\n\n\nbehavioral intention questions are based on a 5-point Likert \n\n\n\nscale and were analysed using paired sample t-test. Results \n\n\n\nand Discussion: A total of 102 valid questionnaires were \n\n\n\ncollected (102/114,89%). The average attitude score of \n\n\n\npharmacists increased from 3.94 to 4.24, an increase of 0.3, \n\n\n\nreaching a statistically significant difference (P<0.001). The \n\n\n\nattitude and behavioral intention score increased from 4.01 to \n\n\n\n4.24, an increase of 0.23, with P value<0.001. We also found \n\n\n\nthat pharmacists were still relatively unfamiliar with \"pre-\n\n\n\nexposure and post-exposure prophylactic administration\" and \n\n\n\nespecially with \"screening principles and related \n\n\n\nservices\".Conclusion: Overall, the education program \n\n\n\nsignificantly improved and supported  pharmacists in \n\n\n\nproviding professional knowledge, better attitude and \n\n\n\nbehavioral intentions towards HIV prevention. \"Screening \n\n\n\nPrinciples and Related Services\" related subjects and \n\n\n\nlearning motivation should be continuously strengthened in \n\n\n\nthe future. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 077 \n\n\n\n\n\n\n\nUnderstanding the Influencing Factors of \n\n\n\nTelepharmacy Implementation in Taiwan: \n\n\n\nA Qualitative Study \n\n\n\n\n\n\n\nWen Hsiu Lin1,2*, I-Hsuan Lee1,2 \n\n\n\n\n\n\n\n1 Taiwan Young Pharmacist Group, Taiwan \n2 Izumo pharmacy, New Taipei City, Taiwan \n\n\n\n* Corresponding author \n\n\n\nEmail: aglwsl3000@gmail.com  \n\n\n\n\n\n\n\nBackground and Objectives: Through the literature review \n\n\n\nfrom Japan, Canada, and Europe, we can learn that \n\n\n\ntelepharmacy is beneficial for the provision of drug \n\n\n\ninformation and to improve the safety of medication for \n\n\n\npeople in remote areas. However, due to the current \n\n\n\nregulations in Taiwan, only pharmacists are allowed to \n\n\n\ndeliver medicines. Therefore, at this stage, Taiwan's \n\n\n\ntelepharmacy care services are only aimed at remote \n\n\n\nprescription review, teleconsultation, telepharmacy effects \n\n\n\nand monitoring. The aim of this study was to understand the \n\n\n\nfactors for promoting telepharmacy, and the opinion of \n\n\n\ncommunity pharmacists. Methods: This study was \n\n\n\nperformed from April 1st, 2022 to July 31st 2022 in Taiwan. \n\n\n\nThe opinion of community pharmacists about telepharmacy \n\n\n\nwas collected through semi-structured interviews. Seven \n\n\n\npharmacists participated in this study, all of them have over \n\n\n\n10 years of practice experience and are active in community \n\n\n\npharmaceutical care. Results and Discussion: Following the \n\n\n\nprocedure of pharmaceutical care in community pharmacy, \n\n\n\nseveral pain points of practicing telepharmacy were found in \n\n\n\nthis study. These included identifying the patient, ensuring \n\n\n\ninformation security, and collecting medical information \n\n\n\nfrom NHI. Several benefits were also foreseeable such as \n\n\n\nassisting medical intervention in remote or medically \n\n\n\nunderserved areas, providing consultation immediately, and \n\n\n\nconquering the barriers of distance. All participants agreed \n\n\n\nthat the impact on pharmacist practice could be divided into \n\n\n\nthree levels: cost of training, regulations, and pharmacist \n\n\n\ncompetence. Conclusion: With this qualitative study, we can \n\n\n\nidentify the help and resistance to promoting telepharmacy \n\n\n\nfor pharmaceutical care in Taiwan. To set up the \n\n\n\ntelepharmacy system in Taiwan, more research and \n\n\n\ninvestigation are needed, and a pilot run is needed to \n\n\n\nunderstand how the entire model works. \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:a0989909181@gmail.com\n\n\nmailto:aglwsl3000@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n104 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 078 \n\n\n\n\n\n\n\nAnalysis of the Effectiveness of OSCE \n\n\n\nApplied to Hospital Pharmacy Training \n\n\n\n\n\n\n\nWJ Chen1*, CK Huang1, SF Huang2   \n\n\n\n \n1 Department of Pharmacy, Tainan Municipal Hospital (Managed by Show \n\n\n\nChwan Medical Care Corporation), Tainan, Taiwan \n2 Department of Pharmacy, Chi Mei Medical Center, Tainan, Taiwan \n\n\n\n* Corresponding author \n\n\n\nEmail: 2f0147@tmh.org.tw  \n\n\n\n\n\n\n\nBackground and Objectives: Interpersonal communication \n\n\n\nskills and the application of evidence-based medicine in \n\n\n\nclinical work are two of the core competencies of pharmacists. \n\n\n\nThe Objective structured clinical examination (OSCE) is a \n\n\n\nmore suitable assessment for these core competencies than \n\n\n\nthe written and oral exams. The purpose of the study was to \n\n\n\ninvestigate the effectiveness of OSCE in assessing the \n\n\n\nclinical competence of PGY pharmacists and pharmacy \n\n\n\ninterns. Methods: Since 2018, we had arranged for PGY \n\n\n\npharmacists and interns to attend joint OSCE training at a \n\n\n\nmedical center. There were 6 themes in the OSCE, the topic \n\n\n\nof the intern's themes was all drug counseling, the themes of \n\n\n\nPGY pharmacists focus on the identification prescription \n\n\n\nerrors and communication with the doctor. In addition to the \n\n\n\ntrainee pass rate, the standard patient perceptions of trainee \n\n\n\nperformance and trainee satisfaction scores on a five-point \n\n\n\nLikert scale were collected as a reference for subsequent \n\n\n\nimprovement. Results and Discussion: From 2018 to 2021, \n\n\n\na total of eight PGY pharmacists and eight interns had \n\n\n\nparticipated in the joint OSCE training, six PGYs and seven \n\n\n\ninterns passed the test. Standard patient assessments of PGY \n\n\n\nand intern\u2019s performance (e.g., professional attitude, \n\n\n\nappropriate response, empathy, overall performance, etc.) \n\n\n\nwere 3.6 \u00b1 0.5 each. The overall satisfaction level of the \n\n\n\ntrainees included clear examination guidelines, standard \n\n\n\npatient performance seems real, appropriate feedback from \n\n\n\nthe examiners, appropriate timing of the test, and appropriate \n\n\n\ndifficulty of the test: 4.3\u00b10.6 for PGY pharmacists and \n\n\n\n4.6\u00b10.4 for interns. All participants agreed that the OSCE \n\n\n\narrangement was necessary and helpful.Conclusion: The \n\n\n\npurpose of formative OSCE is for teaching. Participants \n\n\n\ncould reflect on their performance and set future learning \n\n\n\ngoals after the examiners, so we will continue to arrange for \n\n\n\nPGY pharmacists and pharmacy interns to participate in joint \n\n\n\ntraining OSCE. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 079 \n\n\n\n\n\n\n\nUsing Beers Criteria for Older Inpatients to \n\n\n\nAssess Rational Drug Use at A Public \n\n\n\nHospital in Taiwan \n\n\n\n\n\n\n\nCT Chen*, MS Li  \n \n\n\n\nDepartment of Pharmacy, Heping-Fuyou Branch, Taipei City Hospital, \n\n\n\nTaipei, Taiwan. \n\n\n\n* Corresponding author \n\n\n\nEmail: adamazing000@gmail.com  \n\n\n\n\n\n\n\nBackground and Objectives: Patients over the age of 65 are \n\n\n\na vulnerable population. Potentially inappropriate \n\n\n\nmedications (PIMs) can be defined as medications for which \n\n\n\nuse among older adults should be avoided due to an \n\n\n\nunfavourable balance of benefits and harms when safer and \n\n\n\nequally or more effective therapeutic alternatives are \n\n\n\navailable. We aim to recognize the prevalence and the \n\n\n\ncategories of PIMs and we monitor if there are any adverse \n\n\n\nreactions and give advices to physicians when necessary. \n\n\n\nMethods: A retrospective analysis of prescriptions from \n\n\n\nmedical records of patients over the age of 65 hospitalized in \n\n\n\nTaipei City Hospital Heping-Fuyou Branch ward using the \n\n\n\nAGS 2019 Beers criteria was performed. Data was collected \n\n\n\nfor gender, mean age, medication prescribed, physicians\u2019 \n\n\n\nacceptance rate of pharmacists\u2019 interventions and \n\n\n\npolypharmacy (\u22655 drugs/day). Descriptive statistics were \n\n\n\nused. Results and Discussion: A total of 482 elderly patients \n\n\n\nwere identified and evaluated. The mean age was 77.3 (SD \n\n\n\n8.4) and 54.6% were male. The mean number of drugs used \n\n\n\nwas 6.3 (SD 3.9) and the mean number of PIM was 0.8 (SD \n\n\n\n0.9). Polypharmacy (\u22675 drugs/day) was prevalent in 62.2% \n\n\n\nof patients. The prevalence of PIM was high, at 51.7%. \n\n\n\nAmong them, the most commonly prescribed PIMs were \n\n\n\nomeprazole (10.9%), metoclopramide (9.2%), tramadol \n\n\n\n(8.1%). This indicated the awareness of potential adverse \n\n\n\nevents of prolonged PPIs use (i.e. risk of C. difficile infection \n\n\n\nand fracture) was low. Physicians' acceptance rate of \n\n\n\npharmacists' interventions was 75%.  Conclusion: PIM \n\n\n\nprescription and polypharmacy were found to be common in \n\n\n\nTaipei City Hospital Heping-Fuyou Branch. We should make \n\n\n\nefforts to enhance both the medication safety and physicians\u2019 \n\n\n\nacceptance rate and if the use of PIMs is necessary, it is \n\n\n\nimportant to monitor patients\u2019 responses to the drugs. \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:2f0147@tmh.org.tw\n\n\nmailto:adamazing000@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n105 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 080 \n\n\n\n\n\n\n\nOptimising the Evaluation Efficiency of \n\n\n\nIntegrated Outpatient Clinic Prescriptions \n\n\n\n\n\n\n\nCW Chang*, JF Chen  \n \nDepartment of Pharmacy, Tainan Municipal Hospital (Managed by Show \n\n\n\nChwan Medical Care Corporation), Taiwan \n\n\n\n* Corresponding author \n\n\n\nEmail: ddm33669@gmail.com  \n\n\n\n\n\n\n\nBackground and Objectives: There is integrated outpatient \n\n\n\nclinic service for elder people in our hospital. After \n\n\n\nevaluating patients\u2019 whole condition and medicines, the \n\n\n\nprofessional medical team, including doctors, pharmacists \n\n\n\nand medical case manager, offers new medical suggestions. \n\n\n\nHowever, the procedure of evaluating integrated outpatient \n\n\n\nclinic prescriptions took too much time. The aim of this \n\n\n\nretrospective study was to optimise the evaluation efficiency \n\n\n\nof integrated outpatient clinic prescriptions through lean \n\n\n\nthinking. Methods: This is a retrospective study which \n\n\n\npursue improvement by lean thinking. The procedure of \n\n\n\nevaluating prescriptions caused a lot of waste. First, the \n\n\n\npharmacists needed to wait the referral mails from medical \n\n\n\ncare manager to start evaluating prescriptions. Second, the \n\n\n\npharmacists could not check mails immediately. Last, the \n\n\n\npharmacists needed to open a lot of software for evaluating \n\n\n\nprescriptions. We wanted to diminish or eliminate the whole \n\n\n\nwasted time and set 15 minutes as goal. To evaluate whether \n\n\n\nthe evaluation efficiency of integrated outpatient clinic \n\n\n\nprescriptions had improved, we compared the time of \n\n\n\nevaluating integrated outpatient clinic prescriptions before \n\n\n\n(Sep. 2020 to Feb. 2021), during (Jul. to Aug. 2021), and after \n\n\n\n(Sep. to Oct. 2021) the study. Results and Discussion: After \n\n\n\nthis improvement, we set up the new system and the phone \n\n\n\nmessage informing procedure for evaluating prescriptions. \n\n\n\nThe time of evaluating integrated outpatient clinic \n\n\n\nprescriptions decreased from 40 minutes to 12 minutes, with \n\n\n\na progress rate of 70.0%, and an achievement rate of 112.0%. \n\n\n\nConclusion: Through improving the process, we reduce a lot \n\n\n\nof time of evaluating prescriptions for integrated outpatient \n\n\n\nclinic in our hospital. We do optimise the evaluation \n\n\n\nefficiency of integrated outpatient clinic prescriptions. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 081 \n\n\n\n\n\n\n\nAnti-COVID-19 Drugs Induced Elevated \n\n\n\nLiver Enzymes: A Case Series \n\n\n\n\n\n\n\nKuang-Yu Chou*, Yi-Ping Hsiang \n \n\n\n\nDepartment of Pharmacy, E-Da hospital, Kaohsiung, Taiwan \n\n\n\n* Corresponding author \n\n\n\nEmail: ed110621@edah.org.tw  \n\n\n\n\n\n\n\nBackground and Objectives: COVID-19 had ravaged the \n\n\n\nworld. Despite there are several antiviral therapies, numerous \n\n\n\nof them have adverse effects associated to liver in clinical \n\n\n\ntrials. This study wanted to survey the events of anti-COVID-\n\n\n\n19 drugs induced elevated liver enzymes in real world. \n\n\n\nMethods: It was a case series of patients who had elevated \n\n\n\nliver enzymes due to taking anti-COVID-19 drugs. We \n\n\n\nsurveyed these cases according to the medical record in a \n\n\n\nquasi-medical center in Taiwan. Results and Discussion: \n\n\n\nThere were total three cases from January 1st to July 31st, \n\n\n\n2022. The first case was a 61-year-old man who received \n\n\n\nremdesivir since May 24th. His AST/ALT were within \n\n\n\nnormal range on 23rd. On 27th, his ALT elevated to 621 U/L, \n\n\n\nover 10 fold of upper limited normal. Doctor decided to \n\n\n\ndiscontinue his remdesivir treatment and prescribe silymarin \n\n\n\nto regulate liver function. His ALT got back to normal range \n\n\n\non June 10th. The second case was a 5-year-old boy who \n\n\n\nreceived tocilizumab once and remdesivir since June 18th. \n\n\n\nHis AST/ALT were 35/18 U/L on 18th and 898/897 U/L on \n\n\n\n20th, which elevated from normal range to over 10 fold of \n\n\n\nupper limited normal. His remdesivir treatment was \n\n\n\ndiscontinued on 20th, and his AST/ALT slowly decreased \n\n\n\nsince then. However, his ALT was still over upper limited \n\n\n\nnormal on 27th. The third case was a 36-year-old man who \n\n\n\nreceived molnupiravir since June 27th to 31st. His AST/ALT \n\n\n\nwere 294/86 U/L on 28th, so doctor prescribed silymarin. His \n\n\n\nAST/ALT decreased to 35/73 U/L on July 6th. Conclusion: \n\n\n\nWe evaluated the fluctuation of liver enzymes induced by \n\n\n\nanti-COVID-19 drugs in real world. All three cases had \n\n\n\nelevated liver enzymes after anti-COVID-19 drugs use. One \n\n\n\ngot AST/ALT back to normal range and no irreversible liver \n\n\n\ninjury found, but two still had ALT around 2 fold of upper \n\n\n\nlimited normal at the end of follow-up. \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:ddm33669@gmail.com\n\n\nmailto:ed110621@edah.org.tw\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n106 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 082 \n\n\n\n\n\n\n\nDose-related Study of Opioid Use in \n\n\n\nCritically Ill Patients Receiving \n\n\n\nExtracorporeal Membrane Oxygenation \n\n\n\nMaintenance System \n\n\n\n\n\n\n\nChu-Chen Cheng1,2*, Wen-Hwang Chen1,2 \n\n\n\n\n\n\n\n1 Department of Pharmacy, Tungs' Taichung MetroHarbor \n\n\n\nHospital, Taiwan. \n2 Taichung City New Pharmacist Association \n* Corresponding author \nEmail: t2619@ms.sltung.com.tw  \n\n\n\n\n\n\n\nBackground and Objectives: Patients with extracorporeal \n\n\n\nmembrane oxygenation (ECMO) devices experience pain \n\n\n\nand may be agitated. The use of opioid analgesics can relieve \n\n\n\npain and comfort in patients. Due to ECMO, drug \n\n\n\nhemodynamics may change, side effects or poor pain control \n\n\n\nmay occur. This study evaluates the efficacy and dose-related \n\n\n\neffects of opioid analgesics in such patients. Methods: This \n\n\n\nstudy is a retrospective clinical case collection and analysis. \n\n\n\nDuring the data period from 2018.01.01 to 2020.07.30, a total \n\n\n\nof 20 opioid analgesics were used during the ECMO support \n\n\n\nperiod. The use of morphine, Fentanyl and pethidine drugs \n\n\n\nwas converted into morphine equivalents, and the correlation \n\n\n\nof dose, days and pain score, and benzodiazepine (BZD) dose \n\n\n\nwas evaluated. Results and Discussion: The condition \n\n\n\nimproved by 39.5%, against advice discharge under critical \n\n\n\ncondition by 10%, and death by 49.5%. The most frequent \n\n\n\nuse was morphine, followed by fentanyl and pethidine. \n\n\n\nDifference of pain index before and after analgesia (95% C.I. \n\n\n\n1.6~3.9, p<0.0001), correlation between analgesic dose and \n\n\n\npain index (r=-0.125, p=0.598), correlation between \n\n\n\nanalgesic and BZD dose (r=-0.1, p =0.65), the relationship \n\n\n\nbetween ECMO use days and analgesic dose (r=-0.02, \n\n\n\np=0.93), ECMO use days and opioid analgesic use days \n\n\n\n(r=+0.59, p=0.07). The use of opioids for pain relief during \n\n\n\nECMO can indeed reduce pain, and morphine is used with \n\n\n\ngood pain relief and no metabolite relatively low side effects. \n\n\n\nConclusion: The duration of ECMO use increased, and the \n\n\n\nperiod of pain relief also increased (positive correlation), but \n\n\n\nthe dose used was dependent on demand (not correlated), and \n\n\n\nthe pain relief dose increased with the increase in patient pain \n\n\n\nlevel and disease severity (positive correlation), and BZD can \n\n\n\nreduce it. Dosage of opioid analgesics (concomitant with \n\n\n\nBZD doses is inversely related), and appropriate doses are \n\n\n\ngiven according to pain severity and time. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 083 \n\n\n\n\n\n\n\nUtilisation of Cardiovascular Drugs among \n\n\n\nPulmonary Hypertension with Valvular \n\n\n\nHeart Disease Patients before Valve \n\n\n\nSurgery \n\n\n\n\n\n\n\nFarizan Abdul Ghaffar1,2*, Adyani Md \n\n\n\nRedzuan1, Mohd Makmor-Bakry1 \n \n\n\n\n1 Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, \n\n\n\nMalaysia. \n2 Department of Pharmacy, Hospital Serdang, Kajang, Malaysia \n\n\n\n* Corresponding author \n\n\n\nEmail: farizan.ag@gmail.com  \n\n\n\n\n\n\n\nBackground and Objectives: Valve surgery is the mainstay \n\n\n\nof treatment in pulmonary hypertension (PH) with valvular \n\n\n\nheart disease (VHD). However, a standard goal-directed \n\n\n\nmedical therapy is still required while waiting for surgery. \n\n\n\nThere were limited studies on the utilization of \n\n\n\ncardiovascular (CVS) drugs either before or after valve \n\n\n\nsurgery. The current study was undertaken at a tertiary \n\n\n\ncardiac centre to identify the specific types and patterns of \n\n\n\nCVS drugs utilization before valve surgery. Methods: A \n\n\n\nretrospective observational study (2014 to 2020) on adult \n\n\n\npatients WITH a confirmed diagnosis of PH WITH VHD, \n\n\n\nmean pulmonary artery pressure \u2265 25 mmHg, measured by \n\n\n\ninvasive or non-invasive methods, underwent valve surgery \n\n\n\nand initiated WITH at least one oral CVS medication. Before \n\n\n\nsurgery is defined starting from the pre-operative assessment \n\n\n\nvisit and the day of surgery. Cardiovascular medications are \n\n\n\ndefined as any agent that affects the function of the heart and \n\n\n\nblood vessels. All data obtained were analysed using \n\n\n\ndescriptive analysis. Results and Discussion: Sixty-one \n\n\n\npatients were included in this study. Patients were initiated \n\n\n\nand optimized with oral CVS drugs before surgery for \n\n\n\nunderlying diseases such as hypertension and atrial \n\n\n\nfibrillation as recommended by recent international \n\n\n\nguidelines. Most of the patients developed PH with multiple \n\n\n\nand/or mixed valve diseases despite of the comorbidities \n\n\n\nwhich complicates the management of PH with VHD. The \n\n\n\nfive most common of oral CVS drugs were loop diuretics \n\n\n\n(85%), phosphodiesterase-5 inhibitors (80%), vitamin K \n\n\n\nantagonist (46%), beta-blocker (69%) and potassium \n\n\n\nchloride (52%). Loop diuretics and potassium chloride were \n\n\n\nthe common drug combination. Patients were prescribed with \n\n\n\nphosphodiesterase-5 inhibitors, to reduce pulmonary artery \n\n\n\npressure before surgery. Patients who started with vitamin K \n\n\n\nantagonist, specifically warfarin, 32% of patients achieved \n\n\n\nInternational nationalized ratio target. Conclusion: There \n\n\n\nwere specific types and patterns of CVS drugs.  \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:t2619@ms.sltung.com.tw\n\n\nmailto:farizan.ag@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n107 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 084 \n\n\n\n\n\n\n\nAn Evidence-based Therapy of Secondary \n\n\n\nHyperparathyroidism \n\n\n\n\n\n\n\nFU YU Yang*, Wen Jin Tung \n \n\n\n\nDepartment of Pharmacy, Changhua Christian Medical Foundation Yuanlin \n\n\n\nChristian Hospital, Changhua, Taiwan \n\n\n\n* Corresponding author \n\n\n\nEmail: ncuepe@hotmail.com  \n \n\n\n\nBackground and Objectives: Secondary \n\n\n\nhyperparathyroidism (SHPT) is a major comorbidity of \n\n\n\nchronic kidney disease (CKD). It has been linked with \n\n\n\ncardiovascular disease, leading to poor outcomes. Treatment \n\n\n\nstrategies directed to reduce the parathyroid hormone (PTH) \n\n\n\nconcentrations have included calcimimetics (eg. etelcalcetide, \n\n\n\ncinacalcet), that are new options in reversing SHPT, but the \n\n\n\nbenefits and harms on patient-level outcomes are uncertain. \n\n\n\nSince, the purpose of this study is to provide an evidence-\n\n\n\nbased study in discussion efficacy and safety of the \n\n\n\ncalcimimetics. Methods: According to five steps used in \n\n\n\nevidence-based medicine, we searched the Cochrane library, \n\n\n\nPubmed and Airiti library identifying completed and ongoing \n\n\n\nstudies without language restrictions from 2017 to 31 July \n\n\n\n2022. Results and Discussion: Two studies met our \n\n\n\neligibility criteria and were critically reviewed. Geoffrey et \n\n\n\nal shows that patients randomized to etelcalcetide were \n\n\n\nsignificantly reducing the ratio by more than 50% in Intact \n\n\n\nParathyroid Hormone (iPTH) level compared to cinacalcet \n\n\n\n(OR, 12.2%; 95% CI, 4.7% to 19.5%), but hypocalcemia is \n\n\n\nhigher in etelcalcetide (68.9% vs 59.8%). Palmer et al shows \n\n\n\nsimilar results in reducing iPTH level (OR, 2.78; 95% CI, \n\n\n\n1.19-6.67), but gastrointestinal side effect is higher in \n\n\n\ncinacalcet. Conclusion: Intravenous etelcalcetide can \n\n\n\nsignificantly reduce iPTH level compared to oral cinacalcet, \n\n\n\nbut hypocalcemia is higher than cinacalcet. How to select \n\n\n\ndrugs depends on patient's compliance, economic ability, and \n\n\n\ndrug response. This study intends to provide more clinical \n\n\n\ninformation to medical practitioners. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 085 \n\n\n\n\n\n\n\nStatistical Analysis on Outpatient\u2019s \n\n\n\nReferral for Individual Medication \n\n\n\nGuidance by Pharmacists \n\n\n\n\n\n\n\nYP Hsiang1*, YT Chiu2, YC Kuo2 \n \n\n\n\n1 Department of Pharmacy, E-DA Hospital, Kaohsiung, Taiwan, R.O.C  \n2 Pharmacy Department of E-Da Dachang Hospital, Kaohsiung, Taiwan, \n\n\n\nR.O.C.  \n\n\n\n* Corresponding author \n\n\n\nEmail: ed108228@edah.org.tw  \n\n\n\n\n\n\n\nBackground and Objectives: In June 2022, a hospital in \n\n\n\nTaiwan, R.O.C. aimed to understand the efficacy of a referral \n\n\n\nsystem by the outpatient physician to pharmacist for patient\u2019s \n\n\n\nindividual medication guidance at the consultation counter. \n\n\n\nMethods: Through a computer platform, the outpatient \n\n\n\nphysician identified the patient who needs special medication \n\n\n\neducation and referred to the pharmacist at the consultation \n\n\n\ncounter. Patients will be sent to the consultation counter to \n\n\n\nreceive the pharmacist's medication guidance to improve \n\n\n\npatient's medication compliance. Drug evaluation and \n\n\n\nmedication guidance satisfaction were conducted using the \n\n\n\nLIKERT 5 scoring method. Results and Discussion: The \n\n\n\ndata analysis showed that the patients from the Department \n\n\n\nof Respiratory were in needed for health education \n\n\n\nconsultation (45.45%), followed by the Department of \n\n\n\nNephrology (22.73%). Inhalation-type drug health education \n\n\n\nwas the most requested categories of medication guidance \n\n\n\n(47.73%), followed by self-administrated injectables \n\n\n\n(27.27%). We found that patients were scored with 1.9 points \n\n\n\nLIKERT 5 scoring method before the medical education and \n\n\n\n5 points after the medical education. Medication guidance \n\n\n\nsatisfaction was 4.9 points for patients and 5 points for \n\n\n\nphysician. Conclusion: Outpatient physicians acknowledge \n\n\n\nthe importance of patient\u2019s medication compliance; however, \n\n\n\nmost patients were unfamiliar with or lack of sufficient \n\n\n\nknowledge of medication, resulting in poor medication \n\n\n\ncompliance and poor disease control. Therefore, physicians \n\n\n\nreferred patients to pharmacists to provide individual \n\n\n\nmedication guidance, and specialized health education \n\n\n\nguidance based on individual patients\u2019 tailor-made problems. \n\n\n\nThe results showed that the satisfaction of both physicians \n\n\n\nand patients was 5 and 4.9 respectively, indicating that the \n\n\n\nprofessional service by pharmacist plays an important role in \n\n\n\nmedical behavior. Such referral indicated that pharmacist\u2019s \n\n\n\nservice was well appreciated by the patients and physicians.  \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:ncuepe@hotmail.com\n\n\nmailto:ed108228@edah.org.tw\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n108 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 086 \n\n\n\n\n\n\n\nEfficiency of Pharmacists\u2019 Pre-intervention \n\n\n\nfor Elderly Outpatients with Polypharmacy \n\n\n\n\n\n\n\nHsin-Yi Chou*, Chiou-Maan Lin, Yuk-Ying \n\n\n\nChan, Shin-Tarng Deng \n \nDepartment of Pharmacy Administration, Chang Gung Memorial Hospital, \n\n\n\nLinkou, Taiwan \n\n\n\n* Corresponding author \n\n\n\nEmail: kid524kimo@cgmh.org.tw  \n\n\n\n\n\n\n\nBackground and Objectives: Inappropriate medication use, \n\n\n\nand polypharmacy are common among older adults. Many \n\n\n\nprevious studies proved a comprehensive medication \n\n\n\ninformation system can help prevent drug-related-problem \n\n\n\n(DRP). Furthermore, continued monitoring of potential DRP \n\n\n\nis also necessary to ensure optimal medication use.To \n\n\n\nprovide pre-visit medication evaluation and continued \n\n\n\nfollow-up for elderly outpatients with polypharmacy by \n\n\n\npharmacists in a medical center. Methods: Between March \n\n\n\n1, 2019, and February 29, 2020, we enrolled 2,729 patients \n\n\n\nwith age over 65 years old receiving five or more medications \n\n\n\nand reviewed their current medication profile. Pharmacists \n\n\n\nconfirmed the DRP with doctors before patient visit and keep \n\n\n\nmonitoring to give suggestion up to four continued visits if \n\n\n\nthe prescription remains unchanged. The classification of \n\n\n\nDRP and numbers of drugs per patient were surveyed before \n\n\n\nand after the intervention. Results and Discussion: Among \n\n\n\nall the suggestion of pharmacists, the rate of physicians\u2019 \n\n\n\nacceptance was 61%. The prevalence of DRP was about 4.3% \n\n\n\n(117/2,729). Among the 117 DRP, improper dosage, drug \n\n\n\ncontraindicate to renal impairment and duplications \n\n\n\naccounted for 44.4% (52/117), 28.2 % (33/117), and 21.4 % \n\n\n\n(25/117), respectively. This result shows that dosage \n\n\n\nadjustment in renal impaired patient is ignored.  The mean \n\n\n\nnumbers of drug items and the mean numbers of pill count \n\n\n\nper patient deceased from 45 to 40 (p<0.007), 1687 to 1413 \n\n\n\n(p<0.0002) during six months. Conclusion: Pharmacists \n\n\n\nplay an important role in preventing DRP. The result in our \n\n\n\nstudy shows continued monitoring and proactive intervention \n\n\n\ndo improve the quality of patient care in polypharmacy \n\n\n\nelderly patients.  \n\n\n\n\n\n\n\n\n\n\n\nAbstract 087 \n\n\n\n\n\n\n\nAnalysis of Severe Cases Risk Factors and \n\n\n\nPotential Drug-drug Interactions (DDIs) in \n\n\n\nPatients Receiving Oral Anti-COVID-19 \n\n\n\nVirus Drugs \n\n\n\n\n\n\n\nYC Hsu1*,   YP Hsiang2 \n \n\n\n\n1 Pharmacy, E-DA Cancer Hospital, Kaohsiung City, Taiwan (R.O.C) \n2 Pharmacy, E-DA Hospital, Kaohsiung City, Taiwan (R.O.C) \n\n\n\n* Corresponding author \n\n\n\nEmail: qwerty1610@gmail.com  \n\n\n\n\n\n\n\nBackground and Objectives: In May 2022, Taiwan was at \n\n\n\nthe peak of the COVID-19 epidemic. The oral antiviral drugs \n\n\n\nNirmatrelvir/Ritonavir (Paxlovid\u00ae) and Molnupiravir were \n\n\n\nused for the first time in the treatment of patients with mild \n\n\n\nto moderate COVID-19 confirmed cases, mainly to reduce \n\n\n\nsevere cases and mortality. The purpose of this study was to \n\n\n\nunderstand the distribution of severe cases risk factors in \n\n\n\npatients and to analyse the proportion of potential DDIs. \n\n\n\nMethods: This study utilized retrospective analysis and \n\n\n\ncollected confirmed cases of COVID-19 from May 20, 2022 \n\n\n\nto July 31, 2022, who were confirmed by physicians to have \n\n\n\nsevere cases risk factors and were eligible for the use of the \n\n\n\noral antiviral drug Paxlovid\u00ae or Molnupiravir, and perform \n\n\n\ndescriptive statistical analysis. Results and Discussion: A \n\n\n\ntotal of 415 cases were collected in this study, with an \n\n\n\naverage age of 62.9\u00b117.04 years, 190 males and 225 females. \n\n\n\nThe top 5 with severe cases risk factors were \u226565 years old \n\n\n\n(212; 51.1%), diabetes (115; 27.7%), chronic kidney disease \n\n\n\n(57; 13.7%), cancer (53; 12.8%), cardiovascular disease (45; \n\n\n\n10.8%). The prescription ratio of Paxlovid\u00ae and \n\n\n\nMolnupiravir was 148 (35.7%): 267 (64.3%). In the \n\n\n\nPaxlovid\u00ae group, a total of 17 patients (6.4%) had potential \n\n\n\nDDIs with a total of 24 drugs. Among them, the literature \n\n\n\nrecommends temporarily discontinuing the drugs was \n\n\n\nRosuvastatin and Clopidogrel. Conclusion: This study \n\n\n\nanalysed the use of oral anti-COVID-19 virus drugs in the \n\n\n\nmajority of people aged \u2265 65 years, showing that the elderly \n\n\n\nis one of the main risk indicators. Allowing the elderly to take \n\n\n\nmedicine early can reduce the proportion of severe cases and \n\n\n\nmortality. Paxlovid\u00ae has the effect of CYP3A4 inhibitor, \n\n\n\npharmacists must pay close attention to the DDIs, and \n\n\n\neducate patients on medication in a timely manner to \n\n\n\nmaintain patient medication safety. \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:kid524kimo@cgmh.org.tw\n\n\nmailto:qwerty1610@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n109 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 088 \n\n\n\n\n\n\n\nAnalysis Potential Drug-drug Interactions \n\n\n\n(DDIs) and Risk Factors in COVID-19 \n\n\n\nPatients Receiving Oral Anti-Virus Drugs \n\n\n\nPaxlovid\u00ae and Molnupiravir  \n\n\n\n\n\n\n\nYC Hsu1*, YP Hsiang2 \n \n\n\n\n1 Department of Pharmacy, E-DA Cancer Hospital, Kaohsiung, Taiwan, \n\n\n\nR.O.C \n2 Department of Pharmacy, E-DA Hospital, Kaohsiung, Taiwan, R.O.C \n\n\n\n* Corresponding author \n\n\n\nEmail: qwerty1610@gmail.com  \n\n\n\n\n\n\n\nBackground and Objectives: In May 2022, Taiwan reached \n\n\n\nthe peak of the COVID-19 epidemic. The oral antiviral drugs \n\n\n\nNirmatrelvir/Ritonavir (Paxlovid\u00ae) and Molnupiravir were \n\n\n\ntreated for the first time in the patients with mild to moderate \n\n\n\nCOVID-19, mainly reduce severe complication and mortality. \n\n\n\nThe purpose of this study was to analyse the proportion of \n\n\n\npotential DDIs and risk factors in these populations. \n\n\n\nMethods: This retrospective study collected mild to \n\n\n\nmoderate COVID-19 infected patients who were confirmed \n\n\n\nby physicians from May 20, 2022 to July 31, 2022 in regional \n\n\n\nhospital in South Taiwan. These patients who were eligible \n\n\n\nfor the treatment of the oral antiviral drug Paxlovid\u00ae or \n\n\n\nMolnupiravir on CECC criteria (Central Epidemic Command \n\n\n\nCenter, Nation Health Command Center). Results and \n\n\n\nDiscussion: A total of 415 cases were collected in this study, \n\n\n\nwith an average age of 62.9\u00b117.04 years, 190 males and 225 \n\n\n\nfemales. The top 5 with severe risk factors were \u226565 years \n\n\n\nold (212; 51.1%), diabetes (115; 27.7%), chronic kidney \n\n\n\ndisease (57; 13.7%), cancer (53; 12.8%), cardiovascular \n\n\n\ndisease (45; 10.8%). The prescription ratio of Paxlovid\u00ae and \n\n\n\nMolnupiravir was 148 (35.7%): 267 (64.3%). In the \n\n\n\nPaxlovid\u00ae group, a total of 17 patients (6.4%) had potential \n\n\n\nDDIs. And mostly drug interaction with Paxlovid\u00ae were \n\n\n\nrosuvastatin and clopidogrel. Conclusion: This study we \n\n\n\nfound prescribed oral anti-COVID-19 virus drugs mostly \n\n\n\naged \u2265 65 years, showing that the elderly is one of the main \n\n\n\nrisk indicators. Allowing the elderly to take anti-COVID-19 \n\n\n\nvirus drugs early can reduce the complication and mortality. \n\n\n\nPaxlovid\u00ae is CYP3A4 inhibitor, pharmacists must pay more \n\n\n\nattention to the DDIs, and educate patients and doctors how \n\n\n\nto avoid interaction to maintain medication safety. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 089 \n\n\n\n\n\n\n\nThe Evaluation of Inpatient Oral COVID-\n\n\n\n19 Medication Utilisation in Medical \n\n\n\nCenters of Southern Taiwan \n\n\n\n\n\n\n\nYu Ci Lai*, Yi Ping Hsiang, Hsiu Ling Chang, \n\n\n\nLei Yu Chang \n \n\n\n\nDepartment of Pharmacy, E-Da hospital, Kaohsiung city, Taiwan \n\n\n\n* Corresponding author \n\n\n\nEmail: achi83109@gamil.com  \n\n\n\n\n\n\n\nBackground and Objectives: Paxlovid (nirmatrelvir tablet \n\n\n\nco-packaged with ritonavir tablet) and molnupiravir are the \n\n\n\noral COVID-19 medication. Guideline indicates that \n\n\n\nPaxlovid is the first line treatment for mild COVID-19 \n\n\n\ninfection, but it exhibits many drug-drug interactions (DDI) \n\n\n\nand precautions. Those patients who aren\u2019t suitable for \n\n\n\nPaxlovid will be prescribed molnupiravir. The purpose of this \n\n\n\nstudy was to assess the appropriateness of oral COVID-19 \n\n\n\nmedication selection in in-patients of a medical center. \n\n\n\nMethods: We retrospectively reviewed the medical records \n\n\n\nof residents from January 2022 to June 2022. The assessment \n\n\n\nincluded the reasons for prescribing molnupiravir, rational \n\n\n\nprescription rate, efficacy and safety. Results and \n\n\n\nDiscussion: 177 patients were included (male 59.8%), and \n\n\n\nthe average age was 69 \u00b1 16 years old. The proportion of \n\n\n\nPaxlovid and molnupiravir were 32.2% and 67.8% \n\n\n\nrespectively. Reasons for prescribing molnupiravir included \n\n\n\nDDI (43%), nasogastric tube feeding (22%), renal function \n\n\n\nimpairment (eGFR < 30mL/min) (17%), hemodialysis (17%), \n\n\n\nor contraindication to Paxloid (1%). Among Paxlovid DDI, \n\n\n\nthe medications were anticoagulant (N=14), follows by \n\n\n\nstatins (N=12), antipsychotics (N=11), antiarrhythmic agents \n\n\n\n(N=4), narcotic analgesics (N=3) and others (N=8); while the \n\n\n\nrational prescription rate was 88.3%. For efficacy evaluation, \n\n\n\nwe found that the cure rate was 89.8%, all-cause death rate \n\n\n\n7.4%, and oral medication treated failure rate was 4%. \n\n\n\nDuring study period, two cases experienced adverse reactions. \n\n\n\nConclusion: The evaluations of oral COVID-19 medication \n\n\n\nshow that it\u2019s safe and efficient. DDI is the most reason for \n\n\n\nprescribing molnupiravir, but not every DDI needs to avoid \n\n\n\nPaxlovid. It\u2019s reasonable to stop taking current medication or \n\n\n\nreduce the dosage for couple days when taking Paxlovid. \n\n\n\nThus, when pharmacists find that DDI can be managed, we \n\n\n\ncan advise doctors to choose Paxlovid. In the COVID-19 \n\n\n\nepidemic, it\u2019s our duty to make sure every patient can get \n\n\n\ntheir best therapy. \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\nmailto:qwerty1610@gmail.com\n\n\nmailto:achi83109@gamil.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n110 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 090 \n\n\n\n\n\n\n\nRetrospective Study of Drug Use \n\n\n\nAssessment for Plerixafor \n\n\n\n \nWen-Ling Lin1,2*, Yow-Wen Hsieh1,2 \n\n\n\n \n1 Department of Pharmacy, China Medical University Hospital, Taichung, \n\n\n\nTaiwan \n2 Graduate Institute of Pharmacy, China Medical University, Taichung, \n\n\n\nTaiwan \n\n\n\n* Corresponding author \n\n\n\nEmail: u101055002@gmail.com   \n\n\n\n\n\n\n\nBackground and Objectives: Plerixafor is indicated for \n\n\n\npatients with non-Hodgkin's lymphoma or multiple myeloma \n\n\n\nwho require autologous transplantation, but who are poorly \n\n\n\ndriven. In order to use at least one course of G-CSF combined \n\n\n\nwith chemotherapy for stem cell-driven therapy, if the \n\n\n\nnumber of CD34+ cells collected is less than 2 million per \n\n\n\nkilogram of body weight, it can be applied for use. The study \n\n\n\nnoted that the use of lenalidomide was associated with an \n\n\n\nincrease in peripheral blood stem cell collection failures. This \n\n\n\nstudy retrospectively explored the clinical efficacy of \n\n\n\nplerixafor. Methods: Retrospective medical records were \n\n\n\nreviewed from 2016 to 2021 for inpatient data of inpatients \n\n\n\nusing plerixafor. Each patient was used with G-CSF. The \n\n\n\nprimary assessment was the number of CD34+ cells collected \n\n\n\nper kilogram of body weight. It was used for descriptive and \n\n\n\nsimple inferential analysis in Microsoft Excel 2016 version. \n\n\n\nResults and Discussion: A total of 27 patients were included \n\n\n\nin the evaluation, 51.9% were male, and the mean age was \n\n\n\n58.89\u00b18.49 years; 8 patients had CD34+ cells collected over \n\n\n\n2 million per kilogram of body weight; 7 patients were \n\n\n\ndiagnosed with multiple myeloma, Two of the patients were \n\n\n\ntreated with lenalidomide at the same time, and it was found \n\n\n\nthat the collection of CD34+ cells was insufficient and failed, \n\n\n\nand the collection of CD34+ cells in the remaining 25 \n\n\n\npatients increased, with an average of 1.21\u00b11.14 \n\n\n\nCD34+*106/kg. Conclusion: At present, peripheral blood \n\n\n\nautologous hematopoietic stem cell transplantation is an \n\n\n\nimportant treatment option for non-Hodgkin's lymphoma or \n\n\n\nmultiple myeloma, but it may be forced to abandon treatment \n\n\n\ndue to insufficient peripheral blood hematopoietic stem cells. \n\n\n\nTherefore, the combination of plerixafor with G-CSF has \n\n\n\nbeen shown to increase the effect of motile hematopoietic \n\n\n\nstem cells and increase the number of peripheral blood \n\n\n\nhematopoietic stem cells to provide a new treatment option \n\n\n\nfor transplant recipients. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 091 \n\n\n\n\n\n\n\nCase Report of Suspect Adverse Effects of \n\n\n\nPiperacillin/Tazobactam Induced Drug \n\n\n\nFever \n\n\n\n\n\n\n\nHP Liu1*, YC Hsu1, YP Hsing2 \n\n\n\n\n\n\n\n1 Department of Pharmacy, E-Da Cancer Hospital, Kaohsiung, Taiwan, \n\n\n\nR.O.C..  \n2 Department of Pharmacy, E-Da Hospital, Kaohsiung, Taiwan, R.O.C. \n\n\n\n* Corresponding author \n\n\n\nEmail: ed100348@edah.org.tw  \n\n\n\n\n\n\n\nBackground and Objectives: Drug fever is defined as a \n\n\n\nbody temperature exceeding 38\u00b0C, without any detection of \n\n\n\nnew infections or other causes or potential diseases that may \n\n\n\ncause fever. The occurrence of fever when the suspected \n\n\n\nantibiotics (piperacillin/tazobactam) ordered, and subsidence \n\n\n\n48-72 hours after discontinuing the drug. Method: A 59-\n\n\n\nyear-old man was admitted to the hospital on February 16, \n\n\n\n2020 for routine chemotherapy. On March 3, the result of \n\n\n\nblood culture test was Enterobacter cloacae complex, and the \n\n\n\npatient started fever, so ordered piperacillin/tazobactame \n\n\n\n4.5g Q6H IV to treat. After 7 days antibiotic use, he still had \n\n\n\na high fever (up to 39.4\u00b0C), and skin rashes erupted, chest X-\n\n\n\nray examination showed no plaques or lung infiltration. On \n\n\n\nMarch 9, we ruled out drug-fever, discontinued \n\n\n\npiperacillin/tazobactam and switched to ertapenem 1g QD IV. \n\n\n\nScreened regimen only piperacillin/tazobactam could be a \n\n\n\nculprit drug causing drug fever. Result and Discussion: \n\n\n\nAfter discontinued piperacillin/tazobactam for 48 hours, the \n\n\n\nbody temperature returned to normal, and skin rash subsided. \n\n\n\nSome literature reported the average length of drug fever \n\n\n\ncaused by antibiotics is 6-7.8 days, of which \u00df-lactams occurs \n\n\n\nmore frequently. Hypersensitivity reaction is the main \n\n\n\nmechanism of drug fever caused by antibiotics (5% of \n\n\n\npatients will also had skin rash). In this case, the fever \n\n\n\ncontinued during the use of piperacillin/tazobactam, and even \n\n\n\nreached to 39.4\u00b0C on the 7th day. After discontinued \n\n\n\npiperacillin/tazobactam for 48 hours, body temperature \n\n\n\nreturned to normal without other infection signs. So it is \n\n\n\nhighly suspected to be a drug fever caused by \n\n\n\npiperacillin/tazobactam. Conclusion: We hope this case \n\n\n\nwould keep medical staffs alert to identify drug fever timely, \n\n\n\nwhich could avoid unnecessary diagnostic procedures, \n\n\n\ninappropriate treatments, and extended hospital stay. \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:u101055002@gmail.com\n\n\nmailto:ed100348@edah.org.tw\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n111 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 092 \n\n\n\n\n\n\n\nInnovation and Evaluation of the Outdoor \n\n\n\nOutpatient Pharmacy in Response to \n\n\n\nCOVID-19 Epidemic: A Pilot Study at A \n\n\n\nRegional Hospital in Southern Taiwan  \n \n\n\n\nTsun-Pin Liu1, 2, Wen-Jun Wong 1, Heng-Jung \n\n\n\nChen2, Yaw-Bin Huang 3* \n \n1 Department of Pharmacy, St Martin De Porres Hospital, Chiayi, Taiwan, \n\n\n\nROC  \n2 Chung-Jen Junior College of Nursing, Health Sciences and Management, \n\n\n\nChiayi, Taiwan, ROC \n3 School of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan, \n\n\n\nROC \n\n\n\n* Corresponding author \n\n\n\nEmail: LTB007@stm.org.tw  \n\n\n\n\n\n\n\nBackground and Objectives: The COVID-19 Epidemic \n\n\n\nconstituted to the challenges of meeting the medical needs of \n\n\n\ndrugs for the patients who are PCR positive or diagnosed by \n\n\n\nrapid screening, and protection of medical personnel. This \n\n\n\nstudy aims to develop an innovative outpatient pharmacy \n\n\n\nservice in response to the needs for a safe, fast and effective \n\n\n\npharmaceutical service provision. Methods: This study had \n\n\n\nthree stages: (i) co-production of an innovative outdoor \n\n\n\noutpatient pharmacy with the medical team; (ii) \n\n\n\nimplementation of the service innovation from 2022/5/9 to \n\n\n\n2022/5/31; and (iii) service evaluation.  The pharmacists who \n\n\n\nwork at the innovated outdoor pharmacy completed a \n\n\n\nsatisfaction questionnaire. Results and Discussion: The \n\n\n\ninnovative medical prescription by the physician, innovative \n\n\n\ndrug and the relevant information provision by pharmacists \n\n\n\nhave been developed and implemented. It includes \n\n\n\nsimultaneous printing of the consent form to remind the \n\n\n\nissuance, drug interaction and contraindications, dosage \n\n\n\nsuggestions and prompts for the issuance of prescription \n\n\n\ndrugs. A total of 10 questionnaires were completed and \n\n\n\nreturned for evaluation. About 87% of the respondents were \n\n\n\nsatisfied with process practicability, 88% of them reported \n\n\n\nabout easy to learn, 83% with information quality, 86% with \n\n\n\ninterface quality. Overall satisfactory degree 90%. \n\n\n\nConclusion: The innovated Outdoor Epidemic Pharmacy \n\n\n\nwas opened in just 1 weeks and received good satisfaction. It \n\n\n\nsuggested that making good use of information technology \n\n\n\nand medical team coordination and cooperation can result in \n\n\n\nmore comprehensive care for patients. \n\n\n\n\n\n\n\nAbstract 093 \n\n\n\n\n\n\n\nDrug Utilization Evaluation of Remdesivir \n\n\n\nin A Regional Teaching Hospital in \n\n\n\nSouthern Taiwan \n\n\n\n\n\n\n\nBJ Lyu1*, YCHsu1, YP Hsiang2 \n\n\n\n\n\n\n\n1 Department of Pharmacy, E-Da Cancer Hospital, Kaohsiung, Taiwan \n2 Department of Pharmacy, E-Da Hospital, Kaohsiung, Taiwan \n\n\n\n* Corresponding author \n\n\n\nEmail: lyupika@gmail.com  \n\n\n\n\n\n\n\nBackground and Objectives: According to previous \n\n\n\nresearch, remdesivir have shown to shorten the time to \n\n\n\nrecovery in adults who were hospitalized with COVID-19. \n\n\n\nWe brought in remdesivir since 2022 May due to the \n\n\n\npandemic and this study aimed to evaluate the utilization of \n\n\n\nremdesivir in a regional teaching hospital in southern Taiwan. \n\n\n\nMethods: A retrospective study was conducted. We selected \n\n\n\nhospitalized patients from 2022 May to 2022 June who used \n\n\n\nremdesivir as the treatment of COVID-19 disease. We used \n\n\n\ndescriptive statistics to summarise patients\u2019 profiles (contains \n\n\n\nlaboratory data and POMR records) in the inpatient system \n\n\n\nto review whether the adverse drug reactions can be observed.  \n\n\n\nResults and Discussion: There were 10 patients enrolled in \n\n\n\nthis study, 7 males and 3 females. The mean age was \n\n\n\n72.2\u00b113.5 years. 4 patients with cancer comorbidity. The \n\n\n\naverage days from being diagnosed COVID-19 to discharged \n\n\n\n(or expired) was 8.7 days. 2 patients died during the treatment \n\n\n\nperiod, 4 patients discharged while still need self-health \n\n\n\nmonitoring and 4 patients scheduled outpatient department \n\n\n\nfollow-up after discharging. Reason for using remdesivir: 1 \n\n\n\npatient with SPO2 \u226494% on room air ,7 patients required \n\n\n\nsupplemental oxygen (6 patients with at least one risk factor \n\n\n\nfor disease progression) and 2 patients with at least one risk \n\n\n\nfactor for disease progression which defined by the US CDC. \n\n\n\nDue to the small sample size, there were no common adverse \n\n\n\ndrug reactions (ex. GI disturbance, abnormal liver function \n\n\n\nor abnormal renal function) observed in this study. \n\n\n\nConclusion: The utilization of remdesivir in patients with \n\n\n\nolder age or comorbidity is reasonable. We found no \n\n\n\nobservable adverse drug reactions during the treatment. Since \n\n\n\nthere are not enough clinical experience in using remdesivir, \n\n\n\nphysicians and pharmacists should carefully monitor any \n\n\n\nreaction during remdesivir therapy.   \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:LTB007@stm.org.tw\n\n\nmailto:lyupika@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n112 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 094 \n\n\n\n\n\n\n\nSurvival Analysis of COVID-19 Patients \n\n\n\nAdmitted in a Tertiary Government \n\n\n\nHospital in Nueva Ecija: A Preliminary \n\n\n\nReport on the Compassionate Use of \n\n\n\nRemdesivir \n\n\n\n\n\n\n\nLapuz, Huberto F., Estolano, Melvin R., \n\n\n\nMagno, Jem Marie L., De Guzman, Reina \n\n\n\nElizabeth L., Gustilo, Lailanie M., Arriola, \n\n\n\nLordel M., Pascual, Marilou* \n \n\n\n\nDr. Paulino J. Garcia Memorial Research and Medical Center, 3100 Nueva \n\n\n\nEcija, Philippines \n\n\n\n* Corresponding author \n\n\n\nEmail: maluphd@yahoo.com  \n\n\n\n\n\n\n\nBackground and Objectives: A number of research studies \n\n\n\nand clinical trials were initiated in the search for an effective \n\n\n\ndrug for COVID-19. Remdesivir, originally developed \n\n\n\nagainst the Ebola virus, became an early candidate. \n\n\n\nRemdesivir, the first authorized COVID-19 antiviral \n\n\n\nmedication in Europe, received \u201cCompassionate Special \n\n\n\nPermit\u201d for use in hospitals from the Department of Health \n\n\n\n(DOH) and the Philippine Food and Drugs Administration \n\n\n\n(FDA) upon request by health institutions. The provision of \n\n\n\na baseline set of data can provide information for deeper \n\n\n\nstudy of possible contributory factors on the survival of \n\n\n\nCOVID-19 patients. Methods: The study concluded with a \n\n\n\ntotal of 266 patients based on inclusion and exclusion criteria. \n\n\n\n16.92% of COVID-19 patients received remdesivir. Average \n\n\n\nage was 54.8 years and dominantly on patients 50 years old \n\n\n\nand above; and 93.6% of patients were non-healthcare \n\n\n\nworkers. Topping the list of co-morbidities was hypertension \n\n\n\n(52.25%), followed by diabetes mellitus (31.95), and renal \n\n\n\nrelated disease (8.27%). Results and Discussion: Log rank \n\n\n\ntest results showed that there were no significant differences \n\n\n\nbetween the categories of sexes (p=0.214), exposure \n\n\n\n(p=0.727), and occupation (unable to test for difference) with \n\n\n\nregards to survival under remdesevir. Likewise, there were \n\n\n\nalso no noted significance in comparing the survival of each \n\n\n\ncategory between treatments. Over-all survival probability \n\n\n\non the comparison of the Kaplan-Meier Curves between \n\n\n\nRemdesevir and Non-remdesevir treatments showed a non-\n\n\n\nsignificant logrank value (p=0.536). Univariate Cox \n\n\n\nproportional hazard regressions results showed age \n\n\n\n(HR=1.065), oxygen saturation (HR=0.878), and ventilator \n\n\n\ndays (HR=0.748) to be significant factors on the survivability \n\n\n\nof COVID-19 patients under remdesevir group. Conclusion: \n\n\n\nThe there was a significant higher risk of death in male \n\n\n\npatients, who has a high BMI, with elevated renal markers or \n\n\n\nhave renal related diseases and with longer hospital stay. The \n\n\n\ncurrent studies concluded that early remdesivir treatment \n\n\n\nfrom symptom onset may have better clinical outcomes.   \n\n\n\n\n\n\n\nAbstract 095 \n \n\n\n\nThe Prevalence of Pill Dysphagia Among \n\n\n\nAdult Hospitalised Patients in Hospital \n\n\n\nAngkatan Tentera Tuanku Mizan \n\n\n\n(HATTM) \n\n\n\n\n\n\n\nNorlizawati Moktar1*, Rosman Ab Rahman1, \n\n\n\nNurul Amirah Daud1, Rosmaliah Alias2, \n\n\n\nMohd Shahezwan Abd Wahab3, Mohammad \n\n\n\nHalif Mohamad Yusof1, Mohd Adlan Adnan4, \n\n\n\nA Halim Hj Basari4 \n \n1 Department of Pharmacy, Tuanku Mizan Armed Forces Hospital, Kuala \n\n\n\nLumpur, Malaysia. \n2 Hospital Kuala Lumpur, Kuala Lumpur, Malaysia \n3 Faculty of Pharmacy, Universiti Teknologi MARA, Selangor, Malaysia. \n4 Malaysian Armed Forces Health Service Division, Kuala Lumpur, \n\n\n\nMalaysia. \n\n\n\n* Corresponding author \n\n\n\nEmail: liza_moktar@yahoo.com  \n\n\n\n\n\n\n\nBackground and Objectives: Pill dysphagia can be due to \n\n\n\ndysphagia or drug-induced dysphagia. This problem can lead \n\n\n\nto non-compliance. This study aimed to determine the \n\n\n\nprevalence of pill dysphagia, identify interventions by \n\n\n\npharmacists and evaluate the appropriateness of Pill-5 \n\n\n\nQuestionnaire (P-5Q) as an assessment tool. Methods: A \n\n\n\ncross-sectional study was done from July to August 2022 \n\n\n\naccording to all inclusion criteria. The P-5Q was used to \n\n\n\nassess patients with pill dysphagia and pharmacists will \n\n\n\nperform medication reviews. Results and Discussion: The \n\n\n\nprevalence of pill dysphagia among adult hospitalized \n\n\n\npatients in HATTM was 4.04% (n=8). Interventions have \n\n\n\nbeen done by pharmacists whereby 62.5% (n=5) of patients \n\n\n\nwere suggested to have alternatives dosage forms, 12.5% \n\n\n\n(n=1) were suggested to switch to smaller size pills, 12.5% \n\n\n\n(n=1) were suggested with alternative drugs with a lesser \n\n\n\nanticholinergic burden score and 12.5% (n=1) has no \n\n\n\nintervention performed. From P-5Q analysis, there were \n\n\n\nsignificant differences between patients without pill \n\n\n\ndysphagia (M=0.38, SD=0.999) and patients with pill \n\n\n\ndysphagia (M=12.00, SD=2.796); p < 0.01. There were also \n\n\n\nsignificant differences between both groups for all five \n\n\n\nquestions in P-5Q ; p < 0.01. Conclusion: Pill dysphagia \n\n\n\npatients were detected in this study by using P-5Q as an initial \n\n\n\nscreening tool. Pharmacists can play a vital role to increase \n\n\n\npatient safety and compliance by doing a medication review. \n\n\n\n \n\n\n\n\nmailto:maluphd@yahoo.com\n\n\nmailto:liza_moktar@yahoo.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n113 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 096 \n \n\n\n\nStandardization of Medication Bin \n\n\n\nLabelling with Quick Reference \n\n\n\nInformation to Reduce Medication Error \n\n\n\nand Improve Caller Waiting Time \n\n\n\n\n\n\n\nNursyafiqah Moideen*, Norfaizah Bachok \n \n\n\n\nPharmacy Services, KPJ Bandar Maharani Specialist Hospital, Malaysia \n\n\n\n* Corresponding author \n\n\n\nEmail: n.fiqah@kpjmaharani.com  \n\n\n\n\n\n\n\nBackground and Objectives: To reduce 100% medication \n\n\n\nerrors related to wrong information given during phone \n\n\n\nconversation and to improve caller waiting time (targeted 50% \n\n\n\nreduction) for Prescriber & Staff Nurses while calling \n\n\n\nPharmacy to obtain medication\u2019s information. Methods: \n\n\n\nThis project began in the 4th quarter 2020 and went on until \n\n\n\nJune 2021 involving three phases. In phase 1, list of problems \n\n\n\nthat leads to medication error and increase caller waiting time \n\n\n\nwere identified such as time consuming by the Pharmacy \n\n\n\nStaff to read medication leaflet, MIMS Drug Reference or \n\n\n\nBNF (British National Formulary) thus it will increase caller \n\n\n\nwaiting time. We had also listed the frequently ask questions \n\n\n\nfrom the prescriber or Staff Nurses when they called \n\n\n\nPharmacy for medications\u2019 information. Phase 2 project was \n\n\n\nto eliminate the problem by developing a standardized \n\n\n\nmedication bin labelling with quick reference tools on the \n\n\n\nlabel such as medication\u2019s generic and brand name, Poison \n\n\n\ngroup, storage and stability, special precautions, \n\n\n\nbreastfeeding and pregnancy category, therapeutic category, \n\n\n\nmaximum tolerated dose, route of administration and dilution \n\n\n\nor reconstitution information. Phase 3 is to have a \n\n\n\nsustainability of this project in the future for new medications \n\n\n\nlisted in our hospital formulary. Results and Discussion: \n\n\n\nThe average waiting time required for drug enquiry from \n\n\n\nhealthcare provider was 3.7 minutes before the bin labelling \n\n\n\nimplementation and it has been improved to 15 seconds (93.4% \n\n\n\nwaiting time reductions) post implementation. This \n\n\n\nImplementation had successfully reduced near missed \n\n\n\nmedication error related to wrong information given from 12 \n\n\n\ncases to zero (100% reduction). Furthermore, this \n\n\n\nstandardization was a combination idea of quality \n\n\n\nimprovement project and 5S certification project. 5S which \n\n\n\nconsist of Sort, Straighten, Shine, Standardize and Sustain \n\n\n\nis a practice to organize workplace to create a clean, safe, \n\n\n\norderly, high-performance work environment that promotes \n\n\n\nefficiency. Conclusion: Both study objectives were achieved, \n\n\n\nand continuity of the project should be recommended to \n\n\n\nPharmacy Services in other hospital. This quality \n\n\n\nimprovement project had tremendously improved Pharmacy \n\n\n\nstaffs confident level, knowledge and their work efficiency. \n\n\n\n\n\n\n\nAbstract 097 \n \n\n\n\nDisaster Management Zone (DMZ): \n\n\n\nMilitary Pharmacists\u2019 Unconventional \n\n\n\nInnovation in Responding to Health Threats \n\n\n\n\n\n\n\nNurul Amirah Daud1*, Norlizawati Moktar1, \n\n\n\nMohammad Halif Mohamad Yusof2, Mohd \n\n\n\nAdlan Adnan2, A Halim Hj Basari2 \n \n1 Department of Pharmacy, Tuanku Mizan Armed Forces Hospital, Kuala \n\n\n\nLumpur, Malaysia. \n2Malaysian Armed Forces Health Service Division, Kuala Lumpur, Malaysia. \n\n\n\n* Corresponding author \n\n\n\nEmail: nurulamirahdaud.milrph@gmail.com  \n\n\n\n\n\n\n\nBackground and Objectives: The COVID-19 pandemic is \n\n\n\nan unprecedented public health emergency that caused the \n\n\n\nhealthcare system under immense pressure, especially in \n\n\n\nKlang Valley.  In response to this, Tuanku Mizan Armed \n\n\n\nForces Hospital launched its DMZ to curb this issue. Located \n\n\n\nat the hospital basement car park, DMZ has catered for a total \n\n\n\nof 1079 COVID-19 patients from categories 4 and 5. This \n\n\n\npaper intends to underline operational and strategic revamp \n\n\n\nadapted by military pharmacists especially when DMZ was \n\n\n\noperated after 36 hours of activation with limited manpower. \n\n\n\nMethods: Strategies employed throughout DMZ operation \n\n\n\ninclude: (1) Weekly stock monitoring to ensure all-time \n\n\n\nmedications and consumables readiness; (2) Daily \n\n\n\nstocktaking in Red Zone by pharmacy personnel to prevent \n\n\n\nexcessive unused medications; (3) Medication reconciliation, \n\n\n\npharmacotherapy rounds and medication counseling by \n\n\n\nwhich initiatives done to reduce exposure to COVID-19. \n\n\n\nResults and Discussion: All patients received medications \n\n\n\nas per clinical needs, evidenced by zero stock-out issues. \n\n\n\nReduce unused and returned medications in Red Zone at the \n\n\n\nend of operation compared to early operation days. \n\n\n\nMedication safety was guaranteed, as evidenced by 129 \n\n\n\nmedication errors successfully intervened. Rapid provision \n\n\n\nof medications and counseling with minimal contact. \n\n\n\nConclusion: DMZ has leveraged military pharmacists in \n\n\n\nmanaging medication supply, maintaining pharmaceutical \n\n\n\ncare, and responding quickly to the call of emergency relief \n\n\n\noperations. This paper serves as a guide for standard \n\n\n\noperating procedures (SOPs) development in managing \n\n\n\nfuture health emergencies. \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:n.fiqah@kpjmaharani.com\n\n\nmailto:nurulamirahdaud.milrph@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n114 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 098 \n\n\n\n\n\n\n\nPrescription Error in Tertiary Military \n\n\n\nHospital \u2013 Prevalence and Pattern \n\n\n\n\n\n\n\nNurul Amirah Daud1*, Norlizawati Moktar1, \n\n\n\nMohammad Halif Mohamad Yusof2, Mohd \n\n\n\nAdlan Adnan2, A Halim Hj Basari2 \n\n\n\n \n1 Department of Pharmacy, Tuanku Mizan Armed Forces Hospital, Kuala \n\n\n\nLumpur, Malaysia. \n2 Malaysian Armed Forces Health Service Division, Kuala Lumpur, \n\n\n\nMalaysia. \n\n\n\n* Corresponding author \n\n\n\nEmail: nurulamirahdaud.milrph@gmail.com  \n \n\n\n\nBackground and Objectives: Prescription error accounts \n\n\n\nfor most medication errors reported in Malaysian tertiary \n\n\n\nhospitals. With the limitations of digital hospital \n\n\n\nmanagement systems, manual prescribing is susceptible to \n\n\n\nhuman error. Identification of the prevalence and pattern of \n\n\n\nprescription errors in an inpatient tertiary military hospital is \n\n\n\ndeemed necessary to formulate appropriate solutions. \n\n\n\nMethods: A retrospective study was conducted over 1 month \n\n\n\nby inpatient pharmacists and assistant pharmacists using a \n\n\n\nstandardised data collection form. Data taken from inpatient \n\n\n\nprescriptions from all wards excluding intensive care unit \n\n\n\n(ICU) throughout May 2019. Errors were classified into \n\n\n\nomission errors, commission errors, inappropriate \n\n\n\nprescriptions, and miscellaneous. A comparison of \n\n\n\nprescribing errors between different categories of prescribers \n\n\n\nis also analysed. All results were expressed as percentages. \n\n\n\nResults and Discussion: Prescribing errors in the hospital \n\n\n\nward are within the range of similar studies conducted both \n\n\n\nlocally and internationally. Most come from omission errors \n\n\n\nthat are less likely to cause harm. This might be contributed \n\n\n\nto a lack of training on proper prescribing, since most medical \n\n\n\nofficers came from various military unit backgrounds. The \n\n\n\npercentage of prescribing errors in the pediatric ward is \n\n\n\nhigher than that in the surgical and medical wards. By \n\n\n\ncategory of prescribers, prescribing errors are predominated \n\n\n\nby junior prescribers, despite prescriptions being \n\n\n\ncountersigned by senior doctors. Conclusion: Prescription \n\n\n\nerror is moderately prevalent in Tuanku Mizan Armed Forces \n\n\n\nHospital, but its pattern varies from pre-existing studies. \n\n\n\nIntroduction of e-prescription and continuous education on \n\n\n\nGood Prescribing Practice can reduce prescription errors. \n\n\n\nFuture research should incorporate patient clinical data to \n\n\n\nensure precise clinical judgment on drug regimen selection. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 099 \n\n\n\n\n\n\n\nSystematic Review on Questionnaires to \n\n\n\nMeasure Medication Knowledge in Post \n\n\n\nKidney Transplant Recipients \n\n\n\n\n\n\n\nNurul Syazfeeza Samsudin1*, Nurkasihan \n\n\n\nIbrahim2, Mohd Shahezwan Abd Wahab2, \n\n\n\nJasmine Shan Lii Ching3, Mohd Adlan Adnan1, \n\n\n\nA Halim Hj Basari1 \n \n1 Malaysian Armed Forces Health Service Division, Kuala Lumpur, \n\n\n\nMalaysia. \n2 Faculty of Pharmacy, Universiti Teknologi MARA, Puncak Alam, \n\n\n\nSelangor, Malaysia \n3Department of Pharmacy, Kuala Lumpur Hospital, Kuala Lumpur, \n\n\n\nMalaysia. \n\n\n\n* Corresponding author \n\n\n\nEmail: nurul.syazfeeza86@gmail.com  \n\n\n\n\n\n\n\nBackground and Objectives: Good understanding of \n\n\n\nimmunosuppressants (IS) among post kidney transplant \n\n\n\nrecipients (KTR) is associated with better outcomes. The \n\n\n\nlevel of medication knowledge in this population is \n\n\n\ncommonly obtained from transplant-specific questionnaires. \n\n\n\nWe aimed to identify the constructs and quality limitations of \n\n\n\nthe questionnaires that have been used to measure knowledge \n\n\n\non IS in KTR. Methods: Relevant articles were identified \n\n\n\nfrom PubMed, MEDLINE, CINAHL, Web of Science, \n\n\n\nCochrane Library, and Scopus for all periods until July 2021. \n\n\n\nSearch terms were derived from three keywords: \u2018kidney \n\n\n\ntransplant patients,\u2019 \u2018assessment tools,\u2019 and \u2018drug \n\n\n\nknowledge.\u2019 The criteria for relevant articles were: 1) English \n\n\n\nlanguage, 2) involved adult KTR and 3) original article on \n\n\n\nthe validation of transplant-specific questionnaires that \n\n\n\nmeasure knowledge on IS therapy or the first published \n\n\n\narticle using the questionnaire as a tool to measure \n\n\n\nknowledge on IS therapy. Constructs were identified by \n\n\n\nextracting questions related to IS knowledge. The quality of \n\n\n\nthe questionnaires was evaluated using the COnsensus-based \n\n\n\nStandards for the selection of health Measurement \n\n\n\nINstruments (COSMIN) checklist. Four reviewers were \n\n\n\ninvolved throughout this study. Results and Discussion: The \n\n\n\nsearch yielded 5,216 articles, of which ten fulfilled the \n\n\n\ninclusion criteria. These ten articles reported on eight \n\n\n\nquestionnaires involving eight countries. Fifty-one questions \n\n\n\nrelated to IS knowledge were extracted from a total of 121 \n\n\n\nquestions (42%). The primary constructs derived include 1) \n\n\n\nknowledge on the importance of IS medications; 2) \n\n\n\nknowledge on handling IS; 3) knowledge of the treatment \n\n\n\noutcomes. All eight questionnaires demonstrated insufficient \n\n\n\ncontent validity and low-level evidence for internal \n\n\n\nconsistency. Conclusion: The current transplant-specific \n\n\n\nquestionnaires are incomprehensive to measure IS \n\n\n\nknowledge, and the majority had inadequate evidence of \n\n\n\nvalidity and reliability. Future studies should aim to develop \n\n\n\n\nmailto:nurulamirahdaud.milrph@gmail.com\n\n\nmailto:nurul.syazfeeza86@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n115 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nvalidated questionnaires to measure the knowledge on IS \n\n\n\ntherapy among KTR with appropriate constructs.  \n\n\n\nAbstract 100 \n \n\n\n\nRelationship of Nutritional Status and \n\n\n\nSepsis Mortality  \n\n\n\n\n\n\n\nRoongthip Tangsaghasaksri* \n \n\n\n\nPharmacy Department, Rajavithi Hospital, Bangkok, Thailand. \n\n\n\n* Corresponding author \n\n\n\nEmail: rtangsagha@gmail.com  \n \n\n\n\nBackground and Objectives: Sepsis is a complex, \n\n\n\ndangerous illness that leads to a critical condition and is the \n\n\n\nleading cause of death among hospital patients. It was found \n\n\n\nthat nutritional status had an impact on survival and the \n\n\n\nmortality rate of critically ill patients. It is associated with \n\n\n\norgan failure, risk of complications and death. Objectives are \n\n\n\nto study the relationship between nutritional status and \n\n\n\nmortality of sepsis patients in Rajavithi Hospital also to study \n\n\n\nfactor related to sepsis mortality. Methods: This study was \n\n\n\nconducted by collecting data from patients admitted to \n\n\n\nRajavithi Hospital between January and December 2019 who \n\n\n\nwas diagnosed by a physician as having sepsis, have the \n\n\n\nresults of the screening (SPENT nutrition screening tool) or \n\n\n\nnutritional assessment (nutrition alert form(NAF)). Results \n\n\n\nand Discussion: Of the 808 patients diagnosed with sepsis, \n\n\n\n475 were female, 333 were male, and 400 died (49.5%). The \n\n\n\nmean age of the deceased patients was 65.61\u00b116.48 years. \n\n\n\nThe prevalence of malnutrition in patients with sepsis was \n\n\n\n71.2%. Patients at risk of malnutrition have significantly \n\n\n\nhigher mortality. When analyzing factors contributing to \n\n\n\nmortality among sepsis patients, it was found that patients \n\n\n\nover 60 years of age (> 2times), patients with septic shock \n\n\n\n(4.26 times), patients receiving parenteral nutrition(PN) \n\n\n\n(3.53 times), patients receiving both enteral nutrition(EN) \n\n\n\nand PN (3.75 times), patients with kidney disease (2.04 \n\n\n\ntimes), patients with cancer (1.92 times) , patients treated \n\n\n\nwith vancomycin (1.64 times) and colistin (1.93 times) were \n\n\n\nsignificantly associated with higher mortality than those \n\n\n\nwithout the aforementioned factors. The likelihood of death \n\n\n\nwas reduced by 38and 52 percent in patients receiving \n\n\n\nquinolone and metronidazole respectively. Conclusion: \n\n\n\nAlthough sepsis patients with malnutrition died more than \n\n\n\npatients who has normal nutritional status, administration of \n\n\n\nPN or both EN and PN did not reduce mortality. Sepsis \n\n\n\npatients with septic shock, age over 60 years, has underlying \n\n\n\nof kidney disease or cancer had higher risk of mortality. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 101 \n \n\n\n\nApplying Quality Control Tool Improves \n\n\n\nthe Conformance Rate of Microbial \n\n\n\nMonitoring Performed by Chemotherapy \n\n\n\nPharmacists \n\n\n\n\n\n\n\nShu-Chuan Pi1*, Yi-Ping Hsiang2, Li-Ching \n\n\n\nChang1,3 \n  \n1 Department of Pharmacy, E-DA Cancer Hospital, Kaohsiung, Taiwan.  \n2 Department of Pharmacy, E-Da Hospital, Kaohsiung, Taiwan.  \n3 School of Medicine, I-Shou University, Kaohsiung, Taiwan. \n\n\n\n* Corresponding author \n\n\n\nEmail: ed100221@gmail.com  \n\n\n\n\n\n\n\nBackground and Objectives: Chemotherapy injections are \n\n\n\nhazardous drugs \u2013 if they are not handled properly then they \n\n\n\nwill cause health hazards to related personnel and the \n\n\n\nenvironment. Given that non-conformance cases in routine \n\n\n\nmicrobiological monitoring of biosafety cabinet  (BSC) by \n\n\n\nchemotherapy pharmacists in our hospital, therefore we \n\n\n\ndecide to kick off a quality improvement project. Methods: \n\n\n\nThis study was brainstormed by the member of the \n\n\n\nchemotherapy pharmacist to address the non-conformance \n\n\n\nincidents in microbiological monitoring operation of the BSC \n\n\n\nperformed. The characteristic factor diagram combined with \n\n\n\nthe Plan-Do-Check-Act (PDCA) method to formulate \n\n\n\nimprovement strategy. 1. Strengthen the orientation training \n\n\n\nof newcomers to chemotherapy: (1) Introduce virtual reality \n\n\n\n(VR) teaching; (2) use simulated teaching props to shoot \n\n\n\nnewcomer execution videos. Only after discussion and \n\n\n\nfeedback can they be officially launched. 2. Strengthen the \n\n\n\nwork flow: (1) Revise the direct observation of procedural \n\n\n\nskills (DOPS) for microbial monitoring for the error-prone \n\n\n\nand neglected steps; (2) formulate the teaching and \n\n\n\nevaluation by dedicated pharmacists to ensure the accuracy \n\n\n\nand consistency of learning. Results and Discussion: \n\n\n\nComparing data before (2017/01-2018/12) and after \n\n\n\n(2019/01-2022/06) project implementation, the BSC sterility \n\n\n\nconformance rate was raised from 83.3% to 96.7%. The \n\n\n\nDOPS score increased from 85.7 points to 95.8 points. The \n\n\n\noverall satisfaction rate is more than 4 points based on the \n\n\n\nLikert scale 5 point method. The most satisfying part is \n\n\n\n\"shooting newcomers execution videos\" and \"DOPS \n\n\n\nassessment\" (5 points), followed by \"teaching and evaluation \n\n\n\nby dedicated pharmacists\" (4.75\u00b10.45) and \"VR reality \n\n\n\nteaching\" (4.42\u00b10.51). Conclusion: Through process \n\n\n\nreengineering and refined personnel education, it can \n\n\n\neffectively improve the non-conformance events of the \n\n\n\npharmacist performing microbial monitoring operations. \n\n\n\nHowever, the follow-up should continue to analyse, review \n\n\n\nand revise the relevant operating procedures at any time. \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:rtangsagha@gmail.com\n\n\nmailto:ed100221@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n116 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 102 \n \n\n\n\nThe Role of High Serum Uric Acid Levels \n\n\n\nin Androgenic and Non-Androgenic \n\n\n\nPolycystic Ovarian Syndrome Patients \n\n\n\n\n\n\n\nSrinivasa Babu Puttagunta1*, Ranakishor \n\n\n\nPelluri1, Srikanth Kongara2 \n\n\n\n\n\n\n\n1 Department of Pharmacy Practice, Vignan Pharmacy College, Vadlamudi, \n\n\n\n522213, Guntur, Andhra Pradesh, India.  \n2 Department of Endocrinology and Metabolism, Endo-Life Speciality \n\n\n\nHospital, Guntur, 522001, Andhra Pradesh, India. \n\n\n\n* Corresponding author \n\n\n\nEmail: psbabu0104@gmail.com  \n\n\n\n\n\n\n\nBackground and Objectives: Serum uric acid (SUA) has \n\n\n\nbeen found to be an independent risk factor for metabolic \n\n\n\nsyndrome (MS). However, the reports pertaining to link \n\n\n\nbetween uric acid levels among the androgenic, non-\n\n\n\nandrogenic (clinical) PCOS subjects are conflicting. Hence, \n\n\n\nit was aimed to determine incidence of hyperuricemia and its \n\n\n\nassociation among the PCOS subjects. Methods: A single \n\n\n\ncentre hospital based cross-sectional study conducted in \n\n\n\nsouth India PCOS subjects during the March 2021 to August \n\n\n\n2021. A total 80 subjects were recruited and were stratified \n\n\n\ninto androgenic and no androgenic PCOS with each of forty \n\n\n\nsubjects in both groups. The incidence of hyper uricemia was \n\n\n\nfound to be 66.25% (n = 53). Results and Discussion: The \n\n\n\nmean and SD values of metabolic components such as \n\n\n\nHbA1C and FPG levels and triglycerides, low density \n\n\n\nlipoproteins and total cholesterol were showing statistically \n\n\n\nsignificant (p < 0.05) among the groups. The circulating sex \n\n\n\nhormone binding globulins (SHBG) are low in both groups. \n\n\n\nThese levels are significantly low in androgenic PCOS \n\n\n\nsubjects. The Total testosterone (TT), SHBG, HOMA-IR and \n\n\n\nLDL levels were positively correlated with both hyper and \n\n\n\nnon-hyper urinemic groups and remaining parameters \n\n\n\nshowed negative correlation. Conclusion: The incidence of \n\n\n\nhyperuricemia is high in PCOS subjects. The TT and SHBG, \n\n\n\nHOMA-IR and LDL levels were positively correlated with \n\n\n\nboth hyper and non-hyper urinemic groups. HbA1C and FPG \n\n\n\nand FSI are negatively correlated among the groups. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 103 \n\n\n\n\n\n\n\nLow-dose Cefepime Efficacy Evaluation \n\n\n\nUsing Real-world Data \n\n\n\n\n\n\n\nTY Yi*, AJ Wu  \n\n\n\n\n\n\n\nDepartment of Pharmacy, Taipei Tzu Chi Hospital, Buddhist Tzu Chi \n\n\n\nMedical Foundation, New Taipei City, Taiwan \n\n\n\n* Corresponding author \n\n\n\nEmail: taiyung.yi@gmail.com  \n\n\n\n\n\n\n\nBackground and Objectives: A review of the cefepime \n\n\n\nmedication records revealed that most physicians prescribed \n\n\n\ndoses within UpToDate's usual range, which is above 2 \n\n\n\ngrams per day, while a few did not exceed 2 grams per day. \n\n\n\nThe purpose of this investigation was to determine whether \n\n\n\nlow-dose cefepime was insufficiently effective. Methods: \n\n\n\nThis retrospective study covered the period from 2016 to \n\n\n\n2021. Inclusion criteria: patients admitted to the hospital who \n\n\n\nreceived cefepime. Exclusion criteria: under the age of 20 or \n\n\n\nnot consecutively using cefepime. Low-dose is defined as a \n\n\n\ndaily dosage not exceeding 2 grams and an eGFR greater than \n\n\n\n60 mL/min/1.73 m2. Propensity score matching was used \n\n\n\nbecause there were few low-dose cases. Gender, age, eGFR, \n\n\n\nCRP, and WBC were used as the matching variables. Effect \n\n\n\nindicators were hospitalization days, medication days, CRP \n\n\n\nchanges, and WBC changes. Two-sample t test was \n\n\n\nperformed. Results and Discussion: There were 41 \n\n\n\nparticipants in each of the low-dose and non-low-dose groups, \n\n\n\nand 26 (63%) of them were males. The mean (SD) of \n\n\n\ncontinuous variables: age was 73.0(16.1) and 73.3(19.6), \n\n\n\neGFR was 93.5(18.9) and 92.4(21.5), WBC was \n\n\n\n8750(6280)/mcL and 10280(6970)/mcL, CRP was 7.1(4.9) \n\n\n\nmg/dL and 6.5(5.7) mg/dL. The results of the efficacy \n\n\n\ncomparison between the low-dose group and the non-low-\n\n\n\ndose group (represented by their respective mean values and \n\n\n\np values): the number of days of medication was 7.4 days, 6.2 \n\n\n\ndays, p = 0.238, the days of hospitalization were 26.4 days, \n\n\n\n28.9 days, p = 0.507, WBC differences were 1000/mcL, \n\n\n\n860/mcL, p=0.888, CRP differences were -1.3mg/dL, -\n\n\n\n0.3mg/dL, p=0.216, all efficacy indicators were not \n\n\n\nstatistically significant. Research limitations include: 1. \n\n\n\nConfounding factors are difficult to control in observational \n\n\n\nstudies; 2. Antibiotic prescriptions are not dependent on test \n\n\n\nresults, and variables have missing values. In the low-dose \n\n\n\ngroup, hospitalizations were slightly lower, but medication \n\n\n\ndays were slightly higher. As there was no statistical \n\n\n\ndifference, it is still necessary to examine whether taking into \n\n\n\naccount efficacy can actually reduce the consumption of \n\n\n\nmedical resources. Conclusion: A low dose was not \n\n\n\nassociated with lower efficacy in this study. Physicians can \n\n\n\nutilize this information in prescribing common dose ranges \n\n\n\nand making clinical decisions. \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:psbabu0104@gmail.com\n\n\nmailto:taiyung.yi@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n117 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 104 \n \n\n\n\nIncidence of Liver Injury in Patients \n\n\n\nInitiated with Antiretroviral Therapy in \n\n\n\nPrimary Care Clinics \n\n\n\n\n\n\n\nKausalya Nawaratnam1, Siow Chia Tay1*, \n\n\n\nSumayyah Shafifi A Karim1, Nur Khalidah \n\n\n\nMohd Musa2 \n\n\n\n \n1 Department of Pharmacy, Cheras Health Clinic, Federal Territory of Kuala \n\n\n\nLumpur & Putrajaya Health Department , Ministry of Health Malaysia  \n2 Department of Pharmacy, Cheras Baru Health Clinic, Federal Territory of \n\n\n\nKuala Lumpur & Putrajaya Health Department, Ministry of Health Malaysia  \n\n\n\n* Corresponding author \n\n\n\nEmail: siowchia@hotmail.com  \n\n\n\n\n\n\n\nBackground and Objectives: Liver injury is an alanine \n\n\n\naminotransferase (ALT) elevation of greater than 1.25 times \n\n\n\nthe upper limit of normal (ULN) values. Drug-induced liver \n\n\n\ninjury affected the clinical use of antiretroviral therapy \n\n\n\n(ART). This study aimed to assess the incidence of liver \n\n\n\ninjury on ART initiation and to identify any contributing risk \n\n\n\nfactors. Methods: We conducted a retrospective cohort study \n\n\n\n(NMRR ID: NMRR-20-1482-54763) involving 362 HIV \n\n\n\npositive patients with normal liver function initiated with \n\n\n\nfirst-line ART in 15 primary health clinics in Kuala Lumpur \n\n\n\nand Putrajaya, Malaysia from May 2017 to December 2019. \n\n\n\nBaseline ALT measurements were recorded and followed up \n\n\n\nmonthly for 12 months. Chi-square and Fisher\u2019s exact tests \n\n\n\nwere used to study the association of liver injury with ART \n\n\n\nregimen, concomitant Pneumocystis carinii pneumonia (PCP) \n\n\n\nprophylaxis and isoniazid prophylaxis therapy (IPT). Cox-\n\n\n\nregression analysis was used to identify risk factors involved.  \n\n\n\nResults and Discussion: Upon ART initiation, the incidence \n\n\n\nof liver injury was 34 cases/100 person-year while that of \n\n\n\nsevere liver injury was 2 cases/100 person-year. Mild and \n\n\n\nmoderate liver injury cases increased over the first three \n\n\n\nmonths of ART exposure and gradually reduced starting \n\n\n\nfourth month. Subjects using Tenofovir/Emtricitabine \n\n\n\nregimen developed higher liver injury risk compared to \n\n\n\nLamivudine/Zidovudine regimen (p=0.035, OR=2.174). No \n\n\n\nsignificant difference was found between subjects using \n\n\n\nEfavirenz and Nevirapine. Concomitant PCP prophylaxis \n\n\n\ndemonstrated significantly lower risk of liver injury (p=0.006, \n\n\n\nOR=0.483) while higher risk was observed with concomitant \n\n\n\nIPT (p=0.019, OR=1.793). Conclusion: In summary, \n\n\n\nmonthly monitoring of liver enzymes was important for the \n\n\n\nfirst three months of ART initiation. Subjects initiated with \n\n\n\ntenofovir/emtricitabine, with concomitant isoniazid therapy \n\n\n\nand without PCP prophylaxis were the high-risk groups that \n\n\n\nrequired close monitoring of the liver enzymes. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 105 \n \n\n\n\nEvaluation of Chinese Herbal Extracts on \n\n\n\nEczema Skin \n\n\n\n\n\n\n\nSC Tseng1, 2*, JS Wang2, MM Lee3  \n \n1 Taiwan Pharmacist Association, Taichung City Pharmacist Association, \n\n\n\nTaichung, Taiwan  \n2 Department of Clinical Research Center of Integrated Medicine, Taichung \n\n\n\nTzu Chi Hospital, Taichung, Taiwan \n3 Department of Food Nutrition and Health Biotechnology, Asia University, \n\n\n\nTaichung, Taiwan \n\n\n\n* Corresponding author \n\n\n\nEmail: bigtree621031@gmail.com  \n\n\n\n\n\n\n\nBackground and Objectives: About 10% people in the U.S. \n\n\n\nhave eczema during their lifetime. Steroids are commonly \n\n\n\nused in treating eczema but can easily lead to many side \n\n\n\neffects. Eczema is often difficult to be cured, and severely \n\n\n\naffects patients\u2019 quality of life. It\u2019s an important issue worth \n\n\n\nfurther study. According to the composition of the traditional \n\n\n\nChinese medicine prescription, \"ku shen si tang\", we add \n\n\n\nother Chinese herbal extracts such as Plectranthus \n\n\n\namboinicus and Salvia plebeia to make a cream. It is applied \n\n\n\nto the affected area of eczema. Methods: This study was \n\n\n\nconducted in the Department of Traditional Chinese \n\n\n\nMedicine of Taichung Tzu Chi Hospital, from April to \n\n\n\nNovember in 2021. Patients aged 20 to 80 years old \n\n\n\ndiagnosed with eczema were included in the study. The \n\n\n\nexperimental cream was applied to the lesion twice a day. \n\n\n\nThree questionnaires (DLQI, SCORAD, and EASI) were \n\n\n\nused every two weeks to evaluate the outcome, and there \n\n\n\nwere 6 visits during this 12 weeks study. Results and \n\n\n\nDiscussion: We recruited finally 10 cases. The statistical \n\n\n\nresults of DLQI were highly affected to mildly affected (16.2 \n\n\n\nto 4.5); of SCORAD were moderately affected to mildly \n\n\n\naffected (34.52 to 10.42); and of EASI were mildly affected \n\n\n\nto mildly affected (4.98 to 1.39). All of those were showed \n\n\n\nsignificantly improved after treatments. Conclusion: The \n\n\n\ncream formulation of Chinese medicine extracts is effective \n\n\n\nin treating patients with eczema and has no side effects. \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:siowchia@hotmail.com\n\n\nmailto:bigtree621031@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n118 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 106 \n \n\n\n\nInterprofessional Collaborative Practice in \n\n\n\nHIV Patient: Role of Pharmacist in A \n\n\n\nRegional Hospital \n\n\n\n\n\n\n\nTsung Wei Chang1*, Chun-Ya Huang2, Wen-\n\n\n\nJin Tung1 \n\n\n\n  \n1 Department of Pharmacy, Yuanlin Christian Hospital    \n2 Infection control center, Yuanlin Christian Hospital \n\n\n\n* Corresponding author \n\n\n\nEmail: howard6204@gmail.com  \n\n\n\n\n\n\n\nBackground and Objectives: Dispensing and providing \n\n\n\nmedication is basic service in regional hospital pharmacy \n\n\n\nsetting. With the progress of diverse pharmaceutical care \n\n\n\nprovided by clinical pharmacist, our hospital has also \n\n\n\nimplemented pharmacy service for HIV patient and \n\n\n\npharmacist cooperated with different medical staff such as \n\n\n\nphysician and HIV case manager. In this article, we would \n\n\n\nlike to share our experience and common drug-related \n\n\n\nproblems during providing HIV care. Methods: Since 2019, \n\n\n\nour infection department decided to provide medical service \n\n\n\nfor HIV patient. According to the project from Centers for \n\n\n\nDisease Control, Ministry of Health and Welfare in Taiwan, \n\n\n\npharmacists were regulated to be one of a member in HIV \n\n\n\npatient care team. We collected pharmaceutical care related \n\n\n\nto HIV care form 2019-2022. Results and Discussion: \n\n\n\nPharmacists were got involved in rural health care with \n\n\n\nphysician and HIV case manager monthly, and we can \n\n\n\ncommunicate with each other via face to face, social software \n\n\n\nor phone call smoothly. Pharmacists were also responsible \n\n\n\nfor patient or health care member education, such as \n\n\n\ndelivering speech \u201cNovel trend in antiviral agent in HIV\u201d or \n\n\n\n\u201calleviating discrimination in HIV patient\u201d. Additionally, we \n\n\n\nprovided thirty interaction-related consultations for HIV \n\n\n\npatients. Among these consultations, we found interactions \n\n\n\nbetween nutrition supplements and antiretroviral drugs were \n\n\n\nasked most frequently. Conclusion: Pharmacists can be in \n\n\n\ndifferent clinical teams and collaborate with others \n\n\n\nprofessionals\u2019 members. With the pharmacy service, drug-\n\n\n\nrelated problem form HIV patients can be solved. It might \n\n\n\nincrease the drug compliance and enhance better disease \n\n\n\ncontrol. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 107 \n \n\n\n\nThe Prevalence of Major Drug\u2013drug \n\n\n\nInteractions in Patients Treated with \n\n\n\nNirmatrelvir plus Ritonavir: A \n\n\n\nRetrospective Study \n\n\n\n\n\n\n\nTu Po-Yang1*, Liu Min-Li 1, Hsu Yung-Chia 1, \n\n\n\nHsiang Yi-Ping2 \n\n\n\n \n1 Department of Pharmacy, E-Da Cancer Hospital, \n2 Department of Pharmacy, E-Da Hospital, Kaohsiung, Taiwan, R.O.C \n\n\n\n* Corresponding author \n\n\n\nEmail: kenny42064206@gmail.com  \n\n\n\n\n\n\n\nBackground and Objectives: Nirmatrelvir plus ritonavir \n\n\n\n(Paxlovid\u00ae) is an antiviral agent, which is used as the \n\n\n\ntreatment of mild to moderate Coronavirus Disease (COVID-\n\n\n\n19). Ritonavir is a potent CYP3A4 inhibitor that interacts \n\n\n\nwith many other medications.  We assessed the prevalence of \n\n\n\nmajor drug-drug interactions (DDIs) among patients who \n\n\n\nwere prescribed Paxlovid \u00ae and summarised the data to find \n\n\n\nout which drug class may be commonly involved in major \n\n\n\nDDI with Paxlovid\u00ae. Methods: We utilized our hospital\u2019s \n\n\n\ncomputer-based medication prescription system to search for \n\n\n\nthe DDIs between Paxlovid\u00ae and other medications. The \n\n\n\nlevel of drug-drug interaction was identified mainly by the \n\n\n\nwebsite, Liverpool and manual screening methods. We \n\n\n\ncategorized the drug related to major DDI according to their \n\n\n\ndrug class. Results and Discussion: We collected the data \n\n\n\nfrom June to July in 2022. In the 203 patients included in this \n\n\n\nstudy, 188 patients from out-patients and 15 from emergency, \n\n\n\n92 major DDIs were found in 50 (24.6%) patients. 72 major \n\n\n\nDDIs were classified as \u201cpotential interaction\u201d and 20 DDIs \n\n\n\nclassified as \u201cDo Not Coadminister\u201d. Cardiovascular \n\n\n\nmedications were most associated with major DDIs, and \n\n\n\npsychotropic medications took the second place. In \n\n\n\ncardiovascular medications, atorvastatin and rosuvastatin \n\n\n\nwere concerned in most major DDIs cases. Clonazepam, \n\n\n\ntriazolam and silodosin were the most common medications \n\n\n\nwhich were contraindicated with Paxlovid \u00ae. Conclusion: \n\n\n\nPatients on Paxlovid\u00ae therapy may be at risk of potential \n\n\n\nDDIs. This study provided a descriptive statistic to the \n\n\n\nprevalence of DDIs in patients treated with Paxlovid\u00ae. \n\n\n\nPharmacists should be more aware of these frequent DDIs \n\n\n\nand manage them properly. \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:howard6204@gmail.com\n\n\nmailto:kenny42064206@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n119 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 108 \n \n\n\n\nUsing Plan-Do-Check-Action Management \n\n\n\nMethods to Improve Medication Errors in \n\n\n\nTaiwan Hospital \n\n\n\n\n\n\n\nYih-Dih Cheng1,2*, Wei-Ning Yu1,2, Sonia \n\n\n\nChen1,3, Chun-Ju Kuo1, Yo-Wen Hsieh1, 2 \n\n\n\n \n1 Department of Pharmacy, China Medical University Hospital, Taichung, \n\n\n\nTaiwan \n2 School of Pharmacy, China Medical University, Taichung, Taiwan \n3 Department of Health Services Administration, China Medical University, \n\n\n\nTaichung, Taiwan \n\n\n\n* Corresponding author \n\n\n\nEmail: tovis168@gmail.com  \n\n\n\n\n\n\n\nBackground and Objectives: The percentage of medication \n\n\n\nerrors was found about 36% (24,846/68,203) in hospital \n\n\n\naccording to the Annual Report 2020 of Taiwan Patient-\n\n\n\nsafety Reporting System. The rate of medication error is \n\n\n\nabout 0.0145% (2,695/18,551,036) in our hospital in 2020. \n\n\n\nThe objective of this study was to evaluate whether using \n\n\n\nPlan-Do-Check-Action (PDCA) management methods to \n\n\n\nimprove medication error at each stage of the medication \n\n\n\nprocess. Methods: The study was conducted in a 2,111-bed \n\n\n\ncare academic medical center located in central Taiwan. We \n\n\n\nassessed the error rates of medications at each stage of the \n\n\n\nmedication process before and after implementing eight \n\n\n\nPDCA management methods, including all patient \n\n\n\nprescriptions from January 2020 to June 2022. PDCA cycle \n\n\n\nis also known as the quality cycle, which is a general model \n\n\n\nin the management model. Results and Discussion: Six \n\n\n\nmajor problems were found after reviewing the medication \n\n\n\nprocess, and the eight PDCA strategy and effectiveness \n\n\n\nverification are as follows: PDCA strategy 1~4 \u2013 Reducing \n\n\n\nthe medication error of the physician's prescription. The error \n\n\n\nrate of prescribing was significantly reduced from 0.0175% \n\n\n\n(Q1/2020) to 0.0044% (Q2/2022) (p < 0.005) after using \n\n\n\nPDCA strategy 1~4. PDCA strategy 5~7 \u2013 Reducing the \n\n\n\nmedication error of the pharmacist dispensing. The error rate \n\n\n\nof dispensing was reduced from 0.0041% (Q1/2020) to \n\n\n\n0.0007% (Q2/2022) (p < 0.005) after using PDCA strategy \n\n\n\n5~7. PDCA strategy 8 \u2013 Reducing the medication error of the \n\n\n\nnursing administration. Implementation of automated \n\n\n\ndispensing cabinet (ADC). The rate of administering error \n\n\n\nwas reduced from 0.0003% (Q1/2020) to 0.0001% (Q2/2022) \n\n\n\n(p = 0.207) after using PDCA strategy 8. The medication \n\n\n\nerror rate was significantly decreased about 75% from 0.0221% \n\n\n\n(Q1/2020) to 0.0055% (Q2/2022) (p < 0.005) through \n\n\n\ncontinuous improvement for about two years using eight \n\n\n\nPDCA strategies in our hospital. Conclusion: Repeated \n\n\n\nPDCA cycles could significantly decrease the incidence of \n\n\n\nmedication errors at each stage of the medication process, \n\n\n\nreduce potential medical risks, and ensure the safety of drug \n\n\n\nuse in patients. Overall, our results suggest that the PDCA \n\n\n\nmanagement methods deserves strong consideration as a tool \n\n\n\nto reduce medication error and to improve patient safety. \n\n\n\n\n\n\n\nAbstract 109 \n \n\n\n\nEvaluation of the Appropriateness of \n\n\n\nAntibiotics Doses in Critically Ill Patients \n\n\n\nReceiving Extracorporeal Membrane \n\n\n\nOxygenation System [ECMO] \n\n\n\n\n\n\n\nWen-Hwang Chen1,2*, Chu-Chen, Cheng1,2 \n\n\n\n\n\n\n\n1 Department of Pharmacy, Tungs' Taichung MetroHarbor Hospital, \n\n\n\nTaiwan. \n2 Taichung City New Pharmacist Association, Taichung, Taiwan \n\n\n\n* Corresponding author \n\n\n\nEmail: t2619@ms.sltung.com.tw \n \n\n\n\nBackground and Objectives: Interactions between ECMO \n\n\n\nequipment materials and antibiotics had changed human \n\n\n\nhemodynamics and antibiotics pharmacokinetics. This \n\n\n\nsituation may affect the efficacy of the drug or increase the \n\n\n\npossibility of related adverse reactions, so whether the dosage \n\n\n\nof the drug needed adjustment became an important issue in \n\n\n\nthis type of patients. Here we tried to analyse and determine \n\n\n\nthe rationality of antibiotic dosage in our hospital for patients \n\n\n\nwith ECMO. Methods: This study is a retrospective clinical \n\n\n\nstudy analysis. Data collected from 2018.01.01 to 2019.09.30. \n\n\n\nA total of 46 patients with conditions that needed ECMO \n\n\n\nsupport were used to analyse the difference and rationality \n\n\n\nbetween the antibiotic dose and the dose recommended in the \n\n\n\nliterature. Results and Discussion: In these 46 patients, a \n\n\n\ntotal of 105 doses of antibiotics were given, of which 58.1% \n\n\n\nadhered to the dosing recommendations for patients on \n\n\n\nECMO. In this 58.1% ,  piperacillin/tazobactam accounted \n\n\n\nthe highest at 19.7% followed by ceftriaxone 16.4%, and \n\n\n\nvancomycin 16.4%, imipenem/cilastatin 14.8%, cefazolin \n\n\n\n13.1%, gentamicin 6.6%, levofloxacin 3.3%, moxifloxacin \n\n\n\n3.3%, etc. 45.9% of our patients were given standard dose \n\n\n\nwhile 54.1% were not. Furthermore, if we excluded impaired \n\n\n\nrenal function patients, 85.2% of our patients met the \n\n\n\nrecommended standard dose for patients on ECMO machine. \n\n\n\nIn our hospital there was high rate of compliance but it is \n\n\n\nunclear whether physicians have considered drug \n\n\n\npharmacokinetics when patient with ECMO devices. In \n\n\n\naddition, 14.8% of antibiotics we used had never been studied \n\n\n\nin critically ill patients receiving ECMO hence no \n\n\n\nrecommended standard dose was given. Conclusion: \n\n\n\nHowever, clinicians need to pay attention to dose adjustment \n\n\n\nor monitoring of efficacy when using these antibiotics since \n\n\n\ntheir renal function may change. I hope that more studies \n\n\n\nestablish a new guideline in order to optimize drug dosing in \n\n\n\ncritically ill patients receiving ECMO. \n\n\n\n \n\n\n\n\nmailto:tovis168@gmail.com\n\n\nmailto:t2619@ms.sltung.com.tw\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n120 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 110 \n \n\n\n\nReal-world Efficacy of Low-dose Cefepime: \n\n\n\na Retrospective Study \n\n\n\n\n\n\n\nKR Yang*, TY Yi, TR Peng, AJ Wu \n\n\n\n \n Department of Pharmacy, Taipei Tzu-Chi Hospital, Buddhist Tzu Chi \n\n\n\nMedical Foundation, New Taipei City, Taiwan \n\n\n\n* Corresponding author \n\n\n\nEmail: a0975778633@gmail.com  \n\n\n\n\n\n\n\nBackground and Objectives: A review of the cefepime \n\n\n\nmedication records revealed that most physicians prescribed \n\n\n\ndoses within UpToDate's recommended dosage, which is 2 \n\n\n\ngrams every 8 to 12 hours, while a few patients with normal \n\n\n\nrenal function did not receive enough dose. The purpose of \n\n\n\nthis study was to determine whether low-dose cefepime was \n\n\n\neffective. Methods: This retrospective study covered the \n\n\n\nperiod from 2016 to 2021. The inclusion criteria were met as \n\n\n\nfollow: 1. Hospitalized patients receiving cefepime; 2. eGFR \n\n\n\ngreater than 60 mL/min/1.73 m2; 3. Age over 20. The \n\n\n\noutcomes included the length of hospital stay, duration of \n\n\n\ncefepime use, the change in CRP, and the change in WBC. \n\n\n\nTwo-sample t test was performed. Results and Discussion: \n\n\n\nThere were 41 participants in each of the low-dose and non-\n\n\n\nlow-dose groups, and 26 (63%) of them were males. The \n\n\n\nresults of the efficacy comparison between the low-dose \n\n\n\ngroup and the non-low-dose group (represented by their \n\n\n\nrespective mean values and p values): the mean length of \n\n\n\nhospital stay were 26.4 days, and 28.9 days (p=0.507), the \n\n\n\nmean use durations of cefepime were 7.4 days vs 6.2 days \n\n\n\n(p=0.238), the change in CRP were -1.3mg/dL, and -\n\n\n\n0.3mg/dL (p=0.216), and the change in white blood cells \n\n\n\nwere 1000/mcL, and 860/mcL (p=0.888). The length of \n\n\n\nhospital stay were slightly lower in low-dose group, but the \n\n\n\nmean days of cefepime use were slightly higher than non-\n\n\n\nlow-dose group. There was no statistical difference between \n\n\n\ntwo groups. Conclusion: The efficacy of low-dose cefepime \n\n\n\nis similar to non-low-dose group in this study. But it is still \n\n\n\nnecessary to carefully evaluate the efficacy of low-dose \n\n\n\ncefepime. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nAbstract 111 \n \n\n\n\nThe Effectiveness of Pharmacist \n\n\n\nIntervention in Heart Failure Integrated \n\n\n\nClinic \n\n\n\n\n\n\n\nYi-Fang Weng, Kai-Ruei Yang, Jui-Mei Tsuo, \n\n\n\nAn-Jan Wu, Tzu-Rong Peng* \n \n\n\n\nDepartment of Pharmacy, Taipei Tzu-Chi Hospital, Buddhist Tzu Chi \n\n\n\nMedical Foundation, New Taipei City, Taiwan \n\n\n\n* Corresponding author \n\n\n\nEmail: tch36994@tzuchi.com.tw  \n\n\n\n\n\n\n\nBackground and Objectives: Heart failure (HF) integrated \n\n\n\ncare can help to improve symptom control and quality of life. \n\n\n\nFurthermore, good medication adherence and using \n\n\n\nguideline-recommended medical therapy (GRMT) for \n\n\n\npatients with HF are beneficial to reduce hospitalization due \n\n\n\nto HF (HHF), mortality, and cardiovascular (CV) events. \n\n\n\nTherefore, the study aimed to analyse the effectiveness of \n\n\n\npharmacists\u2019 intervention in HF integrated care in clinics. \n\n\n\nMethods: The observational study was conducted by the 6-\n\n\n\nmonth program of HF integrated care of clinic in a single \n\n\n\nmedical institute in Taiwan. Patients with a new diagnosis of \n\n\n\nHF from 2017/12 to 2021/12 and fully participating in this \n\n\n\nprogram were included. The pharmacists in the program \n\n\n\nprovided medication education and monitored medication \n\n\n\nadherence to ensure patients take medicine appropriately. \n\n\n\nThe use pattern analysis contained the use categories of \n\n\n\nGRMT for HF and their use rate with the target dose. The \n\n\n\neffectiveness was assessed by changes from baseline in left \n\n\n\nventricular ejection fraction (LVEF), HHF, and occurrence \n\n\n\nof CV events within 6 months. Results and Discussion: \n\n\n\nThere were 32 patients with a mean age of 68.2, including 25 \n\n\n\nmales (84.4%) and 7 females (15.6%), with well medication \n\n\n\nadherence. Twenty-six patients received ACEI/ARB/ARNI \n\n\n\n(81.3%), but 2 of them used olmesartan not listed as GRMT. \n\n\n\n30 individuals received beta-blockers of GRMT (93.8%) and \n\n\n\n4 patients added ivabradine to lower heart rate (12.5%); \n\n\n\nbesides, 21 patients used spironolactone (65.6%). In patients \n\n\n\nreceiving ACEI/ARB/ARNI, beta-blockers/ivabradine, and \n\n\n\nspironolactone, 70.8%, 93.5%, and 47.6% of individuals \n\n\n\nachieved the target dose, respectively. The average LVEF \n\n\n\nincreased by 21.7% from baseline. Despite five CV events \n\n\n\noccurring, there was no HHF or death within 6 months. \n\n\n\nConclusion: Through pharmacists\u2019 intervention, individuals \n\n\n\nin HF integrated care in the OPD clinic had optimal \n\n\n\nmedication adherence to GRMT and their average LVEF was \n\n\n\nimproved without any HHF or death. \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:a0975778633@gmail.com\n\n\nmailto:tch36994@tzuchi.com.tw\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n121 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 112 \n\n\n\n\n\n\n\nTopiramate May Not Increase Risk of Age-\n\n\n\nrelated Macular Degeneration: A \n\n\n\nPopulation-based Cohort Study in Taiwan \n\n\n\n\u2013 A Preliminary Report \n\n\n\n\n\n\n\nSonia Chen1,2, Ying-Shu You3, Yih-Dih \n\n\n\nCheng1,4*, Yo-Wen Hsieh1,4, Chien-Ying \n\n\n\nLee5,6, Kuang-Hua Huang2 \n\n\n\n \n1 Department of Pharmacy, China Medical University Hospital, Taichung, \n\n\n\nTaiwan \n2 Department of Health Services Administration, China Medical University, \n\n\n\nTaichung, Taiwan \n3 Institute of Epidemiology and Preventive Medicine, College of Public \n\n\n\nHealth, National Taiwan University, Taipei, Taiwan \n4 School of Pharmacy, China Medical University, Taichung, Taiwan \n5 Department of Pharmacology, Chung Shan Medical University, Taichung, \n\n\n\nTaiwan \n6 Department of Pharmacy, Chung Shan Medical University Hospital, \n\n\n\nTaichung, Taiwan \n\n\n\n* Corresponding author \n\n\n\nEmail: tovis168@gmail.com  \n\n\n\n\n\n\n\nBackground and Objectives: Topiramate is an effective \n\n\n\nantiepileptic drug for seizure and migraine. Evidence that \n\n\n\nsupported an association of topiramate and maculopathy \n\n\n\nwere limited to case reports or series. The aim of this study \n\n\n\nwas to determine if an association exists between topiramate \n\n\n\nuse and age-related macular degeneration (AMD) in a \n\n\n\nnationwide population-based cohort study. Methods: This \n\n\n\ncohort study used claims data from the Taiwan National \n\n\n\nHealth Insurance Research Database for the 2000\u20132015 \n\n\n\nperiod. We analysed 10836 topiramate users and 10836 age, \n\n\n\ngender, index year and comorbidities matched control \n\n\n\npatients (non-topiramate users) at a ratio of 1: 1. The risk of \n\n\n\nAMD was analysed using Kaplan\u2013Meier analysis with log-\n\n\n\nrank test, followed by Cox proportional hazard regression. \n\n\n\nResults and Discussion: The incidence of topiramate users \n\n\n\nfor AMD risk was 0.96 per 1000 person-year, while the \n\n\n\nincidence of non-topiramate user was 1.05 per 1000 person-\n\n\n\nyear. The proportion of patients who developed AMD in the \n\n\n\npatients receiving topiramate was not different from that of \n\n\n\nthe control patients (p = 0.506, X2 test). The AMD free \n\n\n\nsurvival was not different between the patients receiving \n\n\n\ntopiramate and the control patients (p = 0.569, log-rank test) \n\n\n\nin Cox proportional hazard regression. Conclusion: \n\n\n\nTopiramate may not increase the risk of AMD in an \n\n\n\nobservational nationwide cohort study. This study did not \n\n\n\nfind the relationship between topiramate use and AMD \n\n\n\nincidence, regardless of sex, among a Taiwanese population \n\n\n\nof patients. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 113 \n\n\n\n\n\n\n\nOptimisation of Medications by \n\n\n\nPharmacists in A Respiratory Care Ward \u2013 \n\n\n\nThe Experience from A Regional Hospital \n\n\n\nin Northern Taiwan \n\n\n\n\n\n\n\nCY Yu*, SH Hsu  \n \n\n\n\nDepartment of Pharmacy, Taipei City Hospital Yangming Branch, Taipei, \n\n\n\nTaiwan. \n\n\n\n* Corresponding author \n\n\n\nEmail: charicy.yu@gmail.com  \n\n\n\n\n\n\n\nBackground and Objectives: Patients depending on \n\n\n\nprolonged mechanical ventilators in Taiwan are stepped \n\n\n\ndown in the respiratory care ward (RCW) for further \n\n\n\nrespiratory care. Although these patients are relatively stable \n\n\n\nwith the goal of weaning off ventilators, they may \n\n\n\noccasionally experience acute symptoms or have multiple \n\n\n\nunderlying comorbidities that need pharmacotherapy. \n\n\n\nInterventions by pharmacists have always been considered as \n\n\n\nvaluable input in the patient care process for reducing \n\n\n\nmedication errors, rationalizing prescriptions, and lowering \n\n\n\nthe cost of therapies. The present study aims to describe the \n\n\n\nnecessary interventions conducted by pharmacists to \n\n\n\noptimize pharmacotherapy in an RCW of a regional hospital \n\n\n\nin northern Taiwan. Methods: The retrospective electronic \n\n\n\nmedical records data were obtained for a period of 2 years \n\n\n\n(from 2020 to 2021) comprising the patient demographics, \n\n\n\nmedication-related information, and the specific \n\n\n\ninterventions suggested by the pharmacists. The data were \n\n\n\nevaluated, classified, and submitted to descriptive analysis. \n\n\n\nResults and Discussion: A total of 136 pharmacists\u2019 \n\n\n\ninterventions were performed with an acceptance rate of 97.8% \n\n\n\nin 97 patients. The main interventions include dose \n\n\n\nadjustment (21.4%), deletion of a drug (19.9%), drug \n\n\n\ninteraction monitoring (19.1%), microbiological culture \n\n\n\nrequest (17.6%), addition of a drug (13.2%), and others \n\n\n\n(8.8%). Among the adjusted medications, gastrointestinal \n\n\n\nagents (25%) and glucocorticoids (20.6%) were the most \n\n\n\ncommon classes involved, followed by antibiotics (19.1%), \n\n\n\ncardiovascular agents (14.7%), antiepileptics (13.2%), and \n\n\n\nothers (7.4%). Pharmaceutical interventions showed \n\n\n\nbeneficial in clinical (87.5%), preventive (52.2%) and \n\n\n\neconomic (48.5%) impacts. Conclusion: Other than \n\n\n\nrespiratory care, pharmacists\u2019 interventions appear to provide \n\n\n\nadditional pharmaceutical care for patients admitted to the \n\n\n\nRCW. These interventions not only improve the clinical \n\n\n\noutcomes but also beneficial for preventive and economic \n\n\n\nimpacts. \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:tovis168@gmail.com\n\n\nmailto:charicy.yu@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n122 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 114 \n\n\n\n\n\n\n\nPrescription Patterns for Acute Myocardial \n\n\n\nInfarction (AMI) Patients in Secondary \n\n\n\nPrevention \n\n\n\n\n\n\n\nYun-Hsin Yang* \n \n\n\n\nDepartment of Pharmacy, Tainan Municipal Hospital (Managed by Show \n\n\n\nChwan Medical Care Corporation), Taiwan \n\n\n\n* Corresponding author \n\n\n\nEmail: wennyyang830701@gmail.com  \n\n\n\n\n\n\n\nBackground and Objectives: According to the AHA/ACCF \n\n\n\nGuideline suggestions, patients should receive long-term \n\n\n\ntreatment to prevent future events or death after experiencing \n\n\n\nan acute coronary syndrome event. Medications for \n\n\n\nsecondary prevention, including DAPT, ACEI/ARB, statins, \n\n\n\nand beta-blockers, should be initiated prior to hospital \n\n\n\ndischarge. The aim of this study was to analyse the \n\n\n\nprescription patterns for acute myocardial infarction (AMI) \n\n\n\npatients in secondary prevention. Methods: We \n\n\n\nretrospectively analysed the discharge prescriptions for AMI \n\n\n\nsecondary prevention from 75 patients who experienced an \n\n\n\nAMI event in a regional teaching hospital between April \n\n\n\n2022 and August 2022. Results and Discussion: There were \n\n\n\n46 prescriptions (61.3%) with the four medications as \n\n\n\nsuggested by the AHA/ACCF guidelines. All 75 \n\n\n\nprescriptions included DAPT (100.0%); 60 prescriptions \n\n\n\nincluded ACEI/ARB (80.0%); 71 prescriptions included \n\n\n\nstatins (94.7%); and 63 prescriptions included beta-blockers \n\n\n\n(84.0%). All 75 patients in the dataset had Percutaneous \n\n\n\nCoronary Intervention (PCI) for AMI treatment, so they \n\n\n\nreceived DAPT for secondary prevention. The 15 patients \n\n\n\nwho were not prescribed ACEI/ARB had low blood pressure \n\n\n\n(Average 100/61 mmHg). The 4 patients who did not use \n\n\n\nstatins had regular LDL data (Average 73mg/dl). The 12 \n\n\n\npatients who did not need beta-blockers had regular heart \n\n\n\nrates (Average 59 bpm). Conclusion: The best prescription \n\n\n\nfor AMI secondary prevention should include DAPT, \n\n\n\nACEI/ARB, statins, and beta-blockers. However, we still \n\n\n\nneed to consider the clinical conditions of the patients to \n\n\n\nmake an individual and appropriate AMI secondary \n\n\n\nprevention prescription for patients experiencing an AMI \n\n\n\nevent. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nAbstract 115 \n\n\n\n\n\n\n\nManagement of COVID-19 Infection \n\n\n\nCombined with Bacteremia Pneumonia in \n\n\n\nCancer Patients with Neutropenia: A Case \n\n\n\nReport and Literature Review \n\n\n\n\n\n\n\nChing- Chih, Huang 1,2*, Chu-Chen, Cheng1,2  \n\n\n\n \n1Department of Pharmacy, Tungs' Taichung MetroHarbor Hospital, \n\n\n\nTaichung, Taiwan;  \n2 Taichung City New Pharmacist Association, Taichung, Taiwan  \n\n\n\n* Corresponding author \n\n\n\nEmail: amydemy@gmail.com   \n\n\n\n\n\n\n\nBackground and Objectives: COVID-19 pandemic has \n\n\n\ncontinued for almost three years. With the development of \n\n\n\nvaccine and high vaccination rate, the situation has gradually \n\n\n\nimproved. However, in cancer patients, the infection of \n\n\n\nCovid-19 can still easily induce critical situation. In this \n\n\n\nresearch, we discuss one critical case of cancer patient \n\n\n\ninfected by Covid19. Literature such as representative \n\n\n\nguidelines from ESMO (European Society for Medical \n\n\n\nOncology) and NCCN (National Comprehensive Cancer \n\n\n\nNetwork) will also be reviewed in this research. \n\n\n\nMethods/Case description: A 46 year-old patient with head \n\n\n\nand neck cancer was under chemotherapy of PF4 protocol \n\n\n\n(first day of cisplatin 75 mg/m2 and 5-fluorouracil 1000 \n\n\n\nmg/m2, followed by three days of 5-Fluorouracil 1000 \n\n\n\nmg/m2 ) and had just finished his third cycle of treatment. \n\n\n\nThree days after chemotherapy, the patient showed fever and \n\n\n\nillness. C.R.P (C-Reactive Protein), blood culture, sputum \n\n\n\nculture and severe acute respiratory syndrome coronavirus 2 \n\n\n\nAg (antigen) test were checked. Afterwards, the COVID-19 \n\n\n\nantigen test showed Positive and lab data showed WBC \n\n\n\n10500 /\u00b5L, ANC 6420 /\u00b5, C.R.P 7.49 mg/dL. Molunpiravir \n\n\n\nwas prescribed. However, high fever still persisted and \n\n\n\nrespiratory depression was noted. Therefore, Piperacillin-\n\n\n\ntazobactam and teicoplanin were prescribed. One day later, \n\n\n\nsputum culture results showed Pseudomonas aeruginosa and \n\n\n\nKlebsiella pneumoniae infection. On the fifth day after \n\n\n\nCOVID-19 tested positive, the lab data showed WBC 700 \n\n\n\n/\u00b5L, ANC 390 /\u00b5L. Consequently, G-CSF (granulocyte \n\n\n\ncolony-stimulating factor) was then prescribed. Results: \n\n\n\nAfter combining use of antiviral and antibacterial agents, the \n\n\n\nsituation of patient improved and gradually recovered from \n\n\n\nthe infection. With the use of C-G-CSF, WBC and ANC \n\n\n\nincreased to normal range. Conclusion: In cancer patients, \n\n\n\nwhile fever is noted and COVID\u201319 is tested positive, \n\n\n\nanother microorganism infection should not be ruled out and \n\n\n\ncombining use of empirical antibiotics should be considered. \n\n\n\nThe indication of G-CSF should be expanded to \n\n\n\nchemotherapy protocol with lower neutropenia risk for \n\n\n\ncancer patient during COVID-19 pandemic. \n\n\n\n\nmailto:wennyyang830701@gmail.com\n\n\nmailto:amydemy@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n123 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 116 \n \n\n\n\nAcetic Acid Derivatives Improve \n\n\n\nCardiovascular Disease in Patients with \n\n\n\nDyslipidemia \n\n\n\n\n\n\n\nChen-Sheng Chen1,6, Bo-Yi Pan2, Yu-Ting \n\n\n\nHsu2, Fang-Yu Chen2, Wen-Chin Yang3, \n\n\n\nMing-Yi Shen2,4,5,* \n \n\n\n\n1The Ph.D. Program for Cancer Biology and Drug Discovery, China Medical \n\n\n\nUniversity and Academia Sinica, Taiwan \n2Graduate Institute of Biomedical Sciences, China Medical University, \n\n\n\nTaiwan \n3Agricultural Biotechnology Research Center, Academia Sinica, Taiwan \n4Department of Medical Research, China Medical University Hospital, \n\n\n\nTaiwan \n5Department of Nursing, Asia University, Taiwan \n6Taichung City Pharmacists\u2019 Association, Taiwan  \n\n\n\n* Corresponding author \n\n\n\nEmail: shenmy1124@gmail.com   or shenmy@mail.cmu.edu.tw  \n\n\n\n\n\n\n\nBackground and Objectives: About 53% of adults in the \n\n\n\nUnited States have high LDL-C. Fewer than 50% of patients \n\n\n\nreceived treatment, and of those who received treatment, less \n\n\n\nthan 35% achieved control. In addition, patients with high \n\n\n\nLDL-C had approximately twice the incidence of \n\n\n\nAtherosclerotic Cardiovascular Disease (ASCVD) compared \n\n\n\nwith normal patients. The aim of this study was to investigate \n\n\n\nwhether anti-inflammatory drug treatment improves acute \n\n\n\ncardiovascular disease outcomes in patients with \n\n\n\ndyslipidemia. Methods: National Health Insurance Research \n\n\n\nDatabase of the Ministry of Health and Welfare of Taiwan, \n\n\n\n10,143 dyslipidemia patients were diagnosed from 2004, \n\n\n\nfollowed up from 2004 to 2013. After excluding patients with \n\n\n\nsevere comorbidities, we included eligible patients \n\n\n\n(treatment group) and matched patients receiving acetic acid \n\n\n\nderivatives. Untreated control group by propensity score \n\n\n\n(untreated group). Participants were followed for acute \n\n\n\ncoronary syndrome and stroke occurrence after receiving the \n\n\n\nacetic acid derivative or the corresponding calendar date. \n\n\n\nResults were finally presented using Cox proportional \n\n\n\nhazards models and Kaplan-Meier survival curves. Results \n\n\n\nand Discussion: Dyslipidemia patients had a higher risk of \n\n\n\ncardiovascular disease. After using acetic acid derivatives. In \n\n\n\nage, sex, comorbidities and drug treatment adjusted Cox \n\n\n\nmodels. The incidence of acute coronary syndrome (ACS) \n\n\n\nwas reduced by 36.9% (HR=0.631; CI=0.535 to 0.744; \n\n\n\nP<0.0001), and stroke was reduced by 36.3% (HR=0.637; \n\n\n\nCI=0.516 to 0.786; P<0.0001). In this study, the database was \n\n\n\ncounted, and the patients' medication compliance and living \n\n\n\nhabits could not be known, and the results may be biased. \n\n\n\nConclusion: Acetic acid derivatives reduce the incidence of \n\n\n\nACS and stroke in patients with dyslipidemia. The combined \n\n\n\nuse of acetic acid derivatives and hypolipidemic drugs may \n\n\n\nbe a new therapeutic strategy.  \n\n\n\n\n\n\n\nAbstract 117 \n\n\n\n\n\n\n\nAnalysis of Patient Self-administered \n\n\n\nSatisfaction Questionnaires in Psychiatric \n\n\n\nSpecialized Hospital \n\n\n\n\n\n\n\nChia chang Hsu1,2*, Ting Luo1,2, Tsung-Han \n\n\n\nLin1,2, Kuan-Yu Lin1,2, Kuo-Tung Chiang2, \n\n\n\nSzu-Nian Yang2 \n \n1 Department of Clinical Pharmacy, Tri-Service General Hospital Beitou \n\n\n\nBranch, Taipei, Taiwan \n2 Tri-Service General Hospital Beitou Branch, Taipei, Taiwan \n\n\n\n* Corresponding author \n\n\n\nEmail: chiachanga4046@gmail.com  \n\n\n\n\n\n\n\nBackground and Objectives: Patient satisfaction is an \n\n\n\nimportant indicator to understand patients' needs and assess \n\n\n\nthe quality of medical care. The purpose of our study is to \n\n\n\ninvestigate the patient\u2019s satisfaction with hospital services \n\n\n\nand to seek the influential factors. These factors could be \n\n\n\nused as reference to improve the quality of patient\u2019s care. \n\n\n\nMethods: Our study enrolled 100 patients or family \n\n\n\nmembers from the Military medicine ward, day-care, \n\n\n\nrehabilitation center, and outpatient clinics. The \n\n\n\nquestionnaire was designed by the five-point Likert scale. \n\n\n\nThe higher the score, the higher the level of satisfaction with \n\n\n\nhospital services. Kruskal-Wallis t-set and T-test analyses \n\n\n\nwere used to compare the differences in satisfaction of \n\n\n\ndemographic variables. A generalized linear model was used \n\n\n\nto examine the predictors of patient satisfaction, and then to \n\n\n\nexplore the relationship between demographic characteristics \n\n\n\nand patient satisfaction. Results and Discussion: The \n\n\n\ndistribution of cases was mostly male, aged from 26 to 46, \n\n\n\nuniversity graduates, outpatients, and patients themselves. \n\n\n\nThe satisfaction of inpatients was higher than outpatients. \n\n\n\nHospitalization, age, education level, and different medical \n\n\n\ndivisions were important predictors of patient satisfaction. \n\n\n\nWe found that inpatients, older age and lower education level \n\n\n\nwere correlated to higher satisfaction, and psychiatric \n\n\n\npatients had lower satisfaction than Internal medicine \n\n\n\npatients. Conclusion: Our research provides non-severe \n\n\n\nmentally ill patients' autonomous perceptions of service \n\n\n\nsatisfaction as a reference for medical care providers. More \n\n\n\nfocus should be paid on outpatients, younger patients, and \n\n\n\nhigh-educated patients to improve the overall satisfaction. \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:shenmy1124@gmail.com\n\n\nmailto:shenmy@mail.cmu.edu.tw\n\n\nmailto:chiachanga4046@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n124 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 118 \n\n\n\n\n\n\n\nDeveloping the Medication Reminder App \n\n\n\nto Improve Medication Adherence \n\n\n\n\n\n\n\nChin-Ju Chuang1,3,4, Ya-Hsin Hsueh2, Cheng-\n\n\n\nYing Hsieh1, Chiu-Yi Wu1, Yi-Pin Chen1, Pei-\n\n\n\nLing Tsai1, Yung-Cheng Huang1, Shu-Chen \n\n\n\nLin1, Ying-Chun Chen1, Yu-Chen Li1, Zhi-Yu \n\n\n\nTu1, Ling-Chiao Liao1,3,4* \n \n1Department of Pharmacy, National Taiwan University Hospital Yun-Lin \n\n\n\nBranch, Yunlin, Taiwan \n2 Department of Electronic Engineering, National Yunlin University of \n\n\n\nScience and Technology, Yunlin, Taiwan \n3 Federation of Taiwan Pharmacists Associations, Taipei, Taiwan \n4 Yunlin County Pharmacists Association, Yunlin, Taiwan \n\n\n\n* Corresponding author \n\n\n\nEmail: Y00329@ms1.ylh.gov.tw  \n\n\n\n\n\n\n\nBackground and Objectives: This study aims to develop the \n\n\n\nsecond phase of medication reminder app for the IOS \n\n\n\noperating system. We expect it may contribute to increasing \n\n\n\nmedication adherence in patients. Methods: We designed the \n\n\n\nnew version of IOS APP. Patients could use the app with their \n\n\n\nsmartphones to scan the QR code on the medication guidance \n\n\n\nleaflet. We also upgraded the app including user interfaces \n\n\n\nand overall operation process.Results and Discussion: We \n\n\n\ndeveloped a local medication reminder mobile application to \n\n\n\nimprove patient adherence with prescribed medication. The \n\n\n\nnew app called \u300c\u5168\u65b9\u4f4d\u5403\u85e5\u63d0\u9192\u8207\u8a18\u9304\u300d was developed \n\n\n\nsuccessfully. The app had the following features: Scan QR \n\n\n\ncode, Drug information, Medication reminder and \n\n\n\nMedication history. Users scan the QR code on the \n\n\n\nmedication guidance leaflet and their medication list is \n\n\n\ndirectly transmitted to the mobile phone. The app offers \n\n\n\npersonalized reminders to take medicine at the right time and \n\n\n\ninformation about drug and food interaction. Medication \n\n\n\nerrors, such as missing doses, dosing errors, duplicate \n\n\n\nmedications and drug-food interactions, could be avoided. \n\n\n\nConclusion: In the future, we will try out the new app in the \n\n\n\nDrug Counseling Room of our hospital. The pharmacists help \n\n\n\npatients download the app and teach them how to use it. We \n\n\n\nobserve users\u2019 responses and enable to measure their \n\n\n\nsatisfaction after using the app. Furthermore, we will \n\n\n\npromote the app to NTUH healthcare system and other \n\n\n\nhospitals of the Yunlin County. Medication reminder app is \n\n\n\nexpected to reduce medication error and improve patient \n\n\n\nadherence to medical prescriptions. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 119 \n\n\n\n\n\n\n\nDeterminants and Perceived Effectiveness \n\n\n\nof Self-Medication Practices for the \n\n\n\nPrevention or Treatment of COVID-19 \n\n\n\nSymptoms among Adults in Cavite \n\n\n\n\n\n\n\nNicole Allyson Carabeo, Nyah Grenadine \n\n\n\nCortez, Heather Scarllette Manalo, Cyan \n\n\n\nMeniado, Francesca Marie Manansala, Diana \n\n\n\nDalisay Orolfo* \n \n\n\n\nDr. Mariano Que College of Pharmacy, De La Salle Medical and Health \n\n\n\nSciences Institute, Cavite, Philippines \n\n\n\n* Corresponding author \n\n\n\nEmail: cyandm@my.dlshsi.edu.ph  \n\n\n\n\n\n\n\nBackground and Objectives: The increasing trend of self-\n\n\n\nmedication practices (SMPs) against COVID-19 symptoms \n\n\n\nposes numerous risks, especially in low to middle income \n\n\n\ncountries. This study aimed to determine the factors affecting \n\n\n\nSMPs through the modified Andersen model of health \n\n\n\nservice utilization, and their perceived effectiveness in \n\n\n\npreventing or treating COVID-19 symptoms among adults in \n\n\n\nCavite, Philippines. Methods: An online cross-sectional \n\n\n\nsurvey was employed between April and May 2022. Data \n\n\n\nwas analysed using descriptive and inferential statistics. \n\n\n\nResults and Discussion: Among 385 respondents, most \n\n\n\nreported having experienced fever (61.8%) and body ache \n\n\n\n(52.7%).  A total of 77.4% of the respondents performed self-\n\n\n\nmedication using one or more drugs and complementary and \n\n\n\nalternative medicine methods (CAMs) simultaneously. \n\n\n\nParacetamol (60.8%), nasal decongestants (39.5%), and \n\n\n\ncough medicines (35.1%) were the most frequently used \n\n\n\ndrugs, while vitamins and supplements (67.5%), steam \n\n\n\ntherapy (41.8%), and gargling with warm salt-water (29.1%) \n\n\n\nwere the most frequently used CAMs. Contrary to other \n\n\n\nstudies reporting high prevalence of Ivermectin use for \n\n\n\nCOVID-19, only 1.6% occurrence was found in the study. \n\n\n\nHaving minor and easy-to-treat symptoms (41.6%) were the \n\n\n\ntop reasons for self-medicating, whereas fear of worsening \n\n\n\ntheir condition (12.7%) was the top reason against the said \n\n\n\npractice. Level of knowledge (p=0.047), throat pain \n\n\n\n(p=0.038), dry cough (p=0.025), and body ache (p=0.041), \n\n\n\nwere found to be statistically associated with self-medication. \n\n\n\nThe use of all drugs, except Ivermectin, and all CAMs were \n\n\n\nsignificantly associated with perceived effectiveness. \n\n\n\nConclusion: The study found that level knowledge and \n\n\n\nseveral COVID-19 symptoms are associated with SMPs. \n\n\n\nMismatches between symptoms experienced and SMPs were \n\n\n\nalso observed; thus, the implementation of health promotion \n\n\n\nand educational campaigns to the public regarding proper use \n\n\n\nof medications and CAMs is recommended. \n\n\n\n \n\n\n\n\nmailto:Y00329@ms1.ylh.gov.tw\n\n\nmailto:cyandm@my.dlshsi.edu.ph\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n125 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 120 \n \n\n\n\nKnowledge and Perception of the General \n\n\n\nPublic in Cavite, Philippines on Counterfeit \n\n\n\nMedicines \n \n\n\n\nHannah Kristnel DV. Mesa, Danielle Marie J. \n\n\n\nGarduce, Alvin A. Vibar, Mirava A. Villamin, \n\n\n\nKatrice L. Binos* \n \n\n\n\nDr. Mariano Que College of Pharmacy, De La Salle Medical and Health \n\n\n\nSciences Institute, Cavite, Philippines. \n\n\n\n* Corresponding author \n\n\n\nEmail: hannahkristnel.mesa@gmail.com  \n\n\n\n\n\n\n\nBackground and Objectives: The problem of counterfeit \n\n\n\nmedicines persists in developing Asian countries such as the \n\n\n\nPhilippines. Increased demand for over-the-counter \n\n\n\nmedicines and use of e-commerce platforms due to the \n\n\n\nCOVID-19 pandemic have compounded the problem. Thus, \n\n\n\nthis study aimed to assess the knowledge and perception of \n\n\n\nthe general public in Cavite, Philippines on counterfeit \n\n\n\nmedicines and to identify factors associated with knowledge \n\n\n\nand perception. Methods: This study utilized a non-\n\n\n\nexperimental, analytical cross-sectional design. Participants \n\n\n\n(N = 392) were residents of Cavite aged 18-59 years old. \n\n\n\nHealthcare professionals and students were excluded from \n\n\n\nthe study. An online survey questionnaire was used to collect \n\n\n\ndata on socio-demographics, experiences in purchasing/ \n\n\n\nusing medicines, knowledge, and perception towards \n\n\n\ncounterfeit medicines. Pearson\u2019s Chi Square test and \n\n\n\nSpearman\u2019s Rho Correlation test were used to determine \n\n\n\nassociation between variables. Results and Discussion: \n\n\n\nMost respondents (48.5%) demonstrated a high level of \n\n\n\nknowledge and perceived counterfeit medicines negatively \n\n\n\n(66.1%). A significant percentage (17.9%) had a low level of \n\n\n\nknowledge, while 1.5% of respondents had a positive view of \n\n\n\ncounterfeit medicines. Most respondents viewed price as an \n\n\n\nindicator of medicine quality, and cited affordability as a \n\n\n\npossible reason for purchasing counterfeit medicines. Age, \n\n\n\nsex, and monthly household income were found to be \n\n\n\nassociated with the level of knowledge and monthly \n\n\n\nhousehold income was found to be associated with \n\n\n\nperception. Source of medicine information was also found \n\n\n\nto be associated with knowledge and perception, while \n\n\n\nfrequency of medicine purchase/ use was found to be \n\n\n\nassociated with knowledge. Conclusion: This study \n\n\n\ndemonstrated that while the majority of the general public \n\n\n\nmay oppose counterfeit medicines, factors such as \n\n\n\nunaffordability of medications and poor knowledge of \n\n\n\ncounterfeit medicines continue to put patients at risk. Thus, \n\n\n\npharmacists must play an active role in educating the public \n\n\n\nand ensuring access to quality affordable medicines. \n\n\n\n\n\n\n\nAbstract 121 \n \n\n\n\nCombined SGLT2 and ARNI Therapy to \n\n\n\nReduce the Risk of Cardiovascular Disease \n\n\n\nin Type II Diabetes: A Nationwide \n\n\n\nPopulation-base Cohort Study \n\n\n\n\n\n\n\nMing-Chi Hung1, Chiu-Lan Chen2 ,Che- huei \n\n\n\nLin1,3*, Ming-hung Lin1,3* \n\n\n\n \n1 Department of Pharmacy and Master Program, Tajen \n\n\n\nUniversity,Pintung,Taiwan \n2 Department of Pharmacy, Chia-Nan University of Pharmacology and \n\n\n\nScience, Tainan , Taiwan \n3 Fulun Chain Drugstore, Nantou City,Taiwan \n\n\n\n* Corresponding author \n\n\n\nEmail: lmh.roger@msa.hinet.net  \n\n\n\n\n\n\n\nBackground and Objectives: Both atherosclerotic \n\n\n\ncardiovascular disease (ASCVD) and heart failure are \n\n\n\nleading causes of mortality and morbidity for individuals \n\n\n\nwith diabetes and coronary heart disease. As such, it is \n\n\n\nimportant to systematically assess the risk factors associated \n\n\n\nwith CVD to prevent and manage ASCVD. Methods: The \n\n\n\nNational Health Insurance Research Database (NHIRD) was \n\n\n\nused to investigate the association between the non-use of \n\n\n\nSGLT2i or Entresto and the use of SGLT2i or Entresto with \n\n\n\nthe risk of ASCVD in diabetes and heart failure patients from \n\n\n\n2017 to 2018. Results and Discussion: The primary \n\n\n\noutcome of the study was ASCVD including a composite of \n\n\n\ncardiovascular death and hospitalisation for worsening heart \n\n\n\nfailure. Secondary outcomes were all-cause death, cause of \n\n\n\ncardiovascular death, recurrence of heart failure, non-fatal \n\n\n\nmyocardial infarction, non-fatal stroke, ischaemic stroke, \n\n\n\nhaemorrhagic stroke, and new renal replacement therapy. \n\n\n\nThe case group comprised 8,691 patients with coexisting \n\n\n\ndiabetes and heart failure without the use of SGLT2 or \n\n\n\nEntresto and the control group contained 8,691 patients with \n\n\n\ncoexisting diabetes and heart failure who used the SGLT2 or \n\n\n\nEntresto. Conclusion: The use of SGLT2 significantly \n\n\n\nreduced the risk of all-cause death, non-fatal stroke, new \n\n\n\nrenal replacement therapy, cause of death in cardiovascular \n\n\n\nand recurrence of heart failure in patients with diabetes and \n\n\n\nheart failure, therefore a combination of these therapies will \n\n\n\nhelp improve the management of diabetes and heart failure. \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:hannahkristnel.mesa@gmail.com\n\n\nmailto:lmh.roger@msa.hinet.net\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n126 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 122 \n \n\n\n\nThe Impact of Service Marketing Mix \n\n\n\ntoward Customer Purchase Behavior from \n\n\n\nPharmacy Services Online \n\n\n\n\n\n\n\nXue Min Ng*, Mei Teh Goi \n \n\n\n\nFaculty of Business and Management, Open University Malaysia, Kelana \n\n\n\nJaya, Malaysia. \n\n\n\n* Corresponding author \n\n\n\nEmail: xuemin@lppkn.gov.my  \n\n\n\n\n\n\n\nBackground and Objective: Pharmacy service is an \n\n\n\nessential healthcare service in Malaysia. Commonly \n\n\n\nprovided by the community pharmacists in the physical \n\n\n\npharmacy stores, pharmacy services are now delivered online. \n\n\n\nOnline pharmacy services are useful particularly when the \n\n\n\npublic is advised to stay at home amidst the Coronavirus \n\n\n\ndisease 2019 pandemic. The customers can easily obtain \n\n\n\npharmacy services, such as health consultations, counseling \n\n\n\nservices and home deliveries of medicines, online. The \n\n\n\nconcept of the service marketing mix has always shaped the \n\n\n\nmarketing strategies of service organizations. This study \n\n\n\nexamines the impact of service marketing mix toward \n\n\n\ncustomer purchase behavior from pharmacy services online. \n\n\n\nMethods: The service marketing mix dimensions evaluated \n\n\n\nconsist of product, price, place, promotion, people, process \n\n\n\nand physical evidence. Data of 420 respondents was collected \n\n\n\nusing online survey questionnaires. Respondents were asked \n\n\n\nto evaluate 32 items regarding the importance of service \n\n\n\nmarketing mix dimensions and their purchase intention of \n\n\n\npharmacy services online. Results and Discussion: The \n\n\n\nfindings revealed that place and promotion positively and \n\n\n\nstatistically significantly influenced the customer purchase \n\n\n\nintention, which had a positive impact toward customer \n\n\n\npurchase behavior from pharmacy services online. \n\n\n\nConclusion: The community pharmacies should focus on the \n\n\n\nplace and promotion dimension when devising the marketing \n\n\n\nstrategies to deliver their pharmacy services online. \n\n\n\nConsequently, optimal pharmaceutical care can be provided \n\n\n\nat the convenience of customers while the community \n\n\n\npharmacies are benefited from the increase in the sale of \n\n\n\npharmacy services. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 123 \n \n\n\n\nPrediction of in vivo Performance of \n\n\n\nDabigatran Capsules Produced in Nepal \n\n\n\nfrom in vitro (Dissolution) data Using \n\n\n\nNumerical Convolution Method \n\n\n\n\n\n\n\nKhanal,N, Budhathoki U*, Bista D \n \n\n\n\nDepartment of Pharmacy, Kathmandu University, Dhulikhel, Kavre, Nepal \n\n\n\nGPO box 6250 (Kathmandu) \n\n\n\n* Corresponding author \n\n\n\nEmail: uttam@ku.edu.np  \n \n\n\n\nBackground and Objectives: To ensure the in vivo \n\n\n\nperformance of the products. bioavailability or \n\n\n\nbioequivalence study are performed but in Nepalese context \n\n\n\nmarketing license are issued without the in vivo Performance \n\n\n\nstudy data. The main motive of this study is to predict in vivo \n\n\n\nstudy data of locally produced Dabigatran capsules (coded as \n\n\n\nProduct A and Product B which are marketted without in vivo \n\n\n\nperformance study using In vitro in vivo correlation (IVIVC) \n\n\n\nmethod. Methods: Among two approaches of IVIVC i.e. \n\n\n\nConvolution and Deconvolution, Convolution approach was \n\n\n\nused for the prediction of in vivo performance of the products \n\n\n\nfrom the dissolution data. Dissolution study was carried out \n\n\n\nfor test product their plasma drug concentration was \n\n\n\ndetermined using this numerical convolution technique. \n\n\n\n\u201cProduct A\u201d and \u201cProduct B\u201d were the two test products. . \n\n\n\nFrom predicted plasma drug concentration \u2013time data, Area \n\n\n\nunder the curve (AUC) and maximum plasma drug \n\n\n\nconcentration (Cmax) were determined for both test products. \n\n\n\nWhether they are statistically different or not was determine \n\n\n\nand, on that basis, would be concluded that whether test \n\n\n\nproducts are bioequivalence or not. Result and Discussion: \n\n\n\nCmax, AUC of \u201cProduct A\u201d from the convolution method was \n\n\n\nfound to be 0.9562 ng/ml/mg, 16.441 hr*ng/ml/mg. Similarly, \n\n\n\nCmax and AUC of \u201cProduct B\u201d was found to be 0.8638 \n\n\n\nng/ml/mg and 14.8175 hr*ng/ml/mg. The percentage \n\n\n\nprediction error (%PE) values for Cmax and AUC were found \n\n\n\nto be -15.034 and 51.342 for \u201cProduct A\u201d and -27.344 and \n\n\n\n46.009 for \u201cProduct B\u201d Finally, Cmax and AUC for \u201cPradaxa \n\n\n\n110 mg\u201d obtained from literature was found to be (0.8-1.4) \n\n\n\nng/ml/mg and (6-10) ng*h/ml/mg respectively.The predicted \n\n\n\nerror of AUC and Cmax are not within the \u00b120% range for both \n\n\n\nlocal generic products (Product A & B. Conclusion: From \n\n\n\nthis study, it can be concluded that the rate and extent of \n\n\n\nabsorption of test products are not similar with the reference \n\n\n\nproduct. Since dabigatran, an anticoagulant is a lifesaving \n\n\n\ndrug, there may be risk to the patients rather than benefit \n\n\n\nusing local generic products though they are comparatively \n\n\n\ncheaper compared to reference product.  \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:xuemin@lppkn.gov.my\n\n\nmailto:uttam@ku.edu.np\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n127 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 124 \n \n\n\n\nThe Study of Drug Interactions between \n\n\n\nHerbal Medicine and Drugs  \n\n\n\n\n\n\n\nYung-Huei Fu1,3*, Li-Heng Pao2 \n \n1 Division of Pharmaceutical Service, China Medical University Hsinchu \n\n\n\nHospital, Hsinchu, Taiwan \n2 Institute of Health Industry Science and Technology, Chang Gung \n\n\n\nUniversity of Science and Technology, Taoyuan, Taiwan \n3 Hsinchu Pharmacists Association, Taiwan \n\n\n\n* Corresponding author \n\n\n\nEmail: kiwi5652@gmail.com  \n\n\n\n\n\n\n\nBackground and Objectives: P-glycoprotein (P-gp) is \n\n\n\nwidely expressed in the epithelial cells of tissue, especially in \n\n\n\nthe intestine, which is one of critical factors in drug \n\n\n\nabsorption and disposition. P-gp mediated drug efflux is a \n\n\n\nmajor factor contributing to the variance of absorption and \n\n\n\ndistribution of many drugs. Appropriately co-prescribed diet \n\n\n\nand herbal remedies could increase drug efficacy and lessen \n\n\n\ndrug toxicity. The purpose of this project is to study herbal \n\n\n\nmedicine and drug interactions through P-gp inhibition. \n\n\n\nMethods: A simple and reliable in vitro screening method \n\n\n\nwas setup and characterized using HCT-15 cell lines to study \n\n\n\nthe effect of herbal medicine on P-gp mediated transport of a \n\n\n\nmodel substrate. A specific P-gp substrate, rhodamine 123, \n\n\n\nwas used as a fluorescent marker. The increase in \n\n\n\nintracellular retention of rhodamine 123 is reflected in \n\n\n\nincreased intensity of rhodamine 123 fluorescence. The \n\n\n\nfunctional activity of P-gp was evaluated by measuring \n\n\n\nrhodamine 123 retention/efflux in the presence of herbal \n\n\n\nmedicines. Result and Discussion: The increase in \n\n\n\nintracellular retention of rhodamine 123 is reflected in \n\n\n\nincreased intensity of rhodamine 123 fluorescence. \n\n\n\nIntracellular accumulation of rhodamine 123 was measured \n\n\n\nby flow cytometry. In our study, we found several herbal \n\n\n\nmedicines are P-gp modulators. HCT-15 cell lines indicated \n\n\n\nthat the efflux of rhodamine 123 was inhibited by some \n\n\n\nherbal medicines. As our results, intracellular retention of \n\n\n\nrhodamine 123 increased 4.16 to 7.00 fold of the control by \n\n\n\nMoutan cortex, Spatholobi caulis and Aurantii fructus, \n\n\n\nrespectively, at a high concentration (10mg/ml). Intracellular \n\n\n\nretention of rhodamine 123 increased 3.30 to 5.35 fold of the \n\n\n\ncontrol at a low concentration (2 mg/ml). It also shows \n\n\n\nconcentration dependent manner in herb-drug interactions. \n\n\n\nConclusion: In conclusion, this study demonstrated that the \n\n\n\npresence of the herbal medicines significantly decreased the \n\n\n\nP-gp efflux function in HCT-15 cell lines. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 125 \n \n\n\n\nVarying Approaches for Modelling CPD \u2014 \n\n\n\nA Retrospective Review by Indonesian \n\n\n\nYoung Pharmacists Group \n\n\n\n\n\n\n\nAnggun P. Wardhani*, Dwi P. Rahmawati, \n\n\n\nRabella Mufti S, R. Aldizal Mahendra, I Made \n\n\n\nBayu Anggriawan \n\n\n\n\n\n\n\nIndonesian Young Pharmacist Group Pengurus Pusat Ikatan Apoteker \n\n\n\nIndonesia (IYPG PP IAI) \n\n\n\n* Corresponding author \n\n\n\nEmail: anggun.pharm@gmail.com  \n \n\n\n\nBackground and Objectives: As healthcare professionals, \n\n\n\npharmacists need to always demonstrate and maintain their \n\n\n\ncompetency throughout their careers. One of the assessment \n\n\n\ncomponents is through Continuing Professional \n\n\n\nDevelopment (CPD). However, most of the CPD provided by \n\n\n\nprofessional associations is theory centric with one-way \n\n\n\ncommunication. Accordingly, the Indonesian Young \n\n\n\nPharmacist Group (IYPG), that specifically accommodates \n\n\n\nPharmacists under 35 years old, aimed to develop a CPD \n\n\n\nprogram that can be relevant for young pharmacists. \n\n\n\nMethods: A retrospective review was selected to elaborate \n\n\n\nthe CPD models on the events held by the IYPG in the span \n\n\n\nof 2020-2022. Four big events were accounted for the \n\n\n\ndelivery of CPD to young pharmacists: the IYPG summit, \n\n\n\nCOVID-19 charity nights, IYPG talk, and IYPG team \n\n\n\nupgrading events. These events accommodated both learning \n\n\n\nand social-work CPD activities. All participants were given \n\n\n\nthe post-event questionnaire to evaluate their satisfaction \n\n\n\n(using the Likert scale). Results and Discussion: The \n\n\n\nfindings suggested that the events have accommodated the \n\n\n\nCPD relevant to young pharmacists. The IYPG Summit is the \n\n\n\nmain annual event where the experts shared the learning CPD \n\n\n\n(10 credits), and the attendees were also involved in selected \n\n\n\nsocial work (5 credits), while the COVID-19 charity night \n\n\n\nwas mostly concerned about social work CPD (4 credits) and \n\n\n\nalso increased collaborative action during the COVID-19 \n\n\n\npandemic (2 learning CPD credit). The expert talks are \n\n\n\nincorporated in IYPG Talk (2 learning credits & 3 social \n\n\n\nwork credits) and upgrading events (total 4 learning credits), \n\n\n\nenabling CPD learning aspects for the attendees. The total \n\n\n\nnumber of participants for these four events was 2.773 \n\n\n\npharmacists. Using the Likert scale with a score of 1 to 5, of \n\n\n\nwhich 5 are the highest levels (Very Satisfied), on average \n\n\n\nmore than 52% of the participant was Very Satisfied with the \n\n\n\nevent. Moreover, at the recent IYPG Talk event, 82% of the \n\n\n\nrespondents were most likely to join the upcoming events \n\n\n\nheld by IYPG. Conclusion: The CPD models incorporated \n\n\n\nin IYPG events (2020-2022) was found to be relevant for \n\n\n\nyoung pharmacists. Not only that they were able to fulfil the \n\n\n\nCPD requirements from the pharmacist association, but also \n\n\n\nbolstered greater interest of young people to get CPD. \n\n\n\n\nmailto:kiwi5652@gmail.com\n\n\nmailto:anggun.pharm@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n128 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nAbstract 126 \n \n\n\n\nAssessing the Clinical Competence of \n\n\n\nEntry-to Advanced-level Pharmacists using \n\n\n\nCase-based Discussions in Japan \n\n\n\n\n\n\n\nKanayuki Kitahara*, Yukari Kataoka, \n\n\n\nTatsuya Isezaki, Yasuaki Yokoyama, Asami \n\n\n\nFunaki, Ryohkan Funakoshi \n \n\n\n\nDepartment of Pharmacy, Kameda medical hospital, Chiba, Japan. \n\n\n\n* Corresponding author \n\n\n\nEmail: kitahara.kanayuki@kameda.jp  \n \n\n\n\nBackground and Objectives: Although more than 50 \n\n\n\nhospitals offer a pharmacy residency program in Japan, there \n\n\n\nis no foundational core curriculum to achieve clinical \n\n\n\ncompetence. The Royal Pharmaceutical Society (RPS) in the \n\n\n\nUK has published the Foundation Pharmacy Framework for \n\n\n\nband 6 pharmacists. Case-based discussion (CbD) is one of \n\n\n\nthe tools in the framework for assessing clinical decision-\n\n\n\nmaking and the application of pharmacological knowledge in \n\n\n\npatient care. Therefore, we conducted this study to determine \n\n\n\nwhether CbD is a usable tool for assessing clinical \n\n\n\ncompetence in Japan. Methods: The subjects were first-year \n\n\n\npharmacy residents as entry-level (n=78), pharmacists in \n\n\n\nyears 2-5 without specialty certification as basic-level (n=9), \n\n\n\nand the board-certified pharmacists (BCPs) as advanced-\n\n\n\nlevel (n=5). Pharmacy residents had trained in four wards for \n\n\n\none year, and CbD was performed at the end of each ward \n\n\n\ntraining. Other Pharmacists had a one-point measure. For \n\n\n\npharmacy residents, CbD scores administered at the end of \n\n\n\neach ward training were plotted and changes over time were \n\n\n\nanalyzed using one-way ANOVA. For other pharmacists, the \n\n\n\npresence of a ceiling effect was assessed. Results and \n\n\n\nDiscussion: Pharmacy residents showed a significant \n\n\n\nincrease in scores on 4 of the 5 CbD items, except \u201cTreatment \n\n\n\nRecommendations\u201d. No ceiling effect was observed for the \n\n\n\nbasic-level, while a ceiling effect was observed for the \n\n\n\nadvanced -level. These results suggest that CbD can be used \n\n\n\nto visualize the degree of growth of pharmacists with less \n\n\n\nthan 6 years and no specialty certification (entry- and basic-\n\n\n\nlevel) but not for advanced-level pharmacists such as BCPs \n\n\n\nin Japan. Conclusion: CbD is useful for assessing clinical \n\n\n\ncompetence of entry-level and basic-level pharmacists in \n\n\n\nJapan. However, it is difficult to assess advanced-level \n\n\n\npharmacists with CbD. Further studies are needed with a \n\n\n\nlarger number of pharmacists at multiple facilities to evaluate \n\n\n\nthe usefulness of CbD. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 127 \n \n\n\n\nThe Development of Teaching Method and \n\n\n\nGame-Based Materials for Medication-use \n\n\n\nSafety Modular Course \n\n\n\n\n\n\n\nLing-Chiao Liao1,5,6, Yung-Ching Hsu2, Ai-\n\n\n\nTzu Li3, Jou-Wei Lin4, Cheng-Ying Hsieh1, \n\n\n\nYung-Cheng Huang1, Yu-Chen Li1, Chin-Ju \n\n\n\nChuang1,5,6* \n \n1 Department of Pharmacy, National Taiwan University Hospital Yun-Lin \n\n\n\nBranch, Yunlin, Taiwan \n2 Fun 4 Kids Board Game Workshop, Tainan, Taiwan \n3 Department of Adult and Continuing Education National Chung Cheng \n\n\n\nUniversity, Chiayi, Taiwan  \n4 Department of Medicine, National Taiwan University Hospital Yun-Lin \n\n\n\nBranch, Yunlin, Taiwan \n5 Federation of Taiwan Pharmacists Associations, Taipei, Taiwan \n6 Yunlin County Pharmacists Association, Yunlin, Taiwan \n\n\n\n* Corresponding author \n\n\n\nEmail: Y00329@ms1.ylh.gov.tw \n\n\n\n\n\n\n\nBackground and Objectives: The purpose of the study is to \n\n\n\ndevelop a game-based teaching method and materials in \n\n\n\norder to improve learning effectiveness of medication use \n\n\n\nsafety course for the elderly. Methods: A focus group \n\n\n\ndiscussions methodology was used in this study to facilitate \n\n\n\nthe discussion of participants\u2019perceptions on the learning \n\n\n\nmodule and game-based learning material. Neuroscientists, \n\n\n\npharmacists and elder education experts were recruited in the \n\n\n\nfocused group to evaluate the validity of the medication-use \n\n\n\nsafety modular course. The board game was tested by \n\n\n\nexternal experts at 3 workshops. Results and Discussion: \n\n\n\nThe learning module and game-based learning material \n\n\n\ncalled \u300c\u85e5\u60a8\u5065\u5eb7 99\u300dwas developed successfully. The \n\n\n\nboard game includes instruction manual and 4 types of cards \n\n\n\nconsist of body, organ, question and answer cards. Due to the \n\n\n\nCOVID-19 pandemic, the community health activities were \n\n\n\nshut down almost. Therefore, the online board game was \n\n\n\ndeveloped for testing. There were 3 elderly played the online \n\n\n\nboard game and provided positive feedback. Conclusion: \n\n\n\nBased on the results of the first year, the purpose of next year \n\n\n\nis to test the prototype of the medication use safety board \n\n\n\ngame and validate its effectiveness. It will further test in \n\n\n\nActive Aging Learning Center with 30 senior citizens to get \n\n\n\nthe information about flow, medication-use knowledge, and \n\n\n\nbehavior change. \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:kitahara.kanayuki@kameda.jp\n\n\nmailto:Y00329@ms1.ylh.gov.tw\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n129 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 128 \n \n\n\n\nA New Platform to Advance Pharmacy \n\n\n\nWorkforce Education  \n\n\n\n\n\n\n\nMd. Mirajul Islam1*, Mohammad Abusyed1, \n\n\n\nMandip Pokharel2, Sovanrith Phalla3, Tammy \n\n\n\nAllen4  \n \n1 Vennue Foundation, Bangladesh  \n2 Vennue Foundation, Nepal  \n3 Vennue Foundation, Cambodia  \n4 Vennue Foundation, USA  \n\n\n\n* Corresponding author \n\n\n\nEmail: samrat@vennue.org  \n\n\n\n\n\n\n\nBackground and Objectives: In developing countries, \n\n\n\npatients often rely on pharmacies as the first point of access \n\n\n\nto care. Pharmacy workers perform critical functions in the \n\n\n\ncontinuum of care, yet they tend to be undertrained and \n\n\n\nundervalued. To address this problem, Vennue built a health \n\n\n\nworkforce education model that equips pharmacists, as well \n\n\n\nas pharmacy staff and students, with the necessary skills and \n\n\n\nknowledge to provide high-quality care. Vennue also \n\n\n\nprovides a community for professional development, \n\n\n\nbringing together practitioners from around the world to \n\n\n\nconnect through shared learning and practice enhancements.  \n\n\n\nMethods: Vennue\u2019s proprietary curriculum is offered \n\n\n\nthrough a hybrid learning model. Each participant benefits \n\n\n\nfrom an educational toolkit with the following components \n\n\n\noffered through in-person classroom instruction and via the \n\n\n\nVennue Digital Hub (hub.vennue.org): \u2022 Interactive training \n\n\n\nsessions led by Vennue\u2019s instructors \u2022 Roundtable Q&A with \n\n\n\ninternational guest speakers and clinical experts \u2022 Simulation \n\n\n\nactivities to strengthen consultation skills \u2022 Hands-on \n\n\n\nworkshops to develop Standard Operating Procedures \u2022 Peer \n\n\n\nLearning Circles to sustain knowledge into the future. \n\n\n\nResults and Discussion: Launched in January 2021, the \n\n\n\nVennue Hub demonstrated the following results: \u2022 992 \n\n\n\nlearners enrolled as new Hub Members from 15 countries \n\n\n\naround the world \u2022 764 individuals earned certificates in \n\n\n\n\u201cFundamentals of Quality Pharmacy Care\u201d \u2022 54% gain in \n\n\n\nknowledge of pharmacy best practices, measured by pre/post \n\n\n\ntests at the start and finish of each training module \u2022 96% of \n\n\n\nlearners confirmed the learning materials will improve their \n\n\n\npractice, reported in feedback surveys From January 2021 to \n\n\n\nSeptember 2022, the new learning platform enabled Vennue \n\n\n\nto expand its program reach, while delivering strong \n\n\n\nperformance gains in core competencies. These results serve \n\n\n\nas an important proof-of-concept as Vennue continues to \n\n\n\ninvest in the integration of additional certification courses \n\n\n\nonto the Hub. Conclusion: The Vennue Hub provides \n\n\n\nflexible, consistent training for pharmacy workers and \n\n\n\nstudents of all skill levels. It offers cost-free, uninterrupted \n\n\n\naccess to learning resources and community connections. \n\n\n\nVennue\u2019s new platform can be scaled to advance patient care \n\n\n\nand health outcomes. \n\n\n\nAbstract 129 \n \n\n\n\nDrug-related problems (DRP) Identified by \n\n\n\nPharmacy Students during Telepharmacy \n\n\n\nSessions  \n\n\n\n\n\n\n\nNor Elyzatul Akma Hamdan1*, Mahmathi \n\n\n\nKaruppannan1, Munaver Ahmad Nazir \n\n\n\nAhmad2, Ezlina Usir1, Kamaliah Md. Saman1, \n\n\n\nSiti Norlina Md. Said1 \n \n\n\n\n1 Department of Pharmacy Practice, Faculty of Pharmacy, Universiti \n\n\n\nTeknologi MARA (UiTM) Selangor Branch, Puncak Alam Campus, 42300 \n\n\n\nBandar Puncak Alam, Selangor, Malaysia. \n2 Rhazes Consultancy Service Sdn Bhd, Nucleus Tower, Mutiara Damansara, \n\n\n\n47800 Subang Jaya, Selangor, Malaysia \n\n\n\n* Corresponding author \n\n\n\nEmail: elyzatul@uitm.edu.my    \n\n\n\n\n\n\n\nBackground and Objectives: Telepharmacy (TP) services \n\n\n\nreceived much attention during the COVID-19 pandemic. In \n\n\n\norder to equip future pharmacists, components of TP were \n\n\n\nincorporated during final year pharmacy students\u2019 clinical \n\n\n\npharmacy clerkship (CPC). During the TP, students \n\n\n\ninteracted with patients and conducted medication use \n\n\n\nreviews. The objective of this study was to characterize the \n\n\n\ntypes of drug-related problem identified by the students \n\n\n\nduring the TP sessions. Methods: A group of four to five \n\n\n\nfinal-year pharmacy students interviewed one (1) patient \n\n\n\nduring the TP session. There was a total of 48 groups of \n\n\n\nstudents. Patients were recruited from their family members \n\n\n\nand relatives that prescribed at least two (2) chronic \n\n\n\nmedications (i.e diabetes, hypertension, and \n\n\n\nhypercholesterolemia). Each session lasted for about 30 \n\n\n\nminutes. Students were briefed on the conduct of TP prior to \n\n\n\ninteracting with patients.  Each group was given a data \n\n\n\ncollection form to document patients\u2019 details and \n\n\n\ndescriptions of the DRPs identified under the supervision of \n\n\n\na lecturer. These were further analysed retrospectively. \n\n\n\nDescriptive statistics and chi-square analysis were used to \n\n\n\nevaluate the data. Results and Discussion: 187 students \n\n\n\ncompleted 48 medication use reviews via TP.  The students \n\n\n\nreviewed 48 patients and identified 122 DRPs. On average, \n\n\n\nthe patients were 56 years old and were taking a median of 5 \n\n\n\nmedications. The most common DRPs reported were non-\n\n\n\ncompliance issues and adverse drug reactions. Conclusion: \n\n\n\nPharmacy students were able to identify a substantial number \n\n\n\nof DRPs through medication use review activities via TP \n\n\n\nunder the supervision of their lecturer. TP also enhanced \n\n\n\npharmacy students\u2019 communication skills and their \n\n\n\nmedication history-taking ability.  \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:samrat@vennue.org\n\n\nmailto:elyzatul@uitm.edu.my\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n130 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 130 \n \n\n\n\nConsultation and Education of Doping \n\n\n\nAmong Athletes and Their Logistics Staff \n\n\n\n\n\n\n\nHung-Chang Chou1,2,3*, Wei Ho2, Tzu-Chun \n\n\n\nChou2 \n\n\n\n \n1 Federation of Taiwan Pharmacists Associations, Taiwan \n2 Taiwan Young Pharmacist Group, Taiwan \n3 Department of Pharmacy and Master Program, Tajen University, Taiwan \n\n\n\n* Corresponding author \n\n\n\nEmail: chouhungchang@gmail.com  \n\n\n\n\n\n\n\nBackground and Objectives: The World Anti-Doping \n\n\n\nAgency has raised that education are the primary goals of \n\n\n\ntheir anti-doping strategy. Doping control is the norm for \n\n\n\nathletes whether they are in competition or non-competition \n\n\n\nperiod; however, many medicines on the market contain \n\n\n\ndoping ingredients even though they are legally marketed \n\n\n\ndrugs. To prevent the misuse of medicine, the Chinese Taipei \n\n\n\nAnti-Doping Agency provides consultation for service \n\n\n\nathletes and their logistics staff and has established an \n\n\n\n\"Interactive Consultation Platform for Doping Dosing in \n\n\n\nSports\" to provide information for athletes to confirm the \n\n\n\nlegality before using drugs or nutritional supplements. \n\n\n\nMethods: The consultations were conducted from November \n\n\n\n1st in 2018 to April 30th in 2021 in Taiwan. The \n\n\n\nconsultations were raised via online systems and assigned to \n\n\n\nthe specialists such as pharmacists, nutritionists and physical \n\n\n\ntherapists within 24 hours. A total of 276 questions were \n\n\n\nassessed as eligible. Results and Discussion: Most \n\n\n\nconsultations were raised from athletes (n = 188, 67.6%) and \n\n\n\nlogistics staff (n = 61, 21.9%). The categories of \n\n\n\nconsultations are Western medicine (192, 69.6%), \n\n\n\nfood/nutritional supplement (62, 22.5%), herbs (16, 5.8%) \n\n\n\nand others (6, 2.2%). Among all the consultations, the \n\n\n\ndoping-related questions are 25.5%. According to the survey \n\n\n\nof consultations, two articles were prepared and delivered to \n\n\n\nthe athletes and logistics staff to prevent the misuse of the \n\n\n\nmedicine, named \u201cThe Invisible Killer of Athletes: \n\n\n\nEphedrine\u201d and \u201cStomach Medicine as Doping: Oxethazaine.\u201d \n\n\n\nConclusion: It is vital to provide appropriate tool and \n\n\n\ninformation of athletes and logistics staff on the topic of \n\n\n\ndoping consultation. More education about doping for \n\n\n\nathletes and logistics staff would prevent the misuse of \n\n\n\nmedicines. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 131 \n \n\n\n\nHybrid learning to answer the adjustment \n\n\n\nof learning models after the pandemic \n\n\n\n\n\n\n\nArde Toga Nugraha* \n \n\n\n\nDepartment of Pharmacy, Faculty of Science, University Islam Indonesia, \n\n\n\nYogyakarta, Indonesia. \n\n\n\n* Corresponding author \n\n\n\nEmail: arde.toga@uii.ac.id  \n \n\n\n\nBackground and Objectives: Hybrid learning has become \n\n\n\nan attractive learning delivery method in recent years. Many \n\n\n\nUniversities are trying to develop their own Hybrid learning \n\n\n\ncourses as an option to replace part of the face-to-face time \n\n\n\nwith online classes. In terms of theoretical learning, there is \n\n\n\nno significant difference between the results of hybrid \n\n\n\nstudents and distance learning, in fact most of the participants \n\n\n\nprefer visual presentations rather than verbal explanations. \n\n\n\nThe aim of this recearch to knowing the quality of lectures \n\n\n\nconducted in a hybrid with modification.Methods: \n\n\n\nParticipants who took the hybrid medicinal plants and \n\n\n\nsimplicia lectures were students from the Department of \n\n\n\nPharmacy, the University Islam Indonesia and the \n\n\n\nDepartment of Pharmacy, Ma Chung University. The lecture \n\n\n\nis carried out in three stages, preparation stage, program \n\n\n\nsocialization, implementation and evaluation. The evaluation \n\n\n\nwas carried out twice, in the middle of program to improve \n\n\n\nsomething that was felt to be inappropriate. Evaluation is \n\n\n\ndone by looking at the midterm exam, final exam scores and \n\n\n\nalso conducting a satisfaction survey to students. Data \n\n\n\nprocessing is done by descriptive analysis. Results and \n\n\n\nDiscussion: The results of this study show that there are \n\n\n\ndifferences in student motivation to learn. Students feel that \n\n\n\nthe hybrid can increase their sense of learning. However, the \n\n\n\nlearning outcomes are not significantly different still equally \n\n\n\nboth online and offline. Students also feel that offline, online \n\n\n\nand hybrid methods have their respective advantages. \n\n\n\nConclusion: Hybrid learning provides flexibility and still gets a \n\n\n\nsense of learning compared to offline or online only. But still have \n\n\n\nthe same quality. \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:chouhungchang@gmail.com\n\n\nmailto:arde.toga@uii.ac.id\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n131 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 132 \n \n\n\n\nNew Drug Budget and Reimbursement \n\n\n\nPolicy in Taiwan \n\n\n\n\n\n\n\nYY Chan1*, ZF Lu1, CN Hsu2, YC Pan1, WN \n\n\n\nWeng1 \n \n\n\n\n1 Chang Gung Medical Foundation, Taoyuan, Taiwan \n2 Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan \n\n\n\n* Corresponding author \n\n\n\nEmail: yychan.ph@gmail.com  \n\n\n\n\n\n\n\nBackground and Objectives:  Taiwan\u2019s healthcare system \n\n\n\nis internationally regarded for its National Health Insurance \n\n\n\n(NHI) program, which provides universal, easily accessible \n\n\n\nand affordable healthcare with overall 99.9% coverage \n\n\n\n(23.6m people). The relative low spend reflects tight-control \n\n\n\nof expenditure. We evaluated the budget and reimbursement \n\n\n\npolicy of innovative new drugs for the recent 5 years (2013-\n\n\n\n2017). Methods: All data were collected from the meeting \n\n\n\nnotes of the Expert Advisory Meetins, the PBRS committee; \n\n\n\nand the new drug HTA reports released on the NHI \n\n\n\nAdministration Web site. We used descriptive statistics to \n\n\n\nanalyse the trend of the prescription volume and drug \n\n\n\nexpenditure for new drugs from the NHI claims data. Results: \n\n\n\nThe total new drug budget of each year is decided by the \n\n\n\nMinistry of Health and Welfare according to the average \n\n\n\nspending for new drugs in the previous 5 years with an \n\n\n\nassumption of treatment substitution effect, the new drug will \n\n\n\nreplace the current treatment within 5 years since it covered \n\n\n\nby NHI and no more budget thereafter. Each new drug will \n\n\n\nbe classified as one of the three categories (I, 2A, 2B) by their \n\n\n\ntherapeutic value and compared to the current best \n\n\n\ncomparator. A 5-years-budget-scheme is estimated with \n\n\n\nreference to these three categories. In our results, there were \n\n\n\n189 new drugs (18 in category 1, 61 in category 2A, 110 in \n\n\n\ncategory 2B) getting covered by NHI with a spending of \n\n\n\nUSD$1.96 billion in the past 5 years, but with a budget of \n\n\n\nonly USD175 million. Conclusion: Obviously, the budget \n\n\n\nallocation for new drugs is seriously insufficient. The \n\n\n\nshortage of spending was compensated by healthcare \n\n\n\nproviders. Ageing population and growth in chronic disease, \n\n\n\nassociated with rising costs of new health technologies, were \n\n\n\nputting further strain on the healthcare system's resources. A \n\n\n\nreform should be advocated for the new drugs budget and \n\n\n\nreimbursement policy, which has been implemented for 10 \n\n\n\nyears. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 133 \n \n\n\n\nDevelopment of a Searching Program of \n\n\n\nNutrient Information for Patients who have \n\n\n\nDiabetes or Hypertension \n\n\n\n\n\n\n\nGyeongil Jang1, Kwang Joon Kim2, Dongmun \n\n\n\nHa2* \n \n1 School of Pharmacy, Sungkyunkwan University, Suwon, Korea.  \n2 School of Pharmacy, Mokpo National University, Muan, Korea \n\n\n\n* Corresponding author \n\n\n\nEmail: 777sring@gmail.com  \n\n\n\n\n\n\n\nBackground and Objectives: It is essential to supply \n\n\n\nadequate nutrients for the prevention and treatment of \n\n\n\nchronic diseases. The aim of this study was to develop a \n\n\n\nprogram that can evaluate nutritional deficiencies of patients \n\n\n\nwho have chronic diseases in South Korea. Methods: A \n\n\n\ndatabase was built on the potential nutritional status changes \n\n\n\ncaused by chronic diseases or treatment agents for them such \n\n\n\nas diabetes and hypertension by conducting a systematic \n\n\n\nreview of clinical articles regarding those diseases. Based on \n\n\n\nthe database constructed, we developed a searching program \n\n\n\nthat could find deficient nutrients, evidence levels (low, \n\n\n\nmedium, and high) of clinical articles, severity levels \n\n\n\n(negative impacts), and intake information by each disease \n\n\n\nwhen patients entered their demographic factors such as age, \n\n\n\nsex, dietary or exercise habits and drugs they were taking. \n\n\n\nResults and Discussion: Active pharmaceutical ingredients \n\n\n\nfor diabetes that can cause nutrient deficiency were \n\n\n\nmetformin, sulfonylureas, and insulin. Those for \n\n\n\nhypertension were beta blockers, angiotensin-converting \n\n\n\nenzyme inhibitors, calcium channel blockers, and \n\n\n\nhydralazine. Five nutrients (vitamin B12, folic acid, \n\n\n\nmagnesium, coenzyme Q10, and vitamin D) for diabetes, \n\n\n\nfour nutrients (vitamin B6, vitamin D, zinc, and coenzyme \n\n\n\nQ10) for hypertension, and two (vitamin D and coenzyme \n\n\n\nQ10) nutrients for both diseases were determined. The \n\n\n\nevidence levels and severity levels varied based on each \n\n\n\nnutrient and disease. Intake information by each disease such \n\n\n\nas the required amount of each nutrient per day and food \n\n\n\nsources were presented as well. Conclusion: Medications for \n\n\n\ntreating diabetes and hypertension have shown nutritional \n\n\n\ndeficiencies in patients who have those diseases. The \n\n\n\nsearching program of nutrient information developed for the \n\n\n\nprevention and management of chronic diseases is very \n\n\n\nuseful. \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:yychan.ph@gmail.com\n\n\nmailto:777sring@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n132 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 134 \n \n\n\n\nDevelopment of a Computerized Pharmacy \n\n\n\nManagement System Called PM+20 for the \n\n\n\nIT-based Community Pharmacy Practices \n\n\n\nin South Korea \n\n\n\n\n\n\n\nHyuntai, K1*, Jeehye M2 \n\n\n\n\n\n\n\n1 Korea Pharmaceutical Information Center (KPIC), Seoul, Republic of \n\n\n\nKorea.  \n2 Research & Information Center, Korea Pharmaceutical Information \n\n\n\nCenter (KPIC), Seoul, Republic of Korea.  \n\n\n\n* Corresponding author \n\n\n\nEmail: hytakim@kdrug.org  \n \n\n\n\nBackground and Objectives: Recently, the application of a \n\n\n\ncomprehensive pharmacy management software has become \n\n\n\nessential in community pharmacies. The pharmacy \n\n\n\nmanagement software, PharmIT3000, was developed and \n\n\n\nmaintained by KPIC to assist pharmaceutical practices. \n\n\n\nCurrently, about 50% of Korean pharmacies use \n\n\n\nPharmIT3000, which allows the easy-to-use management of \n\n\n\nprescription information, billing and invoicing, \n\n\n\nreimbursement claims, and inventory management. To \n\n\n\nimprove this program by catching up with the evolving \n\n\n\npractices in pharmacy, PM+20 was designed and \n\n\n\nimplemented. Methods: The PM+20 was distinctively \n\n\n\ndesigned and conceptualized based on the analysis of \n\n\n\nrequirements by pharmacists. The program was implemented \n\n\n\nby the technical counseling and cooperative work of experts, \n\n\n\nincluding software engineers, programmers, database \n\n\n\nadministrators, and web designers. The framework was \n\n\n\ndeveloped using Delphi 10.3.3 as the programming language. \n\n\n\nThis system runs on Microsoft SQL2014 Server for database \n\n\n\nmanagement. Additional components, such as TMS, TMS \n\n\n\nVCL Chart, FastReport, CPort, Image En, and WebSocket \n\n\n\nwere applied. Also, a data migration program was developed \n\n\n\nto support efficient data transfer. Results and Discussion: \n\n\n\nThe major functions of PIT3000 were upgraded and new \n\n\n\nfunctions were constructed with user-friendly interfaces in \n\n\n\nPM+20. Following the testing of the beta version of PM+20, \n\n\n\ncurrently, it has finally been released in community \n\n\n\npharmacies and is under the maintenance phase. The PM+20 \n\n\n\nexhibits quick activation of the program and enhanced \n\n\n\naccuracy and integration of data documentation with chart-\n\n\n\nform statistics and analysis utilities. Above all, PM+20 \n\n\n\nprovides integrated drug information based on the KPIC \n\n\n\ndatabase as implemented in the Pharm Chart Menu. \n\n\n\nConclusion: This integrated platform will improve the \n\n\n\ncomputerized pharmaceutical practices in community \n\n\n\npharmacies by minimizing the manual processes and by \n\n\n\nenhancing the efficiency and accuracy of practices. PM+20 \n\n\n\nis expected to assist the expansion of the pharmacist\u2019s \n\n\n\ncapability as a digital healthcare innovator. Our efforts are \n\n\n\ncurrently underway to establish and optimize this platform. \n\n\n\nAbstract 135 \n \n\n\n\nKnowledge, Attitudes, and Practices on the \n\n\n\nUse of Antibiotics among the Residents in \n\n\n\nSilago, Southern Leyte, Philippines: Basis \n\n\n\nfor Antimicrobial Stewardship Program for \n\n\n\nPrimary Health Care \n\n\n\n\n\n\n\nKim Ann Pere1, Vieno Gino Cruz1*, Nimfa B. \n\n\n\nGambalan2, Mark Harvey B. Adamson1, \n\n\n\nElvira V. De Leon3 \n \n1 School of Pharmacy, Graduate studies, Philippine Women\u2019s University, \n\n\n\nManila, Philippines \n2 Department of Pharmacy, College of Allied Health, National University, \n\n\n\nManila, Philippines \n3 College of Pharmacy, Manila Central University, Caloocan, Philippines \n\n\n\n* Corresponding author \n\n\n\nEmail: vcruz@pwu.edu.ph  \n\n\n\n\n\n\n\nBackground and Objectives: The study sought to determine \n\n\n\nknowledge, attitude, and practices (KAP) of residents Silago, \n\n\n\nSouthern Leyte, Philippines on the use of antibiotics which \n\n\n\nserved as the basis for a proposed Antimicrobial Stewardship \n\n\n\n(AMS) program for Primary Healthcare. This study \n\n\n\nspecifically sought to identify associations of residents\u2019 \n\n\n\ncharacteristics, their knowledge on antibiotics, their attitude \n\n\n\ntowards antibiotisc, and their practices on the use of \n\n\n\nantibiotics. Methods: This quantitative, cross-sectional study \n\n\n\nused a descriptive research design that utilized a validated \n\n\n\nand pretested structured questionnaire administered face-to-\n\n\n\nface during Department of Health (DOH) COVID-19 \n\n\n\n\u201cResbakuna\u201d Vaccination Program among 383 residents \n\n\n\nwho consented from 15 barangays who have used an \n\n\n\nantibiotic at least once. Statistical Package for Social \n\n\n\nSciences (SPSS) was used to perform all descriptive statistics \n\n\n\nfor summarizing KAP scores and non-parametric inferential \n\n\n\nstatistics such as Mann-Whitney, Kruskal-Wallis, \n\n\n\nSpearman\u2019s Correlation, and Chi-square test. Results and \n\n\n\nDiscussion: Results showed that residents obtained \n\n\n\n\u201cmoderate knowledge\u201d (M=67.53\u00b1SD=16.77), \u201cmoderate \n\n\n\nattitude\u201d (M=65.34\u00b1SD=20.52), and \u201chigh practice\u201d \n\n\n\n(M=78.61\u00b1SD=17.65) on antibiotic use. Study revealed ages \n\n\n\n\u201c50-59\u201d, and those who acquired antibiotics \u201cappropriately\u201d \n\n\n\nwere significantly associated with \u201chigh\u201d knowledge, \n\n\n\nattitudes, and practices on the use of antibiotics. Conclusion: \n\n\n\nFindings showed that residents of Silago have the appropriate \n\n\n\npractice on antibiotics use but have inadequate knowledge \n\n\n\nand attitude on antibiotics use, thus, it is hoped that this will \n\n\n\nprovide baseline information for primary health care AMS \n\n\n\nprogram implementation. \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:hytakim@kdrug.org\n\n\nmailto:vcruz@pwu.edu.ph\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n133 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 136 \n \n\n\n\nAssociated Factors Related to Influenza \n\n\n\nVaccine Acceptance among Adults in \n\n\n\nCavite During the COVID-19 Pandemic  \n\n\n\n\n\n\n\nPaola Allison B. Ara\u00f1o, Ma. Bernadette A. \n\n\n\nCirilos*, Christine Kate G. Conding, Hazel \n\n\n\nMae C. Equiza, Louie Fernand D. Legaspi \n \n\n\n\nDr. Mariano Que College of Pharmacy, De La Salle Medical and Health \n\n\n\nSciences Institute, Dasmari\u00f1as City, Philippines \n\n\n\n* Corresponding author \n\n\n\nEmail: bernacirilos@gmail.com  \n\n\n\n\n\n\n\nBackground and Objectives: National COVID-19 \n\n\n\nvaccination campaign officially started on March 1, 2021 in \n\n\n\nthe Philippines. Aside from COVID-19, seasonal flu caused \n\n\n\nby Influenza viruses becomes an additional health concern \n\n\n\nfor co-infection. This study aimed to investigate the \n\n\n\nassociated factors related to influenza vaccine acceptance \n\n\n\namong adults in Cavite during the COVID-19 pandemic. The \n\n\n\nstudy also intended to investigate the significant relationship \n\n\n\nbetween influenza vaccine knowledge, influenza vaccine \n\n\n\nperceptions, and influenza vaccine acceptance. Methods: \n\n\n\nData was collected in the province of Cavite using an online \n\n\n\nself-administered questionnaire. The significance of \n\n\n\nassociations was determined using Pearson Chi-Square and \n\n\n\nits strength was identified using Cram\u00e9r's V, while \n\n\n\nSpearman\u2019s Rho was used to measure correlations. Results \n\n\n\nand Discussion: The results of this study showed that most \n\n\n\nadults had a high level of knowledge (69.55%), the average \n\n\n\nof the respondents had a fairly positive perception \n\n\n\n(Mean=3.55), and only some (35.8%) showed acceptance to \n\n\n\ninfluenza vaccine during the COVID-19 pandemic. Sex, and \n\n\n\neducational attainment had a strong significant association, \n\n\n\nwhile employment status had a moderate significant \n\n\n\nassociation with Influenza vaccine knowledge. Educational \n\n\n\nattainment had a strong significant association with influenza \n\n\n\nvaccine perception, while employment status had a  strong \n\n\n\nassociation with Influenza vaccine acceptance. Conclusion: \n\n\n\nThe study concludes that a high level of influenza vaccine \n\n\n\nknowledge would lead to a positive  influenza vaccine \n\n\n\nperception and will increase vaccine acceptance. Moreover, \n\n\n\ninfluenza vaccine perception has a strong positive \n\n\n\nrelationship with vaccine acceptance. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 137 \n\n\n\n \nMilitary Pharmacist Involvement in \n\n\n\nCOVID-19 Vaccination Outreach \n\n\n\nProgramme  \n\n\n\n\n\n\n\nKhan ARK1*, Baharuddin F1, Adnan MA2, \n\n\n\nBasari AH2 \n\n\n\n\n\n\n\n1 Malaysian Joint Force Headquarters, Kuantan, Pahang, Malaysia \n2 Malaysian Armed Forces Headquarters, Kuala Lumpur, Malaysia \n\n\n\n* Corresponding author \n\n\n\nEmail: amirahkhan.ark@gmail.com  \n\n\n\n\n\n\n\nBackground and Objectives:  In Malaysia, National \n\n\n\nCOVID-19 Vaccination Programme (NCVP) started in \n\n\n\n24th February 2021. Traditionally, it is well-known among \n\n\n\nthe public that the vaccination program is often linked with \n\n\n\ndoctors and nurses in our local healthcare scene. Pharmacists \n\n\n\nalso have their roles in this massive vaccination program \n\n\n\nwhich include the areas of regulatory, procurement, \n\n\n\ndistribution, advocacy as well as in monitoring and reporting \n\n\n\nof Adverse Event Following Immunization (AEFI). Methods:  \n\n\n\nThe Military Health Division of Malaysian Joint Force \n\n\n\nHeadquarters organized COVID-19 Vaccination Outreach \n\n\n\nProgramme at South Panching River Federal Land \n\n\n\nDevelopment Authority (FELDA), Pahang in August 2021 as \n\n\n\npart of the Civil-Military Cooperation (CIMIC) Programme \n\n\n\nin collaboration with Kuantan District Health Office, \n\n\n\nMinistry of Health Malaysia. Results and Discussion:  \n\n\n\nOverall, the programme managed to deliver 3,864 doses of \n\n\n\nCOVID-19 vaccine in a timely manner, targeted to the \n\n\n\nFELDA population in anticipation of floods that usually \n\n\n\nhappens in this area during the monsoon season usually at the \n\n\n\nlast quarter of the year. Throughout this programme, military \n\n\n\npharmacists have been actively involved as the coordinator \n\n\n\nof the programme and have successfully undertook the \n\n\n\nresponsibility, mainly in distribution and AEFI monitoring. \n\n\n\nApart from that, military pharmacists were also involved in \n\n\n\nadvocating vaccination by addressing the population\u2019s \n\n\n\nvaccine hesitancy, together with the religious officer from the \n\n\n\nheadquarters. By implementing effective communication \n\n\n\nstrategies, military pharmacists managed to inform the public \n\n\n\nabout the safety and efficacy of available vaccines, addressed \n\n\n\ntheir concerns and fears and dispel myths and misconceptions, \n\n\n\nthus allowing the public to make informed an decision which \n\n\n\ncan finally lead to developing herd immunity against the \n\n\n\nvirus. Conclusion:  With proper recognition, investment and \n\n\n\ntraining, military pharmacists can do more significant roles \n\n\n\nother than the established roles to achieve high vaccination \n\n\n\ncoverage, advocating public health as well as ensuring \n\n\n\nmedication safety among the public. \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:bernacirilos@gmail.com\n\n\nmailto:amirahkhan.ark@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n134 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 138 \n\n\n\n\n\n\n\nMilitary Pharmacist Involvement in Greater \n\n\n\nKlang Valley Special Task Force (GKVSTF) \n\n\n\n\u2013 Medical and General Logistics Cluster \n\n\n\n(MedGenLog Cluster) \n\n\n\n  \nMej Muhammad Najhan bin Md Bohari1*, Lt \n\n\n\nKol Mohamad Halif bin Mohamad Yusof2, \n\n\n\nKol Mohd Adlan bin Adnan3, Brig Jen Dato\u2019 \n\n\n\nDr A. Halim bin Basari3 \n\n\n\n \n1 Malaysian Armed Forces Medical and Dental Depot, Kuala Lumpur. \n2 Tuanku Mizan Armed Forces Hospital, Kuala Lumpur. \n3 Pharmaceutical Service Branch, Health Services Division, Malaysian \n\n\n\nArmed Forces \n\n\n\n* Corresponding author \n\n\n\nEmail: muhd.najhan@yahoo.com  \n \n\n\n\nBackground and Objectives: The GKVSTF was established \n\n\n\nand responsible for the planning and execution of the \n\n\n\nCOVID-19 Pandemic Action Control Plan in the Greater \n\n\n\nKlang Valley Region when COVID-19 cases accelerated in \n\n\n\nJuly 2021, reaching up to 12,000 cases daily. GKVSTF was \n\n\n\ntasked to implement contingency measures to mitigate the \n\n\n\ncrisis. Objective of this report is to share Military \n\n\n\nPharmacists' experience in managing challenges in the \n\n\n\nGKVSTF especially in the Medical and General Logistics \n\n\n\n(MedGenLog) Cluster. Methods: MedGenLog cluster\u2019s \n\n\n\nterms of references are to collect and analyse relevant logistic \n\n\n\ndata and implement actions accordingly with regards to the \n\n\n\nmedical and general logistics needs of all health facilities \n\n\n\nwithin GKV, liaise with the Finance Cluster to secure budget, \n\n\n\nidentify appropriate procurement methods, carry out the \n\n\n\nprocurement process, manage and coordinate an effective \n\n\n\nand efficient supply chain system from the process of \n\n\n\nreceiving, storage and distribution to the facilities. Results \n\n\n\nand Discussion: Throughout the mission, MedGenLog \n\n\n\ncluster had engaged with all respective hospitals and other \n\n\n\nrelevant government and non-government agencies to \n\n\n\nmanage vital medications and consumables supply, manage \n\n\n\noxygen supply, hospital medical and non-medical equipment, \n\n\n\npatient transportation, communication as well as other \n\n\n\nlogistic matters. Conclusion: GKVSTF had significantly \n\n\n\nmanaged the surge of COVID-19 patients by implementing \n\n\n\nout-of-the-book strategies to mitigate the issues. Military \n\n\n\nPharmacists involvement in MedGenLog Cluster were vital \n\n\n\nand gave an impact in implementing and supporting the \n\n\n\nstrategies and managing challenges. The efforts and \n\n\n\ninitiatives from GKVSTF had been subsequently replicated \n\n\n\nand extended to other regions of the country to manage the \n\n\n\nCOVID-19 pandemic. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 139 \n\n\n\n\n\n\n\nThe Flying Pharmacist: Military \n\n\n\nPharmacist\u2019s Experiences and Roles in \n\n\n\nManaging COVID-19 Vaccine Logistics \n\n\n\nUsing Royal Malaysian Airforce (RMAF) \n\n\n\nAircraft \n\n\n\n\n\n\n\nMAE Zamri1*, MA Adnan2, AH Basari2, MA \n\n\n\nRahim3, MH Haron1   \n \n1 Institute of Aviation Medicine (IAM), Subang, Malaysia \n2 Malaysian Armed Forces Health Services Division, Kuala Lumpur, \n\n\n\nMalaysia \n3 Malaysian Armed Forces Medical and Dental Depot, Kuala Lumpur, \n\n\n\nMalaysia \n\n\n\n* Corresponding author \n\n\n\nEmail: amirehsanzamri@gmail.com  \n\n\n\n\n\n\n\nBackground and Objectives:  The first batch of COVID-19 \n\n\n\nvaccine roll-out among the Malaysian Armed Forces (MAF) \n\n\n\nstarted in late February 2021, targeting approximately 50,000 \n\n\n\nmilitary and healthcare personnel in MAF who had been \n\n\n\ncategorized as frontliners and as a high risk group. In \n\n\n\naccordance with the Chief of Defence Forces (CDF) \n\n\n\ncommand to ensure a swift vaccination program to the \n\n\n\ntargeted group, the Royal Malaysian Air Force (RMAF) was \n\n\n\ngiven the \u2018green light\u2019 to deploy its strategic aircraft assets to \n\n\n\nfacilitate vaccination programs throughout Malaysia.  The \n\n\n\ngeneral objective of this case report is to share military \n\n\n\npharmacists\u2019 experiences and roles in managing COVID-19 \n\n\n\nvaccine logistics support from planning to distribution using \n\n\n\nRMAF aircraft. Methods: This is a retrospective case report, \n\n\n\nobservational study, by military pharmacists who had been \n\n\n\nintensively involved with a total of 35 cumulative flying \n\n\n\nhours in delivering COVID-19 vaccines. Results and \n\n\n\nDiscussion: It is observed that delivering vaccines using \n\n\n\naircraft proved to speed up the vaccination program among \n\n\n\nthe Armed Forces Health Facilities in the designated delivery \n\n\n\nareas.  There are many key challenges faced in handling \n\n\n\nCOVID-19 vaccine logistics as the vaccines are fragile and \n\n\n\nsensitive to extreme temperature variation thus required \n\n\n\nproper handling and monitoring to ensure the viability of the \n\n\n\nvaccine is preserved. Pharmacists are well versed in this \n\n\n\nprocess as they are exposed both theoretically and practically \n\n\n\nvia pharmacy training modules prior to the National COVID-\n\n\n\n19 Immunization Programme. Conclusion: Military \n\n\n\npharmacists play critical roles in performing the \n\n\n\nPharmaceutical and Medical Logistics (Pharmamedlog) \n\n\n\nsupport in accomplishing the mission objectives as well as \n\n\n\nsupporting the National COVID-19 Immunization \n\n\n\nProgramme.  \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:muhd.najhan@yahoo.com\n\n\nmailto:amirehsanzamri@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n135 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 140 \n\n\n\n\n\n\n\nCustomer Satisfaction towards Logistic \n\n\n\nPharmacy Services in HTJS \n\n\n\n\n\n\n\nSalihah bt Aidit, Rekarani a/p Rajantharan, \n\n\n\nNurfikriah Husna bt Mohamad Radz*, Nur \n\n\n\nAthirah bt Muhammad Fairuz \n\n\n\n\n\n\n\nDepartment of Pharmacy, Tuanku Ja\u2019afar Hospital, Seremban, Negeri \n\n\n\nSembilan, Malaysia \n\n\n\n* Corresponding author \n\n\n\nEmail: nurfikriahhusna@gmail.com \n\n\n\n\n\n\n\nBackground: Customer satisfaction is one important \n\n\n\nindicator of the quality of care because it reflects whether or \n\n\n\nnot a given service is meeting customer\u2019s expectations and is \n\n\n\nconsistent with their values. This study aimed to determine \n\n\n\nthe level of customer satisfaction towards logistic pharmacy \n\n\n\nservices and factors that affect the satisfaction of customers \n\n\n\ntowards logistic pharmacy services in Tuanku Ja\u2019afar \n\n\n\nHospital, Seremban (HTJS). Objectives: The objectives of \n\n\n\nthis study were to determine the level of satisfaction of \n\n\n\ncustomers towards logistic pharmacy services and to identify \n\n\n\nfactors that affect the satisfaction level of customers towards \n\n\n\nlogistic pharmacy services. Methods: A study was \n\n\n\nconducted in Tuanku Ja\u2019afar Hospital, Seremban. The total \n\n\n\nnumber of respondents were 80. A validated questionnaire \n\n\n\nwas used, and it consisted of two types of questions. First was \n\n\n\n\u201cCustomer Satisfaction Study\u201d and second was \u201cServqual\u2019s \n\n\n\nmodel\u201d. The study only included hospital staff involved in \n\n\n\nindenting from logistic pharmacy. They were referred to as \n\n\n\ncustomers in this study. The questionnaire took 15 to 20 \n\n\n\nminutes per respondent. Data were analysed using IBM SPSS \n\n\n\nSystem (Version 26) to determine the association and \n\n\n\ncorrelation between factors that affected the satisfaction level. \n\n\n\nP-value <0.05 indicated the data were statistically significant.  \n\n\n\nResults and Discussion: Out of all 80 respondents, 58 of \n\n\n\nthem (72.5%) were satisfied with the overall services \n\n\n\nprovided by the logistic pharmacy unit. Meanwhile, the \n\n\n\nremaining 22 respondents (27.5%) felt very satisfied with the \n\n\n\nservices. The three possible factors that contributed towards \n\n\n\ncustomer satisfaction were facilities, customer service and \n\n\n\nquality of service, which showed a statistically significant \n\n\n\ncorrelation with the overall satisfaction of the end user (\u03c7\u00b2: \n\n\n\n16.2, p: 0.006). Conclusion: Most of the respondents were \n\n\n\nsatisfied with the facilities, customer service and quality of \n\n\n\nservices provided by the logistic pharmacy unit in Hospital \n\n\n\nTuanku Ja\u2019afar. In addition, current services provided by the \n\n\n\nlogistic pharmacy unit in Hospital Tuanku Ja\u2019afar Seremban \n\n\n\nmet end users\u2019 expectations.  \n\n\n\n\n\n\n\n\n\n\n\nAbstract 141 \n\n\n\n\n\n\n\nPatient Characteristics and Factors \n\n\n\nAssociated with Defaulters among Drive-\n\n\n\nthrough Patients in Hospital Tuanku \n\n\n\nJa\u2019afar Seremban \n\n\n\n\n\n\n\nNursyafiqah. Md Tahir*, Nurshazlien. \n\n\n\nAbd.Halim, Jayasir Elengko \n \n\n\n\nDepartment of Pharmacy, Hospital Tuanku Ja\u2019afar Seremban, Negeri \n\n\n\nSembilan, Malaysia \n\n\n\n* Corresponding author \n\n\n\nEmail: adrenaliqa2021@gmail.com  \n\n\n\n\n\n\n\nBackground and Objectives: Drive-through pharmacy \n\n\n\nservice was introduced to resolve the problems encountered \n\n\n\nby patients during medicine collection visits such as \n\n\n\ninadequate parking space and long waiting time. However, \n\n\n\ndefaulters among drive-through patients contribute to \n\n\n\ninsufficient storage space for packaged defaulter medication, \n\n\n\nwaste of manpower and finances. This study aimed to \n\n\n\ninvestigate the characteristics and associated factors of \n\n\n\ndefaulters among drive-through patients. Methods: A \n\n\n\nretrospective cohort study was conducted, and simple \n\n\n\nrandom sampling was performed across newly registered and \n\n\n\nexisting drive-through patients in Hospital Tuanku Ja\u2019afar \n\n\n\nfrom May 2021 to June 2021. The outcome measure was the \n\n\n\nstatus of the patients categorized as defaulter and non-\n\n\n\ndefaulter. Collected data consisted of the patient\u2019s \n\n\n\ndemographic, patient characteristics, prescription \n\n\n\ncharacteristics, knowledge of characteristic and logistic \n\n\n\nissues. All data were analysed descriptively, and multiple \n\n\n\nlogistic regression was used in analyzing the association of \n\n\n\nfactors with defaulters. Results and Discussion: A total of \n\n\n\n335 drive-through patients were included in this study.                       \n\n\n\nThe prominent characteristics of defaulter patients were 66.7% \n\n\n\nfemale with a mean (standard deviation (SD)) age of 57.3 \n\n\n\n(17.67) years, 48.5% Malay, 57.6% new registered patients \n\n\n\nand 72.7% patients who were dependent. The proportion of \n\n\n\ndefaulters were 10.7% (95% CI: 6.2, 15.8) and 8.9 % (95% \n\n\n\nCI: 4.4, 13.3) in new registered and existing drive through \n\n\n\npatients respectively. In multivariable analysis, factors \n\n\n\nsignificantly associated with defaulters were female (OR= \n\n\n\n2.58; 95% CI:1.18 - 5.62; P=0.017), semi or fully dependent \n\n\n\n(OR= 2.66; 95% CI: 1.17- 6.05; P=0.020) and those who did \n\n\n\nnot receive notification (OR= 3.35; 95% CI: 1.43 - 7.84; \n\n\n\nP=0.005). Conclusion: There was a higher proportion of \n\n\n\ndefaulters among new patients compared to existing patients. \n\n\n\nFemale patients, semi or fully dependent patients and those \n\n\n\nwho did not receive notification had greater risk to become a \n\n\n\ndefaulter.  \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:nurfikriahhusna@gmail.com\n\n\nmailto:adrenaliqa2021@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n136 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 142 \n\n\n\n\n\n\n\nAssessment of Public Satisfaction on \n\n\n\nNational COVID-19 Immunization \n\n\n\nServices among the Malaysian Population \n\n\n\n\n\n\n\nWan Xin Soo Toh, Yoon Fong Hoo* \n\n\n\n\n\n\n\nSchool of Pharmacy, Faculty of Health and Medical Sciences, Taylor\u2019s \n\n\n\nUniversity, No.1, Jalan Taylor\u2019s, 47500 Subang Jaya, Selangor, Malaysia \n\n\n\n* Corresponding author \n\n\n\nEmail: yoonfong.hoo@taylors.edu.my  \n\n\n\n\n\n\n\nBackground and Objectives: National COVID-19 \n\n\n\nImmunization Programme (PICK) is  a programme \n\n\n\nimplemented by the Malaysian government to curb the \n\n\n\nCOVID-19 pandemic in Malaysia. The public is the \n\n\n\nbeneficiary in health systems. Therefore, by measuring \n\n\n\npublic satisfaction and preferences regularly, the effects of \n\n\n\nservices to the public can be improved continuously. In this \n\n\n\nstudy, we assessed public satisfaction on national COVID-19 \n\n\n\nImmunization services among the Malaysian population. \n\n\n\nMethods: A cross-sectional survey using snowball sampling \n\n\n\nmethod was conducted among Malaysians, aged 18 and \n\n\n\nabove, who have received free COVID-19 vaccinations in \n\n\n\nMalaysia, able to comprehend English. The questionnaire \n\n\n\nconsisted of two sections: socio-demographic data and public \n\n\n\nsatisfaction towards national COVID-19 immunization \n\n\n\nservices. Satisfaction was measured using 15 satisfaction-\n\n\n\nrelated items with 5 determinants of satisfaction:  with a 5-\n\n\n\npoint Likert scale, with 5 for very satisfied and 1 for very \n\n\n\ndissatisfied Descriptive and inferential statistics were utilized \n\n\n\nfor data analysis, with a level of significance at p> 0.05. \n\n\n\nResults and Discussion: Response rate was 89.5% (459/513 \n\n\n\napproached). Females made up 65.4%. Majority of the \n\n\n\nrespondents were aged below 39 (66.2%), MySejahtera users \n\n\n\n(92.8%), Chinese (79.3%), and had tertiary education \n\n\n\n(78.4%). The overall mean satisfaction score (SD) was 4.14 \n\n\n\n(\u00b1 0.56). Factors which showed statistically high positive \n\n\n\ncorrelation with overall public satisfaction include \n\n\n\nimmunization system (P<0.01), consultations by healthcare \n\n\n\nprofessionals before vaccination (p<0.01) and attitudes of \n\n\n\nstaff at the vaccination centre (p<0.01). Conclusion: The \n\n\n\noverall satisfaction level towards COVID-19 immunization \n\n\n\nservices is high among the Malaysian population. Regardless \n\n\n\nof the high satisfaction rate, more extensive and further \n\n\n\nresearch needs to be conducted to provide a better insight on \n\n\n\nthis matter and we still need to keep improving the measures \n\n\n\nin place to further boost the satisfaction among Malaysians \n\n\n\ntowards the immunization services, which can help further \n\n\n\nstrengthen healthcare delivery standards.  \n\n\n\n\n\n\n\n\n\n\n\nAbstract 143 \n\n\n\n\n\n\n\nPerceptions, Attitude, and Barriers of \n\n\n\nPAPPI Regulatory Pharmacists Towards \n\n\n\nRegulatory Pharmacy Experiential Practice: \n\n\n\nA Basis for Capacity Programs \n\n\n\n\n\n\n\nRosita S. Ignacio1, Nimfa B. Gambalan2\uff0c\n\n\n\nVieno Gino Cruz1*, Mark Harvey B. \n\n\n\nAdamson1 \n \n1 School of Pharmacy, Graduate studies, Philippine Women\u2019s University, \n\n\n\nManila, Philippines \n2 Department of Pharmacy, College of Allied Health, National University, \n\n\n\nManila, Philippines \n\n\n\n* Corresponding author \n\n\n\nEmail: vcruz@pwu.edu.ph  \n \n\n\n\nBackground and Objectives: As one of the major fields in \n\n\n\nthe experiential pharmacy practice, regulatory pharmacists \n\n\n\nare involved in the preceptorship of pharmacy students to \n\n\n\nhelp engage them in the acquisition of knowledge and skills \n\n\n\nfor their future responsibilities. This study determined the \n\n\n\nperceptions and attitudes of the regulatory pharmacists \n\n\n\nregarding their roles, benefits, and scope as preceptors, as \n\n\n\nwell as the barriers that they might encounter in the \n\n\n\nintegration of the regulatory pharmacy experiential practice \n\n\n\nin the new pharmacy curriculum. Methods: The research \n\n\n\nemployed an exploratory descriptive design. With regulatory \n\n\n\npharmacists from the Philippine Association of Pharmacists \n\n\n\nin the Pharmaceutical Industry (PAPPI) as respondents, an \n\n\n\nonline instrument, tested for content validity and internal \n\n\n\nconsistency, was administered. Results and Discussion: \n\n\n\nResponse turn-out was 50.42% of the total population. The \n\n\n\nregulatory pharmacists showed high perception and attitudes \n\n\n\nto the roles, scope, and benefits of preceptors as well as on \n\n\n\nthe scope of training. As for the barriers, it was found that \n\n\n\nprovision of facilities, technical infrastructures, organized \n\n\n\nregulatory pharmacy experiential practice, lack of time and \n\n\n\nmotivations, were some of the factors that may be \n\n\n\nencountered in the provision of the regulatory experiential \n\n\n\npharmacy practice. Based on the results, there was a \n\n\n\nsignificant positive correlation between perception and \n\n\n\nattitude of regulatory pharmacists to RPEP (p < .01).  \n\n\n\nConclusion:  To ensure provision of an excellent regulatory \n\n\n\nexperiential practice, it is recommended that capacity \n\n\n\nbuilding programs, strong collaboration between academia \n\n\n\nand industries, as well as workshops on preceptorships, be \n\n\n\nimplemented. Furthermore, it is proposed that the workload \n\n\n\nof preceptors be revised, and recognition be provided for the \n\n\n\ncontribution of the regulatory pharmacists in the experiential \n\n\n\npharmacy practice. \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:yoonfong.hoo@taylors.edu.my\n\n\nmailto:vcruz@pwu.edu.ph\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n137 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 144 \n\n\n\n\n\n\n\nExploratory Factor Analysis of A Patient-\n\n\n\nreported Outcome Measure: A Newly \n\n\n\nDeveloped Medication Adherence \n\n\n\nMeasurement Tool for the Elderly in \n\n\n\nMalaysia \n\n\n\n\n\n\n\nKamaliah Md Saman1*, Nurfatiha Zulkarnain \n\n\n\nHelmi2, Khairil Anuar Md Isa2, Mathumalar \n\n\n\nLoganathan Fahrni1 \n \n\n\n\n1 Department of Pharmacy Practice, Faculty of Pharmacy, Universiti \n\n\n\nTeknologi MARA (UiTM) Cawangan Selangor, Kampus Puncak Alam, \n\n\n\n42300 Bandar Puncak Alam, Selangor, Malaysia \n2 Department of Basic Sciences, Faculty of Health Sciences, Universiti \n\n\n\nTeknologi MARA (UiTM) Cawangan Selangor, Kampus Puncak Alam, \n\n\n\n42300 Bandar Puncak Alam, Selangor, Malaysia  \n\n\n\n* Corresponding author \n\n\n\nEmail: kamaliah@uitm.edu.my  \n\n\n\n\n\n\n\nBackground and Objectives: Measurement of medication \n\n\n\ndefault among the elderly is still a growing concern \n\n\n\nworldwide, compounded by the scarcity of a reliable \n\n\n\nmeasure specific for this cohort of people.  Recently we \n\n\n\ndeveloped a patient-reported outcome measure (PROM) to \n\n\n\nmeasure level of non-adherence to medication among the \n\n\n\nelderly, named Medication Alert Tool For the Elderly \n\n\n\n(MeSATE).   In line with the Consensus-based Standards for \n\n\n\nthe Selection of Health Status Measurement Instrument \n\n\n\n(COSMIN), this study aimed to validate MeSATE  \n\n\n\nreliability for usability purpose in Malaysia by using \n\n\n\nexploratory factorial analysis (EFA). Methods: This cross-\n\n\n\nsectional study was conducted among the residents of long-\n\n\n\nterm nursing care homes around Klang Valley, as well as \n\n\n\npatients from the outpatient, geriatric  and diabetic \n\n\n\nmedication therapy adherence clinic in one of the \n\n\n\ngovernment tertiary hospital and a health centre in Selangor \n\n\n\nand Johor respectively (n=391). Results and Discussion: \n\n\n\nFactor analysis on the MeSATE questions showed that there \n\n\n\nwere four underlying structures, while the Cronbach alpha \n\n\n\ncoefficient indicates that MeSATE had an acceptable \n\n\n\ninternal consistency. Conclusion: MeSATE is a valid and \n\n\n\nreliable measurement tool for food medication adherence \n\n\n\nmeasurement among the Malaysian elderly population.\n\n\n\nAbstract 145 \n\n\n\n\n\n\n\nTransethosomal Gels as Nanocarriers for \n\n\n\nthe Transdermal Delivery of Tamoxifen: \n\n\n\nStatistical Optimization, Characterization, \n\n\n\nand Ex vivo Evaluation \n\n\n\n\n\n\n\nReem Abou Assi1,2, Siok Yee Chan 1* \n \n1 Thoughts Formulation Lab., School of Pharmaceutical Sciences, \n\n\n\nUniversiti Sains Malaysia, 11800 Malaysia \n2 EDEN Research Group, Discipline of Pharmaceutical Technology, \n\n\n\nCollege of Pharmacy, Al-Kitab University, Altun kupri, Kirkuk, 36001, \n\n\n\nIraq. \n\n\n\n* Corresponding author \n\n\n\nEmail: sychan@usm.my  \n\n\n\n\n\n\n\nBackground and Objectives: Tamoxifen is the drug of \n\n\n\nchoice for the prevention and treatment of estrogen \n\n\n\ndependent breast cancer. Its oral administration is associated \n\n\n\nwith low solubility, life threatening side effects and \n\n\n\nconsequently low patients\u2019 adherence. Thus, to circumvent \n\n\n\nthese drawbacks, the transdermal delivery of tamoxifen was \n\n\n\ndeveloped. Precise consideration was given to understanding \n\n\n\nnonionic surfactants impact with different hydrophilic\u2013\n\n\n\nlipophilic balance (HLB) values when used as edge \n\n\n\nenhancers in the transethosomal production and performance. \n\n\n\nMethods: Tamoxifen-loaded transethosomes (TEs) were \n\n\n\nprepared by the cold method and statistically optimized using \n\n\n\nthree sets of 24 factorial design experiments for three \n\n\n\ndifferent edge enhancers of HLB values 16.7, 8.6, 4.3 \n\n\n\nrespectively. The optimized formulations were incorporated \n\n\n\ninto Carbopol 940\u00ae gel base. The prepared tamoxifen-loaded \n\n\n\ntransethosomal gels were further characterized for vesicular \n\n\n\nsize, dispersity, zeta potential, entrapment efficiency, pH, \n\n\n\nviscosity, yield, rheological behavior, and ex vivo skin \n\n\n\npermeation through pig skin. Results and Discussion: The \n\n\n\nresults showed that the tamoxifen-loaded TEs had aspherical \n\n\n\nirregular shape, nanometric size range in all TEs, with higher \n\n\n\nentrapment efficiency in lower HLB values, which is \n\n\n\nattributed to such edge enhancer ability to solubilize more \n\n\n\ntamoxifen. All the formulated gels exhibited non-Newtonian \n\n\n\nplastic flow without thixotropy. Regardless of the HLB value, \n\n\n\ntamoxifen-loaded transethosomal gels were able to \n\n\n\nsignificantly enhance the skin permeation parameters of the \n\n\n\ndrug in comparison to the non-ethosomal gel. Conclusion: \n\n\n\nThese findings suggested that the transethosomal gels (with \n\n\n\nhigh or low HLB values) are promising carriers for the \n\n\n\ntransdermal delivery of tamoxifen, providing an alternative \n\n\n\nroute for breast cancer therapy administration.  \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:kamaliah@uitm.edu.my\n\n\nmailto:sychan@usm.my\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n138 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 146 \n\n\n\n\n\n\n\nViability Assay of Essential Fatty Acids \n\n\n\nfrom the Benincasa hispida Seed Extract in \n\n\n\nKeratinocytes  \n\n\n\n\n\n\n\nRamli RZ* & Hadi H      \n \n\n\n\nDermatopharmaceutics Research Group, Department of Pharmaceutical \n\n\n\nTechnology, Kuliyyah of Pharmacy, International Islamic University \n\n\n\nMalaysia, Kuantan, Pahang, Malaysia \n\n\n\n* Corresponding author \n\n\n\nEmail: rizal.zaim@yahoo.com  \n \n\n\n\nBackground and Objectives: Both omega-3 and omega-6 \n\n\n\nfatty acids (FAs) play different crucial roles in human body, \n\n\n\nand they are the important components in cell membranes \n\n\n\nand the main precursors of other FAs which are needed for \n\n\n\ngrowth and repair functions in the human body. Benincasa \n\n\n\nhispida seed extract\u2019s (BHSE) main contents were found out \n\n\n\nto be mainly consists of polyunsaturated fatty acids (PUFAs). \n\n\n\nIn this study, two methods were carried out which were the \n\n\n\ncell culture of HaCaT cells and the MTS viability assay. \n\n\n\nMethods: The viability assay was first started with the \n\n\n\nculture of HaCaT cells in the 96-well microplate at cell \n\n\n\ndensity of 1 X 10^5. The growth of the cells was monitored \n\n\n\nand maintained using the high glucose Dulbecco Modified \n\n\n\nEagle Medium and in an incubator at 37\u02daC and 5% carbon \n\n\n\ndioxide level. After one day of incubation, the cells were \n\n\n\nfound to be confluent (~ 80%) and the cells were treated with \n\n\n\nsix different concentrations of BHSE (1000 \u00b5g/mL, 500 \n\n\n\n\u00b5g/mL, 250 \u00b5g/mL, 125 \u00b5g/mL, 62.5 \u00b5g/mL and 31.25 \n\n\n\n\u00b5g/mL). Three set of plates were cultured with each plate was \n\n\n\ncultured at 24 hours, 48 hours and 72 hours prior measuring \n\n\n\nthe absorbance (after 4 hours of incubation with MTS reagent) \n\n\n\nusing the microplate reader at 490 nm. Results and \n\n\n\nDiscussion: This study has found that there was no \n\n\n\ncytotoxicity effect of the extract towards the HaCaT cells \n\n\n\n(overall cell viability was more than 80%) with significant \n\n\n\ndifferences were found from 31.25 \u00b5g/mL until 500 \u00b5g/mL \n\n\n\nafter 24 hours and 48 hours treatment durations. Conclusion: \n\n\n\nTo sum up, this data is important in the safety application of \n\n\n\nthe extract especially the PUFAs in any studies to be \n\n\n\nconducted especially in dermatology studies for the \n\n\n\ninvolvement of the keratinocytes. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 147 \n\n\n\n\n\n\n\nThe Development and Characterisation of \n\n\n\nRetinoic Acid Loaded Nanosponge \n\n\n\n\n\n\n\nSyed Omar SS\u00b9*, Hadi H\u00b9, Doolanea AA1,2 \n\n\n\n\n\n\n\n\u00b9 Dermatopharmaceutics Research Group, Department of Pharmaceutical \n\n\n\nTechnology, Faculty of Pharmacy, International Islamic University \n\n\n\nMalaysia, Malaysia \n,2 Department of Pharmaceutical Technology, Faculty of Pharmacy, \n\n\n\nUniversity College MAIWP International, Malaysia \n\n\n\n* Corresponding author \n\n\n\nEmail: shakirahsaggaf@gmail.com  \n\n\n\n\n\n\n\nBackground and Objectives: Retinoic acid (RA) has high \n\n\n\nefficacy against acne but is insoluble in water, unstable in the \n\n\n\npresence of light, heat and air; and may cause side effect on \n\n\n\nthe skin such as dryness, peeling and pruritus.  Nanosponge \n\n\n\nwith its porous structure can entrap RA and maybe able to \n\n\n\nenhance the solubility and stability of RA, improving its \n\n\n\ndelivery while reducing side effects. The objective of this \n\n\n\nstudy is to develop RA loaded nanosponge formulation with \n\n\n\nfavourable characteristics. Methods: Nanosponge was \n\n\n\nprepared with \u03b2-cyclodextrin as the polymer and \n\n\n\ncarbonyldiimidazole as the cross-linker. The nanosponge \n\n\n\nwas then characterized by assessing its particle size, zeta \n\n\n\npotential, surface morphology, Attenuated Total Reflectance \n\n\n\nFourier-transform Infra-Red (ATR-FTIR) Spectroscopy \n\n\n\nstudy, Differential Scanning Calorimetric (DSC) Study. The \n\n\n\nentrapment efficiency was also analysed. Results and \n\n\n\nDiscussion: The RA nanosponge showed desirable \n\n\n\ncharacteristics with particle size of below 300nm, \n\n\n\npolydispersity index below 0.5 and zeta potential value of -\n\n\n\n24.1 mV. Encapsulation efficiency obtained was 78.19% \n\n\n\nwhich is optimal as it is above 60%. Both ATR-FTIR and \n\n\n\nDSC study confirmed inclusion of RA in the cyclodextrin. \n\n\n\nConclusion: Retinoic acid can be loaded into the nanosponge \n\n\n\nand obtain favourable characteristics suitable for further in-\n\n\n\ndepth research. \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:rizal.zaim@yahoo.com\n\n\nmailto:shakirahsaggaf@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n139 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 148 \n\n\n\n\n\n\n\nFormulation and Evaluation of \n\n\n\nVoriconazole Gastro Retentive Floating \n\n\n\nTablets \n\n\n\n\n\n\n\nD Srinivasa Sastry*, S. Jahnavi Purna, G \n\n\n\nSumalatha, D Srilakshmi \n \n\n\n\nVikas Institute of Pharmaceutical Sciences, Near Airport, Nidigatla Road, \n\n\n\nRajahmundry-533101 Andhra Pradesh India,  \n\n\n\nAndhra University, Andhra Pradesh, India \n\n\n\n* Corresponding author \n\n\n\nEmail: dsrinivas78@gmail.com  \n\n\n\n\n\n\n\nBackground and Objectives: The present study was a \n\n\n\nsystematic approach for development of intragastric buoyant \n\n\n\ntablets of voriconazole with a view to enhance its oral \n\n\n\nbioavailability and efficacy.  Methods: Gastro retentive \n\n\n\nfloating tablets of voriconazole using various polymers guar \n\n\n\ngum, xanthan gum, ethyl cellulose and sodium bicarbonate, \n\n\n\nmagnesium stearate and talc in different proportions were \n\n\n\nprepared by direct compression method and subjected to In \n\n\n\nvitro drug release studies. Drug polymer compatibility \n\n\n\nstudies were carried out by FT-IR study. The formulation \n\n\n\nblend was subjected to various preformulation studies, flow \n\n\n\nproperties and all the formulations were found to be good \n\n\n\nindicting that the powder has good flow properties. All the \n\n\n\nformulations were evaluated for hardness, friability, weight \n\n\n\nvariation, drug content and In vitro drug release. Results and \n\n\n\nDiscussion: Among all the formulations, formulation \n\n\n\nprepared with guar gum retarded the drug release up to 12 \n\n\n\nhours (F2). The formulations prepared with xanthan gum and \n\n\n\nethyl cellulose also retarded drug release for more than 12 \n\n\n\nhours. Hence, they were not considered. The optimized \n\n\n\nformulation dissolution data was subjected to release kinetics, \n\n\n\nfrom the release kinetics data was evident that the \n\n\n\nformulation followed Higuchi mechanism of the drug release.  \n\n\n\nConclusion: Thus, the above study clearly indicated that \n\n\n\nvoriconazole may be formulated as gastro retentive floating \n\n\n\ntablets by direct compression method. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 149 \n\n\n\n\n\n\n\nIn vitro Mammalian \u03b1-Glucosidase \n\n\n\nInhibitory Activity of Hylocereus \n\n\n\npolyrhizus \n\n\n\n\n\n\n\nChristian M. Miranda1, Vieno Gino Cruz1*, \n\n\n\nNimfa B. Gambalan2, Jover D. Francisco3, \n\n\n\nRizza Caluag1 \n \n\n\n\n1 School of Pharmacy, Philippines Women\u2019s University, Manila, Philippines \n2 Department of Pharmacy, College of Allied Health, National University, \n\n\n\nManila, Philippines \n3 Laboratory Services, Manila Central University, Caloocan, Philippines \n\n\n\n* Corresponding author \n\n\n\nEmail: vcruz@pwu.edu.ph  \n \n\n\n\nBackground and Objectives: Dragon fruit (Hylocereus \n\n\n\npolyrhizus), a regular priority commodity in the Central and \n\n\n\nNorthern region of the Philippines, may pose as one of the \n\n\n\npotential novel solutions as functional food to the existing \n\n\n\nuncontrollable incidence of diabetes. The purpose of the \n\n\n\nstudy investigates mammalian \u03b1-glucosidase inhibition, in \n\n\n\nvitro, of H. polyrhizus peel to provide information towards \n\n\n\nthe development of alternative approaches in managing \n\n\n\ndiabetes. Methods: Spectrophotometric method was \n\n\n\nperformed to examine the mammalian \u03b1-glucosidase \n\n\n\ninhibition of ethanol fractions (EF), methanol fractions (MF), \n\n\n\nethyl acetate fractions (EAF), and chloroform fractions (CF).  \n\n\n\nFifty percent maximal inhibitory concentration (IC50) was \n\n\n\ndetermined from the generated four-parameter logistic (4PL) \n\n\n\nnon-linear regression interpolated from concentration-\n\n\n\npercent inhibition plot. Standardized phytochemical analyses \n\n\n\nwas employed to identify the presence of phytochemical \n\n\n\nconstituents. Results and Discussion: EF showed a \n\n\n\nconcentration-dependent inhibition towards mammalian \u03b1-\n\n\n\nglucosidase enzyme displaying the lowest IC50 (0.533 \n\n\n\nmg/mL) among different fractions. Alkaloid, flavonoid, and \n\n\n\npolyphenol detected might be responsible for inhibitory \n\n\n\nactivity. Chromoalkaloids (betanin, isobetanin, phyllocactin, \n\n\n\nand isophyllocactin) and Polyphenolics (kaempferol, \n\n\n\nquercetin, phloretin, and myricetin) were reported active \n\n\n\ninhibitor of \u03b1-glucosidase needed for management of \n\n\n\ndiabetes. Conclusion:  The results provided scientific \n\n\n\nevidence in inhibiting \u03b1-glucosidase for the managing \n\n\n\ndiabetes where fractions, especially EF, displayed notable \n\n\n\nIC50. Isolation and standardization of the active components \n\n\n\ndetected may contribute to the inclusion on the potential \n\n\n\ncandidates in the formulation of standardised drug product \n\n\n\nand functional food. \n \n\n\n\n\nmailto:dsrinivas78@gmail.com\n\n\nmailto:vcruz@pwu.edu.ph\n\n\n\n"
"\n\n\n\n\n\nFormulation and Stability of Extemporaneously Prepared Morphine Oral \n\n\n\nSuspension  \n \n\n\n\nLian T. Chan*, Lucy Yeoh \n\n\n\n\n\n\n\nWinwa Medical Sdn Bhd, Bukit Mertajam, Pulau Pinang, Malaysia. \n\n\n\n\n\n\n\n* Contact for correspondence, please email: ltchan@winwamedical.com \n\n\n\n\n\n\n\n\n\n\n\nABSTRACT \n\n\n\n \nMorphine taken by mouth is an effective analgesic for most people with moderate or severe cancer \n\n\n\npain. Hospital pharmacists commonly prepare morphine oral liquid extemporaneously for cancer \n\n\n\npatients who require tube feeding or have difficulties in swallowing because it is not available \n\n\n\ncommercially in Malaysia. This study aims to provide the physical, chemical and microbiological \n\n\n\nstability data to determine the shelf-life and storage condition for the extemporaneous preparation of \n\n\n\nmorphine oral suspension (10mg/5ml) using X-Temp Oral Suspension System. The samples were \n\n\n\ndivided into 2 groups and were stored at 4\u00baC (refrigeration) and 30\u00baC / 75%RH (room temperature) \n\n\n\nprotected from light for 12 months. The physical, chemical and microbiological stability were \n\n\n\nexamined at the interval of months 0, 1, 2, 3, 4, 5, 6, 9 and 12. The content of morphine was \n\n\n\ndetermined using HPLC-UV method. The content of morphine remained above 95% of the original \n\n\n\nconcentration throughout the study period. The colour, clarity and odour remained fairly unchanged \n\n\n\nthroughout the study period and the pH values were steady at around pH 4. The extemporaneous \n\n\n\npreparation was not susceptible to microbial contamination. The results from the stability studies \n\n\n\nconfirmed that the new formulation of morphine oral suspension is stable for up to 12 months when \n\n\n\npacked in HDPE bottles with polypropylene caps and stored at both 4\u00baC and 30\u00baC / 75%RH.  \n\n\n\n\n\n\n\n\n\n\n\nINTRODUCTION \n \n\n\n\nMorphine is an opioid analgesic used to relieve severe, acute pain or moderate to severe, chronic pain \n\n\n\nfor patients with cancer, myocardial infarction and surgery (1,2). Morphine taken by mouth is an \n\n\n\neffective analgesic for cancer pain and is considered the drug of first choice for relieving moderate to \n\n\n\nsevere pain (3). Moderate to severe pain in cancer is common and affects 70 to 80% of patients with \n\n\n\nadvanced disease (3). Morphine has remained the first choice for reasons of familiarity, availability \n\n\n\nand cost rather than proven superiority (3). \n\n\n\n\n\n\n\nAccording to the World Health Organization (WHO), morphine is given orally as an aqueous \n\n\n\nmorphine solution or as standard immediate-release tablet every four hours by the clock (4). \n\n\n\nModified-release tablets or capsules are available in both 12 hour and 24 hour release patterns and \n\n\n\nshould be swallowed whole (5). The effective dose may vary from as little as 5mg to more than \n\n\n\n1000mg partly because of individual variations in systemic bioavailability (4). Immediate-release \n\n\n\nformulations (tablet or aqueous solution) are much more flexible than long-acting preparations, both \n\n\n\nin the dose titration period and when the pain is poorly controlled (3). When compared to immediate- \n\n\n\nand modified-release morphine tablets, morphine oral solution has an earlier onset and is easier to \n\n\n\ntake and more convenient for dose titration (6). \n\n\n\n \nThe lack of commercially available oral liquid dosage form is an on-going problem for health care \n\n\n\nproviders in many practice settings. The pharmacist, both in community and hospital pharmacy \n\n\n\npractice, is often challenged with the preparation of a liquid dosage form not available for paediatric \n\n\n\n\n\n\n\n\n\n\n\n\npatients, those adults unable to swallow tablets or capsules and patients who must receive medications \n\n\n\nvia nasogastric or gastrostomy tubes (7). \n\n\n\n\n\n\n\nWhen there is a need to undertake extemporaneous preparation, the accountable pharmacist must \n\n\n\nchoose a validated formula with supporting stability data (8,9). However, when the stability data and \n\n\n\nvalidated formulations are not available, further research should be carried out to validate the \n\n\n\nformulations used in practice whenever possible and then the formulations should be standardized \n\n\n\namong all the hospitals (9).  \n\n\n\n\n\n\n\nMorphine oral liquid is preferred in cancer patients who require tube feeding or have difficulties in \n\n\n\nswallowing (6). Many hospital pharmacists have to prepare morphine oral liquid extemporaneously \n\n\n\nbecause it is not available commercially (9). In Malaysia, pharmacists in major hospital are tasked to \n\n\n\nprepare morphine oral liquids on a weekly basis to supply them to outpatient departments, satellite \n\n\n\npharmacies and wards. Therefore, it is ideal that the morphine oral liquid has longer shelf-life to meet \n\n\n\nthe clinical requirements of the outpatients who are taking this medicine and also to minimize wastage \n\n\n\ndue to short expiry. \n\n\n\n\n\n\n\nExtemporaneous preparation remains one of the highest risks preparative activities carried out in the \n\n\n\npharmacy, as the risks of unlicensed medicines are combined with inherent risks associated with the \n\n\n\npharmaceutical compounding process (8). Formulation failure can occur when a formulation has not \n\n\n\nbeen adequately validated, potentially resulting in either under- or overdose and associated toxicity or \n\n\n\ntherapeutic failure (8). The causes of formulation failure are numerous and can be complex, including \n\n\n\nphysical incompatibilities, drug/excipient binding issue and drug degradation (8). Generally, as the \n\n\n\ncomplexity of the formulation increases so does the risk of problems occurring. Therefore, the \n\n\n\nformulation of the extemporaneous preparation should be designed as simple as possible for these \n\n\n\nreasons (8). \n\n\n\n\n\n\n\nAccording to the USP36-NF31 Chapter <795>, Pharmaceutical Compounding \u2013 Nonsterile \n\n\n\nPreparations (10), an extemporaneous oral liquid has a beyond-use date (BUD) of not more than 14 \n\n\n\ndays shelf-life when stored at controlled cold temperatures if no stability information or supporting \n\n\n\ndata is available. This study will provide the stability data needed to determine the shelf-life and \n\n\n\nstorage condition for the extemporaneous preparation of morphine oral liquid. The results from the \n\n\n\nstability studies are important to validate the formulation and to confirm that the extemporaneous \n\n\n\npreparation remains stable and efficacious during the course of their use.  \n\n\n\n\n\n\n\nAn oral formulation can be prepared from morphine sulfate or hydrochloride salt (4,5). Morphine \n\n\n\nhydrochloride is a colourless, white or almost white, crystalline powder. It is efflorescent in a dry \n\n\n\natmosphere. It is soluble in water, slightly soluble in alcohol and practically insoluble in toluene (2).  \n\n\n\n\n\n\n\nOral liquids are usually formulated as either a suspension or solution. Drugs in solution are more \n\n\n\nsusceptible to chemical degradation than drugs in the solid state and this should be considered when \n\n\n\npreparing a solution (11). Extemporaneous preparation made from tablets contains excipients such as \n\n\n\nbinders and disintegrating agents in addition to the active drug. Insoluble tablet excipients may \n\n\n\ncompromise the product appearance of the suspension whereas soluble tablet excipients may reduce \n\n\n\ndrug stability, for example, by altering the pH of the preparation (11). \n\n\n\n\n\n\n\nWhen considering the suitability of an extemporaneous oral liquid, a number of factors, in addition to \n\n\n\nchemical stability of active pharmaceutical ingredient (API) need to be considered. This includes \n\n\n\nphysical stability, microbial stability, palatability, excipient suitability (e.g. sugar free for diabetic \n\n\n\npatients), interactions with packaging materials, accurate compounding procedures including \n\n\n\ncalculations and cost (12).  \n\n\n\n\n\n\n\nSince sourcing of API for morphine hydrochloride is possible, pure drug substance is preferred over \n\n\n\ncommercially available tablet for compounding of oral liquids. The use of commercially available \n\n\n\nsuspending base is encouraged and is considered an excellent choice for making the extemporaneous \n\n\n\n\n\n\n\n\n\n\n\n\npreparations as simple for the inexperienced pharmacist making one-off preparations (13). \n\n\n\nCommercial vehicles are considered a convenient choice since many practice settings may not stock a \n\n\n\nwide variety of excipients and many of the stability studies in the literature on oral liquids prepared \n\n\n\nextemporaneously utilize these commercial vehicles (12). \n\n\n\n\n\n\n\nMATERIALS AND METHODS \n\n\n\n \nFormulation and Study Design \n\n\n\nThe extemporaneous preparation of morphine oral suspension (10mg/5ml) was prepared by the \n\n\n\npharmacy department of Universiti Kebangsaan Malaysia Medical Centre (UKMMC). The API of \n\n\n\nmorphine hydrochloride BP, PhEur. was sourced from Johnson Matthey / Macfarlan Smith Limited, \n\n\n\nUnited Kingdom and the commercial vehicle, X-Temp Oral Suspension System was supplied by \n\n\n\nPharm-D Sdn Bhd, Malaysia (Figure 1). \n\n\n\n\n\n\n\nFigure 1: Master formula for morphine oral suspension \n\n\n\nIngredient Amount \n\n\n\n Morphine HCl Powder                 10g \n\n\n\n X-Temp Oral Suspension System qs ad 5000ml \n\n\n\n\n\n\n\nThe commercial vehicle chosen contains specialized suspending system formulated to assist in \n\n\n\nextemporaneous preparation of oral liquid, non-soluble (suspended), aqueous dosage form and is an \n\n\n\norange flavoured, sweetened, sugar-free vehicle containing suitable preservatives. The morphine oral \n\n\n\nsuspension was packed into 100ml semi-transparent high-density polyethylene (HDPE) bottles and \n\n\n\nwas fitted with white polypropylene screw caps. \n\n\n\n\n\n\n\nFifty-five bottles of morphine oral suspension were divided into 2 groups and one group was stored at \n\n\n\n4 \u00b1 2\u00baC (refrigeration) and the other was stored at 30 \u00b1 2\u00baC / 75%RH \u00b1 5%RH (room temperature) in \n\n\n\nthe absence of light.  \n\n\n\n\n\n\n\nDrug product stability encompasses chemical, physical, microbiological, therapeutic and toxicological \n\n\n\nstability not only of the drug substance, but when taking into account of the excipients, also the drug \n\n\n\nproduct (14). Stability studies should be performed for desired drug concentration and in real storage \n\n\n\nconditions (storage temperature, duration and type of container). The physical stability is assessed \n\n\n\nfrom changes in appearance, colour or odour, while the chemical stability is determined using an \n\n\n\nadequate analytical method for drug quantification (10). Microbiological stability should be \n\n\n\nconducted in extemporaneous oral formulations containing no or insufficient preservatives and be \n\n\n\nstored at room temperature over an extended period (10,15). This study focuses on the physical, \n\n\n\nchemical and microbiological stabilities and to confirm that the new formulation for the morphine oral \n\n\n\nsuspension is suitable and stable. \n\n\n\n\n\n\n\nAnalytical Method and Equipment \n\n\n\nThe content of morphine hydrochloride in the oral suspension was assayed by high-performance \n\n\n\nliquid chromatography (HPLC) method with reference to the British Pharmacopoeia and the content \n\n\n\nof morphine hydrochloride was set at 90 to 110% of the stated amount (16). The HPLC method for \n\n\n\nthe analysis of morphine in this study was validated in a previous short-term stability study of \n\n\n\nextemporaneously prepared morphine oral suspension using the above formulation. The evaluation of \n\n\n\nthe analytical method validation includes linearity, accuracy and system suitability (Table 1). A range \n\n\n\nperformed on the HPLC system has confirmed the linearity of the method (R\n2 \n= 0.99998) (Figure 2).  \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nTable 1: Results of analytical method validation \n\n\n\nTest Parameter Validation Results Acceptance Limits \n\n\n\nLinearity & Range   \n\n\n\n R\n2\n = 0.99998 R\n\n\n\n2\n: Not less than 0.999 \n\n\n\nIntercept = 0.40% of the response \n\n\n\nof 100% (working) concentration \n\n\n\nIntercept: NMT 2% of the response \n\n\n\nof 100% (working) concentration \n\n\n\nAccuracy   \n\n\n\nSpiking of placebo \n\n\n\n9 determination (3 \n\n\n\nreplicates / 3 \n\n\n\nconcentration) \n\n\n\n99.3%, 99.6%, 99.7%, 98.1%, \n\n\n\n99.0%, 98.7%, 100.4%, 101.1%, \n\n\n\n100.8% \n\n\n\n% recovery: 98 - 102% of label or \n\n\n\nmean from precision \n\n\n\nSystem Suitability   \n\n\n\nSystem Precision RSD of detector response = 0.07% RSD of detector response: NMT \n\n\n\n2%  \n\n\n\n RSD of retention time = 0.08% RSD of retention time: NMT 1% \n\n\n\nPeak Performance  \n\n\n\nk' = 2.215 \n\n\n\nResolution  = 18.167 \n\n\n\nUSP tailing = 1.344 \n\n\n\nN = 5939 \n\n\n\nAnalyte \n\n\n\nk': NLT 1.5 \n\n\n\nResolution: NLT 2 \n\n\n\nUSP tailing: NMT 2 \n\n\n\nN: NLT 2000 \n\n\n\n \nFigure 2: Calibration curve of the HPLC assay method \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \nThe content of morphine hydrochloride was measured by HPLC-UV method after the sample of \n\n\n\nextemporaneous preparation was made throughout the stability study period. Samples were removed \n\n\n\nfrom each individual bottle on months 0, 1, 2, 3, 4, 5, 6, 9 and 12. A working reference standard of \n\n\n\nmorphine hydrochloride was obtained from Johnson Matthey / Macfarlan Smith Limited, United \n\n\n\nKingdom. \n\n\n\n\n\n\n\nThe HPLC system used for the analysis was an Agilent 1200 RRLC instrument with binary pump SL, \n\n\n\nautosampler SL, DAD SL detector, Thermostat Column Compartment SL and chemstation. The \n\n\n\nchromatographic separation used was Zorbax Eclipse XDB-C18 (4.6mm ID x 100mm, 3.5\uf06dm). The \n\n\n\nDAD detector operated at 230nm. The mobile phase consisted of a mixture of 65 volumes of \n\n\n\n0.005M sodium heptanesulfonate buffer adjusted to pH 2.6 with orthophosphoric acid 85% \n\n\n\n\n\n\n\n\n\n\n\n\nand 35 volumes of methanol. The mobile phase was delivered at a flow rate of 1ml/min. Samples \n\n\n\nwere filtered before HPLC analysis and the injection volume as 5\uf06dL. \n\n\n\n\n\n\n\nPhysicochemical Stability  \n\n\n\nThe physical and chemical tests (such as visual appearance, odour, pH and morphine content) were \n\n\n\nassessed at time 0, 1, 2, 3, 4, 5, 6, 9 and 12 months during storage at both temperatures. The morphine \n\n\n\noral suspensions were examined at each sample time for any change in appearance (colour and clarity) \n\n\n\nor odour. The pH was periodically checked during storage at for both temperatures using a pH meter. \n\n\n\nThe extemporaneous preparation is considered stable if physical characteristics have remained fairly \n\n\n\nunchanged and assay of morphine hydrochloride has remained equal or above 90% of the original \n\n\n\nconcentration during the storage period. \n\n\n\n\n\n\n\nMicrobiological Stability \n\n\n\nMicrobiological stability of the morphine oral suspension stored at 4\u00baC and 30\u00baC was studied at the \n\n\n\ninterval of months 0, 1, 2, 3, 4, 5, 6, 9 and 12. The microbial limit test was designed according to the \n\n\n\nBritish Pharmacopoeia for non-sterile products to determine whether the total bacteria, total fungi and \n\n\n\nEscherichia coli (E. coli) in the extemporaneous preparation complies with the established \n\n\n\nspecification for microbiological quality of this type of product (17).  \n\n\n\n\n\n\n\nRESULTS AND DISCUSSION \n\n\n\n \nPhysicochemical Stability \n\n\n\nMorphine degrades in aqueous solutions with the formation of mainly pseudomorphine, to a lesser \n\n\n\nextent morphine-N-oxide and probably apomorphine and discolouration has been observed when \n\n\n\ndegradation products are found in morphine solution (6,18,19). The results of the colour, clarity and \n\n\n\nodour of the morphine oral suspension remained fairly unchanged and no precipitation was observed \n\n\n\nin any of the samples throughout the 12 months at both storage conditions (Table 2). The orange taste \n\n\n\nand sweetness of the morphine oral suspension were quite the same throughout the stability study \n\n\n\nperiod. Morphine salts are sensitive to change in pH and morphine is liable to be precipitated out of \n\n\n\nsolution at alkaline pH (2). Vermeire and Remon (1999) also concluded that the degradation of \n\n\n\nmorphine is accelerated at higher pH of the solution, whereas temperature and light have only a minor \n\n\n\ninfluence on the degradation rate (18). The results from this study confirmed that the pH values of the \n\n\n\nmorphine oral suspension remained fairly constant (pH3.984 \u2013 4.082) at both temperatures (Table 3). \n\n\n\n\n\n\n\nTable 2: Visual appearance and odour of morphine oral suspension \n\n\n\nTime (Months) \n4\u00baC 30\u00baC \n\n\n\nColour Clarity Odour Colour Clarity Odour \n\n\n\n0 Off white Opaque Orange Off white Opaque Orange \n\n\n\n1 Off white Opaque Orange Off white Opaque Orange \n\n\n\n2 Off white Opaque Orange Off white Opaque Orange \n\n\n\n3 Off white Opaque Orange Off white Opaque Orange \n\n\n\n4 Off white Opaque Orange Off white Opaque Orange \n\n\n\n5 Off white Opaque Orange Off white Opaque Orange \n\n\n\n6 Off white Opaque Orange Off white Opaque Orange \n\n\n\n9 Off white Opaque Orange Off white Opaque Orange \n\n\n\n12 Off white Opaque Orange Off white Opaque Orange \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\nTable 3: pH of morphine oral suspension  \n\n\n\nTime (Months) 4\u00baC 30\u00baC \n\n\n\n0 4.075 4.075 \n\n\n\n1 4.080 4.074 \n\n\n\n2 4.073 4.082 \n\n\n\n3 4.074 4.060 \n\n\n\n4 4.070 4.036 \n\n\n\n5 4.068 4.040 \n\n\n\n6 4.082 4.041 \n\n\n\n9 4.036 3.984 \n\n\n\n12 4.050 4.001 \n\n\n\n\n\n\n\nTable 4: Concentration of morphine oral suspension  \n\n\n\nTime (Months) 4\u00baC 30\u00baC \n\n\n\n0 102.8% 102.8% \n\n\n\n1 97.0% 97.0% \n\n\n\n2 99.3% 101.0% \n\n\n\n3 95.1% 95.6% \n\n\n\n4 96.1% 96.6% \n\n\n\n5 101.4% 97.0% \n\n\n\n6 99.5% 96.6% \n\n\n\n9 96.1% 96.0% \n\n\n\n12 95.5% 96.2% \n\n\n\n \nThe morphine hydrochloride content for all tested samples from the morphine oral suspension were \n\n\n\nall above 95% throughout the 12 months period for both temperatures (Table 4). Even though the rate \n\n\n\nof chemical degradation usually increases with temperature (11), there were no significant differences \n\n\n\nin the assay results between the two storage conditions to establish any possibility of degradation \n\n\n\nduring storage.  \n\n\n\n\n\n\n\nThe analytical results of this stability study proved that the HPLC method developed for the analysis \n\n\n\nof morphine content in extemporaneous preparation to be adequate. The chromatograms illustrated \n\n\n\nbelow showed that the HPLC method to be selective for the purpose of this study with minimal \n\n\n\ninterference from the excipients in the formulation (Figure 3). The chromatograms of tested samples \n\n\n\nat the different intervals throughout the stability study period revealed no other peak that could be \n\n\n\nattributed to a possible morphine degradation compound. \n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n \nFigure 3: Chromatograms of morphine standard solution and extemporaneously prepared morphine \n\n\n\noral suspension \n\n\n\n\n\n\n\nMorphine standard solution \n\n\n\n\n\n\n\n\n\n\n\nMorphine oral suspension \n\n\n\n\n\n\n\n \n \nThese results confirmed that the temperature has little effect on the physical and chemical stabilities \n\n\n\nof morphine in the oral suspension and the morphine content is relatively stable at acidic pH. Storage \n\n\n\nin the refrigerator may not be considered necessary. The extemporaneous preparation of morphine \n\n\n\noral suspension remains stable when stored at room temperature in the same container closure system. \n\n\n\nMorphine solutions should preferably be stored at room temperature in order to avoid precipitation at \n\n\n\nlow temperatures and water evaporation at higher temperatures causing increase in morphine \n\n\n\nconcentration when store in polymer reservoirs (18). \n\n\n\n\n\n\n\nMicrobiological Stability \nNo microbial contamination was observed in all samples of morphine oral suspension during the 12 \n\n\n\nmonths study period for both temperatures (Table 5 and 6). The results showed that the microbial \n\n\n\nquality was within the test limits according to the British Pharmacopoeia (17). The total viable aerobic \n\n\n\nbacteria count was kept low and total yeast and mould count was minimal. E. coli was absent \n\n\n\nthroughout the study period. These results shows that the preservatives of the extemporaneous \n\n\n\npreparation were effective against bacteria and fungi and the morphine oral suspension is \n\n\n\nmicrobiologically stable at both temperatures for up to 12 months.  \n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\nTable 5: Microbial results of morphine oral suspension (4\u00baC) \n\n\n\nTime (Months) \n\n\n\nTotal aerobic bacteria \n\n\n\n(Not more than \n\n\n\n200cfu/g) \n\n\n\nTotal yeast & mould \n\n\n\n(Not more than \n\n\n\n20cfu/g) \n\n\n\nE. coli \n\n\n\n(Absence in 1g) \n\n\n\n0 <10cfu/g <10cfu/g Conforms \n\n\n\n1 <10cfu/g <10cfu/g Conforms \n\n\n\n2 <10cfu/g <10cfu/g Conforms \n\n\n\n3 <10cfu/g <10cfu/g Conforms \n\n\n\n4 <10cfu/g <10cfu/g Conforms \n\n\n\n5 <10cfu/g <10cfu/g Conforms \n\n\n\n6 <10cfu/g <10cfu/g Conforms \n\n\n\n9 <10cfu/g <10cfu/g Conforms \n\n\n\n12 <10cfu/g <10cfu/g Conforms \n\n\n\n\n\n\n\nTable 6: Microbial results of morphine oral suspension (30\u00baC) \n\n\n\nTime (Months) \n\n\n\nTotal aerobic bacteria \n\n\n\n(Not more than \n\n\n\n200cfu/g) \n\n\n\nTotal yeast & mould \n\n\n\n(Not more than \n\n\n\n20cfu/g) \n\n\n\nE. coli \n\n\n\n(Absence in 1g) \n\n\n\n0 <10cfu/g <10cfu/g Conforms \n\n\n\n1 <10cfu/g <10cfu/g Conforms \n\n\n\n2 <10cfu/g <10cfu/g Conforms \n\n\n\n3 <10cfu/g <10cfu/g Conforms \n\n\n\n4 <10cfu/g <10cfu/g Conforms \n\n\n\n5 <10cfu/g <10cfu/g Conforms \n\n\n\n6 <10cfu/g <10cfu/g Conforms \n\n\n\n9 <10cfu/g <10cfu/g Conforms \n\n\n\n12 <10cfu/g <10cfu/g Conforms \n\n\n\n \nFormulation Stability \n\n\n\nThe new formulation for extemporaneous preparation chosen for this study is simple and ideal for any \n\n\n\npharmacist in UKMMC to prepare when compared to the old formulation consisting of morphine \n\n\n\npowder, glycerine, lemon oil, alcohol, water and syrup simplex. No published information is available \n\n\n\nto support the stability of the old formulation and to justify the shelf-life. Furthermore, traditional use \n\n\n\nof syrup BP (syrup simplex) as a suspending agent is not recommended as the typical pH of syrup BP \n\n\n\nis approximately 7.5 to 9.5 and does not promote morphine stability (19). \n\n\n\n\n\n\n\nPreechagoon et. al. (2005) have studied the formulation development and stability testing of oral \n\n\n\nmorphine solution using a preformulation approach (20). The study has highlighted that the pH of the \n\n\n\nsolution is a major factor influencing morphine stability and masking of the bitter taste of morphine is \n\n\n\nanother challenge (20). Even though the formulations have been demonstrated to be stable throughout \n\n\n\nthe study period, some may consider the formulations from this study to be too complex for use at \n\n\n\ndispensary level (19). \n\n\n\n\n\n\n\nThe flavour and sweetener from the commercial vehicle, X-Temp Oral Suspension System were \n\n\n\nsufficient to mask the bitter taste of morphine in the extemporaneous preparation. Besides, the \n\n\n\ncommercial vehicle is buffered to a slightly acidic pH (pH~4.4) and this pH helps to reduce the \n\n\n\ndegradation process of morphine in solution. \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\nCONCLUSIONS \n\n\n\n \nThe results from the physical, chemical and microbiological stability studies confirmed that the \n\n\n\nextemporaneous of morphine oral suspension using X-Temp Oral Suspension System is stable for up \n\n\n\nto 12 months when packed in HDPE bottles with polypropylene caps and stored at both 4\u00baC and 30\u00baC. \n\n\n\nThe extemporaneous preparation can now be prepared with ease by compounding pharmacists in the \n\n\n\nhospitals using X-Temp Oral Suspension System with validated stability and proven shelf-life. This \n\n\n\nnew evidence will be made available and the protocol can be standardized in the prescribing and \n\n\n\ncompounding practices among the hospitals to provide a safe, effective and quality morphine oral \n\n\n\nsuspension to the patients. \n\n\n\n\n\n\n\nThis study not only addressed the chemical, physical and microbial stability, it has also dealt into \n\n\n\nother parameters including palatability, excipient suitability (e.g. alcohol free for children, sugar free \n\n\n\nfor diabetic patients) and interactions with packaging materials of an extemporaneous oral liquid. \n\n\n\nVisual appearance, smell, taste and mouth feel all have a big influence on patient acceptance and \n\n\n\ncompliance, especially in the paediatric patients and are as important factor to consider in the \n\n\n\ndevelopment of a suitable extemporaneous preparation (13). \n\n\n\n\n\n\n\nAlthough some of the risks associated with extemporaneous compounding has been addressed, there \n\n\n\nare still other inherent risks in compounding which include using incorrect formulation and \n\n\n\ncalculations, selecting incorrect drugs and using incorrect quantities (8,21). Therefore, proper \n\n\n\nguidelines with focus on quality assurance and quality control practices should be put in place for \n\n\n\nevery compounding pharmacy to deliver consistent, safe and quality products (22). \n\n\n\n\n\n\n\nACKNOWLEDGEMENTS \n\n\n\n \nThe author wished to thank pharmacy department of Universiti Kebangsaan Malaysia Medical Centre \n\n\n\n(UKMMC) for providing the extemporaneous samples and morphine hydrochloride pure drug \n\n\n\nrequired for this study and BioScenergy International Sdn Bhd for its financial support. \n\n\n\n\n\n\n\nREFERENCES \n\n\n\n \n1. McEvoy GK. AHFS: Drug Information. Bethesda, MD: American Society of Health-System \n\n\n\nPharmacists; 2009. \n\n\n\n2. Sweetman SC. Martindale: The Complete Drug Reference. 36\nth\n ed. United Kingdom: \n\n\n\nPharmaceutical Press; 2009. \n\n\n\n3. Caraceni A, Hanks G, Kaasa S, Bennett MI, Brunelli C, Cherny N, Dale O, De Conno F, Fallon \n\n\n\nM, Hanna M, Faksv\u00e5g Haugen D, Juhl G, King S, Klepstad P, Laugsand EA, Maltoni M, \n\n\n\nMercadante S, Nabal M, Pigni A, Radbruch L, Reid C, Sjogren P, Stone PC, Tassinari D, \n\n\n\nZeppetella G. Use of opioid analgesics in the treatment of cancer pain: evidence-based \n\n\n\nrecommendations from the EAPC. Lancet Oncol 2012; 13:e58-68. \n\n\n\n4. World Health Organization. Cancer pain relief. 2\nnd\n\n\n\n ed. Geneva: WHO; 1996. \n\n\n\n5. Wiffen PJ, Wee B, Moore RA. Oral morphine for cancer pain. Cochrane Database of Systematic \n\n\n\nReviews 2013; Issue 7. Art. No.: CD003868. DOI: 10.1002/14651858.CD003868.pub3. \n\n\n\n6. Lin CY, Shen LJ, Huang CF, Yang HL, Chen YJ, Wu FL. Beyond-use date of extemporaneous \n\n\n\nmorphine hydrochloride oral solution. Journal of Food and Drug Analysis 2013; 21(2):142-146. \n\n\n\n7. Glass BD, Haywood A. Stability considerations in liquid dosage forms extemporaneously \n\n\n\nprepared from commercially available products. J Pharm Pharmaceut Sci 2006; 9(3):398-426. \n\n\n\n8. Jackson M, Lowey A. Risk management. Handbook of Extemporaneous Preparation. United \n\n\n\nKingdom: Pharmaceutical Press; 2010. \n\n\n\n9. Lowey AR, Jackson MN. A survey of extemporaneous preparation in NHS trusts in Yorkshire, \n\n\n\nthe North-East and London. Hospital Pharmacist 2008; 15(6):217-219. \n\n\n\n\n\n\n\n\n\n\n\n\n10. United States Pharmacopeia and National Formulary (USP36-NF31). Chapter 795. \n\n\n\nPharmaceutical compounding \u2013 nonsterile preparations. Rockville, MD: United States \n\n\n\nPharmacopeial Convention, Inc.; 2013. \n\n\n\n11. Woods DJ. Extemporaneous formulation of oral liquids \u2013 a guide.  \n\n\n\n12. http://www.pharminfotech.co.nz/manual/Formulation/extemprep.pdf (5 November 2009). \n\n\n\n13. Haywood A, Glass BD. Liquid dosage forms extemporaneously prepared from commercially \n\n\n\navailable products \u2013 considering new evidence of stability. J Pharm Pharmaceut Sci 2013; \n\n\n\n16(3):441-455. \n\n\n\n14. Jackson M, Lowey A. Formulation and stability. Handbook of Extemporaneous Preparation. \n\n\n\nUnited Kingdom: Pharmaceutical Press; 2010. \n\n\n\n15. Haywood A, Glass B. Managing extemporaneous oral liquids in practice. Journal of Pharmacy \n\n\n\nPractice and Research 2007; 37(2):131-133. \n\n\n\n16. Santos S, Sa A, Saiao A, Pecorelli C. Stability of folic acid in extemporaneous oral suspension. \n\n\n\nBiopharmaceuticals Sciences 2005; 3(2):223-232. \n\n\n\n17. British Pharmacopoeia (2012). Volume I & II - Monographs: medicinal and pharmaceutical \n\n\n\nsubstances. London, England: British Pharmacopoeia Commission; 2012. \n\n\n\n18. British Pharmacopoeia (2012). Volume V. Appendix XVI B - Microbiological examination of \n\n\n\nnon-sterile products. London, England: British Pharmacopoeia Commission; 2012. \n\n\n\n19. Vermeire A, Remon JP. Stability and compatibility of morphine. Int J Pharm 1999; 187(1):17-51. \n\n\n\n20. Jackson M, Lowey A. Morphine sulphate oral liquid. Handbook of Extemporaneous Preparation. \n\n\n\nUnited Kingdom: Pharmaceutical Press; 2010. \n\n\n\n21. Preechagoon D, Sumyai V, Tontisirin K, Aumpon S, Pongjanyakul T. Formulation development \n\n\n\nand stability testing of oral morphine solution utilizing preformulation approach. J Pharm \n\n\n\nPharmaceut Sci 2005; 8(2):362-369. \n\n\n\n22. Kairuz TE, Gargiulo D, Bunt C, Garg S. Quality, safety and efficacy in the \u2018off-label\u2019 use of \n\n\n\nmedicines. Current Drug Safety 2007; 2:89-95. \n\n\n\n23. Liva R. Quality assurance issues in compounding pharmacy. Integrative Medicine 2006; 5(5):70-\n\n\n\n72. \n\n\n\n\n\n"
"\n\nMalaysian Journal of Pharmacy 2001 1:2-8  General article\n\n\n\n3\n\n\n\nPharmacy Practice in Malaysia\nWong Sie Sing\n\n\n\n8 Jalan Court House, 93000 Kuching, Sarawak, Malaysia\n\n\n\nABSTRACT\n\n\n\nPharmacists in Malaysia practise their profession in rugged terrains which demand\nboth professional skills and pioneering spirits. Many of the current pharmaceutical\nstandards, practices, and legislations need overhauling in order to meet the\naspiration of the nation in this new millennium. The Malaysian Pharmaceutical\nSociety has a vital role to play. The profession requires the greatest understanding\nof the Malaysian Medical Association and the Government in this transition period.\n\n\n\nKeywords: pharmacy practice, pharmacy standards, legislations, healthcare, Malaysia\n\n\n\nINTRODUCTION\n\n\n\nPharmacy is a learned profession. It is a well-\nestablished science-based profession which\npossesses all the essential characteristics of a\nprofessional group. Four main characteristics\nreflect the profession\u2019s distinctiveness: the special\nsphere of knowledge and intellectual discipline,\nwell defined functions, professional ethics and\nconduct, and practitioners representative body.\nPersons who desire to partake in the profession\nneed to master the pharmaceutical sciences.\n\n\n\nThe first distinctive characteristic concerns the\nspecial sphere of knowledge and intellectual\ndiscipline. Knowledge in the pharmaceutical\nsciences may be acquired through undergraduate\npharmacy degree courses presently available\nlocally in Universiti Sains Malaysia, Universiti\nMalaya, Universiti Kebangsaan Malaysia,\nInternational Medical University, Sepang Institute\nof Technology and Sedaya College. In addition to\nthese six institutions of higher education,\nUniversiti Teknologi Mara and International\nIslamic University are expected to offer pharmacy\ndegree course soon. Pharmacy graduates from 56\nother overseas universities, in 13 countries, are also\nrecognized by the Pharmacy Board (1). Only pharmacy\nstudents who have satisfactorily completed the\nprescribed  course  are  permitted  to  embark upon\n\n\n\nthe compulsory twelve months  of  pre-registration\ntraining in an establishment recognized by the\nPharmacy Board. Currently a pre-registration\npharmacy graduate has a choice to receive training\nin either hospital pharmacy, community pharmacy,\nmanufacturing pharmacy or wholesale trading\npharmacy.\n\n\n\nThe second feature is the presence of a national\nbody representing all the pharmacy practitioners.\nMalaysian Pharmaceutical Society (MPS) was\nformed and incorporated under the Society Act in\n1965. It promotes pharmaceutical practice, protects\nthe interests of the practitioners and end-users, and\nencourages the advancement of the pharmaceutical\nsciences. It is interesting to add here that another\ntwo pharmaceutical societies, namely Sabah\nPharmaceutical Society and Sarawak\nPharmaceutical Society also co-exist to champion\nthe pharmacy profession in the states of Sabah and\nSarawak, respectively.\n\n\n\nThe third feature relates to the professional ethics\nand conduct which guide all members. The\nCouncil of MPS had issued a guideline on the\nmatter. Uniquely the Pharmacy Board had also\nissued the \u201cCode of Conduct For Pharmacists and\nBody Corporates\u201d. By virtue of the power given to\n\n\n\n\n\n\n\n\nGeneral article: Pharmacy practice in Malaysia\n\n\n\n4\n\n\n\nthe Pharmacy Board under Section 22(1)(e) and (j)\nof the Registration of Pharmacists Act 1951, this\ndocument may be legally binding upon the\npharmacists.\n\n\n\nThe fourth feature of a learned profession is the\nprovision by its practitioners of uniform\nprofessional services and advice to the public. This\nrefers to the supply of medicines to the public,\naccompanied by appropriate advice (that is, patient\nmedication counseling) during the dispensing\nprocess.\n\n\n\nPharmacy, as a learned profession, was rarely\nchallenged since time immemorial. The inherent\ndynamism has brought it through several rounds of\nprofessional metamorphosis. As a result, the\npractice of pharmacy has been described in a\nvariety of ways.\n\n\n\nWHAT IS PHARMACY PRACTICE?\n\n\n\nDiffering views have been presented on this\nmatter. Some consider it a profession, others look\nat it as a trade \u2013 albeit a professional one. There is\nno concise and precise description on what\npharmacy practice should be. Perhaps the\ndifficulty is due to the co-existence of both\nspecialized and generalized professional services\nwhich the profession offers.\n\n\n\nNonetheless, pharmacy practitioners all agree that\npharmacists ought to know the properties (which\ninclude pharmacodynamics, pharmacokinetics,\nmechanisms of drug action, side-effects, adverse\ndrug-drug reactions, adverse drug-food reactions,\nand drug toxicity) of all the medicines, their\nformulation processes, proper storage conditions,\nand appropriate usage. Such knowledge should be\napplied primarily towards public interests during\nthe course of our profession activities. These\nprofessional activities pertain to the supply of\nmedicines for humans, supply of veterinary\nmedicines, infant and enriched formulas for adults,\nsick-room appliances, agricultural, horticultural\nand industrial chemicals, scientific apparatus (such\nas stethoscopes and clinical thermometers),\nsurgical appliances and instruments, electro-\nmedical therapeutic apparatus (such as blood\npressure meters and blood glucose or cholesterol\nmonitors). But many pharmacies also offer non-\nprofessional activities which are often closely\nassociated with pharmacy, such as the supply of\nperfumes, cosmetics, toilet requisites and\nphotographic materials.\n\n\n\nPharmacy practice in Malaysia varies from one\npharmacy to another. Chain-store pharmacies\nusually offer a significant proportion of non-\nprofessional services and activities alongside the\ntraditional professional services. Smaller\nindependent pharmacies normally focus on\nprofessional pharmacy services. Both types are\nrepresentative of private pharmacy practice in\nMalaysia. On the other hand, pharmacy practice in\nthe government sector is quite different.\nGovernment pharmacists enjoy a more favourable\nlegal environment which permits them complete\ncontrol over the supply of medicines. Government\ndoctors do not provide pharmacy services to\npatients, unlike their counterparts in private\npractice. Consequently, private pharmacies operate\nunder very harsh and unfavourable conditions\nimposed by legal and historical limits. Many\ncommunity pharmacies do not even receive one\nprescription chit a day! This unhealthy scenario\nshould be rectified by the government, with the\nfull understanding of the Malaysian medical\nprofession. It is hoped that the pharmacy\nprofession will be granted a new lease of life in\nthis new millennium.\n\n\n\nPHARMACY PRACTICE IN THE NEW\nMILLENNIUM\n\n\n\nMalaysia is one of the front-runners amonst\ndeveloping countries in this high technology\ninformation era through the creation and\nimplementation of the world renowned Multimedia\nSuper Corridor. Our nation ranks 16th as a world\ntrading nation, and we are a signatory to almost all\ninternational treaties including global trade\nliberalization related to the World Trade\nOrganization. Global trade liberation will\ninevitably be accompanied by a free flow of\nprofessionals (such as lawyers, accountants,\npharmacists and doctors). With a relatively lower\npharmacist to population ratio coupled with a\ncomparatively higher salary in our country,\nneighbouring foreign pharmacists will flow into\nMalaysia to fill up any shortage. We may not be\nprepared sufficiently to handle the situation to the\nnational advantage. The interests of local\npractitioners may be damaged. In this context, the\npharmacy profession in Malaysia needs to work\ndoubly hard so as not to be caught unprepared.\n\n\n\nAgainst such a background, MPS has risen to the\noccasion by examining the various professional\nissues and putting in place necessary strategies to\nenhance professionalism in every aspect of the\n\n\n\n\n\n\n\n\nGeneral article: Pharmacy practice in Malaysia\n\n\n\n5\n\n\n\npharmacy practice. The undersigned feels strongly\nthat Malaysian pharmacists need to address the\nfollowing matters in order to be able to contribute\nmore meaningfully, as an important primary\nhealthcare team member, to the overall health of\nthe nation:\n\n\n\n(a) Control over the supply of medicines\n\n\n\nAs mentioned earlier, private medical doctors\ncontrol a large percentage of medicines supplied to\npatients. It is high time that this control be\nexclusively given to pharmacists who, after all, are\nthe only professionals properly trained for the job.\nIn 1984, the Malaysian Medical Association\n(MMA) had agreed, in principle, that the present\nsystem should change for the better. Physicians\nshould focus on diagnosis and prescribing. The\ndispensing of medicines had been mutually agreed\nto be the professional role of pharmacists and\nshould, therefore, be implemented for both the\npublic, as well as the private sector.\n\n\n\nMany brainstorming sessions have been held on\nthis matter. Finally, MPS launched in 1998 Project\n2003 to spearhead this professional activity. Seven\nsub-committees (namely Pharmacy Practice\nStandards Committee, Professional Competence\nCommittee, Professional Image and Public\nEducation Committee, Telepharmacy Committee,\nPharmacy Legislation Committee, Manpower\nProjection Committee, and National Drug Policy\nand National Healthcare System Committee) were\nestablished to examine and prepare reports on\nvarious important aspects of the profession. It is\nhoped that a formal official recommendation will\nbe ready for submission to the Government by the\nmiddle of 2001.\n\n\n\n(b) National Healthcare Fund\n\n\n\nNational healthcare bills have risen sharply in\nrecent years. Health expenses in 1999 were\nreported at about four and a half billion ringgit.\nThere is a need to cap and control the bill and to\ninvolve citizens in this important matter. As a\ncaring and well-planned nation, it seems an\nexcellent idea to introduce a National Healthcare\nFund to finance all future needs of the people in\nour medication-treatment. It should be by and for\nthe people. The government also needs to budget\nfor it because about one-third of the population\nwill require subsidy.\n\n\n\nIndeed, Malaysia cannot afford not to plan ahead\nfor a National Healthcare Fund or a similar scheme\n\n\n\nbecause in about 10 years\u2019 time, a fifth of our\npopulation would have aged beyond 65 years. The\ngeriatric population requires a bigger budget for\nhealth matters. And it will not get cheaper as the\nyears go by.\n\n\n\nThe National Healthcare Fund should finance all\nmedicines supplied. Pharmacists should be paid a\nprofessional fee for services rendered to the public.\nThis will enhance the professional image of\npharmacists, and place us at par with other\nprofessionals in Malaysia. MPS needs to\ncontribute proactively, through seminars and\npublic talks, singularly as well as collectively, with\nother stakeholders (namely MMA, allied health\nbodies, consumer groups, Insurance and Managed\nCare Organizations) to work out a win-win\nformula for all the health service providers and\nusers.\n\n\n\n(c) Even distribution of pharmacy services\n\n\n\nThe present 3000-plus registered pharmacists is\nexpected to increase to about 5000 by the year\n2004. MPS needs to ensure an even distribution of\npharmacies throughout the country. Some sort of\npharmacy zoning system may be necessary. The\npopulace should be entitled to receive similar\nstandards of pharmacy services to that in the big\ncities. A duty roster will ensure round-the clock\navailability of medicines to needy patients.\n\n\n\nIn cities such as Kuala Lumpur, Kota Kinabalu,\nKuching, Johore Bahru and Penang, there are\nprobably too many private community pharmacies\ncatering to the needs of city dwellers. Perhaps\nnewcomers should be given incentives or\nlegislated to set up pharmacies in small towns and\nrural areas. In rural places where there are no\nprivate clinics, private community pharmacies can\nstill complement the services provided by the\ngovernment's rural clinics. A town of 30,000\npeople requires about three private community\npharmacies to work side by side with the\npublic/hospital pharmacies. Distribution of\npharmacies should be worked out on a district\nbasis.\n\n\n\nIt was reported that there are about 350\npharmacists working in government hospitals,\nclinics, laboratories and stores (MMA press\nrelease, 24th August 2000). This represents about\n13% of all practising pharmacists. However, 45%\nof the medical practitioners work in the public\nsector. Obviously the national pharmacist shortage\nlies in the public sector. Urgent action needs to be\n\n\n\n\n\n\n\n\nGeneral article: Pharmacy practice in Malaysia\n\n\n\n6\n\n\n\ntaken by the government to rectify this problem.\n\n\n\nThe Health Minister announced, on 9th December\n2000, the requirement for a compulsory three-year\ngovernment service for all newly qualified\ndentists, effective from 1st January 2001. It is time\nthat pharmacists join the doctors and dentists in\ncompulsory national government service. This is in\nline with the present global paradigm shift in\nhealthcare delivery.\n\n\n\n(d) Self-regulation in pharmacy standards and\npractice\n\n\n\nThere is a need for a paradigm shift in allowing the\nlearned profession to be self-regulated in matters\npertaining to pharmacy standards and practice.\nThese refer to ethics and conduct of pharmacists,\nthe continuing competence of members to practise,\nand assessment of new entrants into the profession.\n\n\n\nSome other professional groups in Malaysia (such\nas the MMA and Malaysian Advocates Society)\nhave been self-regulating in these matters. It is a\nstep forward which will inevitably bring much\nbenefit to the people.\n\n\n\nContinuing Pharmacy Education (CPE) for the\npractising pharmacists is a universal trend carried\nout by most advanced nations. The United States\nof America and the United Kingdom adopt\ndifferent CPE systems. Perhaps the MPS-CPE\npioneering project can form the basic framework\nto build upon. Seminars, conferences and certain\nwrite-ups can be a basis for assessment. To capture\nall CPE efforts, it may be reasonable and feasible\nto adopt the American Log-Book system where the\nonus to maintain records lies with the practitioners.\nThe Royal Pharmaceutical Society of Great Britain\n(RPSGB) had introduced the Continuing\nEducation Logbook in 1995 (2). The RPSGB are\nin the process of consulting its 40,000 members in\nworking out a new framework for professional\nregulation with measures to ensure professional\ncompetence and lifelong learning (3).\n\n\n\nOur present pre-registration training programme\nhas its form but lacks mechanisms for monitoring\nthe actual progress of students. Visual assessment\nmay not be sufficient and objective enough.\nRegular intervals of written assessments are\npreferable. The pharmacist-supervisors\u2019 input will\ndepend on his/her experience and knowledge. A\nsystematic write-up on what to impart and a\nstandard list of reference books/materials should\nstandardize the supervision. Wholesale trading\n\n\n\npharmacy and manufacturing pharmacy do not\nexpose the pre-registration students to adequate\npatient counseling. Many students are left to \u2018learn\non their own\u2019. It is vital for the profession to\nacertain whether it is important for all students to\nattain the same breath and depth of\nprofessionalism in the different disciplines.\n\n\n\nThe undersigned recommends the New Zealand\nsystem that was recently implemented. Since 1997,\nall newly qualified pharmacy graduates in New\nZealand undergo a twelve-month pharmacy pre-\nregistration training program which defines seven\nprofessional competency standards expected of a\nregistered pharmacist. A combination of on-the-job\nassessment, submission of assignments,\nperformance at training days, completion of a\nlearning record, and attendance at a final\nassessment centre determines the standards\nachieved (4). Australia is likely to follow a similar\ncompetence-based accreditation for pharmacists\n(5).\n\n\n\n(e) Education and research\n\n\n\nPharmacy has been designated as one of the\npriority development areas in our knowledge \u2013\nbased new economy which our government is very\ndetermined to nurture. Pharmacy educationists\nneed to ensure that our profession is well\npositioned to derive optimal growth. The choice of\nsubjects in undergraduate pharmacy degree\nprogrammes ought to provide wide coverage and\nsufficient depth in all the pharmaceutical sciences.\nPostgraduate studies should produce specialists in\nvarious disciplines such as pharmaceutics,\npharmacognosy, synthetic-medicinal chemistry,\nclinical pharmacy and pharmaceutical\nbiotechnology. Our educational system needs to\nproduce both generalists as well as specialists who\nwill contribute to the further advancement of the\nprofession.\n\n\n\nThe local pharmaceutical industry may form a\nsymbiotic partnership with academicians. The\nlatter can generate the much needed input in basic\npharmaceutical science research. The former can\ncommercialize useful products or applications for\nmutual benefit. This modulus of operation is a\nnorm in many advanced countries.\n\n\n\nA sound pharmacy education system with\nemphasis and smart partnership in research and\ndevelopment will surely bring forth tremendous\nprogress to the pharmacy profession in Malaysia.\nGreater and closer co-operation between\n\n\n\n\n\n\n\n\nGeneral article: Pharmacy practice in Malaysia\n\n\n\n7\n\n\n\npharmaceutical scientists in universities and the\npharmaceutical industry in areas such as\nproduction of raw material for pharmaceuticals,\nsynthesis of new and useful chemical entities,\nbiotechnology in manufacturing, design of new\nand better methods in extraction of active\ningredients from local medicinal plants,\nformulation, and general transfer of technology\nfrom the academic scientists to the pharmaceutical\nindustry should be encouraged.\n\n\n\n(f) National Formulary and Pharmacopoeia:\n\n\n\nA hallmark of a learned profession is a systematic\naccumulation and compilation of new knowledge\ninto reference standards or specifications which\nposterity can build upon for greater advancement.\nThe legal profession has unmatched achievement\nin this matter. All advanced western nations have\nbuilt up their own wealth of knowledge and\ntechnology over a long period of time. After being\nindependent for four and a half decades, Malaysia\nshould begin to build its own Pharmacopoeia and\nNational Formulary.\n\n\n\nIt is a matter of grave concern that many locally\nconcocted medicinal preparations are not properly\ndocumented. Many rural folks (\"village doctors\")\nhave been using selected plants as medicines for\ngenerations. This knowledge of traditional\nmedicine needs to be preserved in writing (into\nFormulary or Pharmacopoeia) before these old\nfolks leave us for good.\n\n\n\nEven worse still is the fact that we may lose a large\nrange of indigenous plants during our rapid\neconomic development. Malaysia is blessed with\nabout 12,500 species of medicinal plants (6) which\ncan be a valuable source of new drugs. As much as\n50% of modern medicines have been derived from\nplants, the majority of them from the tropical\nforest (7). The Malaysian forest represents one of\nthe richest of the region's tropical forest but is also\nin serious danger of over-exploitation.\n\n\n\nMuch research has been initiated by local scientists\nin the fields of natural product chemistry but the\nscientific impact these efforts has generated is\nminimal. Much of the activities are confined to\ndetecting and identifying the chemical constituents\nthat possess biological activity and are often\ndiscontinued at the juncture where critical animal\nor human testing is required further (8).\n\n\n\nThe Malaysian Herbal Products Blueprint was\nlaunched in September 2000 by the Malaysian\n\n\n\nIndustry-Government Group for High Technology\n(MIGHT). It is hoped that MIGHT will give equal\nemphasis to research and development and\nproduce monographs on Malaysian herbs, in\naddition to developing and promoting the local\nherbal industry (9).\n\n\n\nPerhaps it is the right time for all the six local\ninstitutions of higher learning where pharmacy is\ntaught to jointly initiate and spearhead a national\nproject in establishing an Institute of\nPharmaceutical Research, parallel to the Institute\nof Medical Research.\n\n\n\nIt is also high time for MPS to work side by side\nwith MMA in recommending to the government of\na permanent committee, comprising of experts\nfrom various medical and pharmaceutical\nspecialities, to bring into being a National\nPharmacopoeia and Formulary.\n\n\n\n(g) Pharmacy legislation:\n\n\n\nThe Poisons Act 1952 (Revised 1989) and\nRegistration of Pharmacists Act 1951 (Revised\n1989) are the two main pillars of pharmacy law in\nMalaysia. Other pieces of legislation such as the\nDangerous Drugs Act 1952 (Revised 1980), Sale\nof Drugs Act 1952 (Revised 1989), and Medicines\n(Advertisement and Sale) Act 1956 (Revised\n1983) are built upon these two laws. It is quite\napparent that these acts were first formulated with\nstrong British Colonial characteristics. Although\nthese laws have been reviewed during the last\ndecade, much of the reviews were piecemeal in\nnature without much forward vision and strategy in\ndeveloping the pharmacy profession. With the\nadvent of the Information Technology Era, our\npresent pharmacy legislations are obviously not\nequipped to deal with matters such as electronic\nprescribing, digital signature, Telemedicine and\nTelepharmacy. Significant overhauls are the order\nof the day.\n\n\n\nIt is imperative that Telepharmacy and Internet\npharmacy should also comply completely with all\npharmacy legislations. Professional ethics and high\nstandards should be maintained. Medicines should\nonly be delivered to patients in person. Systems\nand mechanisms to detect and to verify the\nprescriber\u2019s signature that come with electronic\nprescribing should be in place. Malaysian\ncyberspace legislations for pharmacy practice need\nto be incorporated.\n\n\n\nA paradigm shift and legislation overhaul are\n\n\n\n\n\n\n\n\nGeneral article: Pharmacy practice in Malaysia\n\n\n\n8\n\n\n\nsuggested for the following areas of pharmacy\npractice:\n(i) exclusive control over the supply of\n\n\n\nmedicines by the pharmacists;\n(ii) re-classification Group D Poisons as Group\n\n\n\nC Poisons;\n(iii) pharmacists\u2019 control over the supply of\n\n\n\nherbal and traditional medicines/products;\n(iv) introduction of an annual practising\n\n\n\ncertificate to replace the present annual\nretention certificate and Type A Licence;\n\n\n\n(v) self-regulation in professional matters such\nas ethics and conduct, practice standards,\nand continuing education;\n\n\n\n(vi) introduction of a compulsory three-year\nnational service for all new pharmacists;\nand\n\n\n\n(vii) introduction of pharmacy cyberspace\nlegislation to deal with Telepharmacy and\nInternet-Pharmacy.\n\n\n\nCONCLUSION\n\n\n\nPharmacists in Malaysia practise under two\ndifferent sets of legal-historical framework.\nGovernment employed pharmacists enjoy\ncomplete control over the supply of medicines.\nThey are even exempted from many pharmacy\nregulation provisions. On the other hand, private\npharmacists do not have full control over the\nsupply of medicines. Medical doctors, in the\nprivate clinics and private hospitals, still dispense\nmedicines to their own patients. This doctor-\ndispensing practice has been allowed since the\nColonial era when Malaysia suffered from acute\nshortage of all professionals. This outdated and\nunhealthy situation must change in the near future.\nThe government needs to legislate such a change.\nAs a developing country, Malaysia has already\nbeen served with a reasonable ratio of pharmacists\n\n\n\nto doctors per given population. The national ratio\nof private pharmacists to private doctors is 1 to\n2.4. There are 5400 private practising doctors and\n2300 private practising pharmacists. We have\nalready achieved the optimal ratio of one doctor to\nthree pharmacists in the urban places. With the\nannual increase of about 450 new pharmacists\nfrom now on, there is a serious threat of\nunemployment for the pharmacists in a few years'\ntime.\n\n\n\nOn the other hand, there are insufficient numbers\nof pharmacists working in the public sector.\nUrgent measures must be worked out to rectify the\nsituation. The acute shortage of pharmacists in the\npublic sector may be overcome with the new\nentrants. The government's 118 hospitals, 772\nhealth clinics and 1992 rural clinics (Statistics\nDept. Bulletin-1999) certainly need to employ\nmany more pharmacists in order to render quality\nservices to the people.\n\n\n\nMPS needs to work hand-in-hand with the\nGovernment Planning Unit to map out a thorough\nmanpower projection for pharmacists and the\nsupporting staff over the next decade.\n\n\n\nThe pharmacy profession needs the greatest\nunderstanding of the medical profession and the\nconsumer groups in working out the most\nappropriate healthcare delivery system in the\ninterests of the people in this country. MPS has a\nvital role in leading pharmacists through this\ntransition period into a new type of pharmacy\npractice. This new kind of pharmacy profession\nenvisaged will be more fitting for a fast developing\ncountry like Malaysia. Vision 2020 will certainly\nbe incomplete if pharmacists fail to rise to the\noccasion in building a professional and caring\npharmacy practice for the nation.\n\n\n\n*****\nREFERENCES\n\n\n\n1. Kelayakan Farmasi Dari Institusi Pengajian\nTinggi. Malaysian Pharmaceutical Society.\nhttp://www.mps.org.my/html/universiti_yang_\ndiiktiraf.htm (5 Apr. 2001).\n\n\n\n2. Continuing education logbook for 1999. Pharm J\n1999;262:15.\n\n\n\n3. Society starts consultation on a new framework\nfor   professional   regulation.   Pharm  J    2000;\n\n\n\n264: 4000.\n4. Shaw JP, Drumm D. Prescription for registration:\n\n\n\nThe New Zealand pharmacy pre-registration\ntraining programme. Pharm J.1999;263:98-101.\n\n\n\n5. Caldwell J. NZ Society introduces practice\ncertificate based on competence. Pharm J\n2000;265:320.\n\n\n\n6. Latiff A. Traditional use, potential for\n\n\n\n\nhttp://www.mps.org.my/html/universiti_yang_\n\n\n\n\n\n\nGeneral article: Pharmacy practice in Malaysia\n\n\n\n9\n\n\n\nexploitation and conservation of medicinal plants\nin Malaysia. In: Proceedings of the Seminar on\nTraditional Herbs and Medicinal Plants in\nSarawak; 2000 Oct. 10; Kuching : Sarawak\nDevelopment Institute, 2000.\n\n\n\n7. Chai PPK. Global perspectives on the herbs and\nmedicinal plants industry. In: Proceedings of the\nSeminar  on  Traditional   Herbs   and   Medicinal\n\n\n\nPlants in Sarawak; 2000 Oct 10; Kuching:\nSarawak Development Institute, 2000.\n\n\n\n8. Ghazally I, Murtedza M, Laily BD. Chemical\nProspecting in the Malaysian forest 1st ed.\nMalaysia: Pelanduk Publications;1995.\n\n\n\n9. Malaysian Industry-Government Group for High\nTechnology. October 2000.\nhttp://www.might.org.my (5 Apr. 2001).\n\n\n\nFrom page 14\n\n\n\nContinuing Pharmacy Education question:\nStudy this case and give your response (100-200 words) based on the bioethical principles outlined in the\nCPE article on page 9. You may earn 2 CPE points if you submit a credible response to the MPS-CPE\nSecretariat at the Malaysian Pharmaceutical Society, P.O. Box 158, Jalan Sultan, 46710 Petaling Jaya,\nSelangor.\n\n\n\nAs a pharmacist at a regional transplant centre, you are in the team that allocates organs for transplantation.\nYour committee is at a deadlock as to which option to choose. The first is to allocate according to need (the\nsickest person gets the organ). The second option is to allocate according to an ordered pair. In the ordered\npair formula, people who have abused their bodies (a heavy smoker) will be considered only after others\nwho have not abused their bodies have received their transplants. The third proposal suggests that those\nwho have agreed to be organ donors (usually by a pledger card that they carry) should be put at the top of\nthe list. Your vote is key for the majority. Who will you vote for? Why?\n\n\n\n\n\n\n \nTable of Contents\n\n\n \n\n\n \n\n\n \n\n\n \n\n\n \n\n\n \n\n\n \n\n\n \nWong Sie Sing\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nINTRODUCTION\n\n\n\n\nWHAT IS PHARMACY PRACTICE?\n\n\nPHARMACY PRACTICE IN THE NEW MILLENNIUM\n\n\n\n\n\n"
"\n\nMalaysian Journal of Pharmacy 2001;1:22-28 Research article\n\n\n\n23\n\n\n\nPublic Awareness of Community Pharmacy\nand Pharmacists\nHadida Hashim1*, Ahmad Mahmud2, Lim Wai Hing1, Lum Peck Yoong3,\nNatasha Mohd. Yusof1 & Tang Yoke Bun1\n\n\n\n1Department of Pharmacy, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur,\nMalaysia.\n2Pharmaceutical Services Division, Selangor State Health Department, 15th Floor, Wisma MPSA,\nPersiaran Perbandaran, 40000 Shah Alam, Malaysia.\n3Farmasi Wu, No.4, Jalan SS2/63, 47300 Petaling Jaya, Selangor, Malaysia.\n\n\n\n*Author for correspondence\n\n\n\nABSTRACT\n\n\n\nAn exploratory study to ascertain the public\u2019s awareness of community pharmacy\nand pharmacists in a selected subset of the Malaysian population was undertaken,\nutilising an interviewer-administered structured questionnaire approach. A total\nscore was computed for each respondent, ranging from a possible minimum of 0 and\na maximum of 24. The scores achieved were arbitrarily categorised into poor (<11),\nfair (11 \u2013 14), good (15 \u2013 19) and excellent (>19) levels of general knowledge\nregarding community pharmacy and pharmacists. The scores achieved ranged from\n3 to 21, with an average \u201cfair\u201d score of 13.7. The results showed that 93.6% of the\nrespondents (n = 561) interviewed had heard of the term \u201cpharmacist\u201d before.\nInterestingly, 17.5% of the respondents were of the opinion that pharmacists\nworked on farms. A significant 77.4% perceived that a pharmacist served in a\ndoctor\u2019s clinic. It was noted that 84.1% of those surveyed would go to doctors for\nadvice on medicine, while only 49.4% would seek a pharmacist. A majority (76.7%)\nof the respondents interviewed chose to go to a doctor\u2019s clinic for a screening test.\nThe study amplifies the need for a more aggressive projection of the pharmacist\u2019s\nimage in the community in order to be recognized and accepted by the public as an\nintegral partner in the health care profession.\n\n\n\nKeywords: pharmacy, pharmacists, survey, perception, awareness\n\n\n\nINTRODUCTION\n\n\n\nIn this day and age, pharmacists play an\nessential role in educating patients regarding\ndrug therapy as patients become increasingly\nresponsible for their own health care.\nCommunity    pharmacists  are  the  health  care\n\n\n\nprofessionals most accessible to the public (1).\nThe community setting is a platform for the\npharmacist to project himself beyond the\ntraditional image of being simply a \u201cdrug\nsupplier\u201d    in    that    he    is   able  to  provide\n\n\n\n\n\n\n\n\nResearch article: Public awareness of community pharmacy\n\n\n\n24\n\n\n\n pharmacotherapeutic counselling to patients,\napart from general health care information to\nthe public. This is in line with Hepler and\nStrand\u2019s concept of pharmaceutical care (2).\n\n\n\nHowever, this professional expertise will only\nbe fully utilised if the public is aware of and\nunderstands the role played by the pharmacist\nin the community. Hence, this exploratory\nstudy was conducted to ascertain the public\u2019s\nawareness regarding the community pharmacy\nprofession and pharmacists.\n\n\n\nAIM\n\n\n\nThe aim of this study is to examine the public\u2019s\nawareness about community pharmacy and\npharmacists, in a selected subset of the\nMalaysian population.\n\n\n\nMETHOD\n\n\n\nStudy design\n\n\n\nThis public opinion survey was conducted\nusing a structured interview technique, in\nwhich the respondents were asked questions by\ntrained researchers (25 undergraduate students\nand 1 pharmacist).  It took place over a 4-day\nperiod in August 1997, during the University of\nMalaya Convocation Festival. Visitors to the\nPharmacy booth who appeared to be over 18\nyears of age were approached about\nparticipation in the survey. The sampling\nmethod used was that of convenience sampling.\nOnly those who agreed (97.9%) participated in\nthe study, with each interview taking\napproximately 8 to 10 minutes to complete.\n\n\n\nQuestionnaire\n\n\n\nA structured questionnaire was used. Apart\nfrom the portion relating to the demographic\nprofile of the respondents, there were\naltogether 10 questions focussed on the\nfollowing aspects:\na) the respondents\u2019 general awareness of\n\n\n\npharmacists and their places of work\nb) the purchasing pattern of respondents in\n\n\n\nrelation to pharmacies, sinseh\n(traditional Chinese medicine\npractitioner) shops and other places\n\n\n\nc) the awareness of services offered by\ncommunity pharmacies such as treatment\n\n\n\nof minor ailments, screening tests and\nadvice on medications.\n\n\n\nEach question had pre-formulated responses.\nThe questionnaire designed by the research\nteam was piloted with a sample of 25 staff\nmembers of the Faculty of Medicine,\nUniversity of Malaya.\n\n\n\nData analysis\n\n\n\nThe data was entered into a worksheet and\nanalysed using Microsoft Excel\u00ae. A scoring\nsystem was practised as follows:\n\n\n\na) For any question requiring either a \u201cYes\u201d or\n\u201cNo\u201d or \u201cUnsure\u201d response, only the positive\nresponse was given a score of 1, whilst any of the\nother two responses was awarded a score of 0\neach. As an example, for the question \u201cHave you\nheard of the term \u2018Pharmacist\u2019?\u201d a \u201cYes\u201d response\nwas scored as 1.\n\n\n\nb) For any question requiring the choice of one or\nmore than one answer, only the answers deemed\nappropriate was given a score of 1 each and a\ndeduction of 1 was made for each inappropriate\nanswer, with the lowest possible final score of 0\nfor any question. As an example, for the question\n\u201cTo whom would you go for advice on\nmedicines?\u201d where more than one answer may be\ngiven, a respondent who chose \u201cPharmacist\u201d,\n\u201cDoctor\u201d and/or \u201cNurse\u201d was given a score of 1\nfor each of the answers with a deduction of 1 if\n\u201cSinseh\u201d was also selected along with any of the\nappropriate answers.  If \u201cSinseh\u201d was the only\nanswer selected, the respondent received a final\nscore of 0 for that question.\n\n\n\nA total score was computed for each respondent,\nranging from a possible minimum of 0 and a\nmaximum of 24. The scores achieved were\narbitrarily categorised into poor (<11), fair (11 \u2013\n14), good (15 \u2013 19) and excellent (>19) levels of\ngeneral knowledge regarding community\npharmacy and pharmacists.\n\n\n\nRESULTS AND DISCUSSION\n\n\n\nGeneral\n\n\n\nThere were 561 respondents, who were mainly\nMalaysians (97.5%). The ethnic representation\nwas 59% Malays, 29% Chinese and 9%\nIndians. The majority (61.5%) of the\nrespondents were between 18 \u2013 25 years old\nwith 18.2% and 17.1% aged between 26 \u2013 35\n\n\n\n\n\n\n\n\nResearch article: Public awareness of community pharmacy\n\n\n\n25\n\n\n\nyears and 36 \u2013 50 years respectively. In terms\nof gender distribution, 41% of the respondents\nwere male.  The composition of the\nrespondents include undergraduates (55.1%),\nprofessionals (16.6%), non-professionals\n(20.3%), school-going students (3.7%),\npostgraduate students (2.3%), housewives\n(1.1%) and pensioners (0.9%). The majority\n(75%) of respondents lived in urban areas.\n\n\n\nThe respondents\u2019 scores ranged between 3 to 21\nout of a possible maximum of 24. The majority of\nthe respondents obtained scores in the \u201cfair\u201d (48%)\nand \u201cgood\u201d (39.6%) categories.  The mean score\nwas 13.7 and the mode was 14 (both in the \u201cfair\u201d\ncategory). Figure 1 reflects an almost normal\ndistribution. The generally fair scores achieved by\nthe respondents were not unexpected with almost\nthree-quarters (74%) of them either undertaking or\nhad attained a tertiary level of education. There\nwere only four respondents who obtained excellent\nscores: two were undergraduates, one was a\nhousewife while the other was a sales\nexecutive. Surprisingly, no professional\nachieved an \u201cexcellent\u201d score. The scores for\nthe different occupations, genders and ethnic\ngroups were not significantly different based\non the student\u2019s t-test (p>0.05).\n\n\n\nPublic image of pharmacists\n\n\n\nThe  respondents  were  assessed  on  their  level of\n\n\n\nawareness of the term \u201cPharmacist\u201d as well as the\nnature of work and workplace of a pharmacist.\nMost respondents (93.6%) had heard of the term\n\u201cpharmacist\u201d while 89.7% and 88.2% respectively,\nthought they knew what the pharmacist did and\nwhere the pharmacist worked. However, the\nfollowing question, which required the\nrespondents to choose the workplace of the\npharmacist, disproved the above notion. While\nmost respondents associated the pharmacist with\nthe retail sector, hospitals, academia and factories,\na shocking 77.4% associated pharmacists with\ndoctors\u2019 clinics and 17.5% with farms! [Figure 2].\nObviously, the respondents had heard of the term\n\u201cpharmacist\u201d; however, their awareness of a\npharmacist\u2019s role in the community was not\ncompletely accurate. The association with\nworking in a doctor\u2019s clinic suggested a\nconfusion between the roles of dispensers and\npharmacists. Farms were also associated with\npharmacists, possibly due to the perceived\nsimilarity between the words \u201cpharmacy\u201d and\n\u201cfarm\u201d. Most of the study population (91.1%)\nassociated pharmacists with the community or\nretail pharmacies and less with hospitals,\nfactories and pharmaceutical trading houses.\nThis confirms that community pharmacists\nhave a higher visibility and hence would be in\na better position to disseminate information and\ninfluence public opinion on pharmacy.\n\n\n\nIn this survey, quite a large proportion of the\n\n\n\n0 0 1 1 3 4 4\n9\n\n\n\n15\n\n\n\n29\n\n\n\n47\n\n\n\n62\n69\n\n\n\n91\n\n\n\n79\n\n\n\n60\n\n\n\n50\n\n\n\n25\n\n\n\n8\n3 1 0 0 0\n\n\n\n0\n\n\n\n10\n\n\n\n20\n\n\n\n30\n\n\n\n40\n\n\n\n50\n\n\n\n60\n\n\n\n70\n\n\n\n80\n\n\n\n90\n\n\n\n100\n\n\n\n1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24\n\n\n\nScore\n\n\n\nN\num\n\n\n\nbe\nr o\n\n\n\nf R\nes\n\n\n\npo\nnd\n\n\n\nen\nts\n\n\n\nFigure 1. Distribution of the respondents\u2019 scores based on the\nappropriateness of the responses given to the questions administered.\n\n\n\n\n\n\n\n\nResearch article: Public awareness of community pharmacy\n\n\n\n26\n\n\n\npeople interviewed (77.2%) identified the\nuniversity as a place of work for pharmacists. This\nwas not surprising since this study was conducted\non university grounds during the convocation\nfestival.  This percentage would, however, be\nexpected to be smaller if the study was conducted\nin the general population.\n\n\n\nSale items associated with community/retail\npharmacies\n\n\n\nThe familiarity of the respondents with the\npharmacy and sinseh shop was established\nbefore the respondents were asked questions on\ntheir purchasing patterns at these two places. It\nwas found that 88.4% of the respondents had\nvisited a pharmacy before as compared to a\nsinseh shop (67.4%).\n\n\n\nThe respondents were interviewed on their\npreferred places for purchasing groceries,\ntoiletries, health supplements, woundcare products,\ncrude herbs, over-the-counter (OTC) medicines\nand prescription drugs, with more than one\nresponse permitted for these questions. It was seen\nthat a pharmacy was generally associated with\nmultivitamins (89.9%), woundcare products\n(83.2%) and prescription drugs (79.7%), as\ndisplayed in Figure 3. The majority of the\nrespondents (55.4%) preferred to buy OTC\nmedicines from places other than the pharmacy\n\n\n\nand the sinseh shop. Could price and accessibility\nbe a contributing factor?  In comparison, a public\nopinion survey of community pharmaceutical\nservices in Malta (3) revealed that almost 31% of\ntheir study population visited a pharmacy\nprimarily to purchase prescribed medication while\nonly 23.3% did so mainly to obtain OTC products.\n\n\n\nIt was interesting to note that almost 40% of the\nrespondents would also purchase prescription\nmedicines from another doctor\u2019s clinic having\nacquired the prescription from a clinic or hospital.\nThis is certainly an alarming situation as it\nindicates an evident lack of awareness of the\nfunction of a community pharmacy.\n\n\n\nCommunity pharmacies are also often associated\nwith the sale and supply of products other than\ndrugs and medical supplies. Fortunately, although\na pharmacy was not the favoured place the\nrespondents would go for the purchase of groceries\nand toiletries, a certain percentage of the\nrespondents do associate a pharmacy with these\nitems (23% and 43% respectively).  There is\ncertainly justification for the diversification of\nsales range for these community pharmacies.\nProfitability, competition and service are probably\nthe motivation for these premises to offer items\nother than drugs and medical supplies. Hence, a\nsignificant proportion of the respondents inevitably\nperceived the pharmacies that they frequent as a\n\n\n\n6.4\n\n\n\n77.2\n\n\n\n91.1\n\n\n\n60.1\n\n\n\n74.5\n\n\n\n17.5\n\n\n\n77.4\n\n\n\n41.9\n\n\n\n1.1\n0\n\n\n\n10\n\n\n\n20\n\n\n\n30\n\n\n\n40\n50\n\n\n\n60\n\n\n\n70\n\n\n\n80\n\n\n\n90\n\n\n\n100\n\n\n\nSch\noo\n\n\n\nl \n\n\n\nUniv\ners\n\n\n\nity\nReta\n\n\n\nil\n\n\n\nFac\ntor\n\n\n\ny\n\n\n\nHos\npit\n\n\n\nal\nFarm\n\n\n\nDoc\ntor\n\n\n\n's C\nlin\n\n\n\nic\n\n\n\nTrad\ning\n\n\n\n H\nou\n\n\n\nse\n\n\n\nUns\nure\n\n\n\nWorkplace\n\n\n\nPe\nrc\n\n\n\nen\nta\n\n\n\nge\n o\n\n\n\nf r\nes\n\n\n\npo\nnd\n\n\n\nen\nts\n\n\n\n (%\n) \n\n\n\nFigure 2: Public\u2019s perception of pharmacists\u2019 workplaces.\n\n\n\n\n\n\n\n\nResearch article: Public awareness of community pharmacy\n\n\n\n27\n\n\n\n\u201cconvenience store\u201d.\n\n\n\nServices offered by community/retail\npharmacies\n\n\n\nThe  final  section  surveyed  the   respondents\u2019\n\n\n\npreferences in sourcing treatment for minor\nailments and screening tests [Figure 4] and\nadvice on medications [Figure 5]. The respondents\nwere given a choice of a pharmacy, clinic, sinseh\nshop and hospital for the treatment of minor\nailments   such  as  cough, cold or minor aches and\n\n\n\n89.9\n\n\n\n79.7\n\n\n\n8.7\n\n\n\n36.9\n\n\n\n83.2\n\n\n\n43.0 40.7\n\n\n\n23.4\n23.0\n\n\n\n3.4\n\n\n\n66.0\n\n\n\n20\n12.313.0\n\n\n\n12.3\n\n\n\n55.4\n\n\n\n86.1\n\n\n\n24.1\n\n\n\n91.3\n\n\n\n31.225.9\n\n\n\n0\n10\n20\n30\n40\n50\n60\n70\n80\n90\n\n\n\n100\n\n\n\nGroc\neri\n\n\n\nes\n\n\n\nToil\netr\n\n\n\nies\n\n\n\nMult\nivit\n\n\n\nam\nins\n\n\n\nWou\nnd\n\n\n\nca\nre \n\n\n\nProd\nuc\n\n\n\nts\n\n\n\nCrud\ne H\n\n\n\nerb\ns\n\n\n\nOTC M\ned\n\n\n\nicin\nes\n\n\n\nPres\ncri\n\n\n\npti\non\n\n\n\n D\nrug\n\n\n\ns\n\n\n\nItems purchased\n\n\n\nPe\nrc\n\n\n\nen\nta\n\n\n\nge\n o\n\n\n\nf r\nes\n\n\n\npo\nnd\n\n\n\nen\nts\n\n\n\n (%\n)\n\n\n\nPharmacy Sinseh Others Another Doctor's Clinic\n\n\n\nFigure 3: Sale items associated with community pharmacies, sinseh shops and others.\n\n\n\n41.7\n\n\n\n11.210.3\n\n\n\n0.2\n\n\n\n73.6\n76.7\n\n\n\n24.6\n\n\n\n59.0\n\n\n\n0\n\n\n\n10\n\n\n\n20\n\n\n\n30\n\n\n\n40\n\n\n\n50\n\n\n\n60\n\n\n\n70\n\n\n\n80\n\n\n\n90\n\n\n\nMinor ailments Screening tests\n\n\n\nServices required\n\n\n\nPe\nrc\n\n\n\nen\nta\n\n\n\nge\n o\n\n\n\nf r\nes\n\n\n\npo\nnd\n\n\n\nen\nts\n\n\n\n (%\n)\n\n\n\nPharmacy Sinseh Clinic Hospital\n\n\n\nFigure 4: Utilisation of services.\n\n\n\n\n\n\n\n\nResearch article: Public awareness of community pharmacy\n\n\n\n28\n\n\n\npains, where more than one answer may be given.\nAlthough treatment for minor ailments can be\nobtained at the community pharmacies after\nconsultation with the pharmacists, the majority of\nthe respondents (73.6%) preferred the doctor\u2019s\nclinic, with only 41.7% selecting the pharmacy.\nShould we be surprised? This phenomenon was\nalso reflected in a survey conducted in Malta\n(3), where respondents were reported to more\nlikely consult their doctor or self-medicate for\nthe treatment of minor ailments rather seek\nadvice from the pharmacist. Similarly, Hargie\net al (1992) also reported that in Northern\nIreland, general practitioners were the first\npreference for the majority of the patients with\nregards to the treatment of minor conditions\n(4).\n\n\n\nCorrespondingly, when the respondents were\nquestioned on the places associated with offering\nscreening tests, the popular choices were the clinic\n(76.7%) and the hospital (59%). Only 11.2% of\nrespondents would go to a pharmacy for screening\ntests. Some community pharmacies do offer\nservices such as screening tests to the public. This\nstudy indicates that perhaps a majority of the\npublic is unaware of such services being available\nin the community pharmacies and thus would\nprefer to go to general practitioners and hospitals\nfor the treatment of minor ailments as well as for\nscreening tests.\n\n\n\nThe next question quizzed the respondents on\nwhom they would go to for advice on\nmedications, where more than one answer was\npermitted. It was disappointing to note that\nonly 49.4% of the respondents would go to a\npharmacist for information concerning\nmedicines, compared to 84.1% of the\nrespondents who would choose a doctor.\n[Figure 5]\n\n\n\nThus, although pharmacists are deemed to be\nexperts on drugs (1), it is unfortunately not\nperceived as such in the eyes of the majority of\nthe respondents interviewed. This result is in\nconcurrence with the findings of a recent\nsurvey conducted in Northern Ireland by Bell et\nal (2000).  The latter revealed that although the\nmajority of those interviewed (87.8%)\nconsidered pharmacists as experts in the field\nof medicines, however, only 64.6% reported\nthat they would talk initially to a pharmacist\nregarding information or advice concerning\nmedicines (5). One possible reason for this\nsituation may be the lack of rapport between\nthe patients/public and the pharmacists as\ncompared to doctors or nurses. Another reason\nmay be the fact that pharmacists are often\nviewed by the public as business people\nconcerned with making money rather than\nhealth-oriented care-driven professionals. Two\nsurveys conducted in Northern Ireland (4,5) found\nthat about one-third of their study populations\n\n\n\n49.4\n\n\n\n5.9\n\n\n\n84.1\n\n\n\n13.6\n\n\n\n0\n\n\n\n10\n\n\n\n20\n\n\n\n30\n\n\n\n40\n\n\n\n50\n\n\n\n60\n\n\n\n70\n\n\n\n80\n\n\n\n90\n\n\n\nPharmacist Sinseh Doctor Nurse\n\n\n\nHealthcare professionals\n\n\n\nPe\nrc\n\n\n\nen\nta\n\n\n\nge\n o\n\n\n\nf r\nes\n\n\n\npo\nnd\n\n\n\nen\nts\n\n\n\n (%\n)\n\n\n\nFigure 5: Health care professionals whom the respondents would\napproach for advice on medications.\n\n\n\n\n\n\n\n\nResearch article: Public awareness of community pharmacy\n\n\n\n29\n\n\n\nharboured that perception.\n\n\n\nIn examining the situation in other countries, it\nwas found that in India, community pharmacies\nwere not perceived to be respectable (6). In Great\nBritain, on the other hand, two national\nrepresentative surveys had demonstrated that the\npublic interviewed do perceive pharmacists as\nappropriate advisers for common ailments but not\nfor more general health matters (7).  In the United\nStates of America, the 1998 Schering Report XXI\nshowed strong gains in terms of the patients\u2019\nperception of community pharmacists, compared\nto a similar 1978 survey (8).  It is imperative that\nthe Malaysian public should be made aware of and\nunderstand the role of pharmacists in the\ncommunity, in order for the profession to realise\nits full potential and the public to benefit from the\nexpertise available. Improved social interactions\nbetween the public and the pharmacists, in\nparticular personal attention in relation to advice\non the treatment of minor ailments, self-care and\ndispensed medications, is probably the key to\nincreasing the level of public awareness.\n\n\n\nLimitations of the study\n\n\n\nAdmittedly, the study population used in this\nsurvey was biased towards the more educated and\nurban portion of the Malaysian public, specifically\nthose who visited the Pharmacy booth during the\nUniversity of Malaya Convocation Festival. This\nstudy was, however, designed for a quick snap-\nshot of this subset\u2019s perception of community\npharmacies and pharmacists with the thought in\nmind that if this subset demonstrates a lack of\nawareness, then it is most unlikely that the less\neducated and rural subsets of the Malaysian public\nwill be any better.  Another limitation of this study\n\n\n\nwas its setting that did not permit a more extensive\nline of questioning.\n\n\n\nCONCLUSION\n\n\n\nAlthough this study was conducted in a selected\nsubset of the population, it does offer a baseline\nrelating to the public perception of community\npharmacy and the pharmacy profession in 1997, at\nleast in relation to the more educated and urban\nsection of the public. Of late, with increasing\nattention in the mass media on the issue of\ndispensing separation and the role of the\npharmacists, particularly in the community, the\npublic\u2019s perception towards the pharmacists may\nhave since improved.  Its significance or the lack\nof it can only be demonstrated through the conduct\nof a second survey, preferably using a bigger study\npopulation and a stratified random selection of the\ninterview sites representing the various\nstates/territories in Malaysia. Nonetheless, the\nfindings of this survey have clearly impressed the\nurgent need for the pharmacy profession,\nparticularly the community pharmacy sector, to\nproject itself in the eyes of the public as uniquely\nqualified professionals on drugs, and a reliable\nsource of unbiased information as well as advice\non medications and general health care.\n\n\n\nACKNOWLEDGMENTS\n\n\n\nThe authors wish to thank all the 25 undergraduate\nstudents, who conducted the interviews for this\nstudy after undergoing the training provided, and\nMr. Mohamed Azmi bin Ahmad Hassali for his\nassistance in the procurement of the literature.\n\n\n\n*****\nREFERENCES\n\n\n\n1. World Health Organisation. The scope of pharmacy\nand the functions of pharmacists. In: The role of the\npharmacist in the health care system. Report of a\nWHO Consultative Group; 1988 Dec. 13-16; New\nDelhi.\n\n\n\n2. Hepler CD, Strand LM. Opportunities and\nresponsibilities in pharmaceutical care. Am J Hosp\nPharm 1990; 47: 533-43.\n\n\n\n3. Cordina M, McElnay JC, Hughes CM. Societal\nperceptions of community pharmaceutical services\nin Malta. J Clin Pharm Ther 1998; 23: 115-26.\n\n\n\n4. Hargie O,   Morrow N,    Woodman C.    Consumer\n\n\n\nperceptions and attitudes to community pharmacy\nservices. Pharm J 1992; 249:688-91.\n\n\n\n5. Bell HM, McElnay JC, Hughes CM. Societal\nperspectives on the role of the community\npharmacist and community-based pharmaceutical\nservices. J Soc Admin Pharm 2000; 17: 119-28.\n\n\n\n6. Singh H. India: Retail pharmacy not respectable.\nPharm J 1982; 228:145.\n\n\n\n7. Anon. Public faith in pharmacist\u2019s advisory role.\nPharm J 1985; 235:177.\n\n\n\n8. Anon. Pharmacists gain in public esteem. Am Drug\n1999; 216:29.\n\n\n\n\n\n\n \nTable of Contents\n\n\n \nCenter of Ethics at Georgetown University, Professor Andr\u00e9 Hellegers seized the opportunity to turn bioethics into an academic discipline that reflected the needs of the time. This was rather easily acceptable as bioethics can readily be identified with\n\n\n \nKey words: pharmacy, career choice, job factor, workplace, Malaysia\n\n\n \nINTRODUCTION\n\n\nAIM\n\n\nMETHOD\n\n\n \nStudy design\n\n\nQuestionnaire\n\n\nData analysis\n\n\n\n\nRESULTS AND DISCUSSION\n\n\n \nGeneral\n\n\nPublic image of pharmacists\n\n\n \nperceived the pharmacies that they frequent as a \u201cconvenience store\u201d.\n\n\nCorrespondingly, when the respondents were questioned on the places associated with offering screening tests, the popular choices were the clinic (76.7%) and the hospital (59%). Only 11.2% of respondents would go to a pharmacy for screening tests. Some c\n\n\nCONCLUSION\n\n\nACKNOWLEDGMENTS\n\n\nREFERENCES\n\n\n\n\n\n\n\n\n\n\n\n\n\n"
"\n\nMalaysian Journal of Pharmacy Volume 7 Issue 1 (2021) \n \n\n\n\n\n\n\n\n\n\n\n\n34 \n\n\n\n\n\n\n\n*Correspondence: ucn.jaasminerjit@kpjuc.edu.my, \n\n\n\ntcsiang@kpjuc.edu.my \n\n\n\n\n\n\n\n1 School of Pharmacy, KPJ Healthcare University College, Nilai, Malaysia \n2 Faculty of Pharmacy, University of Cyberjaya, Selangor, Malaysia \n3 Faculty of Computing and Engineering, Quest International University, \n\n\n\nIpoh, Perak, Malaysia \n 4 Department of Pharmacy, National University Hospital, Singapore \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n Original Research Article \n\n\n\n\n\n\n\nUtilization Review of Anti-peptic Ulcer Drugs at an Outpatient \n\n\n\nPharmacy Setting of a Private Hospital in Malaysia \n \n\n\n\nPuvithra Ravi Sundram 1, Ching Siang Tan 1*, Shashidharan Menon 1, H. Jaasminerjiit Kaur 1*, \n\n\n\nKah Seng Lee 2, Abdullah Khan 1, Anandarajagopal Kalusalingam 1, Khang Wen Goh 3, Pit Wei \n\n\n\nNg4 \n\n\n\n\n\n\n\n \nArticle Info  \n\n\n\n \nReceived date:  23 Dec 2020 \n\n\n\nAccepted date: 12 May 2021 \n\n\n\nPublished date: 30 June 2021 \n\n\n\n\n\n\n\nKeywords: \n\n\n\nPharmacoepidemiology, peptic \n\n\n\nulcer diseases, gastrointestinal \n\n\n\ntract, prescribing pattern, \n\n\n\nDefined Daily Dose \n\n\n\nABSTRACT \n\n\n\n\n\n\n\nAnti-peptic ulcer drugs (APUDs) such as proton pump inhibitors (PPI), H2 receptor antagonists \n\n\n\n(H2A), antacids are widely prescribed. This study is aimed to describe the utilisation pattern of \n\n\n\nAPUDs based on WHO Defined Daily Dose (DDD) and identify most commonly used APUD in the \n\n\n\nselected hospital. A retrospective study was carried out in outpatient of the selected hospital for year \n\n\n\n2017. Sample size was calculated using Raosoft. DDD of APUDs and direct drug cost were \n\n\n\ncalculated. Data were collected through electronic medical record by retrieving patients\u2019 registration \n\n\n\nnumber. Inclusion criteria were patients above 18 years old and APUDs prescribed for \n\n\n\ngastrointestinal related indications. A total of 160 prescriptions were randomly selected for data \n\n\n\nanalysis. Based on the DDD calculated, Rabeprazole 20mg was most prescribed drug among PPI \n\n\n\n(n=33), while Maalox is most prescribed drug among the antacids (n=23). Based on the DDD \n\n\n\ncalculated, Pantoprazole 20mg recorded highest rates per user per day about 1.26 DDD / user / day \n\n\n\nwhile antacids, Actal reported highest usage rate with 7.11 DDD / user / day. Besides, there are 5.4 \n\n\n\ndays supplied per user for this drug. Dexlansoprazole 60mg is the most expensive drug among all the \n\n\n\nPPI listed in hospital formulary. It has 18.5 days supplied/user, which is the second shortest duration \n\n\n\nof treatment among all the other PPIs. In contrast, omeprazole 20mg is the lowest cost PPI but the \n\n\n\nduration supplied per user is longer resulting in higher total cost of therapy. In conclusion, PPIs were \n\n\n\nthe most commonly prescribed.  \n\n\n\n\n\n\n\nINTRODUCTION  \n  \n\n\n\nPeptic ulcer disease (PUD) has been common ailment, where \n\n\n\nannual incident report stated 0.03% to 0.17% were diagnosed \n\n\n\nby medical examiner and treated as outpatient and 0.03% to \n\n\n\n0.17% during hospital stay. The incidence of PUD has decline \n\n\n\non recent time in some countries, this is attributed to the \n\n\n\ndecrease in Helicobacter pylori infection, particularly in \n\n\n\nWestern populations [1]. Asian countries recorded lower peptic \n\n\n\nacid disorder prevalence rate compared to advance nation \n\n\n\nmeanwhile Malaysian recorded prevalence 9.5% for duodenal \n\n\n\nulcer and 9.4% gastric ulcer respectively [2]. \n\n\n\n\n\n\n\nReports on prevalence and incidence of peptic ulcer secondary \n\n\n\nto geographical variation exists with differences in relative \n\n\n\noccurrences of duodenal and gastric ulcers. Ethnic variations \n\n\n\non peptic ulcer incidence has been reported on the pattern of \n\n\n\npeptic ulcer in Malaysia from endoscopic data at University \n\n\n\nMedical unit at Kuala Lumpur that states Chinese of both \n\n\n\ngender have a higher susceptibility to peptic ulcer [3]. \n\n\n\n\n\n\n\nAnti-Peptic Ulcer Drugs (APUDs) such as H2-receptor \n\n\n\nantagonists (H2RA), proton pump inhibitors (PPI), and \n\n\n\nantacids are commonly used by medical partitioner, on other \n\n\n\nhand synthetic prostaglandins and cytoprotective agents has \n\n\n\nbeen promptly used by  gastroenterologist in private clinics. \n\n\n\nBesides peptic ulcer disorder this agents are also used in \n\n\n\n\n\n\n\n\nSundram, P.R. et al. Mal J Pharm 7 (1) 2021, 34-42 \n\n\n\n\n\n\n\n35 \n\n\n\n\n\n\n\ntreatment non-ulcer dyspepsia and heartburns. These group \n\n\n\ndrugs are co-prescribed as prophylaxis agents during \n\n\n\nnonsteroidal anti-inflammatory drugs (NSAIDs), steroids, anti-\n\n\n\nplatelet and anticoagulation therapy [4]. Many physicians had \n\n\n\nraised concern regarding adverse events due to long-term acid \n\n\n\nsuppression therapy. n other hand with PUD drug endoscopic \n\n\n\nstudy reveal 30% of patient suffered with peptic ulcer whom \n\n\n\nco-prescribed NSAIDs [5]. Therefore, there is a need to \n\n\n\ndevelop a policy on APUD and drug formulary.  \n\n\n\n\n\n\n\nCommon acid suppressants used in gastrointestinal disorders \n\n\n\nare PPI and H2RA. The trend of drug consumption in Malaysia \n\n\n\nhas transformed significantly from H2RA to PPI and currently, \n\n\n\nthere are overconsumption of PPI [6]. A huge number of \n\n\n\npatients, as many as 90% in one study consume these drugs \n\n\n\nwith no appropriate guideline-based indication [7]. Since PPIs \n\n\n\nare easily available, this makes them one of the most widely \n\n\n\nprescribed medications; thus irrational use and unnecessary \n\n\n\nexposure prone to happen. Long-term consumption of a proton \n\n\n\npump inhibitor may lead to gastric carcinoids and increases the \n\n\n\nrisk of hip fractures [8]. Moreover, PPIs are costly thereby \n\n\n\nincreasing the economic burden on the patients. PPI over usage \n\n\n\nhas become very critical, where this study need to be \n\n\n\ncommenced in order to provide a better understanding in \n\n\n\nhealthcare sector [9]. \n\n\n\n\n\n\n\nAccording to Kandasami, the total cost of PUD patient \n\n\n\nprescription surges as more than half of patients suffering from \n\n\n\npeptic ulcers are usually associated with comorbidities that \n\n\n\nnecessitates treatment [10]. Although the prevalence of acid \n\n\n\nrelated disorders in Malaysia is in the region of 8-10%, , only \n\n\n\n0.6% of the population have been prescribed with medications \n\n\n\nfor acid related diseases by Malaysian Society of \n\n\n\nGastroenterology and Hepatology. This shows that there is a \n\n\n\ntreatment gap. Therefore, there is a need to standardise \n\n\n\ntreatment algorithms for acid related disorders in Malaysia and \n\n\n\nthe important role of anti-peptic ulcer drugs in the management \n\n\n\nof acid related disorders needs to be clearly defined. \n\n\n\n\n\n\n\nThe over-prescribing of APUD highlighted the importance of \n\n\n\nthe need to examine the current utilization and appropriateness \n\n\n\nof the anti-peptic ulcer drugs. The outcome of this study will be \n\n\n\nbeneficial to develop a policy on APUD usage and drug \n\n\n\nformulary at the selected hospital. Drug utilization review may \n\n\n\nhelp the prescribers to interpret, understand, and expand the \n\n\n\nprescribing, administration and usage of the medication. This \n\n\n\nmay directly have a positive impact on patient health and \n\n\n\nfinancial status.   \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nMETHOD \n \n\n\n\nOverview of Research Design \n\n\n\n\n\n\n\nA retrospective observational study on drug utilization of anti-\n\n\n\npeptic ulcer drugs had been carried out in the outpatient \n\n\n\ndepartment of a private hospital located at Seremban, Negeri \n\n\n\nSembilan Malaysia. A retrospective study design that trace \n\n\n\ninformation backwards was used. The selected hospital uses \n\n\n\nKPJ Clinical Information System (KCIS) and Hospital \n\n\n\nInformation Technology System (HITS) which is the \n\n\n\nElectronic Medical Record (EMR).  \n\n\n\n\n\n\n\nKCIS creates a boundless communication among the \n\n\n\nhealthcare professionals which manages the clinical aspects of \n\n\n\nthe hospital, while HITS is a system of the hospital \n\n\n\nmanagement that integrates all patients\u2019 information since the \n\n\n\npatient been registered until billing from KPJ Annual Report. \n\n\n\nThese systems are used to obtain data that are needed for this \n\n\n\nstudy. Inclusion and exclusion criteria were applied to select \n\n\n\nthe appropriate drug utilisation data. \n\n\n\n\n\n\n\nPatient selection criteria \n\n\n\n\n\n\n\nPrescriptions from newly registered patients as well as regular \n\n\n\nfollow-up patients were included in the study according to the \n\n\n\ninclusion and exclusion criteria. Prescriptions that fulfilled the \n\n\n\nfollowing inclusion and exclusion criteria adopted from \n\n\n\nliterature were included [11]. \n\n\n\n\n\n\n\nInclusion criteria  \n\n\n\n\n\n\n\n\u2022 Prescription with patient more than age of 18 years old \n\n\n\nreceiving anti-peptic ulcer drugs. \n\n\n\n\u2022 Pharmacologically treated for peptic ulcer with or \n\n\n\nwithout comorbidities. \n\n\n\n\n\n\n\nExclusion criteria  \n\n\n\n\n\n\n\n\u2022 The prescription with incomplete patient data for data \n\n\n\ncollection form. \n\n\n\n\u2022 Non-KPJ prescriptions. \n\n\n\n\n\n\n\nSampling Method \n\n\n\n\n\n\n\nThe sampling technique that has been used in this study were \n\n\n\nblock randomization as well as convenience sampling. Block \n\n\n\nrandomization method was used to randomize subjects into \n\n\n\ngroups that result in equal sample sizes.  Then, in order to \n\n\n\nchoose the sample, convenience sampling was used. \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nSundram, P.R. et al. Mal J Pharm 7 (1) 2021, 34-42 \n\n\n\n\n\n\n\n36 \n\n\n\n\n\n\n\nSample study \n\n\n\n\n\n\n\nThe sample size required for this study was estimated based on \n\n\n\na formula stated by Daniel [12]. For this study, the significance \n\n\n\nlevel was set at \u03b1 = 0.05 (two tailed) and 95% degree of \n\n\n\nconfidence interval (CI) fixed in the calculation sample size by \n\n\n\nusing the formula as stated above. The minimum sample size \n\n\n\ncalculated was 138 patients with peptic ulcer from the \n\n\n\noutpatient department. \n\n\n\n\n\n\n\nVariable Definition  \n\n\n\n\n\n\n\nThe KPJ Clinical Information System (KCIS) was used to \n\n\n\naccess the list of all patients that are previously prescribed with \n\n\n\nanti-peptic ulcer drugs in 2017 and record in a data collection \n\n\n\nform. Only prescriptions that met the inclusion and exclusion \n\n\n\ncriteria were included in this study. So, these patients\u2019 \n\n\n\nprescriptions records were retrieved between January till \n\n\n\nDecember 2017 by using their medical record number (MRN) \n\n\n\nor identification card number (IC). \n\n\n\n\n\n\n\nThe following data were collected for each prescription: \n\n\n\nDemographic data which includes the age, sex and weight of \n\n\n\npatient, diagnosis and relevant prescription data. This includes \n\n\n\nthe name of medication, pharmacological class, dose \n\n\n\nprescribed, dosage regimen which includes frequency and route \n\n\n\nof administration and number of drugs per prescription. The \n\n\n\ncollected prescriptions were evaluated based on criteria of \n\n\n\nprescription and standard guideline on DDD. \n\n\n\n\n\n\n\nThe prescription was assessed based on the following criteria, \n\n\n\nnumber of drugs prescribed, number prescribed in generics, \n\n\n\ndose strength, dosage of drug and duration of therapy. \n\n\n\nMeanwhile, the guideline on DDD that was used as the main \n\n\n\nreference in this study are CPG of Non-variceal Upper \n\n\n\nGastrointestinal Bleeding and National Drug Formulary. \n\n\n\n\n\n\n\nDefined Daily Dose Formula \n\n\n\n\n\n\n\nThe Defined Daily Dose (DDD) for a drug is its assumed \n\n\n\naverage maintenance dose per day for a drug used as a main \n\n\n\nindication in adults as WHO guideline (Eq. 1).  \n\n\n\n \n\ud835\udc47\ud835\udc5c\ud835\udc61\ud835\udc4e\ud835\udc59 \ud835\udc37\ud835\udc37\ud835\udc37\ud835\udc60\n\n\n\n=\n\ud835\udc37\ud835\udc5c\ud835\udc60\ud835\udc4e\ud835\udc54\ud835\udc52 \ud835\udc53\ud835\udc5c\ud835\udc5f\ud835\udc5a \ud835\udc60\ud835\udc61\ud835\udc5f\ud835\udc52\ud835\udc5b\ud835\udc54\ud835\udc61\u210e \u00d7  \ud835\udc44\ud835\udc62\ud835\udc4e\ud835\udc5b\ud835\udc61\ud835\udc56\ud835\udc61\ud835\udc66 \ud835\udc5c\ud835\udc53 \ud835\udc51\ud835\udc5f\ud835\udc62\ud835\udc54 \ud835\udc51\ud835\udc56\ud835\udc60\ud835\udc5d\ud835\udc52\ud835\udc5b\ud835\udc60\ud835\udc52\ud835\udc51\n\n\n\n\ud835\udc4a\ud835\udc3b\ud835\udc42 \ud835\udc4e\ud835\udc60\ud835\udc60\ud835\udc56\ud835\udc54\ud835\udc5b\ud835\udc52\ud835\udc51 \ud835\udc37\ud835\udc37\ud835\udc37 \ud835\udc53\ud835\udc5c\ud835\udc5f \ud835\udc61\u210e\ud835\udc52 \ud835\udc51\ud835\udc5f\ud835\udc62\ud835\udc54\n (\ud835\udc38\ud835\udc5e. 1) \n\n\n\n\n\n\n\n\n\n\n\nTo provides a rough estimate of the proportion of the \n\n\n\npopulation treated daily with a specific drug, rates per residents \n\n\n\nper day is calculated using Eq.2. \n\n\n\n\n\n\n\n\ud835\udc37\ud835\udc37\ud835\udc37\ud835\udc60 \ud835\udc5d\ud835\udc52\ud835\udc5f \ud835\udc51\ud835\udc4e\ud835\udc66 \ud835\udc5d\ud835\udc52\ud835\udc5f 1000 \ud835\udc5f\ud835\udc52\ud835\udc60\ud835\udc56\ud835\udc51\ud835\udc52\ud835\udc5b\ud835\udc61\ud835\udc60\n\n\n\n=\n\ud835\udc37\ud835\udc37\ud835\udc37\ud835\udc37\ud835\udc60 \ud835\udc5d\ud835\udc52\ud835\udc5f \ud835\udc66\ud835\udc52\ud835\udc4e\ud835\udc5f  \n\n\n\n30 \ud835\udc51\ud835\udc4e\ud835\udc66\ud835\udc60 \u00d7  30,000 \ud835\udc5f\ud835\udc52\ud835\udc60\ud835\udc56\ud835\udc51\ud835\udc52\ud835\udc5b\ud835\udc61\ud835\udc60\n\u00d7 1000  (\ud835\udc38\ud835\udc5e. 2) \n\n\n\n\n\n\n\nTo determine whether the DDD is close to the average daily \n\n\n\nmaintenance dose for the drug's main indication (as determined \n\n\n\nby WHO), the rates per user per day is calculated (Eq.3) \n\n\n\n\n\n\n\n\ud835\udc37\ud835\udc37\ud835\udc37\ud835\udc60 \ud835\udc5d\ud835\udc52\ud835\udc5f \ud835\udc51\ud835\udc4e\ud835\udc66 \ud835\udc5d\ud835\udc52\ud835\udc5f \ud835\udc62\ud835\udc60\ud835\udc52\ud835\udc5f =\n\ud835\udc37\ud835\udc37\ud835\udc37\ud835\udc37\ud835\udc60 \ud835\udc5d\ud835\udc52\ud835\udc5f \ud835\udc66\ud835\udc52\ud835\udc4e\ud835\udc5f  \n\n\n\n30 \ud835\udc51\ud835\udc4e\ud835\udc66\ud835\udc60 \u00d7  \ud835\udc41\ud835\udc62\ud835\udc5a\ud835\udc4f\ud835\udc52\ud835\udc5f \ud835\udc5c\ud835\udc53 \ud835\udc62\ud835\udc60\ud835\udc52\ud835\udc5f\ud835\udc60\n  (\ud835\udc38\ud835\udc5e. 3) \n\n\n\n\n\n\n\nUse of DDDs Clinically \n\n\n\n\n\n\n\nA clinical measure can also be calculated to help interpret the \n\n\n\nDDDs/user/day value which assumes dispensation to users \n\n\n\nover an entire year. This can be done in two steps: \n\n\n\n\n\n\n\nFirstly, an intermediate rate of the number of days supplied per \n\n\n\nuser is calculated by summing the number of days supplied \n\n\n\nrecorded on each prescription claim and dividing by the number \n\n\n\nof users. \n\n\n\n\n\n\n\nSecondly, the measure of how the drug is actually being used \n\n\n\nwas calculated by dividing the rate of the DDDs per user by the \n\n\n\nrate of the number of days supplied per user which is also \n\n\n\nknown as DDDs / day supplied. \n\n\n\n\n\n\n\nOutcome Parameter  \n\n\n\n\n\n\n\nThe DDD between the standardized DDD by WHO were \n\n\n\ncompared with DDD based on the drugs prescribed by the \n\n\n\nprescribers and patient\u2019s characteristics. The DDD/1,000 \n\n\n\ninhabitants/day which expressed as DDD methodology and the \n\n\n\ndrug classification system, Anatomical Therapeutic Chemical \n\n\n\n(ATC) were used in estimating the usage of APUD in the \n\n\n\nselected private hospital. Data of DDD of APUD in the selected \n\n\n\nhospital were then analysed and compared to the standard DDD \n\n\n\nof WHO classification of ATC/DDD.  \n\n\n\n\n\n\n\nEthical Consent \n\n\n\n\n\n\n\nThe ethical approval for this study was obtained from the \n\n\n\nResearch Ethic Committee of KPJ University College, Nilai, \n\n\n\nMalaysia (KPJUC/RMC/BPH/EC/2017/100). This approval \n\n\n\nhas been obtained before conducting the study. All data \n\n\n\nobtained were used solely for research and be kept confidential. \n\n\n\n \n\n\n\n\n\n\n\n\nSundram, P.R. et al. Mal J Pharm 7 (1) 2021, 34-42 \n\n\n\n\n\n\n\n37 \n\n\n\n\n\n\n\nRESULT  \n \n\n\n\nPatients\u2019 selection and description \n\n\n\n\n\n\n\nThe prescription data that have met all the inclusion criteria \n\n\n\nwere critically analysed. From the total outpatient prescriptions \n\n\n\nin 2017, 200 prescriptions were found matched the criteria \n\n\n\nbased on the studies requirement and 22 prescriptions were \n\n\n\nexcluded due to the diagnosis as Helicobacter pylori positive. \n\n\n\nHowever, due to some incomplete data were found, only 160 \n\n\n\nprescriptions were finally chosen.  \n\n\n\n\n\n\n\nDemographic Characteristics of Patients \n\n\n\n\n\n\n\nTable I shows the demographic characteristics of the \n\n\n\npopulations in this study and depicts that the most common age \n\n\n\ngroup in which APUDs were prescribed in both male and \n\n\n\nfemale was 50-59 years 31.88% (n=51) whereas the least age \n\n\n\ngroup prescribed with APUDs are below 20 years, 3.13% \n\n\n\n(n=5). The prescriptions of these drugs were slightly more \n\n\n\namong male patients 55% (N = 88) compared to female patients \n\n\n\n45% (n=72). The major ethnicity found to be prescribed the \n\n\n\nmost were Malay 63.75% (n=102) followed by Chinese \n\n\n\n18.75% (n=30) and Indian 17.50% (n=28). \n\n\n\n\n\n\n\nPatterns of Anti-Peptic Ulcer Drugs Utilization \n\n\n\n\n\n\n\nIn this study, the number of drugs prescribed varied according \n\n\n\nto the severity of patient condition and requirement of therapy. \n\n\n\nDrugs prescribed per prescription among 160 patients ranged \n\n\n\nfrom 1 to 2 types of drug products.  \n\n\n\n\n\n\n\nTable II illustrates the utilization pattern of anti-peptic ulcer \n\n\n\ndrugs according to their classification and it reveals that most \n\n\n\ncommon class of anti-peptic ulcer drug prescribed to adult \n\n\n\npopulation in that corresponding hospital setting was proton \n\n\n\npump inhibitors which accounted for 82% (n=159) followed by \n\n\n\nAntacids about 18% (n=35) and no usage of H2 antagonist. \n\n\n\n\n\n\n\nThe drug utilization was further examined specifically based on \n\n\n\neach type of drug products.  PPI was the one most commonly \n\n\n\nprescribed drug class, 17% (n=33) was contributed by \n\n\n\nrabeprazole 20mg whereas the least usage of drug under the PPI \n\n\n\ncategory is pantoprazole 40mg, about 6.7% (n=13).  Besides, \n\n\n\nthe main PPI prescribed by consultant is rabeprazole 20mg \n\n\n\nwhile the most frequent PPI prescribed by medical officers is \n\n\n\npantoprazole 20mg. The distribution of anti-peptic ulcer drugs \n\n\n\nutilization varied based on the strength of medication. The \n\n\n\nhighest maximum usage of antacids is Zellox suspension, about \n\n\n\n11.9% (n=23) whereas the least prescribed is Actal tablet about \n\n\n\n2.6% (n=5).   \n\n\n\n\n\n\n\nFigure I demonstrates 40% (n=64) of prescriptions \n\n\n\nadministered combination of anti-peptic ulcer drugs whereas \n\n\n\n60% (n=96) of them administered a single APUD. The highest \n\n\n\nnumber of samples administering single group of APUDs are \n\n\n\nfrom the age group of 50 to 59 years old. \n\n\n\n\n\n\n\nFrequency of anti-peptic ulcer drugs prescriptions from various \n\n\n\ndepartment are illustrated in Figure II. It shows that out of the \n\n\n\n160 prescriptions of APUDs, most number of outpatient \n\n\n\nprescriptions were found in general surgery department 26.9% \n\n\n\n(n=43) followed by 23.1% (n=37) from general medicine \n\n\n\ndepartment. On the other hand, APUDs were least prescribed \n\n\n\nin urology, otorhinolaryngology (ENT) and obstetrics and \n\n\n\nTable I. Gender and ethnicity of population based on age category \n\n\n\n\n\n\n\nCategory \n\n\n\nNumber of APUDs prescriptions, n (%) \n\n\n\nMale \n\n\n\nn=88 \n\n\n\nFemale \n\n\n\nn=72 \n\n\n\nAge category \n\n\n\nBelow 20 2 (1.25) 3 (1.9) \n\n\n\n20 to 29 2 (1.25) 4 (2.5) \n\n\n\n30 to 39 12 (7.5) 12 (7.5) \n\n\n\n40 to 49 27 (16.9) 16 (10) \n\n\n\n50 to 59 30 (18.8) 21 (13.1) \n\n\n\nAbove 60 15 (9.4) 16 (10) \n\n\n\nEthnicity \n\n\n\nMalay  59 (36.9) 43 (26.9) \n\n\n\nChinese 16 (10) 14 (8.8) \n\n\n\nIndian 13 (8.1) 15 (9.4) \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nTable II. Frequency of anti-peptic ulcer drug prescribed by medical \n\n\n\nofficer and consultant. \n\n\n\n\n\n\n\nDrug \n\n\n\nClassification \n\n\n\nDrugs Consultant Medical \n\n\n\nofficer  \n\n\n\nProton pump \n\n\n\ninhibitor  \n\n\n\n(82%, N=159) \n\n\n\nDexlansoprazole 60 mg  28 0 \n\n\n\nEsomeprazole 40mg 27 2 \n\n\n\nOmeprazole 20mg 21 6 \n\n\n\nPantoprazole 20mg 18 11 \n\n\n\nPantoprazole 40mg 9 4 \n\n\n\nRabeprazole 20mg  31 2 \n\n\n\nAntacid (18%, \n\n\n\nN=35) \n\n\n\nActal Tablet  5 0 \n\n\n\nMaalox Suspension  17 6 \n\n\n\nZellox Suspension  6 1 \n\n\n\n\n\n\n\n \nFigure I. Percentage of sample administering combination of anti-\n\n\n\npeptic ulcer drugs \n\n\n\n \n\n\n\n\nCheow Chin Hou\n\n\n\n\n\n\n\n\n\n\nSundram, P.R. et al. Mal J Pharm 7 (1) 2021, 34-42 \n\n\n\n\n\n\n\n38 \n\n\n\n\n\n\n\ngynaecology.There are two different categories of physicians \n\n\n\ncommonly prescribe APUDs in the particular hospital which \n\n\n\nlocal and internationally educated physicians. Education \n\n\n\nbackground of a physician, indirectly related to the type of \n\n\n\nAPUDs prescribed by the physician. Consultants from local \n\n\n\nand oversea education background for specialist training prefer \n\n\n\ndifferent types APUDs for their patients. The most of APUDs \n\n\n\nprescribed by consultants form local universities are \n\n\n\nesomeprazole 40mg, 10.3% (n=20) whereas consultants from \n\n\n\noversea universities prefer rabeprazole 20mg, 11.9% (n=23). In \n\n\n\nthis hospital, all of the medical officers are from local \n\n\n\nuniversities and the highest number of APUDs prescribed by \n\n\n\nmedical officers from local universities are pantoprazole 20mg, \n\n\n\n5.7% (n=11). \n\n\n\n\n\n\n\nDemographic variables and types of anti-peptic ulcer drugs \n\n\n\nprescribed \n\n\n\n\n\n\n\nThe frequency of anti-peptic ulcer drugs prescribed varies \n\n\n\naccording to the age categories of patients. Table III show the \n\n\n\ndiverse number of APUDs prescribed to the different age \n\n\n\ncategories of patients. The most commonly APUD prescribed \n\n\n\nfor patients below 20 years is Pantoprazole 20mg, 1.5% (n=3) \n\n\n\nand two types of APUDs are among 20 to 29 years old patients, \n\n\n\npantoprazole 20mg and Omeprazole 20mg, 1.03% (n=2). Next, \n\n\n\nOmeprazole 20mg is the maximum usage of drug among 30 to \n\n\n\n39 years old, 3.09% (n=6) whereas among 40 to 49 years old \n\n\n\npatients is esomeprazole 40mg, 6.2% (n=12). The highest \n\n\n\namount of APUD accounted among 50 to 59 years old patients \n\n\n\nis rabeprazole 20mg, 6.7% (n=13) however among the age \n\n\n\ngroup of more than 60 years are two different APUDs, \n\n\n\nomeprazole 20mg and dexlansoprazole 60mg about 3.6% \n\n\n\n(n=7). Furthermore, the highest APUDs users belongs to age \n\n\n\ngroup of 50 to 59 years old.\n\n\n\nDefined Daily Dose (DDD) of Anti-Peptic Ulcer Drugs \n\n\n\n(APUDs) \n\n\n\n\n\n\n\nTable IV shows the results obtained from the calculation of \n\n\n\nDDDs / days supplied per user of APUDs at the selected \n\n\n\nhospital. Based on the DDD calculated, pantoprazole 20mg was \n\n\n\nthe most prescribed drug among proton pump inhibitors (PPI) \n\n\n\nwhereas Actal tablets has the highest usage among the antacids. \n\n\n\nThere are differences in all the anti-peptic ulcer drugs usage \n\n\n\nalthough the difference among APUDs are significantly low. \n\n\n\nAlthough ranitidine from H2 antagonist is available in the drug \n\n\n\nformulary of the hospital, it is never been prescribed during the \n\n\n\nstudy period. Besides, there is a clear comparison among unit \n\n\n\nprice of APUDs and it shows that dexlansoprazole 60mg is the \n\n\n\nhighest cost PPI whereas Maalox 250ml is the highest cost \n\n\n\nantacid available.  \n\n\n\n\n\n\n\nDISCUSSION  \n \n\n\n\nDemographic Characteristics of Patients \n\n\n\n\n\n\n\nIn this retrospective study, a total of 160 prescriptions were \n\n\n\nreviewed as per the inclusion and exclusion criteria. In term of \n\n\n\ngender of the patients receiving the prescriptions, there are \n\n\n\nhigher population of male patients, around 55 % and 45% are \n\n\n\nfemale patients. According to Department of Statistics \n\n\n\nMalaysia, there are 1.12 million of total populations in Negeri \n\n\n\nSembilan and there are slightly more males (555,935) residents \n\n\n\nin the state capital city of Seremban. Cigarette smoking may \n\n\n\nlead to decrease in the circulating growth factor as well as rise \n\n\n\nof free radical production in gastric mucosa and it becomes the \n\n\n\nprominent factor of peptic ulcer disease [13]. Although \n\n\n\nsmoking data was not available in this study, however the \n\n\n\nhigher number of male patients is possibly related to increased \n\n\n\nsmoking habit. \n\n\n\n\n\n\n\n\n\n\n\n  \nFigure II. Distribution of anti-peptic ulcer drug prescriptions of the study in outpatient department \n\n\n\n0 5 10 15 20 25 30\n\n\n\nGeneral Surgery\n\n\n\nGeneral Medicine\n\n\n\nNeurology\n\n\n\nAccident & Emergency\n\n\n\nCardiology\n\n\n\nOrthopaedic\n\n\n\nObstetric & Gynaecology\n\n\n\nNephrology\n\n\n\nENT\n\n\n\nUrology\n\n\n\nFrquency of APUDs prescriptions (%)\n\n\n\n\n\n\n\n\nSundram, P.R. et al. Mal J Pharm 7 (1) 2021, 34-42 \n\n\n\n\n\n\n\n39 \n\n\n\n\n\n\n\nAmong Malay, Chinese and Indian ethnics, there are greater \n\n\n\nnumber of Malay patients in this study and it is due to a vast \n\n\n\ndifference in the distribution of ethnic groups in Negeri \n\n\n\nSembilan: Malay (61.35%), Chinese (23.2%) and Indian \n\n\n\n(15.45%). Ethnicity predisposition differences does not alter \n\n\n\nthe gastric acid secretion among peptic acid patients. The \n\n\n\nfrequency of anti-peptic ulcer drugs usage increases with age \n\n\n\nas depicted in Table 1 whereby the highest number of  APUDs \n\n\n\nprescribed in both male and female was in the 50-59 years age \n\n\n\ngroup. Study has confirmed that age group is not a risk factor \n\n\n\nof peptic ulcer disease, however, stress due to numerous health \n\n\n\ncomplications in this age group is described as the main source \n\n\n\nof peptic ulcers, which are termed as stress induced ulcers [13]. \n\n\n\nEvidence has suggested that Helicobacter pylori infection plays \n\n\n\na major contributory role in peptic ulcer disease and \n\n\n\npreliminary studies have reported that the incidence of \n\n\n\nHelicobacter pylori infection increases with age [14]. \n\n\n\n\n\n\n\nAnti-Peptic Ulcer Drugs Utilization Patterns \n\n\n\n\n\n\n\nAccording to Narayanan, management of peptic ulcer disease \n\n\n\n(PUD) has improved tremendously following the \n\n\n\nadministration of proton pump inhibitors and therapy for \n\n\n\nHelicobacter pylori eradication [15]. This revealed from the \n\n\n\ndecline in the incidence of Helicobacter pylori-associated PUD, \n\n\n\nand the lower percentage of Helicobacter pylori infection, \n\n\n\nparticularly in complicated PUD. Table 2 shows the variety and \n\n\n\nproportion of anti-peptic ulcer drugs found in the study \n\n\n\nprescriptions. Most common class of anti-peptic ulcer drug \n\n\n\nprescribed was PPIs followed by antacids with no usage of H2 \n\n\n\nantagonist. Of all these drugs, rabeprazole 20mg was \n\n\n\nprescribed the most whereas the least prescribed was \n\n\n\npantoprazole 40mg. The maximum usage of antacids in the \n\n\n\nhospital is Zellox suspension 100mL whereas the least usage is \n\n\n\nActal tablet.  Ranitidine was the only H2 blocker that was found \n\n\n\nin the hospital but there is no any usage of ranitidine during the \n\n\n\nstudy period. A recent meta-analysis displayed the effectives of \n\n\n\nPPI therapy by a drop of re-bleeding rate and frequency of \n\n\n\nsurgery in patients with upper gastrointestinal bleeding \n\n\n\nfollowing successful endoscopic therapy, compared to H2RA \n\n\n\ntherapy. [16] Additionally, PPIs were superior to H2RAs for \n\n\n\nprevention of LDA-associated GI erosion or ulcer as according \n\n\n\nto another meta-analysis [16]. \n\n\n\n\n\n\n\nFigure I demonstrates higher population are administering \n\n\n\nsingle group of APUD, primarily PPIs whereas only 40% of \n\n\n\nthem are prescribed combination of APUDs. Irrational use of \n\n\n\nPPIs alone should be avoided because few studies proved that \n\n\n\nthe usage of PPIs alone can cause detrimental to the consumers. \n\n\n\nIn two randomized controlled trials (RCTs), it is evident on the \n\n\n\npresence of dyspepsia in 20% to 44% of healthy volunteers \n\n\n\nafter discontinuation of four to eight weeks of PPI therapy. \n\n\n\nFurthermore, as according to a systemic review, long-term \n\n\n\npractice of PPIs for more than two years is linked with an \n\n\n\nincreased risk of vitamin B12 deficiency due to the alteration \n\n\n\nof intragastric pH levels.  Observational data based systemic \n\n\n\nreviews and meta-analyses shown a connection between \n\n\n\nchronic PPI usage with the risk of fractures in both male and \n\n\n\nTable III. Distribution of anti-peptic ulcer drugs prescriptions according to patients\u2019 age \n\n\n\n\n\n\n\nAnti-peptic ulcer drugs \nPatient\u2019s Age Group (n) \n\n\n\n<20 20-29 30-39 40-49 50-59 60> \n\n\n\nActal Tablet  1  1 1 2  \n\n\n\nDexlansoprazole 60 mg   1 2  10 7 \n\n\n\nEsomeprazole 40mg   5 12 8 4 \n\n\n\nMaalox Suspension    1 1 4 1 \n\n\n\nOmeprazole 20mg  2 6 4 8 7 \n\n\n\nPantoprazole 20mg 3 2 5 8 8 3 \n\n\n\nPantoprazole 40mg 1 1 2 1 4 4 \n\n\n\nRabeprazole 20mg   1 4 9 13 6 \n\n\n\nZellox Suspension 100ml 2 1 4 5 8 3 \n\n\n\n\n\n\n\nTable IV. DDD/day supplied and unit price of each anti-peptic ulcer drugs \n\n\n\n\n\n\n\n\n\n\n\n Type of APUDs \n\n\n\n\n\n\n\nWHO DDD Rates per \n\n\n\nresidents per \n\n\n\nyear \n\n\n\nRates per user \n\n\n\nper day \n\n\n\nIntermediate \n\n\n\nrate \n\n\n\nClinical \n\n\n\nmeasure \n\n\n\nUnit price \n\n\n\n(RM) \n\n\n\nPantoprazole 20mg 2 DDD 0.12 1.26 17.76 0.07 4.60 \n\n\n\nPantoprazole 40mg 1 DDD 0.04 0.82 22.38 0.04 6.00 \n\n\n\nDexlansoprazole 60mg 0.5 DDD 0.03 0.32 18.50 0.02 8.50 \n\n\n\nEsomeprazole 40mg 0.75 DDD 0.08 0.86 30.10 0.03 2.80 \n\n\n\nOmeprazole 20mg 1 DDD 0.09 0.95 28.37 0.03 1.00 \n\n\n\nRabeprazole 20mg 1 DDD 0.11 1.01 30.33 0.03 5.10 \n\n\n\nActal tablets 11.11 DDD 0.12 7.11 5.40 1.32 1.30 \n\n\n\nZellox 100ml 0.38 DDD 0.03 0.37 11.05 0.03 30.00 \n\n\n\nMaalox 250ml 0.13 DDD 0.04 0.15 8.86 0.02 37.50 \n\n\n\nPantoprazole 20mg 2 DDD 0.12 1.26 17.76 0.07 4.60 \n\n\n\n \n\n\n\n\n\n\n\n\nSundram, P.R. et al. Mal J Pharm 7 (1) 2021, 34-42 \n\n\n\n\n\n\n\n40 \n\n\n\n\n\n\n\nfemale patients. Whereas, this connection has not seen with the \n\n\n\nuse of H2 receptor antagonists [17]. Alternatively, a H2 \n\n\n\nantagonist or over-the-counter antacids should be tried before \n\n\n\nprescribing the most potent PPIs because according to table 3, \n\n\n\nhighest number of population administering single group of \n\n\n\nAPUDs are from the age group of 50 to 59 years old and \n\n\n\naccording to a nationwide case-control study from New \n\n\n\nZealand, estimated there were about 20 cases of acute \n\n\n\ninterstitial nephritis per year among every 100 000 current PPI \n\n\n\nusers with more than 60 years old [18]. Thus, as an early \n\n\n\npreventive measure, it is better to prescribe H2 antagonist for \n\n\n\npatients with the age group of more than 50 years old. \n\n\n\n\n\n\n\nFigure II shows that out of the 160 prescriptions of APUDs, \n\n\n\nmost prescriptions were from general surgery department \n\n\n\nfollowed by general medicine department. On the other hand, \n\n\n\nAPUDs were least prescribed in nephrology and \n\n\n\notorhinolaryngology (ENT). This observation was justified in \n\n\n\naccordance to a study done at North India where the surgeon \n\n\n\nmay prescribe acid reducers such as H2 Antagonists and PPIs \n\n\n\nto ease any discomforts after surgery. Likewise, it has been \n\n\n\nproven that a standardised prescribing of APUDs after surgery \n\n\n\nlead to significant reduction in postoperative complications \n\n\n\nsuch as postoperative pain, nausea and vomiting [19]. \n\n\n\nSimilarly, high utilization of these APUDs was also seen in \n\n\n\ngeneral medicine department because the use of PPI according \n\n\n\nto FDA is indicated as in cases of evident GI diseases comprise \n\n\n\nof treatment of symptomatic gastroesophageal reflux disease \n\n\n\n(GERD), maintenance treatment of erosive esophagitis, \n\n\n\neradication of Helicobacter pylori infection, healing and \n\n\n\nmaintenance of gastric ulcers, prevention and treatment of \n\n\n\nNSAID-induced gastric ulcers and treatment of hypersecretory \n\n\n\ncondition as Zollinger-Ellison syndrome [20]. \n\n\n\n\n\n\n\nThis study also indicated that rabeprazole 20mg is the most \n\n\n\nprescribed PPI in the hospital and followed by esomeprazole \n\n\n\n40mg because rabeprazole and esomeprazole increase cure \n\n\n\nrates compared to pantoprazole, omeprazole and lansoprazole, \n\n\n\nthe first generation PPIs. This advantage of new-generation \n\n\n\nPPIs has been reported earlier in reviews and retrospective \n\n\n\nstudies and these new PPIs has been reported to affect \n\n\n\neradication rates due to the higher acid inhibition power. \n\n\n\nMeanwhile, the clinical advantage may be restricted from a \n\n\n\ncost-effective perspective due to higher prices of rabeprazole \n\n\n\nand esomeprazole when compared with omeprazole [21]. In \n\n\n\ncontrast, pantoprazole 40mg has the minimum usage amongst \n\n\n\nall the PPI. The results of a comparative study on esomeprazole \n\n\n\n40mg versus pantoprazole 40mg illustrates a therapeutic \n\n\n\nadvantage of esomeprazole 40 mg over pantoprazole 40 mg by \n\n\n\nproviding healing of erosive esophagitis (EE). This result \n\n\n\npredicted as the healing of EE is inversely related to gastric \n\n\n\nacidity, and esomeprazole has been shown to deliver a greater \n\n\n\nsuppression of gastric acidity than standard doses of all other \n\n\n\nPPIs [22]. \n\n\n\nMcNicholl, states that five studies compared the eradication \n\n\n\nrates of rabeprazole versus esomeprazole [21]. The comparison \n\n\n\nwas not heterogeneous and found no statistically significant \n\n\n\ndifferences. Rabeprazole has the eradication rates about 76.7% \n\n\n\nwhile esomeprazole shows 78.7%. According to a meta-\n\n\n\nanalysis, CYP2C19 phenotype is not affected by the \n\n\n\neradication rates of esomeprazole and rabeprazole, while first-\n\n\n\ngeneration PPIs demonstrates a clearer tendency towards lower \n\n\n\neradication rates in patients. Meanwhile, majority APUDs \n\n\n\nprescribed by medical officers from local universities are \n\n\n\nPantoprazole 20mg because it was approved by FDA in 2000 \n\n\n\nfor the treatment of erosive esophagitis associated with GERD \n\n\n\nand PUD plus it is one of the few PPIs existing in multiple \n\n\n\ndosage forms. According to Mathews, pantoprazole has an \n\n\n\nexcellent safety profile, is as effective as other PPIs, and has a \n\n\n\nlow incidence of drug interactions when evaluated over 100 \n\n\n\nclinical trials. Pantoprazole has also been presented as a safe \n\n\n\nand effective among special patient populations, such as the \n\n\n\nelderly and those with renal or moderate liver disease [23]. \n\n\n\n\n\n\n\nDefined Daily Dose (DDD) and unit price of APUDs \n\n\n\n\n\n\n\nIn order to avoid recurrences of both symptoms and mucosal \n\n\n\nlesions, PPI is one of the mandatory maintenance therapy. \n\n\n\nTable IV clearly demonstrates DDD / day supplied for all the \n\n\n\nAPUDs used and the result justified that APUDs over usage did \n\n\n\nnot occur in this hospital. This demonstrates that several \n\n\n\npatients discontinue PPI therapy after redeeming their first \n\n\n\nprescription, whereas only a minority administer PPI \n\n\n\ncontinuously. Based on the DDD calculated, Pantoprazole \n\n\n\n20mg reported highest rates per user per day among proton \n\n\n\npump inhibitors (PPI) about 1.26 DDD / user / day. The \n\n\n\nmaximum usage of this drug can be due to the compulsory \n\n\n\ntriple regimen inclusive of pantoprazole for Helicobacter pylori \n\n\n\neradication. Furthermore, administration of the slow-release \n\n\n\npantoprazole results in the significantly faster onset of action \n\n\n\ntaking place compared to the administration in a form without \n\n\n\nretarding such release [24]. In addition, Actal reported highest \n\n\n\nrates per user per day among the antacids, which is about 7.11 \n\n\n\nDDD / user / day. This can be seen clearly due to the lowest \n\n\n\ncost among all the antacids available in this hospital. Besides, \n\n\n\nthere are 5.4 days supplied per user for this drug which shows \n\n\n\nmuch less duration than the other two different antacids. Thus, \n\n\n\nit is known as cost effective drug which indirectly reduce \n\n\n\nburden for the patients. \n\n\n\n\n\n\n\nAccording to Table IV, dexlansoprazole 60mg is the most \n\n\n\nexpensive drug among all the PPI listed in hospital formulary \n\n\n\nand it has 18.5 days supplied / user, which is the second shortest \n\n\n\nduration of treatment among all the other PPIs. This is because, \n\n\n\ndexlansoprazole is a modified-release drug because the active \n\n\n\ningredients are manufactured in the form of two types of \n\n\n\ngranules, which are released from capsule twice, at dissimilar \n\n\n\npH values. One part of the drug dose, is released in the proximal \n\n\n\n\n\n\n\n\nSundram, P.R. et al. Mal J Pharm 7 (1) 2021, 34-42 \n\n\n\n\n\n\n\n41 \n\n\n\n\n\n\n\nduodenum at more acidic pH, significantly at pH level of 5.5 \n\n\n\nwhile the second part of drug dose are released in the distal \n\n\n\nsmall intestine at the lesser acidic pH, significantly at the pH of \n\n\n\n6.75. This twofold release mechanism enable the drug to attain \n\n\n\ntwo peak serum concentrations of the drug. Therefore, this \n\n\n\nmodified release drug ensures the longer drug retention period \n\n\n\nin the circulation as well as the most dominant inhibitory effect \n\n\n\non the proton pump inhibitors. Besides, numerous clinical trials \n\n\n\nstates that dexlansoprazole has a good safety profile and hardly \n\n\n\nproduces adverse reactions which usually do not require drug \n\n\n\ndiscontinuation because safety profile of dexlansoprazole at \n\n\n\ndoses of 30, 60 and 90 mg plus oral administration has been \n\n\n\nassessed in clinical trials covering a period of 1 year [25]. In \n\n\n\ncontrast, omeprazole 20mg is the lowest cost PPI but the \n\n\n\nduration supplied per user is longer resulting in higher total cost \n\n\n\nof therapy. Thus, dexlansoprazole could potentially the most \n\n\n\ncost-effective PPI although the single capsule is most \n\n\n\nexpensive among all the other PPIs. \n\n\n\n\n\n\n\nCONCLUSION  \n  \n\n\n\nIn conclusion, the obtained result of utilization of all anti-peptic \n\n\n\nulcer drugs in the selected hospital is lower as compared to \n\n\n\nWHO DDD.  However, this might not show an underutilization \n\n\n\nof anti-peptic ulcer drugs but may be due to a lower number of \n\n\n\nsamples collected, which cannot be used to reflect the overall \n\n\n\nutilization.  Next, most common class of anti-peptic ulcer drug \n\n\n\nprescribed in this studies were Proton Pump Inhibitors which \n\n\n\naccounted for 97% followed by Antacids about 32.5% and no \n\n\n\nusage of H2 Antagonist. Based on the DDD calculated, \n\n\n\nPantoprazole 20mg was the most prescribed drug among PPI, \n\n\n\nabout 1.26 DDD / user / day. Actal is the most commonly used \n\n\n\ndrug among the antacids, which is about 7.11 DDD / user / day. \n\n\n\nThe distribution of anti-peptic ulcer drug prescriptions in \n\n\n\noutpatient department was highest used in general surgery \n\n\n\n26.9% and general medicine 23.1% department. \n\n\n\nDexlansoprazole 60mg is the most expensive drug among all \n\n\n\nthe PPI listed in hospital formulary. It has 18.5 days \n\n\n\nsupplied/user, which is the second shortest duration of \n\n\n\ntreatment among all the other PPIs. In contrast, omeprazole \n\n\n\n20mg is the lowest cost PPI but the duration supplied per user \n\n\n\nis longer resulting in higher total cost of therapy. Based on the \n\n\n\nWHO DDD, it was found that Pantoprazole 20mg and Actel \n\n\n\ntablet had highest DDD with 0.12 per 1000 residents per day. \n\n\n\n\n\n\n\nCONFLICT OF INTEREST \n  \n\n\n\nThe authors declare that there is no conflict of interest. \n\n\n\n\n\n\n\nREFERENCE \n \n\n\n\n[1] Sung J, Kuipers E, El\u2010Serag H. Systematic review: the global \n\n\n\nincidence and prevalence of peptic ulcer disease. Alimentary \n\n\n\npharmacology & therapeutics. 2009;29(9):938-46. \n\n\n\n[2] Mary Chok Chiew Fong AIAS. MALAYSIAN STATISTICS ON \n\n\n\nMEDICINES. Malaysia: Pharmaceutical Services Programme \n\n\n\nMinistry of Health Malaysia; 2015. \n\n\n\n[3] Goh KL. Prevalence of and risk factors for Helicobacter pylori \n\n\n\ninfection in a multi\u2010racial dyspeptic Malaysian population undergoing \n\n\n\nendoscopy. Journal of gastroenterology and hepatology. \n\n\n\n1997;12(6):S29-S35. \n\n\n\n[4] Chandran P, Prakasam KA, Jayachandran A, Mary A. 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An update on the use of \n\n\n\npantoprazole as a treatment for gastroesophageal reflux disease. \n\n\n\nClinical and experimental gastroenterology. 2010;3:11. \n\n\n\n[24] GEORGE S, inventorOral pharmaceutical composition with delayed \n\n\n\nrelease of active ingredient for pantoprazole1995. \n\n\n\n[25] Skrzyd\u0142o-Radoma\u0144ska B, Radwan P. Dexlansoprazole\u2013a new-\n\n\n\ngeneration proton pump inhibitor. Przeglad gastroenterologiczny. \n\n\n\n2015;10(4):191. \n\n\n\n \n\n\n\n\n\n"
"\n\nMalaysian Journal of Pharmacy Volume 8 Issue 2 (2022) \n \n\n\n\n\n\n\n\n1 \n\n\n\n\n\n\n\n*Correspondence: sabariahnoor@usm.my \n\n\n\nDOI:10.52494/DJIQ7058 \n\n\n\n1School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 \n\n\n\nUSM, Penang, Malaysia. \n2Respiratory Department, Penang General Hospital, 10990 George Town, \n\n\n\nPenang. \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n Original Research Article \n\n\n\n\n\n\n\nSystematic Review of Population Pharmacokinetic Models of \n\n\n\nIsoniazid in Children and Adults with Tuberculosis   \n \n\n\n\nWen Rui Tan1, Siti Maisharah Sheikh Ghadzi1, Irfhan Ali Hyder Ali 2, Sabariah Noor Harun1* \n\n\n\n\n\n\n\n \nArticle Info  \n\n\n\n \nReceived date: 07 Jun 2022  \n\n\n\nAccepted date: 19 Oct 2022 \n\n\n\nPublished date: 31 Dec 2022 \n\n\n\n\n\n\n\nKeywords: Population \n\n\n\nPharmacokinetics, Isoniazid, \n\n\n\nTuberculosis, Pharmacokinetic. \n\n\n\nABSTRACT  \n\n\n\n\n\n\n\nIntroduction:  Isoniazid (INH) is one of the first-line anti-tuberculosis (anti-TB) drugs that have \n\n\n\nboth bactericidal and bacteriostatic properties depending on the rate of mycobacterial growth. Several \n\n\n\npopulation pharmacokinetic (PPK) models of INH were established. This systemic review aims to \n\n\n\nsummarise published PPK parameters of INH in the models and to identify covariates influencing \n\n\n\nthe INH pharmacokinetic parameters of models. Method: A search of publications for PPK analyses \n\n\n\nof INH in volunteers or TB patients from 2011 to 2021 was conducted in PubMed and Scopus \n\n\n\ndatabases. Reviews, methodology articles, non-compartmental analysis, in vitro, and animal studies \n\n\n\nwere excluded. Result: Twelve studies were included in this review. Most of the included studies \n\n\n\ndescribed the pharmacokinetics of INH as two-compartmental with first-order absorption and \n\n\n\nelimination in most of the included studies. Eleven studies reported N-acetyltransferase 2 (NAT2) \n\n\n\ngenotype polymorphism as the most common significant covariate affecting the pharmacokinetic \n\n\n\nparameters of INH. Other common significant covariates reported include body weight (n = 2) and \n\n\n\nbody mass index (BMI) (n = 1). Conclusion: The variability of population clearance parameters of \n\n\n\nINH was explained mainly by the NAT2 genotype polymorphism. This indicates that to optimise and \n\n\n\nrationalise the dosing regimen of INH, a patient\u2019s NAT2 genotype should be considered. At the same \n\n\n\ntime, body weight and BMI values should be considered when making dosing adjustments for INH \n\n\n\nto achieve the therapeutic range. \n\n\n\n\n\n\n\nINTRODUCTION  \n  \n\n\n\nIsoniazid (INH) is a prodrug that kills the mycobacterial cell via \n\n\n\na passive diffusion mechanism [1]. Isoniazid is activated by the \n\n\n\nmycobacterial catalase-peroxidase enzyme (KatG) [2], a \n\n\n\nmultifunctional catalase-peroxidase that has other activities, \n\n\n\nincluding peroxynitrite and nicotinamide adenine dinucleotide \n\n\n\n(NADH) oxidase [3]. Due to its high effectiveness and \n\n\n\naffordability, INH is one of the two primary, first-line TB drugs, \n\n\n\nalong with rifampicin (RIF).  \n\n\n\n\n\n\n\nMultidrug-resistant TB (MDR-TB) is simultaneous resistance \n\n\n\nto INH and RIF. Despite, proven drug susceptibility at baseline, \n\n\n\nMDR-TB is still not uncommon. Non-compliance to anti-TB \n\n\n\ntherapy is believed to be associated with MDR-TB and \n\n\n\ntreatment failure emergence, which led to the implementation \n\n\n\nof the directly observed therapy-short-course strategy (DOTs), \n\n\n\nor currently, video observed therapy (VOT). The World Health \n\n\n\nOrganization (WHO) has called the DOTs the most essential \n\n\n\nhealth breakthrough of past decades [4,5]. In addition, the \n\n\n\ndevelopment of a fixed-dose combination (FDC) regimen was \n\n\n\nalso reported to enhance drug compliance among patients with \n\n\n\nTB [4]. However, a study by Srivastava et al. [4] reported a \n\n\n\nsurprising finding which showed that acquired MDR-TB was \n\n\n\nrelated to variability in drug exposure and not to non-\n\n\n\ncompliance. Previous studies have shown that low plasma anti-\n\n\n\nTB drug concentrations may result in treatment failure [6-8] and \n\n\n\nlow plasma concentrations of RIF and INH have been \n\n\n\nassociated with MDR-TB [8]. High variability in \n\n\n\npharmacokinetic (PK) parameters of the first-line anti-TB drugs \n\n\n\nhave been reported with factors such as age, sex, human \n\n\n\nimmunodeficiency virus (HIV) co-infection, and antiretroviral \n\n\n\ntreatment (ART) possibly affecting TB drug concentrations [9]. \n\n\n\nReduced blood concentrations of anti-TBs were demonstrated \n\n\n\n\nmailto:sabariahnoor@usm.my\n\n\n\n\n\n\nTan W. R. et al.                            Mal J Pharm 8 (2) 2022, 1-15 \n\n\n\n\n\n\n\n\n\n\n\n2 \n\n\n\n\n\n\n\nin HIV-infected men or HIV-infected patients who are \n\n\n\nunderweight [9]. Other factors such as diabetes and drug-drug \n\n\n\ninteraction have been shown to affect the PK parameters of first-\n\n\n\nline anti-TB agents [10]. Malnutrition is also reported to affect \n\n\n\ndrug exposure by decreasing total clearance and increasing the \n\n\n\nplasma half-life of anti-TBs [11]. Thus, therapeutic drug \n\n\n\nmonitoring of INH is clinically relevant due to the high \n\n\n\nvariability of INH concentrations [12] and incorporating the \n\n\n\nsignificant covariates influencing the PK of INH to achieve an \n\n\n\noptimal INH concentration is paramount. \n\n\n\n\n\n\n\nConventional clinical practice guidelines recommend dosing \n\n\n\nanti-TB drugs according to ideal body weight and providing \n\n\n\ndosing caps for most first-line agents [13]. However, this \n\n\n\nrecommendation may be placing obese patients with TB at risk \n\n\n\nas increased total body weight is associated with an increased \n\n\n\nrisk of clinical failure [12].  \n\n\n\n\n\n\n\nPopulation pharmacokinetic (PPK) modelling is broadly used to \n\n\n\ndistinguish the pharmacokinetic parameters of a population and \n\n\n\ninvestigate the covariates that contribute to pharmacokinetic \n\n\n\nvariability [14]. Nonlinear mixed-effects modelling is viewed \n\n\n\nby many as the optimum population modelling method \n\n\n\ncurrently. The \u201ceffects\u201d are factors that contribute to the \n\n\n\nvariability of the measured observations and are of two types: \n\n\n\nfixed and random. Fixed effects are the parameters that define \n\n\n\nthe structural PK model while the random effects are described \n\n\n\nas random interpatient variability (covariates) and residual \n\n\n\nrandom error [15].  \n\n\n\n\n\n\n\nExtensive reviews elucidating the PK characteristics of INH \n\n\n\nhave been reported elsewhere [16, 17]. However, a systematic \n\n\n\nreview of the PPK models of INH is still lacking. Analysing and \n\n\n\nunderstanding the significant covariates and their relationship in \n\n\n\ndifferent patient populations is critical for appropriate regimens \n\n\n\nfor individualised therapy. This review aims to compare \n\n\n\npublished population pharmacokinetic (PPK) models of INH \n\n\n\nand to summarise and explore identified covariates influencing \n\n\n\nthe INH PK models.  \n\n\n\n\n\n\n\nMETHOD  \n \n\n\n\nSearch Strategy  \n\n\n\n\n\n\n\nData for this review were identified by a systematic review of \n\n\n\npublications listed in PubMed databases from inception to \n\n\n\nSeptember 2021 following the principles of the Preferred \n\n\n\nReporting Items for Systematic Reviews and Meta-analyses \n\n\n\n(PRISMA) statement [22]. The search terms used include the \n\n\n\nfollowing: \u201cisoniazid\u201d AND (\u201cpopulation pharmacokinetics\u201d \n\n\n\nOR \u201cpharmacometrics\u201d OR \u201cpharmacokinetic model\u201d OR \n\n\n\n\u201cPopPK\u201d OR \u201cpop PK\u201d OR \u201cPPK\u201d OR \u201cnonlinear mixed \n\n\n\neffects model\u201d OR \u201cNONMEM\u201d OR \u201cMONOLIX\u201d OR \n\n\n\n\u201cPmetrics\u201d OR \u201cNLME\u201d). Additional publications were \n\n\n\nidentified by reviewing study reference lists and consulting \n\n\n\nexpert review articles identified through the search. \n\n\n\n\n\n\n\nInclusion/Exclusion Criteria \n\n\n\n\n\n\n\nAll relevant articles selected from the databases and reference \n\n\n\nlists were screened to evaluate their eligibility for inclusion \n\n\n\naccording to specific criteria. The inclusion of studies was based \n\n\n\non original studies describing PPK models for INH in healthy \n\n\n\nvolunteers or patients from infants to adults and the target \n\n\n\npopulation was human. Extrapulmonary TB like tuberculous \n\n\n\nmeningitis is also included in the study, but only the recorded \n\n\n\nplasma concentrations of INH were included in this review and \n\n\n\nnot the concentrations at the other site. Reviews, methodology \n\n\n\narticles, in vitro and animal studies, and studies that used a \n\n\n\npreviously described PK model and those that involved \n\n\n\nnoncompartmental analysis were excluded. PPK analysis was \n\n\n\nperformed in the study, and only the study published in English \n\n\n\nwas selected.  \n\n\n\n\n\n\n\nData Extraction \n\n\n\n\n\n\n\nThe variables that were retrieved from the identified studies \n\n\n\ninclude first author, publication year, country, number of \n\n\n\nsubjects, subject characteristics (age, sex, weight, and \n\n\n\npathology), INH dose, INH, and AcINH levels, sampling \n\n\n\nschedule, and assay method, number of observations, \n\n\n\nobservations per patient, data source, software used for \n\n\n\nmodelling, structural and statistical model, tested and \n\n\n\nstatistically significant covariates, and model validation which \n\n\n\nwas further classified based on the increasing order of quality \n\n\n\ninto three types: basic internal, advanced internal, and external \n\n\n\nmodel validation.  \n\n\n\n\n\n\n\nRESULT  \n \n\n\n\nStudy Identification  \n\n\n\n\n\n\n\nThe initial search strategy identified 107 potentially relevant \n\n\n\narticles, of which 106 remained after duplicates, and review-\n\n\n\ntype articles were removed. After abstract and title scanning \n\n\n\nfor 106 articles, 14 articles were retained for final evaluation. \n\n\n\nA total of 12 studies published between 2013 and 2021 were \n\n\n\nincluded in this review in the final decision, as demonstrated \n\n\n\nin Figure I. Study characteristics of the included publications, \n\n\n\nsamples, and concentrations are summarised in Table I. The \n\n\n\nnumber of study participants varied from 33 to 466, totalling \n\n\n\n1,444 patients in all 12 publications with reported ages ranging \n\n\n\nfrom 0 to 72 years. Only four of the studies included subjects \n\n\n\naged less than 18 years old. Seven studies present data on adult \n\n\n\npatients with pulmonary TB and one study was conducted on \n\n\n\nadult volunteers. \n\n\n\n\n\n\n\n\nTan W. R. et al.                            Mal J Pharm 8 (2) 2022, 1-15 \n\n\n\n\n\n\n\n\n\n\n\n3 \n\n\n\n\n\n\n\nThe assay used to measure INH concentrations \n\n\n\n\n\n\n\nLiquid chromatography with tandem mass spectrometry (LC-\n\n\n\nMS/MS) or high-performance liquid chromatography (HPLC) \n\n\n\nwas used to determine the serum levels of INH and AcINH in \n\n\n\nall studies except one study [18] where spectrocolorimetric was \n\n\n\nused instead. The number of concentration readings ranged \n\n\n\nfrom 195 to 2546. The daily dose was reported in 11 studies. 4 \n\n\n\nstudies were reported in mg/kg, 7 studies reported the dosing in \n\n\n\nmg, and one reported in mg/dose. \n\n\n\nStudy Design \n\n\n\n\n\n\n\nMost PPK studies were performed on patients with pulmonary \n\n\n\nTB, and only one study by Seng et al. [19] engaged healthy \n\n\n\nadults. Four studies included infants and children or paediatrics \n\n\n\n[20-23], and eight studies only enrolled adults [18,19,24-29]. \n\n\n\nSubjects in all included studies were administered INH orally; \n\n\n\n1-12 samples were collected per individual. The sampling time \n\n\n\npoints ranged from 0 (pre-dose) to 24 h post-dosing. The \n\n\n\ndetailed characteristics of all studies are listed in Table I. \n\n\n\n\n\n\n\nModelling Approach \n\n\n\n\n\n\n\nAll twelve PPK analyses were conducted using population \n\n\n\nmodelling software, including NONMEM (Icon plc, Dublin, \n\n\n\nIreland), Phoenix NLME, Monolix (Lixoft, Antony, France), \n\n\n\nand Pmetrics. The most used algorithm was first-order \n\n\n\nconditional estimation with interaction. \n\n\n\n\n\n\n\nStructural Model \n\n\n\n\n\n\n\nThe final PK parameter estimates in each study are summarised \n\n\n\nin Table II. A study by Fredj et al. [18] and Aruldhas et al. [23] \n\n\n\ndescribed the INH structural model as a one-compartment \n\n\n\nmodel disposition model with first-order absorption and transit \n\n\n\ntime (MTT) absorption model, respectively. Of the twelve \n\n\n\nstudies, ten studies described PPK of INH as a two-\n\n\n\ncompartment model, with five studies [19,20,25,28] describing \n\n\n\nfirst-order absorption and elimination. Three studies described \n\n\n\nthe absorption model with MTT [21,22,29]. While the study by \n\n\n\nRao et al. [24] and Naidoo et al. [26] described the absorption \n\n\n\nmodel with a lag time (Table II).  \n\n\n\n\n\n\n\nThe reported mean clearance (CL) from all the studies was \n\n\n\n20.55 L/h (SD = 16.60), and the range of the CL was between \n\n\n\n5.19 to 28.77 L/h. The reported mean central volume of \n\n\n\ndistribution (Vcentral) was 26.63 L (SD = 23.53), with a range \n\n\n\nfrom 1.5 to 73.4 L. The reported mean MTT was 0.66 h (SD = \n\n\n\n0.34), with a range from 0.179 to 0.924 h (Table II). \n\n\n\n\n\n\n\nChildren vs Adults \n\n\n\n\n\n\n\nThere were four PPK studies conducted on children, and the \n\n\n\nother eight articles were conducted on adults. Three studies \n\n\n\ninvolved HIV children [22,24,29]. The estimated median CL for \n\n\n\nchildren was 6.5 (range = 4.44-11.3) L/h and was lower than CL \n\n\n\nin adults at 22.8 L/h (range = 11.4-40.5 L/h). Moreover, the \n\n\n\nmedian Vcentral in children was lower than that in adults. The \n\n\n\ndetermined median Vd was 16.69 (range = 3.78-29.7) L/kg for \n\n\n\nchildren and 29.7 (range = 1.5-73.4) L/kg for adults.  \n\n\n\n\n\n\n\nCovariates model \n\n\n\n\n\n\n\nThe covariates investigated and identified in each study are \n\n\n\nshown in Figure III. Twenty-nine covariates have been \n\n\n\ninvestigated in the twelve studies, and five significant covariates \n\n\n\nhave been identified using a stepwise covariate modelling \n\n\n\napproach. There were three covariates reported significantly \n\n\n\naffecting the CL of INH in the included studies, which include \n\n\n\nNAT2 polymorphism (n = 11), creatinine clearance (n = 1), and \n\n\n\nbody mass index (BMI) (n = 1). Creatinine clearance in the \n\n\n\nstudy, where it was the significant covariate was estimated by \n\n\n\nusing the Cockcroft and Gault equation with total body weight \n\n\n\n[19]. While middle-upper arm circumference (MUAC) (n = 1), \n\n\n\nbody weight (n = 2) and body mass index (BMI) (n = 1) \n\n\n\nsignificantly explained the variability in Vcentral.  Figure IV \n\n\n\nshows a comparison of mean CL as an effect of NAT2 \n\n\n\npolymorphism between studies.\n\n\n\nFigure I: The selection process of the studies included in the systematic \n\n\n\nreview \n\n\n\n\n\n\n\n\nTan W. R. et al.                                                   Mal J Pharm 8 (2) 2022 , 1-15 , XX-XX \n\n\n\n\n\n\n\n4 \n\n\n\n\n\n\n\nTable I: Studies population characteristics, samples, and concentrations \n\n\n\n\n\n\n\nStudy \nN  \n\n\n\n(male/female) \nSample/subject \n\n\n\nTotal \n\n\n\nsample \nAge \n\n\n\nBody \n\n\n\nweight \n\n\n\n(kg) \n\n\n\nSite \nSubject \n\n\n\ncharacteristics \nDose \n\n\n\nSampling \n\n\n\ntime (h) \n\n\n\nIsoniazid \n\n\n\nconcentration \n\n\n\nAcetyl isoniazid \n\n\n\nconcentration \n\n\n\nHorita et al.,  \n\n\n\n2018 [20] \n\n\n\n113  \n\n\n\n(63/59) \n5 565 \n\n\n\n5  \n\n\n\n(2.17-\n\n\n\n8.25) \n\n\n\n14.3 \n\n\n\n(9.7-\n\n\n\n20.1) \n\n\n\nUS \nTuberculosis, \n\n\n\nChildren \n\n\n\n10.99 mg/kg  \n\n\n\n(9.06-12.8) \n0, 1, 2, 4, 8 \n\n\n\nCmax =  \n\n\n\n5.70 \u00b5g/mL \nNA \n\n\n\n\n\n\n\nRao et al.,  \n\n\n\n2021 [24] \n\n\n\n81  \n\n\n\n(52/29) \n4 324 \n\n\n\n36  \n\n\n\n(30-3.5) \n\n\n\n52.5 \n\n\n\n(45.3-\n\n\n\n58) \n\n\n\nUS \nTuberculosis \n\n\n\nwith HIV \n\n\n\n300, 450, 600, 750, \n\n\n\n900 mg \n1, 2, 4, 6 \n\n\n\nCmax =  \n\n\n\n3.6 (2.3-4.6) \n\n\n\nmg/kg \n\n\n\nNA \n\n\n\n\n\n\n\nJing et al.,  \n\n\n\n2020 [25] \n\n\n\n89  \n\n\n\n(59/30) \n1-4 195 \n\n\n\n42.9  \n\n\n\n(16-72) \n\n\n\n60.1 \n\n\n\n(35-100) \nC Tuberculosis \n\n\n\n300 mg/dose  \n\n\n\n(300-600) \nWithin 0.5-6 \n\n\n\nCmax = \n\n\n\n3-6 \u00b5g/mL \nNA \n\n\n\n\n\n\n\nNaidoo et al.,  \n\n\n\n2019 [26] \n\n\n\n172 \n\n\n\n(119/53) \n4 573 \n\n\n\n35  \n\n\n\n(30-41) \n\n\n\n55.7 \n\n\n\n(50.3-\n\n\n\n62.1) \n\n\n\nA Tuberculosis \n\n\n\n225 mg  \n\n\n\n(below 55 kg),  \n\n\n\n300 mg  \n\n\n\n(above 55 kg) \n\n\n\n2.5, 5, 6, 24 \n\n\n\nCmax =  \n\n\n\n4.70 (3.93-5.98) \n\n\n\nmg/L \n\n\n\nNA \n\n\n\n\n\n\n\nZvada et al.,  \n\n\n\n2013 [21] \n\n\n\n76  \n\n\n\n(40/36) \n\n\n\nCohort 1:  \n\n\n\n0.75, 1.5, 3, 4, 6 \n\n\n\nCohort 2:  \n\n\n\n0.5, 1.5, 3,5 \n\n\n\n715 \n\n\n\n2.17  \n\n\n\n(0.417, \n\n\n\n10.7) \n\n\n\n10.5 \n\n\n\n(4.9, \n\n\n\n21.8) \n\n\n\nA Tuberculosis \n\n\n\n1st PK (mg/kg): \n\n\n\n5.03 (3.56, 12.1) \n\n\n\n2nd PK (mg/kg): \n\n\n\n9.77 (2.73, 13.3) \n\n\n\nCohort 1: \n\n\n\n0.75, 1.5, 3, 4, 6 \n\n\n\nCohort 2: \n\n\n\n0.5, 1.5, 3, 5 \n\n\n\nNA NA \n\n\n\n\n\n\n\nPanjasatwong et al.,  \n\n\n\n2021 [22] \n\n\n\n100  \n\n\n\n(56/44) \n2 523 \n\n\n\n3.0  \n\n\n\n(0.167-\n\n\n\n15) \n\n\n\n10.9 \n\n\n\n(4-4.3) \nV \n\n\n\nTuberculous \n\n\n\nmeningitis \n10 mg/kg \n\n\n\n2 of 10 possible time \n\n\n\npoints (i.e., 1, 2, 3, 4, 5, \n\n\n\n6, 8, 12, 18, or 24 h \n\n\n\nafter dose) \n\n\n\nCmax =  \n\n\n\n2.41 mg/L \nNA \n\n\n\n\n\n\n\nSeng et al.,  \n\n\n\n2015 [19] \n33 NA NA \n\n\n\n33  \n\n\n\n(22-56) \n\n\n\n62.5 \n\n\n\n(45.8-\n\n\n\n86.1) \n\n\n\nS Healthy Singapore \n\n\n\n0, 1, 2, 4, 6, 8, 10, 12, \n\n\n\n18, and 24 h after the \n\n\n\nfinal dose of INH \n\n\n\n3 mg/L \n\n\n\n< Cmax \n\n\n\n< 6 mg/L \n\n\n\nNA \n\n\n\n\n\n\n\nFredj et al., \n\n\n\n2021 [18] \n\n\n\n118  \n\n\n\n(39/79) \n2 \n\n\n\nINH \n\n\n\n:298 \n\n\n\n36.7  \n\n\n\n(5-77) \n\n\n\n62 \n\n\n\n(8.9-\n\n\n\n104) \n\n\n\nT1 Tuberculosis \n5, 10, 25 and 15 \n\n\n\nmg/kg \n3 h post-dose NA NA \n\n\n\n\n\n\n\nVan Beek et al.,  \n\n\n\n2021 [27] \n466 NA 2546 NA NA \n\n\n\nT2, \n\n\n\nI1, \n\n\n\nTN, \n\n\n\nSA \n\n\n\nTuberculosis NA NA \nCmax =  \n\n\n\n3.03 mg/L \nNA \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nTan W. R. et al.                                                   Mal J Pharm 8 (2) 2022 , 1-15 , XX-XX \n\n\n\n\n\n\n\n5 \n\n\n\n\n\n\n\nTable I: Studies population characteristics, samples, and concentrations (continued) \n\n\n\n\n\n\n\nStudy \nN \n\n\n\n(male/female) \nSample/subject \n\n\n\nTotal \n\n\n\nsample \nAge \n\n\n\nBody \n\n\n\nweight \n\n\n\n(kg) \n\n\n\nSite \nSubject \n\n\n\ncharacteristics \nDose \n\n\n\nSampling \n\n\n\ntime (h) \n\n\n\nIsoniazid \n\n\n\nconcentration \n\n\n\nAcetyl isoniazid \n\n\n\nconcentration \n\n\n\nHuerta-Garc\u00eda et al.,  \n\n\n\n2020 [28] \n\n\n\n55  \n\n\n\n(31/24) \n\n\n\nHospitalised: \n\n\n\n8-12 \n294 \n\n\n\n44.7  \n\n\n\n(18-72) \n\n\n\n56.6  \n\n\n\n(30-108) \nM Tuberculosis \n\n\n\n225 mg  \n\n\n\n(below 55 kg), \n\n\n\nHospitalised: 0, 20 min, \n\n\n\n40 min, 60 min, 1.5, 2, \n\n\n\n2.5, 3, 4, 6, 8 and 12 h \n\n\n\nOutpatient: 2, 4 h \n\n\n\nNA NA \n\n\n\n\n\n\n\nDenti et al.,  \n\n\n\n2015 [29] \n\n\n\n100  \n\n\n\n(58/42) \n3 574 \n\n\n\n35 \n\n\n\n(29-40) \n\n\n\n51.9  \n\n\n\n(48.3-\n\n\n\n57.3) \n\n\n\nT2 Tuberculosis \n\n\n\n225 mg  \n\n\n\n(below 50 kg),  \n\n\n\n300 mg  \n\n\n\n(above 50 kg) \n\n\n\n2, 4, 6 h post-dose \n\n\n\nSlow \n\n\n\nacetylator: 3.53 \n\n\n\nmg/L \n\n\n\nFast acetylator: \n\n\n\n3.03 mg/L \n\n\n\nNA \n\n\n\n\n\n\n\nAruldhas et al.,  \n\n\n\n2019 [23] \n\n\n\n41  \n\n\n\n(29/12) \n8 290 \n\n\n\n7  \n\n\n\n(3.5-13) \n\n\n\n19.5  \n\n\n\n(13.7-\n\n\n\n33.7) \n\n\n\nI2 Tuberculosis \n\n\n\n50 mg (4-7 kg),  \n\n\n\n100 mg (8-11 kg),  \n\n\n\n150 mg (12-15 kg),  \n\n\n\n200 mg (16-24 kg) \n\n\n\n0.5, 1, 1.5, 2, 2.5, 4 and \n\n\n\n6 h post-dose \n\n\n\nCmax =  \n\n\n\n5.90 mg/L \nNA \n\n\n\n\n\n\n\n\n\n\n\nCmax = maximum concentration; NA=Not applicable \n\n\n\nA = Africa; C = China; I1= Indonesia; I2 = India; M = Mexico; SA = South Africa; S = Singapore; T1 = Tunisia; T2 = Tanzania; TN = The Netherlands; US = United State; V = Vietnam \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nTable II: Model structure, pharmacokinetic parameters, and tested and retained covariates \n\n\n\n\n\n\n\nStudy Assay Software/Algorithm Structure \nFinal population pharmacokinetic \n\n\n\nparameters for Isoniazid \nAcetylisoniazid Covariates tested \n\n\n\nRetained \n\n\n\ncovariates in the \n\n\n\nfinal model \n\n\n\nHorita et al., \n\n\n\n2018 [20] \nLC-MS/MS \n\n\n\nMonolixSuite2016R1/\n\n\n\nFOCE-INTER \n\n\n\nTwo-compartment \n\n\n\nmodel with first-order \n\n\n\nabsorption and linear \n\n\n\nelimination \n\n\n\nKa (h\n-1) = 4.23 \n\n\n\nCL/Fslow (L/h) = 4.44 \n\n\n\nCL/Fnonslow (L/h) = 8.08 \n\n\n\nV1/F (L) = 16.6 \n\n\n\nQ/F (L/h) = 8.46 \n\n\n\nV2/F (L) = 1.07 \n\n\n\nNA \n\n\n\nNAT2 genotype polymorphism, \n\n\n\nage, weight, serum creatinine, sex, \n\n\n\nHIV infection \n\n\n\nNAT2 genotype \n\n\n\npolymorphism \n\n\n\n\n\n\n\nRao et al., \n\n\n\n2021 [24] \nLC-MS/MS \n\n\n\nPhoenix \n\n\n\nNLME/FOCE-\n\n\n\nextended lease squares \n\n\n\nTwo-compartment \n\n\n\nmodel with a lag time \n\n\n\nKa (h\n-1) = 0.9 \n\n\n\nV1 (L) = 2.9 \n\n\n\nV2 (L) = 32.5 \n\n\n\nCL = (L/ h) = 9.2 \n\n\n\nCL2 (L/h) = 9.6 \n\n\n\nTlag = 0.4 \n\n\n\nNA \n\n\n\n\n\n\n\nAge, sex, body weight, mid-upper \n\n\n\narm circumference (MUAC), TB \n\n\n\ndiagnostic group (confirmed and \n\n\n\nunconfirmed), NAT2 genotype. \n\n\n\n\n\n\n\nMid-upper arm \n\n\n\ncircumference \n\n\n\n(MUAC) \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nTan W. R. et al.                                                   Mal J Pharm 8 (2) 2022 , 1-15 , XX-XX \n\n\n\n\n\n\n\n6 \n\n\n\n\n\n\n\nTable II: Model structure, pharmacokinetic parameters, and tested and retained covariates (continued) \n\n\n\nStudy Assay Software/Algorithm Structure \nFinal population pharmacokinetic \n\n\n\nparameters for Isoniazid \nAcetylisoniazid Covariates tested \n\n\n\nRetained \n\n\n\ncovariates in the \n\n\n\nfinal model \n\n\n\nJing et al., \n\n\n\n2020 [25] \nLC-MS/MS \n\n\n\nNONMEM \n\n\n\nv7.2/FOCE \n\n\n\nA two-compartment \n\n\n\nmodel with first-order \n\n\n\nabsorption and \n\n\n\nelimination \n\n\n\nCL/F (L/h) = 31.4 \n\n\n\nV1/F (L) = 21.1 \n\n\n\nV2/F (L) = 27.7 \n\n\n\nQ/F (L/h) = 43.7 \n\n\n\nKa (h\n-1) = 1.7 \n\n\n\nFcw = 0.930 \n\n\n\nFNAT2 \n\n\n\nFast = 1.36 \n\n\n\nSlow = 0.378 \n\n\n\nNA \nNAT2 genotype polymorphism and \n\n\n\nbody weight \n\n\n\nNAT2 genotype \n\n\n\npolymorphism and \n\n\n\nbody weight \n\n\n\n\n\n\n\nNaidoo et al., \n\n\n\n2019 [26] \nLC-MS/MS \n\n\n\nNONMEM \n\n\n\nv7.3/FOCE-I \n\n\n\nTwo-compartment \n\n\n\ndisposition with first-\n\n\n\norder elimination and \n\n\n\nfirst-order absorption \n\n\n\nCL (L/h) \n\n\n\nFast = 40.5 \n\n\n\nIntermediate = 28.4 \n\n\n\nSlow = 17.4 \n\n\n\nVcentral (L) = 73.4 \n\n\n\nIntercompartment clearance, Q = 1.1 \n\n\n\nVperipheral = 19.8 \n\n\n\nBioavailability = 1 (Fixed) \n\n\n\nTlag = 0.13 \n\n\n\nKa (h\n-1) = 3.9 \n\n\n\nScaling factor for variability in \n\n\n\nbioavailability for unobserved doses (-\n\n\n\nfold) = 3.9 \n\n\n\n\n\n\n\nNA \n\n\n\nAntiretroviral therapy, treatment \n\n\n\nphase, NAT2 genotype \n\n\n\npolymorphism, serum creatinine \n\n\n\nNAT2 genotype \n\n\n\npolymorphism \n\n\n\nZvada et al., \n\n\n\n2013 [21] \nLC-MS/MS \n\n\n\nNONMEM v7/FOCE-\n\n\n\nINTER \n\n\n\nTwo-compartment \n\n\n\ndistribution model \n\n\n\nwith absorption transit \n\n\n\ncompartments and \n\n\n\nfirst-order elimination \n\n\n\nCL (L/h) for \n\n\n\nSlow = 4.44 \n\n\n\nIntermediate = 8.49 \n\n\n\nFast = 11.3 \n\n\n\nKa (h\n-1) = 2.47 \n\n\n\nMTT (absorption mean transit time) (h) \n\n\n\n= 0.179 \n\n\n\nNumber of Transit compartment = 4 \n\n\n\n(Fixed) \n\n\n\nVcentral (L) = 11.0 \n\n\n\nQ (L/h) = 2.00 \n\n\n\nVperipheral = 5.03 \n\n\n\nF = 1 (Fixed) \n\n\n\nNA \n\n\n\nSex, NAT2 genotype \n\n\n\npolymorphism, HIV infection, age, \n\n\n\nbody weight, concurrent \n\n\n\nmeningitis prior TB \n\n\n\nNAT2 genotype \n\n\n\npolymorphism \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nTan W. R. et al.                                                   Mal J Pharm 8 (2) 2022 , 1-15 , XX-XX \n\n\n\n\n\n\n\n7 \n\n\n\n\n\n\n\nTable II: Model structure, pharmacokinetic parameters, and tested and retained covariates (continued) \n\n\n\nStudy Assay Software/Algorithm Structure \nFinal population pharmacokinetic \n\n\n\nparameters for Isoniazid \nAcetylisoniazid Covariates tested \n\n\n\nRetained \n\n\n\ncovariates in the \n\n\n\nfinal model \n\n\n\nPanjasatwong et al.,  \n\n\n\n2021 [22] \nLC-MS/MS \n\n\n\nNONMEM \n\n\n\nv7.3/FOCE-I \n\n\n\nTwo-compartment \n\n\n\ntransit model with \n\n\n\nfirst-order absorption \n\n\n\nand linear elimination \n\n\n\nF = 1 (Fixed) \n\n\n\nCL/F (L/h) = 9.43 \n\n\n\nVcentral / F (L) = 3.78 \n\n\n\nMTT (h) = 0.878 \n\n\n\nMAT50 (month) = 12.7 \n\n\n\nHill = 4.7 \n\n\n\nQ/F (L/h) = 28.0 \n\n\n\nVperipheral  = 15.3 \n\n\n\nQCSF /  (L/h) = 13.7 \n\n\n\nNA \n\n\n\nBody weight, age, sex, disease \n\n\n\nseverity, HIV infection, renal and \n\n\n\nliver function tests, nutritional \n\n\n\nstatus, predicted NAT2 phenotypes, \n\n\n\ncentral nervous system (CNS) \n\n\n\ninflammation markers (CSF protein, \n\n\n\nCSF lactate, CSF glucose, and \n\n\n\nCSF/blood glucose ratio) \n\n\n\nCSF \n\n\n\ncompartment, \n\n\n\nbody weight, \n\n\n\nNAT2 genotype \n\n\n\npolymorphism \n\n\n\n(Age-based \n\n\n\nenzyme \n\n\n\nmaturation) \n\n\n\n\n\n\n\n\n\n\n\nSeng et al.,  \n\n\n\n2015 [19] \n\n\n\nLC-MS/MS \nNONMEM \n\n\n\nv7.3/FOCE-INTER \n\n\n\nINH: \n\n\n\nTwo-compartment \n\n\n\nmodel with first-\n\n\n\norder absorption \n\n\n\nAcINH: \n\n\n\nTwo-compartment \n\n\n\nmodel with first-\n\n\n\norder absorption \n\n\n\nINH: \n\n\n\nKa (h\n-1) = 0.6 \n\n\n\nCL/F (L/h) = 65.2 \n\n\n\nVcentral/F (L) = 18 \n\n\n\nQ/F (L/h) = 2.8 \n\n\n\nVPeripheral/F (L) = 15.9 \n\n\n\nFINH = 1 \n\n\n\nAcINH: \n\n\n\nFAcINH = 0.973 \n\n\n\nCL (L/h) = 21.3 \n\n\n\nVcentral/F (L) = 17 \n\n\n\nQ (L/h) = 69.2 \n\n\n\nVPeripheral/F (L) = 80.4 \n\n\n\nFAcINH = 0.965 \n\n\n\nCLA (L/h) = 21.3 \n\n\n\nVcentral/F (L) = 17 \n\n\n\nQA (L/h) = 71.5 \n\n\n\nVperipheral (L) = 81.2 \n\n\n\n\n\n\n\nAge, body weight, height, body \n\n\n\nsurface area (BSA), body mass \n\n\n\nindex (BMI), creatinine clearance, \n\n\n\nbilirubin, alkaline phosphatase \n\n\n\n(ALP), alanine aminotransferase \n\n\n\n(ALT), aspartate aminotransferase \n\n\n\n(AST), gender, race, NAT2 \n\n\n\ngenotype polymorphism \n\n\n\nNAT2 genotype \n\n\n\npolymorphism, \n\n\n\ncreatinine \n\n\n\nclearance \n\n\n\n(AcINH) \n\n\n\nFredj et al., \n\n\n\n2021 [18] \n\n\n\nSpectrocolo\n\n\n\nrimetric \n\n\n\nPmetrics for \n\n\n\nR/Nonparametric \n\n\n\nOne-compartment \n\n\n\nmodel \n\n\n\nKe (h\n-1) = 0.48 \n\n\n\nV (L) = 23.3 \n\n\n\n\n\n\n\nNA \n\n\n\nPolymorphism in NAT2 genotype \n\n\n\npolymorphism, age, body weight, \n\n\n\ngender \n\n\n\nNAT2 genotype \n\n\n\npolymorphism \n\n\n\n\n\n\n\nVan Beek et al., \n\n\n\n2021 [27] \n\n\n\nUPLC/LC-\n\n\n\nMS/MS \nNONMEM v7.4 \n\n\n\nINH: \n\n\n\nTwo-compartment \n\n\n\ndisposition model \n\n\n\nAcINH: \n\n\n\nSingle-compartment \n\n\n\nfirst-order \n\n\n\nelimination \n\n\n\n\n\n\n\n\n\n\n\nINH: \n\n\n\nVcentral (L) = 57.5 \n\n\n\nKa (h\n-1) = 5.42 \n\n\n\nCL (L/h) \n\n\n\nSlow = 12.1 \n\n\n\nFast = 32.7 \n\n\n\nVperipheral (L) = 18.7 \n\n\n\nQ (L/h) = 2.48 \n\n\n\nAcINH: \n\n\n\nVcentral (L) = 39.2 \n\n\n\nCL (L/h) = 6.65 \n\n\n\n\n\n\n\nVcentral (L) = 39.2 \n\n\n\nCL (L/h) = 6.65 \nNA \n\n\n\nNAT2 genotype \n\n\n\npolymorphism \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nTan W. R. et al.                                                   Mal J Pharm 8 (2) 2022 , 1-15 , XX-XX \n\n\n\n\n\n\n\n8 \n\n\n\n\n\n\n\n  \nCL = Clearance; Ka = Absorption constant; Tlag = Lag time V = Volume of distribution; Vcentral = Central volume of distribution; Vperipheral = Peripheral volume of distribution; MTT = Mean Transit Time; Q = Intercompartment \n\n\n\nclearance; F = Bioavailability; NAT2 = N-Acetyltransferase 2; MAT = Maturation of Clearance; BMI = Body Mass Index; CSF = Cerebrospinal fluid \n\n\n\n\n\n\n\n\n\n\n\nTable II: Model structure, pharmacokinetic parameters, and tested and retained covariates (continued) \n\n\n\n\n\n\n\nStudy Assay Software/Algorithm Structure \nFinal population pharmacokinetic \n\n\n\nparameters for Isoniazid \nAcetylisoniazid Covariates tested \n\n\n\nRetained \n\n\n\ncovariates in the \n\n\n\nfinal model \n\n\n\nHuerta-Garc\u00eda et al., \n\n\n\n2020 [28] \nHPLC \n\n\n\nNONMEM \n\n\n\nv7.3/FOCE-I \n\n\n\nTwo-compartment open \n\n\n\nmodel with a first-order \n\n\n\nrate constant of \n\n\n\nabsorption and \n\n\n\nelimination \n\n\n\nCL (L/h) \n\n\n\nSlow = 11.4 \n\n\n\nIntermediate = 19.2 \n\n\n\nFast = 27.4 \n\n\n\nVcentral X BMI (L) = 1.5 \n\n\n\nVperipheral (L) = 3.8 \n\n\n\nKa (h\n-1) = 2.0 \n\n\n\n\n\n\n\nNA \n\n\n\nSmoking, alcoholism, concomitant \n\n\n\ndisease, concomitant drugs, NAT2 \n\n\n\ngenotype polymorphism, body mass \n\n\n\nindex (BMI) (Vcentral) \n\n\n\nNAT2 genotype, \n\n\n\nbody mass index \n\n\n\n(BMI) (Vcentral) \n\n\n\nDenti et al.,  \n\n\n\n2015 [29] \nLC-MS/MS \n\n\n\nNONMEM \n\n\n\nv7.3/FOCE-I \n\n\n\nTwo-compartment \n\n\n\ndisposition with transit \n\n\n\ncompartment absorption \n\n\n\nCL (L/h) \n\n\n\nRapid/Intermediate = 26.1 \n\n\n\nSlow = 15.5 \n\n\n\nVcentral (L) = 48.2 \n\n\n\nQ (L/h) = 16.1 \n\n\n\nVperipheral (L) = 16.5 \n\n\n\nMTT = 0.924 \n\n\n\nNumber of transit compartment = 2.73 \n\n\n\nF = 1 (Fixed) \n\n\n\nNA \n\n\n\nHIV co-infection, nutritional status, age, \n\n\n\nsex, CD4+ lymphocyte count, daily \n\n\n\nweight-adjusted dose, time on TB \n\n\n\ntreatment, NAT2 genotype \n\n\n\nNAT2 genotype \n\n\n\n\n\n\n\nAruldhas et al.,  \n\n\n\n2019 [23] \nLC-MS/MS \n\n\n\nNONMEM \n\n\n\nv7.3/FOCE-I \n\n\n\nOne-compartment \n\n\n\ndisposition model with a \n\n\n\ntransit absorption model \n\n\n\n(fixed, n = 5) \n\n\n\nCL (L/h) \n\n\n\nFast = 2.59 \n\n\n\nSlow = 7.79 \n\n\n\nVcentral/F (L) = 29.7 \n\n\n\nMTT = 0.547 \n\n\n\nNumber of transit compartment = 5 \n\n\n\n(Fixed) \n\n\n\nF = 1 (Fixed) \n\n\n\n\n\n\n\nNA \n\n\n\nAge, sex, body mass index (BMI), body \n\n\n\nweight, height and albumin level, NAT2 \n\n\n\ngenotype \n\n\n\nNAT2 genotype \n\n\n\n\n\n\n\n\nTan W. R. et al.                            Mal J Pharm 8 (2) 2022, 1-15 \n\n\n\n\n\n\n\n9 \n\n\n\n\n\n\n\n\n\n\n\nModel Evaluation \n\n\n\n\n\n\n\nModel evaluation was performed in all twelve studies through \n\n\n\nbasic internal approaches, advanced approaches, and external \n\n\n\nevaluation. All the studies used basic internal evaluation such \n\n\n\nas basic goodness-of-fit (GOF) and visual predictive check \n\n\n\n(VPC) and two [18,28] studies used external validation in \n\n\n\nmodel evaluation using an independent dataset, two of which \n\n\n\nshowed acceptable predictability. Five studies have performed \n\n\n\nadvanced basic internal evaluations like normalised prediction \n\n\n\ndistribution error (NPDE) and bootstrap analysis for model \n\n\n\nevaluation (Table III).  \n\n\n\n\n\n\n\nDISCUSSION  \n \n\n\n\nIn this review, the authors focused on the parametric approach \n\n\n\nto PPK model development. Pharmacokinetics of INH was \n\n\n\nreported to be described as a two-compartment model in ten \n\n\n\nstudies while a one-compartment model was described in two \n\n\n\nstudies. A single study reported the one-compartment INH \n\n\n\nmodel included INH concentration at 3 h after drug intake [18].  \n\n\n\nThis sparse sampling method could be the reason leading to the \n\n\n\nresult obtained being one-compartmental. The sample is only \n\n\n\ntaken at a one-time point and may not have sufficient data to \n\n\n\ndemonstrate a two-compartmental model [18].  \n\n\n\n\n\n\n\nThere is variability in describing the absorption process of \n\n\n\nINH in the included studies. Although the majority of studies \n\n\n\ndescribed the absorption of INH as proportional to the \n\n\n\nconcentration of INH in the gastrointestinal, in certain \n\n\n\npopulations, the absorption of INH was also described to \n\n\n\nrequire at least a 1-hour delay to be fully absorbed (MTT was \n\n\n\n0.66 h (SD = 0.34) with a range from 0.179 to 0.924 h). This  \n\n\n\n\n\n\n\nindicates that not only food, but dosage form of INH also \n\n\n\ndetermines the absorption of INH. During the DOTs or VOT, \n\n\n\npatients need to be emphasised on the factor of food so that \n\n\n\nabsorption could be enhanced. Besides the MTT absorption, \n\n\n\nINH was also described to have at least a 0.13-hour lag time \n\n\n\nto be absorbed in one study. Nevertheless, the lag time model \n\n\n\ndoes not consider the physiological process of absorption, and \n\n\n\nMTT is reported to be more accurate to describe the absorption \n\n\n\nphase [22,30]. \n\n\n\n\n\n\n\nThe NAT2 gene shows large interindividual variability in \n\n\n\nacetylating activities by genetic polymorphisms in humans. \n\n\n\nThe plasma concentrations of INH are highly variable between \n\n\n\nsubjects, mainly because of the variability in the activities of \n\n\n\nthese enzymes. As shown in Figure II, NAT2 genetic \n\n\n\npolymorphism significantly explains the large intra-and inter-\n\n\n\nindividual variation in CL in most of the studies. The \n\n\n\npercentage difference of the NAT2 polymorphism effect \n\n\n\nagainst mean CL (20.55 L/h) is plotted in Figure III. Seng et \n\n\n\nal. [19] have shown the largest difference from mean CL, which \n\n\n\ncould be explained by the Chinese ethnicity. Most of the studies \n\n\n\nbuilt a mixture model to describe the clearance profile of INH.   \n\n\n\n\n\n\n\nNevertheless, a study by Rao et al. performed NAT2 genotypic \n\n\n\nscreening in 34 (65.3%) patients, with 29 being of the slow-\n\n\n\nintermediate type and the remaining rapid metabolisers [24]. \n\n\n\nThere are no significant differences in Cmax or AUC 0-24 \n\n\n\nvalues between the slow-intermediate type and the few rapid \n\n\n\nmetabolisers. This indicates that external validation of the \n\n\n\ndeveloped mixture models is paramount to confirm the effect \n\n\n\nof NAT2 polymorphism in determining the types of \n\n\n\naccelerators.  \n\n\n\n\n\n\n\nFigure II: Isoniazid (INH) clearance due to NAT2 polymorphism \n\n\n\n \n\n\n\n\n\n\n\n\nTan W. R. et al.                                                   Mal J Pharm 8 (2) 2022 , 1-15 , XX-XX \n\n\n\n\n\n\n\n10 \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nFigure III: Investigated and identified covariates \n\n\n\n \n\n\n\n\n\n\n\n\nTan W. R. et al.                                                   Mal J Pharm 8 (2) 2022 , 1-15 , XX-XX \n\n\n\n\n\n\n\n11 \n\n\n\n\n\n\n\n\n\n\n\nTable III: Model variability, error and validation \n\n\n\n\n\n\n\nStudy \nInterindividual variability (IIV) \n\n\n\nResidual error model \nResidual \n\n\n\nModel evaluation \nINH AcINH INH (%) AcINH (%) \n\n\n\nHorita et al.,  \n\n\n\n2018 [20] \n\n\n\nKa (h\n-1) = 0.567 \n\n\n\nCL/Fslow (L/h) = 0.324 \n\n\n\nCL/Fnonslow (L/h) = 0.48 \n\n\n\nVcentral /F (L) = 0.241 \n\n\n\nQ/F (L/h) = 0.637 \n\n\n\nVperipheral/F (L) = 1.9 \n\n\n\nNA Combination NA NA Basic internal (VPC, GOF) \n\n\n\n\n\n\n\nRao et al.,  \n\n\n\n2021 [24] \n\n\n\nKa(h\n-1) = 0.9 \n\n\n\nVcentral (L) = 0.07 \n\n\n\nVperipheral (L) = 0.5 \n\n\n\nCL=(L/h) = 0.8 \n\n\n\nCL2(L/h) = 0.0001 \n\n\n\nTlag = 0.5 \n\n\n\nNA Proportional NA NA Basic internal (VPC, GOF) \n\n\n\n\n\n\n\nJing et al.,  \n\n\n\n2020 [25] \n\n\n\nCL/F (L/h) = 25.6 \n\n\n\nQ/F (L/h) = 63.8 \n\n\n\nKa/F (h-1) = 75.8 \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nNA Exponential 25.1 NA \n\n\n\nBasic internal (VPC, GOF, conditional \n\n\n\nweighted residuals (CWRES) versus time, \n\n\n\nand CWRES versus PRED), advanced \n\n\n\ninternal (Bootstrap analysis, NPDE) \n\n\n\n\n\n\n\nNaidoo et al.,  \n\n\n\n2019 [26] \n\n\n\nCL (L/h) \n\n\n\nFast = 26.3 \n\n\n\n\n\n\n\nNA Combination \n\n\n\nProportional:27.8% \n\n\n\nAdditional: 0.004 \n\n\n\nFIX \n\n\n\n\n\n\n\nNA \nBasic internal (VPC), advanced internal \n\n\n\n(Bootstrap analysis) \n\n\n\n\n\n\n\nZvada et al.,  \n\n\n\n2013 [21] \n\n\n\nCL (L/h) \n\n\n\nFast = 25.1 \n\n\n\nIntermediate = 25.1 \n\n\n\nSlow = 25.1 \n\n\n\nNA Proportional \n\n\n\nCohort 1: \n\n\n\n20.6 \n\n\n\nCohort 2: \n\n\n\n7.00 \n\n\n\nNA \n\n\n\nBasic internal (Conditional weighted \n\n\n\nresiduals versus time, basic GOF, changes in \n\n\n\nthe OFV, VPC) \n\n\n\n\n\n\n\nPanjasatwong et al.,  \n\n\n\n2021 [22] \n\n\n\nCL (L/h) = 20.0 \n\n\n\nVcentral /F (L) = 18.3 \n\n\n\nMTT (h) = 64.5 \n\n\n\nNA Additive NA NA \nBasic internal (VPC, GOF plots, change in \n\n\n\nOFV) \n\n\n\n\n\n\n\nSeng et al.,  \n\n\n\n2015 [19] \n\n\n\nKa (h\n-1) = 12.6 \n\n\n\nCL/F (L/h) = 86.1 \n\n\n\nFINH = 38.1 \n\n\n\nCl (L/h) = 15.4 \n\n\n\n\n\n\n\nCL(L/h) = 15.4 \n\n\n\nVperipheral/F(L) = 19.4 \n\n\n\n\n\n\n\nAdditive on log-\n\n\n\ntransformed data \n32.6 log(mg/L) 20.7 log(mg/L) Basic internal (VPC, GOF) \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nTan W. R. et al.                                                   Mal J Pharm 8 (2) 2022 , 1-15 , XX-XX \n\n\n\n\n\n\n\n12 \n\n\n\n\n\n\n\n\n\n\n\nTable III: Model variability, error and validation (continued) \n\n\n\n\n\n\n\nStudy \nInterindividual variability (IIV) \n\n\n\nResidual error model \nResidual \n\n\n\nModel evaluation \nINH AcINH INH (%) AcINH (%) \n\n\n\nFredj et al., \n\n\n\n2021 [18] \nNA NA NA NA NA \n\n\n\nBasic internal (GOF, NPDE), external \n\n\n\n(validation group) \n\n\n\n\n\n\n\nVan Beek et al.,  \n\n\n\n2021 [27] \n\n\n\nVcentral (L) = 26.4 \n\n\n\nKa (h\n-1) = 83.2 \n\n\n\nCL (L/h) \n\n\n\nFast/slow = 57.5 \n\n\n\nVcentral (L) = 10.3 \n\n\n\nCL (L/h) \n\n\n\n=36.7 \n\n\n\nProportional NA NA Basic internal (VPC, GOF) \n\n\n\n\n\n\n\nHuerta-Garc\u00eda et al.,  \n\n\n\n2020 [28] \n\n\n\nCL (L/h) = 47.0 \n\n\n\nVcentral = 59.4 \n\n\n\nVperipheral (L) = 114.0 \n\n\n\nKa (h\n-1) = 113.6 \n\n\n\n\n\n\n\nNA Proportional 42.9 NA \n\n\n\nBasic internal (VPC, GOF), advanced \n\n\n\ninternal (Bootstrap analysis, NPDE), \n\n\n\nexternal (validation group) \n\n\n\n\n\n\n\nDenti et al.,  \n\n\n\n2015 [29] \n\n\n\nCL (L/h) = 30.7 \n\n\n\nMTT = 37.4 \n\n\n\nF = 12.8 \n\n\n\nNA Combinational NA NA \nBasic internal (OFV, VPC, GOF), advanced \n\n\n\ninternal (Bootstrap analysis) \n\n\n\n\n\n\n\nAruldhas et al.,  \n\n\n\n2019 [23] \n\n\n\nVcentral/F (L) = 23.4 \n\n\n\nMTT = 68.2 \n\n\n\nF = 41.8 \n\n\n\n\n\n\n\nNA Additive 0.0967 NA \nBasic internal (OFV, VPC, GOF), advanced \n\n\n\ninternal (Bootstrap analysis) \n\n\n\n\n\n\n\nCL = Clearance; Ka = Absorption constant; V = Volume of distribution; Vcentral = Central volume of distribution; Vperipheral = Peripheral volume of distribution; MTT = Mean transit time; Q = Intercompartment clearance; F = \n\n\n\nBioavailability. \n\n\n\n\n\n\n\n\n\n\n\nFigure IV: Percentage difference of NAT2 effect on CL compared to mean CL \n\n\n\n\n\n\n\n\nTan W. R. et al.                            Mal J Pharm 8 (2) 2022, 1-15 \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n13 \n\n\n\n\n\n\n\nAcINH is one of the most important urinary metabolites of \n\n\n\nINH. However, it was not investigated and discussed in most \n\n\n\nPPK articles (Table II). One study by Seng et al. described the \n\n\n\nPPK model of AcINH as a two-compartmental model [19]. \n\n\n\nMetabolite AcINH determines how well a patient metabolises \n\n\n\nINH [31]. One of the possible reasons for the lack of data in \n\n\n\nAcINH is the complexity of the assay method used to quantify \n\n\n\nit. A simple HPLC procedure is plagued by the low selectivity \n\n\n\nof UV detection, which requires more elaborate sample \n\n\n\npreparation and chromatographic conditions to achieve \n\n\n\ncomplete baseline separation of all peaks and is unsuitable for \n\n\n\nthe rapid detection of these analytes [32]. Thus, patients who \n\n\n\nare slow acetylators have a higher risk of hepatotoxicity than \n\n\n\nrapid acetylator [33]. Incorporating the effect of AcINH in \n\n\n\noptimising the INH dosing is essential, as slow acetylation may \n\n\n\nlead to isoniazid-induced hepatotoxicity.  \n\n\n\n\n\n\n\nThe NAT2 polymorphism shows the metabolism difference in \n\n\n\nethnicity or race. A study by Naidoo et al. performed on \n\n\n\nAfricans showed that most patients were slow or intermediate \n\n\n\nacetylators with >80% based on NAT2 genotype \n\n\n\npolymorphism. In comparison, less than 10-20% of the \n\n\n\npopulation tested had a rapid acetylator status [26]. Among the \n\n\n\nTanzanian population (East Africa), as many as 48% (n = 48 \n\n\n\nsubjects) were classified as NAT2 slow acetylators, 48% (n = \n\n\n\n48 subjects) as intermediate, and 2% (n = 2) as rapid \n\n\n\nacetylators. In comparison, the acetylation status of 2% (n = 2) \n\n\n\nsubjects could not be determined [29]. In contrast, among the \n\n\n\nUS population, Horita et al. reported mainly slow and \n\n\n\nintermediate INH acetylator [20]. While in the Asian \n\n\n\npopulation, as shown by Seng et al. that the majority of the \n\n\n\nsubjects in his study were classified as fast and intermediate \n\n\n\nINH acetylators. Similarly, a study from China reported that the \n\n\n\nmajority of the Chinese population in the study were fast and \n\n\n\nintermediate INH acetylators. This indicates Asian population, \n\n\n\nespecially the Chinese ethnicity are fast INH metabolisers and \n\n\n\nNAT2 polymorphism was about 20-40% of the population \n\n\n\n[19,25]. This can be reflected in Figures II and III where Seng \n\n\n\net al. [19] and Jing et al. [25] demonstrate the top and third-\n\n\n\nhighest CL in all studies. Discrepancies within regions and \n\n\n\nethnicity highlighted the variable influence of the NAT2 \n\n\n\npolymorphism on TB patient care, while they also reiterate the \n\n\n\nneed for rapid and slow NAT2 genotype polymorphism \n\n\n\nidentification before INH administration to avoid overdosing \n\n\n\nor underdosing [19]. Nevertheless, incorporating genetic \n\n\n\nfactors in routine clinical practice may not be feasible in some \n\n\n\ncountries. The application of a mixture model to cater to the \n\n\n\nunavailability of genetic data could assist in quantifying and \n\n\n\nspecifying different acetylation, which is also applied and \n\n\n\ndescribed for other drugs [34,35]. \n\n\n\n\n\n\n\nThe PK of INH displayed considerable differences among the \n\n\n\ndifferent age groups. The estimated CL in paediatrics is also \n\n\n\nlower than in adults. This can be due to age-based enzyme \n\n\n\nmaturation. At birth time, NAT2 activity is independent of \n\n\n\ngenotype, and the slow-acetylator phenotype predominates. \n\n\n\nWithin the first four years of life, the fast-acetylator phenotype \n\n\n\nin heterozygous and homozygous wild-type individuals \n\n\n\ndevelops [36]. Therefore, the CL of INH in children is lower \n\n\n\nthan in adults because of the Phase II reaction; acetylation in \n\n\n\nmetabolism has not developed completely in children and \n\n\n\ninfants. Children, especially young infants, normally have \n\n\n\nhigher total body water and a lower fat content than adults [36]. \n\n\n\nThus, the lipophilicity of INH [37] may explain the lower \n\n\n\nmedian Vd of INH in children than that in adults. The higher Vd \n\n\n\nvalue in the study by Aruldhas et al. may also attribute to a one-\n\n\n\ncompartmental model built, and the Vd was not distributed to \n\n\n\nthe other compartment [38]. \n\n\n\n\n\n\n\nMid-upper arm circumference (MUAC) was identified as one \n\n\n\nof the significant covariates affecting the Vcentral in people with \n\n\n\nHIV and critical illness [24], which could be explained by the \n\n\n\nhydrophilicity of INH [37]. Compliance assessment has not \n\n\n\nbeen carried out in eleven out of the twelve studies to make sure \n\n\n\nno changes in the INH dosing regimen had occurred before \n\n\n\nassessing the steady-state PK profile. The only study that \n\n\n\ncarried out compliance assessment was Seng et al. study by pill \n\n\n\ncount and medication diaries [19]. While measuring the plasma \n\n\n\nlevel of INH or an anti-TB regimen may provide further insight \n\n\n\ninto the compliance status of patients, the correlation between \n\n\n\nthe serum concentration and compliance towards anti-TB \n\n\n\nshowed conflicting results between adults and children. There \n\n\n\nwas no significant relation between serum concentrations of \n\n\n\npyrazinamide and drug compliance in adult patients [39]. \n\n\n\nHowever, a significant relationship was reported between INH \n\n\n\nand RIF in children with TB [40]. Nevertheless, the \n\n\n\nrelationship between INH and serum concentration may require \n\n\n\nfurther investigation. \n\n\n\n\n\n\n\nCONCLUSION  \n \n\n\n\nIn conclusion, the PPK of INH has been extensively reviewed. \n\n\n\nThe clearance of INH has a large difference between people \n\n\n\nwith different NAT2 genotype polymorphism statuses. This \n\n\n\nreview shows that to optimise the dosing regimen of INH, the \n\n\n\npatient\u2019s NAT2 genotype polymorphism status and age should \n\n\n\nbe considered. Considering a larger sample size and a more \n\n\n\nstringent sampling strategy to be able to assess these factors \n\n\n\nefficiently as the population data is more likely to follow the \n\n\n\nlaw of large numbers and central limit theorem [41]. The \n\n\n\napplication of a mixture model to cater for the unavailability of \n\n\n\n \n\n\n\n\n\n\n\n\nTan W. R. et al.                            Mal J Pharm 8 (2) 2022, 1-15 \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n14 \n\n\n\n\n\n\n\ngenetic data could assist in quantifying and specifying different \n\n\n\nacetylator status. Besides, previously published models, as well \n\n\n\nas future models, should be evaluated externally for a more \n\n\n\naccurate description of models\u2019 predictive performance. \n\n\n\n\n\n\n\nACKNOWLEDGEMENT \n\n\n\n\n\n\n\nAll authors meet the criteria of authorship. TWR was \n\n\n\nresponsible for collecting the data. SMSG reviewed and edited \n\n\n\nthe manuscript. IAH reviewed and edited the manuscript. SNH \n\n\n\nparticipated in concept development, supported data collection, \n\n\n\nand reviewed and edited the manuscript. This work was \n\n\n\nsupported by Fundamental Research Grant Scheme (FRGS), \n\n\n\nMinistry of Higher Education, Malaysia with project code \n\n\n\nFRGS/1/2019/STG03/USM/02/1. \n\n\n\n\n\n\n\nCONFLICT OF INTEREST \n  \n\n\n\nThe authors have no relevant affiliations or financial \n\n\n\ninvolvement with any organization or entity with a financial \n\n\n\ninterest in or financial conflict with the subject matter or \n\n\n\nmaterials discussed in the manuscript. This includes \n\n\n\nemployment, consultancies, honoraria, stock ownership or \n\n\n\noptions, expert testimony, patents received or pending, or \n\n\n\nroyalties. There are no conflicts of interest relevant to the \n\n\n\ncontent of this review. \n\n\n\n\n\n\n\nREFERENCE \n \n\n\n\n[1] Bardou, F., et al., Mechanism of isoniazid uptake in Mycobacterium \n\n\n\ntuberculosis. 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"\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nMal J Pharm . Volume 6 Issue 1 . December 2020 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of Pharmacy \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nA Publication of Malaysian Pharmacists Society \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Volume 6 Issue 1 December 2020 \n \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\n\n\n\n\nEditorial Board  \n\n\n\n\n\n\n\nEditor-in chief        : Dr. Chan Siok Yee \n\n\n\nManaging Editor   : Assoc. Prof. Dr. Long Chiau Ming  \n\n\n\nAssociate Editors   : Prof. Dr. Habibah Abdul Wahad \n\n\n\n  Prof. Dr. Mohd Cairul Iqbal Mohd Amin \n\n\n\n  Prof. Dr. Wong Ting Wui \n\n\n\n  Prof. Dr. Lua Pei Lin \n\n\n\n  Prof. Dr. Chua Siew Siang  \n\n\n\n  Assoc. Prof. Dr. Asrul Asrul Akmal Shafie \n\n\n\n  Assoc. Prof. Dr. Mohd Makmor Bakry \n\n\n\n  Assoc. Prof. Dr. Mohamad Haniki Nik Mohamed  \n\n\n\n  Assoc. Prof. Dr. Mogana Sundari A/P Rajagopal  \n\n\n\n  Assoc. Prof. Dr. Tan Ching Siang \n\n\n\n  Assoc. Prof. Dr. Vikneswaran A/L Murugaiyah \n\n\n\n  Assoc. Prof. Dr. Aisyah Saad Abdul Rahim \n\n\n\n  Assoc. Prof. Dr. Lawrence Anchah  \n\n\n\n  Assistant Prof. Dr. Liew Kai Bin  \n\n\n\n  Dr. Toh Seok Ming  \n\n\n\n  Dr. June Choon Wai Yee \n\n\n\n  Dr. Liau Siao Yen \n\n\n\n  Dr. Syireen Alwi  \n\n\n\n  Dr. Mohd Shahezwan Abd Wahab \n\n\n\n  Mr. Kamarudin Ahmad \n\n\n\n  Mrs. Reem Abou Assi \n\n\n\nAdvisory Board : Emeritus Professor Dr. Yuen Kah Hay \n\n\n\nEmeritus Professor Dr. Paraidathathu Thomas A/L P.G. Thomas \n\n\n\nProf. Dr. Mohd Baidi Bahari  \n\n\n\nTuan Amrahi Buang  \n\n\n\nDr. Sheng Qi \n\n\n\nAssoc. Prof. Dr. Alberto Beradi  \n\n\n\nAssoc. Prof. Dr. Lorina Bisharat \n\n\n\nPublisher:    \n\n\n\nMalaysian Pharmacists Society  \n\n\n\n16-2 Jalan OP 1/5, 1-Puchong Business Park  \n\n\n\nOff Jalan Puchong  \n\n\n\n47160 Puchong, Malaysia  \n\n\n\nTel: 6-03-80791861  \n\n\n\nFax: 6-03-80700388  \n\n\n\nHomepage: www.mps.org.my  \n\n\n\nEmail: maljpharm@gmail.com  \n\n\n\n\n\n\n\nThe Malaysian Journal of Pharmacy is a publication of the Malaysian Pharmacists Society. Enquiries are to be \n\n\n\ndirected to the publisher at the above address. The Publisher reserves copy- right and renewal on all published \n\n\n\nmaterials, and such material may not be reproduced in any form without the written permission of the Publisher. \n\u00a9 Malaysian Journal of Pharmacy \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Volume 6 Issue 1 December 2020 \n \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\n\n\n\n\nTable of Content \n\n\n\n\n\n\n\nWelcome Letter for Malaysian Journal of Pharmacy new Editorial Board  \nChan Siok Yee, Long Chiau Ming \n\n\n\ni \n\n\n\n\n\n\n\nShort communication  \n\n\n\n\n\n\n\nThe Need of Patient Education to Improve Medication Adherence Among \n\n\n\nHypertensive Patients \nChing Siang Tan \n\n\n\n1 \n\n\n\n\n\n\n\nOriginal Articles  \n\n\n\n\n\n\n\nGamified Online Quizzes: Pharmacy Student Perceptions of Learning in an \n\n\n\nUndergraduate Medicinal Chemistry Course \nAisyah Saad Abdul Rahim*, Azidah Abu Ziden and Beow Keat Yap \n\n\n\n6 \n\n\n\n\n\n\n\nFolk Songs for Health Education: A Qualitative Exploratory Study among Public \n\n\n\nand Pharmacy Enforcement Officers  \nKah Seng Lee*, Muthu Kumar Murugiah, Mohammad Aswady Adenan, Tahir Mehmood Khan, \n\n\n\nChin Fen Neoh, Yaman Walid Kassab, Nur Akmar Taha and Zainol Akbar Zainal \n\n\n\n13 \n\n\n\n\n\n\n\nUtilization Pattern of Lipid Modifying Agents in An Outpatient Pharmacy \n\n\n\nDepartment of a Private Hospital in Malaysia \nXin Xuan Cha, Ching Siang Tan*, Shashidharan Menon, H. Jaasminerjiit Kaur, Kah Seng \n\n\n\nLee, Mohamed Mansor Manan, Shafeeq Mohd Faizal \n\n\n\n21 \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Volume 6 Issue 1 December 2020 \n \n\n\n\ni \n\n\n\n\n\n\n\n \n1School of Pharmaceutical Sciences Universiti Sains Malaysia  \n2PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nMessage to the readers \n \n\n\n\nWelcome Letter for Malaysian Journal of Pharmacy new \n\n\n\nEditorial Board  \n \n\n\n\nChan Siok Yee1 and Long Chiau Ming2 \n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy (MJP) since its launch in 2001, upholds the essence of knowledge and experience \n\n\n\ndissemination of regional pharmaceutical related research and sciences. With Dr Yew Su Fong as the founding Editor \n\n\n\nin Chief, a few journal issues were published and in year 2008 the torch was passed on to the successor, Professor Dr \n\n\n\nMohd Baidi Bahari. Under the helm of Prof Baidi, valuable research findings by respective hospitals in Malaysia were \n\n\n\npublished, some disseminated in the form of conference proceeding and abstract. Gradually, MJP has become a \n\n\n\nkeystone to showcase the research findings of fellow pharmacists especially in the hospital setting which provide \n\n\n\npublications that are both informative and impactful, highlighting matters that of high value to the profession. In recent \n\n\n\nyears, the journal\u2019s management and structure grow and improve, along with its appointment of the journal\u2019s immediate \n\n\n\npast Editor in Chief, Associate Professor Dr Asrul Asrul Akmal Shafie that strengthened the workflow of the journal. \n\n\n\nIn term of operation, the way forward for MJP is to keep abreast with the latest trend and technology advancement.  \n\n\n\nWeb-based automated submission system, digital object identifier (DOI), citation tracking are the crucial features to be \n\n\n\nimplemented to encourage article submission to MJP. Given a chance to lead MJP, we would like to take a moment to \n\n\n\nintroduce the revamped structure of our editorial board. The newly assembled board comprises of registered pharmacist \n\n\n\nfrom different disciplines of pharmacy whom either a well cited researcher or highly experienced practising pharmacist. \n\n\n\nTo name a few, Professor Habibah A Wahab, Dean of School of Pharmaceutical Sciences of Universiti Sains Malaysia \n\n\n\n(USM), Professor Mohd Cairul Iqbal Mohd Amin, Deputy Director of Ministry of Higher of Education, Professor \n\n\n\nWong Ting Wui and Associate Professor Dr Asrul Asrul Akmal Shafie who are among the high cited researchers in \n\n\n\ntheir research field. Advisors are included in the structure of our editorial board who are entrusted to advise the Board \n\n\n\non strategic planning and progress of the journal. Advisors include Emeritus Professor Yuen Kah Hay and Emeritus, \n\n\n\nProfessor Dr Paraidathathu Thomas, former Editor in Chief Professor Dr Mohd Baidi Bahari, international renown \n\n\n\nresearcher Dr Sheng Qi and Associate Professor Alberto Berardi. This local and international advisory team is in the \n\n\n\ninterest of transparency, good governance and render the decision-making process to independent scrutiny. Besides, \n\n\n\nthe Board serves on the principle of autonomy and impartiality, to ensure the article published in this MJP is of high \n\n\n\nquality and non-bias. As far as the journal is concerned, the editorial board of MJP have the right to reject manuscript \n\n\n\nthat is deemed not appropriate or unqualified without influence, fear, or favour.  \n\n\n\nMJP is a peer-reviewed publication with an aim to publish content covers all aspects of pharmacist in Malaysia and \n\n\n\nbeyond. It solicits manuscripts across different areas as long as it brings benefit to the growth of pharmacy profession \n\n\n\nas a whole. The scope of the journal includes research performed clinically, community, lab-based, social \n\n\n\nadministrative based, Pharmacy Education as well as industrial related. Relevant contents from academicians, \n\n\n\npharmacy student (final year projects), pharmaceutical industrial research, as well as the mandatory research by \n\n\n\nprovisionally registered pharmacy (PRP) are also welcome. Special Issue may also be considered for current hot topic. \n\n\n\nWe envisage that MJP will serve as a platform to educate, motivate and help the author as well as readers to better \n\n\n\nserve as a pharmacist.\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Volume 6 Issue 1 December 2020 \n \n\n\n\n1 \n\n\n\n*Corresponding author:  \n\n\n\nChing Siang Tan \n\n\n\nEmail: chingsiang9@hotmail.com \n\n\n\n\n\n\n\nSchool of Pharmacy, KPJ Healthcare University College, Malaysia \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nShort communication \n\n\n\n\n\n\n\nThe Need of Patient Education to Improve Medication \n\n\n\nAdherence Among Hypertensive Patients \n \n\n\n\nChing Siang Tan \n \n\n\n\n\n\n\n\nArticle Info  \n\n\n\n \nReceived date: 16 Dec 2020 \n\n\n\nAccepted date: 27 Dec 2020 \n\n\n\nPublished date: 31 Dec 2020  \n\n\n\n\n\n\n\nKeywords:  \n\n\n\npatient education, medication \n\n\n\nadherence, hypertensive \n\n\n\npatient \n\n\n\n\n\n\n\n\n\n\n\nABSTRACT  \n\n\n\n\n\n\n\nEssential medicines have become indispensable to maintain and to improve our lives and health. \n\n\n\nLatest literature again reiterated that inappropriate use of medicine is a global phenomenon in both \n\n\n\ndeveloped and developing countries still prevail. Poor adherence is associated with negative clinical \n\n\n\noutcome of the disease. It is important to note that about 50% of treatment failures are due to poor \n\n\n\nmedication adherence and this results in substantial morbidity and mortality. Patient\u2019s belief and \n\n\n\nperception have been reported to influence medication adherence. Low rate of adherence was found \n\n\n\nstrongly associated with patient\u2019s belief across the studies with chronic diseases with hypertension, \n\n\n\ncoronary heart disease, diabetes, asthma and renal disease. Exploring the health beliefs of patients is \n\n\n\nvital to improve adherence and thereby blood pressure among the patients with hypertension. Lack \n\n\n\nof knowledge about usage of medication and various misleading perceptions of hypertension \n\n\n\nmanagement have resulted inappropriate use of medication especially medication adherence among \n\n\n\ncommunity-dwelling patients with hypertension. Literatures classified non-adherence into primary \n\n\n\nand secondary. Primary non-adherence refers to medication is purposefully never filled or taken; \n\n\n\nSecondary non-adherence is defined as medication is not taken properly or continued as prescribed \n\n\n\nand further classified into intentionally and unintentionally. Patient education aims to train patient in \n\n\n\nthe skill and self-management of their chronic disease by adapting to the treatment or lifestyle \n\n\n\nchanges. Despite improving in patients\u2019 skill and self-care by providing information about the \n\n\n\ntreatment, patient education could enhance their empowerment and medication adherence. Patient \n\n\n\neducation is a basic right of the patients and healthcare members have responsible to provide such \n\n\n\ninformation. However, the authenticity of the available information is yet to be verified. Therefore, \n\n\n\nhealthcare professional could play a vital role here to educate their patients about the appropriate \n\n\n\ninformation.  \n\n\n\n\n\n\n\n\n\n\n\nINTRODUCTION  \n\n\n\n\n\n\n\nEssential medicines are defined as those medicines that satisfy \n\n\n\nthe priority health care needs of the population in a country [1]. \n\n\n\nEssential medicines have become indispensable to maintain \n\n\n\nand to improve our lives and health [2]. Additionally, essential \n\n\n\nmedicines play a significant role in therapeutic assets of \n\n\n\nmedical treatment options. Yet, medicines still are unaffordable, \n\n\n\nunavailable, unsafe and inappropriate used among many people \n\n\n\naround the globe [3, 4]. World Health organisation (WHO) has \n\n\n\ndefined Quality Use of Medicine (QUM) as \u201cPatients receive \n\n\n\nmedications appropriate to their clinical needs, in doses that \n\n\n\nmeet their own individual requirement, for an adequate period \n\n\n\nof time, and at the lowest cost to them and their community\u201d[5]. \n\n\n\nAustralian National Medicines Policies has defined QUM as \n\n\n\n\u201cselecting management and suitable medicine wisely, and \n\n\n\nusing medicines safely and effectively\u201d[6].  \n\n\n\n\n\n\n\nWHO has estimated that more than half of all medicines are \n\n\n\nprescribed, dispensed or sold inappropriately in worldwide [7]. \n\n\n\nMoreover, 50% of the patients did not take medicine in \n\n\n\nappropriate manner [7] and this leads to the various \n\n\n\ncomplications of not well-managed chronic diseases. Latest \n\n\n\nliterature again reiterated that inappropriate use of medicine is \n\n\n\na global phenomenon in both developed and developing \n\n\n\ncountries still prevail [8]. Common problems of inappropriate \n\n\n\nuse of medicine have emerged, including the use of too many \n\n\n\nmedicines per patient with the similar function (polypharmacy), \n\n\n\ninappropriate use of antibiotic, inappropriate self-medication \n\n\n\nespecially prescription-only medicine, inappropriate use of \n\n\n\ninjection when the regime can be substituted with oral \n\n\n\n\nmailto:chingsiang9@hotmail.com\n\n\n\n\n\n\nC.S. Tan Malaysian Journal of Pharmacy 6 (1) 2020 \n\n\n\n\n\n\n\n\n\n\n\n2 \n\n\n\n\n\n\n\nformulation and failure to prescribe according to guidelines [9].  \n\n\n\nIn addition, people tend to forget the details given by doctor \n\n\n\nand pharmacist, not able to buy prescribed medicine at \n\n\n\npharmacy due to financial problem, take initiative to stop \n\n\n\nconsuming prescribed medicine, or taken the wrong dosage \n\n\n\n[10]. Patients were found to have greater tendency to store large \n\n\n\nquantities of medications in urban households with large \n\n\n\npercentages of the medication was being wasted [11]. \n\n\n\n\n\n\n\nMedicine Adherence Underpinned by Patient\u2019s Perception \n\n\n\n\n\n\n\nWHO defines adherence as \u201cthe extent to which a person\u2019s \n\n\n\nbehaviour \u2013 taking medications, following a diet and/ or \n\n\n\nexecuting lifestyle changes, corresponds with agreed \n\n\n\nrecommendations from a health care provider\u201d[12]. \n\n\n\nWorldwide, approximately $177 billion was spent in direct and \n\n\n\nindirect health care cost annual due to poor adherence [13]. \n\n\n\nMedication adherence is one of the important aspects of the \n\n\n\nQUM. Poor adherence is associated with negative clinical \n\n\n\noutcome of the disease [14]. It is important to note that about \n\n\n\n50% of treatment failures are due to poor medication adherence \n\n\n\nand this results in substantial morbidity and mortality [15, 16].   \n\n\n\nPatient\u2019s belief and perception have been reported to influence \n\n\n\nmedication adherence [17-19]. Low rate of adherence was \n\n\n\nfound strongly associated with patient\u2019s belief across the \n\n\n\nstudies with chronic diseases with hypertension [20], coronary \n\n\n\nheart disease [21], diabetes [22], asthma [23] and renal disease \n\n\n\n[24]. Exploring the health beliefs of patients is vital to improve \n\n\n\nadherence and thereby blood pressure (BP) among the patients \n\n\n\nwith hypertension [20]. Literature demonstrated that patient\u2019s \n\n\n\nbeliefs about medicines yielded a significant predictor to \n\n\n\nmedication adherence compare to social demographic factors \n\n\n\n[21]. To maximise treatment outcomes, a number of rigorous \n\n\n\nreviews were focused on the modifying factors, such as \n\n\n\npatient\u2019s beliefs, rather than non-modifying demographic \n\n\n\nvariables [21, 25]. Many patients with hypertension did not \n\n\n\nadhere to antihypertensive medication because they had \n\n\n\nmisperception towards hypertension or they were unconfident \n\n\n\nwith their antihypertensive medication such as concern of \n\n\n\npotential adverse effects [26-28]. In overseas, lack of \n\n\n\nknowledge about usage of medication and various misleading \n\n\n\nperceptions of hypertension management have resulted \n\n\n\ninappropriate use of medication especially medication \n\n\n\nadherence among community-dwelling patients with \n\n\n\nhypertension [28-30]. \n\n\n\n\n\n\n\nPossible reasons of non-adherence includes perceptual factors \n\n\n\nsuch as beliefs, attitudes and preference [21, 31]. Studies have \n\n\n\nshown that medication adherence was greatly influenced by \n\n\n\npatients\u2019 health belief towards hypertension [14]. Patient\u2019s \n\n\n\nbeliefs play an important role in predicting medication \n\n\n\nadherence [22, 32]. Patient\u2019s judgement in the need of \n\n\n\nmedication (necessity belief) relatively to their concern of \n\n\n\nadverse effect influences their motivation to start and continue \n\n\n\nwith medication [33].  \n\n\n\nIt must be noted that literature demonstrated that low \n\n\n\nmedication adherence was observed among patients with \n\n\n\nchronic diseases [34]. A wide variation of non-adherence rate \n\n\n\n(i.e. 7%-67%) has been reported among the patients with \n\n\n\ncardiovascular diseases [35]. Medication adherence among \n\n\n\npatients with hypertension was reported ranged from 50% to \n\n\n\n70% [36]. It is evident that many patients with hypertension \n\n\n\nhave obstacles to adhere to their medication regimens [4]. \n\n\n\nApproximately half of them were found to be non-adherent and \n\n\n\nleading to suboptimal clinical benefits [16, 37]. In Malaysia, \n\n\n\nonly 35% of patients with hypertension have controlled BP \n\n\n\nlevel with antihypertensive medications [38]. A recent local \n\n\n\nstudy revealed that the reasons of poor medication adherence \n\n\n\namong patients with hypertension were due to misconception \n\n\n\nabout side effect of antihypertensive medication and lack of \n\n\n\nknowledge towards hypertension management [31].   \n\n\n\nDifferentiating the Type of Medication Non-adherence \n\n\n\n\n\n\n\nLiteratures classified non-adherence into primary and \n\n\n\nsecondary. Of note, when medication is purposefully never \n\n\n\nfilled or taken; or a new prescription is not filled by patient, it \n\n\n\nis called as primary non-adherence [36, 39]. While, secondary \n\n\n\nnon-adherence is defined as medication is not taken properly or \n\n\n\ncontinued as prescribed [36]. Secondary non-adherence is \n\n\n\nclassified into intentionally and unintentionally. Intentional \n\n\n\nnon-adherence refers to patient\u2019s decision to stop medication \n\n\n\non their own, either insufficient information about benefits or \n\n\n\nside effect of medication [40]. On the other hand, unintentional \n\n\n\nnon-adherence occurs when patient is prevented from taking \n\n\n\nmedication under unplanned circumstances, for instances, \n\n\n\nforgetfulness, does not understand instruction of use for the \n\n\n\nmedication, language barriers or physical barrier to comply \n\n\n\nmedication [41]. Taking a scrutiny into the medication \n\n\n\nadherence break down components; 12% of cardiovascular \n\n\n\npatients did not fill up prescription (primary non-adherence); \n\n\n\n12% of the primary non-adherence was found by not started \n\n\n\nmedication; while 29% of cardiovascular patients did not take \n\n\n\nprescribed medication for long term (secondary non-\n\n\n\nadherence), and only 47% of cardiovascular patients adhered to \n\n\n\nprescribed medication [42]. Another study revealed that the \n\n\n\nadherence rate was dropped to only 35% during the first year \n\n\n\nof treatment among the patients with hypertension [43].  \n\n\n\n\n\n\n\nWay Forward: The Need for Continued Patient Education \n\n\n\nto Mitigate Medication Non-Adherence and Wastage \n\n\n\n\n\n\n\nPatient education is defined as \u201cA systematic experience in \n\n\n\nwhich a combination or a variety of methods are used. These \n\n\n\nmight include the provision of information and advice and \n\n\n\nbehaviour modification techniques, which influence the way the \n\n\n\npatient experiences his illness and/or his knowledge and health \n\n\n\nbehaviour, aimed at improving or maintaining or learning to \n\n\n\ncope with a condition, usually a chronic one\u201d[44]. The concept \n\n\n\nof patient education is to train patient in the skill and self-\n\n\n\nmanagement of their chronic disease by adapting to the \n\n\n\ntreatment or lifestyle changes [45]. Despite improving in \n\n\n\npatients\u2019 skill and self-care by providing information about the \n\n\n\ntreatment, patient education could enhance their empowerment \n\n\n\n\n\n\n\n\nC.S. Tan Malaysian Journal of Pharmacy 6 (1) 2020 \n\n\n\n\n\n\n\n\n\n\n\n3 \n\n\n\n\n\n\n\nand medication adherence [46]. In addition, patient education \n\n\n\ncould reduce the medical expenses in terms of long term care \n\n\n\nfor both patients and society [45]. Patient education plays an \n\n\n\nimportant role in therapeutic plan by improving patients\u2019 self-\n\n\n\nmanagement skills [47] and to enhance patient-centred \n\n\n\nperspective [48].   \n\n\n\nPatient education can be divided into clinical patient education \n\n\n\n(learning and teaching process are carried out at clinical setting) \n\n\n\nand community health education (education program \n\n\n\nemphasises on prevention, wellness and healthcare awareness \n\n\n\namong the community level)[49]. With the expert knowledge \n\n\n\nand proper training, health promoters generally have credibility \n\n\n\nto conduct patient education program. However, expertise \n\n\n\nalone does not make a good health educator. Three principles \n\n\n\nmust be adopted in patient educational programme: (i) patients\u2019 \n\n\n\nbelief and understanding of the aims of education program must \n\n\n\nbe delivered and evaluated through some learning tools [50-52], \n\n\n\n(ii) established relationship between patients and healthcare \n\n\n\nproviders [53, 54], and (iii) attention must be given to low self-\n\n\n\nesteem and non-vocal patients to change their health-related \n\n\n\nbehaviors [55].  \n\n\n\nPreparation of patient education is important. Health educator \n\n\n\nneeds to think through the objectives of the session, the way of \n\n\n\nconducting and the involvement of participants [56]. Jensen \n\n\n\nand Simvska reported that the optimal learning outcome could \n\n\n\nbe achieved throughout active participation during learning \n\n\n\nprocess [57]. Whilst Ewles and Simnett added that learning \n\n\n\nmethods should be variated in different ways i.e. books, leaflets, \n\n\n\nhandout, poster, flip-chart, PowerPoint slides and others [56]. \n\n\n\nHealth care provider could play an important role to educate \n\n\n\npatients in order to enable them to further understand their \n\n\n\nconditions and the given therapy [58]. Evidence demonstrated \n\n\n\nthat patients want health information but some of them have \n\n\n\ndifficulty in understanding and remember the information \n\n\n\ndelivered by the health educator [59].  \n\n\n\nA recent local study revealed that a total of 20,799 excessive \n\n\n\npills were returned by patients with hypertension at a single \n\n\n\nMalaysian government hospital, with a total cost of (Malaysian \n\n\n\nRinggit) MYR 4,362.28 (equal to USD 1037) was wasted \n\n\n\nduring the 8 months of study period with an average wastage \n\n\n\nof MYR 42.35 (equal to USD 10) per patient; changing \n\n\n\nmedication by the doctor and death of patients were the most \n\n\n\ncommon reasons accounted for the wastage [60]. Lack of \n\n\n\nknowledge about usage of medication and various misleading \n\n\n\nperceptions of hypertension management have resulted \n\n\n\ninappropriate use of medication especially medication \n\n\n\nadherence among community-dwelling patients with \n\n\n\nhypertension [29, 30]. Within this context, a pharmacist whom \n\n\n\ntraditional roles focus on medication dispensing and \n\n\n\nprocurement have been serving well as a healthcare educator. \n\n\n\nBeing an expert of medicines, a pharmacist is dedicated to \n\n\n\nprovide medicine counselling to patients, taking into \n\n\n\nconsideration their prescription, non-prescription, self-\n\n\n\nprescribed, herbal medications as well as the drug \n\n\n\ninteraction[61].  \n\n\n\nCONCLUSIONS  \n\n\n\n\n\n\n\nPatient education is a basic right of the patients and healthcare \n\n\n\nmembers have responsible to provide such information. \n\n\n\nHealthcare providers could provide pertinent yet enough \n\n\n\ninformation to the patients and thus avoiding the development \n\n\n\nof confusion. Patients might obtain information from other \n\n\n\nsources, such as social media, friends, neighbour and family \n\n\n\nmembers. However, the authenticity of the available \n\n\n\ninformation is yet to be verified. Therefore, healthcare \n\n\n\nprofessional could play a vital role here to educate their patients \n\n\n\nabout the appropriate information [62].  \n\n\n\n\n\n\n\nThe evolving of patient education and the emerging of the new \n\n\n\ndevelopments are expected from the healthcare professional. \n\n\n\nCurrently healthcare professional have more access and \n\n\n\ntraining opportunity in patient education technique, such as \n\n\n\ncounselling and motivational interview [63]. However, many \n\n\n\nhealthcare professionals confronted challenging when \n\n\n\neducating patient because of limited time was allocated to cover \n\n\n\nall health topics [64]. Therefore, the development of patient \n\n\n\neducation interventions is impeding with the direction of \n\n\n\nreplacing a part of consultation time with providing tools for \n\n\n\nself-monitoring by patient themselves at outside of healthcare \n\n\n\nsetting.  \n\n\n\n\n\n\n\nCONFLICT OF INTEREST \n\n\n\n\n\n\n\nThe authors declare no conflict of interest. This research did \n\n\n\nnot receive any specific grant from funding agencies in the \n\n\n\npublic, commercial or not-for-profit sectors. \n\n\n\n\n\n\n\nREFERENCES  \n \n\n\n\n1. World Health Organization. Essential Medicines and Health Products. \n\n\n\n2020  [cited 2020 21th December]; Available from: \nhttps://www.who.int/medicines/services/essmedicines_def/en/. \n\n\n\n2. Organization, W.H., Towards access 2030: WHO essential medicines \n\n\n\nand health products strategic framework 2016-2030. 2017, World \nHealth Organization. \n\n\n\n3. Tan Ching, S., M.A. Hassali, and F. 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Patient Education and Counseling, 2010. \n\n\n\n78(3): p. 275-281. \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Volume 6 Issue 1 December 2020 \n \n\n\n\n\n\n\n\n6 \n\n\n\n\n\n\n\n*Corresponding author: \n\n\n\nAisyah Saad Abdul Rahim \n\n\n\nEmail: aisyahsaad@gmail.com \n\n\n\n\n\n\n\n1Faculty of Pharmacy, Universiti Teknologi MARA, Puncak Alam, Selangor, \n\n\n\nMalaysia.  \n2School of Educational Studies, Universiti Sains Malaysia, Penang, \n\n\n\nMalaysia.  \n3School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, \n\n\n\nMalaysia. \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n \nOriginal Research Article \n \n\n\n\nGamified Online Quizzes: Pharmacy Student \n\n\n\nPerceptions of Learning in an Undergraduate Medicinal \n\n\n\nChemistry Course \n \n\n\n\nAisyah Saad Abdul Rahim1*, Azidah Abu Ziden2 and Beow Keat Yap3  \n \n\n\n\n  \nArticle Info  \n\n\n\n \nReceived date: 17 Dec 2020 \n\n\n\nAccepted date: 28 Dec 2020 \n\n\n\nPublished date: 31 Dec 2020  \n\n\n\n\n\n\n\nKeywords:  \n\n\n\nActive learning; Game-based \n\n\n\nlearning; Online Quiz; Online \n\n\n\nassessment; Student \n\n\n\nEngagement. \n\n\n\nABSTRACT  \n\n\n\n\n\n\n\nIntroduction: In the context of pharmacy education worldwide and in Malaysia, the use of digital \n\n\n\ntechnologies to promote higher level thinking and discussions is seen as preparing the millennials as \n\n\n\npharmacists in the 21st century. Together with leveraging on millennials' penchant for mobile \n\n\n\ntechnology, gamified online quizzes as an assessment tool that help promote active and collaborative \n\n\n\nlearning in a Medicinal Chemistry course have been used. Objectives: This study investigates \n\n\n\nstudents\u2019 perception of the impact of gamified online quizzes on their learning in a Medicinal \n\n\n\nChemistry course. Method: This study employs mix method research comprising descriptive \n\n\n\nanalysis, content analysis from informal chats and researchers' observation to gather the findings for \n\n\n\nthe study. Three gamified online quizzes using Quizizz, were implemented outside classroom time, \n\n\n\nin place of traditional quizzes. Multiple attempts were allowed within a stipulated time. As \n\n\n\ninterventions, post-quiz discussions were conducted during class time. Students completed an end-\n\n\n\nof-the-course survey. Results: Out of 63 respondents, more than 96% felt that the gamified online \n\n\n\nquizzes enhanced their learning as they learned from the instant feedback, their mistakes and post-\n\n\n\nquiz discussions. Overall student performance based on the percentage and accuracy of answering \n\n\n\nthe quiz improved with time. Student qualitative comments on the survey, the course social media \n\n\n\n(closed group) and informal chats supported the findings from the descriptive data analysis of the \n\n\n\nstudy. Conclusions: From students\u2019 perception, the gamified online quizzes were found to be \n\n\n\nenjoyable and effective in enhancing active, peer learning in an undergraduate medicinal chemistry \n\n\n\ncourse outside class time. For instructors, the online quiz served as an efficient tool for formative \n\n\n\nassessment in a large classroom setting, and could replace traditional classroom quizzes. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nINTRODUCTION  \n\n\n\n\n\n\n\nThe use of online and in-classroom digital games and game-\n\n\n\nbased approaches to promote student engagement via active \n\n\n\nand collaborative learning has gained prominence (1\u20133). It is of \n\n\n\nparticular relevance  during this challenging Covid-19 times \n\n\n\nwhen most face-to-face teaching and learning activities moved \n\n\n\nto online learning\u2013prompting  educators to seek approaches \n\n\n\nthat facilitate and increase students' online engagement (4,5). \n\n\n\n\n\n\n\nGame-based learning provides learners: (a) the environment to \n\n\n\ntake risks, (b) the chance to make mistakes and learn from these \n\n\n\nmistakes in a low-stake but competitive environment, (c) the \n\n\n\nopportunities to keep trying and (d) the avenue to be rewarded \n\n\n\nfor successful attempts. These are similar to how people learn \n\n\n\nto master certain skills or acquire new knowledge in life.  \n\n\n\n\n\n\n\nBesides that, game-based learning employs elements such as \n\n\n\npoint systems, scoreboards, winners and eye-catching avatars \n\n\n\ncoupled with exciting music and colourful, user-friendly \n\n\n\ninterfaces that keep learners motivated and engaged in a non-\n\n\n\n\nmailto:aisyahsaad@gmail.com\n\n\n\n\n\n\nA.S. Abdul Rahim et al. Malaysian Journal of Pharmacy 6 (1) 2020 \n\n\n\n\n\n\n\n7 \n\n\n\n\n\n\n\ngame context (6,7), for instance in learning abstract concepts \n\n\n\nor dry subjects (8\u201311). \n\n\n\n\n\n\n\nIn the context of pharmacy education worldwide and in \n\n\n\nMalaysia, the use of digital technologies to promote higher \n\n\n\nlevel thinking and discussion is seen as preparing the \n\n\n\nmillennials as pharmacists in the 21st century\u2013where skilful \n\n\n\ncommunication, collaboration and critical thinking are \n\n\n\nessential in various pharmacy practices (8,12\u201321). \n\n\n\n\n\n\n\nGamified web-based quizzes e.g. Kahoot, Quizizz and \n\n\n\nSocrative, are increasingly being used as a pedagogical strategy \n\n\n\nto conduct classroom teaching and assessment (7). Despite \n\n\n\ndoubts of its pedagogical effectiveness (22,23), their appeals to \n\n\n\nyoung students lie in engaging and motivating learners in \n\n\n\ngame-based, digital learning experiences (18,24).   \n\n\n\n\n\n\n\nIn previous years, students taking the Principles of Medicinal \n\n\n\nChemistry course at the School of Pharmaceutical Sciences, \n\n\n\nUniversiti Sains Malaysia (USM) were assessed in a number of \n\n\n\nin-class assignments and pop-quizzes. These formed the \n\n\n\nformative assessment part of the course. Anecdotally, this \n\n\n\nsubject was found difficult amongst many students. To help \n\n\n\ntheir learning on the subject, students requested for regular pop-\n\n\n\nquizzes. In doing so, however, the instructors found that \n\n\n\ncreating questions, marking such formative assessments and \n\n\n\nproviding constructive feedback were time-consuming, \n\n\n\nparticularly for a large class.  \n\n\n\n\n\n\n\nTherefore, this study is aimed to seek for a form of formative \n\n\n\nassessment that would help instructors to securely conduct the \n\n\n\nassessment, allows efficient grading, analyse student responses \n\n\n\nand deliver learning analytics. Additionally, this study aimed \n\n\n\nto evaluate a digital tool that leverages on digital natives\u2019 \n\n\n\npenchant for mobile technology.  \n\n\n\n\n\n\n\nThe popularity of various game-based instructions for active \n\n\n\nlearning in pharmacy classroom settings has been reported \n\n\n\npreviously (12,16,19,21,25\u201328); however, its use outside of \n\n\n\nclass time remains relatively unexplored in traditional higher \n\n\n\neducation setting. The use of gamified online quiz by \n\n\n\neffectively utilising the notional student learning time (SLT) \n\n\n\ncould serve as a novel way towards effective learning. This \n\n\n\npreliminary study evaluates pharmacy students\u2019 perceptions of \n\n\n\nlearning using a gamified online quiz approach (ie. using \n\n\n\nQuizizz) with a view of replacing traditional in-class quizzes. \n\n\n\n\n\n\n\n\n\n\n\nMETHOD  \n  \n\n\n\nThe Principles of Medicinal Chemistry course is a 2-unit course \n\n\n\nfor second year pharmacy students at Universiti Sains Malaysia. \n\n\n\nIt consists of topics on drug design and development that \n\n\n\nincludes structure-activity relationship (SAR), quantitative \n\n\n\nSAR (QSAR), drug modelling and pharmacokinetics. The \n\n\n\ncourse is taught by two instructors to a large group of 116 \n\n\n\nstudents. Three unsupervised online quizzes were offered \n\n\n\nduring the semesters, i.e. students were assessed in Week 7, 11 \n\n\n\nand 14. Each quiz was conducted about 3 weeks apart. Students \n\n\n\ncompleted these quizzes as a part of continuous assessment \n\n\n\n(10%) in this course. The online quiz consisted of 20-30 \n\n\n\nmultiple-choice, randomised questions and answers with \n\n\n\nprogressive difficulties, which would evaluate students' six \n\n\n\ncognitive levels based on the Bloom\u2019s Taxonomy, i.e. \n\n\n\nknowledge, comprehension, application, analysis, synthesis \n\n\n\nand evaluation. Using images and diagrams, instructors were \n\n\n\nable to construct more challenging questions by prompting \n\n\n\nstudents to critically examine the visuals (e.g. drug-protein \n\n\n\ninteractions, SAR, molecular modelling in Figure 1), thus \n\n\n\ntesting students\u2019 critical thinking and understanding in \n\n\n\nmedicinal chemistry. \n\n\n\n\n\n\n\nThe quizzes were implemented based on students' preferences \n\n\n\nthat were collected using Google Form. Students were made \n\n\n\naware of the quizzes through the Facebook closed group of the \n\n\n\nmedicinal chemistry course. Students were alerted to six rules \n\n\n\nfor online quizzes\u2013one such rule requires students to use \n\n\n\nassigned name codes to keep their anonymity secured in the \n\n\n\ncyber world and later, for grading purposes (Table 1). \n\n\n\n\n\n\n\nSimple technical support for students (e.g. game pin, access, \n\n\n\nname repeat) was provided by the instructors in the evenings of \n\n\n\nFigure 1: Question samples using a molecular structure and a diagram \n\n\n\n\n\n\n\n\nA.S. Abdul Rahim et al. Malaysian Journal of Pharmacy 6 (1) 2020 \n\n\n\n\n\n\n\n8 \n\n\n\n\n\n\n\nthe quiz, between 8-10 pm. Instructors were also present online \n\n\n\nto monitor the running of the online quiz. Student performance \n\n\n\nreports were downloaded every 15-20 minutes, and at the \n\n\n\nconclusion of the online quiz. The reports are colour-coded as \n\n\n\nshown in Figure 2.  \n \n\n\n\nTable 1: Six rules of online quiz  \n\n\n\n6 Rules of Online Quiz \n \n\n\n\n1. Please make sure you are connected to a stable wi-fi, uni-fi or cable \n\n\n\ninternet. The quiz is web-based. You may use mobile devices or \n\n\n\nlaptops.  \n2. Please use the assigned code names. ANY names different from the \n\n\n\nassigned code names will be removed. No marks given.   \n3. DO NOT SHARE the quiz code or quiz questions with anyone or \n\n\n\nyour juniors/seniors.  \n4. You may repeat the quiz as multiple times\u2013within the allocated time.  \n5. Your quiz marks will be based on your best performance.  \n\n\n\n6. The content of the quiz is copyrighted under the instructor. No \nscreenshot or any audio-visual recording is allowed without prior \n\n\n\npermission.  \n* The assigned code name will be crucial during the grading process.   \n\n\n\nThis makes it visually easy for instructors to quickly check and \n\n\n\nplan for student feedback. Post-quiz discussions based on the \n\n\n\nQuizizz reports were held during the next available lecture hour. \n\n\n\nThe reports were also used for grading purposes. \n\n\n\n\n\n\n\nCriteria and considerations in designing a gamified online \n\n\n\nquiz  \n\n\n\n\n\n\n\na) Which gamified online quiz would be suitable for a large \n\n\n\nclass? \n\n\n\n\n\n\n\n As mentioned earlier, there are several free, gamified online \n\n\n\nstudent response systems available e.g. Kahoot, Socrative and \n\n\n\nQuizizz. For this initial study, the criteria used for selecting the \n\n\n\nonline quiz are: 1) it is a free digital tool, and remains free for \n\n\n\na large number of students (over 100); 2) student- and \n\n\n\ninstructor-friendly (e.g. low learning curve); 3) has built-in \n\n\n\nelements of gamification; 4) able to generate analytics; 5) set a \n\n\n\ndeadline for students; 6) stable, responsive and reliable during \n\n\n\nreal-time uses for a large-sized class and 7) able to be used on \n\n\n\nlaptops and mobile devices. Based on these criteria, Quizizz \n\n\n\nwas selected as the gamified online tool as a part of the \n\n\n\ncontinuous assessment.  \n\n\n\n\n\n\n\nb) How many attempts for an online quiz? How long should it \n\n\n\nbe? \n\n\n\n\n\n\n\nAt the outset of this online quiz, the instructors had little idea \n\n\n\nwhat constitutes a realistic setting for students, in terms of quiz \n\n\n\nduration and number of attempts. Unlike the traditional pen-\n\n\n\nand-paper quiz, the instructors were mindful of the time \n\n\n\nlearners need to familiarise themselves with a new technology. \n\n\n\nAllowing for extra time reduces anxiety in students, a key \n\n\n\nfactor in facilitating learning (28). Allowing for extra time also \n\n\n\nprovides students time to rectify technical issues (e.g. internet \n\n\n\naccess, browser) possibly encountered, often at the start, and \n\n\n\nduring the online quiz.  \n\n\n\n\n\n\n\nFurthermore, the main purpose of offering the gamified online \n\n\n\nquiz is to help students to learn from their mistakes and that of \n\n\n\ntheir peers. Taking these factors into considerations, the first \n\n\n\nonline quiz was opened for 120 minutes. Students could repeat \n\n\n\ntaking the quiz as many times as they wish\u2013within that period. \n\n\n\nAt the end of the 2-hour period, the online dashboard showed \n\n\n\na staggering 834 players with an overall 79% accuracy. \n\n\n\nConsidering that there were 116 students registered for the \n\n\n\nquiz, each student probably attempted close to 7.2 times. The \n\n\n\ntop 10% players took, on average, 1 minute and 25 seconds to \n\n\n\nanswer each quiz question and rose to the top of the scorecard \n\n\n\nwith 100% accuracy. Due to the huge number of attempts, the \n\n\n\nfirst instructor discovered that the overall analytics on student \n\n\n\nperformance could not be processed and downloaded from \n\n\n\nQuizizz website.  \n\n\n\n\n\n\n\nThe second quiz was administered about 3 weeks later by the \n\n\n\nsecond instructor. Initially, the instructor planned for a \n\n\n\ntraditional in-class quiz; but upon overwhelmingly positive \n\n\n\nstudent feedback for the first quiz and requests for a second \n\n\n\nonline quiz, the second quiz was also held using Quizizz. The \n\n\n\ninstructors had a discussion to rectify and improve the first \n\n\n\nsetting. Based on our discussion, students were allowed a \n\n\n\nmaximum of three attempts within a 60-minute period. With \n\n\n\nFigure 2: Colour-coded analytics categorised by questions and students facilitated post-quiz discussions. \n\n\n\n\n\n\n\n\nA.S. Abdul Rahim et al. Malaysian Journal of Pharmacy 6 (1) 2020 \n\n\n\n\n\n\n\n9 \n\n\n\n\n\n\n\nthe duration and number of attempts capped, the second \n\n\n\ninstructor managed to download the final report.  \n\n\n\n\n\n\n\nFor the third quiz, students requested to increase the number of \n\n\n\nattempts. Since the purpose of offering the online quiz is \n\n\n\n\u201cassessment for learning\u201d rather than \u201cassessment of learning\u201d, \n\n\n\nthe first instructor allowed more repeats than the previous quiz.  \n\n\n\nAssessment for learning refers to formative assessments that \n\n\n\nare focused on providing feedback for improvements in  \n\n\n\nstudents' learning, whereas assessment of learning refers to \n\n\n\nsummative evaluations at the end of a course (29). Therefore, \n\n\n\nin the third quiz, the maximum number of attempts were \n\n\n\ncapped at 5 times for a 60-minute quiz. \n\n\n\n\n\n\n\nData Collection \n\n\n\n\n\n\n\nAfter the final quiz, the students were asked to complete an \n\n\n\nonline questionnaire on a voluntary basis\u2013no rewards were \n\n\n\noffered for completing the survey. They were asked to provide \n\n\n\nonly their first name and gender. The purpose of the student \n\n\n\nsurvey was to gauge the student perceptions on learning via \n\n\n\ngamified online quizzes. The questionnaire had a section of 14 \n\n\n\nquestions to find out to what extent gamification features, types \n\n\n\nof questions, flexibility, post-quiz discussions influenced their \n\n\n\nlearning (see Table 2).  \n\n\n\n\n\n\n\nThe survey used a five-point Likert scale for each item \n\n\n\n(1=strongly disagree, 2= disagree, 3=neutral, 4=agree, and \n\n\n\n5=strongly agree). At the end of the questionnaire, there were \n\n\n\nblank spaces for students to write further comments and \n\n\n\nsuggest improvements. Informal chats together with students\u2019 \n\n\n\nfeedback on the course Facebook group were taken into \n\n\n\naccount in this study. The data from students\u2019 comments, \n\n\n\nsuggestions and informal chats were analysed and used to \n\n\n\nsupport the descriptive data from the survey. \n\n\n\n\n\n\n\nRESULTS  \n \n\n\n\nOut of 116 students, 63 students responded to the survey. \n\n\n\nForty-four respondents (69.8%) were female students and 19 \n\n\n\n(30.2%) were male. The results in Table 2 showed that over \n\n\n\n95% thought the online quizzes were more fun, enhanced their \n\n\n\nlearning and were more effective than the traditional in-class \n\n\n\nquiz. Interestingly, 95.9% of respondents believed that online \n\n\n\nTable 2: A survey on students' perception of learning based on the gamified online quiz. \n\n\n\n\n\n\n\nSurvey \nNumber that agreed or \n\n\n\nstrongly agreed \nPercentage \n\n\n\nQ1. The online quiz makes learning more fun than the traditional, in-class quizzes.   56 96.6 \n\n\n\nQ2. Unlike traditional quiz, I can take the quiz repeatedly. These have enhanced my learning in the \n\n\n\ncourse.   \n56 96.6 \n\n\n\nQ3. Unlike traditional quiz, the online quizzes were held after class - in the evenings between 8-10 pm. \nThese have enhanced my learning in the course.   \n\n\n\n47 95.6 \n\n\n\nQ4. Unlike traditional quiz, the online quiz allows a fixed amount of time (often 5 - 30 seconds) for a \n\n\n\nquestion. This has enhanced my learning in the course.   \n23 56.1 \n\n\n\nQ5. Unlike traditional quiz, the online quiz is based on speed and accuracy of your answers. This has \n\n\n\nenhanced my learning in the course.   \n29 70.7 \n\n\n\nQ6. Unlike traditional quiz, the online quiz displays the scoreboard of you and your classmates. This has \n\n\n\nenhanced my learning in the course.   \n22 68.7 \n\n\n\nQ7. Unlike traditional quiz, the online quiz displays memes and funny quotes. This causes distractions \nfor my learning.   \n\n\n\n14 29.8 \n\n\n\nQ8. Unlike traditional quiz, the online quiz offers flexibility. It can be taken anytime, anywhere as long \n\n\n\nas there is internet. This does not help my learning at all.   \n21 39.6 \n\n\n\nQ9. Unlike traditional quiz, the online quiz is entirely based MCQs, and therefore is so easy.   17 43.6 \n\n\n\nQ10. In the online quiz, a variety of questions of different difficulties (easy, medium and hard) were \n\n\n\nposted. These have enhanced my learning in the course.   \n54 98.2 \n\n\n\nQ11. The online quiz makes learning more effective than the traditional, in-class quizzes.   55 96.5 \n\n\n\nQ12. The post-online quiz discussion held by lecturer(s). This activity has enhanced my learning in the \n\n\n\ncourse.   \n58 98.3 \n\n\n\nQ13. Taking the online quiz has made it easy for me to remember concepts, principles about medicinal \n\n\n\nchemistry.   \n55 98.2 \n\n\n\nQ14. I prefer the traditional 1 hour quiz in class. Online quiz does not work for me.   5 7.9 \n\n\n\n \n\n\n\n\n\n\n\n\nA.S. Abdul Rahim et al. Malaysian Journal of Pharmacy 6 (1) 2020 \n\n\n\n\n\n\n\n10 \n\n\n\n\n\n\n\nquizzes in the evenings helped to enhance their learning, \n\n\n\neffectively uses the notional student learning time (SLT). \n\n\n\nAbout 98% indicated that taking the online quizzes made it \n\n\n\neasy for them to remember concepts and principles in \n\n\n\nmedicinal chemistry. Similarly, 98.3% felt that their learning \n\n\n\nwas further enhanced when post-quiz discussions were held. \n\n\n\nBecause the online quizzes were conducted in the evenings, the \n\n\n\nlimited daytime lecture slots were not compromised; instead \n\n\n\nthey were used for post-quiz discussions. Somewhat 39.6% \n\n\n\nagreed or strongly agreed that the \u2018anytime, anywhere\u2019 \n\n\n\nflexibility of taking the online quiz did not help their learning.   \n\n\n\n\n\n\n\nThe web-based quiz used in this course, Quizizz, employs game \n\n\n\nelements e.g. points, live ranking and scoreboard, memes and \n\n\n\nfunny quotes to inject fun and motivate students by rewarding \n\n\n\nthem based on the speed and accuracy of their answers. Two-\n\n\n\nthirds of the respondents disagreed that memes and funny \n\n\n\nquotes cause distractions. When queried about the gamification \n\n\n\nfeatures, specifically on the duration set per questions, varying \n\n\n\nbetween 5-30 seconds, about 56.1% of respondents felt that the \n\n\n\nfixed duration contributed towards enhancing their learning; \n\n\n\nwhereas 70.7% thought speed and accuracy did help their \n\n\n\nlearning. Additionally, 68.7% of the respondents indicated that \n\n\n\nhaving the scoreboard helped their learning.  \n\n\n\n\n\n\n\nStudies have shown that game mechanics e.g. scoreboards, \n\n\n\nrewards and rankings encourage engagement in learners and \n\n\n\nprovide social comparisons, thus may influence students\u2019 \n\n\n\nmotivation and performance (30).  Regarding having the quiz \n\n\n\nin multiple choice questions (MCQ), 43.6% felt it was easy, but \n\n\n\nthe majority thought that having a variety of questions of \n\n\n\ndifferent difficulties (easy, medium and hard) helped to \n\n\n\nenhance learning in the course. Overall, the majority of \n\n\n\nstudents prefer gamified online quizzes to traditional in-class \n\n\n\nquiz.  \n\n\n\n\n\n\n\nDISCUSSION  \n \n\n\n\nThe value of game-based quiz for learning has been well-\n\n\n\ninvestigated recently in higher education settings (2,31\u201333). \n\n\n\nTraditional in-class quizzes, closed or open-book, have been \n\n\n\nroutinely used as a summative assessment. Instructors may or \n\n\n\nmay not discuss the quiz questions. On the other hand, an open-\n\n\n\nbook quiz seems to reduce anxiety, puts less weight on \n\n\n\nmemorisation, encourages deeper engagement with the course \n\n\n\nmaterials and is more realistic as it mimics the real-life working \n\n\n\nenvironment (33). Taking a step further, when learning, \n\n\n\nformative assessment and game elements are combined, it \n\n\n\ncould potentially enhance student engagement in the course, \n\n\n\nencouraging learning without threatening esteem (30,34). To \n\n\n\nthis end, many interactive response systems or similar have \n\n\n\nbeen shown to promote active learning and peer instruction in \n\n\n\nlectures (32,35\u201338). \n\n\n\n\n\n\n\nThe survey results of student perceptions are further supported \n\n\n\nby voluntary written student feedback using the same survey \n\n\n\nand on the closed Facebook group of the course. Table 3 lists \n\n\n\nthe total number of positive comments (10 comments) which \n\n\n\noutnumbered the negative aspects (1 comment).  \n\n\n\n\n\n\n\nAmong the positive comments, many mentioned \u201chaving fun \n\n\n\nduring gamified online quizzes\u201d; discussing and learning from \n\n\n\ntheir friends; felt that they could remember better; get quick \n\n\n\nfeedback and learn from their mistakes. Gamified quiz reframes \n\n\n\nfailure as an essential part of the learning process, thus, \n\n\n\npromoting resilience in learners (23). Some students also \n\n\n\nsuggested this online quiz be implemented in other courses, \n\n\n\nwhile expressing concerns for not having enough time to learn \n\n\n\nand improve their scores in a 1-hour quiz.   \n\n\n\n\n\n\n\nTable 3: Comments from students from the survey and Facebook \n\n\n\n\n\n\n\n\n\n\n\nPositive comments of the gamified online quizzes were  \n\u2022 New way of learning was exciting!  \n\n\n\n\u2022 I wish every quiz is conducted this way. \n\n\n\n\u2022 This approach makes me remember better.  \n\n\n\n\u2022 This is my first time in life having fun while answering quizzes.  \n\n\n\n\u2022 Good as in online quiz is done with flexibility and can be \n\n\n\ndiscussed with friends.  \n\n\n\n\u2022 We can learn in a fun and relaxing way via online quizzes. Do \n\n\n\nit for all subjects.  \n\n\n\n\u2022 I really love this online quiz! Especially when we can learn \n\n\n\nfrom our mistakes and correct them on the spot. I'm looking \n\n\n\nforward to the next quiz!  \n\n\n\n\u2022 I really have fun doing this quiz! This helps me remember \n\n\n\nbetter\u2013l love the avatars.  \n\n\n\n\u2022 This quiz was very fun doing in a group. Really learnt a lot from \n\n\n\nour own mistakes. Thanks for this fun and worthy online quiz! \n\n\n\nLooking forward to the next online quiz!  \n\n\n\n\u2022 Online quiz is much better than traditional quiz. I tend to learn \n\n\n\nfrom my mistakes. Unlike traditional ones, we have the chance \n\n\n\nto attempt more than once and therefore, learning from our \nmistakes.  \n\n\n\n\n\n\n\n\n\n\n\nNegative comments of the gamified online quizzes were  \n\u2022 Just a suggestion regarding the duration of quiz, I think it \n\n\n\nshould be extended to 1.5-2 hours so that students have more \n\n\n\ntime to think and choose the right answer to each question.  \n\n\n\n\n\n\n\n\n\n\n\nInformal interviews with students \n\n\n\n\n\n\n\nTo gain an insight into how the students took the gamified \n\n\n\nonline quizzes, informal interviews were conducted with \n\n\n\nseveral students. The students revealed that they worked in \n\n\n\ngroups. The group size increased from small (3-4 students) to \n\n\n\nlarge (9-10 students) as the quiz progressed. They further \n\n\n\nrevealed that before the start of the quiz, they had all the study \n\n\n\nmaterials (books, lecture notes, mobile phones and tablets\u2013at \n\n\n\nhand) ready. When the quiz began, they would attempt the \n\n\n\nquestions as individuals. If they were unable to answer the \n\n\n\nquestions, they paused and checked with their group mates, \n\n\n\n\n\n\n\n\nA.S. Abdul Rahim et al. Malaysian Journal of Pharmacy 6 (1) 2020 \n\n\n\n\n\n\n\n11 \n\n\n\n\n\n\n\nread the materials and scanned the internet for answers. Since \n\n\n\ntime is the essence, if they still could not find an answer they \n\n\n\ntend to continue without submitting an answer. Such response \n\n\n\nis allowed in Quizizz. These were most apparent in the first half \n\n\n\nhour of the quiz as reported by the analytics.  \n\n\n\n\n\n\n\nAs the quiz progressed, the first instructor learned that the \n\n\n\ninstant feedback was helpful to student in checking their \n\n\n\nconceptions. Once the correct or wrong answers were noted \n\n\n\ndown, discussions ensued with them continuing to learn from \n\n\n\ntheir own mistakes and others. The anecdotes support the \n\n\n\nnotion that gamified quiz promotes informal, peer learning \n\n\n\noutside classroom during the notional SLT.  \n\n\n\n\n\n\n\nPost-quiz discussions  \n\n\n\n\n\n\n\nPost-quiz discussions are an effective form of intervention; \n\n\n\nthese were made during lecture hours. The discussions were \n\n\n\nbased on the analytics generated by Quizizz, which provides a \n\n\n\ndownloadable colour-coded Excel table displaying answers in \n\n\n\ngreen (correct) and red (wrong) as shown in Figure 2.  \n\n\n\n\n\n\n\nThe report helps instructors to quickly pick the questions that \n\n\n\nneeded further clarification and corrections during the post-\n\n\n\ndiscussions. The analytics can also be used as starting points \n\n\n\nfor deeper discussions during the lecture hours. Informal chats \n\n\n\nwith students revealed that this form of intervention is rarely \n\n\n\nconducted in the traditional quiz and large classroom settings, \n\n\n\nwhere formative assessment tend to be overlooked (39,40).  It \n\n\n\nis, therefore, no surprise that 98% of respondents felt the post-\n\n\n\nquiz discussions enhanced their learning (survey item 12). \n\n\n\n\n\n\n\nLimitations of the study \n\n\n\n\n\n\n\nThe online quiz has its limitations; it invites the possibility of \n\n\n\ncheating, particularly the identity of the participants. Cheating \n\n\n\ncan be minimised by assigning unique student names. \n\n\n\nNonetheless, it could have been answered by the same student \n\n\n\nusing 2-3 assigned names, or even by a random person. Having \n\n\n\nsupervised online quizzes could have prevented cheating. \n\n\n\nUnder another course at the School, a similar online quiz using \n\n\n\nElearn@USM, the university\u2019s Moodle-based learning \n\n\n\nmanagement system, had been administered at a computer lab \n\n\n\nin the School. Since the capacity of the computer lab is limited \n\n\n\nto about 50-60 students, the online quiz had to be conducted in \n\n\n\ntwo consecutive sessions. When one group of students was \n\n\n\ntaking the quiz, the other group was being quarantined until the \n\n\n\nfirst group finished. Even though cheating was prevented in this \n\n\n\ncase, conducting such quiz placed greater burden on staffing, \n\n\n\nfacilities and timetabling. \n\n\n\n\n\n\n\nAnother limitation for such online quiz is stable internet \n\n\n\nconnectivity, which is stated as one of the rules in the Table 1. \n\n\n\nStudents are able to access stable Wi-Fi or cable internet \n\n\n\nprovided by the university, on-campus or at student \n\n\n\naccommodation; though, at times overloaded servers may \n\n\n\naffect the internet connectivity. In one instance, a student \n\n\n\nreported that she was unable to log into the online quiz using \n\n\n\nher laptop browsers. She had to switch to her phone using own \n\n\n\ndata plan to attempt the quiz. She finished her third attempt past \n\n\n\nthe deadline. Allowance for time provides a space for any \n\n\n\ntechnical difficulties and helps increase student familiarity with \n\n\n\ntechnology. This incident highlights the importance of time, \n\n\n\nwhich should be included as a part of the design of an online \n\n\n\nquiz or any assessment using a digital tool and platform. \n\n\n\n\n\n\n\nCONCLUSION  \n  \n\n\n\nThe objective of this initial study was to find out the students\u2019 \n\n\n\nperceptions on the employment of gamified online quizzes in a \n\n\n\nmedicinal chemistry course as an alternative to traditional pen-\n\n\n\nand-paper quiz. Overall students\u2019 perceptions towards the \n\n\n\nemployment of online quizzes were extremely positive. For \n\n\n\ninstructors, it provides an efficient way to conduct formative \n\n\n\nassessments throughout the course.  \n\n\n\n\n\n\n\nAdditionally, the gamified quiz environment promotes \n\n\n\ninformal, active and collaborative learning outside lecture \n\n\n\nhours. Students strongly indicated that receiving instant \n\n\n\nfeedback, learning from mistakes and post-quiz discussions are \n\n\n\nthree key factors that enhanced their learning. They also \n\n\n\nrecommended the adoption of the gamified online quiz in other \n\n\n\ncourses in the pharmacy curriculum and could serve as an \n\n\n\nalternative to traditional quiz. A comparison between gamified \n\n\n\nand non-gamified online quizzes would be explored in the \n\n\n\nfuture. \n\n\n\n\n\n\n\nConfronted with multiple lockdowns and remote teaching \n\n\n\nduring the Covid-19 pandemic, adoption of alternative forms of \n\n\n\nassessment in higher education settings using digital tools and \n\n\n\nplatforms are inevitable and on-going. With careful planning, \n\n\n\ndesign and selection of digital tools, gamified online quizzes \n\n\n\ncan promote and sustain active and collaborative learning for \n\n\n\ndeeper engagement and social resilience in 21st century \n\n\n\npharmacy education. \n  \n\n\n\nACKNOWLEDGMENTS  \n  \n\n\n\nThe authors wish to thank all students who had participated in \n\n\n\nthe survey and the online quizzes. \n\n\n\n\n\n\n\nCONFLICT OF INTEREST \n  \n\n\n\nThe authors declare no conflict of interest. This research did \n\n\n\nnot receive any specific grant from funding agencies in the \n\n\n\npublic, commercial or not-for-profit sectors. \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nA.S. Abdul Rahim et al. Malaysian Journal of Pharmacy 6 (1) 2020 \n\n\n\n\n\n\n\n12 \n\n\n\n\n\n\n\nREFERENCES  \n \n\n\n\n1.  Koutromanos G, Avraamidou L. The use of mobile games in formal \nand informal learning environments: A review of the literature. EMI \n\n\n\nEduc Media Int. 2014;51(1).  \n\n\n\n2.  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Innov Educ Teach Int. 2014;51(1).  \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Volume 6 Issue 1 December 2020 \n \n\n\n\n\n\n\n\n13 \n\n\n\n\n\n\n\n*Corresponding author:  \n\n\n\nLee Kah Seng \n\n\n\nEmail: ksl.pharm@gmail.com \n\n\n\n\n\n\n\n\n\n\n\n1Faculty of Pharmacy, University of Cyberjaya, Cyberjaya, Selangor, \n\n\n\nMalaysia  \n2Pharmaceutical Services Division, Penang State Health Department, \n\n\n\nPenang, Malaysia \n3Pharmaceutical Services Division, Kelantan State Health Department, Kota \n\n\n\nBharu, Malaysia \n4Institute of Pharmaceutical Sciences, University of Veterinary and Animal \n\n\n\nSciences, Lahore, Pakistan \n5Faculty of Pharmacy, Universiti Teknologi MARA, Puncak Alam, Selangor, \n\n\n\nMalaysia \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n \nOriginal Research Article \n \n\n\n\nFolk Songs for Health Education: A Qualitative Exploratory \n\n\n\nStudy among Public and Pharmacy Enforcement Officers  \n \n\n\n\nKah Seng Lee1*, Muthu Kumar Murugiah2, Mohammad Aswady Adenan3, Tahir Mehmood Khan4,  \n\n\n\nChin Fen Neoh5, Yaman Walid Kassab1, Nur Akmar Taha1 and Zainol Akbar Zainal1 \n \n\n\n\n  \nArticle Info  \n\n\n\n \nReceived date: 16 Dec 2020 \n\n\n\nAccepted date: 28 Dec 2020 \n\n\n\nPublished date: 31 Dec 2020  \n\n\n\n\n\n\n\nKeywords:  \n\n\n\nDikir Farmasi, regulatory \n\n\n\naffair, health promotion, \n\n\n\nentertainment education   \n\n\n\nABSTRACT  \n\n\n\n\n\n\n\nDikir Farmasi (DF) is a new effort to expand and intensify the dissemination of information about \n\n\n\nthe regulation of the legitimate use of drugs and cosmetics. This study was aimed to explore the \n\n\n\nopinions of Pharmacy Enforcement Division staff and the general public regarding the quality and \n\n\n\nimpact of DF program as a health promotion tool in Malaysia. A qualitative study using semi-\n\n\n\nstructured interviews and focus group discussions (FGDs) were conducted at the Pharmacy \n\n\n\nEnforcement Department and three health clinics located at the city of Kota Bharu, Malaysia. The \n\n\n\ninterviews were audio recorded, translated and transcribed. Thematic analysis was performed to \n\n\n\nidentify the themes and sub-themes of the transcripts. Ethical approval was obtained from Ministry \n\n\n\nof Health Malaysia. All respondents provided a written consent for participation. Nine pharmacy \n\n\n\nofficers and 23 general public participated in this study. Five main themes emerged from the \n\n\n\ninformation gathered and analyzed: 1) language; 2) design; 3) content and delivery 4) costs and \n\n\n\nbenefits and 5) prospect of DF. Certain weaknesses of DF have been raised and the health authorities \n\n\n\ncould utilize this information for an improvement. Significant effort must be made to improve the \n\n\n\npublicity and dissemination of DF to ensure that it reaches the target population. Certain weaknesses \n\n\n\nof DF have been raised and the health authorities could utilize this information for an improvement. \n\n\n\nSignificant effort must be made to improve the publicity and dissemination of DF to ensure that it \n\n\n\nreaches the target population.    \n\n\n\n\n\n\n\n\n\n\n\nINTRODUCTION  \n\n\n\n\n\n\n\nHealth promotion is defined as \u201cthe process of enabling people \n\n\n\nto increase control over, and to improve, their health\u201d.[1] \n\n\n\nCommunicative acts, namely health communication, are \n\n\n\ndeemed as intervention efforts which are instrumental to \n\n\n\nchange public health promotion behaviors.[2] \n\n\n\n\n\n\n\nHealth messages nowadays are often conveyed in a complex \n\n\n\nmanner via electronic multi-media. People with low health \n\n\n\nliteracy particularly face difficulties in comprehending these \n\n\n\nmessages as they often lack of essential health-related \n\n\n\nbackground knowledge hindering them from understanding \n\n\n\nimportant information. [3, 4] This is aggravated by the fact that \n\n\n\nthese people can be chronically ill and less engaged in health \n\n\n\npreventive services.[5, 6] To convey heath messages \n\n\n\neffectively, strategic health communication techniques are \n\n\n\nimperative. One such techniques is entertainment education \n\n\n\n(EE).[7, 8]  \n\n\n\n\n\n\n\nEE embeds pro-social messages into entertainment programs to \n\n\n\ninfluence public attitudes, awareness and behaviors. [9] EE \n\n\n\noffers appealing stories where messages are imparted through \n\n\n\nprominent characters delivering interesting plots of which is \n\n\n\nnot usually found in the traditional persuasive models.[10] \n\n\n\n\nmailto:ksl.pharm@gmail.com\n\n\n\n\n\n\nK.S. Lee et al. Malaysian Journal of Pharmacy 6 (1) 2020 \n\n\n\n\n\n\n\n14 \n\n\n\n\n\n\n\nIn Malaysia, the Pharmacy Enforcement Department of \n\n\n\nKelantan has taken initiatives to promote health education via \n\n\n\na traditional musical form dikir barat, an innovative EE \n\n\n\napproach by introducing Dikir Farmasi (DF) as a means to \n\n\n\npromote health awareness to the public.[11] DF is a new effort \n\n\n\nto expand and intensify the dissemination of information about \n\n\n\nthe regulation of the legitimate use of drugs and cosmetics. The \n\n\n\njuxtaposition of elements of entertainment with an educational \n\n\n\nmessage facilitates pharmacy related messages to be \n\n\n\ncommunicated in a livelier manner. The DF project has been \n\n\n\ncreated to reach out to the Kelantanese people whom deem \n\n\n\ndikir barat as a popular local art, commonly performed during \n\n\n\nfestive and wedding celebrations.[12] In the early 90s, dikir \n\n\n\nbarat was an edutainment. [8]  It was is utilized as a vehicle for \n\n\n\nsocial commentary, to stimulate discussion on current issues \n\n\n\nand scenarios.[11, 13, 14]  \n\n\n\n\n\n\n\nDF combines the elements of dikir barat (a type of traditional \n\n\n\nfolk song rhythm) and traditional sketches from the state of \n\n\n\nKelantan, Malaysia.[15] The DF music album, entitled \u201cLet\u2019s \n\n\n\nuse registered medicine\u201d was produced in June 2011, \n\n\n\nconsisting of four sketches, namely 1) \u201cProcessing of illegal \n\n\n\ndrugs\u201d, 2) \u201cIntroduction to the service of the enforcement unit\u201d, \n\n\n\n3) \u201cRegistration of medication\u201d, and 4) \u201cIllegal cosmetics\u201d, as \n\n\n\nwell as three dikir songs, namely 1) \u201cUnderstanding the service \n\n\n\nof pharmaceutical services\u201d; 2)\u201cKnow your medication\u201d, and \n\n\n\n3) \u201cDrug information\u201d.(9)  The animation drama sketches and \n\n\n\nthe lyrics of songs were produced by the enforcement officers \n\n\n\nfrom the Protection and Consumer Awareness Unit. DF has \n\n\n\nbeen disseminated in the form of theatre performance, \n\n\n\nexhibition, social and printed media as well as through the \n\n\n\ninternet (YouTube) and , official Ministry of Health \n\n\n\nwebsite.[12, 16, 17], Google-Play.[15, 18, 19]The VCDs and \n\n\n\nCDs have been distributed to every health facilities department, \n\n\n\nto taxi drivers, bus conductors, hyper-malls, as well as to other \n\n\n\ngovernment agencies within the state of Kelantan.  \n\n\n\n\n\n\n\nTo the authors\u2019 best knowledge, no documented literature has \n\n\n\nbeen reported about the impacts of the DF public educational \n\n\n\ncampaign. This present study explores the opinions of \n\n\n\nPharmacy Enforcement Division staff and the general public in \n\n\n\nKelantan state of Malaysia. It elucidates the effectiveness and \n\n\n\nshortfalls of DF as health promotional tool and gather thoughts \n\n\n\nand suggestions for improving the program.  \n\n\n\n\n\n\n\n\n\n\n\nMETHOD  \n  \n\n\n\nStudy design \n\n\n\n\n\n\n\nQualitative study utilizing semi-structured interviews and focus \n\n\n\ngroups discussions (FGD). \n\n\n\n\n\n\n\nInclusion criteria:  \n\n\n\ni) Pharmacy enforcement officers at Kelantan Pharmacy \n\n\n\nEnforcement Department.  \n\n\n\nii) The general public:  \n\n\n\n\u2022 Kelantanese  \n\n\n\n\u2022 18 years old or above \n\n\n\n\u2022 With previous exposure to the DF programs  \n\n\n\n\n\n\n\nThe exclusion criteria are those not able to understand standard \n\n\n\nMalay and Kelantanese Malay languages and individuals who \n\n\n\nrefuse giving informed consent.  \n\n\n\n\n\n\n\nSetting \n\n\n\n\n\n\n\nThree health clinics in Kota Bharu, Kelantan were selected due \n\n\n\nto high daily frequency of patients' visit and diverse patients' \n\n\n\nstatistics in terms of gender, age and area of residence.  \n\n\n\n\n\n\n\nSampling \n\n\n\n\n\n\n\nUsing the convenience sampling method, the public \n\n\n\nparticipants were identified and approached to join the study by \n\n\n\na field researcher at the health clinics. The participants were \n\n\n\nrecruited until no new themes emerged from the interviews. \n\n\n\n\n\n\n\nStudy procedure \n\n\n\n\n\n\n\nNine pharmacy officers were included. 40 public individuals \n\n\n\nwere invited, 25 were interested to participate.  However, 2 out \n\n\n\nof 25 failed to participate due to busy routine. Participants were \n\n\n\nbriefed about the aim of study, researcher who did not represent \n\n\n\nany governmental agency and affiliate with DF program, their \n\n\n\nright to express and to withdraw from study with no penalty, \n\n\n\ngoody bag containing a T-shirt and a souvenir as \n\n\n\ncomplementary gifts. The study receives Ethical approval from \n\n\n\nthe Medical Research and Ethics Committee, Ministry of \n\n\n\nHealth Malaysia (NMRR-15-1041-23897). All volunteers had \n\n\n\nto provide an written informed consent form before \n\n\n\nparticipating in this study.  \n\n\n\n\n\n\n\nData Collection \n\n\n\n\n\n\n\nInterviews of pharmacy officers were conducted individually in \n\n\n\na private room at the Kelantan Pharmacy Enforcement \n\n\n\nDepartment. Focus group discussions and semi-structured \n\n\n\ninterviews were conducted with general public. Focus group \n\n\n\nparticipants were divided into three groups; two groups of \n\n\n\nadults and one group of high-school students (7-9 per group).  \n\n\n\n\n\n\n\nThe semi-structured interviews were conducted based on a \n\n\n\nprewritten interview guide, a schematic presentation of \n\n\n\nquestions or topics. The semi-structured interview guide were \n\n\n\ndeveloped through two rounds of panel discussion involving \n\n\n\npharmacy lecturer, personnel that involved in DF and two \n\n\n\neducation lecturers that had watched DF videos. The same \n\n\n\ninterview guide was used for both officers and the general \n\n\n\npublic. All the interviews and FGDs were carried out in \n\n\n\nseparate rooms. Each semi-structured interview lasted 40-60 \n\n\n\nminutes. Interviewees were encouraged to express additional \n\n\n\nviews at end of the interview.  \n\n\n\n\n\n\n\n\nK.S. Lee et al. Malaysian Journal of Pharmacy 6 (1) 2020 \n\n\n\n\n\n\n\n15 \n\n\n\n\n\n\n\nInterviewers' Background \n\n\n\n\n\n\n\nThe interviews were conducted by researchers with PhD and \n\n\n\nhave more than 5 years clinical and research experience. They \n\n\n\nhave been trained to conduct semi-structured interviews, \n\n\n\nqualitative research and thematic analysis. The research team \n\n\n\ncomprised of health administration and law enforcement \n\n\n\nofficers, academician and researchers.  \n\n\n\n\n\n\n\nData processing and analysis \n\n\n\n\n\n\n\nAll interviews and FGDs were audio recorded. The information \n\n\n\nwas translated into English by two experienced translators. A \n\n\n\nthird researcher (SB) was appointed to compare the audio-\n\n\n\nrecorded interviews and FGDs information against the \n\n\n\ntranscribed written copies. No field notes were taken.  \n\n\n\n\n\n\n\nThematic content analysis was used to identify patterns or \n\n\n\nregularities within the data. [16, 17] Two researchers \n\n\n\nindividually free coded the verbatim transcripts line by line. All \n\n\n\nsentences with the same code were reviewed to ensure \n\n\n\nconsistency of interpretation and to confirm additional coding \n\n\n\nlevels are needed. Homogeneity and heterogeneity between the \n\n\n\ncodes were assessed and had them grouped into a hierarchical \n\n\n\ntree structure. The interviews of pharmacy officers were coded \n\n\n\nseparately by another researcher. Similarly, the FGDs and the \n\n\n\ninterviews of general public were coded separately by two \n\n\n\nother researchers. All coded data was then reviewed \n\n\n\nindependently to determine inter-rater agreement. All \n\n\n\ndisagreements were discussed until a consensus was reached. \n\n\n\nNew codes were created, to capture the meaning of groups of \n\n\n\ninitial codes. This process resulted in a tree structure with \n\n\n\nseveral layers.  \n\n\n\n\n\n\n\nRepresentative participant quotes have been provided and the \n\n\n\nstudy results have been reported following the Consolidated \n\n\n\nCriteria for Reporting Qualitative Research (COREQ) \n\n\n\nchecklist.[20] (see supplementary file). \n\n\n\n\n\n\n\nRESULTS  \n \n\n\n\nAfter interviewing nine pharmacy officers (3 men; 6 women, \n\n\n\nwith a mean age of 30.3 years) from the Kelantan Pharmacy \n\n\n\nEnforcement Department, and 23 participants ((15 males; 8  \n\n\n\n\n\n\n\nfemales, with a mean age of 30.61 years) from the general \n\n\n\npublic, two researchers reached a consensus that saturation had \n\n\n\nbeen met. Five main themes were identified: 1) language ; 2) \n\n\n\ndesign ; 3) content and delivery ; 4) costs and benefits and 5) \n\n\n\nprospects of DF. Table 1 and 2 outlined the demographic \n\n\n\ninformation of the pharmacy officers and the general public \n\n\n\nparticipants, respectively. \n\n\n\n\n\n\n\n1. Language of DF \n\n\n\n\n\n\n\n1.1. Understandability \n\n\n\n\n\n\n\nDF is a health-information medium where information \n\n\n\nincluded should be direct and the language employed \n\n\n\nuncomplicated. For verification, respondents were asked if they \n\n\n\nfaced difficulties in understanding the DF contents. All \n\n\n\nrespondents, including the students, did not face problem in \n\n\n\nunderstanding the language since they are Kelantanese or \n\n\n\nresidents of Kelantan. Respondents expressed that the DF \n\n\n\ninformation could not be instantly grabbed at the first exposure.  \n\n\n\n\n\n\n\n1.2. Language as a barrier for non-Kelantanese  \n\n\n\n\n\n\n\nBoth pharmacy officers and the general public expressed \n\n\n\nconcern about the ability of non-Kelantanese to understand the \n\n\n\nKelantanese dialect. The respondents were however not keen \n\n\n\nto use standard Malay language claiming that if DF is expressed \n\n\n\nin non-Kelantanese dialect, DF will lose its charm. The use of \n\n\n\nMalay subtitles was recommended instead.  \n\n\n\n\n\n\n\n2. DF Design  \n\n\n\n\n\n\n\n2.1. Cultural significance    \n\n\n\n\n\n\n\nDF is culturally significant because the components used, dikir \n\n\n\nbarat and the sketches, are parts of Kelantanese cultural arts. \n\n\n\nHowever, one of the respondents indicated that DF as \n\n\n\nentertainment is not a new idea other than by means of modern \n\n\n\naudiovisual aids instead of traditional flyers.  \n\n\n\n\n\n\n\n2.2. The Dikir barat (songs) versus the sketches \n\n\n\n\n\n\n\nBoth the pharmacy officers and the general public preferred \n\n\n\nsketches over dikir as i) the sketches can be understood by all \n\n\n\nTable 1: Demographic information of the pharmacy officers \n \n\n\n\nID Age Gender Education Monthly household income (US Dollar) \n\n\n\nPO-1 29 Female Bachelor of pharmacy 1400-1700 \n\n\n\nPO-2 30 Female Bachelor of pharmacy 1400-1700 \n\n\n\nPO-3 31 Male Bachelor of pharmacy 1400-1700 \n\n\n\nPO-4 32 Female Bachelor of pharmacy 1400-1700 \n\n\n\nPO-5 30 Male Bachelor of pharmacy 1400-1700 \n\n\n\nPO-6 36 Female Master of pharmacy 1400-1700 \n\n\n\nPO-7 37 Female Bachelor of pharmacy 1400-1700 \n\n\n\nPO-8 35 Male Bachelor of pharmacy 1400-1700 \n\n\n\nPO-9 36 Male Bachelor of pharmacy 1400-1700 \n\n\n\n \n\n\n\n\n\n\n\n\nK.S. Lee et al. Malaysian Journal of Pharmacy 6 (1) 2020 \n\n\n\n\n\n\n\n16 \n\n\n\n\n\n\n\nage groups and by non-Kelantanese. ii) the visual effects of \n\n\n\nsketches felicitate learning.   \n\n\n\n\n\n\n\n2.3: Distracting nature of entertaining elements of DF \n\n\n\n\n\n\n\nUnlike pure entertainment, EE actively seek to change the \n\n\n\naudience\u2019s knowledge, attitude and behavior.21According to \n\n\n\nthe pharmacy officers and general public, the entertaining \n\n\n\naspects of DF hindered the delivery of educational messages.  \n\n\n\n\n\n\n\n3. DF content  \n\n\n\n\n\n\n\n3.1:  Length \n\n\n\n\n\n\n\nOfficers and certain public respondents highlighted that \n\n\n\nfrivolous elements such as unnecessary jokes or prelude scenes \n\n\n\nshould be minimized to reduce duration of DF videos. \n\n\n\n\n\n\n\n3.2: Additional content \n\n\n\n\n\n\n\nPharmacy legislations such as fines and punishment for \n\n\n\nconviction of offences should be included in DF to alert people \n\n\n\nfrom violating pharmacy-related laws. \n\n\n\n\n\n\n\nThe roles of Pharmacy Enforcement Division should be \n\n\n\nfeatured to promote public awareness and public-government \n\n\n\ncommunication on issues such as medicine registration.  \n\n\n\n\n\n\n\n3.3 Take-home message \n\n\n\n\n\n\n\nA mass media campaign cannot be effective unless the target \n\n\n\naudience is exposed to, attends to, and comprehends its \n\n\n\nmessage.22Through DF, the importance of medication \n\n\n\nregistration and administration methods were take-home \n\n\n\nmessages for the respondents.   \n\n\n\n\n\n\n\n4. Content and delivery  \n\n\n\n\n\n\n\n4.1: Poor dissemination and publicity \n\n\n\n\n\n\n\nDF has been in existence since 2009, but its implementation \n\n\n\nwas not as effective in accordance to officers and general public.  \n\n\n\n\n\n\n\n\u201cNo one has talked to me directly about matters regarding this \n\n\n\nDF. (PO-6)\u201d  \n\n\n\n\n\n\n\n \u201cErmm\u2026I\u2019m not sure\u2026because nobody has come to me and \n\n\n\nsay they know about DF. I never had such an encounter. I don\u2019t \n\n\n\nknow.(PO-3)\u201d \n\n\n\n\n\n\n\n \u201cThe dissemination is not widespread yet. It focuses more on \n\n\n\nthe urban areas and does not cover the rural areas. (R-16)\u201d \n\n\n\n\n\n\n\nCertain officers lamented that pharmacists lack awareness \n\n\n\nabout DF, so were some of them prior joining Pharmacy \n\n\n\nEnforcement Office. The pharmacists in the public and private \n\n\n\nsectors should be exposed to DF to enable them to translate the \n\n\n\nbenefits of DF to general public.   \n\n\n\n\n\n\n\n4.2: Communication mediums \n\n\n\n\n\n\n\nRespondents also highlighted internet connectivity and \n\n\n\naccessibility were barriers for general public to receive \n\n\n\ninformation of DF.  \n\n\n\n\n\n\n\n \u201cThe sketches have been available on YouTube\u00ae since 2011 \n\n\n\nbut they have only had 2000 views even though thousands of \n\n\n\nKelantanese are reported to have access to the internet. (R-2)\u201d \n\n\n\n\n\n\n\nRespondents expressed the need to have DF broadcasted \n\n\n\nthrough multiple communication mediums, such as social \n\n\n\nmedia, television, radio, billboards, and TV screen in \n\n\n\nsupermarket and pharmacies. \n\n\n\n\n\n\n\n4.3: The need for collaboration  \n\n\n\n\n\n\n\nCalls for collaboration between DF team and other parties, such \n\n\n\nas the National Antidrug Agency and the District or State \n\n\n\nEducation Department, were expressed. This is to equip school \n\n\n\nteachers with the more information on DF and to encourage DF \n\n\n\nlive performances in schools and universities.   \n\n\n\n\n\n\n\n4.4: Other recommendations \n\n\n\n\n\n\n\nMore promotional tours and educational events engaging \n\n\n\nyoung children should be conducted. Celebrity endorsements \n\n\n\nwere suggested by respondents. \n\n\n\n\n\n\n\n \u201cThis campaign should also start as early as in kindergarten \n\n\n\nbecause children are easier to educate than adults. (R-4)\u201d \n\n\n\n\n\n\n\n\u201cThe selection of performers is also important, for instance \n\n\n\nSabri Yunus. His fans will follow whatever he\u2019s doing. The \n\n\n\nsame goes for Halim Yazid. If other performers replace him \n\n\n\nthen the audience may not be interested to follow. (R-4)\u201d \n\n\n\n\n\n\n\n5. Costs and benefits \n\n\n\n\n\n\n\n5.1: Resources consumed \n\n\n\n\n\n\n\nCertain officers expressed concern about the cost effectiveness \n\n\n\nof DF. They doubted if the CDs distributed would be played. \n\n\n\nWhen applicable, one-to-one explanation and the use of apps \n\n\n\nwere recommended. Officers had also expressed the concern \n\n\n\nregarding the time and manpower that DF consumed, \n\n\n\nespecially for live performances requiring them to travel \n\n\n\ninterstates:  \n\n\n\n\n\n\n\n\u201cthe exhibitions really take too much of their time, and they \n\n\n\nalso have other jobs at their own stations...It\u2019s affecting their \n\n\n\nactual job. (PO-8)\u201d  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nK.S. Lee et al. Malaysian Journal of Pharmacy 6 (1) 2020 \n\n\n\n\n\n\n\n17 \n\n\n\n\n\n\n\n Table 2: Demographic information of the participants from general public \n\n\n\n\n\n\n\nID Age Gender Occupation Education Monthly \n\n\n\nhousehold \n\n\n\nincome \n\n\n\n(USD) \n\n\n\nLiving area \n\n\n\n(Rural/urban\n\n\n\n) \n\n\n\nCurrent \n\n\n\nmedical \n\n\n\nconditions \n\n\n\nMedicine received \n\n\n\nfrom \n\n\n\nNumber of \n\n\n\nmedicines \n\n\n\ncurrently taking \n\n\n\nInformation source on DF \n\n\n\nR-1 30 Male Government \n\n\n\nsector \n\n\n\nTertiary  240-480 Rural  NA Government NA Internet \n\n\n\nR-2 19 Female Student  Secondary NA Urban Allergy Private pharmacy 1 (yellow cream) NA \n\n\n\nR-3 25 Male Student Tertiary NA Urban NA Government health \n\n\n\nclinic \n\n\n\nNA Family/Friends \n\n\n\nR-4 32 Male Self-employed Secondary 240 Urban Asthma Pharmacy 1 Road banner/billboard \n\n\n\nR-5 30 Male Private sector Secondary 240 Rural None NA 1 (for cough) Family/ friends \n\n\n\nAdvertisement, internet, \n\n\n\nbrochure, banners \n\n\n\nR-6 20 Male Student  Tertiary NA Rural Allergic rhinitis Government clinic 0 Internet \n\n\n\nR-7 25 Male Self-employed Secondary  480-720 Urban None Government clinic NA Internet \n\n\n\nR-8 27 Male Self-employed Tertiary 240-480 Urban None NA NA Family/Friends \n\n\n\nR-9 30 Male Government \n\n\n\nsector  \n\n\n\nTertiary 240-480 Rural NA Government clinic NA Internet \n\n\n\nR-10 35 Female Government \n\n\n\nsector \n\n\n\nTertiary 480-720 Rural None Government hospital 0 Road tour \n\n\n\nR-11 18 Female Student Secondary NA Urban Short-\n\n\n\nsightedness \n\n\n\nPrivate hospital 2 Internet \n\n\n\nR-12 41 Male Self-employed Secondary 480-720 Rural None Government clinic \n\n\n\n/private pharmacy \n\n\n\n1 (Vitamin C) NA \n\n\n\nR-13 48 Female Housewife Secondary 240-480 Urban None Government /private \n\n\n\nclinic \n\n\n\n0 Family/friends \n\n\n\nR-14 19 Female Student Secondary 480-720 Urban None Hospital/Clinic 0 Teacher \n\n\n\nR-15 37 Female Self-employed Tertiary 1300 Urban None Hospital  0 Exhibitions \n\n\n\nR-16 35 Male Retired NA 240-480 Urban None None 0 Joint-performance with \n\n\n\nDikirFarmasi \n\n\n\nR-17 18 Female NA Secondary NA Urban Asthma NA NA Teacher \n\n\n\nR-18 43 Male Self-employed Secondary 1300 Urban None Government clinic 0 Family/friends \n\n\n\nR-19 37 Male Government Secondary 720-900 Rural Chronic back \n\n\n\npain \n\n\n\nGovernment hospital 3 Advertisement, Internet, \n\n\n\nBrochure \n\n\n\nR-20 40 Male Government NA 1300 Urban None Government \n\n\n\nhospital/Pharmacy \n\n\n\n0 Advertisement, Internet, \n\n\n\nBrochure \n\n\n\nR-21 23 Male Private Tertiary 240 Rural None None 0 Family/friends \n\n\n\nR-22 38 Male Government NA 480-720 Urban None None NA Advertisement, Internet, \n\n\n\nBrochure, banners, \n\n\n\nFamily/friends/ \n\n\n\nR-23 19 Female NA Secondary NA Urban Anemia Government clinic 0 Internet \n \n\n\n\n\n\n\n\n\nK.S. Lee et al. Malaysian Journal of Pharmacy 6 (1) 2020 \n\n\n\n\n\n\n\n18 \n\n\n\n\n\n\n\n\u201cif I have to do performance, have to join the performance, a \n\n\n\nlot of my time is being spent on training.. (PO-7)\u201d \n\n\n\n\n\n\n\n5.2: Behavioral change \n\n\n\n\n\n\n\nDF motivated general public to practise the health knowledge \n\n\n\nin their daily lives and to promoted behavioral change.  \n\n\n\nHowever, some respondents admitted failure in doing so.   \n\n\n\n\n\n\n\n\u201cThe information is very helpful but compliance to the \n\n\n\ninformation is difficult, especially among adults. (R-4)\u201d  \n\n\n\n\n\n\n\n\u201cDikir Farmasi is nice to listen to but to practice is the difficult \n\n\n\npart because I find it interesting to listen to but I don\u2019t practice \n\n\n\nthe knowledge. (R-5)\"   \n\n\n\n\n\n\n\nSome of the respondents, however, reported behavior change \n\n\n\nafter exposure to DF: \n\n\n\n\n\n\n\n\u201cBefore this I used to kept medication recklessly.... and didn\u2019t \n\n\n\nknow that medications can be contaminated. After listening to \n\n\n\nthe CD I will discard the medications. (R-7)\u201d  \n\n\n\n\n\n\n\n\u201cBefore this I used to buy medicines sold at the night market. \n\n\n\nI\u2019ve become more alert and check for registration of medicines \n\n\n\nafter being exposed to DF. (R-1)\u201d  \n\n\n\n\n\n\n\n6. DF Future \n\n\n\n\n\n\n\n6.1: Adaptability of DF over time \n\n\n\n\n\n\n\nThere were disagreements among the general public if DF \n\n\n\nshould adopt dikir or modern music.  \n\n\n\n\n\n\n\n\u201cThe suggestion to include K-Pop elements in dikir can be \n\n\n\nconsidered, but not to the point that the dikir loses its identity. \n\n\n\n(R-4)\u201d \n\n\n\n\n\n\n\nIn toto, the officers were given authority to fully promote DF. \n\n\n\nRespondents highlighted that further assessment on the impact \n\n\n\nand acceptance of DF among public needed to be conducted.  \n\n\n\nPessimistic comments to replace DF with new ideas were \n\n\n\nrecorded, although the options of replacements were not \n\n\n\nformulated:  \n\n\n\n\n\n\n\n\u201c\u2026.ermmm\u2026if I myself, ermm\u2026I will discontinue it, the dikir. \n\n\n\nBecause I myself, am not a huge fan of DF. Maybe\u2026think of \n\n\n\nother ideas\u2026.So far I cannot come up with other ideas. (PO-\n\n\n\n7)\u201d \n\n\n\n\n\n\n\n6.2: Impact and cost-effectiveness  \n\n\n\n\n\n\n\nThere is no known evidence investigating the impact versus \n\n\n\ncost effectiveness of the DF. No research reports the \n\n\n\nappropriateness and public acceptance level of DF. \n\n\n\n\n\n\n\nDISCUSSION  \n  \n\n\n\nThe aim of the study was to explore perspectives of nine \n\n\n\nPharmacy Enforcement Officers and reveal public perception \n\n\n\non DF. The findings of the study revealed that there is a trend \n\n\n\nin the field of health emphasizing on health promotion rather \n\n\n\nthan disease treatments.[20, 21] Health promotion incorporates \n\n\n\nappropriate self-management of medicine. Effective health \n\n\n\npromotion program requires to equip the public with relevant \n\n\n\nknowledge via health communications using advanced \n\n\n\ntechnologies.[20, 21] Officers need to be inculcated with \n\n\n\nappropriate health information for effective delivery to general \n\n\n\npublic.  \n\n\n\n\n\n\n\nAs reflected from the interviews, the Pharmacy Enforcement \n\n\n\nOfficers interviewed are apparently not able to appreciate the \n\n\n\nvalue of DF as a tool in health-promotion. Therefore, it is \n\n\n\nrecommended that the concept of health-promotion and how \n\n\n\nDF relates to it be discussed with the officers in helping them \n\n\n\nto appreciate the value and benefits of DF. It is worth \n\n\n\nmentioning that DF is available in both online and off-line and \n\n\n\na recent study indicated that both methods were found equally \n\n\n\neffective for delivering pharmacy education.[22] \n\n\n\n\n\n\n\nProper planning and evaluation of outcomes are important to \n\n\n\nensure the success of DF. Here we recommend the Precede-\n\n\n\nProceed Model.[23]The Precede-Proceed Model has been \n\n\n\nutilized in multiple preventive health promotion programs in \n\n\n\nAustralia including early health risk detection initiatives. Its \n\n\n\nsuccess has been validated through several rigorously \n\n\n\nevaluated clinical and field trials.[23]Basically, the model\u2019s \n\n\n\npremise is on rigorous population assessment prior to \n\n\n\ndevelopment of health intervention (Precede), and post-\n\n\n\nintervention evaluation (Proceed) to measure the effectiveness \n\n\n\nof the program. The study\u2019s findings point to some \n\n\n\nweaknesses of DF since the contents had not been subjected to \n\n\n\nthe Precede evaluation. DF is deemed to be too lengthy and \n\n\n\nthe entertainment elements are distracting. For example, the \n\n\n\nofficers lamented that DF activities are time-consuming and \n\n\n\ndisrupting to their other duties. To overcome this issue, we \n\n\n\nrecommend that a special portfolio be assigned to officers \n\n\n\nwhose scope of tasks are mainly focused on DF. This officer \n\n\n\nmay be given the responsibility of conducting the relevant \n\n\n\nresearch to assess the impact of DF. The appointed officer \n\n\n\nshould act as the head of all DF programs and attend all DF \n\n\n\nactivities to ensure smooth implementation. The majority of \n\n\n\nrespondents have generally pessimistic views on DF. Personal \n\n\n\nopinions do not necessarily reflect the objective reality as \n\n\n\npersonal views are dependent on the accuracy of the \n\n\n\nindividual\u2019s assessment. Contrary to what people tend to \n\n\n\nbelieve, personal views are often flawed due to biases that can \n\n\n\nprevent the people from arriving at accurate judgments or \n\n\n\ndecisions.[24] These biases may be attributed to the lack of \n\n\n\ninformation required to achieve accurate self-assessment. \n\n\n\nHowever, obtaining accurate information is not always an easy \n\n\n\nand straightforward task.[25] Effective communication \n\n\n\nstrategy is lacking in health education. The implementation of \n\n\n\n\n\n\n\n\nK.S. Lee et al. Malaysian Journal of Pharmacy 6 (1) 2020 \n\n\n\n\n\n\n\n19 \n\n\n\n\n\n\n\nstrategy should adopt theoretical framework that can adapt to \n\n\n\ncultural differences.[26-29] \n\n\n\n\n\n\n\nThis study also explored public\u2019s perception about DF. The \n\n\n\nrespondents lack exposure to DF despite the DF has been \n\n\n\npromoted in supermarket chains, private buses and taxis, 287 \n\n\n\nhealth facilities throughout Kelantan, the Ministry of Defence, \n\n\n\nthe Election Commission of Kelantan, the Department of \n\n\n\nInformation, the Universiti Malaysia Kelantan and Universiti \n\n\n\nTeknologi MARA Kelantan.[11] \n\n\n\n\n\n\n\nAnother main concern of the respondents was that information \n\n\n\nconveyed by DF may not translate into actual behavioral \n\n\n\nchange. The mass media are intensively employed in public \n\n\n\nhealth with vast sums spent annually for the production and \n\n\n\ndistribution of booklets, pamphlets, exhibits, newspaper \n\n\n\narticles, and radio and television programs in the hope that three \n\n\n\neffects might occur: the learning of correct health information, \n\n\n\nthe changing of health attitudes, and ultimately the change of \n\n\n\nbehavior. Changing behavior is the ultimate and highest \n\n\n\npriority in any public health campaign, but most of the mass \n\n\n\nmedia will change knowledge and awareness more easily than \n\n\n\nbehavior. [30] \n\n\n\n\n\n\n\nIn a meta-analysis, Shen et al. analyzed the results of 22 studies \n\n\n\nand concluded that EE messages had a significant small effect \n\n\n\non persuasion (r = .12) with a slightly stronger effect on health \n\n\n\nknowledge that on attitudes, intention, and behaviors. This \n\n\n\nsuggests that EE can be more effective in communication \n\n\n\nhealth-related information, especially in educating people \n\n\n\nabout a variety of health issues than changing attitudes and \n\n\n\nbehaviors.[10] \n\n\n\n\n\n\n\nStrengths and limitations of this study \n\n\n\n\n\n\n\nTo the best of our knowledge, no documented literature has \n\n\n\ninvestigated the conduct and organization of DF program (i.e. \n\n\n\nhealth promotion delivered in a pharmacy). In this study, a \n\n\n\ntotal of nine pharmacy enforcement officers from Kelantan \n\n\n\nPharmacy Enforcement Department and twenty three general \n\n\n\npublic participants from three different health clinics in Kota \n\n\n\nBharu, Kelantan presented multiple perspective regarding the \n\n\n\nquality and impact of DF. Two data collection methods (semi-\n\n\n\nstructured interviews and focus group discussions (FGDs)) \n\n\n\nwere used to generate data. \n\n\n\n\n\n\n\nIn term of weakness of the study, the respondents had only \n\n\n\nbeen interviewed once. Since DF is still being implemented, \n\n\n\nits progress still needs to be followed and the respondents \n\n\n\nshould be interviewed again after a specified timeframe to \n\n\n\nobserve for changes in their opinions. In addition, the team \n\n\n\nleader of DF has not been interviewed. The opinions of the \n\n\n\nteam leader will be valuable in order to have balanced views. \n\n\n\nThe second part of our study consisted of interviews of 23 \n\n\n\ngeneral public. While their opinions gave us very valuable \n\n\n\ninsights into different aspect of DF, they cannot represent and \n\n\n\nspeak for the whole population in Kelatan, Malaysia and other \n\n\n\nrural residents of Malaysia. Moreover, there is a chance that \n\n\n\nreporting bias exists since the interviews were conducted face-\n\n\n\nto-face which may have put some pressure on the respondents. \n\n\n\nFuture studies may include pharmacists from other settings \n\n\n\nsuch as hospital pharmacists or academician pharmacists since \n\n\n\nthey are also involved in health education and their opinions \n\n\n\ncan contribute to the betterment of DF. \n \n\n\n\nCONCLUSION  \n  \n\n\n\nDF represented an innovative health promotion platform for the \n\n\n\nKelantan Pharmacy Enforcement Division. It intensifies the \n\n\n\ndissemination degree of knowledge and information related to \n\n\n\ndrugs and cosmetics regulations to the public. In general, the \n\n\n\npublic has positive views on DF. This is reflected in their \n\n\n\nfavorable and optimistic comments on DF. However, certain \n\n\n\nweaknesses have been raised; significant effort must be made \n\n\n\nto improve the publicity and dissemination of DF to ensure that \n\n\n\nit reaches the target population and it is used to its optimum \n\n\n\npotential. The elements of entertainment and comedy provided \n\n\n\nextra value to education in an interesting and informal way. \n\n\n\nHowever, more research needs to be done in order to analyze \n\n\n\nthe actual impacts of DF and to evaluate its effectiveness versus \n\n\n\nits cost. It is hoped that DF can benefit from this study and more \n\n\n\ninnovations in health education are to be implemented in future. \n  \n\n\n\nACKNOWLEDGMENTS  \n  \n\n\n\nWe are thankful to Khadeeja Munawar, Long Chiau Ming, \n\n\n\nShahrzad Salmasi, Kong Chien Phang for interview \n\n\n\ntranscribing and language editing. \n\n\n\n\n\n\n\nCONFLICT OF INTERST \n  \n\n\n\nThe authors declare no conflict of interest.  \n\n\n\n\n\n\n\nREFERENCES  \n \n\n\n\n1. World Health Organisation, Milestones in Health Promotion: \nStatements from Global Conferences. 2009, WHO press: Geneva, \n\n\n\nSwitzerland  \n\n\n\n2. Rimal, R.N. and M.K. Lapinski, Why health communication is \nimportant in public health. 2009, World Health Organisation, . p. 247-\n\n\n\n247. \n\n\n\n3. Hamdan, N.K.A., et al., Knowledge and Perception of Facial Candling \nfor Allergic Rhinitis among University Staff and Students. Evidence-\n\n\n\nBased Complementary and Alternative Medicine, 2020. 2020. \n\n\n\n4. 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Kelantan State Health Department, Dikir Farmasi Mobile Application. \n\n\n\nAvailable from: \n\n\n\nhttps://play.google.com/store/apps/details?id=air.DikirFarmasi&hl=e\nn. Accessed 16 April 2016. 2015. \n\n\n\n20. Kickbusch, I.S., Health literacy: addressing the health and education \n\n\n\ndivide. Health Promot Int, 2001. 16(3): p. 289-97. \n21. Kickbusch, I., Think health: what makes the difference? Health \n\n\n\nPromot Int, 1997. 12(4): p. 265-272. \n\n\n\n22. Lean, Q.Y., et al., Online versus classroom learning in pharmacy \neducation: Students' preference and readiness. Pharmacy Education, \n\n\n\n2020. 20: p. 19-27. \n\n\n\n23. Ackerson, L.K. and K. Viswanath, The social context of interpersonal \ncommunication and health. J Health Commun, 2009. 14 Suppl 1: p. \n\n\n\n5-17. \n\n\n\n24. Schafer, T., A. Tipandjan, and P. Sedlmeier, The functions of music \nand their relationship to music preference in India and Germany. Int J \n\n\n\nPsychol, 2012. 47(5): p. 370-80. \n\n\n\n25. Singhal, A., et al., Entertainment-education and social change: \nHistory, research, and practice. 2003: Routledge. \n\n\n\n26. Sorensen, K., et al., Health literacy and public health: a systematic \n\n\n\nreview and integration of definitions and models. BMC Public Health, \n2012. 12: p. 80. \n\n\n\n27. Appelt, K.C., et al., The Decision Making Individual Differences \n\n\n\nInventory and guidelines for the study of individual differences in \n\n\n\njudgment and decision-making research. Judgment and Decision \n\n\n\nMaking, 2011. 6(3): p. 252. \n\n\n\n28. Glanz, K. and D.B. Bishop, The role of behavioral science theory in \ndevelopment and implementation of public health interventions. Annu \n\n\n\nRev Public Health, 2010. 31: p. 399-418. \n\n\n\n29. Sam, D.L. and J.W. Berry, Acculturation when individuals and groups \nof different cultural backgrounds meet. Perspectives on Psychological \n\n\n\nScience, 2010. 5(4): p. 472-481. \n30. Ting, C.Y., et al., A Cross-Sectional Study on the Use of, Preference \n\n\n\nfor, and Perceived Reliability of Mass Media for Drug-Related \n\n\n\nInformation Among the General Public in Sarawak. Therapeutic \n\n\n\nInnovation & Regulatory Science, 2016. 51: p. 1-9. \n\n\n\n\n\n\n\n \n\n\n\n\nhttp://www.pharmacy.gov.my/v2/en/videos/sketsa-iklan-ubat-dikir-farmasi-2.html\n\n\nhttp://www.pharmacy.gov.my/v2/en/videos/sketsa-iklan-ubat-dikir-farmasi-2.html\n\n\nhttp://www.youtube.com/watch?v=pl06Bd3HzR0\n\n\nhttp://www.pharmacy.gov.my/v2/en/content/pharmacy-enforcement-division.html\n\n\nhttp://www.pharmacy.gov.my/v2/en/content/pharmacy-enforcement-division.html\n\n\nhttp://www.pharmacy.gov.my/v2/en/videos/dikir-farmasi-jom-guna-ubat-berdaftar.html\n\n\nhttp://www.pharmacy.gov.my/v2/en/videos/dikir-farmasi-jom-guna-ubat-berdaftar.html\n\n\nhttp://jknkelantan.moh.gov.my/v3/modules/AMS/article.php?storyid=17\n\n\nhttp://jknkelantan.moh.gov.my/v3/modules/AMS/article.php?storyid=17\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Volume 6 Issue 1 December 2020 \n \n\n\n\n21 \n\n\n\n\n\n\n\n*Corresponding author:  \n\n\n\nJaasminerjit Kaur \n\n\n\nEmail: ucn.jaasminerjit@kpjuc.edu.my \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n1School of Pharmacy, KPJ Healthcare University College, Nilai, Negeri \n\n\n\nSembilan, Malaysia \n2Faculty of Pharmacy, University of Cyberjaya, Cyberjaya, Selangor, \nMalaysia \n3Faculty of Pharmacy, Universiti Teknologi MARA, Puncak Alam, \n\n\n\nSelangor, Malaysia \n4KPJ Seremban Specialist Hospital, Seremban 70200, Negeri Sembilan, \n\n\n\nMalaysia \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nOriginal Research Article \n\n\n\n\n\n\n\nUtilization Pattern of Lipid Modifying Agents in An \n\n\n\nOutpatient Pharmacy Department of a Private Hospital in \n\n\n\nMalaysia \n \n\n\n\nXin Xuan Cha1, Ching Siang Tan1, Shashidharan Menon1, H. Jaasminerjiit Kaur1*, Kah Seng Lee2, Mohamed \n\n\n\nMansor Manan3, Shafeeq Mohd Faizal4 \n \n\n\n\n\n\n\n\nArticle Info  \n\n\n\n \nReceived date: 16 Dec 2020 \n\n\n\nAccepted date: 30 Dec 2020 \n\n\n\nPublished date: 31 Dec 2020  \n\n\n\n\n\n\n\nKeywords:  \n\n\n\nPharmacoepidemiology, Statin, \n\n\n\ncardiovascular diseases, \n\n\n\nprescribing pattern, Defined \n\n\n\nDaily Dose  \n\n\n\n\n\n\n\nABSTRACT  \n\n\n\n\n\n\n\nIntroduction: Lipid-modifying drugs have been used to treat dyslipidemia as well as for the primary \n\n\n\nand secondary prevention of CVDs and stroke. Objectives: This study aims to describe the drug \n\n\n\nutilization pattern of lipid-modifying drugs in a private hospital. Method: A retrospective study was \n\n\n\ncarried out in outpatient of the selected hospital. Patients were selected based on inclusion and \n\n\n\nexclusion criteria by using convenience sampling. Data were collected through KCIS by retrieving \n\n\n\npatients\u2019 registration number. Defined daily dose (DDD) was calculated and compared to World \n\n\n\nHealth Organization DDD. Medicine prices were also analysed. Results: A total of 180 patients\u2019 \n\n\n\nrecord were analysed, 70% of them were male; 40.6% of the patients were from the age range of 50 \n\n\n\nto 59 years old; ethnicity breakdown was Malay (69.4%), Indian (18.3%) and Chinese (12.2%). \n\n\n\nAmong all lipid-modifying drugs, utilization of statins was the highest as statins are the preferred \n\n\n\nline in the treatment of dyslipidemia. Innovator brands were more preferred where most of the lipid-\n\n\n\nmodifying drugs used in the selected hospital are innovator brand drugs. In terms of cost, lipid-\n\n\n\nmodifying drugs contributes to about 27% of the total cost of prescription in average. Conclusion: \n\n\n\nThe utilization of all lipid-modifying drugs in the selected hospital was lower as compared to WHO \n\n\n\nDDD. As compared to combination therapy, monotherapy with atorvastatin was generally preferred \n\n\n\nin the selected hospital. The utilization of atorvastatin was found to be the highest in the OPD of the \n\n\n\nselected hospital.  \n\n\n\n\n\n\n\n\n\n\n\nINTRODUCTION  \n\n\n\n\n\n\n\nDyslipidemia is a medical condition referring to an abnormal \n\n\n\nlipid level in the blood. Elevated levels of LDL cholesterol in \n\n\n\nblood are associated with Cardiovascular Diseases (CVDs), \n\n\n\ncerebral stroke and renal failure or even death [1]. CVDs are \n\n\n\nprincipal cause of death globally as well as in Malaysia [10].  \n\n\n\nAccording to National Health & Morbidity Survey 2015, \n\n\n\nMalaysian has a high risk of CVDs, an estimation of 73% of \n\n\n\ntotal death is due to non-communicable diseases (NCDs). \n\n\n\nThese NCDs include overweight or obesity, diabetes mellitus, \n\n\n\nhypertension as well as hypercholesterolemia. The prevalence \n\n\n\nof hypercholesterolemia in Malaysia has increased from 32.6% \n\n\n\nin the year 2011 to 47.7% in the year 2015 indicating poor \n\n\n\ndyslipidemia management [2]. \n\n\n\nLipid-modifying Agents (LMAs) are used for primary & \n\n\n\nsecondary prevention of CVDs [13]. The total expenditure of \n\n\n\nLMAs has been increased by 56.6% from RM 210 million in \n\n\n\nthe year 2009 to RM 329 million in the year 2010. This \n\n\n\ninflation was greatly contributed by the private sector (64.8%) \n\n\n\n[12]. \n\n\n\nIncrement of cost per year in LMAs is directly proportional to \n\n\n\nprevalence of CVS patient. This is a clear implication on the \n\n\n\nneed of drug utilization review (DUR) to identify the \n\n\n\nappropriateness in the usage of LMAs. DUR is defined as an \n\n\n\nauthorized, structured, ongoing review of prescribing, \n\n\n\n\nmailto:ucn.jaasminerjit@kpjuc.edu.my\n\n\n\n\n\n\nX.X Cha et al. Malaysian Journal of Pharmacy 6 (1) 2020 \n\n\n\n\n\n\n\n\n\n\n\n22 \n\n\n\n\n\n\n\ndispensing and use of medication with the goals of promoting \n\n\n\noptimal medication therapy and ensuring drug therapy meets \n\n\n\nstandard [3]. \n\n\n\nIn this research, drug utilization of LMAs in a private \n\n\n\nhealthcare centre was conducted in a private hospital in Negeri \n\n\n\nSembilan, with the intention to describe if the Defined Daily \n\n\n\nDoses (DDDs) of LMAs are prescribed and utilized \n\n\n\naccordingly based on the WHO DDD criteria in private \n\n\n\nhospitals. DDD is defined as an assumed average maintenance \n\n\n\ndose/day for a drug used for its main indication in adults [10]. \n\n\n\nThis study will be able to provide information on the \n\n\n\ncompliance of WHO DDD in the private hospital and cost of \n\n\n\nlipid-modifying drugs can be calculated in order to reduce the \n\n\n\nusage of high-end drug. This may eventually facilitates the \n\n\n\ndevelopment of hospital drug formularies.   \n\n\n\nThe objectives of this study include to describe the drug \n\n\n\nutilization pattern and analyse by comparing WHO DDD \n\n\n\ncriteria of LMAs prescribed in the OPD of private healthcare \n\n\n\ncentre. Secondly, to identify the highly utilized LMA \n\n\n\nprescribed in the OPD of private healthcare centre and to \n\n\n\ncalculate the cost of LMA per prescription. \n\n\n\n\n\n\n\nMETHODOLOGY \n\n\n\n\n\n\n\nA retrospective, observational, quantitative study on the \n\n\n\nutilization of lipid-modifying agents was conducted in the \n\n\n\noutpatient department of private hospital, Malaysia. A list of \n\n\n\nitem movement for each lipid-modifying drug in the selected \n\n\n\nprivate hospital with the transaction date between 1st January \n\n\n\n2017 till 31st December 2017 was first generated together with \n\n\n\npatients\u2019 name, Medical Record Number (MRN), transaction \n\n\n\ndate, quantity dispensed as well as prescriber\u2019s name by using \n\n\n\nthe Hospital Information Technology System (HITS).  \n\n\n\nThe prescription was chosen using convenience sampling \n\n\n\nmethod. List of MRN generated were used to retrieve patient's \n\n\n\nprescription via KPJ Clinical Information System (KCIS). \n\n\n\nSelection of patient according to eligibility criteria. The \n\n\n\ninclusion criteria include newly registered (in year 2017) and \n\n\n\nexisting patients (follow up from past years) prescribed LMAs, \n\n\n\npatients of either sex age 18 years old and above while \n\n\n\nprescription with incomplete data were excluded from studies. \n\n\n\nPatient\u2019s medical data was not collected as it was not \n\n\n\naccessible in the private hospital. \n\n\n\n\n\n\n\nData retrieved were collected using data collection form \n\n\n\nthrough KCIS include patient's demographic, like age, gender \n\n\n\nand race as well as prescription details such as name and brand \n\n\n\nof prescribed medicine, frequency, dose and duration of the \n\n\n\nmedicine prescribed as well as prescriber details like \n\n\n\nprescriber category and education background for each patient \n\n\n\nwere recorded. Costs of lipid-modifying drugs and total cost \n\n\n\nper prescription were calculated based on the price reference \n\n\n\nlist provided by the pharmacist.  \n\n\n\n\n\n\n\nDemographic information and prescribing record of each \n\n\n\npatient were analysed descriptively and statistically by using \n\n\n\nthe Statistical Package for Social Science (SPSS) program \n\n\n\nversion 22.0 which were expressed in mean and standard \n\n\n\ndeviation. The DDD was computed based formula derived \n\n\n\nfrom Manitoba Centre for Health Policy. The ethical issues \n\n\n\nand informed consent have been approved by Research Ethics \n\n\n\nCommittee of KPJ University College, Nilai, Malaysia. This \n\n\n\napproval has been obtained before conducting the study. \n\n\n\n\n\n\n\n\n\n\n\nTable 1: Demographic profiles of selected patients \n\n\n\n\n\n\n\nCategory Frequency (n=180) Percent (%) \n\n\n\nGender \n\n\n\nMale 126 70.0 \n\n\n\nFemale 54 30.0 \n\n\n\nAge (years) \n\n\n\nBelow 20 0 0.0 \n\n\n\n20 \u2013 29 1 0.6 \n\n\n\n30 \u2013 39  4 2.2 \n\n\n\n40 \u2013 49  36 20.0 \n\n\n\n50 \u2013 59  73 40.6 \n\n\n\n60 and above 66 36.7 \n\n\n\nEthnicity \n\n\n\nMalay 125 69.4 \n\n\n\nChinese 22 12.2 \n\n\n\nIndian 33 18.3 \n\n\n\n \n\n\n\n\n\n\n\n\nX.X Cha et al. Malaysian Journal of Pharmacy 6 (1) 2020 \n\n\n\n\n\n\n\n\n\n\n\n23 \n\n\n\n\n\n\n\nRESULT AND DISCUSSION \n\n\n\n\n\n\n\nIn this study, demographic characteristic, dyslipidemia can be \n\n\n\nseen higher in men (70%) than in women (30%). This result is \n\n\n\nconsistent with several findings from China and American-\n\n\n\nbased studies [4,5]. This could be attributed to the unhealthy \n\n\n\nlifestyle such as alcohol drinking and cigarette smoking in \n\n\n\nmen, while on the other hand, women are generally more \n\n\n\nhealth conscious [11]. \n\n\n\n\n\n\n\nDyslipidemia can be seen increasing by age, peaking in the age \n\n\n\ngroup of 50 to 59 years (40.6%), but slightly reducing in age \n\n\n\ngroup of more than 60 years (36.7%). Similarly, in other \n\n\n\nstudies from China, America and Africa, the prevalence of \n\n\n\ndyslipidemia increases with age [4, 5, 6, 14]. In terms of \n\n\n\nethcinity, dyslipidemia is most prevalent in Malay (69.4%), \n\n\n\nfollowed by Indian (18.3%) and Chinese (12.2%). \n\n\n\n\n\n\n\nThe average number of drugs per prescription was 5.54 drugs \n\n\n\nper prescription. Previous study reported by WHO suggested \n\n\n\nthat for a patient without chronic diseases such as \n\n\n\nhyperlipidemia, hypertension, about two to three drugs per \n\n\n\nprescription is ideal to ensure proper adherence [10]. However, \n\n\n\nthis study reported higher number of drugs per prescription. \n\n\n\nThis may increase risk of drug interaction. Other study \n\n\n\nsuggested that personal patients\u2019 request or demand could lead \n\n\n\nto over-prescribing of multi-vitamins or medications for minor \n\n\n\nailments [15]. Medication counselling and bedside counselling \n\n\n\nare also implemented to ensure patients have proper \n\n\n\nunderstanding of each medication prescribed in order to \n\n\n\nenhance medication adherence. \n\n\n\n\n\n\n\nIn terms of drug utilization of statin, this study revealed that \n\n\n\nthe most frequently prescribed statin was atorvastatin (64.7%) \n\n\n\nand the least was simvastatin (11.8%), remaining was \n\n\n\nrosuvastatin (23.5%). A study supported that atorvastatin was \n\n\n\nthe safest statin in association with renal function [7] while \n\n\n\nanother study also reported that atorvastatin is more cost- \n\n\n\neffective as compared to rosuvastatin as the additional efficacy \n\n\n\nof rosuvastatin does not support the extra cost [8]. \n\n\n\n\n\n\n\nThe utilization rates per residents per day and the rates per user \n\n\n\nper day were lower compared to the WHO DDD. This low \n\n\n\ndrug utilization rate is due to the low sample size obtained, \n\n\n\nwhich ultimately affects the result of utilization rates. This low \n\n\n\nlevel of utilization obtained cannot be used to reflect the \n\n\n\noverall usage of lipid-modifying drugs in OPD of the selected \n\n\n\nhospital. \n\n\n\n\n\n\n\nThe average cost of lipid-modifying drugs per prescription \n\n\n\ncontributes to about 27% of the total cost of prescription. The \n\n\n\nLMA used are mostly innovator brand drugs with a high price \n\n\n\nper unit. Generic brands of atorvastatin at a cheaper price were \n\n\n\nleast preferred. The high cost of lipid-modifying drugs directly \n\n\n\ncontributes to the rise in total cost of prescription, which may \n\n\n\nburden the patients financially especially those with low or \n\n\n\nmoderate income will eventually leads to poorer medication \n\n\n\nadherence. Majority of the patients with dyslipidemia also has \n\n\n\nat least one comorbidity of either CVDs such as hypertension, \n\n\n\nmyocardial infarction, coronary artery disease and/or diabetes. \n\n\n\nThe higher the number of comorbidities, the higher the \n\n\n\nnumber of prescription drugs, which in turn increases the cost \n\n\n\nof prescription [9]. With a significant increase in cost, patients \n\n\n\nespecially those with low or moderate income will eventually \n\n\n\nleads to poorer medication adherence where they either stop \n\n\n\n\n\n\n\nTable 2: Drug utilization based on DDD \n\n\n\n\n\n\n\nLipid-modifying Drug WHO DDD  \n\n\n\n(DDD) \n\n\n\nTotal DDD \n\n\n\n(DDD) \n\n\n\nRates per residents per day  \n\n\n\n(DDD per 1,000 residents per \n\n\n\nday) \n\n\n\nRates per user per \n\n\n\nday \n\n\n\n(DDD per user per \n\n\n\nday) \n\n\n\nSimvastatin 20mg 30 820 0.07 1.71 \n\n\n\nAtorvastatin 20mg 20 2,655 0.24 1.84 \n\n\n\nAtorvastatin 40mg 20 820 0.07 2.10 \n\n\n\nAtorvastatin 80mg 20 4,360 0.39 5.38 \n\n\n\nRosuvastatin 10mg 10 1,030 0.09 2.27 \n\n\n\nRosuvastatin 20mg 10 1,940 0.17 4.04 \n\n\n\nFenofibrate 145mg 200 837.38 0.07 1.34 \n\n\n\nEzetimibe/Simvastatin 10/20mg - 1,065 0.10 1.87 \n\n\n\nEzetimibe/Simvastatin 10/40mg - 930 0.08 1.82 \n\n\n\n \n\n\n\n\n\n\n\n\nX.X Cha et al. Malaysian Journal of Pharmacy 6 (1) 2020 \n\n\n\n\n\n\n\n\n\n\n\n24 \n\n\n\n\n\n\n\nfilling their prescription or reduce the frequency of taking the \n\n\n\nmedication, which ultimately worsen health outcomes. \n\n\n\n\n\n\n\nStudy Limitation and Further Study \n\n\n\n\n\n\n\nOne limitation in this study is convenience sampling method \n\n\n\nused with a low sample size, which affects the utilization rate \n\n\n\nmeasured and that the result obtained shall not be used to \n\n\n\ngeneralize or represent the overall utilization. However this \n\n\n\nstudy serves as a pilot study to aid in further studies on drug \n\n\n\nutilization. Another limitation is the restricted access to \n\n\n\npatients\u2019 medical to obtain important information such as \n\n\n\ndiagnosis, comorbidity, laboratory results like lipid profile, \n\n\n\nlifestyle and family histories which could be an aid in \n\n\n\ncalculating Framingham Point Scores in order to identify the \n\n\n\nappropriateness of lipid-modifying drug prescribing.  Further \n\n\n\nstudies can be done using all patients\u2019 data to reflect on the \n\n\n\nactual utilization of lipid-modifying drugs. The \n\n\n\nappropriateness on prescribing of lipid-modifying drugs can \n\n\n\nbe identified if complete access to patients\u2019 medical notes is \n\n\n\npermitted. Since the average number of drugs per prescription \n\n\n\nin the selected hospital is close to 6 drugs, medication \n\n\n\nadherence can be evaluated to ensure patients are taking \n\n\n\nmedication correctly. \n\n\n\n\n\n\n\nCONCLUSIONS  \n\n\n\n\n\n\n\nThe drug utilization of LMAs in OPD of private healthcare \n\n\n\ncentre is lower as compared to WHO DDD which may be due \n\n\n\nto low number of samples collected and may not be used to \n\n\n\nreflect the overall utilization. Monotherapy with Atorvastatin \n\n\n\nis generally preferred in private healthcare centre. Innovator \n\n\n\nbrands were more preferred where most of the LMAs using in \n\n\n\nprivate healthcare centre are innovator drugs. The higher price \n\n\n\nper unit of innovator drugs increases the cost of LMA where \n\n\n\nphysician may consider switching from innovator brands to \n\n\n\ngeneric drugs for a more cost-saving approach.  The average \n\n\n\nnumber of drugs per prescription was found to be high at 5.54, \n\n\n\nthis increases the risk of drug-drug interactions and in turn \n\n\n\nincreases patients\u2019 health risks. Pharmacists are recommended \n\n\n\nto actively participate in prevention of drug-drug interactions \n\n\n\nby involving in medication reconciliation to reduce \n\n\n\ninappropriate and unnecessary drug prescribing. \n\n\n\n\n\n\n\nCONFLICT OF INTEREST \n\n\n\n\n\n\n\nThe authors declare no conflict of interest. \n\n\n\n\n\n\n\nREFERENCES  \n \n\n\n\n1. Williams, G. H., & Young, W. F. 2013. Dyslipidemia. Retrieved from \n\n\n\nHormone Health Network website: (online). \n\n\n\nhttps://www.hormone.org/diseases-and-conditions/heart-health-and-\nmetabolism/dyslipidemia (last accessed 30th September 2018).  \n\n\n\n2. Ministry of Health Malaysia. National Health & Morbidity Survey \n\n\n\n2015. Kuala Lumpur, Malaysia: Institue for Public Health, Ministry \nof Health, Malaysia. 2015. \n\n\n\n3. Academy of Managed Care Pharmacy. 2009. Drug Utilization Review. \n\n\n\n(online). \n\n\n\nhttp://www.amcp.org/WorkArea/DownloadAsset.aspx?id=9296 (last \n\n\n\naccessed 17th December 2017). \n4. Goff, D. C., et al. 2006. Dyslipidemia Prevalence, Treatment, and \n\n\n\nControl in the Multi-Ethnic Study of Atherosclerosis (MESA). \n\n\n\nCirculation, 113(5), 647-656. \ndoi:10.1161/CIRCULATIONAHA.105.552737 \n\n\n\n5. Taylor, H. A. et al. 2009. Dyslipidemia and the Treatment of Lipid \n\n\n\nDisorders in African Americans. The American Journal of Medicine, \n122(5), 454-463. doi:10.1016/j.amjmed.2008.09.049 \n\n\n\n6. Cai, L., et al. 2012. Prevalence, Awareness, Treatment, and Control of \n\n\n\nDyslipidemia among Adults in Beijing, China. Journal of \nAtherosclerosis and Thrombosis, 19(2), 159-168.  \n\n\n\n7. Barakat, L., et al. 2013. Comparison of Efficacy and Safety of \n\n\n\nRosuvastatin, Atorvastatin and Pravastatin among Dyslipidemic \nDiabetic Patients. International Scholarly Research Notices (ISRN) \n\n\n\nPharmacology, 2013, 7. doi:http://dx.doi.org/10.1155/2013/146579 \n\n\n\n8. Mould-Quevedo, J. n. F., et al. 2014. Cost-Effectiveness Analysis of \n\n\n\nAtorvastatin versus Rosuvastatin in Primary and Secondary \n\n\n\nCardiovascular Prevention Populations in Brazil and Columbia. Value \n\n\n\nin Health Regional Issues, 5(2), 48-57. \ndoi:http://dx.doi.org/10.1016/j.vhri.2014.07.007 \n\n\n\n9. The National Institute for Health and Care Exellence Guideline \n\n\n\n(NICE). 2018. Multimorbidity and polypharmacy. (online). \nhttps://www.nice.org.uk/advice/ktt18/chapter/evidence-context (last \n\n\n\naccessed 29th September 2017). \n\n\n\n10. World Health Organization. 2017. Definition and General \nConsiderations. (online). \n\n\n\nhttps://www.whocc.no/ddd/definition_and_general_considera/ (last \n\n\n\naccessed 16th November 2017). \n11. Kwon, Y. J., et al. (2016). High-risk drinking is associated with \n\n\n\ndyslipidemia in a different way, based on the 2010\u20132012 KNHANES. \n\n\n\nClinica Chimica Acta, 456, 170-175. \n12. Ministry of Health Malaysia. 2014. Malaysian Statistics On \n\n\n\nMedicines 2009 & 2010. Petaling Jaya: Ministry of Health Malaysia. \n\n\n\n13. Clark, M. A. et al. 2012. Lippincott\u2019s Illustrated Reviews: \n\n\n\nPharmacology (Vol. 5). Philadelphia: Lippincott Williams & \n\n\n\nWilkins. \n \n\n\n\n \n\n\n\n\n\n\n \nCover \n\n\nEditorial Board v2\n\n\nTable of content\n\n\nWelcome remark long chan\n\n\nMJP-V6S1-Proof#1\n\n\nMJP-V6S1-Proof#2\n\n\nMJP-V6S1-Proof#3\n\n\nMJP-V6S1-Proof#5\n\n\n\n"
"\n\nMalaysian Journal of Pharmacy 2001; 1(2):39-44  CPE Article \n\n\n\nContinuing Pharmacy Education  \n \n\n\n\nAdverse Effects Of Herbs And Drug-Herbal \nInteractions \n \nAbas Hj Hussin \n \nSchool of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Pulau Pinang, Malaysia. \n \n \nABSTRACT \n \nMany people have turned away from conventional medicines, with the belief that \n\u2018natural\u2019 substances like herbs are safer than synthetic substances. This belief is \naugmented by many other unwarranted claims such as herbal products do not \ncontain chemicals while conventional medicines do, thus contributing to the latter\u2019s \nside effects. The increasing use of herbal medicines has resulted in concern about \nthe efficacy and safety of these products.  Herbs can be hazardous in many ways. \nThey may be intrinsically toxic or toxic when taken in combination with other \npreparations. Because herbal preparations are usually not evaluated for purity and \nconsistency of active compounds, they often contain contaminants. Inclusion of \nincorrect but toxic species, allergens, pollen, insect parts, heavy metals such as lead, \nmercury and arsenic and scheduled poisons (drugs), whether intentional or \nunintentional, have been cited as the causes of herbal adverse reactions or toxicities. \nThe increasing use of herbal medicines means that there is potential for more drug \ninteractions, particularly between herbal products and conventional \u2018Western\u2019 \nmedicines. Toxicity and drug-local herb interaction studies are scarcely conducted \nand therefore should be encouraged. Proper documentation of adverse effects of \nherbs should be initiated and patients should be asked about their use of herbal \nproducts in order to evaluate the potential of these products to interact with \nconcurrent prescription medications. The public should be made aware of the \nadverse effects of herbal products. \n \nKeywords: herbs, adverse effects, safety, herbal toxicities, drug-herbal interactions \n \n \n \nINTRODUCTION \n \nHerbal medicines refer to the use of plants for the \npromotion of healing and maintenance of health. It \nis said that the use of herbal medicines originated \nin Egypt back in 1550 BC, yet many of their \npharmacological effects remain poorly understood. \nOut of the estimated 800,000 plant species on \nEarth (1), about a quarter  have been categorized \nand   only   a  small   fraction  of  these  have  been  \n\n\n\n \n \n \n \nexamined for pharmacological efficacy. The search \ncontinues for more medications from plant sources \nto help treat the many diseases which still plague \nsociety.  \n \nAn herb is defined as a plant or plant part used for \nits aromatic, savoury, medicinal or cosmetic \nproperties. Generally, the whole plant or plant \n\n\n\n\n\n\n\n\nCPE Article: Adverse effects of herbs \n\n\n\nparts are used singly or in combination with more \nthan one plant for the purpose of treatment. \nHowever, the herbal industry now produces herbal \nproducts containing isolated chemicals or extracts \nof single plants in modern pharmaceutical dosage \nforms. This practice is against that of traditional \nherbal practitioners who support the use of the \nwhole plant or plant parts, as they believe that \nthere is synergism or antagonism among the many \nconstituents and that the pharmacological activity \ndepends on their combined effects. \n \nHerbal usage \n \nIt has been estimated that 80% of the world \npopulation use some form of herbal medicine. \nThere is little doubt that the use of herbal \nmedicines is growing. Worldwide, the usage \nincreases at a rate of 10-20% annually (2). It has \nbeen estimated that one third of Americans use \nherbal products (3) with herbal medicine sales in \nthe United States reaching an estimated total of \nabout US$3.24 billion (~RM12.3 billion) in 1997. \nIn the same year, Malaysians spent about RM2.0 \nbillion on herbals. This amounts to about RM45.00 \nspent on herbals per person per year in the United \nStates by comparison to about RM91.00 per \nperson per year in Malaysia taking into account \npopulations of 273 million and 22 million \nrespectively. This illustrates the potential of the \nherbal market in our country. In 1999, more than \n8000 herbal products were registered with the \nMinistry of Health. Despite the paucity of \nknowledge of the pharmacological efficacies of \nherbals, sales of tested, partially tested and \nuntested preparations either manufactured locally \nor imported into Malaysia are on the rise. Of \nprimary concern is the quality and reliability of the \nproducts available in the marketplace today since \nsafety and efficacy prior to marketing are not \nguaranteed and no outside monitoring of the \nidentity or potency of the herbals is required. This \nis in sharp contrast to the strict requirements and \nstipulations that need to be adhered to for each \npharmaceutical product prior to registration. \n \nThe safety of herbal medicines is of particular \nimportance because the majority of these products \nis self-prescribed and is used to treat minor and \noften chronic conditions. However, most patients \nconsuming herbal preparations are not aware of the \npotential adverse effects these preparations may \nproduce.  \n\n\n\nWhy do people resort to herbals ? \n \nBasically, people who use herbals can be classified \ninto four groups: \na) Those who solely use herbals for therapeutic \n\n\n\npurposes while dismissing the efficacy of \nmodern medicines. This group is fast \ndisappearing as the world becomes more \ndevelop. \n\n\n\nb) Those who use more herbals than \nconventional modern medicines for \ntherapeutic purposes. In some cases, patients \nwho leave mainstream medicine do so only \nafter realizing that it has nothing more to offer \nin treating their health problems. \n\n\n\nc) Those who use more modern medicines than \nherbals for therapeutic purposes. This group, \nmost probably, constitutes the majority of the \nMalaysian population. \n\n\n\nd) Those who use modern medicines and do not \nbelieve in the efficacy of herbals. \nUnfortunately, this group of people are \nunaware of the role of herbals/plants in drug \ndevelopment. \n\n\n\n \nThe first reason for the use of herbals is that it is \npart of the culture and belief of some people for \nmaintenance of health or to treat certain ailments. \n \nThe second reason for the increased use of herbals \nis the relatively cheaper cost of herbal products \nand hence affordability to the lower income group. \nThis was particularly true a few years ago, but \nnowadays, it is not surprising to find some herbal \nproducts in the local market which are expensive; \nand in fact, more expensive than modern \nmedicines. Also, the easy availability of herbals \nmakes them more accessible by comparison to \nconventional medicines where one has to obtain a \nprescription from a doctor. The availability of \ninformation with the advent of the Internet \ncertainly has some effect on the increasing trend of \nself-medication. \n \nThe third reason is that the public has the \nimpression of herbals being natural and that \nanything natural is safe. There is also this notion \nthat herbal products do not contain chemicals and \nthat chemicals, only found in modern medicines, \nare linked to toxicity, more adverse effects and \nhence are more harmful. Not only are these ideas \npropagated by irresponsible, uneducated and \nunscrupulous salespersons at the \u2018pasar malam\u2019 \n(night market) and bazaars, unfortunately they \nhave also been broadcasted in privately sponsored \nradio programmes. \n\n\n\n\n\n\n\n\nCPE Article: Adverse effects of herbs \n\n\n\nAdverse effects of herbals \n \nIt is undeniable that plants have an important role \nin the development of modern medicines. More \nthan 60\u201370 % of modern medicines in the world \nmarket are directly or indirectly derived from plant \nproducts. In the last few years, research has \nuncovered interesting and beneficial chemicals in \nherbs. However, herbs are not non-toxic just \nbecause they are natural. Medicinal herbs contain \npowerful, pharmacologically active compounds. \nWhile some herbs in common use appear to be \nfairly safe, all medicines, herbal or otherwise, \nshould be used with caution. \n \nThe number of reports of adverse effects of herbal \nmedicines is now increasing due to increased use \nand also probably due to increased awareness \namong the consumers and clinical practitioners. In \nMalaysia, adverse effects of herbal (traditional) \nmedicines are reported to the Malaysian Adverse \nDrug Reaction Advisory Committee (MADRAC), \nNational Pharmaceutical Control Bureau, Ministry \nof Health. The number of reports of adverse \nreactions attributable to traditional medicine has \nincreased from 11 in 1997 to 23 in 1999. Adverse \neffects or poisoning pertaining to herbals reported \nto the National Poison Centre from 1995 to June \n2000 are as follows: 8 cases (1995), 3 cases \n(1996), 5 cases (1997), 11 cases (1998), 7 cases \n(1999) and 9 cases (until June 2000). The list of \nherbals involved include Datura fastuosa \n(\u2018kecubong\u2019), Datura metel (\u2018kecubong\u2019), Datura \nstramonium (\u2018terong pengar\u2019) Pithecallobium \njiringa (\u2018jering\u2019), Ganoderma mycelium (\u2018kulat \nkayu\u2019), lemon grass (\u2018serai\u2019), margosa (\u2018daun \nmambu\u2019), nutmeg (Myristica fragrans), eucalyptus \n(Eucalyptus globulus), yohimbine, cassava (\u2018ubi \nkayu\u2019), camphor, stephamine, \u2018Air Abu Kansui\u2019, \n\u2018Minyak Rohini\u2019, \u2018Yu Yee\u2019 oil, \u2018Pil Kuda\u2019, \n\u2018Minyak Angin\u2019, \u2018Slimming gel\u2019 (Pusat Racun \nNegara \u2013 personal communication). The most \ncommon adverse effects reported are hepatic and \nrenal problems. However, it is difficult to identify \nthe causative agent associated with the adverse \nreactions encountered because traditional herbal \npreparations often contain multiple ingredients. \nThe above number of reported cases most probably \ndoes not reflect the actual frequency of adverse \nreactions caused by traditional herbal preparations, \nas most cases go unreported. \n \nWays in which herbal preparations cause \ntoxicity \n \nPatients consuming herbal preparations should be \naware that herbs could cause a variety of toxic \n\n\n\nreactions. Certain groups of the population should \nbe extra cautious as they are more susceptible to \nherbal adverse reactions or toxicities. They include \npregnant and nursing women; some compounds in \nherbs can cross the placenta and are clearly linked \nto birth defects or other problems in newborns. \nChildren and infants are much more sensitive than \nadults to the effects of all medicines including \nherbs. The elderly with cardiovascular problems, \ndiabetes and other chronic diseases may show \nexaggerated toxic/adverse reactions to herbs. \nHerbs can be hazardous in many ways. The ways \nin which herbal products produce toxicity can be \nclassified as follows: \n \n\n\n\na) Some herbals may contain toxic ingredients \nSome herbs are found to contain toxic \nconstituents with various potential adverse \neffects. Pennyroyal (Mentha pulegium) oil \ncontains a potent abortifacient compound and \nhas been reported to cause both liver and \nkidney damage and death (4). Dobb and Edis \n(1984) reported neuropathy and coma in a \npatient who took a herbal laxative to control \nweight (5). The herbal laxative was found to \ncontain podophyllin which is known to cause \nsevere neurological symptoms. Noni \n(equivalent to our local \u2018mengkudu\u2019 or \nMorinda citrifolia) juice has been reported to \ncontain high potassium levels and should be \nused with special caution in patients with renal \nproblems because high levels of potassium \nmay cause arrhythmias and even myocardial \ninfarction. The consumption of various herbs \nsuch as germander (Teucrium chamaedrys), \ncomfrey (Symphytum spp) and chapparal \n(Larrea tridentata) has been shown to be \nassociated with hepatoxicity and in many \ncases this has been attributed to pyrrolizidine \nalkaloids (6).  \n \n\n\n\nb) Unintentional substitution of the herb with a \ntoxic species \nA Chinese herbal preparation used for \nslimming caused severe kidney damage in 105 \nBelgians. The herbal treatment also caused 18 \ncases of cancer. Investigations showed that \none of the ingredients of the weight reducing \npills, Stephania tetrandra , was replaced with \nAristolochia fangchi, an herb related to herbs \nvariously called birthwort, snakeroot and \nDutchman\u2019s pipe. In animal studies, \nAristolochia fangchi causes kidney damage \nand cancer (7-9). \n \n\n\n\nc) Intentional addition of drugs \nThe intentional addition of drugs is done to \nproduce the therapeutic effects or potentiate \n\n\n\n\n\n\n\n\nCPE Article: Adverse effects of herbs \n\n\n\nthe effects of the herbals. Toxic effects of \nChinese herbal preparations adulterated with \ndrugs have been reported (10). These products \nwere found to contain the following \ncompounds: steroids (e.g. prednisolone, \ndexamethasone), pain killer (aminopyrine, \nacetaminophen), skeletal muscle relaxant (e.g. \nchlorzoxazone) minor tranquilizer (e.g. \ndiazepam) and glybenclamide. A recent report \nby the Minister of Health, Malaysia, indicated \nthat about 37% of 5000 renal problems in \nMalaysia might be attributed to the chronic \nuse of traditional herbal preparations. Many of \nthe locally available herbal preparations have \nbeen found to be adulterated with steroids, \ndrugs, poisons and high levels of heavy metals \n(11). A subsequent report by the Ministry of \nHealth stated that almost 95% of unregistered \ntraditional herbal preparations in the local \nmarket have been found to contain steroids \n(12). \n \n\n\n\nd) Environmental contamination of the herbs \nBecause herbal preparations are usually not \nevaluated for purity and consistency of active \ncomponents, they often contain unintentional \ncontaminants. Chan et al (1977) reported cases \nof lead poisoning in China due to ingestion of \ncertain Chinese herbal preparations (13). \nParsons (1981) reported a case of arsenic \npoisoning due to contamination of yellow root \nherbal tea in the southern U.S. The poisoning \nwas probably due to soil and stream \ncontamination in the plant\u2019s natural habitat \n(14). \n \n\n\n\ne) Toxic when taken in combination with modern \nmedicines \nWhen herbs with some potential for toxicity \nare mixed with modern medicines, there may \nbe potentiation of the toxicity of the herb by \nthe metabolic and physiological effects of the \ndrug. In some cases, herbal use may be \ncontraindicated with certain disease states. \nInteraction of herbals with drugs may also \nbring about changes in the pharmacokinetic \nand pharmacodynamic properties of the latter. \nFor example, herbal-drug interaction may \ncause decrease or increase in the absorption, \ndistribution, metabolism and excretion of the \ndrug. The interaction may also \nincrease/decrease the desired pharmacological \neffects of the drug. \n\n\n\n \nInteractions between herbs and prescription \nanticoagulants or antiplatelet drugs (e.g. \nwarfarin, heparin, coumarin, and aspirin) \n\n\n\npresent perhaps the greatest risk of herb-drug \ninteractions in modern practice. Herbal \nproducts that may potentially increase the risk \nof bleeding or potentiate the effects of these \ndrugs include feverfew, garlic, ginger, ginkgo, \nliquorice root, parsley, turmeric, ginseng and \nephedra. These herbal products have the \npotential to cause unexpected bleeding in \npatients undergoing surgery. A case report \nshowed that Ginkgo biloba extract caused \nspontaneous bleeding into the eye from the iris \nwithin a week of daily Ginkgo biloba extract \nsupplementation in a patient who had been \ntaking aspirin to prevent myocardial infarction \n(15). St. John\u2019s Wort (Hypericum perforatum) \nvalerian (Valeriana officinalis) and kava-kava \n(Piper methysticum) may prolong the effects \nof some anaesthetics and impair awakening \nfrom anaesthesia. A study by the National \nInstitute of Health found that popular herbal \nproducts such as garlic and St John\u2019s Wort can \ndecrease the effectiveness of a variety of \nprescription medications used to treat AIDS, \nsome cancers, heart disease and organ-\ntransplant patients. St John\u2019s Wort is also able \nto decrease the effectiveness of birth control \npills by as much as 50%. Studies conducted by \nthe author have indicated that various Malay, \nIndian, Chinese, Western herbal products and \nhomeopathic preparations are able to influence \nthe metabolism of a modern drug in-vitro . \nParkia speciosa , locally known as \u2018petai\u2019, has \nbeen found to significantly increase liver drug \nmetabolism in-vitro  (16) and in-vivo. Studies \non Pithecallobium jiringa (\u2018jering\u2019) and \nPithecallobium microcarpus (\u2018kerdas\u2019) also \nshowed similar significant increases in liver \ndrug metabolism (17).  \n\n\n\n \nCONCLUSION \n \nWhen used wisely, herbal medicines have a place \nin the control of certain ailments and dis eases. \nFrom the above discussion, findings by many \nresearchers have reinforced the idea that the use of \nnatural herbal medicines may not be without risk. \nIn the U.S., nearly 70% of patients who use herbal \nmedicines do not inform their health care providers \nabout their use of herbal therapies (18). More \nresearch on adverse reactions on locally available \nherbal preparations should be encouraged and \npublic education on the good and bad effects of \nherbals need to be emphasized. Health care \nprofessionals should remain vigilant for potential \ninteractions between herbals and prescription \nmedications, especially when it involves \n\n\n\n\n\n\n\n\nCPE Article: Adverse effects of herbs \n\n\n\nmedications with narrow therapeutic indices. \n \nACKNOWLEDGEMENTS \n \nA  version  of  this  paper  is  also available in PRN  \n\n\n\nConsult as part of its CPE education material. The \nauthor wishes to express his thanks to the editorial \nboard of PRN Consult for allowing the article to be \nshared with the readers of the Malaysian Journal of \nPharmacy.  \n \n\n\n\n\n\n\n\n***** \n \nREFERENCES \n \n1. von Reis Altschul S. Exploring the herbarium. Sci \n\n\n\nAm 1977; 236: 96-114. \n2. Phillipson JD. Global trend and market size of \n\n\n\nherbal medicine in primary health care. In: Chan \nKL, Hussin AH, Sadikun A, Yuen KH, Asmawi \nMZ, Ismail Z, editors. Trends in Traditional \nMedicine Research. Penang: Universiti Sains \nMalaysia; 1995. \n\n\n\n3. Johnstone BA. One third of nation\u2019s adults use \nherbal remedies. Herbalgram 1997;40:49. \n\n\n\n4. Center for Disease Control, Atlanta, Georgia. \nMorbidity and Mortality. Weekly Report 1978; \n27:51. \n\n\n\n5. Dobb GJ, Edis RH. Coma and neuropathy after \ningestion of herbal laxative containing podophyllin. \nMed J Aust  1984; 140:495-496. \n\n\n\n6. MacGregor, FB, Abernethy VE, Dahabra S. \nHepatotoxicity of herbal remedies. BMJ 1989; \n299:1156-1157. \n\n\n\n7. Nortier JL, Martinez MC, Schmeiser HH, et al. \nUrothelial carcinoma associated with the use of a \nChinese herb (Aristolochia fangchi). N Engl J Med \n2000; 342:1686-1692. \n\n\n\n8. Arlt VM, Pfohl-Leszkowicz A, Cosyns J, et al. \nAnalyses of DNA adducts formed by ochratoxin A \nand aristolochic acid in patients with Chinese herbs \nnephropathy. Mutat Res 2001; 494:143-150. \n\n\n\n9. Tanaka A, Nishida R, Maeda K, et al. Chinese herb \nnephropathy in Japan presents adult-onset Fanconi \nsyndrome: could different components of \naristolochic acids cause a different type of Chinese  \n\n\n\n\n\n\n\n \nherb nephropathy? Clin Nephrol 2000; 53:301-306. \n\n\n\n10. Anonymous. Chinese herbal medicines. Clin \nToxicol  1975; 8:137-138. \n\n\n\n11. Ahsan AA. Ubat tradisional turut rosakkan buah \npinggang (Traditional medicines cause kidney \ndamage)  Utusan Malaysia . 2000; 5 Aug. p 2. \n\n\n\n12. Shakri MHM. 95% ubat tradisional ada steroid \n(95% Of traditional medicines contain steroids) . \nMingguan Malaysia 2000; 3 September. p. 17. \n\n\n\n13. Chan H, Yeh YY, Billmeier GJ, Evans WE. Lead \npoisoning from ingestion of Chinese herbal \nmedicine. Clin Toxicol 1977; 10:273-281. \n\n\n\n14. Parsons JS. Contaminated herbal tea as a potential \nsource of chronic arsenic poisoning. N Carolina \nMed J  1981; 42:38-39. \n\n\n\n15. Kleijnen J, Knipschild P. Gingko biloba . Lancet \n1999;  340:1136-1139. \n\n\n\n16. Hussin AH, Ariff AM, Husin M, Taher Y. \nInfluence of Petai  (Parkia speciosa , Hassk) on \ndrug metabolism in rat liver J Biosci  1999; 10:7-10. \n\n\n\n17. Hussin AH, Zulkifli M, Hadijah MT, Zainah A. In-\nvitro  effect of Pithecallobium jiringa  (jering) and \nPithecallobium microcarpus (kerdas) on hepatic \ndrug metabolism. In:  Abstract Book of the 15th \nScientific Meeting of the Malaysian Society of \nPharmacology and Physiology; 2000 May 8-9;  \nKubang Kerian: Malaysian Society of \nPharmacology and Physiology, 2000. p. ORL32.  \n\n\n\n18. Eisenberg DM, Kessler RC, Foster C. \nUnconventional medicine in the United States : \nprevalence, costs and patterns of use. N Engl J Med \n1993; 328:246-252. \n\n\n\n\n\n\n\n\n\n\n\nContinuing Pharmacy Education questions: \n \nStudy the questions below and in the following page and send your answers (only one of A, B, C and D is \ncorrect) to the MPS-CPE Secretariat at the Malaysian Pharmaceutical Society, P.O. Box 158, Jalan \nSultan, 46710 Petaling Jaya, Selangor. You may earn up to 2 CPE points. \n \n1. What are the reasons for the shift towards \n\n\n\nmore usage of herbals? \n \n\n\n\nA. Conventional drugs are safer than \nherbals. \n\n\n\nB. Conventional drugs are more stringently \nregulated. \n\n\n\n\n\n\n\nC. Herbal medicines are naturally derived \nand hence perceived safer. \n\n\n\nD. Herbal medicines are naturally derived \nand hence perceived safer. \n\n\n\n\n\n\n\n\nCPE Article: Adverse effects of herbs \n\n\n\n2. Which of the following is NOT true about \nherbal usage? \n\n\n\n \nA. Herbal usage is increasing worldwide. \nB. On average, Malaysian individuals \n\n\n\nspend less on herbal products annually \nthan American individuals do. \n\n\n\nC. Most of the herbal medicine usage is \nself-prescribed. \n\n\n\nD. Most herbal medicines are used to treat \nchronic ailments. \n\n\n\n \n3. Herbal me dicines are less stringently \n\n\n\nregulated because \n \n\n\n\ni. little is known about their efficacy. \n \n\n\n\nii. little is known about their appropriate \ndoses. \n\n\n\niii. little is known about their adverse \neffects. \n\n\n\niv. little is known about interaction with \nmodern drugs. \n\n\n\nA. i and ii are correct. \nB. ii and iii are correct. \nC. ii, iii and iv are correct. \nD. i, ii, iii and iv are correct. \n\n\n\n \n5. Herbal medicines are popular because \n \n\n\n\ni. they are relatively cheaper than most \nconventional drugs. \n\n\n\nii. they are more easily accessible than \nconventional drugs. \n\n\n\niii. they have been used, culturally, for \nmany generations. \n\n\n\niv. they are perceived safer than \nconventional drugs because they are \nnaturally derived. \n\n\n\nA. i and ii are correct. \nB. i, ii and iii are correct. \nC. ii, iii and iv are correct. \nD. i, ii, iii and iv are correct. \n\n\n\n \n4. Which of the following is NOT true about \n\n\n\nherbal products? \n \n\n\n\nA. Many herbal products often contain \nunintentional contaminants. \n\n\n\nB. The pharmacological activity of a herbal \nproduct depends solely on one active ingredient. \n\n\n\nC. Many herbal products contain plant parts \nof single or mixtures of plants  \n\n\n\nD. More than 60-70% of conventional drugs are \ndirectly or indirectly derived from plants or \nplant products. \n\n\n\n6. Statistics from the Ministry of Health, \nMalaysia have recently indicated that the \nmajority of the adverse effects attributable \nto herbal usage are \n\n\n\n \nA. hepatic and renal problems. \n\n\n\nB. respiratory and renal problems. \n\n\n\nC. skin and respiratory problems. \n\n\n\nD. heart and skin problems. \n\n\n\n \n7. The following are true about herb-drug \n\n\n\ninteractions: \n \n\n\n\ni. Gingko biloba may increase the risk of \nbleeding if taken with warfarin. \n\n\n\nii. St. John\u2019s Wort may suppress the effect \nof general anaesthetics. \n\n\n\niii. \u2018Petai\u2019 has been shown to affect liver \ndrug metabolism in vitro . \n\n\n\niv. Noni juice may cause problems in \npatients with heart problems. \n\n\n\nA. i and iii are correct. \nB. ii and iv are correct. \nC. i, iii and iv are correct. \nD. ii, iii and iv are correct. \n\n\n\n \n8. The following are ways in which herbal \n\n\n\npreparations may be toxic EXCEPT \n \n\n\n\nA. intentional addition of scheduled \npoisons. \n\n\n\nB. unintentional contamination of the \nherbal products with heavy metals. \n\n\n\nC. unintentional addition of scheduled \npoisons. \n\n\n\nD. the addition of herbs with intrinsic toxic \nconstituents. \n\n\n\n \n9. In general, herbal medicines \n \n\n\n\ni. should be used with caution, just like \nwith drugs. \n\n\n\nii. may be used to treat certain ailments \nprovided that they are used wisely. \n\n\n\niii. usage should be monitored for \ninteractions with drugs. \n\n\n\niv. R&D should be encouraged and the \npublic be made more aware of its  \nsafety.  \n\n\n\nA. i, ii and iii are correct. \nB. i, ii and iv are correct. \nC. ii, iii and iv are correct. \nD. i, ii, iii and iv are correct. \n\n\n\n\n\n"
"\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n311 \n \n\n\n\n\n\n\n\nSTARZ-DRP: A Step-by-step Approach for Pharmacy Triage Services  \n\n\n\nAzmi Sarriff \n1\n, Nazri Nordin\n\n\n\n2\n, Mohamed Azmi Hassali\u00b3 \n\n\n\n1\nDiscipline of Clinical Pharmacy, \n\n\n\n2\nPost Graduate Student(Clinical Pharmacy), \u00b3Discipline of Social & \n\n\n\nAdministrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Penang \n\n\n\nCorresponding Author: Dr. Azmi Sarriff,  e-mail: azmi@usm.my \n\n\n\n\n\n\n\nABSTRACT \n\n\n\n \nThis article highlights the importance of structured and systematic processes in triaging patients with minor \n\n\n\nillnesses. The main aim is to describe a model or protocol for organizing a community pharmacist\u2019s \n\n\n\nknowledge in a manner that allows him/her to begin identifying the actual and potential drug-related problems \n\n\n\n(DRPs). We consulted standard reference textbooks and key pharmacy journals looking for common \n\n\n\nmnemonics which has been promoted as a decision aids for the supply of non-prescription medicines. Our \n\n\n\nfocus was to examine each method in terms of the collecting relevant information with respect to detection of \n\n\n\nDRPs associated with self-medicating patients. The positives and negatives attributes of each method were \n\n\n\nassessed. We noticed that each of the mnemonics examine were incomplete in some area. Even for an \n\n\n\nestablished and popular aide-memoire, WWHAM, which is an easily remembered mnemonic to obtain a \n\n\n\ngeneral picture of the patient\u2019s presenting compliant does not provides adequate information for triage and \n\n\n\nrecognize patient-specific medication related problems. Although other mnemonics are more comprehensive \n\n\n\nthan WWHAM, they are still limited. Moreover, by no means these methods were universally use and apply \n\n\n\nin the community pharmacy practice. Alternatively, the proposed approach provides a platform for triaging a \n\n\n\nself-medication patient as well as identifying DRPs for collaborating with other health care professionals. \n\n\n\nTherefore, the STARZ-DRP is an alternative approach for conducting self-care consultation. In depth study is \n\n\n\nneeded to determinate whether it is more effective than other methods for pharmacy triage service when \n\n\n\nstudied in a controlled, systematic manner.  \n\n\n\n\n\n\n\nKeywords:  self-care consultation, minor illness, pharmacy triage, referral, drug-related problem. \n\n\n\n\n\n\n\n \nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011, pg 311 -  324 \n \n \n\n\n\nINTRODUCTION \n\n\n\nManaging minor illnesses by self-medication is a \n\n\n\ncommon practice worldwide. When done \n\n\n\ncorrectly, self-medication benefits the individual\u2019s \n\n\n\nhealth and is recognized by the World Health \n\n\n\nOrganization (WHO) as part of self-care.\n1,2\n\n\n\n\n\n\n\nAccording to WHO definition, self-medication is \n\n\n\n\u201cthe selection and use of medicines by individuals \n\n\n\nto treat self-recognized illnesses or symptoms\u201d \n1\n. If \n\n\n\na person chooses to self-medicate, he/she should \n\n\n\nbe able to recognize the symptoms and determine \n\n\n\nit as a self-limited condition and suitable for self-\n\n\n\ncare. In this regards, Winfield and Richards (1998) \n\n\n\nstates health problems as a minor illness if a \n\n\n\nperson perceived it as non-threatening and having \n\n\n\nlimited duration.\n3\n Furthermore, he/she should be \n\n\n\nable to select an appropriate medicine, recognize \n\n\n\nand monitor its effects and side effects, and lastly \n\n\n\nhe/she should follow directions to use as indicated \n\n\n\non the label. However, this is not the case for most \n\n\n\nof the time. Instances of inappropriate use of over-\n\n\n\nthe-counter (OTC) medicines by consumers\n4,5,6\n\n\n\n and \n\n\n\nassociated with iatrogenic disease\n7\n has been \n\n\n\nreported. The inappropriate use of OTC medicines \n\n\n\nhas many implications including delay or mask the \n\n\n\ndiagnosis of serious illness, with increased risks of \n\n\n\ninteractions and adverse drug reactions.\n8\n  \n\n\n\nIt seems that self-medicating with non-prescription \n\n\n\nmedications is a desirable choice for many \n\n\n\npeoples, but it is of concerns that most peoples do \n\n\n\nnot always use non-prescription medications \n\n\n\noptimally. Now, community pharmacists (CP) are \n\n\n\nin an ideal position to give timely advice to those \n\n\n\n\nmailto:azmi@usm.my\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n312 \n \n\n\n\nwho are self-medicating and reinforce advice \n\n\n\ngiven by other healthcare professionals. They often \n\n\n\nhave seen as a convenient \u2018first point of call\u2019 for \n\n\n\nadvice on common symptoms and other health \n\n\n\nproblems. They are also view as a gatekeeper to \n\n\n\nproper and safe use of medications. In fact, CPs \n\n\n\nand their staff do all these activities on a daily \n\n\n\nbasis when customers approached them for advice \n\n\n\nabout how to manage symptoms or self-treatment \n\n\n\nof minor illnesses. It is a primary objective of all \n\n\n\nhealthcare providers including community \n\n\n\npharmacists, is to improve the quality of patients\u2019 \n\n\n\nlife. All of them work to achieve two broad \n\n\n\ncategories of patient outcomes, that are, (i) cure, \n\n\n\nslow, or prevent a patient\u2019s disease; and (ii) \n\n\n\neliminate, reduce, or prevent a patient\u2019s symptom.\n9 \n\n\n\nWith regards to self-treating patients on minor \n\n\n\nillnesses, the CPs are most likely to involve in the \n\n\n\nlatter category of patients\u2019 outcomes. Perhaps they \n\n\n\nare usually the last healthcare provider with whom \n\n\n\na patient comes in contact before using a \n\n\n\nmedication. They have a key responsibility in \n\n\n\nresponding to patients who are intend to self-\n\n\n\nmedicate with non-prescription medications.  \n\n\n\nIt has been reported that almost 20% of all drug-\n\n\n\nrelated admissions to a medical ward result from \n\n\n\nthe use of non-prescription medication, especially \n\n\n\nOTC medications.\n10 \n\n\n\nConsequently, health \n\n\n\nprofessionals, especially community pharmacist, \n\n\n\nneed to be aware of any non-prescription \n\n\n\nmedications that patients are using, in order to be \n\n\n\nable to appropriately advise them on the potential \n\n\n\nfor worsening their disease process, adverse \n\n\n\nevents, or drug interactions.\n11 \n\n\n\n Although the role of \n\n\n\nCP in responding to customer who present with \n\n\n\nminor illness is longstanding and well-recognized, \n\n\n\nformal investigations of the extent and quality of \n\n\n\nthis role had not been performed until recently. \n\n\n\nFrom around the late 1970s, surveys investigating \n\n\n\nsymptoms presented to community pharmacist \n\n\n\nhave been conducted.\n12,13,14,15\n\n\n\n Detailed examination \n\n\n\nof symptom presented to CPs show that these \n\n\n\nbroad categorizations conceal a wide range of \n\n\n\npresentations requiring adequate clinical and \n\n\n\ncommunicative skills from the community \n\n\n\npharmacist. Furthermore, there are number factors \n\n\n\nthat make responding to symptoms in the \n\n\n\npharmacy particularly challenging for the \n\n\n\ncommunity pharmacist,\n16 \n\n\n\nsome of these includes \n\n\n\nno access to the patient medical notes or history, \n\n\n\nlimited opportunities for a physical examination, \n\n\n\ndetailed conversation need to be initiated, \n\n\n\ncustomer may have already approached another \n\n\n\nmember of staff, symptoms may be presented on \n\n\n\nbehalf of another person, and the customer may \n\n\n\nalready have sought advice, information or \n\n\n\ntreatment from another sources.  \n\n\n\nAlthough the DRP term has been used for quite \n\n\n\nsome time\n17\n\n\n\n, it was not until 1990 when first paper \n\n\n\ndealing with drug-related problems (DRPs) as a \n\n\n\nconcept, first appeared\n18\n\n\n\n. The DRP was defined as \n\n\n\n\u201can undesirable patient experience that involves \n\n\n\ndrug therapy and that actually or potentially \n\n\n\ninterferes with a desired patient outcome\u201d. This is \n\n\n\nparticularly important in the context of self-\n\n\n\nmedication where each person  has a unique \n\n\n\nmedication experience , that is, the sum of all \n\n\n\nevents in a person\u2019s life that involve medicine \n\n\n\nuse.\n19\n\n\n\n It includes the person\u2019s expectations, wants, \n\n\n\nconcerns, preferences, attitudes, and beliefs, as \n\n\n\nwell as the cultural, ethical and religious \n\n\n\ninfluences on his/her medication taking behaviour. \n\n\n\nThese experiences will have a profound effect on \n\n\n\nthe decisions a person makes everyday as to \n\n\n\nwhether or not to take his/her medications. Once a \n\n\n\nperson\u2019s medication experience is explored, then, \n\n\n\nthe CP can successfully execute his/her \n\n\n\nresponsibilities of identifying, resolving, and \n\n\n\npreventing drug-related problems.  \n\n\n\nMost DRPs are avoidable and few researchers \n\n\n\nhave showed that CPs are assuming an active role \n\n\n\nin preventing and solving DRPs. Westerlund,LT \n\n\n\net.al. (2001) conducted a study in 45 volunteer \n\n\n\npharmacies in Sweden during 10 weeks in late \n\n\n\n1999. The study found that the most common \n\n\n\nDRPs were uncertainty about the indication for the \n\n\n\ndrug (33.5%) and therapy failure (19.5%) while \n\n\n\ndyspepsia was the most frequently specified \n\n\n\nsymptom (11.4%).\n20\n\n\n\n In 2005, a nationwide survey \n\n\n\nin Germany was conducted in community \n\n\n\npharmacies to record all identified DRPs. More \n\n\n\nthan a thousand community pharmacies participate \n\n\n\nin the survey had documented 10,427 DRPs (9.1 \n\n\n\nDRP per pharmacy per week). Overall, drug-drug \n\n\n\ninteractions were the most frequently reported \n\n\n\nDRP (8.6%) and, according to CPs , more than \n\n\n\n80% of identified DRPs could be resolved \n\n\n\ncompletely. The prescribing physician was \n\n\n\ncontacted in 60.5% of all such cases. Median time \n\n\n\nneeded for solving a DRP was 5 minutes.\n21\n\n\n\n A \n\n\n\nrecent study showed that, in nearly 1 out of 5 \n\n\n\nencounters, direct pharmacist-patient interaction in \n\n\n\nself-medication revealed relevant DRPs in German \n\n\n\ncommunity pharmacies.\n22\n\n\n\n The most frequent \n\n\n\ninterventions were referral to a physician (39.5%) \n\n\n\nand switching patients to a more appropriate drug \n\n\n\nproduct (28.1%). The studies cited here have \n\n\n\ndemonstrated a need for more professional \n\n\n\nattention and intervention by CPs to prevent and \n\n\n\nrectify DRPs in non-prescription consumers. \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n313 \n \n\n\n\nCommunity pharmacists can help the self-treating \n\n\n\npatients assessed the underlying conditions \n\n\n\ncorrectly, choose  OTC product, suggesting a non-\n\n\n\ndrug therapy, referral to another health \n\n\n\nprofessional, and ensuring correctly used of \n\n\n\nmedicines. These interventions are likened to the \n\n\n\ntelephone triage services offered by nurses. \n\n\n\nPerhaps, it should be realised that the function of \n\n\n\nthe telephone triage nurse is to determine the \n\n\n\nseverity of the caller's complaint using a series of \n\n\n\nalgorithms developed by a coordinated effort of \n\n\n\nphysicians and nurses.\n23,24\n\n\n\n  Here, an important \n\n\n\naspect in the decision-making process is either to \n\n\n\ntreat, not to treat, or refer the customer to another \n\n\n\nhealthcare professional, most commonly the \n\n\n\ngeneral practitioner (GP).\n8\n  \n\n\n\nCommunity pharmacists need to develop a method \n\n\n\nof information seeking and decision aid that works \n\n\n\nfor them. For this purpose, the use of mnemonics \n\n\n\nand acronyms has been advocated to helps CPs \n\n\n\nremember what questions to ask a patient. There \n\n\n\nare a number of established framework called \n\n\n\nWWHAM, ASMETHOD, SIT DOWN SIR, \n\n\n\nENCORE, CHAPS-FRAPS \n25,26,27,28,29\n\n\n\n and recently \n\n\n\nthe mnemonic QuEST/SCHOLAR\n30,\n\n\n\n which has \n\n\n\nbeen promoted as a decision aids aimed to be use \n\n\n\nas an assessment process that can assist \n\n\n\ncommunity pharmacists in questioning patients \n\n\n\nand improving their ability to give the appropriate \n\n\n\nadvice about self-care. Irrespective of the choice of \n\n\n\nany decision aids, CPs have a key responsibility in \n\n\n\nidentifying, preventing, and resolving drug-related \n\n\n\nproblems in patients who are intend to self-\n\n\n\nmedicate with non-prescription medications. \n\n\n\nMoreover, there are concerns that pharmacy staff \n\n\n\nuses the mnemonic as a matter of rote rather than \n\n\n\nin the informed way, tailored to individual \n\n\n\nconsultations.\n31\n\n\n\n As every customer is different \n\n\n\nwith a unique medication experiences and \n\n\n\ntherefore it is unlikely than an acronym can be \n\n\n\nfully applied. Thus, using acronym in rote fashion \n\n\n\nmay miss vital information that could shape the \n\n\n\ncourse of action. Therefore, the objective of this \n\n\n\narticle is to describe a framework called STARZ-\n\n\n\nDRP, as a decision aid to ensure that customers are \n\n\n\ncounsel appropriately and triage correctly.  \n\n\n\nMETHODS \n\n\n\n\n\n\n\nWe consult standard reference textbooks\n25,26,27 \n\n\n\nand \n\n\n\nkey pharmacy journals\n29,30\n\n\n\n, looking for the \n\n\n\ncommon  mnemonics which has been promoted as \n\n\n\na decision aids for the supply of non-prescription \n\n\n\nmedicines. We believe that the clinical application \n\n\n\nof such decision aids is depending at the levels of \n\n\n\ninformation obtain from self-medicating patients \n\n\n\nnecessary for triaging process. Therefore, each \n\n\n\nmnemonic is evaluate base on the types of \n\n\n\ninformation collected with regards to: (i) details \n\n\n\nabout the patient\u2019s symptom presentation; (ii) \n\n\n\ndetails about the patient\u2019s medication experiences \n\n\n\nwhich includes allergies or sensitivities to \n\n\n\nmedications, concurrent medications, coexisting \n\n\n\ndisease states, action taken as well as perceptions \n\n\n\ntowards medication safety and effectiveness; and \n\n\n\n(iii) details about the patient-specific factors \n\n\n\nrelated to medication compliance, knowledge, and \n\n\n\ncost implication on medication use. Besides these, \n\n\n\nthe mnemonic is also evaluated for its ability to \n\n\n\nrecognize DRPs in a busy community pharmacy. It \n\n\n\nmeans that the mnemonic should prompt the CPs \n\n\n\nfor quick decision whether the  \n\n\n\n\n\n\n\nFigure 1.0   Flow chart for Pharmacy Triage Process  \n\n\n\nSTART             Step 1: Symptom assessment using acronym, STARZ  \n\n\n\nS-The patient\u2019s presenting symptoms (check figure 2.0 for serious or danger symptoms) \n\n\n\nT-Check onset and duration of presenting symptoms \n\n\n\nA-Explore any other associated symptoms (check figure 2.0) \n\n\n\nR-Check for recurrent or repeating symptoms \n\n\n\n          Assessment Questions (AQ) \n\n\n\n  AQ#1 : Is the patient\u2019s problem (or symptom) too serious for                      DRP #1(refer) \n\n\n\n                            self-treatment?                                            YES \n\n\n\n\n\n\n\n                                                                    NO      \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n314 \n \n\n\n\n      Step 2 : Zoom into the patient\u2019s medication experience. \n\n\n\n                    ( Medication Utilization Reviews ) \n\n\n\n  AQ#2: Have you tried some products to resolve the problems? ( DRP#4 &5) \n\n\n\n\n\n\n\n  AQ#3: Have you consulted a doctor to resolve the problems? (DRP#2) \n\n\n\n\n\n\n\n  AQ#4 Are you allergic to any drug or other substances? (DRP#10) \n\n\n\n  (Does the patient\u2019s problem is a manifestation of an allergic reaction?) \n\n\n\n\n\n\n\n  AQ#5: Do you have a known medical problem? (DRP#3,9,&12) \n\n\n\n  (Does the patient\u2019s problem is a manifestation of a chronic  \n\n\n\n                  diseases (a major disease)? \n\n\n\n\n\n\n\n  AQ#6: Are you taking any prescription drugs? (DRP#2,5,8,9,14,17) \n\n\n\n\n\n\n\n  AQ#7: Are you taking any other medications?(DRP# 12&13) \n\n\n\n\n\n\n\n  AQ#8: Are you experience any reactions from drugs? (DRP#11) \n\n\n\n\n\n\n\nAQ#9 : Do you stop taking your medications when you feel better? (DRP#8 & 17) \n\n\n\n\n\n\n\n   AQ#10: Do you stop taking your medications when you feel worse? (DRP#8 & 17) \n    \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nExplore Patient\u2019s Specific Factors \n\n\n\n \n\uf0b7 Pregnancy and lactation status \n\n\n\n    \uf0b7 Social history (smoking, alcohol) \n\n\n\n    \uf0b7 Religious and cultural beliefs (optional) \n\n\n\n    \uf0b7 Baseline knowledge of drug and disease \n\n\n\n    \uf0b7 Concerns about cost of therapy \n\n\n\n    \uf0b7 Patient\u2019s vital signs (BP, HR, T) \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n    Assessment Questions(AQ) \n \n\n\n\n  AQ#11 : Is there any barrier to drug taking because of religious or cultural beliefs?  (DRP# 6 &16)                        \n\n\n\n                           \n  AQ#12 : Do you smoke? Or Do you drink alcohol? ( DRP# 7)                                                                                                        \n\n\n\n\n\n\n\n  AQ#13 : Are you pregnant? Are you breast fed your baby? (DRP # 9)                              \n\n\n\n\n\n\n\n  AQ#14: Do you understand about your illness? (DRP # 8)                                                                                              \n\n\n\n\n\n\n\n  AQ# 15: Do you have any concern about the cost of therapy?  ( DRP#15)                                \n\n\n\n\n\n\n\n  AQ#16: Do you have any other queries about your illness and/or drug therapy?(DRP#18)  \n\n\n\n\n\n\n\n\n\n\n\n    Step 3 : Identification of drug-related problems (DRPs) \n\n\n\n                                                     ( check Table 3.0) \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n315 \n \n\n\n\nTable 1.0   Evaluation of mnemonics for self-care counselling.   \n\n\n\nMnemonics Information related to \n\n\n\nsymptom presentations\uf066 \n\n\n\nInformation related to \n\n\n\nmedication \n\n\n\nexperience\uf066 \n\n\n\nInformation \n\n\n\nrelated to patient -\n\n\n\nspecific factors \uf066 \n\n\n\nApplication in \n\n\n\nclinical practice \n\n\n\nWWHAM \nW- Who is the patient? \n\n\n\nW- What are the \n\n\n\nsymptoms? \n\n\n\nH- How long have the \n\n\n\nsymptoms  \n\n\n\nbeen present? \n\n\n\nA- Action taken? \n\n\n\nM- Medication being \n\n\n\ntaken? \n\n\n\n\n\n\n\n\n\n\n\n\uf0b7 Establishes presenting \n\n\n\ncompliant \n\n\n\n\uf0b7 Duration of symptoms \n\n\n\n\n\n\n\n\uf0b7 No data about other \n\n\n\nassociated symptoms. \n\n\n\n\uf0b7 No data about recurring \n\n\n\n or re-emergence of  \n\n\n\nsymptoms \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\uf0b7 Establishes action taken. \n\n\n\n\uf0b7 Establishes details about \n\n\n\npast and present \n\n\n\nmedications history. \n\n\n\n\n\n\n\n\uf0b7 No data on allergies and \n\n\n\nsensitivities to drug. \n\n\n\n\uf0b7 No data on immunization \n\n\n\nhistory. \n\n\n\n\uf0b7 No data on medical \n\n\n\nproblems/history \n\n\n\n\uf0b7No data on social history \n\n\n\n(smoking/alcohol) \n\n\n\n\n\n\n\n\uf0b7 Establishes identity \n\n\n\nof the  patient. \n\n\n\n\n\n\n\n\n\n\n\n\uf0b7 No data related to \n\n\n\npatient\u2019s knowledge,  \n\n\n\nmedication taking \n\n\n\n behavior. and cost of \n\n\n\ntreatment.  \n\n\n\n\uf0b7 No data about \n\n\n\npatient\u2019s vital signs \n\n\n\n \u2013 BP, HR, T \n\n\n\n\n\n\n\n\uf0b7 Useful for \n\n\n\npharmacy assistant \n\n\n\nfor first contact \n\n\n\nwith the patient \n\n\n\n\uf0b7 Provides \n\n\n\npharmacist with \n\n\n\nlimited information \n\n\n\nfor decision-\n\n\n\nmaking process. \n\n\n\n\uf0b7  Provides \n\n\n\npharmacist with \n\n\n\nlimited information \n\n\n\nto identify \n\n\n\nDRPs. \n\n\n\nASMETHOD \nA-Age/appearance \n\n\n\nS-Self/someone else \n\n\n\nM-Medication \n\n\n\nE- Extra medicines \n\n\n\nT-Time persisting \n\n\n\nH-History \n\n\n\nO-Other symptoms \n\n\n\nD-Danger symptoms \n\n\n\n\n\n\n\n\uf0b7 Establishes more details of \n\n\n\nthe presenting compliant, \n\n\n\nassociated symptoms, and \n\n\n\nduration of symptoms. \n\n\n\n\n\n\n\n\uf0b7 No data about recurring \n\n\n\n or re-emergence of  \n\n\n\nsymptoms \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\uf0b7 Establishes details about \n\n\n\npast and present \n\n\n\nmedications history. \n\n\n\n\n\n\n\n\uf0b7 No data on allergies and \n\n\n\nsensitivities to drug. \n\n\n\n\uf0b7 No data on immunization \n\n\n\nhistory. \n\n\n\n\uf0b7  No data on social \n\n\n\nhistory \n\n\n\n(smoking/alcohol) \n\n\n\n\n\n\n\n\uf0b7 Establishes identity \n\n\n\nand age of the \n\n\n\npatient. \n\n\n\n\n\n\n\n\n\n\n\n\uf0b7 No data related to \n\n\n\npatient\u2019s knowledge,  \n\n\n\nmedication taking \n\n\n\n behavior. and cost of \n\n\n\ntreatment.  \n\n\n\n\uf0b7 No data about \n\n\n\npatient\u2019s vital signs \n\n\n\n- BP, HR, T \n\n\n\n\n\n\n\n\uf0b7 Useful for details \n\n\n\nanalysis \n\n\n\nof symptoms. \n\n\n\n\uf0b7Provides \n\n\n\npharmacist with \n\n\n\nlimited information \n\n\n\nfor decision-\n\n\n\nmaking process. \n\n\n\n\uf0b7  Provides \n\n\n\npharmacist with \n\n\n\nlimited information \n\n\n\nto identify DRPs. \n\n\n\n\n\n\n\nSIT DOWN SIR \nS-site/location \n\n\n\nI-Intensity/severity \n\n\n\nT-Type or nature \n\n\n\nD-Duration \n\n\n\nO-Onset \n\n\n\nW-\n\n\n\nWith(other)symptoms \n\n\n\nN-Annoyed/aggravated \n\n\n\nS-Spread/radiation \n\n\n\nI-Incidence/frequency \n\n\n\nR-Relieved by? \n\n\n\n\n\n\n\n\uf0b7 Establishes more details of \n\n\n\nthe presenting compliant, \n\n\n\nassociated symptoms, \n\n\n\nseverity, and duration of \n\n\n\nsymptoms. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\uf0b7 None \n\n\n\n\n\n\n\n\uf0b7 No data on allergies and \n\n\n\nsensitivities to drug. \n\n\n\n\uf0b7 No data on immunization \n\n\n\nhistory. \n\n\n\n\uf0b7 No data on action taken \n\n\n\n and medications history. \n\n\n\n\uf0b7 No data on medical \n\n\n\nproblems/history \n\n\n\n\uf0b7No data on social history \n\n\n\n(smoking/alcohol) \n\n\n\n \n\uf0b7 Not specifically \n\n\n\nstated. \n\n\n\n\n\n\n\n\uf0b7 No data related to \n\n\n\npatient\u2019s knowledge,  \n\n\n\nmedication taking \n\n\n\n behavior. and cost of \n\n\n\ntreatment.  \n\n\n\n\uf0b7 No data about \n\n\n\npatient\u2019s vital signs  \n\n\n\n \u2013 BP, HR, T \n\n\n\n \n\uf0b7  Useful for \n\n\n\ndetails analysis of \n\n\n\nsymptoms. \n\n\n\n\uf0b7Amount of data \n\n\n\nexceeds the \n\n\n\ninformation needed \n\n\n\nfor triage. \n\n\n\n\uf0b7 Provides \n\n\n\npharmacist with \n\n\n\nlimited information \n\n\n\nfor decision-\n\n\n\nmaking process. \n\n\n\n\uf0b7  Provides \n\n\n\npharmacist with \n\n\n\nlimited information \n\n\n\nto identify DRPs. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nENCORE \nE-Explore \n\n\n\nN-No medication? \n\n\n\nC-Care \n\n\n\nO-Observe \n\n\n\nR-Refer \n\n\n\nE-Explain \n\n\n\n \n\uf0b7 Did not elicit all symptoms. \n\n\n\n\n\n\n\n\uf0b7 No data about other \n\n\n\nassociated symptoms. \n\n\n\n\uf0b7 No data about recurring \n\n\n\n or re-emergence of  \n\n\n\nsymptoms. \n\n\n\n\uf0b7 No data on onset and \n\n\n\nduration of symptoms. \n\n\n\n\n\n\n\n\uf0b7 Establishes action taken. \n\n\n\n\uf0b7 Establishes details about \n\n\n\npast and present \n\n\n\nmedications history. \n\n\n\n\n\n\n\n\uf0b7 No data on allergies and \n\n\n\nsensitivities to drug. \n\n\n\n\uf0b7 No data on immunization \n\n\n\nhistory. \n\n\n\n\uf0b7 No data on medical \n\n\n\n \n\uf0b7 Not specifically \n\n\n\nstated. \n\n\n\n\n\n\n\n\n\n\n\n\uf0b7 No data related to \n\n\n\npatient\u2019s knowledge,  \n\n\n\nmedication taking \n\n\n\n behavior. and cost of \n\n\n\ntreatment.  \n\n\n\n\uf0b7 No data about \n\n\n\n \n\uf0b7 Emphasizes the \n\n\n\nimportance of \n\n\n\nexplaining the \n\n\n\ndecision about \n\n\n\ntreatment. \n\n\n\n\uf0b7  Provides \n\n\n\npharmacist with \n\n\n\nlimited information \n\n\n\nto identify DRPs. \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n316 \n \n\n\n\n* CHAPS-FRAPS (C-Chief complaint, H-History of present illness, A-Allergies, P-Past medical history, S-Social history, F-\n\n\n\nFamilial history,  \n\n\n\nR-Review of other symptoms, A-Assessments, P-Plan, and S-SOAP ) \n\n\n\n\n\n\n\n\uf023 QuEST/SCHOLAR (Qu- Quickly and accurately assess the patient, E- Establish that the patient is an appropriate self-care \n\n\n\ncandidate, \n\n\n\nS- Suggest appropriate self-care strategies, T- Talk with the patient ; S-Symptoms, C-Characteristics, H-History, O-Onset, L-Location, \n\n\n\nA-Aggravating factors, R-Remitting factors) \n\n\n\n\n\n\n\n\uf066 the notes in italics highlight limited or no information related to the respective domains.       \n \n\n\n\n\n\n\n\npresenting signs and symptoms is either caused by \n\n\n\nor may be treated with a drug.  \n\n\n\nThe acronym, STARZ and classification of \n\n\n\nDRPs \n\n\n\nThe provision of advice about how best to manage \n\n\n\nhealth issues either to recommend no action, refer, \n\n\n\nor recommend a non-prescription medicines \n\n\n\n(NPM), is essentially is a form of \u2018triage\u2019. A \n\n\n\nframework called STARZ-DRP, a three steps \n\n\n\ndecision tool is develop for triaging patients in the \n\n\n\ncommunity pharmacy setting. Each letter \n\n\n\nrepresents a sequential step in the decision-making \n\n\n\nprocess. (Table 2.0) The centrality of the decision \n\n\n\ntools to the CPs is to determine what is or is not \n\n\n\nappropriate for NPM. It contained important key \n\n\n\nassessment questions based on the principles of \n\n\n\npharmaceutical care (Figure 1.0).  In this context, \n\n\n\nCipolle states that \u201c in the practice of \n\n\n\npharmaceutical care, decisions concerning an \n\n\n\nindication are made first, then, decisions \n\n\n\nconcerning effectiveness can be established, \n\n\n\nfollowed by safety considerations.\u201d The \n\n\n\ncompliance issues represent the ability of the \n\n\n\npatient to take the medication as intended.\n19\n\n\n\n In the \n\n\n\nface of busy commercial transactions, however, it \n\n\n\nis quite difficult for CP to become aware that a \n\n\n\npatients\u2019 symptom has a problem unless he/she set \n\n\n\nout with the intention of looking for drug-related \n\n\n\nproblems. This requires careful observation and \n\n\n\nadequate questioning to identify the symptoms \n\n\n\nreported by patients, which may have a potentially \n\n\n\nserious cause. For this purpose, a set of key \n\n\n\nassessment questions is design to identify and \n\n\n\n problems/history \n\n\n\n\uf0b7No data on social history \n\n\n\n(smoking/alcohol) \n\n\n\n\n\n\n\npatient\u2019s vital signs  \n\n\n\n \u2013 BP, HR, T \n\n\n\nCHAPS-FRAPS* \uf0b7  Establishes more details of \n\n\n\nthe presenting compliant and \n\n\n\nassociated symptoms.  \n\n\n\n\n\n\n\n\uf0b7 No data about recurring \n\n\n\n or re-emergence of  \n\n\n\nsymptoms. \n\n\n\n\n\n\n\n\uf0b7  Establishes details about \n\n\n\nallergies, past medical \n\n\n\nhistory, social and family \n\n\n\nhistory. \n\n\n\n\n\n\n\n\uf0b7 No data on immunization \n\n\n\nhistory. \n\n\n\n\uf0b7 No data on medications \n\n\n\nhistory. \n\n\n\n\n\n\n\n\n\n\n\n\uf0b7  Not specifically \n\n\n\nstated. \n\n\n\n\n\n\n\n\n\n\n\n\uf0b7 No data related to \n\n\n\npatient\u2019s knowledge,  \n\n\n\nmedication taking \n\n\n\n behavior. and cost of \n\n\n\ntreatment.  \n\n\n\n\uf0b7 No data about \n\n\n\npatient\u2019s vital signs \n\n\n\n \u2013 BP, HR, T \n\n\n\n\uf0b7 Useful for self-\n\n\n\ncare counseling. \n\n\n\n\uf0b7  Amount of data \n\n\n\nexceeds the \n\n\n\ninformation needed \n\n\n\nfor triage. \n\n\n\n\uf0b7  Provides \n\n\n\npharmacist with \n\n\n\nlimited information \n\n\n\nto identify DRPs. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nQuEST/SCHOLAR\uf023 \uf0b7  Establishes more details of \n\n\n\nthe presenting compliant and \n\n\n\nother related \n\n\n\nsymptom-specific data.  \n\n\n\n\n\n\n\n\uf0b7  Establishes details \n\n\n\nrelated to patient\u2019s \n\n\n\nmedication experiences. \n\n\n\n\uf0b7  Not specifically \n\n\n\nstated. \n\n\n\n\n\n\n\n\uf0b7No data related to \n\n\n\npatient\u2019s knowledge,  \n\n\n\nmedication taking \n\n\n\n behavior. and cost of \n\n\n\ntreatment.  \n\n\n\n\uf0b7 No data about \n\n\n\npatient\u2019s vital signs \n\n\n\n \u2013 BP, HR, T \n\n\n\n\uf0b7  Provide \n\n\n\nstructured \n\n\n\napproach to \n\n\n\ncounsel patients \n\n\n\nwith self-care \n\n\n\nissues.  \n\n\n\n\uf0b7  Amount of data \n\n\n\nexceeds the \n\n\n\ninformation needed \n\n\n\nfor triage. \n\n\n\n\uf0b7 Need additional \n\n\n\npatient-specific \n\n\n\ndata to identify \n\n\n\nDRPs.   \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n317 \n \n\n\n\ncategorize the DRPs. The categories of DRPs are \n\n\n\nsummarized in Table 3.0. \n\n\n\nRESULTS AND DISCUSSION \n\n\n\n\n\n\n\nAlthough varieties of self-care counselling \n\n\n\nstrategies exist, however, each of these methods is \n\n\n\nincomplete in some area (Table 1.0) The \n\n\n\nWWHAM, a popular and an established aide-\n\n\n\nmemoire used by pharmacy assistants, no doubt, it \n\n\n\nis an easily remembered mnemonic to obtain a \n\n\n\ngeneral picture of the patient\u2019s presenting \n\n\n\ncompliant but it does not encourage elaboration for \n\n\n\nsymptom assessment. There is evidence that \n\n\n\npharmacy assistants use WWHAM as a matter of \n\n\n\nrote rather than in a informed way, tailored to \n\n\n\nindividual consultations.\n31 \n\n\n\nIn fact, it was not \n\n\n\noptimally utilized as showed by another study that \n\n\n\nmost of the consultations involved a maximum of \n\n\n\ntwo WWHAM items, instead out of 5 items. Of \n\n\n\nconcerns, it was noticed that more than 60% of \n\n\n\nconsultations did not establish whether the \n\n\n\nrequestor for non-prescription medicine was using \n\n\n\nother medications concurrently.\n32 \n\n\n\nThese findings\n \n\n\n\nhas implications in terms of the potential DRPs \n\n\n\nrelated to drug interactions and exacerbations of \n\n\n\nclinical conditions.  \n\n\n\nAlthough other mnemonics, ENCORE, \n\n\n\nASMETHOD, SIT DOWN SIR are more \n\n\n\ncomprehensive than WWHAM, they are still \n\n\n\nlimited. To our knowledge, none of these methods \n\n\n\nwas studied exclusively in the community \n\n\n\npharmacy practice setting like WWHAM. \n\n\n\nMoreover, by no means these methods were \n\n\n\nuniversally use and apply in the community \n\n\n\npharmacy practice. Similarly, the mnemonic \n\n\n\nCHAPS-FRAPS provides a detail analysis of \n\n\n\nsymptoms and patient-specific factors, but it do \n\n\n\nnot address when a patient should be referred nor \n\n\n\nprovides indication for the recognition of DRPs. \n\n\n\nUnlike the other mnemonics, the \n\n\n\nQuEST/SCHOLAR process provides more \n\n\n\ncomprehensive picture of symptom presentation as \n\n\n\nwell as goes on to address the patient\u2019s medication \n\n\n\nexperiences so that the pharmacist can use this \n\n\n\ninformation to guide product selection or physician \n\n\n\nreferral. Furthermore, this approach includes a \n\n\n\nstructure for counselling the patient. Even though \n\n\n\nthe process deliberately use the word quickly to \n\n\n\nfind out what is wrong with the patient, but it is of \n\n\n\nconcerns, perhaps whether a busy practitioner likes \n\n\n\nthe CP able to collect relevant information for the \n\n\n\npurpose of identifying, resolving, and preventing \n\n\n\ndrug-related problems. On the contrary, the \n\n\n\namount of data may vastly exceed the information \n\n\n\nneeded for triaging self-medicating patients, after \n\n\n\ngoing through the whole QuEST/SCHOLAR \n\n\n\nprocess.  \n\n\n\nIn the self-care context when there is need for \n\n\n\nmedicines, the CP has a key role in assisting to \n\n\n\nidentify the best intervention. Apart from helping \n\n\n\nto choose an OTC medicine that is safe and \n\n\n\neffective, the CP may refer patients to another \n\n\n\nhealth professional, most commonly to the general \n\n\n\npractitioner. Direct referrals of patients to GPs \n\n\n\nhave been reported to range from 6% to 15%. \n33,34,35,36\n\n\n\n Another study found that 15% of \n\n\n\npharmacy customers seeking advice were \n\n\n\nrecommends to see their doctors, of which, 53% \n\n\n\ndirectly and 47% conditionally.\n37\n\n\n\n Conditional \n\n\n\nreferrals is an option offered where the patients are \n\n\n\nadvised to seek medical assistance if symptoms do \n\n\n\nnot clear within a given timeframe. An interesting \n\n\n\nobservation by Hassel et.al (1997) was that CP\u2019s  \n\n\n\nreferred their clients to GPs when they were in \n\n\n\ndoubt or uncertainty about their health problems.\n33\n\n\n\n\n\n\n\nClearly, this findings showed that CPs is keenly \n\n\n\naware of their limits in providing care at the \n\n\n\npharmacy. Now, perhaps, there is a need for \n\n\n\nsimple aids for pharmacy triage that is not only to \n\n\n\nprovide guidelines for decision-making but more \n\n\n\nimportantly is to gain professional confidence.  \n\n\n\nOwing to some barriers and challenges in \n\n\n\nresponding to symptoms in the pharmacy, a simple \n\n\n\ndecision aids is proposed aimed for a quick \n\n\n\nscreening and triaging process for patients who are \n\n\n\nneeded for further assessment by other healthcare \n\n\n\npractitioners. Here, it is important to emphasize \n\n\n\nthat CP has the appropriate communication skills \n\n\n\nto collect information adequately. Besides this, it is \n\n\n\nessential to have accurate knowledge of minor \n\n\n\nillnesses and its management. Any deficiencies of \n\n\n\nthese aspects make the process of data collection \n\n\n\ninefficient, and may deliberately impair the \n\n\n\ntriaging process.  A description of each of the \n\n\n\nmajor steps involved in the process follows. \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n318 \n \n\n\n\n\n\n\n\nTable 2.0  Definition of letters in STARZ \n# \uf02a\n\n\n\n\n\n\n\n_________________________________________________________________________________________________ \n\n\n\nLetter   Description \n_________________________________________________________________________________________________ \n\n\n\nS  Symptom presentation refer to subjective evidence of health problem which is perceived by \n\n\n\nthe patient.   \n\n\n\n\n\n\n\nT   Time of onset and duration of the presenting symptoms.  \n\n\n\n\n\n\n\nA   Associated symptoms refer to patient symptoms explore and determine by the pharmacist \n\n\n\nduring the interview. It does not refer to the symptom presented earlier by the patient. This is \n\n\n\ndone by using the pictorial documentation form as depicted in Figure 2.0. To aid and ease the \n\n\n\npharmacist during the interview, the human body is arbitrarily divided into four regions: (i) \n\n\n\nFront part, the position of body facing the pharmacist (asking for symptoms like bloating, \n\n\n\nheartburn, nausea, vomiting, breathlessness), then proceed to (ii) back  \n\n\n\npart of the body (asking for symptoms like lower and upper back pain, shoulder pain, and \n\n\n\nneck pain), continued to the (iii) upper part, this is, the patient head (asking for symptoms like \n\n\n\nheadache, dizziness, problems with sleep), and lastly go down to (iv) the lower part of the \n\n\n\nbody (asking for symptoms like numbness of both legs and hands, constipation, and swollen \n\n\n\nfeet). Perhaps, the process is likened to the  filtering or screening process particularly to rule \n\n\n\nout the presence of severe symptoms.  \n\n\n\n\n\n\n\nR  Recurrence problem refers to the symptom presentation which has been treated before, but \n\n\n\nthe symptom recur and persists despite the treatment prescribed.   \n\n\n\n\n\n\n\nZ Zoom into the patient\u2019s medication experience refer to information collected by the \n\n\n\npharmacist related to any medical problems (for examples, hypertension, diabetes, \n\n\n\nhyperthyroid), medication utilisation (for examples, use of prescription and non-prescription \n\n\n\ndrugs, herbals, supplements ), immunisation history, allergies as well as sensitivities to drugs,  \n\n\n\nexperiences of drug side effects and adverse reactions, and consumption of alcohol, caffeine \n\n\n\nand tobacco.  \n\n\n\n\n\n\n\n_________________________________________________________________________________________________ \n\n\n\n# \n This is not a diagnostic tool, rather it is a format with the purpose of organizes a community pharmacist\u2019s knowledge in \n\n\n\na manner that allows him/her to begin identifying the actual and potential drug-related problems and subsequently triage \n\n\n\npatients to the appropriate health care professionals. \n\n\n\n\uf02a The patient\u2019s vital signs will be measured when necessary. At times, the patient\u2019s blood pressure, pulse rate, and body \n\n\n\ntemperature are measured to aid pharmacist assessing the appropriateness of presenting symptom for self-medication.      \n\n\n\n\n\n\n\n_________________________________________________________________________________________________ \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n319 \n \n\n\n\nStep 1 : The acronym, STAR, for symptom \n\n\n\nassessment. \n\n\n\nEither the CP or the patient can initiate the \n\n\n\nbeginning of the interaction. In this situation, \n\n\n\ncommunication is essential in order to develop a \n\n\n\ntherapeutic relationship and be receptive to create \n\n\n\nconditions conducive for conducting the interview \n\n\n\nand collecting patient data.\n19\n\n\n\n It is important to \n\n\n\nintroduce personally and the patient should be \n\n\n\naddressed by his or her name.\n38\n\n\n\n\n\n\n\nIn the first step, objective information is obtained \n\n\n\nby asking the patient about his/her age and gender \n\n\n\n(usually obtained by visual observation). Then, \n\n\n\nexplore the patient\u2019s chief complaint or reason for \n\n\n\nthe pharmacy visit. At this point, it is important not \n\n\n\nto confuse the patient\u2019s self-diagnosis with \n\n\n\npatient\u2019s symptoms. The pharmacists should act \n\n\n\nprofessionally and refrain from implying \n\n\n\nacceptance of the patient\u2019s self-diagnosis. Instead, \n\n\n\nsimply acknowledge the patient\u2019s complaint and \n\n\n\nthen proceed with the interview.  \n\n\n\n\n\n\n\nTable 3.0  Categories of drug-related problem (DRPs) \n\n\n\n\n\n\n\nINDICATION \n\n\n\n\n\n\n\nDRP#1 : No indication for NPM \n\n\n\nDRP#2 : Uncertainty about the indication of drug \n\n\n\nDRP#3 : Need for additional therapy \n\n\n\n\n\n\n\nEFFECTIVENESS \n\n\n\n\n\n\n\n\n\n\n\nDRP#4: Inappropriate drug choice \n\n\n\nDRP#5: Dose too low \n\n\n\nDRP#6: Ineffective therapy \n\n\n\nDRP#7: Interference with medical therapy by  \n\n\n\nsmoking/alcohol consumption \n\n\n\nDRP#8: Lack of understanding of the medication \n\n\n\nDRP#9: Monitoring required \n\n\n\n\n\n\n\nSAFETY \n\n\n\n\n\n\n\n\n\n\n\nDRP#10: Use of medication to which the patient is allergic \n\n\n\nDRP#11: Adverse drug events \n\n\n\nDRP#12: Potential drug-disease interaction \n\n\n\nDRP#13: Potential drug-drug interaction \n\n\n\nDRP#14: Dose too high \n\n\n\n\n\n\n\nCOMPLIANCE \n\n\n\n\n\n\n\n\n\n\n\nDRP#15: Problems arising from financial impact of therapy \n\n\n\nDRP#16: Interference with medical therapy by cultural/religious beliefs \n\n\n\nDRP#17: Failure of the patient to adhere to labelling instructions  \n\n\n\nDRP#18: others \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n320 \n \n\n\n\nThe first letter, S, represents the patient\u2019s \n\n\n\npresenting symptoms. Besides the previously \n\n\n\nemphasized communication skills, it is essential to \n\n\n\nhave accurate clinical knowledge in order to \n\n\n\ndistinguish between minor and major disease. This \n\n\n\nrequires careful observation and adequate \n\n\n\nquestioning to identify the symptoms reported by \n\n\n\npatients. In fact, the pharmacist is provided with a \n\n\n\nchecklist of serious or danger symptoms.     \n\n\n\n(Figure 2.0) The second letter, T, denotes the time \n\n\n\nof onset and duration of the presenting symptoms. \n\n\n\nThese objective data would provide the CP with \n\n\n\nthe opportunity to clarify the history of presenting \n\n\n\nsymptoms being reported. Proceed with the third \n\n\n\nletter, A, stands for the associated or related \n\n\n\nsymptoms. It is therefore necessary for the CP to \n\n\n\nask the presence (or absence) and nature of \n\n\n\nassociated or related symptoms. This is best \n\n\n\nundertaken on a systematic body system basis. We \n\n\n\ndesign a pictorial documentation form to aid CPs \n\n\n\nduring the interview process.(Figure 2.0) At this \n\n\n\nstage, it is necessary to ask the patient in detail \n\n\n\nabout the symptoms. This is to ascertain that no \n\n\n\nrelated symptoms pertaining to the parts of body \n\n\n\nsystem are overlooked. Lastly, the fourth letter, R, \n\n\n\nstands for recurrence or repeated symptoms. It is \n\n\n\nimportant to establish whether the presenting \n\n\n\nsymptom has occurred before. If it is a recurrence, \n\n\n\nit is useful to explore the course of action that has \n\n\n\nalready been tried and how successful it was.  \n\n\n\nIn general, referral is indicated in the following \n\n\n\nsituations: (i) the CP is in doubt about the patient\u2019s \n\n\n\npresenting symptom (the letter, S) or presence of \n\n\n\nserious or danger symptoms; (ii) the symptom is \n\n\n\nminor but persistent (the letter, T); (iii) the \n\n\n\npresenting symptom is associated with a group of \n\n\n\nsymptoms ( the letter, A) ; and (iv) the symptom \n\n\n\nhas recurred repeatedly (the letter, R). Obviously, \n\n\n\nif in doubt, further inquiry should be made before \n\n\n\nreaching a decision. However, in most situations, \n\n\n\nthe decision is based on an accurate knowledge of \n\n\n\nminor illnesses as well as fully capable of \n\n\n\ndistinguishing between minor and major disorders. \n\n\n\nNevertheless, one\u2019s should be remind that the \n\n\n\nSTAR is not a diagnostic process but rather \n\n\n\nprovides the CP with opportunity for screening or \n\n\n\nsieving the patients prior making the decision for \n\n\n\ntriage. This is called as the \u2018filter effect\u2019, which is \n\n\n\nan important aspect of pharmacy triage, which can \n\n\n\nbe likened to the \u2018gatekeeper effect\u2019 attributed to \n\n\n\nthe telephone triage services.    \n\n\n\nStep 2 : Zoom into the patient\u2019s medication \n\n\n\nexperience. \n\n\n\nAs stated earlier, each patient has a unique \n\n\n\nmedication experience describe as an individual\u2019s \n\n\n\nsubjective experience of taking a medication in his \n\n\n\ndaily life. In this regards, Cipolle (2004) state \u201ca \n\n\n\npractitioner cannot make sound clinical decisions \n\n\n\nwithout a good understanding of the patient\u2019s \n\n\n\nmedication experience\u201d and urge pharmacy \n\n\n\npractitioners to take responsibility for improving \n\n\n\neach patient\u2019s medication experience.\n19\n\n\n\n For this to \n\n\n\noccur, it is essential that the CP has the appropriate \n\n\n\ncommunication and interviewing skills to obtain \n\n\n\ninformation related to the consumption of \n\n\n\nprescription and non-prescription medications, \n\n\n\nherbal products, and dietary supplements. It is also \n\n\n\nhelpful to obtain information about coexisting \n\n\n\nmedical conditions, allergies or sensitivities to \n\n\n\nmedications, as well as immunization history, and \n\n\n\npatient\u2019s use of alcohol, caffeine, and tobacco. \n\n\n\nThis information should be evaluated in the \n\n\n\ncontext of the patient\u2019s presenting symptom.  \n\n\n\nA person may engage in a number of practices or \n\n\n\nbehaviours related to drug taking and drug use. \n\n\n\nThese may includes self-alteration of a drug\u2019s \n\n\n\ndosage without prescriber knowledge, use of \n\n\n\nmultiple drug products, refusal to take medications \n\n\n\nbecause of the perceived drug\u2019s side effects or \n\n\n\nadverse drug reactions, or seeking treatment from \n\n\n\nmultiple clinics and pharmacies. The CPs, \n\n\n\ntherefore, should be alert to any routine practices \n\n\n\nor behaviour that may contribute to unnecessary \n\n\n\nhealth risk.\n39\n\n\n\n Thus, a tactful exploration of the \n\n\n\npatient\u2019s general understanding, knowledge, and \n\n\n\nexpectations concerning drug taking and use, as \n\n\n\nwell as the way he actually perform daily \n\n\n\nactivities, will provide CPs with enough \n\n\n\ninformation to identify the patient\u2019s drug-related \n\n\n\nproblems and formulate a plan for appropriate \n\n\n\naction.   \n\n\n\nStep 3 : Identification of drug-related problems \n\n\n\n(DRPs). \n\n\n\nThe scenery of DRPs should be view at the outset \n\n\n\nof the symptoms reported by patients. It can, \n\n\n\nperhaps, be scented throughout the entire courses \n\n\n\nof step 1 and 2, since this is where the CP gathers \n\n\n\nsymptom-specific as well as patient-specific data \n\n\n\nand critically examine it to determine if problem \n\n\n\nexists. In the face of busy commercial transactions, \n\n\n\nhowever, it is quite difficult for CP to become \n\n\n\naware that a patients\u2019 symptom has a problem \n\n\n\nunless he/she set out with the intention of looking \n\n\n\nfor drug-related problems. As studied by Currie \n\n\n\net.al.(1997), the detection of DRPs were increased \n\n\n\nafter the CPs went through a training program. A \n\n\n\n40-hour pharmaceutical care training program was \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n321 \n \n\n\n\ndeveloped and presented to pharmacists, and \n\n\n\npatients were randomly assigned to receive either \n\n\n\ntraditional pharmacy services or pharmaceutical \n\n\n\ncare, consisting of initial work-up and follow-up \n\n\n\nwith documentation in a patient record. The \n\n\n\nfindings showed that patients receiving \n\n\n\npharmaceutical care were more than seven times as \n\n\n\nlikely to have any problems identified, more than \n\n\n\neight times as likely to have an intervention \n\n\n\nperformed, and more than eight times as likely to \n\n\n\n\n\n\n\n\n\n\n\nFigure 2.0 Pictorial Documentation Form \n\n\n\n\n\n\n\n3. Upper part:\n\n\n\n\uf031Headache\n\n\n\n\uf031Dizziness\n\n\n\n\uf031Problem with sleep\n\n\n\n\uf031 Other(s):_______________________________ BP:\n\n\n\nPulse:\n\n\n\nTemp (\ufffdC):\n\n\n\nAssociated symptom(s)\n\n\n\n1. Front part:\n\n\n\n\uf031Bloating\n\n\n\n\uf031Heartburn\n\n\n\n\uf031Nausea\n\n\n\n\uf031Vomiting\n\n\n\n\uf031 Breathlessness\n\n\n\n2. Back part:\n\n\n\n\uf031Low back pain\n\n\n\n\uf031Upper back pain\n\n\n\n\uf031Shoulder pain \n\n\n\n\uf031Neck pain\n\n\n\n4. Lower part:\n\n\n\n\uf031Numbness of hand(s)\n\n\n\n\uf031Numbness of leg(s)\n\n\n\n\uf031Swollen feet(s)\n\n\n\n\uf031Constipation\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n322 \n \n\n\n\nhave a drug-related problem identified than were \n\n\n\npatients receiving traditional pharmacy services \n\n\n\nonly.\n40\n\n\n\n\n\n\n\nIt is certain that we need to have knowledge about \n\n\n\nthe patient\u2019s total drug use to address issues \n\n\n\nregarding DRPs. In addition, we need to explore \n\n\n\nother factors influencing the patient\u2019s use of \n\n\n\nmedicines. In the entire course of self-medication \n\n\n\npractices there are three main processes where a \n\n\n\nDRP can be generated: (i) patient\u2019s presenting \n\n\n\nsymptom ;(ii) patient\u2019s drug utilization pattern; \n\n\n\nand (iii)  patient\u2019s specific factors that may impede \n\n\n\nand influence the patient\u2019s medication taking \n\n\n\nbehavior. In practice, however, it may not be \n\n\n\nfeasible to begin identifying medication problems \n\n\n\nunless the patient is interview thoroughly about \n\n\n\ndrug use and relevant aspects to uncover potential \n\n\n\nand actual DRPs. In fact, this is a method currently \n\n\n\nused in clinical practice, especially by clinical \n\n\n\npharmacists in hospitals and nursing homes,\n41,42\n\n\n\n\n\n\n\nand a high proportion of the DRPs identified in the \n\n\n\ninterviews were of major clinical significance.\n43 \n\n\n\n\n\n\n\nThe true prevalence of DRPs in self-medicating \n\n\n\npatients is unknown. Therefore, a tactful \n\n\n\nexploration of the patient\u2019s presenting symptom, \n\n\n\ndrug taking practices and behaviors, as well as the \n\n\n\nway patient actually cope with his/her illness, will \n\n\n\nprovide pharmacists with enough information to \n\n\n\nidentify the DRPs and formulate a plan for \n\n\n\nappropriate action. The categories of DRPs listed \n\n\n\nin Table 3.0 is an addition to the seven categories \n\n\n\nproposed by Cipolle et.al (1998)\n19\n\n\n\n We concur with \n\n\n\nCipolle that the  categories apply across all patient, \n\n\n\npractitioner, and institutional variables. The \n\n\n\nadditional items in the list are mainly to take into \n\n\n\naccount the three main processes of self-\n\n\n\nmedication practices mentioned earlier. In this \n\n\n\ncontext, the order of how the DRP were identified \n\n\n\nis important. In the practice of pharmaceutical care \n\n\n\nfor minor illnesses, decisions\u2019 concerning an \n\n\n\nindication for NPM is made first. By asking the \n\n\n\nkey questions as depict in Figure 1.0, then, \n\n\n\npossible causes of DRPs are determined. Most \n\n\n\nimportantly, this will guide the CPs in the process \n\n\n\nof problem solving during the encounter with \n\n\n\npatients. In addition, reasons for referral and \n\n\n\neffective care plan can be establish. Finally yet \n\n\n\nimportantly, the process may seem lengthy and \n\n\n\ntedious, but once it becomes habitual and is \n\n\n\nperform routinely, the process can be both \n\n\n\ncomprehensive and time-effective.  \n\n\n\nCurrently, a demonstration project of the STARZ-\n\n\n\nDRP model is been studied among a group of \n\n\n\ncommunity pharmacies in Penang. Ten retail \n\n\n\npharmacies were recruited in the study that \n\n\n\ncomprises of five control and five study \n\n\n\npharmacies. All pharmacists taking part in the \n\n\n\nstudy was instructed to obtain information on the \n\n\n\npatient drug use during a natural dialogue and to \n\n\n\napply the proposed model consistently but still \n\n\n\nwith professional judgment. Hence, the model was \n\n\n\nnot meant to be use literally but to be adjusted to \n\n\n\nthe actual patient and his/her medication \n\n\n\nexperience. The control group continues carry out \n\n\n\ntheir usual care while the study group exposed to \n\n\n\nthe elements of pharmaceutical care that comprises \n\n\n\nof patient assessment, care plan, and monitoring. \n\n\n\nThe STARZ-DRP was the assessment part of the \n\n\n\npharmaceutical care. Patients who fulfilled the \n\n\n\ninclusion criteria and complaints of headache, \n\n\n\ndysmenorrhoea, back pain, constipation, \n\n\n\ndyspepsia, nasal symptoms, sore throat, cough and \n\n\n\nhigh temperature are invites to participate in the \n\n\n\nstudy. Apart from the documentation of the \n\n\n\npatient\u2019s DRPs, a group of experts\u2019 panel evaluate \n\n\n\nthe appropriateness for triaging patients by \n\n\n\ncommunity pharmacists. The group comprises of \n\n\n\n10 general practitioners and 10 community \n\n\n\npharmacists. To the best of our knowledge, this is \n\n\n\nthe first study of this kind, an attempt to provide a \n\n\n\ndocumentation of the pharmaceutical care practice \n\n\n\nfor minor ailments.  \n\n\n\nCONCLUSIONS \n\n\n\nThis article highlights the importance of structured \n\n\n\nand systematic processes in triaging patients with \n\n\n\nminor illnesses. The STARZ-DRP introduces a \n\n\n\nformat with the purpose of organizes a community \n\n\n\npharmacist\u2019s knowledge in a manner that allows \n\n\n\nhim/her to begin identifying the actual and \n\n\n\npotential DRPs. However, it should be noted that \n\n\n\nSTARZ-DRP is not intended to advocate self-\n\n\n\nmedication, but to provide a platform for \n\n\n\ncollaboration with other health care professionals \n\n\n\nin order to promote rational use of medicines.  \n\n\n\nAgain, it is important to emphasize the importance \n\n\n\nof an effective communication skill and accurate \n\n\n\nclinical knowledge to distinguish between minor \n\n\n\nillness and major disease.  Further study is needed \n\n\n\nto determinate whether STARZ-DRP is more \n\n\n\neffective than other methods for pharmacy triage \n\n\n\nservice when studied in a controlled, systematic \n\n\n\nmanner.  \n\n\n\n\n\n\n\nACKNOWLEDGEMENTS \n\n\n\nWe are grateful to the Universiti Sains Malaysia \n\n\n\nfor providing the Research University (RU) Grant \n\n\n\nto fund this research. Under this RU grant, we are \n\n\n\ncurrently conducting a research project entitled \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n323 \n \n\n\n\n\u201cEstablishing and implementing the philosophy of \n\n\n\npharmaceutical care in the community pharmacy \n\n\n\npractice \u2013 A Malaysian perspective. \u201d (Grant \n\n\n\nnumber: 1001/PFARMASI/8120234)   \n\n\n\nREFERENCES \n\n\n\n1. WORLD HEALTH ORGANIZATION. The role of the pharmacist in self-care and self-medication.    \n\n\n\nHangue: World Health Organization.1998 \n\n\n\n2. World Self-Medication Industry. WSMI declaration on self-care and self-medication(2006) Available \n\n\n\nat :  http://www.wsmi.org/pdf/bali_declaration.pdf Accessed on : 18 September 2010 \n\n\n\n3. Winfield,A.J. and Richards,R.M.E. Pharmaceutical practice. 2\nnd\n\n\n\n. Ed. Hong Kong.  1998 \n\n\n\n4. Ajuoga, E., Sansgiry,S.S., Ngo,C. Use/misuse of over-the-counter medications and associated adverse  \n\n\n\ndrug events among HIV-infected patients. Res Soc Admin Pharm, 2008 ;4(3): 292-301  \n\n\n\n5. Biskupiak,J.E., Brixner,D.I., Howard,K., Oderda, D.M Gastrointestinal complications of over-the-\n\n\n\ncounter nonsteroidal antiinflammatory drugs, J Pain Palliat Care Pharmacother , 2006; 20 (3), 7\u201314 \n\n\n\n6. Sorensen,H.T.,Mellemkjaer,L.,Blot,W.J. et al., Risk of upper gastrointestinal bleeding associated with \n\n\n\nuse of low-dose aspirin, Am J Gastroenterol , 2000; 95 (9): 2218\u20132224 \n\n\n\n7. Fored,C.M.,Ejerblad,E.,Lindblad,P., et al., Acetaminophen, aspirin, and chronic renal failure, N Engl \n\n\n\nJ Med , 2001; 345 (25):1801\u20131808 \n\n\n\n8. Pray, S.W.  Non-prescription Product Therapeutics, 2\nnd\n\n\n\n. Eds. Lippincott Williams and Wilkins, \n\n\n\nBaltimore,  MD 2006 pages 18-29 \n\n\n\n9. Hepler,C.D., Strand,L.M. Opportunities and responsibilities in pharmaceutical care. 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Journal of Social Administrative Pharmacy, 1990; 7: 221-224 \n\n\n\n16. Waterfield, J. Community Pharmacy Handbook. 2008 London, Chicago: Pharmaceutical Press. \n\n\n\n17. Dick, M. L., & Winship, H. W. A cost effectiveness comparison of a pharmacist using three methods  \n\n\n\nfor identifiying posible drug related problems. Drug Intell Clin Pharm,1975; 9(5): 257-262. \n\n\n\n18. Strand, L. M., Morley, P. C., Cipole, R. J., Ramsey, R., & Lamsam, G. D. Drug-related problems: \n\n\n\ntheir structur and function. Ann Pharmacother,1990; 24(11): 1093-1097. \n\n\n\n19. Cipolle, R.J., Strand, L.M., Morley. Pharmaceutical Care Practice: The Clinician\u2019s Guide. 2\nnd\n\n\n\n. \n\n\n\ned.2004. New York: McGraw-Hill. \n\n\n\n20. Westerlund LT, Marklund BR, Handl WH, Thunberg ME, and Allebeck P Nonprescription drug-\n\n\n\nrelated problems and pharmacy interventions. Ann Pharmacotherapy, 2001; 35 (11) : 1343-1349 \n\n\n\n21. H\u00e4mmerlein A, Griese N, Schulz M. Survey of Drug-Related Problems Identified by Community \n\n\n\nPharmacies.  Ann Pharmacotherapy, 2007;41(11):1852-1832 \n\n\n\n22. Griese N, Berger K, Eickhoff C.Prevalence of drug-related problems in self-medication (OTC use).  \n\n\n\nPharmacotherapy,2009;29(Suppl); 39e \n\n\n\n23. Sara Courson What is Telephone Nurse Triage? Connection magazine. Available at : < http: // www. \n\n\n\nConectionsartclemagazine.com  /articles/5/090.html> Assessed on : 20 September 2010 \n\n\n\n24. O'Connell JM, Towles W, Yin M, Malakar CLPatient Decision Making: Use of and Adherence \n\n\n\ntoTelephone-Based Nurse Triage Recommendations. Med Decis Making,2002; 22(4): 309-317 \n\n\n\n\nhttp://www.wsmi.org/pdf/bali_declaration.pdf\n\n\nhttp://www.conectionsartclemagazine.com/articles/5/090.html\n\n\nhttp://www.conectionsartclemagazine.com/articles/5/090.html\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n324 \n \n\n\n\n25. Blenkinsopp,A.,Paxton,P.,Blenkinsopp,J. Symptoms in the pharmacy: A guide to the management of \n\n\n\ncommon Illness, 5\nth\n. Eds. 2005. Blackwell Publishing,Oxford,UK. pages 1-13 \n\n\n\n26. Edwards,C., Stillman,P. Minor illness or Major disease? The clinical pharmacist in the community. \n\n\n\n4\nth\n. Eds. 2006. Pharmaceutical Press, London. pages 1-10 \n\n\n\n27. Rutter,P. Community pharmacy. Symptoms, Diagnosis and Treatment. 2004. Churchill Livingstone. \n\n\n\nAn Imprint of Elsevier Limited. pages ix \u2013 xi. \n\n\n\n28. Rutter PM, Horsley E, Brown DT. Evaluation of community pharmacists' recommendations \n\n\n\ntostandardized patient scenarios. Ann Pharmacother, 2004; 38:1080\u20135. \n\n\n\n29. McCallian DJ, Cheigh NH. The pharmacist's role in self-care. J Am Pharm Assoc, 2002; 42:S40\u20131 \n\n\n\n30. Shauna M B, Kirby J,Conrad WF. A Structured Approach for Teaching Students to Counsel Self-care.  \n\n\n\nPatients. Am J Pharm Educ, 2007;71(1): 1-7 \n\n\n\n31. Watson,M.C., Bond,C.M. The evidence based supply of non-prescription medicines: barriers and \n\n\n\nbeliefs. Int J Pharm Prac, 2004; 12: 65-72 \n\n\n\n32. Watson,M.C., Hart,J., Johnson,M. Bond,C.M. (2008) Exploring the supply of non-prescription \n\n\n\nmedicines from community pharmacies in Scotland. Pharm World Sci, 2008; 30:526-535 \n\n\n\n33. Hassell K, Noyce PR Rogers A, Harris J and Wilkinson J  A pathway to the GP: The pharmaceutical  \n\n\n\nconsultation' as a first port of call in primary health care. Family Practice, 1997 14(6): 498-502 \n\n\n\n34. Seston L, Nicolson M, Hassell K, Cantrill J and Noyce P Variation in the incidence, presentation and \n\n\n\nmanagement of nine minor ailments in community pharmacy. Pharm J, 2001; 266: 429-432 \n\n\n\n35. Bissell, P, Ward PR and Noyce P Variation within community pharmacy: 3. Referring customers to \n\n\n\nother health professionals. J Soc Admin Pharm, 1997; 14(2): 116-123 \n\n\n\n\n\n\n\n36. Tully MP, Hassel K and Noyce P  Advice-giving in community pharmacies in the UK. J Health        \n\n\n\nServices Res Policy, 1997; 2(1): 38-50 \n\n\n\n37. Marklund B, Karlsson G and Bengtsson C The advisory service of the pharmacies as an activity of its \n\n\n\nown and as a part of collaboration with primary health care services. J Soc Admin Pharm, 1990; 7(3): \n\n\n\n111-116 \n\n\n\n38. Berger BA. Communication skills for pharmacists: Building relationships and improvise patient care. \n\n\n\nWashington : American Pharmaceutical Association, 2005 \n\n\n\n39. Azmi S.Drug counseling: The need for a systematic approach. J Pharm Technol, 1993 9: 6-9 \n\n\n\n40. Currie JD, Chrischilles EA,Kuehl AK, Buser RA.Effect of a training program on community    \n\n\n\npharmacists\u2019 detection of and intervention in drug-related problems. J Am Pharm Assoc,1997; Mar-\n\n\n\nApr, NS37(2):182-191 \n\n\n\n41. Furniss,L.,Burns,A,Craig,S.K.,et.al. Effects of a pharmacist\u2019s medication review in nursing homes.  \n\n\n\nRandomised controlled trial. Br.J.Psychiatry,2000; 176: 563-7 \n\n\n\n42. Kaboli,P.J.,Hoth,A.B.,McClimon,B.J.,et.al.Clinical pharmacists and inpatient medical care: a       \n\n\n\nsystematic review. Arch Intern Med,2006;166:955-64 \n\n\n\n43. Viktil,K.K.,Blix,H.S.,Moger,T.A.,et.al. Interview of patients by pharmacists contributes significantly \n\n\n\nto the identification of drug-related problems(DRPs). Pharmacoepidemiol Drug Saf,2006;15:667-74 \n\n\n\n44. van Mil JWF, Westerlund LT, Hersberger KE, Schaefer MA. Drug-related problem classification \n\n\n\nsystems.  Ann Pharmacother,2004; 38: 859-867 \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n"
"\n\n\n\n\n\n1 \n\n\n\nEXPLORATION OF EQ-5D-5L BOLT-ON ITEMS AMONG MALAYSIAN POPULATION \n\n\n\n\n\n\n\nThakumar AV1, Shafie AA1*, Lim CJ1 \n1Discipline of Social & Administrative Pharmacy, Universiti Sains Malaysia, Penang, Malaysia. \n* Contact for correspondence, please email: aakmal@usm.my \n\n\n\nABSTRACT \n\n\n\nThis study aimed to assess the adequacy of EQ-5D-5L in defining health as perceived by Malaysians \n\n\n\nusing a mixed methodology approach. Potential additional dimensions (i.e. bolt-on items) to supplement \n\n\n\nthe current instrument were also explored. This study was carried out in two phases. In phase one, focus \n\n\n\ngroup discussions (N = 6-8 in each group) were employed to gauge the perception of Malaysians on the \n\n\n\ndimensions deemed important additions to the EQ-5D-5L instrument. Phase two involved further \n\n\n\nvalidation of bolt-ons to the EQ-5D-5L using a cross-sectional survey of 100 general public in Penang, \n\n\n\nMalaysia. A total of 11 bolt-ons were identified from phase 1. These bolt-ons were sleep, vitality, \n\n\n\nhappiness, close relationships, stress, mental abilities, social support, religion, vision, hearing, and \n\n\n\nspeaking.  In phase 2, the bolt-ons of \u2018vitality\u2019 and \u2018stress\u2019 stood out with 70% (n=70) and 64% (n=64) \n\n\n\nparticipants reported facing most problems with, respectively. Both phases of study suggest that \n\n\n\nadditional dimensions for the existing EQ-5D-5L instrument may be useful to better capture the HRQoL \n\n\n\namong Malaysians. Larger scale study is warranted to further validate the bolt-ons identified in this \n\n\n\nstudy.  \n\n\n\nKeywords: Health-related quality of life, EQ-5D-5L, bolt-on, health dimensions \n\n\n\nINTRODUCTION \n\n\n\nHealth-related quality of life (HRQoL) instruments offer a way to measure patient-reported outcomes \n\n\n\nin addition to existing clinical indicators for a more wholesome assessment of a person\u2019s well-being \n\n\n\n(1). Currently, these instruments are widely applied in economic valuations, besides quantifying the \n\n\n\neffectiveness of medical treatments, and monitoring patients\u2019 medical progress (2).  \n\n\n\nOne of the most commonly used generic HRQoL measures is the EuroQol five-dimensional \n\n\n\nquestionnaire (EQ-5D). The EQ-5D instrument comprises five dimensions, namely mobility, self-care, \n\n\n\nusual activities, pain/ discomfort and anxiety/depression (3). The EQ visual analogue scale (EQ-VAS) \n\n\n\nusually accompanies the 5 earlier questions and measures general health on a thermometer-like scale \n\n\n\nfrom 0 (worst possible health imaginable) to 100 (best possible health imaginable) (4). Designed with \n\n\n\nsimplicity in mind, the original EQ-5D has three levels (known as EQ-5D-3L) of severity ranging from \n\n\n\n\u2018no problem\u2019 to \u2018unable to\u2019 perform a specific task. However, having suffered from ceiling effects (5, \n\n\n\n6), a newer version with five levels of severity (EQ-5D-5L) has been introduced since 2009 (7).  \n\n\n\nIn tandem with the growth of health technology assessment in Malaysia, the application of the EQ-5D-\n\n\n\n5L instrument has been increasingly utilised in the country (8). Importantly, the concept and application \n\n\n\nof HRQoL, being subjective in nature, has shown to be influenced by both culture and socioeconomic \n\n\n\nstatus (9, 10), and these differences may extend between the context of Malaysia and the European \n\n\n\ncountries in which the instrument was originally developed. A recent study (11) conducted on the data \n\n\n\nof 51 countries of the World Values Survey indicated that self-reported health is indeed associated with \n\n\n\ncultural values that differ between countries. Therefore, the dimensions included in the EQ-5D-5L \n\n\n\ninstrument, which was developed and catered to the European population, may not truly reflect how \n\n\n\nAsians choose to define health. \n\n\n\nHaving a HRQoL tool that fits the need of the local population would mean that the scope of dimensions \n\n\n\nchosen reflects the definition of health as a population. HRQoL tools that functions alternatively as \n\n\n\npreference-based measures, such as the EQ-5D-5L can be used to generate health utilities. These health \n\n\n\nutilities sum up the values of the dimensions to quantify the value of health. Consequently, patient-\n\n\n\nreported outcome measures (PROM), including the EQ-5D-5L must quantify health with only a selected \n\n\n\nnumber of health dimensions before becoming too burdensome on respondents. The choice of HRQoL \n\n\n\ndimensions to include in an instrument has far reaching implications, especially when used in economic \n\n\n\nevaluations. Health utilities that fail to reflect the true health concerns of a population will not be \n\n\n\neffective as outcome variables in quantifying or comparing benefits of different treatment approaches. \n\n\n\nIn the initial stages of development, the interpretation and perception of the five health dimensions of \n\n\n\nEQ-5D-5L instrument were tested qualitatively in focus groups in different European populations (12), \n\n\n\n\n\n\n\n\n\n\n\n\n2 \n\n\n\nsignifying that the dimensions chosen are suitable for the European populations. To date, there is no \n\n\n\nqualitative study done to determine how Asian populations (including Malaysians), perceive the \n\n\n\ndimensions of the EQ-5D-5L instrument and whether the scope of HRQoL fits the need of the local \n\n\n\npopulation.  \n\n\n\nTherefore, assessing the perception of Malaysians about the use of EQ-5D-5L will be timely to guide \n\n\n\nthe application of this instrument. Furthermore, exploring additional dimensions  (commonly known as \n\n\n\nbolt-ons) (13) that can supplement the EQ-5D-5L instrument will be useful to  better capture the HRQoL \n\n\n\nneeds of the Malaysian population. This study aimed to assess the adequacy of the EQ-5D-5L in \n\n\n\ndefining health as perceived by Malaysians using a mixed methodology approach. Specifically, a \n\n\n\nqualitative approach was applied to study the perception of Malaysians on the EQ-5D-5L and EQ-VAS \n\n\n\nin describing the HRQoL and to explore potential bolt-ons to complement the existing EQ-5D-5L \n\n\n\ninstrument and subsequently, a quantitative approach was used to explore the suitability of the bolt-ons.  \n\n\n\nMETHODS \n\n\n\nThis study was divided into two phases. Focus group discussions were held in the first phase with the \n\n\n\naims to gauge the perception and understanding of Malaysian population on the original EQ-5D-5L \n\n\n\ninstrument and subsequently, to explore additional dimension(s) (if any) to strengthen the instrument. \n\n\n\nIn the second phase, the effects of bolt-ons (based on findings in phase 1) to the EQ-5D-5L descriptive \n\n\n\ninstrument were further studied. Ethics approval has been granted by the Malaysia Medical Research \n\n\n\n& Ethics Committee (ID NMRR-13-1377-18574). \n\n\n\nStudy Population and Setting \n\n\n\nIn phase 1, focus groups comprised of 6 to 8 participants each, were conducted. The inclusion criteria \n\n\n\nfor participant recruitment were Malaysians aged between 30 and 50 years who were able to converse \n\n\n\nin Malay or English. Participants were recruited via purposive sampling to ensure that the final cohort \n\n\n\nhad a healthy mix of different gender, ethnicity and age, whilst adhering to the inclusion criteria and \n\n\n\nwritten consents were also obtained. The focus groups were held in Universiti Sains Malaysia, Penang. \n\n\n\nA semi-structured interview guide was used in the discussion and the number of focus groups conducted \n\n\n\nwas determined by data saturation. Topics of discussion included understanding of the five dimensions \n\n\n\nin the EQ-5D-5L, factors influencing the EQ-VAS scores, and any other aspects perceived to affect \n\n\n\ntheir definition of health and HRQoL. Both sessions were conducted in a mix of the Malay and English \n\n\n\nlanguages to facilitate delivery of ideas where participants were informed that they could speak their \n\n\n\npreferred language and each session was audio recorded.  \n\n\n\nPhase 2 of the study was a cross-sectional survey that involved 100 conveniently sampled general \n\n\n\npublic. Malaysians aged 18 years and above, and were able to speak or write in Malay or English were \n\n\n\nrecruited. The questionnaire was self-completed by the respondents and assistance was provided when \n\n\n\nclarification was required. The questionnaire consisted of five parts, namely socio-demographic \n\n\n\ninformation, self-reported health using EQ-5D-5L descriptive instrument, bolt-ons structured in the \n\n\n\nsame manner as the EQ-5D-5L descriptive instrument (identified from Phase 1) (APPENDIX 1), EQ \n\n\n\nvisual analogue scale (EQ-VAS), and the ease of understanding of the EQ-5D-5L and bolt-ons using a \n\n\n\n5-point Likert type scale (1= very easy to understand, 5= very difficult to understand) (as shown in \n\n\n\nAppendix). The questionnaire was available in both Malay and English languages. \n\n\n\nData Analysis \n\n\n\nThe focus group audio recordings were independently transcribed verbatim by two researchers and \n\n\n\ncrosschecked for inconsistency. The finalized transcriptions were analysed for emergent themes using \n\n\n\nthe framework approach, as described elsewhere (14). Basically, the framework approach involves \n\n\n\nsystematically summarizing the data of the transcript into a framework matrix to facilitate clear \n\n\n\ninterpretation of underlying themes or concepts. All co-investigators were involved in discussing to \n\n\n\nreach a consensus on themes, codes, and representative quotes.  \n\n\n\nDescriptive analysis was applied in phase 2. The frequencies and percentages of all variables, together \n\n\n\nwith mean and standard deviation of continuous variables were presented in table forms.  Chi-square \n\n\n\ntest was used to test the relationship between various categorical socio-demographic variables and the \n\n\n\nease of understanding of each dimension, Fisher\u2019s Exact Probability Test for 2 x 2 tables with \n\n\n\nfrequencies less than 10, while Mann-Whitney test was applied for continuous variables. The ease of \n\n\n\nunderstanding responses of each dimension was grouped into two, those who answered \u201cvery easy\u201d or \n\n\n\n\n\n\n\n\n\n\n\n\n3 \n\n\n\n\u201ceasy\u201d and those who answered \u201cmoderate\u201d or higher. Data were analysed using SPSS Statistics version \n\n\n\n22 (IBM, Illinois) and p-value of < 0.05 was considered statistically significant. \n\n\n\nRESULTS  \n\n\n\nPhase 1: Focus Group Discussions \n\n\n\nData saturation was reached after two intensive discussion sessions. The recruited participants \n\n\n\ncomprised a mix of the major races in the Malaysian population i.e. Malay, Chinese, and Indian (Table \n\n\n\n1). Each focus group lasted for about one and a half hour. Opinions expressed in Malay were later \n\n\n\ntranslated to English and face validated by a native speaker investigator prior to data analysis. \n\n\n\nThree themes were identified in phase 1: \n\n\n\ni) Understanding about EQ-5D-5L  \n\n\n\nGenerally, the participants found all five dimensions in EQ-5D-5L were easy to comprehend. The \n\n\n\nmobility dimension was generally interpreted as only walking abilities as stated in the severity \n\n\n\ndescriptions of the dimension in the instrument,  \n\n\n\n\u201cLooking from the statements, it is already written here problems with walking, so I presume that \n\n\n\nmobility (dimension) refers to walking. So, I am answering the question based on the word \u2018walking\u2019 \n\n\n\n(abilities) and not the general word of mobility.\u201d (Female, 31, Chinese)  \n\n\n\n\n\n\n\nTable 1: Phase 1 study sample characteristics (n=14) \n\n\n\nVariables                                                                            n % \n\n\n\nAge (years), mean (SD), range   39.1 (7.4), (30-49) \n\n\n\nNumber of participants   \n\n\n\n Focus group One 8 57.1 \n\n\n\nFocus group Two 6 42.9 \n\n\n\nGender \n \n\n\n\n\n\n\n\nMale 7 50.0 \n\n\n\nFemale 7 50.0 \n\n\n\nEthnicity \n \n\n\n\n\n\n\n\nMalay 5 35.7 \n\n\n\nChinese 5 35.7 \n\n\n\nIndian 4 28.6 \n\n\n\nReligion   \n\n\n\nMuslim 6 42.9 \n\n\n\nBuddhist 2 14.3 \n\n\n\nHindu 3 21.4 \n\n\n\nNone/ did not disclose 3 21.4 \n\n\n\nEducation Level \n \n\n\n\n\n\n\n\nSecondary school 5 35.7 \n\n\n\nMatriculation/ STPM/ Diploma 1 7.1 \n\n\n\nCollege/ University 8 57.1 \n\n\n\nEmployment Status   \n\n\n\nEmployed 10 71.4 \n\n\n\nHouse caretaker 2 14.3 \n\n\n\nRetired 2 14.3 \n\n\n\nMarital Status \n \n\n\n\n\n\n\n\nMarried 13 92.9 \n\n\n\nWidowed 1 7.1 \n\n\n\nHousehold Income \n \n\n\n\n\n\n\n\nLess or equal to RM 1,500 4 28.5 \n\n\n\nRM 1,501 - RM 3,000 5 35.7 \n\n\n\nRM 3,001 - RM 4,500 1 7.1 \n\n\n\nRM 4,501 - RM 6,000 1 7.1 \n\n\n\nRM 6,001 - RM 7,500 3 21.4 \n\n\n\n\n\n\n\n\n\n\n\n\n4 \n\n\n\nThe self-care dimension was interpreted by most respondents as the ability to carry out one\u2019s basic and \n\n\n\ndaily activities,  \n\n\n\n\u201cTo me, the second dimension (self-care) describes the ability of a person to care for himself. That is \n\n\n\nwhat I understand. Whether a person is able to perform his daily activities independently or whether \n\n\n\nhe needs assistance or not in terms of bathing, wearing clothes, cleaning\u2026\u201d (Male, 33, Malay) \n\n\n\nParticipants perceived the usual activities dimension as their daily routines,  \n\n\n\n\u201cUsual activities are things such as going to and coming back from work. Seems like that. Activities \n\n\n\nthat we usually perform daily.\u201d (Male, 32, Malay) \n\n\n\nComparatively, more respondents were facing problems themselves in the dimension of pain/discomfort \n\n\n\nand anxiety/depression and therefore were explaining their own experiences in facing those health \n\n\n\nissues. The pain/ discomfort dimension was perceived to encompass either physical discomforts or \n\n\n\npains,  \n\n\n\n\u201cThe (dimension) that is having pain, a slight pain. I just twisted my back because of hiking or \n\n\n\nsomething else. I\u2019m not too sure. Yeah, so I have got some slight discomfort.\u201d (Male, 48, Chinese) \n\n\n\nNearly all participants associated anxiety/depression dimension as having the feeling of worry due to \n\n\n\nstressful life events, \n\n\n\n\u201c\u2026my son just coming home from hospital (after a dengue infection). He is going to sit for an exam \n\n\n\ntomorrow. So, I am worried about his health. He is not fit yet. So I am just worried and then Deepavali \n\n\n\nis around the corner. So with all this, I am a housewife and I am also working, so the (whole thing) is \n\n\n\nstressful.\u201d (Female, 48, Indian) \n\n\n\nii) Factors influencing the score of EQ-VAS \n\n\n\nOne of the key factors affecting the rating of EQ-VAS was the existing environmental problem, \n\n\n\n\u201cI score 50 for today because of the haze and cough. As for the kids, they will also be having the cough \n\n\n\ncausing their health to become worse.\u201d (Male, 33, Indian) \n\n\n\n\u201cI scored 70 because of the terrible haze last week. Everything is related to haze. For example, when I \n\n\n\nwanted to do some outdoor activities, like playing ball in the open air, the breathing is badly affected. \n\n\n\nIt\u2019s bad.\u201d (Male, 32, Malay) \n\n\n\nWhilst some of the participants rated their EQ-VAS score based on measurable HRQoL factors such as \n\n\n\nobtaining sufficient sleep or having physical pains after vigorous sports, others chose to rate their health \n\n\n\nbased on being able complete unfinished business or spend quality time with family, \n\n\n\n\u201cI rate my scale as 85 because we had Eid holidays and I was able to spend a lot of quality time with \n\n\n\nmy child and wife.\u201d (Male, 32, Malay) \n\n\n\niii) The concept and dimensions of \u2018health\u2019  \n\n\n\nThe participants were asked to define \u201chealth\u201d and discuss about various aspects affecting their health. \n\n\n\nInterestingly, the majority of the participants emphasized on the importance of the mental and social \n\n\n\naspects in defining good health, \n\n\n\n\u201cIf you\u2019re mentally not healthy, then you will easily commit suicide, and you will still not be in a \n\n\n\ncomplete health state. In terms of social, we need to interact with people. Only we interact with people \n\n\n\nthen we share our problems, (receive) encouragement from peers. That definitely will help to build the \n\n\n\nmore complete health state. So I think both elements (mental and social) are important.\u201d (Female, 33, \n\n\n\nChinese) \n\n\n\nBesides, there were others who stressed upon the spiritual aspect in affecting people\u2019s health,  \n\n\n\n\u201cOkay, to me, an individual has to be healthy from the inside, spiritually. Viewing from a Muslim \n\n\n\nperspective, when we pray or read the Quran, so, the inner self will reflect our outer self. Being loyal \n\n\n\nto God will allow us to be healthier and calmer.\u201d (Male, 33, Malay) \n\n\n\n\u2018Sleep\u2019 was also commonly deemed as an important dimension to influence health, with participants \n\n\n\nsharing their experience of developing chronic diseases and nervous breakdowns as a result of lacking \n\n\n\nsleep,  \n\n\n\n\u201cI put sleep as number one because if you don't get enough sleep, the disease will just break in. \n\n\n\nHypertension, heart attack... And all this start from the sleep, don't have enough rest and even with a \n\n\n\nlittle bit of tension you cannot handle because the brain is too tired.\u201d (Female, 48, Indian) \n\n\n\n\n\n\n\n\n\n\n\n\n5 \n\n\n\nThe feeling of stress, especially due to the workload and uncompleted tasks was prevalent among some \n\n\n\nparticipants. The stress often affects health in a negative way, \n\n\n\n\u201cFeeling unhealthy because of stressing up with work...Or anything else that you have unfinished \n\n\n\nbusiness. Then you feel unhappy with the thing until you complete it or at least attempt to complete it.\u201d \n\n\n\n(Male, 36, Indian) \n\n\n\nSocial support was perceived by a number of participants as another influential factor affecting health \n\n\n\nas it helps people overcome the stresses of daily living, \n\n\n\n\u201c... and social support has to be there to support everybody to take through their daily living so if you \n\n\n\ncan\u2019t do daily living properly, then you are going to get stressed and back to the same circle certainly.\u201d \n\n\n\n(Male, 36, Indian) \n\n\n\nFactors that have been deemed important to influence HRQoL by two or more participants were then \n\n\n\nconsidered as bolt-ons. In total, 11 bolt-ons were identified include sleeping, social support, vitality, \n\n\n\nhappiness, close relationships, stress, mental abilities, religion, vision, hearing, and speaking. These \n\n\n\nwere further tested in phase 2. \n\n\n\n\n\n\n\nPhase 2: Bolt-On Survey  \n\n\n\nThe demographics of the 100 participants are shown in Table 2. 95% of the survey participants claimed \n\n\n\nthat their comprehension level of the EQ-5D-5L descriptive instrument with bolt-ons ranged between \n\n\n\n1 (very easy to understand) to 2 (easy) of the 5-point Likert scale, and no one reported a comprehension \n\n\n\nlevel of higher than 3 (moderate).  \n\n\n\nIn general, responses of moderate on the bolt-on descriptive instrument tended to come from those \n\n\n\nwhose highest educational qualification was pre-university level (matriculation/STPM/diploma), male \n\n\n\ngender. No obvious trend was observed for age, marital status, income, and household number. \n\n\n\nHowever, no statistical significance was reached on the test of associations on all the bolt-on \n\n\n\ndimensions. In the original EQ-5D-5L dimensions, similar trends were observed, and none of the \n\n\n\nsociodemographic variables were statistically associated to the responses, except gender where only \n\n\n\nmales reported moderate ease of comprehension. \n\n\n\n\n\n\n\n\n\n\n\n\n6 \n\n\n\n\n\n\n\nTable 2: Phase 2 study sample characteristics (n=100)  \n\n\n\nVariables  n \n\n\n\nLanguage   \n\n\n\nMalay 70  \n\n\n\nEnglish 30  \n\n\n\nGender   \n\n\n\nMale 41  \n\n\n\nFemale 59  \n\n\n\nEthnicity   \n\n\n\nMalay 59  \n\n\n\nChinese 19  \n\n\n\nIndian 17  \n\n\n\nOthers 5  \n\n\n\nAge (years), mean (SD), range  30.4 (11.4), (19-80) \n\n\n\nCurrent health status   \n\n\n\n       Excellent 8  \n\n\n\nVery Good 22  \n\n\n\nGood 55  \n\n\n\nFair 15  \n\n\n\nPoor  0  \n\n\n\nEducation Level   \n\n\n\nNo formal education 1  \n\n\n\nSecondary school 7  \n\n\n\nMatriculation/ STPM/ Diploma 66  \n\n\n\nBachelor's degree 19 \n\n\n\nPostgraduate's degree 7  \n\n\n\nEmployment Status  \n\n\n\nEmployed 63 \n\n\n\nHouse caretaker 2 \n\n\n\nStudent 27 \n\n\n\nUnemployed 7 \n\n\n\nMarital Status   \n\n\n\nNever married 59  \n\n\n\nMarried 40  \n\n\n\nDivorced/Separated 0 \n\n\n\nWidowed 1  \n\n\n\nHousehold Number, mean (SD) 4.2 \n\n\n\nHousehold Income   \n\n\n\nLess than RM 1,500 14  \n\n\n\nRM 1,500 - RM 3,000 29  \n\n\n\nRM 3,001 - RM 4,500 24  \n\n\n\nRM 4,501 - RM 6,000 14  \n\n\n\nRM 6,001 - RM 7,500 6  \n\n\n\nAbove 7,500 13  \n\n\n\nTime to complete survey (min), mean (SD)  6.9 (2.8) \n\n\n\nEQVAS Score (1-100), mean (SD), range 84.0 (11.2), (40-100) \n\n\n\n\n\n\n\n\n\n\n\n\n7 \n\n\n\nNote: The figures (n) also reflect the percentage, % as there are a total of 100 participants. \n\n\n\nIn assessing their self-reported on the pain/discomfort dimension health problem on the EQ-5D-5L \n\n\n\ndescriptive instrument, the majority of participants reported facing no problems in the five original \n\n\n\nhealth dimensions (Figure 1). Of the 5 dimensions, the highest self-reported problems (ranging from \n\n\n\nslight problems to extreme problems) were associated with anxiety/depression (39%) and \n\n\n\npain/discomfort (34%). Comparatively, of the bolt-ons, two particular dimensions, i.e. vitality (70%) \n\n\n\nand stress (61%) denoted most significant amount of self-reported problems among the 100 participants. \n\n\n\n\n\n\n\n\n\n\n\nDISCUSSION  \n\n\n\nOverall, all participants showed good understanding of the individual 5 dimensions in EQ-5D-5L in \n\n\n\nboth phase 1 and 2. The simple way the original EQ-5D-5L dimensions were worded was used as a \n\n\n\nbasis to which the bolt-ons were constructed. This factor could have contributed to at least 95% of the \n\n\n\nrespondents stating the EQ-5D-5L descriptive instrument with bolt-ons questions were either very easy \n\n\n\nor easy to understand and subsequently ease of understanding of the bolt-ons was also not associated \n\n\n\nwith any socioeconomic factors. Comprehension level for the bolt-ons was not affected by age, gender, \n\n\n\neducation level, employment status, marital status, income and household number.  \n\n\n\nThis is in line with the intentions of the developers of the EQ-5D-5L instrument for easy administration \n\n\n\nof this HRQoL assessment tool. Past qualitative studies conducted in the early stages of development \n\n\n\nof the EQ-5D instrument showed that even among health researchers, the meaning of terms used to \n\n\n\ndescribe dimensions may be interpreted variably (12). This led to the EuroQol Group initiating an \n\n\n\noutline to define key concepts of the instrument with primary uses in translating the EQ-5D into \n\n\n\ndifferent languages. Having proper understanding of the dimensions is important to ensure \n\n\n\ncomparability and validity among studies conducted in different setting and countries.  \n\n\n\n\n\n\n\n\n\n\n\n\n8 \n\n\n\nThe EQ-VAS, being part of the measure of general health in EQ-5D-5L, captured a wider range of \n\n\n\nissues that might influence individual perception of own health, from the usual physical illness to \n\n\n\nsubjective matters such as spending enough time with one\u2019s loved ones. Observing the wide spectrum \n\n\n\nof reasons for the EQ-VAS responses of participants, the visual analogue scale may be better used as a \n\n\n\ncomplementary HRQoL tool, rather than a stand-alone tool considering that perception and rating of \n\n\n\n\u2018health\u2019 may vary significantly among individuals. However, the existence of a global health question \n\n\n\nsuch as the EQ-VAS allow perceptions of health that may not be collectively be shared by the majority \n\n\n\nof the population, be captured by a number ranging from zero to 100. \n\n\n\nThe concept of health or HRQoL is generally accepted to encompass physical, mental, and social \n\n\n\nwellbeing. Focus group discussions revealed that personal definitions of health may vary slightly but \n\n\n\nthere are recurring concepts of health that are shared by many. Of the 11 bolt-on suggested, 5 can be \n\n\n\nclassified as physical abilities (speaking, hearing, vision, vitality, sleep), 3 under mental concepts \n\n\n\n(mental abilities, happiness, stress), and the remaining 3 under social concepts (close relationships, \n\n\n\nsocial support, religion).  \n\n\n\nIn structuring the concepts for the bolt-ons, similar wordings were used to describe the Likert scale with \n\n\n\nno problems being the first option and extreme problems being the last option. Only the religion bolt-\n\n\n\non, being a more abstract concept, was worded differently with emphasis of religious belief to one\u2019s \n\n\n\napproach in life (from entire dependence on religion to none at all on the Likert scale). \n\n\n\nThe dimension of vitality, of which respondents collectively reported having most problems with (70% \n\n\n\nin this study), showed similar trend as in another large-scale EQ-5D-3L bolt-on study in Switzerland. \n\n\n\nThe dimension was defined as \u2018energy/fatigue (15) in that study, and the description was quite similar \n\n\n\nto our description for vitality, despite a different term was used. Although the Swiss study involved \n\n\n\nrandomly selected general population aged 20 and above, no information on how representative the \n\n\n\nsample were. Therefore, it cannot be said for certain that vitality is a culturally prevailing dimension \n\n\n\nfor the Swiss population, only that adding this dimension to the original EQ-5D dimensions help to \n\n\n\nexplain the variance (R2) when regressed onto the EQ-VAS. \n\n\n\nStress is another dimension in this study with a higher percentage of respondents reporting having \n\n\n\nproblem with. Surprisingly, stress has never been suggested in any previous EQ-5D-3L bolt-on studies. \n\n\n\nThis could be because most of the past studies were conducted to address instrument limitations in \n\n\n\ncondition-specific cases. The dimension of stress may be perceived as too general to test for in condition \n\n\n\nspecific studies. Also, the factor of culture may come into play. The dimension was included in the \n\n\n\nphase 2 of our study as it was frequently highlighted in the focus group discussions (phase 1) as an \n\n\n\nimportant factor associated with feeling unhealthy. This feeling of un-healthiness was usually triggered \n\n\n\nby a variety of personal or work-related stressors and indeed, stress is often linked to poorer well-being \n\n\n\nand increased health issues (16). \n\n\n\nPast bolt-on studies have been conducted in Southern Yorkshire, UK or the Netherlands where five \n\n\n\nadditional dimensions including tiredness, vision, hearing (17), cognition (18) and sleep (19) have been \n\n\n\ntested. The former four dimensions were shown to significantly impact health state values in their utility \n\n\n\nindex while only the sleep dimension was deemed less significant. Contrarily, a recent bolt-on study on \n\n\n\nthe EQ-5D-3L instrument in Cape Town, South Africa (20) added sleep and concentration as bolt-ons \n\n\n\nas means to explain the variance of health in community based-populations. The bolt-ons did increase \n\n\n\nthe explanatory power of the original instrument when the EQ visual analogue scale (EQ-VAS) was \n\n\n\nused as the dependent variable. Additionally, a vision bolt-on study conducted in Singapore (21) \n\n\n\ndemonstrated that adding vision bolt-on to the existing EQ-5D-3L instrument better discriminated those \n\n\n\nwith different levels of vision problems. The study suggested the index score of EQ-5D-3L with vision \n\n\n\nbolt-on was significantly more sensitive than the standard EQ-5D-3L index score in detecting changes \n\n\n\nof people with varying levels of visual impairment. However, it is to be noted that the study focused on \n\n\n\ndiscriminating different levels of visual impairment using the bolt-on index, and not deriving new bolt-\n\n\n\nons based on differences in cultural values. \n\n\n\nDepending on the populations and methods of testing used, the results of bolt-on studies generally vary \n\n\n\nin various countries with different cultures. A standardisation of methodology in bolt-on studies carried \n\n\n\nout in different populations may assist in revealing the true usefulness of particular bolt-on(s). \n\n\n\nThere are a few limitations in this study. Our study was conducted in the state of Penang, thus may not \n\n\n\nbe generalizable to the whole of Malaysia. Also, phase 2 of the study only captured the self-reported \n\n\n\nhealth problems as reflected by the EQ-5D-5L descriptive instrument together with bolt-ons. No \n\n\n\n\n\n\n\n\n\n\n\n\n9 \n\n\n\npreference-based valuation method was employed to quantify the explicit value of additional \n\n\n\ndimensions to better scope the need of such bolt-ons. Being an exploratory study, the sample size \n\n\n\nemployed was small and the methodology was simple. Possible bias in the study might arise from the \n\n\n\nconvenience sampling design of phase 2. The over-sampling of those who have employment may have \n\n\n\nskewed the results to favour vitality and stress as the two dimensions with highest reported problems. \n\n\n\nHowever, to the best of our knowledge, our study was the first in Malaysia and Southeast Asia to explore \n\n\n\npotential bolt-ons based on local culture and social-economic status. Observing that bolt-ons vitality \n\n\n\nand stress have more than half of the respondents reporting problem in them, these could be two \n\n\n\nadditional dimensions worthy of more emphasis in future HRQoL studies. Therefore, it is hoped that \n\n\n\nthe preliminary results of this study will provide insights into guiding the selection of bolt-ons for larger \n\n\n\nscale validation studies in the near future. \n\n\n\nCONCLUSION \n\n\n\nIn our study, the HRQoL concept was seen to encompass a wider scope than currently covered by the \n\n\n\nEQ-5D-5L instrument, with the vitality and stress having most potential for bolt-ons in future valuation \n\n\n\nstudies.  This study suggested that the prospect of adding bolt-ons to complement the EQ-5D-5L \n\n\n\ninstrument would better suit the HRQoL needs of the Malaysian population.  \n\n\n\nACKNOWLEDGEMENTS \n\n\n\nWe would like to extend our gratification to the following undergraduate pharmacy students for their \n\n\n\nassistance in the study- Chiew YK, Teoh AXY, Jayakumar T, Tan RS, Wong XM, Koh Y, Mohd \n\n\n\nNazdmi MAN, Thum CS, Kamarul Zaman MA, and Mohd Ali NA. 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Med Decis Making. 2014;34(1):42-53. doi: 10.1177/0272989X13480428. \n\n\n\nPubMed PMID: edselc.2-52.0-84890605215. \n\n\n\n20. Jelsma J, Maart S. Should additional domains be added to the EQ-5D health-related quality of life \n\n\n\ninstrument for community-based studies? An analytical descriptive study. Population Health \n\n\n\nMetrics. 2015;13(1):13. PubMed PMID: doi:10.1186/s12963-015-0046-0. \n\n\n\n21. Luo N, Wang X, Ang M, Finkelstein EA, Aung T, Wong T-Y, et al. A Vision \u201cBolt-On\u201d Item Could \n\n\n\nIncrease the Discriminatory Power of the EQ-5D Index Score. Value Health. 2015;18(8):1037-42. \n\n\n\ndoi: http://dx.doi.org/10.1016/j.jval.2015.08.002. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n"
"\n\n\n\n\n\n\n\n\n\nPROCEEDINGS of \n\n\n\n1st International Postgraduates \n\n\n\nConference of Pharmaceutical and \n\n\n\nHealth Sciences (IPCPHS) 2022 \n\n\n\n\n\n\n\n11th - 14th October 2022 \n\n\n\n \nVenue: Zoom Virtual Platform, School of \n\n\n\nPharmaceutical Sciences, Universiti Sains Malaysia  \n\n\n\n\n\n\n\nTheme: 50th Anniversary of School of \n\n\n\nPharmaceutical Sciences \u2013 Global Opportunities  \n\n\n\n\n\n\n\nEditors \n \n\n\n\nReem Abou Assi \n\n\n\nIbrahim M Abdulbaqi \n\n\n\nMohammed Zawiah \n\n\n\nChan Siok Yee \n\n\n\nNurzalina Abdul Karim Khan \n\n\n\nAmer Hayat Khan \n\n\n\n \nPublisher:  \nMalaysian Pharmacists Society  \n\n\n\n16-2 Jalan OP 1/5, 1-Puchong Business Park  \n\n\n\nOff Jalan Puchong, 47160 Puchong, Malaysia  \n\u00a9 Malaysian Journal of Pharmacy \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nISSN 1675-3666 \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 140-181 \n\n\n\n\n\n\n\nResearch abstracts of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022 \n\n\n\nDOI:  10.52494/YOXJ1358 \n\n\n\n\n\n\n\n141 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\n\n\n\n\nOral Presentation \n\n\n\n \nClinical Pharmacy  \n\n\n\n \nAbstract 001 \n\n\n\nExploring Pakistani Nurses\u2019 Knowledge and Obstacles Encountered When Administering \n\n\n\nResuscitation Medication: A Cross-sectional Analysis \n\n\n\nSafia Alvi, Amer Hayat Khan, Muhammad Salman and Syed Azhar Sayed Sulaiman \n\n\n\n\n\n\n\nAbstract 002 \n\n\n\nThe Role of The Clinical Pharmacist in a Case of Losartan-Induced Faintness and Dysarthria \n\n\n\nKhaled Mohammed Alakhali*, Abdullah Ahmed. Al-dahbali, Sakran, Faiz Khaled Mohammed \n\n\n\n\n\n\n\nAbstract 003 \n\n\n\nFactors Associated with Mortality of COVID-19 Patients with Hypertension: A Cross \n\n\n\nSectional Study \n\n\n\nNarendar Kumar, Syed Azhar Syed Sulaiman*, Furqan Khurshid Hashmi, Shafique Hussain \n\n\n\n\n\n\n\nAbstract 004 \n\n\n\nTreatment Outcomes of Pulmonary Tuberculosis: A Retrospective Study in District \n\n\n\nHeadquarter Hospital, Pakistan \n\n\n\nRabbiya Ahmad*, Saifullah Mehsud, Fazli Maula, Obaidullah Malik, and Amer Hayat Khan \n\n\n\n\n\n\n\nAbstract 005 \n\n\n\nDrug Resistance Pattern, Prevalence and Risk Factors for Resistance To Second Line Anti-\n\n\n\nTuberculosis Drugs in Balochistan, Pakistan \n\n\n\nAsad Khan, Naila Kakar, Nafees Ahmad, Abdul Wahid, Amer Hayat Khan* \n\n\n\n\n\n\n\nAbstract 006 \n\n\n\nPharmacy Students\u2019 Readiness and Preparedness to Contribute During Disasters: A Cross-\n\n\n\nSectional Two Institutional Study from The UAE \n\n\n\nAlaa Ahmad Farajallah*, Muaed Alomar, Subish Palaian, Mohammad Majed Al-Ahmad, \n\n\n\nMohamed Izham Mohamed Ibrahim \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 140-181 \n\n\n\n\n\n\n\nResearch abstracts of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022 \n\n\n\nDOI:  10.52494/YOXJ1358 \n\n\n\n\n\n\n\n142 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 007 \n\n\n\nTop 30 Drugs Associated with Acute Kidney Injury (Aki) Cases: A Real-World \n\n\n\nPharmacovigilant Study \n\n\n\nMohammad A. Khaleel *, Amer Hayat Khan, S. M. Sheikh Ghadzi and Azreen Syazril Adnan \n\n\n\n\n\n\n\nAbstract 008 \n\n\n\nEvaluation of Types, Frequency, and Setting of Drug-related Problems Among Hospitalized \n\n\n\nPatients in a Private Hospital in Sana'a, Yemen \n\n\n\nAbdulsalam Halboup*, Mohammed Kubas \n\n\n\n\n\n\n\nAbstract 009 \n\n\n\nThe Health\u2011Related Quality of Life and Treatment Satisfaction Among Tacrolimus Treated \n\n\n\nPatients Post-Renal Transplantation in Riyadh, Saudi Arabia \n\n\n\nAmany Mohamed Alboghdadly*, Amer Hayat Khan, and Syed Azhar Syed Sulaiman \n\n\n\n\n\n\n\nAbstract 010 \n\n\n\nTuberculosis: Risk Factors, Developing Drug-Resistant, Treatment Outcomes and Survival \n\n\n\nTrend in Hospital Pulau Pinang, Malaysia: A Retrospective Study \n\n\n\nAseel Rezeq Yaghi, Amer Hayat Khan*, Sabariah Noor Harun and Irfhan Ali Haider \n\n\n\n\n\n\n\nAbstract 011 \n\n\n\nIncidence and Management of Adverse Drug Events Among Drug-Resistant Tuberculosis \n\n\n\nPatients: A Prospective Study Results from a High Burden Country \n\n\n\nAsif Massud*, Amer Hayat Khan, Syed Azhar Syed Sulaiman, Nafees Ahmad, Muhammad \n\n\n\nShafqat \n\n\n\n\n\n\n\nAbstract 012 \n\n\n\nQualitative Assessment of Knowledge, Attitude and Practice of Healthcare Practitioners \n\n\n\nabout Precision Medicine Among Cancer Patients in Lahore, Pakistan \n\n\n\nRida Naeem, Furqan K. Hashmi,  Dzul Azri Mohamed Noor* \n\n\n\n\n\n\n\nAbstract 013 \n\n\n\nThe Impact of Education Level Over Adoption of Standard Operating Procedures Against \n\n\n\nSars-Cov2 Infection Among the Covid-19 Booster Dose Recipients In Pakistan \n\n\n\nAli Qureshi*,Syed Azhar Syed Sulaiman, and Nur Aiziti Athira binti Daud \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 140-181 \n\n\n\n\n\n\n\nResearch abstracts of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022 \n\n\n\nDOI:  10.52494/YOXJ1358 \n\n\n\n\n\n\n\n143 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 014 \n\n\n\nPublic Awareness and Perceptions on The Corona Virus (Covid-19) in Duhok \n\n\n\nProvince/Kurdistan Region, Iraq \n\n\n\nManhal Ahmed Abdulkader*, Rabie Gabriel Abdullah, Ali Farhad Abdullah, Matti Shamil \n\n\n\nKhudhur, Sarwar Saad Abdullghani, Muhammad Izaddin Ibrahim, Shinwar Mohammed \n\n\n\nHasan, and Ahmad Faris Khaleel \n\n\n\n\n\n\n\nAbstract 015 \n\n\n\nPractice And Associated Factors Determination of Antibiotics Self-Medication Among \n\n\n\nCommunity Residents in Boyolali, Indonesia \n\n\n\nHidayah Karuniawati*, Sri Suryawati, Syed Azhar Syed Sulaiman*, Taufik Taufik, Wan \n\n\n\nIsmahanisa Ismail, Md. Sanower Hossain \n\n\n\n\n\n\n\nAbstract 016 \n\n\n\nImplementing PharmindBot on Facebook for Pharmacy Research Purposes: An Artificial \n\n\n\nIntelligence-Based Chatbot \n\n\n\nRamez M. Alkoudmani*, Mei Lan Tan, and Guat See Ooi \n\n\n\n\n\n\n\nAbstract 017 \n\n\n\nMedication Management Review Clinic in Jordan: Development and Review of First Two \n\n\n\nCases \n\n\n\nLoai M. Saadah*, Amer H. Khan, Syed Azhar Syed Sulaiman and Iman A. Basheti \n\n\n\n\n\n\n\nAbstract 018 \n\n\n\nAtorvastatin Therapy Among Egyptians: A Cross-Sectional Study Among Community \n\n\n\nPharmacists \n\n\n\nMohammed Gamal Mohammed Maslub\u2020, Moutaz Bellah Yasser\u2020, Mahasen Ali Radwan, \n\n\n\nZeyad Ali Abdalla, Mohammed Soliman, Abubakar Sha'aban, Nur Aizati Athirah Daud* \n\n\n\n\n\n\n\n\n\n\n\nPharmaceutical Technology  \n \n\n\n\nAbstract 019 \n\n\n\nSpray Dryer and Electrospray Techniques Assisted Encapsulation of Insulin in \n\n\n\nMicroparticles Coated with Pectin Microbeads for Colon-Targeted Oral Drug Delivery \n\n\n\nHazem Choukaife, Abd Almonem Doolaanea, Zalilawati Bnti Rashed and Mulham Alfatama* \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 140-181 \n\n\n\n\n\n\n\nResearch abstracts of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022 \n\n\n\nDOI:  10.52494/YOXJ1358 \n\n\n\n\n\n\n\n144 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 020 \n\n\n\nScreening Electrospinning Critical Parameters for Fibres Production: Excipients\u2019 Nature \n\n\n\nNurul Atiqah Ismail, Reem Abou Assi and Siok Yee Chan* \n\n\n\n\n\n\n\nAbstract 021 \n\n\n\nBioavailability And Pharmaceutical Analysis of Novel Chocolate Based Ibuprofen \n\n\n\nFormulations \n\n\n\nAya Kabariti*, M. albed Alhnan, Ghaleb Oriquat, Basel Arafat \n\n\n\n\n\n\n\n\n\n\n\nPharmacology And Biomedical Sciences \n \n\n\n\nAbstract 022 \n\n\n\nIsorhamnetin Decreased The Expression Of HMG-CoA Reductase and Increased LDL \n\n\n\nReceptors in Hep G2 Cells \n\n\n\nRanda El-Rayyes*, Manal M. Abbas, Razan Obeidat, Manal A. Abbas \n\n\n\n\n\n\n\nAbstract 023 \n\n\n\nA Novel BAK-BAX-CDK1 Signalling Complex Links Activation of The Spindle Assembly \n\n\n\nCheckpoint to Apoptosis \n\n\n\nOmeed Omar Darweesh* \n\n\n\n\n\n\n\nAbstract 024 \n\n\n\nAntihyperglycemic Activity of Standardized Swietenia Macrophylla Seed Ethanolic Extract \n\n\n\nin Type 2 Diabetic Rats \n\n\n\nMeyyammai Swaminathan*, Mariam Ahmad, Khairul Niza Abd Razak, Nor Adlin Yusoff, \n\n\n\nGabriel Akyirem Akowuah, Elaine Hui-Chien Lee, Syed Azhar Syed Sulaiman, Mun Fei, Yam, \n\n\n\nFaradianna E. Lokman, Sue Hay, Chan, Bey Hing, Goh, Vikneswaran Murugaiyah \n\n\n\n\n\n\n\n\n\n\n\nPharmaceutical And Medicinal Chemistry \n \n\n\n\nAbstract 025 \n\n\n\nIncreased In-vitro Binding of Di(5-Furfural) Ether, A Degradant of 5- \n\n\n\nHydroxymethylfurfural, with Endogenous Macromolecules: Experimental and Theoretical \n\n\n\nApproaches \n\n\n\nThomas, Olusegun Emmanue*, Akin-Taylor Akintayo and Oduwole Rashidat \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 140-181 \n\n\n\n\n\n\n\nResearch abstracts of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022 \n\n\n\nDOI:  10.52494/YOXJ1358 \n\n\n\n\n\n\n\n145 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 026 \n\n\n\nPharmacophore Modelling, Molecular Docking, And Molecular Dynamics Simulation to \n\n\n\nIdentify Potent Inhibitors of Alpha-Synuclein Aggregation \n\n\n\nSani Yahaya Najib1*, Yusuf Oloruntoyin Ayipo, Waleed Abdullah Ahmad Alananzeh, Mohd \n\n\n\nNizam Mordi \n\n\n\n\n\n\n\nComplementary Medicine And Natural Products \n \n\n\n\nAbstract 027 \n\n\n\nTheophylline Causes Regression of Endometriotic Implants in a Rat Surgical Model \n\n\n\nManal A. Abbas*, Ahmad M. Disi, Mutasem O. Taha \n\n\n\n\n\n\n\nAbstract 028 \n\n\n\nComplementary and Alternative Medicine (CAM) Use in Insomnia: Current Update on \n\n\n\nKnowledge, Attitude, and Perception (KAP) Among the Community in Malaysia \n\n\n\nSiti Nur Afza Atirah Binti Zahari, Syarifah Syamimi Putri Adiba Binti Syed Putera*, and Zakiah \n\n\n\nbinti Noordin \n\n\n\n\n\n\n\nAbstract 029 \n\n\n\nHealth Benefits of Honey: Knowledge, Attitude and Perception (KAP) Among the \n\n\n\nCommunity in Malaysia \n\n\n\nWan Nor Aidah Basirah binti Wan Ab Rahman, Syarifah Syamimi Putri Adiba Binti Syed \n\n\n\nPutera*, and Aina Amanina Binti Abdul Jalil \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 140-181 \n\n\n\n\n\n\n\nResearch abstracts of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022 \n\n\n\nDOI:  10.52494/YOXJ1358 \n\n\n\n\n\n\n\n146 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\n\n\n\n\nE-Poster Presentation  \n \n\n\n\nClinical Pharmacy  \n \n\n\n\nAbstract 030 \n\n\n\nKnowledge, Attitude, and Practice of Community Pharmacists Regarding Smuggled \n\n\n\nMedicines in Yemen \n\n\n\nMohammed Battah*, Gamil Othman, Hamas Al-Qadhi, Asma Al- Aghbari1 and Heba Al-\n\n\n\nMaqtari \n\n\n\n\n\n\n\nAbstract 031 \n\n\n\nGram-Negative Bacteria Susceptibility to Antibiotics Stratified by Gender \n\n\n\nNehad J. Ahmad, Amer H. Khan* \n\n\n\n\n\n\n\nAbstract 032 \n\n\n\nDescriptive Analysis of Adverse Drug Reactions Reports of \n\n\n\nAmoxicillin \n\n\n\nNehad J. Ahmed, and Amer H. Khan* \n\n\n\n\n\n\n\nAbstract 033 \n\n\n\nAssessment of Emotional Distress Among Health Care Professionals at Different Hospitals \n\n\n\nin Sindh, Pakistan \n\n\n\nNarendar Kumar,* Syed Azhar Syed Sulaiman , and Shaib Muhammad \n\n\n\n\n\n\n\nAbstract 034 \n\n\n\nPopulation-Based Knowledge, Attitude, and Perception Study for COVID-19 Vaccine in \n\n\n\nSindh, Pakistan \n\n\n\nNarendar Kumar, Syed Azhar Syed Sulaiman,*, Furqan Khurshid Hashmi \n\n\n\n\n\n\n\nAbstract 035 \n\n\n\nCauses of Drug Related Problems Among Chronic Kidney Disease Patients with Diabetes \n\n\n\nMellitus and/ or Hypertension in Private Hospital, Yemen \n\n\n\nEgbal Abdulrahman, Amer Hayat Khan*, Elham Aldolimy, Odai Alburaihi, Omaima Alsubari, \n\n\n\nMoath Aledressi \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 140-181 \n\n\n\n\n\n\n\nResearch abstracts of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022 \n\n\n\nDOI:  10.52494/YOXJ1358 \n\n\n\n\n\n\n\n147 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 036 \n\n\n\nAssessment of Mortality Risk Predictors Associated With COVID-9 Infection In Pakistani \n\n\n\nPatients: An Observational Study. \n\n\n\nMuhammad Zeeshan Munir*, Amer Hayat Khan, Tahir Mehmood Khan \n\n\n\n\n\n\n\nAbstract 037 \n\n\n\nDevelopment And Validation Of A Guideline-Guided Prognostic Model Of Mortality In \n\n\n\nPatients With First-Ever Acute Ischemic Stroke \n\n\n\nMustapha Mohammed*, Hadzliana Zainal, Siew Chin Ong, Balamurugan Tangiisuran, \n\n\n\nSabariah Noor Harun, Siti Maisharah Sheikh Ghazi \n\n\n\n\n\n\n\nAbstract 038 \n\n\n\nEvaluation of The Impact of Antibiotic Stewardship Program on Antibiotics Utilization as \n\n\n\nSurgical Prophylaxis at a Secondary Hospital in United Arab Emirates \n\n\n\nMaryam Salem Alkaabi, Sabariah Noor Harun, and Abubakar Sha\u2019aban \n\n\n\n\n\n\n\nAbstract 039 \n\n\n\nClinicodemographic Characteristics Identification of Malaysian Patients with Rheumatoid \n\n\n\nArthritis Using Biologic and Targeted Disease Modifying Anti Rheumatoid Drugs \n\n\n\nNasreh Shamsi Poor Gheshmi*, Syed Azhar Syed Sulaiman, and Yaman Walid Kassab \n\n\n\n\n\n\n\nAbstract 040 \n\n\n\nSafety Assessment of Biologic And Targeted Disease Modifying Anti Rheumatoid Drugs \n\n\n\nAmong Malaysian Patients with Rheumatoid Arthritis \n\n\n\nNasreh Shamsi Poor Gheshmi*, Syed Azhar Syed Sulaiman, and Yaman Walid Kassab \n\n\n\n\n\n\n\nAbstract 041 \n\n\n\nExamining The efficacy of Biologic and Targeted Anti Rheumatic Drugs Among Malaysian \n\n\n\nPopulation with Rheumatoid Arthritis \n\n\n\nNasreh Shamsi Poor Gheshmi*, Syed Azhar Syed Sulaiman, and Yaman Walid Kassab \n\n\n\n\n\n\n\n\n\n\n\nPharmaceutical Technology  \n \n\n\n\nAbstract 042 \n\n\n\nSolvent System Effect on the Viscosity and Conductivity of Electrospinnable Polymer \n\n\n\nSolutions for Incorporation of Medicinal Herbal Extract \n\n\n\nSiew Mei Tan, Siok Yee Chan* \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 140-181 \n\n\n\n\n\n\n\nResearch abstracts of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022 \n\n\n\nDOI:  10.52494/YOXJ1358 \n\n\n\n\n\n\n\n148 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 043 \n\n\n\nOptimization of Polyhydroxyalkanoate Microparticles for a High Encapsulation of \n\n\n\nRifapentine and Verapamil Using a Water-in-Oil-in- Water Double Emulsion Technique \n\n\n\nPriyanka Prakash, K Sudesh Kumar, and Thaigarajan Parumasivam* \n\n\n\n\n\n\n\nPharmacology and Biomedical Sciences \n \n\n\n\nAbstract 044 \n\n\n\nAirway Smooth Muscles Relaxant and Mast Cells Stabilizing Activity of Some Medicinal \n\n\n\nPlants Used in Managing Asthma in North-western Nigeria \n\n\n\nIbrahim Mu\u2019azzamu Aliyu*, Mohammed Garba Magaji, Jamilu Ya\u2019u , Nuhu Mohammed \n\n\n\nDanjuma, Sagir Mustapha Mustapha Mohammed \n\n\n\n\n\n\n\nAbstract 045 \n\n\n\nProtective Effect of Andrographolide on \u0392-Amyloid Induced Toxicity in Transgenic \n\n\n\nCaenorhabditis Elegans \n\n\n\nBoon-Keat Khor, Wai-Lam Liew, Chong-Lew Lee, Kit-Lam Chan, Nurzalina A.K. Khan, Kah-\n\n\n\nHay Yuen, Vikneswaran Murugaiyah* \n\n\n\n\n\n\n\n\n\n\n\nPharmaceutical and Medicinal Chemistry \n \n\n\n\nAbstract 046 \n\n\n\nIn-Silico Study of 2-Phenoxy-N-(3,4,5-Trimethoxyphenyl) Acetamide Against Mutant p53 in \n\n\n\nBreast Cancer Drug Discovery \n\n\n\nBakti Wahyu Saputra, Jeffry Julianus* \n\n\n\n\n\n\n\nAbstract 047 \n\n\n\nPotential of N-(naphthalene-1-yl)-2-phenoxyacetamide as Mutant p53 Reactivator: In Silico \n\n\n\nStudies \n\n\n\nBryan Afela Wahono, Jeffry Julianus* \n\n\n\n \nAbstract 048 \n\n\n\nEffects of Fenugreek Seeds on Some Blood Parameters in Type 2 Diabetics Receiving \n\n\n\nMetformin and Glyburide \n\n\n\nRaghda Lahdo*, Rafah Manafikhi \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 140-181 \n\n\n\n\n\n\n\nResearch abstracts of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022 \n\n\n\nDOI:  10.52494/YOXJ1358 \n\n\n\n\n\n\n\n149 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 049 \n\n\n\nInvestigating The Relationship Between Thyroid Disorders and Breast Cancer \n\n\n\nAya Zrek, Anawar Shamout, Raghda Lahdo* \n\n\n\n\n\n\n\nAbstract 50 \n\n\n\nKnowledge, Attitude, And Practice Assessment Of Lung Cancer Risk Factors Among Health \n\n\n\nPractitioners In Erbil, Iraq \n\n\n\nIbrahim M Abdulbaqi*, Habibah A. Wahab*, Ibrahim Ahmed Moyasser, Shaheen Nozad Yousif \n\n\n\n\n\n\n\nAbstract 051 \n\n\n\nPrevalence of Tuberculosis Infection and Treatment Outcome in Babylon Province of Iraq; \n\n\n\nA Retrospective Study \n\n\n\n Taif Said Jasim*, Amer Hayat Khan, and Nada Khazal K. Hindi \n\n\n\n\n\n\n\nAbstract 052 \n\n\n\nAdverse Drug Reactions in Hospitalised Children with Chronic Kidney Disease in A \n\n\n\nPaediatric Tertiary Care Hospital of Pakistan  \n\n\n\nAsma Fareed Khan*, Amer Hayat Khan, Shahida Perveen, Muhammad Tahir \n\n\n\n\n\n\n\nAbstract 053 \n\n\n\nDevelopment and Validation of RP-HPLC Method for the Detection and Quantification of \n\n\n\nTamoxifen in Pure, and Lipid-Based Formulation \n\n\n\nReem Abou Assi, Chan Siok Yee* \n\n\n\n\n\n\n\nAbstract 054 \n\n\n\nBreast Cancer Risk Factors Among Public and Health Practitioners in Kirkuk, Iraq: The \n\n\n\nEvaluation of Knowledge, Attitude, And Practice \n\n\n\nIbrahim M Abdulbaqi*, Habibah A. Wahab* Duha Arshad Shaker, Baraah Omar Ayoub \n\n\n\n\n\n\n\nAbstract 055 \n\n\n\nA Simple (Rp-HPLC) Method for The Detection and Quantification of Docetaxel in Bulk \n\n\n\nand Liquid Crystals Nanocarriers and its Validation \n\n\n\nIbrahim M. Abdulbaqi*, Anan Yaghmur , Yusrida Darwis, Noratiqah Mohtar, Thaigarajan \n\n\n\nParumasivam, Habibah A. Wahab* \n\n\n\n\n\n\n\nAbstract 056 \n\n\n\nAwareness About Relationship Between Climate Change and Health Hazards in Iraqi \n\n\n\nMedical Students \n\n\n\nAisha Marwan Abd Al Majeed, Sakar Najmadeen Mohammad, Reem Abou Assi*, Siok Yee \n\n\n\nChan* \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 140-181 \n\n\n\n\n\n\n\nResearch abstracts of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022 \n\n\n\nDOI:  10.52494/YOXJ1358 \n\n\n\n\n\n\n\n150 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\n\n\n\n\nAbstract 057 \n\n\n\nNanocrystalline Cellulose (NCC) Isolation from Kapok Pulp Via Sulphuric Acid Hydrolysis \n\n\n\nAbdulsalam Q. Almashhadani*, Cheu Peng Leh, Siok-Yee Chan, Chong Yew Lee, Choon Fu \n\n\n\nGoh* \n\n\n\n\n\n\n\nAbstract 058 \n\n\n\nIsolation and Chemical Structural Characterisation of a Compound with Wound Healing \n\n\n\nActivity from The Euphorbia hirta L. Extract \n\n\n\nDania F. Alsaffar, Sura F. Alsaffar, Nur Hidaya kaz Abdula* \n\n\n\n\n\n\n\nAbstract 059 \n\n\n\nMinocycline Improved Anxiety-Like Behaviour in Lipopolysaccharide (LPS)-Induced \n\n\n\nNeuroinflammation Rat\u2019s Model \n\n\n\nEntesar Yaseen Abdo Qaid*, Rahimah Zakaria, Zuraidah Abdullah, and Idris Long \n\n\n\n\n\n\n\nAbstract 060 \n\n\n\nTo Produce and Characterise Inhalable Nano- and Micro- Polyhydroxyalkanoate (PHA) \n\n\n\nParticles Containing Verapamil Hydrochloride Using a Modified Water-in-Oil-in-Water \n\n\n\n(W/O/W) Double Emulsion Technique \n\n\n\nSowmya Ramachandran, Thaigarajan Parumasivam*, and K Sudesh Kumar \n\n\n\n\n\n\n\nAbstract 061 \n\n\n\nAnalysis of Increased AST and ALT in COVID-19 Patients with Favipiravir \n\n\n\nSuharjono*, Chairunnisa, Mariyatul Qibtiyah, and Ariani Permatasari \n\n\n\n\n\n\n\nAbstract 062 \n\n\n\nFormulation of Co-Enzyme Q10 Ternary Inclusion Complexes Using Betacyclodextrin (\u0392cd) \n\n\n\nand Hydrophilic Polymers Silica Syloid Xdp/ Sodium Alginate) \n\n\n\nRabia Munir, SajidAsghar, Muhammad Irfan, IkramUllah Khan \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 140-181 \n\n\n\n\n\n\n\nResearch abstracts of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022 \n\n\n\nDOI:  10.52494/YOXJ1358 \n\n\n\n\n\n\n\n151 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 001 \n\n\n\n\n\n\n\nExploring Pakistani Nurses\u2019 Knowledge \n\n\n\nand Obstacles Encountered when \n\n\n\nAdministering Resuscitation Medication: A \n\n\n\nCross-sectional Analysis \n \n\n\n\nSafia Alvi1*, Amer Hayat khan1, Muhammad \n\n\n\nSalman2, 3, Syed Azhar Syed Sulaiman1 \n \n1Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, \n\n\n\nUniversiti Sains Malaysia, 11800 Penang, Malaysia.  \n\n\n\n2Institute of Pharmacy, Faculty of Pharmaceutical and Allied Health \n\n\n\nSciences, Lahore College for Women University, Lahore, Pakistan.  \n3Faculty of Pharmacy, The University of Lahore, 1-Km Defense Road, \n\n\n\nLahore, Pakistan \n\n\n\n* drsofyanaalvi@gmail.com \n\n\n\n\n\n\n\nBackground: Medication errors are one of the most common \n\n\n\ncauses of patient morbidity and mortality and it places an \n\n\n\nimmense burden on healthcare system. Insufficient \n\n\n\nknowledge of nurses is considered a major factor in drugs \n\n\n\nadministration errors leading to compromised patient safety. \n\n\n\nObjectives: This study aimed to evaluate nurses\u2019 knowledge \n\n\n\nregrading resuscitation medication administration. Methods: \n\n\n\nA cross-sectional study was conducted among nurses \n\n\n\nworking in public and private hospitals of Lahore city (10 \n\n\n\nprivate, 6 public and 2 teaching hospitals). Nurses were \n\n\n\nrecruited using a convenient sampling method during a \n\n\n\nperiod of three months (March-June 2021). A pre-validated, \n\n\n\nself-administered questionnaire was used to collect data. The \n\n\n\ndata were analyzed using SPSS version 27. Results: A total \n\n\n\nof 409 nurses were included in the study of which, 55.3% \n\n\n\nwere found to have adequate knowledge (score >70%) of \n\n\n\nresuscitation medications, while 44.7% had insufficient \n\n\n\nknowledge. Increasing age and experience (p<0.001), being \n\n\n\nin a public hospital, (p=0.032) and ACLS training (p=0.006) \n\n\n\nwas associated with significantly better knowledge. Major \n\n\n\nobstacles faced by nurses during the administration of \n\n\n\nresuscitation medication were \u201cInterruption of drug \n\n\n\nadministration procedure when other tasks need to be \n\n\n\nhandled\u201d (75.6%), \u201cInsufficient knowledge\u201d (69.4%), and \n\n\n\n\u201cHesitation to ask questions\u201d (67.7 %). Conclusion: \n\n\n\nPakistani nurses were found to have inadequate knowledge \n\n\n\nregarding resuscitation medications administration. Hospital \n\n\n\nadministration must ensure that nursing staff receive \n\n\n\nresuscitation medications-related training. Moreover, they \n\n\n\nshould encourage nursing staff to obtain BLS and/or ACLS \n\n\n\ntrainings as this will reduce medication errors events and \n\n\n\nimprove patient safety. \n\n\n\nAbstract 002 \n\n\n\n\n\n\n\nThe Role of The Clinical Pharmacist In A \n\n\n\nCase of Losartan-Induced Faintness And \n\n\n\nDysarthria \n \n\n\n\nKhaled Mohammed Alakhali1,2*, Abdullah \n\n\n\nAhmed. Al-dahbali2,3, Sakran, Faiz Khaled \n\n\n\nMohammed2 \n \n1Department of Pharmacy, Medical school in Thamar University, Republic \n\n\n\nof Yemen. \n2Lebanese International University, School of Pharmacy, Department of \n\n\n\nBiomedical Sciences, Republic of Yemen. \n3Department of Clinical Pharmacy, College of Pharmacy in Sanaa \nUniversity, Republic of Yemen. \n\n\n\n* alakhalikhaled@gmail.com \n\n\n\n\n\n\n\nBackground: A common first-line antihypertensive drug, \n\n\n\nlosartan is well absorbed after oral administration and goes \n\n\n\nthrough a significant first-pass metabolism. Losartan \n\n\n\nfrequently causes headaches, dizziness, lethargy, nausea, \n\n\n\nvomiting, blurred vision, and anemia as adverse effects. \n\n\n\nObjective: Here, we present a case of a 59-year-old Yemeni \n\n\n\nwoman, who took losartan and developed faintness and \n\n\n\ndysarthria. Method: The patient was initiated with 50 mg \n\n\n\ndaily oral losartan monotherapy for diagnosed moderate \n\n\n\nhypertension. After 12 days of taking the drug, she presented \n\n\n\nto the emergency department in Saudi German Hospital in \n\n\n\nSana\u2019a city with dizziness, faintness, dysarthria, \n\n\n\nlightheadedness with generalized weakness. The in-hospital \n\n\n\nneurological specialist suspected the patient had a transient \n\n\n\nischemic attack. On examination, her blood pressure was \n\n\n\nfound to be 150/86, and her heart rate 72. The patient was \n\n\n\ntreated in the hospital as a stroke patient for five days and \n\n\n\ndischarged with stroke medications. After discharge, on the \n\n\n\nsecond day, the patient has the same previous symptoms. \n\n\n\nThere was no evidence of any other possible metabolic, \n\n\n\ninfective, organic, or other pathologic causes giving rise to \n\n\n\ndysarthria, except losartan itself. Results: A clinical \n\n\n\npharmacist discovered adverse drug reaction probability was \n\n\n\n\u201cprobable\u201d that oral losartan was responsible for the \n\n\n\ndevelopment of faint and dysarthria in this patient. The drugs \n\n\n\nfor hypertension were changed by the clinical pharmacist to \n\n\n\namlodipine 5mg. After 3 days, the patient was stable, and the \n\n\n\nsymptoms resolved. Conclusions: This case report suggests \n\n\n\nthat losartan could induce faintness and dysarthria as side \n\n\n\neffects \n\n\n\n \n\n\n\n\nmailto:drsofyanaalvi@gmail.com\n\n\nmailto:alakhalikhaled@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 140-181 \n\n\n\n\n\n\n\nResearch abstracts of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022 \n\n\n\nDOI:  10.52494/YOXJ1358 \n\n\n\n\n\n\n\n152 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 003 \n\n\n\n\n\n\n\nFactors Associated with Mortality of \n\n\n\nCOVID-19 Patients with Hypertension: A \n\n\n\nCross Sectional Study \n \n\n\n\nNarendar Kumar1, Syed Azhar Syed \n\n\n\nSulaiman1*, Furqan Khurshid Hashmi2, \n\n\n\nShafique Hussain3 \n \n1Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, \n\n\n\nUniversiti Sains Malaysia \n2University College of Pharmacy, University of the Punjab, Allama Iqbal \n\n\n\nCampus, Lahore, Pakistan \n3Department of Pharmacy Services, Indus Hospital and Health Network, \nKarachi Pakistan \n\n\n\n*sazhar.usm@gmail.com  \n\n\n\n\n\n\n\nBackground: Hypertension is one of the predisposing \n\n\n\nfactors for prolonged hospitalization, intensive care, and \n\n\n\ndeath among COVID-19 infected patients. Hence, it requires \n\n\n\nspecial attention, particularly for older patients vulnerable to \n\n\n\nincreased risk of COVID-19-related health problems. \n\n\n\nObjective: This research aimed to determine the factors \n\n\n\nassociated with mortality of COVID-19 patients with \n\n\n\nhypertension. Methods: A cross-sectional study was \n\n\n\nperformed at a tertiary care hospital in Karachi, Pakistan, \n\n\n\nfrom May to October 2021. COVID-19 patients with known \n\n\n\nhypertension were included in the study by evaluating \n\n\n\npatients\u2019 medical record. Mann Whitney U test and Chi-\n\n\n\nSquared tests were performed to compare patients in death \n\n\n\nand recovered groups. The significance level was set at 0.05. \n\n\n\nResults: Out of 299 COVID-19 patients with hypertension, \n\n\n\nthe majority were females (58%), median [IQR] age of 63 \n\n\n\n[55-70] years, with co-existing diabetes (49.5%). The \n\n\n\nmortality was associated with age groups (p=0.036) and \n\n\n\nbaseline severity (p=0.001). Clinically, fever (p=0.005), \n\n\n\nshortness of breath (p=0.003), respiratory rate (p=0.026), and \n\n\n\noxygen saturation (p<0.001 were found to be associated with \n\n\n\ndeath. Laboratory examinations such as total leucocytes \n\n\n\ncount (p<0.001), neutrophils (p<0.001), C-reactive proteins \n\n\n\n(p<0.001), D-dimer (p=0.005), ferritin (p=0.016), lactate \n\n\n\ndehydrogenase (p<0.001), and procalcitonin levels (p=0.001) \n\n\n\nwere significantly higher among death cases. The mortalities \n\n\n\nwere comparatively lower (p=0.002) among angiotensin \n\n\n\nconverting enzyme inhibitors (ACEI) or angiotensin receptor \n\n\n\nblockers (ARB) consumers. Conclusion: Our study \n\n\n\nconcluded that older age, severe illness with poor oxygen \n\n\n\nsaturation, shortness of breath, higher inflammatory markers \n\n\n\nand need of mechanical ventilation were associated with the \n\n\n\nmortality among COVID-19 patients with hypertension. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 004 \n\n\n\n\n\n\n\nTreatment Outcomes of Pulmonary \n\n\n\nTuberculosis: A Retrospective Study in \n\n\n\nDistrict Headquarter Hospital, Pakistan \n\n\n\n\n\n\n\nRabbiya Ahmad1*, Saifullah Mehsud2, Fazli \n\n\n\nMaula3, Obaidullah Malik4, and Amer Hayat \n\n\n\nKhan1 \n \n1Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, \n\n\n\nUniversiti Sains Malaysia, 11800, Gelugor, Penang, Malaysia, \n2Department of Pharmaceutical Sciences, Abbottabad University of Science \n\n\n\nand Technology, Havelian, Abbottabad, Pakistan. \n3Department of Pulmonology, Peshawar medical college Peshawar, Khyber \nPakhtoon Khawa, Pakistan. \n4Drug Regulatory Authority of Pakistan, Islamabad, Pakistan \n\n\n\n*rabbiyahmad@gmail.com  \n\n\n\n\n\n\n\nBackground: Pakistan shares the 61% burden of \n\n\n\nTuberculosis (TB) in WHO's Eastern Mediterranean Region. \n\n\n\nObjective: This study aimed to identify the predictors and \n\n\n\nfactors associated with unsuccessful treatment outcomes of \n\n\n\npulmonary tuberculosis (PTB). Methods: A retrospective \n\n\n\nstudy was conducted in the DHQ, Hospital Bannu, Khyber \n\n\n\nPakhtunkhwa, Pakistan from 1st January 2014 to 31st \n\n\n\nDecember 2018. Data were collected from TB registers, and \n\n\n\nTB medical personal files using National TB program (NTP) \n\n\n\nguidelines for Pakistan. Drug-resistant and drug-susceptible \n\n\n\nTB patients were included. SPSS 23.0 was used for analyzing \n\n\n\nthe data. Logistic regression analysis was done to determine \n\n\n\nthe final predictors of unsuccessful treatment outcomes. \n\n\n\nResults: A total of 1426 patients were included in the study. \n\n\n\nThe success ratio of the treatment was observed to be 60.7% \n\n\n\namong PTB patients. The odds of unsuccessful treatment \n\n\n\noutcomes were higher among patients who were 15 or \n\n\n\nyounger (95% CL: 1.02-5.89; AOR = 1.24) and patients aged \n\n\n\n16 to 25 years (95% CL: 1.448-3.42; AOR = 2.228). Patients \n\n\n\nwith comorbidities like diabetes (95% CL: 1.43-3.84; AOR \n\n\n\n= 2.86;) showed a significant association with unsuccessful \n\n\n\ntreatment outcomes. The patients having symptoms like \n\n\n\nsweating (95% CL: 1.62-14.51; AOR = 4.86) and hemoptysis \n\n\n\n(95% CL: 1.35-6.76; AOR = 3.03) were predictors of the \n\n\n\nunsuccessful treatment. Conclusion: This study reveals that \n\n\n\nthe ratio of unsuccessful treatment outcomes is still high. \n\n\n\nYounger patients, with comorbidities, and with symptoms \n\n\n\nlike sweating and hemoptysis were predictors of \n\n\n\nunsuccessful treatment. \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:*sazhar.usm@gmail.com\n\n\nmailto:*rabbiyahmad@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 140-181 \n\n\n\n\n\n\n\nResearch abstracts of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022 \n\n\n\nDOI:  10.52494/YOXJ1358 \n\n\n\n\n\n\n\n153 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 005 \n\n\n\n\n\n\n\nDrug Resistance Pattern, Prevalence and \n\n\n\nRisk Factors for Resistance to Second Line \n\n\n\nAnti-Tuberculosis Drugs in Balochistan, \n\n\n\nPakistan \n\n\n\n\n\n\n\nAsad Khan1, Naila Kakar2, Nafees Ahmad2, \n\n\n\nAbdul Wahid2, Amer Hayat Khan1* \n \n1School of Pharmaceutical Sciences, Universiti Sains Malaysia, Malaysia \n2Faculty of Pharmacy and Health Sciences University of Balochistan, \n\n\n\nPakistan \n\n\n\n* dramer@usm.my  \n \n\n\n\nBackground: Pakistan is high burden drug resistant \n\n\n\ntuberculosis (DR-TB) country according to World health \n\n\n\nOrganization Global Tuberculosis report 2021. For devising \n\n\n\na treatment regimen and optimizing empirical drug therapy, \n\n\n\nthe local epidemiology and drug resistance patterns are \n\n\n\nneeded to be considered. Objectives: To evaluate drug \n\n\n\nresistance pattern, prevalence and risk factors for resistance \n\n\n\nto second line anti-tuberculosis drugs (SLD) among DR-TB \n\n\n\npatients in Balochistan, Pakistan. Methods: This was a cross-\n\n\n\nsectional study conducted at programmatic management unit \n\n\n\nof DR-TB (PMDT) of Fatimah Jinnah Chest and General \n\n\n\nHospital, Quetta. Where 354 patients of DR-TB patients \n\n\n\nirrespective of their age, TB site and drug resistance pattern \n\n\n\nwere included in the study. A standardized data collection \n\n\n\nform was used to collect patients\u2019 socio demographic, \n\n\n\nmicrobiological and clinical data. Data was analysed by \n\n\n\nSPSS 20. A p-value <0.05 was taken statistically significant. \n\n\n\nResults: Among the subjects, majority were females (61.7%), \n\n\n\nbelonged to the age group 19-30 years (36.7%), were \n\n\n\npreviously treated for TB (95.8%) at public sector hospital \n\n\n\n(42.7%) and did not suffer from any other comorbidity \n\n\n\n(88.7%). The study participants were resistant to a median of \n\n\n\nthree anti-TB drugs (range 1-8). The most common type of \n\n\n\nDR-TB was multi DR-TB (77.1%), followed by mono DR-\n\n\n\nTB (18.1%), extensive DR-TB(3.1%) and poly-DR (1.7%). \n\n\n\nA total of 147 (41.5%) patients were resistant to any second \n\n\n\nline anti-TB drug (SLD). Among SLD, the resistance was \n\n\n\nhigh for fluoroquinolones (38.4%), followed by ethionamide \n\n\n\n(4.8%) and injectable SLD (4.2%). Upon multivariate binary \n\n\n\nlogistic regression analysis previous treatment of cat-II \n\n\n\nregimen had statistically significant association with \n\n\n\nresistance to any SLD (OR=5.273, 95%CI=1.098-25.316). \n\n\n\nConclusion: The high degree of SLD resistance observed \n\n\n\nparticularly to fluoroquinolones is distressing. Testing cat-I \n\n\n\nfailures for drug resistance rather than putting them on cat-II \n\n\n\ntreatment and more restrictive policies to control non-\n\n\n\nprescription sale and indiscriminate use of fluoroquinolones \n\n\n\nare recommended. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 006 \n\n\n\n\n\n\n\nPharmacy Students\u2019 Readiness and \n\n\n\nPreparedness to Contribute During \n\n\n\nDisasters: A Cross-Sectional Two \n\n\n\nInstitutional Study from the UAE \n \n\n\n\nAlaa Ahmad Farajallah 1,2*, Muaed Alomar1, \n\n\n\nSubish Palaian1, Mohammad Majed Al-\n\n\n\nAhmad3,4, Mohamed Izham Mohamed \n\n\n\nIbrahim5 \n \n\n\n\n1Department of Clinical Sciences, College of Pharmacy and Health Sciences, \nAjman University, Ajman, UAE. \n2Department of Clinical Pharmacy, School of Pharmaceutical Sciences, \n\n\n\nUniversiti Sains Malaysia. \n3Department of Clinical Pharmacy, College of Pharmacy, Al Ain University, \n\n\n\nAl Ain Campus, Al Ain, UAE. \n4AAU Health and Biomedical Research Center, Al Ain University, Abu \nDhabi, United Arab Emirates, \n5Department of Clinical Pharmacy and Practice, College of Pharmacy, QU \n\n\n\nHealth, Qatar University, Doha, Qatar. \n* a.farajallah@ajman.ac.ae  \n\n\n\n\n\n\n\nBackground: Pharmacists\u2019 involvement in disaster \n\n\n\nmanagement has been acknowledged in the literature where \n\n\n\nthey can be engaged in various clinical and non-clinical \n\n\n\nservices. The scope of pharmacy education globally has been \n\n\n\nshifted towards competency-based education where more \n\n\n\ntraining and skilled base programs had been added to \n\n\n\npharmacy colleges\u2019 curricula. The current pharmacy \n\n\n\neducation in UAE is undergoing various changes with more \n\n\n\nweightage for experiential learning. However, none of the \n\n\n\ncurrent BPharm study plans incorporate medicine disaster \n\n\n\nmanagement and preparedness. Objectives: To investigate \n\n\n\nthe pharmacy students\u2019 knowledge, attitude, and readiness to \n\n\n\ncontribute during disasters in the United Arab Emirates \n\n\n\n(UAE). Methods: A quantitative, descriptive, cross-sectional \n\n\n\nstudy was conducted in two pharmacy colleges in the UAE \n\n\n\nusing a pre-validated electronic questionnaire distributed \n\n\n\nthrough students\u2019 official university emails and reminders \n\n\n\nthrough WhatsApp. Data were collected using simple \n\n\n\nrandom sampling from February 2021 to November 2021. \n\n\n\nThe questionnaire consisted of four sections: demographic \n\n\n\ninformation, knowledge, attitude, and readiness to practice \n\n\n\nwith perceived barriers. Results: A total of 258 pharmacy \n\n\n\nstudents responded to the survey. The majority were fourth-\n\n\n\nyear students (51.2%, n = 132) with a mean (sd) age of 20.46 \n\n\n\nyears [SD \u00b12.35]. years. The average score for total \n\n\n\nknowledge was 155.3 (60.2%), with no statistical differences \n\n\n\nbetween groups. The median (IQR) scores for total attitude, \n\n\n\ntotal readiness to practice, and barriers to disaster medicine \n\n\n\nwere 4. Conclusions: There is a need to assess and improve \n\n\n\nthe current level of knowledge, preparation, and readiness of \n\n\n\npharmacy students through educational modules targeting \n\n\n\nvarious skills such as teamwork, emergency response, etc. \n\n\n\ninto pharmacy curricula and assessing their impact. \n\n\n\n\nmailto:dramer@usm.my\n\n\nmailto:a.farajallah@ajman.ac.ae\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 140-181 \n\n\n\n\n\n\n\nResearch abstracts of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022 \n\n\n\nDOI:  10.52494/YOXJ1358 \n\n\n\n\n\n\n\n154 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstrat 007 \n\n\n\n\n\n\n\nTop 30 Drugs Associated with Acute \n\n\n\nKidney Injury (Aki) Cases: A Real-World \n\n\n\nPharmacovigilant Study \n \n\n\n\n Mohammad A. Khaleel1*, Amer Hayat Khan1, \n\n\n\nS. M. Sheikh Ghadzi1 and Azreen Syazril \n\n\n\nAdnan2 \n \n1Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, \n\n\n\nUniversiti Sains Malaysia, 11800, Gelugor, Penang, Malaysia \n2Advanced Medical & Dental Institute, Universiti Sains Malaysia, Bertam, \nKepala Batas 13200, Pulau Pinang, Malaysia \n\n\n\n* mamk77@yahoo.com  \n\n\n\n\n\n\n\nBackground: Spontaneous adverse events reporting \n\n\n\ndatabases are an invaluable resource for pharmacovigilance \n\n\n\nanalysis and post-marketing medication safety monitoring. \n\n\n\nOne of the largest spontaneous adverse drug events reporting \n\n\n\nsystems in the world is the United States Food and Drug \n\n\n\nAdministration (FDA) Adverse Event Reporting System \n\n\n\n(FAERS). Objective: To find the top 30 drugs associated \n\n\n\nwith AKI in FAERS. Methods: Data set used for the period \n\n\n\nof January 2004 to September 2021. Cases of AKI were \n\n\n\nidentified using the Standardised Medical Dictionary for \n\n\n\nRegulatory Activities (MedDRA) Queries (SMQs), using the \n\n\n\nacute renal failure SMQ coded 20000003, composed of 19 \n\n\n\nPreferred Terms (PT) with a narrow scope. The lower limit \n\n\n\nof a two-sided 95 per cent credibility interval for the \n\n\n\nInformation Component (IC025) was applied to detect and \n\n\n\nrank signals of drugs associated with AKI. Results: The top \n\n\n\n30 drugs associated with AKI in descending order as drug \n\n\n\nname (count of reactions,IC025): Dihydroxyaluminum \n\n\n\nsodium carbonate (1608,3.48); Aprotinin (2653,3.08); \n\n\n\nProtamine sulfate (1064,2.82); Dexlansoprazole (8345,2.79); \n\n\n\nIobitridol (102,2.75); Glucarpidase (68,2.72); Serelaxin \n\n\n\n(17,2.66); Pancuronium (428,2.63); Human plasma \n\n\n\npreparation (761,2.47); Bismuth subsalicylate (1297,2.45); \n\n\n\nBrincidofovir (32,2.37); Telavancin (47,2.25); Remdesivir \n\n\n\n(837,2.22); Methoxyflurane (14,2.21); Protamines \n\n\n\n(157,2.18); Elvitegravir (2676,2.16); Econazole (1213,2.14); \n\n\n\nCidofovir (234,2.13); Milrinone (588,2.13); Nitroprusside \n\n\n\n(250,2.12); Lomeprol (100,2.11); Bictegravir (1735,2.11); \n\n\n\nCobicistat (3065,2.10); Tenofovir alafenamide (4387,2.07); \n\n\n\nFenoldopam (29,2.07); Foscarnet (555,2.06); Citric acid \n\n\n\n(728,2.05); Diethylene glycol (7,2.05); Tenofovir disoproxil \n\n\n\n(11003,2.05); Mannitol (881,2.02). Conclusion: This report \n\n\n\nlists drugs that require further investigation to determine their \n\n\n\nrisk of AKI.  \n\n\n\n\n\n\n\n\n\n\n\nAbstrat 008 \n\n\n\n\n\n\n\nAssessment of Patient Safety Culture \n\n\n\namong Healthcare Providers in A Tertiary \n\n\n\nHospital at Johor Bahru, Malaysia \n \n\n\n\nAbdulsalam Halboup1,*, Mohammed Kubas2 \n \n1Department of Clinical Pharmacy and Pharmacy Practice, Faculty of \n\n\n\nPharmacy, University of Science and Technology, Sana\u2019a, Yemen \n2Clinical Pharmacy Department, University of Science and Technology \n\n\n\nHospital, Sana\u2019a, Yemen \n\n\n\n* a_halboob@yahoo.com  \n\n\n\n\n\n\n\nBackground: Drug-related problems (DRPs) are drug-\n\n\n\nrelated events that lead to inadequate medical care or to harm \n\n\n\npatients. Objective: This study aims to determine the types, \n\n\n\nfrequency, and settings of DRPs among hospitalized patients. \n\n\n\nMethods: A cross-sectional study with clinical pharmacist \n\n\n\nintervention was conducted between June 2013 and \n\n\n\nNovember 2015. Patients who were admitted to the medical \n\n\n\nwards, Intensive Care Unit (ICU), and Coronary Care Unit \n\n\n\n(CCU) at University of Science and Technology Hospital in \n\n\n\nSana'a, Yemen, were interviewed and their medical records \n\n\n\nand medication orders were assessed for DRPs by the clinical \n\n\n\npharmacist who provided pharmaceutical care services \n\n\n\ninpatient settings. Results: A total of 3307 DRPs were \n\n\n\nidentified after evaluated 957 patients, with an average of 3.5 \n\n\n\nDRPs/patient. The most frequently encountered DRP type \n\n\n\nwas indication problems (29.2%, n=965), followed by \n\n\n\nadverse drug events (26.2 %, n=867), and dosing errors \n\n\n\n(25.3%, n=838). This study also showed that 15.3% (n=506) \n\n\n\nof patients required frequent monitoring, and 4.0% (n=131) \n\n\n\nof patients needed education and counselling. The most \n\n\n\nfrequent DRPs were identified in ICU (43.6%, n=417), \n\n\n\nfollowed by CCU (30.9%, n=296), and medical ward (25.5%, \n\n\n\nn=244). Conclusion: Certain types of DRPs are common \n\n\n\namong patients in the hospital, especially in critical settings. \n\n\n\nTherefore, measures to tackle these types of DRPs should be \n\n\n\ntaken. \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:mamk77@yahoo.com\n\n\nmailto:a_halboob@yahoo.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 140-181 \n\n\n\n\n\n\n\nResearch abstracts of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022 \n\n\n\nDOI:  10.52494/YOXJ1358 \n\n\n\n\n\n\n\n155 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 009 \n\n\n\n\n\n\n\nThe Health\u2011related Quality of Life and \n\n\n\nTreatment Satisfaction Among Tacrolimus \n\n\n\nTreated Patients Post-Renal Transplantation \n\n\n\nin Riyadh, Saudi Arabia \n \n\n\n\nAmany Mohamed Alboghdadly1*, Amer \n\n\n\nHayat Khan2, and Syed Azhar Syed \n\n\n\nSulaiman3,4  \n \n1Department of Clinical Pharmacy, School of Pharmaceutical Sciences, \nUniversiti Sains Malaysia, 11800 Pulau Pinang, Malaysia. \n2Department of Clinical Pharmacy, School of Pharmaceutical Sciences, \n\n\n\nUniversiti Sains Malaysia, 11800 Pulau Pinang, Malaysia. \n3Department of Clinical Pharmacy, School of Pharmaceutical Sciences, \n\n\n\nUniversiti Sains Malaysia, 11800 Pulau Pinang, Malaysia \n4Advanced Medical and Dental Institute, Universiti Sains Malaysia, Bertam, \nPulau Pinang, Malaysia \n\n\n\n* amanyalboghdadly@gmail.com  \n\n\n\n\n\n\n\nBackground: Renal transplantation (RTP) has a higher \n\n\n\nquality of life than dialysis. However, kidney transplant \n\n\n\nrecipients frequently experience some adverse effects \n\n\n\naccompanied by immunosuppressive treatment, which \n\n\n\nnegatively affect the physical and mental health-related \n\n\n\nquality of life (HRQoL). Objectives: To evaluate the HRQoL \n\n\n\nand treatment satisfaction among tacrolimus-treated patients \n\n\n\npost-RTP and to determine the effect of other demographic, \n\n\n\nclinical, and social factors on their HRQoL and treatment \n\n\n\nsatisfaction. Methods: A convenience sample of 100 renal \n\n\n\ntransplant recipients on tacrolimus-based regimens from \n\n\n\nJanuary 2017 to September 2019 in the Security Force \n\n\n\nHospital in Riyadh, Saudi Arabia, were enrolled in this study, \n\n\n\nquality of life and treatment satisfaction were prospectively \n\n\n\nanalyzed using Kidney Disease Quality of Life Instrument-\n\n\n\nSF36 (KDQOL-SF36) and Treatment Satisfaction \n\n\n\nQuestionnaire for Medication (TSQM 1.4) after one month \n\n\n\n& 6 months of RTP. Results: A total of 100 renal \n\n\n\ntransplanted patients, 78%, were male, mean age was 45.3 \u00b1 \n\n\n\n13.87 years. The most comorbidities before RTP were \n\n\n\nhypertension, 39.7%, dyslipidemia, 37.5%, and diabetes \n\n\n\nmellitus, 23.2%. Young male patients with high education \n\n\n\nlevels had high scores. The mean scores of KDQoL in \n\n\n\npatients with dyslipidemia and diabetes were significantly \n\n\n\ndecreased (P<0.05). Also, mean scores of TSQM 1.4 (side \n\n\n\neffects of the treatment) and KDQoL in acute cellular \n\n\n\nrejection patients were significantly decreased than those \n\n\n\nwithout renal rejection (P<0.05). Conclusions: Tacrolimus-\n\n\n\ntreated patients showed some improvement in the overall \n\n\n\nHRQoL and treatment satisfaction after 6 months of RTP. A \n\n\n\nmultidisciplinary team should integrate psychological health \n\n\n\nprofessions to encourage renal transplant recipients to adapt \n\n\n\nbetter. \n\n\n\nAbstract 010 \n\n\n\n\n\n\n\nTuberculosis: Risk Factors, Developing \n\n\n\nDrug-Resistant, Treatment Outcomes and \n\n\n\nSurvival Trend in Hospital Pulau Pinang, \n\n\n\nMalaysia: A Retrospective Study \n \n\n\n\nAseel Rezeq Yaghi1, Amer Hayat Khan1*, \n\n\n\nSabariah Noor Harun2 and Irfhan Ali Haider3 \n \n1Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, \n\n\n\nUniversiti Sains Malaysia, 11800, Gelugor, Penang, Malaysia \n2School of Pharmacy, The University of Queensland, Brisbane QLD 4072, \n\n\n\nAustralia \n3Respiratory Department, Penang General Hospital, Malaysia \n\n\n\n* dramer2006@gmail.com  \n\n\n\n\n\n\n\nBackground: Multi-drug resistant tuberculosis (MDR-TB) \n\n\n\nhas emerged as a serious health issue worldwide. Although \n\n\n\nTB incidence is declining, mortality rate is in increase. \n\n\n\nObjectives: To investigate the factors associated with the \n\n\n\ndevelopment of MDR-TB and mortality among TB patients. \n\n\n\nMethods: A retrospective cohort study, carried on Hospital \n\n\n\nPulau Pinang, Malaysia. Medical records of TB patients \n\n\n\ntreated and followed up for 6 months from 2014 till 2018 \n\n\n\nwere reviewed. By using SPSS version 23.0. Cox regression \n\n\n\nmodel was used to identify the factors associated with MDR-\n\n\n\nTB occurrence and mortality among TB patients. Results: \n\n\n\nOut of 351 TB patients, 325 (92.6%) patients were drug-\n\n\n\nsusceptible TB and 26 (7.4 %) patients were MDR-TB. \n\n\n\nAmong drug-susceptible TB patients, 245 (75.4%) patients \n\n\n\nachieved successful outcomes and 73 (22.5%) passed away. \n\n\n\nIn multivariable Cox regression, drug abuse (p-value= .034, \n\n\n\nHR= 1.836, 95%CI= 1.019 \u2013 3.309), high levels of white \n\n\n\nblood cells (p-value= .000, HR= 1.102, 95%CI= 1.057 \u2013 \n\n\n\n1.148) and urea (p-value= .002, HR= 1.029, 95%CI= 1.011 \n\n\n\n\u2013 1.047), and low levels of platelets (p-value= .000, \n\n\n\nHR= .996, 95%CI= .995 - .998) and albumin (p-value= .006, \n\n\n\nHR= .964, 95%CI= .940 - .990) were significantly \n\n\n\nassociated with mortality. Moreover, relapsed cases (p-\n\n\n\nvalue= 0.044, HR= 3.035, 95%CI= 1.028 \u2013 8.957), alcohol \n\n\n\nconsumption (p-value= 0.000, HR= 7.591, 95%CI= 3.097 \u2013 \n\n\n\n18.610) and being single (p-value= 0.000, HR= 6.817, \n\n\n\n95%CI= 2.599-17.879) were significant risk factors for \n\n\n\nMDR-TB development. Conclusion: The success rate \n\n\n\nachieved in the study site (75.4%) was encouraging but still \n\n\n\nless than WHO target (85%) and still has a room for further \n\n\n\nimprovement.  \n\n\n\n\nmailto:amanyalboghdadly@gmail.com\n\n\nmailto:dramer2006@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 140-181 \n\n\n\n\n\n\n\nResearch abstracts of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022 \n\n\n\nDOI:  10.52494/YOXJ1358 \n\n\n\n\n\n\n\n156 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 011 \n\n\n\n\n\n\n\nIncidence and Management of Adverse \n\n\n\nDrug Events Among Drug-Resistant \n\n\n\nTuberculosis Patients: A Prospective Study \n\n\n\nResults From A High Burden Country \n\n\n\n\n\n\n\nAsif Massud1,2*, Amer Hayat Khan1, Syed \n\n\n\nAzhar Syed Sulaiman1, Nafees Ahmad3, \n\n\n\nMuhammad Shafqat4 \n \n1Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, \n\n\n\nUniversiti Sains Malaysia, Penang, Malaysia \n2Faculty of pharmaceutical sciences, Government College University, \n\n\n\nFaisalabad, Pakistan \n3Faculty of Pharmacy, University of Balochistan, Quetta, Pakistan \n4Programmatic management of drug-resistant Tuberculosis (PMDT) unit, \n\n\n\nNishtar Medical University, Hospital, Multan, Pakistan \n\n\n\n* asifmassud@gmail.com  \n\n\n\n\n\n\n\nBackground: Management of Drug-resistant tuberculosis \n\n\n\n(DR-TB) involves a higher frequency of adverse drug events \n\n\n\n(ADEs) needing effective and timely response, which if left \n\n\n\nuntreated may result in a higher rate of loss to follow up of \n\n\n\ndrug-resistant patients. Objectives: Prospective study was \n\n\n\naimed at identifying the incidence, cause, and management \n\n\n\nmethods for ADEs along with risk factors among DR-TB \n\n\n\npatients at Nishtar Medical University Hospital, Pakistan. \n\n\n\nMethods: Prospective DR-TB patients, enrolled during \n\n\n\nJanuary 2016 to May 2019, were evaluated for ADEs as per \n\n\n\nNational TB Program criteria, Pakistan. Multivariate logistic \n\n\n\nregression was used to assess the independent variables \n\n\n\nADEs occurrence. Results: Among 271 DR-TB patients, \n\n\n\nmajority of the patients were males (51.3%), aged being < 50 \n\n\n\nyears (77.5%), weighed > 40 kg (69%), urban residents \n\n\n\n(51.7%), married (70.8%) and non-smokers (88.6%) and \n\n\n\nfemales were 49.7% of the cohort. Among patients, \n\n\n\n55(18.5%) patients did not experience any ADEs, while at \n\n\n\nleast 15(5.5%), 33(12.2%), 55(20.3%) and 53(19.6%) \n\n\n\npatients encountered one, two, three and four ADEs, \n\n\n\nrespectively. Gastrointestinal disturbances (66.7%) and \n\n\n\nelectrolyte disturbances (55.7%) remained one of the highest \n\n\n\nreported ADEs during therapy, followed by arthralgia \n\n\n\n(49.1%), psychiatric disturbance (39.4%), ototoxicity (24%), \n\n\n\nsleep disturbances (17.7%), pruritic reactions/rash (12.9%), \n\n\n\ndyspnoea (12.5%), and tinnitus (8.8%). Baseline pulmonary \n\n\n\ncavitation (p-value 0.001, OR 3.419; 95% CI (1.694 - 6.902) \n\n\n\nwas significantly associated with ADEs occurrence among \n\n\n\nDR-TB patients. Conclusion: Overall nearly 81.2 % of the \n\n\n\nDR-TB patients encountered therapy related ADEs. The \n\n\n\nhigher frequency of Amikacin-related temporary hearing loss \n\n\n\nleading to the treatment modification among patients is of \n\n\n\nconcern. ADEs were high among the study cohort, however, \n\n\n\nmanaged efficiently. \n\n\n\nAbstract 012 \n\n\n\n\n\n\n\nQualitative Assessment of Knowledge, \n\n\n\nAttitude and Practice of Healthcare \n\n\n\nPractitioners About Precision Medicine \n\n\n\nAmong Cancer Patients in Lahore, Pakistan \n \n\n\n\nRida Naeem1, Furqan K. Hashmi2, Dzul Azri \n\n\n\nMohamed Noor1* \n \n\n\n\n1School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 \n\n\n\nMalaysia \n2University College of Pharmacy, University of the Punjab, Allama Iqbal \n\n\n\nCampus, 54000, Lahore, Pakistan \n*dzulazri@usm.my \n \n\n\n\nBackground: Precision medicine (PM) allows healthcare \n\n\n\npractitioners (HCPs) to give treatment according to the \n\n\n\npatient\u2019s genetic findings taking into consideration the \n\n\n\nphysiological and environmental characteristics. PM is a \n\n\n\nrelatively new treatment approach in Pakistan. Therefore, it \n\n\n\nis important to investigate the level of awareness, attitude, \n\n\n\nand challenges faced by HCPs during practicing PM for \n\n\n\ncancer treatment. Objectives: the present study aims to \n\n\n\nexplore the level of awareness, attitude, and challenges faced \n\n\n\nby the HCPs during the treatment of cancer using PM \n\n\n\napproach. Methods: Phenomenology-based qualitative \n\n\n\napproach was used. Face-to-face in-depth interviews were \n\n\n\nconducted using the purposive sampling approach among \n\n\n\noncologists of Lahore, Pakistan. The data were analyzed \n\n\n\nusing thematic content analysis to identify themes and sub-\n\n\n\nthemes. Results: Sample size saturation achieved with 14 \n\n\n\nphysicians. Out of these,11 were aware of PM. They were \n\n\n\nkeen on training to hone their skills and agreed currently on \n\n\n\nproviding PM. HCPs believed PM was expensive and given \n\n\n\nto affluent patients only. Other impeding factors include cost, \n\n\n\nlack of knowledge, and drug unavailability. Conclusions: \n\n\n\nDespite basic knowledge and will to practice, resource and \n\n\n\ncost constraints were marked as significant barriers. \n\n\n\nAdditional training programs and inclusion into the \n\n\n\ncurriculum may help to implement PM in the future. Health \n\n\n\nauthorities need to ensure a cheaper PM treatment available \n\n\n\nto cancer patients. \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:asifmassud@gmail.com\n\n\nmailto:*dzulazri@usm.my\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 140-181 \n\n\n\n\n\n\n\nResearch abstracts of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022 \n\n\n\nDOI:  10.52494/YOXJ1358 \n\n\n\n\n\n\n\n157 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 013 \n\n\n\n\n\n\n\nThe Impact of Education Level Over \n\n\n\nAdoption of Standard Operating \n\n\n\nProcedures Against Sars-Cov2 Infection \n\n\n\nAmong the COVID-19 Booster Dose \n\n\n\nRecipients in Pakistan \n \n\n\n\nAli Qureshi1,2*, Syed Azhar Syed Sulaiman1, \n\n\n\nNur Aiziti Athira binti Daud1 \n \n\n\n\n1Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, \nUniversiti Sains Malaysia, 11800 Penang, Malaysia \n2Faculty of Pharmacy, University of Sindh Jamshoro, Pakistan \n\n\n\n* ali.qureshi33@student.usm.my \n\n\n\n\n\n\n\nBackground: Generally, the public does not comply with \n\n\n\nthe standard operating procedures against COVID-19 after \n\n\n\ngetting vaccinated. Objective: This study was conducted in \n\n\n\nPakistan, to identify the impact of education level on the \n\n\n\nadoption of standard operating procedures against SARS-\n\n\n\nCOV2 infection among the COVID-19 booster vaccine \n\n\n\nrecipients. Methods: This cross-sectional survey was \n\n\n\nconducted online among the Pakistani population from 18th \n\n\n\nJune to 8th July 2022. The tool was designed by using online \n\n\n\nGoogle forms. Various demographic and attitude related \n\n\n\nquestions were included in the questionnaire. The \n\n\n\nassociation between dependent and categorical independent \n\n\n\nvariables was determined by using the chi-square test. The \n\n\n\nsignificance was measured at P < 0.05. Statistical analysis \n\n\n\nwas performed by using IBM SPSS Statistics (v 23). Results: \n\n\n\nA total of 196 respondents were obtained with a total of 75% \n\n\n\nof them being male, the mean age +SD was 29.38 + 6.3 years. \n\n\n\nAmong them, 85.7% of respondents were from urban areas. \n\n\n\nIt was highlighted that 38.8% of respondents were infected \n\n\n\nwith COVID-19 before. All respondents had received their \n\n\n\nbooster shot. The positive attitude toward wearing a face \n\n\n\nmask (P < 0.001), hand sanitization (P < 0.001), and social \n\n\n\ndistancing (P < 0.001) was significantly associated with \n\n\n\nhigher education (\u2265 graduation). Conclusion: Education \n\n\n\nlevel was noted to have a significant impact on a better \n\n\n\nunderstanding of the importance of the adoption of standard \n\n\n\nprocedures against SARS-COV2. \n\n\n\n\n\n\n\nAbstract 014 \n\n\n\n\n\n\n\nPublic Awareness and Perceptions on The \n\n\n\nCorona Virus (COVID-19) in Duhok \n\n\n\nProvince/Kurdistan Region, Iraq \n \n\n\n\nManhal Ahmed Abdulkader1*, Rabie \n\n\n\nGabriel Abdullah2, Ali Farhad \n\n\n\nAbdullah1 , Matti Shamil Khudhur1, \n\n\n\nSarwar Saad Abdullghani1, Muhammad \n\n\n\nIzaddin Ibrahim1, Shinwar Mohammed \n\n\n\nHasan1 , Ahmad Faris Khaleel1 \n \n1Department of Clinical Pharmacy, College of Pharmacy, University \n\n\n\nof Duhok, Kurdistan Region, Iraq. \n2Department of Pharmacology, College of Pharmacy, University of \n\n\n\nDuhok, Kurdistan Region, Iraq \n\n\n\n* Manhal.abdulkader@uod.ac  \n\n\n\n\n\n\n\nBackground: Novel Corona Virus Disease (COVID-19) \n\n\n\neffectively took the world by storm, resulting in a huge \n\n\n\npandemic worldwide as declared by the World Health \n\n\n\nOrganization. Global attempts have been made to prevent the \n\n\n\nspread of the disease through governmental policies, \n\n\n\nregulations and personal actions that rely on public \n\n\n\nawareness. Objectives: The aim of this study is to assess the \n\n\n\nawareness, perceptions, and anxiety of the public regarding \n\n\n\nthis pandemic. Methods: A web-based (google forms) \n\n\n\nsurvey with random sampling was conducted using a \n\n\n\nquestionnaire developed for this study. The questionnaire \n\n\n\nconsisted of 4 sections including demographics, awareness \n\n\n\nabout transmission methods and prevention measures, public \n\n\n\nperceptions about information source, and perceived anxiety \n\n\n\nfrom COVID-19. Results: A total of 1426 responses were \n\n\n\nreceived with male number slightly lower than female \n\n\n\n(n=706, 49.5%). The participants in our survey had good \n\n\n\nknowledge and awareness as they had an overall mean score \n\n\n\nof 3.58. Participants living in urban areas, that had university-\n\n\n\nlevel education and/or were 30-40 years of age had higher \n\n\n\nknowledge than their peers. Social media and the internet \n\n\n\nwere the main sources of information for about 49.6% of the \n\n\n\nparticipants. Unlike other studies, the majority of the \n\n\n\nparticipants did not have pandemic-related anxiety as \n\n\n\nCoronavirus news did not worry them and it has not affected \n\n\n\ntheir sleeping and eating habits. Conclusion: The public in \n\n\n\nthis study has good general knowledge and awareness about \n\n\n\nCOVID-19. However, some myths still need to be \n\n\n\nhighlighted and corrected to increase public awareness and \n\n\n\nreduce the chance of infection. \n\n\n\n \n\n\n\n\nmailto:ali.qureshi33@student.usm.my\n\n\nmailto:Manhal.abdulkader@uod.ac\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 140-181 \n\n\n\n\n\n\n\nResearch abstracts of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022 \n\n\n\nDOI:  10.52494/YOXJ1358 \n\n\n\n\n\n\n\n158 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 015 \n\n\n\n\n\n\n\nPractice and Associated Factors \n\n\n\nDetermination of Antibiotics Self-\n\n\n\nMedication Among Community Residents \n\n\n\nin Boyolali, Indonesia  \n \n\n\n\nHidayah Karuniawati1,2*, Sri Suryawati3, Syed \n\n\n\nAzhar Syed Sulaiman1*, Taufik Taufik4, Wan \n\n\n\nIsmahanisa Ismail5, Md. Sanower Hossain6,7 \n \n1School  of Pharmaceutical Sciences, Universiti Sains Malaysia,  Malaysia \n2Faculty of Pharmacy, Universitas Muhammadiyah Surakarta,  Indonesia \n3Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, \n\n\n\nYogyakarta, Indonesia \n4Faculty of Psychology Universitas Muhammadiyah Surakarta, Indonesia \n5Faculty of Health Science, Universiti Teknologi MARA, Cawangan, Pulau \n\n\n\nPinang, Malaysia \n6Department of Biomedical Science, Kulliyyah of Allied Health Sciences, \n\n\n\nInternational Islamic University Malaysia, Kuantan 25200, Malaysia \n7Faculty of Science, Sristy College of Tangail, Tangail-1900, Bangladesh \n*hk170@ums.ac.id; sazhar@usm.my  \n\n\n\n\n\n\n\nBackground: Antibiotic resistance (ABR) is a global crisis \n\n\n\nmainly driven by antibiotic overuse and misuse, including \n\n\n\nself-medication. Determining the associated factors of \n\n\n\nantibiotics self-medication (ASM) is crucial to take \n\n\n\nnecessary preventive measures. Objective: This study \n\n\n\ninvestigated the prevalence, practice, and factors associated \n\n\n\nwith ASM in the general community residing in Boyolali, \n\n\n\nIndonesia. Methods: This cross-sectional study was \n\n\n\nconducted using a validated questionnaire with the cluster \n\n\n\nsampling method applied to select households. ASM \n\n\n\nbehaviour variables were determined using the multivariate \n\n\n\nlogistic regression analysis. Results: During the study, 961 \n\n\n\nrespondents participated (46.9% male and 53.1% female). \n\n\n\nASM prevalence was 16%. Amoxicillin (50.0%) and \n\n\n\ntetracycline (33%) were frequently used as antibiotics for \n\n\n\nself-medication for diseases of non-bacterial infections. The \n\n\n\nreasons for ASM were mainly personal experience and not \n\n\n\nconsulting with a doctor to save money. Most respondents \n\n\n\nreported that antibiotics could kill viruses (84.3%) and reduce \n\n\n\nfever (73.2%). They do not know that antibiotics must be \n\n\n\nbought after being prescribed by a doctor (66.8%), do not \n\n\n\nknow how to use antibiotics correctly (63.5%), and do not \n\n\n\nknow that inappropriate use of antibiotics will cause ABR \n\n\n\n(35.1%). Age, marital status, employment status, antibiotic \n\n\n\naccess knowledge, and antibiotic misuse were significantly \n\n\n\nassociated with ASM (p<0.05). Conclusion: This study \n\n\n\ndetermined 16% ASM, but the tolerance to ASM should be \n\n\n\nzero. Because any single percent of ASM could spread ABR \n\n\n\nwidely among the whole community. Educating and \n\n\n\nencouraging people to avoid ASM is recommended to \n\n\n\nprevent ABR development and spread among societies. \n\n\n\n\n\n\n\nAbstract 016 \n\n\n\n\n\n\n\nImplementing PharmindBot on Facebook \n\n\n\nfor Pharmacy Research Purposes: An \n\n\n\nArtificial Intelligence-Based Chatbot  \n\n\n\n\n\n\n\nRamez M. Alkoudmani*, Mei Lan Tan, and \n\n\n\nGuat See Ooi \n \n\n\n\nDiscipline of Clinical Pharmacy School of Pharmaceutical Sciences, \nUniversiti Sains Malaysia, Minden, Pulau Pinang, Malaysia \n\n\n\n* cpe4ever@gmail.com \n\n\n\n\n\n\n\nBackground: The world is moving fast towards digital \n\n\n\ntransformation as we live in the fourth industrial revolution \n\n\n\n(4IR) and artificial intelligence (AI) era. Conversational \n\n\n\nchatbots were used successfully in healthcare. In 2019-2020, \n\n\n\na conversational chatbot (PharmindBot) linked to the \n\n\n\nPharmind page on Facebook\u00ae was designed and successfully \n\n\n\nimplemented. More than 170,000 fans subscribed to \n\n\n\nPharmindBot until December 2021. PharmindBot has been \n\n\n\nused effectively to reach thousands of healthcare \n\n\n\nprofessionals (pharmacists, nurses and physicians) in the \n\n\n\nArab region who interacted with educational posts published \n\n\n\non the Pharmind public page on Facebook\u00ae. Objective: To \n\n\n\nimplement a chatbot called \"PharmindBot\" that runs on \n\n\n\nFacebook\u00ae to reach thousands of healthcare professionals \n\n\n\nand to collect data for research purposes. Methods: \n\n\n\nPharmindBot was successfully implemented on the \n\n\n\nFacebook\u00ae platform following three sequential steps. Firstly, \n\n\n\nChatPion was installed on the Pharmind website. Secondly, \n\n\n\nthe PharmindBot application (app) was developed on \n\n\n\nFacebook\u00ae. Finally, PharmindBot app was integrated with \n\n\n\nthe Pharmind Chatbot system. Evaluation: Auto-reply by \n\n\n\nPharmindBot was tested using a test post which published on \n\n\n\nthe Pharmind page on Facebook\u00ae asking followers to leave \n\n\n\npre-defined keywords. PharmindBot ability to collect and \n\n\n\nsave data was tested by asking testers to fill an online survey \n\n\n\nwithin Facebook Messenger\u00ae for quantitative data and to \n\n\n\nanswer predified series of questions for qualitative data. \n\n\n\nResults: PharmindBot was tested on 1000 subscribers who \n\n\n\ninteracted with it. Almost all testers (n= 990, 99%) obtained \n\n\n\na successful reply from the chatbot after sending a pre-\n\n\n\ndefined keyword. However, very few subscribers (n=10, 1%) \n\n\n\ndid not get any responses. The chatbot replied privately to \n\n\n\nalmost all public comments (n=985, 98.5%). No missing data \n\n\n\nwas found when the chatbot was used to collect quantitative \n\n\n\nand qualitative data. Conclusions: Pharmindbot reached \n\n\n\nthousands of healthcare professionals and provided them \n\n\n\nwith automated responses. The chatbot also collected \n\n\n\nqualitative and quantitative data effectively and efficiently \n\n\n\nwith little costs.  \n\n\n\n\nmailto:sazhar@usm.my\n\n\nmailto:cpe4ever@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 140-181 \n\n\n\n\n\n\n\nResearch abstracts of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022 \n\n\n\nDOI:  10.52494/YOXJ1358 \n\n\n\n\n\n\n\n159 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 017 \n\n\n\n\n\n\n\nMedication Management Review Clinic in \n\n\n\nJordan: Development and Review of First \n\n\n\nTwo Cases \n \n\n\n\nLoai M. Saadah1,2*, Amer H. Khan1, Syed \n\n\n\nAzhar Syed Sulaiman1, Iman A. Basheti2 \n \n1 Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, \nUniversiti Sains Malaysia, 11800 Penang, Malaysia \n2 Department of Clinical Pharmacy, Faculty of Pharmacy, Applied Sciences \n\n\n\nUniversity Pharmacy, 11931 Amman, Hashemite Kingdom of Jordan \n* loaisaadah@student.usm.my \n\n\n\n\n\n\n\nBackground: Developing nations still lacks medication \n\n\n\nmanagement review services like their developed \n\n\n\ncounterparts. Objectives: We describe first two cases in the \n\n\n\nleading medication management review service in Amman, \n\n\n\nJordan. Methods: This is a descriptive study with two case \n\n\n\nreports. A team of 3 clinical pharmacists developed necessary \n\n\n\nforms, visited pharmacy locations, and ensured compliance \n\n\n\nwith medication management service criteria. Patients were \n\n\n\nrecruited if they have 1 chronic condition, 4 chronic \n\n\n\nmedications, 12 medication doses, or been hospitalized in the \n\n\n\nlast 1 month. Moreover, patients who had undiagnosed signs \n\n\n\nand symptoms which may have been due to drug-induced \n\n\n\ndisease also qualified for the service. Clinical pharmacist \n\n\n\nthen identified, prevented, and resolved all drug-related \n\n\n\nproblems. All patients pay a flat fee of 10 Jordanian Dinars \n\n\n\nper 15-minute interview. Results: We present our first and \n\n\n\nsecond cases from the service. Case I is 73-year-old diabetic \n\n\n\nwoman who is demented and forgetful with faecal and \n\n\n\nurinary incontinence as well as visual and auditory \n\n\n\nhallucinations. Case II is 77-year-old diabetic man with \n\n\n\nmorning oedema, hypertension, hypothyroidism, and benign \n\n\n\nprostatic hyperplasia. Case I had acute kidney injury while \n\n\n\nCase II had chronic kidney disease (CKD stage 3). Case I & \n\n\n\nII received 13 & 12 medications, respectively, with both \n\n\n\nhaving 7 clinical pharmacy interventions including \n\n\n\nprescribing new items. Both patients improved on follow-up \n\n\n\nwith forgetfulness mitigated in the first and oedema resolved \n\n\n\nin the second. Conclusions: We have a great demand for \n\n\n\nmedication management services in Jordan and our \n\n\n\npreliminary evidence predict huge benefits. \n\n\n\n\n\n\n\nAbstract 018 \n\n\n\n\n\n\n\nAtorvastatin Therapy Among Egyptians: A \n\n\n\nCross-Sectional Study Among Community \n\n\n\nPharmacists \n \n\n\n\nMohammed Gamal Mohammed Maslub1,2,3\u2020, \n\n\n\nMoutaz Bellah Yasser2\u2020, Mahasen Ali \n\n\n\nRadwan2, Zeyad Ali Abdalla2, Mohammed \n\n\n\nSoliman4, Abubakar Sha'aban5, Nur Aizati \n\n\n\nAthirah Daud1* \n \n1School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 USM, \nPulau Pinang, Malaysia \n2Department of Pharmacy Practice/ Clinical Pharmacy, Faculty of Pharmacy, \n\n\n\nEgyptian Russian University, 11829 Egypt \n3International Society of Pharmacovigilance (ISoP), Egypt Chapter, Cairo, \n\n\n\nEgypt \n4Department of Cardiology, Faculty of Medicine, Helwan University, 11795 \nEgypt \n5Division of Population Medicine, Cardiff University, Cardiff, Wales, CF14 \n\n\n\n4YS United Kingdom \n* aizati@usm.my  \n\n\n\n\u2020 Co-first authors \n\n\n\n\n\n\n\nBackground: Atorvastatin is the most prescribed statin \n\n\n\nglobally. Community pharmacists are among the most \n\n\n\naccessible healthcare professionals in providing information \n\n\n\nand services on rational medication use. Objective: The \n\n\n\nstudy aims to investigate the opinions of community \n\n\n\npharmacists on the response to atorvastatin amongst \n\n\n\nEgyptian outpatients. Methods: This is a cross-sectional \n\n\n\nsurvey aimed at community pharmacists across Egypt\u2019s five \n\n\n\nmain regions. A survey link was provided via Google Forms\u00ae \n\n\n\nto 1500 pharmacists via email, contact number, or social \n\n\n\nmedia platforms. It comprised five sections: 1) demographics, \n\n\n\nplus pharmacists\u2019 experience concerning 2) dyslipidemia, 3) \n\n\n\natorvastatin prescriptions, 4) causes of variations in therapy \n\n\n\noutcomes, and 5) atorvastatin-related adverse reactions. \n\n\n\nParticipation was voluntary and informed consent was \n\n\n\nobtained. The Chi-square test of independence was used to \n\n\n\nevaluate differences in response frequencies. The \n\n\n\nsignificance cut-off value was set at 0.05. Results: A total of \n\n\n\n1444 respondents completed the survey. The elderly were \n\n\n\nmost reported to get prescriptions for dyslipidemia (69.5%). \n\n\n\nMore than half (58%) reported that females presented more \n\n\n\nwith dyslipidemia. Over two-thirds (87.3%) agreed that \n\n\n\natorvastatin was the most prescribed statin in their \n\n\n\npharmacies. The majority (93.1%) believed that patient-\n\n\n\nrelated differences influenced atorvastatin therapy outcomes \n\n\n\n(e.g., lipid profile). Many respondents (25.9%) agreed that \n\n\n\ndrug-drug interactions influenced these outcomes the most. \n\n\n\nElevation of hepatic enzymes was rated differently across \n\n\n\nEgypt\u2019s regions (p= 0.037). Conclusions: This study shows \n\n\n\nthat the majority of pharmacists reported atorvastatin as the \n\n\n\nmost frequently prescribed statin. Most pharmacists \n\n\n\n\nmailto:loaisaadah@student.usm.my\n\n\nmailto:aizati@usm.my\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 140-181 \n\n\n\n\n\n\n\nResearch abstracts of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022 \n\n\n\nDOI:  10.52494/YOXJ1358 \n\n\n\n\n\n\n\n160 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nattributed variations in treatment outcomes to drug-drug \n\n\n\ninteractions with atorvastatin. \n\n\n\n\n\n\n\nAbstract 019 \n\n\n\n\n\n\n\nSpray Dryer and Electrospray Techniques \n\n\n\nAssisted Encapsulation of Insulin in \n\n\n\nMicroparticles Coated with Pectin \n\n\n\nMicrobeads for Colon-Targeted Oral Drug \n\n\n\nDelivery \n \n\n\n\nHazem Choukaife1, Abd Almonem Doolaanea2, \n\n\n\nZalilawati Bnti Rashed3 and Mulham \n\n\n\nAlfatama1* \n \n\n\n\n1Faculty of Pharmacy, Universiti Sultan Zainal Abidin, Besut Campus, \n\n\n\nTerengganu 22200, Malaysia \n2 Department of Pharmaceutical Technology, Kulliyyah of Pharmacy, \n\n\n\nInternational Islamic University Malaysia, Kuantan 25200, Pahang, \n\n\n\nMalaysia \n3 Faculty of Bioresources & Food Industry, Universiti Sultan Zainal Abidin, \n\n\n\nBesut Campus, Terengganu, Malaysia \n\n\n\n* mulham4122@yahoo.com ;  mulham@unisza.edu.my  \n \n\n\n\nBackground: The current diabetes therapy for type-1 and to \n\n\n\nlarge extent type-II, relies mainly on subcutaneous insulin \n\n\n\ninjections. However, frequent daily injections may lead to \n\n\n\nlow patient compliance and substantial inconvenience. \n\n\n\nElectrospray technique can quickly obtain uniform and \n\n\n\nspherical particles with the diameter of interest by applying \n\n\n\nan electric field on the feed needle tip. Electrospray and spry \n\n\n\ndryer techniques introduce an effective encapsulation, batch-\n\n\n\nscalability and reproducibility in particles production. \n\n\n\nObjective: This study aimed to formulate a colon-targeted \n\n\n\nsystem to deliver insulin orally by preparing insulin-chitosan \n\n\n\nmicroparticles coated with pectin microbeads (INS-Cs-MPs \n\n\n\ncoated PMBs). Method: The insulin was encapsulated in \n\n\n\nchitosan microparticles prepared by the spray drying \n\n\n\ntechnique. Then, the microparticles were coated using pectin \n\n\n\npolymer through the electrospray technique based on the \n\n\n\nionic gelation. The optimization of the insulin-loaded \n\n\n\nchitosan microparticles was performed based on the chitosan \n\n\n\nconcentration, inlet temperature, and feed flow rate. \n\n\n\nMeanwhile, the physiochemical properties of pectin \n\n\n\nmicrobeads were controlled by studying the crosslinking \n\n\n\ntime, feed flow rate and high voltage of the electrospray \n\n\n\nequipment. Results: The optimized microparticles were \n\n\n\nsuccessfully prepared with particle size, yield, drug loading, \n\n\n\nand zeta potential of 1.06 \u00b1 0.8 \u03bcm, 47.23 \u00b1 0.5%, 7.6 \u00b1 0.1%, \n\n\n\nand +21.61 \u00b1 1.49 mV, respectively. The INS-Cs-MPs coated \n\n\n\nPMBs were also successfully prepared with size, sphericity, \n\n\n\nand aspect ratio of 0.73 \u00b1 0.15 mm, 0.05 \u00b1 0.07, and 1.85 \u00b1 \n\n\n\n0.14, respectively. The microbeads demonstrated desirable \n\n\n\nwater uptake, erosion and swelling as the microbeads were \n\n\n\ncompletely dissolved in the simulated colon fluid. The drug \n\n\n\nrelease of microbeads had lower release than the \n\n\n\nmicroparticles in the simulated gastric. Conclusion: The \n\n\n\nresults suggest that the produced INS-Cs-MPs coated PMBs \n\n\n\nsystem with the suitable particle size (0.73\u00b1 0.15 mm) is a \n\n\n\npromising system for colon-targeted oral insulin delivery. \n\n\n\nAdditional work is needed to evaluate the cell cytotoxicity of \n\n\n\nthe microbeads as well as the efficiency of lowering glucose \n\n\n\nlevel in-vivo. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 020 \n\n\n\n\n\n\n\nScreening Electrospinning Critical \n\n\n\nParameters for Fibres Production: \n\n\n\nExcipients\u2019 Nature \n \n\n\n\nNurul Atiqah Ismail1, Reem Abou Assi1,2 Siok \n\n\n\nYee Chan1* \n \n\n\n\n1Discipline of Pharmaceutical Technology, School of Pharmaceutical \n\n\n\nSciences, Universiti Sains Malaysia, Malaysia \n2EDEN Research Group, Discipline of Pharmaceutical Technology, College \nof Pharmacy, Al-Kitab University, Altun kupri, Kirkuk, 36001, Iraq \n\n\n\n* sychan@usm.my  \n\n\n\n\n\n\n\nBackground: Electrospinning is a heat-free manufacturing \n\n\n\ntechnique employing high voltage upon polymer \n\n\n\nsolution/melt to produce nano- and microfibres which is \n\n\n\ngoverned by several parameters such as excipients (i.e., \n\n\n\npolymers, salts) and needle types used (i.e., single and \n\n\n\ncoaxial needles). Objective: This study investigated the \n\n\n\nelectrospinnability of four polymers via single-needle and \n\n\n\ncoaxial electrospinning with highlights on electrolyte (using \n\n\n\nNaCl) to improve the conductivity of polymer solution. \n\n\n\nMethods: Different polymers namely Polyvinylpyrrolidone \n\n\n\n(PVP) K29/32 (10%), PVP K90 (10%), Polyvinylalcohol \n\n\n\n(PVA) (5-10%), and Hydroxypropylmethylcellulose \n\n\n\n(HPMC) (1-3%) were electrospun under conditions of 1 \n\n\n\nmL/hr, 5-15 kV and 15 cm needle-to-collector distance, final \n\n\n\nfibres were subjected to optical microscopy analysis. \n\n\n\nElectrospinnability of HPMC was further investigated with \n\n\n\nthe addition of 0.5% sodium chloride (NaCl). Results: In \n\n\n\nsingle-needle electrospinning, unlike PVP K29/32, PVP \n\n\n\nK90 showed excellent electrospinning abilities, PVA \n\n\n\nconcentrations increment were directly proportional to the \n\n\n\nproduction of beadless and uniform nanofibres, whereas \n\n\n\nHPMC has poor electrospinnability with and without salt \n\n\n\naddition. With coaxial electrospinning PVP K90 as sheath, \n\n\n\nthe formation of wet and beaded nanofibres was significant \n\n\n\nfor PVA and HPMC whereas beadless and uniform \n\n\n\nnanofibres were produced with HPMC 1.5% and 0.5% NaCl. \n\n\n\nConclusion: It can be inferred that the type of polymers and \n\n\n\ntheir concentrations are crucial variables in electrospinning. \n\n\n\nSalt addition also played a vital role in producing good \n\n\n\nnanofibres at low concentrations when incorporated with \n\n\n\nnatural polymers collectively with coaxial electrospinning. \n\n\n\n\nmailto:mulham4122@yahoo.com\n\n\nmailto:mulham@unisza.edu.my\n\n\nmailto:sychan@usm.my\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 140-181 \n\n\n\n\n\n\n\nResearch abstracts of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022 \n\n\n\nDOI:  10.52494/YOXJ1358 \n\n\n\n\n\n\n\n161 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nTherefore, this preliminary screening gives insights into the \n\n\n\nimportant variables needed to be optimised in \n\n\n\nelectrospinning technique. \n \n\n\n\nAbstract 021 \n\n\n\n\n\n\n\nBioavailability and Pharmaceutical \n\n\n\nAnalysis of Novel Chocolate Based \n\n\n\nIbuprofen Formulations  \n\n\n\n\n\n\n\nAya Kabariti1, *, M. albed Alhnan2, Ghaleb \n\n\n\nOriquat1, Basel Arafat1 \n \n1School of Pharmacy and medical Sciences, Al Ahliyya Amman University \n2School of Pharmacy and biomedical sciences, University of Central \nLancashire \n\n\n\n* Kabariti_a@yahoo.com  \n\n\n\n\n\n\n\nBackground: Chocolate chewable tablet and suspension \n\n\n\ndosage forms are considered an excellent taste masker and \n\n\n\neasy to swallow, making them a favourable dosage forms for \n\n\n\nthe elderly and children. However, limited research is \n\n\n\ncurrently available relating to the effect of chocolate on the \n\n\n\nbioavailability of drugs in vivo. Objective: the present study \n\n\n\nis to compare the pharmacokinetic profile of the non-\n\n\n\nsteroidal anti-inflammatory drug (ibuprofen) in its \n\n\n\nconventional suspension form with those incorporated into \n\n\n\nnovel chocolate-based dosage forms. Method: High \n\n\n\nPerformance Liquid Chromatography-Ultraviolet (HPLC-\n\n\n\nUV) was validated to be used for the determination of \n\n\n\nibuprofen in rat serum. The chocolate-based ibuprofen \n\n\n\ngranules (solid suspension and co-crystals of ibuprofen and \n\n\n\nchocolate), provided by UCLAN, were triturated in a mortar \n\n\n\nand then suspended with (0.25%) methocelTM solution. \n\n\n\nEach different formulation along with conventional \n\n\n\nibuprofen control was orally gavaged into Sprague-Dawley \n\n\n\nrats (n=8) then blood samples at different time intervals were \n\n\n\ncollected, treated and analysed using statistical software. \n\n\n\nResults: Analysis of the in vivo data revealed a significant \n\n\n\nreduction (p<0.05) in the maximum serum concentration of \n\n\n\nibuprofen from 65.540\u00b16.673\u03bcg/ml when ibuprofen was \n\n\n\nadministered alone to 43.366\u00b19.589\u03bcg/ml and \n\n\n\n45.816\u00b17.620\u03bcg/ml when ibuprofen was incorporated into \n\n\n\nthe co-crystals or solid suspension chocolate matrices, \n\n\n\nrespectively. On the other hand, there were no significant \n\n\n\ndifferences found in the area under concentration curves to 8 \n\n\n\nhours and to infinity time between the different formulations. \n\n\n\nConclusion: Finding from this study give indication on \n\n\n\npossible sustained effect of ibuprofen when incorporated into \n\n\n\nthe different chocolate matrices and the great potential those \n\n\n\nnovel formulations could possess. \n\n\n\n\n\n\n\nAbstract 022 \n\n\n\n\n\n\n\nIsorhamnetin Decreased The Expression of \n\n\n\nHMG-CoA Reductase and Increased LDL \n\n\n\nReceptors in Hep G2 Cells  \n\n\n\n\n\n\n\nRanda El-Rayyes*, Manal M. Abbas, Razan \n\n\n\nObeidat, Manal A. Abbas \n \n\n\n\nFaculty of Allied Medical Sciences, Al-Ahliyya Amman University, \n\n\n\nAmman 19328, Jordan \n\n\n\n* m.abbas@ammanu.edu.jo  \n\n\n\n\n\n\n\nBackground: Isorhamnetin is a flavonoid component existed \n\n\n\nin many plants. It has many biological functions, including \n\n\n\nanti-tumor, anti-oxidant and anti-inflammatory effects. \n\n\n\nPrevious in vivo studies showed that isorhamnetin lowered \n\n\n\nserum cholesterol in rats fed with cholesterol-enriched diet. \n\n\n\nHowever, cholesterol-lowering mechanism is still unknown. \n\n\n\nObjective: We investigated the hypocholesterolemic effect \n\n\n\nof isorhamnetin in cholesterol biosynthesis in-vitro. Material \n\n\n\nand Methods: Human hepatocellular carcinoma cell line, \n\n\n\nHepG2, was used in the study. The effect of isorhamnetin on \n\n\n\nthe expression of hydroxymethylglutaryl CoA reductase \n\n\n\n(HMG-CoA reductase) and LDL receptor (LDLR) genes and \n\n\n\nproteins was investigated by real time polymerase chain \n\n\n\nreaction (RT-PCR) and Western blot while ELISA was used \n\n\n\nto study of isorhamnetin oxidative stress status. For all tested \n\n\n\nparameters, one-way analysis of variance (ANOVA) was \n\n\n\nused, p value less than 0.05 was considered significant. \n\n\n\nResults: Isorhamnetin inhibits the proliferation of HepG2 \n\n\n\ncells in time-dependent manner, IC50 100 \u03bcM, 53 \u03bcM and 40 \n\n\n\n\u03bcM at 24, 48 and 72 hours, respectively. Isorhamnetin \n\n\n\ndownregulated HMG-CoA reductase gene expression \n\n\n\nsignificantly. Also, all tested doses of isorhamnetin \n\n\n\ndownregulated LDLR expression and produced no change in \n\n\n\nmembranous LDLR protein expression. In cell lysate, LDLR \n\n\n\nwas increased by all studied concentrations of isorhamnetin. \n\n\n\nIsorhamnetin at 100 \u03bcM decreased intracellular HMG-CoA \n\n\n\nreductase compared to vehicle-treated control. Furthermore, \n\n\n\nisorhamnetin increased superoxide dismutase activity and \n\n\n\nreduced H2O2 level, due to catalase activity. Conclusion: \n\n\n\nIsorhamnetin may have beneficial effects on cholesterol \n\n\n\nmechanism. Future detailed studies are needed to investigate \n\n\n\nthe effect of Isorhamnetin on LDLR degradation.  \n\n\n\n \n\n\n\n\nmailto:Kabariti_a@yahoo.com\n\n\nmailto:m.abbas@ammanu.edu.jo\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 140-181 \n\n\n\n\n\n\n\nResearch abstracts of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022 \n\n\n\nDOI:  10.52494/YOXJ1358 \n\n\n\n\n\n\n\n162 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 023 \n\n\n\n\n\n\n\nA Novel BAK-BAX-CDK1 Signalling \n\n\n\nComplex Links Activation of The Spindle \n\n\n\nAssembly Checkpoint to Apoptosis  \n\n\n\n\n\n\n\nOmeed Omar Darweesh1,2  \n \n1Department of Molecular and Cell Biology, University of Leicester, \n\n\n\nLeicester, UK. \n2College of Pharmacy, Al-kitab University, Kirkuk, Iraq. \n* od54@leicester.ac.uk \n\n\n\n\n\n\n\nBackground: Antimitotic anticancer drugs, such as Taxol, \n\n\n\ndisrupt microtubule formation and prevent microtubule-\n\n\n\nkinetochore attachments to activate the mitotic checkpoint \n\n\n\n(also known as the Spindle Assembly Checkpoint). In \n\n\n\nresponse to mitotic checkpoint switch-on, a key cell cycle \n\n\n\nregulator cyclin-dependent kinase 1 (CDK1) is chronically \n\n\n\nactivated resulting in mitotically arrested cells. One \n\n\n\nconsequence of prolonged mitotic arrest is the initiation of \n\n\n\ncell death via a well-characterised signalling pathway called \n\n\n\nmitochondrial apoptosis. Objective: In this study, we aim to \n\n\n\nidentify the cytoplasmic signals that link mitotic checkpoint \n\n\n\nactivation to cell death. Methods: This study was conducted \n\n\n\nusing a variety of molecular and cell biology techniques, \n\n\n\nincluding subcellular fractionation, immunoprecipitation, \n\n\n\nwestern blotting, cell death assays, flow cytometry, \n\n\n\nimmunofluorescence microscopy and mass spectrometry. \n\n\n\nHuman cancer cell lines HeLa wild type, U2OS, HCT-116 \n\n\n\nwild type, HCT-116 BAK/BAX double knockout cells, and \n\n\n\ndiploid RPE1 cells were used. Results: This study discovered \n\n\n\npreviously unknown connections between CDK1 and \n\n\n\nproapoptotic proteins BAK and BAX. Our findings indicate \n\n\n\nthat activated CDK1 forms an apoptotic complex with the \n\n\n\npro-apoptotic proteins BAK and BAX during prolonged \n\n\n\nmitotic arrest. The phosphorylation of the mitochondrial \n\n\n\nbased anti-apoptotic proteins Bcl-2 and Bcl-xL and the \n\n\n\ninduction of cell death are dependent on BAK and BAX-\n\n\n\nmediated delivery of activated CDK1 to the mitochondrion. \n\n\n\nConclusions: The interactions between cell cycle regulator \n\n\n\nprotein CDK1 and key pro-apoptotic proteins BAK and BAX \n\n\n\nidentify the cytoplasmic signals that link mitotic checkpoint \n\n\n\nactivation to apoptosis.  \n\n\n\n\n\n\n\n\n\n\n\nAbstract 024 \n\n\n\n\n\n\n\nAntihyperglycemic Activity of \n\n\n\nStandardized Swietenia Macrophylla Seed \n\n\n\nEthanolic Extract in Type 2 Diabetic Rats \n \n\n\n\nMeyyammai Swaminathan1*, Mariam \n\n\n\nAhmad1, Khairul Niza Abd Razak1, Nor Adlin \n\n\n\nYusoff2, Gabriel Akyirem Akowuah3, Elaine \n\n\n\nHui-Chien Lee1, Syed Azhar Syed Sulaiman1, \n\n\n\nMun Fei, Yam1, Faradianna E. Lokman4, Sue \n\n\n\nHay, Chan6, Bey Hing, Goh7, Vikneswaran \n\n\n\nMurugaiyah1,5 \n \n\n\n\n1School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800, \nMalaysia \n2Advance Medical and Dental Institute, Universiti Sains Malaysia, 13200, \n\n\n\nMalaysia \n3Faculty of Pharmaceutical Sciences, University College Sedaya \n\n\n\nInternational, 56000, Malaysia \n4Department of Diabetes, Cardiovascular, Diabetes and Nutrition Research \nCentre, Institute for Medical Research, 50588, Malaysia \n5Centre for Drug Research, Universiti Sains Malaysia, 11800, Malaysia \n6Usains Biomics Laboratory, 11800, Malaysia \n7Monash University, 47500, Malaysia \n\n\n\n* meyyammaiswaminathan@gmail.com \n\n\n\n\n\n\n\nBackground: Swietenia macrophylla (S. macrophylla) \n\n\n\n(family Meliaceae) has been widely used traditionally as \n\n\n\nantioxidant, antidiabetic, antimicrobial and anti-\n\n\n\ninflammatory agents. Objective: Swietenia macrophylla \n\n\n\nseed ethanolic extract\u2019s (SMEE) antihyperglycemic activity \n\n\n\nwas investigated in type 2 diabetic (T2D) Goto-Kakizaki \n\n\n\n(GK) rats. Two limonoids, swietenine and 3,6-O,O-\n\n\n\ndiacetylswietenolide with antihyperglycemic properties in \n\n\n\nSMEE were quantified using HPLC method. Methods: Two \n\n\n\ndoses (250 and 500 mg/kg) were used for treatment. Oral \n\n\n\nglucose tolerance test (OGTT); body weight profile; and \n\n\n\nantihyperglycemic activity of SMEE on T2D GK rats were \n\n\n\nstudied. A reverse-phased analytical HPLC method was \n\n\n\ndeveloped for simultaneous identification and quantification \n\n\n\nof the two limonoids. Separation peaks were monitored at \n\n\n\nflow rate of 1.0ml/min with a low-pressure gradient elution \n\n\n\nwith mobile phase (A) water, 70 to 10 % (B) and acetonitrile, \n\n\n\n30 to 90 %, over 36 minutes and UV detection at 220 nm. \n\n\n\nResults: On day 15 of OGTT, the SMEE group at 500 mg/kg \n\n\n\nshowed lower fasting blood glucose levels. Results: \n\n\n\nAntihyperglycemic test displayed a better and sustained \n\n\n\nglucose regulation over 7 hours in the SMEE group on days \n\n\n\n1 and 8. Method validation of HPLC analysis attained good \n\n\n\nlinearity (r \u2265 0.9970) of calibration curves in the range of \n\n\n\n1.56 -200 \u03bcg/mL. The content of swietenine and 3,6-O, O-\n\n\n\ndiacetylswietenolide was 27.5 \u03bcg (2.75%) and 14.53 \u03bcg \n\n\n\n(1.45%) in 1 mg of SMEE. While LOD and LOQ were r \u2265 \n\n\n\n0.0975 and 1.5625 \u03bcg/mL for both swietenine and 3,6-O, O-\n\n\n\ndiacetylswietenolide. Conclusion: Quantification of \n\n\n\n\nmailto:od54@leicester.ac.uk\n\n\nmailto:meyyammaiswaminathan@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 140-181 \n\n\n\n\n\n\n\nResearch abstracts of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022 \n\n\n\nDOI:  10.52494/YOXJ1358 \n\n\n\n\n\n\n\n163 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nswietenine and 3,6-O,O-diacetylswietenolide from SMEE \n\n\n\nand the in-vivo investigations verifies the S. macrophylla \n\n\n\nseed\u2019s antidiabetic properties in T2D rats. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 025 \n\n\n\n\n\n\n\nIncreased In-vitro Binding of Di(5-Furfural) \n\n\n\nEther, A Degradant Of 5-\n\n\n\nHydroxymethylfurfural, With Endogenous \n\n\n\nMacromolecules: Experimental and \n\n\n\nTheoretical Approaches \n \n\n\n\nThomas, Olusegun Emmanuel*, Akin-Taylor \n\n\n\nAkintayo, Oduwole Rashidat  \n \nDept. of Pharmaceutical Chemistry, Faculty of Pharmacy, University of \n\n\n\nIbadan, Ibadan, Nigeria \n\n\n\n*seguntom@yahoo.com  \n\n\n\n\n\n\n\nBackground: Earlier studies have investigated the safety \n\n\n\n(including the DNA and albumin binding activities) of the \n\n\n\nfood additive, 5-hydroxymethylfurfural. In contrast, there is \n\n\n\na dearth of the safety assessment of its degradant, di(5-\n\n\n\nfurfural) ether, which may pose a greater risk as it has been \n\n\n\ndetected in parenteral solutions at concentrations greater than \n\n\n\nthose of the intact additive. Objective: The aim of this study \n\n\n\nwas a comparative in-vitro investigation of the binding \n\n\n\ninteractions of 5-hydroxymethylfurfural and di(5-furfural) \n\n\n\nether with albumin and ct-DNA. Materials and Methods: \n\n\n\nDi(5-furfural) ether was synthesised via thermal dehydration \n\n\n\nof 5-hydroxymethylfurfural. The binding of the compounds \n\n\n\nwith albumin and ct-DNA were investigated using UV \n\n\n\nspectroscopy, viscometry, molecular docking and DFT \n\n\n\ncalculations. Results: Photometric titrations showed that, \n\n\n\nwhen compared with 5-hydroxymethylfurfural, di(5-furfural) \n\n\n\nether induced more pronounced perturbations in the spectra \n\n\n\nof albumin and DNA. The binding constants of di(5-furfural) \n\n\n\nether to albumin and DNA respectively were 1.5 and 5 folds \n\n\n\ngreater than 5-hydroxymethylfurfural. Docking also \n\n\n\nconfirmed higher binding energies and stabilisation of di(5-\n\n\n\nfurfural) ether complexes with albumin and DNA. The \n\n\n\nincreased binding affinity of di(5-furfural) ether was \n\n\n\nattributed to its higher C/H ratio which facilitated an \n\n\n\nextensive network of hydrophobic interactions with Tyr149, \n\n\n\nLeu237, Ala290, Ile289, Arg194 residues of BSA Site I and \n\n\n\nminor groove of DNA. DFT calculations showed that the \n\n\n\nhigher electrophilicity of the di(5-furfural) ether might \n\n\n\nenhance its interaction with the negatively charged DNA \n\n\n\nbackbone. Conclusions: In comparison to 5-\n\n\n\nhydroxymethylfurfural, di(5-furfural) ether showed \n\n\n\nincreased binding and stability of resultant ligand-protein \n\n\n\ncomplexes formed with albumin and DNA. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 026 \n\n\n\n\n\n\n\nPharmacophore Modelling, Molecular \n\n\n\nDocking, and Molecular Dynamics \n\n\n\nSimulation to Identify Potent Inhibitors of \n\n\n\nAlpha-Synuclein Aggregation  \n\n\n\n\n\n\n\nSani Yahaya Najib1,2*, Yusuf Oloruntoyin \n\n\n\nAyipo1,3, Waleed Abdullah Ahmad Alananzeh1, \n\n\n\nMohd Nizam Mordi1 \n \n1Centre for Drug Research, Universiti Sains Malaysia, USM 11800, Pulau \n\n\n\nPinang, Malaysia \n2Department of Pharmaceutical and Medicinal Chemistry, Bayero \n\n\n\nUniversity Kano, PMB 3011, Kano Nigeria. \n3Department of Chemistry, Kwara State University, Malete, PMB 1530, \nIlorin, Nigeria \n\n\n\n* najibsani62@gmail.com  \n\n\n\n\n\n\n\nBackground: Aggregation of \u03b1-synuclein is strongly \n\n\n\nimplicated as an underlying pathogenesis of Parkinson\u2019s \n\n\n\ndisease (PD) and its inhibition has been demonstrated as one \n\n\n\nof the strategies PD treatments. However, the few inhibitors \n\n\n\nof \u03b1-synuclein applied in clinical conditions elicit unpleasant \n\n\n\nside effects, making a search for better candidates significant. \n\n\n\nObjectives: This study is aimed at identifying potent \n\n\n\ninhibitors of \u03b1-synuclein aggregation from natural product \n\n\n\ninterbioscreen (IBS) databases. Method: Using ligand-based \n\n\n\nPharmacophore modeling, Glide XP docking, molecular \n\n\n\ndynamics, and pk-CSM pharmacokinetics prediction \n\n\n\nparameters were applied in silico for identification of \n\n\n\npotential ant-PD compounds. Results: The top-ranked \n\n\n\npharmacophore model was validated with Gunner-Henry \n\n\n\n(GH) scoring method and enrichment factor (EF) of 0.87 and \n\n\n\n23.43 respectively, making it ideal model for database \n\n\n\nscreening. The Pharmacophore model with features \n\n\n\nHHHHHHDDDDA identified 100 hits from \u201c877,377 IBS \n\n\n\ndatabase. The top ranked docked compounds, STOCK2S-\n\n\n\n85121, STOCK3S-13122, STOCK2S-57139, STOCK75-\n\n\n\n07150, & STOCK4S-24924 demonstrated docking scores of \n\n\n\n-4.789, -4.451, -4.413, -4.365, & -4.227 compared to \n\n\n\nreference compound (levodopa) with docking scores of -\n\n\n\n3.556 kcal/mol respectively. Molecular dynamics via root \n\n\n\nmean square deviation and fluctuations further revealed \n\n\n\nSTOCK2S-85121 having better stability in the binding \n\n\n\npocket compared to other ligands. Conclusion: Therefore, \n\n\n\nSTOCK2S-85121 is recommended for further evaluation as \n\n\n\npotential anti-PD agent. \n\n\n\n \n\n\n\n\nmailto:*seguntom@yahoo.com\n\n\nmailto:najibsani62@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 140-181 \n\n\n\n\n\n\n\nResearch abstracts of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022 \n\n\n\nDOI:  10.52494/YOXJ1358 \n\n\n\n\n\n\n\n164 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 027 \n\n\n\n\n\n\n\nTheophylline Causes Regression of \n\n\n\nEndometriotic Implants in a Rat \n\n\n\nSurgical Model \n \n\n\n\nManal A. Abbas1,2*, Ahmad M. Disi3, Mutasem \n\n\n\nO. Taha4 \n \n1Faculty of Allied Medical Sciences, Al-Ahliyya Amman University, \nAmman 19328, Jordan \n2Pharmacological and Diagnostic Research Center, Al-Ahliyya \n\n\n\nAmman University, Amman 19328, Jordan \n3Faculty of Science, The University of Jordan, 11942 Amman, Jordan \n4Faculty of pharmacy, The University of Jordan, 11942 Amman, \n\n\n\nJordan \n* m.abbas@ammanu.edu.jo  \n\n\n\n\n\n\n\nBackground: Endometriosis is one of the most frequent \n\n\n\ndiseases in gynaecology. Currently therapies are \n\n\n\nunsatisfactory. Objectives: The present study evaluates the \n\n\n\neffectiveness of theophylline as a treatment for \n\n\n\nendometriosis. Methods: The effect of theophylline on \n\n\n\nregression of endometriotic implants was studied in a rat \n\n\n\nsurgical model. Two squares of 4 x 4 mm of open uterus \n\n\n\nwere sutured in the peritoneal cavity. After 28 days, the size \n\n\n\nof cyst was measured by a caliper and treatment started for \n\n\n\n21 days with theophylline. At the end of treatment cyst size \n\n\n\nwas measured again. Light and electron microscopic studies \n\n\n\nwere performed in addition to TUNEL assay for the \n\n\n\nassessment of apoptosis. Results: Theophylline 10 and 15 \n\n\n\nmg/kg reduced endometriotic cyst size by 52% and 66%, \n\n\n\nrespectively. Histologically, the stroma was highly \n\n\n\nvascularized especially around glandular tissue and heavily \n\n\n\ninfiltrated with inflammatory cells in animals that received \n\n\n\nvehicle as the only treatment. In ovarictomized rats, \n\n\n\nglandular tissue was highly reduced. In rats treated with \n\n\n\ntheophylline, glandular tissue within stroma of cysts was \n\n\n\nscarce, fibrosis was localized directly under the luminal \n\n\n\nepithelium and mixed inflammatory cells were seen in the \n\n\n\nstroma and in cyst lumen. No significant difference in mast \n\n\n\ncells degranulation in theophylline-treated group was \n\n\n\nencountered. Furthermore, apoptosis was detected in stroma \n\n\n\nof cysts of rats treated with theophylline. Ultrastructural \n\n\n\nstudies revealed active mast cells with reduced electron \n\n\n\ndensity of their granules in theophylline-treated and control \n\n\n\ngroups. Conclusions: Theophylline causes regression of \n\n\n\nendometriotic implants and increases apoptosis without \n\n\n\naffecting mast cell degranulation. \n\n\n\n\n\n\n\nAbstract 028 \n\n\n\n\n\n\n\nComplementary and Alternative Medicine \n\n\n\n(CAM) Use in Insomnia: Current Update on \n\n\n\nKnowledge, Attitude, and Perception (KAP) \n\n\n\nAmong the Community in Malaysia \n \n\n\n\nSiti Nur Afza Atirah Binti Zahari1, Syarifah \n\n\n\nSyamimi Putri Adiba Binti Syed Putera1*,  \n\n\n\nZakiah binti Noordin2,3 \n \n1 Department of Clinical Pharmacy and Pharmacy Practice, Faculty of \nPharmacy and Health Sciences, Universiti Kuala Lumpur Royal College of \n\n\n\nMedicine Perak, Malaysia \n2Department of Pharmacy Practice, Faculty of Pharmacy, Universiti \nTeknologi MARA Cawangan Selangor, Malaysia \n3Cardiology Therapeutics Research Group, Universiti Teknologi MARA, \n\n\n\nBandar Puncak Alam, Malaysia. \n* syarifah.syamimi@unikl.edu.my \n\n\n\n\n\n\n\nBackground: 10-30% of adults have chronic insomnia, \n\n\n\nwhile 9 out of 10 Malaysian have insomnia. CAM therapy \n\n\n\ncan be one of treatment for insomnia other than the \n\n\n\nconventional treatment. Objective: This study aims to \n\n\n\nevaluate the current update on KAP toward CAM therapy use \n\n\n\nin insomnia among the community in Malaysia. Method: A \n\n\n\nself-administered, face-validated online questionnaire was \n\n\n\ndistributed among 396 participants aged 18 years and above \n\n\n\nrecruited using convenience sampling between January and \n\n\n\nMay 2022. The questionnaire consists of 5 sections: \n\n\n\ndemographic, pattern usage of CAM therapy, knowledge, \n\n\n\nattitude, and perception of CAM therapy for insomnia. \n\n\n\nSection 1 and 2 consist of multiple-choice questions while \n\n\n\neach KAP part comprises 5-6 items Likert scale questions. \n\n\n\nThe overall score for each KAP section is calculated and the \n\n\n\nlevel is classified by using Bloom's cut-off point. Descriptive \n\n\n\nstatistics were performed using SPSS version 22 and the data \n\n\n\nwere presented in frequency and percentage. Results: Most \n\n\n\nof the respondents were single (81.3%), female (68.9%) \n\n\n\nuniversity students (74%) with bachelor's degree (63.4%). \n\n\n\nMost respondents have never experienced insomnia (58.3%) \n\n\n\nand thus never practiced CAM therapy for insomnia (82.3%). \n\n\n\nMusic-based intervention (n=36) and fixed sleeping patterns \n\n\n\n(n=55) are some reported CAM therapy practiced by \n\n\n\ninsomniac respondents. Results: it showed that participants \n\n\n\nhave a positive perception (53.8%) and good knowledge \n\n\n\n(61.6%) of CAM therapy and insomnia but a moderate \n\n\n\nattitude (50.3%) toward CAM therapy for insomnia. \n\n\n\nConclusions: CAM therapy is not widely practiced among \n\n\n\nMalaysian and health education programs aimed at \n\n\n\nimproving the public's understanding of CAM therapy for \n\n\n\ninsomnia is needed.  \n\n\n\n \n\n\n\n\nmailto:m.abbas@ammanu.edu.jo\n\n\nmailto:syarifah.syamimi@unikl.edu.my\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 140-181 \n\n\n\n\n\n\n\nResearch abstracts of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022 \n\n\n\nDOI:  10.52494/YOXJ1358 \n\n\n\n\n\n\n\n165 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 029 \n\n\n\n\n\n\n\nHealth Benefits of Honey: Knowledge, \n\n\n\nAttitude and Perception (KAP) Among the \n\n\n\nCommunity in Malaysia \n \n\n\n\nWan Nor Aidah Basirah binti Wan Ab \n\n\n\nRahman, Syarifah Syamimi Putri Adiba Binti \n\n\n\nSyed Putera*, Aina Amanina Binti Abdul Jalil \n \n\n\n\nDepartment of Clinical Pharmacy and Pharmacy Practice, Faculty of \n\n\n\nPharmacy and Health Sciences, Universiti Kuala Lumpur Royal College of \n\n\n\nMedicine Perak, Malaysia \n\n\n\n* syarifah.syamimi@unikl.edu.my \n\n\n\n\n\n\n\nBackground: According to current scientific research, honey \n\n\n\nmay be beneficial and protective in treating various medical \n\n\n\nillnesses. Objective: To evaluate the KAP toward the health \n\n\n\nbenefits of honey among the community in Malaysia. \n\n\n\nMethod: A cross-sectional study was conducted using a self-\n\n\n\nadministered, face-validated online questionnaire distributed \n\n\n\namong 400 participants aged 18 years and above recruited \n\n\n\nusing convenience sampling between January and May 2022. \n\n\n\nThe questionnaire consists of five domains: demographic \n\n\n\ncharacteristics, honey\u2019s usage patterns, knowledge, attitude, \n\n\n\nand perception of the health benefits of honey. Sections 1 and \n\n\n\n2 consist of multiple-choice questions, while each KAP part \n\n\n\ncomprises 2-7 items Likert scale questions. The overall score \n\n\n\nfor each KAP section is calculated, and the level is classified \n\n\n\nby using Bloom's cut-off point. The statistical analysis in \n\n\n\nmethods for this study was analyzed using the SPSS version \n\n\n\n23. Descriptive statistics were performed using SPSS version \n\n\n\n22, and the data were presented in frequency and percentage. \n\n\n\nResults: Most of the respondents were single (83.9%), \n\n\n\nfemale (58%) university students (36.5%) with bachelor's \n\n\n\ndegree (66%). Among Malaysian, Tualang (n=218) is the \n\n\n\nmost frequently consumed honey to suppress cough (n=342), \n\n\n\nwith an expenditure of more than RM60 per month (n=162). \n\n\n\nResults also showed that participants have good knowledge \n\n\n\n(n=185, 46.3%), an optimistic attitude (n=275, 68.8%), and a \n\n\n\npositive perception (n=276, 69%) toward the health benefit \n\n\n\nof honey. Conclusion: The majority of the study participants \n\n\n\nwere knowledgeable about honey, and awareness of its \n\n\n\nbenefit must be directed to the public. \n\n\n\n\n\n\n\nAbstract 030 \n\n\n\n\n\n\n\nKnowledge, Attitude, and Practice of \n\n\n\nCommunity Pharmacists Regarding \n\n\n\nSmuggled Medicines in Yemen \n \n\n\n\nMohammed Battah1,2*, Gamil Othman1, \n\n\n\nHamas Al-Qadhi1, Asma Al-Aghbari1, Heba \n\n\n\nAl-Maqtari1 \n \n\n\n\n1Department of Clinical Pharmacy and Pharmacy Practice, Faculty of \n\n\n\nPharmacy, University of Science and Technology, Sana\u2019a, Yemen \n2Department of Clinical Pharmacy, School of Pharmaceutical Sciences, \n\n\n\nUniversity Sains Malaysia, Gelugor, Malaysia \n* m.albattah@student.usm.my; mmalbattah@gmail.com \n\n\n\n\n\n\n\nBackground: Smuggling is a global problem with \n\n\n\ndetrimental effects on patients, community, and health \n\n\n\nsystem. Objective: This study aimed to assess community \n\n\n\npharmacists' knowledge, practice and attitude towards \n\n\n\nsmuggled medicines in Yemen. Method: A cross-sectional \n\n\n\nstudy was conducted among community pharmacists in \n\n\n\nYemen between February and August 2020. Besides \n\n\n\nsociodemographic variables, community pharmacists' \n\n\n\nknowledge, practice and attitude were evaluated. Factors \n\n\n\nassociated with knowledge of smuggled drug were analyzed \n\n\n\nusing SPSS with a significance level of P < 0.05. Results: A \n\n\n\ntotal of 430 questionnaires were distributed, and 400 \n\n\n\ncommunity pharmacists agreed to participate (93%). The \n\n\n\nmajority of participants were male (89%), had Bachelor's \n\n\n\ndegrees (66%), and had less than five-year experience (52%). \n\n\n\nParticipants demonstrated good knowledge about smuggled \n\n\n\nmedicines, which was significantly associated with \n\n\n\nparticipants' qualifications and years of experience. Notably, \n\n\n\nthe majority of participants (92%) admitted that smuggled \n\n\n\nmedicines are pervasive in Yemen. Although most \n\n\n\nparticipants (66%) were aware of the negative impact of \n\n\n\nsmuggled medicines on patients' health, they had a negative \n\n\n\nattitude and poor practices. The most frequently smuggled \n\n\n\ndrugs were anti-diabetic agents (42%), followed by \n\n\n\nantihypertensive agents (22%). Long-standing civil war in \n\n\n\nthe country is the leading factor behind medicines smuggling. \n\n\n\nOthers contributing factors are low economic status, \n\n\n\naffordability of smuggled medicines, and unavailability of \n\n\n\nlicensed medicines. Conclusion: Although their good \n\n\n\nknowledge regarding smuggled medicines, community \n\n\n\npharmacists in Yemen have a negative attitude and frequently \n\n\n\ndeal with smuggled medicines. Extensive work by health \n\n\n\nauthorities to increase the accessibility and affordability of \n\n\n\nmedicines is required. \n\n\n\n \n\n\n\n\nmailto:syarifah.syamimi@unikl.edu.my\n\n\nmailto:mmalbattah@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 140-181 \n\n\n\n\n\n\n\nResearch abstracts of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022 \n\n\n\nDOI:  10.52494/YOXJ1358 \n\n\n\n\n\n\n\n166 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 031 \n\n\n\n\n\n\n\nGram-Negative Bacteria Susceptibility to \n\n\n\nAntibiotics Stratified by Gender \n \n\n\n\nNehad J. Ahmad1,2*, Amer H. Khan1 \n \n\n\n\n1Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, \nUniversiti Sains Malaysia, George Town 11800, Penang, Malaysia \n2Clinical Pharmacy Department, College of Pharmacy, Prince Sattam Bin \n\n\n\nAbdulaziz University, Al-Kharj 16273, Saudi Arabia \n* nehad@student.usm.my;n.ahmed@psau.edu.sa  \n\n\n\n\n\n\n\nBackground: The use of antibiotics early in the course of \n\n\n\ntreating illnesses can reduce morbidity and save lives. On the \n\n\n\nother hand, improper antibiotic use promotes the emergence \n\n\n\nand spread of bacteria resistant to treatment, hastening the \n\n\n\ndevelopment of bacterial resistance. An antibiogram is an \n\n\n\neasy and accessible way to assess the bacterial \n\n\n\nsusceptibilities to different antibiotics. A hospital's \n\n\n\ncumulative antibiograms can mask discrepancies between \n\n\n\npatient demographics, hospital departments, or anatomical \n\n\n\nregions. Objective: The aim of the study was to describe the \n\n\n\ndifferences in gram-negative bacteria susceptibility of male \n\n\n\nand female patients in a public hospital in Qassim. Methods: \n\n\n\nThe study included reviewing the bacteria susceptibility \n\n\n\nresults that were collected from the laboratory department in \n\n\n\nthe hospital from January 2021 to December 2021. Results: \n\n\n\nTwo thousand four hundred seventy-two isolates were \n\n\n\ncollected in the hospital. More than 52% of the bacteria in \n\n\n\nmales and more than 58% of bacteria in females were gram-\n\n\n\nnegative bacteria. The most prevalent gram-negative bacteria \n\n\n\nin male patients were Klebsiella pneumoniae, Escherichia \n\n\n\ncoli, Acinetobacter baumannii, and Pseudomonas aeruginosa. \n\n\n\nThe most prevalent gram-negative bacteria in female patients \n\n\n\nwere Klebsiella pneumoniae, Escherichia coli, Pseudomonas \n\n\n\naeruginosa, and Acinetobacter baumannii. Conclusions: The \n\n\n\nsusceptibility of gram-negative bacteria to different \n\n\n\nantibiotics in female patients is different from males. So, it is \n\n\n\nimportant to assess the microbes that male and female \n\n\n\npatients have and to be aware of the bacterial isolates' \n\n\n\npatterns of antibiotic susceptibility before selecting the \n\n\n\nappropriate antibiotics. \n\n\n\n\n\n\n\nAbstract 032 \n\n\n\n\n\n\n\nDescriptive Analysis of Adverse Drug \n\n\n\nReactions Reports of Amoxicillin \n \n\n\n\nNehad J. Ahmed1,2*, and Amer H. Khan1 \n \n1Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, \nUniversiti Sains Malaysia, George Town 11800, Penang, Malaysia \n2Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin \n\n\n\nAbdulaziz University, Al-Kharj 16273, Saudi Arabia \n* n.ahmed@psau.edu.sa;  nehad@student.usm.my  \n\n\n\n\n\n\n\nBackground: Amoxicillin is one of the most antibiotics \n\n\n\nwhich is typically used for the treatment of bacterial \n\n\n\ninfections, particularly respiratory tract infections. It is well-\n\n\n\ntolerated but could cause several complaints such as nausea, \n\n\n\nvomiting, and diarrhoea. It could also cause rare but serious \n\n\n\nadverse events such as anaphylactic reactions. Objective: \n\n\n\nThe aim of the study was to identify the most common \n\n\n\nadverse events which are caused by amoxicillin. Methods: \n\n\n\nThe present study was a descriptive study based on the \n\n\n\nreports that were submitted to the World Health \n\n\n\nOrganization using the Vigi Access database. Results: It\u2019s \n\n\n\nfound that 143008 reports were received till July 2022. The \n\n\n\nresults found that about 49% of the reports were submitted \n\n\n\nin Asia. More than 59% of the patients were females.; and \n\n\n\ntheir age was between 18 and 64 years. The most reported \n\n\n\nadverse events were skin and subcutaneous tissue disorders \n\n\n\n(particularly rash and pruritis) (48%), gastrointestinal \n\n\n\nadverse events (such as diarrhoea, nausea, and vomiting) \n\n\n\n(12%), general disorders and administration problems (8%), \n\n\n\nand immune system disorders (7%). Conclusion: A regular \n\n\n\nevaluation of the safety of antibiotics such as amoxicillin \n\n\n\nshould be implemented to facilitate the development of \n\n\n\npolicies and guidelines to decrease the frequency of serious \n\n\n\nadverse events.  \n\n\n\n\nmailto:nehad@student.usm.my;n.ahmed@psau.edu.sa\n\n\nmailto:nehad@student.usm.my\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 140-181 \n\n\n\n\n\n\n\nResearch abstracts of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022 \n\n\n\nDOI:  10.52494/YOXJ1358 \n\n\n\n\n\n\n\n167 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 033 \n\n\n\n\n\n\n\nAssessment of Emotional Distress among \n\n\n\nHealth Care Professionals at Different \n\n\n\nHospitals in Sindh, Pakistan \n \n\n\n\nNarendar Kumar1, *, Syed Azhar Syed \n\n\n\nSulaiman1, and Shaib Muhammad2 \n \n1Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, \nUniversiti Sains Malaysia \n2Department of Pharmaceutics, Faculty of Pharmacy, University of Sindh, \n\n\n\nJamshoro, Pakistan \n* narendar.sharma87@gmail.com  \n\n\n\n\n\n\n\nBackground: During the coronavirus disease 2019 \n\n\n\n(COVID-19) pandemic, healthcare professionals (HCP) \n\n\n\nworked in a stressful environment, which affected their \n\n\n\nphysical and mental well beings. Furthermore, the fear of \n\n\n\nswift transmission, inadequate equipment at healthcare \n\n\n\nfacilities, and the non-serious attitudes of the public were \n\n\n\nthe key factors to cause emotional distress among HCPs. \n\n\n\nObjectives: The study aimed to determine the impact of \n\n\n\nCOVID-19 on healthcare professionals' concerns and \n\n\n\nemotional distress. Methods: A web-based a cross-\n\n\n\nsectional survey was conducted from October 1, 2020, to \n\n\n\nDecember 31, 2020. The questionnaire consisted of 16 \n\n\n\nitems and was designed using Google Form and the link \n\n\n\nwas promoted to HCPs through various social media \n\n\n\nplatforms including Facebook, Whatsapp, and Telegram. \n\n\n\nChi-squared and Kruskal Wallis tests were used to \n\n\n\ncompared emotional distress among different variables. \n\n\n\nResults: A total of 368 respondents included; physicians \n\n\n\n(56%) aged between 18 and 37 (79%), working in public \n\n\n\nsector hospitals (67%) for less than five years (64%). HCPs \n\n\n\nwere more concerned about their family members' health \n\n\n\n(72.0%) and 50.8% about their own (50.8%), whereas \n\n\n\n35.3% reported being emotionally distressed. Our findings \n\n\n\nsuggested that emotional distress was significantly \n\n\n\nassociated with years of experience (p = 0.048) and \n\n\n\nworking in the COVID-19 ward (p = 0.010). Conclusion: \n\n\n\nOur study concluded that the COVID-19 pandemic has \n\n\n\nincreased the psychological pressure on HCPs and stressed \n\n\n\nthem for their family's health. HCPs working in COVID-\n\n\n\n19 wards faced significant emotional distress compared \n\n\n\nwith HCPs from other wards. \n\n\n\n\n\n\n\nAbstract 034 \n\n\n\n\n\n\n\nPopulation-based knowledge, Attitude, and \n\n\n\nPerception Study for COVID-19 Vaccine in \n\n\n\nSindh, Pakistan \n \n\n\n\nNarendar Kumar1, Syed Azhar Syed \n\n\n\nSulaiman1, *, Furqan Khurshid Hashmi2 \n \n1Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, \nUniversiti Sains Malaysia \n2University College of Pharmacy, University of the Punjab, Allama Iqbal \n\n\n\nCampus, Lahore, Pakistan \n* sazhar.usm@gmail.com  \n\n\n\n\n\n\n\nBackground: COVID-19 vaccination is one of the most \n\n\n\neffective ways to immunize the population against COVID-\n\n\n\n19. However, there is vaccine hesitancy among the \n\n\n\npopulation in Pakistan. Objective: The aim of this study was \n\n\n\nto evaluate the knowledge, attitudes, perceptions, and \n\n\n\nwillingness to receive COVID-19 vaccines among people in \n\n\n\nSindh, Pakistan. Methods: An online survey was conducted \n\n\n\nin July 2021 using a validated survey questionnaire which \n\n\n\nwas developed using Google Forms. The questionnaire \n\n\n\nconsisted of 5 sections including demographic characteristics \n\n\n\n(5 items), knowledge (7 items), attitude (4 items), perception \n\n\n\n(5 items), and willingness for vaccination (1 item). The link \n\n\n\nwas forwarded to the public using the snowball sampling \n\n\n\ntechnique. Chi-squared test and Kruskal Wallis tests were \n\n\n\napplied using SPSS (v.22) to compare the knowledge and \n\n\n\nattitudes among different variables. Results: A total of 926 \n\n\n\nrespondents completely filled the questionnaire including; \n\n\n\nmales (59%), aged 18-31 years (67%), and belonged to \n\n\n\nHyderabad (38%). Majority of the respondents (60%) were \n\n\n\nuniversity graduates and doing a private job (35%). More \n\n\n\nthan half of the respondents had average knowledge and \n\n\n\nattitude towards COVID-19 vaccination (56% and 54%), \n\n\n\nrespectively. Around 77% of respondents believed that \n\n\n\neveryone should get vaccinated and that health care workers \n\n\n\nshould be given priority. The majority of respondents (81%) \n\n\n\nwere willing to be vaccinated against COVID-19. \n\n\n\nConclusion: Regardless of average knowledge, low positive \n\n\n\nattitude, perception about side effects of COVID-19 and poor \n\n\n\nhealthcare facilities, people were willing to get vaccinated.    \n\n\n\n \n\n\n\n\nmailto:narendar.sharma87@gmail.com\n\n\nmailto:sazhar.usm@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 140-181 \n\n\n\n\n\n\n\nResearch abstracts of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022 \n\n\n\nDOI:  10.52494/YOXJ1358 \n\n\n\n\n\n\n\n168 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 035 \n\n\n\n\n\n\n\nCauses of Drug Related Problems Among \n\n\n\nChronic Kidney Disease Patients with \n\n\n\nDiabetes Mellitus and/ or Hypertension in \n\n\n\nPrivate Hospital, Yemen \n \n\n\n\nEgbal Abdulrahman1, Amer Hayat Khan1*, \n\n\n\nElham Aldolimy2, Odai Alburaihi3, Omaima \n\n\n\nAlsubari3, Moath Aledressi3 \n \n1Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, \nUniversiti Sains Malaysia, 11800 Penang, Malaysia \n2Department of nephrology, Science and Technology Hospital, Sana\u2019a, \n\n\n\nYemen \n3Department of Clinical Pharmacy, School of pharmaceutical sciences, 21st \n\n\n\nSeptember university of medical sciences, Sana\u2019a, Yemen \n\n\n\n* dramer@usm.my  \n\n\n\n\n\n\n\nBackground: Chronic kidney disease (CKD) is a worldwide \n\n\n\nhealth issue. Drug-related problems (DRPs) result from the \n\n\n\ncoexistence of CKD and comorbidities, which increases \n\n\n\nhospital stay and healthcare costs as well as increasing the \n\n\n\nrisk of morbidity and mortality. Objective: Identify and \n\n\n\nevaluate the DRPs and their causes among chronic kidney \n\n\n\ndisease with Diabetes Mellitus (DM) and/or Hypertension \n\n\n\n(HTN). Methods: From 1 December 2021 to 28 February \n\n\n\n2022, a cross-sectional study was carried out at the \n\n\n\nnephrology department of Science and Technology Hospital, \n\n\n\nSana'a, Yemen. A total of 106 CKD patients with DM and/ \n\n\n\nor HTN were included in the study. Sociodemographic and \n\n\n\nclinical date was gathered from the medical records. The \n\n\n\nStatistical Package for the Social Sciences (SPSS) version \n\n\n\n23.0 was used for data descriptive analysis. Results: Most of \n\n\n\nthe included patients were males (74.5%) and non-elderly \n\n\n\n(54.7%). DRPs were found in 81.1% of recruited patients. A \n\n\n\ntotal of 233 DRPs were identified, with at least two DRPs \n\n\n\nidentified for each patient. DRPs with the highest prevalence \n\n\n\nwere drug selection (40%), dose selection (34.4%), and \n\n\n\ntreatment duration (5.6%). The most common cause of drug \n\n\n\nselection (48.6%) was inappropriate drug selection, and the \n\n\n\nmost common cause of dose selection (52.5%) was too low \n\n\n\ndose. Conclusions: DRPs are common in CKD patients with \n\n\n\ndiabetes and/or hypertension. As a result, awareness of DRPs \n\n\n\naids in identifying, resolving, and preventing potential DRPs, \n\n\n\nresulting in better patient care.  \n\n\n\n\n\n\n\nAbstract 036 \n\n\n\n\n\n\n\nAssessment of Mortality Risk Predictors \n\n\n\nAssociated with COVID-9 Infection in \n\n\n\nPakistani Patients: An Observational Study \n \n\n\n\nMuhammad Zeeshan Munir1,2*, Amer Hayat \n\n\n\nKhan2, Tahir Mehmood Khan1,3 \n \n\n\n\n1Institute of Pharmaceutical Sciences, University of Veterinary and Animal \nSciences, 54000 Syed Abdul Qadir Jillani (Out Fall) Road, Lahore \u2013 \n\n\n\nPakistan. \n2Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, \nUniversiti Sains Malaysia, Gelugor 11800, Penang, Malaysia. \n3School of Pharmacy, Monash University Malaysia Sdn Bhd, Jalan Lagoon \n\n\n\nSelatan, 45700 Banday Sunway, Selangor Malaysia. \n* Zeeshan.munir@uvas.edu.pk  \n\n\n\n\n\n\n\nBackground: Mortality predictor\u2019s data in Pakistani \n\n\n\nCOVID-19 patients is inadequate. Understanding \n\n\n\nrelationship between clinical features, treatment trajectories, \n\n\n\nand mortality is critical for establishing a foundation for \n\n\n\npatient care. Objective: The study aimed to examine \n\n\n\nCOVID-19 patients from March, 2021 until February, 2022 \n\n\n\nevaluating data such as patient demographics, comorbidities, \n\n\n\nclinical features, laboratory results, and drugs provided as \n\n\n\nmortality predictors related to COVID-19. Methods: In this \n\n\n\nretrospective observational study, data was acquired by \n\n\n\nevaluating the medical records of 1000 cases confirmed by \n\n\n\nPCR-test in Pakistani districts of Lahore and Sargodha. Chi-\n\n\n\nsquare and logistic regression analysis were performed using \n\n\n\nSPSS programme for statistical analysis. Results: Out of the \n\n\n\n1000 cases, 288 people died. Males and those > 40 years had \n\n\n\na greater mortality rate. 90.2% of those who were placed on \n\n\n\nmechanical ventilation perished (OR=124.267, CI95%, \n\n\n\n65.959-234.119). Most prevalent complaints were dyspnoea, \n\n\n\nfever, and cough, with a strong connection between SpO2 \n\n\n\n<95% (OR=3.234, CI95%, 1.554-6.728) RR >20 bpm \n\n\n\n(OR=2.595, CI95%, 1.203-5.597), and death. C-reactive \n\n\n\nprotein (OR=2.979, CI95%, 1.686-5.261) and d dimer \n\n\n\n(OR=1.659, CI95 %, 1.010-2.727) were found to be \n\n\n\nlaboratory predictors of death. Patients with renal (OR=2.344, \n\n\n\nCI95%, 1.384-3.968) or hepatic impairment (OR=1.555, \n\n\n\nCI95%, 0.962-2.513) were additionally at risk of dying. Only \n\n\n\nantivirals were substantially related with a decreased risk of \n\n\n\nmortality (OR=0.475, CI95%, 0.235-0.959) among all drugs \n\n\n\nadministered. Conclusion: Participants who died in the study \n\n\n\nwere older, male with indications of respiratory distress or \n\n\n\norgan failure, and had elevated CRP or D-dimer levels. All \n\n\n\nof the characteristics described here were associated with \n\n\n\ndeath in COVID-19 infection. \n\n\n\n \n\n\n\n\nmailto:dramer@usm.my\n\n\nmailto:Zeeshan.munir@uvas.edu.pk\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 140-181 \n\n\n\n\n\n\n\nResearch abstracts of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022 \n\n\n\nDOI:  10.52494/YOXJ1358 \n\n\n\n\n\n\n\n169 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 037 \n\n\n\n\n\n\n\nDevelopment And Validation of a \n\n\n\nGuideline-Guided Prognostic Model of \n\n\n\nMortality in Patients with First-Ever Acute \n\n\n\nIschemic Stroke  \n\n\n\n\n\n\n\nMustapha Mohammed1,2*, Hadzliana Zainal1, \n\n\n\nSiew Chin Ong3, Balamurugan Tangiisuran1, \n\n\n\nSabariah Noor Harun1, Siti Maisharah Sheikh \n\n\n\nGhadzi1, Norsima Nazifah Sidek4, Keng Lee \n\n\n\nYee5, Looi Irene6, Zariah Abdul Aziz4 \n \n1School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 \n\n\n\nGelugor, Pulau Pinang, Malaysia \n2Department of Clinical Pharmacy and Pharmacy Practice, Faculty of \n\n\n\nPharmaceutical Sciences, Ahmadu Bello University, 810107 Zaria, Kaduna, \n\n\n\nNigeria \n3Discipline of Social and Administrative Pharmacy, School of \n\n\n\nPharmaceutical Sciences, Universiti Sains Malaysia, 11800 Gelugor, Pulau \n\n\n\nPenang, Malaysia \n4Clinical Research Centre, Hospital Sultanah Nur Zahirah, 20400 Kuala \n\n\n\nTerengganu, Terengganu, Malaysia \n5National Institute of Health, Ministry of Health, 40170 Shah Alam, \nSelangor, Malaysia \n6Clinical Research Centre, Hospital Seberang Jaya, 3700 Permatang Pauh, \n\n\n\nPulau Pinang, Malaysia \n* mohammedmmrx@gmail.com  \n\n\n\n\n\n\n\nBackgrounds: Prognostic models help predict acute \n\n\n\nischemic stroke outcomes and can guide risk and care \n\n\n\nstratification. Objective: This study developed and validated \n\n\n\na guideline-guided prognostic model of mortality following \n\n\n\na first acute ischemic stroke. Methods: The study recruited \n\n\n\n899 patients with first-ever acute ischemic stroke from the \n\n\n\nMalaysian National Stroke Registry (NSR) from 2010 to \n\n\n\n2020 and followed up for three months. The NSR guideline-\n\n\n\nguided key performance indicators were thrombolytic \n\n\n\ntherapy, antiplatelet within 48 hrs, dysphagia screening, deep \n\n\n\nvenous thrombosis (DVT) prophylaxis, anticoagulants for \n\n\n\natrial fibrillation (AF), discharge on antiplatelets, discharge \n\n\n\non lipid-lowering agents, stroke education, and rehabilitation. \n\n\n\nMultivariate logistic regression was used to develop the \n\n\n\nguideline-guided prognostic model. The model was validated \n\n\n\nusing performance measures; the Hosmer-Lemeshow (H-S) \n\n\n\ngoodness-of-fit (calibration) and the area under the receiver \n\n\n\noperating characteristic (AUROC) curve (discrimination). \n\n\n\nResults: The guideline-guided factors that significantly \n\n\n\ndecreased the risk of mortality were antiplatelet within 48 hrs. \n\n\n\n(adjusted odds ratio, aOR, 0.40 [95% confidence interval, CI, \n\n\n\n0.19-0.81), dysphagia screening (aOR, 0.30 [95% CI, 0.15-\n\n\n\n0.61]), antiplatelets upon discharge (aOR, 0.17 [95% CI, \n\n\n\n0.08-0.35]), lipid-lowering agents upon discharge (aOR, 0.37 \n\n\n\n[95% CI, 0.17-0.82]), stroke education (aOR, 0.02 [95% CI, \n\n\n\n0.01-0.05]) and rehabilitation (aOR, 0.08 [95% CI, 0.04-\n\n\n\n0.16]). The validation performance of model was \n\n\n\nAUROC=0.941 (95% CI, 0.92-0.96), H-L test=4.35 \n\n\n\n(p=0.630), Omnibus test=142.53 (p<0.001) and Nagelkerke \n\n\n\nR2 0.741. Conclusion: The guideline-guided prognostic \n\n\n\nvariables predictive of mortality were antiplatelets within 48 \n\n\n\nhrs, dysphagia screening, antiplatelets upon discharge, lipid-\n\n\n\nlowering agents, stroke education and rehabilitation. The \n\n\n\nmodel demonstrated excellent performance, accurate \n\n\n\ndiscrimination and calibration with potential clinical utility. \n\n\n\n\n\n\n\nAbstract 038 \n\n\n\n\n\n\n\nEvaluation of The Impact of Antibiotic \n\n\n\nStewardship Program on Antibiotics \n\n\n\nUtilization as Surgical Prophylaxis at a \n\n\n\nSecondary Hospital in United Arab \n\n\n\nEmirates \n \n\n\n\nMaryam Salem Alkaabi1,2, Sabariah Noor \n\n\n\nHarun1, and Abubakar Sha\u2019aban1 \n \n1School of Pharmaceutical Sciences, Universiti Sains Malaysia, \nMalaysia.  \n2Dibba Hospital, Fujairah, United Arab Emirates  \n\n\n\n* Maryam.alkaabi@student.usm.my  \n\n\n\n\n\n\n\nBackground: Overuse or misuse of antibiotics, especially \n\n\n\nbroad-spectrum antibiotics, may result in nosocomial \n\n\n\ninfections, leading to increased mortality rate, extended \n\n\n\nhospital stay, and cost. The antibiotic stewardship program \n\n\n\n(ASP) is introduced to combat the irrational use of antibiotics. \n\n\n\nObjective: To evaluate the effectiveness of the newly \n\n\n\nimplemented surgical antibiotics prophylaxis (SAP) \n\n\n\nguidelines. Methods: This study was a retrospective, \n\n\n\nhospital-based study conducted over five years (2017 to \n\n\n\n2022), one year before and four years after implementation \n\n\n\nof ASP at Dibba hospital, United Arab Emirates. The study \n\n\n\nincluded adult patients who undergo surgical operations \n\n\n\nduring the study period. Results: Out of 3290 patients \n\n\n\nincluded in the study,1756 received SAP. The percentage of \n\n\n\npatients who received SAP improved from pre-ASP 53.6% \n\n\n\nto 56.7% four years post-ASP. The most frequently used SAP \n\n\n\nin pre-ASP was amoxicillin with clavulanic acid (decreased \n\n\n\nfrom 44% to 0% in t), in contrast to Cefazolin (increased \n\n\n\nfrom 0% to 83%). The appropriate selection of SAP was \n\n\n\nimproved from 42% to 97%, appropriate SAP timing \n\n\n\nincreased from 81% to 98%, appropriate SAP duration was \n\n\n\nnoticeably enhanced from 46% to 98%. The incidence of \n\n\n\nsurgical site infection (SSI) decreased from 34.82% in pre-\n\n\n\nASP to 7.99%, 17.91%, 5.40%, and 3.71% in the first, second, \n\n\n\nthird, and fourth post-ASP years, respectively. Conclusions: \n\n\n\nFour years Implementation of SAP guidelines have \n\n\n\nsignificantly improved the rational use of antibiotics \n\n\n\nresulting in improved clinical outcomes. \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:mohammedmmrx@gmail.com\n\n\nmailto:Maryam.alkaabi@student.usm.my\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 140-181 \n\n\n\n\n\n\n\nResearch abstracts of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022 \n\n\n\nDOI:  10.52494/YOXJ1358 \n\n\n\n\n\n\n\n170 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 039 \n\n\n\n\n\n\n\nClinicodemographic Characteristics \n\n\n\nIdentification of Malaysian Patients with \n\n\n\nRheumatoid Arthritis Using Biologic and \n\n\n\nTargeted Disease Modifying Anti \n\n\n\nRheumatoid Drugs \n \n\n\n\nNasreh Shamsi Poor Gheshmi1,*, Syed Azhar \n\n\n\nSyed Sulaiman1, Yaman Walid Kassab2 \n \n1School of Pharmaceutical Sciences, Universiti Sains Malaysia (USM), \nPenang, Malaysia \n2Faculty of Pharmacy, Syrian Private University, Damascus, Syria \n\n\n\n* nasreh@student.usm.my \n\n\n\n\n\n\n\nBackground: Rheumatoid arthritis (RA) is considered a \n\n\n\nsystemic inflammatory disease that can cause progressive \n\n\n\njoint destruction. The prevalence of RA is known to be 0.5 to \n\n\n\n1 percent. Biologic and targeted disease modifying anti \n\n\n\nrheumatic drugs (DMARDs) found to be effective in RA \n\n\n\ntreatment. Objective: This study aimed to identify the \n\n\n\ndemographic and clinical variables among Malaysian RA \n\n\n\npatients receiving biologic and targeted DMARDs. Method: \n\n\n\nWe conducted a retrospective cohort study at Serdang and \n\n\n\nPutrajaya Hospital from August 2021 until November 2021. \n\n\n\n215 patients were selected randomly. Data collection \n\n\n\nincluded demographic and clinical features at four different \n\n\n\ntimes intervals. Result: In our study we found that RA \n\n\n\npopulation included 66.5% females and 33.5% males, with a \n\n\n\nmean age of 54.67 years old. We demonstrated that 46.5% \n\n\n\nwere Malay, 38.6% Indian and 32 14.9% Chinese. 81.4% of \n\n\n\npatients had comorbidities that hypertension (49.8%) and \n\n\n\nosteoarthritis (46%) were common. Examination of data at \n\n\n\nbaseline indicated that 54% were biologic na\u00efve. Furthermore, \n\n\n\n59.3% of RA patients received monotherapy. The results \n\n\n\nshowed that 51.2%, received TNF inhibitor, whereas non-\n\n\n\nTNF inhibitors and targeted DMARDs was received by \n\n\n\n32.1%, and 16.7% patients respectively. We demonstrated \n\n\n\nthat the mean DAS28 ESR improved considerably across \n\n\n\ntime points, F (1, 214) = 4911.89, p < 0.001. Conclusion: \n\n\n\nThe results indicated that RA is a common disorder among \n\n\n\nMalaysian population and has a significant disease burden \n\n\n\nwhich females are more affected. Furthermore, we have \n\n\n\nobserved that there was a significant clinical response \n\n\n\nimprovement after initiation of biologic and targeted \n\n\n\nDMARDs. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 040 \n\n\n\n\n\n\n\nSafety Assessment of Biologic and Targeted \n\n\n\nDisease Modifying Anti Rheumatoid Drugs \n\n\n\nAmong Malaysian Patients with \n\n\n\nRheumatoid Arthritis \n \n\n\n\nNasreh Shamsi Poor Gheshmi1,*, Syed Azhar \n\n\n\nSyed Sulaiman1, and Yaman Walid Kassab2 \n \n1School of Pharmaceutical Sciences, Universiti Sains Malaysia (USM), \nPenang, Malaysia \n2Faculty of Pharmacy, Syrian Private University, Damascus, Syria \n\n\n\n* nasreh@student.usm.my \n\n\n\n\n\n\n\nBackground: Rheumatoid arthritis (RA) treatment with \n\n\n\nbiologic and targeted disease-modifying anti-rheumatic \n\n\n\ndrugs (bDMARDs, tDMARDs) showed a significant clinical \n\n\n\nimprovement, however these agents are associated with \n\n\n\nvarious adverse events (AEs), including infection, abnormal \n\n\n\nliver, and lipid function. Objective: To identify the safety \n\n\n\nissues of bDMARDs and tDMARDs among Malaysian RA \n\n\n\npatients. Methods: We conducted a retrospective cohort \n\n\n\nstudy of RA patients enrolled in Serdang and Putrajaya \n\n\n\nHospital from August 2021 until November 2021. 215 \n\n\n\npatients who received bDMARDs and tDMARDs were \n\n\n\nselected randomly. Data included demographic and clinical \n\n\n\nfeatures at four different times intervals. We used frequency \n\n\n\nand Friedman tests to analyse data. Result: This study \n\n\n\nincluded 66.5% females and 33.5% males with a mean age of \n\n\n\n54.6 \u00b1 10.162 years. Most of patients (83.3%) were treated \n\n\n\nwith bDMARDs, whereas 16.7% received tDMARDs. \n\n\n\nExamination of lipid profile indicated a significant increase \n\n\n\nin LDL level \u03c72 (3, n=215) =31.034, p<0.001 and TG level \n\n\n\n\u03c72 (3, n=215) =133.169, p<0.001. Inspection of the median \n\n\n\nvalues showed an increase in AST level from baseline \n\n\n\n(median=19) to 12 months post therapy (median=21) and \n\n\n\nALT level from baseline (median=15) to 12 months post \n\n\n\ntherapy (median=19), demonstrating a substantial impact of \n\n\n\nthese agents on liver profile enzymes including AST \u03c72 (3, \n\n\n\nn=215) =30.013, p<0.001 and ALT \u03c72 (3, n=215) =20.022, \n\n\n\np<0.001. Conclusion: Our analysis found a potential impact \n\n\n\nof these agents on liver and lipid profile. These findings will \n\n\n\nhelp healthcare providers to identify AEs of these agents to \n\n\n\nprevent or manage them well. \n\n\n\n\nmailto:nasreh@student.usm.my\n\n\nmailto:nasreh@student.usm.my\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 140-181 \n\n\n\n\n\n\n\nResearch abstracts of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022 \n\n\n\nDOI:  10.52494/YOXJ1358 \n\n\n\n\n\n\n\n171 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 041 \n\n\n\n\n\n\n\nExamining The efficacy of Biologic and \n\n\n\nTargeted Anti Rheumatic Drugs Among \n\n\n\nMalaysian Population with Rheumatoid \n\n\n\nArthritis \n \n\n\n\nNasreh Shamsi Poor Gheshmi1,*, Syed Azhar \n\n\n\nSyed Sulaiman1, Yaman Walid Kassab2 \n \n\n\n\n1School of Pharmaceutical Sciences, Universiti Sains Malaysia (USM), \n\n\n\nPenang, Malaysia \n2Faculty of Pharmacy, Syrian Private University, Damascus, Syria \n\n\n\n* nasreh@student.usm.my \n\n\n\n\n\n\n\nBackground: Rheumatoid arthritis (RA) is considered a \n\n\n\nsystemic inflammatory disease that can cause progressive \n\n\n\njoint destruction. Biologic and targeted disease modifying \n\n\n\nanti rheumatic drugs (bDMARDs, tDMARDs) showed an \n\n\n\nefficient impact in reducing disease activity score. Objective: \n\n\n\nTo investigate the effectiveness of bDMARDs and \n\n\n\ntDMARDs among Malaysian RA patients. Methods: We \n\n\n\nconducted a retrospective cohort study at Serdang and \n\n\n\nPutrajaya Hospital from August 2021 until November 2021. \n\n\n\n215 patients receiving bDMARDs and tDMARDs were \n\n\n\nselected randomly. Data collection included demographic \n\n\n\nand clinical features at four different times intervals. All data \n\n\n\nwere analysed by SPSS software using frequency and \n\n\n\nrepeated measure ANOVA tests. Results: A total of 66.5% \n\n\n\n(n=143) females and 33.5% (n=72) males with the mean age \n\n\n\nof 54.6 \u00b1 10.162 were enrolled. The pattern of DMARDs \n\n\n\nprescription shows that out of 215 patients, 83.3% (n=179) \n\n\n\nreceived bDMARDs, while 16.7% (n=36) were treated with \n\n\n\ntDMARDs. Efficacy was evaluated using disease activity \n\n\n\nscore of 28 joints (DAS28 ESR) at baseline and 3 different \n\n\n\ntimes intervals post therapy. We found that the mean DAS28 \n\n\n\nESR improved significantly across time points, F (1, 214) = \n\n\n\n4911.89, p < 0.001. The findings shows that the mean of \n\n\n\nDAS28 ESR statistically decreased from baseline (5.217 \u00b1 \n\n\n\n1.355) to 3 months (3.929 \u00b1 1.303; p < 0.001), 6 months \n\n\n\n(3.549 \u00b1 1.304; p < 0.001) and 12 months (3.189 \u00b1 1.076; p \n\n\n\n< 0.001). Conclusions: Findings from this observational \n\n\n\nstudy indicated a significant clinical response improvement \n\n\n\nafter initiation of bDMARDs and tDMARDs among RA \n\n\n\npatients. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 042 \n\n\n\n\n\n\n\nSolvent System Effect on The Viscosity and \n\n\n\nConductivity of Electrospinnable Polymer \n\n\n\nSolutions for Incorporation of Medicinal \n\n\n\nHerbal Extract  \n\n\n\n\n\n\n\nSiew Mei Tan, and Siok Yee Chan* \n\n\n\n \nSchool of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 \n\n\n\nMalaysia \n\n\n\n* sychan@usm.my \n\n\n\n\n\n\n\nBackground: The existence of an electrospun sheath layer \n\n\n\nacts as a promising protective layer and has the potential to \n\n\n\nmask the bitter taste of herbal extracts. Objective (s): The \n\n\n\naim of this research is to investigate the different solvent \n\n\n\nsystems used in affecting the viscosity and conductivity of \n\n\n\nthe electrospinnable polymer solutions, ultimately \n\n\n\ninfluencing the stability of the jet formation prior to fiber \n\n\n\ndeposition. Methods: The electrospinnable polymer \n\n\n\nsolutions were prepared using each solvent system of solely \n\n\n\nethanol and a combination of ethanol and dimethylacetamide \n\n\n\n(4:1) with Eudragit L100-55 and Eudragit L100 polymer \n\n\n\nblends in the ratio of 1:0, 1:1, 1:3, 1:5, and 0:1 respectively. \n\n\n\nThe viscosity and conductivity of all the aforementioned \n\n\n\npolymer solutions were measured. All the electrospinnable \n\n\n\npolymer solutions were electrospun with the core layer \n\n\n\nCarica papaya leaf extract in order to observe and capture the \n\n\n\nstability of jet formation during the electrospinning process \n\n\n\nusing a smartphone camera. Results: Eudragit polymers with \n\n\n\na solvent system comprising the combination of ethanol and \n\n\n\ndimethylacetamide (4:1) showed an increasing trend in both \n\n\n\nthe viscosity and conductivity of the spinnable solution, as \n\n\n\ncompared to those with ethanol solvent only. A more stable \n\n\n\njet was formed using the spinnable solution with a solvent \n\n\n\nsystem comprising of ethanol and dimethylacetamide. \n\n\n\nConclusions: The employed Eudragit sheath layer \n\n\n\nsuccessfully served as a carrier system for Carica papaya leaf \n\n\n\nextract. This study elucidates the solvent system effect on the \n\n\n\nviscosity and conductivity of the spinnable solutions for \n\n\n\nstable jet formation. \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:nasreh@student.usm.my\n\n\nmailto:sychan@usm.my\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 140-181 \n\n\n\n\n\n\n\nResearch abstracts of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022 \n\n\n\nDOI:  10.52494/YOXJ1358 \n\n\n\n\n\n\n\n172 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 043 \n\n\n\n\n\n\n\nOptimization of Polyhydroxyalkanoate \n\n\n\nMicroparticles for A High Encapsulation of \n\n\n\nRifapentine and Verapamil Using a Water-\n\n\n\nIn-Oil-In-Water Double Emulsion \n\n\n\nTechnique \n \n\n\n\nPriyanka Prakash1, K Sudesh Kumar2, and \n\n\n\nThaigarajan Parumasivam1* \n \n1School of Pharmaceutical Sciences, Universiti Sains Malaysia, Minden \n\n\n\n11800, Penang, Malaysia \n2School of Biological Sciences, Universiti Sains Malaysia, Minden 11800, \n\n\n\nPenang, Malaysia \n\n\n\n*thaigarp@usm.my \n\n\n\n\n\n\n\nBackground: The conventional WHO-consolidated \n\n\n\ntreatment for tuberculosis involves the consumption of four \n\n\n\nantibiotics for a lengthy six months. This often results in \n\n\n\nskipped treatments, which gives rise to drug-resistant \n\n\n\nMycobacterium tuberculosis. Thus, inhaled therapy using \n\n\n\nbiocompatible polyhydroxyalkanoates is a feasible option. \n\n\n\nObjective: To optimize poly(3-hydroxybutyrate-co-4-\n\n\n\nhydroxybutyrate-co-5-hydroxyvalerate) [P(3HB-co-4HB-\n\n\n\nco-5HV] microparticles of size 1 to 3 microns for a high \n\n\n\nencapsulation of anti-tubercular drugs rifapentine and \n\n\n\nverapamil, in combination, using a water-in-oil-in-water \n\n\n\ndouble emulsion technique. Methods: P(3HB-co-4HB-co-\n\n\n\n5HV) microparticles were formulated using a water-in-oil-in-\n\n\n\nwater (w1/o/w2) double emulsion method, where the \n\n\n\nparameters tested were the surfactant (w2-phase) types (i.e., \n\n\n\npolyvinyl alcohol, polyethylene glycol, Tween 80), \n\n\n\nsurfactant concentrations (i.e., 1%, 2%, 3%, 5%), surfactant \n\n\n\nvolumes (i.e., 10ml, 15ml, 20ml), internal water phase (w1) \n\n\n\nand oil phase (o) volumes (i.e., 0.5ml and 1ml, 1ml and \n\n\n\n1.5ml), P(3HB-co-4HB-co-5HV) mass (i.e., 20mg, 40mg, \n\n\n\n60mg, 80mg), and combined drug mass (i.e., 40mg, 80mg, \n\n\n\n120mg, 200mg, 320mg, 400mg). The encapsulation \n\n\n\nefficiency was determined using high-performance liquid \n\n\n\nchromatography. Results: The highest encapsulation \n\n\n\nefficiencies were obtained for rifapentine and verapamil in \n\n\n\npolyvinyl alcohol, with a concentration of 2% (77.15\u00b10.22% \n\n\n\nand 41.97\u00b13.10%, respectively), and a volume of 20ml \n\n\n\n(85.14\u00b12.25% and 56.33\u00b12.62%, respectively), with a 0.5ml \n\n\n\nw1-phase and 1.0ml o-phase (94.29\u00b10.57% and \n\n\n\n69.15\u00b11.52%. respectively), alongside a P(3HB-co-4HB-co-\n\n\n\n5HV) mass of 60mg (93.31\u00b11.18% and 71.13\u00b12.09%, \n\n\n\nrespectively), and a combined drug mass of 400mg (95\u00b10.51% \n\n\n\nand 74.07\u00b13.09%, respectively). Conclusion: The optimal \n\n\n\nconditions for a high encapsulation of verapamil and \n\n\n\nrifapentine in P(3HB-co-4HB-co-5HV) microparticles are \n\n\n\n200mg of verapamil in 0.5ml w1-phase, 200mg of rifapentine \n\n\n\nand 60mg of P(3HB-co-4HB-co-5HV) in 1ml o-phase, and \n\n\n\n20ml of 2% polyvinyl alcohol as the w2-phase. \n\n\n\nAbstract 044 \n\n\n\n\n\n\n\nAirway Smooth Muscles Relaxant and \n\n\n\nMast Cells Stabilizing Activity of Some \n\n\n\nMedicinal Plants Used in Managing \n\n\n\nAsthma in North-western Nigeria  \n\n\n\n\n\n\n\nIbrahim Mu\u2019azzamu Aliyu1*, Mohammed \n\n\n\nGarba Magaji1, Jamilu Ya\u2019u1, Nuhu \n\n\n\nMohammed Danjuma1, Sagir Mustapha1,2, \n\n\n\nMustapha Mohammed3,4, Zakiyyah Yakubu \n\n\n\nYahaya Ibrahim5  \n \n1Department of Pharmacology and Therapeutics, Ahmadu Bello University, \nZaria, Kaduna, Nigeria \n2Department of Pharmacology, School of Medical Sciences, Universiti Sains \nMalaysia, Health Campus, Kota Bharu, Kelantan, Malaysia \n3Department of Clinical Pharmacy and Pharmacy Practice, Ahmadu Bello \n\n\n\nUniversity, Zaria, Kaduna, Nigeria \n4 School of Pharmaceutical Sciences, Universiti Sains Malaysia, Gelugor, \n\n\n\nPulau Pinang, Malaysia \n5 Department of Pharmacognosy and Ethnomedicine, Usmanu Danfodiyo \nUniversity, Sokoto, Nigeria \n\n\n\n* ialiyu71@gmail.com  \n\n\n\n\n\n\n\nBackground: Cassia occidentalis whole plant (COWP), \n\n\n\nJatropha curcas leaves (JCL), Ximenia americana Santalales \n\n\n\nleaves (XAL), and Eucalyptus citriodora leaves (ECL) have \n\n\n\nbeen revealed to be widely used by locals of North-western \n\n\n\nNigeria for the management of asthma. Objective: This study \n\n\n\nwas aimed at providing a pharmacological rationale for the \n\n\n\nethnomedical use of these plants in the management of \n\n\n\nasthma. Methods: The four plants (COWP, JCL, XAL and \n\n\n\nECL) were extracted with 70% ethanol using cold maceration \n\n\n\nextraction for 72 hours and the resulting extracts were \n\n\n\nscreened using invitro models for their effects on the \n\n\n\nspontaneous contraction of isolated rabbit ileum strip; \n\n\n\nHistamine-induced pre-contracted isolated guinea pig ileum \n\n\n\nstrip; Histamine-induced pre-contracted isolated guinea pig \n\n\n\ntrachea chain; and on ovalbumin-induced peritoneal mast cell \n\n\n\ndegranulation in Wistar rats. Results: The ethanol extracts of \n\n\n\nCOWP, ECL, JCL, and XAL at 100 mg/mL remarkably \n\n\n\nrelaxed spontaneous contractions of isolated rabbit ileum. \n\n\n\nGreatest relaxation was obtained with XAL. The four plants\u2019 \n\n\n\nextracts significantly (p<0.05) inhibited histamine-induced \n\n\n\ncontractions of isolated guinea pig ileum. In addition, the \n\n\n\nextracts significantly inhibited (p<0.05) histamine-induced \n\n\n\ncontraction of isolated guinea pig trachea. The ethanol \n\n\n\nextracts of COWP and JCL exhibited mast cell stabilizing \n\n\n\neffect in ovalbumin-induced rat peritoneal mast cell \n\n\n\ndegranulation. However, ECL and XAL did not protect \n\n\n\nagainst ovalbumin-induced rat peritoneal mast cell \n\n\n\ndegranulation. Conclusions: The four plant extracts (COWP, \n\n\n\nECL, JCL, and XAL) possess broncho-relaxant activity, with \n\n\n\nonly COWP and JCL exhibiting mast cell stabilizing activity \n\n\n\nin laboratory animals. The findings support the claim for the \n\n\n\n\nmailto:*thaigarp@usm.my\n\n\nmailto:ialiyu71@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 140-181 \n\n\n\n\n\n\n\nResearch abstracts of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022 \n\n\n\nDOI:  10.52494/YOXJ1358 \n\n\n\n\n\n\n\n173 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\ntraditional use of the plants in inflammatory and allergic \n\n\n\nconditions including asthma. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 045 \n\n\n\n\n\n\n\nProtective Effect of Andrographolide On \u0392-\n\n\n\nAmyloid Induced Toxicity in Transgenic \n\n\n\nCaenorhabditis Elegans \n \n\n\n\nBoon-Keat Khor1, Wai-Lam Liew2, Chong-\n\n\n\nLew Lee2, Kit-Lam Chan2, Nurzalina A.K. \n\n\n\nKhan3, Kah-Hay Yuen3, Vikneswaran \n\n\n\nMurugaiyah1,4* \n \n1Discipline of Pharmacology, School of Pharmaceutical Sciences, \n2Discipline of Pharmaceutical Chemistry, School of Pharmaceutical \nSciences, \n3Discipline of Pharmaceutical Technology, School of Pharmaceutical \n\n\n\nSciences, \n4Centre for Drug Research, Universiti Sains Malaysia, 11800 Penang, \n\n\n\nMalaysia \n\n\n\n* vicky@usm.com  \n\n\n\n\n\n\n\nBackground: Alzheimer\u2019s disease is characterised by \n\n\n\nneuropathological hallmarks such as deposition of \u03b2-amyloid \n\n\n\nand neurofibrillary tangles. These misfolded by-products can \n\n\n\ntrigger toxicity to the neurons, leading to neuronal death and \n\n\n\nmemory loss. Objective: This study aims is to investigate the \n\n\n\nprotective effect of andrographolide, the major bioactive \n\n\n\nditerpene of Andrographis paniculata in the \u03b2-amyloid1-42-\n\n\n\ninduced phenotype and behaviour toxicity in transgenic C. \n\n\n\nelegans. Method: Transgenic C. elegans GMC101and \n\n\n\nCL2355, and their control strain CL2122 were used in the \n\n\n\nstudy. C. elegans GMC101, which expressed amyloid in \n\n\n\nmuscle was treated with andrographolide (0.1,1,10 \u03bcM) from \n\n\n\nthe egg stage and paralysis was scored 24 hr after upshifting \n\n\n\nthe cultured temperature to 25 \u00b0C. The detection of \u03b2-amyloid \n\n\n\nand reactive oxygen species was done using Thioflavin-T and \n\n\n\nDCFDA fluorescent dye. C. elegans CL2355 which \n\n\n\nexpressed amyloid in the pan-neuronal was treated with \n\n\n\nandrographolide (10 \u03bcM) from the egg stage and collected \n\n\n\nfor behaviour study at 36 hr after upshifting the temperature \n\n\n\nto 25 \u00b0C. 1-butanol was used as the attractant. Result: The \n\n\n\npresent study found that treatment with andrographolide (10 \n\n\n\n\u03bcM) significantly delayed the paralysis induced by \u03b2-amyloid \n\n\n\nin transgenic C. elegans GMC101. A lower amount of \u03b2-\n\n\n\namyloid and reactive oxygen species was detected in \n\n\n\ntransgenic C. elegans GMC101 treated with andrographolide. \n\n\n\nIn the behaviour study of transgenic C. elegans CL2355, the \n\n\n\nabnormalities induced by \u03b2-amyloid were ameliorated by \n\n\n\nandrographolide. Conclusion: These findings indicate that \n\n\n\nandrographolide is a potential lead for further development \n\n\n\nas a protective agent against \u03b2-amyloid1-42-induced \n\n\n\npathology in humans. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 046 \n\n\n\n\n\n\n\nIn-Silico Study of 2\u2010Phenoxy\u2010N\u2010(3,4,5\u2010\n\n\n\nTrimethoxyphenyl) Acetamide Against \n\n\n\nMutant p53 in Breast Cancer Drug \n\n\n\nDiscovery \n \n\n\n\nBakti Wahyu Saputra,  Jeffy Julianus* \n \n\n\n\nFaculty of Pharmacy, Universitas Sanata Dharma, Depok, Sleman 55282, \nYogyakarta, Indonesia \n\n\n\n* jeffry@usd.ac.id  \n\n\n\n\n\n\n\nBackground: Cancer is the major cause of death in the world \n\n\n\nwith approximately 10 million of death in 2020. Particularly, \n\n\n\nbreast cancer is the second leading cause of death in women \n\n\n\nafter lung cancer. p53 is a protein expressed by breast cancer \n\n\n\ncell, important for cancer cell apoptosis by regulating the \n\n\n\nexpression of ER\u03b1, an oestrogen receptor that signalling \n\n\n\nproliferation of breast cancer. Unfortunately, the p53 has \n\n\n\nbeen mutated leading to the uncontrol of ER\u03b1 expression \n\n\n\nalong with an inefficient effect of tamoxifen as ER\u03b1 \n\n\n\nantagonist. Objective: This study is aimed to investigate the \n\n\n\npotential effect of 2\u2010phenoxy\u2010N\u2010(3,4,5\u2010trimethoxyphenyl) \n\n\n\nacetamide as inducer of mutant p53 (PDB 2BIM) using in \n\n\n\nsilico study. Method: The in-silico study was carried out \n\n\n\nusing molecular docking method with AutoDock4 software. \n\n\n\nLamarckian genetic was used as the searching algorithm to \n\n\n\ncalculate the free energy of binding. The binding poses and \n\n\n\nchemical interactions were visualized using Biovia \n\n\n\nDiscovery Studio 2021. Results: The result shows free \n\n\n\nenergy of binding between ligand and protein is -7.24 \n\n\n\nkcal/mol demonstrating chemical interactions such as \n\n\n\nhydrogen bond with Ser116 and van der Waals interactions \n\n\n\nwith Leu114, Gly117, and Thr123. Conclusion: The ligand \n\n\n\nis potential to be mutant p53 inducer.  \n\n\n\n\n\n\n\n\n\n\n\nAbstract 047 \n\n\n\n\n\n\n\nPotential of N-(naphthalene-1-yl)-2-\n\n\n\nphenoxyacetamide as Mutant p53 \n\n\n\nReactivator: In silico Studies \n \n\n\n\nBryan Afela Wahono1, Jeffry Julianus1* \n \n\n\n\n1 Faculty of Pharmacy, Universitas Sanata Dharma, Campus 3, Paingan, \n\n\n\nMaguwoharjo, Depok, Sleman 55282, Yogyakarta, Indonesia \n* jeffry@usd.ac.id  \n\n\n\n\n\n\n\nBackground: Breast cancer is one of the main causes of \n\n\n\ndeath in women worldwide which luminal type A breast \n\n\n\ncancer is the most common case. Most of these cases have \n\n\n\nmutation in the p53 gene that inhibits the process of apoptosis \n\n\n\n\nmailto:vicky@usm.com\n\n\nmailto:jeffry@usd.ac.id\n\n\nmailto:jeffry@usd.ac.id\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 140-181 \n\n\n\n\n\n\n\nResearch abstracts of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022 \n\n\n\nDOI:  10.52494/YOXJ1358 \n\n\n\n\n\n\n\n174 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nin cancer cells. Objective: This study aims to evaluate \n\n\n\nbinding interaction between N-(naphthalene-1-yl)-2-\n\n\n\nphenoxyacetamide as the ligand with mutant p53 in the effort \n\n\n\nto find novel anti breast cancer. Method: The study was \n\n\n\ncarried out by docking mutant p53 (PDB: 2BIM) with ligand \n\n\n\nusing AutoDock 4.2. with Lamarckian Genetic at the \n\n\n\nsearching algorithm to calculate the binding energy. Results: \n\n\n\nThe type of chemical interaction is visualized using Biovia \n\n\n\nDiscovery Studio 2021. Results: they demonstrates free \n\n\n\nenergy of binding -7.52 Kcal/mol. This energy is contributed \n\n\n\nby conventional hydrogen bond with THR123, van der Waals \n\n\n\nwith LEU114, THR140, CYS141, pi-sigma with CYS124, \n\n\n\npi-lone pair with THR123, and pi-alkyl with ALA119, \n\n\n\nVAL122, and PRO142. Conclusion: The estimated \n\n\n\ninhibition constant (Ki) is 3.032 \u03bcM leading to a conclusion \n\n\n\nthat the ligand is potentially active to reactivate mutant p53, \n\n\n\nthere by it is a good lead compound for breast cancer drug. \n\n\n\n\n\n\n\nAbstract 048 \n\n\n\n\n\n\n\nEffects of Fenugreek Seeds on Some Blood \n\n\n\nParameters in Type 2 Diabetics Receiving \n\n\n\nMetformin and Glyburide \n \n\n\n\nRaghda Lahdo1*, Rafah Manafikhi2 \n \n1Department of biochemistry and microbiology, Faculty of Pharmacy, \n\n\n\nUniversity of Aleppo, Al-Wataniya Private University, Syria \n2Department of biochemistry and microbiology, Faculty of Pharmacy, \n\n\n\nUniversity of Aleppo, Syria \n\n\n\n*raghdals@yahoo.fr  \n\n\n\n\n\n\n\nBackground: Type 2 diabetes mellitus is a metabolic \n\n\n\ndisorder characterized by failure of glucose homeostasis with \n\n\n\ndisturbance of carbohydrate and fat metabolism caused by \n\n\n\nInsulin Resistance. To overcome this disturbance, treatment \n\n\n\nwith antidiabetic agents have been developed, and the interest \n\n\n\nin natural remedies have been increased. Recently the study \n\n\n\nof drug - food interactions in modifying treatment response \n\n\n\nis extensively investigated. Objectives: To evaluate the \n\n\n\neffects of natural substances such as Fenugreek on some \n\n\n\nblood parameters in patients with Type 2 Diabetes who were \n\n\n\ntreated with Metformin and Glyburide. Methods: The study \n\n\n\nlasted for 8 weeks, the patients were divided into 2 groups: \n\n\n\ngroup F (n=53) was given Fenugreek Seeds in the form of \n\n\n\nsoaked in boiled water at a dose of 10 g/day in combination \n\n\n\nwith their treatment, group C (control n=45) received their \n\n\n\ntreatment alone. Fasting Blood Sugar (FBS), Glycated \n\n\n\nHemoglobin (HbA1c), Triglyceride (TG), Total Cholesterol \n\n\n\n(TC), High-Density Lipoprotein Cholesterol (HDL-C), Low-\n\n\n\nDensity Lipoprotein Cholesterol (LDL-C) and Atherogenic \n\n\n\nIndex of Plasma (AIP) were measured at the beginning and \n\n\n\nat the end of the study. Results: Results showed a significant \n\n\n\ndecrease (p < 0.05) in HbA1c, TG and AIP levels in group F \n\n\n\nat week 8 in comparison with values at week 0 and in \n\n\n\ncomparison to group C. There was an insignificant decrease \n\n\n\n(p > 0.05) in FBS, TC and LDL-C levels. While no change in \n\n\n\nHDL-C levels was observed. The effect of Fenugreek could \n\n\n\nbe contributed to Galactomannan compound, which acts as \n\n\n\ninhibitor of intestinal Lipase, or to Saponins which inhibit the \n\n\n\naction of Bile Acids. Conclusions: The combination of \n\n\n\nFenugreek with antidiabetic agents (Metformin and \n\n\n\nGlyburide) had showed hypolipidemic effects, so it could be \n\n\n\na good addition in the management of patients with Type 2 \n\n\n\nDiabetes. \n\n\n\n\n\n\n\nAbstract 049 \n\n\n\n\n\n\n\nInvestigating The Relationship Between \n\n\n\nThyroid Disorders and Breast Cancer \n \n\n\n\nAya Zrek1, Anawar Shamout2, Raghda \n\n\n\nLahdo3* \n \n1Department of biochemistry and microbiology, Faculty of Pharmacy, \nUniversity of Aleppo, Syria \n2Department of Oncology, Faculty of Medicine/ University of Aleppo, Syria \n3Department of biochemistry and microbiology, Faculty of Pharmacy, \nUniversity of Aleppo, Al-Wataniya Private University, Syria \n\n\n\n*raghdals@yahoo.fr  \n\n\n\n\n\n\n\nBackground: Breast cancer is one of the most common \n\n\n\ninvasive cancers in women in the world, there are several \n\n\n\nfactors that may increase the chances of developing breast \n\n\n\ncancer. Thyroid disorders are also one of the most common \n\n\n\ndiseases. Due to the high prevalence and incidence of breast \n\n\n\ncancer and thyroid disorders, it was important to study the \n\n\n\nrelationship between these two diseases. Objectives: To \n\n\n\ninvestigate the relationship between Thyroid gland disorders \n\n\n\nand breast cancer in Aleppo Governorate, in order to \n\n\n\ndetermine if thyroid disorder is a predisposing risk factor for \n\n\n\nbreast cancer. Methods: Evaluation of thyroid gland function \n\n\n\nin patients with breast cancer and age-matched control \n\n\n\nwomen without breast or thyroid disease (35-75 year). Breast \n\n\n\ncancer patients (n=68), and healthy controls (n=25). Thyroid \n\n\n\nhormones (FT4, TSH) assays were determined. Results: This \n\n\n\nstudy showed that the mean values of TSH level in women \n\n\n\nwith breast cancer (3.7 \u00b13.56 \u03bclU/ml) was higher \n\n\n\nsignificantly than healthy (1.7 \u00b10.9 \u03bclU/ml), and there was \n\n\n\nnon-significant increase in mean values of FT4 level between \n\n\n\nwomen with breast cancer (1.17 \u00b10.20 ng/dl) and healthy (1.1 \n\n\n\n\u00b1 0.22 ng/dl). These Values were compatible with \n\n\n\nSubclinical Hypothyroidism. The percentage of those who \n\n\n\nhad subclinical hypothyroidism and were diagnosed with \n\n\n\nbreast cancer was (95.65%), which was higher significantly \n\n\n\nthan those who had subclinical hypothyroidism from healthy \n\n\n\ncontrols (4.35%). Conclusion: The results showed a \n\n\n\nsignificant relationship between breast cancer and \n\n\n\nSubclinical hypothyroidism. Therefore, Thyroid function \n\n\n\ndisorder could be considered as a risk factor for breast cancer, \n\n\n\nand early investigation of thyroid functions may contribute to \n\n\n\nreducing the progression and development of breast cancer. \n\n\n\n\nmailto:*raghdals@yahoo.fr\n\n\nmailto:*raghdals@yahoo.fr\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 140-181 \n\n\n\n\n\n\n\nResearch abstracts of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022 \n\n\n\nDOI:  10.52494/YOXJ1358 \n\n\n\n\n\n\n\n175 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 050 \n \n\n\n\nKnowledge, Attitude, And Practice \n\n\n\nAssessment Of Lung Cancer Risk Factors \n\n\n\nAmong Health Practitioners In Erbil, Iraq \n\n\n\n\n\n\n\nIbrahim M Abdulbaqi1,2*, Habibah A. \n\n\n\nWahab2*, Ibrahim Ahmed Moyasser1\u2020, \n\n\n\nShaheen Nozad Yousif1\u2020 \n\n\n\n \n1PractSol Research Group, College of Pharmacy, Al-Kitab University, Altun \n\n\n\nkupri, Kirkuk 36001, Iraq. \n2School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang \n\n\n\n11800, Malaysia. \n\n\n\n*ibrahim.m.abdulbaqi@uoalkitab.edu.iq;habibahw@usm.my  \n\u2020 Co-first authors \n\n\n\n\n\n\n\nBackground: Globally, lung cancer (LC) is the most \n\n\n\nprevalent cause of major cancer incidence and death in men. \n\n\n\nNationally, LC is at a 23.3% incidence as per the Iraq-Global \n\n\n\nCancer Observatory report in 2020. The mortality of LC is \n\n\n\nhigher in low- and middle-income countries compared to \n\n\n\ndeveloped high-income countries due to screening and early \n\n\n\ndetection. Lung cancer screening (LCS) with low-dose \n\n\n\ncomputed tomography (LDCT) is effective at reducing lung \n\n\n\ncancer mortality Objectives: This study assesses primary \n\n\n\ncare providers\u2019 (PCP) knowledge, attitudes, and practice \n\n\n\nrelated to LCS and the recent US Preventive Services Task \n\n\n\nForce guidelines in the public hospitals of Erbil, Iraq. \n\n\n\nMethods: Either hand-delivered self-filling or an online \n\n\n\nadopted questionnaire was used, which included \n\n\n\ndichotomous and five-point Likert-scale questions about \n\n\n\nproviders\u2019 clinical practice, knowledge (20 items), attitudes \n\n\n\n(5 items), and beliefs (4 items). The questionnaire was \n\n\n\nprovided in three languages: English, Kurdish, and Arabic. \n\n\n\nResults: Most of the participants (n = 150) were males \n\n\n\n(60.7%), with bachelor\u2019s degrees (62%), and a much lower \n\n\n\npercentage had higher education degrees (20%), among \n\n\n\nwhich (31.3%) were physicians, (23.3%) pharmacists, \n\n\n\nresidents (15.3%), and (11.3%) nurses. (47.3%) stated that \n\n\n\ntheir academic curriculum did not cover lung cancer in \n\n\n\ntraining/workshop/research mode. Interestingly, (71%) and \n\n\n\n(49%) preferred to receive treatment/screening in the private \n\n\n\nsector for LC, respectively. The majority had no clear \n\n\n\nknowledge and attitude toward the presence of \u201cguidelines\u201d \n\n\n\nfor screening referral and post-screening, while x-ray chest \n\n\n\nscreening was the dominating screening preference practice. \n\n\n\nConclusions: In terms of LC screening recommendations \n\n\n\nand post-screening guidelines, PCP are in need of sufficient \n\n\n\ntraining to make sharp decisions. Releasing national \n\n\n\nguidelines based on the USPSTF guidelines is a step forward. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 051 \n\n\n\n\n\n\n\nPrevalence of Tuberculosis Infection and \n\n\n\nTreatment Outcome in Babylon Province of \n\n\n\nIraq; A Retrospective Study \n  \n\n\n\nTaif Said Jasim1*, Amer Hayat Khan2, and \n\n\n\nNada Khazal K. Hindi3 \n  \n1 the Discipline of Microbiology, Universiti Sains Malaysia \n2 the Discipline of Clinical Pharmacy, Universiti Sains Malaysia \n\n\n\n3 the Discipline of Microbiology, Nursing of college\\University of Babylon \n\n\n\n* taifsaad747@gmail.com  \n\n\n\n\n\n\n\nBackground: About one-third of the world\u2019s population is \n\n\n\ninfected by tuberculosis. It mainly affects the lungs \n\n\n\n(pulmonary tuberculosis) and also can affect other sites of the \n\n\n\nbody (Extra-pulmonary tuberculosis). Objective: The main \n\n\n\npurpose of this study is to experience the prevalence of \n\n\n\ntuberculosis and the treatment outcome rate in Babylon of \n\n\n\nIraq. Methods: Collection of data from medical records of \n\n\n\ntuberculosis patients retrospectively was conducted at the \n\n\n\nhealth centre from January 2016 to March 2021 in the \n\n\n\nBabylon province of Iraq. This study focused on the \n\n\n\ncharacteristics of TB patients; age, gender, type of \n\n\n\nTuberculosis, and treatment outcome. Data analysis with \n\n\n\nSPSS version 26 by use (Frequencies and percentages Mean \n\n\n\nand SD, Pearson correlation, and Independent Sample t-test). \n\n\n\nResults: Total of tuberculosis patients (N= 1774) that \n\n\n\nregistered at medical records of a health centre in Babylon. \n\n\n\nWe found these results; female patients (n=948; 53.4%), as \n\n\n\ncompared with those who are male patients (n= 826; 46.6%). \n\n\n\nThe age group between 61 years old and older was recorded \n\n\n\nwith the highest percentage (n=359; 20.2%) and the less \n\n\n\npercentage of those who are <10 years old (n=122; 6.9%). \n\n\n\nSite of infection, pulmonary tuberculosis (n= 992; 56.0%) \n\n\n\nand extra-pulmonary tuberculosis (n= 782; 44.0%). \n\n\n\nTreatment outcome are complete (63.7%), cure (24.1%), \n\n\n\ndeath (3.1%), default (0.5%), fail (0.3%), transfer (0.1%) and \n\n\n\nother (8.1%). Which successful treatment percentage \n\n\n\n(87.8%), while unsuccessful treatment (12.1%). Conclusions: \n\n\n\nIn this study, we found that who is females infected with \n\n\n\ntuberculosis more than males. In addition, we found patients \n\n\n\ninfected with Tuberculosis who are 61 years old have the \n\n\n\nhighest percentage (n=359; 20.2%). While as for treatment \n\n\n\noutcomes, the successful treatment percentage (87.8%) and \n\n\n\nthe unsuccessful treatment percentage (12.1%) in Babylon \n\n\n\nprovince, Iraq. \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:*ibrahim.m.abdulbaqi@uoalkitab.edu.iq;habibahw@usm.my\n\n\nmailto:taifsaad747@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 140-181 \n\n\n\n\n\n\n\nResearch abstracts of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022 \n\n\n\nDOI:  10.52494/YOXJ1358 \n\n\n\n\n\n\n\n176 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 052 \n\n\n\n\n\n\n\nAdverse Drug Reactions in Hospitalised \n\n\n\nChildren with Chronic Kidney Disease in \n\n\n\nA Paediatric Tertiary Care Hospital of \n\n\n\nPakistan  \n\n\n\n\n\n\n\nAsma Fareed Khan1,2*, Amer Hayat Khan1, \n\n\n\nShahida Perveen2, Muhammad Tahir1,3 \n \n1Universiti Sains Malaysia, Pulau Pinang, Malaysia. \n2Children\u2019s Hospital & University of Child Health Sciences, Lahore, \nPakistan. \n3Superior University, Lahore, Pakistan. \n\n\n\n*asma.fareed@student.usm.my  \n\n\n\n\n\n\n\nBackground: Chronic kidney disease (CKD) in children is \n\n\n\nthe major cause of morbidity and mortality. Treatment of \n\n\n\npatients with CKD is specific and complex, therefore are at \n\n\n\nincreased risk of developing adverse drug reactions (ADRs). \n\n\n\nObjectives: To determine the incidence, causality, severity, \n\n\n\nand preventability of the ADRs in CKD paediatric patients. \n\n\n\nMethods: A Prospective observational study was conducted \n\n\n\non 50 paediatric CKD patients with stages 3\u20135 admitted to \n\n\n\nthe Nephrology ward of a tertiary care children\u2019s hospital for \n\n\n\ntwo months. Adverse drug reactions were recognized from \n\n\n\npatient reports, medical records, and interviewing parents \n\n\n\nand confirmed by the duty physician and nurse in charge. The \n\n\n\ncausality, preventability & severity were assessed using \n\n\n\nNaranjo Scale, Schumock and Thornton scale, and Hartwig \n\n\n\nand Seigel Scale respectively. Results: Out of 50 patients, \n\n\n\nADRs were observed in 11 patients, giving an incidence of \n\n\n\n22%. Out of 11, 8 were females (72.72%) while 4 were males \n\n\n\n(27.27%). The mean age was 10.5\u00b12.4 years. Patients have \n\n\n\nbeen prescribed 8 to 12 drugs. Female patients experienced \n\n\n\nthe majority of ADRs. Most common ADRs were due to \n\n\n\nantibacterial (72.72%). Most of the ADRs were probable \n\n\n\n(45.45%), followed by possible (27.27%) and definite \n\n\n\n(27.27%) ADRs. All ADRs were preventable. Most of the \n\n\n\nADRs (72.72%) were in the moderate category. Conclusion: \n\n\n\nThe study concluded that the frequency of ADRs increase \n\n\n\nwith polypharmacy. There is a need for active ADR reporting \n\n\n\nto improve drug safety in CKD paediatric patients. \n\n\n\nAbstract 053 \n\n\n\n\n\n\n\nDevelopment and Validation of RP-HPLC \n\n\n\nMethod for the Detection and \n\n\n\nQuantification of Tamoxifen in Pure, and \n\n\n\nLipid-Based Formulation  \n\n\n\n\n\n\n\nReem Abou Assi1,2, Chan Siok Yee1* \n \n1Thoughts Formulation Lab., School of Pharmaceutical Sciences, Universiti \n\n\n\nSains Malaysia, 11800 Malaysia \n2EDEN Research Group, Discipline of Pharmaceutical Technology, College \n\n\n\nof Pharmacy, Al-Kitab University, Altun kupri, Kirkuk, 36001, Iraq. \n\n\n\n* sychan@usm.my   \n \n\n\n\nBackground: The available HPLC-UV methods for the \n\n\n\ntamoxifen evaluation are expensive, complicated, time \n\n\n\nconsuming and their mobile phase is not compatible with \n\n\n\nlipid-based nanoformulations particularly in terms of \n\n\n\nparticipate formation. Objectives: developing and \n\n\n\nvalidating a simple, rapid, specific, and reproducible \n\n\n\nreverse phase HPLC\u2013UV method for quantifying \n\n\n\ntamoxifen in pure and lipid-based formulations for drug \n\n\n\nqualification, release study, and stability studies. Methods: \n\n\n\nThe separation was done using a reversed-phase Agilent\u00ae \n\n\n\nC18 (5\u03bcm x 4.6 mm x 150 mm) column, ammonium \n\n\n\nacetate buffer or solution (pH= 6.8 and 4.8 respectively) \n\n\n\nwith acetonitrile as mobile phase at different ratios (v/v%). \n\n\n\nThe system was operated isocratically at different flow \n\n\n\nrates and column temperatures. The sample injection \n\n\n\nvolume was 10 \u03bcl, with a 10 min/sample running time. \n\n\n\nResults: The final method\u2019s optimized conditions were \n\n\n\nammonium acetate buffer (pH = 4.8) and acetonitrile at \n\n\n\n30:70 (v/v%) with a flow rate of 0.7 ml/min at 45\u00b0C oven \n\n\n\ntemperature under 236 nm wavelength. Ammonium \n\n\n\nacetate buffer offers higher selectivity, while acetonitrile \n\n\n\nwas considered over methanol due to its lower noise under \n\n\n\nsuch UV detection wavelength. The linearity was observed \n\n\n\nover the concentration range of 0.2 - 5 \u03bcg/mL (R2 > \n\n\n\n0.9999). The limit of detection (LOD) and limit of \n\n\n\nquantification (LOQ) were 0.027 \u03bcg/ml and 0.082 \u03bcg/ml, \n\n\n\nrespectively. The developed method was confirmed to be \n\n\n\naccurate, and precise. Moreover, parameters of theoretical \n\n\n\nplates (N > 1500), tailing factor (T \u2264 1.5), and resolution \n\n\n\n(Rs > 3) were as per United States Pharmacopeia (USP). \n\n\n\nConclusions: A reverse phase HPLC\u2013UV method was \n\n\n\nsuccessfully developed for the quantification of tamoxifen \n\n\n\nin pure and in lipid-based formulation under various in-\n\n\n\nvitro and ex-vivo assays. \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:*asma.fareed@student.usm.my\n\n\nmailto:sychan@usm.my\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 140-181 \n\n\n\n\n\n\n\nResearch abstracts of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022 \n\n\n\nDOI:  10.52494/YOXJ1358 \n\n\n\n\n\n\n\n177 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 054 \n \n\n\n\nBreast Cancer Risk Factors Among Public \n\n\n\nand Health Practitioners in Kirkuk, Iraq: \n\n\n\nThe Evaluation of Knowledge, Attitude, \n\n\n\nAnd Practice \n \n\n\n\nIbrahim M Abdulbaqi1,2*, Habibah A. \n\n\n\nWahab2* Duha Arshad Shaker1\u2020, Baraah \n\n\n\nOmar Ayoub1\u2020 \n \n1PractSol Research Group, College of Pharmacy, Al-Kitab University, Altun \nkupri, Kirkuk 36001, Iraq. \n2School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang \n\n\n\n11800, Malaysia. \n*ibrahim.m.abdulbaqi@uoalkitab.edu.iq ; habibahw@usm.my   \n\n\n\n\u2020 Co-first authors \n\n\n\n\n\n\n\nBackground: Breast cancer (BC) is one of the most common \n\n\n\ncancers that cause death among women, ranking second \n\n\n\nworldwide and first in Iraq according to Word Health \n\n\n\nOrganization. It has different classes of hormonal or non-\n\n\n\nhormonal types that affects disease development by various \n\n\n\nmechanisms, which if not well detected at early-stage results \n\n\n\nin high rates of mortality. Objectives To measure knowledge \n\n\n\nand attitude about BC risk factors in Iraqi women, as well as \n\n\n\nthe importance of periodic examination, and early detection \n\n\n\nin treating BC among healthcare provider at public hospital \n\n\n\nin Kirkuk. Methods: Either hand-delivered self-filling or \n\n\n\nonline questionnaire was used which included dichotomous \n\n\n\nand five-point Likert-scale questions about public knowledge \n\n\n\n(30 items), attitudes (10 items), and healthcare providers\u2019 \n\n\n\nclinical practices (24 items), the questionnaire was provided \n\n\n\nin three languages English, Kurdish, and Arabic. Results: \n\n\n\nTotal sample size was n = 300, (45.33%) were medical \n\n\n\nstudents. Interestingly, (6.66%) of the participants had a BC \n\n\n\ncase, and (47.66%) know someone who has BC. (48.22%) of \n\n\n\nthe participant had their first period at the age of 11 \u2013 13 old, \n\n\n\nreflecting a high-risk factor among the population, while \n\n\n\n(43.56 %) had a positive attitude considering that breast \n\n\n\ncancer examination should start since puberty, and in a \n\n\n\nmonthly manner (51.78). Despite the fact that (27.11%) state \n\n\n\nthat self-examination is done via hand, yet majority were not \n\n\n\nsure how to conduct such examination reflecting knowledge \n\n\n\ngap. Interestingly, among health practitioners (61.33%) \n\n\n\ndeclare that they will refer to physician upon feeling any \n\n\n\nabnormality in breast tissue, yet, when asked to choose from \n\n\n\nthe clinical breast examination standard list, answers were \n\n\n\nnot precise. Conclusions: Women and health practitioner in \n\n\n\nIraq below the age 30 are in need of awareness campaign to \n\n\n\nunderstand their level of risk factors, and significantly impact \n\n\n\ntheir lives by early detections.   \n\n\n\nAbstract 055 \n \n\n\n\nA Simple (Rp-HPLC) Method for The \n\n\n\nDetection and Quantification of Docetaxel \n\n\n\nin Bulk and Liquid Crystals Nanocarriers \n\n\n\nand its Validation \n \n\n\n\nIbrahim M. Abdulbaqi 1,2*, Anan Yaghmur 3, \n\n\n\nYusrida Darwis1, Noratiqah Mohtar1, \n\n\n\nThaigarajan Parumasivam1, Habibah A. \n\n\n\nWahab1* \n \n1School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 \nMalaysia \n2College of Pharmacy, Al-Kitab University, Altun kupri, Kirkuk, 36001, Iraq. \n3Department of Pharmacy, Faculty of Health and Medical Sciences, \nUniversity of Copenhagen, Universitetsparken 2, DK-2100 Copenhagen \u00d8, \n\n\n\nDenmark \n\n\n\n*Habibahw@usm.my \n\n\n\n\n\n\n\nBackground: The available HPLC-UV methods for \n\n\n\nquantifying docetaxel evaluation are expensive, time-\n\n\n\nconsuming, and not designed to quantify the drug in lipid-\n\n\n\nbased formulations. Objective: To develop and validate a \n\n\n\nsimple reversed-phase high-performance liquid \n\n\n\nchromatography (RP-HPLC) method for the determination of \n\n\n\ndocetaxel in bulk and liquid crystals nano-formulation. \n\n\n\nMethods: The chromatographic conditions were optimized \n\n\n\nusing stainless steel reversed-phase Agilent\u00ae C18 with the \n\n\n\ndimensions of 150 mm x 4.6 mm ID x 5\u03bcm. The mobile phase \n\n\n\nconsisted of acetonitrile and ammonium acetate buffer (20 \n\n\n\nmmol/l, pH=6.5) in the ratio of (50:50 v/v). The flow rate was \n\n\n\nset at 1 ml/min, and the detection wavelength was 230 nm. \n\n\n\nThe column was maintained at 45 \u00b0C, and the injection \n\n\n\nvolume was 20 \u03bcl. Results: There was no peak interference \n\n\n\nfrom formulation excipients, diluents, impurities, or \n\n\n\ndissolution media, with the main peak of docetaxel at the \n\n\n\nretention time of 5.9 min, indicating the selectivity of the \n\n\n\nmethod. The limit of detection (LOD) and the limit of \n\n\n\nquantification (LOQ) were 0.0287 \u03bcg/ml and 0.0871 \u03bcg/ml, \n\n\n\nrespectively. The developed method was confirmed to be \n\n\n\nselective, precise, and accurate. Conclusion: A sensitive, \n\n\n\nsimple, specific HPLC\u2013UV method for determining \n\n\n\ndocetaxel in bulk and liquid crystals formulation was \n\n\n\nsuccessfully developed. The Statistical analysis confirmed \n\n\n\nthat the method was accurate, precise, and reproducible. The \n\n\n\nmethod could be used for the routine assay, content \n\n\n\nuniformity, and the in-vitro release studies of docetaxel from \n\n\n\nthe liquid crystals\u2019 formulations. \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:*ibrahim.m.abdulbaqi@uoalkitab.edu.iq\n\n\nmailto:habibahw@usm.my\n\n\nmailto:*Habibahw@usm.my\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 140-181 \n\n\n\n\n\n\n\nResearch abstracts of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022 \n\n\n\nDOI:  10.52494/YOXJ1358 \n\n\n\n\n\n\n\n178 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 056 \n\n\n\n\n\n\n\nAwareness About Relationship Between \n\n\n\nClimate Change and Health Hazards in \n\n\n\nIraqi Medical Students \n \n\n\n\nAisha Marwan Abd Al Majeed1, Sakar \n\n\n\nNajmadeen Mohammad1\u2020, Reem Abou Assi1,2*, \n\n\n\nSiok Yee Chan2* \n \n1EDEN Research Group, College of Pharmacy, Al-Kitab University, Altun \n\n\n\nKupri, Kirkuk, 36001, Iraq \n2Thoughts Formulation Lab., School of Pharmaceutical Sciences, Universiti \n\n\n\nSains Malaysia, 11800 Malaysia \n* reem.a.abouasi@uoalkitab.edu.iq; sychan@usm.my  \n\n\n\n\u2020 Co-first authors \n\n\n\n\n\n\n\nBackground: Climate change arguably represents one of the \n\n\n\ngreatest global health threats of our time. In 2019, the United \n\n\n\nNation Environment Programme ranked Iraq as the fifth most \n\n\n\nvulnerable country to climate change and desertification. \n\n\n\nClimate change is already affecting health in many ways, \n\n\n\nincluding causing death and disease as a result of frequent \n\n\n\nextreme weather events, such as heat waves, and dust storms. \n\n\n\nUnderstanding the level of the Iraqi medical students\u2019 \n\n\n\nawareness level about the relation of climate change and \n\n\n\nhealth issues can assist in addressing the gap of this critical \n\n\n\nissue Objectives: To measure the awareness among Iraqi \n\n\n\npharmacy students regarding climate change and its relation \n\n\n\nto health concerns. Methods: An online questionnaire \n\n\n\ncontains 17 items was designed containing dichotomous \n\n\n\nquestions and five-point Likert-scale questions. Results: The \n\n\n\ntotal number of participants were 106, majority (63.2%) \n\n\n\nfemales. While (93.4%) have heard of climate changes, most \n\n\n\nparticipant knew about it from internet (77.4%), and \n\n\n\ntelevision (61.3%). Although 76.4% of the participants are \n\n\n\naware that the climate change will impact their life, yet 58.5% \n\n\n\nonly stated that they are ready to do something about it, 38.7% \n\n\n\ndeclared that they are already taking action in this regard. \n\n\n\nInterestingly 47% of the participant are agreeing to the fact \n\n\n\nthat climate change can negatively impact humans\u2019 health, \n\n\n\nyet 79.2% of the participant agree that climate changes health \n\n\n\nwise impact is not limited to vulnerable categories (elderly, \n\n\n\ninfant). Suggested disease to escalate due to climate change \n\n\n\nis mainly respiratory diseases (Asthma, flu, cancer), as well \n\n\n\nas skin and infectious diseases. Conclusion: Students had \n\n\n\ntheoretical awareness regarding the health hazards of the \n\n\n\nclimate change, but this awareness in not translated into \n\n\n\naction. This could be initiated via national wide awareness \n\n\n\ncampaigns and some changes in the educational/academic \n\n\n\ncurriculum. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 057 \n \n\n\n\nNanocrystalline Cellulose (NCC) Isolation \n\n\n\nfrom Kapok Pulp Via Sulphuric Acid \n\n\n\nHydrolysis \n \n\n\n\nAbdulsalam Q. Almashhadani1*, Cheu Peng \n\n\n\nLeh2, Siok-Yee Chan1, Chong Yew Lee3, Choon \n\n\n\nFu Goh1* \n \n1Discipline of Pharmaceutical Technology, School of Pharmaceutical \n\n\n\nSciences, Universiti Sains Malaysia, 11800 Minden, Penang, Malaysia  \n2School of Industrial Technology, Universiti Sains Malaysia, 11800 Minden, \n\n\n\nPenang, Malaysia \n3School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 \n\n\n\nMinden, Penang, Malaysia \n\n\n\n* abdulsalamqahtan@student.usm.my  \n \n\n\n\nBackground: Nanocrystalline cellulose (NCC) is commonly \n\n\n\nisolated by sulphuric acid hydrolysis of cellulosic materials; \n\n\n\nhowever, the effects of hydrolysis conditions on NCC yield \n\n\n\nand properties of kapok pulp (Ceiba pentandra) are not fully \n\n\n\nunderstood. Objective: To understand the influence of acid \n\n\n\nhydrolytic reaction conditions (independent variables) on the \n\n\n\nNCC characteristics (dependent variables) from kapok pulp. \n\n\n\nMethods: A two-level factorial design approach was used to \n\n\n\nisolate NCC from kapok pulp and to study the NCC yield, \n\n\n\nparticle size, zeta potential and colour. The reaction factors \n\n\n\nwere acid concentration (50 and 60%w/w), reaction \n\n\n\ntemperature (50 and 80\u00b0C), reaction time (40 and 80 min), \n\n\n\nacid-to-pulp ratio (30 and 80 mL.g-1) and sonication time (5 \n\n\n\nand 20 min). Results: All obtained NCC were between 173.9 \n\n\n\nand 488 nm and exhibited a high zeta potential of-38.4 \u2013 -\n\n\n\n42.9 mV, which may be improved as reaction time and \n\n\n\ntemperature increase. The obtained data indicates that acid \n\n\n\nconcentration and reaction temperature mostly influence the \n\n\n\nNCC yield. Hydrolysis conducted at a high acid \n\n\n\nconcentration of 60%w/w combined with a reaction \n\n\n\ntemperature of 50\u00b0C resulted in a higher NCC yield (10.6 \u2013 \n\n\n\n16.5%) than that carried out at the same condition but at 80\u00b0C \n\n\n\n(6.0 \u2013 9.0%). The NCC colour depends on the acid \n\n\n\nconcentration and reaction temperature. Most reactions \n\n\n\ncarrying out at an acid concentration of 60%w/w at 80 \u00b0C \n\n\n\nresulted in a dark brown NCC colour, indicating that the NCC \n\n\n\nwas burned. Conclusions: The current study reveals that as \n\n\n\nacid concentration increases, the NCC yield increases and the \n\n\n\nNCC colour develops into a darker tint. On the other hand, a \n\n\n\nhigh reaction temperature (80\u00b0C) can enhance the zeta \n\n\n\npotential and increase the NCC colour but reduce the NCC \n\n\n\nyield. Furthermore, increasing reaction time can enhance zeta \n\n\n\npotential of NCC. \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:reem.a.abouasi@uoalkitab.edu.iq\n\n\nmailto:sychan@usm.my\n\n\nmailto:abdulsalamqahtan@student.usm.my\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 140-181 \n\n\n\n\n\n\n\nResearch abstracts of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022 \n\n\n\nDOI:  10.52494/YOXJ1358 \n\n\n\n\n\n\n\n179 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 058 \n \n\n\n\nIsolation and Chemical Structural \n\n\n\nCharacterisation of a Compound with \n\n\n\nWound Healing Activity from The \n\n\n\nEuphorbia hirta L. Extract \n \n\n\n\nDania F. Alsaffar1, Sura F. Alsaffar2, Nur \n\n\n\nHidaya kaz Abdula1* \n \n1School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, \n\n\n\nMalaysia. \n2Department of Biology, College of Science, Baghdad University, \n\n\n\nBaghdad, Iraq. \n* hidayahkaz@usm.my  \n\n\n\n\n\n\n\nBackground: Euphorbia hirta, a member of the \n\n\n\nEuphorbiaceae family, is wildly used in traditional medicine \n\n\n\nto treat a number of disease conditions in tropical and \n\n\n\nsubtropical countries. It has been identified to possess anti-\n\n\n\ninflammatory and wound healing effects. Objectives: The \n\n\n\naim of present study focuses on the isolation of the main \n\n\n\nactive compounds associated with wound healing activity of \n\n\n\nplant. Methods: The ariel part of E. hirta ground to a fine \n\n\n\npowder and sequentially extracted with n-hexane, \n\n\n\nchloroform, methanol, and water using serial exhaustive \n\n\n\nextraction (SEE) method. All extracts were assessed for \n\n\n\npotential wound healing activity by measuring the migration, \n\n\n\nproliferation, and viability of human fibroblast cells, Hs27. \n\n\n\nThe extract that shows the best wound healing activities were \n\n\n\nfurther fractionated using a bioactivity-guided approach, in \n\n\n\norder to identify the active compounds responsible for wound \n\n\n\nhealing. The structure elucidation of isolated compounds \n\n\n\nwere confirmed by IR, LC-MS/MS, NMR and HPLC. \n\n\n\nResults: The methanolic extract showed the highest \n\n\n\nproliferation and cells migration percent after 24-hour \n\n\n\ntreatment. The isolated compound was subsequently \n\n\n\nidentified as kaempeferol-3-O-glucoside (Astragalin). \n\n\n\nConclusion: This study provides a novel information to \n\n\n\nsupport the ethnomedicinal usage of E. hirta L as a wound \n\n\n\nhealer. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 059 \n\n\n\n \nMinocycline Improved Anxiety-Like \n\n\n\nBehaviour in Lipopolysaccharide (LPS)-\n\n\n\nInduced Neuroinflammation Rat\u2019s Model \n \n\n\n\nEntesar Yaseen Abdo Qaid1*, Rahimah \n\n\n\nZakaria2, Zuraidah Abdullah1, and Idris \n\n\n\nLong1\n \n\n\n\n1Biomedicine Programme, School of Health Sciences, Universiti Sains \nMalaysia, Kelantan, Malaysia \n2Physiology Department, School of Medical Sciences, Universiti Sains \n\n\n\nMalaysia, Kelantan, Malaysia \n* idriskk@usm.my  \n \n\n\n\nBackground: Minocycline has shown beneficial anxiolytic \n\n\n\neffects in various neuroinflammatory diseases. However, its \n\n\n\nanti-anxiety property in lipopolysaccharide (LPS)-induced \n\n\n\nneuroinflammation rat model has not been clearly understood. \n\n\n\nObjective: This study investigates the anxiolytic effects of \n\n\n\nminocycline and N-Methyl-D-Aspartate (NMDA) receptor \n\n\n\nantagonist (memantine) in LPS-induced neuroinflammation \n\n\n\nrat model. Methods: Male Sprague Dawley rats were divided \n\n\n\ninto 5 groups: (i) control, (ii) untreated LPS (iii) LPS treated \n\n\n\nwith 25 mg/kg minocycline, (iv) LPS treated with 50 mg/kg \n\n\n\nminocycline and (v) LPS treated with 10 mg/kg memantine. \n\n\n\nMinocycline (25 & 50 mg/kg) and memantine (10 mg/kg) \n\n\n\ntreatments were given intraperitoneally once daily for 14 \n\n\n\ndays, while LPS was injected once at day 5. Open field test \n\n\n\n(OFT) was performed to assess anxiety-like behaviour on \n\n\n\ndays 23 till days 28. The parameters used to assess anxiety \n\n\n\nare rearing frequency, time spent in the centre of the open \n\n\n\nfield and frequency of entries into the centre and grooming \n\n\n\nfrequency. Results: There was a significant decrease in \n\n\n\nrearing frequency, time spent in the centre of the open field \n\n\n\nand frequency of entries into the centre (p<0.05, p<0.05, \n\n\n\np<0.05) and increase in grooming frequency (p<0.05) in the \n\n\n\nLPS compared to control groups. Minocycline at both doses \n\n\n\nand memantine significantly increased rearing frequency, \n\n\n\ntime spent in the centre of the open field and frequency of \n\n\n\nentries into the centre (p<0.05, p<0.05, p<0.05) and \n\n\n\ndecreased grooming frequency (p<0.05) compared to LPS \n\n\n\ntreated group. Conclusion: Minocycline can attenuate \n\n\n\nanxiety-like behaviour in LPS injected rat comparable to \n\n\n\nmemantine. Thus, minocycline has beneficial preventive-\n\n\n\ntherapeutic effects for neuroinflammatory diseases such as \n\n\n\nAlzheimer\u2019s disease (AD) and Parkinson disease (PD). \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:hidayahkaz@usm.my\n\n\nmailto:idriskk@usm.my\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 140-181 \n\n\n\n\n\n\n\nResearch abstracts of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022 \n\n\n\nDOI:  10.52494/YOXJ1358 \n\n\n\n\n\n\n\n180 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 060 \n \n\n\n\nTo Produce and Characterise Inhalable \n\n\n\nNano- and Micro- Polyhydroxyalkanoate \n\n\n\n(PHA) Particles Containing Verapamil \n\n\n\nHydrochloride Using a Modified Water-in-\n\n\n\nOil-in-Water (W/O/W) Double Emulsion \n\n\n\nTechnique \n \n\n\n\nSowmya Ramachandran1, Thaigarajan \n\n\n\nParumasivam1*, and K Sudesh Kumar2 \n \n1School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang \n2School of Biological Sciences, Universiti Sains Malaysia, Penang \n\n\n\n* thaigarp@usm.my  \n\n\n\n\n\n\n\nBackground: Polyhydroxyalkanoates (PHA) have garnered \n\n\n\nsignificant attention as a depot in drug delivery due to their \n\n\n\nfavourable biocompatibility, biodegradability, and sustained \n\n\n\ndrug release properties. Objective: To produce optimised \n\n\n\ninhalable nano (size <500 nm) and micron (size 1-3\u03bcm) size \n\n\n\nP(3HB-co- 4HB-co-5HV-co-3HHx) particles using a water-\n\n\n\nin-oil-in-water (W1/O/W2) double emulsion technique for a \n\n\n\nhigh encapsulation of verapamil as a model drug. Methods: \n\n\n\nThe parameters tested were surfactant (polyvinyl alcohol-\n\n\n\nPVA) concentration (i.e., 1%, 3%, 5%), internal water phase \n\n\n\n(W1) and oil phase (O) , PHA mass (i.e., 20mg, 40mg, and \n\n\n\n60mg) and drug concentration (i.e., 20mg, 40mg, and 60mg). \n\n\n\nBased on statistics, surface methodology (RSM) using a \n\n\n\ncentral composite design was employed to optimise these \n\n\n\nvariables for a high drug loading and entrapment efficiencies \n\n\n\nof verapamil. Results: We found that the optimal conditions \n\n\n\nfor high drug loading (23.37\u00b112.22%) and entrapment \n\n\n\nefficiency (38.95\u00b120.37%) of P (3HB-co- 4HB-co-5HV-co-\n\n\n\n3HHx) nanoparticles are 60mg of verapamil in 0.5ml W1-\n\n\n\nphase, 40mg of PHA in 1ml O-phase and 1% PVA in 15ml \n\n\n\nW2-phase. On the other hand, for microparticles are 40mg of \n\n\n\nverapamil in 0.5ml W1-phase, 60mg of PHA in 1ml O-phase \n\n\n\nand 3% PVA in 15ml W2-phase which showed drug loading \n\n\n\nand entrapment efficiency of 18.09\u00b11.14% and 45.24\u00b12.86%, \n\n\n\nrespectively. Conclusion: In this study, we have reported \n\n\n\noptimal conditions to produce nano- and micro- P(3HB-co- \n\n\n\n4HB-co-5HV-co-3HHx) particles with high drug loading and \n\n\n\nencapsulation efficiency of verapamil. Further studies are \n\n\n\nbeing carried out to investigate the powder's dispersibility for \n\n\n\nthe application of pulmonary drug delivery.  \n\n\n\n\n\n\n\n\n\n\n\nAbstract 061 \n \n\n\n\nAnalysis of Increased AST and ALT in \n\n\n\nCOVID-19 Patients with Favipiravir \n \n\n\n\nSuharjono1*, Chairunnisa1, Mariyatul \n\n\n\nQibtiyah2, and Ariani Permatasari3 \n \n1Master of Clinical Pharmacy Programme, Faculty of Pharmacy, Universitas \n\n\n\nAirlangga \n2Department of Pharmacy, Dr.Soetomo General Hospital, Surabaya \n3Department of Pulmonology and Respiratory, Dr Soetomo General \n\n\n\nHospital, Surabaya \n* suharjono@ff.unair.ac.id   \n\n\n\n\n\n\n\nBackground: COVID-19 can be categorized as a pandemic \n\n\n\nand is the first pandemic caused by the SARS-CoV-2 virus. \n\n\n\nFavipiravir is one of the Emergency Use Authorization \n\n\n\nantiviral drugs for COVID-19. One of the most common side \n\n\n\neffects of Favipiravir is an increase in serum transaminase. \n\n\n\nFurthermore, there are other risk factors that can cause \n\n\n\nhepatotoxicities such as COVID-19 disease itself, sex, age, \n\n\n\ncomorbidities, and the potential hepatotoxicity drugs in \n\n\n\nCOVID-19 therapy. Objective: This study aims to evaluate \n\n\n\nthe effect of Favipiravir on increasing AST and ALT in \n\n\n\nCOVID-19 patients and the risk factors that can cause these \n\n\n\neffects. Methods: This study retrospectively on COVID-19 \n\n\n\npatients who received Favipiravir therapy in June-August \n\n\n\n2021 at Dr. Soetomo General Hospital, Surabaya. The total \n\n\n\nsample was 230 medical records. The results obtained where \n\n\n\npatients with gender male patients were 52.6% higher than \n\n\n\nfemale patients by 47.4%. Statistical analysis was performed \n\n\n\nwith SPSS version 26. Results: The prevalence of increases \n\n\n\nabove upper limit of normal between day-7 and day-14 in \n\n\n\nAST (16.5%) and ALT (24.3%). An increase \u22653-5 times \n\n\n\nupper limit of normal in AST (3.9%) and ALT (8.3%). \n\n\n\nALT >5 times upper limit of normal (5.2%). The risk factors \n\n\n\nfor sex, age, coronavirus symptoms, co-morbidities, and the \n\n\n\npotential hepatotoxic drugs tested in this study were not \n\n\n\nstatistically significant in increasing AST and ALT. Further \n\n\n\nresearch to determine the hepatotoxicity of use Favipiravir \n\n\n\nprospectively. Conclusions: Favipiravir could affect AST \n\n\n\nand ALT function and reversible. \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:suharjono@ff.unair.ac.id\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 140-181 \n\n\n\n\n\n\n\nResearch abstracts of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022 \n\n\n\nDOI:  10.52494/YOXJ1358 \n\n\n\n\n\n\n\n181 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 062 \n\n\n\n\n\n\n\nFormulation of Co-Enzyme Q10 Ternary \n\n\n\nInclusion Complexes Using \n\n\n\nBetacyclodextrin (\u0392cd) and Hydrophilic \n\n\n\nPolymers Silica Syloid Xdp/ Sodium \n\n\n\nAlginate) \n \n\n\n\nRabia Munir, SajidAsghar, Muhammad Irfan, \n\n\n\nIkramUllah Khan \n \n\n\n\nDepartment of pharmaceutics, Faculty of pharmaceutical Sciences, \nGovernment college university, Faisalabad, Punjab, Pakistan \n\n\n\n*haroonkhalid80@gmail.com; syedharoonkhalid@gcuf.edu.pk  \n\n\n\n\n\n\n\nBackground: Co-enzyme Q10 (CoQ10) is an insoluble, \n\n\n\npoorly permeable antioxidant with great biological value \n\n\n\nwhich act as anti-aging and anti-wrinkle agent. CoQ10 can \n\n\n\nquench the free radicals and helps in slowing the process of \n\n\n\naging. Objective: The present study was designed to evaluate \n\n\n\nthe effect of hydrophilic polymers silica Syloid (XDP) and \n\n\n\nsodium alginate on the complexation efficiency and \n\n\n\ndissolution of CoQ10 and beta cyclodextrin (\u03b2CD) complex. \n\n\n\nMethods: The binary inclusion complexes were prepared \n\n\n\nusing solvent evaporation, kneading and freeze-drying \n\n\n\nmethods at various W/W% drug and polymer ratios (1:1, 1:2 \n\n\n\nand 1:4). The addition of hydrophilic polymers (silica Syloid \n\n\n\nXDO and sodium alginate) at 0.5, 2.5, 5.0 and 10 % W/W \n\n\n\nmarkedly improved the complexation and solubilizing \n\n\n\nefficiency of \u03b2CD. The samples were further evaluated for \n\n\n\nphysicochemical evaluation and morphology Results: The \n\n\n\nbinary and ternary samples showed high stability constant \n\n\n\n(Ks) value and complexation efficiency (CE). The \n\n\n\ndissolution study results revealed significant enhancement in \n\n\n\nthe release of the binary inclusion complex and ternary \n\n\n\ninclusion complex compared to pure CoQ10. Fourier \n\n\n\ntransform infrared (FTIR) results confirm the complex \n\n\n\nformation. X-ray powder diffractometry (XRD) and scanning \n\n\n\nelectron microscopy (SEM) data revealed modification in the \n\n\n\nstructure of CoQ10. Conclusion: In conclusion, a remarkable \n\n\n\nenhancement in dissolution was attained due to marked \n\n\n\nimprovement in solubility through complexation of CoQ10 \n\n\n\nwith \u03b2CD and silica Syloid (XDP)/\u03b2CD. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\nmailto:*haroonkhalid80@gmail.com\n\n\nmailto:syedharoonkhalid@gcuf.edu.pk\n\n\n\n"
"\n\nMalaysian Journal of Pharmacy 2003;1(3):86-90  Research article \n\n\n\n 86\n\n\n\nOutpatient Prescription Intervention \nActivities by Pharmacists in a Teaching \nHospital \n \nChua Siew Siang1*, Kuan Mun Ni1, Mohamed Noor bin Ramli2 \n \n\n\n\n1Department of Pharmacy, Faculty of Medicine, University of Malaya, 50602 Kuala Lumpur \n2Outpatient Polyclinic Pharmacy Unit, Universiti Malaya Medical Centre, 59100 Kuala Lumpur  \nMalaysia \n \n*Author for correspondence  \n \nABSTRACT \n \nPrescriptions with prescribing errors received by an outpatient pharmacy of a \nteaching hospital were sampled. The types of pharmacist interventions on \nproblematic prescriptions and its outcome were identified and documented. From a \ntotal of 6340 prescriptions processed by the outpatient pharmacy in a one-week \nperiod, 43 prescriptions (0.68%) required interventions by the pharmacy staff. \nThese included 54% of the prescriptions that were incomplete or inadequately \nwritten  (errors of omission) and 46% that contained the wrong drug, dose regimen, \nstrength and dosage form (errors of commission). A total of 62 types of action were \ntaken by the pharmacy staff to resolve the 43 problematic prescriptions. These \ninclude contacting the prescribers concerned (24.2%), clarifying with the patient or \nhis/her representative (19.4%), contacting the prescriber\u2019s nurse (17.7%) and \nchecking the patient\u2019s appointment or identity card (4.8%).  Of the 43 problematic \nprescriptions, 48.8% were clarified without any change and dispensed while 32.6% \nwere changed and dispensed. The study reinforces the importance of prescription \nscreening and interventions by pharmacists in minimising preventable adverse \nevents attributed to medication errors. It also emphasizes the necessity of \ninterdisciplinary communication and cooperation in identifying and resolving \nprescribing errors and irregularities in order to achieve optimal therapeutic \noutcomes for the patient. \n \nKeywords: prescription, pharmacist, intervention, errors of omission, errors of \ncommission \n \n \n \nINTRODUCTION \n \nThe dispensing \u201cchain\u201d may be conceptualised \nas a sequence of interrelated, interdependent, and \nat least historically, interdisciplinary activities \nthat result in the delivery of the prescription drug \nand appropriate drug-use information to the \npatient (1). \n\n\n\n \n \nA study showed that 99% of the 137 general \npractitioners surveyed agreed that pharmacists \nhave a role to play in the screening of \nprescriptions for possible problems (2). Most \npharmacists would probably agree that the \nscreening of prescriptions is one of the \n\n\n\n\n\n\n\n\nResearch article: Outpatient prescription intervention activities by pharmacists \n\n\n\n 87\n\n\n\nprofessional responsibilities assumed by every \npharmacist but the degree to which prescription \nscreening is performed varies greatly among \ndifferent drug-delivery systems and even among \ndifferent pharmacists\u2019 practices. Thus, \nprescription screening represents a legitimate \nvalue-added pharmaceutical service in practice, \nif not in principle (3).  \n \nMany studies had identified and documented \nproblems associated with prescribing errors. The \nextent of such errors varied from 2.6% to 15.4% \nor estimated as 2.87 to 4.9 per 1000 medication \norders (1, 4-11).  An audit on community \npharmacies found that 2.6% of the prescriptions \nrequired active pharmacist intervention to \nresolve a prescribing error (1). Another study \nconducted in outpatient pharmacies found that \napproximately 4 per 100 dispensed prescriptions \nhad problems and required pharmacists \nintervention (5). In 44% of the intervention, the \noutcome was a change in drug, strength or \ndirections of drug use (5).    \n \nMost prescription interventions by pharmacists \nhave a limited potential for medical harm \nalthough it may be inappropriate in some \ninstances as mentioned by Hawkey and \ncolleagues (7). However, it should be noted that \na small number of detected prescribing errors \nhave a major potential for medical harm if not \ncorrected and hence, the importance of \npharmacist interventions is not overemphasized. \nThe ultimate goal for combining the unique \nknowledge and competencies of both medical \nand pharmaceutical professionals is to achieve \noptimal therapeutic outcomes and quality of life \nfor the patient. Therefore, both professions have \na definite role to play and should work hand-in-\nhand towards achieving this common goal.  \n \nAlthough most pharmacists in Malaysia are \ninvolved in prescription screening and \ninterventions to varying degree, documentation \nof such activities appeared scarce in the \nliterature. Therefore, the present study was \nconducted to identify and document the types of \npharmacist intervention and its outcome on \nproblematic prescriptions.   \n \nMETHOD \n \nThis study was conducted over a one-week \nperiod in May 1998 in the Outpatient Pharmacy \nDepartment (OPPD) of a large teaching hospital \nin Malaysia. This OPPD received an average of \n\n\n\n1057 prescriptions per day during the study \nperiod and was run by one registered pharmacist, \n3 trainee pharmacists and 8 pharmacy assistants.  \n \nThe study sampled problematic prescriptions \nreceived by the OPPD within the one-week \nperiod (excluding the Sunday). Senior pharmacy \nassistants act as the front line for the screening of \nprescriptions received by this OPPD. Any \nproblematic prescriptions would be referred to \nthe trainee pharmacist or the pharmacist.  The \nresearcher would then record the type of \nintervention made by the pharmacy staff and its \noutcome prospectively. A standard format \nrecommended by Rupp (3) was used to record all \nthe data. Reasons for pharmacist intervention \nwere classified according to the types of \nprescribing errors used by Rupp (3), that is errors \nof omission and errors of commission.   \n \nRESULTS \n \nOf the 6340 prescriptions received by the OPPD \nduring the one-week sampling period (excluding \nthe Sunday), 43 required intervention by the \npharmacy staff. This gives an overall \nintervention rate of 0.68% and an average of 7.2 \nprescriptions intervened per day.  \n\n\n\n \nA total of 50 different errors were identified in \nthe 43 prescriptions with an average of 1.2 errors \nper prescription. Most of the prescriptions had \none error (37 prescriptions) while another 5 had \n2 errors and 1 prescription had 3 errors. These \nerrors are classified as in Table 1 with examples \nfor each type of errors. Violation of legal or \nprocedural requirements such as absence of the \nprescriber\u2019s name or signature, registration \nnumber for psychotropic agents and patient \nparticulars are also included. The prescription \nintervened in the category of drug therapy \nmonitoring was due to a possibility of \nhypokalaemia from the use of LasixR without the \nconcurrent use of Slow KR.   \n\n\n\n \nA total of 62 types of action were taken by the \npharmacy staff to resolve the 43 problematic \nprescriptions, giving an average of 1.4 actions \nper problematic prescription. These include \ncontacting the prescribers concerned (24.2%), \nclarifying with the patient or his/her \nrepresentative (19.4%), contacting the \nprescriber\u2019s nurse (17.7%) and checking the \npatient\u2019s appointment or identity card (4.8%).  \n \nOf the 43 problematic prescriptions, 48.8% were \n\n\n\n\n\n\n\n\nResearch article: Outpatient prescription intervention activities by pharmacists \n\n\n\n 88\n\n\n\nTable 1:  Classification of reasons for pharmacist intervention. \n \n\n\n\nReasons for pharmacist \nintervention  \n\n\n\nFrequency \n(%, n=50)  \n\n\n\nExamples \n\n\n\nErrors of omission   \nQuantity to supply not specified   9 (18) T. Pantoprazole 40mg bd \n\n\n\nT. Daonil 5mg bd \nT. Imipramine 25mg on \nMorphine Mixture 10mg tds \n \n\n\n\nDose / regimen not specified   5 (10) Glibenclamide od x 12/52 \n\u2018O\u2019 Cephalexin 250mg x 1/12 \n \n\n\n\nForm / strength not specified   4 (8) Dipyridamole 1 tab od x 16/52 \nHumulin 10 IU tds x 1/52  \nZocor  1 daily x 3 mths \n \n\n\n\nNo signature or name of \nprescriber \n\n\n\n  2 (4)  \n\n\n\nNo registration number   1 (2)  \nNo patient\u2019s name   1 (2)    \nIllegible   5 (10) Patient\u2019s name \n\n\n\nCaptopril 0.25 daily x 2/52 \nSy. Prednisolone 25mg tds \nHCT (hydrocortisone or \nhydrochlorothiazide) \n \n\n\n\n      Subtotal 27 (54)  \n\n\n\nErrors of commission   \nWrong dose / regimen 12 (24) Famotidine 200mg \n\n\n\nDiamicron 1 gm tds \nMetformin 80mg bd \nThyroxine 200mcg bd \nLisinopril 10mg tds \nNuelin 5mg on \nBactrim 250mg bd x 1/52. \nPrednisolone 60mg/m2 \n130mg x 28 days \n \n\n\n\nRequired strength not available   5 (10) Prothiaden 100mg nocte x 16/52 (only \n75mg available) \n \n\n\n\nWrong drug / indication   1 (2) Magnesium sulphate (should be \nmagnesium trisilicate) \n \n\n\n\nWrong dosage form   2 (4) Humulin R 8IU tds x 8/52 (should be \npenfill) \n \n\n\n\nDose did not correlate with \nquantity \n\n\n\n  1 (2) Methotrexate 25mg ( 1 tab) should be \n10 tablets \n \n\n\n\nRequired brand not available   1 (2) Sy. Vermox 5ml stat \n \n\n\n\nPossible side effects / toxicity   1 (2) Lasix given without Slow KR \n \n\n\n\n     Subtotal 23 (46)  \n\n\n\nTotal  50 (100)  \n \n\n\n\n\n\n\n\n\nResearch article: Outpatient prescription intervention activities by pharmacists \n\n\n\n 89\n\n\n\nclarified without any change and dispensed while \n32.6% were changed and dispensed. Three \nprescriptions were dispensed as written and this \nincluded the prescription where addition of Slow \nKR was suggested for the patient on LasixR. The \nother two prescriptions involved methotrexate 5 \nmg daily and a prescription with three different \ntypes of syrups for a baby. Two patients were \nsent back to the clinics concerned with their \nproblematic prescriptions but did not return \nwhile the prescribers for another two \nprescriptions could not be contacted. One \nprescription was not dispensed as the strength \nrequested by the prescriber was not available in \nthe hospital and the patient was asked to buy it \nfrom another pharmacy.  \n \nDISCUSSION \n \nThe rate of omission errors (54%) and \ncommission errors (46%) obtained in this study \nare comparable to that reported by Rupp and \ncolleagues (1), with 51% and 29%, respectively. \nIt should be emphasized that one of the main \nerrors in the present study involved wrong dose \nor regimen prescribed (24%). The study by Rupp \nand colleagues (1) showed similar results. This \nerror of commission could lead to fatal \nconsequences if left unidentified and \nuncorrected. For example, famotidine was \nprescribed as 200 mg instead of 20 mg. This \nrepresents a 10 times overdose if the error has \nnot been detected. Decimal points in drug dosage \nshould also be clearly written especially for drug \nwith a wide dose range such as prednisolone that \nmay be prescribed as 2.5mg or 25mg, depending \non the condition of the patient.  Additionally, \ndrugs with similar names often cause confusion \nas in the case of magnesium sulphate being \nprescribed instead of magnesium trisilicate.  \nAronson (12) had suggested some measures to \nminimize such confusion. \n \nFrom the results of the study, the proportion of \nprescription interventions appeared small \n(0.68%) compared to other studies where \nintervention rate of 2.6 and 2.9% had been \nrecorded (1, 7). Some problematic prescriptions \nespecially those with errors of omission may \nhave been dispensed with some assumptions and \nhence no pharmacist intervention was \ndocumented. The possibility of some \nprescriptions with errors being dispensed to the \npatients without being detected could not be \nruled out. The utilisation of information \ntechnology via computerization of prescription \n\n\n\nscreening and electronic prescribing may \nminimise such occurrence. However, the \nstandardization of processes and the expanded \nuse of the expertise of pharmacists through better \nintegration of the health care team are just as \nimportant. \n \nThe pharmacist or trainee pharmacist had to \ncontact the prescriber or the prescriber\u2019s nurse 26 \ntimes to resolve 23 problematic prescriptions \n(53% of the 43 problematic prescriptions). This \nemphasizes the importance of interdisciplinary \ncommunication and cooperation in identifying \nand resolving prescribing errors and \nirregularities.  The community pharmacists in the \nstudy by Rupp and colleagues (1) had to contact \nthe prescriber or prescriber\u2019s assistants to resolve \n80% of the problematic prescriptions. This \nhigher rate could be explained by the difference \nin the sampling frame between the two studies. \nThe present study involved prescription \nscreening by the pharmacy staff who were more \nfamiliar with the prescribing habits of the \nprescribers in the same hospital. Therefore, the \npharmacy staff could resolve a higher proportion \nof the problems encountered without contacting \nthe prescribers than the community pharmacists \nin the study by Rupp and colleagues (1) who \nreceived prescriptions from many different \nclinics and hospitals. \n\n\n\n \nThe results also showed that the prescribers \nsubsequently changed 32.6% of the problematic \nprescriptions identified by the pharmacy staff.  \nAnother 48.8% of the prescriptions were \nclarified without any change and dispensed. This \nis comparable to the study by Rupp and \ncolleagues (1) that showed similar outcome \ndescription of 32% and 53.8%, respectively. \nThese results further support the importance of \npharmacist intervention in minimising \npreventable adverse events attributed to \nmedication errors.  \n\n\n\n \nAlthough the present study was conducted in \nonly one hospital, research of such nature could \nprovide an invaluable database for future \nreference and for identifying specific individual \nand institutional deficiencies in prescribing. \nConsequently, appropriate design and \nimplementation of strategic educational \nprogrammes or institutional procedures could be \ndeveloped to eliminate the occurrence of such \npreventable medication errors and to limit the \nrisk to patients.   \n\n\n\n \n\n\n\n\n\n\n\n\nResearch article: Outpatient prescription intervention activities by pharmacists \n\n\n\n 90\n\n\n\nCONCLUSION \n \nThe study reinforces the importance of \nprescription screening and interventions by \npharmacists in minimising preventable adverse \nevents attributed to medication errors.  It also \nemphasizes the necessity of interdisciplinary \ncommunication and cooperation in identifying \nand resolving prescribing errors and irregularities \n\n\n\nin order to achieve optimal therapeutic outcomes \nfor the patient. \n \nACKNOWLEDGEMENT \n \nThe authors wish to thank the staff of the \nOutpatient Polyclinic Pharmacy Unit, Universiti \nMalaya Medical Centre for their assistance and \ncooperation.\n\n\n\n\n\n\n\n***** \n \n\n\n\nREFERENCES \n \n1. Rupp MT, Schondelmeyer SW, Wilson GT, \n\n\n\nKrause JE. Documenting prescribing errors and \npharmacist interventions in community pharmacy \npractice. Am Pharm  1988; NS28: 30-37. \n\n\n\n2. Ellis BC, Dovey SM, Collins DM, Tilyard MW, \nClark DWJ. General practitioners\u2019 views on the \nrole of the community pharmacist. N Z Med J \n1992; 105: 403-405. \n\n\n\n3. Rupp MT. Screening for prescribing errors. Am \nPharm 1991; NS31: 71-78. \n\n\n\n4. Bates DW, Boyle DL, Vander Vliet MB, \nSchneider J, Leape LL. Relationship between \nmedication errors and adverse drug events. J Gen \nIntern Med 1995; 10: 199-205. \n\n\n\n5. Christensen DB, Campbell WH, Madsen S, \nHartzema AG, Nudelman PM. Documenting \noutpatient problem intervention activities of \npharmacists in an HMO. Med Care 1981; 19: 105-\n117. \n\n\n\n6. Folli HL, Poole RL, Benitz WE, Russo JC. \nMedication error prevention by clinical \npharmacists in two children\u2019s hospital.  \n\n\n\n \n \nPediatrics 1987; 79: 718-722.  \n\n\n\n7. Hawkey CJ, Hodgson S, Norman A, Daneshmend \nTK, Garner ST. Effect of reactive pharmacy \nintervention on quality of hospital prescribing. \nBMJ 1990; 300: 986-990.        \n\n\n\n8. Ingrim NB, Hokanson JA, Guernsey BG, Doutre \nWH, Blair CW Jr, Verrett TJ. Physician \nnoncompliance with prescription writing \nrequirements. Am J Hosp Pharm 1983; 40: 414-\n417. \n\n\n\n9. Morrill GB, Barreuther C. Screening discharged \nprescriptions. Am J Hosp Pharm 1988; 45: 1904-\n1905. \n\n\n\n10. Lesar TS, Briceland L, Stein DS. Factors related to \nerrors in medication prescribing. JAMA 1997; 277: \n312-317. \n\n\n\n11. Lesar TS, Lomaestro BM, Pohl H. Medication \nprescribing errors in a teaching hospital. A 9-year \nexperience. Arch Intern Med 1997; 157: 1569-76. \n\n\n\n12. Aronson JK. Confusion over similar drug names: \nProblems and solutions. Drug Safety 1995; 12(3): \n155-160.  \n\n\n\n\n\n"
"\n\nMalaysian Journal of Pharmacy Volume 8 Issue 1 (2022) \n \n\n\n\n\n\n\n\n19 \n \n\n\n\n*Correspondence: boontianglau@gmail.com 1 Department of Pharmacy, Hospital Port Dickson, Malaysia. 71050 Port \nDickson, Negeri Sembilan, Malaysia \n2 Department of Pharmacy, Hospital Tuanku Jaafar Seremban, Malaysia. \n70300 Seremban, Negeri Sembilan, Malaysia. \n3 Department of Pharmacy, Hospital Tuanku Ampuan Najihah, Malaysia. \n72000 Kuala Pilah, Negeri Sembilan, Malaysia \n\n\n\n\n\n\n\nMALAYSIAN \nJournal of \nPharmacy \n\n\n\n Original Article \n \n\n\n\nContraceptive Intention among Postpartum Women and \nWillingness for Pharmacist Counselling in Negeri Sembilan, \nMalaysia: A Cross-Sectional Study  \n \nBoon-Tiang Lau1*, Siew-Yen Ng2, Mohd-Farizh Che-Pa2, Muhammad-Faizal Maarof3, Dinesh-Kumar \nSubaramaniam3, Zetty-Ellyssa Sallehuddin2, Noor-Izzati-Filza Salihoudin2, Noor-Husna-Nazirah A. \nRazak1, Jing-Sze Teen2, Kalai-Divvya Ramasamy2, Syamimi-Aqilah Abdull-Kahar3  \n \n\n\n\n \nArticle Info  \n \nReceived date: 30 Jan 2022  \nAccepted date: 03 Apr 2022 \nPublished date: 30 Jun 2022 \n \nKeywords: Postpartum, \ncontraceptive \n\n\n\nABSTRACT  \n  \nIntroduction:  Postpartum woman and child health is a public health concern as closely spaced \npregnancies can lead to adverse maternal and infant outcomes. However, data regarding \ncontraceptive intention among Malaysian postpartum women is lacking. Objective: This study aimed \nto determine the preferred contraceptive methods among postpartum women, the barriers to \ncontraceptive use among non-users, and the willingness to seek contraceptive counselling provided \nby pharmacists, besides also aiming to explore factors associated with the intention to use \ncontraceptives. Method: This research involved a cross-sectional study among postpartum women \nwho delivered their babies in three main hospitals in Negeri Sembilan, Malaysia. A simple random \nsampling method was used to recruit study participants from September 2019 to January 2020. A \nface and content validated questionnaire was used for data collection. Descriptive data were presented \nas numbers and percentages. Pearson Chi-squared test and multiple logistic regression were used for \ninferential analysis. Result: The response rate was 98.8%. Of the 409 respondents, 84.8% were \u2264 35 \nyears of age, 99.5% were married, and 79.2% were of Malay descent. More than half (62.9%) \npreferred using modern and non-modern contraceptive methods. The main barriers to contraceptive \nuse were not feeling like using any contraceptive method (52%) and concerns about side effects \n(26.7%). Spouse education level (adj OR 2.141, 95% CI 1.267 - 3.617) and experience on previous \nformal contraceptive counselling (adj OR 3.642, 95% CI 2.091 - 6.343) significantly influenced the \nintention. The majority of respondents (82.4%) were willing to get contraceptive counselling from a \npharmacist. Conclusion: The majority of the Malaysian postpartum women express interest in using \nboth modern and non-modern contraceptive methods. Pharmacists could expand their services by \nadvising on the appropriate choice of contraceptive methods in the future. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nLau B.T.et al. Mal J Pharm 8 (1) 2022, 19-25 \n \n\n\n\n20 \n \n\n\n\n\n\n\n\nINTRODUCTION  \n \nShort interpregnancy interval is a public health concern. It is \nknown that closely spaced pregnancies can lead to adverse \nmaternal and infant outcomes, such as preterm birth [1,2,3], \nlow birth weight [4,5,6], and small for gestational age [3]. In \nfact, the adverse pregnancy outcomes are higher for \nconceptions within the first-year postpartum [7], and can be \nfurther exacerbated if the pregnancy interval is less than six \nmonths [3,8]. The World Health Organization recommends a \nperiod of at least 24 months between a delivery and its \npregnancy [9]. Indeed, by maintaining an interpregnancy \ninterval of more than two years, greater than 30% of maternal \ndeaths and 10% of child mortality could be prevented [10].  \n \nBecause of the known harms, an adequately spaced pregnancy \nis of paramount importance. Unintended pregnancies after \nchild delivery could be averted through postpartum \ncontraception, also known as family planning, by initiating \ncontraceptive methods within the first 12 months of delivery \n[11,12]. Generally, contraceptive methods, or birth control \nmethods, can be categorised as modern and non-modern [13]. \nThe effectiveness of each method varies across the board \n[14,15]. Data from low-to-middle-income countries have \nreported an overall pooled modern contraceptive prevalence \nrate of 41.2% during the postpartum period [16]. Meanwhile, \nin Malaysia, approximately 52.2% of married women aged \nbetween 15 - 49 have had prior use of, or were using family \nplanning methods whereby 34.3% and 17.9% of women used \nmodern and non-modern methods, respectively [13]. To date, \nhowever data on contraception among Malaysian postpartum \nwomen is still considerably lacking. Furthermore, the potential \nbarriers to contraceptive use among local postpartum women \nhave yet to be determined. \n \nThis study aimed to evaluate the intention of postpartum \nwomen to use contraception. The barriers faced by the \nparticipants against the use of contraceptives among non-users, \nand their willingness to obtain postpartum contraceptive \ncounselling from a pharmacist were also assessed. The factors \naffecting contraceptive intention was also examined in the \nstudy. \n \nEthics approval \n \nThis study was registered with the National Medical Research \nRegistry, Ministry of Health Malaysia (NMRR-19-363-45994). \nThe questionnaire and methodology for this study were \napproved by The Medical Research and Ethics Committee, \nMinistry of Health Malaysia (KKM/NIHSEC/P19-1046). \n \n \n \n\n\n\nMETHOD  \n \nStudy Design and Study Subjects \n \nThis was a multi-centred, cross-sectional study conducted in \nseven Obstetrics and Gynaecology (O & G) wards of three \nleading hospitals in Negeri Sembilan, Malaysia: Hospital \nTuanku Ja'afar Seremban, Hospital Tuanku Ampuan Najihah, \nand Hospital Port Dickson from 1 September 2019 to 31 \nJanuary 2020. \n \nThe target population was postpartum women hospitalised for \nat least one day at four O & G wards of Hospital Tuanku Ja'afar \nSeremban, two O & G wards of Hospital Tuanku Ampuan \nNajihah and one O & G ward of Hospital Port Dickson. \nPostpartum women who were \u2265 18 years old and understood \nthe Malay or English language were included in the study. \nPatients who did not wish to be interviewed, were mentally \nand/or physically unstable, or did not complete the \nquestionnaire were excluded. \n \nThere were 15 233 births in 2018, i.e., 10451 (~65%), 3588 \n(~25%), and 1194 (~10%) in Hospital Tuanku Ja'afar \nSeremban, Hospital Tuanku Ampuan Najihah, and Hospital \nPort Dickson, respectively. Preliminary considerations suggest \nthat a total of 375 study subjects were needed after taking into \naccount the number of births, a margin of error 5%, a \nconfidence interval of 95%, and a response distribution of \n52.2% [13]. Furthermore, it is suggested that approximately \n450 postpartum women were required, with the presumption of \n20% non-response rate. A total of 293 participants were \npatients from Hospital Tuanku Ja'afar Seremban, 113 from \nHospital Tuanku Ampuan Najihah, and 45 from Hospital Port \nDickson. Potential study subjects were recruited through a \nsimple random sampling method by generating random \nnumbers via Microsoft Office Excel. Written informed consent \nwas obtained from study participants, and they had the right to \nwithdraw from the study at any point during the study period. \n \nStudy instrument \n \nA set of question for the questionnaire were written in the \nMalay and English languages and were used in this study. \nThere were four main components in the questionnaire: \nsociodemographic background (Section A), the contraceptive \nintention (Section B), barriers to practice contraception \n(Section C), and willingness to get contraceptive counselling \nfrom the pharmacist (Section D). Section A included age, \nreligion, participant\u2019s highest education level, spouse\u2019s highest  \n \n \n \n \n\n\n\n\n\n\n\n\nLau B.T.et al. Mal J Pharm 8 (1) 2022, 19-25 \n \n\n\n\n20 \n \n\n\n\neducation level, employment status, household income, \nresidence, duration of marriage, number of pregnancies, \nnumber of live births or children, experience of using \ncontraceptive and formal contraceptive counselling. Section B \nencompassed contraceptive intention, methods preferred, \nreasons for using contraception and time to start contraception. \nThe specific details related to modern and non-modern \ncontraceptives were adapted from Mahmud, Jaffar, Hashim et \nal. (2014) [13] as well as Hubacher and Trussell (2015) [17]. \nThe actual and potential barriers to practice contraception \namong non-users were documented in Section C [18], while \nSection D documented the willingness of postpartum women \nto receive contraceptive counselling from the pharmacist. The \ninitial draft was reviewed by two senior pharmacy lecturers and \nfive pharmacists with more than five years of working \nexperience. The contents were revised accordingly and piloted \namong thirty postpartum women. Modifications were made for \nthe second draft and piloted with another set of thirty \npostpartum women. Subsequently, the finalised questionnaire \nwas distributed to the researchers for official data collection. \nThe data obtained from the pilot tests were not included in the \nresult. \n \nData collection \n \nBefore distributing the questionnaires to potential study \nsubjects, the researchers would explain the study's objectives \nand obtain written consent from the participants for \nparticipation in the study. Each study subject would take \napproximately 15 minutes to complete the questionnaire. The \nresearchers would assist them in answering the questionnaire, \nwhere it is required. \n \nData analysis \n \nStatistical analyse were performed using IBM\u00ae SPSS Statistics \nversion 23.0. Categorical data were presented as numbers and \npercentages. The association between sociodemographic \nvariables and the intention to use contraceptive was analysed \nwith the Pearson's Chi-squared test. Furthermore, all variables \nwere included in the multiple logistic regression analysis to \nidentify factors associated with contraceptive intention. A \nconfidence interval of 95% was utilised in this study, and \nresults were considered statistically significant if the two-tailed \np-value was < 0.05. \n \nRESULT  \n \nSocio-demography of respondents \n \nThe response rate was 98.8% after excluding five incomplete \nquestionnaires. Most of the respondents were \u2264 35 years old (n \n= 347, 84.8%), Malay (n = 324, 79.2%), of the religion of Islam \n(n = 329, 80.4%), married (n = 407, 99.5%), had received \n\n\n\ntertiary education (n = 229, 56%), employed (n = 207, 50.6%), \nfrom urban areas (n = 318, 77.8%), have had < 5 pregnancies \n(n = 362, 88.5%), and had < 5 live children (n = 380, 92.9%). \nLess than half of the respondents (n = 167, 40.8%) had some \nexperience of using contraceptive prior to the current \npregnancy. Approximately half of the respondents (n = 215, \n52.6%) had received formal contraceptive counselling before \nthe present childbirth. The sociodemographic characteristics of \nthe 409 respondents are shown in Table I. \n \nContraceptive intention \n \nMost of the respondents (n = 334, 81.7%) had considered \npostpartum, of which 97 (29%), 27 (8.1%), and 210 (62.9%) \nconsidered modern methods, non-modern methods, and both \nmethods respectively. Male condoms (n = 124, 37.1%), \ncombined hormonal contraceptive pills (n = 110, 32.9%), \nprogestin implants (n = 66, 19.8%) were among the modern \ncontraceptive methods most favoured by the respondents. In \ncontrast, combined hormonal contraceptive ring, vasectomy, \ndiaphragm and sponge with spermicide, and diaphragm were \namong the less-preferred modern methods (for each of the four-\nmethod specified, n = 4, 1.2%). For non-modern contraceptive \nmethods, the respondents preferred to use rhythm method (n = \n158, 47.3%), followed by breastfeeding (n = 126, 37.7%), \nabstinence (n = 99, 29.6%), and the withdrawal method (n = \n31, 9.3%). The details are summed up in Table II.  \n \nThe reasons specified for the practices of postpartum \ncontraception methods were also found to be as follow: to \nprovide space (or a time gap) before attempting the next \npregnancy (n = 245, 73.4%), to limit the number of children (n \n= 74, 22.2%), and others (n = 15, 4.5%). \n \nAdditionally, most respondents who chose to use contraception \nwere unsure about the point in time on which such methods \nwere to be initiated (n = 101, 30.2%). A total of 24% (n = 80) \nof participants were interested in beginning contraception six \nweek postpartum, while the other participants specified \ninitiation peroids between six weeks and six months \npostpartum (n = 58, 17.4%), between six months and one year \npostpartum (n = 45, 13.5%), after one year postpartum (n = 28, \n8.4%), and before hospital discharge (n = 22, 6.6%). \n \nBarriers to practise contraception \n \nA total of 75 respondents who refused to use postpartum \ncontraception for a number of reason, including the following:- \nnot feeling like using contraception (n = 39, 52%), concerned \nabout side effects  (n = 20, 26.7%), husband's disapproval (n = \n6, 8%), complication during current pregnancy (n = 6, 8%), not \nexpecting to have intercourse (n = 5, 6.7%),  to have next child \nat short interval (n = 4, 5.3%), disturbance on sexual activities \n(n = 2, 2.7%),  previous miscarriage (n = 2, 2.7%), lack of \n\n\n\n\n\n\n\n\nLau B.T.et al. Mal J Pharm 8 (1) 2022, 19-25 \n \n\n\n\n21 \n \n\n\n\nknowledge about contraceptive methods (n = 2, 2.7%), \ndisturbance on social activities (n = 1, 1.3%), or other reasons \n(n = 1, 1.3%). \n\n\n\n\n\n\n\nWillingness to receive pharmacist counselling \n \nThere were 337 (82.4%) study participants who were willing to \nseek out contraceptive counselling from a pharmacist in future. \nOnly less than one fifth of the participants (n = 72, 17.6%) felt \notherwise. \n\n\n\nAssociation between sociodemographic characteristics and \ncontraceptive intention \n \nThe association of respondents' sociodemographic \ncharacteristics and their contraceptive intention were analysed \nusing the Pearson's Chi-squared test. The variables \nsignificantly associated with the intention were religion, \nrespondent\u2019s and spouse\u2019s education level, household income, \nand experience of receiving formal contraceptive counselling \n(p < 0.05). There was no significant association between age, \nemployment status, residence, duration of the marriage, \nnumber of pregnancies, number of live children, the experience \nof using contraception and the contraceptive intention. The \ndetails are shown in Table III. \n \nMultiple logistic regression suggested the spouse's highest \neducation level and experience of receiving formal \ncontraceptive counselling before the current delivery \nsignificantly influenced a woman's intention to use \ncontraception. Postpartum women whose spouses had tertiary \neducation were two times more likely to use contraception than \nthose whose spouses had secondary or lower education (adj OR  \n \n\n\n\nTable II. The preference for contraceptive methods among the \nrespondents \n \n\n\n\nVariables (N = 409) n (%) a \nModern methods  \n   Male condom 124 (37.1) \n   Combined hormonal contraceptive pill 110 (32.9) \n   Progestin implant 66 (19.8) \n   Progestin-only injection 57 (17.1) \n   Hormonal intrauterine device 49 (14.7) \n   Progestin-only pill 41 (12.3) \n   Emergency contraceptive pill 37 (11.1) \n   Copper intrauterine device 28 (8.4) \n   Contraceptive patch 25 (7.5) \n   Female condom 23 (6.9) \n   Tubal ligation 9 (2.7) \n   Combined hormonal contraceptive ring 4 (1.2) \n   Vasectomy 4 (1.2) \n   Diaphragm and sponge with spermicide 4 (1.2) \n   Diaphragm 4 (1.2) \nNon-modern methods   \n   Rhythm method 158 (47.3) \n   Breastfeeding 126 (37.7) \n   Abstinence 99 (29.6) \n   Withdrawal method 31 (9.3) \n\n\n\n\n\n\n\na Note that the total number of responses, in both numbers and in percentages, \ndo not add up to 409 or 100% respectively because each respondent could \nselect more than one method. \n\n\n\n\n\n\n\nTable I. Sociodemographic characteristics of respondents \n \n\n\n\nVariables (N = 409) n (%) \n\n\n\nAge \n   \u2264 35 years old 347 (84.8) \n   > 35 years old 62 (15.2) \nRace \n   Malay 324 (79.2) \n   Chinese 32 (7.8) \n   Indian 40 (9.8) \n   Others 13 (3.1) \nReligion \n   Islam 329 (80.4) \n   Buddhism 31 (7.6) \n   Hindu 38 (9.3) \n   Christian 9 (2.2) \n   Others 2 (0.5) \nMarital status \n   Married 407 (99.5) \n   Single 1 (0.2) \n   Divorcee 1 (0.2) \nHighest education level \n   Primary school and lower 4 (1.0) \n   Secondary school 169 (41.3) \n   Tertiary education 236 (57.7) \nSpouse highest education level \n   Primary school and lower 11 (2.7) \n   Secondary school 169 (41.3) \n   Tertiary education 229 (56.0) \nEmployment status \n   Student 4 (1.0) \n   Housewife 134 (32.8) \n   Unemployed 27 (6.6) \n   Employed 207 (50.6) \n   Self-employed 37 (9.0) \nHousehold income (Monthly) \n   < RM1000 32 (7.8) \n   RM1000 - RM1999 79 (19.3) \n   RM2000 - RM2999  95 (23.2) \n   RM3000 - RM3999 94 (23.0) \n   RM4000 - RM4999 74 (18.1) \n   \u2265 RM5000  35 (8.6) \nResidence \n   Urban 318 (77.8) \n   Rural 91 (22.2) \nDuration of marriage \n   < 5 years 208 (50.9) \n   \u2265 5 years 201 (49.1) \nNumber of pregnancies  \n   < 5 362 (88.5) \n   \u2265 5 47 (11.5) \nNumber of live children \n   < 5 380 (92.9) \n   \u2265 5 29 (7.1) \n\n\n\n \n\n\n\n\n\n\n\n\nLau B.T.et al. Mal J Pharm 8 (1) 2022, 19-25 \n \n\n\n\n22 \n \n\n\n\n2.141, 95% CI 1.267 - 3.617). Those who received formal \ncontraceptive counselling were three times more likely to use \ncontraception than their counterparts (adj OR 3.642, 95% CI \n2.091 - 6.343). The details are presented in Table IV. \n\n\n\n\n\n\n\nDISCUSSION \n \nThere are various contraceptive methods available with \ndifferent effectiveness and safety profiles. Irrespective of \nmodern or non-modern methods, the first-year unintended \npregnancy rate is low if used consistently and correctly [14]. \n \n\n\n\nIn this study, preferred modern contraceptive methods include \nthe use of male condom, followed by combined hormonal \ncontraceptive pill and progestin implants. Meanwhile, the \npreferred non-modern method is the rhythm method, while \nother methods such as breastfeeding and abstinence follow suit, \nthough they are relatively less used. These results are similar to \na study conducted by Dev, Kohler, Feder, et al [16], whereby it \nis reported that injectables, oral contraceptive pills, condoms, \nbreastfeeding, and rhythm methods are commonly used by \npostpartum women in low- and middle-income countries. \nAlthough similarity in preference can be observed, each \ncontraceptive method's uptake varies by country or region. For \nexample, the uptake of injectables was only 2.7% in Nigeria \n[19] but could be as high as 68.5% in Ethiopia [20]. \n \n\n\n\nBreastfeeding is relatively common practice across different \ngeographical borders. In fact, breastfeeding and rhythm \nmethods are commonly used in West Africa [16], despite how \nbreastfeeding was not found to be the first option of non-\nmodern contraception in our study. The World Health \nOrganization recommends mothers to exclusively breastfeed \nchildren for optimal growth, development, and health for the \nfirst six months [21]. Alongside these benefits are faster \nmaternal weight loss after delivery and delayed return of \nmenstrual periods postpartum [21]. However, as a \ncontraceptive technique, it is noteworthy that breastfeeding is \nonly effective for the first six months after childbirth and even \nif it used correctly, its effectiveness is known to be lower than \nother modern contraceptive options [14]. \n \nFurthermore, non-lactating women are potentially fertile \nbecause ovulation could occur as early as three to four weeks \npost-delivery [22], which can prove to be problematic as far as \npreventing pregnancies is concern, as sexual intercourse is \nbelieved to typically occur within the first six weeks \npostpartum [23,24]. This, therefore, further emphasises the \nimportance of commencing contraception as early as possible \nduring the postpartum period, in-line with the suggestion set by  \n \n \n\n\n\nTable III. Association between respondent's sociodemographic \ncharacteristics and contraceptive intention \n \n\n\n\nVariables \n(N = 409) \n\n\n\nIntention to use \ncontraceptive \u03c72 \n\n\n\np-\nvaluea \n\n\n\nYes (%) No (%) \nAge \n  \u2264 35 years old 283 (81.6) 64 (18.4) 0.017 (1) 0.895 \n  > 35 years old 51 (82.3) 11 (17.7)   \nReligion \n  Islam 275 (83.8) 53 (16.2) 5.251 (1) 0.022 \n  Non-Islam 59 (72.8) 22 (27.2)   \nHighest education level \nSecondary  \n\n\n\nschool and lower \n133 (76.9) 40 (23.1) 4.582 (1) 0.032 \n\n\n\n  Tertiary \neducation \n\n\n\n201 (85.2) 35 (14.8) \n  \n\n\n\nSpouse's highest education level \n  Secondary \nschool and lower \n\n\n\n136 (75.6) 44 (24.4) 8.007 (1) 0.005 \n\n\n\n  Tertiary \neducation \n\n\n\n198 (86.5) 31 (13.5)   \n\n\n\nEmployment status \n  Employedb 202 (82.8) 42 (17.2) 0.511 (1) 0.475 \n  Unemployedc 132 (80.0) 33 (20.0)   \nHousehold income \n  Low incomed 155 (75.2) 51 (24.8) 11.423 (1) 0.001 \n  High incomee 179 (88.2) 24 (11.8)   \nResidence \n  Urban 254 (79.9) 64 (20.1) 3.053 (1) 0.081 \n  Rural 80 (87.9) 11 (12.1)   \nDuration of marriage \n  < 5 years 165 (79.3) 43 (20.7) 1.542 (1) 0.214 \n  \u2265 5 years 169 (84.1) 32 (15.9)   \nNumber of pregnancies \n  < 5 292 (80.7) 70 (19.3) 2.102 (1) 0.147 \n  \u2265 5 42 (89.4) 5 (10.6)   \nNumber of live children \n  < 5 308 (81.1) 72 (18.9) 1.332 (1) 0.249 \n  \u2265 5 26 (89.7) 3 (10.3)   \nExperience of using contraceptive \n  Yes 142 (85.0) 25 (15.0) 2.137 (1) 0.144 \n  No 192 (79.3) 50 (20.7)   \nReceived formal contraceptive counselling \n  Yes 194 (90.2) 21 (9.8) 22.231 (1) <0.001 \n  No 140 (72.2) 54 (27.8)   \n\n\n\n\n\n\n\na p<0.05 is considered as statistically significant (Pearson's Chi-squared test); \nb includes employed and self-employed; c includes students, housewives, the \nunemployed; d household income \u2264RM2999 monthly; e household income \n\u22653000 monthly \n\n\n\nTable IV. Factors affecting postpartum women\u2019s contraceptive intention \n \n\n\n\nVariables \nAdj \nOR \n\n\n\n(95% \nCI) \n\n\n\n\u03c72 stat \n(df) \n\n\n\np-\nvaluea \n\n\n\nSpouse highest education level \nTertiary education \n\n\n\n2.141 \n1.267 - \n3.617 \n\n\n\n8.092 \n(1) \n\n\n\n0.004 Secondary school and \nlower (Reference) \nReceived formal contraceptive counselling \nYes \n\n\n\n3.642 \n2.091 - \n6.343 \n\n\n\n20.839 \n(1) <0.001 \n\n\n\nNo (Reference) \n\n\n\n \na p < 0.05 is considered as statistically significant (Multiple Logistic \nRegression, Forward LR Method) \n\n\n\n\n\n\n\n\nLau B.T.et al. Mal J Pharm 8 (1) 2022, 19-25 \n \n\n\n\n23 \n \n\n\n\nthe World Health Organization to begin contraceptive methods \nwithin the first 12 months following delivery [12]. Therefore to \naddress this issue, timely counselling on contraceptive methods \nis essential to prevent unintended pregnancy. \n \nAntenatal care services provide an opportunity to promote \nmodern postpartum contraception due to their excellent \nutilisation [25,26]. Indeed, postnatal care services can further \nimproved upon in order to match the extent of utilisation of \nantenatal care services, since the utilisation rates are \ncomparatively lower than antenatal care service [26,27]. In \nsupport of this, Zapata, Murtaza, Whiteman, et al [28] reported \non how the prevalence of postpartum contraceptive use was the \nhighest when counselling was provided during both prenatal \nand postpartum periods. It is therefore crucial that the minimum \ninterpregnancy interval and contraceptive choice should be \nemphasised during both antenatal and postnatal encounters to \nensure that postpartum women understand the importance of \ncontraception. \n \nEmphasis should be placed on potential patient factors that may \ncontribute to the use of contraceptives at each antenatal and \npostnatal encounter to ascertain an effective contraceptive \ncounselling. Dev, Kohler, Feder, et al [16] reported that \ndifferences in the sociodemographic background could \ninfluence contraceptive practice among postpartum women. \nSpecifically, women who were young, married, more educated, \nof higher socioeconomic status, and from urban residences, \nwere more likely to use contraception [16]. Besides that, \nsupport from their male partners seems to be associated with \ncontraceptive use during the postpartum period [16]. Findings \nfrom our study suggest that postpartum women whose spouses \nhad tertiary education and those who received formal \ncontraceptive counselling before the current delivery are more \nlikely to practice contraception during the postpartum period. \nThis supports the importance of proper counselling for both \nwomen and their spouses during antenatal care services to \nencourage postpartum contraceptive acceptance. \n \nThe reluctance of women to practice contraception or family \nplanning can be attributed to a myriad of factors. Fear of \nadverse effects is a common cause for poor acceptance and high \nrates of contraception discontinuation among postpartum \nwomen [16], indicating that well-planned and intensified \ncounselling sessions should be an integral part of antenatal and \npostnatal visits to encourage postpartum family planning. The \nadverse effects of contraceptive methods should be explained \nand appropriately addressed during these encounters to \nmitigate their worries, to allow them to understand options \navailable to them, and receive advice on contraception methods  \nthat suits their needs. While doctors and nurses have been  \n \n \n \n\n\n\ndelivering antenatal and postnatal care services at present,  \npharmacists could expand their role in this service which \nrequires multidisciplinary engagement. Unfortunately, \nliterature findings on the impact of postpartum contraceptive \ncounselling by pharmacists are scarce. Schatz, Chapman, and \nChang [29] reported more than two-thirds of postpartum \nwomen would like to receive contraceptive counselling by a \npharmacist, especially on hormonal and implantable forms of \ncontraception. In this context, inpatient and clinical \npharmacists are in a strategic position to provide contraceptive \ncounselling for postpartum women. In addition to explaining \ncontraceptive methods, a pharmacist can advise on patient-\nspecific alternatives by examining their co-morbidities, \npotential drug-drug or drug-disease interactions, financial \naffordability, personal preferences, and others. \n \nThere are several limitations in this study. Although most of the \nstudy participants expressed desire to use contraception after \nchildbirth, the prevalence of its practice among postpartum \nwomen is not confirmed during the postnatal care service. We \nalso acknowledge the possibility of acquiescence bias, since \nstudy participants answered the questionnaire in the presence \nof researchers. Furthermore, the fact that this study was \nconducted in government-funded hospitals may implicate that \nthe results may not be representative of patients in private \nhealthcare facilities. Future research could be designed to \ncheck on the contraceptive prevalence rates among postpartum \nwomen, and to establish a causal relationship between factors \naffecting contraceptive use among women in this population. \n \n\n\n\nCONCLUSION  \n \nThe majority of postpartum women in this study expressed \ninterest in using both modern and non-modern contraceptive \nmethods. It was found that the main barriers to contraceptive \nuse were inherent hesitancy to use any method and concerns \nabout side effects. Fortunately, the majority of postpartum \nwomen were interested into receiving contraceptive \ncounselling from a pharmacist. This study reports that the \neducation level of spouses and prior formal counselling before \nchild delivery of postpartum women significantly affect their \ncontraceptive intention. Healthcare professionals, including \npharmacists, could improve maternal and foetal health \noutcomes by providing contraceptive counselling, and by \naddressing effectiveness and side effects of postpartum \ncontraceptives. \n \nACKNOWLEDGEMENT \n  \nWe would like to thank the Director General of Health, \nMalaysia for his permission to publish this article. \n \n \n\n\n\n\n\n\n\n\nLau B.T.et al. Mal J Pharm 8 (1) 2022, 19-25 \n \n\n\n\n24 \n \n\n\n\nCONFLICT OF INTEREST \n \nThis study has no conflict of interest. This research did not \nreceive any specific grant from funding agencies in public, \ncommercial or not-for-profit sectors. \n \nREFERENCE \n \n[1] DeFranco EA, Stamilio DM, Boslaugh SE, Gross GA, Muglia LJ. A \n\n\n\nshort interpregnancy interval is a risk factor for preterm birth and its \nrecurrence. Am J Obstet Gynecol. 2007 Sep;197(3):264.e1-6. \nhttps://doi.org/10.1016/j.ajog.2007.06.042 \n\n\n\n[2] Fuentes-Afflick E, Hessol NA. 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Afr Health Sci. 2011 \nSep;11(3):390-7. \nhttps://www.ajol.info/index.php/ahs/article/view/73402 \n\n\n\n[27] Sonalkar S, Hunter T, Gurney EP, McAllister A, Schreiber CA. A \nDecision Analysis Model of 1-Year Effectiveness of Intended \nPostplacental Compared With Intended Delayed Postpartum \nIntrauterine Device Insertion. Obstet Gynecol. 2018 \nNov;132(5):1211-1221. \nhttps://doi.org/10.1097/AOG.0000000000002926 \n\n\n\n[28] Zapata LB, Murtaza S, Whiteman MK, Jamieson DJ, Robbins CL, \nMarchbanks PA, D'Angelo DV, Curtis KM. Contraceptive counseling \nand postpartum contraceptive use. Am J Obstet Gynecol. 2015 \nFeb;212(2):171.e1-8. https://doi.org/10.1016/j.ajog.2014.07.059 \n\n\n\n[29] Schatz K, Chapman J, Chang J. Examining the impact of a \npharmacists postpartum counseling service; evidence from a \nuniversity hospital. Innov Pharm. 2014 1 January;5(1). \nhttps://doi.org/10.24926/iip.v5i1.328 \n \n\n\n\n\n\n"
"\n\nMalaysian Journal of Pharmacy 2003;1(3) 76-85  Research article  \n\n\n\n 76\n\n\n\nAwareness of Hepatitis A and Hepatitis B \namong Residents in Kuala Lumpur and \nSelangor \n \nHo Chiew Lim, Hesham Rashwan* \n \n\n\n\nDepartment of Pharmacy, Faculty of Allied Health Sciences, Universiti Kebangsaan Malaysia, \n50300 Kuala Lumpur, Malaysia.  \n \n* Author for correspondence, email heshrash@medic.ukm.my \n \n \nABSTRACT \n \nA survey was carried out to assess the level of knowledge and vaccination coverage \nof hepatitis A and B among 753 subjects (>12 years of age) from rural areas, town \nareas, undergraduates and healthcare workers. The main objective of the study was \nto assess the relationship between the extent of hepatitis A and B knowledge and \nvaccination status of the participants. A questionnaire was distributed and \ncompleted by the subjects. The results showed that the overall level of knowledge \namong the public was low compared to healthcare workers and undergraduates. \nThe hepatitis A vaccination coverage was very low among all the groups (<8%). The \nhepatitis B vaccination coverage was generally low among the groups of non-\nhealthcare workers (<35%) and higher among healthcare workers (65.6%). There \nwas a strong correlation between the extent of knowledge of hepatitis A and B and \nthe status of vaccination among the participants (p<0.01). The study concluded that \nhealth education on hepatitis A and B should be provided and vaccination \nprogrammes should be held more frequently among the public, especially in rural \nareas. \n \n\n\n\nKeywords: hepatitis, healthcare workers, knowledge, survey, vaccination \n \n \nINTRODUCTION \n \nHepatitis A and B continue to be a major health \nproblem in Malaysia and also worldwide. \nAlthough hepatitis B and A vaccines were \napproved in late 1981 (1) and in 1992 (2), \nrespectively, hepatitis A and B continue to be the \nmost frequently reported vaccine-preventable \ndiseases. Data from Ministry of Health Malaysia \n(2000) (3) indicated that the incidence of viral \nhepatitis was 1 326 cases with 13 fatalities in \n1991 and this was reduced to 686 cases with 7 \nfatalities in 1995. The average incidence rate \nfrom 1991 to 1995 was about 4.2 per 100,000 \npopulation.   As   most   of   the   infections   are  \n\n\n\n \n \nasymptomatic and subclinical, it is almost certain \nthat cases of hepatitis are under-reported. \nAccording to the Malaysian Liver Foundation \n(1999) (4), there are 2.4 million hepatitis B virus \n(HBV) carriers in Malaysia, and they will \ncontinue to be the source of HBV infection to the \nothers. \n \nBoth hepatitis A virus (HAV) and hepatitis B \nvirus (HBV) infections may result in a wide \nspectrum of clinical outcomes, ranging from \nsilent anicteric infection to subclinical disease \nand classical icteric hepatitis to fulminant hepatic \n\n\n\n\n\n\n\n\nResearch article: Awareness of hepatitis  \n\n\n\n 77\n\n\n\nfailure with coma and occasionally death (5). \nHepatitis A will not lead to long term \ncomplications, and most of the patients recover \nwithin two months from the onset of illness (6), \nhowever, acute liver failure due to severe \nhepatitis A is well documented and no specific \ndrug treatment is available (7). Exposure to \nHBV, particularly in early in life, may also result \nin an asymptomatic carrier state that can progress \nto chronic active hepatitis, cirrhosis of the liver \nand eventually hepatocellular carcinoma (8). As \nboth infections can spread from person to person, \nthe key control of HAV and HBV infections is \nimmunoprophylaxis. \n \nThis study was carried out to determine the level \nof knowledge and the vaccination coverage of \nboth hepatitis A and B in different groups of \npopulation, including the general public, \nhealthcare workers and undergraduates. The \nrelationship between the extent of hepatitis A \nand B knowledge and vaccination status of the \nparticipants was assessed. Hopefully this study \ncan provide the information relevant to the \ndevelopment of the vaccination strategies for \nboth hepatitis A and B and contribute to the \nelimination of hepatitis A and B in Malaysia. \n \nMETHOD \n \nStudy design  \n \nThe study was conducted from January to July \n2000 in Kuala Lumpur and Selangor. A cross-\nsectional survey was carried out to identify the \nlevel of knowledge of hepatitis A and B and the \nvaccination coverage among the population \nthrough questionnaires. \n \nStudy population \n \nThe study population consisted of subjects above \n12 years of age. The study population was made \nup from four groups: (I) residents from rural \nareas i.e. Kampung Nakhoda and  Sungai Tua \nBahru, Selayang, Selangor Darul Ehsan; (II) \nresidents from town areas who were mainly from \nSerdang, Sri Kembangan, Balakong, Cheras, \nKajang and Bangi; (III) healthcare workers from \nthe nephrology unit and blood bank, Hospital  \nKuala Lumpur; and (IV) undergraduates from \nFaculty of Dentistry and Faculty of Allied Health \nSciences, Universiti Kebangsaan Malaysia \n(UKM). Sampling was on voluntary basis. \n \n\n\n\nQuestionnaires \n \nQuestionnaires were presented in English and \nMalay. The survey was carried out in divided \nsessions. Participants were given a questionnaire \nand explanation was provided to assist them in \ncompleting the questionnaire. Participants who \nwere illiterate were interviewed with \nunderstandable language. The information \nobtained through the questionnaires included \nage, gender, race, occupation, education level, \nhousehold income, knowledge about hepatitis A \nand B, awareness of vaccination for hepatitis A \nand B, awareness of blood testing for hepatitis A \nand B virus, and family members\u2019 or subject\u2019s \nprevious diagnosis of hepatitis.  \n \nAfter completing the questionnaires, participants \nwere given brochures about hepatitis A and B. \nBrochures in different languages, including \nMalay, English, and Chinese were available. \nPosters about prevention of hepatitis A and B \nwere also exhibited. Participants were \nencouraged to seek vaccination for both hepatitis \nA and B. All the brochures and posters were \nprovided by SmithKline Beecham Sdn. Bhd \n(now known as GlaxoSmithKline Sdn. Bhd.). \n\n\n\n \nStatistical analysis \n \nData were analysed using Statistical Package for \nSocial Sciences (SPSS) version 9.05. Descriptive \nstatistics, including frequencies and percentages, \nwere calculated for each item on the \nquestionnaires; cases with missing data were \nexcluded. In addition, comparisons of the level \nof knowledge on the diseases and vaccination \nrate among four groups of subjects were made by \ndescriptive analysis. \n \nIn order to enable further assessment on the \nrelationship between the extent of knowledge \nand the vaccination status of hepatitis A and/or B \namong the participants, answers to \nquestionnaires were marked. One mark was \ngiven to each correct answer and the total mark \nwas 15. The subjects were classified into three \ngroups based on their overall knowledge about \nhepatitis A and B. The classification is as \nfollowing: \n\n\n\n \nDegree of knowledge Score of correct \n\n\n\nanswers \nLow \u2264 5 \nIntermediate 6-10 \nHigh \u2265 11 \n\n\n\n\n\n\n\n\nResearch article: Awareness of hepatitis  \n\n\n\n 78\n\n\n\nChi-squared test (testing of independence) was \nperformed to evaluate the correlation of the \nextent of knowledge and receiving hepatitis A \nand/or B vaccine(s) among the participants. The \ntwo parameters were considered not independent \nif the p value was less than 0.01. \n \nRESULTS \n \nA total of 753 subjects were enrolled in the \nsurvey from 4 study groups: (I) residents from \nrural areas i.e. Kampung Nakhoda and Sungai \nTua Bahru, Selayang, Selangor Darul Ehsan \n(n=165) with a mean age of 37.7\u00b112.1; (II) \nresidents from town areas (n=206), mainly from \nSerdang, Sri Kembangan, Balakong, Cheras, \nKajang and Bangi with a mean age of 24.8\u00b18.2; \n(III) healthcare workers (HCWs) (n=194) from \nthe nephrology unit (64.0%) and blood bank \n(36.0%) from Hospital Kuala Lumpur with a \nmean age of 32.3\u00b193.2 and mean working period \nof 98 months; and (IV) undergraduates (n=188) \nfrom the Faculty of Dentistry (24.5%) and \nFaculty of Allied Health Sciences (75.5%), \nUniversiti Kebangsaan Malaysia (UKM) with a \nmean age of 22.1\u00b11.9. \n \nGenerally, the mean age of the participants from \nrural areas and HCWs were higher than the \nparticipants from town areas and undergraduates. \nFemale participants outnumbered males. Most of  \n\n\n\nthe residents from the rural areas, HCWs and \nundergraduates were Malays (97.6%, 84.3% and \n73.5%, respectively). However, the percentage of \nMalay and Chinese participants from town areas \nwere almost equal, with 49.5% and 47.5%, \nrespectively.  \n \nMost of the participants from rural areas (59.4%) \nhad secondary education, however, most of the \nparticipants from town areas (67.8%) had tertiary \neducation. There was an almost equal percentage \nof HCWs with secondary education and tertiary \neducation. 41.5% and 40.4% of the participants \nfrom rural areas were from low and middle \nincome groups, respectively. For those from \ntown areas, 29.3%, 42.5%, and 28.2% were from \nlow, middle and high income groups, \nrespectively. Most of the HCWs were in the \nmiddle income group (69.1%), while most of the \nundergraduates were from the low (36.5%) and \nmiddle (37.7%) income groups. Demographic \ndetails of the subjects are shown in Table 1. \n \nKnowledge of hepatitis A and B \n \nA high proportion of undergraduates (85.0%) \nhad knowledge on hepatitis compared to the \npublic from town areas (63.6%) and rural areas \n(52.7%). Most of the public knew about the \ndiseases through the mass media; \nundergraduates, however, acquired knowledge of \nthe diseases through formal education. All \n\n\n\nTable 1: Demographic data of patients. \n \nGroups Public from \n\n\n\nrural areas (%) \nPublic from \n\n\n\ntown areas (%) \nHealth care \nworkers (%) \n\n\n\nUndergraduates \n(%) \n\n\n\nTotal subjects \n(%) \n\n\n\nNo. of subjects (n) 165 206 194 188 753 \nMean age (years) 37.67 24.75 32.29 22.06 28.87 \nGender \n   Male \n   Female \n\n\n\n \n63 (38.2) \n102 (61.8) \n\n\n\n \n84 (40.8) \n122 (59.2) \n\n\n\n \n33 (17.3) \n158 (82.7) \n\n\n\n \n45 (24.3) \n140 (75.7) \n\n\n\n \n225 (30.1) \n522 (69.9) \n\n\n\nRace \n   Malay \n   Chinese \n   Indian \n   Others \n\n\n\n \n161 (97.6) \n\n\n\n2 (1.2) \n1 (0.6) \n1 (0.6) \n\n\n\n \n102 (49.5) \n98 (47.5) \n\n\n\n3 (1.5) \n3 (1.5) \n\n\n\n \n161 (84.3) \n10 (5.2) \n18 (9.4) \n2 (1.1) \n\n\n\n \n136 (73.5) \n30 (16.2) \n12 (6.5) \n7 (3.8) \n\n\n\n \n560 (75.0) \n140 (18.7) \n34 (4.6) \n13 (1.7) \n\n\n\nEducation level \n   Primary school \n   Secondary school \n   College/University \n\n\n\n \n25 (15.6) \n95 (59.4) \n40 (25.0) \n\n\n\n \n8 (3.9) \n\n\n\n58 (28.3) \n139 (67.8) \n\n\n\n \n11 (6.1) \n81 (45.3) \n87 (48.6) \n\n\n\n\n\n\n\n188 (100) \n\n\n\n \n44 (6.0) \n\n\n\n235 (32.1) \n453 (61.9) \n\n\n\nFamily monthly income \n   <RM 1000 \n   RM 1000-2500 \n   RM 2500-4000 \n   >RM 4000 \n\n\n\n \n39 (41.5) \n38 (40.4) \n\n\n\n9 (9.6) \n8 (8.5) \n\n\n\n \n53 (29.3) \n77 (42.5) \n28 (15.5) \n23 (12.7) \n\n\n\n \n48 (27.0) \n123 (69.1) \n\n\n\n5 (2.8) \n2 (1.1) \n\n\n\n \n55 (36.5) \n57 (37.7) \n27 (17.9) \n12 (7.9) \n\n\n\n \n195 (32.3) \n295 (48.8) \n69 (11.4) \n45 (7.5) \n\n\n\nNote: The total number of respondents does not equal 753 due to missing values. \n The percentages are based on the number of subjects who responded to the items. \n\n\n\n \n\n\n\n\n\n\n\n\nResearch article: Awareness of hepatitis  \n\n\n\n 79\n\n\n\nTable 2: Knowledge about hepatitis (hep.) A and B among respondents. \n \n\n\n\nPublic Knowledge about hep. A or B \nRural areas \n\n\n\n(%) \nTown areas \n\n\n\n(%) \n\n\n\nHealthcare \nworkers (%) \n\n\n\nUndergraduates \n(%) \n\n\n\nTotal (%) \n\n\n\nKnow about hepatitis. \n   Yes \n       Through media \n       Education \n       Family \n       Friends \n       Healthcare workers \n   No \n   Not sure \n\n\n\n \n87 (52.7) \n\n\n\n66 (76.7) \n17 (20.0) \n10 (11.6) \n13 (15.1) \n10 (11.6) \n\n\n\n51 (30.9) \n27 (16.4) \n\n\n\n \n131 (63.6) \n\n\n\n78 (59.5) \n45 (34.4) \n18 (13.7) \n17 (13.0) \n\n\n\n   9 (6.9) \n20 (9.7) \n55 (26.7) \n\n\n\n \n- \n \n \n \n \n- \n- \n\n\n\n \n159 (85.0) \n\n\n\n   54 (34.0) \n     140 (88.1) \n\n\n\n10 (6.3) \n  21 (13.2) \n      5 (3.1) \n\n\n\n2 (1.1) \n26 (13.9) \n\n\n\n \n377 (63.4) \n\n\n\n\n\n\n\n55 (9.2) \n163 (27.4) \n\n\n\nKnowledge of organ affected \n   Liver \n   Heart \n   Kidneys \n   Brain \n   Not sure \n\n\n\n \n78 (50.3) \n27 (17.4) \n10 (6.5) \n3 (1.9) \n\n\n\n43 (27.7) \n\n\n\n \n143 (69.4) \n31 (15.0) \n23 (11.2) \n\n\n\n6 (2.9) \n20 (9.7) \n\n\n\n \n190 (99.0) \n\n\n\n1 (0.5) \n22 (11.5) \n2 (1.0) \n1 (0.5) \n\n\n\n \n186 (100.0) \n\n\n\n0 (0.0) \n0 (0.0) \n0 (0.0) \n0 (0.0) \n\n\n\n \n579 (78.3) \n59 (8.0) \n55 (7.4) \n11 (1.5) \n64 (8.7) \n\n\n\nKnowledge of spreading by virus \n   Yes \n   No \n   No sure \n\n\n\n \n81 (50.3) \n15 (9.3) \n65 (40.4) \n\n\n\n \n120 (58.5) \n19 (9.3) \n66 (32.2) \n\n\n\n \n176 (95.1) \n\n\n\n5 (2.7) \n4 (2.2) \n\n\n\n \n182 (96.8) \n\n\n\n0 (0.0) \n6 (3.2) \n\n\n\n \n559 (75.6) \n39 (5.3) \n\n\n\n141 (19.1) \nKnowledge of causing jaundice \n   Yes \n   No  \n   Not sure \n\n\n\n \n84 (52.2) \n14 (8.7) \n63 (39.1) \n\n\n\n \n107 (52.7) \n10 (4.9) \n86 (42.4) \n\n\n\n \n190 (99.0) \n\n\n\n2 (1.0) \n0 (0.0) \n\n\n\n \n164 (87.7) \n\n\n\n3 (1.6) \n20 (10.7) \n\n\n\n \n545 (73.4) \n29 (3.9) \n\n\n\n169 (22.7) \nKnowledge of transmission of hep. A through \nfood & water \n   Yes \n   No \n   Not sure  \n\n\n\n\n\n\n\n68 (42.5) \n22 (13.8) \n70 (43.7) \n\n\n\n\n\n\n\n100 (48.6) \n26 (12.6) \n80 (38.8) \n\n\n\n\n\n\n\n177 (91.8) \n8 (4.1) \n8 (4.1) \n\n\n\n\n\n\n\n147 (79.0) \n4 (2.2) \n\n\n\n35 (18.8) \n\n\n\n\n\n\n\n492 (60.2) \n60 (7.4) \n\n\n\n265 (32.4) \nKnowledge of mode of hep. B transmission \n   Blood \n   Saliva \n   Sexual \n   Mother to child \n   Casual contact \n   Not sure \n\n\n\n \n94 (60.6) \n34 (21.9) \n26 (16.8) \n42 (27.1) \n8 (5.2) \n\n\n\n38 (24.5) \n\n\n\n \n106 (51.7) \n60 (29.3) \n35 (17.1) \n63 (30.7) \n13 (6.3) \n20 (9.8) \n\n\n\n \n180 (93.8) \n80 (41.7) \n99 (51.6) \n\n\n\n106 (55.2) \n2 (1.0) \n1 (0.5) \n\n\n\n \n168 (89.8) \n87 (46.5) \n\n\n\n140 (72.9) \n112 (58.3) \n\n\n\n14 (7.3) \n0 (0.0) \n\n\n\n \n548 (74.2) \n261 (35.3) \n300 (40.6) \n323 (43.7) \n37 (5.0) \n59 (8.0) \n\n\n\nKnowledge of complications of hep. B \n   Liver damage \n   Liver cancer \n   Death \n   Heart disease \n   Kidney failure \n\n\n\n \n86 (55.1) \n44 (28.2) \n33 (21.2) \n22 (14.1) \n27 (17.3) \n\n\n\n \n114 (55.9) \n57 (28.9) \n62 (30.4) \n20 (9.8) \n23 (11.3) \n\n\n\n \n158 (82.7) \n112 (58.6) \n49 (25.7) \n4 (2.1) \n6 (3.1) \n\n\n\n \n172 (93.5) \n113 (61.4) \n96 (52.2) \n4 (2.2) \n8 (4.3) \n\n\n\n \n530 (72.1) \n326 (44.3) \n240 (32.7) \n50 (6.8) \n64 (8.7) \n\n\n\nKnowledge of treatment availability for hep. B \n   Yes  \n   No \n   Not sure \n\n\n\n \n82 (50.9) \n32 (19.9) \n47 (29.2) \n\n\n\n \n94 (46.1) \n51 (25.0) \n59 (28.9) \n\n\n\n \n105 (56.4) \n63 (33.9) \n18 (9.7) \n\n\n\n \n86 (51.5) \n63 (37.7) \n18 (10.8) \n\n\n\n \n367 (51.1) \n209 (29.1) \n142 (19.8) \n\n\n\nKnowledge of availability of hep. A vaccine \n   Yes  \n   No \n   Not sure \n\n\n\n \n91 (56.5) \n24 (14.9) \n46 (28.6) \n\n\n\n \n137 (66.5) \n14 (6.8) \n55 (26.7) \n\n\n\n \n107 (57.5) \n63 (33.9) \n16 (8.6) \n\n\n\n \n153 (81.8) \n\n\n\n4 (2.1) \n30 (16.1) \n\n\n\n \n488 (65.9) \n105 (14.2) \n147 (19.9) \n\n\n\nKnowledge of availability of hep. B vaccine \n   Yes  \n   No \n   Not sure \n\n\n\n \n91 (56.5) \n24 (14.9) \n46 (28.6) \n\n\n\n \n133 (64.6) \n17 (8.2) \n56 (27.2) \n\n\n\n \n183 (94.3) \n\n\n\n5 (2.6) \n6 (3.1) \n\n\n\n \n175 (93.1) \n\n\n\n1 (0.5) \n12 (6.4) \n\n\n\n \n582 (77.7) \n47 (6.3) \n\n\n\n120 (16.0) \nKnowledge of number of shots in a full course \nof hep. B vaccination \n   1X \n   2X \n   3X \n   4X \n   Not sure \n\n\n\n\n\n\n\n19 (13.4) \n27 (19.0) \n34 (23.9) \n3 (2.1) \n\n\n\n59 (41.6) \n\n\n\n\n\n\n\n19 (9.5) \n46 (22.9) \n111 (55.1) \n\n\n\n7 (3.5) \n18 (9.0) \n\n\n\n\n\n\n\n4 (2.2) \n8 (4.4) \n\n\n\n167 (91.3) \n3 (1.6) \n1 (0.5) \n\n\n\n\n\n\n\n9 (5.0) \n8 (4.4) \n\n\n\n155 (86.1) \n1 (0.6) \n7 (3.9) \n\n\n\n\n\n\n\n51 (7.2) \n89 (12.6) \n467 (66.2) \n14 (2.0) \n85 (12.0) \n\n\n\nNote: The total number of respondents does not equal 753 due to missing values. \n The percentages are based on the number of subjects responded to the items. \n\n\n\n\n\n\n\n\nResearch article: Awareness of hepatitis  \n\n\n\n 80\n\n\n\n the undergraduates and almost all the HCWs \nknew that hepatitis would affect the liver \ncompared to only 69.4% and 50.3% of the public \nfrom town areas and from rural areas, \nrespectively. A relatively high percentage of the \nundergraduates and HCWs knew that some types \nof hepatitis are caused by viruses and can cause \njaundice compared to only about 50% of the \npublic with that knowledge.  \n \nHCWs (91.8%) were superior in knowing that \nfood and water are the sources of transmission of \nhepatitis A, followed by undergraduates (79.0%), \nparticipants from town areas (48.6%), and those \nfrom rural areas (42.5%). Blood is generally \nmore acknowledged as a transmission mode of \nhepatitis B among the participants with 93.8% \nfor HCWs, 89.8% for undergraduates, 60.6% for \nthose from rural areas, and 51.7% for those from \ntown areas. Generally, half of the HCWs and \nundergraduates recognised that sexual, mother to \nchild and saliva as transmission modes of \nhepatitis B, compared to a relatively low \npercentage (<30%) of the public.  \n\n\n\n \nUndergraduates were superior to the other \ngroups in knowing liver damage (93.5%), liver \ncancer (61.4%) and death (52.2%) as the \ncomplications of hepatitis B, followed by HCWs \nwith 82.7%, 58.6% and 25.7, respectively; \nparticipants from town areas with 55.9%, 28.9% \nand 30.4%, respectively; and those from rural \nareas with 55.1%, 28.2% and 21.2%, \nrespectively.  31.4% and 21.1% of the public \nfrom rural areas and town areas, respectively, \nsaid that hepatitis B can cause complications of \nheart disease and renal failure, which is not \ncorrect. \n\n\n\n \nThe availability of hepatitis A and B vaccines \nwas generally well known among HCWs and \nundergraduates (81.7%), with the exception that \nonly 57.5% of HCWs knew about the availability \nof hepatitis A vaccine. About half of the \nparticipants from town and rural areas knew \nabout the availability of hepatitis A and B \nvaccines. Details of the knowledge about \nhepatitis A and B among the four different \ngroups are shown in Table 2. \n \nVaccination coverage of hepatitis A and B \n \nMajority of the participants were not vaccinated \nfor hepatitis A with only 7.8% of the participants \nfrom town areas, 3.6% of the participants from \nrural areas, 3.2% of the HCWs and none of the \n\n\n\nundergraduates was vaccinated for hepatitis A. \nFrom the total of those who received the \nvaccination, 100% of the HCWs had received the \nfull course of the vaccination. However, all the \nparticipants from rural areas and 31.2% of those \nfrom town areas, who had received the hepatitis \nA vaccination could not remember the number of \ndoses taken. \n \n65.6% of the HCWs were vaccinated against \nhepatitis B compared to a relatively low \npercentage of participants from town areas \n(31.6%), undergraduates (21.9%), and those \nfrom rural areas (13.9%). From those who had \nreceived the vaccination, 73.0% of HCWs, \n56.9% of those from town areas and 39.0% of \nundergraduates had fulfilled the 3- dose \nvaccination course. However, a relatively low \npercentage of them, ranging from 5% to 19.5%, \nhad received the vaccine in the last five years. \nMost of the HCWs were exposed to blood or \nbody fluids of patients everyday (>90%) and \nonly 6% of them were not exposed to blood or \nbody fluids of patients.  \n\n\n\n \nInvestigation on the previous diagnosis of \nhepatitis of the subjects or their household \nmembers showed that the average prevalence of \nhepatitis infection for subjects or their household \nmembers was 6.6% with the highest prevalence \namong participants from rural areas (9.3%), \nfollowed by participants from town areas (8.3%), \nundergraduates (8.0%), and HCWs (1.0%). \nHepatitis B was the major type of infection.  \n\n\n\n \nA relatively small proportion of participants \nfrom rural areas (17.2%), participants from town \nareas (25.7%), and undergraduates (19.8%) have \nhad a blood test conducted before, compared to \nHCWs (67.7%). Again, hepatitis B was the more \ncommon disease tested for. Details of the results \nare shown in Table 3. \n \nAssociation between the extent of knowledge \nand the vaccination status among the study \npopulation \n \nFigures 1 and 2 depict the level of knowledge \nand vaccination status for hepatitis A and/or B \namong the subjects of different groups, \nrespectively. Figure 3 shows the association \nbetween the level of knowledge and vaccination \nstatus. There was a strong association between \nthe level of knowledge and vaccination status \namong the study population. For those with a \nlow level of knowledge, only a small proportion \n\n\n\n\n\n\n\n\nResearch article: Awareness of hepatitis  \n\n\n\n 81\n\n\n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \nof them (17.0%) had been vaccinated against \nhepatitis A and/or B. In contrast, a higher \nproportion of those with intermediate or high \nlevel of knowledge had been vaccinated, i.e. \n41.8% and 42.5%, respectively. In conclusion, the \nlevel of knowledge and vaccination status were \nsignificantly dependent in this study  (p<0.01). \n \nDISCUSSION \n \nThe overall level of knowledge about hepatitis A \nand B was generally poor among the general \npublic. In comparison, HCWs and undergraduates \nhad far better knowledge about hepatitis A and B \n(Table 2) as they had a higher level of education \nand were more exposed to health information. \nParticipants from town areas had slightly better \nlevel of knowledge about hepatitis A and B than \nthose  from rural areas  which could be  attributed \n\n\n\n  \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \nto the fact that a higher number of them had \ntertiary education compared to participants from  \nrural areas (Table 1). This agreed with the \nfindings of the study of Wiecha (9) and Taylor et \nal. (10) that there is a significant association \nbetween the level of knowledge about hepatitis B \nand the education level. \n \nBoth of the groups from rural and town areas \nwere poor in recognising the modes of \ntransmission of both hepatitis A and B. \nAwareness of the transmission modes is \nimportant, so that effective preventive measures \ncould be taken such as modification of lifestyles \nand vaccination against hepatitis A and B. \n\n\n\n \nIn East and Southeast Asian countries, 30 to 50% \nof all chronic infections among children result \nfrom  perinatal  transmission  and  9 500  infants \n\n\n\nTable 3: Vaccination of hepatitis A & B coverage among respondents. \n \n\n\n\nPublic  \nRural areas \n\n\n\n(%) \nTown areas \n\n\n\n(%) \n\n\n\nHealthcare \nworkers (%) \n\n\n\nUndergraduates \n(%) \n\n\n\nTotal (%) \n\n\n\nEver received hepatitis A vaccine \n   Yes \n     Dose: 1X \n               2X \n               cannot remember \n   No \n   Not sure \n\n\n\n \n6 (3.6) \n\n\n\n0 (0.0) \n0 (0.0) \n\n\n\n   6 (100.0) \n139 (84.3) \n20 (12.1) \n\n\n\n \n16 (7.8) \n\n\n\n4 (25.0) \n7 (43.8) \n5 (31.2) \n\n\n\n134 (65.0) \n56 (27.2) \n\n\n\n \n6 (3.2) \n\n\n\n0 (0.0) \n    6 (100.0) \n\n\n\n0 (0.0) \n157 (83.5) \n25 (13.3) \n\n\n\n \n0 (0.0) \n \n \n \n148 (79.1) \n39 (20.9) \n\n\n\n \n28 (3.7) \n\n\n\n4 (14.3) \n13 (46.4) \n11 (39.3) \n\n\n\n578 (77.5) \n140 (18.8) \n\n\n\nEver received hepatitis B vaccine \n   Yes \n     Dose: 1X \n             2X \n             3X \n             cannot remember \n \n     Time: <5 years ago \n                5-10 years ago \n                >10 years ago \n               cannot remember \n   No \n   Not sure \n\n\n\n \n23 (13.9) \n\n\n\n    2 (10.0) \n0 (0.0) \n0 (0.0) \n\n\n\n   18 (90.0) \n \n\n\n\n1 (5.0) \n0 (0.0) \n1 (5.0) \n\n\n\n18 (90.0) \n124 (75.2) \n18 (10.9) \n\n\n\n \n65 (31.6) \n\n\n\n9 (13.9) \n10 (15.4) \n37 (56.9) \n9 (13.8) \n\n\n\n \n8 (12.3) \n\n\n\n12 (18.5) \n3 (4.6) \n\n\n\n42 (64.6) \n87 (42.2) \n54 (26.2) \n\n\n\n \n126 (65.6) \n\n\n\n11 (8.7) \n18 (14.3) \n92 (73.0) \n\n\n\n5 (4.0) \n \n\n\n\n24 (19.0) \n21 (16.7) \n\n\n\n8 (6.3) \n73 (57.9) \n\n\n\n55 (28.7) \n11 (5.7) \n\n\n\n \n41 (21.9) \n\n\n\n3 (7.3) \n1 (2.5) \n\n\n\n16 (39.0) \n21 (51.2) \n\n\n\n \n8 (19.5) \n\n\n\n12 (29.3) \n8 (19.5) \n\n\n\n13 (31.7) \n117 (62.6) \n29 (15.5) \n\n\n\n \n255 (34.0) \n\n\n\n25 (9.9) \n29 (11.5) \n\n\n\n145 (57.5) \n53 (21.1) \n\n\n\n \n41 (16.3) \n45 (17.9) \n20 (7.9) \n\n\n\n146 (57.9) \n383 (51.1) \n112 (14.9) \n\n\n\nHousehold member or subject \never had hepatitis  \n   Yes \n      hepatitis A \n      hepatitis B \n      hepatitis C \n   No \n   Not sure \n\n\n\n \n \n15 (9.3) \n\n\n\n0 (0.0) \n15 (100.0) \n\n\n\n0 (0.0) \n146 (90.1) \n1 (0.6) \n\n\n\n \n \n17 (8.3) \n\n\n\n3 (17.6) \n13 (76.5) \n\n\n\n           1 (5.9) \n184 (89.3) \n5 (2.4) \n\n\n\n \n \n2 (1.0) \n\n\n\n             0 (0.0) \n          2 (100.0) \n\n\n\n            0 (0.0) \n188 (98.0) \n2 (1.0) \n\n\n\n \n \n15 (8.0) \n\n\n\n           2 (13.3) \n           13 (86.7) \n\n\n\n        0 (0.0) \n162 (86.6) \n10 (5.4) \n\n\n\n\n\n\n\n49 (6.6) \n \n \n \n\n\n\n680 (91.0) \n18 (2.4) \n\n\n\nEver had blood test for hepatitis  \n   Yes  \n      hepatitis A \n      hepatitis B \n      cannot remember \n   No \n   Not sure \n\n\n\n \n28 (17.2) \n\n\n\n0 (0.0) \n27 (96.4) \n\n\n\n1 (3.6) \n135 (82.8) \n0 (0.0) \n\n\n\n \n49 (25.7) \n\n\n\n   9 (18.4) \n45 (91.8) \n\n\n\n0 (0.0) \n137 (71.7) \n5 (2.6) \n\n\n\n \n86 (67.7) \n\n\n\n23 (26.7) \n77 (89.5) \n\n\n\n0 (0.0) \n37 (29.1) \n4 (3.2) \n\n\n\n \n35 (19.8) \n\n\n\n2 (5.7) \n34 (97.1) \n\n\n\n1(2.9) \n136 (76.8) \n6 (3.4) \n\n\n\n \n198 (30.1) \n\n\n\n\n\n\n\n445 (67.6) \n15 (2.3) \n\n\n\nNote: The total number of respondents does not equal 753 due to missing values. \n The percentages are based on the number of subjects who  responded to the items. \n\n\n\n\n\n\n\n\nResearch article: Awareness of hepatitis  \n\n\n\n 82\n\n\n\n\n\n\n\nFigure 1. Level of knowledge among the different subject groups. \n\n\n\n73 60\n26\n\n\n\n68\n106\n\n\n\n32\n3\n\n\n\n82\n109\n\n\n\n6\n54\n\n\n\n128\n150\n\n\n\n302 295\n\n\n\n0\n50\n\n\n\n100\n150\n200\n250\n300\n350\n\n\n\nlow intermediate high\n\n\n\nLevel of knowledge\n\n\n\nN\nu\n\n\n\nm\nb\n\n\n\ner\n o\n\n\n\nf \nsu\n\n\n\nb\nje\n\n\n\nct\ns\n\n\n\nResidents from rural areas\n\n\n\nResidents from town areas\n\n\n\nHealthcare workers\n\n\n\nUndergraduates\n\n\n\nTotal\n\n\n\n\n\n\n\n27\n\n\n\n120\n\n\n\n17\n\n\n\n73 78\n46\n\n\n\n125\n\n\n\n55\n7\n\n\n\n41\n\n\n\n106\n\n\n\n24\n\n\n\n266\n\n\n\n359\n\n\n\n94\n\n\n\n0\n50\n\n\n\n100\n150\n200\n250\n300\n350\n400\n\n\n\nYes No Not sure\n\n\n\nVaccination status\n\n\n\nN\nu\n\n\n\nm\nb\n\n\n\ner\n o\n\n\n\nf \nsu\n\n\n\nb\nje\n\n\n\nct\ns Residents from rural areas\n\n\n\nResidents from town areas\n\n\n\nHealthcare workers\n\n\n\nUndergraduates\n\n\n\nTotal\n\n\n\n\n\n\n\nFigure 2. Hepatitis A and/or B vaccination coverage among subjects in different groups. \n\n\n\nFigure 3: Association of the extent of knowledge with hepatitis A and/or B vaccination \nstatus (n=719, p< 0.01) \n \n\n\n\n17.0 15.4\n\n\n\n63.3\n\n\n\n19.7\n\n\n\n42.841.8\n\n\n\n50.4\n\n\n\n7.1\n\n\n\n42.5\n\n\n\n0\n10\n20\n30\n40\n50\n60\n70\n\n\n\nYes No Not sure\n\n\n\nVaccination Status\n\n\n\nS\nu\n\n\n\nb\nje\n\n\n\nct\ns \n\n\n\n(%\n)\n\n\n\nlow\n\n\n\nintermediate\n\n\n\nhigh\n\n\n\nLevel of \nknowledge\n\n\n\n \n\n\n\n\n\n\n\n\nResearch article: Awareness of hepatitis  \n\n\n\n 83\n\n\n\n would become infected if prophylaxis is not \nprovided (11). Understanding the possibility of \nHBV transmission from mothers to babies would \nenable women to be more aware about the \nimportance of hepatitis B surface antigen \n(HBsAg) screening, so that prophylactic measures \ncould be taken to protect the babies from HBV \ninfection. \n\n\n\n \nWith the successful implementation of the \nnational childhood immunisation programme \nagainst hepatitis B in Malaysia, sexual \ntransmission would inevitably emerge as the \nleading cause of HBV infection among healthy \nsusceptible adolescents and adults as in the West. \nSo, the public should be aware that their sexual \nbehaviour could lead to HBV infection.  \n \nAwareness of the complications of hepatitis B is \nalso important, so that people would realise about \nthe importance of taking preventive measures, \nespecially vaccination against the disease. \nUnfortunately, most of the public did not know \nthat hepatitis B can lead to severe complications \nof liver cancer and death (Table 2).  \n \nMalaysia had incorporated hepatitis B vaccination \ninto the national immunisation programme since \n1989. According to Ministry of Health Malaysia \n(12), the vaccination coverage among babies is \n98.3% for first dose, 91.6% for second dose and \n89.6% for third dose. However, there is no data \navailable about the rate of hepatitis A or B \nvaccination among adults in Malaysia. According \nto the results in this study, the overall vaccination \ncoverage was very low for hepatitis A (3.7%) and \nlow for hepatitis B (34.0%). Only about 2% of the \ntotal study population received both hepatitis A \nand B vaccines (not shown in results). The results \nalso implicated that most of the subjects who had \nbeen vaccinated, did not complete the course of \nvaccination and also did not follow-up on their \nimmunisation status. Preventive strategies against \nthe diseases, especially vaccination programmes, \nshould be developed and taken aggressively to \nimprove the vaccination coverage among the \nadults. \n\n\n\n \nA study by Chen et al. (13) and Hsu et al. (14) \nshowed that after a nationwide mass vaccination \nprogramme was launched in Taiwan in July 1984, \nthe HBsAg prevalence decreased markedly from \nthe year 1984 to 1994. Chang et al. (15) reported \nthat after the implementation of nationwide \nhepatitis B immunisation programmes, the annual \nincidence of hepatocellular carcinoma in children \n\n\n\nhad declined. So, immunisation programmes have \nproven effective not only in controlling hepatitis \nB infection, but also in controlling hepatocellular \ncarcinoma in Taiwan.  \n\n\n\n \nA low vaccination rate among participants from \nrural areas was probably due to the low level of \nknowledge about the diseases and the availability \nof the vaccines. Compared to those from rural \nareas, vaccination coverage of participants from \ntown areas was slightly better probably as they \nhad a higher level of knowledge about hepatitis A \nand B.  However, undergraduates, who had a high \nlevel of knowledge, had a very low vaccination \ncoverage for both hepatitis A (none) and hepatitis \nB (21.9%) (Table 3). This might be due to their \ndependence on parents or study loans for financial \nassistance.  \n\n\n\n \nHCWs are always at the risk of HBV infection \nbecause of the occupational exposure to blood \nborne pathogens (16). Risk increases with \npercutaneous exposures involving deeper \npenetration, larger volume of blood, high viral \ntitres and repeated or prolonged exposures (16-\n18). It is noteworthy to mention that in this study \nmost of the HCWs (over 90%) were exposed to \nblood and other body fluids of patients everyday, \nhowever, only about two thirds of them received \nthe hepatitis B vaccine and only 73% of them \ncompleted the 3-dose course. \n\n\n\n \nOnly six of the total number of HCWs in this \nstudy received the hepatitis A vaccine (Table 3). \nThis might be due to the fact that HAV is not a \nblood-borne pathogen and that the disease is \nusually self-limiting and non-fatal. So, there is \nless emphasis on the risk of hepatitis A among the \nHCWs and this was proven by a lower percentage \nof HCWs (57.5%) knowing about the availability \nof the hepatitis A vaccine compared to the \nhepatitis B vaccine (94.3%) (Table 2). Although \nHAV generally will not be transmitted through \nblood or blood products, however, prevention of \nhepatitis A is potentially important among HCWs \nand particular care should be required when \nnursing patients with diarrhoea (19). \n\n\n\n \nConsidering the long-term consequences of HBV \ninfection, the health of the HCWs is at risk. The \nhealth of the general population is also at risk \nconsidering the transmission risk of the virus to \nthe patients treated by the infected HCWs. In \n1991, the Centers For Disease Control And \nPrevention (CDC) estimated that during the past \n20 years more than 300 patients in the USA had \n\n\n\n\n\n\n\n\nResearch article: Awareness of hepatitis  \n\n\n\n 84\n\n\n\nbeen infected with HBV \u2018in association with \ntreatment\u2019 by infected HCWs (20).  \n\n\n\n \nOver 80% of 84 nurses and 26 physicians from \nfive St. Louis-area hospitals agreed that every \nhospital employee should get the hepatitis B \nvaccine (17). Mahoney et al. (21) showed that the \nnumber of infections among HCWs declined from \n17 000 in 1983 to 400 in 1995 after the \nimplementation of hepatitis B vaccination and \nbarrier precautions for blood exposure. So, all \nHCWs should be vaccinated against hepatitis B. \n \nThis study revealed a strong correlation between \nthe extent of knowledge and vaccination status of \nhepatitis A and/or B among the participants \n(p<0.01) (Figure 3). Similar studies by \nAdebamowo & Ajuwan (22) and Kamolraranakul \net al. (23) showed that the overall level of \nknowledge about HBV infection was deemed \npoor and lack of knowledge on HBV infection \nwas one of the reasons that leads to non-\nimmunisation.  \n \nLimitations  \n \nThere are some limitations to the findings in this \nstudy. Firstly, the study only involved certain \ngroups of the population from particular \nresidential areas or working places, so the results \nmay not represent the general population in \nMalaysia. Secondly, by using the convenience \nsampling based on voluntary basis, the proportion \nof races, gender, age, numbers of subjects were \nnot the same in each group, thus potentially \nintroducing bias into the analysis. Thirdly, all data \nwere self-reported and the validity of the \nresponses were not evaluated. Fourthly, the \nhistory of vaccination and blood tests was based \non the ability to recall and this might introduce  \ninaccuracy in recording of the data. Fifth, the \ninclusion  of  13-16  year old  subjects could have  \n\n\n\ncaused a problem of irreliability of information. \nLastly, people with a low literacy level may have \nhad difficulty with comprehension and tended not \nto answer the questions, especially those \nregarding knowledge of the disease.  \n \nCONCLUSION \n \nGenerally the degree of knowledge about hepatitis \nA and B among the public was low. \nUndergraduates and HCWs had a high degree of \nknowledge about hepatitis A and B. The overall \nvaccination coverage for hepatitis A and B was \npoor and the vaccination rate for hepatitis B was \nhigher than hepatitis A. Not all the HCWs were \nvaccinated against hepatitis B as they were \nsupposed to be. Most of them who received the \nhepatitis B vaccine did not follow up on their \nimmunisation status. Quite a number of the public \ndid not know their immunisation status. The \nextent of knowledge is a crucial factor in \ndetermining the vaccination status of the \nparticipants (p<0.01). \n \nThe results of this study showed that more \nattention should be addressed at providing health \neducation on hepatitis A and B to the public, \nparticularly those in the rural areas. Large scale \nnationwide awareness programmes, campaigns, \nand vaccination programmes should be carried \nout frequently in various states, especially in rural \nareas. More specific educational efforts should \nstart before launching vaccination programmes in \norder to increase acceptance. As most of the \npublic got to know about hepatitis through the \nmass media, information about the disease and its \npreventive measures can be broadcasted to the \npublic through television, radio, newspapers and \nmagazines. HCWs and undergraduates should be \nroutinely immunised before starting work in \nhealth institutes, especially in hospitals. \n \n\n\n\n\n\n\n\n***** \n \nREFERENCES \n \n1. Margolis, HS. Testimony of Harold S. Margolis \n\n\n\nMay 18, 1999. \nhttp://www.cdc.gov/ncidod/disease/hepatitis/marg\nolis.htm. (18 Nov. 1999). \n\n\n\n2. Advisory Committee on Immunization Practices \n(ACIP). Prevention of hepatitis A through active \nor passive immunization: Recommendations of the \nACIP. 1999; 1-37. \n\n\n\n \n \n3. Kementerian Kesihatan Malaysia.  Kawalan \n\n\n\nPenyakit Kesihatan. 2000; 37-38. \n4. Malaysian Liver Foundation.  Useful information: \n\n\n\nhepatitis B. 1999. http://www.liver.org.my/ (18 \nNov. 1999). \n\n\n\n5. Galasso GJ, Whitley RJ, Merigan TC. Antiviral \nagents and human viral diseases. 4th ed. U.S.: \nLippincott-Raven; 1997. \n\n\n\n\n\n\n\n\nResearch article: Awareness of hepatitis  \n\n\n\n 85\n\n\n\n6. Tong, MJ, EI-Farra NS, Grew MI. Clinical \nmanifestations of hepatitis A: recent experience in \na community teaching hospital. J Infect Dis 1995; \n171 (Suppl 1): S15-18. \n\n\n\n7. Shah U, Habib Z. Liver failure attributable to \nhepatitis A virus infection in a developing country. \nPediatrics 1999; 105:436-438. \n\n\n\n8. Moradpour D, Wands JR.  Understanding hepatitis \nB virus infection. N Engl J Med 1995; 332: 1092-\n1093. \n\n\n\n9. Wiecha, JM. Differences in knowledge of hepatitis \nB among Vietnamese, African-American, \nHispanic and White adolescents in Worcester, \nMassachusetts. Pediatrics 1999; 104: 1212-1216. \n\n\n\n10. Taylor VM, Jackson JC, Pineda M, Pham P, \nFischer M, Yasui Y.  Hepatitis B knowledge \namong Vietnamese immigrants: implications for \nprevention of hepatocellular carcinoma. J Cancer \nEduc 2000; 15:51-55. \n\n\n\n11. Plotkin SA, Orenstein WA. Vaccines. 3rd ed.  U.S.: \nW.B. Saunders Company; 1999. \n\n\n\n12. Kementerian Kesihatan Malaysia. Laporan \nTahunan. 1994; 47-49. \n\n\n\n13. Chen H, Chang M, Ni Y, Hsu H, Lee P, Lee C, \nChen D.  Seroepidemiology of hepatitis B virus \ninfection in children: ten years mass vaccination in \nTaiwan. JAMA 1996; 276: 906-908. \n\n\n\n14. Hsu H, Lu C, Lee S, Lin S, Chen D.  \nSeroepidemiolgic survey for hepatitis B virus \ninfection in Taiwan: the effect of hepatitis mass \nimmunization. J Infect Dis 1999; 179: 367-370. \n\n\n\n15. Chang M, Chen C, Lai M, Hsu H, Wu T, Kong, \nM, Liang D, Shau W, Chen, D. Universal hepatitis \nB vaccination in Taiwan and the incidence of \nhepatocellular carcinoma in children. N Engl J  \n\n\n\n Med. 1997; 336: 1855-1859.  \n16. Belo AC. Distribution of hepatitis B virus markers \n\n\n\namong surgical specialties in Lagos, Nigeria. \nTrans R Soc Trop Med Hyg  2000; 94: 53-54. \n\n\n\n17. Jeffe DB, Mutah S, L\u2019Ecuyer PB, Kim LE, Singal \nRB, Evanoff BA, Fraser VJ. Healthcare worker\u2019s \nattitudes and compliance with universal \nprecautions: gender, occupation, and specialty \ndifferences. Infect Control Hosp Epidemiol 1997; \n18: 710-712. \n\n\n\n18. Fry DE. Hepatitis: risks for the surgeon. Am \nSurgeon 2000; 66: 178-183. \n\n\n\n19. Smith S, Weber S, Wiblin T, Nettleman M. Cost-\neffectiveness of hepatitis A vaccination in \nhealthcare workers. Infect Control Hosp Epidemiol \n1997; 18: 688-691. \n\n\n\n20. Ristinen E, Mamtani R. Ethics of transmission of \nhepatitis B virus by health-care workers. The \nLancet 1998; 352: 1381-1383.  \n\n\n\n21. Mahoney FJ, Stewart K, Hu H, Coleman P, Alter \nM. Progress toward the elimination of hepatitis B \nvirus transmission among health care workers in \nthe United States. Arch Intern Med. 1997; 157: \n2601-2605. \n\n\n\n22. Adebamowo CA, Ajuwan A. The immunization \nstatus and level of knowledge about hepatitis B \nvirus infection among Nigerian surgeons. West Afr \nJ Med 1997; 16:93-96. \n\n\n\n23. Kamolraranakul P, Ungtavorn P, Israsena S & \nSakulramrung R. The influence of dissemination \nof information on the changes of knowledge, \nattitude and acceptance of hepatitis B vaccination \namong hospital personnel in Chulalongkorn. \nPublic Health 1994; 108:49-53. \n\n\n\n\n\n\n\n \n\n\n\n\n\n"
"\n\nMalaysian Journal of Pharmacy Volume 8 Issue 2 (2022) \n \n\n\n\n\n\n\n\n16 \n\n\n\n\n\n\n\n*Correspondence: orolandn@gmail.com \n\n\n\nDOI: 10.52494/KWQH7710 \n\n\n\n1Department of Clinical Pharmacy and Pharmacy Administration Faculty \n\n\n\nof Pharmacy, University of Maiduguri. Maiduguri, Nigeria.  \n2Department of Medicine, Nephrology Unit, University of Maiduguri \n\n\n\nTeaching Hospital, Maiduguri, Nigeria.  \n3Department of Clinical Pharmacy and Pharmacy Management, \n\n\n\nUniversity of Nigeria, Nsukka, Nigeria \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n Original Research Article \n\n\n\n\n\n\n\nEvaluation of the Impact of Clinical Pharmacists\u2019 Educational \n\n\n\nIntervention on the Knowledge of Patients with Chronic \n\n\n\nKidney Disease   \n \n\n\n\nIbrahim Ummate2, John David Ohieku1, Sani Ibn Yakubu1, Maxwell Ogochukwu Adibe3, Roland \n\n\n\nNnaemeka Okoro1* \n\n\n\n\n\n\n\n \nArticle Info  \n\n\n\n \nReceived date: 02 Feb 2022  \n\n\n\nAccepted date: 07 Jul 2022 \n\n\n\nPublished date: 31 Dec 2022 \n\n\n\n\n\n\n\nKeywords: Chronic kidney \n\n\n\ndisease (CKD); CKD \n\n\n\nknowledge; Nigeria; clinical \n\n\n\npharmacist; pre-dialysis CKD. \n\n\n\nABSTRACT  \n\n\n\n\n\n\n\nIntroduction: Chronic kidney disease (CKD) is a progressive disease associated with high morbidity \n\n\n\nand mortality at all stages. Objective: To determine the impact of pharmacists\u2019 educational \n\n\n\ninterventions on the CKD knowledge and knowledge levels of patients with pre-dialysis CKD, and \n\n\n\nto identify potential predictors of good CKD knowledge. Method: Two main healthcare facilities in \n\n\n\nMaiduguri, Nigeria, were the study settings for this randomised, controlled, prospective study with a \n\n\n\n12-month follow-up. Participants were randomised to the usual care (UC) and pharmacists\u2019 \n\n\n\nintervention (PI) groups on a 1:1 ratio. The PI group was offered usual care plus face-to-face CKD \n\n\n\neducation and self-management of CKD, an educational CKD infographic leaflet, and telephonic \n\n\n\ninterventions. Categorical data were compared using Chi-square or Fisher exact tests where relevant, \n\n\n\nwhile an independent sample T-test was used to compare the mean values of the two study groups. \n\n\n\nA p-value of less than 0.05 was considered to be statistically significant. Result: Baseline \n\n\n\ncharacteristics were similar between the PI (n = 73) and UC (n = 74) patients, although participants \n\n\n\nin the PI group were significantly more female (71.2% vs. 52.7%; p = 0.021). The overall mean \n\n\n\nknowledge score of the PI group was significantly higher than the UC group at 6 months (18.9 \u00b1 3.4 \n\n\n\nvs.14.6 \u00b1 4.4, p < 0.001), and at 12 months (19.5 \u00b1 3.8 vs.16.8 \u00b1 6.0, p < 0.001), respectively. At 6 \n\n\n\nmonths, a significant proportion of the participants in the intervention group had high knowledge \n\n\n\ncompared with those in the UC group (16.4% vs. 9.0%, p < 0.001). At the end of the study, the \n\n\n\nadjusted analysis revealed that those between 40 and 64 years of age (AOR 26.3, 95% CI 2.1 \u2013 331.0) \n\n\n\nand 65 years of age or more (AOR 10.1 95% CI 1.1 - 89.7) were more likely to have good CKD \n\n\n\nknowledge. Also, participants in the intervention group (AOR 2.7, 95% CI1.0 - 7.2) had a higher \n\n\n\nlikelihood of having good CKD knowledge. Conclusion: Educational interventions provided by \n\n\n\npharmacy students/clinical pharmacists resulted in significant improvements in the CKD knowledge \n\n\n\nof patients with pre-dialysis CKD. \n\n\n\n\n\n\n\n\n\n\n\nINTRODUCTION  \n \n\n\n\nChronic kidney disease (CKD) is a major global health issue, \n\n\n\nparticularly in resource-constrained nations [1]. It is a \n\n\n\nprogressive condition that can cause kidney failure and \n\n\n\nnecessitate renal replacement treatment, and it is associated \n\n\n\nwith morbidity and mortality at all stages [2]. The economic, \n\n\n\nclinical, and humanistic consequences are tremendous [3]. \n\n\n\nFortunately, medicines exist to decrease disease consequences \n\n\n\n[4], as well as to delay or even stop progression to severe stages \n\n\n\n\nmailto:orolandn@gmail.com\n\n\n\n\n\n\nIbrahim Ummate.et al. Mal J Pharm 8 (2) 2022, 16-26 \n\n\n\n\n\n\n\n17 \n\n\n\n\n\n\n\n[5]. Almost all medications are aiming at preventing renal \n\n\n\ndisease progression and minimizing related consequences, on \n\n\n\nthe other  \n\n\n\nhand, relying mainly on patient self-care. Throughout the \n\n\n\nvarious stages of CKD, patients with CKD need to invest \n\n\n\nconsiderable time into managing their health, including \n\n\n\nmodifying their diet and lifestyle, managing numerous \n\n\n\nmedications, and attending medical appointments. Therefore, \n\n\n\nknowledge of the disease and its management is required for \n\n\n\nthe effective management of CKD at home by patients. As a \n\n\n\nresult of the disease's complexity, which necessitates patients' \n\n\n\nactive participation and the acquisition of self-management \n\n\n\nskills, medical education is crucial in the CKD population [6]. \n\n\n\nTherefore, insufficient medical education is a major issue in \n\n\n\nmany chronic diseases, including CKD. Chronically ill people \n\n\n\nwith low medical education have little understanding of their \n\n\n\nmedical condition or how to manage it [7]. \n\n\n\n\n\n\n\nEvidence suggests that the general population, as well as CKD \n\n\n\npatients, have a lack of knowledge about the disease. Most \n\n\n\npeople in the general population lack knowledge of their kidney \n\n\n\ndisease [8]. The worst of it all is that most patients with CKD \n\n\n\nwho are being managed by experts have limited knowledge of \n\n\n\nthe disease [9]. A study revealed that a considerable proportion \n\n\n\nof patients with CKD stages 3 - 5 have poor knowledge about \n\n\n\ntheir own CKD diagnosis, and what to do if their kidneys fail \n\n\n\n[9]. Furthermore, studies consistently demonstrate that patients \n\n\n\nneed more knowledge about their chronic medical conditions \n\n\n\nto promote self-care behaviors [10-14] and that a lack of \n\n\n\neffective communication from health professionals is \n\n\n\nperceived as a constraint to acquiring and comprehending this \n\n\n\ninformation [15]. \n\n\n\n\n\n\n\nThe provision of CKD-specific knowledge interventions, such \n\n\n\nas knowledge of kidney physiology, functions, causes of CKD, \n\n\n\nsymptoms, diagnosis, the importance of dietary and lifestyle \n\n\n\nmodifications, and adherence to medication, control of co-\n\n\n\nmorbidities to slow down disease progression among others is \n\n\n\ncritical since educational interventions have been found to \n\n\n\npostpone the start of dialysis and lower the risk of death due to \n\n\n\nCKD [16]. There is, however, a scarcity of data on educational \n\n\n\nprogrammes for the CKD population in low- and middle-\n\n\n\nincome countries (LMICs), including Nigeria. As a result, the \n\n\n\naims of the study were to determine the impact of pharmacists\u2019 \n\n\n\neducational interventions on the CKD knowledge and \n\n\n\nknowledge levels of patients with pre-dialysis CKD and to \n\n\n\nidentify potential predictors of good CKD knowledge. \n\n\n\n\n\n\n\nMETHOD  \n \n\n\n\nStudy Design and Setting \n\n\n\n\n\n\n\nThis was a randomised, controlled, prospective study with  a \n\n\n\n12-month follow-up. The study was conducted from November \n\n\n\n2019 to October 2020 in two main healthcare facilities in \n\n\n\nMaiduguri, Nigeria.  \n\n\n\n\n\n\n\nSample Size Calculation \n\n\n\n\n\n\n\nAn online Sealed Envelope\u00ae sample size calculator was used \n\n\n\nto calculate the required sample size [17]. This study was \n\n\n\npowered at 90% (2-sided test level of 0.05) to detect a \n\n\n\ndifference in the mean overall knowledge scores at 6 and 12 \n\n\n\nmonths between the  35 percent receiving usual care and the 65 \n\n\n\npercent receiving the intervention. The sample size required for \n\n\n\neach group was 54 people. The minimal sample size of 108 was \n\n\n\nincreased to account for an anticipated 7% noncompliance in \n\n\n\nboth groups, yielding a final value of 148. \n\n\n\n\n\n\n\nCalculation is based on the formula: \n\n\n\nn = f (\u03b1/2, \u03b2) \u00d7 [p1 \u00d7 (100 \u2212 p1) + p2 \u00d7 (100 \u2212 p2)] / (p2 \u2212 p1)2 \n\n\n\n\n\n\n\nWhere p1 and p2 are the percent 'success' in the control and \n\n\n\nexperimental group respectively, and  \n\n\n\nf (\u03b1, \u03b2) = [\u03a6-1(\u03b1) + \u03a6-1(\u03b2)]2 \n\n\n\n\n\n\n\n\u03a6-1 is the cumulative distribution function of a standardised \n\n\n\nnormal deviate. \n\n\n\n\n\n\n\nAdjustment for non-compliance is based on formula:  \n\n\n\nnadj = n \u00d7 10,000 / (100 - c1 - c2)2 \n\n\n\n\n\n\n\nWhere c1 and c2 are the percent non-compliance in the control \n\n\n\nand experimental group respectively. \n\n\n\n\n\n\n\nEligibility Criteria  \n\n\n\n\n\n\n\nPatients that were 18 to 85 years old with a confirmed CKD \n\n\n\nstage 1 \u2013 4 diagnosis who consented, stated readiness to abide \n\n\n\nby the study protocols, and expressed a willingness to remain \n\n\n\nin Maiduguri throughout the study period were enrolled. \n\n\n\nPatients with acute renal failure (ARF), eligible individuals \n\n\n\nwho refused to sign informed consent, and those at CKD stage \n\n\n\n5 were excluded. Pregnant or lactating women, patients on \n\n\n\ndialysis or post-renal transplant patients, patients with HIV \n\n\n\ninfection, critically sick patients or patients known to have \n\n\n\ncurrent psychosis, dementia, or cognitive impairment, and \n\n\n\nthose who expressed a readiness to withdraw from the study \n\n\n\nwere also excluded. \n\n\n\n\n\n\n\nEthical Considerations \n\n\n\n\n\n\n\nEthical approvals were provided by the Research Ethics \n\n\n\nCommittees of the study healthcare facilities. All participants \n\n\n\nwho volunteered to take part in this study provided written \n\n\n\ninformed consent. The confidentiality of patients\u2019 information \n\n\n\nwas upheld throughout the study period. During data collection, \n\n\n\ncodes were used to identify participants. \n\n\n\n\n\n\n\n\nIbrahim Ummate.et al. Mal J Pharm 8 (2) 2022, 16-26 \n\n\n\n\n\n\n\n18 \n\n\n\n\n\n\n\n\n\n\n\nParticipants Selection, Randomisation, and Stratification \n\n\n\n\n\n\n\nIn order to identify those eligible for the study the health \n\n\n\ninformation of patients with CKD was reviewed in the clinic \n\n\n\nusing screening and eligibility forms. The patients who had \n\n\n\nbeen identified were approached and invited to participate \n\n\n\nutilising the consent explanation forms. The consent \n\n\n\ndeclaration form was signed by all who volunteered to be \n\n\n\nincluded in the trial. Participants were randomised in a 1:1 ratio \n\n\n\nto the Usual Care (UC) and Pharmacists' Intervention (PI) \n\n\n\ngroups (Figure 1) using computer-generated random numbers \n\n\n\nstratified by CKD stage [18]. \n\n\n\n\n\n\n\nUsual Care Received \n\n\n\n\n\n\n\nThe usual/conventional care provided to the UC group by the \n\n\n\nhospitals, included hospital visits for follow-up or due to new \n\n\n\nsickness, physician consultations, regular medical \n\n\n\ninvestigations, review of diagnosis, medications, and referral \n\n\n\nwhen necessary. The usual care was provided with no \n\n\n\nteachings/coaching about their medical conditions or \n\n\n\nmedicines and with no patient empowerment to fully \n\n\n\nparticipate in self-management techniques. \n\n\n\n\n\n\n\nInterventions  \n\n\n\n\n\n\n\nFor 12 months, participants in the PI group got usual care as \n\n\n\nwell as pharmacists\u2019 interventions provided by three final-year \n\n\n\npharmacy students trained by the authors. The PI group \n\n\n\nreceived usual care and face-to-face CKD education at baseline \n\n\n\n(group education), 6 months, and 12 months (individualised \n\n\n\naccording to each patient's needs), as well as educational \n\n\n\ninfographics on CKD at baseline. The structured education \n\n\n\nprogramme for patients in the intervention group consisted of \n\n\n\nfive sessions of 90 - 120 minutes each covering the physiology \n\n\n\nof kidneys and six kidney disease education lessons [19]: (i) \n\n\n\nComprehending renal disease, (ii) Renal disease management, \n\n\n\n(iii) Manifestations of worsening renal disease, (iv) Treatment \n\n\n\nchoices for renal failure, (v) Preparations for renal failure \n\n\n\ntreatments, and (vi) Living with renal failure. The structured \n\n\n\nsessions were conducted once at baseline in groups of 4 to 10 \n\n\n\npatients after data collection. Additionally, throughout the \n\n\n\nstudy period, cell phone CKD educational text messages based \n\n\n\non the topics covered during the baseline face-to-face education \n\n\n\nwere provided to each patient fortnightly, while participants \n\n\n\nphoned-in when the need arises, Reinforcement interventions \n\n\n\nthrough phone calls were also provided on individual needs \n\n\n\nbasis.  \n\n\n\n\n\n\n\nBlinding \n\n\n\n\n\n\n\nThe profession of the investigators was not made known to the \n\n\n\nparticipants to rule out potential sources of bias because \n\n\n\npharmacists are seen mainly by patients as drug dispensers in \n\n\n\nNigeria.  \n\n\n\nFollow-Up Visits \n\n\n\n\n\n\n\nAt six and 12 months, all participants returned to the research \n\n\n\nclinic for follow-ups. The same instrument was used to conduct \n\n\n\nan additional CKD knowledge assessment and reinforcing \n\n\n\ninterventions according to each participant\u2019s needs were also \n\n\n\nprovided. \n\n\n\n\n\n\n\nStudy Outcomes \n\n\n\n\n\n\n\nThe primary outcome of the study was a change in the mean \n\n\n\nknowledge scores between the baseline and the first and second \n\n\n\nfollow-ups, respectively. The secondary outcomes were the \n\n\n\nproportion of participants with correct knowledge of CKD at \n\n\n\nsix and 12 months, respectively, and the potential predictors of \n\n\n\ngood CKD knowledge at 12 months.  \n\n\n\n\n\n\n\nVariables Definition \n\n\n\n\n\n\n\nChronic kidney disease was defined as  reduced kidney \n\n\n\nfunction (eGFR < 60 mL / min / 1.73m2) and / or the presence \n\n\n\nof markers of kidney damage for a period exceeding three \n\n\n\nmonths [20]. \n\n\n\n\n\n\n\nStudy Instrument \n\n\n\n\n\n\n\nA previously validated Kidney Disease Knowledge Survey \n\n\n\n(KiKS) questionnaire was used in this study [21]. This tool was \n\n\n\nupdated by the authors of the present study to improve the \n\n\n\nparticipants' understanding and facilitate filling. The \u201cdon't \n\n\n\nknow\u201d option was added to help collect the correct responses \n\n\n\nthat best describe an individual., Tylenol was replaced with \n\n\n\nparacetamol, which is the name used in Nigeria. To ensure the \n\n\n\nvalidity of the instrument in our study population, face validity \n\n\n\nwas checked by four experts in CKD (two nephrologists and \n\n\n\nconsultant renal pharmacists each). Based on their feedback, all \n\n\n\nthe 28 items were kept without revision. Furthermore, a pilot \n\n\n\nstudy was conducted using the updated questionnaire on 20 \n\n\n\npatients with CKD that were excluded from the main study. \n\n\n\nThe updated questionnaire had Cronbach\u2019s alpha values of 0.71 \n\n\n\nfor general knowledge, 0.64 for kidney functions, and 0.67 for \n\n\n\nCKD symptoms of progression respectively, indicating \n\n\n\nacceptable reliability scores. \n\n\n\n\n\n\n\nThe KiKS assesses CKD-specific knowledge in patients with \n\n\n\nCKD (stages 1 - 5) to better ascertain their degree of \n\n\n\ncomprehension. The questions focus on knowledge of renal \n\n\n\nfunction, therapeutic options for renal failure, signs, and \n\n\n\nsymptoms of disease progression, potentially beneficial or \n\n\n\ntoxic medications, blood pressure targets, and other important \n\n\n\ntopics to preserve kidney function. There are 28 questions in \n\n\n\nall, five of which are multiple-choice and 23 of which are \n\n\n\n\n\n\n\n\nIbrahim Ummate.et al. Mal J Pharm 8 (2) 2022, 16-26 \n\n\n\n\n\n\n\n19 \n\n\n\n\n\n\n\nyes/no/don\u2019t know. The 28 questions are organised into three \n\n\n\ndomains, namely: (i) General knowledge (9 questions), (ii) \n\n\n\nKnowledge of kidney functions (9 questions), and (iii) \n\n\n\nKnowledge of symptoms of progression of CKD or failure (10 \n\n\n\nquestions). The sum of all the 28 questions constituted the total \n\n\n\nknowledge. \n\n\n\n\n\n\n\nData Collection  \n\n\n\n\n\n\n\nParticipants\u2019 relevant demographics were gathered at the \n\n\n\nbaseline. Comorbidities were extracted from the patients\u2019 \n\n\n\nmedical records, while self-reported CKD knowledge \n\n\n\ninformation was gathered during each research visit. \n\n\n\n\n\n\n\nData Processing \n\n\n\n\n\n\n\nGlomerular filtration rate (GFR) based on the Modification of \n\n\n\nDiet in Renal Disease Equation for Adult was used for disease \n\n\n\nstaging [22,23]. To determine the CKD knowledge level, each \n\n\n\ncorrect answer was assigned one point, while zero points were  \n\n\n\nassigned to each incorrect or don\u2019t know answer. The overall \n\n\n\nknowledge score is the total of the correct answers to each \n\n\n\nquestion, ranging from 0 to 28 points, where 28 points indicate \n\n\n\nthe highest level of knowledge. The overall knowledge was \n\n\n\ncategorised, using Bloom\u2019s cut-off point, as high if the score is \n\n\n\nbetween 80 and 100% (22 \u2013 28 points), moderate if the score is \n\n\n\nbetween 60 and 79% (17 \u2013 21 points), and low if the score is \n\n\n\nless than 60% (< 17 points) [24]. For the multivariable logistic \n\n\n\nregression analysis, good CKD knowledge was coded one, \n\n\n\nwhile sub-optimal CKD knowledge (low and moderate \n\n\n\nknowledge) was coded zero. \n\n\n\n\n\n\n\nData Analysis \n\n\n\n\n\n\n\nIn the analysis of the study data, per protocol procedure was \n\n\n\nused. Continuous data were summarised using their mean \u00b1 \n\n\n\nstandard deviation (SD), while categorical variables were \n\n\n\nrepresented by crude counts and percentages. Proportions were \n\n\n\ncompared with chi-square or fisher's exact tests (when more \n\n\n\nthan 20 percent of cells have expected frequencies of less than \n\n\n\nfive). The independent samples t-test was used to compare the \n\n\n\nmean values of the study groups. The multivariable logistic \n\n\n\nregression analysis was performed at the end of the study to \n\n\n\nidentify the potential predictors of good CKD knowledge \n\n\n\namong the study participants. In all analyses, p-values less than \n\n\n\n0.05 were considered statistically significant (2-sided). SPSS \n\n\n\nfor Windows version 21 was used for all analyses. \n\n\n\n\n\n\n\nRESULT  \n \n\n\n\nThe UC group received 74 (50.3%) of the 147 eligible and \n\n\n\nrecruited participants, whereas the PI group received 73 \n\n\n\n(49.7%). Sixty-seven (90.5%) participants in the UC group and \n\n\n\n67 (91.8%) in the PI group visited the research clinic during the  \n\n\n\n\n\n\n\n6 months follow-up, and their data were examined. \n\n\n\nFurthermore, 50 (67.6%) participants in the UC group and 56  \n\n\n\n(76.7%) in the PI groups completed the last follow-up, and only \n\n\n\ntheir data were included in the analysis at this timepoint (Figure \n\n\n\nI). \n\n\n\nPI and UC groups had average age values of 51.1 (13.4) years \n\n\n\nand 53.3 (12.1) years, respectively. Overall, the baseline data \n\n\n\nof the study groups were similar, although the PI group had \n\n\n\nmore females with a significant difference (71.2% vs. 52.7%, p \n\n\n\n= 0.021). The detailed baseline information of the participants \n\n\n\nis presented in Table I. \n\n\n\n\n\n\n\nThe mean general knowledge score of the PI group was \n\n\n\nsignificantly higher than that of the UC group at six months \n\n\n\n(5.8 \u00b1 1.4 vs. 4.4 \u00b1 1.6, p < 0.001), and at 12 months (5.6 \u00b1 1.5 \n\n\n\nvs. 5.0 \u00b1 1.9, p = 0.039). The mean kidney functions knowledge \n\n\n\nscore of the PI group was significantly higher than that of the \n\n\n\nUC group at six months (7.2 \u00b1 1.5 vs. 6.0 \u00b1 2.4, p = 0.001), and \n\n\n\nat 12 months (6.7 \u00b1 1.4 vs. 5.7 \u00b1 2.9, p = 0.033). Also, the mean \n\n\n\nCKD symptoms of progression or failure knowledge of the PI \n\n\n\ngroup was significantly higher than that of the UC group at six \n\n\n\nmonths (5.9 \u00b1 2.0 vs. 4.2 \u00b1 2.4, p < 0.001), and at 12 months \n\n\n\n(7.2 \u00b1 2.2 vs. 6.2 \u00b1 2.9, p = 0.040). Further, the mean overall \n\n\n\nknowledge of the PI group was significantly higher compared \n\n\n\nwith the UC group at six months (18.9 \u00b1 3.4 vs.14.6 \u00b1 4.4, p < \n\n\n\n0.001), and at 12 months (19.5 \u00b1 3.8 vs.16.8 \u00b1 6.0, p < 0.001), \n\n\n\nrespectively (Table II).  \n\n\n\n\n\n\n\n\n\n\n\nFigure I. Study Flow Diagram \n\n\n\n\n\n\n\n\nIbrahim Ummate.et al. Mal J Pharm 8 (2) 2022, 16-26 \n\n\n\n\n\n\n\n20 \n\n\n\n\n\n\n\nThe overall CKD knowledge level was generally low (73.5%) \n\n\n\nin both groups at baseline with no statistically significant \n\n\n\ndifference between the two study groups (72.6% in the PI vs. \n\n\n\n74.3% in the UC, p = 0.519). At six months, a significant \n\n\n\nproportion of the participants in the intervention group had high \n\n\n\nknowledge compared with those in the UC group (16.4% vs. \n\n\n\n9.0%, p < 0.001). Also, at 12 months, a higher proportion of \n\n\n\nparticipants in the intervention group had high knowledge \n\n\n\ncompared with those in the UC group, although no statistically \n\n\n\nsignificant level was reached (41.1% vs. 20.0%, p = 0.058). The \n\n\n\ndetailed distribution of the study participants based on their \n\n\n\noverall knowledge levels is presented in Table III. \n\n\n\n\n\n\n\nThe analysis of the individual items of the general knowledge \n\n\n\ndomain revealed a significantly higher proportion of \n\n\n\nparticipants in the intervention group than in the UC group that \n\n\n\nhad correct knowledge of the reasons why protein in urine is a \n\n\n\nproblem at the end of the study (19.6% vs. 0.0%, p = 0.001), \n\n\n\nmedications a person with CKD should avoid (91.0% vs. \n\n\n\n43.3%, p < 0.001]), and treatment options for kidney failure at \n\n\n\nsix months (61.2% vs. 25.4%, p < 0.001). Also, a significantly \n\n\n\nhigher proportion of participants in the intervention group than \n\n\n\nin the UC group had correct knowledge about the definition of \n\n\n\nglomerular filtration rate (GFR) at the baseline (8.2% vs. 0.0%, \n\n\n\np = 0.012), six months (6.0% vs. 0.0%, p = 0.043), and 12 \n\n\n\nmonths (35.7% vs. 4.0%, p < 0.001).  Further, a significantly \n\n\n\nhigher proportion of participants in the intervention group than  \n\n\n\nin the UC group that had correct knowledge of stages of CKD \n\n\n\nat six months (88.1% vs. 70.1%, p = 0.011) and 12 months  \n\n\n\n\n\n\n\n (88.1% vs. 70.1%, p = 0.022), and increased risk of heart \n\n\n\ndisease at six months (89.6% vs. 64.2%, p = 0.001) (Table IV). \n\n\n\n\n\n\n\nTable II. Summary Results of Knowledge Domains \n\n\n\n\n\n\n\nDomain \n\n\n\nUC PI  UC PI Differential  \n\n\n\nMean \n\n\n\nChange \n\n\n\nfrom \n\n\n\nBaseline \n\n\n\n(PI-UC) \n\n\n\nRemark \nMean\u00b1SD Mean\u00b1SD P-Value \n\n\n\nMean \n\n\n\nChange \n\n\n\nfrom \n\n\n\nBaseline \n\n\n\nP-Value \n\n\n\nMean \n\n\n\nChange \n\n\n\nfrom \n\n\n\nBaseline \n\n\n\nP-Value \n\n\n\nGeneral knowledge \n\n\n\nBaseline 3.7 \u00b1 1.4 3.5 \u00b1 1.6 0.396 - - - - - - \n\n\n\n6 months 4.4 \u00b1 1.6 5.8 \u00b1 1.4 < 0.001* 0.7 0.007* 2.3 < 0.001* 1.6 Improved knowledge \n\n\n\n12 months 5.0 \u00b1 1.9 5.6 \u00b1 1.5 0.039* 1.3  < 0.001* 2.1  < 0.001* 0.8 Improved knowledge \n\n\n\n\n\n\n\nKidney functions \n\n\n\nBaseline 3.4 \u00b1 2.8 3.3 \u00b1 2.7 0.681 - - - - - - \n\n\n\n6 months 6.0 \u00b1 2.4 7.2 \u00b1 1.5 0.001* 2.5  < 0.001* 3.9  < 0.001* 1.4 Improved knowledge \n\n\n\n12 months 5.7 \u00b1 2.9 6.7 \u00b1 1.4 0.033* 2.3 < 0.001* 3.4 < 0.001* 1.1 Improved knowledge \n\n\n\n\n\n\n\nSymptoms of progression or failure \n\n\n\nBaseline 4.6 \u00b1 3.0 4.5 \u00b1 2.5 0.730 - - - - - - \n\n\n\n6 months 4.2 \u00b1 2.4 5.9 \u00b1 2.0 < 0.001* -0.4 0.400 1.4 < 0.001* 1.8 Improved knowledge \n\n\n\n12 months 6.2 \u00b1 2.9 7.2 \u00b1 2.2 0.040* 1.6 0.005* 2.7 < 0.001* 1.1 Improved knowledge \n\n\n\n\n\n\n\nOverall Knowledge \n\n\n\nBaseline 11.7 \u00b1 5.9 11.2 \u00b1 5.6 0.559 - - - - - - \n\n\n\n6 months 14.6 \u00b1 4.4 18.9 \u00b1 3.4 < 0.001* 2.9 0.001* 7.7 < 0.001* 4.8 Improved knowledge \n\n\n\n12 months 16.8 \u00b1 6.0 19.5 \u00b1 3.8 < 0.001* 5.1 <0.001* 8.3 < 0.001* 3.2 Improved knowledge \n\n\n\n\n\n\n\n*Independent samples is significant at p < 0.05 \n\n\n\nTable I. Baseline Information of the Recruited Patient (N=147) \n\n\n\n\n\n\n\nVariables \nGroup \n\n\n\nAll N (%) UC n (%) PI n (%) P-Value \n\n\n\nAge (years) \n\n\n\n   < 40 21 (14.3) 10 (13.5) 11 (15.1) \n\n\n\n0.814 \n\n\n\n\n\n\n\n   40 - 64 101 (68.7) 50 (67.6) 51 (69.9) \n\n\n\n   \u2265 65 25 (17.0) 14 (18.9) 11 (15.1) \n\n\n\nSex \n\n\n\n   Male 56 (38.1) 35 (47.3) 21 (28.8) \n0.021* \n\n\n\n   Female 91 (61.9) 39 (52.7) 52 (71.2) \n\n\n\nMarital status \n\n\n\n   Single 23 (15.6) 8 (10.8) 15 (20.5) \n0.104 \n\n\n\n   Married 124 (88.4) 66 (89.2) 58 (79.5) \n\n\n\nEducational level \n\n\n\n   None 43 (29.2) 24 (32.4) 19 (26.0) \n\n\n\n0.653 \n   Primary 32 (21.8) 14 (18.9) 18 (24.7) \n\n\n\n   Secondary 25 (17.0) 14 (18.9) 11 (15.1) \n\n\n\n   Tertiary 47 (32.0) 22 (29.7) 25 (34.2) \n\n\n\nStage (mL / min / 1.73m2) \n\n\n\n   1 (\u2265 90) 0 (0.0) 0 (0.0) 0 (0.0) \n\n\n\n0.682 \n   2 (89 - 60) 6 (4.1) 2 (2.7) 4 (5.5) \n\n\n\n   3 (59 - 30) 42 (28.6) 22 (29.7) 20 (27.4) \n\n\n\n   4 (29 - 15) 99 (67.3) 50 (67.6) 49 (67.1) \n\n\n\nComorbidity \n\n\n\n   Hypertension     \n\n\n\n      Yes 147(100.0) 74 (100.4) 73 (100.0) \n- \n\n\n\n      No 0 (0.0) 0 (0.0) 0 (0.0) \n\n\n\n   Diabetes     \n\n\n\n      Yes 4 (2.7) 3 (4.1) 1 (1.4) \n0.319 \n\n\n\n      No 143 (97.3) 71 (95.9) 72 (98.6) \n\n\n\n\n\n\n\n*Chi-square test is significant at p < 0.05 \n\n\n\n\n\n\n\n\nIbrahim Ummate.et al. Mal J Pharm 8 (2) 2022, 16-26 \n\n\n\n\n\n\n\n21 \n\n\n\n\n\n\n\nThe analysis of the individual items of the kidney functions \n\n\n\ndomain indicated that interventions provided by pharmacists \n\n\n\nled to significantly higher proportions of participants with \n\n\n\ncorrect knowledge of the roles of the kidneys in urine \n\n\n\nproduction at 12 months (100.0% in the PI vs. 84.0% in the UC, \n\n\n\np = 0.002), the role in waste clearance at 12 months (94.6% in \n\n\n\nthe PI vs. 76.0% in the UC, p = 0.006), and no hair loss role at \n\n\n\nsix months (74.6% in the PI vs. 22.4% in the UC, p < 0.001). \n\n\n\nAlso, significantly higher proportions of participants in the\u201d \n\n\n\nintervention group than in the UC had correct knowledge about \n\n\n\nno glucose control role of kidney at 12 months (12.5% vs. \n\n\n\n0.0%, p = 0.001), the role in potassium control at six months \n\n\n\n(88.1% vs. 73.1%, p = 0.029), and the role in phosphorus \n\n\n\ncontrol at six months (89.6% vs. 71.6%, p = 0.009) (Table V). \n\n\n\n\n\n\n\nAlso, the analysis of the individual items in the symptoms of \n\n\n\nprogression or failure domain revealed significantly higher \n\n\n\nproportion of participants in the intervention group than in the \n\n\n\nUC group with correct knowledge of symptom of increased \n\n\n\nfatigue at 6 months (89.6% vs. 65.7%, p = 0.001), shortness of \n\n\n\nTable III. Overall Knowledge Level of the Study Participants \n\n\n\n\n\n\n\nKnowledge \n\n\n\nLevel \n\n\n\nBaseline 6 Months 12 Months \n\n\n\nAll \n\n\n\nN (%) \n\n\n\nUC \n\n\n\nn (%) \n\n\n\nPI \n\n\n\nn (%) \n\n\n\nP-\n\n\n\nvalue \n\n\n\nAll \n\n\n\nN (%) \n\n\n\nUC \n\n\n\nn (%) \n\n\n\nPI \n\n\n\nn (%) \nP-value \n\n\n\nAll \n\n\n\nN (%) \n\n\n\nUC \n\n\n\nn (%) \n\n\n\nPI \n\n\n\nn (%) \n\n\n\nP-\n\n\n\nvalue \n\n\n\nLow (< 17) \n108 55 53  67 52 15  31 18 13  \n\n\n\n(73.5) (74.3) (72.6)  (50.0) (77.6) (22.4)  (29.2) (36.0) (23.2)  \n\n\n\nModerate  \n\n\n\n(17 - 21) \n\n\n\n35 16 19 0.519 50 9 41 < 0.001* 42 22 20 0.058 \n\n\n\n(23.8) (21.6) (26.0)  (37.3) (13.4) (61.2)  (39.6) (44.0) (35.7)  \n\n\n\nHigh  \n\n\n\n(22 - 28) \n\n\n\n4 3 1  17 6 11  33 10 23  \n\n\n\n(2.7) (4.1) (1.4)  (12.7) (9.0) (16.4)  (31.1) (20.0) (41.1)  \n\n\n\n\n\n\n\n*Chi-square or Fisher\u2019s exact test significant at p < 0.05 \n\n\n\n\n\n\n\nTable IV. Percentage Distribution of Correct Answers in the General Knowledge Domain \n\n\n\n\n\n\n\nGeneral Knowledge item \nUC \n\n\n\nn (%) \n\n\n\nPI \n\n\n\nn (%) \nP value \n\n\n\nDifferential Change  \n\n\n\n(PI \u2013 UC) % \n\n\n\nBlood pressure goal    (PI \u2013 UC) % \n\n\n\n   Baseline 30 (40.5) 27 (37.0) 0.664 -3.5 \n\n\n\n   6 months 48 (71.6) 54 (80.6) 0.224 9.0 \n\n\n\n   12 months 38 (76.0) 41 (73.2) 0.742 -2.8 \n\n\n\nMedications important to kidney health \n\n\n\n   Baseline 53 (71.6) 44 (60.3) 0.150 -11.3 \n\n\n\n   6 months 41 (61.2) 48 (71.6) 0.204 10.4 \n\n\n\n   12 months 38 (76.0) 36 (64.3) 0.192 -11.7 \n\n\n\nReasons why protein in urine is a problem \n\n\n\n   Baseline 1 (1.4) 2 (2.7) 0.579 1.3 \n\n\n\n   6 months 8 (11.9) 1 (1.5) 0.017* -10.4 \n\n\n\n   12 months 0 (0.0) 11 (19.6) 0.001* 19.6 \n\n\n\nContraindicated medications in CKD \n\n\n\n   Baseline 5 (6.8) 9 (12.3) 0.258 5.5 \n\n\n\n   6 months 29 (43.3) 61 (91.0) < 0.001* 47.7 \n\n\n\n   12 months 28 (56.0) 40 (71.4) 0.101 15.4 \n\n\n\nTreatment options for kidney failure \n\n\n\n   Baseline 57 (77.0) 59 (80.8) 0.574 3.8 \n\n\n\n   6 months 17 (25.4) 41 (61.2) < 0.001* 35.8 \n\n\n\n   12 months 18 (36.0) 18 (32.1) 0.674 -3.9 \n\n\n\nDefinition of glomerular filtration rate (GFR) \n\n\n\n   Baseline 0 (0.0) 6 (8.2) 0.012* 8.2 \n\n\n\n   6 months 0 (0.0) 4 (6.0) 0.043* 6.0 \n\n\n\n   12 months 2 (4.0) 20 (35.7) < 0.001* 31.7 \n\n\n\nKnowledge of CKD stages \n\n\n\n   Baseline 38 (51.4) 34 (46.6) 0.562 -4.8 \n\n\n\n   6 months 47 (70.1) 59 (88.1) 0.011* 18.0 \n\n\n\n   12 months 47 (70.1) 59 (88.1) 0.022* 18.0 \n\n\n\nIncreased risk of heart disease due to CKD \n\n\n\n   Baseline 40 (54.1) 29 (39.7) 0.081 -14.4 \n\n\n\n   6 months 43 (64.2) 60 (89.6) 0.001* 25.4 \n\n\n\n   12 months 40 (80.0) 49 (87.5) 0.296 7.5 \n\n\n\nUnderstanding increased risk of mortality   \n\n\n\n   Baseline 49 (66.2) 44 (60.3) 0.460 -5.9 \n\n\n\n   6 months 61 (91.0) 63 (94.0) 0.511 3.0 \n\n\n\n   12 months 46 (92.0) 51 (91.1) 0.869 -0.9 \n\n\n\n\n\n\n\n*Chi-square or Fisher\u2019s exact test significant at p < 0.05 \n\n\n\n\n\n\n\n\nIbrahim Ummate.et al. Mal J Pharm 8 (2) 2022, 16-26 \n\n\n\n\n\n\n\n22 \n\n\n\n\n\n\n\n\n\n\n\nbreath at six months (68.7% vs. 26.9%, p < 0.001), and \n\n\n\nmetallic/bad taste at six months (74.6% vs. 34.3%, p < 0.001), \n\n\n\nand 12 months (87.5% vs. 72.0, p = 0.047). Further, \n\n\n\nsignificantly higher proportions of participants in the \n\n\n\nintervention group compared with the control group had correct \n\n\n\nknowledge about nausea/vomiting symptom at six months \n\n\n\n(56.7% vs. 34.3%, p = 0.010), difficulty sleeping at six months \n\n\n\n(65.7% vs. 40.3%, p = 0.003, weight loss at six months (52.2% \n\n\n\nvs. 31.3%, p = 0.015, and 12 months (85.7% vs. 64.0%, p = \n\n\n\n0.010), and no symptoms at all at 12 months (42.9% vs. 24.0%, \n\n\n\np = 0.041) (Table VI).\n\n\n\nThe multivariate logistic analysis using only the participants \n\n\n\nthat completed the study revealed that patients between 40 and \n\n\n\n64 years of age (AOR 26.3, 95% CI 2.1 - 331.0) and 65 years \n\n\n\nor more (AOR 10.1, 95% CI 1.1 - 89.7) had significantly higher \n\n\n\nodds of having good CKD knowledge compared to younger \n\n\n\nones. Also, patients in the intervention group (AOR 2.7, 95% \n\n\n\nCI 1.0 - 7.2) had a significantly higher odds of having good \n\n\n\nCKD knowledge compared to those in the UC group, as shown \n\n\n\nin Table VII. \n\n\n\n\n\n\n\n\n\n\n\nDISCUSSION \n \n\n\n\nTo the best of our knowledge, this is the first study to assess the \n\n\n\nefficacy of pharmacist-led educational interventions in a CKD \n\n\n\npopulation in Africa. Our study found that the intervention \n\n\n\ngroup had a significantly larger proportion of participants who \n\n\n\nhad correct information about kidneys and CKD than the \n\n\n\ncontrol group. Overall, knowledge of CKD improved \n\n\n\nsignificantly in the intervention group compared to the control  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nTable V. Percentage Distribution of Correct Answers in the Kidney Functions Domain \n\n\n\n\n\n\n\nGeneral Knowledge item \nUC \n\n\n\nn (%) \n\n\n\nPI \n\n\n\nn (%) \nP value \n\n\n\nDifferential Change \n\n\n\n(PI \u2013 UC) % \n\n\n\nUrine production \n\n\n\n   Baseline 45 (60.8) 40 (54.8) 0.463 - 6.0  \n\n\n\n   6 months 60 (89.6) 65 (97.0) 0.088 7.4  \n\n\n\n   12 months 42 (84.0) 56 (100.0) 0.002* 16.0 \n\n\n\nRole in waste clearance (\u2018cleaning blood\u2019) \n\n\n\n   Baseline 41 (55.4) 32 (43.8) 0.161 - 11.6 \n\n\n\n   6 months 57 (85.1) 62 (92.5) 0.176 7.4 \n\n\n\n   12 months 38 (76.0) 53 (94.6) 0.006* 18.6 \n\n\n\nRole in bone health \n\n\n\n   Baseline 28 (37.8) 29 (39.7) 0.814 1.9 \n\n\n\n   6 months 58 (86.6) 60 (89.6) 0.593 3.0 \n\n\n\n   12 months 36 (72.0) 48 (85.7) 0.084 13.7 \n\n\n\nRole in hair loss \n\n\n\n   Baseline 9 (12.2) 13 (17.8) 0.343 5.6 \n\n\n\n   6 months 15 (22.4) 50 (74.6) < 0.001* 52.2 \n\n\n\n   12 months 16 (32.0) 24 (42.9) 0.250 10.9 \n\n\n\nRole in anemia \n\n\n\n   Baseline 34 (45.9) 30 (41.1) 0.559 - 4.8 \n\n\n\n   6 months 53 (79.1) 59 (88.1) 0.161 9.0 \n\n\n\n   12 months 40 (80.0) 47 (83.9) 0.603 3.9 \n\n\n\nRole in BP control \n\n\n\n   Baseline 37 (50.0) 32 (43.8) 0.453 - 6.2 \n\n\n\n   6 months 55 (82.1) 62 (92.5) 0.072 10.4 \n\n\n\n   12 months 38 (76.0) 48 (85.7) 0.202 9.7 \n\n\n\nRole in glucose control \n\n\n\n   Baseline 7 (9.5) 7 (9.6) 0.453 0.1 \n\n\n\n   6 months 5 (7.5) 2 (3.0) 0.245 - 4.5 \n\n\n\n   12 months 0 (0.0) 7 (12.5) 0.001* 12.5 \n\n\n\nRole in potassium control \n\n\n\n   Baseline 27 (36.5) 28 (38.4) 0.813 1.9 \n\n\n\n   6 months 49 (73.1) 59 (88.1) 0.029* 15.0 \n\n\n\n   12 months 38 (76.0) 46 (82.1) 0.442 6.1 \n\n\n\nRole in phosphorus control \n\n\n\n   Baseline 26 (35.1) 26 (35.6) 0.950 0.5 \n\n\n\n   6 months 48 (71.6) 60 (89.6) 0.009* 18.0 \n\n\n\n   12 months 38 (76.0) 44 (78.6) 0.798 2.6 \n\n\n\n\n\n\n\n*Chi-square or Fisher\u2019s exact test is significant at p < 0.05 \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nIbrahim Ummate.et al. Mal J Pharm 8 (2) 2022, 16-26 \n\n\n\n\n\n\n\n23 \n\n\n\n\n\n\n\n\n\n\n\ngroup at six months. Also, a significantly higher proportion of \n\n\n\nparticipants in the intervention group had good knowledge of \n\n\n\nCKD compared to those in the control group at six months. \n\n\n\n\n\n\n\nIn our study, pharmacists\u2019 interventions resulted in \n\n\n\nsignificantly greater proportions of participants who had \n\n\n\ncorrect knowledge about kidneys and CKD. Given the limited \n\n\n\nCKD knowledge among patients with CKD [9], and the \n\n\n\nincreasing prevalence of kidney failure [25], it is imperative to \n\n\n\nimprove CKD knowledge and its management to help improve \n\n\n\nself-management practices capable of retarding or halting the \n\n\n\nprogression to renal failure. Available evidence has shown that \n\n\n\neducational interventions enhance outcomes in other chronic \n\n\n\ndiseases such as heart failure [26], diabetes [27], and chronic \n\n\n\nobstructive pulmonary disease [28]. \n\n\n\n\n\n\n\nOverall, there was improved knowledge of CKD in the \n\n\n\nintervention group compared with the usual care group during \n\n\n\nthe study period. In agreement with our result, an India-based \n\n\n\nnon-randomised and non-controlled study of 69 patients with \n\n\n\nCKD over six months duration that evaluated pharmacists\u2019 \n\n\n\ninterventions also observed significantly improved knowledge \n\n\n\nof CKD among the participants at the end of the study [29]. In \n\n\n\nthis study, pharmacists educated and counselled patients with \n\n\n\nCKD by utilising patient information leaflets, while follow-up \n\n\n\nwas done bi-monthly for a period of six months. A study that \n\n\n\nevaluated the impact of pharmaceutical care among 120 \n\n\n\npatients with pre-dialysis CKD in Pakistan also noted \n\n\n\nsignificant knowledge improvement in the intervention group \n\n\n\nat the end of three months follow-up period [30]. \n\n\n\n\n\n\n\n\n\n\n\nTable VI. Percentage Distribution of Correct Answers in the Symptoms of CKD Progression or Failure Domain \n\n\n\n\n\n\n\nCKD Symptoms Item \nUC \n\n\n\nn (%) \n\n\n\nPI \n\n\n\nn (%) \nP value \n\n\n\nDifferential Change \n\n\n\n(PI \u2013 UC) % \n\n\n\nIncreased fatigue \n\n\n\n   Baseline 48 (64.9) 57 (78.1) 0.077 13.2 \n\n\n\n   6 months 44 (65.7) 60 (89.6) 0.001* 23.9 \n\n\n\n   12 months 40 (80.0) 52 (92.9) 0.051 12.9 \n\n\n\nShortness of breath \n\n\n\n   Baseline 42 (56.8) 36 (49.3) 0.364 -7.5 \n\n\n\n   6 months 18 (26.9) 46 (68.7) < 0.001* 41.8 \n\n\n\n   12 months 38 (76.0) 40 (71.4) 0.594 -4.6 \n\n\n\nMetallic/Bad taste \n\n\n\n   Baseline 44 (59.5) 44 (60.3) 0.921 0.8 \n\n\n\n   6 months 23 (34.3) 50 (74.6) < 0.001* 40.3 \n\n\n\n   12 months 36 (72.0) 49 (87.5) 0.047* 15.5 \n\n\n\nUnusual itching \n\n\n\n   Baseline 31 (41.9) 31 (42.5) 0.942 0.6 \n\n\n\n   6 months 34 (50.7) 42 (62.7) 0.163 12.0 \n\n\n\n   12 months 36 (72.0) 45 (80.4) 0.311 8.4 \n\n\n\nNausea/vomiting \n\n\n\n   Baseline 41(55.4) 34 (46.6) 0.288 -8.8 \n\n\n\n   6 months 23 (34.3) 38 (56.7) 0.010* 22.4 \n\n\n\n   12 months 28 (56.0) 41 (73.2) 0.065 17.2 \n\n\n\nHair loss \n\n\n\n   Baseline 33 (44.6) 35 (47.9) 0.684 3.3 \n\n\n\n   6 months 57 (85.1) 55 (82.1) 0.641 -3.0 \n\n\n\n   12 months 22 (44.0) 18 (32.1) 0.209 -11.9 \n\n\n\nDifficulty sleeping \n\n\n\n   Baseline 38 (51.4) 34 (46.6) 0.562 -4.8 \n\n\n\n   6 months 27 (40.3) 44 (65.7) 0.003* 25.4 \n\n\n\n   12 months 34 (68.0) 42 (75.0) 0.424 7.0 \n\n\n\nWeight loss \n\n\n\n   Baseline 35 (47.3) 29 (39.7) 0.354 -7.6 \n\n\n\n   6 months 21 (31.3) 35 (52.2) 0.015* 20.9 \n\n\n\n   12 months 32 (64.0) 48 (85.7) 0.010* 21.7 \n\n\n\nConfusion \n\n\n\n   Baseline 26 (35.1) 18 (24.7) 0.170 -10.4 \n\n\n\n   6 months 23 (34.3) 23 (34.3) 1.000 0.0 \n\n\n\n   12 months 30 (60.0) 43 (76.8) 0.063 16.8 \n\n\n\nNo symptoms at all     \n\n\n\n   Baseline 3 (4.1) 7 (9.6) 0.188 5.5 \n\n\n\n   6 months 13 (19.4) 3 (4.5) 0.008* -14.9 \n\n\n\n   12 months 12 (24.0) 24 (42.9) 0.041* 18.9 \n\n\n\n\n\n\n\n*Chi-square or Fisher\u2019s exact test is significant at p < 0.05 \n\n\n\n\n\n\n\n\nIbrahim Ummate.et al. Mal J Pharm 8 (2) 2022, 16-26 \n\n\n\n\n\n\n\n24 \n\n\n\n\n\n\n\nIn this study, pharmacists\u2019 interventions included the provision \n\n\n\nof information on the disease, proper diets, counselling to \n\n\n\nenhance medication adherence, and follow-up through the \n\n\n\ntelephone. Additionally, the result of our study is comparable \n\n\n\nwith that of a non-randomised controlled multi-healthcare \n\n\n\nprofessional collaborative interventional study conducted in \n\n\n\nKorea among patients with pre-dialysis CKD, which reported a \n\n\n\nsignificant improvement in CKD knowledge scores over time \n\n\n\nin the intervention group compared to the control group [31]. \n\n\n\nIn this study, CKD specialists (physicians, nurses, and \n\n\n\nnutritionists) offered interventions such as face-to-face group \n\n\n\neducation and individualised consultation, re-inforcement \n\n\n\neducation, and consultation to build up patients\u2019 self-\n\n\n\nmanagement skills to retard disease progression. Another study \n\n\n\ndone in Korea that included patients undergoing early \n\n\n\nhaemodialysis noted that educational interventions resulted in \n\n\n\nimproved knowledge of patients [32]. Further, a prospective, \n\n\n\npre\u2013post study that enrolled 64 patients with dialysis CKD in \n\n\n\nNepal also reported improved knowledge after pharmacist-\n\n\n\nprovided counselling intervention [33].  Despite, the shorter \n\n\n\nduration of some of these previous studies, in the absence of \n\n\n\nadditional important healthcare professionals required for renal \n\n\n\ncare in the study settings, these findings may suggest a \n\n\n\ncommunication gap between patient and physician. As a result, \n\n\n\nthere is a greater need for a shift in educational tactics, as well \n\n\n\nas the deployment of extra resources and appropriate healthcare \n\n\n\nprofessionals to help facilitate kidney disease education for \n\n\n\npatients. Regarding the additional healthcare professionals \n\n\n\nrequired, a multidisciplinary renal care team that includes a \n\n\n\nclinical pharmacist and other relevant healthcare professionals \n\n\n\nis critical to optimising health outcomes in CKD. The \n\n\n\nimportance of pharmacists in providing patients with \n\n\n\ninformation on blood pressure monitoring, cardiovascular risk \n\n\n\nminimization, medication dose adjustment, and information on \n\n\n\nrenally-eliminated medications, and anaemia management in \n\n\n\nrenal diseases cannot be overstated. This is evidenced by a \n\n\n\nconsiderably higher proportion of participants in our study's \n\n\n\nintervention group who knew about contraindicated \n\n\n\nmedications or those to be used with caution in renal disease \n\n\n\nduring the 12-month trial period. Available evidence \n\n\n\ndemonstrates that increased disease-specific knowledge results \n\n\n\nin an enhanced personal-care practices [29].  \n\n\n\n\n\n\n\nFurthermore, the current pharmacist education programme \n\n\n\ncould expand opportunities for direct connections between \n\n\n\nCKD patients and other important renal care professionals. \n\n\n\nConversely, no significant improvement in knowledge of \n\n\n\nkidney function in the intervention group was observed in the \n\n\n\nKorean study [29]. This finding suggests a potential gap in the \n\n\n\nunderstanding of kidney functions by the participants of this \n\n\n\nstudy despite educational interventions provided by multi-\n\n\n\nhealthcare professionals. Also, contrary to our results, a pre-\n\n\n\nand post-study that involved allied health staff or CKD nurse \n\n\n\neducators\u2019 CKD educational interventions in Australia reported \n\n\n\na minor improvement in patients\u2019 knowledge of kidney disease \n\n\n\nat 12.7 months [34]. Variations in methods, healthcare \n\n\n\nprofessionals, and interventions involved could account for the \n\n\n\nobserved differences.   \n\n\n\nPharmacists' intervention as a significant predictor of good \n\n\n\nCKD knowledge, underscores the importance of kidney disease \n\n\n\npatient education provided by pharmacists. Congruent with our \n\n\n\nresult, a similar study found higher knowledge scores among \n\n\n\nparticipants that reported seeing a CKD educator [21]. \n\n\n\nFurthermore, it has been reported that educational interventions \n\n\n\nprolong the time to dialysis initiation in patients near renal \n\n\n\nreplacement [35]. Like other essential members of the \n\n\n\nmultidisciplinary renal care team, asides from drug-related \n\n\n\nroles, a clinical pharmacist can help fill the knowledge gap of \n\n\n\npatients with CKD about the disease and lifestyle modifications \n\n\n\nto slow the progression of the disease. On the other hand, the \n\n\n\nlikelihood of older participants having better knowledge than \n\n\n\nthe younger ones may be due to their longer time with the \n\n\n\ndisease and increased access to information about the disease \n\n\n\nand its management from health professionals. \n\n\n\n\n\n\n\nThe main strength of the study was the utilisation of two centres \n\n\n\nto control different hospital environment features. Other \n\n\n\nstrengths were randomisation, blinding of participants about \n\n\n\nthe investigators\u2019 profession to avoid bias and a 12-month \n\n\n\nfollow-up. The study did, however, have certain limitations. \n\n\n\nPatients that were included in the study may differ from those \n\n\n\nwho did not participate in some important aspects, which may \n\n\n\nlimit the generalisability of the study findings. Another \n\n\n\nweakness of the study was attrition bias or loss during follow-\n\n\n\nup. Although the tool used is valid and reliable, the data on \n\n\n\nCKD knowledge was self-reported. \n\n\n\nTable VII. The Results of Multivariate Logistic Regression Analysis \n\n\n\nof the Determinants of Good CKD Knowledge \n\n\n\n\n\n\n\nVariable AOR (95% CI) P Value \n\n\n\nAge group (years)   \n\n\n\n   < 40 1.0  \n\n\n\n   40 - 64 26.3 (2.1 - 331.0) 0.011* \n\n\n\n   \u2265 65 10.1 (1.1 - 89.7) 0.038* \n\n\n\nSex   \n\n\n\n   Male 1.0  \n\n\n\n   Female 0.4 (0.2 - 1.2) 0.117 \n\n\n\nMarital status   \n\n\n\n   Single 1.0  \n\n\n\n   Married 1.0 (0.3 - 4.0) 0.977 \n\n\n\nEducational level   \n\n\n\n   None 1.0  \n\n\n\n   Primary 0.8 (0.2 - 2.4) 0.644 \n\n\n\n   Secondary 1.4 (0.4 - 5.3) 0.584 \n\n\n\n   Tertiary 0.4 (0.1 - 1.9) 0.250 \n\n\n\nStudy group   \n\n\n\n   Control 1.0  \n\n\n\n   Experimental 2.7 (1.0 - 7.2) 0.040* \n\n\n\n\n\n\n\n*Significant at p < 0.05; AOR: adjusted odds ratio; CI: Confidence \n\n\n\ninterval \n\n\n\n\n\n\n\n\nIbrahim Ummate.et al. Mal J Pharm 8 (2) 2022, 16-26 \n\n\n\n\n\n\n\n25 \n\n\n\n\n\n\n\nCONCLUSION  \n \n\n\n\nClinical pharmacists\u2019 educational interventions led to a \n\n\n\nsignificant improvement in the CKD knowledge of patients \n\n\n\nwith pre-dialysis CKD. This demonstrates that the pharmacist \n\n\n\nis a neglected but critical renal care provider in the study \n\n\n\nsetting. Therefore, further studies to evaluate the impact of the \n\n\n\ninterventions provided on healthcare-seeking behaviours, and \n\n\n\nself-management practices are warranted. As a result, there is a \n\n\n\nneed for healthcare policies that include other healthcare \n\n\n\nprofessionals, such as pharmacists, in renal care in LMICs. This \n\n\n\nstrategy has the capacity to improve the quality of care \n\n\n\nprovided to patients with CKD. Finally, more studies are also \n\n\n\nrequired to investigate the long-term economical and clinical \n\n\n\noutcomes of this type of educational programme. \n\n\n\n\n\n\n\nACKNOWLEDGEMENT \n  \n\n\n\nThe authors are grateful to all the study participants for making \n\n\n\nthemselves available for this study. \n\n\n\n\n\n\n\nCONFLICT OF INTEREST \n  \n\n\n\nThis study has no conflict of interest. This research did not \n\n\n\nreceive any specific grant from funding agencies in public, \n\n\n\ncommercial or not-for-profit sectors. \n\n\n\n\n\n\n\nREFERENCE \n \n\n\n\n[1] Okoro RN, Farate VT. Evaluation of potential drug\u2013drug interactions \n\n\n\namong patients with chronic kidney disease in northeastern Nigeria. \n\n\n\nAfrican Journal of Nephrology. 2019;22(1):77-81. \n\n\n\nDoi: https://doi.org/10.21804/22-1-3577 \n\n\n\n[2] Go AS, Chertow GM, Fan D, et al. Chronic kidney disease and the \n\n\n\nrisks of death, cardiovascular events, and hospitalization. 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Doi: https://doi.org/10.1155/2010/501957 \n\n\n\n[26] Riegel B, Moser DK, Anker SD, et al. State of the science: Promoting \n\n\n\nself-care in persons with heart failure: A scientific statement from the \n\n\n\nAmerican Heart Association. Circulation. 2009;120(2):1141-63. \n\n\n\nDoi: https://doi.org/10.1161/CIRCULATIONAHA.109.192628 \n\n\n\n[27] Steinsbekk A, Rygg L, Lisulo M, et al. Group based diabetes self-\n\n\n\nmanagement education compared to routine treatment for people with \n\n\n\n\nhttps://doi.org/10.21804/22-1-3577\n\n\nhttps://doi.org/10.1056/NEJMoa041031\n\n\nhttps://doi.org/10.1053/j.ajkd.2008.11.019\n\n\nhttps://doi.org/10.1016/S0140-6736(03)12948-0\n\n\nhttps://doi.org/10.1056/NEJMoa011303\n\n\nhttps://doi.org/10.5527/wjn.v5.i2.147\n\n\nhttps://doi.org/10.1177/0193945909334096\n\n\nhttps://doi.org/10.1681/ASN.2004070539\n\n\nhttps://doi.org/10.1038/ki.2008.376\n\n\nhttps://doi.org/10.1053/j.ajkd.2005.08.017\n\n\nhttps://www.niddk.nih.gov/health-information/communication-programms/nkdep/\n\n\nhttps://www.niddk.nih.gov/health-information/communication-programms/nkdep/\n\n\nhttps://doi.org/10.1016/S0272-6386(02)70084-X\n\n\nhttps://doi.org/10.1053/j.ajkd.2010.09.018\n\n\nhttps://doi.org/10.7326/0003-4819-145-4-200608150-00004\n\n\nhttps://doi.org/10.7326/0003-4819-145-4-200608150-00004\n\n\nhttps://www.kidney.org/content/mdrd-study-equation\n\n\nhttps://doi.org/10.1155/2010/501957\n\n\nhttps://doi.org/10.1161/CIRCULATIONAHA.109.192628\n\n\n\n\n\n\nIbrahim Ummate.et al. Mal J Pharm 8 (2) 2022, 16-26 \n\n\n\n\n\n\n\n26 \n\n\n\n\n\n\n\ntype 2 diabetes mellitus. A systematic review with meta-analysis. \n\n\n\nBMC Health Serv Res, 2012;12:213. \n\n\n\nDoi: https://doi.org/10.1186/1472-6963-12-213 \n\n\n\n[28] Hurley J, Gerkin RD, Fahy B, et al. Meta-analysis of self-management \n\n\n\neducation for patients with chronic obstructive pulmonary disease. \n\n\n\nSouthwest Journal of Pulmonary, Critical Care and Sleep. 2012;4:194-\n\n\n\n202. \n\n\n\n[29] Baby B, Antony CL, Wilson S, et al. Evaluation of the impact of \n\n\n\npharmaceutical care on improving knowledge and medication \n\n\n\nadherence in CKD patients. Int J Pharm Pharm Sci. 2017;9(1):63-6. \n\n\n\nDoi: https://doi.org/10.22159/ijpps.2017v9i1.15053 \n\n\n\n[30] Khokhar A, Khan YH, Mallhi TH, et al. Effectiveness of pharmacist \n\n\n\nintervention model for chronic kidney disease patients; a prospective \n\n\n\ncomparative study. Intl J Clin Pharm. 2020. \n\n\n\nDoi: https://doi.org/10.1007/s11096-020-00982-w \n\n\n\n[31] Choi ES, Lee J. Effects of a Face-to-face Self-management Program \n\n\n\non Knowledge, Self-care Practice and Kidney Function in Patients \n\n\n\nwith Chronic Kidney Disease before the Renal Replacement Therapy. \n\n\n\nJ Korean Acad Nurs. 2012;42(7):1070-8. \n\n\n\nDoi: https://doi.org/10.4040/jkan.2012.42.7.1070  \n\n\n\n[32] Kim AY, Kim SJ. The effect of education program on early \n\n\n\nhemodialysis patients\u2019 knowledge, self-care practice and physiologic \n\n\n\nindex. The Seoul Journal of Nursing, 2008;13(1):95-109. \n\n\n\n[33] Ghimirey A, Sapkota B, Shrestha S, et al. Evaluation of pharmacist \n\n\n\ncounseling in improving knowledge, attitude, and practice in chronic \n\n\n\nkidney disease patients. SAGE Open Medicine. 2013.  \n\n\n\nDoi: https://doi.org/10.1177/2050312113516111 \n\n\n\n[34] Gray NA, Kapojos JK, Burke MT, et al. Patient kidney disease \n\n\n\nknowledge remains inadequate with standard nephrology outpatient \n\n\n\ncare. Clinical Kidney Journal. 2016;9(1):113-8. \n\n\n\nDoi: https://doi.org/10.1093/ckj/sfv108 \n\n\n\n[35] Devins GM, Mendelssohn DC, Barre PE, Binik YM. Predialysis \n\n\n\npsychoeducational intervention and coping styles influence time to \n\n\n\ndialysis in chronic kidney disease. Am J Kidney Dis. 2003;42(4):693-\n\n\n\n703. Doi: https://doi.org/10.1016/s0272-6386(03)00835-7 \n\n\n\n \n\n\n\n\nhttps://doi.org/10.1186/1472-6963-12-213\n\n\nhttps://doi.org/10.22159/ijpps.2017v9i1.15053\n\n\nhttps://doi.org/10.1007/s11096-020-00982-w\n\n\nhttps://doi.org/10.4040/jkan.2012.42.7.1070\n\n\nhttps://doi.org/10.1177/2050312113516111\n\n\nhttps://doi.org/10.1093/ckj/sfv108\n\n\nhttps://doi.org/10.1016/s0272-6386(03)00835-7\n\n\n\n"
"\n\n\n\n\n\n \nPP12684/8/2008 \n\n\n\nVol. 1 Issue 9. October 2011 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJOURNAL of PHARMACY \n \n\n\n\nIn this issue: \n\n\n\n\n\n\n\n\uf0b7 STARZ-DRP: A Step-by-step Approach \n\n\n\nfor Pharmacy Triage Services  \n\n\n\n\n\n\n\n\uf0b7 Predictors of Herbal Utilization by \n\n\n\nMultiethnic Secondary Care Patients in \n\n\n\nMalaysia: a Cross Sectional Survey  \n\n\n\n\n\n\n\n\uf0b7 Calculated 10 Years Risk of CHD: \n\n\n\nPrimary Preventive Measures in Medical \n\n\n\nWard PPUKM (University Kebangsaan \n\n\n\nMalaysia Medical Centre) \n\n\n\n \n\uf0b7 Study of Aminoglycosides Use among In-\n\n\n\npatients at Hospital Kuala Lumpur \n\n\n\n\n\n\n\nSupplement \n \n\n\n\nProceedings of the Malaysian Pharmaceutical Society \n\n\n\nPharmacy Scientific Conference 2011 \n \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nA Publication of the Malaysian Pharmaceutical Society \n\n\n\n                                                                                          M\nA\n\n\n\nL\nA\n\n\n\nY\nS\n\n\n\nIA\nN\n\n\n\n JO\nU\n\n\n\nR\nN\n\n\n\nA\nL\n\n\n\n O\nF\n\n\n\n P\nH\n\n\n\nA\nR\n\n\n\nM\nA\n\n\n\nC\nY\n\n\n\n                                                              V\no\nl . 1\n\n\n\n. Issu\ne 9\n\n\n\n\n\n\n\n\n\n\n\nbarcode \n\n\n\n\n\n\n\n\n i \n\n\n\n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy \n Vol.1 Issue 9, June 2011     \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nThe Official Journal of the Malaysian Pharmaceutical Society       \n\n\n\n\n\n\n\n \n Editor-in-Chief: Assoc. Prof. Dr. Mohd Baidi bin Bahari \n\n\n\n\n\n\n\n Associate Editors: Prof. Dr. Abas bin Hj Hussin \n\n\n\n  Assoc. Prof. Dr. Ab. Fatah bin Hj Ab Rahman \n\n\n\n  Prof. Dr. Abu Bakar bin Abdul Majeed \n\n\n\n  Prof. Dr. Aishah bte Adam \n\n\n\n  Assoc. Prof. Dr. Chung Lip Yong \n\n\n\n  Dato\u2019 Prof. Dr. Mohd. Isa bin Abdul Majid \n\n\n\n  Prof. Dr. Yuen Kah Hay \n\n\n\n  Prof. Dr. Paraidathathu Thomas a/l P.G. Thomas \n\n\n\n  Mr. John Chang \n\n\n\n  Mr. Lam Kai Kun  \n\n\n\n\n\n\n\n Publisher: Malaysian Pharmaceutical Society \n\n\n\n5-B Lorong Rahim Kajai 13 \n\n\n\nTaman Tun Dr Ismail \n\n\n\n60000 kuala Lumpur \n\n\n\n  Tel: 6-03-77291409 \n\n\n\nFax: 6-03-77263749 \n\n\n\n  Homepage: www.mps.org.my \n\n\n\nEmail: mspharm@po.jaring.my \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \nThe Malaysian Journal of Pharmacy is a publication of the Malaysian Pharmaceutical Society.  \n\n\n\nEnquiries are to be directed to the publisher at the above address.  The Publisher reserves \n\n\n\ncopyright and renewal on all published materials, and such material may not be reproduced in any \n\n\n\nform without the written permission of the Publisher.     \n\n\n\n\n\n\n\n \n\n\n\n\nhttp://www.mps.org.my/\n\n\nmailto:mspharm@po.jaring.my\n\n\n\n\n\n\n ii \n\n\n\nTable of contents \n\n\n\n\n\n\n\nEditorial \n  \n\n\n\nPharmacist Roles in Health Promotion \n\n\n\n\n\n\n\nMohd Baidi Bahari \n\n\n\n\n\n\n\n\n\n\n\niii \n\n\n\n\n\n\n\nResearch Papers \n  \n\n\n\nSTARZ-DRP: A Step-by-step Approach for Pharmacy \n\n\n\nTriage Services  \n \n\n\n\nAzmi Sarriff, Nazri Nordin, Mohamed Azmi Hassali \n\n\n\n\n\n\n\n\n\n\n\n311 \n\n\n\n Predictors of Herbal Utilization by Multiethnic Secondary \n\n\n\nCare Patients in Malaysia: a Cross Sectional Survey  \n\n\n\n\n\n\n\nMohd Baidi Bahari and Saw June Tze \n\n\n\n\n\n\n\n326 \n\n\n\n Calculated 10 Years Risk of CHD: Primary Preventive \n\n\n\nMeasures in Medical Ward PPUKM (University \n\n\n\nKebangsaan Malaysia Medical Centre) \n\n\n\n\n\n\n\nSemira Abdi Beshir, Rosnani Hashim\n \n\n\n\n\n\n\n\n337 \n\n\n\n Study of Aminoglycosides Use among In-patients at \n\n\n\nHospital Kuala Lumpur \n\n\n\n \nEndang Kumolosasi,  Siti Aishah Mohamad Nor, Tengku Karmila \n\n\n\nTengku Mohd Kamil\n \n\n\n\n\n\n\n\n\n\n\n\n346 \n\n\n\nSupplement   \n\n\n\n\n\n\n\nProceedings of Malaysian Pharmaceutical Society Pharmacy \n\n\n\nScientific Conference 2011 \n\n\n\n\n\n\n\n\n\n\n\n356 \n\n\n\nInstruction to Author   \n\n\n\n\n\n\n\nPlease refer to webpage www.mps.org.my for the latest update \n\n\n\n \n\n\n\n\nhttp://www.mps.org.my/\n\n\n\n\n\n\n iii \n\n\n\n\n\n\n\nEditorial     \n \n \n\n\n\n\n\n\n\nPharmacist  Roles in Health Promotion. \n \nHealth promotion is defined as the process of enabling people to increase control over and improve their \n\n\n\nhealth.  Health promotion programs deliver benefits for the community in promoting wellbeing, reducing \n\n\n\npreventable illness and finally lowering overall health care expenditures.  Through health promotion \n\n\n\nservice pharmacists could contribute to achieve the Ministry of Health mission in empowering all \n\n\n\nMalaysian to manage their own health.  Pharmacist as an expert in drugs could use their knowledge and \n\n\n\nskills to develop policies in ensuring the medicines are at highest quality, protects public from hazardous \n\n\n\nmedications and provides rational, cost-effective and optimal use of medicines. Pharmacist in public \n\n\n\nsectors has wide opportunity to participate in health promotion activities through various clinics such as \n\n\n\ncigarette cessation, Medication Therapeutic Adherence Clinics, methadone replacement therapy, home \n\n\n\nmedication review visits and others.  On the other hand, health promotion in community pharmacy refers \n\n\n\nto delivering strategies aimed at prevention, early detection and treatment of disease through public health \n\n\n\neducation program, health awareness raising activities, healthy life campaign and improving access to \n\n\n\nhealth information and advice.  Although most of the said activities are available throughout the country, \n\n\n\nthe extents and scopes vary depending on the facilities and expertise available.  Pharmacists in community \n\n\n\nand public sectors should work hand in hand with other public health providers to offer more meaningful \n\n\n\nand high impact health promotion services to the public.  Monitoring the outcome of the health promotion \n\n\n\nactivities need to be done to ensure the mission of the MOH is achieved. \n\n\n\n \nAndrew W Joyce, V Bruce Sunderland, Suzanne Burrows, Alexandra McManus, Peter Howat, Bruce \n\n\n\nMaycock; Community Pharmacy\u2019s Role in Promoting Healthy Behaviours, Journal of Pharmacy Practice \n\n\n\nand Research Volume 37, No. 1, 2007 \n\n\n\n \nStuart Anderson; Community pharmacy and public health in Great Britain, 1936 to 2006: how a phoenix \n\n\n\nrose from the ashes, J Epidemiol Community Health 2007;61:844\u2013848 \n\n\n\n \nWorld Health Organization (1994) The role of the pharmacist in the health care system. Geneva: WHO \n\n\n\n(unpublished document WHO/PHARM/94.569). \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nDr. Mohd Baidi Bahari \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n311 \n \n\n\n\n\n\n\n\nSTARZ-DRP: A Step-by-step Approach for Pharmacy Triage Services  \n\n\n\nAzmi Sarriff \n1\n, Nazri Nordin\n\n\n\n2\n, Mohamed Azmi Hassali\u00b3 \n\n\n\n1\nDiscipline of Clinical Pharmacy, \n\n\n\n2\nPost Graduate Student(Clinical Pharmacy), \u00b3Discipline of Social & \n\n\n\nAdministrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Penang \n\n\n\nCorresponding Author: Dr. Azmi Sarriff,  e-mail: azmi@usm.my \n\n\n\n\n\n\n\nABSTRACT \n\n\n\n \nThis article highlights the importance of structured and systematic processes in triaging patients with minor \n\n\n\nillnesses. The main aim is to describe a model or protocol for organizing a community pharmacist\u2019s \n\n\n\nknowledge in a manner that allows him/her to begin identifying the actual and potential drug-related problems \n\n\n\n(DRPs). We consulted standard reference textbooks and key pharmacy journals looking for common \n\n\n\nmnemonics which has been promoted as a decision aids for the supply of non-prescription medicines. Our \n\n\n\nfocus was to examine each method in terms of the collecting relevant information with respect to detection of \n\n\n\nDRPs associated with self-medicating patients. The positives and negatives attributes of each method were \n\n\n\nassessed. We noticed that each of the mnemonics examine were incomplete in some area. Even for an \n\n\n\nestablished and popular aide-memoire, WWHAM, which is an easily remembered mnemonic to obtain a \n\n\n\ngeneral picture of the patient\u2019s presenting compliant does not provides adequate information for triage and \n\n\n\nrecognize patient-specific medication related problems. Although other mnemonics are more comprehensive \n\n\n\nthan WWHAM, they are still limited. Moreover, by no means these methods were universally use and apply \n\n\n\nin the community pharmacy practice. Alternatively, the proposed approach provides a platform for triaging a \n\n\n\nself-medication patient as well as identifying DRPs for collaborating with other health care professionals. \n\n\n\nTherefore, the STARZ-DRP is an alternative approach for conducting self-care consultation. In depth study is \n\n\n\nneeded to determinate whether it is more effective than other methods for pharmacy triage service when \n\n\n\nstudied in a controlled, systematic manner.  \n\n\n\n\n\n\n\nKeywords:  self-care consultation, minor illness, pharmacy triage, referral, drug-related problem. \n\n\n\n\n\n\n\n \nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011, pg 311 -  324 \n \n \n\n\n\nINTRODUCTION \n\n\n\nManaging minor illnesses by self-medication is a \n\n\n\ncommon practice worldwide. When done \n\n\n\ncorrectly, self-medication benefits the individual\u2019s \n\n\n\nhealth and is recognized by the World Health \n\n\n\nOrganization (WHO) as part of self-care.\n1,2\n\n\n\n\n\n\n\nAccording to WHO definition, self-medication is \n\n\n\n\u201cthe selection and use of medicines by individuals \n\n\n\nto treat self-recognized illnesses or symptoms\u201d \n1\n. If \n\n\n\na person chooses to self-medicate, he/she should \n\n\n\nbe able to recognize the symptoms and determine \n\n\n\nit as a self-limited condition and suitable for self-\n\n\n\ncare. In this regards, Winfield and Richards (1998) \n\n\n\nstates health problems as a minor illness if a \n\n\n\nperson perceived it as non-threatening and having \n\n\n\nlimited duration.\n3\n Furthermore, he/she should be \n\n\n\nable to select an appropriate medicine, recognize \n\n\n\nand monitor its effects and side effects, and lastly \n\n\n\nhe/she should follow directions to use as indicated \n\n\n\non the label. However, this is not the case for most \n\n\n\nof the time. Instances of inappropriate use of over-\n\n\n\nthe-counter (OTC) medicines by consumers\n4,5,6\n\n\n\n and \n\n\n\nassociated with iatrogenic disease\n7\n has been \n\n\n\nreported. The inappropriate use of OTC medicines \n\n\n\nhas many implications including delay or mask the \n\n\n\ndiagnosis of serious illness, with increased risks of \n\n\n\ninteractions and adverse drug reactions.\n8\n  \n\n\n\nIt seems that self-medicating with non-prescription \n\n\n\nmedications is a desirable choice for many \n\n\n\npeoples, but it is of concerns that most peoples do \n\n\n\nnot always use non-prescription medications \n\n\n\noptimally. Now, community pharmacists (CP) are \n\n\n\nin an ideal position to give timely advice to those \n\n\n\n\nmailto:azmi@usm.my\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n312 \n \n\n\n\nwho are self-medicating and reinforce advice \n\n\n\ngiven by other healthcare professionals. They often \n\n\n\nhave seen as a convenient \u2018first point of call\u2019 for \n\n\n\nadvice on common symptoms and other health \n\n\n\nproblems. They are also view as a gatekeeper to \n\n\n\nproper and safe use of medications. In fact, CPs \n\n\n\nand their staff do all these activities on a daily \n\n\n\nbasis when customers approached them for advice \n\n\n\nabout how to manage symptoms or self-treatment \n\n\n\nof minor illnesses. It is a primary objective of all \n\n\n\nhealthcare providers including community \n\n\n\npharmacists, is to improve the quality of patients\u2019 \n\n\n\nlife. All of them work to achieve two broad \n\n\n\ncategories of patient outcomes, that are, (i) cure, \n\n\n\nslow, or prevent a patient\u2019s disease; and (ii) \n\n\n\neliminate, reduce, or prevent a patient\u2019s symptom.\n9 \n\n\n\nWith regards to self-treating patients on minor \n\n\n\nillnesses, the CPs are most likely to involve in the \n\n\n\nlatter category of patients\u2019 outcomes. Perhaps they \n\n\n\nare usually the last healthcare provider with whom \n\n\n\na patient comes in contact before using a \n\n\n\nmedication. They have a key responsibility in \n\n\n\nresponding to patients who are intend to self-\n\n\n\nmedicate with non-prescription medications.  \n\n\n\nIt has been reported that almost 20% of all drug-\n\n\n\nrelated admissions to a medical ward result from \n\n\n\nthe use of non-prescription medication, especially \n\n\n\nOTC medications.\n10 \n\n\n\nConsequently, health \n\n\n\nprofessionals, especially community pharmacist, \n\n\n\nneed to be aware of any non-prescription \n\n\n\nmedications that patients are using, in order to be \n\n\n\nable to appropriately advise them on the potential \n\n\n\nfor worsening their disease process, adverse \n\n\n\nevents, or drug interactions.\n11 \n\n\n\n Although the role of \n\n\n\nCP in responding to customer who present with \n\n\n\nminor illness is longstanding and well-recognized, \n\n\n\nformal investigations of the extent and quality of \n\n\n\nthis role had not been performed until recently. \n\n\n\nFrom around the late 1970s, surveys investigating \n\n\n\nsymptoms presented to community pharmacist \n\n\n\nhave been conducted.\n12,13,14,15\n\n\n\n Detailed examination \n\n\n\nof symptom presented to CPs show that these \n\n\n\nbroad categorizations conceal a wide range of \n\n\n\npresentations requiring adequate clinical and \n\n\n\ncommunicative skills from the community \n\n\n\npharmacist. Furthermore, there are number factors \n\n\n\nthat make responding to symptoms in the \n\n\n\npharmacy particularly challenging for the \n\n\n\ncommunity pharmacist,\n16 \n\n\n\nsome of these includes \n\n\n\nno access to the patient medical notes or history, \n\n\n\nlimited opportunities for a physical examination, \n\n\n\ndetailed conversation need to be initiated, \n\n\n\ncustomer may have already approached another \n\n\n\nmember of staff, symptoms may be presented on \n\n\n\nbehalf of another person, and the customer may \n\n\n\nalready have sought advice, information or \n\n\n\ntreatment from another sources.  \n\n\n\nAlthough the DRP term has been used for quite \n\n\n\nsome time\n17\n\n\n\n, it was not until 1990 when first paper \n\n\n\ndealing with drug-related problems (DRPs) as a \n\n\n\nconcept, first appeared\n18\n\n\n\n. The DRP was defined as \n\n\n\n\u201can undesirable patient experience that involves \n\n\n\ndrug therapy and that actually or potentially \n\n\n\ninterferes with a desired patient outcome\u201d. This is \n\n\n\nparticularly important in the context of self-\n\n\n\nmedication where each person  has a unique \n\n\n\nmedication experience , that is, the sum of all \n\n\n\nevents in a person\u2019s life that involve medicine \n\n\n\nuse.\n19\n\n\n\n It includes the person\u2019s expectations, wants, \n\n\n\nconcerns, preferences, attitudes, and beliefs, as \n\n\n\nwell as the cultural, ethical and religious \n\n\n\ninfluences on his/her medication taking behaviour. \n\n\n\nThese experiences will have a profound effect on \n\n\n\nthe decisions a person makes everyday as to \n\n\n\nwhether or not to take his/her medications. Once a \n\n\n\nperson\u2019s medication experience is explored, then, \n\n\n\nthe CP can successfully execute his/her \n\n\n\nresponsibilities of identifying, resolving, and \n\n\n\npreventing drug-related problems.  \n\n\n\nMost DRPs are avoidable and few researchers \n\n\n\nhave showed that CPs are assuming an active role \n\n\n\nin preventing and solving DRPs. Westerlund,LT \n\n\n\net.al. (2001) conducted a study in 45 volunteer \n\n\n\npharmacies in Sweden during 10 weeks in late \n\n\n\n1999. The study found that the most common \n\n\n\nDRPs were uncertainty about the indication for the \n\n\n\ndrug (33.5%) and therapy failure (19.5%) while \n\n\n\ndyspepsia was the most frequently specified \n\n\n\nsymptom (11.4%).\n20\n\n\n\n In 2005, a nationwide survey \n\n\n\nin Germany was conducted in community \n\n\n\npharmacies to record all identified DRPs. More \n\n\n\nthan a thousand community pharmacies participate \n\n\n\nin the survey had documented 10,427 DRPs (9.1 \n\n\n\nDRP per pharmacy per week). Overall, drug-drug \n\n\n\ninteractions were the most frequently reported \n\n\n\nDRP (8.6%) and, according to CPs , more than \n\n\n\n80% of identified DRPs could be resolved \n\n\n\ncompletely. The prescribing physician was \n\n\n\ncontacted in 60.5% of all such cases. Median time \n\n\n\nneeded for solving a DRP was 5 minutes.\n21\n\n\n\n A \n\n\n\nrecent study showed that, in nearly 1 out of 5 \n\n\n\nencounters, direct pharmacist-patient interaction in \n\n\n\nself-medication revealed relevant DRPs in German \n\n\n\ncommunity pharmacies.\n22\n\n\n\n The most frequent \n\n\n\ninterventions were referral to a physician (39.5%) \n\n\n\nand switching patients to a more appropriate drug \n\n\n\nproduct (28.1%). The studies cited here have \n\n\n\ndemonstrated a need for more professional \n\n\n\nattention and intervention by CPs to prevent and \n\n\n\nrectify DRPs in non-prescription consumers. \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n313 \n \n\n\n\nCommunity pharmacists can help the self-treating \n\n\n\npatients assessed the underlying conditions \n\n\n\ncorrectly, choose  OTC product, suggesting a non-\n\n\n\ndrug therapy, referral to another health \n\n\n\nprofessional, and ensuring correctly used of \n\n\n\nmedicines. These interventions are likened to the \n\n\n\ntelephone triage services offered by nurses. \n\n\n\nPerhaps, it should be realised that the function of \n\n\n\nthe telephone triage nurse is to determine the \n\n\n\nseverity of the caller's complaint using a series of \n\n\n\nalgorithms developed by a coordinated effort of \n\n\n\nphysicians and nurses.\n23,24\n\n\n\n  Here, an important \n\n\n\naspect in the decision-making process is either to \n\n\n\ntreat, not to treat, or refer the customer to another \n\n\n\nhealthcare professional, most commonly the \n\n\n\ngeneral practitioner (GP).\n8\n  \n\n\n\nCommunity pharmacists need to develop a method \n\n\n\nof information seeking and decision aid that works \n\n\n\nfor them. For this purpose, the use of mnemonics \n\n\n\nand acronyms has been advocated to helps CPs \n\n\n\nremember what questions to ask a patient. There \n\n\n\nare a number of established framework called \n\n\n\nWWHAM, ASMETHOD, SIT DOWN SIR, \n\n\n\nENCORE, CHAPS-FRAPS \n25,26,27,28,29\n\n\n\n and recently \n\n\n\nthe mnemonic QuEST/SCHOLAR\n30,\n\n\n\n which has \n\n\n\nbeen promoted as a decision aids aimed to be use \n\n\n\nas an assessment process that can assist \n\n\n\ncommunity pharmacists in questioning patients \n\n\n\nand improving their ability to give the appropriate \n\n\n\nadvice about self-care. Irrespective of the choice of \n\n\n\nany decision aids, CPs have a key responsibility in \n\n\n\nidentifying, preventing, and resolving drug-related \n\n\n\nproblems in patients who are intend to self-\n\n\n\nmedicate with non-prescription medications. \n\n\n\nMoreover, there are concerns that pharmacy staff \n\n\n\nuses the mnemonic as a matter of rote rather than \n\n\n\nin the informed way, tailored to individual \n\n\n\nconsultations.\n31\n\n\n\n As every customer is different \n\n\n\nwith a unique medication experiences and \n\n\n\ntherefore it is unlikely than an acronym can be \n\n\n\nfully applied. Thus, using acronym in rote fashion \n\n\n\nmay miss vital information that could shape the \n\n\n\ncourse of action. Therefore, the objective of this \n\n\n\narticle is to describe a framework called STARZ-\n\n\n\nDRP, as a decision aid to ensure that customers are \n\n\n\ncounsel appropriately and triage correctly.  \n\n\n\nMETHODS \n\n\n\n\n\n\n\nWe consult standard reference textbooks\n25,26,27 \n\n\n\nand \n\n\n\nkey pharmacy journals\n29,30\n\n\n\n, looking for the \n\n\n\ncommon  mnemonics which has been promoted as \n\n\n\na decision aids for the supply of non-prescription \n\n\n\nmedicines. We believe that the clinical application \n\n\n\nof such decision aids is depending at the levels of \n\n\n\ninformation obtain from self-medicating patients \n\n\n\nnecessary for triaging process. Therefore, each \n\n\n\nmnemonic is evaluate base on the types of \n\n\n\ninformation collected with regards to: (i) details \n\n\n\nabout the patient\u2019s symptom presentation; (ii) \n\n\n\ndetails about the patient\u2019s medication experiences \n\n\n\nwhich includes allergies or sensitivities to \n\n\n\nmedications, concurrent medications, coexisting \n\n\n\ndisease states, action taken as well as perceptions \n\n\n\ntowards medication safety and effectiveness; and \n\n\n\n(iii) details about the patient-specific factors \n\n\n\nrelated to medication compliance, knowledge, and \n\n\n\ncost implication on medication use. Besides these, \n\n\n\nthe mnemonic is also evaluated for its ability to \n\n\n\nrecognize DRPs in a busy community pharmacy. It \n\n\n\nmeans that the mnemonic should prompt the CPs \n\n\n\nfor quick decision whether the  \n\n\n\n\n\n\n\nFigure 1.0   Flow chart for Pharmacy Triage Process  \n\n\n\nSTART             Step 1: Symptom assessment using acronym, STARZ  \n\n\n\nS-The patient\u2019s presenting symptoms (check figure 2.0 for serious or danger symptoms) \n\n\n\nT-Check onset and duration of presenting symptoms \n\n\n\nA-Explore any other associated symptoms (check figure 2.0) \n\n\n\nR-Check for recurrent or repeating symptoms \n\n\n\n          Assessment Questions (AQ) \n\n\n\n  AQ#1 : Is the patient\u2019s problem (or symptom) too serious for                      DRP #1(refer) \n\n\n\n                            self-treatment?                                            YES \n\n\n\n\n\n\n\n                                                                    NO      \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n314 \n \n\n\n\n      Step 2 : Zoom into the patient\u2019s medication experience. \n\n\n\n                    ( Medication Utilization Reviews ) \n\n\n\n  AQ#2: Have you tried some products to resolve the problems? ( DRP#4 &5) \n\n\n\n\n\n\n\n  AQ#3: Have you consulted a doctor to resolve the problems? (DRP#2) \n\n\n\n\n\n\n\n  AQ#4 Are you allergic to any drug or other substances? (DRP#10) \n\n\n\n  (Does the patient\u2019s problem is a manifestation of an allergic reaction?) \n\n\n\n\n\n\n\n  AQ#5: Do you have a known medical problem? (DRP#3,9,&12) \n\n\n\n  (Does the patient\u2019s problem is a manifestation of a chronic  \n\n\n\n                  diseases (a major disease)? \n\n\n\n\n\n\n\n  AQ#6: Are you taking any prescription drugs? (DRP#2,5,8,9,14,17) \n\n\n\n\n\n\n\n  AQ#7: Are you taking any other medications?(DRP# 12&13) \n\n\n\n\n\n\n\n  AQ#8: Are you experience any reactions from drugs? (DRP#11) \n\n\n\n\n\n\n\nAQ#9 : Do you stop taking your medications when you feel better? (DRP#8 & 17) \n\n\n\n\n\n\n\n   AQ#10: Do you stop taking your medications when you feel worse? (DRP#8 & 17) \n    \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nExplore Patient\u2019s Specific Factors \n\n\n\n \n\uf0b7 Pregnancy and lactation status \n\n\n\n    \uf0b7 Social history (smoking, alcohol) \n\n\n\n    \uf0b7 Religious and cultural beliefs (optional) \n\n\n\n    \uf0b7 Baseline knowledge of drug and disease \n\n\n\n    \uf0b7 Concerns about cost of therapy \n\n\n\n    \uf0b7 Patient\u2019s vital signs (BP, HR, T) \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n    Assessment Questions(AQ) \n \n\n\n\n  AQ#11 : Is there any barrier to drug taking because of religious or cultural beliefs?  (DRP# 6 &16)                        \n\n\n\n                           \n  AQ#12 : Do you smoke? Or Do you drink alcohol? ( DRP# 7)                                                                                                        \n\n\n\n\n\n\n\n  AQ#13 : Are you pregnant? Are you breast fed your baby? (DRP # 9)                              \n\n\n\n\n\n\n\n  AQ#14: Do you understand about your illness? (DRP # 8)                                                                                              \n\n\n\n\n\n\n\n  AQ# 15: Do you have any concern about the cost of therapy?  ( DRP#15)                                \n\n\n\n\n\n\n\n  AQ#16: Do you have any other queries about your illness and/or drug therapy?(DRP#18)  \n\n\n\n\n\n\n\n\n\n\n\n    Step 3 : Identification of drug-related problems (DRPs) \n\n\n\n                                                     ( check Table 3.0) \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n315 \n \n\n\n\nTable 1.0   Evaluation of mnemonics for self-care counselling.   \n\n\n\nMnemonics Information related to \n\n\n\nsymptom presentations\uf066 \n\n\n\nInformation related to \n\n\n\nmedication \n\n\n\nexperience\uf066 \n\n\n\nInformation \n\n\n\nrelated to patient -\n\n\n\nspecific factors \uf066 \n\n\n\nApplication in \n\n\n\nclinical practice \n\n\n\nWWHAM \nW- Who is the patient? \n\n\n\nW- What are the \n\n\n\nsymptoms? \n\n\n\nH- How long have the \n\n\n\nsymptoms  \n\n\n\nbeen present? \n\n\n\nA- Action taken? \n\n\n\nM- Medication being \n\n\n\ntaken? \n\n\n\n\n\n\n\n\n\n\n\n\uf0b7 Establishes presenting \n\n\n\ncompliant \n\n\n\n\uf0b7 Duration of symptoms \n\n\n\n\n\n\n\n\uf0b7 No data about other \n\n\n\nassociated symptoms. \n\n\n\n\uf0b7 No data about recurring \n\n\n\n or re-emergence of  \n\n\n\nsymptoms \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\uf0b7 Establishes action taken. \n\n\n\n\uf0b7 Establishes details about \n\n\n\npast and present \n\n\n\nmedications history. \n\n\n\n\n\n\n\n\uf0b7 No data on allergies and \n\n\n\nsensitivities to drug. \n\n\n\n\uf0b7 No data on immunization \n\n\n\nhistory. \n\n\n\n\uf0b7 No data on medical \n\n\n\nproblems/history \n\n\n\n\uf0b7No data on social history \n\n\n\n(smoking/alcohol) \n\n\n\n\n\n\n\n\uf0b7 Establishes identity \n\n\n\nof the  patient. \n\n\n\n\n\n\n\n\n\n\n\n\uf0b7 No data related to \n\n\n\npatient\u2019s knowledge,  \n\n\n\nmedication taking \n\n\n\n behavior. and cost of \n\n\n\ntreatment.  \n\n\n\n\uf0b7 No data about \n\n\n\npatient\u2019s vital signs \n\n\n\n \u2013 BP, HR, T \n\n\n\n\n\n\n\n\uf0b7 Useful for \n\n\n\npharmacy assistant \n\n\n\nfor first contact \n\n\n\nwith the patient \n\n\n\n\uf0b7 Provides \n\n\n\npharmacist with \n\n\n\nlimited information \n\n\n\nfor decision-\n\n\n\nmaking process. \n\n\n\n\uf0b7  Provides \n\n\n\npharmacist with \n\n\n\nlimited information \n\n\n\nto identify \n\n\n\nDRPs. \n\n\n\nASMETHOD \nA-Age/appearance \n\n\n\nS-Self/someone else \n\n\n\nM-Medication \n\n\n\nE- Extra medicines \n\n\n\nT-Time persisting \n\n\n\nH-History \n\n\n\nO-Other symptoms \n\n\n\nD-Danger symptoms \n\n\n\n\n\n\n\n\uf0b7 Establishes more details of \n\n\n\nthe presenting compliant, \n\n\n\nassociated symptoms, and \n\n\n\nduration of symptoms. \n\n\n\n\n\n\n\n\uf0b7 No data about recurring \n\n\n\n or re-emergence of  \n\n\n\nsymptoms \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\uf0b7 Establishes details about \n\n\n\npast and present \n\n\n\nmedications history. \n\n\n\n\n\n\n\n\uf0b7 No data on allergies and \n\n\n\nsensitivities to drug. \n\n\n\n\uf0b7 No data on immunization \n\n\n\nhistory. \n\n\n\n\uf0b7  No data on social \n\n\n\nhistory \n\n\n\n(smoking/alcohol) \n\n\n\n\n\n\n\n\uf0b7 Establishes identity \n\n\n\nand age of the \n\n\n\npatient. \n\n\n\n\n\n\n\n\n\n\n\n\uf0b7 No data related to \n\n\n\npatient\u2019s knowledge,  \n\n\n\nmedication taking \n\n\n\n behavior. and cost of \n\n\n\ntreatment.  \n\n\n\n\uf0b7 No data about \n\n\n\npatient\u2019s vital signs \n\n\n\n- BP, HR, T \n\n\n\n\n\n\n\n\uf0b7 Useful for details \n\n\n\nanalysis \n\n\n\nof symptoms. \n\n\n\n\uf0b7Provides \n\n\n\npharmacist with \n\n\n\nlimited information \n\n\n\nfor decision-\n\n\n\nmaking process. \n\n\n\n\uf0b7  Provides \n\n\n\npharmacist with \n\n\n\nlimited information \n\n\n\nto identify DRPs. \n\n\n\n\n\n\n\nSIT DOWN SIR \nS-site/location \n\n\n\nI-Intensity/severity \n\n\n\nT-Type or nature \n\n\n\nD-Duration \n\n\n\nO-Onset \n\n\n\nW-\n\n\n\nWith(other)symptoms \n\n\n\nN-Annoyed/aggravated \n\n\n\nS-Spread/radiation \n\n\n\nI-Incidence/frequency \n\n\n\nR-Relieved by? \n\n\n\n\n\n\n\n\uf0b7 Establishes more details of \n\n\n\nthe presenting compliant, \n\n\n\nassociated symptoms, \n\n\n\nseverity, and duration of \n\n\n\nsymptoms. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\uf0b7 None \n\n\n\n\n\n\n\n\uf0b7 No data on allergies and \n\n\n\nsensitivities to drug. \n\n\n\n\uf0b7 No data on immunization \n\n\n\nhistory. \n\n\n\n\uf0b7 No data on action taken \n\n\n\n and medications history. \n\n\n\n\uf0b7 No data on medical \n\n\n\nproblems/history \n\n\n\n\uf0b7No data on social history \n\n\n\n(smoking/alcohol) \n\n\n\n \n\uf0b7 Not specifically \n\n\n\nstated. \n\n\n\n\n\n\n\n\uf0b7 No data related to \n\n\n\npatient\u2019s knowledge,  \n\n\n\nmedication taking \n\n\n\n behavior. and cost of \n\n\n\ntreatment.  \n\n\n\n\uf0b7 No data about \n\n\n\npatient\u2019s vital signs  \n\n\n\n \u2013 BP, HR, T \n\n\n\n \n\uf0b7  Useful for \n\n\n\ndetails analysis of \n\n\n\nsymptoms. \n\n\n\n\uf0b7Amount of data \n\n\n\nexceeds the \n\n\n\ninformation needed \n\n\n\nfor triage. \n\n\n\n\uf0b7 Provides \n\n\n\npharmacist with \n\n\n\nlimited information \n\n\n\nfor decision-\n\n\n\nmaking process. \n\n\n\n\uf0b7  Provides \n\n\n\npharmacist with \n\n\n\nlimited information \n\n\n\nto identify DRPs. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nENCORE \nE-Explore \n\n\n\nN-No medication? \n\n\n\nC-Care \n\n\n\nO-Observe \n\n\n\nR-Refer \n\n\n\nE-Explain \n\n\n\n \n\uf0b7 Did not elicit all symptoms. \n\n\n\n\n\n\n\n\uf0b7 No data about other \n\n\n\nassociated symptoms. \n\n\n\n\uf0b7 No data about recurring \n\n\n\n or re-emergence of  \n\n\n\nsymptoms. \n\n\n\n\uf0b7 No data on onset and \n\n\n\nduration of symptoms. \n\n\n\n\n\n\n\n\uf0b7 Establishes action taken. \n\n\n\n\uf0b7 Establishes details about \n\n\n\npast and present \n\n\n\nmedications history. \n\n\n\n\n\n\n\n\uf0b7 No data on allergies and \n\n\n\nsensitivities to drug. \n\n\n\n\uf0b7 No data on immunization \n\n\n\nhistory. \n\n\n\n\uf0b7 No data on medical \n\n\n\n \n\uf0b7 Not specifically \n\n\n\nstated. \n\n\n\n\n\n\n\n\n\n\n\n\uf0b7 No data related to \n\n\n\npatient\u2019s knowledge,  \n\n\n\nmedication taking \n\n\n\n behavior. and cost of \n\n\n\ntreatment.  \n\n\n\n\uf0b7 No data about \n\n\n\n \n\uf0b7 Emphasizes the \n\n\n\nimportance of \n\n\n\nexplaining the \n\n\n\ndecision about \n\n\n\ntreatment. \n\n\n\n\uf0b7  Provides \n\n\n\npharmacist with \n\n\n\nlimited information \n\n\n\nto identify DRPs. \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n316 \n \n\n\n\n* CHAPS-FRAPS (C-Chief complaint, H-History of present illness, A-Allergies, P-Past medical history, S-Social history, F-\n\n\n\nFamilial history,  \n\n\n\nR-Review of other symptoms, A-Assessments, P-Plan, and S-SOAP ) \n\n\n\n\n\n\n\n\uf023 QuEST/SCHOLAR (Qu- Quickly and accurately assess the patient, E- Establish that the patient is an appropriate self-care \n\n\n\ncandidate, \n\n\n\nS- Suggest appropriate self-care strategies, T- Talk with the patient ; S-Symptoms, C-Characteristics, H-History, O-Onset, L-Location, \n\n\n\nA-Aggravating factors, R-Remitting factors) \n\n\n\n\n\n\n\n\uf066 the notes in italics highlight limited or no information related to the respective domains.       \n \n\n\n\n\n\n\n\npresenting signs and symptoms is either caused by \n\n\n\nor may be treated with a drug.  \n\n\n\nThe acronym, STARZ and classification of \n\n\n\nDRPs \n\n\n\nThe provision of advice about how best to manage \n\n\n\nhealth issues either to recommend no action, refer, \n\n\n\nor recommend a non-prescription medicines \n\n\n\n(NPM), is essentially is a form of \u2018triage\u2019. A \n\n\n\nframework called STARZ-DRP, a three steps \n\n\n\ndecision tool is develop for triaging patients in the \n\n\n\ncommunity pharmacy setting. Each letter \n\n\n\nrepresents a sequential step in the decision-making \n\n\n\nprocess. (Table 2.0) The centrality of the decision \n\n\n\ntools to the CPs is to determine what is or is not \n\n\n\nappropriate for NPM. It contained important key \n\n\n\nassessment questions based on the principles of \n\n\n\npharmaceutical care (Figure 1.0).  In this context, \n\n\n\nCipolle states that \u201c in the practice of \n\n\n\npharmaceutical care, decisions concerning an \n\n\n\nindication are made first, then, decisions \n\n\n\nconcerning effectiveness can be established, \n\n\n\nfollowed by safety considerations.\u201d The \n\n\n\ncompliance issues represent the ability of the \n\n\n\npatient to take the medication as intended.\n19\n\n\n\n In the \n\n\n\nface of busy commercial transactions, however, it \n\n\n\nis quite difficult for CP to become aware that a \n\n\n\npatients\u2019 symptom has a problem unless he/she set \n\n\n\nout with the intention of looking for drug-related \n\n\n\nproblems. This requires careful observation and \n\n\n\nadequate questioning to identify the symptoms \n\n\n\nreported by patients, which may have a potentially \n\n\n\nserious cause. For this purpose, a set of key \n\n\n\nassessment questions is design to identify and \n\n\n\n problems/history \n\n\n\n\uf0b7No data on social history \n\n\n\n(smoking/alcohol) \n\n\n\n\n\n\n\npatient\u2019s vital signs  \n\n\n\n \u2013 BP, HR, T \n\n\n\nCHAPS-FRAPS* \uf0b7  Establishes more details of \n\n\n\nthe presenting compliant and \n\n\n\nassociated symptoms.  \n\n\n\n\n\n\n\n\uf0b7 No data about recurring \n\n\n\n or re-emergence of  \n\n\n\nsymptoms. \n\n\n\n\n\n\n\n\uf0b7  Establishes details about \n\n\n\nallergies, past medical \n\n\n\nhistory, social and family \n\n\n\nhistory. \n\n\n\n\n\n\n\n\uf0b7 No data on immunization \n\n\n\nhistory. \n\n\n\n\uf0b7 No data on medications \n\n\n\nhistory. \n\n\n\n\n\n\n\n\n\n\n\n\uf0b7  Not specifically \n\n\n\nstated. \n\n\n\n\n\n\n\n\n\n\n\n\uf0b7 No data related to \n\n\n\npatient\u2019s knowledge,  \n\n\n\nmedication taking \n\n\n\n behavior. and cost of \n\n\n\ntreatment.  \n\n\n\n\uf0b7 No data about \n\n\n\npatient\u2019s vital signs \n\n\n\n \u2013 BP, HR, T \n\n\n\n\uf0b7 Useful for self-\n\n\n\ncare counseling. \n\n\n\n\uf0b7  Amount of data \n\n\n\nexceeds the \n\n\n\ninformation needed \n\n\n\nfor triage. \n\n\n\n\uf0b7  Provides \n\n\n\npharmacist with \n\n\n\nlimited information \n\n\n\nto identify DRPs. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nQuEST/SCHOLAR\uf023 \uf0b7  Establishes more details of \n\n\n\nthe presenting compliant and \n\n\n\nother related \n\n\n\nsymptom-specific data.  \n\n\n\n\n\n\n\n\uf0b7  Establishes details \n\n\n\nrelated to patient\u2019s \n\n\n\nmedication experiences. \n\n\n\n\uf0b7  Not specifically \n\n\n\nstated. \n\n\n\n\n\n\n\n\uf0b7No data related to \n\n\n\npatient\u2019s knowledge,  \n\n\n\nmedication taking \n\n\n\n behavior. and cost of \n\n\n\ntreatment.  \n\n\n\n\uf0b7 No data about \n\n\n\npatient\u2019s vital signs \n\n\n\n \u2013 BP, HR, T \n\n\n\n\uf0b7  Provide \n\n\n\nstructured \n\n\n\napproach to \n\n\n\ncounsel patients \n\n\n\nwith self-care \n\n\n\nissues.  \n\n\n\n\uf0b7  Amount of data \n\n\n\nexceeds the \n\n\n\ninformation needed \n\n\n\nfor triage. \n\n\n\n\uf0b7 Need additional \n\n\n\npatient-specific \n\n\n\ndata to identify \n\n\n\nDRPs.   \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n317 \n \n\n\n\ncategorize the DRPs. The categories of DRPs are \n\n\n\nsummarized in Table 3.0. \n\n\n\nRESULTS AND DISCUSSION \n\n\n\n\n\n\n\nAlthough varieties of self-care counselling \n\n\n\nstrategies exist, however, each of these methods is \n\n\n\nincomplete in some area (Table 1.0) The \n\n\n\nWWHAM, a popular and an established aide-\n\n\n\nmemoire used by pharmacy assistants, no doubt, it \n\n\n\nis an easily remembered mnemonic to obtain a \n\n\n\ngeneral picture of the patient\u2019s presenting \n\n\n\ncompliant but it does not encourage elaboration for \n\n\n\nsymptom assessment. There is evidence that \n\n\n\npharmacy assistants use WWHAM as a matter of \n\n\n\nrote rather than in a informed way, tailored to \n\n\n\nindividual consultations.\n31 \n\n\n\nIn fact, it was not \n\n\n\noptimally utilized as showed by another study that \n\n\n\nmost of the consultations involved a maximum of \n\n\n\ntwo WWHAM items, instead out of 5 items. Of \n\n\n\nconcerns, it was noticed that more than 60% of \n\n\n\nconsultations did not establish whether the \n\n\n\nrequestor for non-prescription medicine was using \n\n\n\nother medications concurrently.\n32 \n\n\n\nThese findings\n \n\n\n\nhas implications in terms of the potential DRPs \n\n\n\nrelated to drug interactions and exacerbations of \n\n\n\nclinical conditions.  \n\n\n\nAlthough other mnemonics, ENCORE, \n\n\n\nASMETHOD, SIT DOWN SIR are more \n\n\n\ncomprehensive than WWHAM, they are still \n\n\n\nlimited. To our knowledge, none of these methods \n\n\n\nwas studied exclusively in the community \n\n\n\npharmacy practice setting like WWHAM. \n\n\n\nMoreover, by no means these methods were \n\n\n\nuniversally use and apply in the community \n\n\n\npharmacy practice. Similarly, the mnemonic \n\n\n\nCHAPS-FRAPS provides a detail analysis of \n\n\n\nsymptoms and patient-specific factors, but it do \n\n\n\nnot address when a patient should be referred nor \n\n\n\nprovides indication for the recognition of DRPs. \n\n\n\nUnlike the other mnemonics, the \n\n\n\nQuEST/SCHOLAR process provides more \n\n\n\ncomprehensive picture of symptom presentation as \n\n\n\nwell as goes on to address the patient\u2019s medication \n\n\n\nexperiences so that the pharmacist can use this \n\n\n\ninformation to guide product selection or physician \n\n\n\nreferral. Furthermore, this approach includes a \n\n\n\nstructure for counselling the patient. Even though \n\n\n\nthe process deliberately use the word quickly to \n\n\n\nfind out what is wrong with the patient, but it is of \n\n\n\nconcerns, perhaps whether a busy practitioner likes \n\n\n\nthe CP able to collect relevant information for the \n\n\n\npurpose of identifying, resolving, and preventing \n\n\n\ndrug-related problems. On the contrary, the \n\n\n\namount of data may vastly exceed the information \n\n\n\nneeded for triaging self-medicating patients, after \n\n\n\ngoing through the whole QuEST/SCHOLAR \n\n\n\nprocess.  \n\n\n\nIn the self-care context when there is need for \n\n\n\nmedicines, the CP has a key role in assisting to \n\n\n\nidentify the best intervention. Apart from helping \n\n\n\nto choose an OTC medicine that is safe and \n\n\n\neffective, the CP may refer patients to another \n\n\n\nhealth professional, most commonly to the general \n\n\n\npractitioner. Direct referrals of patients to GPs \n\n\n\nhave been reported to range from 6% to 15%. \n33,34,35,36\n\n\n\n Another study found that 15% of \n\n\n\npharmacy customers seeking advice were \n\n\n\nrecommends to see their doctors, of which, 53% \n\n\n\ndirectly and 47% conditionally.\n37\n\n\n\n Conditional \n\n\n\nreferrals is an option offered where the patients are \n\n\n\nadvised to seek medical assistance if symptoms do \n\n\n\nnot clear within a given timeframe. An interesting \n\n\n\nobservation by Hassel et.al (1997) was that CP\u2019s  \n\n\n\nreferred their clients to GPs when they were in \n\n\n\ndoubt or uncertainty about their health problems.\n33\n\n\n\n\n\n\n\nClearly, this findings showed that CPs is keenly \n\n\n\naware of their limits in providing care at the \n\n\n\npharmacy. Now, perhaps, there is a need for \n\n\n\nsimple aids for pharmacy triage that is not only to \n\n\n\nprovide guidelines for decision-making but more \n\n\n\nimportantly is to gain professional confidence.  \n\n\n\nOwing to some barriers and challenges in \n\n\n\nresponding to symptoms in the pharmacy, a simple \n\n\n\ndecision aids is proposed aimed for a quick \n\n\n\nscreening and triaging process for patients who are \n\n\n\nneeded for further assessment by other healthcare \n\n\n\npractitioners. Here, it is important to emphasize \n\n\n\nthat CP has the appropriate communication skills \n\n\n\nto collect information adequately. Besides this, it is \n\n\n\nessential to have accurate knowledge of minor \n\n\n\nillnesses and its management. Any deficiencies of \n\n\n\nthese aspects make the process of data collection \n\n\n\ninefficient, and may deliberately impair the \n\n\n\ntriaging process.  A description of each of the \n\n\n\nmajor steps involved in the process follows. \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n318 \n \n\n\n\n\n\n\n\nTable 2.0  Definition of letters in STARZ \n# \uf02a\n\n\n\n\n\n\n\n_________________________________________________________________________________________________ \n\n\n\nLetter   Description \n_________________________________________________________________________________________________ \n\n\n\nS  Symptom presentation refer to subjective evidence of health problem which is perceived by \n\n\n\nthe patient.   \n\n\n\n\n\n\n\nT   Time of onset and duration of the presenting symptoms.  \n\n\n\n\n\n\n\nA   Associated symptoms refer to patient symptoms explore and determine by the pharmacist \n\n\n\nduring the interview. It does not refer to the symptom presented earlier by the patient. This is \n\n\n\ndone by using the pictorial documentation form as depicted in Figure 2.0. To aid and ease the \n\n\n\npharmacist during the interview, the human body is arbitrarily divided into four regions: (i) \n\n\n\nFront part, the position of body facing the pharmacist (asking for symptoms like bloating, \n\n\n\nheartburn, nausea, vomiting, breathlessness), then proceed to (ii) back  \n\n\n\npart of the body (asking for symptoms like lower and upper back pain, shoulder pain, and \n\n\n\nneck pain), continued to the (iii) upper part, this is, the patient head (asking for symptoms like \n\n\n\nheadache, dizziness, problems with sleep), and lastly go down to (iv) the lower part of the \n\n\n\nbody (asking for symptoms like numbness of both legs and hands, constipation, and swollen \n\n\n\nfeet). Perhaps, the process is likened to the  filtering or screening process particularly to rule \n\n\n\nout the presence of severe symptoms.  \n\n\n\n\n\n\n\nR  Recurrence problem refers to the symptom presentation which has been treated before, but \n\n\n\nthe symptom recur and persists despite the treatment prescribed.   \n\n\n\n\n\n\n\nZ Zoom into the patient\u2019s medication experience refer to information collected by the \n\n\n\npharmacist related to any medical problems (for examples, hypertension, diabetes, \n\n\n\nhyperthyroid), medication utilisation (for examples, use of prescription and non-prescription \n\n\n\ndrugs, herbals, supplements ), immunisation history, allergies as well as sensitivities to drugs,  \n\n\n\nexperiences of drug side effects and adverse reactions, and consumption of alcohol, caffeine \n\n\n\nand tobacco.  \n\n\n\n\n\n\n\n_________________________________________________________________________________________________ \n\n\n\n# \n This is not a diagnostic tool, rather it is a format with the purpose of organizes a community pharmacist\u2019s knowledge in \n\n\n\na manner that allows him/her to begin identifying the actual and potential drug-related problems and subsequently triage \n\n\n\npatients to the appropriate health care professionals. \n\n\n\n\uf02a The patient\u2019s vital signs will be measured when necessary. At times, the patient\u2019s blood pressure, pulse rate, and body \n\n\n\ntemperature are measured to aid pharmacist assessing the appropriateness of presenting symptom for self-medication.      \n\n\n\n\n\n\n\n_________________________________________________________________________________________________ \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n319 \n \n\n\n\nStep 1 : The acronym, STAR, for symptom \n\n\n\nassessment. \n\n\n\nEither the CP or the patient can initiate the \n\n\n\nbeginning of the interaction. In this situation, \n\n\n\ncommunication is essential in order to develop a \n\n\n\ntherapeutic relationship and be receptive to create \n\n\n\nconditions conducive for conducting the interview \n\n\n\nand collecting patient data.\n19\n\n\n\n It is important to \n\n\n\nintroduce personally and the patient should be \n\n\n\naddressed by his or her name.\n38\n\n\n\n\n\n\n\nIn the first step, objective information is obtained \n\n\n\nby asking the patient about his/her age and gender \n\n\n\n(usually obtained by visual observation). Then, \n\n\n\nexplore the patient\u2019s chief complaint or reason for \n\n\n\nthe pharmacy visit. At this point, it is important not \n\n\n\nto confuse the patient\u2019s self-diagnosis with \n\n\n\npatient\u2019s symptoms. The pharmacists should act \n\n\n\nprofessionally and refrain from implying \n\n\n\nacceptance of the patient\u2019s self-diagnosis. Instead, \n\n\n\nsimply acknowledge the patient\u2019s complaint and \n\n\n\nthen proceed with the interview.  \n\n\n\n\n\n\n\nTable 3.0  Categories of drug-related problem (DRPs) \n\n\n\n\n\n\n\nINDICATION \n\n\n\n\n\n\n\nDRP#1 : No indication for NPM \n\n\n\nDRP#2 : Uncertainty about the indication of drug \n\n\n\nDRP#3 : Need for additional therapy \n\n\n\n\n\n\n\nEFFECTIVENESS \n\n\n\n\n\n\n\n\n\n\n\nDRP#4: Inappropriate drug choice \n\n\n\nDRP#5: Dose too low \n\n\n\nDRP#6: Ineffective therapy \n\n\n\nDRP#7: Interference with medical therapy by  \n\n\n\nsmoking/alcohol consumption \n\n\n\nDRP#8: Lack of understanding of the medication \n\n\n\nDRP#9: Monitoring required \n\n\n\n\n\n\n\nSAFETY \n\n\n\n\n\n\n\n\n\n\n\nDRP#10: Use of medication to which the patient is allergic \n\n\n\nDRP#11: Adverse drug events \n\n\n\nDRP#12: Potential drug-disease interaction \n\n\n\nDRP#13: Potential drug-drug interaction \n\n\n\nDRP#14: Dose too high \n\n\n\n\n\n\n\nCOMPLIANCE \n\n\n\n\n\n\n\n\n\n\n\nDRP#15: Problems arising from financial impact of therapy \n\n\n\nDRP#16: Interference with medical therapy by cultural/religious beliefs \n\n\n\nDRP#17: Failure of the patient to adhere to labelling instructions  \n\n\n\nDRP#18: others \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n320 \n \n\n\n\nThe first letter, S, represents the patient\u2019s \n\n\n\npresenting symptoms. Besides the previously \n\n\n\nemphasized communication skills, it is essential to \n\n\n\nhave accurate clinical knowledge in order to \n\n\n\ndistinguish between minor and major disease. This \n\n\n\nrequires careful observation and adequate \n\n\n\nquestioning to identify the symptoms reported by \n\n\n\npatients. In fact, the pharmacist is provided with a \n\n\n\nchecklist of serious or danger symptoms.     \n\n\n\n(Figure 2.0) The second letter, T, denotes the time \n\n\n\nof onset and duration of the presenting symptoms. \n\n\n\nThese objective data would provide the CP with \n\n\n\nthe opportunity to clarify the history of presenting \n\n\n\nsymptoms being reported. Proceed with the third \n\n\n\nletter, A, stands for the associated or related \n\n\n\nsymptoms. It is therefore necessary for the CP to \n\n\n\nask the presence (or absence) and nature of \n\n\n\nassociated or related symptoms. This is best \n\n\n\nundertaken on a systematic body system basis. We \n\n\n\ndesign a pictorial documentation form to aid CPs \n\n\n\nduring the interview process.(Figure 2.0) At this \n\n\n\nstage, it is necessary to ask the patient in detail \n\n\n\nabout the symptoms. This is to ascertain that no \n\n\n\nrelated symptoms pertaining to the parts of body \n\n\n\nsystem are overlooked. Lastly, the fourth letter, R, \n\n\n\nstands for recurrence or repeated symptoms. It is \n\n\n\nimportant to establish whether the presenting \n\n\n\nsymptom has occurred before. If it is a recurrence, \n\n\n\nit is useful to explore the course of action that has \n\n\n\nalready been tried and how successful it was.  \n\n\n\nIn general, referral is indicated in the following \n\n\n\nsituations: (i) the CP is in doubt about the patient\u2019s \n\n\n\npresenting symptom (the letter, S) or presence of \n\n\n\nserious or danger symptoms; (ii) the symptom is \n\n\n\nminor but persistent (the letter, T); (iii) the \n\n\n\npresenting symptom is associated with a group of \n\n\n\nsymptoms ( the letter, A) ; and (iv) the symptom \n\n\n\nhas recurred repeatedly (the letter, R). Obviously, \n\n\n\nif in doubt, further inquiry should be made before \n\n\n\nreaching a decision. However, in most situations, \n\n\n\nthe decision is based on an accurate knowledge of \n\n\n\nminor illnesses as well as fully capable of \n\n\n\ndistinguishing between minor and major disorders. \n\n\n\nNevertheless, one\u2019s should be remind that the \n\n\n\nSTAR is not a diagnostic process but rather \n\n\n\nprovides the CP with opportunity for screening or \n\n\n\nsieving the patients prior making the decision for \n\n\n\ntriage. This is called as the \u2018filter effect\u2019, which is \n\n\n\nan important aspect of pharmacy triage, which can \n\n\n\nbe likened to the \u2018gatekeeper effect\u2019 attributed to \n\n\n\nthe telephone triage services.    \n\n\n\nStep 2 : Zoom into the patient\u2019s medication \n\n\n\nexperience. \n\n\n\nAs stated earlier, each patient has a unique \n\n\n\nmedication experience describe as an individual\u2019s \n\n\n\nsubjective experience of taking a medication in his \n\n\n\ndaily life. In this regards, Cipolle (2004) state \u201ca \n\n\n\npractitioner cannot make sound clinical decisions \n\n\n\nwithout a good understanding of the patient\u2019s \n\n\n\nmedication experience\u201d and urge pharmacy \n\n\n\npractitioners to take responsibility for improving \n\n\n\neach patient\u2019s medication experience.\n19\n\n\n\n For this to \n\n\n\noccur, it is essential that the CP has the appropriate \n\n\n\ncommunication and interviewing skills to obtain \n\n\n\ninformation related to the consumption of \n\n\n\nprescription and non-prescription medications, \n\n\n\nherbal products, and dietary supplements. It is also \n\n\n\nhelpful to obtain information about coexisting \n\n\n\nmedical conditions, allergies or sensitivities to \n\n\n\nmedications, as well as immunization history, and \n\n\n\npatient\u2019s use of alcohol, caffeine, and tobacco. \n\n\n\nThis information should be evaluated in the \n\n\n\ncontext of the patient\u2019s presenting symptom.  \n\n\n\nA person may engage in a number of practices or \n\n\n\nbehaviours related to drug taking and drug use. \n\n\n\nThese may includes self-alteration of a drug\u2019s \n\n\n\ndosage without prescriber knowledge, use of \n\n\n\nmultiple drug products, refusal to take medications \n\n\n\nbecause of the perceived drug\u2019s side effects or \n\n\n\nadverse drug reactions, or seeking treatment from \n\n\n\nmultiple clinics and pharmacies. The CPs, \n\n\n\ntherefore, should be alert to any routine practices \n\n\n\nor behaviour that may contribute to unnecessary \n\n\n\nhealth risk.\n39\n\n\n\n Thus, a tactful exploration of the \n\n\n\npatient\u2019s general understanding, knowledge, and \n\n\n\nexpectations concerning drug taking and use, as \n\n\n\nwell as the way he actually perform daily \n\n\n\nactivities, will provide CPs with enough \n\n\n\ninformation to identify the patient\u2019s drug-related \n\n\n\nproblems and formulate a plan for appropriate \n\n\n\naction.   \n\n\n\nStep 3 : Identification of drug-related problems \n\n\n\n(DRPs). \n\n\n\nThe scenery of DRPs should be view at the outset \n\n\n\nof the symptoms reported by patients. It can, \n\n\n\nperhaps, be scented throughout the entire courses \n\n\n\nof step 1 and 2, since this is where the CP gathers \n\n\n\nsymptom-specific as well as patient-specific data \n\n\n\nand critically examine it to determine if problem \n\n\n\nexists. In the face of busy commercial transactions, \n\n\n\nhowever, it is quite difficult for CP to become \n\n\n\naware that a patients\u2019 symptom has a problem \n\n\n\nunless he/she set out with the intention of looking \n\n\n\nfor drug-related problems. As studied by Currie \n\n\n\net.al.(1997), the detection of DRPs were increased \n\n\n\nafter the CPs went through a training program. A \n\n\n\n40-hour pharmaceutical care training program was \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n321 \n \n\n\n\ndeveloped and presented to pharmacists, and \n\n\n\npatients were randomly assigned to receive either \n\n\n\ntraditional pharmacy services or pharmaceutical \n\n\n\ncare, consisting of initial work-up and follow-up \n\n\n\nwith documentation in a patient record. The \n\n\n\nfindings showed that patients receiving \n\n\n\npharmaceutical care were more than seven times as \n\n\n\nlikely to have any problems identified, more than \n\n\n\neight times as likely to have an intervention \n\n\n\nperformed, and more than eight times as likely to \n\n\n\n\n\n\n\n\n\n\n\nFigure 2.0 Pictorial Documentation Form \n\n\n\n\n\n\n\n3. Upper part:\n\n\n\n\uf031Headache\n\n\n\n\uf031Dizziness\n\n\n\n\uf031Problem with sleep\n\n\n\n\uf031 Other(s):_______________________________ BP:\n\n\n\nPulse:\n\n\n\nTemp (\ufffdC):\n\n\n\nAssociated symptom(s)\n\n\n\n1. Front part:\n\n\n\n\uf031Bloating\n\n\n\n\uf031Heartburn\n\n\n\n\uf031Nausea\n\n\n\n\uf031Vomiting\n\n\n\n\uf031 Breathlessness\n\n\n\n2. Back part:\n\n\n\n\uf031Low back pain\n\n\n\n\uf031Upper back pain\n\n\n\n\uf031Shoulder pain \n\n\n\n\uf031Neck pain\n\n\n\n4. Lower part:\n\n\n\n\uf031Numbness of hand(s)\n\n\n\n\uf031Numbness of leg(s)\n\n\n\n\uf031Swollen feet(s)\n\n\n\n\uf031Constipation\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n322 \n \n\n\n\nhave a drug-related problem identified than were \n\n\n\npatients receiving traditional pharmacy services \n\n\n\nonly.\n40\n\n\n\n\n\n\n\nIt is certain that we need to have knowledge about \n\n\n\nthe patient\u2019s total drug use to address issues \n\n\n\nregarding DRPs. In addition, we need to explore \n\n\n\nother factors influencing the patient\u2019s use of \n\n\n\nmedicines. In the entire course of self-medication \n\n\n\npractices there are three main processes where a \n\n\n\nDRP can be generated: (i) patient\u2019s presenting \n\n\n\nsymptom ;(ii) patient\u2019s drug utilization pattern; \n\n\n\nand (iii)  patient\u2019s specific factors that may impede \n\n\n\nand influence the patient\u2019s medication taking \n\n\n\nbehavior. In practice, however, it may not be \n\n\n\nfeasible to begin identifying medication problems \n\n\n\nunless the patient is interview thoroughly about \n\n\n\ndrug use and relevant aspects to uncover potential \n\n\n\nand actual DRPs. In fact, this is a method currently \n\n\n\nused in clinical practice, especially by clinical \n\n\n\npharmacists in hospitals and nursing homes,\n41,42\n\n\n\n\n\n\n\nand a high proportion of the DRPs identified in the \n\n\n\ninterviews were of major clinical significance.\n43 \n\n\n\n\n\n\n\nThe true prevalence of DRPs in self-medicating \n\n\n\npatients is unknown. Therefore, a tactful \n\n\n\nexploration of the patient\u2019s presenting symptom, \n\n\n\ndrug taking practices and behaviors, as well as the \n\n\n\nway patient actually cope with his/her illness, will \n\n\n\nprovide pharmacists with enough information to \n\n\n\nidentify the DRPs and formulate a plan for \n\n\n\nappropriate action. The categories of DRPs listed \n\n\n\nin Table 3.0 is an addition to the seven categories \n\n\n\nproposed by Cipolle et.al (1998)\n19\n\n\n\n We concur with \n\n\n\nCipolle that the  categories apply across all patient, \n\n\n\npractitioner, and institutional variables. The \n\n\n\nadditional items in the list are mainly to take into \n\n\n\naccount the three main processes of self-\n\n\n\nmedication practices mentioned earlier. In this \n\n\n\ncontext, the order of how the DRP were identified \n\n\n\nis important. In the practice of pharmaceutical care \n\n\n\nfor minor illnesses, decisions\u2019 concerning an \n\n\n\nindication for NPM is made first. By asking the \n\n\n\nkey questions as depict in Figure 1.0, then, \n\n\n\npossible causes of DRPs are determined. Most \n\n\n\nimportantly, this will guide the CPs in the process \n\n\n\nof problem solving during the encounter with \n\n\n\npatients. In addition, reasons for referral and \n\n\n\neffective care plan can be establish. Finally yet \n\n\n\nimportantly, the process may seem lengthy and \n\n\n\ntedious, but once it becomes habitual and is \n\n\n\nperform routinely, the process can be both \n\n\n\ncomprehensive and time-effective.  \n\n\n\nCurrently, a demonstration project of the STARZ-\n\n\n\nDRP model is been studied among a group of \n\n\n\ncommunity pharmacies in Penang. Ten retail \n\n\n\npharmacies were recruited in the study that \n\n\n\ncomprises of five control and five study \n\n\n\npharmacies. All pharmacists taking part in the \n\n\n\nstudy was instructed to obtain information on the \n\n\n\npatient drug use during a natural dialogue and to \n\n\n\napply the proposed model consistently but still \n\n\n\nwith professional judgment. Hence, the model was \n\n\n\nnot meant to be use literally but to be adjusted to \n\n\n\nthe actual patient and his/her medication \n\n\n\nexperience. The control group continues carry out \n\n\n\ntheir usual care while the study group exposed to \n\n\n\nthe elements of pharmaceutical care that comprises \n\n\n\nof patient assessment, care plan, and monitoring. \n\n\n\nThe STARZ-DRP was the assessment part of the \n\n\n\npharmaceutical care. Patients who fulfilled the \n\n\n\ninclusion criteria and complaints of headache, \n\n\n\ndysmenorrhoea, back pain, constipation, \n\n\n\ndyspepsia, nasal symptoms, sore throat, cough and \n\n\n\nhigh temperature are invites to participate in the \n\n\n\nstudy. Apart from the documentation of the \n\n\n\npatient\u2019s DRPs, a group of experts\u2019 panel evaluate \n\n\n\nthe appropriateness for triaging patients by \n\n\n\ncommunity pharmacists. The group comprises of \n\n\n\n10 general practitioners and 10 community \n\n\n\npharmacists. To the best of our knowledge, this is \n\n\n\nthe first study of this kind, an attempt to provide a \n\n\n\ndocumentation of the pharmaceutical care practice \n\n\n\nfor minor ailments.  \n\n\n\nCONCLUSIONS \n\n\n\nThis article highlights the importance of structured \n\n\n\nand systematic processes in triaging patients with \n\n\n\nminor illnesses. The STARZ-DRP introduces a \n\n\n\nformat with the purpose of organizes a community \n\n\n\npharmacist\u2019s knowledge in a manner that allows \n\n\n\nhim/her to begin identifying the actual and \n\n\n\npotential DRPs. However, it should be noted that \n\n\n\nSTARZ-DRP is not intended to advocate self-\n\n\n\nmedication, but to provide a platform for \n\n\n\ncollaboration with other health care professionals \n\n\n\nin order to promote rational use of medicines.  \n\n\n\nAgain, it is important to emphasize the importance \n\n\n\nof an effective communication skill and accurate \n\n\n\nclinical knowledge to distinguish between minor \n\n\n\nillness and major disease.  Further study is needed \n\n\n\nto determinate whether STARZ-DRP is more \n\n\n\neffective than other methods for pharmacy triage \n\n\n\nservice when studied in a controlled, systematic \n\n\n\nmanner.  \n\n\n\n\n\n\n\nACKNOWLEDGEMENTS \n\n\n\nWe are grateful to the Universiti Sains Malaysia \n\n\n\nfor providing the Research University (RU) Grant \n\n\n\nto fund this research. Under this RU grant, we are \n\n\n\ncurrently conducting a research project entitled \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n323 \n \n\n\n\n\u201cEstablishing and implementing the philosophy of \n\n\n\npharmaceutical care in the community pharmacy \n\n\n\npractice \u2013 A Malaysian perspective. \u201d (Grant \n\n\n\nnumber: 1001/PFARMASI/8120234)   \n\n\n\nREFERENCES \n\n\n\n1. WORLD HEALTH ORGANIZATION. The role of the pharmacist in self-care and self-medication.    \n\n\n\nHangue: World Health Organization.1998 \n\n\n\n2. World Self-Medication Industry. WSMI declaration on self-care and self-medication(2006) Available \n\n\n\nat :  http://www.wsmi.org/pdf/bali_declaration.pdf Accessed on : 18 September 2010 \n\n\n\n3. Winfield,A.J. and Richards,R.M.E. Pharmaceutical practice. 2\nnd\n\n\n\n. Ed. Hong Kong.  1998 \n\n\n\n4. Ajuoga, E., Sansgiry,S.S., Ngo,C. 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Survey of Drug-Related Problems Identified by Community \n\n\n\nPharmacies.  Ann Pharmacotherapy, 2007;41(11):1852-1832 \n\n\n\n22. Griese N, Berger K, Eickhoff C.Prevalence of drug-related problems in self-medication (OTC use).  \n\n\n\nPharmacotherapy,2009;29(Suppl); 39e \n\n\n\n23. Sara Courson What is Telephone Nurse Triage? Connection magazine. Available at : < http: // www. \n\n\n\nConectionsartclemagazine.com  /articles/5/090.html> Assessed on : 20 September 2010 \n\n\n\n24. O'Connell JM, Towles W, Yin M, Malakar CLPatient Decision Making: Use of and Adherence \n\n\n\ntoTelephone-Based Nurse Triage Recommendations. Med Decis Making,2002; 22(4): 309-317 \n\n\n\n\nhttp://www.wsmi.org/pdf/bali_declaration.pdf\n\n\nhttp://www.conectionsartclemagazine.com/articles/5/090.html\n\n\nhttp://www.conectionsartclemagazine.com/articles/5/090.html\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n324 \n \n\n\n\n25. Blenkinsopp,A.,Paxton,P.,Blenkinsopp,J. Symptoms in the pharmacy: A guide to the management of \n\n\n\ncommon Illness, 5\nth\n. Eds. 2005. Blackwell Publishing,Oxford,UK. pages 1-13 \n\n\n\n26. Edwards,C., Stillman,P. Minor illness or Major disease? The clinical pharmacist in the community. \n\n\n\n4\nth\n. Eds. 2006. Pharmaceutical Press, London. pages 1-10 \n\n\n\n27. Rutter,P. Community pharmacy. Symptoms, Diagnosis and Treatment. 2004. Churchill Livingstone. \n\n\n\nAn Imprint of Elsevier Limited. pages ix \u2013 xi. \n\n\n\n28. Rutter PM, Horsley E, Brown DT. Evaluation of community pharmacists' recommendations \n\n\n\ntostandardized patient scenarios. Ann Pharmacother, 2004; 38:1080\u20135. \n\n\n\n29. McCallian DJ, Cheigh NH. The pharmacist's role in self-care. J Am Pharm Assoc, 2002; 42:S40\u20131 \n\n\n\n30. Shauna M B, Kirby J,Conrad WF. A Structured Approach for Teaching Students to Counsel Self-care.  \n\n\n\nPatients. Am J Pharm Educ, 2007;71(1): 1-7 \n\n\n\n31. Watson,M.C., Bond,C.M. The evidence based supply of non-prescription medicines: barriers and \n\n\n\nbeliefs. Int J Pharm Prac, 2004; 12: 65-72 \n\n\n\n32. Watson,M.C., Hart,J., Johnson,M. Bond,C.M. (2008) Exploring the supply of non-prescription \n\n\n\nmedicines from community pharmacies in Scotland. Pharm World Sci, 2008; 30:526-535 \n\n\n\n33. Hassell K, Noyce PR Rogers A, Harris J and Wilkinson J  A pathway to the GP: The pharmaceutical  \n\n\n\nconsultation' as a first port of call in primary health care. Family Practice, 1997 14(6): 498-502 \n\n\n\n34. Seston L, Nicolson M, Hassell K, Cantrill J and Noyce P Variation in the incidence, presentation and \n\n\n\nmanagement of nine minor ailments in community pharmacy. Pharm J, 2001; 266: 429-432 \n\n\n\n35. Bissell, P, Ward PR and Noyce P Variation within community pharmacy: 3. Referring customers to \n\n\n\nother health professionals. J Soc Admin Pharm, 1997; 14(2): 116-123 \n\n\n\n\n\n\n\n36. Tully MP, Hassel K and Noyce P  Advice-giving in community pharmacies in the UK. J Health        \n\n\n\nServices Res Policy, 1997; 2(1): 38-50 \n\n\n\n37. Marklund B, Karlsson G and Bengtsson C The advisory service of the pharmacies as an activity of its \n\n\n\nown and as a part of collaboration with primary health care services. J Soc Admin Pharm, 1990; 7(3): \n\n\n\n111-116 \n\n\n\n38. Berger BA. Communication skills for pharmacists: Building relationships and improvise patient care. \n\n\n\nWashington : American Pharmaceutical Association, 2005 \n\n\n\n39. Azmi S.Drug counseling: The need for a systematic approach. J Pharm Technol, 1993 9: 6-9 \n\n\n\n40. Currie JD, Chrischilles EA,Kuehl AK, Buser RA.Effect of a training program on community    \n\n\n\npharmacists\u2019 detection of and intervention in drug-related problems. J Am Pharm Assoc,1997; Mar-\n\n\n\nApr, NS37(2):182-191 \n\n\n\n41. Furniss,L.,Burns,A,Craig,S.K.,et.al. Effects of a pharmacist\u2019s medication review in nursing homes.  \n\n\n\nRandomised controlled trial. Br.J.Psychiatry,2000; 176: 563-7 \n\n\n\n42. Kaboli,P.J.,Hoth,A.B.,McClimon,B.J.,et.al.Clinical pharmacists and inpatient medical care: a       \n\n\n\nsystematic review. Arch Intern Med,2006;166:955-64 \n\n\n\n43. Viktil,K.K.,Blix,H.S.,Moger,T.A.,et.al. Interview of patients by pharmacists contributes significantly \n\n\n\nto the identification of drug-related problems(DRPs). Pharmacoepidemiol Drug Saf,2006;15:667-74 \n\n\n\n44. van Mil JWF, Westerlund LT, Hersberger KE, Schaefer MA. Drug-related problem classification \n\n\n\nsystems.  Ann Pharmacother,2004; 38: 859-867 \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n325 \n \n\n\n\nPredictors of Herbal Utilization by Multiethnic Secondary Care Patients in Malaysia: a Cross \n\n\n\nSectional Survey  \nMohd Baidi Bahari and Saw June Tze \n\n\n\nSchool of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Pulau Pinang \n\n\n\nCorresponding Author:  Dr. Mohd Baidi Bin Bahari, e-mail: baidi@usm.my \n\n\n\n________________________________________________________________________________________ \n\n\n\nABATRACT \n\n\n\nThis study was carried out to determine the extent to which demographic characteristic and disease variables \n\n\n\nare significantly associated with herbal use. This study was a cross sectional survey conducted by structured \n\n\n\ninterview using a validated questionnaire. The subjects were selected using a convenience sampling of 250 \n\n\n\npatients attending medical wards in Penang Hospital.  Univariate and multivariate analysis were performed to \n\n\n\nexamine the predictors of herbal use. The result found 42.4% of participants (n=106) used herbal medicines, \n\n\n\nwith more than one third used herbs and conventional treatments concomitantly (67.9%).  A total of 76 \n\n\n\npatients (30.4%) used herbal medicines in the past 12 months, and 37 (14.8%) patients had ever been used \n\n\n\nherbs.  Multiple stepwise selection logistic regression modelling identified two significant determinants \n\n\n\n(P<0.05) of herbal use.  These were demographic factor, education attainment and disease variable, kidney \n\n\n\nproblem.   Study findings indicate that patients with higher education attainment are more likely to use herbal \n\n\n\nmedicines.  In contrast, those who suffer from kidney problems are associated with more than three times \n\n\n\ndecreased odds. \n\n\n\nKeywords: Herbal medicine, education, kidney problem, demographics, disease \n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011, pg 325 - 335 \n \n\n\n\n\n\n\n\nINTRODUCTION \n\n\n\nThere is a rapid growing interest in herbal use \n\n\n\nglobally.  The World Health Organization (WHO) \n\n\n\nestimates that 65%-80% of the world's population \n\n\n\nuse traditional medicine as their primary form of \n\n\n\nhealth care.\n1\n  According to WHO, up to 80% of the \n\n\n\npopulation in Africa depends on traditional \n\n\n\nmedicine for primary health care and in China, \n\n\n\nherbal medicines account for 30\u201350% of total \n\n\n\nmedicinal expenditure. On the other hand, more \n\n\n\nthan 50% of the populations have used \n\n\n\ncomplementary or alternative medicine at least \n\n\n\nonce In Europe, North America and other \n\n\n\nindustrialized regions.\n2\n  \n\n\n\nMany studies have reported high rate of herbal use \n\n\n\nin patient population.  In a recent survey \n\n\n\nperformed in a primary care setting in Alabama, \n\n\n\n26% were taking herbal products and the \n\n\n\ncombined rate of herbal and supplement intake \n\n\n\nwas 48%.\n3\n  A cross sectional survey on the use of \n\n\n\ncomplementary therapy by ambulatory patients \n\n\n\nfound that almost half of the patients (48.2%) used \n\n\n\nany vitamins or herbs.  As much as 16.4% of \n\n\n\npatients were using herbal products during the \n\n\n\nstudy, 18.3% within the past year, and 22.3% \n\n\n\never.\n4\n The most commonly used therapies among \n\n\n\nurban emergency department patients documented \n\n\n\nin a small study were massage (31%), \n\n\n\nchiropractory (30%), herbs (24%), and meditation \n\n\n\n(18%).\n5\n Studies in other patient populations have \n\n\n\nalso shown a significant prevalence of herbal \n\n\n\nuse.\n6,7\n\n\n\n Therefore, it is common for patients \n\n\n\nattending mainstream medical care to use herbs.  \n\n\n\nThese studies also supported the complementary \n\n\n\nrole of unorthodox medical therapies in health \n\n\n\npromotion and disease treatment among patient \n\n\n\npopulation. \n\n\n\nAs herbal medicine is a progressively regular form \n\n\n\nof complementary therapy used worldwide, the \n\n\n\n\nmailto:baidi@usm.my\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n326 \n \n\n\n\ncorrelates or predictors of such unconventional \n\n\n\ntherapy among patient population have been of \n\n\n\ngreat interest.  Numerous studies have examined \n\n\n\nthe association between the demographic \n\n\n\npredictors and herbal utilization. Although the \n\n\n\nfindings is not unanimous, some of the consistent \n\n\n\npredictors identified in the literature include being \n\n\n\nfemale \n8,9\n\n\n\n, middle age group (25-49 years) \n10\n\n\n\n, \n\n\n\nhigher education level \n3,11\n\n\n\n , wealthier \n12,13\n\n\n\n, and \n\n\n\nemployed. \n14\n\n\n\n Perceived poorer health status \n12,15\n\n\n\n, \n\n\n\nand chronic health problems \n5,16\n\n\n\n are also potential \n\n\n\ndeterminants of herbal use. \n\n\n\nUtilization of herbal medicines tends to be higher \n\n\n\nin some distinct patient population with specific \n\n\n\nmedical conditions such as cancer \n6, 17\n\n\n\n, arthritis \n18, \n\n\n\n19\n, human immunodeficiency virus (HIV) disease \n\n\n\n20\n, asthma \n\n\n\n7,21\n, and chronic pain \n\n\n\n10,12\n.  Recent \n\n\n\nsurvey reported an overall prevalence for herbal \n\n\n\npreparation use of 13% to 63% among cancer \n\n\n\npatients.\n17\n\n\n\n Asthma patients have long been known \n\n\n\nto use other forms of traditional therapies, \n\n\n\nincluding herbal medicines in addition to \n\n\n\nconventional treatment.  A 1997 UK postal survey \n\n\n\nof 4741 asthmatic patients in an asthma \n\n\n\norganization revealed that the one year prevalence \n\n\n\nof alternative therapy was 11% for herbal \n\n\n\ntherapy.\n22\n\n\n\n Besides, rheumatological problems \n\n\n\nconstituted the greatest percentage of cases being \n\n\n\ntreated by medical practitioners practicing Chinese \n\n\n\ntraditional medicine.\n20\n\n\n\n\n\n\n\nDespite there is well established prevalence \n\n\n\nestimates of herbal use in most developed \n\n\n\ncountries, similar studies in Malaysia are \n\n\n\nparticularly lacking.  Therefore, more information \n\n\n\non predictors of herbal utilization based on a \n\n\n\nrepresentative sample of patient population is \n\n\n\nrequired.  The study focuses on the herbal use \n\n\n\namong secondary care patients as this group of \n\n\n\npatients are usually associated with chronic illness \n\n\n\nand on long term multiple medications, thereby \n\n\n\npredisposing the increased risk of adverse effects \n\n\n\nand drug herb interactions. Information from study \n\n\n\nmay assist in evaluating potential determinants that \n\n\n\ninspire patients to turn to herbal therapies and \n\n\n\nfacilitate the design of future research on herbal \n\n\n\nusage.  Thus, using patient population that \n\n\n\nrepresents ethnic distribution in our society, we \n\n\n\naimed to describe the pattern of herbal utilization \n\n\n\nby multiethnic secondary care patients and \n\n\n\ndetermine the extent to which demographic \n\n\n\ncharacteristic and disease variables increase the \n\n\n\nlikelihood of herbal utilization.  We hypothesized \n\n\n\nthat demographic characteristic as well as presence \n\n\n\nof chronic medical problems are significantly \n\n\n\nassociated with herbal use. \n\n\n\nMETHOD \n\n\n\nSample \n\n\n\nA face to face interview using questionnaire was \n\n\n\ncarried out on patients in medical ward, Penang \n\n\n\nGeneral Hospital.  The study population consists \n\n\n\nof medical patients from cardiology, neurology, \n\n\n\ninfectious and nephrology wards.  A convenience \n\n\n\nsample was selected from all patients attending \n\n\n\nmedical ward, Hospital Pulau Pinang. All eligible \n\n\n\npatients presented during the study period were \n\n\n\nincluded for participation.  Patients were excluded \n\n\n\nif they were below 18 years, pregnant, unable to \n\n\n\ngive consent for any reason, such as having \n\n\n\nneurological problem or language barrier.  A cover \n\n\n\nletter explaining the purpose of the study was \n\n\n\nshown to the patients before the consent was \n\n\n\nobtained.  Participation was voluntary.  \n\n\n\nConcurrently, the medical record was reviewed for \n\n\n\ndemographic information, diagnoses, and \n\n\n\nmedications.  Overall, data were collected on 250 \n\n\n\npatients. \n\n\n\nQuestionnaire \n\n\n\nA questionnaire related to study framework was \n\n\n\ndesigned.  The questionnaire consists of four \n\n\n\nsections.  The first and second part of \n\n\n\nquestionnaire contained questions on demographic \n\n\n\nand socioeconomic background of respondents.  \n\n\n\nThe socio-demographic variables included \n\n\n\nemployment and lifestyle habits (smoking and \n\n\n\nalcohol consumption) in addition to age, gender, \n\n\n\nmarital status, education and income level.  The \n\n\n\nthird section elicits information on perceived \n\n\n\nhealth, current medical illness, drug regimen, \n\n\n\nfamily history and past medical history.  Patients \n\n\n\nwere asked to rate their physical health status, on a \n\n\n\nstandard 5 point Likert scale ranging from \n\n\n\nexcellent to poor.   Respondents were also asked \n\n\n\nwhether they had experienced any of a list of 14 \n\n\n\nhealth related problems within the past year (Table \n\n\n\n2).  The final section consisted of questions on the \n\n\n\nuse of herbal medicines, specifying name and \n\n\n\ndetails of the herbal medicine used.  Patients who \n\n\n\nuse herbal medicine was further classified under \n\n\n\ncurrent herbal user (past 12 months) and previous \n\n\n\nusers (beyond 1 year or ever been used).  Other \n\n\n\ninformations include duration, types of herbs used, \n\n\n\nregistration with Drug Control authority (DCA), \n\n\n\nMalaysia; and reason for their use (treatment of \n\n\n\nacute or chronic illness, health maintenance). \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n327 \n \n\n\n\nDefinition of herbal medicines \n\n\n\nThe terminology used for herbal medicines is non-\n\n\n\nstandard.  Most of the previous studies classify \n\n\n\nherbs under \u201cdietary supplement\u201d which also \n\n\n\nencompasses vitamins, minerals as in accordance \n\n\n\nwith DSHEA 1994 (Dietary Supplement Heath \n\n\n\nand education Act).  However, this study adopted \n\n\n\nthe definition of herbal medicines as stipulated in \n\n\n\nWorld Health Organisation (WHO) guidelines for \n\n\n\nthe appropriate use of herbal medicines in 1998.  \n\n\n\nAccording to the guidelines, herbal medicine is \n\n\n\ndefined as \u201cplant derived materials or products \n\n\n\nwith therapeutic or other human health benefits \n\n\n\nwhich contain either raw or processed ingredients \n\n\n\nfrom one or more plants\u201d.  Under this definition, \n\n\n\nthere are three kinds of herbal medicines, raw, \n\n\n\nprocessed plant materials and medicinal herbal \n\n\n\nproducts.  Raw plant material is defined as fresh or \n\n\n\ndry plant materials which are marketed whole or \n\n\n\nsimply cut into small pieces.   Processed plant \n\n\n\nmaterial is defined as plant materials treated \n\n\n\naccording to traditional procedures to improve \n\n\n\ntheir safety and efficacy, to facilitate their clinical \n\n\n\nuse, or to make medicinal preparations.  Medicinal \n\n\n\nherbal products is defined as finished, labelled \n\n\n\npharmaceutical products in dosage forms that \n\n\n\ncontain one or more of the following: powdered \n\n\n\nplant materials, extracts, purified extracts, or \n\n\n\npartially purified active substances isolated from \n\n\n\nplant materials.  Medicines containing plant \n\n\n\nmaterial combined with chemically defined active \n\n\n\nsubstances, including chemically defined, isolated \n\n\n\nconstituents of plants, are not considered to be \n\n\n\nherbal medicines. \n\n\n\nData analysis \n\n\n\nData were analyzed using the Statistical Package \n\n\n\nfor Social Sciences SPSS version 15.0.  \n\n\n\nDescriptive statistics were used to determine the \n\n\n\nprevalence of herbal use.  Pearson\u2019s Chi-square \n\n\n\ntest, and where necessary Fisher\u2019s exact test were \n\n\n\nused to determine the association between herbal \n\n\n\nuse and each of the independent variables related \n\n\n\nto demographic and medical/disease \n\n\n\ncharacteristics; a p value of \u2264 0.05 was considered \n\n\n\nto be statistically significant.  All tests were two \n\n\n\ntailed.  Variables found to be significantly \n\n\n\nassociated with herbal use on univariate analysis \n\n\n\nwere added in a   forward stepwise selection to \n\n\n\nconstruct the final model of predictor variables.\n23 \n\n\n\n\n\n\n\nFinally, the logistic model, which gives the \n\n\n\nprobability that the outcome (herbal use) occurs as \n\n\n\nan exponential function of the independent \n\n\n\nvariables (socio-demographic factors) will be \n\n\n\nderived.  Spearman rank correlation coefficient \n\n\n\nwas obtained in order to measure how strongly two \n\n\n\nindependent variables are related to one another.  \n\n\n\nRESULT \n\n\n\nDescriptive statistics \n\n\n\nThe final study population comprised 127 women \n\n\n\n(50.8%) and 123 men (49.2%).  The mean age was \n\n\n\n52.7 years (SD, 15.05; range, 18-86).  Malay \n\n\n\npatients made up 42.4% of respondents, followed \n\n\n\nby Chinese (34%), Indian (22.4%) and others \n\n\n\n(1.2%).  More than half of the patients\u2019 age fell \n\n\n\ninto age group 35-59 years (52.8%).  About 48.8 \n\n\n\n% of participants had education below secondary \n\n\n\nlevel and 61.6% reported to have a gross \n\n\n\nhousehold income in the lowest category (< \n\n\n\nRM1000).  Most of the patients were unemployed \n\n\n\n(58%) and for those who are employed, 62.5% \n\n\n\njoined private sector.    Table 1 summarizes socio-\n\n\n\ndemographic characteristics of the subjects \n\n\n\nincluded in the analysis. \n\n\n\nSocio-demographic characteristic and herbal use \n\n\n\nIn this study, almost half of the patients (42.4%, \n\n\n\nn=106) reported using herbs, predominantly men \n\n\n\n(47.2%).  More than one third used herbs and \n\n\n\nconventional treatments concomitantly (67.9%).  \n\n\n\nThe 12 months prevalence of herbal use was \n\n\n\n30.4% as compared to 14.8% of patients who had \n\n\n\never used it.  The proportions of herbal users \n\n\n\nvaried across ethnic group, with Chinese reported \n\n\n\nthe highest rate of herbal use (47.1%), followed by \n\n\n\nMalay (45.3%), and Indian (32.1%).  Patients in \n\n\n\nthe age group of 35-59 years were found to be \n\n\n\nmajor user of herbal medicines (47%).  Marital \n\n\n\nstatus and employment had no effect on herbal \n\n\n\nuse.  A substantially higher percentage of patients \n\n\n\nwith higher income level (> RM 3000) used herbal \n\n\n\nmedicines, as compared to lower income group, \n\n\n\nwith 72.7% and 41% respectively (not shown in \n\n\n\ndata).  However, lifestyle habit such as smoking \n\n\n\nand alcohol consumption had no significant effect \n\n\n\non herbal use (Table 1). \n\n\n\nMedical/ disease variables and herbal use \n\n\n\nTable 2 shows medical/disease variables \n\n\n\nassociated with herbal use.  The 5 most commonly \n\n\n\ncited medical problems were hypertension \n\n\n\n(60.8%); cardiovascular problems (55.2%); \n\n\n\ndiabetes mellitus (42.4%); kidney problems (26%); \n\n\n\nand infection (12.8%).  In this study, the \n\n\n\npercentage of herbal user was found to be higher \n\n\n\nin patients with the following medical illnesses: \n\n\n\nthyroid problem (83.3%), arthritis (70.6%), \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n328 \n \n\n\n\nchronic lung disease (66.7%), infection (53.1%), \n\n\n\ncancer (50%), and cardiovascular problems \n\n\n\n(47.1%).  On the other hand, 65.2% of patients \n\n\n\nhave family history of illness; and 88.4% of \n\n\n\npatients have past medical history.  However, \n\n\n\nneither family history of illness nor past medical \n\n\n\nhistory was associated with higher use of herbal \n\n\n\nmedicine.  In total, 74.4% of patients assessed \n\n\n\ntheir health as poor. A higher proportion of \n\n\n\npatients reported very poor and poor perceived \n\n\n\nhealth (44.7%) than of patients with fair or good \n\n\n\nuse herbal medicine.   \n\n\n\nUnivariate statistics \n\n\n\nUnivariate analysis showed that use of herbal \n\n\n\nmedicine correlated positively with \n\n\n\nsociodemographic characteristic such as education \n\n\n\n(p=0.002), income level (p=0.021) and smoking \n\n\n\nstatus (p=0.043).  Medical or disease variables that \n\n\n\nsignificantly associated with herbal use were \n\n\n\narthritis (p=0.029) and kidney problems \n\n\n\n(P=0.003).  The results of univariate analysis are \n\n\n\nshown in Table 3 (a) and (b). \n\n\n\n\n\n\n\nTable 1   Descriptive characteristics of the study population \n\n\n\nVariable No of patient (%) User (%) Non-user (%) \n    \n\n\n\nGender    \n\n\n\n         Male 123 (49.2) 58 (47.2) 65 (52.8) \n         Female 127 (50.8) 48 (37.8) 79 (62.2) \nAge (years)    \n          18-34 32 (12.8) 12 (37.5) 20 (62.5) \n          35-59 132 (52.8) 62 (47.0) 70 (53.0) \n          60-88 86 (34.4) 32 (37.2) 54 (62.8) \nEthnic/ race    \n          Malay 106 (42.4) 48 (45.3) 58 (54.7) \n          Chinese 85 (34.0) 40 (47.1) 45 (52.9) \n          Indian 56 (22.4) 18 (32.1) 38 (67.9) \n          Others 3 ( 1.2) 0 (0) 3 (100) \nReligion    \n          Islam 107(42.8) 49 (45.8) 58 (54.2) \n          Buddhist 83 (33.2) 39 (47.0) 44 (53.0) \n          Hinduism 56 (22.4) 18 (32.1) 38 (67.9) \n          Christianity 1 (0.4) 0 (0) 1(100) \n          Others 3 (1.2) 0 (0) 3 (100) \nMarital status    \n          Single 32 (12.8) 11 (34.4) 21 (65.6) \n          Married 215 (86.0) 93 (43.3) 122 (56.7) \n          Divorced 3 (1.2) 2 (66.7) 1(33.3) \nWorking status    \n          Working  79 (31.6) 35 (44.3) 44(55.7) \n          Not working 145 (58.0) 55 (37.9) 90 (62.1) \n          Retired 26 (10.4) 16 (61.5) 10 (38.5) \nEmployment    \n          Private 50 (62.5) 21(42.0) 29 (58.0) \n          Self-employed 8 (10.0) 5 (62.5) 3 (37.5) \n          Government 22 (27.5) 10 (45.5) 12 (54.5) \nIncome (monthly)    \n          <RM 1000 154 ( 61.6) 56 (36.4) 98 (63.6) \n          RM 1000-3000 85 (34.0) 42 (49.4) 43 (50.6) \n          RM 3000-5000 9 (3.6) 7 (77.8) 2 (22.2) \n          >RM 5000 2 (0.8) 1 (50.0) 1(50.0) \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n329 \n \n\n\n\nEducation level    \n          None 29 (11.6) 7 (24.1) 22 (75.9) \n          Primary 93 (37.2) 30 (32.3) 63 (67.7) \n          Secondary 104 (41.6) 56 (53.8) 48 (46.2) \n          Tertiary 24 (9.6) 13 (54.2) 11(45.8) \nSmoking    \n         Never 159 (63.6) 58 (36.5) 101(63.5) \n         Former 72 (28.8) 38 (52.8) 34 (47.2) \n        Current 19 (7.6) 10 (52.6) 9 (47.4) \nAlcohol    \n        Never 190 (76.0) 77 (40.5) 113 (59.5) \n        Former 47 (18.8) 26 (53.1) 21(46.9) \n        Current 13 (5.2) 3 (23.1) 10 (76.9) \nFamily History of Illness    \n         Yes 163 (65.2) 72 (44.2) 91 (55.8) \n         No 69 (27.6) 28 (40.6) 41 (59.4) \n         Unknown 18 (7.2) 6 (33.3) 12 (66.7) \nPast Medical History    \n          Yes 221 (88.4) 90 (40.7) 131 (59.3) \n          No 29 (11.6) 16 (55.2) 13 (44.8) \nDrug Allergy    \n          Yes 35 (14) 17 (48.6) 18 (51.4) \n          No 214 (85.6) 89 (41.6) 125 (58.4) \nPerceived Health    \n         Very poor 4 (1.6) 3 (75.0) 1 (25.0) \n         Poor 186 (74.4) 82 (44.1) 104 (55.9) \n         Fair 51(20.4) 18 (35.3) 33 (64.7) \n         Good \n \n\n\n\n9 (3.6) \n \n\n\n\n3 (33.3) \n \n\n\n\n6 (66.7) \n \n\n\n\n\n\n\n\n\n\n\n\nTo ascertain which of the demographic/ disease \n\n\n\nvariables were independently related to herbal use \n\n\n\namong medical patients, a logistic regression was \n\n\n\nconducted.  Each of these variables was dummy \n\n\n\ncoded and used as independent variables.   \n\n\n\nMultiple logistic regression model \n\n\n\nMultiple stepwise selection logistic regression \n\n\n\nmodelling resulted in the final selection of two \n\n\n\nsignificant determinants (p<0.05) of herbal use \n\n\n\namong medical patients.  These were: (i) education \n\n\n\nattainment (OR 4.06; 95% CI 1.47-11.26) and; (ii) \n\n\n\nkidney problem (OR 0.35; 95% CI 0.18-0.69).  \n\n\n\nElements strongly associated with herbal use on \n\n\n\nunivariate analysis such as income level, smoking \n\n\n\nstatus, and arthritis problem were no longer \n\n\n\nassociated with herbal use when controlled for \n\n\n\nother variables.  Table 4 indicates the adjusted \n\n\n\nodds ratios and 95% confidence intervals for the \n\n\n\nindependent variables that emerged as significant \n\n\n\npredictors. \n\n\n\nOn the other hand, the relationship between age \n\n\n\ngroups, income level, education and perceived \n\n\n\nhealth were investigated using Spearman rank \n\n\n\ncorrelation coefficient.  There was a weak, \n\n\n\nnegative correlation between age groups and \n\n\n\nincome level as well as education level (r= -0.227; \n\n\n\np<0.01 and r= -0.152; p<0.05 respectively).  \n\n\n\nSimilar observation was found between education \n\n\n\nand income level except there was a positive \n\n\n\ncorrelation between these two variables (r= 0.173; \n\n\n\np<0.01).  Table 5 presents the intercorrelations of \n\n\n\nhypothesized predictor variables and use of herbal \n\n\n\nmedicine. \n\n\n\nDISCUSSION \n\n\n\nHerbal use in survey sample was high and \n\n\n\ngenerally consistent with the western population.\n3, \n\n\n\n4\n The higher usage of herbal medicine in middle \n\n\n\naged patients reported in other studies is in \n\n\n\nagreement with our results.\n11, 14\n\n\n\n Unlike previous \n\n\n\nfindings \n8,9 \n\n\n\n, male patients were the predominant \n\n\n\nuser of herbal medicine in this study. Possible \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n330 \n \n\n\n\nexplanation for this discrepancy lies in the \n\n\n\nadoption of \u201cdietary supplement\u201d definition in \n\n\n\nprior studies, which also includes vitamins, herbs \n\n\n\nand functional food. Nevertheless, when the \n\n\n\ninfluences of all possible confounders were \n\n\n\nadjusted, gender was no longer related to an \n\n\n\nincreased use of herbal medicines.   \n\n\n\n\n\n\n\nTable 2   Medical /disease variables with herbal use \n\n\n\nVariables \n \n\n\n\nNo of patient  \n(%) \n\n\n\n              Herbal User \nDisease No Disease \n\n\n\nCurrent Medical Illness    \n\n\n\n          Thyroid problem 6 (2.4) 5  (83.3) 101 (41.4) \n          Arthritis  17 (6.8) 12 (70.6) 94 (40.3) \n          Chronic lung disease 9 (3.6) 6  (66.7) 100 (41.5) \n          Infection 32 (12.8) 17 (53.1) 89 (40.8) \n          Cancer 6 (2.4) 3  (50.0) 103 (42.2) \n          Cardiovascular 138 (55.2) 65 (47.1) 41 (36.6) \n          GI problem 20 (8) 9  (45.0) 97 (42.2) \n          Asthma 14 (5.6) 6  (42.9) 100 (42.4) \n          Hypertension 152 (60.8) 61 (40.1) 45 (45.9) \n          Neurological problem 13 (5.2) 5  (38.5) 101 (42.6) \n         Systemic Lupus  \n         Erythematous (SLE) \n\n\n\n11 (4.4) \n \n\n\n\n4  (36.4) \n \n\n\n\n102 (42.7) \n \n\n\n\n          Diabetes Mellitus 106 (42.4) 38 (35.8) 68 (47.2) \n          Kidney problem 65 (26.0) 17 (26.2) 89 (48.1) \n          Skin problem \n \n\n\n\n1 (0.4) \n \n\n\n\n0 (0) \n \n\n\n\n106 (42.6) \n \n\n\n\n\n\n\n\nAmong ethnic group, Chinese reported with higher \n\n\n\nrate of herbal use, which is in agreement with prior \n\n\n\nresearch.\n7\n The popularity of traditional medicine \n\n\n\namong Chinese remains undiminished despite the \n\n\n\nrapid modernization of mainstream medical care.  \n\n\n\nHerbal use has also been related to various health \n\n\n\nrelated behaviour pattern.  Former smokers and \n\n\n\ndrinkers used herbal medicine to a greater extent \n\n\n\nthan non-smokers as well as non-drinkers, which is \n\n\n\nin contrast to previously reported by Gregar.\n24\n\n\n\n\n\n\n\nHowever, when all the possible confounders were \n\n\n\ntaken into consideration, there was no significant \n\n\n\neffect on the outcome variables. \n\n\n\n\n\n\n\nMost common medical illness correlated with the \n\n\n\nherbal use in this study was thyroid problem, \n\n\n\nwhich is contrary to other reports.\n12, 19\n\n\n\n\n\n\n\nNonetheless, study has found that a large \n\n\n\npercentage of patients with arthritis, chronic lung \n\n\n\ndisease, and cancer used herbal medicines, which \n\n\n\ncorresponds well to other findings.\n17, 18, 25\n\n\n\n People \n\n\n\nwho resort to alternative treatment usually have \n\n\n\nchronic conditions for which modern medicines \n\n\n\nand synthetic drugs have failed to provide a \n\n\n\nsatisfactory solution.  Poor prognosis in cancer \n\n\n\n(paltiel 2001) and alleged non noxious effects of \n\n\n\nherbal medicine versus toxic chemotherapy \n\n\n\nregimen may create demands for natural \n\n\n\nsupplements including herbs.  Research indicated \n\n\n\nthat patient with arthritis are more likely to explore \n\n\n\nalternative medicine in coping with this \n\n\n\ndevastating disease, with an estimated 60-90% of \n\n\n\npersons with arthritis use complementary \n\n\n\ntherapy.\n26\n\n\n\n\n\n\n\nFrom the study, we did not observe any \n\n\n\nstatistically significant socio-demographic factors \n\n\n\nassociated with the herbal use except higher \n\n\n\neducation level.  This may be attributed to low \n\n\n\nsocioeconomic diversity within the study sample \n\n\n\nand resulting low variability among the \n\n\n\ndemographic variables. Based on the results from \n\n\n\nthe multiple logistic regressions, education \n\n\n\nemerged as an important predictor of herbal use.  \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n331 \n \n\n\n\nUnlike other Asian countries \n27, 28\n\n\n\n, education that \n\n\n\npredicted the use of herbal medicine is in basic \n\n\n\nagreement with that reported in Western countries \n8, 9\n\n\n\n but the new finding in this study is the kidney \n\n\n\nproblem, which requires further investigation.  \n\n\n\nEducation may enhance the chances that people \n\n\n\nexposed to diverse unconventional therapies, either \n\n\n\nby advertising media or personal reading of \n\n\n\nrelevant books.  However, a controversial saying is \n\n\n\nthat patients with lower education background are \n\n\n\nmore culture-bound \n28\n\n\n\n and less aware of the \n\n\n\nimportance of evidence based information, thus \n\n\n\nmore likely to conform to alternative therapy. \n\n\n\n\n\n\n\nTable 3(a)   Univariate analysis of factors associated with herbal use amongst                     \n\n\n\nmultiethnic secondary care patients (socio-demographic) \n\n\n\n\n\n\n\nVariables Total  Herbal Use, n (%) P-value \n\n\n\n\n\n\n\nGender    \n       Male 123 58 (47.2) 0.171 \n       Female 127 48 (37.8)  \nAge    \n       18-34 32 12 (37.5) 0.302 \n       35-59 132 62 (47.0)  \n       60-88 86 32 (37.2)  \nMarital status    \n       Single/divorced 35 13 (37.1) 0.621 \n       Married 215 93 (91.2)  \nEthnic     \n       Malay 106 48 (45.3) 0.442 \n       Chinese 85 40 (47.1)  \n       Indian  56 18 (32.1)  \nWorking status    \n       Working  79 35 (44.3) 0.074 \n       Not working 145 55 (37.9)  \n       Retired 26 16 (61.5)  \nEmployment    \n      Private 50 21 (42) 0.556 \n      Self-employed 8 5 (62.5)  \n      Government 22 10 (45.5)  \nIncome level    \n      \u2264 RM1000 154 56 (36.4) 0.021 \n      > RM1000 96 50 (52.1)  \nEducation    \n      None 29 7 (24.1) 0.002 \n      Primary 93 30 (32.3)  \n      Secondary 104 56 (53.8)  \n      Tertiary 24 13 (54.2)  \nSmoking status    \n     Never 159 58 (36.5) 0.043 \n     Former 72 38 (52.8)  \n     Current 19 10 (52.6)  \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n332 \n \n\n\n\nAlcohol status    \n     Never 190 77 (40.5) 0.065 \n     Former 47 26 (55.3)  \n     Current 13 3 (23.1)  \nSelf Perceived Health    \n     Very poor/ Poor 190 85 (44.7) 0.238 \n     Fair/ Good \n \n\n\n\n60 \n \n\n\n\n21 (35) \n  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nTable 3(b)    Univariate analysis of factors associated with herbal use amongst                    \n\n\n\nmultiethnic secondary care patients (disease/ current illness) \n\n\n\n\n\n\n\nVariables Total  Herbal Use, n (%)  P-value \n\n\n\n\n\n\n\n          Thyroid problem 6 5  (83.3) 0.086 \n          Arthritis  17 12 (70.6) 0.029 \n          Chronic lung disease 9 6  (66.7) 0.174 \n          Infection 32 17 (53.1) 0.261 \n          Cancer 6 3  (50.0) 0.7 \n          Cardiovascular 138 65 (47.1) 0.123 \n          GI problem 20 9  (45.0) 0.992 \n          Asthma 14 6  (42.9) 1 \n          Hypertension 152 61 (40.1) 0.44 \n          Neurological problem 13 5  (38.5) 0.994 \n         Systemic Lupus  \n         Erythematous (SLE) \n\n\n\n11 \n \n\n\n\n4  (36.4) \n \n\n\n\n0.764 \n \n\n\n\n          Diabetes Mellitus 106 38 (35.8) 0.095 \n          Kidney problem 65 17 (26.2) 0.003 \n          Skin problem \n \n\n\n\n1 \n \n\n\n\n0 (0) \n \n\n\n\n1 \n \n\n\n\n\n\n\n\nTable 4   Significant Predictors in the Multiple Logistic Regression (p<0.05) \n\n\n\nVariable    OR 95% CI     P -value \n\n\n\n\n\n\n\nEducation *   4.06 1.47-11.23      0.007 \n\n\n\nKidney problem \u2020   0.35 0.18-0.69       0.002 \n\n\n\n\n\n\n\nOR: Odds ratio; CI: confidence interval \n*Coded on a 4 point Likert scale \n\n\n\n\u2020Coded as dichotomous variable  \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n333 \n \n\n\n\n\n\n\n\n\n\n\n\nTable 5   Intercorrelations of hypothesized predictor variables and use of herbal medicine \n\n\n\nVariables \n\n\n\n\n\n\n\n1 2 3 4 \n\n\n\nAge groups \u2026    \n\n\n\nIncome level -0.227 *  \u2026   \n\n\n\nEducation level -0.152 \u2020 0.173 * \u2026  \n\n\n\nPerceived health -0.057 0.076 0.039 \u2026 \n\n\n\n\n\n\n\n\n\n\n\n* Correlation is significant at the .01 level (2-tailed) \n\n\n\n\u2020 Correlation is significant at the .05 level (2-tailed). \n\n\n\n\n\n\n\nOur study found an intriguing determinant of \n\n\n\nherbal disuse, which is kidney problem.  Patient \n\n\n\nwith kidney problem was three times less likely to \n\n\n\nuse herbal medicine.  The hypothesized \n\n\n\nexplanation is that patient with failing kidney \n\n\n\nfunction would not take the risk of more exposure \n\n\n\nto herbs as the \u201ctoxin-filtrating\u201d properties of \n\n\n\nkidney is well acknowledged.\n29\n\n\n\n This is further \n\n\n\nvalidated by the intrinsic functioning or properties \n\n\n\nof kidney, where active uptake by tubular cells and \n\n\n\nhigh concentration in the medullary region \n\n\n\nincreased the risk of kidney injury.\n30\n\n\n\n  Repetitive \n\n\n\nstringent warnings by clinicians against using any \n\n\n\nmedications other than those prescribed may also \n\n\n\naccount for decreased likelihood of herbal use.   \n\n\n\nVarious renal syndromes were reported after the \n\n\n\nuse of medicinal plants, including tubular necrosis, \n\n\n\nacute interstitial nephritis, hypertension, papillary \n\n\n\nnecrosis, and nephrolithiasis.\n30\n\n\n\n This alarming rate \n\n\n\nof published data on damaging effect of herbal \n\n\n\nextracts to kidney may in turn discourage the use \n\n\n\nof herbal medicines.  For example, the \n\n\n\nmineralcorticoid activity of licorice (Glycyrrhiza \n\n\n\nglabra) is manifested as headache, sodium and \n\n\n\nwater retention, hypokalemia, metabolic alkalosis, \n\n\n\nhypertension, heart failure, and suppression of the \n\n\n\nrenin-aldosterone system.\n30\n\n\n\n Many products contain \n\n\n\nsubstantial amount of glycyrrhizic acid; namely, \n\n\n\nhealth products (herbal cough mixtures, licorice \n\n\n\ntea, licorice root).\n31\n\n\n\n This compound can be found \n\n\n\nin 74% of Chinese herbal teas. \n32 \n\n\n\n\n\n\n\nHerbal medicine also may be hazardous for renal \n\n\n\npatients because of potential drug herb \n\n\n\ninteractions.  For example, the immunostimulating \n\n\n\neffect of Echinacea (Echinacea angustifolia), and \n\n\n\nlicorice (Glycyrrhiza glabra), may offset the \n\n\n\nimmunosuppressive effect of cyclosporine, a \n\n\n\ncommonly use drug in kidney transplant .\n33\n\n\n\n  This is \n\n\n\nparticularly important in our study as majority of \n\n\n\nthe kidney patients in our study sample suffered \n\n\n\nfrom end stage renal failure and awaiting for \n\n\n\nkidney transplant.  In addition, the effect of \n\n\n\ncyclosporine will be reduced if co administered \n\n\n\nwith St John\u2019s Wort (Hypericum perforatum), a \n\n\n\npotential inducer of liver enzymes as these two \n\n\n\nelements share the common metabolic pathway.\n34\n\n\n\n\n\n\n\nThe need for nephrologists and other caregivers to \n\n\n\nelicit information of herbal use among patients is \n\n\n\nwarranted despite the low frequency of herbal use \n\n\n\nin kidney patients verified in our study. \n\n\n\nCONCLUSION \n\n\n\nOur study results indicate that there is no single \n\n\n\ndeterminant of the present popularity of herbal \n\n\n\nmedicines exists.   Higher education level and \n\n\n\nkidney problems were significantly correlated with \n\n\n\nherbal utilization among secondary care patients \n\n\n\nwhen the influences of socio-demographic \n\n\n\ncharacteristic were adjusted.  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The Measurement Group and HRSA/HAB\u2019s SPNS Cooperative Agreement \n\n\n\nSteeringCommittee Module 26B: CES-D8 Form (Availableat www.TheMeasurementGroup.com. \n\n\n\nCulver City, California). \n\n\n\n28. Lee GBW, Charn TC, Chew ZH, Ng TP.  (2004) Complementary and alternative medicine use in \n\n\n\npatients with chronic diseases in primary care is associated with perceived quality of care and cultural \n\n\n\nbeliefs. Family Practice; 21: 654-660 \n\n\n\n29. Rang HP, Dale MM, Ritter JM. (1996) Pharmacology, General principles: absorption, distribution and \n\n\n\nfate of drugs, 3\nrd\n\n\n\n edn. Churchill,:pp 87-90  \n\n\n\n30. Bagnis CI, Deray G, Baumelou A et al. (Dis 2004) Herbs and the Kidney. Am J Kidney; 44: 1-11. \n\n\n\n31. De Klerk GJ, Nieuwenhuis MG, Beutler J (1997) Lesson of the week: Hypokalaemia and \n\n\n\nhypertension associated with the use of liquorice flavored chewing gum. BMJ 314:731-735  \n\n\n\n32. Winslow LC, Kroll DJ (1998) Herbs as medicines. 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(1996) Patterns of alternative medicine use by cancer patients. \n\n\n\nMed J Aust;165:545-548 \n\n\n\n39. Cassileth BR, Deng G. (2004) Complementary and Alternative Therapies for Cancer. Oncologist; 9: \n\n\n\n80-89. \n\n\n\n40. De Jong N, Ocke MC, Branderhorst H et al. (2003) Demographic and lifestyle characteristics of \n\n\n\nfunctional food consumers and dietary supplement users. Br J Nutrition; 89: 273-281.\\ \n\n\n\n41. Eisenberg DM. (1997) Advising Patients Who Seek Alternative Medical Therapies. Ann Intern Med; \n\n\n\n127(1): 61-69. \n\n\n\n42. Gy\u00f6rik SA and Brutsche MH. (2003) Complementary and alternative medicine for bronchial asthma: \n\n\n\nis there new evidence? Curr Opin Pulm Med; 10: 37\u201343 \n\n\n\n43. Kessler RC, Davis RB, Foster DF et al. (2001) Long-Term Trends in the Use of Complementary and \n\n\n\nAlternative Medical Therapies in the United States. Ann Intern Med; 135: 262-268. \n\n\n\n44. Kuo GM, Hawley ST, Weiss LT et al. (2004) Factors associated with herbal use among urban \n\n\n\nmultiethnic primary care patients: a cross-sectional survey. BMC Complementary Alternative \n\n\n\nMedicine; 4:18. \n\n\n\n45. WHO. Traditional Medicine \u2013 Growing Needs and Potential. WHO Policy Perspective on Medicine \n\n\n\nNo.2 May 2002. WHO, Geneva. \n\n\n\n46. Wojcikowski K, Johnson DW, Gobe G. (2004) Medicinal herbal extracts \u2013 renal friend or foe? Part \n\n\n\ntwo: Herbal extracts with potential renal benefits. Nephrology; 9: 400-405. \n\n\n\n47. Zollman C, Vickers A. (1999) ABC of complementary medicine: What is complementary medicine? \n\n\n\nBMJ; 319: 693-696. \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n336 \n \n\n\n\nCalculated 10 Years Risk of CHD: Primary Preventive Measures in Medical Ward PPUKM \n\n\n\n(University Kebangsaan Malaysia Medical Centre) \n\n\n\nSemira Abdi Beshir \n1\n, Rosnani Hashim\n\n\n\n1 \n\n\n\n\n\n\n\nDepartment of Clinical Pharmacy, Faculty of Pharmacy, Cyberjaya University College of Medical Sciences. \n\n\n\n\n\n\n\nCorresponding Author: Mrs.Semira Abdi, email semiraabdi@gmail.com \n\n\n\n\n\n\n\nABSTRACT \n\n\n\nCoronary heart disease (CHD) is the leading cause of morbidity and mortality globally. Identification of \n\n\n\ncommon risk factors and risk stratification helps to prioritize primary preventive measures and hence can \n\n\n\nreduce this epidemic. This retrospective cross sectional study was carried out to assess the primary preventive \n\n\n\nmeasures according to 10 years CHD risk stratification. One hundred thirty (67 female and 63 female) middle \n\n\n\naged (40-65 years) patients admitted to PPUKM\u2019s medical ward with no prior diagnosis of CHD were \n\n\n\nselected. Patient diagnosed with diabetes or hypertension related to pregnancy was excluded. The patients\u2019 \n\n\n\nmedical record and order management system (OMS) were screened to obtain relevant demographic \n\n\n\ninformation, medical and medication history and related laboratory results. The Joint British Societies CHD \n\n\n\nrisk prediction chart was used to calculate the 10 years CHD risk. Gender specific differences of 10 years \n\n\n\ncalculated CHD risk, baseline measure of BP, cholesterol, weight, BMI, HbA1C level and number of patients \n\n\n\nwho received primary preventive measures were used as outcome measures. Results showed that male patients \n\n\n\nhad a significantly higher 10 years CHD risk than female (P < 0.05). Hypertension was the most prevalent risk \n\n\n\nfactor followed by diabetes and dyslipidemia. About10% (n=6) of hypertensive patients with SBP\u2265160 mmHg \n\n\n\nand 32 (37%) diabetic patients did not receive antihypertensive therapy and lipid lowering therapy \n\n\n\nrespectively. Hence, there is a need for further improvement in primary preventive measures for CHD. \n\n\n\n\n\n\n\nKey words: Coronary heart disease, risk factors, primary prevention, Joint British Risk prediction chart, 10 \n\n\n\nyears CHD risk  \n\n\n\n Malaysian Journal of Pharmacy  Vol. 1 issue 9, 2011, pg 336 - 344 \n\n\n\n\n\n\n\n\n\n\n\nINTRODUCTION \n\n\n\n\n\n\n\nCHD is the principal cause of morbidity and \n\n\n\nmortality in many countries world-wide. WHO \n\n\n\n(2001) estimated that by the year 2020, it will be \n\n\n\nthe single largest cause of disease burden globally. \n\n\n\nAccording to department of statistics of Malaysia, \n\n\n\nCHD is among the three leading cause of \n\n\n\nmedically certified death in Malaysia. National \n\n\n\nheart association of Malaysia (2009) estimated that \n\n\n\nCHD afflicted 141 persons/100,000 populations \n\n\n\neach year.  \n\n\n\n\n\n\n\nRisk factors for CHD which are defined and \n\n\n\nconfirmed by the Framingham study conducted by \n\n\n\nGordon et al. (1977) and other interventional trials \n\n\n\ninclude, male gender, advanced age, family history \n\n\n\nof early heart disease, cigarette smoking, high \n\n\n\nblood pressure, high blood cholesterol, being \n\n\n\noverweight, physical inactivity, and diabetes. \n\n\n\nHowever, these studies were conducted \n\n\n\npredominantly on Caucasian and migrant Asian \n\n\n\npopulations. Recently there is a growing interest to \n\n\n\nexamine the impact and role of established risk \n\n\n\nfactors of CHD on Asian population in times of \n\n\n\neconomic advancement and modernization in Asia \n\n\n\n(Jeannette et al 2001).\n \n\n\n\nGlobal risk assessment is an approach to CHD \n\n\n\nprevention that estimates the absolute risk based \n\n\n\non the summation of risks contributed by each risk \n\n\n\nfactor. The risk factors do not add their effects in a \n\n\n\nsimple way. Rather, they multiply each other's \n\n\n\neffects. Although not all risk factors are \n\n\n\nmodifiable, all can contribute to the risk \n\n\n\nassessment, and the intensity of risk factor \n\n\n\nmanagement can be adjusted according to the \n\n\n\nseverity of the overall risk. \n\n\n\n\n\n\n\nPrimary prevention of CHD requires modification \n\n\n\nof risk factors or prevention of their development \n\n\n\nwith the aim of delaying or preventing new-onset \n\n\n\nCHD.  The National Cholesterol Education Program \n\n\n\n\nmailto:semiraabdi@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n337 \n \n\n\n\nAdult Treatment Panel guidelines (NCEP ATP III) \n\n\n\nprovide recommendations for CHD prevention, \n\n\n\nfocusing on lipid lowering by adjusting the\n \nintensity \n\n\n\nof cholesterol lowering therapy with absolute risk. \n\n\n\nAs indicated in the report by joint national \n\n\n\ncommittee (1993), the National High Blood \n\n\n\nPressure Education Program (NHBPEP) has set \n\n\n\nforth a parallel approach for blood pressure control. \n\n\n\nIn contrast to the NCEP, however, earlier NHBPEP \n\n\n\nreports did not match the intensity of therapy to \n\n\n\nabsolute risk for CHD. \"Normalization\" of blood \n\n\n\npressure is the essential goal of therapy regardless \n\n\n\nof risk status. \n\n\n\n\n\n\n\nThis study was set to determine the occurrence of \n\n\n\ncommon risk factors and global assessment of \n\n\n\nthese risk factors to examine the extent of primary \n\n\n\npreventive measures based on the risk stratification \n\n\n\nand furthermore, it looked into the trends of \n\n\n\nprescribing for antihypertensive and lipid lowering \n\n\n\nagents for primary prevention of CHD. \n\n\n\n\n\n\n\nMETHODS \n\n\n\n\n\n\n\nThis is a retrospective, cross-sectional survey that \n\n\n\nincluded conveniently sampled participants \n\n\n\nadmitted to medical ward of PPUKM between the \n\n\n\nyear 2007 and 2008.  Patients\u2019 information about \n\n\n\ntheir age, sex, race, medical condition, medication \n\n\n\nhistory and related laboratory results were \n\n\n\nobtained from patients\u2019 medical record and the \n\n\n\norder management system (OMS). \n\n\n\n\n\n\n\nThe study utilized the Joint British Societies (JBS) \n\n\n\nCHD risk prediction charts to calculate the 10 \n\n\n\nyears CHD risk. The British risk prediction chart is \n\n\n\nsuperior to other risk assessment methods because \n\n\n\nit directly plots the Framingham function for a \n\n\n\ngiven level of absolute CHD risk resulting in more \n\n\n\naccurate value. Furthermore, this method \n\n\n\nrepresents the Framingham data more \n\n\n\nappropriately than other charts since it stratifies the \n\n\n\nCHD risk into three categories (<15% (green \n\n\n\nband), 15-30% (orange band) and >30% (red \n\n\n\nband)). \n\n\n\n\n\n\n\nThe study included patients between 40 and 65 \n\n\n\nyears of age without a prior diagnosis of CHD. \n\n\n\nThe patients < 40 years of age are not recruited for \n\n\n\nthe study since JBS cannot be used to accurately \n\n\n\npredict the CHD risk in this age group. Patients \n\n\n\nwith diabetes or hypertension related to pregnancy \n\n\n\nare excluded. Missing values were considered as \n\n\n\nabsent (zero). Subjects were considered smokers if \n\n\n\nthey were reported as smokers regardless of the \n\n\n\nnumber of cigarettes they smoke daily and they are \n\n\n\nconsidered as previous smokers if they stopped \n\n\n\nsmoking for at least 6 months (Larabie 2005). \n\n\n\n\n\n\n\nHypercholesterolemia is defined according to the \n\n\n\ncategories indicated on the NCEP ATPIII \n\n\n\nguidelines. Patients having \u2265 30 kg/m\n2\n body mass\n\n\n\n\n\n\n\nindex (BMI) were considered obese. Respondents \n\n\n\nwere considered to have diabetes if they were \n\n\n\nreported to be diagnosed with diabetes in past year, \n\n\n\nor have a blood sugar level greater than or equal to \n\n\n\n126 mg/dL or if were prescribed with oral \n\n\n\nhypoglycaemic agent or insulin. Hypertension was \n\n\n\nconsidered present if respondents had a reported \n\n\n\nhigh blood pressure (SBP \u2265 140 mm Hg and DBP \n\n\n\n\u226590 mm Hg) on two or more occasions or if they \n\n\n\nwere ever prescribed medication to lower their \n\n\n\nblood pressure. Family history was considered \n\n\n\npresent if the record indicated diagnosis of CHD or \n\n\n\nstroke (TIA) in first degree relatives regardless of \n\n\n\nage of onset.  \n\n\n\n\n\n\n\nOUTCOME MEASURES \n\n\n\n\n\n\n\nThe outcome measures include baseline measure \n\n\n\nof BP, cholesterol, weight, BMI, HbA1C level, 10 \n\n\n\nyears calculated risk of CHD, and proportion of \n\n\n\npatients who received primary preventive \n\n\n\nmeasures, trends of prescribing for primary \n\n\n\nprevention. \n\n\n\n\n\n\n\nSTATISTICAL ANALYSES \n\n\n\n\n\n\n\nAnalyses were performed using SPSS version 15.0 \n\n\n\nfor window. Descriptive statistics was used to \n\n\n\ncharacterize respondents, chi-square tests to assess \n\n\n\ndifferences in proportions, and the student t test to \n\n\n\nassess differences in means. The difference is \n\n\n\nconsidered significant for a statistical P value of P \n\n\n\n< 0.05. \n\n\n\n\n\n\n\nRESULTS \n\n\n\n\n\n\n\nA total of 200 patients medical records were \n\n\n\nscreened for this study and 130 (67 female and 63 \n\n\n\nmale) patients were included based on the \n\n\n\ninclusion criteria. Malays accounted for 53% \n\n\n\n(n=69) of the population studied (n=130) while the \n\n\n\nremaining 47% were Chinese (n=47, 36%), \n\n\n\nIndians (n=13, 10%) and other races (n=1, 1%). \n\n\n\n\n\n\n\nThe (mean \u00b1 SD) age and weight of the study \n\n\n\npopulation was 55.54 \u00b1 6.764 years and 66.0 \u00b1 \n\n\n\n13.08kg. The BMI was calculated for 105 patients, \n\n\n\n17% (n=18) were found to obese (BMI \u2265 \n\n\n\n30kg/m2) and 27% (n=28) were overweight (BMI \n\n\n\nbetween 25-30 kg / m\n2\n). \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n338 \n \n\n\n\n\n\n\n\nA total of 23.8% (n=31) of the subjects were \n\n\n\ncurrent smokers and 27 (20.7%) subjects had \n\n\n\nstopped smoking in the previous 6 months to 3 \n\n\n\nyears. \n\n\n\nThe difference for measured baseline TC, HDL-C, \n\n\n\nLDL-C and SBP between male and female was not \n\n\n\nsignificant (P > 0.05). Similarly there was no \n\n\n\nsignificant difference between different races with \n\n\n\nregard to calculated 10 years CHD risk. The  \n\n\n\ncalculated 10 years CHD risk differed significantly \n\n\n\nbetween male and female subjects at  level of \n\n\n\nt(128) =2.106, P < 0.05 (Table 1).  \n\n\n\n\n\n\n\nFamily history record was not found for 23 % of \n\n\n\nthe study population. For those with family history \n\n\n\nrecords, 63.85% did not have any history of CHD, \n\n\n\nwhile 13.08% were indicated to have family \n\n\n\nhistory of CHD.  \n\n\n\n\n\n\n\nHypertension is the most common risk factor in \n\n\n\nthis study population and  25.6% (32) of the \n\n\n\npatients were treated with monotherapy while dual \n\n\n\ntherapy and multiple drug therapy (\u22653drugs) was \n\n\n\ngiven to 35% (42) and 24% (29) of the patients \n\n\n\ncorrespondingly. Conversly, 15% (n=13) of \n\n\n\npatients did not receive any drug for the \n\n\n\nmanagement of their high blood pressure. \n\n\n\n\n\n\n\n\n\n\n\nTable 1.  Gender Specific Differences in Weight, BP, Cholesterol and Calculated 10 Years CHD Risk. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nParameters Mean \u00b1 SD P value \n\n\n\nMale Female \n\n\n\n\n\n\n\n\n\n\n\nWeight \n\n\n\n\n\n\n\n\n\n\n\n68.58kg \u00b1 12.89 \n\n\n\n\n\n\n\n63.58 kg \u00b1 12.89 \n\n\n\n\n\n\n\nHDL-C \n\n\n\n\n\n\n\n55.33 mg/dL \u00b1 30.37 49.90mg/dL \u00b1 27.29 0.5 \n\n\n\nTC \n\n\n\n\n\n\n\n192.2 mg/dL \u00b1 53.34 197.69mg/dL \u00b1 65.57 0.59 \n\n\n\nLDL-C \n\n\n\n\n\n\n\n109.68mg/dL \u00b1 42.66 120.50mg/dL \u00b1 50.43 0.19 \n\n\n\nSystolic blood pressure \n\n\n\n\n\n\n\n155.20mmHg \u00b1 31.2 162.5mmHg \u00b1 26.47 0.16 \n\n\n\n10 years calculated risk of CHD \n\n\n\n\n\n\n\n18.8%  \u00b1 10.87 15.22% \u00b1 8.56 0.037* \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n339 \n \n\n\n\nFigure 1. Distribution of CHD risk factors among the population \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nTable 2. Demographic Characteristics of Respondents According to Risk Stratification \n\n\n\n\n\n\n\nDemographic \n\n\n\ncharacteristics \n\n\n\n\n\n\n\n Risk stratification \n\n\n\n<15% 15-30% >30% \n\n\n\nMale \n\n\n\nFemale \n\n\n\n25 \n\n\n\n37 \n\n\n\n26 \n\n\n\n27 \n\n\n\n12 \n\n\n\n3 \n\n\n\nMalay \n\n\n\nChinese \n\n\n\nIndian \n\n\n\nOthers \n\n\n\n31 \n\n\n\n23 \n\n\n\n7 \n\n\n\n1 \n\n\n\n30 \n\n\n\n19 \n\n\n\n4 \n\n\n\n0 \n\n\n\n8 \n\n\n\n5 \n\n\n\n2 \n\n\n\n0 \n\n\n\n\n\n\n\n\n\n\n\nDISCUSSION \n\n\n\n\n\n\n\n\n\n\n\nThe findings of the study showed that 52 % (n=68) \n\n\n\nof the population have a 10 years CHD risk greater \n\n\n\nthan or equal to 15% according to the JBS CHD \n\n\n\nprediction chart risk category. \n\n\n\n\n\n\n\nThe 10-year risk stratification for CHD provide \n\n\n\nguidance for prioritizing primary prevention \n\n\n\nmeasures of CHD.  The remaining 48 % (n=62) \n\n\n\nwere found to have low absolute risk (10 years \n\n\n\nCHD risk < 15%). Low absolute risk particularly \n\n\n\namong young adults does not ensure a lifetime of \n\n\n\nlow risk because the number and severity of \n\n\n\nmetabolic risk factors worsen with aging. Hence \n\n\n\nperiodic monitoring is needed to assess the \n\n\n\nchanges in risk status over time. \n\n\n\n\n\n\n\nAlthough JBS risk prediction chart is a valuable \n\n\n\ntool in predicting CHD risk, it has some \n\n\n\nlimitations. This arises from the fact that the \n\n\n\nscoring system is derived from Framingham heart \n\n\n\nstudy participants which differ from the subjects \n\n\n\nconsidered in this study by their geographical \n\n\n\nlocation and ethnic group. However, an advantage \n\n\n\nof using JBS is that it suggests priorities for \n\n\n\ninstituting primary prevention strategies. \n\n\n\n\n\n\n\nThis study comprises of patients between 40-65 \n\n\n\nyears of age which could benefit greatly from the \n\n\n\nprimary preventive measures.  \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n340 \n \n\n\n\n\n\n\n\n\n\n\n\nFigure 2. Number of Patients Who Received Anti Hypertensive Therapy Versus The Systolic Blood \n\n\n\nPressure \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nFigure 3. Use of Lipid Lowering Therapy According to Risk Stratification \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n31 \n\n\n\n28 \n\n\n\n13 \n\n\n\n31 \n\n\n\n25 \n\n\n\n2 \n\n\n\n0\n\n\n\n5\n\n\n\n10\n\n\n\n15\n\n\n\n20\n\n\n\n25\n\n\n\n30\n\n\n\n35\n\n\n\n<15% 15-30% >30%\n\n\n\nN\nu\n\n\n\nm\nb\n\n\n\ner\n o\n\n\n\nf \n p\n\n\n\nat\nie\n\n\n\nn\nts\n\n\n\n\n\n\n\n10 years CHD risk \n\n\n\nReceived lipid\nlowering therapy\n\n\n\nReceived no lipid\nlowering therapy\n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n341 \n \n\n\n\nTable 4. Total Cholesterol Range-Diabetes-Lipid Lowering Therapy Cross Tabulation \n\n\n\nLipid lowering \n\n\n\ntherapy \n\n\n\n\n\n\n\nTotal cholesterol \n\n\n\nrange \n\n\n\nDiabetes Total \n\n\n\n\n\n\n\nGiven  \n\n\n\n  Diabetes No Diabetes  \n\n\n\nTC Range  < 200 23 7 30 \n\n\n\n200-239 16 6 22 \n\n\n\n\u2265 240 15 5 20 \n\n\n\n  Total 54 18 72 \n\n\n\nNot given  TC Range  < 200 24 16 40 \n\n\n\n200-239 7 9 16 \n\n\n\n\u2265 240 1 1 2 \n\n\n\n  Total 32 26 58 \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nFigure 4. Use of Aspirin According to Risk Stratification \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nThe number of female subjects in the study is \n\n\n\nhigher than male subjects, because male subjects \n\n\n\nhave higher chance of being diagnosed with CHD \n\n\n\nthan females in this age group. As reported by \n\n\n\nParanjape et al. (2005) women in the age group of \n\n\n\n20\u201350 are shown to have much less susceptibility \n\n\n\nto coronary heart disease and other atherosclerotic \n\n\n\ndiseases as compared to men. The findings of this \n\n\n\nstudy  \n\n\n\n\n\n\n\nalso showed significantly higher calculated 10 \n\n\n\nyears risk of CHD for male than female         (P < \n\n\n\n0.05).  There is no statistical difference between \n\n\n\nthe different sexes and races with regard to risk \n\n\n\nstratification (Table 2).  \n\n\n\nAccording to the Framingham Heart Study, obesity \n\n\n\nincreases an individual's risk of CHD by 104 \n\n\n\npercent. This is because obesity raises blood \n\n\n\ncholesterol and triglyceride levels, and reduces \n\n\n\nHDL levels which lead to more plaque build up in \n\n\n\nthe arteries. Obesity increases blood pressure and \n\n\n\ncan lead to diabetes. A total 17% of the subjects \n\n\n\n(n=18) were found obese and n=28 (27%) were \n\n\n\noverweight.  As reported by Gotto (2002) and \n\n\n\nNHLBI (2005) patients who are under high risk for \n\n\n\nCHD but had BMI > 25kg/m\n2\n would require total \n\n\n\nlife style changes (TLC). \n\n\n\n0\n\n\n\n5\n\n\n\n10\n\n\n\n15\n\n\n\n20\n\n\n\n25\n\n\n\n30\n\n\n\n35\n\n\n\n40\n\n\n\n<15% 15-30% >30%\n\n\n\n22 \n\n\n\n27 \n\n\n\n12 \n\n\n\n40 \n\n\n\n26 \n\n\n\n3 \n\n\n\nN\nu\n\n\n\nm\nb\n\n\n\ne\nr \n\n\n\no\nf \n\n\n\np\nat\n\n\n\nie\nn\n\n\n\nts\n \n\n\n\n10 years CHD risk \n\n\n\nReceived aspirin\n\n\n\nReceive no\naspirin\n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n342 \n \n\n\n\nEzzati et al. (2005) reported that smoking \n\n\n\ncontributes to high prevalence rate in CHD \n\n\n\nmortality and is mostly related to men in all \n\n\n\nregions and it. Similarly in this study, 92.5% \n\n\n\n(n=25) of the smokers in the study were male \n\n\n\n(Figure 1). Rapid reversal of CHD mortality is \n\n\n\nobserved epidemiologically after smoking \n\n\n\ncessation, even in patients with established CHD. \n\n\n\nThomson & Rigotti (2003) recommended to give \n\n\n\ndue emphasis to efforts to reduce smoking \n\n\n\nprevalence. \n\n\n\nIn this study, 90% subjects were having \n\n\n\nhypertension (Figure 1) and according to the study \n\n\n\ndone by Lee et al. (2000) in Singapore to compare \n\n\n\nthe relatively different contributions of risk factors \n\n\n\nto the risk of CHD between Asians and Caucasians \n\n\n\nshowed that hypertension is the most important \n\n\n\nrisk factor for CHD in Asians. \n\n\n\nOut of 117 hypertensive patients in this study, 88% \n\n\n\n(n=100) received antihypertensive therapy. \n\n\n\nAccording to the Joint British recommendations on \n\n\n\nprevention of CHD, life style advice and drug \n\n\n\ntreatment should be given for a patient with SBP is \n\n\n\n\u2265 160 mmHg or DBP \u2265 100 mmHg, regardless of \n\n\n\nabsolute CHD risk. In this study 10% (n=6) of the \n\n\n\nsubjects with SBP \u2265 160 were not on any \n\n\n\nmedication (Figure 2). \n\n\n\nAs indicated by Benner et al. (2001), large \n\n\n\nprospective randomized trials have confirmed the \n\n\n\nimportance of blood pressure control in reduction \n\n\n\nof cardiovascular mortality and morbidity, \n\n\n\nirrespective of the class drugs used.  \n\n\n\nDiabetes too increases the risk of developing \n\n\n\nCHD. ATP III indicated that most patients with \n\n\n\ndiabetes are at high risk even in the absence of \n\n\n\nestablished CHD. For effective CHD prevention it \n\n\n\nis recommended that optimal glycaemic control \n\n\n\nshould be reached (HbA1c< 7%). Results from this \n\n\n\nstudy showed that subjects had a significantly \n\n\n\ndifferent HbA1c level (t (87) =3.387, P< 0.05) \n\n\n\nfrom the target level and the majority of subjects \n\n\n\nwere having HbA1c level greater than 7 %.  \n\n\n\nA study by Hu et al. (2001) shows that type II \n\n\n\ndiabetics have the same cardiovascular risk as non-\n\n\n\ndiabetics post myocardial infarction, suggesting a \n\n\n\nstrong case for all patients with type II diabetes to \n\n\n\nreceive cholesterol lowering therapy. \n\n\n\nThe findings of this study showed a significant \n\n\n\nassociation between diabetes and lipid lowering \n\n\n\ntherapy use (P < 0.05). Among diabetic patients, \n\n\n\n62%, (n=54) received lipid lowering agent. On the \n\n\n\ncontrary, 37% (n=32) of the diabetic subjects did \n\n\n\nnot obtain any lipid lowering agent. Only 3% \n\n\n\n(n=1) of these patients had TC \u2265 240mg/dL while \n\n\n\n22% (n=7) and 75% (n=24) had a borderline TC \n\n\n\n(200-239 mg/dL) and desirable TC (< 200mg/dL) \n\n\n\nrespectively (Table 4).  \n\n\n\nDyslipidemia is the third prevalent risk factor after \n\n\n\nhypertension and diabetes occurring in 46.2% (60) \n\n\n\nof the subjects. Lipid lowering therapy was given \n\n\n\nto 87%, 53% and 50% of subjects with 10 years \n\n\n\nrisk of CHD > 30%, 15-30 % and < 15% \n\n\n\nrespectively. The Joint British guideline \n\n\n\nrecommended all patients with 10 years CHD risk \n\n\n\n\u226515% should receive lipid lowering therapy. \n\n\n\n\n\n\n\nLaw et al. (2003) reported that lipid lowering \n\n\n\ntherapy (statin) is effective in decreasing coronary \n\n\n\nheart disease (CHD) and stroke risk, both in \n\n\n\nprimary and in secondary prevention. \n\n\n\nThe benefit of treatment with a statin is observed \n\n\n\namong people with annual levels of risk as low as \n\n\n\n1%. Heart Protection Study Collaborative Group \n\n\n\n(2005) suggest that even at this level of risk statin \n\n\n\ntreatment is cost effective within the terms of \n\n\n\nreference applied to other medical treatment.  \n\n\n\nAspirin uses for primary prevention have been \n\n\n\nevaluated in three major meta-analysis conducted \n\n\n\nby Hyden et al (2005), Sanmuganathan et al. \n\n\n\n(2001) and Ridker et al (2005). The use of aspirin \n\n\n\nfor the primary prevention of CHD was reported to \n\n\n\nbe beneficial among patients with high \n\n\n\ncardiovascular risk. Furthermore De Backer et al. \n\n\n\n(2003) recommends aspirin for primary prevention \n\n\n\nin adults with diabetes or well-controlled \n\n\n\nhypertension and in men at high risk > 20%. \n\n\n\nHowever the benefits of aspirin in patients with \n\n\n\nlower risk remains controversial. \n\n\n\nIn this study, aspirin use increased with increase in \n\n\n\n10-year CHD risk level (Table 6). The association \n\n\n\nof the risk level with use of aspirin was statistically \n\n\n\nsignificant; (X\n2\n=10.19, df= 2, P < 0.05).  \n\n\n\nMoreover, use of aspirin is strongly associated \n\n\n\nwith presence of diabetes (X\n2\n=4.397, df= 1, P < \n\n\n\n0.05) and dyslipidemia.  \n\n\n\nCONCLUSION \n\n\n\nRisk factor modification is crucial to reduce the \n\n\n\nmorbidity and mortality related to CHD. This \n\n\n\nstudy reveals that the most prevalent risk factor for \n\n\n\nCHD was hypertension and this may be attributed \n\n\n\nto healthcare factors including under diagnosis or \n\n\n\ninadequate control of previously diagnosed \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n343 \n \n\n\n\nhypertension. Primary prevention measures are \n\n\n\nhighly recommended for those with higher risk \n\n\n\ngroups for each risk factors modulated. However, \n\n\n\nnot all treatment eligible patients received primary \n\n\n\npreventive measures as observed in this study. \n\n\n\nTherefore, future evaluation into the reason for \n\n\n\nsuboptimal primary prevention practice is required \n\n\n\nto improve the management practice.  \n\n\n\n\n\n\n\nACKNOWLEDGMENT \n\n\n\n\n\n\n\nThe authors would like to acknowledge the \n\n\n\nmedical ward staff of HUKM and record room \n\n\n\npersonnel for their invaluable assistance\n\n\n\n. \n\n\n\n\n\n\n\n\n\n\n\nREFERENCES  \n\n\n\n1. World Health Organization. The World Health Report 2001: Making a Difference. Geneva: WHO.  \n\n\n\n2. National Heart Association of Malaysia (NHAM).2009.Heart Disease Top Killer in Government \n\n\n\nHospitals.www.malaysianheart.org/article.php?aid=42. \n\n\n\n3. Gordon T, Castelli WP, Hjortland MC, Kannel WB, Dawber TR. Predicting coronary heart disease in \n\n\n\nmiddle-aged and older persons: the Framingham study. JAMA. 1977;238: 497-499. \n\n\n\n4. Ho JE, Paultre F. & Lori M. 2005. The gender gap in Coronary Heart Disease Mortality: Is there a \n\n\n\ndifference between Blacks and Whites? Journal of Womens Health 2(14):117-127. \n\n\n\n5. Jeannette L, Derrick H, Kee SC, Suok KC, Bee YT & Kenneth H. 2001. Risk factors and incident \n\n\n\ncoronary heart disease in Chinese, Malay and Asian Indian males: the Singapore Cardiovascular Cohort \n\n\n\nStudy. Int J Epidemiol 30:983-988. \n\n\n\n6. NCEP. 2001. Executive Summary of the Third Report of the National Cholesterol Education Program \n\n\n\nExpert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult \n\n\n\nTreatment Panel III). JAMA 285:2486\u20132497. \n\n\n\n7. Joint National Committee. The Fifth Report of the Joint National Committee on Detection, Evaluation, \n\n\n\nand Treatment of High Blood Pressure. Bethesda, Md: National Heart, Lung, and Blood Institute; \n\n\n\n1993:49. NIH publication. 93\u20131088. \n\n\n\n8. Joint British recommendations on Prevention of coronary heart disease in clinical practice. 2000. JBS \n\n\n\nrecommendations on Prevention of CHD in clinical practice: summary. British Cardiac Society, British \n\n\n\nHyperlipidemia Association, British Hypertension Society, British Diabetic Association. BMJ 320:705-\n\n\n\n708. \n\n\n\n9. Larabie, L.C. 2005. To what extent do smokers plan quit attempts? Tobacco Control 14:425-428. \n\n\n\n10. Khoo KL, Tan H, Khoo TH. 1991.Cardiovascular mortality in peninsular Malaysia: 1950-1989. Med J \n\n\n\nMalaysia. 46:7-20. \n\n\n\n11. NHLBI. 2005. Your Guide To Lowering Your Cholesterol with TLC. National Institute Of Health \n\n\n\nNational Heart, Lung, and Blood Institute (NHLBI). NIH Publications No 06-5235. \n\n\n\n12. Paranjape SG ,  Turankar AV, Wakode SL ,  Dakhale GN. 2005. Estrogen protection against coronary \n\n\n\nheart disease: Are the relevant effects of estrogen mediated through its effects on uterus \u2013 such as the \n\n\n\ninduction of menstruation, increased bleeding, and the facilitation of pregnancy? Medical Hypotheses \n\n\n\n65(4): 725-727. \n\n\n\n13. Ezzati, M., Henley, S.J., Thun MJ. & Lopez AD. 2005. Role of smoking in global and regional \n\n\n\ncardiovascular mortality. Circulation 112(4):489-497. \n\n\n\n14. Thomson CC & Rigotti NA 2003. Hospital and Clinic Based Smoking Cessation Interventions for \n\n\n\nSmokers with Cardiovascular Disease. Progress in Cardiov Dis 45(6):459-479. \n\n\n\n15. Lee WL, Chepung  AM, Cape D, & Zinman B. 2000. Impact of diabetes on coronary artery disease in \n\n\n\nwomen and men: a meta analysis of prospective studies. Diabetes Care 23:962-968. \n\n\n\n16. Brenner BM, Cooper ME, de Zeeuw D, Keane WF, Mitch, WE, Parving, H.H., Remuzzi G, Snapinn SM, \n\n\n\nZhang Z. & Shahinfar S. 2001. Effects of losartan on renal and cardiovascular outcomes in patients with \n\n\n\ntype 2 diabetes and nephropathy. RENAAL Study Investigators. N Engl J Med 345(12):861-869.  \n\n\n\n17. Nayaran P & Man AJ. 1998. Clinical pharmacology of modern antihypertensive agents and their \n\n\n\ninteraction with alpha-adrenoceptor antagonists. Br J Urol 81(1):6-16. \n\n\n\n\njavascript:AL_get(this,%20'jour',%20'Circulation.');\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n344 \n \n\n\n\n18. Verdecchia P, Reboldi G, Angeli F, Gattobigio R, Bentivoglio M, Thijs L, Staessen JA & Porcellati C. \n\n\n\n2005. Angiotensin-converting enzyme inhibitors and calcium channel blockers for coronary heart disease \n\n\n\nand stroke prevention. Hypertension. 46(2):386-92.  \n\n\n\n19. Hu FB, Stampfer MJ, Solomon, CG, Liu S, Willett WC, Speizer FE, Nathan DM & Manson JE 2001. The \n\n\n\nimpact of diabetes mellitus on mortality from all causes and coronary heart disease in women: 20 years of \n\n\n\nfollow-up. Arch Intern Med 161(14):1717-23. \n\n\n\n20. Sowers JR. 2003. Effect of statins on vascularature: implication for aggressive lipid management in \n\n\n\ncardiovascular metabolic syndro-me.  Am J Cardiol 91:14B-22B. \n\n\n\n21. Law MR, Wald NJ, Rudnicka A  R. 2003.Quantifying effect of statins on low density lipoprotein \n\n\n\ncholesterol, ischaemic heart disease, and stroke: systematic review and meta-analysis.   BMJ .326.1423\u2013\n\n\n\n1427.  \n\n\n\n22. Heart Protection Study Collaborative Group. 2005. Cost effectiveness of simvastatin in people at different \n\n\n\nlevels of vascular disease risk: economic analysis of a randomised trial in 20536 individuals. Lancet \n\n\n\n365.1779\u20131785.  \n\n\n\n23. Hayden M, Pignone M, Phillips C & Mulrow C. 2002. Aspirin for the primary prevention of \n\n\n\ncardiovascular events: a summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern \n\n\n\nMed 136:161-172. \n\n\n\n24. Sanmuganathan PS, Ghahramani, P, Jackson PR, Wallis EJ & Ramsay LE 2001. Aspirin for primary \n\n\n\nprevention of coronary heart disease: safety and absolute benefit related to coronary risk derived from \n\n\n\nmeta-analysis of randomised trials. Heart 85:265\u2013271. \n\n\n\n25. Ridker PM, Cook NR, Lee IM, Gordon D, Gaziano, JM, Manson, JAE, Hennekens CH & Buring, JE \n\n\n\n2005. A randomized trial of low-dose aspirin in the primary prevention of cardiovascular disease in \n\n\n\nwomen. N Engl J Med 352:1293\u20131304. \n\n\n\n26. De Backer, G., Ambrosioni, E., Borch-Johnsen, K., Brotons, C., Cifkova, R., Dallongeville, J., Ebrahim, \n\n\n\nS., Faergeman, O., Graham, I., Mancia, G., Cats, V.M., Orth-Gom\u00e9r, K., Perk, J., Py\u00f6r\u00e4l\u00e4, K., Rodicio, \n\n\n\nJ.L., Sans, S., Sansoy, V., Sechtem, U., Silber, S., Thomsen, T. & Wood, D. 2004. European guidelines on \n\n\n\ncardiovascular disease prevention in clinical practice. Third Joint Task Force of European and other \n\n\n\nSocieties on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of \n\n\n\neight societies and by invited experts). European Society of Cardiology. American Heart Association. \n\n\n\nAmerican College of Cardiology. Atherosclerosis 173(2):381-91. \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n345 \n \n\n\n\nStudy of Aminoglycosides Use among In-patients at Hospital Kuala Lumpur \n\n\n\n \nEndang Kumolosasi\n\n\n\n1\n,  Siti Aishah Mohamad Nor\n\n\n\n1\n, Tengku Karmila Tengku Mohd Kamil\n\n\n\n1 \n\n\n\n\n\n\n\n1\nFaculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur. \n\n\n\n\n\n\n\nCorrespondence Author: Endang Kumolosasi, Email: e_kumolosasi@yahoo.co.id \n\n\n\n\n\n\n\n_________________________________________________________________________________ \n\n\n\n\n\n\n\nABSTRACT \n\n\n\n\n\n\n\nAminoglycosides are a group of antibiotics that have been widely used in treatment of infections especially \n\n\n\ncaused by gram negative bacteria. The purpose of this research was to study the aminoglycosides use among \n\n\n\nin-patients. This study was carried out retrospectively which included the patients 18 years and above who had \n\n\n\nreceived aminoglycosides therapy from July 2008 until December 2008. Patients with incomplete data were \n\n\n\nexcluded. A total of 104 patients were included in this study based on the inclusion criteria. The \n\n\n\naminoglycosides were used in patients who had normal renal function and also in patients who were in end \n\n\n\nstage renal failure. Gentamicin was the most frequently used (44.2%), followed by amikacin (33.7%), \n\n\n\nnetilmicin (13.4%) and the least frequently used was streptomycin (8.7%). The culture and sensitivity test had \n\n\n\nbeen performed only to 62% of patients. Indication was appropriate in 95.2% patients and was inappropriate \n\n\n\nin 4.8% patients (p<0.001). Appropriate doses were given to  59.6% patients and  37.4% patients had received \n\n\n\ninappropriate doses (p>0.05) and 5.8% patients were not assessable. Duration of therapy was appropriate in \n\n\n\n87.5% patients and there were 12.5% patients did not received therapy in appropriate duration (p<0.001). A \n\n\n\ntotal of 77(89.5%) cases of pharmacodynamic and 9(10.4%) cases of pharmacokinetic potential drug-drug \n\n\n\ninteractions between aminoglycosides and other drugs were identified. There were 3 cases had minor severity \n\n\n\nand the rest had moderate severity. Conclusion: The appropriateness of aminoglycosides use still needs to be \n\n\n\nimproved in order to ensure  their effectiveness and safety in clinical setting. \n\n\n\n\n\n\n\nKeywords:  aminoglycosides; antibiotic; infection treatment; drug use evaluation; drug interactions. \n\n\n\n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011, pg 345 - 355 \n\n\n\n\n\n\n\n\n\n\n\nINTRODUCTION \n\n\n\n\n\n\n\nAminoglycosides are active particularly against \n\n\n\naerobic, gram-negative bacteria and  also active \n\n\n\nagainst certain gram-positive organisms. The most \n\n\n\ncommonly used aminoglycoside was gentamicin \n\n\n\nbut amikacin may be particularly effective against \n\n\n\nresistant organisms\n1\n. Aminoglycosides exhibit\n\n\n\n\n\n\n\nconcentration-dependent bactericidal activity and \n\n\n\npostantibiotic\n \neffect that allows continued efficacy \n\n\n\neven when serum concentrations\n \n\n\n\nfall below \n\n\n\nexpected minimal inhibitory concentrations\n2\n\n\n\n. \n\n\n\n\n\n\n\nAminoglycosides are most frequently used \n\n\n\nclinically in empirical therapy of serious infections \n\n\n\nsuch as septicemia, nosocomial respiratory tract \n\n\n\ninfections, complicated urinary tract infections and \n\n\n\ncomplicated intra-abdominal infections caused by \n\n\n\naerobic gram-negative bacilli\n3\n. They are also used \n\n\n\nfor prophylaxis, especially against endocarditis\n1\n. \n\n\n\nHowever, in long-term treatment, once an \n\n\n\norganism had been identified and susceptibilities \n\n\n\nhad been determined, aminoglycosides were often \n\n\n\ndiscontinued in favor of less toxic antibiotic \n\n\n\noptions\n3\n \n\n\n\n\n\n\n\nSince aminoglycoside antibiotics were being \n\n\n\nintroduced into therapeutic practice in 1944, \n\n\n\ngentamicin and amikacin were the most commonly \n\n\n\nused antibiotics worldwide for the treatment of \n\n\n\ngram-negative bacterial infections. In many cases, \n\n\n\nthey have been the only effective antibiotics \n\n\n\nagainst bacterial strains resistant to other \n\n\n\nantibiotics. Aminoglycosides show poor degree of \n\n\n\noral absorption, thus intravenous administration is \n\n\n\nusually used\n4,5\n\n\n\n They are eliminated by glomerular \n\n\n\nfiltration and 3 to 5 % of the total dose is partially \n\n\n\nreabsorbed by proximal tubular cells\n6,4\n\n\n\n. \n\n\n\nThe usefulness of aminoglycosides for the \n\n\n\ntreatment of wide range of gram negative \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n346 \n \n\n\n\ninfections caused them to be widely prescribed, \n\n\n\nbut serious toxicity of these antibiotics had limited \n\n\n\ntheir use\n7\n. The prolonged and improper use of \n\n\n\naminoglycosides may cause development of \n\n\n\nresistance pathogens and also development of \n\n\n\nnephrotoxicity and ototoxicity. A review on the \n\n\n\nuse of these agents may give benefit for quality \n\n\n\nand safe use of aminoglycosides. Drug utilization \n\n\n\nevaluations are carried out  primarily aimed to \n\n\n\nimprove prescribing, and thus the quality of health \n\n\n\ncare, and also to minimize needless drug \n\n\n\nexpenditure. The optimal utilization of \n\n\n\naminoglycosides is important to minimize the \n\n\n\ndevelopment of resistance pathogen and minimize \n\n\n\ntoxicity. Therefore, it is necessary to evaluate the \n\n\n\nusage of aminoglycosides in the hospital settings \n\n\n\nto improve the quality use of these agents by \n\n\n\npromoting proper utilization\n8\n.  \n\n\n\n\n\n\n\nThe objective of this research is to study the use of \n\n\n\naminoglycoside antibiotics among in-patients \n\n\n\nincluding evaluation of the appropriateness of \n\n\n\nindication, dosing and duration of aminoglycosides \n\n\n\ntherapy and the possible drug interactions that \n\n\n\noccurred during the treatment.  \n\n\n\n\n\n\n\nMETHODOLOGY \n\n\n\n\n\n\n\nThis study was conducted retrospectively over a \n\n\n\nperiod of six months from July 2008 to December \n\n\n\n2008. The inclusive criteria for this study were the \n\n\n\npatients who received aminoglycosides within July \n\n\n\n2008 to December 2008 with the age 18 years and \n\n\n\nabove. The exclusive criterion was the patients \n\n\n\nwho had incomplete data. \n\n\n\n\n\n\n\nData were collected by using the collecting data \n\n\n\nforms that were included patient demographics \n\n\n\nsuch as registration number, age, gender, body \n\n\n\nweight, past medical history as well as therapeutic \n\n\n\ndata including indication, dose, duration, \n\n\n\nfrequency of aminoglycosides, concurrent \n\n\n\nmedication taken and laboratory data such as full \n\n\n\nblood count, culture and sensitivity test and renal \n\n\n\nfunction test. The sample size was calculated using \n\n\n\nKrejcie & Morgan 1970 sample size calculation \n\n\n\nand 104 patients were able to be included in this \n\n\n\nstudy. \n\n\n\n\n\n\n\nIn order to  assess the appropriateness of \n\n\n\naminoglycosides use, the guidelines for antibiotic \n\n\n\nuse were referred such as Hospital Antibiotic \n\n\n\nGuidelines 2008 and National Antibiotic \n\n\n\nGuidelines 2008. The guidelines provide relevant \n\n\n\ninformation on the use of aminoglycosides, \n\n\n\nincluding indication, dose, duration of therapy, in \n\n\n\nchoosing the aminoglycosides. The dosing was \n\n\n\nconsidered appropriate if it was within the dosing \n\n\n\nrange and being adjusted according to creatinine \n\n\n\nclearance, otherwise it was considered as \n\n\n\nsubtherapeutic or overdose. Meanwhile, the \n\n\n\nindication to use the drug was considered \n\n\n\nappropriate if it was given based on lab results \n\n\n\nwhich were microbiological culture and sensitivity \n\n\n\ntest or adhered to the indication as in the \n\n\n\nguidelines. Meanwhile, the duration of treatment \n\n\n\nwas considered appropriate if it was taken at least \n\n\n\n1 day for prophylaxis, at least 3 days for acute \n\n\n\ninfections and at least 2 months for tuberculosis \n\n\n\ntreated by streptomycin. The duration also was \n\n\n\nconsidered appropriate even though it was taken \n\n\n\nless than these stated durations but continued with \n\n\n\nother antibiotics based on culture and sensitivity \n\n\n\ntest. Drug interactions were assessed using the \n\n\n\nreference of Drug Interaction Analysis and \n\n\n\nManagement\n9\n\n\n\n.\n \nPharmacokinetic drug interactions \n\n\n\nwere assessed regarding to the effect of drug \n\n\n\naction on absorption, distribution, metabolism and \n\n\n\nelimination. Pharmacodynamic drug interactions \n\n\n\nwere assessed regarding to the enhancement of \n\n\n\neffect of other drugs in the body or reciprocally. \n\n\n\nClassification on severity of interactions had been \n\n\n\ndivided into 3 categories which are major, \n\n\n\nmoderate and minor. \n\n\n\n\n\n\n\nSTATISTICAL ANALYSIS  \n\n\n\n\n\n\n\nData were analyzed using Microsoft Excel 2007 \n\n\n\nand SPSS 16.0. The Chi- square test was used \n\n\n\nwhere appropriate. Data were presented in \n\n\n\ndescriptive form such as pie-chart, bar chart and \n\n\n\ntable. The statistical tests were performed using \n\n\n\n0.05 level of significance. \n\n\n\n\n\n\n\nRESULTS \n\n\n\n\n\n\n\nTable 1 showed a total of 104 in-patients who had \n\n\n\nbeen treated with aminoglycosides for various \n\n\n\ninfections within July 2008 until December 2008. \n\n\n\nMost of the patients included in this study were \n\n\n\nadults 73.1% and the elderly were 26.9% patients. \n\n\n\nThe patients consisted of 59.6 % male and 40.4 % \n\n\n\nfemale. The mean duration of hospitalization was \n\n\n\n27 \u00b1 24 days. Most of the patients had normal \n\n\n\nrenal function 53.8% and 9 patients (8.7%) were in \n\n\n\nend stage renal failure with the creatinine \n\n\n\nclearance less than 15 ml per minute. Meanwhile, \n\n\n\n6 patients (5.8%) and 12 patients (11.5%) were in \n\n\n\nstage 4 and stage 3 of renal failure respectively. \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n347 \n \n\n\n\nTable 1: Demographic data, duration of hospitalization and renal function status of  104 patients \n\n\n\nreceived aminoglycosides therapy. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n            NA: Not Assessable \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nFigure 1: Percentage of aminoglycosides use (N=104) \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n44.2% \n\n\n\n34.7% \n\n\n\n13.4% \n8.7% Gentamicin\n\n\n\nAmikacin\n\n\n\nNetilmicin\n\n\n\nStreptomycin\n\n\n\nVariable No. of patients \n\n\n\n (N=104) \n\n\n\n% of patients \n\n\n\nAge (years) \n\n\n\n        18-65 \n\n\n\n        >65 \n\n\n\n\n\n\n\n76  \n\n\n\n28  \n\n\n\n\n\n\n\n73.1 \n\n\n\n26.9 \n\n\n\nGender \n\n\n\n        Male \n\n\n\n        Female \n\n\n\n\n\n\n\n62 \n\n\n\n42 \n\n\n\n\n\n\n\n59.6 \n\n\n\n40.4 \n\n\n\n Race \n\n\n\n        Malay \n\n\n\n        Chinese \n\n\n\n        Indian \n\n\n\n        Others \n\n\n\n\n\n\n\n60  \n\n\n\n32  \n\n\n\n3  \n\n\n\n9  \n\n\n\n\n\n\n\n57.7 \n\n\n\n30.8 \n\n\n\n2.9 \n\n\n\n8.7 \n\n\n\nDuration of hospitalization (days) \n\n\n\n        Mean \u00b1 SD                 \n\n\n\n        Median (range) \n\n\n\n\n\n\n\n27 \u00b1 24 \n\n\n\n20 (2-113) \n\n\n\n\n\n\n\nRenal function status  \n\n\n\n(Creatinine clearance, ml/min) \n\n\n\n       \u2265 90 (stage 1) \n\n\n\n      60-89 (stage 2) \n\n\n\n      30-59 (stage 3) \n\n\n\n      15-29 (stage 4) \n\n\n\n      <15 (stage 5 or ESRF) \n\n\n\n      NA \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n56  \n\n\n\n19  \n\n\n\n12  \n\n\n\n6  \n\n\n\n9  \n\n\n\n2 \n\n\n\n\n\n\n\n\n\n\n\n53.8 \n\n\n\n18.3 \n\n\n\n11.5 \n\n\n\n5.8 \n\n\n\n8.7 \n\n\n\n1.9 \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n348 \n \n\n\n\nFigure 2: Number of patients received aminoglycosides for various types of diagnosis   (N=104) \n\n\n\n\n\n\n\n\n\n\n\nAmong four types of aminoglycosides used, the \n\n\n\nmost commonly prescribed was gentamicin (44.2 \n\n\n\n%), followed by amikacin (34.7 %) and netilmicin \n\n\n\n(13.4%). The least frequently prescribed was \n\n\n\nstreptomycin (8.7%). The results were shown in \n\n\n\nFigure 1. \n\n\n\n\n\n\n\nFigure 2 showed that gentamicin, amikacin and \n\n\n\nnetilmicin were most widely used to treat sepsis. In \n\n\n\ntuberculosis treatment, 9 patients were treated with \n\n\n\nstreptomycin and 1 patient was treated with \n\n\n\namikacin and gentamicin respectively. In \n\n\n\nrespiratory tract infection, urinary tract infection \n\n\n\nand meningitis, only gentamicin and amikacin \n\n\n\nwere used. Gentamicin was the only one \n\n\n\naminoglycoside that had been used in prophylaxis, \n\n\n\nand most of them were used in endocarditis \n\n\n\nprophylaxis following surgery procedure. The \n\n\n\naminoglycosides also were indicated for other \n\n\n\ndiagnosis such as infective endocarditis, \n\n\n\npanniculitis and infected wound. \n\n\n\n\n\n\n\nIn this study, 62% patients had performed culture \n\n\n\nand sensitivity test. There were 38% patients who \n\n\n\ndid not have culture and sensitivity results. The \n\n\n\npercentage of patients based on culture and \n\n\n\nsensitivity test were shown in Figure 3.  \n\n\n\n\n\n\n\n\n\n\n\nTable 2:  Range of aminoglycoside doses per day received by patients  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n15 \n\n\n\n5 \n2 2 1 \n\n\n\n12 \n9 \n\n\n\n22 \n\n\n\n8 \n\n\n\n1 1 \n1 \n\n\n\n2 \n\n\n\n12 \n\n\n\n2 \n\n\n\n9 \n\n\n\n0\n\n\n\n10\n\n\n\n20\n\n\n\n30\n\n\n\n40\n\n\n\n50\n\n\n\nSepsis Respiratory\n\n\n\ntract\n\n\n\ninfection\n\n\n\nUrinary tract\n\n\n\ninfection\n\n\n\nMeningitis TuberculosisProphylaxis Others\n\n\n\nN\no\n. \no\nf \n\n\n\np\na\nti\n\n\n\nen\nts\n\n\n\n\n\n\n\nTypes of diagnosis  \n\n\n\nGentamicin Amikacin Netilmicin Streptomycin\n\n\n\nDrug Patients` dose range \n\n\n\n(mg/kg/day) \n\n\n\nUsual dose therapeutic range \n\n\n\n(mg/kg/day) \n\n\n\nGentamicin 1 - 47.61 3 - 7 \n\n\n\nAmikacin 3.13 - 19.74 15 - 20 \n\n\n\nNetilmicin 2.14 - 8.04 3 - 7 \n\n\n\nStreptomycin 0.01mg - 1g/day 15 - 30mg/kg/day  \n\n\n\nor 1 - 2 g/day  \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n349 \n \n\n\n\nFigure 3: Percentage of patients based on culture and sensitivity (C & S) test (N=104) \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nTable 3:  Duration of aminoglycoside therapies  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nTable 4:  Appropriateness of aminoglycoside indications  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n62% \n\n\n\n38% \n\n\n\nPatients with C & S test Patients without C & S test\n\n\n\nDuration of therapy \n\n\n\n(days) \n\n\n\nNumber of patient \n\n\n\nN:104 \n\n\n\nPercentage of \n\n\n\npatient \n\n\n\n1-2 31 29.8 \n\n\n\n3-7 38 36.5 \n\n\n\n8-14 26 25 \n\n\n\n>14 9 8.7 \n\n\n\nTypes of \n\n\n\nAminoglycosides \n\n\n\nAppropriate Inappropriate Total (%)  \n\n\n\nNumber of \n\n\n\npatients \n\n\n\n%  of \n\n\n\npatients \n\n\n\nNumber \n\n\n\nof \n\n\n\npatients \n\n\n\n%  of \n\n\n\nPatients \n\n\n\n\n\n\n\nGentamicin    41 39.4 5 4.8 46 (44.2) \n\n\n\nAmikacin       35 33.7 - - 35 (33.7) \n\n\n\nNetilmicin      14 13.7 - - 14 (13.5) \n\n\n\nStreptomycin  9 8.7 - - 9 (8.7) \n\n\n\nTotal of patients         99 95.2 5 4.8 104 (100) \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n350 \n \n\n\n\nTable 2 showed that some doses of all types of \n\n\n\naminoglycosides had been used in subtherapeutic \n\n\n\ndose. Some doses of gentamicin, and netilmicin \n\n\n\nwere used in overdose. \n\n\n\n\n\n\n\nTable 3 showed that most of the patients (36.5%) \n\n\n\nhad received the aminoglycosides therapy for 3 to \n\n\n\n7 days.  There were 29.8% patients had received \n\n\n\naminoglycosides therapy for less than 3 days, and  \n\n\n\nmost of patients received aminoglycosides for \n\n\n\nprophylaxis following surgical procedure. Only 9 \n\n\n\npatients (8.7%) had received aminoglycosides for \n\n\n\nmore than 14 days.  \n\n\n\n\n\n\n\nGentamicin was appropriately indicated in 39.4% \n\n\n\npatients. However, there were 4.8% patients had \n\n\n\nreceived gentamicin for inappropriate indication. \n\n\n\nThe use of amikacin, netilmicin and streptomycin \n\n\n\nin all patients who received these antibiotics were \n\n\n\nappropriate. The results were shown in Table 4. \n\n\n\n\n\n\n\nTable 5 showed that 27(26%) patients had received \n\n\n\nappropriate dose of gentamicin. A total of 12 \n\n\n\n(11.5%) of patients were found to receive \n\n\n\ngentamicin in subtherapeutic dose and 4 (3.9%) \n\n\n\npatients had received more than therapeutic dose \n\n\n\nand 3 (2.9%) patients were not assessable. The \n\n\n\ndose of amikacin was given appropriately in \n\n\n\n19(18.3%) of patients. However, 14 (13.5%) \n\n\n\npatients had received subtherapeutic dose of \n\n\n\namikacin and 2 (1.9%) patients had received \n\n\n\namikacin in more than therapeutic dose . The 2 \n\n\n\n(1.9%) patients that received more than therapeutic \n\n\n\ndose of netilmicin and 9 (8.7%) patients had  \n\n\n\nappropriate doses, but subtherapeutic doses had \n\n\n\nbeen given to 3(2.9%) of patients. Dose of \n\n\n\nstreptomycin was given appropriately to 7 (6.7%) \n\n\n\npatients and 2 (1.9%) patients had received \n\n\n\nsubtherapeutic dose of streptomycin. \n\n\n\n\n\n\n\nDuration of therapy was found to be appropriate in \n\n\n\n43 (41.3%) patients for gentamicin, 33 (31.7%) \n\n\n\npatients for amikacin, 12 (11.5%) patients for \n\n\n\nnetilmicin and 3 (2.9%) patients for streptomycin. \n\n\n\nInappropriate duration of therapy was found in 3 \n\n\n\n(2.9%) patients for gentamicin, 2 (1.9%) patients \n\n\n\nfor amikacin, 2 (1.9%) patients for netilmicin and \n\n\n\n6 (5.8%) patients for streptomycin. The results \n\n\n\nwere shown in Table 6. \n\n\n\n\n\n\n\nTable 7 showed that the indication of the \n\n\n\naminoglycosides were appropriate in majority of \n\n\n\nthe patients (p<0.001). There were 99 (95.2%) of \n\n\n\npatients had appropriately indicated with \n\n\n\naminoglycosides and 5 (4.8%) patients were not \n\n\n\napproprietly indicated. The dose of \n\n\n\naminoglycosides was appropriate in 62 (59.6%) of \n\n\n\npatients and was found to be inappropriate in 39 \n\n\n\n(37.5%) patients (p>0.05). A total of 91 (87.5%) \n\n\n\npatients had been treated with appropriate duration \n\n\n\nof therapy. However, inappropriate duration had \n\n\n\nbeen occurred in 13 (12.5%) patients (p<0.001). \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nTable 5: Appropriateness of aminoglycoside doses  \n\n\n\nNote: Inappropriateness of doses: 38 (37.4%) of patients \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nTypes of \n\n\n\nAmino-\n\n\n\nglycosides \n\n\n\nAppropriate  Sub-\n\n\n\ntherapeutic  \n\n\n\nMore than \n\n\n\ntherapeutic \n\n\n\ndose  \n\n\n\n\n\n\n\nNot \n\n\n\nAssessable  \n\n\n\nTotal (%) \n\n\n\nNumber of     \n\n\n\npatients (%) \n\n\n\n\n\n\n\nNumber of     \n\n\n\npatients (%) \n\n\n\nNumber of     \n\n\n\npatients (%) \n\n\n\nNumber of      \n\n\n\npatients (%) \n\n\n\nGentamicin 27 (26) 12 (11.5) 4 (3.9) 3 (2.9) 46 (44.2) \n\n\n\nAmikacin 19 (18.3) 14 (13.5) 2 (1.9) - 35 (33.7) \n\n\n\nNetilmicin 9 (8.7) 3 (2.9) 2 (1.9) - 14 (13.5) \n\n\n\nStreptomycin 7 (6.7) 2 (1.9) - - 9 (8.7) \n\n\n\nTotal of patients 62 (59.6) 31 (29.8) 8 (7.6) 3 (2.9) 104 (100) \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n351 \n \n\n\n\nTable 6: Appropriateness of aminoglycoside durations  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nTable 7 showed that the indication of the \n\n\n\naminoglycosides were appropriate in majority of \n\n\n\nthe patients (p<0.001). There were 99 (95.2%) of \n\n\n\npatients had appropriately indicated with \n\n\n\naminoglycosides and 5 (4.8%) patients were not \n\n\n\napproprietly indicated. The dose of \n\n\n\naminoglycosides was appropriate in 62 (59.6%) of \n\n\n\npatients and was found to be inappropriate in 39 \n\n\n\n(37.5%) patients (p>0.05). A total of 91 (87.5%) \n\n\n\npatients had been treated with appropriate duration \n\n\n\nof therapy. However, inappropriate duration had \n\n\n\nbeen occurred in 13 (12.5%) patients (p<0.001). \n\n\n\n\n\n\n\nTable 8 showed that pharmacodynamic drug \n\n\n\ninteractions were predominant (89.5%) compared \n\n\n\nto pharmacokinetic interactions (10.5%). The cases \n\n\n\nof potential drug interactions were the highest \n\n\n\nbetween aminoglycosides and penicillin (44.2%). \n\n\n\nThe potential interactions between \n\n\n\naminoglycosides and cephalosporins were \n\n\n\n34(39.5%) cases. There were also 5 and 6 cases of \n\n\n\npotential interactions of aminoglycosides with \n\n\n\nvancomycin and non-steroidal antiiflammatory \n\n\n\ndrugs (NSAIDs) respectively. The potential \n\n\n\ninteractions of aminoglycosides with loop diuretics \n\n\n\nhad been identified only in 3 cases. The severity \n\n\n\nfor all these interactions is moderate except for \n\n\n\naminoglycosides and loop diuretics interactions, \n\n\n\nthe severity is minor. \n\n\n\n\n\n\n\nDISCUSSION \n \n\n\n\nNephrotoxicity is one of the major \n\n\n\naminoglycosides adverse effects\n4,7,10,11\n\n\n\nIn this study, \n\n\n\nsome patients who had received aminoglycosides \n\n\n\ntherapy were having renal impairment and renal \n\n\n\nfailure. They were more likely to get \n\n\n\nnephrotoxicity compared to patients with normal \n\n\n\nrenal function. Aminoglycoside associated \n\n\n\nnephrotoxicity appeared to be more common \n\n\n\namong patients with preexisting renal \n\n\n\nimpairment\n12\n\n\n\n. \n\n\n\n\n\n\n\nNephrotoxicity can occur  when the usual doses \n\n\n\nwere given to patients with underlying renal \n\n\n\ndisease. In order to prevent aminoglycoside-\n\n\n\ninduced nephrotoxicity in clinical practice, \n\n\n\naminoglycosides should be used as once daily dose \n\n\n\nrather than divided dose especially in high-risk \n\n\n\nindividuals. The combination of aminoglycosides \n\n\n\nwith other potential nephrotoxins such as \n\n\n\namphotericin, cisplatin, diuretics should be \n\n\n\navoided. During aminoglycoside therapy, adequate \n\n\n\nhydration must be ensured especially in the \n\n\n\nelderly. Besides that, the dose should be modified \n\n\n\naccording to individual glomerular filtration rate\n13\n\n\n\n. \n\n\n\n\n\n\n\n\n\n\n\nTable 7: Summary of appropriateness of aminoglycosides use  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n*There were significant differences (p<0.001). \n\n\n\nTypes of \n\n\n\nAmino-\n\n\n\nglycosides  \n\n\n\nAppropriate Inappropriate Total (%) \n\n\n\nNumber of \n\n\n\npatients \n\n\n\n% of patients  Number of \n\n\n\npatients \n\n\n\n% of \n\n\n\npatients  \n\n\n\nGentamicin   43 41.3 3 2.9 46 (44.2) \n\n\n\nAmikacin     33 31.7 2 1.9 35 (33.7) \n\n\n\nNetilmicin  12 11.5 2 1.9 14 (13.5) \n\n\n\nStreptomycin  3 2.9 6 5.8 9 (8.7) \n\n\n\nTotal of \n\n\n\npatients \n\n\n\n\n\n\n\n91 \n\n\n\n\n\n\n\n87.5 \n\n\n\n\n\n\n\n13 \n\n\n\n\n\n\n\n12.5 \n\n\n\n\n\n\n\n104 (100) \n\n\n\nCriteria  No. of patients (%)  \n\n\n\n    p value Appropriate Inappropriate Not Assessable Total \n\n\n\nIndication  99  (95.2) 5 (4.8) - 104 (100) 0.000* \n\n\n\nDose  62 (59.6) 39 (37.5) 3 (2.9) 104 (100) 0.486  \n\n\n\nDuration  91 (87.5) 13 (12.5) - 104 (100) 0.000* \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n352 \n \n\n\n\nTable 8: Potential drug-drug interactions between aminoglycosides and other drugs \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nAccording to Gonzalez and Spencer (1998), in \n\n\n\norder to minimize aminoglycosides toxicity, they \n\n\n\nshould only be used when their unique antibiotic \n\n\n\npotency is needed, such as treatment of infection in \n\n\n\ncritically ill patients, in nosocomial infections or \n\n\n\ninfections with organisms resistant to less toxic \n\n\n\ntherapies\n1\n. The clinician should change to a \n\n\n\npotentially less toxic antibiotic as soon as the \n\n\n\ninfecting organisms and its antibiotic sensitivities \n\n\n\nhave been determined. Potential risk factors that \n\n\n\npredispose to nephrotoxicity should be identified \n\n\n\nand corrected when possible. \n\n\n\n\n\n\n\nIn this study, the gentamicin was found to be the \n\n\n\nmost frequently prescribed compared to the other \n\n\n\ntypes of aminoglycosides. Amikacin mostly were \n\n\n\nprescribed by the doctor when the organisms were \n\n\n\nfound resistant to gentamicin. According to \n\n\n\nGonzalez and Spencer (1998), gentamicin was the \n\n\n\nmost commonly used aminoglycoside, but \n\n\n\namikacin may be particularly effective against \n\n\n\nresistant organisms\n1\n. Gallagher and MacDougall \n\n\n\n(2009) also stated that gentamicin and tobramycin \n\n\n\nwere the most widely used drugs and amikacin \n\n\n\nwas used when the pathogens resistant to these \n\n\n\nfirst two drugs\n14\n\n\n\n. Gentamicin remains the \n\n\n\naminoglycoside of choice in hospitals because of \n\n\n\nits low cost and less resistant among \n\n\n\nEnterobacteriaceae and Pseudomonas \n\n\n\naeruginosa\n15,16,17\n\n\n\n.Streptomycin was the least used \n\n\n\naminoglycoside as it was only used in hospital for \n\n\n\nthe treatment of tuberculosis. \n\n\n\n\n\n\n\nThe findings from this study showed that \n\n\n\naminoglycosides were indicated mostly for sepsis \n\n\n\nin this hospital. The aminoglycosides are useful in \n\n\n\nthe treatment of sepsis caused by aerobic gram-\n\n\n\nnegative bacilli\n11\n\n\n\n. Begg and Barclay (1995) also \n\n\n\nstated that aminoglycosides remain the drugs of \n\n\n\nchoice to treat septicaemia\n18\n\n\n\n. Based on the result, \n\n\n\namikacin was the antibiotic of choice in treating \n\n\n\nsepsis compared to the other types of \n\n\n\naminoglycosides. The study done by Francetic and \n\n\n\ncolleagues (2008) had revealed that the overall \n\n\n\nnumber of patients having gram-negative bacteria \n\n\n\nbloodstream infection was significantly reduced \n\n\n\nduring amikacin treatment, with the reduction of \n\n\n\nsepsis rate from 3.6% to 2.2%\n19\n\n\n\n.  \n\n\n\n\n\n\n\nCulture and sensitivity tests are the basis for the \n\n\n\nappropriate and optimal use of antibiotics in \n\n\n\ntreating various infections\n8\n. The selection of \n\n\n\nantibiotics will be more appropriate if the culture \n\n\n\nand sensitivity result were available. In this study, \n\n\n\nthe patients who had no culture and sensitivity \n\n\n\nresults were treated with aminoglycosides for \n\n\n\nempirical therapy. Although there were no culture \n\n\n\nand sensitivity result in a number of cases, the \n\n\n\nchoice of appropriate antibiotics are is still very \n\n\n\nimportant. This is because appropriate empirical \n\n\n\nantibiotic treatment was associated with a better \n\n\n\nsurvival and shortened duration of hospital stay in \n\n\n\npatients with bacterial infections\n20\n\n\n\n. \n\n\n\n\n\n\n\nThe indication of aminoglycosides in this study \n\n\n\nwas appropriate in most of the patients (95.2%). \n\n\n\nThese findings were similar to the results of \n\n\n\nRamesh and colleagues study (2002) that showed \n\n\n\nthe appropriateness of aminoglycosides indication \n\n\n\nwas high (72%)\n8\n. The indication was inappropriate \n\n\n\nin a few patients because  the same \n\n\n\naminoglycosides were still used in the patients \n\n\n\neven though the culture and sensitivity results \n\n\n\nshowed that the bacteria were already resistant to \n\n\n\nthose antibiotics. The indication was also \n\n\n\nDrug interaction \n\n\n\nAminoglycoside \n\n\n\nwith \n\n\n\nTypes of interaction Severity Number of \n\n\n\ninteraction \n\n\n\ncases(N:86) \n\n\n\n% of \n\n\n\ninteraction \n\n\n\ncases \n\n\n\nCephalosporins Pharmacodynamic Moderate 34 39.5 \n\n\n\nPenicillins Pharmacodynamic Moderate 38 44.2 \n\n\n\nVancomycin \n\n\n\n\n\n\n\nPharmacodynamic Moderate 5 5.8 \n\n\n\nTotal pharmacodynamic interactions \n\n\n\n\n\n\n\n77 89.5 \n\n\n\nLoop diuretics Pharmacokinetic Minor 3 3.5 \n\n\n\nNSAIDS \n\n\n\n\n\n\n\nPharmacokinetic Moderate 6 6.9 \n\n\n\nTotal pharmacokinetic interactions \n\n\n\n\n\n\n\n9 10.5 \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n353 \n \n\n\n\nconsidered inapproproate when the treatments \n\n\n\ngiven were not adhering to the guidelines. \n\n\n\n\n\n\n\nThere were a number of patients who received \n\n\n\nmore than therapeutic dose of  aminoglycosides. \n\n\n\nThese patients had higher risk of getting adverse \n\n\n\neffects as a study done by Zahid and colleagues \n\n\n\n(2007) concluded that aminoglycosides cause \n\n\n\nnephrotoxicity by producing damaging effects on \n\n\n\nrenal tubules especially at higher dose\n21\n\n\n\n. \n\n\n\nAccording to Sandhu and colleagues (2007), the \n\n\n\nnephrotoxicity was more likely to occur if large \n\n\n\ndoses are given over prolong periods\n13\n\n\n\n. Therefore, \n\n\n\nit should be used at the lowest dose and shortest \n\n\n\npossible course of therapy. Besides that, the dose \n\n\n\nappropriateness of 3 patients (2.9%) who had \n\n\n\nreceived gentamicin cannot be assessed because \n\n\n\nthere was no information about the serum \n\n\n\ncreatinine of these patients.  \n\n\n\n\n\n\n\nAccording to Sanford and Root (1999), there were \n\n\n\nalmost none for all studies of treatment of \n\n\n\ninfections with antimicrobial agents that had \n\n\n\nestablished the minimal duration of therapy for any \n\n\n\ninfection\n22\n\n\n\n. Mostly, the recommendations of \n\n\n\ntreatment duration are based on experiences either \n\n\n\nthe treatments are success, failure or relapse. Short \n\n\n\ncourse therapy is given for 3 to 14 days, \n\n\n\nintermediate courses is recommended for about 4 \n\n\n\nto 6 weeks for infections that are difficult to \n\n\n\neradicate such as endocarditis and long courses of \n\n\n\nmore than 6 months for the infections such as \n\n\n\ntuberculosis. \n\n\n\n\n\n\n\nThere was not much evidence-based information \n\n\n\non the appropriate duration of treatment for most \n\n\n\ninfectious diseases. In many infections, optimal \n\n\n\nduration is defined by the absence of relapse after \n\n\n\nan arbitrarily chosen number of days for example \n\n\n\nare 7, 10 and 14 days of treatment. Usually, the \n\n\n\nminimum duration required is not known\n23\n\n\n\n. The \n\n\n\noptimal duration for a course of antimicrobial \n\n\n\ntherapy is unknown and many studies are \n\n\n\ninvestigating the issue. Reduction in duration of \n\n\n\ntherapy reduced total antibiotic use and resistance. \n\n\n\nBesides that, it also reduced toxicity and costs\n24\n\n\n\n. \n\n\n\nAccording to Hedrick (2006), shorter duration of \n\n\n\nantibiotics therapy was associated with similar or \n\n\n\nfewer complications than prolonged therapy\n25\n\n\n\n. \n\n\n\n\n\n\n\nThe appropriateness of aminoglycosides duration \n\n\n\nis very important because of the narrow \n\n\n\ntherapeutic\n \nindex and its potential toxicity\n\n\n\n26,27\n. The \n\n\n\nreduction\n \n\n\n\nin the duration of aminoglycosides \n\n\n\ntherapy was associated\n \nwith a lower incidence of \n\n\n\nnephrotoxicity\n27\n\n\n\n. According to Kashuba and \n\n\n\ncolleagues (1999), the risk of nephrotoxicity\n \nand \n\n\n\nototoxicity can be minimized by shortening the \n\n\n\ncourses of aminoglycoside therapy\n28\n\n\n\n.  \n\n\n\n\n\n\n\nIn this study, the potential interaction cases \n\n\n\nbetween aminoglycosides and penicillins were the \n\n\n\nhighest. According to Beringer and Winter (2004), \n\n\n\ncabercillin, ticarcillin and related extended-\n\n\n\nspectrum penicillins chemically inactivate \n\n\n\ngentamicin and tobramycin in vitro\n29\n\n\n\n. This \n\n\n\ninactivation can become clinically significant in \n\n\n\nvivo in patients with renal failure. Nevertheless, in \n\n\n\nprevious studies, there was synergy between\n \nan \n\n\n\naminoglycoside and \u00df-lactam antibiotics in the\n \n\n\n\ntreatment of Pseudomonas aeruginosa infections\n30\n\n\n\n. \n\n\n\nBates and colleagues (2002) demonstrated that the \n\n\n\nuse of aminoglycoside followed by furosemide \n\n\n\nmay increase the risk for ototoxicity\n31\n\n\n\n.  \n\n\n\n\n\n\n\n\n\n\n\nCONCLUSION \n\n\n\n\n\n\n\nA total of 104 in-patients had been treated with \n\n\n\naminoglycosides for various infections within July \n\n\n\n2008 until December 2008. Based on this study, \n\n\n\nthe aminoglycosides were used in patients who had \n\n\n\nnormal renal function and also in patients who \n\n\n\nwere in renal diseases and in  end stage renal \n\n\n\nfailure. The culture and sensitivity test had been \n\n\n\nperformed only to 62% of patients. Inappropriate \n\n\n\nindication of aminoglycosides was found in 4.8% \n\n\n\npatients. A total of 37.4 % patients did not receive \n\n\n\nappropriate dose and most of them (29.8%) had \n\n\n\nreceived subtherapeutic while 7.6% had received \n\n\n\naminoglycosides in  more than therapeutic dose. \n\n\n\nThe duration of aminoglycosides therapy was \n\n\n\ninappropriate in 12.5% patients. There were 89.5% \n\n\n\ncases of pharmacodynamic and 10.5% cases of \n\n\n\npharmacokinetic potential aminoglycosides drug \n\n\n\ninteractions had been identified in this study. \n\n\n\nThere were 3 cases of potential interactions that \n\n\n\nhad minor severity and the others had moderate \n\n\n\nseverity. Based on the findings, the \n\n\n\nappropriateness of aminoglycosides use still needs \n\n\n\nto be improved.  \n\n\n\n\n\n\n\nACKNOWLEDGEMENT \n\n\n\n\n\n\n\nA special thanks to the Director of Hospital Kuala \n\n\n\nLumpur for giving us an opportunity to conduct a \n\n\n\nresearch project in this hospital. We wish to thank \n\n\n\nProf.Dr.P.T.Thomas for his suggestions for this \n\n\n\npublication. \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n354 \n \n\n\n\n\n\n\n\nREFERENCES  \n\n\n\n\n\n\n\n1. Gonzalez, L. S. & Spencer, J. P. Aminoglycosides: A Practical Review. American Family Physician 1998; \n\n\n\n58(8): 1811-1819. \n\n\n\n2. Contopoulos-Ioannidis, D. G. , Giotis, N. D.,  Baliatsa,\n \n D. V. &  Ioannidis, J. P. A. Extended-Interval \n\n\n\nAminoglycoside Administration for Children: A Meta analysis. Pediatrics 2004; 114(1):  111-118. \n\n\n\n3. Durante-Mangoni, E., Grammatikos, A., Utili, R. & Falagas, M. E. Do we still need the aminoglycosides? \n\n\n\nInternational Journal of Antimicrobia Agents. 2009; 33(3): 201-205. \n\n\n\n4. Martinez-Salgado, C., Lopez-Hernandez, F.  J., Lopez-Novoa, J. M. Glomerular nephrotoxicity of \n\n\n\naminoglycosides. 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N., Drusano,\n\n\n\n \nG. L. & Bertino, J. S. Optimizing Aminoglycoside Therapy for \n\n\n\nNosocomial Pneumonia Caused by Gram Negative Bacteria. Antimicrobial Agents and Chemotherapy. 1999; \n\n\n\n43(3): 623-629. \n\n\n\n29. Beringer, P. & Winter, M. E. Aminoglycoside Antibiotics. Dlm. Winter, M. E. (pnyt). Basic Clinical \n\n\n\nPharmacokinetics, 4\nth\n ed. USA: Lippincontt William & Wilkins. 2004. \n\n\n\n30. Mayer, I. & Nagy, E. Investigation of the synergic effects of aminoglycoside fluoroquinolone and third-\n\n\n\ngeneration cephalosporin combinations against clinical isolates of Pseudomonas spp. Journal of \n\n\n\nAntimicrobial Chemotherapy. 1999; 43(5): 651-657. \n\n\n\n\n\n\n\n31. Bates, D. E., Beaumont, S. J.  & Baylis, B. W. Ototoxicity induced by gentamicin and furosemide.  The \n\n\n\nAnnals of Pharmacotherapy. 2002; 36(3): 446-451.  \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nSUPPLEMENT \n\n\n\nABSTRACT FROM MALAYSIAN PHARMACEUTICAL SOCIETY PHARMACY SCIENTIFIC CONFERENCE 2011 \n21st \u2013 23rd October, 2011,  Hotel  Istana, Kuala Lumpur \n \n\n\n\nADVANCING COMPETENCIES FOR FUTURE PRACTICE \n\n\n\nJointly organised by the Malaysian Pharmaceutical Society and the Pharmaceutical Services Division \nMinistry of Health, Malaysia \n\n\n\n \nOrganising Committee \n \nADVISOR:  YBhg Dato\u2019 Eisah Abdul Rahman \n \nORGANISING COMMITTEE \n\n\n\nProf Dr P T Thomas (Chairman of Organising Committee) \n\n\n\nAssoc Prof Dr Jamia Azdina Jamal \n\n\n\nMs Abida Haq Syed M Haq \n\n\n\nMs Adliah Mohd Ali \n\n\n\nAssoc Prof Dr Mohamed Azmi Ahmad Hassali \n\n\n\nMr Chang Chiew Pheng, John \n\n\n\nAssoc Prof Dr Chua Siew Siang \n\n\n\nMr Dexter Van Dort \n\n\n\nMs Lee Hong Gee, Mary \n\n\n\nDr  Lee Wen Huey, Shaun \n\n\n\nDr Ng Shiow Fern \n\n\n\nDr Nour Hanah Othman \n\n\n\nAssoc Prof Wong Kok Thong \n\n\n\nAssoc Prof Dr Wong Tin Wui \n\n\n\nProf Dr Yeoh Peng Nam \n\n\n\nMs Yip Sook Ying \n\n\n\nProf Dr Zhari Ismail \n\n\n\nMr Lam Kai Kun \n\n\n\n\n\n\n\nREVIEWERS OF ABSTRACTS: \n\n\n\nAssoc. Prof. Dr Jamia Azdina Jamal (Chairperson of Scientific Committee) \n\n\n\nMs Adliah Mohd Ali \n\n\n\nAssoc Prof Dr Mohamed Azmi Ahmad Hassali \n\n\n\nAssoc Prof Dr  Chua Siew Siang \n\n\n\nMs Lee Hong Gee, Mary \n\n\n\nDr  Lee Wen Huey, Shaun \n\n\n\nDr Low Bee Yean \n\n\n\nDr Ng Shiow Fern \n\n\n\nProf Dr P T Thomas \n\n\n\nAssoc Prof Wong Kok Thong \n\n\n\nAssoc Prof Dr Wong Tin Wui \n\n\n\nProf Dr Yeoh Peng Nam \n\n\n\nProf Dr Zhari Ismail \n\n\n\n \n\n\n\n\n\n\n\n\nTABLE OF CONTENTS \n\n\n\nOral Presentations  \n\n\n\nPHARMACOLOGY / TRADITIONAL & COMPLEMENTARY MEDICINE \n\n\n\n\n\n\n\nNo Author Title \n\n\n\nOPM \u2013 01 Manjari Mittal Antihyperglycaemic and Cytoprotective Evaluation of Curcuma longa \nRhizomes on Diabetic Rats  \n\n\n\nOPM \u2013 02 Pan Yan Studies of In Vitro Modulatory Effects of Labisia pumila on Cytochrome \nP450 2C19   \n\n\n\nOPM \u2013 03 Anbu Jeba Sunilson Protective Effect of Coccinia grandis Leaves Against Anti-Tuberculosis \nDrugs Induced Hepatic Injury in Rats  \n\n\n\nOPM \u2013 04 Chong Yaw Shing Effect of Pandanus amarylifolius in the Isolated Guinea Pig Ileum : A \nPilot Study   \n\n\n\nOPM \u2013 05 Yeoh Peng Nam Tracheal Relaxant Effect of Pandanus amarylifolius in the Guinea Pig  \n\n\n\n\n\n\n\nPHARMACEUTICAL CHEMISTRY \n \n\n\n\nNo Author Title \n\n\n\nOPC \u2013 01 Mai Chun Wai Insight into the Structure Requirements of Alkenyl Indazole Scaffold-\nbased Derivatives as Aurora Kinase Inhibitors Using 3D-QSAR and \nMolecular Docking  \n\n\n\nOPC \u2013 02 Irna Elina Ridzwan A Single Compound Alternative to a Buprenorphine/Naltrexone \nCombination to Treat Polydrug Abuse  \n\n\n\nOPC \u2013 03 Harish Rajak Synthesis and Antimicrobial Evaluation of Some Novel Schiff Bases \nContaining Imidazo[2,1-b]-1,3,4-oxadiazole  \n\n\n\n\n\n\n\nPHARMACEUTICAL TECHNOLOGY \n \n\n\n\nNo Author Title \n\n\n\nOPT \u2013 01 Brajesh Kumar Tiwari Surface Modified Liposomes for Transmucosal Vaccination through \nNasal Route  \n\n\n\nOPT \u2013 02 Ravi Shankar Pandey Development of Synthetic Skin Lipid-Based Vesicles for \nTranscutaneous Immunization \n\n\n\nOPT \u2013 03 Shobha Yadav Topical Delivery of Bifonazole using Organogel - Formulation and \nCharacterization \n\n\n\nOPT \u2013 04 Gabriel Loh Onn Kit Effect of Solid Dispersion Technique on Dissolution of Norfloxacin  \n\n\n\nOPT \u2013 05 Venkateskumar Krishnamoorthy   Risperidone-PEG 6000 Binary Systems - Physico-Chemical \nCharacterization and Mathematical Modeling \n\n\n\nOPT \u2013 06 Mohanad Naji Sahib Formulation and in vitro pulmonary deposition of budesonide \nnanomicelles using different nebulisers \n\n\n\nOPT \u2013 07 Palanirajan Vijayarajkumar \n \n\n\n\nFormulation and Evaluation of Efavirenz Loaded Citric Acid \n\n\n\nDendrimers \n\n\n\nOPT \u2013 08 Sheelpriya Walde Physicochemical and Film Forming Properties of Starch Extracted \nfrom Echinochloa colonum \n\n\n\nOPT \u2013 09 \n \nOPT \u2013 10 \n\n\n\nAshish Kumar Jain \n \n\n\n\nNanolipobeads as Drug Delivery System for Effective Management of \nPeptic Ulcer \nDevelopment of Dissolution Medium and UV Spectorphotometric \n\n\n\n\n\n\n\n\nB.V.S.Lokesh Method for Determination of Valsartan in Tablets \n\n\n\n\n\n\n\nPHARMACY EDUCATION \n \n\n\n\nNo Author Title \n\n\n\nOES \u2013 01 Goh Su Lun Evaluation of an Innovative Workplace Quit Smoking Program for \nSmoking Employees in a Manufacturing Company \n\n\n\nOES \u2013 02 Zainun Kassim Perception of Pharmacy Students at Private Universities in Malaysia \ntowards the Roles of Community Pharmacists \n\n\n\nOES \u2013 03 Ibrahim Abdullah Perception of pharmacy Students at Private Universities in Malaysia \ntowards the Roles of Pharmacists in Academia \n\n\n\nOES \u2013 04 Lee Hong Gee Issues Associated With Medication Use by the Visually Impaired \n\n\n\nOES \u2013 05 Surulivel Rajan Mallayasam   Learning Case History Assessment Skills Using Standardized Patients \nin Comparison with Didactical Teaching \u2013 Students Perception \n\n\n\nOES \u2013 06 Molugulu Nagashekhara   Influence of Organizational Factors on Ethical Behavior of Medical \nRepresentatives in India   \n\n\n\n\n\n\n\nPHARMACY PRACTICE/SOCIAL PHARMACY/ CLINICAL PHARMACY \n \n\n\n\nNo Author Title \n\n\n\nOPP \u2013 01 Quah Joo Lee Five year evaluation of the quality of anticoagulation therapy \nmanagement in the warfarin medication therapy adherence clinic \n(WMTAC) in Duchess of Kent Hospital, Sandakan, Sabah \n\n\n\nOPP \u2013 02 Jamaluddin Awang The knowledge and perception of contraception and sexual health \namongst AIMST University students \n\n\n\nOPP \u2013 03 Kong Su Shan Outcome of appropriate empiric antimicrobial therapy for nosocomial \npneumonia in the intensive care unit (ICU), Hospital Ampang \n\n\n\nOPP \u2013 04 Chen Li Li Prevalence and Factors associated with Potentially Inappropriate \nMedications among Older Residents in Penang Nursing Homes  \n\n\n\nOPP \u2013 05 Siti Nadiah Rusli Acute Coronary Syndrome (ACS) Secondary Prevention \nPharmacotherapy Third National Audit: A Comparison Between \nCardiology Centers and Non-cardiology Centers  \n\n\n\nOPP \u2013 06 Ho Jia Wen Patients Own Drug (POD) System and Impact of Ward Pharmacists \nIntervention  \n\n\n\nOPP \u2013 07 Lawrence Anak Anchah Cost-Utility Analysis of the Modified Cardiac Rehabilitation Program: A \nPreference-Based on SF-6D \n\n\n\nOPP \u2013 08 Lim Su Ming An Assessment of Prescriptions Received in Community Pharmacies \nin Selangor, Malaysia  \n\n\n\nOPP \u2013 09 Lo Yoke Lin Risk of Nephrotoxicity among Orthopaedic Patients Receiving \nVancomycin Treatment in University of Malaya Medical Centre \n(UMMC)  \n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\nPosters Presentations \n\n\n\nPHARMACOLOGY / TRADITIONAL & COMPLEMENTARY MEDICINE \n \n\n\n\nNo Author Title \n\n\n\nPPM \u2013 01 C Santiago Inhibition of Penicillin Binding Protein (PBP2a) Production in \nMethicillin-resistant Staphylococcus aureus (MRSA) \n\n\n\nPPM \u2013 02 Kamal Dua Efficacy of Minocycline, a Selective Inhibitor of Microglial Activation, on \nExisting Behavioral Hypersensitivity Following Streptozotocin-induced \nDiabetic Neuropathic Pain   \n\n\n\nPPM \u2013 03 A Ahmad Rational Use of Antibiotics in Infected Diabetic Foot: A Case Report \nfrom Pakistan   \n\n\n\nPPM \u2013 04 C Santiago Anti-Methicillin Resistant Staphylococcus aureus (MRSA) Activity of \nEthyl Acetate Extract from Acalypha wilkesiana   \n\n\n\nPPM \u2013 05 A.J.M. Christina The 7a.m to 7 p.m Variation in Biological Rhythm of BP in Young \nPopulation of Malaysia- The Step to a Chronopharmacological and \nChronotherapeutic Approach  \n\n\n\nPPM \u2013 06 Anbu Jeba Sunilson Chemopreventive and Cytotoxic Activity of Spilanthes calva. L.  \n\n\n\nPPM \u2013 07 PNYeoh Effect of Pandanus amarylifolius on Pain in the Hot Plate and Tail \nPinch Experiments in Mice  \n\n\n\nPPM \u2013 08 M Sivakumar Development and Evaluation of a Polyherbal Formulation for \nRheumatoid Arthritis  \n\n\n\nPPM \u2013 09 Anuradha.S.N. Recent Treatment Preference for Diabetes Among Population in \nPenang, Malaysia   \n\n\n\nPPM \u2013 10 Nor Samira Talib Auricular Acupuncture as an Adjunct to Methadone Maintenance \nTreatment (MMT):  Effects on Relapse Rate, Methadone Dose and \nSmoking Habit  \n\n\n\nPPM \u2013 11 Ibtisam Abdul Wahab The Prismatic Crystals of Calcium Oxalate in Vitex Species  \n\n\n\nPPM \u2013 12 B H Tan In Vitro Modulatory Effects of Glucosamine and Chondroitin on Human \nHepatic Cytochrome P450 2D6  \n\n\n\nPPM \u2013 13 B V S Lokesh An Overview on Lack of Proper Evaluation and Standardised \nAnalytical Methods of Currently Marketed Herbal Products:  A \nRemedial Approach    \n\n\n\nPPM \u2013 14 P Madhavan In vitro Antimicrobial Activity of Hazelnut Extracts on Streptococcus \npneumoniae, Klebsiella pneumoniae and Candida albicans Using Disk \nDiffusion Method  \n\n\n\nPPM \u2013 15 P Madhavan In vitro Antimicrobial Activity of Strobilanthes crispus Ethanolic Leaf \nExtracts using Disk Diffusion Method  \n\n\n\nPPM \u2013 16 A.V. Anita Gnana Kumari Antimicrobial Activity of Methanol Extracts of Sphaeranthus zeylanicus \nLeaves: An In-Vitro Investigation  \n\n\n\n\n\n\n\nPHARMACEUTICAL CHEMISTRY  \n \n\n\n\nNo Author Title \n\n\n\nPPC \u2013 01 S D Bhinge Development and Validation of an HPLC Method for Simultaneous \nDetermination of Atorvastatin Calcium and Fenofibrate in Rabbit \nPlasma  \n\n\n\nPPC \u2013 02 Bandar E. Aldhubiab Enhancing Solubility of Drugs by the Complex Behaviour of Poly-Vinyl \nPyrrolidone (PVP)  \n\n\n\nPPC \u2013 03 N.H. Khan Preparation and Analysis of Fermental Impurities and Degradation \nProducts (4-Epimers, Anhydro and Iso-derivatives ) of \n\n\n\n\n\n\n\n\nChlortetracycline  \n\n\n\nPPC \u2013 04 N. H. Khan Preliminary Phytochemical and Antimicrobial Screening of Momordica \ncharantia  \n\n\n\nPPC \u2013 05 M. Arockia Babu Molecular Modelling Studies on 4-Pyrrol-1-yl Benzoic Acid Hydrazide \nAnalogues as Anti-Tuberculosis Agents  \n\n\n\nPPC \u2013 06 Harish Rajak Synthesis and SAR Studies of Novel Benztriazole Substituted 1,3,4-\nThiadiazoles: Structural Features Vital for Antiepileptic Activity  \n\n\n\nPPC \u2013 07 I. Abdul Wahab Thin Layer Chromatography of Papaver Extracts  \n\n\n\nPPC \u2013 08 M J A Siddiqui High Performance Liquid Chromatography (HPLC) Coupled with \nMicrOTOF-Q Mass Spectroscopic Procedure for Qualitative and \nQuantitative Determination of Vinca rosea Methanol \n\n\n\nPPC \u2013 09 M Atif Development and Validation of High-Performance Liquid \nChromatographic Method for Determination of Glipizide in Human \nPlasma  \n\n\n\nPPC \u2013 10 Armaghan Shafaei Cytotoxicity Studies and Analysis of Primary and Secondary \nMetabolites in Methanol and Water Extracts of Ficus deltoidea Leaves  \n\n\n\nPPC \u2013 11 C W Mai p38 Alpha Mitogen Activated Protein Kinase Inhibitors: 3D-QSAR and \nMolecular Docking \n\n\n\nPPC \u2013 12 Rosniza R Multivariate Analysis of Aqueous Extracts of Labisia pumila var. alata \nusing High Performance Liquid Chromatography-Photodiode Array \nand Chemometrics \n\n\n\n\n\n\n\nPHARMACEUTICAL TECHNOLOGY \n \n\n\n\nNo Author Title \n\n\n\nPPT \u2013 01 P.S.Rajinikanth Helicobacter pylori Targeted Drug Delivery System: Preparation and \nEvaluation of Floating Beads of Amoxicillin \n\n\n\nPPT \u2013 02 Kamal Dua Investigation on Dissolution Enhancement of UDCA by Complextaion \nwith \u00b2-Cyclodextrin-Choline Dichloride Coprecipitate  \n\n\n\nPPT \u2013 03 Anil K. Kharya Design and Characterization of Mucoadhesive Buccal Delivery System \nof Testosterone: In Vitro and In Vivo Studies \n\n\n\nPPT \u2013 04 Manoj Kumar Floating Microspheres for Enhanced Bioavailability of An Anti-Diabetic \nDrug \n\n\n\nPPT \u2013 05 M. J. Qureshi Preparation and In-Vivo Evaluation of Indomethacin Loaded \nTransdermal Nanoemulsion  \n\n\n\nPPT \u2013 06 Adinarayana Gorajana Enhancement of The Dissolution Rate of Efavirenz using Solid \nDispersion Technique \n\n\n\nPPT \u2013 07 Mohd Shakrie Palan Abdullah Extraction and Characterization of Gelatin from Chicken Leg (Gallus \ngallus domesticus)  \n\n\n\nPPT \u2013 08 L M Thong Zeta Potential Measurements: Potential Indicator of Insulin Location \nwithin Solid Lipid Nanoparticles (SLNs) \n\n\n\nPPT \u2013 09 Sajeev Kumar B Dissolution Enhancement of Poorly Water-Soluble Drugs by \nNanonization Process \n\n\n\nPPT \u2013 10 S  Rajesh Formulation and Development of Azithromycin Floating Tablets  \n\n\n\nPPT \u2013 11 N.D.Pawar Bioanalytical Method Validation of Pioglitazone in Human Plasma  \n\n\n\nPPT \u2013 12 Kamal Dua Investigation on Intestinal Absorption of Ursodeoxycholic acid Using \u00b2-\nCyclodextrin  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nPHARMACY EDUCATION \n\n\n\n \nNo Author Title \n\n\n\nPPE \u2013 01 S Q Jamshed The Impact of Didactic Lecture to Improve the Understanding of \nPharmacy Students Towards Generic Medicine  \n\n\n\nPPE \u2013 02 S Q Jamshed Understanding and Perception of Final Year Pharmacy Students \nTowards Generic Medicine: A Questionnaire-based Study  \n\n\n\nPPE \u2013 03 Omar Saad Saleh Abrika Perceptions of Libyan Pharmacy Practitioners on the Importance of \nSocial Pharmacy Subjects in the Current Pharmacy Undergraduate \nCurriculum  \n\n\n\nPPE \u2013 04 Hari R Students\u2019 Evaluation, Perception and Knowledge on Pharmaceutical \nBiotechnology Course in Universiti Sains Malaysia  \n\n\n\nPPE \u2013 05 PJ Hayball University of Sunderland's New MPharm: A Cogent, Integrated Course \nfrom Level-1 Aligned to the New (2011) Education and Training \nStandards of the General Pharmaceutical Council (UK)  \n\n\n\nPPE \u2013 06 Saraswathi Simansalam \n \n\n\n\nEmpowering UCSI University Pharmacy Students to Counsel for \nNonprescription Drug Therapy  \n\n\n\nPPE \u2013 07 Mohamed Azmi Ahmad Hassali Barriers to Rational Drug Use in Treatment of Malaria in Health Care \nFacilities in Pakistan: A Qualitative Study  \n\n\n\nPPE \u2013 08 Salmiah MA Active Learning Attitudes in Pharmacy Education in Klang Valley \n\n\n\nPPE \u2013 09 I Abdullah IPTS Pharmacist Wannabe: Personal and Career Goal Influences, \nCommitment and Future Career Ambitions  \n\n\n\nPPE \u2013 10 Saraswathi Simansalam \n \n\n\n\nEquipping Pharmacy Undergraduates with Knowledge and Skills on \nSmoking Cessation Intervention: Findings from Environmental Scan of \nUniversities Curricula and Assessment of Students' Knowledge  \n\n\n\nPPE \u2013 11 Noorizan Abd Aziz Assessment of Non Halal Medications Used by Cardiac Outpatients: \nIncidence and Category of  Halalness  \n\n\n\nPPE \u2013 12 Emilia Binti Talib Perception on Packaging and Labeling of Pharmaceutical Products  \n\n\n\nPPE \u2013 13 Lim Pui Shen Consumer Perception and Purchasing Behavior of Cosmeceuticals  \n\n\n\nPPE \u2013 14 Flora Ku Yee Wei Measurement of Patient Satisfaction on Retail Pharmacy Services  \n\n\n\n\n\n\n\nPHARMACY PRACTICE/SOCIAL PHARMACY \n\n\n\n \nNo Author Title \n\n\n\nPPP \u2013 01 JL Quah Establishment and Evaluation of a Pharmacist Managed Smoking \nCessation Clinic (PMSCC) in Sabah: A Model for Future Service \nProvider \n\n\n\nPPP \u2013 02 Liew E T Home Medication Review (HMR): Benefits to Warfarin Medication \nTherapy Adherence Clinic (MTAC) Patients in Sandakan  \n\n\n\nPPP \u2013 03 Che Noriah Othman Patients Compliance towards Self-Medication Practice at Sarawak \nGeneral Hospital - Case Study of Hypertensive Patients  \n\n\n\nPPP \u2013 04 K N Ting Mixed Beliefs and Limited Knowledge about Side-Effects amongst \nPharmacy Clients \n\n\n\nPPP \u2013 05 M Atif Tuberculosis Knowledge among University Students in Pakistan  \n\n\n\nPPP \u2013 06 KT Wong Malaysian Pharmacists' Perspectives on Smoking Cessation Services   \n\n\n\nPPP \u2013 07 S Q Jamshed Is There any Correlation Between GPs Perception and Attitude \nTowards Generic Medicine Prescribing in Karachi, Pakistan?  \n\n\n\nPPP \u2013 08 S Q Jamshed Understanding of Primary Care Doctors about Essential Drug List \n(EDL): A Qualitative Study \n\n\n\nPPP \u2013 09 P.Thennarasu  Adverse Drug Reactions in Patients on Cancer Chemotherapy in a \nSouth Indian University Hospital  \n\n\n\nPPP \u2013 10 N.Vanitha Rani Assessment of Medication Knowledge and Adherence in Patients \nUndergoing Hemodialysis in a South Indian University Hospital  \n\n\n\n\n\n\n\n\nPPP \u2013 11 S Q Jamshed Understanding and Perception of Community Pharmacists Towards \nGeneric Medicine Substitution: A Questionnaire-Based Study  \n\n\n\nPPP \u2013 12 Mohamed Azmi Ahmad Hassali Decision Analysis Modelling of Dispensing Separation Policy in \nMalaysia   \n\n\n\nPPP \u2013 13 Noor Salihah Zakaria Predicting Non-Adherence among Haart Patients: Demographic or \nPsychosocial Attributes?   \n\n\n\nPPP \u2013 14 G.Kannan Apo B, Apo A, Apo B/Apo A1- Better Markers for Cad in South Indian \nPopulation?  \n\n\n\nPPP \u2013 15 Fatokun O Generic Medicines Promotion in Malaysia: Views from the Malaysian \nGeneric Pharmaceutical Industry Stakeholders   \n\n\n\nPPP \u2013 16 N E Ismail Satisfaction of Systemic Lupus Erythematosus Patients toward \nMedical Care in a Tertiary Care Hospital at Klang Valley  \n\n\n\nPPP \u2013 17 N E Ismail Illness Perception of Systemic Lupus Erythematosus Patients in an \nOutpatient Clinic of a Tertiary Care Hospital  \n\n\n\nPPP \u2013 18 Y W Shim Comparison of A Portable Device And Conventional Laboratory \nMeasured INR in Duchess of Kent Hospital, Sandakan \n\n\n\nPPP \u2013 19 M H Law Knowledge, Attitude and Behaviour of Pharmacy Staff in Handling \nCytotoxic Drugs in Sarawak Government Health Institutions   \n\n\n\nPPP \u2013 20 Wan Azuati W. Omar The Evaluation of Prevalence and Awareness towards Hypertension \nControl among Healthcare Employees in Kerian District, Perak \n\n\n\nPPP \u2013 21 K Rajiah The Community Pharmacist as a Member of Healthcare Team in \nKarachi, Pakistan: Opinion of Patients  \n\n\n\nPPP \u2013 22 Mohamed Azmi Ahmad Hassali Current Prescribing Trends in Treatment of Malaria in Health Care \nSystem of Pakistan  \n\n\n\nPPP \u2013 23 Shalini Sivadasan A Study on Utilization of Antibiotics among Hospitalized Patients at a \nGovernment Hospital in Kedah, Malaysia \n\n\n\nPPP \u2013 24 Azhar S Perception of Academic Pharmacist towards their Role in Health Care \nSystem of Pakistan: A Qualitative Assessment   \n\n\n\nPPP \u2013 25 M A Nawab Khan A Study on Knowledge of HIV Transmission among Public Secondary \nSchool Students in Urban and Rural Areas in Malaysia   \n\n\n\nPPP \u2013 26 A N Mariani Compliance to Oral Contraceptives in Primary Healthcare Centre  \n\n\n\nPPP \u2013 27 M A Nawab Khan A Study on Attitude towards HIV Patients among Public Secondary \nSchool Students in Urban And Rural Regions in Malaysia   \n\n\n\nPPP \u2013 28 M A Hameed Self-Medication Practices among Malaysian Undergraduate Pharmacy \nStudents  \n\n\n\nPPP \u2013 29 AHM Yahaya Non-Prescription Medicines: What Malaysian Purchased From \nCommunity Pharmacies?  \n\n\n\nPPP \u2013 30 Haq N Knowledge and Awareness of Patients Regarding Hepatitis B  \n\n\n\nPPP \u2013 31 S S Chua Use of Nonprescription Medications by the General Public in the Klang \nValley  \n\n\n\nPPP \u2013 32 S J Choo Medication Reconciliation: An Approach towards Cost Savings  \n\n\n\nPPP \u2013 33 N N A Nik Othseman Comparing Du90% Profiles of Anti-Epileptic Drugs in Public and \nPrivate Sectors in Malaysia  \n\n\n\nPPP \u2013 34 N Abdul Rahman Du90% Profiles of Anti-Hypertensive Drugs in Public and Private \nSectors in Malaysia  \n\n\n\nPPP \u2013 35 P F Chong Evaluation of the Involvement of a Nutritional Support Team on the \nOutcomes of Patients on Parenteral Nutrition \n\n\n\nPPP \u2013 36 Adliah Mhd Ali Factors Influencing Medication Adherence among Uncontrolled \nHypertensive Patients  \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\nCLINICAL PHARMACY \n\n\n\n \nNo Author Title \n\n\n\nPCP \u2013 01 E P Tay Nutritional Aspect of Patients on Chemotherapy in Hospital Melaka: \nThe Facts & the Future \n\n\n\nPCP \u2013 02 M Atif Health Related Quality of Life (HRQoL) in Co-Morbid Tuberculosis \nRelapse Patient: A Case Report from Malaysia  \n\n\n\nPCP \u2013 03 Sonal Sekhar M Study on assessment of migraine disability and side effects of \nmigraine medications \n\n\n\nPCP \u2013 04 Rajesh V Evaluation of Antibiotic Usage Pattern in Appendicectomy and \nColorectal Surgeries in Surgery Unit of a Tertiary care Teaching \nHospital  \n\n\n\nPCP \u2013 05 Nurulumi A A Study of Degree of Malnutrition in Elective Surgical and \nChemotherapy Patients in Tertiary Hospital  \n\n\n\nPCP \u2013 06 Noor Salihah Zakaria Chemotherapy-Induced Nausea and Vomiting (CINV) among Breast \nCancer Patients: An Investigation in Relation to Anti-Emetic Therapy \nand Clinical Conditions  \n\n\n\nPCP \u2013 07 Kho SS A Prospective Study of Vancomycin Prescribing Patterns in Sarawak \nGeneral Hospital  \n\n\n\nPCP \u2013 08 C M Ling Various Doses of Rituximab on Response Outcome in Diffuse Large \nB-Cell Lymphoma (DLBCL)  \n\n\n\nPCP \u2013 09 SA Abdulameer Is there a Link between Osteoporosis and Diabetes? Findings from a \nSystematic Review of the Literature \n\n\n\nPCP \u2013 10 Tan A.G.H.K An Epidemiological Investigation of Carbapenem-Resistant \nAcinetobacter baumannii in Sarawak General Hospital: A Preliminary \nStudy  \n\n\n\nPCP \u2013 11 S W Ng Antibiotic Usage in adult Continuous Ambulatory Peritoneal Dialysis \n(CAPD) related peritonitis in Sarawak General Hospital \n\n\n\nPCP \u2013 12 Salmiah MA Awareness of Systemic Lupus Erythematosus (SLE) in Selangor \n\n\n\nPCP \u2013 13 Lou JY Evaluation of Drug Free Period (DFP) of Single-Daily Dosing (SDD) of \nAmikacin Using Different Assay Sensitivity Limits and Machines in \nSarawak Hospitals \n\n\n\nPCP \u2013 14 N E Ismail Self-reported Treatment Adherence in Patients with Systemic Lupus \nErythematosus Attending Rheumatology Clinic in a Tertiary Care \nHospital at Klang Valley \n\n\n\nPCP \u2013 15 KL Chin Clinical Outcomes of Paediatric Ischemic Stroke Patients Treated with \nAntithrombotic Therapy: A Systematic Review  \n\n\n\nPCP \u2013 16 Venkatraghavan S Evaluation of Complications among South Indian Post Renal \nTransplant Patients \n\n\n\nPCP \u2013 17 Y K Lai PPUKM Experience of Caffeine Use in Apnoea of Prematurity   \n\n\n\nPCP \u2013 18 M Z Rosdi The Use of N-Acetylcysteine in Paracetamol Poisoning in Hospital \nMelaka   \n\n\n\nPCP \u2013 19 Yahaya Hassan Drug Therapy Problems in Hospitalized Chronic Kidney Disease \n(CKD) Patients: The Influence of CKD Stages  \n\n\n\nPCP \u2013 20 Tan Jas Min Preliminary Study: The Effects of Pharmacists' Counselling on the \nKnowledge of Skin Preparations in Chronic Skin Condition Patients   \n\n\n\nPCP \u2013 21 Loganadan NK Outcome of Pharmacist Run Medication Therapy Adherence Clinic \n(MTAC) on Insulin and Drug Related Problems of Type 2 Diabetes \nPatients  \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                           MPS Pharmacy Scientific Conference 2011 \n \n\n\n\n356 \n \n\n\n\nORAL PRESENTATION \n\n\n\n \nPHARMACOLOGY/TRADITIONAL & COMPLEMENTARY MEDICINE \n\n\n\n\n\n\n\nOPM \u2013 01 (000035) \n \n \n\n\n\nAntihyperglycaemic and Cytoprotective Evaluation of Curcuma longa Rhizomes on Diabetic Rats  \n\n\n\n\n\n\n\nManjari Mittal\n1\n, Vijay Juyal\n\n\n\n1\n, Anita Singh\n\n\n\n3\n \n\n\n\n1\nUttarakhand Technical University , Dehradun, Uttarakhand, India \n\n\n\n2\nDept. of Pharmacy, Devasthali Vidhyapeeth, Rudrapur, Uttarakhand, India \n\n\n\n\n\n\n\nIndia has a rich history of using plants for medicinal purpose, Turmeric (Curcuma longa) is extensively used \n\n\n\nas home remedy for various diseases and belongs to family Zingiberaceae. It is a perennial plant having \n\n\n\noblong brownish yellow coloured branched rhizomes.  The present study designed to evaluate \n\n\n\nantihyperglycaemic and cytoprotective activity of Curcuma longa rhizomes in diabetic rats. On the basis of \n\n\n\nphytochemical screening of various extracts of Curcuma longa rhizome, methanolic extract was found to be \n\n\n\nrich in phytoconstituents, so methanolic extract was selected for further evaluation. All male Wistar rats were \n\n\n\ndivided into five groups with six animals in each group. Group-I was normal rats, Group- II, III, IV and V \n\n\n\nwere made diabetic by a single intraperitoneal injection of alloxan monohydrate 120mg/kg bw. Group II \n\n\n\nserved as diabetic control, Group III as standard (glimepiride 1mg/kg bw orally) and Group IV and V as test \n\n\n\ngroups using methanolic extract at dose of 50 and 100 mg/kg bw orally respectively. Blood samples were \n\n\n\ncollected through retro orbital route on 0, 10, 20, 30 days after treatment. Administration of methanol extract \n\n\n\nof Curcuma longa rhizomes in diabetic rats showed dose dependent reduction in hyperglycemia significantly \n\n\n\n(p<0.05). The level of serum creatinine, blood urea, AST, ALT, serum cholesterol and triglyceride were also \n\n\n\nsignificantly (p<0.05) decreased after 30 days when compared to diabetic rats. Thus Curcuma longa having \n\n\n\nblood glucose lowering activity and also protect the body from increased levels of serum creatinine, blood \n\n\n\nurea, AST, ALT, cholesterol and triglyceride. \n\n\n\n\n\n\n\nOPM \u2013 02 (000069) \n \n \n\n\n\nStudies of In Vitro Modulatory Effects of Labisia pumila on Cytochrome P450 2C19   \n \n\n\n\nY Pan\n1\n, B A Abd-Rashid\n\n\n\n 2\n, Z Ismail\n\n\n\n 2\n, R Ismail \n\n\n\n3\n, J W Mak \n\n\n\n1\n, C E Ong \n\n\n\n4\n \n\n\n\n1\n School of Pharmacy and Health Sciences, International Medical University, Bukit Jalil,  Kuala Lumpur. \n\n\n\n2\n Herbal Medicine Research Unit, Division of Biochemistry, Institute for Medical Research, Kuala Lumpur. \n\n\n\n3\n Pharmacogenetics Research Group, Institute for Research in Molecular Medicine, Universiti Sains \n\n\n\nMalaysia, Kubang Kerian, Kelantan. \n4\n Jeffrey Cheah School of Medicine and Health Sciences, Monash University Sunway Campus, Bandar \n\n\n\nSunway, Selangor \n\n\n\n\n\n\n\nKacip Fatimah (Labisia pumila), has been used by many generations of Malay women to induce and facilitate \n\n\n\nchildbirth as well as a post-partum medicine. Cytochrome P450 (CYP) is a superfamily of enzymes involved \n\n\n\nin the metabolism of a majority of currently prescribed drugs and many environmental chemicals. CYP2C19 \n\n\n\nis one of the most important CYP isoforms responsible for the metabolism of many clinically used drugs \n\n\n\nincluding omeprazole, proguanil, certain barbiturates, citalopram, and diazepam. Concurrent administration of \n\n\n\nthose drugs with any xenobiotic modulating the CYP2C19 activity may lead to accumulation of the drugs, and \n\n\n\nsubsequently leading to adverse drug reactions. Furthermore, there are marked ethnic differences in poor \n\n\n\nmetabolizer (PM) frequency for CYP2C19, ranging from 2 to 5% in Caucasians to 18 to 23% in Asian \n\n\n\npopulations. Since no data has been documented regarding the modulatory effects of Kacip Fatimah on \n\n\n\nCYP2C19, in this study, enzyme assay (S-mephenytoin hydroxylase) based on high performance liquid \n\n\n\nchromatography (HPLC) was established to determine inhibitory potentials of various Kacip Fatimah extracts \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                           MPS Pharmacy Scientific Conference 2011 \n \n\n\n\n357 \n \n\n\n\n(aqueous, dichloromethane, ethanol, hexane). Results showed that hexane and dichloromethane extracts \n\n\n\ninhibited CYP2C19 activities more potently with IC50 values of 24.8 \u03bcg/ml and 4.1 \u03bcg/ml as well as with Ki \n\n\n\nvalues of 10.6 \u03bcg/ml and 6.9 \u03bcg/ml, respectively. As a conclusion, if these in vitro inhibitory effects were \n\n\n\nconfirmed using in vivo models, coadministration of Kacip Fatimah products with CYP2C19 substrates need \n\n\n\nto be closely monitored. \n\n\n\n\n\n\n\nOPM \u2013 03 (000139) \n \n\n\n\n \nProtective Effect of Coccinia grandis Leaves Against Anti-Tuberculosis Drugs Induced Hepatic Injury \n\n\n\nin Rats  \n  \n\n\n\nAnbu Jeba Sunilson, Abdullah Khan, Khaja Pasha & Qusro Bin Hassan \n\n\n\nSchool of Pharmacy, KPJ International University College of Nursing and Health Sciences, Kota Seriemas, \n\n\n\nNilai, Negeri Sembilan, Malaysia. \n\n\n\n\n\n\n\nCoccinia grandis Linn. (Cucurbitaceae) is a perennial branched handsome tendril climber, distributed \n\n\n\nthroughout India. It has been used in folk medicine for the treatment of jaundice. The aim of this work was to \n\n\n\nstudy the hepatoprotective effect of crude ethanolic and aqueous extracts from the leaves of C. grandis against \n\n\n\nliver damage induced by the combination of three anti-tuberculosis drugs in rats. The ethanolic extract at an \n\n\n\noral dose of 200 mgkg\n-1\n\n\n\n exhibited a significant (p<0.05) protective effect as shown by lowering serum levels \n\n\n\nof glutamic oxaloacetic transaminase, glutamic pyruvic transaminase, alkaline phosphatase, total bilirubin and \n\n\n\ntotal cholesterol and increasing levels of total protein and albumin levels as compared to silymarin, the \n\n\n\npositive control. These biochemical observations were supported by histopathological examination of liver \n\n\n\nsections. The activity may be due to the presence of flavonoid compounds. The extracts showed no sign of \n\n\n\nacute toxicity up to a dose level of 2000 mgkg\n-1\n\n\n\n. Thus it could be concluded that ethanolic extract of \n\n\n\nC.grandis leaves possesses significant hepatoprotective activity. \n\n\n\n\n\n\n\n\n\n\n\nOPM \u2013 04 (000176) \n \n \n\n\n\nEffect of Pandanus amarylifolius in the Isolated Guinea Pig Ileum : A Pilot Study   \n \n\n\n\nYSChong\n1\n, PNYeoh\n\n\n\n2\n,\n \nYSChen\n\n\n\n1\n, ATay\n\n\n\n1\n, MP Rao\n\n\n\n2\n \n\n\n\n1\n School of Medical Sciences, International Medical University, Kuala Lumpur, Malaysia. \n\n\n\n2\n School of Pharmacy & Health Sciences, International Medical University, Kuala Lumpur, Malaysia. \n\n\n\n\n\n\n\nThe effect of various doses of Pandanus amarylifolius (PA) was investigated in isolated male guinea pig \n\n\n\nileum in aerated Krebs-Henseleit solution using 1 g tension at 37\no\nC\n\n\n\n \nwith the Powerlab for recording. At doses \n\n\n\nof 10 \u03bcg/ml, 30\n \n\u03bcg/ml, 100 \u03bcg/ml, 300 \u03bcg/ml, 1 mg/ml, 3 mg/ml PA did not cause any effect on isolated \n\n\n\nguinea pig ileum. At 5 mg/ml, the tissue showed increase in spontaneous gut activity. Cumulative doses of 0.5 \n\n\n\nto 1.04 mg/ml PA decreased the response to the EC50 dose of acetylcholine significantly (P<0.0001), while \n\n\n\ndoses of 0.05 to 0.20 mg/ml PA produced graded reduction to the EC50 response to acetylcholine. PA (1.5 \n\n\n\nmg/ml) also shifted the dose response curve of acetylcholine to the right like with atropine, but at the doses \n\n\n\nstudied the change in the mean EC50 of acetylcholine was not statistically significant (p>0.05). Results of this \n\n\n\nstudy indicate PA to have an anticholinergic effect. \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                           MPS Pharmacy Scientific Conference 2011 \n \n\n\n\n358 \n \n\n\n\n\n\n\n\nOPM \u2013 05 (000179) \n \n\n\n\n\n\n\n\nTracheal Relaxant Effect of Pandanus amarylifolius in the Guinea Pig  \n \n\n\n\nPN Yeoh\n1\n, YS Chong\n\n\n\n2\n, YS Chen\n\n\n\n2 \n,\n \nA Tay\n\n\n\n2\n,\n \nMP Rao\n\n\n\n1\n \n\n\n\n1\n School of Pharmacy & Health Sciences, International Medical University, Kuala Lumpur, Malaysia.\n\n\n\n\n\n\n\n2\n School of Medical Sciences, International Medical University, Kuala Lumpur, Malaysia. \n\n\n\n\n\n\n\nThe ethanolic extract of Pandanus amarylifolius (PA) was tested in the isolated trachea of the male guinea \n\n\n\npig. Doses of 10 \u03bcg/ml to 5 mg/ml were investigated for its effect and for interaction with the effect to \n\n\n\nhistamine. PA did not show any effect on tracheal muscle when given by itself. But it caused a significant \n\n\n\ncumulative relaxation (p<0.05 to p<0.001) to the contractile response to the EC50 dose of histamine. The \n\n\n\nresults showed PA to have a relaxation action in the guinea pig trachea. Additional study with propranolol (10\n-\n\n\n\n5\nM) showed that the relaxant effect due to PA was not changed in the presence of propranolol, indicating that \n\n\n\nthe relaxant action is probably not related to blockade of beta adrenoceptors. \n\n\n\n\n\n\n\n\n\n\n\nPHARMACEUTICAL CHEMISTRY \n\n\n\n\n\n\n\nOPC \u2013 01 (000115) \n\n\n\n\n\n\n\nInsight into the Structure Requirements of Alkenyl Indazole Scaffold-based Derivatives as Aurora \n\n\n\nKinase Inhibitors Using 3D-QSAR and Molecular Docking  \n \n\n\n\nC W Mai, Y A M Natalie, M R Pichika, Y B Kang \n\n\n\nPharmaceutical Chemistry, School of Pharmacy and Health Sciences, International Medical University, \n\n\n\nKuala Lumpur \n\n\n\n\n\n\n\nAurora kinase inhibitors have been discovered and some have advanced to human clinical trials. However, a \n\n\n\ndetailed study on how the structural features of these compounds can influence their biological activity is \n\n\n\nsignificant in favour of improving their activities. Comparative molecular field analysis (CoMFA) and \n\n\n\ncomparative molecular similarity indices analysis (CoMSIA) studies have been carried out on a series of \n\n\n\nalkenyl indazoles as aurora kinase inhibitors. The data set contained compounds with known 50% inhibition \n\n\n\nconcentration (PIC50) values, and certain compounds were used as a training set to develop the three-\n\n\n\ndimensional quantitative structure-activity relationship (3D-QSAR) model. The CoMFA model, yielded a \n\n\n\ncross-validated coefficient, q\n2\n value of 0.360 and a conventional correlation coefficient, r\n\n\n\n2\n value of 1.000. On \n\n\n\nthe other hand, the CoMSIA model yielded a q\n2\n value of 0.385 and r\n\n\n\n2\n value of 0.999. The contour maps \n\n\n\nobtained from the 3D-QSAR studies were analysed and results suggest that the electrostatic field plays an \n\n\n\nimportant role in ligand-receptor interactions with field contributions of 50.3% (CoMFA model) and 43.8% \n\n\n\n(CoMSIA model). The predictive capabilities of both models were externally validated with a test set of \n\n\n\ncompounds that were not included in the training set. The predictive correlation coefficient, obtained from the \n\n\n\nCoMFA and CoMSIA models are 0.72 and 0.58 respectively. Thus it suggests that the CoMFA model has a \n\n\n\nbetter external predictive ability over the CoMSIA model. These observations were further supported by \n\n\n\ndocking studies. It can be concluded that the CoMFA analysis can be used in designing the new aurora kinase \n\n\n\ninhibitor analogues with better potency. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                           MPS Pharmacy Scientific Conference 2011 \n \n\n\n\n359 \n \n\n\n\nOPC \u2013 02 (000183) \n\n\n\n\n\n\n\nA Single Compound Alternative to a Buprenorphine/Naltrexone Combination to Treat Polydrug Abuse  \n\n\n\n\n\n\n\nIrna Elina Ridzwan\n1,3\n\n\n\n, M.J.Clarke\n2\n, J.R.Traynor\n\n\n\n2\n, S.M.Husbands\n\n\n\n1\n, C.P.Bailey\n\n\n\n1\n \n\n\n\n1\n Department of Pharmacy and Pharmacology, University of Bath, UK \n\n\n\n2\n Department of Pharmacology, University of Michigan, UK \n\n\n\n3\n Kulliyyah of Pharmacy, International Islamic University Malaysia (IIUM), Malaysia \n\n\n\n\n\n\n\nBuprenorphine is currently used as a maintenance therapy for opioid addiction, but recent studies suggest that \n\n\n\na combination of buprenorphine and naltrexone may be effective in preventing relapse to opioid use, but also \n\n\n\nreducing cocaine and alcohol use. However, it has proven to be a challenge to design a single formulation of \n\n\n\nthis combination because of the different routes of administration. The aim of this project is to synthesize a \n\n\n\nsingle compound, alternative to this drug combination. In previous work carried out within this research \n\n\n\ngroup, compounds BU127 a buprenorphine analogues, were reported to have receptor profiles similar to \n\n\n\nbuprenorphine but with relatively lower efficacy at mu-opioid receptor, as desired. Based on this finding, we \n\n\n\nsynthesized and evaluated in vitro a series of analogues to investigate if the opioid receptor profile of the \n\n\n\ncompounds can be optimized to closely mimic that combination. These compounds have been screened at a \n\n\n\nsingle high concentration (10 \u00b5M), in a [35S]GTPcS assay, to determine efficacy at mu, kappa and ORL-1 \n\n\n\nreceptors. For each of the new ligands, kappa efficacy was observed. This ranged from partial agonist activity \n\n\n\nthrough to high efficacy, predicting that ligands from this particular series would not be suitable for \n\n\n\nconsideration as alternatives to the combination. The compounds are being further evaluated in rat and mouse \n\n\n\nvas deferens for opioid receptor profiling in order to determined the ORL-1, mu and opioid receptor activity \n\n\n\nof the new ligands. The results provide useful new structure-activity data that should help in the design of \n\n\n\nfuture compounds. \n\n\n\n\n\n\n\nOPC \u2013 03 (000053) \n\n\n\n\n\n\n\nSynthesis and Antimicrobial Evaluation of Some Novel Schiff Bases Containing Imidazo[2,1-b]-1,3,4-\n\n\n\noxadiazole  \n\n\n\n\n\n\n\nHarish Rajak, Chinmay Behera, Poonam Parmar, Bhupendra S Thakur, JS Dangi \n\n\n\nSLT Institute of Pharmaceutical Sciences,Guru Ghasidas University, Bilaspur-495 009 (CG), India. \n\n\n\n\n\n\n\nThe rapid emergence of drug resistance in the treatment of microbial disease emphasizes worldwide need for \n\n\n\nnewer antimicrobial agents. A novel series of Schiff bases containing imidazo[2,1-b]-1,3,4-oxadiazole ring \n\n\n\ni.e., 2-(4-substituted-phenyl)-6-methyl-imidazo[2,1-b][1,3,4]oxadiazole-5-carboxylic acid (4-substituted-\n\n\n\nbenzylidene)-hydrazide were synthesized for their antimicrobial activity. The structures of the compounds \n\n\n\nwere confirmed by elemental and IR, NMR and MS spectral analysis. The antimicrobial potential of \n\n\n\nsynthesized compounds were evaluated against Escherichia coli, Staphylococcus aureus, Bacillus subtilis, \n\n\n\nStaphylococcus epidermidis, Pseudomonas fluorescens, Aspergillus niger and Candida albicans using disk \n\n\n\ndiffusion method. The MIC of the all the synthesized compounds were calculated by plotting concentration of \n\n\n\nthe compounds and their respective zone of inhibition using agar diffusion web tool. Majority of the \n\n\n\ncompounds were found to possess a broad spectrum of antimicrobial activities against all the pathogenic \n\n\n\nmicroorganisms tested including P. fluorescens and C. albicans responsible for nosocomial infection. The \n\n\n\ncompound 2-(4-chloro-phenyl)-6-methyl-imidazo[2,1-b][1,3,4]oxadiazole-5-carboxylic acid (4-methoxy-\n\n\n\nbenzyli dene)-hydrazide was found to be the most active in antibacterial evaluation with MIC of 1.37, 1.60, \n\n\n\n1.11, 1.09 and 1.23 \u00b5g/ml against E. coli, S. aureus, B. subtilis, S, epidermidis and P. fluorescens, \n\n\n\nrespectively. In antifungal evaluation, most active compound was 2-(4-chloro-phenyl)-6-methyl-imidazo[2,1-\n\n\n\nb][1,3,4]oxadiazole-5-carboxylic acid (4-chloro-benzylidene)-hydrazide, which showed MIC of 2.22 and 2.06 \n\n\n\n\u00b5g/ml against A. niger and C. albicans respectively. A comparison of antibacterial and antifungal activities \n\n\n\nshown by synthesized compounds indicates that antibacterial activities have upper edge on the antifungal \n\n\n\nactivities in terms of their zone of inhibitions and MIC values. An effort has also been made to establish \n\n\n\ncorrelation between structure and antimicrobial activity of the compounds. \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                           MPS Pharmacy Scientific Conference 2011 \n \n\n\n\n360 \n \n\n\n\n\n\n\n\nPHARMACEUTICAL TECHNOLOGY \n\n\n\n \nOPT \u2013 01 (000017) \n\n\n\n\n\n\n\nSurface Modified Liposomes for Transmucosal Vaccination through Nasal Route  \n\n\n\n\n\n\n\nTiwari B.K.\n1\n, Agrawal A.\n\n\n\n1\n, Agrawal G.P.\n\n\n\n1\n \n\n\n\n1 \nDepartment of Pharmaceutical Sciences, Dr. H.S. Gour Central University, Sagar(M.P.) India \n\n\n\n\n\n\n\nThe aim of the present investigation was to evaluate the prospective of surface-engineered vesicular carriers \n\n\n\nfor mucosal immunization via the nasal route. IgG antibody was immobilized on the surface of hepatitis B \n\n\n\nsurface antigen (HBsAg)\u2013loaded liposomes. The developed formulations were characterized on the basis of \n\n\n\nphysicochemical parameters, such as morphology, particle size, polydispersity index, entrapment efficiency, \n\n\n\nand zeta potential. Liposomal formulations were then evaluated for in-process antigen stability and storage \n\n\n\nstability. In vivo studies were conducted to visualize targeting potential, localization pattern, and \n\n\n\nimmunogenicity. In addition, immune response was compared with alum-HBsAg vaccine injected \n\n\n\nintramuscularly. The serum anti-HBsAg titer, obtained from the postnasal administration of IgG-coupled \n\n\n\nliposomes, was significantly higher than plain liposomes. Moreover, IgG-coupled liposomes generated both \n\n\n\nhumoral (i.e., systemic and mucosal) and cellular immune responses upon nasal administration, while the \n\n\n\nalum-adsorbed antigen displayed neither cellular (cytokine level) nor mucosal (IgA) response. The \n\n\n\nformulation also displayed enhanced transmucosal transport, improved in vitro stability, and effective \n\n\n\nimmunoadjuvant property. To conclude, IgG antibody-coupled liposomes may serve as novel carriers to \n\n\n\naugment the secretory immune response of antigen encapsulated in the liposomes, apparently by escalating \n\n\n\nliposome uptake via M cells, thereby rationalizing their use as a carrier adjuvant for nasal subunit vaccines. \n\n\n\n\n\n\n\nOPT \u2013 02 (000040) \n\n\n\n\n\n\n\nDevelopment of Synthetic Skin Lipid-Based Vesicles for Transcutaneous Immunization \n \n\n\n\nRavi Shankar Pandey\n1\n, Manoj Kumar\n\n\n\n1\n, Vinod Kumar Dixit\n\n\n\n2 \n\n\n\n1\nSLT Institute of Pharmaceutical Sciences, Guru Ghasidas Vishwavidyalaya, Bilaspur (C.G.)- 495009 INDIA \n\n\n\n2\nDepartment of Pharmaceutical Sciences, Dr. Harisingh Gour Vishwavidyalaya, Sagar (M.P.)-470003 INDIA \n\n\n\n\n\n\n\nSynthetic skin lipid-based vesicles were developed and evaluated for topical delivery of vaccines using \n\n\n\nOvalbumin (OVA) as a model antigen. Synthetic skin lipid liposomes (SCLLs) and plain liposomes (PCLs) \n\n\n\nwere prepared by reverse-phase evaporation method. Various formulation variables were studied namely \n\n\n\nmolar ratio of lipids, OVA concentration, pH and ionic strength. The formulations were characterized for size, \n\n\n\nshape, surface charge, antigen integrity, OVA loading efficiency and in vitro release by various biophysical \n\n\n\nmethods.  The immune stimulating activity of SCLLs and PCLs were studied by measuring the serum anti-\n\n\n\nOVA IgG titre following topical immunization to the Balb/c mice. It was observed that mean diameters of \n\n\n\nSCLL dispersions (260\u00b160 nm) were smaller than PCL (360\u00b172 nm). OVA-SCLL vesicles in specific ratio of \n\n\n\nskin lipids and formulated at pH 4.5 were stable and showed high association of OVA with preserved \n\n\n\nantigenicity. Zeta potential was found negative (-37.7\u00b111.2) in these vesicles.  Loading of OVA further \n\n\n\nenhanced the surface charge and reduced the size of vesicles. TEM studies revealed that SCLL were mixture \n\n\n\nof concentric oligolamellar and unilamellar vesicles. SDS-PAGE studies revealed that SCLL and PCL both \n\n\n\npreserve the antigen conformation and this was also confirmed by in vitro enzyme linked immune-sorbent \n\n\n\nassay (ELISA).  Serum IgG titers determined after three consecutive topical administrations were \n\n\n\nsignificantly improved when compared to the corresponding OVA solution or OVA-liposomes (p < 0.05). It \n\n\n\ncan be concluded that SCLL holds promise for effective non-invasive topical delivery of antigen. \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                           MPS Pharmacy Scientific Conference 2011 \n \n\n\n\n361 \n \n\n\n\nOPT \u2013 03 (0000163) \n\n\n\n\n\n\n\nTopical Delivery of Bifonazole using Organogel - Formulation and Characterization \n \n\n\n\nShobha Yadav\n1\n, Pramod Yeole\n\n\n\n2\n, Abhay Ittadwar\n\n\n\n1 \n\n\n\n1\n Gurunanak College of Pharmacy, Nagpur, India \n\n\n\n2\n Institute of Pharmaceutical Education and Research, Wardha, India \n\n\n\n\n\n\n\nBifonazole is an antifungal agent applied topically for treating skin and nail infections. Topical drug delivery \n\n\n\nsystem provides a high local concentration of drug at the desired site but formulation may exhibit poor drug \n\n\n\npermeation. Creams are generally less effective than gels or sprays but newer formulations like \n\n\n\nmicroemulsions have greater potential in effective drug delivery. Hence, an attempt has been made to develop \n\n\n\norganogels of bifonazole using different organogelators such as lecithin and non-ionic surfactant. The present \n\n\n\nstudy was undertaken to investigate the potential of organogel as a novel topical drug delivery system. \n\n\n\nVarious formulations containing pluronic lecithin (FL1 to FL8) and non-ionic surfactant (FS1 to FS7) were \n\n\n\ndeveloped. Formulations were evaluated for psychorheology, drug content, pH, viscosity and spreadibility. It \n\n\n\nwas found that all formulations passed the primary requirements of a good topical formulation. To find the \n\n\n\nmost promising formulations, all the formulations were evaluated for in vitro drug release. FL2 and FS4 were \n\n\n\nfound to be the best in all respects. These selected formulations were then compared with the marketed \n\n\n\nformulation via diffusion and antifungal activity studies. FS4 showed higher drug release and larger mean \n\n\n\nzone of inhibition than FL2 and marketed formulation. An optimized non-ionic surfactant organogel is \n\n\n\ndesigned for effective delivery of bifonazole. \n\n\n\n\n\n\n\n\n\n\n\nOPT \u2013 04 (000098) \n\n\n\n\n\n\n\nEffect of Solid Dispersion Technique on Dissolution of Norfloxacin  \n\n\n\n\n\n\n\nGabriel Loh Onn Kit, Yvonne Tan Tze Fung, Peh Kok Khiang  \n\n\n\nSchool of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Minden, Penang, Malaysia \n\n\n\n\n\n\n\nThe effect of solid dispersion technique on dissolution of norfloxacin, a poorly water-soluble BCS Class IV \n\n\n\ndrug was examined. Three hydrophilic polymers were employed in the preparation of solid dispersion, \n\n\n\nnamely, hydroxypropyl methyl cellulose (HPMC), polyvinylpyrrolidone (PVP), and hydroxypropyl cellulose-\n\n\n\nlow substituted (HPC-L), using solvent evaporation method. Norfloxacin was first dissolved in acetone \n\n\n\nfollowed by the addition of the hydrophilic polymers. The organic solvent was then removed by heat under \n\n\n\nconstant stirring. After drying in oven overnight, the solid dispersion was sieved before evaluated for drug \n\n\n\ncontent, thermal (differential scanning calorimetr, DSC), chemical interaction (fourier transform infrared \n\n\n\nspectroscopy, FTIR) and dissolution profiles. Norfloxacin content was 97-99% which was within the \n\n\n\nacceptable limit of pharmacopeia. DSC analysis showed a reduction in the intensity and enthalpy of \n\n\n\nnorfloxacin endothermic peak, with a shift to lower melting point for all the hydrophilic polymers. FTIR \n\n\n\nspectra did not show any chemical interaction between norfloxacin and hydrophilic polymers. Solid dispersion \n\n\n\nshowed an increase in drug dissolution when compared with norfloxacin alone. Solid dispersion prepared with \n\n\n\nHPMC was noted to have faster drug dissolution followed HPC-L and lastly PVP. In conclusion, solid \n\n\n\ndispersion technique can be used to improve dissolution and hence bioavailability of poorly soluble \n\n\n\ncompound. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                           MPS Pharmacy Scientific Conference 2011 \n \n\n\n\n362 \n \n\n\n\nOPT \u2013 05 (000159) \n\n\n\n\n\n\n\nRisperidone-PEG 6000 Binary Systems - Physico-Chemical Characterization and Mathematical \n\n\n\nModeling \n \n\n\n\nVenkateskumar K\n1\n,  Verma PRP\n\n\n\n2\n, Suchandra Sen\n\n\n\n3\n \n\n\n\n1\nFaculty of Pharmacy, AIMST University, Semeling, Kedah Darul Aman, Malaysia \n\n\n\n2\nDepartment of Pharmaceutical Sciences, Birla Institute of Technology, Mesra, Ranchi, 835215, India \n\n\n\n3\nDepartment of Pharmaceutics, KMCH College of Pharmacy, Coimbatore-641048, India \n\n\n\n\n\n\n\nThe present study aims to provide an insight to the role of hydrophilic carriers on dissolution enhancement of \n\n\n\npoorly water-soluble risperidone in binary systems with PEG 6000 (polyethylene glycol 6000). Solid \n\n\n\ndispersions were formulated by melt dispersion method and subjected to physicochemical characterization. \n\n\n\nPhase solubility studies showed a linear increase in aqueous solubility of drug with an increase in carrier \n\n\n\ncontent. The negative thermodynamic parameters like Gibbs free energy and enthalpy, and positive entropy \n\n\n\nindicated the spontaneity and solubilisation effect of PEG 6000. All dispersions showed increased dissolution \n\n\n\nrate in comparison to pure risperidone to varying degrees and dispersions with the highest concentration of \n\n\n\nPEG 6000 was selected as the optimized batch. Mathematical modelling of release data indicated drug release \n\n\n\nprimarily followed Fickian diffusion. X-ray diffractometry, differential scanning calorimetry, Fourier \n\n\n\ntransform infrared, near infrared, Raman and particle size analysis revealed the change in crystal quality/loss \n\n\n\nof crystallinity of drug with a significant reduction in particle size. Wettability studies indicated that the \n\n\n\nwettability of drug was increased by PEG 6000. Permeability studies across natural and synthetic membranes \n\n\n\nindicated the permeation potential of such systems. It is concluded that binary systems can be used to develop \n\n\n\nfast-release dosage forms. \n\n\n\n\n\n\n\n\n\n\n\nOPT \u2013 06 (000090) \n\n\n\n\n\n\n\nFormulation and In Vitro Pulmonary Deposition of Budesonide Nanomicelles using Different \n\n\n\nNebulisers \n \n\n\n\nMN Sahib, Y Darwis, KK Peh, YTF Tan \n\n\n\nSchool of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia \n\n\n\n\n\n\n\nAsthma is a chronic pulmonary disorder characterised by reversible narrowing of the airway due to \n\n\n\ninflammation and airflow obstruction. Inhaled corticosteroids are the cornerstone of management in most \n\n\n\nasthmatic patients. Nebulisations of these compounds have many drawbacks due to poor water solubility and \n\n\n\nnon-optimized deposition pattern of the drug. The aims of this study were to prepare and investigate the in \n\n\n\nvitro pulmonary deposition of budesonide (BUD) loaded sterically stabilized phospholipid nanomicelles \n\n\n\n(SSMs) as pulmonary delivery system for nebulisation. BUD-SSMs were prepared by the coprecipitation and \n\n\n\nreconstitution method. Physicochemical and in vitro pulmonary deposition evaluations using Pari LC and \n\n\n\nOmron nebulisers were characterised. Solubility of BUD was increased to 1197.75\u00b17.42 \u00b5g/ml which was \n\n\n\n>50 times the actual BUD solubility. Particle size (14.31\u00b11.40 nm) and zeta potential (-46.61\u00b12.94 mV) \n\n\n\nresults showed beneficial advantages for the pulmonary delivery system since particles of less than 260 nm \n\n\n\ncan evade the macrophages and negatively charged particles are easier to be arrested in the lungs than \n\n\n\npositively charged particles. The BUD-SSMs have an entrapment efficiency of 100.20\u00b11.03%, yield of 97% \n\n\n\nand a prolonged drug release over 6 days. In addition, the aerodynamic characteristic values were more \n\n\n\nsuperior than some commercial products. SSMs formulation showed a beneficial potential to nebulise poorly \n\n\n\nwater-soluble corticosteroid to the lung. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                           MPS Pharmacy Scientific Conference 2011 \n \n\n\n\n363 \n \n\n\n\n\n\n\n\n\n\n\n\nOPT \u2013 07 (000096) \n\n\n\n \nFormulation and Evaluation of Efavirenz Loaded Citric Acid Dendrimers \n\n\n\nPalanirajan Vijayarajkumar \n\n\n\nUCSI University, Faculty of Pharmaceutical Sciences, No.1 Jalan Menara Gading, 56000 Cheras, Kuala \n\n\n\nLumpur, Malaysia.  \n\n\n\n\n\n\n\nThe present studies were aimed at developing and exploring the use of citric acid dendritic nanostructure for \n\n\n\nthe solubilization and sustained delivery of an anti-viral drug, Efavirenz. The citric acid dendritic \n\n\n\nnanostructure was synthesized and characterized by using IR and NMR spectroscopy.The molecular \n\n\n\nmodelling studies were performed to elucidate the binding pattern of the Efavirenz with 3\nrd \n\n\n\ngeneration citric \n\n\n\nacid dendrimer. Efavirenz was efficiently loaded into citric acid dendritic nanostructure using dissolution \n\n\n\nmethod. Various physicochemical and physiological parameters such as UV, DSC, drug loading, \n\n\n\nsolubilization and in-vitro release concerning the citric acid dendritic nanostructure were evaluated. From this \n\n\n\npresent study, it can be concluded that citric acid dendrimer units increased the aqueous solubility of efavirenz \n\n\n\nand demonstrated citric acid dendrimer is suitable for sustained delivery of efavirenz. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nOPT \u2013 08 (000166) \n\n\n\n\n\n\n\nPhysicochemical and Film Forming Properties of Starch Extracted from Echinochloa colonum \n \n\n\n\nDr. Vinita Kale, Abhishek Chawardol, Shrikant Gadekar, Sheelpriya Walde \n\n\n\nGurunanak College of Pharmacy, Dixit Nagar, Nari, Nagpur, India.  \n\n\n\n\n\n\n\nWith the ever increasing population and fast depletion of natural resources, it has now become necessary that \n\n\n\nattention is paid to explore the possibilities of plant as new resources. This study aims to evaluate the potential \n\n\n\nof under-utilised plants and their possible role as pharmaceutical excipient. Echinochloa colonum grows \n\n\n\namongst the rice paddy as weed. This study investigated the powder properties of starch isolated from \n\n\n\nEchinochloa colonum and its film forming properties for tablet coating. The microscopy observation revealed \n\n\n\nthat the isolated starch particles were polygonal in shape with an average particle size of 0.21 \u00b1 0.23 mm. The \n\n\n\nvalues of Hausner\u2019s ratio (1.2410 \u00b1 0.1600) and Carr\u2019s index (19.4233 \u00b1 0.2800 %) indicated that \n\n\n\nEchinochloa colonum starch would give superior flow. From the results of bulk density, tapped density, \n\n\n\nporosity and packing fraction, Echinochloa colonum starch exhibited a large optimum volume reduction due \n\n\n\nto packing. It appeared that under the applied tapping pressure, the polygonal shape, fine texture and small \n\n\n\nparticle size of Echinochloa colonum starch promoted close packing of particles. Processing starch solution \n\n\n\nwith optimum heating temperature and time produced films with high tensile strength (29.88 MPa) but low \n\n\n\nstrain at break (2.60 %). Sorbitol or glycerol was not suitable as plasticizer due to its anti-plasticizing \n\n\n\nphenomenon on the said film unlike castor oil. The starch isolated from Echinochloa colonum can be used as a \n\n\n\nsubstitute of synthetic polymer in pharmaceutical industry. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                           MPS Pharmacy Scientific Conference 2011 \n \n\n\n\n364 \n \n\n\n\nOPT \u2013 09 (000014) \n\n\n\n\n\n\n\nNanolipobeads as Drug Delivery System for Effective Management of Peptic Ulcer \n \n\n\n\nAshish Kumar Jain, Govind P. Agrawal \n\n\n\nPharmaceutics Research Lab., Deptt. of Pharmaceutical Sciences, Dr. H.S. Gour Central University, Sagar- \n\n\n\n470 003, India. \n\n\n\n\n\n\n\nThe study evaluated nanolipobeads consisting of (i) poly vinyl alcohol (PVA) (ii) ranitidine bismuth citrate \n\n\n\n(RBC) and amoxicillin trihydrate (AMOX) and (iii) phosphotidylethanolamine (PE) for the treatment of \n\n\n\nmucosal ulcer through target delivery of drugs to H. Pylori. The effects of formulation and process variables \n\n\n\nin the preparation of PVA hrdrogel nanoparticles viz surfactant concentration, stirring speed, stirring time, \n\n\n\nsonication time, number of freeze thaw cycles and oil:PVA phase ratio on particle size distribution and drug \n\n\n\nentrapment efficiency were examined. The optimized PVA hydrogel nanoparticles had a mean size of 268.2 \u00b1 \n\n\n\n3.4 nm with in vitro drug release of RBC amounting to 94.3 \u00b1 1.4 % at 144 h of dissolution. These \n\n\n\nnanoparticles were acetylated at their surfaces using 1M polymitoyl chloride prior to combining equal parts of \n\n\n\nacylated PVA hydrogel nanoparticles with AMOX loaded PE liposome suspension (174.8 \u00b1 5.2 nm) through \n\n\n\nsurface interaction to produce nanolipobeads. The optimized nanolipobeads had a mean size of 773.4 \u00b1 2.3 nm \n\n\n\nwith in vitro sustained release of 96.3 \u00b1 1.6 % AMOX and 91.4 \u00b1 1.2 % RBC over 144 h of dissolution. These \n\n\n\nnanolipobeads could reduce the absolute alcohol-induced ulcerogenic index in animal model from 3.00 \u00b1 0.08 \n\n\n\nto 0.20 \u00b1 0.01 suggesting their usefulness as dual drug delivery system for treatment of peptic ulcer.  \n\n\n\n\n\n\n\nOPT \u2013 10 (000127) \n\n\n\n\n\n\n\nDevelopment of Dissolution Medium and UV Spectorphotometric Method for Determination of \n\n\n\nValsartan in Tablets  \n \n\n\n\nB V S Lokesh\n1\n, Leong Meng Fai\n\n\n\n2\n \n\n\n\n1\n Department of Pharmaceutical Chemistry, Faculty of Pharmaceutical Sciences, UCSI University, Kuala \n\n\n\nLumpur, Malaysia. \n2\n Faculty of Pharmaceutical Sciences, UCSI University, Kuala Lumpur, Malaysia. \n\n\n\n\n\n\n\nDissolution of drugs from solid dosage forms is a quality parameter required assessment during pre-\n\n\n\nformulation study, pilot scale-up and production. In vitro dissolution is introduced to assess batch-to-batch \n\n\n\nconsistency of drug release from a formulation and identify potential problems associated with in vivo drug \n\n\n\nrelease and absorption. The selection of a dissolution medium with an acceptable volume for poorly water-\n\n\n\nsoluble drugs and composition having a good discriminating power can be difficult. Valsartan (VST) is a safe \n\n\n\nand effective antihypertensive drug for treatment of mild to moderate hypertension. VST is a poorly water-\n\n\n\nsoluble and highly permeable drug. There is no official dissolution medium available in the literature. The \n\n\n\npresent study aims to develop an economical and industrially feasible dissolution method for VST assayed \n\n\n\nusing UV-spectrophotometer. VST showed a high solubility in pH 7.4 phosphate buffer medium satisfying the \n\n\n\nsink conditions. The absorbance maximum (\u03bbmax) of VST was 207 nm. The linearity was studied by plotting \n\n\n\nabsorbance (A) against concentration(C) in the range of 1-10 \u03bcg/ml VST with the linear regression coefficient \n\n\n\nbeing 0.997 and the linear regression equation as A=0.094 C + 0.010. The dissolution rate of VST commercial \n\n\n\ntablets was determined at 37.0 \u00b1 0.5\u00b0C in 900 ml of buffer using a USP standard dissolution apparatus II \n\n\n\n(using paddles) at 50 rpm. The experiments were conducted in triplicates and samples were assayed for VST \n\n\n\nrelease. The extent of dissolution for commercial formulations was high in pH 7.4 phosphate buffer within the \n\n\n\nrange of 99.6-100.4% of the labeled claim. The results indicated no significant difference from the method \n\n\n\nproposed in USP30-NF25 illustrating its high precision and accuracy. In conclusion, an industrially feasible, \n\n\n\neconomical and easier dissolution method was developed for commercial VST tablets. \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                           MPS Pharmacy Scientific Conference 2011 \n \n\n\n\n365 \n \n\n\n\nPHARMACY EDUCATION \n\n\n\n\n\n\n\nOES \u2013 01 (000091) \n\n\n\n\n\n\n\n \nEvaluation of an Innovative Workplace Quit Smoking Program for Smoking Employees in a \n\n\n\nManufacturing Company \n \n\n\n\nGoh S.L.\n1\n, Hassali MA\n\n\n\n1\n, Shafie AA\n\n\n\n1\n, Habil MH\n\n\n\n2\n, Md Haris Robson NZ\n\n\n\n2\n \n\n\n\n1 \nDiscipline of Social & Administrative Pharmacy, Universiti Sains Malaysia, Pulau Pinang, Malaysia \n\n\n\n2 \nUniversity of Malaya Centre for Addiction Sciences (UMCAS), Department of Psychological Medicine, \n\n\n\nFaculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia \n\n\n\n\n\n\n\nThe workplace is a potential setting to reach a large group of smokers and implement smoking cessation \n\n\n\nprogram. Hence, a free innovative multicomponent workplace quit smoking program was designed \n\n\n\nspecifically to help the smoking employees to stop smoking. To evaluate the effectiveness of this innovative \n\n\n\nworkplace smoking cessation program. All smokers were invited to attend the launch of the quit smoking \n\n\n\nprogram. The intervention included 12-week behavioural therapy together with pharmacotherapy, simple self-\n\n\n\nhelp materials as well as social and environmental support. Successful quitting smoking was defined as the 7-\n\n\n\nday point-prevalence of smoking abstinence at Week-12; confirmed by CO measurement. 167 people signed \n\n\n\nup for the program during the launch. From the total of 159 participants, only two of them were females. A \n\n\n\ntotal of 8 participants (5%) opted out of the program when it was started. The 7-day point-prevalence of \n\n\n\nsmoking abstinence at Week-12 was 60% (n=101, male). Both female participants did not quit smoking \n\n\n\nsuccessfully and were still smoking at the end of the program (week-12). Free smoking cessation program, \n\n\n\npeer support and management pressure do motivate smoking employees to quit smoking. To be smoke-free, \n\n\n\nstrong will power is still a crucial factor to ensure the smokers follow through the whole program and stop \n\n\n\nsmoking at the end of the program. For female smokers, their smoking spouses will be another barrier for \n\n\n\nthem to stop smoking. This free multicomponent workplace quit smoking program is effective to help \n\n\n\nsmoking employee to quit smoking. \n\n\n\n\n\n\n\n\n\n\n\nOES \u2013 02 (000145) \n\n\n\n\n\n\n\nPerception of Pharmacy Students at Private Universities in Malaysia towards the Roles of Community \n\n\n\nPharmacists \n \n\n\n\nN E Ismail\n1\n, N S Mohd Ismail\n\n\n\n1\n, W N Wan Mahmood\n\n\n\n1\n, M A Nawab Khan\n\n\n\n1\n, M A Hameed\n\n\n\n1\n, A Adam\n\n\n\n2\n, M \n\n\n\nA Ahmad Hassali\n3\n, A A Shafie\n\n\n\n3\n, M H Nik Mohamed\n\n\n\n4\n, S Mohd\n\n\n\n5\n, E Yusuf\n\n\n\n6\n, Z Kasim\n\n\n\n6\n, B Efendie\n\n\n\n7\n, M R \n\n\n\nBaig\n8\n \n\n\n\n1 \nClinical Pharmaceutics Research Group (CPRG) & Inhalational Delivery Research Unit (IDRU), Faculty of \n\n\n\nPharmacy, Universiti Teknologi MARA (UiTM), Puncak Alam Campus, 42300 Bandar Puncak Alam, \n\n\n\nSelangor, Malaysia \n2\n Faculty of Pharmacy, Universiti Teknologi MARA (UiTM), Puncak Alam Campus, 42300 Bandar Puncak \n\n\n\nAlam, Selangor, Malaysia \n3 \nSchool of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Pulau Pinang, Malaysia \n\n\n\n4 \nKulliyyah of Pharmacy, International Islamic University Malaysia, 25200 Kuantan, Pahang, Malaysia \n\n\n\n5 \nFaculty of Pharmacy, Cyberjaya University College of Medical Sciences, 63000 Cyberjaya, Selangor, \n\n\n\nMalaysia \n6 \nFaculty of Health and Life Sciences, Management and Science University, 40100 Shah Alam, Selangor, \n\n\n\nMalaysia \n7 \nSchool of Pharmacy and Health Sciences, International Medical University, 57000 Kuala Lumpur, Malaysia \n\n\n\n8 \nFaculty of Pharmacy, AIMST University, 08100 Bedong, Malaysia \n\n\n\n\n\n\n\nCommunity pharmacists involve in broad areas of activity in relation to health promotion as they are \n\n\n\nrecognised as highly accessible and credible health advisor that offering direct sources of diverse health \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                           MPS Pharmacy Scientific Conference 2011 \n \n\n\n\n366 \n \n\n\n\ninformation to the general public. This cross-sectional study determined the perception of undergraduate \n\n\n\nstudents towards the roles of a community pharmacist. Post local ethics approval and consent, developed self-\n\n\n\nadministered questionnaire was reviewed by a group of pharmacist and pilot tested before being distributed \n\n\n\nrandomly among Bachelor of Pharmacy students (year one until four) in four private universities in Malaysia \n\n\n\n(n = 1040), from August until September 2010. Both descriptive and inferential statistics were used for data \n\n\n\nanalysis whereby p value < 0.05 was considered as statistically significant. The response rate was 56.1% (n = \n\n\n\n583). The overall mean (SD) age of students was 21.0 years old (\u00b11.8), majority were females (78.9%), \n\n\n\nChinese (56.6%), single (99.7%) and enrolled into pharmacy degree programme via matriculation \n\n\n\nqualification (32.1%). The top fifteen perceived involvement roles and counselling activities of community \n\n\n\npharmacists with significant differences* due to different year of study (where applicable) were drug misuse*, \n\n\n\ndiabetes*, report adverse events*, refer patients to other sources of help and care when necessary*, asthma \n\n\n\nand COPD*, cardiovascular disease prevention*, monitoring blood pressure, pregnancy and lactation drugs, \n\n\n\nsexual health, child health, contraceptive*, treating minor ailments promptly and effectively, traditional and \n\n\n\ncomplementary medicine, pain management and smoking cessation*. Overall, students agreed that community \n\n\n\npharmacists should engage in greater role in public health in addition to dispense and distribute medications. \n\n\n\n\n\n\n\nOES \u2013 03 (000162) \n\n\n\n\n\n\n\nPerception of Pharmacy Students at Private Universities in Malaysia towards the Roles of Pharmacists \n\n\n\nin Academia \n \n\n\n\nN E Ismail\n1\n, N S Mohd Ismail\n\n\n\n1\n, W N Wan Mahmood\n\n\n\n1\n, M A Nawab Khan\n\n\n\n1\n, A Adam\n\n\n\n2\n, M A Ahmad \n\n\n\nHassali\n3\n, A A Shafie\n\n\n\n3\n, M H Nik Mohamed\n\n\n\n4\n, S Mohd\n\n\n\n5\n, E Yusuf\n\n\n\n6\n, Z Kasim\n\n\n\n6\n, I Abdullah\n\n\n\n6\n, B Efendie\n\n\n\n7\n, M R \n\n\n\nBaig\n8 \n\n\n\n1\n Clinical Pharmaceutics Research Group (CPRG) & Inhalational Delivery Research Unit (IDRU), Faculty of \n\n\n\nPharmacy, Universiti Teknologi MARA (UiTM), Puncak Alam Campus, 42300 Bandar Puncak Alam, \n\n\n\nSelangor, Malaysia \n2\n Faculty of Pharmacy, Universiti Teknologi MARA (UiTM), Puncak Alam Campus, 42300 Bandar Puncak \n\n\n\nAlam, Selangor, Malaysia \n3\n School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Pulau Pinang, Malaysia \n\n\n\n4\n Kulliyyah of Pharmacy, International Islamic University Malaysia, 25200 Kuantan, Pahang, Malaysia \n\n\n\n5\n Faculty of Pharmacy, Cyberjaya University College of Medical Sciences, 63000 Cyberjaya, Selangor, \n\n\n\nMalaysia \n6\n Faculty of Health and Life Sciences, Management and Science University, 40100 Shah Alam, Selangor, \n\n\n\nMalaysia \n7\n School of Pharmacy and Health Sciences, International Medical University, 57000 Kuala Lumpur, Malaysia \n\n\n\n8\n Faculty of Pharmacy, AIMST University, 08100 Bedong, Malaysia \n\n\n\n\n\n\n\nJob of delivering pharmacists for the profession has been done committedly by pharmacy academia. The \n\n\n\navailability of appropriate numbers of well-qualified faculty members teaching in its professional and \n\n\n\ngraduate programmes is fundamental for the triumph of academic pharmacy. This cross-sectional study \n\n\n\nassessed the perception of local undergraduate students towards the roles of registered pharmacists in \n\n\n\nacademia. Post ethics consensus, developed self-administered questionnaire was reviewed by a group of \n\n\n\npharmacist and pilot tested before being distributed randomly among Bachelor of Pharmacy students (year \n\n\n\none until four) in four private universities in Malaysia (n = 1040), from August until September 2010. Both \n\n\n\ndescriptive and inferential statistics were used for data analysis whereby p value < 0.05 was considered as \n\n\n\nstatistically significant. The response rate was 56.1% (n = 583). The overall mean (SD) age of students was \n\n\n\n21.0 years old (\u00b11.8), majority were females (78.9%), Chinese (56.6%), single (99.7%) and enrolled into \n\n\n\npharmacy degree programme via matriculation qualification (32.1%). The top tenth perceived agreement on \n\n\n\nroles and undertakings of pharmacists in academia with significant differences* due to different year of study \n\n\n\n(where applicable) were patient care \u2013 educator/practitioner*; providing consultancy service; continuous \n\n\n\nprofessional development and education*; clinical, community and industrial site visits; teaching and learning \n\n\n\ndelivery, skills and development*; health care policy development; inter professional learning; research \n\n\n\ndevelopment and knowledge transfer; supervision of research student; and professional organization \n\n\n\ncommittees*. Lecturers that shared their knowledge and experience with students in addition to students\u2019 own \n\n\n\nobservational and future interest attributable to knowledge on roles of pharmacists in academia. \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                           MPS Pharmacy Scientific Conference 2011 \n \n\n\n\n367 \n \n\n\n\n. \n\n\n\nOES \u2013 04 (000180) \n\n\n\n\n\n\n\nIssues Associated With Medication Use by the Visually Impaired \n \n\n\n\nHG Lee, SY Ong, SS Chua \nDepartment of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur \n\n\n\n\n\n\n\nA recent newspaper publication quoted a comment by the Malaysian Association for the Blind (MAB) that \n\n\n\npeople with disability wish to be helped so that they can live independently rather than just providing them \n\n\n\nwith cash subsidy. This study was conducted to investigate the perception of the visually impaired on issues \n\n\n\nrelated to the use of medications and also the accessibility of medication information. A structured and \n\n\n\nvalidated questionnaire was administered to the visually impaired community in the Klang Valley. \n\n\n\nRespondents were recruited using convenient sampling. A total of 109 respondents participated in the study, \n\n\n\nwith a mean age (standard deviation) of 44.2 (13.86) years and 65.8% were men and 79.3% were currently \n\n\n\nemployed. Half of the respondents stayed with their family members (54.1%). Two third of the respondents \n\n\n\nagreed that the privileges and needs of visually impaired community in the area of healthcare have been \n\n\n\nneglected by the government (66%). Respondents with difficulties taking medication are also more likely to \n\n\n\nhave difficulties remembering information given by the doctors or pharmacists (p=0.012). In addition, 80% of \n\n\n\nthe respondents claimed that they could remember the instruction on how to take their medications, but more \n\n\n\nthan one third (35.7%) of those who claimed that they remember the instruction, still find that instructions or \n\n\n\ninformation given by the healthcare professionals were confusing about their medications. More studies \n\n\n\nshould be conducted to provide data for policy makers to improve the healthcare services for the visually \n\n\n\nimpaired community. \n\n\n\n\n\n\n\nOES \u2013 05 (000042) \n\n\n\n\n\n\n\nLearning Case History Assessment Skills Using Standardized Patients in Comparison with Didactical \n\n\n\nTeaching: Students Perception  \n \n\n\n\nSurulivel Rajan M, Poojee Sudhapalli, Mukesh kumar Sharma, Shabaz Mohiuddin\n \n\n\n\nDepartment of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal University, \n\n\n\nManipal, India \n \n\n\n\nAssessment of case history is a vital skill for performing SOAP analysis by Doctor of Pharmacy (Pharm. D) \n\n\n\nstudents. This study assessed students\u2019 perception on learning from standardized patient (SP) based program \n\n\n\nin comparison to didactical teaching. Pharm. D second year students were taught about history taking skills \n\n\n\nwith didactical teaching followed by interaction with SP in groups. These SPs have been trained to portray \n\n\n\nreal cases. At the end of training session, specific questionnaire was administered which comparatively \n\n\n\nassessed didactical teaching with SP interview. Issues like students\u2019 learning via SP interview in comparison \n\n\n\nwith didactical teaching, problems faced in didactical teaching and SP based interview, suggestions for \n\n\n\nimprovement, preferred mode of training, effect of individual skill on learning were included in the \n\n\n\nquestionnaire. Twenty eight students participated in this study. Twenty one opined that SP based training was \n\n\n\nexcellent in comparison to didactical teaching in terms of learning.  Problems of didactical teaching listed \n\n\n\nwere: poor in imparting practical knowledge (13/28); less interactive (10/28); monotonous (4/28) and difficult \n\n\n\nto understand (2/28). Nine did not have problems with didactical teaching. On the other hand, problems of SP \n\n\n\nbased interview were: 16 did not report any problem; 3 responses indicated lack of individual interaction with \n\n\n\nSP; 7 opined that more training was required for handling SP. This perceptional study thrown light on many \n\n\n\naspects of learning from SP. Overall, students' perception was in favour of SP based training underscoring the \n\n\n\nimportance of this approach in teaching essential skills to Pharm. D students. \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                           MPS Pharmacy Scientific Conference 2011 \n \n\n\n\n368 \n \n\n\n\nOES \u2013 06 (000118) \n\n\n\n\n\n\n\nInfluence of Organizational Factors on Ethical Behavior of Medical Representatives in India   \n \n\n\n\nMolugulu Nagashekhara\n1\n, Syed Omar Syed Agil\n\n\n\n2 \n\n\n\n1 \nMasterskill College of Nursing and Health, KK Metro Campus, Kota Kinabalu, Sabah, Malaysia \n\n\n\n2 \nRazak School of Government, Universiti Tun Abdul Razak, Capital Square, Block C & D No. 8, Jalan \n\n\n\nMunshi Abdullah, 50100 Kuala Lumpur, Malaysia \n \n\n\n\nThe recent unethical behaviors of pharmaceutical industries in India are inundating the media these days. The \n\n\n\npharmaceutical industry contributes 1.6 percent of GDP and is the fastest growing sector in the Indian \n\n\n\neconomy. Study of ethical behavior among medical representatives in the profession is an under-portrayed \n\n\n\ncomponent that deserves in-depth research. The purpose of this study is to measure influence of organizational \n\n\n\nfactors (organizational culture, code of ethics, ethics training and incentive scheme) on ethical behavior of \n\n\n\nmedical representatives. The research design is hypothesis based. It is a cross-sectional and correlational \n\n\n\nstudy, conducted under non-contrived settings. A simple random and cluster sampling is done among 300 \n\n\n\nmedical representatives using structured questionnaire. Chi-square tests were used to measure the association; \n\n\n\nstrength of the association is measured through Cramer\u2019s V and Phi Value between organizational culture, \n\n\n\ncode of ethics, ethics training and incentive scheme on ethical behavior of medical representatives.  The \n\n\n\nmodel chosen for testing ethical behavior through four variables gives an R2 value of 74.6% with an adjusted \n\n\n\nR2 of 66.5%. Therefore, code of ethics and training on ethics are very important when medical representatives \n\n\n\nface ethical dilemma in the field. The incentives offered by companies should be minimal and should not \n\n\n\nemphasize on performance related pay schemes. We conclude that apart from organizational factors, the study \n\n\n\nof individual and external factors is imperative for better understanding. \n\n\n\n\n\n\n\n\n\n\n\nPHARMACY PRACTICE/SOCIAL PHARMACY/ CLINICAL PHARMACY \n \n\n\n\nOPP \u2013 01 (000100) \n \n \n\n\n\nFive Year Evaluation of the Quality of Anticoagulation Therapy Management in the Warfarin \n\n\n\nMedication Therapy Adherence Clinic (WMTAC) in Duchess of Kent Hospital, Sandakan, Sabah  \n \n\n\n\nG P Hoo\n1\n, S J Law\n\n\n\n1\n, J L Quah\n\n\n\n1\n, Y W Shim\n\n\n\n1\n, A R Masturah\n\n\n\n1\n, A C Y Lim\n\n\n\n2\n, K Zorina\n\n\n\n3\n \n\n\n\n1\n Department of Pharmacy, Duchess of Kent Hospital, Sandakan, Sabah \n\n\n\n2\n Department of General Medicine, Duchess of Kent Hospital, Sandakan, Sabah \n\n\n\n3\n Director, Duchess of Kent Hospital, Sandakan, Sabah \n\n\n\n\n\n\n\nTraditionally, management of oral anticoagulation therapy in majority of clinical situations is usually \n\n\n\nundertaken by doctors. The Warfarin Medication Therapy Adherence Clinic (WMTAC) was started in \n\n\n\nDuchess of Kent Hospital (HDOK) in December 2005, among the first two hospitals in Malaysia where \n\n\n\npharmacists manage warfarin therapy. In the WMTAC, pharmacists work closely with medical officers and \n\n\n\nphysicians in an outpatient setting. The study objective was to evaluate the quality of anticoagulation therapy \n\n\n\nmanagement of the WMTAC over five years. A retrospective, medical record review was carried out. \n\n\n\nOutpatient INR control by the WMTAC was studied for 12 months for the following years; 2006, 2007, 2008, \n\n\n\n2009 and 2010. As a baseline, patients receiving warfarin therapy under usual medical care (UMC) was \n\n\n\nstudied for 8 months in 2005. The number of patients recruited under periods 2005, 2006, 2007, 2008, 2009 \n\n\n\nand 2010 were 87, 128, 185, 244, 270 and 284 respectively. Throughout the 6 study periods, there was \n\n\n\ngenerally an increasing trend observed in percentage time spent within patients\u2019 expanded therapeutic range \n\n\n\n(2005=57.0%, 2006=64.0%, 2007=62.2%, 2008=65.4%, 2009=70.5%, 2010=69.0%). There was also \n\n\n\ngenerally a decreasing trend in terms of high-risk INR values (defined as INR<1.5 and INR>4.5). Mean \n\n\n\npatient contact with caregivers per patient-year had slight fluctuations over the years (2005=17.7, 2006=18.9, \n\n\n\n2007=16.7, 2008=16.4, 2009=15.7, 2010=17.1). In conclusion, the quality of anticoagulation therapy \n\n\n\nmanagement by the WMTAC has been improving throughout the years. Nevertheless, the WMTAC team \n\n\n\nshould continuously strive to achieve further improvements and better patient care. \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                           MPS Pharmacy Scientific Conference 2011 \n \n\n\n\n369 \n \n\n\n\nOPP \u2013 02 (000046) \n \n \n\n\n\nThe Knowledge and Perception of Contraception and Sexual Health amongst AIMST University \n\n\n\nStudents  \n \n\n\n\nJamaluddin Awang, Annie Toh Jia Yuin, Lim Ern Sze \n\n\n\nFaculty of Pharmacy, AIMST University, Semeling, Sg. Petani, Kedah \n \n\n\n\nThis study is to determine the knowledge and perception of contraception and sexual health amongst AIMST \n\n\n\nuniversity students. A 308 self-administered, pre-validated, open and closed ended 20-items questionnaire \n\n\n\nwere received from the respondents, of which 146 were male, and 162 female. Appropriate statistical tests \n\n\n\nwere done to validate the data. 98.4% of the respondents have correctly identified once a month as a normal \n\n\n\nmenstrual cycle. 94.8% were aware that pregnancy was possible after unprotected sex once attained puberty. \n\n\n\nHIV was the most known sexually transmitted disease (STDs), by 96.4% of the respondents, while \n\n\n\ngonorrhoea was the least known, only by 51.0% of the respondents. 95.5% of the respondents were aware of \n\n\n\nthe use of condoms for contraception, and 92.2% believed that it offered protection against STDs, while \n\n\n\n78.9% viewed it as a reliable contraceptive method. 87.3% of the respondents have some knowledge of oral \n\n\n\ncontraceptives, but 10.1% misleadingly thought that it could prevent STDs, while 61.0% of the respondents \n\n\n\nthought that it is reliable as contraceptive, and 59.7% perceived it as causing mood swings or depression as \n\n\n\nside effects. Only 40.9% of the respondents have heard of emergency morning-after pill, and of this, only \n\n\n\n21.4% responded correctly on its proper use. 68.5% gained information on contraception through internet. \n\n\n\n40.3% of the respondents were of the opinion that sex education should start early at the lower secondary \n\n\n\nschool level. 64.7% of the respondents agreed that a pharmacist was the best resource person to obtain \n\n\n\ninformation on contraception and sexual health. Overall, this study revealed certain level of knowledge of \n\n\n\nAIMST University students on this matter. \n\n\n\n\n\n\n\nOPP \u2013 03 (000056) \n \n \n\n\n\nOutcome of Appropriate Empiric Antimicrobial Therapy for Nosocomial Pneumonia in the Intensive \n\n\n\nCare Unit (ICU), Hospital Ampang   \n \n\n\n\nS S Kong \n1,2\n\n\n\n, M M Bakry\n 2 \n\n\n\n1\n Pharmacy Department, Hospital Ampang, Selangor \n\n\n\n2\n Faculty of Pharmacy, Universiti Kebangsaan Malaysia (UKM), Kuala Lumpur \n\n\n\n\n\n\n\nNosocomial pneumonia represents one of the most common nosocomial infections and major cause of ICU \n\n\n\nmortality. Early diagnosis and initiation of the right antimicrobial play the key role in determining the \n\n\n\ntreatment outcomes. This study aimed at evaluating the outcomes of appropriate empiric antimicrobial for \n\n\n\nnosocomial pneumonia in the ICU. The outcomes measured were the mortality rate, ICU length of stay (LOS) \n\n\n\nand hospital LOS. This was a retrospective observational study involving 209 subjects admitted to ICU of \n\n\n\nHospital Ampang from November 2009 to December 2010 who fulfilled the selection criteria. The \n\n\n\nappropriateness of antimicrobial was determined by evaluating the antimicrobial agent against microbial \n\n\n\nsensitivity result. All demographic data and baseline severity scores were not significantly different between \n\n\n\nthe subjects receiving appropriate and inappropriate antimicrobials. The subjects infected with multidrug-\n\n\n\nresistant Gram-negative bacilli were more likely to receive inappropriate antimicrobials: Acinetobacter spp. \n\n\n\n(OR: 4.7055, CI: 1.9561 \u2013 11.319, p<0.001); Stenotrophomonas maltophilia (OR: 8.9302, CI: 2.5971 \u2013 \n\n\n\n30.7062, p<0.001); ESBL-producing Klebsiella pneumoniae (OR: 12, CI: 1.5307 \u2013 94.0724, p=0.008). The \n\n\n\nsubjects who were more likely to receive appropriate antimicrobials were those infected by Pseudomonas \n\n\n\naeruginosa (OR: 2.7237, CI: 1.2508 \u2013 5.9311, p=0.016); non-ESBL-producing Klebsiella pneumoniae (OR: \n\n\n\n7.1346, CI: 2.3547 \u2013 21.617, p<0.001); Staphylococcus aureus (100% appropriate, p=0.002). The subjects \n\n\n\nreceiving inappropriate empiric antimicrobials had higher mortality rate compared to patients receiving \n\n\n\nappropriate empiric antimicrobials (OR: 4.8098, CI: 2.6423 \u2013 8.7552, p<0.001). Among the antimicrobials, \n\n\n\nmeropenem was associated with higher mortality rate (OR: 5.135, CI:  1.7209 \u2013 15.3226, p=0.003). There was \n\n\n\nno difference of ICU and hospital LOS among the subjects receiving appropriate and inappropriate \n\n\n\nantimicrobials (p>0.05). In conclusion, subjects receiving appropriate empiric antimicrobial were associated \n\n\n\nwith positive outcome in term of survival, but the ICU and hospital LOS were not significantly shorter than \n\n\n\nthe subjects receiving inappropriate antimicrobial. \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                           MPS Pharmacy Scientific Conference 2011 \n \n\n\n\n370 \n \n\n\n\nOPP \u2013 04 (000084) \n\n\n\n\n\n\n\nPrevalence and Factors associated with Potentially Inappropriate Medications among Older Residents \n\n\n\nin Penang Nursing Homes  \n \n\n\n\nChen LL\n1\n, Tangiisuran B\n\n\n\n1\n, Shafie AA\n\n\n\n2\n, Hassali MA\n\n\n\n2\n \n\n\n\n1\n Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, \n\n\n\nMalaysia \n2\n Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains \n\n\n\nMalaysia, Penang, Malaysia \n\n\n\n\n\n\n\nPotentially inappropriate medications (PIMs) among older people is a major contributor of adverse drug \n\n\n\nevents leading to increased hospitalization, mortality and lower health related quality of life. Screening tools \n\n\n\nsuch as Beers criteria is being widely used to identify PIMs. The study was to determine the prevalence and \n\n\n\nfactors associated with Beers PIMs in nursing home elderly residents. A cross sectional study was conducted \n\n\n\nat four non-governmental organization nursing homes in Penang from January to February 2011. The study \n\n\n\npopulation included elderly residents (> 65 years old) with at least one prescribed medication and non-\n\n\n\nmedically demented. Relevant information was collected using direct interview and medical chart review \n\n\n\nprocess. Beers criteria were applied to determine the appropriateness of each medication in the elderly \n\n\n\nresidents. Data were analyzed using descriptive statistics and logistic regression to determine the associated \n\n\n\nfactors. Results and Discussion: Two hundred and eleven residents were included in this study with median \n\n\n\nage of 77 (interquartile range, IQR 72-82) years. Median number of routine medications was 4 (IQR 3-6). \n\n\n\nBeers criteria identified 79 PIMs affecting 69 residents (32.7%). The commonly identified PIMs were short \n\n\n\nacting nifedipine (37%), chlorpheniramine (20%) and diphenhydramine (9%). Multivariate logistic regression \n\n\n\nanalysis revealed that PIMs use was significantly associated with higher number of medications [OR=1.405, \n\n\n\n95% CI (1.193-1.654)] and longer stay at nursing home [OR=1.132, 95% CI (1.045-1.226)]. In conclusion, \n\n\n\nPIMs are highly prevalent among nursing home residents and are associated with the number of medications \n\n\n\nand residential years. This finding warrants further attention from our policy makers. \n\n\n\n\n\n\n\nOPP \u2013 05 (000092) \n \n \n\n\n\nAcute Coronary Syndrome (ACS) Secondary Prevention Pharmacotherapy Third National Audit: A \n\n\n\nComparison Between Cardiology Centers and Non-cardiology Centers  \n \n\n\n\nSiti Nadiah R\n1\n, Lai LYH\n\n\n\n2\n, Tiong LL\n\n\n\n2\n, Sahimi M\n\n\n\n4\n, Kamarun MA\n\n\n\n5\n, Fong AYY\n\n\n\n2,3\n, Yakub S\n\n\n\n6\n, Yanti NS\n\n\n\n2\n, \n\n\n\nSim KH\n2,3\n\n\n\n, Then PHH\n6,7\n\n\n\n on behalf of the ACS Pharmacotherapy Audit Team \n1\n Department of Pharmacy, Sarawak General Hospital Heart Center, Kuching \n\n\n\n2\n Clinical Research Centre, Hospital Umum Sarawak, Kuching \n\n\n\n3\n Department of Cardiology, Sarawak General Hospital Heart Center, Kuching \n\n\n\n4\n Department of Pharmacy, Tengku Ampuan Afzan Hospital, Kuantan \n\n\n\n5\n Department of Pharmacy, Ampang Hospital, Kuala Lumpur \n\n\n\n6\n Swinburne University of Technology Sarawak Campus \n\n\n\n7\n Logos Biomed Systems Sdn Bhd, Kuching \n\n\n\n\n\n\n\nDual antiplatelets, beta-blockers (BB), HMG-CoA Reductase Inhibitors (\u2018statins\u2019) and Angiotensin \n\n\n\nConverting Enzyme Inhibitors/Angiotensin Receptor Blockers (\u2018ACEI/ARBs\u2019), was shown to improve \n\n\n\ncardiovascular outcomes as secondary prevention pharmacotherapy for Acute Coronary Syndrome (ACS). \n\n\n\nThe objective is to compare the prescribing trend of ACS secondary prevention pharmacotherapy (ACSSPP) \n\n\n\nin Ministry of Health (MoH) hospitals, specifically between the cardiology centers (CC) and the non-\n\n\n\ncardiology centers (NCC). Ward and pharmacy documentations of patients admitted with ACS from 9/8/2010 \n\n\n\nto 8/12/2010 were audited, while prescribers were concurrently exposed with an intervention display of \n\n\n\nclinical evidence, international standards and results from the previous audit cycles. Collected data were \n\n\n\ntransmitted securely through a dedicated web-based electronic case report forms (eCRF), and analyzed using \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                           MPS Pharmacy Scientific Conference 2011 \n \n\n\n\n371 \n \n\n\n\nSPSS 16.0. A total of 871 ACS patients from 17 hospitals were enrolled in this audit cycle, with 327 from CC \n\n\n\nand 544 from NCC. At baseline, patient population in both groups was similar for age, gender, ethnicity, \n\n\n\nsmoking status, ACS stratum and concurrent diseases. 86.1% of patients were prescribed with double \n\n\n\nantiplatelets upon discharge in CC compared to 80.3% of the NCC. The percentage of patients discharged \n\n\n\nwith statins was comparable between both groups (96.6 vs. 98.0% respectively), with simvastatin as the most \n\n\n\nprescribed statin. CC showed higher percentage of prescription of beta-blockers, compared to the NCC (82.6 \n\n\n\nvs. 65.4%), with majority prescriptions of metoprolol. However, there is a slightly lower percentage of \n\n\n\nACEI/ARB prescription in CC with 72.2%, compared to 78.9% of the NCC, perindopril being the most \n\n\n\nprescribed. Generally, there is an encouraging use of evidence-based ACSSP in MoH hospitals. \n\n\n\n\n\n\n\n\n\n\n\nOPP \u2013 06 (000103) \n \n \n\n\n\nPatients Own Drug (POD) System and Impact of Ward Pharmacists Intervention  \n \n\n\n\nHo JW, Pau KB, Lau CL, Loong LS, Kong SH, Lai YK, Roberts SA, Tajurudin FW \n\n\n\nPharmacy Department, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur \n\n\n\n\n\n\n\nPatients\u2019 Own Drug (POD) are medications brought into the hospital by patients or carers. If deemed suitable \n\n\n\nand with permission, these medications would be administered. In our institution, POD system was introduced \n\n\n\nsince 2009 but constant review is required to improve the practice. The study was conducted to observe the \n\n\n\ncurrent practice and to assess the effectiveness of intervention by ward pharmacists on implementation of \n\n\n\nPOD system. A prospective observational study was performed from May to July 2011 in medical and cardiac \n\n\n\nwards. Head nurses were interviewed to identify the problems of implementation. This was followed by active \n\n\n\ninterventions by ward pharmacists which included (1) enhancing POD promotion to the general public via \n\n\n\ndistribution of pamphlets (2) POD reconciliation with current prescriptions (3) informing carers to bring POD \n\n\n\nfrom home (4) reminding and assisting nurses to use POD. Before intervention, 61.2% of patients had home \n\n\n\nmedications continued during admission. 55.4% of POD were brought upon admission but only 37% were \n\n\n\nused. The main factors identified were (1) lack of patient\u2019s awareness to bring POD (2) order medication \n\n\n\nsupply instead of using POD (3) inadequate storage space. After interventions, the number of patients who \n\n\n\nbrought POD increased by 12.8% and POD usage increased by 23%. The active interventions by ward \n\n\n\npharmacists managed to promote and increase the usage of POD system although there were still limitations \n\n\n\nwith the unit of use drug distribution system. Constant reminder to patients and other healthcare providers are \n\n\n\nneeded to ensure successful implementation of the POD system. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nOPP \u2013 07 (000104) \n \nCost-Utility Analysis of the Modified Cardiac Rehabilitation Program: A Preference-Based on SF-6D \n \n\n\n\nAnchah L\n1\n, Izham M, Sim KH\n\n\n\n3\n, Alan FYY \n\n\n\n3\n, Yanti NS\n\n\n\n1\n, Tiong LL\n\n\n\n1\n, Bibi FMS \n\n\n\n1\n, Hassali MA\n\n\n\n2\n, Yahaya \n\n\n\nH\n2\n \n\n\n\n1\n Pharmacy Department, Sarawak General Hospital \n\n\n\n2\n Universiti Sains Malaysia, Penang \n\n\n\n3\n Department of Cardiology, Sarawak General Hospital \n\n\n\n\n\n\n\nThe rehabilitation model in Malaysia might differ from the conventional model that based on in-patient \n\n\n\neducation and counseling. The cost effectiveness and humanistic outcomes studies in phase I and short course \n\n\n\nphase II of cardiac rehabilitation program (CRP) are currently reviewed. The main objective is o assess the \n\n\n\ncost-effectiveness of collaboration clinical pharmacy service in phase I and phase II cardiac rehabilitation. A \n\n\n\nquasi-experimental design was applied for acute coronary syndrome (ACS) patients admitted at Sarawak \n\n\n\nGeneral Hospital from 2008 until 2010. 112 ACS patients completed the SF-36 which translated into SF-6D. \n\n\n\nA one-way analysis of variance was used to compare the three groups, modified CRP (MCRP), conventional \n\n\n\nCRP (CCRP) and the usual care. Estimation of QALY gain and the incremental cost-effectiveness ratio \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                           MPS Pharmacy Scientific Conference 2011 \n \n\n\n\n372 \n \n\n\n\n(ICER) were compared. At baseline there were no difference in demographic or physical characteristic data \n\n\n\nbetween MRCP (n=22), CCRP (n=28), and Control (n=62). At 12-months follow-up, there were \n\n\n\nimprovements of health related quality of life (HRQOL). In MCRP (+10.57; 95%CI: -2.09, 23.23), reported \n\n\n\nless bodily pain (BP) than CCRP (+3.72, 95%CI:-8.94, 16.39) and Control (-4.16, 95%CI: -14.92, 6.59). The \n\n\n\ngeneral health (GH) in MCRP (+3.66, 95%CI:-9.88, 17.20), reported better than CCRP (+1.10, Cl:-10.34 to \n\n\n\n12.54) and Control group (-2.87, 95%Cl:-12.96 to 7.21). Annual health care resources used in MCRP have \n\n\n\nshown more costly at median RM 25,994 (6,110 to 75,509) as compared to CCRP RM 21,471 ( 7,813 to \n\n\n\n61,542) and the usual care RM 16,620 ( 4,565 to 61,854). However, the total direct cost of health care \n\n\n\nresources annually for bypass (CABG) in MCRP is estimated with median RM 51,542 (44,266 to 75,509) that \n\n\n\nsimilar to CCRP RM 53,376 (46,538 to 61,542). The utility index SF-6D of MCRP 0.828 (95%, 0.751-0.906) \n\n\n\nand CCRP 0.838 (95%, 0.761-0.917) are higher than control group 0.740(95%, 0.636-0.845). Thus, give a \n\n\n\nhigher quality adjusted life year (QALY) gain in rehabilitation program. The MCRP group represented an \n\n\n\nICER of RM 91,560.00 and the CCRP ICER of RM 74,938.46 with better result. The findings suggest that \n\n\n\nmoderately effective strategies in MCRP for secondary prevention strategies provide a good value for money. \n\n\n\nWithout any cardiac rehabilitation for post ACS patients will cause a high impact in annual cost of treatments \n\n\n\nand poor improvement in quality of life. \n\n\n\n\n\n\n\nOPP \u2013 08 (000149) \n \n \n\n\n\nAn Assessment of Prescriptions Received in Community Pharmacies in Selangor, Malaysia  \n \n\n\n\nSM Lim \n\n\n\nSchool of Pharmacy, University of Nottingham Malaysia Campus, Selangor \n\n\n\n\n\n\n\nThe rising of global drug expenditures and increasing health demands have contributed to the evolution of \n\n\n\npharmacy practice from focusing on dispensing medicines to include more responsibilities in healthcare \n\n\n\nprovision. Pharmacists and doctors in developed countries have successfully taken on the paradigm shift in \n\n\n\npatient healthcare. If the situation in Malaysia is to change as in the proposals for the separation of prescribing \n\n\n\nand dispensing, doctors will need to write many more prescriptions than they currently do. This study aims to \n\n\n\nexamine the quantity and quality of prescriptions received by community pharmacists in terms of meeting \n\n\n\nlegal requirements and to describe the types of medicines prescribed. This prospective convenience sampling \n\n\n\nstudy involved evaluating the prescriptions received by ten community pharmacies in Selangor from January \n\n\n\n2010 till December 2010. A total of 1212 items in 682 prescriptions were received during the study period of \n\n\n\none year. This study showed that only 5.4% of the prescriptions deemed legal. The prescriptions containing \n\n\n\npatient\u2019s name, patient\u2019s address, date, prescriber\u2019s address, prescriber\u2019s signature, total amount of drug and \n\n\n\ndose were 80.6%, 8.2%, 67.2%, 83.6%, 92.9%, 87.2% and 82.1%, respectively. The three most commonly \n\n\n\nprescribed medicines were cardiovascular drugs (24.8%), anti-infective (19.6%) and CNS drugs (18.4%). \n\n\n\nInterestingly, less than 50% of the 682 prescriptions received by community pharmacists are from general \n\n\n\npractitioners. In conclusion, genuine cooperation between doctors and pharmacists together with the Ministry \n\n\n\nof Health is absolutely essential to resolve the prescription-dispensing setbacks, ultimately developing a world \n\n\n\nclass healthcare system in Malaysia. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                           MPS Pharmacy Scientific Conference 2011 \n \n\n\n\n373 \n \n\n\n\n\n\n\n\nOPP \u2013 09 (000155) \n\n\n\n\n\n\n\nRisk of Nephrotoxicity among Orthopaedic Patients Receiving Vancomycin Treatment in University of \n\n\n\nMalaya Medical Centre (UMMC)  \n\n\n\n\n\n\n\nY L Lo\n1\n, S N Tong\n\n\n\n1\n, L L Yeap \n\n\n\n2\n, Y Hanifah\n\n\n\n3 \n \n\n\n\n1\n Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur Malaysia \n\n\n\n2\n Department of Pharmacy, University of Malaya Medical Centre, Kuala Lumpur  Malaysia \n\n\n\n3\n Department of Medical Microbiology, University of Malaya Medical Centre, Kuala Lumpur Malaysia \n\n\n\n\n\n\n\nOrthopaedic patients often require a high vancomycin dose and a long duration of treatment for better tissue \n\n\n\npenetration in the treatment of infections caused by susceptible organisms. A high vancomycin dose, however, \n\n\n\nmay subject a patient to a higher risk of nephrotoxicity. The aim of this study is to determine the occurrence \n\n\n\nrate of nephrotoxicity among vancomycin-treated orthopaedic patients and to identify potential risk factors of \n\n\n\nvancomycin-associated nephrotoxicity. This retrospective cohort study involved 279 orthopaedic patients with \n\n\n\n132 cases (patients received vancomycin) and 147 controls (patients received other antibiotics). Patients' \n\n\n\ndemographic and clinical data, including renal profile, vancomycin dosage, corresponding serum vancomycin \n\n\n\nconcentrations and microbiological data were collected from routine therapeutic drug monitoring database and \n\n\n\npatients' medical records. These data were then analyzed to assess the occurrence rate of nephrotoxicity and to \n\n\n\nidentify potential risk factors of nephrotoxicity. Nephrotoxicity was found in 33% of vancomycin cases \n\n\n\ncompared to 16% in controls (P=0.002) with an odds ratio of 2.48. Doses of vancomycin of more than 4 \n\n\n\ng/day, persistent vancomycin trough concentrations of  greater than 15 mg/L and a prolonged vancomycin \n\n\n\ntreatment duration exceeding 14 days were found to be associated with a higher risk of vancomycin-induced \n\n\n\nnephrotoxicity.  In conclusion, orthopaedic patients who are exposed to high vancomycin doses, persistently \n\n\n\nelevated vancomycin trough levels and a prolonged vancomycin treatment, carried a higher risk of \n\n\n\nvancomycin-induced nephrotoxicity. \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                           MPS Pharmacy Scientific Conference 2011 \n \n\n\n\n374 \n \n\n\n\nPOSTER PRESENTATION \n\n\n\nPHARMACOLOGY/TRADITIONAL & COMPLEMENTARY MEDICINE \n\n\n\n\n\n\n\n\n\n\n\nPPM \u2013 01 (000023) \n\n\n\n\n\n\n\nInhibition of Penicillin Binding Protein (PBP2a) Production in Methicillin-resistant Staphylococcus \n\n\n\naureus (MRSA) \n \n\n\n\nC Santiago, M. Othman, H S Loh, K H Lim, C Wiart, T J Khoo, A Spowage, K N Ting \n\n\n\nUniversity of Nottingham Malaysia Campus, Semenyih, Selangor \n\n\n\n\n\n\n\nThe emergence of multi-drug resistant Staphylococcus aureus strains has becoming a serious clinical problem. \n\n\n\nIn MRSA, it has been shown that the expression of an altered form of penicillin binding protein (i.e. PBP2a) \n\n\n\ncontributes to its resistant to \u03b2-lactam antibiotics. This study investigates the antibacterial effects of Duabanga \n\n\n\ngrandiflora extracts in methicillin susceptible Staphylococcus aureus (MSSA) and MRSA. In addition, the \n\n\n\neffects of the extracts on the expression of PBP2a in MRSA were investigated. All ethanol leaves and bark \n\n\n\nextracts tested were able to inhibit the growth of both MRSA and MSSA with minimum inhibition \n\n\n\nconcentration (MIC) of less than 0.75 mg/ml and 0.375 mg/ml, respectively. In the presence sub-inhibitory \n\n\n\nconcentrations of D. grandiflora extracts, the MIC of ampicillin required to inhibit MRSA decrease by 64-fold \n\n\n\n(50 \uf06dg/ml to 0.78 \uf06dg/ml) whilst the susceptibility of MSSA to ampicillin was not altered (MIC of 0.31 \uf06dg/ml). \n\n\n\nHence suggesting a specific effect of the plant extracts on the resistance mechanism of MRSA. All the \n\n\n\nextracts tested suppressed and inhibited the expression of the resistant protein PBP2a. Images from the \n\n\n\nscanning electron microscope confirmed the deterioration of MRSA cell wall in the presence of the plant \n\n\n\nextracts. D. grandiflora extracts are able to inhibit the growth of MRSA cultures possibly through the \n\n\n\ninhibition of PBP2a expression. \n\n\n\n \nPPM \u2013 02 (000026) \n \n \n\n\n\nEfficacy of Minocycline, a Selective Inhibitor of Microglial Activation, on Existing Behavioral \n\n\n\nHypersensitivity Following Streptozotocin-induced Diabetic Neuropathic Pain   \n \n\n\n\nKavita Pabreja, Kamal Dua, H.S. Nagaraja \n\n\n\nInternational Medical University, Bukit Jalil, Kuala Lumpur, Malaysia \n\n\n\n\n\n\n\nIncreasing evidence points to a role for spinal neuroimmune dysregulation (glial cell activation and cytokine \n\n\n\nexpression) in the pathogenesis of neuropathic pain. Suppression of microglial activation with broad spectrum \n\n\n\ntetracycline antibiotic, minocycline, pre-emptively attenuates the development of streptozotocin (STZ)-\n\n\n\ninduced behavioral hypersensitivity. The present work aims to investigate the ability of minocycline in \n\n\n\nreversing existing, long-term behavioral hypersensitivity following diabetic neuropathy. Sprague Dawley rats \n\n\n\nreceived single intraperitoneal injection of STZ and the development of hyperalgesia and allodynia was \n\n\n\nassessed twice weekly for six weeks. On day 28, rats received either saline or minocycline (40 and 80 mg/kg) \n\n\n\nintraperitoneally. On day 32, lumbar spinal cord sections were processed for assessment of astrocytic glial \n\n\n\nfibrillary acidic protein (GFAP) and microglial OX-42 (antibody against CR3/CD11b). Initiation of \n\n\n\nminocycline treatment on day 28 after diabetes induction (treatment of existing hypersensitivity) failed to \n\n\n\nattenuate hyperalgesia and allodynia. Robust increase in GFAP immunoreactivity was observed on day 32 \n\n\n\nestablishing the role of activated astroglia in the maintenance of diabetic neuropathic pain. Post-treatment with \n\n\n\nminocycline, had no effect on the markers of oxidative- nitrosative stress and inflammation as compared to \n\n\n\ndiabetic control animals. Chronic administration of minocycline failed to reverse existing hypersensitivity due \n\n\n\nto the replacement of microglia by hypertrophic astrocytes. Moreover, minocycline is a selective inhibitor of \n\n\n\nmicroglial activation and does not inhibit activated astrocytes. The present study highlights the role of \n\n\n\nastroglia in the long-term maintenance of diabetic neuropathic pain and inefficacy of minocycline as a \n\n\n\npromising pharmacological tool in established diabetic neuropathic pain. \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                           MPS Pharmacy Scientific Conference 2011 \n \n\n\n\n375 \n \n\n\n\nPPM \u2013 03 (000038) \n \n \n\n\n\nRational Use of Antibiotics in Infected Diabetic Foot: A Case Report from Pakistan   \n \n\n\n\nA Ahmad \n1\n, Munavar Zubaid Abdul Sattar \n\n\n\n1\n, M Atif \n\n\n\n2\n, F Saleem \n\n\n\n3\n, N Saqib \n\n\n\n4\n, M Asif \n\n\n\n5\n \n\n\n\n1\n Discipline of Physiology, School of Pharmaceutical Sciences, University Sains Malaysia, Penang, Malaysia. \n\n\n\n2\n Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, University Sains Malaysia, Penang, \n\n\n\nMalaysia. \n3\n Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, University Sains \n\n\n\nMalaysia, Penang, Malaysia. \n4\n Ministry of Health, Karachi, Pakistan. \n\n\n\n5\n Department of Pharmacy, The Islamia University of Bahawalpur, Punjab, Pakistan. \n\n\n\n\n\n\n\nDiabetic foot is one of the major and most frequently occurring complications of diabetes mellitus (DM). A \n\n\n\nmale patient with history of type II DM (25 years) reported at tertiary health care unit with ulcer on big toe of \n\n\n\nright foot. Upon examination, doctor noticed putrid smell and drainage of pus. Toe was also deformed and \n\n\n\nswollen (sausage toe). ESR of patient was elevated to 83 mm per hour. Fasting blood glucose (11.8 mmol) and \n\n\n\nHbA1c (12.7%) levels were also elevated. For diabetes, he was on metformin (tablet, 500 mg) bid and insulin \n\n\n\n70/30 (SC, 40 iu) before breakfast. Patient was hospitalized as a suspected case of infectious foot ulcer. He \n\n\n\nwas prescribed ceftriaxone (IV injection, 1g) and ofloxacin (tablet, 200 mg), bid for five days. On fourth day, \n\n\n\ndoctors decided to perform surgical intervention (pus drainage and revascularization) as patient was not \n\n\n\nresponding to antibiotic therapy. On seventh day doctors decided to amputate big toe of right foot. \n\n\n\nStaphylococcus aureus, beta-hemolytic streptococci, aerobic gram negative and gram positive organisms, \n\n\n\nanaerobes and methicillin resistant staphylococcus aureus (MRSA) are most common pathogens involved in \n\n\n\ndiabetic foot. Ciprofloxacin (IV injection, 400mg) bid plus clindamycin (iv injection, 600 mg) three times a \n\n\n\nday are among the first line drugs for severe diabetic foot infections. Linezolide (IV injection, 600mg) bid \n\n\n\nshould be added for MRSA involvement. In case of wound with purulent discharge, metronidazole (IV, 500 \n\n\n\nmg) should be supplemented as an adjuvant therapy. Culture and sensitivity test should be radical part of \n\n\n\ndiabetic foot management. \n\n\n\n \nPPM \u2013 04 (000044) \n \n \n\n\n\nAnti-Methicillin Resistant Staphylococcus aureus (MRSA) Activity of Ethyl Acetate Extract from \n\n\n\nAcalypha wilkesiana   \n \n\n\n\nC Santiago\n1\n, M Othman\n\n\n\n1\n, H S Loh\n\n\n\n2\n, K H Lim\n\n\n\n1\n, C Wiart\n\n\n\n1\n, T J Khoo\n\n\n\n1\n, K N Ting\n\n\n\n3\n \n\n\n\n1\nSchool of Pharmacy, University of Nottingham Malaysia Campus \n\n\n\n2\nSchool of Biosciences, University of Nottingham Malaysia Campus  \n\n\n\n3\nSchool of Biomedical Sciences, University of Nottingham Malaysia Campus \n\n\n\n\n\n\n\nMany medicines that we use today and in the past are derived from nature, of which many are plant-based. \n\n\n\nThis research encompasses the study of local plants to discover new drugs to treat infectious diseases. \n\n\n\nAlthough there have been a rapid escalation in the discovery of antibacterial agents, the emergence of \n\n\n\nbacterial resistant strains such as methicillin-resistant Staphylococcus aureus (MRSA) is a major threat. It is \n\n\n\nknown as the highest profile pathogen that causes nosocomial infections and remains the most common single \n\n\n\nmulti-drug resistant bacterium. One plant of interest is Acalypha wilkesiana, a shrub that is commonly found \n\n\n\nin tropical and subtropical countries. The present study examined the effect of ethyl acetate extract of A. \n\n\n\nwilkesiana on the survival of MRSA. The crude extract and its fractions were tested for anti-MRSA activity \n\n\n\nvia microbroth dilution assay. The minimal inhibitory concentration (MIC) of the crude extract was 6.0 mg/ml \n\n\n\nand the MIC for the fractions ranged from 1.5 mg/ml to 6.0 mg/ml.  Fractions B and G were the two most \n\n\n\npotent fractions with MIC value of 1.5 mg/ml. At sub-inhibitory concentration of the crude ethyl acetate \n\n\n\nextract (1/8 x MIC) the growth of the bacteria was markedly reduced after 24 hours of incubation when \n\n\n\ncompared to control (-80.2% survival). A qualitative analysis of the crude extract showed presence of \n\n\n\nphytochemicals such as alkaloids, tannins, phenolics, saponins, and flavonoids. Thus, the anti-MRSA \n\n\n\nproperties observed may be attributed to these phytochemicals. Further work will be carried out to isolate the \n\n\n\nactive constituents. \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                           MPS Pharmacy Scientific Conference 2011 \n \n\n\n\n376 \n \n\n\n\nPPM \u2013 05 (000121) \n \n \n\n\n\nThe 7a.m to 7 p.m Variation in Biological Rhythm of BP in Young Population of Malaysia- The Step to \n\n\n\na Chronopharmacological and Chronotherapeutic Approach  \n \n\n\n\nA.J.M. Christina, Lee Kah Hong, Lim Sze Ne, Simrajeet Singh Dhilon, Christapher P.V. \n\n\n\nFaculty of Pharmacy, AIMST University, Semeling, Kedah, Malaysia \n\n\n\n\n\n\n\nBiological rhythms are periodic biological fluctuations in an organism that correspond to or in response to \n\n\n\nperiodic environmental changes. Chronobiology, the study of biological rhythms, categorizes rhythms by the \n\n\n\nduration of the cycle. The most studied type of biological rhythm is circadian rhythm, which fluctuates on an \n\n\n\napproximately 24 h basis. Many cardiovascular parameters   including heart rate and blood pressure exhibit a \n\n\n\nstrong circadian rhythm or pattern. This pattern is altered in hypertensive patients and literature supports a \n\n\n\nstrong correlation between the altered circadian pattern of blood pressure and cardiovascular complications in \n\n\n\nhypertensive patients. Literature further supports that this circadian pattern is influenced by age, sex and \n\n\n\nstress. Hence this study was designed to evaluate the normal daytime rhythm of blood pressure in a young \n\n\n\npopulation. Blood pressure recording was done  for a population of 50 ( below 25 years) subjects at 7 time \n\n\n\npoints between 7am and 7pm (7am, 9am, 11am, 1pm, 3pm, 5pm and 7pm) and  repeated 3 times within a \n\n\n\nweek with the gap of 24 hours. Mean values of this reading was considered as the blood pressure of the \n\n\n\nparticular subjects. Using the mean blood pressure values at 7 time points, the diurnal pattern can be \n\n\n\nestablished. The daytime rhythm of systolic BP increased from 7 a.m and reached a peak at 3 p.m after which \n\n\n\nit gradually declined till 7 p.m. and reached the same value at 7 p.m. The circadian pattern of diastolic \n\n\n\npressure shows a gradual increase from 7 a.m (0001 CT) till 11 a.m (0005 CT) at which the mean diastolic BP \n\n\n\nwas 80 \u00b1 1.1 mmHg. From 11.00 a.m onwards the pressure remained in the same level till 3.00 p.m (0009 \n\n\n\nCT). The amplitude was insignificant for both systolic and diastolic pressure. Determination of the circadian \n\n\n\nrhythm in a hypertensive population will enlighten how chronopharmacology of antihypertensive drugs alter \n\n\n\nthe pattern and how chronotherapeutic approach can be optimized. \n\n\n\n\n\n\n\n \nPPM \u2013 06 (000141) \n \n \n\n\n\nChemopreventive and Cytotoxic Activity of Spilanthes calva. L.  \n \n\n\n\nAnbu Jeba Sunilson\n1\n, A.V. Anita Gnana Kumari\n\n\n\n1\n, K. Anandarajagopal\n\n\n\n2\n, Khaja Pasha\n\n\n\n1\n, Qusro Bin \n\n\n\nHassan\n1\n, Abdullah Khan\n\n\n\n1 \n\n\n\n1\nSchool of Pharmacy, KPJ International University College of Nursing and Health Sciences, Kota Seriemas, \n\n\n\n71800, Nilai, Negeri Sembilan, Malaysia \n2\nSchool of Pharmacy, Masterskill University College of Health Sciences, Cheras, Selangor, Malaysia \n\n\n\n\n\n\n\nSpilanthes species are widely distributed in tropics and subtropics. They occur as wild and cultivated too. \n\n\n\nThese have been used popularly by traditional physicians for treatment of various ailments. Chemopreventive \n\n\n\nand cytotoxic effect of ethanol extract of Spilanthes calva L. (EESC) was evaluated in N-nitrosodiethylamine \n\n\n\n(DEN,200 mg/kg) induced experimental liver tumor in rats and human cancer cell lines. Oral administration \n\n\n\nof ethanol extract of Spilanthes calva L. (250 mg/kg) effectively suppressed liver tumor induced by DEN as \n\n\n\nrevealed by decrease in DEN induced elevated levels of serum glutamate pyruvate transaminase (SGPT), \n\n\n\nserum glutamate oxaloacetate transaminase (SGOT), alkaline phosphatase (ALP), total bilirubin, gamma \n\n\n\nglutamate transpeptidase (GGTP), lipid peroxidase (LPO), glutathione peroxidase (GPx) and glutathione S-\n\n\n\ntransferase (GST). The extract produced an increase in superoxide dismutase and catalase (enzymatic \n\n\n\nantioxidant) levels and total proteins when compared to those in liver tumor bearing rats. The \n\n\n\nhistopathological findings of liver samples were compared with respective controls. EESC was found to be \n\n\n\ncytotoxic against human epithelial larynx cancer (HEp2) and human breast cancer (HBL-100) cells. These \n\n\n\nresults show a significant chemopreventive and cytotoxic effect of ethanol extract of Spilanthes calva against \n\n\n\nDEN induced liver tumor and human cancer cell lines. \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                           MPS Pharmacy Scientific Conference 2011 \n \n\n\n\n377 \n \n\n\n\nPPM \u2013 07 (000174) \n \n \n\n\n\nEffect of Pandanus amarylifolius on Pain in the Hot Plate and Tail Pinch Experiments in Mice  \n \n\n\n\nPNYeoh\n1\n, YSChong\n\n\n\n2\n,\n  \nYSChen\n\n\n\n2\n, ATay\n\n\n\n2\n,\n \nMP Rao\n\n\n\n1\n \n\n\n\n1\n School of Pharmacy & Health Sciences, International Medical University, Kuala Lumpur,    Malaysia\n\n\n\n.  \n\n\n\n2\n School of Medical Sciences, International Medical University, Kuala Lumpur, Malaysia. \n\n\n\n\n\n\n\nThe ethanolic extract of Pandanus amarylifolius (PA) were tested on BALB/c mice for reaction to pain in the \n\n\n\nHot Plate (57\u00b0C) and Tail Pinch test (artery clip). Four groups (6 mice each) were injected i.p. with either \n\n\n\nsaline or a dose of PA, 25, 50 or 100 mg/kg. Each mouse was tested on the hot plate, 45 min after injection. \n\n\n\nThe reaction time to pain (biting its paws, jumping, and running) was recorded.  Another 4 groups of mice, \n\n\n\nsimilarly treated were individually exposed to the tail pinch test 45 min after injection. The reaction time \n\n\n\ntaken for the mouse to bite the artery clip was recorded. Means and standard errors of the reaction times for all \n\n\n\ngroups were calculated and compared using ANOVA and paired T test. In the Hot Plate test, the mean \n\n\n\nreaction times for the control (saline treated), 25, 50 and 100 mg/kg PA were 11.67, 8.66, 6.16 and 7.16 secs \n\n\n\nrespectively. The reaction times of all doses of the PA treated mice were significantly shorter (p<0.05 - <0.01) \n\n\n\nwhen compared to the control. In the Tail Pinch test, the mean reaction times were: control 32.17 sec., PA: 25, \n\n\n\n50 and 100 mg/kg were 1.16, 6.33 and 1.00 secs, respectively. Again all treated mice reacted significantly \n\n\n\nfaster (P<0.001) compared to control mice. Both the Hot Plate and the Tail Pinch tests in mice showed that \n\n\n\nPA has a hyperalgesia effect instead of an analgesic effect as reported by an earlier study. \n\n\n\n \nPPM \u2013 08 (000055) \n \n \n\n\n\nDevelopment and Evaluation of a Polyherbal Formulation for Rheumatoid Arthritis  \n \n\n\n\nM Sivakumar\n1\n, Anoop Austin\n\n\n\n2\n, Pallab Das Gupta, D Chammundeeswari, C Uma Maheshwara Reddy \n\n\n\n1\n Department of Pharmacognosy, Faculty of Pharmacy, Sri Ramachandra University, Chennai, India. \n\n\n\n2\n Director, Rumi Herbals Pvt.Ltd, Research and Development Centre, Chennai, India. \n\n\n\n\n\n\n\nRheumatoid arthritis is an autoimmune inflammatory disease of joints and surrounding connective tissues \n\n\n\nrequiring long term treatment with NSAIDs and immnosuppressants which have a long list of potential side \n\n\n\neffects. Herbal medicine is effective, safe and is being traditionally used in the management of the disease but \n\n\n\nmany do not have scientific evidence.  Hence a polyherbal formulation named \u201cArthrito\u201d comprising of 15 \n\n\n\nmedicinal plants was made in collaboration with Rumi Herbals Pvt. Ltd., Chennai, India. The formulation was \n\n\n\nstandardized, stability studies under accelerated conditions, in-vitro anti inflammatory activity using human \n\n\n\nred blood corpuscle membrane stabilization method and anti-arthritic activity by inhibition of protein \n\n\n\ndenaturation method were performed at the concentrations of 50,100,200, 400, 800, 1000 \u03bcg/ml using \n\n\n\ndiclofenac sodium as standard. Loss on drying, total ash and acid insoluble ash were not more than 1, 4 and \n\n\n\n1% respectively and pH 5 to 6. Water soluble and alcohol soluble extractive values were not less than 10 and \n\n\n\n15% w/w respectively. Phytochemical constituents were found to be alkaloids, steroids, glycosides, phenols, \n\n\n\ntannins, saponins, proteins and little amount of gum & mucilage in Arthrito. The heavy metals done by x-ray \n\n\n\nfluorescent spectroscopy and the microbial load were found to be well within standard limits defined by the \n\n\n\nWHO and AYUSH and formulation was found to have a shelf life of more than two years. The anti\u2013\n\n\n\ninflammatory and anti-arthritic activity was found to be dose dependent and increase with increase in \n\n\n\nconcentration. The result indicated that the polyherbal formulation of Arthrito is a safe and potent anti arthritic \n\n\n\ndrug. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                           MPS Pharmacy Scientific Conference 2011 \n \n\n\n\n378 \n \n\n\n\nPPM \u2013 09 (000061) \n \n \n\n\n\nRecent Treatment Preference for Diabetes Among Population in Penang, Malaysia   \n \n\n\n\nAnuradha.S.N.\n1\n , Lalitambigai Joobi\n\n\n\n2,\n Villashene Ganasan\n\n\n\n2,\n Kaayathree Murugaya\n\n\n\n2\n  Shamini \n\n\n\nSelvakumar\n2.\n \n\n\n\n1\nFaculty of Pharmacy, Masterskill University College of Health Sciences, Malaysia.  \n\n\n\n2\nSchool of Pharmacy, Masterskill University College of Health Science, Ipoh, Perak \n\n\n\n\n\n\n\nComplementary and alternative medicine (CAM) refers to wide range of clinical therapies outside of \n\n\n\nconventional medicine. The term \"complementary\" refers to therapies that are used in conjuction with \n\n\n\nconventional medicine, whereas \"alternative\" medicine includes therapies that are used in place of \n\n\n\nconventional medicine. The principle objective of the survey is to assess the association between different \n\n\n\ntypes of complementary and alternative medicine (CAM) preferred and practiced and to review clinical \n\n\n\nevidence supporting complementary and alternative medicine intervention for improving glycemia control in \n\n\n\npatients with diabetes mellitus. We conducted an electronic literature search of Journal of Diabetology, \n\n\n\nJournal of Clinical and Diagnostic Research.The studies were randomly selected from the pool of people on \n\n\n\nthe treatment preferance for diabetes among the population in Penang, Malaysia with a sample size of 200 in \n\n\n\nMay and Jun 2011. Data were extracted in standarized manner and designed by using quantitative analysis \n\n\n\nmethod. Out of the 200 people 34% of them have diabetes for 3 to 5 years and 7.5% have diabetes more than \n\n\n\n15 years. 66% of the population have taken alternative medicine for diabetes and 34% of them taken modern \n\n\n\nmedicine. There might be numerous reasons for exploring better glycemic control for CAM users. The reasons \n\n\n\nare such as established safety and efficiency of herbal drug, practices like yoga and taichi and efficiency of \n\n\n\ntraditional Chinese Medicine on glycemic control. In short, better understanding and knowledge could give a \n\n\n\ndeeper picture about the different aspects of CAM use and this opens up the gate to future studies of this \n\n\n\nnature. \n\n\n\n \nPPM \u2013 10 (000063) \n \n \n\n\n\nAuricular Acupuncture as an Adjunct to Methadone Maintenance Treatment (MMT):  Effects on \n\n\n\nRelapse Rate, Methadone Dose and Smoking Habit  \n \n\n\n\nNor Samira Talib, Zabidah Ismail, Lua P.L. \n\n\n\nCentre for Clinical and Quality of Life Studies (CCQoLS), Faculty of Medicine and Health Sciences, \n\n\n\nUniversiti Sultan Zainal Abidin (UniSZA), Kampus Kota, Jalan Sultan Mahmud 20400 Kuala Terengganu. \n\n\n\n\n\n\n\nIt has been interestingly demonstrated in many countries that Auricular Acupuncture (AA) could be beneficial \n\n\n\nas an adjunct therapy to Methadone Maintenance Treatment (MMT). This study was conducted to determine \n\n\n\nthe clinical outcomes of AA addition to MMT with regard to: 1) relapse rate; 2) methadone dose and 3) \n\n\n\nsmoking habit. AA was administered to opiate abusers on regular MMT from three centres in Terengganu. \n\n\n\nEach patient underwent the procedure thrice weekly for eight weeks (total = 24 sessions, each session = 30 \n\n\n\nminutes). Participants who received less than eight sessions were classified as dropouts. The following \n\n\n\noutcomes were evaluated pre- and post-AA treatment: relapse rate (via drug urine test), number of cigarettes \n\n\n\nsmoked/week and daily methadone dose. Data was analysed using descriptive and non-parametric statistics \n\n\n\n(SPSS 16). Complete participations were received from 22 out of 38 Malay males (response rate = 57.9%; \n\n\n\nmedian age = 40.5 years; single = 59.1%; \u2265 SPM education = 68.2%; \u2265 15 years of addiction = 68.2%; \n\n\n\nemployed = 90.9%). At post-intervention, negative urine results were obtained from 81.8% of respondents \n\n\n\nwhile the number of weekly cigarettes used was significantly lower than baseline (p=0.002). Despite no \n\n\n\nsignificant difference for daily methadone dose (p>0.05), their quality of sleep has significantly improved and \n\n\n\nall agreed \u201cto recommend AA to others\u201d.  Overall, AA seems promising as a potential therapy in drug \n\n\n\naddiction treatment, particularly to complement the existing standard MMT. Future randomised controlled \n\n\n\ntrials are warranted to support and reaffirm these intriguing preliminary findings. \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                           MPS Pharmacy Scientific Conference 2011 \n \n\n\n\n379 \n \n\n\n\nPPM \u2013 11 (000071) \n \n \n\n\n\nThe Prismatic Crystals of Calcium Oxalate in Vitex Species  \n \n\n\n\nEshak, Z., Jahidin, A. H., Abdul Wahab, I. \n\n\n\nFaculty of Pharmacy, Universiti Teknologi MARA, 42300 Puncak Alam, Selangor Darul Ehsan, Malaysia \n\n\n\n\n\n\n\nThe Vitex genus from the Verbenaceae family, contains approximately 250 species. The Vitex plant is well-\n\n\n\nknown in both ethnobotanical and phytochemical investigations. Pharmacological studies that were carried out \n\n\n\non this genus have illustrated its safety and efficacy in treating several diseases. From the literature, the \n\n\n\nbiological characteristics include apoptotic, antimitotic, antibacterial and wound healing properties. The Vitex \n\n\n\nextracts also exhibited potent tyrosinase inhibitor. During one study of the anatomical characteristics of Vitex \n\n\n\nagnus-castus, calcium oxalates were found only in the cross or transverse sections of the leaves. This \n\n\n\nbiomineral is also described as prismatic crystals. Nevertheless, it was reported that only some Vitex species \n\n\n\nhave this kind of crystal, while others do not. Meanwhile, in this presentation, a micro imaging study showed \n\n\n\nthat prismatic crystals of calcium oxalate were observed in the leaves of Vitex trifolia. From this specimen, the \n\n\n\nprismatic calcium oxalates of 10-25 microns in length, along with a styloid-type of oxalate, were \n\n\n\nobserved using a confocal laser scanning microscope. In conclusion, this possibly might be the first \n\n\n\nobservation of co-occurrence of two types of crystalline calcium oxalates from Vitex species. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nPPM \u2013 12 (000073) \n \n \n\n\n\nIn Vitro Modulatory Effects of Glucosamine and Chondroitin on Human Hepatic Cytochrome P450 \n\n\n\n2D6  \n  \n\n\n\nB H Tan \n1\n, Y Pan \n\n\n\n2\n, U D Palanisamy \n\n\n\n1\n, I Othman \n\n\n\n1\n, B C Yiap \n\n\n\n2\n, C E Ong \n\n\n\n1\n. \n\n\n\n1\n Jeffrey Cheah School of Medicine and Health Sciences, Monash University Sunway Campus, Bandar \n\n\n\nSunway, Selangor. \n2\n School of Pharmacy and Health Sciences, International Medical University, Bukit Jalil, Kuala Lumpur. \n\n\n\n\n\n\n\nGlucosamine and chondroitin are two naturally derived compounds that are widely used in the treatment of \n\n\n\nosteoarthritis. Despite their popularity as dietary supplements, interaction of these supplements with one of the \n\n\n\nmajor human hepatic cytochrome P450 (CYP) isoforms, CYP2D6, which is involved in metabolism of many \n\n\n\nclinical drugs, has yet to be investigated. Since drug-natural compounds interaction is an important issue in \n\n\n\nensuring the safety and effectiveness of the treatment of osteoarthritis, we aim to probe the potential \n\n\n\ninteraction of glucosamine and chondroitin with CYP2D6 in this study. Recombinant CYP2D6 was expressed \n\n\n\nby culturing E. coli DH5a cells harbouring the cDNA of CYP2D6 that was cloned into pCWori+ expression \n\n\n\nvector. Protein expression was induced by using isopropyl b\u2013D-thiogalactopyranoside. Cells were harvested \n\n\n\nto obtain the subcellular fractions. Expression of the protein was confirmed by reduced carbon monoxide \n\n\n\ndifference spectra. The activity of CYP2D6 was determined by dextromethorphan O-demethylase assays \n\n\n\nusing high-performance liquid chromatography (HPLC), with Km and Vmax of 1.98 \u00b1 0.25 \u00b5M and 167.53 \u00b1 \n\n\n\n28.82 pmol/min/mg protein, respectively. Probe substrate was incubated with or without each of different \n\n\n\nforms of glucosamine and chondroitin. All the forms of glucosamine and chondroitin exhibited no significant \n\n\n\ninhibition on the activity of CYP2D6, suggesting low or negligible modulatory effects of these compounds on \n\n\n\nCYP2D6 enzymatic activity. Therefore, glucosamine and chondroitin have negligible potential to produce \n\n\n\nclinically relevant metabolic drug interactions with concomitant medications that are the substrate for \n\n\n\nCYP2D6. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                           MPS Pharmacy Scientific Conference 2011 \n \n\n\n\n380 \n \n\n\n\nPPM \u2013 13 (000110) \n \n \n\n\n\nAn Overview on Lack of Proper Evaluation and Standardised Analytical Methods of Currently \n\n\n\nMarketed Herbal Products:  A Remedial Approach    \n \n\n\n\nB V S Lokesh \n\n\n\nDepartment of Pharmaceutical Chemistry, Faculty of Pharmaceutical Sciences, UCSI University, Kuala  \n\n\n\nLumpur \n \n\n\n\nTraditional medicines have been used in chronic and potential life threatening diseases and they are widely \n\n\n\nused by the young, aged people for health maintenance. Herbal therapy is famous as a traditional medical \n\n\n\npractice, based on the use of plants and plant extracts. World\u2019s multicultural society is composed of various \n\n\n\ncommunities with the practice of traditional medicine, which is influenced by mostly usage of medicinal herbs \n\n\n\nand herbal products along with synthetic drugs for major diseases. In this current review, the author has made \n\n\n\nan attempt to emphasize the lack of proper evaluation and standardised analytical methods for medicinal herbs \n\n\n\nand herbal products. It is also suggested in this review on handling safety issues and concerns of herbal \n\n\n\nproduct usage on a larger community. Chronic usage of these adulterated traditional medicines which contain \n\n\n\nsynthetic drug contaminants, steroids and heavy metals may result in secondary health complications, \n\n\n\ndeficiencies, adverse herb interactions and herb-drug interactions leading to complications of regular body \n\n\n\nfunctions. It is recommended to estimate the active drug content uniformity based on sustainable harvesting of \n\n\n\nselected local sources of herbs by using sophisticated modern analytical methods like UPLC, LC-MS, GC-\n\n\n\nMS, NMR and HPTLC techniques. It is needed to evaluate the current trends of qualitative and quantitative \n\n\n\naspects of active drugs in selected herbs and their safety. It is also suggested to compare and correlate with \n\n\n\nstandardized methods of regular time to time variations of active growing herbs and a continuous research has \n\n\n\nto be conducted to impart regulations on ethical practice, good manufacturing practices and quality control of \n\n\n\nherbal products for appropriate product registration and licensing. This review showed important reasons to \n\n\n\nmotivate the regulatory authorities in improving traditional health care policies and research methodologies on \n\n\n\nquality, safety by appropriate or more suitable means of evaluation of herbal medicinal products. It is \n\n\n\nconcluded that the national integrated research program may be conducted in collaboration with local \n\n\n\nsuppliers/distributors on the safety issues and the legal supply of herbal medicines and it may be reassessed by \n\n\n\nevaluating the clinical trials on indigenous traditional medicinal plants and herbal products to assure their \n\n\n\nsafety and efficacy.  \n\n\n\n\n\n\n\nPPM \u2013 14 (000131) \n \n \n\n\n\nIn vitro Antimicrobial Activity of Hazelnut Extracts on Streptococcus pneumoniae, Klebsiella \n\n\n\npneumoniae and Candida albicans Using Disk Diffusion Method  \n \n\n\n\nP Madhavan, GA Akowuah, WK CheongSchool of Pharmacy, Faculty of Pharmaceutical Sciences, UCSI \n\n\n\nUniversity, Kuala Lumpur. \n\n\n\nLately, there has been an increase in antimicrobial resistance with conventional antimicrobial agents by \n\n\n\npathogenic bacteria. It was reported that phenolic compounds have antimicrobial activity against commensal, \n\n\n\nprobiotic and pathogenic bacteria. Therefore, this study aimed to screen the antimicrobial activity of ethyl \n\n\n\nacetate, methanol, and 50% aqueous methanol extracts of hazel nut on ATCC strains of Streptococcus \n\n\n\npneumoniae, Klebsiella pneumoniae and Candida albicans using disk diffusion method. The selected seeds \n\n\n\nand nuts were extracted with 50% methanol, methanol, and ethyl acetate. The antimicrobial assay was \n\n\n\nperformed according to the guidelines in Clinical and Laboratory Standards Institute (CLSI) Protocol. \n\n\n\nDiameter of the inhibition zones was recorded. Extracts with higher antimicrobial potential were further \n\n\n\nevaluated in IC50 study. All the extracts were found to have antimicrobial activity against S. pneumoniae \n\n\n\n(range from 6.13\u00b10.06 mm to 17.50\u00b11.10 mm), K. pneumoniae (range from 4.60\u00b10.00 mm to 6.07\u00b10.32 mm), \n\n\n\nbut not on C. albicans. Methanol (17.50\u00b11.10 mm) and ethyl acetate (17.23\u00b11.10 mm) extracts of hazelnut \n\n\n\nwere found to have the highest antimicrobial activity and were taken for further evaluation in the IC50 study. \n\n\n\nThe IC50 obtained for hazelnut in methanol and ethyl acetate is 0.15 mg/ml and 0.76 mg/ml, respectively. \n\n\n\nFurther observation in light microscope revealed lower cell count and morphology changes as compared to the \n\n\n\ncontrol. In conclusion, the methanol and ethyl acetate extracts of hazelnut were found to have the highest \n\n\n\ninhibitory action on S. pneumoniae and K. pneumonia. \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                           MPS Pharmacy Scientific Conference 2011 \n \n\n\n\n381 \n \n\n\n\n\n\n\n\nPPM \u2013 15 (000132) \n \n \n\n\n\nIn vitro Antimicrobial Activity of Strobilanthes crispus Ethanolic Leaf Extracts using Disk Diffusion \n\n\n\nMethod  \n \n\n\n\nP Madhavan\n1\n, CS Yap\n\n\n\n1\n, AS Mohamed Saleem\n\n\n\n1\n, V Lim\n\n\n\n2\n \n\n\n\n1\nSchool of Pharmacy, Faculty of Pharmaceutical Sciences, UCSI University, Kuala Lumpur. \n\n\n\n2\nAdvance Medical and Dental Institute, University Sains Malaysia, Penang. \n\n\n\n\n\n\n\nStrobilanthes crispus, also known by the common name \u201cpecah kaca\u201d in Malaysia, is a local traditional \n\n\n\nmedicinal plant. Potential medicinal properties of S. crispus leaf extracts, including anticancer and anti-\n\n\n\ndiabetic activities have been well-documented in recent studies. In addition, S. crispus leaf extracts exhibit \n\n\n\nhigh antioxidant activities. Therefore, the aim of this study was to assess the potential antimicrobial activities \n\n\n\nof ethanolic leaf extract of S. crispus by employing disk diffusion method. Susceptibilities of various ATCC \n\n\n\nstrains of Aspergillus brasiliensis, Candida albicans, Klebsiella pneumoniae, Pseudomonas aeruginosa, \n\n\n\nStaphylococcus aureus, and Streptococcus pneumoniae towards ethanolic leaf extract of S. crispus were \n\n\n\ndetermined. The optimum incubation period and the minimum inhibitory concentration were determined. \n\n\n\nDiameter of the zone of inhibition was recorded. From this study, it was found that the ethanolic leaf extract \n\n\n\nof S. crispus exhibited inhibitory activity against S. aureus with an inhibition zone of 15.0 mm at 250 mg/mL \n\n\n\nand S. pneumonia with an inhibition zone of 7.1 mm at 200 mg/mL leaf extracts. The optimum incubation \n\n\n\nperiod for the inhibitory action of ethanolic leaf extract of S. crispus on S. aureus and S. pneumonia was 24 \n\n\n\nhours. No visible inhibition was observed against A. brasiliensis, C. albicans, K. pneumoniae, and P. \n\n\n\naeruginosa. In conclusion, the ethanolic leaf extract of S. crispus possess antibacterial activity against S. \n\n\n\naureus and S. pneumoniae. \n\n\n\n\n\n\n\nPPM \u2013 16 (000140) \n \n \n\n\n\nAntimicrobial Activity of Methanol Extracts of Sphaeranthus zeylanicus Leaves: An In-Vitro \n\n\n\nInvestigation  \n \n\n\n\nA.V. Anita Gnana Kumari\n1\n, A. Palavesam\n\n\n\n2\n, J. Anbu Jeba Sunilson\n\n\n\n1\n, K. Anandarajagopal\n\n\n\n2\n \n\n\n\n1\nSchool of Pharmacy, KPJ International University College of Nursing and Health Sciences, Kota Seriemas, \n\n\n\nNilai, Negeri Sembilan, Malaysia  \n2\nCentre for Marine Science and Technology, M.S. University, Rajakkamangalam, Kanyakumari District, \n\n\n\nTamilnadu, India  \n3\nSchool of Pharmacy, Masterskill University College of Health Sciences, Cheras, Selangor, Malaysia \n\n\n\n\n\n\n\nThe objective of the present study was to evaluate antimicrobial activity of the methanol extract of \n\n\n\nSphaeranthus zeylanicus (Asteraceae) Leaves.  The antimicrobial activity of the extract was tested against \n\n\n\nsome selective gram positive, gram negative bacterial and fungal strains. The preliminary antimicrobial \n\n\n\nactivity was evaluated by agar disk diffusion method. Minimum Inhibitory concentration (MIC) was \n\n\n\ndetermined by tube dilution method while minimum bactericidal concentration (MBC) and minimum \n\n\n\nfungicidal concentration (MFC) were determined by agar diffusion method. Commercial antibiotics were used \n\n\n\nas positive reference standards to determine the sensitivity of the strains. The methanol extract of S. zeylanicus \n\n\n\nleaves showed significant inhibitory activity against standard strains such as Staphylococcus aureus, \n\n\n\nEscherichia coli and Streptococcus faecalis.  Neither the concentrated extract nor its dilutions inhibited \n\n\n\nKlebsiella pneumonia, Pseudomonas aeruginosa and Candida albicans. The findings of our study show the \n\n\n\nmethanol extract of S. zeylanicus leaves possess antimicrobial activity with different potency against variety \n\n\n\nof selected microorganisms. The differentiating activities of extracts encourage developing a novel broad \n\n\n\nspectrum antimicrobial herbal formulation in future. \n\n\n\n\n\n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                           MPS Pharmacy Scientific Conference 2011 \n \n\n\n\n382 \n \n\n\n\nPHARMACEUTICAL CHEMISTRY \n\n\n\n\n\n\n\nPPC \u2013 01 (000007) \n\n\n\n\n\n\n\nDevelopment and Validation of an HPLC Method for Simultaneous Determination of Atorvastatin \n\n\n\nCalcium and Fenofibrate in Rabbit Plasma  \n \n\n\n\nS D Bhinge\n1\n, S M Malipatil\n\n\n\n2\n, A Jondhale\n\n\n\n1\n, A S Savali\n\n\n\n3\n \n\n\n\n1\nDepartment of Pharmaceutical Chemistry,\n\n\n\n \nRMES\u2019s College of Pharmacy, Gulbarga, Karnataka, India. \n\n\n\n2\nDepartment of Pharmaceutical Chemistry,\n\n\n\n \nHKES\u2019s College of Pharmacy, Gulbarga, Karnataka, India. \n\n\n\n3\nDepartment of Pharmacology,\n\n\n\n \nRMES\u2019s College of Pharmacy, Gulbarga, Karnataka, India. \n\n\n\n\n\n\n\nAn accurate, rapid and simple reversed-phase high performance liquid chromatography (RP-HPLC) method \n\n\n\nwas validated for simultaneous estimation of atorvastatin calcium, fenofibrate and for diclofinac (internal \n\n\n\nstandard) in rabbit plasma. Plasma samples were treated with acetonitrile to precipitate protein. \n\n\n\nChromatographic separation was accomplished using CAPCELL PAK C8 (4.6 mm x 250 mm, 5 mm) \n\n\n\nanalytical column with a mobile phase consisting of phosphate buffer and acetonitrile. Detection and \n\n\n\nquantification were performed by UV/Vis detection at 260 nm. The lower limit of detection and quantification \n\n\n\nwere 0.05 \u00b5gmL\n\u22121\n\n\n\n and 0.20 \u00b5gmL\n\u22121\n\n\n\n for atorvastatin calcium and 0.07 \u00b5gmL\n\u22121\n\n\n\n and 0.35 \u00b5gmL\n\u22121\n\n\n\n for \n\n\n\nfenofibrate, respectively. The calibration curves are linear over the concentration range 1 to 40 \u00b5gmL\n\u22121\n\n\n\n for \n\n\n\nboth atorvastatin and fenofibrate in rabbit plasma. The method was quantitatively evaluated in terms of \n\n\n\nlinearity, precision, accuracy, recovery, selectivity and stability. The method is simple, convenient and \n\n\n\nsuitable for the analysis of atorvastatin calcium and fenofibrate from rabbit plasma. \n\n\n\n \nPPC \u2013 02 (000018) \n\n\n\n\n\n\n\nEnhancing Solubility of Drugs by the Complex Behaviour of Poly-Vinyl Pyrrolidone (PVP)  \n \n\n\n\nBandar E. Aldhubiab\n1\n, Min Wu\n\n\n\n2\n, Samuel H. Yalkowsky\n\n\n\n2\n \n\n\n\n1\nDepartment of Pharmaceutical Sciences, College of Clinical Pharmacy, King Faisal University, Saudi \n\n\n\nArabia. \n2\nDepartment of Pharmaceutical Sciences, College of Pharmacy, University of Arizona, United States of \n\n\n\nAmerica. \n\n\n\n\n\n\n\nThis study was to understand the mechanism of solubilization of a set of poorly soluble drugs by poly-vinyl \n\n\n\npyrrolidone (PVP) and to compare with N-methyl pyrrolidone (NMP), 2-pyrrolidone and traditional \n\n\n\ncosolvents like ethanol, propylene glycol,  and polyethylene glycol 400. The solubilization efficiency of PVP \n\n\n\nhas been determined for 10 poorly soluble drugs. The solubilities of the compounds were determined for 0%, \n\n\n\n1.0%, 2.5%, 5.0%, 7.5%, 10.0%, 15.0%, 20.0%, 30.0%, 40.0%, and 50.0% of PVP in aqueous media using \n\n\n\nHPLC. In the case of weak electrolytes, the pH was maintained at least 2 units from their respective pKa so as \n\n\n\nto ensure greater than 99% unionized form was present. The experimental data were analyzed using the \n\n\n\nmathematical model of Sanghvi et al. (2002) in which the total solubility enhancement is a sum of two effects \n\n\n\n(cosolvation and complexation). Our results support that PVP has both cosolvent and complexation additions. \n\n\n\nThe linear relationship between \u03c3 and log Kow indicates that the more hydrophobic the solute, the more it will \n\n\n\nbe solubilized by PVP. However, the complex stability is not proportional to the hydrophobicity or the \n\n\n\npartition coefficient. Stacking complexation is also affected by aromaticity and molecular geometry. In \n\n\n\nconclusion, PVP is a stronger complexing agent but a weaker cosolvent than NMP and 2-pyrrolidone. The \n\n\n\ncosolvent constant (s) value of 1.04 indicates that PVP is a more efficient cosolvent than either ethanol, \n\n\n\npropylene glycol or polyethylene glycol 400. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                           MPS Pharmacy Scientific Conference 2011 \n \n\n\n\n383 \n \n\n\n\nPPC \u2013 03 (000030) \n\n\n\n\n\n\n\nPreparation and Analysis of Fermental Impurities and Degradation Products (4-Epimers, Anhydro and \n\n\n\nIso-derivatives ) of Chlortetracycline  \n \n\n\n\nN.H. Khan\n1\n, N. Perveen\n\n\n\n2\n \n\n\n\n1\nFaculty of Pharmacy, AIMST University, Semeling, 08100 Bedong, Kedah Darul Aman, Malaysia. \n\n\n\n2\nSchool of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Minden, Penang, Malaysia. \n\n\n\n\n\n\n\nThe decomposition products of chlortetracycline are 4-epichlortetracycline HCL, anhydrochlortetracycline \n\n\n\nHCL, 4-epianhydrochlortetracycline HCL, isochlortetracycline HCL and 4-epiisochlortetracycline HCL. The \n\n\n\nrelated products of chlortetracycline were prepared and purified in our laboratory following European \n\n\n\nPharmacopoeia and United States Pharmacopeia. Reagents were prepared following European \n\n\n\nPharmacopoeial instructions. Solvents and chemicals complied with the European Pharmacopoeia. Loss on \n\n\n\ndrying, determination of water, non- aqueous titration of bases and halogen salts of bases and sulphated ash \n\n\n\nwere analysed. Physical properties such as specific optical rotation, UV and Visible spectroscopy, solubility, \n\n\n\nmelting points and others were determined. Purity of these products was determined by HPLC and GLC. \n\n\n\nResults obtained for non-aqueous titrations, semi-micro determinations of water, loss on drying, sulphated ash \n\n\n\nand residual organic solvents (by GLC) were compared with those available in the literature. Karl Fischer \n\n\n\nresults were confirmed by those for loss on drying. The GLC results explained the difference between Karl \n\n\n\nFischer titration and loss on drying observed for 4-epichlortetracycline HCL. The purity of the related \n\n\n\nsubstances was almost above 95%. Difference in physical and instrumental results was observed of with those \n\n\n\nof literature. The problem of availability of related substances may be solved by self-preparing and self-\n\n\n\npurifying because these samples are available at a very high price. \n\n\n\n \nPPC \u2013 04 (000031) \n\n\n\n\n\n\n\nPreliminary Phytochemical and Antimicrobial Screening of Momordica charantia  \n \n\n\n\nW. S. C. Nikki\n1\n, T. Bilberry\n\n\n\n1\n, Vaisnavi a/p Kanthabalan\n\n\n\n1\n, N. H. Khan\n\n\n\n1\n, N. Perveen\n\n\n\n 2\n \n\n\n\n1\nFaculty of Pharmacy, AIMST University, Semeling, 08100 Bedong, Kedah Darul Aman, Malaysia. \n\n\n\n2\nSchool of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Minden, Penang, Malaysia. \n\n\n\n\n\n\n\n\n\n\n\nMomordica charantia is a tropical and subtropical vine of the family Cucurbitaceae with wide range of \n\n\n\npharmacological importance. All parts of the plant taste very bitter. It is known as the most bitter, edible \n\n\n\nvegetable and humans are the only mammals that have developed a taste for it. The objective of this short \n\n\n\nterm research was to evaluate the phytochemical constituents and antimicrobial activity of aqueous and \n\n\n\nethanolic extracts of the fruits of Momordica charantia, obtained by maceration with water, extraction \n\n\n\nfollowing reflux condensation and Soxhlet extraction with absolute alcohol. Phytochemical analysis for the \n\n\n\nimportant chemical groups from aqueous and ethanolic extracts was carried out that revealed the positive tests \n\n\n\nfor the presence of alkaloids, carbohydrates, steroids and terpenoids. Antimicrobial activity was carried out \n\n\n\nusing Disk Diffusion method by comparing the clear inhibition zone of standard antibiotic and the extracts on \n\n\n\nMueller-Hinton agar. Each extract was prepared into different concentration of 5.0%, 10.0% and 15.0% \n\n\n\nexcept for water extract which was prepared into concentration of 5.0% and 10.0% using disk diffusion \n\n\n\nmethod with 3 antibiotics as the standard antibiotic (penicillin, ampicillin and streptomycin). Four bacterial \n\n\n\nstrains were used, namely Bacillus subtilis, Pseudomonas aeruginosa, Methicillin-resistant Staphylococcus \n\n\n\naureus and Escherichia coli. Dimethyl sulphoxide and water was used as negative control. No zone of \n\n\n\ninhibition was observed in the antimicrobial test for both extracts of Momordica charantia. It is suggested that \n\n\n\na long term research project is a need for further investigation of this plant. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                           MPS Pharmacy Scientific Conference 2011 \n \n\n\n\n384 \n \n\n\n\nPPC \u2013 05 (000051) \n\n\n\n\n\n\n\nMolecular Modelling Studies on 4-Pyrrol-1-yl Benzoic Acid Hydrazide Analogues as Anti-Tuberculosis \n\n\n\nAgents  \n \n\n\n\nGhan Sheah Lin, Chia Wei Ling, Kang Yew Beng, Bhoomendra Atmaram, M. Arockia Babu \n\n\n\nSchool of Pharmacy and Health Sciences, International Medical University (IMU), 57000 Kuala Lumpur \n\n\n\n\n\n\n\nCrucial drawbacks of existing pharmacotherapy for tuberculosis, especially pharmacokinetics, toxicities, side \n\n\n\neffects and the emergence of multidrug-resistant Mycobacterium tuberculosis (M. Tb), have propelled the \n\n\n\ndevelopment of new anti-tubercular agents. 3D-QSAR study was performed on 4-pyrrol-1-yl benzoic acid \n\n\n\nhydrazide analogues employing Discovery Studio. Several statistically significant QSAR models were \n\n\n\nobtained using genetic function approximation (GFA) technique. Out of these models, the best QSAR model \n\n\n\nobtained is given below as: BA = -1.5389\u22120.093225* Dipole_X+0.36661*Dipole_Y+0.009615*Jurs_TPSA; \n\n\n\nr=0.945, r\n2\n=0.89, r\n\n\n\n2\nadj=0.86, q\n\n\n\n2\n=0.68, RMS Residual Error=0.2336, Friedman L.O.F=0.1425. Electronic \n\n\n\ndescriptors of Dipole_Y and spatial descriptor of total polar surface area (Jurs_TPSA) were identified to \n\n\n\ncontribute positively towards the biological activity. The QSAR model suggests that the molecule\u2019s total polar \n\n\n\nsurface area, orientation and polarity play crucial role in activity. Furthermore, CDOCKER, a docking \n\n\n\nalgorithm based on molecular dynamics (MD) was used to dock ligand to Mycobacterium tuberculosis \n\n\n\nthymidylate kinase (TMPKmt) in order to understand the binding interactions between ligand and receptor. \n\n\n\nDocking analysis reveals that active compounds of this derivative found to have interaction with one or more \n\n\n\namino acids including ARG74, ARG95, ASN 100, ARG160 and GLU166 of TMPKmt. These results of 3D-\n\n\n\nQSAR and docking studies may be useful for future development of drugs with improved activity against \n\n\n\nMycobacterium tuberculosis. \n\n\n\n \nPPC \u2013 06 (000052) \n\n\n\n\n\n\n\nSynthesis and SAR Studies of Novel Benztriazole Substituted 1,3,4-Thiadiazoles: Structural Features \n\n\n\nVital for Antiepileptic Activity  \n\n\n\n\n\n\n\nHarish Rajak, Ravitas Deshmukh, Poonam Parmar, Bhupendra S Thakur, JS Dangi \nSLT Institute of Pharmaceutical Sciences, Guru Ghasidas University, Bilaspur-495 009 (CG), India. \n\n\n\n\n\n\n\nIn search for a better antiepileptic molecule and the importance of semicarbazones and 2,5-disubstituted 1,3,4-\n\n\n\nthiadiazoles as anticonvulsant pharmacophore encouraged us to carry out the synthesis of three novel series of \n\n\n\nN\n1\n-{5-[(1H-benztriazol-1-ylmethyl)-1,3,4-thiadiazol-2-yl}-N\n\n\n\n4\n-(2/3/4-substitutedbenzaldehyde)-     \n\n\n\nsemicarbazone,N\n1\n-{5-[(1H-benztriazol-1-ylmethyl)-1,3,4-thiadiazol-2-yl}-N\n\n\n\n4\n-[1-(4-\n\n\n\nsubstitutedphenyl)ethanone]-semicarbazone,  and N\n1\n-{5-[(1H-benztriazol-1-ylmethyl)-1,3,4-thiadiazol-2-yl}-\n\n\n\nN\n4\n-[1-(4-substitutedphenyl) (phenyl) methanone]-semicarbazone for their potential anticonvulsant activity. \n\n\n\nThese compounds were designed and synthesized to meet structural requirements necessary to meet four site \n\n\n\nbinding hypothesis for anticonvulsant activity.  The structures of the compounds were confirmed by elemental \n\n\n\nand IR, NMR and MS spectral analysis. The test compounds were subjected to maximal electroshock seizure \n\n\n\n(MES) and subcutaneous pentylenetrtrazole (scPTZ) methods for determination of their anticonvulsant \n\n\n\nproperties. The rotarod assay was performed in mice to evaluate neurotoxicity of the test compounds. In order \n\n\n\nto find out the mechanism of action, most active compounds found after primary anticonvulsant screening \n\n\n\nwere selected for in-vitro GABA assay. In the present studies, N\n1\n-{5-[(1Hbenztriazol-1-ylmethyl)-1,3,4-\n\n\n\nthiadiazol-2-yl}-N\n4\n-[1-(4-hydroxyphenyl) (phenyl) methanone]-semicarbazone came out as the most active \n\n\n\ncompound, showing considerable activity in MES (at 100 mg/kg after 0.5 h and 4.0 h) and scPTZ model (at \n\n\n\n300 mg/kg after 4.0 h) without any neurotoxicity (up to 300 mg/kg after 4.0 h). The results of the in-vitro \n\n\n\nGABA assay shows that promising compounds enhance the GABA level several folds as compared to the \n\n\n\ncontrol which confirmed that the presently studied test compounds exhibit anticonvulsant activity via GABA-\n\n\n\nmediation. The results of these studies validated that the pharmacophore model with four binding sites is \n\n\n\ndecisive for anticonvulsant activity. \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                           MPS Pharmacy Scientific Conference 2011 \n \n\n\n\n385 \n \n\n\n\nPPC \u2013 07 (000070) \n\n\n\n\n\n\n\nThin Layer Chromatography of Papaver Extracts  \n \n\n\n\nI. Abdul Wahab, H.F. Mohsin, N.I. Md Nasir, N.H. Zulkefli, N.I.S. Md Nasir \n\n\n\nFaculty of Pharmacy, Universiti Teknologi MARA, 42300 Puncak Alam, Selangor Darul Ehsan, Malaysia. \n\n\n\n\n\n\n\nA topic of the phytochemistry of Papaver species was offered to pharmacy undergraduates in their final year \n\n\n\nproject. The study plan includes literature search and laboratory work involving the seeds, obtained from a \n\n\n\nherbalist and a bakery. Unground Papaver seeds were subjected to organic extractions, using methanol, ethyl \n\n\n\nacetate and chloroform independently, in order to analyse their chemical components. Thin layer \n\n\n\nchromatography of Papaver extracts were performed with various solvents compositions, resulting \n\n\n\nin unsatisfactory profiles. The separations were not fully achieved, whereby, tailing spots were observed on \n\n\n\nthe silica aluminium sheets. Later, high performance thin layer chromatography was approached. The results \n\n\n\nwere very much improved, whereby, more than four spots were separated with toluene:ethyl acetate (60:40) \n\n\n\nfrom both the methanol and ethyl acetate extracts. Meanwhile, toluene:acetone (80:20) was found to be the \n\n\n\nsuitable mobile phase for the chloroform extract. Efforts were also undertaken to purify and identify the white \n\n\n\nand yellowish, crystalline compounds, probably a type of alkaloid that was reported to provide stimulating and \n\n\n\npain relieving effects. It is hoped that this introduction of plant chemistry could cultivate the knowledge of \n\n\n\nnatural products\u2019 constituents with health contributing elements for the student pharmacists. \n\n\n\n \nPPC \u2013 08 (000099) \n\n\n\n\n\n\n\nHigh Performance Liquid Chromatography (HPLC) Coupled with MicrOTOF-Q Mass Spectroscopic \n\n\n\nProcedure for Qualitative and Quantitative Determination of Vinca rosea Methanol Extract  \n \n\n\n\nM J A Siddiqui\n1\n, Z Ismail\n\n\n\n2\n, M R Hamdan\n\n\n\n2\n, S Q Jamshed\n\n\n\n1\n \n\n\n\n1\nPharmaceutical Chemistry, School of Pharmacy and Health Sciences, International Medical University, \n\n\n\nBukit Jalil, 57000 Kuala Lumpur, Malaysia. \n2\nSchool of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Minden, Penang, Malaysia. \n\n\n\n\n\n\n\nVinca rosea (Apocynaceae) is one of the most significant and high value medicinal plants known for its \n\n\n\nanticancer alkaloids used in chemotherapy to treat numerous cancers. An HPLC coupled with MicroTOF-Q \n\n\n\nmass spectroscopic procedure for qualitative and quantitative determination of Vinca rosea methanol extract \n\n\n\nwas performed. The quantitative determination was conducted by liquid chromatography equipped with \n\n\n\noptimal separation that was achieved by gradient mobile phase consisting of A= water+0.1% formic acid; \n\n\n\nB=acetonitrile (5-95% in 15 min) on a column (Trinity RSLC C18, 2.1 x 33 mm; 3 \u03bcm) using Dionex 3000 \n\n\n\nLC.  MicrOTOF-Q successfully detected the alkaloids namely vinblastine, vincristine, catharanthine and \n\n\n\nvindoline by high-resolution ion chromatogram (hr EIC) with SigmaFit formulae of these compound to \n\n\n\nconfirm. All four compounds eluted from Vinca rosea methanol extract at retention time 3.95, 4.14, 4.77 and \n\n\n\n5.08 min respectively. Catharanthine is eluted at 5.08 at m/z 337 with loss of NH2 (320.16) and loss of acetate \n\n\n\ngroup at 305.15 m/z). While dimers was observed in case of vinblastine because it contained tertiary amine \n\n\n\nthat  protonates to yield a +2 charge at 406 m/z but the signal to noise of 811 m/z was low. In case of \n\n\n\nvincristine that was difficult to protonate, a +1 charge is observed at 825.40 m/z. Detailed results will be \n\n\n\ndiscussed. The method was successfully employed to characterize diverse alkaloids present in samples, and \n\n\n\nconsequently could be used in the future for quantification purposes and suitable for the standardization and \n\n\n\nquality assurance of V. rosea plant extracts. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                           MPS Pharmacy Scientific Conference 2011 \n \n\n\n\n386 \n \n\n\n\nPPC \u2013 09 (000111) \n\n\n\n\n\n\n\nDevelopment and Validation of High-Performance Liquid Chromatographic Method for Determination \n\n\n\nof Glipizide in Human Plasma  \n \n\n\n\nM Atif\n1\n, SAS Sulaiman\n\n\n\n1\n, MA Hassali\n\n\n\n2\n, AA Shafie\n\n\n\n2\n, F Saleem\n\n\n\n2\n, N Saqib\n\n\n\n3\n, M Qamar-Uz-Zaman\n\n\n\n4\n, M Asif\n\n\n\n4\n \n\n\n\n1\nDiscipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, \n\n\n\nMalaysia. \n2\nDiscipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains \n\n\n\nMalaysia, Penang, Malaysia. \n3\nMinistry of Health, Karachi, Pakistan. \n\n\n\n4\nDepartment of Pharmacy, The Islamia University of Bahawalpur, Punjab, Pakistan. \n\n\n\n\n\n\n\nAn accurate, reproducible high performance liquid chromatographic (HPLC) method has been developed for \n\n\n\nquantitative estimation of glipizide administered as a tablet dosage form. Chromatographic system consisted \n\n\n\nof C18 column (ZORBAX ODS 4.6 x 150 mm, 5 \u00b5m) and 0.01 M acetonitrile-potassium di-hydrogen \n\n\n\nphosphate buffer (35:65) pH adjusted to 3.5 with o-phosphoric acid as mobile phase. Blank plasma was spiked \n\n\n\nwith glipizide solution of various concentrations. Samples were extracted with toluene and evaporated to \n\n\n\ndryness by using nitrogen gas. Dried residues were reconstituted with mobile phase and injected to \n\n\n\nchromatographic system. Mobile phase was eluted at a flow rate of 1.5 mL/min and effluent was monitored at \n\n\n\na wavelength of 275 nm. The retention time for glipizide was 7.3 minutes with a run time of 20 minutes. The \n\n\n\nlinearity was observed in concentration range of 50-1600ng/mL with a mean recovery of 98%. The intra-day \n\n\n\nand inter-day accuracy and precision of method were determined on three separate days. Developed method \n\n\n\ncan be successfully used for pharmacokinetic study of glipizide in human plasma. \n\n\n\n\n\n\n\n\n\n\n\nPPC \u2013 10 (000119) \n\n\n\n\n\n\n\nCytotoxicity Studies and Analysis of Primary and Secondary Metabolites in Methanol and Water \n\n\n\nExtracts of Ficus deltoidea Leaves  \n \n\n\n\nArmaghan Shafaei\n1\n, Syima Muslim\n\n\n\n2\n, Zhari Ismail\n\n\n\n1\n, Amin Malik Shah Bin Abdul Majid\n\n\n\n2\n \n\n\n\n1\nDepartment of Chemistry, School of Pharmaceutical Science, Universiti Sains Malaysia, 11800 Minden, \n\n\n\nPenang, Malaysia \n2\nDepartment of Pharmacology, School of Pharmaceutical Science, Universiti Sains Malaysia, 11800 Minden, \n\n\n\nPenang, Malaysia \n\n\n\n\n\n\n\nFicus deltoidea (Moraceae), an epiphytic shrub, is widely distributed in the Southeast Asian countries. In \n\n\n\nMalaysia, F. deltoidea is locally known as Mas cotek. F.deltoidea is traditionally used for treatment of gout, \n\n\n\nhigh blood pressure, skin infection, dysentery and diarrhea. This study was conducted to investigate the \n\n\n\nprimary and secondary metabolic contents and cytotoxicity activity of water and methanol extracts of F. \n\n\n\ndeltoidea. Primary and secondary metabolic contents were evaluated for total proteins, polysaccharides, \n\n\n\nglycosaponins, phenolics, flavonoids and total tannins using linear regression equation that it was obtained \n\n\n\nfrom calibration curve of standard (P<0.05). Methanol extract showed high content of total proteins, \n\n\n\nglycosaponins, phenolics, flavonoids and total tannins while contents of polysaccharides were high in water \n\n\n\nextract. Cytotoxicity was detected by MTT assay using MDA-MB-231 and MCF-7 that were derived from \n\n\n\nhuman breast cancer cell. The cells were cultured in DMEM growth medium supplemented with 10% fetal \n\n\n\nbovine serum and 1% penicillin-streptomycin. Both extract showed moderate cytotoxic activity using extract \n\n\n\nin high and medium concentration with IC50 values of 19.55 and 22.29 \u00b5g/mL for methanol extract and 20.13 \n\n\n\nand 22.62 \u00b5g/mL for water extract on MCF-7 and MDA-MB-231 cell lines, respectively. The results show \n\n\n\nthat methanol and water extracts have strong cytotoxic activity on MCF-7 and MDA-MB-231 breast cancer \n\n\n\ncell line, this may be due to different contents of total proteins, total polysaccharides, total glycosaponins, \n\n\n\nphenolics, flavonoids and total tannins in extracts of F. deltoidea. \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                           MPS Pharmacy Scientific Conference 2011 \n \n\n\n\n387 \n \n\n\n\nPPC \u2013 11 (000123) \n\n\n\n\n\n\n\np38 Alpha Mitogen Activated Protein Kinase Inhibitors: 3D-QSAR and Molecular Docking Studies  \n \n\n\n\nC W Mai, S Y Ngiow, M R Pichika, Y B Kang \n\n\n\nPharmaceutical Chemistry, School of Pharmacy and Health Sciences, International Medical University, \n\n\n\nKuala Lumpur, Malaysia. \n\n\n\n\n\n\n\nIn recent years, at least few millions of drug-like compounds have been identified as potential therapeutic \n\n\n\nagents, and waiting to be tested. It is impossible to test all these compounds because it is just not cost \n\n\n\neffective, too laboratory intensive and time consuming. Thus, computer-aided rational drug design could be \n\n\n\nthe solution for this challenge. For this study, we have special interest to determine the molecular properties of \n\n\n\na potent p38\u03b1 Mitogen-activated protein kinase (MAPK) inhibitor because overproduction of p38\u03b1 MAPK has \n\n\n\nbeen related to chronic inflammatory diseases. However until today, there is no clinically marketed p38\u03b1 \n\n\n\nMAPK inhibitor because the essential chemical characteristic of a potent and safe p38\u03b1 MAPK inhibitor has \n\n\n\nyet to be identified. In this study, we applied ligand-based approach on N-pyrimidyl amide based compounds. \n\n\n\n3D-quantitative structural activity relationships of those inhibitors were studied through Comparative \n\n\n\nMolecular Field Analysis (CoMFA) and Comparative Molecular Similarity Indices Analysis (CoMSIA). The \n\n\n\n3D-QSAR studies results were further confirmed with molecular dynamic stimulation by docking.  We have \n\n\n\nconcluded that steric, hydrogen bond donor and hydrogen bond acceptor fields are important descriptors of a \n\n\n\npotent p38\u03b1 MAPK inhibitor. With that, a new set of more potent compounds are identified and warrant for \n\n\n\nfuture studies. \n\n\n\n\n\n\n\nPPC \u2013 12 (000189) \n\n\n\n\n\n\n\nMultivariate Analysis of Aqueous Extracts of Labisia pumila var. alata using High Performance Liquid \n\n\n\nChromatography-Photodiode Array and Chemometrics \n \n\n\n\nRosniza R, Jamia Azdina J, Bukhori A B, Nurul Akmarina M A K, Noor Azlina A J\n \n\n\n\nDrug and Herbal Research Centre, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, \n\n\n\nMalaysia. \n\n\n\n\n\n\n\nQuality control is important to ensure the quality, safety and effectiveness of herbal medicines and their \n\n\n\nproducts. The objective of this study was to develop qualitative and quantitative analytical methods for \n\n\n\nLabisia pumila var. alata using high performance liquid chromatography-photodiode array (HPLC-PDA) \n\n\n\ncombined with chemometrics (PCA, HCA and SIMCA). The analysis was conducted on 40 aqueous extracts \n\n\n\n(20 different locations) and herbal preparations (4 extracts). The optimum conditions for separation were \n\n\n\nobtained with an X-Bridge-C18 column (4.6 x 250 mm, 5 \u03bcm) by an isocratic elution using acetonitrile and \n\n\n\nphosphoric buffer (3:97) as a mobile phase, at a flow rate of 0.5 mL/min, an operating temperature of 25\uf0b0C \n\n\n\nand a maximum wavelength at 270 nm. The system was validated by tests for linearity (r > 0.9999), \n\n\n\nconcentration range (0.78-100 \u00b5g/mL), selectivity, recovery (101.247%), precision (relative standard \n\n\n\ndeviation between 1.546-1.806% of intraday and 0.065-0.214% of interday), limit of detection (LOD=0.021 \n\n\n\n\u00b5g/mL) and limit of quantitation (LOQ=0.007 \u00b5g/mL). Analysis of 40 extracts of L. pumila var. alata showed \n\n\n\nthat the leaf extracts had higher concentration of gallic acid (0.76\u00b10.03-7.44\u00b10.01 \u00b5g/mL, n=6) than the root \n\n\n\nextracts (0.29\u00b10.03-2.68\u00b10.01 \u00b5g/mL, n=6). Whereas only two herbal products were found to contain gallic \n\n\n\nacid at 0.63\u00b10.07 \u00b5g/mL and 0.30\u00b10.06 \u00b5g/mL, respectively. The PCA and HCA analysis using HPLC \n\n\n\nfingerprint of 40 extracts of L. pumila var. alata based on peak area of the peaks at the retention time between \n\n\n\n6.0 and 15.5 minutes showed that the roots and leaves of L. pumila var. alata were grouped according to their \n\n\n\nrespective locations. The relative humidity and altitude were two main factors found to be correlated to the \n\n\n\nclustering. SIMCA successfully classified and assessed the quality of the aqueous extracts of the roots and \n\n\n\nleaves of L. pumila var. alata obtained from 20 different locations and the 4 herbal products containing L. \n\n\n\npumila var. alata based on the plant parts. In conclusion, the developed HPLC-PDA method combined with \n\n\n\nchemometric techniques (PCA, HCA and SIMCA) was found to be suitable for qualitative and quantitative \n\n\n\nanalysis of aqueous extracts of L. pumila var. alata and their products. \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                           MPS Pharmacy Scientific Conference 2011 \n \n\n\n\n388 \n \n\n\n\n\n\n\n\nPHARMACEUTICAL TECHNOLOGY \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nPPT \u2013 01 (000022) \n\n\n\n\n\n\n\nHelicobacter pylori Targeted Drug Delivery System: Preparation and Evaluation of Floating Beads of \n\n\n\nAmoxicillin \n\n\n\n\n\n\n\nP.S.Rajinikanth\n1\n, B.Mishra\n\n\n\n2\n \n\n\n\n1 \nDepartment of Pharmaceutical Technology, School of Pharmacy and Health Sciences, International \n\n\n\nMedical University, 57000 Kuala Lumpur, Malaysia.  \n 2\n\n\n\nDepartment of Pharmaceutics, Institute of Technology, Banaras Hindu University, Varanasi -221005, \n\n\n\nIndia. \n\n\n\n\n\n\n\nGellan gum-based floating beads containing amoxicillin were prepared by ionotropic gelation method for \n\n\n\nstomach-specific drug delivery against Helicobacter pylori. The size, shape, drug incorporation efficiency, \n\n\n\nbuoyancy, in vitro drug release, anti-microbial and drug-polymer interaction characteristics of beads were \n\n\n\nexamined. Scanning electron microscopy analysis showed that the beads were spherical in shape with rough \n\n\n\nouter surfaces. The beads showed good buoyancy properties in dissolution medium and in rabbit stomach, and \n\n\n\nindicated absence of interactions between drug and polymer. The drug was released by means of matrix \n\n\n\ndiffusion mechanism. The beads exhibited good anti-microbial activity against isolated H. pylori strain and \n\n\n\nstability at storage of 40\u00b0C/75 RH% for 6 months. The floating beads of gellan gum can be used to locally \n\n\n\nadministered amoxicillin in the stomach against H. pylori. \n\n\n\n \nPPT \u2013 02 (000024) \n\n\n\n\n\n\n\nInvestigation on Dissolution Enhancement of UDCA by Complextaion with \u00b2-Cyclodextrin-Choline \n\n\n\nDichloride Coprecipitate  \n \n\n\n\nKamal Dua, Kavita Pabreja \n\n\n\nDepartment of Pharmaceutical Technology, School of Pharmacy and Health Sciences, International Medical \n\n\n\nUniversity, Bukit Jalil, 57000 Kuala Lumpur, Malaysia. \n\n\n\n\n\n\n\nThe objective of the present investigation was to study the effect of presence of choline dichloride (CDC) in \u00b2-\n\n\n\ncyclodextrin (\u00b2-CD) on in vitro dissolution of ursodeoxycholic acid (UDCA) from molecular inclusion \n\n\n\ncomplexes. The molecular inclusion complexes of UDCA with \u00b2-CD coprecipitated with CDC were prepared \n\n\n\nusing kneading method. In vitro dissolution of pure drug, physical mixtures and cyclodextrin inclusion \n\n\n\ncomplexes (UDCA-\u00b2-CD-CDC) were carried out. Molecular inclusion complexes of UDCA with \n\n\n\ncoprecipitated \u00b2-CD showed considerable increase in the dissolution rate in comparison with physical mixture \n\n\n\nand pure drug in 0.1 N HCl, pH1.2 and phosphate buffer, pH 7.4. Inclusion complexes with 1:2M ratio \n\n\n\nshowed maximum dissolution rate in comparison to other ratios. FT-IR spectroscopy and differential scanning \n\n\n\ncalorimetry studies indicated no interaction between UDCA and \u00b2-CD-CDC in complexes at solid state. \n\n\n\nDissolution enhancement was attributed to the formation of water-soluble inclusion complexes with the \n\n\n\nprecipitated form of \u00b2 -CD. The in vitro release from all the formulations was best described by first order \n\n\n\nkinetics followed by Higuchi release model. In conclusion, dissolution of ursodeoxycholic acid can be \n\n\n\nenhanced by using the \u00b2 -CD-CDC coprecipitate as a host molecule. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                           MPS Pharmacy Scientific Conference 2011 \n \n\n\n\n389 \n \n\n\n\n\n\n\n\n\n\n\n\nPPT \u2013 03 (000036) \n\n\n\n\n\n\n\nDesign and Characterization of Mucoadhesive Buccal Delivery System of Testosterone: In Vitro and In \n\n\n\nVivo Studies \n \n\n\n\nAnil K. Kharya, Lavakesh K. Omray, Govind P. Agrawal \nPharmaceutics Research Laboratory, Department of Pharmaceutical Sciences, Dr. H. S. Gour Central \n\n\n\nUniversity, Sagar- 470003 (M.P)-India \n\n\n\n\n\n\n\nThe mucoadhesive buccal films carrying testosterone were prepared by cast film method using natural \n\n\n\nbiodegradable mucoadhesive film forming chitosan as matrix polymer. The thickness, density, folding \n\n\n\nendurance, surface pH, drug content, in vitro residence time, bioadhesive force, percent swelling index, \n\n\n\npercent moisture absorption capacity, in vitro drug release, in vitro drug permeation across the goat mucus \n\n\n\nmembrane and in vivo study were performed on these formulations. The drug released from films through \n\n\n\nnon-fickian diffusion following the formation of solvent-filled pore in matrix and matrix erosion at pH 6.8. \n\n\n\nThe drug permeation across the buccal mucosal membrane from selected film T4 was satisfactory due to such \n\n\n\npolymeric matrix had a relatively hydrophilic composition enabling drug release less retarded. In vivo study \n\n\n\nshowed that the plasma concentration of testosterone promptly increased and reached the peak level within 5 h \n\n\n\nof application of mucoadhesive buccal film. The results demonstrated the feasibility of developing \n\n\n\nmucoadhesive buccal film for delivery of testosterone.  \n\n\n\n\n\n\n\n\n\n\n\n \nPPT \u2013 04 (000039) \n\n\n\n\n\n\n\nFloating Microspheres for Enhanced Bioavailability of An Anti-Diabetic Drug \n \n\n\n\nManoj Kumar, R.S. Pandey, J.S. Dangi \n\n\n\nSLT Institute of Pharmaceutical Sciences, Guru Ghasidas Vishwavidyalaya, Bilaspur, Chhattisgarh-495009, \n\n\n\nIndia. \n\n\n\n\n\n\n\nThe objective of the present investigation was to evaluate gastro-retentive performance and pharmacokinetic \n\n\n\nparameters of optimized floating microspheres consisting of (i) calcium silicate (CS) as porous carrier; (ii) \n\n\n\nmetformin (MF), an oral hypoglycemic agent; and (iii) Eudragit S as polymer. The prepared microspheres \n\n\n\nwere characterized for their micromeritic properties, floating behavior and drug entrapment efficiency, as well \n\n\n\nas by Fourier transform infrared spectroscopy, differential scanning calorimetry, X-ray powder diffractometry \n\n\n\nand scanning electron microscopy techniques. Optimized formulation was orally administered to albino \n\n\n\nrabbits and blood samples were used to determine pharmacokinetic parameters of MF from floating \n\n\n\nmicrospheres, against that of the marketed tablet formulation.  The optimized formulation demonstrated \n\n\n\nfavorable in-vitro-floating and drug release characteristics. The drug release pattern followed the Higuchi \n\n\n\ndissolution model. Prolonged gastric residence time of over 4 h was achieved in all animals for CS-based \n\n\n\nfloating microspheres of MF. The relative bioavailability of MF loaded in floating microspheres was found to \n\n\n\nbe higher by about 2.5 times than that of the marketed tablet. It is concluded that the CS-based floating \n\n\n\nmicroparticles can be used to sustain release of MF in stomach-jejunum transit which eventually enhances \n\n\n\ndrug bioavailability. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                           MPS Pharmacy Scientific Conference 2011 \n \n\n\n\n390 \n \n\n\n\n\n\n\n\n\n\n\n\nPPT \u2013 05 (000059) \n\n\n\n\n\n\n\nPreparation and In-Vivo Evaluation of Indomethacin Loaded Transdermal Nanoemulsion  \n \n\n\n\nM. J. Qureshi\n1\n,  F. Shakeel\n\n\n\n2 \n\n\n\n1\nDepartment of Pharmaceutical Technology, International Medical University, Kuala Lumpur, Malaysia \n\n\n\n2\nDepartment of Pharmaceutics, Faculty of Pharmacy, Garyounis University, Benghazi, Libya \n\n\n\n\n\n\n\nIndomethacin, a potent non-steroidal anti-inflammatory drug, has been recommended for the treatment of \n\n\n\nvarious kinds of pains, inflammation and arthritis. This study designed nanoemulsion of indomethacin for \n\n\n\ntransdermal application.  The solubility of indomethacin was determined in different oils, surfactants and co-\n\n\n\nsurfactants. Pseudoternary phase diagrams were constructed to determine nanoemulsion zones.  Optimized \n\n\n\nnanoemulsions and commercial diclofenac diethylamine gel (Votran\u00ae gel) were subjected to in vivo anti-\n\n\n\ninflammatory studies using male Wistar rats with carrageenan induced hind paw edema. Based on solubility \n\n\n\nprofile of indomethacin , Labrafil, Tween-80 and Transcutol-HP were selected as oil phase, surfactant and co-\n\n\n\nsurfactant respectively for nanoemulsion development. Mean droplet size of all nanoemulsions was less than \n\n\n\n100 nm. The smallest droplet size, and lowest polydispersity index and product viscosity were obtained with \n\n\n\nformulation F6 which contained  indomethacin formulated with 5 % w/w Labrafil, 33.75 % w/w Tween-80, \n\n\n\n11.25 % w/w Transcutol-HP and 50 % w/w distilled water. F6 provided the highest In vitro skin permeation \n\n\n\nand enhancement ratio. Percent inflammation inhibition was more than 75 % by F6 after 6 hours of \n\n\n\napplication when compared to Votran\u00ae gel (< 30 %). The results indicated that nanoemulsion is a promising \n\n\n\nvehicle for transdermal delivery of indomethacin. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nPPT \u2013 06 (000067) \n\n\n\n\n\n\n\nEnhancement of The Dissolution Rate of Efavirenz using Solid Dispersion Technique \n \n\n\n\nAdinarayana Gorajana, Sanjay Garg, Chuah Jo Ni, Koh Pang Tsen \n\n\n\nDepartment of Pharmaceutics, School of Pharmacy and Health Sciences, International Medical University, \n\n\n\n57000 Kuala Lumpur, Malaysia. \n\n\n\n\n\n\n\nThe aim of this study is to enhance the dissolution rate of Efavirenz (EFV) by developing solid dispersion \n\n\n\nsystems (binary and ternary). Solid dispersions of EFV were prepared using solvent method with polyethylene \n\n\n\nglycol 8000 (PEG 8000) and polyvinylpyrrolidone K30 (PVP K30) as carriers. The ternary solid dispersion \n\n\n\nsystems incorporate Tween 80 as the third component. Various weight ratios of drug, carriers and surfactant \n\n\n\nwere employed and optimum drug-carrier ratio was investigated. Dissolution tests were carried out in 0.15% \n\n\n\nSLS and evaluated on the basis of cumulative percentage drug release, sampling time (Q10 & Q30) and \n\n\n\ndissolution efficiency (%DE). Physicochemical characterisation of the solid dispersions was carried out using \n\n\n\nDifferential Scanning Calorimetry, X-Ray Powder Diffraction, Fourier Transform Infrared Spectroscopy and \n\n\n\nScanning Electron Microscopy. Dissolution was remarkably improved in all binary solid dispersion systems \n\n\n\ncompared to pure EFV (p < 0.05). A drug-polymer weight ratio of 1:10 was identified as an optimum ratio \n\n\n\nand formulations with PVP K30 showed better improvement in dissolution. Incorporation of Tween 80 to the \n\n\n\n1:10 formulations showed further improvement in dissolution rate. Physicochemical characterisation results \n\n\n\nsuggested that EFV existed in the amorphous form in all the solid dispersion systems providing evidence for \n\n\n\nthe improvement in dissolution. Both binary and ternary solid dispersion systems showed improvement in \n\n\n\ndissolution of EFV. It was observed that formulations with PVP K30 showed better dissolution profile and \n\n\n\n1:10 was identified as an optimum drug-polymer weight ratio. \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                           MPS Pharmacy Scientific Conference 2011 \n \n\n\n\n391 \n \n\n\n\n\n\n\n\n\n\n\n\nPPT \u2013 07 (000101) \n\n\n\n\n\n\n\nExtraction and Characterization of Gelatin from Chicken Leg (Gallus gallus domesticus)  \n\n\n\n\n\n\n\nMohd Shakrie Palan Abdullah\u00b9, Mohamed Ibrahim Noordin\u00b9, Syed Ibrahim Mohd Ismail\u00b2, Wan \n\n\n\nAzman Wan Ismail\u00b9 \n\n\n\n\u00b9Department of Pharmacy, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia.  \n\n\n\n\u00b2Ain Medicare Sdn. Bhd, Kawasan Perindustrian Pengkalan Chepa 2, 16100 Kota Bharu Kelantan, Malaysia. \n\n\n\n\n\n\n\nThere is a need to search for alternative source of gelatin due to religious and health issues. In this study, \n\n\n\ngelatin was extracted from chicken legs by modified acid extraction process followed by lyophilization. \n\n\n\nVarious tests were conducted namely identification, proximate analysis, pH, gel strength, clarity, viscosity and \n\n\n\nthermal analysis to characterize the gelatin. The result shows that the gelatin had average yield of 5.18%, pH \n\n\n\nof 3.8, moisture content of 7.17%, total protein content of 93.77%, total fat content of 0.93% and total ash of \n\n\n\n1.57%. Its bloom strength was found to be higher than commercially available bovine gelatin. All test results \n\n\n\nof the newly extracted gelatin comply with pharmacopoeia standard. \n\n\n\n\n\n\n\n\n\n\n\n \nPPT \u2013 08 (000102) \n\n\n\n\n\n\n\nZeta Potential Measurements: Potential Indicator of Insulin Location within Solid Lipid Nanoparticles \n\n\n\n(SLNs) \n\n\n\n\n\n\n\nL M Thong, N Billa\n \n\n\n\nSchool of Pharmacy, Faculty of Science, University of Nottingham Malaysia Campus, Malaysia. \n\n\n\n\n\n\n\nSolid lipid nanoparticles (SLNs) have gained considerable interest as a promising colloidal drug carrier, as \n\n\n\nthey are able to incorporate and protect highly susceptible protein drugs from degradation in oral delivery. In \n\n\n\nthis present work, insulin was used as the model peptide. The purpose of this study was to investigate the \n\n\n\nlocation of insulin within the SLN matrix by means of a simple and reliable method, which has so far not been \n\n\n\naddressed in the literature. It is believed that the location of drug, which fits into 3 hypothetical models: \n\n\n\nmatrix, core-shell and drug-enriched core, is crucial in influencing the drug uptake by the enterocytes \n\n\n\nsubsequently. SLNs were prepared by solvent-evaporation emulsification technique, in which insulin in one \n\n\n\nformulation was encapsulated, whilst physically adsorbed to the unloaded SLN dispersion in the other. These \n\n\n\nformulations were subjected  to zeta potential measurements using zetasizer, followed by drug release studies. \n\n\n\nThe zeta potential of the unloaded SLNs, insulin-loaded SLNs and surface-adsorbed insulin SLNs were -\n\n\n\n51.7\u00b11.0, -45.8\u00b11.0 and -40.8\u00b11.0 mV respectively. Surface-adsorbed insulin caused an increase in zeta \n\n\n\npotential value. The drug release studies for insulin-loaded SLNs displayed a trend consistent with controlled \n\n\n\nrelease behaviour. On the other hand, the surface-adsorbed insulin SLNs had an initial burst release for first 10 \n\n\n\nminutes, gradually declining thereafter. Using zeta potential measurements, one can deduce that insulin is \n\n\n\npossibly dispersed within the matrix for insulin-loaded SLNs, whereas the surface-adsorbed insulin SLNs \n\n\n\npossibly adopts the core-shell model. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                           MPS Pharmacy Scientific Conference 2011 \n \n\n\n\n392 \n \n\n\n\n\n\n\n\n\n\n\n\nPPT \u2013 09 (000125) \n\n\n\n\n\n\n\nDissolution Enhancement of Poorly Water-Soluble Drugs by Nanonization Process \n \n\n\n\nSajeev Kumar B.\n1\n, R. Saraswathi \n\n\n\n2\n, Prasyaanth Nadarajan\n\n\n\n1\n, Sangeetha Selarajoo\n\n\n\n1\n, Venkates Kumar\n\n\n\n1\n \n\n\n\n1 \nFaculty of Pharmacy, AIMST University, Semeling, 1800 Bedong, Kedah Darul Aman, Malaysia. \n\n\n\n2 \nDirector & Principal, Al Shifa College of Pharmacy, Kizhattoor, Kerala, India - 679 325. \n\n\n\n\n\n\n\nLow drug solubility and bioavailability issues have been the most vital subject in drug development. Nearly \n\n\n\n40% of newly developed drug molecules are poorly water-soluble and potentially low in bioavailability. \n\n\n\nNanonization of drug through polymer encapsulation would be a viable approach. The present work analyzes \n\n\n\nthe effects of polymer on solubility and dissolution rate of drug processed by size reduction technique. \n\n\n\nGlibenclamide (GB), polyethylene glycol (PEG 20000) and Tween 80 were used as model drug, polymer and \n\n\n\nsurfactant respectively. Lyophilized GB nanoparticles were formulated by solvent-evaporation method and \n\n\n\nhad in-vitro dissolution, solid state property, release kinetics and particle size characterized. The formulations \n\n\n\nshowed a 10-fold increase in solubility with respect to pure GB. The percent cumulative drug release was \n\n\n\nfound to be higher in formulations (FGB1A and FGB1B) in comparison to marketed product. FT-IR and DSC \n\n\n\nanalysis suggested that both drug and polymer were compatible. SEM analysis revealed the presence of \n\n\n\nnanosized drug particles in selected samples. It was concluded that current process/formulation strategy can be \n\n\n\nused to enhance the poor aqueous solubility of the model drug and can be considered in prospective \n\n\n\nformulation development. Solvent-evaporation method is simple, reliable and cost effective for solubility \n\n\n\nenhancement studies. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nPPT \u2013 10 (000152) \n\n\n\n\n\n\n\nFormulation and Development of Azithromycin Floating Tablets  \n \n\n\n\nS  Rajesh, S Prathaban, Y Prasanna Raju, V Loganathan \nFaculty of Pharmaceutical Sciences, UCSI University, No.1,Jalan Menara Gading,UCSI Heights, Kuala \n\n\n\nLumpur, Malaysia. \n\n\n\n\n\n\n\nFloating tablets of azithromycin were developed to prolong its gastric residence time and increase its \n\n\n\nbioavailability. Azithromycin is stable and has a high absorption rate in the stomach. Different floating tablet \n\n\n\nformulations were prepared with varying concentrations of hydroxypropyl methylcellulose (HPMC). The \n\n\n\ntablets were prepared using wet granulation technique with drug to polymer ratios of 1.0:0.5, 1.0:1.0, and \n\n\n\n1.0:2.0 for formulation 1, 2, and 3 respectively. The floating tablets were evaluated for uniformity of weight, \n\n\n\nhardness, friability, drug content, in vitro buoyancy and dissolution studies. The physicochemical parameters \n\n\n\nof tablets were found satisfactory. All batches showed good in vitro buoyancy and drug release profile with \n\n\n\nreference to United States Pharmacopeia (USP) 24 paddle-type dissolution in simulated gastric fluid (pH 1.2). \n\n\n\nFormulation 3 floated rapidly, typically within 4 minutes, and constantly floated on the dissolution medium \n\n\n\nfor more than 8 hours with desirable drug release profiles. Further in vivo investigations shall be conducted to \n\n\n\nverify the bioavailability attribute of azithromycin. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                           MPS Pharmacy Scientific Conference 2011 \n \n\n\n\n393 \n \n\n\n\nPPT \u2013 11 (000153) \n\n\n\n\n\n\n\nBioanalytical Method Validation of Pioglitazone in Human Plasma  \n \n\n\n\nN.D.Pawar\n1\n, C.G. Bonde\n\n\n\n2\n, N.H.Patel\n\n\n\n3\n, A.B. Bagde\n\n\n\n1\n \n\n\n\n1 \nSaraswathi Vidya Bhawan\u2019s College of Pharmacy, Dombivli, Thane, India. \n\n\n\n2\n School of Pharmacy & Technology Management, NMIMS University, India. \n\n\n\n3\n Drugs Monitoring Research Institute Ltd, Navi Mumbai, India. \n\n\n\n\n\n\n\nPioglitazone, a member of the drug group known as thiazolidinediones or \"insulin sensitizers\", is used in the \n\n\n\npresent study. An efficient and sensitive method using LC-MS/MS (API \u2013 2000) detector has been established \n\n\n\nfor the quantitation of this antidiabetic drug from human plasma. Analyte-free human EDTA plasma was used \n\n\n\nas blank plasma for the preparation of calibration standards and quality control samples of pioglitazone under \n\n\n\ninvestigation. Pure glimipride at 99.3% was used as the internal standard with mobile phase made of \n\n\n\nacetonitrile: 2mM ammonium acetate (90:10) v/v. Solid phase extraction procedure was used with column \n\n\n\ntemperature kept ambient. The method was specific and linear over the range of 5.117-1207.629 ng/ml of \n\n\n\ndrug. All data integration and interpretation of unknown samples were performed by analyst software version \n\n\n\n1.4.2. The method for estimation of pioglitazone from human plasma by LC-MS/MS was validated for all \n\n\n\nparameters such as, system suitability, selectivity and sensitivity, calibration curve, percent recovery,  \n\n\n\nprecision and accuracy, stabilities included bench top, freeze thaw, auto sampler, stock solution and coolant \n\n\n\nstability, dilution integrity, carry over, partial volume, matrix effect and re-injection reproducibility . The \n\n\n\nresults obtained from method validation fulfilled all requirements and recommendations. The ease of sample \n\n\n\npreparation, small sample size, acceptable linearity of method make this assay highly suitable for \n\n\n\npharmacokinetics, bioequivalence and bioavailability studies. \n\n\n\n \nPPT \u2013 12 (000169) \n\n\n\n\n\n\n\nInvestigation on Intestinal Absorption of Ursodeoxycholic acid Using \u00b2-Cyclodextrin  \n \n\n\n\nDua Kamal\n1\n, Pabreja Kavita\n\n\n\n2\n, Agrawal D.K.\n\n\n\n3\n  \n\n\n\n1\nDepartment of Pharmaceutical Technology, School of Pharmacy, International Medical University, 57000 \n\n\n\nKuala Lumpur, Malaysia. \n2\n Department of Life Sciences, School of Pharmacy, International Medical University, 57000 Kuala Lumpur, \n\n\n\nMalaysia. \n3\nDr. K.N.Modi Institute of Pharmaceutical Education and Research, Modinagar, 201 204, U.P., India. \n\n\n\n\n\n\n\nA number of microorganisms and plants produce enzymes called cyclodextrin glucosyltransferases, which \n\n\n\ndegrade starch to cyclic products named cyclodextrins. Cyclodextrins are cyclic oligosaccharides consisting of \n\n\n\na lipophilic central cavity and a hydrophilic outer surface which potentially useful for inclusion complexes \n\n\n\ndesign. Complexing a drug may alter the rate and extent of drug absorption. The complex formation is well \n\n\n\napplied in the administration of water-insoluble drug. Ursodeoxycholic acid (UDCA) is a drug used to \n\n\n\ndissolve cholesterol gallstones along with the treatment of other liver diseases, such as primary biliary \n\n\n\ncirrhosis, chronic hepatitis and biliary pains. Aqueous solubility of ursodeoxycholic acid was enhanced by \n\n\n\ncomplexing with \u03b2-cyclodextrin. Absorption studies using in-situ rat gut technique exhibited a greater rate of \n\n\n\nintestinal absorption of ursodeoxycholic acid when it was complexed with \u03b2-cyclodextrin. The rate of drug \n\n\n\nabsorption increased proportionately with a rise in the concentration of \u03b2-cyclodextrin. The intestinal \n\n\n\nabsorption followed the first order kinetics. Statistical correlation of in vitro drug dissolution and in vitro drug \n\n\n\nabsorption indicated a positive correlation (r\n2\n= 0.957 to 0.982).  The enhanced rate of intestinal drug \n\n\n\nabsorption was probably due to the formation of readily soluble molecular inclusion complexes of drug with \n\n\n\n\u03b2-cyclodextrin. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                           MPS Pharmacy Scientific Conference 2011 \n \n\n\n\n394 \n \n\n\n\nPHARMACY EDUCATION \n\n\n\n \nPPE \u2013 01 (000045) \n\n\n\n\n\n\n\nThe Impact of Didactic Lecture to Improve the Understanding of Pharmacy Students Towards Generic \n\n\n\nMedicine  \n \n\n\n\nS Q Jamshed\n1\n, M I M Ibrahim\n\n\n\n2\n, M A Hassali\n\n\n\n3\n, Z D Babar\n\n\n\n3\n, A A Shafie\n\n\n\n3\n, M J A Siddiqui\n\n\n\n1\n \n\n\n\n1 \nSchool of Medical and Health Sciences, International Medical University, Kuala Lumpur, Malaysia \n\n\n\n2 \nCollege of Pharmacy, Qatar University, Qatar \n\n\n\n3 \nDiscipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains \n\n\n\nMalaysia, Penang, Malaysia \n4\nFaculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand \n\n\n\n\n\n\n\nPharmacists in Pakistan can be influential in augmenting the thoughtful use of medicines and can be suitable \n\n\n\ninitiators to support the healthcare system, provided their understanding and know-how towards the healthcare \n\n\n\nsystem, healthcare spending, out-of-pocket payments, and cost-cutting treatment modalities are strong. \n\n\n\nPharmacy students are thought to be vital to explore in this regard because the knowledge and views at this \n\n\n\npoint of career will eventually set and transform their future conduct. In the light of this fact, the current study \n\n\n\ntried to improve the understanding and perception of future pharmacy practitioners towards healthcare system \n\n\n\nof Pakistan with special reference on Generic Medicines. The instrument, which is a 23-item questionnaire \n\n\n\npertaining to the statements on demographics and understanding towards generic medicines, bioequivalence \n\n\n\ncriteria, perception regarding their utilization, as well as items on national drug policy and essential drug list \n\n\n\nwas administered to pharmacy students (n=236). This was then subsequently followed by a 2-hour didactic \n\n\n\nlecture with evidence-based material as short-term interventional tool. A post-test was immediately \n\n\n\nadministered after the completion of the didactic lecture. Participants showed slight improvement in median \n\n\n\nscores of understanding pretest (37/60) and posttest (41/60). No change was found in the median scores of \n\n\n\nperception pretest (30/35) and posttest (30/35). In terms of student feedback to initiate and develop an \n\n\n\ninnovative curricular content, the respondents (n=150) rated the session as highly informative. Further \n\n\n\neducational interventions with problem-based learning and educational trips to local pharmaceutical industries \n\n\n\nwere suggested to strengthen their perception towards generic medicines \n\n\n\n\n\n\n\n\n\n\n\nPPE \u2013 02 (000048) \n\n\n\n\n\n\n\nUnderstanding and Perception of Final Year Pharmacy Students Towards Generic Medicine: A \n\n\n\nQuestionnaire-based Study  \n \n\n\n\nS Q Jamshed\n1\n, M I M Ibrahim\n\n\n\n2\n, M A Hassali\n\n\n\n3\n, Z D Babar\n\n\n\n3\n, A A Shafie\n\n\n\n3\n, M J A Siddiqui\n\n\n\n1\n \n\n\n\n1 \nSchool of Medical and Health Sciences, International Medical University, Kuala Lumpur, Malaysia \n\n\n\n2 \nCollege of Pharmacy, Qatar University, Qatar \n\n\n\n3 \nDiscipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains \n\n\n\nMalaysia, Penang, Malaysia \n4\nFaculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand \n\n\n\n\n\n\n\nIn Pakistan, the recent medicine price hike has positioned pharmacist in an improved situation to advise the \n\n\n\nhealthcare professionals as well as consumers and thus, the pharmacists, right from the stage of their academic \n\n\n\nand professional training need to be well equipped to suggest cheaper generic alternatives. The understanding \n\n\n\nand perception of pharmacy students towards generic medicines can play an important role to promote quality \n\n\n\nuse of medicines. In the light of these facts, this study was aimed to investigate the understanding and \n\n\n\nperception of final year pharmacy students about generic medicines, their bioequivalence, safety and efficacy. \n\n\n\nFinal year Pharm D students from government-sponsored (n=85) and privately funded universities (n=151) \n\n\n\nwere invited to participate in the study. The 23-item questionnaire had items pertaining to the understanding \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                           MPS Pharmacy Scientific Conference 2011 \n \n\n\n\n395 \n \n\n\n\nand perception of the students regarding the bioequivalence, safety, and efficacy profile of generic medicines. \n\n\n\nHalf of the respondents (50%; n=118) agreed that a generic medicine is bioequivalent to the brand name \n\n\n\nmedicine. This showed statistical significance with respect to gender (p=0.001). In terms of quality, \n\n\n\neffectiveness and safety, more than three-fourth of the students wrongly understood that generic medicines are \n\n\n\nof inferior quality (75.8%; n=179) and are less effective than brand name medicines (79.7%; n=188). The \n\n\n\ncurrent study showed gaps in the understanding of basic concepts of generic medicines. The students \n\n\n\nexpressed positive perception towards generic medicines. To be precise, pharmacy students can assist in \n\n\n\nreducing healthcare expenditure, by building confidence and trust in generic alternatives right from the time of \n\n\n\ntheir clinical rotation. \n\n\n\n\n\n\n\n\n\n\n\nPPE \u2013 03 (000049) \n\n\n\n\n\n\n\nPerceptions of Libyan Pharmacy Practitioners on the Importance of Social Pharmacy Subjects in the \n\n\n\nCurrent Pharmacy Undergraduate Curriculum  \n \n\n\n\nOmar Saad Saleh Abrika\n1\n, Mohamed Azmi Hassali\n\n\n\n1\n, Abduelmula R. Abduelkarem\n\n\n\n2\n \n\n\n\n1\n Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universti of Sains \n\n\n\nMalaysia, 11800 Minden, Penang, Malaysia \n2\n Department of Clinical Pharmacy, College of Pharmacy and Health Sciences, Ajman University of Science \n\n\n\nand Technology, UAE \n\n\n\n\n\n\n\nThe incorporation of social pharmacy-related subjects into pharmacy training has played an important role in \n\n\n\ntransforming pharmacy provision in meeting public health needs. The contemporary pharmacists' roles \n\n\n\nare directed towards patient care and understanding of patients' psychology and the behavioral aspects in \n\n\n\nrelation to quality use of medicine. Within this context, in order to carry out this function effectively within \n\n\n\nthe society, future pharmacists need to be well prepared on how to deal with patients' behavior and \n\n\n\npsychology. The concept of behavioural sciences and health psychology are embedded as the fundamental \n\n\n\nfoundation in the field of social pharmacy and it is imperative that this field need to be taught and nurtured to \n\n\n\nthe future pharmacy practitioners. This study aim to explore and evaluate knowledge among pharmacy \n\n\n\npractitioners in Libya towards social pharmacy education. A qualitative research methodology was adopted in \n\n\n\nthis study. Participants who were working at community and hospital as well as pharmaceutical industries \n\n\n\nwere selected using purposive sampling technique. A total of 10 practitioners were interviewed. Based on the \n\n\n\ncontent analysis of the interviews, a total of 2 major themes emerged, namely current knowledge of social \n\n\n\npharmacy education and the need for incorporating social pharmacy-related subjects in the pharmacy \n\n\n\neducation. Majority of the respondents knew about the concept. However, half of those were unaware of this \n\n\n\nterm expressed interest in knowing more about it. There is a positive perception towards introduction of social \n\n\n\npharmacy into undergraduate curricula among the respondents and they believed that it is necessary for future \n\n\n\npharmacists to know about social pharmacy components. The findings from the pharmacy practitioners\u2019 \n\n\n\nevaluation suggest the needs to incorporate a similar course in all pharmacy schools in Libya and there are \n\n\n\nreasons to believe that social pharmacy will play a crucial role in future pharmacy. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                           MPS Pharmacy Scientific Conference 2011 \n \n\n\n\n396 \n \n\n\n\nPPE \u2013 04 (000066) \n\n\n\n\n\n\n\nStudents\u2019 Evaluation, Perception and Knowledge on Pharmaceutical Biotechnology Course in \n\n\n\nUniversiti Sains Malaysia  \n \n\n\n\nHassali MA\n1\n, Shafie AA\n\n\n\n1\n, Hari R\n\n\n\n1\n \n\n\n\n1\n Discipline of Social and Adminstrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains \n\n\n\nMalaysia \n\n\n\n\n\n\n\nAs the use of biotechnology is becoming more important in the pharmaceutical field, there is a need for \n\n\n\npharmacy education to make significant change on its curriculum. The present study was undertaken to \n\n\n\ndetermine students\u2019 assessment of a pharmaceutical biotechnology course perception and delivery at a public \n\n\n\nuniversity in Malaysia. A cross-sectional survey was performed on 81 pharmacy students from School of \n\n\n\nPharmaceutical Sciences, Universiti Sains Malaysia (USM) who had previously completed the Pharmaceutical \n\n\n\nBiotechnology course. A pre-validated structured questionnaire was used as the instrument for gathering the \n\n\n\ndata. In general, degree of response towards students\u2019 satisfaction about the quality of the course was \n\n\n\nmoderate in which 31 students (38.3%, n=81) gave positive response and 18 respondents (22.3%, n=81) \n\n\n\nshowed dissatisfaction towards the quality of the course while others were unsure. Majority (45.7%, n=81) of \n\n\n\nthe students felt that Pharmaceutical Biotechnology course is very interesting. Overall, the students felt the \n\n\n\ncourse delivery has more room for improvement apart from having a positive perception towards the \n\n\n\nPharmaceutical Biotechnology course in School of Pharmaceutical Sciences, USM. \n\n\n\n\n\n\n\n\n\n\n\nPPE \u2013 05 (000068) \n\n\n\n\n\n\n\nUniversity of Sunderland's New MPharm: A Cogent, Integrated Course from Level-1 Aligned to the \n\n\n\nNew (2011) Education and Training Standards of the General Pharmaceutical Council (UK)  \n \n\n\n\nAK Husband\n1\n, PJ Hayball\n\n\n\n2\n, B Efendie\n\n\n\n3\n \n\n\n\n1 \nDepartment of Pharmacy, Health & Well-Being, Faculty of Applied Sciences, University of Sunderland, \n\n\n\nSunderland, United Kingdom. \n2 \nSunderland School of Pharmacy (Malaysia), University of Sunderland, Kuala Lumpur, Malaysia. \n\n\n\n3 \nFaculty of Pharmacy, SEGi University College, Kota Damansara, Selangor, Malaysia. \n\n\n\n\n\n\n\nThe new Master of Pharmacy (MPharm) of the University of Sunderland, implemented this year in \n\n\n\nSunderland and Malaysia (SEGi University College), is the first and only UK programme to be fully \n\n\n\naccredited by the General Pharmaceutical Council against their new Education and Training Standards (2011). \n\n\n\nThe programme is integrated and the curriculum is of a spiral design with important concepts re-adressed with \n\n\n\nincreasing complexity as students progress through the course . Throughout the programme we use patient-\n\n\n\nbased scenarios to direct teaching and learning; initially, deconstructing case studies to enable student \n\n\n\nappreciation of the scientific basis of the problem. Early in the programme traditional lectures, tutorials and \n\n\n\nlaboratory classes are supplemented by small-group \"integration\" sessions. In the first two years of the \n\n\n\nprogramme formal teaching is intermitently paused to allow formative testing of students followed by directed \n\n\n\nreview and learning sessions. Concepts around consultation, prescribing, physical examination and disease \n\n\n\nmanagement are delivered with increasing complexity as students progress through the programme. Beyond \n\n\n\nLevel 1 students study specific body systems using specific cases or diseases to aid learning navigation by \n\n\n\nstudents. By the end of Level 2 we expect students to be fully aware of normal structure and function of the \n\n\n\nhuman body. At Level 3 discussions with students of therapeutics will begin to assess prescribing decisions of \n\n\n\nothers developing their critical thinking skills. Building on the skills developed thus far, students in final year \n\n\n\nwill critically examine prescribing decisions with added complexity and requiring greater scope of \n\n\n\nunderstanding of patient treatment and support. The final module will deal entirely with preparing students for \n\n\n\nthe pratice environment with pharmacy law updates, ethics and health policy debates. The assessment strategy \n\n\n\nand module design align with the integration principles of the programme. \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                           MPS Pharmacy Scientific Conference 2011 \n \n\n\n\n397 \n \n\n\n\n\n\n\n\nPPE \u2013 06 (000079) \n\n\n\n\n\n\n\nEmpowering UCSI University Pharmacy Students to Counsel for Nonprescription Drug Therapy  \n \n\n\n\nSaraswathi Simansalam \n\n\n\nSchool of Pharmacy, Faculty of Pharmaceutical Sciences, UCSI University, Kuala Lumpur \n\n\n\n\n\n\n\nPharmacy professionals, as gatekeepers for self-medication, are committed in assuring the safe, appropriate \n\n\n\nand effective use of nonprescription drugs and nutritional supplements. The comfort levels of the pharmacists \n\n\n\nin providing counselling are likely to be reflective of their experiences as pharmacy students. Deficiencies in \n\n\n\nprofessional training of self-care had resulted in failure of pharmacists providing counselling. Nonprescription \n\n\n\ndrugs is offered as a 3-credit unit core course in the first semester of the three-year pharmacy programme at \n\n\n\nUCSI. The main objective of this research project was to determine whether the use of structured framework \n\n\n\nand role-plays improves students' self-confidence to counsel for self-care nonprescription drug therapy. A \n\n\n\nstructured interviewing framework (QuEST) and 5 sessions of role-play were incorporated into \n\n\n\nNonprescription Drugs course for the academic year of 2010/2011. Fifteen-item questionnaires aim to assess \n\n\n\nstudents' confidence in identifying a self-care patient's problem, asking background questions, determining \n\n\n\nwhether a patient needed physician referral and counseling on the selected product, were adapted from a study \n\n\n\ndone previously. The first sets of questionnaires were distributed after the completion of the first role-play to \n\n\n\nassess students' pre-test self-confidence. The second sets of questionnaires were administered at the end of the \n\n\n\nsemester to assess students' post-test self-confidence. Students' pre- and post-test self-confidence regarding \n\n\n\nnonprescription counseling issues were assessed among 57 students. Excel t-test was used to detect the \n\n\n\ndifferences between the pre- and post-test self-confidence levels. Students' self-confidence level improved \n\n\n\nfrom 2.37+0.12 to 3.73+0.14 (p<0.001). Incorporating structured interviewing framework with 5 sessions of \n\n\n\nrole-plays for Nonprescription Drugs course significantly improved students' self-confidence regarding \n\n\n\nnonprescription counselling issues. \n\n\n\n \nPPE \u2013 07 (000094) \n\n\n\n\n\n\n\nBarriers to Rational Drug Use in Treatment of Malaria in Health Care Facilities in Pakistan: A \n\n\n\nQualitative Study  \n \n\n\n\nMadeeha Malik\n1, 2\n\n\n\n, Mohamed Azmi Ahmad Hassali\n1\n, Asrul Akmal Shafie\n\n\n\n1\n, Azhar Hussain\n\n\n\n1, 2\n  \n\n\n\n1 \nDiscipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains \n\n\n\nMalaysia, 11800 Minden, Penang, Malaysia \n2 \nHamdard Institute of Pharmaceutical Sciences Hamdard University, F-8 Markaz, Johar Road  Islamabad, \n\n\n\nPakistan \n\n\n\n\n\n\n\nIrrational use of drugs in treating malaria is a major dilemma of present medical practice. The study aimed to \n\n\n\nexplore the perceptions\u2019 of doctors regarding salient factors affecting rational drug use in treatment of malaria \n\n\n\nin two major cities of Pakistan. A qualitative study with snowball sampling technique was used to identify \n\n\n\nfifteen doctors working at both public and private tertiary care hospitals in Islamabad and Rawalpindi. The \n\n\n\ninterviews, were audio-taped and transcribed verbatim, were evaluated by thematic content analysis and by \n\n\n\nother authors\u2019 analyses. Thematic content analysis of the interviews yielded four major themes and several \n\n\n\nsubthemes: The major themes included: (1) Current scenario of rational drug use in malaria; (2) Factors \n\n\n\nresponsible for irrational drug use in malaria; (3) Role of Malaria Control Program in promoting rational drug \n\n\n\nuse; (4) Strategies to improve irrational drug use in treatment of malaria. This study showed that all the \n\n\n\nrespondents in the two cities agreed on irrational drug use in treatment of malaria. The respondents \n\n\n\nhighlighted over diagnosis of malaria, self medication, trend of empirical treatment, inadequate lab support, \n\n\n\nlow quality anti malarial drugs and inadequate role of malaria control program as the main factors responsible \n\n\n\nfor irrational drug use in treatment of malaria. \n\n\n\n\n\n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                           MPS Pharmacy Scientific Conference 2011 \n \n\n\n\n398 \n \n\n\n\nPPE \u2013 08 (000113) \n\n\n\n\n\n\n\nActive Learning Attitudes in Pharmacy Education in Klang Valley \n \n\n\n\nMohd Khairol Amir MK, Salmiah MA, Manan MM, Zainal FI \n\n\n\nFaculty of Pharmacy, Universiti Teknologi MARA, Selangor Malaysia \n \n\n\n\nActive learning is a technique where students not just listening to a lecture, it involves more than that. \n\n\n\nDiscovering, processing, and applying information is something that should be done by students. This study \n\n\n\nwas set out to investigate current active learning attitudes in pharmacy education in Klang Valley, Selangor, \n\n\n\nMalaysia. Cross-sectional descriptive design and convenience survey methods were used. The sample \n\n\n\nconsisted of 145 students from UiTM and UM who completed the questionnaires with males (n=53) and \n\n\n\nfemales (n=92). Active learning attitudes of the students were assessed with a modification of attitude \n\n\n\nsurveys. Nineteen active learning items were analyzed and classified into four topics: participation in class, \n\n\n\nlearning strategies, self-efficacy and motivation. About 26.9 % of the students claimed they have not been \n\n\n\nexposed to the active learning concept while 73.1 % more answer yes. There is no significant difference in the \n\n\n\nstudents\u2019 participation in active learning strategies between the UiTM students and UM students (p>0.05). All \n\n\n\nfour topics of both universities are not significantly different. It can be concluded that students from both \n\n\n\nuniversities, UiTM and UM demonstrated a positive attitude toward active learning, believed it helped (or \n\n\n\nwould helped) them to learn the material, and would prefer an active learning approach for future courses. \n\n\n\n \nPPE \u2013 09 (000120) \n\n\n\n\n\n\n\nIPTS Pharmacist Wannabe: Personal and Career Goal Influences, Commitment and Future Career \n\n\n\nAmbitions  \n \n\n\n\nN E Ismail\n1, 2\n\n\n\n, N S Mohd Ismail\n1, 2\n\n\n\n, W N Wan Mahmood\n1,2\n\n\n\n, A Adam\n2\n, M A Ahmad Hassali\n\n\n\n3\n, A A Shafie\n\n\n\n3\n, \n\n\n\nM H Nik Mohamed\n4\n, S Mohd\n\n\n\n5\n, E Yusuf\n\n\n\n6\n, I Abdullah\n\n\n\n6\n, B Efendie\n\n\n\n7\n, M R Baig\n\n\n\n8\n \n\n\n\n1\n Clinical Pharmaceutics Research Group (CPRG) & Inhalational Delivery Research Unit (IDRU) \n\n\n\n \n2\n Faculty of Pharmacy, Universiti Teknologi MARA (UiTM), Puncak Alam Campus, 42300 Bandar Puncak \n\n\n\nAlam, Selangor, Malaysia \n3\n School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Pulau Pinang, Malaysia \n\n\n\n4 \nKulliyyah of Pharmacy, International Islamic University Malaysia, 25200 Kuantan, Pahang, Malaysia \n\n\n\n5\n Faculty of Pharmacy, Cyberjaya University College of Medical Sciences, 63000 Cyberjaya, Selangor, \n\n\n\nMalaysia \n6\n Faculty of Health and Life Sciences, Management and Science University, 40100 Shah Alam, Selangor, \n\n\n\nMalaysia \n7 \nSchool of Pharmacy and Health Sciences, International Medical University, 57000 Kuala Lumpur, Malaysia \n\n\n\n8\n Faculty of Pharmacy, AIMST University, 08100 Bedong, Malaysia \n\n\n\n\n\n\n\nPharmacists are greatly recruited in various professional practising based areas as such hospital, community, \n\n\n\npharmaceutical industry, academia, enforcement and regulatory. Strong determination is a must while \n\n\n\nundertaking this tough yet remarkable four-year pharmacy programme. Therefore, this cross-sectional study \n\n\n\ndetermined influential factors of career preferences, commitment and future career ambitions following \n\n\n\ngraduation. Post local ethics approval, developed self-administered questionnaire was reviewed by a group of \n\n\n\npharmacist and pilot tested before being distributed randomly among Bachelor of Pharmacy students (year \n\n\n\none until four) in four private universities in Malaysia (n = 1040), from August until September 2010. Both \n\n\n\ndescriptive and inferential statistics were used for data analysis whereby p value < 0.05 was considered as \n\n\n\nstatistically significant. The response rate was 56.1% (n = 583). The overall mean (SD) age of students was \n\n\n\n21.0 years old (\u00b11.8), majority were females (78.9%), Chinese (56.6%), single (99.7%) and enrolled into \n\n\n\npharmacy degree programme via matriculation qualification (32.1%). For personal influence, item \u201cI want to \n\n\n\nstudy with high achiever\u201d and \u201cI want to carry on family tradition\u201d scored the highest and the lowest (p < \n\n\n\n0.05), respectively. For career goal, item \u201cI wanted a steady professional job with good career opportunities\u201d \n\n\n\nscored the highest. Different year of study significantly influenced their personal and career goal toward \n\n\n\npharmacy. Students showed high commitment to be pharmacists with selected private (24.2%) and \n\n\n\ngovernment hospitals (26.6%) as their first future work setting. \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                           MPS Pharmacy Scientific Conference 2011 \n \n\n\n\n399 \n \n\n\n\nPPE \u2013 10 (000126) \n\n\n\n\n\n\n\nEquipping Pharmacy Undergraduates with Knowledge and Skills on Smoking Cessation Intervention: \n\n\n\nFindings from Environmental Scan of Universities Curricula and Assessment of Students' Knowledge  \n \n\n\n\nS Simansalam, MHN Mohamed \n\n\n\nKulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang, Malaysia. \n\n\n\n\n\n\n\nTobacco smoking remains the main cause of preventable diseases and premature deaths, killing approximately \n\n\n\n10,000 Malaysians every year. Pharmacists are uniquely positioned to assist the nation's tobacco cessation \n\n\n\nefforts, but are not contributing optimally, as most are inadequately trained on the provision of smoking \n\n\n\ncessation intervention during their undergraduate education. An study of 16 pharmacy schools in Malaysia \n\n\n\nrevealed substantial discrepancies in their curricula devoted to smoking cessation counseling. Three schools \n\n\n\n(18.8%) did not have tobacco-related topics in their Bachelor of Pharmacy curricula. Tobacco-related topics \n\n\n\nwere part of core courses in 9 schools; median teaching duration = 2.75 hours vs. part of elective courses in 3 \n\n\n\nschools; median teaching duration = 2 hours. Teaching hours from two schools were unquantifiable since self-\n\n\n\ndirected online learning and problem-based learning were used. One school introduced tobacco-related topics \n\n\n\nin the first semester of the first year, 6 schools (46.2%) at the second year and another 6 in the third and final \n\n\n\nyears. Lecture (75%) is the primary mode of delivery; others include workshop and role-play. Ten (76.9%) \n\n\n\nschools used coursework and final examination as assessment method. Only 3 (23.1%) schools included \n\n\n\nOSCE and role-play as part of assessment. In a pilot study among 127 third and final year pharmacy students \n\n\n\nfrom a selected pharmacy school, only 13.4% scored above 50% in the knowledge assessment of tobacco-\n\n\n\nrelated and smoking cessation counselling component. Conclusion: A standard curriculum related to tobacco-\n\n\n\nrelated topics and smoking cessation training is urgently needed for pharmacy undergraduates to equip future \n\n\n\npharmacists with knowledge and skills on smoking cessation intervention \n \nPPE \u2013 11 (000128) \n\n\n\n\n\n\n\nAssessment of Non Halal Medications Used by Cardiac Outpatients: Incidence and Category of  \n\n\n\nHalalness  \n \n\n\n\nHadeer Akram AbdulRazzaq\n1\n, Noorizan Abd Aziz\n\n\n\n2\n, Yahaya Hassan\n\n\n\n2\n, Moad Fahmi Najjar\n\n\n\n1\n, Azmi \n\n\n\nSarriff\n1\n, Omar Ismail\n\n\n\n3\n \n\n\n\n1\n School of Pharmacy, Universiti Sains Malaysia, 11800 Minden, Pulau Pinang, Malaysia. \n\n\n\n2\nFaculty of Pharmacy, Universiti Teknologi MARA, 42300 Bandar Puncak Alam, Selangor, Malaysia. \n\n\n\n3\n Department of Cardiology, Hospital Pulau Pinang, 10300 Pulau Pinang, Malaysia. \n\n\n\n\n\n\n\nPresently Muslim physicians, pharmacists, other health care professionals and patients are concerned on the \n\n\n\nhalalness of medications. The objective of the study is to determine halalness of cardiovascular medications \n\n\n\nthat frequently used for chronic diseases. Cross sectional study among 500 cardiac outpatients dispensed \n\n\n\nmedications in Penang Hospital, Malaysia were carried out from December 2008 to May 2009  All the \n\n\n\ninformation on medications were collected from the pharmacy department. The   medications' ingredients \n\n\n\nsuch as active ingredients and excipients were evaluated based on the halalness status according to Islamic \n\n\n\nlaw. The result showed Muslim patients consists of 34.4% (n=172) of the participants. Majority of \n\n\n\nmedications do not have information on the excipient. The medications with  Mushbooh (unsure halalness \n\n\n\nstatus) excipients were 28% (n=30), and 23.3% (n=7) of them were antihyperlipidemic (atorvastatin). The \n\n\n\npercentage of Muslim patients who used Mushbooh active ingredients is 54.7% (94), which related with \n\n\n\nantihypertensive medication (perindopril). All active ingredients of antihyperlipidemic medications, beta-\n\n\n\nblockers, diuretics, digoxin, warfarin, aspirin, trimetazidine, isosorbide dinitrate were categorized permissible \n\n\n\n(Halal), while angiotensin converting enzymes inhibitors and angiotensin II receptor blockers were \n\n\n\ncategorized under  'mushbooh'  which containing magnesium stearate, lactose  and macrogol in which the \n\n\n\nsource of origin can be from animal source. In conclusion some medications were uncertain on the halalness \n\n\n\nstatus. The drug manufacturers, Ministry of Health and JAKIM have responsible to ensure all information on \n\n\n\nthe active ingredient and excipient and their  halalness be stated in the medication leaflet or label.  \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                           MPS Pharmacy Scientific Conference 2011 \n \n\n\n\n400 \n \n\n\n\n\n\n\n\nPPE \u2013 12 (000135) \n\n\n\n\n\n\n\nPerception on Packaging and Labeling of Pharmaceutical Products  \n \n\n\n\nMolugulu Nagashekhara\n1\n, Emilia Binti Talib\n\n\n\n1\n, Henny I\n\n\n\n1\n, Allan Wong\n\n\n\n1\n, Nurul Atiqah\n\n\n\n1\n, Stella Saikam\n\n\n\n1\n, \n\n\n\nReginee Ann\n1\n, Md.Sabiq\n\n\n\n1\n \n\n\n\n1 \nFaculty of Pharmacy, Masterskill College of Nursing and Health, KK Metro Branch, Kota Kinabalu, Sabah, \n\n\n\nMalaysia \n\n\n\n\n\n\n\nPackaging and labeling specifications play a vital role in minimizing medication errors. Carton or container \n\n\n\nlabel is the significant source of instruction and information on medicines. Predominantly, poor labeling \n\n\n\ncontribute to medication errors for both patients and health care personnel. The purpose of this study is to find \n\n\n\nout and compare the perception on packaging and labeling of registered and unregistered pharmaceutical \n\n\n\nproducts. Based on FDA guidelines, a 13 item questionnaire using 5 point Likert scale (7 items on registered \n\n\n\nproducts with Cronbach\u2019s alpha 0.857 and 6 items on unregistered products with Cronbach\u2019s alpha 0.731) \n\n\n\nwere distributed to allied health students through convenience sampling (n=300). Results shows that \n\n\n\nrespondents are pleased with the packaging and labeling of registered products (mean=15.65) and \n\n\n\ndiscontented with the unregistered pharmaceutical products (mean=18.95). Illegible prints of expiry date and \n\n\n\nits format, directions, quality of the packaging material are the general problems in unregistered products. \n\n\n\nCertainly, details on pharmaceutical products packaging have a persistent relationship with the patient\u2019s \n\n\n\ncompliance. Hence, we suggest the pharmacy enforcement branch confiscate unregistered pharmaceutical \n\n\n\nproducts by increasing their frequency of visits to retail stores, mini markets and other related outlets. We \n\n\n\nsuggest the Ministry of Health to educate the public to buy only registered pharmaceutical products by \n\n\n\nspecifying \u2018MAL number\u2019 with hologram sticker through the commanding audio and visual media. In future \n\n\n\nstudy, preference on consideration of demographic descriptions of the population is significant in improved \n\n\n\nunderstanding of perception. \n\n\n\n\n\n\n\nPPE \u2013 13 (000136) \n\n\n\n\n\n\n\nConsumer Perception and Purchasing Behavior of Cosmeceuticals  \n \n\n\n\nMolugulu Nagashekhara\n1\n, E. Beverly Joeman\n\n\n\n1\n, Lim Pui Shen\n\n\n\n1\n, Alice G\n\n\n\n1\n, Husniah M A\n\n\n\n1\n, Jacqueline C S \n\n\n\nY\n1 \n, Syed Omar Syed Agil\n\n\n\n2\n \n\n\n\n1 \nMasterskill College of Nursing and Health, KK Metro Branch, Kota Kinabalu, Sabah, Malaysia \n\n\n\n2 \nRazak School of Government, University Tun Abdul Razak, Capital Square \n\n\n\n\n\n\n\nThe ubiquitous trend of consumers\u2019 desire to maintain a youthful appearance has led to the rapid expansion of \n\n\n\ncosmeceutical product categories such as skin care, facial, fragrance and hair care products in Malaysia. The \n\n\n\npurpose of this paper is to study the consumer\u2019s perception and purchasing behavior of cosmeceuticals among \n\n\n\nresidents of Kota Kinabalu, Sabah. A survey is carried through a structured questionnaire, using convenience \n\n\n\nsampling method (n=300). It is a cross sectional study, and the unit of analysis is the residents of Kota \n\n\n\nKinabalu.  Results indicate that when buying cosmeceuticals, quality of the product is a significant factor \n\n\n\n(53.3%) followed by cost (24%), and brand (18.7%). Domestic products of skin care (54.3%), fragrance \n\n\n\n(53.3%), hair care (55%), and facial (53.7%) are preferred over imported cosmeceuticals. Reasons for \n\n\n\npurchase and use of cosmeceuticals are to improve appearance and for personal satisfaction (46%), health \n\n\n\n(39%) and as fashion/trend (15%). Chi-square test is significant and has strong association between the \n\n\n\nincome level per month and the amount spent on cosmeceuticals. A majority of the respondents are loyal to a \n\n\n\nbrand; unless rigorous promotion of a new brand with convincing promotional strategies is done. This study \n\n\n\nwill help new and developing cosmeceutical companies to produce best competitive products, better quality, \n\n\n\nreasonable price and attractive packaging with persuasive promotional strategies.  Product line and product \n\n\n\ndepth in each category of cosmeceuticals are significant factors to attract the youth market.  \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                           MPS Pharmacy Scientific Conference 2011 \n \n\n\n\n401 \n \n\n\n\n \nPPE \u2013 14 (000144) \n\n\n\n\n\n\n\nMeasurement of Patient Satisfaction on Retail Pharmacy Services  \n \n\n\n\nMolugulu Nagashekhara\n1\n, E. Beverly Joeman\n\n\n\n1\n, Flora Ku Yee Wei\n\n\n\n1\n, Tsan L K\n\n\n\n1\n, Elviany J\n\n\n\n1\n, Sitti Arlin \n\n\n\nB\n1\n, Norhayati N\n\n\n\n1\n, Saimun S\n\n\n\n1\n, Jaimy I\n\n\n\n1\n \n\n\n\n1 \nMasterskill College of Nursing and Health, KK Metro Branch, Kota Kinabalu, Sabah, Malaysia \n\n\n\n\n\n\n\nIn the field of pharmacy, patient satisfaction on pharmacy services plays a significant role in providing the \n\n\n\nquality of service. A research was carried out to gauge patient satisfaction to improve retail pharmacy services \n\n\n\nin Kota Kinabalu, Sabah.  In this study, three retail pharmacy services were measured: general services, \n\n\n\ncognitive services, and intervention services.  A survey is carried out through an instrument of structured \n\n\n\nquestionnaire involving nine items each (using 5-point Likert Scale) for all the services. Simple random and \n\n\n\nconvenience sampling methods are utilized in this research (n=250). A pilot study was conducted to determine \n\n\n\nthe reliability of the scales using Cronbach\u2019s alpha value, which resulted in 0.643, 0.695 and 0.674 for \n\n\n\nGeneral, Intervention, and Cognitive Services.   The data analysis resulted in ratings for Intervention Services \n\n\n\n(86.4%, mean=2.85), General Services (85.2%, mean=2.84) and Cognitive Services (80.8%, mean=2.80). At a \n\n\n\nglance, the pharmacy community looks to be meeting the patients\u2019 expectations.  Nonetheless, for the strength \n\n\n\nof data collected it is recommended that larger geographical areas and higher-level education groups of \n\n\n\nrespondents be involved in future studies.  As a result of this study, it is suggested that pharmacy staff be more \n\n\n\nknowledgeable, that is to reduce deceptive practice of medication promotion, to include health education as \n\n\n\npart of their service to increase the awareness, to promote free health screening services in collaboration with \n\n\n\npharmaceutical companies and to be more health centered rather than profit oriented.   \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                           MPS Pharmacy Scientific Conference 2011 \n \n\n\n\n402 \n \n\n\n\nPHARMACY PRACTICE/SOCIAL PHARMACY \n\n\n\n \nPPP \u2013 01 (000006) \n \n \n\n\n\nEstablishment and Evaluation of a Pharmacist Managed Smoking Cessation Clinic (PMSCC) in Sabah: \n\n\n\nA Model for Future Service Provider \n \n\n\n\nJL Quah\n1\n, LT Pee\n\n\n\n1\n, HH Tan\n\n\n\n1\n, SH Phua\n\n\n\n1\n, YL Yeo\n\n\n\n2\n, K Zorina\n\n\n\n3\n \n\n\n\n1\n Department of Pharmacy, Duchess of Kent Hospital, Sandakan \n\n\n\n2\n Department of Pharmacy, Sandakan Community Polyclinic, Sandakan \n\n\n\n3\n Hospital Director, Duchess of Kent Hospital, Sandakan \n\n\n\n\n\n\n\nThere is lack of smoking cessation services as well as data to support this services in Malaysia. The objective \n\n\n\nof this study is to evaluate a part-time pharmacist-managed smoking cessation clinic (PMSCC) in Sandakan, \n\n\n\nSabah. A retrospective, intention-to-treat analysis was carried out for an 18 month period. The main outcome \n\n\n\nwas based on self-reported continuous quit rate at 3 and 6 months. As a secondary outcome, the reduction in \n\n\n\nsmoking rate was also measured. Other outcomes included the number of hospitals inspired by the PMSCC to \n\n\n\nprovide smoking cessation services, number of pharmacists who were trained at the PMSCC, number of \n\n\n\noutreach activities and quantity of smoking cessation materials developed and distributed. During the study \n\n\n\nperiod, 81 smokers attended the clinic with a total of 311 counseling sessions. Fourty-seven patients agreed to \n\n\n\nbe enrolled in a 6 month follow-up. The continuous abstinence rate at 3 months and 6 months was 42.6% \n\n\n\n(95% confidence interval, CI 28-57%) and 34.0% (95% CI 20-48%) respectively. Other benefits of the clinic \n\n\n\nincluded training of healthcare workers, organization of seminars, health talks and promotion of research and \n\n\n\ntraining. This evaluation of a pharmacy-based smoking cessation service in Sabah showed that the service was \n\n\n\nacceptable to Malaysian smokers. The quit-rate in this part-time clinic was comparable to those of full-time \n\n\n\nand better funded clinics in the West. In conclusion, a part-time PMSCC is a promising model for piloting \n\n\n\nsmoking cessation services in Sabah. \n\n\n\n \nPPP \u2013 02 (000009) \n\n\n\n\n\n\n\nHome Medication Review (HMR): Benefits to Warfarin Medication Therapy Adherence Clinic \n\n\n\n(MTAC) Patients in Sandakan  \n\n\n\n\n\n\n\nLiew E.T\n1\n, Lim B.K\n\n\n\n1\n, Tan C.H\n\n\n\n1\n, Quah J.L\n\n\n\n1\n, Shim Y.W\n\n\n\n1\n, Lim C.Y\n\n\n\n2\n, Zorina K\n\n\n\n3\n \n\n\n\n1\n Department of Pharmacy, Duchess of Kent Hospital, Sandakan, Sabah \n\n\n\n2\n Department of General Medicine, Duchess of Kent Hospital, Sandakan, Sabah \n\n\n\n3\n Director, Duchess of Kent Hospital, Sandakan, Sabah \n\n\n\n\n\n\n\nPharmacists are in an ideal position to assist with medication related problems. Home medication review \n\n\n\n(HMR) allows pharmacists to get greater insight into patients\u2019 methods of managing their medications. A \n\n\n\nstudy to evaluate the effects of HMR on patients\u2019 knowledge and compliance towards their medications, as \n\n\n\nwell as improvement of INR readings was carried out. Eighteen Warfarin MTAC patients were included in \n\n\n\nthis cohort study. The subjects were visited twice by pharmacists in their own homes. The second visit was \n\n\n\ncarried out 3-4 months after the first visit. Dose, frequency, indication and time-of-administration (DFIT) \n\n\n\nscore and pill excess count were conducted to measure the knowledge and compliance of study subjects. INR \n\n\n\nreadings prior and after both visits were compared. A patient satisfactory survey was also carried out. DFIT \n\n\n\nscore showed significant improvement during the second visit compared to the first, in terms of dose (84.0% \n\n\n\nvs 93.3%, p=0.047), frequency (84.1% vs 93.1%, p=0.031), indication (67.8% vs 88.5%, p=0.045) and time-\n\n\n\nof-administration (68.1% vs 88.8%, p=0.017). Mean DFIT value also improved significantly (76.0% vs \n\n\n\n90.9%, p=0.0206). Pill excess count showed non-significant reduction (108.7% vs 54.3%, p=0.064). INR \n\n\n\nreadings post first visit showed no significant improvement compared to control, but improved post second \n\n\n\nvisit (55.6% vs 75.5%, p=0.042). The mean patient satisfaction score was 84% (95% CI: 67.6 to 100%). HMR \n\n\n\nimproved patients\u2019 DFIT score, decreased pill excess and improved INR readings after two visits. Further \n\n\n\nstudies are required to assess the impact of HMR in the long term \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                           MPS Pharmacy Scientific Conference 2011 \n \n\n\n\n403 \n \n\n\n\n\n\n\n\nPPP \u2013 03 (000012) \n\n\n\n\n\n\n\nPatients Compliance towards Self-Medication Practice at Sarawak General Hospital - Case Study of \n\n\n\nHypertensive Patients  \n \n\n\n\nChe Noriah Othman, Siti Normiyah Hussin, Roz Azinur Che Lamin, Nur Syuhadah Othman  \nFaculty of Pharmacy, Universiti Teknologi MARA, Pulau Pinang  \n\n\n\n\n\n\n\nUncontrolled blood pressure is a major risk factor of cardiovascular diseases. Self-medication practice has \n\n\n\nbecome one of the vital components in managing diseases. This study was conducted from July 2010 to April \n\n\n\n2011 to investigate patients' compliance toward self-medication practice among hypertensive patients at \n\n\n\nSarawak General Hospital, Malaysia. Hypertensive patients on medical treatment for the last three months \n\n\n\nwho met the inclusion criteria were chosen as subjects. Questionnaires that consist of the history of \n\n\n\nhypertension, self-medication practice and Morisky score were distributed to all the patients. Data were \n\n\n\nanalyzed and results were expressed as percentages. Out of 190 respondents, 50% (n=95) were males and 50% \n\n\n\n(n=95) were females. Their mean age was 65.4 +/-10.9 and from various ethnicities. Out of the 190 \n\n\n\nrespondents, 61.5 % (n=117) practised self-medication. Reasons for such practice were time saving (44.7%; \n\n\n\nn=53), ease and convenience (28.9%; n=33), cost-effective (18.4%; n=21) and provision of quick relief (7.9%; \n\n\n\nn=9.2). The highest compliance rate was seen in 38.9% of the respondents (n=74) and these included 20.5% \n\n\n\nmales and 18.4% females, while 27.4% (n=52) showed medium compliance which consisted of 14.2% males \n\n\n\nand 13.2% females and 33.7% (n=64) were classifed as low compliance and these includes 15.3% of males \n\n\n\nand 18.4% of females. Self-medication practice was common among adult patients with hypertension. \n\n\n\nCompliance towards self-medication practice was reported to be high among males. Patients' knowledge on \n\n\n\nself-medication practice and hypertension were concluded to be adequate. \n\n\n\n \nPPP \u2013 04 (000019) \n\n\n\n\n\n\n\nMixed Beliefs and Limited Knowledge about Side-Effects amongst Pharmacy Clients \n \n\n\n\nM Healy, S Begum, K N Ting \n\n\n\nUniversity of Nottingham Malaysia Campus, Selangor, Malaysia \n\n\n\n\n\n\n\nPatients\u2019 general beliefs about the benefits and harms of medicines are likely to influence their behaviour \n\n\n\ntowards their medications. One way which health professionals can help to minimise poor medication \n\n\n\nadherence is to identify patient\u2019s concerns about medicines in particular, side-effects. The study aimed to \n\n\n\nassess pharmacy clients\u2019 general beliefs and understanding of medicine side-effects. Participants were \n\n\n\nrandomly recruited from three different pharmacies around the Klang Valley in March 2011. A qualitative \n\n\n\nsemi-structured interview was employed. Discussion points were categorised into themes and coded manually. \n\n\n\nUniversity ethical approval was obtained. The gender distribution of the participants (n=27) was almost equal \n\n\n\nand all had completed secondary education with a small proportion of university graduates (n=6). One in \n\n\n\nevery three participants claimed or appeared to understand the term side-effects whilst some (n=7) associated \n\n\n\nthe term with allergy. Long term problems arising from chronic use of medicines were described to have \n\n\n\ndetrimental effects on the kidneys and livers. Some believed that side-effects can be averted through drinking \n\n\n\n\u2018lots of water\u2019 or taking supplement and exercising. At least a quarter of the participants were informed by \n\n\n\ntheir doctors that there was no side-effect associated with their medications. Out of the 27 patients \n\n\n\ninterviewed, only eight learned about the potential side-effects from their doctors and two were informed by \n\n\n\npharmacists. There is a general mixed beliefs and limited knowledge of side-effects amongst the participants. \n\n\n\nIt appears that there is a critical knowledge gap pertaining to side-effects amongst these patients. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                           MPS Pharmacy Scientific Conference 2011 \n \n\n\n\n404 \n \n\n\n\nPPP \u2013 05 (000028) \n\n\n\n\n\n\n\nTuberculosis Knowledge among University Students in Pakistan  \n \n\n\n\nM Atif\n1\n, SAS Sulaiman\n\n\n\n2\n, AA Shafie\n\n\n\n3\n, M Qamar-Uz-Zaman\n\n\n\n4\n, N Saqib \n\n\n\n5\n, M Asif\n\n\n\n4\n \n\n\n\n1\n Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, University Sains Malaysia, Penang, \n\n\n\nMalaysia \n2\n Dean, School of Pharmaceutical Sciences, University Sains Malaysia, Penang, Malaysia \n\n\n\n3\n Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, University Sains \n\n\n\nMalaysia, Penang, Malaysia \n4\n Department of Pharmacy, The Islamia University of Bahawalpur, Pakistan \n\n\n\n5\n Ministry of Health, Karachi, Pakistan \n\n\n\n\n\n\n\nTuberculosis (TB) is public health issue with an annual incidence rate of around 9 million cases. Pakistan is \n\n\n\nranked sixth among the TB high burden countries in the world and shares 63% of TB burden in the Eastern \n\n\n\nMediterranean region of WHO. A cross sectional self administered survey was conducted among students of \n\n\n\n\u2018The Islamia University of Bahawalpur\u2019, Punjab, Pakistan. A total of 600 students from Faculty of Pharmacy \n\n\n\nand Alternative Medicine, Science, Arts, Education and Islamic Learning (120 from each faculty) were asked \n\n\n\nto fill a pre-tested and validated questionnaire which comprised of socio demographic variables and questions \n\n\n\nabout aetiology, mode of transmission, diagnosis, risk factors, treatment and prevention of tuberculosis. Chi \n\n\n\nSquare and Fishers Exact test were used to find association between variables. P value <0.05 were considered \n\n\n\nstatistically significant. Only 45% of respondents were aware that TB is an infectious disease and can be \n\n\n\nspread by coughing and sneezing of infected person. 56% respondents were of the opinion that it is curable \n\n\n\nand 51% considered it a preventable condition. Only 19% respondents knew that HIV, diabetes and \n\n\n\nmalnutrition are risk factors for tuberculosis. Respondents from faculty of Pharmacy and Alternative Medicine \n\n\n\nhad significantly higher scores (P<0.05) for aetiology, mode of transmission and treatment of TB. In this \n\n\n\nstudy we observed that respondents from all faculties except Faculty of Pharmacy and Alternative Medicine \n\n\n\nhad poor knowledge scores for tuberculosis. Proper knowledge of TB is vital for educated community of \n\n\n\nPakistan to cope the challenge of this devastating illness. \n\n\n\n \nPPP \u2013 06 (000029) \n\n\n\n\n\n\n\nMalaysian Pharmacists' Perspectives on Smoking Cessation Services   \n \n\n\n\nS Patel\n1\n, KT Wong\n\n\n\n2\n, Jeff JF Kong\n\n\n\n3\n \n\n\n\n1\n School of Pharmacy, University of Nottingham, Nottingham, United Kingdom \n\n\n\n2\n School of Pharmacy, University of Nottingham Malaysia, Semenyih, Selangor Darul Ehsan \n\n\n\n3\n DF Pharmacy, Kajang, Selangor Darul Ehsan \n\n\n\n\n\n\n\nSmoking is the single largest preventable cause of illness and mortality in today's world. It is estimated that \n\n\n\n10,000 lives are taken annually due to smoking in Malaysia. This study aims to gain a brief overview of \n\n\n\nSmoking Cessation Services provided in Malaysia, the characteristics of the smokers, as well as the barriers \n\n\n\nencountered and improvements needed to enhance the quality of the service. A qualitative study using \n\n\n\nvalidated questionnaires was undertaken with a convenient sample (n=12) of community and hospital \n\n\n\npharmacists practising in the state of Selangor. These semi-structured interviews were recorded, transcribed \n\n\n\nverbatim and thematically analysed using the constant comparison method. Pseudonyms were used to \n\n\n\nmaintain anonymity of respondents. Ethical approval was obtained from the ethical committee of the \n\n\n\nUniversity of Nottingham, United Kingdom. It was mentioned that male Malay smokers was the highest \n\n\n\nsmoking group. Health and family were the two main reasons for smokers attempting to quit. Hospital settings \n\n\n\nwere successful at yielding high quit attempts. Community pharmacists involvement in Smoking Cessation \n\n\n\nServices were largely tied to the provision and sale of nicotine replacement therapy (NRT) products. The main \n\n\n\nbarriers were lack of reimbursement, poor publicity of the service, high cost of NRT's, lack of motivation of \n\n\n\nsmokers and inadequate training. Suggested improvements were reimbursement for services, subsidising \n\n\n\nNRT's and improved training. There is a need for pharmacists to collaborate with the Malaysian \n\n\n\nPharmaceutical Society and the Ministry of Health for the service to take off successfully. \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                           MPS Pharmacy Scientific Conference 2011 \n \n\n\n\n405 \n \n\n\n\nPPP \u2013 07 (000047) \n\n\n\n\n\n\n\nIs There any Correlation Between GPs Perception and Attitude Towards Generic Medicine Prescribing \n\n\n\nin Karachi, Pakistan?  \n \n\n\n\nS Q Jamshed\n1\n, M I M Ibrahim\n\n\n\n2\n, M A Hassali\n\n\n\n3\n, Bee Yean Low\n\n\n\n4\n, Z D Babar\n\n\n\n5\n, A A Shafie\n\n\n\n3 \n, M J A \n\n\n\nSiddiqui\n1\n \n\n\n\n1\n School of Medical and Health Sciences, International Medical University, Kuala Lumpur, Malaysia \n\n\n\n2\n College of Pharmacy, Qatar University, Qatar \n\n\n\n3\n Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains \n\n\n\nMalaysia, Penang, Malaysia \n4\n School of Pharmacy, Faculty of Science, University of Nottingham, Malaysia Campus \n\n\n\n5\n Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand \n\n\n\n\n\n\n\nIn Pakistan general practitioners, family practitioners, and private practitioners earn their major share of \n\n\n\nincome by dispensing to their patients, probably for monetary gains or due to the unavailability of pharmacy \n\n\n\naround the area. In spite of that, it is not known how they perceive and prescribe generic medicines in their \n\n\n\npractice. This study is a mere attempt to explore the perception and attitude of doctors towards generic \n\n\n\nmedicines prescribing. This study was done in Karachi on 206 randomly selected general practitioners, who \n\n\n\nadmitted to dispense medicines at their private clinics. A questionnaire which was devised on qualitative \n\n\n\nresults had statements related to quality, safety, efficacy, generic prescribing trend in doctors, and factors \n\n\n\nacting as barriers and facilitators to prescribe generic medicines. The mean perception score was 48.5\u00b14.6 \n\n\n\n(median 48), out of 70. Slightly less than half of the respondents (n=94; 45.6%) showed good perception \n\n\n\ntoward generic medicine prescribing. Likewise in case of attitude, scores for each of the twelve items were \n\n\n\nsummed for total attitude scores. The mean attitude score was 41.08\u00b15.1 (median 41), out of 60. Similarly, \n\n\n\n44% (n=91) of the doctors expressed good attitude toward generic medicines. In the current research \n\n\n\nknowledge gaps were identified among general practitioners in Karachi, Pakistan. The Spearman correlation \n\n\n\ntest results indicated significant positive correlation of moderate magnitude between perception and attitude \n\n\n\nscores. A country-wide study can give a more comprehensive view of the issues and can be helpful to foster a \n\n\n\npromotional environment for generics among the prescribers. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nPPP \u2013 08 (000050) \n\n\n\n\n\n\n\nUnderstanding of Primary Care Doctors about Essential Drug List (EDL): A Qualitative Study \n \n\n\n\nS Q Jamshed\n1\n, I Azhar\n\n\n\n2 \n, Z D Babar\n\n\n\n3\n, M A Hassali\n\n\n\n4\n, M J A Siddiqui\n\n\n\n1\n, Fahad Saleem\n\n\n\n4\n \n\n\n\n1\n School of Medical and Health Sciences, International Medical University, Kuala Lumpur, Malaysia \n\n\n\n2\n Department of Pharmacognosy, Faculty of Pharmacy, University of Karachi, Pakistan \n\n\n\n3\n Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand \n\n\n\n4\n Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains \n\n\n\nMalaysia, Penang \n\n\n\n\n\n\n\nThe easy access and affordability of essential drugs is crucial for improving national health indicators. At \n\n\n\npresent Pakistan has an Essential Drug List (EDL), which enlisted patented products only. This study tried to \n\n\n\nexplore the understanding of doctors about EDL. A qualitative research method was adopted. A semi-\n\n\n\nstructured interview guide was used as an instrument to probe purposively selected 8 doctors working in \n\n\n\ngovernment dispensaries. The study was conducted in December 2009. All the interviews were conducted by \n\n\n\na final year pharmacy student as part of the student\u2019s research project. The interviewer was trained by a \n\n\n\nqualitative trainer at the University of Karachi, Pakistan. The interview transcripts were subjected to analysis \n\n\n\nby the principal author and later verified. Thematic content analysis identified four major themes; lack of \n\n\n\nunderstanding of EDL, lack of access to EDL, formulation of generic drug policy and addition of EDL content \n\n\n\nin medical curricula. All the respondents were unable to interpret the concept of EDL and were unaware of \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                           MPS Pharmacy Scientific Conference 2011 \n \n\n\n\n406 \n \n\n\n\nwhether generics or patents are enlisted on EDL. All of them denied that they had ever seen EDL in their \n\n\n\nprofessional career. When appraised about its importance, three-quarter of respondents evoked the idea of \n\n\n\ngeneric drug policy, which, in turn, would trigger the market for high-quality, cost-effective generics or \n\n\n\nbranded generics. Half of the respondents suggested including health policy content in medical curricula. All \n\n\n\nof them advocated prescribing of essential drugs because it contributes to curtail healthcare expenditures. To \n\n\n\nbe precise, doctors were found to be unaware of the concept of EDL. \n\n\n\n\n\n\n\n\n\n\n\nPPP \u2013 09 (000054) \n\n\n\n\n\n\n\nAdverse Drug Reactions in Patients on Cancer Chemotherapy in a South Indian University Hospital  \n \n\n\n\nP.Thennarasu\n1\n, Anitha Ramesh\n\n\n\n2\n, Sunil Vemullapalli, Kannan G, Vanitha rani N, Uma Maheswara \n\n\n\nReddy C \n1\n Department of Pharmacy Practice, Faculty of Pharmacy, Sri Ramachandra University, Chennai, India \n\n\n\n2\n Medical Oncology, Sri Ramachandra Medical Center and Hospital, Chennai, India \n\n\n\n\n\n\n\nCancer chemotherapeutic drugs are often associated with several adverse drug reactions (ADRs) and the \n\n\n\nsafety profile of each drug varies. A study was conducted to assess the incidence of ADRs of \n\n\n\nchemotherapeutic agents in patients admitted in the oncology wards recieving chemotherapy. 109 patients (46 \n\n\n\nmales, 63 females; mean age 53.75\u00b112.75 years), were included and data on the type of cancer, \n\n\n\nchemotherapeutic drug regimens prescribed, pre-medications given before chemotherapy, co-medications \n\n\n\nprescribed and ADRs experienced were obtained from patient\u2019s medical records. The causality assessment of \n\n\n\nsuspected ADRs were done using WHO and Naranjo\u2019s scale, severity assessment of suspected ADRs using \n\n\n\nHartwig and Siegel scale and preventability of suspected ADRs using Schumock and Thornton scale. Majority \n\n\n\nof the patients (27.52%) were diagnosed with breast cancer and paclitaxel was the most commonly prescribed \n\n\n\nchemotherapeutic agent (36.60%). Gastrointestinal ADRs (nausea and vomiting) were found in 82.50% of the \n\n\n\nstudy population. TAC (Taxol, Anthracycline and Cyclophosphamide) regimen was the common regimen \n\n\n\ngiven and alopecia and dry mouth (76.19%) were the most common ADRs in this regimen. 70.50% of the \n\n\n\nADRs were under the category of \u201cPossible\u201d 25.9% were \u201cProbable\u201d and only 1 ADR had a \u201cCertain\u201d causal \n\n\n\nlink with the drug (numbness of the legs caused by Capecitabine) based on WHO scale. Based on Naranjo\u2019s \n\n\n\nscale, 61.4% ADRs were \u201cProbable\u201d, 36.60% were \u201cPossible\u201d and only 1 ADR had a \u201cDefinite\u201d causal link \n\n\n\nwith the drug. 65% of the ADRs were mild, 35% were moderate and no severe ADRs were observed. Nausea, \n\n\n\nvomiting, anorexia, fever, decrease in hemoglobin and WBC were the ADRs definitely preventable. Diarrhea \n\n\n\nand constipation were probably preventable. Monitoring of chemotherapy related ADRs in cancer ward can \n\n\n\nfacilitate quality improvement initiatives, as well as potentially improve patient care.  \n\n\n\n\n\n\n\n\n\n\n\nPPP \u2013 10 (000057) \n\n\n\n\n\n\n\nAssessment of Medication Knowledge and Adherence in Patients Undergoing Hemodialysis in a South \n\n\n\nIndian University Hospital  \n \n\n\n\nN.Vanitha Rani\n1\n, P.Soundararajan\n\n\n\n2\n, C.H. Lakshmi Samyuktha, G.Kannan, P.Thennarasu, C.Uma \n\n\n\nMaheswara Reddy \n1\n Department of Pharmacy Practice, Faculty of Pharmacy, Sri Ramachandra University \n\n\n\n2\n Department of Nephrology, Sri Ramachandra Medical Center and Hospital, Porur, Chennai-600116, Tamil \n\n\n\nNadu, India \n\n\n\n\n\n\n\nChronic kidney disease patients on haemodialysis often have complex drug regimen and receive on an average \n\n\n\n10-12 medications daily, many of which requires multiple doses/day. Very few data are available on studies \n\n\n\nassessing medication knowledge and medication adherence of dialysis patients as most studies are focused \n\n\n\nalmost exclusively on fluids and diet with little or no attention paid to medication. A study was conducted to \n\n\n\nevaluate the medication knowledge using Medication Knowledge Assessment Questionnaire (MKAQ) and \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                           MPS Pharmacy Scientific Conference 2011 \n \n\n\n\n407 \n \n\n\n\nmedication adherence behaviour using Brief Medication Questionnaire (BMQ) to assess the effect of patient \n\n\n\ncounselling in improving medication knowledge and adherence in patients on maintenance haemodialysis in a \n\n\n\nUniversity hospital. 85 patients (57 males and 28 females; mean age 50.52\u00b113.28 years) were included and \n\n\n\n79% were on twice weekly dialysis. Patient data were obtained by history interview and review of their \n\n\n\nmedical records and patients were counseled regarding their disease, dialysis procedure, the drugs, diet and \n\n\n\nfluid restrictions on regular dialysis days. The average number of drugs prescribed for a patient was found to \n\n\n\nbe 6.47\u00b11.57 and antihypertensives were the most prescribed drugs (75.3%). Based on the mean MKAQ \n\n\n\nscore, there was a significant increase in the medication knowledge from baseline of 14.30\u00b16.97 to \n\n\n\n19.32\u00b16.61 at the end of sixth week (p<0.001) and to 33.62\u00b17.76 at the end of twelfth week of counseling \n\n\n\n(p=<0.001). The mean BMQ score was 4.26\u00b10.95 at the baseline, 2.99\u00b10.82 on the sixth week and 1.73\u00b10.94 \n\n\n\non the twelfth week of counseling, indicating a significant improvement in medication adherence with patient \n\n\n\ncounseling (p=0.000). The study emphasized that provision of constant patient education to hemodialysis \n\n\n\npatients would increase the medication knowledge of the patients and improve their adherence. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nPPP \u2013 11 (000058) \n\n\n\n\n\n\n\nUnderstanding and Perception of Community Pharmacists Towards Generic Medicine Substitution: A \n\n\n\nQuestionnaire-Based Study  \n \n\n\n\nS Q Jamshed\n1 \n, M I M Ibrahim\n\n\n\n2 \n, M A Hassali\n\n\n\n3 \n, Z D Babar\n\n\n\n4 \n, M J A Siddiqui\n\n\n\n1\n \n\n\n\n1\n School of Medical and Health Sciences, International Medical University, Kuala Lumpur, Malaysia\n\n\n\n\n\n\n\n2\n College of Pharmacy, Qatar University, Qatar \n\n\n\n3\n Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains \n\n\n\nMalaysia, Penang, Malaysia \n4\n Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand \n\n\n\n5\n School of Medical and Health Sciences, International Medical University, Kuala Lumpur, Malaysia \n\n\n\n\n\n\n\nThe objective of this study was to investigate the understanding and perception of community pharmacists \n\n\n\ntowards generic medicines in relation to dispensing and substitution. A cross-sectional survey of 48 \n\n\n\nconveniently selected community pharmacies was conducted by using a questionnaire. Majority of the \n\n\n\npharmacists (66.7%) understand that generic medicines are copy of the brand name medicines. More than \n\n\n\nthree-quarter of the community pharmacists (77.1%) understand that low-priced medicines are as effective as \n\n\n\nhigh-priced medicines. Three-quarter of the respondents (75%) disagreed that profit margin is the main factor \n\n\n\nin purchasing low-cost medicines. This showed statistical significance with respect to experience (p<0.05). A \n\n\n\nlarge majority of community pharmacists (95%) agreed that medical representative is a good source of \n\n\n\ninformation for them. Nearly all the community pharmacists (96%) believed that socioeconomic condition of \n\n\n\nthe patient generally influence their dispensing behavior. More than three-quarter of the respondents (83%) \n\n\n\nexpressed their comfort in changing the brand name medicine prescription to generic medicine prescription. \n\n\n\nMore than half of the community pharmacists (52.1%) expressed their hesitancy in dispensing generic \n\n\n\nmedicines in some specific therapeutic classes. More than three-quarter of the community pharmacists \n\n\n\n(79.2%) wish to dispense low-cost generic medicines to their customers. A very large majority of community \n\n\n\npharmacists (85%) addressed the need of financial incentive to dispense generic medicines. Community \n\n\n\npharmacists expressed good understanding and perception towards generic medicine dispensing and \n\n\n\nsubstitution. A generic drug policy with community pharmacists being well-informed and confident about \n\n\n\ngeneric medications, as well as incentivized in the presence of a well-positioned regulatory system is the need \n\n\n\nof hour. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                           MPS Pharmacy Scientific Conference 2011 \n \n\n\n\n408 \n \n\n\n\n\n\n\n\nPPP \u2013 12 (000060) \n\n\n\n\n\n\n\nDecision Analysis Modelling of Dispensing Separation Policy in Malaysia   \n \n\n\n\nKhor Xin Yun, Shafie A.A., Hassali M.A. \n\n\n\nDiscipline of Social & Administrative Pharmacy, Universiti Sains Malaysia, Penang, Malaysia \n\n\n\n\n\n\n\nSeparation of medicines' dispensing role from doctor or more commonly known as dispensing separation is a \n\n\n\nhotly debated proposition in Malaysia but it was never openly or seriously pursued in research or policy. The \n\n\n\npurpose of this study is to assess the benefits of dispensing separation policy from a Malaysian societal \n\n\n\nperspective using cost-benefit analysis (CBA). This was evaluated using a decision tree model that compares \n\n\n\nthe possible costs and benefits of the dispensing process of hypertensive medicines by a pharmacist, with \n\n\n\ndispensing by a doctor for six months in the base case analysis. The costs considered in the model included \n\n\n\ndrug price, treatment of adverse drug effects, dispensing fees, transportation to the pharmacy and productivity \n\n\n\nlosses. The model considered resources saved by the health sector, patients and patient families, society and \n\n\n\nwillingness-to-pay for dispensing separation as a benefit of the policy. The net-monetary benefit (NMB) of \n\n\n\nmedicines dispensed by a pharmacist was calculated by the difference between the costs from the benefit. \n\n\n\nScenario and one-way sensitivity analysis was done to assess the robustness of the study. The NMB for base-\n\n\n\nanalysis of an uncomplicated hypertensive patient was found to be positive at MYR355.04. The NMB for \n\n\n\ndiabetic patients and dyslipidemia patients are MYR345.97 and MYR437.44, respectively. Higher costs of \n\n\n\nadverse drug events, more expensive drug prices and older patients would result in higher monetary benefit \n\n\n\nwith a dispensing separation policy. Society and patients will experience greater health and non-health related \n\n\n\nbenefits if dispensing separation policy is implemented. \n\n\n\n\n\n\n\nPPP \u2013 13 (000064) \n\n\n\n\n\n\n\nPredicting Non-Adherence among Haart Patients: Demographic or Psychosocial Attributes?   \n\n\n\n\n\n\n\nLua P.L.\n1\n, Ahmad Kashfi Abdul Rahman \n\n\n\n2\n, Farah Nadiah Sulaiman \n\n\n\n2\n, Rohana Hassan \n\n\n\n2\n, Ahmad \n\n\n\nBakhtiar Abdul Aziz \n2\n, Noor Salihah Zakaria\n\n\n\n1\n \n\n\n\n1\n Centre for Clinical and Quality of Life Studies (CCQoLS), Faculty of Medicine and Health Sciences, \n\n\n\nUniversiti Sultan Zainal Abidin (UniSZA), Kampus Kota, Jalan Sultan Mahmud 20400 Kuala Terengganu \n2 \nDepartment of Medicine, Hospital Sultanah Nur Zahirah, Jalan Sultan Mahmud 20400 Kuala Terengganu \n\n\n\n\n\n\n\nPatients on highly-active anti-retroviral therapy (HAART) are consistently expected to completely adhere to \n\n\n\ntheir medication. Because adherence is related to social, psychological, institutional and personal attributes, \n\n\n\npredicting non-adherence becomes critical for healthcare providers caring for HIV-infected individuals. This \n\n\n\ninvestigation intended to determine the attibutes associated with the risk of  non-adherence. A sample of \n\n\n\nHAART out-patients were enrolled from Hospital Sultanah Nur Zahirah, Kuala Terengganu. The Malay \n\n\n\nModified Morisky Medication Adherence Scale (MMMAS; mean score = 0-1), Patient Satisfaction With \n\n\n\nPharmaceutical Care Questionnaire (PSPCQ; mean score = 1-5) and HIV/AIDS-Targeted Quality of Life \n\n\n\n(HAT-QoL; mean score = 1-5) were administered (higher scores = favourable outcomes).  Data was analysed \n\n\n\nusing SPSS 16, employing descriptive technique and multiple logistic regression. Demographic, clinical and \n\n\n\npsychosocial attributes acted as independent variables against adherence. Seventy respondents were recruited \n\n\n\n(age = 37.3 \u00b1 7.1 years; male = 80.0%; unmarried = 48.6%; self-employed = 58.6%; diagnosed > 6 months = \n\n\n\n85.7%). Overall Patient Satisfaction, Financial Worry (FW) and HIV Mastery (HM) were significantly related \n\n\n\nto non-adherence (p < 0.05), whereby improved satisfaction would reduce the risk of being non-adherent by \n\n\n\n99.9% (OR = 0.001; 95% CI: 0.000-0.574). Enhanced HRQoL i.e. being less concerned about finances and \n\n\n\nbetter-able to control undesirable behaviour could also minimise such risk by approximately 6% each \n\n\n\n(ORFW=0.941; ORHM=0.943). Findings implicate the importance of psychosocial attibutes over demographic \n\n\n\nvariables in ensuring maximum drug adherence among HAART recipients. In particular, the role of patient \n\n\n\nsatisfaction towards pharmacy services is undeniably paramount and requires constant improved monitoring. \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                           MPS Pharmacy Scientific Conference 2011 \n \n\n\n\n409 \n \n\n\n\nPPP \u2013 14 (000072) \n \n \n\n\n\nApo B, Apo A, Apo B/Apo A1- Better Markers for Cad in South Indian Population?  \n \n\n\n\nG.Kannan\n1\n, N.N. Rajendran\n\n\n\n2\n, J.S.N.Murthy\n\n\n\n3\n, G. B. Tharani\n\n\n\n4 \n\n\n\n1\nDepartment of Pharmacy Practice, Faculty of Pharmacy, Sri Ramachandra University, Chennai, India \n\n\n\n2\nDirector of PG studies and Research, Swami Vivekanada College of Pharmacy, Thiruchengode, India \n\n\n\n3\nDepartment of Cardiology, Sri Ramachandra Medical Center, Chennai, India \n\n\n\n4\nDepartment of Pharmacology, Saveetha Medical College, Kancheepuram, India \n\n\n\n\n\n\n\nCoronary artery disease (CAD) is the leading cause for morbidity and mortality in developing countries. By \n\n\n\n2015, it is expected to account for 34% of male and 32% of female deaths in India. A study was done to \n\n\n\nevaluate whether Apo B, Apo A and Apo B/Apo A1 stands to be better markers for CAD in South Indians. \n\n\n\nThe subjects comprised of angiographically proven CAD (n=125) as Group I and non CAD (n+125) as Group \n\n\n\nII. Detailed medical history was obtained; cardiac markers, lipid and sugar profile were estimated. Serum Apo \n\n\n\nA and Apo B levels were measured by immunoturbidimetry. Based on Pearson\u2019s correlation, Apo A was \n\n\n\nlower in Group I (Mean \u00b1SEM= 141.06) than in Group II (Mean \u00b1 SEM =162.8), while the level of Apo B \n\n\n\nwas higher in Group I (Mean\u00b1SEM=125.70) than in Group II (Mean \u00b1 SEM =104.85). The same trend was \n\n\n\nobserved while computing for the severity by angiography and lesion of CAD (p<0.05) using Gensini score. \n\n\n\nApo A levels were lower in CAD patients with diabetes and Apo B levels higher in CAD patients with \n\n\n\ndiabetes when compared with non-CAD subjects. By ROC analysis cut off values for Apo B and Apo A were \n\n\n\ndetermined as 109.3 and 150.2 mg/dL respectively. The odds ratio calculated using these cut off values to \n\n\n\nevaluate HDL-C, LDL-C, Apo A, Apo B and Apo B/Apo A1 as risk factors for CAD were found to be 0.508, \n\n\n\n1.184, 3.202, 10.509 and 13.610 respectively (p<0.05). Apo B, Apo A and Apo B/Apo A1 can serve as \n\n\n\npreferable cardiac markers than LDL and HDL cholesterols in the  diagnosis of CAD and substitute as \n\n\n\nprimary targets for pharmacotherapy in the prevention of CAD. \n\n\n\n. \n\n\n\nPPP \u201315 (000076) \n\n\n\n\n\n\n\nGeneric Medicines Promotion in Malaysia: Views from the Malaysian Generic Pharmaceutical \n\n\n\nIndustry Stakeholders   \n  \n\n\n\nFatokun O.\n1,2\n\n\n\n , Ibrahim M.I.M\n3\n  Hassali M.A.\n\n\n\n1\n \n\n\n\n1\nDiscipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains \n\n\n\nMalaysia, Penang, Malaysia \n2\nDepartment of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, UCSI University, Kuala Lumpur, \n\n\n\nMalaysia \n3\nCollege of Pharmacy, Qatar University, Doha, Qatar \n\n\n\n\n\n\n\nThe market entry and use of generic medicines have been shown to reduce drug expenditure and increase \n\n\n\naccess to medicines. However, generics promotion is needed to create incentives for their production by the \n\n\n\ngeneric industry. This study assessed the views of Malaysian generic drug manufacturers on promotion of \n\n\n\ngeneric medicines in Malaysia. Data was gathered by using a mail survey approach. The questionnaire was \n\n\n\nmailed to members of the Malaysian Organization of Pharmaceutical Industries. From a total of 26 \n\n\n\nquestionnaires, an overall response rate of 61.5% was achieved. A majority of the respondents (61.5%) were \n\n\n\nsatisfied with generic dispensing in Malaysia, while 69.2% were dissatisfied with the level of generic \n\n\n\nprescribing. With regards to the level of generic awareness and education, a majority of the respondents \n\n\n\n(53.8%) were dissatisfied with generic public awareness and 66.7% were dissatisfied with the level of generic \n\n\n\nmedicines information to health professionals. Government policies were fairly perceived by 38.5% of the \n\n\n\nrespondents to be effective in promoting generic medicines, while equal proportions (23.1%) viewed the \n\n\n\npolicies either effective or not effective. Spearman\u2019s rho correlation revealed a significant positive \n\n\n\nrelationship between government policies and regulations (rho=0.561, p=0.046). Overall, Malaysian generic \n\n\n\nindustry stakeholders perceived the level of generic dispensing in Malaysia to be satisfactory. However, the \n\n\n\nlevel of generic prescribing, public awareness and education on generics need to be enhanced in order to \n\n\n\ncreate an enabling market environment for generic medicines production. The generic industry expressed \n\n\n\nambiguous perceptions on effectiveness of government policies and regulations in promoting generic \n\n\n\nmedicines. \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                           MPS Pharmacy Scientific Conference 2011 \n \n\n\n\n410 \n \n\n\n\nPPP \u2013 16 (000077) \n\n\n\n\n\n\n\nSatisfaction of Systemic Lupus Erythematosus Patients toward Medical Care in a Tertiary Care \n\n\n\nHospital at Klang Valley  \n \n\n\n\nN E Ismail\n 1\n, H M Abd Rahman\n\n\n\n1\n, S Sockalingam\n\n\n\n2\n \n\n\n\n1\nClinical Pharmaceutics Research Group (CPRG) & Inhalational Delivery Research Unit (IDRU), Faculty of \n\n\n\nPharmacy, Universiti Teknologi MARA (UiTM), Puncak Alam Campus, 42300 Bandar Puncak Alam, \n\n\n\nSelangor, Malaysia \n2\nUniversity Malaya Medical Centre (UMMC), Lembah Pantai, 59100 Kuala Lumpur, Malaysia \n\n\n\n\n\n\n\nThe unpredictability and chronic nature of systemic lupus erythematosus (SLE), its symptomology, and the \n\n\n\nside-effects of therapy can impact patient\u2019s physical and psychological well-being. Satisfaction with medical \n\n\n\ncare may be an imperative indicator of actual long-term medical care received, hence improving quality of \n\n\n\nhealth and life. This cross-sectional study determined SLE patient\u2019s satisfaction with prevailing medical care \n\n\n\nsystem. Post ethics approval, the Patient Satisfaction Questionnaire-18 (PSQ-18) was randomly distributed \n\n\n\namong consented SLE patients (n = 42) that attending routine medical appointment at the Rheumatology \n\n\n\nClinic of University Malaya Medical Centre (UMMC) between June and October 2010. Mean patient age was \n\n\n\n35.62 years with disease duration of 13.38 years; 97.62% were female, 45.24% Chinese, 52.38% married, \n\n\n\n47.62% completed secondary school, 28.57% students, 97.62% never smoke and drink, 4.76% with family \n\n\n\nhistory of SLE, 66.67% of affected joints, 90.48% on prednisolone, 61.90% received free medications, \n\n\n\n73.81% not taking complementary medicines, 64.29% aware of the drug\u2019s side effects, 42.86% waited 3-4 \n\n\n\nhours to meet doctor and 80.95% never missed appointment. The means (SD) of the seven subscales of the \n\n\n\nPSQ-18 were fairly similar with scoring of 3.26 (0.85) for financial aspect, 3.29 (0.52) accessibility and \n\n\n\nconvenience, 3.36 (0.74) time spent with doctors, 3.58 (0.50) technical quality, 3.62 (0.52) interpersonal \n\n\n\nmanner, 3.69 (0.62) communication and 3.85 (0.71) general satisfaction. This suggests that the average \n\n\n\nresponse was slightly towards agreement, indicating satisfaction with a variety of aspects of health care. \n\n\n\nHowever, since the highest score of the scale is 5, this indicates room for enhancement. \n\n\n\n \nPPP \u2013 17 (000078) \n\n\n\n\n\n\n\nIllness Perception of Systemic Lupus Erythematosus Patients in an Outpatient Clinic of a Tertiary Care \n\n\n\nHospital  \n \n\n\n\nN E Ismail\n 1\n, H M Abd Rahman1, S Sockalingam\n\n\n\n2\n \n\n\n\n1\n Clinical Pharmaceutics Research Group (CPRG) & Inhalational Delivery Research Unit (IDRU), Faculty of \n\n\n\nPharmacy, Universiti Teknologi MARA (UiTM), Puncak Alam Campus, 42300 Bandar Puncak Alam, \n\n\n\nSelangor, Malaysia  \n2\n University Malaya Medical Centre (UMMC), Lembah Pantai, 59100 Kuala Lumpur, Malaysia \n\n\n\n\n\n\n\nSystemic Lupus Erythematosus (SLE), a non-curable chronic multi-system autoimmune disease, requires \n\n\n\nongoing assessment and treatment. This cross-sectional study assessed SLE patient\u2019s cognitive and emotional \n\n\n\nrepresentations of their illness. Post ethics approval, the Brief Illness Perception Questionnaire (Brief-IPQ) \n\n\n\nwas randomly distributed among consented SLE patients (n = 42) that attending routine medical appointment \n\n\n\nat the Rheumatology Clinic of University Malaya Medical Centre (UMMC) between June and October 2010. \n\n\n\nMean patient age was 35.6 years with disease duration of 13.4 years; 97.6% were female, 45.2% Chinese, \n\n\n\n52.4% married, 47.6% completed secondary school, 28.6% students, 97.6% never smoke and drink, 4.8% with \n\n\n\nfamily history of SLE, 66.7% of affected joints, 90.5% on prednisolone, 61.9% received free medications, \n\n\n\n73.8% not taking complementary medicines, 64.3% aware of the drug\u2019s side effects, 42.9% waited 3-4 hours \n\n\n\nto meet doctor and 81.0% never missed appointment. The means (\u00b1SD) of the eight-item scales of the Brief-\n\n\n\nIPQ were 5.7 (\u00b12.8) for consequences, 8.3 (\u00b12.7) timeline, 4.6 (\u00b12.1) personal control, 2.9 (\u00b12.4) treatment \n\n\n\ncontrol, 5.3 (\u00b12.5) identity, 5.8 (\u00b12.7) concern, 3.8 (\u00b12.4) understanding and 5.9 (\u00b12.5) emotional response. \n\n\n\nThe three most important factors that patients believe caused their illness were stress (7.1%), hereditary \n\n\n\n(4.8%) and environment (4.8%). Deprived patient\u2019s illness perception correlates to patient\u2019s destitute \n\n\n\nbehaviours. These suggest that patients perceived SLE as a disease that affects their lives and continues \n\n\n\nforever, personal and treatment control provide low recovery due to incessantly experiencing severe \n\n\n\nsymptoms, high concern but lack of understanding toward SLE thus affect them emotionally, subsequently \n\n\n\nmay diminish their treatment outcomes. \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                           MPS Pharmacy Scientific Conference 2011 \n \n\n\n\n411 \n \n\n\n\nPPP\u2013 18 (000082) \n\n\n\n\n\n\n\nComparison of A Portable Device And Conventional Laboratory Measured INR in Duchess of Kent \n\n\n\nHospital, Sandakan \n \n\n\n\nY W Shim\n1\n, J L Quah\n\n\n\n1\n, A R Masturah\n\n\n\n 1\n, S Y Liau\n\n\n\n1\n, M M Noraishah\n\n\n\n2\n, C Y Lim\n\n\n\n3\n, K Zorina\n\n\n\n4 \n\n\n\n1\n Department of Pharmacy, Duchess of Kent Hospital \n\n\n\n2 \nDepartment of Pathology, Duchess of Kent Hospital \n\n\n\n3\n Department of General Medicine, Duchess of Kent Hospital \n\n\n\n4\n Director, Duchess of Kent Hospital, Sandakan, Sabah \n\n\n\n\n\n\n\nFrequent monitoring is mandatory for all patients on warfarin due to its\u2019 narrow therapeutic index profile. A \n\n\n\nprospective study to compare the accuracy as well as correlate the INR results was obtained using \n\n\n\nCoaguchek\n\u00ae\nXS and the standard laboratory assays and patient\u2019s acceptance of this device was carried out. 50 \n\n\n\nstabilized warfarin subjects from Warfarin Medication Therapy Adherence Clinic were randomly sampled. \n\n\n\nAfter obtaining informed consent, blood samples were drawn for testing by using standard laboratory assays \n\n\n\nand CoaguChek\n\u00ae\n XS concurrently. A total of 48 patients were recruited and 96 INR readings were collected. \n\n\n\nThere were 27 male (56.8%) with mean age of 53.7. The correlation of INRs obtained from CoaguChek\n\u00ae\n XS \n\n\n\nand laboratory, r\n2\n = 0.831. The Bland Altman plot shown a good magnitude of agreement between both \n\n\n\nmethods and the disagreement was widened at INR>3.5. 81.25% of the measurements were within 0.5 INR \n\n\n\nunits of each others. For laboratory INR values of <2.0, 2.0-3.5 and >3.5, 86.66%, 89.28% and 20% of the \n\n\n\nreadings were within 0.5 INR units respectively. There were 48 responses to the patient preferences \n\n\n\nassessment. Of these, 93.80% of patients preferred the Coaguchek\n\u00ae\n XS, 83.30% preferred the shorter waiting \n\n\n\ntime and 27.80% said it was less painful. The results from this study were found to be consistent with findings \n\n\n\nfrom similar studies. In conclusion, INRs measured by CoaguChek\n\u00ae\n XS and laboratory are closely correlated \n\n\n\nand agreeable at INR below 3.5 and patients preferred CoaguChek\n\u00ae\n XS as compared to conventional \n\n\n\nlaboratory monitoring. \n\n\n\n \nPPP \u2013 19 (000085) \n\n\n\n\n\n\n\nKnowledge, Attitude and Behaviour of Pharmacy Staff in Handling Cytotoxic Drugs in Sarawak \n\n\n\nGovernment Health Institutions   \n \n\n\n\nM H Law, C M Ling, C Y Ngu, G K Phua, H C Yong, F Ahmad Faiz, Y Nurulhusna Syuhaidah  \nOncology Pharmacy Unit, Department of Pharmacy, Sarawak General Hospital, Sarawak, Malaysia \n\n\n\n\n\n\n\nConstraint in pharmacy staffing for cytotoxic drug reconstitution (CDR) could be due to lack of knowledge, \n\n\n\npositive attitude and behaviour among staff towards handling cytotoxic drugs.  This cross-sectional study \n\n\n\nexplores level of their knowledge, attitude and behavior at Sarawak Government Health Institutions.  It also \n\n\n\nexamines influence of knowledge on their attitude and behaviour.  A survey using self-administered \n\n\n\nquestionnaire was conducted over 66 pharmacy departments in Sarawak.  The questionnaire was developed \n\n\n\nbased on archived literature and tested for validity and reliability. 259 pharmacists and 286 pharmacist \n\n\n\nassistants participated in the survey (response rate 79.6%). Mean score (\u00b1S.D.) of knowledge was 68.2 (\u00b10.6) \n\n\n\nwith lacking in aspects of occupational exposure to cytotoxic drugs.  40.2% presumed that CDR is not \n\n\n\nnecessarily the responsibility of pharmacy.  41.7% felt distressed if they were assigned for CDR.  About one-\n\n\n\nthird claimed no practice of handling cytotoxic drugs.  Only half (49.7%) reported use of gloves and mask \n\n\n\nduring filling of cytotoxic drug prescriptions.  Significant association was found between the knowledge level \n\n\n\nand attitude on pharmacy\u2019s responsibility for CDR and assignment to CDR unit respectively (\u03a7\n2\n = 10.038, p = \n\n\n\n0.007; \u03a7\n2\n = 7.423, p = 0.024).  No significant association between knowledge level and all practices \n\n\n\ninvestigated.  These preliminary findings revealed fairly satisfactory level of knowledge, lacking of positive \n\n\n\nattitude and behaviour among pharmacy staff in handling cytotoxic drugs.  More educational trainings and \n\n\n\nawareness programmes are warranted for cultivating positive working attitude.  However, further analysis of \n\n\n\nthe study data and subsequent research are necessary to formulate effective strategies to promote safe practice \n\n\n\nof handling cytotoxic drugs. \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                           MPS Pharmacy Scientific Conference 2011 \n \n\n\n\n412 \n \n\n\n\nPPP \u2013 20 (000086) \n \n \n\n\n\nThe Evaluation of Prevalence and Awareness towards Hypertension Control among Healthcare \n\n\n\nEmployees in Kerian District, Perak \n \n\n\n\nWan Azuati W. Omar\n1\n, Zuraidah M. Yusoff\n\n\n\n2\n, Mohamed Azmi A. Hassali\n\n\n\n3\n, T. Balamurugan\n\n\n\n2\n  \n\n\n\n1\nPharmacy Department, Hospital Taiping, Perak, Malaysia \n\n\n\n2\nDiscipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, \n\n\n\nMalaysia \n3\nDiscipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains \n\n\n\nMalaysia, Penang, Malaysia \n \n\n\n\nThe aim of this study is to provide a preliminary data on the prevalence, awareness, treatment and control of \n\n\n\nhypertension, particularly among the healthcare employees. To describe the prevalence, awareness, treatment, \n\n\n\nadherence and control of hypertension among healthcare employees in Kerian district, Perak. A cross-\n\n\n\nsectional, descriptive population survey using a pretested standardized questionnaire form distributed by drop-\n\n\n\noff method. Conveniently sampled subjects from the hospital, health clinics and dental clinics in the district \n\n\n\nthat complied with the inclusion criteria were included. The total number of participants was 374. This survey \n\n\n\nachieved response rate of 84.2%. Mean age of respondents were 36.4 years with 54.5% were categorized in \n\n\n\nthe younger age group. Prevalence of hypertension and prehypertension among employees were estimated to \n\n\n\nbe 16% and 29.1% respectively. Men were more prevalent than women (24% and 14%, p-value <0.001). \n\n\n\nAwareness of hypertension was 72% while for prehypertensive 28.3%. Treatment with antihypertensive was \n\n\n\nreceived by 54% of hypertensive employees with blood pressure control rate of 70%. A considerable \n\n\n\nknowledge gap related to hypertension and its complications was found among the healthcare employees. \n\n\n\nMajority of treated respondents reported poor to medium adherence to antihypertensive medication. Although \n\n\n\nthe prevalence of hypertension among the healthcare employees was low, the high prevalence of \n\n\n\nprehypertension, moderate awareness of hypertension status and low awareness of prehypertension status, \n\n\n\nmedium level of adherence to antihypertensive treatment and inadequate control among the treated \n\n\n\npopulation, showed the continuing needs for improvements. \n \n\n\n\nPPP \u2013 21 (000093) \n \n\n\n\nThe Community Pharmacist as a Member of Healthcare Team in Karachi, Pakistan: Opinion of \n\n\n\nPatients  \n \n\n\n\nS Q Jamshed\n1\n, K Rajiah\n\n\n\n1\n, M S Iqbal\n\n\n\n1\n , M J A Siddiqui\n\n\n\n1\n, F Saleem\n\n\n\n2\n, M A Hassali\n\n\n\n2\n, I Azhar\n\n\n\n3\n \n\n\n\n1\nPharmacy Practice, School of Pharmacy and Health Sciences, International Medical University, Kuala \n\n\n\nLumpur, Malaysia \n2\nDiscipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains \n\n\n\nMalaysia, Penang, Malaysia \n3 \nDepartment of Pharmacognosy, Faculty of Pharmacy, University of Karachi, Karachi, Pakistan \n\n\n\n\n\n\n\nThe pharmacy profession has taken strides from the traditional business of compounding and dispensing to \n\n\n\npatient-centred pharmaceutical care; ranging from therapeutic regimen management, adverse drug reaction \n\n\n\nmonitoring and pharmacogenomics. In Pakistan, the profession of pharmacy is rapidly evolving with \n\n\n\nappreciable number of pharmacists shifting their paradigm from industry to community pharmacies. \n\n\n\nAdditionally, health authorities in Pakistan urged to reinforce pharmaceutical care services to improve the \n\n\n\nquality of life of patients and drug use. In this context, this pilot study aimed to investigate the perception of \n\n\n\npatients about the roles of community pharmacists.  The study was conducted from December 2009 till March \n\n\n\n2010. Ten community pharmacies that had 24-hour presence of a professionally qualified community \n\n\n\npharmacist were randomly selected.  A convenience sample of 300 exit patients outside the community \n\n\n\npharmacies was recruited. Of the total respondents, 200 (66%) were males, 250 (83.3%) were below 60 years \n\n\n\nof age, and 275 (91.6%) approached the pharmacy for prescription medicines. A majority (n=285; 95%) \n\n\n\nexpressed their comfort to have an interaction with a community pharmacist. Slightly more than half of the \n\n\n\nrespondents (n= 175; 58.3%) cited counselling time as \u2018adequate and sufficient\u2019 and rated the quality of verbal \n\n\n\ninformation as \u2018good\u2019. Nearly three-quarter of the respondents (n= 215; 71.6%) stated that the information \n\n\n\nabout the cost of prescription is appropriate. More than half of the respondents (n= 200; 66.6%) addressed the \n\n\n\nneed of a separate counseling counter and more counseling time from the pharmacists. This study showed \n\n\n\nwell-rounded opinions of patients about community pharmacists. \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                           MPS Pharmacy Scientific Conference 2011 \n \n\n\n\n413 \n \n\n\n\nPPP \u2013 22 (000095) \n\n\n\n\n\n\n\n\n\n\n\nCurrent Prescribing Trends in Treatment of Malaria in Health Care System of Pakistan  \n \n\n\n\nMadeeha Malik\n1\n, Mohamed Azmi Ahmad Hassali\n\n\n\n1\n, Asrul Akmal Shafie\n\n\n\n1\n, Azhar Hussain\n\n\n\n1,2 \n\n\n\n\n\n\n\n1\nDiscipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains \n\n\n\nMalaysia, 11800 Minden, Penang, Malaysia \n2\nHamdard Institute of Pharmaceutical Sciences, Hamdard University, F-8 Markaz, Johar Road  Islamabad, \n\n\n\nPakistan \n\n\n\n\n\n\n\nIrrational prescribing practices is one of the major contributing factors towards anti malarial drug resistance in \n\n\n\ntreatment of malaria. To investigate current prescribing practices for treating malaria in health care system of \n\n\n\nPakistan. The study population consisted of five public tertiary health care hospitals from federal capital city \n\n\n\nIslamabad, Pakistan. A sample of 150 malaria prescriptions; thirty from each health facility was collected for \n\n\n\nanalysis. Malaria diagnosis was written on the prescription in (n=36, 24%) of the cases out of which in only \n\n\n\n(n=37, 24.7%) malaria parasite test was performed and in only (n=27, 18.1%) cases it was positive. In 141 \n\n\n\n(94.1%) of the prescriptions, brand names of drugs were used. One hundred and eighteen (78.7%) \n\n\n\nprescriptions had the dose of antimalarials while only (28.7%) had the strength of anti malarials mentioned. \n\n\n\nAntibiotics were prescribed in 113 (75.3%) cases along with anti malarial drugs while injections were used in \n\n\n\n67 (44.7%) cases. There was a significant difference (p \u2264 0.05) in prescribing practices among different public \n\n\n\nhealth facilities. The findings suggest that over diagnosis, over use of antibiotics & injections and \n\n\n\nunawareness of practitioners regarding standard malaria treatment guidelines are the major aggravating factors \n\n\n\nfor irrational drug use in treatment of malaria. \n\n\n\n\n\n\n\n\n\n\n\nPPP \u2013 23 (000108) \n\n\n\n\n\n\n\n\n\n\n\nA Study on Utilization of Antibiotics among Hospitalized Patients at a Government Hospital in Kedah, \n\n\n\nMalaysia \n \n\n\n\nShalini Sivadasan\n1,5\n\n\n\n, Cavineswari Sithambaranathan\n1\n, Aw Hong San\n\n\n\n1\n, Rosliza Saffiee\n\n\n\n2\n, Mirza Rafiullah \n\n\n\nBaig\n1\n, Basanta Kumar Mohanty\n\n\n\n3\n, Saraswathi Raman\n\n\n\n4,5\n  \n\n\n\n1\nFaculty of Pharmacy, AIMST University, Semeling-08100, Kedah, Malaysia \n\n\n\n2\nPharmacist, Hospital Sultan Abdul Halim, Sungai Petani, Kedah, Malaysia \n\n\n\n3\nFaculty of Medicine, AIMST University, Semeling-08100, Kedah, Malaysia \n\n\n\n4\nAlShifa College of Pharmacy, Perinthalmanna, Kerala, India \n\n\n\n5\nDepartment of Pharmacy, Karpagam University, Coimbatore, India  \n\n\n\n\n\n\n\nTo analyze the utilization pattern of antibiotics among hospitalized patients in Sultan Abdul Halim Hospital, \n\n\n\nKedah, Malaysia. The cross-sectional descriptive study was conducted for a period of three months. The study \n\n\n\nincluded hospitalized patients from various departments who received at least one antibiotic in their treatment. \n\n\n\nThe data were collected utilizing a questionnaire data collection form that included patient demographics, \n\n\n\ndiagnosis, antibiotics received, doses, frequency, previous treatment if any, concomitant drugs prescribed \n\n\n\n(generic/brand name), duration etc. A total of 201 prescriptions were randomly selected and documented \n\n\n\nwhere in 712 drugs were prescribed and all were prescribed by its generic name (100%). The treatment with \n\n\n\nantibiotics for the conditions strongly adhered to the National antibiotic guidelines. It was found that 95.15% \n\n\n\nof the drugs prescribed were from the National Formulary. Among the 712 drugs prescribed, 46.63% (n=332) \n\n\n\nwere antibiotics, wherein the most prescribed were the beta-lactams (47.29%) as compared to the other classes \n\n\n\nof antibiotics. It was also found that the majority of antibiotics were prescribed in the form of injectables \n\n\n\n(56.33%) during the hospital stay of the patients.  The present study identified that the utilization of antibiotics \n\n\n\namong hospitalized patient strongly complies with the National Antibiotic Guidelines and the drugs prescribed \n\n\n\nstrongly adheres to the National Formulary by the Ministry of Health at a higher rate as compared to the \n\n\n\nNational Essential Drug List. The generic prescription was high, which can reduce the number of irrational \n\n\n\ncombinations and therefore the drug use in this hospital set up is considered to be rational in these terms. \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                           MPS Pharmacy Scientific Conference 2011 \n \n\n\n\n414 \n \n\n\n\n\n\n\n\nPPP \u2013 24 (000129) \n\n\n\n\n\n\n\n\n\n\n\nPerception of Academic Pharmacist towards their Role in Health Care System of Pakistan: A \n\n\n\nQualitative Assessment   \n  \n\n\n\nAzhar S\n1\n\n\n\n,\n \nHassali MA\n\n\n\n2\n, Ahmad M\n\n\n\n3\n, Saleem F\n\n\n\n2\n, Jamshed S\n\n\n\n4\n, Masood I\n\n\n\n2\n, Haq N\n\n\n\n2\n \n\n\n\n1\nDepartment of Pharmacy COMSAT Abbottabad Pakistan  \n\n\n\n2\nSchool of Pharmaceutical Sciences Universiti Sains Malaysia  \n\n\n\n3\nCollege of Pharmacy GC University Faisalabad Pakistan  \n\n\n\n4\nDepartment of Pharmacy, International Medical University Malaysia (IMU) \n\n\n\n\n\n\n\nThe main objective of this study was to explore the perception of Pakistani academic pharmacists towards \n\n\n\ntheir roles in Pakistan\u2019s healthcare system. A qualitative approach was used to gain this understanding. The \n\n\n\nstudy was conducted in two cities of Pakistan, Islamabad and Lahore, from April to June 2007, using a semi-\n\n\n\nstructured interview guide, developed after extensive literature review. A total of 11 academic pharmacists \n\n\n\nwere interviewed using this semi-structured interview guide. All the interviews were transcribed verbatim and \n\n\n\nthematically analyzed for its content. Thematic content analysis yields 5 major themes: 1) Perception \n\n\n\nconcerning curriculum, 2) Job contentment approach, 3) Perception of Pharmaceutical care in Pakistan, 4) \n\n\n\nCollaboration with other healthcare professionals 5) Strategies to improve the status of pharmacists. Based on \n\n\n\nthe findings of qualitative results, high demand is seen on the curriculum alignment, which is very important \n\n\n\nfor the actual pharmacy practice activities, ultimately, this is important for a number of reasons including job \n\n\n\nsatisfaction and to provide the best healthcare for patients, skills and more structured experiential training. It \n\n\n\ncan be anticipated that with the support of the government, university academics, Pakistan Pharmacists \n\n\n\nAssociation and Pharmacy Council, the profession of pharmacy will develop rapidly by securing a more \n\n\n\nconventional role of pharmacists. \n\n\n\n\n\n\n\nPPP \u2013 25 (000133) \n\n\n\n\n\n\n\n\n\n\n\nA Study on Knowledge of HIV Transmission among Public Secondary School Students in Urban and \n\n\n\nRural Areas in Malaysia   \n \n\n\n\nM A Nawab Khan, N A Md Rosly, M A Hameed, N E Ismail \n\n\n\nClinical Pharmaceutics Research Group (CPRG) & Inhalational Delivery Research Unit (IDRU), Faculty of \n\n\n\nPharmacy, Universiti Teknologi MARA (UiTM), Puncak Alam Campus, 42300 Bandar Puncak Alam, \n\n\n\nSelangor, Malaysia \n\n\n\n\n\n\n\nHuman Immunodeficiency virus (HIV), a retrovirus, is accountable for Acquired Immunodeficiency \n\n\n\nSyndrome (AIDS). This cross-sectional study evaluated the level of knowledge and sources of information on \n\n\n\nHIV transmission among public secondary school students. Following ethics approval, 600 self-administered \n\n\n\nquestionnaires were randomly disseminated to students in 6 different secondary schools and areas (i.e. 3 urban \n\n\n\nschools and 3 rural schools). Data were analyzed using Statistical Package of Social Sciences (SPSS) version \n\n\n\n16 including Pearson Chi-Square test and frequency analysis where applicable. About 275 students from \n\n\n\nurban (Kuala Lumpur, Shah Alam, and Kuantan) and 275 students from rural (Kemaman) completed and \n\n\n\nreturned the questionnaires (response rate: 96.2%). Many respondents were female (72.9%) and within the age \n\n\n\nrange of 15-16 years old (60.4%). Most respondents had heard about HIV. Only 4.7% rural respondents did \n\n\n\nnot ever hear about HIV and were excluded. Most respondents in both areas knew that sharing needles can \n\n\n\ntransmit HIV (93.5% urban; 97.1% rural). Out of fifteen items concerning transmission of HIV, eight items \n\n\n\nshowed significant value (p < 0.05) of rural vs. urban: saliva, urine, tears, using same swimming pool, blood \n\n\n\ntransfusion, mosquito bites, sharing foods and donating blood to HIV patients. About 90.2% and 96.7% of \n\n\n\nrespondents in urban and rural areas used television as main source of knowledge on HIV, respectively. The \n\n\n\nimplementation of incessant HIV and AIDS education programme could be useful in schools in Malaysia in \n\n\n\norder to enhance and sustain awareness concerning HIV and AIDS among students. \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                           MPS Pharmacy Scientific Conference 2011 \n \n\n\n\n415 \n \n\n\n\nPPP \u2013 26 (000138) \n\n\n\n\n\n\n\n\n\n\n\nCompliance to Oral Contraceptives in Primary Healthcare Centre  \n  \n\n\n\n H Rosnani\n1\n, A N Mariani\n\n\n\n1 \n, G Syafawati\n\n\n\n1\n,\n  \nM  Mohd. Dziehan\n\n\n\n2\n \n\n\n\n1\nFaculty of Pharmacy, Cyberjaya University College of Medical Sciences \n\n\n\n2\nHealth Clinic Telok Panglima Garang \n\n\n\n\n\n\n\nOral contraceptive is an important birth control method for many women, but its success depends on many \n\n\n\nfactors. Many unintended pregnancies are attributable to either misuse or discontinuation of oral  \n\n\n\ncontraceptives (OCs). This cross-sectional study was carried out to determine compliance to oral \n\n\n\ncontraceptives in primary healthcare setting. A total of 92 participants were chosen based on convenience \n\n\n\nsampling and interviewed at the Family Planning Clinic, Health Clinic Telok Panglima Garang, Banting for 6 \n\n\n\nmonths. The Morisky scale was used to determine patients' compliance. Dose, Frequency, Indication and \n\n\n\nTime (DFIT) form was used to determine patients' compliance and knowledge based on individual OC. \n\n\n\nResults were analysed using SPSS. The primary motivation for using oral contraceptives was to space birth \n\n\n\n(70%). 24% of the participants were compliant despite experiencing side-effects. Another 25% of the \n\n\n\nrespondents did not comply due to side effects.There was a significant correlation between compliance and \n\n\n\nside-effects (p<0.05). Association between compliance and age (p<0.05) showed that 44% of the participants \n\n\n\nwere non- compliance and 56% of these participants were from the age group of 35 years old and above. Most \n\n\n\nof the participants (90%) did not know the mechanism of action of oral contraceptives. In conclusion, \n\n\n\ncompliance to oral contraceptives can be affected by various factors such as age, side-effects, knowledge, \n\n\n\nmotivation and attitudes of the users. Pharmacists' can play a greater role in explaining the ways OCs work as \n\n\n\nwell as allay the fear of side-effects in order to improve patient compliance. \n\n\n\n\n\n\n\nPPP \u2013 27 (000142) \n\n\n\n\n\n\n\n\n\n\n\nA Study on Attitude towards HIV Patients among Public Secondary School Students in Urban And \n\n\n\nRural Regions in Malaysia   \n \n\n\n\nM A Nawab Khan, N A Md Rosly, M A Hameed, N E Ismail \n\n\n\nClinical Pharmaceutics Research Group (CPRG) & Inhalational Delivery Research Unit (IDRU), Faculty of \n\n\n\nPharmacy, Universiti Teknologi MARA (UiTM), Puncak Alam Campus, 42300 Bandar Puncak Alam, \n\n\n\nSelangor, Malaysia \n\n\n\n\n\n\n\nMisconception on transmission of human immunodeficiency virus (HIV) resulted in poor attitute towards HIV \n\n\n\ninfected patients. This cross-sectional study assessed the level of acceptance towards HIV patients among \n\n\n\npublic secondary school students. After ethic approval, 600 adapted self-administered questionnaires were \n\n\n\nrandomly disseminated to students in 6 different secondary schools and areas (i.e. 3 urban schools and 3 rural \n\n\n\nschools). Data were analyzed using Statistical Package of Social Sciences (SPSS) version 16 including \n\n\n\nPearson Chi-Square test and frequency analysis where applicable. About 275 students from urban (Kuala \n\n\n\nLumpur, Shah Alam, and Kuantan) and 275 students from rural (Kemaman) completed and returned the \n\n\n\nquestionnaires (response rate: 96.2%). Many respondents were female (72.9%) and within the age range of \n\n\n\n15-16 years old (60.4%). Most respondents had heard about HIV. Only 4.7% rural respondents did not hear \n\n\n\nabout HIV and were excluded. In comparison between urban and rural areas: about 60.0% and 59.6% \n\n\n\nrespondents agreed to talk with HIV patients, 58.2% and 66.9% disagreed that HIV / AIDS infected patients \n\n\n\nshould be quarantined in hospital for all their life, 64.7% and 73.5% agreed that HIV infected students should \n\n\n\nnot be eliminated from schools (p = 0.011), 51.6% and 59.6% respondents would not ignore HIV positive \n\n\n\nfriends, 44.7% and 51.6% respondents would sit near HIV patients, while 54.9% and 53.8% \n\n\n\nrespondents would not share food with HIV patients; respectively. Overall, rural respondents showed more \n\n\n\ncompassion toward HIV patients as compared to urban respondents. HIV stigma reduction intercession \n\n\n\nprograms should be implemented in schools. \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                           MPS Pharmacy Scientific Conference 2011 \n \n\n\n\n416 \n \n\n\n\nPPP \u2013 28 (000147) \n\n\n\n\n\n\n\n\n\n\n\nSelf-Medication Practices among Malaysian Undergraduate Pharmacy Students  \n \n\n\n\nM A Hameed\n1\n, I Abdul Halim Zaki\n\n\n\n1\n, M A Hadi\n\n\n\n1\n, M R Baig\n\n\n\n2\n, S H Syed\n\n\n\n3\n, M A Nawab Khan\n\n\n\n1\n, N E Ismail\n\n\n\n1\n \n\n\n\n1\nClinical Pharmaceutics Research Group (CPRG) & Inhalational Delivery Research Unit (IDRU), Faculty of \n\n\n\nPharmacy, Universiti Teknologi MARA (UiTM), Puncak Alam Campus, 42300 Bandar Puncak Alam, \n\n\n\nSelangor, Malaysia \n2\nFaculty of Pharmacy, AIMST University, 08100 Bedong, Malaysia \n\n\n\n3\nSchool of Pharmacy and Health Sciences, International Medical University, 57000 Kuala Lumpur, Malaysia \n\n\n\n\n\n\n\nSelf-medication can be defined as health activities to treat oneself with or without drugs using health \n\n\n\ninformation from various sources. Appropriate medical care and self-medication practices can reduce number \n\n\n\nof hospital stays especially among chronically ill adults in addition to boost confident and responsibility \n\n\n\ntowards own health management. This cross-sectional study investigated the self-medication practices among \n\n\n\nMalaysian undergraduate pharmacy students. Self-administered questionnaires were randomly distributed to \n\n\n\nyear one until year four students from 2 public and 2 private universities in Malaysia between July and \n\n\n\nOctober 2010. Both descriptive and inferential statistics were used for data analysis whereby p value < 0.05 \n\n\n\nwas considered as statistically significant. About 400 questionnaires were sent to the corresponding \n\n\n\nuniversities however 375 questionnaires were completed and returned (response rate: 93.8%). The mean \n\n\n\n(\u00b1SD) age of respondents was 20.7 (\u00b11.6) years old and many were females (80.3%). About 70.1% of the \n\n\n\nrespondents practiced self-medication and 40.8% reported having done so at least once in the past month. \n\n\n\nMain indications for self-medication were headache (74.1%) and cough and common cold (71.7%) that highly \n\n\n\ninvolved painkillers (86.7%) and vitamins and minerals (68.8%). Many respondents self-medicated (84.3%) \n\n\n\nbecause their ailments were too minor for physicians\u2019 consultations. Nonetheless, 63.2 % respondents were \n\n\n\nagainst frequent self-medication practices because of the risk of using wrong drugs. The commonest self-\n\n\n\nmedication source was respondents\u2019 own experiences (74.4%). In conclusion, gender and different years of \n\n\n\nstudy did not influence self-medication practices among Malaysian undergraduate pharmacy students. It is \n\n\n\nimperative to educate students and public about responsible self-medication. \n\n\n\n\n\n\n\nPPP \u2013 29 (000151) \n\n\n\n\n\n\n\n\n\n\n\nNon-Prescription Medicines: What Malaysian Purchased From Community Pharmacies?  \n \n\n\n\nMA Hassali, AA Shafie, AHM Yahaya \nDiscipline of Social & Administrative Pharmacy, School of Pharmaceutical Sciences, USM, Penang \n \n\n\n\nIn recent years, there has been an increasing trend in self-medication with non-prescription medicines \n\n\n\navailable in pharmacies. Currently, there is no published study to show the current situation in Malaysia on \n\n\n\nhow its general public utilized non-prescription medicines from community pharmacies. Therefore, the study \n\n\n\nwas conducted to explore the pattern of non-prescription medicine purchased by consumers from community \n\n\n\npharmacies in Malaysia.  A cross-sectional survey which comprised of 2729 community pharmacy consumers \n\n\n\nwas conducted nation-wide. A pharmacy \u201cexit survey\u201d was developed and administered to pharmacy \n\n\n\nconsumers of 59 randomly selected community pharmacies in order to collect information on the purchased \n\n\n\nnon-prescription medicine(s). A total of 3462 non-prescription medicines were purchased by consumers \n\n\n\ninterviewed in two weeks period. About 39.3% of item purchased are listed under group C Poison, 43.6% \n\n\n\nwere over-the-counter medicines, and 5.4% were group B medicines. There were also 9.6% of traditional \n\n\n\nmedicines and 2% of cosmetic items being purchased. Medicines for alimentary tract and metabolism, \n\n\n\nrespiratory system and musculoskeletal system as categorized by Anatomical Therapeutic Coding were among \n\n\n\nthe highest purchased medicines. Factors such as gender, ethnicity and types of occupation were found to be \n\n\n\nassociated with types of medicine purchased. There was also correlation between age and medicine purchased \n\n\n\n(rs=0.053, p=0.006). In conclusion, Malaysian purchased non-prescription medicines from community \n\n\n\npharmacies to treat minor ailments and practice self-medication. The socio-demographic factors that were \n\n\n\nassociated with non-medicine purchased served as useful information for policy makers and pharmaceutical \n\n\n\nindustries for future development of rational drug use education among consumers in the country. \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                           MPS Pharmacy Scientific Conference 2011 \n \n\n\n\n417 \n \n\n\n\n\n\n\n\nPPP \u2013 30 (000160) \n\n\n\n\n\n\n\n\n\n\n\nKnowledge and Awareness of Patients Regarding Hepatitis B  \n \n\n\n\nHaq N\n1\n, Shafie AA\n\n\n\n1\n, Hassali MA\n\n\n\n1\n, Ibrahim MIM\n\n\n\n2\n, Saleem F\n\n\n\n1\n \n\n\n\n1\nUniversiti Sains Malaysia (USM), Pinang, Penang, Malaysia \n\n\n\n2\nQassim University, Saudi Arabia \n\n\n\n\n\n\n\nA descriptive study was conducted to evaluate knowledge and awareness of hepatitis B in hepatitis B patients \n\n\n\nattending public hospitals in Quetta, Pakistan. By using a questionnaire-based cross sectional analysis. A pre-\n\n\n\ntested questionnaire contain 20 questions (six questions for general information, four for symptoms, six for \n\n\n\ntransmission and 4 for treatment) along with question regarding source of information for hepatitis B \n\n\n\ninformation. Registered Hepatitis B patients of age 18 years and above were approached. Descriptive statistics \n\n\n\nwere used to describe demographic of the patients. Percentages and frequencies were used to categorize the \n\n\n\ncategorical variables, while means and standard deviations were calculated for the continuous variables. Non \n\n\n\nparametric tests (Mann-Whitney and Kruskal Wallis Test) were used where appropriate. Knowledge scored \n\n\n\nwas categorized into good, medium and poor knowledge. All analyses were performed using SPSS 16.0. \n\n\n\nAbout 390 hepatitis B patients from all registered patients in public hospitals were enrolled in the study and \n\n\n\n232 (59.5%) were males. Majority (n=126, 32.3%) were categorized in age group of 18-30 years 36.07\u00b19.235. \n\n\n\nThe mean knowledge score was calculated as 8.55\u00b12.780 (out of 20) and categorized as having poor \n\n\n\nknowledge. All the demographic characteristics (i.e. age group, gender, education level, occupation, income \n\n\n\nlevel and locality) had significant relation with knowledge scores of the patients regarding hepatitis B. This \n\n\n\nstudy shows that there is poor level of knowledge and awareness of hepatitis B in patients. Patient centric \n\n\n\neducational and awareness interventional program is recommended. This will also help preventing further \n\n\n\nspread of infection. \n\n\n\n\n\n\n\n\n\n\n\nPPP \u2013 31 (000168) \n\n\n\n\n\n\n\n\n\n\n\nUse of Nonprescription Medications by the General Public in the Klang Valley  \n \n\n\n\nS S Chua, N H Sabki \n\n\n\nDepartment of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur \n\n\n\n\n\n\n\nThe use of nonprescription medications is increasing worldwide as the practice of self-medication becomes \n\n\n\nmore common. This is a cross-sectional study which was conducted to determine the extent and types of \n\n\n\nnonprescription medications used in the Klang Valley. Data was collected via interview using a structured \n\n\n\nquestionnaire, at 10 shopping complexes and high streets in the Klang Valley. A total of 400 respondents were \n\n\n\nrecruited with 61.5% female. The mean age of the respondents (standard deviation) was 33.4(11.8) years old. \n\n\n\nOf the 400 respondents, 298 (74.5%) have used a nonprescription medication before. Demographic data of the \n\n\n\nrespondents was not associated with the use of nonprescription medications except for marital status. \n\n\n\nRespondents who were single were more likely to use nonprescription medications than married respondents \n\n\n\n(80.9 vs 70.6%, p = 0.021). Analgesics were the most commonly used nonprescription medications in the \n\n\n\nKlang Valley (35.5%), followed by cough (17.1%) and cold preparations (11.6%). Whereas, paracetamol was \n\n\n\nthe active ingredient most commonly found in the nonprescription medications used (32.1%). Out of the 298 \n\n\n\nrespondents who have used nonprescription medications before, 234 (78.5%) obtained their medication(s) \n\n\n\nfrom pharmacies while 21.5% from non-pharmacy outlets such as doctors\u2019 clinics, supermarkets, Chinese \n\n\n\nmedical halls, 7-Eleven convenient stores, grocery shops and medical centres. The common sources of \n\n\n\ninformation on nonprescription medications were pharmacists (52.2%), doctors (16.4%) and family members \n\n\n\n(14.4%). Therefore, pharmacists have a significant role to play in the selection and safe use of nonprescription \n\n\n\nmedications. \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                           MPS Pharmacy Scientific Conference 2011 \n \n\n\n\n418 \n \n\n\n\n\n\n\n\n\n\n\n\nPPP \u2013 32 (000175) \n\n\n\n\n\n\n\n\n\n\n\nMedication Reconciliation: An Approach towards Cost Savings  \n \n\n\n\nA Tumin, S J Choo, L W Lee, Y L Low, M H Mohd Yunos, C W Poh, X N Sia, S H Mohd Jalil, P C \n\n\n\nTeh, B J Wong \nDepartment of Pharmacy, Hospital Selayang, Selangor \n\n\n\n\n\n\n\nMedication reconciliation enables the pharmacists to trace the patients\u2019 medications, and is commonly \n\n\n\npracticed among the local hospitals. This study aimed to quantify the amount and value of the medications \n\n\n\nsaved through the implementation of medication reconciliation programme, and to identify the patients\u2019 \n\n\n\npractice towards extra/unused medications. This is a descriptive and prospective study, which was conducted \n\n\n\nfrom April to June 2011. A total of 170 patients, whom consents were obtained, were identified from the \n\n\n\ncardiology and nephrology wards. The medication stock was recorded upon admission and was compared \n\n\n\nwith the discharge medications. The total amount and cost saved were derived by using the supplier\u2019s cost list. \n\n\n\nThe questionnaires were distributed among the patients and all data was analyzed using the Statistical Package \n\n\n\nfor Social Sciences (SPSS). A total cost of RM13077.05 was saved across all pharmacological groups with a \n\n\n\ntotal of 33070 pills saved. The cardiovascular medications comprised both the highest total cost saved (RM \n\n\n\n8703.74) and total pills saved (17532 pills). 112 (65.8%) patients agreed that frequent hospital re-admission \n\n\n\nmakes up the unused/extra medications, and 86 (50.5%) patients would store the unused/extra medications for \n\n\n\nfuture use. Medication reconciliation is useful as a tool in order to save both amount and cost of medications, \n\n\n\nas the unused/extra medications can be traced, retrieved and reused for other indicated patients. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nPPP \u2013 33 (000185) \n\n\n\n\n\n\n\n\n\n\n\nComparing Du90% Profiles of Anti-Epileptic Drugs in Public and Private Sectors in Malaysia  \n \n\n\n\nN N A Nik Othseman\n1\n, K K Lim\n\n\n\n1\n, C M Y Sam\n\n\n\n1\n, N Abdul Rahman\n\n\n\n1\n, L M Lian\n\n\n\n1\n, S Sivasampu\n\n\n\n1\n, S F Abu\n\n\n\n2\n \n\n\n\n1\nClinical Research Centre, National Institute of Health, Ministry of Health \n\n\n\n2\nPharmaceutical Services Division, Ministry of Health \n\n\n\n\n\n\n\nWhile a Malaysian guideline on epilepsy management was released in 2005 and was further updated in 2010, \n\n\n\nthere has been no quality indicator of anti-epileptic drugs (AEDs) utilisation in the country. This study \n\n\n\ncompared AEDs utilisation by Malaysian public and private sector in 2006 and 2007 using the DU90% \n\n\n\nmethodology, which determines the number of drugs accounting for 90% of total utilisation. Data from \n\n\n\nNational Medicine Use Survey (NMUS) database were used. Drugs were coded according to ATC/DDD \n\n\n\nsystem and its utilisation expressed as DDD/1000population/day. Drugs found within the DU90% segments \n\n\n\nwere classified as either old- or new-generation AEDs. Overall AEDs utilisation was much higher in public \n\n\n\nsector. Old-generation AEDs occupied the bulk of the DU90% segments in 2006 (public 91%, private 74%), \n\n\n\nwhich coincided with the 2005 guideline recommendations. Despite being recommended as a second-choice \n\n\n\ndrug, phenytoin was consistently the most used AED (\u224830%) possibly due to its cheap price, except in private \n\n\n\nsector in 2007 where valproic acid was preferred. Proportion of old-generation AEDs utilisation declined in \n\n\n\n2007 (public 87%, private 59%), following the increase in use of new-generation AEDs. Lamotrigine (\u22484%) \n\n\n\nwas the only new-generation AED found within the DU90% segment of public sector in 2007. In the private \n\n\n\nsector, two-fold and five-fold increase was observed for gabapentin and levetiracetam utilisation, respectively. \n\n\n\nThe DU90% methodology is a useful method in assessing the pattern and general quality of AED utilisation in \n\n\n\nMalaysia. \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                           MPS Pharmacy Scientific Conference 2011 \n \n\n\n\n419 \n \n\n\n\nPPP \u2013 34 (000186) \n\n\n\n\n\n\n\n\n\n\n\nDu90% Profiles of Anti-Hypertensive Drugs in Public and Private Sectors in Malaysia  \n \n\n\n\nN Abdul Rahman\n1\n, C M Y Sam\n\n\n\n1\n, K K Lim\n\n\n\n1\n, N N A Nik Othseman\n\n\n\n1\n, L M Lian\n\n\n\n1\n, S Sivasampu\n\n\n\n1\n, S F Abu\n\n\n\n2\n \n\n\n\n1\nClinical Research Centre, National Institute of Health, Ministry of Health \n\n\n\n2\nPharmaceutical Services Division, Ministry of Health \n\n\n\n\n\n\n\nIn 2006, almost one in three Malaysians above 18 years old were hypertensive and only a quarter of those \n\n\n\nunder treatment had their blood pressure under control. This study aimed to address the dire need of a quality \n\n\n\nassessment of anti-hypertensive drug utilisation in the country, using data extracted from the National \n\n\n\nMedicine Use Survey (NMUS) database for years 2006 and 2007. The ATC/DDD coding was applied and \n\n\n\ndrug utilisation was expressed as DDD/1000population/day. Anti-hypertensive utilisation data were presented \n\n\n\nas a range of drugs accounting for 90% of total drug utilisation (DU90%) for public and private sectors for \n\n\n\nboth years. While anti-hypertensive drug utilisation was much higher in public sector, a larger range of drugs \n\n\n\nwere observed within the DU90% segments of the private compared to public sector (23 vs 10 drugs), \n\n\n\nindicating a wide variation in private practice. Beta-blockers within the DU90% segment constituted 32% of \n\n\n\ntotal utilisation in public sector in 2006. However, this proportion reduced to 28% in 2007 along with a \n\n\n\ncorresponding increase in use of ACE inhibitors and calcium-channel blockers, which was in line with clinical \n\n\n\nevidence. Interestingly, utilisation of ACE inhibitors in the private sector declined in 2007, with a concurrent \n\n\n\ngrowth of angiotensin-receptor blockers and fixed-dose combination drugs utilisation. The latter two drugs did \n\n\n\nnot appear in the DU90% segment of public sector. The DU90% profiles were shown to be a simple quality \n\n\n\nindicator of anti-hypertensive drug utilisation in Malaysia. The study suggested the need of regular review of \n\n\n\nanti-hypertensive drug prescribing, particularly that in the private sector. \n\n\n\n\n\n\n\n\n\n\n\nPPP \u2013 35 (000191) \n\n\n\n\n\n\n\n\n\n\n\nEvaluation of the Involvement of a Nutritional Support Team on the Outcomes of Patients on \n\n\n\nParenteral Nutrition \n\n\n\n\n\n\n\nP F Chong \n1\n, T Paraidathathu\n\n\n\n2\n \n\n\n\n1\nDepartment of Pharmacy, Hospital Sungai Buloh, Selangor \n\n\n\n2 \nFaculty of Pharmacy, Universiti  Kebangsaan Malaysia, Kuala Lumpur \n\n\n\n\n\n\n\nA Nutrition Support Team (NST) was established in October 2009 in Hospital Sungai Buloh but the \n\n\n\neffectiveness of the team in optimizing PN has not been evaluated since its establishment. This study \n\n\n\nevaluated the effects of NST in Hospital Sungai Buloh in terms of patient outcomes, treatment outcomes and \n\n\n\nthe adherence to biochemical monitoring guidelines. A retrospective review was carried out on two groups of \n\n\n\npatients who received PN, i.e. group A (patients started on PN before the intervention of NST, n = 106) and \n\n\n\ngroup B (patients started on PN after the intervention of NST, n = 106). Statistically significant reduction in \n\n\n\nmetabolic abnormalities was seen with the intervention of NST. Sodium abnormalities declined from 67% to \n\n\n\n44% (P<0.01); potassium abnormalities declined from 42% to 15% (P<0.01); magnesium abnormalities \n\n\n\ndeclined from 13% to 3% (P<0.05) and phosphate abnormalities declined from 21% to 9% (P= 0.01). The \n\n\n\nincidences of hypertriglyceridemia was also significantly reduced from 68% to 45% (P= 0.002) after NST \n\n\n\nintervention. There was significant improvement in the level of adherence to biochemical monitoring \n\n\n\nguidelines from 46% to 72% (P<0.01). However, the length of hospital stay, patient mortality and duration of \n\n\n\nPN were similar in both groups. Daily monitoring of laboratory values and routine NST rounds can identify \n\n\n\nand correct metabolic abnormalities in a timely fashion. Nevertheless, patients\u2019 length of hospital stay and \n\n\n\nmortality are multifactorial and were seen to be beyond just nutrition support or merely the intervention of \n\n\n\nNST. Overall, the general effectiveness of NST has not been conclusively demonstrated in this study. There is \n\n\n\nevidence that patients managed by the NST have significant reduction in metabolic abnormalities and in their \n\n\n\nmanagement there was improved adherence to biochemical monitoring guidelines. However, the effects of \n\n\n\nNST in improving patient mortality and the length of hospital stay were not seen. \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                           MPS Pharmacy Scientific Conference 2011 \n \n\n\n\n420 \n \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nPPP \u2013 36 (000192) \n\n\n\n\n\n\n\n\n\n\n\nFactors Influencing Medication Adherence among Uncontrolled Hypertensive Patients  \n \n\n\n\nNazariah Haron\n 1\n, Adliah Mhd Ali \n\n\n\n2 \n\n\n\n1\n Pharmacy Department, Hospital Putrajaya, Malaysia. \n\n\n\n2\n Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur. \n\n\n\n\n\n\n\nIdentification of contributing factors influencing patients medication adherence is important in developing \n\n\n\nstrategies to improve patients\u2019 adherence. This cross-sectional study is conducted to determine predicting \n\n\n\nfactors for medication adherence among uncontrolled hypertensive patients. Hypertensive patients with \n\n\n\nuncontrolled blood pressure upon admission were screened to assess their cognitive function and health \n\n\n\nliteracy status. Antihypertensive medication adherence was assessed by using the 8-item Morisky Medication \n\n\n\nAdherence Scale (MMAS-BM). Multivariable logistic regression was used to ascertain predictors of \n\n\n\nmedication adherence as determined by the MMAS-BM.  A total of 74 patients admitted to medical wards in \n\n\n\nUniversiti Kebangsaan Malaysia Medical Centre (UKMMC) were included in this study. Majority of the \n\n\n\npatients were unemployed (78%), with primary school level of education (71.6%) and could only read at the \n\n\n\nlevel of less than a high school level (52.3%) - based on REALM-SF. The mean age was 65.3 years, with \n\n\n\ndiabetes (70.3%) and dyslipidemia (45.9%) identified as the common comorbid diseases. About 43.1% of the \n\n\n\npatients reported low medication adherence with MMAS-BM score of less than 6. Multivariate analyses \n\n\n\nshowed that age was the only factor associated with low self reported medication adherence. Socio-\n\n\n\ndemographic factors, comorbidities and medication regime were not found to significantly affect patients\u2019 \n\n\n\nadherence towards their antihypertensive medication. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nCLINICAL PHARMACY \n\n\n\n\n\n\n\nPCP \u2013 01 (000037) \n\n\n\n\n\n\n\n\n\n\n\nNutritional Aspect of Patients on Chemotherapy in Hospital Melaka: The Facts & the Future \n\n\n\n\n\n\n\nL P Chong, M Z Laila , E P Tay, A Arif \n\n\n\nPharmacy Department Hospital Melaka \n\n\n\n\n\n\n\nMalnutrition and weight loss are common problems in cancer patients that adversely affect the quality of life \n\n\n\nand survival. The importance of early identification of the severity of malnutrition in cancer patients who are \n\n\n\nreceiving active therapy is contemplated. The treatment goal for malnourished cancer patient is thus provision \n\n\n\nof nutrition support to reverse or decrease the cachectic state. Early intervention is important for effective \n\n\n\nmanagement of nutrition issues in these patients. The study was to evaluate the nutrition status of patients \n\n\n\nundergoing chemotherapy and to determine an appropriate tool for nutritional assessment for these patients. \n\n\n\nThis cross-sectional study was performed from January to May 2010, involving all cancer patients admitted \n\n\n\nfor chemotherapy. Subjects were interviewed and evaluation of nutrition status was done using both Patient-\n\n\n\nGenerated Subjective Global Assessment (PG-SGA) and Malnutrition Screening Tool (MST). More than 75% \n\n\n\nof cancer patients receiving chemotherapy was malnourished. More than 50% complained of not eating well. \n\n\n\nLess than a third of subjects were referred to dietitian for review during hospitalization stay. MST is a \n\n\n\nrelatively simple and accurate nutritional evaluation tool comparable to the well-developed PG-SGA (r = \n\n\n\n0.758, p = 0.01).  The nutritional aspect of cancer patients receiving chemotherapy requires urgent attention. \n\n\n\nMST, a relatively simple nutritional evaluation tool, can be used for early detection of nutrition status in these \n\n\n\npatients for the provision of appropriate nutrition intervention and better treatment prognosis. \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                           MPS Pharmacy Scientific Conference 2011 \n \n\n\n\n421 \n \n\n\n\n\n\n\n\nPCP \u2013 02 (000027) \n\n\n\n\n\n\n\nHealth Related Quality of Life (HRQoL) in Co-Morbid Tuberculosis Relapse Patient: A Case Report \n\n\n\nfrom Malaysia  \n\n\n\n\n\n\n\nM Atif \n1\n, SAS Sulaiman\n\n\n\n2\n, AA Shafie\n\n\n\n3\n, MA Hassali\n\n\n\n3\n, F Saleem\n\n\n\n3\n \n\n\n\n1\nDiscipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang \n\n\n\n2\nSchool of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang \n\n\n\n3\nDiscipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains \n\n\n\nMalaysia, Penang \n\n\n\n\n\n\n\nA case report is presented to describe changes in Health Related Quality of Life (HRQoL) of a pulmonary \n\n\n\ntuberculosis (PTB) patient and to illustrate impact of malnutrition and type II diabetes mellitus (DM) on the \n\n\n\nrelapse of PTB. A Chinese male patient with complaints of productive cough, loss of weight & appetite was \n\n\n\nregistered as sputum smear confirmed patient of PTB. Diagnosis was also supported by routine investigations \n\n\n\nlike Acid Fast Bacilli (AFB) smear, chest X-ray and ESR. Patient had past history of PTB and type II DM. He \n\n\n\nwas on metformin 1g (tablet) and gliclazide 160mg (tablet) two times in a day for glycaemic control. For \n\n\n\nmanagement of secondary tuberculosis, he was prescribed WHO recommended therapy. Elevated HbA1c \n\n\n\nlevels (12.9%) and history of drop off serum albumin concentration (28 g/L) at the start of TB treatment \n\n\n\ndemonstrated inappropriate glycaemic control and malnutrition over the past months. SF-36v2 health survey \n\n\n\nwas used to estimate HRQoL scores at start, after two months and at the end of TB therapy. Although \n\n\n\npatient\u2019s perception of mental and physical health improved with the progress of treatment but vitality (VT), \n\n\n\nsocial functioning (SF) and role emotion (RE) scores were still lower than Malaysian norms. Patient was \n\n\n\ndeclared \u2018Cure\u2019 but state of \u2018Health\u2019 as defined by WHO has not been achieved. Relapse of the PTB might be \n\n\n\na consequence of inappropriate glycaemic control and malnutrition. This case report demonstrates the need for \n\n\n\nmore comprehensive efforts of National Tuberculosis Programs to improve HRQoL of TB patients. \n\n\n\n\n\n\n\n\n\n\n\nPCP \u2013 03 (000032) \n\n\n\n\n\n\n\n\n\n\n\nStudy on assessment of migraine disability and side effects of migraine medications \n\n\n\n\n\n\n\nSonal Sekhar M\n1\n, Shalini Sasidharan\n\n\n\n2\n, Anand Kumar\n\n\n\n3\n \n\n\n\n1\nLecturer, Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal \n\n\n\nUniversity,  Manipal, Karnataka, India. \n2\nDepartment of Pharmacy Practice, Amrita School of Pharmacy, Amrita Vishwa Vidyapeetham University, \n\n\n\nAIMS Healthsciences     Camapus, Kochi, Kerala, India. \n3\nProfessor and Head, Department of Neurology, Amrita Institute of Medical Sciences, Amrita Vishwa \n\n\n\nVidyapeetham University, AIMS    Healthsciences Camapus, Kochi, Kerala, India. \n\n\n\n\n\n\n\nMigraine is a major health problem due to its frequency and accompanying morbidities, which include \n\n\n\ndisability and functional impairment. Various studies indicate that knowledge on disability is an important \n\n\n\nparameter to determine migraine severity and influences health professionals in their judgments of disease \n\n\n\nseverity and treatment requirements. Purpose of the study is to assess the disability due to migraine and side \n\n\n\neffects of the drugs prescribed for them. A prospective, cross sectional study was conducted in the Department \n\n\n\nof Neurology, in a tertiary care teaching hospital over a period of one month and a total follow up period of 6 \n\n\n\nmonths. Migraine headache related disability was assessed by using migraine disability assessment scale \n\n\n\n(MIDAS) in base line visit and in two follow up visits. During the follow up the side effects of the migraine \n\n\n\ndrugs were also studied. Out of 26 patients, 5, 3, 7 and 11 were coming under Grade I, II, III and IV disability \n\n\n\ngroups respectively. During the baseline visit and final follow up, the mean disability scores of grade I, grade \n\n\n\nII, grade III and Grade IV patients was found to be 4.4, 7.3,14 and 26.3; and 0.8, 1.3, 2.1 and 3.4 respectively. \n\n\n\nThe common side effects noted were drowsiness, weight gain, increased appetite, constipation, gastritis etc. \n\n\n\nMigraine care could be improved by incorporating assessments of migraine related disability into management \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                           MPS Pharmacy Scientific Conference 2011 \n \n\n\n\n422 \n \n\n\n\nstrategies. Drug therapy can significantly improve migraine disability but side effects of the drugs are very \n\n\n\ncommon. \n\n\n\n\n\n\n\n\n\n\n\nPCP \u2013 04 (000041) \n\n\n\n\n\n\n\n\n\n\n\nEvaluation of Antibiotic Usage Pattern in Appendicectomy and Colorectal Surgeries in Surgery Unit of \n\n\n\na Tertiary care Teaching Hospital  \n\n\n\n\n\n\n\nRajesh V \n1\n, Surulivel Rajan M\n\n\n\n1\n, Ann Tintu Baby\n\n\n\n1\n, Gabriel Rodrigues\n\n\n\n2\n, Anand Rao BH\n\n\n\n2\n \n\n\n\n1\n Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal, India. \n\n\n\n2\n Department of Surgery, Kasturba Hospital, Manipal, India. \n\n\n\n\n\n\n\nPostoperative infectious complications are an important cause of morbidity and mortality. Postoperative \n\n\n\nwound infections affect quality of life and have financial implications for the patient. The objective of the \n\n\n\nstudy was to evaluate the antibiotic usage pattern in patients undergoing appendicectomy and colorectal \n\n\n\nsurgeries. A Cross-sectional, observational, prospective study was carried out for 6 months with the prior \n\n\n\napproval of Institutional ethics committee. The data were collected regarding demography and antibiotic use. \n\n\n\nA total of 78 cases were included in the study, which constitutes of 29 appendicectomy and 49 colo-rectal \n\n\n\nsurgeries. There were 51 males and 27 females. The antibiotic usage pattern showed that ciprofloxacin-\n\n\n\ntinidazole (88.23%) as i.v was commonly prescribed prophylactic antibiotic, followed by cefotaxime-\n\n\n\ntinidazole and ciprofloxacin. In all cases antibiotics were continued for 2 to 23 days depending on the post-\n\n\n\noperative complications. In majority of the cases i.v to oral shift was done between second day to fifth day of \n\n\n\nsurgery. Out of 78 cases 4 got infected with an incidence rate of 5.13 %. Bacterial culture was obtained for all \n\n\n\nthe cases. Of the 4 cases, 3 yielded monomicrobial pathogens and 1 yielded polymicrobial pathogens. Of the 4 \n\n\n\nculture reports, 5 organisms were isolated. Most common pathogen was E.coli 1 (80%) followed by \n\n\n\nEnterococcus spp (20%). Ciprofloxacin-tinidazole combination was the most common anti-biotic used in this \n\n\n\ngroup with E-coli as the most common organism for infection. There is a need for constant surveillance of \n\n\n\nsensitivity pattern for these antibiotics against this organism. \n\n\n\n\n\n\n\n\n\n\n\nPCP \u2013 05 (000062) \n\n\n\n\n\n\n\n\n\n\n\nA Study of Degree of Malnutrition in Elective Surgical and Chemotherapy Patients in Tertiary Hospital  \n\n\n\n\n\n\n\nNurulumi A\n1\n\n\n\n,  Nur Sabrina MAL\n1\n,  Ching MW\n\n\n\n2\n \n\n\n\n1\nDepartment of Clinical Pharmacy, Faculty of Pharmacy, Cyberjaya University College of Medical Sciences. \n\n\n\n2\nDepartment of Pharmacy,Hospital Putrajaya \n\n\n\n\n\n\n\nMalnutrition is a serious issue that is often unrecognized and thus remains untreated although it has been \n\n\n\nreported for decades. It occurs worldwide and affects patients of all ages. As malnutrition is associated with \n\n\n\nnumerous clinical complications. The general objective of this study is to evaluate  the degree of malnutrition \n\n\n\nin elective surgical and chemotherapy patients in tertiary hospital. The specific objectives are 1) to identify the \n\n\n\ndegree of malnutrition in elective surgical and chemotherapy patients in tertiary hospital; 2) to compare the \n\n\n\nnutritional status pre- and post- surgery and chemotherapy; and 3) to investigate the need of nutritional \n\n\n\nsupport in malnutrition patients. A prospective, cohort, observational study in Hospital Putrajaya involving 50 \n\n\n\npatients electively admitted for surgery and 30 chemotherapy patients. Collection of data was done \n\n\n\nby interviewing the patients- pre and post- operatively for surgical patients, and between chemotherapy cycles \n\n\n\nfor chemotherapy patients- with the assistance PG-SGA nutritional screening tool. Collected data were then \n\n\n\nanalyzed using Microsoft Excel 2010 and SPSS software. Results shown that 10- 90% of the studied \n\n\n\npopulation was malnourished and required nutrition interventions with 12% of the surgical patients in this \n\n\n\ngroup developed complications post-operatively. In conclusion, malnutrition is prevalent pre- and post-\n\n\n\noperatively, and at each chemotherapy cycle with the most required nutrition intervention of patient education \n\n\n\nand counselling. \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                           MPS Pharmacy Scientific Conference 2011 \n \n\n\n\n423 \n \n\n\n\n\n\n\n\n\n\n\n\nPCP \u2013 06 (000065) \n\n\n\n\n\n\n\n\n\n\n\nChemotherapy-Induced Nausea and Vomiting (CINV) among Breast Cancer Patients: An Investigation \n\n\n\nin Relation to Anti-Emetic Therapy and Clinical Conditions  \n\n\n\n\n\n\n\nNoor Salihah Zakaria\n1\n, Nik Mazlan Mamat\n\n\n\n2\n, Lua P.L.\n\n\n\n1\n \n\n\n\n1 \nCentre for Clinical and Quality of Life Studies (CCQoLS), Faculty of Medicine and Health Sciences, \n\n\n\nUniversiti Sultan Zainal Abidin (UniSZA), Kampus Kota, Jalan Sultan Mahmud, 20400 Kuala Terengganu. \n2\n Kulliyyah of Allied Health Sciences, International Islamic University Malaysia (IIUM), Kuantan. \n\n\n\n\n\n\n\nDespite the availability of the modern anti-emetics, chemotherapy-induced nausea and vomiting (CINV) \n\n\n\nremains a distressing symptom experienced by a large proportion of cancer patients. The study intended to \n\n\n\ndescribe CINV in relation to anti-emetic therapy and clinical conditions in breast cancer patients receiving \n\n\n\nchemotherapy. A cross sectional study using a convenient sample was conducted in two government hospitals \n\n\n\nlocated in the East Coast of Peninsular Malaysia.The following aspects were evaluated: CINV and oral anti-\n\n\n\nemetic usage [using Morrow Assessment of Nausea and Emesis Follow-up (MANE-F)] and nutritional status \n\n\n\n[based on weight, Body Mass Index (BMI) and haemoglobin (Hb) level]. Descriptive statistics were employed \n\n\n\nusing SPSS 16. Only 34 female patients met the inclusion criteria (age = 49 \u00b1 9.5 years; Malay = 88.2%; \n\n\n\nhousewife = 47.1%; no family history = 67.6%). Patients were predominantly in stage two (50.0%) and on \n\n\n\nsecond chemotherapy cycle (31.2%). Majority experienced nausea during or after chemotherapy (91.2%) and \n\n\n\nrated it as \u2018severe\u2019. A lower proportion of respondents reported very mild to moderate level of anticipatory \n\n\n\nnausea (14.7%). Mostly, patients had taken anti-emetic (88.2%) and considered it \u2018somewhat useful\u2019 in \n\n\n\nmanaging their symptoms. Overall, patients sustained modest nutritional status (as reflected by current weight \n\n\n\n= 60.9kg \u00b1 11.4; BMI= 25.6kg/m2 \u00b1 4.6), although their Hb level was slightly lower than normal (median = \n\n\n\n11.8g/dL, IqR = 1.5). In this community-based sample, CINV continues to be a substantial problem for the \n\n\n\npatients, entailing for a rational use of anti-emetics plus additional therapeutic management of Hb level. \n\n\n\n\n\n\n\n\n\n\n\nPCP \u2013 07 (000074) \n\n\n\n\n\n\n\n\n\n\n\nA Prospective Study of Vancomycin Prescribing Patterns in Sarawak General Hospital  \n\n\n\n\n\n\n\nKho SS\n1\n, Tang CJ\n\n\n\n2\n, Tey XY\n\n\n\n2\n, Pan CW\n\n\n\n2\n, Koo KT\n\n\n\n2\n, Phan HS\n\n\n\n2\n, Ting SM\n\n\n\n2\n, A Deli\n\n\n\n2\n \n\n\n\n1\nPharmacy Department, Hospital Sentosa \n\n\n\n2\nPharmacy Department, Sarawak General Hospital \n\n\n\n\n\n\n\nThe suboptimal use of certain key antimicrobial agents have been directly linked to the development of \n\n\n\nantibiotic resistance, which has an overwhelming impact on patients and society, increasing morbidity and \n\n\n\nmortality rates as well as healthcare costs. This study aims to evaluate vancomycin prescribing patterns in \n\n\n\nadult inpatients in Sarawak General Hospital (SGH) in three aspects: to evaluate the level of appropriateness \n\n\n\nof vancomycin usage; to assess the degree of monitoring of renal function and incidence of nephrotoxicity; \n\n\n\nand to determine whether clinical outcomes of patients were correlated with trough serum vancomycin \n\n\n\nlevels. A prospective study of vancomycin prescribing patterns was performed between April and July 2010 \n\n\n\nby linking therapeutic drug monitoring profiles of patients on vancomycin with hospitalization \n\n\n\ndata. Vancomycin was found to be appropriately prescribed in 65% of 23 patients recruited for this study. \n\n\n\nAdequate renal function monitoring was carried out in 52% of the study patients. 7% of 14 excluding all end-\n\n\n\nstage renal failure patients suffered nephrotoxicity after initiation of vancomycin therapy. A total of 18 \n\n\n\npatients fulfilled the study\u2019s inclusion and exclusion criteria for the study of clinical outcomes. No patients \n\n\n\nwith trough serum vancomycin levels of 5-10mcg/ml achieved the initial clinical efficacy parameter of \u201cdays \n\n\n\ntill afebrile = 3\u201d whilst 44% achieved this with levels of 11-20mcg/ml. This study finds that in general \n\n\n\nvancomycin is appropriately prescribed in SGH but the monitoring of renal function needs to be more vigilant \n\n\n\nto prevent and detect vancomycin-induced nephrotoxicity. The results, although not statistically significant, \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                           MPS Pharmacy Scientific Conference 2011 \n \n\n\n\n424 \n \n\n\n\nalso suggest that higher trough serum vancomycin levels of 11-20mcg/ml may achieve better clinical \n\n\n\noutcomes. \n\n\n\n\n\n\n\nPCP \u2013 08 (000075) \n\n\n\n\n\n\n\n\n\n\n\nVarious Doses of Rituximab on Response Outcome in Diffuse Large B-Cell Lymphoma (DLBCL)  \n\n\n\n\n\n\n\nC M Ling\n1\n, L P Chew\n\n\n\n2\n \n\n\n\n1\nOncology Pharmacy Unit, Department of Pharmacy, Sarawak General Hospital, Sarawak, Malaysia. \n\n\n\n2\nHaematology Unit, Department of Medicine, Sarawak General Hospital, Sarawak, Malaysia. \n\n\n\n\n\n\n\nThe use of monoclonal antibody rituximab has been incorporated in treatment of diffuse large b-cell \n\n\n\nlymphoma (DLBCL) in view of its improved clinical outcome and favorable toxicity profile.  However, many \n\n\n\npatients are unable to afford the cost of standard regimen of 6 cycles.  This population-based retrospective \n\n\n\nstudy evaluates the response rate and overall survival of DLBCL patients in Sarawak General Hospital (SGH) \n\n\n\ngiven various doses of rituximab in combination with cyclophosphamide, doxorubicin, vincristine and \n\n\n\nprednisone (R-CHOP).  All DLBCL patients who were treated with R-CHOP were identified as historical \n\n\n\ncohort based on availability of medical records.  Patients\u2019 records were followed until January 31, 2011.  27 \n\n\n\npatients were included and evaluated.  12 received standard R-CHOP (6 or more doses of rituximab) (mean \n\n\n\nfollow-up, 17 months) while 15 received 1 to 5 doses of rituximab in R-CHOP (mean follow-up, 16 months).  \n\n\n\nPatients who received 1 to 5 doses of rituximab demonstrated higher rate of complete remission compared \n\n\n\nwith those received standard R-CHOP (80% vs. 58%; chi-square p=0.50).  Compared to standard R-CHOP, \n\n\n\nthose received 1 to 5 doses of rituximab were associated with higher rate of overall survival (93% vs. 75%; \n\n\n\nlog-rank p=0.35).  A multivariate analysis using Cox Regression excluded the confounding effects of \n\n\n\ndemographic characteristics and clinical prognostic factors.  This preliminary result suggested the possibility \n\n\n\nof instituting R-CHOP chemotherapy with lesser doses of rituximab in contrary to the current standard \n\n\n\nregimen.  \n\n\n\n\n\n\n\n\n\n\n\nPCP \u2013 09 (000087) \n\n\n\n\n\n\n\n\n\n\n\nIs there a Link between Osteoporosis and Diabetes? Findings from a Systematic Review of the \n\n\n\nLiterature \n\n\n\n\n\n\n\nSA Abdulameer, SAS Sulaiman, MA Hassali, MN Sahib \n\n\n\nSchool of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Minden, Penang, Malaysia \n\n\n\n\n\n\n\nDiabetes mellitus (DM) and osteoporosis (OP) are two global chronic medical diseases with a growing \n\n\n\nincidence in the aging populations, especially in Asia. Although the relation between DM and OP has been \n\n\n\ninvestigated widely but it remains controversial and complex, whether DM is a risk factor for developing OP \n\n\n\nor whether OP is one of the long-term complications of DM. The study was conducted to review the literature \n\n\n\non the relation between OP and DM. Systematic reviews of full-length articles published in English from \n\n\n\nJanuary 1950 to May 2011 were identified using PubMed and other available electronic databases at \n\n\n\nUniversiti Sains Malaysia Library Database. Search strategy with keywords was used: DM, insulin, OP, bone \n\n\n\nmass, skeletal. Studies of more than 20 patients with type 1 DM (T1DM) were included, while studies with \n\n\n\nmore than 50 patients with type 2 DM (T2DM) were considered relevant. Ninety studies were identified and, \n\n\n\nthere were conflicting results concerning the influence of DM on bone mineral density (BMD). In general, \n\n\n\nmost of the studies showed unambiguous evidence about decrease BMD in T1DM but there was still \n\n\n\ncontroversy about the effects of diabetes on bone mass in T2DM. In conclusion, screening, identification and \n\n\n\nprevention of potential risk factors for OP in DM is crucial. Calcium and vitamin D intake, and regular \n\n\n\nexercise are important to improve muscle strength and balance. In addition, adequate glycemic control and \n\n\n\nprevention of diabetic complications are the starting point of therapy in T1DM and T2DM. \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                           MPS Pharmacy Scientific Conference 2011 \n \n\n\n\n425 \n \n\n\n\n\n\n\n\n\n\n\n\nPCP \u2013 10 (000105) \n\n\n\n\n\n\n\nAn Epidemiological Investigation of Carbapenem-Resistant Acinetobacter baumannii in Sarawak \n\n\n\nGeneral Hospital: A Preliminary Study  \n\n\n\n\n\n\n\nTan A.G.H.K.\n1\n, Ong C.H.Y.\n\n\n\n1\n, Chieng I.Y.Y.\n\n\n\n1\n, Siti Fatimah M.F.\n\n\n\n1\n, Muhammad Solleh R.\n\n\n\n1\n, Phan H.S.\n\n\n\n1\n, \n\n\n\nOh A.L.\n1\n, Aminah H.D.\n\n\n\n1\n, Noriah M.Y.\n\n\n\n2\n \n\n\n\n1\nDepartment of Pharmacy, Sarawak General Hospital; \n\n\n\n2\nMicrobiology Unit, Pathology Department, Sarawak General Hospital. \n\n\n\n\n\n\n\nCarbapenem resistance in Acinetobacter baumannii is on a worryingly increasing trend of late, contributing to \n\n\n\nmajor healthcare problems.  In order to identify potential risk factors, a retrospective case-control study, set in \n\n\n\na 934-bedded tertiary hospital, of all patients who had A. baumannii isolated between January 1 and \n\n\n\nDecember 31, 2010 was conducted.  Of 180 adult cases considered, only 85 were included in the study after \n\n\n\nbeing subjected to pre-specified inclusion-exclusion criteria, most being excluded due to incomplete patient \n\n\n\ndata.  Of eligible cases, the carbapenem-resistant A. baumannii (CRAB) arm consisted of 48 (56.5%) patients, \n\n\n\nwhereas the carbapenem-sensitive A. baumannii (CSAB) arm consisted of 37 (43.5%) patients.  In univariable \n\n\n\nanalysis, we found that intensive-care unit (ICU) stay (odds ratio [OR], 11.67; 95% confidence interval [CI], \n\n\n\n3.84\u201335.51), ventilator use (OR, 8.8; 95% CI, 3.24\u201323.93), \u03b2-lactam\u2013\u03b2-lactamase inhibitor use (OR, 6.61; \n\n\n\n95% CI, 2.48\u201317.63), and aminoglycoside use (OR, 4.61; 95% CI, 0.94\u201322.50) were significant risk factors \n\n\n\nfor CRAB (p<0.05).  In multivariable analysis, only ICU stay (OR, 4.28; 95% CI, 1.18\u201315.55), ventilator use \n\n\n\n(OR, 3.63; 95% CI, 1.12\u201311.73), and \u03b2-lactam\u2013\u03b2-lactamase inhibitor use (OR, 3.29; 95% CI, 1.06\u201310.17) \n\n\n\nwere independently associated with carbapenem resistance.  This study concluded that carbapenem resistance \n\n\n\nis strongly related to ICU stay, ventilator use, and may be increased by the selection pressure of certain \n\n\n\nantibiotics.  Further studies need to be conducted to confirm these risk factors and to investigate the effects of \n\n\n\nmodifying such risk factors. \n\n\n\n\n\n\n\n\n\n\n\nPCP \u2013 11 (000106) \n\n\n\n\n\n\n\n\n\n\n\nAntibiotic Usage in adult Continuous Ambulatory Peritoneal Dialysis (CAPD) related peritonitis in \n\n\n\nSarawak General Hospital \n\n\n\n\n\n\n\nS W Ng\n1\n, H K Chan\n\n\n\n1\n, P Y Goh\n\n\n\n1\n, K S Law\n\n\n\n1\n, , Y S Sia Susan\n\n\n\n1\n, W M Wan Mohd Khairul\n\n\n\n1\n, Y C Wong\n\n\n\n1\n, H \n\n\n\nH Tan Clare\n2\n, H D Aminah\n\n\n\n1\n \n\n\n\n1\n Department of Pharmacy, Sarawak General Hospital, Kuching, Sarawak, Malaysia. \n\n\n\n2\n Nephrology Unit, Department of Medicine, Sarawak General Hospital, Kuching, Sarawak, Malaysia. \n\n\n\n\n\n\n\nPeritonitis is a major complication of Continuous Ambulatory Peritoneal Dialysis (CAPD), accounting for \n\n\n\nconsiderable mortality and hospitalization among CAPD patients. This study aimed to identify the bacterial \n\n\n\naetiology and to assess pattern of antibiotic usage of CAPD peritonitis in Sarawk General Hospital (SGH) as \n\n\n\nwell as methicillin-resistance Staphylococcus aureus (MRSA) rate versus vancomycin usage. This study \n\n\n\ninvolved all CAPD patients who had been diagnosed with peritonitis in year 2010. All the data will be \n\n\n\ncollected according to the audit form developed. In 2010, there were 32 patients with CAPD-related peritonitis \n\n\n\nwho were followed up in SGH. A total of 45 episodes of peritonitis were recorded in this year. Among 36 \n\n\n\ncases of culture-positive peritonitis episodes, most cases of peritonitis were caused by Staphylococcus aureus \n\n\n\nand Pseudomonas aeruginosa which involved 6 cases respectively, followed by 5 cases with Candida albicans. \n\n\n\nFirst line antibiotics treatments for peritonitis are intraperitoneal (IP) cloxacillin or cefazolin plus IP \n\n\n\nceftazidime. There were 20 resolved cases with first line antibiotic treatments and 25 unresolved cases which \n\n\n\nwere then treated with second and third line antibiotic treatments. However, the final outcome showed all \n\n\n\nperitonitis episodes were resolved except with 6 cases resolved only after catheter removal and a case resulted \n\n\n\nin death. Among 45 episodes of peritonitis, 3 episodes were caused by MRSA whereas vancomycin was used \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                           MPS Pharmacy Scientific Conference 2011 \n \n\n\n\n426 \n \n\n\n\nin 13 episodes. Further data collection needs to be done to further evaluate the efficacy of antibiotic used in \n\n\n\nperitonitis. \n\n\n\n\n\n\n\nPCP \u2013 12 (000112) \n\n\n\n\n\n\n\n\n\n\n\nAwareness of Systemic Lupus Erythematosus (SLE) in Selangor \n\n\n\n\n\n\n\nShahir AS, Salmiah MA, Manan MM, Zainal FI \n\n\n\nFaculty of Pharmacy, Universiti Teknologi Mara, Selangor Malaysia \n\n\n\n\n\n\n\nSystemic lupus erythematosus (SLE), a chronic autoimmune disease that affects the body, regardless of age, \n\n\n\nrace and gender, and women of child bearing age are more prone to this disease. SLE is associated with \n\n\n\nsignificant morbidity and mortality with unknown aetiology or a cure. Early intervention is the most important \n\n\n\ntreatment as it can slow the progression of the disease. Diagnosing SLE is difficult as its symptoms imitate \n\n\n\nsymptoms of other diseases. Currently, 11,000 people were diagnosed with this disease in Malaysia and public \n\n\n\nawareness of this disease is low. A study to screen the public for SLE and awareness using SLE screening \n\n\n\nquestionnaire were administered to respondents in Selangor. In 279 respondents, (males=85 and females=194) \n\n\n\nthe overall mean score was 1.59. Respondents who gave a positive respond to 3 or more items in the \n\n\n\nquestionnaire would have a probability of having SLE and thus advised to go for further testing in hospitals to \n\n\n\nconfirm the diagnosis. The number of respondents scoring 3 or more were 56 (20%) of the total respondents. \n\n\n\nNo significance between mean score and gender, with mean score for males = 1.45 and females = 1.66. The \n\n\n\nage group above 30 years old had the highest mean score which was 2.19 and has a significance difference \n\n\n\nwhen compared to other age groups. The result shows a need for an increased awareness of SLE among the \n\n\n\npublic for earlier intervention and reduce the morbidity and mortality associated with this disease. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nPCP \u2013 13 (000116) \n\n\n\n\n\n\n\n\n\n\n\nEvaluation of Drug Free Period (DFP) of Single-Daily Dosing (SDD) of Amikacin Using Different Assay \n\n\n\nSensitivity Limits and Machines in Sarawak Hospitals \n\n\n\n\n\n\n\nLou JY\n1\n, Diana M\n\n\n\n2\n, Jane F\n\n\n\n3\n, Law KS\n\n\n\n1\n, Harry C\n\n\n\n2\n, Ab Fatah\n\n\n\n4\n \n\n\n\n1\n Pharmacy Department Sarawak General Hospital, \n\n\n\n2\n Pharmacy Department, Sibu Hospital \n\n\n\n3\n Pharmacy Department, Miri Hospital, \n\n\n\n4\n School of Pharmaceutical Sciences, University Science Malaysia \n\n\n\n\n\n\n\nDrug free period (DFP) is used in monitoring single-daily dosing of aminoglycosides.  Based on the duration \n\n\n\nof Post Antibiotic Effect (PAE) of aminoglycosides, the optimum range of DFP is within 2-8 hours.  The \n\n\n\nobjectives of the study were to assess whether patients who were on SDD of amikacin achieve optimum DFP \n\n\n\nand to compare DFP calculated based on different assay sensitivity limits.  All adult patients with SDD of \n\n\n\namikacin were included to measure drug levels at post 2- and -6 hours from Miri Hospital, Sibu Hospital and \n\n\n\nSarawak General Hospital retrospectively from January to March 2011. The time taken for the concentration \n\n\n\nto reach the sensitivity limit of the analyzer was calculated using Ct = Co x e \n\u2013kt\n\n\n\n . Ct is the sensitivity limit of \n\n\n\nmachine TDxFLx (0.8 mg/L), Siemen ViVa E (2.5 mg/L) and Cobas Intergra 400 (0.3 mg/L). DFP is the \n\n\n\ndosing interval minus the time (t).  Thirteen out of 26 patients on SDD Amikacin were selected (age ranges \n\n\n\n18-57 years), mean creatinine clearance (Clcr) of 109.5\u00b143.7ml/min and average dose 16mg/kg/day. Mean \n\n\n\nDFP for TDxFLx was 11.91\u00b13.47h, 8.8 \u00b14.39h for Cobas Integra 400 and 15.52\u00b12.76h for Siemen VivaE. \n\n\n\nDFP was 5.32\u00b15.32 h if 0.1 mg/L was used as approximation to zero concentration. If used 0.3mg/L, 53.85% \n\n\n\nachieved DFP, and none achieved targeted DFP if 2.5mg/L was used. Moreover, only 38.46% achieved \n\n\n\ntargeted DFP if used 0.1mg/L and 23.1% for 0.8mg/L. Variation of DFP from different assay sensitivity limits \n\n\n\nnecessitates a need to establish an appropriate cut-off point for DFP estimation by using population data.  \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                           MPS Pharmacy Scientific Conference 2011 \n \n\n\n\n427 \n \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nPCP \u2013 14 (000117) \n\n\n\n\n\n\n\n\n\n\n\nSelf-reported Treatment Adherence in Patients with Systemic Lupus Erythematosus Attending \n\n\n\nRheumatology Clinic in a Tertiary Care Hospital at Klang Valley \n\n\n\n\n\n\n\nN E Ismail\n1\n, H M Abd Rahman\n\n\n\n1\n, S Sockalingam\n\n\n\n2\n \n\n\n\n1\nClinical Pharmaceutics Research Group (CPRG) & Inhalational Delivery Research Unit (IDRU), Faculty of \n\n\n\nPharmacy, Universiti Teknologi MARA (UiTM), Selangor, Malaysia  \n2\nUniversity Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia \n\n\n\n\n\n\n\nTreatment adherence is a crucial component of clinical effectiveness along with disease control management \n\n\n\nin patients with systemic lupus erythematosus (SLE), a chronic multi-system autoimmune disease. However, \n\n\n\npatients\u2019 apprehension towards the side effects of their long-term medications is a recognised deterrent to \n\n\n\ntreatment adherence. This cross-sectional study determined SLE patient\u2019s adherence towards treatment \n\n\n\nregime. Post ethics approval, the new self-reported Morisky Medication Adherence Scale (MMAS) (8 items) \n\n\n\nwas randomly distributed among consented SLE patients that attending routine medical appointment at the \n\n\n\nRheumatology Clinic of University Malaya Medical Centre (UMMC) between June and October 2010. Mean \n\n\n\npatient age was 35.62 years with disease duration of 13.38 years (n = 42); 97.62% were female, 45.24% \n\n\n\nChinese, 52.38% married, 47.62% completed secondary school, 28.57% students, 97.62% never smoke and \n\n\n\ndrink, 4.76% with family history of SLE, 66.67% of affected joints, 90.48% on prednisolone, 61.90% received \n\n\n\nfree medications, 73.81% not taking complementary medicines, 64.29% aware of the drug\u2019s side effects, \n\n\n\n42.86% waited 3-4 hours to meet doctor and 80.95% never missed appointment. The mean (SD) score for the \n\n\n\nmedication adherence scale was 7.93 (\u00b1 2.78), indicating borderline of high adherence toward treatment. As \n\n\n\neach item of MMAS measured a specific medication-taking behaviour therefore it is not a determinant of \n\n\n\nadherence behaviour. Nonetheless, no gold-standard medication adherence survey exists. Obedient in \n\n\n\nattending follow-up appointment with good physician-patient relationship and continuous voluntarily \n\n\n\npsychosocial support and education from Persatuan SLE Malaysia (PSLEM) may influence the treatment \n\n\n\nadherence. \n\n\n\n\n\n\n\nPCP \u2013 15 (000130) \n\n\n\n\n\n\n\n\n\n\n\nClinical Outcomes of Paediatric Ischemic Stroke Patients Treated with Antithrombotic Therapy: A \n\n\n\nSystematic Review  \n\n\n\n\n\n\n\nKL Chin, NA Aziz \n\n\n\nDepartment of Clinical Pharmacy, Faculty of Pharmacy, Universiti Teknologi MARA, Malaysia \n\n\n\n\n\n\n\nChildhood arterial ischaemic stroke is increasingly being diagnosed and recognized. Across the globe, \n\n\n\npaediatric ischaemic stroke occurs at a rate of 2 to 3 per 100,000 children per year. Notably, interests on the \n\n\n\neffects of antithrombotic therapy on clinical outcomes in paediatric ischaemic stroke have increased in recent \n\n\n\nyears. Our main objective is to assess clinical outcomes in paediatric ischaemic stroke with the use of \n\n\n\nantithrombotics.  We also aim to evaluate major bleeding episodes with the use of antithrombotics. The \n\n\n\nPubmed, ScienceDirect and MEDLINE databases were searched from January 1980 through March 31, 2011. \n\n\n\nStudies were eligible for inclusion if they were case series; published in English; included search terms for \n\n\n\npaediatric ischaemic stroke, childhood stroke, and cerebral infarction. Reference list from these articles were \n\n\n\nhand-searched to identify additional articles. We excluded studies that reports on perinatal strokes and those \n\n\n\nthat did not report diagnosis. Seven articles fulfilled the inclusion criteria. The results showed up to 50% of \n\n\n\nthe children studied in these reports were found to have neurological deficits such as motor impairment, \n\n\n\ncognitive impairment, developmental delay, speech impairment and visual impairment. Children diagnosed \n\n\n\nwith cerebral sinovenous thrombosis are reported to have higher mortality rate compared to others. Most of \n\n\n\nthe subjects in these studies tolerated well to various antithrombotic treatment. Major bleeding episodes are \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                           MPS Pharmacy Scientific Conference 2011 \n \n\n\n\n428 \n \n\n\n\nnot commonly reported in children treated with antithrombotic agents. In conclusion, antithrombotic treatment \n\n\n\nis associated with better neurological outcomes with minimum risks of major bleeding. \n\n\n\n\n\n\n\nPCP \u2013 16 (000154) \n\n\n\n\n\n\n\n\n\n\n\nEvaluation of Complications among South Indian Post Renal Transplant Patients \n\n\n\n\n\n\n\nVenkatraghavan S\n1\n, Shabaz M\n\n\n\n1\n, Haritha N\n\n\n\n1\n, Ravindra Prabhu A\n\n\n\n2\n  \n\n\n\n1\nDepartment of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal University, \n\n\n\nManipal, India. \n2\nDepartment of Nephrology, Kasturba Medical College and Hospital, Manipal University, Manipal, India. \n\n\n\n\n\n\n\nRenal transplantation is a mainstay of therapeutic intervention in patients with End Stage Renal Disease. The \n\n\n\nmajor complications post transplantation are infection and diabetes mellitus due to immunosuppression. The \n\n\n\nobjective of the study is to evaluate the pattern of complications among the post renal transplants. From Jan \n\n\n\n2008 to Dec 2010, patient details were collected from hospital inpatients and out patient records from a \n\n\n\ntertiary care teaching hospital in South India. Of the 24 renal transplants, majority (n=21; 79.2%) were males \n\n\n\nand the median age of the patients was found to be 31.5 years (IQR 25.5-40 years). The main \n\n\n\nimmunosuppressive regimen prescribed was a combination of (Tacrolimus + Azathioprine + Prednisolone) in \n\n\n\n19 (79.2%) patients.  Complications associated with immunosuppression were infections {bacterial in 13 \n\n\n\n(54.16%), Viral in 7 (29.16%) and fungal in 8 (33.33%)}, electrolyte imbalance in 10 (41.66%), skin reactions \n\n\n\nin 8 (33.33%) and Diabetes Mellitus in 12 (50%) patients respectively. Post allograft biopsy and Renal Artery \n\n\n\nDoppler studies suggested 3 (12.5%) of patients experienced acute graft rejection and 8(33.33%) had delayed \n\n\n\ngraft rejection. The measured serum concentrations of Tacrolimus and Cyclosporine and related dose \n\n\n\nadjustments proved to have poor correlation with clinical outcome. Out of 24 cases observed 3 (12.5%) \n\n\n\nexpired due to multiple organ failure, sepsis and cardiac arrest. To conclude, the study enlightens the need for \n\n\n\ncontrolled immunosuppression to reduce complications and the role of pharmacist in building indigenous PK-\n\n\n\nPD models to achieve better clinical outcome. \n\n\n\n\n\n\n\n\n\n\n\nPCP \u2013 17 (000156) \n\n\n\n\n\n\n\n\n\n\n\nPPUKM Experience of Caffeine Use in Apnoea of Prematurity   \n\n\n\n\n\n\n\nY K Lai\n1\n, R S Ramaiyah\n\n\n\n1\n, F W Ahmad Tajuddin\n\n\n\n1\n, F N Abdul Manap\n\n\n\n1\n, N Yusuf\n\n\n\n1\n, F C Cheah\n\n\n\n2\n \n\n\n\n1\nDepartment of Pharmacy, Pusat Perubatan Universiti Kebangsaan Malaysia, Kuala Lumpur \n\n\n\n2\nDepartment of Paediatric, Pusat Perubatan Universiti Kebangsaan Malaysia, Kuala Lumpur \n\n\n\n\n\n\n\nApnoea of prematurity (AOP) affects approximately 85% of infants less than 34 weeks gestation. \n\n\n\nMethylxanthines have been the recommended pharmacological treatment with caffeine being the preferred \n\n\n\nagent. Caffeine has shown to be beneficial beyond symptomatic reduction, including the improvement of \n\n\n\nsurvival rate and reduction of bronchopulmonary dysplasia (BPD) rate. In Malaysia, caffeine is an \n\n\n\nunregistered drug and Pusat Perubatan Universiti Kebangsaan Malaysia begun using caffeine in place of \n\n\n\ntheophylline since August 2009. This study looked into the caffeine treatment regimen used and the \n\n\n\ncharacteristics of patient population on caffeine treatment. Records of subjects were reviewed and analysed. \n\n\n\nCaffeine solution of 10mg/ml was prepared extemporaneously by dissolving caffeine anhydrous powder in \n\n\n\nwater for injection. Loading dose was administered as infusion via nasogastric tube and maintenance dose as \n\n\n\nbolus. Between August 2009 and March 2010, 30 premature infants received  caffeine with a mean birth-\n\n\n\nweight of 1.34\u00b10.4 kg and gestational age of 29.6\u00b12.2 weeks. The mean loading dose used was 19.81\u00b12.18 \n\n\n\nmg and maintenance dose 5.0\u00b10 mg. More than half (n=17, 57%)  were initiated within the first 24 hours and \n\n\n\n27% before 48 hours. Majority (70%) had ceased treatment by 35 weeks gestation. Most infants receiving \n\n\n\ncaffeine were on respiratory support: 21 were ventilated (3.7\u00b14.5 days); 29 were on continuous positive \n\n\n\nairway pressure (12.4\u00b113.5 days) and 11 were on oxygen >21% (3.6\u00b13.9 days). Seven infants had patent \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                           MPS Pharmacy Scientific Conference 2011 \n \n\n\n\n429 \n \n\n\n\nductus arteriosus and two developed BPD. The use of caffeine compared to theophylline has reduced the need \n\n\n\nfor regular therapeutic drug monitoring. \n\n\n\n\n\n\n\n\n\n\n\nPCP \u2013 18 (000157) \n\n\n\n\n\n\n\n\n\n\n\nThe Use of N-Acetylcysteine in Paracetamol Poisoning in Hospital Melaka   \n\n\n\n\n\n\n\nM Z Rosdi, H M Nurul, S S Wai, S C Ku \n\n\n\nDepartment of Pharmacy, Melaka Hospital \n\n\n\n\n\n\n\nN-Acetylcysteine (NAC), an intravenous preparation, is the drug of choice in the treatment of paracetamol \n\n\n\n(PCM) poisoning. The study was conducted to assess the use of N-Acetylcysteine in the treatment of \n\n\n\nparacetamol poisoning based on the serum level of PCM and the total dose of PCM ingested. A retrospective \n\n\n\nreview of Therapeutic Drug Monitoring (TDM) form as well as patient\u2019s case note was performed for all \n\n\n\npatients that required blood monitoring for suspected toxicity of PCM from January 1, 2008, to December 31, \n\n\n\n2008. Data collected included details regarding PCM poisoning and sampling time, medication served in the \n\n\n\nward and laboratory results such as liver profile, TDM and coagulation profile. Appropriateness of NAC given \n\n\n\nwere further examined and compared with the toxic dose of PCM ingested (>150mg/kg), TDM results, and \n\n\n\ncoagulation and liver profiles. There were 100 paracetamol overdose cases that met the inclusion criteria. Of \n\n\n\nthese, based on the serum level of PCM, only 20 (20%) patients were recommended to be treated with NAC \n\n\n\nby the TDM pharmacist. However, NAC was prescribed in 39 (39%) patients and 34 of these patients \n\n\n\ncompleted the 20.25 hours course of NAC. Twenty patient were admitted with total dose of PCM ingested of \n\n\n\nmore than 150mg/kg and 15 (15%) were prescribed with NAC. Six patients with PCM level indicative of \n\n\n\ntoxicity developed raised Alanine Transferase (ALT) (p<0.05). Serum level of PCM should be the main \n\n\n\nindicator prior to the start of treatment with NAC in patients admitted to emergency department with PCM \n\n\n\noverdose. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nPCP \u2013 19 (000164) \n\n\n\n\n\n\n\n\n\n\n\nDrug Therapy Problems in Hospitalized Chronic Kidney Disease (CKD) Patients: The Influence of \n\n\n\nCKD Stages  \n\n\n\n\n\n\n\nYahaya Hassan\n1\n, Noorizan Abd Aziz\n\n\n\n1\n, Mansoor Adam\n\n\n\n2\n, Rowa AlRamahi\n\n\n\n3\n, Rozina Ghazali\n\n\n\n4\n \n\n\n\n1\nSchool of Pharmacy Practice, Universiti Teknologi MARA (UiTM), Selangor, Malaysia   \n\n\n\n2\nClinical Pharmacy Program, Universiti Sains Malaysia, Penang, Malaysia \n\n\n\n3\nAn-Najah National University, Nablus, Palaetine \n\n\n\n4\nDepartment of Medicine, Penang Hospital, Penang, Malaysia \n\n\n\n\n\n\n\nDrug therapy problems (DTP) can cause significant morbidity, mortality, and unnecessary increase in overall \n\n\n\nhealthcare costs. Therefore, there is a substantial clinical need to address this problem. The aim of this study \n\n\n\nwas to determine the appearance rates and types of DTP among chronic kidney disease (CKD) patients, and to \n\n\n\ncompare between end stage renal disease (ESRD) patients and other CKD patients. A prospective \n\n\n\nobservational study was conducted among patients with CKD who were \u226518 years and admitted to the general \n\n\n\nmedical ward of Penang Hospital (Malaysia). DTP were identified through review of patients\u2019 medical charts \n\n\n\nand patients interviews. Statistical Package for Social Science (SPSS) version 12 was used for data analysis. \n\n\n\nSix hundred and seventy five DTP were identified in 147 ESRD patients, and 409 DTP in 149 non-ESRD \n\n\n\npatients. The mean number of DTP for patients in the ESRD group (3.5\u00b11.1) was significantly higher than \n\n\n\nthat of the non-ESRD group (2.7\u00b11.6), (P<0.001). The most common DTP among the ESRD patients were: \n\n\n\nindication without drug (20.9%), improper drug selection (20.7%) and drug interactions (19.4%). Among the \n\n\n\nnon-ESRD group, the most common DTP were: indication without drug (20.3%), drug interactions (19.0%), \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                           MPS Pharmacy Scientific Conference 2011 \n \n\n\n\n430 \n \n\n\n\nand improper drug selection (18.0%). DTP occur at a high rate in CKD patients. ESRD patients are at \n\n\n\nincreased risk for DTP. Healthcare providers should be aware of this problem and efforts to avoid or resolve \n\n\n\nDTP should be undertaken.  \n\n\n\n\n\n\n\nPCP \u2013 20 (000178) \n\n\n\n\n\n\n\n\n\n\n\nPreliminary Study: The Effects of Pharmacists' Counselling on the Knowledge of Skin Preparations in \n\n\n\nChronic Skin Condition Patients   \n\n\n\n\n\n\n\nKhairunnisa Bt Ishak, Tan Jas Min, Ling Yee Fang, Tan Yee Mun, Wong Choy Shan \n\n\n\nDepartment of Pharmacy, Hospital Seri Manjung, Perak, Malaysia \n\n\n\n\n\n\n\nChronic skin condition patients depend heavily on skin preparations to improve their skin condition and \n\n\n\nquality of life. Limited counselling with regards to the use of skin preparations were given by healthcare \n\n\n\nproviders. Hence, we aim to study the effects of pharmacists\u2019 counselling on the knowledge of skin \n\n\n\npreparations among patients with chronic skin conditions. A pre and post intervention study was conducted \n\n\n\nfrom December 2010 till May 2011 at Hospital Seri Manjung. Patients who fulfilled the inclusion criteria \n\n\n\nwere given counselling on their skin preparations. Patients were given questionnaire to assess pre and post \n\n\n\ncounselling knowledge and symptoms. Paired t and Mc Nemar test were performed to analyse data where \n\n\n\nappropriate. A total of 20 patients were involved in the study. The number of skin preparations prescribed, \n\n\n\nranged from three to nine with five being the highest number. Pharmacists\u2019 counselling did improve patients\u2019 \n\n\n\nknowledge on the correct site, frequency and duration of application as well as the potency of topical \n\n\n\ncorticosteroids (p<0.05). Patients\u2019 symptoms improved after counselling. Pharmacists counselling did \n\n\n\nimprove patient\u2019s knowledge of skin preparations and disease symptoms.  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nPCP \u2013 21 (000181) \n\n\n\n\n\n\n\n\n\n\n\nOutcome of Pharmacist Run Medication Therapy Adherence Clinic (MTAC) on Insulin and Drug \n\n\n\nRelated Problems of Type 2 Diabetes Patients  \n\n\n\n\n\n\n\nLoganadan NK, Lim KY, Kan MY, Mohd Nur N, Ariffin F \n\n\n\nPharmacy Department, Hospital Kuala Lumpur, Kuala Lumpur \n\n\n\n\n\n\n\nInsulin and drug related problems of Type 2 diabetes patients left unaddressed would be a major hindrance to \n\n\n\nthe achievement of target goals. The study was to document the incidence and types of insulin and drug \n\n\n\nrelated problems of Type 2 diabetes patients, to assess the outcome of pharmacist-run Medication Therapy \n\n\n\nAdherence Clinic (MTAC) on the insulin and drug related problems and to document the time taken to resolve \n\n\n\nthe detected insulin and drug related problems. A prospective cohort study using convenience sampling was \n\n\n\nconducted from February 2008 to June 2011 at the MTAC of Pharmacy Department of Hospital Kuala \n\n\n\nLumpur. Insulin and drug related problems of Type 2 diabetes patients who visited the MTAC on a monthly \n\n\n\ninterval were detected, documented and given appropriate recommendations by pharmacists. The number of \n\n\n\npharmacist visits taken for the problems to resolve was also documented. A total of 317 insulin and drug \n\n\n\nrelated problems were detected by the pharmacists in MTAC throughout the follow-up period of which \n\n\n\ncompliance problems (43.9%) were the main problem, followed by insulin injection problems (27.4%) and \n\n\n\nhypoglycemia (17.0%). Pharmacists' recommendations managed to significantly resolve (p<0.05) a majority \n\n\n\nof 248 problems (78.2%) compared to 69 unresolved problems (21.8%). Most of the problems were resolved \n\n\n\nafter more than three visits with the pharmacist (47.2%), followed by two visits (27.8%) and one visit \n\n\n\n(19.4%). In conclusion, pharmacists have managed to detect and reduce many persisting medication related \n\n\n\nproblems of Type 2 diabetes patients thus helping them to better achieve their target goals. \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n"
"\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n246 \n\n\n\nSerum Trace Elements and Immunoglobulin Profile in Lung \n\n\n\nCancer Patients \n\n\n\n \nA F M Nazmus Sadat\n\n\n\n1\n, Md. Iqbal Hossain\n\n\n\n2\n, Md.  Khalid Hossain\n\n\n\n3\n, Md. Selim \n\n\n\nReza\n4\n, Zabun Nahar\n\n\n\n2\n, Md. Nazrul Islam Khan\n\n\n\n5\n, SK. Nazrul Islam\n\n\n\n5\n, and \n\n\n\nAbul Hasnat\n2* \n\n\n\n \n1\nDepartment of Pharmacy, The University of Asia Pacific, Dhaka-1000, \n\n\n\nBangladesh. \n2\nDepartment of Clinical Pharmacy and Pharmacology, Faculty of \n\n\n\nPharmacy, University of Dhaka. Dhaka-1000, Bangladesh. \n3\nDepartment of \n\n\n\nPharmaceutical Chemistry, Faculty of Pharmacy, University of Dhaka. Dhaka-\n\n\n\n1000, Bangladesh. \n4\nAhsania Mission Cancer Hospital, Dhaka, Bangladesh. \n\n\n\n5\nInstitute of Nutrition and Food Science, University of Dhaka. Dhaka-1000, \n\n\n\nBangladesh. \n\n\n\n*Corresponding author \n\n\n\nMalaysian Journal of Pharmacy 2008: 1( 6): 246 -255                                               \n\n\n\n\n\n\n\nAbstract \n\n\n\nThe aim of this study was to determine the serum concentrations of trace \n\n\n\nelements (Zn, Cu, Mn, Pb) and immunoglobulins (IgG, IgA & IgM) in lung \n\n\n\ncancer patients. The study was conducted among 45 lung cancer patients and 50 \n\n\n\nage and gender-matched healthy volunteers. Flame atomic absorption \n\n\n\nspectroscopy method was employed to analyze the serum trace element \n\n\n\nconcentrations, and turbidimetry method using immunoglobulin kit was used for \n\n\n\nthe estimation of serum immunoglobulin levels. Results showed that the majority \n\n\n\nof the patients were literate and older married patients were smokers.  Compared \n\n\n\nto the control volunteers, they had significantly (P<0.05) lower BMI.  Serum \n\n\n\nconcentrations of trace elements and IgG were found to be significantly (p<0.05) \n\n\n\nlower in the lung cancer patients.  In the cancer patients, the concentration of \n\n\n\nzinc, copper, manganese and lead were 0.028\u00b10.007 mg/L, 0.029\u00b10.027 mg/L, \n\n\n\n0.011\u00b10.15 mg/L and 0.053\u00b10.049 mg/L respectively, while these were \n\n\n\n1.14\u00b10.27 mg/L, 1.15\u00b11.09 mg/L, 0.44\u00b10.59 mg/L and 2.209\u00b11.885 mg/L, \n\n\n\nrespectively in the healthy controls. IgG concentration was found to be \n\n\n\n14.96\u00b13.92 g/L in lung cancer patients and 20.56\u00b18.02 g/L in healthy volunteers. \n\n\n\nThe concentrations of serum IgA and IgM were found to be unchanged. \n\n\n\nCorrelative analysis suggested that serum lead value had a significant correlation \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n247 \n\n\n\nwith age in the lung cancer patient (r \u2550 \u20130.369, p \u2550 0.013). The decreased \n\n\n\nconcentration of trace elements and IgG may have a prognostic significance for \n\n\n\nthe detection of lung cancer. \n\n\n\n\n\n\n\nKey words: lung cancer, trace elements, immunoglobulin  \n\n\n\n\n\n\n\nIntroduction \n\n\n\n\n\n\n\nLung cancer is the most common \n\n\n\nmalignancy in the world. Its overall \n\n\n\n5-year survival rate is only 14% (1), \n\n\n\nand it has not changed substantially \n\n\n\nover the past two decades (2) The \n\n\n\nglobal incidence of lung cancer is \n\n\n\nincreasing with time. When \n\n\n\nadvanced, these tumors are difficult \n\n\n\nto treat, and existing therapies often \n\n\n\ndo not offer long-term disease \n\n\n\ncontrol. The poor prognosis is \n\n\n\nlargely due to lack of sufficient \n\n\n\nscreening and early diagnostic tools \n\n\n\nto physicians. Currently the \n\n\n\nscreening and early diagnosis of \n\n\n\nlung cancer relies mainly on chest \n\n\n\nX-ray, low-dose computed \n\n\n\ntomography, bronchoscopy, sputum \n\n\n\ncytology, and tumor markers \n\n\n\nincluding carcinoembryonic antigen \n\n\n\n(CEA), cytokeratin-19 fragments \n\n\n\n(Cyfra21-1), carbohydrate antigen \n\n\n\n19-9 (CA19-9), squamous cell \n\n\n\ncarcinoma antigen (SCCAg) and \n\n\n\nneuron-specific enolase (NSE), etc. \n\n\n\n(3). All these methods, however, \n\n\n\nlack adequate sensitivity and/or \n\n\n\nspecificity (4-7). Thus, there is an \n\n\n\nurgent need to search for more \n\n\n\nspecific methods that would provide \n\n\n\nmore specific information for \n\n\n\nscreening and early diagnosis of \n\n\n\nlung cancer. Because of the marked \n\n\n\nheterogeneity of lung cancer (7), a \n\n\n\npanel of biomarkers for screening \n\n\n\nand diagnosis would be most \n\n\n\nappropriate.  Kinetic turbidimetric \n\n\n\nmethod for the immunochemical \n\n\n\nquantification of immunoglobulins, \n\n\n\nan innovative turbidimetry  \n\n\n\n\n\n\n\ntechnology introduced by Skoug JW \n\n\n\n& Pardue HL in 1988 (8) has a new \n\n\n\nway to overcome many of the \n\n\n\nlimitations of the above procedures \n\n\n\n(9-10).  \n\n\n\n\n\n\n\nSince it is recognized that patients \n\n\n\nwith lung cancer have defective \n\n\n\nimmune responses       (11-12), \n\n\n\ndifferent factors may contribute for \n\n\n\nthe development of lung cancer. \n\n\n\nHowever, three-dimensional active \n\n\n\nconformation of some proteins \n\n\n\nnamely thymidylate synthetase, \n\n\n\ndihydrofolate reductase, p53, p16, \n\n\n\nK-ras etc. are very important. Some \n\n\n\nmetal ions act as a vital role to form \n\n\n\nthe three dimensional protein \n\n\n\nstructure (13). So conversion of \n\n\n\nactive to inactive or inactive to \n\n\n\nactive conformation of proteins may \n\n\n\ndepend on some particular trace \n\n\n\nelements. Trace elements at \n\n\n\noptimum levels are required for \n\n\n\nnumerous metabolic and \n\n\n\nphysiological processes in the \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n248 \n\n\n\nhuman body (14). They play a part \n\n\n\nin the synthesis and structural \n\n\n\nstabilization of both proteins and \n\n\n\nnucleic acids. Therefore, imbalances \n\n\n\nin the optimum levels of these trace \n\n\n\nelements may adversely affect \n\n\n\nbiological processes, and are \n\n\n\nassociated with many diseases, such \n\n\n\nas cancer (15). Lacking or imbalance \n\n\n\nof these trace elements may cause \n\n\n\nlung cancer.  In view of these above \n\n\n\ninvestigations, the present study was \n\n\n\ndesigned to investigate the \n\n\n\napplication of serum \n\n\n\nimmunoglobulin profiling to \n\n\n\ndistinguish lung cancer patients from \n\n\n\na healthy population, and to \n\n\n\ndetermine the relationship of trace \n\n\n\nelements and immunoglobulins \n\n\n\nlevels in lung cancer patients with \n\n\n\ntheir nutritional status and socio-\n\n\n\neconomic factors.  \n \n\n\n\nMaterials and methods \n\n\n\n\n\n\n\nStudy subjects  \n\n\n\nForty-five lung cancer patients \n\n\n\ncomprising 25 males and 20 females \n\n\n\nwere randomly recruited from \n\n\n\nAhsania Mission Cancer Hospital, \n\n\n\nDhaka Medical College Hospital, \n\n\n\nHoly Family Red Cresent Hospital \n\n\n\nand Bangabandu Sheikh Mujib \n\n\n\nMedical University, Dhaka. Fifty \n\n\n\nhealthy volunteers comprising 25 \n\n\n\nmales and 25 females were recruited \n\n\n\npurposively as control. Regarding \n\n\n\npatients, both small cell lung cancer \n\n\n\n(SCLC) and non-small cell lung \n\n\n\ncancer patients were identified as \n\n\n\nlung cancer patients. The study \n\n\n\nsubjects were briefed about the \n\n\n\npurpose of the study and written \n\n\n\nconsent was taken from each of \n\n\n\nthem. Ethical approval was obtained \n\n\n\nfrom the Bangladesh Medical \n\n\n\nResearch Council (BMRC).  \n\n\n\n\n\n\n\nSocio-economic and smoking \n\n\n\ninformation were collected in a \n\n\n\nquestionnaire. A routine physical \n\n\n\ncheck up such as organ activity, \n\n\n\nweight, nutritional condition, blood \n\n\n\npressure was given to all of the \n\n\n\npatients by an oncologist. Socio-\n\n\n\neconomic information was recorded \n\n\n\nat the time of admission into the \n\n\n\nhospital. Anthropometric data \n\n\n\n(height and weight) and information \n\n\n\non smoking habit were collected \n\n\n\nduring hospitalization under the \n\n\n\ndirect supervision of a lung cancer \n\n\n\nspecialist.  \n\n\n\n\n\n\n\nBlood analysis \n\n\n\nA 5ml venous blood sample was \n\n\n\ncollected from the antecubital vein \n\n\n\nof each of the lung cancer patients \n\n\n\nand healthy volunteers in a sterile \n\n\n\ntube.  The blood was then allowed to \n\n\n\nclot and centrifuged for 15 min at \n\n\n\n3000 rpm to extract the serum. The \n\n\n\nserum was aliquoted   into eppendorf \n\n\n\ntubes and stored at \uf02d80\u00b0 C for \n\n\n\nanalysis of trace elements and \n\n\n\nimmunoglobulins. \n\n\n\n\n\n\n\nAnalysis of trace elements  \n\n\n\nThe trace elements (Zn, Cu, Mn, Pb) \n\n\n\nlevels in both patients and controls \n\n\n\nwere determined by using flame \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n249 \n\n\n\natomic absorption spectrometry \n\n\n\n(Varian SpectraAA 220) according \n\n\n\nto the method of Falchuk Kh et. al. \n\n\n\n1990 (16). Samples were diluted by \n\n\n\ndeionized water by a factor of 40.  \n\n\n\n\n\n\n\nImmunoglobulin profiling \n\n\n\nThe serum immunoglobulin (IgG, \n\n\n\nIgA and IgM) levels in both patients \n\n\n\nand controls were determined by \n\n\n\nturbidimetry method using \n\n\n\nimmunoglobulin kit (Chronolab, \n\n\n\nSwitzerland). In this method anti-\n\n\n\nhuman antibodies were mixed with \n\n\n\nsamples containing IgG, IgA and \n\n\n\nIgM that formed insoluble antigen-\n\n\n\nantibody complexes. These \n\n\n\ncomplexes caused an absorbance \n\n\n\nchange depending upon the \n\n\n\nimmunoglobulin concentration that \n\n\n\nwas quantified by a calibrator. The \n\n\n\nserum was diluted with saline (1:4), \n\n\n\nand 10 \u00b5l of the diluted serum was \n\n\n\npipetted into microtitre plate. \n\n\n\nSeparate microtitre plate was used \n\n\n\nfor each of the immunoglobulins \n\n\n\n(IgG, IgM and IgA). Five (5) \u00b5l, 10 \n\n\n\n\u00b5l, 25 \u00b5l, 50 \u00b5l and 75 \u00b5l calibrator \n\n\n\nprotein were pipetted into marked \n\n\n\nwells of each of the microtitre plate \n\n\n\nfor calibration. 230 \u00b5l of tris-buffer \n\n\n\nwas then added into each serum-\n\n\n\ncontaining well of the three plates. \n\n\n\nTen (10) \u00b5l of tris-buffer was added \n\n\n\nto calibrator containing wells to \n\n\n\nmake total volume 240 \u00b5l. The plate \n\n\n\ncontent was mixed well with the \n\n\n\nhelp of a vortex mixer. The diluted \n\n\n\nrespective anti-human IgG, IgM and \n\n\n\nIgA (1:1 diluted with saline) were \n\n\n\nadded to the wells of respective \n\n\n\nmicrotitre plates. The plates were \n\n\n\nincubated for 2 minutes (as specified \n\n\n\nin the kit procedure) to allow \n\n\n\ncomplete reaction of anti-human \n\n\n\nimmunoglobulin with the test serum \n\n\n\nand calibrator protein. After proper \n\n\n\nmixing, absorbance was taken at 550 \n\n\n\nnm for IgG and IgA and at 405 nm \n\n\n\nfor IgM.  \n\n\n\nStatistical Analysis  \n\n\n\nSPSS software package (Version \n\n\n\n11.5, SPSS Inc. Chicago, USA) was \n\n\n\nused to analyze the data. Descriptive \n\n\n\nstatistics were used for all variables.  \n\n\n\nValues were expressed as \n\n\n\npercentage, mean and standard \n\n\n\ndeviation. Comparison of trace \n\n\n\nelements and immunoglobulins of \n\n\n\nlung cancer patients and controls \n\n\n\nwere performed by cross-table \n\n\n\nvariables and independent sample t-\n\n\n\ntest. Correlative analysis was \n\n\n\nperformed to find correlation of BMI \n\n\n\nand socio-economic factors on the \n\n\n\nserum trace element and \n\n\n\nimmunoglobulin concentrations. \n\n\n\n\n\n\n\nResults \n\n\n\nTable 1 shows the socio-economic \n\n\n\ninformation of the lung cancer \n\n\n\npatients and control subjects. It was \n\n\n\nshown that the majority of lung \n\n\n\ncancer patients were literate (56%) \n\n\n\nwith various professions having \n\n\n\nmonthly income 109.53\u00b170.44 US$, \n\n\n\naverage age 52.33\uf0b112.03 years and \n\n\n\n78% were found to be married. The \n\n\n\nmean BMI of patients was \n\n\n\n19.79\uf0b12.58, which was significantly \n\n\n\n(p<0.05) lower than that of the \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n250 \n\n\n\ncontrol subjects (25.53\uf0b14.54).  The \n\n\n\nvast majority (84%) of the patients \n\n\n\nwere smokers. \n\n\n\n\n\n\n\nTable 1: Socio-demographic status and chronic energy deficiency data \n\n\n\n(CED) of Lung cancer controls (n=50) and patients (n=45) \n\n\n\n\n\n\n\n Patients Controls \n\n\n\nParameter n % Mean\u00b1SD n % Mean\u00b1SD \n\n\n\n   Education       \n\n\n\n           Illiterate 20 44.44 \n\n\n\n\n\n\n\n18 36 \n\n\n\n \n           Secondary (vi-x class) 12 26.67 9 18 \n\n\n\n           Higher secondary 8 17.78 15 30 \n\n\n\nGraduate and above 5 11.11 8 16 \n\n\n\n   Occupation       \n\n\n\n            Service 15 33.33 \n\n\n\n\n\n\n\n16 32 \n\n\n\n             Small business 18 40 22 44 \n\n\n\n            House wife 12 26.67 12 24 \n\n\n\n  Monthly income in US $       \n\n\n\n            0-50 14 31.11 \n\n\n\n109.53\u00b170.44 \n\n\n\n12 24 \n\n\n\n97.53\u00b160.62 \n\n\n\n            51-100 16 35.56 14 28 \n\n\n\n            101-150 6 13.33 9 18 \n\n\n\n            151-200 6 13.33 8 16 \n\n\n\n            201-300 3 6.67 7 14 \n\n\n\n   Age in years       \n\n\n\n            25-40 13 28.89 \n\n\n\n52.33\u00b112.03 \n\n\n\n15 30 \n\n\n\n52.86\u00b113.21 \n            41-50 12 26.67 12 24 \n\n\n\n            51-60 14 31.11 15 30 \n\n\n\n            61-80 6 13.33 8 16 \n\n\n\nSmoking Behavior        \n\n\n\n            Non Smoker 5 11.11 \n\n\n\n\n\n\n\n8 16 \n\n\n\n            Partial Smoker 22 48.89 24 48 \n\n\n\n           Habituate  18 40 18 36 \n\n\n\n  Marital status   \n\n\n\n\n\n\n\n\n\n\n\n             Married 35 77.78 35 70 \n\n\n\n           Unmarried 10 22.22 15 30 \n\n\n\n   BMI       \n\n\n\n          15.5-18.4 (CED) 13 28.89 \n\n\n\n19.79\u00b12.58 \n\n\n\n4 8  \n\n\n\n25.53\u00b14.54 \n\n\n\n\n\n\n\n          18.5-25.0 (Normal) 30 66.67 19 38 \n\n\n\n         > 25.0 (Obese) 2 4.44 27 54 \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n251 \n\n\n\nSerum trace element levels are \n\n\n\npresented in the table 2.  It was \n\n\n\nshown that compared to the control \n\n\n\nsubjects, serum concentrations of \n\n\n\ntrace elements were found to be \n\n\n\nsignificantly (p<0.05) lower in the \n\n\n\nlung cancer patients.  The \n\n\n\nconcentration of zinc, copper, \n\n\n\nmanganese and lead were \n\n\n\n0.028\u00b10.007 mg/L, 0.029\u00b10.027 \n\n\n\nmg/L, 0.011\u00b10.15 mg/L and \n\n\n\n0.053\u00b10.049 mg/L in the lung cancer \n\n\n\npatients respectively, while these \n\n\n\nvalues were 1.14\u00b10.27 mg/L, \n\n\n\n1.15\u00b11.09 mg/L, 0.44\u00b10.59 mg/L \n\n\n\nand 2.209\u00b11.885 mg/L, respectively \n\n\n\nin the healthy controls. Serum IgG, \n\n\n\nIgA and IgM concentrations of lung \n\n\n\ncancer patients were 14.96\u00b13.92 g/L, \n\n\n\n5.06\u00b11.88 g/L and 5.33\u00b12.24 g/L, \n\n\n\nwhich were 20.56\u00b18.02 g/L, \n\n\n\n4.50\u00b11.40 g/L and 4.49\u00b12.44 g/L in \n\n\n\ncontrol subjects respectively (table \n\n\n\n3).  It was indicated that there was a \n\n\n\ngeneral trend of lowering of serum \n\n\n\nimmunoglobulin IgG level in lung \n\n\n\ncancer patients. Serum IgG \n\n\n\nconcentration was decreased \n\n\n\nsignificantly (p=0.021) in lung \n\n\n\ncancer patients.  The concentration \n\n\n\nof IgA and IgM were not changed \n\n\n\nsignificantly (P>0.05).  \n\n\n\n\n\n\n\nTable 2: Serum trace elements levels of lung cancer patients (n=45) and \n\n\n\nhealthy controls (n=50). \n\n\n\n\n\n\n\n\n\n\n\nTrace elements \n\n\n\n(mg/L) \n\n\n\nPatients Controls \n\n\n\np- value \nn % Mean \u00b1SD n % Mean \u00b1SD \n\n\n\nZn \n\n\n\n\n\n\n\n<0.03 \n\n\n\n0.03-1 \n\n\n\n> 1 \n\n\n\n32 \n\n\n\n13 \n\n\n\n\n\n\n\n71 \n\n\n\n29 \n\n\n\n\n\n\n\n0.028\u00b10.007 \n\n\n\n\n\n\n\n18 \n\n\n\n32 \n\n\n\n\n\n\n\n36 \n\n\n\n64 \n\n\n\n1.14\u00b10.27 \nP= \n\n\n\n0.000 \n\n\n\nCu \n\n\n\n\n\n\n\n<0.03 l \n\n\n\n0.03-1 \n\n\n\n> 1 \n\n\n\n\n\n\n\n27 \n\n\n\n18 \n\n\n\n\n\n\n\n\n\n\n\n60 \n\n\n\n40 \n\n\n\n\n\n\n\n\n\n\n\n0.029\u00b10.027 \n\n\n\n\n\n\n\n13 \n\n\n\n11 \n\n\n\n26 \n\n\n\n\n\n\n\n26 \n\n\n\n22 \n\n\n\n52 \n\n\n\n\n\n\n\n1.15\u00b11.09 \n\n\n\n\n\n\n\nP= \n\n\n\n0.000 \n\n\n\nMn \n\n\n\n\n\n\n\n<0.03 \n\n\n\n0.03-1 \n\n\n\n> 1 \n\n\n\n39 \n\n\n\n6 \n\n\n\n86.67 \n\n\n\n13.33 \n\n\n\n\n\n\n\n0.011\u00b10.15 \n\n\n\n\n\n\n\n24 \n\n\n\n13 \n\n\n\n13 \n\n\n\n\n\n\n\n48 \n\n\n\n26 \n\n\n\n26 \n\n\n\n\n\n\n\n0.44\u00b10.59 \n\n\n\n\n\n\n\nP= \n\n\n\n0.000 \n\n\n\n\n\n\n\nPb \n\n\n\n\n\n\n\n\n\n\n\n< 0.1 \n\n\n\n0.1-3 \n\n\n\n> 3 \n\n\n\n\n\n\n\n42 \n\n\n\n3 \n\n\n\n\n\n\n\n93.33 \n\n\n\n6.67 \n\n\n\n\n\n\n\n\n\n\n\n0.053\u00b10.049 \n\n\n\n\n\n\n\n10 \n\n\n\n23 \n\n\n\n17 \n\n\n\n20 \n\n\n\n46 \n\n\n\n34 \n\n\n\n\n\n\n\n2.209\u00b11.885 \n\n\n\n\n\n\n\n\n\n\n\nP= \n\n\n\n0.000 \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n252 \n\n\n\nTable 3: Serum immunoglobulins levels of lung cancer patients (n=45) and \n\n\n\nhealthy controls (n=50). \n\n\n\n\n\n\n\n\n\n\n\nImmunoglobulins \n\n\n\n(g/L) \n\n\n\nPatients Controls \np-value \n\n\n\n n % Mean \u00b1SD n % Mean \u00b1SD \n\n\n\n\n\n\n\nIgG \n\n\n\n\n\n\n\n<15  \n\n\n\n16-20  \n\n\n\n> 20  \n\n\n\n\n\n\n\n8 \n\n\n\n17 \n\n\n\n20 \n\n\n\n\n\n\n\n18 \n\n\n\n38 \n\n\n\n44 \n\n\n\n\n\n\n\n\n\n\n\n14.96\u00b13.92 \n\n\n\n\n\n\n\n11 \n\n\n\n18 \n\n\n\n21 \n\n\n\n\n\n\n\n22 \n\n\n\n36 \n\n\n\n42 \n\n\n\n\n\n\n\n\n\n\n\n20.56\u00b18.02 \n\n\n\n\n\n\n\n\n\n\n\nP= 0.021 \n\n\n\n\n\n\n\nIgA \n\n\n\n\n\n\n\n2-4  \n\n\n\n5-6  \n\n\n\n>6  \n\n\n\n\n\n\n\n6 \n\n\n\n30 \n\n\n\n9 \n\n\n\n\n\n\n\n13 \n\n\n\n67 \n\n\n\n20 \n\n\n\n\n\n\n\n\n\n\n\n5.06\u00b11.88 \n\n\n\n\n\n\n\n8 \n\n\n\n31 \n\n\n\n11 \n\n\n\n\n\n\n\n16 \n\n\n\n62 \n\n\n\n22 \n\n\n\n\n\n\n\n\n\n\n\n4.50\u00b11.40 \n\n\n\n\n\n\n\n\n\n\n\nP= 0.265 \n\n\n\n\n\n\n\nIgM \n\n\n\n\n\n\n\n<3  \n\n\n\n3-5  \n\n\n\n> 5  \n\n\n\n\n\n\n\n14 \n\n\n\n23 \n\n\n\n8 \n\n\n\n\n\n\n\n\n\n\n\n31 \n\n\n\n51 \n\n\n\n18 \n\n\n\n\n\n\n\n\n\n\n\n5.33\u00b12.24 \n\n\n\n\n\n\n\n19 \n\n\n\n22 \n\n\n\n9 \n\n\n\n\n\n\n\n38 \n\n\n\n44 \n\n\n\n18 \n\n\n\n\n\n\n\n\n\n\n\n4.49\u00b12.44 \n\n\n\n\n\n\n\n\n\n\n\nP= 0.762 \n\n\n\n\n\n\n\n\n\n\n\nCorrelation of serum trace elements \n\n\n\nand immunoglobulins in lung cancer \n\n\n\npatients with their socio-economic \n\n\n\nfactors are presented in table 4. Only \n\n\n\nserum lead concentration of the \n\n\n\npatients was found to be influenced \n\n\n\nwith the age of patients; in fact \n\n\n\nconcentration of lead is negatively \n\n\n\ncorrelated with the age of cancer \n\n\n\npatients. There was no correlation \n\n\n\nbetween other parameters.   \n\n\n\n\n\n\n\nTable 4. Correlation between different parameters in lung cancer patients (n \n\n\n\n= 45). \n \n\n\n\n  Pb Zn Mn Cu IgG IgM IgA \n\n\n\nBMI \n\n\n\n(kg/m\n2\n) \n\n\n\nr 0.013 0.019 0.048 0.106 0.024 0.055 -0.032 \n\n\n\n p 0.931 0.900 .752 0.490 0.877 0.720 0.836 \n\n\n\nIncome r 0.021 -0.009 -0.023 -0.156 -0.073 -0.247 -0.082 \n\n\n\n p 0.892 0.955 0.881 0.308 0.635 0.102 0.594 \n\n\n\nAge r -0.369 0.134 0.203 -0.166 0.261 0.192 0.045 \n\n\n\n p 0.013 0.380 0.181 0.275 0.083 0.207 0.767 \n \nr= Pearson Correlation \np= Significance (2-tailed) \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n253 \n\n\n\nDiscussion \n\n\n\n\n\n\n\nSerum trace elements level is used as \n\n\n\ndiagnostic tool in cancer (17). \n\n\n\nAnalysis of serum trace elements \n\n\n\nindicated a significant decrease in \n\n\n\nconcentration of zinc, copper, \n\n\n\nmanganese and lead.  Previous \n\n\n\nreports also found a decreased serum \n\n\n\nZn level in lung cancer patients \n\n\n\ncompared to controls, which is \n\n\n\nconsistent with our present findings \n\n\n\nbut some other reports also \n\n\n\nsuggested a significant increase in \n\n\n\nserum Cu level in lung cancer \n\n\n\npatients which is contradictory with \n\n\n\nour findings. (18-20). Trace \n\n\n\nelements play an important role in \n\n\n\nmaintaining three dimensional \n\n\n\nstructure of some proteins such as \n\n\n\nthymidylate synthetase, \n\n\n\ndihydrofolate reductase, p53, p16, \n\n\n\nK-ras etc. (13). So it may be \n\n\n\nsuggested that the decreased trace \n\n\n\nelements in the cancer patients may \n\n\n\nbe because of the deformed protein \n\n\n\nstructure. It is further noted that the \n\n\n\ndeficiency of trace elements like \n\n\n\nzinc, selenium might be risk factors \n\n\n\nfor the development of some cancers \n\n\n\n(21).  \n\n\n\nCirculating immune complexes are \n\n\n\ndetectable in the patients with \n\n\n\ncarcinomas of the head and neck, \n\n\n\nstomach, rectum, external genitals, \n\n\n\nlungs, with Hodgkin's disease, and \n\n\n\nmelanomas (22). Immunoglobulin \n\n\n\nlevels are abnormal in all the \n\n\n\naforementioned conditions. In \n\n\n\npulmonary carcinoma, cancer of the \n\n\n\nhead and neck, and Hodgkin's  \n\n\n\n\n\n\n\n\n\n\n\ndisease the concentrations of \n\n\n\nimmune complexes and IgG \n\n\n\ncorrelate (22). Serum \n\n\n\nimmunoglobulin analysis indicated \n\n\n\nthat the concentration of IgG was \n\n\n\ndecreased significantly in the lung \n\n\n\ncancer patients. Viramontes L, et. al. \n\n\n\n1989 (23) found decreased IgA \n\n\n\nconcentration in lung cancer \n\n\n\npatients, which is contradictory with \n\n\n\nour findings. Previous study also \n\n\n\nsuggested defective immune activity \n\n\n\nin cancer patients (11-12). Some \n\n\n\ninvestigators reported a positive \n\n\n\ncorrelation between the extent of \n\n\n\nmetastatic breast cancer and the \n\n\n\nserum level of various \n\n\n\nimmunoglobulins (24), particularly \n\n\n\nIgA.   \n\n\n\n\n\n\n\nConclusion. \n\n\n\nFrom socio-demographic data it was \n\n\n\nfound that the mean BMI of lung \n\n\n\ncancer patients was significantly \n\n\n\n(p<0.000) lower than that of the \n\n\n\ncontrol subjects, which is well \n\n\n\npredicted. Correlative analysis \n\n\n\nsuggested a significant correlation \n\n\n\nbetween serum lead value and age of \n\n\n\nthe patients. \n\n\n\n\n\n\n\n\n\n\n\nReferences: \n\n\n\n1. Spira A & Ettinger DS. \n\n\n\nMultidisciplinary management of \n\n\n\nlung cancer. N Engl J Med 2004. \n\n\n\n350:379\u2013392. \n\n\n\n2. Mitchell H & Megraud F. \n\n\n\nEpidemiology and diagnosis of \n\n\n\n\nhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&itool=pubmed_Abstract&term=%22Viramontes+L%22%5BAuthor%5D\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n254 \n\n\n\nHelicobacter pylori infection. \n\n\n\nHelicobacter  2002. 7(Suppl 1): \n\n\n\n8-16. \n\n\n\n3. Stieber P, Aronsson AC & Bialk \n\n\n\nP. Tumor markers in lung \n\n\n\ncancer: EGTM \n\n\n\nrecommendations. Anticancer \n\n\n\nRes 1999. 19:2817\u20132819. \n\n\n\n4. Lam S, Kennedy T, Unger M, \n\n\n\nMiller YE, Gelmont D, Rusch V, \n\n\n\nGipe B, Howard D, LeRiche JC, \n\n\n\nColdman A & Gazdar AF. \n\n\n\nLocalization of bronchial \n\n\n\nintraepithelial neoplastic lesions \n\n\n\nby fluorescence bronchoscopy. \n\n\n\nChest  1998. 113:696\u2013702. \n\n\n\n5. Kulpa J, Wojcik E, Reinfuss M \n\n\n\n& Kolodziejski L. \n\n\n\nCarcinoembryonic antigen, \n\n\n\nsquamous cell carcinoma \n\n\n\nantigen, CYFRA21-1, and \n\n\n\nneuro-specific enolase in \n\n\n\nsquamous cell lung cancer \n\n\n\npatients. Clin Chem 2002. \n\n\n\n48:1931\u20131937. \n\n\n\n6. Swensen SJ, Jett JR, Hartman \n\n\n\nTE, Midthun DE, Sloan JA, \n\n\n\nSykes AM, Aughenbaugh GL & \n\n\n\nClemens MA. Lung cancer \n\n\n\nscreening with CT: Mayo clinic \n\n\n\nexperience. Radiology 2003. \n\n\n\n226:756\u2013761.  \n\n\n\n7. Zhong L, Peng X, Hidalgo GE, \n\n\n\nDoherty DE, Stromberg AJ & \n\n\n\nHirschowitz EA. Identification \n\n\n\nof circulating antibodies to \n\n\n\ntumor-associated proteins for \n\n\n\ncombined use as markers of non-\n\n\n\nsmall cell lung cancer. \n\n\n\nProteomics 2004. 4:1216\u20131225. \n\n\n\n8. Skoug JW & Pardue HL. Kinetic \n\n\n\nturbidimetric method for the \n\n\n\nimmunochemical quantification \n\n\n\nof immunoglobulins, including \n\n\n\nsamples with excess antigen. \n\n\n\nClin Chem 1988. 34(2): 309-15. \n\n\n\n9. Rosty C, Christa L, Kuzdzal S, \n\n\n\nBaldwin WM, Zahurak ML, \n\n\n\nCarnot F, Chan DW, Canto M, \n\n\n\nLillemoe KD, Cameron JL, Yeo \n\n\n\nCJ, Hruban RH & Goggins M. \n\n\n\nIdentification of \n\n\n\nhepatocarcinoma-intestine-\n\n\n\npancreas/pancreatitis \u2013 \n\n\n\nassociated protein I as a \n\n\n\nbiomarker for pancreatic ductal \n\n\n\nadenocarcinoma by protein \n\n\n\nbiochip technology. Cancer Res \n\n\n\n2002. 62:1868\u20131875. \n\n\n\n10. Wadsworth JT, Somers KD, \n\n\n\nCazares LH, Malik G, Adam BL, \n\n\n\nStack BC Jr, Wright GL Jr, & \n\n\n\nSemmes OJ. Serum protein \n\n\n\nprofiles to identify head and \n\n\n\nneck cancer. Clin Cancer Res. \n\n\n\n2004. 10:1625\u20131632. \n\n\n\n11. Cohen H. Peptic ulcer and \n\n\n\nHelicobacter pylori. \n\n\n\nGastroenterol Clin North Am \n\n\n\n2000. 29: 775-789. \n\n\n\n12. Cave DR. Chronic gastritis and \n\n\n\nHelicobacter pylori. Semin \n\n\n\nGastrointestinal Dis 2001. 12: \n\n\n\n196-202. \n\n\n\n13. Martz E. Protein Explorer: Easy \n\n\n\nYet Powerful Macromolecular \n\n\n\nVisualization, Trends in \n\n\n\nBiochemical Sciences 2002. 107-\n\n\n\n109. \n\n\n\n14. Mertz W. The essential trace \n\n\n\nelements, Science 1981. 213: \n\n\n\n1332-1338. \n\n\n\n15. Muralidhar LH et al. Serum trace \n\n\n\nelement levels and the \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n255 \n\n\n\ncomplexity of inter-element \n\n\n\nrelations in patients with \n\n\n\nParkinson disease. J Trace Elem \n\n\n\nin Med  Biol 2004. 18:163-171. \n\n\n\n16. Falchuk Kh et al. Aqueous \n\n\n\nhoumour and serum zinc and \n\n\n\ncopper concentrations of patients \n\n\n\nwith flaucoma and cataract. Br J \n\n\n\nOphthalmol 1990. 74: 661-662.  \n\n\n\n17. Kuo HW, Chen SF, Wu CC, \n\n\n\nChen DR & Lee JH. Serum and \n\n\n\ntissue trace elements in patients \n\n\n\nwith breast cancer in Taiwan. \n\n\n\nBiol Trace Elem Res 2002. \n\n\n\n89(1):1-11. \n\n\n\n18. Altavilla G, Adamo V, Alafaci \n\n\n\nE, Buemi B, Chillemi S, La \n\n\n\nScala R, Marabello G & Palmara \n\n\n\nD. Serum levels of copper and \n\n\n\nzinc in patients with lung cancer. \n\n\n\nMinerva Med 1985. 76(44): \n\n\n\n2117-20. \n\n\n\n19. Diez M, Arroyo M, Cerdan FJ, \n\n\n\nMunoz M, Martin MA & \n\n\n\nBalibrea JL. Serum and tissue \n\n\n\ntrace metal levels in lung cancer \n\n\n\npatients. Oncology 1989. 46(4): \n\n\n\n230-4. \n\n\n\n20. Zhao X, Han C & Jing J. \n\n\n\nRelationship of serum trace \n\n\n\nelements to lung cancer and its \n\n\n\nclinical application.  Zhonghua \n\n\n\nLiu Xing Bing Xue Za Zhi 1998. \n\n\n\n19(5): 286-9  \n\n\n\n21. Cunzhi H, Jiexian J, Xianwen Z, \n\n\n\nJingang G, Shumin Z & Lili D. \n\n\n\nSerum and tissue levels of six \n\n\n\ntrace elements and copper/zinc \n\n\n\nratio in patients with cervical \n\n\n\ncancer and uterine myoma.  Biol \n\n\n\nTrace Elem Res  2003. \n\n\n\n94(2):113-22. \n\n\n\n22. Savina NP. Circulating immune \n\n\n\ncomplexes in malignant tumors. \n\n\n\nSov Med 1989. (8):8-10. \n\n\n\n23. Viramontes L, Cicero R, Acosta \n\n\n\nG, Barragan L, Orozco R, Torres \n\n\n\nS. Determination of secretory \n\n\n\nimmunoglobulin A, IgG and IgM \n\n\n\nin bronchial lavage from patients \n\n\n\nwith primary and metastatic lung \n\n\n\nneoplasms.Arch Invest Med \n\n\n\n(Mex) 1989. 20(2): 175-81. \n\n\n\n24. Pettingale KW, Merrett TG & \n\n\n\nTee DE. Prognostic value of \n\n\n\nserum levels of \n\n\n\nimmunoglobulins (IgG, IgA, \n\n\n\nIgM and IgE) in breast cancer: a \n\n\n\npreliminary study.   Br J Cancer \n\n\n\n1977. 36(5):550-7. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n"
"\n\nMalaysian Journal of Pharmacy Volume 7 Issue 1 (2021) \n \n\n\n\n\n\n\n\n1 \n\n\n\n\n\n\n\n*Correspondence: chiasiang.kow@monash.edu  \n1School of Postgraduate Studies, International Medical University, Kuala \n\n\n\nLumpur, Malaysia \n2School of Pharmacy, Monash University Malaysia, Bandar Sunway, \n\n\n\nSelangor, Malaysia \n3School of Pharmacy, University of Lincoln, Lincolnshire, United Kingdom \n4Department of Pharmacy, University of Huddersfield, Huddersfield, \n\n\n\nUnited Kingdom  \n5School of Biomedical Sciences and Pharmacy, University of Newcastle, \n\n\n\nCallaghan, Australia \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n \nLetter \n\n\n\n\n\n\n\nAntifungal Treatment of Mucormycosis Associated with \n\n\n\nCOVID-19 \n \n\n\n\nChia Siang Kow1,2*, Syed Imran Ahmed3, Syed Shahzad Hasan4,5 \n\n\n\n \nMucormycosis is an angioinvasive fungal infection due to fungi \n\n\n\nof the order Mucorales. The prognosis from mucormycosis can \n\n\n\nbe poor despite early diagnosis and aggressive therapy. The \n\n\n\nsystematic review and meta-analysis by Muthu and colleagues \n\n\n\n[1] investigated the rate of mortality in patients with pulmonary \n\n\n\nmucormycosis. While there had been a significant decrease in \n\n\n\nthe mortality rate over time, the recent (2010-2020) rate of \n\n\n\nmortality is still substantial, in which about one in two patients \n\n\n\n(49.8%; 95% confidence interval 43.2% to 56.3%) with \n\n\n\npulmonary mucormycosis died from the disease. Yet, patients \n\n\n\noriginated from the lower-middle-income countries had a \n\n\n\nhigher mortality rate, in which about three in four patients \n\n\n\n(71.5%; 95% confidence interval 58.7% to 84.3%) with \n\n\n\npulmonary mucormycosis died from the disease. Indeed, there \n\n\n\nhas been a recent surge in the occurrence of mucormycosis in \n\n\n\nlower-middle-income countries,  especially in India. As raised \n\n\n\nby Szarpak [2], the increased incidence with a fairly severe \n\n\n\ncourse of mycormycosis was reported in patients with a history \n\n\n\nof coronavirus disease 2019 (COVID-19) and received \n\n\n\nsystemic corticosteroid therapy.  \n\n\n\n\n\n\n\nThe presence of multiple risk factors in patients with COVID-\n\n\n\n19, along with the additional immunosuppression caused by \n\n\n\nsystemic corticosteroids, predispose the occurrence of \n\n\n\nmucormycosis, which could negate the mortality benefits \n\n\n\noffered by systemic corticosteroids in this patient population \n\n\n\n[3]. Common risk factors include the presence of diabetes \n\n\n\nmellitus, particularly with ketoacidosis. Noteworthily, the \n\n\n\nmanagement of patients with mucormycosis, which is \n\n\n\nconsidered rare before the COVID-19 pandemic, had not been \n\n\n\noptimal as described in a case report [4]. Optimal antifungal \n\n\n\ntherapy is of utmost importance considering the substantial rate \n\n\n\nof mortality.   \n\n\n\n\n\n\n\nIntravenous amphotericin B is the drug of choice for initial \n\n\n\ntherapy of mucormycosis; a lipid formulation of amphotericin \n\n\n\nB (liposomal amphotericin B or amphotericin B lipid) is \n\n\n\npreferred to reduce the risk of nephrotoxicity. In a meta-\n\n\n\nanalysis of five randomized trials, the incidence of \n\n\n\nnephrotoxicity was significantly lower with liposomal \n\n\n\namphotericin B compared with amphotericin B deoxycholate \n\n\n\n(15% versus 33%; relative risk = 0.48; 95% confidence interval \n\n\n\n0.36 to 0.64) [6]. The usual starting dose for amphotericin B is \n\n\n\n5 mg/kg daily, which can be increased up to 10 mg/kg daily to \n\n\n\ncontrol the infection. \n\n\n\n\n\n\n\nWhile amphotericin B is generally considered the first-line \n\n\n\nagent for the treatment of mucormycosis. Posaconazole or \n\n\n\nisavuconazole is used as step-down therapy for patients who \n\n\n\nhave responded to amphotericin B. Therefore, once patients \n\n\n\nrespond and are deemed suitable for discharge, they could be \n\n\n\ninitiated with either one of the aforementioned antifungal \n\n\n\nagents. Posaconazole and isavuconazole are broad-spectrum \n\n\n\nazoles that are active in vitro against the pathogens of \n\n\n\nmucormycosis. A systematic review [7] of 96 case reports of \n\n\n\npatients with mucormycosis reported a response rate of 72.9% \n\n\n\nwith posaconazole. On the other hand, isavuconazole has been \n\n\n\nevaluated in a multicenter open-label single-arm study that \n\n\n\nincluded a total of 37 patients with mucormycosis [8]. When \n\n\n\nthe researchers compared patients, who received isavuconazole \n\n\n\nwith their contemporary counterparts who received \n\n\n\namphotericin B (the majority received a lipid formulation), it \n\n\n\nwas observed that the weighted all-cause mortality was similar \n\n\n\n\n\n\n\n\nKow, C.S. et al. Mal J Pharm 7 (1) 2021, 1-2 \n\n\n\n\n\n\n\n2 \n\n\n\n\n\n\n\nin those who received isavuconazole (33%) and in those who \n\n\n\nreceived amphotericin B followed by posaconazole (41%). \n\n\n\nPosaconazole (delayed-release tablets) can be dosed at 300 mg \n\n\n\nevery 12 hours on the first day, then 300 mg once daily, with \n\n\n\nno dosage adjustment necessary for patients with a decline in \n\n\n\nrenal function. Whereas isavuconazole can be loaded at a dose \n\n\n\nof 200 mg every 8 hours for 2 days, followed by a maintenance \n\n\n\ndose of 200 mg orally once daily starting 12 to 24 hours after \n\n\n\nthe last loading dose.  \n\n\n\n\n\n\n\nAntifungal therapy should be continued until clinical resolution \n\n\n\nof the signs and symptoms, as well as resolution of radiographic \n\n\n\nsigns of mucormycosis. Perhaps in the context where there is a \n\n\n\nwidespread outbreak of mucormycosis, the use of systemic \n\n\n\ncorticosteroids should be more judicious in patients at high risk, \n\n\n\nsuch as those with diabetes, keeping in mind that systemic \n\n\n\ncorticosteroids could aggravate hyperglycemia. The use of \n\n\n\nintravenous pulse methylprednisolone therapy for as short as \n\n\n\nthree days to limit its side effects can be considered [9]. \n\n\n\nBesides, baricitinib, a Janus kinase inhibitor, which has proven \n\n\n\nmortality benefits, can be considered as an alternative to \n\n\n\nsystemic corticosteroids in patients with COVID-19 [10]. \n\n\n\n\n\n\n\nREFERENCE \n \n\n\n\n[1] Muthu V, Agarwal R, Dhooria S, et al. Has the mortality from \n\n\n\npulmonary mucormycosis changed over time? A systematic review \n\n\n\nand meta-analysis. Clin Microbiol Infect. 2021;27(4):538-549.  \n\n\n\n[2] Szarpak L. Mucormycosis - a serious threat in the COVID-19 \n\n\n\npandemic? [published online ahead of print, 2021 May 21]. J Infect. \n\n\n\n2021;S0163-4453(21)00257-7.  \n\n\n\n[3] Kow CS, Hasan SS. Corticosteroid-related in-hospital hyperglycemia: \n\n\n\ndoes it negate mortality benefits in COVID-19? [published online \n\n\n\nahead of print, 2020 Sep 18]. Clin Infect Dis. 2020;ciaa1423.  \n\n\n\n[4] Garg D, Muthu V, Sehgal IS, et al. Coronavirus Disease (Covid-19) \n\n\n\nAssociated Mucormycosis (CAM): Case Report and Systematic \n\n\n\nReview of Literature. Mycopathologia. 2021;186(2):289-298. \n\n\n\n[5] Rajendra Santosh AB, Muddana K, Bakki SR. Fungal Infections of \n\n\n\nOral Cavity: Diagnosis, Management, and Association with COVID-\n\n\n\n19 [published online ahead of print, 2021 Mar 27]. SN Compr Clin \n\n\n\nMed. 2021;1-12  \n\n\n\n[6] Mistro S, Maciel Ide M, de Menezes RG, Maia ZP, Schooley RT, \n\n\n\nBadar\u00f3 R. Does lipid emulsion reduce amphotericin B nephrotoxicity? \n\n\n\nA systematic review and meta-analysis. Clin Infect Dis. \n\n\n\n2012;54(12):1774-1777.  \n\n\n\n[7] Vehreschild JJ, Birtel A, Vehreschild MJ, et al. Mucormycosis treated \n\n\n\nwith posaconazole: review of 96 case reports. Crit Rev Microbiol. \n\n\n\n2013;39(3):310-324.  \n\n\n\n[8] Marty FM, Ostrosky-Zeichner L, Cornely OA, et al. Isavuconazole \n\n\n\ntreatment for mucormycosis: a single-arm open-label trial and case-\n\n\n\ncontrol analysis. Lancet Infect Dis. 2016;16(7):828-837.  \n\n\n\n[9] Hasan SS, Kow CS, Mustafa ZU, Merchant HA. Does \n\n\n\nmethylprednisolone reduce the mortality risk in hospitalized COVID-\n\n\n\n19 patients? A meta-analysis of randomized control trials [published \n\n\n\nonline ahead of print, 2021 May 4]. Expert Rev Respir Med. \n\n\n\n2021;10.1080/17476348.2021.1925546.  \n\n\n\n[10] Marconi VC, Ramanan AV, de Bono S, Kartman CE, Krishnan V, \n\n\n\nLiao R, Piruzeli ML, Goldman JD, Alatorre-Alexander J, de Cassia \n\n\n\nPellegrini R, Estrada V. Baricitinib plus Standard of Care for \n\n\n\nHospitalized Adults with COVID-19. Preprint. medRxiv. \n\n\n\n2021;2021.04.30.21255934  \n\n\n\n\n\n"
"\n\n\n\n\n\n \n \nMALAYSIAN \nJOURNALofPHARMACY \n \n\n\n\nSupplement: \nProceedingsofthe9th National Pharmacy R&D \nConference 2016 \n\n\n\n\n\n\n\n \n \n \n \nAPublicationoftheMalaysianPharmaceuticalSociety \n\n\n\n\n\n\n\nVol. 2 Issue 2. August 2016 \n\n\n\n\n\n\n\nVol.5 Issue 1. December 2019 \n \n \n \n \n \n \n \n\n\n\n  MALAYSIAN \n  JOURNAL of PHARMACY \n \n        In this issue: \n \n\n\n\n\u2022 Knowledge level of government healthcare personnel in \nLabuan towards Registered Product and Notified Cosmetic) \n \n\n\n\n\u2022 The impact of implementing WMTAC towards \nanticoagulation treatment in Dungun Hospital \n\n\n\n\n\n\n\n\n\n\n\n \n \nA Publication of the Malaysian Pharmaceutical Society \n\n\n\n\n\n\n\n\nEDITORIAL BOARD \n \nMalaysian Journal of Pharmacy \nVol.5 Issue 1, December 2019 \n___________________________________________________________________ \n \nThe Official Journal of the Malaysian Pharmaceutical Society \n \nEditor-in-Chief:   Assoc. Prof. Dr. Asrul Akmal Shafie \n \nManaging Editor:   Mr. Ho Rhu Yann \n \nInternational Advisory Board: Assoc. Prof. Dr. Chua Siew Siang \n\n\n\nProf. Dr. Mohd Baidi Bahari    \n \nAssociate Editors:   Mr. Lam Kai Kun \n     Prof. Dr. Mohamed Azmi Ahmad Hassali \n     Assoc. Prof. Dr. Mohamad Haniki Nik Mohamed \n     Ms. Syireen Alwi \n     Prof. P T Thomas \n     Dr. Wong Tin Wui \n     Assoc. Prof. Dr. Vikneswaran a/l Murugaiyah \n     Prof. Dr. Yuen Kah Hay \n \n \nPublisher: \n \nMalaysian Pharmaceutical Society   \n16-2 Jalan OP 1/5, 1-Puchong Business Park \nOff Jalan Puchong \n47160 Puchong \nMalaysia \nTel: 6-03-80791861 \nFax: 6-03-80700388 \nHomepage: www.mps.org.my \nEmail: mps.online@gmail.com \n \n\n\n\n\n\n\n\n \nThe Malaysian Journal of Pharmacy is a publication of the Malaysian Pharmaceutical Society. \nEnquiries are to be directed to the publisher at the above address. The Publisher reserves copy- \nright and renewal on all published materials, and such material may not be reproduced in any \nform without the written permission of the Publisher. \n \n\n\n\n\n\n\n\n \n \nISSN 1675-3666 \n9 771675 366005 \n\n\n\n\n\n\n\n\nTable of Contents \n \n \nKnowledge level of government healthcare personnel in Labuan \ntowards Registered Product and Notified Cosmetic \n\n\n\n 1 \n\n\n\n   \nThe impact of implementing WMTAC towards anticoagulation \ntreatment in Dungun Hospital \n\n\n\n 8 \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n1 \n \n\n\n\nKnowledge level of government healthcare personnel in Labuan towards \nRegistered Product and Notified Cosmetic \n\n\n\nZS Sujata Tan \n\n\n\nPharmacy Enforcement Branch, Pharmaceutical Services Division, Labuan State Health \nDepartment, Ministry of Health Malaysia, Jalan Hospital, 87000, Wilayah Persekutuan \nLabuan, Malaysia. \n\n\n\n* Contact for correspondence, please email: zstan@moh.gov.my \n \n\n\n\nABSTRACT \n\n\n\nIntroduction: All pharmaceutical products in Malaysia must be registered with the Drug \nControl Authority (DCA) whereas cosmetics must be notified with the National \nPharmaceutical Regulatory Agency (NPRA). Availability of unregistered products and \nunnotified cosmetics in the market are longstanding issues affecting public safety and health. \nIt is vital that all government healthcare personnel (GHP) as the front liners are equipped with \nthe knowledge to properly advise the public on this issue. \n\n\n\nObjective: This study aims to determine the level of knowledge towards registered products \nand notified cosmetics among various groups of GHP under the Ministry of Health facilities in \nLabuan. \n\n\n\nMethods: This was a cross-sectional study performed from August to November 2017 using a \nvalidated 12 question questionnaire. Respondents were divided into 4 groups (doctors/dentist, \npharmacist, nurse, allied healthcare professional) and results between the groups were analysed \nusing Chi-square analysis. Respondent\u2019s knowledge was given score and those who scored 9 \nmarks and above were considered to have good knowledge. Those who scored 8 marks and \nbelow were considered to have poor knowledge. \n\n\n\nResults: Only 40.2% Pharmacists have the highest score of good knowledge on registered \nproducts and notified cosmetics at 81.8% (n=18).  The level of good knowledge among allied \nhealth professionals (AHP) stood at 42.9% (n=21), 36.4% of nurses (n=43) and 20% of doctors \n(n=6). However in total, only 40.2% (n=88) of the study population had good knowledge.   \n\n\n\nConclusion: The level of knowledge towards registered products and notified cosmetics \namong doctors, pharmacist, nurses and allied health professional in Labuan is poor as only \n40.2% have good knowledge. This study shows a significant association between the levels of \nknowledge among GHP varies between groups of profession. Pharmacist group has the highest \nscore in knowledge in this study and thus should be another reference for the general public \nand patients when it comes to health-related matters. Further re-education should be conducted \nto improve the knowledge of GHPs in Labuan with regards to this subject.  \n\n\n\nKeywords: registered products, notified cosmetics, government healthcare personnel, \npharmacy, pharmacy enforcement \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n2 \n \n\n\n\nINTRODUCTION \n\n\n\nThe National Survey on the Use of Medicines (NSUM) by Malaysian Consumers 201512, \nshowed that 58.6% of the participants preferred to consult government doctors when \nexperiencing health related problems. Therefore, it is vitally essential for all our government \nhealthcare personnel to have knowledge on registered products and notified cosmetics as they \nare often the first line of contact when the general public has any enquiries.  \n\n\n\nAll medicinal and pharmaceutical products, which include health supplements and traditional \npreparations must be registered with the Drug Control Authority (DCA), Ministry of Health \nMalaysia (MOH) before being marketed and sold to consumers1. The availability of \nunregistered products and unnotified cosmetics in the market are longstanding issues affecting \npublic safety and health. In 2016 alone, the Pharmacy Enforcement Division of Malaysia had \nconfiscated RM54.9 million worth of unregistered products and unnotified cosmetics \nrespectively, indicating the issue is still at large amongst the general public5. \n\n\n\nAccording to Regulation 7(1)(A) Control of Drugs and Cosmetics Regulations 1984, \u201cNo \nperson shall manufacture, sell, supply, import, possess or administer any product unless the \nproduct is a registered product\u201d6.  It is clear that only registered products are allowed in this \ncountry and everyone must follow these regulations. Moreover, all registered products undergo \nevaluation of the products' quality, safety and efficacy (except for traditional preparations and \nhealth supplements) to ensure safety of the public7. \n\n\n\nCosmetic products in Malaysia must also be notified with the National Pharmaceutical \nRegulatory Agency, Ministry of Health Malaysia (MOH) before being marketed and sold to \nconsumers. Cosmetics include any substance or preparation intended to be placed in contact \nwith various external parts of the human body (epidermis, hair system, nails, lips and external \ngenital organs) or with teeth and the mucous membranes of the oral cavity, with a view \nexclusively or mainly to cleaning them, perfuming them, changing their appearance and/or \ncorrecting body odours and/or protecting them or keeping them in good condition8. Some \nexamples of cosmetic products include body soap, facial cleansers and creams, sunscreens, \ntoothpaste and mouth rinse, hair shampoos and conditioners, hair dyes, perfumes and \ndeodorants, and colour cosmetics including lipsticks, eye shadow, compact powder and nail \npolish.  \n\n\n\nThis study aims to determine the level of knowledge towards registered products and notified \ncosmetics among various groups of government healthcare personnel under the Ministry of \nHealth facilities in Labuan. This study group was chosen due to logistical reasons as the author \nis a staff under the Labuan State Health Department, Ministry of Health, which has to direct \naccess to the government healthcare personnel. This was the first effort to conduct such \nresearch within Malaysia. \n\n\n\n\n\n\n\nMETHODS \n\n\n\nDesign and study population \n\n\n\nA cross sectional study was performed on government healthcare personnel under the Labuan \nState Health Department, which also included Rural Health Clinics (Klinik Desa), Community \nClinics (previously known as 1Malaysia Clinic), Health Clinics and Labuan Hospital, from \nAugust to November 2017. The inclusion criteria included all healthcare personnel that are \navailable during the conduct of the study. Personnel who were absent or on leave during the \nconduct of the study were excluded. Based on a population of roughly 500 GHP (information \nprovided by the Human Resource Section, Labuan State Health Department), the sample size \nwas calculated using Raosoft sample size calculator (margin of error = 5%, confidence level = \n\n\n\n\n\n\n\n\n\n\n\n\n3 \n \n\n\n\n95%, response distribution = 50%) which yielded the minimum sample size of 218 \nparticipants.9 Healthcare personnel without a healthcare related diploma/degree are excluded \nfrom this study.  \n\n\n\n\n\n\n\nInstrumentation \n\n\n\nQuestionnaires were distributed to GHP via the respective Deputy State Health Directors. This \nvalidated questionnaire consists of 12 questions in Malay language and was originally designed \nby Sabah State Pharmacy Enforcement Branch. [Questions 1 to 12 will test on knowledge of \nregistered products whereas Question 12 will test on knowledge of notified cosmetics (refer to \nAppendix 1)]. There was also a question asking whether the GHP had prior exposure to \ninformation on registered products and cosmetics. The respondents\u2019 will be divided into four \ngroups; doctors/dentist, pharmacist, nurse, allied healthcare professional (e.g. nutritionist and \ndietitian).  \n\n\n\nThose who scored 9 marks and above were considered to have good knowledge on registered \nproducts and notified cosmetics. Those who scored 8 marks and below were considered to have \npoor knowledge. This grading scale was decided upon discussion with officers from Labuan \nPharmacy Enforcement Branch as the officers felt that as healthcare personnel whom are \neducating the public on health related issues on a daily basis, they should be able to answer \nmost, if not all the questions correctly, and a high score of 9 out of 12 was decided to gauge \ngood knowledge. \n\n\n\n\n\n\n\nStatistical Analysis \n\n\n\nData was entered into Microsoft Excel and Chi Square analysis was performed using IBM \nStatistical Package for the Social Sciences (SPSS) version 19. Socio-demographic data and \ncategorical data were presented as frequencies and percentages. A p-value of <0.05 was \nconsidered as statistically significant.  \n\n\n\n\n\n\n\nEthical Approval \n\n\n\nEthical approval for this study was obtained from the Medical Research and Ethics Committee \n(MREC), Ministry of Health Malaysia (NMRR-17-541-34803 (IIR)). \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nRESULTS \n\n\n\nSocio-demographic characteristics \n\n\n\nQuestionnaires were distributed to 14 facilities involved in this study and 219 were returned. \nThe highest respondents from government healthcare personnel were mostly nurses (53.9%, \nn=118) and most of the participants fall within the age group of 26-30 years old (39.7%, n=87). \nThere were more female participants (88%, n=193) and there were slightly more diploma \nholders compared to degree holders (57.1%, n=125) [Table 1]. \n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n4 \n \n\n\n\nTable 1. Socio-demographic characteristics among study population presented in percentages \n\n\n\nCharacteristics  All (%) n = 219 \nGender   \n     Male \n     Female \n\n\n\n 26 (11.9%) \n193 (88.1%) \n\n\n\nEducation level   \n     Diploma \n     Degree \n\n\n\n 125 (57.1%) \n94 (42.9%) \n\n\n\nAge   \n     20-25 \n     26-30 \n     31-35 \n     36-40 \n     40-45 \n     > 46 \n     Undisclosed \n\n\n\n 18 (8.2%) \n87 (39.7%) \n49 (22.4%) \n27 (12.3%) \n14 (6.4%) \n22 (10%) \n2 (0.9%) \n\n\n\nOccupation   \n     Doctor/Dentist \n     Pharmacist \n     Nurse \n     Allied Healthcare Professional \n\n\n\n 30 (13.7%) \n22 (10%) \n\n\n\n118 (53.9%) \n49 (22.4%) \n\n\n\n\n\n\n\nKnowledge scores \n\n\n\nFrom the study, 40.2% (n=88) of the study population had good knowledge towards registered \nproducts and notified cosmetics [Table 2], despite 89.5% (n=196) stating that they have \nreceived prior information with regards to the topic at hand [Table 3]. Individually, pharmacists \nhave the highest score of good knowledge at 81.8% (n=18). The level of good knowledge \namong allied health professionals (AHP) stood at 42.9% (n=21), 36.4% of nurses (n=43) and \n20% of doctors (n=6). Chi-square analysis demonstrates that the level of knowledge among \ngovernment healthcare personnel are significantly different (p<0.001). \n \n\n\n\n\n\n\n\n\n\n\n\nTable 2 Tabulated responses to questionnaire \n\n\n\nOccupation Good Understanding \nDoctor/Dentist (n=30) \n \n\n\n\n6 (20.0%) \n \n\n\n\nPharmacist (n=22) \n \n\n\n\n18 (81.8%) \n \n\n\n\nNurse (n=118) \n \n\n\n\n43 (36.4%) \n \n\n\n\nAllied Health Professional (n=49) 21 (42.9%) \n \n\n\n\nTotal 88 (40.2%) \n \n\n\n\n0 cells (0.0%) have expected count less than 5. The minimum expected count is 8.84. Therefore, \nthe assumptions are fulfilled. The Pearson Chi Square analysis value is 21.784 with a degree \nof freedom of 3. The p-value is less than 0.001 thus this study is statistically significant. \n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n5 \n \n\n\n\nTable 3: Prior Exposure to information on registered products and notified cosmetics \n\n\n\nOccupation Prior exposure to information on \n registered products & notified cosmetics \n\n\n\nDoctor/Dentist (n=30) \n \n\n\n\n29 (13.2%) \n \n\n\n\nPharmacist (n=22) \n \n\n\n\n22 (10.0%) \n \n\n\n\nNurse (n=118) 100 (45.7%) \n \n\n\n\nAllied Health Professional (n=49) \n \n\n\n\n45 (20.5%) \n \n\n\n\nTotal 196 (89.5%) \n \n\n\n\nDISCUSSION \n\n\n\nThere is a high prevalence of usage of traditional and complementary medicine in Malaysia in \nwhich many these products remain unregistered and had been confiscated by Pharmacy \nEnforcement officers11. When the public has any doubts or any enquiries with regards to this \ntopic, the government healthcare personnel are usually the one first person they will get \nprofessional health advice from as they are the front-liners for healthcare in Malaysia12.  \n\n\n\nDespite 89.5% (n=196) of the participants answering that they have received or were exposed \nbefore to information related to registered products and cosmetics, only 40.2% (n=88) have \nmanaged to score 9 questions or more correctly to be classified as having good knowledge at \nhand. \n\n\n\nOut of the 40.2%, pharmacists (81.8%, n=18) have the highest knowledge compared to other \ngroups. As their main role is to counsel patients on medication use as well as a huge \ninvolvement in the Ministry of Health\u2019s \u201cKnow Your Medicine\u201d campaign, it is understandable \nthat their knowledge is the highest11. The \u201cKnow Your Medicine\u201d campaign is a pharmacist \nled program which aims to educate patients on the 5R concepts, namely the right patient, right \nmedicines, right dose, right route of administration and the right time of administration. \nTherefore, it was expected that more pharmacists, if not all, would have scored \u2018good \nknowledge\u2019 in the questionnaire as they were already well trained on this subject matter.  \n\n\n\nDoctors and dentists (20%, n = 6) have the poorest knowledge amongst all the participants. \nThere may be several factors contributing to this, such as having a lack of time to answer the \nquestionnaire properly, or perhaps they do not understand the magnitude of the issue at hand. \nThe other two groups only fared slightly better.  \n\n\n\nPerhaps, further continuous professional development, such as organising more workshops to \nimprove the knowledge of Labuan\u2019s GHP, should be recommended to enhance and improve \nthe existing knowledge of all GHPs from the Ministry of Health in Labuan towards registered \nproducts and notified cosmetics.  \n\n\n\nThere were some limitations to our study. First, this was a none-randomised survey which was \nconducted in a non-controlled environment. The participants may refer to materials through \nvarious leaflets or brochures, research the answers online or even discuss the questions amongst \npeers. The investigators expected that the performance of the participants would be better with \nthis limitation in place, but the final poor results were surprising. The scale that was used to \ngrade the knowledge of the GHP was not based on any study and thus, may not be scientifically \naccurate to determine the GHP\u2019s exact knowledge levels. Finally, while the study population \nhad met the requirements of the sample size, some of the individual divided groups of separate \nhealthcare personnel (e.g. doctors/dentist) may be too small to represent the actual population. \n\n\n\n\n\n\n\n\n\n\n\n\n6 \n \n\n\n\nTherefore, the results from this study is only valid to the study sample and must not be \ngeneralized to a larger population. \n\n\n\n\n\n\n\nCONCLUSION \n\n\n\nIn this study, the level of knowledge towards registered products and notified cosmetics among \ndoctors, pharmacist, nurses and allied health professional in Labuan is poor as only 40.2% \namong the study population have good knowledge. This study shows a significant association \nbetween the levels of knowledge among GHP varies between groups of profession. Pharmacist \ngroup has the highest score in knowledge in this study and thus should be another reference for \nthe general public and patients when it comes to health-related matters. Further re-education \nshould be conducted to improve the knowledge of GHPs in Labuan with regards to this subject.  \n\n\n\n\n\n\n\nACKNOWLEDGMENT \n\n\n\nThe author would like to thank the Director General of Health Malaysia for his permission to \npublish this paper.  \n\n\n\nThe author would also like to thank the following people for their assistance to this study:  \n\n\n\n\u2022 Dr Ismuni bin Bohari, State Health Director, Labuan State Health Department \n\u2022 Mdm Normi bt Kamaruzaman, Deputy State Health Director, Labuan State Health \n\n\n\nDepartment \n\u2022 Mdm Soo Bee Kuan, Head of Pharmacy Enforcement Branch, Labuan State Health \n\n\n\nDepartment \n\u2022 Mdm Rabiawati bt Omar, Senior Principal Assistant Director, Labuan State Health \n\n\n\nDepartment \n\u2022 Mr Tan Chee Hoong, Pharmacist, Labuan State Health Department \n\u2022 Ms Law Kah Ee, Pharmacist, Labuan State Health Department \n\u2022 Mr Ong Soon Teck, Pharmacist, Labuan State Health Department \n\u2022 Ms Kuan Siaw Hui, Pharmacist, Labuan State Health Department \n\u2022 Mr Zul Yazid bin Ahmad Riza, Pharmacist, Labuan State Health Department \n\u2022 Ms Wan Amira bt Wan Omar, Pharmacist, Labuan State Health Department \n\u2022 Dr Stephenie Ann, Clinic Research Centre Hospital Queen Elizabeth 1 \n\u2022 Ms Noor Ilyani binti Ismail, Pharmacist, Hospital Mesra Bukit Padang \n \n\n\n\nCONFLICT OF INTEREST \n\n\n\nThe author has none to declare. \n\n\n\n\n\n\n\nDECLARATION OF FUNDING \n\n\n\nThis study is fully funded by the Ministry of Health Malaysia. \n\n\n\n\n\n\n\nREFERENCES \n\n\n\n1. How to identify registered drugs or pharmaceutical products? [Internet]. Malaysia: \nPharmaceutical Services Program, Ministry of Health Malaysia; 2017 [cited 2017 Feb 6]. \n\n\n\n\n\n\n\n\n\n\n\n\n7 \n \n\n\n\nAvailable from: https://www.pharmacy.gov.my/v2/en/faq/how-identify-registered-drugs-\nor-pharmaceutical-products.html \n\n\n\n2. Malaysian Laws on Poisons and Sale of Drugs. Kuala Lumpur: International Law Book \nServices; 2013.328p.  \n\n\n\n3. Mior Abdullah WNA. Campurpalsu Dalam Produk Tradisional. [Internet]. Malaysia: \nMyHEALTH, Ministry of Health Malaysia; 2016 [cited 2017 Feb 5]. Available from: \nhttp://www.myhealth.gov.my/campurpalsu-dalam-produk-tradisional/ \n\n\n\n4. Product. [Internet].  Malaysia: Pharmaceutical Services Program, Ministry of Health \nMalaysia; 2017 [cited 2017 Feb 6]. Available from: \nhttp://www.pharmacy.gov.my/v2/en/faq-categories/produk \n\n\n\n5. Statistik Farmasi 2016. [Internet]. Malaysia: Pharmaceutical Services Program, Ministry \nof Health Malaysia; 2017 [cited 2017 Feb 6]. Available from: \nhttps://www.pharmacy.gov.my/v2/sites/default/files/statistic/Statistik%20Farmasi%202016.p\ndf \n\n\n\n6. Regulation 7(1)(A), Control of Drugs and Cosmetics Regulations 1984.  \n7. National Pharmaceutical Regulatory Agency. [Internet]. Malaysia: National \n\n\n\nPharmaceutical Regulatory Agency, Ministry of Health Malaysia; 2017 [cited F e b   6,   \n2017]. Available from http://npra.moh.gov.my/ \n\n\n\n8. Guidelines for Control of Cosmetic Products in Malaysia. [Internet]. Malaysia: National \nPharmaceutical Regulatory Agency, Ministry of Health Malaysia; 2017 [ updated Feb \n2017; cited  Feb  6,   2017].  Available at:  \nhttps://www.npra.gov.my/images/Guidelines_Central/Guidelines_on_Cosmetic/2017/feb2017/\nGUIDELINES_FOR_CONTROL_OF_COSMETIC_PRODUCTS_IN_MALAYSIA.pdf \n\n\n\n9. Naing NN. A practical guide on determination of sample size in health sciences research:  \nSample size determination in descriptive studies. Malaysia : Pustaka Aman Press; 2009. \npp 54-5 \n\n\n\n10. Siti ZM, Tahir A, Farah AI et al. Use of traditional and complementary medicine in \nMalaysia: a baseline study. Complement Ther Med. 2009 Oct-Dec;17(5-6):292-9. \n\n\n\n11. Izham MI. Peranan Ahli Farmasi Dalam Kesihatan. [Internet].  Malaysia: Pusat Racun \nNegara, Universiti Sains Malaysia; 2017 [cited  Feb  6,   2017]. Available at:  \nhttp://www.prn.usm.my/index.php/archive/magazines/dewan-kosmik/304-peranan-ahli-\nfarmasi-dalam-kesihatan \n\n\n\n12. Mohamad Azmi H, Fahad S et al. A National Survey on the Use of Medicines (NSUM) \nby Malaysian Consumers. Pharmaceutical Services Division Malaysia. [Internet]. \nMalaysia: Pharmaceutical Services Program, Ministry of Health Malaysia; 2015 [cited \n2017 Feb 6].  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Available from: \nhttps://www.pharmacy.gov.my/v2/en/content/know-your-medicine-programmes.html \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\nhttps://www.pharmacy.gov.my/v2/en/faq/how-identify-registered-drugs-or-pharmaceutical-products.html\n\n\nhttps://www.pharmacy.gov.my/v2/en/faq/how-identify-registered-drugs-or-pharmaceutical-products.html\n\n\nhttp://www.myhealth.gov.my/campurpalsu-dalam-produk-tradisional/\n\n\nhttp://www.pharmacy.gov.my/v2/en/faq-categories/produk\n\n\nhttps://www.pharmacy.gov.my/v2/sites/default/files/statistic/Statistik%20Farmasi%202016.pdf\n\n\nhttps://www.pharmacy.gov.my/v2/sites/default/files/statistic/Statistik%20Farmasi%202016.pdf\n\n\nhttp://npra.moh.gov.my/\n\n\nhttps://www.npra.gov.my/images/Guidelines_Central/Guidelines_on_Cosmetic/2017/feb2017/GUIDELINES_FOR_CONTROL_OF_COSMETIC_PRODUCTS_IN_MALAYSIA.pdf\n\n\nhttps://www.npra.gov.my/images/Guidelines_Central/Guidelines_on_Cosmetic/2017/feb2017/GUIDELINES_FOR_CONTROL_OF_COSMETIC_PRODUCTS_IN_MALAYSIA.pdf\n\n\nhttp://www.prn.usm.my/index.php/archive/magazines/dewan-kosmik/304-peranan-ahli-farmasi-dalam-kesihatan\n\n\nhttp://www.prn.usm.my/index.php/archive/magazines/dewan-kosmik/304-peranan-ahli-farmasi-dalam-kesihatan\n\n\nhttps://www.pharmacy.gov.my/v2/sites/default/files/document-upload/national-survey-use-medicine-iii-nsum-iii.pdf\n\n\nhttps://www.pharmacy.gov.my/v2/sites/default/files/document-upload/national-survey-use-medicine-iii-nsum-iii.pdf\n\n\nhttps://www.pharmacy.gov.my/v2/en/content/know-your-medicine-programmes.html\n\n\n\n\n\n\n\n\n\n\n8 \n \n\n\n\nThe impact of implementing WMTAC towards anticoagulation treatment in \nDungun Hospital \n\n\n\nAN Alias*, SF Ali, W Yusoff, NAS Yahaya, NH Abdul Karim, SA Fadzillah \n\n\n\nPharmacy Unit, Dungun Hospital, 23000, Dungun, Terengganu, Malaysia. \n \n* Contact for correspondence, please email: farmasidungun@gmail.com \n\n\n\nABSTRACT \n\n\n\nObjective:   The   main   objective   of   this   study   is   to   compare   patients\u2019   outcome   in \nanticoagulation treatment before and after Warfarin Medication Therapy Adherence Clinic \n(WMTAC).  The study compares the cost of INR test between usual care (UC) and WMTAC. \nThe study also determines factors affecting International Normalized Ratio (INR) level among \nWMTAC patients. \n\n\n\nMethods:  A retrospective study involving WMTAC patients was conducted by trained \npharmacists at Dungun Hospital. Patients were reviewed by UC for 4 months and continuously \nfollowed up by WMTAC for another 4 months were included in this study. Patients who passed \naway, transferred out and defaulted were excluded from the study. The data were derived from \nPatient Medical Record and recorded in Warfarin Data Collection Form for analyze. \n\n\n\nResults: The time in therapeutic range (TTR) was 73.46% for WMTAC and 45.58% for UC \n(p<0.001). The expanded TTR for WMTAC was 90.37% and 61.88% for UC (p<0.001).  The \npercentage of time INR level <1.5 were 0.57% for WMTAC patients and 7.92% for UC patients, \nwhile 5.28% UC patients had INR level > 5. The total reagent costs of INR test were MYR \n341.04 for WMTAC and MYR 519.40 for UC. The known factors affecting INR level in \nWMTAC patients were diet (55%), missed dose (36%) and drug interaction (9%). \n\n\n\nConclusion: According to this study, the WMTAC implementation significantly improved \nanticoagulation treatment. Besides that, it also beneficial for our reagent cost expenses.  \n\n\n\nKeywords: Cost, Expanded TTR, INR, TTR, WMTAC \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n9 \n \n\n\n\nINTRODUCTION \n\n\n\nOral anticoagulant (OAC) is commonly used despite its narrow therapeutic index, thus it is vital \nto maintain INR within targeted range [1\u20133]. It is such a successful agent for the medical \nmanagement  commonly  used  in  the  management, for the prevention of stroke and systemic \nembolism in adults, involving patients who are having either atrial fibrillation (AF), deep vein \nthrombosis (DVT), pulmonary embolism (PE), prevention of recurrent DVT or recurrent PE \n[1,2,4,5] . Hence pharmacist-managed Warfarin Medication Therapy Adherence Clinic \n(WMTAC) being established in most countries. Implementation of the pharmacist-managed \nanticoagulation clinic (ACC) had positive impact on patient care [6\u20138]. In Malaysia, Warfarin \nMTAC was introduced in 2004 as part of the clinical pharmacy services in the Ambulatory \nClinic System which emphasizes on medication management to improve on quality, safety and \ncost effectiveness of patient care [9]. \n\n\n\nWarfarin Medication Therapy Adherence Clinic (WMTAC) was implemented at Dungun \nHospital since 18 February 2013. Pharmacist-managed WMTAC is collaborating with  Medical  \nOfficer  in  the management  of  patients  with  anticoagulation  therapy  by  providing  \nmedication  counseling services. The aim of WMTAC was to provide service continuity and \nenhance patient care for patients on anticoagulation therapy through education, frequent \nmonitoring, and close follow-up. The continuity of patient care will maximize the benefits of \nanticoagulation therapy and minimize the adverse effect and complications resulting from OAC \ntherapy. WMTAC also provides Consultative services to healthcare providers on anticoagulant \ndrug management and related issues [9]. \n\n\n\nMany studies have demonstrated good INR level in WMTAC patients. Another study stated \nthat WMTAC patients were found to have better International Normalized Ratio (INR) control \ncompared to patients who received intervention by usual care (UC). Patients who were receiving \ntreatment by UC, their INR result were reviewed by the doctors then received any adjustment \nthat will be made based on the result. There is no specific dosing nomogram was utilized but \nbased on doctors\u2019 management and practices. Nevertheless, it is still important that joint \ncooperation between physicians, pharmacists, and nurses should exist in order to achieve \ndesired therapeutic outcomes. [10]. \n\n\n\nEvidence has shown that there is an improvement in Time in Therapeutic Range (TTR) and \nclinical outcomes in patients managed by trained staff using standardized procedures and dosing \ndecision support tools. Study by Van De Ham et al conclude that INR patterns of patients can \npredict the clinical outcomes over TTR, and this also can help us to identify patients who need \nadditional OAC monitoring [11]. \n\n\n\nMany similar studies were conducted in Malaysia and found that WMTAC had achieved better \nINR level compared to UC. Since WMTAC has been established at Dungun Hospital from \n2013, we decided to carry out the study to measure the importance and needs of WMTAC \nservice among our population. The objective of this study is to compare anticoagulation control \nbefore and after WMTAC care. In addition, from this study we were able to determine the \neffectiveness of WMTAC service in Dungun Hospital.  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n10 \n \n\n\n\nMETHODOLOGY \n\n\n\nSelection and description of participants \n\n\n\nA retrospective study was conducted from June to July 2016 in WMTAC and Outpatient \nDepartment (OPD) at Dungun Hospital, Terengganu. All data for 81 patients in WMTAC were \nderived from patient medical record from 2013 to 2015. The patients who has met the inclusion \ncriteria were included in the study as participants. Those participants who were selected has \nbeen reviewed by UC for 4 months and followed by WMTAC for another 4 months. We chose \na total of 8 months because that is the longest and most complete data that we can retrieved \nfrom the patient medical record. During the treatment under UC, the participants received \nstandard care from medical officers and no algorithm or protocol used. In the followed-up \nsession by WMTAC, the same standard care with some additional services such as medication \ncounselling and close drug therapy monitoring were given to the participants by trained \npharmacist. On the other hand, participants who had at least two INR values not more than 6 \nweeks apart were also included in the study. Patients with incomplete data, passed way and \ntransferred out were excluded from this study. Flow of the study was shown in.\n\n\n\n \nFigure 1: Flow of the study \n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n11 \n \n\n\n\nTechnical information \n\n\n\nThe primary outcome of this study is to measure the percentage of time patients\u2019 INR  within  \nthe  recommended  TTR,  to  determine  the  percentage  of  TTR  within  \u00b10.2  units  of  the \nrecommended therapeutic range (\u2018expanded therapeutic range\u2019) and to measure the percentage \nof time the INR was above 5.0 or below 1.5. TTR is a percent of days where INR is between \ntargeted therapeutic range. TTR of INR between targeted range is very important not only for \nsafety but also for effectiveness of warfarin anticoagulation in patients [13]. Expanded TTR is \nthe percentage of TTR of INR within \u00b10.2 units of the recommended therapeutic range [9]. \n\n\n\nThe secondary outcome was to compare the INR cost test between WMTAC and UC. The cost \ninvolved was only the reagent used per patient. The tertiary outcome was to determine factors \naffecting INR level among patients under WMTAC care. \n\n\n\nThe data were derived from Patient Medical Record, including patient\u2019s demographic, \nindication for warfarin, INR target, duration of therapy and risk factor (bleeding or \nthromboembolic events). INR results and weekly dose recommended also were taken into \naccount. All the data that have been collected will be recorded in Warfarin Data Collection \nForm .This study was approved by Medical Review and Ethical Committee of Ministry of \nHealth (MOH) and registered with National Medical Research Registry (NMMR) NMRR-16-\n2089-30772.  \n\n\n\n\n\n\n\nStatistical Analysis \n\n\n\nStatistical analyses were done by using IBM Statistical Package for Social Science (SPSS) \nVersion 21.0. Means and standard deviations were calculated for continuous data whilst \nfrequency and percentage were tabulated for categorical data. TTR was calculated using a \nmodification of the Rosendaal linear interpolation method [12]. This method of calculating TTR \nexamines the amount of time between INR results to determine how long the patient may have \nbeen within therapeutic range.  Paired t-test was used to compare adequacy of anticoagulation \nbefore and after WMTAC care. All statistical assessments were conducted at 5% significance \nlevel with its\u2019 95% confident interval. \n\n\n\n\n\n\n\nRESULT \n\n\n\nA total of 41 participants were included in this study. The median age is 48 years old and 63.4% \nof patients are female. The most common indications for warfarin were atrial fibrillation and \nmechanical heart valves which are 51% and 44% respectively.  \n\n\n\n\n\n\n\n\n\n\n\n\n12 \n \n\n\n\n\n\n\n\na PE: Pulmonary embolism; b CVA: cardiovascular accident; c MI: myocardial infarction; d ACS: Acute coronary syndrome \n\n\n\n\n\n\n\nThe number of INR test per patient within 4 months in the WMTAC and UC group was 4 and \n6, respectively. The number of INR tests per patient greater than 4 weeks apart in WMTAC and \nUC group was 1 and 0 respectively. \n\n\n\n\n\n\n\nTable 2: Frequency of INR testing among warfarin patient (n=41) \n\n\n\nVariables Warfarin MTAC Usual Care \nTotal number of INR test 174 265 \nNumber of INR test per patient 4 6 \nINR tests >4 weeks apart, n 58 14 \nNumber of INR test>4 weeks apart per patient 1 0 \nNumber of withhold session 8 23 \nNumber of withhold session per patient 0 1 \nNumber of adjustment dose 39 108 \nNumber of adjustment dose per patient 1 3 \n\n\n\nThe WMTAC group spent significantly more time than the UC group in the therapeutic range \nTTR: 73.46% versus 45.58%; p<0.001, as well as in the expanded TTR: 90.37% versus 61.88%; \np<0.001. \n\n\n\nThe percentage of time that the patients INR <1.5 and >5.0 in WMTAC group is less than the \nUC group (0.57% versus 7.92% & 0.00% versus 5.28%) respectively. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nTable 1: Sociodemographic characteristic of WMTAC patients at Hospital Dungun (n=41) \nVariables n (%) \nAge in years, median  \n  Male 63 \n  Female 48 \nGender  \n  Male 15 (36.6) \n  Female 26 (63.4) \nIndication for anticoagulation  \n  Atrial Fibrillation 21 (51.2) \n  Mechanical Heart Valve 18 (43.9) \n  PEa 1 (2.4) \n  CVAb 1 (2.4) \n  MIc/ACSd 1 (2.4) \nTarget INR range (Based on individualized target)  \n  2.0-3.0 27 (65.9) \n  2.0-2.5 1 (2.4) \n  2.5-3.0 3 (7.3) \n  2.5-3.5 10 (24.4) \nRisk Factor for thromboembolism or bleeding  \n  Hypertension 19 (46.3) \n  Stroke history 6 (14.6) \n  Diabetes 2 (4.9) \n  Age > 65 6 (14.6) \n  Renal disease 1 (2.4) \n  Antiplatelet 7 (17.1) \n\n\n\n\n\n\n\n\n\n\n\n\n13 \n \n\n\n\nTable 3: Anticoagulation control among warfarin patients \n\n\n\nVariables WMTAC UC p-valuea \n\n\n\nPercentage of Time INR in Range    \nTherapeutic range (TTR)b 73.46 45.58 p<0.001 \nExpanded range (Expanded TTR)c 90.37 61.88 p<0.001 \n   <1.5                                                          0.57 7.92  \n   >5.0                                                              0.00 5.28  \na Paired t-test; b Therapeutic range: 2.0-3.0, 2.0-2.5, 2.5-3.0 or 2.5-3.5; c expanded therapeutic range \u00b10.26,12,1 \n\n\n\n\n\n\n\nThere is a significant association between number of INR test, number of adjustment dose and \nnumber of withhold session with TTR in UC group (p<0.001, p=0.002 and p=0.001) \nrespectively. While there is no significant association between number of INR test, number of \nadjustment dose and number of withhold session with TTR in WMTAC group (p=0.376, \np=0.641and p=0.976) respectively. \n\n\n\n\n\n\n\nTable 4: Relation between Interventions and TTR \n\n\n\nGroup Interventions TTRa p-valueb \nWMTAC      No. of INR test number of adjustment dose 73.46 p=0.376 \n No. of adjustment dose          73.46 p=0.641 \n No. of withhold session 73.46 p=0.976 \nUC No. of INR test 45.58 p<0.001 \n No. of adjustment dose 45.58 p=0.002 \n No. of withhold session 45.58 p<0.001 \na Therapeutic range: 2.0-3.0, 2.0-2.5, 2.5-3.0 or 2.5-3.5; bSimple Linear Regression test \n\n\n\n\n\n\n\nThe total number of INR test in UC group was 265 which totaled to MYR 519.40. While the \ntotal cost of INR test under WMTAC was MYR 341 which involved 174 INR test. Thus, there \nis 34% of cost reduction when referred to WMTAC.  \n\n\n\n\n\n\n\nTable 5: Total reagent cost of INR test under UC and WMTAC \n\n\n\nVariables Usual care (UC) \n(4 months) \n\n\n\nWarfarin MTAC \n(4 months) \n\n\n\nTotal number of INR test 265 174 \nTotal cost of INR test (MYR) 519.40 341.04 \nAverage number of INR test per patient 6.5 4.2 \nAverage cost of INR test (MYR) per patient 12.74 8.23 \nNote: Cost per INR test is MYR 1.96 \n\n\n\nThe largest contributing factors affecting INR among WMTAC patients was diet which 55% \nfollowed by missed dose, 36% and drug interaction, 9%. From 55% of diet, the type of diet that \ninvolves was fruit (about 50%) then followed by green leafy and nuts. \n\n\n\n\n\n\n\n\n\n\n\n\n14 \n \n\n\n\n \nFigure 2: Factors affecting INR level under Warfarin MTAC \n\n\n\n\n\n\n\nDISCUSSION \n\n\n\nThe result demonstrated that participants in the WMTAC group spent more time in both the \nTTR and the expanded TTR compared to the UC group and these differences were statistically \nsignificant. This result was well supported by a study conducted by You J.H.S.  et al., where \npatients in the pharmacist-managed group spent a higher percentage of time in both the \ntherapeutic INR range and expanded therapeutic range than those in the physician-managed \ngroup [64% (n=112) versus 59% (n=109),  p<0.001] and [78% versus 76% p<0.001] \nrespectively [14]. The study conducted in Canada showed patients managed by the \nanticoagulation clinics were within the TTR and expanded therapeutic range more than patients \nmanaged by family physicians (73% versus 65%, p<0.0001) and 91% versus 85%, p<0.0001) \nas in accordingly [12]. This finding also supported by other study done by Hassan SS. et al, \nSaokaew S. et al and Thanimalai S. et al [10, 15, 16] \n\n\n\nThe percentage of time patients\u2019 INR was <1.5 and >5 is lower in WMTAC group compared to \nUC group respectively. This finding was supported by one of the studies conducted by Wilson \nS.J. et al. presented high risk INR values (<1.5 or >5.0) were more often observed in patients \nmanaged by family physicians (40%) than in patients managed by anticoagulation clinics (30%, \np = 0.001) [17].  The other study conducted by Young S. et al. found the percentage of time \nINR values was <1.5 and >5 were lower for both pharmacist care (PC) compared to usual care \n(UC) [ 0.7% (n=112) versus 1.9% (n=81) p<0.0001] and [0.3% versus 0.1% p< 0.0001] \nrespectively [12]. \n\n\n\nOur study only indicates a significant difference in UC group when comparing TTR with \nnumber of INR test, number of adjustment dose and number of withhold session. While TTR \nof WMTAC group did not has any influence in those third variables. This finding reflected on \nhow each group intervene the patients in each their INR visits. The WMTAC group used \nwarfarin dosage adjustment algorithms, assessed patients for factors that would affect the result \nand/or the subsequent recommendation for examples changes in medications or diet, sign and \nsymptoms of hemorrhagic or thromboembolic events, missed dose and illnesses and provide \neducation/counselling [11, 13]. \n\n\n\nThe total cost of INR test was lower in WMTAC group compared to UC group. Chan et al found \nthat the cost per patient per months was lower in the pharmacist-managed group (76 +/- US \ndollar) (43 +/- 53 British pound) compare to physician-managed group (98 +/- 158 US dollar) \n(55 +/- 89 British pound) [18]. Another study found that the direct anticoagulation care cost \n\n\n\n55\n\n\n\n36\n\n\n\n9\n\n\n\n0\n\n\n\n10\n\n\n\n20\n\n\n\n30\n\n\n\n40\n\n\n\n50\n\n\n\n60\n\n\n\nDiet Missed dose Drug interaction\n\n\n\nPe\nrc\n\n\n\nen\nta\n\n\n\nge\n %\n\n\n\n\n\n\n\n\n\n\n\n\n15 \n \n\n\n\nwas 35,465 US dollar versus 111,586 US dollar and the overall medical care cost was 754,191 \nUS dollar versus 1,480,661 US dollar for the anticoagulation service group versus the usual \ncare group [19]. \n\n\n\nThe limitation of this study was inconsistent WMTAC follow up, which may affect the \ncontinuity management of INR control. Thus, data from patient medical record will be missing. \nPatient with incomplete data would only produce limited data and they were excluded from the \nstudy. As the result we managed to get small sample size. \n\n\n\n\n\n\n\nCONCLUSIONS \n\n\n\nWMTAC resulted in a significantly better anticoagulation control. The WMTAC compared to \nusual care achieved significantly better INR control as measured by the percentage of time \npatient\u2019s INR values were kept in both therapeutic and expanded range. Besides that it also \nshowed benefit in our reagent cost expenses. \n\n\n\n\n\n\n\nACKNOWLEDGEMENT \n\n\n\nWe would like to thank the Director of Health Malaysia for permission to publish this paper. \nWe thank our patients and colleagues for the helpfulness throughout the research period. We \nalso thank Chief of Dungun Hospital, Dr Farah Najwa for giving permission to conduct this \nresearch. We are really grateful because we managed to complete our research. This research \ncannot be completed without the effort and co-operation from our group members. Last but not \nleast, we would also want to extend our appreciation to those who could not be mentioned here \nbut here played their role throughout our research journey. \n\n\n\n\n\n\n\nCONFLICT OF INTEREST \nThe author has none to declare. \n  \n\n\n\nREFERENCES \n\n\n\n1. Yahaya HM, Hassali MA, Awaisu A, Shafie AA.  Factors Associated with Warfarin \nTherapy Knowledge and Anticoagulation Control among Patients Attending a Warfarin \nClinic in Malaysia. Journal of Clinical and Diagnostic Research 2009 Aug 3:1663 - 1670. \n\n\n\n2. Kuruvilla M. A review of Warfarin dosing and monitoring. Bayl Univ Med Cent. 2001 Jul \n14:305-306. \n\n\n\n3. Pirmohamed M. Warfarin: Almost 60 years old and still causing problem. Br J Clin \nPharmacol.2006 Nov 62(5):1365-2125 \n\n\n\n4. Ciurus T, Radwan AC, Lelonek M. Factors affecting the quality of anticoagulation with \nwarfarin: experience of one cardiac centre. Kardiochir Torakochirurgia Pol. 2015 Dec \n12(4):334\u2013340. \n\n\n\n5. Keeling D, Baglin T, Tait C, Watson H, Perry D, Baglin C, et al. Guideline on oral-\nanticoagulation with warfarin. Br J Haematol.2011 Aug 154(3): 311-24 \n\n\n\n6. David LD & Robert WB. Development and Implementation of a Pharmacist- managed \ninpatient Warfarin Protocol. Bayl Univ Med Cent.2005 Oct 18(4):397-400 \n\n\n\n7. Yamada K & Nabeshima T. Pharmacist-managed clinics for patient education and \ncounselling in Japan: current status and future perspective. J Pharm Health Care Sci. 2015 \nJan 1:2 \n\n\n\n\n\n\n\n\n\n\n\n\n16 \n \n\n\n\n8. Dib JG, Mohammed K, Momattin H & Aishehri AM. Implementation of Pharmacist- \nmanaged Anticoagulation Clinic in Saudi Arabian Health Centre. Hosp Pharm. 2014 Mar \n49(3):260-268 \n\n\n\n9. Ahmad KM, Naina B, Mohamed S, Rajik MA, Badarudin NZ, et al. Protocol Medication \nTherapy Adherence Clinic: Warfarin. 1st ed. Haq AHSM, Rahman SSA, Othman NA, et al. \neditors. Malaysia Pharmaceutical Services Division Ministry of Health Malaysia; 2010 \n\n\n\n10. Hasan SS, Syed IA, Basariah N, Chong DW, Mei TK, Chin OH. Factors affecting warfarin-\nrelated knowledge and INR control of patients attending physician- and pharmacist-\nmanaged anticoagulation clinics. J Pharm Pract 2011 Oct 24(5):485-93 \n\n\n\n11. Van De Ham HA, Klungel OH, Leufkens HG, Van Staa TP. The patterns of anticoagulation \ncontrol and the risk of stroke, bleeding and mortality patients with non-valvular atrial \nfibrillation. Journal Thromb Haemost 2013 Jan 11(1): 107-115   \n\n\n\n12. Young S, Bishop L, Twells L, Dillon C,Hawboldt J, O'shea P. Comprison of Pharmacist \nManaged Anticoagulation with Usual Medical Care in a Family Medicine Clinic. BMC Fam \nPractic. 2011 12(88):1471-2296. \n\n\n\n13. Caldeira D, Cruz I, Morgado G, Stuart B, Gomes C, Martins C, Jo\u00e3o I, and Pereira H, \nEvaluation of time in therapeutic range in anticoagulated patients: a single-center, \nretrospective, observational study. BMC Res Notes.2014 Dec 9(7): 891 \n\n\n\n14. You J.H.S, Cheng G & Chan T.Y.K, Comparison of a clinical pharmacist-managed \nanticoagulation service with routine medical care: Impact on clinical outcomes & health \ncare costs. Hong Kong Med J. 2008 14(Suppl 3):s23-7 \n\n\n\n15. Saokaew S, Sapoo U, Nathisuman S, Chaiyakunapruk N and Permsuwan U, \nAnticoagulation control of pharmacist-managed collaborative care versus usual care in \nThailand. Int J Clin Pharm. 2012 Feb 34(1):105-12 \n\n\n\n16. Thanimalai S, Shafie AA, Hassali MA, Sinnadurai J, Comparing effectiveness of two \nanticoagulation management models in a Malaysian tertiary hospital. Int. J. Clin. Pharm. \n2013 35(5) 736-43 \n\n\n\n17. Wilson SJ, Wells PS, Geoffrey ML, Martin J, Burton E & Anderson DR. Comparing the \nquality of oral anticoagulant management by anticoagulant management by anticoagulation \nclinics & by family physician: A randomized controlled trial.  Canadian Medical Assciation \nJ. 2003 169(4):293-8 \n\n\n\n18. Chan FW, Wong RS, Lau WH, Chan TY, Cheng G & You JH. Management of Chinese \npatients on Warfarin therapy in two models of anticoagulation service \u2013 a prospective \nrandomized trial. British Journal of Clinical Pharmacology.2006 Nov 62(5):601-9     \n\n\n\n19. Hall D, Buchanan J, Helms B, Eberts M, Mark S, Manolis C, Peele P & Docimo A. Health \ncare expenditures and therapeutic outcomes of a pharmacist-managed anticoagulation \nservice versus usual medical care. Pharmacotherapy J. 2011 Jul 31(7):686-94            \n\n\n\n\n\n\n \nKnowledge level of government healthcare personnel in Labuan towards Registered Product and Notified Cosmetic\n\n\nZS Sujata Tan\n\n\n* Contact for correspondence, please email: zstan@moh.gov.my\n\n\n* Contact for correspondence, please email: farmasidungun@gmail.com\n\n\n \nThe percentage of time patients\u2019 INR was <1.5 and >5 is lower in WMTAC group compared to UC group respectively. This finding was supported by one of the studies conducted by Wilson S.J. et al. presented high risk INR values (<1.5 or >5.0) were more of...\n\n\n\n\n\n"
"\n\nMalaysian Journal of Pharmacy Volume 7 Issue 2 (2021) \n \n\n\n\n\n\n\n\n3 \n\n\n\n\n\n\n\n\n\n\n\n*Correspondence: sarahrobert@ppukm.ukm.edu.my Pharmacy Department, Hospital Cancelor Tuanku Muhriz, Universiti \n\n\n\nKebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, 56000 \n\n\n\nCheras, Wilayah Persekutuan Kuala Lumpur \n \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n Short Communication \n\n\n\n\n\n\n\nAn Evaluation of Interventions by Clinical Pharmacists in a \n\n\n\nTertiary Hospital \n \n\n\n\nSarah Anne Robert*, Suet Yin Chin, Lay Yen Gan, Chee Lan Lau, Kiew Bing Pau, Shue Hong Kong, \n\n\n\nFarah Waheeda Tajurudin, Mei Kuen Yin, Sheah Lin Ghan, Nur Jannah Azman, Xin Yun Chua, \n\n\n\nPoy Kei Lye, Stephanie Wai Yee Tan, Muhd Nordin Saud, Dexter Van Dort  \n\n\n\n\n\n\n\n \nArticle Info  \n\n\n\n \nReceived date: 4 Jan 2021  \n\n\n\nAccepted date: 15 Jul 2021 \n\n\n\nPublished date: 31 Dec 2021 \n\n\n\n\n\n\n\nKeywords: Ward based clinical \n\n\n\npharmacists, Intervention, \n\n\n\nhospital. \n\n\n\nABSTRACT  \n\n\n\n\n\n\n\nIntroduction:  Problems with medication therapy are a major concern in health care because of the \n\n\n\nassociated increase in morbidity, mortality and increased cost of treatment. Clinical pharmacy \n\n\n\nservices are well established in developed countries such as the United States and have been reported \n\n\n\nto reduce adverse drug events, medication errors, patient\u2019s length of stay, mortality rates and costs. \n\n\n\nClinical pharmacists proactively ensure rational medication use, avoiding medication errors at point \n\n\n\nof prescribing. They participate in ward rounds, communicate with the team in the wards, interview \n\n\n\npatients, perform medication reconciliation, provide counselling, therapeutic drug monitoring, \n\n\n\nantibiotic stewardship, discharge screening and follow ups. Any discrepancy or problems detected \n\n\n\nwill be conveyed to the relevant team member for correction.  Objective: To describe and evaluate \n\n\n\nthe interventions performed by clinical pharmacists in a tertiary teaching hospital in Malaysia. \n\n\n\nMethod: A clinical pharmacy observational retrospective study was conducted between January and \n\n\n\nDecember 2019. Fourteen clinical pharmacists were assigned to respective wards in the medical, \n\n\n\nsurgery and intensive care units to provide pharmaceutical care. All interventions performed in the \n\n\n\nwards were documented systematically. Result: A total of 3345 interventions were recorded. The \n\n\n\nmost frequent interventions were on rational drug therapy (n = 1456, 43.5%), followed by corrections \n\n\n\nmade on prescription (n = 1349, 40.3%) and changes in dosage and frequency (n = 540, 16.2%).  The \n\n\n\nmajority of suggestions (n = 3264, 97.6%) have been accepted. Conclusion: To our knowledge, this \n\n\n\nis the first study reporting clinical pharmacist interventions in a teaching hospital in Malaysia. The \n\n\n\ninvolvement of clinical pharmacist in the wards contributed to the optimisation of pharmacotherapy, \n\n\n\nsafety and better patients\u2019 outcomes. There was good inter-professional collaboration at the ward \n\n\n\nlevel. \n\n\n\n\n\n\n\n\n\n\n\nINTRODUCTION  \n  \n\n\n\nClinical pharmacists are pharmacy practitioners who specialize \n\n\n\nin providing care for patients directly and managing patients\u2019 \n\n\n\nmedications [1]. The American College of Clinical Pharmacy \n\n\n\ndefines clinical pharmacy as a health science discipline in \n\n\n\nwhich pharmacists provide patient care that optimizes \n\n\n\nmedication therapy and promotes health, wellness and disease \n\n\n\nprevention. This practice which uses the philosophy of \n\n\n\npharmaceutical care, blends a caring orientation with \n\n\n\nspecialized therapeutic knowledge, experience and judgement \n\n\n\nfor the purpose of ensuring optimal patient outcomes [2]. \n\n\n\nClinical pharmacists proactively ensure rational medication \n\n\n\nuse, avoiding medication errors at the point of prescribing.  \n\n\n\n\n\n\n\nClinical pharmacy services are well established in developed \n\n\n\ncountries such as the United States and have been reported to \n\n\n\nreduce adverse drug events, medication errors, patients\u2019 length \n\n\n\nof stay, mortality rates and costs [1]. Studies have shown that \n\n\n\n\n\n\n\n\nRobert S.A.et al. Mal J Pharm 7 (2) 2021, 3-6 \n\n\n\n\n\n\n\n4 \n\n\n\n\n\n\n\nwith clinical pharmacist participation in medical inpatient acute \n\n\n\ncare teams and medication chart review, preventable adverse \n\n\n\ndrug events were reduced by as high as 78% [3,4]. Clinical \n\n\n\npharmacist involvement in critical care team rounds resulted in \n\n\n\na potential cost saving of more than $210 000 in 4.5 months \n\n\n\n[5]. Participation in ward rounds, communicating with the \n\n\n\nhealth care team in the wards, interviewing patients, medication \n\n\n\nreconciliation, providing counselling, therapeutic drug \n\n\n\nmonitoring, discharge screening and follow up has shown \n\n\n\nbetter patient health outcomes [1]. In antimicrobial stewardship \n\n\n\nprogrammes, clinical pharmacists were also key members; with \n\n\n\nparticipation in developing guidelines, policy, monitoring drug \n\n\n\nusage, reviewing complex cases, intravenous to oral conversion \n\n\n\nand review of the appropriateness of antimicrobial use in an \n\n\n\nattempt to reduce antimicrobial resistance. This has promoted \n\n\n\nthe implementation of clinical pharmacy services globally \n\n\n\nincluding in developing countries.   \n\n\n\n\n\n\n\nMalaysia has introduced ward-based clinical pharmacy \n\n\n\nservices, where clinical pharmacists are given the responsibility \n\n\n\nof ensuring that patients receive optimal treatment, provide \n\n\n\ncounselling and promote proper and effective use of drugs. \n\n\n\nWith the paucity of reports about clinical pharmacists\u2019 \n\n\n\nintervention during ward rounds in Malaysian hospitals, this \n\n\n\nstudy aims to describe and evaluate the interventions performed \n\n\n\nby clinical pharmacists in the wards in a tertiary teaching \n\n\n\nhospital in Malaysia. \n\n\n\n\n\n\n\nMETHOD  \n \n\n\n\nStudy Design \n\n\n\n\n\n\n\nThis was an observational retrospective study conducted by \n\n\n\nfourteen clinical pharmacists in a single teaching hospital from \n\n\n\n1st January to 31st December 2019. Clinical pharmacists were \n\n\n\nassigned to fourteen wards (7 medical wards, 3 surgical wards, \n\n\n\n1 intensive care unit, 1 coronary care unit, 1 coronary recovery \n\n\n\nward, 1 neonatal intensive care unit) and were accountable to \n\n\n\ndocument all the interventions done while carrying out other \n\n\n\nclinical tasks in the wards. \n\n\n\n\n\n\n\nIntervention, Data Collection and Data Analysis \n\n\n\n\n\n\n\nAll documented interventions were conveyed to prescribers or \n\n\n\nnurses by direct communication, noting on the patient chart or \n\n\n\nphone messaging to the relevant team member. The \n\n\n\nintervention was considered accepted if the prescription was \n\n\n\nmodified as suggested within 2 working days. The data \n\n\n\nrecorded were then classified based on quantities and types of \n\n\n\ninterventions [6,7]. They were then categorised into \n\n\n\nprescription issues, dose and frequency modifications and \n\n\n\nrationalization of therapy. Prescription issues included wrong \n\n\n\ndrug indented, strength or route and transcribing near misses\u2019 \n\n\n\nrectification. Dose and frequency modifications have included \n\n\n\ndose optimisation or adjustment according to infection site and \n\n\n\norgan function. Rationalization of therapy was based on drug \n\n\n\nindication and de-escalation of antibiotics according to culture. \n\n\n\nThe data was analysed using SPSS version 26 using descriptive \n\n\n\nstatistics.  \n\n\n\n\n\n\n\nRESULT AND DISCUSSION \n \n\n\n\nIn this study, a total of 3345 pharmaceutical interventions were \n\n\n\ndocumented throughout one year. This demonstrates the \n\n\n\nimportance of clinical pharmacists based in the wards as part of \n\n\n\nthe team. Pharmaceutical care delivered by the clinical \n\n\n\npharmacists likely has improved pharmacotherapy by \n\n\n\nappropriate prescribing, monitoring and administration of \n\n\n\nmedication. The interventions performed were classified into \n\n\n\nthree main categories, with the most frequent one being rational \n\n\n\ntherapy (n = 1456, 43.5%), followed by correction on \n\n\n\nprescription (n = 1349, 40.3%) and changes in dose or \n\n\n\nfrequency (n = 540, 16.2%). Figure I. \n\n\n\n\n\n\n\nThe detailed characteristics of interventions and frequency are \n\n\n\nsummarised in Table I. Rational therapy was based on \n\n\n\nsuggestions to restart medications patients were taking but \n\n\n\nmissed out in the prescription (n = 381, 11.4%), suggestions for \n\n\n\nintravenous to oral switch (n = 362, 10.8%), drugs prescribed \n\n\n\nwithout an indication (n = 175, 5.2%), correction on drug \n\n\n\nadministration (n = 155, 4.6%), double therapy (n = 131, 3.9%), \n\n\n\nsuggestions to monitor lab parameters (n = 119, 3.6%), \n\n\n\ninappropriate route of administration / suitability of \n\n\n\nformulation for nasogastric tube feeding (n = 46, 1.4%), \n\n\n\ncontraindication (n = 45, 1.3%), duration of therapy (n = 36, \n\n\n\n1.1%),  and drug-drug interactions (n = 6, 0.02%).   Suggestions \n\n\n\nfor intravenous to oral switch were indicated, having \n\n\n\nadvantages such as reduced risk of thrombophlebitis and \n\n\n\nbacteraemia from use of venous access, possibility of earlier \n\n\n\ndischarge and cost savings [8]. Discontinuing unnecessary \n\n\n\nprescription also contributes to avoid adverse drug reactions \n\n\n\n[9]. In addition, reviewing the appropriateness of antimicrobial \n\n\n\nuse to ensure judicial use in the medical, surgical and intensive \n\n\n\ncare units of the hospital contributes to reducing the emergence \n\n\n\nof antimicrobial resistance and health-care-associated \n\n\n\ninfections [10]. \n\n\n\n\n\n\n\nCorrections on prescriptions included interventions performed \n\n\n\nduring prescribing and transcribing stages. Patients case notes \n\n\n\nand medication charts were reviewed and clarification were \n\n\n\nalso made when a deviation between prescriber\u2019s order and \n\n\n\nmedication chart were detected. The numbers were as follows: \n\n\n\nwrong dose (n = 479, 14.3%), missed medication (n = 289, \n\n\n\n8.6%), wrong frequency (n = 276, 8.3%), wrong drug (n = 211, \n\n\n\n6.3%), wrong duration (n = 72, 2.2%), duplicated prescription \n\n\n\nand wrong patient both (n = 9, 0.3%). Wrong dose was the most \n\n\n\nfrequent intervention made. Despite different ways of \n\n\n\nclassifying types of intervention done, our results were \n\n\n\n\n\n\n\n\nRobert S.A.et al. Mal J Pharm 7 (2) 2021, 3-6 \n\n\n\n\n\n\n\n5 \n\n\n\n\n\n\n\nconsistent with other studies where most common types of drug \n\n\n\nrelated problem were reported to be dose too low [11]. The least \n\n\n\nfrequent intervention was incomplete prescription (0.1%, n = \n\n\n\n4) such as prescription without dose, frequency, formulation or \n\n\n\nstrength clearly stated. This may be attributed to the electronic \n\n\n\nprescribing system. \n\n\n\n\n\n\n\nChanges / adjustments in dose and frequency were based on \n\n\n\nrenal and hepatic function (n = 288, 8.6%) and optimised \n\n\n\ndosage based on indication (n = 252, 7.5%). Changes in dose \n\n\n\nand frequency in particular renal and hepatic adjustments \n\n\n\ndirectly influences the minimisation of adverse drug reactions \n\n\n\nfrom overdosing, avoiding prolonged stay and indirectly saves \n\n\n\ncost [12].  \n\n\n\n\n\n\n\nOverall, total of 97.6% (n = 3264) interventions were accepted \n\n\n\nby the team. Globally, including Asian countries, an acceptance \n\n\n\nrate of 41 - 96% has been reported [3,13]. An example of \n\n\n\nrejected interventions is as follows: suggestion for addition of \n\n\n\nstatin therapy in a patient with underlying ischaemic heart \n\n\n\ndisease, reason for rejection was patient low-density \n\n\n\nlipoprotein was 1.54mmol/L and physician was keen to review \n\n\n\nangiogram findings first. The high acceptance of pharmacist\u2019s \n\n\n\nintervention demonstrates successful integration of clinical \n\n\n\npharmacists into the hospital multidisciplinary team to improve \n\n\n\npharmacotherapy of warded patients using evidence-based \n\n\n\nmedicine. This study showed that the team in the ward were \n\n\n\nwilling to accept and use the expert input of ward pharmacists \n\n\n\nto improve the quality of patient healthcare and safe use of \n\n\n\nmedicine. In addition, clinical pharmacists were always \n\n\n\navailable for drug information consultation or clarification for \n\n\n\nboth physicians and nurses. A total of 1879 queries received in \n\n\n\nthe ward were answered by clinical pharmacists in the one-year \n\n\n\nperiod. In addition, updates on new drugs, guidelines, policies, \n\n\n\nproduct recalls and availability of supply were provided \n\n\n\ncontinuously. To our knowledge, this is the first study reporting \n\n\n\non clinical pharmacist interventions in a teaching hospital in \n\n\n\nMalaysia. We reckon that ward-based clinical pharmacy \n\n\n\nservices by adequately trained pharmacists is a key component \n\n\n\nwithin the hospital setting as a cost-effective, safety and quality \n\n\n\nimprovement pharmacotherapy measure. \n\n\n\n\n\n\n\nThis study has limitations. Although the same training and  \n\n\n\nclassification system was used in recording the interventions; \n\n\n\nthere may be variation in definitions. This may limit the \n\n\n\ngeneralisability of the results. The clinical pharmacists also \n\n\n\nhave different levels of experiences.  \n\n\n\n\n\n\n\nCONCLUSION  \n \n\n\n\nThe high number of interventions and acceptance in the wards \n\n\n\nindicates the need of clinical pharmacists to be part of the \n\n\n\nhealthcare team. In addition to improving patients\u2019 outcome, \n\n\n\nthe inter-professional collaborations are better enriched. \n\n\n\n\n\n\n\nACKNOWLEDGEMENT \n  \n\n\n\nThere was no funding obtained for this work. We thank all our \n\n\n\ncolleagues especially Ms Michelle Tan, Ms Izyan Ibrahim and \n\n\n\nMs Hafiza Saripin from Drug Information Unit and Ms \n\n\n\nShariffah Norasmah, Mr Ehwan Kadir and Ms Pau Lok Ying \n\n\n\nand staffs from the Inpatient Unit for the support and \n\n\n\ncooperation at all times.   \n\n\n\n\n\n\n\nCONFLICT OF INTEREST \n  \n\n\n\nThis study has no conflict of interest. This research did not \n\n\n\nreceive any specific grant from funding agencies in public, \n\n\n\ncommercial or not-for-profit sectors. \n\n\n\n\n\n\n\nTable I. Characteristics of Interventions \n\n\n\n\n\n\n\nTypes of Interventions n % \n\n\n\nCorrection on Prescription   \n\n\n\n   Incomplete Prescription 4 0.1 \n\n\n\n   Wrong drug 211 6.3 \n\n\n\n   Duplicated prescription 9 0.3 \n\n\n\n   Wrong dose 479 14.3 \n\n\n\n   Wrong frequency 276 8.3 \n\n\n\n   Missed medication 289 8.6 \n\n\n\n   Wrong patient 9 0.3 \n\n\n\n   Wrong duration 72 2.2 \n\n\n\nChanges in Dose or Frequency   \n\n\n\n   Renal/hepatic dose adjustment 288 8.6 \n\n\n\n   Optimise dosage 252 7.5 \n\n\n\nRational Therapy   \n\n\n\n   Suggest new therapy 362 10.8 \n\n\n\n   Drug on previously but not prescribed 381 11.4 \n\n\n\n   Drug prescribed but not indicated 175 5.2 \n\n\n\n   Double therapy 131 3.9 \n\n\n\n   Contraindication 45 1.3 \n\n\n\n   Drug-drug interaction 6 0.2 \n\n\n\n   Inappropriate route of administration/ formulation 46 1.4 \n\n\n\n   Duration of therapy 36 1.1 \n\n\n\n   Suggest monitor lab parameters 119 3.6 \n\n\n\n   Correction of medication administration 155 4.6 \n\n\n\n\n\n\n\n\n\n\n\nFigure I. Interventions Performed by Clinical Pharmacists \n\n\n\n\n\n\n\n0 500 1000 1500 2000\n\n\n\nDose/Frequency Changes\n\n\n\nCorrection on prescription\n\n\n\nRational of Therapy\n\n\n\n\n\n\n\n\nRobert S.A.et al. Mal J Pharm 7 (2) 2021, 3-6 \n\n\n\n\n\n\n\n6 \n\n\n\n\n\n\n\nREFERENCE \n \n\n\n\n[1] Jacobi J. Clinical Pharmacists: Practitioners who are Essential \n\n\n\nMembers of your Clinical Care Team. RevMedClinCondes. 2016;27 \n\n\n\n(5):571-7.  https://doi.org/10.1016/j.rmclc.2016.09.002 \n\n\n\n[2] American College of Clinical Pharmacy. The Definition of Clinical \n\n\n\nPharmacy Pharmacotherapy 2008;28 (6):816-7.  \n\n\n\nhttps://doi.org/10.1592/phco.28.6.816 \n\n\n\n[3] Anderson AC, Brodin H, Nilsson JLG. Pharmacist Interventions in \n\n\n\nRelation to Patient Drug-RElated Problems Journal of Social and \n\n\n\nAdministrative Pharmacy 2003;20:82-91.  \n\n\n\n[4] Phansalkar S, Hoffman JM, Nebeker JR, Hurdle JF. 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"\n\nMalaysian Journal of Pharmacy Volume 8 Issue 2 (2022) \n \n\n\n\n\n\n\n\n\n\n\n\niii \n\n\n\n\n\n\n\n*Correspondence: chiaumingl@sunway.edu.my / \n\n\n\nsychan@usm.my  \n\n\n\nDOI: 10.52494/TIOG4999 \n\n\n\n1School of Medical and Life Sciences, Sunway University, Sunway City \n\n\n\n47500, Malaysia  \n2School of Pharmaceutical Sciences Universiti Sains Malaysia, Minden \n\n\n\n11800, Malaysia  \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n Editorial \n\n\n\n\n\n\n\nThe Paradigm shift of Pharmacy Profession at Post-COVID-19 \n\n\n\nEra in Malaysia \n\n\n\n\n\n\n\nLong Chiau Ming1, Siok Yee Chan2 \n\n\n\n \nMalaysia currently has a total 19,260 registered pharmacists with active practising certificate which is regulated by the Pharmacy \n\n\n\nBoard of Malaysia and relevant pharmacy laws and regulations. In tandem with the evolvement of medicine, pharmacists are \n\n\n\nresponsible for ensuring the safe and effective use of medications [1, 2], and they play a key role in providing healthcare to the \n\n\n\npublic as a frontliner, educator and clinician [3-8]. For instance, in community pharmacies, pharmacists dispense prescription and \n\n\n\nover-the-counter medications, compound extemporaneous preparation [9-11], provide medication, immunization, travel medicine \n\n\n\nand disease advice to patients [12-15], and offer other value added services such as medication adherence tool, blood pressure and \n\n\n\nblood glucose monitoring [16-18]. It is worth noting that with the implementation of Regulation 23 of Poison Regulation as early \n\n\n\nas year 1952, dispensing separation have been fully implemented in all public hospitals whereby all supply of medications should \n\n\n\nbe solely on prescription and the supply to be recorded, labelled and dispensed at the pharmacy. With medication dispensing as the \n\n\n\ncore professional duties, hospital pharmacists are also responsible for the procurement, storage, and distribution of medications, as \n\n\n\nwell as the preparation of radioactive diagnostic, cytotoxic drug and sterile products [5]. They also actively involved in patient \n\n\n\ncare, such as pharmacokinetics, pharmacotherapy services, medication therapy adherence clinic, medication reconciliation, \n\n\n\nreviewing medication orders and providing drug and poison information to healthcare professionals [19, 20]. \n\n\n\n\n\n\n\nDuring the pandemic, due to the urgency and need of volunteer in national vaccination program, pharmacists have been involved \n\n\n\nas COVID-19 frontliner [21, 22]. They spearheaded not just the procurement, storage and logistic coordination but also clinical \n\n\n\npharmacotherapy in ward and health screening prior to COVID-19 immunization [23-25]. At the same time in term of emergency \n\n\n\nand disaster relief work such as floods, pharmacists have quickly risen to the occasion and forged ahead beyond the pharmacy \n\n\n\ncurriculum to champion healthcare delivery. Efforts on the ground include training and certification of immunisation for \n\n\n\npharmacists, curriculum design of vaccination and disaster preparedness [26], travel medicine [27] volunteerism module to be \n\n\n\nembedded in the pharmacy curriculum in cultivating the initiative and preparedness. There are various ongoing and planned \n\n\n\ninitiatives at individual or team basis such as food bank, mental health social enterprises, silence volunteerism, as well as the \n\n\n\ndispensing separation discourse that could transform the healthcare system of the nation.  \n\n\n\n\n\n\n\nAs technology and the internet of things have proved the urgent need for digital health integration into our healthcare system, there \n\n\n\nhave been commendable efforts to push for electronic/digital prescriptions, which could enable big data to demonstrate the \n\n\n\nimportance of the role of pharmacists in validating the dispensing process. This is in line with the amendment of Poisons Act 1952, \n\n\n\nPoisons (Amendment) Bill 2022) that was approved by Malaysian Parliament in July 2022 [28, 29] that incorporated virtual and \n\n\n\nonline transaction such as electronic prescriptions and online pharmacy. The evolving roles of pharmacists in digital health pose \n\n\n\nboth challenges and opportunities that they face in this rapidly changing environment. \n\n\n\n\n\n\n\nFollowing this digitalisation as success of several online medical consultation portals, pharmacists are being called upon to leverage \n\n\n\ntheir expertise in medication management to help patients navigate the complex landscape of digital health tools [30, 31]. This \n\n\n\nincludes providing support and guidance on the safe and effective use of medications and collaborating with other healthcare \n\n\n\nproviders to ensure the best possible outcomes for patients [32, 33]. One key area where pharmacists can add value in digital health \n\n\n\nis in the management of chronic conditions and infectious disease such as COVID-19. These diseases, such as asthma, diabetes, \n\n\n\nand hypertension, require careful pharmacotherapy services in order to minimise its complications. Pharmacists can use digital \n\n\n\nhealth tools, such as telemedicine platforms and mobile apps, to provide ongoing support and guidance especially to paediatric and \n\n\n\n\nmailto:chiaumingl@sunway.edu.my\n\n\nmailto:sychan@usm.my\n\n\n\n\n\n\nLong and Chan Mal J Pharm 8 (2) 2022, iii-v \n\n\n\n\n\n\n\niv \n\n\n\n\n\n\n\nolder patients, helping them to better manage their health and avoid hospitalisation. Pharmacists can also play a key role in helping \n\n\n\npatients to navigate the complex landscape of digital health tools. With so many different apps and medical devices available, it \n\n\n\ncan be difficult for patients to know which ones are safe and effective. Pharmacists can provide guidance on the selection and use \n\n\n\nof these tools, helping patients to make informed decisions about their healthcare [32, 34-38]. \n\n\n\n\n\n\n\nDriven by the post-pandemic need of sustainability and flexibility, the integration of digital health technologies into the healthcare \n\n\n\nsystem is here to stay. In fact, the transition to virtual healthcare helps pharmacists to leverage their expertise in digital health. For \n\n\n\nexample, pharmacists can work with healthcare organizations and technology companies to develop new digital health tools and \n\n\n\nservices that meet the needs of patients and providers. Several online pharmacy spin-off from the local brick and mortar pharmacies \n\n\n\nhave become a viable healthcare business model.  Meanwhile, pharmacists can also spearheading the digital transformation by \n\n\n\ncombining both data science and digital health tools to carve out the competitive advantage of pharmacy in digital health.  \n\n\n\n\n\n\n\nTo maintain the competitive advantage, the whole pharmacy team need to stay up-to-date with the latest digital health technologies \n\n\n\nas this field evolve at a rapid pace. With hindsight, pharmacist associations should continue playing proactive roles to offer \n\n\n\nContinuing Professional Education (a.k.a. CPE) training related to information technology and digital science. The expansion of \n\n\n\npharmacists' roles into infection control and the integration of digital health technologies into the healthcare system present both \n\n\n\nchallenges and opportunities. In fact, we are now standing on the shoulders of senior pharmacists giants that adapted successfully \n\n\n\nto the advent of computerisation in the 1980s, the current generation of pharmacists must remain steadfast and stay current with \n\n\n\nthe latest technologies to develop data science competencies to be effective in the digital health ecosystem. \n\n\n\n\n\n\n\n\n\n\n\nREFERENCES \n \n[1] Mahmud, A.; Hashim, H.; Hing, L. W.; Yoong, L. P.; Yusof, N. M.; Bun, T. Y., Public awareness of community pharmacy and pharmacist. Malaysian \n\n\n\nJournal of Pharmacy (MJP) 2001, 1, (1), 22-28. https://doi.org/10.52494/QVBX2853  \n\n\n\n[2] Sing, W. S., Pharmacy practice in Malaysia. Malaysian Journal of Pharmacy (MJP) 2001, 1, (1), 2-8. https://doi.org/10.52494/RCWN2182  \n\n\n\n[3] Hussin, A. H., Adverse effects of herbs and drug-herbal interactions. 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H.; Richard, Y.; Hui, J. T. S., Implementation of the benchmarking guidelines on community pharmacies in Malaysia. \n\n\n\nMalaysian Journal of Pharmaceutical Sciences 2008, 6, (1), 13-31. \n\n\n\n[17] Zalina, Z., Knowledge, attitude and perception towards allergic reactions of paracetamol among general public in Kelantan, Malaysia. Malaysian journal \n\n\n\nof Pharmacy 2018, 4, (1), 60-61. http://eprints.unisza.edu.my/id/eprint/5694  \n\n\n\n[18] Lau, B.-T.; Subaramaniam, D.-K.; Teen, J.-S.; Ramasamy, K.-D.; Che-Pa, M.-F.; Maarof, M.-F.; Noor-Husna-Nazirah, A. R.; Ng, S.-Y.; Abdull-Kahar, \n\n\n\nS.-A.; Sallehuddin, Z.-E., Contraceptive Intention among Postpartum Women and Willingness for Pharmacist Counselling in Negeri Sembilan, Malaysia: \n\n\n\nA Cross-Sectional Study. Malaysian Journal of Pharmacy (MJP) 2022, 8, (1), 19-25. http://dx.doi.org/10.52494/ZDQD3721  \n\n\n\n[19] Chang, C. T.; Chan, H. K.; Cheng, J. T.; Thong, K. S.; Cheah, M. F.; Tan, R. 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K., Assessment of Vancomycin Pharmacokinetic Parameters among Malaysian Adult Patients in Penang with Different \n\n\n\nKidney Functions. Malaysian Journal of Pharmacy (MJP) 2021, 7, (2), 44-50. http://dx.doi.org/10.52494/JEGX6828  \n\n\n\n[21] Rosli, H. I.; Pee, L. T.; Chong, P. F., Clinical Pharmacist in a COVID-19 Hospital-A Malaysian Experience. Malaysian Journal of Pharmacy (MJP) 2021, \n\n\n\n7, (1), 3-6. http://dx.doi.org/10.52494/MWHH2973  \n\n\n\n[22] Tan, C. S.; Lokman, S.; Rao, Y.; Kok, S. H.; Ming, L. C., Public and private sectors collective response to combat COVID-19 in Malaysia. Journal of \n\n\n\npharmaceutical policy and practice 2021, 14, (1), 1-4. https://doi.org/10.1186/s40545-021-00322-x  \n\n\n\n[23] Alphonsoes, A. A.; Zain, F. M.; Velisamy, M. V.; Pilus, M.; Ali, N. A.; Suleiman, N., Patterns of Prescription Medicines Sale Through E-Marketplace in \n\n\n\nMalaysia and Associating Factors. Malaysian Journal of Pharmacy (MJP) 2021, 7, (2), 85-97. \n\n\n\n[24] Chung, E. S. N.; Ahmad, K.; Sim, S. M.; Chai, S.; Wong, S. F., Pharmacy Value-Added Services: Experience in a Malaysian Public Hospital. Malaysian \n\n\n\nJournal of Pharmacy (MJP) 2021, 7, (1), 22-27. http://dx.doi.org/10.52494/VHSZ7452  \n\n\n\n[25] Si, C. C.; Vong, I. C.; Wong, I. T.; Ng, K. L.; Wong, S. M.; Cheong, T. C.; Chau, V. V.; Chio, W., Monotherapy with Lopinavir/Ritonavir or in Combination \n\n\n\nwith Interferon Beta-1b in Patients with Non-severe COVID-19 Disease: A Clinical Case Series. Malaysian Journal of Pharmacy (MJP) 2021, 7, (1), 11-\n\n\n\n15. http://dx.doi.org/10.52494/FVTA3688  \n\n\n\n[26] Ang, W. C.; Fadzil, M. S.; Ishak, F. N.; Adenan, N. N.; Nik Mohamed, M. H., Readiness and willingness of Malaysian community pharmacists in providing \n\n\n\nvaccination services. Journal of Pharmaceutical Policy and Practice 2022, 15, (1), 1-8. https://doi.org/10.1186/s40545-022-00478-0  \n\n\n\n[27] Bhuvan, K.; Khan, T. M.; Xuan, W. Y.; Alrasheedy, A. A.; Ibrahim, M. I. M.; Leggat, P. A., Travel health-related activities and services provided by \n\n\n\ncommunity pharmacies in Selangor, Malaysia: A cross-sectional analysis. Travel medicine and infectious disease 2020, 33, 101463. \nhttps://doi.org/10.1016/j.tmaid.2019.07.019  \n\n\n\n[28] Lee, K. S.; Lim, Y. W.; Ming, L. C., The fate of the new pharmacy bill: going backwards or forwards? Journal of pharmaceutical policy and practice 2016, \n\n\n\n9, (1), 1-4. https://doi.org/10.1186/s40545-016-0081-7  \n\n\n\n[29] Lee, K. S.; Lim, Y. W.; Ming, L. C., Can the New Pharmacy Bill safeguard patient's right in healthcare? Current Medicine Research and Practice 2016, 6, \n\n\n\n(4), 167-168. http://dx.doi.org/10.1016/j.cmrp.2016.07.004  \n\n\n\n[30] Elangovan, D.; Long, C. S.; Bakrin, F. S.; Tan, C. S.; Goh, K. W.; Hussain, Z.; Al-Worafi, Y. M.; Lee, K. S.; Kassab, Y. W.; Ming, L. C., Application of \n\n\n\nBlockchain Technology in Hospital Information System. In Mathematical Modeling and Soft Computing in Epidemiology, 2020; Vol. 28, pp 231-46. \nhttps://www.taylorfrancis.com/chapters/edit/10.1201/9781003038399-12  \n\n\n\n[31] Elangovan, D.; Long, C. S.; Bakrin, F. S.; Tan, C. S.; Goh, K. W.; Yeoh, S. F.; Loy, M. J.; Hussain, Z.; Lee, K. S.; Idris, A. C., The Use of Blockchain \n\n\n\nTechnology in the Health Care Sector: Systematic Review. JMIR medical informatics 2022, 10, (1), e17278. https://doi.org/10.2196/17278  \n\n\n\n[32] Ming, L. C.; Hameed, M. A.; Lee, D. D.; Apidi, N. A.; Lai, P. S. M.; Hadi, M. A.; Al-Worafi, Y. M. A.; Khan, T. M., Use of Medical Mobile Applications \n\n\n\nAmong Hospital Pharmacists in Malaysia. Ther Innov Regul Sci 2016, 50, (4), 419-426. https://doi.org/10.1177/2168479015624732  \n\n\n\n[33] Park, T.; Kim, H.; Song, S.; Griggs, S. K., Economic Evaluation of Pharmacist-Led Digital Health Interventions: A Systematic Review. Int J Environ Res \n\n\n\nPublic Health 2022, 19, (19). https://doi.org/10.3390/ijerph191911996  \n\n\n\n[34] Loy, M. J.; Goh, K. W.; Osili, N.; Ming, L. C.; Dhaliwal, J. S.; Hermansyah, A.; Al-Worafi, Y. M.; Lee, K. S., Features and Functionalities of Medical \n\n\n\nMobile Applications for the Endemic Phase of COVID\u201019: Review and Content Analysis. Progress In Microbes & Molecular Biology 2022, 5, (1). \nhttps://doi.org/a10.36877/pmmb.0000285  \n\n\n\n[35] Ming, L. C.; Untong, N.; Aliudin, N. A.; Osili, N.; Kifli, N.; Tan, C. S.; Goh, K. W.; Ng, P. W.; Al-Worafi, Y. M.; Lee, K. S.; Goh, H. P., Mobile Health \n\n\n\nApps on COVID-19 Launched in the Early Days of the Pandemic: Content Analysis and Review. JMIR Mhealth Uhealth 2020, 8, (9), e19796. \nhttps://doi.org/10.2196/19796  \n\n\n\n[36] Morse, S. S.; Murugiah, M. K.; Soh, Y. C.; Wong, T. W.; Ming, L. C., Mobile Health Applications for Pediatric Care: Review and Comparison. Ther \n\n\n\nInnov Regul Sci 2018, 52, (3), 383-391. https://doi.org/10.1177/2168479017725557  \n\n\n\n[37] Izahar, S.; Lean, Q. Y.; Hameed, M. A.; Murugiah, M. K.; Patel, R. P.; Al-Worafi, Y. M.; Wong, T. W.; Ming, L. C., Content Analysis of Mobile Health \n\n\n\nApplications on Diabetes Mellitus. Front Endocrinol (Lausanne) 2017, 8, 318. https://doi.org/10.3389/fendo.2017.00318  \n\n\n\n[38] Apidi, N. A.; Murugiah, M. K.; Muthuveloo, R.; Soh, Y. C.; Caruso, V.; Patel, R.; Ming, L. C., Mobile Medical Applications for Dosage Recommendation, \n\n\n\nDrug Adverse Reaction, and Drug Interaction: Review and Comparison. Ther Innov Regul Sci 2017, 51, (4), 480-485. \nhttps://doi.org/10.1177/2168479017696266  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\nhttp://dx.doi.org/10.52494/JEGX6828\n\n\nhttp://dx.doi.org/10.52494/MWHH2973\n\n\nhttps://doi.org/10.1186/s40545-021-00322-x\n\n\nhttp://dx.doi.org/10.52494/VHSZ7452\n\n\nhttp://dx.doi.org/10.52494/FVTA3688\n\n\nhttps://doi.org/10.1186/s40545-022-00478-0\n\n\nhttps://doi.org/10.1016/j.tmaid.2019.07.019\n\n\nhttps://doi.org/10.1186/s40545-016-0081-7\n\n\nhttp://dx.doi.org/10.1016/j.cmrp.2016.07.004\n\n\nhttps://www.taylorfrancis.com/chapters/edit/10.1201/9781003038399-12\n\n\nhttps://doi.org/10.2196/17278\n\n\nhttps://doi.org/10.1177/2168479015624732\n\n\nhttps://doi.org/10.3390/ijerph191911996\n\n\nhttps://doi.org/a10.36877/pmmb.0000285\n\n\nhttps://doi.org/10.2196/19796\n\n\nhttps://doi.org/10.1177/2168479017725557\n\n\nhttps://doi.org/10.3389/fendo.2017.00318\n\n\nhttps://doi.org/10.1177/2168479017696266\n\n\n\n"
"\n\nMalaysian Journal of Pharmacy Volume 8 Issue 1 (2022) \n \n\n\n\n\n\n\n\n1 \n \n \n\n\n\n*Correspondence: chngchinchin@gmail.com 1 Clinical Research Centre, Hospital Pulau Pinang, Ministry of Health \nMalaysia. 10450 George Town, Penang, Malaysia \n2 Department of Medicine, Hospital Pulau Pinang, Ministry of Health \nMalaysia. Jalan Residensi, 10990 George Town, Pulau Pinang, Malaysia.  \n\n\n\n\n\n\n\nMALAYSIAN \nJournal of \nPharmacy \n\n\n\n Original Article \n \n\n\n\nBaclofen Prescribing Practice and Its Appropriateness in an \nOutpatient Setting of a Tertiary Hospital \n \nChin Chin Ch\u2019ng1*, Ru Shing Ng1, Hong Chin Wee1, Serene Li Ching T\u2019ng1, Loke Meng Ong1,2  \n \n\n\n\n \nArticle Info  \n \nReceived date: 28 Jul 2021  \nAccepted date: 03 Mar 2022 \nPublished date: 30 Jun 2022 \n \nKeywords: Baclofen; \nprescribing appropriateness; \nmedication errors; prescribing \nerrors. \n\n\n\nABSTRACT  \n  \nIntroduction:  Reports of baclofen toxicity in patients with severe renal impairment have raised \nconcerns regarding prescribing practice of the drug in the outpatient department. The aim of this \nstudy is to determine the incidence of inappropriate prescribing of baclofen and its prescribing \npattern. Method: This was a retrospective, observational study of prescriptions from July to \nDecember 2014 in an outpatient clinic of a public hospital in Malaysia. All prescriptions containing \nbaclofen were selected and records of these patients were retrieved and reviewed. Where available, \nresults of serum creatinine were also collected. Appropriateness of baclofen use was determined by \n3 independent doctors based on labelled indication of baclofen. Result: Out of 65,922 prescriptions \nscreened, 691 (1.1%) prescriptions which contained baclofen and whose records could be retrieved \nwere included in the analysis. Most of the prescriptions were for pain (78.2%) and contained at least \none pain medication. Baclofen was prescribed concomitantly with NSAIDs, antihypertensives and \noral hyperglycaemic agents in 535 (77.4%), 49 (7.1%) and 25 (3.6%) cases respectively. Two patients \nhad kidney failure. The overall proportion of inappropriate use of baclofen was high (n = 641, 92.7%). \nAlthough the trend of baclofen use reduced drastically after September 2014, possibly due to stricter \nprescribing practices that was enforced in the department, the proportion of its inappropriate use \nremained high. Conclusion: Inappropriate use of baclofen is prevalent. Rigorous interventions such \nas trainings should be carried out to avoid future preventable overdoses or toxicities. \n \n\n\n\n \nINTRODUCTION  \n  \nIn 2014, 5 cases of baclofen toxicity had been reported in \npatients with severe renal impairment in a public hospital in \nMalaysia. In the aforementioned report, all five patients \npresented with an acute onset of altered sensorium within 24 - \n48 hours of ingesting baclofen with total doses ranging from 20 \n- 40 mg. They had been prescribed baclofen for muscle ache \nand backache from the outpatient department (OPD).  \n \nBaclofen is an antispasmodic medication which a structural \nanalogue of \u03b3-aminobutyric acid (GABA) that acts at the spinal \ncord level by inhibiting both monosynaptic and polysynaptic \nreflexes [1], resulting the relief of muscle spasticity. It has been \nshown to be effective in the treatment of muscle spasticity due \nto multiple sclerosis and spinal lesions of traumatic, infectious, \n\n\n\ndegenerative, neoplastic and unknown origin that show \nsymptoms of skeletal hypertonus, and spastic and dyssynergic \nbladder dysfunction [2]. However, it is not recommended for \npatients with Parkinson's disease or spasticity caused by \nstrokes, cerebral palsy or rheumatoid disorders. Its lipophilicity \nand penetration into the cerebrospinal fluid are responsible for \nits CNS side effects such as sedation, fatigue, dizziness, \nlowering of the seizure threshold and cognitive dysfunction. \nInteractions and adverse reactions may occur when baclofen is \ntaken concomitantly with other drugs such as tricyclic \nantidepressants, MOA inhibitors and levodopa. \n \nBecause baclofen is predominantly excreted unchanged by the \nkidney, its clearance is significantly decreased, in patients with \nseverely impaired renal function, thus prolonging its half-life. \nIn fact, previous studies have reported altered consciousness, \n\n\n\n\n\n\n\n\nCh\u2019ng C.C.et al. Mal J Pharm 8 (1) 2022, 1-6 \n \n\n\n\n2 \n \n\n\n\nseizures, hallucinations, hypothermia, bradycardia, \nhypertension, abdominal pain [3], progressive confusion, \ngeneralized decrease in muscle tone [4], encephalopathy, ataxia \nand dystonia [5] in renal failure patients with baclofen \nintoxication. It is therefore suggested that baclofen should be \nprescribed only when it is clinically indicated whereby when \nthe expected benefit outweighs the potential risks, it is to be \nprescribed at a lower dose and with caution [2].  \n \nThe appropriateness of drug use is crucial in ensuring and \nascertaining the reduction of patient morbidity and mortality, \nimproving quality of life and in containing drug and healthcare \nexpenditure. Unfortunately, despite its importance, the \nirrational use of drugs is still a global problem and few \ncountries have taken sufficient actions to correct the situation \n[6]. The aim of this study is to determine the incidence \nproportion of baclofen prescribing and its appropriateness in a \ntertiary hospital in Malaysia and to describe its prescribing \npattern. \n \nMETHOD  \n \nStudy Design \n \nThis report involves a retrospective, observational study to \ndetermine the pattern and appropriateness of baclofen \nprescribing in an outpatient clinic of a tertiary public hospital \nin Malaysia. Prescriptions from the clinic from July to \nDecember 2014 were screened, from which, all prescriptions \ncontaining baclofen were selected. Consecutively, records of \nthese patients were retrieved and reviewed. Patient \ndemographics, symptoms, diagnosis, baclofen dose and \nduration, concomitant medications, comorbidities, medical \nhistory and prescriber category were recorded. Additionally, \nresults of serum creatinine were also retrieved if available. \nPrescriptions with missing patient records were excluded. The \nappropriateness of baclofen use was determined as per labelled \nindication and in situations when the diagnosis was not \nindicated, or where there is doubt, the appropriateness of its use \nbased on the medical records, was decided by three specialists. \nThis study was approved by the Medical Research and Ethics \nCommittee in Malaysia (KKM / NIHSEC / P15 - 589). There \nwere no potential competing interests involving any \ninvestigators in this study. \n \nStatistical analysis \n \nContinuous variables were summarised as means and standard \ndeviations if they were normally distributed, or as medians and \ninterquartile ranges if they were non-normally distributed. \nCategorical variables were summarised as frequencies and \npercentages. The incidence proportion of baclofen prescribing \nwas estimated from the total prescriptions issued from the \nclinic throughout the six months of the study, while the \n\n\n\nincidence proportion of inappropriate use of baclofen was \nestimated from the total prescriptions with baclofen over the \nsame period of time. All statistical analyses were performed \nwith STATA 11 (StataCorp, College Station, TX). \n \nRESULT  \n \nWe screened 65,922 prescriptions from the outpatient \ndepartment from July to December of 2014. From these \nprescriptions, 846 prescriptions contained baclofen, thereby \nresulting in an incidence proportion of baclofen prescribing of \n1.3% over the period of six months. Of these prescriptions, 691 \n(81.7%) clinical records were retrieved and included in the \nanalysis. All prescriptions were ordered by medical doctors, \nand none were prescribed by medical assistants. \n \nThe main demographic profile of the patients with the relevant \nprescriptions is shown in Table I. There were 104 (15.1%) \nprescriptions for elderly patients aged 65 years and above and \n22 (3.2%) prescriptions for children less than 18 years old. The \nmost frequent comorbidities recorded were hypertension \n(12.2%), diabetes mellitus (8.3%), dyslipidaemia (4.6%), \nosteoarthritis (3.8%) and gastritis (2.7%). \n\n\n\nBased on demographic profile matching, 123 (17.8%) \nprescriptions were from return patients who collected their \nprescriptions more than once within the study period. Another \n27 prescriptions had missing birthdates, and thus could not be \nmatched. The repeat prescriptions consist of 50 patients who \nreturned once, 6 patients who returned twice and one patient \nwho returned 4 times. \n \nTable II illustrates the dose, frequency and duration of baclofen \nprescribed. The dose of baclofen ranged from 10 mg to 60 mg \n\n\n\nTable I. Demographic profile of prescriptions, n = 691 \n \n\n\n\nCharacteristics  N (%) \nMean age, years (SD)  45.5 \n\n\n\n(16.50) \nGendera  Male 409 (59.3) \n Female 281 (40.7) \nRace Malay 221 (32.0) \n Chinese 256 (37.1) \n Indian 158 (22.9) \n Others b 51 (7.3) \n Unknown 5 (0.7) \nGlomerular filtration \nrate,c mls / min / 1.73m2 \n\n\n\n\u2265 90 (Stage 1) 94 (57) \n\n\n\n 60 to < 90 (Stage 2) 64 (38.8) \n 30 to < 60 (Stage 3) 3 (3.0) \n 15 to < 30 (Stage 4) 2 (1.2) \n\n\n\nNote: \naOne prescription had missing gender and the information could not be \ninferred from the records \nbCategory \u2018Others\u2019 include non-Malaysians and 1 Malaysian Iban case \ncCategorization of eGFR was based on the Kidney Disease Outcomes \nQuality Initiative (KDOQI) staging for kidney disease (n = 165) \n\n\n\n\n\n\n\n\nCh\u2019ng C.C.et al. Mal J Pharm 8 (1) 2022, 1-6 \n \n\n\n\n3 \n \n\n\n\nper day, with a mean daily dose of baclofen of 25.9mg ranging \nfrom 10mg to 60mg per day. The number of medications per \nprescription ranged from 2 to 15 with a mean of 5.4 (1.77) \nmedications per prescription. \n \n\n\n\nTable III shows the indications for the prescription of baclofen. \nIt is suggested that baclofen had mostly been prescribed for \npain (78.2%), whereby the majority of the pain symptoms were \nrelated to musculoskeletal pain (91.1%). Of these prescriptions \nfor musculoskeletal pain, 92 prescriptions (18.7%) were related \nto traumatic or soft tissue injuries, while the remaining 400 \n(81.3%) were related to non-traumatic events such as joint and \ntendon pain as well as back pain. \n \nThe majority of the prescriptions contained at least one pain \nmedication. We found 623 (90.2%) prescriptions with at least \none oral pain medication, 531 (76.8%) with topical methyl \nsalicylate ointment and 29 (4.2%) with intramuscular \ndiclofenac sodium. One prescription contained two concurrent \noral NSAIDs. In total, baclofen was prescribed concomitantly \nwith NSAIDs in 535 (77.4%) prescriptions.  \n \nAlmost one-fourth (165; 23.9%) of the records had information \non serum creatinine. Using the Modification of Diet in Renal \nDisease Study (MDRD) equation for estimated glomerular \nfiltration rate (eGFR), we found 71 (43%) prescriptions \nwhereby baclofen was prescribed for patients who had eGFR \nbelow 90 mL / min / 1.73m2, out of which two Stage 4 chronic \nkidney disease (CKD) (Table I) case were identified. Two other \nprescriptions were prescribed for patients with kidney failure \nalthough, no serum creatinine information was available in the \nrecords of these two patients. \n \n\n\n\nBaclofen was prescribed in the same prescription together with \nantihypertensives and/or diuretics 49 times and with oral \nhyperglycaemic agents (OHA) 25 times. The mean total daily \ndose of baclofen in prescriptions with concomitant \nantihypertensive and/or diuretic medications and concomitant \nOHAs were 24.0 (SD 8.35) mg and 22.4 (SD 10.52) mg, \nrespectively. The minimum and maximum daily baclofen doses \nin both these groups were 10 mg and 60 mg respectively. \n\n\n\nTable IV shows the breakdown number of prescriptions \ncontaining baclofen by month and the appropriateness of its \nuse. Aside from the month of August, where the number of \nprescribed baclofen was the highest, the general baclofen \nprescribing trend had been decreasing. The decrease was most \nprominent in the months of October, November, and December \nof 2014. \n \n\n\n\nTable II. Dose, frequency and duration of baclofen prescribed n = 691 \n \n\n\n\nPrescription  \nMean dose (SD), mg 10.1 (2.73) \nMean total daily dose per prescription (SD), mg 25.9 (9.85) \nMean total prescribed dose per prescription \n(SD), mga \n\n\n\n217.5 (170.80) \n\n\n\nDose frequency, n (%)  \nOD 2 (0.3) \nBD 311 (45.0) \nTDS 377 (54.6) \nPRN 1 (0.1) \nMean prescribed duration (SD), days 8.0 (4.03) \nPrescribed durationa, n (%)  \n3 days 2 (0.3) \n5 days 31 (4.6) \n7 days 556 (81.5) \n14 days 91 (13.3) \n21 days 1 (0.2) \n90 days 1 (0.2) \n\n\n\nNote: \nan = 682. Nine prescriptions were incomplete with no duration of \nprescribed baclofen \nPRN: pro re nata (when necessary) \n\n\n\nTable III. Prescribed indications, n = 691 \n \n\n\n\nSymptom/Diagnosis   n (%) \n\n\n\nMusculoskeletal pain, n = 492 (71.2%) \n\n\n\nTraumatic  Soft tissue injury 92 \n(13.3) \n\n\n\nNon-traumatic  Spine/Back 99 \n(14.3) \n\n\n\n  Joint and tendon 104 \n(15.1) \n\n\n\n  Limb 51 (7.4) \n  Neck 26 (3.8) \n  Others 22 (3.2) \n  Unspecified 98 \n\n\n\n(14.2) \n    \nNon-musculoskeletal \npain,  \nn = 48 (7.0%) \n\n\n\n Chest 21 (3.0) \n Abdominal 7 (1.0) \n Headache 17 (2.5) \n Miscellaneous 3 (0.4) \n\n\n\n    \nNot related to pain, n = \n106 (15.3%) \n\n\n\n Spasm 36 (5.2) \n Miscellaneous 45 (6.5) \n Follow-up 25 (3.6) \n\n\n\n    \nMissing symptoms & \ndiagnosis, n = 45 (6.5%) \n\n\n\n  \n45 (6.5) \n\n\n\n\n\n\n\nTable IV. Number of prescriptions by month, n = 65,922 \n \n\n\n\nMonth \nTotal \n\n\n\nprescriptions \nfrom OPD, n \n\n\n\nTotal \nprescriptions \n\n\n\ncontaining \nbaclofen, \n\n\n\nn (%) \n\n\n\nPrescribing \ninappropriateness, \n\n\n\nn (%) \n\n\n\nJuly 10,112 175 (1.73) 166 (94.9) \nAugust 11,033 350 (3.17) 328 (93.7) \nSeptember 11,038 99 (0.90) 92 (92.9) \nOctober 11,399 26 (0.23) 21 (80.8) \nNovember 10,952 22 (0.20) 20 (90.9) \nDecember 11,388 19 (0.17) 14 (73.7) \n\n\n\n \n\n\n\n\n\n\n\n\nCh\u2019ng C.C.et al. Mal J Pharm 8 (1) 2022, 1-6 \n \n\n\n\n4 \n \n\n\n\nThe inappropriate use of baclofen was high with an incidence \nproportion of inappropriate baclofen of 92.8% over the six \nmonths study. Prescriptions and records with neither symptom \nnor diagnosis were considered inappropriately prescribed. \nSome of the common symptoms and diagnoses for these \ninappropriately prescribed prescriptions were undefined back \npain (9.8%), undefined muscle pain (5.9%), shoulder pain \n(4.7%), fall (3.2%) and headache (2.6%). Additionally, the \nproportion of inappropriate use did not change much \nthroughout the six months. \n \n\n\n\nDISCUSSION \n \nBaclofen toxicity in severely impaired renal function patients \nis relatively rare despite being well-acknowledged for a long \ntime. In fact, several cases of baclofen toxicity IN GENERAL \nhave been reported, dating all the way back to 1976 have \nreported baclofen overdoses [7,8]. Elsewhere, Chen KS et al. \nreported nine cases of baclofen toxicity in such patients in a \nhospital in Taiwan from 1991 to 1995 [3]. More recently, there \nwere another two reported cases of baclofen toxicity in End-\nStage Renal Disease (ESRD) in the United States [4,5], where \none of the two patients was prescribed baclofen for muscle \nspasms while the other patient was prescribed the drug for back \npain. For the case of both patients, however, baclofen use for \nmuscle aches, backaches and general muscle spasms could \nhave been potentially inappropriate. \n \nFor the case of our study, we had found a sizable number of \nprescriptions for baclofen with no records of diagnoses or \nsymptoms indicating the use of the drug. Furthermore, some of \nthose prescriptions were only indicated for the refill of baclofen \nwith no documentation of its indication. Such critically \nincomplete records are a cause for concern. Meanwhile, the \nremaining records with documented symptoms and diagnoses \nhad little-to-no elaboration of the cause or origin of the \ncomplaint. \n \nIn most cases in our study, baclofen was found to not be the \nfirst-line choice of drug for its corresponding indication, and \nfurther justification of its use can only be attained by further \nelucidating information gathered from the records. Evidence-\nbased guidelines would suggest that its use is considered \npossibly appropriate if it was prescribed for muscle stiffness or \nprolapsed intervertebral disc. Besides that, its use is also \ndeemed possibly appropriate in prescriptions for muscle \nspasms in accordance with the NICE guideline on the treatment \nof spasticity for those aged under 19 years old [9], whereby the \nguidelines recommended baclofen for muscle spasms caused \nby spasticity. In addition to that, some studies have reported on \nthe effectiveness of baclofen in treating hemifacial spasms \n[10,11]. In spite of those guidelines and reports, we could not \npreclude its appropriateness due to inadequate information on \n\n\n\nthe diagnoses of muscle stiffness, spasms and hemispasm in our \ncohort. \n \nDespite how the diagnoses of several cases were left dubious, \nwe were able to determine definitively that baclofen was \ninappropriately prescribed in more than 90% of the \nprescriptions. These prescriptions involved the dispensing of \nbaclofen for gastritis and abdominal pain, headaches, pain or \ncramps in the limbs, upper respiratory tract infection as well as \nchest pain, all of which are indications for baclofen use that \ncould not be justified.  \n \nWhen baclofen is used together with drugs that could impact \nrenal function such as NSAIDs, its excretion could be \nsignificantly reduced and may lead to baclofen toxicity. Of the \n691 prescriptions, 77.4% contained at least one concomitant \nNSAIDs prescribed but only 23.9% of these prescriptions had \nrecords of creatinine. In fact, creatinine tests are usually not \nindicated in the premise for patients in the OPD unless there is \nreason to suspect renal impairment. Of the cases with available \nserum creatinine information, it is found that 43% of patients \nhad kidney function below the normal range based on the \nKidney Disease Outcomes Quality Initiative (KDOQI) CKD \nstaging (with eGFR below 90 mL / min / 1.73m2). It can be \nsurmised that for such cases, doctors prescribing baclofen who \nhad been uninformed of a patient\u2019s comorbid kidney disease \nmay cause potential baclofen accumulation, leading to toxicity. \nIn support of this, it is found that most cases of baclofen \ntoxicities in the literature were in patients with ESRD [3,4,5], \nwhich also include five locally reported toxicity cases. \nTherefore, it is important to prospectively ensure that renal \nfunction is not impaired before prescribing baclofen and to \navoid using it in end-stage kidney disease. \n \nFurthermore, the implications of polypharmacy and drug-\ndisease interactions in baclofen use is also an important \nconsideration.  Dhabali et al. reported that higher numbers of \ndrug-drug interactions were seen in older patients and in those \nwith multiple prescribed medications [12]. In our sample, most \nof the prescriptions contained between four to six drugs, \nincreasing the risk of drug interactions. Besides that, we have \nalso found several cases where baclofen was prescribed in \npatients with comorbid diabetes mellitus and hypertension. \nThese cases deserve attention because baclofen can increase \nblood glucose concentrations and concomitant treatment with \nantihypertensives can enhance the reduction in blood pressure. \nNevertheless, assessment and monitoring for side effects could, \nunfortunately, not be done as they were outpatients. To \nexacerbate the occurrence of drug-disease and drug-drug \ninteractions, many of the hospitals in Malaysia have yet to \nincorporate an integrated electronic medical record system, and \npatients may have comorbid conditions with corresponding \nmedications that are prescribed elsewhere unbeknownst to the \n\n\n\n\n\n\n\n\nCh\u2019ng C.C.et al. Mal J Pharm 8 (1) 2022, 1-6 \n \n\n\n\n5 \n \n\n\n\nOPD. Thus, doctors will have to be more careful when \nprescribing to prevent such medication interactions and errors.  \n \nIncorrect dosing for baclofen in renal failure patients, \noftentimes leading to an overdose, is a serious issue that cannot \nbe overlooked. A study carried out on medication errors \nreported to the National Medication Error Reporting System in \nMalaysia found that more than 75% of the errors were \nattributed to the prescribing stage. Incorrect drug dosage was \nreported to be the most common error [13]. A review paper on \nmedication errors in Southeast Asia by Salmasi et al. also \nrevealed incorrect dosing to be the most frequently reported \ntype of prescribing error [14]. A survey conducted on senior \npractising hospital pharmacists in West Malaysia found that \n60% of the participants agreed that prescribing errors among \ndoctors were common [15]. Another study carried out in the US \nalso found most (70%) medication errors originated from the \nprescribing stage and incorrect dose and drug selection were \nthe two most commonly reported errors [16]. \n \nStudies have shown that several factors may contribute to such \ninappropriate prescribing or prescribing errors. Shortage of \nstaff, overworked staff, distractions, prescriber level of \nknowledge or lack of training, prescriber conflicts of interest, \nprevious prescribing experience or practice as well as failure to \ncomply with clinical guidelines and patient demand can all lead \nto errors [14,17,18]. On average, the OPD of this hospital sees \nclose to 800 patients a day, which is an exorbitant amount that \ncan be attributed to the fact that it is inexpensive to seek \ntreatment from public hospitals in Malaysia. The number of \nstaff is not commensurate with the high number of patients, \nleading to overworked and distracted staff, and possibly \ncontributing to poor documentation practices in the department.  \n \nStricter prescribing practices for baclofen were enforced in the \nOPD in September 2014 after five cases of baclofen toxicity in \nchronic kidney patients were reported. Consequently, the effect \nof this newfound awareness was reflected in the drastically \nreduced number of prescribed baclofen beginning in September \n2014. Additionally, interventions to assuage this issue, \nincluding continuous professional education sessions and \nmandatory validation by the head of departments for every \nprescribed baclofen were implemented. This need for \nvalidation may deter junior doctors from prescribing the drug \nwhich could explain the reduction in its prescription. Despite \nthese actions, however, the proportion of its inappropriate use \ndid not change much, a fact that may be attributed to the passing \ndown of misinformation, whereby previous malpractice \ninvolving baclofen is handed down from one generation of \ndoctors to another.  \n \nAs of December 2014, we saw a larger drop in inappropriate \nuse, suggesting that the education sessions were taking effect. \nTo supplement these educational endeavours, guidelines and \n\n\n\ntraining on guidelines should be introduced and carried out \nmore often to ascertain a more lasting impact. A review by le \nGrand et al. found that standard treatment guidelines in several \ncountries such as Kenya, Fiji and Indonesia have had positive \nchanges in prescribing practices [18]. Unfortunately, this was a \nshort study, and we were not able to determine if the drop \npersisted in later months. Nevertheless, guidelines and training \nappear to be promising and can be explored further in future \ninterventions. Proper and more detailed recording should also \nbe enforced to prevent future medication errors due to a lack of \nmedical information. \n \nCONCLUSION  \n \nThe proportion of inappropriate use of baclofen was very high. \nAlthough the number of baclofen prescribed was significantly \nreduced after the enforcement of stricter prescribing practices, \nthe same could not be demonstrated in the proportion of its \ninappropriate use. Therefore, more frequent and rigorous \ninterventions should be enforced to ensure lasting improved \nprescribing practices to avoid any risk of future preventable \noverdoses or toxicities. \n \nACKNOWLEDGEMENT \n  \nWe would like to thank Dr Chan Wei Heng (Department of \nOrthopaedics, Penang Hospital), Dr Choo Chin Yin \n(Department of Orthopaedics, Hospital Seberang Jaya), Dr \nYoon Chee Kin (Department of Medicine, Penang Hospital) \nand the staffs in the outpatient department of Penang Hospital \nfor their assistance in the study. We would also like to thank \nthe Director General of Health Malaysia for his permission to \npublish this article. This study was not supported by any grant \nor funding. \n \n\n\n\nCONFLICT OF INTEREST \n  \nThis study has no conflict of interest. This research did not \nreceive any specific grant from funding agencies in public, \ncommercial or not-for-profit sectors. \n \n\n\n\nREFERENCE \n \n[1] Novartis Pharmaceuticals Canada Inc. Product Monograph Lioresal \n\n\n\n(baclofen) 10 and 20 mg tablet [Internet]. [cited 2017 Jan 5].  \nhttps://www.ask.novartispharma.ca/download.htm?res=lioresal_scrip\n_e.pdf&resTitleId=802 \n\n\n\n[2] Australian Product Information - Lioresal (Baclofen) Tablets \n[Internet]. [cited 2017 Jan 5].  \nhttp://www.guildlink.com.au/gc/ws/nv/pi.cfm?product=nvplrsor1011\n3 \n\n\n\n[3] Chen KS, Bullard MJ, Chien YY, Lee SY. Baclofen toxicity in \npatients with severely impaired renal function. Ann Pharmacother. \n1997 Nov;31(11):1315\u201320  \nhttps://doi.org/10.1177/106002809703101108 \n\n\n\n\n\n\n\n\nCh\u2019ng C.C.et al. Mal J Pharm 8 (1) 2022, 1-6 \n \n\n\n\n6 \n \n\n\n\n[4] Ijaz M, Tariq H, Kashif M, Marquez JG. Encephalopathy and \nhypotonia due to baclofen toxicity in a patient with end-stage renal \ndisease. Am J Case Rep. 2015 Apr 20;16:232\u20135. \nhttps://doi.org/10.12659/AJCR.893222 \n\n\n\n[5] Porter LM, Merrick SS, Katz KD. Baclofen Toxicity in a Patient with \nHemodialysis-Dependent End-Stage Renal Disease. J Emerg Med. \n2017 Apr;52(4):e99\u2013100. \nhttps://doi.org/10.1016/j.jemermed.2016.09.025 \n\n\n\n[6] The World Medicines Situation Report [Internet]. [cited 2017 Jan 5]. \nhttp://www.who.int/medicines/areas/policy/world_medicines_situati\non/en/ \n\n\n\n[7] May CR. Baclofen overdose. Ann Emerg Med. 1983 Mar;12(3):171\u2013\n3. https://doi.org/10.1016/s0196-0644(83)80562-9 \n\n\n\n[8] Paulson GW. Overdose of lioresal. Neurology. 1976 \nNov;26(11):1105\u20136. https://doi.org/10.1212/wnl.26.11.1105 \n\n\n\n[9] Spasticity in under 19s: management [Internet]. London: National \nInstitute for Health and Care Excellence (UK); 2016 [cited 2021 Nov \n17]. (National Institute for Health and Care Excellence: Clinical \nGuidelines). http://www.ncbi.nlm.nih.gov/books/NBK554883/ \n\n\n\n[10] Sandyk R, Gillman MA. Baclofen in hemifacial spasm. Int J Neurosci. \n1987 Apr;33(3\u20134):261\u20134. \nhttps://doi.org/10.3109/00207458708987410 \n\n\n\n[11] Sandyk R. Baclofen in hemifacial spasm. Eur Neurol. \n1984;23(3):163\u20135 https://doi.org/10.1159/000115698 \n\n\n\n[12] Dhabali A a. H, Awang R, Zyoud SH. Clinically important drug-drug \ninteractions in primary care. J Clin Pharm Ther. 2012 Aug;37(4):426\u2013\n30. https://doi.org/10.1111/j.1365-2710.2011.01314.x \n\n\n\n[13] Samsiah A, Othman N, Jamshed S, Hassali MA, Wan-Mohaina WM. \nMedication errors reported to the National Medication Error \nReporting System in Malaysia: a 4-year retrospective review (2009 to \n2012). Eur J Clin Pharmacol. 2016 Dec;72(12):1515\u201324. \nhttps://doi.org/10.1007/s00228-016-2126-x \n\n\n\n[14] Salmasi S, Khan TM, Hong YH, Ming LC, Wong TW. Medication \nErrors in the Southeast Asian Countries: A Systematic Review. PLOS \nONE. 2015 Sep 4;10(9):e0136545. \nhttps://doi.org/10.1371/journal.pone.0136545 \n\n\n\n[15] Rahman AR, Noor AR, Hassan Y. How good are doctors as drug \nprescribers? Med J Malaysia. 1994 Dec;49(4):364\u20138.  \n\n\n\n[16] Kuo GM, Phillips RL, Graham D, Hickner JM. Medication errors \nreported by US family physicians and their office staff. Qual Saf \nHealth Care. 2008 Aug;17(4):286\u201390. \nhttps://doi.org/10.1136/qshc.2007.024869 \n\n\n\n[17] le Grand A, Hogerzeil HV, Haaijer-Ruskamp FM. Intervention \nresearch in rational use of drugs: a review. Health Policy Plan. 1999 \nJun;14(2):89\u2013102. https://doi.org/10.1093/heapol/14.2.89 \n\n\n\n[18] Joshua IB, Passmore PR, Parsons R, Sunderland VB. Appropriateness \nof prescribing in selected healthcare facilities in Papua New Guinea. \nHealth Policy Plan. 2014 Mar;29(2):257\u201365. \nhttps://doi.org/10.1093/heapol/czt012 \n\n\n\n\n\n"
"\n\nMalaysian Journal of Pharmacy Volume 7 Issue 2 (2021) \n \n\n\n\n\n\n\n\n22 \n\n\n\n\n\n\n\n\n\n\n\n*Correspondence: chua_ss@hotmail.com \n1Department of Pharmacy, Faculty of Medicine, University of Malaya, \n\n\n\n50603 Kuala Lumpur, Malaysia \n2School of Pharmacy, Faculty of Health and Medical Sciences, Taylor\u2019s \nUniversity, 1 Jalan Taylor\u2019s, 47500 Subang Jaya, Selangor, Malaysia \n3School of Medicine, Faculty of Health and Medical Sciences, Taylor\u2019s \n\n\n\nUniversity, 1 Jalan Taylor\u2019s, 47500 Subang Jaya, Selangor, Malaysia \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n Original Article \n\n\n\n\n\n\n\nKnowledge of Malaysian University Students on Methods of \n\n\n\nContraception, Assessed Using a Validated Instrument  \n\n\n\n(Knowledge on Methods of Contraception) \n \n\n\n\nPei Wen Kang1, Siew Siang Chua2*, Anitha Ponnupillai3  \n\n\n\n\n\n\n\n \nArticle Info  \n\n\n\n \nReceived date: 4 May 2021  \n\n\n\nAccepted date: 29 Jul 2021 \n\n\n\nPublished date: 31 Dec 2021 \n\n\n\n\n\n\n\nKeywords: Contraception, \n\n\n\nknowledge, university students, \n\n\n\nvalidation, KMC-25. \n\n\n\nABSTRACT  \n\n\n\n\n\n\n\nBackground: Sexually active woman or couple may not be aware of the different methods of \n\n\n\ncontraception and this can lead to unplanned pregnancy with psychological and social effects, and \n\n\n\nwith significant impact on a woman\u2019s\u2019 life. Objective: To develop and validate an instrument, \n\n\n\nKnowledge on Methods of Contraception (KMC) and to assess the knowledge of non-medical \n\n\n\nrelated university students on the methods of contraception. Method: The 25-item KMC (KMC-\n\n\n\n25) was initially administered to 130 non-medical related university students and retested after four \n\n\n\nweeks. Fifty pharmacy undergraduates were recruited for comparison. The validated KMC-25 was \n\n\n\nthen completed by another 402 non-medical related university students. Result: Internal \n\n\n\nconsistency of the KMC-25 was good with Cronbach\u2019s alpha = 0.78. There was significant \n\n\n\ncorrelation between the test-retest total scores (p < 0.001) and no significant difference for all the \n\n\n\nitems, indicating stable reliability. Flesch Reading Ease score was 49.3 which means that the KMC-\n\n\n\n25 could be easily understood by undergraduates. The KMC-25 scores between pharmacy and non-\n\n\n\nmedical related students were significantly different with median (interquartile range, IQR) of 60 \n\n\n\n(50 - 68) and 26 (12 - 40), respectively (p < 0.001). Out of 402 respondents, only 34 (8.4%) scored \n\n\n\n50% and above, and were considered to have adequate knowledge on methods of contraception. \n\n\n\nKnowledge on contraception was significantly related to various characteristics of the students. \n\n\n\nConclusion: The present study showed that KMC-25 is a reliable and valid instrument to assess \n\n\n\nuniversity students\u2019 knowledge on methods of contraception. However, university students from \n\n\n\nnon-medical related programs have poor knowledge and this warrants the implementation of \n\n\n\neducational programs. \n\n\n\n INTRODUCTION  \n\n\n\n\n\n\n\nApproximately 210 million pregnancies were reported \n\n\n\nannually with an estimated 38% of unplanned pregnancies \n\n\n\nwhere 22% resulted in abortion [1]. A nationwide \n\n\n\nMillennium Cohort Study in the United Kingdom also \n\n\n\nrevealed 33% unplanned pregnancy [2]. In recent years, \n\n\n\nyoung people reach adolescence early, prefer to marry and \n\n\n\ngive birth later, but are more likely to be sexually active \n\n\n\nbefore marriage [3]. Adolescent pregnancy has become a \n\n\n\nmain concern worldwide since such pregnancies are often \n\n\n\nunplanned and unwanted. Furthermore, adolescent \n\n\n\npregnancy can have negative impact on a woman\u2019s physical, \n\n\n\nmental, economic and social status.\n\n\n\n\n\n\n\n\n\n\n\n\nKang P.W. et al. Mal J Pharm 7 (2) 2021, 22-31 \n\n\n\n\n\n\n\n\n\n\n\n23 \n\n\n\n\n\n\n\nIt has been estimated that 1.8 billion young people are between \n\n\n\nthe age of 18 and 25 years and majority of these people are \n\n\n\nsexually active [4]. A study in Malaysia reported that 5.4% of \n\n\n\nstudents aged between 12 and 19 years already had sexual \n\n\n\nintercourse 0. Another study by the National Population and \n\n\n\nFamily Board of Malaysia found that 2.2% of young adults who \n\n\n\nwere 15 - 24 years old, already had sexual intercourse [6].  \n\n\n\n\n\n\n\nMalaysia is a developing country with multiracial \n\n\n\ncommunities. In the current era of modernization, many \n\n\n\nMalaysians still uphold a conservative and traditional view \n\n\n\nwith regards to sex-related issues [7]. The education system did \n\n\n\nnot have a comprehensive sexual education program. Human \n\n\n\nreproductive system was only taught in secondary schools as a \n\n\n\nscience subject which was very technical until the introduction \n\n\n\nof the module, Reproductive and Social Health Education in \n\n\n\n2006 which covered more topics on human reproduction with \n\n\n\nemphasis on the risk of premarital sex and moral values [8,9]. \n\n\n\nA survey supported by the Ministry of Health in 2015 found \n\n\n\nthat 35% of Malaysian young women did not realise that they \n\n\n\ncould become pregnant even if they had sex for the first time \n\n\n\n[8]. In recent years, unwanted or unplanned pregnancies in \n\n\n\nMalaysia had led to a rise in abortions and abandoned babies, \n\n\n\nwith 900 cases of baby dumping being reported from 2010 to \n\n\n\n2019 [9]. \n\n\n\n\n\n\n\nBesides the well-documented benefits of birth control to the \n\n\n\nwomen\u2019s health and the welfare of children, contraception is \n\n\n\nalso a key factor for a better-balanced and rewarding life for \n\n\n\nboth women and men [10]. Contraception, also known as \n\n\n\nfamily planning or birth control, empowers couples to make \n\n\n\nwell informed choices and allows them the fundamental human \n\n\n\nrights to decide on the number of children they desire and to \n\n\n\nplan appropriate interpregnancy interval between their children \n\n\n\nas well as the timing of their children\u2019s birth [11]. A couple has \n\n\n\nthe luxury of choosing from an array of birth control methods \n\n\n\nwhich are available with different mode of administration, \n\n\n\nmechanism of action, safety profiles, effectiveness, \n\n\n\nreversibility and convenience [12]. However, not every \n\n\n\nsexually active woman or couple know about the choices of \n\n\n\ncontraception.     \n\n\n\n\n\n\n\nA study in Malaysia indicated that female university students \n\n\n\nhad poor knowledge on reproduction and pregnancy, \n\n\n\ncontraceptive uses and contraceptive methods available [7]. \n\n\n\nThis study was conducted about 10 years ago and on only \n\n\n\nfemale university students. In addition, this previous study did \n\n\n\nnot focus on knowledge of different methods of contraception. \n\n\n\nAnother study found that students aged between 13 and 17 \n\n\n\nyears also had inadequate knowledge about contraception, with \n\n\n\na majority thinking that washing the vagina or having a hot \n\n\n\nshower after sexual intercourse could prevent pregnancy [13]. \n\n\n\nStudies on knowledge of contraception are still scarce in \n\n\n\nMalaysia. However, a validated instrument is required to assess \n\n\n\nsuch knowledge. University students in Malaysia are mainly \n\n\n\nbetween 19 to 24 years old which has been categorized as \n\n\n\nyouths and are usually sexually active. Therefore, the present \n\n\n\nstudy was conducted to develop and validate a self-\n\n\n\nadministered knowledge instrument, and to assess the \n\n\n\nknowledge of university students on contraception. \n\n\n\n\n\n\n\nMETHOD  \n\n\n\n\n\n\n\nThe study consisted of two phases: Phase 1 was to develop and \n\n\n\nvalidate an instrument, Knowledge on Methods of \n\n\n\nContraception (KMC) and Phase 2 was to determine the \n\n\n\nknowledge of university students on methods of contraception. \n\n\n\nA cross-sectional study was conducted at the various non-\n\n\n\nmedical faculties of a major public university in Malaysia. \n\n\n\nEthical approval was obtained from the Medical Ethics \n\n\n\nCommittee of University Malaya Medical Centre (Medic. No: \n\n\n\n201411-783), before commencement of the study. All \n\n\n\nrespondents provided written informed consent. \n\n\n\n\n\n\n\nIncluded were students who were registered as undergraduates \n\n\n\nin any of the 10 non-medical related faculties in the public \n\n\n\nuniversity under study at the time of recruitment. Students from \n\n\n\nmedical related faculties such as the Faculty of Dentistry and \n\n\n\nFaculty of Medicine, as well as Academies of Islamic Studies \n\n\n\nor Malay Studies, postgraduates, foreigners, students with \n\n\n\ncognitive problems or those who had already graduated, were \n\n\n\nexcluded. \n\n\n\n\n\n\n\nThe sample size for this study was calculated based on the \n\n\n\nnumber of items in KMC-25 to participant ratio. Munro [14] \n\n\n\nrecommended a ratio of 1 : 5 and hence, the minimum number \n\n\n\nof participants required for Phase 1 of the study should be 125. \n\n\n\nIn addition, using Raosoft sample size calculator (Raosoft.com) \n\n\n\nand assuming that the proportion of students with adequate \n\n\n\nknowledge on contraception is 50% in an undergraduate \n\n\n\nstudent population of about 10,000 at 95% confidence level, the \n\n\n\nminimum sample size required for Phase 2 was 370. \n\n\n\n\n\n\n\nThe first version of the Knowledge on Methods of \n\n\n\nContraception (KMC) instrument consisted of 40 items (KMC-\n\n\n\n40). It was developed based on studies in the literature \n\n\n\n[7,13,15-20]. A pilot study was conducted on 40 undergraduate \n\n\n\nstudents from non-medical related faculties to test the clarity \n\n\n\nand face validity of the questionnaire as well as feasibility of \n\n\n\nthe study procedure, and then the questionnaire was modified \n\n\n\naccordingly. The Cronbach\u2019s alpha, corrected item-total \n\n\n\ncorrelation, Cronbach\u2019s alpha if item deleted, Difficulty Factor \n\n\n\nand Flesch Reading Ease were considered for the removal of \n\n\n\nany items in KMC-40.\n\n\n\n\n\n\n\n\n\n\n\n\nKang P.W. et al. Mal J Pharm 7 (2) 2021, 22-31 \n\n\n\n\n\n\n\n\n\n\n\n24 \n\n\n\n\n\n\n\nConsequently, the KMC-40 was modified to only 25 items \n\n\n\n(KMC-25). The 25 items were classified into four categories: \n\n\n\nQuestions 1 to 5 were for Natural Methods, Questions 6 to 11 \n\n\n\nfor Barrier Methods, Questions 12 to 22 for Hormonal Methods \n\n\n\nand Questions 23 to 25 for Intrauterine Devices. \n\n\n\n\n\n\n\nPhase 1: Development and validation of an instrument, \n\n\n\nKnowledge on Methods of Contraception (KMC) \n\n\n\n\n\n\n\nA researcher was stationed in each of the non-medical faculty \n\n\n\nof the public university. Students were approached to \n\n\n\nparticipate in the study based on convenience sampling. The \n\n\n\nresearcher approached each student and explained the aim and \n\n\n\nprocedures of the study. If the student agreed to participate, he \n\n\n\nor she would sign an informed consent form and was then given \n\n\n\na questionnaire to fill. The completed questionnaire was \n\n\n\nreturned to the researcher who would ensure that the \n\n\n\nquestionnaire had been filled. The researcher contacted all the \n\n\n\nrespondents after three to four weeks to fill the KMC-25 again. \n\n\n\n\n\n\n\nPhase 2: Knowledge of university students on methods of \n\n\n\ncontraception \n\n\n\n\n\n\n\nPhase 2 of the study followed similar procedure as Phase 1 \n\n\n\nexcept that the respondents filled the KMC-25 only once. The \n\n\n\ntotal number of undergraduate students registered in each non-\n\n\n\nmedical faculty was obtained from the Admission and Record \n\n\n\nSection of the university. The number of respondents recruited \n\n\n\nfrom each faculty was based on the proportion of students in \n\n\n\neach faculty relative to the undergraduate student population in \n\n\n\nthe university. A researcher was stationed in each of the non-\n\n\n\nmedical faculty and approached any student to participate in the \n\n\n\nstudy based on convenience sampling. If the student agreed to \n\n\n\nparticipate, he or she would sign an informed consent form and \n\n\n\nthe KMC-25 would be given for him/her to fill in by himself or \n\n\n\nherself. The researcher checked the completed questionnaire \n\n\n\nand thanked the respondent. \n\n\n\n\n\n\n\nData Analysis \n\n\n\n\n\n\n\nData analysis was conducted using the Statistical Package for \n\n\n\nthe Social Sciences (SPSS), Version 22 (Armonk, NY:IBM \n\n\n\nCorp.). One mark was allocated for each correct answer in the \n\n\n\nKMC-25 while zero was given for incorrect or unsure response. \n\n\n\nThis gave a minimum total score of zero and a maximum of 25. \n\n\n\nThe score was then converted to a percentage by a \n\n\n\nmultiplication of 4. A respondent with a total score of 50% and \n\n\n\nabove was considered to have adequate knowledge on the \n\n\n\nmethods of contraception while those with a score below 50% \n\n\n\nwas considered to have inadequate knowledge. \n\n\n\n\n\n\n\n\n\n\n\nData from the KMC-25 was analyzed for internal consistency \n\n\n\nusing Cronbach\u2019s alpha values, corrected item-total correlation \n\n\n\nand Cronbach\u2019s alpha if item was deleted. A Cronbach\u2019s alpha \n\n\n\nvalue of 0.70 to 0.95 is considered as having good internal \n\n\n\nconsistency [21]. Low values of Cronbach\u2019s alpha indicate \n\n\n\npoor interrelation between items while very high values imply \n\n\n\nthat the questions are very similar and there is redundancy [22]. \n\n\n\nIf the Cronbach\u2019s alpha value increases substantially with the \n\n\n\ndeletion of an item, then the item should be excluded to produce \n\n\n\na more homogeneous scale.  An item with its item-total \n\n\n\ncorrelation coefficient less than 0.2 means that it is not related \n\n\n\nto the total score and should be removed [23]. \n\n\n\n\n\n\n\nStable reliability was determined by comparing the scores \n\n\n\nobtained from two separate administrations of the KMC-25. \n\n\n\nSpearman\u2019s correlation coefficient (rho) was used to determine \n\n\n\nthe strength of the relationship between the total knowledge \n\n\n\nscore of the respondents in the test-retest. According to the rule \n\n\n\nof thumb, Spearman\u2019s rho is interpreted as followed: negligible \n\n\n\ncorrelation (0 to 0.3), low correlation (0.3 to 0.5), moderate \n\n\n\ncorrelation (0.5 to 0.7), high correlation (0.7 to 0.9) and very \n\n\n\nhigh correlation (0.9 to 1.0) [24]. In addition, McNemar Test \n\n\n\nwas used to compare the answer to each item in the KMC-25 \n\n\n\nbetween the two tests results. \n\n\n\n\n\n\n\nFlesch Reading Ease Calculator (http://www.readability \n\n\n\nformulas.com/free-readability-formula-tests.php) was used to \n\n\n\nensure that the KMC-25 could be read and understood easily. \n\n\n\nThe higher the number means the easier it is to read the text. A \n\n\n\nscore between 0 and 30 is considered as easily understood by \n\n\n\ncollege graduates, while a score between 40 and 50 by 9th to \n\n\n\n10th graders (around 14 to 15 years old students), a score \n\n\n\nbetween 60 and 70 by 8th and 9th graders (around 13 to 14 \n\n\n\nyears old), and between 90 to 100 can be easily understood by \n\n\n\n5th graders (around 10 years old). \n\n\n\n\n\n\n\nDifficulty factor determines whether the question is too easy or \n\n\n\ntoo difficult to answer. It is calculated by using the number of \n\n\n\nrespondents who answered a particular question correctly \n\n\n\ndivided by the total number of respondents. An item with value \n\n\n\nless than 0.2 means it is too difficult while those more than 0.8 \n\n\n\nis too easy [25]. \n\n\n\n\n\n\n\nDiscriminant validity was conducted by comparing the \n\n\n\nknowledge scores of KMC-25 between non-medical students \n\n\n\nand final year pharmacy students who should have better \n\n\n\nknowledge due to the inclusion of topics on contraception in \n\n\n\ntheir pharmacy curriculum. Comparison was done using Mann-\n\n\n\nWhitney U test. A p-value of less than 0.05 was considered as \n\n\n\nstatistically significant. \n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\nKang P.W. et al. Mal J Pharm 7 (2) 2021, 22-31 \n\n\n\n\n\n\n\n\n\n\n\n25 \n\n\n\n\n\n\n\nPossible predictors of knowledge on contraceptive methods \n\n\n\nwere analyzed using univariate and multivariate Poisson \n\n\n\nregression under the Generalized Linear Model function in \n\n\n\nSPSS. \n\n\n\n\n\n\n\nRESULT  \n\n\n\n\n\n\n\nPhase 1: Development and validation of an instrument, KMC \n\n\n\n\n\n\n\nThe content validity of the KMC-25 was conducted by four \n\n\n\nexperienced pharmacists and a clinician. A total of 130 \n\n\n\nrespondents from non-medical faculties participated in this \n\n\n\nphase of the study. \n\n\n\n\n\n\n\nThe Cronbach\u2019s alpha of the final KMC-25 was 0.78. Five \n\n\n\nitems had a corrected item-total correlation of less than 0.2 and \n\n\n\nnone of the items produced an increase in Cronbach\u2019s alpha \n\n\n\nvalue of more than 0.01 if it was deleted. (Table I.) \n\n\n\n\n\n\n\nOnly 68 respondents participated in the retest. The McNemar \n\n\n\ntest showed no significant difference between the first and \n\n\n\nsecond test (test-retest) for each item of the KMC-25, except \n\n\n\nfor item 4. (Table I.) In addition, Spearman\u2019s correlation \n\n\n\ncoefficient showed that there was a high positive correlation \n\n\n\nbetween the total scores of the KMC-25 for the test and retest \n\n\n\nresults (Spearman\u2019s rho = 0.868; p < 0.001). \n\n\n\n\n\n\n\nFlesch Reading Ease score for KMC-25 was 49.3 and graded \n\n\n\nas Level 10 which indicated that the KMC-25 could be easily \n\n\n\nunderstood by students aged 14 to 15 years. This means that \n\n\n\nKMC-25 can be even more easily understood by university \n\n\n\nstudents. Of the 25 items in the KMC-25, 11 (44%) items had \n\n\n\ndifficulty factor less than 0.2 but none was more than 0.8. \n\n\n\n(Table I.) \n\n\n\n\n\n\n\nFifty final year pharmacy students were recruited in this study \n\n\n\nto test the discriminant validity of KMC-25 instrument.  \n\n\n\nSignificant difference was found between the total KMC-25 \n\n\n\nscores of final year pharmacy students and non-medical related \n\n\n\nstudents, with p < 0.001. (Table II.) \n\n\n\n\n\n\n\nPhase 2: Knowledge of university students on methods of \n\n\n\ncontraception \n\n\n\n\n\n\n\nCharacteristics of Respondents \n\n\n\n\n\n\n\nOut of 412 students who were approached by the researcher and \n\n\n\nwho met the inclusion criteria, 10 declined to participate as they \n\n\n\nwere rushing to class. Therefore, the response rate of this study \n\n\n\nwas 97.6%. Characteristics of 402 respondents in Phase 2 of \n\n\n\nthe study are presented in Table III. Occupation of family \n\n\n\nmembers which was considered as medically related included \n\n\n\nnurses (19), doctors (10), pharmacists (4), medical assistants \n\n\n\n(2), dental surgery assistants (1), physiotherapists (1), and \n\n\n\ndietitians (1). \n\n\n\n\n\n\n\nKnowledge Scores of Respondents \n\n\n\n\n\n\n\nOut of 402 respondents, only 34 (8.5%) scored 50% and above, \n\n\n\nand were considered to have adequate knowledge on methods \n\n\n\nof contraception. The total KMC-25 score ranged from 0 to \n\n\n\n80%, with one respondent scoring 80% while 27 respondents \n\n\n\n(6.7%) did not answer any of the questions correctly. The mean \n\n\n\n(SD) knowledge score of the respondents was 25 (16.8)%. Nine \n\n\n\npossible predictors of contraceptive knowledge were analyzed \n\n\n\nas shown in Table III. Multivariate Poisson regression analysis \n\n\n\nidentified seven of the independent variables to be significantly \n\n\n\nassociated with the knowledge on methods of contraception. \n\n\n\nThe incidence rate ratio (IRR) of each predictor is as shown in \n\n\n\nTable III. The group with the lowest mean total knowledge \n\n\n\nscore in each independent variable was used as the reference.    \n\n\n\n\n\n\n\nThe percentage of respondents who answered each item in \n\n\n\nKMC-25 correctly is as shown in Table IV. \n\n\n\n\n\n\n\nSources of Information on Methods of Contraception \n\n\n\n\n\n\n\nThe respondents obtained information on methods of \n\n\n\ncontraception from various sources (Figure I). The respondents \n\n\n\nwere allowed to select more than one source of information and \n\n\n\nhence, the percentages in Figure I added up to more than 100%. \n\n\n\nA couple of respondents obtained information of contraception \n\n\n\nfrom drama and movie (one respondent) or fiction and novel \n\n\n\n(one respondent).   \n\n\n\n\n\n\n\nDISCUSSION  \n\n\n\n\n\n\n\nInternal consistency estimates of Cronbach\u2019s alpha are highly \n\n\n\ndependent on item variances and their intercorrelations [26]. In \n\n\n\nthe present study, the KMC-25 has achieved good internal \n\n\n\nconsistency since its Cronbach\u2019s alpha was in the range of 0.70 \n\n\n\nto 0.95. The Cronbach\u2019s alpha of KMC-25 did not change much \n\n\n\nif any of the items was omitted. Therefore, the 25 items were \n\n\n\nretained even though five of the items had corrected item-total \n\n\n\ncorrelation of less than 0.2. This allows for item variability so \n\n\n\nthat the knowledge of different methods of contraception could \n\n\n\nbe assessed. \n\n\n\n\n\n\n\nResponse to all the items did not show any significant \n\n\n\ndifference between the test and retest. In addition, the total \n\n\n\nscores of the test-retest showed a high Spearman\u2019s rho of more \n\n\n\nthan 0.8 which implies a high positive correlation between the \n\n\n\ntwo tests. Therefore, the KMC-25 has achieved stable \n\n\n\nreliability which means that the questions are clear enough for \n\n\n\n\n\n\n\n\n\n\n\n\nKang P.W. et al. Mal J Pharm 7 (2) 2021, 22-31 \n\n\n\n\n\n\n\n\n\n\n\n26 \n\n\n\n\n\n\n\n \nTable I. Reliability and Difficulty Factor of KMC-25 (N = 130) \n\n\n\n\n\n\n\n\n\n\n\nNo \n\n\n\n\n\n\n\nItemd \n\n\n\nCorrected \n\n\n\nItem-Total \n\n\n\nCorrelation \n\n\n\nCronbach's \n\n\n\nAlpha if Item \n\n\n\nDeleted \n\n\n\nDifficulty \n\n\n\nFactor \n\n\n\nMcNemar Test,  \n\n\n\nn = 68 \n\n\n\np value \n\n\n\n1. Natural methods are 100% effective in preventing pregnancy. 0.354 0.770 0.48 0.302 \n\n\n\n2. A woman will not get pregnant if her partner does not ejaculate during \n\n\n\nsexual intercourse. \n\n\n\n0.278 0.774 0.24 0.267 \n\n\n\n3. All women can detect a small rise in their body temperature to prevent \n\n\n\npregnancy. \n\n\n\n0.178 a 0.779 0.19 b 1.000 \n\n\n\n4. Washing the vagina immediately after having sex can prevent pregnancy. 0.378 0.768 0.47 0.002** \n\n\n\n5. A woman can detect her fertile period by looking at the texture of her \n\n\n\ncervical mucous. \n\n\n\n0.338 0.771 0.23 0.804 \n\n\n\n6. All barrier methods can protect against sexually transmitted diseases \n\n\n\n(STDs). \n\n\n\n0.450 0.764 0.30 0.581 \n\n\n\n7. Condoms can break if the tip is not pinched to remove air bubbles. 0.248 0.776 0.30 0.332 \n\n\n\n8. Spermicide will increase the efficiency of a condom. 0.164 a 0.779 0.10 b 0.508 \n\n\n\n9. All barrier methods, including condoms can be reused. 0.431 0.765 0.67 0.607 \n\n\n\n10. Diaphragms and cervical caps are designed to be used with spermicides. 0.153 a 0.779 0.09 b 0.549 \n\n\n\n11. Diaphragms and cervical caps form a barrier to prevent sperm from entering \n\n\n\ninto the uterus. \n\n\n\n0.484 0.761 0.53 0.210 \n\n\n\n12. Oral birth control pills do not work unless they are taken around the same \n\n\n\ntime every day. \n\n\n\n0.212 0.777 0.18 b 0.118 \n\n\n\n13 Oral birth control pills are available everywhere including grocery shops \n\n\n\nand supermarkets. \n\n\n\n0.231 0.778 0.38 0.093 \n\n\n\n14. A woman who has been taking birth control pills for several years will \n\n\n\nnever get pregnant even if she stops using the pill. \n\n\n\n0.302 0.773 0.42 1.000 \n\n\n\n15. Birth control pills with only one type of hormone (progestin) decrease the \n\n\n\nrisk of breast cancer. \n\n\n\n0.183 a 0.778 0.08 b 0.581 \n\n\n\n16. Birth control pills with high content of progestin (female hormone) have \n\n\n\nlower risk of ovarian cancer than those with low content of progestin. \n\n\n\n0.154 a 0.779 0.05 b 1.000 \n\n\n\n17. Combined birth control pills are more likely to increase body weight than \n\n\n\nthose with progestin only. \n\n\n\n0.209 0.777 0.12 b 0.754 \n\n\n\n18. All types of birth control pills are effective in preventing pregnancy if taken \n\n\n\nimmediately after sexual intercourse. \n\n\n\n0.394 0.767 0.39 0.167 \n\n\n\n19. Emergency birth control pills should be used continuously to prevent \n\n\n\npregnancy. \n\n\n\n0.224 0.777 0.20 0.824 \n\n\n\n20. Implants contain similar hormones as birth control pills. 0.346 0.771 0.10 b 1.000 \n\n\n\n21. Implants are preferred to birth control pills because the problem of missing \n\n\n\npills will not occur. \n\n\n\n0.479 0.763 0.19 b 0.189 \n\n\n\n22. Injections are preferred compared to implants as skin allergies do not occur. 0.264 0.775 0.16 b 1.000 \n\n\n\n23. Intrauterine device (IUD) will prevent pregnancy permanently.  0.399 0.768 0.20 0.791 \n\n\n\n24. IUD can be inserted by the woman herself just before any sexual activity. 0.289 0.774 0.18 b 0.057 \n\n\n\n25. IUD can cause abnormal bleeding and pain. \n\n\n\nTotal score (Spearman\u2019s Correlation Coefficient) \n\n\n\n0.478 0.763 0.23 0.581 \n\n\n\n< 0.001** \n\n\n\n(0.868) \n \n\n\n\naValue < 0.2; bDifficulty factor < 0.2;  \n\n\n\n**p-value < 0.01 \n\n\n\n \nTable II. Comparison between total knowledge scores of final year pharmacy students and non-medical students \n\n\n\n\n\n\n\nTypes of students \n\n\n\nMann-Whitney U test Chi square test \n\n\n\nMedian (IQR) \n\n\n\nscores \nMean rank \n\n\n\nZ value \n\n\n\n(p value) \n\n\n\nInadequate \n\n\n\nknowledge (< 50) \n\n\n\nFrequency (%) \n\n\n\nAdequate \n\n\n\nknowledge (> 50) \n\n\n\nFrequency (%) \n\n\n\n\ud835\udcb32 \n\n\n\n(p value) \n\n\n\nPharmacy students 60 (50 - 68) 144.62 \n-8.657 \n\n\n\n(< 0.001) \n\n\n\n12 (24%) \n\n\n\n \n38 (76%) \n\n\n\n79.768 \n\n\n\n(< 0.001) \n\n\n\nNon-medical related \n\n\n\nstudents \n26 (12 - 40) 69.68  119 (91.5%) 11 (8.5%) \n\n\n\n\n\n\n\n\n\n\n\nIQR: Interquartile range \n\n\n\n\n\n\n\n\n\n\n\n\nKang P.W. et al. Mal J Pharm 7 (2) 2021, 22-31 \n\n\n\n\n\n\n\n\n\n\n\n27 \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nTable III. Characteristics of respondents and possible predictors of contraceptive knowledge (N = 402) \n\n\n\n\n\n\n\nCharacteristics \nFrequency \n\n\n\n(%) \nTotal Knowledge Scores Univariate Poisson Regression Multivariate Poisson Regression \n\n\n\n  \nMean (SD) Median (IQR) \n\n\n\nCrude IRR  \n\n\n\n(95% CI) \n\n\n\nP \n\n\n\nvalue \n\n\n\nAdjusted IRR  \n\n\n\n(95% CI) \n\n\n\nP \n\n\n\nvalue \n\n\n\nGender     < 0.001  0.005** \n   Male 126 (31.3%) 28.95 (18.1) 28 (0 - 80) 1.248 (1.198; 1.300)  1.072 (1.022; 1.126)  \n\n\n\n   Female 276 (68.7%) 23.20 (15.9) 22 (0 - 76) 1  1  \n\n\n\nEthnicity     < 0.001  0.081 \n   Malay 177 (44.0%) 20.75 (15.3) 20 (0 - 76) 1.089 (1.001; 1.183)  1.225 (0.838; 1.789)  \n\n\n\n   Chinese 175 (43.5%) 30.15 (16.9) 32 (0 - 80) 1.582 (1.458; 1.716)  1.268 (1.029; 1.563)  \n\n\n\n   Indian 34 (8.5%) 19.06 (16.2) 16 (0 - 64) 1  1  \n   Othersa 16 (4.0%) 28.50 (17.5) 34 (0 - 52) NA  NA  \n\n\n\nReligion     < 0.001  0.18 \n\n\n\n   Muslim 181 (45.0%) 20.84 (15.3) 20 (0 - 76) 1.145 (1.045; 1.254)  0.860 (0.582; 1.272)  \n\n\n\n   Buddhist 136 (33.8%) 29.68 (17.2) 28 (0 - 80) 1.630 (1.489; 1.785)  1.120 (0.891; 1.409)  \n\n\n\n   Christian 46 (11.4%) 30.17 (16.2) 32 (0 - 56) 1.657 (1.499; 1.832)  1.211 (0.973; 1.507)  \n\n\n\n   Hindu 29 (7.2%) 18.21 (16.5) 16 (0 - 64) 1  1  \n   Othersb 10 (2.5%) 32.80 (16.5) 30 (8 - 68) NA  NA  \n\n\n\nMarital status     < 0.001  < 0.001** \n\n\n\n   Married 3 (0.7%) 38.67 (16.2) 39 (24 - 56) 1.553 (1.293; 1.865)  1.957 (1.593; 2.403)  \n   Single  399 (99.3%) 24.90 (16.8) 24 (0 - 80) 1  1  \n\n\n\nSecondary education     < 0.001  < 0.001** \n\n\n\n   Rural Areac 12 (3.0 %) 30.00 (16.9) 30 (8 - 52) 1.207 (1.087; 1.341)  1.301 (1.166; 1.452)  \n   Urban Area 390 (97.0%) 24.85 (16.8) 24 (0 - 80) 1  1  \n\n\n\nStream in Secondary \n\n\n\nSchool  \n\n\n\n    < 0.001  0.001** \n\n\n\n   Science 329 (81.8%) 26.08 (16.7) 24 (0 - 80) 1.293 (1.224; 1.367)  1.135 (1.057; 1.220)  \n\n\n\n   Art 73 (18.2%) 20.16 (16.6) 16 (0 - 60) 1  1  \n\n\n\nOccupation of Family \n\n\n\nMembers \n\n\n\n    < 0.001  0.009** \n\n\n\n   Non-medical Related 367 (91.3%) 25.34 (17.0) 24 (0 - 80) 1.179 (1.095; 1.270)  1.119 (1.029; 1.218)  \n   Medical Related 35 (8.7%) 21.48 (14.5) 24 (0 - 56) 1  1  \n\n\n\nCurrent Year of Study     < 0.001  < 0.001** \n\n\n\n   Year 1 167 (41.5%) 22.75 (15.6) 20 (0 - 64) 1.007 (0.954; 1.064)  1.133 (1.062; 1.209)  \n   Year 2 103 (25.6) 26.87 (16.4) 28 (0 - 76) 1.190 (1.122; 1.261)  1.182 (1.105; 1.264)  \n\n\n\n   Year 4 47 (1.7) 33.28 (19.3) 32 (8 - 76) 1.473 (1.378; 1.575)  1.208 (1.117; 1.307)  \n\n\n\n   Year 3 85 (21.1) 22.59 (16.6) 20 (0 - 80) 1  1  \nFaculty of Study     < 0.001  < 0.001** \n\n\n\n   Law 23 (5.7) 29.04 (17.7) 28 (4 - 76) 1.683 (1.522; 1.861)  1.373 (1.224; 1.539)  \n\n\n\n   Science 99 (24.6) 27.27 (15.5) 28 (0 - 68) 1.581 (1.465; 1.706)  1.359 (1.239; 1.490)  \n   Education 22 (5.5) 23.27 (16.0) 24 (0 - 52) 1.349 (1.210; 1.504)  1.392 (1.224; 1.583)  \n\n\n\n   Engineering 66 (16.4) 33.82 (19.3) 32 (4 - 80) 1.960 (1.813; 2.119)  1.635; 1.476; 1.810)  \n\n\n\n   Built Environment 30 (7.5) 20.53 (14.3) 20 (0 - 48) 1.190 (1.074; 1.319)  1.090 (0.969; 1.225)  \n   Languages &  \n\n\n\n   Linguistics \n\n\n\n24 (6.0) 20.67 (17.8) 20 (0 - 64) 1.198 (1.073; 1.337)  1.070 (0.944; 1.212)  \n\n\n\n   Business &      \n   Accountancy \n\n\n\n42 (10.4) 23.33 (16.9) 22 (0 - 60) 1.352 (1.235; 1.481)  1.253 (1.132; 1.385)  \n\n\n\n   Economics &  \n\n\n\n   Administration \n\n\n\n26 (6.5) 23.54 (14.7) 20 (8 - 56) 1.364 (1.230; 1.512)  1.149 (1.028; 1,283)  \n\n\n\n  Computer Science &     \n\n\n\n  IT \n\n\n\n19 (4.7) 18.74 (12.7) 16 (0 - 40) 1.086 (0.960; 1.228)  0.965 (0.840; 1.109)  \n\n\n\n  Arts and Social  \n  Science \n\n\n\n51 (12.7) 17.25 (13.4) 16 (0 - 44) 1  1  \n\n\n\n \nOthersa : include Buginese, Dusun, Punjabi, Bumiputera Sabah, Sikh, Bidayuh, Kadazan, Bajau, Lundayeh.  \n\n\n\n                    and Eurasian. These were excluded from Kruskal\u2013Wallis Test due to too small sample size in the study. \n\n\n\nOthersb : include Catholic, Atheist, Sikhism, Free thinker and Taoism.   \n\n\n\nAreac :  Rural area refers to area with population between 1 000 and 10 000. \n\n\n\n\n\n\n\nSD = Standard deviation; IQR = Interquartile range; IRR = Incidence rate ratio; CI = Confidence interval;  \n\n\n\nNA = Not applicable (excluded from the analysis) \n\n\n\n\n\n\n\n**p < 0.01    \n\n\n\n\n\n\n\n\n\n\n\n\nKang P.W. et al. Mal J Pharm 7 (2) 2021, 22-31 \n\n\n\n\n\n\n\n\n\n\n\n28 \n\n\n\n\n\n\n\n\n\n\n\nTable IV. Percentage of Correct Answers on each item in KMC-25 (N = 402) \n\n\n\n\n\n\n\nNo. Items      \n\n\n\nCorrect \n\n\n\nanswer \n\n\n\nFrequency (%) \n\n\n\nTotal score for \n\n\n\neach category  \n\n\n\n (%) \n\n\n\n1. Natural methods are 100% effective in preventing pregnancy. 178 (44.3) \n\n\n\nNatural Method \n\n\n\n31.20 \n\n\n\n2. A woman will not get pregnant if her partner does not ejaculate during sexual intercourse. 81 (20.1) \n\n\n\n3. All women can detect a small rise in their body temperature to prevent pregnancy. 79 (19.7) \n\n\n\n4. Washing the vagina immediately after having sex can prevent pregnancy. 210 (52.2) \n\n\n\n5. A woman can detect her fertile period by looking at the texture of her cervical mucous. 80 (19.9) \n\n\n\n6. All barrier methods can protect against sexually transmitted diseases (STDs). 114 (28.4) \n\n\n\nBarrier Method \n\n\n\n31.33 \n\n\n\n7. Condoms can break if the tip is not pinched to remove air bubbles. 121 (30.1) \n\n\n\n8. Spermicide will increase the efficiency of a condom. 33 (8.2) \n\n\n\n9. All barrier methods, including condoms can be reused. 260 (64.7) \n\n\n\n10. Diaphragms and cervical caps are designed to be used with spermicides. 42 (10.4) \n\n\n\n11. Diaphragms and cervical caps form a barrier to prevent sperm from entering into the uterus. 185 (46.0) \n\n\n\n12. Oral birth control pills do not work unless they are taken around the same time every day. 96 (23.9) \n\n\n\nHormonal \n\n\n\nMethod \n\n\n\n20.45 \n\n\n\n13 Oral birth control pills are available everywhere including grocery shops and supermarkets. 136 (33.8) \n\n\n\n14. A woman who has been taking birth control pills for several years will never get pregnant even if she \n\n\n\nstops using the pill. \n159 (39.6) \n\n\n\n15. Birth control pills with only one type of hormone (progestin) decrease the risk of breast cancer. 39 (9.7) \n\n\n\n16. Birth control pills with high content of progestin (female hormone) have lower risk of ovarian cancer than \n\n\n\nthose with low content of progestin. \n35 (8.7) \n\n\n\n17. Combined birth control pills are more likely to increase body weight than those with progestin only. 59 (14.7) \n\n\n\n18. All types of birth control pills are effective in preventing pregnancy if taken immediately after sexual \n\n\n\nintercourse. \n141 (35.1) \n\n\n\n19. Emergency birth control pills should be used continuously to prevent pregnancy. 70 (17.4) \n\n\n\n20. Implants contain similar hormones as birth control pills. 48 (11.9) \n\n\n\n21. Implants are preferred to birth control pills because the problem of missing pills will not occur. 55 (13.7) \n\n\n\n22. Injections are preferred compared to implants as skin allergies do not occur. 67 (16.7) \n\n\n\n23. Intrauterine device (IUD) will prevent pregnancy permanently. 75 (18.7) \nIUD \n\n\n\n18.67 \n24. IUD can be inserted by the woman herself just before any sexual activity. 72 (17.9) \n\n\n\n25. IUD can cause abnormal bleeding and pain. 80 (19.9) \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n                                                                                                  Figure I. Sources of Information (N = 402) \n\n\n\n\n\n\n\n\n\n\n\n\nKang P.W. et al. Mal J Pharm 7 (2) 2021, 22-31 \n\n\n\n\n\n\n\n\n\n\n\n29 \n\n\n\n\n\n\n\nthe respondents to interpret them the same way in both tests. \n\n\n\n\n\n\n\nFlesch Reading Ease score for KMC-25 was 49.3 which means \n\n\n\nthat the target population which were university students \n\n\n\nshould be able to read and understand the statements in the \n\n\n\nKMC-25 easily. Therefore, if a respondent gave an incorrect \n\n\n\nanswer, it was not because he or she had difficulty to \n\n\n\ncomprehend the meaning of the statement but more because he \n\n\n\nor she did not have sufficient knowledge to answer it correct. \n\n\n\n\n\n\n\nOf the 25 items in the KMC-25, 11 (44%) were considered as \n\n\n\ndifficult to answer but no item was too easy. Although this \n\n\n\nKMC-25 contains some difficult questions, these questions are \n\n\n\ndeemed essential for someone to practice correct contraception \n\n\n\nand hence, these items were retained in the instrument.   \n\n\n\n\n\n\n\nThe total knowledge score of final year pharmacy students was \n\n\n\nsignificantly higher (p < 0.001) than that of non\u2013medical \n\n\n\nrelated students with a median (IQR) of 60 (50 - 68)% and 26 \n\n\n\n(12 - 40)%, respectively. In addition, the proportion of \n\n\n\npharmacy students with adequate knowledge on methods of \n\n\n\ncontraception was significantly higher than that of non-medical \n\n\n\nrelated students [76% versus 8.5%, p < 0.001]. This is as \n\n\n\nexpected and indicates that the KMC-25 can differentiate \n\n\n\npeople with different knowledge level on the methods of \n\n\n\ncontraception. \n\n\n\n\n\n\n\nPhase 2 of the study also found that only 8.5 % of the university \n\n\n\nstudents from non-medical related faculties have adequate \n\n\n\nknowledge on the methods of contraception. Other studies \n\n\n\nreported similar findings [7,19,27,28]. However, adolescents in \n\n\n\nSouthern Africa and Ghana had higher knowledge on \n\n\n\ncontraceptive issues [29,30]. \n\n\n\n\n\n\n\nThe present study showed that university students with \n\n\n\nsignificantly better knowledge on methods of contraception are \n\n\n\nmales (compared to females), already married (relative to those \n\n\n\nstill single), had their secondary education in rural area (relative \n\n\n\nto urban), from Science stream (relative to Arts stream), with \n\n\n\nfamily members in non-medical related occupations (compared \n\n\n\nto medical related occupations), and in Year 4 of their degree \n\n\n\nprogram (compared to Year 3). In addition, students from \n\n\n\nEngineering or other degree programs (except from Computer \n\n\n\nScience and Information Technology) had significantly better \n\n\n\nknowledge than those from Arts and Social Science. \n\n\n\n\n\n\n\nMale students are probably more inquisitive and hence, tend to \n\n\n\nknow more about contraceptive methods compared to female \n\n\n\nstudents. Naturally, students who are already married, from \n\n\n\nScience stream in schools and studying in Science related \n\n\n\nprograms will be more knowledgeable about contraception \n\n\n\nthan those who are still single, from Arts stream in schools and \n\n\n\nstudying in Arts related degree programs. Students from \n\n\n\nScience stream and Science related degree programs are \n\n\n\nprobably exposed to more in-depth science education which is \n\n\n\nrelated to reproduction. However, students from secondary \n\n\n\nschools in rural areas and those with family members who have \n\n\n\nnon-medical related occupations were shown to have higher \n\n\n\nknowledge than those from urban schools and with family \n\n\n\nmembers who have medical related occupations. These are \n\n\n\nunexpected and currently there is no logical explanation.    \n\n\n\n\n\n\n\nIn the present study, the respondents scored the highest point in \n\n\n\nBarrier Method, followed by Natural Method, Hormonal \n\n\n\nMethod and IUD. In addition, of the items in the KMC-25, the \n\n\n\nhighest proportion of respondents (64.7%) knew that condoms \n\n\n\ncannot be reused. Similarly, another study in Malaysia, and \n\n\n\nother studies in Nigeria and in Ghana, reported that the most \n\n\n\ncommon contraceptive method known was the condom \n\n\n\n[7,27,29]. On the contrary, a study in Turkey showed that all \n\n\n\nthe participants knew about contraceptive pills which were \n\n\n\neasily available and commonly used [31]. The reason for this \n\n\n\ndifference may be because condoms are easily available in \n\n\n\nMalaysia whereas, contraceptive pills are controlled \n\n\n\nmedications and can only be obtained from licensed health care \n\n\n\nproviders.  \n\n\n\n\n\n\n\nMajority of the respondents (80%) believed that a woman \n\n\n\nwould not get pregnant if her partner did not have ejaculation \n\n\n\nduring sexual intercourse. A similar study in Malaysia reported \n\n\n\n61.8% of their respondents with the same belief [7]. This lack \n\n\n\nof understanding can lead to unintended pregnancy. Less than \n\n\n\n20% of the respondents could answer the questions on \n\n\n\nhormonal method and intrauterine devices (IUDs) correctly \n\n\n\nprobably because these questions were more technical. A \n\n\n\nNigeria study stated that injectable hormonal contraceptives \n\n\n\nand intrauterine devices were mostly available only at \n\n\n\ndesignated family planning clinics [32]. Similar availability \n\n\n\noccurs in Malaysia and hence, respondents had less exposure \n\n\n\nto these two methods of contraception. Respondents had poor \n\n\n\nawareness and knowledge on the insertion of IUD as well as \n\n\n\nthe relationship between birth control pills and breast or \n\n\n\novarian cancer. Majority of the respondents (more than 80%) \n\n\n\nthought that IUD can be inserted by women themselves instead \n\n\n\nof by health care professionals. \n\n\n\n\n\n\n\nMost of the respondents obtained information on methods of \n\n\n\ncontraception from the internet (87.3%), followed by from their \n\n\n\nteachers or friends. However, a previous study in Malaysia \n\n\n\nfound magazines (22.4%) and internet (20.4%) were the most \n\n\n\ncommon sources of information for contraception [7]. This \n\n\n\ndifference is attributed to the advance in technology and the \n\n\n\nincreased use of internet by most university students. Less than \n\n\n\n42% of the respondents in the present study seek a doctor\u2019s \n\n\n\n\n\n\n\n\n\n\n\n\nKang P.W. et al. Mal J Pharm 7 (2) 2021, 22-31 \n\n\n\n\n\n\n\n\n\n\n\n30 \n\n\n\n\n\n\n\nadvice, and even lesser (25%) asked information from a \n\n\n\npharmacist. This shows that most of the respondents prefer to \n\n\n\nseek information on contraception from other sources than \n\n\n\nfrom health care providers and hence, is an area of concern as \n\n\n\nthere is a high possibility of incorrect information.   \n\n\n\n\n\n\n\nThe limitation of the present study is that it was conducted in \n\n\n\nonly one university although it is a major university in Malaysia \n\n\n\nand hence, the findings may not be representative of all \n\n\n\nuniversity students in Malaysia. Multiple site studies should be \n\n\n\nconducted in future to obtain better representation of the target \n\n\n\npopulation. \n\n\n\n\n\n\n\nCONCLUSION   \n \n\n\n\nThe present study shows that KMC-25 is a reliable and valid \n\n\n\ninstrument to assess university students\u2019 knowledge on \n\n\n\nmethods of contraception. University students from non-\n\n\n\nmedical related programs have poor knowledge on the methods \n\n\n\nof contraception. This warrants the implementation of \n\n\n\nreproductive and sexual educational programs to improve their \n\n\n\nknowledge level and to prevent or minimize unplanned or \n\n\n\nunwanted pregnancy. \n\n\n\n\n\n\n\nACKNOWLEDGEMENT  \n \n\n\n\nWe would like to thank the Medical Ethics Committee of \n\n\n\nUniversity Malaya Medical Centre for approving this study. In \n\n\n\naddition, we would like to express our appreciation to Ms \n\n\n\nWong Lai Yan, Ms Syireen Alwi, Ms Tan Bee Kim and Ms Lee \n\n\n\nHooi Leng for helping to review the content of KMC-25, and \n\n\n\nto Associate Professor Karuthan Chinna for his advice on the \n\n\n\nstatistical procedure. We are most grateful to all the students \n\n\n\nwho agreed to participate in this study. \n\n\n\n\n\n\n\nCONFLICT OF INTEREST   \n\n\n\n\n\n\n\nThis study has no conflict of interest. This research did not \n\n\n\nreceive any specific grant from funding agencies in public, \n\n\n\ncommercial or not-for-profit sectors. \n\n\n\n\n\n\n\nREFERENCE \n \n\n\n\n[1] The Alan Guttmacher Institute (AGI). Sharing responsibility: women, \n\n\n\nsociety and abortion worldwide. [cited 2021, January 17]. Available \n\n\n\nfrom:https://www.guttmacher.org/sites/default/files/pdfs/pubs/sharin\n\n\n\ng.pdf.  \n\n\n\n[2] Barton K, Redshaw M, Quigley MA, Carson C. 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Knowledge and attitude of medical  \n\n\n\nundergraduate, interns and postgraduate students in India towards \n\n\n\nemergency contraception. N Am J Med Sci. 2013;5(1):37-40.  \n\n\n\nhttp://doi.org/10.4103/1947-2714.106193 \n[17] Malek A, Shafiee-Kandjani A, Safaiyan A, Abbasi-Shokoohi H. \n\n\n\nSexual knowledge among high school students in northwestern Iran. \n\n\n\nISRN Pediatr. 2012;2012:1-5. http://doi.org/10.5402/2012/645103 \n\n\n\n[18] Michael EJ. Use of contraceptives methods among women in stable \n\n\n\nmarital relations attending health facilities in Kahama district, \n\n\n\nShinyanga region. [Dissertation].  Tanzania: Muhimbili University of \n\n\n\nHealth and Allied Sciences; 2012. \n\n\n\n[19] Shafei MN, Shah MS, Tengku Ismail TA. Knowledge and attitude \n\n\n\ntowards family planning practice and prevalence of short birth spacing \n\n\n\namong residents of suburban area in Terengganu, Malaysia. 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"\n\nMalaysian Journal of Pharmacy Volume 7 Issue 1 (2021) \n \n\n\n\n\n\n\n\n7 \n\n\n\n\n\n\n\n*Correspondence: evelyncheelc@gmail.com \n\n\n\n\n\n\n\n1 Pharmacy Department, Hospital Kuala Lumpur, Malaysia \n2 Pharmacy Department, Hospital Selayang, Malaysia \n3 Primary Care Medicine Department, University Malaya, Malaysia \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n Case Study \n\n\n\n\n\n\n\nWarfarin - Fenofibrate Interaction: Hospital Kuala Lumpur \n\n\n\nExperience \n \n\n\n\nChew Ken Wey1, Evelyn Chee Li Ching1*, Naga Jothy Nagesvararao1,2, Nirmala Jagan1,3 \n\n\n\n\n\n\n\n  \nArticle Info  \n\n\n\n \nReceived date: 31 Dec 2020 \n\n\n\nAccepted date:  1 May 2021 \n\n\n\nPublished date: 30 June 2021 \n\n\n\n\n\n\n\nKeywords: warfarin, \n\n\n\nfenofibrate, interaction, INR  \n\n\n\nABSTRACT  \n\n\n\n\n\n\n\nCase reports in western populations reported that fenofibrate enhances the anticoagulatory effect of \n\n\n\nwarfarin. We are reporting ten cases of warfarin-fenofibrate interaction among Malaysian patients\u2019 \n\n\n\ncases that were managed at the anticoagulation clinic of Hospital Kuala Lumpur. Patients taking \n\n\n\nwarfarin and micronized fenofibrate 145mg daily concurrently between the year 2014 to 2018 were \n\n\n\nidentified in May 2018. Ten active patients were included, and the relevant data were retrieved \n\n\n\nretrospectively. All patients received warfarin for stroke prevention in atrial fibrillation (AF), with a \n\n\n\ntarget international normalised ratio (INR) of 2 to 3. No dose adjustment was done upon initiation of \n\n\n\nfenofibrate. Warfarin doses were adjusted to achieve the targeted range but fenofibrate was not \n\n\n\ndiscontinued. Eight patients had INR levels above the target range when INR being reassessed \n\n\n\nbetween 20 to 62 days after initiation of fenofibrate. Their weekly warfarin doses were between \n\n\n\n17.5mg-46.5mg. Baseline INR ranged between 1.6 -3.1. Percentage of dose reduction ranged \n\n\n\nbetween 5%-60%. Four of the patients were on other concurrent interacting medications such as statin \n\n\n\nand levothyroxine. Only one patient, whose case was with an INR 3.1 before initiation of fenofibrate, \n\n\n\nrequired admission for hematoma (INR 12). Two patients had INR within the target range, and INR \n\n\n\nwere assessed at 14 and 21 days after fenofibrate initiation. Their weekly warfarin doses were \n\n\n\nbetween 24.5mg and 26.5mg while baseline INR was 2.8 and 1.9 respectively. Interaction between \n\n\n\nfenofibrate and warfarin may increase INR among Malaysian patients, thus close monitoring of INR \n\n\n\nis warranted. Empirical warfarin dose reduction may be considered upon initiation of this drug \n\n\n\ncombination for patients with AF. The next INR reassessment date should be arranged not later than \n\n\n\nthree weeks after initiation of fenofibrate.   \n\n\n\n\n\n\n\nINTRODUCTION  \n  \n\n\n\nWarfarin has been the most commonly prescribed oral \n\n\n\nanticoagulant in the management of atrial fibrillation (AF), \n\n\n\nvenous thromboembolism and valvular heart disease, despite \n\n\n\nthe emergence of direct oral anticoagulants (DOACs). This has \n\n\n\nled to a high number of patients referred to anticoagulant \n\n\n\nclinics for warfarin therapy. The management of warfarin is \n\n\n\nchallenging because the drug has a narrow therapeutic index \n\n\n\nand is accompanied by drug-drug, drug-food, and drug-disease \n\n\n\ninteractions that may influence the anticoagulant effects. This \n\n\n\nmay lead to a change in patients\u2019 international normalized ratio \n\n\n\n(INR) and poses a risk of bleeding or thrombosis. \n\n\n\n\n\n\n\nIn Malaysia, fenofibrate is prescribed for patients with mixed \n\n\n\ndyslipidaemia and hypertriglyceridemia as well as patients \n\n\n\nwith mild to moderate hypercholesterolemia who are statin \n\n\n\nintolerant [1]. According to the Malaysian Statistics on \n\n\n\nMedicines 2011 \u2013 2014, there was an increasing trend of \n\n\n\nprescribing fenofibrates in the public sector [2].  The \n\n\n\nprevalence of dyslipidaemia in a patient with AF is 46.3% \n\n\n\naccording to International AF Registry therefore co-\n\n\n\nadministration of warfarin and fenofibrate by patients is \n\n\n\nbecoming more common [3]. \n\n\n\n\n\n\n\nFenofibrate had been reported to have major interaction with \n\n\n\nwarfarin from case reports [4-6]. These case reports showed a \n\n\n\nsignificant increase in INR upon initiation of fenofibrate in \n\n\n\npatients whose warfarin therapy had been stabilized [4-6]. An \n\n\n\nincrease in INR values will place the patients at higher risk of \n\n\n\nbleeding and/or hospitalization due to over-warfarinization. In \n\n\n\norder to address the issue, warfarin dose reduction or \n\n\n\n\n\n\n\n\nChew, K.W. et al. Mal J Pharm 7 (1) 2021, 7-10 \n\n\n\n\n\n\n\n8 \n\n\n\n\n\n\n\ndiscontinuation of fenofibrate are the options that had been \n\n\n\ndiscussed [4].  Different values of total warfarin dose reduction \n\n\n\nupon initiation of fenofibrate had been concluded from these \n\n\n\nreports [4-6].   \n\n\n\n\n\n\n\nThe mechanism of interaction between warfarin and \n\n\n\nfenofibrate is not clearly understood. One of the postulated \n\n\n\nmechanisms proposed is that the metabolism of either or both \n\n\n\nfenofibrate and (R)-enantiomer of warfarin, which are \n\n\n\nmetabolized via CYP 3A4 enzymes will be delayed, hence \n\n\n\nleading to the reduction in the clearance of warfarin [7]. On the \n\n\n\nother hand, fenofibrate inhibits CYP 2C9, a cytochrome that \n\n\n\nmetabolizes the (S)-enantiomer of warfarin, thereby reducing \n\n\n\nwarfarin elimination [7]. Pea F and Furlanut M. (2001) \n\n\n\nsuggested that the interaction is due to fenofibrate affecting the \n\n\n\ncoagulation synthesis factor by altering receptor synthesis [8]. \n\n\n\nLastly, it had been proposed that fenofibrate displaces warfarin \n\n\n\nfrom its protein-binding sites, hence enhancing the \n\n\n\nhypoprothrombinaemia effects [9]. \n\n\n\n\n\n\n\nCurrently, limited published data is describing warfarin-\n\n\n\nfenofibrate interaction among the multiracial Malaysian \n\n\n\npopulation. Genetic variations in CYP2C9 lead to the \n\n\n\nvariations in the response in warfarin metabolism [10]. Zhao et \n\n\n\nal showed that there are genetic variations of CYP2C9 in \n\n\n\ndifferent Singapore ethnics groups, namely Malay, Chinese, \n\n\n\nand Indian, which are similar to the Malaysian population [11]. \n\n\n\nThe details on the effect of warfarin-fenofibrate interaction in \n\n\n\nthe Malaysian population are scarce. We report ten cases of \n\n\n\nwarfarin-fenofibrate interaction among patients managed at \n\n\n\nHospital Kuala Lumpur (HKL), Malaysia. This clinic is co-\n\n\n\nmanaged by medical officers and clinical/ trained pharmacists \n\n\n\nto optimise anticoagulation therapy. \n\n\n\n\n\n\n\nMETHOD  \n  \n\n\n\nThe HKL Anticoagulation Registry was screened to identify \n\n\n\npatients prescribed with warfarin and fenofibrate concurrently, \n\n\n\nbetween 2014 and 2018. The relevant clinical information \n\n\n\nretrieved from the medical notes includes: demographic data, \n\n\n\nINR before and after initiation of fenofibrate, weekly warfarin \n\n\n\ndose before and after initiation of fenofibrate, concurrent \n\n\n\nmedications and incidences of bleeding. Incidences of bleeding \n\n\n\ninclude hematoma, gastrointestinal bleeding (GIB) and \n\n\n\nintracranial haemorrhage (ICH). Only incidences of bleeding \n\n\n\nthat were documented by the medical practitioners in the case \n\n\n\nnotes were considered. Results were limited to active adults of \n\n\n\nat least 18 years old who started on both warfarin and \n\n\n\nfenofibrate concurrently between 2014 and 2018.  \n\n\n\n\n\n\n\nPatients with missing needed data for the study, pregnant and \n\n\n\nlactating mothers were excluded. The study received approval \n\n\n\nfrom the National Medical Research Registration (NMRR-19-\n\n\n\n2171-48579). \n\n\n\n\n\n\n\nRESULT \n\n\n\n\n\n\n\nTen patients who fulfilled the inclusion criteria were identified \n\n\n\nduring screening. All 10 patients received Micronized \n\n\n\nFenofibrate 145mg (Lipantyl Penta\u00ae by Abbott) and a mixed \n\n\n\nbrand of warfarin between 2014 and 2018. The 10 patients \n\n\n\nreceived warfarin for the indication of stroke prevention in AF, \n\n\n\nwith a target INR of 2 to 3. Six of the patients were male. The \n\n\n\ndemographic data, baseline INR, and weekly warfarin dose \n\n\n\nprior to initiation of fenofibrate of patients are presented in \n\n\n\nTable I. Patients ranged from 46- to 76-year-olds. The baseline \n\n\n\nINR ranged from 1.6 to 3.1 with the weekly doses of warfarin \n\n\n\nbetween 17.5 mg to 46.5 mg.  \n\n\n\n\n\n\n\nDetails of the study data are presented in Table II. After \n\n\n\ninitiation of fenofibrate, only two patients had their INR levels \n\n\n\nmaintained within the target range while 8 patients had INR \n\n\n\nabove the target range. No adjustment to the weekly warfarin \n\n\n\ndose was made upon initiation of fenofibrate in all 10 patients. \n\n\n\nFenofibrate was not discontinued in all 10 patients. \n\n\n\n\n\n\n\nFor the 8 patients who had INR above the target range, their \n\n\n\nlevels were reassessed between 20 to 62 days after initiation of \n\n\n\nfenofibrate. Weekly warfarin doses were between 17.5mg to \n\n\n\n46.5mg with baseline INR between 1.6 and 3.1 upon initiation \n\n\n\nTable I: Demographic data, baseline INR and weekly warfarin dose prior to initiation of fenofibrate of patients \n\n\n\n\n\n\n\nNo Age (years) Gender Ethnicity INR before initiation of \n\n\n\nFenofibrate (Pre) \n\n\n\nINR within \n\n\n\nrange (Pre) \n\n\n\nWeekly Warfarin dose before \n\n\n\ninitiation of Fenofibrate (mg) \n\n\n\n1 68 Female Indian 2.8 Yes 24.5 \n\n\n\n2 51 Male Punjabi 2.9 Yes 46.5 \n\n\n\n3 67 Male Chinese 1.6 No 27.0 \n\n\n\n4 59 Male Indian 1.8 No 28.0 \n\n\n\n5 69 Male Malay 1.9 No 26.5 \n\n\n\n6 55 Female Indian 2.0 Yes 17.5 \n\n\n\n7 68 Female Malay 1.8 No 39.5 \n\n\n\n8 46 Male Malay 3.1 No 46.5 \n\n\n\n9 76 Female Chinese 2.0 Yes 17.5 \n\n\n\n10 61 Male Chinese 2.5 Yes 17.5 \n\n\n\n \n\n\n\n\n\n\n\n\nChew, K.W. et al. Mal J Pharm 7 (1) 2021, 7-10 \n\n\n\n\n\n\n\n9 \n\n\n\n\n\n\n\nof fenofibrate. Warfarin doses were adjusted by the prescribers \n\n\n\nto achieve the target range. The percentages of weekly warfarin \n\n\n\ndose dosage adjustment to achieve the targeted ranged between \n\n\n\n5% to 60%.  \n\n\n\n\n\n\n\nFour of the 8 patients were on other concurrent interacting \n\n\n\nmedications such as statin and levothyroxine. Patient 2, patient \n\n\n\n3, and patient 8 had fenofibrate initiated to substitute \n\n\n\ngemfibrozil. Patient 2 had simvastatin initiated on the same day \n\n\n\nas fenofibrate. This patient required 30% of the weekly \n\n\n\nwarfarin dosage adjustment to achieve the targeted range. \n\n\n\nPatient 3 had simvastatin changed to atorvastatin on the day of \n\n\n\nfenofibrate initiation. This patient required 7% changes in the \n\n\n\nweekly warfarin dosage after initiation of fenofibrate to \n\n\n\nachieve the targeted INR range. \n\n\n\n\n\n\n\nPatient 8 had an INR of 12 on the 26th days after the initiation \n\n\n\nof fenofibrate and required ward admission for hematoma. \n\n\n\nFenofibrate was not stopped but the weekly warfarin dose was \n\n\n\nreduced by 32% to achieve the targeted INR range. The \n\n\n\nlevothyroxine dose for patient 10 was increased from 75mcg to \n\n\n\n100mcg on the day of initiation of fenofibrate. \n\n\n\n\n\n\n\nTwo patients who had INR within their targeted range were \n\n\n\nreassessed at 14 and 21 days after initiation of fenofibrate. \n\n\n\nTheir weekly warfarin doses were between 24.5mg and 26.5mg \n\n\n\nwhile the baseline INR were 2.8 and 1.9 respectively. \n\n\n\n\n\n\n\nDISCUSSION  \n  \n\n\n\nEight patients were reported to have INR above the targeted \n\n\n\nrange. This is similar to the previously published case reports \n\n\n\n[4-6], whereby warfarin \u2013 fenofibrate interaction led to an \n\n\n\nincrease in INR for most of patients. The degree of changes \n\n\n\nvaried with reported case reports and among the multi-ethnic \n\n\n\npatients in this case series. The overall weekly warfarin dose \n\n\n\nreduction from baseline was highest among the Indians (2 \n\n\n\npatients; 5% & 60%), followed by Chinese (3 patients, ranging \n\n\n\nbetween 7% to 40%) and the lowest in Malays (2 patients; 14% \n\n\n\n& 32%, respectively). It is unclear whether the genetic \n\n\n\nvariations of CYP2C9 in different ethnicities contribute to the \n\n\n\nresult. \n\n\n\n\n\n\n\nHalf of the patients required reduction of 30% or more of their \n\n\n\nweekly warfarin dose to achieve the target INR range. One \n\n\n\npatient (Patient 8) had reported hematoma after initiation of \n\n\n\nfenofibrate. The effect of fenofibrate in warfarin could \n\n\n\npotentially influence the INR of 12 and resulted in a hematoma. \n\n\n\nPrevious studies had reported that the risk of major bleeding is \n\n\n\nhigh when INR is above 9 [12-13]. Our results were aligned \n\n\n\nwith previous published case reports that required up to 41% \n\n\n\nwarfarin dose reduction to maintain a therapeutic INR after \n\n\n\ninitiation of fenofibrate [4]. \n\n\n\n\n\n\n\nTwo of the patients had INR maintained within the target range \n\n\n\n14 and 21 days after initiation of fenofibrate. The other eight \n\n\n\npatients\u2019 INR was above the target range of 20 to 62 days after \n\n\n\nTable II: Detail data of patients after initiation of Micronized Fenofibrate 145mg. \n\n\n\n\n\n\n\nPatient \n\n\n\nNo \n\n\n\nWeekly \n\n\n\nWarfarin \n\n\n\ndose*(mg) \n\n\n\nTime to \n\n\n\nreassessment of \n\n\n\nINR\u2e38 (days) \n\n\n\nINR \u2e38 INR within \n\n\n\nrange \n\n\n\n(post) \n\n\n\nAdjusted \n\n\n\nWeekly \n\n\n\nWarfarin dose \n\n\n\n\u2e38(post) (mg) \n\n\n\nPercentage of \n\n\n\nweekly Warfarin \n\n\n\ndose reduction \n\n\n\n(%) \n\n\n\n\n\n\n\nRemarks \n\n\n\n1 24.5 21 2.8 Yes 24.5 No change - \n\n\n\n2 46.5 30 5.1 No 31.5 32 Gemfibrozil was substituted with \n\n\n\nfenofibrate \n\n\n\nSimvastatin was initiated on the \n\n\n\nsame day. \n\n\n\n3 27.0 57 3.6 No 25.0 7 Gemfibrozil was substituted with \n\n\n\nfenofibrate \n\n\n\nSimvastatin was substituted with \n\n\n\natorvastatin. \n\n\n\n4 28.0 62 3.4 No 26.5 5 - \n\n\n\n5 26.5 14 2.7 Yes 26.5 No change - \n\n\n\n6 17.5 30 7.3 No 7.0 60 - \n\n\n\n7 39.5 28 5.9 No 34.0 14 - \n\n\n\n8 46.5 26 12.0 No 31.5 32 Gemfibrozil substituted with \n\n\n\nfenofibrate. \n\n\n\nPatient was warded due to \n\n\n\nhematoma & elevated INR (12.0) \n\n\n\nduring the follow up in \n\n\n\nanticoagulation clinic. \n\n\n\n9 17.5 39 4.65 No 11.5 34  \n\n\n\n10 17.5 20 5.7 No 10.5 40 Levothyroxine dose was increased \n\n\n\nfrom 75 mcg once daily to 100 mcg \n\n\n\nonce daily. \n\n\n\n\n\n\n\n*Before initiation of Fenofibrate, \u2e38After initiation of Fenofibrate  \n\n\n\n\n\n\n\n\nChew, K.W. et al. Mal J Pharm 7 (1) 2021, 7-10 \n\n\n\n\n\n\n\n10 \n\n\n\n\n\n\n\ninitiation of fenofibrate. The degree of INR elevation in these \n\n\n\npatients may be affected by the duration of INR reassessment \n\n\n\nafter initiation of fenofibrate and concurrent interacting \n\n\n\nmedications. Our results indicated that the potential for the \n\n\n\nonset of interaction between warfarin and fenofibrate occurs \n\n\n\nafter 3 weeks. \n\n\n\n\n\n\n\nThree patients had their lipid-lowering fibric acid derivatives \n\n\n\nswitched from gemfibrozil to fenofibrate. Two of them (Patient \n\n\n\n2 and Patient 8) required 32% weekly warfarin dose reduction \n\n\n\nto achieve the target INR range, patient 8 eventually required \n\n\n\nto be warded due to hematoma. Another patient (Patient 3) \n\n\n\nrequired only 7% weekly warfarin dose reduction, however the \n\n\n\npatient\u2019s simvastatin (Known to cause an increase in INR when \n\n\n\nused concomitantly with warfarin) had been switched to \n\n\n\natorvastatin (No interaction with warfarin) on the same day as \n\n\n\ninitiation of fenofibrate [14]. The lower magnitude of \n\n\n\nfenofibrate-warfarin interaction for patient 3 may be affected \n\n\n\nby the switching of statins. Further investigation is needed to \n\n\n\nreview the contribution of these confounding factors towards \n\n\n\nthe degree of interaction between warfarin and fenofibrate. \n\n\n\n\n\n\n\nThere are potential limitations to consider in our case series. \n\n\n\nThe data were collected retrospectively without a control \n\n\n\ngroup. We were unable to assess the patient\u2019s adherence to the \n\n\n\nprescribed medication. Concurrent factors such as concurrent \n\n\n\nmedications and a mixed brand of warfarin used by patients \n\n\n\nmay have affected the outcome of the data. \n\n\n\n\n\n\n\nCONCLUSION  \n  \n\n\n\nEmpiric warfarin dosage reduction and close monitoring of \n\n\n\npatient\u2019s INR can be considered after initiation of fenofibrate \n\n\n\nbased on authors\u2019 experience. Individual patient characteristics \n\n\n\nsuch as concurrent medications and patient\u2019s adherence to \n\n\n\nprescribed medications should be considered when \n\n\n\ndetermining the extent of empiric warfarin dosage reduction. \n\n\n\nThe next INR reassessment date should be arranged not later \n\n\n\nthan three weeks after initiation of fenofibrate.  \n\n\n\n\n\n\n\nOur data showed that the overall weekly warfarin dose \n\n\n\nreduction after initiation of fenofibrate varied among the multi-\n\n\n\nethnic patients. The effect of different ethnicities on the degree \n\n\n\nof interaction between warfarin and fenofibrate requires further \n\n\n\ninvestigation. \n\n\n\n\n\n\n\nACKNOWLEDGMENT \n  \n\n\n\nWe would like to thank the Director General of Health \n\n\n\nMalaysia for his permission to publish this article. We would \n\n\n\nalso want to express our gratitude to Hospital Kuala Lumpur \n\n\n\n(HKL) Pharmacy Department and HKL Research & \n\n\n\nDevelopment Committee for their encouragement and support. \n\n\n\n\n\n\n\nCONFLICT OF INTEREST \n  \n\n\n\nThere is no conflict of interest.  \n\n\n\n\n\n\n\nREFERENCE \n \n\n\n\n[1] Clinical Practice Guideline: Management of Dyslipidaemia, 5th ed. \n\n\n\nMalaysia: Ministry of Health; 2017 July. Fibric Acid Derivatives \n\n\n\n(Fibrates); p.56.2. Rimal RN, Lapinski MK. Why health \n\n\n\ncommunication is important in public health: World Health \n\n\n\nOrganisation, , 2009:247-47. \n\n\n\n[2] Chok CFM and Chan LY. Malaysian Statistics on Medicines 2011 \u2013 \n\n\n\n2014. Malaysia: Ministry of Health Malaysia: Pharmaceutical \n\n\n\nServices Division. p254 \n\n\n\n[3] Alam M., Bandeali SJ., Shahzad SA., Lakkis N. Real-life Global \n\n\n\nSurvey Evaluating Patients with Atrial Fibrillation (REALISE-AF): \n\n\n\nResults of an International Observation Registry. Expert Rev. \n\n\n\nCardiovasc. Ther. 2012; 10(3), 283\u2013291. \n\n\n\n[4] Breault RR, Klakowicz A, George-Phillips KL, Bungard TJ. Warfarin \n\n\n\nDosing After Initiation of Fenofibrate. CJHP. 2005; 58 (1): 31-33. \n\n\n\n[5] Kim KY, Mancano MA. Fenofibrate potentiates warfarin effects. Ann \n\n\n\nPharmacotherapy 2003;37:212-215 \n\n\n\n[6] Aldridge MA, Ito MK. Fenofibrate and warfarin interaction. \n\n\n\nPharmacotherapy 2001; 21(7):886-889. \n\n\n\n[7] Nahar R, Sazena R, Deb R, Parakh R, Shad S, et al. CYP2C9, \n\n\n\nVKORC1, CYP4F2, ABCB1 and F5 variants: Influence on quality of \n\n\n\nlong-term anticoagulation. Pharmacological Reports. 2014; 66: 243-\n\n\n\n249. \n\n\n\n[8] Pea F, Furlanut M. Pharmacokinetic Aspects of Treating Infections in \n\n\n\nthe Intensive Care Unit: Focus on Drug Interactions. Clin \n\n\n\nPharmacokinet 2001; 40 (11): 833-868. \n\n\n\n[9] Aldridge MA, Ito MK. Fenofibrate and warfarin interaction. \n\n\n\nPharmacotherapy 2001;21(7):886-9. \n\n\n\n[10] Yin T, Miyata T. Warfarin dose and the pharmacogenomics of \n\n\n\nCYP2C9 and VKORC1- Rationale and perspectives. Thrombosis \n\n\n\nResearch. 2007; 120: 1\u201310 \n\n\n\n[11] Zhao F, Loke C, Rankin SC, Guo JY, Lee HS, et al. Novel CYP2C9 \n\n\n\ngenetic variants in Asian subjects and their influence on maintenance \n\n\n\nwarfarin dose. Clin Pharmacol Ther. 2004;76 (3): 210-219. \n\n\n\n[12] Gracia DA, Regan Susan, Crowther M, Hylek EM. The risk of \n\n\n\nhaemorrhage among patients with warfarin-associated coagulopathy. \n\n\n\nJournal of the American College of Cardiology. 2006; 47 (4): 804-\n\n\n\n808. \n\n\n\n[13] Pagano MB, Chandler WL. Bleeding risk and response to therapy in \n\n\n\npatients with INR higher than 9. Am J Clin Pathol. 2012; 138: 546-\n\n\n\n550    \n\n\n\n[14] Wiggins, B. S., Saseen, J. J., Page, R. L., 2nd, Reed, B. N., Sneed, K., \n\n\n\nKostis, J. B., Lanfear, D., Virani, S., Morris, P. B., & American Heart \n\n\n\nAssociation Clinical Pharmacology Committee of the Council on \n\n\n\nClinical Cardiology; Council on Hypertension; Council on Quality of \n\n\n\nCare and Outcomes Research; and Council on Functional Genomics \n\n\n\nand Translational Biology (2016). Recommendations for \n\n\n\nManagement of Clinically Significant Drug-Drug Interactions With \n\n\n\nStatins and Select Agents Used in Patients With Cardiovascular \n\n\n\nDisease: A Scientific Statement From the American Heart \n\n\n\nAssociation. Circulation, 134(21), e468\u2013e495. \n\n\n\nhttps://doi.org/10.1161/CIR.0000000000000456 \n\n\n\n\n\n\n\n \n\n\n\n\nhttps://doi.org/10.1161/CIR.0000000000000456\n\n\n\n"
"\n\nMalaysian Journal of Pharmacy Volume 6 Issue 1 December 2020 \n \n\n\n\n\n\n\n\n6 \n\n\n\n\n\n\n\n*Corresponding author: \n\n\n\nAisyah Saad Abdul Rahim \n\n\n\nEmail: aisyahsaad@gmail.com \n\n\n\n\n\n\n\n1Faculty of Pharmacy, Universiti Teknologi MARA, Puncak Alam, Selangor, \n\n\n\nMalaysia.  \n2School of Educational Studies, Universiti Sains Malaysia, Penang, \n\n\n\nMalaysia.  \n3School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, \n\n\n\nMalaysia. \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n \nOriginal Research Article \n \n\n\n\nGamified Online Quizzes: Pharmacy Student \n\n\n\nPerceptions of Learning in an Undergraduate Medicinal \n\n\n\nChemistry Course \n \n\n\n\nAisyah Saad Abdul Rahim1*, Azidah Abu Ziden2 and Beow Keat Yap3  \n \n\n\n\n  \nArticle Info  \n\n\n\n \nReceived date: 17 Dec 2020 \n\n\n\nAccepted date: 28 Dec 2020 \n\n\n\nPublished date: 31 Dec 2020  \n\n\n\n\n\n\n\nKeywords:  \n\n\n\nActive learning; Game-based \n\n\n\nlearning; Online Quiz; Online \n\n\n\nassessment; Student \n\n\n\nEngagement. \n\n\n\nABSTRACT  \n\n\n\n\n\n\n\nIntroduction: In the context of pharmacy education worldwide and in Malaysia, the use of digital \n\n\n\ntechnologies to promote higher level thinking and discussions is seen as preparing the millennials as \n\n\n\npharmacists in the 21st century. Together with leveraging on millennials' penchant for mobile \n\n\n\ntechnology, gamified online quizzes as an assessment tool that help promote active and collaborative \n\n\n\nlearning in a Medicinal Chemistry course have been used. Objectives: This study investigates \n\n\n\nstudents\u2019 perception of the impact of gamified online quizzes on their learning in a Medicinal \n\n\n\nChemistry course. Method: This study employs mix method research comprising descriptive \n\n\n\nanalysis, content analysis from informal chats and researchers' observation to gather the findings for \n\n\n\nthe study. Three gamified online quizzes using Quizizz, were implemented outside classroom time, \n\n\n\nin place of traditional quizzes. Multiple attempts were allowed within a stipulated time. As \n\n\n\ninterventions, post-quiz discussions were conducted during class time. Students completed an end-\n\n\n\nof-the-course survey. Results: Out of 63 respondents, more than 96% felt that the gamified online \n\n\n\nquizzes enhanced their learning as they learned from the instant feedback, their mistakes and post-\n\n\n\nquiz discussions. Overall student performance based on the percentage and accuracy of answering \n\n\n\nthe quiz improved with time. Student qualitative comments on the survey, the course social media \n\n\n\n(closed group) and informal chats supported the findings from the descriptive data analysis of the \n\n\n\nstudy. Conclusions: From students\u2019 perception, the gamified online quizzes were found to be \n\n\n\nenjoyable and effective in enhancing active, peer learning in an undergraduate medicinal chemistry \n\n\n\ncourse outside class time. For instructors, the online quiz served as an efficient tool for formative \n\n\n\nassessment in a large classroom setting, and could replace traditional classroom quizzes. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nINTRODUCTION  \n\n\n\n\n\n\n\nThe use of online and in-classroom digital games and game-\n\n\n\nbased approaches to promote student engagement via active \n\n\n\nand collaborative learning has gained prominence (1\u20133). It is of \n\n\n\nparticular relevance  during this challenging Covid-19 times \n\n\n\nwhen most face-to-face teaching and learning activities moved \n\n\n\nto online learning\u2013prompting  educators to seek approaches \n\n\n\nthat facilitate and increase students' online engagement (4,5). \n\n\n\n\n\n\n\nGame-based learning provides learners: (a) the environment to \n\n\n\ntake risks, (b) the chance to make mistakes and learn from these \n\n\n\nmistakes in a low-stake but competitive environment, (c) the \n\n\n\nopportunities to keep trying and (d) the avenue to be rewarded \n\n\n\nfor successful attempts. These are similar to how people learn \n\n\n\nto master certain skills or acquire new knowledge in life.  \n\n\n\n\n\n\n\nBesides that, game-based learning employs elements such as \n\n\n\npoint systems, scoreboards, winners and eye-catching avatars \n\n\n\ncoupled with exciting music and colourful, user-friendly \n\n\n\ninterfaces that keep learners motivated and engaged in a non-\n\n\n\n\nmailto:aisyahsaad@gmail.com\n\n\n\n\n\n\nA.S. Abdul Rahim et al. Malaysian Journal of Pharmacy 6 (1) 2020 \n\n\n\n\n\n\n\n7 \n\n\n\n\n\n\n\ngame context (6,7), for instance in learning abstract concepts \n\n\n\nor dry subjects (8\u201311). \n\n\n\n\n\n\n\nIn the context of pharmacy education worldwide and in \n\n\n\nMalaysia, the use of digital technologies to promote higher \n\n\n\nlevel thinking and discussion is seen as preparing the \n\n\n\nmillennials as pharmacists in the 21st century\u2013where skilful \n\n\n\ncommunication, collaboration and critical thinking are \n\n\n\nessential in various pharmacy practices (8,12\u201321). \n\n\n\n\n\n\n\nGamified web-based quizzes e.g. Kahoot, Quizizz and \n\n\n\nSocrative, are increasingly being used as a pedagogical strategy \n\n\n\nto conduct classroom teaching and assessment (7). Despite \n\n\n\ndoubts of its pedagogical effectiveness (22,23), their appeals to \n\n\n\nyoung students lie in engaging and motivating learners in \n\n\n\ngame-based, digital learning experiences (18,24).   \n\n\n\n\n\n\n\nIn previous years, students taking the Principles of Medicinal \n\n\n\nChemistry course at the School of Pharmaceutical Sciences, \n\n\n\nUniversiti Sains Malaysia (USM) were assessed in a number of \n\n\n\nin-class assignments and pop-quizzes. These formed the \n\n\n\nformative assessment part of the course. Anecdotally, this \n\n\n\nsubject was found difficult amongst many students. To help \n\n\n\ntheir learning on the subject, students requested for regular pop-\n\n\n\nquizzes. In doing so, however, the instructors found that \n\n\n\ncreating questions, marking such formative assessments and \n\n\n\nproviding constructive feedback were time-consuming, \n\n\n\nparticularly for a large class.  \n\n\n\n\n\n\n\nTherefore, this study is aimed to seek for a form of formative \n\n\n\nassessment that would help instructors to securely conduct the \n\n\n\nassessment, allows efficient grading, analyse student responses \n\n\n\nand deliver learning analytics. Additionally, this study aimed \n\n\n\nto evaluate a digital tool that leverages on digital natives\u2019 \n\n\n\npenchant for mobile technology.  \n\n\n\n\n\n\n\nThe popularity of various game-based instructions for active \n\n\n\nlearning in pharmacy classroom settings has been reported \n\n\n\npreviously (12,16,19,21,25\u201328); however, its use outside of \n\n\n\nclass time remains relatively unexplored in traditional higher \n\n\n\neducation setting. The use of gamified online quiz by \n\n\n\neffectively utilising the notional student learning time (SLT) \n\n\n\ncould serve as a novel way towards effective learning. This \n\n\n\npreliminary study evaluates pharmacy students\u2019 perceptions of \n\n\n\nlearning using a gamified online quiz approach (ie. using \n\n\n\nQuizizz) with a view of replacing traditional in-class quizzes. \n\n\n\n\n\n\n\n\n\n\n\nMETHOD  \n  \n\n\n\nThe Principles of Medicinal Chemistry course is a 2-unit course \n\n\n\nfor second year pharmacy students at Universiti Sains Malaysia. \n\n\n\nIt consists of topics on drug design and development that \n\n\n\nincludes structure-activity relationship (SAR), quantitative \n\n\n\nSAR (QSAR), drug modelling and pharmacokinetics. The \n\n\n\ncourse is taught by two instructors to a large group of 116 \n\n\n\nstudents. Three unsupervised online quizzes were offered \n\n\n\nduring the semesters, i.e. students were assessed in Week 7, 11 \n\n\n\nand 14. Each quiz was conducted about 3 weeks apart. Students \n\n\n\ncompleted these quizzes as a part of continuous assessment \n\n\n\n(10%) in this course. The online quiz consisted of 20-30 \n\n\n\nmultiple-choice, randomised questions and answers with \n\n\n\nprogressive difficulties, which would evaluate students' six \n\n\n\ncognitive levels based on the Bloom\u2019s Taxonomy, i.e. \n\n\n\nknowledge, comprehension, application, analysis, synthesis \n\n\n\nand evaluation. Using images and diagrams, instructors were \n\n\n\nable to construct more challenging questions by prompting \n\n\n\nstudents to critically examine the visuals (e.g. drug-protein \n\n\n\ninteractions, SAR, molecular modelling in Figure 1), thus \n\n\n\ntesting students\u2019 critical thinking and understanding in \n\n\n\nmedicinal chemistry. \n\n\n\n\n\n\n\nThe quizzes were implemented based on students' preferences \n\n\n\nthat were collected using Google Form. Students were made \n\n\n\naware of the quizzes through the Facebook closed group of the \n\n\n\nmedicinal chemistry course. Students were alerted to six rules \n\n\n\nfor online quizzes\u2013one such rule requires students to use \n\n\n\nassigned name codes to keep their anonymity secured in the \n\n\n\ncyber world and later, for grading purposes (Table 1). \n\n\n\n\n\n\n\nSimple technical support for students (e.g. game pin, access, \n\n\n\nname repeat) was provided by the instructors in the evenings of \n\n\n\nFigure 1: Question samples using a molecular structure and a diagram \n\n\n\n\n\n\n\n\nA.S. Abdul Rahim et al. Malaysian Journal of Pharmacy 6 (1) 2020 \n\n\n\n\n\n\n\n8 \n\n\n\n\n\n\n\nthe quiz, between 8-10 pm. Instructors were also present online \n\n\n\nto monitor the running of the online quiz. Student performance \n\n\n\nreports were downloaded every 15-20 minutes, and at the \n\n\n\nconclusion of the online quiz. The reports are colour-coded as \n\n\n\nshown in Figure 2.  \n \n\n\n\nTable 1: Six rules of online quiz  \n\n\n\n6 Rules of Online Quiz \n \n\n\n\n1. Please make sure you are connected to a stable wi-fi, uni-fi or cable \n\n\n\ninternet. The quiz is web-based. You may use mobile devices or \n\n\n\nlaptops.  \n2. Please use the assigned code names. ANY names different from the \n\n\n\nassigned code names will be removed. No marks given.   \n3. DO NOT SHARE the quiz code or quiz questions with anyone or \n\n\n\nyour juniors/seniors.  \n4. You may repeat the quiz as multiple times\u2013within the allocated time.  \n5. Your quiz marks will be based on your best performance.  \n\n\n\n6. The content of the quiz is copyrighted under the instructor. No \nscreenshot or any audio-visual recording is allowed without prior \n\n\n\npermission.  \n* The assigned code name will be crucial during the grading process.   \n\n\n\nThis makes it visually easy for instructors to quickly check and \n\n\n\nplan for student feedback. Post-quiz discussions based on the \n\n\n\nQuizizz reports were held during the next available lecture hour. \n\n\n\nThe reports were also used for grading purposes. \n\n\n\n\n\n\n\nCriteria and considerations in designing a gamified online \n\n\n\nquiz  \n\n\n\n\n\n\n\na) Which gamified online quiz would be suitable for a large \n\n\n\nclass? \n\n\n\n\n\n\n\n As mentioned earlier, there are several free, gamified online \n\n\n\nstudent response systems available e.g. Kahoot, Socrative and \n\n\n\nQuizizz. For this initial study, the criteria used for selecting the \n\n\n\nonline quiz are: 1) it is a free digital tool, and remains free for \n\n\n\na large number of students (over 100); 2) student- and \n\n\n\ninstructor-friendly (e.g. low learning curve); 3) has built-in \n\n\n\nelements of gamification; 4) able to generate analytics; 5) set a \n\n\n\ndeadline for students; 6) stable, responsive and reliable during \n\n\n\nreal-time uses for a large-sized class and 7) able to be used on \n\n\n\nlaptops and mobile devices. Based on these criteria, Quizizz \n\n\n\nwas selected as the gamified online tool as a part of the \n\n\n\ncontinuous assessment.  \n\n\n\n\n\n\n\nb) How many attempts for an online quiz? How long should it \n\n\n\nbe? \n\n\n\n\n\n\n\nAt the outset of this online quiz, the instructors had little idea \n\n\n\nwhat constitutes a realistic setting for students, in terms of quiz \n\n\n\nduration and number of attempts. Unlike the traditional pen-\n\n\n\nand-paper quiz, the instructors were mindful of the time \n\n\n\nlearners need to familiarise themselves with a new technology. \n\n\n\nAllowing for extra time reduces anxiety in students, a key \n\n\n\nfactor in facilitating learning (28). Allowing for extra time also \n\n\n\nprovides students time to rectify technical issues (e.g. internet \n\n\n\naccess, browser) possibly encountered, often at the start, and \n\n\n\nduring the online quiz.  \n\n\n\n\n\n\n\nFurthermore, the main purpose of offering the gamified online \n\n\n\nquiz is to help students to learn from their mistakes and that of \n\n\n\ntheir peers. Taking these factors into considerations, the first \n\n\n\nonline quiz was opened for 120 minutes. Students could repeat \n\n\n\ntaking the quiz as many times as they wish\u2013within that period. \n\n\n\nAt the end of the 2-hour period, the online dashboard showed \n\n\n\na staggering 834 players with an overall 79% accuracy. \n\n\n\nConsidering that there were 116 students registered for the \n\n\n\nquiz, each student probably attempted close to 7.2 times. The \n\n\n\ntop 10% players took, on average, 1 minute and 25 seconds to \n\n\n\nanswer each quiz question and rose to the top of the scorecard \n\n\n\nwith 100% accuracy. Due to the huge number of attempts, the \n\n\n\nfirst instructor discovered that the overall analytics on student \n\n\n\nperformance could not be processed and downloaded from \n\n\n\nQuizizz website.  \n\n\n\n\n\n\n\nThe second quiz was administered about 3 weeks later by the \n\n\n\nsecond instructor. Initially, the instructor planned for a \n\n\n\ntraditional in-class quiz; but upon overwhelmingly positive \n\n\n\nstudent feedback for the first quiz and requests for a second \n\n\n\nonline quiz, the second quiz was also held using Quizizz. The \n\n\n\ninstructors had a discussion to rectify and improve the first \n\n\n\nsetting. Based on our discussion, students were allowed a \n\n\n\nmaximum of three attempts within a 60-minute period. With \n\n\n\nFigure 2: Colour-coded analytics categorised by questions and students facilitated post-quiz discussions. \n\n\n\n\n\n\n\n\nA.S. Abdul Rahim et al. Malaysian Journal of Pharmacy 6 (1) 2020 \n\n\n\n\n\n\n\n9 \n\n\n\n\n\n\n\nthe duration and number of attempts capped, the second \n\n\n\ninstructor managed to download the final report.  \n\n\n\n\n\n\n\nFor the third quiz, students requested to increase the number of \n\n\n\nattempts. Since the purpose of offering the online quiz is \n\n\n\n\u201cassessment for learning\u201d rather than \u201cassessment of learning\u201d, \n\n\n\nthe first instructor allowed more repeats than the previous quiz.  \n\n\n\nAssessment for learning refers to formative assessments that \n\n\n\nare focused on providing feedback for improvements in  \n\n\n\nstudents' learning, whereas assessment of learning refers to \n\n\n\nsummative evaluations at the end of a course (29). Therefore, \n\n\n\nin the third quiz, the maximum number of attempts were \n\n\n\ncapped at 5 times for a 60-minute quiz. \n\n\n\n\n\n\n\nData Collection \n\n\n\n\n\n\n\nAfter the final quiz, the students were asked to complete an \n\n\n\nonline questionnaire on a voluntary basis\u2013no rewards were \n\n\n\noffered for completing the survey. They were asked to provide \n\n\n\nonly their first name and gender. The purpose of the student \n\n\n\nsurvey was to gauge the student perceptions on learning via \n\n\n\ngamified online quizzes. The questionnaire had a section of 14 \n\n\n\nquestions to find out to what extent gamification features, types \n\n\n\nof questions, flexibility, post-quiz discussions influenced their \n\n\n\nlearning (see Table 2).  \n\n\n\n\n\n\n\nThe survey used a five-point Likert scale for each item \n\n\n\n(1=strongly disagree, 2= disagree, 3=neutral, 4=agree, and \n\n\n\n5=strongly agree). At the end of the questionnaire, there were \n\n\n\nblank spaces for students to write further comments and \n\n\n\nsuggest improvements. Informal chats together with students\u2019 \n\n\n\nfeedback on the course Facebook group were taken into \n\n\n\naccount in this study. The data from students\u2019 comments, \n\n\n\nsuggestions and informal chats were analysed and used to \n\n\n\nsupport the descriptive data from the survey. \n\n\n\n\n\n\n\nRESULTS  \n \n\n\n\nOut of 116 students, 63 students responded to the survey. \n\n\n\nForty-four respondents (69.8%) were female students and 19 \n\n\n\n(30.2%) were male. The results in Table 2 showed that over \n\n\n\n95% thought the online quizzes were more fun, enhanced their \n\n\n\nlearning and were more effective than the traditional in-class \n\n\n\nquiz. Interestingly, 95.9% of respondents believed that online \n\n\n\nTable 2: A survey on students' perception of learning based on the gamified online quiz. \n\n\n\n\n\n\n\nSurvey \nNumber that agreed or \n\n\n\nstrongly agreed \nPercentage \n\n\n\nQ1. The online quiz makes learning more fun than the traditional, in-class quizzes.   56 96.6 \n\n\n\nQ2. Unlike traditional quiz, I can take the quiz repeatedly. These have enhanced my learning in the \n\n\n\ncourse.   \n56 96.6 \n\n\n\nQ3. Unlike traditional quiz, the online quizzes were held after class - in the evenings between 8-10 pm. \nThese have enhanced my learning in the course.   \n\n\n\n47 95.6 \n\n\n\nQ4. Unlike traditional quiz, the online quiz allows a fixed amount of time (often 5 - 30 seconds) for a \n\n\n\nquestion. This has enhanced my learning in the course.   \n23 56.1 \n\n\n\nQ5. Unlike traditional quiz, the online quiz is based on speed and accuracy of your answers. This has \n\n\n\nenhanced my learning in the course.   \n29 70.7 \n\n\n\nQ6. Unlike traditional quiz, the online quiz displays the scoreboard of you and your classmates. This has \n\n\n\nenhanced my learning in the course.   \n22 68.7 \n\n\n\nQ7. Unlike traditional quiz, the online quiz displays memes and funny quotes. This causes distractions \nfor my learning.   \n\n\n\n14 29.8 \n\n\n\nQ8. Unlike traditional quiz, the online quiz offers flexibility. It can be taken anytime, anywhere as long \n\n\n\nas there is internet. This does not help my learning at all.   \n21 39.6 \n\n\n\nQ9. Unlike traditional quiz, the online quiz is entirely based MCQs, and therefore is so easy.   17 43.6 \n\n\n\nQ10. In the online quiz, a variety of questions of different difficulties (easy, medium and hard) were \n\n\n\nposted. These have enhanced my learning in the course.   \n54 98.2 \n\n\n\nQ11. The online quiz makes learning more effective than the traditional, in-class quizzes.   55 96.5 \n\n\n\nQ12. The post-online quiz discussion held by lecturer(s). This activity has enhanced my learning in the \n\n\n\ncourse.   \n58 98.3 \n\n\n\nQ13. Taking the online quiz has made it easy for me to remember concepts, principles about medicinal \n\n\n\nchemistry.   \n55 98.2 \n\n\n\nQ14. I prefer the traditional 1 hour quiz in class. Online quiz does not work for me.   5 7.9 \n\n\n\n \n\n\n\n\n\n\n\n\nA.S. Abdul Rahim et al. Malaysian Journal of Pharmacy 6 (1) 2020 \n\n\n\n\n\n\n\n10 \n\n\n\n\n\n\n\nquizzes in the evenings helped to enhance their learning, \n\n\n\neffectively uses the notional student learning time (SLT). \n\n\n\nAbout 98% indicated that taking the online quizzes made it \n\n\n\neasy for them to remember concepts and principles in \n\n\n\nmedicinal chemistry. Similarly, 98.3% felt that their learning \n\n\n\nwas further enhanced when post-quiz discussions were held. \n\n\n\nBecause the online quizzes were conducted in the evenings, the \n\n\n\nlimited daytime lecture slots were not compromised; instead \n\n\n\nthey were used for post-quiz discussions. Somewhat 39.6% \n\n\n\nagreed or strongly agreed that the \u2018anytime, anywhere\u2019 \n\n\n\nflexibility of taking the online quiz did not help their learning.   \n\n\n\n\n\n\n\nThe web-based quiz used in this course, Quizizz, employs game \n\n\n\nelements e.g. points, live ranking and scoreboard, memes and \n\n\n\nfunny quotes to inject fun and motivate students by rewarding \n\n\n\nthem based on the speed and accuracy of their answers. Two-\n\n\n\nthirds of the respondents disagreed that memes and funny \n\n\n\nquotes cause distractions. When queried about the gamification \n\n\n\nfeatures, specifically on the duration set per questions, varying \n\n\n\nbetween 5-30 seconds, about 56.1% of respondents felt that the \n\n\n\nfixed duration contributed towards enhancing their learning; \n\n\n\nwhereas 70.7% thought speed and accuracy did help their \n\n\n\nlearning. Additionally, 68.7% of the respondents indicated that \n\n\n\nhaving the scoreboard helped their learning.  \n\n\n\n\n\n\n\nStudies have shown that game mechanics e.g. scoreboards, \n\n\n\nrewards and rankings encourage engagement in learners and \n\n\n\nprovide social comparisons, thus may influence students\u2019 \n\n\n\nmotivation and performance (30).  Regarding having the quiz \n\n\n\nin multiple choice questions (MCQ), 43.6% felt it was easy, but \n\n\n\nthe majority thought that having a variety of questions of \n\n\n\ndifferent difficulties (easy, medium and hard) helped to \n\n\n\nenhance learning in the course. Overall, the majority of \n\n\n\nstudents prefer gamified online quizzes to traditional in-class \n\n\n\nquiz.  \n\n\n\n\n\n\n\nDISCUSSION  \n \n\n\n\nThe value of game-based quiz for learning has been well-\n\n\n\ninvestigated recently in higher education settings (2,31\u201333). \n\n\n\nTraditional in-class quizzes, closed or open-book, have been \n\n\n\nroutinely used as a summative assessment. Instructors may or \n\n\n\nmay not discuss the quiz questions. On the other hand, an open-\n\n\n\nbook quiz seems to reduce anxiety, puts less weight on \n\n\n\nmemorisation, encourages deeper engagement with the course \n\n\n\nmaterials and is more realistic as it mimics the real-life working \n\n\n\nenvironment (33). Taking a step further, when learning, \n\n\n\nformative assessment and game elements are combined, it \n\n\n\ncould potentially enhance student engagement in the course, \n\n\n\nencouraging learning without threatening esteem (30,34). To \n\n\n\nthis end, many interactive response systems or similar have \n\n\n\nbeen shown to promote active learning and peer instruction in \n\n\n\nlectures (32,35\u201338). \n\n\n\n\n\n\n\nThe survey results of student perceptions are further supported \n\n\n\nby voluntary written student feedback using the same survey \n\n\n\nand on the closed Facebook group of the course. Table 3 lists \n\n\n\nthe total number of positive comments (10 comments) which \n\n\n\noutnumbered the negative aspects (1 comment).  \n\n\n\n\n\n\n\nAmong the positive comments, many mentioned \u201chaving fun \n\n\n\nduring gamified online quizzes\u201d; discussing and learning from \n\n\n\ntheir friends; felt that they could remember better; get quick \n\n\n\nfeedback and learn from their mistakes. Gamified quiz reframes \n\n\n\nfailure as an essential part of the learning process, thus, \n\n\n\npromoting resilience in learners (23). Some students also \n\n\n\nsuggested this online quiz be implemented in other courses, \n\n\n\nwhile expressing concerns for not having enough time to learn \n\n\n\nand improve their scores in a 1-hour quiz.   \n\n\n\n\n\n\n\nTable 3: Comments from students from the survey and Facebook \n\n\n\n\n\n\n\n\n\n\n\nPositive comments of the gamified online quizzes were  \n\u2022 New way of learning was exciting!  \n\n\n\n\u2022 I wish every quiz is conducted this way. \n\n\n\n\u2022 This approach makes me remember better.  \n\n\n\n\u2022 This is my first time in life having fun while answering quizzes.  \n\n\n\n\u2022 Good as in online quiz is done with flexibility and can be \n\n\n\ndiscussed with friends.  \n\n\n\n\u2022 We can learn in a fun and relaxing way via online quizzes. Do \n\n\n\nit for all subjects.  \n\n\n\n\u2022 I really love this online quiz! Especially when we can learn \n\n\n\nfrom our mistakes and correct them on the spot. I'm looking \n\n\n\nforward to the next quiz!  \n\n\n\n\u2022 I really have fun doing this quiz! This helps me remember \n\n\n\nbetter\u2013l love the avatars.  \n\n\n\n\u2022 This quiz was very fun doing in a group. Really learnt a lot from \n\n\n\nour own mistakes. Thanks for this fun and worthy online quiz! \n\n\n\nLooking forward to the next online quiz!  \n\n\n\n\u2022 Online quiz is much better than traditional quiz. I tend to learn \n\n\n\nfrom my mistakes. Unlike traditional ones, we have the chance \n\n\n\nto attempt more than once and therefore, learning from our \nmistakes.  \n\n\n\n\n\n\n\n\n\n\n\nNegative comments of the gamified online quizzes were  \n\u2022 Just a suggestion regarding the duration of quiz, I think it \n\n\n\nshould be extended to 1.5-2 hours so that students have more \n\n\n\ntime to think and choose the right answer to each question.  \n\n\n\n\n\n\n\n\n\n\n\nInformal interviews with students \n\n\n\n\n\n\n\nTo gain an insight into how the students took the gamified \n\n\n\nonline quizzes, informal interviews were conducted with \n\n\n\nseveral students. The students revealed that they worked in \n\n\n\ngroups. The group size increased from small (3-4 students) to \n\n\n\nlarge (9-10 students) as the quiz progressed. They further \n\n\n\nrevealed that before the start of the quiz, they had all the study \n\n\n\nmaterials (books, lecture notes, mobile phones and tablets\u2013at \n\n\n\nhand) ready. When the quiz began, they would attempt the \n\n\n\nquestions as individuals. If they were unable to answer the \n\n\n\nquestions, they paused and checked with their group mates, \n\n\n\n\n\n\n\n\nA.S. Abdul Rahim et al. Malaysian Journal of Pharmacy 6 (1) 2020 \n\n\n\n\n\n\n\n11 \n\n\n\n\n\n\n\nread the materials and scanned the internet for answers. Since \n\n\n\ntime is the essence, if they still could not find an answer they \n\n\n\ntend to continue without submitting an answer. Such response \n\n\n\nis allowed in Quizizz. These were most apparent in the first half \n\n\n\nhour of the quiz as reported by the analytics.  \n\n\n\n\n\n\n\nAs the quiz progressed, the first instructor learned that the \n\n\n\ninstant feedback was helpful to student in checking their \n\n\n\nconceptions. Once the correct or wrong answers were noted \n\n\n\ndown, discussions ensued with them continuing to learn from \n\n\n\ntheir own mistakes and others. The anecdotes support the \n\n\n\nnotion that gamified quiz promotes informal, peer learning \n\n\n\noutside classroom during the notional SLT.  \n\n\n\n\n\n\n\nPost-quiz discussions  \n\n\n\n\n\n\n\nPost-quiz discussions are an effective form of intervention; \n\n\n\nthese were made during lecture hours. The discussions were \n\n\n\nbased on the analytics generated by Quizizz, which provides a \n\n\n\ndownloadable colour-coded Excel table displaying answers in \n\n\n\ngreen (correct) and red (wrong) as shown in Figure 2.  \n\n\n\n\n\n\n\nThe report helps instructors to quickly pick the questions that \n\n\n\nneeded further clarification and corrections during the post-\n\n\n\ndiscussions. The analytics can also be used as starting points \n\n\n\nfor deeper discussions during the lecture hours. Informal chats \n\n\n\nwith students revealed that this form of intervention is rarely \n\n\n\nconducted in the traditional quiz and large classroom settings, \n\n\n\nwhere formative assessment tend to be overlooked (39,40).  It \n\n\n\nis, therefore, no surprise that 98% of respondents felt the post-\n\n\n\nquiz discussions enhanced their learning (survey item 12). \n\n\n\n\n\n\n\nLimitations of the study \n\n\n\n\n\n\n\nThe online quiz has its limitations; it invites the possibility of \n\n\n\ncheating, particularly the identity of the participants. Cheating \n\n\n\ncan be minimised by assigning unique student names. \n\n\n\nNonetheless, it could have been answered by the same student \n\n\n\nusing 2-3 assigned names, or even by a random person. Having \n\n\n\nsupervised online quizzes could have prevented cheating. \n\n\n\nUnder another course at the School, a similar online quiz using \n\n\n\nElearn@USM, the university\u2019s Moodle-based learning \n\n\n\nmanagement system, had been administered at a computer lab \n\n\n\nin the School. Since the capacity of the computer lab is limited \n\n\n\nto about 50-60 students, the online quiz had to be conducted in \n\n\n\ntwo consecutive sessions. When one group of students was \n\n\n\ntaking the quiz, the other group was being quarantined until the \n\n\n\nfirst group finished. Even though cheating was prevented in this \n\n\n\ncase, conducting such quiz placed greater burden on staffing, \n\n\n\nfacilities and timetabling. \n\n\n\n\n\n\n\nAnother limitation for such online quiz is stable internet \n\n\n\nconnectivity, which is stated as one of the rules in the Table 1. \n\n\n\nStudents are able to access stable Wi-Fi or cable internet \n\n\n\nprovided by the university, on-campus or at student \n\n\n\naccommodation; though, at times overloaded servers may \n\n\n\naffect the internet connectivity. In one instance, a student \n\n\n\nreported that she was unable to log into the online quiz using \n\n\n\nher laptop browsers. She had to switch to her phone using own \n\n\n\ndata plan to attempt the quiz. She finished her third attempt past \n\n\n\nthe deadline. Allowance for time provides a space for any \n\n\n\ntechnical difficulties and helps increase student familiarity with \n\n\n\ntechnology. This incident highlights the importance of time, \n\n\n\nwhich should be included as a part of the design of an online \n\n\n\nquiz or any assessment using a digital tool and platform. \n\n\n\n\n\n\n\nCONCLUSION  \n  \n\n\n\nThe objective of this initial study was to find out the students\u2019 \n\n\n\nperceptions on the employment of gamified online quizzes in a \n\n\n\nmedicinal chemistry course as an alternative to traditional pen-\n\n\n\nand-paper quiz. Overall students\u2019 perceptions towards the \n\n\n\nemployment of online quizzes were extremely positive. For \n\n\n\ninstructors, it provides an efficient way to conduct formative \n\n\n\nassessments throughout the course.  \n\n\n\n\n\n\n\nAdditionally, the gamified quiz environment promotes \n\n\n\ninformal, active and collaborative learning outside lecture \n\n\n\nhours. Students strongly indicated that receiving instant \n\n\n\nfeedback, learning from mistakes and post-quiz discussions are \n\n\n\nthree key factors that enhanced their learning. They also \n\n\n\nrecommended the adoption of the gamified online quiz in other \n\n\n\ncourses in the pharmacy curriculum and could serve as an \n\n\n\nalternative to traditional quiz. A comparison between gamified \n\n\n\nand non-gamified online quizzes would be explored in the \n\n\n\nfuture. \n\n\n\n\n\n\n\nConfronted with multiple lockdowns and remote teaching \n\n\n\nduring the Covid-19 pandemic, adoption of alternative forms of \n\n\n\nassessment in higher education settings using digital tools and \n\n\n\nplatforms are inevitable and on-going. With careful planning, \n\n\n\ndesign and selection of digital tools, gamified online quizzes \n\n\n\ncan promote and sustain active and collaborative learning for \n\n\n\ndeeper engagement and social resilience in 21st century \n\n\n\npharmacy education. \n  \n\n\n\nACKNOWLEDGMENTS  \n  \n\n\n\nThe authors wish to thank all students who had participated in \n\n\n\nthe survey and the online quizzes. \n\n\n\n\n\n\n\nCONFLICT OF INTEREST \n  \n\n\n\nThe authors declare no conflict of interest. This research did \n\n\n\nnot receive any specific grant from funding agencies in the \n\n\n\npublic, commercial or not-for-profit sectors. \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nA.S. Abdul Rahim et al. Malaysian Journal of Pharmacy 6 (1) 2020 \n\n\n\n\n\n\n\n12 \n\n\n\n\n\n\n\nREFERENCES  \n \n\n\n\n1.  Koutromanos G, Avraamidou L. The use of mobile games in formal \nand informal learning environments: A review of the literature. EMI \n\n\n\nEduc Media Int. 2014;51(1).  \n\n\n\n2.  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"\n\n\n\n\n\n1 \n \n\n\n\nKnowledge level of government healthcare personnel in Labuan towards \nRegistered Product and Notified Cosmetic \n\n\n\nZS Sujata Tan \n\n\n\nPharmacy Enforcement Branch, Pharmaceutical Services Division, Labuan State Health \nDepartment, Ministry of Health Malaysia, Jalan Hospital, 87000, Wilayah Persekutuan \nLabuan, Malaysia. \n\n\n\n* Contact for correspondence, please email: zstan@moh.gov.my \n \n\n\n\nABSTRACT \n\n\n\nIntroduction: All pharmaceutical products in Malaysia must be registered with the Drug \nControl Authority (DCA) whereas cosmetics must be notified with the National \nPharmaceutical Regulatory Agency (NPRA). Availability of unregistered products and \nunnotified cosmetics in the market are longstanding issues affecting public safety and health. \nIt is vital that all government healthcare personnel (GHP) as the front liners are equipped with \nthe knowledge to properly advise the public on this issue. \n\n\n\nObjective: This study aims to determine the level of knowledge towards registered products \nand notified cosmetics among various groups of GHP under the Ministry of Health facilities in \nLabuan. \n\n\n\nMethods: This was a cross-sectional study performed from August to November 2017 using a \nvalidated 12 question questionnaire. Respondents were divided into 4 groups (doctors/dentist, \npharmacist, nurse, allied healthcare professional) and results between the groups were analysed \nusing Chi-square analysis. Respondent\u2019s knowledge was given score and those who scored 9 \nmarks and above were considered to have good knowledge. Those who scored 8 marks and \nbelow were considered to have poor knowledge. \n\n\n\nResults: Only 40.2% Pharmacists have the highest score of good knowledge on registered \nproducts and notified cosmetics at 81.8% (n=18).  The level of good knowledge among allied \nhealth professionals (AHP) stood at 42.9% (n=21), 36.4% of nurses (n=43) and 20% of doctors \n(n=6). However in total, only 40.2% (n=88) of the study population had good knowledge.   \n\n\n\nConclusion: The level of knowledge towards registered products and notified cosmetics \namong doctors, pharmacist, nurses and allied health professional in Labuan is poor as only \n40.2% have good knowledge. This study shows a significant association between the levels of \nknowledge among GHP varies between groups of profession. Pharmacist group has the highest \nscore in knowledge in this study and thus should be another reference for the general public \nand patients when it comes to health-related matters. Further re-education should be conducted \nto improve the knowledge of GHPs in Labuan with regards to this subject.  \n\n\n\nKeywords: registered products, notified cosmetics, government healthcare personnel, \npharmacy, pharmacy enforcement \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n2 \n \n\n\n\nINTRODUCTION \n\n\n\nThe National Survey on the Use of Medicines (NSUM) by Malaysian Consumers 201512, \nshowed that 58.6% of the participants preferred to consult government doctors when \nexperiencing health related problems. Therefore, it is vitally essential for all our government \nhealthcare personnel to have knowledge on registered products and notified cosmetics as they \nare often the first line of contact when the general public has any enquiries.  \n\n\n\nAll medicinal and pharmaceutical products, which include health supplements and traditional \npreparations must be registered with the Drug Control Authority (DCA), Ministry of Health \nMalaysia (MOH) before being marketed and sold to consumers1. The availability of \nunregistered products and unnotified cosmetics in the market are longstanding issues affecting \npublic safety and health. In 2016 alone, the Pharmacy Enforcement Division of Malaysia had \nconfiscated RM54.9 million worth of unregistered products and unnotified cosmetics \nrespectively, indicating the issue is still at large amongst the general public5. \n\n\n\nAccording to Regulation 7(1)(A) Control of Drugs and Cosmetics Regulations 1984, \u201cNo \nperson shall manufacture, sell, supply, import, possess or administer any product unless the \nproduct is a registered product\u201d6.  It is clear that only registered products are allowed in this \ncountry and everyone must follow these regulations. Moreover, all registered products undergo \nevaluation of the products' quality, safety and efficacy (except for traditional preparations and \nhealth supplements) to ensure safety of the public7. \n\n\n\nCosmetic products in Malaysia must also be notified with the National Pharmaceutical \nRegulatory Agency, Ministry of Health Malaysia (MOH) before being marketed and sold to \nconsumers. Cosmetics include any substance or preparation intended to be placed in contact \nwith various external parts of the human body (epidermis, hair system, nails, lips and external \ngenital organs) or with teeth and the mucous membranes of the oral cavity, with a view \nexclusively or mainly to cleaning them, perfuming them, changing their appearance and/or \ncorrecting body odours and/or protecting them or keeping them in good condition8. Some \nexamples of cosmetic products include body soap, facial cleansers and creams, sunscreens, \ntoothpaste and mouth rinse, hair shampoos and conditioners, hair dyes, perfumes and \ndeodorants, and colour cosmetics including lipsticks, eye shadow, compact powder and nail \npolish.  \n\n\n\nThis study aims to determine the level of knowledge towards registered products and notified \ncosmetics among various groups of government healthcare personnel under the Ministry of \nHealth facilities in Labuan. This study group was chosen due to logistical reasons as the author \nis a staff under the Labuan State Health Department, Ministry of Health, which has to direct \naccess to the government healthcare personnel. This was the first effort to conduct such \nresearch within Malaysia. \n\n\n\n\n\n\n\nMETHODS \n\n\n\nDesign and study population \n\n\n\nA cross sectional study was performed on government healthcare personnel under the Labuan \nState Health Department, which also included Rural Health Clinics (Klinik Desa), Community \nClinics (previously known as 1Malaysia Clinic), Health Clinics and Labuan Hospital, from \nAugust to November 2017. The inclusion criteria included all healthcare personnel that are \navailable during the conduct of the study. Personnel who were absent or on leave during the \nconduct of the study were excluded. Based on a population of roughly 500 GHP (information \nprovided by the Human Resource Section, Labuan State Health Department), the sample size \nwas calculated using Raosoft sample size calculator (margin of error = 5%, confidence level = \n\n\n\n\n\n\n\n\n\n\n\n\n3 \n \n\n\n\n95%, response distribution = 50%) which yielded the minimum sample size of 218 \nparticipants.9 Healthcare personnel without a healthcare related diploma/degree are excluded \nfrom this study.  \n\n\n\n\n\n\n\nInstrumentation \n\n\n\nQuestionnaires were distributed to GHP via the respective Deputy State Health Directors. This \nvalidated questionnaire consists of 12 questions in Malay language and was originally designed \nby Sabah State Pharmacy Enforcement Branch. [Questions 1 to 12 will test on knowledge of \nregistered products whereas Question 12 will test on knowledge of notified cosmetics (refer to \nAppendix 1)]. There was also a question asking whether the GHP had prior exposure to \ninformation on registered products and cosmetics. The respondents\u2019 will be divided into four \ngroups; doctors/dentist, pharmacist, nurse, allied healthcare professional (e.g. nutritionist and \ndietitian).  \n\n\n\nThose who scored 9 marks and above were considered to have good knowledge on registered \nproducts and notified cosmetics. Those who scored 8 marks and below were considered to have \npoor knowledge. This grading scale was decided upon discussion with officers from Labuan \nPharmacy Enforcement Branch as the officers felt that as healthcare personnel whom are \neducating the public on health related issues on a daily basis, they should be able to answer \nmost, if not all the questions correctly, and a high score of 9 out of 12 was decided to gauge \ngood knowledge. \n\n\n\n\n\n\n\nStatistical Analysis \n\n\n\nData was entered into Microsoft Excel and Chi Square analysis was performed using IBM \nStatistical Package for the Social Sciences (SPSS) version 19. Socio-demographic data and \ncategorical data were presented as frequencies and percentages. A p-value of <0.05 was \nconsidered as statistically significant.  \n\n\n\n\n\n\n\nEthical Approval \n\n\n\nEthical approval for this study was obtained from the Medical Research and Ethics Committee \n(MREC), Ministry of Health Malaysia (NMRR-17-541-34803 (IIR)). \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nRESULTS \n\n\n\nSocio-demographic characteristics \n\n\n\nQuestionnaires were distributed to 14 facilities involved in this study and 219 were returned. \nThe highest respondents from government healthcare personnel were mostly nurses (53.9%, \nn=118) and most of the participants fall within the age group of 26-30 years old (39.7%, n=87). \nThere were more female participants (88%, n=193) and there were slightly more diploma \nholders compared to degree holders (57.1%, n=125) [Table 1]. \n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n4 \n \n\n\n\nTable 1. Socio-demographic characteristics among study population presented in percentages \n\n\n\nCharacteristics  All (%) n = 219 \nGender   \n     Male \n     Female \n\n\n\n 26 (11.9%) \n193 (88.1%) \n\n\n\nEducation level   \n     Diploma \n     Degree \n\n\n\n 125 (57.1%) \n94 (42.9%) \n\n\n\nAge   \n     20-25 \n     26-30 \n     31-35 \n     36-40 \n     40-45 \n     > 46 \n     Undisclosed \n\n\n\n 18 (8.2%) \n87 (39.7%) \n49 (22.4%) \n27 (12.3%) \n14 (6.4%) \n22 (10%) \n2 (0.9%) \n\n\n\nOccupation   \n     Doctor/Dentist \n     Pharmacist \n     Nurse \n     Allied Healthcare Professional \n\n\n\n 30 (13.7%) \n22 (10%) \n\n\n\n118 (53.9%) \n49 (22.4%) \n\n\n\n\n\n\n\nKnowledge scores \n\n\n\nFrom the study, 40.2% (n=88) of the study population had good knowledge towards registered \nproducts and notified cosmetics [Table 2], despite 89.5% (n=196) stating that they have \nreceived prior information with regards to the topic at hand [Table 3]. Individually, pharmacists \nhave the highest score of good knowledge at 81.8% (n=18). The level of good knowledge \namong allied health professionals (AHP) stood at 42.9% (n=21), 36.4% of nurses (n=43) and \n20% of doctors (n=6). Chi-square analysis demonstrates that the level of knowledge among \ngovernment healthcare personnel are significantly different (p<0.001). \n \n\n\n\n\n\n\n\n\n\n\n\nTable 2 Tabulated responses to questionnaire \n\n\n\nOccupation Good Understanding \nDoctor/Dentist (n=30) \n \n\n\n\n6 (20.0%) \n \n\n\n\nPharmacist (n=22) \n \n\n\n\n18 (81.8%) \n \n\n\n\nNurse (n=118) \n \n\n\n\n43 (36.4%) \n \n\n\n\nAllied Health Professional (n=49) 21 (42.9%) \n \n\n\n\nTotal 88 (40.2%) \n \n\n\n\n0 cells (0.0%) have expected count less than 5. The minimum expected count is 8.84. Therefore, \nthe assumptions are fulfilled. The Pearson Chi Square analysis value is 21.784 with a degree \nof freedom of 3. The p-value is less than 0.001 thus this study is statistically significant. \n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n5 \n \n\n\n\nTable 3: Prior Exposure to information on registered products and notified cosmetics \n\n\n\nOccupation Prior exposure to information on \n registered products & notified cosmetics \n\n\n\nDoctor/Dentist (n=30) \n \n\n\n\n29 (13.2%) \n \n\n\n\nPharmacist (n=22) \n \n\n\n\n22 (10.0%) \n \n\n\n\nNurse (n=118) 100 (45.7%) \n \n\n\n\nAllied Health Professional (n=49) \n \n\n\n\n45 (20.5%) \n \n\n\n\nTotal 196 (89.5%) \n \n\n\n\nDISCUSSION \n\n\n\nThere is a high prevalence of usage of traditional and complementary medicine in Malaysia in \nwhich many these products remain unregistered and had been confiscated by Pharmacy \nEnforcement officers11. When the public has any doubts or any enquiries with regards to this \ntopic, the government healthcare personnel are usually the one first person they will get \nprofessional health advice from as they are the front-liners for healthcare in Malaysia12.  \n\n\n\nDespite 89.5% (n=196) of the participants answering that they have received or were exposed \nbefore to information related to registered products and cosmetics, only 40.2% (n=88) have \nmanaged to score 9 questions or more correctly to be classified as having good knowledge at \nhand. \n\n\n\nOut of the 40.2%, pharmacists (81.8%, n=18) have the highest knowledge compared to other \ngroups. As their main role is to counsel patients on medication use as well as a huge \ninvolvement in the Ministry of Health\u2019s \u201cKnow Your Medicine\u201d campaign, it is understandable \nthat their knowledge is the highest11. The \u201cKnow Your Medicine\u201d campaign is a pharmacist \nled program which aims to educate patients on the 5R concepts, namely the right patient, right \nmedicines, right dose, right route of administration and the right time of administration. \nTherefore, it was expected that more pharmacists, if not all, would have scored \u2018good \nknowledge\u2019 in the questionnaire as they were already well trained on this subject matter.  \n\n\n\nDoctors and dentists (20%, n = 6) have the poorest knowledge amongst all the participants. \nThere may be several factors contributing to this, such as having a lack of time to answer the \nquestionnaire properly, or perhaps they do not understand the magnitude of the issue at hand. \nThe other two groups only fared slightly better.  \n\n\n\nPerhaps, further continuous professional development, such as organising more workshops to \nimprove the knowledge of Labuan\u2019s GHP, should be recommended to enhance and improve \nthe existing knowledge of all GHPs from the Ministry of Health in Labuan towards registered \nproducts and notified cosmetics.  \n\n\n\nThere were some limitations to our study. First, this was a none-randomised survey which was \nconducted in a non-controlled environment. The participants may refer to materials through \nvarious leaflets or brochures, research the answers online or even discuss the questions amongst \npeers. The investigators expected that the performance of the participants would be better with \nthis limitation in place, but the final poor results were surprising. The scale that was used to \ngrade the knowledge of the GHP was not based on any study and thus, may not be scientifically \naccurate to determine the GHP\u2019s exact knowledge levels. Finally, while the study population \nhad met the requirements of the sample size, some of the individual divided groups of separate \nhealthcare personnel (e.g. doctors/dentist) may be too small to represent the actual population. \n\n\n\n\n\n\n\n\n\n\n\n\n6 \n \n\n\n\nTherefore, the results from this study is only valid to the study sample and must not be \ngeneralized to a larger population. \n\n\n\n\n\n\n\nCONCLUSION \n\n\n\nIn this study, the level of knowledge towards registered products and notified cosmetics among \ndoctors, pharmacist, nurses and allied health professional in Labuan is poor as only 40.2% \namong the study population have good knowledge. This study shows a significant association \nbetween the levels of knowledge among GHP varies between groups of profession. Pharmacist \ngroup has the highest score in knowledge in this study and thus should be another reference for \nthe general public and patients when it comes to health-related matters. Further re-education \nshould be conducted to improve the knowledge of GHPs in Labuan with regards to this subject.  \n\n\n\n\n\n\n\nACKNOWLEDGMENT \n\n\n\nThe author would like to thank the Director General of Health Malaysia for his permission to \npublish this paper.  \n\n\n\nThe author would also like to thank the following people for their assistance to this study:  \n\n\n\n\u2022 Dr Ismuni bin Bohari, State Health Director, Labuan State Health Department \n\u2022 Mdm Normi bt Kamaruzaman, Deputy State Health Director, Labuan State Health \n\n\n\nDepartment \n\u2022 Mdm Soo Bee Kuan, Head of Pharmacy Enforcement Branch, Labuan State Health \n\n\n\nDepartment \n\u2022 Mdm Rabiawati bt Omar, Senior Principal Assistant Director, Labuan State Health \n\n\n\nDepartment \n\u2022 Mr Tan Chee Hoong, Pharmacist, Labuan State Health Department \n\u2022 Ms Law Kah Ee, Pharmacist, Labuan State Health Department \n\u2022 Mr Ong Soon Teck, Pharmacist, Labuan State Health Department \n\u2022 Ms Kuan Siaw Hui, Pharmacist, Labuan State Health Department \n\u2022 Mr Zul Yazid bin Ahmad Riza, Pharmacist, Labuan State Health Department \n\u2022 Ms Wan Amira bt Wan Omar, Pharmacist, Labuan State Health Department \n\u2022 Dr Stephenie Ann, Clinic Research Centre Hospital Queen Elizabeth 1 \n\u2022 Ms Noor Ilyani binti Ismail, Pharmacist, Hospital Mesra Bukit Padang \n \n\n\n\nCONFLICT OF INTEREST \n\n\n\nThe author has none to declare. \n\n\n\n\n\n\n\nDECLARATION OF FUNDING \n\n\n\nThis study is fully funded by the Ministry of Health Malaysia. \n\n\n\n\n\n\n\nREFERENCES \n\n\n\n1. 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Malaysia: Pharmaceutical Services Program, Ministry \nof Health Malaysia; 2017 [cited 2017 Feb 6]. Available from: \nhttps://www.pharmacy.gov.my/v2/sites/default/files/statistic/Statistik%20Farmasi%202016.p\ndf \n\n\n\n6. Regulation 7(1)(A), Control of Drugs and Cosmetics Regulations 1984.  \n7. National Pharmaceutical Regulatory Agency. [Internet]. Malaysia: National \n\n\n\nPharmaceutical Regulatory Agency, Ministry of Health Malaysia; 2017 [cited F e b   6,   \n2017]. Available from http://npra.moh.gov.my/ \n\n\n\n8. Guidelines for Control of Cosmetic Products in Malaysia. [Internet]. Malaysia: National \nPharmaceutical Regulatory Agency, Ministry of Health Malaysia; 2017 [ updated Feb \n2017; cited  Feb  6,   2017].  Available at:  \nhttps://www.npra.gov.my/images/Guidelines_Central/Guidelines_on_Cosmetic/2017/feb2017/\nGUIDELINES_FOR_CONTROL_OF_COSMETIC_PRODUCTS_IN_MALAYSIA.pdf \n\n\n\n9. Naing NN. A practical guide on determination of sample size in health sciences research:  \nSample size determination in descriptive studies. Malaysia : Pustaka Aman Press; 2009. \npp 54-5 \n\n\n\n10. Siti ZM, Tahir A, Farah AI et al. Use of traditional and complementary medicine in \nMalaysia: a baseline study. Complement Ther Med. 2009 Oct-Dec;17(5-6):292-9. \n\n\n\n11. Izham MI. Peranan Ahli Farmasi Dalam Kesihatan. [Internet].  Malaysia: Pusat Racun \nNegara, Universiti Sains Malaysia; 2017 [cited  Feb  6,   2017]. Available at:  \nhttp://www.prn.usm.my/index.php/archive/magazines/dewan-kosmik/304-peranan-ahli-\nfarmasi-dalam-kesihatan \n\n\n\n12. Mohamad Azmi H, Fahad S et al. A National Survey on the Use of Medicines (NSUM) \nby Malaysian Consumers. Pharmaceutical Services Division Malaysia. [Internet]. \nMalaysia: Pharmaceutical Services Program, Ministry of Health Malaysia; 2015 [cited \n2017 Feb 6].  Available at: \nhttps://www.pharmacy.gov.my/v2/sites/default/files/document-upload/national-survey-\nuse-medicine-iii-nsum-iii.pdf \n\n\n\n13. The Know Your Medicine Programmes [Internet]. Malaysia: Pharmaceutical Services \nProgram, Ministry of Health Malaysia; 2013 [cited 2019 April 23]. Available from: \nhttps://www.pharmacy.gov.my/v2/en/content/know-your-medicine-programmes.html \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\nhttps://www.pharmacy.gov.my/v2/en/faq/how-identify-registered-drugs-or-pharmaceutical-products.html\n\n\nhttps://www.pharmacy.gov.my/v2/en/faq/how-identify-registered-drugs-or-pharmaceutical-products.html\n\n\nhttp://www.myhealth.gov.my/campurpalsu-dalam-produk-tradisional/\n\n\nhttp://www.pharmacy.gov.my/v2/en/faq-categories/produk\n\n\nhttps://www.pharmacy.gov.my/v2/sites/default/files/statistic/Statistik%20Farmasi%202016.pdf\n\n\nhttps://www.pharmacy.gov.my/v2/sites/default/files/statistic/Statistik%20Farmasi%202016.pdf\n\n\nhttp://npra.moh.gov.my/\n\n\nhttps://www.npra.gov.my/images/Guidelines_Central/Guidelines_on_Cosmetic/2017/feb2017/GUIDELINES_FOR_CONTROL_OF_COSMETIC_PRODUCTS_IN_MALAYSIA.pdf\n\n\nhttps://www.npra.gov.my/images/Guidelines_Central/Guidelines_on_Cosmetic/2017/feb2017/GUIDELINES_FOR_CONTROL_OF_COSMETIC_PRODUCTS_IN_MALAYSIA.pdf\n\n\nhttp://www.prn.usm.my/index.php/archive/magazines/dewan-kosmik/304-peranan-ahli-farmasi-dalam-kesihatan\n\n\nhttp://www.prn.usm.my/index.php/archive/magazines/dewan-kosmik/304-peranan-ahli-farmasi-dalam-kesihatan\n\n\nhttps://www.pharmacy.gov.my/v2/sites/default/files/document-upload/national-survey-use-medicine-iii-nsum-iii.pdf\n\n\nhttps://www.pharmacy.gov.my/v2/sites/default/files/document-upload/national-survey-use-medicine-iii-nsum-iii.pdf\n\n\nhttps://www.pharmacy.gov.my/v2/en/content/know-your-medicine-programmes.html\n\n\n\n"
"\n\nMalaysian Journal of Pharmacy Volume 7 Issue 1 (2021) \n \n\n\n\n\n\n\n\n3 \n\n\n\n\n\n\n\n*Correspondence: layting118@gmail.com Department of Pharmacy, Sungai Buloh Hospital, Selangor, Malaysia \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n Short Communication \n\n\n\n\n\n\n\nClinical Pharmacist in a COVID-19 Hospital- A Malaysian \n\n\n\nExperience \n \n\n\n\nLay Ting Pee*, Hairos Izha Rosli, Pei Feng Chong \n\n\n\n\n\n\n\n  \nArticle Info  \n\n\n\n \nReceived date: 16 March 2021 \n\n\n\nAccepted date: 16 June 2021 \n\n\n\nPublished date: 30 June 2021 \n\n\n\n\n\n\n\nKeywords: Clinical Pharmacy, \n\n\n\nCOVID-19 Pandemic, SARS-\n\n\n\nCOV-2, Malaysia \n\n\n\nABSTRACT  \n\n\n\n\n\n\n\nThe coronavirus disease 2019 (COVID-19) pandemic has hugely affected healthcare services, \n\n\n\nparticularly pharmacy services in a COVID-19 hospital. Before the COVID-19 outbreak, clinical \n\n\n\npharmacists routinely reviewed patients\u2019 medications upon ward admission, actively participated in \n\n\n\nward rounds and partook in transitional care activities focusing on medication reconciliation and \n\n\n\npatient education in the wards. However, in order to limit contact with COVID patients, hospital \n\n\n\npharmacy department reacted promptly by establishing remote clinical pharmacy services in order to \n\n\n\nsustain the quality of inpatient pharmaceutical care. This commentary describes the challenges faced \n\n\n\nby clinical pharmacists in a Malaysian hospital as we continue to provide clinical pharmacy services \n\n\n\namidst the new norm.   \n\n\n\n\n\n\n\nINTRODUCTION  \n \n\n\n\nCoronavirus Disease 2019 (COVID-19) was caused by severe \n\n\n\nacute respiratory syndrome coronavirus 2 (SARS-CoV-2) and \n\n\n\nwas first identified in December 2019 in Wuhan, China [1].  \n\n\n\nThe virus is thought to have been transmitted by respiratory \n\n\n\ndroplets and contact routes. Droplets transmission can occur \n\n\n\nwhen an infected person with symptoms (e.g. coughing or \n\n\n\nsneezing) is in close contact (less than 1 m) with another person \n\n\n\n[2]. Infected droplets may also contaminate surfaces and \n\n\n\nobjects and a person may get infected by touching \n\n\n\ncontaminated surfaces or objects and then touching their eyes, \n\n\n\nnose or mouth [3]. Mild symptoms of COVID-19 includes \n\n\n\nfever, fatigue, myalgia, cough, sore throat, runny nose, \n\n\n\nsneezing or gastrointestinal symptoms (nausea, vomiting, \n\n\n\nabdominal pain, diarrhea). Critically, it can progress to acute \n\n\n\nrespiratory distress syndrome (ARDS) and may result in shock, \n\n\n\nencephalopathy, myocardial injury, heart failure, coagulation \n\n\n\ndysfunction and acute kidney injury [4].  \n\n\n\n\n\n\n\nAccording to the World Health Organization (WHO), as of 18 \n\n\n\nApril 2021, the total number of confirmed COVID-19 cases \n\n\n\nstood approximately 141 million cases with 3 million reported \n\n\n\ndeaths worldwide [5]. In Malaysia, the total number of cases \n\n\n\nare 375,054 with 1378 reported deaths [6]. In order to reduce \n\n\n\nthe spread of COVID-19, Malaysian government implemented \n\n\n\nstaggered movement control order starting from 18 March 2020 \n\n\n\ntill early 2021 [7]. In addition to that, the Malaysian Ministry \n\n\n\nof Health and the National Security Council have been actively \n\n\n\nurging the public to stay at home, practice social distancing, \n\n\n\nfrequent hand hygiene and to wear mask at all times [8]. \n\n\n\nIn combating COVID-19, the Ministry of Health has \n\n\n\ndesignated several hospitals and facilities to be COVID-19 \n\n\n\nreferral and screening centres for centralized and standardized \n\n\n\ninpatient treatment [9]. For the state of Selangor, Hospital \n\n\n\nSungai Buloh (HSgB) is the designated hospital to handle \n\n\n\nCOVID-19 cases [10]. HSgB is a 620-bedded hospital serving \n\n\n\nas the centre of excellence for infectious diseases, emergency \n\n\n\nand trauma, neurosurgery, maxilla-facial surgery, burn and \n\n\n\nplastic surgery and also orthopaedic and traumatology. HSgB \n\n\n\nessentially covers Gombak, Petaling and Kuala Selangor \n\n\n\ndistricts where these make up to 40% of the Selangor \n\n\n\npopulation or approximately 2.18 million populations [11]. As \n\n\n\nof 14 April 2021, Selangor has amassed a total of 121358 cases, \n\n\n\nthe highest in Malaysia with 350 deaths [12]. To date, HSgB \n\n\n\nhas treated a total of 44100 cases, with 267 mortalities [13]. \n\n\n\n\n\n\n\nHSgB\u2019s clinical pharmacy service consists of 19 full time ward \n\n\n\npharmacists in the following wards: neonatal intensive care \n\n\n\nunit, cardiac care unit, intensive care unit, medical wards (male \n\n\n\nand female), infectious disease wards, orthopedic male ward, \n\n\n\nsurgical male ward, obstetrics and gynecology wards, \n\n\n\nneurosurgical ward and paediatric wards. Routinely before the \n\n\n\nCOVID-19 pandemic, clinical pharmacists would review the \n\n\n\nappropriateness of medications by clerking patients\u2019 case notes, \n\n\n\nactively participate in ward rounds with physicians, partake in \n\n\n\n\n\n\n\n\n\n\n\n\nPee, L.T. et al. Mal J Pharm 7 (1) 2021, 3-6 \n\n\n\n\n\n\n\n4 \n\n\n\n\n\n\n\ntransitional care activities focusing on medication \n\n\n\nreconciliation, dispense patients\u2019 discharge medications at \n\n\n\nbedside and also handled patients\u2019 medication counseling and \n\n\n\neducation in the wards.  \n\n\n\n\n\n\n\nChallenges but now the new norm \n\n\n\n\n\n\n\nAs soon as HSgB was declared as a COVID hospital, we \n\n\n\nswiftly changed our usual ways of daily duties, to better support \n\n\n\nthe pharmacy department and hospital as a whole. Our routine \n\n\n\nchanged to adapt the \u201cnew norm\u201d way of life, to avoid 3Cs \n\n\n\n(crowded places, confined spaces and close conversation) and \n\n\n\nto practice 3Ws (wash, wear and warn). Some of the challenges \n\n\n\nthat we faced were staggered working hours to ensure social \n\n\n\ndistancing is practiced, limited assessment of patients in the \n\n\n\nward with no participation in clinical rounds with the \n\n\n\nphysicians, inadequate evidence for COVID-19 treatment, \n\n\n\nmedication administration and charting accuracy in the wards, \n\n\n\nlack of assessment in patients\u2019 own medication history and the \n\n\n\nmedication availability during their admission, and the \n\n\n\nincreasing involvement albeit lack of experience, in clinical \n\n\n\ntrials with the physicians. \n\n\n\n\n\n\n\nStaggered working hours and work from home (WFH) \n\n\n\nschedule \n\n\n\n\n\n\n\nIn order to promote social distancing and less crowding at our \n\n\n\nwork places, we had to rapidly rearrange our work force, and at \n\n\n\nthe same time ensure adequate support to the entire pharmacy \n\n\n\nand hospital services. We utilized a pairing system among \n\n\n\nclinical pharmacists whereby one of the pair will be present at \n\n\n\nwork and the partner will be contactable via phone during WFH \n\n\n\nhours. Effective communication and proper passing over had \n\n\n\nensured that patients continuously received the best possible \n\n\n\npharmaceutical care needed.  \n\n\n\n\n\n\n\nLimited assessment in inpatient pharmaceutical care \n\n\n\n\n\n\n\nIn order to limit contact with COVID-19 patients and to prevent \n\n\n\nunnecessary use of Personal Protective Equipment (PPE), we \n\n\n\nhave resorted to remote inpatient review by clerking patients at \n\n\n\npharmacy workstations instead of traditionally in the wards. \n\n\n\nMedication reviews are done through a local area network via \n\n\n\nelectronic Hospital Information System (eHIS). On the other \n\n\n\nhand, medication-related interventions identified by clinical \n\n\n\npharmacists are communicated to the wards via telephone.  In \n\n\n\naddition, tele-pharmaceutical strategies have also been \n\n\n\nimplemented for patient care [14, 15]. Such strategies include \n\n\n\nremote communication through phone or video call to obtain \n\n\n\npatients\u2019 medication history and medication counseling. \n\n\n\nFurthermore, instructional videos for medical device \n\n\n\ncounseling such as insulin pen and inhalers are first sent to \n\n\n\npatients\u2019 smart phones for self-viewing. Once patients have \n\n\n\nviewed the instructional video, pharmacists will proceed to \n\n\n\nmake a video call to the patient for further assessment and \n\n\n\nclarification.  \n\n\n\n\n\n\n\nAnother challenge faced by clinical pharmacists was \n\n\n\nverification of medication administration in the wards. Prior to \n\n\n\nthe COVID-19 pandemic, most of the wards in HSgB fully \n\n\n\nutilized the electronic medication administration charting \n\n\n\nsystem. With this system, clinical pharmacists would normally \n\n\n\nverify that medication administrations were done properly and \n\n\n\naccurately in the ward. However during the pandemic, the \n\n\n\nwards employed a hybrid medication administration system of \n\n\n\nboth electronic as well as manual charting. The addition of \n\n\n\nmanual charting has been implemented as there has been extra \n\n\n\nnursing staff employed from other health facilities to cater to \n\n\n\nthe large volume of patients and unfortunately, these nurses are \n\n\n\nunfamiliar with the hospital\u2019s electronic system. The clinical \n\n\n\npharmacists thus have an added role to ensure that manual \n\n\n\ncharting of medication administration is done properly and \n\n\n\naccurately in the wards. Moreover, patients are warded in \n\n\n\nisolation rooms and staffs entering these rooms are restricted to \n\n\n\npreserve PPE supplies. Hence, for patients who are well and \n\n\n\nindependent, medications for the day are dispensed to patient\u2019s \n\n\n\nbedside and then self-administered by patients. With this new \n\n\n\nchange in practice, clinical pharmacists face difficulties by \n\n\n\nensuring that medications are indeed delivered to patients and \n\n\n\nthe manual charting are recorded accurately by the nurses. \n\n\n\n\n\n\n\nAvailability of patient\u2019s own medication \n\n\n\n\n\n\n\nDuring the COVID-19 season, we see heterogeneity of patients \n\n\n\nbeing admitted to the wards. Some patients have their \n\n\n\nunderlying co-morbidities followed up in private health \n\n\n\nfacilities and some of their prescribed medications are not \n\n\n\nreadily available under the public hospital medication \n\n\n\nformulary. These patients will therefore need their home \n\n\n\nmedications delivered to them directly during their inpatient \n\n\n\nstay for self-administration.  With this challenging logistic \n\n\n\nissue in hand, clinical pharmacists have to liaise with patients\u2019 \n\n\n\nfamily members to ensure that complete patients\u2019 home \n\n\n\nmedications are brought to the hospital soonest possible. \n\n\n\n\n\n\n\nAntiviral stewardship, use of novel experimental agents and \n\n\n\ninvolvement in clinical trials \n\n\n\n\n\n\n\nMost of the drugs which are currently being prescribed such as \n\n\n\nFavipiravir, Remdesivir, Tocilizumab and interferon, are either \n\n\n\nprescribed for experimental, compassionate or off-labelled use. \n\n\n\nAs an infectious disease (ID) hospital, clinical pharmacists \n\n\n\nwere actively practicing antimicrobial stewardship to ensure \n\n\n\neffective and judicial use of antimicrobials. However, at the \n\n\n\nstart of COVID-19 outbreak in Malaysia in February 2020, we \n\n\n\nhad to quickly adjust our direction to antiviral stewardship due \n\n\n\n\n\n\n\n\n\n\n\n\nPee, L.T. et al. Mal J Pharm 7 (1) 2021, 3-6 \n\n\n\n\n\n\n\n5 \n\n\n\n\n\n\n\nto the increased usage of antivirals in COVID-19 treatment. \n\n\n\nAntiviral stewardship has thus far helped in the development of \n\n\n\nlocal treatment protocol on repurposed antivirals, which \n\n\n\ncurrently guides practitioners in the best recommended doses \n\n\n\nand treatment regimes. On the other hand, this stewardship also \n\n\n\nhelps to monitor and manage drug shortages due to supply \n\n\n\nchain interruptions.  \n\n\n\n\n\n\n\nThe use of novel experimental agents proved to be an \n\n\n\nunprecedented and arduous decision based on their lack of \n\n\n\nclinical evidence in treating COVID-19, which is to be \n\n\n\nexpected. For the ease of all health practitioners in HSgB, the \n\n\n\nclinical pharmacists have been working hand-in-hand with \n\n\n\npharmacy resources and information unit and the ID physicians \n\n\n\nin creating a local, quick and comprehensive COVID-19 \n\n\n\ntreatment guide. In addition, medications used for COVID-19 \n\n\n\nis not readily available in our local setting hence challenging us \n\n\n\nto race against time in providing the most efficient treatment, \n\n\n\nespecially to the critically ill patients. Up until this moment in \n\n\n\nfacing this adversity, clinical pharmacists have been working \n\n\n\ntogether closely with inpatient and procurement pharmacists to \n\n\n\nensure the availability and timely supply of COVID-19 drugs \n\n\n\nare sustained.  \n\n\n\n\n\n\n\nThe pandemic also created opportunities for clinical \n\n\n\npharmacists to be involved in esteemed and renowned clinical \n\n\n\ntrials such as the Solidarity Trial initiated by WHO and \n\n\n\nSTORM Study initiated by the Malaysian Ministry of Health.    \n\n\n\n\n\n\n\nDISCUSSION  \n \n\n\n\nClinical pharmacist contributed to a great extent in current \n\n\n\npandemic, from administrative tasks to pharmaceutical \n\n\n\ninterventions by optimizing medication therapy in severe and \n\n\n\ncritically ill COVID-19 patients.  Overall, with the help of \n\n\n\ntechnology and collaboration from all other healthcare givers, \n\n\n\nclinical pharmacists were able to carry out our tasks the best we \n\n\n\npossibly could in these unprecedented times. We were able to \n\n\n\ncarry out our basic core duties of patient clerking remotely and \n\n\n\ngiving patient education and counseling virtually. However, in \n\n\n\nterm of inpatient medication reconciliation, this effort was \n\n\n\nlargely limited due to the instability of COVID-19 patients \n\n\n\nparticularly in patients with category 4 and above. We also \n\n\n\nencountered some difficulties when contacting family member \n\n\n\nor caregivers for medication reconciliation. Clinical \n\n\n\npharmacists\u2019 involvement in the antimicrobial stewardship \n\n\n\ncould have been further enhanced to ensure judicious use of \n\n\n\nantibiotic with the increased use of antibiotic in COVID-19 \n\n\n\npatients. This effort would require extended collaboration with \n\n\n\nother healthcare givers who are pre-occupied with patient-care \n\n\n\nnow.   \n\n\n\n\n\n\n\nThis commentary describes the main activities and challenges \n\n\n\nfaced by clinical pharmacists during the first wave of the \n\n\n\nCOVID-19 pandemic. Considering the lessons learnt, future \n\n\n\neffort should look into efficacy and safety of virtual patient \n\n\n\ncare, the impact of COVID-19 on patient pharmaceutical care \n\n\n\nas well as healthcare-related cost-saving in middle income \n\n\n\ncountry.  \n\n\n\n\n\n\n\nCONCLUSION  \n \n\n\n\nIn summary, we as clinical pharmacists in a COVID-19 \n\n\n\nhospital faced an unprecedented and challenging situation since \n\n\n\nthe pandemic began globally. We needed to act swiftly and \n\n\n\nproactively in response to the Covid-19 outbreak in order to \n\n\n\nsustain the quality of patient care and continue to adapt the new \n\n\n\nnorm as a way of work and life.  We learnt the importance of a \n\n\n\ncontingency plan to cater for sudden changes in usual practice, \n\n\n\nsuch as a pandemic of a novel virus. We need to be versatile \n\n\n\nand ever ready to accept and adapt to new changes. Last but not \n\n\n\nleast, teamwork is important to achieve a greater good for the \n\n\n\nbest patient care during the COVID-19 pandemic.   \n\n\n\n\n\n\n\nACKNOWLEDGMENT \n  \n\n\n\nWe would like to thank the Director General of Health \n\n\n\nMalaysia for his permission to publish this article.  \n\n\n\n\n\n\n\nCONFLICT OF INTEREST \n \n\n\n\n The authors declare no conflict of interest.  \n\n\n\n\n\n\n\nREFERENCE \n \n[1] World Health Organization [Internet] Newsroom. WHO Timeline- \n\n\n\nCOVID-19. [cited 2020 June 4]. Available from \n\n\n\nhttps://www.who.int/news-room/detail/27-04-2020-who-timeline---\n\n\n\ncovid-19. \n\n\n\n[2] World Health Organization [Internet] Newsroom. 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Available from: \n\n\n\nhttps://covid-19.moh.gov.my/ \n\n\n\n[11] Hospital Sungai Buloh [Internet]. Background. [cited 2020 June 12]. \n\n\n\nAvailable from: \n\n\n\nhttps//hsgbuloh.moh.gov.my/index.php/ms/mengenai-kami/latar-\n\n\n\nbelakang. \n\n\n\n[12] Department of Statistic Malaysia [Internet]. COVID-19 Current \n\n\n\nSituation in Malaysia. [cited 2021April 14]. Available form: \n\n\n\nhttps://ukkdosm.github.io/covid-19. \n\n\n\n[13] Crisis Preparedness and Response Centre, Hospital Sungai Buloh.  \n\n\n\n[14] Li H, Zheng S, Liu F, Liu W, Zhao R. Fighting against COVID-19: \n\n\n\nInnovative strategies for clinical pharmacists. Res Social Adm Pharm. \n\n\n\n2020 Apr 6: S1551-7411(20)30328-4. \n\n\n\ndoi:10.1016/j.sapharm.2020.04.003. Epub ahead of print. PMID: \n\n\n\n32278766; PMCID: PMC7194937. \n\n\n\n[15] Bukhari N., Rasheed H., Nayyer B., Babar Z.U.D. Pharmacists at the \n\n\n\nfrontline beating the COVID-19 pandemic. J of Pharm Policy and \n\n\n\nPract. 2020:13(1):8.doi:10.1186/s40545-020-00210-w. \n\n\n\n \n\n\n\n\n\n"
"\n\nMalaysian Journal of Pharmacy Volume 7 Issue 2 (2021) \n \n\n\n\n\n\n\n\n13 \n\n\n\n\n\n\n\n*Correspondence: khoboonphiaw@gmail.com \n1Pharmacy Department, Sarawak General Hospital, Tun Ahmad Zaidi \n\n\n\nAdruce Road, 93586, Kuching, Sarawak, Malaysia. \n2Pharmacy Department, Mosque Road Health Clinic, Mosque Road, \n\n\n\n93400, Kuching, Sarawak, Malaysia. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n Original Article \n\n\n\n\n\n\n\nA Qualitative Study Exploring Pharmacists' Perspectives on \n\n\n\nthe Conceptualization and Operationalization of Patient-\n\n\n\nCentred Care in the Hospital Pharmacy Setting \n \n\n\n\nBoon Phiaw Kho1*, Mei Wen Chai2, Adelyn Yin Yin Foo 1 \n\n\n\n\n\n\n\n \nArticle Info  \n\n\n\n \nReceived date: 7 June 2021  \n\n\n\nAccepted date: 14 Jul 2021 \n\n\n\nPublished date: 31 Dec 2021 \n\n\n\n\n\n\n\nKeywords: Patient-centred \n\n\n\ncare; hospital pharmacy \n\n\n\nservices; healthcare delivery; \n\n\n\ncompetent communication; \n\n\n\nhealth services accessibility. \n\n\n\nABSTRACT  \n\n\n\n\n\n\n\nObjective: The objectives of this study were to determine how hospital pharmacists in a developing \n\n\n\ncountry interpret the term \"patient-centred care (PCC)\", how it was or can be operationalized in \n\n\n\nhospital pharmacy practice, and barriers faced in delivering such care. Method: A generic qualitative \n\n\n\napproach was utilized. Semi-structured interviews were conducted with purposively sampled \n\n\n\npharmacists from a Malaysian tertiary referral hospital until data saturation, using an interview guide \n\n\n\ninformed by relevant literature. Interviews were audio-recorded and transcribed verbatim, with \n\n\n\nresultant transcripts subsequently coded and analysed using thematic analysis technique. Result: \n\n\n\nFifteen pharmacists were interviewed. Hospital pharmacists conceptualized the basic spirit of PCC \n\n\n\nas \"putting patients first\". On the operationalization of PCC in pharmacy services, one \n\n\n\ntheme/viewpoint was that all processes of care that are patient-oriented, including efforts that \n\n\n\nfacilitate patient convenience, improve ecosystem of care and access of care should be considered as \n\n\n\nPCC. A contrasting theme only regard pharmacy services demonstrating specific elements, such as \n\n\n\nprovision of individualized therapy, holistic in nature and enable building of rapport and trust \n\n\n\nbetween patient and pharmacist, as being consistent with PCC principles. Improving pharmacists' \n\n\n\ncommunication skills, patients' health literacy and over-reliance on clinicians as well as resource \n\n\n\nlimitations are deemed integral for successful implementation of PCC services. Conclusion: Beyond \n\n\n\nthe concept of putting patients first, there was confusion on the exact concept of PCC and its \n\n\n\nsubsequent operationalization in hospital pharmacy practice. Development of a pharmacy specific \n\n\n\nPCC framework to serve as a universal blueprint to guide operationalization is recommended. \n\n\n\n\n\n\n\n\n\n\n\nINTRODUCTION  \n\n\n\n\n\n\n\nPatient-centred care (PCC) is a healthcare service provision \n\n\n\napproach that is associated with better health outcomes for \n\n\n\npatients, improving their satisfaction, well-being, and to a \n\n\n\ncertain extent clinical outcome [1,2,3]. The central philosophy \n\n\n\nof PCC is providing healthcare tailored to the needs of \n\n\n\nindividual patients, with elements of care widely regarded as \n\n\n\nfundamental components include involvement of patients in \n\n\n\ntheir healthcare, establishment of good relationships between \n\n\n\npatients and their healthcare providers, healthcare providers \n\n\n\nhaving a holistic understanding of their patients, the practice of \n\n\n\neffective communication as well as patient empowerment \n\n\n\n[2,4,5]. In PCC, the relationship between both parties has to be \n\n\n\negalitarian rather than paternalistic, hence the need for \n\n\n\nhealthcare providers to have the ability to demonstrate \n\n\n\nempathy, concern and interest toward patients, besides having \n\n\n\nexcellent listening and communication skills [2,6,7]. The \n\n\n\noverall environment where care takes place has to be \n\n\n\nconducive, with supportive management and an organizational \n\n\n\nsystem that is primed to deliver PCC [8]. \n\n\n\n \n\n\n\n\n\n\n\n\nKho B.P. et al. Mal J Pharm 7 (2) 2021, 13-21 \n\n\n\n\n\n\n\n\n\n\n\n14 \n\n\n\n\n\n\n\nOperationalization of PCC is essential to translate PCC from \n\n\n\nabstract theories into measurable patient outcomes [6]. Scholl \n\n\n\net al. (2014) advocated for a unified theory and synchronized \n\n\n\n'language' of patient-centredness to standardize its\u2019 \n\n\n\noperationalization, including measurement tools [4]. Quality of \n\n\n\nPCC is assessed and measured using a mix of patient-reported \n\n\n\noutcomes and healthcare outcomes indicators [9]. Physician-\n\n\n\npatient consultations using PCC principles were found to \n\n\n\nalleviate patients\u2019 discomfort and concern, leading to faster \n\n\n\nrecovery, better emotional well-being and less healthcare \n\n\n\nutilization [10]. PCC approaches were also found to reduce the \n\n\n\nneed for high-cost, high intensity care such as hospitalization \n\n\n\nor emergency department visits, as well as resulting in \n\n\n\nshortened hospital length of stay for those admitted [11-13].  \n\n\n\n\n\n\n\nHowever, emphasis and practice of PCC were found to differ \n\n\n\nbetween healthcare providers.  Studies on doctors emphasized \n\n\n\nthe shared decision-making process between patient and \n\n\n\nprovider, whereas acknowledging patients' values and beliefs \n\n\n\nin the care process and providing for their social and emotional \n\n\n\nneeds were the focus of studies on nurses [2]. Unfortunately, \n\n\n\nthe primary focus of the pharmacy profession regarding PCC is \n\n\n\nnot clear. Existing studies focused on specific processes of \n\n\n\nPCC, for example patient-centred pharmacy consultations \n\n\n\n[14,15], patient-centred communication [16] and patient-\n\n\n\ncentred professionalism [7,17,18]. Five core elements were \n\n\n\nproposed by Kibicho and Owczarzak (2012): consideration of \n\n\n\nthe patients' context, tailored interventions, patient \n\n\n\nempowerment, collaboration between providers and cultivating \n\n\n\nsustained relationship with patients [19]. Furthermore, concept \n\n\n\nand practice can also vary due to cultural difference, and there \n\n\n\nwas a paucity of research on PCC in the developing Asian \n\n\n\nregion [4].  \n\n\n\n\n\n\n\nIn Malaysia, the integration of PCC into existing government \n\n\n\nhospital pharmacy practice is not well explored. Malaysia \n\n\n\npractices a dual healthcare system, with government and \n\n\n\nprivate facilities operating in parallel. Government hospitals \n\n\n\nand health clinics provide a plethora of healthcare services \n\n\n\nincluding pharmacy at a heavily subsidized fee, whereas \n\n\n\nprivate facilities charge premium prices for their services [20]. \n\n\n\nDespite this, the pharmacy program at government facilities is \n\n\n\ncomparatively more established, providing extended pharmacy \n\n\n\nservices such as medication therapy adherence clinic (MTAC), \n\n\n\nward pharmacy services and home medicines review beyond \n\n\n\nthe basic procurement, ward supply and outpatient dispensing \n\n\n\nservices [21]. To the best of our knowledge, only one study on \n\n\n\nPCC in the Malaysian pharmacy context was published [15]. \n\n\n\nThe study which focused on pharmacist-patient interaction in \n\n\n\nMTAC consultations revealed a discordance in the preference \n\n\n\nand expectations between pharmacists and patients on PCC, \n\n\n\nfurther highlighting the importance of contextual consideration \n\n\n\nin operationalizing the concept [15]. \n\n\n\nThe objectives of this paper were to determine how hospital \n\n\n\npharmacists interpret the term \"patient-centred care\", how it \n\n\n\nwas or can be operationalized in their daily practice and barriers \n\n\n\nfaced in delivering such care. Comprehension of the concept \n\n\n\nand its application is important for hospital pharmacists to have \n\n\n\na greater impact on patient care. As pharmacists have diverse \n\n\n\nroles in a hospital, it is also interesting to find out whether it \n\n\n\ncan be practiced in different departments. Elucidation of \n\n\n\nbarriers and suggested facilitators will assist in the future \n\n\n\nimplementation of pharmacy services anchored in PCC. \n\n\n\n\n\n\n\nMETHOD  \n\n\n\n\n\n\n\nStudy design \n\n\n\n\n\n\n\nA generic qualitative approach was employed as the nature of \n\n\n\ninquiry did not fit the ambit of established methodologies [22-\n\n\n\n24]. This study was more focused on how to implement PCC, \n\n\n\nrather than discovery of a theory (grounded theory) or \n\n\n\ninvestigation of a lived experience (phenomenology) [23]. A \n\n\n\nconstructionist paradigm was used in this research, where it \n\n\n\nwas tacitly acknowledged that study investigators, being in the \n\n\n\nsame profession as participants, have an influence on the \n\n\n\ninterpretation of the data, with interpretation also equally \n\n\n\ninfluenced by the study context and societal beliefs [25].  \n\n\n\n\n\n\n\nStudy setting and participants \n\n\n\n\n\n\n\nIn-depth, face-to-face semi-structured interviews were \n\n\n\nconducted among pharmacists working in Sarawak General \n\n\n\nHospital, a 1003-bedded tertiary referral hospital in Malaysia. \n\n\n\nThere are around 140 pharmacists, including 40 interns in the \n\n\n\nhospital. Pharmacy services provided include procurement, in-\n\n\n\npatient medication supply, out-patient dispensing, parenteral \n\n\n\nand cytotoxic drug reconstitution, clinical pharmacy service as \n\n\n\nwell as MTAC. \n\n\n\n\n\n\n\nPurposive sampling was employed to recruit participants from \n\n\n\ndifferent pharmacy departments and years of working \n\n\n\nexperience, in order to ensure maximal variation of \n\n\n\nperspectives [26,27]. Participant selection was carried out by \n\n\n\nthe primary investigator (KBP), being a work colleague of all \n\n\n\nparticipants. KBP did not conduct the interviews to minimize \n\n\n\nelements of bias and coercion; this procedure was done by the \n\n\n\nother 2 co-investigators (AF and CMW), who were pharmacy \n\n\n\ninterns. AF did the first 4 interviews; subsequent interviews \n\n\n\nwere conducted by CMW. Interview training was provided by \n\n\n\nKBP, who had experience conducting similar qualitative \n\n\n\nresearch. Both interviewers did a practice interview before \n\n\n\ncommencing actual interviews. \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nKho B.P. et al. Mal J Pharm 7 (2) 2021, 13-21 \n\n\n\n\n\n\n\n\n\n\n\n15 \n\n\n\n\n\n\n\nData collection  \n\n\n\n\n\n\n\nA semi-structured interview guide (Table I.) was constructed \n\n\n\nby KBP and AF based on the study objectives and available \n\n\n\nliterature, primarily Scholl et al. (2014), Constand et al. (2014) \n\n\n\nand Kitson et al. (2012). Interviews were conducted from \n\n\n\nSeptember 2018 until June 2019, audio-recorded and then \n\n\n\ntranscribed verbatim by AF and CMW. Denaturalized \n\n\n\ntranscription was used as only the content of the interviews was \n\n\n\nof interest [28]. All transcripts were checked by KBP for errors \n\n\n\nbefore being analysed.  \n\n\n\n\n\n\n\n\n\n\n\nData analysis \n\n\n\n\n\n\n\nData analysis was carried out using thematic principles \n\n\n\nrecommended by Braun and Clarke (2006). This method was \n\n\n\nchosen as it is widely used and not linked to any theory nor \n\n\n\nepistemology, hence suitable for generic qualitative research \n\n\n\n[29]. After each interview, the resultant transcript was reread \n\n\n\nmultiple times and compared to previous transcripts to enhance \n\n\n\ninterpretation and structuring into themes [30]. Coding was \n\n\n\ncarried out independently by KBP and CMW to reduce bias. \n\n\n\nDiscussion was however held after reading or coding each \n\n\n\ntranscript to determine areas to be further explored in \n\n\n\nsubsequent interviews (iterative process) [31]. After data \n\n\n\nsaturation was deemed reached, both investigators came up \n\n\n\nwith their own thematic maps and candidate themes and sub-\n\n\n\nthemes, which were discussed and consolidated with inputs \n\n\n\nfrom AF. Throughout the process, investigators were \n\n\n\nconstantly mindful to give fair dealing to the diverse \n\n\n\nviewpoints of participants and reflect on how their \n\n\n\npreconceived notions on PCC guided interpretation. \n\n\n\nTranscribing and coding were facilitated by Microsoft Word, \n\n\n\nwhereas thematic analysis was carried out using Microsoft \n\n\n\nExcel. The conduct and reporting of this study were based on \n\n\n\nthe Standards for Reporting Qualitative Research (SRQR) [32]. \n\n\n\n\n\n\n\nEthical consideration \n\n\n\n\n\n\n\nConduct of this research was registered with the Malaysian \n\n\n\nNational Medical Research Register (NMRR-18-1550-42239) \n\n\n\nand was approved by the Medical Research and Ethics \n\n\n\nCommittee (MREC), Ministry of Health Malaysia \n\n\n\n[Ref:KKM/NIHSEC/P18-1490(11) dated August 14, 2018]. \n\n\n\nAll participants gave informed consent to participate in this \n\n\n\nresearch and be audio-recorded. \n\n\n\n\n\n\n\nRESULT  \n\n\n\n\n\n\n\nA total of 15 respondents were interviewed before data \n\n\n\nsaturation, defined as no new significant codes emerging from \n\n\n\ntwo consecutive interviews, was deemed reached [33]. \n\n\n\nSummarized characteristics of respondents are available in \n\n\n\nTable II. No potential participants refused to participate in the \n\n\n\nstudy. All interviews were conducted in English in enclosed \n\n\n\nrooms within the hospital to minimize disruption. No other \n\n\n\npersonnel besides the interviewer and participant were present \n\n\n\nduring each interview. Interviews were between 30-45 minutes \n\n\n\nlong. No repeat interviews were carried out.  \n\n\n\n\n\n\n\nParticipants conceptualized the basic spirit of PCC as \"putting \n\n\n\npatients first\", describing it as providing optimal care for \n\n\n\npatients by focusing on their feelings and needs. In a PCC \n\n\n\nfocused pharmacy, pharmacy services provided revolve around \n\n\n\nand are responsive toward patients' requirements foremost. \n\n\n\n\n\n\n\n\"Whatever we do, we have to think about the patient, in terms \n\n\n\nof patient\u2019s safety, in terms of patient\u2019s benefits, everything \n\n\n\nrelated for the purpose of producing a good outcome for the \n\n\n\npatient.\" [PC8] \n\n\n\n\n\n\n\nHowever, beyond this basic concept, understanding of \n\n\n\nparticipants diverged. Two main themes dominate how PCC is \n\n\n\nexpressed in pharmacy services, namely as an underpinning \n\n\n\nvalue guiding all processes of care, or manifest in specific \n\n\n\npharmacy services (Figure I.).\n\n\n\nTable I. Semi-structured Interview Guide \n\n\n\n\n\n\n\nNum. Question \n\n\n\n1. What do you understand about patient-centred care?  \n\n\n\n2. What do you think are the essential components of patient-\n\n\n\ncentred care? \n\n\n\n3. How do you practice patient-centred care in your daily \n\n\n\npharmacy work?  \n\n\n\n4. Do you think pharmacists are in a position to provide patient \n\n\n\ncentred care? \n\n\n\n5. Generally, what do you think about the current level of \n\n\n\npatient-centred care among pharmacists and pharmacy-users \n\n\n\nin Malaysian government hospitals?  \n\n\n\n6. What are the current practices that are aligned with patient-\n\n\n\ncentred care?  \n\n\n\n7. What is your personal opinion on incorporating components \n\n\n\nof patient-centred care into the pharmacy service?  \n\n\n\n8. As far as you know, what are the possible challenges faced in \n\n\n\ndelivering patient-centred care?  \n\n\n\n9. Do you think the current pharmacy work culture is suitable \n\n\n\nfor patient-centred care? \n\n\n\n10. What are the current system artefacts that constrained patient-\n\n\n\ncentred care? \n\n\n\n11. What can we do to overcome the challenges?  \n\n\n\n12. How do you think we can best manage the trade-off between \n\n\n\nproviding a fast and efficient service and spending time to \n\n\n\nincorporate patient centred care elements in our service? \n\n\n\n13. What do you think are the expectations of patients regarding \n\n\n\npatient-centred care with respect to pharmacy services? \n\n\n\n14. What we can do to improve the acceptance of patients with \n\n\n\nregards to patient-centred care?  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nKho B.P. et al. Mal J Pharm 7 (2) 2021, 13-21 \n\n\n\n\n\n\n\n\n\n\n\n16 \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nTable II. Characteristics of participants \n\n\n\n\n\n\n\nParticipant No. Current pharmacy dept. \nYears of working \n\n\n\nexperience \n\n\n\nInvolvement in \n\n\n\nMTAC \n\n\n\nWorking experience \n\n\n\nin other institutions \nGender \n\n\n\nPC1 Clinical 7 Yes No Female \n\n\n\nPC2 Oncology pharmacy 10 No Yes Female \n\n\n\nPC3 Outpatient 7 Yes Yes Female \n\n\n\nPC4 Outpatient 11 No Yes Male \n\n\n\nPC5 Drug Info 7 Yes Yes Female \n\n\n\nPC6 Clinical 6 No Yes Female \n\n\n\nPC7 Clinical 5 Yes Yes Male \n\n\n\nPC8 Outpatient 2 No No Female \n\n\n\nPC9 Inpatient 21 No Yes Female \n\n\n\nPC10 Inpatient 4 No No Female \n\n\n\nPC11 Inpatient 4 No Yes Female \n\n\n\nPC12 Clinical 15 No Yes Female \n\n\n\nPC13 Inpatient 4 No No Female \n\n\n\nPC14 Outpatient 7 Yes Yes Female \n\n\n\nPC15 Clinical 5 No No Female \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nFigure I. Conceptualization of patient-centred care \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nKho B.P. et al. Mal J Pharm 7 (2) 2021, 13-21 \n\n\n\n\n\n\n\n\n\n\n\n17 \n\n\n\n\n\n\n\nTheme 1: PCC as an underpinning value in all processes of \n\n\n\ncare \n\n\n\n\n\n\n\n1. Patient-oriented services \n\n\n\n\n\n\n\nParticipants expressed that any process of care that is patient-\n\n\n\noriented during its operationalization constitutes PCC. This \n\n\n\nincludes ensuring basic safety of patients, for example \n\n\n\ndispensing correct medications; as well as making services \n\n\n\nconvenient to patients, such as providing alternative methods \n\n\n\nfor patients to collect their repeat medications so that they do \n\n\n\nnot have to wait in line at the pharmacy.  \n\n\n\n\n\n\n\n\"I think in all our work, there are some elements of PCC, if in-\n\n\n\ninpatient, [during] filling medications... we always come \n\n\n\nacross many prescriptions that we think are not right, we will \n\n\n\nintervene. That is also a part of PCC, rather than just looking \n\n\n\nat the prescriptions and following blindly whatever that was \n\n\n\nwritten.\" [PC8] \n\n\n\n\n\n\n\n\"[Pharmacy Value Added Services (VAS)] can help patients \n\n\n\nwho are inconvenienced to come and collect their medications, \n\n\n\nlike we post their medications [via postal service], and also \n\n\n\nthey can [pre-inform] they want to collect within the next 3 \n\n\n\ndays, so that we can prepare, so that when they come, they no \n\n\n\nneed to wait. For me, VAS is one type of PCC.\" [PC11] \n\n\n\n\n\n\n\n2. Improving ecosystem of care \n\n\n\n\n\n\n\nEfforts that improve work efficiency and indirectly lead to \n\n\n\nbetter patient care were also considered as PCC. This includes \n\n\n\nthe use of technology such as robotized filling of medicines to \n\n\n\nfree up pharmacists' time, enabling them to concentrate on \n\n\n\npatient related activities. Building an effective communication \n\n\n\nsystem to facilitate sharing of information between healthcare \n\n\n\nprofessionals across facilities, in order to reduce information \n\n\n\ngaps that hamper provision of optimal care was also \n\n\n\nhighlighted as being essential. \n\n\n\n\n\n\n\n\"If you want PCC, sometimes it is more like developing a \n\n\n\nsystem to link between the facilities. For example, if this patient \n\n\n\nis allergic to paracetamol, if there is a system linked between \n\n\n\nfacilities, the facility can access the data.\" [PC6] \n\n\n\n\n\n\n\n3. Improving access to care \n\n\n\n\n\n\n\nSome participants have a health system-wide view on the \n\n\n\npractice of PCC, believing it includes efforts to bring health \n\n\n\nservices nearer to patients, such as enhancing accessibility for \n\n\n\nthose who are not able to visit hospitals due to physical \n\n\n\ndisabilities. They also believed that the current government \n\n\n\nsubsidized public healthcare system is aligned with the concept \n\n\n\nof PCC, as it ensures that the poor have equal access to \n\n\n\nhealthcare and medicines.  \n\n\n\n\n\n\n\n\"...especially psychiatric patients because some of them are like \n\n\n\nthey don\u2019t want to go for follow-ups, maybe due to the worry \n\n\n\nhow other people look at them, they don\u2019t want to come to \n\n\n\nhospital. For those patients, you need to visit them and counsel \n\n\n\nthem. If not, they will default for sure.\" [PC15] \n\n\n\n\n\n\n\nTheme 2: PCC expressed in specialized services fulfilling \n\n\n\ncertain elements \n\n\n\n\n\n\n\nParticipants highlighted medication therapy adherence clinics \n\n\n\n(MTAC), clinical pharmacy services and home medicines \n\n\n\nreview (HMR) as pharmacy services most aligned with PCC.  \n\n\n\nThese services have elements of care that are similar: \n\n\n\n\n\n\n\n1. Individualized therapy \n\n\n\n\n\n\n\nProponents of this view opined that PCC services must have an \n\n\n\nelement of individualized care in them, where pharmacists \n\n\n\ninteract with patients on a one-to-one basis, enabling \n\n\n\npersonalization and tailoring of services to match patients' \n\n\n\nneeds. For example, clinical pharmacy services were deemed \n\n\n\nPCC oriented as pharmacists work in an environment with \n\n\n\nminimal barriers for them to care for and communicate with \n\n\n\npatients, and for patients to approach them. In contrast, \n\n\n\ndispensary pharmacists are hindered by a physical counter and \n\n\n\npressure to dispense quickly, reducing their tendency to \n\n\n\nindividualize treatment plans.  \n\n\n\n\n\n\n\n\"(Roles in PCC vary) depending on which department you are \n\n\n\nworking, like for example, inpatient [pharmacy], our roles will \n\n\n\nbe lesser compared to clinical pharmacists... I think the person \n\n\n\nwho can play the most role in PCC are the clinical pharmacists. \n\n\n\nThey are exposed to the patients the most.\" [PC11] \n\n\n\n\n\n\n\n2. Holistic care: focus beyond disease state \n\n\n\n\n\n\n\nPCC means taking into account patients' psychological and \n\n\n\nsocial issues, rather than merely focusing on their disease state \n\n\n\nand medications while caring for them. This is based on the \n\n\n\nbelief that external issues can also significantly impact the \n\n\n\nhealth outcome of patients. For example, in asthma or diabetes \n\n\n\nmellitus MTAC, participants envisioned a bigger role for \n\n\n\npharmacists in encouraging patients to make lifestyle \n\n\n\nmodifications to better control their disease. Pharmacists also \n\n\n\nhave signposting function, playing a pivotal role in referring \n\n\n\npatients to other healthcare professionals for specific needs. \n\n\n\n\n\n\n\n\"When you see patient in the ward or MTAC...you have more \n\n\n\ntime to sit down with them, you explore more other than [just] \n\n\n\ngiving medication counselling, you actually explore more like \n\n\n\n\n\n\n\n\nKho B.P. et al. Mal J Pharm 7 (2) 2021, 13-21 \n\n\n\n\n\n\n\n\n\n\n\n18 \n\n\n\n\n\n\n\nhow is patient doing at home, how is patient's acceptance \n\n\n\ntowards his disease...because a disease is more than just a \n\n\n\ndisease itself, it affects the patient's life.\" [PC4] \n\n\n\n\n\n\n\n3. Building of rapport and trust \n\n\n\n\n\n\n\nGood communication forms the foundation of PCC, however \n\n\n\nbeyond conveying correct messages to patients to facilitate \n\n\n\ninformed choices and providing effective education on their \n\n\n\nmedicines, communication in PCC services form bonds and \n\n\n\nsubsequently build trust between pharmacists and patients. \n\n\n\nEstablishment of trust between both parties will render patients \n\n\n\nmore open and receptive toward pharmacists' suggestions, and \n\n\n\nmore likely to make the necessary changes to improve their \n\n\n\nhealth outcomes.  \n\n\n\n\n\n\n\n\"If you try to forcefully educate someone, they might not be \n\n\n\nreceptive to it... [but] if you communicate well with the patients, \n\n\n\nyou actually kind of develop a relationship with the patients \n\n\n\nwhich will make them trust you more and you tend to listen to \n\n\n\nsomeone's advice if you know that person, instead of a \n\n\n\nstranger.\" [PC13] \n\n\n\n\n\n\n\nTheme 3: Barriers and facilitators of PCC in the pharmacy \n\n\n\n\n\n\n\nParticipants highlighted several prominent factors that were felt \n\n\n\nto hinder the provision of PCC in the hospital pharmacy setting \n\n\n\nand also suggested solutions: \n\n\n\n\n\n\n\n1. Communication skills \n\n\n\n\n\n\n\nExcellent communication ability, including the ability to listen \n\n\n\nis regarded by participants as a rudimentary skill pharmacists \n\n\n\nshould have to provide PCC. This will enable better \n\n\n\nunderstanding of patients' needs and obtaining sufficient \n\n\n\ninformation to uncover underlying issues, including during \n\n\n\npatient counseling.  Participants acknowledged that most \n\n\n\npharmacists still have room for improvement in this area, and \n\n\n\nsuggested more workshops, hands-on practices and role-\n\n\n\nmodelling to improve this skill. Rotating between departments \n\n\n\nwas also suggested as a way to ensure all pharmacists have a \n\n\n\nchance to participate in PCC activities. \n\n\n\n\n\n\n\n\"Sometimes, they (patient) abandon the medications not \n\n\n\nbecause they don't want to listen, it's just [that] they don't have \n\n\n\nthe full understanding. Might be something happened to the \n\n\n\nquality of the counseling, whether the pharmacist made the \n\n\n\npatient understand what the medication is for.\" [PC6] \n\n\n\n\n\n\n\n\"Certain people (pharmacists) need training not just \n\n\n\nknowledge-wise but also how to deliver [the message] to the \n\n\n\npatients effectively... Those kinds of courses and workshops, \n\n\n\n[they] can be asked to attend.\" [PC8] \n\n\n\n2. Beyond \"doctor, doctor\" \n\n\n\n\n\n\n\nParticipants noted that the provision of PCC requires patients' \n\n\n\ninvolvement in the decision-making process regarding their \n\n\n\ncare. However, they conceded that the current healthcare \n\n\n\nsystem is clinician-centred, with the belief that \"doctors know \n\n\n\nbest\" being pervasive and prominent. Patients with insufficient \n\n\n\nhealth literacy do not feel confident to make their own \n\n\n\nhealthcare decisions. Many patients are also not familiar with \n\n\n\npharmacists' extended roles beyond dispensing. Increased pro-\n\n\n\nactiveness among pharmacists to promote their roles was \n\n\n\nsuggested, including asking patients about their needs to \n\n\n\novercome their reservations. Holding awareness campaigns to \n\n\n\nfurther promote the profession, including via social media, was \n\n\n\nalso recommended. \n\n\n\n\n\n\n\n\"Some of them they will ask: you are doctor or pharmacist? If \n\n\n\npharmacist they don't bother to tell you anymore... They \n\n\n\nthought that we only give medications, give medications. They \n\n\n\nthink we are just dispensing machines.\" [PC15] \n\n\n\n\n\n\n\n3. Institutional barriers \n\n\n\n\n\n\n\nVarious institutional barriers, namely insufficient manpower, \n\n\n\nfacilities, use of technology and organizational support are also \n\n\n\npresent. Participants lamented that the high pharmacist-to-\n\n\n\npatient ratio and lack of counseling rooms limit opportunities \n\n\n\nto conduct PCC activities. In terms of organizational support, \n\n\n\nthere is a need to have key performance indicators (KPIs) that \n\n\n\nare more aligned with PCC and increased emphasis on PCC \n\n\n\nactivities. Nevertheless, work re-engineering to facilitate the \n\n\n\nprovision of PCC was actively practiced, for example \n\n\n\nconducting group counseling to save time or scheduling patient \n\n\n\ncounseling at off-peak hours to spend more time with patients, \n\n\n\nas participants believed that this concept is the future of \n\n\n\npharmacy. Participants also acknowledged that they need to \n\n\n\nwork hard on constantly improving their competency, in order \n\n\n\nto be able to work more efficiently.    \n\n\n\n\n\n\n\n\"To be frank, we are all chasing KPIs, trying to achieve our \n\n\n\npersonal targets...the KPI 30 minutes to dispense...we will keep \n\n\n\nchasing like, oh 30 minutes, then we will rush our job like that, \n\n\n\nso will [be] prone to error\u2026 [patient-centred KPI will be] like \n\n\n\nhow many patients that we had counselled, that we really sit \n\n\n\ndown and counsel.\" [PC14] \n\n\n\n\n\n\n\nDISCUSSION  \n\n\n\n\n\n\n\nOur findings highlighted two different views on the practice \n\n\n\nof PCC in the pharmacy setting. Some participants opined that \n\n\n\nPCC is practiced by re-engineering all pharmacy services to \n\n\n\nhave a \"patient first\" orientation while another group of \n\n\n\nparticipants believed that PCC only manifests in services that \n\n\n\n\n\n\n\n\nKho B.P. et al. Mal J Pharm 7 (2) 2021, 13-21 \n\n\n\n\n\n\n\n\n\n\n\n19 \n\n\n\n\n\n\n\nfulfil key elements such as listening, communicating, \n\n\n\nempowering, educating and collaborating with patients. This \n\n\n\ndemonstrates a lack of deep appreciation or true understanding \n\n\n\nof what PCC entails, or a reflection of the current ambiguity \n\n\n\nshrouding its definition, as well as how it should be practiced \n\n\n\nin the pharmacy setting [34].  \n\n\n\n\n\n\n\nBased on current literature, for a particular service to be \n\n\n\nconsidered as PCC, key elements of the concept must be \n\n\n\npresent during service delivery [4,34,35]. Hence patient safety \n\n\n\nefforts and services facilitating collection of repeat \n\n\n\nmedications, despite being patient-centred do not make the cut \n\n\n\nas patient-centred care. Likewise, infrastructure enhancements \n\n\n\nsuch as the utilization of drug filling robots and electronic \n\n\n\nhealth records only indirectly facilitate PCC by freeing \n\n\n\npharmacists' time to engage with patients [34]. For dispensing \n\n\n\nservices to be regarded as PCC, elements of patient \n\n\n\ncollaboration and empowerment, as well as treatment \n\n\n\nindividualization need to exist. For example, patients had to be \n\n\n\nasked whether they wish to discuss their treatment, rather than \n\n\n\nhaving pharmacists forcing the same generic counseling scripts \n\n\n\nto them [36]. This distinction had to be clarified among \n\n\n\npharmacists, as a correct grasp of the concept is a prerequisite \n\n\n\nfor proper operationalization. \n\n\n\n\n\n\n\nParticipants mainly discussed PCC based on current available \n\n\n\nservices, i.e., whether and why an existing service is considered \n\n\n\nPCC, rather than how PCC elements can be incorporated into \n\n\n\ndifferent facets of pharmacy practice, or what new services that \n\n\n\nare aligned with the concept can be introduced. Most \n\n\n\nparticipants cited MTAC as the quintessential PCC service, as \n\n\n\nit involves one-to-one interaction between pharmacist and \n\n\n\npatients with chronic diseases over multiple encounters, \n\n\n\nenabling a reciprocal, long-term relationship to be established \n\n\n\n[15,37]. Patient empowerment in the form of self-management \n\n\n\ntraining was also provided, such as self-monitoring of blood \n\n\n\nglucose and foot care for diabetic patients [38]. Nevertheless, \n\n\n\nalignment of MTAC with PCC principles can be enhanced by \n\n\n\nmaking the service open and accessible to all patients to self-\n\n\n\nenrol rather than provider initiated, and shifting the focal point \n\n\n\nfrom the medication regime to the patient [19]. For in-patient \n\n\n\nand ward pharmacy services, there are various services that can \n\n\n\nbe introduced or adapted to be more patient-centred, including \n\n\n\npolypharmacy or multi-morbidity management, transition of \n\n\n\ncare coordination during admission and discharge to ensure \n\n\n\ncontinuity of care, as well as medication de-prescribing [39]. \n\n\n\nFor out-patient pharmacy service, patients' issues with route of \n\n\n\nadministration, medication timing, potential and current side \n\n\n\neffects as well as management of lifelong chronic medications \n\n\n\ncan be targeted [40].  \n\n\n\n\n\n\n\nIt is heartening that participants demonstrated favourable \n\n\n\nattitude towards PCC and agreed that it is the future of \n\n\n\npharmacy practice, yet translating this attitude fully into actual \n\n\n\npractice is a challenge, as testified by global and local \n\n\n\nexperiences [40,41]. For instance, some pharmacists may yet to \n\n\n\nmaster the level of communication skills critical to the \n\n\n\nprovision of PCC. Good communication skills foster the \n\n\n\nestablishment of trust between patients and healthcare \n\n\n\nproviders, as well as facilitate shared decision making [2,4]. \n\n\n\nHence it is essential that more training focusing on improving \n\n\n\npharmacists\u2019 communication skills is provided. Besides, health \n\n\n\ncoaching techniques, which seek to modulate patients' beliefs, \n\n\n\nvalues and attitudes to alter their health behaviour can also be \n\n\n\nintroduced. Incorporation of health coaching during patient \n\n\n\ninteraction was found to improve healthcare providers' ability \n\n\n\nto provide PCC [42].  \n\n\n\n\n\n\n\nPatients\u2019 readiness to be involved in shared decision making \n\n\n\nand make informed decisions on their healthcare are important \n\n\n\nelements of PCC [43]. Unfortunately, in Malaysia, limited \n\n\n\nhealth literacy among the general public hindered their \n\n\n\nparticipation in healthcare decision making [41,44]. Patients \n\n\n\ndo not have sufficient understanding of their diseases and \n\n\n\nmedicines to enable a constructive discussion of their \n\n\n\ncondition. Patient empowerment at the grassroots level on \n\n\n\nmedicines use is important to alleviate this lack of awareness, \n\n\n\nfor example organization of \u201cKnow Your Medicines\" \n\n\n\ncampaigns which aim to inculcate basic knowledge of \n\n\n\nmedicines use among the Malaysian public [45]. At the \n\n\n\ninstitutional level, the lack of pharmacy resources, primarily \n\n\n\nmanpower and facilities are recurring themes in the literature \n\n\n\non PCC implementation in healthcare organizations [46,47]. \n\n\n\nIncreased time needed to interact and care for patients is \n\n\n\nexpected when PCC is practiced, even though there were \n\n\n\nsuggestions that redesign of services to be patient-centred may \n\n\n\nnot require additional manpower, and even result in efficacy \n\n\n\ngains [38,40,47]. Nonetheless, additional resources including \n\n\n\nmanpower and facility upgrades are often considered \n\n\n\nnecessary by healthcare workers to implement new services, \n\n\n\nhence availability of resources will directly impact their \n\n\n\nreceptiveness and accommodation of these services [48].  \n\n\n\n\n\n\n\nStrengths and limitations  \n\n\n\n\n\n\n\nThis study is one of the few focusing on PCC in developing \n\n\n\nAsian countries. It explored the conceptualization and \n\n\n\noperationalization of PCC in all hospital pharmacy services, \n\n\n\nexpanding on the work of Ng et al. (2019) which only focused \n\n\n\non MTAC consultations. Limitation wise, the study was \n\n\n\nconfined to a single institution, which runs the risk of \n\n\n\nparticipants' perspectives being moulded by the culture of the \n\n\n\ninstitution. This was mitigated by recruitment of participants \n\n\n\nwho had previously served in different institutions in wide-\n\n\n\nranging capacities, diversifying the experiences and \n\n\n\nviewpoints. Findings were derived from analysis of hospital \n\n\n\npharmacists\u2019 perceptions, which may be tainted by social \n\n\n\n\n\n\n\n\nKho B.P. et al. Mal J Pharm 7 (2) 2021, 13-21 \n\n\n\n\n\n\n\n\n\n\n\n20 \n\n\n\n\n\n\n\ndesirability bias. As noticed during the conduct of this research, \n\n\n\nmost participants regarded their current duties as PCC. \n\n\n\nTriangulation using direct observation of actual behaviour or \n\n\n\ncritical incident analysis may be useful in future studies. \n\n\n\nPatients' perspectives and needs for pharmacy related PCC are \n\n\n\nequally important, and a similar study exploring their \n\n\n\nviewpoints will also triangulate the findings of this research \n\n\n\nand provide greater insights.  \n\n\n\n\n\n\n\nCONCLUSION   \n\n\n\n\n\n\n\nBeyond the concept of putting patients first, there is confusion \n\n\n\non the exact concept of PCC and its subsequent \n\n\n\noperationalization in hospital pharmacy practice. There is also \n\n\n\na lack of ideas on how it can be incorporated in existing \n\n\n\npharmacy services. There is a need to develop a universal \n\n\n\nframework to serve as reference for the development of patient-\n\n\n\ncentred pharmacy services or incorporation of PCC elements \n\n\n\ninto current pharmacy processes, which is important to ensure \n\n\n\nconsistent definition, operationalization and evaluation of these \n\n\n\nservices.    \n\n\n\n\n\n\n\nACKNOWLEDGEMENT  \n\n\n\n\n\n\n\nWe would like to thank the Director General of Health \n\n\n\nMalaysia for his permission to publish this article. We would \n\n\n\nalso like to acknowledge Natasha Ngumbang, Grace Wong Su \n\n\n\nLin and Phang Sze Ying, pharmacists at Sarawak General \n\n\n\nHospital for their assistance in drafting the research proposal, \n\n\n\nas well as participants for sharing their experiences and \n\n\n\nperspectives.   \n\n\n\n\n\n\n\nCONFLICT OF INTEREST   \n\n\n\n\n\n\n\nThis study has no conflict of interest. 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"\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n220 \n\n\n\nAdherence To Antihypertensives Among Haemodialysis Patients \n\n\n\nAt Five Non-Governmental Organisation Centres In Malaysia \n\n\n\n\n\n\n\nHui-Lin Saw\n1\n, Yoke-Lin Lo\n\n\n\n1*\n, Chae-Miang. Cher\n\n\n\n1\n, Sean-Hau Chang\n\n\n\n2\n  \n\n\n\n1\nDepartment of Pharmacy, \n\n\n\n2\nDepartment of Medicine, Faculty of Medicine, \n\n\n\nUniversity of Malaya, 50603 Kuala Lumpur \n\n\n\n\n\n\n\n* Corresponding author \nMalaysian Journal of Pharmacy 2008: 1( 6): 220 -233                                               \n\n\n\n\n\n\n\nAbstract \n\n\n\nBackground: Uncontrolled hypertension is associated with increased \n\n\n\ncardiovascular mortality among haemodialysis (HD) patients. Poor adherence to \n\n\n\nantihypertensive regimens was found to contribute to inadequate control of blood \n\n\n\npressure. The study is aimed to investigate the adherence to antihypertensives and \n\n\n\nfactors affecting adherence among HD patients at non-governmental organisation \n\n\n\n(NGO) dialysis centres at the vicinity around Kuala Lumpur  \n\n\n\nMethods: Cross-sectional surveys using questionnaires were conducted in five \n\n\n\nNGO dialysis centres and Statistical Package for the Social Sciences (SPSS) was \n\n\n\nemployed to conduct all statistical analyses. Patients who took at least 80% of the \n\n\n\nprescribed antihypertensives were considered as adherent.  \n\n\n\nResults: Two hundred and thirty-one respondents were interviewed; of which, \n\n\n\n68% of patients were adherent. Patients\u2019 socio-demographic characteristics did \n\n\n\nnot show any correlation to their adherence (p>0.05). On the other hand, the \n\n\n\nsetting of dialysis centres did influence drug adherence significantly (p=0.033). \n\n\n\nMedication cost influenced adherence in a way that those who received \n\n\n\nmedication for free and who had no difficulty paying for their medications were \n\n\n\nmore adherent when compared to their counterparts (p=0.004 and p=0.016, \n\n\n\nrespectively). The number of prescribed medications also showed significant \n\n\n\nrelationship with adherence (p=0.032). Furthermore, patients who did not \n\n\n\nexperience major side effects from antihypertensives revealed better adherence \n\n\n\n(p=0.019). Conclusions: Adherence to antihypertensives was suboptimal among \n\n\n\nHD patients at the NGO dialysis centres studied. Thus, all potential barriers to \n\n\n\nadherence should be taken into consideration in the treatment of hypertension \n\n\n\namong these patients.  \n\n\n\n\n\n\n\nKeywords: haemodialysis; drug adherence; antihypertensives \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n221 \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nIntroduction \n\n\n\n\n\n\n\nCardiovascular disease is the main \n\n\n\ncause of death in haemodialysis \n\n\n\n(HD) patients. In Malaysia, it \n\n\n\naccounted for 26% of death in \n\n\n\ndialysis population in year 2004 \n1\n. \n\n\n\nHypertension is one of the risk \n\n\n\nfactors to increased cardiovascular \n\n\n\nmortality \n2,3\n\n\n\n while antihypertensive \n\n\n\ntherapy was found to decrease the \n\n\n\nrisk \n3\n.  \n\n\n\nPrevalence of hypertension in HD \n\n\n\npatients is very high and in the \n\n\n\nUnited States it was found to be 86% \n4\n. Tozawa and colleagues \n\n\n\n5\n reported \n\n\n\nthat antihypertensives were the \n\n\n\nsecond most commonly prescribed \n\n\n\ngroup of drugs in HD patients with \n\n\n\n71% of patients were prescribed at \n\n\n\nleast one antihypertensive agent.   \n\n\n\nDespite advanced development of \n\n\n\neffective antihypertensive drugs and \n\n\n\ntreatment guidelines, \n\n\n\npharmacological treatment of \n\n\n\nhypertension in HD patients \n\n\n\ncontinue to be a great challenge to \n\n\n\nhealthcare providers partly because \n\n\n\nHD patients are known to be poor \n\n\n\ncompliers to their medications \n5-7\n\n\n\n. \n\n\n\nDrug adherence is now recognised \n\n\n\nglobally as the foundation to the \n\n\n\nsuccess of medical therapy, because \n\n\n\npatients will only obtain the full \n\n\n\nbenefit of the medications provided \n\n\n\nthey follow the prescribed regimens \n\n\n\nreasonably closely. More than one \n\n\n\nstudies found that poor adherence to \n\n\n\nantihypertensives was one of the \n\n\n\nmajor factors to uncontrolled \n\n\n\nhypertension \n8,9\n\n\n\n. \n\n\n\nVery few studies, if any, regarding \n\n\n\ndrug adherence among HD patients \n\n\n\nhave been carried out in Malaysia. In \n\n\n\nview of the importance of adherence \n\n\n\nto antihypertensives on blood \n\n\n\npressure (BP) control, the need for a \n\n\n\nresearch to study adherence to \n\n\n\nantihypertensives and factors \n\n\n\naffecting adherence among HD \n\n\n\npatients in Malaysia either as a \n\n\n\nwhole population or in subgroups of \n\n\n\npopulation is clear and warranted. \n\n\n\nNon-governmental organisation \n\n\n\n(NGO) dialysis centres became the \n\n\n\nfocus of this study because over the \n\n\n\nyears, the NGOs have been playing \n\n\n\nan increasing role in dialysis \n\n\n\nprovision in this country. A recent \n\n\n\nreport showed that 34% of dialysis \n\n\n\npatients in Malaysia were receiving \n\n\n\ntheir HD treatment in NGO dialysis \n\n\n\ncentres in year 2004 \n1\n. These centres \n\n\n\nare mostly non-profit, charitable \n\n\n\norganisations which provide \n\n\n\nsubsidized treatment to patients from \n\n\n\nlow-income groups.    \n\n\n\nThe aims of this study are to assess \n\n\n\nthe degree of adherence to \n\n\n\nantihypertensive regimens among \n\n\n\nHD patients at various NGO dialysis \n\n\n\ncentres, to examine adherence \n\n\n\naccording to socio-demographic \n\n\n\ncharacteristic and to identify various \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n222 \n\n\n\nfactors affecting adherence to \n\n\n\nantihypertensive(s).  \n\n\n\n\n\n\n\nMethods  \n\n\n\n\n\n\n\nStudy population  \n\n\n\nNGO dialysis centres located in the \n\n\n\nvicinity of the University of Malaya \n\n\n\nwere identified. Subsequently, \n\n\n\nethical approval to interview \n\n\n\nconsenting patients and to review \n\n\n\ntheir medical records was obtained \n\n\n\nfrom the respective authorities. All \n\n\n\nadult HD patients who were \n\n\n\nprescribed at least one \n\n\n\nantihypertensive agent were eligible \n\n\n\nto participate in this study. Subjects \n\n\n\nwere recruited by convenience \n\n\n\nsampling. \n\n\n\nPatients who had received \n\n\n\nhaemodialysis therapy for less than \n\n\n\nthree months were excluded from \n\n\n\nthe study because their clinical \n\n\n\nconditions and their drug regimens \n\n\n\nwere yet to be stabilised \n10\n\n\n\n. Patients \n\n\n\nwho could not be interviewed \n\n\n\nbecause they were too ill, had \n\n\n\ndifficulties with communication or \n\n\n\nhad severe physical or mental \n\n\n\ndisabilities were excluded. Those \n\n\n\nwho could not recall their drug \n\n\n\nregimens were also excluded.  \n\n\n\nData collection  \n\n\n\nA pilot study was conducted to \n\n\n\ncheck the clarity and reliability of \n\n\n\nthe questionnaire.  Amendments \n\n\n\nwere made to the questionnaire \n\n\n\nbefore the actual study was carried \n\n\n\nout. Interviews were conducted from \n\n\n\nOctober, 2005 to February, 2006. \n\n\n\nPatients were interviewed using \n\n\n\nstructured questionnaires while they \n\n\n\nwere receiving their dialysis \n\n\n\ntreatment. The questionnaire \n\n\n\nincluded questions on socio-\n\n\n\ndemographic characteristics, the \n\n\n\npatient\u2019s renal disease and drug \n\n\n\ntreatment. Information obtained was \n\n\n\ncorroborated with their medical \n\n\n\nrecords. Four questions used to \n\n\n\nassess adherence to \n\n\n\nantihypertensives were adopted from \n\n\n\nthe Brief Medication Questionnaire \n\n\n\ndeveloped by Svarstad and \n\n\n\ncolleagues \n11\n\n\n\n. These questions \n\n\n\nfocused in the past one week to \n\n\n\nminimise recall bias.  \n\n\n\n\n\n\n\nPercentage of adherence in the past \n\n\n\nseven days was calculated as \n\n\n\nfollows: \n\n\n\n\n\n\n\nPercentage of adherence \n\n\n\n= \n  weekpast the in consumed be to  wasthat pills ensiveantihypert of number Total\n\n\n\n weekpast the in patient theby  consumed pills ensiveantihypert of number Total\nX 100% \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n223 \n\n\n\nData analysis  \n\n\n\n\n\n\n\nFor the purpose of statistical \n\n\n\nanalysis, adherence was defined as \n\n\n\ntaking at least 80% of the prescribed \n\n\n\nantihypertensives dose within the \n\n\n\npast seven days \n12,13\n\n\n\n. All statistical \n\n\n\nanalyses were performed using \n\n\n\nStatistical Package for the Social \n\n\n\nSciences (SPSS Inc., Chicago IL, \n\n\n\nUSA.). Chi-square tests were used to \n\n\n\nanalyse the relationships between \n\n\n\nadherence to antihypertensive(s) and \n\n\n\n(i) patients\u2019 socio-demographic \n\n\n\ncharacteristics and (ii) patients\u2019 \n\n\n\nclinical characteristics. The variables \n\n\n\nwere considered to be significantly \n\n\n\nrelated to adherence to \n\n\n\nantihypertensives if p values were \n\n\n\nless than 0.05. \n\n\n\n\n\n\n\nResults \n\n\n\n\n\n\n\nPatient characteristics  \n\n\n\n\n\n\n\nOf 252 eligible patients approached \n\n\n\nby the investigators, 21 refused to \n\n\n\nparticipate (response rate of 92%), \n\n\n\nresulting in a total of 231 patients \n\n\n\nfrom five NGO dialysis centres \n\n\n\nparticipated in this study. These five \n\n\n\ncentres were labelled as Centre A, B, \n\n\n\nC, D and E for the purpose of \n\n\n\nconfidentiality. The age of HD \n\n\n\npatients in this study population \n\n\n\nranged from 26 to 82 years (mean = \n\n\n\n52.82 years; SD = 12.54 years). \n\n\n\nMale patients accounted for 57.6% \n\n\n\nand 42.4% female. More than half of \n\n\n\nthe patients were Chinese (61%), \n\n\n\n21.4% of Malay, 17% of Indian and \n\n\n\none Portuguese. These patients had \n\n\n\nbeen dialysed from a minimum of 3 \n\n\n\nmonths up to a maximum of 15 \n\n\n\nyears (mean = 3.49; SD = 3.00). The \n\n\n\nnumber of concurrent diseases (other \n\n\n\nthan end stage renal failure) ranged \n\n\n\nfrom one to five (mean = 2.36; SD = \n\n\n\n0.91); whereas the number of \n\n\n\nprescribed medications taken by \n\n\n\nthem ranged from three to eleven \n\n\n\n(mean = 6.44; SD = 2.06).    \n\n\n\n\n\n\n\nDegree of adherence  \n\n\n\n\n\n\n\nThere were 57% of patients admitted \n\n\n\n100% adherence to their \n\n\n\nantihypertensives, 11% achieved \n\n\n\nadherence rate at least 80% (but not \n\n\n\nto 100%) and 32 % showed an \n\n\n\nadherence rate less than 80%.  \n\n\n\n\n\n\n\nPatient socio-demographic \n\n\n\ncharacteristics and non-adherence  \n\n\n\n\n\n\n\nAs seen in Table 1, socio-\n\n\n\ndemographic characteristics did not \n\n\n\nshow significant relationships with \n\n\n\nadherence to antihypertensive(s).  \n\n\n\n\n\n\n\nClinical characteristics of non-\n\n\n\nadherent patients  \n\n\n\n\n\n\n\nTable 2 summarises the correlations \n\n\n\nbetween adherence to \n\n\n\nantihypertensives and patient clinical \n\n\n\ncharacteristics. A few significant \n\n\n\nrelationships were observed between \n\n\n\npatients\u2019 clinical characteristics and \n\n\n\nnon-adherence to antihypertensives.\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n224 \n\n\n\nTable 1: Socio-demographic characteristics and non-adherence to \n\n\n\nantihypertensive(s) \n\n\n\n\n\n\n\nCharacteristics Number of patients \n\n\n\ninterviewed \n\n\n\nNumber of non-\n\n\n\nadherent patients (%) \n\n\n\n\n\n\n\n\n\n\n\n(p) \n\n\n\nTotal 231 74  \n\n\n\nGender \n\n\n\n   Male \n\n\n\n   Female \n\n\n\n\n\n\n\n\n\n\n\n133 \n\n\n\n98 \n\n\n\n\n\n\n\n45 (33.8) \n\n\n\n29 (29.6) \n\n\n\n(0.495) \n\n\n\n\n\n\n\nAge (in years) \n\n\n\n   26-45 \n\n\n\n   46-65 \n\n\n\n   66-85 \n\n\n\n\n\n\n\n\n\n\n\n65 \n\n\n\n136 \n\n\n\n30 \n\n\n\n\n\n\n\n22 (33.8) \n\n\n\n41 (30.1) \n\n\n\n11 (36.7) \n\n\n\n(0.735) \n\n\n\nRace \n\n\n\n   Chinese \n\n\n\n   Indian \n\n\n\n   Malay \n\n\n\n   Portuguese \n\n\n\n\n\n\n\n\n\n\n\n144 \n\n\n\n46 \n\n\n\n40 \n\n\n\n1 \n\n\n\n\n\n\n\n43 (29.9) \n\n\n\n14 (30.4) \n\n\n\n16 (40.0) \n\n\n\n1  \n\n\n\n(0.301) \n\n\n\nMarital status \n\n\n\n   Married \n\n\n\n   Never married \n\n\n\n   Divorced/ separated \n\n\n\n   Spouse deceased \n\n\n\n\n\n\n\n\n\n\n\n171 \n\n\n\n42 \n\n\n\n10 \n\n\n\n8 \n\n\n\n\n\n\n\n52 (30.4) \n\n\n\n14 (33.3) \n\n\n\n5 (50.0) \n\n\n\n3 (37.5) \n\n\n\n(0.608) \n\n\n\nEducation \n\n\n\n   Illiterate \n\n\n\n   Primary school \n\n\n\n   Secondary school \n\n\n\n   Tertiary education \n\n\n\n\n\n\n\n\n\n\n\n27 \n\n\n\n79 \n\n\n\n105 \n\n\n\n20 \n\n\n\n\n\n\n\n\n\n\n\n9 (33.3) \n\n\n\n29 (36.7) \n\n\n\n31 (29.5) \n\n\n\n5 (25.0) \n\n\n\n(0.666) \n\n\n\nEmployment \n\n\n\n   Unemployed \n\n\n\n   Employed/self-employed \n\n\n\n\n\n\n\n\n\n\n\n184 \n\n\n\n47 \n\n\n\n\n\n\n\n57 (31.0) \n\n\n\n17 (36.2) \n\n\n\n(0.496) \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n225 \n\n\n\nTable 2: Clinical characteristics and non-adherence to antihypertensives \n\n\n\n\n\n\n\nCharacteristics Number of patients \n\n\n\ninterviewed \n\n\n\nNumber of non-\n\n\n\nadherent patients (%) \n\n\n\np value \n\n\n\nTotal 231 74  \n\n\n\nDialysis centres  \n\n\n\n   Centre A \n\n\n\n   Centre B \n\n\n\n   Centre C \n\n\n\n   Centre D \n\n\n\n   Centre E \n\n\n\n\n\n\n\n\n\n\n\n96 \n\n\n\n70 \n\n\n\n35 \n\n\n\n21 \n\n\n\n9 \n\n\n\n\n\n\n\n25 (26.0%) \n\n\n\n32 (45.7%) \n\n\n\n9 (25.7%) \n\n\n\n4 (19.0%) \n\n\n\n4 (44.4%) \n\n\n\n(0.033*) \n\n\n\nLength of time on dialysis  \n\n\n\n   \u2264 2 years \n\n\n\n   > 2-5 years \n\n\n\n   > 5 years  \n\n\n\n\n\n\n\n109 \n\n\n\n74 \n\n\n\n48 \n\n\n\n\n\n\n\n\n\n\n\n33 (30.3%) \n\n\n\n26 (35.1%) \n\n\n\n15 (31.3%) \n\n\n\n(0.781) \n\n\n\nCause of renal failure  \n\n\n\n   Diabetes  \n\n\n\n   Hypertension  \n\n\n\n   Others  \n\n\n\n\n\n\n\n109  \n\n\n\n35 \n\n\n\n87 \n\n\n\n\n\n\n\n\n\n\n\n37 (33.9%) \n\n\n\n10 (28.6%) \n\n\n\n27 (31.0%) \n\n\n\n(0.812) \n\n\n\nNumber of co-morbidities  \n\n\n\n   1 \n\n\n\n   2 \n\n\n\n   \u2265 3 \n\n\n\n\n\n\n\n40 \n\n\n\n96 \n\n\n\n95 \n\n\n\n\n\n\n\n\n\n\n\n13 (32.5%) \n\n\n\n31 (32.3%) \n\n\n\n30 (31.6%) \n\n\n\n(0.992) \n\n\n\nNumber of prescribed \n\n\n\nmedications \n\n\n\n   3-5 \n\n\n\n   6-8 \n\n\n\n   9-11 \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n79 \n\n\n\n110 \n\n\n\n42 \n\n\n\n\n\n\n\n\n\n\n\n32 (40.5%) \n\n\n\n26 (23.6%) \n\n\n\n16 (38.1%) \n\n\n\n(0.032*) \n\n\n\nNumber of \n\n\n\nantihypertensives \n\n\n\n   1 \n\n\n\n   2 \n\n\n\n   3-5  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n106 \n\n\n\n79 \n\n\n\n46 \n\n\n\n\n\n\n\n\n\n\n\n35 (33.0%) \n\n\n\n27 (34.2%) \n\n\n\n12 (26.1%) \n\n\n\n(0.618) \n\n\n\n\n\n\n\nMonthly medication \n\n\n\nexpenses \n\n\n\n   Free (Government \n\n\n\nsubsidized) \n\n\n\n   RM 1-RM 50 \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n122 \n\n\n\n27 \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n29 (23.8%) \n\n\n\n13 (48.1%) \n\n\n\n(0.021*) \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n226 \n\n\n\n   RM 51-RM 100 \n\n\n\n   > RM 100    \n\n\n\n\n\n\n\n49 \n\n\n\n33 \n\n\n\n21 (42.9%) \n\n\n\n11 (33.3%) \n\n\n\nDifficulty paying for \n\n\n\nmedications \n\n\n\n   Had difficulty  \n\n\n\n   No difficulty  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n58 \n\n\n\n173 \n\n\n\n\n\n\n\n\n\n\n\n26 (44.8%) \n\n\n\n48 (27.7%) \n\n\n\n(0.016*) \n\n\n\nSide effects \n\n\n\n   Experienced side effects \n\n\n\n   No side effect \n\n\n\n\n\n\n\n27 \n\n\n\n204 \n\n\n\n\n\n\n\n\n\n\n\n14 (51.9%) \n\n\n\n60 (29.4%) \n\n\n\n(0.019*) \n\n\n\n\n\n\n\n\n\n\n\n* Significant difference \n \n\n\n\n\n\n\n\nThe locations of dialysis centres \n\n\n\ninfluenced adherence to \n\n\n\nantihypertensives significantly (p = \n\n\n\n0.033). Patients from Centre B were \n\n\n\nmore likely to be nonadherent \n\n\n\ncompared to those from Centre A \n\n\n\n(p=0.008), C (p=0.048) and D (p = \n\n\n\n0.028).  No significant difference \n\n\n\nwas found among Centre A, C and \n\n\n\nD. Centre E was not included in the \n\n\n\ncomparison because its sample size \n\n\n\nwas too small. The number of \n\n\n\nprescribed medications, rather than \n\n\n\nthe number of prescribed \n\n\n\nantihypertensives was found to \n\n\n\ninfluence non-adherence to \n\n\n\nantihypertensives. Those patients \n\n\n\nwho took six to eight medications \n\n\n\ndaily were significantly more \n\n\n\nadherent than those taking three to \n\n\n\nfive medications (p = 0.013). In \n\n\n\ngeneral, patients whose medications \n\n\n\nwere fully subsidised showed \n\n\n\nsignificantly better adherence than \n\n\n\nthose paying for their medications (p \n\n\n\n= 0.004).  \n\n\n\n\n\n\n\nContradictorily, when a medicine \n\n\n\nwith a higher cost was prescribed, \n\n\n\nthe adherence rate was also higher \n\n\n\n(Figure 1). Finally, patients who had \n\n\n\ndifficulty paying for their \n\n\n\nmedications and those who \n\n\n\nexperienced side effects from their \n\n\n\nantihypertensives were significantly \n\n\n\nless adherent than their counterparts\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n227 \n\n\n\nFigure 1: Comparison of adherence to antihypertensives according to monthly \n\n\n\nmedication expenses \n\n\n\n\n\n\n\n0\n\n\n\n10\n\n\n\n20\n\n\n\n30\n\n\n\n40\n\n\n\n50\n\n\n\n60\n\n\n\n70\n\n\n\n80\n\n\n\n90\n\n\n\n100\n\n\n\nFree RM1-\n\n\n\nRM50\n\n\n\nRM51-\n\n\n\nRM100\n\n\n\nMore\n\n\n\nthan RM\n\n\n\n100\n\n\n\nMonthly medication expenses\n\n\n\n%\n o\n\n\n\nf \np\n\n\n\na\nti\n\n\n\ne\nn\n\n\n\nts\n\n\n\nCompliant\n\n\n\nNon-compliant\n\n\n\n\n\n\n\nDiscussion \n\n\n\n\n\n\n\nAs has been found in previous \n\n\n\nresearch, an adherence rate of at \n\n\n\nleast 80% is required to achieve a \n\n\n\ndesired reduction in BP \n12,13\n\n\n\n. With \n\n\n\nthis cut-off point, 68% of patients \n\n\n\nwere found to have adequately \n\n\n\ncomplied with their antihypertensive \n\n\n\nregimens.   The degree of adherence \n\n\n\nto antihypertensive medications in \n\n\n\nthis study was found to be higher \n\n\n\ncompared to a study by Curtin and \n\n\n\ncolleagues \n14\n\n\n\n, where only 52% to \n\n\n\n57% of patients acquired at least \n\n\n\n80% of adherence. This difference \n\n\n\ncould be due to the variation in \n\n\n\nmethods that were employed in \n\n\n\ncarrying out the research \n15\n\n\n\n. In their \n\n\n\nstudy, Medication Event Monitoring \n\n\n\nSystem (MEMS\nTM\n\n\n\n) was used to \n\n\n\nmonitor patients\u2019 adherence over a \n\n\n\nperiod of six weeks. Furthermore, \n\n\n\ninterview method is known to \n\n\n\noverestimate adherence rate because \n\n\n\npatients tend to underreport their \n\n\n\nnon-adherent behaviour and some \n\n\n\nmay be unwilling to disclose this \n\n\n\nmedically unacceptable behaviour \n11\n\n\n\n.     \n\n\n\n\n\n\n\nSocio-demographic characteristics \n\n\n\nwere not found to be associated with \n\n\n\nadherence to antihypertensives. \n\n\n\nMultiple studies have been \n\n\n\nconducted to study the relationship \n\n\n\nbetween drug adherence and \n\n\n\ndemographic characteristics. So far \n\n\n\nthe results are inconclusive \n6,14,16\n\n\n\n. \n\n\n\nThis study was unable to assess the \n\n\n\nrelationship between household \n\n\n\nincome and adherence to  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n228 \n\n\n\nantihypertensives as about 10% of \n\n\n\npatients did not know or were \n\n\n\nunwilling to disclose their household \n\n\n\nincome and some admitted \n\n\n\nunderreporting their household \n\n\n\nincome. Enrolment for most NGO \n\n\n\ndialysis centres in Malaysia gives \n\n\n\npriority to those from a lower \n\n\n\nincome group. Hence, it is \n\n\n\nunderstandable why patients refused \n\n\n\nto disclose their actual household \n\n\n\nincome.  \n\n\n\n\n\n\n\nThe setting of dialysis centres was \n\n\n\nfound to significantly influence \n\n\n\npatients\u2019 adherence to \n\n\n\nantihypertensives. This observation \n\n\n\nis probably closely related to the \n\n\n\nnature of healthcare provider-patient \n\n\n\nrelationship. Centre A is the only \n\n\n\ncentre in this study which has an in-\n\n\n\nhouse nephrologist and doctors. \n\n\n\nMedical consultation is readily \n\n\n\naccessible whenever patients \n\n\n\nexperience any doubt or problems \n\n\n\nregarding their antihypertensive \n\n\n\nregimens. Constant availability of \n\n\n\ndoctors to patients provides a sense \n\n\n\nof security and nurtures a trusting \n\n\n\ndoctor-patient relationship and \n\n\n\nsubsequently promotes patient \n\n\n\nadherence \n17,18\n\n\n\n. On the other hand, \n\n\n\nthe other dialysis centres are \n\n\n\naffiliated to nearby hospitals and \n\n\n\npatients are followed-up by visiting \n\n\n\ndoctors. In these centres, the ratio of \n\n\n\nstaff nurse to patients seemed to \n\n\n\ninfluence patient adherence. The \n\n\n\nratio of staff nurse to patients in \n\n\n\nCentre B, C and D were 1:10, 1:5 to \n\n\n\n7 and 1:5, respectively. It is evident \n\n\n\nthat the lower the ratio of staff nurse \n\n\n\nto patients, the higher the adherence \n\n\n\nrate was observed. This could be due \n\n\n\nto a better quality and quantity of \n\n\n\ntime spent between nurses and \n\n\n\npatients facilitating drug adherence.  \n\n\n\n\n\n\n\nThe impact of healthcare provider-\n\n\n\npatient interaction on patient care is \n\n\n\nalways a topic of interest among \n\n\n\nresearchers \n19-21\n\n\n\n. In the management \n\n\n\nof patients with chronic diseases, in \n\n\n\nthis case, HD patients, a \n\n\n\nmultidisciplinary involvement of \n\n\n\nhealthcare team is essential (Joy et \n\n\n\nal. 2005). Pharmacists in Malaysia \n\n\n\ndo not yet have rapport with HD \n\n\n\npatients as compared to rapport of \n\n\n\ndoctors and nurses to HD patients. \n\n\n\nPharmacists can provide counselling \n\n\n\nto HD patients regarding their \n\n\n\nmedications and benefits of being \n\n\n\nadherent to prescribed regimens. \n\n\n\nThey can also help in addressing \n\n\n\npatients\u2019 feedbacks about their \n\n\n\nmedications. Throughout the years, \n\n\n\nmany studies have successfully \n\n\n\nproven the positive impact of \n\n\n\npharmacist\u2019s involvement in the care \n\n\n\nof HD patients \n22-25\n\n\n\n.  \n\n\n\n\n\n\n\nA linear relationship between the \n\n\n\nnumber of prescribed medications \n\n\n\nand adherence to antihypertensives \n\n\n\nwas not found. The exact reason \n\n\n\nbehind this observation is unclear. \n\n\n\nNevertheless, it is worth noting that \n\n\n\nthe use of pillbox was found to be \n\n\n\nbeneficial in facilitating drug \n\n\n\nadherence especially for patients \n\n\n\nwith polypharmacy. \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n229 \n\n\n\nHigh medication cost adversely \n\n\n\naffects drug adherence \n26,27\n\n\n\n. Drug \n\n\n\naffordability is always a concern \n\n\n\namong HD patients because other \n\n\n\nthan monthly medication expenses, \n\n\n\nthey have to pay for their HD \n\n\n\ntreatment and other medications \n\n\n\nsuch as erythropoietin and calcitriol. \n\n\n\nIn this study, it was found that \n\n\n\npatients received their subsidized \n\n\n\nmedication were more likely to be \n\n\n\nadherent to antihypertensives than \n\n\n\nthose who have to pay the full cost \n\n\n\nfor their medications. This could \n\n\n\nmean that if HD patients received \n\n\n\ntheir medications partially \n\n\n\nsubsidized, their adherence may be \n\n\n\nimproved.  \n\n\n\n\n\n\n\nPatients who admitted having \n\n\n\ndifficulty paying for their \n\n\n\nmedications appeared to be less \n\n\n\nadherent than their counterparts. \n\n\n\nThis was possible that financial \n\n\n\ntension forced them to adopt \n\n\n\nstrategies such as reducing or \n\n\n\nskipping doses of their \n\n\n\nanytihypertensives in order to make \n\n\n\nthe medications last longer \n26\n\n\n\n. There \n\n\n\nwere patients in this study who \n\n\n\nadmitted being unable to refill their \n\n\n\nprescriptions in time due to financial \n\n\n\nconstraint.  \n\n\n\nPiette and colleagues \n28\n\n\n\n concluded in \n\n\n\ntheir study that problems associated \n\n\n\nwith cost of medication are rather \n\n\n\ncomplex. Patients can react to cost \n\n\n\nof medication differently. Some \n\n\n\nwould continue taking their \n\n\n\nmedication despite the cost, but \n\n\n\nsome would forgo treatment even \n\n\n\nthough they could afford it. In order \n\n\n\nto have a better view about the effect \n\n\n\nof medication cost on individual \n\n\n\npatients, Heisler and colleagues \n29\n\n\n\n\n\n\n\nsuggested that healthcare providers \n\n\n\nshould discuss about this issue with \n\n\n\ntheir patients as part of the \n\n\n\nassessment of drug adherence. \n\n\n\nIdentifying patients with financial \n\n\n\ndifficulty and subsequently \n\n\n\nappropriate actions such as \n\n\n\nrecruiting financial aid from welfare \n\n\n\nbodies or prescribing less expensive \n\n\n\nalternatives would probably be \n\n\n\nhelpful in promoting drug \n\n\n\nadherence.  \n\n\n\nSide effects associated with \n\n\n\nantihypertensives such as dizziness, \n\n\n\ngeneral weakness, a \u2018weak heart\u2019 \n\n\n\nand a slow heart rate were identified \n\n\n\nby patients. In this study, less than \n\n\n\nhalf of the patients told their doctors \n\n\n\nabout their drug problems. This \n\n\n\nphenomenon agreed with the finding \n\n\n\nby Kjellgren and colleagues \n17\n\n\n\n that \n\n\n\npatients are usually reluctant to tell \n\n\n\ntheir doctors about the side effects \n\n\n\nthey experienced if these side effects \n\n\n\ncan be alleviated by altering the \n\n\n\ndosage themselves. Furthermore, \n\n\n\npatients did not have ready access to \n\n\n\ndoctors in most dialysis centres in \n\n\n\nthis study. Failure of patients to tell \n\n\n\ntheir doctors about the side effects of \n\n\n\ndrugs they experienced may actually \n\n\n\nendanger their wellbeing especially \n\n\n\nif these side effects occur frequently \n18\n\n\n\n. In view of this, healthcare \n\n\n\nproviders have the responsibility to \n\n\n\nconstantly seek feedbacks from \n\n\n\npatients on whether they experience \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n230 \n\n\n\nany side effects from their current \n\n\n\ntherapy \n17\n\n\n\n. These feedbacks help \n\n\n\nreveal their non-adherent behaviour.  \n\n\n\nAs reported by Horne and Weinman \n30\n\n\n\n, there were patients who did not \n\n\n\nexperience side effects from the \n\n\n\ncurrent antihypertensive regimens, \n\n\n\nyet due to previous hypotensive \n\n\n\nepisodes, they pre-empted by \n\n\n\nintentionally reduce the doses of \n\n\n\ntheir medications.  In the present \n\n\n\nstudy, many patients withheld their \n\n\n\nantihypertensive doses on own \n\n\n\naccord before dialysis due to the \n\n\n\nconcern of intradialytic hypotension. \n\n\n\nThis action has been identified in \n\n\n\nprevious studies as one of the major \n\n\n\nfactors contributing to inadequate \n\n\n\ncontrol of blood pressure among HD \n\n\n\npatients \n8,9\n\n\n\n. It was suggested that re-\n\n\n\nevaluation of blood pressure profiles \n\n\n\nand antihypertensive regimens of \n\n\n\nthese patients is warranted.  \n\n\n\nThe interpretation of results in the \n\n\n\npresent study should take into \n\n\n\naccount the limitations. This study \n\n\n\nwas conducted in only 5 out of 93 \n\n\n\nNGO dialysis centres in Malaysia \n1\n. \n\n\n\nIn addition, the degree of adherence \n\n\n\nto antihypertensives might be \n\n\n\noverestimated because patients who \n\n\n\nwere at risk of non-adherence, for \n\n\n\nexample those who were confused \n\n\n\nwith their drug regimens, cognitively \n\n\n\nimpaired, unable to recall their drug \n\n\n\nregimens and those who were too \n\n\n\nsick to be interviewed, were \n\n\n\nexcluded from this study. \n\n\n\n\n\n\n\nConclusion  \n\n\n\n\n\n\n\nAdherence to antihypertensives \n\n\n\namong HD patients at NGO dialysis \n\n\n\ncentres appeared to be suboptimal. \n\n\n\nSocio-demographic characteristics \n\n\n\ndid not predict adherence. Other \n\n\n\nfactors such as healthcare provider-\n\n\n\npatient relationship, medication cost, \n\n\n\ndrug affordability and side effects of \n\n\n\nmedications seemed to be the \n\n\n\nstronger determinants of adherence. \n\n\n\n\n\n\n\nThe understanding regarding drug \n\n\n\nadherence among HD patients in \n\n\n\nMalaysia is still lacking. It is hope  \n\n\n\nthat this study will serve as a \n\n\n\nstimulus to further studies in drug \n\n\n\nadherence among HD patients. By \n\n\n\nunderstanding the factors that \n\n\n\npredispose to non-adherence, \n\n\n\nspecific interventions can be \n\n\n\ndeveloped to enable patients to gain \n\n\n\noptimal benefits from their \n\n\n\nmedications.  \n\n\n\nThe inherent limitation of interview \n\n\n\nmethod to accurately measure drug \n\n\n\nadherence can be overcome by \n\n\n\nassessing the laboratory test results \n\n\n\nand examining the clinical features \n\n\n\nof the patients.  \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n231 \n\n\n\nReferences \n\n\n\n\n\n\n\n1.  Lim YN, Lim TO. Twelfth \n\n\n\nReport of the Malaysian Dialysis \n\n\n\nand Transplant  Registry 2004. \n\n\n\nKuala Lumpur: National Renal \n\n\n\nRegistry, 2005. \n\n\n\n\n\n\n\n2. 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Improvement of \n\n\n\nmedication compliance in \n\n\n\nuncontrolled hypertension. \n\n\n\nLancet 1976;1(7972):1265-8. \n\n\n\n\n\n\n\n13. Haynes RB, Gibson ES, Taylor \n\n\n\nDW, Bernholz CD, Sackett DL. \n\n\n\nProcess versus outcome in \n\n\n\nhypertension: a positive result. \n\n\n\nCirculation 1982;65(1):28-33. \n\n\n\n\n\n\n\n14. Curtin RB, Svarstad BL, Andress \n\n\n\nD, Keller T, Sacksteder P. \n\n\n\nDifferences in older versus \n\n\n\nyounger hemodialysis patients' \n\n\n\nnoncompliance with oral \n\n\n\nmedications. Geriatric \n\n\n\nNephrology & Urology \n\n\n\n1997;7(1):35-44. \n\n\n\n\n\n\n\n15. Dunbar-Jacob J, Mortimer-\n\n\n\nStephens MK. Treatment \n\n\n\nadherence in chronic disease. \n\n\n\nJournal of Clinical \n\n\n\nEpidemiology 2001;54 Suppl \n\n\n\n1:S57-60. \n\n\n\n\n\n\n\n16. Col N, Fanale JE, Kronholm P. \n\n\n\nThe role of medication \n\n\n\nnoncompliance and adverse drug \n\n\n\nreactions in hospitalizations of \n\n\n\nthe elderly. Archives of Internal \n\n\n\nMedicine 1990;150(4):841-5. \n\n\n\n\n\n\n\n17. Kjellgren KI, Svensson S, \n\n\n\nAhlner J, Saljo R. \n\n\n\nAntihypertensive treatment and \n\n\n\npatient autonomy--the follow-up \n\n\n\nappointment as a resource for \n\n\n\ncare. Patient Education & \n\n\n\nCounseling 2000;40(1):39-49. \n\n\n\n\n\n\n\n18. Svensson S, Kjellgren KI, \n\n\n\nAhlner J, Saljo R. Reasons for \n\n\n\nadherence with antihypertensive \n\n\n\nmedication. International \n\n\n\nJournal of Cardiology \n\n\n\n2000;76(2-3):157-63. \n\n\n\n\n\n\n\n19. Caris-Verhallen WM, Kerkstra \n\n\n\nA, Bensing JM, Grypdonck MH. \n\n\n\nEffects of video interaction \n\n\n\nanalysis training on nurse-patient \n\n\n\ncommunication in the care of the \n\n\n\nelderly. Patient Education & \n\n\n\nCounseling 2000;39(1):91-103. \n\n\n\n\n\n\n\n20. Franks P, Jerant AF, Fiscella K, \n\n\n\nShields CG, Tancredi DJ, \n\n\n\nEpstein RM. Studying physician \n\n\n\neffects on patient outcomes: \n\n\n\nphysician interactional style and \n\n\n\nperformance on quality of care \n\n\n\nindicators. Social Science & \n\n\n\nMedicine 2006;62(2):422-32. \n\n\n\n\n\n\n\n21. Pilnick A. \"Patient counselling\" \n\n\n\nby pharmacists: four approaches \n\n\n\nto the delivery of counselling \n\n\n\nsequences and their interactional \n\n\n\nreception. Social Science & \n\n\n\nMedicine 2003;56(4):835-49. \n\n\n\n22. Skoutakis VA, Acchiardo SR, \n\n\n\nMartinez DR, Lorisch D, Wood \n\n\n\nGC. Role-effectiveness of the \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n233 \n\n\n\npharmacist in the treatment of \n\n\n\nhemodialysis patients. American \n\n\n\nJournal of Hospital Pharmacy \n\n\n\n1978;35(1):62-5. \n\n\n\n\n\n\n\n23.Grabe DW, Low CL, Bailie GR, \n\n\n\nEisele G. Evaluation of drug-\n\n\n\nrelated problems in an outpatient \n\n\n\nhemodialysis unit and the impact \n\n\n\nof a clinical pharmacist. Clinical \n\n\n\nNephrology 1997;47(2):117-21. \n\n\n\n\n\n\n\n24. Manley HJ, Carroll CA. The \n\n\n\nclinical and economic impact of \n\n\n\npharmaceutical care in end-stage \n\n\n\nrenal disease patients. Seminars \n\n\n\nin Dialysis 2002;15(1):45-9. \n\n\n\n\n\n\n\n25. Manley HJ, McClaran ML, \n\n\n\nOverbay DK, et al. Factors \n\n\n\nassociated with medication-\n\n\n\nrelated problems in ambulatory \n\n\n\nhemodialysis patients. American \n\n\n\nJournal of Kidney Diseases \n\n\n\n2003;41(2):386-93. \n\n\n\n\n\n\n\n26. Kennedy J, Coyne J, Sclar D. \n\n\n\nDrug affordability and \n\n\n\nprescription noncompliance in \n\n\n\nthe United States: 1997-2002. \n\n\n\nClinical Therapeutics \n\n\n\n2004;26(4):607-14. \n\n\n\n\n\n\n\n27. Ponnusankar S, Surulivelrajan \n\n\n\nM, Anandamoorthy N, Suresh B. \n\n\n\nAssessment of impact of \n\n\n\nmedication counseling on \n\n\n\npatients' medication knowledge \n\n\n\nand compliance in an outpatient \n\n\n\nclinic in South India. Patient \n\n\n\nEducation & Counseling \n\n\n\n2004;54(1):55-60. \n\n\n\n\n\n\n\n28. Piette JD, Heisler M, Horne R, \n\n\n\nAlexander GC. A conceptually \n\n\n\nbased approach to understanding \n\n\n\nchronically ill patients' responses \n\n\n\nto medication cost pressures. \n\n\n\nSocial Science & Medicine \n\n\n\n2006;62(4):846-857. \n\n\n\n\n\n\n\n29. Heisler M, Wagner TH, Piette \n\n\n\nJD. Clinician identification of \n\n\n\nchronically ill patients who have \n\n\n\nproblems paying for prescription \n\n\n\nmedications. American Journal \n\n\n\nof Medicine 2004;116(11):753-8. \n\n\n\n\n\n\n\n30. Horne R, Weinman J. 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"\n\nMalaysian Journal of Pharmacy Volume 7 Issue 1 (2021) \n \n\n\n\n\n\n\n\n16 \n\n\n\n\n\n\n\n*Correspondence: farmasihraub@gmail.com \n\n\n\n\n\n\n\nDepartment of Pharmacy, Hospital Raub, Ministry of Health Malaysia  \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n Original Research Article \n\n\n\n\n\n\n\nImpact of Medication Reconciliation by Clinical Pharmacist \n\n\n\nduring Hospital Admission of Patients with Chronic Kidney \n\n\n\nDisease (CKD) Stage IV-V in Hospital Raub, Pahang \n \n\n\n\nChen Tze Seong \n\n\n\n\n\n\n\n  \nArticle Info  \n\n\n\n \nReceived date: 16 Feb 2021 \n\n\n\nAccepted date: 8 June 2021 \n\n\n\nPublished date: 30 June 2021 \n\n\n\n\n\n\n\nKeywords:  \n\n\n\nmedication reconciliation, \n\n\n\nhospital admission, clinical \n\n\n\npharmacist, CKD stage IV-V  \n\n\n\nABSTRACT  \n\n\n\n\n\n\n\nMedication errors are more likely to occur during patient\u2019s transition of care. There was very little \n\n\n\ninformation about impact of medication reconciliation activities done for patients with chronic kidney \n\n\n\ndisease (CKD) Stage IV-V during admission stage in Malaysian Primary Hospitals. The objective of \n\n\n\nthis study is to evaluate the impact of clinical pharmacist\u2019s medication reconciliation activities during \n\n\n\nhospital admission of patients with CKD stage IV-V. This cross-sectional study was carried out in \n\n\n\ntwo multidisciplinary wards (male & female ward) in Hospital Raub, Pahang over 12 months with \n\n\n\nethical approval. A clinical pharmacist was assigned to enroll potential study subjects in both wards. \n\n\n\nPatients over 18 years old who had previous history of CKD Stage IV-V were included in the study \n\n\n\nafter obtaining informed consent. Medication reconciliation was carried out by the clinical \n\n\n\npharmacist within 24 working hours during the admission of study subjects. All detected medication \n\n\n\ndiscrepancies were further classified as \u201cintended\u201d or \u201cunintended\u201d after discussion with the \n\n\n\nprescribing medical officer. The Severity Level of each unintended medication discrepancy was rated \n\n\n\nby a visiting medical specialist. Twelve patients with CKD stage V were recruited to the study. A \n\n\n\ntotal of 49 medication discrepancies were identified and most (89.8%) were found to be unintended. \n\n\n\nThe most common unintended medication discrepancy identified was omission error.  Most of the \n\n\n\nunintended medication discrepancies (59.1%) was rated as \u201cNo potential harm\u201d, while 40.9% were \n\n\n\nrated as \u201cPotential for monitoring and/or Intervention to preclude harm\u201d. None of the unintended \n\n\n\nmedication discrepancy was rated as \u201cPotential harm\u201d. In conclusion, medication discrepancies were \n\n\n\ncommon during admission of patients with late-stage chronic kidney disease in a primary hospital. \n\n\n\nMedication reconciliation performed by clinical pharmacist during admission has a potential role in \n\n\n\npreventing potential harms that may arise from unintentional medication discrepancies. \n\n\n\n\n\n\n\nINTRODUCTION  \n  \n\n\n\nChronic Kidney Disease (CKD) is indicated as gradual \n\n\n\ndeterioration of renal function over time and CKD can cause \n\n\n\nmajor health complications [1]. It was reported that 10-13% of \n\n\n\nthe population in China, Taiwan, and Japan have CKD [2].  \n\n\n\nBesides, Asian population has a higher prevalence of CKD as \n\n\n\ncompared to American population [3]. \n\n\n\n\n\n\n\nAccording to a nationwide population-based cross-sectional \n\n\n\nstudy conducted by Saminathan et al. [4] from September 2017 \n\n\n\nto June 2018, the prevalence of respondents with stage I, stage \n\n\n\nII, stage III, stage IV and stage V CKD in Malaysia were \n\n\n\n3.85%, 4.82%, 6.48%, 0.25% and 0.08% respectively in 2018 \n\n\n\n[4], as compared to 4.16%, 2.05%, 2.26%, 0.24% and 0.36% \n\n\n\nrespectively from a similar study which included only \n\n\n\nrespondents from West Malaysia in 2011 [5]. Saminathan et al. \n\n\n\nstated that out of all respondents with CKD, only 5% of them \n\n\n\nwere aware of their diagnosis [4]. \n\n\n\n\n\n\n\nPatients with CKD are considered as a complex population. \n\n\n\nAccording to study conducted by Manley et al., patients with \n\n\n\nend stage renal failure undergoing haemodialysis were \n\n\n\nprescribed an average of 12 medications [6]. Medication errors \n\n\n\nare more likely to occur during patient\u2019s transition of care [7]. \n\n\n\nBesides, incidence of adverse drug reactions increases with \n\n\n\n\n\n\n\n\n\n\n\n\nChen T.S. Mal J Pharm 7 (1) 2021, 16-21 \n\n\n\n\n\n\n\n17 \n\n\n\n\n\n\n\nincreasing number of medications used and worsening of renal \n\n\n\nfunction [8]. \n\n\n\n\n\n\n\nMedication reconciliation is defined as the process of \n\n\n\ncomparing a patient\u2019s medication list ordered by prescriber to \n\n\n\npatient\u2019s previous medications during transition of care [9]. \n\n\n\nBased on data from Buckley et al.,  medication discrepancies \n\n\n\nduring hospital admission are common and accounted for up to \n\n\n\n67% of all hospitalised patients [10]. An unintentional \n\n\n\nmedication discrepancy occurs when prescribers omitted, \n\n\n\nchanged, or added a medication unintentionally [11]. Any \n\n\n\nunintentional medication discrepancy has the potential to \n\n\n\nbecome a medication error and cause patient harm [11].   \n\n\n\n\n\n\n\nA systematic review from Tam et al. showed that inaccurate or \n\n\n\nincomplete medication orders during patient\u2019s admission \n\n\n\naccounted for 27% of total hospital medication errors [12]. \n\n\n\nObtaining accurate medication histories during patient\u2019s \n\n\n\nadmission is crucial to improve medication safety as errors in \n\n\n\nmedication history taking may lead to inappropriate drug \n\n\n\ntherapy for hospitalised patients [12].  \n\n\n\n\n\n\n\nBased on a study conducted by Hassali et al., 90.1% of \n\n\n\nrespondents consisting of 86 General Practitioners in the \n\n\n\nPenang State agreed that medication reconciliation can be a \n\n\n\npractical strategy in improving medication safety [13]. \n\n\n\nMedication Reconciliation was announced as 2005 National \n\n\n\nPatient Safety Goal #8 by the Joint Commission [9]. According \n\n\n\nto the safety goal, medication reconciliation should be \n\n\n\nimplemented in all patient care settings [9].  \n\n\n\n\n\n\n\nThere was only one similar study in Malaysia done by Islahudin \n\n\n\net al. for medication reconciliation during admission of patients \n\n\n\nto healthcare facilities [14].  The study found out that \n\n\n\nmedication reconciliation tool identified more medication \n\n\n\ndiscrepancies than standard medication history taking during \n\n\n\npatient admissions in a tertiary hospital [14]. \n\n\n\n\n\n\n\nThe objective of this study was to evaluate the impact of clinical \n\n\n\npharmacist\u2019s medication reconciliation activities during \n\n\n\nhospital admission of patients with CKD stage IV-V. To date \n\n\n\nthere was very little information about impact of medication \n\n\n\nreconciliation activities done for specific populations (eg. Late-\n\n\n\nStage CKD patients) during admission stage in Malaysian \n\n\n\nPrimary Hospitals. The primary outcome of this study was the \n\n\n\nnumber of medication discrepancies detected during the \n\n\n\nadmission of patients with CKD stage IV-V over the study \n\n\n\nperiod. As compared to the similar study conducted by \n\n\n\nIslahudin et al. [14], we also evaluated the \u201cseverity level of \n\n\n\neach unintended medication discrepancy if left undetected\u201d, \n\n\n\nwhich was the secondary outcome of this study. \n\n\n\n\n\n\n\nMETHOD  \n  \n\n\n\nThis was a cross-sectional study to determine the number of \n\n\n\nunintended medication discrepancies identified through \n\n\n\nmedication reconciliation activities performed by a clinical \n\n\n\npharmacist during admission of patient with CKD stage IV-V \n\n\n\nin multidisciplinary wards.  \n\n\n\n\n\n\n\nThis study was carried out in two multidisciplinary wards (male \n\n\n\n& female ward) in Hospital Raub over a period of 12 months \n\n\n\nfrom 24th May 2018 to 23rd May 2019. Hospital Raub is a \n\n\n\nprimary hospital with 89 beds and multidisciplinary wards \n\n\n\ncomprise 56 beds. This study protocol was approved by the \n\n\n\nMedical Research and Ethics Committee (MREC), Ministry of \n\n\n\nHealth Malaysia [Reference numbers: KKM.NIHSEC.P18-\n\n\n\n469(5) for initial ethical approval and KKM/NIHSEC/P18-\n\n\n\n469(9) for subsequent annual ethical renewal]. \n\n\n\n\n\n\n\nThe mean of total admission of patients to these \n\n\n\nmultidisciplinary wards in Hospital Raub from 2015-2017 were \n\n\n\n3569 patients. As there was no study regarding prevalence of \n\n\n\nCKD patients admitted to ward, prevalence data from the study \n\n\n\nconducted by Hooi et al. [5] was used as it was the first study \n\n\n\nshowing prevalence of CKD by stages in Malaysia, and newer \n\n\n\nprevalence data was yet to be reported in early 2018, when this \n\n\n\nstudy was initiated. According to Hooi et al., total percentage \n\n\n\nof noninstitutionalized adult patients with CKD stage IV-V in \n\n\n\nWest Malaysia in 2011 was 0.60% [5]. \n\n\n\n\n\n\n\nThe sample size of this study was calculated using the \u201cSample \n\n\n\nSize for Frequency\u201d calculator from openepi.com [15]. After \n\n\n\nentering population size as 100,000 people, anticipated \n\n\n\nfrequency (in percentage) is calculated as 0.60%, confidence \n\n\n\nlimits as 5%, and design effect as 1. A sample size of 12 study \n\n\n\nsubjects was required for 97% confidence level [15]. \n\n\n\nConvenient sampling method was used to recruit study \n\n\n\nsubjects. \n\n\n\n\n\n\n\nPatients over 18 years old who had previous history of CKD \n\n\n\nand with estimated Glomerular Filtration Rate (eGFR) of less \n\n\n\nthan 30ml/min/1.73m2  upon admission were included in our \n\n\n\nstudy. On the other hand, patients/caregivers who were \n\n\n\nunresponsive or unwilling to communicate with clinical \n\n\n\npharmacist were excluded from this study. Besides, patients \n\n\n\nwho were diagnosed as having Acute Kidney Injury (AKI) by \n\n\n\nward Medical Officer (MO) during the time of admission were \n\n\n\nalso excluded. Acute Kidney Injury is diagnosed when Serum \n\n\n\nCreatinine (SCr) level increases \u226526.5 \u03bcmol/l from baseline \n\n\n\nvalue or patient\u2019s urine output is < 0.5 ml/kg/h for 6 hours [16]. \n\n\n\n\n\n\n\nThe Modification of Diet in Renal Disease (MDRD) formula \n\n\n\nwas used in estimating Glomerular Filtration Rate (GFR) for \n\n\n\nrenal function assessment and drug dosage adjustment in this \n\n\n\n\n\n\n\n\n\n\n\n\nChen T.S. Mal J Pharm 7 (1) 2021, 16-21 \n\n\n\n\n\n\n\n18 \n\n\n\n\n\n\n\nstudy. The eGFR Calculator mobile app (version 2.3) from the \n\n\n\nNational Kidney Foundation (NKF) was used to calculate \n\n\n\nestimated GFR for each study subject [17]. \n\n\n\n\n\n\n\nThis study focused on medication reconciliation activities \n\n\n\nconducted by a clinical pharmacist in detecting and resolving \n\n\n\nany unintended medication discrepancies within 24 hours post-\n\n\n\nadmission of Late-Stage CKD patients. Patients that were \n\n\n\nadmitted on weekends or public holidays were reviewed within \n\n\n\n24 hours on the subsequent first working day. A clinical \n\n\n\npharmacist (also as the investigator in this study) was assigned \n\n\n\nto cover both multidisciplinary ward on working days to screen \n\n\n\neach newly admitted patient to determine potential participant \n\n\n\nfor this study. The clinical pharmacist informed each eligible \n\n\n\npatient that there would be no harm to participate in this study, \n\n\n\nas no invasive procedure or interventional product was to be \n\n\n\nintroduced to him/her. Each participant was informed that he or \n\n\n\nshe would not be reimbursed for participation in the study. \n\n\n\nEvery eligible patient who agreed to take part in the study was \n\n\n\nrequired to complete the patient information leaflet/informed \n\n\n\nconsent form. \n\n\n\n\n\n\n\nAfter the patient or caregiver had completed the consent form, \n\n\n\nthe clinical pharmacist determined the patient\u2019s actual stage of \n\n\n\nCKD by entering the patient\u2019s age, gender, and serum \n\n\n\ncreatinine level in the \u201cMDRD Study Equation\u201d section of the \n\n\n\neGFR Calculator mobile app [17]. Patients with an estimated \n\n\n\nGFR greater than 30ml/min/1.73m2 were excluded from the \n\n\n\nstudy. After that, using a data collection form adapted from the \n\n\n\nMedication History Assessment Form (CP1) [18], the clinical \n\n\n\npharmacist conducted an interview with the patient or caregiver \n\n\n\nto obtain the patient\u2019s demographic information, past medical \n\n\n\nhistory, history of drug allergy and past medication history. The \n\n\n\nlist of medication history generated by the clinical pharmacist \n\n\n\nwas used to compare to the list of medications prescribed \n\n\n\nduring admission, and all medication discrepancies were \n\n\n\ndocumented.  \n\n\n\n\n\n\n\nThe clinical pharmacist then contacted corresponding \n\n\n\nprescribing Medical Officer (MO) regarding the detected \n\n\n\nmedication discrepancies and inquired whether each \n\n\n\ndiscrepancy was intended or unintended. Unintended \n\n\n\nmedication discrepancy was determined when the MO \n\n\n\nindicated that the difference between the patients\u2019 previous \n\n\n\nmedication list and the medication list prescribed at the time of \n\n\n\npatient admission was unintentional. Then, the clinical \n\n\n\npharmacist requested ward MO to make corrections on ward \n\n\n\nmedication chart if the medication discrepancies were found to \n\n\n\nbe unintended or erroneous. The medication reconciliation \n\n\n\nprocess was considered complete once interventions were done \n\n\n\nfor each unintended medication discrepancy.  \n\n\n\n\n\n\n\nIn order to evaluate severity level of each unintended \n\n\n\nmedication discrepancy if left undetected, a visiting medical \n\n\n\nspecialist was invited to rate each medication discrepancy \n\n\n\nbased on the 3 Severity levels (Table I). The severity levels \n\n\n\nratings for medication discrepancies were adapted from the \n\n\n\npotential harm ratings from Gleason et al, 2010 [19].  The \n\n\n\ndefinition of each Severity Level and Categories of Medication \n\n\n\nErrors involved in each level were adapted from the National \n\n\n\nCoordinating Council for Medication Error Reporting and \n\n\n\nPrevention (NCC MERP) Index for Categorizing Medication \n\n\n\nErrors [20].   \n\n\n\n\n\n\n\nThe data collected was analysed descriptively with \u2018Statistical \n\n\n\nPackage for the Social Sciences\u2019 (SPSS for Windows) version \n\n\n\n21. For categorical variables, results were presented as \n\n\n\nfrequency and its percentage whereas results for numerical \n\n\n\nvariables were presented as Mean \u00b1 Standard Deviation (SD) \n\n\n\nor Median \u00b1 Interquartile Range (IQR). Only descriptive \n\n\n\nstatistics were used in this study. \n\n\n\n\n\n\n\nRESULT \n \n\n\n\nTwelve patients with CKD stage IV-V were recruited to the \n\n\n\nstudy. Details of sociodemographic and baseline characteristics \n\n\n\nof the study population are summarized in Table II. All \n\n\n\nTable I: Severity Level Ratings for Medication Discrepancies \n \n\n\n\nSeverity Level of Medication \n\n\n\nDiscrepancy [19] \n\n\n\nDefinition [20] * Category of Medication Errors [20] \n\n\n\ninvolved in each Level* \n\n\n\n\n\n\n\nLevel 1 No Potential harm Category C:  An error reached the patient but did not result in patient harm \n\n\n\n\n\n\n\nLevel 2 Potential for monitoring and/or \n\n\n\nIntervention to preclude harm \n\n\n\n\n\n\n\nCategory D:  An error reached the patient, monitoring and/or intervention \n\n\n\nis required to preclude harm. \n\n\n\n\n\n\n\nLevel 3 Potential harm Category E:  An error reached the patient and may have caused temporary \n\n\n\nharm to the patient, intervention is required. \n\n\n\n\n\n\n\nCategory F:  An error reached the patient and may have caused temporary \n\n\n\nharm to the patient and may necessitate initial or prolonged hospitalization. \n\n\n\n\n\n\n\n*Adapted from the National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP)  (www.nccmerp.org) \n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\nChen T.S. Mal J Pharm 7 (1) 2021, 16-21 \n\n\n\n\n\n\n\n19 \n\n\n\n\n\n\n\nrecruited patients were evaluated as having CKD Stage V. \n\n\n\nAmong all patients recruited, two patients (16.7%) had no \n\n\n\nmedication discrepancies. This study identified a total of 49 \n\n\n\nmedication discrepancies, and in which 44 (89.8%) \n\n\n\ndiscrepancies were found to be unintended. Details of different \n\n\n\ntypes of unintended medication discrepancies are shown in \n\n\n\nTable III. \n\n\n\n \nTable II: Demographic Data of the Study Population  (n = 12) \n\n\n\n\n\n\n\nCharacteristics Value \n\n\n\nGender, number (%)  \n\n\n\n  Male 7 (58.3) \n\n\n\n  Female 5 (41.7) \n\n\n\nMedian age (years) 65.5 (10.8) \n\n\n\nStage of CKD, number (%)  \n\n\n\n  Stage IV 0 (0.0) \n\n\n\n  Stage V 12 (100.0) \n\n\n\nMean (SD) number of medications prescribed on \n\n\n\nadmission  \n7.2 (3.8) \n\n\n\nMean (SD) number of regular medications before \n\n\n\nadmission \n9.0 (2.3) \n\n\n\n\u00a7Source of medication history,  \n\n\n\nnumber (%) \n \n\n\n\nPharmacy Information System (PhIS) record 11 (91.7) \n\n\n\nPatient\u2019s current outpatient prescription 6 (50.0) \n\n\n\nPatient\u2019s own medication  4 (33.3) \n\u00a7Cumulative percentage > 100% as some patients had >1 source of medication \n\n\n\nhistory. \n\n\n\n\n\n\n\nMedications for Bone and Mineral Disease was found to be the \n\n\n\nmost common medication class involved in unintended \n\n\n\nmedication discrepancies during admission, followed by \n\n\n\nVitamins/Iron supplements, Antihypertensives and \n\n\n\nAntidiabetic Agents (Table IV). Among all the unintentional \n\n\n\nmedication discrepancies, 59.1% were judged as Severity \n\n\n\nLevel 1 (no potential harm if left undetected), while 40.9% \n\n\n\nwere judged as Severity Level 2 (potential for monitoring \n\n\n\nand/or intervention to preclude harm if left undetected). No \n\n\n\nunintended medication discrepancy was classified as Severity \n\n\n\nLevel 3 (potential harm to patient if left undetected).  \n\n\n\n \nTable III: Types of Unintended Medication Discrepancies Identified (n = \n\n\n\n44) \n\n\n\n\n\n\n\nType of Discrepancy Number (%)\u0394 \n\n\n\nOmitted Drug 34 (77.3) \n\n\n\nWrong Dose 6 (13.6) \n\n\n\nWrong Frequency 2 (4.5) \n\n\n\nWrong Drug 2 (4.5) \n\n\n\n\u0394 Percentages may not add up to 100% due to rounding. \n\n\n\n\n\n\n\nTable IV: Medication Class Involved in Unintended Medication \n\n\n\nDiscrepancies (n = 44) \n\n\n\n\n\n\n\nMedication Class Number (%)\u0394 \n\n\n\nMedications for Bone and Mineral Disease 11 (25.0) \n\n\n\nOther (Vitamin/ Iron) Supplements 8 (18.2) \n\n\n\nAntihypertensives 7 (15.9) \n\n\n\nAntidiabetic Agents 6 (13.6) \n\n\n\nMedications for Stress Ulcer Prophylaxis/ Gastritis 4 (9.1) \n\n\n\nCholesterol-Lowering Agents 3 (6.8) \n\n\n\nDiuretics 2 (4.5) \n\n\n\nAntiplatelets 2 (4.5) \n\n\n\nThyroid Replacement Medications 1 (2.3) \n\n\n\n\u0394 Percentages may not add up to 100% due to rounding. \n \n\n\n\n\n\n\n\nDISCUSSION  \n \n\n\n\nNone of the patient recruited in this study was classified under \n\n\n\nCKD Stage IV. This might be due to more patients with CKD \n\n\n\nStage V were admitted during the study period. A study \n\n\n\nconducted by Go et al. found out that there was a graded \n\n\n\nassociation between lower levels of estimated GFR and the \n\n\n\nrisks of hospitalization [21].   \n\n\n\n\n\n\n\nMost of the medication discrepancies were found to be \n\n\n\nunintended. The result in this study showed that the most \n\n\n\ncommon medication discrepancy identified during admission \n\n\n\nof patient was omission error, follow by wrong dose, and then \n\n\n\nby wrong frequency. This coincides with the similar study \n\n\n\ninvolving eligible patients admitted to the Orthopedic Service \n\n\n\n[22]. The most common interventions done in this study was \n\n\n\naddition of the omitted medications. This result is consistent \n\n\n\nwith the findings of other similar studies which also recruited \n\n\n\npatient from other disciplines [14,23\u201325]. \n\n\n\nMost of the unintended medication discrepancies (59.1%) was \n\n\n\njudged as Severity Level 1, which indicates that the \n\n\n\ndiscrepancies were unlikely to cause harm if left undetected. \n\n\n\nThis result agrees with the findings from a similar study from \n\n\n\nCornish et al., where eligible patients admitted to the general \n\n\n\ninternal medicine clinical teaching units in a tertiary care \n\n\n\nteaching hospital were recruited [25]. The study found that \n\n\n\n61.4% of the unintended medication discrepancies were \n\n\n\nconsidered as unlikely to cause harm [25].  \n\n\n\n\n\n\n\nAnother finding from this study showed that 40.9% of the \n\n\n\nunintended medication discrepancies were deemed to have the \n\n\n\npotential to cause harm & monitoring and intervention may \n\n\n\nhave been required to preclude harm (Severity Level 2). This \n\n\n\n\n\n\n\n\n\n\n\n\nChen T.S. Mal J Pharm 7 (1) 2021, 16-21 \n\n\n\n\n\n\n\n20 \n\n\n\n\n\n\n\nfinding is in agreement with the systematic review conducted \n\n\n\nby Tam et al., where limited data suggested that 11-50% of \n\n\n\nmedication history errors at admission to hospital were \n\n\n\nclinically important [12]. Besides that, this data also coincides \n\n\n\nwith the findings from other studies, where more than 30% of \n\n\n\nthe unintended medication discrepancies were deemed to have \n\n\n\npotential to cause moderate harm [23,25]. There is no \n\n\n\nmedication discrepancy classified as Severity Level 3 in this \n\n\n\nstudy. On the contrary, the study from Cornish et al. revealed \n\n\n\nthat 5.7% of the identified medication discrepancies were \n\n\n\njudged to have the potential to result in severe discomfort or \n\n\n\nclinical deterioration [25]. \n\n\n\n\n\n\n\nAll recommendations proposed were accepted by the MO who \n\n\n\ndid the admission with acceptance rate of 100%. Other studies \n\n\n\ninvolving medication reconciliation on admission also showed \n\n\n\nthat most recommendations by pharmacy team regarding the \n\n\n\nunintended discrepancies were accepted [14,22,23]. \n\n\n\n\n\n\n\nIn this study, more than 1 source of medication list were \n\n\n\nobtained from several patients as different sources of \n\n\n\nmedication can be used to ensure the accuracy of patient\u2019s \n\n\n\nmedication history [23]. This is important for those who are \n\n\n\nunder follow up at different disciplines/facilities. The main \n\n\n\nsource of medication list used in this study is the Pharmacy \n\n\n\nInformation System (PhIS) [26].  \n\n\n\n\n\n\n\nSince 2016, PhIS had been implemented in most healthcare \n\n\n\nfacilities in PAHANG State [26]. The PhIS system shows the \n\n\n\ncomplete current medication record for patients who are under \n\n\n\nfollow up in Hospital Raub, including the regular medications \n\n\n\nfrom other Ministry of Health (MOH) facilities if patient opted \n\n\n\nthe Integrated Drug Dispensing System (SPUB), a Value-\n\n\n\nAdded Service (VAS) where patients can obtain the next drug \n\n\n\nsupply of active prescriptions from any of the MOH health \n\n\n\nfacilities listed in the MOH's SPUB Directory through a \n\n\n\nnationwide referral system [26,27].  \n\n\n\n\n\n\n\nPhIS system is accessible in emergency department and all \n\n\n\nwards in Hospital Raub. Patient\u2019s latest medication list from \n\n\n\noutpatient/ specialist clinics can be retrieved by clinical \n\n\n\npharmacist from PhIS during ward round, thus improving the \n\n\n\naccuracy of the medication history taking as some patients \n\n\n\nmight leave their regular medications at home while some \n\n\n\nmight bring incomplete medication list to ward. \n\n\n\n\n\n\n\nThis study showed that PhIS system was underutilized among \n\n\n\nmedical officers in Hospital Raub Emergency Department \n\n\n\nthroughout the study period as most patients\u2019 complete \n\n\n\nmedication lists were obtained from PhIS by the clinical \n\n\n\npharmacist and yet the most common unintended discrepancy \n\n\n\nwas omission of patient\u2019s regular medication. Further \n\n\n\ninvestigations are required to determine the root cause of PhIS \n\n\n\nunderutilization by medical officers during admission of \n\n\n\npatients in Hospital Raub. \n\n\n\n\n\n\n\nLimitations \n\n\n\n\n\n\n\nThis study only involved small sample of patients from a \n\n\n\nprimary hospital, so the result might not be generalized to other \n\n\n\nareas with bigger population. Besides, all recruited patients in \n\n\n\nthis study were classified under CKD Stage V, thus the result \n\n\n\nmight not be generalized to population with higher \n\n\n\nhospitalization rate of patients with CKD Stage IV. The \n\n\n\npotential harm of each unintended medication discrepancy was \n\n\n\njudged by only one visiting medical specialist, and there was \n\n\n\npossibility that other medical specialist might have different \n\n\n\njudgement on some of the medication discrepancies. \n\n\n\n\n\n\n\nCONCLUSION \n  \nMedication discrepancies were common during admission of \n\n\n\npatients with late-stage chronic kidney disease in a primary \n\n\n\nhospital. Medication reconciliation performed by clinical \n\n\n\npharmacist during admission has a potential role in preventing \n\n\n\npotential harms that may arise from unintentional medication \n\n\n\ndiscrepancies. \n\n\n\n\n\n\n\nCONFLICT OF INTEREST \n \n\n\n\nThe author declares no conflict of interest. This research did \n\n\n\nnot receive any specific grant from funding agencies in the \n\n\n\npublic, commercial or not-for-profit sectors. \n\n\n\n\n\n\n\nACKNOWLEDGEMENT \n \n\n\n\nThe author would like to thank the Director General of Health \n\n\n\nMalaysia for his permission to publish this article. \n\n\n\n\n\n\n\nREFERENCE \n \n[1] NKF. The National Kidney Foundation: Kidney Disease [Internet]. \n\n\n\nThe National Kidney Foundation. 2019 [cited 2020 Jan 24]. Available \n\n\n\nfrom: https://www.kidney.org/atoz/content/about-chronic-kidney-\n\n\n\ndisease \n\n\n\n[2] Stenvinkel P. Chronic kidney disease: A public health priority and \n\n\n\nharbinger of premature cardiovascular disease. Vol. 268, Journal of \n\n\n\nInternal Medicine. 2010. p. 456\u201367.  \n\n\n\n[3] Zhang Q-L, Rothenbacher D. Prevalence of chronic kidney disease in \n\n\n\npopulation-based studies: systematic review. BMC Public Health. \n\n\n\n2008;8(117).  \n\n\n\n[4] Saminathan TA, Hooi LS, Mohd Yusoff MF, Ong LM, Bavanandan \n\n\n\nS, Rodzlan Hasani WS, et al. Prevalence of chronic kidney disease \n\n\n\nand its associated factors in Malaysia; Findings from a nationwide \n\n\n\npopulation-based cross-sectional study. BMC Nephrol. \n\n\n\n2020;21(1):344.  \n\n\n\n[5] Hooi LS, Ong LM, Ahmad G, Bavanandan S, Ahmad NA, Naidu BM, \n\n\n\net al. A population-based study measuring the prevalence of chronic \n\n\n\n\n\n\n\n\n\n\n\n\nChen T.S. Mal J Pharm 7 (1) 2021, 16-21 \n\n\n\n\n\n\n\n21 \n\n\n\n\n\n\n\nkidney disease among adults in West Malaysia. Kidney Int. \n\n\n\n2013;84(5):1034\u201340.  \n\n\n\n[6] Manley HJ, Garvin CG, Drayer DK, Reid GM, Bender WL, Neufeld \n\n\n\nTK, et al. Medication prescribing patterns in ambulatory \n\n\n\nhaemodialysis patients: Comparisons of USRDS to a large not-for-\n\n\n\nprofit dialysis provider. Nephrol Dial Transpl. 2004;19(7):1842\u20138.  \n\n\n\n[7] Rogers G, Alper E, Brunelle D, Federico F, Fenn CA, Leape LL, et al. \n\n\n\nReconciling medications at admission: Safe practice \n\n\n\nrecommendations and implementation strategies. Jt Comm J Qual \n\n\n\nPatient Saf. 2006;32(1):37\u201350.  \n\n\n\n[8] Kappel J, Calissi P. Nephrology: 3. Safe drug prescribing for \n\n\n\npatientswith renal insufficiency. C Can Med Assoc J. \n\n\n\n2002;166(4):473\u20137.  \n\n\n\n[9] Sentinel Event Alert 35. Using medication reconciliation to prevent \n\n\n\nerrors. Jt Comm J Qual Patient Saf. 2006;32(4):230\u20132.  \n\n\n\n[10] Buckley MS, Harinstein LM, Clark KB, Smithburger PL, Eckhardt \n\n\n\nDJ, Alexander E, et al. Impact of a Clinical Pharmacy Admission \n\n\n\nMedication Reconciliation Program on Medication Errors in \u201cHigh-\n\n\n\nRisk\u201d Patients. Ann Pharmacother. 2013;47(12):1599\u2013610.  \n\n\n\n[11] Fernandes O. Medication Reconciliation: Practical tips, strategies and \n\n\n\ntools for pharmacists. Pharmacy Practice. 2009;(october):24\u201355.  \n\n\n\n[12] Tam VC, Knowles SR, Cornish PL, Fine N, Marchesano R, Etchells \n\n\n\nEE. Frequency, type and clinical importance of medication history \n\n\n\nerrors at admission to hospital: a systematic review. Can Med Assoc J \n\n\n\n[Internet]. 2005 Aug 30 [cited 2015 Apr 20];173(5):510\u20135. Available \n\n\n\nfrom: \n\n\n\nhttp://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1188190\n\n\n\n&tool=pmcentrez&rendertype=abstract \n\n\n\n[13] Hassali MAA, Al-Haddad M, Shafie AA, Tangiisuran B, Saleem F, \n\n\n\nAtif M, et al. Perceptions Among General Medical Practitioners \n\n\n\nToward Implementation of Medication Reconciliation Program for \n\n\n\nPatients Discharged From Hospitals in Penang, Malaysia. J Patient \n\n\n\nSaf. 2012;8(2):76\u201380.  \n\n\n\n[14] Islahudin F, Ahmad N, Abidin ZZ. Impact of medication \n\n\n\nreconciliation during patient admission. Int J Pharm Sci. \n\n\n\n2013;5(3):631\u20134.  \n\n\n\n[15] Dean A, Sullivan K, Soe M. OpenEpi: Open Source Epidemiologic \n\n\n\nStatistics for Public Health [Internet]. 2013 [cited 2018 Feb 21]. \n\n\n\nAvailable from: http://www.openepi.com/Menu/OE_Menu.htm \n\n\n\n[16] Kellum JA, Lameire N, Aspelin P, Barsoum RS, Burdmann E a, \n\n\n\nGoldstein SL, et al. KDIGO Clinical Practice Guideline for Acute \n\n\n\nKidney Injury. Kidney Int Suppl [Internet]. 2012;2(1):1\u2013138. \n\n\n\nAvailable from: \n\n\n\nhttp://www.kdigo.org/clinical_practice_guidelines/pdf/KDIGO AKI \n\n\n\nGuideline.pdf \n\n\n\n[17] National Kidney Foundation. eGFR Calculators (Version 2.3) [Mobile \n\n\n\napp] [Internet]. App Store; 2015. Available from: \n\n\n\nhttps://apps.apple.com/my/app/egfr-calculators/id483182385?l=ms \n\n\n\n[18] Pharmaceutical Services Division, Ministry of Health Malaysia. \n\n\n\nAppendix C1: Medication History Assessment Form (CP1). In: Renal \n\n\n\nPharmacy Service Guideline. Petaling Jaya: Pharmaceutical Services \n\n\n\nDivision, Ministry of Health Malaysia; 2011. p. 42\u20133.  \n\n\n\n[19] Gleason KM, McDaniel MR, Feinglass J, Baker DW, Lindquist L, \n\n\n\nLiss D, et al. Results of the medications at transitions and clinical \n\n\n\nhandoffs (match) study: An analysis of medication reconciliation \n\n\n\nerrors and risk factors at hospital admission. J Gen Intern Med. \n\n\n\n2010;25(5):441\u20137.  \n\n\n\n[20] NCC MERP. Categorizing Medication Errors [Internet]. NCC MERP. \n\n\n\n2001 [cited 2017 Dec 9]. Available from: \n\n\n\nhttp://www.nccmerp.org/types-medication-errors \n\n\n\n[21] Go AS, Chertow GM, Fan D, Mcculloch CE, Hsu C-Y. Chronic \n\n\n\nKidney Disease and the Risks of Death, Cardiovascular Events, and \n\n\n\nHospitalization. N Engl J Med [Internet]. 2004;351(13):1296\u2013305. \n\n\n\nAvailable from: www.nejm.org \n\n\n\n[22] Moriel MC, Pardo J, Catal\u00e0 RM, Segura M. Prospective Study on \n\n\n\nConciliation of Medication in Orthopaedic Patients. Farm Hosp \n\n\n\n(English Ed. 2008;32(2):65\u201370.  \n\n\n\n[23] Karaoui LR, Chamoun N, Fakhir J, Abi Ghanem W, Droubi S, Diab \n\n\n\nMarzouk AR, et al. Impact of pharmacy-led medication reconciliation \n\n\n\non admission to internal medicine service: Experience in two tertiary \n\n\n\ncare teaching hospitals. BMC Health Serv Res. 2019;19(1):493.  \n\n\n\n[24] Patel R, Butler K, Garrett D, Badger N, Cheoun D, Hallman L. The \n\n\n\nimpact of a pharmacist\u2019s participation on hospitalists\u2019 rounds. Hosp \n\n\n\nPharm. 2010;45(2):129\u201334.  \n\n\n\n[25] Cornish PL, Knowles SR, Marchesano R, Tam V, Shadowitz S, \n\n\n\nJuurlink DN, et al. Unintended Medication Discrepancies at the Time \n\n\n\nof Hospital Admission. Arch Intern Med. 2005;165:424\u20139.  \n\n\n\n[26] thesundaily.my. PhIS to provide better pharmacy system for patients \n\n\n\n[Internet]. 2016 [cited 2020 Jan 18]. Available from: \n\n\n\nhttps://www.thesundaily.my/archive/1713039-JSARCH352297 \n\n\n\n[27] Pharmaceutical Services Programme, Ministry of Health Malaysia. \n\n\n\nSistem Pendispensan Ubat Bersepadu (SPUB) | Program \n\n\n\nPerkhidmatan Farmasi [Internet]. 2018 [cited 2020 Jan 18]. Available \n\n\n\nfrom: https://www.pharmacy.gov.my/v2/ms/entri/sistem-\n\n\n\npendispensan-ubat-bersepadu-spub.html \n\n\n\n\n\n"
"\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nMal J Pharm . Volume 8 Issue 2 . Dec 2022 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of Pharmacy \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nA Publication of Malaysian Pharmacists Society \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Volume 8 Issue 2 Dec 2022 \n \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\n\n\n\n\nEditorial Board  \n\n\n\n\n\n\n\nEditor-in chief        : Assoc. Prof. Dr. Chan Siok Yee \n\n\n\nManaging Editor   : Prof. Dr. Long Chiau Ming  \n\n\n\nAssociate Editors   : Prof. Dr. Habibah Abdul Wahad \n\n\n\n  Prof. Dr. Mohd Cairul Iqbal Mohd Amin \n\n\n\n  Prof. Dr. Wong Ting Wui \n\n\n\n  Prof. Dr. Lua Pei Lin \n\n\n\n  Prof. Dr. Chua Siew Siang  \n\n\n\n  Prof. Dr. Mohd Makmor Bakry  \n\n\n\nProf. Dr. Asrul Asrul Akmal Shafie \n\n\n\n  Prof. Dr. Vikneswaran A/L Murugaiyah \n\n\n\n  Prof. Dr. Mohamad Haniki Nik Mohamed  \n\n\n\n  Assoc. Prof. Dr. Mogana Sundari A/P Rajagopal  \n\n\n\n  Assoc. Prof. Dr. Tan Ching Siang \n\n\n\n  Assoc. Prof. Dr. Aisyah Saad Abdul Rahim \n\n\n\n  Assoc. Prof. Dr. Lawrence Anchah  \n\n\n\n  Assistant Prof. Dr. Liew Kai Bin  \n\n\n\n  Dr. Toh Seok Ming  \n\n\n\n  Dr. June Choon Wai Yee \n\n\n\n  Dr. Liau Siao Yen \n\n\n\n  Dr. Syireen Alwi  \n\n\n\nDr. Nour Hanah Binti Othman \n\n\n\n  Dr. Mohd Shahezwan Abd Wahab \n\n\n\n  Mr. Kamarudin Ahmad \n\n\n\n  Mrs. Reem Abou Assi \n\n\n\nAdvisory Board : Emeritus Professor Dr. Yuen Kah Hay \n\n\n\nEmeritus Professor Dr. Paraidathathu Thomas A/L P.G. Thomas \n\n\n\nProf. Dr. Mohd Baidi Bahari  \n\n\n\nDr. Sheng Qi \n\n\n\nAssoc. Prof. Dr. Alberto Beradi  \n\n\n\nAssoc. Prof. Dr. Lorina Bisharat \n\n\n\nPublisher:    \n\n\n\nMalaysian Pharmacists Society  \n\n\n\n16-2 Jalan OP 1/5, 1-Puchong Business Park  \n\n\n\nOff Jalan Puchong  \n\n\n\n47160 Puchong, Malaysia  \n\n\n\nTel: 6-03-80791861  \n\n\n\nFax: 6-03-80700388  \n\n\n\nHomepage: www.mps.org.my  \n\n\n\nEmail: maljpharm@gmail.com  \n\n\n\n\n\n\n\nThe Malaysian Journal of Pharmacy is a publication of the Malaysian Pharmacists Society. Enquiries are to be \n\n\n\ndirected to the publisher at the above address. The Publisher reserves copy- right and renewal on all published \n\n\n\nmaterials, and such material may not be reproduced in any form without the written permission of the Publisher. \n\u00a9 Malaysian Journal of Pharmacy \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Volume 8 Issue 2 Dec 2022 \n \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\n\n\n\n\nTable of Content \n\n\n\n \nEditorial  \n\n\n\n\n\n\n\nThe Paradigm shift of Pharmacy Profession at Post-COVID-19 Era in \n\n\n\nMalaysia \nLong Chiau Ming, Siok Yee Chan* \n\n\n\niii-v \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nOriginal Research Articles   \n\n\n\n\n\n\n\nSystematic Review of Population Pharmacokinetic Models of Isoniazid in \n\n\n\nChildren and Adults with Tuberculosis   \nWen Rui Tan, Siti Maisharah Sheikh Ghadzi, Irfhan Ali Hyder Ali, Sabariah Noor Harun* \n\n\n\n1-15 \n\n\n\n\n\n\n\nEvaluation of the Impact of Clinical Pharmacists\u2019 Educational Intervention on \n\n\n\nthe Knowledge of Patients with Chronic Kidney Disease   \nIbrahim Ummate, John David Ohieku, Sani Ibn Yakubu, Maxwell Ogochukwu Adibe, \n\n\n\nRoland Nnaemeka Okoro* \n\n\n\n16-26 \n\n\n\n\n\n\n\nAn Evaluation of Medication Adherence to Tyrosine Kinase Inhibitors Among \n\n\n\nChronic Myeloid Leukemia Patients Underwent Medication Therapy \n\n\n\nAdherence Clinic in a Malaysian Tertiary Hospital \nStephanie Wai Yee Tan*, Sarah Anne Robert, Lay Yen Gan, Suet Yin Chin, Chee Lan Lau, \n\n\n\nAisya Nabilah Abd Rahman, Kiew Bing Pau, Shue Hong Kong, Farah Waheeda Tajurudin, \n\n\n\nMei Kuen Yin, Sheah Lin Ghan, Nur Jannah Azman, Pooi Wan Mok, Xin Yun Chua, Poy \n\n\n\nKei Lye, Rozita Mohd Idris, Nur Liyana Saharudin, Dexter Van Dort \n\n\n\n27-31 \n\n\n\n\n\n\n\nCyclosporine use in post haematopoietic stem cell transplant: Factors affecting \n\n\n\nthe initial cyclosporine concentration and its association with acute graft-\n\n\n\nversus-host-disease \nChoi Jing Herng*, Nur Azrina Binti Muhamad Moosa , Suuria A/P Subramaniam , Lim V \n\n\n\nCo, Io Shir Hwa \n\n\n\n32-38 \n\n\n\n\n\n\n\n i \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Volume 8 Issue 2 Dec 2022 \n \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\n\n\n\n\nRetracted 39-46 \n\n\n\n\n\n\n\nSupplementary  \n\n\n\n\n\n\n\nProceedings of 28th Federation of Asian Pharmaceutical Associations, MPS-\n\n\n\nNational Pharmacists Convention 2022 \nEditors: Siok Yee Chan, Chun Wai Mai, Siew Siang Chua, Siew Hua Gan, Mohamad Haniki \n\n\n\nbin Nik Mohamed, Mohd Zulkefeli bin Mat Jusoh, Mohd bin Makmor Bakry, Paraidathathu \n\n\n\nThomas A/L P.G. Thomas \n\n\n\n47-139 \n\n\n\n\n\n\n\nProceedings of 1st International Postgraduates Conference of Pharmaceutical \n\n\n\nand Health Sciences (IPCPHS) 2022 \nEditors: Reem Abou Assi, Ibrahim M Abdulbaqi, Mohammed Zawiah, Siok Yee Chan, \n\n\n\nNurzalina Abdul Karim Khan, Amer Hayat Khan \n\n\n\n140-181 \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \nii \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Volume 8 Issue 2 (2022) \n \n\n\n\n\n\n\n\n\n\n\n\niii \n\n\n\n\n\n\n\n*Correspondence: chiaumingl@sunway.edu.my / \n\n\n\nsychan@usm.my  \n\n\n\nDOI: 10.52494/TIOG4999 \n\n\n\n1School of Medical and Life Sciences, Sunway University, Sunway City \n\n\n\n47500, Malaysia  \n2School of Pharmaceutical Sciences Universiti Sains Malaysia, Minden \n\n\n\n11800, Malaysia  \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n Editorial \n\n\n\n\n\n\n\nThe Paradigm shift of Pharmacy Profession at Post-COVID-19 \n\n\n\nEra in Malaysia \n\n\n\n\n\n\n\nLong Chiau Ming1, Siok Yee Chan2 \n\n\n\n \nMalaysia currently has a total 19,260 registered pharmacists with active practising certificate which is regulated by the Pharmacy \n\n\n\nBoard of Malaysia and relevant pharmacy laws and regulations. In tandem with the evolvement of medicine, pharmacists are \n\n\n\nresponsible for ensuring the safe and effective use of medications [1, 2], and they play a key role in providing healthcare to the \n\n\n\npublic as a frontliner, educator and clinician [3-8]. For instance, in community pharmacies, pharmacists dispense prescription and \n\n\n\nover-the-counter medications, compound extemporaneous preparation [9-11], provide medication, immunization, travel medicine \n\n\n\nand disease advice to patients [12-15], and offer other value added services such as medication adherence tool, blood pressure and \n\n\n\nblood glucose monitoring [16-18]. It is worth noting that with the implementation of Regulation 23 of Poison Regulation as early \n\n\n\nas year 1952, dispensing separation have been fully implemented in all public hospitals whereby all supply of medications should \n\n\n\nbe solely on prescription and the supply to be recorded, labelled and dispensed at the pharmacy. With medication dispensing as the \n\n\n\ncore professional duties, hospital pharmacists are also responsible for the procurement, storage, and distribution of medications, as \n\n\n\nwell as the preparation of radioactive diagnostic, cytotoxic drug and sterile products [5]. They also actively involved in patient \n\n\n\ncare, such as pharmacokinetics, pharmacotherapy services, medication therapy adherence clinic, medication reconciliation, \n\n\n\nreviewing medication orders and providing drug and poison information to healthcare professionals [19, 20]. \n\n\n\n\n\n\n\nDuring the pandemic, due to the urgency and need of volunteer in national vaccination program, pharmacists have been involved \n\n\n\nas COVID-19 frontliner [21, 22]. They spearheaded not just the procurement, storage and logistic coordination but also clinical \n\n\n\npharmacotherapy in ward and health screening prior to COVID-19 immunization [23-25]. At the same time in term of emergency \n\n\n\nand disaster relief work such as floods, pharmacists have quickly risen to the occasion and forged ahead beyond the pharmacy \n\n\n\ncurriculum to champion healthcare delivery. Efforts on the ground include training and certification of immunisation for \n\n\n\npharmacists, curriculum design of vaccination and disaster preparedness [26], travel medicine [27] volunteerism module to be \n\n\n\nembedded in the pharmacy curriculum in cultivating the initiative and preparedness. There are various ongoing and planned \n\n\n\ninitiatives at individual or team basis such as food bank, mental health social enterprises, silence volunteerism, as well as the \n\n\n\ndispensing separation discourse that could transform the healthcare system of the nation.  \n\n\n\n\n\n\n\nAs technology and the internet of things have proved the urgent need for digital health integration into our healthcare system, there \n\n\n\nhave been commendable efforts to push for electronic/digital prescriptions, which could enable big data to demonstrate the \n\n\n\nimportance of the role of pharmacists in validating the dispensing process. This is in line with the amendment of Poisons Act 1952, \n\n\n\nPoisons (Amendment) Bill 2022) that was approved by Malaysian Parliament in July 2022 [28, 29] that incorporated virtual and \n\n\n\nonline transaction such as electronic prescriptions and online pharmacy. The evolving roles of pharmacists in digital health pose \n\n\n\nboth challenges and opportunities that they face in this rapidly changing environment. \n\n\n\n\n\n\n\nFollowing this digitalisation as success of several online medical consultation portals, pharmacists are being called upon to leverage \n\n\n\ntheir expertise in medication management to help patients navigate the complex landscape of digital health tools [30, 31]. This \n\n\n\nincludes providing support and guidance on the safe and effective use of medications and collaborating with other healthcare \n\n\n\nproviders to ensure the best possible outcomes for patients [32, 33]. One key area where pharmacists can add value in digital health \n\n\n\nis in the management of chronic conditions and infectious disease such as COVID-19. These diseases, such as asthma, diabetes, \n\n\n\nand hypertension, require careful pharmacotherapy services in order to minimise its complications. Pharmacists can use digital \n\n\n\nhealth tools, such as telemedicine platforms and mobile apps, to provide ongoing support and guidance especially to paediatric and \n\n\n\n\nmailto:chiaumingl@sunway.edu.my\n\n\nmailto:sychan@usm.my\n\n\n\n\n\n\nLong and Chan Mal J Pharm 8 (2) 2022, iii-v \n\n\n\n\n\n\n\niv \n\n\n\n\n\n\n\nolder patients, helping them to better manage their health and avoid hospitalisation. Pharmacists can also play a key role in helping \n\n\n\npatients to navigate the complex landscape of digital health tools. With so many different apps and medical devices available, it \n\n\n\ncan be difficult for patients to know which ones are safe and effective. Pharmacists can provide guidance on the selection and use \n\n\n\nof these tools, helping patients to make informed decisions about their healthcare [32, 34-38]. \n\n\n\n\n\n\n\nDriven by the post-pandemic need of sustainability and flexibility, the integration of digital health technologies into the healthcare \n\n\n\nsystem is here to stay. In fact, the transition to virtual healthcare helps pharmacists to leverage their expertise in digital health. For \n\n\n\nexample, pharmacists can work with healthcare organizations and technology companies to develop new digital health tools and \n\n\n\nservices that meet the needs of patients and providers. Several online pharmacy spin-off from the local brick and mortar pharmacies \n\n\n\nhave become a viable healthcare business model.  Meanwhile, pharmacists can also spearheading the digital transformation by \n\n\n\ncombining both data science and digital health tools to carve out the competitive advantage of pharmacy in digital health.  \n\n\n\n\n\n\n\nTo maintain the competitive advantage, the whole pharmacy team need to stay up-to-date with the latest digital health technologies \n\n\n\nas this field evolve at a rapid pace. With hindsight, pharmacist associations should continue playing proactive roles to offer \n\n\n\nContinuing Professional Education (a.k.a. CPE) training related to information technology and digital science. The expansion of \n\n\n\npharmacists' roles into infection control and the integration of digital health technologies into the healthcare system present both \n\n\n\nchallenges and opportunities. In fact, we are now standing on the shoulders of senior pharmacists giants that adapted successfully \n\n\n\nto the advent of computerisation in the 1980s, the current generation of pharmacists must remain steadfast and stay current with \n\n\n\nthe latest technologies to develop data science competencies to be effective in the digital health ecosystem. \n\n\n\n\n\n\n\n\n\n\n\nREFERENCES \n \n[1] Mahmud, A.; Hashim, H.; Hing, L. W.; Yoong, L. P.; Yusof, N. M.; Bun, T. Y., Public awareness of community pharmacy and pharmacist. Malaysian \n\n\n\nJournal of Pharmacy (MJP) 2001, 1, (1), 22-28. https://doi.org/10.52494/QVBX2853  \n\n\n\n[2] Sing, W. S., Pharmacy practice in Malaysia. Malaysian Journal of Pharmacy (MJP) 2001, 1, (1), 2-8. https://doi.org/10.52494/RCWN2182  \n\n\n\n[3] Hussin, A. H., Adverse effects of herbs and drug-herbal interactions. Malaysian Journal of Pharmacy (MJP) 2002, 1, (2), 39-44. \nhttp://dx.doi.org/10.52494/CGMK2164  \n\n\n\n[4] Ahmad, A., Managing cytotoxic drugs. Malaysian Journal of Pharmacy (MJP) 2003, 1, (3), 63-68. http://dx.doi.org/10.52494/BWLZ9208  \n\n\n\n[5] Shamsuddin, A. F., Brief history and development of parenteral nutrition support. Malaysian Journal of Pharmacy (MJP) 2003, 1, (3), 69-75. \nhttp://dx.doi.org/10.52494/VIPX1100  \n\n\n\n[6] Siang, C. S.; Ni, K. M.; bin Ramli, M. N., Outpatient prescription intervention activities by pharmacists in a teaching hospital. Malaysian Journal of \n\n\n\nPharmacy 2003, 1, (3), 86. http://dx.doi.org/10.52494/HJPB1043  \n\n\n\n[7] Rugayah, B.; Noormah, M.; Mohamed, M.; Shahnaz, S., Assessment of Malaysian Clinical Practice Guidelines. Journal: Malaysian Journal of Pharmacy \n\n\n\n2012, (10), 1-14. http://dx.doi.org/10.52494/FUNL2762  \n\n\n\n[8] Tan, C. S., The need of patient education to improve medication adherence among hypertensive patients. 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Journal of Pharmaceutical Policy and Practice 2022, 15, (1), 1-8. https://doi.org/10.1186/s40545-022-00478-0  \n\n\n\n[27] Bhuvan, K.; Khan, T. M.; Xuan, W. Y.; Alrasheedy, A. A.; Ibrahim, M. I. M.; Leggat, P. A., Travel health-related activities and services provided by \n\n\n\ncommunity pharmacies in Selangor, Malaysia: A cross-sectional analysis. Travel medicine and infectious disease 2020, 33, 101463. \nhttps://doi.org/10.1016/j.tmaid.2019.07.019  \n\n\n\n[28] Lee, K. S.; Lim, Y. W.; Ming, L. C., The fate of the new pharmacy bill: going backwards or forwards? Journal of pharmaceutical policy and practice 2016, \n\n\n\n9, (1), 1-4. https://doi.org/10.1186/s40545-016-0081-7  \n\n\n\n[29] Lee, K. S.; Lim, Y. W.; Ming, L. C., Can the New Pharmacy Bill safeguard patient's right in healthcare? Current Medicine Research and Practice 2016, 6, \n\n\n\n(4), 167-168. http://dx.doi.org/10.1016/j.cmrp.2016.07.004  \n\n\n\n[30] Elangovan, D.; Long, C. S.; Bakrin, F. S.; Tan, C. S.; Goh, K. W.; Hussain, Z.; Al-Worafi, Y. M.; Lee, K. S.; Kassab, Y. W.; Ming, L. C., Application of \n\n\n\nBlockchain Technology in Hospital Information System. In Mathematical Modeling and Soft Computing in Epidemiology, 2020; Vol. 28, pp 231-46. \nhttps://www.taylorfrancis.com/chapters/edit/10.1201/9781003038399-12  \n\n\n\n[31] Elangovan, D.; Long, C. S.; Bakrin, F. S.; Tan, C. S.; Goh, K. W.; Yeoh, S. F.; Loy, M. J.; Hussain, Z.; Lee, K. S.; Idris, A. C., The Use of Blockchain \n\n\n\nTechnology in the Health Care Sector: Systematic Review. JMIR medical informatics 2022, 10, (1), e17278. https://doi.org/10.2196/17278  \n\n\n\n[32] Ming, L. C.; Hameed, M. A.; Lee, D. D.; Apidi, N. A.; Lai, P. S. M.; Hadi, M. A.; Al-Worafi, Y. M. A.; Khan, T. M., Use of Medical Mobile Applications \n\n\n\nAmong Hospital Pharmacists in Malaysia. Ther Innov Regul Sci 2016, 50, (4), 419-426. https://doi.org/10.1177/2168479015624732  \n\n\n\n[33] Park, T.; Kim, H.; Song, S.; Griggs, S. K., Economic Evaluation of Pharmacist-Led Digital Health Interventions: A Systematic Review. Int J Environ Res \n\n\n\nPublic Health 2022, 19, (19). https://doi.org/10.3390/ijerph191911996  \n\n\n\n[34] Loy, M. J.; Goh, K. W.; Osili, N.; Ming, L. C.; Dhaliwal, J. S.; Hermansyah, A.; Al-Worafi, Y. M.; Lee, K. S., Features and Functionalities of Medical \n\n\n\nMobile Applications for the Endemic Phase of COVID\u201019: Review and Content Analysis. Progress In Microbes & Molecular Biology 2022, 5, (1). \nhttps://doi.org/a10.36877/pmmb.0000285  \n\n\n\n[35] Ming, L. C.; Untong, N.; Aliudin, N. A.; Osili, N.; Kifli, N.; Tan, C. S.; Goh, K. W.; Ng, P. W.; Al-Worafi, Y. M.; Lee, K. S.; Goh, H. P., Mobile Health \n\n\n\nApps on COVID-19 Launched in the Early Days of the Pandemic: Content Analysis and Review. JMIR Mhealth Uhealth 2020, 8, (9), e19796. \nhttps://doi.org/10.2196/19796  \n\n\n\n[36] Morse, S. S.; Murugiah, M. K.; Soh, Y. C.; Wong, T. W.; Ming, L. 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Ther Innov Regul Sci 2017, 51, (4), 480-485. \nhttps://doi.org/10.1177/2168479017696266  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\nhttp://dx.doi.org/10.52494/JEGX6828\n\n\nhttp://dx.doi.org/10.52494/MWHH2973\n\n\nhttps://doi.org/10.1186/s40545-021-00322-x\n\n\nhttp://dx.doi.org/10.52494/VHSZ7452\n\n\nhttp://dx.doi.org/10.52494/FVTA3688\n\n\nhttps://doi.org/10.1186/s40545-022-00478-0\n\n\nhttps://doi.org/10.1016/j.tmaid.2019.07.019\n\n\nhttps://doi.org/10.1186/s40545-016-0081-7\n\n\nhttp://dx.doi.org/10.1016/j.cmrp.2016.07.004\n\n\nhttps://www.taylorfrancis.com/chapters/edit/10.1201/9781003038399-12\n\n\nhttps://doi.org/10.2196/17278\n\n\nhttps://doi.org/10.1177/2168479015624732\n\n\nhttps://doi.org/10.3390/ijerph191911996\n\n\nhttps://doi.org/a10.36877/pmmb.0000285\n\n\nhttps://doi.org/10.2196/19796\n\n\nhttps://doi.org/10.1177/2168479017725557\n\n\nhttps://doi.org/10.3389/fendo.2017.00318\n\n\nhttps://doi.org/10.1177/2168479017696266\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Volume 8 Issue 2 (2022) \n \n\n\n\n\n\n\n\n1 \n\n\n\n\n\n\n\n*Correspondence: sabariahnoor@usm.my \n\n\n\nDOI:10.52494/DJIQ7058 \n\n\n\n1School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 \n\n\n\nUSM, Penang, Malaysia. \n2Respiratory Department, Penang General Hospital, 10990 George Town, \n\n\n\nPenang. \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n Original Research Article \n\n\n\n\n\n\n\nSystematic Review of Population Pharmacokinetic Models of \n\n\n\nIsoniazid in Children and Adults with Tuberculosis   \n \n\n\n\nWen Rui Tan1, Siti Maisharah Sheikh Ghadzi1, Irfhan Ali Hyder Ali 2, Sabariah Noor Harun1* \n\n\n\n\n\n\n\n \nArticle Info  \n\n\n\n \nReceived date: 07 Jun 2022  \n\n\n\nAccepted date: 19 Oct 2022 \n\n\n\nPublished date: 31 Dec 2022 \n\n\n\n\n\n\n\nKeywords: Population \n\n\n\nPharmacokinetics, Isoniazid, \n\n\n\nTuberculosis, Pharmacokinetic. \n\n\n\nABSTRACT  \n\n\n\n\n\n\n\nIntroduction:  Isoniazid (INH) is one of the first-line anti-tuberculosis (anti-TB) drugs that have \n\n\n\nboth bactericidal and bacteriostatic properties depending on the rate of mycobacterial growth. Several \n\n\n\npopulation pharmacokinetic (PPK) models of INH were established. This systemic review aims to \n\n\n\nsummarise published PPK parameters of INH in the models and to identify covariates influencing \n\n\n\nthe INH pharmacokinetic parameters of models. Method: A search of publications for PPK analyses \n\n\n\nof INH in volunteers or TB patients from 2011 to 2021 was conducted in PubMed and Scopus \n\n\n\ndatabases. Reviews, methodology articles, non-compartmental analysis, in vitro, and animal studies \n\n\n\nwere excluded. Result: Twelve studies were included in this review. Most of the included studies \n\n\n\ndescribed the pharmacokinetics of INH as two-compartmental with first-order absorption and \n\n\n\nelimination in most of the included studies. Eleven studies reported N-acetyltransferase 2 (NAT2) \n\n\n\ngenotype polymorphism as the most common significant covariate affecting the pharmacokinetic \n\n\n\nparameters of INH. Other common significant covariates reported include body weight (n = 2) and \n\n\n\nbody mass index (BMI) (n = 1). Conclusion: The variability of population clearance parameters of \n\n\n\nINH was explained mainly by the NAT2 genotype polymorphism. This indicates that to optimise and \n\n\n\nrationalise the dosing regimen of INH, a patient\u2019s NAT2 genotype should be considered. At the same \n\n\n\ntime, body weight and BMI values should be considered when making dosing adjustments for INH \n\n\n\nto achieve the therapeutic range. \n\n\n\n\n\n\n\nINTRODUCTION  \n  \n\n\n\nIsoniazid (INH) is a prodrug that kills the mycobacterial cell via \n\n\n\na passive diffusion mechanism [1]. Isoniazid is activated by the \n\n\n\nmycobacterial catalase-peroxidase enzyme (KatG) [2], a \n\n\n\nmultifunctional catalase-peroxidase that has other activities, \n\n\n\nincluding peroxynitrite and nicotinamide adenine dinucleotide \n\n\n\n(NADH) oxidase [3]. Due to its high effectiveness and \n\n\n\naffordability, INH is one of the two primary, first-line TB drugs, \n\n\n\nalong with rifampicin (RIF).  \n\n\n\n\n\n\n\nMultidrug-resistant TB (MDR-TB) is simultaneous resistance \n\n\n\nto INH and RIF. Despite, proven drug susceptibility at baseline, \n\n\n\nMDR-TB is still not uncommon. Non-compliance to anti-TB \n\n\n\ntherapy is believed to be associated with MDR-TB and \n\n\n\ntreatment failure emergence, which led to the implementation \n\n\n\nof the directly observed therapy-short-course strategy (DOTs), \n\n\n\nor currently, video observed therapy (VOT). The World Health \n\n\n\nOrganization (WHO) has called the DOTs the most essential \n\n\n\nhealth breakthrough of past decades [4,5]. In addition, the \n\n\n\ndevelopment of a fixed-dose combination (FDC) regimen was \n\n\n\nalso reported to enhance drug compliance among patients with \n\n\n\nTB [4]. However, a study by Srivastava et al. [4] reported a \n\n\n\nsurprising finding which showed that acquired MDR-TB was \n\n\n\nrelated to variability in drug exposure and not to non-\n\n\n\ncompliance. Previous studies have shown that low plasma anti-\n\n\n\nTB drug concentrations may result in treatment failure [6-8] and \n\n\n\nlow plasma concentrations of RIF and INH have been \n\n\n\nassociated with MDR-TB [8]. High variability in \n\n\n\npharmacokinetic (PK) parameters of the first-line anti-TB drugs \n\n\n\nhave been reported with factors such as age, sex, human \n\n\n\nimmunodeficiency virus (HIV) co-infection, and antiretroviral \n\n\n\ntreatment (ART) possibly affecting TB drug concentrations [9]. \n\n\n\nReduced blood concentrations of anti-TBs were demonstrated \n\n\n\n\nmailto:sabariahnoor@usm.my\n\n\n\n\n\n\nTan W. R. et al.                            Mal J Pharm 8 (2) 2022, 1-15 \n\n\n\n\n\n\n\n\n\n\n\n2 \n\n\n\n\n\n\n\nin HIV-infected men or HIV-infected patients who are \n\n\n\nunderweight [9]. Other factors such as diabetes and drug-drug \n\n\n\ninteraction have been shown to affect the PK parameters of first-\n\n\n\nline anti-TB agents [10]. Malnutrition is also reported to affect \n\n\n\ndrug exposure by decreasing total clearance and increasing the \n\n\n\nplasma half-life of anti-TBs [11]. Thus, therapeutic drug \n\n\n\nmonitoring of INH is clinically relevant due to the high \n\n\n\nvariability of INH concentrations [12] and incorporating the \n\n\n\nsignificant covariates influencing the PK of INH to achieve an \n\n\n\noptimal INH concentration is paramount. \n\n\n\n\n\n\n\nConventional clinical practice guidelines recommend dosing \n\n\n\nanti-TB drugs according to ideal body weight and providing \n\n\n\ndosing caps for most first-line agents [13]. However, this \n\n\n\nrecommendation may be placing obese patients with TB at risk \n\n\n\nas increased total body weight is associated with an increased \n\n\n\nrisk of clinical failure [12].  \n\n\n\n\n\n\n\nPopulation pharmacokinetic (PPK) modelling is broadly used to \n\n\n\ndistinguish the pharmacokinetic parameters of a population and \n\n\n\ninvestigate the covariates that contribute to pharmacokinetic \n\n\n\nvariability [14]. Nonlinear mixed-effects modelling is viewed \n\n\n\nby many as the optimum population modelling method \n\n\n\ncurrently. The \u201ceffects\u201d are factors that contribute to the \n\n\n\nvariability of the measured observations and are of two types: \n\n\n\nfixed and random. Fixed effects are the parameters that define \n\n\n\nthe structural PK model while the random effects are described \n\n\n\nas random interpatient variability (covariates) and residual \n\n\n\nrandom error [15].  \n\n\n\n\n\n\n\nExtensive reviews elucidating the PK characteristics of INH \n\n\n\nhave been reported elsewhere [16, 17]. However, a systematic \n\n\n\nreview of the PPK models of INH is still lacking. Analysing and \n\n\n\nunderstanding the significant covariates and their relationship in \n\n\n\ndifferent patient populations is critical for appropriate regimens \n\n\n\nfor individualised therapy. This review aims to compare \n\n\n\npublished population pharmacokinetic (PPK) models of INH \n\n\n\nand to summarise and explore identified covariates influencing \n\n\n\nthe INH PK models.  \n\n\n\n\n\n\n\nMETHOD  \n \n\n\n\nSearch Strategy  \n\n\n\n\n\n\n\nData for this review were identified by a systematic review of \n\n\n\npublications listed in PubMed databases from inception to \n\n\n\nSeptember 2021 following the principles of the Preferred \n\n\n\nReporting Items for Systematic Reviews and Meta-analyses \n\n\n\n(PRISMA) statement [22]. The search terms used include the \n\n\n\nfollowing: \u201cisoniazid\u201d AND (\u201cpopulation pharmacokinetics\u201d \n\n\n\nOR \u201cpharmacometrics\u201d OR \u201cpharmacokinetic model\u201d OR \n\n\n\n\u201cPopPK\u201d OR \u201cpop PK\u201d OR \u201cPPK\u201d OR \u201cnonlinear mixed \n\n\n\neffects model\u201d OR \u201cNONMEM\u201d OR \u201cMONOLIX\u201d OR \n\n\n\n\u201cPmetrics\u201d OR \u201cNLME\u201d). Additional publications were \n\n\n\nidentified by reviewing study reference lists and consulting \n\n\n\nexpert review articles identified through the search. \n\n\n\n\n\n\n\nInclusion/Exclusion Criteria \n\n\n\n\n\n\n\nAll relevant articles selected from the databases and reference \n\n\n\nlists were screened to evaluate their eligibility for inclusion \n\n\n\naccording to specific criteria. The inclusion of studies was based \n\n\n\non original studies describing PPK models for INH in healthy \n\n\n\nvolunteers or patients from infants to adults and the target \n\n\n\npopulation was human. Extrapulmonary TB like tuberculous \n\n\n\nmeningitis is also included in the study, but only the recorded \n\n\n\nplasma concentrations of INH were included in this review and \n\n\n\nnot the concentrations at the other site. Reviews, methodology \n\n\n\narticles, in vitro and animal studies, and studies that used a \n\n\n\npreviously described PK model and those that involved \n\n\n\nnoncompartmental analysis were excluded. PPK analysis was \n\n\n\nperformed in the study, and only the study published in English \n\n\n\nwas selected.  \n\n\n\n\n\n\n\nData Extraction \n\n\n\n\n\n\n\nThe variables that were retrieved from the identified studies \n\n\n\ninclude first author, publication year, country, number of \n\n\n\nsubjects, subject characteristics (age, sex, weight, and \n\n\n\npathology), INH dose, INH, and AcINH levels, sampling \n\n\n\nschedule, and assay method, number of observations, \n\n\n\nobservations per patient, data source, software used for \n\n\n\nmodelling, structural and statistical model, tested and \n\n\n\nstatistically significant covariates, and model validation which \n\n\n\nwas further classified based on the increasing order of quality \n\n\n\ninto three types: basic internal, advanced internal, and external \n\n\n\nmodel validation.  \n\n\n\n\n\n\n\nRESULT  \n \n\n\n\nStudy Identification  \n\n\n\n\n\n\n\nThe initial search strategy identified 107 potentially relevant \n\n\n\narticles, of which 106 remained after duplicates, and review-\n\n\n\ntype articles were removed. After abstract and title scanning \n\n\n\nfor 106 articles, 14 articles were retained for final evaluation. \n\n\n\nA total of 12 studies published between 2013 and 2021 were \n\n\n\nincluded in this review in the final decision, as demonstrated \n\n\n\nin Figure I. Study characteristics of the included publications, \n\n\n\nsamples, and concentrations are summarised in Table I. The \n\n\n\nnumber of study participants varied from 33 to 466, totalling \n\n\n\n1,444 patients in all 12 publications with reported ages ranging \n\n\n\nfrom 0 to 72 years. Only four of the studies included subjects \n\n\n\naged less than 18 years old. Seven studies present data on adult \n\n\n\npatients with pulmonary TB and one study was conducted on \n\n\n\nadult volunteers. \n\n\n\n\n\n\n\n\nTan W. R. et al.                            Mal J Pharm 8 (2) 2022, 1-15 \n\n\n\n\n\n\n\n\n\n\n\n3 \n\n\n\n\n\n\n\nThe assay used to measure INH concentrations \n\n\n\n\n\n\n\nLiquid chromatography with tandem mass spectrometry (LC-\n\n\n\nMS/MS) or high-performance liquid chromatography (HPLC) \n\n\n\nwas used to determine the serum levels of INH and AcINH in \n\n\n\nall studies except one study [18] where spectrocolorimetric was \n\n\n\nused instead. The number of concentration readings ranged \n\n\n\nfrom 195 to 2546. The daily dose was reported in 11 studies. 4 \n\n\n\nstudies were reported in mg/kg, 7 studies reported the dosing in \n\n\n\nmg, and one reported in mg/dose. \n\n\n\nStudy Design \n\n\n\n\n\n\n\nMost PPK studies were performed on patients with pulmonary \n\n\n\nTB, and only one study by Seng et al. [19] engaged healthy \n\n\n\nadults. Four studies included infants and children or paediatrics \n\n\n\n[20-23], and eight studies only enrolled adults [18,19,24-29]. \n\n\n\nSubjects in all included studies were administered INH orally; \n\n\n\n1-12 samples were collected per individual. The sampling time \n\n\n\npoints ranged from 0 (pre-dose) to 24 h post-dosing. The \n\n\n\ndetailed characteristics of all studies are listed in Table I. \n\n\n\n\n\n\n\nModelling Approach \n\n\n\n\n\n\n\nAll twelve PPK analyses were conducted using population \n\n\n\nmodelling software, including NONMEM (Icon plc, Dublin, \n\n\n\nIreland), Phoenix NLME, Monolix (Lixoft, Antony, France), \n\n\n\nand Pmetrics. The most used algorithm was first-order \n\n\n\nconditional estimation with interaction. \n\n\n\n\n\n\n\nStructural Model \n\n\n\n\n\n\n\nThe final PK parameter estimates in each study are summarised \n\n\n\nin Table II. A study by Fredj et al. [18] and Aruldhas et al. [23] \n\n\n\ndescribed the INH structural model as a one-compartment \n\n\n\nmodel disposition model with first-order absorption and transit \n\n\n\ntime (MTT) absorption model, respectively. Of the twelve \n\n\n\nstudies, ten studies described PPK of INH as a two-\n\n\n\ncompartment model, with five studies [19,20,25,28] describing \n\n\n\nfirst-order absorption and elimination. Three studies described \n\n\n\nthe absorption model with MTT [21,22,29]. While the study by \n\n\n\nRao et al. [24] and Naidoo et al. [26] described the absorption \n\n\n\nmodel with a lag time (Table II).  \n\n\n\n\n\n\n\nThe reported mean clearance (CL) from all the studies was \n\n\n\n20.55 L/h (SD = 16.60), and the range of the CL was between \n\n\n\n5.19 to 28.77 L/h. The reported mean central volume of \n\n\n\ndistribution (Vcentral) was 26.63 L (SD = 23.53), with a range \n\n\n\nfrom 1.5 to 73.4 L. The reported mean MTT was 0.66 h (SD = \n\n\n\n0.34), with a range from 0.179 to 0.924 h (Table II). \n\n\n\n\n\n\n\nChildren vs Adults \n\n\n\n\n\n\n\nThere were four PPK studies conducted on children, and the \n\n\n\nother eight articles were conducted on adults. Three studies \n\n\n\ninvolved HIV children [22,24,29]. The estimated median CL for \n\n\n\nchildren was 6.5 (range = 4.44-11.3) L/h and was lower than CL \n\n\n\nin adults at 22.8 L/h (range = 11.4-40.5 L/h). Moreover, the \n\n\n\nmedian Vcentral in children was lower than that in adults. The \n\n\n\ndetermined median Vd was 16.69 (range = 3.78-29.7) L/kg for \n\n\n\nchildren and 29.7 (range = 1.5-73.4) L/kg for adults.  \n\n\n\n\n\n\n\nCovariates model \n\n\n\n\n\n\n\nThe covariates investigated and identified in each study are \n\n\n\nshown in Figure III. Twenty-nine covariates have been \n\n\n\ninvestigated in the twelve studies, and five significant covariates \n\n\n\nhave been identified using a stepwise covariate modelling \n\n\n\napproach. There were three covariates reported significantly \n\n\n\naffecting the CL of INH in the included studies, which include \n\n\n\nNAT2 polymorphism (n = 11), creatinine clearance (n = 1), and \n\n\n\nbody mass index (BMI) (n = 1). Creatinine clearance in the \n\n\n\nstudy, where it was the significant covariate was estimated by \n\n\n\nusing the Cockcroft and Gault equation with total body weight \n\n\n\n[19]. While middle-upper arm circumference (MUAC) (n = 1), \n\n\n\nbody weight (n = 2) and body mass index (BMI) (n = 1) \n\n\n\nsignificantly explained the variability in Vcentral.  Figure IV \n\n\n\nshows a comparison of mean CL as an effect of NAT2 \n\n\n\npolymorphism between studies.\n\n\n\nFigure I: The selection process of the studies included in the systematic \n\n\n\nreview \n\n\n\n\n\n\n\n\nTan W. R. et al.                                                   Mal J Pharm 8 (2) 2022 , 1-15 , XX-XX \n\n\n\n\n\n\n\n4 \n\n\n\n\n\n\n\nTable I: Studies population characteristics, samples, and concentrations \n\n\n\n\n\n\n\nStudy \nN  \n\n\n\n(male/female) \nSample/subject \n\n\n\nTotal \n\n\n\nsample \nAge \n\n\n\nBody \n\n\n\nweight \n\n\n\n(kg) \n\n\n\nSite \nSubject \n\n\n\ncharacteristics \nDose \n\n\n\nSampling \n\n\n\ntime (h) \n\n\n\nIsoniazid \n\n\n\nconcentration \n\n\n\nAcetyl isoniazid \n\n\n\nconcentration \n\n\n\nHorita et al.,  \n\n\n\n2018 [20] \n\n\n\n113  \n\n\n\n(63/59) \n5 565 \n\n\n\n5  \n\n\n\n(2.17-\n\n\n\n8.25) \n\n\n\n14.3 \n\n\n\n(9.7-\n\n\n\n20.1) \n\n\n\nUS \nTuberculosis, \n\n\n\nChildren \n\n\n\n10.99 mg/kg  \n\n\n\n(9.06-12.8) \n0, 1, 2, 4, 8 \n\n\n\nCmax =  \n\n\n\n5.70 \u00b5g/mL \nNA \n\n\n\n\n\n\n\nRao et al.,  \n\n\n\n2021 [24] \n\n\n\n81  \n\n\n\n(52/29) \n4 324 \n\n\n\n36  \n\n\n\n(30-3.5) \n\n\n\n52.5 \n\n\n\n(45.3-\n\n\n\n58) \n\n\n\nUS \nTuberculosis \n\n\n\nwith HIV \n\n\n\n300, 450, 600, 750, \n\n\n\n900 mg \n1, 2, 4, 6 \n\n\n\nCmax =  \n\n\n\n3.6 (2.3-4.6) \n\n\n\nmg/kg \n\n\n\nNA \n\n\n\n\n\n\n\nJing et al.,  \n\n\n\n2020 [25] \n\n\n\n89  \n\n\n\n(59/30) \n1-4 195 \n\n\n\n42.9  \n\n\n\n(16-72) \n\n\n\n60.1 \n\n\n\n(35-100) \nC Tuberculosis \n\n\n\n300 mg/dose  \n\n\n\n(300-600) \nWithin 0.5-6 \n\n\n\nCmax = \n\n\n\n3-6 \u00b5g/mL \nNA \n\n\n\n\n\n\n\nNaidoo et al.,  \n\n\n\n2019 [26] \n\n\n\n172 \n\n\n\n(119/53) \n4 573 \n\n\n\n35  \n\n\n\n(30-41) \n\n\n\n55.7 \n\n\n\n(50.3-\n\n\n\n62.1) \n\n\n\nA Tuberculosis \n\n\n\n225 mg  \n\n\n\n(below 55 kg),  \n\n\n\n300 mg  \n\n\n\n(above 55 kg) \n\n\n\n2.5, 5, 6, 24 \n\n\n\nCmax =  \n\n\n\n4.70 (3.93-5.98) \n\n\n\nmg/L \n\n\n\nNA \n\n\n\n\n\n\n\nZvada et al.,  \n\n\n\n2013 [21] \n\n\n\n76  \n\n\n\n(40/36) \n\n\n\nCohort 1:  \n\n\n\n0.75, 1.5, 3, 4, 6 \n\n\n\nCohort 2:  \n\n\n\n0.5, 1.5, 3,5 \n\n\n\n715 \n\n\n\n2.17  \n\n\n\n(0.417, \n\n\n\n10.7) \n\n\n\n10.5 \n\n\n\n(4.9, \n\n\n\n21.8) \n\n\n\nA Tuberculosis \n\n\n\n1st PK (mg/kg): \n\n\n\n5.03 (3.56, 12.1) \n\n\n\n2nd PK (mg/kg): \n\n\n\n9.77 (2.73, 13.3) \n\n\n\nCohort 1: \n\n\n\n0.75, 1.5, 3, 4, 6 \n\n\n\nCohort 2: \n\n\n\n0.5, 1.5, 3, 5 \n\n\n\nNA NA \n\n\n\n\n\n\n\nPanjasatwong et al.,  \n\n\n\n2021 [22] \n\n\n\n100  \n\n\n\n(56/44) \n2 523 \n\n\n\n3.0  \n\n\n\n(0.167-\n\n\n\n15) \n\n\n\n10.9 \n\n\n\n(4-4.3) \nV \n\n\n\nTuberculous \n\n\n\nmeningitis \n10 mg/kg \n\n\n\n2 of 10 possible time \n\n\n\npoints (i.e., 1, 2, 3, 4, 5, \n\n\n\n6, 8, 12, 18, or 24 h \n\n\n\nafter dose) \n\n\n\nCmax =  \n\n\n\n2.41 mg/L \nNA \n\n\n\n\n\n\n\nSeng et al.,  \n\n\n\n2015 [19] \n33 NA NA \n\n\n\n33  \n\n\n\n(22-56) \n\n\n\n62.5 \n\n\n\n(45.8-\n\n\n\n86.1) \n\n\n\nS Healthy Singapore \n\n\n\n0, 1, 2, 4, 6, 8, 10, 12, \n\n\n\n18, and 24 h after the \n\n\n\nfinal dose of INH \n\n\n\n3 mg/L \n\n\n\n< Cmax \n\n\n\n< 6 mg/L \n\n\n\nNA \n\n\n\n\n\n\n\nFredj et al., \n\n\n\n2021 [18] \n\n\n\n118  \n\n\n\n(39/79) \n2 \n\n\n\nINH \n\n\n\n:298 \n\n\n\n36.7  \n\n\n\n(5-77) \n\n\n\n62 \n\n\n\n(8.9-\n\n\n\n104) \n\n\n\nT1 Tuberculosis \n5, 10, 25 and 15 \n\n\n\nmg/kg \n3 h post-dose NA NA \n\n\n\n\n\n\n\nVan Beek et al.,  \n\n\n\n2021 [27] \n466 NA 2546 NA NA \n\n\n\nT2, \n\n\n\nI1, \n\n\n\nTN, \n\n\n\nSA \n\n\n\nTuberculosis NA NA \nCmax =  \n\n\n\n3.03 mg/L \nNA \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nTan W. R. et al.                                                   Mal J Pharm 8 (2) 2022 , 1-15 , XX-XX \n\n\n\n\n\n\n\n5 \n\n\n\n\n\n\n\nTable I: Studies population characteristics, samples, and concentrations (continued) \n\n\n\n\n\n\n\nStudy \nN \n\n\n\n(male/female) \nSample/subject \n\n\n\nTotal \n\n\n\nsample \nAge \n\n\n\nBody \n\n\n\nweight \n\n\n\n(kg) \n\n\n\nSite \nSubject \n\n\n\ncharacteristics \nDose \n\n\n\nSampling \n\n\n\ntime (h) \n\n\n\nIsoniazid \n\n\n\nconcentration \n\n\n\nAcetyl isoniazid \n\n\n\nconcentration \n\n\n\nHuerta-Garc\u00eda et al.,  \n\n\n\n2020 [28] \n\n\n\n55  \n\n\n\n(31/24) \n\n\n\nHospitalised: \n\n\n\n8-12 \n294 \n\n\n\n44.7  \n\n\n\n(18-72) \n\n\n\n56.6  \n\n\n\n(30-108) \nM Tuberculosis \n\n\n\n225 mg  \n\n\n\n(below 55 kg), \n\n\n\nHospitalised: 0, 20 min, \n\n\n\n40 min, 60 min, 1.5, 2, \n\n\n\n2.5, 3, 4, 6, 8 and 12 h \n\n\n\nOutpatient: 2, 4 h \n\n\n\nNA NA \n\n\n\n\n\n\n\nDenti et al.,  \n\n\n\n2015 [29] \n\n\n\n100  \n\n\n\n(58/42) \n3 574 \n\n\n\n35 \n\n\n\n(29-40) \n\n\n\n51.9  \n\n\n\n(48.3-\n\n\n\n57.3) \n\n\n\nT2 Tuberculosis \n\n\n\n225 mg  \n\n\n\n(below 50 kg),  \n\n\n\n300 mg  \n\n\n\n(above 50 kg) \n\n\n\n2, 4, 6 h post-dose \n\n\n\nSlow \n\n\n\nacetylator: 3.53 \n\n\n\nmg/L \n\n\n\nFast acetylator: \n\n\n\n3.03 mg/L \n\n\n\nNA \n\n\n\n\n\n\n\nAruldhas et al.,  \n\n\n\n2019 [23] \n\n\n\n41  \n\n\n\n(29/12) \n8 290 \n\n\n\n7  \n\n\n\n(3.5-13) \n\n\n\n19.5  \n\n\n\n(13.7-\n\n\n\n33.7) \n\n\n\nI2 Tuberculosis \n\n\n\n50 mg (4-7 kg),  \n\n\n\n100 mg (8-11 kg),  \n\n\n\n150 mg (12-15 kg),  \n\n\n\n200 mg (16-24 kg) \n\n\n\n0.5, 1, 1.5, 2, 2.5, 4 and \n\n\n\n6 h post-dose \n\n\n\nCmax =  \n\n\n\n5.90 mg/L \nNA \n\n\n\n\n\n\n\n\n\n\n\nCmax = maximum concentration; NA=Not applicable \n\n\n\nA = Africa; C = China; I1= Indonesia; I2 = India; M = Mexico; SA = South Africa; S = Singapore; T1 = Tunisia; T2 = Tanzania; TN = The Netherlands; US = United State; V = Vietnam \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nTable II: Model structure, pharmacokinetic parameters, and tested and retained covariates \n\n\n\n\n\n\n\nStudy Assay Software/Algorithm Structure \nFinal population pharmacokinetic \n\n\n\nparameters for Isoniazid \nAcetylisoniazid Covariates tested \n\n\n\nRetained \n\n\n\ncovariates in the \n\n\n\nfinal model \n\n\n\nHorita et al., \n\n\n\n2018 [20] \nLC-MS/MS \n\n\n\nMonolixSuite2016R1/\n\n\n\nFOCE-INTER \n\n\n\nTwo-compartment \n\n\n\nmodel with first-order \n\n\n\nabsorption and linear \n\n\n\nelimination \n\n\n\nKa (h\n-1) = 4.23 \n\n\n\nCL/Fslow (L/h) = 4.44 \n\n\n\nCL/Fnonslow (L/h) = 8.08 \n\n\n\nV1/F (L) = 16.6 \n\n\n\nQ/F (L/h) = 8.46 \n\n\n\nV2/F (L) = 1.07 \n\n\n\nNA \n\n\n\nNAT2 genotype polymorphism, \n\n\n\nage, weight, serum creatinine, sex, \n\n\n\nHIV infection \n\n\n\nNAT2 genotype \n\n\n\npolymorphism \n\n\n\n\n\n\n\nRao et al., \n\n\n\n2021 [24] \nLC-MS/MS \n\n\n\nPhoenix \n\n\n\nNLME/FOCE-\n\n\n\nextended lease squares \n\n\n\nTwo-compartment \n\n\n\nmodel with a lag time \n\n\n\nKa (h\n-1) = 0.9 \n\n\n\nV1 (L) = 2.9 \n\n\n\nV2 (L) = 32.5 \n\n\n\nCL = (L/ h) = 9.2 \n\n\n\nCL2 (L/h) = 9.6 \n\n\n\nTlag = 0.4 \n\n\n\nNA \n\n\n\n\n\n\n\nAge, sex, body weight, mid-upper \n\n\n\narm circumference (MUAC), TB \n\n\n\ndiagnostic group (confirmed and \n\n\n\nunconfirmed), NAT2 genotype. \n\n\n\n\n\n\n\nMid-upper arm \n\n\n\ncircumference \n\n\n\n(MUAC) \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nTan W. R. et al.                                                   Mal J Pharm 8 (2) 2022 , 1-15 , XX-XX \n\n\n\n\n\n\n\n6 \n\n\n\n\n\n\n\nTable II: Model structure, pharmacokinetic parameters, and tested and retained covariates (continued) \n\n\n\nStudy Assay Software/Algorithm Structure \nFinal population pharmacokinetic \n\n\n\nparameters for Isoniazid \nAcetylisoniazid Covariates tested \n\n\n\nRetained \n\n\n\ncovariates in the \n\n\n\nfinal model \n\n\n\nJing et al., \n\n\n\n2020 [25] \nLC-MS/MS \n\n\n\nNONMEM \n\n\n\nv7.2/FOCE \n\n\n\nA two-compartment \n\n\n\nmodel with first-order \n\n\n\nabsorption and \n\n\n\nelimination \n\n\n\nCL/F (L/h) = 31.4 \n\n\n\nV1/F (L) = 21.1 \n\n\n\nV2/F (L) = 27.7 \n\n\n\nQ/F (L/h) = 43.7 \n\n\n\nKa (h\n-1) = 1.7 \n\n\n\nFcw = 0.930 \n\n\n\nFNAT2 \n\n\n\nFast = 1.36 \n\n\n\nSlow = 0.378 \n\n\n\nNA \nNAT2 genotype polymorphism and \n\n\n\nbody weight \n\n\n\nNAT2 genotype \n\n\n\npolymorphism and \n\n\n\nbody weight \n\n\n\n\n\n\n\nNaidoo et al., \n\n\n\n2019 [26] \nLC-MS/MS \n\n\n\nNONMEM \n\n\n\nv7.3/FOCE-I \n\n\n\nTwo-compartment \n\n\n\ndisposition with first-\n\n\n\norder elimination and \n\n\n\nfirst-order absorption \n\n\n\nCL (L/h) \n\n\n\nFast = 40.5 \n\n\n\nIntermediate = 28.4 \n\n\n\nSlow = 17.4 \n\n\n\nVcentral (L) = 73.4 \n\n\n\nIntercompartment clearance, Q = 1.1 \n\n\n\nVperipheral = 19.8 \n\n\n\nBioavailability = 1 (Fixed) \n\n\n\nTlag = 0.13 \n\n\n\nKa (h\n-1) = 3.9 \n\n\n\nScaling factor for variability in \n\n\n\nbioavailability for unobserved doses (-\n\n\n\nfold) = 3.9 \n\n\n\n\n\n\n\nNA \n\n\n\nAntiretroviral therapy, treatment \n\n\n\nphase, NAT2 genotype \n\n\n\npolymorphism, serum creatinine \n\n\n\nNAT2 genotype \n\n\n\npolymorphism \n\n\n\nZvada et al., \n\n\n\n2013 [21] \nLC-MS/MS \n\n\n\nNONMEM v7/FOCE-\n\n\n\nINTER \n\n\n\nTwo-compartment \n\n\n\ndistribution model \n\n\n\nwith absorption transit \n\n\n\ncompartments and \n\n\n\nfirst-order elimination \n\n\n\nCL (L/h) for \n\n\n\nSlow = 4.44 \n\n\n\nIntermediate = 8.49 \n\n\n\nFast = 11.3 \n\n\n\nKa (h\n-1) = 2.47 \n\n\n\nMTT (absorption mean transit time) (h) \n\n\n\n= 0.179 \n\n\n\nNumber of Transit compartment = 4 \n\n\n\n(Fixed) \n\n\n\nVcentral (L) = 11.0 \n\n\n\nQ (L/h) = 2.00 \n\n\n\nVperipheral = 5.03 \n\n\n\nF = 1 (Fixed) \n\n\n\nNA \n\n\n\nSex, NAT2 genotype \n\n\n\npolymorphism, HIV infection, age, \n\n\n\nbody weight, concurrent \n\n\n\nmeningitis prior TB \n\n\n\nNAT2 genotype \n\n\n\npolymorphism \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nTan W. R. et al.                                                   Mal J Pharm 8 (2) 2022 , 1-15 , XX-XX \n\n\n\n\n\n\n\n7 \n\n\n\n\n\n\n\nTable II: Model structure, pharmacokinetic parameters, and tested and retained covariates (continued) \n\n\n\nStudy Assay Software/Algorithm Structure \nFinal population pharmacokinetic \n\n\n\nparameters for Isoniazid \nAcetylisoniazid Covariates tested \n\n\n\nRetained \n\n\n\ncovariates in the \n\n\n\nfinal model \n\n\n\nPanjasatwong et al.,  \n\n\n\n2021 [22] \nLC-MS/MS \n\n\n\nNONMEM \n\n\n\nv7.3/FOCE-I \n\n\n\nTwo-compartment \n\n\n\ntransit model with \n\n\n\nfirst-order absorption \n\n\n\nand linear elimination \n\n\n\nF = 1 (Fixed) \n\n\n\nCL/F (L/h) = 9.43 \n\n\n\nVcentral / F (L) = 3.78 \n\n\n\nMTT (h) = 0.878 \n\n\n\nMAT50 (month) = 12.7 \n\n\n\nHill = 4.7 \n\n\n\nQ/F (L/h) = 28.0 \n\n\n\nVperipheral  = 15.3 \n\n\n\nQCSF /  (L/h) = 13.7 \n\n\n\nNA \n\n\n\nBody weight, age, sex, disease \n\n\n\nseverity, HIV infection, renal and \n\n\n\nliver function tests, nutritional \n\n\n\nstatus, predicted NAT2 phenotypes, \n\n\n\ncentral nervous system (CNS) \n\n\n\ninflammation markers (CSF protein, \n\n\n\nCSF lactate, CSF glucose, and \n\n\n\nCSF/blood glucose ratio) \n\n\n\nCSF \n\n\n\ncompartment, \n\n\n\nbody weight, \n\n\n\nNAT2 genotype \n\n\n\npolymorphism \n\n\n\n(Age-based \n\n\n\nenzyme \n\n\n\nmaturation) \n\n\n\n\n\n\n\n\n\n\n\nSeng et al.,  \n\n\n\n2015 [19] \n\n\n\nLC-MS/MS \nNONMEM \n\n\n\nv7.3/FOCE-INTER \n\n\n\nINH: \n\n\n\nTwo-compartment \n\n\n\nmodel with first-\n\n\n\norder absorption \n\n\n\nAcINH: \n\n\n\nTwo-compartment \n\n\n\nmodel with first-\n\n\n\norder absorption \n\n\n\nINH: \n\n\n\nKa (h\n-1) = 0.6 \n\n\n\nCL/F (L/h) = 65.2 \n\n\n\nVcentral/F (L) = 18 \n\n\n\nQ/F (L/h) = 2.8 \n\n\n\nVPeripheral/F (L) = 15.9 \n\n\n\nFINH = 1 \n\n\n\nAcINH: \n\n\n\nFAcINH = 0.973 \n\n\n\nCL (L/h) = 21.3 \n\n\n\nVcentral/F (L) = 17 \n\n\n\nQ (L/h) = 69.2 \n\n\n\nVPeripheral/F (L) = 80.4 \n\n\n\nFAcINH = 0.965 \n\n\n\nCLA (L/h) = 21.3 \n\n\n\nVcentral/F (L) = 17 \n\n\n\nQA (L/h) = 71.5 \n\n\n\nVperipheral (L) = 81.2 \n\n\n\n\n\n\n\nAge, body weight, height, body \n\n\n\nsurface area (BSA), body mass \n\n\n\nindex (BMI), creatinine clearance, \n\n\n\nbilirubin, alkaline phosphatase \n\n\n\n(ALP), alanine aminotransferase \n\n\n\n(ALT), aspartate aminotransferase \n\n\n\n(AST), gender, race, NAT2 \n\n\n\ngenotype polymorphism \n\n\n\nNAT2 genotype \n\n\n\npolymorphism, \n\n\n\ncreatinine \n\n\n\nclearance \n\n\n\n(AcINH) \n\n\n\nFredj et al., \n\n\n\n2021 [18] \n\n\n\nSpectrocolo\n\n\n\nrimetric \n\n\n\nPmetrics for \n\n\n\nR/Nonparametric \n\n\n\nOne-compartment \n\n\n\nmodel \n\n\n\nKe (h\n-1) = 0.48 \n\n\n\nV (L) = 23.3 \n\n\n\n\n\n\n\nNA \n\n\n\nPolymorphism in NAT2 genotype \n\n\n\npolymorphism, age, body weight, \n\n\n\ngender \n\n\n\nNAT2 genotype \n\n\n\npolymorphism \n\n\n\n\n\n\n\nVan Beek et al., \n\n\n\n2021 [27] \n\n\n\nUPLC/LC-\n\n\n\nMS/MS \nNONMEM v7.4 \n\n\n\nINH: \n\n\n\nTwo-compartment \n\n\n\ndisposition model \n\n\n\nAcINH: \n\n\n\nSingle-compartment \n\n\n\nfirst-order \n\n\n\nelimination \n\n\n\n\n\n\n\n\n\n\n\nINH: \n\n\n\nVcentral (L) = 57.5 \n\n\n\nKa (h\n-1) = 5.42 \n\n\n\nCL (L/h) \n\n\n\nSlow = 12.1 \n\n\n\nFast = 32.7 \n\n\n\nVperipheral (L) = 18.7 \n\n\n\nQ (L/h) = 2.48 \n\n\n\nAcINH: \n\n\n\nVcentral (L) = 39.2 \n\n\n\nCL (L/h) = 6.65 \n\n\n\n\n\n\n\nVcentral (L) = 39.2 \n\n\n\nCL (L/h) = 6.65 \nNA \n\n\n\nNAT2 genotype \n\n\n\npolymorphism \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nTan W. R. et al.                                                   Mal J Pharm 8 (2) 2022 , 1-15 , XX-XX \n\n\n\n\n\n\n\n8 \n\n\n\n\n\n\n\n  \nCL = Clearance; Ka = Absorption constant; Tlag = Lag time V = Volume of distribution; Vcentral = Central volume of distribution; Vperipheral = Peripheral volume of distribution; MTT = Mean Transit Time; Q = Intercompartment \n\n\n\nclearance; F = Bioavailability; NAT2 = N-Acetyltransferase 2; MAT = Maturation of Clearance; BMI = Body Mass Index; CSF = Cerebrospinal fluid \n\n\n\n\n\n\n\n\n\n\n\nTable II: Model structure, pharmacokinetic parameters, and tested and retained covariates (continued) \n\n\n\n\n\n\n\nStudy Assay Software/Algorithm Structure \nFinal population pharmacokinetic \n\n\n\nparameters for Isoniazid \nAcetylisoniazid Covariates tested \n\n\n\nRetained \n\n\n\ncovariates in the \n\n\n\nfinal model \n\n\n\nHuerta-Garc\u00eda et al., \n\n\n\n2020 [28] \nHPLC \n\n\n\nNONMEM \n\n\n\nv7.3/FOCE-I \n\n\n\nTwo-compartment open \n\n\n\nmodel with a first-order \n\n\n\nrate constant of \n\n\n\nabsorption and \n\n\n\nelimination \n\n\n\nCL (L/h) \n\n\n\nSlow = 11.4 \n\n\n\nIntermediate = 19.2 \n\n\n\nFast = 27.4 \n\n\n\nVcentral X BMI (L) = 1.5 \n\n\n\nVperipheral (L) = 3.8 \n\n\n\nKa (h\n-1) = 2.0 \n\n\n\n\n\n\n\nNA \n\n\n\nSmoking, alcoholism, concomitant \n\n\n\ndisease, concomitant drugs, NAT2 \n\n\n\ngenotype polymorphism, body mass \n\n\n\nindex (BMI) (Vcentral) \n\n\n\nNAT2 genotype, \n\n\n\nbody mass index \n\n\n\n(BMI) (Vcentral) \n\n\n\nDenti et al.,  \n\n\n\n2015 [29] \nLC-MS/MS \n\n\n\nNONMEM \n\n\n\nv7.3/FOCE-I \n\n\n\nTwo-compartment \n\n\n\ndisposition with transit \n\n\n\ncompartment absorption \n\n\n\nCL (L/h) \n\n\n\nRapid/Intermediate = 26.1 \n\n\n\nSlow = 15.5 \n\n\n\nVcentral (L) = 48.2 \n\n\n\nQ (L/h) = 16.1 \n\n\n\nVperipheral (L) = 16.5 \n\n\n\nMTT = 0.924 \n\n\n\nNumber of transit compartment = 2.73 \n\n\n\nF = 1 (Fixed) \n\n\n\nNA \n\n\n\nHIV co-infection, nutritional status, age, \n\n\n\nsex, CD4+ lymphocyte count, daily \n\n\n\nweight-adjusted dose, time on TB \n\n\n\ntreatment, NAT2 genotype \n\n\n\nNAT2 genotype \n\n\n\n\n\n\n\nAruldhas et al.,  \n\n\n\n2019 [23] \nLC-MS/MS \n\n\n\nNONMEM \n\n\n\nv7.3/FOCE-I \n\n\n\nOne-compartment \n\n\n\ndisposition model with a \n\n\n\ntransit absorption model \n\n\n\n(fixed, n = 5) \n\n\n\nCL (L/h) \n\n\n\nFast = 2.59 \n\n\n\nSlow = 7.79 \n\n\n\nVcentral/F (L) = 29.7 \n\n\n\nMTT = 0.547 \n\n\n\nNumber of transit compartment = 5 \n\n\n\n(Fixed) \n\n\n\nF = 1 (Fixed) \n\n\n\n\n\n\n\nNA \n\n\n\nAge, sex, body mass index (BMI), body \n\n\n\nweight, height and albumin level, NAT2 \n\n\n\ngenotype \n\n\n\nNAT2 genotype \n\n\n\n\n\n\n\n\nTan W. R. et al.                            Mal J Pharm 8 (2) 2022, 1-15 \n\n\n\n\n\n\n\n9 \n\n\n\n\n\n\n\n\n\n\n\nModel Evaluation \n\n\n\n\n\n\n\nModel evaluation was performed in all twelve studies through \n\n\n\nbasic internal approaches, advanced approaches, and external \n\n\n\nevaluation. All the studies used basic internal evaluation such \n\n\n\nas basic goodness-of-fit (GOF) and visual predictive check \n\n\n\n(VPC) and two [18,28] studies used external validation in \n\n\n\nmodel evaluation using an independent dataset, two of which \n\n\n\nshowed acceptable predictability. Five studies have performed \n\n\n\nadvanced basic internal evaluations like normalised prediction \n\n\n\ndistribution error (NPDE) and bootstrap analysis for model \n\n\n\nevaluation (Table III).  \n\n\n\n\n\n\n\nDISCUSSION  \n \n\n\n\nIn this review, the authors focused on the parametric approach \n\n\n\nto PPK model development. Pharmacokinetics of INH was \n\n\n\nreported to be described as a two-compartment model in ten \n\n\n\nstudies while a one-compartment model was described in two \n\n\n\nstudies. A single study reported the one-compartment INH \n\n\n\nmodel included INH concentration at 3 h after drug intake [18].  \n\n\n\nThis sparse sampling method could be the reason leading to the \n\n\n\nresult obtained being one-compartmental. The sample is only \n\n\n\ntaken at a one-time point and may not have sufficient data to \n\n\n\ndemonstrate a two-compartmental model [18].  \n\n\n\n\n\n\n\nThere is variability in describing the absorption process of \n\n\n\nINH in the included studies. Although the majority of studies \n\n\n\ndescribed the absorption of INH as proportional to the \n\n\n\nconcentration of INH in the gastrointestinal, in certain \n\n\n\npopulations, the absorption of INH was also described to \n\n\n\nrequire at least a 1-hour delay to be fully absorbed (MTT was \n\n\n\n0.66 h (SD = 0.34) with a range from 0.179 to 0.924 h). This  \n\n\n\n\n\n\n\nindicates that not only food, but dosage form of INH also \n\n\n\ndetermines the absorption of INH. During the DOTs or VOT, \n\n\n\npatients need to be emphasised on the factor of food so that \n\n\n\nabsorption could be enhanced. Besides the MTT absorption, \n\n\n\nINH was also described to have at least a 0.13-hour lag time \n\n\n\nto be absorbed in one study. Nevertheless, the lag time model \n\n\n\ndoes not consider the physiological process of absorption, and \n\n\n\nMTT is reported to be more accurate to describe the absorption \n\n\n\nphase [22,30]. \n\n\n\n\n\n\n\nThe NAT2 gene shows large interindividual variability in \n\n\n\nacetylating activities by genetic polymorphisms in humans. \n\n\n\nThe plasma concentrations of INH are highly variable between \n\n\n\nsubjects, mainly because of the variability in the activities of \n\n\n\nthese enzymes. As shown in Figure II, NAT2 genetic \n\n\n\npolymorphism significantly explains the large intra-and inter-\n\n\n\nindividual variation in CL in most of the studies. The \n\n\n\npercentage difference of the NAT2 polymorphism effect \n\n\n\nagainst mean CL (20.55 L/h) is plotted in Figure III. Seng et \n\n\n\nal. [19] have shown the largest difference from mean CL, which \n\n\n\ncould be explained by the Chinese ethnicity. Most of the studies \n\n\n\nbuilt a mixture model to describe the clearance profile of INH.   \n\n\n\n\n\n\n\nNevertheless, a study by Rao et al. performed NAT2 genotypic \n\n\n\nscreening in 34 (65.3%) patients, with 29 being of the slow-\n\n\n\nintermediate type and the remaining rapid metabolisers [24]. \n\n\n\nThere are no significant differences in Cmax or AUC 0-24 \n\n\n\nvalues between the slow-intermediate type and the few rapid \n\n\n\nmetabolisers. This indicates that external validation of the \n\n\n\ndeveloped mixture models is paramount to confirm the effect \n\n\n\nof NAT2 polymorphism in determining the types of \n\n\n\naccelerators.  \n\n\n\n\n\n\n\nFigure II: Isoniazid (INH) clearance due to NAT2 polymorphism \n\n\n\n \n\n\n\n\n\n\n\n\nTan W. R. et al.                                                   Mal J Pharm 8 (2) 2022 , 1-15 , XX-XX \n\n\n\n\n\n\n\n10 \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nFigure III: Investigated and identified covariates \n\n\n\n \n\n\n\n\n\n\n\n\nTan W. R. et al.                                                   Mal J Pharm 8 (2) 2022 , 1-15 , XX-XX \n\n\n\n\n\n\n\n11 \n\n\n\n\n\n\n\n\n\n\n\nTable III: Model variability, error and validation \n\n\n\n\n\n\n\nStudy \nInterindividual variability (IIV) \n\n\n\nResidual error model \nResidual \n\n\n\nModel evaluation \nINH AcINH INH (%) AcINH (%) \n\n\n\nHorita et al.,  \n\n\n\n2018 [20] \n\n\n\nKa (h\n-1) = 0.567 \n\n\n\nCL/Fslow (L/h) = 0.324 \n\n\n\nCL/Fnonslow (L/h) = 0.48 \n\n\n\nVcentral /F (L) = 0.241 \n\n\n\nQ/F (L/h) = 0.637 \n\n\n\nVperipheral/F (L) = 1.9 \n\n\n\nNA Combination NA NA Basic internal (VPC, GOF) \n\n\n\n\n\n\n\nRao et al.,  \n\n\n\n2021 [24] \n\n\n\nKa(h\n-1) = 0.9 \n\n\n\nVcentral (L) = 0.07 \n\n\n\nVperipheral (L) = 0.5 \n\n\n\nCL=(L/h) = 0.8 \n\n\n\nCL2(L/h) = 0.0001 \n\n\n\nTlag = 0.5 \n\n\n\nNA Proportional NA NA Basic internal (VPC, GOF) \n\n\n\n\n\n\n\nJing et al.,  \n\n\n\n2020 [25] \n\n\n\nCL/F (L/h) = 25.6 \n\n\n\nQ/F (L/h) = 63.8 \n\n\n\nKa/F (h-1) = 75.8 \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nNA Exponential 25.1 NA \n\n\n\nBasic internal (VPC, GOF, conditional \n\n\n\nweighted residuals (CWRES) versus time, \n\n\n\nand CWRES versus PRED), advanced \n\n\n\ninternal (Bootstrap analysis, NPDE) \n\n\n\n\n\n\n\nNaidoo et al.,  \n\n\n\n2019 [26] \n\n\n\nCL (L/h) \n\n\n\nFast = 26.3 \n\n\n\n\n\n\n\nNA Combination \n\n\n\nProportional:27.8% \n\n\n\nAdditional: 0.004 \n\n\n\nFIX \n\n\n\n\n\n\n\nNA \nBasic internal (VPC), advanced internal \n\n\n\n(Bootstrap analysis) \n\n\n\n\n\n\n\nZvada et al.,  \n\n\n\n2013 [21] \n\n\n\nCL (L/h) \n\n\n\nFast = 25.1 \n\n\n\nIntermediate = 25.1 \n\n\n\nSlow = 25.1 \n\n\n\nNA Proportional \n\n\n\nCohort 1: \n\n\n\n20.6 \n\n\n\nCohort 2: \n\n\n\n7.00 \n\n\n\nNA \n\n\n\nBasic internal (Conditional weighted \n\n\n\nresiduals versus time, basic GOF, changes in \n\n\n\nthe OFV, VPC) \n\n\n\n\n\n\n\nPanjasatwong et al.,  \n\n\n\n2021 [22] \n\n\n\nCL (L/h) = 20.0 \n\n\n\nVcentral /F (L) = 18.3 \n\n\n\nMTT (h) = 64.5 \n\n\n\nNA Additive NA NA \nBasic internal (VPC, GOF plots, change in \n\n\n\nOFV) \n\n\n\n\n\n\n\nSeng et al.,  \n\n\n\n2015 [19] \n\n\n\nKa (h\n-1) = 12.6 \n\n\n\nCL/F (L/h) = 86.1 \n\n\n\nFINH = 38.1 \n\n\n\nCl (L/h) = 15.4 \n\n\n\n\n\n\n\nCL(L/h) = 15.4 \n\n\n\nVperipheral/F(L) = 19.4 \n\n\n\n\n\n\n\nAdditive on log-\n\n\n\ntransformed data \n32.6 log(mg/L) 20.7 log(mg/L) Basic internal (VPC, GOF) \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nTan W. R. et al.                                                   Mal J Pharm 8 (2) 2022 , 1-15 , XX-XX \n\n\n\n\n\n\n\n12 \n\n\n\n\n\n\n\n\n\n\n\nTable III: Model variability, error and validation (continued) \n\n\n\n\n\n\n\nStudy \nInterindividual variability (IIV) \n\n\n\nResidual error model \nResidual \n\n\n\nModel evaluation \nINH AcINH INH (%) AcINH (%) \n\n\n\nFredj et al., \n\n\n\n2021 [18] \nNA NA NA NA NA \n\n\n\nBasic internal (GOF, NPDE), external \n\n\n\n(validation group) \n\n\n\n\n\n\n\nVan Beek et al.,  \n\n\n\n2021 [27] \n\n\n\nVcentral (L) = 26.4 \n\n\n\nKa (h\n-1) = 83.2 \n\n\n\nCL (L/h) \n\n\n\nFast/slow = 57.5 \n\n\n\nVcentral (L) = 10.3 \n\n\n\nCL (L/h) \n\n\n\n=36.7 \n\n\n\nProportional NA NA Basic internal (VPC, GOF) \n\n\n\n\n\n\n\nHuerta-Garc\u00eda et al.,  \n\n\n\n2020 [28] \n\n\n\nCL (L/h) = 47.0 \n\n\n\nVcentral = 59.4 \n\n\n\nVperipheral (L) = 114.0 \n\n\n\nKa (h\n-1) = 113.6 \n\n\n\n\n\n\n\nNA Proportional 42.9 NA \n\n\n\nBasic internal (VPC, GOF), advanced \n\n\n\ninternal (Bootstrap analysis, NPDE), \n\n\n\nexternal (validation group) \n\n\n\n\n\n\n\nDenti et al.,  \n\n\n\n2015 [29] \n\n\n\nCL (L/h) = 30.7 \n\n\n\nMTT = 37.4 \n\n\n\nF = 12.8 \n\n\n\nNA Combinational NA NA \nBasic internal (OFV, VPC, GOF), advanced \n\n\n\ninternal (Bootstrap analysis) \n\n\n\n\n\n\n\nAruldhas et al.,  \n\n\n\n2019 [23] \n\n\n\nVcentral/F (L) = 23.4 \n\n\n\nMTT = 68.2 \n\n\n\nF = 41.8 \n\n\n\n\n\n\n\nNA Additive 0.0967 NA \nBasic internal (OFV, VPC, GOF), advanced \n\n\n\ninternal (Bootstrap analysis) \n\n\n\n\n\n\n\nCL = Clearance; Ka = Absorption constant; V = Volume of distribution; Vcentral = Central volume of distribution; Vperipheral = Peripheral volume of distribution; MTT = Mean transit time; Q = Intercompartment clearance; F = \n\n\n\nBioavailability. \n\n\n\n\n\n\n\n\n\n\n\nFigure IV: Percentage difference of NAT2 effect on CL compared to mean CL \n\n\n\n\n\n\n\n\nTan W. R. et al.                            Mal J Pharm 8 (2) 2022, 1-15 \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n13 \n\n\n\n\n\n\n\nAcINH is one of the most important urinary metabolites of \n\n\n\nINH. However, it was not investigated and discussed in most \n\n\n\nPPK articles (Table II). One study by Seng et al. described the \n\n\n\nPPK model of AcINH as a two-compartmental model [19]. \n\n\n\nMetabolite AcINH determines how well a patient metabolises \n\n\n\nINH [31]. One of the possible reasons for the lack of data in \n\n\n\nAcINH is the complexity of the assay method used to quantify \n\n\n\nit. A simple HPLC procedure is plagued by the low selectivity \n\n\n\nof UV detection, which requires more elaborate sample \n\n\n\npreparation and chromatographic conditions to achieve \n\n\n\ncomplete baseline separation of all peaks and is unsuitable for \n\n\n\nthe rapid detection of these analytes [32]. Thus, patients who \n\n\n\nare slow acetylators have a higher risk of hepatotoxicity than \n\n\n\nrapid acetylator [33]. Incorporating the effect of AcINH in \n\n\n\noptimising the INH dosing is essential, as slow acetylation may \n\n\n\nlead to isoniazid-induced hepatotoxicity.  \n\n\n\n\n\n\n\nThe NAT2 polymorphism shows the metabolism difference in \n\n\n\nethnicity or race. A study by Naidoo et al. performed on \n\n\n\nAfricans showed that most patients were slow or intermediate \n\n\n\nacetylators with >80% based on NAT2 genotype \n\n\n\npolymorphism. In comparison, less than 10-20% of the \n\n\n\npopulation tested had a rapid acetylator status [26]. Among the \n\n\n\nTanzanian population (East Africa), as many as 48% (n = 48 \n\n\n\nsubjects) were classified as NAT2 slow acetylators, 48% (n = \n\n\n\n48 subjects) as intermediate, and 2% (n = 2) as rapid \n\n\n\nacetylators. In comparison, the acetylation status of 2% (n = 2) \n\n\n\nsubjects could not be determined [29]. In contrast, among the \n\n\n\nUS population, Horita et al. reported mainly slow and \n\n\n\nintermediate INH acetylator [20]. While in the Asian \n\n\n\npopulation, as shown by Seng et al. that the majority of the \n\n\n\nsubjects in his study were classified as fast and intermediate \n\n\n\nINH acetylators. Similarly, a study from China reported that the \n\n\n\nmajority of the Chinese population in the study were fast and \n\n\n\nintermediate INH acetylators. This indicates Asian population, \n\n\n\nespecially the Chinese ethnicity are fast INH metabolisers and \n\n\n\nNAT2 polymorphism was about 20-40% of the population \n\n\n\n[19,25]. This can be reflected in Figures II and III where Seng \n\n\n\net al. [19] and Jing et al. [25] demonstrate the top and third-\n\n\n\nhighest CL in all studies. Discrepancies within regions and \n\n\n\nethnicity highlighted the variable influence of the NAT2 \n\n\n\npolymorphism on TB patient care, while they also reiterate the \n\n\n\nneed for rapid and slow NAT2 genotype polymorphism \n\n\n\nidentification before INH administration to avoid overdosing \n\n\n\nor underdosing [19]. Nevertheless, incorporating genetic \n\n\n\nfactors in routine clinical practice may not be feasible in some \n\n\n\ncountries. The application of a mixture model to cater to the \n\n\n\nunavailability of genetic data could assist in quantifying and \n\n\n\nspecifying different acetylation, which is also applied and \n\n\n\ndescribed for other drugs [34,35]. \n\n\n\n\n\n\n\nThe PK of INH displayed considerable differences among the \n\n\n\ndifferent age groups. The estimated CL in paediatrics is also \n\n\n\nlower than in adults. This can be due to age-based enzyme \n\n\n\nmaturation. At birth time, NAT2 activity is independent of \n\n\n\ngenotype, and the slow-acetylator phenotype predominates. \n\n\n\nWithin the first four years of life, the fast-acetylator phenotype \n\n\n\nin heterozygous and homozygous wild-type individuals \n\n\n\ndevelops [36]. Therefore, the CL of INH in children is lower \n\n\n\nthan in adults because of the Phase II reaction; acetylation in \n\n\n\nmetabolism has not developed completely in children and \n\n\n\ninfants. Children, especially young infants, normally have \n\n\n\nhigher total body water and a lower fat content than adults [36]. \n\n\n\nThus, the lipophilicity of INH [37] may explain the lower \n\n\n\nmedian Vd of INH in children than that in adults. The higher Vd \n\n\n\nvalue in the study by Aruldhas et al. may also attribute to a one-\n\n\n\ncompartmental model built, and the Vd was not distributed to \n\n\n\nthe other compartment [38]. \n\n\n\n\n\n\n\nMid-upper arm circumference (MUAC) was identified as one \n\n\n\nof the significant covariates affecting the Vcentral in people with \n\n\n\nHIV and critical illness [24], which could be explained by the \n\n\n\nhydrophilicity of INH [37]. Compliance assessment has not \n\n\n\nbeen carried out in eleven out of the twelve studies to make sure \n\n\n\nno changes in the INH dosing regimen had occurred before \n\n\n\nassessing the steady-state PK profile. The only study that \n\n\n\ncarried out compliance assessment was Seng et al. study by pill \n\n\n\ncount and medication diaries [19]. While measuring the plasma \n\n\n\nlevel of INH or an anti-TB regimen may provide further insight \n\n\n\ninto the compliance status of patients, the correlation between \n\n\n\nthe serum concentration and compliance towards anti-TB \n\n\n\nshowed conflicting results between adults and children. There \n\n\n\nwas no significant relation between serum concentrations of \n\n\n\npyrazinamide and drug compliance in adult patients [39]. \n\n\n\nHowever, a significant relationship was reported between INH \n\n\n\nand RIF in children with TB [40]. Nevertheless, the \n\n\n\nrelationship between INH and serum concentration may require \n\n\n\nfurther investigation. \n\n\n\n\n\n\n\nCONCLUSION  \n \n\n\n\nIn conclusion, the PPK of INH has been extensively reviewed. \n\n\n\nThe clearance of INH has a large difference between people \n\n\n\nwith different NAT2 genotype polymorphism statuses. This \n\n\n\nreview shows that to optimise the dosing regimen of INH, the \n\n\n\npatient\u2019s NAT2 genotype polymorphism status and age should \n\n\n\nbe considered. Considering a larger sample size and a more \n\n\n\nstringent sampling strategy to be able to assess these factors \n\n\n\nefficiently as the population data is more likely to follow the \n\n\n\nlaw of large numbers and central limit theorem [41]. The \n\n\n\napplication of a mixture model to cater for the unavailability of \n\n\n\n \n\n\n\n\n\n\n\n\nTan W. R. et al.                            Mal J Pharm 8 (2) 2022, 1-15 \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n14 \n\n\n\n\n\n\n\ngenetic data could assist in quantifying and specifying different \n\n\n\nacetylator status. Besides, previously published models, as well \n\n\n\nas future models, should be evaluated externally for a more \n\n\n\naccurate description of models\u2019 predictive performance. \n\n\n\n\n\n\n\nACKNOWLEDGEMENT \n\n\n\n\n\n\n\nAll authors meet the criteria of authorship. TWR was \n\n\n\nresponsible for collecting the data. SMSG reviewed and edited \n\n\n\nthe manuscript. IAH reviewed and edited the manuscript. SNH \n\n\n\nparticipated in concept development, supported data collection, \n\n\n\nand reviewed and edited the manuscript. This work was \n\n\n\nsupported by Fundamental Research Grant Scheme (FRGS), \n\n\n\nMinistry of Higher Education, Malaysia with project code \n\n\n\nFRGS/1/2019/STG03/USM/02/1. \n\n\n\n\n\n\n\nCONFLICT OF INTEREST \n  \n\n\n\nThe authors have no relevant affiliations or financial \n\n\n\ninvolvement with any organization or entity with a financial \n\n\n\ninterest in or financial conflict with the subject matter or \n\n\n\nmaterials discussed in the manuscript. This includes \n\n\n\nemployment, consultancies, honoraria, stock ownership or \n\n\n\noptions, expert testimony, patents received or pending, or \n\n\n\nroyalties. There are no conflicts of interest relevant to the \n\n\n\ncontent of this review. \n\n\n\n\n\n\n\nREFERENCE \n \n\n\n\n[1] Bardou, F., et al., Mechanism of isoniazid uptake in Mycobacterium \n\n\n\ntuberculosis. 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R. et al.                            Mal J Pharm 8 (2) 2022, 1-15 \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n15 \n\n\n\n\n\n\n\n[doi] LID - 739. Antibiotics, 2021. 10(2079-6382 (Print)). \n\n\n\nhttps://doi.org/10.3390/antibiotics10060739  \n\n\n\n[25] Jing, W., et al., Population Pharmacokinetic Analysis of Isoniazid \n\n\n\namong Pulmonary Tuberculosis Patients from China. LID - \n\n\n\n10.1128/AAC.01736-19 [doi] LID - e01736-19. Antimicrobial \n\n\n\nAgents and Chemotherapy, 2020. 64(1098-6596 (Electronic)). \n\n\n\nhttps://doi.org/10.1128/AAC.01736-19  \n\n\n\n[26] Naidoo, A., et al., Effects of genetic variability on rifampicin and \n\n\n\nisoniazid pharmacokinetics in South African patients with recurrent \n\n\n\ntuberculosis. Pharmacogenomics, 2019(1744-8042 (Electronic)). \n\n\n\nhttps://doi.org/10.2217/pgs-2018-0166  \n\n\n\n[27] Van Beek, S.W., et al., A Model-Informed Method for the Purpose of \n\n\n\nPrecision Dosing of Isoniazid in Pulmonary Tuberculosis. Clinical \n\n\n\nPharmacokinetics, 2021. 60(7): p. 943-953. \n\n\n\nhttps://doi.org/10.1007/s40262-020-00971-2  \n\n\n\n[28] Huerta-Garc\u00eda, A.P., et al., Population pharmacokinetics of isoniazid \n\n\n\nand dose recommendations in Mexican patients with tuberculosis. \n\n\n\n2020(2210-7711 (Electronic)). https://doi.org/10.1007/s11096-020-\n\n\n\n01086-1  \n\n\n\n[29] Denti, P. et al., Pharmacokinetics of Isoniazid, Pyrazinamide, and \n\n\n\nEthambutol in Newly Diagnosed Pulmonary TB Patients in Tanzania. \n\n\n\nPLOS ONE, 2015. 10(10): p. e0141002. \nhttps://doi.org/10.1371/journal.pone.0141002  \n\n\n\n[30] Savic, R.M., et al., Implementation of a transit compartment model for \n\n\n\ndescribing drug absorption in pharmacokinetic studies. J \n\n\n\nPharmacokinet Pharmacodyn, 2007. 34(5): p. 711-26. \n\n\n\nhttps://doi.org/10.1007/s10928-007-9066-0  \n\n\n\n[31] Flockhart, D.A. and Z. 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Korean Journal of anesthesiology, 2017. 70(2): p. \n\n\n\n144-156 https://doi.org/10.4097/kjae.2017.70.2.144 \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\nhttps://doi.org/10.3390/antibiotics10060739\n\n\nhttps://doi.org/10.1128/AAC.01736-19\n\n\nhttps://doi.org/10.2217/pgs-2018-0166\n\n\nhttps://doi.org/10.1007/s40262-020-00971-2\n\n\nhttps://doi.org/10.1007/s11096-020-01086-1\n\n\nhttps://doi.org/10.1007/s11096-020-01086-1\n\n\nhttps://doi.org/10.1371/journal.pone.0141002\n\n\nhttps://doi.org/10.1007/s10928-007-9066-0\n\n\nhttps://doi.org/10.1016/B978-0-12-802101-9.00018-1\n\n\nhttps://doi.org/10.1016/B978-0-12-802101-9.00018-1\n\n\nhttps://doi.org/10.1080/00032719.2012.682236\n\n\nhttps://doi.org/10.1016/j.apsb.2016.07.014\n\n\nhttps://doi.org/10.1111/bcp.14783\n\n\nhttps://doi.org/10.1097/00007691-200112000-00007\n\n\nhttps://doi.org/10.3390/pharmaceutics3010053\n\n\nhttps://pubchem.ncbi.nlm.nih.gov/compound/Isoniazid\n\n\nhttps://doi.org/10.1128/AAC.01701-16\n\n\nhttps://he02.tci-thaijo.org/index.php/sirirajmedj/article/view/80897\n\n\nhttps://doi.org/10.1186/s12879-021-06764-7\n\n\nhttps://doi.org/10.4097/kjae.2017.70.2.144\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Volume 8 Issue 2 (2022) \n \n\n\n\n\n\n\n\n16 \n\n\n\n\n\n\n\n*Correspondence: orolandn@gmail.com \n\n\n\nDOI: 10.52494/KWQH7710 \n\n\n\n1Department of Clinical Pharmacy and Pharmacy Administration Faculty \n\n\n\nof Pharmacy, University of Maiduguri. Maiduguri, Nigeria.  \n2Department of Medicine, Nephrology Unit, University of Maiduguri \n\n\n\nTeaching Hospital, Maiduguri, Nigeria.  \n3Department of Clinical Pharmacy and Pharmacy Management, \n\n\n\nUniversity of Nigeria, Nsukka, Nigeria \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n Original Research Article \n\n\n\n\n\n\n\nEvaluation of the Impact of Clinical Pharmacists\u2019 Educational \n\n\n\nIntervention on the Knowledge of Patients with Chronic \n\n\n\nKidney Disease   \n \n\n\n\nRoland Nnaemeka Okoro1*, Ibrahim Ummate2, John David Ohieku1, Sani Ibn Yakubu1, Maxwell \n\n\n\nOgochukwu Adibe3 \n\n\n\n\n\n\n\n \nArticle Info  \n\n\n\n \nReceived date: 02 Feb 2022  \n\n\n\nAccepted date: 07 Jul 2022 \n\n\n\nPublished date: 31 Dec 2022 \n\n\n\n\n\n\n\nKeywords: Chronic kidney \n\n\n\ndisease (CKD); CKD \n\n\n\nknowledge; Nigeria; clinical \n\n\n\npharmacist; pre-dialysis CKD. \n\n\n\nABSTRACT  \n\n\n\n\n\n\n\nIntroduction: Chronic kidney disease (CKD) is a progressive disease associated with high morbidity \n\n\n\nand mortality at all stages. Objective: To determine the impact of pharmacists\u2019 educational \n\n\n\ninterventions on the CKD knowledge and knowledge levels of patients with pre-dialysis CKD, and \n\n\n\nto identify potential predictors of good CKD knowledge. Method: Two main healthcare facilities in \n\n\n\nMaiduguri, Nigeria, were the study settings for this randomised, controlled, prospective study with a \n\n\n\n12-month follow-up. Participants were randomised to the usual care (UC) and pharmacists\u2019 \n\n\n\nintervention (PI) groups on a 1:1 ratio. The PI group was offered usual care plus face-to-face CKD \n\n\n\neducation and self-management of CKD, an educational CKD infographic leaflet, and telephonic \n\n\n\ninterventions. Categorical data were compared using Chi-square or Fisher exact tests where relevant, \n\n\n\nwhile an independent sample T-test was used to compare the mean values of the two study groups. \n\n\n\nA p-value of less than 0.05 was considered to be statistically significant. Result: Baseline \n\n\n\ncharacteristics were similar between the PI (n = 73) and UC (n = 74) patients, although participants \n\n\n\nin the PI group were significantly more female (71.2% vs. 52.7%; p = 0.021). The overall mean \n\n\n\nknowledge score of the PI group was significantly higher than the UC group at 6 months (18.9 \u00b1 3.4 \n\n\n\nvs.14.6 \u00b1 4.4, p < 0.001), and at 12 months (19.5 \u00b1 3.8 vs.16.8 \u00b1 6.0, p < 0.001), respectively. At 6 \n\n\n\nmonths, a significant proportion of the participants in the intervention group had high knowledge \n\n\n\ncompared with those in the UC group (16.4% vs. 9.0%, p < 0.001). At the end of the study, the \n\n\n\nadjusted analysis revealed that those between 40 and 64 years of age (AOR 26.3, 95% CI 2.1 \u2013 331.0) \n\n\n\nand 65 years of age or more (AOR 10.1 95% CI 1.1 - 89.7) were more likely to have good CKD \n\n\n\nknowledge. Also, participants in the intervention group (AOR 2.7, 95% CI1.0 - 7.2) had a higher \n\n\n\nlikelihood of having good CKD knowledge. Conclusion: Educational interventions provided by \n\n\n\npharmacy students/clinical pharmacists resulted in significant improvements in the CKD knowledge \n\n\n\nof patients with pre-dialysis CKD. \n\n\n\n\n\n\n\n\n\n\n\nINTRODUCTION  \n \n\n\n\nChronic kidney disease (CKD) is a major global health issue, \n\n\n\nparticularly in resource-constrained nations [1]. It is a \n\n\n\nprogressive condition that can cause kidney failure and \n\n\n\nnecessitate renal replacement treatment, and it is associated \n\n\n\nwith morbidity and mortality at all stages [2]. The economic, \n\n\n\nclinical, and humanistic consequences are tremendous [3]. \n\n\n\nFortunately, medicines exist to decrease disease consequences \n\n\n\n[4], as well as to delay or even stop progression to severe stages \n\n\n\n\nmailto:orolandn@gmail.com\n\n\n\n\n\n\nRoland Nnaemeka Okoro et al. Mal J Pharm 8 (2) 2022, 16-26 \n\n\n\n\n\n\n\n17 \n\n\n\n\n\n\n\n[5]. Almost all medications are aiming at preventing renal \n\n\n\ndisease progression and minimizing related consequences, on \n\n\n\nthe other  \n\n\n\nhand, relying mainly on patient self-care. Throughout the \n\n\n\nvarious stages of CKD, patients with CKD need to invest \n\n\n\nconsiderable time into managing their health, including \n\n\n\nmodifying their diet and lifestyle, managing numerous \n\n\n\nmedications, and attending medical appointments. Therefore, \n\n\n\nknowledge of the disease and its management is required for \n\n\n\nthe effective management of CKD at home by patients. As a \n\n\n\nresult of the disease's complexity, which necessitates patients' \n\n\n\nactive participation and the acquisition of self-management \n\n\n\nskills, medical education is crucial in the CKD population [6]. \n\n\n\nTherefore, insufficient medical education is a major issue in \n\n\n\nmany chronic diseases, including CKD. Chronically ill people \n\n\n\nwith low medical education have little understanding of their \n\n\n\nmedical condition or how to manage it [7]. \n\n\n\n\n\n\n\nEvidence suggests that the general population, as well as CKD \n\n\n\npatients, have a lack of knowledge about the disease. Most \n\n\n\npeople in the general population lack knowledge of their kidney \n\n\n\ndisease [8]. The worst of it all is that most patients with CKD \n\n\n\nwho are being managed by experts have limited knowledge of \n\n\n\nthe disease [9]. A study revealed that a considerable proportion \n\n\n\nof patients with CKD stages 3 - 5 have poor knowledge about \n\n\n\ntheir own CKD diagnosis, and what to do if their kidneys fail \n\n\n\n[9]. Furthermore, studies consistently demonstrate that patients \n\n\n\nneed more knowledge about their chronic medical conditions \n\n\n\nto promote self-care behaviors [10-14] and that a lack of \n\n\n\neffective communication from health professionals is \n\n\n\nperceived as a constraint to acquiring and comprehending this \n\n\n\ninformation [15]. \n\n\n\n\n\n\n\nThe provision of CKD-specific knowledge interventions, such \n\n\n\nas knowledge of kidney physiology, functions, causes of CKD, \n\n\n\nsymptoms, diagnosis, the importance of dietary and lifestyle \n\n\n\nmodifications, and adherence to medication, control of co-\n\n\n\nmorbidities to slow down disease progression among others is \n\n\n\ncritical since educational interventions have been found to \n\n\n\npostpone the start of dialysis and lower the risk of death due to \n\n\n\nCKD [16]. There is, however, a scarcity of data on educational \n\n\n\nprogrammes for the CKD population in low- and middle-\n\n\n\nincome countries (LMICs), including Nigeria. As a result, the \n\n\n\naims of the study were to determine the impact of pharmacists\u2019 \n\n\n\neducational interventions on the CKD knowledge and \n\n\n\nknowledge levels of patients with pre-dialysis CKD and to \n\n\n\nidentify potential predictors of good CKD knowledge. \n\n\n\n\n\n\n\nMETHOD  \n \n\n\n\nStudy Design and Setting \n\n\n\n\n\n\n\nThis was a randomised, controlled, prospective study with  a \n\n\n\n12-month follow-up. The study was conducted from November \n\n\n\n2019 to October 2020 in two main healthcare facilities in \n\n\n\nMaiduguri, Nigeria.  \n\n\n\n\n\n\n\nSample Size Calculation \n\n\n\n\n\n\n\nAn online Sealed Envelope\u00ae sample size calculator was used \n\n\n\nto calculate the required sample size [17]. This study was \n\n\n\npowered at 90% (2-sided test level of 0.05) to detect a \n\n\n\ndifference in the mean overall knowledge scores at 6 and 12 \n\n\n\nmonths between the  35 percent receiving usual care and the 65 \n\n\n\npercent receiving the intervention. The sample size required for \n\n\n\neach group was 54 people. The minimal sample size of 108 was \n\n\n\nincreased to account for an anticipated 7% noncompliance in \n\n\n\nboth groups, yielding a final value of 148. \n\n\n\n\n\n\n\nCalculation is based on the formula: \n\n\n\nn = f (\u03b1/2, \u03b2) \u00d7 [p1 \u00d7 (100 \u2212 p1) + p2 \u00d7 (100 \u2212 p2)] / (p2 \u2212 p1)2 \n\n\n\n\n\n\n\nWhere p1 and p2 are the percent 'success' in the control and \n\n\n\nexperimental group respectively, and  \n\n\n\nf (\u03b1, \u03b2) = [\u03a6-1(\u03b1) + \u03a6-1(\u03b2)]2 \n\n\n\n\n\n\n\n\u03a6-1 is the cumulative distribution function of a standardised \n\n\n\nnormal deviate. \n\n\n\n\n\n\n\nAdjustment for non-compliance is based on formula:  \n\n\n\nnadj = n \u00d7 10,000 / (100 - c1 - c2)2 \n\n\n\n\n\n\n\nWhere c1 and c2 are the percent non-compliance in the control \n\n\n\nand experimental group respectively. \n\n\n\n\n\n\n\nEligibility Criteria  \n\n\n\n\n\n\n\nPatients that were 18 to 85 years old with a confirmed CKD \n\n\n\nstage 1 \u2013 4 diagnosis who consented, stated readiness to abide \n\n\n\nby the study protocols, and expressed a willingness to remain \n\n\n\nin Maiduguri throughout the study period were enrolled. \n\n\n\nPatients with acute renal failure (ARF), eligible individuals \n\n\n\nwho refused to sign informed consent, and those at CKD stage \n\n\n\n5 were excluded. Pregnant or lactating women, patients on \n\n\n\ndialysis or post-renal transplant patients, patients with HIV \n\n\n\ninfection, critically sick patients or patients known to have \n\n\n\ncurrent psychosis, dementia, or cognitive impairment, and \n\n\n\nthose who expressed a readiness to withdraw from the study \n\n\n\nwere also excluded. \n\n\n\n\n\n\n\nEthical Considerations \n\n\n\n\n\n\n\nEthical approvals were provided by the Research Ethics \n\n\n\nCommittees of the study healthcare facilities. All participants \n\n\n\nwho volunteered to take part in this study provided written \n\n\n\ninformed consent. The confidentiality of patients\u2019 information \n\n\n\nwas upheld throughout the study period. During data collection, \n\n\n\ncodes were used to identify participants. \n\n\n\n\n\n\n\n\nRoland Nnaemeka Okoro et al. Mal J Pharm 8 (2) 2022, 16-26 \n\n\n\n\n\n\n\n18 \n\n\n\n\n\n\n\n\n\n\n\nParticipants Selection, Randomisation, and Stratification \n\n\n\n\n\n\n\nIn order to identify those eligible for the study the health \n\n\n\ninformation of patients with CKD was reviewed in the clinic \n\n\n\nusing screening and eligibility forms. The patients who had \n\n\n\nbeen identified were approached and invited to participate \n\n\n\nutilising the consent explanation forms. The consent \n\n\n\ndeclaration form was signed by all who volunteered to be \n\n\n\nincluded in the trial. Participants were randomised in a 1:1 ratio \n\n\n\nto the Usual Care (UC) and Pharmacists' Intervention (PI) \n\n\n\ngroups (Figure 1) using computer-generated random numbers \n\n\n\nstratified by CKD stage [18]. \n\n\n\n\n\n\n\nUsual Care Received \n\n\n\n\n\n\n\nThe usual/conventional care provided to the UC group by the \n\n\n\nhospitals, included hospital visits for follow-up or due to new \n\n\n\nsickness, physician consultations, regular medical \n\n\n\ninvestigations, review of diagnosis, medications, and referral \n\n\n\nwhen necessary. The usual care was provided with no \n\n\n\nteachings/coaching about their medical conditions or \n\n\n\nmedicines and with no patient empowerment to fully \n\n\n\nparticipate in self-management techniques. \n\n\n\n\n\n\n\nInterventions  \n\n\n\n\n\n\n\nFor 12 months, participants in the PI group got usual care as \n\n\n\nwell as pharmacists\u2019 interventions provided by three final-year \n\n\n\npharmacy students trained by the authors. The PI group \n\n\n\nreceived usual care and face-to-face CKD education at baseline \n\n\n\n(group education), 6 months, and 12 months (individualised \n\n\n\naccording to each patient's needs), as well as educational \n\n\n\ninfographics on CKD at baseline. The structured education \n\n\n\nprogramme for patients in the intervention group consisted of \n\n\n\nfive sessions of 90 - 120 minutes each covering the physiology \n\n\n\nof kidneys and six kidney disease education lessons [19]: (i) \n\n\n\nComprehending renal disease, (ii) Renal disease management, \n\n\n\n(iii) Manifestations of worsening renal disease, (iv) Treatment \n\n\n\nchoices for renal failure, (v) Preparations for renal failure \n\n\n\ntreatments, and (vi) Living with renal failure. The structured \n\n\n\nsessions were conducted once at baseline in groups of 4 to 10 \n\n\n\npatients after data collection. Additionally, throughout the \n\n\n\nstudy period, cell phone CKD educational text messages based \n\n\n\non the topics covered during the baseline face-to-face education \n\n\n\nwere provided to each patient fortnightly, while participants \n\n\n\nphoned-in when the need arises, Reinforcement interventions \n\n\n\nthrough phone calls were also provided on individual needs \n\n\n\nbasis.  \n\n\n\n\n\n\n\nBlinding \n\n\n\n\n\n\n\nThe profession of the investigators was not made known to the \n\n\n\nparticipants to rule out potential sources of bias because \n\n\n\npharmacists are seen mainly by patients as drug dispensers in \n\n\n\nNigeria.  \n\n\n\nFollow-Up Visits \n\n\n\n\n\n\n\nAt six and 12 months, all participants returned to the research \n\n\n\nclinic for follow-ups. The same instrument was used to conduct \n\n\n\nan additional CKD knowledge assessment and reinforcing \n\n\n\ninterventions according to each participant\u2019s needs were also \n\n\n\nprovided. \n\n\n\n\n\n\n\nStudy Outcomes \n\n\n\n\n\n\n\nThe primary outcome of the study was a change in the mean \n\n\n\nknowledge scores between the baseline and the first and second \n\n\n\nfollow-ups, respectively. The secondary outcomes were the \n\n\n\nproportion of participants with correct knowledge of CKD at \n\n\n\nsix and 12 months, respectively, and the potential predictors of \n\n\n\ngood CKD knowledge at 12 months.  \n\n\n\n\n\n\n\nVariables Definition \n\n\n\n\n\n\n\nChronic kidney disease was defined as  reduced kidney \n\n\n\nfunction (eGFR < 60 mL / min / 1.73m2) and / or the presence \n\n\n\nof markers of kidney damage for a period exceeding three \n\n\n\nmonths [20]. \n\n\n\n\n\n\n\nStudy Instrument \n\n\n\n\n\n\n\nA previously validated Kidney Disease Knowledge Survey \n\n\n\n(KiKS) questionnaire was used in this study [21]. This tool was \n\n\n\nupdated by the authors of the present study to improve the \n\n\n\nparticipants' understanding and facilitate filling. The \u201cdon't \n\n\n\nknow\u201d option was added to help collect the correct responses \n\n\n\nthat best describe an individual., Tylenol was replaced with \n\n\n\nparacetamol, which is the name used in Nigeria. To ensure the \n\n\n\nvalidity of the instrument in our study population, face validity \n\n\n\nwas checked by four experts in CKD (two nephrologists and \n\n\n\nconsultant renal pharmacists each). Based on their feedback, all \n\n\n\nthe 28 items were kept without revision. Furthermore, a pilot \n\n\n\nstudy was conducted using the updated questionnaire on 20 \n\n\n\npatients with CKD that were excluded from the main study. \n\n\n\nThe updated questionnaire had Cronbach\u2019s alpha values of 0.71 \n\n\n\nfor general knowledge, 0.64 for kidney functions, and 0.67 for \n\n\n\nCKD symptoms of progression respectively, indicating \n\n\n\nacceptable reliability scores. \n\n\n\n\n\n\n\nThe KiKS assesses CKD-specific knowledge in patients with \n\n\n\nCKD (stages 1 - 5) to better ascertain their degree of \n\n\n\ncomprehension. The questions focus on knowledge of renal \n\n\n\nfunction, therapeutic options for renal failure, signs, and \n\n\n\nsymptoms of disease progression, potentially beneficial or \n\n\n\ntoxic medications, blood pressure targets, and other important \n\n\n\ntopics to preserve kidney function. There are 28 questions in \n\n\n\nall, five of which are multiple-choice and 23 of which are \n\n\n\n\n\n\n\n\nRoland Nnaemeka Okoro et al. Mal J Pharm 8 (2) 2022, 16-26 \n\n\n\n\n\n\n\n19 \n\n\n\n\n\n\n\nyes/no/don\u2019t know. The 28 questions are organised into three \n\n\n\ndomains, namely: (i) General knowledge (9 questions), (ii) \n\n\n\nKnowledge of kidney functions (9 questions), and (iii) \n\n\n\nKnowledge of symptoms of progression of CKD or failure (10 \n\n\n\nquestions). The sum of all the 28 questions constituted the total \n\n\n\nknowledge. \n\n\n\n\n\n\n\nData Collection  \n\n\n\n\n\n\n\nParticipants\u2019 relevant demographics were gathered at the \n\n\n\nbaseline. Comorbidities were extracted from the patients\u2019 \n\n\n\nmedical records, while self-reported CKD knowledge \n\n\n\ninformation was gathered during each research visit. \n\n\n\n\n\n\n\nData Processing \n\n\n\n\n\n\n\nGlomerular filtration rate (GFR) based on the Modification of \n\n\n\nDiet in Renal Disease Equation for Adult was used for disease \n\n\n\nstaging [22,23]. To determine the CKD knowledge level, each \n\n\n\ncorrect answer was assigned one point, while zero points were  \n\n\n\nassigned to each incorrect or don\u2019t know answer. The overall \n\n\n\nknowledge score is the total of the correct answers to each \n\n\n\nquestion, ranging from 0 to 28 points, where 28 points indicate \n\n\n\nthe highest level of knowledge. The overall knowledge was \n\n\n\ncategorised, using Bloom\u2019s cut-off point, as high if the score is \n\n\n\nbetween 80 and 100% (22 \u2013 28 points), moderate if the score is \n\n\n\nbetween 60 and 79% (17 \u2013 21 points), and low if the score is \n\n\n\nless than 60% (< 17 points) [24]. For the multivariable logistic \n\n\n\nregression analysis, good CKD knowledge was coded one, \n\n\n\nwhile sub-optimal CKD knowledge (low and moderate \n\n\n\nknowledge) was coded zero. \n\n\n\n\n\n\n\nData Analysis \n\n\n\n\n\n\n\nIn the analysis of the study data, per protocol procedure was \n\n\n\nused. Continuous data were summarised using their mean \u00b1 \n\n\n\nstandard deviation (SD), while categorical variables were \n\n\n\nrepresented by crude counts and percentages. Proportions were \n\n\n\ncompared with chi-square or fisher's exact tests (when more \n\n\n\nthan 20 percent of cells have expected frequencies of less than \n\n\n\nfive). The independent samples t-test was used to compare the \n\n\n\nmean values of the study groups. The multivariable logistic \n\n\n\nregression analysis was performed at the end of the study to \n\n\n\nidentify the potential predictors of good CKD knowledge \n\n\n\namong the study participants. In all analyses, p-values less than \n\n\n\n0.05 were considered statistically significant (2-sided). SPSS \n\n\n\nfor Windows version 21 was used for all analyses. \n\n\n\n\n\n\n\nRESULT  \n \n\n\n\nThe UC group received 74 (50.3%) of the 147 eligible and \n\n\n\nrecruited participants, whereas the PI group received 73 \n\n\n\n(49.7%). Sixty-seven (90.5%) participants in the UC group and \n\n\n\n67 (91.8%) in the PI group visited the research clinic during the  \n\n\n\n6 months follow-up, and their data were examined. \n\n\n\nFurthermore, 50 (67.6%) participants in the UC group and 56  \n\n\n\n(76.7%) in the PI groups completed the last follow-up, and only \n\n\n\ntheir data were included in the analysis at this timepoint (Figure \n\n\n\nI). \n\n\n\n\n\n\n\n\n\n\n\nPI and UC groups had average age values of 51.1 (13.4) years \n\n\n\nand 53.3 (12.1) years, respectively. Overall, the baseline data \n\n\n\nof the study groups were similar, although the PI group had \n\n\n\nmore females with a significant difference (71.2% vs. 52.7%, p \n\n\n\n= 0.021). The detailed baseline information of the participants \n\n\n\nis presented in Table I. \n\n\n\n\n\n\n\nThe mean general knowledge score of the PI group was \n\n\n\nsignificantly higher than that of the UC group at six months \n\n\n\n(5.8 \u00b1 1.4 vs. 4.4 \u00b1 1.6, p < 0.001), and at 12 months (5.6 \u00b1 1.5 \n\n\n\nvs. 5.0 \u00b1 1.9, p = 0.039). The mean kidney functions knowledge \n\n\n\nscore of the PI group was significantly higher than that of the \n\n\n\nUC group at six months (7.2 \u00b1 1.5 vs. 6.0 \u00b1 2.4, p = 0.001), and \n\n\n\nat 12 months (6.7 \u00b1 1.4 vs. 5.7 \u00b1 2.9, p = 0.033). Also, the mean \n\n\n\nCKD symptoms of progression or failure knowledge of the PI \n\n\n\ngroup was significantly higher than that of the UC group at six \n\n\n\nmonths (5.9 \u00b1 2.0 vs. 4.2 \u00b1 2.4, p < 0.001), and at 12 months \n\n\n\n(7.2 \u00b1 2.2 vs. 6.2 \u00b1 2.9, p = 0.040). Further, the mean overall \n\n\n\nknowledge of the PI group was significantly higher compared \n\n\n\nwith the UC group at six months (18.9 \u00b1 3.4 vs.14.6 \u00b1 4.4, p < \n\n\n\n0.001), and at 12 months (19.5 \u00b1 3.8 vs.16.8 \u00b1 6.0, p < 0.001), \n\n\n\nrespectively (Table II).  \n\n\n\n\n\n\n\nFigure I. Study Flow Diagram \n\n\n\n\n\n\n\n\nRoland Nnaemeka Okoro et al. Mal J Pharm 8 (2) 2022, 16-26 \n\n\n\n\n\n\n\n20 \n\n\n\n\n\n\n\nThe overall CKD knowledge level was generally low (73.5%) \n\n\n\nin both groups at baseline with no statistically significant \n\n\n\ndifference between the two study groups (72.6% in the PI vs. \n\n\n\n74.3% in the UC, p = 0.519). At six months, a significant \n\n\n\nproportion of the participants in the intervention group had high \n\n\n\nknowledge compared with those in the UC group (16.4% vs. \n\n\n\n9.0%, p < 0.001). Also, at 12 months, a higher proportion of \n\n\n\nparticipants in the intervention group had high knowledge \n\n\n\ncompared with those in the UC group, although no statistically \n\n\n\nsignificant level was reached (41.1% vs. 20.0%, p = 0.058). The \n\n\n\ndetailed distribution of the study participants based on their \n\n\n\noverall knowledge levels is presented in Table III. \n\n\n\n\n\n\n\nThe analysis of the individual items of the general knowledge \n\n\n\ndomain revealed a significantly higher proportion of \n\n\n\nparticipants in the intervention group than in the UC group that \n\n\n\nhad correct knowledge of the reasons why protein in urine is a \n\n\n\nproblem at the end of the study (19.6% vs. 0.0%, p = 0.001), \n\n\n\nmedications a person with CKD should avoid (91.0% vs. \n\n\n\n43.3%, p < 0.001]), and treatment options for kidney failure at \n\n\n\nsix months (61.2% vs. 25.4%, p < 0.001). Also, a significantly \n\n\n\nhigher proportion of participants in the intervention group than \n\n\n\nin the UC group had correct knowledge about the definition of \n\n\n\nglomerular filtration rate (GFR) at the baseline (8.2% vs. 0.0%, \n\n\n\np = 0.012), six months (6.0% vs. 0.0%, p = 0.043), and 12 \n\n\n\nmonths (35.7% vs. 4.0%, p < 0.001).  Further, a significantly \n\n\n\nhigher proportion of participants in the intervention group than  \n\n\n\nin the UC group that had correct knowledge of stages of CKD \n\n\n\nat six months (88.1% vs. 70.1%, p = 0.011) and 12 months  \n\n\n\n\n\n\n\n (88.1% vs. 70.1%, p = 0.022), and increased risk of heart \n\n\n\ndisease at six months (89.6% vs. 64.2%, p = 0.001) (Table IV). \n\n\n\n\n\n\n\nTable II. Summary Results of Knowledge Domains \n\n\n\n\n\n\n\nDomain \n\n\n\nUC PI  UC PI Differential  \n\n\n\nMean \n\n\n\nChange \n\n\n\nfrom \n\n\n\nBaseline \n\n\n\n(PI-UC) \n\n\n\nRemark \nMean\u00b1SD Mean\u00b1SD P-Value \n\n\n\nMean \n\n\n\nChange \n\n\n\nfrom \n\n\n\nBaseline \n\n\n\nP-Value \n\n\n\nMean \n\n\n\nChange \n\n\n\nfrom \n\n\n\nBaseline \n\n\n\nP-Value \n\n\n\nGeneral knowledge \n\n\n\nBaseline 3.7 \u00b1 1.4 3.5 \u00b1 1.6 0.396 - - - - - - \n\n\n\n6 months 4.4 \u00b1 1.6 5.8 \u00b1 1.4 < 0.001* 0.7 0.007* 2.3 < 0.001* 1.6 Improved knowledge \n\n\n\n12 months 5.0 \u00b1 1.9 5.6 \u00b1 1.5 0.039* 1.3  < 0.001* 2.1  < 0.001* 0.8 Improved knowledge \n\n\n\n\n\n\n\nKidney functions \n\n\n\nBaseline 3.4 \u00b1 2.8 3.3 \u00b1 2.7 0.681 - - - - - - \n\n\n\n6 months 6.0 \u00b1 2.4 7.2 \u00b1 1.5 0.001* 2.5  < 0.001* 3.9  < 0.001* 1.4 Improved knowledge \n\n\n\n12 months 5.7 \u00b1 2.9 6.7 \u00b1 1.4 0.033* 2.3 < 0.001* 3.4 < 0.001* 1.1 Improved knowledge \n\n\n\n\n\n\n\nSymptoms of progression or failure \n\n\n\nBaseline 4.6 \u00b1 3.0 4.5 \u00b1 2.5 0.730 - - - - - - \n\n\n\n6 months 4.2 \u00b1 2.4 5.9 \u00b1 2.0 < 0.001* -0.4 0.400 1.4 < 0.001* 1.8 Improved knowledge \n\n\n\n12 months 6.2 \u00b1 2.9 7.2 \u00b1 2.2 0.040* 1.6 0.005* 2.7 < 0.001* 1.1 Improved knowledge \n\n\n\n\n\n\n\nOverall Knowledge \n\n\n\nBaseline 11.7 \u00b1 5.9 11.2 \u00b1 5.6 0.559 - - - - - - \n\n\n\n6 months 14.6 \u00b1 4.4 18.9 \u00b1 3.4 < 0.001* 2.9 0.001* 7.7 < 0.001* 4.8 Improved knowledge \n\n\n\n12 months 16.8 \u00b1 6.0 19.5 \u00b1 3.8 < 0.001* 5.1 <0.001* 8.3 < 0.001* 3.2 Improved knowledge \n\n\n\n\n\n\n\n*Independent samples is significant at p < 0.05 \n\n\n\nTable I. Baseline Information of the Recruited Patient (N=147) \n\n\n\n\n\n\n\nVariables \nGroup \n\n\n\nAll N (%) UC n (%) PI n (%) P-Value \n\n\n\nAge (years) \n\n\n\n   < 40 21 (14.3) 10 (13.5) 11 (15.1) \n\n\n\n0.814 \n\n\n\n\n\n\n\n   40 - 64 101 (68.7) 50 (67.6) 51 (69.9) \n\n\n\n   \u2265 65 25 (17.0) 14 (18.9) 11 (15.1) \n\n\n\nSex \n\n\n\n   Male 56 (38.1) 35 (47.3) 21 (28.8) \n0.021* \n\n\n\n   Female 91 (61.9) 39 (52.7) 52 (71.2) \n\n\n\nMarital status \n\n\n\n   Single 23 (15.6) 8 (10.8) 15 (20.5) \n0.104 \n\n\n\n   Married 124 (88.4) 66 (89.2) 58 (79.5) \n\n\n\nEducational level \n\n\n\n   None 43 (29.2) 24 (32.4) 19 (26.0) \n\n\n\n0.653 \n   Primary 32 (21.8) 14 (18.9) 18 (24.7) \n\n\n\n   Secondary 25 (17.0) 14 (18.9) 11 (15.1) \n\n\n\n   Tertiary 47 (32.0) 22 (29.7) 25 (34.2) \n\n\n\nStage (mL / min / 1.73m2) \n\n\n\n   1 (\u2265 90) 0 (0.0) 0 (0.0) 0 (0.0) \n\n\n\n0.682 \n   2 (89 - 60) 6 (4.1) 2 (2.7) 4 (5.5) \n\n\n\n   3 (59 - 30) 42 (28.6) 22 (29.7) 20 (27.4) \n\n\n\n   4 (29 - 15) 99 (67.3) 50 (67.6) 49 (67.1) \n\n\n\nComorbidity \n\n\n\n   Hypertension     \n\n\n\n      Yes 147(100.0) 74 (100.4) 73 (100.0) \n- \n\n\n\n      No 0 (0.0) 0 (0.0) 0 (0.0) \n\n\n\n   Diabetes     \n\n\n\n      Yes 4 (2.7) 3 (4.1) 1 (1.4) \n0.319 \n\n\n\n      No 143 (97.3) 71 (95.9) 72 (98.6) \n\n\n\n\n\n\n\n*Chi-square test is significant at p < 0.05 \n\n\n\n\n\n\n\n\nRoland Nnaemeka Okoro et al. Mal J Pharm 8 (2) 2022, 16-26 \n\n\n\n\n\n\n\n21 \n\n\n\n\n\n\n\nThe analysis of the individual items of the kidney functions \n\n\n\ndomain indicated that interventions provided by pharmacists \n\n\n\nled to significantly higher proportions of participants with \n\n\n\ncorrect knowledge of the roles of the kidneys in urine \n\n\n\nproduction at 12 months (100.0% in the PI vs. 84.0% in the UC, \n\n\n\np = 0.002), the role in waste clearance at 12 months (94.6% in \n\n\n\nthe PI vs. 76.0% in the UC, p = 0.006), and no hair loss role at \n\n\n\nsix months (74.6% in the PI vs. 22.4% in the UC, p < 0.001). \n\n\n\nAlso, significantly higher proportions of participants in the\u201d \n\n\n\nintervention group than in the UC had correct knowledge about \n\n\n\nno glucose control role of kidney at 12 months (12.5% vs. \n\n\n\n0.0%, p = 0.001), the role in potassium control at six months \n\n\n\n(88.1% vs. 73.1%, p = 0.029), and the role in phosphorus \n\n\n\ncontrol at six months (89.6% vs. 71.6%, p = 0.009) (Table V). \n\n\n\n\n\n\n\nAlso, the analysis of the individual items in the symptoms of \n\n\n\nprogression or failure domain revealed significantly higher \n\n\n\nproportion of participants in the intervention group than in the \n\n\n\nUC group with correct knowledge of symptom of increased \n\n\n\nfatigue at 6 months (89.6% vs. 65.7%, p = 0.001), shortness of \n\n\n\nTable III. Overall Knowledge Level of the Study Participants \n\n\n\n\n\n\n\nKnowledge \n\n\n\nLevel \n\n\n\nBaseline 6 Months 12 Months \n\n\n\nAll \n\n\n\nN (%) \n\n\n\nUC \n\n\n\nn (%) \n\n\n\nPI \n\n\n\nn (%) \n\n\n\nP-\n\n\n\nvalue \n\n\n\nAll \n\n\n\nN (%) \n\n\n\nUC \n\n\n\nn (%) \n\n\n\nPI \n\n\n\nn (%) \nP-value \n\n\n\nAll \n\n\n\nN (%) \n\n\n\nUC \n\n\n\nn (%) \n\n\n\nPI \n\n\n\nn (%) \n\n\n\nP-\n\n\n\nvalue \n\n\n\nLow (< 17) \n108 55 53  67 52 15  31 18 13  \n\n\n\n(73.5) (74.3) (72.6)  (50.0) (77.6) (22.4)  (29.2) (36.0) (23.2)  \n\n\n\nModerate  \n\n\n\n(17 - 21) \n\n\n\n35 16 19 0.519 50 9 41 < 0.001* 42 22 20 0.058 \n\n\n\n(23.8) (21.6) (26.0)  (37.3) (13.4) (61.2)  (39.6) (44.0) (35.7)  \n\n\n\nHigh  \n\n\n\n(22 - 28) \n\n\n\n4 3 1  17 6 11  33 10 23  \n\n\n\n(2.7) (4.1) (1.4)  (12.7) (9.0) (16.4)  (31.1) (20.0) (41.1)  \n\n\n\n\n\n\n\n*Chi-square or Fisher\u2019s exact test significant at p < 0.05 \n\n\n\n\n\n\n\nTable IV. Percentage Distribution of Correct Answers in the General Knowledge Domain \n\n\n\n\n\n\n\nGeneral Knowledge item \nUC \n\n\n\nn (%) \n\n\n\nPI \n\n\n\nn (%) \nP value \n\n\n\nDifferential Change  \n\n\n\n(PI \u2013 UC) % \n\n\n\nBlood pressure goal    (PI \u2013 UC) % \n\n\n\n   Baseline 30 (40.5) 27 (37.0) 0.664 -3.5 \n\n\n\n   6 months 48 (71.6) 54 (80.6) 0.224 9.0 \n\n\n\n   12 months 38 (76.0) 41 (73.2) 0.742 -2.8 \n\n\n\nMedications important to kidney health \n\n\n\n   Baseline 53 (71.6) 44 (60.3) 0.150 -11.3 \n\n\n\n   6 months 41 (61.2) 48 (71.6) 0.204 10.4 \n\n\n\n   12 months 38 (76.0) 36 (64.3) 0.192 -11.7 \n\n\n\nReasons why protein in urine is a problem \n\n\n\n   Baseline 1 (1.4) 2 (2.7) 0.579 1.3 \n\n\n\n   6 months 8 (11.9) 1 (1.5) 0.017* -10.4 \n\n\n\n   12 months 0 (0.0) 11 (19.6) 0.001* 19.6 \n\n\n\nContraindicated medications in CKD \n\n\n\n   Baseline 5 (6.8) 9 (12.3) 0.258 5.5 \n\n\n\n   6 months 29 (43.3) 61 (91.0) < 0.001* 47.7 \n\n\n\n   12 months 28 (56.0) 40 (71.4) 0.101 15.4 \n\n\n\nTreatment options for kidney failure \n\n\n\n   Baseline 57 (77.0) 59 (80.8) 0.574 3.8 \n\n\n\n   6 months 17 (25.4) 41 (61.2) < 0.001* 35.8 \n\n\n\n   12 months 18 (36.0) 18 (32.1) 0.674 -3.9 \n\n\n\nDefinition of glomerular filtration rate (GFR) \n\n\n\n   Baseline 0 (0.0) 6 (8.2) 0.012* 8.2 \n\n\n\n   6 months 0 (0.0) 4 (6.0) 0.043* 6.0 \n\n\n\n   12 months 2 (4.0) 20 (35.7) < 0.001* 31.7 \n\n\n\nKnowledge of CKD stages \n\n\n\n   Baseline 38 (51.4) 34 (46.6) 0.562 -4.8 \n\n\n\n   6 months 47 (70.1) 59 (88.1) 0.011* 18.0 \n\n\n\n   12 months 47 (70.1) 59 (88.1) 0.022* 18.0 \n\n\n\nIncreased risk of heart disease due to CKD \n\n\n\n   Baseline 40 (54.1) 29 (39.7) 0.081 -14.4 \n\n\n\n   6 months 43 (64.2) 60 (89.6) 0.001* 25.4 \n\n\n\n   12 months 40 (80.0) 49 (87.5) 0.296 7.5 \n\n\n\nUnderstanding increased risk of mortality   \n\n\n\n   Baseline 49 (66.2) 44 (60.3) 0.460 -5.9 \n\n\n\n   6 months 61 (91.0) 63 (94.0) 0.511 3.0 \n\n\n\n   12 months 46 (92.0) 51 (91.1) 0.869 -0.9 \n\n\n\n\n\n\n\n*Chi-square or Fisher\u2019s exact test significant at p < 0.05 \n\n\n\n\n\n\n\n\nRoland Nnaemeka Okoro et al. Mal J Pharm 8 (2) 2022, 16-26 \n\n\n\n\n\n\n\n22 \n\n\n\n\n\n\n\n\n\n\n\nbreath at six months (68.7% vs. 26.9%, p < 0.001), and \n\n\n\nmetallic/bad taste at six months (74.6% vs. 34.3%, p < 0.001), \n\n\n\nand 12 months (87.5% vs. 72.0, p = 0.047). Further, \n\n\n\nsignificantly higher proportions of participants in the \n\n\n\nintervention group compared with the control group had correct \n\n\n\nknowledge about nausea/vomiting symptom at six months \n\n\n\n(56.7% vs. 34.3%, p = 0.010), difficulty sleeping at six months \n\n\n\n(65.7% vs. 40.3%, p = 0.003, weight loss at six months (52.2% \n\n\n\nvs. 31.3%, p = 0.015, and 12 months (85.7% vs. 64.0%, p = \n\n\n\n0.010), and no symptoms at all at 12 months (42.9% vs. 24.0%, \n\n\n\np = 0.041) (Table VI).\n\n\n\nThe multivariate logistic analysis using only the participants \n\n\n\nthat completed the study revealed that patients between 40 and \n\n\n\n64 years of age (AOR 26.3, 95% CI 2.1 - 331.0) and 65 years \n\n\n\nor more (AOR 10.1, 95% CI 1.1 - 89.7) had significantly higher \n\n\n\nodds of having good CKD knowledge compared to younger \n\n\n\nones. Also, patients in the intervention group (AOR 2.7, 95% \n\n\n\nCI 1.0 - 7.2) had a significantly higher odds of having good \n\n\n\nCKD knowledge compared to those in the UC group, as shown \n\n\n\nin Table VII. \n\n\n\n\n\n\n\n\n\n\n\nDISCUSSION \n \n\n\n\nTo the best of our knowledge, this is the first study to assess the \n\n\n\nefficacy of pharmacist-led educational interventions in a CKD \n\n\n\npopulation in Africa. Our study found that the intervention \n\n\n\ngroup had a significantly larger proportion of participants who \n\n\n\nhad correct information about kidneys and CKD than the \n\n\n\ncontrol group. Overall, knowledge of CKD improved \n\n\n\nsignificantly in the intervention group compared to the control  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nTable V. Percentage Distribution of Correct Answers in the Kidney Functions Domain \n\n\n\n\n\n\n\nGeneral Knowledge item \nUC \n\n\n\nn (%) \n\n\n\nPI \n\n\n\nn (%) \nP value \n\n\n\nDifferential Change \n\n\n\n(PI \u2013 UC) % \n\n\n\nUrine production \n\n\n\n   Baseline 45 (60.8) 40 (54.8) 0.463 - 6.0  \n\n\n\n   6 months 60 (89.6) 65 (97.0) 0.088 7.4  \n\n\n\n   12 months 42 (84.0) 56 (100.0) 0.002* 16.0 \n\n\n\nRole in waste clearance (\u2018cleaning blood\u2019) \n\n\n\n   Baseline 41 (55.4) 32 (43.8) 0.161 - 11.6 \n\n\n\n   6 months 57 (85.1) 62 (92.5) 0.176 7.4 \n\n\n\n   12 months 38 (76.0) 53 (94.6) 0.006* 18.6 \n\n\n\nRole in bone health \n\n\n\n   Baseline 28 (37.8) 29 (39.7) 0.814 1.9 \n\n\n\n   6 months 58 (86.6) 60 (89.6) 0.593 3.0 \n\n\n\n   12 months 36 (72.0) 48 (85.7) 0.084 13.7 \n\n\n\nRole in hair loss \n\n\n\n   Baseline 9 (12.2) 13 (17.8) 0.343 5.6 \n\n\n\n   6 months 15 (22.4) 50 (74.6) < 0.001* 52.2 \n\n\n\n   12 months 16 (32.0) 24 (42.9) 0.250 10.9 \n\n\n\nRole in anemia \n\n\n\n   Baseline 34 (45.9) 30 (41.1) 0.559 - 4.8 \n\n\n\n   6 months 53 (79.1) 59 (88.1) 0.161 9.0 \n\n\n\n   12 months 40 (80.0) 47 (83.9) 0.603 3.9 \n\n\n\nRole in BP control \n\n\n\n   Baseline 37 (50.0) 32 (43.8) 0.453 - 6.2 \n\n\n\n   6 months 55 (82.1) 62 (92.5) 0.072 10.4 \n\n\n\n   12 months 38 (76.0) 48 (85.7) 0.202 9.7 \n\n\n\nRole in glucose control \n\n\n\n   Baseline 7 (9.5) 7 (9.6) 0.453 0.1 \n\n\n\n   6 months 5 (7.5) 2 (3.0) 0.245 - 4.5 \n\n\n\n   12 months 0 (0.0) 7 (12.5) 0.001* 12.5 \n\n\n\nRole in potassium control \n\n\n\n   Baseline 27 (36.5) 28 (38.4) 0.813 1.9 \n\n\n\n   6 months 49 (73.1) 59 (88.1) 0.029* 15.0 \n\n\n\n   12 months 38 (76.0) 46 (82.1) 0.442 6.1 \n\n\n\nRole in phosphorus control \n\n\n\n   Baseline 26 (35.1) 26 (35.6) 0.950 0.5 \n\n\n\n   6 months 48 (71.6) 60 (89.6) 0.009* 18.0 \n\n\n\n   12 months 38 (76.0) 44 (78.6) 0.798 2.6 \n\n\n\n\n\n\n\n*Chi-square or Fisher\u2019s exact test is significant at p < 0.05 \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nRoland Nnaemeka Okoro et al. Mal J Pharm 8 (2) 2022, 16-26 \n\n\n\n\n\n\n\n23 \n\n\n\n\n\n\n\n\n\n\n\ngroup at six months. Also, a significantly higher proportion of \n\n\n\nparticipants in the intervention group had good knowledge of \n\n\n\nCKD compared to those in the control group at six months. \n\n\n\n\n\n\n\nIn our study, pharmacists\u2019 interventions resulted in \n\n\n\nsignificantly greater proportions of participants who had \n\n\n\ncorrect knowledge about kidneys and CKD. Given the limited \n\n\n\nCKD knowledge among patients with CKD [9], and the \n\n\n\nincreasing prevalence of kidney failure [25], it is imperative to \n\n\n\nimprove CKD knowledge and its management to help improve \n\n\n\nself-management practices capable of retarding or halting the \n\n\n\nprogression to renal failure. Available evidence has shown that \n\n\n\neducational interventions enhance outcomes in other chronic \n\n\n\ndiseases such as heart failure [26], diabetes [27], and chronic \n\n\n\nobstructive pulmonary disease [28]. \n\n\n\n\n\n\n\nOverall, there was improved knowledge of CKD in the \n\n\n\nintervention group compared with the usual care group during \n\n\n\nthe study period. In agreement with our result, an India-based \n\n\n\nnon-randomised and non-controlled study of 69 patients with \n\n\n\nCKD over six months duration that evaluated pharmacists\u2019 \n\n\n\ninterventions also observed significantly improved knowledge \n\n\n\nof CKD among the participants at the end of the study [29]. In \n\n\n\nthis study, pharmacists educated and counselled patients with \n\n\n\nCKD by utilising patient information leaflets, while follow-up \n\n\n\nwas done bi-monthly for a period of six months. A study that \n\n\n\nevaluated the impact of pharmaceutical care among 120 \n\n\n\npatients with pre-dialysis CKD in Pakistan also noted \n\n\n\nsignificant knowledge improvement in the intervention group \n\n\n\nat the end of three months follow-up period [30]. \n\n\n\n\n\n\n\n\n\n\n\nTable VI. Percentage Distribution of Correct Answers in the Symptoms of CKD Progression or Failure Domain \n\n\n\n\n\n\n\nCKD Symptoms Item \nUC \n\n\n\nn (%) \n\n\n\nPI \n\n\n\nn (%) \nP value \n\n\n\nDifferential Change \n\n\n\n(PI \u2013 UC) % \n\n\n\nIncreased fatigue \n\n\n\n   Baseline 48 (64.9) 57 (78.1) 0.077 13.2 \n\n\n\n   6 months 44 (65.7) 60 (89.6) 0.001* 23.9 \n\n\n\n   12 months 40 (80.0) 52 (92.9) 0.051 12.9 \n\n\n\nShortness of breath \n\n\n\n   Baseline 42 (56.8) 36 (49.3) 0.364 -7.5 \n\n\n\n   6 months 18 (26.9) 46 (68.7) < 0.001* 41.8 \n\n\n\n   12 months 38 (76.0) 40 (71.4) 0.594 -4.6 \n\n\n\nMetallic/Bad taste \n\n\n\n   Baseline 44 (59.5) 44 (60.3) 0.921 0.8 \n\n\n\n   6 months 23 (34.3) 50 (74.6) < 0.001* 40.3 \n\n\n\n   12 months 36 (72.0) 49 (87.5) 0.047* 15.5 \n\n\n\nUnusual itching \n\n\n\n   Baseline 31 (41.9) 31 (42.5) 0.942 0.6 \n\n\n\n   6 months 34 (50.7) 42 (62.7) 0.163 12.0 \n\n\n\n   12 months 36 (72.0) 45 (80.4) 0.311 8.4 \n\n\n\nNausea/vomiting \n\n\n\n   Baseline 41(55.4) 34 (46.6) 0.288 -8.8 \n\n\n\n   6 months 23 (34.3) 38 (56.7) 0.010* 22.4 \n\n\n\n   12 months 28 (56.0) 41 (73.2) 0.065 17.2 \n\n\n\nHair loss \n\n\n\n   Baseline 33 (44.6) 35 (47.9) 0.684 3.3 \n\n\n\n   6 months 57 (85.1) 55 (82.1) 0.641 -3.0 \n\n\n\n   12 months 22 (44.0) 18 (32.1) 0.209 -11.9 \n\n\n\nDifficulty sleeping \n\n\n\n   Baseline 38 (51.4) 34 (46.6) 0.562 -4.8 \n\n\n\n   6 months 27 (40.3) 44 (65.7) 0.003* 25.4 \n\n\n\n   12 months 34 (68.0) 42 (75.0) 0.424 7.0 \n\n\n\nWeight loss \n\n\n\n   Baseline 35 (47.3) 29 (39.7) 0.354 -7.6 \n\n\n\n   6 months 21 (31.3) 35 (52.2) 0.015* 20.9 \n\n\n\n   12 months 32 (64.0) 48 (85.7) 0.010* 21.7 \n\n\n\nConfusion \n\n\n\n   Baseline 26 (35.1) 18 (24.7) 0.170 -10.4 \n\n\n\n   6 months 23 (34.3) 23 (34.3) 1.000 0.0 \n\n\n\n   12 months 30 (60.0) 43 (76.8) 0.063 16.8 \n\n\n\nNo symptoms at all     \n\n\n\n   Baseline 3 (4.1) 7 (9.6) 0.188 5.5 \n\n\n\n   6 months 13 (19.4) 3 (4.5) 0.008* -14.9 \n\n\n\n   12 months 12 (24.0) 24 (42.9) 0.041* 18.9 \n\n\n\n\n\n\n\n*Chi-square or Fisher\u2019s exact test is significant at p < 0.05 \n\n\n\n\n\n\n\n\nRoland Nnaemeka Okoro et al. Mal J Pharm 8 (2) 2022, 16-26 \n\n\n\n\n\n\n\n24 \n\n\n\n\n\n\n\nIn this study, pharmacists\u2019 interventions included the provision \n\n\n\nof information on the disease, proper diets, counselling to \n\n\n\nenhance medication adherence, and follow-up through the \n\n\n\ntelephone. Additionally, the result of our study is comparable \n\n\n\nwith that of a non-randomised controlled multi-healthcare \n\n\n\nprofessional collaborative interventional study conducted in \n\n\n\nKorea among patients with pre-dialysis CKD, which reported a \n\n\n\nsignificant improvement in CKD knowledge scores over time \n\n\n\nin the intervention group compared to the control group [31]. \n\n\n\nIn this study, CKD specialists (physicians, nurses, and \n\n\n\nnutritionists) offered interventions such as face-to-face group \n\n\n\neducation and individualised consultation, re-inforcement \n\n\n\neducation, and consultation to build up patients\u2019 self-\n\n\n\nmanagement skills to retard disease progression. Another study \n\n\n\ndone in Korea that included patients undergoing early \n\n\n\nhaemodialysis noted that educational interventions resulted in \n\n\n\nimproved knowledge of patients [32]. Further, a prospective, \n\n\n\npre\u2013post study that enrolled 64 patients with dialysis CKD in \n\n\n\nNepal also reported improved knowledge after pharmacist-\n\n\n\nprovided counselling intervention [33].  Despite, the shorter \n\n\n\nduration of some of these previous studies, in the absence of \n\n\n\nadditional important healthcare professionals required for renal \n\n\n\ncare in the study settings, these findings may suggest a \n\n\n\ncommunication gap between patient and physician. As a result, \n\n\n\nthere is a greater need for a shift in educational tactics, as well \n\n\n\nas the deployment of extra resources and appropriate healthcare \n\n\n\nprofessionals to help facilitate kidney disease education for \n\n\n\npatients. Regarding the additional healthcare professionals \n\n\n\nrequired, a multidisciplinary renal care team that includes a \n\n\n\nclinical pharmacist and other relevant healthcare professionals \n\n\n\nis critical to optimising health outcomes in CKD. The \n\n\n\nimportance of pharmacists in providing patients with \n\n\n\ninformation on blood pressure monitoring, cardiovascular risk \n\n\n\nminimization, medication dose adjustment, and information on \n\n\n\nrenally-eliminated medications, and anaemia management in \n\n\n\nrenal diseases cannot be overstated. This is evidenced by a \n\n\n\nconsiderably higher proportion of participants in our study's \n\n\n\nintervention group who knew about contraindicated \n\n\n\nmedications or those to be used with caution in renal disease \n\n\n\nduring the 12-month trial period. Available evidence \n\n\n\ndemonstrates that increased disease-specific knowledge results \n\n\n\nin an enhanced personal-care practices [29].  \n\n\n\n\n\n\n\nFurthermore, the current pharmacist education programme \n\n\n\ncould expand opportunities for direct connections between \n\n\n\nCKD patients and other important renal care professionals. \n\n\n\nConversely, no significant improvement in knowledge of \n\n\n\nkidney function in the intervention group was observed in the \n\n\n\nKorean study [29]. This finding suggests a potential gap in the \n\n\n\nunderstanding of kidney functions by the participants of this \n\n\n\nstudy despite educational interventions provided by multi-\n\n\n\nhealthcare professionals. Also, contrary to our results, a pre-\n\n\n\nand post-study that involved allied health staff or CKD nurse \n\n\n\neducators\u2019 CKD educational interventions in Australia reported \n\n\n\na minor improvement in patients\u2019 knowledge of kidney disease \n\n\n\nat 12.7 months [34]. Variations in methods, healthcare \n\n\n\nprofessionals, and interventions involved could account for the \n\n\n\nobserved differences.   \n\n\n\nPharmacists' intervention as a significant predictor of good \n\n\n\nCKD knowledge, underscores the importance of kidney disease \n\n\n\npatient education provided by pharmacists. Congruent with our \n\n\n\nresult, a similar study found higher knowledge scores among \n\n\n\nparticipants that reported seeing a CKD educator [21]. \n\n\n\nFurthermore, it has been reported that educational interventions \n\n\n\nprolong the time to dialysis initiation in patients near renal \n\n\n\nreplacement [35]. Like other essential members of the \n\n\n\nmultidisciplinary renal care team, asides from drug-related \n\n\n\nroles, a clinical pharmacist can help fill the knowledge gap of \n\n\n\npatients with CKD about the disease and lifestyle modifications \n\n\n\nto slow the progression of the disease. On the other hand, the \n\n\n\nlikelihood of older participants having better knowledge than \n\n\n\nthe younger ones may be due to their longer time with the \n\n\n\ndisease and increased access to information about the disease \n\n\n\nand its management from health professionals. \n\n\n\n\n\n\n\nThe main strength of the study was the utilisation of two centres \n\n\n\nto control different hospital environment features. Other \n\n\n\nstrengths were randomisation, blinding of participants about \n\n\n\nthe investigators\u2019 profession to avoid bias and a 12-month \n\n\n\nfollow-up. The study did, however, have certain limitations. \n\n\n\nPatients that were included in the study may differ from those \n\n\n\nwho did not participate in some important aspects, which may \n\n\n\nlimit the generalisability of the study findings. Another \n\n\n\nweakness of the study was attrition bias or loss during follow-\n\n\n\nup. Although the tool used is valid and reliable, the data on \n\n\n\nCKD knowledge was self-reported. \n\n\n\nTable VII. The Results of Multivariate Logistic Regression Analysis \n\n\n\nof the Determinants of Good CKD Knowledge \n\n\n\n\n\n\n\nVariable AOR (95% CI) P Value \n\n\n\nAge group (years)   \n\n\n\n   < 40 1.0  \n\n\n\n   40 - 64 26.3 (2.1 - 331.0) 0.011* \n\n\n\n   \u2265 65 10.1 (1.1 - 89.7) 0.038* \n\n\n\nSex   \n\n\n\n   Male 1.0  \n\n\n\n   Female 0.4 (0.2 - 1.2) 0.117 \n\n\n\nMarital status   \n\n\n\n   Single 1.0  \n\n\n\n   Married 1.0 (0.3 - 4.0) 0.977 \n\n\n\nEducational level   \n\n\n\n   None 1.0  \n\n\n\n   Primary 0.8 (0.2 - 2.4) 0.644 \n\n\n\n   Secondary 1.4 (0.4 - 5.3) 0.584 \n\n\n\n   Tertiary 0.4 (0.1 - 1.9) 0.250 \n\n\n\nStudy group   \n\n\n\n   Control 1.0  \n\n\n\n   Experimental 2.7 (1.0 - 7.2) 0.040* \n\n\n\n\n\n\n\n*Significant at p < 0.05; AOR: adjusted odds ratio; CI: Confidence \n\n\n\ninterval \n\n\n\n\n\n\n\n\nRoland Nnaemeka Okoro et al. Mal J Pharm 8 (2) 2022, 16-26 \n\n\n\n\n\n\n\n25 \n\n\n\n\n\n\n\nCONCLUSION  \n \n\n\n\nClinical pharmacists\u2019 educational interventions led to a \n\n\n\nsignificant improvement in the CKD knowledge of patients \n\n\n\nwith pre-dialysis CKD. This demonstrates that the pharmacist \n\n\n\nis a neglected but critical renal care provider in the study \n\n\n\nsetting. Therefore, further studies to evaluate the impact of the \n\n\n\ninterventions provided on healthcare-seeking behaviours, and \n\n\n\nself-management practices are warranted. As a result, there is a \n\n\n\nneed for healthcare policies that include other healthcare \n\n\n\nprofessionals, such as pharmacists, in renal care in LMICs. This \n\n\n\nstrategy has the capacity to improve the quality of care \n\n\n\nprovided to patients with CKD. Finally, more studies are also \n\n\n\nrequired to investigate the long-term economical and clinical \n\n\n\noutcomes of this type of educational programme. \n\n\n\n\n\n\n\nACKNOWLEDGEMENT \n  \n\n\n\nThe authors are grateful to all the study participants for making \n\n\n\nthemselves available for this study. \n\n\n\n\n\n\n\nCONFLICT OF INTEREST \n  \n\n\n\nThis study has no conflict of interest. This research received \n\n\n\ngrant from the Nigerian Tertiary Education Fund (TETfund). \n\n\n\n\n\n\n\nREFERENCE \n \n\n\n\n[1] Okoro RN, Farate VT. Evaluation of potential drug\u2013drug interactions \n\n\n\namong patients with chronic kidney disease in northeastern Nigeria. \n\n\n\nAfrican Journal of Nephrology. 2019;22(1):77-81. \n\n\n\nDoi: https://doi.org/10.21804/22-1-3577 \n\n\n\n[2] Go AS, Chertow GM, Fan D, et al. Chronic kidney disease and the \n\n\n\nrisks of death, cardiovascular events, and hospitalization. N Engl J \n\n\n\nMed. 2004;351(13):1296-305. \n\n\n\nDoi: https://doi.org/10.1056/NEJMoa041031 \n\n\n\n[3] Levey AS, Schoolwerth AC, Burrows NR, et al. Comprehensive \n\n\n\npublic health strategies for preventing the development, progression, \n\n\n\nand complications of CKD: Report of an expert panel convened by the \n\n\n\nCenters for Disease Control and Prevention. Am J Kid Dis. \n\n\n\n2009;53(3):522-35. Doi: https://doi.org/10.1053/j.ajkd.2008.11.019 \n\n\n\n[4] Sever PS, Dahlof B, Poulter NR, et al. Prevention of coronary and \n\n\n\nstroke events with atorvastatin in hypertensive patients who have \n\n\n\naverage or lower-than-average cholesterol concentrations, in the \n\n\n\nAnglo-Scandinavian Cardiac Outcomes Trial-Lipid Lowering Arm \n\n\n\n(ASCOT-LLA): a multicenter randomised controlled trial. Lancet. \n\n\n\n2003;361(9364):1149-58.  \n\n\n\nDoi: https://doi.org/10.1016/S0140-6736(03)12948-0  \n\n\n\n[5] Lewis EJ, Hunsicker LG, Clarke WR, et al. Renoprotective effect of \n\n\n\nthe angiotensin-receptor antagonist irbesartan in patients with \n\n\n\nnephropathy due to type 2 diabetes. N Engl J Med. 2001;345(12):851-\n\n\n\n60. Doi: https://doi.org/10.1056/NEJMoa011303 \n\n\n\n[6] Jain D, Green JA. Health literacy in kidney disease: Review of the \n\n\n\nliterature and implications for clinical practice. World Journal of \n\n\n\nNephrology. 2016;5(2):147-51.  \n\n\n\nDoi: https://doi.org/10.5527/wjn.v5.i2.147 \n\n\n\n[7] Sakraida TJ, Robinson MV. Health Literacy Self-Management by \n\n\n\nPatients with Type 2 Diabetes and Stage 3 Chronic Kidney Disease. \n\n\n\nWest J Nurs Res. 2009;31(5):627-47. \n\n\n\nDoi: https://doi.org/10.1177/0193945909334096 \n\n\n\n[8] Coresh J, Byrd-Holt D, Astor BC, et al. Chronic kidney disease \n\n\n\nawareness, prevalence, and trends among U.S. adults, 1999 to 2000. 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Doi: https://doi.org/10.1155/2010/501957 \n\n\n\n[26] Riegel B, Moser DK, Anker SD, et al. State of the science: Promoting \n\n\n\nself-care in persons with heart failure: A scientific statement from the \n\n\n\nAmerican Heart Association. Circulation. 2009;120(2):1141-63. \n\n\n\nDoi: https://doi.org/10.1161/CIRCULATIONAHA.109.192628 \n\n\n\n[27] Steinsbekk A, Rygg L, Lisulo M, et al. Group based diabetes self-\n\n\n\nmanagement education compared to routine treatment for people with \n\n\n\ntype 2 diabetes mellitus. A systematic review with meta-analysis. \n\n\n\nBMC Health Serv Res, 2012;12:213. \n\n\n\n\nhttps://doi.org/10.21804/22-1-3577\n\n\nhttps://doi.org/10.1056/NEJMoa041031\n\n\nhttps://doi.org/10.1053/j.ajkd.2008.11.019\n\n\nhttps://doi.org/10.1016/S0140-6736(03)12948-0\n\n\nhttps://doi.org/10.1056/NEJMoa011303\n\n\nhttps://doi.org/10.5527/wjn.v5.i2.147\n\n\nhttps://doi.org/10.1177/0193945909334096\n\n\nhttps://doi.org/10.1681/ASN.2004070539\n\n\nhttps://doi.org/10.1038/ki.2008.376\n\n\nhttps://doi.org/10.1053/j.ajkd.2005.08.017\n\n\nhttps://www.niddk.nih.gov/health-information/communication-programms/nkdep/\n\n\nhttps://www.niddk.nih.gov/health-information/communication-programms/nkdep/\n\n\nhttps://doi.org/10.1016/S0272-6386(02)70084-X\n\n\nhttps://doi.org/10.1053/j.ajkd.2010.09.018\n\n\nhttps://doi.org/10.7326/0003-4819-145-4-200608150-00004\n\n\nhttps://doi.org/10.7326/0003-4819-145-4-200608150-00004\n\n\nhttps://www.kidney.org/content/mdrd-study-equation\n\n\nhttps://doi.org/10.1155/2010/501957\n\n\nhttps://doi.org/10.1161/CIRCULATIONAHA.109.192628\n\n\n\n\n\n\nRoland Nnaemeka Okoro et al. Mal J Pharm 8 (2) 2022, 16-26 \n\n\n\n\n\n\n\n26 \n\n\n\n\n\n\n\nDoi: https://doi.org/10.1186/1472-6963-12-213 \n\n\n\n[28] Hurley J, Gerkin RD, Fahy B, et al. Meta-analysis of self-management \n\n\n\neducation for patients with chronic obstructive pulmonary disease. \n\n\n\nSouthwest Journal of Pulmonary, Critical Care and Sleep. 2012;4:194-\n\n\n\n202. \n\n\n\n[29] Baby B, Antony CL, Wilson S, et al. Evaluation of the impact of \n\n\n\npharmaceutical care on improving knowledge and medication \n\n\n\nadherence in CKD patients. Int J Pharm Pharm Sci. 2017;9(1):63-6. \n\n\n\nDoi: https://doi.org/10.22159/ijpps.2017v9i1.15053 \n\n\n\n[30] Khokhar A, Khan YH, Mallhi TH, et al. Effectiveness of pharmacist \n\n\n\nintervention model for chronic kidney disease patients; a prospective \n\n\n\ncomparative study. Intl J Clin Pharm. 2020. \n\n\n\nDoi: https://doi.org/10.1007/s11096-020-00982-w \n\n\n\n[31] Choi ES, Lee J. Effects of a Face-to-face Self-management Program \n\n\n\non Knowledge, Self-care Practice and Kidney Function in Patients \n\n\n\nwith Chronic Kidney Disease before the Renal Replacement Therapy. \n\n\n\nJ Korean Acad Nurs. 2012;42(7):1070-8. \n\n\n\nDoi: https://doi.org/10.4040/jkan.2012.42.7.1070  \n\n\n\n[32] Kim AY, Kim SJ. The effect of education program on early \n\n\n\nhemodialysis patients\u2019 knowledge, self-care practice and physiologic \n\n\n\nindex. The Seoul Journal of Nursing, 2008;13(1):95-109. \n\n\n\n[33] Ghimirey A, Sapkota B, Shrestha S, et al. Evaluation of pharmacist \n\n\n\ncounseling in improving knowledge, attitude, and practice in chronic \n\n\n\nkidney disease patients. SAGE Open Medicine. 2013.  \n\n\n\nDoi: https://doi.org/10.1177/2050312113516111 \n\n\n\n[34] Gray NA, Kapojos JK, Burke MT, et al. Patient kidney disease \n\n\n\nknowledge remains inadequate with standard nephrology outpatient \n\n\n\ncare. 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Doi: https://doi.org/10.1016/s0272-6386(03)00835-7 \n\n\n\n \n\n\n\n\nhttps://doi.org/10.1186/1472-6963-12-213\n\n\nhttps://doi.org/10.22159/ijpps.2017v9i1.15053\n\n\nhttps://doi.org/10.1007/s11096-020-00982-w\n\n\nhttps://doi.org/10.4040/jkan.2012.42.7.1070\n\n\nhttps://doi.org/10.1177/2050312113516111\n\n\nhttps://doi.org/10.1093/ckj/sfv108\n\n\nhttps://doi.org/10.1016/s0272-6386(03)00835-7\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Volume 8 Issue 2 (2022) \n \n\n\n\n\n\n\n\n27 \n\n\n\n\n\n\n\n*Correspondence: stephanietan@ppukm.ukm.edu.my \n\n\n\nDOI: 10.52494/EHEI1319 \n\n\n\nPharmacy Department, Hospital Canselor Tuanku Muhriz, Universiti \n\n\n\nKebangsaan Malaysia \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n Original Research Article \n\n\n\n\n\n\n\nAn Evaluation of Medication Adherence to Tyrosine Kinase \n\n\n\nInhibitors Among Chronic Myeloid Leukemia Patients \n\n\n\nUnderwent Medication Therapy Adherence Clinic in a \n\n\n\nMalaysian Tertiary Hospital \n \n\n\n\nStephanie Wai Yee Tan*, Sarah Anne Robert, Lay Yen Gan, Suet Yin Chin, Chee Lan Lau, Aisya \n\n\n\nNabilah Abd Rahman, Kiew Bing Pau, Shue Hong Kong, Farah Waheeda Tajurudin, Mei Kuen Yin, \n\n\n\nSheah Lin Ghan, Nur Jannah Azman, Pooi Wan Mok, Xin Yun Chua, Poy Kei Lye, Rozita Mohd \n\n\n\nIdris, Nur Liyana Saharudin, Dexter Van Dort \n\n\n\n\n\n\n\n \nArticle Info  \n\n\n\n \nReceived date: 19 Apr 2022 \n\n\n\nAccepted date: 05 Dec 2022 \n\n\n\nPublished date: 31 Dec 2022 \n\n\n\n\n\n\n\nKeywords: chronic myeloid \n\n\n\nleukemia; tyrosine kinase \n\n\n\ninhibitor; medication \n\n\n\nadherence \n\n\n\nABSTRACT  \n\n\n\n\n\n\n\nIntroduction: The treatment of chronic phase chronic myeloid leukemia (CML) has changed \n\n\n\ndramatically within the last two decades with the emergence of tyrosine kinase inhibitors (TKI). \n\n\n\nTreatment adherence to long-term TKI is pivotal to improving clinical outcomes in CML patients. \n\n\n\nObjective: To evaluate medication adherence to TKI and contributory variables affecting medication \n\n\n\nadherence among CML patients underwent Medication Therapy Adherence Clinic (MTAC). \n\n\n\nMethod: This was a single-centre cross-sectional study conducted between January and December \n\n\n\n2021. Malaysia Medication Adherence Assessment Tool (MyMAAT) was employed to assess \n\n\n\nmedication adherence among CML MTAC patients. Descriptive statistics were used to summarise \n\n\n\nadherence information. Fisher\u2019s exact test was performed to examine relationships between TKI \n\n\n\nadherence level, demographic and clinical variables. Result: Records of 41 patients (61% male, 39% \n\n\n\nfemale) at average age of 51 years old (range = 26 to 75) were analysed. They had been taking \n\n\n\nimatinib (48.8%) and nilotinib (51.2%) for an average of 6.3 years (range = 17 days to 18 years). \n\n\n\nOverall, 90% of the patients were adherent (MyMAAT score \u2265 54) to their TKI treatment (95% of \n\n\n\npatients on imatinib, 86% of patients on nilotinib). Medication adherence to TKI was not significantly \n\n\n\ninfluenced by demographic variables (i.e. age, gender) and clinical variables (i.e. years on TKI, \n\n\n\nnumber of TKI pills per day, type of TKI therapy). Conclusion: Majority of the CML MTAC patients \n\n\n\n(90%) were adherent to their TKI therapy. Adherence scores were not affected by the demographics \n\n\n\nand clinical variables investigated in this study. This affirms the role of pharmacists in implementing \n\n\n\nan individualised and comprehensive intervention strategy. \n\n\n\n\n\n\n\nINTRODUCTION  \n \n\n\n\nChronic myeloid leukaemia (CML) is a clonal \n\n\n\nmyeloproliferative disease characterised by the presence of the \n\n\n\nPhiladelphia chromosome and its fusion gene, BCR-ABL. \n\n\n\nBCL-ABL oncogene codes for an oncoprotein which in turn \n\n\n\nstimulates myeloid cells proliferation [1]. According to the \n\n\n\nMalaysian National Cancer Registry Report 2007\u20132011, there \n\n\n\nwere 573 CML patients in Malaysia at the time of reporting, \n\n\n\nwhich accounts for 12.5% of total leukaemia cases in the \n\n\n\ncountry [2].  \n\n\n\n\n\n\n\nThe advent of tyrosine kinase inhibitor (TKI) targeting the \n\n\n\nBCL-ABL oncoprotein has transformed the treatment \n\n\n\nlandscape of this previously fatal disease by augmenting \n\n\n\ndisease response and reducing treatment-related morbidity. \n\n\n\n\nmailto:stephanietan@ppukm.ukm.edu.my\n\n\n\n\n\n\nTan W.Y. et al. Mal J Pharm 8 (2) 2022, 27-31 \n\n\n\n\n\n\n\n\n\n\n\n28 \n\n\n\n\n\n\n\nImatinib, nilotinib and ponatinib are the TKIs currently \n\n\n\nregistered in Malaysia. The majority of CML patients in \n\n\n\nMalaysia gain access to TKI therapy under the Malaysia Patient \n\n\n\nAssistance Programme (MYPAP), a public-private partnership \n\n\n\nlaunched by a pharmaceutical company in collaboration with \n\n\n\nthe Ministry of Health [3]. \n\n\n\n\n\n\n\nAlthough treatment outcome for CML patients has markedly \n\n\n\nimproved owing to the emergence of these oral targeted \n\n\n\ntherapies, the suboptimal response is still reported in a \n\n\n\nsubgroup of patients [4]. Apart from the development of \n\n\n\ngenetic mutations and poor access to medication, poor \n\n\n\nadherence to TKI is also one of the factors contributing to \n\n\n\nsuboptimal response and treatment failure [5][6]. \n\n\n\n\n\n\n\nMedication adherence can be defined as the extent to which the \n\n\n\npatient\u2019s actions meet the prescriber\u2019s recommendations or \n\n\n\nexpectations [7]. For long-term conditions, it is estimated that \n\n\n\n30-50% of prescribed medicines are not taken as \n\n\n\nrecommended. A meta-analysis found that between a quarter to \n\n\n\none-third of CML patients were not adhering to their TKI \n\n\n\ntherapy [8]. \n\n\n\n\n\n\n\nThe CML Medication Therapy Adherence Clinic (MTAC) is a \n\n\n\nservice provided by the Pharmacy Department of Hospital \n\n\n\nCanselor Tuanku Muhriz (HCTM UKM). Interviews, \n\n\n\nindividualised counselling, and medication adherence \n\n\n\nassessment are carried out by pharmacists during MTAC to \n\n\n\noptimise TKI therapy and enhance patients\u2019 adherence to \n\n\n\nprescribed treatment. All CML MTAC pharmacists underwent \n\n\n\none training session on theory and one practical session in an \n\n\n\nactual clinic setting. \n\n\n\n\n\n\n\nTo date, there has been a lack of local studies focusing on \n\n\n\nmedication adherence among CML patients treated with TKIs. \n\n\n\nThis study aims to evaluate medication adherence to TKI \n\n\n\namong CML MTAC patients and explore the possible variables \n\n\n\nassociated with TKI adherence in a tertiary hospital in \n\n\n\nMalaysia. \n\n\n\n\n\n\n\nMATERIAL AND METHOD \n \n\n\n\nStudy Design and Population \n\n\n\n\n\n\n\nThis cross-sectional study included adult patients who attended \n\n\n\nCML MTAC between January 2021 to December 2021 \n\n\n\n(totalling 16 sessions) conducted by 15 pharmacists on a \n\n\n\nrotation basis. The CML MTAC is held fortnightly in \n\n\n\nconjunction with CML outpatient clinics. Patients recruited are \n\n\n\ndiagnosed with chronic- or accelerated-phase CML, are on \n\n\n\nactive treatment with either imatinib or nilotinib for \u2265 2 weeks \n\n\n\nand  can arrive 30 minutes earlier than their assigned time for \n\n\n\ntheir doctor\u2019s appointments. Total population sampling was \n\n\n\nemployed. As part of the MTAC workflow, patients\u2019 \n\n\n\nmedication adherence was evaluated using the Malaysia \n\n\n\nMedication Adherence Assessment Tool (MyMAAT), a 12-\n\n\n\nitem, bilingual (English and Malay), a self-administered \n\n\n\nquestionnaire consisting of 5 constructs. [9] Each question is a \n\n\n\n5-point Likert item from \"strongly disagree\" to \"strongly \n\n\n\nagree\u201d.  The MyMAAT score was the sum of the marks for the \n\n\n\nindividual items ranging between 12 and 60. Medication \n\n\n\nadherence was categorised as good adherence (MyMAAT \n\n\n\nscore \u226554) and moderate/poor adherence (MyMAAT score \n\n\n\n<54). The scores were documented manually on the patient\u2019s \n\n\n\npharmaceutical care form. \n\n\n\n\n\n\n\nThe sample size was calculated using Cochran\u2019s equation. This \n\n\n\nstudy requires 41 samples to represent the population size of 45 \n\n\n\nat a 5% confidence interval with an alpha of 0.05, a power of \n\n\n\n0.8 and an estimated proportion of 0.5. \n\n\n\n\n\n\n\nData Analysis \n\n\n\n\n\n\n\nStatistical analysis was performed using SPSS\u00ae (version 26). \n\n\n\nPower and sample size calculations were performed using \n\n\n\nG*Power 3.1.9.4. the demographic characteristics of the \n\n\n\npatients (age and gender) were obtained from the hospital \n\n\n\ninformation system. Clinical characteristics (type of TKI, dose \n\n\n\nand frequency, TKI pills per day, duration on TKI treatment) \n\n\n\nwere retrieved from the hospital's e-prescribing system. \n\n\n\nDescriptive statistics were used to summarise the adherence \n\n\n\ninformation retrieved from pharmaceutical care forms. \n\n\n\nMedication adherence was assessed during every MTAC visit. \n\n\n\nIf there were two MyMAAT scores available in our records for \n\n\n\nthe same patient within the study period, the latest score was \n\n\n\nused for data analysis. Hence, the medication adherence \n\n\n\nmeasured represented the patient\u2019s adherence after at least one \n\n\n\nsession of MTAC.  Fisher\u2019s exact test was employed to \n\n\n\nexamine the association between patients\u2019 demographic and \n\n\n\nclinical variables with medication adherence towards TKI \n\n\n\ntherapy. A two-tailed p-value of <0.05 was considered as \n\n\n\nstatistically significant. \n\n\n\n\n\n\n\nPost-hoc Analysis  \n\n\n\n\n\n\n\nThe internal consistency of MyMAAT was tested using \n\n\n\nCronbach\u2019s alpha (Cronbach\u2019s alpha = 0.787). The required \n\n\n\nsample size for Fisher\u2019s exact test to achieve the power of 0.8, \n\n\n\nwith \u03b1=0.05 was 808 (404 per group). \n\n\n\n\n\n\n\nRESULT  \n \n\n\n\nOf the 45 patient records retrieved from the CML MTAC, 41 \n\n\n\npatients were included in the final analysis. A total of 4 patients \n\n\n\nwere excluded due to incomplete data (n=3) and funding issues \n\n\n\nleading to interruption of drug supply (n=1). \n\n\n\n\n\n\n\n\nTan W.Y. et al. Mal J Pharm 8 (2) 2022, 27-31 \n\n\n\n\n\n\n\n\n\n\n\n29 \n\n\n\n\n\n\n\nAdherence to TKI treatment \n\n\n\n\n\n\n\nOverall, 90% (n=37) of the study population showed good \n\n\n\nadherence to TKI treatment. As shown in Figure 1, amongst \n\n\n\npatients receiving imatinib (n=20) and nilotinib (n=21), 95% \n\n\n\nand 86% of them demonstrated good medication adherence, \n\n\n\nrespectively. \n\n\n\n\n\n\n\n \nFigure I. Adherence to TKI Treatment Among CML MTAC Patients \n\n\n\n\n\n\n\nDemographic and Clinical Variables \n\n\n\n\n\n\n\nTable I shows the demographic and clinical variables of the 41 \n\n\n\npatients analysed. 41.5% (n=17) of the patients were elderly, \n\n\n\naged at least 60 years old. 82.4% (n=14) of the elderly patients \n\n\n\nshowed good adherence. The number of male patients recruited \n\n\n\n(n=25, 61.0%) was higher than that of female patients (n=16, \n\n\n\n39.0%). A greater proportion of males (n=24, 96.0%) showed \n\n\n\ngood adherence compared to their female counterparts (n=13, \n\n\n\n81.2%). The majority of the patients (n=31, 75.6%) had been \n\n\n\non TKI treatment for less than 10 years with 87.1% (n=27) of \n\n\n\nthem showing a good adherence. Meanwhile, 100% (n=10) of \n\n\n\npatients on TKI treatment for more than 10 years demonstrated \n\n\n\ngood adherence. Most of the patients (n=25, 61.0%) were \n\n\n\ntaking only one to two tablets per day for their CML treatment \n\n\n\nwith 84% (n=21) of them demonstrating good adherence. 39% \n\n\n\n(n=16) of the study population were taking three to four tablets \n\n\n\nper day and all of them showed good adherence. \n\n\n\n\n\n\n\nAmongst all the demographic and clinical variables analysed, \n\n\n\nthere was no significant difference (p-value > 0.05) observed \n\n\n\nacross the subjects in terms of adherence towards TKI \n\n\n\ntreatment. \n\n\n\n\n\n\n\n\n\n\n\nTable I: Association between demographic and clinical characteristics of patients (n=41) with adherence to TKI treatment \n\n\n\n\n\n\n\nCharacteristic Frequency Percentage Adherence Level Frequency (Percentage) p-value \n\n\n\nGood Moderate/Poor \n\n\n\nAge* Mean = 51 Range = 26-75    \n\n\n\n<60 years 24 58.5 23 (95.8) 1 (4.2) 0.29 \n\n\n\n\u226560 years 17 41.5 14 (82.4) 3 (17.6)  \n\n\n\n\n\n\n\nGender      \n\n\n\nMale 25 61.0 24 (96.0) 1 (4.0) 0.28 \n\n\n\nFemale 16 39.0 13 (81.2) 3 (18.8)  \n\n\n\n\n\n\n\nYears on TKI Treatment* Mean = 6.3 Range=17days-18 years    \n\n\n\n<10 years 31 75.6 27 (87.1) 4 (12.9) 0.56 \n\n\n\n\u226510 years 10 24.4 10 (100.0) 0 (0.0)  \n\n\n\n\n\n\n\nType of TKI      \n\n\n\nImatinib 20 48.8 19 (95.0) 1 (5.0) 0.61 \n\n\n\nNilotinib 21 51.2 18 (85.7) 3 (14.3)  \n\n\n\n\n\n\n\nDosing Frequency      \n\n\n\nOnce a day 20 48.8 19 (95.0) 1 (5.0) 0.61 \n\n\n\nTwice a day 21 51.2 18 (85.7) 3 (14.3)  \n\n\n\n\n\n\n\n\n\n\n\nTKI Pill(s) per Day      \n\n\n\n1-2 25 61.0 21 (84.0) 4 (16.0) 0.14 \n\n\n\n3-4 16 39.0 16 (100.0) 0 (0.0)  \n\n\n\n\n\n\n\n*at the time of adherence evaluation \n\n\n\nGood adherence (MyMAAT score \u226554), Moderate/Poor adherence (MyMAAT score <54) \n\n\n\n\n\n\n\n\nTan W.Y. et al. Mal J Pharm 8 (2) 2022, 27-31 \n\n\n\n\n\n\n\n\n\n\n\n30 \n\n\n\n\n\n\n\nDISCUSSION \n \n\n\n\nThe substantially higher number of male CML patients \n\n\n\nrecruited in the study is consistent with the male/female ratio \n\n\n\nof 1.2\u20131.7 demonstrated in epidemiology studies. [10] The \n\n\n\nsimilar amount of imatinib and nilotinib patients recruited is in \n\n\n\ncongruence with the MYPAP allocation of 1:1 for these TKIs \n\n\n\nat our institution. \n\n\n\n\n\n\n\nThe study population demonstrated relatively better adherence \n\n\n\ntowards TKI treatment as a whole compared to another local \n\n\n\nstudy conducted among CML patients. [11] Patients on \n\n\n\nimatinib treatment showed higher medication adherence \n\n\n\nprobably due to a better tolerance profile. Compared to other \n\n\n\nTKIs, imatinib showed better tolerability due to fewer drug-\n\n\n\nrelated adverse effects and its convenience with once-daily \n\n\n\ndosing [12]. More optimal adherence among the patients in this \n\n\n\nstudy might be the effect of participation in CML MTAC. All \n\n\n\npatients in this study were active MTAC patients who have \n\n\n\nattended at least 1 session of MTAC prior to data collection. \n\n\n\nThe beneficial effects of medication management services on \n\n\n\nTKI adherence and clinical outcome were demonstrated in a \n\n\n\nnumber of studies. [13] A randomised controlled trial done in \n\n\n\ntwo Malaysian hospitals found that pharmacist-led \n\n\n\ninterventions resulted in significantly better medication \n\n\n\nadherence and faster achievement of major molecular response, \n\n\n\nespecially during the early months after treatment initiation. \n\n\n\n[14] \n\n\n\n\n\n\n\nTKI-specific clinical factors like the number of TKI pills per \n\n\n\nday and dosing frequency were not associated with TKI \n\n\n\nadherence in this study. TKI adherence can be affected by the \n\n\n\ntotal pill burden per day contributed by medications used to \n\n\n\ntreat other concomitant diseases. Concomitant drug burden was \n\n\n\nidentified by Efficace F et al. to be one of the predictors of \n\n\n\ntreatment non-adherence in patients on long-term imatinib \n\n\n\ntherapy. [15] Another group of predictors which was not \n\n\n\nexplored in the present study is drug-related issues like \n\n\n\nsideeffects of TKI. Lee PM et al. found a significant association \n\n\n\nbetween nausea and vomiting experienced by CML patients \n\n\n\nand patient adherence in a Malaysian hospital. [11] \n\n\n\n\n\n\n\nMyMAAT is a relatively new tool developed to assess \n\n\n\nmedication adherence and validated among the diabetic \n\n\n\npopulation (Cronbach alpha = 0.910). [9] It is widely utilised \n\n\n\nby pharmacists in Malaysian hospitals for various patient \n\n\n\npopulations and is included in various MTAC protocols. [16] \n\n\n\n[17] To the best of our knowledge, this is the first study that \n\n\n\nutilises MyMAAT to assess medication adherence in CML \n\n\n\npatients. Apart from assessing overall adherence based on the \n\n\n\ntotal score, pharmacists can identify domains in which the \n\n\n\npatients showed suboptimal scoring and provide follow-up \n\n\n\ncounselling and/or education tailored to individual patients. \n\n\n\nCompared to the most widely used MMAS-8 which involves a \n\n\n\nfixed charge per form used, MyMAAT is more economical. \n\n\n\n[18] Other commonly used adherence assessment methods like \n\n\n\npill count and medication possession ratio require patients to \n\n\n\nbring their medications to every clinic visit and have the \n\n\n\navailability of complete dispensing records respectively. These \n\n\n\nare less convenient to be employed for day-to-day practice for \n\n\n\nMTAC service. \n\n\n\n\n\n\n\nA pilot study to test the feasibility of MyMAAT in CML \n\n\n\npatients was not carried out as data was collected \n\n\n\nretrospectively from MTAC records where MyMAAT was \n\n\n\nalready incorporated into the clinic workflow. Post-hoc \n\n\n\nreliability analysis shows acceptable internal consistency of \n\n\n\nMyMAAT (Cronbach alpha = 0.787) in our study population. \n\n\n\nValidation of the tool in CML population could be done in \n\n\n\nfuture studies with a larger sample size. \n\n\n\n\n\n\n\nOne of the limitations of this study is the small sample size as \n\n\n\nit was a single-centre study targeting a relatively uncommon \n\n\n\ndisease. The study population consisted of patients who \n\n\n\nattended MTAC throughout 2021 during the coronavirus \n\n\n\npandemic. They might be more health-conscious and more \n\n\n\nadherent to their treatment. This study also did not include \n\n\n\npatients who defaulted clinic appointments. The final sample \n\n\n\nsize of 41 was able to represent the study population and reflect \n\n\n\nthe overall medication adherence level. However, post-hoc \n\n\n\nanalysis demonstrated that the sample size was inadequate to \n\n\n\nachieve desirable power to detect the association of different \n\n\n\nvariables and medication adherence (if any). \n\n\n\n\n\n\n\nDespite attending regular physician consultations and \n\n\n\ncounselling sessions by pharmacists, 10% of the patients \n\n\n\nshowed suboptimal adherence which has no association with \n\n\n\ncertain demographics and clinical variables. This highlights \n\n\n\nother factors or gaps in service that require further approaches. \n\n\n\nFurther studies could be done prospectively to explore other \n\n\n\nfactors like socioeconomic status, access to medication, drug-\n\n\n\nrelated issues, education level as well as concomitant diseases \n\n\n\nand medications that might influence TKI adherence. \n\n\n\n\n\n\n\nCONCLUSION  \n \n\n\n\nMajority of the CML MTAC patients (90%) were adherent to \n\n\n\ntheir long-term TKI treatment. This affirms the role of \n\n\n\npharmacists in implementing an individualised and \n\n\n\ncomprehensive intervention strategy to optimise TKI treatment \n\n\n\nand resolve drug-related issues during MTAC service. \n\n\n\nAdherence scores were not affected by the demographics and \n\n\n\nclinical variables investigated in this study. Future studies \n\n\n\ninvolving a larger sample size are warranted to identify factors \n\n\n\nassociated with adherence to TKI therapy. \n\n\n\n \n\n\n\n\n\n\n\n\nTan W.Y. et al. Mal J Pharm 8 (2) 2022, 27-31 \n\n\n\n\n\n\n\n\n\n\n\n31 \n\n\n\n\n\n\n\nCONFLICT OF INTEREST \n  \n\n\n\nThe authors declare no conflict of interest. \n\n\n\n\n\n\n\nACKNOWLEDGEMENT \n  \n\n\n\nThere was no funding obtained for this work. We thank all our \n\n\n\ncolleagues especially staff from the Outpatient Pharmacy Unit \n\n\n\nin ensuring correct use and sufficient supply of patients\u2019 TKI \n\n\n\nmedications as well as staff from CML Outpatient Clinic in \n\n\n\nfacilitating pharmacists to run CML MTAC smoothly. \n\n\n\n\n\n\n\nREFERENCE \n \n\n\n\n[1] National Comprehensive Cancer Network. Clinical Practice \n\n\n\nGuidelines in Oncology: Chronic Myeloid Leukemia V.2.2022.2021 \n\n\n\n[cited 2022 Feb 5] Available from: \n\n\n\nhttps://www.nccn.org/professionals/physician_gls/pdf/cml.pdf. \n\n\n\n[2] Azizah Ab M NSIT, Noor Hashimah A, Asmah Z.A, Mastulu W. \n\n\n\nMalaysian National Cancer Registry Report 2011 [cited 2022 Feb 5] \n\n\n\nAvailable from: https://www.crc.gov.my/wp-\n\n\n\ncontent/uploads/documents/report/MNCRRrepor2007-2011.pdf.  \n\n\n\n[3] Ministry of Health Malaysia. National Strategic Plan for Cancer \n\n\n\nControl Programme 2016-2020, 1st ed. [cited 2022 Feb 5] Available \n\n\n\nfrom: https://www.iccp-portal.org/plans/national-strategic-plan-\n\n\n\ncancer-control-programme \n\n\n\n[4] Deininger M, O\u2019Brien SG, Guilhot F, Goldman JM, Hochhaus A, \n\n\n\nHughes TP, et al. 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Global, Regional, \n\n\n\nand National Burden of Chronic Myeloid Leukemia, 1990-2017: A \n\n\n\nSystematic Analysis for the Global Burden of Disease Study 2017. \n\n\n\nFront Oncol. 2020 Dec 15;10:580759. \n\n\n\nhttps://doi.org/10.3389/fonc.2020.580759 \n\n\n\n[11] Lee PM, Chang CT, Yusoff ZM. Adherence to tyrosine kinase \n\n\n\ninhibitors among adult chronic myeloid leukemia patients in a \n\n\n\nMalaysia hospital. Int J Clin Pharm. 2021;43(1):46\u201354.  \n\n\n\nhttps://doi.org/10.1007/s11096-020-01070-9 \n\n\n\n[12] Tang L, Zhang H, Peng Yz, Li Cg, Jiang Hw, Xu M, et al. \n\n\n\nComparative efficacy and tolerability of front-line treatments for \n\n\n\nnewly diagnosed chronic-phase chronic myeloid leukemia: an update \n\n\n\nnetwork meta-analysis. BMC Cancer. 2019;19:849.  \n\n\n\nhttps://doi.org/10.1186/s12885-019-6039-9 \n\n\n\n[13] Tan BK, Bee PC, Chua SS, Chen LC. Monitoring and Improving \n\n\n\nAdherence to Tyrosine Kinase Inhibitors in Patients with Chronic \n\n\n\nMyeloid Leukemia: A Systematic Review. Patient Prefer Adherence. \n\n\n\n2021 Nov 18;15:2563-2575. https://doi.org/10.2147/PPA.S269355. \n\n\n\n[14] Tan BK, Chua SS, Chen LC, Chang KM, Balashanker S, Bee PC. \n\n\n\nEfficacy of a medication management service in improving adherence \n\n\n\nto tyrosine kinase inhibitors and clinical outcomes of patients with \n\n\n\nchronic myeloid leukaemia: a randomised controlled trial. Sup Care \n\n\n\nCancer. 2020;28(7):3237\u20133247. https://doi.org/10.1007/s00520-019-\n\n\n\n05133-0 \n\n\n\n[15]  Efficace F, Baccarani M, Rosti G, Cottone F, Castagnetti F, Breccia \n\n\n\nM, et al. Investigating factors associated with adherence behaviour in \n\n\n\npatients with chronic myeloid leukemia: an observational patient-\n\n\n\ncentered outcome study. British Journal of Cancer. 2012 Sep \n\n\n\n4;107(6):904\u2013909. https://doi.org/10.1038/bjc.2012.348. \n\n\n\n[16] Ministry of Health Malaysia. Pharmacy Information System (PhIS) \n\n\n\nand Clinic Pharmacy System (CPS): User Manual Medication \n\n\n\nTherapy Adherence Clinic (MTAC), 12th Ed. [cited 2022 Oct 28] \n\n\n\nAvailable from: \n\n\n\nhttps://phisportal.moh.gov.my/sites/default/files/phis_attachments_3\n\n\n\n9556/U.%20MANUAL_MTAC-12th%20E.pdf \n\n\n\n[17]  Pharmaceutical Services Programme, Ministry of Health Malaysia. \n\n\n\nProtocol Medication Therapy Adherence Clinic (MTAC) Psoriasis, \n\n\n\n2nd Ed. 2021. \n\n\n\n[18]  Morisky Medication Adherence Research, LLC. (n.d,) MMAS \n\n\n\nLicense Pricing. [cited 2022 Oct 28] Available from: \n\n\n\nhttp://www.moriskyscale.com/mmas-license-pricing.html#/ \n\n\n\n \n\n\n\n\nhttps://www.nccn.org/professionals/physician_gls/pdf/cml.pdf\n\n\nhttps://www.crc.gov.my/wp-content/uploads/documents/report/MNCRRrepor2007-2011.pdf.\n\n\nhttps://www.crc.gov.my/wp-content/uploads/documents/report/MNCRRrepor2007-2011.pdf.\n\n\nhttps://www.iccp-portal.org/plans/national-strategic-plan-cancer-control-programme\n\n\nhttps://www.iccp-portal.org/plans/national-strategic-plan-cancer-control-programme\n\n\nhttps://doi.org/10.1182/blood.V114.22.1126.1126\n\n\nhttps://doi.org/10.1182/blood-2010-10-309807\n\n\nhttps://doi.org/10.1200/JCO.2009.26.3087\n\n\nhttps://doi.org/10.1182/blood.V128.22.3610.3610\n\n\nhttps://doi.org/10.1371/journal.pone.0241909\n\n\nhttps://doi.org/10.3389/fonc.2020.580759\n\n\nhttps://doi.org/10.1007/s11096-020-01070-9\n\n\nhttps://doi.org/10.1186/s12885-019-6039-9\n\n\nhttps://doi.org/10.2147/PPA.S269355.\n\n\nhttps://doi.org/10.1007/s00520-019-05133-0\n\n\nhttps://doi.org/10.1007/s00520-019-05133-0\n\n\nhttps://doi.org/10.1038/bjc.2012.348.\n\n\nhttps://phisportal.moh.gov.my/sites/default/files/phis_attachments_39556/U.%20MANUAL_MTAC-12th%20E.pdf\n\n\nhttps://phisportal.moh.gov.my/sites/default/files/phis_attachments_39556/U.%20MANUAL_MTAC-12th%20E.pdf\n\n\nhttp://www.moriskyscale.com/mmas-license-pricing.html%23/\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Volume 8 Issue 2 (2022) \n \n\n\n\n\n\n\n\n\n\n\n\n32 \n\n\n\n\n\n\n\n*Correspondence: cjherng1205@yahoo.com.my \n\n\n\nDOI: 10.52494/RIPY4395 \n\n\n\nDepartment of Pharmacy, Hospital Ampang, Ministry of Health Malaysia, \n\n\n\nJalan Mewah Utara, Taman Pandan Mewah, 68000 Ampang Jaya, \n\n\n\nSelangor, Malaysia. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n Original Research Article \n\n\n\n\n\n\n\nCyclosporine use in post haematopoietic stem cell transplant: \n\n\n\nFactors affecting the initial cyclosporine concentration and its \n\n\n\nassociation with acute graft-versus-host-disease \n   \n\n\n\nChoi Jing Herng*, Nur Azrina Binti Muhamad Moosa , Suuria A/P Subramaniam , Lim V Co, Io Shir \n\n\n\nHwa \n\n\n\n \nArticle Info  \n\n\n\n \nReceived date: 14 Nov 2022  \n\n\n\nAccepted date: 03 Dec 2022 \n\n\n\nPublished date: 31 Dec 2022 \n\n\n\n\n\n\n\nKeywords: Haematopoietic \n\n\n\nstem cell transplant, graft-\n\n\n\nversus-host disease, \n\n\n\ncyclosporine \n\n\n\nABSTRACT  \n\n\n\n\n\n\n\nBackground: Cyclosporine (CSA) is required as a prophylaxis of graft-versus-host disease (GVHD) \n\n\n\nfollowing allogeneic haematopoietic stem cell transplant (HSCT). However, subtherapeutic CSA \n\n\n\nconcentration will increase the incidence of acute GVHD which is one of the major concerns. \n\n\n\nObjective: This study aims to identify the incidence of patients who achieved therapeutic initial CSA \n\n\n\nlevel with a standard intravenous CSA dose of 1.5 mg/kg BD, the occurrence of acute GVHD and \n\n\n\nfactors associated with subtherapeutic CSA at the initial concentration in post-HSCT patients. \n\n\n\nMethod: A retrospective single-centred study was conducted which involved 69 patients who \n\n\n\nunderwent allogeneic HSCT between January 2020 and December 2020 in Hospital Ampang. The \n\n\n\nfactors assessed were patients\u2019 demographics, concurrent medications, liver and renal functions. \n\n\n\nMann-Whitney test, Kruskal Wallis test and Spearman correlation test were used to identify the \n\n\n\nfactors associated with sub-therapeutic CSA initial concentration. Result: 17.4% had therapeutic \n\n\n\ninitial CSA level (200-400 ng/mL) and among 69 patients, 37.7% of them developed acute GVHD \n\n\n\npost-transplantation. Besides, only ethnicity and serum creatinine significantly affected the initial \n\n\n\nCSA levels. There was no significant association between the initial CSA level and the occurrence \n\n\n\nof acute GVHD. Conclusion: With the standard intravenous CSA dose of 1.5 mg/kg BD, only 17.4% \n\n\n\nwere able to achieve a therapeutic initial CSA level due to the drug pharmacokinetic variability in \n\n\n\ndifferent individuals. Hence, this study served as a baseline study for the future prospective clinical \n\n\n\nstudy to develop a population pharmacokinetic model in optimising the intravenous CSA dose to \n\n\n\nachieve the desired therapeutic range and improve the transplant outcomes. \n\n\n\n\n\n\n\n\n\n\n\nINTRODUCTION  \n \n\n\n\nHaematopoietic stem cell transplant (HSCT) is a curative, \n\n\n\nhighly specialised treatment for managing numerous \n\n\n\nmalignant and non-malignant diseases [1]. This process \n\n\n\ninvolves the intravenous infusion of haematopoietic stem cells \n\n\n\nto replace the unhealthy blood cells and rebuild normal blood \n\n\n\ncell production. Although HSCT has been an effective \n\n\n\ntreatment option for haematologic diseases such as leukaemia \n\n\n\nand lymphoma, the procedure has potentially high treatment-\n\n\n\nrelated mortality, such as graft-versus-host disease (GVHD) \n\n\n\ndevelopment that happens in allogeneic HSCT where the \n\n\n\nrecipient T cells recognize the host as foreign [2]. This \n\n\n\nscenario limits the success of a potentially curative transplant. \n\n\n\nTherefore, immunosuppressive treatment is required as a \n\n\n\nprophylaxis of GVHD following allogeneic HSCT. \n\n\n\n\n\n\n\nThe most common GVHD prophylaxis post-allogeneic HSCT \n\n\n\nhas been based on a calcineurin inhibitor, cyclosporine (CSA), \n\n\n\ntogether with a short course of methotrexate (MTX) [1]. \n\n\n\nDespite the long history of this regimen, there are uncertainties \n\n\n\nabout its dosing due to the narrow CSA therapeutic index and \n\n\n\nits complicated pharmacokinetics which show marked inter \n\n\n\nand intra-patient variability [3]. Hence, the dose, target blood \n\n\n\n\nmailto:cjherng1205@yahoo.com.my\n\n\n\n\n\n\nHerng C.J.et al. Mal J Pharm 8 (2) 2022, 32-38 \n\n\n\n\n\n\n\n33 \n \n\n\n\nlevel, and infusion schedule varies among facilities and \n\n\n\nprotocols, and different practices make data generalisation for \n\n\n\nspecific populations impossible [4]. \n\n\n\n\n\n\n\nMultiple studies have demonstrated that a subtherapeutic \n\n\n\ninitial CSA concentration would increase the incidence of \n\n\n\ngrade 2-4 acute GVHD [2,5\u20137], which is a significant \n\n\n\ncomplication of HSCT and a major cause of treatment-related \n\n\n\nmortality [8]. There is no previous study conducted in \n\n\n\nMalaysia to address this issue. Therefore, the current study \n\n\n\naimed to identify the incidence rate of patients who achieved \n\n\n\ntherapeutic initial CSA level with standard intravenous CSA \n\n\n\ndose, the occurrence rate of acute GVHD, and the factors \n\n\n\nassociated with subtherapeutic CSA initial concentrations in \n\n\n\npatients undergoing HSCT. \n\n\n\n\n\n\n\nMETHOD  \n \n\n\n\nThis study was conducted retrospectively at Hospital Ampang, \n\n\n\na tertiary hospital known as one of the largest haematology \n\n\n\ncentres in Malaysia where various types of chemotherapy and \n\n\n\ntransplantation are conducted here, including allogeneic \n\n\n\nHSCT. The study was carried out upon approval by the \n\n\n\nNational Medical Research Register (NMRR) and Medical \n\n\n\nResearch & Ethics Committees of Malaysia (MREC) with ID \n\n\n\nNMRR-21-1705-60857. \n\n\n\n\n\n\n\nAll patients who had undergone allogeneic HSCT received \n\n\n\nintravenous CSA beginning on Day-1 of transplantation with \n\n\n\na dose of 3 mg/kg in 2 divided doses by intravenous infusion \n\n\n\nfor the prophylaxis of GVHD post-transplantation. According \n\n\n\nto the Ampang Hospital Haematology Protocol, the initial \n\n\n\ntargeted concentration of CSA should be around 200 ng/mL \n\n\n\n[9], and titration of 25 mg/dose will be given to the patient if \n\n\n\nthe first dose of 3 mg/kg/day does not reach the therapeutic \n\n\n\nconcentration. The initial CSA level was resampled at least on \n\n\n\nthe third day after dose adjustment since the duration for CSA \n\n\n\nto reach a steady state was around 3-5 days. \n\n\n\n\n\n\n\nSince CSA requires therapeutic drug monitoring (TDM), the \n\n\n\nlist of potential patients was identified from the Hospital \n\n\n\nAmpang patient TDM database. The patient\u2019s medical records \n\n\n\nwere traced using the patient\u2019s registration numbers and \n\n\n\nretrieved from the hospital medical record archive and the \n\n\n\nelectronic-Hospital Information System (e-His). Patients who \n\n\n\nhad undergone allogeneic HSCT between January 2020 and \n\n\n\nDecember 2020 in Hospital Ampang were included according \n\n\n\nto these inclusion and exclusion criteria: \n\n\n\n\n\n\n\nInclusion criteria: \n\n\n\n\u2022 Patients who had undergone allogeneic HSCT for the first \n\n\n\ntime \n\n\n\n\u2022 Patients who received intravenous CSA for the first time for \n\n\n\nallogeneic HSCT  \n\n\n\nExclusion criteria: \n\n\n\n\u2022 Paediatric patients aged 12 years old and below \n\n\n\n\u2022 Patients who have CSA allergy \n\n\n\n\n\n\n\nThere were 71 HSCT patients on CSA for the first time within \n\n\n\nthe sampling period, and 69 of these patients met the study \n\n\n\ninclusion criteria. By setting the margin of error to 5% and a \n\n\n\nconfidence level of 95%, the Raosoft\u00ae sample size calculator \n\n\n\nwas used to calculate the sample size, and the recommended \n\n\n\nminimum sample size was 61 patients. Since the sample size \n\n\n\ncalculated was small, all 69 patients were included in our \n\n\n\nstudy. \n\n\n\n\n\n\n\nDemographic and clinical data of patients were obtained from \n\n\n\nboth e-HIS and hospital medical record archives over four \n\n\n\nmonths from August to November 2021. Patients\u2019 data, \n\n\n\nincluding age, gender, body weight, height, serum creatinine \n\n\n\n(SCr), alanine aminotransferase (ALT), concurrent \n\n\n\nmedications, CSA dose, initial CSA level, presence of acute \n\n\n\nGVHD and GVHD area were collected. Serum creatinine and \n\n\n\nALT levels on Day-1 of transplantation were collected, and \n\n\n\nintravenous CSA was administered on the same day. Only data \n\n\n\non antibiotics, antivirals and antifungals were recorded for \n\n\n\nconcurrent medications, as Stockley\u2019s Drug Interaction \n\n\n\nCheckers showed that these medications potentially interacted \n\n\n\nwith CSA. Data privacy and confidentiality were guaranteed \n\n\n\nas the names of patients were not collected, and the data \n\n\n\ncollected was kept on a password-protected database that only \n\n\n\nresearchers could access the database. \n\n\n\n\n\n\n\nThe primary outcome of this study was to identify the \n\n\n\nincidence of patients who achieved therapeutic initial CSA \n\n\n\nlevel with standard intravenous CSA dose and the occurrence \n\n\n\nof acute GVHD in post-transplantation patients. At the same \n\n\n\ntime, the secondary outcome was to identify the factors \n\n\n\nassociated with sub-therapeutic initial CSA concentration in \n\n\n\npatients undergoing HSCT. The IBM SPSS\u00ae for Windows \n\n\n\nversion 22 was used to analyse the data collected statistically. \n\n\n\nCategorical data in our study included gender, ethnicity, ALT \n\n\n\nlevel, concurrent medications, acute GVHD and its area, while \n\n\n\nthe numerical data included age, weight, height, SCr and \n\n\n\ncreatinine clearance (CrCL). The descriptive analysis was then \n\n\n\nused to analyse the categorical and numerical data and \n\n\n\npresented in terms of frequency, percentage, median and \n\n\n\ninterquartile range. \n\n\n\n\n\n\n\nBefore inferential statistical analysis, a normality test was \n\n\n\nconducted. It was found that data generated in this study were \n\n\n\nnot normally distributed. Thus, non-parametric tests were \n\n\n\napplied for data analysis. To identify the factors associated with \n\n\n\nsub-therapeutic CSA initial concentration, the Mann-Whitney \n\n\n\ntest and Kruskal Wallis test were used to analyse the difference \n\n\n\nof median initial CSA levels between different groups of \n\n\n\ncategorical data, as mentioned above. In contrast, the Spearman \n\n\n\n\n\n\n\n\nHerng C.J.et al. Mal J Pharm 8 (2) 2022, 32-38 \n\n\n\n\n\n\n\n34 \n \n\n\n\ncorrelation test was used to analyse the correlation between the \n\n\n\nmedian initial CSA levels and different numerical data such as \n\n\n\nage, weight, height, and SCr. The strength of correlation was \n\n\n\nmeasured by the absolute value of correlation coefficient (r), \n\n\n\n0.00-0.19 was regarded as \u201cvery weak\u201d, 0.20-0.39 as \u201cweak\u201d, \n\n\n\n0.40-0.59 as \u201cmoderate\u201d, 0.60-0.79 as \u201cstrong\u201d and 0.8-1.0 as \n\n\n\na \u201cvery strong\u201d correlation [10]. Besides, a Chi-square test was \n\n\n\napplied to identify the frequencies of acute GVHD between the \n\n\n\ntwo CSA level groups (<200 ng/mL and 200-400 ng/mL). A p-\n\n\n\nvalue of <0.05 for the two-tail test was considered statistically \n\n\n\nsignificant. \n\n\n\n\n\n\n\nRESULTS \n \n\n\n\nIn this study, the baseline demographic and clinical \n\n\n\ncharacteristics of 69 patients were collected, and the data were \n\n\n\nsummarised as shown in Table I. There were slightly more \n\n\n\nfemale patients than male patients, with 52.2% and 47.8%, \n\n\n\nrespectively. Besides, more than half of the patients were \n\n\n\nMalay (68.1%), followed by Chinese (18.8%), Indian (8.7%) \n\n\n\nand others (4.3%). The median age, weight and height of the  \n\n\n\n \nTable I: Demographic and clinical characteristics of patients (n=69) \n \n\n\n\nDemographic and clinical characteristics n (%) \n\n\n\nGender   \n\n\n\nMale 33 (47.8) \n\n\n\nFemale 36 (52.2) \n\n\n\nEthnicity   \n\n\n\nMalay 47 (68.1) \n\n\n\nChinese 13 (18.8) \n\n\n\nIndian 6 (8.7) \n\n\n\nOthers 3 (4.3) \n\n\n\nAge (years) 32 (22.00)* \n\n\n\nWeight (kg) 66 (21.50)* \n\n\n\nHeight (cm) 162 (12.50)* \n\n\n\nALT   \n\n\n\nNormal 56 (81.2) \n\n\n\nHigh 13 (18.8) \n\n\n\nSCr (umol/L) 49 (24.00)* \n\n\n\nCrCL (mL/min) 147 (103.50)* \n\n\n\nConcurrent antibiotics   \n\n\n\nCiprofloxacin 63 (91.3) \n\n\n\nCiprofloxacin & Sulfamethoxazole/Trimethoprim 6 (8.7) \n\n\n\nConcurrent antifungals   \n\n\n\nFluconazole 54 (78.3) \n\n\n\nAmphotericin 6 (8.7) \n\n\n\nMicafungin 9 (13.0) \n\n\n\nConcurrent antivirals   \n\n\n\nAcyclovir 63 (91.3) \n\n\n\nAcyclovir & Ganciclovir 6 (8.7) \n\n\n\nInitial CSA level (ng/mL)   \n\n\n\n<200 53 (76.8) \n\n\n\n200-400 12 (17.4) \n\n\n\n>400 4 (5.8) \n\n\n\nPresence of acute GVHD   \n\n\n\nYes 26 (37.7) \n\n\n\nNo 43 (62.3) \n\n\n\nGVHD site   \n\n\n\nSkin 7 (26.9) \n\n\n\nGut 7 (26.9) \n\n\n\nLiver 3 (11.5) \n\n\n\nOcular 1 (3.9) \n\n\n\n\u2267 2 sites 8 (30.8) \n\n\n\n* Median (IQR) \n\n\n\nTable II: Factors associated with subtherapeutic initial CSA levels (n=69) \n\n\n\n\n\n\n\nDemographic and \n\n\n\nclinical \n\n\n\ncharacteristics \n\n\n\nInitial CSA level \n\n\n\n(ng/mL) \n\n\n\nSpearman \n\n\n\ncorrelation, \n\n\n\nr \n\n\n\np- \n\n\n\nvalue \nMedian (IQR) \n\n\n\nGender     \n\n\n\nMale 150.30 (99.25)  0.627b \n\n\n\nFemale 138.75 (103.98)   \n\n\n\nEthnicity     \n\n\n\nMalay 156.20 (105.00)  0.030a* \n\n\n\nChinese 103.40 (66.80)   \n\n\n\nIndian 132.15 (390.75)   \n\n\n\nOther 60.00 (77.50)   \n\n\n\nAge (years)   -0.061 0.619c \n\n\n\nWeight (kg)   0.168 0.167c \n\n\n\nHeight (cm)   0.060 0.624c \n\n\n\nALT     \n\n\n\nNormal 138.75 (84.98)  0.061b \n\n\n\nHigh 184.50 (161.80)   \n\n\n\nSCr (umol/L)   0.257 0.033c* \n\n\n\nCrCL (mL/min)   -0.064 0.602c \n\n\n\n     \na Kruskal Walli\u2019s test. X2 statistics (df) = 8.975(3). Post hoc multiple \n\n\n\ncomparisons test: Malay vs Chinese, p = 0.039 (Bonferroni correction of \n\n\n\np-value) \nb Mann-Whitney test \nc Spearman correlation \n\n\n\n* The p-value of less than 0.05 (p<0.05) was considered to be significant \n\n\n\n\n\n\n\npatients were 32 years old (IQR: 22.00), 66 kg (IQR: 21.50) \n\n\n\nand 162 cm (IQR: 12.50).  \n\n\n\n\n\n\n\nA large portion of patients (81.2%) had normal ALT levels. \n\n\n\nThe median SCr value was reported as 49 umol/L (IQR: \n\n\n\n24.00), while the median CrCL value was 147 mL/min (IQR:  \n\n\n\n103.50). For concurrent medications, 91.3% of patients took \n\n\n\nciprofloxacin as prophylaxis antibiotic, and the rest took two \n\n\n\ntypes of antibiotics (ciprofloxacin and \n\n\n\nsulfamethoxazole/trimethoprim). This percentage distribution \n\n\n\nwas similar for patients who took different antivirals \n\n\n\n(acyclovir and ganciclovir). Meanwhile, 78.3%, 8.7% and \n\n\n\n13.0% of patients took fluconazole, amphotericin and \n\n\n\nmicafungin as antifungal prophylaxis. \n\n\n\n\n\n\n\nFurthermore, a majority of patients (76.8%) had sub-\n\n\n\ntherapeutic initial CSA levels of <200 ng/mL while 17.4% \n\n\n\nachieved the therapeutic range of 200-400 ng/mL, followed by \n\n\n\n5.8% who achieved >400 ng/mL. Among 69 patients, 37.7% \n\n\n\nof them developed acute GVHD post-transplantation, and the \n\n\n\nGVHD site reported were skin (26.9%), gut (26.9%), liver \n\n\n\n(11.5%), ocular (3.9%) and more than two areas (30.8%). \n\n\n\n\n\n\n\nOverall, the median initial CSA level was reported as 147.4 \n\n\n\nng/mL (IQR: 97.15), and the Mann-Whitney test was \n\n\n\nconducted to determine the difference in initial CSA levels in \n\n\n\npatients with different demographics and clinical \n\n\n\ncharacteristics. Based on Table II, the results of the Mann-\n\n\n\nWhitney test showed that there was no significant difference \n\n\n\nin median initial CSA levels between male and female \n\n\n\npatients, z = -0.487, p-value = 0.627 and also between those \n\n\n\nwith normal and high ALT levels, z = -1.872, p-value =  0.061.  \n\n\n\n\n\n\n\n\nHerng C.J.et al. Mal J Pharm 8 (2) 2022, 32-38 \n\n\n\n\n\n\n\n35 \n \n\n\n\nMeanwhile, there was a significant difference in the median \n\n\n\ninitial CSA levels among the four ethnicity groups (X2 \n\n\n\nstatistics (df) = 8.975(3)). Post hoc analysis using multiple \n\n\n\ncomparisons showed that there was a significant difference in \n\n\n\nmedian initial CSA levels between Malay and Chinese groups \n\n\n\n(p-value= 0.030). P-value was Bonferroni adjusted. Malay \n\n\n\npatients had significantly higher median initial CSA levels \n\n\n\n(156.20 ng/mL (IQR= 105.00)) compared to Chinese patients \n\n\n\n(103.40 ng/mL (IQR= 66.80)). However, there was no \n\n\n\nsignificant difference between other ethnic groups. \n\n\n\nFurthermore, the correlations between the initial CSA level \n\n\n\nand age, weight, height and CrCL of the patients were found \n\n\n\nto be very weak and statistically insignificant, with p-values of \n\n\n\n0.619, 0.167, 0.624 and 0.602, respectively. In addition, there \n\n\n\nwas a weak positive correlation (r =0.257) between the initial \n\n\n\nCSA levels and SCr with a p-value of 0.033, which suggested \n\n\n\nthat the initial CSA levels increased significantly with serum \n\n\n\ncreatinine. \n\n\n\n\n\n\n\nBesides, the concurrent antibiotics, antifungals and antivirals \n\n\n\nthat the patient took along with intravenous CSA were also \n\n\n\nrecorded in this study for further analysis. The difference in \n\n\n\ninitial CSA level among patients taking the different groups of \n\n\n\nconcurrent medications was analysed through the Mann-\n\n\n\nWhitney and Kruskal Wallis tests respectively. The results of \n\n\n\nboth tests was summarised in Table III. There were no \n\n\n\nsignificant differences in initial CSA levels between different \n\n\n\nantibiotics, antifungals and antivirals groups with p-values of \n\n\n\nmore than 0.05. \n\n\n\n \nTable III: Difference between concurrent medications and initial CSA \n\n\n\nlevel (n=69) \n\n\n\n\n\n\n\nConcurrent \n\n\n\nmedications \n\n\n\nInitial CSA level \n\n\n\n(ng/mL) \np-\n\n\n\nvalue \nMedian (IQR) \n\n\n\nAntibiotics    \n\n\n\nCiprofloxacin 150.30 (113.60) 0.539a \n\n\n\nCiprofloxacin & \n\n\n\nSulfamethoxazole/Trimethoprim \n\n\n\n129.40 (38.32)  \n\n\n\nAntifungals    \n\n\n\nFluconazole 148.85 (89.63) 0.840b \n\n\n\nAmphotericin 130.90 (285.50)  \n\n\n\nMicafungin 147.40 (339.55)  \n\n\n\nAntivirals    \n\n\n\nAcyclovir 152.80 (109.30) 0.079a \n\n\n\nAcyclovir & Ganciclovir 121.60 (63.55)  \na Mann-Whitney test  b Kruskal Wallis test \n\n\n\n \nTable IV: Association between initial CSA level and presence of acute \n\n\n\nGVHD (n=69) \n\n\n\n\n\n\n\nPresence \n\n\n\nof acute \n\n\n\nGVHD \n\n\n\nInitial CSA level X2 \n\n\n\n(df) \n\n\n\np-value \n\n\n\n< 200 ng/mL, \n\n\n\nn (%) \n\n\n\n\u2267 200 ng/mL, \n\n\n\nn (%) \n\n\n\nYes 20 (76.9) 6 (23.1) 0.000 \n\n\n\n(1) \n\n\n\n>0.950a \n\n\n\nNo 33 (76.7) 10 (23.3)   \n\n\n\n     \naChi-square test \n\n\n\nIn this study, the number of patients who developed acute \n\n\n\nGVHD post-transplantation was also recorded, and its \n\n\n\nassociation with the initial CSA levels was identified through \n\n\n\na Chi-square test, and the result was tabulated in Table IV. \n\n\n\nAlthough the association was not statistically significant, X2 \n\n\n\n(1, n=69) = 0.000, p-value >0.950, there were 20 patients with \n\n\n\nan initial CSA level of <200 ng/mL (76.9%) developed acute \n\n\n\nGVHD as compared to only six patients with an initial CSA \n\n\n\nlevel of \u2267200 ng/mL (23.1%). \n\n\n\n\n\n\n\nDISCUSSION \n \n\n\n\nTo our knowledge, this is the first retrospective study \n\n\n\ninvestigating the factors affecting the initial CSA levels and \n\n\n\nits association with the occurrence of acute GVHD among the \n\n\n\nMalaysian allogeneic HSCT patients in Hospital Ampang, one \n\n\n\nof the well-known haematology centres where patients with \n\n\n\nhaematology-related illness are referred to various \n\n\n\nchemotherapy and transplantations. \n\n\n\n\n\n\n\nIn this study, with the current standard dose of intravenous \n\n\n\nCSA 1.5 mg/kg BD and the method of rounding the dose to \n\n\n\nthe nearest 25 mg, most of the patients (76.8%) had sub-\n\n\n\ntherapeutic initial CSA levels of <200 ng/mL and the least \n\n\n\nnumber of patients (5.8%) had achieved initial CSA levels \n\n\n\nof >400 ng/mL. Based on previous studies, demographic and \n\n\n\nclinical factors such as age, gender, liver and renal functions \n\n\n\nand drug-drug interactions were reported to contribute to \n\n\n\ndifferent initial CSA levels [11\u201313], and the influence of these \n\n\n\nfactors in our study sample would be further discussed in the \n\n\n\nfollowing paragraphs. Besides, sampling error might also be \n\n\n\none of the factors, as a study has suggested avoiding sampling \n\n\n\nor sample interpretation in the first hour of infusion where \n\n\n\ninconsistent results had been reported [14]. \n\n\n\n\n\n\n\nNext, factors affecting the initial CSA levels were also \n\n\n\nidentified in our study. Firstly, no significant difference in \n\n\n\ninitial CSA level was found between male and female HSCT \n\n\n\npatients (p-value = 0.627), and the current research supported \n\n\n\nthe results of 2 previous studies [11,15]. However, some \n\n\n\nresearchers have shown that gender significantly affects the \n\n\n\nCSA pharmacokinetics in solid organ transplant patients [16\u2013\n\n\n\n18]. This conflicting gender effect on initial CSA levels might \n\n\n\nbe explained by the interindividual variation of P-glycoprotein \n\n\n\nexpression and CYP3A activity regardless of gender [16].  \n\n\n\n\n\n\n\nMoreover, it was reported in previous studies that clearance of \n\n\n\nCSA decreased with increasing age; therefore, initial CSA \n\n\n\nlevels varied across paediatric, adult and geriatric populations \n\n\n\n[13,16,19]. Nonetheless, age was not significantly correlated \n\n\n\nwith initial CSA level in this study and this outcome was \n\n\n\npossible due to the fact that only the adult population with a \n\n\n\nmedian age of 32 years old (IQR: 22.00) was involved in this \n\n\n\nstudy, and no significant difference was found among this \n\n\n\n\n\n\n\n\nHerng C.J.et al. Mal J Pharm 8 (2) 2022, 32-38 \n\n\n\n\n\n\n\n36 \n \n\n\n\npopulation. Previous studies supported our findings that age \n\n\n\ndid not significantly affect CSA pharmacokinetics compared \n\n\n\nto the paediatric population [20,21]. \n\n\n\n\n\n\n\nThe correlation between initial CSA level and weight was also \n\n\n\nevaluated in this study, but it was found to be statistically \n\n\n\ninsignificant, which opposed the previous studies that body \n\n\n\nweight was significantly associated with CSA clearance and \n\n\n\nits level [14,21\u201324]. Consistently, height was insignificantly \n\n\n\ncorrelated with the initial CSA level which is in agreement \n\n\n\nwith another study [11]. \n\n\n\n\n\n\n\nLimited studies were conducted to analyse ethnicity\u2019s \n\n\n\nassociation with CSA pharmacokinetics. In Malaysia, a \n\n\n\nretrospective study conducted among solid organ \n\n\n\ntransplantation patients did not show an effect of ethnicity on \n\n\n\nCSA pharmacokinetics [16]. However, a statistically \n\n\n\nsignificant difference in the initial CSA level between Malay \n\n\n\nand Chinese patients was demonstrated in our study. \n\n\n\nCurrently, evidence on the effect of CSA clearance among \n\n\n\ndifferent ethnicities in Malaysia is still lacking. However, it \n\n\n\nhad been previously demonstrated in a foreign study that CSA \n\n\n\nclearance was higher in white patients than in black and Asian \n\n\n\npatients, suggesting that different ethnic groups had different \n\n\n\nCSA levels [25]. \n\n\n\n\n\n\n\nBesides, the normal range of ALT was defined as between 4-\n\n\n\n36 U/L [26] and patients were classified into two groups \n\n\n\n(normal and high ALT levels). This finding was contrary to \n\n\n\nother studies which showed CSA was extensively metabolised \n\n\n\nby the liver and that liver function altered CSA \n\n\n\npharmacokinetics [11,12]. The difference in initial CSA level \n\n\n\nbetween normal and high ALT groups in this study was \n\n\n\nreported to be insignificant. \n\n\n\n\n\n\n\nFurthermore, the current study showed that initial CSA levels \n\n\n\nincreased significantly with SCr, which contrasts with \n\n\n\nprevious studies that reported an insignificant effect of SCr on \n\n\n\ninitial CSA levels [11,24,27]. Generally, SCr and CrCL \n\n\n\nyielded a reasonable estimation of renal function, but CrCL \n\n\n\nprovided a more accurate assessment as it was adjusted based \n\n\n\non parameters such as age, gender, body weight and height \n\n\n\n[28]. Due to limited patient numbers and short study duration \n\n\n\nin the current study, these parameters were not found to \n\n\n\nsignificantly affect the initial CSA level; thus, CrCL showed a \n\n\n\nsimilar finding. \n\n\n\n\n\n\n\nIn addition, infections were the major cause of morbidity and \n\n\n\nmortality after transplantation; thus, antimicrobial agents were \n\n\n\nwidely used in patients who had received transplantation [29]. \n\n\n\nAs drug-drug interaction might affect the pharmacokinetics of \n\n\n\nCSA and its serum level, its influence on the initial CSA level \n\n\n\nwas also analysed statistically in this study. Nonetheless, the \n\n\n\ndifference in initial CSA levels between different antibiotics, \n\n\n\nantifungals and antivirals groups was statistically \n\n\n\ninsignificant. With the exception that antifungals such as \n\n\n\nmicafungin and antivirals showed a similar result to the \n\n\n\nprevious study [30], other groups of antimicrobial agents \n\n\n\nshowed opposing findings to previous studies and Stockley\u2019s \n\n\n\nDrug Interaction Checkers [14,20,30\u201332]. \n\n\n\n\n\n\n\nDuring data collection, although it was necessary to report the \n\n\n\ngrades of acute GVHD to determine its severity, only the \n\n\n\noccurrence area of acute GVHD was collected as the grade of \n\n\n\nacute GVHD was not recorded in patients\u2019 clinical notes and \n\n\n\nbed head tickets (BHT). The current study reported that among \n\n\n\n69 patients, 37.7% of them developed acute GVHD post-\n\n\n\ntransplantation, and the acute GVHD area reported were skin \n\n\n\n(26.9%), gut (26.9%), liver (11.5%), ocular (3.9%) with \n\n\n\n30.8% patients reporting multiple area involvement. The \n\n\n\nassociation between the initial CSA level and the presence of \n\n\n\nacute GVHD was also assessed in this study to justify the \n\n\n\nimpact of the initial CSA level in causing acute GVHD and \n\n\n\nfurther deterioration of the patient\u2019s health. The result showed \n\n\n\nthe association was not statistically significant, which was not \n\n\n\nin agreement with previous studies [4,33,34]. \n\n\n\n\n\n\n\nDespite the result being statistically insignificant, 76.9% of \n\n\n\npatients with an initial CSA level of <200 ng/mL developed \n\n\n\nacute GVHD compared to only 23.1% with an initial CSA \n\n\n\nlevel of \u2267200 ng/mL. Besides, a study reported that \n\n\n\nmaintaining CSA trough levels of \u2267200 ng/mL resulted in a \n\n\n\nlower incidence of acute GVHD in the following weeks and \n\n\n\nfound significant benefits of maintaining a higher serum \n\n\n\nconcentration of CSA in the minimisation of acute GVHD [5]. \n\n\n\nMoreover, it was essential to prevent acute GVHD as the cost \n\n\n\nof treating GVHD was much higher compared to the cost of \n\n\n\npreventing GVHD. A retrospective analysis of hospital data \n\n\n\nreported higher hospital readmission rates and associated costs \n\n\n\nfollowing HSCT among patients with acute GVHD compared \n\n\n\nwith those without GVHD, and the readmission rate and costs \n\n\n\nincreased with the severity of acute GVHD [35]. Another \n\n\n\nretrospective study summarised that patients with acute \n\n\n\nGVHD had a longer length of stay, a higher ICU admission \n\n\n\nrate, and a higher median total cost compared with patients \n\n\n\nwith no GVHD during initial hospitalisation for HSCT and \n\n\n\nexperienced higher rates of hospital readmission and inpatient \n\n\n\nmortality during the 100 days following HSCT [36]. \n\n\n\n\n\n\n\nOur study was limited by its retrospective nature and the fact \n\n\n\nthat only included patients from a single medical centre. \n\n\n\nVariations in the composition of patient cohorts among various \n\n\n\ncentres prevented us from making general conclusions \n\n\n\nregarding initial CSA levels, factors affecting it and its \n\n\n\nassociation with the occurrence of acute GVHD. Moreover, \n\n\n\ntime constraints limited our sample size as we only included \n\n\n\ndata in a year due to the time-consuming process of obtaining \n\n\n\nthe manual patient medical record from the hospital archive. \n\n\n\n\nhttps://www.sciencedirect.com/topics/medicine-and-dentistry/graft-versus-host-disease\n\n\n\n\n\n\nHerng C.J.et al. Mal J Pharm 8 (2) 2022, 32-38 \n\n\n\n\n\n\n\n37 \n \n\n\n\nCONCLUSION  \n \n\n\n\nIn conclusion, therapeutic drug monitoring was crucial in \n\n\n\ndesigning patient-specific CSA dosage regimens as with the \n\n\n\ncurrent standard dosing method. We found that there was only \n\n\n\na small portion of patients could achieve therapeutic initial \n\n\n\nCSA levels due to the drug pharmacokinetic variability in \n\n\n\ndifferent individuals. In this study, only ethnicity and SCr \n\n\n\nwere found to affect the initial CSA level significantly. \n\n\n\nHowever, our findings should not be generalised due to the \n\n\n\nlimitations of the small sample size from a single centre. Last \n\n\n\nbut not least, even though we did not prove the significant \n\n\n\nbenefits of maintaining an initial CSA level at the therapeutic \n\n\n\nrange, the minimisation of acute GVHD served as a baseline \n\n\n\nstudy for a future prospective clinical study to develop a \n\n\n\npopulation pharmacokinetic model in optimising the \n\n\n\nintravenous CSA dose to achieve the desired therapeutic range \n\n\n\nand maximise the transplant outcomes. \n\n\n\n\n\n\n\n\n\n\n\nACKNOWLEDGEMENT \n \n\n\n\nWe thank the Director General of Health Malaysia for his \n\n\n\npermission to publish this article. 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Inpatient \n\n\n\nHealthcare Resource Utilisation, Costs, and Mortality in Adult \n\n\n\nPatients with Acute Graft-versus-Host Disease, Including Steroid-\n\n\n\nRefractory or High-Risk Disease, following Allogeneic \n\n\n\nHematopoietic Cell Transplantation: HCRU, Costs, and Mortality \n\n\n\nAssociated with Acute  GVHD. Biol  Blood  Marrow  Transplant. \n\n\n\n2020;26(3):600\u20135. https://doi.org/10.1016/j.bbmt.2019.10.028  \n\n\n\n\nhttps://doi.org/10.1177/1060028015577798\n\n\nhttps://pubmed.ncbi.nlm.nih.gov/19377217/\n\n\nhttps://doi.org/10.1111%2Fj.1365-2125.2008.03217.x\n\n\nhttps://doi.org/10.18773/au\n\n\nhttps://doi.org/10.1086/516138\n\n\nhttps://doi.org/10.5414/cp201738\n\n\nhttps://doi.org/10.1038/bmt.2009.316\n\n\nhttps://doi.org/10.1128%2FAAC.01489-12\n\n\nhttps://doi.org/10.1016/j.bbmt.2012.11.337\n\n\nhttps://doi.org/10.18632/oncotarget.10988\n\n\nhttps://doi.org/10.1111/ctr.12065\n\n\nhttps://doi.org/10.1016/j.bbmt.2019.10.028\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nPROCEEDINGS of \n\n\n\n28th Federation of Asian \n\n\n\nPharmaceutical Associations, MPS-\n\n\n\nNational Pharmacists Convention \n\n\n\n2022 \n\n\n\n\n\n\n\n10th - 12th November 2022 \n \nVenue: Kuala Lumpur Convention Centre, Malaysia \n\n\n\nTheme: Pharmacists Building a Better Healthcare \n\n\n\nSystem \n\n\n\n\n\n\n\nEditors \n \n\n\n\nChan Siok Yee \n\n\n\nMai Chun Wai  \n\n\n\nChua Siew Siang \n\n\n\nGan Siew Hua \n\n\n\nMohamad Haniki bin Nik Mohamed \n\n\n\nMohd Zulkefeli bin Mat Jusoh \n\n\n\nMohd bin Makmor Bakry \n\n\n\nParaidathathu Thomas A/L P.G. Thomas \n\n\n\n\n\n\n\nPublisher:  \n\n\n\n\n\n\n\nMalaysian Pharmacists Society  \n\n\n\n16-2 Jalan OP 1/5, 1-Puchong Business Park  \n\n\n\nOff Jalan Puchong, 47160 Puchong, Malaysia  \n\n\n\n \n\u00a9 Malaysian Journal of Pharmacy \n\n\n\n\n\n\n\n\n\n\n\nISSN 1675-3666 \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n47 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\n\n\n\n\nOral Presentation  \n \n\n\n\n\n\n\n\nCommunity Pharmacy  \n\n\n\n \nAbstract 001 \n\n\n\nPharmacists\u2019 Perceptions on Future Implementation of A Medication Review Service \n\n\n\nModel in Community Settings: A Qualitative Study Utilising the Consolidated \n\n\n\nFramework for Implementation Research (CFIR) and the Expert Recommendations for \n\n\n\nImplementing Change (ERIC) strategy tool \nMaali Mujahid, Ernieda Hatah*, Mohd Makmor-Bakry \n\n\n\n\n\n\n\nAbstract 002 \n\n\n\nRole of Community Pharmacist in Cardiovascular Diseases-Related Health Promotion \n\n\n\nand Dyslipidemia Management in Malaysia: A Cross-Sectional Study \n\n\n\nFarhana Fakhira Ismail, Adyani Md Redzuan*, Chong Wei Wen \n\n\n\n\n\n\n\nAbstract 003 \n\n\n\nA Survey of the Adoption and Perception of Mobile Health Applications Among \n\n\n\nCommunity Pharmacists in Malaysia \n\n\n\nHui Leng Ng, Jason Siau Ee Loo*, Renukha Sellappans \n\n\n\n\n\n\n\nAbstract 004 \n\n\n\nInvestigating Pharmacy Value-Added Services (PVAS) in Community Pharmacies: A \n\n\n\nStudy in Urban and Suburban Areas of Perak, Malaysia \nZaswiza Mohamad Noor*, Nik Nur \u2018Alya Nik Pa \n\n\n\n\n\n\n\n\n\n\n\nHospital Pharmacy  \n \n\n\n\nAbstract 005 \n\n\n\nEvaluation of Anticoagulation Control in Patients with Atrial Fibrillation \nAdyani Md Redzuan*, Azeta Abdullah, Chandini Menon A/P Premakuma, Farah Waheeda  Tajurudin \n\n\n\n\n\n\n\nAbstract 006 \n\n\n\nPrediction of Aspirin Induced Gastric Toxicity and Resistance in Rats Using NMR-Based \n\n\n\nPharmacometabonomics \n\n\n\nIbrahim B*, Sha\u2019aban A, Zainal H \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n48 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 007 \n\n\n\nA Study on Adverse Effect Induced by Chemotherapy Drug Used For Colorectal Cancer \n\n\n\nand Their Management in Nepal Cancer Hospital and Research Center \n\n\n\nShrestha BM*, Bista D, Shakya R \n\n\n\n\n\n\n\nAbstract 008 \n\n\n\nAssessment of Patient Safety Culture among Healthcare Providers in A Tertiary Hospital \n\n\n\nat Johor Bahru, Malaysia \n\n\n\nSok May Cheong*, Palanisamy Sivanandy, Pravinkumar Vishwanath Ingle \n\n\n\n\n\n\n\nAbstract 009 \n\n\n\nHerbal Medicine Tool: Identifying Herbal Users among Malaysian Women \n\n\n\nFarida Tengku Azlan Shah Tengku Mohamad, Jamia Azdina Islahudin*, Malina Jasamai Jamal \n\n\n\n\n\n\n\nAbstract 010 \n\n\n\nPharmacists\u2019 Virtual Consultations for Diabetes Patients in Malaysia: Impact on \n\n\n\nMedication Adherence and Glycaemic Control \nLoganadan NK*, Tse Yeen Soong, Wai Han Lee, Hui Ling Tong, Phei Ching Lim, Sin YeNg, Nur Diniah \n\n\n\nShaharum, Wan Ruwaida Wan Mokhtar, Siong Hung Ting, Aziani Yacob, Wai Yin Yong, Kai Yin Go, \n\n\n\nRodhiah Abd Rahman, Shamala Ayadurai, Huay Sin Tan \n \n\n\n\nAbstract 011 \n\n\n\nThe Impact of Pharmacist-Managed Titration Clinic (PMTC): A Pilot Study \n\n\n\nPoh Lee Geetha Ng*, Syafiqah Abdul Jalil, Nurish Ezzantie Mishan, Nur Asyikin Mohd Yunus, Michelle \n\n\n\nMaryanne Tan, Nik Qistina Nik Ramli, Norhawani Mansor, Kok Han Chee, Nor Aziah Abdullah \n\n\n\n\n\n\n\nAbstract 012 \n\n\n\nComparison of Eight Methods for Estimation of Creatinine Clearance in Patients with \n\n\n\nUnstable Kidney Function \u2013 A Multi-center, Prospective, Observational Study from \n\n\n\nMalaysia. \nYen Ping Ng*, Chee Ping Chong, Ee Siung Liew, Shye Ling Teoh, Cheng Hoon Yap \n\n\n\n\n\n\n\nAbstract 013 \n\n\n\nExposure to Potentially Harmful Excipients in Medications among Neonates at A State \n\n\n\nHospital in Malaysia \n\n\n\nNoraida Mohamed Shah*, Shien Woan Wong, Soo PiingChew, Siti Azdiah Abdul Aziz \n\n\n\n\n\n\n\nAbstract 014 \n\n\n\nAntiseizure Medication Prescribing: A Glimpse of Current Practice in A Ministry of \n\n\n\nHealth Tertiary Care Centre \n\n\n\nRusli RA*, Makmor Bakry M, Mohamed Shah N, Hung KY, Loo XL \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n49 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 015 \n\n\n\nAssessment of Anticoagulation Control, Bleeding, and Thromboembolic Complications \n\n\n\nin Anticoagulation Medication Therapy Adherence Clinic (ACMTAC) Service in \n\n\n\nMalaysia \n\n\n\nSahimi Mohamed, Wardati Mazlan Kipli, Nik Azlean Nik Ismail, Jivanraj R Nagarajah \n\n\n\n\n\n\n\nAbstract 016 \n\n\n\nAssessment of Psychological Health among PLWH during COVID-19 and Its Association \n\n\n\nwith Antiretroviral Therapy Adherence \n\n\n\nAbdul-Aziz SA, Islahudin F, Shukri AH \n\n\n\n\n\n\n\nAbstract 017 \n\n\n\nRole of Pharmacist in Providing Pharmaceutical Care to Tuberculosis Patients in Tertiary \n\n\n\nCare Paediatric Hospital \nFaraz Ashraf \n \n\n\n\n\n\n\n\nIndustrial Pharmacy and Marketing \n \n\n\n\nAbstract 018 \n\n\n\nImpact of a Communication Skills Training Program on Malaysian Hospital Pharmacists\u2019 \n\n\n\nPatient-Centred Communication Attitudes and Behaviours \n\n\n\nYew Keong Ng, Noraida Mohamed Shah, Timothy F Chen, Navin Kumar Loganadan, Shue Hong Kong, Yi \n\n\n\nYun Cheng, Siti Shahida Md Sharifudin, Wei Wen Chong \n\n\n\n\n\n\n\nAbstract 019 \n\n\n\nRapid Quantitative Estimation of Favipiravir in Rat Plasma by Liquid Chromatography-\n\n\n\nTandem Mass Spectroscopy and its Application to Pharmacokinetic Studies \n\n\n\nP D Sri Lakshmi*, G Venkateswarulu, D Srinivasa Sumalatha, P Geetha Bhavani Sastry \n\n\n\n\n\n\n\nAbstract 020 \n\n\n\nTreatment Burden, Medication Adherence and Health Literacy in Elderly with \n\n\n\nMultimorbidity \n\n\n\nSelvakumar D*, Sivanandy P, Ingle PV, Theivasigamani K, Kumar S, Shanmugham S \n\n\n\n\n\n\n\nAbstract 021 \n\n\n\nPrEP Talk: A Multivariate Analysis Exploring the Awareness, Attitude, and Preference \n\n\n\nof Filipino University Students in Metro Manila toward Human Immunodeficiency \n\n\n\nVirus (HIV) Pre-Exposure Prophylaxis (PrEP) \nErnest Van Rito*, Danica Jane Rubi, Mila Iloiza Sangcap, Alicia Alaine Descargar, Kenneth Domdom, Renz \n\n\n\nMarion Ricafrente, Zedierick Tanjista \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n50 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 022 \n\n\n\nRisk of Haemorrhagic Stroke due to Methamphetamine Abuse - A Case Series \n\n\n\nJ John Kirubakaran*, Mina Jafarnia, Farzaneh Raveshi \n\n\n\n\n\n\n\nAbstract 023 \n\n\n\nKnowledge, Attitude, and Practices among Filipinos towards Vitamin D \n\n\n\nSupplementation amidst the Pandemic \n\n\n\nJoseph Samuel S. Anthony*, Earrol Jem R. Berdos, Swituel S. Guevarra, Daniella G. Tulabut, Elvira V. De \n\n\n\nLeon. \n\n\n\n\n\n\n\nAbstract 024 \n\n\n\nTherapeutic Effects and Possibilities of Citrus maxima (Pomelo) Leaves Aqueous Extract \n\n\n\nof a Commercial Product \nJia Rou Khor, Siok Yee Chan* \n\n\n\n\n\n\n\nAbstract 025 \n\n\n\nKnowledge, Attitude, and Practice of the Medical Practitioners towards Adverse Drug \n\n\n\nReactions Reporting \n\n\n\nKirthikaa Gopal Krishnan*, Palanisamy Sivanandy, Nafeeza Bt Hj Mohd Ismail \n\n\n\n\n\n\n\nAbstract 026 \n\n\n\nAdoption of Machine Learning Algorithms in Predicting Vaccine Hesitancy: A Narrative \n\n\n\nReview \n\n\n\nMunaver Ahmad Nazir Ahmad*, Nour Hanah Othman, Irraivan Elamvazuthi, Zaswiza, Mohamad Noor \n\n\n\n\n\n\n\nAbstract 027 \n\n\n\nKnowledge, Attitude, and Acceptance on Coronavirus Disease (COVID-19) Vaccination \n\n\n\nAmong Non-allied Health Individuals in the Greater Manila Area (Metro Manila, \n\n\n\nBulacan, Cavite, Laguna, and Rizal), Philippines \n\n\n\nRose Anne Chua*, Asia Nykyle Stefanie Abello, Samantha Jillian Araneta, Paolo Jose De Los Santos, Kim \n\n\n\nShekinah Mei Hosena, Mary Patricia Joson, Christine Janelle Mataga, Gizelle Parado, Jennie Wong \n\n\n\n\n\n\n\nAbstract 028 \n\n\n\nThe Interaction between Herbal Extract and Eudragit Polymer Blend on Physicochemical \n\n\n\nand Mechanical Characteristics of Core/shell Composite Orodispersible Films \n\n\n\nSiew Mei Tan, Siok Yee Chan* \n\n\n\n\n\n\n\nAbstract 029 \n\n\n\nRemoving Communication Barrier between Pharmacy and Deaf Patients \n\n\n\nNur Azrida Azhari Wasi, Ching Wern Chong, Yoshnni M Navaneethan*, Muhammad Fikree Ahmad, Siti \n\n\n\nNur-Hussaini Mohamad Termizi, Umi Aqilah Amir, Mohd Firdaus Abdullah, Sharmili Retnam, Yuan Wah \n\n\n\nLoo, Farid Ahmad Nasir, Siti Rahimah Mohd Radzi, Suhaila Mustaffa, Noor Azwani Abd Samad, Narian \n\n\n\nSingh Sadu Singh \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n51 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\n\n\n\n\nPharmacy Education \n \n\n\n\nAbstract 030 \n\n\n\nDigital Health Perception among the Pharmacy Students of Asian Countries \n\n\n\nAbdishakur Hassan Mohamed*, Rohit Kumar Verma, Palanisamy Sivanandy, Manisha Pandey, Jayashree \n\n\n\nMayuren \n\n\n\n\n\n\n\nAbstract 031 \n\n\n\nAcademic Restructuring towards Flexible Learning in Philippine Pharmacy Education \n\n\n\nAleth Therese L. Dacanay, Maria Fay Nenette M. Cariaga*, Vina Rose D. Talan, Shiela DV Miranda, Ellen \n\n\n\nMae P. Abiqui \n\n\n\n\n\n\n\nAbstract 032 \n\n\n\nA Shared Culture of Caring in the Time of the COVID-19 Pandemic: The Essence of \n\n\n\nInterprofessional Collaboration as Perceived by Pharmacy and Medical \n\n\n\nTechnology/Medical Laboratory Science Students \n\n\n\nLangit MRD*, Abesamis RAS, Adonis LD , Agustin AJR, Amoy NNT, Aquino GRM, Archog XMGD, Ayeo \n\n\n\nSS, Baladad AGB, Balocating JLZ, Baquir AMG \n\n\n\n\n\n\n\nAbstract 033 \n\n\n\nKnowledge, Awareness, Acceptability, and Perceived Research Misconduct among the \n\n\n\nSchools of Pharmacy in Malaysia \n\n\n\nWan Ping Ng, Khong Yun Pang, Pei Boon Ooi, Chia Wei Phan* \n\n\n\n\n\n\n\nAbstract 034 \n\n\n\nSmoking Cessation Problem-based Learning: Virtual Experience \n\n\n\nSoraya Ismail*, Mohamad Haniki Nik Mohamed \n\n\n\n\n\n\n\nAbstract 035 \n\n\n\nContinuing Professional Development: A Need Assessment among Pharmacists in \n\n\n\nMalaysia \n\n\n\nSyireen Alwi*, Siew Siang Chua, May Hoi Lee, Mei Hui Tang \n\n\n\n\n\n\n\n\n\n\n\nSocial and Administrative Pharmacy  \n \n\n\n\nAbstract 036 \n\n\n\nPotential Roles of Pharmacists in HIV/AIDS Care Delivery in Nepal: A Qualitative Study \n\n\n\nAyushma Shahi, Sweta Shrestha, Badri K.C, Khagendra Acharya, Sait Kumar Pradhan \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n52 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 037 \n\n\n\nAssessing Health Literacy among The Newly Diagnosed Type 2 Diabetes and Pre-\n\n\n\ndiabetes Patients in Malaysia \n\n\n\nAzrina Ely Ahmad Azhari, Jim Chai, Claire Anderson \n\n\n\n\n\n\n\nAbstract 038 \n\n\n\nPerspectives and Challenges Managing Older Adults: A Qualitative Study with Primary \n\n\n\nHealth General Practitioners and Pharmacists In Penang, Malaysia \n\n\n\nChristina Malini Christopher*, Ali Qais Blebil, Bhuvan KC, Deepa Alex, Mohamed Izham Ibrahim \n\n\n\n\n\n\n\nAbstract 039 \n\n\n\nKnowledge, Attitude and Practice of Filipinos on Sunscreen Utilisation \n\n\n\nAndrea Gail A. Cunanan, Ryah Monique C. Fernandez, Jermie Anne S. Li,Christine Marie S. Terrado \n\n\n\n\n\n\n\nAbstract 040 \n\n\n\nA Strategy to Strengthen Halal Pharmamedlog Initiatives by Malaysian Armed Forces - \n\n\n\nFirst Government Agency in the World \n\n\n\nNur Hidayah AR, Muhammad Najhan MB, Mohd Azrizal MR, Mohd Adlan A, A Halim B \n\n\n\n\n\n\n\nAbstract 041 \n\n\n\nThe Stress, Satisfaction, and Fulfilment of Early Career Pharmacists \u2013 A Qualitative \n\n\n\nStudy of their Professional and Personal Lives \n\n\n\nPY Chee, LV Tan, CCW Lee, BBN Choo, WL Cheong \n\n\n\n\n\n\n\nAbstract 042 \n\n\n\nHealth Care Team Patterns through Perception of Interprofessional Interaction Between \n\n\n\nPharmacists and Medical Technologists in a City in Northern Philippines \n\n\n\nLangit MRD, Estacio BRB, Estrella JIOV, Galicio FIF, Gamino CDR, Gloria JAA, Gomez PNC, Hamadain \n\n\n\nSKIL, Hulipas LEM, Jamandre CAD, Lababit AMM \n\n\n\n\n\n\n\nAbstract 043 \n\n\n\nFoundation and Advanced Competencies of Community and Hospital Pharmacists in \n\n\n\nNorthern Philippines \n\n\n\nLangit MRD, Aum RVD, Balaki BKT, Barroga, DAF, Bete CD, Cari\u00f1o NJP, Lim AGP, Mangubat NSJ, \n\n\n\nObedoza CDL, Umagat JM \n\n\n\n\n\n\n\nAbstract 044 \n\n\n\nThe Pharmacist\u2019s Contribution During the COVID 19 Pandemic: Medicine Delivery \n\n\n\nServices \nMohamad Aizuddin Mohamad Noor, Zaswiza Mohamad Noor \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n53 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 045 \n\n\n\nA Narrative Review of Vaccine Hesitancy in Childhood Immunisation in Malaysia. \nNour Hanah Othman*, Munaver Ahmad Nazir Ahmad, Mohammed Tahir Ansari \n\n\n\n\n\n\n\nAbstract 046 \n\n\n\nElectronic Prescription Services Trends across Community Pharmacies in Malaysia \n\n\n\nHui Yin Yow, Jason Siau-Ee Loo, Yi Yang Ten, Megat Helmi Mohd Zubairi, Nusaibah Abdul Rahim* \n\n\n\n\n\n\n\nAbstract 047 \n\n\n\nImproving Knowledge, Attitude, and Perception of Falls among the Geriatric Population \n\n\n\nthrough Educational Intervention \n\n\n\nPriya Manirajan*, Palanisamy Sivanandy, Pravinkumar Vishwanath Ingle \n\n\n\n\n\n\n\n\n\n\n\nScientific  \n \n\n\n\nAbstract 048 \n\n\n\nMussel-inspired Mucoadhesive Gelatine Film Loaded with Cetylpyridinium Chloride \n\n\n\nAmina Ahmady, Nor Khaizan Anuar, Siti Alwani Ariffin, Nor Hayati Abu Samah* \n\n\n\n\n\n\n\nAbstract 049 \n\n\n\nDesign of Degenerate, Universal Primers for Multiplex PCR Determination of Biofilm-\n\n\n\nFormation in Staphylococcus aureus, Pseudomonas aeruginosa, Klebsiella pneumoniae, \n\n\n\nand Escherichia coli \nClodualdo F. Narciso III, Deo Raphael A. Paloma, Dan Ira King M. Tuatis, Sigfredo B. Mata* \n\n\n\n\n\n\n\nAbstract 050 \n\n\n\nIn vitro Anticancer Activity of Myriostachya wightiana Whole Plant Methanolic Extract \n\n\n\non Breast, Hepatocellular and Colorectal Cancer Cell Lines \n\n\n\nAnupama Dasi*, Y. Indira Muzib3 \n\n\n\n\n\n\n\nAbstract 051 \n\n\n\nInvestigation of Pittosporum molucannum Plant Extracts as Potential Source of Natural \n\n\n\nBiopesticides \n\n\n\nMelissa June Paderog*, Remi Charlene Salvilla \n\n\n\n\n\n\n\nAbstract 052 \n\n\n\nDocking Study Using Vina for Phytochemicals from Mangifera zeylanica to Treat \n\n\n\nDengue \n\n\n\nMohamed Jiffry Ifran, Mohamed Jaffry Rizzaly, Mudalige Heshani, Perera Ominda \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n54 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 053 \n\n\n\nSynergistic Killing of Polymyxin B Combinations with Chloramphenicol Derivatives \n\n\n\nagainst Multidrug Resistant (MDR) Klebsiella pneumoniae \n\n\n\nNurulain Idris, Nusaibah Abdul Rahim*, Kok Hoong Leong, Eng Hwa Wong \n\n\n\n\n\n\n\nAbstract 054 \n\n\n\nEffect of B. hispida Seed Extract towards Protein Expression of AHR, OVOL-1 and \n\n\n\nCYP1A1 \n\n\n\nRamli RZ, Hadi H \n\n\n\n\n\n\n\nAbstract 055 \n\n\n\nEffect of Retinoic Acid Loaded Nanosponge Gel-cream Formulation vs Commercial \n\n\n\nFormulation in Animal Model \nSyed Omar SS, Hadi H, Doolanea AA \n\n\n\n\n\n\n\nAbstract 056 \n\n\n\nGenotyping of SNPs in ABCB1 (rs1045642, rs1128503) and OPRM1 (rs1799971, rs9479757) \n\n\n\nAssociated with Pain Control and Adverse Effects of Morphine among Cancer Pain \n\n\n\nPatients in Malaysia \nShobha Elizabeth Satkunananthan, Sabrina Anne Stephen, Hui Yin Yow, Vijayaprakash Suppiah, Fauziah \n\n\n\nAb Aziz, Hasriza Hashim, Gaik-Theng Toh* \n\n\n\n\n\n\n\nAbstract 057 \n\n\n\nEvaluation of the CYP1A2, CYP2D6, and CYP3A4 Inhibition by the Ten DOH-Approved \n\n\n\nPhilippine Medicinal Plants using Enzyme-Specific Fluorometric Substrates in Pooled \n\n\n\nHuman Liver Microsomes \n\n\n\nSigfredo B. Mata*, Hadiyya Mary Glenn A. Paraiso, Alicia P. Catabay \n\n\n\n\n\n\n\nAbstract 058 \n\n\n\nNeuroprotective Effects of Palm Oil Derived Tocotrienol-Rich Fraction in Aluminium \n\n\n\nChloride Induced Vascular Dementia Rats \n\n\n\nShaikh Sohrab A., Muthuraman Arunachalam*, Rajavel Varatharajan \n\n\n\n\n\n\n\nAbstract 059 \n\n\n\nPharmacokinetics of Loratadine after Intranasal Application of Its Gel Formulation \n\n\n\nSophia S. Pagaran*, Bea May I. Remedio, Gerard Lee L. See \n\n\n\n\n\n\n\nAbstract 060 \n\n\n\nAnomalous Dissolution Enhancement of Aged Supersaturated Electrospun Solid \n\n\n\nDispersion System \n\n\n\nXin Yi Teoh, Siok Yee Chan* \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n55 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\n\n\n\n\nAbstract 061 \n\n\n\nPhytochemical Investigation and Antioxidant Activity Determination using ORAC \n\n\n\nAssay of the Dried Bark and Fresh Leaves of Pterocarpus indicus Willd. (Fam. Fabaceae) \nBengala, TJL, Mata, SB, Catabay, AP \n\n\n\n\n\n\n\n\n\n\n\nPoster Presentation \n \n\n\n\n\n\n\n\nCommunity Pharmacy  \n \n\n\n\nAbstract 062 \n\n\n\nPharmacist\u2019s Preferences, Evaluation and Perceptions of Telepharmacy Application \n\n\n\nServices: A Pilot Study \n\n\n\nAdelin Suraya Mokhtar, Ezlina Usir, Munaver Ahmad Nazir Ahmad \n\n\n\n\n\n\n\nAbstract 063 \n\n\n\nRole of Pharmacist during the COVID-19 Pandemic in Taiwan: A Scoping Review \n\n\n\nBen Chen \n\n\n\n\n\n\n\nAbstract 064 \n\n\n\nEvaluation of the Efficacy of Valproic Acid used in Residents of A Long-term Care \n\n\n\nInstitution \n\n\n\nYC Chen, JY Huang, CY Wu, KP Chen, ZA Peng \n\n\n\n\n\n\n\nAbstract 065 \n\n\n\nPatients\u2019 Perspective on Community Pharmacy Services of a Ward (10) of Kathmandu \n\n\n\nMetropolitan \n\n\n\nDurga Bista*, Ankita Ojha, Badri K.C \n\n\n\n\n\n\n\nAbstract 066 \n\n\n\nPeace, Love and Care of Medicine on Radio Broadcasts \n\n\n\nYP Hsiang*, CL Tai, CF Chiang, MT Cheng, FS Hong, LC Liu \n\n\n\n\n\n\n\nAbstract 067 \n\n\n\nEffectiveness of Individualized Health Education Provided by Volunteer Pharmacists on \n\n\n\nTier C Local Stations \n\n\n\nYN Hsieh*, CM Hsiao, CS Chen, ML Chen, SL Lee, CP Hsu \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n56 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 068 \n\n\n\nExploring the Role of Pharmacy as A Community Drug Addiction Counselling Centre \n\n\n\nJungkeun Lee*, Seungwan Moon, Jungwha Yoon \n\n\n\n\n\n\n\nAbstract 069 \n\n\n\nEstablishment of the Betel Nut-free Environment by Community Pharmacists: A Pilot \n\n\n\nStudy in Taiwan \n\n\n\nI-Hsuan Lee*, Yu-Chieh Cheng, Tzu-Chun (Frank) Chou, Hung-Chang (Ivan) Chou* \n\n\n\n\n\n\n\nAbstract 070 \n\n\n\nDirect Selling of Nootropic Drugs in An E-commerce Platform in the Philippines \n\n\n\nGwyne Kylie P. Gumapac, Jonas L. Miranda, Beryll N. Nacar, Sigfredo B. Mata* \n\n\n\n\n\n\n\nAbstract 071 \n\n\n\nPharmacists Approach to Specialty Care Facilities for People who have Parkinson\u2019s \n\n\n\nDisease \n\n\n\nHashimoto M*, Shogen T., Sugita N. \n\n\n\n\n\n\n\nAbstract 072 \n\n\n\nExploring the Lived Experiences of Community Pharmacists\u2019 on Pharmacy-Based \n\n\n\nImmunization: A Phenomenological Study \n\n\n\nKarl Kirby Z. Costales, Maureen Canda-Borcelas*, Hazel Joy B. Da-anton, Raye Marie P. Damole, Ruby \n\n\n\nFelina D. Mahinay \n\n\n\n\n\n\n\nAbstract 073 \n\n\n\nCurrent Contributions and Future Opportunities for Community Pharmacists during the \n\n\n\nCOVID-19 pandemic in Taiwan \n\n\n\nNai-Hwa Mei* \n\n\n\n\n\n\n\nAbstract 074 \n\n\n\nKnowledge, Attitude and Barriers to Compliance for the Pharmacy Support Workforce \n\n\n\nRequirements and Responsibilities on the Philippine Pharmacy Act \nNoelle Marie H. Fontanilla*, Nimfa B. Gambalan, Vieno Gino Cruz, Mark Harvey B. Adamson \n\n\n\n\n\n\n\nAbstract 075 \n\n\n\nKnowledge, Attitude and Perception of Community Pharmacists on Teleconsultation \n\n\n\nNoor Batrisyia Auni Zaidisam*, Mathumalar Loganathan, Munaver Ahmad Nazir Ahmad, Ezlina Usir, \n\n\n\nAdelin Suraya Mokhtar \n\n\n\n\n\n\n\nAbstract 076 \n\n\n\nAnalysis on the Effectiveness of Education Program for Improving Accessibility of \n\n\n\nPharmacy Involvement in HIV Care \nShao Ti Hsu*, Ling Chun Liao, Yu Chen Wang, I-Hsuan Lee, Tzu-Chun Chou \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n57 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 077 \n\n\n\nUnderstanding the Influencing Factors of Telepharmacy Implementation in Taiwan: A \n\n\n\nQualitative Study \n\n\n\nWen Hsiu Lin*, I-Hsuan Lee  \n\n\n\n\n\n\n\nHospital Pharmacy  \n \n\n\n\nAbstract 078 \n\n\n\nAnalysis of the Effectiveness of OSCE Applied to Hospital Pharmacy Training \n\n\n\nWJ Chen, CK Huang, SF Huang \n\n\n\n\n\n\n\nAbstract 079 \n\n\n\nUsing Beers Criteria for Older Inpatients to Assess Rational Drug Use at A Public \n\n\n\nHospital in Taiwan \n\n\n\nCT Chen, MS Li \n\n\n\n\n\n\n\nAbstract 080 \n\n\n\nOptimising the Evaluation Efficiency of Integrated Outpatient Clinic Prescriptions \n\n\n\nCW Chang, JF Chen \n\n\n\n\n\n\n\nAbstract 081 \n\n\n\nAnti-COVID-19 Drugs Induced Elevated Liver Enzymes: A Case Series \n\n\n\nKuang-Yu Chou, Yi-Ping Hsiang \n\n\n\n\n\n\n\nAbstract 082 \n\n\n\nDose-related Study of Opioid Use in Critically Ill Patients Receiving Extracorporeal \n\n\n\nMembrane Oxygenation Maintenance System \n\n\n\nChu-Chen Cheng, Wen-Hwang Chen \n\n\n\n\n\n\n\nAbstract 083 \n\n\n\nUtilisation of Cardiovascular Drugs among Pulmonary Hypertension with Valvular \n\n\n\nHeart Disease Patients before Valve Surgery \n\n\n\nFarizan Abdul Ghaffar*, Adyani Md Redzuan, Mohd Makmor-Bakry \n\n\n\n\n\n\n\nAbstract 084 \n\n\n\nAn Evidence-based Therapy of Secondary Hyperparathyroidism \n\n\n\nFU YU Yang, Wen Jin Tung \n\n\n\n\n\n\n\nAbstract 085 \n\n\n\nStatistical Analysis on Outpatient\u2019s Referral for Individual Medication Guidance by \n\n\n\nPharmacists \n\n\n\nYP Hsiang*, YT Chiu, YC Kuo \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n58 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\n\n\n\n\nAbstract 086 \n\n\n\nEfficiency of Pharmacists\u2019 Pre-intervention for Elderly Outpatients with Polypharmacy \n\n\n\nHsin-Yi Chou, Chiou-Maan Lin, Yuk-Ying Chan, Shin-Tarng Deng \n\n\n\n\n\n\n\nAbstract 087 \n\n\n\nAnalysis of Severe Cases Risk Factors and Potential Drug-drug Interactions (DDIs) in \n\n\n\nPatients Receiving Oral Anti-COVID-19 Virus Drugs \n\n\n\nYC Hsu*,   YP Hsiang \n\n\n\n\n\n\n\nAbstract 088 \n\n\n\nAnalysis Potential Drug-drug Interactions (DDIs) and Risk Factors in COVID-19 Patients \n\n\n\nReceiving Oral Anti-Virus Drugs Paxlovid\u00ae and Molnupiravir \n\n\n\nYC Hsu*, YP Hsiang \n\n\n\n\n\n\n\nAbstract 089 \n\n\n\nThe Evaluation of Inpatient Oral COVID-19 Medication Utilisation in Medical Centers \n\n\n\nof Southern Taiwan \n\n\n\nYu Ci Lai*, Yi Ping Hsiang, Hsiu Ling  Chang, Lei Yu Chang \n\n\n\n\n\n\n\nAbstract 090 \n\n\n\nRetrospective Study of Drug Use Assessment for Plerixafor \n\n\n\nWen-Ling Lin*, Yow-Wen Hsieh \n\n\n\n\n\n\n\nAbstract 091 \n\n\n\nCase Report of Suspect Adverse Effects of Piperacillin/Tazobactam Induced Drug Fever \n\n\n\nHP Liu, YC Hsu, YP Hsing \n\n\n\n\n\n\n\nAbstract 092 \n\n\n\nInnovation and Evaluation of the Outdoor Outpatient Pharmacy in Response to COVID-\n\n\n\n19 Epidemic: A Pilot Study at A Regional Hospital in Southern Taiwan \n\n\n\nTsun-Pin Liu, Wen-Jun Wong, Heng-Jung Chen2, Yaw-Bin Huang* \n\n\n\n\n\n\n\nAbstract 093 \n\n\n\nDrug Utilization Evaluation of Remdesivir in A Regional Teaching Hospital in Southern \n\n\n\nTaiwan \n\n\n\nBJ Lyu*, YCHsu, YP Hsiang \n\n\n\n\n\n\n\nAbstract 094 \n\n\n\nSurvival Analysis of COVID-19 Patients Admitted in a Tertiary Government Hospital in \n\n\n\nNueva Ecija: A Preliminary Report on the Compassionate Use of Remdesivir \n\n\n\nLapuz, Huberto F., Estolano, Melvin R., Magno, Jem Marie L., De Guzman, Reina Elizabeth L., Gustilo, \n\n\n\nLailanie M., Arriola, Lordel M., Pascual, Marilou* \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n59 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 095 \n\n\n\nThe Prevalence of Pill Dysphagia Among Adult Hospitalised Patients in Hospital \n\n\n\nAngkatan Tentera Tuanku Mizan (HATTM) \nNorlizawati Moktar*, Rosman Ab Rahman, Nurul Amirah Daud, Rosmaliah Alias, Mohd Shahezwan Abd \n\n\n\nWahab, Mohammad Halif Mohamad Yusof, Mohd Adlan Adnan, A Halim Hj Basari \n\n\n\n\n\n\n\nAbstract 096 \n\n\n\nStandardization of Medication Bin Labelling with Quick Reference Information to \n\n\n\nReduce Medication Error and Improve Caller Waiting Time \n\n\n\nNursyafiqah Moideen, Norfaizah Bachok \n\n\n\n\n\n\n\nAbstract 097 \n\n\n\nDisaster Management Zone (DMZ): Military Pharmacists\u2019 Unconventional Innovation in \n\n\n\nResponding to Health Threats \n\n\n\nNurul Amirah Daud, Norlizawati Moktar, Mohammad Halif Mohamad Yusof, Mohd Adlan Adnan, A \n\n\n\nHalim Hj Basari \n\n\n\n\n\n\n\nAbstract 098 \n\n\n\nPrescription Error in Tertiary Military Hospital \u2013 Prevalence and Pattern \n\n\n\nNurul Amirah Daud, Norlizawati Moktar, Mohammad Halif Mohamad Yusof, Mohd Adlan Adnan, A \n\n\n\nHalim Hj Basari \n\n\n\n\n\n\n\nAbstract 099 \n\n\n\nSystematic Review on Questionnaires to Measure Medication Knowledge in Post Kidney \n\n\n\nTransplant Recipients \n\n\n\nNurul Syazfeeza Samsudin*, Nurkasihan Ibrahim, Mohd Shahezwan Abd Wahab, Jasmine Shan Lii Ching, \n\n\n\nMohd Adlan Adnan, A Halim Hj Basari \n\n\n\n\n\n\n\nAbstract 100 \n\n\n\nRelationship of Nutritional Status and Sepsis Mortality \n\n\n\nRoongthip Tangsaghasaksri \n\n\n\n\n\n\n\nAbstract 101 \n\n\n\nApplying Quality Control Tool Improves the Conformance Rate of Microbial Monitoring \n\n\n\nPerformed by Chemotherapy Pharmacists \nShu-Chuan Pi*, Yi-Ping Hsiang, Li-Ching Chang \n\n\n\n\n\n\n\nAbstract 102 \n\n\n\nThe Role of High Serum Uric Acid Levels in Androgenic and Non-Androgenic Polycystic \n\n\n\nOvarian Syndrome Patients \n\n\n\nSrinivasa Babu Puttagunta, Ranakishor Pelluri, Srikanth Kongara \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n60 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 103 \n\n\n\nLow-dose Cefepime Efficacy Evaluation Using Real-world Data \n\n\n\nTY Yi, AJ Wu \n\n\n\n\n\n\n\nAbstract 104 \n\n\n\nIncidence of Liver Injury in Patients Initiated with Antiretroviral Therapy in Primary \n\n\n\nCare Clinics \n\n\n\nKausalya Nawaratnam, Siow Chia Tay, Sumayyah Shafifi A Karim, Nur Khalidah Mohd Mus \n \n\n\n\nAbstract 105 \n\n\n\nEvaluation of Chinese Herbal Extracts on Eczema Skin \n\n\n\nSC Tseng, JS Wang, MM Lee \n\n\n\n\n\n\n\nAbstract 106 \n\n\n\nInterprofessional Collaborative Practice in HIV Patient: Role of Pharmacist in A Regional \n\n\n\nHospital \nTsung Wei Chang*, Chun-Ya Huang, Wen-Jin Tung \n\n\n\n\n\n\n\nAbstract 107 \n\n\n\nThe Prevalence of Major Drug\u2013drug Interactions in Patients Treated with Nirmatrelvir \n\n\n\nplus Ritonavir: A Retrospective Study \n\n\n\nTu Po-Yang*, Liu Min-Li, Hsu Yung-Chia, Hsiang Yi-Ping \n\n\n\n\n\n\n\nAbstract 108 \n\n\n\nUsing Plan-Do-Check-Action Management Methods to Improve Medication Errors in \n\n\n\nTaiwan Hospital \nYih-Dih Cheng2*, Wei-Ning Yu, Sonia Chen, Chun-Ju Kuo, Yo-Wen Hsieh \n\n\n\n\n\n\n\nAbstract 109 \n\n\n\nEvaluation of the Appropriateness of Antibiotics Doses in Critically Ill Patients \n\n\n\nReceiving Extracorporeal Membrane Oxygenation System [ECMO] \nWen-Hwang Chen, Chu-Chen, Cheng \n\n\n\n\n\n\n\nAbstract 110 \n\n\n\nReal-world Efficacy of Low-dose Cefepime: a Retrospective Study \n\n\n\nKR Yang, TY Yi, TR Peng, AJ Wu \n \n\n\n\nAbstract 111 \n\n\n\nThe Effectiveness of Pharmacist Intervention in Heart Failure Integrated Clinic \n\n\n\nYi-Fang Weng, Kai-Ruei Yang, Jui-Mei Tsuo, An-Jan Wu, Tzu-Rong Peng* \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n61 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 112 \n\n\n\nTopiramate May Not Increase Risk of Age-related Macular Degeneration: A Population-\n\n\n\nbased Cohort Study in Taiwan \u2013 A Preliminary Report \nSonia Chen, Ying-Shu You, Yih-Dih Cheng*, Yo-Wen Hsieh, Chien-Ying Lee, Kuang-Hua Huang \n\n\n\n\n\n\n\nAbstract 113 \n\n\n\nOptimisation of Medications by Pharmacists in A Respiratory Care Ward \u2013 The \n\n\n\nExperience from A Regional Hospital in Northern Taiwan \nCY Yu, SH Hsu \n\n\n\n\n\n\n\nAbstract 114 \n\n\n\nPrescription Patterns for Acute Myocardial Infarction (AMI) Patients in Secondary \n\n\n\nPrevention \n\n\n\nYun-Hsin Yang \n\n\n\n\n\n\n\nAbstract 115 \n\n\n\nManagement of COVID-19 Infection Combined with Bacteremia Pneumonia in Cancer \n\n\n\nPatients with Neutropenia: A Case Report and Literature Review \n\n\n\nChing- Chih, Huang, Chu-Chen, Cheng \n\n\n\n\n\n\n\n\n\n\n\nIndustrial Pharmacy and Marketing \n \n\n\n\nAbstract 116 \n\n\n\nAcetic Acid Derivatives Improve Cardiovascular Disease in Patients with Dyslipidemia \n\n\n\nChen-Sheng Chen, Bo-Yi Pan, Yu-Ting Hsu, Fang-Yu Chen, Wen-Chin Yang, Ming-Yi Shen* \n\n\n\n\n\n\n\nAbstract 117 \n\n\n\nAnalysis of Patient Self-administered Satisfaction Questionnaires in Psychiatric \n\n\n\nSpecialized Hospital \nChia chang Hsu*, Ting Luo, Tsung-Han Lin, Kuan-Yu Lin, Kuo-Tung Chiang, Szu-Nian Yang \n\n\n\n\n\n\n\nAbstract 118 \n\n\n\nDeveloping the Medication Reminder App to Improve Medication Adherence \n\n\n\nChin-Ju Chuang, Ya-Hsin Hsueh, Cheng-Ying Hsieh, Chiu-Yi Wu, Yi-Pin Chen, Pei-Ling Tsai, Yung-Cheng \n\n\n\nHuang, Shu-Chen Lin, Ying-Chun Chen, Yu-Chen Li, Zhi-Yu Tu, Ling-Chiao Liao* \n\n\n\n\n\n\n\nAbstract 119 \n\n\n\nDeterminants and Perceived Effectiveness of Self-Medication Practices for the \n\n\n\nPrevention or Treatment of COVID-19 Symptoms among Adults in Cavite \n\n\n\nNicole Allyson Carabeo, Nyah Grenadine Cortez, Heather Scarllette Manalo, Cyan Meniado, Francesca \n\n\n\nMarie Manansala, Diana Dalisay Orolfo* \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n62 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 120 \n\n\n\nKnowledge and Perception of the General Public in Cavite, Philippines on Counterfeit Medicines \n\n\n\nHannah Kristnel DV. Mesa, Danielle Marie J. Garduce, Alvin A. Vibar, Mirava A. Villamin, Katrice L. Binos* \n\n\n\n\n\n\n\nAbstract 121 \n\n\n\nCombined SGLT2 and ARNI Therapy to Reduce the Risk of Cardiovascular Disease in \n\n\n\nType II Diabetes: A Nationwide Population-base Cohort Study \n\n\n\nMing-Chi Hung, Chiu-Lan Chen ,Che- huei Lin*, Ming-hung Lin* \n\n\n\n\n\n\n\nAbstract 122 \n\n\n\nThe Impact of Service Marketing Mix toward Customer Purchase Behavior from \n\n\n\nPharmacy Services Online \n\n\n\nXue Min Ng*, Mei Teh Goi \n\n\n\n\n\n\n\nAbstract 123 \n\n\n\nPrediction of in vivo Performance of Dabigatran Capsules Produced in Nepal from in \n\n\n\nvitro (Dissolution) data Using Numerical Convolution Method \n\n\n\nKhanal,N, Budhathoki U, Bista D \n\n\n\n\n\n\n\nAbstract 124 \n\n\n\nThe Study of Drug Interactions between Herbal Medicine and Drugs \n\n\n\nYung-Huei Fu, Li-Heng Pao \n\n\n\n\n\n\n\n\n\n\n\nPharmacy Education \n \n\n\n\nAbstract 125 \n\n\n\nVarying Approaches for Modelling CPD \u2014 A Retrospective Review by Indonesian \n\n\n\nYoung Pharmacists Group \n\n\n\nAnggun P. Wardhani, Dwi P. Rahmawati, Rabella Mufti S, R. Aldizal Mahendra, I Made Bayu Anggriawan \n\n\n\n\n\n\n\nAbstract 126 \n\n\n\nAssessing the Clinical Competence of Entry-to Advanced-level Pharmacists using Case-\n\n\n\nbased Discussions in Japan \n\n\n\nKanayuki Kitahara, Yukari Kataoka, Tatsuya Isezaki, Yasuaki Yokoyama, Asami Funaki, Ryohkan \n\n\n\nFunakoshi \n\n\n\n\n\n\n\nAbstract 127 \n\n\n\nThe Development of Teaching Method and Game-Based Materials for Medication-use \n\n\n\nSafety Modular Course \n\n\n\nLing-Chiao Liao, Yung-Ching Hsu, Ai-Tzu Li, Jou-Wei Lin, Cheng-Ying Hsieh, Yung-Cheng Huang, Yu-\n\n\n\nChen Li, Chin-Ju Chuang* \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n63 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 128 \n\n\n\nA New Platform to Advance Pharmacy Workforce Education \n\n\n\nMd. Mirajul Islam, Mohammad Abusyed, Mandip Pokharel, Sovanrith Phalla, Tammy Allen \n\n\n\n\n\n\n\nAbstract 129 \n\n\n\nDrug-related problems (DRP) Identified by Pharmacy Students during Telepharmacy \n\n\n\nSessions \nNor Elyzatul Akma Hamdan1*, Mahmathi Karuppannan, Munaver Ahmad Nazir Ahmad, Ezlina Usir, \n\n\n\nKamaliah Md. Saman, and Siti Norlina Md. Said \n\n\n\n\n\n\n\nAbstract 130 \n\n\n\nConsultation and Education of Doping Among Athletes and Their Logistics Staff \n\n\n\nHung-Chang Chou, Wei Ho, Tzu-Chun Chou \n\n\n\n\n\n\n\nAbstract 131 \n\n\n\nHybrid learning to answer the adjustment of learning models after the pandemic \n\n\n\nArde Toga Nugraha \n\n\n\n\n\n\n\n\n\n\n\nSocial and Administrative Pharmacy  \n \n\n\n\nAbstract 132 \n\n\n\nNew Drug Budget and Reimbursement Policy in Taiwan \n\n\n\nYY Chan, ZF Lu, CN Hsu, YC Pan, WN Weng \n\n\n\n\n\n\n\nAbstract 133 \n\n\n\nDevelopment of a Searching Program of Nutrient Information for Patients who have \n\n\n\nDiabetes or Hypertension \n\n\n\nGyeongil Jang, Kwang Joon Kim, Dongmun Ha \n\n\n\n\n\n\n\nAbstract 134 \n\n\n\nDevelopment of a Computerized Pharmacy Management System Called PM+20 for the \n\n\n\nIT-based Community Pharmacy Practices in South Korea \n\n\n\nHyuntai, K, Jeehye M \n\n\n\n\n\n\n\nAbstract 135 \n\n\n\nKnowledge, Attitudes, and Practices on the Use of Antibiotics among the Residents in \n\n\n\nSilago, Southern Leyte, Philippines: Basis for Antimicrobial Stewardship Program for \n\n\n\nPrimary Health Care \n\n\n\nKim Ann Pere, Vieno Gino Cruz, Nimfa B. Gambalan, Mark Harvey B. Adamson, Elvira V. De Leon \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n64 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 136 \n\n\n\nAssociated Factors Related to Influenza Vaccine Acceptance among Adults in Cavite \n\n\n\nDuring the COVID-19 Pandemic \n\n\n\nPaola Allison B. Ara\u00f1o, Ma. Bernadette A. Cirilos, Christine Kate G. Conding, Hazel Mae C. Equiza, Louie \n\n\n\nFernand D. Legaspi \n\n\n\n\n\n\n\nAbstract 137 \n\n\n\nMilitary Pharmacist Involvement in COVID-19 Vaccination Outreach Programme \n\n\n\nKhan ARK, Baharuddin F, Adnan MA, Basari AH \n\n\n\n\n\n\n\nAbstract 138 \n\n\n\nMilitary Pharmacist Involvement in Greater Klang Valley Special Task Force (GKVSTF) \n\n\n\n\u2013 Medical and General Logistics Cluster (MedGenLog Cluster) \nMej Muhammad Najhan bin Md Bohari, Lt Kol Mohamad Halif bin Mohamad Yusof, Kol Mohd Adlan bin \n\n\n\nAdnan, Brig Jen Dato\u2019 Dr A. Halim bin Basari \n\n\n\n\n\n\n\nAbstract 139 \n\n\n\nThe Flying Pharmacist: Military Pharmacist\u2019s Experiences and Roles in Managing \n\n\n\nCOVID-19 Vaccine Logistics Using Royal Malaysian Airforce (RMAF) Aircraft \nMAE Zamri, MA Adnan, AH Basari, MA Rahim, MH Haron \n\n\n\n\n\n\n\nAbstract 140 \n\n\n\nCustomer Satisfaction towards Logistic Pharmacy Services in HTJS \n\n\n\nSalihah bt Aidit, Rekarani a/p Rajantharan, Nurfikriah Husna bt Mohamad Radz*, Nur Athirah bt \n\n\n\nMuhammad Fairuz \n\n\n\n\n\n\n\nAbstract 141 \n\n\n\nPatient Characteristics and Factors Associated with Defaulters among Drive-through \n\n\n\nPatients in Hospital Tuanku Ja\u2019afar Seremban \n\n\n\nNursyafiqah. Md Tahir, Nurshazlien. Abd.Halim, Jayasir Elengko \n\n\n\n\n\n\n\nAbstract 142 \n\n\n\nAssessment of Public Satisfaction on National COVID-19 Immunization Services among \n\n\n\nthe Malaysian Population \n\n\n\nWan Xin Soo Toh, Yoon Fong Hoo* \n\n\n\n\n\n\n\nAbstract 143 \n\n\n\nPerceptions, Attitude, and Barriers of PAPPI Regulatory Pharmacists Towards \n\n\n\nRegulatory Pharmacy Experiential Practice: A Basis for Capacity Programs \n\n\n\nRosita S. Ignacio, Nimfa B. Gambalan\uff0cVieno Gino Cruz*\uff0c Mark Harvey B. Adamson \n\n\n\n\n\n\n\nAbstract 144 \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n65 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nExploratory Factor Analysis of A Patient-reported Outcome Measure: A Newly \n\n\n\nDeveloped Medication Adherence Measurement Tool for the Elderly in Malaysia \n\n\n\nKamaliah Md Saman*, Nurfatiha Zulkarnain Helmi, Khairil Anuar Md Isa, Mathumalar Loganathan  Fahrni \n\n\n\n\n\n\n\n\n\n\n\nScientific  \n \n\n\n\nAbstract 145 \n\n\n\nTransethosomal Gels as Nanocarriers for the Transdermal Delivery of Tamoxifen: \n\n\n\nStatistical Optimization, Characterization, and Ex vivo Evaluation \n\n\n\nReem Abou Assi1,2, Siok Yee Chan 1* \n\n\n\n\n\n\n\nAbstract 146 \n\n\n\nViability Assay of Essential Fatty Acids from the Benincasa hispida Seed Extract in \n\n\n\nKeratinocytes \n\n\n\nRamli RZ, Hadi H \n\n\n\n\n\n\n\nAbstract 147 \n\n\n\nThe Development and Characterisation of Retinoic Acid Loaded Nanosponge \n\n\n\nSyed Omar SS, Hadi H, Doolanea AA \n\n\n\n\n\n\n\nAbstract 148 \n\n\n\nFormulation and Evaluation of Voriconazole Gastro Retentive Floating Tablets \n\n\n\nD Srinivasa Sastry*, S. Jahnavi Purna, G Sumalatha, D Srilakshmi \n\n\n\n\n\n\n\nAbstract 149 \n\n\n\nIn vitro Mammalian \u03b1-Glucosidase Inhibitory Activity of Hylocereus polyrhizus \n\n\n\nChristian M. Miranda, Vieno Gino Cruz, Nimfa B. Gambalan, Jover D. Francisco, Rizza Caluag \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n66 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 001 \n\n\n\n\n\n\n\nPharmacists\u2019 Perceptions on Future \n\n\n\nImplementation of A Medication Review \n\n\n\nService Model in Community Settings: A \n\n\n\nQualitative Study Utilising the \n\n\n\nConsolidated Framework for \n\n\n\nImplementation Research (CFIR) and the \n\n\n\nExpert Recommendations for \n\n\n\nImplementing Change (ERIC) strategy tool \n\n\n\n\n\n\n\nMaali Mujahid, Ernieda Hatah*, Mohd \n\n\n\nMakmor-Bakry \n \n\n\n\nFaculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda \n\n\n\nAbd Aziz, 50300 Kuala Lumpur, Malaysia. \n\n\n\n* Corresponding author \n\n\n\nEmail: ernieda@ukm.edu.my \n\n\n\n\n\n\n\nBackground and Objectives:  Pharmacists' roles have been \n\n\n\nevolving to include more patient-centred care services such \n\n\n\nas medication reviews that help patients receive the most \n\n\n\nbenefits from their medications. In Malaysia, medication \n\n\n\nreview service is yet to be widely implemented in the \n\n\n\ncommunity pharmacy settings for several reasons, including \n\n\n\nthe non-dispensing separation healthcare system. To \n\n\n\nimplement a feasible medication review service model in \n\n\n\nMalaysia, it is important to gather community pharmacists\u2019 \n\n\n\nperspectives on such services. Therefore, the present study \n\n\n\nwas conducted to explore community pharmacists\u2019 \n\n\n\nperceptions of barriers, facilitators, and strategies for the \n\n\n\nimplementation of a medication review service model in \n\n\n\nMalaysia. Methods: A focus group discussion followed by \n\n\n\nsemi-structured interviews were conducted among \n\n\n\npurposively sampled community pharmacists with interest in \n\n\n\nmedication review service. A deductive approach was used \n\n\n\nto generate and analyse the data according to the consolidated \n\n\n\nframework for implementation research (CFIR). After data \n\n\n\nmapping, the CFIR-ERIC matching tool was used to generate \n\n\n\nappropriate strategies according to the barriers identified. \n\n\n\nResults and Discussion: Twenty community pharmacists \n\n\n\nparticipated in this study. Several barriers and facilitators to \n\n\n\nservice implementation were identified based on the \n\n\n\nrespondents\u2019 feedback. The CFIR-ERIC strategies matching \n\n\n\ntool analysis reported potential plans that can mitigate the \n\n\n\nbarriers such as: identify and prepare champions, conduct \n\n\n\nlocal consensus discussions, conduct educational meetings, \n\n\n\nalter incentive/allowance structures, and develop a formal \n\n\n\nimplementation blueprint. Conclusion: The findings will \n\n\n\nguide the development of a medication review service model \n\n\n\nthat is tailored for implementation in community pharmacy \n\n\n\nsettings in Malaysia. \n\n\n\nAbstract 002 \n\n\n\n\n\n\n\nRole of Community Pharmacist in \n\n\n\nCardiovascular Diseases-Related Health \n\n\n\nPromotion and Dyslipidemia Management \n\n\n\nin Malaysia: A Cross-Sectional Study  \n\n\n\n\n\n\n\nFarhana Fakhira Ismail1,2, Adyani Md \n\n\n\nRedzuan1*, Chong Wei Wen1  \n \n1 Centre for Quality Management of Medicine, Faculty of Pharmacy, \n\n\n\nUniversiti Kebangsaan Malaysia, Kuala Lumpur, 50300, Malaysia  \n2 Department of Clinical Pharmacy, Faculty of Pharmacy, Universiti \n\n\n\nTeknologi MARA, Selangor, 42300, Malaysia.  \n\n\n\n* Corresponding author \n\n\n\nEmail: farhanafakhira.288@gmail.com \n\n\n\n\n\n\n\nBackground and Objectives: In Europe, cardiovascular \n\n\n\ndisease (CVD) is the primary cause of morbidity and \n\n\n\nmortality. It is connected to a heavy clinical and financial \n\n\n\nburden. Similarly in Malaysia, it is found that 64% of \n\n\n\nMalaysia adults had elevated total cholesterol (TC) and 56.7% \n\n\n\nwith elevated low density lipoprotein cholesterol (LDL-C). \n\n\n\nPharmacists in the community are well-positioned to assist \n\n\n\npatients who have CVD or who are at risk of developing this. \n\n\n\nTherefore, the purpose of this study was to investigate the \n\n\n\ncurrent involvement of community pharmacists (CPs) in \n\n\n\nMalaysia specifically in dyslipidemia management. Their \n\n\n\nperceived barriers in providing CVD and dyslipidemia \n\n\n\nservices are explored in depth. Methods: A self-administered \n\n\n\nsurvey was sent to all CPs in Malaysia using convenience \n\n\n\nsampling. The survey was conducted online and being shared \n\n\n\nin relevant groups involving CPs in Facebook, Whatsapp and \n\n\n\nTelegram platforms. The data was analysed using descriptive \n\n\n\nand inferential statistics. Results and Discussion: A total of \n\n\n\n312 CPs took part in the study. Chinese population, CPs with \n\n\n\npremises located in the urban area, more than one pharmacist \n\n\n\navailable at one shift and completion of dyslipidemia training \n\n\n\nshow significantly higher practice. For CVD-related health \n\n\n\npromotional activities, more than 50% of the respondents \n\n\n\nopted for never or rarely in providing educational materials, \n\n\n\nconducting the risk assessment score and collaborating with \n\n\n\nother healthcare professionals. For dyslipidemia \n\n\n\nmanagement, lack of practice was seen in counselling of \n\n\n\nantiplatelet therapy, referral of patients to dietitians and \n\n\n\nreview of patients\u2019 drug history. Lack of access to medical \n\n\n\nrecords (71.2%) was the highest perceived barrier \n\n\n\nencountered by CPs, followed by lack of CVD-related \n\n\n\neducational materials (70.8%). Conclusion: Current \n\n\n\ninvolvement of CPs in Malaysia is found to be satisfactory \n\n\n\nand can be improved. Support and strategies can be \n\n\n\nimplemented effectively in the near future to increase the \n\n\n\ninvolvement of CPs in CVD prevention. \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:ernieda@ukm.edu.my\n\n\nmailto:farhanafakhira.288@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n67 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 003 \n\n\n\n\n\n\n\nA Survey of the Adoption and Perception \n\n\n\nof Mobile Health Applications Among \n\n\n\nCommunity Pharmacists in Malaysia  \n\n\n\n\n\n\n\nHui Leng Ng, Jason Siau Ee Loo*, Renukha \n\n\n\nSellappans \n \n\n\n\nSchool of Pharmacy, Faculty of Health and Medical Sciences, Taylor\u2019s \n\n\n\nUniversity, No.1, Jalan Taylor\u2019s, 47500 Subang Jaya, Selangor, Malaysia  \n\n\n\n* Corresponding author \n\n\n\nEmail: huileng1999@gmail.com \n\n\n\n\n\n\n\nBackground and Objectives: Mobile health applications are \n\n\n\none of the most accessible health technologies that will play \n\n\n\nan integral role in the future of healthcare. Community \n\n\n\npharmacists are key stakeholders in promoting mHealth \n\n\n\napplications among the general public, therefore \n\n\n\nunderstanding their adoption and perception of these \n\n\n\napplications is key in shaping the integration of these \n\n\n\ntechnologies into healthcare systems. In this study, we \n\n\n\ndetermine the adoption and perception towards mHealth \n\n\n\napplications of community pharmacists in Malaysia. \n\n\n\nMethods: A cross-sectional survey was conducted with 300 \n\n\n\ncommunity pharmacists practising in the Klang Valley, \n\n\n\nMalaysia using a stratified sampling approach and a self \n\n\n\nadministered questionnaire. The questionnaire included three \n\n\n\nsections: demographic characteristics, adoption of mHealth \n\n\n\napplications, and perception towards mHealth applications. \n\n\n\nDescriptive and inferential statistics together with factor \n\n\n\nanalysis were utilised for data analysis. Results and \n\n\n\nDiscussion: The adoption of mHealth applications among \n\n\n\nrespondents overall was high at 79.7%. However, among \n\n\n\nthese mHealth application users only 65.7% recommended \n\n\n\nthem to their patients. Respondents showed a higher usage of \n\n\n\nmHealth applications in the literature category, followed by \n\n\n\npatient monitoring and personal care. Respondents mainly \n\n\n\nrecommended applications in the personal care and \n\n\n\ncommunication with healthcare professionals category to \n\n\n\npatients. Factor analysis revealed the most influential factor \n\n\n\ndriving mHealth application adoption was positive \n\n\n\nperception towards mHealth applications aspects related to \n\n\n\nprofessional practice. This was significantly higher than \n\n\n\nperception towards other aspects of mHealth such as patient \n\n\n\ncare, mHealth application features, and reliability of mHealth \n\n\n\napplications. Conclusion: The overall adoption of mHealth \n\n\n\napplications is high among community pharmacists. \n\n\n\nHowever, community pharmacists are more likely to utilise \n\n\n\nmHealth applications for their own professional practice and \n\n\n\nless likely to recommend them to patients. Improving the \n\n\n\nperception of mHealth applications in aspects of patient care \n\n\n\nand reliability may help improve community pharmacists\u2019 \n\n\n\npromotion of mHealth applications among the general public. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 004 \n\n\n\n\n\n\n\nInvestigating Pharmacy Value-Added \n\n\n\nServices (PVAS) in Community \n\n\n\nPharmacies: A Study in Urban and \n\n\n\nSuburban Areas of Perak, Malaysia \n\n\n\n\n\n\n\nZaswiza Mohamad Noor*, Nik Nur \u2018Alya Nik \n\n\n\nPa \n \n\n\n\nDepartment of Pharmacy, Faculty of Pharmacy and Health Sciences, Royal \n\n\n\nCollege of Medicine Perak, Universiti Kuala Lumpur, 30450 Ipoh, Perak, \n\n\n\nMalaysia \n\n\n\n* Corresponding author \n\n\n\nEmail: zaswiza@unikl.edu.my \n\n\n\n\n\n\n\nBackground and Objectives: Community pharmacies \n\n\n\nmonitor and deliver health services to the community, apart \n\n\n\nfrom dispensing medications. PVAS are extended services \n\n\n\nprovided to enhance pharmaceutical care. At present, digital \n\n\n\ntechnology is also needed as a platform for PVAS. This study \n\n\n\nwas conducted to investigate the PVAS available in \n\n\n\ncommunity pharmacies, to identify the practice differences in \n\n\n\nurban and suburban areas, and to identify the pharmacists\u2019 \n\n\n\nreadiness to use digital technology. Methods: This cross-\n\n\n\nsectional study was conducted face-to-face and via online. \n\n\n\nValidated-questionnaire consisted of three-parts, was \n\n\n\ndistributed to community pharmacists (CPs) in urban and \n\n\n\nsuburban areas of Perak. Survey-link was provided either via \n\n\n\nemail or posted to social media. Paper-based survey was \n\n\n\ngiven to the CPs at the premise. Sample size was calculated \n\n\n\nusing Raosoft Software. Data were analysed using SPSS \n\n\n\nV.20 descriptively. Results and Discussion: Sixty-one \n\n\n\n(N=61) CPs responded; female (57%), age 36-40 years-old \n\n\n\n(29%), and Malays (44%). The most provided PVAS are \n\n\n\nhealth screening (100%), supplement-TCM consultation \n\n\n\n(79%), and diet-lifestyle counselling (77%). CPs also provide \n\n\n\ncounselling for smoking cessation (36%) and weight \n\n\n\nmanagement (44%). Eighty-five percent of CPs in urban \n\n\n\nareas used digital technology as a platform for PVAS. For \n\n\n\nreadiness to use technology, only 49% of the CPs were ready. \n\n\n\nHome delivery (51%) and mobile pharmacy (40%) were \n\n\n\nchosen as the most appropriate PVAS. Conclusion: No \n\n\n\nsignificant difference was found between PVAS provided by \n\n\n\nurban and suburban pharmacies. Although the CPs in urban \n\n\n\nareas prefer digital technology for certain PVAS, most of the \n\n\n\nCPs are already prepared with knowledge and budget for new \n\n\n\nfuture-PVAS. \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:huileng1999@gmail.com\n\n\nmailto:zaswiza@unikl.edu.my\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n68 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 005 \n\n\n\n\n\n\n\nEvaluation of Anticoagulation Control in \n\n\n\nPatients with Atrial Fibrillation  \n\n\n\n\n\n\n\nAdyani Md Redzuan*, Azeta Abdullah, \n\n\n\nChandini Menon A/P Premakuma, Farah \n\n\n\nWaheeda  Tajurudin \n \n1 Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda \n\n\n\nAbdul Aziz, 50300 Kuala Lumpur \n\n\n\n* Corresponding author \n\n\n\nEmail: adyani@ukm.edu.my \n\n\n\n\n\n\n\nBackground and Objectives: Time in therapeutic range \n\n\n\n(TTR) measures the stability of the international normalized \n\n\n\nratio (INR) in patients on warfarin therapy. Low values are \n\n\n\nassociated with poor outcome. This study aims to evaluate \n\n\n\nthe warfarin treatment for atrial fibrillation (AF) by \n\n\n\ndetermining the TTR and the significant predictors that affect \n\n\n\nthe TTR control. Methods: In a retrospective observational \n\n\n\nstudy, all patients with AF attending follow-up in Warfarin \n\n\n\nClinic, UKM Medical Centre from January 2020 until June \n\n\n\n2021 were reviewed. The collected data includes patients\u2019 \n\n\n\ndemographics and their clinical characteristics which were \n\n\n\nretrieved from INR\u2019s booklet and electronic medical record \n\n\n\n(C-HEtS, Medipro\u00ae). Results and Discussion: Seventy-\n\n\n\nthree patients who met the inclusion criteria were included in \n\n\n\nthis study. Binary logistic regression was carried out to \n\n\n\nidentify the significant predictors of TTR. The calculated \n\n\n\nmean TTR were 52%, (SD 24.97%). Of the included patients, \n\n\n\n60.3% (n=44) were in the poor control category. The results \n\n\n\nof binary logistic regression revealed that the significant \n\n\n\npredictors of TTR control were age (OR 0.92; 95% CI: 0.86-\n\n\n\n0.99; p = 0.024) and number of medications (OR: 1.17; 95% \n\n\n\nCI: 1.02-1.35; p = 0.025). Younger age and increased number \n\n\n\nof medications leading to poor TTR values presumably due \n\n\n\nto poor adherence. Conclusion: Since majority of patients \n\n\n\nunder Warfarin Clinic follow-up had poor TTR control, it is \n\n\n\nnecessary for patients to be well-educated and understand the \n\n\n\nimportance of adherence through counselling in order to \n\n\n\nmaintain good INR control. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 006 \n\n\n\n\n\n\n\nPrediction of Aspirin Induced Gastric \n\n\n\nToxicity and Resistance in Rats Using \n\n\n\nNMR-Based Pharmacometabonomics \n\n\n\n\n\n\n\nIbrahim B1*, Sha\u2019aban A2, Zainal H2 \n\n\n\n\n\n\n\n1 Faculty of Pharmacy, Universiti Malaya, 50603 Kuala Lumpur, Malaysia \n2 School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 \n\n\n\nPenang, Malaysia \n\n\n\n* Corresponding author \n\n\n\nEmail: baharudin.ibrahim@um.edu.my \n\n\n\n\n\n\n\nBackground and Objectives: Low Dose Aspirin (LDA) is \n\n\n\nthe cornerstone of secondary prevention in coronary artery \n\n\n\ndisease (CAD). Despite its established efficacy, it suffers a \n\n\n\nmajor setback of causing gastrointestinal toxicity. In addition, \n\n\n\nsome patients still experience atherothrombotic events while \n\n\n\non aspirin secondary prophylaxis, a term known as aspirin \n\n\n\nresistance. The aim of this project was to evaluate the use of \n\n\n\npharmacometabonomics, in finding metabolites that can \n\n\n\npredict aspirin-induced gastric toxicity and aspirin resistance \n\n\n\nin rats. Methods: Pre-dose models were developed using H-\n\n\n\nNMR spectroscopic data from the biofluids of Sprague \n\n\n\nDawley (SD) rats and the respective class identities of the rats. \n\n\n\nThe class identities were either gastric toxic versus non-\n\n\n\ngastric toxic or aspirin resistant versus aspirin sensitive. \n\n\n\nApproximately, 300 \u00b5l of rat serum and an equal volume of \n\n\n\nphosphate buffer were mixed and analysed using nuclear \n\n\n\nmagnetic resonance (NMR) spectroscopy. The spectra were \n\n\n\nsubjected to multivariate statistical analysis including \n\n\n\nprincipal component analysis and orthogonal-partial least \n\n\n\nsquare discriminant analysis and the discriminating \n\n\n\nmetabolites were identified using metabolomics database. \n\n\n\nResults and Discussion: The multivariate statistical analysis, \n\n\n\nfrom which the models were developed, showed a significant \n\n\n\nseparation between the two classes in each case. Pre-dose \n\n\n\npharmacometabonomic serum analysis identified valine, \n\n\n\nlactate, acetoacetate and pyruvate as biomarkers for aspirin-\n\n\n\ninduced gastric toxicity. Meanwhile, lactate, trimethylamine \n\n\n\nN-oxide and 4-hydroxyphenylacetate were identified as \n\n\n\nbiomarkers for aspirin resistance. The AUROC were 0.988 \n\n\n\nand 0.874 respectively for gastric toxicity and resistance \n\n\n\ndiscriminations. Conclusion: NMR-based \n\n\n\npharmacometabonomics has good potential to identify \n\n\n\nbiomarkers to predict aspirin induced gastric toxicity and \n\n\n\naspirin resistance. This technology known as precision \n\n\n\nmedicine can be used to predict aspirin response on different \n\n\n\nindividuals even before starting the therapy. \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:adyani@ukm.edu.my\n\n\nmailto:baharudin.ibrahim@um.edu.my\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n69 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstrat 007 \n\n\n\n\n\n\n\nA Study on Adverse Effect Induced by \n\n\n\nChemotherapy Drug Used For Colorectal \n\n\n\nCancer and Their Management in Nepal \n\n\n\nCancer Hospital and Research Center \n \n\n\n\n Shrestha BM1*, Bista D 1, Shakya R1  \n \n1 Department Pharmacy, School of Science, Kathmandu University, \n\n\n\nDhulikhel, Kavre, Nepal   \n\n\n\n* Corresponding author \n\n\n\nEmail: aoki.shrestha593@gmail.com \n \n\n\n\nBackground and Objectives: Colorectal Cancer (CRC) is \n\n\n\nthe third most common malignancy and second most leading \n\n\n\ncause of death globally. The main objective of this study was \n\n\n\nto study various types of adverse drug reactions (ADRs) \n\n\n\nassociated with chemotherapy administered in CRC in one of \n\n\n\nthe cancer hospitals of Nepal. Methods: A retrospective \n\n\n\nobservational study was conducted at the Nepal Cancer \n\n\n\nHospital and Research Centre in patients who visited from \n\n\n\nJanuary 2020 to December 2021 for the treatment of \n\n\n\ncolorectal cancer. Patient who met the study criteria were \n\n\n\nenrolled in the study and the data was collected from their \n\n\n\ncase records. The ADRs reported were noted down and \n\n\n\nmanagement of such ADRs were taken into account.  Results \n\n\n\nand Discussion: A total of 90 patient received \n\n\n\nchemotherapy, out of which ADRs were observed in 90% \n\n\n\n(n=81). There were in total 381 ADRs recorded among them. \n\n\n\nCommon regimen administered for treatment of CRC were \n\n\n\n5FU/LV, FOLFOX, CAPOX and Oral Capecitabine. \n\n\n\nInfection (55.6%) and diarrhea (51.9%) were the most \n\n\n\nprevalent ADRs in CRC patients receiving chemotherapy. \n\n\n\nOlder population showed more ADRs compared to younger \n\n\n\n(P=0.05) and oral capecitabine reported less ADRs when \n\n\n\ncompared to other chemotherapy regimen. Severe ADRs \n\n\n\nwere seen in 38.3% (n=31) patients that included mainly \n\n\n\ndiarrhea (n=14) and sepsis (n=9). Most of the severe ADRs \n\n\n\nled to prolonged hospitalization. Majority of the ADRs were \n\n\n\nmanaged symptomatically and only in severe or \n\n\n\nhypersensitivity cases the chemotherapy regimen was \n\n\n\nchanged or stopped. Conclusion: ADRs are inevitable with \n\n\n\nchemotherapy administered. Health care professionals \n\n\n\nincluding pharmacists can play an important role in detection \n\n\n\nand management of ADRs. Proper monitoring of patients on \n\n\n\nchemotherapy, timely detection and prevention of ADRs can \n\n\n\nbe critical step in enchancing quality of life of CRC patients. \n\n\n\nInterventional studies aiming to improve detection and \n\n\n\nreporting of such ADRs is recommended.  \n\n\n\n\n\n\n\n\n\n\n\nAbstrat 008 \n\n\n\n\n\n\n\nAssessment of Patient Safety Culture \n\n\n\namong Healthcare Providers in A Tertiary \n\n\n\nHospital at Johor Bahru, Malaysia \n \n\n\n\nSok May Cheong1*, Palanisamy Sivanandy2, \n\n\n\nPravinkumar Vishwanath Ingle2 \n \n1 School of Postgraduate Studies, International Medical University, Kuala \n\n\n\nLumpur, Malaysia \n2 Department of Pharmacy Practice, School of Pharmacy, International \n\n\n\nMedical University, Kuala Lumpur, Malaysia \n\n\n\n* Corresponding author \n\n\n\nEmail: 00000033167@student.imu.edu.my \n\n\n\n\n\n\n\nBackground and Objectives: Patient safety culture is the \n\n\n\ncombination of attitudes and behaviors toward patient safety \n\n\n\nthat are addressed when a patient walks into a healthcare \n\n\n\ninstitution. The objectives of the study were to identify the \n\n\n\ncurrent status of patient safety culture and to evaluate and \n\n\n\ncorrelate the healthcare providers (HCPs) knowledge, \n\n\n\nattitude, and perception of patient safety culture in tertiary \n\n\n\nhospital settings. Methods: A cross-sectional study was \n\n\n\ncarried out among the HCPs of a tertiary hospital in Medini \n\n\n\nJohor. A structured validated questionnaire which includes \n\n\n\nHospital Survey On Patient Safety Culture (HSOPSC) was \n\n\n\nused in this study to analyse the level of patient safety culture \n\n\n\nin the study settings. Results and Discussion: A total of 100 \n\n\n\nHCPs were approached and only half of them (50%) \n\n\n\nresponded to this online survey and the response rate was \n\n\n\n50%. The overall patient safety grade was rated as very good \n\n\n\nor excellent by 31 (62%) respondents. Around 42% (n=21) \n\n\n\nof the respondents believed that the staff in the unit worked \n\n\n\nmore hours than was ideal for patient care. The study \n\n\n\nrevealed that feedback and communication about errors were \n\n\n\ngood in this study setting, whereas staffing and non-punitive \n\n\n\nresponse to error require improvement in terms of patient \n\n\n\nsafety culture. Conclusion: HCPs in this study setting had \n\n\n\nfavourable attitudes toward the culture of patient safety in \n\n\n\ntheir organization. Every healthcare organization should \n\n\n\naddress the issue of safety culture holistically. \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\nmailto:aoki.shrestha593@gmail.com\n\n\nmailto:00000033167@student.imu.edu.my\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n70 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 009 \n\n\n\n\n\n\n\nHerbal Medicine Tool: Identifying Herbal \n\n\n\nUsers among Malaysian Women \n\n\n\n\n\n\n\nFarida Islahudin,  Tengku Mohamad Tengku \n\n\n\nAzlan Shah, Lay Yan Ling, Jamia Azdina \n\n\n\nJamal*, Malina Jasamai  \n \n\n\n\nFaculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda \n\n\n\nAbdul Aziz, 50300 Kuala Lumpur, Malaysia.  \n\n\n\n* Corresponding author \n\n\n\nEmail: faridaislahudin@ukm.edu.my \n\n\n\n\n\n\n\nBackground and Objectives: The use of herbal medicine is \n\n\n\ngaining popularity among women to prevent and manage \n\n\n\ndiseases. Many believe herbal medicines are safe but are \n\n\n\nreluctant to disclose its use to their healthcare professionals. \n\n\n\nWith the lack of disclosure, appropriate herbal counselling by \n\n\n\nhealthcare professionals remains challenging. Therefore, the \n\n\n\ncurrent work aims to develop and validate a tool to predict \n\n\n\nherbal users among adult Malaysian women.  Methods: The \n\n\n\nquestionnaire-based study was performed among adult \n\n\n\nwomen who understood either Malay or English to assess \n\n\n\nsociodemographic data and characteristics of herbs used. \n\n\n\nIncomplete questionnaires were excluded. A simple and \n\n\n\nmultiple logistic regression was performed on two-thirds of \n\n\n\nthe data. Score-values were then assigned based on \n\n\n\nsignificant factors. Score-values were then compared with \n\n\n\nlogistic regression-values in the remaining one-third of the \n\n\n\ndata for validation. Result and Discussion: A total of 1435 \n\n\n\nrespondents were included. The most common herbal \n\n\n\nmedicines used were raw herbs (n=439, 65.4%), followed by \n\n\n\ncommercial herbs (n=220, 32.8%). The developed model \n\n\n\nbased on two-thirds of the data (n=957, 66.7%) demonstrated \n\n\n\nthat Malays, married women, employed and a monthly \n\n\n\nincome of less than MYR3000 was associated with herbal use \n\n\n\n(\u03c7\u00b2=235.9, df=6, p<0.001), in which beta-values were used to \n\n\n\nassign scores. The developed score-values of the significant \n\n\n\nfactors demonstrated an area under the receiving operator \n\n\n\ncurve (ROC) of 0.751. Validation of score-values on one-\n\n\n\nthird of the data (n=478, 33.3%) demonstrated an area under \n\n\n\nthe ROC of 0.765. It was demonstrated there was no \n\n\n\nsignificant difference between the two models (p=0.302), \n\n\n\ndemonstrating that the model was acceptable. Conclusion: \n\n\n\nThe tool predicts high risk herbal users among Malaysian \n\n\n\nwomen. Healthcare professionals, in particular pharmacists, \n\n\n\nmay find the tool easy to use and may facilitate appropriate \n\n\n\neducation of herbal medicine, better coordination of care, \n\n\n\nreduce unwanted adverse effects and lead to better patient \n\n\n\noutcomes. \n\n\n\n\n\n\n\nAbstract 010 \n\n\n\n\n\n\n\nPharmacists\u2019 Virtual Consultations for \n\n\n\nDiabetes Patients in Malaysia: Impact on \n\n\n\nMedication Adherence and Glycaemic \n\n\n\nControl \n \n\n\n\nLoganadan NK1,2*, Tse Yeen Soong2, Wai Han \n\n\n\nLee2, Hui Ling Tong2, Phei Ching Lim2, Sin \n\n\n\nYeNg2, Nur Diniah Shaharum2, Wan Ruwaida \n\n\n\nWan Mokhtar2, Siong Hung Ting2, Aziani \n\n\n\nYacob2, Wai Yin Yong2, Kai Yin Go2, Rodhiah \n\n\n\nAbd Rahman2, Shamala Ayadurai2, Huay Sin \n\n\n\nTan2 \n \n1Pharmacy Unit, Endocrine Institute, Putrajaya Hospital, 62250 Putrajaya, \n\n\n\nMalaysia \n2Pharmacy Practice and Development Division, Ministry of Health, Lot 36, \n\n\n\nJalan Universiti, 46200 Petaling Jaya, Selangor, Malaysia \n\n\n\n* Corresponding author \n\n\n\nEmail: pharmnavin@gmail.com \n\n\n\n\n\n\n\nBackground and Objectives: Virtual consultation is an \n\n\n\nalternative platform for providing pharmaceutical care for \n\n\n\nchronic disease patients mainly during the COVID-19 \n\n\n\npandemic where physical visits to healthcare facilities were \n\n\n\nrestricted. This study investigated the outcomes of virtual \n\n\n\nconsultations by pharmacists on diabetes patients undergoing \n\n\n\nthe Diabetes Medication Therapy Adherence Clinic \n\n\n\n(DMTAC) follow-up. Methods: This was a prospective \n\n\n\nstudy involving 17 hospitals from all the states in Malaysia \n\n\n\nfrom April to September 2020. Type 2 diabetes (T2DM) \n\n\n\npatients attending the DMTAC clinic for more than one year \n\n\n\nand having either a telephone or mobile phone were included. \n\n\n\nThose with poor phone line connectivity, language barrier, \n\n\n\nand unconducive environment for virtual consultation were \n\n\n\nexcluded. Pharmacists provided virtual consultations at least \n\n\n\ntwice between physical visits at baseline and six months. \n\n\n\nData were analyzed using SPSS Version 26.0. Results and \n\n\n\nDiscussion: The 65 subjects included had a median age of \n\n\n\n58.0 [48.0\u201365.5] years. Poor medication adherence (21.2%), \n\n\n\npoor understanding of medication instructions (18.2%), and \n\n\n\ninability to adjust insulin doses (16.7%) were the main \n\n\n\npharmaceutical care issues that warranted pharmacists\u2019 \n\n\n\ninterventions. The Malaysia Medication Adherence \n\n\n\nAssessment Tool (MyMAAT) score improved significantly \n\n\n\nfrom 51.0 [45.5\u201357.8] at baseline to 54.0 [52.0\u201357.0] after \n\n\n\nsix months (p<0.05). This translated into significant \n\n\n\nimprovements in glycaemic control indicated by an HbA1c \n\n\n\nreduction of 1.3% from 9.2% [7.8-10.4] at baseline to 7.9% \n\n\n\n[7.5\u20139.6] after six months (p<0.05). Hypoglycaemia present \n\n\n\nat baseline were resolved in majority (83.7%) of the patients \n\n\n\nat 6th month. Conclusion: The virtual consultations by \n\n\n\nDMTAC pharmacists improved medication adherence and \n\n\n\nglycaemic control for T2DM patients. This approach should \n\n\n\n\nmailto:faridaislahudin@ukm.edu.my\n\n\nmailto:pharmnavin@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n71 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nbe adopted to complement physical pharmacist follow-ups to \n\n\n\nensure a sustained pharmaceutical care delivery. \n\n\n\nAbstract 011 \n\n\n\n\n\n\n\nThe Impact of Pharmacist-Managed \n\n\n\nTitration Clinic (PMTC): A Pilot Study \n\n\n\n\n\n\n\nPoh Lee Geetha Ng1*, Syafiqah Abdul Jalil1, \n\n\n\nNurish Ezzantie Mishan1, Nur Asyikin Mohd \n\n\n\nYunus2, Michelle Maryanne Tan2, Nik Qistina \n\n\n\nNik Ramli2, Norhawani Mansor2, Kok Han \n\n\n\nChee3, Nor Aziah Abdullah1 \n \n1 Department of Pharmacy Tengku Ampuan Rahimah Klang Hospital \n2 Department of Medicine Tengku Ampuan Rahimah Klang Hospital \n3 Department of Medicine University Malaya Medical Centre \n\n\n\n* Corresponding author \n\n\n\nEmail: poohdini19@yahoo.com \n\n\n\n\n\n\n\nBackground and Objectives: The key to reduce morbidity \n\n\n\nand mortality of cardiovascular disease is by having an ACE \n\n\n\ninhibitor (ACE-I) or Angiotensin Receptor Blocker (ARB) \n\n\n\nand beta-blockers commenced promptly in the treatment \n\n\n\nmanagement. Nonetheless, these drugs are often not \n\n\n\nprescribed, or doses are not optimized. One strategy to \n\n\n\nimprove this is by involving the pharmacist to optimize the \n\n\n\nmedication management. The aim of this study was to \n\n\n\nevaluate the impact by determining the proportion of patients \n\n\n\non target or maximum tolerated ACE-I (perindopril) and \n\n\n\nbeta-blocker (bisoprolol) doses, their blood pressure and \n\n\n\nheart rate in the Pharmacist-Managed Titration Clinic \n\n\n\n(PMTC) versus General Medical Clinic (GMC) managed by \n\n\n\nthe physician. Methods: This was a prospective study \n\n\n\ninvolving patients who attended the clinic from May 2019 \n\n\n\nuntil March 2020. 16 patients are screened in the ward during \n\n\n\ntheir admission due to cardiovascular disease by the \n\n\n\npharmacist. Patients must at least be on 2 doses of perindopril \n\n\n\nand bisoprolol and doses are not yet maximized. They are \n\n\n\ncompared to 16 patients who attended the GMC through \n\n\n\nsimple random sampling. Results and Discussion: At \n\n\n\nbaseline, mean blood pressure systolic, diastolic, heart rate, \n\n\n\ndoses of beta-blocker and ACE-I/ARB in both groups were \n\n\n\nsimilar. In PMTC, mean blood pressure systolic was \n\n\n\n118\u00b117.4 mmHg compared to 135\u00b115.3 mmHg for GMC \n\n\n\n(p<0.05). Mean diastolic blood pressure for PMTC was \n\n\n\n74\u00b112.6 mmHg compared 81\u00b111.6 mmHg (p>0.05). Mean \n\n\n\nheart rate was 69\u00b110.5 bpm in PMTC versus 78\u00b15.9 bpm in \n\n\n\nGMC (p<0.05). Mean dose for bisoprolol was 5\u00b13.3 mg in \n\n\n\nPMTC versus 2.7\u00b11.72 mg in GMC (p<0.05). Mean dose for \n\n\n\nperindopril was 4\u00b12.7 mg in PMTC versus 2.8\u00b12.1 mg in \n\n\n\nGMC (p>0.05). Conclusion: This study demonstrates the \n\n\n\nbeneficial impact of PMTC in terms of improvement of blood \n\n\n\npressure, heart rate and optimisation doses of ACE-I/ARB \n\n\n\nand beta-blocker for cardiovascular disease medication \n\n\n\nmanagement. \n\n\n\n\n\n\n\nAbstract 012 \n\n\n\n\n\n\n\nComparison of Eight Methods for \n\n\n\nEstimation of Creatinine Clearance in \n\n\n\nPatients with Unstable Kidney Function \u2013 \n\n\n\nA Multi-center, Prospective, Observational \n\n\n\nStudy from Malaysia. \n\n\n\n\n\n\n\nYen Ping Ng1*, Chee Ping Chong2, Ee Siung \n\n\n\nLiew3, Shye Ling Teoh4, Cheng Hoon Yap5 \n\n\n\n\n\n\n\n1 Clinical Pharmacy Unit, AIMST University, 08100 Bedong, Kedah, \n\n\n\nMalaysia. \n2 Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, \n\n\n\nUniversiti Sains Malaysia (USM), 11800 Minden, Penang, Malaysia. \n3 Intensive Care Unit, Queen Elizabeth Hospital, Sabah, Malaysia. \n4 Intensive Care Unit, Sultan Abdul Halim Hospital, Sungai Petani, Kedah, \n\n\n\nMalaysia. \n5 Pharmacist, Klinik Kesihatan Butterworth, Ministry of Health Malaysia, \n\n\n\nPenang, Malaysia. \n\n\n\n* Corresponding authors \n\n\n\nEmail: yenpingng@hotmail.com \n\n\n\n\n\n\n\nBackground and Objectives: Estimation of creatinine \n\n\n\nclearance (Clcr) has long been a problem in critically ill \n\n\n\npatients with unstable kidney function. The commonly used \n\n\n\nmethods like Cockcroft-Gault method requires a stable \n\n\n\nkidney function. A reliable and more accurate tool is needed \n\n\n\nin the estimation of Clcr to guide drug dosage adjustment. \n\n\n\nThe study aimed to compare the eight methods to estimate \n\n\n\nClcr with measured Clcr. In addition, the study also aimed to \n\n\n\ndetermine the agreement between estimated Clcr with \n\n\n\nmeasured Clcr. Methods: This was a multicentre, \n\n\n\nprospective, observational study. Three intensive care units \n\n\n\nin Malaysia tertiary public hospitals. Two serum creatinine \n\n\n\nsamples over 24 hours apart and simultaneously 24 hours \n\n\n\nurine collection. This study was approved by the Malaysian \n\n\n\nmedical research ethical committee (MREC) \u2013 NMRR-16-\n\n\n\n736-29621 (IIR). Results and Discussion: A total of 43 \n\n\n\npatients were recruited. During the early phase of unstable \n\n\n\nkidney functions (regardless of acute deteriorating or acute \n\n\n\nimproving), only the modified Cockcroft-Gault method \n\n\n\nshowed non-significant different with the measured Clcr (p = \n\n\n\n0.741).  A sub-set analysis on 23 patients with acute \n\n\n\ndeteriorating kidney functions was performed. Only the \n\n\n\nmodified Cockcroft-Gault revealed non-significant different \n\n\n\nwith the measured Clcr (p = 0.843).  Sub-set analysis \n\n\n\nperformed on 20 patients with rapid improving kidney \n\n\n\nfunctions, the Chiou method greatly underestimated the Clcr \n\n\n\nby approximately 34%, p < 0.001. Bland-Altman analysis \n\n\n\nrevealed that Clcr estimated with modified Cockcroft-Gault \n\n\n\nmethod showed agreement to measured Clcr, p > 0.05. \n\n\n\nConclusion: Owing to the precision of estimation and the \n\n\n\nconsistency (reproducibility) as well as the simplicity of \n\n\n\nmodified Cockcroft-Gault method, it should be the reliable \n\n\n\n\nmailto:poohdini19@yahoo.com\n\n\nmailto:yenpingng@hotmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n72 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nmethod to assess renal function in critically ill patients with \n\n\n\nunstable kidney function. \n\n\n\n\n\n\n\nAbstract 013 \n\n\n\n\n\n\n\nExposure to Potentially Harmful Excipients \n\n\n\nin Medications among Neonates at A State \n\n\n\nHospital in Malaysia \n\n\n\n\n\n\n\nNoraida Mohamed Shah1*, Shien Woan Wong \n1,2, Soo PiingChew2, Siti Azdiah Abdul Aziz1 \n \n\n\n\n1 Centre for Quality Management of Medicines, Faculty of Pharmacy, \n\n\n\nUniversiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia \n2 Pharmacy Department, Hospital Melaka, Melaka, Malaysia \n\n\n\n* Corresponding author \n\n\n\nEmail: noraida_mshah@ukm.edu.my \n \n\n\n\nBackground and Objectives: Medicines may contain \n\n\n\npotentially harmful excipients (PHE) which are toxic to \n\n\n\nneonates. The extent of PHE exposure among neonates in \n\n\n\nMalaysia remains unknown. This study aimed to determine \n\n\n\nthe incidence, types and predictors of PHE exposure among \n\n\n\nhospitalized neonates. Methods: A prospective \n\n\n\nobservational study was conducted from March to April 2022 \n\n\n\nin neonatal wards at Hospital Melaka. All neonates receiving \n\n\n\nat least one medication were randomly selected. Medical and \n\n\n\nmedication related data were retrieved from patients\u2019 medical \n\n\n\nrecords. The PHEs of interest were aspartame, benzalkonium \n\n\n\nchloride, benzyl alcohol, benzoic acid or benzoates, ethanol, \n\n\n\nparabens, polysorbate 80, propylene glycol, saccharin \n\n\n\nsodium, sorbitol and sulphites. Product information leaflets \n\n\n\n(PILs) and summaries of product characteristics (SPCs) were \n\n\n\nreferred to obtain information on active pharmaceutical \n\n\n\ningredient, strength, trade name as well as type and amount \n\n\n\nof the excipients.  Results and Discussion: A total of 108 \n\n\n\nneonates were recruited and 97.2% of them were exposed to \n\n\n\nat least one PHE. The high incidence of PHE exposure in \n\n\n\nneonates is similarly seen in other countries worldwide. \n\n\n\nParabens (47.2%) and sulphites (27.5%) were the two most \n\n\n\ncommonly administered PHEs. Benzyl alcohol is \n\n\n\ncontraindicated in neonates but was administered to 8% of \n\n\n\nneonates in this study. The median daily dose of ethanol \n\n\n\n(24.11 mg/kg/day, IQR 19.73, 28.49) exceeded the \n\n\n\nacceptable daily intake (ADI) by four times. However, the \n\n\n\ndose was not available for all PHEs as this information is not \n\n\n\nalways available in the PIL or SPC. Administration of \n\n\n\ncardiovascular drugs was associated with a higher risk of \n\n\n\nexposure to any PHE (OR 6.38, CI 2.75, 14.79, p-value < \n\n\n\n0.001). Conclusion: The exposure of PHE among neonates \n\n\n\nin this study is high with certain PHEs exceeding the ADI. It \n\n\n\nhighlights the need for certain strategies to be implemented \n\n\n\nto reduce such exposure in neonates. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 014 \n\n\n\n\n\n\n\nAntiseizure Medication Prescribing: A \n\n\n\nGlimpse of Current Practice in A Ministry \n\n\n\nof Health Tertiary Care Centre \n\n\n\n\n\n\n\nRusli RA1*, Makmor Bakry M1, Mohamed \n\n\n\nShah N1, Hung KY2, Loo XL3 \n\n\n\n \n1 Centre of Quality Management of Medicines, Faculty of Pharmacy, \n\n\n\nUniversiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.   \n2 Aeromedical Unit, Department of Medical, Hospital Tengku \n\n\n\nAmpuan Rahimah, Selangor, Malaysia  \n3 Department of Pharmacy, Hospital Tengku Ampuan Rahimah, \n\n\n\nSelangor, Malaysia \n\n\n\n* Corresponding author \n\n\n\nEmail: roseanizar@gmail.com \n\n\n\n\n\n\n\nBackground and Objectives: Antiseizure medication (ASM) \n\n\n\nis the mainstay of treatment for epilepsy patients. Throughout \n\n\n\nthe years, new ASMs were approved to be registered by \n\n\n\nMinistry of Health, Malaysia. This study aims to determine \n\n\n\nthe current prescribing practice of ASM in a tertiary care \n\n\n\ncentre. Methods: All prescriptions containing at least one \n\n\n\nASM from 1 January 2019 to 31 December 2021 were \n\n\n\npreliminary screened for eligibility. Samples were \n\n\n\nrandomised using stratified sampling method according to \n\n\n\nthe portion of ASM usage. Each of the subject\u2019s follow up \n\n\n\ncard was retrospectively review and all relevant data was \n\n\n\nrecorded. Result and Discussion: A total number of 260 \n\n\n\npatients were included for analysis. The commonly \n\n\n\nprescribed ASM monotherapy for initial management of \n\n\n\nepilepsy was sodium valproate (50.4%), followed by \n\n\n\ncarbamazepine (8.1%), phenytoin (8.1%) and levetiracetam \n\n\n\n(4.6%) across all seizure types. For initial management, \n\n\n\nsodium valproate and phenytoin (7.7%) was the most \n\n\n\ncommon ASM combination followed by sodium valproate \n\n\n\nand carbamazepine (4.2%). At maintenance, polytherapy \n\n\n\n(54.6%) was prescribed more often compared to \n\n\n\nmonotherapy (45.6%) with the combination of sodium \n\n\n\nvalproate and levetiracetam tops the polytherapy prescribing \n\n\n\n(10%). Majority (95.4%) have at least one concurrent \n\n\n\nmedications with 38.5% of the patients have only folic acid \n\n\n\ntablet being co-prescribed. Half of the patients (50.6%) have \n\n\n\ntheir ASM being monitored for serum concentration within \n\n\n\nthe recent period. Conclusion: Sodium valproate remains the \n\n\n\ndrug of choice as initial as well as maintenance therapy for \n\n\n\nmost seizure types. The role of levetiracetam in the treatment \n\n\n\nof epilepsy whether as mono- or polytherapy has become \n\n\n\nmore prominent in line with its approval by Ministry of \n\n\n\nHealth over the last decade. Newer agent such as zonisamide \n\n\n\nis still being sparingly prescribed. A nationwide study is \n\n\n\nwarranted for better insights into overall ASM prescribing in \n\n\n\ngovernment healthcare centres. \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:noraida_mshah@ukm.edu.my\n\n\nmailto:roseanizar@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n73 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 015 \n\n\n\n\n\n\n\nAssessment of Anticoagulation Control, \n\n\n\nBleeding, and Thromboembolic \n\n\n\nComplications in Anticoagulation \n\n\n\nMedication Therapy Adherence Clinic \n\n\n\n(ACMTAC) Service in Malaysia  \n \n\n\n\nSahimi Mohamed2*, Wardati Mazlan Kipli1, \n\n\n\nNik Azlean Nik Ismail3, Jivanraj R \n\n\n\nNagarajah4 \n \n1 Department of Clinical Pharmacy & Pharmacy Practice, Faculty of \n\n\n\nPharmacy, University of Malaya, 50603 Kuala Lumpur, Malaysia.  \n2 Department of Pharmacy, Hospital Serdang, Ministry of Health Malaysia, \n\n\n\nJalan Puchong, 43000 Kajang, Selangor, Malaysia.  \n3 Department of Pharmacy, Hospital Raja Perempuan Zainab II, Ministry of \n\n\n\nHealth Malaysia, Jalan Hospital, 15200 Kota Bharu, Kelantan, Malaysia.  \n4 Department of Pharmacy, Hospital Kuala Lumpur, Ministry of Health \n\n\n\nMalaysia, Jalan Pahang, 50586 Kuala Lumpur, Malaysia.  \n\n\n\n* Corresponding author \n\n\n\nEmail: sahimimohd@gmail.com \n\n\n\n\n\n\n\nBackground and Objectives:  The risk of thromboembolic \n\n\n\nevents and bleeding must be balanced while using warfarin \n\n\n\nas an anticoagulant. Time in therapeutic range (TTR) is an \n\n\n\nimportant assessment for the quality of anticoagulation \n\n\n\ntreatment as it has been proven to be associated with bleeding \n\n\n\nand thromboembolic events. In Malaysia, the pharmacist-\n\n\n\nmanaged Anticoagulation Medication Therapy Adherence \n\n\n\nClinic (ACMTAC) follow-up and monitor the dosage of \n\n\n\nwarfarin. This study aimed to evaluate the degree of \n\n\n\nanticoagulation control, bleeding complications and \n\n\n\nthromboembolic events under ACMTAC service. Methods: \n\n\n\nThis multicentre and cross-sectional study included patients \n\n\n\ntreated with warfarin from 1st Jan 2019 to 31st December \n\n\n\n2021 under ACMTAC in Malaysia. A multistage sampling \n\n\n\nwas used to select facilities with ACMTAC and systematic \n\n\n\nsampling was used to select patients from each facility. The \n\n\n\nTTR value was calculated using Rosendaal\u2019s method and \n\n\n\nTTR \u226565% was defined as a good control. Results and \n\n\n\nDiscussion: Of 1464 patients from 49 facilities, the mean age \n\n\n\nwas 60.3 (13.1) years and 732 (50%) were female. The main \n\n\n\nindications for warfarin treatment were atrial fibrillation \n\n\n\n(65.7%) and valve replacement (23.1%). The annual mean \n\n\n\nTTR for all patients in 2019, 2020 and 2021 were \n\n\n\n63.1(24.5)%, 64.0(25.0)% and 64.1(26.3)% respectively. \n\n\n\nThe percentage of ACMTACs with good anticoagulant \n\n\n\ncontrol over three consecutive years was 49.5, 55.1 and 53.4. \n\n\n\nThromboembolic events occurred in 15 (1.0%) while events \n\n\n\nof stroke and TIA in 12 (0.8%). Bleeding events occurred in \n\n\n\n227 (15.5%), bruises in 87 (5.9%) and  gum bleeding in 40 \n\n\n\n(2.7%). Conclusion: Overall, there was a moderate quality \n\n\n\nof anticoagulation control in warfarin-treated patients under \n\n\n\nACMTAC. Nearly half of the patients achieved the \n\n\n\nminimally recommended TTR of 65%. Bleeding and \n\n\n\nthromboembolic events in this study were low. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 016 \n\n\n\n\n\n\n\nAssessment of Psychological Health among \n\n\n\nPLWH during COVID-19 and Its \n\n\n\nAssociation with Antiretroviral Therapy \n\n\n\nAdherence  \n\n\n\n\n\n\n\nAbdul-Aziz SA*, Islahudin F, Shukri AH \n \n\n\n\nCenter for Quality Management of Medicines, Faculty of Pharmacy, \n\n\n\nUniversiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.  \n\n\n\n* Corresponding author \n\n\n\nEmail: sitiazdiah@ukm.edu.my \n\n\n\n\n\n\n\nBackground and Objectives: COVID-19 not only affects \n\n\n\nphysiological health but also impairs psychological health of \n\n\n\nthe global population. This includes individuals on chronic \n\n\n\ntreatment such as people living with HIV (PLWH) infection. \n\n\n\nThe impact can cause non-adherence towards highly active \n\n\n\nantiretroviral therapy, which will lead to unsuccessful \n\n\n\ntreatment outcomes leading to progression to AIDS and death. \n\n\n\nHowever, investigations on this issue are still limited among \n\n\n\nlocal HIV infected population. This study aims to determine \n\n\n\nthe impact of COVID-19 on PLWH related to psychological \n\n\n\nhealth and adherence towards antiretroviral therapy. \n\n\n\nMethods: A cross-sectional survey was conducted in two \n\n\n\nhospital-based Infectious Disease (ID) clinics in Pahang state. \n\n\n\nPLWH who met inclusion and exclusion criteria were \n\n\n\nconveniently recruited in this study. Data was collected \n\n\n\nbetween 1st April 2022 until 31st July 2022. Psychological \n\n\n\nhealth was assessed by using Impact of Event Scale-Revised \n\n\n\n(IES-R Malay version) and antiretroviral therapy adherence \n\n\n\nlevel was assessed by using the Malaysia Medication \n\n\n\nAdherence Assessment Tool (MyMAAT). Spearman\u2019s rank \n\n\n\ncorrelation test was utilised to analyse correlation between \n\n\n\npsychological health and antiretroviral therapy adherence \n\n\n\nlevel. Results and Discussion: Of 59 participants, mean age \n\n\n\nwas 38.02 (\u00b111.02) years old. One-fourth (n=15, 25.4%) of \n\n\n\nthe patients had psychological stress of median (IQR) score \n\n\n\nof, 6 (1 - 14.5) and more than one-third (n=21, 35.6%) had \n\n\n\nbehavioural stress with a median (IQR) score of 4 (0 to 10) \n\n\n\nduring the COVID-19 phase in Malaysia. For antiretroviral \n\n\n\ntherapy adherence, majority of patients had good adherence \n\n\n\ntowards antiretroviral therapy (n=49, 83.1%). A significant \n\n\n\nnegative correlation was associated between psychological \n\n\n\nand behaviour domain with adherence (r= -0.359, p <0.05 \n\n\n\nand r=- 0.344, p <0.05 respectively). Conclusion: Despite \n\n\n\nthe fact that the nation is entering a \u2018transition to endemic\u2019 \n\n\n\nCOVID-19 phase, psychological health impairment was still \n\n\n\nreported among PLWH. Our findings found a negative \n\n\n\ncorrelation between poor psychological health and \n\n\n\nantiretroviral therapy adherence level.  \n\n\n\n\nmailto:sahimimohd@gmail.com\n\n\nmailto:sitiazdiah@ukm.edu.my\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n74 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 017 \n\n\n\n\n\n\n\nRole of Pharmacist in Providing \n\n\n\nPharmaceutical Care to Tuberculosis \n\n\n\nPatients in Tertiary Care Paediatric \n\n\n\nHospital \n\n\n\n\n\n\n\nFaraz Ashraf* \n \n\n\n\nThe University of Child Health Sciences & The Children\u2019s Hospital, \n\n\n\nLahore, Pakistan. \n\n\n\n*Corresponding author \n\n\n\nEmail: drfarazashraf@gmail.com  \n\n\n\n\n\n\n\nBackground and Objectives: Pharmacist\u2019s role shifts from \n\n\n\ndispensing to bedside care, resulting better patient health \n\n\n\noutcomes. Pharmacists in developed countries ensure \n\n\n\nrational drug use, improve clinical outcomes, and promote \n\n\n\nhealth status by working as part of a multidisciplinary team \n\n\n\nof healthcare professionals. However, clinical pharmacist \n\n\n\nservices on healthcare utilization in low-and middle-income \n\n\n\ncountries (LMICs) like Pakistan are unclear. Pharmacists can \n\n\n\nimprove the implementation of critical pathways by \n\n\n\ndocumenting processes and out- comes, ensuring proper \n\n\n\npatient selection and medication use, monitoring patients for \n\n\n\ndrug efficacy and adverse effects, and providing for \n\n\n\ncontinuity of care. Objective of this study is to assess the role \n\n\n\nof a clinical pharmacist-directed patient education on the \n\n\n\ntherapy adherence of paediatric TB patients and to identify \n\n\n\nthe major pharmaceutical care needs. Methods: Data was \n\n\n\ncollected by using questionnaire designed to collect \n\n\n\ndemographic variables as well as knowledge, attitude, and \n\n\n\nadherence to the treatment. This study includes all patients \n\n\n\nwho enrolled from Jan 2019 to June 2019. Results and \n\n\n\nDiscussion: In this study, 58.47% of the respondents were \n\n\n\nmale and 41.53% were female. It was found that 64.98% of \n\n\n\nthe respondents appreciated the role of pharmacist in TB \n\n\n\nclinic and agreed that their medication outcome and \n\n\n\nsatisfaction has increased with pharmacist interaction. \n\n\n\nResults showed that 23.88% patients needed extra \n\n\n\npharmaceutical care, and all agreed to receive the guidance \n\n\n\nfrom the Pharmacist. Approximately 11.14% \n\n\n\npatients/attendants refused to receive pharmaceutical care \n\n\n\nand guidance from the pharmacist and did not show consent \n\n\n\nfor follow-up. Many patients faced side effects of drugs. \n\n\n\nAmong them, 64.13% patients were satisfied with the \n\n\n\nguidance provided by the Pharmacist to manage and \n\n\n\nunderstand side effects. Conclusion: Patients' adherence to \n\n\n\nTB treatment improved when a pharmacist provided patient \n\n\n\neducation on medication use and addressed patients' \n\n\n\npharmaceutical care issues. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 018 \n\n\n\n\n\n\n\nImpact of a Communication Skills Training \n\n\n\nProgram on Malaysian Hospital \n\n\n\nPharmacists\u2019 Patient-Centred \n\n\n\nCommunication Attitudes and Behaviours \n\n\n\n\n\n\n\nYew Keong Ng1, Noraida Mohamed Shah1, \n\n\n\nTimothy F Chen2, Navin Kumar Loganadan3, \n\n\n\nShue Hong Kong4, Yi Yun Cheng5, Siti \n\n\n\nShahida Md Sharifudin6, Wei Wen Chong1* \n\n\n\n \n1 Centre of Quality Management of Medicines, Faculty of Pharmacy, \n\n\n\nUniversiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia \n2 School of Pharmacy, Faculty of Medicine and Health, The University of \n\n\n\nSydney, NSW, Australia. \n3 Department of Pharmacy, Hospital Putrajaya, Ministry of Health, \n\n\n\nPutrajaya, Malaysia. \n4 Department of Pharmacy, Universiti Kebangsaan Malaysia Medical Centre, \n\n\n\nKuala Lumpur, Malaysia \n5 Department of Pharmacy, Hospital Ampang, Ministry of Health, Selangor, \n\n\n\nMalaysia \n6 Department of Pharmacy, Hospital Kuala Lumpur, Ministry of Health, \n\n\n\nKuala Lumpur, Malaysia \n\n\n\n* Corresponding author \n\n\n\nEmail: weiwen@ukm.edu.my \n\n\n\n\n\n\n\nBackground and Objectives: Effective communication is \n\n\n\nintegral in the process of providing patient-centred care in \n\n\n\nhealth encounters. Communication skills training (CST) \n\n\n\nprograms have been proposed to improve patient-centred \n\n\n\ncommunication among pharmacists. This study aimed to \n\n\n\nevaluate the effects of a CST program on patient-centred \n\n\n\ncommunication scores, communication self-efficacy, and \n\n\n\nattitudes toward concordance among pharmacists providing \n\n\n\nmedication therapy adherence clinic (MTAC) services in \n\n\n\npublic hospitals. Methods: A CST program for pharmacists \n\n\n\nbased on a patient-centred communication framework (the \n\n\n\nFour Habits Model) and motivational interviewing \n\n\n\ntechniques was developed and implemented. A pre-test/post-\n\n\n\ntest quasi-experimental design was used to evaluate the \n\n\n\neffects of this CST program. Pharmacists underwent pre-\n\n\n\ntest/post-test audiotaped simulated consultations and \n\n\n\ncompleted the Revised United States\u2013Leeds Attitudes \n\n\n\ntowards Concordance scale and communication self-efficacy \n\n\n\nscale. The Four Habits Coding Scheme (FHCS) was used to \n\n\n\nevaluate patient-centred communication scores from the \n\n\n\naudiotapes. Results and Discussion: A total of 38 \n\n\n\npharmacists from four tertiary hospitals participated in the \n\n\n\ntraining program. However, only 23 pharmacists completed \n\n\n\nboth pre- and post-intervention simulated consultations. \n\n\n\nImprovements were noted in the FHCS scores, including \n\n\n\nexploring patients\u2019 concerns (pre-test median = 3, post-test \n\n\n\nmedian = 4, Z = -2.73; p < 0.05), acceptability (pre-test \n\n\n\nmedian = 3, post-test median = 4, Z = -2.58; p < 0.05), and \n\n\n\nbarriers to treatment (pre-test median = 3, post-test median = \n\n\n\n4, Z = -2.86; p < 0.05). However, there were no significant \n\n\n\n\nmailto:drfarazashraf@gmail.com\n\n\nmailto:weiwen@ukm.edu.my\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n75 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nimprovement in scores regarding involving patients in \n\n\n\ndecision-making but there was an improvement in \n\n\n\nrecognising patients\u2019 needs and potential medication \n\n\n\nuncertainty. Conclusion: CST may help increase the \n\n\n\nadoption of patient-centred communication behaviours in \n\n\n\npharmacists\u2019 consultations with patients and improve \n\n\n\npharmacists\u2019 attitudes towards concordance and \n\n\n\ncommunication self-efficacy. Future CST studies may \n\n\n\nconsider incorporating tools to enhance patient involvement \n\n\n\nin decision-making. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 019 \n\n\n\n\n\n\n\nRapid Quantitative Estimation of \n\n\n\nFavipiravir in Rat Plasma by Liquid \n\n\n\nChromatography-Tandem Mass \n\n\n\nSpectroscopy and its Application to \n\n\n\nPharmacokinetic Studies \n\n\n\n\n\n\n\nP D Sri Lakshmi1*, G Venkateswarulu2, D \n\n\n\nSrinivasa Sumalatha2, P Geetha Bhavani \n\n\n\nSastry2 \n\n\n\n\n\n\n\n1 Department of Pharmaceutical Chemistry, Vikas Institute of \n\n\n\nPharmaceutical Sciences, Rajahmundry, AP \n2 Department of Pharmaceutical Analysis, Vikas Pharmacy College, \n\n\n\nVissanapet, AP. \n\n\n\n* Corresponding author \n\n\n\nEmail: dsrilakshmi83@gmail.com \n \n\n\n\nBackground and Objectives: To validate bio-analytical \n\n\n\nLCMS/MS method for the estimation of favipiravir in bulk \n\n\n\nand pharmaceutical drugs in rat plasma. To develop a simple, \n\n\n\nrapid and specific LCMS/MS bio-analytical method for the \n\n\n\nestimation of Favipiravir in bulk and combined \n\n\n\npharmaceutical dosage forms. To validate the proposed \n\n\n\nmethods in accordance with the analytical parameters \n\n\n\nmentioned in the ICH guidelines, such as system suitability, \n\n\n\naccuracy, precision, specificity, linearity, recovery, matrix \n\n\n\nfactor, stability, LOD and LOQ. Methods: Chromatographic \n\n\n\nseparation of favipiravir was achieved on Waters Alliance-\n\n\n\ne2695, by using X-bridge phenyl, 150x4.6mm, 3.5\u00b5m \n\n\n\ncolumn and the mobile phase containing 0.1% formic acid & \n\n\n\nACN in the ratio of 40:60% v/v. The flow rate was 1.0 \n\n\n\nmL/min; detection was carried out by using a photodiode \n\n\n\narray detector at ambient temperature. Results and \n\n\n\nDiscussion: The number of theoretical plates and tailing \n\n\n\nfactor for favipiravir were NLT 2000 and should not more \n\n\n\nthan 2 respectively. Percentage relative standard deviation of \n\n\n\npeak areas of all measurements always less than 2.0. The \n\n\n\nproposed method was bio-analytical validated according to \n\n\n\nUSFDA guidelines. Conclusion: The method was found to \n\n\n\nbe simple, economical, suitable, precise, accurate & stable \n\n\n\nmethod for pharmacokinetics analysis of favipiravir and \n\n\n\nstudy of its stability. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 020 \n\n\n\n\n\n\n\nTreatment Burden, Medication Adherence \n\n\n\nand Health Literacy in Elderly with \n\n\n\nMultimorbidity \n\n\n\n\n\n\n\nSelvakumar D1*, Sivanandy P2, Ingle PV2, \n\n\n\nTheivasigamani K3, Kumar S2, Shanmugham \n\n\n\nS2 \n \n\n\n\n1 School of Postgraduate Studies, International Medical University, Kuala \n\n\n\nLumpur, Malaysia \n2 Department of Pharmacy Practice, School of Pharmacy, International \n\n\n\nMedical University, Kuala Lumpur, Malaysia \n3 Department of Pharmacy Practice, Nandha College of Pharmacy, Erode, \n\n\n\nIndia. \n\n\n\n* Corresponding author \n\n\n\nEmail: 00000034565@student.imu.edu.my \n\n\n\n\n\n\n\nBackground and Objectives: Many chronic health \n\n\n\nconditions occur outside healthcare institutions in the form of \n\n\n\nself-management routines that the elderly perform on their \n\n\n\nown at home. Elderly people who have poor health literacy \n\n\n\nand are burdened with their treatment regimen may struggle \n\n\n\nwith adhering to their medication plans.  The prospective \n\n\n\nstudy aims to explore quantitatively how treatment burden \n\n\n\nand health literacy affect medication adherence in elderly \n\n\n\nliving with multimorbidity. Methods: Face-to-face \n\n\n\nstructured interviews were conducted in 10 general \n\n\n\npractitioners (GP) clinics in Selangor among elderly \n\n\n\naged >60 years to collect the data comprising of (1) \n\n\n\ndemographic details, (2) treatment burden assessed using the \n\n\n\nBurden of Treatment Questionnaire (TBQ-15), (3) health \n\n\n\nliteracy of participants assessed using the Short Form Health \n\n\n\nLiteracy Questionnaire (HLS-SF12) and (4) medication \n\n\n\nadherence level of participants assessed using the Malaysia \n\n\n\nMedication Adherence Assessment Tool (MyMAAT). \n\n\n\nResults and Discussion: The preliminary data collected for \n\n\n\nthis study included 36 elderly aged 60 years and above with \n\n\n\n2 or more chronic conditions. The mean score for treatment \n\n\n\nburden, health literacy, and medication adherence for the \n\n\n\nparticipants was 53.9 (SD = 29.7), 20.6 (SD = 9.0), and 36.0 \n\n\n\n(SD =18.9). All the participants (100%) in this study had a \n\n\n\nhigh treatment burden and showed low medication adherence \n\n\n\n(p<0.05) and 72.4% of participants with limited health \n\n\n\nliteracy had low medication adherence (p<0.05). The \n\n\n\nfindings of this study indicate that elderly with \n\n\n\nmultimorbidity who have a high treatment burden and low \n\n\n\nhealth literacy significantly are less adherent to their \n\n\n\nmedications. Conclusion: Low health literacy and high \n\n\n\ntreatment burden significantly affected the elderly with \n\n\n\nmultimorbidity and hurt their health outcomes. \n\n\n\n\nmailto:dsrilakshmi83@gmail.com\n\n\nmailto:00000034565@student.imu.edu.my\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n76 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 021 \n\n\n\n\n\n\n\nPrEP Talk: A Multivariate Analysis \n\n\n\nExploring the Awareness, Attitude, and \n\n\n\nPreference of Filipino University Students \n\n\n\nin Metro Manila toward Human \n\n\n\nImmunodeficiency Virus (HIV) Pre-\n\n\n\nExposure Prophylaxis (PrEP)  \n\n\n\n\n\n\n\nErnest Van Rito*, Danica Jane Rubi, Mila \n\n\n\nIloiza Sangcap, Alicia Alaine Descargar, \n\n\n\nKenneth Domdom, Renz Marion Ricafrente, \n\n\n\nZedierick Tanjista \n \n\n\n\nCollege of Pharmacy, Our Lady of Fatima University, Quezon City, \n\n\n\nPhilippines  \n\n\n\n* Corresponding author \n\n\n\nEmail: ecrito@student.fatima.edu.ph \n\n\n\n\n\n\n\nBackground and Objectives: Pre-Exposure Prophylaxis \n\n\n\n(PrEP) acts as an additional preventive choice in the sexual \n\n\n\ntransmission of the virus has been emerging in popularity in \n\n\n\nthe Philippines. To date, the country\u2019s implementation of \n\n\n\nPrEP is still under pilot testing, thus there are no available \n\n\n\ndetailed-reports. The purpose of the study is to assess the use \n\n\n\nof PrEP among Filipino university students by identifying \n\n\n\ntheir awareness, attitude, and preference. Methods: Primary \n\n\n\ndata was obtained from an anonymous online survey \n\n\n\nconducted among 300 Filipino university students in Metro \n\n\n\nManila. Multivariate analysis of the survey data was \n\n\n\nemployed to identify the factors that affect their attitude and \n\n\n\npreference, and to establish their knowledge and awareness \n\n\n\nto the medication. Results and Discussion: Three factors \n\n\n\nthat explain preference over an HIV prevention were \n\n\n\nidentified using factor analysis, namely, familiarity, social \n\n\n\nImpact, and sexual lifestyle. Consequently, the study \n\n\n\nexplored the effects of these factors on different clusters that \n\n\n\nresulted from cluster analysis. These clusters were sexually \n\n\n\nactive, sexually informed, and sexually inactive. \n\n\n\nConsiderably low knowledge and awareness scores were \n\n\n\nrecorded across all clusters, with an overall 51.4% average \n\n\n\ncorrect response. In spite of that, respondents demonstrated \n\n\n\nfavorable attitudes and high interest in PrEP, with 67% (201) \n\n\n\nsaying that they would use the medication. Conclusion: The \n\n\n\npositive response and high levels of interest recorded, despite \n\n\n\ntheir low knowledge and awareness, highlights its \n\n\n\nimportance in promoting PrEP uptake to the key populations. \n\n\n\nMoreover, the three identified factors could serve as \n\n\n\ninstrumental figures in influencing strategies that the public \n\n\n\nand private sectors may take on for advancing PrEP in the \n\n\n\ncountry. These sectors can tailor fit their actions based on the \n\n\n\ncharacteristics of different groups of people as described by \n\n\n\nthe cluster analysis. Overall, the key insights from the study \n\n\n\nmay serve as guides in improving awareness, preference, and \n\n\n\nutilization of PrEP in the Philippines. \n\n\n\n\n\n\n\nAbstract 022 \n\n\n\n\n\n\n\nRisk of Haemorrhagic Stroke due to \n\n\n\nMethamphetamine Abuse - A Case Series  \n\n\n\n\n\n\n\nJ John Kirubakaran1*, Mina Jafarnia2, \n\n\n\nFarzaneh Raveshi3 \n \n1 Vikas Institute of Pharmaceutical Sciences, Rajahmundry, East Godavari \n\n\n\nDt, AP, India. \n2 Dr Ramezanpour Pharmacy, Garms\u0101r, Semnan, Iran. \n3 Delfinado Pharmacy, Qom, Iran \n\n\n\n* Corresponding author \n\n\n\nEmail: john.mpharm@gmail.com \n\n\n\n\n\n\n\nBackground and Objectives: Drug abuse is the biggest \n\n\n\nissue in the western world and even a major part of the world \n\n\n\nis facing. Irrespective of age groups, everyone is being \n\n\n\nvictims to that. Methamphetamine is one among those which \n\n\n\nis a common form of abuses seen in the western world. \n\n\n\nCerebrovascular complications show a worse effect on the \n\n\n\nvictim's quality of life. Hence, the present study is \n\n\n\nconcentrated on the adverse cerebrovascular outcomes due to \n\n\n\nmethamphetamine abuse. Methods: A systematic review is \n\n\n\ndone by taking case reports and case series between a \n\n\n\ntimeline of 2000-2019. The collection of studies was done \n\n\n\nfrom EMBASE, MEDLINE and PUBMED. The quality of \n\n\n\neach study is assessed by using the new castle-Ottawa scale. \n\n\n\nThe inclusion criteria were Case reports, Case series with \n\n\n\npatients having a history of methamphetamine use. Patients \n\n\n\nwho stopped use of methamphetamine one year back and \n\n\n\nstudies which involve abuse of other illegal drugs were \n\n\n\nexcluded from the study. We evaluated for the stroke which \n\n\n\nshow an absolute involvement of methamphetamine as risk \n\n\n\nfactor. Results and Discussion: Following the exclusion and \n\n\n\ninclusion criteria, articles were collected from 25 case reports \n\n\n\nand being assessed for the occurrence of stroke in subjects \n\n\n\nwho were consuming methamphetamine. Of the 25 cases \n\n\n\nbeing collected, hemorrhagic stroke comprises of 13 (52%) \n\n\n\ncases, ischemic stroke comprises of 9 (36%) cases, \n\n\n\ncardiogenic shock 1(4%), hypovolemic shock 1(4%) and \n\n\n\nanterograde amnesia 1(4%). All the cases show that chronic \n\n\n\nuse of methamphetamine led to stroke. All the cases were \n\n\n\nstrongly evidenced by the confirmatory diagnosis as \n\n\n\nmethamphetamine being the cause for the cerebrovascular \n\n\n\nevents. CT scan was the diagnostic technique used as the \n\n\n\nconfirmatory diagnosis. Thereby, the study strongly \n\n\n\ninterprets that methamphetamine use can cause stroke even \n\n\n\nin healthy individuals. Conclusion: There data can be \n\n\n\ninterpreted as methamphetamine abuse may lead to stroke. \n\n\n\nBased on this study, it can be interpreted that chronic abuse \n\n\n\nof methamphetamine may lead to cerebrovascular \n\n\n\ncomplications of which stroke is the most common \n\n\n\n\nmailto:ecrito@student.fatima.edu.ph\n\n\nmailto:john.mpharm@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n77 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\ncomplications. The risk of hemorrhagic stroke is more than \n\n\n\nischemic stroke.  \n\n\n\n\n\n\n\nAbstract 023 \n\n\n\n\n\n\n\nKnowledge, Attitude, and Practices among \n\n\n\nFilipinos towards Vitamin D \n\n\n\nSupplementation amidst the Pandemic  \n\n\n\n\n\n\n\nJoseph Samuel S. Anthony*, Earrol Jem R. \n\n\n\nBerdos, Swituel S. Guevarra, Daniella G. \n\n\n\nTulabut, Elvira V. De Leon.  \n \n\n\n\nManila Central University \n\n\n\n* Corresponding author \n\n\n\nEmail: samanthony652@gmail.com \n\n\n\n\n\n\n\nBackground and Objectives: Vitamin D has been recently \n\n\n\nstudied to have immune enhancing effects, especially \n\n\n\ntowards respiratory illness prevention and recovery. \n\n\n\nHowever, it is not commonly viewed as a preventive measure \n\n\n\nfor Covid19 and other respiratory tract infections such as \n\n\n\nasthma, TB, and COPD. The aim of this study is to determine \n\n\n\nthe knowledge, attitude, and practice of Filipinos aged 20-50 \n\n\n\nyears old residing in Quezon City towards vitamin D \n\n\n\nsupplementation during the pandemic. Methods: The survey \n\n\n\ntool was developed using statements from other references \n\n\n\nand was validated to ensure credible data gathering. It was \n\n\n\nposted on social media platforms accompanied by a poster \n\n\n\nindicating the inclusion criteria for eligible participants. \n\n\n\nResults and Discussion: The questionnaire garnered results \n\n\n\nstating that the Filipino consumers in Quezon City have high \n\n\n\nlevels of knowledge, attitude, and practice proper vitamin D \n\n\n\nintake wherein females (60.69%) were the more common \n\n\n\nparticipants in the age group of 20-29 years\u2019 old (86%). It \n\n\n\nwas also noted that the prevalence of Covid-19 symptoms \n\n\n\ncontributed to the increase in vitamin D supplementation \n\n\n\nbased on supplement sale increase in 2020. The study also \n\n\n\nfound out that knowledge, attitude, and practices have \n\n\n\npositive correlations with each other when it comes to \n\n\n\nvitamin D supplementation amidst the pandemic. \n\n\n\nConclusion: The relationship exists between knowledge and \n\n\n\nattitude, knowledge and practice, and attitude and practice of \n\n\n\nFilipinos towards vitamin D supplementation amidst the \n\n\n\npandemic. It shows positive significant correlations with \n\n\n\neach other. This means that higher levels of knowledge are \n\n\n\nassociated with a higher level of attitude and frequent proper \n\n\n\npractice of vitamin D supplement intake. A higher level of \n\n\n\nattitude implies a high level of knowledge and frequent \n\n\n\nproper practice of vitamin D supplement intake. It is \n\n\n\nrecommended for pharmacist to continue proper education \n\n\n\nand information regarding vitamin D supplementation.  \n\n\n\n\n\n\n\n\n\n\n\nAbstract 024 \n\n\n\n\n\n\n\nTherapeutic Effects and Possibilities of \n\n\n\nCitrus maxima (Pomelo) Leaves Aqueous \n\n\n\nExtract of a Commercial Product \n\n\n\n\n\n\n\nJia Rou Khor, Siok Yee Chan* \n\n\n\n\n\n\n\nDiscipline of Pharmaceutical Technology, School of Pharmaceutical \n\n\n\nSciences, Universiti Sains Malaysia (USM), 11800 Gelugor, Penang, \n\n\n\nMalaysia \n\n\n\n* Corresponding author \n\n\n\nEmail: sychan@usm.my \n\n\n\n\n\n\n\nBackground and Objectives: For thousands of years, \n\n\n\npopulation in rural and tribal areas has relied primarily on \n\n\n\nCitrus maxima leaves as a natural traditional medicine. In \n\n\n\norder to find natural items that can be utilised in addition to \n\n\n\nconventional medicine, our study would want to gain a \n\n\n\ngreater understanding of the therapeutic characteristics of \n\n\n\nCitrus maxima leaves of  a commercial product. Methods: \n\n\n\nPhytochemical analysis was performed to identify and screen \n\n\n\nfor bioactive chemical elements in medicinal plant. The \n\n\n\nneutralisation effect and capacity of fresh and dry leaves of \n\n\n\nyoung and old leaves were experimentally evaluated. To \n\n\n\nmeasure the anti-inflammatory efficacy and antioxidant \n\n\n\nactivity of all four-leaf extracts, egg albumin denaturation \n\n\n\nassay and DPPH radical scavenging assay were carried out. \n\n\n\nResults and Discussion: Screening assays for \n\n\n\nphytochemicals identified the classes of active \n\n\n\nphytochemicals as flavonoids, steroids, tannins, and cardiac \n\n\n\nglycoside. The outcome demonstrated that the dried old leaf \n\n\n\nextract had an excellent neutralizing effect by raising the pH \n\n\n\nof the artificial gastric juice from its initial pH of 1.2 to 4.16 \n\n\n\n\u00b1 0.04 with the preeminent consumption of 89.85 \u00b1 0.08 mL \n\n\n\nof artificial gastric juice and 5.669 \u00b1 0.005 moles of H+ ions, \n\n\n\nrespectively. Fresh old leaf extract displayed appreciable \n\n\n\nactivity preventing the denaturation of egg albumin with \n\n\n\n71.10 \u00b1 0.62% inhibition. The maximum potential of anti-\n\n\n\noxidant was seen in fresh young leaf extract with 76.91 \u00b1 \n\n\n\n1.197% inhibition. Conclusion: All the assays evidenced the \n\n\n\nneutralising, anti-inflammatory and anti-oxidant effect of \n\n\n\nCitrus maxima leaves, with dried old leaves, fresh old leaves \n\n\n\nand fresh young leaves being the most prominent. Our study's \n\n\n\npertinent findings will pave the way for the discovery of \n\n\n\nnatural remedies that may be utilised in conjunction with \n\n\n\nconventional medicine. \n\n\n\n \n\n\n\n\nmailto:samanthony652@gmail.com\n\n\nmailto:sychan@usm.my\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n78 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 025 \n\n\n\n\n\n\n\nKnowledge, Attitude, and Practice of the \n\n\n\nMedical Practitioners towards Adverse \n\n\n\nDrug Reactions Reporting \n\n\n\n\n\n\n\nKirthikaa Gopal Krishnan1*, Palanisamy \n\n\n\nSivanandy2, Nafeeza Bt Hj Mohd Ismail3  \n \n1 School of Postgraduate Studies, International Medical University, Kuala \n\n\n\nLumpur, Malaysia \n2 Department of Pharmacy Practice, School of Pharmacy, International \n\n\n\nMedical University, Kuala Lumpur, Malaysia \n3 Faculty of Medicine, Universiti Teknologi MARA, Selangor, Malaysia  \n\n\n\n* Corresponding author \n\n\n\nEmail: kirthikaagopalkrishnan@gmail.com \n\n\n\n\n\n\n\nBackground and Objectives: In Malaysia, the rate of \n\n\n\nadverse drug reaction (ADR) reporting among private \n\n\n\npractitioners is exceptionally low, with only 5.26% reporting. \n\n\n\nThe failure to report ADRs increases the likelihood of ADR \n\n\n\ncases significantly and reduces the quality of life of patients. \n\n\n\nThis study was aimed to analyse medical practitioners' \n\n\n\nknowledge, attitudes, and practices (KAP) on \n\n\n\npharmacovigilance and the ADR reporting system and to \n\n\n\nidentify the factors that influence ADR underreporting. \n\n\n\nMethods: A cross-sectional survey of 600 private and public \n\n\n\nmedical practitioners in Kuala Lumpur and Selangor was \n\n\n\nundertaken. A structured validated questionnaire was used to \n\n\n\ncollect demographic data, medical practitioners\u2019 KAP of \n\n\n\nADRs and reporting system. Results and Discussion: This \n\n\n\nsurvey included 600 private and public medical practitioners. \n\n\n\nAround 78.3% of respondents believed that reporting ADRs \n\n\n\nhelped to discover safe pharmaceuticals, and 82% said that it \n\n\n\nhelped to gauge the occurrence of ADRs. In terms of practice, \n\n\n\n68.9% of respondents said they would only report an event if \n\n\n\nthey were certain the reaction was an ADR. In terms of \n\n\n\nattitudes, 84%, 62.4%, and 26.5% of people were complacent, \n\n\n\nignorant, or indifferent. Conclusion: Half of the participants \n\n\n\nin this survey showed medium to moderate understanding, \n\n\n\nattitudes, beliefs, and practice of ADR reporting. ADRs were \n\n\n\nunderreported at all levels of practice, academic, and \n\n\n\nprofessional experience. A well-structured periodic \n\n\n\nintervention programme is required to address the \n\n\n\nfundamental cause and raise the rate of ADR reporting. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 026 \n\n\n\n\n\n\n\nAdoption of Machine Learning Algorithms \n\n\n\nin Predicting Vaccine Hesitancy: A \n\n\n\nNarrative Review  \n\n\n\n\n\n\n\nMunaver Ahmad Nazir Ahmad1*, Nour \n\n\n\nHanah Othman2, Irraivan Elamvazuthi3, \n\n\n\nZaswiza, Mohamad Noor4 \n \n\n\n\n\u00b9 Faculty of Pharmacy and Health Sciences, Royal College of Medicine \n\n\n\nPerak, Universiti Kuala Lumpur, Malaysia.  \n\n\n\n\u00b2 Faculty of Pharmacy and Health Sciences, Royal College of Medicine \n\n\n\nPerak, Universiti Kuala Lumpur, Malaysia.  \n\n\n\n\u00b3 Dept of Electrical & Electronic Engineering, Universiti Teknologi \n\n\n\nPETRONAS, Malaysia.  \n\n\n\n\u2074 Faculty of Pharmacy and Health Sciences, Royal College of Medicine \n\n\n\nPerak, Universiti Kuala Lumpur, Malaysia. \n\n\n\n* Corresponding author \n\n\n\nEmail: munavernazirrcmp@gmail.com \n\n\n\n\n\n\n\nBackground and Objectives: The alarming increase of \n\n\n\nvaccine hesitancy (VH) cases among Malaysian parents has \n\n\n\nled to a resurgence of vaccine preventable diseases (VPD) \n\n\n\nand mortalities among children in the last 10 years. \n\n\n\nNumerous studies have assessed various factors of vaccine \n\n\n\nhesitancy. However, less research has been conducted on \n\n\n\nhow well these factors perform in predicting vaccine \n\n\n\nhesitancy. Recently, machine learning algorithms (MLA) \n\n\n\nhave been used to predict vaccine hesitancy accurately. \n\n\n\nTherefore, the objective of this study is to review the use of \n\n\n\nmachine learning algorithms to predict vaccine hesitancy.  \n\n\n\nMethods: A narrative review of existing literature using a \n\n\n\nnon-systematic search for original articles was conducted \n\n\n\nthrough online search databases, namely Pubmed, DOAJ \n\n\n\nOpen Access, and Google Scholar from 2018 to 2022, on \n\n\n\nmachine learning algorithms to predict vaccine hesitancy \n\n\n\n(VH). Fifteen (15) articles were then included in this review. \n\n\n\nKey words used to conduct the search were \u201cmachine \n\n\n\nlearning algorithms\u201d, \u201cvaccine hesitancy\u201d, \u201crefusal\u201d, \n\n\n\n\u201cimmunisation\u201d, \u201cartificial intelligence\u201d, \u201cadopting\u201d, and \n\n\n\n\u201cpredicting\u201d. Results and Discussion: The findings \n\n\n\nhighlighted the increasing roles played by machine learning \n\n\n\nalgorithms in predicting vaccine hesitancy, across various \n\n\n\nsocioeconomic and demographic profiles in low-, middle- \n\n\n\nand high-income countries. The phases of development, \n\n\n\nvalidation, and performance analysis of a battery of machine \n\n\n\nlearning models predicting vaccine hesitancy was also \n\n\n\ndocumented. Strategies to develop parsimonious models to \n\n\n\nprovide health workers and policymakers with interpretable \n\n\n\nmodel that can be easily explained was also provided.  \n\n\n\nConclusion: This review has found that MLA is an objective \n\n\n\nmethod to predict VH and can be used by policy makers to \n\n\n\nincrease vaccination uptake among the population. \n\n\n\n \n\n\n\n\nmailto:kirthikaagopalkrishnan@gmail.com\n\n\nmailto:munavernazirrcmp@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n79 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 027 \n\n\n\n\n\n\n\nKnowledge, Attitude, and Acceptance on \n\n\n\nCoronavirus Disease (COVID-19) \n\n\n\nVaccination Among Non-allied Health \n\n\n\nIndividuals in the Greater Manila Area, \n\n\n\nPhilippines \n\n\n\n\n\n\n\nRose Anne Chua*, Asia Nykyle Stefanie \n\n\n\nAbello, Samantha Jillian Araneta, Paolo Jose \n\n\n\nDe Los Santos, Kim Shekinah Mei Hosena, \n\n\n\nMary Patricia Joson, Christine Janelle \n\n\n\nMataga, Gizelle Parado, Jennie Wong \n \n\n\n\nDepartment of Preventive, Family, and Community Medicine and \n\n\n\nResearch. College of Medicine. Chinese General Hospital Colleges. \n\n\n\nManila, Philippines \n\n\n\n* Corresponding Author \n\n\n\nEmail: rose.chua@cghc.edu.ph /rose.anne.v.chua@gmail.com  \n\n\n\n\n\n\n\nBackground and Objectives: The Coronavirus Disease \n\n\n\n2019 (COVID-19) pandemic wreaked havoc on healthcare \n\n\n\nsystems, posing novel problems. Vaccination is considered \n\n\n\nthe best hope for a long-term solution. However, this has to \n\n\n\nbe accepted by a majority of the population to achieve herd \n\n\n\nimmunity. The aim of the study was to assess the knowledge, \n\n\n\nattitude, and acceptance (KAA) of COVID-19 vaccination \n\n\n\namong non-allied health individuals and determine their \n\n\n\nrelationship to demographic profiles. Methods: An online \n\n\n\nself-administered questionnaire was developed through \n\n\n\nliterature review and modified, undergone expert \n\n\n\nevaluation/validation, translation and back translation, and \n\n\n\npre-testing. The instrument was distributed to respondents \n\n\n\nresiding in the Greater Manila Area: GMA (Metro Manila, \n\n\n\nBulacan, Cavite, Laguna, and Rizal), Philippines. Data \n\n\n\ncollection was conducted in June 2022. Descriptive and \n\n\n\ninferential statistics were generated using Microsoft Excel \n\n\n\n2020 and R/Python version 4.2.0 2022. Results and \n\n\n\nDiscussion: Most of the respondents were young adults \n\n\n\n(54%), male (50%), single (67%), with tertiary education \n\n\n\n(54%), and belonging to the middle class (39%). Age \n\n\n\n(0.02546), educational background (0.0002017), monthly \n\n\n\nhousehold income (0.002824), and internet signal (0.02266) \n\n\n\nwere found to significantly influence knowledge. Those \n\n\n\nsignificantly affected attitude were: age (0.01767), \n\n\n\neducational background (0.0003589), monthly household \n\n\n\nincome (0.0006069), internet Signal (0.0359), time spent on \n\n\n\nsocial media (0.01968), and political stance (0.001231). \n\n\n\nThose that showed significant association with acceptance \n\n\n\nwere educational background (0.02556), monthly household \n\n\n\nincome (0.00002606), and internet signal (0.005458). \n\n\n\nConclusion: This study offers insight into the KAA of \n\n\n\nCOVID-19 vaccination among non-allied health individuals \n\n\n\nin the GMA. Demographics such as educational \n\n\n\nbackground, monthly household income, internet signal, and \n\n\n\ntime spent on social media influenced the KAA. \n\n\n\n\n\n\n\nAbstract 028 \n\n\n\n\n\n\n\nThe Interaction between Herbal Extract and \n\n\n\nEudragit Polymer Blend on \n\n\n\nPhysicochemical and Mechanical \n\n\n\nCharacteristics of Core/shell Composite \n\n\n\nOrodispersible Films \n\n\n\n\n\n\n\nSiew Mei Tan, Siok Yee Chan* \n \n\n\n\nThoughts Formulation Lab, Discipline of Pharmaceutical Technology, \n\n\n\nSchool of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang \n\n\n\n11800, Malaysia  \n\n\n\n* Corresponding author \n\n\n\nEmail: sychan@usm.my \n\n\n\n\n\n\n\nBackground and Objectives: Orodispersible fibre film with \n\n\n\ncore/shell composite is a promising drug dosage form to \n\n\n\novercome the bitter taste drawback of herbal extracts using \n\n\n\ncoaxial electrospun technology. However, the interaction \n\n\n\nbetween the core and the shell layer are not fully \n\n\n\ncomprehended. This research aims to reveal the interaction \n\n\n\neffects of different ratios of Eudragit polymer blends (shell) \n\n\n\nand Carica papaya leaf extract (core) on the physicochemical \n\n\n\nand mechanical characteristics of core/shell composite \n\n\n\norodispersible fibre films. Methods: The orodispersible fibre \n\n\n\nfilms were formulated using the coaxial electrospinning \n\n\n\nmethod with Eudragit L100-55 and Eudragit L100 polymer \n\n\n\nblends in the ratio of 1:0, 1:1, 1:3, 1:5, and 0:1 respectively. \n\n\n\nBlank formulations were prepared to compare with those \n\n\n\nloaded with the Carica papaya leaf extract. The developed \n\n\n\nformulations were characterised for their film thickness, \n\n\n\nmoisture content, swelling properties, mechanical strength, \n\n\n\nand film disintegration (wetting time). ATR-FTIR analysis \n\n\n\nwas conducted to study the drug-excipient compatibility. \n\n\n\nResults and Discussion: The employed polymers in coaxial \n\n\n\nelectrospun manner successfully produced homogenous and \n\n\n\nadequate flexibility fibre films, with a uniform green color \n\n\n\nfrom the inside and off-white color from the outside. The \n\n\n\ndeveloped orodispersible films offered an immediate \n\n\n\ndisintegration profile in simulated human saliva (pH 6.8), \n\n\n\nshowing the potential production of oral formulation. ATR-\n\n\n\nFTIR analysis showed the compatibility between the shell \n\n\n\nand core layer. Conclusion: The coaxial electrospinning was \n\n\n\nsuccessfully used in developing orodispersible films as a \n\n\n\npharmaceutical dosage form for the oral delivery of Carica \n\n\n\npapaya leaf extract with the abilities to overcome the bitter \n\n\n\ntaste. This study elucidates the relationship between polymer \n\n\n\ncarrier and herbal extract in affecting the physicochemical \n\n\n\nand mechanical behaviours of the orodispersible films at \n\n\n\ndifferent ratios of polymer blends.  \n\n\n\n \n\n\n\n\nmailto:rose.chua@cghc.edu.ph\n\n\nmailto:/rose.anne.v.chua@gmail.com\n\n\nmailto:sychan@usm.my\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n80 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 029 \n\n\n\n\n\n\n\nRemoving Communication Barrier between \n\n\n\nPharmacy and Deaf Patients \n\n\n\n\n\n\n\nNur Azrida Azhari Wasi, Ching Wern Chong, \n\n\n\nYoshnni M Navaneethan*, Muhammad \n\n\n\nFikree Ahmad, Siti Nur-Hussaini Mohamad \n\n\n\nTermizi, Umi Aqilah Amir, Mohd Firdaus \n\n\n\nAbdullah, Sharmili Retnam, Yuan Wah Loo, \n\n\n\nFarid Ahmad Nasir, Siti Rahimah Mohd \n\n\n\nRadzi, Suhaila Mustaffa, Noor Azwani Abd \n\n\n\nSamad, Narian Singh Sadu Singh \n \n\n\n\nDepartment of Pharmacy, University of Malaya Medical Centre, Kuala \n\n\n\nLumpur, Malaysia \n\n\n\n* Corresponding Author \n\n\n\nEmail: yoshnni@ummc.edu.my \n\n\n\n\n\n\n\nBackground and Objectives: Deaf community in Malaysia \n\n\n\nuses Malaysian Sign Language in communication. In the \n\n\n\nUniversity of Malaya Medical Centre (UMMC), however, \n\n\n\nthe Pharmacy Department uses either Malay or English for \n\n\n\nmedication instruction on the labels as well as when \n\n\n\ndispensing medication to patients. This communication \n\n\n\nbarrier can compromise deaf patient\u2019s safety when using \n\n\n\nmedications. Methods: A survey was conducted in 2020 \n\n\n\nacross the hospital to assess the current practice in delivering \n\n\n\ncare towards deaf patients. Following the survey, an \n\n\n\nimprovement was initiated in 2021 in collaboration with the \n\n\n\nMalaysia Federation of the Deaf (MFD) to create 75 \n\n\n\nmedication instruction videos in Malaysian Sign Language. \n\n\n\nEach video is linked to a QR code that is printed and stuck \n\n\n\non the medication upon dispensing to deaf patients. Patients \n\n\n\nwill scan the QR codes to access the videos.  Results and \n\n\n\nDiscussion: Pre-improvement survey (N=275) which \n\n\n\nincludes 64 pharmacy staff found that most (97%) staff are \n\n\n\nnot equipped to cater to deaf patients given the existing \n\n\n\ncommunication barrier. Engagement with the deaf \n\n\n\ncommunity via MFD creates a library of medication \n\n\n\ninstructions in Malaysian Sign Language that is verified for \n\n\n\ndeaf community use. A post-improvement survey among \n\n\n\nPharmacy frontliners (N=111) showed that 96.3% feels that \n\n\n\nthis standardized approach eases communication with deaf \n\n\n\npatients.  Conclusion: Providing QR code labels with \n\n\n\nembedded medication instructions in sign language removes \n\n\n\ncommunication barriers in the dispensing process and creates \n\n\n\nan inclusive system for ensuring safe and correct medication \n\n\n\nuse by deaf patients. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 030 \n\n\n\n\n\n\n\nDigital Health Perception among the \n\n\n\nPharmacy Students of Asian Countries \n\n\n\n\n\n\n\nAbdishakur Hassan Mohamed1*, Rohit \n\n\n\nKumar Verma2, Palanisamy Sivanandy2, \n\n\n\nManisha Pandey2, Jayashree Mayuren2 \n \n\n\n\n1 School of Postgraduate Studies, International Medical University, Kuala \n\n\n\nLumpur, Malaysia \n2 Department of Pharmacy Practice, School of Pharmacy, International \n\n\n\nMedical University, Kuala Lumpur, Malaysia \n\n\n\n* Corresponding author \n\n\n\nEmail: abdishakurmoha2030@gmail.com \n\n\n\n\n\n\n\nBackground and Objectives: In the recent decade, there has \n\n\n\nbeen a gradual uptake and adoption of digital health in the \n\n\n\nhealthcare industry. The utilisation of digital health tools at \n\n\n\nhealthcare facilities has greatly improved patient-related \n\n\n\noutcomes, supported healthcare staff by reducing their \n\n\n\nworkload and improved care coordination. Hence, it is \n\n\n\nimperative for healthcare professionals to be well-acquainted \n\n\n\nwith digital health literacy and are competent-level digital \n\n\n\nskills. Therefore, institutions/universities must implement \n\n\n\ndigital health literacy competencies in the curriculum to \n\n\n\nprepare future healthcare professionals to leverage the \n\n\n\npotential of digital technologies to improve patient health. \n\n\n\nThe study aimed to evaluate the perceptions of Asian \n\n\n\npharmacy students on digital health. Methods: It was a \n\n\n\nmixed-methods study conducted online through an \n\n\n\nanonymous and self-administered survey targeted toward \n\n\n\npharmacy students in Asian countries. The online survey \n\n\n\nquestionnaire has both qualitative and quantitative items. The \n\n\n\npharmacy students from approved universities in Asian \n\n\n\ncountries willing to participate in this survey were included. \n\n\n\nA total of 44 approved universities were included from India \n\n\n\n(22), Malaysia (6), Thailand (3), Indonesia (4), Bangladesh \n\n\n\n(3), Philippines (3), Pakistan (1), Sri Lanka (1), and South \n\n\n\nKorea (1). Results and Discussions: The study survey \n\n\n\nreceived 304 responses. More than three-fourths of the \n\n\n\nrespondents understood and were familiar with eHealth \n\n\n\n(n=226, 74.34%). In addition to that, the majority of the \n\n\n\nrespondents saw the advantage of the use of \"Big data\", \n\n\n\n\"Telehealth\", and \"mHealth\" in the future. In terms of the \n\n\n\nimplementation of eHealth in the pharmacy curriculum, \n\n\n\n80.59% (n=245) of the respondents were in favour since \n\n\n\nnearly 80% of respondents had received less than 5 hours of \n\n\n\neHealth training. Conclusion: The findings in this study have \n\n\n\ndemonstrated that digital health-related components in the \n\n\n\npharmacy curriculum and perceived digital health literacy \n\n\n\namong Asian pharmacy students ranged from acceptable to \n\n\n\nreasonable levels. Furthermore, the majority of students \n\n\n\nfavour and anticipate the implementation of eHealth \n\n\n\neducation in the pharmacy curriculum. \n\n\n\n \n\n\n\n\nmailto:yoshnni@ummc.edu.my\n\n\nmailto:abdishakurmoha2030@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n81 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 031 \n\n\n\n\n\n\n\nAcademic Restructuring towards Flexible \n\n\n\nLearning in Philippine Pharmacy Education \n\n\n\n\n\n\n\nAleth Therese L. Dacanay, Maria Fay Nenette \n\n\n\nM. Cariaga*, Vina Rose D. Talan, Shiela DV \n\n\n\nMiranda, Ellen Mae P. Abiqui \n\n\n\n\n\n\n\nPhilippine Association of Colleges of Pharmacy, Manila, Philippines \n\n\n\n*Corresponding author \n\n\n\nEmail: pacoppresident@gmail.com \n\n\n\n\n\n\n\n\n\n\n\nBackground and Objectives: Due to Covid-19, schools \n\n\n\nphysically shut down in 2020, which led to the \n\n\n\nimplementation of flexible learning in pharmacy education. \n\n\n\nThe first phase of this study sought to determine the stage \n\n\n\nwhere schools are from the continuum of pre-emerging to \n\n\n\nempowering, forming the basis of the creation of the ACTS \n\n\n\n(Assess, Cope, Transition, Synergize) framework; Philippine \n\n\n\nAssociation of Colleges of Pharmacy [PACOP] \n\n\n\nRecommending Guidelines on Academic Restructuring \n\n\n\ntowards Flexible Learning and action plan in serving all \n\n\n\nschools of pharmacy during the height of the pandemic. The \n\n\n\nsecond phase determined the stage two years after integrated \n\n\n\naction plan implementation, with the adopted 2021 \n\n\n\nframework, AAT (Absorptive Adaptive Transformative)-\n\n\n\nResilience Capacities or ARTS (Adaptation Resilience \n\n\n\nTransformative Synergy).  Methods: Survey research using \n\n\n\nan adapted tool was employed. Eighty-seven and fifty-three \n\n\n\nschools, represented by the deans or heads, participated in the \n\n\n\nfirst and second phase, respectively, out of 124 schools. \n\n\n\nQualitative inputs were used to supplement the discussion of \n\n\n\nfindings. Data were analysed using descriptive statistics and \n\n\n\nthematic analysis.  Results and Discussion: Along areas of \n\n\n\ncourse plan modification, lecture, laboratory, research, \n\n\n\nexperiential pharmacy practice (EPP) and health and \n\n\n\nwellness; and specific domains like mode of delivery, \n\n\n\ngradable assessments, and grading system, results in 2020 \n\n\n\nshowed that schools were mostly on the pre-emerging \n\n\n\n(42.35%) to emerging phase (34.12%). Now in 2022, schools \n\n\n\nhave migrated to engaging (37.74%), extending (35.8%) and \n\n\n\nempowering (18.9%) stages. Best practices\u2019 themes were \n\n\n\nborderless integration of industry experts and practitioners in \n\n\n\nthe [FLO] delivery; resilience of schools and industry/ \n\n\n\norganization partners 3) stronger collaboration with all \n\n\n\nstakeholders; hybrid/ hyflex mode as main recovery plan \n\n\n\nstrategy. Conclusion: Moving forward, there is still a need \n\n\n\nfor recovery interventions, revision of existing \n\n\n\nrecommending guidelines, measures of sustainability and \n\n\n\nCQI, and official guidelines for EPP delivery. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 032 \n\n\n\n\n\n\n\nA Shared Culture of Caring in the Time of \n\n\n\nthe COVID-19 Pandemic: The Essence of \n\n\n\nInterprofessional Collaboration as \n\n\n\nPerceived by Pharmacy and Medical \n\n\n\nTechnology/Medical Laboratory Science \n\n\n\nStudents \n\n\n\n\n\n\n\nLangit MRD1,3,4*, Abesamis RAS2, Adonis \n\n\n\nLD2 , Agustin AJR2, Amoy NNT2, Aquino \n\n\n\nGRM2, Archog XMGD2, Ayeo SS2, Baladad \n\n\n\nAGB2, Balocating JLZ2, Baquir AMG2 \n \n1 Department of Pharmacy,  \n2 Department of Medical Laboratory Science, School of Natural Sciences, \n\n\n\nSaint Louis University, Baguio City, Philippines \n\n\n\n3 The Graduate School, University of Santo Tomas, Sampaloc, Manila, \n\n\n\nPhilippines \n4 Executive Secretary, Philippine Pharmacists Association, Manila, \n\n\n\nPhilippines \n\n\n\n* Corresponding author \n\n\n\nEmail address: mrdlangit@slu.edu.ph ; secretary.ppha@gmail.com \n\n\n\n\n\n\n\nBackground and Objectives: COVID-19 pandemic has \n\n\n\naffected an unimaginable number of lives. Healthcare \n\n\n\nproviders have played an essential role in battling the \n\n\n\npandemic with strategies which organised the healthcare \n\n\n\nsystem to reduce the current issues or challenges. This study \n\n\n\nsought to assess the perception, attitude, and perceived view \n\n\n\nof medical laboratory science and pharmacy students on \n\n\n\ninterprofessional collaboration during the COVID-19 \n\n\n\npandemic. Methods: A 30-item questionnaire was \n\n\n\ndistributed randomly using google forms, to the Third and \n\n\n\nFourth-Year students taking either BS Pharmacy (BSPharm) \n\n\n\nor BS Medical Laboratory Science (BSMLS) at a private \n\n\n\nuniversity in Northern Philippines. A total of 198 \n\n\n\nrespondents returned the questionnaire. t-test and chi-square \n\n\n\nwere used to compare the mean values of dependent and \n\n\n\nindependent variables to determine their statistical \n\n\n\nrelationship. Results and Discussion: Interaction between \n\n\n\nBSPharm and BSMLS students was observed to be high \n\n\n\n(\u201cRegularly\u201d= 35.90%; \u201cQuite a lot\u201d= 18.70%; \n\n\n\n\u201cSomewhat\u201d= 35.90%; \u201cNot at all\u201d= 9.60%), but \n\n\n\ncollaboration showed the opposite (\u201cRegularly\u201d= 27.60%; \n\n\n\n\u201cQuite a lot\u201d= 26.00%; \u201cSomewhat\u201d= 22.40%; \u201cNot at all\u201d= \n\n\n\n24.00%). There is a lack of collaboration between student-\n\n\n\nprofessionals and student-medical technologists in general. \n\n\n\nNevertheless, they understand the responsibilities of their \n\n\n\nown department and see interprofessional collaboration as \n\n\n\nan important factor in providing quality service in patient \n\n\n\ncare. Conclusion: The results showed that interprofessional \n\n\n\neducation and collaborative experience is essential in \n\n\n\nenhancing students\u2019 patient-centeredness, teamwork and \n\n\n\ncollaboration, especially in times of pandemic. Therefore, \n\n\n\n\nmailto:pacoppresident@gmail.com\n\n\nmailto:mrdlangit@slu.edu.ph\n\n\nmailto:secretary.ppha@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n82 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nmore effort should be made in interacting and collaborating \n\n\n\nwith other student professionals.  \n\n\n\nAbstract 033 \n\n\n\n\n\n\n\nKnowledge, Awareness, Acceptability, and \n\n\n\nPerceived Research Misconduct among the \n\n\n\nSchools of Pharmacy in Malaysia \n\n\n\n\n\n\n\nWan Ping Ng1, Khong Yun Pang2, Pei Boon \n\n\n\nOoi3, Chia Wei Phan1,4* \n \n\n\n\n1 Department of Pharmaceutical Life Sciences, Faculty of Pharmacy, \n\n\n\nUniversiti Malaya, 50603 Kuala Lumpur, Malaysia. \n2 Psychology Department, Faculty of Social Science & Liberal Arts, UCSI \n\n\n\nUniversity, 56000 Cheras, Malaysia. \n3Department of Medical Sciences, School of Medical & Life Sciences, \n\n\n\nSunway University, Bandar Sunway, 47500 Petaling Jaya, Selangor, \n\n\n\nMalaysia. \n4 Clinical Investigation Centre (CIC), University Malaya Medical Centre, \n\n\n\n59100 Kuala Lumpur, Malaysia. \n\n\n\n* Corresponding author \n\n\n\nEmail: phancw@um.edu.my \n\n\n\n\n\n\n\nBackground and Objectives: Research misconduct is a \n\n\n\ngrowing issue which needs more attention. The higher \n\n\n\nprevalence of research misconduct in health-related \n\n\n\nresearch as compared to research in other fields negatively \n\n\n\ninfluences the healthcare sector. Factors which might \n\n\n\ninfluence research practice include level of knowledge and \n\n\n\nawareness regarding research misconduct, as well as \n\n\n\nacceptability to unethical research practices. This study \n\n\n\naimed to investigate the relationship between research \n\n\n\nmisconduct and its knowledge, awareness, and \n\n\n\nacceptability with focus on Malaysia pharmacy education \n\n\n\ncommunity, i.e., the educators and students. Methods: \n\n\n\nEthics approval was obtained from the Universiti Malaya \n\n\n\nEthics Committee (UMREC). A cross-sectional study \n\n\n\nusing an online questionnaire was conducted. A total of \n\n\n\n393 pharmacy students and pharmacy academicians in \n\n\n\nMalaysia were involved. Data was analysed using PLS-\n\n\n\nSEM to assess the proposed hypotheses.  Results and \n\n\n\nDiscussion: A statistically significant positive relationship \n\n\n\nwas found between awareness of terminologies regarding \n\n\n\nresearch misconduct and perceived research misconduct in \n\n\n\nthe workplace. However, acceptability of unethical \n\n\n\npractices in research demonstrated a negative correlation \n\n\n\nwith perceived research misconduct. Knowledge and \n\n\n\nawareness regarding research misconduct have no \n\n\n\nsignificant relationship with perceived research \n\n\n\nmisconduct. Both awareness on terminologies and \n\n\n\nacceptability to unethical practices explained 10.8% of \n\n\n\nvariance in perceived research misconduct. Conclusion: \n\n\n\nThe study indicates that awareness, knowledge, and \n\n\n\nacceptability of research misconduct might not be the main \n\n\n\npredictors to questionable conduct of research among the \n\n\n\npharmacy academicians and students. Future study on \n\n\n\nother factors which might contribute to research \n\n\n\nmisconduct is highly recommended to investigate the \n\n\n\nsignificant contributing factors of irresponsible conduct of \n\n\n\nresearch. \n\n\n\n\n\n\n\nAbstract 034 \n\n\n\n\n\n\n\nSmoking Cessation Problem-based \n\n\n\nLearning: Virtual Experience \n\n\n\n\n\n\n\nSoraya Ismail1*, Mohamad Haniki Nik \n\n\n\nMohamed2 \n\n\n\n \n1 Department of Basic Medical Sciences, Kulliyyah (Faculty) of Medicine, \n\n\n\nInternational Islamic University Malaysia \n2 Department of Pharmacy Practice, Kulliyyah (Faculty) of Pharmacy, \n\n\n\nInternational Islamic University Malaysia \n\n\n\n* Corresponding author \n\n\n\nEmail: dr_soraya@iium.edu.my \n\n\n\n\n\n\n\nBackground and Objectives: Problem-based learning (PBL) \n\n\n\nis a student-centred teaching and learning methodology \n\n\n\nwhere students collaboratively address specific issues. \n\n\n\nTobacco use is a major health issue globally. Health \n\n\n\nprofessions and students need to have knowledge and skills \n\n\n\nto facilitate smoking cessation.  The objective of this study is \n\n\n\nto assess feasibility of PBL during a virtual attachment \n\n\n\ninvolving institutions from Malaysia and the USA. Methods: \n\n\n\nA 4-week smoking cessation virtual attachment was \n\n\n\nconducted for three third-year University of Pittsburgh, USA \n\n\n\npharmacy students. Malaysian smoking cessation experts \n\n\n\ndesigned and facilitated a PBL smoking cessation module. It \n\n\n\nwas split into two 2-hour sessions with 3 triggers; Trigger 1: \n\n\n\n\u2018Chief Presentation\u2019, Trigger 2: \u2018History & Motivational \n\n\n\nInterview\u2019, and Trigger 3: \u2018Brief 5A\u2019s Intervention\u2019.  \n\n\n\nStudents received Trigger 1 a day earlier and discussed \n\n\n\namongst themselves. In session 1, Triggers 1-3 were given \n\n\n\nsequentially and discussed after completing all tasks from \n\n\n\neach trigger. In session 2 one-week later, facilitators gave \n\n\n\nformative assessment and students provided reflection \n\n\n\nregarding the PBL session. Upon completing the four-week \n\n\n\nvirtual attachment, students provided feedback and \n\n\n\nfacilitators graded the students. Result and Discussion:  A \n\n\n\ncomprehensive and interactive PBL session was successfully \n\n\n\nconducted virtually. Based on the clinical practice guidelines \n\n\n\nof both countries, there were differences in terms of \n\n\n\navailability and use of cessation medications, but the general \n\n\n\nprinciples of smoking cessation consultation and \n\n\n\ninterventions were similar. Students were able to discuss the \n\n\n\ncase openly, putting forth ideas and questions in both \n\n\n\nsessions. All students provided positive feedbacks regarding \n\n\n\nthe PBL. Conclusion:  With the extensive development of \n\n\n\nonline platforms connecting the world over, student virtual \n\n\n\nattachment and mobility programmes can be easily \n\n\n\nconducted with minimal cost.  A suitable module embedding \n\n\n\nPBL can be designed and conducted to best suit the online \n\n\n\nplatform and the intended students.    \n\n\n\n \n\n\n\n\nmailto:phancw@um.edu.my\n\n\nmailto:dr_soraya@iium.edu.my\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n83 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 035 \n\n\n\n\n\n\n\nContinuing Professional Development: A \n\n\n\nNeed Assessment among Pharmacists in \n\n\n\nMalaysia \n\n\n\n\n\n\n\nSyireen Alwi1*, Siew Siang Chua2, May Hoi \n\n\n\nLee3, Mei Hui Tang3 \n\n\n\n \n1 Department of Clinical Pharmacy and Pharmacy Practice, Faculty of \n\n\n\nPharmacy, Universiti Malaya, Malaysia \n2 Malaysian Academy of Pharmacy, Malaysia \n3 Faculty of Pharmacy, Universiti Malaya, Malaysia \n\n\n\n* Corresponding author \n\n\n\nEmail: syireen@um.edu.my \n\n\n\n\n\n\n\nBackground and Objectives: Continuing Professional \n\n\n\nDevelopment (CPD) is a lifelong learning model to maintain \n\n\n\nand enhance pharmacists\u2019 competencies. As the practice of \n\n\n\npharmacy is advancing, it is essential to keep pharmacists \n\n\n\nupdated and ultimately improve patient care. This study \n\n\n\naimed to assess the needs of pharmacists to fulfil the CPD \n\n\n\nrequirements. Methods: A cross-sectional survey was \n\n\n\ncarried out using an online, validated semi-structured \n\n\n\nquestionnaire. The questionnaire was shared with \n\n\n\npharmacists on social media and through pharmacists\u2019 \n\n\n\nWhatsApp groups. Results and Discussion: A total of 557 \n\n\n\nresponses were obtained, of which 57% were from hospital \n\n\n\npharmacy background. Continuing pharmacy education \n\n\n\n(CPE) sessions (93.2%), structured activities such as seminar \n\n\n\n(91.4%) and workshops (87.6%) were the most preferred \n\n\n\nCPD activities. This finding is consistent with other studies \n\n\n\nthat showed most of the respondents preferred directed \n\n\n\nlearning more than non-directed learning. Nutrition and diet \n\n\n\n(95.4%) and pharmacotherapy of geriatric population (90.8%) \n\n\n\nwere the most preferred CPD topic and area of specialisation \n\n\n\namong respondents with community pharmacy background \n\n\n\nwhilst infectious diseases (85.5%) and pain management \n\n\n\n(83.9%) for respondents with hospital pharmacy background \n\n\n\nas these are common areas encountered by them during their \n\n\n\npractice. The main barriers to CPD participation were cost of \n\n\n\nparticipation (83.5%), time constraints (83.1%) and \n\n\n\naccessibility to CPD venue (81.1%). Out-of-pocket payment \n\n\n\nand high workload could be the main reasons for these \n\n\n\nbarriers. Improved range of CPD topics (94.8%) and more \n\n\n\nfrequent CPD activities (92.3%) were the top two motivators \n\n\n\nto CPD involvement. Thus, reduced cost, better timing of \n\n\n\nCPD activities, improved relevance of topics and increased \n\n\n\naccessibility would lead to increase CPD participation. \n\n\n\nConclusion: These findings have also enabled CPD \n\n\n\nproviders to develop modalities to improve CPD \n\n\n\nprogrammes to meet the needs of pharmacists.  \n\n\n\n\n\n\n\nAbstract 036 \n\n\n\n\n\n\n\nPotential Roles of Pharmacists in \n\n\n\nHIV/AIDS Care Delivery in Nepal: A \n\n\n\nQualitative Study \n\n\n\n\n\n\n\nAyushma Shahi1*, Sweta Shrestha1, Badri \n\n\n\nK.C1, Khagendra Acharya2, Sait Kumar \n\n\n\nPradhan3 \n \n\n\n\n1 Department of Pharmacy, School of Science, Kathmandu University, \n\n\n\nDhulikhel, Kavre, Nepal \n2 Department of Management Informatics and Communication, School of \n\n\n\nManagement, Kathmandu University, Dhulikhel, Kavre, Nepal \n3 Department of Clinical Physiology, Maharajgunj Medical Campus, \n\n\n\nInstitute of Medicine, Nepal \n\n\n\n* Corresponding author \n\n\n\nEmail: ayushmas4@gmail.com \n\n\n\n\n\n\n\nBackground and Objectives: Nepal is facing escalating \n\n\n\ninfection rates of HIV/AIDS, a major global public health \n\n\n\nthreat. Continuum of services is an identified strategic \n\n\n\ncomponent of the Joint United Nations Programme on \n\n\n\nHIV/AIDS (UNAIDS) commitment to end this public health \n\n\n\ncrisis by 2030 and achieve the Sustainable Development \n\n\n\nGoal 6. Pharmacists are integral members of the continuum \n\n\n\nof care in HIV/AIDS hence, this study aimed to gain an \n\n\n\ninsight into the views of stakeholders on the roles of \n\n\n\npharmacists in this arena.  Methods:  A qualitative approach \n\n\n\nwas used where 15 key informants were interviewed using a \n\n\n\nsemi-structured interview protocol. Participants were \n\n\n\nselected through a sequence of purposive sampling and \n\n\n\nsnowball sampling technique. The interviews were \n\n\n\nconducted, transcribed verbatim and analyzed using thematic \n\n\n\nanalysis. Results and Discussion:  Potential roles of \n\n\n\npharmacists reside in adherence monitoring, \n\n\n\npharmacovigilance, provincial and district level ART centers. \n\n\n\nPharmacists and other stakeholders held divergent views on \n\n\n\nthe pharmacist's role in dispensing and counseling \n\n\n\nantiretroviral medications. Barriers to the pharmacists' \n\n\n\ninvolvement were lack of workforce, advocacy and \n\n\n\ngovernment support, frailty of professional organizations, \n\n\n\nself-limited scope, policy constraints, structural limitations, \n\n\n\nbiasedness, and societal unawareness. Pharmacists \n\n\n\nthemselves and organizations such as National Government \n\n\n\nOrganizations (NGOs) and International Government \n\n\n\nOrganizations (INGOs) were identified as the facilitators. \n\n\n\nConclusion:  Stakeholders are willing to expand the role of \n\n\n\npharmacists in HIV/AIDS care in Nepal. Nevertheless, some \n\n\n\ncrucial impediments exist. Primarily, an aggressive and \n\n\n\nassertive advocacy is needed from pharmacists themselves \n\n\n\nand their professional organizations to establish their roles in \n\n\n\nHIV/AIDS care delivery. Additionally, unearthing potential \n\n\n\nof pharmacists as contributors in HIV/AIDS care delivery or \n\n\n\nany other chronic disease management equally demands a \n\n\n\nstrong support from the government officials as well as the \n\n\n\nother health care professionals. \n\n\n\n\nmailto:syireen@um.edu.my\n\n\nmailto:ayushmas4@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n84 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\n\n\n\n\nAbstract 037 \n\n\n\n\n\n\n\nAssessing Health Literacy among The \n\n\n\nNewly Diagnosed Type 2 Diabetes and Pre-\n\n\n\ndiabetes Patients in Malaysia  \n\n\n\n\n\n\n\nAzrina Ely Ahmad Azhari1*, Jim Chai1, Claire \n\n\n\nAnderson2 \n \n1 School of Pharmacy, University of Nottingham Malaysia, Semenyih, \n\n\n\nSelangor, Malaysia \n2 Division of Pharmacy Practice and Policy, School of Pharmacy, University \n\n\n\nof Nottingham, Nottingham, United Kingdom \n\n\n\n* Corresponding author \n\n\n\nEmail: hyxaa1@nottingham.edu.my \n\n\n\n\n\n\n\nBackground and Objectives: Health literacy refers to the \n\n\n\nability of an individual to access, understand, appraise, and \n\n\n\napply health information and services. In Malaysia, one in \n\n\n\nthree adults have low health literacy. Low health literacy is \n\n\n\nassociated with poorer diabetes knowledge and self-care \n\n\n\nmanagement. We aimed to assess the health literacy of newly \n\n\n\ndiagnosed type 2 diabetes and pre-diabetes patients to \n\n\n\nidentify their strengths and limitations in health literacy. \n\n\n\nMethods: The Health Literacy Questionnaire (HLQ) which \n\n\n\nexamines the 9 scales of health literacy was used. 28 \n\n\n\nparticipants who were recruited from online platforms and \n\n\n\ntwo public clinics for qualitative interview were invited to fill \n\n\n\nin the questionnaire. Data were collected using self-\n\n\n\nadministered questionnaires which were available online and \n\n\n\npaper based. Descriptive statistics was used to summarise the \n\n\n\nresponses to the questionnaire questions. Data from the semi-\n\n\n\nstructured interviews were coded and categorised into themes \n\n\n\nusing thematic analysis. Results and Discussion: The HLQ \n\n\n\nprovided 9 separate scores to indicate a person\u2019s strengths \n\n\n\nand limitations in their health literacy and the strengths and \n\n\n\nlimitations of the sample population can be explained in \n\n\n\nterms of the number of participants with a lower or higher \n\n\n\nlevel of health literacy for each scale. In this study, among \n\n\n\nthe 9 scales of the HLQ, the lowest score was found for scale \n\n\n\n7 \u2018Navigating the healthcare system\u2019 and the highest score \n\n\n\nwas scale 5 \u2018Appraisal of health information\u2019. Conclusion: \n\n\n\nThe limitations in health literacy among the newly diagnosed \n\n\n\ntype 2 diabetes and pre-diabetes patients were identified. The \n\n\n\nresults were consistent with the themes identified from the \n\n\n\ninterview data. Improving accessibility of health information \n\n\n\nand services for diabetes patients are needed to increase \n\n\n\npatients\u2019 knowledge and empower self-care behaviours.  \n\n\n\nAbstract 038 \n\n\n\n\n\n\n\nPerspectives and Challenges Managing \n\n\n\nOlder Adults: A Qualitative Study with \n\n\n\nPrimary Health General Practitioners and \n\n\n\nPharmacists In Penang, Malaysia \n\n\n\n\n\n\n\nChristina Malini Christopher1*, Ali Qais \n\n\n\nBlebil1, Bhuvan KC2, Deepa Alex3, Mohamed \n\n\n\nIzham Ibrahim4 \n\n\n\n \n 1 School of Pharmacy, Monash University Malaysia, Subang Jaya, \n\n\n\nSelangor, Malaysia     \n2 Faculty of Pharmacy and Pharmaceutical Sciences, Monash \n\n\n\nUniversity Parkville Campus, Melbourne, Australia \n3Jeffrey Cheah School of Medicine and Health Sciences, Monash \n\n\n\nUniversity Malaysia, Subang Jaya, Selangor, Malaysia \n4 Clinical Pharmacy and Practice Department, College of Pharmacy, \n\n\n\nQU Health, Qatar University, Doha, Qatar \n\n\n\n* Corresponding author \n\n\n\nEmail: christina.christopher@monash.edu \n\n\n\n\n\n\n\nBackground and Objectives: There has been an increase in \n\n\n\nthe older adult demographic, and there is a need to prioritize \n\n\n\nhealthy ageing to suit their needs. Primary care facilities, due \n\n\n\nto their accessibility and use, seem to be the first choice for \n\n\n\nhealthcare services for older adults. This study aims to \n\n\n\nunderstand the health care providers' perspectives on older \n\n\n\nadults' medication use problems at the primary care level. \n\n\n\nMethods: The study used a qualitative methodology \n\n\n\ncomprising 30 in-depth interviews among general \n\n\n\npractitioners and pharmacists in Penang, Malaysia, in public \n\n\n\nand private primary care settings. Participants were recruited \n\n\n\nbased on purposive sampling. Interviews were transcribed \n\n\n\nverbatim, and data were coded based on the principles of \n\n\n\nthematic analysis in NVivo.  Results and Discussion: \n\n\n\nFindings reported on the perspectives of professional \n\n\n\nhealthcare providers in providing healthcare services to older \n\n\n\nadults. Three themes emerged from the study. Theme one \n\n\n\nhighlighted aligning health systems with the needs of older \n\n\n\npopulations. Theme two explored feedback on shared \n\n\n\ndecision-making among health care providers. The final \n\n\n\ntheme delineated the challenges of medication use and \n\n\n\nfacilities among older adults. Conclusion: This study \n\n\n\nidentified various challenges faced by primary care providers \n\n\n\nin responding to older adults' medication-related problems at \n\n\n\nthe primary care level. Inputs from the primary health care \n\n\n\nsystem frontier are essential to reduce the challenges and \n\n\n\nuplift the quality of ageing populations' healthcare in \n\n\n\nMalaysia. \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:hyxaa1@nottingham.edu.my\n\n\nmailto:christina.christopher@monash.edu\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n85 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 039 \n\n\n\n\n\n\n\nKnowledge, Attitude and Practice of \n\n\n\nFilipinos on Sunscreen Utilisation  \n\n\n\n\n\n\n\nAndrea Gail A. Cunanan*, Ryah Monique C. \n\n\n\nFernandez, Jermie Anne S. Li,Christine Marie \n\n\n\nS. Terrado \n \n\n\n\nManila Central University, University in Caloocan, Philippines \n\n\n\n* Corresponding author \n\n\n\nEmail: andreagailcunanan1701@gmail.com \n \n\n\n\nBackground and Objectives:  Non-melanoma skin cancer \n\n\n\nis a type of cancer that is mainly caused by overexposure to \n\n\n\nultraviolet (UV) light and recent study shows the increasing \n\n\n\nnumber of people at risk of this cancer were Filipinos. This \n\n\n\nstudy aims to identify the knowledge, attitude, and practices \n\n\n\nof Filipinos in Brgy. Catmon, Malabon City on sunscreen \n\n\n\nutilization.  Methods:  By using the snowball sampling \n\n\n\ntechnique, the researchers were able to gather 100 \n\n\n\nrespondents online. Pearson-R was used to determine if there \n\n\n\nis a significant relationship between the knowledge, attitudes, \n\n\n\nand practices on sunscreen utilisation.  T-test and Analysis of \n\n\n\nVariance was used to determine if there was a difference \n\n\n\nbetween the respondent\u2019s knowledge, attitudes, and practices \n\n\n\non sunscreen utilization when grouped according to their \n\n\n\nprofile.  Results and Discussion: The study revealed that \n\n\n\nrespondents\u2019 knowledge, attitude, and practices on sunscreen \n\n\n\nutilization have a moderately high positive relationship.  The \n\n\n\nstudy also revealed that the respondents\u2019 knowledge, attitude, \n\n\n\nand practices on sunscreen utilisation have a significant \n\n\n\ndifference when grouped according to their socio-\n\n\n\ndemographic profile, specifically the respondents\u2019 gender. \n\n\n\nThis indicates that other demographic profiles such as age, \n\n\n\neconomic status, field of work, and their skin type does not \n\n\n\ndiffer in their knowledge, attitude, and practices on sunscreen \n\n\n\nutilization. Conclusion:  The results of this study can be used \n\n\n\nto encourage health professionals on better education and \n\n\n\ncounselling on the harmful effects of sun exposure, \n\n\n\nnecessitating the daily use of sunscreen to aid in preventing \n\n\n\nskin cancer, for better skin care, and better health. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 040 \n\n\n\n\n\n\n\nA Strategy to Strengthen Halal \n\n\n\nPharmamedlog Initiatives by Malaysian \n\n\n\nArmed Forces - First Government Agency \n\n\n\nin the World \n\n\n\n\n\n\n\nNur Hidayah AR1*, Muhammad Najhan MB1, \n\n\n\nMohd Azrizal MR1, Mohd Adlan A2, A Halim \n\n\n\nB2  \n \n1 Malaysian Armed Forces Medical & Dental Depot, Kuala Lumpur, \n\n\n\nMalaysia  \n2 Malaysian Armed Forces Headquarters, Health Services Division, Kuala \n\n\n\nLumpur, Malaysia \n\n\n\n* Corresponding author \n\n\n\nEmail: mjhidayahrahim@gmail.com \n\n\n\n\n\n\n\nBackground and Objectives:  Malaysian government aims \n\n\n\nto be the most competitive country in the global halal \n\n\n\nindustry. Halal Pharmamedlog refers to management of \n\n\n\npharmaceuticals and medical logistics (Pharmamedlog) \n\n\n\nitems under circumstances of Islamic Law. Previously, there \n\n\n\nwas no JAKIM halal certified Pharmamedlog warehouse in \n\n\n\nMalaysia. 93 Medical and Dental Depot Malaysian Armed \n\n\n\nForces (93 MDDMAF) took the challenge to obtain halal \n\n\n\nrecognition in order to support MAF Health Services Action \n\n\n\nPlan 2030 which contains Syariah Compliance Pharmacy \n\n\n\nPractice (SCPP) of Pharmamedlog activities. Methods:  A \n\n\n\ndescriptive study was carried out from November 2020 to \n\n\n\nMarch 2022 in 7 stores of 93 MDDMAF which handled \n\n\n\nPharmamedlog items. Halal Pharmaceutical Decision Tree \n\n\n\n(HPDT) was a novel halal assessment tool and was developed \n\n\n\nwith the consensus of Halal Subject Matter Experts. HPDT \n\n\n\nanalysed sources of active ingredients and excipients that \n\n\n\npotentially originated from animals and substances forbidden \n\n\n\nto Muslims. Colour coding of green (permissible), grey \n\n\n\n(doubtful) and red (forbidden) were used to describe product \n\n\n\nhalal category. Halal Critical Points (HCPs) were then \n\n\n\nidentified and controlled to guarantee halal integrity of \n\n\n\nproducts and processes. Results and Discussion:  \n\n\n\nAssessment of 1465 Pharmamedlog items showed that 94% \n\n\n\nof the health products were categorized as green items, 4% as \n\n\n\ngrey, and 2% as red. Clear process of segregations needed to \n\n\n\nbe shown to preserve halal integrity during the management \n\n\n\nof Pharmamedlog. 13 HCPs were identified and strictly \n\n\n\nmonitored through Halalan Thoyyiban Risk Management \n\n\n\nPlan. After thorough audit, 7 stores of the 93 MDDMAF have \n\n\n\nbeen certified halal by JAKIM on 16th April 2022. This \n\n\n\nrecognition is the first in the world received by a government \n\n\n\nagency. Conclusion:  MAF is committed to ensure all health \n\n\n\nfacilities and supply chain partners adapt and cultivate Halal \n\n\n\nSupply Chain Management System through SCPP Plan-Do-\n\n\n\nCheck-Act cycles to ensure safety, quality and efficacy of \n\n\n\nPharmamedlog items in MAF. \n\n\n\n\nmailto:andreagailcunanan1701@gmail.com\n\n\nmailto:mjhidayahrahim@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n86 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 041 \n\n\n\n\n\n\n\nThe Stress, Satisfaction, and Fulfilment of \n\n\n\nEarly Career Pharmacists \u2013 A Qualitative \n\n\n\nStudy of their Professional and Personal \n\n\n\nLives \n\n\n\n\n\n\n\nPY Chee, LV Tan, CCW Lee, BBN Choo, WL \n\n\n\nCheong* \n \n\n\n\nSchool of Pharmacy, Monash University Malaysia, Bandar Sunway, \n\n\n\nMalaysia \n\n\n\n* Corresponding author \n\n\n\nEmail: cheong.wingloong@monash.edu \n\n\n\n\n\n\n\nBackground and Objectives:  Early career pharmacists are \n\n\n\nreportedly highly stressed and burnt out. Developing \n\n\n\ninterventions to support their well-being requires an \n\n\n\nunderstanding of the factors that affect their stress, \n\n\n\nsatisfaction, and fulfilment. This study aims to examine and \n\n\n\ndevelop a better understanding of: 1) the factors that affect \n\n\n\nthe stress of both their professional and personal lives, 2) the \n\n\n\naspects of professional and personal life that affect their \n\n\n\nsatisfaction and fulfilment, and 3) what they need to achieve \n\n\n\nsatisfaction and fulfilment in their professional and personal \n\n\n\nlives. Methods:  A cross-sectional study using a \n\n\n\nquestionnaire was developed. The questionnaire contained 8 \n\n\n\nquestions designed to collect qualitative data on the factors \n\n\n\naffecting the stress, satisfaction, and fulfilment in the \n\n\n\nprofessional and personal lives of early career pharmacists. \n\n\n\nQuestionnaire responses were analysed using a qualitative \n\n\n\ncontent analysis approach and themes describing influential \n\n\n\nfactors were developed. Results and Discussion:  Some of \n\n\n\nthe factors that contribute to the stress, satisfaction and \n\n\n\nfulfilment of early career pharmacists were identified. The \n\n\n\nstressors identified include the workplace environment and \n\n\n\nrelationships with colleagues, the demands of a pharmacist \n\n\n\ncareer, the lack of career advancement pathways, job \n\n\n\ninsecurity, relationships, and their weaknesses. Factors \n\n\n\ncontributing to satisfaction and fulfilment included \n\n\n\nsupportive work environments and relationships, being \n\n\n\nappreciated and making a difference, growth, supportive \n\n\n\nrelationships, and self-care. Conclusion:  Supporting the \n\n\n\nwell-being of early career pharmacists is important for a \n\n\n\nresilient, engaged, and effective pharmacy workforce. Key \n\n\n\ninterventions include eliminating job insecurity, establishing \n\n\n\nclear career pathways, improving work environments and \n\n\n\nrelationships, and investing in skills development. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 042 \n\n\n\n\n\n\n\nHealth Care Team Patterns through \n\n\n\nPerception of Interprofessional Interaction \n\n\n\nBetween Pharmacists and Medical \n\n\n\nTechnologists in a City in Northern \n\n\n\nPhilippines \n\n\n\n\n\n\n\nLangit MRD1,3,4*, Estacio BRB2, Estrella \n\n\n\nJIOV2, Galicio FIF2, Gamino CDR2, Gloria \n\n\n\nJAA2, Gomez PNC2, Hamadain SKIL2, \n\n\n\nHulipas LEM2, Jamandre CAD2, Lababit \n\n\n\nAMM2 \n\n\n\n \n1 Department of Pharmacy, 2 Department of Medical Laboratory Science, \n\n\n\nSchool of Natural Sciences, Saint Louis University, Baguio City, \n\n\n\nPhilippines \n\n\n\n \n3 The Graduate School, University of Santo Tomas, Sampaloc, Manila, \n\n\n\nPhilippines \n4Executive Secretary, Philippine Pharmacists Association, Manila, \n\n\n\nPhilippines \n\n\n\n* Corresponding author \n\n\n\nEmail: mrdlangit@slu.edu.ph \n \n\n\n\nBackground and Objectives: Interprofessional \n\n\n\ncollaboration in healthcare is a crucial factor in delivering \n\n\n\nquality health and patient care. The aim of this study was to \n\n\n\ninvestigate healthcare team patterns involving \n\n\n\ninterprofessional collaboration between medical \n\n\n\ntechnologists and pharmacists. Methods: A quantitative, \n\n\n\ndescriptive cross-sectional design study wherein, a 30-item \n\n\n\nquestionnaire was distributed through physical \n\n\n\nquestionnaires and Google Forms to pharmacists and medical \n\n\n\ntechnologists working at four tertiary hospitals in a city in \n\n\n\nNorthern Philippines. A total of 105 respondents were \n\n\n\nrecruited, with a response rate of 64.7%. This study utilized \n\n\n\nsimple random sampling. All consenting medical \n\n\n\ntechnologists and pharmacists with at least six-month \n\n\n\nhospital experience were included in the study. Results and \n\n\n\nDiscussion: Interprofessional interactions between medical \n\n\n\ntechnologists and pharmacists is infrequently observed, \n\n\n\ncompared to interprofessional interactions between other \n\n\n\nhealthcare professionals. The ranking of interaction with \n\n\n\npharmacists is significantly negatively correlated with the \n\n\n\nranking of interaction with medical technologists (rs=-0.895; \n\n\n\nP-value=0.001) indicating that those who interact more with \n\n\n\npharmacists interact less with medical technologists. \n\n\n\nEvidence suggests a significant difference between the mean \n\n\n\nindex on \u201cTeamwork and Collaboration\u201d, and \u201cPatient-\n\n\n\nCenteredness\u201d of the two professions (P-value=0.001; P-\n\n\n\nvalue=0.014). This indicates that pharmacists exhibit greater \n\n\n\npositive attitude towards \u201cTeamwork and Collaboration\u201d and \n\n\n\n\u201cPatient-Centeredness\u201d than medical technologists. However, \n\n\n\nboth professions showed readiness for interprofessional \n\n\n\n\nmailto:cheong.wingloong@monash.edu\n\n\nmailto:mrdlangit@slu.edu.ph\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n87 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nlearning. Conclusion: There is a lack of established \n\n\n\ninterprofessional interactions and collaboration between \n\n\n\npharmacists and medical technologists despite existence calls \n\n\n\nfor the creation of interactive and collaborative opportunities. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 043 \n\n\n\n\n\n\n\nFoundation and Advanced Competencies \n\n\n\nof Community and Hospital Pharmacists in \n\n\n\nNorthern Philippines \n\n\n\n\n\n\n\nLangit MRD1,2,3*, Aum RVD1, Balaki BKT1, \n\n\n\nBarroga, DAF1, Bete CD1, Cari\u00f1o NJP1, Lim \n\n\n\nAGP1, Mangubat NSJ1, Obedoza CDL1, \n\n\n\nUmagat JM1 \n\n\n\n \n1 Department of Pharmacy, School of Nursing, Allied Health and \n\n\n\nBiological Sciences, Saint Louis University, Baguio City, Philippines \n2 The Graduate School, University of Santo Tomas, Sampaloc, Manila, \n\n\n\nPhilippines \n3 Philippine Pharmacists Association, Manila, Philippines \n\n\n\n*Corresponding author  \n\n\n\nEmail: mrdlangit@slu.edu.ph \n\n\n\n\n\n\n\nBackground and Objectives: In most developed countries, \n\n\n\na competency framework specific to the practice of pharmacy \n\n\n\nin the community is well\u2013established and recognized as a \n\n\n\nmeans to facilitate individual continuing professional \n\n\n\ndevelopment and assist with performance review, thus \n\n\n\nprogress could be seen in the provision of pharmaceutical \n\n\n\ncare. However, such is not yet in place in certain developing \n\n\n\ncountries including the Philippines.  This study aimed to \n\n\n\ndetermine the awareness and preparedness of pharmacists to \n\n\n\ncareer progression and specialization through assessing their \n\n\n\nactual and perceived level of practice and to determine the \n\n\n\ncorrelation between the current level of practice of \n\n\n\ncommunity and hospital pharmacists to the length of \n\n\n\nexperience in their current practice areas. Methods: A \n\n\n\nquestionnaire was developed using the Philippines Practice \n\n\n\nStandards for Pharmacists. Seventy community and hospital \n\n\n\npharmacists were selected via non-probability convenience \n\n\n\nsampling. Results and Discussion: Perceived level of \n\n\n\npractice of community and hospital pharmacists showed an \n\n\n\nadvanced level on all standards. The actual level of hospital \n\n\n\npharmacists under Business Sustainability Assurance \n\n\n\nresulted as advanced and the rest were expert. For community \n\n\n\npharmacists, all were advanced except for Providing Quality \n\n\n\nMedicines and Patient Needs which was expert. The \n\n\n\ncorrelation of actual level vs. perceived level demonstrated \n\n\n\nsignificant positive correlation for both pharmacists in all \n\n\n\ncompetency standards except for Business Sustainability \n\n\n\nAssurance which only showed significant correlation. The \n\n\n\nlength of practice in hospital pharmacy was correlated with \n\n\n\nProviding Quality Medicines and Patient Needs and the rest \n\n\n\nwere not correlated. Conclusion: There is a current \n\n\n\nrecognition of pharmacy practice, particularly the role of \n\n\n\neach pharmacist to ensure patient safety. The advancement of \n\n\n\ncompetencies proves the strong sense of responsibility \n\n\n\namong Filipino Pharmacists to continually improve, and thus \n\n\n\nprovide better quality services to the clients and patients. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 044 \n\n\n\n\n\n\n\nThe Pharmacist\u2019s Contribution During the \n\n\n\nCOVID 19 Pandemic: Medicine Delivery \n\n\n\nServices  \n\n\n\n\n\n\n\nMohamad Aizuddin Mohamad Noor 1*, \n\n\n\nZaswiza Mohamad Noor2  \n \n1 School of Pharmacy, University of Kuala Lumpur, Malaysia.  \n2 Department of Pharmacy Practice, School of Pharmacy, University of \n\n\n\nKuala Lumpur, Malaysia.  \n\n\n\n*Corresponding author  \n\n\n\nEmail: aizuddin.mnoor@gmail.com \n\n\n\n\n\n\n\nBackground and Objectives: SARS-CoV-2 (COVID 19) \n\n\n\nwas a global pandemic which changed the socioeconomic of \n\n\n\nevery nation. Malaysia also was not excluded and \n\n\n\nimplemented various strategies to counter the pandemic such \n\n\n\nas the execution of Movement Control Order (MCO) that \n\n\n\nrestricted the movement of people, which affected and \n\n\n\nlimited access to healthcare services. Pharmacists as the \n\n\n\nmedication expert and one of the frontliners in the healthcare \n\n\n\nsector play roles, in many aspects of its profession,to cater \n\n\n\nthe needs of society and ensure the accessibility to medicines \n\n\n\nthroughout the pandemic. The objective of this research was \n\n\n\nto assess the pharmacists\u2019 roles in medicine delivery during \n\n\n\nthe Movement Control Order (MCO) during the COVID-19 \n\n\n\npandemic and in particular to ensure the access to medicines \n\n\n\nand promotion of quality use of medicines. Methods: The \n\n\n\nparticipants were chosen from an online form offered during \n\n\n\nmedicine delivery service during MCO and involved repeat \n\n\n\nprescriptions from the nearby government healthcare \n\n\n\nfacilities. Participants were interviewed through phone calls \n\n\n\nafter the medicines were delivered. The responses were \n\n\n\nrecorded and analysed. Results and Discussion: A total of \n\n\n\n80 participants were involved in this study. All participants \n\n\n\nagreed that pharmacy delivery medicines services helped \n\n\n\nthem to collect the medications. Majority of the participants \n\n\n\npreferred the pharmacists to deliver the medicine as the \n\n\n\npharmacist could also  provide counselling on the usage of \n\n\n\nmedication. Furthermore, the majority of the participants \n\n\n\nwere willing to continue the services after the MCO. \n\n\n\nConclusion: Pharmacists help access to medicines and \n\n\n\nquality use of medicines. The medicines delivery services \n\n\n\nshould be expanded as pharmacy value-added services that \n\n\n\ninvolve both government and private sectors. \n\n\n\n\nmailto:mrdlangit@slu.edu.ph\n\n\nmailto:aizuddin.mnoor@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n88 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 045 \n\n\n\n\n\n\n\nA Narrative Review of Vaccine Hesitancy \n\n\n\nin Childhood Immunisation in Malaysia \n\n\n\n\n\n\n\nNour Hanah Othman1*, Munaver Ahmad \n\n\n\nNazir Ahmad1, Mohammed Tahir Ansari2 \n\n\n\n \n1 Department of Pharmaceutical Sciences, Faculty of Pharmacy and Health \n\n\n\nSciences, Universiti Kuala Lumpur, Royal College of Medicine. \n2 School of Pharmacy, University of Nottingham Malaysia \n\n\n\n* Corresponding author \n\n\n\nEmail: nourhanah@unikl.edu.my \n\n\n\n\n\n\n\nBackground and Objectives: Vaccination has been known \n\n\n\nto be the most effective strategy in the prevention of many \n\n\n\ncommunicable diseases. In Malaysia, since 2013 there has \n\n\n\nbeen a resurgence in vaccine preventable diseases in children. \n\n\n\nThe aim of this study was to examine the prevalence of \n\n\n\nvaccine hesitancy (VH) in Malaysia and the factors that \n\n\n\ncontribute towards vaccine hesitancy. Methods: Relevant \n\n\n\narticles on vaccine hesitancy in childhood immunisation in \n\n\n\nMalaysia were searched using Google Scholar, PubMed and \n\n\n\nMendeley databases. The search was restricted for articles \n\n\n\npublished in the English language from 2015 \u2013 2022. Studies \n\n\n\ngiving insight into vaccine hesitancy, refusal, defaulters, and \n\n\n\nhighlighted factors contributing to these parameters were \n\n\n\nincluded.  Results and Discussion: VH includes those who \n\n\n\nrefuse or delayed getting their child immunised. A total of 10 \n\n\n\npapers were included in the review which varied in terms of \n\n\n\nmethodology, vaccine hesitancy measurement methods, \n\n\n\nsettings and participants. The prevalence of vaccine \n\n\n\nhesitancy from 3 studies was in the range of 6.8% to 11.6%. \n\n\n\nThe range of defaulters is much wider whereby the \n\n\n\npercentage of mothers or parents who defaulted is between \n\n\n\n0.03% - 20.7%. Parents or mothers who refused childhood \n\n\n\nvaccination accounted for a very small percentage (0.08% - \n\n\n\n0.47%). Common reasons for VH are low education level, \n\n\n\ndoubts about vaccine content and religion. Interestingly, VH \n\n\n\nis more common among non-Muslims in the urban areas, but \n\n\n\nmore Muslims mothers are vaccine-hesitant in rural states. \n\n\n\nConclusion: Vaccine hesitancy (VH) is complex and \n\n\n\ndepends on various settings that include time, place and \n\n\n\nvaccines. Factors that are associated with VH are also wide \n\n\n\nranging. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 046 \n\n\n\n\n\n\n\nElectronic Prescription Services Trends \n\n\n\nacross Community Pharmacies in Malaysia \n\n\n\n\n\n\n\nHui Yin Yow1, Jason Siau-Ee Loo2, Yi Yang \n\n\n\nTen3, Megat Helmi Mohd Zubairi4, Nusaibah \n\n\n\nAbdul Rahim3* \n \n1 Department of Pharmaceutical Life Sciences, Faculty of Pharmacy, \n\n\n\nUniversiti Malaya, Kuala Lumpur, Malaysia. \n2 School of Pharmacy, Faculty of Health and Medical Sciences, Taylor\u2019s \n\n\n\nUniversity, Selangor, Malaysia. \n3 Department of Clinical Pharmacy & Pharmacy Practice, Faculty of \n\n\n\nPharmacy, Universiti Malaya, Kuala Lumpur, Malaysia. \n4 DOC2US, Heydoc International Sdn Bhd, Selangor, Malaysia. \n\n\n\n*Corresponding author  \n\n\n\nEmail: nusaibah.abdulrahim@um.edu.my \n\n\n\n\n\n\n\nBackground and Objectives: Telehealth services have \n\n\n\nincreased exponentially, particularly during Covid-19 \n\n\n\npandemic. E-prescribing is the direct transmission of \n\n\n\nelectronic prescriptions (e-prescriptions) from prescribers to \n\n\n\ncommunity pharmacies via digital devices. To date, there is \n\n\n\na lack of studies investigating e-prescription services in \n\n\n\nMalaysia. Thus, the study aims to investigate usage of e-\n\n\n\nprescription services in community pharmacies and \n\n\n\ndetermine trends of most common medication classes \n\n\n\nprescribed. Methods: A retrospective observational study \n\n\n\nwas conducted by retrieving records from a telemedicine \n\n\n\ndatabase used among community pharmacies in Malaysia. \n\n\n\nThe e-prescribing records from January 2019 to December \n\n\n\n2021 were extracted using a designated data collection form. \n\n\n\nData cleaning, standardization and data analysis were \n\n\n\nperformed using Python v3.9. The diagnoses and medicines \n\n\n\nwere classified according to the International Classification \n\n\n\nof Disease (ICD-11) and Anatomical Therapeutic Chemical \n\n\n\n(ATC) system, respectively. The usage of the service across \n\n\n\ntime, demographic profile of users and the most common \n\n\n\nmedication classes prescribed were identified. Results and \n\n\n\nDiscussion: A total of 743,542 records were included, \n\n\n\nincluding 109,664 (14.7%), 206,262 (27.7%) and 427,616 \n\n\n\n(57.5%) records, respectively for 2019, 2020 and 2021. There \n\n\n\nwere 207,024 (27.8%) unique users and 536,548 (72.2%) \n\n\n\nrepeated users over the 3 years. The user population \n\n\n\ncomprised of 59.7% female and 40.3% male, with a mean age \n\n\n\nof 51 \u00b1 21 years and primarily Malaysians (97.3%). The most \n\n\n\ncommonly prescribed medication classes were for \n\n\n\ncardiovascular system (52.7%), alimentary tract and \n\n\n\nmetabolism (21.1%), musculoskeletal system (7.2%), blood \n\n\n\nand blood-forming organs (5.2%) and nervous system (2.9%).   \n\n\n\nConclusion: This study concludes that the increase in usage \n\n\n\nof e-prescription services and its potential to remain as a \n\n\n\nfeature of the health care system in community pharmacies. \n\n\n\nFurther investigation on its role in prescribing and dispensing \n\n\n\npractices and impact on medication safety, quality and health \n\n\n\ncare delivery are warranted.  \n\n\n\n\nmailto:nourhanah@unikl.edu.my\n\n\nmailto:nusaibah.abdulrahim@um.edu.my\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n89 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 047 \n\n\n\n\n\n\n\nImproving Knowledge, Attitude, and \n\n\n\nPerception of Falls among the Geriatric \n\n\n\nPopulation through Educational \n\n\n\nIntervention \n\n\n\n\n\n\n\nPriya Manirajan1*, Palanisamy Sivanandy2, \n\n\n\nPravinkumar Vishwanath Ingle2 \n \n1 School of Postgraduate Studies, International Medical University, Kuala \n\n\n\nLumpur, Malaysia \n2 Department of Pharmacy Practice, School of Pharmacy, International \n\n\n\nMedical University, Kuala Lumpur, Malaysia \n\n\n\n* Corresponding author \n\n\n\nEmail: priyamanirajan28@gmail.com \n\n\n\n\n\n\n\nBackground and Objectives: As the global elderly \n\n\n\npopulation grows, especially in Southeast Asia, fall \n\n\n\nincidences are predicted to increase dramatically in the future. \n\n\n\nElderly people who experience falls suffer from lower quality \n\n\n\nof life and incur more medical expenses as a result of \n\n\n\ntreatment for their injuries. As one of the main factors in \n\n\n\nincreasing the risk of falls, numerous research has been \n\n\n\nconducted in recent years to determine the relationship \n\n\n\nbetween drugs and falls. This study was aimed to assess the \n\n\n\nknowledge, attitude, and perception (KAP) of falls among the \n\n\n\ngeriatric population in a primary care Malaysian clinic setting, \n\n\n\nreview the fall risk-increasing drugs (FRIDs) and provide \n\n\n\neducational intervention to improve the awareness of falls \n\n\n\nand FRIDs and analyse the effectiveness of the educational \n\n\n\nintervention. Methods: This interventional study was carried \n\n\n\nout in a primary care setting using a validated structured \n\n\n\nquestionnaire to assess the KAP of falls. Elderly patients who \n\n\n\nwere 65 years and above, seeking medical treatment in the \n\n\n\nprimary care setting, and able to read, understand, and \n\n\n\nrespond to the study questionnaire and educational \n\n\n\ninterventional materials were included in the study. Results \n\n\n\nand Discussion: In a total of 310 respondents, 74% of them \n\n\n\nhad obtained primary level education, and 46% of them were \n\n\n\nliving alone or with their partner/caregiver. The percentage \n\n\n\nof elderly patients who experienced falls after the age of 65 \n\n\n\nyears was 31%. The study showed that the participants\u2019 KAP \n\n\n\nof falls and FRIDS improved significantly (p<0.05) after the \n\n\n\npharmacist-led educational intervention. Conclusion: The \n\n\n\neducational intervention provided to the elderly population in \n\n\n\nthe rural region improved the knowledge of the elderly \n\n\n\npopulation in the primary care clinical settings. Health policy \n\n\n\nfocusing on prevention measures needs to be curated in the \n\n\n\nfuture to meet the demands of the ageing population. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 048 \n\n\n\n\n\n\n\nMussel-inspired Mucoadhesive Gelatine \n\n\n\nFilm Loaded with Cetylpyridinium \n\n\n\nChloride \n\n\n\n\n\n\n\nAmina Ahmady1, Nor Khaizan Anuar1,2, Siti \n\n\n\nAlwani Ariffin1,3, Nor Hayati Abu Samah1,3* \n \n1 Faculty of Pharmacy, Universiti Teknologi MARA (UiTM), Puncak Alam \n\n\n\nCampus, Selangor, Malaysia;  \n2 Non-Destructive Biomedical and Pharmaceutical Research Centre, Smart \n\n\n\nManufacturing Research Institute, UiTM, Selangor, Malaysia.  \n3 Marine Pharmaceutical Research Group (MaREG), UiTM, Puncak Alam \n\n\n\nCampus, Selangor, Malaysia  \n\n\n\n* Corresponding author \n\n\n\nEmail: aminaahmady8@gmail.com \n\n\n\n\n\n\n\nBackground and Objectives: Mouthwashes containing \n\n\n\nantiseptic agents are commonly used to prevent or treat oral \n\n\n\ncavity health issues. Recently their use has been suggested to \n\n\n\nreduce the severity and transmission rate of COVID-19 \n\n\n\ndisease. However, mouthwashes have low retention times in \n\n\n\nthe oral cavity. This study aimed to formulate buccal films \n\n\n\ncontaining an antiseptic agent with enhanced retention time \n\n\n\nin the oral cavity. Methods: A series of films made of bovine \n\n\n\ngelatine cross-linked by tannic acid (GelTA) were prepared \n\n\n\nby solvent evaporation and loaded with cetylpyridinium \n\n\n\nchloride (CPC), followed by physical and functional \n\n\n\ncharacterisation. Results and Discussion: The GelTA films \n\n\n\nmass and thickness were in the range of 16.4\u201323.0 mg and \n\n\n\n89.9\u2013103.3 \u00b5m, respectively. The cross-linking of gelatine \n\n\n\nusing tannic acid notably increased the films\u2019 dissolution \n\n\n\ntimes. The miscibility of CPC in BG-TA5-GLY20-7  was \n\n\n\nhigher by 3-fold than in the control film . Reduced film \n\n\n\nsolubility, swelling ratio, pH and contact angle were \n\n\n\nobserved in CPC-loaded films compared to blank film. \n\n\n\nMoreover, the release of CPC from the GelTA film prepared \n\n\n\nat pH 7 was significantly extended (6 h) compared with the \n\n\n\ncontrol film (1 h). There was a positive correlation (R=0.865, \n\n\n\np=0.00) between the erosion of GelTA films and CPC release. \n\n\n\nFurthermore, the BG-TA5-GLY20-7 film demonstrated \n\n\n\nantimicrobial activities against S. aureus in agar disc \n\n\n\ndiffusion studies with the ZOI  of 6.8 \u00b1 0.8 and 11.0 \u00b1 0.9 for \n\n\n\nthe blank and CPC loaded films (20% CPC), respectively. \n\n\n\nConclusion: GelTA film prepared at pH 7 has potential \n\n\n\napplications as a buccal film matrix considering its functional \n\n\n\nproperties and extended dissolution and release of CPC. \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:priyamanirajan28@gmail.com\n\n\nmailto:aminaahmady8@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n90 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 049 \n\n\n\n\n\n\n\nDesign of Degenerate, Universal Primers \n\n\n\nfor Multiplex PCR Determination of \n\n\n\nBiofilm-Formation in Staphylococcus \n\n\n\naureus, Pseudomonas aeruginosa, Klebsiella \n\n\n\npneumoniae, and Escherichia coli \n\n\n\n\n\n\n\nClodualdo F. Narciso III, Deo Raphael A. \n\n\n\nPaloma, Dan Ira King M. Tuatis, Sigfredo B. \n\n\n\nMata* \n \n\n\n\nDr. Mariano Que College of Pharmacy, De La Salle Medical and Health \n\n\n\nSciences Institute, Cavite, Philippines \n\n\n\n* Corresponding author \n\n\n\nEmail: sbmata@dlshsi.edu.ph \n\n\n\n\n\n\n\nBackground and Objectives: Biofilm-forming pathogens \n\n\n\nStaphylococcus aureus, Pseudomonas aeruginosa, \n\n\n\nKlebsiella pneumoniae, and Escherichia coli are responsible \n\n\n\nfor a significant proportion of nosocomial infections. \n\n\n\nMultiplex polymerase chain reaction (PCR) using degenerate \n\n\n\nprimers has potential for simultaneous detection of multiple \n\n\n\nbacterial species. This study aimed to design degenerate, \n\n\n\nuniversal primers for multiplex PCR determination of \n\n\n\nbiofilm formation in S. aureus, P. aeruginosa, K. \n\n\n\npneumoniae, and E. coli. Methods: FASTA gene sequences \n\n\n\nof clinically significant biofilm-forming bacterial strains \n\n\n\nwere collected from NCBI Nucleotide database. Consensus \n\n\n\nsequences were generated from chosen genes using multiple \n\n\n\nsequence alignment (MSA). These sequences were used to \n\n\n\ngenerate primers, which were characterized, validated, and \n\n\n\nsubjected to principal component analysis (PCA) to \n\n\n\ndetermine significant degenerate primer sequences. Primer \n\n\n\nselection followed by post-validation was performed to all \n\n\n\ncollected genes to determine hallmark nucleotide bands. \n\n\n\nFinally, a touchdown multiplex PCR method was proposed. \n\n\n\nResults and Discussion: From the six clinically significant \n\n\n\nbiofilm-forming bacterial strains, 96 genes were associated \n\n\n\nwith biofilm-forming activity. There were three MSA \n\n\n\nprofiles generated: first, for the S. aureus rqcH gene \n\n\n\nproducing fibrinogen-binding protein (SAOUHSC_01175) \n\n\n\nand P. aeruginosa pslE gene; and second, for enterococcal \n\n\n\nHha toxicity modulator, tomB gene; and third, for hemolysin \n\n\n\nexpression-modulating hha gene. From these, two degenerate \n\n\n\nconsensus sequences were used to generate 60 primers. A \n\n\n\ntotal of 13 primers for the first consensus sequence, and ten \n\n\n\nprimers for the second consensus sequence were determined \n\n\n\nas significant degenerate primers. Two primer pairs having \n\n\n\nsatisfactory characteristics were selected for design of a \n\n\n\ntouchdown multiplex PCR. Conclusion: Degenerate \n\n\n\nuniversal primers were designed to produce hallmark bands \n\n\n\nfor clinically significant biofilm-forming strains of chosen \n\n\n\nbacterial species. Actual PCR using the proposed method \n\n\n\nwill be performed to determine effectiveness of these \n\n\n\ndegenerate primers in detecting these biofilm-forming \n\n\n\nstrains. \n\n\n\nAbstract 050 \n \n\n\n\nIn vitro Anticancer Activity of \n\n\n\nMyriostachya wightiana Whole Plant \n\n\n\nMethanolic Extract on Breast, \n\n\n\nHepatocellular and Colorectal Cancer Cell \n\n\n\nLines \n\n\n\n\n\n\n\nAnupama Dasi1,2*, Y. Indira Muzib3 \n\n\n\n \n1 Research Scholar, Sri Padmavathi Mahila Viswavidyalayam, Tirupati;  \n2 Vikas Institute of Pharmaceutical Sciences, Rajahmundry. \n3 Professor,Institute of Pharmaceutical technology, Sri Padmavathi \n\n\n\nMahilaViswavidyalayam, Tirupati. \n\n\n\n* Corresponding author \n\n\n\nEmail: 99anupama@gmail.com \n\n\n\n\n\n\n\nBackground and Objectives: Cancer is an evil spirit that \n\n\n\ncauses alarming symptoms of death owing to the disease's \n\n\n\nglobal growth and is estimated to have caused 9.6 deaths \n\n\n\nglobally in 2018. Myriostachya wightiana, (Poaceae) a grass \n\n\n\nplant of mangroves are of tremendous ecological importance \n\n\n\nsince they are rich in potential bioactive chemicals. The \n\n\n\nobjective of the study was to evaluate the Anti-cancer activity \n\n\n\nof methanolic extract of Myriostachya wightiana whole plant. \n\n\n\nThe extract was subjected to preliminary phytochemical \n\n\n\nscreening with aim to study in-vitro cytotoxic activity in \n\n\n\ndifferent cell lines followed by docking studies and in-vivo \n\n\n\nanimal studies. Methods: The crude flour from the entire \n\n\n\nplant was extracted in succession of polar solvents with \n\n\n\nincreasing polarity. The extract was dried and weighed after \n\n\n\nbeing evaporated to dryness. The extract was screened for \n\n\n\nflavonoids, alkaloids, carbohydrates, tannins, and other \n\n\n\nphytochemicals. In-vitro cytotoxic study was performed on \n\n\n\nthe human breast cancer cell-line MCF-7, human colorectal \n\n\n\ncancer cell line CACO-2 and hepatocellular cancer cell line \n\n\n\nHEPG-2 using 3-(4,5-dimethythiazol- 2-yl)-2,5-diphenyl \n\n\n\ntetrazolium bromide (MTT) assay. Results and Discussion: \n\n\n\nMyriostachya wightiana Methanolic extract was found to be \n\n\n\neffective with IC50 values103.47 \u00b5g/ml ,110.22 \n\n\n\n\u00b5g/ml,110.85 \u00b5g/ml on MCF-7, HEPG-2,CaCO 2 with the \n\n\n\nstandard drug Vinblastine sulphate respectively. Conclusion: \n\n\n\nThe study indicated that methanolic extract of Myriostachya \n\n\n\nwightiana was active with IC50 against human breast cancer \n\n\n\ncell line MCF 7, colorectal cancer cell line CACO 2 & \n\n\n\nhepatocellular cancer cell line HEPG 2. There is an urgent \n\n\n\nneed for more research into this plant in order to uncover and \n\n\n\nisolate its active anticancer components. \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\nmailto:99anupama@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n91 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 051 \n\n\n\n\n\n\n\nInvestigation of Pittosporum molucannum \n\n\n\nPlant Extracts as Potential Source of \n\n\n\nNatural Biopesticides \n\n\n\n\n\n\n\nMelissa June Paderog*, Remi Charlene \n\n\n\nSalvilla \n  \nDepartment of Pharmacy, College of Pharmacy and Medical Technology, \n\n\n\nUniversity of San Agustin, Gen. Luna St., Iloilo City, Philippines 5000. \n\n\n\n* Corresponding author \n\n\n\nEmail: mpaderog@usa.edu.ph \n\n\n\n\n\n\n\nBackground and Objectives: Unintentional pesticide \n\n\n\npoisoning (UPP) in humans has been an inherent public \n\n\n\nhealth problem most developing and agricultural countries, \n\n\n\nfaces since the 1960\u2019s. Pesticides are substances that are used \n\n\n\nto kill or repel plants and animals considered to be pests. \n\n\n\nHowever, despite its benefits, pesticides poses health risks. \n\n\n\nPittosporum moluccanum locally known as \u201cbuyo-buyo\u201d was \n\n\n\ntraditionally used as herbal pesticides although no further \n\n\n\nscientific findings support this claim. Thus, this study aims to \n\n\n\nprovide initial findings on the plant\u2019s potential as a source of \n\n\n\nnatural biopesticides. Methods: In this study, extracts were \n\n\n\nobtained through maceration of the plant\u2019s leaves, fruits, and \n\n\n\nbarks in ethanol, followed by filltration, and finally \n\n\n\nconcentration using rotary evaporator. The extracts were \n\n\n\nchemically profiled through thin-layer chromatographic \n\n\n\nprinciples and toxicity was screened using brine shrimp \n\n\n\nlethality assay and MTT cytotoxicity assay. Herbicidal \n\n\n\nactivity was determined using phototoxicity assay and \n\n\n\nactivity was compared to glyophosate (positive control) and \n\n\n\nwater (growth control). Results and Discussion: TLC \n\n\n\nexperiment results suggest that the leaves, fruits and barks \n\n\n\ncontain semipolar compounds that are UV active at 365nm \n\n\n\nand 254nm wavelengths. Alkaloids and flavonoids were \n\n\n\nfound on the three plant extracts, phenolics were found in \n\n\n\nleaves and fruits, and tannins was found only on leaves. \n\n\n\nFurthermore, toxicity profiling suggests an LC50 of 0.098 \n\n\n\nmg/mL for leaves extract and 3.125 mg/mL for barks and \n\n\n\nfruits extracts. In addition, the fruits extract was found to be \n\n\n\ncytotoxic (CC50) at 0.39 ug/mL while both the leaves and \n\n\n\nbarks at 0.2 ug/mL. Herbicidal assay suggests that the \n\n\n\nextracts totally inhibit seed germination (100 % + SD 0.00) \n\n\n\nat 2 ug/mL while the positive control (13.5 ug/mL \n\n\n\nglyophosate) only exhibited 92.34 % + 0.47) inhibition. \n\n\n\nConclusion: Findings of this study suggests that \n\n\n\nP.molucannum plant contains UV active compounds that \n\n\n\ncould be a potential source of biopesticides specifically \n\n\n\nagainst weeds. \n\n\n\nAbstract 052 \n\n\n\n\n\n\n\nDocking Study Using Vina for \n\n\n\nPhytochemicals from Mangifera zeylanica \n\n\n\nto Treat Dengue  \n\n\n\n\n\n\n\nMohamed Jiffry Ifran*, Mohamed Jaffry \n\n\n\nRizzaly, Mudalige Heshani, Perera Ominda \n \n\n\n\nSchool of Science, BMS, Colombo-6, Sri Lanka \n\n\n\n*Corresponding author  \n\n\n\nEmail: mohamedifran1999@gmail.com \n\n\n\n\n\n\n\nBackground and Objectives: Dengue has emerged as a \n\n\n\nglobal public health challenge which unmet specific drug \n\n\n\ntreatment or vector control has become a threat to the world \n\n\n\ndue to increased morbidity rate. The current unavailability of \n\n\n\ndrugs has urged the need for novel antiviral drugs. NS3 \n\n\n\nprotease (PDB ID: 2FOM) is known for its viral replication \n\n\n\nof the dengue virus type II is used in this study. This study \n\n\n\nexplores the possibility of phytochemical compounds as NS3 \n\n\n\nprotease antagonists by detecting the common amino acid \n\n\n\nresidues in the binding pocket. Methods: 2OFM, which is a \n\n\n\nprimary target protein to treat dengue, was retrieved from \n\n\n\nRCSB PDB. In this study, docking of phytochemicals which \n\n\n\nwere downloaded from NCBI PubChem from the source, \n\n\n\nMangifera zeylanica was carried out in a single config.txt file \n\n\n\nusing AutoDock vina 1.2.6 with FDA-approved drug as \n\n\n\ncontrol ligand to find the antagonist candidate of NS3. All the \n\n\n\nligands were docked at a time by generating and executing \n\n\n\nthe *.BAT file through vina.exe and ligands (*. pdbqt files) \n\n\n\nfolder pathways. BIOVIA discovery studio was utilized to \n\n\n\nvisualize the interactions between protein and ligand. \n\n\n\nPotential drug candidates against dengue were assessed using \n\n\n\nSwiss-ADME webtool based on Lipinski\u2019s rule of five, \n\n\n\nblood-brain barrier permeability and GI absorption for oral \n\n\n\nadministration. Results and Discussion: Phytochemical, \n\n\n\nlupeol showed the lowest binding energy (-8.9 kcal/mol) \n\n\n\nwhile it does not obey Lipinski\u2019s rule. Epicatechin showed -\n\n\n\n8.5 kcal/mol and acceptance for Lipinski\u2019s rule. Other \n\n\n\nphytochemicals\u2019 binding affinities range from -5.1 to -8.6 \n\n\n\nkcal/mol. Conclusion: Epicatechin can be selected as a \n\n\n\npotential drug candidate. LEU149 was detected as a common \n\n\n\namino acid with respect to hydrogen bond and LEU76 and \n\n\n\nILE165 were identified as the common amino acid residue \n\n\n\ncorresponding to hydrophobic interaction. Further, in-vitro \n\n\n\nand in-vivo experiments can be persuaded. \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:mpaderog@usa.edu.ph\n\n\nmailto:mohamedifran1999@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n92 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 053 \n\n\n\n\n\n\n\nSynergistic Killing of Polymyxin B \n\n\n\nCombinations with Chloramphenicol \n\n\n\nDerivatives against Multidrug Resistant \n\n\n\n(MDR) Klebsiella pneumoniae \n\n\n\n\n\n\n\nNurulain Idris1, Nusaibah Abdul Rahim1*, \n\n\n\nKok Hoong Leong2, Eng Hwa Wong3 \n \n1 Department of Clinical Pharmacy and Pharmacy Practice,  \n2 Department of Pharmaceutical Chemistry, Faculty of Pharmacy, \n\n\n\nUniversiti Malaya, Kuala Lumpur, Malaysia. \n3 School of Medicine, Faculty of Health and Medical Sciences, Taylor\u2019s \n\n\n\nUniversity Lakeside Campus, Selangor, Malaysia. \n\n\n\n* Corresponding author \n\n\n\nEmail: nusaibah.abdulrahim@um.edu.my  \n \n\n\n\nBackground and Objectives: Combination antibiotics is \n\n\n\na treatment strategy to achieve synergistic killing against \n\n\n\nmultidrug resistant (MDR) Klebsiella pneumoniae. \n\n\n\nCombination interactions can be classified into synergy \n\n\n\n(\u22652 log10 CFU/mL), additive (1-2 log10 CFU/mL), and \n\n\n\nindifferent activity (<2 log10 CFU/mL) of bacterial killing \n\n\n\nwhen compared to the most active monotherapy. This \n\n\n\nstudy aimed to determine the antimicrobial \n\n\n\npharmacodynamics of polymyxin B combination with \n\n\n\nchloramphenicol and its less cytotoxic derivatives \n\n\n\n(thiamphenicol and florfenicol) against MDR K. \n\n\n\npneumoniae. Methods: Broth microdilution was used to \n\n\n\ndetermine the minimum inhibitory concentration (MIC) \n\n\n\nagainst Acinetobacter baumanii 19606 and MDR K. \n\n\n\npneumoniae, ATCC 700603, BAA-2146, and 700721 \n\n\n\nisolates. Time kill assay was used to assess the bacterial \n\n\n\nkilling of polymyxin B (20mg/L) in combination with \n\n\n\nchloramphenicol (160mg/L), thiamphenicol (64mg/L) and \n\n\n\nflorfenicol (64mg/L) against MDR. K. pneumoniae isolates. \n\n\n\nViable cell count was done to determine the antimicrobial \n\n\n\npharmacodynamic effect of antibiotics alone and in \n\n\n\ncombination expressed as bacterial burden (log10 CFU/mL) \n\n\n\nat 1, 4 and 24h. Results and Discussion: All isolates were \n\n\n\nsusceptible to polymyxin B and resistant to \n\n\n\nchloramphenicol, thiamphenicol and florfenicol. \n\n\n\nMonotherapy polymyxin B showed a regrowth of bacteria \n\n\n\nafter 24h for all isolates. Chloramphenicol, thiamphenicol \n\n\n\nand florfenicol were ineffective against all isolates when \n\n\n\ntreated alone. The combination of polymyxin B with \n\n\n\nchloramphenicol exhibited synergistic activity against all \n\n\n\nisolates. Treatment of polymyxin B and florfenicol \n\n\n\ndemonstrated synergistic and additive killing of all isolates \n\n\n\nand combination of polymyxin B with thiamphenicol \n\n\n\nshowed indifferent and additive killing of bacteria. The \n\n\n\nsynergistic activity combination of polymyxin B with \n\n\n\nchloramphenicol against MDR K. pneumoniae were \n\n\n\nsimilar as previous study. Conclusion: The combination of \n\n\n\npolymyxin B with florfenicol and thiamphenicol \n\n\n\ndemonstrated synergistic and additive killing against MDR \n\n\n\nK. pneumoniae isolates. Further investigation assessing the \n\n\n\ncytotoxic effect of polymyxin B combination with \n\n\n\nthiamphenicol and florfenicol at clinically relevant \n\n\n\nconcentrations are warranted. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 054 \n \n\n\n\nEffect of B. hispida Seed Extract towards \n\n\n\nProtein Expression of AHR, OVOL-1 and \n\n\n\nCYP1A1 \n\n\n\n\n\n\n\nRamli RZ*, Hadi H \n \n\n\n\nDermatopharmaceutics Research Group, Department of Pharmaceutical \n\n\n\nTechnology, Kuliyyah of Pharmacy, International Islamic University \n\n\n\nMalaysia, Kuantan, Pahang, Malaysia \n\n\n\n* Corresponding author \n\n\n\nEmail: rizal.zaim@yahoo.com \n\n\n\n\n\n\n\nBackground and Objectives: Atopic dermatitis (AD) is skin \n\n\n\ndisease which can be characterized by pruritic and \n\n\n\neczematous dermatitis that can be chronically varied through \n\n\n\nremissions and relapses. Primarily, AD is caused by the skin \n\n\n\nbarrier dysfunction while the skin sensitization to allergens \n\n\n\ncould also contributed to the severity of the skin disease. This \n\n\n\nstudy aims to discover the skin barrier repair functions of the \n\n\n\nBenincasa hispida seed extract (BHSE) which mainly \n\n\n\nconsists of polyunsaturated fatty acids (PUFAs) towards the \n\n\n\nskin barrier proteins which usually were downregulated in \n\n\n\nAD. Methods: The methods that were implemented in this \n\n\n\nstudy were the immunoblotting including Sodium Dodecyl \n\n\n\nSulphate Polyacrylamide Gel Electrophoresis (SDS-PAGE) \n\n\n\nto study the upregulations of three main skin barrier proteins \n\n\n\nwhich are Filaggrin, Loricrin and Involucrin and the \n\n\n\nreceptors and other proteins (Aryl Hydrocarbon Receptors, \n\n\n\nOvo Like Transcriptional Repressor 1 and Cytochrome P450 \n\n\n\nFamily 1 Subfamily A Member 1) which were involved in \n\n\n\nthe upregulations of the mentioned skin barrier proteins. The \n\n\n\nprocedures started with the SDS-PAGE to separate the \n\n\n\nprotein mixture of HaCaT lysate according to their respective \n\n\n\nmolecular weight, followed by protein transfer or blotting \n\n\n\ntowards the polyvinylidene fluoride membrane and lastly, the \n\n\n\nblocking steps of primary and secondary antibody before \n\n\n\nchemiluminiscent visualization. Results and Discussion: \n\n\n\nThis study found that the BHSE was able to upregulate all of \n\n\n\nthe proteins involved in the skin barrier restoration in dose \n\n\n\ndependent manner of the selected concentrations of 250 \n\n\n\n\u00b5g/mL, 125 \u00b5g/mL and 62.5 \u00b5g/mL. Conclusion: Based on \n\n\n\nthis finding, it can concluded that there were upregulations \n\n\n\non the protein expressions in most of the interested proteins \n\n\n\nwhich each one of them plays a crucial role in restoring the \n\n\n\nskin barrier dysfunction and therefore, suggesting the ability \n\n\n\nof the BHSE in the treatment for AD through the restoration \n\n\n\nof skin barrier dysfunction.   \n\n\n\n\nmailto:nusaibah.abdulrahim@um.edu.my\n\n\nmailto:rizal.zaim@yahoo.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n93 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 055 \n \n\n\n\nretracted \n\n\n\n\n\n\n\nAbstract 056 \n\n\n\n\n\n\n\nGenotyping of SNPs in ABCB1 (rs1045642, \n\n\n\nrs1128503) and OPRM1 (rs1799971, \n\n\n\nrs9479757) Associated with Pain Control \n\n\n\nand Adverse Effects of Morphine among \n\n\n\nCancer Pain Patients in Malaysia \n\n\n\n\n\n\n\nShobha Elizabeth Satkunananthan1, Sabrina \n\n\n\nAnne Stephen1, Hui Yin Yow2, Vijayaprakash \n\n\n\nSuppiah3, Fauziah Ab Aziz4, Hasriza Hashim4, \n\n\n\nGaik-Theng Toh5* \n \n1School of Pharmacy, Faculty of Health & Medical Sciences, Taylor\u2019s \n\n\n\nUniversity, Selangor, Malaysia \n2Department of Pharmaceutical Life Sciences, Faculty of Pharmacy, \n\n\n\nUniversiti Malaya, Kuala Lumpur, Malaysia. \n3Clinical and Health Sciences, University of South Australia, Adelaide, \n\n\n\nAustralia \n4Department of Palliative Medicine and Supportive Care, National Cancer \n\n\n\nInstitute, Wilayah Persekutuan Putrajaya, Malaysia \n5School of Medicine, Faculty of Health & Medical Sciences, Taylor\u2019s \n\n\n\nUniversity, Selangor, Malaysia \n\n\n\n* Corresponding author \n\n\n\nEmail: gaiktheng.toh@taylors.edu.my  \n\n\n\n\n\n\n\nBackground and Objectives: Single nucleotide \n\n\n\npolymorphisms (SNPs) affect treatment outcomes in opioid-\n\n\n\ntreated patients with evidence predominantly from Caucasian \n\n\n\npopulations. The association of SNPs with cancer pain \n\n\n\ntreatment outcomes within multi-ethnic Malaysian \n\n\n\npopulation remains unknown. This study aimed to investigate \n\n\n\nthe relationship of SNPs in ABCB1 and OPRM1 genes on \n\n\n\nmorphine pharmacodynamic parameters (pain control, dose \n\n\n\nrequirement, and adverse effects) and non-genetic \n\n\n\npharmacodynamics of morphine (gender, ethnicity, ECOG \n\n\n\nscores and cancer stage). Methods: 66 Malaysian solid \n\n\n\ntumour cancer patients treated with morphine were recruited \n\n\n\nfrom National Cancer Institute. Data (demographic and \n\n\n\nclinical) and saliva samples were collected from all \n\n\n\nparticipants. Patients\u2019 pain severity was evaluated by using \n\n\n\nBrief Pain Inventory. Incidence of adverse effects were \n\n\n\ndetermined through a questionnaire. Both questionnaires \n\n\n\nused Likert scales and were available in English and Malay. \n\n\n\nDue to COVID-19 restrictions, 38 out of 66 subjects \n\n\n\ncompleted the questionnaires. DNA extracted from saliva \n\n\n\nsamples were genotyped for SNPs in ABCB1 (rs1045642, \n\n\n\nrs1128503) and OPRM1 (rs1799971, rs9479757). Statistical \n\n\n\nanalyses were performed to determine the associations \n\n\n\nbetween genetic and non-genetic factors with morphine. \n\n\n\nResults and Discussion: The AA genotype in ABCB1 \n\n\n\nrs1128503 SNP had the highest pain score in the last 24 hours \n\n\n\n(p=0.043). ABCB1 (rs1045642, rs1128503) and OPRM1 \n\n\n\n(rs1799971, rs9479757) SNPs were associated with several \n\n\n\nadverse effects incidence (p<0.05). Ethnicity was associated \n\n\n\nwith the incidence of hallucination (p=0.041) in patients. \n\n\n\nECOG scores and cancer stages were also associated with \n\n\n\nseveral adverse effects incidence (p<0.05). However, \n\n\n\nmorphine dose was not associated with genetic or non-\n\n\n\ngenetic factors. Conclusion6U6Y The association between \n\n\n\ngenetic and non-genetic factors with pain severity and \n\n\n\nadverse effects incidence was seen in this study, but not with \n\n\n\ndose requirement. This pilot study should be validated in \n\n\n\nfuture genetic association studies on larger cohorts to \n\n\n\nelucidate the role of pharmacogenomics in treating cancer \n\n\n\npain in Asian patients. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 057 \n \n\n\n\nEvaluation of the CYP1A2, CYP2D6, and \n\n\n\nCYP3A4 Inhibition by the Ten DOH-\n\n\n\nApproved Philippine Medicinal Plants \n\n\n\nusing Enzyme-Specific Fluorometric \n\n\n\nSubstrates in Pooled Human Liver \n\n\n\nMicrosomes \n\n\n\n\n\n\n\nSigfredo B. Mata*, Hadiyya Mary Glenn A. \n\n\n\nParaiso, Alicia P. Catabay \n \n\n\n\nDr. Mariano Que College of Pharmacy, De La Salle Medical and Health \n\n\n\nSciences Institute, Cavite, Philippines \n\n\n\n* Corresponding author \n\n\n\nEmail: sbmata@dlshsi.edu.ph \n\n\n\n\n\n\n\nBackground and Objectives: Herb-drug interaction is a \n\n\n\nsafety concern in using herbal medicines and plant-based \n\n\n\ndietary supplements. Cytochrome P450 enzymes (CYP) \n\n\n\nconstitute the major enzyme family known for oxidative \n\n\n\nbiotransformation of most drugs and other lipophilic \n\n\n\nsubstrates. CYP inhibition can result in high levels of \n\n\n\nunmetabolized drug molecule possibly eliciting toxic effects. \n\n\n\nThis study aimed to determine the inhibition of CYP1A2, \n\n\n\nCYP2D6, and CYP3A4 by the ten Philippine herbal \n\n\n\nmedicines approved by Philippine Department of Health \n\n\n\n(DOH). Methods: CYP inhibition in pooled human liver \n\n\n\nmicrosomes was determined using a spectrofluorometric \n\n\n\ntechnique that involved isoform-specific substrates: 7-\n\n\n\nmethoxyresorufin (7-MR), 7-benzyloxy-4-\n\n\n\ntrifluoromethylcoumarin (BFC), and 7-benzyloxyquinoline \n\n\n\n(BQ) monitoring the activity of CYP1A2, CYP2D6, and \n\n\n\nCYP3A4, respectively. The substrates at Km were incubated \n\n\n\nwith microsomes, phosphate buffer (pH 7.4), and NADPH \n\n\n\nwith or without methanolic extracts of each plant. \n\n\n\nMicrosome-substrate mixtures were pre-incubated before \n\n\n\n\nmailto:gaiktheng.toh@taylors.edu.my\n\n\nmailto:sbmata@dlshsi.edu.ph\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n94 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nadding NADPH, which initiated CYP activity. After \n\n\n\nincubation, microsomal protein was separated from \n\n\n\nsupernatant. Fluorescence intensity of supernatant at \n\n\n\nfluorophore-specific emission and excitation wavelengths \n\n\n\nshowed O-demethylation by CYP1A2 and O-dealkylation by \n\n\n\nCYP2D6 and CYP3A4. Percentage mean inhibition values \n\n\n\nwere determined based on fluorescence intensity of \n\n\n\nuninhibited substrates. Extracts showing at least 50% \n\n\n\ninhibition at Km were considered as having inhibitory effect \n\n\n\non enzymes. Results and Discussion: Ehretia microphylla, \n\n\n\nQuisqualis indica, Blumea balsamifera, and Cassia alata \n\n\n\nexhibited high CYP1A2 inhibition values: 82.98%, 64.81%, \n\n\n\n63.75%, and 60.58%, respectively, at 50 \u00b5g\u00b7mL-1. Only Q. \n\n\n\nindica showed more than 50% inhibition at 25 \u00b5g\u00b7mL-1. \n\n\n\nCYP2D6 and CYP3A4 inhibitions were not observed even at \n\n\n\nthe highest extract concentration (72 \u00b5g\u00b7mL-1). Nonetheless, \n\n\n\nAllium sativum at 14.6 \u00b5g\u00b7mL-1 showed mean CYP3A4 \n\n\n\ninhibition above 50%. Conclusion: CYP1A2, CYP2D6, and \n\n\n\nCYP3A4 have broad substrate specificity and clinical \n\n\n\nrelevance. Due to possible CYP inhibitory action of some \n\n\n\nPhilippine medicinal plants, their concomitant use with \n\n\n\ncertain drugs should be considered with caution. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 058 \n \n\n\n\nNeuroprotective Effects of Palm Oil \n\n\n\nDerived Tocotrienol-Rich Fraction in \n\n\n\nAluminium Chloride Induced Vascular \n\n\n\nDementia Rats \n\n\n\n\n\n\n\nShaikh Sohrab A., Muthuraman \n\n\n\nArunachalam*, Rajavel Varatharajan \n \n\n\n\nPharmacology Unit, Faculty of Pharmacy, AIMST University, Semeling, \n\n\n\n08100 Bedong, Kedah, Malaysia. \n\n\n\n* Corresponding author \n\n\n\nEmail: shaikh.sohrab@aimst.edu.my \n\n\n\n\n\n\n\nBackground and Objectives: Vascular dementia (VaD) is a \n\n\n\ncommon type of dementia and can be caused by aluminium \n\n\n\nexposure. Available medicines for the management of VaD \n\n\n\nare limited. Palm oil derived tocotrienol rich fraction (TRF) \n\n\n\nis known to produce neuroprotective actions in neurological \n\n\n\nconditions, however, its effect on VaD is not explored. Hence, \n\n\n\nthe objective was to evaluate the neuroprotective effects of \n\n\n\nTRF in aluminum chloride (AlCl3) induced VaD rats. \n\n\n\nMethods: AlCl3 (150 mg/kg; i.p.) was administered daily for \n\n\n\n7 days to rats for inducing VaD and later rats were treated \n\n\n\nwith TRF 30, 60, and 120 mg/kg; p.o. for 21 days. VaD \n\n\n\ninduced memory loss was assessed by Morris water maze test. \n\n\n\nBiochemical markers like plasma homocysteine, brain \n\n\n\nacetylcholinesterase (AChE) activity, reduced glutathione \n\n\n\n(GSH), and superoxide dismutase (SOD) levels were \n\n\n\nestimated. Brain coronal sections were stained with \n\n\n\nhematoxylin and eosin for histopathological analysis. \n\n\n\nResults and Discussion: VaD in AlCl3 treated rats was \n\n\n\nconfirmed by significant increase in the plasma \n\n\n\nhomocysteine levels (9.61 \u00b1 1.00 umol/L) and brain AChE \n\n\n\nactivity (6.16 \u00b1 0.24 umol/min/gm of tissue), decrease in \n\n\n\nGSH (4.67 \u00b1 0.29 uM/mg of protein), and SOD (4.78 \u00b1 0.86 \n\n\n\nU/mg of protein) levels as compared to normal rats. However, \n\n\n\ntreatment with TRF 60 in VaD rats significantly decreased \n\n\n\nthe levels of plasma homocysteine (5.50 \u00b1 0.37 umol/L) and \n\n\n\nbrain AChE activity (3.81 \u00b1 0.19 umol/min/gm of tissue), \n\n\n\nincreased GSH (7.15 \u00b1 0.48 uM/mg of protein), and SOD \n\n\n\n(8.87 \u00b1 0.68 U/mg of protein) levels as compared to AlCl3 \n\n\n\ntreated rats. Furthermore, neurodegeneration and memory \n\n\n\nloss were also significantly protected by TRF. Moreover, \n\n\n\nTRF 60 and 120 effects were found to be equipotent. \n\n\n\nConclusion: This study exhibits the neuroprotective role of \n\n\n\nTRF in VaD rats and hence provides new knowledge to \n\n\n\nunderstand TRF effectiveness in the management of VaD. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 059 \n\n\n\n \nPharmacokinetics of Loratadine after \n\n\n\nIntranasal Application of Its Gel \n\n\n\nFormulation \n\n\n\n\n\n\n\nSophia S. Pagaran1*, Bea May I. Remedio1, \n\n\n\nGerard Lee L. See2 \n \n1Department of Pharmacy, School of Health Care Professions, University \n\n\n\nof San Carlos, Cebu, the Philippines \n2Pharmaceutical Research and Drug Development Laboratories, \n\n\n\nDepartment of Pharmacy, School of Health Care Professions, University of \n\n\n\nSan Carlos, Cebu, the Philippines \n\n\n\n* Corresponding author \n\n\n\nEmail: 17100131@usc.edu.ph \n\n\n\n\n\n\n\nBackground and Objectives: Loratadine is a second-\n\n\n\ngeneration antihistamine administered orally to treat allergic \n\n\n\nrhinitis and urticaria. However, its oral administration can \n\n\n\ncause several side effects such as headache, dizziness, fatigue, \n\n\n\nand nausea. To address these issues, intranasal drug delivery \n\n\n\nis considered due to avoidance of the first-pass effect and \n\n\n\nimproved bioavailability. In situ nasal gel formulation, in \n\n\n\nparticular, is advantageous due to its sustained and controlled \n\n\n\nrelease of drugs. Methods: In this study, an in situ gel \n\n\n\nformulation was evaluated for its pharmacokinetic \n\n\n\nparameters through an in vivo experiment in rabbits and was \n\n\n\ncompared with that of loratadine administered as intravenous \n\n\n\nand intranasal solutions. Results and Discussion: The in situ \n\n\n\ngel exhibited the highest mean residence time when \n\n\n\ncompared with intravenous and intranasal solution which \n\n\n\nindicates the accumulation of loratadine in a specific tissue \n\n\n\nfor a longer period of time and exhibits its therapeutic \n\n\n\nefficacy. The pH of the formulation was within the \n\n\n\nphysiological range (pH = 6.60 \u00b1 0.13). Drug plasma \n\n\n\n\nmailto:shaikh.sohrab@aimst.edu.my\n\n\nmailto:17100131@usc.edu.ph\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n95 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nconcentration significantly increased 6 to 8 hours after \n\n\n\nadministration of gel (p < 0.05). The fraction of dose \n\n\n\nabsorbed for the in situ nasal gel (F = 0.83) was 2.3-fold \n\n\n\nhigher than that of the intranasal solution (F = 0.36). \n\n\n\nConclusion: Based on the results, the rise in drug plasma \n\n\n\nconcentration from the in situ gel formulation appeared to be \n\n\n\nslower and more gradual compared to the intravenous and \n\n\n\nintranasal solutions. The incorporation of loratadine into in \n\n\n\nsitu nasal gels may be beneficial for patients suffering from \n\n\n\ndiseases affecting the nasal mucosa, such as allergic rhinitis, \n\n\n\ndue to its improved bioavailability, convenient dosing, and \n\n\n\neasy administration. \n\n\n\n\n\n\n\n\n\n\n\n Abstract 060 \n \n\n\n\nAnomalous Dissolution Enhancement of \n\n\n\nAged Supersaturated Electrospun Solid \n\n\n\nDispersion System \n\n\n\n\n\n\n\nXin Yi Teoh, Siok Yee Chan* \n \n\n\n\nThoughts Formulation Laboratory, Discipline of Pharmaceutical \n\n\n\nTechnology, School of Pharmaceutical Sciences, Universiti Sains \n\n\n\nMalaysia, 11800 Penang, Malaysia \n\n\n\n* Corresponding author \n\n\n\nEmail: sychan@usm.my  \n\n\n\n\n\n\n\nBackground and Objectives: Supersaturation was \n\n\n\nintroduced as part of the strategy for improving the \n\n\n\ndissolution profile of the amorphous solid dispersion (ASD) \n\n\n\nsystem. However, supersaturation stability over time remains \n\n\n\nthe main hurdle for a sustainable dissolution enhancement. \n\n\n\nWorse still, physical stability, particularly ageing and \n\n\n\nrecrystallisation persist as the challenges which restrict the \n\n\n\ndevelopment of ASD. Therefore, this study aims to \n\n\n\ninvestigate the effect of storage conditions on the physical \n\n\n\nstability of the supersaturated electrospun system, \n\n\n\nparticularly the sustainability of dissolution enhancement and \n\n\n\ninhibition of solution-mediated recrystallisation. Methods: \n\n\n\nElectrospun samples were stored in two distinctive \n\n\n\nconditions, i.e., 75% RH, 40\u00b0C and 0% RH, 25\u00b0C for 3 \n\n\n\nmonths and 12 months respectively. Physical characteristics \n\n\n\nof aged electrospun samples were tested with polarised light \n\n\n\nmicroscopy, Differential Scanning Calorimetry and \n\n\n\nAttenuated Total Reflectance-Fourier Transform Infrared. \n\n\n\nDrug content assay was conducted to identify drug stability \n\n\n\nafter storage. Dissolution studies were carried out in a non-\n\n\n\nsink condition to assess the release stability across \n\n\n\nrecrystallisation tendency. Results and Discussion: In the \n\n\n\nhighly humid and relatively high temperature condition, the \n\n\n\naged electrospun sample has recrystallised and lost the \n\n\n\nadvantage of an ASD system in achieving supersaturation, \n\n\n\nresembling the dissolution profile of its crystalline \n\n\n\ncounterpart. In contrast, electrospun sample stored in dry and \n\n\n\ntemperate conditions has remained sample amorphicity and \n\n\n\nunexpectedly showed inhibition towards solution-mediated \n\n\n\nrecrystallisation, hence sustaining the dissolution \n\n\n\nenhancement. Such positive transformation in the aged \n\n\n\nelectrospun sample could be due to the achievement of an \n\n\n\nequilibrium glassy state by structural relaxation during the \n\n\n\nageing process. Conclusion: Structural relaxation was \n\n\n\nproposed to exert a stabilising effect on ASD which inhibit \n\n\n\nsolution-mediated recrystallisation. The presented result \n\n\n\nsuggested ageing improves the sustainability of dissolution \n\n\n\nenhancement in the ASD system which was not previously \n\n\n\nstabilised through a formulation design.  \n\n\n\n\n\n\n\n\n\n\n\nAbstract 061 \n \n\n\n\nPhytochemical Investigation and \n\n\n\nAntioxidant Activity Determination using \n\n\n\nORAC Assay of the Dried Bark and Fresh \n\n\n\nLeaves of Pterocarpus indicus Willd. (Fam. \n\n\n\nFabaceae) \n\n\n\n\n\n\n\nBengala, TJL*, Mata, SB, Catabay, AP \n \n\n\n\nDr. Mariano Que College of Pharmacy, De La Salle Medical and Health \n\n\n\nSciences Institute, Dasmari\u00f1as City, Philippines \n\n\n\n* Corresponding author  \n\n\n\nEmail: tlbengala@dlshsi.edu.ph  \n\n\n\n\n\n\n\nBackground and Objectives: The study aimed to look at the \n\n\n\neffects of different drying and processing protocols (DPPs) \n\n\n\non selected parameters: IR peaks, Moisture Content (MC), \n\n\n\nTotal Extractives (TE), Phytochemical Tests (PCS), and \n\n\n\nORAC Score. The different DPPs can cause post-harvest \n\n\n\nmodifications resulting to changes in the kind and amount of \n\n\n\nphytochemicals in each sample. Methods: The samples were \n\n\n\nmacerated in ethanol and the extract was vacuum evaporated. \n\n\n\nThe extracts were then used for phytochemical screening and \n\n\n\nFTIR analysis. The collected peaks were binned and were \n\n\n\nanalyzed with Hierarchical Clustering and Principal \n\n\n\nComponent Analysis using R. Results and Discussion: The \n\n\n\nPCS revealed that the DPPs with significant air-drying time \n\n\n\n(DPPs 1 and 2) tested positive for polyphenols and flavonoids. \n\n\n\nThe combination of air- and oven-drying (DPP 2) may have \n\n\n\nled to some metabolite decomposition as evidence by a \n\n\n\ndecrease in TE. Oven-drying only (DPP 4) resulted in a lower \n\n\n\ndegree of variety in the metabolites present. The absence of \n\n\n\nany form of drying (DPP 3) resulted in a product that did not \n\n\n\nhave any of the desired metabolites. The PCA and HCA \n\n\n\nanalysis have revealed that clustering was observed on \n\n\n\nproducts from DPPs 3, 6, and 7 (air-drying only); DPPs 1, 2 \n\n\n\nand 5 (both air- and oven drying); lastly DPP 4 (oven-drying \n\n\n\nonly). The ORAC score of DPPs 2,4, and 5 (all belonging to \n\n\n\ndifferent clusters) were not significantly different to one \n\n\n\nanother; the highest score was reported on DPP 5 (H-ORAC \n\n\n\n= 24627.7). Conclusion: There may be an optimum \n\n\n\ncombination of air- and oven-drying that will ensure the \n\n\n\n\nmailto:sychan@usm.my\n\n\nmailto:tlbengala@dlshsi.edu.ph\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n96 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nhighest amount and activity of antioxidant compounds for the \n\n\n\nprocessed Narra bark. The methods used in this study may be \n\n\n\nused for the quality control of dietary supplements and herbal \n\n\n\nmedicines. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 062 \n\n\n\n\n\n\n\nPharmacist\u2019s Preferences, Evaluation and \n\n\n\nPerceptions of Telepharmacy Application \n\n\n\nServices: A Pilot Study  \n\n\n\n\n\n\n\nAdelin Suraya Mokhtar1*, Ezlina Usir1, \n\n\n\nMunaver Ahmad Nazir Ahmad2 \n \n1 Department of Clinical Pharmacy, Faculty of Pharmacy, Universiti \n\n\n\nTeknologi MARA Cawangan Selangor, 42300 Bandar Puncak Alam, \n\n\n\nSelangor, Malaysia. \n2 Rhazes Telehealth, Rhazes Consultancy Services Sdn Bhd, Nucleus Tower,  \n\n\n\nMutiara Damansara, 47800 Subang Jaya, Selangor, Malaysia \n\n\n\n* Corresponding author \n\n\n\nEmail: adelinsuraya29@gmail.com  \n\n\n\n\n\n\n\nBackground and Objectives: Information on the evaluation \n\n\n\nand opinions of telepharmacy application systems among \n\n\n\npharmacists is needed to facilitate the adoption of \n\n\n\ntelepharmacy services. The purpose of this study were to \n\n\n\ndetermine the i) preferences, evaluation, and perceptions of \n\n\n\npharmacist towards the telepharmacy systems and ii) \n\n\n\nrelationship between the demographic background and their \n\n\n\npreferences on telepharmacy application system services. \n\n\n\nMethods: Self-administration survey was conducted via an \n\n\n\nonline and face-to-face survey from April to May 2022. The \n\n\n\ntarget population was community pharmacists who work in \n\n\n\ncommunity pharmacies in Klang Valley. An invitation link \n\n\n\nwas sent via Gmail and Whatsapp platform to a list of \n\n\n\ncommunity pharmacies. Data collected were analysed using \n\n\n\ndescriptive statistics, Kruskal-Wallis and Mann-Whitney U \n\n\n\ntest. Results and Discussion: A total of 24 respondents met \n\n\n\nthe inclusion criteria, with 14 (58.3%) had 1-5 years of \n\n\n\nworking as a pharmacist, and two-third (66.6%) showed \n\n\n\ninterest in using telepharmacy. Aspects to consider in using \n\n\n\ntelepharmacy are ease of use and the ability to use \n\n\n\ntelepharmacy application and conduct consultation from the \n\n\n\nsmartphone. The pharmacists disagree to the statement \u2018I \n\n\n\nfound no difference between how I conducted face-to-face \n\n\n\nconsultation and how I provided consultation via \n\n\n\ntelepharmacy\u2019. Conclusion: Despite the growing recognition \n\n\n\nof telepharmacy, its implementation and utilization of \n\n\n\ntelepharmacy by pharmacists in Klang Valley is still quite \n\n\n\nlow. Nevertheless, our study provides a current view of the \n\n\n\ntelepharmacy setting, which will aid future development and \n\n\n\napplication of telepharmacy by pharmacists, professional \n\n\n\norganizations, and government officials. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 063 \n\n\n\n\n\n\n\nRole of Pharmacist during the COVID-19 \n\n\n\nPandemic in Taiwan: A Scoping Review  \n\n\n\n\n\n\n\nBen Chen* \n \n\n\n\nThe Federation of Taiwan Pharmacists Associations \n\n\n\n* Corresponding author \n\n\n\nEmail: ben.chenshunjen@gmail.com  \n\n\n\n\n\n\n\nBackground and Objectives: Since the start of the \n\n\n\nnew Coronavirus (COVID-19) outbreak in December 2019, \n\n\n\npharmacists in Taiwan are playing a key role adopting \n\n\n\ninnovative strategies to minimize the adverse impact of the \n\n\n\npandemic. It is the objective to identify and describe core \n\n\n\nservices provided by the pharmacist in Taiwan during the \n\n\n\nCOVID-19 pandemic. Methods: A literature search was \n\n\n\nperformed in Google Scholar for studies published between \n\n\n\nDecember 1st, 2019 and August 20th, 2022 in English.  \n\n\n\nStudies that reported services provided by pharmacists \n\n\n\nduring the COVID-19 pandemic in Taiwan were included. \n\n\n\nResults and Discussion: A total of 3980 records were \n\n\n\nidentified, of which 16 studies fully met the eligibility criteria. \n\n\n\nMost of them were conducted in Taiwan. The most common \n\n\n\ntype of publication were literatures describing the workplace \n\n\n\nof the pharmacist in community and hospitals. These findings \n\n\n\nshowed the different roles of pharmacists during the COVID-\n\n\n\n19 pandemic, such as disease prevention and infection \n\n\n\ncontrol, adequate storage and drug supply, patient care and \n\n\n\nsupport for healthcare professionals. Pharmacists' \n\n\n\ninterventions were mostly conducted for healthcare \n\n\n\nprofessionals and patients, through one-to-one contact, \n\n\n\ntelephone or video conference. The pharmacists' main \n\n\n\nresponsibility was to provide drug information for healthcare \n\n\n\nprofessionals as well as patient counselling. Yet, pharmacists \n\n\n\ndeliver medicine to patients at home under quarantine. \n\n\n\nConclusion: A reasonable number of studies that described \n\n\n\nthe role of the pharmacists during the COVID-19 pandemic \n\n\n\nwere found. All studies reported actions taken by pharmacists, \n\n\n\nalthough without providing a satisfactory description. Thus, \n\n\n\nfuture research with more detailed description as well as an \n\n\n\nevaluation of the impact of pharmacist intervention is needed \n\n\n\nin order to guide future actions in this and/or other pandemic. \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:adelinsuraya29@gmail.com\n\n\nmailto:ben.chenshunjen@gmail.com\n\n\nhttps://www.sciencedirect.com/topics/pharmacology-toxicology-and-pharmaceutical-science/coronavirinae\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n97 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 064 \n\n\n\n\n\n\n\nEvaluation of the Efficacy of Valproic Acid \n\n\n\nused in Residents of A Long-term Care \n\n\n\nInstitution \n\n\n\n\n\n\n\nYC Chen1,2*, JY Huang1,2, CY Wu1,2, KP \n\n\n\nChen1,2, ZA Peng1,2  \n \n\n\n\n1 Chih-Ta Community Pharmacy, Taiwan \n2 New Taipei City Pharmacists Association, Taiwan \n\n\n\n* Corresponding author \n\n\n\nEmail: chenyichi2005@gmail.com  \n\n\n\n \nBackground and Objectives: Drug use evaluation is rarely \n\n\n\npracticed in long-term care (LTC) institutions in Taiwan. Our \n\n\n\nstudy looked at the efficacy of valproic acid by analysing \n\n\n\nprescriptions, test values and clinical effects, and assessment \n\n\n\nof the rationale of the medicines in LTC institutions to ensure \n\n\n\npatient safety. Methods: This was a retrospective study of \n\n\n\nresidents, diagnosed with epilepsy and taking valproic acid \n\n\n\nin a private LTC institution in New Taipei City from January \n\n\n\n1, 2017, to July 31, 2020, by regular tracking drug \n\n\n\nconcentration, drug interaction, liver damage index, platelet \n\n\n\nvalues, and clinical effects. Results and Discussion: We \n\n\n\ncollected 56 medicine concentration data from total 19 \n\n\n\nresidents, 31 cases were between the normal value of the \n\n\n\nvalproic acid concentration, 23 cases were lower than the \n\n\n\ntreatment range, 2 cases were higher than the treatment range, \n\n\n\nthe symptoms of most residents were well control. We \n\n\n\nobserved that residents\u2019 plasma concentration and the clinical \n\n\n\nefficacy of epilepsy treatment did not have an absolute \n\n\n\nrelation, which was roughly the same as the results in \n\n\n\npublished research literature. There were 4 pharmacy \n\n\n\nrecommendations for dose adjustment of valproic acid, 1 for \n\n\n\ndrug interaction, 1 for adverse reaction that occurs after \n\n\n\ntaking the medicine, 2 for excessive dosage, 3 were for \n\n\n\nabnormal liver damage indicators, and 5 cases were platelet \n\n\n\nabnormalities. There were limited indicators that could be \n\n\n\ntracked regularly in the LTC institution, so the observed \n\n\n\nincrease in liver injury indicators was not significantly \n\n\n\nassociated with oral valproic acid. Conclusion: Most LTC \n\n\n\ninstitutions had limited resources in Taiwan, so we must \n\n\n\ncooperate and re-educate all staffs in LTC to assess the \n\n\n\neffectiveness of treatment correctly to improve the safety of \n\n\n\nmedication for residents. \n\n\n\n\n\n\n\nAbstract 065 \n\n\n\n\n\n\n\nPatients\u2019 Perspective on Community \n\n\n\nPharmacy Services of a Ward (10) of \n\n\n\nKathmandu Metropolitan  \n\n\n\n\n\n\n\nDurga Bista*, Ankita Ojha, Badri K.C \n\n\n\n\n\n\n\nDepartment of Pharmacy, Kathmandu University, Dhulikhel, Nepal \n\n\n\n* Corresponding author \n\n\n\nEmail: durga.bista@ku.edu.np  \n\n\n\n\n\n\n\nBackground and Objectives: The patient-centered role of \n\n\n\npharmacists is undervalued as  the public are not aware about \n\n\n\nthe roles of pharmacists. This research aimed to identify \n\n\n\npatients\u2019 perception and satisfaction towards pharmaceutical \n\n\n\ncare service and factors affecting their preferences for \n\n\n\ncommunity pharmacy. Methods: A cross\u2010sectional and mix \n\n\n\nmethod study. Quantitative study was done using a validated \n\n\n\nquestionnaire and Q methodology study was done using a \n\n\n\nnormal distribution grid and Q statements which is \n\n\n\nconsidered as both quantitative and qualitative study. Q \n\n\n\nmethodology was used to collect the perception towards \n\n\n\ncommunity pharmacists through the Q method software. \n\n\n\nResults and Discussion: Out of 406 participants, 30.5% \n\n\n\nrespondents perceived balance between business and health \n\n\n\naspects of pharmacy practices, some as drug experts while \n\n\n\nothers viewed pharmacists as being more concerned with \n\n\n\nbusiness. In addition, 43.8% of the participants were found to \n\n\n\ndiscuss their drug related queries with pharmacists, may be \n\n\n\ndue to the low cost of treatment. More than 70% of the \n\n\n\nrespondents had no hesitancy when contacting pharmacists \n\n\n\nfor health-related information regarding mild illnesses \n\n\n\nbecause they believed that pharmacists are sufficiently \n\n\n\nqualified to address drug-related questions. A high level of \n\n\n\nsupport (88.1%) was for the role of pharmacists to counsel \n\n\n\nthe patient about the directions for use of medications. Level \n\n\n\nof satisfaction indicated that 72.4% were satisfied and highly \n\n\n\nsatisfied with the service. They were also confident about \n\n\n\npharmacists' ability to protect the privacy of their medical \n\n\n\nrecords and felt at ease to discuss their health with them. Out \n\n\n\nof 52 participants in Q methodology, a majority perceived \n\n\n\npharmacists were competent to advise on good quality drug \n\n\n\nusage and monitor their health, providing sufficient \n\n\n\ncounselling time. Conclusion: Pharmacists were regarded as \n\n\n\nthe most trusted personnel to contact. However, in order to \n\n\n\nfacilitate the expansion of pharmaceutical care services, the \n\n\n\npublic should be made aware about their distinctive \n\n\n\nprofessional talents. \n\n\n\n\nmailto:chenyichi2005@gmail.com\n\n\nmailto:durga.bista@ku.edu.np\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n98 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 066 \n\n\n\n\n\n\n\nPeace, Love and Care of Medicine on Radio \n\n\n\nBroadcasts \n\n\n\n\n\n\n\nYP Hsiang1,2*, CL Tai 1, CF Chiang1, MT \n\n\n\nCheng1, FS Hong1, LC Liu1  \n \n1 Kaohsiung First Pharmacists Association, Taiwan, R.O.C. \n2 Department of Pharmacy, E-DA Hospital, Taiwan, R.O.C. \n\n\n\n* Corresponding author \n\n\n\nEmail: ed108228@edah.org.tw  \n \n\n\n\nBackground and Objectives: Kaohsiung First Pharmacists \n\n\n\nAssociation (KFPA) cooperated with the Taiwan Drug Relief \n\n\n\nFoundation to promote peace, love and care of medicine on \n\n\n\nKaohsiung Broadcasting Station. People can learn more \n\n\n\nabout healthy information through radio broadcasts, and \n\n\n\nenjoy better medication environment under COVID-\n\n\n\npandemic. Methods: From January to December 2021, a \n\n\n\ntotal 30-minute topic was conducted on the first Thursday of \n\n\n\neach month. KFPA planned health themes and provided \n\n\n\naudiences with accurate medical information and health care \n\n\n\nknowledge. Results and Discussion: In 2021, the KFPA \n\n\n\nhold a total of 7 broadcasts on Kaohsiung Broadcasting \n\n\n\nStation. The topics were women disease, drug side effect, \n\n\n\nophthalmology, depression, hyperglycemia, and antibiotic \n\n\n\nmanagement. These sharing were specially selected by the \n\n\n\nKFPA for community pharmacists and hospital pharmacists. \n\n\n\nRadio programs can use the official website of the TDRF and \n\n\n\nFacebook page of \"Smart Drugs and Healthy Eating\" to \n\n\n\nrelease the program preview information before the \n\n\n\nbroadcast, and provided the link to audience. Such radio \n\n\n\nprograms can be listened at anywhere, regardless of location \n\n\n\nand space. It\u2019s a very worth promotion during the COVID-19 \n\n\n\npandemic. Conclusion: The broadcast and network \n\n\n\ntransmission speed are too fast, and the audience has no field \n\n\n\nand movement restrictions. In the COVID-pandemic \n\n\n\nprevention policy, broadcasting activities is an excellent \n\n\n\nmethod to promote community health education. KFPA had \n\n\n\nlong cooperated with national and local health authorities, \n\n\n\nthrough the monthly radio program \"Peace, Love and Care of \n\n\n\nMedicine\", it can increase the public's correct concept of drug \n\n\n\nuse, and also enhance the professional image of pharmacists \n\n\n\nregardless of the pandemic.  \n\n\n\n\n\n\n\nAbstract 067 \n\n\n\n\n\n\n\nEffectiveness of Individualized Health \n\n\n\nEducation Provided by Volunteer \n\n\n\nPharmacists on Tier C Local Stations \n\n\n\n\n\n\n\nYN Hsieh1, 2*, CM Hsiao1, CS Chen1, ML \n\n\n\nChen1, SL Lee1, CP Hsu1 \n\n\n\n \n1 Taichung City Pharmacists Association, Taichung, Taiwan, ROC  \n2 Department of Pharmacy, Hong En Hospital, Taichung, Taiwan, ROC \n\n\n\n* Corresponding author \n\n\n\nEmail: pu068704@hotmail.com  \n\n\n\n\n\n\n\nBackground and Objectives: In Taiwan, pharmacists have \n\n\n\nbecome increasingly involved in community practice and \n\n\n\nlong-term care institutions. This study combines \n\n\n\nthe Taichung City Office of Food and Drug Safety with the \n\n\n\npower of the community by instructing volunteer \n\n\n\npharmacists from the Taichung City Pharmacists \n\n\n\nAssociation to provide a wide range of pharmaceutical care \n\n\n\nservices and improve medication use among the community \n\n\n\npopulation with support from the health resources of tier C \n\n\n\nlocal service stations. Methods: Participants aged 45 years \n\n\n\nor older were recruited in this cross-sectional study from tier \n\n\n\nC local service stations in Taichung City, during September \n\n\n\n2019 to November 2019. A single group pretest and posttest \n\n\n\ntrial was conducted. Repeated attendees of activities \n\n\n\norganized by four tier C local service stations were eligible. \n\n\n\nThe short-term effectiveness of educational medication \n\n\n\nsafety lectures on health promotion in the tier C long-term \n\n\n\ncare stations was assessed. Results and Discussion: The \n\n\n\nvolunteer pharmacists conducted 12 medication safety and \n\n\n\nhealth promotion events at four tier C local service stations \n\n\n\nin Taichung City. A total of 190 questionnaires were \n\n\n\ndistributed to assess the efficacy of the program. All single \n\n\n\nitems exhibited significant improvements 3 months after the \n\n\n\neducational medication safety lectures. We also designed a \n\n\n\ngamified intervention, namely \u201cA Healthy Monopoly,\u201d that \n\n\n\naimed to motivate participants to increase their medication \n\n\n\nknowledge through the game. Conclusions: These results \n\n\n\ndemonstrated that volunteer pharmacists can play a valuable \n\n\n\nrole in community health care and that pharmaceutical care \n\n\n\ninterventions can improve the safety of the environment in \n\n\n\nTaiwan. \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:ed108228@edah.org.tw\n\n\nmailto:pu068704@hotmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n99 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 068 \n\n\n\n\n\n\n\nExploring the Role of Pharmacy as A \n\n\n\nCommunity Drug Addiction Counselling \n\n\n\nCentre \n\n\n\n\n\n\n\nJungkeun Lee*, Seungwan Moon, Jungwha \n\n\n\nYoon \n \nGyeonggi Branch, Korean Association Against Drug Abuse, Suwon, Korea \n\n\n\n* Corresponding author \n\n\n\nEmail: fourkidspapa@hotmail.com  \n\n\n\n\n\n\n\nBackground and Objectives: Pharmacy is a valuable local \n\n\n\nresource that provides not only medication counseling in the \n\n\n\nusual sense, but also counseling on narcotics and drug \n\n\n\naddiction. The present study was conducted to explore the \n\n\n\nrole of pharmacy as a community drug addiction counselling \n\n\n\ncentre. Methods: As a member of Gyeonggi Pharmaceutical \n\n\n\nAssociation, 46 \u2018Magmi Pharmacies\u2019 were selected to \n\n\n\nparticipate in the pilot project centering on pharmacies that \n\n\n\nshare the common awareness on safe and correct use of legal \n\n\n\nnarcotic drugs. The Project was carried out for two months \n\n\n\nfrom Oct .2021, and an 8-item questionnaire was used to \n\n\n\nsurvey the local residents who received the service.  Results \n\n\n\nand Discussion: We distributed promotional materials and \n\n\n\nbrochures on drug abuse and addiction to more than 10,000 \n\n\n\nlocal residents. We also performed detailed information \n\n\n\nprovision and counseling service on a total of 325 \n\n\n\nmedications. Psychotropic drugs accounted for most of the \n\n\n\ndrug counselling with 262 cases, as well as 2 narcotics and \n\n\n\n26 non-narcotic prescription drugs and 35 over-the-counter \n\n\n\ndrugs. When local residents were surveyed, the need for \n\n\n\nMagmi Pharmacy service and satisfaction with the \n\n\n\ncounseling service were high regardless of gender, age, and \n\n\n\noccupation. The overall service was satisfactory, such as the \n\n\n\nexpertise of the information obtained, and the reinforcement \n\n\n\nof the motivation to change through the service. Conclusion: \n\n\n\nIn order for pharmacies to function as community drug \n\n\n\ncounselling centres, pharmacists must not only remain as \n\n\n\nexperts in drugs, but also develop competence as \u2018counsellors\u2019 \n\n\n\nso that they can intervene in psychological and behavioral \n\n\n\ntherapy as well as drug counselling. The Magmi Pharmacy \n\n\n\nproject demonstrated that pharmacies have considerable \n\n\n\npotential and roles as local drug addiction counselling centres \n\n\n\nthat can reinforce the correct use of drugs and prevention of \n\n\n\ndrug misuse, ultimately contributing to public health \n\n\n\npromotion through an integrated drug counselling process. \n\n\n\n\n\n\n\nAbstract 069 \n\n\n\n\n\n\n\nEstablishment of the Betel Nut-free \n\n\n\nEnvironment by Community Pharmacists: \n\n\n\nA Pilot Study in Taiwan \n\n\n\n\n\n\n\nI-Hsuan Lee1,2*, Yu-Chieh Cheng2, Tzu-Chun \n\n\n\n(Frank) Chou2, Hung-Chang (Ivan) Chou1,2,3* \n\n\n\n\n\n\n\n1 Federation of Taiwan Pharmacists Associations, Taiwan \n2 Taiwan Young Pharmacist Group, Taiwan \n3 Department of Pharmacy and Master Program, Tajen University, Taiwan \n\n\n\n* Corresponding author \n\n\n\nEmail: heyman1799@gmail.com  \n\n\n\n\n\n\n\nBackground and Objectives: Regarding the hazards of \n\n\n\nbetel nut, the International Agency for Research on Cancer \n\n\n\nconcluded from various research outcomes that \"chewing \n\n\n\nbetel nut containing tobacco\" or \"simultaneous smoking and \n\n\n\nchewing betel nut\" are harmful to humans. From the latest \n\n\n\ncancer registration data and cause of death statistics, over \n\n\n\n8,000 new cases of oral cancer are diagnosed each year, and \n\n\n\n3,300 people passed away from oral cancer, one of the \n\n\n\nleading cancers in Taiwanese male. To reduce the prevalence \n\n\n\nrate of betel nut chewing, the establishment of a base to \n\n\n\ncontrol and eliminate betel nuts at community pharmacy is \n\n\n\nvital. Methods: This study was performed from September \n\n\n\n1st in 2021 to July 31st in 2022 in Taiwan. The lectures on \n\n\n\nbetel nuts and cancer prevention were held in Eastern Taiwan \n\n\n\nfor pharmacists to update their clinical regulation and \n\n\n\nknowledge. Surveys were conducted pre- and post-course. \n\n\n\nThe pharmacists provided consultation and education to \n\n\n\npotential patients and held numerous events on health \n\n\n\neducation in the community to improve the public health \n\n\n\nliteracy. Results and Discussion: The average accurate rate \n\n\n\nof examination for pharmacist professional education \n\n\n\nincreases from 83.3 \u00b1 20.6% to 90.5 \u00b1 14.9% (n = 83, p < \n\n\n\n0.01). After the courses, pharmacists in 15 community \n\n\n\npharmacies participated in the consultation and education to \n\n\n\nthe public. The consultations were raised by patients (n = 42, \n\n\n\n60.9%) or their families (n = 27, 39.1%). The majority of \n\n\n\npatients were elderly, male and blue-collar workers. The \n\n\n\nreduction in betel nuts chewing was observed, and the \n\n\n\npercentage of complete abstinence from betel nuts was 28.1% \n\n\n\n(n = 9). Conclusion: With this pilot study, the community \n\n\n\npharmacy as a base for the prevention and control of betel \n\n\n\nnuts was successfully established, and this project would be \n\n\n\nfurther extended in Taiwan. \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:fourkidspapa@hotmail.com\n\n\nmailto:heyman1799@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n100 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 070 \n\n\n\n\n\n\n\nDirect Selling of Nootropic Drugs in An E-\n\n\n\ncommerce Platform in the Philippines \n\n\n\n\n\n\n\nGwyne Kylie P. Gumapac1, Jonas L. \n\n\n\nMiranda1*, Beryll N. Nacar1, Sigfredo B. \n\n\n\nMata2* \n \n\n\n\nDr. Mariano Que College of Pharmacy, De La Salle Medical and Health \n\n\n\nSciences Institute, Cavite, Philippines \n\n\n\n* Corresponding author \n\n\n\nEmail: miranda.jonaslegaspi@gmail.com  \n \n\n\n\nBackground and Objectives: Availability of prescription \n\n\n\nand controlled substances, including nootropics, in e-\n\n\n\ncommerce platforms has become a growing concern with an \n\n\n\nincrease of Internet and social media users. Despite FDA \n\n\n\nrestrictions, there is evidence of poor digital surveillance of \n\n\n\nregulated drugs. The objective of this study was to evaluate \n\n\n\nthe regulatory issues on direct selling of nootropic (\u201cbrain \n\n\n\nboosting\u201d) drugs on an e-commerce platform in the \n\n\n\nPhilippines. Methods: Search terms and other terms \n\n\n\nassociated with nootropics were collected from an e-\n\n\n\ncommerce website and Google. The nootropics found were \n\n\n\ninitially filtered using the inclusion and exclusion criteria, \n\n\n\nand classified according to seller\u2019s name and pertinent \n\n\n\nproduct information. Subsequently, duplicated items (same \n\n\n\nproduct and seller) were eliminated. Data validation was \n\n\n\ndone while excluding ineligible data. Data were reviewed \n\n\n\nindependently before characterization based on product \n\n\n\ncategory [over-the-counter (OTC) drug, prescription drug or \n\n\n\nfood supplement], country/region of origin, popularity \n\n\n\n(number sold, ratings, reviews, and products sold), and FDA \n\n\n\nregistration based on Philippines FDA Verification Portal \n\n\n\nand Indonesian BADAN-POM database. Final data were \n\n\n\nfiltered using the eligibility criteria. Then, these were sorted \n\n\n\nand analysed. Results and Discussion: A total of 96 unique \n\n\n\nnootropics products, of which 33 contained prescription and \n\n\n\ncontrolled drugs, were found in the e-commerce website. An \n\n\n\nexamination of their registration status in their countries of \n\n\n\norigin confirmed that only products containing citicoline \n\n\n\n(24.2%) were registered; the rest were unregistered (75.8%). \n\n\n\nEven though citicoline products are registered, they require a \n\n\n\nprescription and these should not be sold direct-to-consumer. \n\n\n\nOf the unregistered nootropic drugs, two are categorized as \n\n\n\ncontrolled substances: namely, modafinil (27.3%)  and \n\n\n\narmodafinil (15.2%). Both are popular in terms of the number \n\n\n\nsold, ratings, and reviews. Conclusion: Unregistered drugs \n\n\n\ncontaining controlled substances were available and highly \n\n\n\naccessible direct-to-consumer showing lack of regulatory \n\n\n\ncompliance among online sellers and the e-commerce \n\n\n\nplatform. Direct-to-consumer regulatory policies need to be \n\n\n\nreviewed to strengthen digital surveillance of the online \n\n\n\npharmaceutical marketplace. \n\n\n\n\n\n\n\nAbstract 071 \n \n\n\n\nPharmacists Approach to Specialty Care \n\n\n\nFacilities for People who have Parkinson\u2019s \n\n\n\nDisease \n\n\n\n\n\n\n\nHashimoto M1*, Shogen T.2, Sugita N.3 \n\n\n\n \n1 Spatel, Kanazawa, 2Temarikobu Pharmacy, 3Drug Information Office, \n\n\n\nSpatel, Kanazawa, Japan \n\n\n\n* Corresponding author \n\n\n\nEmail: hashimoto@temariyakkyoku.com  \n \n\n\n\nBackground and Objectives: The treatment of people who \n\n\n\nhave Parkinson\u2019s disease should be customized for each \n\n\n\nindividual. The Temari Group attempted to provide optimal \n\n\n\ncare by assembling a team of healthcare professionals \n\n\n\nincluding physical therapists, nurses, care workers, \n\n\n\noccupational therapists, and speech therapists. Methods: The \n\n\n\nway the Temari Group approached this was to first gather \n\n\n\ninformation about the people who have Parkinson\u2019s disease \n\n\n\nand survey them to know what medications each individual \n\n\n\nhad been taking. Further research was done to know the \n\n\n\nadherence to their daily medicine schedule, the effectiveness \n\n\n\nof the medicine, and to what extent people suffered from side \n\n\n\neffects. At the specialty care facility, we led a meeting about \n\n\n\npharmaceutical care for patients with Parkinson\u2019s disease. \n\n\n\nWe held monthly meetings with all healthcare professionals \n\n\n\nto discuss the care of people with Parkinson\u2019s disease, the \n\n\n\neffectiveness of their medicine, side effects, and so on. After \n\n\n\none year, we met again to identify any issues we had and how \n\n\n\nthey could be improved. Results and Discussion: We were \n\n\n\nable to know about the patients who suffer from Parkinson\u2019s \n\n\n\nmedicine intake, schedule, effectiveness of the medicine, and \n\n\n\nfinally, the side effects. Furthermore, all healthcare \n\n\n\nprofessionals got together to share their thoughts, opinions, \n\n\n\nand information, so as to improve patient care in \n\n\n\nfuture.Conclusion: We can see that the collaboration of \n\n\n\nhealthcare professionals has contributed to and improved the \n\n\n\nactivities of daily life and quality of life of those with \n\n\n\nParkinson\u2019s disease. We continue to see pharmacists play an \n\n\n\nimportant role in the collaborative treatment of patients with \n\n\n\nParkinson\u2019s disease, now and in future.  \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:miranda.jonaslegaspi@gmail.com\n\n\nmailto:hashimoto@temariyakkyoku.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n101 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 072 \n\n\n\n\n\n\n\nExploring the Lived Experiences of \n\n\n\nCommunity Pharmacists\u2019 on Pharmacy-\n\n\n\nBased Immunization: A Phenomenological \n\n\n\nStudy \n\n\n\n\n\n\n\nKarl Kirby Z. Costales, Maureen Canda-\n\n\n\nBorcelas*, Hazel Joy B. Da-anton, Raye Marie \n\n\n\nP. Damole, Ruby Felina D. Mahinay \n \n\n\n\nUniversity of the Immaculate Conception, College of Pharmacy and \n\n\n\nChemistry, Davao City, Philippines \n\n\n\n* Corresponding author \n\n\n\nEmail: mcanda@uic.edu.ph  \n \n\n\n\nBackground and Objectives: Increasing levels of vaccine \n\n\n\nhesitancy and the recent COVID-19 pandemic have \n\n\n\nnecessitated the implementation of pharmacy-based \n\n\n\nimmunization in the Philippines. Previous researches has \n\n\n\nprimarily employed quantitative methods. This \n\n\n\nphenomenological study aimed to explore the lived \n\n\n\nexperiences of community pharmacists on pharmacy-based \n\n\n\nimmunization among the three districts of Davao City. \n\n\n\nMethods: This study employed a phenomenological \n\n\n\nqualitative research design using purposive sampling. Data \n\n\n\nwas gathered through in-depth interviews with validated \n\n\n\nsemi-structured questionnaires, with four participants per \n\n\n\ndistrict. Consent was sent through their emails and Google \n\n\n\nMeet platform was utilized. Data was duly analysed through \n\n\n\nthematic analysis to identify recurring concepts and, \n\n\n\neventually, themes. Results and Discussion: Nine themes \n\n\n\nwere generated: Positive experience, accessibility and \n\n\n\nconvenience, enhanced trust and therapeutic relationship, \n\n\n\nadvancing public health, insufficient manpower and more \n\n\n\nworkload, unsuitable setting and inadequate training for \n\n\n\nvaccination and emergencies, lack of motivation and \n\n\n\nexperience, top-down support for effective pharmacy-based \n\n\n\nimmunization, and increased sales and improved brand \n\n\n\nreputation. Younger participants were more open to the \n\n\n\nconcept of administering vaccines in their pharmacies. \n\n\n\nPharmacy-based immunization is beneficial because it \n\n\n\ncapitalizes on the patients\u2019 preference for pharmacies over \n\n\n\nhospitals and other vaccination sites. The major downside is \n\n\n\nthe lack of manpower, resulting in negative impacts on the \n\n\n\nquality of work. Conclusion: Based on the results, effective \n\n\n\nimplementation of pharmacy-based immunization required \n\n\n\nthat the challenges are resolved and issues mitigated. \n\n\n\nCommunity pharmacists support pharmacy-based \n\n\n\nimmunization. Relevant stakeholders (pharmacy \n\n\n\norganizations and drug store owners) could utilize this study \n\n\n\nto address concerns of community pharmacists, resulting in \n\n\n\nimproved immunization services. Through the use of online \n\n\n\nplatforms and heads of pharmacy organizations, this could \n\n\n\nhelp improve awareness of the program, educate the \n\n\n\nstakeholders, and create better guidelines. \n\n\n\n\n\n\n\nAbstract 073 \n \n\n\n\nCurrent Contributions and Future \n\n\n\nOpportunities for Community Pharmacists \n\n\n\nduring the COVID-19 pandemic in Taiwan \n\n\n\n\n\n\n\nNai-Hwa Mei1,2* \n\n\n\n \n1 International Health Program, Institute of Public Health, National Yang \n\n\n\nMing Chiao Tung University, Taipei, Taiwan \n2 Guandu Song Community Pharmacy, Taipei, Taiwan \n\n\n\n* Corresponding author \n\n\n\nEmail: meit014828@gmail.com  \n\n\n\n\n\n\n\nBackground and Objectives: The global spread of COVID-\n\n\n\n19 continues to place unprecedented demands on healthcare \n\n\n\nservices. In this time of crisis, innovative and adaptive \n\n\n\nmethods of practicing will be required across all health \n\n\n\nprofessions. Community pharmacists in Taiwan have since \n\n\n\nplayed a vital role in response to the current pandemic. As \n\n\n\ntheir scope of practice extends to the optimization of chronic \n\n\n\nmedication use, evidence-based health advice, rationing of \n\n\n\npersonal protective equipment, and medication home \n\n\n\ndeliveries, their expertise is undoubtedly still underutilized. \n\n\n\nTherefore, this study was to highlight the roles and activities \n\n\n\nthat community pharmacists have taken to aid in relieving \n\n\n\npressure on other healthcare services and government \n\n\n\nofficials. The results of this study will act as a roadmap for \n\n\n\npolicymakers when restructuring existing and expanding \n\n\n\nfuture health services provided by pharmacists in response to \n\n\n\npublic health crises such as COVID-19. Methods: Data from \n\n\n\nMarch 2020 to June 2022 was collected from Guandu Song \n\n\n\nCommunity Pharmacy\u2019s electronic database and further \n\n\n\nanalysed through software data, Microsoft Excel and STATA. \n\n\n\nResults and Discussion: Pharmacists performed an average \n\n\n\nof 50 daily medication reviews among the 10 participating \n\n\n\nlong-term care (LTC) facilities. Overall, 99 drug-related \n\n\n\nproblems (DRPs) and potentially inappropriate medication \n\n\n\n(PIM) were documented. This included suggestions to \n\n\n\nchange an \u201cinappropriate drug of choice\u201d, \u201cno indication of \n\n\n\ndrug use\u201d, and \u201cduplicate medication\u201d. The acceptance rate \n\n\n\nfrom physicians was 91%. Whereas, the daily average of \n\n\n\nindividual COVID-19 rapid test kits distributed was 410. In \n\n\n\naddition, pharmacists handed out more than 200 surgical \n\n\n\nmasks per day in accordance with the government\u2019s rationing \n\n\n\nscheme. Conclusion: This study suggests that community \n\n\n\npharmacists have significantly contributed during a public \n\n\n\nhealth crisis by ensuring continuity of pharmaceutical \n\n\n\nservices and providing novel services. Their vital role within \n\n\n\na community during the COVID-19 health crisis further \n\n\n\nillustrates that they are an essential team player in the \n\n\n\nmanagement of emerging infectious diseases. \n\n\n\n\nmailto:mcanda@uic.edu.ph\n\n\nmailto:meit014828@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n102 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 074 \n \n\n\n\nKnowledge, Attitude and Barriers to \n\n\n\nCompliance for the Pharmacy Support \n\n\n\nWorkforce Requirements and \n\n\n\nResponsibilities on the Philippine \n\n\n\nPharmacy Act  \n\n\n\n\n\n\n\nNoelle Marie H. Fontanilla1*, Nimfa B. \n\n\n\nGambalan2, Vieno Gino Cruz1, Mark Harvey \n\n\n\nB. Adamson1 \n\n\n\n \n1 School of Pharmacy, Graduate studies, Philippine Women\u2019s University, \n\n\n\nManila, Philippines \n2 Department of Pharmacy, College of Allied Health, National University, \n\n\n\nManila, Philippines \n\n\n\n* Corresponding author \n\n\n\nEmail: vcruz@pwu.edu.ph, nbgambalan@national-u.edu.ph, \n\n\n\nnoellemariefontanilla@gmail.com  \n\n\n\n\n\n\n\nBackground and Objectives: The New Philippine \n\n\n\nPharmacy Act revolutionize Community Pharmacy practice \n\n\n\nwhich requires training and define specific roles for \n\n\n\nPharmacy Support Workforce (PSW). The study assessed the \n\n\n\nknowledge, attitude, and barriers (KAB) in compliance to \n\n\n\nresponsibilities and requirements on PSW among \n\n\n\nindependent drug stores in Rodriguez, Rizal, Philippines \n\n\n\nMethods:  This quantitative, cross-sectional study used a \n\n\n\ndescriptive research design that utilized a validated and \n\n\n\npretested structured questionnaire administered face-to-face \n\n\n\namong all consented independent drug store where \n\n\n\nrespondents include pharmacy owners and PSW such as \n\n\n\npharmacy technicians, pharmacy assistants, and pharmacy \n\n\n\naides. Statistical Package for Social Sciences (SPSS) was \n\n\n\nused to perform all descriptive statistics for summarizing \n\n\n\nKAB scores and non-parametric inferential statistics such as \n\n\n\nMann-Whitney, Kruskal-Wallis, and Spearman\u2019s Correlation. \n\n\n\nResults and Discussion: Owners (88.1%) and PSW (77.4%) \n\n\n\nhad \u2018poor knowledge\u2019 but with \u2018positive attitude\u2019 towards \n\n\n\ncompliance. Most are hesitant to finance their training. \n\n\n\nInaccessibility of training site is a moderate barrier to \n\n\n\ncompliance. KAB between owners and PSW did not \n\n\n\nsignificantly differ.  Level of knowledge (LOK) significantly \n\n\n\ndiffered with training attendance (\ud835\udc5d < 0.001) for owners and \n\n\n\nPSW and with the highest educational attainment (\ud835\udc5d = 0.018) \n\n\n\nand length of employment (LOE) (\ud835\udc5d = 0.0403) for PSW.  \n\n\n\nPSW\u2019s attitude differed with LOE (\ud835\udc5d = 0.049). Owner\u2019s LOK \n\n\n\nis positively associated with administrative barriers (\ud835\udc5f = 0.32) \n\n\n\nand owner\u2019s and PSW\u2019s attitude is negatively associated with \n\n\n\npersonal barriers (\ud835\udc5f\ud835\udc60 = \u22120.39 and \ud835\udc5f\ud835\udc60 = \u22120.53, \ud835\udc5d < 0.01). \n\n\n\nFurther PSW\u2019s attitude is negatively associated with \n\n\n\nadministrative barriers (\ud835\udc5f\ud835\udc60 = \u22120.45, \ud835\udc5d = 0.001). Conclusion:  \n\n\n\nBased on the results obtained, accessible and affordable \n\n\n\ntraining should be provided to owners and PSW to enhance \n\n\n\ntheir competencies and comply with requirements. \n\n\n\nAbstract 075 \n \n\n\n\nKnowledge, Attitude and Perception of \n\n\n\nCommunity Pharmacists on \n\n\n\nTeleconsultation \n\n\n\n\n\n\n\nNoor Batrisyia Auni Zaidisam1,2*, \n\n\n\nMathumalar Loganathan1, Munaver Ahmad \n\n\n\nNazir Ahmad1, Ezlina Usir1, Adelin Suraya \n\n\n\nMokhtar1 \n \n1 Faculty of Pharmacy, Universiti Teknologi MARA (UiTM), Selangor, \n\n\n\nMalaysia \n2 Rhazes Consultancy Services Sdn Bhd, Selangor, Malaysia \n\n\n\n* Corresponding author \n\n\n\nbatrisyiaauni@gmail.com  \n\n\n\n\n\n\n\nBackground and Objectives: Teleconsultation was \n\n\n\nincreasingly used to communicate with patients, particularly \n\n\n\nduring the COVID-19 outbreak. Most of the healthcare \n\n\n\nproviders showed a positive attitude and perception of \n\n\n\nteleconsultation however, community pharmacists receive \n\n\n\nscant attention in the literature. This study was conducted to \n\n\n\nassess community pharmacists' knowledge, attitude and \n\n\n\nperception of teleconsultation. Methods: A semi-structured \n\n\n\ninterview was done with community pharmacists servicing in \n\n\n\nthe Klang Valley, Malaysia. A selected number of \n\n\n\ncommunity pharmacists were introduced to a video on \n\n\n\nconsultation services provided by a telehealth provider and \n\n\n\nanswered a set of questionnaires. Results and Discussion: A \n\n\n\ntotal of 27 community pharmacists participated in the semi-\n\n\n\nstructured interview and 13 community pharmacists were \n\n\n\nselected for the video demonstration and were asked to \n\n\n\nanswer a set of questionnaires. The themes which emerged \n\n\n\nfrom the interview were knowledge of teleconsultation, \n\n\n\nattitude and perceptions of teleconsultation application and \n\n\n\nbarriers to teleconsultation. As for the demonstration, 69.2% \n\n\n\nshowed good knowledge scores while 53.8% showed \n\n\n\nmoderate scores in their attitude and 53.8% and 61.5% \n\n\n\nshowed poor perception scores on usefulness and practicality, \n\n\n\nrespectively. There are no statistically significant differences \n\n\n\nbetween the attitude scores of the participants with \u201cgood \n\n\n\nknowledge\u201d and \u201cmoderate knowledge\u201d (Kruskal-Wallis, H \n\n\n\n= 0.032, p = 0.859). There is a weak and positive correlation \n\n\n\nbetween overall knowledge scores and perception. At the \n\n\n\nsame time, there is a strong and positive correlation between \n\n\n\noverall attitude scores and perception. Conclusion: \n\n\n\nCommunity pharmacists were aware and knowledgeable \n\n\n\nabout teleconsultation but their attitude and perception can be \n\n\n\nimproved. As community pharmacists will be the ones to \n\n\n\nprovide such services, efforts must be taken to improve their \n\n\n\nattitude and perception so they can provide good quality \n\n\n\nservices in the near future. \n\n\n\n\nmailto:vcruz@pwu.edu.ph\n\n\nmailto:nbgambalan@national-u.edu.ph\n\n\nmailto:noellemariefontanilla@gmail.com\n\n\nmailto:batrisyiaauni@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n103 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 076 \n\n\n\n\n\n\n\nAnalysis on the Effectiveness of Education \n\n\n\nProgram for Improving Accessibility of \n\n\n\nPharmacy Involvement in HIV Care \n\n\n\n\n\n\n\nShao Ti Hsu1*, Ling Chun Liao1,2, Yu Chen \n\n\n\nWang1, I-Hsuan Lee1, Tzu-Chun Chou1 \n\n\n\n \n1 Taiwan Young Pharmacists' Group, Taiwan \n2 Department of Pharmacy, National Taiwan University Hsin-Chu Hospital \n\n\n\n* Corresponding author \n\n\n\nEmail: a0989909181@gmail.com  \n\n\n\n\n\n\n\nBackground and Objectives: The number of community \n\n\n\npharmacies in Taiwan joining the professional system of \n\n\n\nAIDS care continues to increase, from 17 to 56 between the \n\n\n\nyears 2017 and 2021. Advanced knowledge of pharmacists \n\n\n\nto care for HIV- infected patients and their intention to \n\n\n\nprovide public health services for prevention and treatment \n\n\n\nhave to be evaluated, promoted and strengthened. In 2021, \n\n\n\nTaiwan Young Pharmacists Group hosted two educational \n\n\n\ntraining courses for pharmacists, supported by Taiwan CDC. \n\n\n\nTwo courses were held in eastern and northern Taiwan, \n\n\n\nincluding online and on-site courses. This study was \n\n\n\nconducted to evaluate the effectiveness of the education and \n\n\n\ntraining courses. Methods: Pre-test and post-test \n\n\n\nquestionnaire data of trainees were collected and analysed for \n\n\n\nany differences in the training pharmacists\u2019 HIV prevention \n\n\n\nknowledge, attitude and behavior intention in the HIV \n\n\n\neducation program. The questionnaire consists of five true or \n\n\n\nfalse questions and five multiple-choice questions, each with \n\n\n\nfour options. The proportion of responses before and after the \n\n\n\ncourse were analysed using McNemar's test. The attitude and \n\n\n\nbehavioral intention questions are based on a 5-point Likert \n\n\n\nscale and were analysed using paired sample t-test. Results \n\n\n\nand Discussion: A total of 102 valid questionnaires were \n\n\n\ncollected (102/114,89%). The average attitude score of \n\n\n\npharmacists increased from 3.94 to 4.24, an increase of 0.3, \n\n\n\nreaching a statistically significant difference (P<0.001). The \n\n\n\nattitude and behavioral intention score increased from 4.01 to \n\n\n\n4.24, an increase of 0.23, with P value<0.001. We also found \n\n\n\nthat pharmacists were still relatively unfamiliar with \"pre-\n\n\n\nexposure and post-exposure prophylactic administration\" and \n\n\n\nespecially with \"screening principles and related \n\n\n\nservices\".Conclusion: Overall, the education program \n\n\n\nsignificantly improved and supported  pharmacists in \n\n\n\nproviding professional knowledge, better attitude and \n\n\n\nbehavioral intentions towards HIV prevention. \"Screening \n\n\n\nPrinciples and Related Services\" related subjects and \n\n\n\nlearning motivation should be continuously strengthened in \n\n\n\nthe future. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 077 \n\n\n\n\n\n\n\nUnderstanding the Influencing Factors of \n\n\n\nTelepharmacy Implementation in Taiwan: \n\n\n\nA Qualitative Study \n\n\n\n\n\n\n\nWen Hsiu Lin1,2*, I-Hsuan Lee1,2 \n\n\n\n\n\n\n\n1 Taiwan Young Pharmacist Group, Taiwan \n2 Izumo pharmacy, New Taipei City, Taiwan \n\n\n\n* Corresponding author \n\n\n\nEmail: aglwsl3000@gmail.com  \n\n\n\n\n\n\n\nBackground and Objectives: Through the literature review \n\n\n\nfrom Japan, Canada, and Europe, we can learn that \n\n\n\ntelepharmacy is beneficial for the provision of drug \n\n\n\ninformation and to improve the safety of medication for \n\n\n\npeople in remote areas. However, due to the current \n\n\n\nregulations in Taiwan, only pharmacists are allowed to \n\n\n\ndeliver medicines. Therefore, at this stage, Taiwan's \n\n\n\ntelepharmacy care services are only aimed at remote \n\n\n\nprescription review, teleconsultation, telepharmacy effects \n\n\n\nand monitoring. The aim of this study was to understand the \n\n\n\nfactors for promoting telepharmacy, and the opinion of \n\n\n\ncommunity pharmacists. Methods: This study was \n\n\n\nperformed from April 1st, 2022 to July 31st 2022 in Taiwan. \n\n\n\nThe opinion of community pharmacists about telepharmacy \n\n\n\nwas collected through semi-structured interviews. Seven \n\n\n\npharmacists participated in this study, all of them have over \n\n\n\n10 years of practice experience and are active in community \n\n\n\npharmaceutical care. Results and Discussion: Following the \n\n\n\nprocedure of pharmaceutical care in community pharmacy, \n\n\n\nseveral pain points of practicing telepharmacy were found in \n\n\n\nthis study. These included identifying the patient, ensuring \n\n\n\ninformation security, and collecting medical information \n\n\n\nfrom NHI. Several benefits were also foreseeable such as \n\n\n\nassisting medical intervention in remote or medically \n\n\n\nunderserved areas, providing consultation immediately, and \n\n\n\nconquering the barriers of distance. All participants agreed \n\n\n\nthat the impact on pharmacist practice could be divided into \n\n\n\nthree levels: cost of training, regulations, and pharmacist \n\n\n\ncompetence. Conclusion: With this qualitative study, we can \n\n\n\nidentify the help and resistance to promoting telepharmacy \n\n\n\nfor pharmaceutical care in Taiwan. To set up the \n\n\n\ntelepharmacy system in Taiwan, more research and \n\n\n\ninvestigation are needed, and a pilot run is needed to \n\n\n\nunderstand how the entire model works. \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:a0989909181@gmail.com\n\n\nmailto:aglwsl3000@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n104 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 078 \n\n\n\n\n\n\n\nAnalysis of the Effectiveness of OSCE \n\n\n\nApplied to Hospital Pharmacy Training \n\n\n\n\n\n\n\nWJ Chen1*, CK Huang1, SF Huang2   \n\n\n\n \n1 Department of Pharmacy, Tainan Municipal Hospital (Managed by Show \n\n\n\nChwan Medical Care Corporation), Tainan, Taiwan \n2 Department of Pharmacy, Chi Mei Medical Center, Tainan, Taiwan \n\n\n\n* Corresponding author \n\n\n\nEmail: 2f0147@tmh.org.tw  \n\n\n\n\n\n\n\nBackground and Objectives: Interpersonal communication \n\n\n\nskills and the application of evidence-based medicine in \n\n\n\nclinical work are two of the core competencies of pharmacists. \n\n\n\nThe Objective structured clinical examination (OSCE) is a \n\n\n\nmore suitable assessment for these core competencies than \n\n\n\nthe written and oral exams. The purpose of the study was to \n\n\n\ninvestigate the effectiveness of OSCE in assessing the \n\n\n\nclinical competence of PGY pharmacists and pharmacy \n\n\n\ninterns. Methods: Since 2018, we had arranged for PGY \n\n\n\npharmacists and interns to attend joint OSCE training at a \n\n\n\nmedical center. There were 6 themes in the OSCE, the topic \n\n\n\nof the intern's themes was all drug counseling, the themes of \n\n\n\nPGY pharmacists focus on the identification prescription \n\n\n\nerrors and communication with the doctor. In addition to the \n\n\n\ntrainee pass rate, the standard patient perceptions of trainee \n\n\n\nperformance and trainee satisfaction scores on a five-point \n\n\n\nLikert scale were collected as a reference for subsequent \n\n\n\nimprovement. Results and Discussion: From 2018 to 2021, \n\n\n\na total of eight PGY pharmacists and eight interns had \n\n\n\nparticipated in the joint OSCE training, six PGYs and seven \n\n\n\ninterns passed the test. Standard patient assessments of PGY \n\n\n\nand intern\u2019s performance (e.g., professional attitude, \n\n\n\nappropriate response, empathy, overall performance, etc.) \n\n\n\nwere 3.6 \u00b1 0.5 each. The overall satisfaction level of the \n\n\n\ntrainees included clear examination guidelines, standard \n\n\n\npatient performance seems real, appropriate feedback from \n\n\n\nthe examiners, appropriate timing of the test, and appropriate \n\n\n\ndifficulty of the test: 4.3\u00b10.6 for PGY pharmacists and \n\n\n\n4.6\u00b10.4 for interns. All participants agreed that the OSCE \n\n\n\narrangement was necessary and helpful.Conclusion: The \n\n\n\npurpose of formative OSCE is for teaching. Participants \n\n\n\ncould reflect on their performance and set future learning \n\n\n\ngoals after the examiners, so we will continue to arrange for \n\n\n\nPGY pharmacists and pharmacy interns to participate in joint \n\n\n\ntraining OSCE. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 079 \n\n\n\n\n\n\n\nUsing Beers Criteria for Older Inpatients to \n\n\n\nAssess Rational Drug Use at A Public \n\n\n\nHospital in Taiwan \n\n\n\n\n\n\n\nCT Chen*, MS Li  \n \n\n\n\nDepartment of Pharmacy, Heping-Fuyou Branch, Taipei City Hospital, \n\n\n\nTaipei, Taiwan. \n\n\n\n* Corresponding author \n\n\n\nEmail: adamazing000@gmail.com  \n\n\n\n\n\n\n\nBackground and Objectives: Patients over the age of 65 are \n\n\n\na vulnerable population. Potentially inappropriate \n\n\n\nmedications (PIMs) can be defined as medications for which \n\n\n\nuse among older adults should be avoided due to an \n\n\n\nunfavourable balance of benefits and harms when safer and \n\n\n\nequally or more effective therapeutic alternatives are \n\n\n\navailable. We aim to recognize the prevalence and the \n\n\n\ncategories of PIMs and we monitor if there are any adverse \n\n\n\nreactions and give advices to physicians when necessary. \n\n\n\nMethods: A retrospective analysis of prescriptions from \n\n\n\nmedical records of patients over the age of 65 hospitalized in \n\n\n\nTaipei City Hospital Heping-Fuyou Branch ward using the \n\n\n\nAGS 2019 Beers criteria was performed. Data was collected \n\n\n\nfor gender, mean age, medication prescribed, physicians\u2019 \n\n\n\nacceptance rate of pharmacists\u2019 interventions and \n\n\n\npolypharmacy (\u22655 drugs/day). Descriptive statistics were \n\n\n\nused. Results and Discussion: A total of 482 elderly patients \n\n\n\nwere identified and evaluated. The mean age was 77.3 (SD \n\n\n\n8.4) and 54.6% were male. The mean number of drugs used \n\n\n\nwas 6.3 (SD 3.9) and the mean number of PIM was 0.8 (SD \n\n\n\n0.9). Polypharmacy (\u22675 drugs/day) was prevalent in 62.2% \n\n\n\nof patients. The prevalence of PIM was high, at 51.7%. \n\n\n\nAmong them, the most commonly prescribed PIMs were \n\n\n\nomeprazole (10.9%), metoclopramide (9.2%), tramadol \n\n\n\n(8.1%). This indicated the awareness of potential adverse \n\n\n\nevents of prolonged PPIs use (i.e. risk of C. difficile infection \n\n\n\nand fracture) was low. Physicians' acceptance rate of \n\n\n\npharmacists' interventions was 75%.  Conclusion: PIM \n\n\n\nprescription and polypharmacy were found to be common in \n\n\n\nTaipei City Hospital Heping-Fuyou Branch. We should make \n\n\n\nefforts to enhance both the medication safety and physicians\u2019 \n\n\n\nacceptance rate and if the use of PIMs is necessary, it is \n\n\n\nimportant to monitor patients\u2019 responses to the drugs. \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:2f0147@tmh.org.tw\n\n\nmailto:adamazing000@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n105 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 080 \n\n\n\n\n\n\n\nOptimising the Evaluation Efficiency of \n\n\n\nIntegrated Outpatient Clinic Prescriptions \n\n\n\n\n\n\n\nCW Chang*, JF Chen  \n \nDepartment of Pharmacy, Tainan Municipal Hospital (Managed by Show \n\n\n\nChwan Medical Care Corporation), Taiwan \n\n\n\n* Corresponding author \n\n\n\nEmail: ddm33669@gmail.com  \n\n\n\n\n\n\n\nBackground and Objectives: There is integrated outpatient \n\n\n\nclinic service for elder people in our hospital. After \n\n\n\nevaluating patients\u2019 whole condition and medicines, the \n\n\n\nprofessional medical team, including doctors, pharmacists \n\n\n\nand medical case manager, offers new medical suggestions. \n\n\n\nHowever, the procedure of evaluating integrated outpatient \n\n\n\nclinic prescriptions took too much time. The aim of this \n\n\n\nretrospective study was to optimise the evaluation efficiency \n\n\n\nof integrated outpatient clinic prescriptions through lean \n\n\n\nthinking. Methods: This is a retrospective study which \n\n\n\npursue improvement by lean thinking. The procedure of \n\n\n\nevaluating prescriptions caused a lot of waste. First, the \n\n\n\npharmacists needed to wait the referral mails from medical \n\n\n\ncare manager to start evaluating prescriptions. Second, the \n\n\n\npharmacists could not check mails immediately. Last, the \n\n\n\npharmacists needed to open a lot of software for evaluating \n\n\n\nprescriptions. We wanted to diminish or eliminate the whole \n\n\n\nwasted time and set 15 minutes as goal. To evaluate whether \n\n\n\nthe evaluation efficiency of integrated outpatient clinic \n\n\n\nprescriptions had improved, we compared the time of \n\n\n\nevaluating integrated outpatient clinic prescriptions before \n\n\n\n(Sep. 2020 to Feb. 2021), during (Jul. to Aug. 2021), and after \n\n\n\n(Sep. to Oct. 2021) the study. Results and Discussion: After \n\n\n\nthis improvement, we set up the new system and the phone \n\n\n\nmessage informing procedure for evaluating prescriptions. \n\n\n\nThe time of evaluating integrated outpatient clinic \n\n\n\nprescriptions decreased from 40 minutes to 12 minutes, with \n\n\n\na progress rate of 70.0%, and an achievement rate of 112.0%. \n\n\n\nConclusion: Through improving the process, we reduce a lot \n\n\n\nof time of evaluating prescriptions for integrated outpatient \n\n\n\nclinic in our hospital. We do optimise the evaluation \n\n\n\nefficiency of integrated outpatient clinic prescriptions. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 081 \n\n\n\n\n\n\n\nAnti-COVID-19 Drugs Induced Elevated \n\n\n\nLiver Enzymes: A Case Series \n\n\n\n\n\n\n\nKuang-Yu Chou*, Yi-Ping Hsiang \n \n\n\n\nDepartment of Pharmacy, E-Da hospital, Kaohsiung, Taiwan \n\n\n\n* Corresponding author \n\n\n\nEmail: ed110621@edah.org.tw  \n\n\n\n\n\n\n\nBackground and Objectives: COVID-19 had ravaged the \n\n\n\nworld. Despite there are several antiviral therapies, numerous \n\n\n\nof them have adverse effects associated to liver in clinical \n\n\n\ntrials. This study wanted to survey the events of anti-COVID-\n\n\n\n19 drugs induced elevated liver enzymes in real world. \n\n\n\nMethods: It was a case series of patients who had elevated \n\n\n\nliver enzymes due to taking anti-COVID-19 drugs. We \n\n\n\nsurveyed these cases according to the medical record in a \n\n\n\nquasi-medical center in Taiwan. Results and Discussion: \n\n\n\nThere were total three cases from January 1st to July 31st, \n\n\n\n2022. The first case was a 61-year-old man who received \n\n\n\nremdesivir since May 24th. His AST/ALT were within \n\n\n\nnormal range on 23rd. On 27th, his ALT elevated to 621 U/L, \n\n\n\nover 10 fold of upper limited normal. Doctor decided to \n\n\n\ndiscontinue his remdesivir treatment and prescribe silymarin \n\n\n\nto regulate liver function. His ALT got back to normal range \n\n\n\non June 10th. The second case was a 5-year-old boy who \n\n\n\nreceived tocilizumab once and remdesivir since June 18th. \n\n\n\nHis AST/ALT were 35/18 U/L on 18th and 898/897 U/L on \n\n\n\n20th, which elevated from normal range to over 10 fold of \n\n\n\nupper limited normal. His remdesivir treatment was \n\n\n\ndiscontinued on 20th, and his AST/ALT slowly decreased \n\n\n\nsince then. However, his ALT was still over upper limited \n\n\n\nnormal on 27th. The third case was a 36-year-old man who \n\n\n\nreceived molnupiravir since June 27th to 31st. His AST/ALT \n\n\n\nwere 294/86 U/L on 28th, so doctor prescribed silymarin. His \n\n\n\nAST/ALT decreased to 35/73 U/L on July 6th. Conclusion: \n\n\n\nWe evaluated the fluctuation of liver enzymes induced by \n\n\n\nanti-COVID-19 drugs in real world. All three cases had \n\n\n\nelevated liver enzymes after anti-COVID-19 drugs use. One \n\n\n\ngot AST/ALT back to normal range and no irreversible liver \n\n\n\ninjury found, but two still had ALT around 2 fold of upper \n\n\n\nlimited normal at the end of follow-up. \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:ddm33669@gmail.com\n\n\nmailto:ed110621@edah.org.tw\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n106 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 082 \n\n\n\n\n\n\n\nDose-related Study of Opioid Use in \n\n\n\nCritically Ill Patients Receiving \n\n\n\nExtracorporeal Membrane Oxygenation \n\n\n\nMaintenance System \n\n\n\n\n\n\n\nChu-Chen Cheng1,2*, Wen-Hwang Chen1,2 \n\n\n\n\n\n\n\n1 Department of Pharmacy, Tungs' Taichung MetroHarbor \n\n\n\nHospital, Taiwan. \n2 Taichung City New Pharmacist Association \n* Corresponding author \nEmail: t2619@ms.sltung.com.tw  \n\n\n\n\n\n\n\nBackground and Objectives: Patients with extracorporeal \n\n\n\nmembrane oxygenation (ECMO) devices experience pain \n\n\n\nand may be agitated. The use of opioid analgesics can relieve \n\n\n\npain and comfort in patients. Due to ECMO, drug \n\n\n\nhemodynamics may change, side effects or poor pain control \n\n\n\nmay occur. This study evaluates the efficacy and dose-related \n\n\n\neffects of opioid analgesics in such patients. Methods: This \n\n\n\nstudy is a retrospective clinical case collection and analysis. \n\n\n\nDuring the data period from 2018.01.01 to 2020.07.30, a total \n\n\n\nof 20 opioid analgesics were used during the ECMO support \n\n\n\nperiod. The use of morphine, Fentanyl and pethidine drugs \n\n\n\nwas converted into morphine equivalents, and the correlation \n\n\n\nof dose, days and pain score, and benzodiazepine (BZD) dose \n\n\n\nwas evaluated. Results and Discussion: The condition \n\n\n\nimproved by 39.5%, against advice discharge under critical \n\n\n\ncondition by 10%, and death by 49.5%. The most frequent \n\n\n\nuse was morphine, followed by fentanyl and pethidine. \n\n\n\nDifference of pain index before and after analgesia (95% C.I. \n\n\n\n1.6~3.9, p<0.0001), correlation between analgesic dose and \n\n\n\npain index (r=-0.125, p=0.598), correlation between \n\n\n\nanalgesic and BZD dose (r=-0.1, p =0.65), the relationship \n\n\n\nbetween ECMO use days and analgesic dose (r=-0.02, \n\n\n\np=0.93), ECMO use days and opioid analgesic use days \n\n\n\n(r=+0.59, p=0.07). The use of opioids for pain relief during \n\n\n\nECMO can indeed reduce pain, and morphine is used with \n\n\n\ngood pain relief and no metabolite relatively low side effects. \n\n\n\nConclusion: The duration of ECMO use increased, and the \n\n\n\nperiod of pain relief also increased (positive correlation), but \n\n\n\nthe dose used was dependent on demand (not correlated), and \n\n\n\nthe pain relief dose increased with the increase in patient pain \n\n\n\nlevel and disease severity (positive correlation), and BZD can \n\n\n\nreduce it. Dosage of opioid analgesics (concomitant with \n\n\n\nBZD doses is inversely related), and appropriate doses are \n\n\n\ngiven according to pain severity and time. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 083 \n\n\n\n\n\n\n\nUtilisation of Cardiovascular Drugs among \n\n\n\nPulmonary Hypertension with Valvular \n\n\n\nHeart Disease Patients before Valve \n\n\n\nSurgery \n\n\n\n\n\n\n\nFarizan Abdul Ghaffar1,2*, Adyani Md \n\n\n\nRedzuan1, Mohd Makmor-Bakry1 \n \n\n\n\n1 Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, \n\n\n\nMalaysia. \n2 Department of Pharmacy, Hospital Serdang, Kajang, Malaysia \n\n\n\n* Corresponding author \n\n\n\nEmail: farizan.ag@gmail.com  \n\n\n\n\n\n\n\nBackground and Objectives: Valve surgery is the mainstay \n\n\n\nof treatment in pulmonary hypertension (PH) with valvular \n\n\n\nheart disease (VHD). However, a standard goal-directed \n\n\n\nmedical therapy is still required while waiting for surgery. \n\n\n\nThere were limited studies on the utilization of \n\n\n\ncardiovascular (CVS) drugs either before or after valve \n\n\n\nsurgery. The current study was undertaken at a tertiary \n\n\n\ncardiac centre to identify the specific types and patterns of \n\n\n\nCVS drugs utilization before valve surgery. Methods: A \n\n\n\nretrospective observational study (2014 to 2020) on adult \n\n\n\npatients WITH a confirmed diagnosis of PH WITH VHD, \n\n\n\nmean pulmonary artery pressure \u2265 25 mmHg, measured by \n\n\n\ninvasive or non-invasive methods, underwent valve surgery \n\n\n\nand initiated WITH at least one oral CVS medication. Before \n\n\n\nsurgery is defined starting from the pre-operative assessment \n\n\n\nvisit and the day of surgery. Cardiovascular medications are \n\n\n\ndefined as any agent that affects the function of the heart and \n\n\n\nblood vessels. All data obtained were analysed using \n\n\n\ndescriptive analysis. Results and Discussion: Sixty-one \n\n\n\npatients were included in this study. Patients were initiated \n\n\n\nand optimized with oral CVS drugs before surgery for \n\n\n\nunderlying diseases such as hypertension and atrial \n\n\n\nfibrillation as recommended by recent international \n\n\n\nguidelines. Most of the patients developed PH with multiple \n\n\n\nand/or mixed valve diseases despite of the comorbidities \n\n\n\nwhich complicates the management of PH with VHD. The \n\n\n\nfive most common of oral CVS drugs were loop diuretics \n\n\n\n(85%), phosphodiesterase-5 inhibitors (80%), vitamin K \n\n\n\nantagonist (46%), beta-blocker (69%) and potassium \n\n\n\nchloride (52%). Loop diuretics and potassium chloride were \n\n\n\nthe common drug combination. Patients were prescribed with \n\n\n\nphosphodiesterase-5 inhibitors, to reduce pulmonary artery \n\n\n\npressure before surgery. Patients who started with vitamin K \n\n\n\nantagonist, specifically warfarin, 32% of patients achieved \n\n\n\nInternational nationalized ratio target. Conclusion: There \n\n\n\nwere specific types and patterns of CVS drugs.  \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:t2619@ms.sltung.com.tw\n\n\nmailto:farizan.ag@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n107 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 084 \n\n\n\n\n\n\n\nAn Evidence-based Therapy of Secondary \n\n\n\nHyperparathyroidism \n\n\n\n\n\n\n\nFU YU Yang*, Wen Jin Tung \n \n\n\n\nDepartment of Pharmacy, Changhua Christian Medical Foundation Yuanlin \n\n\n\nChristian Hospital, Changhua, Taiwan \n\n\n\n* Corresponding author \n\n\n\nEmail: ncuepe@hotmail.com  \n \n\n\n\nBackground and Objectives: Secondary \n\n\n\nhyperparathyroidism (SHPT) is a major comorbidity of \n\n\n\nchronic kidney disease (CKD). It has been linked with \n\n\n\ncardiovascular disease, leading to poor outcomes. Treatment \n\n\n\nstrategies directed to reduce the parathyroid hormone (PTH) \n\n\n\nconcentrations have included calcimimetics (eg. etelcalcetide, \n\n\n\ncinacalcet), that are new options in reversing SHPT, but the \n\n\n\nbenefits and harms on patient-level outcomes are uncertain. \n\n\n\nSince, the purpose of this study is to provide an evidence-\n\n\n\nbased study in discussion efficacy and safety of the \n\n\n\ncalcimimetics. Methods: According to five steps used in \n\n\n\nevidence-based medicine, we searched the Cochrane library, \n\n\n\nPubmed and Airiti library identifying completed and ongoing \n\n\n\nstudies without language restrictions from 2017 to 31 July \n\n\n\n2022. Results and Discussion: Two studies met our \n\n\n\neligibility criteria and were critically reviewed. Geoffrey et \n\n\n\nal shows that patients randomized to etelcalcetide were \n\n\n\nsignificantly reducing the ratio by more than 50% in Intact \n\n\n\nParathyroid Hormone (iPTH) level compared to cinacalcet \n\n\n\n(OR, 12.2%; 95% CI, 4.7% to 19.5%), but hypocalcemia is \n\n\n\nhigher in etelcalcetide (68.9% vs 59.8%). Palmer et al shows \n\n\n\nsimilar results in reducing iPTH level (OR, 2.78; 95% CI, \n\n\n\n1.19-6.67), but gastrointestinal side effect is higher in \n\n\n\ncinacalcet. Conclusion: Intravenous etelcalcetide can \n\n\n\nsignificantly reduce iPTH level compared to oral cinacalcet, \n\n\n\nbut hypocalcemia is higher than cinacalcet. How to select \n\n\n\ndrugs depends on patient's compliance, economic ability, and \n\n\n\ndrug response. This study intends to provide more clinical \n\n\n\ninformation to medical practitioners. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 085 \n\n\n\n\n\n\n\nStatistical Analysis on Outpatient\u2019s \n\n\n\nReferral for Individual Medication \n\n\n\nGuidance by Pharmacists \n\n\n\n\n\n\n\nYP Hsiang1*, YT Chiu2, YC Kuo2 \n \n\n\n\n1 Department of Pharmacy, E-DA Hospital, Kaohsiung, Taiwan, R.O.C  \n2 Pharmacy Department of E-Da Dachang Hospital, Kaohsiung, Taiwan, \n\n\n\nR.O.C.  \n\n\n\n* Corresponding author \n\n\n\nEmail: ed108228@edah.org.tw  \n\n\n\n\n\n\n\nBackground and Objectives: In June 2022, a hospital in \n\n\n\nTaiwan, R.O.C. aimed to understand the efficacy of a referral \n\n\n\nsystem by the outpatient physician to pharmacist for patient\u2019s \n\n\n\nindividual medication guidance at the consultation counter. \n\n\n\nMethods: Through a computer platform, the outpatient \n\n\n\nphysician identified the patient who needs special medication \n\n\n\neducation and referred to the pharmacist at the consultation \n\n\n\ncounter. Patients will be sent to the consultation counter to \n\n\n\nreceive the pharmacist's medication guidance to improve \n\n\n\npatient's medication compliance. Drug evaluation and \n\n\n\nmedication guidance satisfaction were conducted using the \n\n\n\nLIKERT 5 scoring method. Results and Discussion: The \n\n\n\ndata analysis showed that the patients from the Department \n\n\n\nof Respiratory were in needed for health education \n\n\n\nconsultation (45.45%), followed by the Department of \n\n\n\nNephrology (22.73%). Inhalation-type drug health education \n\n\n\nwas the most requested categories of medication guidance \n\n\n\n(47.73%), followed by self-administrated injectables \n\n\n\n(27.27%). We found that patients were scored with 1.9 points \n\n\n\nLIKERT 5 scoring method before the medical education and \n\n\n\n5 points after the medical education. Medication guidance \n\n\n\nsatisfaction was 4.9 points for patients and 5 points for \n\n\n\nphysician. Conclusion: Outpatient physicians acknowledge \n\n\n\nthe importance of patient\u2019s medication compliance; however, \n\n\n\nmost patients were unfamiliar with or lack of sufficient \n\n\n\nknowledge of medication, resulting in poor medication \n\n\n\ncompliance and poor disease control. Therefore, physicians \n\n\n\nreferred patients to pharmacists to provide individual \n\n\n\nmedication guidance, and specialized health education \n\n\n\nguidance based on individual patients\u2019 tailor-made problems. \n\n\n\nThe results showed that the satisfaction of both physicians \n\n\n\nand patients was 5 and 4.9 respectively, indicating that the \n\n\n\nprofessional service by pharmacist plays an important role in \n\n\n\nmedical behavior. Such referral indicated that pharmacist\u2019s \n\n\n\nservice was well appreciated by the patients and physicians.  \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:ncuepe@hotmail.com\n\n\nmailto:ed108228@edah.org.tw\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n108 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 086 \n\n\n\n\n\n\n\nEfficiency of Pharmacists\u2019 Pre-intervention \n\n\n\nfor Elderly Outpatients with Polypharmacy \n\n\n\n\n\n\n\nHsin-Yi Chou*, Chiou-Maan Lin, Yuk-Ying \n\n\n\nChan, Shin-Tarng Deng \n \nDepartment of Pharmacy Administration, Chang Gung Memorial Hospital, \n\n\n\nLinkou, Taiwan \n\n\n\n* Corresponding author \n\n\n\nEmail: kid524kimo@cgmh.org.tw  \n\n\n\n\n\n\n\nBackground and Objectives: Inappropriate medication use, \n\n\n\nand polypharmacy are common among older adults. Many \n\n\n\nprevious studies proved a comprehensive medication \n\n\n\ninformation system can help prevent drug-related-problem \n\n\n\n(DRP). Furthermore, continued monitoring of potential DRP \n\n\n\nis also necessary to ensure optimal medication use.To \n\n\n\nprovide pre-visit medication evaluation and continued \n\n\n\nfollow-up for elderly outpatients with polypharmacy by \n\n\n\npharmacists in a medical center. Methods: Between March \n\n\n\n1, 2019, and February 29, 2020, we enrolled 2,729 patients \n\n\n\nwith age over 65 years old receiving five or more medications \n\n\n\nand reviewed their current medication profile. Pharmacists \n\n\n\nconfirmed the DRP with doctors before patient visit and keep \n\n\n\nmonitoring to give suggestion up to four continued visits if \n\n\n\nthe prescription remains unchanged. The classification of \n\n\n\nDRP and numbers of drugs per patient were surveyed before \n\n\n\nand after the intervention. Results and Discussion: Among \n\n\n\nall the suggestion of pharmacists, the rate of physicians\u2019 \n\n\n\nacceptance was 61%. The prevalence of DRP was about 4.3% \n\n\n\n(117/2,729). Among the 117 DRP, improper dosage, drug \n\n\n\ncontraindicate to renal impairment and duplications \n\n\n\naccounted for 44.4% (52/117), 28.2 % (33/117), and 21.4 % \n\n\n\n(25/117), respectively. This result shows that dosage \n\n\n\nadjustment in renal impaired patient is ignored.  The mean \n\n\n\nnumbers of drug items and the mean numbers of pill count \n\n\n\nper patient deceased from 45 to 40 (p<0.007), 1687 to 1413 \n\n\n\n(p<0.0002) during six months. Conclusion: Pharmacists \n\n\n\nplay an important role in preventing DRP. The result in our \n\n\n\nstudy shows continued monitoring and proactive intervention \n\n\n\ndo improve the quality of patient care in polypharmacy \n\n\n\nelderly patients.  \n\n\n\n\n\n\n\n\n\n\n\nAbstract 087 \n\n\n\n\n\n\n\nAnalysis of Severe Cases Risk Factors and \n\n\n\nPotential Drug-drug Interactions (DDIs) in \n\n\n\nPatients Receiving Oral Anti-COVID-19 \n\n\n\nVirus Drugs \n\n\n\n\n\n\n\nYC Hsu1*,   YP Hsiang2 \n \n\n\n\n1 Pharmacy, E-DA Cancer Hospital, Kaohsiung City, Taiwan (R.O.C) \n2 Pharmacy, E-DA Hospital, Kaohsiung City, Taiwan (R.O.C) \n\n\n\n* Corresponding author \n\n\n\nEmail: qwerty1610@gmail.com  \n\n\n\n\n\n\n\nBackground and Objectives: In May 2022, Taiwan was at \n\n\n\nthe peak of the COVID-19 epidemic. The oral antiviral drugs \n\n\n\nNirmatrelvir/Ritonavir (Paxlovid\u00ae) and Molnupiravir were \n\n\n\nused for the first time in the treatment of patients with mild \n\n\n\nto moderate COVID-19 confirmed cases, mainly to reduce \n\n\n\nsevere cases and mortality. The purpose of this study was to \n\n\n\nunderstand the distribution of severe cases risk factors in \n\n\n\npatients and to analyse the proportion of potential DDIs. \n\n\n\nMethods: This study utilized retrospective analysis and \n\n\n\ncollected confirmed cases of COVID-19 from May 20, 2022 \n\n\n\nto July 31, 2022, who were confirmed by physicians to have \n\n\n\nsevere cases risk factors and were eligible for the use of the \n\n\n\noral antiviral drug Paxlovid\u00ae or Molnupiravir, and perform \n\n\n\ndescriptive statistical analysis. Results and Discussion: A \n\n\n\ntotal of 415 cases were collected in this study, with an \n\n\n\naverage age of 62.9\u00b117.04 years, 190 males and 225 females. \n\n\n\nThe top 5 with severe cases risk factors were \u226565 years old \n\n\n\n(212; 51.1%), diabetes (115; 27.7%), chronic kidney disease \n\n\n\n(57; 13.7%), cancer (53; 12.8%), cardiovascular disease (45; \n\n\n\n10.8%). The prescription ratio of Paxlovid\u00ae and \n\n\n\nMolnupiravir was 148 (35.7%): 267 (64.3%). In the \n\n\n\nPaxlovid\u00ae group, a total of 17 patients (6.4%) had potential \n\n\n\nDDIs with a total of 24 drugs. Among them, the literature \n\n\n\nrecommends temporarily discontinuing the drugs was \n\n\n\nRosuvastatin and Clopidogrel. Conclusion: This study \n\n\n\nanalysed the use of oral anti-COVID-19 virus drugs in the \n\n\n\nmajority of people aged \u2265 65 years, showing that the elderly \n\n\n\nis one of the main risk indicators. Allowing the elderly to take \n\n\n\nmedicine early can reduce the proportion of severe cases and \n\n\n\nmortality. Paxlovid\u00ae has the effect of CYP3A4 inhibitor, \n\n\n\npharmacists must pay close attention to the DDIs, and \n\n\n\neducate patients on medication in a timely manner to \n\n\n\nmaintain patient medication safety. \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:kid524kimo@cgmh.org.tw\n\n\nmailto:qwerty1610@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n109 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 088 \n\n\n\n\n\n\n\nAnalysis Potential Drug-drug Interactions \n\n\n\n(DDIs) and Risk Factors in COVID-19 \n\n\n\nPatients Receiving Oral Anti-Virus Drugs \n\n\n\nPaxlovid\u00ae and Molnupiravir  \n\n\n\n\n\n\n\nYC Hsu1*, YP Hsiang2 \n \n\n\n\n1 Department of Pharmacy, E-DA Cancer Hospital, Kaohsiung, Taiwan, \n\n\n\nR.O.C \n2 Department of Pharmacy, E-DA Hospital, Kaohsiung, Taiwan, R.O.C \n\n\n\n* Corresponding author \n\n\n\nEmail: qwerty1610@gmail.com  \n\n\n\n\n\n\n\nBackground and Objectives: In May 2022, Taiwan reached \n\n\n\nthe peak of the COVID-19 epidemic. The oral antiviral drugs \n\n\n\nNirmatrelvir/Ritonavir (Paxlovid\u00ae) and Molnupiravir were \n\n\n\ntreated for the first time in the patients with mild to moderate \n\n\n\nCOVID-19, mainly reduce severe complication and mortality. \n\n\n\nThe purpose of this study was to analyse the proportion of \n\n\n\npotential DDIs and risk factors in these populations. \n\n\n\nMethods: This retrospective study collected mild to \n\n\n\nmoderate COVID-19 infected patients who were confirmed \n\n\n\nby physicians from May 20, 2022 to July 31, 2022 in regional \n\n\n\nhospital in South Taiwan. These patients who were eligible \n\n\n\nfor the treatment of the oral antiviral drug Paxlovid\u00ae or \n\n\n\nMolnupiravir on CECC criteria (Central Epidemic Command \n\n\n\nCenter, Nation Health Command Center). Results and \n\n\n\nDiscussion: A total of 415 cases were collected in this study, \n\n\n\nwith an average age of 62.9\u00b117.04 years, 190 males and 225 \n\n\n\nfemales. The top 5 with severe risk factors were \u226565 years \n\n\n\nold (212; 51.1%), diabetes (115; 27.7%), chronic kidney \n\n\n\ndisease (57; 13.7%), cancer (53; 12.8%), cardiovascular \n\n\n\ndisease (45; 10.8%). The prescription ratio of Paxlovid\u00ae and \n\n\n\nMolnupiravir was 148 (35.7%): 267 (64.3%). In the \n\n\n\nPaxlovid\u00ae group, a total of 17 patients (6.4%) had potential \n\n\n\nDDIs. And mostly drug interaction with Paxlovid\u00ae were \n\n\n\nrosuvastatin and clopidogrel. Conclusion: This study we \n\n\n\nfound prescribed oral anti-COVID-19 virus drugs mostly \n\n\n\naged \u2265 65 years, showing that the elderly is one of the main \n\n\n\nrisk indicators. Allowing the elderly to take anti-COVID-19 \n\n\n\nvirus drugs early can reduce the complication and mortality. \n\n\n\nPaxlovid\u00ae is CYP3A4 inhibitor, pharmacists must pay more \n\n\n\nattention to the DDIs, and educate patients and doctors how \n\n\n\nto avoid interaction to maintain medication safety. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 089 \n\n\n\n\n\n\n\nThe Evaluation of Inpatient Oral COVID-\n\n\n\n19 Medication Utilisation in Medical \n\n\n\nCenters of Southern Taiwan \n\n\n\n\n\n\n\nYu Ci Lai*, Yi Ping Hsiang, Hsiu Ling Chang, \n\n\n\nLei Yu Chang \n \n\n\n\nDepartment of Pharmacy, E-Da hospital, Kaohsiung city, Taiwan \n\n\n\n* Corresponding author \n\n\n\nEmail: achi83109@gamil.com  \n\n\n\n\n\n\n\nBackground and Objectives: Paxlovid (nirmatrelvir tablet \n\n\n\nco-packaged with ritonavir tablet) and molnupiravir are the \n\n\n\noral COVID-19 medication. Guideline indicates that \n\n\n\nPaxlovid is the first line treatment for mild COVID-19 \n\n\n\ninfection, but it exhibits many drug-drug interactions (DDI) \n\n\n\nand precautions. Those patients who aren\u2019t suitable for \n\n\n\nPaxlovid will be prescribed molnupiravir. The purpose of this \n\n\n\nstudy was to assess the appropriateness of oral COVID-19 \n\n\n\nmedication selection in in-patients of a medical center. \n\n\n\nMethods: We retrospectively reviewed the medical records \n\n\n\nof residents from January 2022 to June 2022. The assessment \n\n\n\nincluded the reasons for prescribing molnupiravir, rational \n\n\n\nprescription rate, efficacy and safety. Results and \n\n\n\nDiscussion: 177 patients were included (male 59.8%), and \n\n\n\nthe average age was 69 \u00b1 16 years old. The proportion of \n\n\n\nPaxlovid and molnupiravir were 32.2% and 67.8% \n\n\n\nrespectively. Reasons for prescribing molnupiravir included \n\n\n\nDDI (43%), nasogastric tube feeding (22%), renal function \n\n\n\nimpairment (eGFR < 30mL/min) (17%), hemodialysis (17%), \n\n\n\nor contraindication to Paxloid (1%). Among Paxlovid DDI, \n\n\n\nthe medications were anticoagulant (N=14), follows by \n\n\n\nstatins (N=12), antipsychotics (N=11), antiarrhythmic agents \n\n\n\n(N=4), narcotic analgesics (N=3) and others (N=8); while the \n\n\n\nrational prescription rate was 88.3%. For efficacy evaluation, \n\n\n\nwe found that the cure rate was 89.8%, all-cause death rate \n\n\n\n7.4%, and oral medication treated failure rate was 4%. \n\n\n\nDuring study period, two cases experienced adverse reactions. \n\n\n\nConclusion: The evaluations of oral COVID-19 medication \n\n\n\nshow that it\u2019s safe and efficient. DDI is the most reason for \n\n\n\nprescribing molnupiravir, but not every DDI needs to avoid \n\n\n\nPaxlovid. It\u2019s reasonable to stop taking current medication or \n\n\n\nreduce the dosage for couple days when taking Paxlovid. \n\n\n\nThus, when pharmacists find that DDI can be managed, we \n\n\n\ncan advise doctors to choose Paxlovid. In the COVID-19 \n\n\n\nepidemic, it\u2019s our duty to make sure every patient can get \n\n\n\ntheir best therapy. \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\nmailto:qwerty1610@gmail.com\n\n\nmailto:achi83109@gamil.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n110 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 090 \n\n\n\n\n\n\n\nRetrospective Study of Drug Use \n\n\n\nAssessment for Plerixafor \n\n\n\n \nWen-Ling Lin1,2*, Yow-Wen Hsieh1,2 \n\n\n\n \n1 Department of Pharmacy, China Medical University Hospital, Taichung, \n\n\n\nTaiwan \n2 Graduate Institute of Pharmacy, China Medical University, Taichung, \n\n\n\nTaiwan \n\n\n\n* Corresponding author \n\n\n\nEmail: u101055002@gmail.com   \n\n\n\n\n\n\n\nBackground and Objectives: Plerixafor is indicated for \n\n\n\npatients with non-Hodgkin's lymphoma or multiple myeloma \n\n\n\nwho require autologous transplantation, but who are poorly \n\n\n\ndriven. In order to use at least one course of G-CSF combined \n\n\n\nwith chemotherapy for stem cell-driven therapy, if the \n\n\n\nnumber of CD34+ cells collected is less than 2 million per \n\n\n\nkilogram of body weight, it can be applied for use. The study \n\n\n\nnoted that the use of lenalidomide was associated with an \n\n\n\nincrease in peripheral blood stem cell collection failures. This \n\n\n\nstudy retrospectively explored the clinical efficacy of \n\n\n\nplerixafor. Methods: Retrospective medical records were \n\n\n\nreviewed from 2016 to 2021 for inpatient data of inpatients \n\n\n\nusing plerixafor. Each patient was used with G-CSF. The \n\n\n\nprimary assessment was the number of CD34+ cells collected \n\n\n\nper kilogram of body weight. It was used for descriptive and \n\n\n\nsimple inferential analysis in Microsoft Excel 2016 version. \n\n\n\nResults and Discussion: A total of 27 patients were included \n\n\n\nin the evaluation, 51.9% were male, and the mean age was \n\n\n\n58.89\u00b18.49 years; 8 patients had CD34+ cells collected over \n\n\n\n2 million per kilogram of body weight; 7 patients were \n\n\n\ndiagnosed with multiple myeloma, Two of the patients were \n\n\n\ntreated with lenalidomide at the same time, and it was found \n\n\n\nthat the collection of CD34+ cells was insufficient and failed, \n\n\n\nand the collection of CD34+ cells in the remaining 25 \n\n\n\npatients increased, with an average of 1.21\u00b11.14 \n\n\n\nCD34+*106/kg. Conclusion: At present, peripheral blood \n\n\n\nautologous hematopoietic stem cell transplantation is an \n\n\n\nimportant treatment option for non-Hodgkin's lymphoma or \n\n\n\nmultiple myeloma, but it may be forced to abandon treatment \n\n\n\ndue to insufficient peripheral blood hematopoietic stem cells. \n\n\n\nTherefore, the combination of plerixafor with G-CSF has \n\n\n\nbeen shown to increase the effect of motile hematopoietic \n\n\n\nstem cells and increase the number of peripheral blood \n\n\n\nhematopoietic stem cells to provide a new treatment option \n\n\n\nfor transplant recipients. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 091 \n\n\n\n\n\n\n\nCase Report of Suspect Adverse Effects of \n\n\n\nPiperacillin/Tazobactam Induced Drug \n\n\n\nFever \n\n\n\n\n\n\n\nHP Liu1*, YC Hsu1, YP Hsing2 \n\n\n\n\n\n\n\n1 Department of Pharmacy, E-Da Cancer Hospital, Kaohsiung, Taiwan, \n\n\n\nR.O.C..  \n2 Department of Pharmacy, E-Da Hospital, Kaohsiung, Taiwan, R.O.C. \n\n\n\n* Corresponding author \n\n\n\nEmail: ed100348@edah.org.tw  \n\n\n\n\n\n\n\nBackground and Objectives: Drug fever is defined as a \n\n\n\nbody temperature exceeding 38\u00b0C, without any detection of \n\n\n\nnew infections or other causes or potential diseases that may \n\n\n\ncause fever. The occurrence of fever when the suspected \n\n\n\nantibiotics (piperacillin/tazobactam) ordered, and subsidence \n\n\n\n48-72 hours after discontinuing the drug. Method: A 59-\n\n\n\nyear-old man was admitted to the hospital on February 16, \n\n\n\n2020 for routine chemotherapy. On March 3, the result of \n\n\n\nblood culture test was Enterobacter cloacae complex, and the \n\n\n\npatient started fever, so ordered piperacillin/tazobactame \n\n\n\n4.5g Q6H IV to treat. After 7 days antibiotic use, he still had \n\n\n\na high fever (up to 39.4\u00b0C), and skin rashes erupted, chest X-\n\n\n\nray examination showed no plaques or lung infiltration. On \n\n\n\nMarch 9, we ruled out drug-fever, discontinued \n\n\n\npiperacillin/tazobactam and switched to ertapenem 1g QD IV. \n\n\n\nScreened regimen only piperacillin/tazobactam could be a \n\n\n\nculprit drug causing drug fever. Result and Discussion: \n\n\n\nAfter discontinued piperacillin/tazobactam for 48 hours, the \n\n\n\nbody temperature returned to normal, and skin rash subsided. \n\n\n\nSome literature reported the average length of drug fever \n\n\n\ncaused by antibiotics is 6-7.8 days, of which \u00df-lactams occurs \n\n\n\nmore frequently. Hypersensitivity reaction is the main \n\n\n\nmechanism of drug fever caused by antibiotics (5% of \n\n\n\npatients will also had skin rash). In this case, the fever \n\n\n\ncontinued during the use of piperacillin/tazobactam, and even \n\n\n\nreached to 39.4\u00b0C on the 7th day. After discontinued \n\n\n\npiperacillin/tazobactam for 48 hours, body temperature \n\n\n\nreturned to normal without other infection signs. So it is \n\n\n\nhighly suspected to be a drug fever caused by \n\n\n\npiperacillin/tazobactam. Conclusion: We hope this case \n\n\n\nwould keep medical staffs alert to identify drug fever timely, \n\n\n\nwhich could avoid unnecessary diagnostic procedures, \n\n\n\ninappropriate treatments, and extended hospital stay. \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:u101055002@gmail.com\n\n\nmailto:ed100348@edah.org.tw\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n111 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 092 \n\n\n\n\n\n\n\nInnovation and Evaluation of the Outdoor \n\n\n\nOutpatient Pharmacy in Response to \n\n\n\nCOVID-19 Epidemic: A Pilot Study at A \n\n\n\nRegional Hospital in Southern Taiwan  \n \n\n\n\nTsun-Pin Liu1, 2, Wen-Jun Wong 1, Heng-Jung \n\n\n\nChen2, Yaw-Bin Huang 3* \n \n1 Department of Pharmacy, St Martin De Porres Hospital, Chiayi, Taiwan, \n\n\n\nROC  \n2 Chung-Jen Junior College of Nursing, Health Sciences and Management, \n\n\n\nChiayi, Taiwan, ROC \n3 School of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan, \n\n\n\nROC \n\n\n\n* Corresponding author \n\n\n\nEmail: LTB007@stm.org.tw  \n\n\n\n\n\n\n\nBackground and Objectives: The COVID-19 Epidemic \n\n\n\nconstituted to the challenges of meeting the medical needs of \n\n\n\ndrugs for the patients who are PCR positive or diagnosed by \n\n\n\nrapid screening, and protection of medical personnel. This \n\n\n\nstudy aims to develop an innovative outpatient pharmacy \n\n\n\nservice in response to the needs for a safe, fast and effective \n\n\n\npharmaceutical service provision. Methods: This study had \n\n\n\nthree stages: (i) co-production of an innovative outdoor \n\n\n\noutpatient pharmacy with the medical team; (ii) \n\n\n\nimplementation of the service innovation from 2022/5/9 to \n\n\n\n2022/5/31; and (iii) service evaluation.  The pharmacists who \n\n\n\nwork at the innovated outdoor pharmacy completed a \n\n\n\nsatisfaction questionnaire. Results and Discussion: The \n\n\n\ninnovative medical prescription by the physician, innovative \n\n\n\ndrug and the relevant information provision by pharmacists \n\n\n\nhave been developed and implemented. It includes \n\n\n\nsimultaneous printing of the consent form to remind the \n\n\n\nissuance, drug interaction and contraindications, dosage \n\n\n\nsuggestions and prompts for the issuance of prescription \n\n\n\ndrugs. A total of 10 questionnaires were completed and \n\n\n\nreturned for evaluation. About 87% of the respondents were \n\n\n\nsatisfied with process practicability, 88% of them reported \n\n\n\nabout easy to learn, 83% with information quality, 86% with \n\n\n\ninterface quality. Overall satisfactory degree 90%. \n\n\n\nConclusion: The innovated Outdoor Epidemic Pharmacy \n\n\n\nwas opened in just 1 weeks and received good satisfaction. It \n\n\n\nsuggested that making good use of information technology \n\n\n\nand medical team coordination and cooperation can result in \n\n\n\nmore comprehensive care for patients. \n\n\n\n\n\n\n\nAbstract 093 \n\n\n\n\n\n\n\nDrug Utilization Evaluation of Remdesivir \n\n\n\nin A Regional Teaching Hospital in \n\n\n\nSouthern Taiwan \n\n\n\n\n\n\n\nBJ Lyu1*, YCHsu1, YP Hsiang2 \n\n\n\n\n\n\n\n1 Department of Pharmacy, E-Da Cancer Hospital, Kaohsiung, Taiwan \n2 Department of Pharmacy, E-Da Hospital, Kaohsiung, Taiwan \n\n\n\n* Corresponding author \n\n\n\nEmail: lyupika@gmail.com  \n\n\n\n\n\n\n\nBackground and Objectives: According to previous \n\n\n\nresearch, remdesivir have shown to shorten the time to \n\n\n\nrecovery in adults who were hospitalized with COVID-19. \n\n\n\nWe brought in remdesivir since 2022 May due to the \n\n\n\npandemic and this study aimed to evaluate the utilization of \n\n\n\nremdesivir in a regional teaching hospital in southern Taiwan. \n\n\n\nMethods: A retrospective study was conducted. We selected \n\n\n\nhospitalized patients from 2022 May to 2022 June who used \n\n\n\nremdesivir as the treatment of COVID-19 disease. We used \n\n\n\ndescriptive statistics to summarise patients\u2019 profiles (contains \n\n\n\nlaboratory data and POMR records) in the inpatient system \n\n\n\nto review whether the adverse drug reactions can be observed.  \n\n\n\nResults and Discussion: There were 10 patients enrolled in \n\n\n\nthis study, 7 males and 3 females. The mean age was \n\n\n\n72.2\u00b113.5 years. 4 patients with cancer comorbidity. The \n\n\n\naverage days from being diagnosed COVID-19 to discharged \n\n\n\n(or expired) was 8.7 days. 2 patients died during the treatment \n\n\n\nperiod, 4 patients discharged while still need self-health \n\n\n\nmonitoring and 4 patients scheduled outpatient department \n\n\n\nfollow-up after discharging. Reason for using remdesivir: 1 \n\n\n\npatient with SPO2 \u226494% on room air ,7 patients required \n\n\n\nsupplemental oxygen (6 patients with at least one risk factor \n\n\n\nfor disease progression) and 2 patients with at least one risk \n\n\n\nfactor for disease progression which defined by the US CDC. \n\n\n\nDue to the small sample size, there were no common adverse \n\n\n\ndrug reactions (ex. GI disturbance, abnormal liver function \n\n\n\nor abnormal renal function) observed in this study. \n\n\n\nConclusion: The utilization of remdesivir in patients with \n\n\n\nolder age or comorbidity is reasonable. We found no \n\n\n\nobservable adverse drug reactions during the treatment. Since \n\n\n\nthere are not enough clinical experience in using remdesivir, \n\n\n\nphysicians and pharmacists should carefully monitor any \n\n\n\nreaction during remdesivir therapy.   \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:LTB007@stm.org.tw\n\n\nmailto:lyupika@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n112 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 094 \n\n\n\n\n\n\n\nSurvival Analysis of COVID-19 Patients \n\n\n\nAdmitted in a Tertiary Government \n\n\n\nHospital in Nueva Ecija: A Preliminary \n\n\n\nReport on the Compassionate Use of \n\n\n\nRemdesivir \n\n\n\n\n\n\n\nLapuz, Huberto F., Estolano, Melvin R., \n\n\n\nMagno, Jem Marie L., De Guzman, Reina \n\n\n\nElizabeth L., Gustilo, Lailanie M., Arriola, \n\n\n\nLordel M., Pascual, Marilou* \n \n\n\n\nDr. Paulino J. Garcia Memorial Research and Medical Center, 3100 Nueva \n\n\n\nEcija, Philippines \n\n\n\n* Corresponding author \n\n\n\nEmail: maluphd@yahoo.com  \n\n\n\n\n\n\n\nBackground and Objectives: A number of research studies \n\n\n\nand clinical trials were initiated in the search for an effective \n\n\n\ndrug for COVID-19. Remdesivir, originally developed \n\n\n\nagainst the Ebola virus, became an early candidate. \n\n\n\nRemdesivir, the first authorized COVID-19 antiviral \n\n\n\nmedication in Europe, received \u201cCompassionate Special \n\n\n\nPermit\u201d for use in hospitals from the Department of Health \n\n\n\n(DOH) and the Philippine Food and Drugs Administration \n\n\n\n(FDA) upon request by health institutions. The provision of \n\n\n\na baseline set of data can provide information for deeper \n\n\n\nstudy of possible contributory factors on the survival of \n\n\n\nCOVID-19 patients. Methods: The study concluded with a \n\n\n\ntotal of 266 patients based on inclusion and exclusion criteria. \n\n\n\n16.92% of COVID-19 patients received remdesivir. Average \n\n\n\nage was 54.8 years and dominantly on patients 50 years old \n\n\n\nand above; and 93.6% of patients were non-healthcare \n\n\n\nworkers. Topping the list of co-morbidities was hypertension \n\n\n\n(52.25%), followed by diabetes mellitus (31.95), and renal \n\n\n\nrelated disease (8.27%). Results and Discussion: Log rank \n\n\n\ntest results showed that there were no significant differences \n\n\n\nbetween the categories of sexes (p=0.214), exposure \n\n\n\n(p=0.727), and occupation (unable to test for difference) with \n\n\n\nregards to survival under remdesevir. Likewise, there were \n\n\n\nalso no noted significance in comparing the survival of each \n\n\n\ncategory between treatments. Over-all survival probability \n\n\n\non the comparison of the Kaplan-Meier Curves between \n\n\n\nRemdesevir and Non-remdesevir treatments showed a non-\n\n\n\nsignificant logrank value (p=0.536). Univariate Cox \n\n\n\nproportional hazard regressions results showed age \n\n\n\n(HR=1.065), oxygen saturation (HR=0.878), and ventilator \n\n\n\ndays (HR=0.748) to be significant factors on the survivability \n\n\n\nof COVID-19 patients under remdesevir group. Conclusion: \n\n\n\nThe there was a significant higher risk of death in male \n\n\n\npatients, who has a high BMI, with elevated renal markers or \n\n\n\nhave renal related diseases and with longer hospital stay. The \n\n\n\ncurrent studies concluded that early remdesivir treatment \n\n\n\nfrom symptom onset may have better clinical outcomes.   \n\n\n\n\n\n\n\nAbstract 095 \n \n\n\n\nThe Prevalence of Pill Dysphagia Among \n\n\n\nAdult Hospitalised Patients in Hospital \n\n\n\nAngkatan Tentera Tuanku Mizan \n\n\n\n(HATTM) \n\n\n\n\n\n\n\nNorlizawati Moktar1*, Rosman Ab Rahman1, \n\n\n\nNurul Amirah Daud1, Rosmaliah Alias2, \n\n\n\nMohd Shahezwan Abd Wahab3, Mohammad \n\n\n\nHalif Mohamad Yusof1, Mohd Adlan Adnan4, \n\n\n\nA Halim Hj Basari4 \n \n1 Department of Pharmacy, Tuanku Mizan Armed Forces Hospital, Kuala \n\n\n\nLumpur, Malaysia. \n2 Hospital Kuala Lumpur, Kuala Lumpur, Malaysia \n3 Faculty of Pharmacy, Universiti Teknologi MARA, Selangor, Malaysia. \n4 Malaysian Armed Forces Health Service Division, Kuala Lumpur, \n\n\n\nMalaysia. \n\n\n\n* Corresponding author \n\n\n\nEmail: liza_moktar@yahoo.com  \n\n\n\n\n\n\n\nBackground and Objectives: Pill dysphagia can be due to \n\n\n\ndysphagia or drug-induced dysphagia. This problem can lead \n\n\n\nto non-compliance. This study aimed to determine the \n\n\n\nprevalence of pill dysphagia, identify interventions by \n\n\n\npharmacists and evaluate the appropriateness of Pill-5 \n\n\n\nQuestionnaire (P-5Q) as an assessment tool. Methods: A \n\n\n\ncross-sectional study was done from July to August 2022 \n\n\n\naccording to all inclusion criteria. The P-5Q was used to \n\n\n\nassess patients with pill dysphagia and pharmacists will \n\n\n\nperform medication reviews. Results and Discussion: The \n\n\n\nprevalence of pill dysphagia among adult hospitalized \n\n\n\npatients in HATTM was 4.04% (n=8). Interventions have \n\n\n\nbeen done by pharmacists whereby 62.5% (n=5) of patients \n\n\n\nwere suggested to have alternatives dosage forms, 12.5% \n\n\n\n(n=1) were suggested to switch to smaller size pills, 12.5% \n\n\n\n(n=1) were suggested with alternative drugs with a lesser \n\n\n\nanticholinergic burden score and 12.5% (n=1) has no \n\n\n\nintervention performed. From P-5Q analysis, there were \n\n\n\nsignificant differences between patients without pill \n\n\n\ndysphagia (M=0.38, SD=0.999) and patients with pill \n\n\n\ndysphagia (M=12.00, SD=2.796); p < 0.01. There were also \n\n\n\nsignificant differences between both groups for all five \n\n\n\nquestions in P-5Q ; p < 0.01. Conclusion: Pill dysphagia \n\n\n\npatients were detected in this study by using P-5Q as an initial \n\n\n\nscreening tool. Pharmacists can play a vital role to increase \n\n\n\npatient safety and compliance by doing a medication review. \n\n\n\n \n\n\n\n\nmailto:maluphd@yahoo.com\n\n\nmailto:liza_moktar@yahoo.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n113 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 096 \n \n\n\n\nStandardization of Medication Bin \n\n\n\nLabelling with Quick Reference \n\n\n\nInformation to Reduce Medication Error \n\n\n\nand Improve Caller Waiting Time \n\n\n\n\n\n\n\nNursyafiqah Moideen*, Norfaizah Bachok \n \n\n\n\nPharmacy Services, KPJ Bandar Maharani Specialist Hospital, Malaysia \n\n\n\n* Corresponding author \n\n\n\nEmail: n.fiqah@kpjmaharani.com  \n\n\n\n\n\n\n\nBackground and Objectives: To reduce 100% medication \n\n\n\nerrors related to wrong information given during phone \n\n\n\nconversation and to improve caller waiting time (targeted 50% \n\n\n\nreduction) for Prescriber & Staff Nurses while calling \n\n\n\nPharmacy to obtain medication\u2019s information. Methods: \n\n\n\nThis project began in the 4th quarter 2020 and went on until \n\n\n\nJune 2021 involving three phases. In phase 1, list of problems \n\n\n\nthat leads to medication error and increase caller waiting time \n\n\n\nwere identified such as time consuming by the Pharmacy \n\n\n\nStaff to read medication leaflet, MIMS Drug Reference or \n\n\n\nBNF (British National Formulary) thus it will increase caller \n\n\n\nwaiting time. We had also listed the frequently ask questions \n\n\n\nfrom the prescriber or Staff Nurses when they called \n\n\n\nPharmacy for medications\u2019 information. Phase 2 project was \n\n\n\nto eliminate the problem by developing a standardized \n\n\n\nmedication bin labelling with quick reference tools on the \n\n\n\nlabel such as medication\u2019s generic and brand name, Poison \n\n\n\ngroup, storage and stability, special precautions, \n\n\n\nbreastfeeding and pregnancy category, therapeutic category, \n\n\n\nmaximum tolerated dose, route of administration and dilution \n\n\n\nor reconstitution information. Phase 3 is to have a \n\n\n\nsustainability of this project in the future for new medications \n\n\n\nlisted in our hospital formulary. Results and Discussion: \n\n\n\nThe average waiting time required for drug enquiry from \n\n\n\nhealthcare provider was 3.7 minutes before the bin labelling \n\n\n\nimplementation and it has been improved to 15 seconds (93.4% \n\n\n\nwaiting time reductions) post implementation. This \n\n\n\nImplementation had successfully reduced near missed \n\n\n\nmedication error related to wrong information given from 12 \n\n\n\ncases to zero (100% reduction). Furthermore, this \n\n\n\nstandardization was a combination idea of quality \n\n\n\nimprovement project and 5S certification project. 5S which \n\n\n\nconsist of Sort, Straighten, Shine, Standardize and Sustain \n\n\n\nis a practice to organize workplace to create a clean, safe, \n\n\n\norderly, high-performance work environment that promotes \n\n\n\nefficiency. Conclusion: Both study objectives were achieved, \n\n\n\nand continuity of the project should be recommended to \n\n\n\nPharmacy Services in other hospital. This quality \n\n\n\nimprovement project had tremendously improved Pharmacy \n\n\n\nstaffs confident level, knowledge and their work efficiency. \n\n\n\n\n\n\n\nAbstract 097 \n \n\n\n\nDisaster Management Zone (DMZ): \n\n\n\nMilitary Pharmacists\u2019 Unconventional \n\n\n\nInnovation in Responding to Health Threats \n\n\n\n\n\n\n\nNurul Amirah Daud1*, Norlizawati Moktar1, \n\n\n\nMohammad Halif Mohamad Yusof2, Mohd \n\n\n\nAdlan Adnan2, A Halim Hj Basari2 \n \n1 Department of Pharmacy, Tuanku Mizan Armed Forces Hospital, Kuala \n\n\n\nLumpur, Malaysia. \n2Malaysian Armed Forces Health Service Division, Kuala Lumpur, Malaysia. \n\n\n\n* Corresponding author \n\n\n\nEmail: nurulamirahdaud.milrph@gmail.com  \n\n\n\n\n\n\n\nBackground and Objectives: The COVID-19 pandemic is \n\n\n\nan unprecedented public health emergency that caused the \n\n\n\nhealthcare system under immense pressure, especially in \n\n\n\nKlang Valley.  In response to this, Tuanku Mizan Armed \n\n\n\nForces Hospital launched its DMZ to curb this issue. Located \n\n\n\nat the hospital basement car park, DMZ has catered for a total \n\n\n\nof 1079 COVID-19 patients from categories 4 and 5. This \n\n\n\npaper intends to underline operational and strategic revamp \n\n\n\nadapted by military pharmacists especially when DMZ was \n\n\n\noperated after 36 hours of activation with limited manpower. \n\n\n\nMethods: Strategies employed throughout DMZ operation \n\n\n\ninclude: (1) Weekly stock monitoring to ensure all-time \n\n\n\nmedications and consumables readiness; (2) Daily \n\n\n\nstocktaking in Red Zone by pharmacy personnel to prevent \n\n\n\nexcessive unused medications; (3) Medication reconciliation, \n\n\n\npharmacotherapy rounds and medication counseling by \n\n\n\nwhich initiatives done to reduce exposure to COVID-19. \n\n\n\nResults and Discussion: All patients received medications \n\n\n\nas per clinical needs, evidenced by zero stock-out issues. \n\n\n\nReduce unused and returned medications in Red Zone at the \n\n\n\nend of operation compared to early operation days. \n\n\n\nMedication safety was guaranteed, as evidenced by 129 \n\n\n\nmedication errors successfully intervened. Rapid provision \n\n\n\nof medications and counseling with minimal contact. \n\n\n\nConclusion: DMZ has leveraged military pharmacists in \n\n\n\nmanaging medication supply, maintaining pharmaceutical \n\n\n\ncare, and responding quickly to the call of emergency relief \n\n\n\noperations. This paper serves as a guide for standard \n\n\n\noperating procedures (SOPs) development in managing \n\n\n\nfuture health emergencies. \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:n.fiqah@kpjmaharani.com\n\n\nmailto:nurulamirahdaud.milrph@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n114 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 098 \n\n\n\n\n\n\n\nPrescription Error in Tertiary Military \n\n\n\nHospital \u2013 Prevalence and Pattern \n\n\n\n\n\n\n\nNurul Amirah Daud1*, Norlizawati Moktar1, \n\n\n\nMohammad Halif Mohamad Yusof2, Mohd \n\n\n\nAdlan Adnan2, A Halim Hj Basari2 \n\n\n\n \n1 Department of Pharmacy, Tuanku Mizan Armed Forces Hospital, Kuala \n\n\n\nLumpur, Malaysia. \n2 Malaysian Armed Forces Health Service Division, Kuala Lumpur, \n\n\n\nMalaysia. \n\n\n\n* Corresponding author \n\n\n\nEmail: nurulamirahdaud.milrph@gmail.com  \n \n\n\n\nBackground and Objectives: Prescription error accounts \n\n\n\nfor most medication errors reported in Malaysian tertiary \n\n\n\nhospitals. With the limitations of digital hospital \n\n\n\nmanagement systems, manual prescribing is susceptible to \n\n\n\nhuman error. Identification of the prevalence and pattern of \n\n\n\nprescription errors in an inpatient tertiary military hospital is \n\n\n\ndeemed necessary to formulate appropriate solutions. \n\n\n\nMethods: A retrospective study was conducted over 1 month \n\n\n\nby inpatient pharmacists and assistant pharmacists using a \n\n\n\nstandardised data collection form. Data taken from inpatient \n\n\n\nprescriptions from all wards excluding intensive care unit \n\n\n\n(ICU) throughout May 2019. Errors were classified into \n\n\n\nomission errors, commission errors, inappropriate \n\n\n\nprescriptions, and miscellaneous. A comparison of \n\n\n\nprescribing errors between different categories of prescribers \n\n\n\nis also analysed. All results were expressed as percentages. \n\n\n\nResults and Discussion: Prescribing errors in the hospital \n\n\n\nward are within the range of similar studies conducted both \n\n\n\nlocally and internationally. Most come from omission errors \n\n\n\nthat are less likely to cause harm. This might be contributed \n\n\n\nto a lack of training on proper prescribing, since most medical \n\n\n\nofficers came from various military unit backgrounds. The \n\n\n\npercentage of prescribing errors in the pediatric ward is \n\n\n\nhigher than that in the surgical and medical wards. By \n\n\n\ncategory of prescribers, prescribing errors are predominated \n\n\n\nby junior prescribers, despite prescriptions being \n\n\n\ncountersigned by senior doctors. Conclusion: Prescription \n\n\n\nerror is moderately prevalent in Tuanku Mizan Armed Forces \n\n\n\nHospital, but its pattern varies from pre-existing studies. \n\n\n\nIntroduction of e-prescription and continuous education on \n\n\n\nGood Prescribing Practice can reduce prescription errors. \n\n\n\nFuture research should incorporate patient clinical data to \n\n\n\nensure precise clinical judgment on drug regimen selection. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 099 \n\n\n\n\n\n\n\nSystematic Review on Questionnaires to \n\n\n\nMeasure Medication Knowledge in Post \n\n\n\nKidney Transplant Recipients \n\n\n\n\n\n\n\nNurul Syazfeeza Samsudin1*, Nurkasihan \n\n\n\nIbrahim2, Mohd Shahezwan Abd Wahab2, \n\n\n\nJasmine Shan Lii Ching3, Mohd Adlan Adnan1, \n\n\n\nA Halim Hj Basari1 \n \n1 Malaysian Armed Forces Health Service Division, Kuala Lumpur, \n\n\n\nMalaysia. \n2 Faculty of Pharmacy, Universiti Teknologi MARA, Puncak Alam, \n\n\n\nSelangor, Malaysia \n3Department of Pharmacy, Kuala Lumpur Hospital, Kuala Lumpur, \n\n\n\nMalaysia. \n\n\n\n* Corresponding author \n\n\n\nEmail: nurul.syazfeeza86@gmail.com  \n\n\n\n\n\n\n\nBackground and Objectives: Good understanding of \n\n\n\nimmunosuppressants (IS) among post kidney transplant \n\n\n\nrecipients (KTR) is associated with better outcomes. The \n\n\n\nlevel of medication knowledge in this population is \n\n\n\ncommonly obtained from transplant-specific questionnaires. \n\n\n\nWe aimed to identify the constructs and quality limitations of \n\n\n\nthe questionnaires that have been used to measure knowledge \n\n\n\non IS in KTR. Methods: Relevant articles were identified \n\n\n\nfrom PubMed, MEDLINE, CINAHL, Web of Science, \n\n\n\nCochrane Library, and Scopus for all periods until July 2021. \n\n\n\nSearch terms were derived from three keywords: \u2018kidney \n\n\n\ntransplant patients,\u2019 \u2018assessment tools,\u2019 and \u2018drug \n\n\n\nknowledge.\u2019 The criteria for relevant articles were: 1) English \n\n\n\nlanguage, 2) involved adult KTR and 3) original article on \n\n\n\nthe validation of transplant-specific questionnaires that \n\n\n\nmeasure knowledge on IS therapy or the first published \n\n\n\narticle using the questionnaire as a tool to measure \n\n\n\nknowledge on IS therapy. Constructs were identified by \n\n\n\nextracting questions related to IS knowledge. The quality of \n\n\n\nthe questionnaires was evaluated using the COnsensus-based \n\n\n\nStandards for the selection of health Measurement \n\n\n\nINstruments (COSMIN) checklist. Four reviewers were \n\n\n\ninvolved throughout this study. Results and Discussion: The \n\n\n\nsearch yielded 5,216 articles, of which ten fulfilled the \n\n\n\ninclusion criteria. These ten articles reported on eight \n\n\n\nquestionnaires involving eight countries. Fifty-one questions \n\n\n\nrelated to IS knowledge were extracted from a total of 121 \n\n\n\nquestions (42%). The primary constructs derived include 1) \n\n\n\nknowledge on the importance of IS medications; 2) \n\n\n\nknowledge on handling IS; 3) knowledge of the treatment \n\n\n\noutcomes. All eight questionnaires demonstrated insufficient \n\n\n\ncontent validity and low-level evidence for internal \n\n\n\nconsistency. Conclusion: The current transplant-specific \n\n\n\nquestionnaires are incomprehensive to measure IS \n\n\n\nknowledge, and the majority had inadequate evidence of \n\n\n\nvalidity and reliability. Future studies should aim to develop \n\n\n\n\nmailto:nurulamirahdaud.milrph@gmail.com\n\n\nmailto:nurul.syazfeeza86@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n115 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nvalidated questionnaires to measure the knowledge on IS \n\n\n\ntherapy among KTR with appropriate constructs.  \n\n\n\nAbstract 100 \n \n\n\n\nRelationship of Nutritional Status and \n\n\n\nSepsis Mortality  \n\n\n\n\n\n\n\nRoongthip Tangsaghasaksri* \n \n\n\n\nPharmacy Department, Rajavithi Hospital, Bangkok, Thailand. \n\n\n\n* Corresponding author \n\n\n\nEmail: rtangsagha@gmail.com  \n \n\n\n\nBackground and Objectives: Sepsis is a complex, \n\n\n\ndangerous illness that leads to a critical condition and is the \n\n\n\nleading cause of death among hospital patients. It was found \n\n\n\nthat nutritional status had an impact on survival and the \n\n\n\nmortality rate of critically ill patients. It is associated with \n\n\n\norgan failure, risk of complications and death. Objectives are \n\n\n\nto study the relationship between nutritional status and \n\n\n\nmortality of sepsis patients in Rajavithi Hospital also to study \n\n\n\nfactor related to sepsis mortality. Methods: This study was \n\n\n\nconducted by collecting data from patients admitted to \n\n\n\nRajavithi Hospital between January and December 2019 who \n\n\n\nwas diagnosed by a physician as having sepsis, have the \n\n\n\nresults of the screening (SPENT nutrition screening tool) or \n\n\n\nnutritional assessment (nutrition alert form(NAF)). Results \n\n\n\nand Discussion: Of the 808 patients diagnosed with sepsis, \n\n\n\n475 were female, 333 were male, and 400 died (49.5%). The \n\n\n\nmean age of the deceased patients was 65.61\u00b116.48 years. \n\n\n\nThe prevalence of malnutrition in patients with sepsis was \n\n\n\n71.2%. Patients at risk of malnutrition have significantly \n\n\n\nhigher mortality. When analyzing factors contributing to \n\n\n\nmortality among sepsis patients, it was found that patients \n\n\n\nover 60 years of age (> 2times), patients with septic shock \n\n\n\n(4.26 times), patients receiving parenteral nutrition(PN) \n\n\n\n(3.53 times), patients receiving both enteral nutrition(EN) \n\n\n\nand PN (3.75 times), patients with kidney disease (2.04 \n\n\n\ntimes), patients with cancer (1.92 times) , patients treated \n\n\n\nwith vancomycin (1.64 times) and colistin (1.93 times) were \n\n\n\nsignificantly associated with higher mortality than those \n\n\n\nwithout the aforementioned factors. The likelihood of death \n\n\n\nwas reduced by 38and 52 percent in patients receiving \n\n\n\nquinolone and metronidazole respectively. Conclusion: \n\n\n\nAlthough sepsis patients with malnutrition died more than \n\n\n\npatients who has normal nutritional status, administration of \n\n\n\nPN or both EN and PN did not reduce mortality. Sepsis \n\n\n\npatients with septic shock, age over 60 years, has underlying \n\n\n\nof kidney disease or cancer had higher risk of mortality. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 101 \n \n\n\n\nApplying Quality Control Tool Improves \n\n\n\nthe Conformance Rate of Microbial \n\n\n\nMonitoring Performed by Chemotherapy \n\n\n\nPharmacists \n\n\n\n\n\n\n\nShu-Chuan Pi1*, Yi-Ping Hsiang2, Li-Ching \n\n\n\nChang1,3 \n  \n1 Department of Pharmacy, E-DA Cancer Hospital, Kaohsiung, Taiwan.  \n2 Department of Pharmacy, E-Da Hospital, Kaohsiung, Taiwan.  \n3 School of Medicine, I-Shou University, Kaohsiung, Taiwan. \n\n\n\n* Corresponding author \n\n\n\nEmail: ed100221@gmail.com  \n\n\n\n\n\n\n\nBackground and Objectives: Chemotherapy injections are \n\n\n\nhazardous drugs \u2013 if they are not handled properly then they \n\n\n\nwill cause health hazards to related personnel and the \n\n\n\nenvironment. Given that non-conformance cases in routine \n\n\n\nmicrobiological monitoring of biosafety cabinet  (BSC) by \n\n\n\nchemotherapy pharmacists in our hospital, therefore we \n\n\n\ndecide to kick off a quality improvement project. Methods: \n\n\n\nThis study was brainstormed by the member of the \n\n\n\nchemotherapy pharmacist to address the non-conformance \n\n\n\nincidents in microbiological monitoring operation of the BSC \n\n\n\nperformed. The characteristic factor diagram combined with \n\n\n\nthe Plan-Do-Check-Act (PDCA) method to formulate \n\n\n\nimprovement strategy. 1. Strengthen the orientation training \n\n\n\nof newcomers to chemotherapy: (1) Introduce virtual reality \n\n\n\n(VR) teaching; (2) use simulated teaching props to shoot \n\n\n\nnewcomer execution videos. Only after discussion and \n\n\n\nfeedback can they be officially launched. 2. Strengthen the \n\n\n\nwork flow: (1) Revise the direct observation of procedural \n\n\n\nskills (DOPS) for microbial monitoring for the error-prone \n\n\n\nand neglected steps; (2) formulate the teaching and \n\n\n\nevaluation by dedicated pharmacists to ensure the accuracy \n\n\n\nand consistency of learning. Results and Discussion: \n\n\n\nComparing data before (2017/01-2018/12) and after \n\n\n\n(2019/01-2022/06) project implementation, the BSC sterility \n\n\n\nconformance rate was raised from 83.3% to 96.7%. The \n\n\n\nDOPS score increased from 85.7 points to 95.8 points. The \n\n\n\noverall satisfaction rate is more than 4 points based on the \n\n\n\nLikert scale 5 point method. The most satisfying part is \n\n\n\n\"shooting newcomers execution videos\" and \"DOPS \n\n\n\nassessment\" (5 points), followed by \"teaching and evaluation \n\n\n\nby dedicated pharmacists\" (4.75\u00b10.45) and \"VR reality \n\n\n\nteaching\" (4.42\u00b10.51). Conclusion: Through process \n\n\n\nreengineering and refined personnel education, it can \n\n\n\neffectively improve the non-conformance events of the \n\n\n\npharmacist performing microbial monitoring operations. \n\n\n\nHowever, the follow-up should continue to analyse, review \n\n\n\nand revise the relevant operating procedures at any time. \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:rtangsagha@gmail.com\n\n\nmailto:ed100221@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n116 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 102 \n \n\n\n\nThe Role of High Serum Uric Acid Levels \n\n\n\nin Androgenic and Non-Androgenic \n\n\n\nPolycystic Ovarian Syndrome Patients \n\n\n\n\n\n\n\nSrinivasa Babu Puttagunta1*, Ranakishor \n\n\n\nPelluri1, Srikanth Kongara2 \n\n\n\n\n\n\n\n1 Department of Pharmacy Practice, Vignan Pharmacy College, Vadlamudi, \n\n\n\n522213, Guntur, Andhra Pradesh, India.  \n2 Department of Endocrinology and Metabolism, Endo-Life Speciality \n\n\n\nHospital, Guntur, 522001, Andhra Pradesh, India. \n\n\n\n* Corresponding author \n\n\n\nEmail: psbabu0104@gmail.com  \n\n\n\n\n\n\n\nBackground and Objectives: Serum uric acid (SUA) has \n\n\n\nbeen found to be an independent risk factor for metabolic \n\n\n\nsyndrome (MS). However, the reports pertaining to link \n\n\n\nbetween uric acid levels among the androgenic, non-\n\n\n\nandrogenic (clinical) PCOS subjects are conflicting. Hence, \n\n\n\nit was aimed to determine incidence of hyperuricemia and its \n\n\n\nassociation among the PCOS subjects. Methods: A single \n\n\n\ncentre hospital based cross-sectional study conducted in \n\n\n\nsouth India PCOS subjects during the March 2021 to August \n\n\n\n2021. A total 80 subjects were recruited and were stratified \n\n\n\ninto androgenic and no androgenic PCOS with each of forty \n\n\n\nsubjects in both groups. The incidence of hyper uricemia was \n\n\n\nfound to be 66.25% (n = 53). Results and Discussion: The \n\n\n\nmean and SD values of metabolic components such as \n\n\n\nHbA1C and FPG levels and triglycerides, low density \n\n\n\nlipoproteins and total cholesterol were showing statistically \n\n\n\nsignificant (p < 0.05) among the groups. The circulating sex \n\n\n\nhormone binding globulins (SHBG) are low in both groups. \n\n\n\nThese levels are significantly low in androgenic PCOS \n\n\n\nsubjects. The Total testosterone (TT), SHBG, HOMA-IR and \n\n\n\nLDL levels were positively correlated with both hyper and \n\n\n\nnon-hyper urinemic groups and remaining parameters \n\n\n\nshowed negative correlation. Conclusion: The incidence of \n\n\n\nhyperuricemia is high in PCOS subjects. The TT and SHBG, \n\n\n\nHOMA-IR and LDL levels were positively correlated with \n\n\n\nboth hyper and non-hyper urinemic groups. HbA1C and FPG \n\n\n\nand FSI are negatively correlated among the groups. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 103 \n\n\n\n\n\n\n\nLow-dose Cefepime Efficacy Evaluation \n\n\n\nUsing Real-world Data \n\n\n\n\n\n\n\nTY Yi*, AJ Wu  \n\n\n\n\n\n\n\nDepartment of Pharmacy, Taipei Tzu Chi Hospital, Buddhist Tzu Chi \n\n\n\nMedical Foundation, New Taipei City, Taiwan \n\n\n\n* Corresponding author \n\n\n\nEmail: taiyung.yi@gmail.com  \n\n\n\n\n\n\n\nBackground and Objectives: A review of the cefepime \n\n\n\nmedication records revealed that most physicians prescribed \n\n\n\ndoses within UpToDate's usual range, which is above 2 \n\n\n\ngrams per day, while a few did not exceed 2 grams per day. \n\n\n\nThe purpose of this investigation was to determine whether \n\n\n\nlow-dose cefepime was insufficiently effective. Methods: \n\n\n\nThis retrospective study covered the period from 2016 to \n\n\n\n2021. Inclusion criteria: patients admitted to the hospital who \n\n\n\nreceived cefepime. Exclusion criteria: under the age of 20 or \n\n\n\nnot consecutively using cefepime. Low-dose is defined as a \n\n\n\ndaily dosage not exceeding 2 grams and an eGFR greater than \n\n\n\n60 mL/min/1.73 m2. Propensity score matching was used \n\n\n\nbecause there were few low-dose cases. Gender, age, eGFR, \n\n\n\nCRP, and WBC were used as the matching variables. Effect \n\n\n\nindicators were hospitalization days, medication days, CRP \n\n\n\nchanges, and WBC changes. Two-sample t test was \n\n\n\nperformed. Results and Discussion: There were 41 \n\n\n\nparticipants in each of the low-dose and non-low-dose groups, \n\n\n\nand 26 (63%) of them were males. The mean (SD) of \n\n\n\ncontinuous variables: age was 73.0(16.1) and 73.3(19.6), \n\n\n\neGFR was 93.5(18.9) and 92.4(21.5), WBC was \n\n\n\n8750(6280)/mcL and 10280(6970)/mcL, CRP was 7.1(4.9) \n\n\n\nmg/dL and 6.5(5.7) mg/dL. The results of the efficacy \n\n\n\ncomparison between the low-dose group and the non-low-\n\n\n\ndose group (represented by their respective mean values and \n\n\n\np values): the number of days of medication was 7.4 days, 6.2 \n\n\n\ndays, p = 0.238, the days of hospitalization were 26.4 days, \n\n\n\n28.9 days, p = 0.507, WBC differences were 1000/mcL, \n\n\n\n860/mcL, p=0.888, CRP differences were -1.3mg/dL, -\n\n\n\n0.3mg/dL, p=0.216, all efficacy indicators were not \n\n\n\nstatistically significant. Research limitations include: 1. \n\n\n\nConfounding factors are difficult to control in observational \n\n\n\nstudies; 2. Antibiotic prescriptions are not dependent on test \n\n\n\nresults, and variables have missing values. In the low-dose \n\n\n\ngroup, hospitalizations were slightly lower, but medication \n\n\n\ndays were slightly higher. As there was no statistical \n\n\n\ndifference, it is still necessary to examine whether taking into \n\n\n\naccount efficacy can actually reduce the consumption of \n\n\n\nmedical resources. Conclusion: A low dose was not \n\n\n\nassociated with lower efficacy in this study. Physicians can \n\n\n\nutilize this information in prescribing common dose ranges \n\n\n\nand making clinical decisions. \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:psbabu0104@gmail.com\n\n\nmailto:taiyung.yi@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n117 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 104 \n \n\n\n\nIncidence of Liver Injury in Patients \n\n\n\nInitiated with Antiretroviral Therapy in \n\n\n\nPrimary Care Clinics \n\n\n\n\n\n\n\nKausalya Nawaratnam1, Siow Chia Tay1*, \n\n\n\nSumayyah Shafifi A Karim1, Nur Khalidah \n\n\n\nMohd Musa2 \n\n\n\n \n1 Department of Pharmacy, Cheras Health Clinic, Federal Territory of Kuala \n\n\n\nLumpur & Putrajaya Health Department , Ministry of Health Malaysia  \n2 Department of Pharmacy, Cheras Baru Health Clinic, Federal Territory of \n\n\n\nKuala Lumpur & Putrajaya Health Department, Ministry of Health Malaysia  \n\n\n\n* Corresponding author \n\n\n\nEmail: siowchia@hotmail.com  \n\n\n\n\n\n\n\nBackground and Objectives: Liver injury is an alanine \n\n\n\naminotransferase (ALT) elevation of greater than 1.25 times \n\n\n\nthe upper limit of normal (ULN) values. Drug-induced liver \n\n\n\ninjury affected the clinical use of antiretroviral therapy \n\n\n\n(ART). This study aimed to assess the incidence of liver \n\n\n\ninjury on ART initiation and to identify any contributing risk \n\n\n\nfactors. Methods: We conducted a retrospective cohort study \n\n\n\n(NMRR ID: NMRR-20-1482-54763) involving 362 HIV \n\n\n\npositive patients with normal liver function initiated with \n\n\n\nfirst-line ART in 15 primary health clinics in Kuala Lumpur \n\n\n\nand Putrajaya, Malaysia from May 2017 to December 2019. \n\n\n\nBaseline ALT measurements were recorded and followed up \n\n\n\nmonthly for 12 months. Chi-square and Fisher\u2019s exact tests \n\n\n\nwere used to study the association of liver injury with ART \n\n\n\nregimen, concomitant Pneumocystis carinii pneumonia (PCP) \n\n\n\nprophylaxis and isoniazid prophylaxis therapy (IPT). Cox-\n\n\n\nregression analysis was used to identify risk factors involved.  \n\n\n\nResults and Discussion: Upon ART initiation, the incidence \n\n\n\nof liver injury was 34 cases/100 person-year while that of \n\n\n\nsevere liver injury was 2 cases/100 person-year. Mild and \n\n\n\nmoderate liver injury cases increased over the first three \n\n\n\nmonths of ART exposure and gradually reduced starting \n\n\n\nfourth month. Subjects using Tenofovir/Emtricitabine \n\n\n\nregimen developed higher liver injury risk compared to \n\n\n\nLamivudine/Zidovudine regimen (p=0.035, OR=2.174). No \n\n\n\nsignificant difference was found between subjects using \n\n\n\nEfavirenz and Nevirapine. Concomitant PCP prophylaxis \n\n\n\ndemonstrated significantly lower risk of liver injury (p=0.006, \n\n\n\nOR=0.483) while higher risk was observed with concomitant \n\n\n\nIPT (p=0.019, OR=1.793). Conclusion: In summary, \n\n\n\nmonthly monitoring of liver enzymes was important for the \n\n\n\nfirst three months of ART initiation. Subjects initiated with \n\n\n\ntenofovir/emtricitabine, with concomitant isoniazid therapy \n\n\n\nand without PCP prophylaxis were the high-risk groups that \n\n\n\nrequired close monitoring of the liver enzymes. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 105 \n \n\n\n\nEvaluation of Chinese Herbal Extracts on \n\n\n\nEczema Skin \n\n\n\n\n\n\n\nSC Tseng1, 2*, JS Wang2, MM Lee3  \n \n1 Taiwan Pharmacist Association, Taichung City Pharmacist Association, \n\n\n\nTaichung, Taiwan  \n2 Department of Clinical Research Center of Integrated Medicine, Taichung \n\n\n\nTzu Chi Hospital, Taichung, Taiwan \n3 Department of Food Nutrition and Health Biotechnology, Asia University, \n\n\n\nTaichung, Taiwan \n\n\n\n* Corresponding author \n\n\n\nEmail: bigtree621031@gmail.com  \n\n\n\n\n\n\n\nBackground and Objectives: About 10% people in the U.S. \n\n\n\nhave eczema during their lifetime. Steroids are commonly \n\n\n\nused in treating eczema but can easily lead to many side \n\n\n\neffects. Eczema is often difficult to be cured, and severely \n\n\n\naffects patients\u2019 quality of life. It\u2019s an important issue worth \n\n\n\nfurther study. According to the composition of the traditional \n\n\n\nChinese medicine prescription, \"ku shen si tang\", we add \n\n\n\nother Chinese herbal extracts such as Plectranthus \n\n\n\namboinicus and Salvia plebeia to make a cream. It is applied \n\n\n\nto the affected area of eczema. Methods: This study was \n\n\n\nconducted in the Department of Traditional Chinese \n\n\n\nMedicine of Taichung Tzu Chi Hospital, from April to \n\n\n\nNovember in 2021. Patients aged 20 to 80 years old \n\n\n\ndiagnosed with eczema were included in the study. The \n\n\n\nexperimental cream was applied to the lesion twice a day. \n\n\n\nThree questionnaires (DLQI, SCORAD, and EASI) were \n\n\n\nused every two weeks to evaluate the outcome, and there \n\n\n\nwere 6 visits during this 12 weeks study. Results and \n\n\n\nDiscussion: We recruited finally 10 cases. The statistical \n\n\n\nresults of DLQI were highly affected to mildly affected (16.2 \n\n\n\nto 4.5); of SCORAD were moderately affected to mildly \n\n\n\naffected (34.52 to 10.42); and of EASI were mildly affected \n\n\n\nto mildly affected (4.98 to 1.39). All of those were showed \n\n\n\nsignificantly improved after treatments. Conclusion: The \n\n\n\ncream formulation of Chinese medicine extracts is effective \n\n\n\nin treating patients with eczema and has no side effects. \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:siowchia@hotmail.com\n\n\nmailto:bigtree621031@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n118 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 106 \n \n\n\n\nInterprofessional Collaborative Practice in \n\n\n\nHIV Patient: Role of Pharmacist in A \n\n\n\nRegional Hospital \n\n\n\n\n\n\n\nTsung Wei Chang1*, Chun-Ya Huang2, Wen-\n\n\n\nJin Tung1 \n\n\n\n  \n1 Department of Pharmacy, Yuanlin Christian Hospital    \n2 Infection control center, Yuanlin Christian Hospital \n\n\n\n* Corresponding author \n\n\n\nEmail: howard6204@gmail.com  \n\n\n\n\n\n\n\nBackground and Objectives: Dispensing and providing \n\n\n\nmedication is basic service in regional hospital pharmacy \n\n\n\nsetting. With the progress of diverse pharmaceutical care \n\n\n\nprovided by clinical pharmacist, our hospital has also \n\n\n\nimplemented pharmacy service for HIV patient and \n\n\n\npharmacist cooperated with different medical staff such as \n\n\n\nphysician and HIV case manager. In this article, we would \n\n\n\nlike to share our experience and common drug-related \n\n\n\nproblems during providing HIV care. Methods: Since 2019, \n\n\n\nour infection department decided to provide medical service \n\n\n\nfor HIV patient. According to the project from Centers for \n\n\n\nDisease Control, Ministry of Health and Welfare in Taiwan, \n\n\n\npharmacists were regulated to be one of a member in HIV \n\n\n\npatient care team. We collected pharmaceutical care related \n\n\n\nto HIV care form 2019-2022. Results and Discussion: \n\n\n\nPharmacists were got involved in rural health care with \n\n\n\nphysician and HIV case manager monthly, and we can \n\n\n\ncommunicate with each other via face to face, social software \n\n\n\nor phone call smoothly. Pharmacists were also responsible \n\n\n\nfor patient or health care member education, such as \n\n\n\ndelivering speech \u201cNovel trend in antiviral agent in HIV\u201d or \n\n\n\n\u201calleviating discrimination in HIV patient\u201d. Additionally, we \n\n\n\nprovided thirty interaction-related consultations for HIV \n\n\n\npatients. Among these consultations, we found interactions \n\n\n\nbetween nutrition supplements and antiretroviral drugs were \n\n\n\nasked most frequently. Conclusion: Pharmacists can be in \n\n\n\ndifferent clinical teams and collaborate with others \n\n\n\nprofessionals\u2019 members. With the pharmacy service, drug-\n\n\n\nrelated problem form HIV patients can be solved. It might \n\n\n\nincrease the drug compliance and enhance better disease \n\n\n\ncontrol. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 107 \n \n\n\n\nThe Prevalence of Major Drug\u2013drug \n\n\n\nInteractions in Patients Treated with \n\n\n\nNirmatrelvir plus Ritonavir: A \n\n\n\nRetrospective Study \n\n\n\n\n\n\n\nTu Po-Yang1*, Liu Min-Li 1, Hsu Yung-Chia 1, \n\n\n\nHsiang Yi-Ping2 \n\n\n\n \n1 Department of Pharmacy, E-Da Cancer Hospital, \n2 Department of Pharmacy, E-Da Hospital, Kaohsiung, Taiwan, R.O.C \n\n\n\n* Corresponding author \n\n\n\nEmail: kenny42064206@gmail.com  \n\n\n\n\n\n\n\nBackground and Objectives: Nirmatrelvir plus ritonavir \n\n\n\n(Paxlovid\u00ae) is an antiviral agent, which is used as the \n\n\n\ntreatment of mild to moderate Coronavirus Disease (COVID-\n\n\n\n19). Ritonavir is a potent CYP3A4 inhibitor that interacts \n\n\n\nwith many other medications.  We assessed the prevalence of \n\n\n\nmajor drug-drug interactions (DDIs) among patients who \n\n\n\nwere prescribed Paxlovid \u00ae and summarised the data to find \n\n\n\nout which drug class may be commonly involved in major \n\n\n\nDDI with Paxlovid\u00ae. Methods: We utilized our hospital\u2019s \n\n\n\ncomputer-based medication prescription system to search for \n\n\n\nthe DDIs between Paxlovid\u00ae and other medications. The \n\n\n\nlevel of drug-drug interaction was identified mainly by the \n\n\n\nwebsite, Liverpool and manual screening methods. We \n\n\n\ncategorized the drug related to major DDI according to their \n\n\n\ndrug class. Results and Discussion: We collected the data \n\n\n\nfrom June to July in 2022. In the 203 patients included in this \n\n\n\nstudy, 188 patients from out-patients and 15 from emergency, \n\n\n\n92 major DDIs were found in 50 (24.6%) patients. 72 major \n\n\n\nDDIs were classified as \u201cpotential interaction\u201d and 20 DDIs \n\n\n\nclassified as \u201cDo Not Coadminister\u201d. Cardiovascular \n\n\n\nmedications were most associated with major DDIs, and \n\n\n\npsychotropic medications took the second place. In \n\n\n\ncardiovascular medications, atorvastatin and rosuvastatin \n\n\n\nwere concerned in most major DDIs cases. Clonazepam, \n\n\n\ntriazolam and silodosin were the most common medications \n\n\n\nwhich were contraindicated with Paxlovid \u00ae. Conclusion: \n\n\n\nPatients on Paxlovid\u00ae therapy may be at risk of potential \n\n\n\nDDIs. This study provided a descriptive statistic to the \n\n\n\nprevalence of DDIs in patients treated with Paxlovid\u00ae. \n\n\n\nPharmacists should be more aware of these frequent DDIs \n\n\n\nand manage them properly. \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:howard6204@gmail.com\n\n\nmailto:kenny42064206@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n119 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 108 \n \n\n\n\nUsing Plan-Do-Check-Action Management \n\n\n\nMethods to Improve Medication Errors in \n\n\n\nTaiwan Hospital \n\n\n\n\n\n\n\nYih-Dih Cheng1,2*, Wei-Ning Yu1,2, Sonia \n\n\n\nChen1,3, Chun-Ju Kuo1, Yo-Wen Hsieh1, 2 \n\n\n\n \n1 Department of Pharmacy, China Medical University Hospital, Taichung, \n\n\n\nTaiwan \n2 School of Pharmacy, China Medical University, Taichung, Taiwan \n3 Department of Health Services Administration, China Medical University, \n\n\n\nTaichung, Taiwan \n\n\n\n* Corresponding author \n\n\n\nEmail: tovis168@gmail.com  \n\n\n\n\n\n\n\nBackground and Objectives: The percentage of medication \n\n\n\nerrors was found about 36% (24,846/68,203) in hospital \n\n\n\naccording to the Annual Report 2020 of Taiwan Patient-\n\n\n\nsafety Reporting System. The rate of medication error is \n\n\n\nabout 0.0145% (2,695/18,551,036) in our hospital in 2020. \n\n\n\nThe objective of this study was to evaluate whether using \n\n\n\nPlan-Do-Check-Action (PDCA) management methods to \n\n\n\nimprove medication error at each stage of the medication \n\n\n\nprocess. Methods: The study was conducted in a 2,111-bed \n\n\n\ncare academic medical center located in central Taiwan. We \n\n\n\nassessed the error rates of medications at each stage of the \n\n\n\nmedication process before and after implementing eight \n\n\n\nPDCA management methods, including all patient \n\n\n\nprescriptions from January 2020 to June 2022. PDCA cycle \n\n\n\nis also known as the quality cycle, which is a general model \n\n\n\nin the management model. Results and Discussion: Six \n\n\n\nmajor problems were found after reviewing the medication \n\n\n\nprocess, and the eight PDCA strategy and effectiveness \n\n\n\nverification are as follows: PDCA strategy 1~4 \u2013 Reducing \n\n\n\nthe medication error of the physician's prescription. The error \n\n\n\nrate of prescribing was significantly reduced from 0.0175% \n\n\n\n(Q1/2020) to 0.0044% (Q2/2022) (p < 0.005) after using \n\n\n\nPDCA strategy 1~4. PDCA strategy 5~7 \u2013 Reducing the \n\n\n\nmedication error of the pharmacist dispensing. The error rate \n\n\n\nof dispensing was reduced from 0.0041% (Q1/2020) to \n\n\n\n0.0007% (Q2/2022) (p < 0.005) after using PDCA strategy \n\n\n\n5~7. PDCA strategy 8 \u2013 Reducing the medication error of the \n\n\n\nnursing administration. Implementation of automated \n\n\n\ndispensing cabinet (ADC). The rate of administering error \n\n\n\nwas reduced from 0.0003% (Q1/2020) to 0.0001% (Q2/2022) \n\n\n\n(p = 0.207) after using PDCA strategy 8. The medication \n\n\n\nerror rate was significantly decreased about 75% from 0.0221% \n\n\n\n(Q1/2020) to 0.0055% (Q2/2022) (p < 0.005) through \n\n\n\ncontinuous improvement for about two years using eight \n\n\n\nPDCA strategies in our hospital. Conclusion: Repeated \n\n\n\nPDCA cycles could significantly decrease the incidence of \n\n\n\nmedication errors at each stage of the medication process, \n\n\n\nreduce potential medical risks, and ensure the safety of drug \n\n\n\nuse in patients. Overall, our results suggest that the PDCA \n\n\n\nmanagement methods deserves strong consideration as a tool \n\n\n\nto reduce medication error and to improve patient safety. \n\n\n\n\n\n\n\nAbstract 109 \n \n\n\n\nEvaluation of the Appropriateness of \n\n\n\nAntibiotics Doses in Critically Ill Patients \n\n\n\nReceiving Extracorporeal Membrane \n\n\n\nOxygenation System [ECMO] \n\n\n\n\n\n\n\nWen-Hwang Chen1,2*, Chu-Chen, Cheng1,2 \n\n\n\n\n\n\n\n1 Department of Pharmacy, Tungs' Taichung MetroHarbor Hospital, \n\n\n\nTaiwan. \n2 Taichung City New Pharmacist Association, Taichung, Taiwan \n\n\n\n* Corresponding author \n\n\n\nEmail: t2619@ms.sltung.com.tw \n \n\n\n\nBackground and Objectives: Interactions between ECMO \n\n\n\nequipment materials and antibiotics had changed human \n\n\n\nhemodynamics and antibiotics pharmacokinetics. This \n\n\n\nsituation may affect the efficacy of the drug or increase the \n\n\n\npossibility of related adverse reactions, so whether the dosage \n\n\n\nof the drug needed adjustment became an important issue in \n\n\n\nthis type of patients. Here we tried to analyse and determine \n\n\n\nthe rationality of antibiotic dosage in our hospital for patients \n\n\n\nwith ECMO. Methods: This study is a retrospective clinical \n\n\n\nstudy analysis. Data collected from 2018.01.01 to 2019.09.30. \n\n\n\nA total of 46 patients with conditions that needed ECMO \n\n\n\nsupport were used to analyse the difference and rationality \n\n\n\nbetween the antibiotic dose and the dose recommended in the \n\n\n\nliterature. Results and Discussion: In these 46 patients, a \n\n\n\ntotal of 105 doses of antibiotics were given, of which 58.1% \n\n\n\nadhered to the dosing recommendations for patients on \n\n\n\nECMO. In this 58.1% ,  piperacillin/tazobactam accounted \n\n\n\nthe highest at 19.7% followed by ceftriaxone 16.4%, and \n\n\n\nvancomycin 16.4%, imipenem/cilastatin 14.8%, cefazolin \n\n\n\n13.1%, gentamicin 6.6%, levofloxacin 3.3%, moxifloxacin \n\n\n\n3.3%, etc. 45.9% of our patients were given standard dose \n\n\n\nwhile 54.1% were not. Furthermore, if we excluded impaired \n\n\n\nrenal function patients, 85.2% of our patients met the \n\n\n\nrecommended standard dose for patients on ECMO machine. \n\n\n\nIn our hospital there was high rate of compliance but it is \n\n\n\nunclear whether physicians have considered drug \n\n\n\npharmacokinetics when patient with ECMO devices. In \n\n\n\naddition, 14.8% of antibiotics we used had never been studied \n\n\n\nin critically ill patients receiving ECMO hence no \n\n\n\nrecommended standard dose was given. Conclusion: \n\n\n\nHowever, clinicians need to pay attention to dose adjustment \n\n\n\nor monitoring of efficacy when using these antibiotics since \n\n\n\ntheir renal function may change. I hope that more studies \n\n\n\nestablish a new guideline in order to optimize drug dosing in \n\n\n\ncritically ill patients receiving ECMO. \n\n\n\n \n\n\n\n\nmailto:tovis168@gmail.com\n\n\nmailto:t2619@ms.sltung.com.tw\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n120 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 110 \n \n\n\n\nReal-world Efficacy of Low-dose Cefepime: \n\n\n\na Retrospective Study \n\n\n\n\n\n\n\nKR Yang*, TY Yi, TR Peng, AJ Wu \n\n\n\n \n Department of Pharmacy, Taipei Tzu-Chi Hospital, Buddhist Tzu Chi \n\n\n\nMedical Foundation, New Taipei City, Taiwan \n\n\n\n* Corresponding author \n\n\n\nEmail: a0975778633@gmail.com  \n\n\n\n\n\n\n\nBackground and Objectives: A review of the cefepime \n\n\n\nmedication records revealed that most physicians prescribed \n\n\n\ndoses within UpToDate's recommended dosage, which is 2 \n\n\n\ngrams every 8 to 12 hours, while a few patients with normal \n\n\n\nrenal function did not receive enough dose. The purpose of \n\n\n\nthis study was to determine whether low-dose cefepime was \n\n\n\neffective. Methods: This retrospective study covered the \n\n\n\nperiod from 2016 to 2021. The inclusion criteria were met as \n\n\n\nfollow: 1. Hospitalized patients receiving cefepime; 2. eGFR \n\n\n\ngreater than 60 mL/min/1.73 m2; 3. Age over 20. The \n\n\n\noutcomes included the length of hospital stay, duration of \n\n\n\ncefepime use, the change in CRP, and the change in WBC. \n\n\n\nTwo-sample t test was performed. Results and Discussion: \n\n\n\nThere were 41 participants in each of the low-dose and non-\n\n\n\nlow-dose groups, and 26 (63%) of them were males. The \n\n\n\nresults of the efficacy comparison between the low-dose \n\n\n\ngroup and the non-low-dose group (represented by their \n\n\n\nrespective mean values and p values): the mean length of \n\n\n\nhospital stay were 26.4 days, and 28.9 days (p=0.507), the \n\n\n\nmean use durations of cefepime were 7.4 days vs 6.2 days \n\n\n\n(p=0.238), the change in CRP were -1.3mg/dL, and -\n\n\n\n0.3mg/dL (p=0.216), and the change in white blood cells \n\n\n\nwere 1000/mcL, and 860/mcL (p=0.888). The length of \n\n\n\nhospital stay were slightly lower in low-dose group, but the \n\n\n\nmean days of cefepime use were slightly higher than non-\n\n\n\nlow-dose group. There was no statistical difference between \n\n\n\ntwo groups. Conclusion: The efficacy of low-dose cefepime \n\n\n\nis similar to non-low-dose group in this study. But it is still \n\n\n\nnecessary to carefully evaluate the efficacy of low-dose \n\n\n\ncefepime. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nAbstract 111 \n \n\n\n\nThe Effectiveness of Pharmacist \n\n\n\nIntervention in Heart Failure Integrated \n\n\n\nClinic \n\n\n\n\n\n\n\nYi-Fang Weng, Kai-Ruei Yang, Jui-Mei Tsuo, \n\n\n\nAn-Jan Wu, Tzu-Rong Peng* \n \n\n\n\nDepartment of Pharmacy, Taipei Tzu-Chi Hospital, Buddhist Tzu Chi \n\n\n\nMedical Foundation, New Taipei City, Taiwan \n\n\n\n* Corresponding author \n\n\n\nEmail: tch36994@tzuchi.com.tw  \n\n\n\n\n\n\n\nBackground and Objectives: Heart failure (HF) integrated \n\n\n\ncare can help to improve symptom control and quality of life. \n\n\n\nFurthermore, good medication adherence and using \n\n\n\nguideline-recommended medical therapy (GRMT) for \n\n\n\npatients with HF are beneficial to reduce hospitalization due \n\n\n\nto HF (HHF), mortality, and cardiovascular (CV) events. \n\n\n\nTherefore, the study aimed to analyse the effectiveness of \n\n\n\npharmacists\u2019 intervention in HF integrated care in clinics. \n\n\n\nMethods: The observational study was conducted by the 6-\n\n\n\nmonth program of HF integrated care of clinic in a single \n\n\n\nmedical institute in Taiwan. Patients with a new diagnosis of \n\n\n\nHF from 2017/12 to 2021/12 and fully participating in this \n\n\n\nprogram were included. The pharmacists in the program \n\n\n\nprovided medication education and monitored medication \n\n\n\nadherence to ensure patients take medicine appropriately. \n\n\n\nThe use pattern analysis contained the use categories of \n\n\n\nGRMT for HF and their use rate with the target dose. The \n\n\n\neffectiveness was assessed by changes from baseline in left \n\n\n\nventricular ejection fraction (LVEF), HHF, and occurrence \n\n\n\nof CV events within 6 months. Results and Discussion: \n\n\n\nThere were 32 patients with a mean age of 68.2, including 25 \n\n\n\nmales (84.4%) and 7 females (15.6%), with well medication \n\n\n\nadherence. Twenty-six patients received ACEI/ARB/ARNI \n\n\n\n(81.3%), but 2 of them used olmesartan not listed as GRMT. \n\n\n\n30 individuals received beta-blockers of GRMT (93.8%) and \n\n\n\n4 patients added ivabradine to lower heart rate (12.5%); \n\n\n\nbesides, 21 patients used spironolactone (65.6%). In patients \n\n\n\nreceiving ACEI/ARB/ARNI, beta-blockers/ivabradine, and \n\n\n\nspironolactone, 70.8%, 93.5%, and 47.6% of individuals \n\n\n\nachieved the target dose, respectively. The average LVEF \n\n\n\nincreased by 21.7% from baseline. Despite five CV events \n\n\n\noccurring, there was no HHF or death within 6 months. \n\n\n\nConclusion: Through pharmacists\u2019 intervention, individuals \n\n\n\nin HF integrated care in the OPD clinic had optimal \n\n\n\nmedication adherence to GRMT and their average LVEF was \n\n\n\nimproved without any HHF or death. \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:a0975778633@gmail.com\n\n\nmailto:tch36994@tzuchi.com.tw\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n121 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 112 \n\n\n\n\n\n\n\nTopiramate May Not Increase Risk of Age-\n\n\n\nrelated Macular Degeneration: A \n\n\n\nPopulation-based Cohort Study in Taiwan \n\n\n\n\u2013 A Preliminary Report \n\n\n\n\n\n\n\nSonia Chen1,2, Ying-Shu You3, Yih-Dih \n\n\n\nCheng1,4*, Yo-Wen Hsieh1,4, Chien-Ying \n\n\n\nLee5,6, Kuang-Hua Huang2 \n\n\n\n \n1 Department of Pharmacy, China Medical University Hospital, Taichung, \n\n\n\nTaiwan \n2 Department of Health Services Administration, China Medical University, \n\n\n\nTaichung, Taiwan \n3 Institute of Epidemiology and Preventive Medicine, College of Public \n\n\n\nHealth, National Taiwan University, Taipei, Taiwan \n4 School of Pharmacy, China Medical University, Taichung, Taiwan \n5 Department of Pharmacology, Chung Shan Medical University, Taichung, \n\n\n\nTaiwan \n6 Department of Pharmacy, Chung Shan Medical University Hospital, \n\n\n\nTaichung, Taiwan \n\n\n\n* Corresponding author \n\n\n\nEmail: tovis168@gmail.com  \n\n\n\n\n\n\n\nBackground and Objectives: Topiramate is an effective \n\n\n\nantiepileptic drug for seizure and migraine. Evidence that \n\n\n\nsupported an association of topiramate and maculopathy \n\n\n\nwere limited to case reports or series. The aim of this study \n\n\n\nwas to determine if an association exists between topiramate \n\n\n\nuse and age-related macular degeneration (AMD) in a \n\n\n\nnationwide population-based cohort study. Methods: This \n\n\n\ncohort study used claims data from the Taiwan National \n\n\n\nHealth Insurance Research Database for the 2000\u20132015 \n\n\n\nperiod. We analysed 10836 topiramate users and 10836 age, \n\n\n\ngender, index year and comorbidities matched control \n\n\n\npatients (non-topiramate users) at a ratio of 1: 1. The risk of \n\n\n\nAMD was analysed using Kaplan\u2013Meier analysis with log-\n\n\n\nrank test, followed by Cox proportional hazard regression. \n\n\n\nResults and Discussion: The incidence of topiramate users \n\n\n\nfor AMD risk was 0.96 per 1000 person-year, while the \n\n\n\nincidence of non-topiramate user was 1.05 per 1000 person-\n\n\n\nyear. The proportion of patients who developed AMD in the \n\n\n\npatients receiving topiramate was not different from that of \n\n\n\nthe control patients (p = 0.506, X2 test). The AMD free \n\n\n\nsurvival was not different between the patients receiving \n\n\n\ntopiramate and the control patients (p = 0.569, log-rank test) \n\n\n\nin Cox proportional hazard regression. Conclusion: \n\n\n\nTopiramate may not increase the risk of AMD in an \n\n\n\nobservational nationwide cohort study. This study did not \n\n\n\nfind the relationship between topiramate use and AMD \n\n\n\nincidence, regardless of sex, among a Taiwanese population \n\n\n\nof patients. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 113 \n\n\n\n\n\n\n\nOptimisation of Medications by \n\n\n\nPharmacists in A Respiratory Care Ward \u2013 \n\n\n\nThe Experience from A Regional Hospital \n\n\n\nin Northern Taiwan \n\n\n\n\n\n\n\nCY Yu*, SH Hsu  \n \n\n\n\nDepartment of Pharmacy, Taipei City Hospital Yangming Branch, Taipei, \n\n\n\nTaiwan. \n\n\n\n* Corresponding author \n\n\n\nEmail: charicy.yu@gmail.com  \n\n\n\n\n\n\n\nBackground and Objectives: Patients depending on \n\n\n\nprolonged mechanical ventilators in Taiwan are stepped \n\n\n\ndown in the respiratory care ward (RCW) for further \n\n\n\nrespiratory care. Although these patients are relatively stable \n\n\n\nwith the goal of weaning off ventilators, they may \n\n\n\noccasionally experience acute symptoms or have multiple \n\n\n\nunderlying comorbidities that need pharmacotherapy. \n\n\n\nInterventions by pharmacists have always been considered as \n\n\n\nvaluable input in the patient care process for reducing \n\n\n\nmedication errors, rationalizing prescriptions, and lowering \n\n\n\nthe cost of therapies. The present study aims to describe the \n\n\n\nnecessary interventions conducted by pharmacists to \n\n\n\noptimize pharmacotherapy in an RCW of a regional hospital \n\n\n\nin northern Taiwan. Methods: The retrospective electronic \n\n\n\nmedical records data were obtained for a period of 2 years \n\n\n\n(from 2020 to 2021) comprising the patient demographics, \n\n\n\nmedication-related information, and the specific \n\n\n\ninterventions suggested by the pharmacists. The data were \n\n\n\nevaluated, classified, and submitted to descriptive analysis. \n\n\n\nResults and Discussion: A total of 136 pharmacists\u2019 \n\n\n\ninterventions were performed with an acceptance rate of 97.8% \n\n\n\nin 97 patients. The main interventions include dose \n\n\n\nadjustment (21.4%), deletion of a drug (19.9%), drug \n\n\n\ninteraction monitoring (19.1%), microbiological culture \n\n\n\nrequest (17.6%), addition of a drug (13.2%), and others \n\n\n\n(8.8%). Among the adjusted medications, gastrointestinal \n\n\n\nagents (25%) and glucocorticoids (20.6%) were the most \n\n\n\ncommon classes involved, followed by antibiotics (19.1%), \n\n\n\ncardiovascular agents (14.7%), antiepileptics (13.2%), and \n\n\n\nothers (7.4%). Pharmaceutical interventions showed \n\n\n\nbeneficial in clinical (87.5%), preventive (52.2%) and \n\n\n\neconomic (48.5%) impacts. Conclusion: Other than \n\n\n\nrespiratory care, pharmacists\u2019 interventions appear to provide \n\n\n\nadditional pharmaceutical care for patients admitted to the \n\n\n\nRCW. These interventions not only improve the clinical \n\n\n\noutcomes but also beneficial for preventive and economic \n\n\n\nimpacts. \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:tovis168@gmail.com\n\n\nmailto:charicy.yu@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n122 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 114 \n\n\n\n\n\n\n\nPrescription Patterns for Acute Myocardial \n\n\n\nInfarction (AMI) Patients in Secondary \n\n\n\nPrevention \n\n\n\n\n\n\n\nYun-Hsin Yang* \n \n\n\n\nDepartment of Pharmacy, Tainan Municipal Hospital (Managed by Show \n\n\n\nChwan Medical Care Corporation), Taiwan \n\n\n\n* Corresponding author \n\n\n\nEmail: wennyyang830701@gmail.com  \n\n\n\n\n\n\n\nBackground and Objectives: According to the AHA/ACCF \n\n\n\nGuideline suggestions, patients should receive long-term \n\n\n\ntreatment to prevent future events or death after experiencing \n\n\n\nan acute coronary syndrome event. Medications for \n\n\n\nsecondary prevention, including DAPT, ACEI/ARB, statins, \n\n\n\nand beta-blockers, should be initiated prior to hospital \n\n\n\ndischarge. The aim of this study was to analyse the \n\n\n\nprescription patterns for acute myocardial infarction (AMI) \n\n\n\npatients in secondary prevention. Methods: We \n\n\n\nretrospectively analysed the discharge prescriptions for AMI \n\n\n\nsecondary prevention from 75 patients who experienced an \n\n\n\nAMI event in a regional teaching hospital between April \n\n\n\n2022 and August 2022. Results and Discussion: There were \n\n\n\n46 prescriptions (61.3%) with the four medications as \n\n\n\nsuggested by the AHA/ACCF guidelines. All 75 \n\n\n\nprescriptions included DAPT (100.0%); 60 prescriptions \n\n\n\nincluded ACEI/ARB (80.0%); 71 prescriptions included \n\n\n\nstatins (94.7%); and 63 prescriptions included beta-blockers \n\n\n\n(84.0%). All 75 patients in the dataset had Percutaneous \n\n\n\nCoronary Intervention (PCI) for AMI treatment, so they \n\n\n\nreceived DAPT for secondary prevention. The 15 patients \n\n\n\nwho were not prescribed ACEI/ARB had low blood pressure \n\n\n\n(Average 100/61 mmHg). The 4 patients who did not use \n\n\n\nstatins had regular LDL data (Average 73mg/dl). The 12 \n\n\n\npatients who did not need beta-blockers had regular heart \n\n\n\nrates (Average 59 bpm). Conclusion: The best prescription \n\n\n\nfor AMI secondary prevention should include DAPT, \n\n\n\nACEI/ARB, statins, and beta-blockers. However, we still \n\n\n\nneed to consider the clinical conditions of the patients to \n\n\n\nmake an individual and appropriate AMI secondary \n\n\n\nprevention prescription for patients experiencing an AMI \n\n\n\nevent. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nAbstract 115 \n\n\n\n\n\n\n\nManagement of COVID-19 Infection \n\n\n\nCombined with Bacteremia Pneumonia in \n\n\n\nCancer Patients with Neutropenia: A Case \n\n\n\nReport and Literature Review \n\n\n\n\n\n\n\nChing- Chih, Huang 1,2*, Chu-Chen, Cheng1,2  \n\n\n\n \n1Department of Pharmacy, Tungs' Taichung MetroHarbor Hospital, \n\n\n\nTaichung, Taiwan;  \n2 Taichung City New Pharmacist Association, Taichung, Taiwan  \n\n\n\n* Corresponding author \n\n\n\nEmail: amydemy@gmail.com   \n\n\n\n\n\n\n\nBackground and Objectives: COVID-19 pandemic has \n\n\n\ncontinued for almost three years. With the development of \n\n\n\nvaccine and high vaccination rate, the situation has gradually \n\n\n\nimproved. However, in cancer patients, the infection of \n\n\n\nCovid-19 can still easily induce critical situation. In this \n\n\n\nresearch, we discuss one critical case of cancer patient \n\n\n\ninfected by Covid19. Literature such as representative \n\n\n\nguidelines from ESMO (European Society for Medical \n\n\n\nOncology) and NCCN (National Comprehensive Cancer \n\n\n\nNetwork) will also be reviewed in this research. \n\n\n\nMethods/Case description: A 46 year-old patient with head \n\n\n\nand neck cancer was under chemotherapy of PF4 protocol \n\n\n\n(first day of cisplatin 75 mg/m2 and 5-fluorouracil 1000 \n\n\n\nmg/m2, followed by three days of 5-Fluorouracil 1000 \n\n\n\nmg/m2 ) and had just finished his third cycle of treatment. \n\n\n\nThree days after chemotherapy, the patient showed fever and \n\n\n\nillness. C.R.P (C-Reactive Protein), blood culture, sputum \n\n\n\nculture and severe acute respiratory syndrome coronavirus 2 \n\n\n\nAg (antigen) test were checked. Afterwards, the COVID-19 \n\n\n\nantigen test showed Positive and lab data showed WBC \n\n\n\n10500 /\u00b5L, ANC 6420 /\u00b5, C.R.P 7.49 mg/dL. Molunpiravir \n\n\n\nwas prescribed. However, high fever still persisted and \n\n\n\nrespiratory depression was noted. Therefore, Piperacillin-\n\n\n\ntazobactam and teicoplanin were prescribed. One day later, \n\n\n\nsputum culture results showed Pseudomonas aeruginosa and \n\n\n\nKlebsiella pneumoniae infection. On the fifth day after \n\n\n\nCOVID-19 tested positive, the lab data showed WBC 700 \n\n\n\n/\u00b5L, ANC 390 /\u00b5L. Consequently, G-CSF (granulocyte \n\n\n\ncolony-stimulating factor) was then prescribed. Results: \n\n\n\nAfter combining use of antiviral and antibacterial agents, the \n\n\n\nsituation of patient improved and gradually recovered from \n\n\n\nthe infection. With the use of C-G-CSF, WBC and ANC \n\n\n\nincreased to normal range. Conclusion: In cancer patients, \n\n\n\nwhile fever is noted and COVID\u201319 is tested positive, \n\n\n\nanother microorganism infection should not be ruled out and \n\n\n\ncombining use of empirical antibiotics should be considered. \n\n\n\nThe indication of G-CSF should be expanded to \n\n\n\nchemotherapy protocol with lower neutropenia risk for \n\n\n\ncancer patient during COVID-19 pandemic. \n\n\n\n\nmailto:wennyyang830701@gmail.com\n\n\nmailto:amydemy@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n123 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 116 \n \n\n\n\nAcetic Acid Derivatives Improve \n\n\n\nCardiovascular Disease in Patients with \n\n\n\nDyslipidemia \n\n\n\n\n\n\n\nChen-Sheng Chen1,6, Bo-Yi Pan2, Yu-Ting \n\n\n\nHsu2, Fang-Yu Chen2, Wen-Chin Yang3, \n\n\n\nMing-Yi Shen2,4,5,* \n \n\n\n\n1The Ph.D. Program for Cancer Biology and Drug Discovery, China Medical \n\n\n\nUniversity and Academia Sinica, Taiwan \n2Graduate Institute of Biomedical Sciences, China Medical University, \n\n\n\nTaiwan \n3Agricultural Biotechnology Research Center, Academia Sinica, Taiwan \n4Department of Medical Research, China Medical University Hospital, \n\n\n\nTaiwan \n5Department of Nursing, Asia University, Taiwan \n6Taichung City Pharmacists\u2019 Association, Taiwan  \n\n\n\n* Corresponding author \n\n\n\nEmail: shenmy1124@gmail.com   or shenmy@mail.cmu.edu.tw  \n\n\n\n\n\n\n\nBackground and Objectives: About 53% of adults in the \n\n\n\nUnited States have high LDL-C. Fewer than 50% of patients \n\n\n\nreceived treatment, and of those who received treatment, less \n\n\n\nthan 35% achieved control. In addition, patients with high \n\n\n\nLDL-C had approximately twice the incidence of \n\n\n\nAtherosclerotic Cardiovascular Disease (ASCVD) compared \n\n\n\nwith normal patients. The aim of this study was to investigate \n\n\n\nwhether anti-inflammatory drug treatment improves acute \n\n\n\ncardiovascular disease outcomes in patients with \n\n\n\ndyslipidemia. Methods: National Health Insurance Research \n\n\n\nDatabase of the Ministry of Health and Welfare of Taiwan, \n\n\n\n10,143 dyslipidemia patients were diagnosed from 2004, \n\n\n\nfollowed up from 2004 to 2013. After excluding patients with \n\n\n\nsevere comorbidities, we included eligible patients \n\n\n\n(treatment group) and matched patients receiving acetic acid \n\n\n\nderivatives. Untreated control group by propensity score \n\n\n\n(untreated group). Participants were followed for acute \n\n\n\ncoronary syndrome and stroke occurrence after receiving the \n\n\n\nacetic acid derivative or the corresponding calendar date. \n\n\n\nResults were finally presented using Cox proportional \n\n\n\nhazards models and Kaplan-Meier survival curves. Results \n\n\n\nand Discussion: Dyslipidemia patients had a higher risk of \n\n\n\ncardiovascular disease. After using acetic acid derivatives. In \n\n\n\nage, sex, comorbidities and drug treatment adjusted Cox \n\n\n\nmodels. The incidence of acute coronary syndrome (ACS) \n\n\n\nwas reduced by 36.9% (HR=0.631; CI=0.535 to 0.744; \n\n\n\nP<0.0001), and stroke was reduced by 36.3% (HR=0.637; \n\n\n\nCI=0.516 to 0.786; P<0.0001). In this study, the database was \n\n\n\ncounted, and the patients' medication compliance and living \n\n\n\nhabits could not be known, and the results may be biased. \n\n\n\nConclusion: Acetic acid derivatives reduce the incidence of \n\n\n\nACS and stroke in patients with dyslipidemia. The combined \n\n\n\nuse of acetic acid derivatives and hypolipidemic drugs may \n\n\n\nbe a new therapeutic strategy.  \n\n\n\n\n\n\n\nAbstract 117 \n\n\n\n\n\n\n\nAnalysis of Patient Self-administered \n\n\n\nSatisfaction Questionnaires in Psychiatric \n\n\n\nSpecialized Hospital \n\n\n\n\n\n\n\nChia chang Hsu1,2*, Ting Luo1,2, Tsung-Han \n\n\n\nLin1,2, Kuan-Yu Lin1,2, Kuo-Tung Chiang2, \n\n\n\nSzu-Nian Yang2 \n \n1 Department of Clinical Pharmacy, Tri-Service General Hospital Beitou \n\n\n\nBranch, Taipei, Taiwan \n2 Tri-Service General Hospital Beitou Branch, Taipei, Taiwan \n\n\n\n* Corresponding author \n\n\n\nEmail: chiachanga4046@gmail.com  \n\n\n\n\n\n\n\nBackground and Objectives: Patient satisfaction is an \n\n\n\nimportant indicator to understand patients' needs and assess \n\n\n\nthe quality of medical care. The purpose of our study is to \n\n\n\ninvestigate the patient\u2019s satisfaction with hospital services \n\n\n\nand to seek the influential factors. These factors could be \n\n\n\nused as reference to improve the quality of patient\u2019s care. \n\n\n\nMethods: Our study enrolled 100 patients or family \n\n\n\nmembers from the Military medicine ward, day-care, \n\n\n\nrehabilitation center, and outpatient clinics. The \n\n\n\nquestionnaire was designed by the five-point Likert scale. \n\n\n\nThe higher the score, the higher the level of satisfaction with \n\n\n\nhospital services. Kruskal-Wallis t-set and T-test analyses \n\n\n\nwere used to compare the differences in satisfaction of \n\n\n\ndemographic variables. A generalized linear model was used \n\n\n\nto examine the predictors of patient satisfaction, and then to \n\n\n\nexplore the relationship between demographic characteristics \n\n\n\nand patient satisfaction. Results and Discussion: The \n\n\n\ndistribution of cases was mostly male, aged from 26 to 46, \n\n\n\nuniversity graduates, outpatients, and patients themselves. \n\n\n\nThe satisfaction of inpatients was higher than outpatients. \n\n\n\nHospitalization, age, education level, and different medical \n\n\n\ndivisions were important predictors of patient satisfaction. \n\n\n\nWe found that inpatients, older age and lower education level \n\n\n\nwere correlated to higher satisfaction, and psychiatric \n\n\n\npatients had lower satisfaction than Internal medicine \n\n\n\npatients. Conclusion: Our research provides non-severe \n\n\n\nmentally ill patients' autonomous perceptions of service \n\n\n\nsatisfaction as a reference for medical care providers. More \n\n\n\nfocus should be paid on outpatients, younger patients, and \n\n\n\nhigh-educated patients to improve the overall satisfaction. \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:shenmy1124@gmail.com\n\n\nmailto:shenmy@mail.cmu.edu.tw\n\n\nmailto:chiachanga4046@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n124 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 118 \n\n\n\n\n\n\n\nDeveloping the Medication Reminder App \n\n\n\nto Improve Medication Adherence \n\n\n\n\n\n\n\nChin-Ju Chuang1,3,4, Ya-Hsin Hsueh2, Cheng-\n\n\n\nYing Hsieh1, Chiu-Yi Wu1, Yi-Pin Chen1, Pei-\n\n\n\nLing Tsai1, Yung-Cheng Huang1, Shu-Chen \n\n\n\nLin1, Ying-Chun Chen1, Yu-Chen Li1, Zhi-Yu \n\n\n\nTu1, Ling-Chiao Liao1,3,4* \n \n1Department of Pharmacy, National Taiwan University Hospital Yun-Lin \n\n\n\nBranch, Yunlin, Taiwan \n2 Department of Electronic Engineering, National Yunlin University of \n\n\n\nScience and Technology, Yunlin, Taiwan \n3 Federation of Taiwan Pharmacists Associations, Taipei, Taiwan \n4 Yunlin County Pharmacists Association, Yunlin, Taiwan \n\n\n\n* Corresponding author \n\n\n\nEmail: Y00329@ms1.ylh.gov.tw  \n\n\n\n\n\n\n\nBackground and Objectives: This study aims to develop the \n\n\n\nsecond phase of medication reminder app for the IOS \n\n\n\noperating system. We expect it may contribute to increasing \n\n\n\nmedication adherence in patients. Methods: We designed the \n\n\n\nnew version of IOS APP. Patients could use the app with their \n\n\n\nsmartphones to scan the QR code on the medication guidance \n\n\n\nleaflet. We also upgraded the app including user interfaces \n\n\n\nand overall operation process.Results and Discussion: We \n\n\n\ndeveloped a local medication reminder mobile application to \n\n\n\nimprove patient adherence with prescribed medication. The \n\n\n\nnew app called \u300c\u5168\u65b9\u4f4d\u5403\u85e5\u63d0\u9192\u8207\u8a18\u9304\u300d was developed \n\n\n\nsuccessfully. The app had the following features: Scan QR \n\n\n\ncode, Drug information, Medication reminder and \n\n\n\nMedication history. Users scan the QR code on the \n\n\n\nmedication guidance leaflet and their medication list is \n\n\n\ndirectly transmitted to the mobile phone. The app offers \n\n\n\npersonalized reminders to take medicine at the right time and \n\n\n\ninformation about drug and food interaction. Medication \n\n\n\nerrors, such as missing doses, dosing errors, duplicate \n\n\n\nmedications and drug-food interactions, could be avoided. \n\n\n\nConclusion: In the future, we will try out the new app in the \n\n\n\nDrug Counseling Room of our hospital. The pharmacists help \n\n\n\npatients download the app and teach them how to use it. We \n\n\n\nobserve users\u2019 responses and enable to measure their \n\n\n\nsatisfaction after using the app. Furthermore, we will \n\n\n\npromote the app to NTUH healthcare system and other \n\n\n\nhospitals of the Yunlin County. Medication reminder app is \n\n\n\nexpected to reduce medication error and improve patient \n\n\n\nadherence to medical prescriptions. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 119 \n\n\n\n\n\n\n\nDeterminants and Perceived Effectiveness \n\n\n\nof Self-Medication Practices for the \n\n\n\nPrevention or Treatment of COVID-19 \n\n\n\nSymptoms among Adults in Cavite \n\n\n\n\n\n\n\nNicole Allyson Carabeo, Nyah Grenadine \n\n\n\nCortez, Heather Scarllette Manalo, Cyan \n\n\n\nMeniado, Francesca Marie Manansala, Diana \n\n\n\nDalisay Orolfo* \n \n\n\n\nDr. Mariano Que College of Pharmacy, De La Salle Medical and Health \n\n\n\nSciences Institute, Cavite, Philippines \n\n\n\n* Corresponding author \n\n\n\nEmail: cyandm@my.dlshsi.edu.ph  \n\n\n\n\n\n\n\nBackground and Objectives: The increasing trend of self-\n\n\n\nmedication practices (SMPs) against COVID-19 symptoms \n\n\n\nposes numerous risks, especially in low to middle income \n\n\n\ncountries. This study aimed to determine the factors affecting \n\n\n\nSMPs through the modified Andersen model of health \n\n\n\nservice utilization, and their perceived effectiveness in \n\n\n\npreventing or treating COVID-19 symptoms among adults in \n\n\n\nCavite, Philippines. Methods: An online cross-sectional \n\n\n\nsurvey was employed between April and May 2022. Data \n\n\n\nwas analysed using descriptive and inferential statistics. \n\n\n\nResults and Discussion: Among 385 respondents, most \n\n\n\nreported having experienced fever (61.8%) and body ache \n\n\n\n(52.7%).  A total of 77.4% of the respondents performed self-\n\n\n\nmedication using one or more drugs and complementary and \n\n\n\nalternative medicine methods (CAMs) simultaneously. \n\n\n\nParacetamol (60.8%), nasal decongestants (39.5%), and \n\n\n\ncough medicines (35.1%) were the most frequently used \n\n\n\ndrugs, while vitamins and supplements (67.5%), steam \n\n\n\ntherapy (41.8%), and gargling with warm salt-water (29.1%) \n\n\n\nwere the most frequently used CAMs. Contrary to other \n\n\n\nstudies reporting high prevalence of Ivermectin use for \n\n\n\nCOVID-19, only 1.6% occurrence was found in the study. \n\n\n\nHaving minor and easy-to-treat symptoms (41.6%) were the \n\n\n\ntop reasons for self-medicating, whereas fear of worsening \n\n\n\ntheir condition (12.7%) was the top reason against the said \n\n\n\npractice. Level of knowledge (p=0.047), throat pain \n\n\n\n(p=0.038), dry cough (p=0.025), and body ache (p=0.041), \n\n\n\nwere found to be statistically associated with self-medication. \n\n\n\nThe use of all drugs, except Ivermectin, and all CAMs were \n\n\n\nsignificantly associated with perceived effectiveness. \n\n\n\nConclusion: The study found that level knowledge and \n\n\n\nseveral COVID-19 symptoms are associated with SMPs. \n\n\n\nMismatches between symptoms experienced and SMPs were \n\n\n\nalso observed; thus, the implementation of health promotion \n\n\n\nand educational campaigns to the public regarding proper use \n\n\n\nof medications and CAMs is recommended. \n\n\n\n \n\n\n\n\nmailto:Y00329@ms1.ylh.gov.tw\n\n\nmailto:cyandm@my.dlshsi.edu.ph\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n125 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 120 \n \n\n\n\nKnowledge and Perception of the General \n\n\n\nPublic in Cavite, Philippines on Counterfeit \n\n\n\nMedicines \n \n\n\n\nHannah Kristnel DV. Mesa, Danielle Marie J. \n\n\n\nGarduce, Alvin A. Vibar, Mirava A. Villamin, \n\n\n\nKatrice L. Binos* \n \n\n\n\nDr. Mariano Que College of Pharmacy, De La Salle Medical and Health \n\n\n\nSciences Institute, Cavite, Philippines. \n\n\n\n* Corresponding author \n\n\n\nEmail: hannahkristnel.mesa@gmail.com  \n\n\n\n\n\n\n\nBackground and Objectives: The problem of counterfeit \n\n\n\nmedicines persists in developing Asian countries such as the \n\n\n\nPhilippines. Increased demand for over-the-counter \n\n\n\nmedicines and use of e-commerce platforms due to the \n\n\n\nCOVID-19 pandemic have compounded the problem. Thus, \n\n\n\nthis study aimed to assess the knowledge and perception of \n\n\n\nthe general public in Cavite, Philippines on counterfeit \n\n\n\nmedicines and to identify factors associated with knowledge \n\n\n\nand perception. Methods: This study utilized a non-\n\n\n\nexperimental, analytical cross-sectional design. Participants \n\n\n\n(N = 392) were residents of Cavite aged 18-59 years old. \n\n\n\nHealthcare professionals and students were excluded from \n\n\n\nthe study. An online survey questionnaire was used to collect \n\n\n\ndata on socio-demographics, experiences in purchasing/ \n\n\n\nusing medicines, knowledge, and perception towards \n\n\n\ncounterfeit medicines. Pearson\u2019s Chi Square test and \n\n\n\nSpearman\u2019s Rho Correlation test were used to determine \n\n\n\nassociation between variables. Results and Discussion: \n\n\n\nMost respondents (48.5%) demonstrated a high level of \n\n\n\nknowledge and perceived counterfeit medicines negatively \n\n\n\n(66.1%). A significant percentage (17.9%) had a low level of \n\n\n\nknowledge, while 1.5% of respondents had a positive view of \n\n\n\ncounterfeit medicines. Most respondents viewed price as an \n\n\n\nindicator of medicine quality, and cited affordability as a \n\n\n\npossible reason for purchasing counterfeit medicines. Age, \n\n\n\nsex, and monthly household income were found to be \n\n\n\nassociated with the level of knowledge and monthly \n\n\n\nhousehold income was found to be associated with \n\n\n\nperception. Source of medicine information was also found \n\n\n\nto be associated with knowledge and perception, while \n\n\n\nfrequency of medicine purchase/ use was found to be \n\n\n\nassociated with knowledge. Conclusion: This study \n\n\n\ndemonstrated that while the majority of the general public \n\n\n\nmay oppose counterfeit medicines, factors such as \n\n\n\nunaffordability of medications and poor knowledge of \n\n\n\ncounterfeit medicines continue to put patients at risk. Thus, \n\n\n\npharmacists must play an active role in educating the public \n\n\n\nand ensuring access to quality affordable medicines. \n\n\n\n\n\n\n\nAbstract 121 \n \n\n\n\nCombined SGLT2 and ARNI Therapy to \n\n\n\nReduce the Risk of Cardiovascular Disease \n\n\n\nin Type II Diabetes: A Nationwide \n\n\n\nPopulation-base Cohort Study \n\n\n\n\n\n\n\nMing-Chi Hung1, Chiu-Lan Chen2 ,Che- huei \n\n\n\nLin1,3*, Ming-hung Lin1,3* \n\n\n\n \n1 Department of Pharmacy and Master Program, Tajen \n\n\n\nUniversity,Pintung,Taiwan \n2 Department of Pharmacy, Chia-Nan University of Pharmacology and \n\n\n\nScience, Tainan , Taiwan \n3 Fulun Chain Drugstore, Nantou City,Taiwan \n\n\n\n* Corresponding author \n\n\n\nEmail: lmh.roger@msa.hinet.net  \n\n\n\n\n\n\n\nBackground and Objectives: Both atherosclerotic \n\n\n\ncardiovascular disease (ASCVD) and heart failure are \n\n\n\nleading causes of mortality and morbidity for individuals \n\n\n\nwith diabetes and coronary heart disease. As such, it is \n\n\n\nimportant to systematically assess the risk factors associated \n\n\n\nwith CVD to prevent and manage ASCVD. Methods: The \n\n\n\nNational Health Insurance Research Database (NHIRD) was \n\n\n\nused to investigate the association between the non-use of \n\n\n\nSGLT2i or Entresto and the use of SGLT2i or Entresto with \n\n\n\nthe risk of ASCVD in diabetes and heart failure patients from \n\n\n\n2017 to 2018. Results and Discussion: The primary \n\n\n\noutcome of the study was ASCVD including a composite of \n\n\n\ncardiovascular death and hospitalisation for worsening heart \n\n\n\nfailure. Secondary outcomes were all-cause death, cause of \n\n\n\ncardiovascular death, recurrence of heart failure, non-fatal \n\n\n\nmyocardial infarction, non-fatal stroke, ischaemic stroke, \n\n\n\nhaemorrhagic stroke, and new renal replacement therapy. \n\n\n\nThe case group comprised 8,691 patients with coexisting \n\n\n\ndiabetes and heart failure without the use of SGLT2 or \n\n\n\nEntresto and the control group contained 8,691 patients with \n\n\n\ncoexisting diabetes and heart failure who used the SGLT2 or \n\n\n\nEntresto. Conclusion: The use of SGLT2 significantly \n\n\n\nreduced the risk of all-cause death, non-fatal stroke, new \n\n\n\nrenal replacement therapy, cause of death in cardiovascular \n\n\n\nand recurrence of heart failure in patients with diabetes and \n\n\n\nheart failure, therefore a combination of these therapies will \n\n\n\nhelp improve the management of diabetes and heart failure. \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:hannahkristnel.mesa@gmail.com\n\n\nmailto:lmh.roger@msa.hinet.net\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n126 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 122 \n \n\n\n\nThe Impact of Service Marketing Mix \n\n\n\ntoward Customer Purchase Behavior from \n\n\n\nPharmacy Services Online \n\n\n\n\n\n\n\nXue Min Ng*, Mei Teh Goi \n \n\n\n\nFaculty of Business and Management, Open University Malaysia, Kelana \n\n\n\nJaya, Malaysia. \n\n\n\n* Corresponding author \n\n\n\nEmail: xuemin@lppkn.gov.my  \n\n\n\n\n\n\n\nBackground and Objective: Pharmacy service is an \n\n\n\nessential healthcare service in Malaysia. Commonly \n\n\n\nprovided by the community pharmacists in the physical \n\n\n\npharmacy stores, pharmacy services are now delivered online. \n\n\n\nOnline pharmacy services are useful particularly when the \n\n\n\npublic is advised to stay at home amidst the Coronavirus \n\n\n\ndisease 2019 pandemic. The customers can easily obtain \n\n\n\npharmacy services, such as health consultations, counseling \n\n\n\nservices and home deliveries of medicines, online. The \n\n\n\nconcept of the service marketing mix has always shaped the \n\n\n\nmarketing strategies of service organizations. This study \n\n\n\nexamines the impact of service marketing mix toward \n\n\n\ncustomer purchase behavior from pharmacy services online. \n\n\n\nMethods: The service marketing mix dimensions evaluated \n\n\n\nconsist of product, price, place, promotion, people, process \n\n\n\nand physical evidence. Data of 420 respondents was collected \n\n\n\nusing online survey questionnaires. Respondents were asked \n\n\n\nto evaluate 32 items regarding the importance of service \n\n\n\nmarketing mix dimensions and their purchase intention of \n\n\n\npharmacy services online. Results and Discussion: The \n\n\n\nfindings revealed that place and promotion positively and \n\n\n\nstatistically significantly influenced the customer purchase \n\n\n\nintention, which had a positive impact toward customer \n\n\n\npurchase behavior from pharmacy services online. \n\n\n\nConclusion: The community pharmacies should focus on the \n\n\n\nplace and promotion dimension when devising the marketing \n\n\n\nstrategies to deliver their pharmacy services online. \n\n\n\nConsequently, optimal pharmaceutical care can be provided \n\n\n\nat the convenience of customers while the community \n\n\n\npharmacies are benefited from the increase in the sale of \n\n\n\npharmacy services. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 123 \n \n\n\n\nPrediction of in vivo Performance of \n\n\n\nDabigatran Capsules Produced in Nepal \n\n\n\nfrom in vitro (Dissolution) data Using \n\n\n\nNumerical Convolution Method \n\n\n\n\n\n\n\nKhanal,N, Budhathoki U*, Bista D \n \n\n\n\nDepartment of Pharmacy, Kathmandu University, Dhulikhel, Kavre, Nepal \n\n\n\nGPO box 6250 (Kathmandu) \n\n\n\n* Corresponding author \n\n\n\nEmail: uttam@ku.edu.np  \n \n\n\n\nBackground and Objectives: To ensure the in vivo \n\n\n\nperformance of the products. bioavailability or \n\n\n\nbioequivalence study are performed but in Nepalese context \n\n\n\nmarketing license are issued without the in vivo Performance \n\n\n\nstudy data. The main motive of this study is to predict in vivo \n\n\n\nstudy data of locally produced Dabigatran capsules (coded as \n\n\n\nProduct A and Product B which are marketted without in vivo \n\n\n\nperformance study using In vitro in vivo correlation (IVIVC) \n\n\n\nmethod. Methods: Among two approaches of IVIVC i.e. \n\n\n\nConvolution and Deconvolution, Convolution approach was \n\n\n\nused for the prediction of in vivo performance of the products \n\n\n\nfrom the dissolution data. Dissolution study was carried out \n\n\n\nfor test product their plasma drug concentration was \n\n\n\ndetermined using this numerical convolution technique. \n\n\n\n\u201cProduct A\u201d and \u201cProduct B\u201d were the two test products. . \n\n\n\nFrom predicted plasma drug concentration \u2013time data, Area \n\n\n\nunder the curve (AUC) and maximum plasma drug \n\n\n\nconcentration (Cmax) were determined for both test products. \n\n\n\nWhether they are statistically different or not was determine \n\n\n\nand, on that basis, would be concluded that whether test \n\n\n\nproducts are bioequivalence or not. Result and Discussion: \n\n\n\nCmax, AUC of \u201cProduct A\u201d from the convolution method was \n\n\n\nfound to be 0.9562 ng/ml/mg, 16.441 hr*ng/ml/mg. Similarly, \n\n\n\nCmax and AUC of \u201cProduct B\u201d was found to be 0.8638 \n\n\n\nng/ml/mg and 14.8175 hr*ng/ml/mg. The percentage \n\n\n\nprediction error (%PE) values for Cmax and AUC were found \n\n\n\nto be -15.034 and 51.342 for \u201cProduct A\u201d and -27.344 and \n\n\n\n46.009 for \u201cProduct B\u201d Finally, Cmax and AUC for \u201cPradaxa \n\n\n\n110 mg\u201d obtained from literature was found to be (0.8-1.4) \n\n\n\nng/ml/mg and (6-10) ng*h/ml/mg respectively.The predicted \n\n\n\nerror of AUC and Cmax are not within the \u00b120% range for both \n\n\n\nlocal generic products (Product A & B. Conclusion: From \n\n\n\nthis study, it can be concluded that the rate and extent of \n\n\n\nabsorption of test products are not similar with the reference \n\n\n\nproduct. Since dabigatran, an anticoagulant is a lifesaving \n\n\n\ndrug, there may be risk to the patients rather than benefit \n\n\n\nusing local generic products though they are comparatively \n\n\n\ncheaper compared to reference product.  \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:xuemin@lppkn.gov.my\n\n\nmailto:uttam@ku.edu.np\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n127 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 124 \n \n\n\n\nThe Study of Drug Interactions between \n\n\n\nHerbal Medicine and Drugs  \n\n\n\n\n\n\n\nYung-Huei Fu1,3*, Li-Heng Pao2 \n \n1 Division of Pharmaceutical Service, China Medical University Hsinchu \n\n\n\nHospital, Hsinchu, Taiwan \n2 Institute of Health Industry Science and Technology, Chang Gung \n\n\n\nUniversity of Science and Technology, Taoyuan, Taiwan \n3 Hsinchu Pharmacists Association, Taiwan \n\n\n\n* Corresponding author \n\n\n\nEmail: kiwi5652@gmail.com  \n\n\n\n\n\n\n\nBackground and Objectives: P-glycoprotein (P-gp) is \n\n\n\nwidely expressed in the epithelial cells of tissue, especially in \n\n\n\nthe intestine, which is one of critical factors in drug \n\n\n\nabsorption and disposition. P-gp mediated drug efflux is a \n\n\n\nmajor factor contributing to the variance of absorption and \n\n\n\ndistribution of many drugs. Appropriately co-prescribed diet \n\n\n\nand herbal remedies could increase drug efficacy and lessen \n\n\n\ndrug toxicity. The purpose of this project is to study herbal \n\n\n\nmedicine and drug interactions through P-gp inhibition. \n\n\n\nMethods: A simple and reliable in vitro screening method \n\n\n\nwas setup and characterized using HCT-15 cell lines to study \n\n\n\nthe effect of herbal medicine on P-gp mediated transport of a \n\n\n\nmodel substrate. A specific P-gp substrate, rhodamine 123, \n\n\n\nwas used as a fluorescent marker. The increase in \n\n\n\nintracellular retention of rhodamine 123 is reflected in \n\n\n\nincreased intensity of rhodamine 123 fluorescence. The \n\n\n\nfunctional activity of P-gp was evaluated by measuring \n\n\n\nrhodamine 123 retention/efflux in the presence of herbal \n\n\n\nmedicines. Result and Discussion: The increase in \n\n\n\nintracellular retention of rhodamine 123 is reflected in \n\n\n\nincreased intensity of rhodamine 123 fluorescence. \n\n\n\nIntracellular accumulation of rhodamine 123 was measured \n\n\n\nby flow cytometry. In our study, we found several herbal \n\n\n\nmedicines are P-gp modulators. HCT-15 cell lines indicated \n\n\n\nthat the efflux of rhodamine 123 was inhibited by some \n\n\n\nherbal medicines. As our results, intracellular retention of \n\n\n\nrhodamine 123 increased 4.16 to 7.00 fold of the control by \n\n\n\nMoutan cortex, Spatholobi caulis and Aurantii fructus, \n\n\n\nrespectively, at a high concentration (10mg/ml). Intracellular \n\n\n\nretention of rhodamine 123 increased 3.30 to 5.35 fold of the \n\n\n\ncontrol at a low concentration (2 mg/ml). It also shows \n\n\n\nconcentration dependent manner in herb-drug interactions. \n\n\n\nConclusion: In conclusion, this study demonstrated that the \n\n\n\npresence of the herbal medicines significantly decreased the \n\n\n\nP-gp efflux function in HCT-15 cell lines. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 125 \n \n\n\n\nVarying Approaches for Modelling CPD \u2014 \n\n\n\nA Retrospective Review by Indonesian \n\n\n\nYoung Pharmacists Group \n\n\n\n\n\n\n\nAnggun P. Wardhani*, Dwi P. Rahmawati, \n\n\n\nRabella Mufti S, R. Aldizal Mahendra, I Made \n\n\n\nBayu Anggriawan \n\n\n\n\n\n\n\nIndonesian Young Pharmacist Group Pengurus Pusat Ikatan Apoteker \n\n\n\nIndonesia (IYPG PP IAI) \n\n\n\n* Corresponding author \n\n\n\nEmail: anggun.pharm@gmail.com  \n \n\n\n\nBackground and Objectives: As healthcare professionals, \n\n\n\npharmacists need to always demonstrate and maintain their \n\n\n\ncompetency throughout their careers. One of the assessment \n\n\n\ncomponents is through Continuing Professional \n\n\n\nDevelopment (CPD). However, most of the CPD provided by \n\n\n\nprofessional associations is theory centric with one-way \n\n\n\ncommunication. Accordingly, the Indonesian Young \n\n\n\nPharmacist Group (IYPG), that specifically accommodates \n\n\n\nPharmacists under 35 years old, aimed to develop a CPD \n\n\n\nprogram that can be relevant for young pharmacists. \n\n\n\nMethods: A retrospective review was selected to elaborate \n\n\n\nthe CPD models on the events held by the IYPG in the span \n\n\n\nof 2020-2022. Four big events were accounted for the \n\n\n\ndelivery of CPD to young pharmacists: the IYPG summit, \n\n\n\nCOVID-19 charity nights, IYPG talk, and IYPG team \n\n\n\nupgrading events. These events accommodated both learning \n\n\n\nand social-work CPD activities. All participants were given \n\n\n\nthe post-event questionnaire to evaluate their satisfaction \n\n\n\n(using the Likert scale). Results and Discussion: The \n\n\n\nfindings suggested that the events have accommodated the \n\n\n\nCPD relevant to young pharmacists. The IYPG Summit is the \n\n\n\nmain annual event where the experts shared the learning CPD \n\n\n\n(10 credits), and the attendees were also involved in selected \n\n\n\nsocial work (5 credits), while the COVID-19 charity night \n\n\n\nwas mostly concerned about social work CPD (4 credits) and \n\n\n\nalso increased collaborative action during the COVID-19 \n\n\n\npandemic (2 learning CPD credit). The expert talks are \n\n\n\nincorporated in IYPG Talk (2 learning credits & 3 social \n\n\n\nwork credits) and upgrading events (total 4 learning credits), \n\n\n\nenabling CPD learning aspects for the attendees. The total \n\n\n\nnumber of participants for these four events was 2.773 \n\n\n\npharmacists. Using the Likert scale with a score of 1 to 5, of \n\n\n\nwhich 5 are the highest levels (Very Satisfied), on average \n\n\n\nmore than 52% of the participant was Very Satisfied with the \n\n\n\nevent. Moreover, at the recent IYPG Talk event, 82% of the \n\n\n\nrespondents were most likely to join the upcoming events \n\n\n\nheld by IYPG. Conclusion: The CPD models incorporated \n\n\n\nin IYPG events (2020-2022) was found to be relevant for \n\n\n\nyoung pharmacists. Not only that they were able to fulfil the \n\n\n\nCPD requirements from the pharmacist association, but also \n\n\n\nbolstered greater interest of young people to get CPD. \n\n\n\n\nmailto:kiwi5652@gmail.com\n\n\nmailto:anggun.pharm@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n128 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nAbstract 126 \n \n\n\n\nAssessing the Clinical Competence of \n\n\n\nEntry-to Advanced-level Pharmacists using \n\n\n\nCase-based Discussions in Japan \n\n\n\n\n\n\n\nKanayuki Kitahara*, Yukari Kataoka, \n\n\n\nTatsuya Isezaki, Yasuaki Yokoyama, Asami \n\n\n\nFunaki, Ryohkan Funakoshi \n \n\n\n\nDepartment of Pharmacy, Kameda medical hospital, Chiba, Japan. \n\n\n\n* Corresponding author \n\n\n\nEmail: kitahara.kanayuki@kameda.jp  \n \n\n\n\nBackground and Objectives: Although more than 50 \n\n\n\nhospitals offer a pharmacy residency program in Japan, there \n\n\n\nis no foundational core curriculum to achieve clinical \n\n\n\ncompetence. The Royal Pharmaceutical Society (RPS) in the \n\n\n\nUK has published the Foundation Pharmacy Framework for \n\n\n\nband 6 pharmacists. Case-based discussion (CbD) is one of \n\n\n\nthe tools in the framework for assessing clinical decision-\n\n\n\nmaking and the application of pharmacological knowledge in \n\n\n\npatient care. Therefore, we conducted this study to determine \n\n\n\nwhether CbD is a usable tool for assessing clinical \n\n\n\ncompetence in Japan. Methods: The subjects were first-year \n\n\n\npharmacy residents as entry-level (n=78), pharmacists in \n\n\n\nyears 2-5 without specialty certification as basic-level (n=9), \n\n\n\nand the board-certified pharmacists (BCPs) as advanced-\n\n\n\nlevel (n=5). Pharmacy residents had trained in four wards for \n\n\n\none year, and CbD was performed at the end of each ward \n\n\n\ntraining. Other Pharmacists had a one-point measure. For \n\n\n\npharmacy residents, CbD scores administered at the end of \n\n\n\neach ward training were plotted and changes over time were \n\n\n\nanalyzed using one-way ANOVA. For other pharmacists, the \n\n\n\npresence of a ceiling effect was assessed. Results and \n\n\n\nDiscussion: Pharmacy residents showed a significant \n\n\n\nincrease in scores on 4 of the 5 CbD items, except \u201cTreatment \n\n\n\nRecommendations\u201d. No ceiling effect was observed for the \n\n\n\nbasic-level, while a ceiling effect was observed for the \n\n\n\nadvanced -level. These results suggest that CbD can be used \n\n\n\nto visualize the degree of growth of pharmacists with less \n\n\n\nthan 6 years and no specialty certification (entry- and basic-\n\n\n\nlevel) but not for advanced-level pharmacists such as BCPs \n\n\n\nin Japan. Conclusion: CbD is useful for assessing clinical \n\n\n\ncompetence of entry-level and basic-level pharmacists in \n\n\n\nJapan. However, it is difficult to assess advanced-level \n\n\n\npharmacists with CbD. Further studies are needed with a \n\n\n\nlarger number of pharmacists at multiple facilities to evaluate \n\n\n\nthe usefulness of CbD. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 127 \n \n\n\n\nThe Development of Teaching Method and \n\n\n\nGame-Based Materials for Medication-use \n\n\n\nSafety Modular Course \n\n\n\n\n\n\n\nLing-Chiao Liao1,5,6, Yung-Ching Hsu2, Ai-\n\n\n\nTzu Li3, Jou-Wei Lin4, Cheng-Ying Hsieh1, \n\n\n\nYung-Cheng Huang1, Yu-Chen Li1, Chin-Ju \n\n\n\nChuang1,5,6* \n \n1 Department of Pharmacy, National Taiwan University Hospital Yun-Lin \n\n\n\nBranch, Yunlin, Taiwan \n2 Fun 4 Kids Board Game Workshop, Tainan, Taiwan \n3 Department of Adult and Continuing Education National Chung Cheng \n\n\n\nUniversity, Chiayi, Taiwan  \n4 Department of Medicine, National Taiwan University Hospital Yun-Lin \n\n\n\nBranch, Yunlin, Taiwan \n5 Federation of Taiwan Pharmacists Associations, Taipei, Taiwan \n6 Yunlin County Pharmacists Association, Yunlin, Taiwan \n\n\n\n* Corresponding author \n\n\n\nEmail: Y00329@ms1.ylh.gov.tw \n\n\n\n\n\n\n\nBackground and Objectives: The purpose of the study is to \n\n\n\ndevelop a game-based teaching method and materials in \n\n\n\norder to improve learning effectiveness of medication use \n\n\n\nsafety course for the elderly. Methods: A focus group \n\n\n\ndiscussions methodology was used in this study to facilitate \n\n\n\nthe discussion of participants\u2019perceptions on the learning \n\n\n\nmodule and game-based learning material. Neuroscientists, \n\n\n\npharmacists and elder education experts were recruited in the \n\n\n\nfocused group to evaluate the validity of the medication-use \n\n\n\nsafety modular course. The board game was tested by \n\n\n\nexternal experts at 3 workshops. Results and Discussion: \n\n\n\nThe learning module and game-based learning material \n\n\n\ncalled \u300c\u85e5\u60a8\u5065\u5eb7 99\u300dwas developed successfully. The \n\n\n\nboard game includes instruction manual and 4 types of cards \n\n\n\nconsist of body, organ, question and answer cards. Due to the \n\n\n\nCOVID-19 pandemic, the community health activities were \n\n\n\nshut down almost. Therefore, the online board game was \n\n\n\ndeveloped for testing. There were 3 elderly played the online \n\n\n\nboard game and provided positive feedback. Conclusion: \n\n\n\nBased on the results of the first year, the purpose of next year \n\n\n\nis to test the prototype of the medication use safety board \n\n\n\ngame and validate its effectiveness. It will further test in \n\n\n\nActive Aging Learning Center with 30 senior citizens to get \n\n\n\nthe information about flow, medication-use knowledge, and \n\n\n\nbehavior change. \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:kitahara.kanayuki@kameda.jp\n\n\nmailto:Y00329@ms1.ylh.gov.tw\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n129 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 128 \n \n\n\n\nA New Platform to Advance Pharmacy \n\n\n\nWorkforce Education  \n\n\n\n\n\n\n\nMd. Mirajul Islam1*, Mohammad Abusyed1, \n\n\n\nMandip Pokharel2, Sovanrith Phalla3, Tammy \n\n\n\nAllen4  \n \n1 Vennue Foundation, Bangladesh  \n2 Vennue Foundation, Nepal  \n3 Vennue Foundation, Cambodia  \n4 Vennue Foundation, USA  \n\n\n\n* Corresponding author \n\n\n\nEmail: samrat@vennue.org  \n\n\n\n\n\n\n\nBackground and Objectives: In developing countries, \n\n\n\npatients often rely on pharmacies as the first point of access \n\n\n\nto care. Pharmacy workers perform critical functions in the \n\n\n\ncontinuum of care, yet they tend to be undertrained and \n\n\n\nundervalued. To address this problem, Vennue built a health \n\n\n\nworkforce education model that equips pharmacists, as well \n\n\n\nas pharmacy staff and students, with the necessary skills and \n\n\n\nknowledge to provide high-quality care. Vennue also \n\n\n\nprovides a community for professional development, \n\n\n\nbringing together practitioners from around the world to \n\n\n\nconnect through shared learning and practice enhancements.  \n\n\n\nMethods: Vennue\u2019s proprietary curriculum is offered \n\n\n\nthrough a hybrid learning model. Each participant benefits \n\n\n\nfrom an educational toolkit with the following components \n\n\n\noffered through in-person classroom instruction and via the \n\n\n\nVennue Digital Hub (hub.vennue.org): \u2022 Interactive training \n\n\n\nsessions led by Vennue\u2019s instructors \u2022 Roundtable Q&A with \n\n\n\ninternational guest speakers and clinical experts \u2022 Simulation \n\n\n\nactivities to strengthen consultation skills \u2022 Hands-on \n\n\n\nworkshops to develop Standard Operating Procedures \u2022 Peer \n\n\n\nLearning Circles to sustain knowledge into the future. \n\n\n\nResults and Discussion: Launched in January 2021, the \n\n\n\nVennue Hub demonstrated the following results: \u2022 992 \n\n\n\nlearners enrolled as new Hub Members from 15 countries \n\n\n\naround the world \u2022 764 individuals earned certificates in \n\n\n\n\u201cFundamentals of Quality Pharmacy Care\u201d \u2022 54% gain in \n\n\n\nknowledge of pharmacy best practices, measured by pre/post \n\n\n\ntests at the start and finish of each training module \u2022 96% of \n\n\n\nlearners confirmed the learning materials will improve their \n\n\n\npractice, reported in feedback surveys From January 2021 to \n\n\n\nSeptember 2022, the new learning platform enabled Vennue \n\n\n\nto expand its program reach, while delivering strong \n\n\n\nperformance gains in core competencies. These results serve \n\n\n\nas an important proof-of-concept as Vennue continues to \n\n\n\ninvest in the integration of additional certification courses \n\n\n\nonto the Hub. Conclusion: The Vennue Hub provides \n\n\n\nflexible, consistent training for pharmacy workers and \n\n\n\nstudents of all skill levels. It offers cost-free, uninterrupted \n\n\n\naccess to learning resources and community connections. \n\n\n\nVennue\u2019s new platform can be scaled to advance patient care \n\n\n\nand health outcomes. \n\n\n\nAbstract 129 \n \n\n\n\nDrug-related problems (DRP) Identified by \n\n\n\nPharmacy Students during Telepharmacy \n\n\n\nSessions  \n\n\n\n\n\n\n\nNor Elyzatul Akma Hamdan1*, Mahmathi \n\n\n\nKaruppannan1, Munaver Ahmad Nazir \n\n\n\nAhmad2, Ezlina Usir1, Kamaliah Md. Saman1, \n\n\n\nSiti Norlina Md. Said1 \n \n\n\n\n1 Department of Pharmacy Practice, Faculty of Pharmacy, Universiti \n\n\n\nTeknologi MARA (UiTM) Selangor Branch, Puncak Alam Campus, 42300 \n\n\n\nBandar Puncak Alam, Selangor, Malaysia. \n2 Rhazes Consultancy Service Sdn Bhd, Nucleus Tower, Mutiara Damansara, \n\n\n\n47800 Subang Jaya, Selangor, Malaysia \n\n\n\n* Corresponding author \n\n\n\nEmail: elyzatul@uitm.edu.my    \n\n\n\n\n\n\n\nBackground and Objectives: Telepharmacy (TP) services \n\n\n\nreceived much attention during the COVID-19 pandemic. In \n\n\n\norder to equip future pharmacists, components of TP were \n\n\n\nincorporated during final year pharmacy students\u2019 clinical \n\n\n\npharmacy clerkship (CPC). During the TP, students \n\n\n\ninteracted with patients and conducted medication use \n\n\n\nreviews. The objective of this study was to characterize the \n\n\n\ntypes of drug-related problem identified by the students \n\n\n\nduring the TP sessions. Methods: A group of four to five \n\n\n\nfinal-year pharmacy students interviewed one (1) patient \n\n\n\nduring the TP session. There was a total of 48 groups of \n\n\n\nstudents. Patients were recruited from their family members \n\n\n\nand relatives that prescribed at least two (2) chronic \n\n\n\nmedications (i.e diabetes, hypertension, and \n\n\n\nhypercholesterolemia). Each session lasted for about 30 \n\n\n\nminutes. Students were briefed on the conduct of TP prior to \n\n\n\ninteracting with patients.  Each group was given a data \n\n\n\ncollection form to document patients\u2019 details and \n\n\n\ndescriptions of the DRPs identified under the supervision of \n\n\n\na lecturer. These were further analysed retrospectively. \n\n\n\nDescriptive statistics and chi-square analysis were used to \n\n\n\nevaluate the data. Results and Discussion: 187 students \n\n\n\ncompleted 48 medication use reviews via TP.  The students \n\n\n\nreviewed 48 patients and identified 122 DRPs. On average, \n\n\n\nthe patients were 56 years old and were taking a median of 5 \n\n\n\nmedications. The most common DRPs reported were non-\n\n\n\ncompliance issues and adverse drug reactions. Conclusion: \n\n\n\nPharmacy students were able to identify a substantial number \n\n\n\nof DRPs through medication use review activities via TP \n\n\n\nunder the supervision of their lecturer. TP also enhanced \n\n\n\npharmacy students\u2019 communication skills and their \n\n\n\nmedication history-taking ability.  \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:samrat@vennue.org\n\n\nmailto:elyzatul@uitm.edu.my\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n130 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 130 \n \n\n\n\nConsultation and Education of Doping \n\n\n\nAmong Athletes and Their Logistics Staff \n\n\n\n\n\n\n\nHung-Chang Chou1,2,3*, Wei Ho2, Tzu-Chun \n\n\n\nChou2 \n\n\n\n \n1 Federation of Taiwan Pharmacists Associations, Taiwan \n2 Taiwan Young Pharmacist Group, Taiwan \n3 Department of Pharmacy and Master Program, Tajen University, Taiwan \n\n\n\n* Corresponding author \n\n\n\nEmail: chouhungchang@gmail.com  \n\n\n\n\n\n\n\nBackground and Objectives: The World Anti-Doping \n\n\n\nAgency has raised that education are the primary goals of \n\n\n\ntheir anti-doping strategy. Doping control is the norm for \n\n\n\nathletes whether they are in competition or non-competition \n\n\n\nperiod; however, many medicines on the market contain \n\n\n\ndoping ingredients even though they are legally marketed \n\n\n\ndrugs. To prevent the misuse of medicine, the Chinese Taipei \n\n\n\nAnti-Doping Agency provides consultation for service \n\n\n\nathletes and their logistics staff and has established an \n\n\n\n\"Interactive Consultation Platform for Doping Dosing in \n\n\n\nSports\" to provide information for athletes to confirm the \n\n\n\nlegality before using drugs or nutritional supplements. \n\n\n\nMethods: The consultations were conducted from November \n\n\n\n1st in 2018 to April 30th in 2021 in Taiwan. The \n\n\n\nconsultations were raised via online systems and assigned to \n\n\n\nthe specialists such as pharmacists, nutritionists and physical \n\n\n\ntherapists within 24 hours. A total of 276 questions were \n\n\n\nassessed as eligible. Results and Discussion: Most \n\n\n\nconsultations were raised from athletes (n = 188, 67.6%) and \n\n\n\nlogistics staff (n = 61, 21.9%). The categories of \n\n\n\nconsultations are Western medicine (192, 69.6%), \n\n\n\nfood/nutritional supplement (62, 22.5%), herbs (16, 5.8%) \n\n\n\nand others (6, 2.2%). Among all the consultations, the \n\n\n\ndoping-related questions are 25.5%. According to the survey \n\n\n\nof consultations, two articles were prepared and delivered to \n\n\n\nthe athletes and logistics staff to prevent the misuse of the \n\n\n\nmedicine, named \u201cThe Invisible Killer of Athletes: \n\n\n\nEphedrine\u201d and \u201cStomach Medicine as Doping: Oxethazaine.\u201d \n\n\n\nConclusion: It is vital to provide appropriate tool and \n\n\n\ninformation of athletes and logistics staff on the topic of \n\n\n\ndoping consultation. More education about doping for \n\n\n\nathletes and logistics staff would prevent the misuse of \n\n\n\nmedicines. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 131 \n \n\n\n\nHybrid learning to answer the adjustment \n\n\n\nof learning models after the pandemic \n\n\n\n\n\n\n\nArde Toga Nugraha* \n \n\n\n\nDepartment of Pharmacy, Faculty of Science, University Islam Indonesia, \n\n\n\nYogyakarta, Indonesia. \n\n\n\n* Corresponding author \n\n\n\nEmail: arde.toga@uii.ac.id  \n \n\n\n\nBackground and Objectives: Hybrid learning has become \n\n\n\nan attractive learning delivery method in recent years. Many \n\n\n\nUniversities are trying to develop their own Hybrid learning \n\n\n\ncourses as an option to replace part of the face-to-face time \n\n\n\nwith online classes. In terms of theoretical learning, there is \n\n\n\nno significant difference between the results of hybrid \n\n\n\nstudents and distance learning, in fact most of the participants \n\n\n\nprefer visual presentations rather than verbal explanations. \n\n\n\nThe aim of this recearch to knowing the quality of lectures \n\n\n\nconducted in a hybrid with modification.Methods: \n\n\n\nParticipants who took the hybrid medicinal plants and \n\n\n\nsimplicia lectures were students from the Department of \n\n\n\nPharmacy, the University Islam Indonesia and the \n\n\n\nDepartment of Pharmacy, Ma Chung University. The lecture \n\n\n\nis carried out in three stages, preparation stage, program \n\n\n\nsocialization, implementation and evaluation. The evaluation \n\n\n\nwas carried out twice, in the middle of program to improve \n\n\n\nsomething that was felt to be inappropriate. Evaluation is \n\n\n\ndone by looking at the midterm exam, final exam scores and \n\n\n\nalso conducting a satisfaction survey to students. Data \n\n\n\nprocessing is done by descriptive analysis. Results and \n\n\n\nDiscussion: The results of this study show that there are \n\n\n\ndifferences in student motivation to learn. Students feel that \n\n\n\nthe hybrid can increase their sense of learning. However, the \n\n\n\nlearning outcomes are not significantly different still equally \n\n\n\nboth online and offline. Students also feel that offline, online \n\n\n\nand hybrid methods have their respective advantages. \n\n\n\nConclusion: Hybrid learning provides flexibility and still gets a \n\n\n\nsense of learning compared to offline or online only. But still have \n\n\n\nthe same quality. \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:chouhungchang@gmail.com\n\n\nmailto:arde.toga@uii.ac.id\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n131 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 132 \n \n\n\n\nNew Drug Budget and Reimbursement \n\n\n\nPolicy in Taiwan \n\n\n\n\n\n\n\nYY Chan1*, ZF Lu1, CN Hsu2, YC Pan1, WN \n\n\n\nWeng1 \n \n\n\n\n1 Chang Gung Medical Foundation, Taoyuan, Taiwan \n2 Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan \n\n\n\n* Corresponding author \n\n\n\nEmail: yychan.ph@gmail.com  \n\n\n\n\n\n\n\nBackground and Objectives:  Taiwan\u2019s healthcare system \n\n\n\nis internationally regarded for its National Health Insurance \n\n\n\n(NHI) program, which provides universal, easily accessible \n\n\n\nand affordable healthcare with overall 99.9% coverage \n\n\n\n(23.6m people). The relative low spend reflects tight-control \n\n\n\nof expenditure. We evaluated the budget and reimbursement \n\n\n\npolicy of innovative new drugs for the recent 5 years (2013-\n\n\n\n2017). Methods: All data were collected from the meeting \n\n\n\nnotes of the Expert Advisory Meetins, the PBRS committee; \n\n\n\nand the new drug HTA reports released on the NHI \n\n\n\nAdministration Web site. We used descriptive statistics to \n\n\n\nanalyse the trend of the prescription volume and drug \n\n\n\nexpenditure for new drugs from the NHI claims data. Results: \n\n\n\nThe total new drug budget of each year is decided by the \n\n\n\nMinistry of Health and Welfare according to the average \n\n\n\nspending for new drugs in the previous 5 years with an \n\n\n\nassumption of treatment substitution effect, the new drug will \n\n\n\nreplace the current treatment within 5 years since it covered \n\n\n\nby NHI and no more budget thereafter. Each new drug will \n\n\n\nbe classified as one of the three categories (I, 2A, 2B) by their \n\n\n\ntherapeutic value and compared to the current best \n\n\n\ncomparator. A 5-years-budget-scheme is estimated with \n\n\n\nreference to these three categories. In our results, there were \n\n\n\n189 new drugs (18 in category 1, 61 in category 2A, 110 in \n\n\n\ncategory 2B) getting covered by NHI with a spending of \n\n\n\nUSD$1.96 billion in the past 5 years, but with a budget of \n\n\n\nonly USD175 million. Conclusion: Obviously, the budget \n\n\n\nallocation for new drugs is seriously insufficient. The \n\n\n\nshortage of spending was compensated by healthcare \n\n\n\nproviders. Ageing population and growth in chronic disease, \n\n\n\nassociated with rising costs of new health technologies, were \n\n\n\nputting further strain on the healthcare system's resources. A \n\n\n\nreform should be advocated for the new drugs budget and \n\n\n\nreimbursement policy, which has been implemented for 10 \n\n\n\nyears. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 133 \n \n\n\n\nDevelopment of a Searching Program of \n\n\n\nNutrient Information for Patients who have \n\n\n\nDiabetes or Hypertension \n\n\n\n\n\n\n\nGyeongil Jang1, Kwang Joon Kim2, Dongmun \n\n\n\nHa2* \n \n1 School of Pharmacy, Sungkyunkwan University, Suwon, Korea.  \n2 School of Pharmacy, Mokpo National University, Muan, Korea \n\n\n\n* Corresponding author \n\n\n\nEmail: 777sring@gmail.com  \n\n\n\n\n\n\n\nBackground and Objectives: It is essential to supply \n\n\n\nadequate nutrients for the prevention and treatment of \n\n\n\nchronic diseases. The aim of this study was to develop a \n\n\n\nprogram that can evaluate nutritional deficiencies of patients \n\n\n\nwho have chronic diseases in South Korea. Methods: A \n\n\n\ndatabase was built on the potential nutritional status changes \n\n\n\ncaused by chronic diseases or treatment agents for them such \n\n\n\nas diabetes and hypertension by conducting a systematic \n\n\n\nreview of clinical articles regarding those diseases. Based on \n\n\n\nthe database constructed, we developed a searching program \n\n\n\nthat could find deficient nutrients, evidence levels (low, \n\n\n\nmedium, and high) of clinical articles, severity levels \n\n\n\n(negative impacts), and intake information by each disease \n\n\n\nwhen patients entered their demographic factors such as age, \n\n\n\nsex, dietary or exercise habits and drugs they were taking. \n\n\n\nResults and Discussion: Active pharmaceutical ingredients \n\n\n\nfor diabetes that can cause nutrient deficiency were \n\n\n\nmetformin, sulfonylureas, and insulin. Those for \n\n\n\nhypertension were beta blockers, angiotensin-converting \n\n\n\nenzyme inhibitors, calcium channel blockers, and \n\n\n\nhydralazine. Five nutrients (vitamin B12, folic acid, \n\n\n\nmagnesium, coenzyme Q10, and vitamin D) for diabetes, \n\n\n\nfour nutrients (vitamin B6, vitamin D, zinc, and coenzyme \n\n\n\nQ10) for hypertension, and two (vitamin D and coenzyme \n\n\n\nQ10) nutrients for both diseases were determined. The \n\n\n\nevidence levels and severity levels varied based on each \n\n\n\nnutrient and disease. Intake information by each disease such \n\n\n\nas the required amount of each nutrient per day and food \n\n\n\nsources were presented as well. Conclusion: Medications for \n\n\n\ntreating diabetes and hypertension have shown nutritional \n\n\n\ndeficiencies in patients who have those diseases. The \n\n\n\nsearching program of nutrient information developed for the \n\n\n\nprevention and management of chronic diseases is very \n\n\n\nuseful. \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:yychan.ph@gmail.com\n\n\nmailto:777sring@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n132 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 134 \n \n\n\n\nDevelopment of a Computerized Pharmacy \n\n\n\nManagement System Called PM+20 for the \n\n\n\nIT-based Community Pharmacy Practices \n\n\n\nin South Korea \n\n\n\n\n\n\n\nHyuntai, K1*, Jeehye M2 \n\n\n\n\n\n\n\n1 Korea Pharmaceutical Information Center (KPIC), Seoul, Republic of \n\n\n\nKorea.  \n2 Research & Information Center, Korea Pharmaceutical Information \n\n\n\nCenter (KPIC), Seoul, Republic of Korea.  \n\n\n\n* Corresponding author \n\n\n\nEmail: hytakim@kdrug.org  \n \n\n\n\nBackground and Objectives: Recently, the application of a \n\n\n\ncomprehensive pharmacy management software has become \n\n\n\nessential in community pharmacies. The pharmacy \n\n\n\nmanagement software, PharmIT3000, was developed and \n\n\n\nmaintained by KPIC to assist pharmaceutical practices. \n\n\n\nCurrently, about 50% of Korean pharmacies use \n\n\n\nPharmIT3000, which allows the easy-to-use management of \n\n\n\nprescription information, billing and invoicing, \n\n\n\nreimbursement claims, and inventory management. To \n\n\n\nimprove this program by catching up with the evolving \n\n\n\npractices in pharmacy, PM+20 was designed and \n\n\n\nimplemented. Methods: The PM+20 was distinctively \n\n\n\ndesigned and conceptualized based on the analysis of \n\n\n\nrequirements by pharmacists. The program was implemented \n\n\n\nby the technical counseling and cooperative work of experts, \n\n\n\nincluding software engineers, programmers, database \n\n\n\nadministrators, and web designers. The framework was \n\n\n\ndeveloped using Delphi 10.3.3 as the programming language. \n\n\n\nThis system runs on Microsoft SQL2014 Server for database \n\n\n\nmanagement. Additional components, such as TMS, TMS \n\n\n\nVCL Chart, FastReport, CPort, Image En, and WebSocket \n\n\n\nwere applied. Also, a data migration program was developed \n\n\n\nto support efficient data transfer. Results and Discussion: \n\n\n\nThe major functions of PIT3000 were upgraded and new \n\n\n\nfunctions were constructed with user-friendly interfaces in \n\n\n\nPM+20. Following the testing of the beta version of PM+20, \n\n\n\ncurrently, it has finally been released in community \n\n\n\npharmacies and is under the maintenance phase. The PM+20 \n\n\n\nexhibits quick activation of the program and enhanced \n\n\n\naccuracy and integration of data documentation with chart-\n\n\n\nform statistics and analysis utilities. Above all, PM+20 \n\n\n\nprovides integrated drug information based on the KPIC \n\n\n\ndatabase as implemented in the Pharm Chart Menu. \n\n\n\nConclusion: This integrated platform will improve the \n\n\n\ncomputerized pharmaceutical practices in community \n\n\n\npharmacies by minimizing the manual processes and by \n\n\n\nenhancing the efficiency and accuracy of practices. PM+20 \n\n\n\nis expected to assist the expansion of the pharmacist\u2019s \n\n\n\ncapability as a digital healthcare innovator. Our efforts are \n\n\n\ncurrently underway to establish and optimize this platform. \n\n\n\nAbstract 135 \n \n\n\n\nKnowledge, Attitudes, and Practices on the \n\n\n\nUse of Antibiotics among the Residents in \n\n\n\nSilago, Southern Leyte, Philippines: Basis \n\n\n\nfor Antimicrobial Stewardship Program for \n\n\n\nPrimary Health Care \n\n\n\n\n\n\n\nKim Ann Pere1, Vieno Gino Cruz1*, Nimfa B. \n\n\n\nGambalan2, Mark Harvey B. Adamson1, \n\n\n\nElvira V. De Leon3 \n \n1 School of Pharmacy, Graduate studies, Philippine Women\u2019s University, \n\n\n\nManila, Philippines \n2 Department of Pharmacy, College of Allied Health, National University, \n\n\n\nManila, Philippines \n3 College of Pharmacy, Manila Central University, Caloocan, Philippines \n\n\n\n* Corresponding author \n\n\n\nEmail: vcruz@pwu.edu.ph  \n\n\n\n\n\n\n\nBackground and Objectives: The study sought to determine \n\n\n\nknowledge, attitude, and practices (KAP) of residents Silago, \n\n\n\nSouthern Leyte, Philippines on the use of antibiotics which \n\n\n\nserved as the basis for a proposed Antimicrobial Stewardship \n\n\n\n(AMS) program for Primary Healthcare. This study \n\n\n\nspecifically sought to identify associations of residents\u2019 \n\n\n\ncharacteristics, their knowledge on antibiotics, their attitude \n\n\n\ntowards antibiotisc, and their practices on the use of \n\n\n\nantibiotics. Methods: This quantitative, cross-sectional study \n\n\n\nused a descriptive research design that utilized a validated \n\n\n\nand pretested structured questionnaire administered face-to-\n\n\n\nface during Department of Health (DOH) COVID-19 \n\n\n\n\u201cResbakuna\u201d Vaccination Program among 383 residents \n\n\n\nwho consented from 15 barangays who have used an \n\n\n\nantibiotic at least once. Statistical Package for Social \n\n\n\nSciences (SPSS) was used to perform all descriptive statistics \n\n\n\nfor summarizing KAP scores and non-parametric inferential \n\n\n\nstatistics such as Mann-Whitney, Kruskal-Wallis, \n\n\n\nSpearman\u2019s Correlation, and Chi-square test. Results and \n\n\n\nDiscussion: Results showed that residents obtained \n\n\n\n\u201cmoderate knowledge\u201d (M=67.53\u00b1SD=16.77), \u201cmoderate \n\n\n\nattitude\u201d (M=65.34\u00b1SD=20.52), and \u201chigh practice\u201d \n\n\n\n(M=78.61\u00b1SD=17.65) on antibiotic use. Study revealed ages \n\n\n\n\u201c50-59\u201d, and those who acquired antibiotics \u201cappropriately\u201d \n\n\n\nwere significantly associated with \u201chigh\u201d knowledge, \n\n\n\nattitudes, and practices on the use of antibiotics. Conclusion: \n\n\n\nFindings showed that residents of Silago have the appropriate \n\n\n\npractice on antibiotics use but have inadequate knowledge \n\n\n\nand attitude on antibiotics use, thus, it is hoped that this will \n\n\n\nprovide baseline information for primary health care AMS \n\n\n\nprogram implementation. \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:hytakim@kdrug.org\n\n\nmailto:vcruz@pwu.edu.ph\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n133 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 136 \n \n\n\n\nAssociated Factors Related to Influenza \n\n\n\nVaccine Acceptance among Adults in \n\n\n\nCavite During the COVID-19 Pandemic  \n\n\n\n\n\n\n\nPaola Allison B. Ara\u00f1o, Ma. Bernadette A. \n\n\n\nCirilos*, Christine Kate G. Conding, Hazel \n\n\n\nMae C. Equiza, Louie Fernand D. Legaspi \n \n\n\n\nDr. Mariano Que College of Pharmacy, De La Salle Medical and Health \n\n\n\nSciences Institute, Dasmari\u00f1as City, Philippines \n\n\n\n* Corresponding author \n\n\n\nEmail: bernacirilos@gmail.com  \n\n\n\n\n\n\n\nBackground and Objectives: National COVID-19 \n\n\n\nvaccination campaign officially started on March 1, 2021 in \n\n\n\nthe Philippines. Aside from COVID-19, seasonal flu caused \n\n\n\nby Influenza viruses becomes an additional health concern \n\n\n\nfor co-infection. This study aimed to investigate the \n\n\n\nassociated factors related to influenza vaccine acceptance \n\n\n\namong adults in Cavite during the COVID-19 pandemic. The \n\n\n\nstudy also intended to investigate the significant relationship \n\n\n\nbetween influenza vaccine knowledge, influenza vaccine \n\n\n\nperceptions, and influenza vaccine acceptance. Methods: \n\n\n\nData was collected in the province of Cavite using an online \n\n\n\nself-administered questionnaire. The significance of \n\n\n\nassociations was determined using Pearson Chi-Square and \n\n\n\nits strength was identified using Cram\u00e9r's V, while \n\n\n\nSpearman\u2019s Rho was used to measure correlations. Results \n\n\n\nand Discussion: The results of this study showed that most \n\n\n\nadults had a high level of knowledge (69.55%), the average \n\n\n\nof the respondents had a fairly positive perception \n\n\n\n(Mean=3.55), and only some (35.8%) showed acceptance to \n\n\n\ninfluenza vaccine during the COVID-19 pandemic. Sex, and \n\n\n\neducational attainment had a strong significant association, \n\n\n\nwhile employment status had a moderate significant \n\n\n\nassociation with Influenza vaccine knowledge. Educational \n\n\n\nattainment had a strong significant association with influenza \n\n\n\nvaccine perception, while employment status had a  strong \n\n\n\nassociation with Influenza vaccine acceptance. Conclusion: \n\n\n\nThe study concludes that a high level of influenza vaccine \n\n\n\nknowledge would lead to a positive  influenza vaccine \n\n\n\nperception and will increase vaccine acceptance. Moreover, \n\n\n\ninfluenza vaccine perception has a strong positive \n\n\n\nrelationship with vaccine acceptance. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 137 \n\n\n\n \nMilitary Pharmacist Involvement in \n\n\n\nCOVID-19 Vaccination Outreach \n\n\n\nProgramme  \n\n\n\n\n\n\n\nKhan ARK1*, Baharuddin F1, Adnan MA2, \n\n\n\nBasari AH2 \n\n\n\n\n\n\n\n1 Malaysian Joint Force Headquarters, Kuantan, Pahang, Malaysia \n2 Malaysian Armed Forces Headquarters, Kuala Lumpur, Malaysia \n\n\n\n* Corresponding author \n\n\n\nEmail: amirahkhan.ark@gmail.com  \n\n\n\n\n\n\n\nBackground and Objectives:  In Malaysia, National \n\n\n\nCOVID-19 Vaccination Programme (NCVP) started in \n\n\n\n24th February 2021. Traditionally, it is well-known among \n\n\n\nthe public that the vaccination program is often linked with \n\n\n\ndoctors and nurses in our local healthcare scene. Pharmacists \n\n\n\nalso have their roles in this massive vaccination program \n\n\n\nwhich include the areas of regulatory, procurement, \n\n\n\ndistribution, advocacy as well as in monitoring and reporting \n\n\n\nof Adverse Event Following Immunization (AEFI). Methods:  \n\n\n\nThe Military Health Division of Malaysian Joint Force \n\n\n\nHeadquarters organized COVID-19 Vaccination Outreach \n\n\n\nProgramme at South Panching River Federal Land \n\n\n\nDevelopment Authority (FELDA), Pahang in August 2021 as \n\n\n\npart of the Civil-Military Cooperation (CIMIC) Programme \n\n\n\nin collaboration with Kuantan District Health Office, \n\n\n\nMinistry of Health Malaysia. Results and Discussion:  \n\n\n\nOverall, the programme managed to deliver 3,864 doses of \n\n\n\nCOVID-19 vaccine in a timely manner, targeted to the \n\n\n\nFELDA population in anticipation of floods that usually \n\n\n\nhappens in this area during the monsoon season usually at the \n\n\n\nlast quarter of the year. Throughout this programme, military \n\n\n\npharmacists have been actively involved as the coordinator \n\n\n\nof the programme and have successfully undertook the \n\n\n\nresponsibility, mainly in distribution and AEFI monitoring. \n\n\n\nApart from that, military pharmacists were also involved in \n\n\n\nadvocating vaccination by addressing the population\u2019s \n\n\n\nvaccine hesitancy, together with the religious officer from the \n\n\n\nheadquarters. By implementing effective communication \n\n\n\nstrategies, military pharmacists managed to inform the public \n\n\n\nabout the safety and efficacy of available vaccines, addressed \n\n\n\ntheir concerns and fears and dispel myths and misconceptions, \n\n\n\nthus allowing the public to make informed an decision which \n\n\n\ncan finally lead to developing herd immunity against the \n\n\n\nvirus. Conclusion:  With proper recognition, investment and \n\n\n\ntraining, military pharmacists can do more significant roles \n\n\n\nother than the established roles to achieve high vaccination \n\n\n\ncoverage, advocating public health as well as ensuring \n\n\n\nmedication safety among the public. \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:bernacirilos@gmail.com\n\n\nmailto:amirahkhan.ark@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n134 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 138 \n\n\n\n\n\n\n\nMilitary Pharmacist Involvement in Greater \n\n\n\nKlang Valley Special Task Force (GKVSTF) \n\n\n\n\u2013 Medical and General Logistics Cluster \n\n\n\n(MedGenLog Cluster) \n\n\n\n  \nMej Muhammad Najhan bin Md Bohari1*, Lt \n\n\n\nKol Mohamad Halif bin Mohamad Yusof2, \n\n\n\nKol Mohd Adlan bin Adnan3, Brig Jen Dato\u2019 \n\n\n\nDr A. Halim bin Basari3 \n\n\n\n \n1 Malaysian Armed Forces Medical and Dental Depot, Kuala Lumpur. \n2 Tuanku Mizan Armed Forces Hospital, Kuala Lumpur. \n3 Pharmaceutical Service Branch, Health Services Division, Malaysian \n\n\n\nArmed Forces \n\n\n\n* Corresponding author \n\n\n\nEmail: muhd.najhan@yahoo.com  \n \n\n\n\nBackground and Objectives: The GKVSTF was established \n\n\n\nand responsible for the planning and execution of the \n\n\n\nCOVID-19 Pandemic Action Control Plan in the Greater \n\n\n\nKlang Valley Region when COVID-19 cases accelerated in \n\n\n\nJuly 2021, reaching up to 12,000 cases daily. GKVSTF was \n\n\n\ntasked to implement contingency measures to mitigate the \n\n\n\ncrisis. Objective of this report is to share Military \n\n\n\nPharmacists' experience in managing challenges in the \n\n\n\nGKVSTF especially in the Medical and General Logistics \n\n\n\n(MedGenLog) Cluster. Methods: MedGenLog cluster\u2019s \n\n\n\nterms of references are to collect and analyse relevant logistic \n\n\n\ndata and implement actions accordingly with regards to the \n\n\n\nmedical and general logistics needs of all health facilities \n\n\n\nwithin GKV, liaise with the Finance Cluster to secure budget, \n\n\n\nidentify appropriate procurement methods, carry out the \n\n\n\nprocurement process, manage and coordinate an effective \n\n\n\nand efficient supply chain system from the process of \n\n\n\nreceiving, storage and distribution to the facilities. Results \n\n\n\nand Discussion: Throughout the mission, MedGenLog \n\n\n\ncluster had engaged with all respective hospitals and other \n\n\n\nrelevant government and non-government agencies to \n\n\n\nmanage vital medications and consumables supply, manage \n\n\n\noxygen supply, hospital medical and non-medical equipment, \n\n\n\npatient transportation, communication as well as other \n\n\n\nlogistic matters. Conclusion: GKVSTF had significantly \n\n\n\nmanaged the surge of COVID-19 patients by implementing \n\n\n\nout-of-the-book strategies to mitigate the issues. Military \n\n\n\nPharmacists involvement in MedGenLog Cluster were vital \n\n\n\nand gave an impact in implementing and supporting the \n\n\n\nstrategies and managing challenges. The efforts and \n\n\n\ninitiatives from GKVSTF had been subsequently replicated \n\n\n\nand extended to other regions of the country to manage the \n\n\n\nCOVID-19 pandemic. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 139 \n\n\n\n\n\n\n\nThe Flying Pharmacist: Military \n\n\n\nPharmacist\u2019s Experiences and Roles in \n\n\n\nManaging COVID-19 Vaccine Logistics \n\n\n\nUsing Royal Malaysian Airforce (RMAF) \n\n\n\nAircraft \n\n\n\n\n\n\n\nMAE Zamri1*, MA Adnan2, AH Basari2, MA \n\n\n\nRahim3, MH Haron1   \n \n1 Institute of Aviation Medicine (IAM), Subang, Malaysia \n2 Malaysian Armed Forces Health Services Division, Kuala Lumpur, \n\n\n\nMalaysia \n3 Malaysian Armed Forces Medical and Dental Depot, Kuala Lumpur, \n\n\n\nMalaysia \n\n\n\n* Corresponding author \n\n\n\nEmail: amirehsanzamri@gmail.com  \n\n\n\n\n\n\n\nBackground and Objectives:  The first batch of COVID-19 \n\n\n\nvaccine roll-out among the Malaysian Armed Forces (MAF) \n\n\n\nstarted in late February 2021, targeting approximately 50,000 \n\n\n\nmilitary and healthcare personnel in MAF who had been \n\n\n\ncategorized as frontliners and as a high risk group. In \n\n\n\naccordance with the Chief of Defence Forces (CDF) \n\n\n\ncommand to ensure a swift vaccination program to the \n\n\n\ntargeted group, the Royal Malaysian Air Force (RMAF) was \n\n\n\ngiven the \u2018green light\u2019 to deploy its strategic aircraft assets to \n\n\n\nfacilitate vaccination programs throughout Malaysia.  The \n\n\n\ngeneral objective of this case report is to share military \n\n\n\npharmacists\u2019 experiences and roles in managing COVID-19 \n\n\n\nvaccine logistics support from planning to distribution using \n\n\n\nRMAF aircraft. Methods: This is a retrospective case report, \n\n\n\nobservational study, by military pharmacists who had been \n\n\n\nintensively involved with a total of 35 cumulative flying \n\n\n\nhours in delivering COVID-19 vaccines. Results and \n\n\n\nDiscussion: It is observed that delivering vaccines using \n\n\n\naircraft proved to speed up the vaccination program among \n\n\n\nthe Armed Forces Health Facilities in the designated delivery \n\n\n\nareas.  There are many key challenges faced in handling \n\n\n\nCOVID-19 vaccine logistics as the vaccines are fragile and \n\n\n\nsensitive to extreme temperature variation thus required \n\n\n\nproper handling and monitoring to ensure the viability of the \n\n\n\nvaccine is preserved. Pharmacists are well versed in this \n\n\n\nprocess as they are exposed both theoretically and practically \n\n\n\nvia pharmacy training modules prior to the National COVID-\n\n\n\n19 Immunization Programme. Conclusion: Military \n\n\n\npharmacists play critical roles in performing the \n\n\n\nPharmaceutical and Medical Logistics (Pharmamedlog) \n\n\n\nsupport in accomplishing the mission objectives as well as \n\n\n\nsupporting the National COVID-19 Immunization \n\n\n\nProgramme.  \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:muhd.najhan@yahoo.com\n\n\nmailto:amirehsanzamri@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n135 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 140 \n\n\n\n\n\n\n\nCustomer Satisfaction towards Logistic \n\n\n\nPharmacy Services in HTJS \n\n\n\n\n\n\n\nSalihah bt Aidit, Rekarani a/p Rajantharan, \n\n\n\nNurfikriah Husna bt Mohamad Radz*, Nur \n\n\n\nAthirah bt Muhammad Fairuz \n\n\n\n\n\n\n\nDepartment of Pharmacy, Tuanku Ja\u2019afar Hospital, Seremban, Negeri \n\n\n\nSembilan, Malaysia \n\n\n\n* Corresponding author \n\n\n\nEmail: nurfikriahhusna@gmail.com \n\n\n\n\n\n\n\nBackground: Customer satisfaction is one important \n\n\n\nindicator of the quality of care because it reflects whether or \n\n\n\nnot a given service is meeting customer\u2019s expectations and is \n\n\n\nconsistent with their values. This study aimed to determine \n\n\n\nthe level of customer satisfaction towards logistic pharmacy \n\n\n\nservices and factors that affect the satisfaction of customers \n\n\n\ntowards logistic pharmacy services in Tuanku Ja\u2019afar \n\n\n\nHospital, Seremban (HTJS). Objectives: The objectives of \n\n\n\nthis study were to determine the level of satisfaction of \n\n\n\ncustomers towards logistic pharmacy services and to identify \n\n\n\nfactors that affect the satisfaction level of customers towards \n\n\n\nlogistic pharmacy services. Methods: A study was \n\n\n\nconducted in Tuanku Ja\u2019afar Hospital, Seremban. The total \n\n\n\nnumber of respondents were 80. A validated questionnaire \n\n\n\nwas used, and it consisted of two types of questions. First was \n\n\n\n\u201cCustomer Satisfaction Study\u201d and second was \u201cServqual\u2019s \n\n\n\nmodel\u201d. The study only included hospital staff involved in \n\n\n\nindenting from logistic pharmacy. They were referred to as \n\n\n\ncustomers in this study. The questionnaire took 15 to 20 \n\n\n\nminutes per respondent. Data were analysed using IBM SPSS \n\n\n\nSystem (Version 26) to determine the association and \n\n\n\ncorrelation between factors that affected the satisfaction level. \n\n\n\nP-value <0.05 indicated the data were statistically significant.  \n\n\n\nResults and Discussion: Out of all 80 respondents, 58 of \n\n\n\nthem (72.5%) were satisfied with the overall services \n\n\n\nprovided by the logistic pharmacy unit. Meanwhile, the \n\n\n\nremaining 22 respondents (27.5%) felt very satisfied with the \n\n\n\nservices. The three possible factors that contributed towards \n\n\n\ncustomer satisfaction were facilities, customer service and \n\n\n\nquality of service, which showed a statistically significant \n\n\n\ncorrelation with the overall satisfaction of the end user (\u03c7\u00b2: \n\n\n\n16.2, p: 0.006). Conclusion: Most of the respondents were \n\n\n\nsatisfied with the facilities, customer service and quality of \n\n\n\nservices provided by the logistic pharmacy unit in Hospital \n\n\n\nTuanku Ja\u2019afar. In addition, current services provided by the \n\n\n\nlogistic pharmacy unit in Hospital Tuanku Ja\u2019afar Seremban \n\n\n\nmet end users\u2019 expectations.  \n\n\n\n\n\n\n\n\n\n\n\nAbstract 141 \n\n\n\n\n\n\n\nPatient Characteristics and Factors \n\n\n\nAssociated with Defaulters among Drive-\n\n\n\nthrough Patients in Hospital Tuanku \n\n\n\nJa\u2019afar Seremban \n\n\n\n\n\n\n\nNursyafiqah. Md Tahir*, Nurshazlien. \n\n\n\nAbd.Halim, Jayasir Elengko \n \n\n\n\nDepartment of Pharmacy, Hospital Tuanku Ja\u2019afar Seremban, Negeri \n\n\n\nSembilan, Malaysia \n\n\n\n* Corresponding author \n\n\n\nEmail: adrenaliqa2021@gmail.com  \n\n\n\n\n\n\n\nBackground and Objectives: Drive-through pharmacy \n\n\n\nservice was introduced to resolve the problems encountered \n\n\n\nby patients during medicine collection visits such as \n\n\n\ninadequate parking space and long waiting time. However, \n\n\n\ndefaulters among drive-through patients contribute to \n\n\n\ninsufficient storage space for packaged defaulter medication, \n\n\n\nwaste of manpower and finances. This study aimed to \n\n\n\ninvestigate the characteristics and associated factors of \n\n\n\ndefaulters among drive-through patients. Methods: A \n\n\n\nretrospective cohort study was conducted, and simple \n\n\n\nrandom sampling was performed across newly registered and \n\n\n\nexisting drive-through patients in Hospital Tuanku Ja\u2019afar \n\n\n\nfrom May 2021 to June 2021. The outcome measure was the \n\n\n\nstatus of the patients categorized as defaulter and non-\n\n\n\ndefaulter. Collected data consisted of the patient\u2019s \n\n\n\ndemographic, patient characteristics, prescription \n\n\n\ncharacteristics, knowledge of characteristic and logistic \n\n\n\nissues. All data were analysed descriptively, and multiple \n\n\n\nlogistic regression was used in analyzing the association of \n\n\n\nfactors with defaulters. Results and Discussion: A total of \n\n\n\n335 drive-through patients were included in this study.                       \n\n\n\nThe prominent characteristics of defaulter patients were 66.7% \n\n\n\nfemale with a mean (standard deviation (SD)) age of 57.3 \n\n\n\n(17.67) years, 48.5% Malay, 57.6% new registered patients \n\n\n\nand 72.7% patients who were dependent. The proportion of \n\n\n\ndefaulters were 10.7% (95% CI: 6.2, 15.8) and 8.9 % (95% \n\n\n\nCI: 4.4, 13.3) in new registered and existing drive through \n\n\n\npatients respectively. In multivariable analysis, factors \n\n\n\nsignificantly associated with defaulters were female (OR= \n\n\n\n2.58; 95% CI:1.18 - 5.62; P=0.017), semi or fully dependent \n\n\n\n(OR= 2.66; 95% CI: 1.17- 6.05; P=0.020) and those who did \n\n\n\nnot receive notification (OR= 3.35; 95% CI: 1.43 - 7.84; \n\n\n\nP=0.005). Conclusion: There was a higher proportion of \n\n\n\ndefaulters among new patients compared to existing patients. \n\n\n\nFemale patients, semi or fully dependent patients and those \n\n\n\nwho did not receive notification had greater risk to become a \n\n\n\ndefaulter.  \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:nurfikriahhusna@gmail.com\n\n\nmailto:adrenaliqa2021@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n136 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 142 \n\n\n\n\n\n\n\nAssessment of Public Satisfaction on \n\n\n\nNational COVID-19 Immunization \n\n\n\nServices among the Malaysian Population \n\n\n\n\n\n\n\nWan Xin Soo Toh, Yoon Fong Hoo* \n\n\n\n\n\n\n\nSchool of Pharmacy, Faculty of Health and Medical Sciences, Taylor\u2019s \n\n\n\nUniversity, No.1, Jalan Taylor\u2019s, 47500 Subang Jaya, Selangor, Malaysia \n\n\n\n* Corresponding author \n\n\n\nEmail: yoonfong.hoo@taylors.edu.my  \n\n\n\n\n\n\n\nBackground and Objectives: National COVID-19 \n\n\n\nImmunization Programme (PICK) is  a programme \n\n\n\nimplemented by the Malaysian government to curb the \n\n\n\nCOVID-19 pandemic in Malaysia. The public is the \n\n\n\nbeneficiary in health systems. Therefore, by measuring \n\n\n\npublic satisfaction and preferences regularly, the effects of \n\n\n\nservices to the public can be improved continuously. In this \n\n\n\nstudy, we assessed public satisfaction on national COVID-19 \n\n\n\nImmunization services among the Malaysian population. \n\n\n\nMethods: A cross-sectional survey using snowball sampling \n\n\n\nmethod was conducted among Malaysians, aged 18 and \n\n\n\nabove, who have received free COVID-19 vaccinations in \n\n\n\nMalaysia, able to comprehend English. The questionnaire \n\n\n\nconsisted of two sections: socio-demographic data and public \n\n\n\nsatisfaction towards national COVID-19 immunization \n\n\n\nservices. Satisfaction was measured using 15 satisfaction-\n\n\n\nrelated items with 5 determinants of satisfaction:  with a 5-\n\n\n\npoint Likert scale, with 5 for very satisfied and 1 for very \n\n\n\ndissatisfied Descriptive and inferential statistics were utilized \n\n\n\nfor data analysis, with a level of significance at p> 0.05. \n\n\n\nResults and Discussion: Response rate was 89.5% (459/513 \n\n\n\napproached). Females made up 65.4%. Majority of the \n\n\n\nrespondents were aged below 39 (66.2%), MySejahtera users \n\n\n\n(92.8%), Chinese (79.3%), and had tertiary education \n\n\n\n(78.4%). The overall mean satisfaction score (SD) was 4.14 \n\n\n\n(\u00b1 0.56). Factors which showed statistically high positive \n\n\n\ncorrelation with overall public satisfaction include \n\n\n\nimmunization system (P<0.01), consultations by healthcare \n\n\n\nprofessionals before vaccination (p<0.01) and attitudes of \n\n\n\nstaff at the vaccination centre (p<0.01). Conclusion: The \n\n\n\noverall satisfaction level towards COVID-19 immunization \n\n\n\nservices is high among the Malaysian population. Regardless \n\n\n\nof the high satisfaction rate, more extensive and further \n\n\n\nresearch needs to be conducted to provide a better insight on \n\n\n\nthis matter and we still need to keep improving the measures \n\n\n\nin place to further boost the satisfaction among Malaysians \n\n\n\ntowards the immunization services, which can help further \n\n\n\nstrengthen healthcare delivery standards.  \n\n\n\n\n\n\n\n\n\n\n\nAbstract 143 \n\n\n\n\n\n\n\nPerceptions, Attitude, and Barriers of \n\n\n\nPAPPI Regulatory Pharmacists Towards \n\n\n\nRegulatory Pharmacy Experiential Practice: \n\n\n\nA Basis for Capacity Programs \n\n\n\n\n\n\n\nRosita S. Ignacio1, Nimfa B. Gambalan2\uff0c\n\n\n\nVieno Gino Cruz1*, Mark Harvey B. \n\n\n\nAdamson1 \n \n1 School of Pharmacy, Graduate studies, Philippine Women\u2019s University, \n\n\n\nManila, Philippines \n2 Department of Pharmacy, College of Allied Health, National University, \n\n\n\nManila, Philippines \n\n\n\n* Corresponding author \n\n\n\nEmail: vcruz@pwu.edu.ph  \n \n\n\n\nBackground and Objectives: As one of the major fields in \n\n\n\nthe experiential pharmacy practice, regulatory pharmacists \n\n\n\nare involved in the preceptorship of pharmacy students to \n\n\n\nhelp engage them in the acquisition of knowledge and skills \n\n\n\nfor their future responsibilities. This study determined the \n\n\n\nperceptions and attitudes of the regulatory pharmacists \n\n\n\nregarding their roles, benefits, and scope as preceptors, as \n\n\n\nwell as the barriers that they might encounter in the \n\n\n\nintegration of the regulatory pharmacy experiential practice \n\n\n\nin the new pharmacy curriculum. Methods: The research \n\n\n\nemployed an exploratory descriptive design. With regulatory \n\n\n\npharmacists from the Philippine Association of Pharmacists \n\n\n\nin the Pharmaceutical Industry (PAPPI) as respondents, an \n\n\n\nonline instrument, tested for content validity and internal \n\n\n\nconsistency, was administered. Results and Discussion: \n\n\n\nResponse turn-out was 50.42% of the total population. The \n\n\n\nregulatory pharmacists showed high perception and attitudes \n\n\n\nto the roles, scope, and benefits of preceptors as well as on \n\n\n\nthe scope of training. As for the barriers, it was found that \n\n\n\nprovision of facilities, technical infrastructures, organized \n\n\n\nregulatory pharmacy experiential practice, lack of time and \n\n\n\nmotivations, were some of the factors that may be \n\n\n\nencountered in the provision of the regulatory experiential \n\n\n\npharmacy practice. Based on the results, there was a \n\n\n\nsignificant positive correlation between perception and \n\n\n\nattitude of regulatory pharmacists to RPEP (p < .01).  \n\n\n\nConclusion:  To ensure provision of an excellent regulatory \n\n\n\nexperiential practice, it is recommended that capacity \n\n\n\nbuilding programs, strong collaboration between academia \n\n\n\nand industries, as well as workshops on preceptorships, be \n\n\n\nimplemented. Furthermore, it is proposed that the workload \n\n\n\nof preceptors be revised, and recognition be provided for the \n\n\n\ncontribution of the regulatory pharmacists in the experiential \n\n\n\npharmacy practice. \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:yoonfong.hoo@taylors.edu.my\n\n\nmailto:vcruz@pwu.edu.ph\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n137 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 144 \n\n\n\n\n\n\n\nExploratory Factor Analysis of A Patient-\n\n\n\nreported Outcome Measure: A Newly \n\n\n\nDeveloped Medication Adherence \n\n\n\nMeasurement Tool for the Elderly in \n\n\n\nMalaysia \n\n\n\n\n\n\n\nKamaliah Md Saman1*, Nurfatiha Zulkarnain \n\n\n\nHelmi2, Khairil Anuar Md Isa2, Mathumalar \n\n\n\nLoganathan Fahrni1 \n \n\n\n\n1 Department of Pharmacy Practice, Faculty of Pharmacy, Universiti \n\n\n\nTeknologi MARA (UiTM) Cawangan Selangor, Kampus Puncak Alam, \n\n\n\n42300 Bandar Puncak Alam, Selangor, Malaysia \n2 Department of Basic Sciences, Faculty of Health Sciences, Universiti \n\n\n\nTeknologi MARA (UiTM) Cawangan Selangor, Kampus Puncak Alam, \n\n\n\n42300 Bandar Puncak Alam, Selangor, Malaysia  \n\n\n\n* Corresponding author \n\n\n\nEmail: kamaliah@uitm.edu.my  \n\n\n\n\n\n\n\nBackground and Objectives: Measurement of medication \n\n\n\ndefault among the elderly is still a growing concern \n\n\n\nworldwide, compounded by the scarcity of a reliable \n\n\n\nmeasure specific for this cohort of people.  Recently we \n\n\n\ndeveloped a patient-reported outcome measure (PROM) to \n\n\n\nmeasure level of non-adherence to medication among the \n\n\n\nelderly, named Medication Alert Tool For the Elderly \n\n\n\n(MeSATE).   In line with the Consensus-based Standards for \n\n\n\nthe Selection of Health Status Measurement Instrument \n\n\n\n(COSMIN), this study aimed to validate MeSATE  \n\n\n\nreliability for usability purpose in Malaysia by using \n\n\n\nexploratory factorial analysis (EFA). Methods: This cross-\n\n\n\nsectional study was conducted among the residents of long-\n\n\n\nterm nursing care homes around Klang Valley, as well as \n\n\n\npatients from the outpatient, geriatric  and diabetic \n\n\n\nmedication therapy adherence clinic in one of the \n\n\n\ngovernment tertiary hospital and a health centre in Selangor \n\n\n\nand Johor respectively (n=391). Results and Discussion: \n\n\n\nFactor analysis on the MeSATE questions showed that there \n\n\n\nwere four underlying structures, while the Cronbach alpha \n\n\n\ncoefficient indicates that MeSATE had an acceptable \n\n\n\ninternal consistency. Conclusion: MeSATE is a valid and \n\n\n\nreliable measurement tool for food medication adherence \n\n\n\nmeasurement among the Malaysian elderly population.\n\n\n\nAbstract 145 \n\n\n\n\n\n\n\nTransethosomal Gels as Nanocarriers for \n\n\n\nthe Transdermal Delivery of Tamoxifen: \n\n\n\nStatistical Optimization, Characterization, \n\n\n\nand Ex vivo Evaluation \n\n\n\n\n\n\n\nReem Abou Assi1,2, Siok Yee Chan 1* \n \n1 Thoughts Formulation Lab., School of Pharmaceutical Sciences, \n\n\n\nUniversiti Sains Malaysia, 11800 Malaysia \n2 EDEN Research Group, Discipline of Pharmaceutical Technology, \n\n\n\nCollege of Pharmacy, Al-Kitab University, Altun kupri, Kirkuk, 36001, \n\n\n\nIraq. \n\n\n\n* Corresponding author \n\n\n\nEmail: sychan@usm.my  \n\n\n\n\n\n\n\nBackground and Objectives: Tamoxifen is the drug of \n\n\n\nchoice for the prevention and treatment of estrogen \n\n\n\ndependent breast cancer. Its oral administration is associated \n\n\n\nwith low solubility, life threatening side effects and \n\n\n\nconsequently low patients\u2019 adherence. Thus, to circumvent \n\n\n\nthese drawbacks, the transdermal delivery of tamoxifen was \n\n\n\ndeveloped. Precise consideration was given to understanding \n\n\n\nnonionic surfactants impact with different hydrophilic\u2013\n\n\n\nlipophilic balance (HLB) values when used as edge \n\n\n\nenhancers in the transethosomal production and performance. \n\n\n\nMethods: Tamoxifen-loaded transethosomes (TEs) were \n\n\n\nprepared by the cold method and statistically optimized using \n\n\n\nthree sets of 24 factorial design experiments for three \n\n\n\ndifferent edge enhancers of HLB values 16.7, 8.6, 4.3 \n\n\n\nrespectively. The optimized formulations were incorporated \n\n\n\ninto Carbopol 940\u00ae gel base. The prepared tamoxifen-loaded \n\n\n\ntransethosomal gels were further characterized for vesicular \n\n\n\nsize, dispersity, zeta potential, entrapment efficiency, pH, \n\n\n\nviscosity, yield, rheological behavior, and ex vivo skin \n\n\n\npermeation through pig skin. Results and Discussion: The \n\n\n\nresults showed that the tamoxifen-loaded TEs had aspherical \n\n\n\nirregular shape, nanometric size range in all TEs, with higher \n\n\n\nentrapment efficiency in lower HLB values, which is \n\n\n\nattributed to such edge enhancer ability to solubilize more \n\n\n\ntamoxifen. All the formulated gels exhibited non-Newtonian \n\n\n\nplastic flow without thixotropy. Regardless of the HLB value, \n\n\n\ntamoxifen-loaded transethosomal gels were able to \n\n\n\nsignificantly enhance the skin permeation parameters of the \n\n\n\ndrug in comparison to the non-ethosomal gel. Conclusion: \n\n\n\nThese findings suggested that the transethosomal gels (with \n\n\n\nhigh or low HLB values) are promising carriers for the \n\n\n\ntransdermal delivery of tamoxifen, providing an alternative \n\n\n\nroute for breast cancer therapy administration.  \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:kamaliah@uitm.edu.my\n\n\nmailto:sychan@usm.my\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n138 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 146 \n\n\n\n\n\n\n\nViability Assay of Essential Fatty Acids \n\n\n\nfrom the Benincasa hispida Seed Extract in \n\n\n\nKeratinocytes  \n\n\n\n\n\n\n\nRamli RZ* & Hadi H      \n \n\n\n\nDermatopharmaceutics Research Group, Department of Pharmaceutical \n\n\n\nTechnology, Kuliyyah of Pharmacy, International Islamic University \n\n\n\nMalaysia, Kuantan, Pahang, Malaysia \n\n\n\n* Corresponding author \n\n\n\nEmail: rizal.zaim@yahoo.com  \n \n\n\n\nBackground and Objectives: Both omega-3 and omega-6 \n\n\n\nfatty acids (FAs) play different crucial roles in human body, \n\n\n\nand they are the important components in cell membranes \n\n\n\nand the main precursors of other FAs which are needed for \n\n\n\ngrowth and repair functions in the human body. Benincasa \n\n\n\nhispida seed extract\u2019s (BHSE) main contents were found out \n\n\n\nto be mainly consists of polyunsaturated fatty acids (PUFAs). \n\n\n\nIn this study, two methods were carried out which were the \n\n\n\ncell culture of HaCaT cells and the MTS viability assay. \n\n\n\nMethods: The viability assay was first started with the \n\n\n\nculture of HaCaT cells in the 96-well microplate at cell \n\n\n\ndensity of 1 X 10^5. The growth of the cells was monitored \n\n\n\nand maintained using the high glucose Dulbecco Modified \n\n\n\nEagle Medium and in an incubator at 37\u02daC and 5% carbon \n\n\n\ndioxide level. After one day of incubation, the cells were \n\n\n\nfound to be confluent (~ 80%) and the cells were treated with \n\n\n\nsix different concentrations of BHSE (1000 \u00b5g/mL, 500 \n\n\n\n\u00b5g/mL, 250 \u00b5g/mL, 125 \u00b5g/mL, 62.5 \u00b5g/mL and 31.25 \n\n\n\n\u00b5g/mL). Three set of plates were cultured with each plate was \n\n\n\ncultured at 24 hours, 48 hours and 72 hours prior measuring \n\n\n\nthe absorbance (after 4 hours of incubation with MTS reagent) \n\n\n\nusing the microplate reader at 490 nm. Results and \n\n\n\nDiscussion: This study has found that there was no \n\n\n\ncytotoxicity effect of the extract towards the HaCaT cells \n\n\n\n(overall cell viability was more than 80%) with significant \n\n\n\ndifferences were found from 31.25 \u00b5g/mL until 500 \u00b5g/mL \n\n\n\nafter 24 hours and 48 hours treatment durations. Conclusion: \n\n\n\nTo sum up, this data is important in the safety application of \n\n\n\nthe extract especially the PUFAs in any studies to be \n\n\n\nconducted especially in dermatology studies for the \n\n\n\ninvolvement of the keratinocytes. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 147 \n\n\n\n\n\n\n\nThe Development and Characterisation of \n\n\n\nRetinoic Acid Loaded Nanosponge \n\n\n\n\n\n\n\nSyed Omar SS\u00b9*, Hadi H\u00b9, Doolanea AA1,2 \n\n\n\n\n\n\n\n\u00b9 Dermatopharmaceutics Research Group, Department of Pharmaceutical \n\n\n\nTechnology, Faculty of Pharmacy, International Islamic University \n\n\n\nMalaysia, Malaysia \n,2 Department of Pharmaceutical Technology, Faculty of Pharmacy, \n\n\n\nUniversity College MAIWP International, Malaysia \n\n\n\n* Corresponding author \n\n\n\nEmail: shakirahsaggaf@gmail.com  \n\n\n\n\n\n\n\nBackground and Objectives: Retinoic acid (RA) has high \n\n\n\nefficacy against acne but is insoluble in water, unstable in the \n\n\n\npresence of light, heat and air; and may cause side effect on \n\n\n\nthe skin such as dryness, peeling and pruritus.  Nanosponge \n\n\n\nwith its porous structure can entrap RA and maybe able to \n\n\n\nenhance the solubility and stability of RA, improving its \n\n\n\ndelivery while reducing side effects. The objective of this \n\n\n\nstudy is to develop RA loaded nanosponge formulation with \n\n\n\nfavourable characteristics. Methods: Nanosponge was \n\n\n\nprepared with \u03b2-cyclodextrin as the polymer and \n\n\n\ncarbonyldiimidazole as the cross-linker. The nanosponge \n\n\n\nwas then characterized by assessing its particle size, zeta \n\n\n\npotential, surface morphology, Attenuated Total Reflectance \n\n\n\nFourier-transform Infra-Red (ATR-FTIR) Spectroscopy \n\n\n\nstudy, Differential Scanning Calorimetric (DSC) Study. The \n\n\n\nentrapment efficiency was also analysed. Results and \n\n\n\nDiscussion: The RA nanosponge showed desirable \n\n\n\ncharacteristics with particle size of below 300nm, \n\n\n\npolydispersity index below 0.5 and zeta potential value of -\n\n\n\n24.1 mV. Encapsulation efficiency obtained was 78.19% \n\n\n\nwhich is optimal as it is above 60%. Both ATR-FTIR and \n\n\n\nDSC study confirmed inclusion of RA in the cyclodextrin. \n\n\n\nConclusion: Retinoic acid can be loaded into the nanosponge \n\n\n\nand obtain favourable characteristics suitable for further in-\n\n\n\ndepth research. \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:rizal.zaim@yahoo.com\n\n\nmailto:shakirahsaggaf@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 47-139 \n\n\n\n\n\n\n\nResearch Presentation of 28th FAPA - Federation of Asian Pharmaceutical Associations and MPS- National Pharmacy Convention 2022 \n\n\n\nDOI:  10.52494/JACT2738 \n\n\n\n\n\n\n\n139 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 148 \n\n\n\n\n\n\n\nFormulation and Evaluation of \n\n\n\nVoriconazole Gastro Retentive Floating \n\n\n\nTablets \n\n\n\n\n\n\n\nD Srinivasa Sastry*, S. Jahnavi Purna, G \n\n\n\nSumalatha, D Srilakshmi \n \n\n\n\nVikas Institute of Pharmaceutical Sciences, Near Airport, Nidigatla Road, \n\n\n\nRajahmundry-533101 Andhra Pradesh India,  \n\n\n\nAndhra University, Andhra Pradesh, India \n\n\n\n* Corresponding author \n\n\n\nEmail: dsrinivas78@gmail.com  \n\n\n\n\n\n\n\nBackground and Objectives: The present study was a \n\n\n\nsystematic approach for development of intragastric buoyant \n\n\n\ntablets of voriconazole with a view to enhance its oral \n\n\n\nbioavailability and efficacy.  Methods: Gastro retentive \n\n\n\nfloating tablets of voriconazole using various polymers guar \n\n\n\ngum, xanthan gum, ethyl cellulose and sodium bicarbonate, \n\n\n\nmagnesium stearate and talc in different proportions were \n\n\n\nprepared by direct compression method and subjected to In \n\n\n\nvitro drug release studies. Drug polymer compatibility \n\n\n\nstudies were carried out by FT-IR study. The formulation \n\n\n\nblend was subjected to various preformulation studies, flow \n\n\n\nproperties and all the formulations were found to be good \n\n\n\nindicting that the powder has good flow properties. All the \n\n\n\nformulations were evaluated for hardness, friability, weight \n\n\n\nvariation, drug content and In vitro drug release. Results and \n\n\n\nDiscussion: Among all the formulations, formulation \n\n\n\nprepared with guar gum retarded the drug release up to 12 \n\n\n\nhours (F2). The formulations prepared with xanthan gum and \n\n\n\nethyl cellulose also retarded drug release for more than 12 \n\n\n\nhours. Hence, they were not considered. The optimized \n\n\n\nformulation dissolution data was subjected to release kinetics, \n\n\n\nfrom the release kinetics data was evident that the \n\n\n\nformulation followed Higuchi mechanism of the drug release.  \n\n\n\nConclusion: Thus, the above study clearly indicated that \n\n\n\nvoriconazole may be formulated as gastro retentive floating \n\n\n\ntablets by direct compression method. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 149 \n\n\n\n\n\n\n\nIn vitro Mammalian \u03b1-Glucosidase \n\n\n\nInhibitory Activity of Hylocereus \n\n\n\npolyrhizus \n\n\n\n\n\n\n\nChristian M. Miranda1, Vieno Gino Cruz1*, \n\n\n\nNimfa B. Gambalan2, Jover D. Francisco3, \n\n\n\nRizza Caluag1 \n \n\n\n\n1 School of Pharmacy, Philippines Women\u2019s University, Manila, Philippines \n2 Department of Pharmacy, College of Allied Health, National University, \n\n\n\nManila, Philippines \n3 Laboratory Services, Manila Central University, Caloocan, Philippines \n\n\n\n* Corresponding author \n\n\n\nEmail: vcruz@pwu.edu.ph  \n \n\n\n\nBackground and Objectives: Dragon fruit (Hylocereus \n\n\n\npolyrhizus), a regular priority commodity in the Central and \n\n\n\nNorthern region of the Philippines, may pose as one of the \n\n\n\npotential novel solutions as functional food to the existing \n\n\n\nuncontrollable incidence of diabetes. The purpose of the \n\n\n\nstudy investigates mammalian \u03b1-glucosidase inhibition, in \n\n\n\nvitro, of H. polyrhizus peel to provide information towards \n\n\n\nthe development of alternative approaches in managing \n\n\n\ndiabetes. Methods: Spectrophotometric method was \n\n\n\nperformed to examine the mammalian \u03b1-glucosidase \n\n\n\ninhibition of ethanol fractions (EF), methanol fractions (MF), \n\n\n\nethyl acetate fractions (EAF), and chloroform fractions (CF).  \n\n\n\nFifty percent maximal inhibitory concentration (IC50) was \n\n\n\ndetermined from the generated four-parameter logistic (4PL) \n\n\n\nnon-linear regression interpolated from concentration-\n\n\n\npercent inhibition plot. Standardized phytochemical analyses \n\n\n\nwas employed to identify the presence of phytochemical \n\n\n\nconstituents. Results and Discussion: EF showed a \n\n\n\nconcentration-dependent inhibition towards mammalian \u03b1-\n\n\n\nglucosidase enzyme displaying the lowest IC50 (0.533 \n\n\n\nmg/mL) among different fractions. Alkaloid, flavonoid, and \n\n\n\npolyphenol detected might be responsible for inhibitory \n\n\n\nactivity. Chromoalkaloids (betanin, isobetanin, phyllocactin, \n\n\n\nand isophyllocactin) and Polyphenolics (kaempferol, \n\n\n\nquercetin, phloretin, and myricetin) were reported active \n\n\n\ninhibitor of \u03b1-glucosidase needed for management of \n\n\n\ndiabetes. Conclusion:  The results provided scientific \n\n\n\nevidence in inhibiting \u03b1-glucosidase for the managing \n\n\n\ndiabetes where fractions, especially EF, displayed notable \n\n\n\nIC50. Isolation and standardization of the active components \n\n\n\ndetected may contribute to the inclusion on the potential \n\n\n\ncandidates in the formulation of standardised drug product \n\n\n\nand functional food. \n \n\n\n\n\nmailto:dsrinivas78@gmail.com\n\n\nmailto:vcruz@pwu.edu.ph\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nPROCEEDINGS of \n\n\n\n1st International Postgraduates \n\n\n\nConference of Pharmaceutical and \n\n\n\nHealth Sciences (IPCPHS) 2022 \n\n\n\n\n\n\n\n11th - 14th October 2022 \n\n\n\n \nVenue: Zoom Virtual Platform, School of \n\n\n\nPharmaceutical Sciences, Universiti Sains Malaysia  \n\n\n\n\n\n\n\nTheme: 50th Anniversary of School of \n\n\n\nPharmaceutical Sciences \u2013 Global Opportunities  \n\n\n\n\n\n\n\nEditors \n \n\n\n\nReem Abou Assi \n\n\n\nIbrahim M Abdulbaqi \n\n\n\nMohammed Zawiah \n\n\n\nChan Siok Yee \n\n\n\nNurzalina Abdul Karim Khan \n\n\n\nAmer Hayat Khan \n\n\n\n \nPublisher:  \nMalaysian Pharmacists Society  \n\n\n\n16-2 Jalan OP 1/5, 1-Puchong Business Park  \n\n\n\nOff Jalan Puchong, 47160 Puchong, Malaysia  \n\u00a9 Malaysian Journal of Pharmacy \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nISSN 1675-3666 \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 140-181 \n\n\n\n\n\n\n\nResearch abstracts of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022 \n\n\n\nDOI:  10.52494/YOXJ1358 \n\n\n\n\n\n\n\n141 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\n\n\n\n\nOral Presentation \n\n\n\n \nClinical Pharmacy  \n\n\n\n \nAbstract 001 \n\n\n\nExploring Pakistani Nurses\u2019 Knowledge and Obstacles Encountered When Administering \n\n\n\nResuscitation Medication: A Cross-sectional Analysis \n\n\n\nSafia Alvi, Amer Hayat Khan, Muhammad Salman and Syed Azhar Sayed Sulaiman \n\n\n\n\n\n\n\nAbstract 002 \n\n\n\nThe Role of The Clinical Pharmacist in a Case of Losartan-Induced Faintness and Dysarthria \n\n\n\nKhaled Mohammed Alakhali*, Abdullah Ahmed. Al-dahbali, Sakran, Faiz Khaled Mohammed \n\n\n\n\n\n\n\nAbstract 003 \n\n\n\nFactors Associated with Mortality of COVID-19 Patients with Hypertension: A Cross \n\n\n\nSectional Study \n\n\n\nNarendar Kumar, Syed Azhar Syed Sulaiman*, Furqan Khurshid Hashmi, Shafique Hussain \n\n\n\n\n\n\n\nAbstract 004 \n\n\n\nTreatment Outcomes of Pulmonary Tuberculosis: A Retrospective Study in District \n\n\n\nHeadquarter Hospital, Pakistan \n\n\n\nRabbiya Ahmad*, Saifullah Mehsud, Fazli Maula, Obaidullah Malik, and Amer Hayat Khan \n\n\n\n\n\n\n\nAbstract 005 \n\n\n\nDrug Resistance Pattern, Prevalence and Risk Factors for Resistance To Second Line Anti-\n\n\n\nTuberculosis Drugs in Balochistan, Pakistan \n\n\n\nAsad Khan, Naila Kakar, Nafees Ahmad, Abdul Wahid, Amer Hayat Khan* \n\n\n\n\n\n\n\nAbstract 006 \n\n\n\nPharmacy Students\u2019 Readiness and Preparedness to Contribute During Disasters: A Cross-\n\n\n\nSectional Two Institutional Study from The UAE \n\n\n\nAlaa Ahmad Farajallah*, Muaed Alomar, Subish Palaian, Mohammad Majed Al-Ahmad, \n\n\n\nMohamed Izham Mohamed Ibrahim \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 140-181 \n\n\n\n\n\n\n\nResearch abstracts of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022 \n\n\n\nDOI:  10.52494/YOXJ1358 \n\n\n\n\n\n\n\n142 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 007 \n\n\n\nTop 30 Drugs Associated with Acute Kidney Injury (Aki) Cases: A Real-World \n\n\n\nPharmacovigilant Study \n\n\n\nMohammad A. Khaleel *, Amer Hayat Khan, S. M. Sheikh Ghadzi and Azreen Syazril Adnan \n\n\n\n\n\n\n\nAbstract 008 \n\n\n\nEvaluation of Types, Frequency, and Setting of Drug-related Problems Among Hospitalized \n\n\n\nPatients in a Private Hospital in Sana'a, Yemen \n\n\n\nAbdulsalam Halboup*, Mohammed Kubas \n\n\n\n\n\n\n\nAbstract 009 \n\n\n\nThe Health\u2011Related Quality of Life and Treatment Satisfaction Among Tacrolimus Treated \n\n\n\nPatients Post-Renal Transplantation in Riyadh, Saudi Arabia \n\n\n\nAmany Mohamed Alboghdadly*, Amer Hayat Khan, and Syed Azhar Syed Sulaiman \n\n\n\n\n\n\n\nAbstract 010 \n\n\n\nTuberculosis: Risk Factors, Developing Drug-Resistant, Treatment Outcomes and Survival \n\n\n\nTrend in Hospital Pulau Pinang, Malaysia: A Retrospective Study \n\n\n\nAseel Rezeq Yaghi, Amer Hayat Khan*, Sabariah Noor Harun and Irfhan Ali Haider \n\n\n\n\n\n\n\nAbstract 011 \n\n\n\nIncidence and Management of Adverse Drug Events Among Drug-Resistant Tuberculosis \n\n\n\nPatients: A Prospective Study Results from a High Burden Country \n\n\n\nAsif Massud*, Amer Hayat Khan, Syed Azhar Syed Sulaiman, Nafees Ahmad, Muhammad \n\n\n\nShafqat \n\n\n\n\n\n\n\nAbstract 012 \n\n\n\nQualitative Assessment of Knowledge, Attitude and Practice of Healthcare Practitioners \n\n\n\nabout Precision Medicine Among Cancer Patients in Lahore, Pakistan \n\n\n\nRida Naeem, Furqan K. Hashmi,  Dzul Azri Mohamed Noor* \n\n\n\n\n\n\n\nAbstract 013 \n\n\n\nThe Impact of Education Level Over Adoption of Standard Operating Procedures Against \n\n\n\nSars-Cov2 Infection Among the Covid-19 Booster Dose Recipients In Pakistan \n\n\n\nAli Qureshi*,Syed Azhar Syed Sulaiman, and Nur Aiziti Athira binti Daud \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 140-181 \n\n\n\n\n\n\n\nResearch abstracts of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022 \n\n\n\nDOI:  10.52494/YOXJ1358 \n\n\n\n\n\n\n\n143 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 014 \n\n\n\nPublic Awareness and Perceptions on The Corona Virus (Covid-19) in Duhok \n\n\n\nProvince/Kurdistan Region, Iraq \n\n\n\nManhal Ahmed Abdulkader*, Rabie Gabriel Abdullah, Ali Farhad Abdullah, Matti Shamil \n\n\n\nKhudhur, Sarwar Saad Abdullghani, Muhammad Izaddin Ibrahim, Shinwar Mohammed \n\n\n\nHasan, and Ahmad Faris Khaleel \n\n\n\n\n\n\n\nAbstract 015 \n\n\n\nPractice And Associated Factors Determination of Antibiotics Self-Medication Among \n\n\n\nCommunity Residents in Boyolali, Indonesia \n\n\n\nHidayah Karuniawati*, Sri Suryawati, Syed Azhar Syed Sulaiman*, Taufik Taufik, Wan \n\n\n\nIsmahanisa Ismail, Md. Sanower Hossain \n\n\n\n\n\n\n\nAbstract 016 \n\n\n\nImplementing PharmindBot on Facebook for Pharmacy Research Purposes: An Artificial \n\n\n\nIntelligence-Based Chatbot \n\n\n\nRamez M. Alkoudmani*, Mei Lan Tan, and Guat See Ooi \n\n\n\n\n\n\n\nAbstract 017 \n\n\n\nMedication Management Review Clinic in Jordan: Development and Review of First Two \n\n\n\nCases \n\n\n\nLoai M. Saadah*, Amer H. Khan, Syed Azhar Syed Sulaiman and Iman A. Basheti \n\n\n\n\n\n\n\nAbstract 018 \n\n\n\nAtorvastatin Therapy Among Egyptians: A Cross-Sectional Study Among Community \n\n\n\nPharmacists \n\n\n\nMohammed Gamal Mohammed Maslub\u2020, Moutaz Bellah Yasser\u2020, Mahasen Ali Radwan, \n\n\n\nZeyad Ali Abdalla, Mohammed Soliman, Abubakar Sha'aban, Nur Aizati Athirah Daud* \n\n\n\n\n\n\n\n\n\n\n\nPharmaceutical Technology  \n \n\n\n\nAbstract 019 \n\n\n\nSpray Dryer and Electrospray Techniques Assisted Encapsulation of Insulin in \n\n\n\nMicroparticles Coated with Pectin Microbeads for Colon-Targeted Oral Drug Delivery \n\n\n\nHazem Choukaife, Abd Almonem Doolaanea, Zalilawati Bnti Rashed and Mulham Alfatama* \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 140-181 \n\n\n\n\n\n\n\nResearch abstracts of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022 \n\n\n\nDOI:  10.52494/YOXJ1358 \n\n\n\n\n\n\n\n144 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 020 \n\n\n\nScreening Electrospinning Critical Parameters for Fibres Production: Excipients\u2019 Nature \n\n\n\nNurul Atiqah Ismail, Reem Abou Assi and Siok Yee Chan* \n\n\n\n\n\n\n\nAbstract 021 \n\n\n\nBioavailability And Pharmaceutical Analysis of Novel Chocolate Based Ibuprofen \n\n\n\nFormulations \n\n\n\nAya Kabariti*, M. albed Alhnan, Ghaleb Oriquat, Basel Arafat \n\n\n\n\n\n\n\n\n\n\n\nPharmacology And Biomedical Sciences \n \n\n\n\nAbstract 022 \n\n\n\nIsorhamnetin Decreased The Expression Of HMG-CoA Reductase and Increased LDL \n\n\n\nReceptors in Hep G2 Cells \n\n\n\nRanda El-Rayyes*, Manal M. Abbas, Razan Obeidat, Manal A. Abbas \n\n\n\n\n\n\n\nAbstract 023 \n\n\n\nA Novel BAK-BAX-CDK1 Signalling Complex Links Activation of The Spindle Assembly \n\n\n\nCheckpoint to Apoptosis \n\n\n\nOmeed Omar Darweesh* \n\n\n\n\n\n\n\nAbstract 024 \n\n\n\nAntihyperglycemic Activity of Standardized Swietenia Macrophylla Seed Ethanolic Extract \n\n\n\nin Type 2 Diabetic Rats \n\n\n\nMeyyammai Swaminathan*, Mariam Ahmad, Khairul Niza Abd Razak, Nor Adlin Yusoff, \n\n\n\nGabriel Akyirem Akowuah, Elaine Hui-Chien Lee, Syed Azhar Syed Sulaiman, Mun Fei, Yam, \n\n\n\nFaradianna E. Lokman, Sue Hay, Chan, Bey Hing, Goh, Vikneswaran Murugaiyah \n\n\n\n\n\n\n\n\n\n\n\nPharmaceutical And Medicinal Chemistry \n \n\n\n\nAbstract 025 \n\n\n\nIncreased In-vitro Binding of Di(5-Furfural) Ether, A Degradant of 5- \n\n\n\nHydroxymethylfurfural, with Endogenous Macromolecules: Experimental and Theoretical \n\n\n\nApproaches \n\n\n\nThomas, Olusegun Emmanue*, Akin-Taylor Akintayo and Oduwole Rashidat \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 140-181 \n\n\n\n\n\n\n\nResearch abstracts of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022 \n\n\n\nDOI:  10.52494/YOXJ1358 \n\n\n\n\n\n\n\n145 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 026 \n\n\n\nPharmacophore Modelling, Molecular Docking, And Molecular Dynamics Simulation to \n\n\n\nIdentify Potent Inhibitors of Alpha-Synuclein Aggregation \n\n\n\nSani Yahaya Najib1*, Yusuf Oloruntoyin Ayipo, Waleed Abdullah Ahmad Alananzeh, Mohd \n\n\n\nNizam Mordi \n\n\n\n\n\n\n\nComplementary Medicine And Natural Products \n \n\n\n\nAbstract 027 \n\n\n\nTheophylline Causes Regression of Endometriotic Implants in a Rat Surgical Model \n\n\n\nManal A. Abbas*, Ahmad M. Disi, Mutasem O. Taha \n\n\n\n\n\n\n\nAbstract 028 \n\n\n\nComplementary and Alternative Medicine (CAM) Use in Insomnia: Current Update on \n\n\n\nKnowledge, Attitude, and Perception (KAP) Among the Community in Malaysia \n\n\n\nSiti Nur Afza Atirah Binti Zahari, Syarifah Syamimi Putri Adiba Binti Syed Putera*, and Zakiah \n\n\n\nbinti Noordin \n\n\n\n\n\n\n\nAbstract 029 \n\n\n\nHealth Benefits of Honey: Knowledge, Attitude and Perception (KAP) Among the \n\n\n\nCommunity in Malaysia \n\n\n\nWan Nor Aidah Basirah binti Wan Ab Rahman, Syarifah Syamimi Putri Adiba Binti Syed \n\n\n\nPutera*, and Aina Amanina Binti Abdul Jalil \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 140-181 \n\n\n\n\n\n\n\nResearch abstracts of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022 \n\n\n\nDOI:  10.52494/YOXJ1358 \n\n\n\n\n\n\n\n146 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\n\n\n\n\nE-Poster Presentation  \n \n\n\n\nClinical Pharmacy  \n \n\n\n\nAbstract 030 \n\n\n\nKnowledge, Attitude, and Practice of Community Pharmacists Regarding Smuggled \n\n\n\nMedicines in Yemen \n\n\n\nMohammed Battah*, Gamil Othman, Hamas Al-Qadhi, Asma Al- Aghbari1 and Heba Al-\n\n\n\nMaqtari \n\n\n\n\n\n\n\nAbstract 031 \n\n\n\nGram-Negative Bacteria Susceptibility to Antibiotics Stratified by Gender \n\n\n\nNehad J. Ahmad, Amer H. Khan* \n\n\n\n\n\n\n\nAbstract 032 \n\n\n\nDescriptive Analysis of Adverse Drug Reactions Reports of \n\n\n\nAmoxicillin \n\n\n\nNehad J. Ahmed, and Amer H. Khan* \n\n\n\n\n\n\n\nAbstract 033 \n\n\n\nAssessment of Emotional Distress Among Health Care Professionals at Different Hospitals \n\n\n\nin Sindh, Pakistan \n\n\n\nNarendar Kumar,* Syed Azhar Syed Sulaiman , and Shaib Muhammad \n\n\n\n\n\n\n\nAbstract 034 \n\n\n\nPopulation-Based Knowledge, Attitude, and Perception Study for COVID-19 Vaccine in \n\n\n\nSindh, Pakistan \n\n\n\nNarendar Kumar, Syed Azhar Syed Sulaiman,*, Furqan Khurshid Hashmi \n\n\n\n\n\n\n\nAbstract 035 \n\n\n\nCauses of Drug Related Problems Among Chronic Kidney Disease Patients with Diabetes \n\n\n\nMellitus and/ or Hypertension in Private Hospital, Yemen \n\n\n\nEgbal Abdulrahman, Amer Hayat Khan*, Elham Aldolimy, Odai Alburaihi, Omaima Alsubari, \n\n\n\nMoath Aledressi \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 140-181 \n\n\n\n\n\n\n\nResearch abstracts of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022 \n\n\n\nDOI:  10.52494/YOXJ1358 \n\n\n\n\n\n\n\n147 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 036 \n\n\n\nAssessment of Mortality Risk Predictors Associated With COVID-9 Infection In Pakistani \n\n\n\nPatients: An Observational Study. \n\n\n\nMuhammad Zeeshan Munir*, Amer Hayat Khan, Tahir Mehmood Khan \n\n\n\n\n\n\n\nAbstract 037 \n\n\n\nDevelopment And Validation Of A Guideline-Guided Prognostic Model Of Mortality In \n\n\n\nPatients With First-Ever Acute Ischemic Stroke \n\n\n\nMustapha Mohammed*, Hadzliana Zainal, Siew Chin Ong, Balamurugan Tangiisuran, \n\n\n\nSabariah Noor Harun, Siti Maisharah Sheikh Ghazi \n\n\n\n\n\n\n\nAbstract 038 \n\n\n\nEvaluation of The Impact of Antibiotic Stewardship Program on Antibiotics Utilization as \n\n\n\nSurgical Prophylaxis at a Secondary Hospital in United Arab Emirates \n\n\n\nMaryam Salem Alkaabi, Sabariah Noor Harun, and Abubakar Sha\u2019aban \n\n\n\n\n\n\n\nAbstract 039 \n\n\n\nClinicodemographic Characteristics Identification of Malaysian Patients with Rheumatoid \n\n\n\nArthritis Using Biologic and Targeted Disease Modifying Anti Rheumatoid Drugs \n\n\n\nNasreh Shamsi Poor Gheshmi*, Syed Azhar Syed Sulaiman, and Yaman Walid Kassab \n\n\n\n\n\n\n\nAbstract 040 \n\n\n\nSafety Assessment of Biologic And Targeted Disease Modifying Anti Rheumatoid Drugs \n\n\n\nAmong Malaysian Patients with Rheumatoid Arthritis \n\n\n\nNasreh Shamsi Poor Gheshmi*, Syed Azhar Syed Sulaiman, and Yaman Walid Kassab \n\n\n\n\n\n\n\nAbstract 041 \n\n\n\nExamining The efficacy of Biologic and Targeted Anti Rheumatic Drugs Among Malaysian \n\n\n\nPopulation with Rheumatoid Arthritis \n\n\n\nNasreh Shamsi Poor Gheshmi*, Syed Azhar Syed Sulaiman, and Yaman Walid Kassab \n\n\n\n\n\n\n\n\n\n\n\nPharmaceutical Technology  \n \n\n\n\nAbstract 042 \n\n\n\nSolvent System Effect on the Viscosity and Conductivity of Electrospinnable Polymer \n\n\n\nSolutions for Incorporation of Medicinal Herbal Extract \n\n\n\nSiew Mei Tan, Siok Yee Chan* \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 140-181 \n\n\n\n\n\n\n\nResearch abstracts of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022 \n\n\n\nDOI:  10.52494/YOXJ1358 \n\n\n\n\n\n\n\n148 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 043 \n\n\n\nOptimization of Polyhydroxyalkanoate Microparticles for a High Encapsulation of \n\n\n\nRifapentine and Verapamil Using a Water-in-Oil-in- Water Double Emulsion Technique \n\n\n\nPriyanka Prakash, K Sudesh Kumar, and Thaigarajan Parumasivam* \n\n\n\n\n\n\n\nPharmacology and Biomedical Sciences \n \n\n\n\nAbstract 044 \n\n\n\nAirway Smooth Muscles Relaxant and Mast Cells Stabilizing Activity of Some Medicinal \n\n\n\nPlants Used in Managing Asthma in North-western Nigeria \n\n\n\nIbrahim Mu\u2019azzamu Aliyu*, Mohammed Garba Magaji, Jamilu Ya\u2019u , Nuhu Mohammed \n\n\n\nDanjuma, Sagir Mustapha Mustapha Mohammed \n\n\n\n\n\n\n\nAbstract 045 \n\n\n\nProtective Effect of Andrographolide on \u0392-Amyloid Induced Toxicity in Transgenic \n\n\n\nCaenorhabditis Elegans \n\n\n\nBoon-Keat Khor, Wai-Lam Liew, Chong-Lew Lee, Kit-Lam Chan, Nurzalina A.K. Khan, Kah-\n\n\n\nHay Yuen, Vikneswaran Murugaiyah* \n\n\n\n\n\n\n\n\n\n\n\nPharmaceutical and Medicinal Chemistry \n \n\n\n\nAbstract 046 \n\n\n\nIn-Silico Study of 2-Phenoxy-N-(3,4,5-Trimethoxyphenyl) Acetamide Against Mutant p53 in \n\n\n\nBreast Cancer Drug Discovery \n\n\n\nBakti Wahyu Saputra, Jeffry Julianus* \n\n\n\n\n\n\n\nAbstract 047 \n\n\n\nPotential of N-(naphthalene-1-yl)-2-phenoxyacetamide as Mutant p53 Reactivator: In Silico \n\n\n\nStudies \n\n\n\nBryan Afela Wahono, Jeffry Julianus* \n\n\n\n \nAbstract 048 \n\n\n\nEffects of Fenugreek Seeds on Some Blood Parameters in Type 2 Diabetics Receiving \n\n\n\nMetformin and Glyburide \n\n\n\nRaghda Lahdo*, Rafah Manafikhi \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 140-181 \n\n\n\n\n\n\n\nResearch abstracts of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022 \n\n\n\nDOI:  10.52494/YOXJ1358 \n\n\n\n\n\n\n\n149 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 049 \n\n\n\nInvestigating The Relationship Between Thyroid Disorders and Breast Cancer \n\n\n\nAya Zrek, Anawar Shamout, Raghda Lahdo* \n\n\n\n\n\n\n\nAbstract 50 \n\n\n\nKnowledge, Attitude, And Practice Assessment Of Lung Cancer Risk Factors Among Health \n\n\n\nPractitioners In Erbil, Iraq \n\n\n\nIbrahim M Abdulbaqi*, Habibah A. Wahab*, Ibrahim Ahmed Moyasser, Shaheen Nozad Yousif \n\n\n\n\n\n\n\nAbstract 051 \n\n\n\nPrevalence of Tuberculosis Infection and Treatment Outcome in Babylon Province of Iraq; \n\n\n\nA Retrospective Study \n\n\n\n Taif Said Jasim*, Amer Hayat Khan, and Nada Khazal K. Hindi \n\n\n\n\n\n\n\nAbstract 052 \n\n\n\nAdverse Drug Reactions in Hospitalised Children with Chronic Kidney Disease in A \n\n\n\nPaediatric Tertiary Care Hospital of Pakistan  \n\n\n\nAsma Fareed Khan*, Amer Hayat Khan, Shahida Perveen, Muhammad Tahir \n\n\n\n\n\n\n\nAbstract 053 \n\n\n\nDevelopment and Validation of RP-HPLC Method for the Detection and Quantification of \n\n\n\nTamoxifen in Pure, and Lipid-Based Formulation \n\n\n\nReem Abou Assi, Chan Siok Yee* \n\n\n\n\n\n\n\nAbstract 054 \n\n\n\nBreast Cancer Risk Factors Among Public and Health Practitioners in Kirkuk, Iraq: The \n\n\n\nEvaluation of Knowledge, Attitude, And Practice \n\n\n\nIbrahim M Abdulbaqi*, Habibah A. Wahab* Duha Arshad Shaker, Baraah Omar Ayoub \n\n\n\n\n\n\n\nAbstract 055 \n\n\n\nA Simple (Rp-HPLC) Method for The Detection and Quantification of Docetaxel in Bulk \n\n\n\nand Liquid Crystals Nanocarriers and its Validation \n\n\n\nIbrahim M. Abdulbaqi*, Anan Yaghmur , Yusrida Darwis, Noratiqah Mohtar, Thaigarajan \n\n\n\nParumasivam, Habibah A. Wahab* \n\n\n\n\n\n\n\nAbstract 056 \n\n\n\nAwareness About Relationship Between Climate Change and Health Hazards in Iraqi \n\n\n\nMedical Students \n\n\n\nAisha Marwan Abd Al Majeed, Sakar Najmadeen Mohammad, Reem Abou Assi*, Siok Yee \n\n\n\nChan* \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 140-181 \n\n\n\n\n\n\n\nResearch abstracts of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022 \n\n\n\nDOI:  10.52494/YOXJ1358 \n\n\n\n\n\n\n\n150 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\n\n\n\n\nAbstract 057 \n\n\n\nNanocrystalline Cellulose (NCC) Isolation from Kapok Pulp Via Sulphuric Acid Hydrolysis \n\n\n\nAbdulsalam Q. Almashhadani*, Cheu Peng Leh, Siok-Yee Chan, Chong Yew Lee, Choon Fu \n\n\n\nGoh* \n\n\n\n\n\n\n\nAbstract 058 \n\n\n\nIsolation and Chemical Structural Characterisation of a Compound with Wound Healing \n\n\n\nActivity from The Euphorbia hirta L. Extract \n\n\n\nDania F. Alsaffar, Sura F. Alsaffar, Nur Hidaya kaz Abdula* \n\n\n\n\n\n\n\nAbstract 059 \n\n\n\nMinocycline Improved Anxiety-Like Behaviour in Lipopolysaccharide (LPS)-Induced \n\n\n\nNeuroinflammation Rat\u2019s Model \n\n\n\nEntesar Yaseen Abdo Qaid*, Rahimah Zakaria, Zuraidah Abdullah, and Idris Long \n\n\n\n\n\n\n\nAbstract 060 \n\n\n\nTo Produce and Characterise Inhalable Nano- and Micro- Polyhydroxyalkanoate (PHA) \n\n\n\nParticles Containing Verapamil Hydrochloride Using a Modified Water-in-Oil-in-Water \n\n\n\n(W/O/W) Double Emulsion Technique \n\n\n\nSowmya Ramachandran, Thaigarajan Parumasivam*, and K Sudesh Kumar \n\n\n\n\n\n\n\nAbstract 061 \n\n\n\nAnalysis of Increased AST and ALT in COVID-19 Patients with Favipiravir \n\n\n\nSuharjono*, Chairunnisa, Mariyatul Qibtiyah, and Ariani Permatasari \n\n\n\n\n\n\n\nAbstract 062 \n\n\n\nFormulation of Co-Enzyme Q10 Ternary Inclusion Complexes Using Betacyclodextrin (\u0392cd) \n\n\n\nand Hydrophilic Polymers Silica Syloid Xdp/ Sodium Alginate) \n\n\n\nRabia Munir, SajidAsghar, Muhammad Irfan, IkramUllah Khan \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 140-181 \n\n\n\n\n\n\n\nResearch abstracts of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022 \n\n\n\nDOI:  10.52494/YOXJ1358 \n\n\n\n\n\n\n\n151 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 001 \n\n\n\n\n\n\n\nExploring Pakistani Nurses\u2019 Knowledge \n\n\n\nand Obstacles Encountered when \n\n\n\nAdministering Resuscitation Medication: A \n\n\n\nCross-sectional Analysis \n \n\n\n\nSafia Alvi1*, Amer Hayat khan1, Muhammad \n\n\n\nSalman2, 3, Syed Azhar Syed Sulaiman1 \n \n1Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, \n\n\n\nUniversiti Sains Malaysia, 11800 Penang, Malaysia.  \n\n\n\n2Institute of Pharmacy, Faculty of Pharmaceutical and Allied Health \n\n\n\nSciences, Lahore College for Women University, Lahore, Pakistan.  \n3Faculty of Pharmacy, The University of Lahore, 1-Km Defense Road, \n\n\n\nLahore, Pakistan \n\n\n\n* drsofyanaalvi@gmail.com \n\n\n\n\n\n\n\nBackground: Medication errors are one of the most common \n\n\n\ncauses of patient morbidity and mortality and it places an \n\n\n\nimmense burden on healthcare system. Insufficient \n\n\n\nknowledge of nurses is considered a major factor in drugs \n\n\n\nadministration errors leading to compromised patient safety. \n\n\n\nObjectives: This study aimed to evaluate nurses\u2019 knowledge \n\n\n\nregrading resuscitation medication administration. Methods: \n\n\n\nA cross-sectional study was conducted among nurses \n\n\n\nworking in public and private hospitals of Lahore city (10 \n\n\n\nprivate, 6 public and 2 teaching hospitals). Nurses were \n\n\n\nrecruited using a convenient sampling method during a \n\n\n\nperiod of three months (March-June 2021). A pre-validated, \n\n\n\nself-administered questionnaire was used to collect data. The \n\n\n\ndata were analyzed using SPSS version 27. Results: A total \n\n\n\nof 409 nurses were included in the study of which, 55.3% \n\n\n\nwere found to have adequate knowledge (score >70%) of \n\n\n\nresuscitation medications, while 44.7% had insufficient \n\n\n\nknowledge. Increasing age and experience (p<0.001), being \n\n\n\nin a public hospital, (p=0.032) and ACLS training (p=0.006) \n\n\n\nwas associated with significantly better knowledge. Major \n\n\n\nobstacles faced by nurses during the administration of \n\n\n\nresuscitation medication were \u201cInterruption of drug \n\n\n\nadministration procedure when other tasks need to be \n\n\n\nhandled\u201d (75.6%), \u201cInsufficient knowledge\u201d (69.4%), and \n\n\n\n\u201cHesitation to ask questions\u201d (67.7 %). Conclusion: \n\n\n\nPakistani nurses were found to have inadequate knowledge \n\n\n\nregarding resuscitation medications administration. Hospital \n\n\n\nadministration must ensure that nursing staff receive \n\n\n\nresuscitation medications-related training. Moreover, they \n\n\n\nshould encourage nursing staff to obtain BLS and/or ACLS \n\n\n\ntrainings as this will reduce medication errors events and \n\n\n\nimprove patient safety. \n\n\n\nAbstract 002 \n\n\n\n\n\n\n\nThe Role of The Clinical Pharmacist In A \n\n\n\nCase of Losartan-Induced Faintness And \n\n\n\nDysarthria \n \n\n\n\nKhaled Mohammed Alakhali1,2*, Abdullah \n\n\n\nAhmed. Al-dahbali2,3, Sakran, Faiz Khaled \n\n\n\nMohammed2 \n \n1Department of Pharmacy, Medical school in Thamar University, Republic \n\n\n\nof Yemen. \n2Lebanese International University, School of Pharmacy, Department of \n\n\n\nBiomedical Sciences, Republic of Yemen. \n3Department of Clinical Pharmacy, College of Pharmacy in Sanaa \nUniversity, Republic of Yemen. \n\n\n\n* alakhalikhaled@gmail.com \n\n\n\n\n\n\n\nBackground: A common first-line antihypertensive drug, \n\n\n\nlosartan is well absorbed after oral administration and goes \n\n\n\nthrough a significant first-pass metabolism. Losartan \n\n\n\nfrequently causes headaches, dizziness, lethargy, nausea, \n\n\n\nvomiting, blurred vision, and anemia as adverse effects. \n\n\n\nObjective: Here, we present a case of a 59-year-old Yemeni \n\n\n\nwoman, who took losartan and developed faintness and \n\n\n\ndysarthria. Method: The patient was initiated with 50 mg \n\n\n\ndaily oral losartan monotherapy for diagnosed moderate \n\n\n\nhypertension. After 12 days of taking the drug, she presented \n\n\n\nto the emergency department in Saudi German Hospital in \n\n\n\nSana\u2019a city with dizziness, faintness, dysarthria, \n\n\n\nlightheadedness with generalized weakness. The in-hospital \n\n\n\nneurological specialist suspected the patient had a transient \n\n\n\nischemic attack. On examination, her blood pressure was \n\n\n\nfound to be 150/86, and her heart rate 72. The patient was \n\n\n\ntreated in the hospital as a stroke patient for five days and \n\n\n\ndischarged with stroke medications. After discharge, on the \n\n\n\nsecond day, the patient has the same previous symptoms. \n\n\n\nThere was no evidence of any other possible metabolic, \n\n\n\ninfective, organic, or other pathologic causes giving rise to \n\n\n\ndysarthria, except losartan itself. Results: A clinical \n\n\n\npharmacist discovered adverse drug reaction probability was \n\n\n\n\u201cprobable\u201d that oral losartan was responsible for the \n\n\n\ndevelopment of faint and dysarthria in this patient. The drugs \n\n\n\nfor hypertension were changed by the clinical pharmacist to \n\n\n\namlodipine 5mg. After 3 days, the patient was stable, and the \n\n\n\nsymptoms resolved. Conclusions: This case report suggests \n\n\n\nthat losartan could induce faintness and dysarthria as side \n\n\n\neffects \n\n\n\n \n\n\n\n\nmailto:drsofyanaalvi@gmail.com\n\n\nmailto:alakhalikhaled@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 140-181 \n\n\n\n\n\n\n\nResearch abstracts of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022 \n\n\n\nDOI:  10.52494/YOXJ1358 \n\n\n\n\n\n\n\n152 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 003 \n\n\n\n\n\n\n\nFactors Associated with Mortality of \n\n\n\nCOVID-19 Patients with Hypertension: A \n\n\n\nCross Sectional Study \n \n\n\n\nNarendar Kumar1, Syed Azhar Syed \n\n\n\nSulaiman1*, Furqan Khurshid Hashmi2, \n\n\n\nShafique Hussain3 \n \n1Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, \n\n\n\nUniversiti Sains Malaysia \n2University College of Pharmacy, University of the Punjab, Allama Iqbal \n\n\n\nCampus, Lahore, Pakistan \n3Department of Pharmacy Services, Indus Hospital and Health Network, \nKarachi Pakistan \n\n\n\n*sazhar.usm@gmail.com  \n\n\n\n\n\n\n\nBackground: Hypertension is one of the predisposing \n\n\n\nfactors for prolonged hospitalization, intensive care, and \n\n\n\ndeath among COVID-19 infected patients. Hence, it requires \n\n\n\nspecial attention, particularly for older patients vulnerable to \n\n\n\nincreased risk of COVID-19-related health problems. \n\n\n\nObjective: This research aimed to determine the factors \n\n\n\nassociated with mortality of COVID-19 patients with \n\n\n\nhypertension. Methods: A cross-sectional study was \n\n\n\nperformed at a tertiary care hospital in Karachi, Pakistan, \n\n\n\nfrom May to October 2021. COVID-19 patients with known \n\n\n\nhypertension were included in the study by evaluating \n\n\n\npatients\u2019 medical record. Mann Whitney U test and Chi-\n\n\n\nSquared tests were performed to compare patients in death \n\n\n\nand recovered groups. The significance level was set at 0.05. \n\n\n\nResults: Out of 299 COVID-19 patients with hypertension, \n\n\n\nthe majority were females (58%), median [IQR] age of 63 \n\n\n\n[55-70] years, with co-existing diabetes (49.5%). The \n\n\n\nmortality was associated with age groups (p=0.036) and \n\n\n\nbaseline severity (p=0.001). Clinically, fever (p=0.005), \n\n\n\nshortness of breath (p=0.003), respiratory rate (p=0.026), and \n\n\n\noxygen saturation (p<0.001 were found to be associated with \n\n\n\ndeath. Laboratory examinations such as total leucocytes \n\n\n\ncount (p<0.001), neutrophils (p<0.001), C-reactive proteins \n\n\n\n(p<0.001), D-dimer (p=0.005), ferritin (p=0.016), lactate \n\n\n\ndehydrogenase (p<0.001), and procalcitonin levels (p=0.001) \n\n\n\nwere significantly higher among death cases. The mortalities \n\n\n\nwere comparatively lower (p=0.002) among angiotensin \n\n\n\nconverting enzyme inhibitors (ACEI) or angiotensin receptor \n\n\n\nblockers (ARB) consumers. Conclusion: Our study \n\n\n\nconcluded that older age, severe illness with poor oxygen \n\n\n\nsaturation, shortness of breath, higher inflammatory markers \n\n\n\nand need of mechanical ventilation were associated with the \n\n\n\nmortality among COVID-19 patients with hypertension. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 004 \n\n\n\n\n\n\n\nTreatment Outcomes of Pulmonary \n\n\n\nTuberculosis: A Retrospective Study in \n\n\n\nDistrict Headquarter Hospital, Pakistan \n\n\n\n\n\n\n\nRabbiya Ahmad1*, Saifullah Mehsud2, Fazli \n\n\n\nMaula3, Obaidullah Malik4, and Amer Hayat \n\n\n\nKhan1 \n \n1Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, \n\n\n\nUniversiti Sains Malaysia, 11800, Gelugor, Penang, Malaysia, \n2Department of Pharmaceutical Sciences, Abbottabad University of Science \n\n\n\nand Technology, Havelian, Abbottabad, Pakistan. \n3Department of Pulmonology, Peshawar medical college Peshawar, Khyber \nPakhtoon Khawa, Pakistan. \n4Drug Regulatory Authority of Pakistan, Islamabad, Pakistan \n\n\n\n*rabbiyahmad@gmail.com  \n\n\n\n\n\n\n\nBackground: Pakistan shares the 61% burden of \n\n\n\nTuberculosis (TB) in WHO's Eastern Mediterranean Region. \n\n\n\nObjective: This study aimed to identify the predictors and \n\n\n\nfactors associated with unsuccessful treatment outcomes of \n\n\n\npulmonary tuberculosis (PTB). Methods: A retrospective \n\n\n\nstudy was conducted in the DHQ, Hospital Bannu, Khyber \n\n\n\nPakhtunkhwa, Pakistan from 1st January 2014 to 31st \n\n\n\nDecember 2018. Data were collected from TB registers, and \n\n\n\nTB medical personal files using National TB program (NTP) \n\n\n\nguidelines for Pakistan. Drug-resistant and drug-susceptible \n\n\n\nTB patients were included. SPSS 23.0 was used for analyzing \n\n\n\nthe data. Logistic regression analysis was done to determine \n\n\n\nthe final predictors of unsuccessful treatment outcomes. \n\n\n\nResults: A total of 1426 patients were included in the study. \n\n\n\nThe success ratio of the treatment was observed to be 60.7% \n\n\n\namong PTB patients. The odds of unsuccessful treatment \n\n\n\noutcomes were higher among patients who were 15 or \n\n\n\nyounger (95% CL: 1.02-5.89; AOR = 1.24) and patients aged \n\n\n\n16 to 25 years (95% CL: 1.448-3.42; AOR = 2.228). Patients \n\n\n\nwith comorbidities like diabetes (95% CL: 1.43-3.84; AOR \n\n\n\n= 2.86;) showed a significant association with unsuccessful \n\n\n\ntreatment outcomes. The patients having symptoms like \n\n\n\nsweating (95% CL: 1.62-14.51; AOR = 4.86) and hemoptysis \n\n\n\n(95% CL: 1.35-6.76; AOR = 3.03) were predictors of the \n\n\n\nunsuccessful treatment. Conclusion: This study reveals that \n\n\n\nthe ratio of unsuccessful treatment outcomes is still high. \n\n\n\nYounger patients, with comorbidities, and with symptoms \n\n\n\nlike sweating and hemoptysis were predictors of \n\n\n\nunsuccessful treatment. \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:*sazhar.usm@gmail.com\n\n\nmailto:*rabbiyahmad@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 140-181 \n\n\n\n\n\n\n\nResearch abstracts of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022 \n\n\n\nDOI:  10.52494/YOXJ1358 \n\n\n\n\n\n\n\n153 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 005 \n\n\n\n\n\n\n\nDrug Resistance Pattern, Prevalence and \n\n\n\nRisk Factors for Resistance to Second Line \n\n\n\nAnti-Tuberculosis Drugs in Balochistan, \n\n\n\nPakistan \n\n\n\n\n\n\n\nAsad Khan1, Naila Kakar2, Nafees Ahmad2, \n\n\n\nAbdul Wahid2, Amer Hayat Khan1* \n \n1School of Pharmaceutical Sciences, Universiti Sains Malaysia, Malaysia \n2Faculty of Pharmacy and Health Sciences University of Balochistan, \n\n\n\nPakistan \n\n\n\n* dramer@usm.my  \n \n\n\n\nBackground: Pakistan is high burden drug resistant \n\n\n\ntuberculosis (DR-TB) country according to World health \n\n\n\nOrganization Global Tuberculosis report 2021. For devising \n\n\n\na treatment regimen and optimizing empirical drug therapy, \n\n\n\nthe local epidemiology and drug resistance patterns are \n\n\n\nneeded to be considered. Objectives: To evaluate drug \n\n\n\nresistance pattern, prevalence and risk factors for resistance \n\n\n\nto second line anti-tuberculosis drugs (SLD) among DR-TB \n\n\n\npatients in Balochistan, Pakistan. Methods: This was a cross-\n\n\n\nsectional study conducted at programmatic management unit \n\n\n\nof DR-TB (PMDT) of Fatimah Jinnah Chest and General \n\n\n\nHospital, Quetta. Where 354 patients of DR-TB patients \n\n\n\nirrespective of their age, TB site and drug resistance pattern \n\n\n\nwere included in the study. A standardized data collection \n\n\n\nform was used to collect patients\u2019 socio demographic, \n\n\n\nmicrobiological and clinical data. Data was analysed by \n\n\n\nSPSS 20. A p-value <0.05 was taken statistically significant. \n\n\n\nResults: Among the subjects, majority were females (61.7%), \n\n\n\nbelonged to the age group 19-30 years (36.7%), were \n\n\n\npreviously treated for TB (95.8%) at public sector hospital \n\n\n\n(42.7%) and did not suffer from any other comorbidity \n\n\n\n(88.7%). The study participants were resistant to a median of \n\n\n\nthree anti-TB drugs (range 1-8). The most common type of \n\n\n\nDR-TB was multi DR-TB (77.1%), followed by mono DR-\n\n\n\nTB (18.1%), extensive DR-TB(3.1%) and poly-DR (1.7%). \n\n\n\nA total of 147 (41.5%) patients were resistant to any second \n\n\n\nline anti-TB drug (SLD). Among SLD, the resistance was \n\n\n\nhigh for fluoroquinolones (38.4%), followed by ethionamide \n\n\n\n(4.8%) and injectable SLD (4.2%). Upon multivariate binary \n\n\n\nlogistic regression analysis previous treatment of cat-II \n\n\n\nregimen had statistically significant association with \n\n\n\nresistance to any SLD (OR=5.273, 95%CI=1.098-25.316). \n\n\n\nConclusion: The high degree of SLD resistance observed \n\n\n\nparticularly to fluoroquinolones is distressing. Testing cat-I \n\n\n\nfailures for drug resistance rather than putting them on cat-II \n\n\n\ntreatment and more restrictive policies to control non-\n\n\n\nprescription sale and indiscriminate use of fluoroquinolones \n\n\n\nare recommended. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 006 \n\n\n\n\n\n\n\nPharmacy Students\u2019 Readiness and \n\n\n\nPreparedness to Contribute During \n\n\n\nDisasters: A Cross-Sectional Two \n\n\n\nInstitutional Study from the UAE \n \n\n\n\nAlaa Ahmad Farajallah 1,2*, Muaed Alomar1, \n\n\n\nSubish Palaian1, Mohammad Majed Al-\n\n\n\nAhmad3,4, Mohamed Izham Mohamed \n\n\n\nIbrahim5 \n \n\n\n\n1Department of Clinical Sciences, College of Pharmacy and Health Sciences, \nAjman University, Ajman, UAE. \n2Department of Clinical Pharmacy, School of Pharmaceutical Sciences, \n\n\n\nUniversiti Sains Malaysia. \n3Department of Clinical Pharmacy, College of Pharmacy, Al Ain University, \n\n\n\nAl Ain Campus, Al Ain, UAE. \n4AAU Health and Biomedical Research Center, Al Ain University, Abu \nDhabi, United Arab Emirates, \n5Department of Clinical Pharmacy and Practice, College of Pharmacy, QU \n\n\n\nHealth, Qatar University, Doha, Qatar. \n* a.farajallah@ajman.ac.ae  \n\n\n\n\n\n\n\nBackground: Pharmacists\u2019 involvement in disaster \n\n\n\nmanagement has been acknowledged in the literature where \n\n\n\nthey can be engaged in various clinical and non-clinical \n\n\n\nservices. The scope of pharmacy education globally has been \n\n\n\nshifted towards competency-based education where more \n\n\n\ntraining and skilled base programs had been added to \n\n\n\npharmacy colleges\u2019 curricula. The current pharmacy \n\n\n\neducation in UAE is undergoing various changes with more \n\n\n\nweightage for experiential learning. However, none of the \n\n\n\ncurrent BPharm study plans incorporate medicine disaster \n\n\n\nmanagement and preparedness. Objectives: To investigate \n\n\n\nthe pharmacy students\u2019 knowledge, attitude, and readiness to \n\n\n\ncontribute during disasters in the United Arab Emirates \n\n\n\n(UAE). Methods: A quantitative, descriptive, cross-sectional \n\n\n\nstudy was conducted in two pharmacy colleges in the UAE \n\n\n\nusing a pre-validated electronic questionnaire distributed \n\n\n\nthrough students\u2019 official university emails and reminders \n\n\n\nthrough WhatsApp. Data were collected using simple \n\n\n\nrandom sampling from February 2021 to November 2021. \n\n\n\nThe questionnaire consisted of four sections: demographic \n\n\n\ninformation, knowledge, attitude, and readiness to practice \n\n\n\nwith perceived barriers. Results: A total of 258 pharmacy \n\n\n\nstudents responded to the survey. The majority were fourth-\n\n\n\nyear students (51.2%, n = 132) with a mean (sd) age of 20.46 \n\n\n\nyears [SD \u00b12.35]. years. The average score for total \n\n\n\nknowledge was 155.3 (60.2%), with no statistical differences \n\n\n\nbetween groups. The median (IQR) scores for total attitude, \n\n\n\ntotal readiness to practice, and barriers to disaster medicine \n\n\n\nwere 4. Conclusions: There is a need to assess and improve \n\n\n\nthe current level of knowledge, preparation, and readiness of \n\n\n\npharmacy students through educational modules targeting \n\n\n\nvarious skills such as teamwork, emergency response, etc. \n\n\n\ninto pharmacy curricula and assessing their impact. \n\n\n\n\nmailto:dramer@usm.my\n\n\nmailto:a.farajallah@ajman.ac.ae\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 140-181 \n\n\n\n\n\n\n\nResearch abstracts of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022 \n\n\n\nDOI:  10.52494/YOXJ1358 \n\n\n\n\n\n\n\n154 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstrat 007 \n\n\n\n\n\n\n\nTop 30 Drugs Associated with Acute \n\n\n\nKidney Injury (Aki) Cases: A Real-World \n\n\n\nPharmacovigilant Study \n \n\n\n\n Mohammad A. Khaleel1*, Amer Hayat Khan1, \n\n\n\nS. M. Sheikh Ghadzi1 and Azreen Syazril \n\n\n\nAdnan2 \n \n1Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, \n\n\n\nUniversiti Sains Malaysia, 11800, Gelugor, Penang, Malaysia \n2Advanced Medical & Dental Institute, Universiti Sains Malaysia, Bertam, \nKepala Batas 13200, Pulau Pinang, Malaysia \n\n\n\n* mamk77@yahoo.com  \n\n\n\n\n\n\n\nBackground: Spontaneous adverse events reporting \n\n\n\ndatabases are an invaluable resource for pharmacovigilance \n\n\n\nanalysis and post-marketing medication safety monitoring. \n\n\n\nOne of the largest spontaneous adverse drug events reporting \n\n\n\nsystems in the world is the United States Food and Drug \n\n\n\nAdministration (FDA) Adverse Event Reporting System \n\n\n\n(FAERS). Objective: To find the top 30 drugs associated \n\n\n\nwith AKI in FAERS. Methods: Data set used for the period \n\n\n\nof January 2004 to September 2021. Cases of AKI were \n\n\n\nidentified using the Standardised Medical Dictionary for \n\n\n\nRegulatory Activities (MedDRA) Queries (SMQs), using the \n\n\n\nacute renal failure SMQ coded 20000003, composed of 19 \n\n\n\nPreferred Terms (PT) with a narrow scope. The lower limit \n\n\n\nof a two-sided 95 per cent credibility interval for the \n\n\n\nInformation Component (IC025) was applied to detect and \n\n\n\nrank signals of drugs associated with AKI. Results: The top \n\n\n\n30 drugs associated with AKI in descending order as drug \n\n\n\nname (count of reactions,IC025): Dihydroxyaluminum \n\n\n\nsodium carbonate (1608,3.48); Aprotinin (2653,3.08); \n\n\n\nProtamine sulfate (1064,2.82); Dexlansoprazole (8345,2.79); \n\n\n\nIobitridol (102,2.75); Glucarpidase (68,2.72); Serelaxin \n\n\n\n(17,2.66); Pancuronium (428,2.63); Human plasma \n\n\n\npreparation (761,2.47); Bismuth subsalicylate (1297,2.45); \n\n\n\nBrincidofovir (32,2.37); Telavancin (47,2.25); Remdesivir \n\n\n\n(837,2.22); Methoxyflurane (14,2.21); Protamines \n\n\n\n(157,2.18); Elvitegravir (2676,2.16); Econazole (1213,2.14); \n\n\n\nCidofovir (234,2.13); Milrinone (588,2.13); Nitroprusside \n\n\n\n(250,2.12); Lomeprol (100,2.11); Bictegravir (1735,2.11); \n\n\n\nCobicistat (3065,2.10); Tenofovir alafenamide (4387,2.07); \n\n\n\nFenoldopam (29,2.07); Foscarnet (555,2.06); Citric acid \n\n\n\n(728,2.05); Diethylene glycol (7,2.05); Tenofovir disoproxil \n\n\n\n(11003,2.05); Mannitol (881,2.02). Conclusion: This report \n\n\n\nlists drugs that require further investigation to determine their \n\n\n\nrisk of AKI.  \n\n\n\n\n\n\n\n\n\n\n\nAbstrat 008 \n\n\n\n\n\n\n\nAssessment of Patient Safety Culture \n\n\n\namong Healthcare Providers in A Tertiary \n\n\n\nHospital at Johor Bahru, Malaysia \n \n\n\n\nAbdulsalam Halboup1,*, Mohammed Kubas2 \n \n1Department of Clinical Pharmacy and Pharmacy Practice, Faculty of \n\n\n\nPharmacy, University of Science and Technology, Sana\u2019a, Yemen \n2Clinical Pharmacy Department, University of Science and Technology \n\n\n\nHospital, Sana\u2019a, Yemen \n\n\n\n* a_halboob@yahoo.com  \n\n\n\n\n\n\n\nBackground: Drug-related problems (DRPs) are drug-\n\n\n\nrelated events that lead to inadequate medical care or to harm \n\n\n\npatients. Objective: This study aims to determine the types, \n\n\n\nfrequency, and settings of DRPs among hospitalized patients. \n\n\n\nMethods: A cross-sectional study with clinical pharmacist \n\n\n\nintervention was conducted between June 2013 and \n\n\n\nNovember 2015. Patients who were admitted to the medical \n\n\n\nwards, Intensive Care Unit (ICU), and Coronary Care Unit \n\n\n\n(CCU) at University of Science and Technology Hospital in \n\n\n\nSana'a, Yemen, were interviewed and their medical records \n\n\n\nand medication orders were assessed for DRPs by the clinical \n\n\n\npharmacist who provided pharmaceutical care services \n\n\n\ninpatient settings. Results: A total of 3307 DRPs were \n\n\n\nidentified after evaluated 957 patients, with an average of 3.5 \n\n\n\nDRPs/patient. The most frequently encountered DRP type \n\n\n\nwas indication problems (29.2%, n=965), followed by \n\n\n\nadverse drug events (26.2 %, n=867), and dosing errors \n\n\n\n(25.3%, n=838). This study also showed that 15.3% (n=506) \n\n\n\nof patients required frequent monitoring, and 4.0% (n=131) \n\n\n\nof patients needed education and counselling. The most \n\n\n\nfrequent DRPs were identified in ICU (43.6%, n=417), \n\n\n\nfollowed by CCU (30.9%, n=296), and medical ward (25.5%, \n\n\n\nn=244). Conclusion: Certain types of DRPs are common \n\n\n\namong patients in the hospital, especially in critical settings. \n\n\n\nTherefore, measures to tackle these types of DRPs should be \n\n\n\ntaken. \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:mamk77@yahoo.com\n\n\nmailto:a_halboob@yahoo.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 140-181 \n\n\n\n\n\n\n\nResearch abstracts of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022 \n\n\n\nDOI:  10.52494/YOXJ1358 \n\n\n\n\n\n\n\n155 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 009 \n\n\n\n\n\n\n\nThe Health\u2011related Quality of Life and \n\n\n\nTreatment Satisfaction Among Tacrolimus \n\n\n\nTreated Patients Post-Renal Transplantation \n\n\n\nin Riyadh, Saudi Arabia \n \n\n\n\nAmany Mohamed Alboghdadly1*, Amer \n\n\n\nHayat Khan2, and Syed Azhar Syed \n\n\n\nSulaiman3,4  \n \n1Department of Clinical Pharmacy, School of Pharmaceutical Sciences, \nUniversiti Sains Malaysia, 11800 Pulau Pinang, Malaysia. \n2Department of Clinical Pharmacy, School of Pharmaceutical Sciences, \n\n\n\nUniversiti Sains Malaysia, 11800 Pulau Pinang, Malaysia. \n3Department of Clinical Pharmacy, School of Pharmaceutical Sciences, \n\n\n\nUniversiti Sains Malaysia, 11800 Pulau Pinang, Malaysia \n4Advanced Medical and Dental Institute, Universiti Sains Malaysia, Bertam, \nPulau Pinang, Malaysia \n\n\n\n* amanyalboghdadly@gmail.com  \n\n\n\n\n\n\n\nBackground: Renal transplantation (RTP) has a higher \n\n\n\nquality of life than dialysis. However, kidney transplant \n\n\n\nrecipients frequently experience some adverse effects \n\n\n\naccompanied by immunosuppressive treatment, which \n\n\n\nnegatively affect the physical and mental health-related \n\n\n\nquality of life (HRQoL). Objectives: To evaluate the HRQoL \n\n\n\nand treatment satisfaction among tacrolimus-treated patients \n\n\n\npost-RTP and to determine the effect of other demographic, \n\n\n\nclinical, and social factors on their HRQoL and treatment \n\n\n\nsatisfaction. Methods: A convenience sample of 100 renal \n\n\n\ntransplant recipients on tacrolimus-based regimens from \n\n\n\nJanuary 2017 to September 2019 in the Security Force \n\n\n\nHospital in Riyadh, Saudi Arabia, were enrolled in this study, \n\n\n\nquality of life and treatment satisfaction were prospectively \n\n\n\nanalyzed using Kidney Disease Quality of Life Instrument-\n\n\n\nSF36 (KDQOL-SF36) and Treatment Satisfaction \n\n\n\nQuestionnaire for Medication (TSQM 1.4) after one month \n\n\n\n& 6 months of RTP. Results: A total of 100 renal \n\n\n\ntransplanted patients, 78%, were male, mean age was 45.3 \u00b1 \n\n\n\n13.87 years. The most comorbidities before RTP were \n\n\n\nhypertension, 39.7%, dyslipidemia, 37.5%, and diabetes \n\n\n\nmellitus, 23.2%. Young male patients with high education \n\n\n\nlevels had high scores. The mean scores of KDQoL in \n\n\n\npatients with dyslipidemia and diabetes were significantly \n\n\n\ndecreased (P<0.05). Also, mean scores of TSQM 1.4 (side \n\n\n\neffects of the treatment) and KDQoL in acute cellular \n\n\n\nrejection patients were significantly decreased than those \n\n\n\nwithout renal rejection (P<0.05). Conclusions: Tacrolimus-\n\n\n\ntreated patients showed some improvement in the overall \n\n\n\nHRQoL and treatment satisfaction after 6 months of RTP. A \n\n\n\nmultidisciplinary team should integrate psychological health \n\n\n\nprofessions to encourage renal transplant recipients to adapt \n\n\n\nbetter. \n\n\n\nAbstract 010 \n\n\n\n\n\n\n\nTuberculosis: Risk Factors, Developing \n\n\n\nDrug-Resistant, Treatment Outcomes and \n\n\n\nSurvival Trend in Hospital Pulau Pinang, \n\n\n\nMalaysia: A Retrospective Study \n \n\n\n\nAseel Rezeq Yaghi1, Amer Hayat Khan1*, \n\n\n\nSabariah Noor Harun2 and Irfhan Ali Haider3 \n \n1Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, \n\n\n\nUniversiti Sains Malaysia, 11800, Gelugor, Penang, Malaysia \n2School of Pharmacy, The University of Queensland, Brisbane QLD 4072, \n\n\n\nAustralia \n3Respiratory Department, Penang General Hospital, Malaysia \n\n\n\n* dramer2006@gmail.com  \n\n\n\n\n\n\n\nBackground: Multi-drug resistant tuberculosis (MDR-TB) \n\n\n\nhas emerged as a serious health issue worldwide. Although \n\n\n\nTB incidence is declining, mortality rate is in increase. \n\n\n\nObjectives: To investigate the factors associated with the \n\n\n\ndevelopment of MDR-TB and mortality among TB patients. \n\n\n\nMethods: A retrospective cohort study, carried on Hospital \n\n\n\nPulau Pinang, Malaysia. Medical records of TB patients \n\n\n\ntreated and followed up for 6 months from 2014 till 2018 \n\n\n\nwere reviewed. By using SPSS version 23.0. Cox regression \n\n\n\nmodel was used to identify the factors associated with MDR-\n\n\n\nTB occurrence and mortality among TB patients. Results: \n\n\n\nOut of 351 TB patients, 325 (92.6%) patients were drug-\n\n\n\nsusceptible TB and 26 (7.4 %) patients were MDR-TB. \n\n\n\nAmong drug-susceptible TB patients, 245 (75.4%) patients \n\n\n\nachieved successful outcomes and 73 (22.5%) passed away. \n\n\n\nIn multivariable Cox regression, drug abuse (p-value= .034, \n\n\n\nHR= 1.836, 95%CI= 1.019 \u2013 3.309), high levels of white \n\n\n\nblood cells (p-value= .000, HR= 1.102, 95%CI= 1.057 \u2013 \n\n\n\n1.148) and urea (p-value= .002, HR= 1.029, 95%CI= 1.011 \n\n\n\n\u2013 1.047), and low levels of platelets (p-value= .000, \n\n\n\nHR= .996, 95%CI= .995 - .998) and albumin (p-value= .006, \n\n\n\nHR= .964, 95%CI= .940 - .990) were significantly \n\n\n\nassociated with mortality. Moreover, relapsed cases (p-\n\n\n\nvalue= 0.044, HR= 3.035, 95%CI= 1.028 \u2013 8.957), alcohol \n\n\n\nconsumption (p-value= 0.000, HR= 7.591, 95%CI= 3.097 \u2013 \n\n\n\n18.610) and being single (p-value= 0.000, HR= 6.817, \n\n\n\n95%CI= 2.599-17.879) were significant risk factors for \n\n\n\nMDR-TB development. Conclusion: The success rate \n\n\n\nachieved in the study site (75.4%) was encouraging but still \n\n\n\nless than WHO target (85%) and still has a room for further \n\n\n\nimprovement.  \n\n\n\n\nmailto:amanyalboghdadly@gmail.com\n\n\nmailto:dramer2006@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 140-181 \n\n\n\n\n\n\n\nResearch abstracts of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022 \n\n\n\nDOI:  10.52494/YOXJ1358 \n\n\n\n\n\n\n\n156 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 011 \n\n\n\n\n\n\n\nIncidence and Management of Adverse \n\n\n\nDrug Events Among Drug-Resistant \n\n\n\nTuberculosis Patients: A Prospective Study \n\n\n\nResults From A High Burden Country \n\n\n\n\n\n\n\nAsif Massud1,2*, Amer Hayat Khan1, Syed \n\n\n\nAzhar Syed Sulaiman1, Nafees Ahmad3, \n\n\n\nMuhammad Shafqat4 \n \n1Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, \n\n\n\nUniversiti Sains Malaysia, Penang, Malaysia \n2Faculty of pharmaceutical sciences, Government College University, \n\n\n\nFaisalabad, Pakistan \n3Faculty of Pharmacy, University of Balochistan, Quetta, Pakistan \n4Programmatic management of drug-resistant Tuberculosis (PMDT) unit, \n\n\n\nNishtar Medical University, Hospital, Multan, Pakistan \n\n\n\n* asifmassud@gmail.com  \n\n\n\n\n\n\n\nBackground: Management of Drug-resistant tuberculosis \n\n\n\n(DR-TB) involves a higher frequency of adverse drug events \n\n\n\n(ADEs) needing effective and timely response, which if left \n\n\n\nuntreated may result in a higher rate of loss to follow up of \n\n\n\ndrug-resistant patients. Objectives: Prospective study was \n\n\n\naimed at identifying the incidence, cause, and management \n\n\n\nmethods for ADEs along with risk factors among DR-TB \n\n\n\npatients at Nishtar Medical University Hospital, Pakistan. \n\n\n\nMethods: Prospective DR-TB patients, enrolled during \n\n\n\nJanuary 2016 to May 2019, were evaluated for ADEs as per \n\n\n\nNational TB Program criteria, Pakistan. Multivariate logistic \n\n\n\nregression was used to assess the independent variables \n\n\n\nADEs occurrence. Results: Among 271 DR-TB patients, \n\n\n\nmajority of the patients were males (51.3%), aged being < 50 \n\n\n\nyears (77.5%), weighed > 40 kg (69%), urban residents \n\n\n\n(51.7%), married (70.8%) and non-smokers (88.6%) and \n\n\n\nfemales were 49.7% of the cohort. Among patients, \n\n\n\n55(18.5%) patients did not experience any ADEs, while at \n\n\n\nleast 15(5.5%), 33(12.2%), 55(20.3%) and 53(19.6%) \n\n\n\npatients encountered one, two, three and four ADEs, \n\n\n\nrespectively. Gastrointestinal disturbances (66.7%) and \n\n\n\nelectrolyte disturbances (55.7%) remained one of the highest \n\n\n\nreported ADEs during therapy, followed by arthralgia \n\n\n\n(49.1%), psychiatric disturbance (39.4%), ototoxicity (24%), \n\n\n\nsleep disturbances (17.7%), pruritic reactions/rash (12.9%), \n\n\n\ndyspnoea (12.5%), and tinnitus (8.8%). Baseline pulmonary \n\n\n\ncavitation (p-value 0.001, OR 3.419; 95% CI (1.694 - 6.902) \n\n\n\nwas significantly associated with ADEs occurrence among \n\n\n\nDR-TB patients. Conclusion: Overall nearly 81.2 % of the \n\n\n\nDR-TB patients encountered therapy related ADEs. The \n\n\n\nhigher frequency of Amikacin-related temporary hearing loss \n\n\n\nleading to the treatment modification among patients is of \n\n\n\nconcern. ADEs were high among the study cohort, however, \n\n\n\nmanaged efficiently. \n\n\n\nAbstract 012 \n\n\n\n\n\n\n\nQualitative Assessment of Knowledge, \n\n\n\nAttitude and Practice of Healthcare \n\n\n\nPractitioners About Precision Medicine \n\n\n\nAmong Cancer Patients in Lahore, Pakistan \n \n\n\n\nRida Naeem1, Furqan K. Hashmi2, Dzul Azri \n\n\n\nMohamed Noor1* \n \n\n\n\n1School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 \n\n\n\nMalaysia \n2University College of Pharmacy, University of the Punjab, Allama Iqbal \n\n\n\nCampus, 54000, Lahore, Pakistan \n*dzulazri@usm.my \n \n\n\n\nBackground: Precision medicine (PM) allows healthcare \n\n\n\npractitioners (HCPs) to give treatment according to the \n\n\n\npatient\u2019s genetic findings taking into consideration the \n\n\n\nphysiological and environmental characteristics. PM is a \n\n\n\nrelatively new treatment approach in Pakistan. Therefore, it \n\n\n\nis important to investigate the level of awareness, attitude, \n\n\n\nand challenges faced by HCPs during practicing PM for \n\n\n\ncancer treatment. Objectives: the present study aims to \n\n\n\nexplore the level of awareness, attitude, and challenges faced \n\n\n\nby the HCPs during the treatment of cancer using PM \n\n\n\napproach. Methods: Phenomenology-based qualitative \n\n\n\napproach was used. Face-to-face in-depth interviews were \n\n\n\nconducted using the purposive sampling approach among \n\n\n\noncologists of Lahore, Pakistan. The data were analyzed \n\n\n\nusing thematic content analysis to identify themes and sub-\n\n\n\nthemes. Results: Sample size saturation achieved with 14 \n\n\n\nphysicians. Out of these,11 were aware of PM. They were \n\n\n\nkeen on training to hone their skills and agreed currently on \n\n\n\nproviding PM. HCPs believed PM was expensive and given \n\n\n\nto affluent patients only. Other impeding factors include cost, \n\n\n\nlack of knowledge, and drug unavailability. Conclusions: \n\n\n\nDespite basic knowledge and will to practice, resource and \n\n\n\ncost constraints were marked as significant barriers. \n\n\n\nAdditional training programs and inclusion into the \n\n\n\ncurriculum may help to implement PM in the future. Health \n\n\n\nauthorities need to ensure a cheaper PM treatment available \n\n\n\nto cancer patients. \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:asifmassud@gmail.com\n\n\nmailto:*dzulazri@usm.my\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 140-181 \n\n\n\n\n\n\n\nResearch abstracts of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022 \n\n\n\nDOI:  10.52494/YOXJ1358 \n\n\n\n\n\n\n\n157 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 013 \n\n\n\n\n\n\n\nThe Impact of Education Level Over \n\n\n\nAdoption of Standard Operating \n\n\n\nProcedures Against Sars-Cov2 Infection \n\n\n\nAmong the COVID-19 Booster Dose \n\n\n\nRecipients in Pakistan \n \n\n\n\nAli Qureshi1,2*, Syed Azhar Syed Sulaiman1, \n\n\n\nNur Aiziti Athira binti Daud1 \n \n\n\n\n1Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, \nUniversiti Sains Malaysia, 11800 Penang, Malaysia \n2Faculty of Pharmacy, University of Sindh Jamshoro, Pakistan \n\n\n\n* ali.qureshi33@student.usm.my \n\n\n\n\n\n\n\nBackground: Generally, the public does not comply with \n\n\n\nthe standard operating procedures against COVID-19 after \n\n\n\ngetting vaccinated. Objective: This study was conducted in \n\n\n\nPakistan, to identify the impact of education level on the \n\n\n\nadoption of standard operating procedures against SARS-\n\n\n\nCOV2 infection among the COVID-19 booster vaccine \n\n\n\nrecipients. Methods: This cross-sectional survey was \n\n\n\nconducted online among the Pakistani population from 18th \n\n\n\nJune to 8th July 2022. The tool was designed by using online \n\n\n\nGoogle forms. Various demographic and attitude related \n\n\n\nquestions were included in the questionnaire. The \n\n\n\nassociation between dependent and categorical independent \n\n\n\nvariables was determined by using the chi-square test. The \n\n\n\nsignificance was measured at P < 0.05. Statistical analysis \n\n\n\nwas performed by using IBM SPSS Statistics (v 23). Results: \n\n\n\nA total of 196 respondents were obtained with a total of 75% \n\n\n\nof them being male, the mean age +SD was 29.38 + 6.3 years. \n\n\n\nAmong them, 85.7% of respondents were from urban areas. \n\n\n\nIt was highlighted that 38.8% of respondents were infected \n\n\n\nwith COVID-19 before. All respondents had received their \n\n\n\nbooster shot. The positive attitude toward wearing a face \n\n\n\nmask (P < 0.001), hand sanitization (P < 0.001), and social \n\n\n\ndistancing (P < 0.001) was significantly associated with \n\n\n\nhigher education (\u2265 graduation). Conclusion: Education \n\n\n\nlevel was noted to have a significant impact on a better \n\n\n\nunderstanding of the importance of the adoption of standard \n\n\n\nprocedures against SARS-COV2. \n\n\n\n\n\n\n\nAbstract 014 \n\n\n\n\n\n\n\nPublic Awareness and Perceptions on The \n\n\n\nCorona Virus (COVID-19) in Duhok \n\n\n\nProvince/Kurdistan Region, Iraq \n \n\n\n\nManhal Ahmed Abdulkader1*, Rabie \n\n\n\nGabriel Abdullah2, Ali Farhad \n\n\n\nAbdullah1 , Matti Shamil Khudhur1, \n\n\n\nSarwar Saad Abdullghani1, Muhammad \n\n\n\nIzaddin Ibrahim1, Shinwar Mohammed \n\n\n\nHasan1 , Ahmad Faris Khaleel1 \n \n1Department of Clinical Pharmacy, College of Pharmacy, University \n\n\n\nof Duhok, Kurdistan Region, Iraq. \n2Department of Pharmacology, College of Pharmacy, University of \n\n\n\nDuhok, Kurdistan Region, Iraq \n\n\n\n* Manhal.abdulkader@uod.ac  \n\n\n\n\n\n\n\nBackground: Novel Corona Virus Disease (COVID-19) \n\n\n\neffectively took the world by storm, resulting in a huge \n\n\n\npandemic worldwide as declared by the World Health \n\n\n\nOrganization. Global attempts have been made to prevent the \n\n\n\nspread of the disease through governmental policies, \n\n\n\nregulations and personal actions that rely on public \n\n\n\nawareness. Objectives: The aim of this study is to assess the \n\n\n\nawareness, perceptions, and anxiety of the public regarding \n\n\n\nthis pandemic. Methods: A web-based (google forms) \n\n\n\nsurvey with random sampling was conducted using a \n\n\n\nquestionnaire developed for this study. The questionnaire \n\n\n\nconsisted of 4 sections including demographics, awareness \n\n\n\nabout transmission methods and prevention measures, public \n\n\n\nperceptions about information source, and perceived anxiety \n\n\n\nfrom COVID-19. Results: A total of 1426 responses were \n\n\n\nreceived with male number slightly lower than female \n\n\n\n(n=706, 49.5%). The participants in our survey had good \n\n\n\nknowledge and awareness as they had an overall mean score \n\n\n\nof 3.58. Participants living in urban areas, that had university-\n\n\n\nlevel education and/or were 30-40 years of age had higher \n\n\n\nknowledge than their peers. Social media and the internet \n\n\n\nwere the main sources of information for about 49.6% of the \n\n\n\nparticipants. Unlike other studies, the majority of the \n\n\n\nparticipants did not have pandemic-related anxiety as \n\n\n\nCoronavirus news did not worry them and it has not affected \n\n\n\ntheir sleeping and eating habits. Conclusion: The public in \n\n\n\nthis study has good general knowledge and awareness about \n\n\n\nCOVID-19. However, some myths still need to be \n\n\n\nhighlighted and corrected to increase public awareness and \n\n\n\nreduce the chance of infection. \n\n\n\n \n\n\n\n\nmailto:ali.qureshi33@student.usm.my\n\n\nmailto:Manhal.abdulkader@uod.ac\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 140-181 \n\n\n\n\n\n\n\nResearch abstracts of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022 \n\n\n\nDOI:  10.52494/YOXJ1358 \n\n\n\n\n\n\n\n158 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 015 \n\n\n\n\n\n\n\nPractice and Associated Factors \n\n\n\nDetermination of Antibiotics Self-\n\n\n\nMedication Among Community Residents \n\n\n\nin Boyolali, Indonesia  \n \n\n\n\nHidayah Karuniawati1,2*, Sri Suryawati3, Syed \n\n\n\nAzhar Syed Sulaiman1*, Taufik Taufik4, Wan \n\n\n\nIsmahanisa Ismail5, Md. Sanower Hossain6,7 \n \n1School  of Pharmaceutical Sciences, Universiti Sains Malaysia,  Malaysia \n2Faculty of Pharmacy, Universitas Muhammadiyah Surakarta,  Indonesia \n3Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, \n\n\n\nYogyakarta, Indonesia \n4Faculty of Psychology Universitas Muhammadiyah Surakarta, Indonesia \n5Faculty of Health Science, Universiti Teknologi MARA, Cawangan, Pulau \n\n\n\nPinang, Malaysia \n6Department of Biomedical Science, Kulliyyah of Allied Health Sciences, \n\n\n\nInternational Islamic University Malaysia, Kuantan 25200, Malaysia \n7Faculty of Science, Sristy College of Tangail, Tangail-1900, Bangladesh \n*hk170@ums.ac.id; sazhar@usm.my  \n\n\n\n\n\n\n\nBackground: Antibiotic resistance (ABR) is a global crisis \n\n\n\nmainly driven by antibiotic overuse and misuse, including \n\n\n\nself-medication. Determining the associated factors of \n\n\n\nantibiotics self-medication (ASM) is crucial to take \n\n\n\nnecessary preventive measures. Objective: This study \n\n\n\ninvestigated the prevalence, practice, and factors associated \n\n\n\nwith ASM in the general community residing in Boyolali, \n\n\n\nIndonesia. Methods: This cross-sectional study was \n\n\n\nconducted using a validated questionnaire with the cluster \n\n\n\nsampling method applied to select households. ASM \n\n\n\nbehaviour variables were determined using the multivariate \n\n\n\nlogistic regression analysis. Results: During the study, 961 \n\n\n\nrespondents participated (46.9% male and 53.1% female). \n\n\n\nASM prevalence was 16%. Amoxicillin (50.0%) and \n\n\n\ntetracycline (33%) were frequently used as antibiotics for \n\n\n\nself-medication for diseases of non-bacterial infections. The \n\n\n\nreasons for ASM were mainly personal experience and not \n\n\n\nconsulting with a doctor to save money. Most respondents \n\n\n\nreported that antibiotics could kill viruses (84.3%) and reduce \n\n\n\nfever (73.2%). They do not know that antibiotics must be \n\n\n\nbought after being prescribed by a doctor (66.8%), do not \n\n\n\nknow how to use antibiotics correctly (63.5%), and do not \n\n\n\nknow that inappropriate use of antibiotics will cause ABR \n\n\n\n(35.1%). Age, marital status, employment status, antibiotic \n\n\n\naccess knowledge, and antibiotic misuse were significantly \n\n\n\nassociated with ASM (p<0.05). Conclusion: This study \n\n\n\ndetermined 16% ASM, but the tolerance to ASM should be \n\n\n\nzero. Because any single percent of ASM could spread ABR \n\n\n\nwidely among the whole community. Educating and \n\n\n\nencouraging people to avoid ASM is recommended to \n\n\n\nprevent ABR development and spread among societies. \n\n\n\n\n\n\n\nAbstract 016 \n\n\n\n\n\n\n\nImplementing PharmindBot on Facebook \n\n\n\nfor Pharmacy Research Purposes: An \n\n\n\nArtificial Intelligence-Based Chatbot  \n\n\n\n\n\n\n\nRamez M. Alkoudmani*, Mei Lan Tan, and \n\n\n\nGuat See Ooi \n \n\n\n\nDiscipline of Clinical Pharmacy School of Pharmaceutical Sciences, \nUniversiti Sains Malaysia, Minden, Pulau Pinang, Malaysia \n\n\n\n* cpe4ever@gmail.com \n\n\n\n\n\n\n\nBackground: The world is moving fast towards digital \n\n\n\ntransformation as we live in the fourth industrial revolution \n\n\n\n(4IR) and artificial intelligence (AI) era. Conversational \n\n\n\nchatbots were used successfully in healthcare. In 2019-2020, \n\n\n\na conversational chatbot (PharmindBot) linked to the \n\n\n\nPharmind page on Facebook\u00ae was designed and successfully \n\n\n\nimplemented. More than 170,000 fans subscribed to \n\n\n\nPharmindBot until December 2021. PharmindBot has been \n\n\n\nused effectively to reach thousands of healthcare \n\n\n\nprofessionals (pharmacists, nurses and physicians) in the \n\n\n\nArab region who interacted with educational posts published \n\n\n\non the Pharmind public page on Facebook\u00ae. Objective: To \n\n\n\nimplement a chatbot called \"PharmindBot\" that runs on \n\n\n\nFacebook\u00ae to reach thousands of healthcare professionals \n\n\n\nand to collect data for research purposes. Methods: \n\n\n\nPharmindBot was successfully implemented on the \n\n\n\nFacebook\u00ae platform following three sequential steps. Firstly, \n\n\n\nChatPion was installed on the Pharmind website. Secondly, \n\n\n\nthe PharmindBot application (app) was developed on \n\n\n\nFacebook\u00ae. Finally, PharmindBot app was integrated with \n\n\n\nthe Pharmind Chatbot system. Evaluation: Auto-reply by \n\n\n\nPharmindBot was tested using a test post which published on \n\n\n\nthe Pharmind page on Facebook\u00ae asking followers to leave \n\n\n\npre-defined keywords. PharmindBot ability to collect and \n\n\n\nsave data was tested by asking testers to fill an online survey \n\n\n\nwithin Facebook Messenger\u00ae for quantitative data and to \n\n\n\nanswer predified series of questions for qualitative data. \n\n\n\nResults: PharmindBot was tested on 1000 subscribers who \n\n\n\ninteracted with it. Almost all testers (n= 990, 99%) obtained \n\n\n\na successful reply from the chatbot after sending a pre-\n\n\n\ndefined keyword. However, very few subscribers (n=10, 1%) \n\n\n\ndid not get any responses. The chatbot replied privately to \n\n\n\nalmost all public comments (n=985, 98.5%). No missing data \n\n\n\nwas found when the chatbot was used to collect quantitative \n\n\n\nand qualitative data. Conclusions: Pharmindbot reached \n\n\n\nthousands of healthcare professionals and provided them \n\n\n\nwith automated responses. The chatbot also collected \n\n\n\nqualitative and quantitative data effectively and efficiently \n\n\n\nwith little costs.  \n\n\n\n\nmailto:sazhar@usm.my\n\n\nmailto:cpe4ever@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 140-181 \n\n\n\n\n\n\n\nResearch abstracts of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022 \n\n\n\nDOI:  10.52494/YOXJ1358 \n\n\n\n\n\n\n\n159 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 017 \n\n\n\n\n\n\n\nMedication Management Review Clinic in \n\n\n\nJordan: Development and Review of First \n\n\n\nTwo Cases \n \n\n\n\nLoai M. Saadah1,2*, Amer H. Khan1, Syed \n\n\n\nAzhar Syed Sulaiman1, Iman A. Basheti2 \n \n1 Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, \nUniversiti Sains Malaysia, 11800 Penang, Malaysia \n2 Department of Clinical Pharmacy, Faculty of Pharmacy, Applied Sciences \n\n\n\nUniversity Pharmacy, 11931 Amman, Hashemite Kingdom of Jordan \n* loaisaadah@student.usm.my \n\n\n\n\n\n\n\nBackground: Developing nations still lacks medication \n\n\n\nmanagement review services like their developed \n\n\n\ncounterparts. Objectives: We describe first two cases in the \n\n\n\nleading medication management review service in Amman, \n\n\n\nJordan. Methods: This is a descriptive study with two case \n\n\n\nreports. A team of 3 clinical pharmacists developed necessary \n\n\n\nforms, visited pharmacy locations, and ensured compliance \n\n\n\nwith medication management service criteria. Patients were \n\n\n\nrecruited if they have 1 chronic condition, 4 chronic \n\n\n\nmedications, 12 medication doses, or been hospitalized in the \n\n\n\nlast 1 month. Moreover, patients who had undiagnosed signs \n\n\n\nand symptoms which may have been due to drug-induced \n\n\n\ndisease also qualified for the service. Clinical pharmacist \n\n\n\nthen identified, prevented, and resolved all drug-related \n\n\n\nproblems. All patients pay a flat fee of 10 Jordanian Dinars \n\n\n\nper 15-minute interview. Results: We present our first and \n\n\n\nsecond cases from the service. Case I is 73-year-old diabetic \n\n\n\nwoman who is demented and forgetful with faecal and \n\n\n\nurinary incontinence as well as visual and auditory \n\n\n\nhallucinations. Case II is 77-year-old diabetic man with \n\n\n\nmorning oedema, hypertension, hypothyroidism, and benign \n\n\n\nprostatic hyperplasia. Case I had acute kidney injury while \n\n\n\nCase II had chronic kidney disease (CKD stage 3). Case I & \n\n\n\nII received 13 & 12 medications, respectively, with both \n\n\n\nhaving 7 clinical pharmacy interventions including \n\n\n\nprescribing new items. Both patients improved on follow-up \n\n\n\nwith forgetfulness mitigated in the first and oedema resolved \n\n\n\nin the second. Conclusions: We have a great demand for \n\n\n\nmedication management services in Jordan and our \n\n\n\npreliminary evidence predict huge benefits. \n\n\n\n\n\n\n\nAbstract 018 \n\n\n\n\n\n\n\nAtorvastatin Therapy Among Egyptians: A \n\n\n\nCross-Sectional Study Among Community \n\n\n\nPharmacists \n \n\n\n\nMohammed Gamal Mohammed Maslub1,2,3\u2020, \n\n\n\nMoutaz Bellah Yasser2\u2020, Mahasen Ali \n\n\n\nRadwan2, Zeyad Ali Abdalla2, Mohammed \n\n\n\nSoliman4, Abubakar Sha'aban5, Nur Aizati \n\n\n\nAthirah Daud1* \n \n1School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 USM, \nPulau Pinang, Malaysia \n2Department of Pharmacy Practice/ Clinical Pharmacy, Faculty of Pharmacy, \n\n\n\nEgyptian Russian University, 11829 Egypt \n3International Society of Pharmacovigilance (ISoP), Egypt Chapter, Cairo, \n\n\n\nEgypt \n4Department of Cardiology, Faculty of Medicine, Helwan University, 11795 \nEgypt \n5Division of Population Medicine, Cardiff University, Cardiff, Wales, CF14 \n\n\n\n4YS United Kingdom \n* aizati@usm.my  \n\n\n\n\u2020 Co-first authors \n\n\n\n\n\n\n\nBackground: Atorvastatin is the most prescribed statin \n\n\n\nglobally. Community pharmacists are among the most \n\n\n\naccessible healthcare professionals in providing information \n\n\n\nand services on rational medication use. Objective: The \n\n\n\nstudy aims to investigate the opinions of community \n\n\n\npharmacists on the response to atorvastatin amongst \n\n\n\nEgyptian outpatients. Methods: This is a cross-sectional \n\n\n\nsurvey aimed at community pharmacists across Egypt\u2019s five \n\n\n\nmain regions. A survey link was provided via Google Forms\u00ae \n\n\n\nto 1500 pharmacists via email, contact number, or social \n\n\n\nmedia platforms. It comprised five sections: 1) demographics, \n\n\n\nplus pharmacists\u2019 experience concerning 2) dyslipidemia, 3) \n\n\n\natorvastatin prescriptions, 4) causes of variations in therapy \n\n\n\noutcomes, and 5) atorvastatin-related adverse reactions. \n\n\n\nParticipation was voluntary and informed consent was \n\n\n\nobtained. The Chi-square test of independence was used to \n\n\n\nevaluate differences in response frequencies. The \n\n\n\nsignificance cut-off value was set at 0.05. Results: A total of \n\n\n\n1444 respondents completed the survey. The elderly were \n\n\n\nmost reported to get prescriptions for dyslipidemia (69.5%). \n\n\n\nMore than half (58%) reported that females presented more \n\n\n\nwith dyslipidemia. Over two-thirds (87.3%) agreed that \n\n\n\natorvastatin was the most prescribed statin in their \n\n\n\npharmacies. The majority (93.1%) believed that patient-\n\n\n\nrelated differences influenced atorvastatin therapy outcomes \n\n\n\n(e.g., lipid profile). Many respondents (25.9%) agreed that \n\n\n\ndrug-drug interactions influenced these outcomes the most. \n\n\n\nElevation of hepatic enzymes was rated differently across \n\n\n\nEgypt\u2019s regions (p= 0.037). Conclusions: This study shows \n\n\n\nthat the majority of pharmacists reported atorvastatin as the \n\n\n\nmost frequently prescribed statin. Most pharmacists \n\n\n\n\nmailto:loaisaadah@student.usm.my\n\n\nmailto:aizati@usm.my\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 140-181 \n\n\n\n\n\n\n\nResearch abstracts of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022 \n\n\n\nDOI:  10.52494/YOXJ1358 \n\n\n\n\n\n\n\n160 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nattributed variations in treatment outcomes to drug-drug \n\n\n\ninteractions with atorvastatin. \n\n\n\n\n\n\n\nAbstract 019 \n\n\n\n\n\n\n\nSpray Dryer and Electrospray Techniques \n\n\n\nAssisted Encapsulation of Insulin in \n\n\n\nMicroparticles Coated with Pectin \n\n\n\nMicrobeads for Colon-Targeted Oral Drug \n\n\n\nDelivery \n \n\n\n\nHazem Choukaife1, Abd Almonem Doolaanea2, \n\n\n\nZalilawati Bnti Rashed3 and Mulham \n\n\n\nAlfatama1* \n \n\n\n\n1Faculty of Pharmacy, Universiti Sultan Zainal Abidin, Besut Campus, \n\n\n\nTerengganu 22200, Malaysia \n2 Department of Pharmaceutical Technology, Kulliyyah of Pharmacy, \n\n\n\nInternational Islamic University Malaysia, Kuantan 25200, Pahang, \n\n\n\nMalaysia \n3 Faculty of Bioresources & Food Industry, Universiti Sultan Zainal Abidin, \n\n\n\nBesut Campus, Terengganu, Malaysia \n\n\n\n* mulham4122@yahoo.com ;  mulham@unisza.edu.my  \n \n\n\n\nBackground: The current diabetes therapy for type-1 and to \n\n\n\nlarge extent type-II, relies mainly on subcutaneous insulin \n\n\n\ninjections. However, frequent daily injections may lead to \n\n\n\nlow patient compliance and substantial inconvenience. \n\n\n\nElectrospray technique can quickly obtain uniform and \n\n\n\nspherical particles with the diameter of interest by applying \n\n\n\nan electric field on the feed needle tip. Electrospray and spry \n\n\n\ndryer techniques introduce an effective encapsulation, batch-\n\n\n\nscalability and reproducibility in particles production. \n\n\n\nObjective: This study aimed to formulate a colon-targeted \n\n\n\nsystem to deliver insulin orally by preparing insulin-chitosan \n\n\n\nmicroparticles coated with pectin microbeads (INS-Cs-MPs \n\n\n\ncoated PMBs). Method: The insulin was encapsulated in \n\n\n\nchitosan microparticles prepared by the spray drying \n\n\n\ntechnique. Then, the microparticles were coated using pectin \n\n\n\npolymer through the electrospray technique based on the \n\n\n\nionic gelation. The optimization of the insulin-loaded \n\n\n\nchitosan microparticles was performed based on the chitosan \n\n\n\nconcentration, inlet temperature, and feed flow rate. \n\n\n\nMeanwhile, the physiochemical properties of pectin \n\n\n\nmicrobeads were controlled by studying the crosslinking \n\n\n\ntime, feed flow rate and high voltage of the electrospray \n\n\n\nequipment. Results: The optimized microparticles were \n\n\n\nsuccessfully prepared with particle size, yield, drug loading, \n\n\n\nand zeta potential of 1.06 \u00b1 0.8 \u03bcm, 47.23 \u00b1 0.5%, 7.6 \u00b1 0.1%, \n\n\n\nand +21.61 \u00b1 1.49 mV, respectively. The INS-Cs-MPs coated \n\n\n\nPMBs were also successfully prepared with size, sphericity, \n\n\n\nand aspect ratio of 0.73 \u00b1 0.15 mm, 0.05 \u00b1 0.07, and 1.85 \u00b1 \n\n\n\n0.14, respectively. The microbeads demonstrated desirable \n\n\n\nwater uptake, erosion and swelling as the microbeads were \n\n\n\ncompletely dissolved in the simulated colon fluid. The drug \n\n\n\nrelease of microbeads had lower release than the \n\n\n\nmicroparticles in the simulated gastric. Conclusion: The \n\n\n\nresults suggest that the produced INS-Cs-MPs coated PMBs \n\n\n\nsystem with the suitable particle size (0.73\u00b1 0.15 mm) is a \n\n\n\npromising system for colon-targeted oral insulin delivery. \n\n\n\nAdditional work is needed to evaluate the cell cytotoxicity of \n\n\n\nthe microbeads as well as the efficiency of lowering glucose \n\n\n\nlevel in-vivo. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 020 \n\n\n\n\n\n\n\nScreening Electrospinning Critical \n\n\n\nParameters for Fibres Production: \n\n\n\nExcipients\u2019 Nature \n \n\n\n\nNurul Atiqah Ismail1, Reem Abou Assi1,2 Siok \n\n\n\nYee Chan1* \n \n\n\n\n1Discipline of Pharmaceutical Technology, School of Pharmaceutical \n\n\n\nSciences, Universiti Sains Malaysia, Malaysia \n2EDEN Research Group, Discipline of Pharmaceutical Technology, College \nof Pharmacy, Al-Kitab University, Altun kupri, Kirkuk, 36001, Iraq \n\n\n\n* sychan@usm.my  \n\n\n\n\n\n\n\nBackground: Electrospinning is a heat-free manufacturing \n\n\n\ntechnique employing high voltage upon polymer \n\n\n\nsolution/melt to produce nano- and microfibres which is \n\n\n\ngoverned by several parameters such as excipients (i.e., \n\n\n\npolymers, salts) and needle types used (i.e., single and \n\n\n\ncoaxial needles). Objective: This study investigated the \n\n\n\nelectrospinnability of four polymers via single-needle and \n\n\n\ncoaxial electrospinning with highlights on electrolyte (using \n\n\n\nNaCl) to improve the conductivity of polymer solution. \n\n\n\nMethods: Different polymers namely Polyvinylpyrrolidone \n\n\n\n(PVP) K29/32 (10%), PVP K90 (10%), Polyvinylalcohol \n\n\n\n(PVA) (5-10%), and Hydroxypropylmethylcellulose \n\n\n\n(HPMC) (1-3%) were electrospun under conditions of 1 \n\n\n\nmL/hr, 5-15 kV and 15 cm needle-to-collector distance, final \n\n\n\nfibres were subjected to optical microscopy analysis. \n\n\n\nElectrospinnability of HPMC was further investigated with \n\n\n\nthe addition of 0.5% sodium chloride (NaCl). Results: In \n\n\n\nsingle-needle electrospinning, unlike PVP K29/32, PVP \n\n\n\nK90 showed excellent electrospinning abilities, PVA \n\n\n\nconcentrations increment were directly proportional to the \n\n\n\nproduction of beadless and uniform nanofibres, whereas \n\n\n\nHPMC has poor electrospinnability with and without salt \n\n\n\naddition. With coaxial electrospinning PVP K90 as sheath, \n\n\n\nthe formation of wet and beaded nanofibres was significant \n\n\n\nfor PVA and HPMC whereas beadless and uniform \n\n\n\nnanofibres were produced with HPMC 1.5% and 0.5% NaCl. \n\n\n\nConclusion: It can be inferred that the type of polymers and \n\n\n\ntheir concentrations are crucial variables in electrospinning. \n\n\n\nSalt addition also played a vital role in producing good \n\n\n\nnanofibres at low concentrations when incorporated with \n\n\n\nnatural polymers collectively with coaxial electrospinning. \n\n\n\n\nmailto:mulham4122@yahoo.com\n\n\nmailto:mulham@unisza.edu.my\n\n\nmailto:sychan@usm.my\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 140-181 \n\n\n\n\n\n\n\nResearch abstracts of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022 \n\n\n\nDOI:  10.52494/YOXJ1358 \n\n\n\n\n\n\n\n161 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nTherefore, this preliminary screening gives insights into the \n\n\n\nimportant variables needed to be optimised in \n\n\n\nelectrospinning technique. \n \n\n\n\nAbstract 021 \n\n\n\n\n\n\n\nBioavailability and Pharmaceutical \n\n\n\nAnalysis of Novel Chocolate Based \n\n\n\nIbuprofen Formulations  \n\n\n\n\n\n\n\nAya Kabariti1, *, M. albed Alhnan2, Ghaleb \n\n\n\nOriquat1, Basel Arafat1 \n \n1School of Pharmacy and medical Sciences, Al Ahliyya Amman University \n2School of Pharmacy and biomedical sciences, University of Central \nLancashire \n\n\n\n* Kabariti_a@yahoo.com  \n\n\n\n\n\n\n\nBackground: Chocolate chewable tablet and suspension \n\n\n\ndosage forms are considered an excellent taste masker and \n\n\n\neasy to swallow, making them a favourable dosage forms for \n\n\n\nthe elderly and children. However, limited research is \n\n\n\ncurrently available relating to the effect of chocolate on the \n\n\n\nbioavailability of drugs in vivo. Objective: the present study \n\n\n\nis to compare the pharmacokinetic profile of the non-\n\n\n\nsteroidal anti-inflammatory drug (ibuprofen) in its \n\n\n\nconventional suspension form with those incorporated into \n\n\n\nnovel chocolate-based dosage forms. Method: High \n\n\n\nPerformance Liquid Chromatography-Ultraviolet (HPLC-\n\n\n\nUV) was validated to be used for the determination of \n\n\n\nibuprofen in rat serum. The chocolate-based ibuprofen \n\n\n\ngranules (solid suspension and co-crystals of ibuprofen and \n\n\n\nchocolate), provided by UCLAN, were triturated in a mortar \n\n\n\nand then suspended with (0.25%) methocelTM solution. \n\n\n\nEach different formulation along with conventional \n\n\n\nibuprofen control was orally gavaged into Sprague-Dawley \n\n\n\nrats (n=8) then blood samples at different time intervals were \n\n\n\ncollected, treated and analysed using statistical software. \n\n\n\nResults: Analysis of the in vivo data revealed a significant \n\n\n\nreduction (p<0.05) in the maximum serum concentration of \n\n\n\nibuprofen from 65.540\u00b16.673\u03bcg/ml when ibuprofen was \n\n\n\nadministered alone to 43.366\u00b19.589\u03bcg/ml and \n\n\n\n45.816\u00b17.620\u03bcg/ml when ibuprofen was incorporated into \n\n\n\nthe co-crystals or solid suspension chocolate matrices, \n\n\n\nrespectively. On the other hand, there were no significant \n\n\n\ndifferences found in the area under concentration curves to 8 \n\n\n\nhours and to infinity time between the different formulations. \n\n\n\nConclusion: Finding from this study give indication on \n\n\n\npossible sustained effect of ibuprofen when incorporated into \n\n\n\nthe different chocolate matrices and the great potential those \n\n\n\nnovel formulations could possess. \n\n\n\n\n\n\n\nAbstract 022 \n\n\n\n\n\n\n\nIsorhamnetin Decreased The Expression of \n\n\n\nHMG-CoA Reductase and Increased LDL \n\n\n\nReceptors in Hep G2 Cells  \n\n\n\n\n\n\n\nRanda El-Rayyes*, Manal M. Abbas, Razan \n\n\n\nObeidat, Manal A. Abbas \n \n\n\n\nFaculty of Allied Medical Sciences, Al-Ahliyya Amman University, \n\n\n\nAmman 19328, Jordan \n\n\n\n* m.abbas@ammanu.edu.jo  \n\n\n\n\n\n\n\nBackground: Isorhamnetin is a flavonoid component existed \n\n\n\nin many plants. It has many biological functions, including \n\n\n\nanti-tumor, anti-oxidant and anti-inflammatory effects. \n\n\n\nPrevious in vivo studies showed that isorhamnetin lowered \n\n\n\nserum cholesterol in rats fed with cholesterol-enriched diet. \n\n\n\nHowever, cholesterol-lowering mechanism is still unknown. \n\n\n\nObjective: We investigated the hypocholesterolemic effect \n\n\n\nof isorhamnetin in cholesterol biosynthesis in-vitro. Material \n\n\n\nand Methods: Human hepatocellular carcinoma cell line, \n\n\n\nHepG2, was used in the study. The effect of isorhamnetin on \n\n\n\nthe expression of hydroxymethylglutaryl CoA reductase \n\n\n\n(HMG-CoA reductase) and LDL receptor (LDLR) genes and \n\n\n\nproteins was investigated by real time polymerase chain \n\n\n\nreaction (RT-PCR) and Western blot while ELISA was used \n\n\n\nto study of isorhamnetin oxidative stress status. For all tested \n\n\n\nparameters, one-way analysis of variance (ANOVA) was \n\n\n\nused, p value less than 0.05 was considered significant. \n\n\n\nResults: Isorhamnetin inhibits the proliferation of HepG2 \n\n\n\ncells in time-dependent manner, IC50 100 \u03bcM, 53 \u03bcM and 40 \n\n\n\n\u03bcM at 24, 48 and 72 hours, respectively. Isorhamnetin \n\n\n\ndownregulated HMG-CoA reductase gene expression \n\n\n\nsignificantly. Also, all tested doses of isorhamnetin \n\n\n\ndownregulated LDLR expression and produced no change in \n\n\n\nmembranous LDLR protein expression. In cell lysate, LDLR \n\n\n\nwas increased by all studied concentrations of isorhamnetin. \n\n\n\nIsorhamnetin at 100 \u03bcM decreased intracellular HMG-CoA \n\n\n\nreductase compared to vehicle-treated control. Furthermore, \n\n\n\nisorhamnetin increased superoxide dismutase activity and \n\n\n\nreduced H2O2 level, due to catalase activity. Conclusion: \n\n\n\nIsorhamnetin may have beneficial effects on cholesterol \n\n\n\nmechanism. Future detailed studies are needed to investigate \n\n\n\nthe effect of Isorhamnetin on LDLR degradation.  \n\n\n\n \n\n\n\n\nmailto:Kabariti_a@yahoo.com\n\n\nmailto:m.abbas@ammanu.edu.jo\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 140-181 \n\n\n\n\n\n\n\nResearch abstracts of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022 \n\n\n\nDOI:  10.52494/YOXJ1358 \n\n\n\n\n\n\n\n162 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 023 \n\n\n\n\n\n\n\nA Novel BAK-BAX-CDK1 Signalling \n\n\n\nComplex Links Activation of The Spindle \n\n\n\nAssembly Checkpoint to Apoptosis  \n\n\n\n\n\n\n\nOmeed Omar Darweesh1,2  \n \n1Department of Molecular and Cell Biology, University of Leicester, \n\n\n\nLeicester, UK. \n2College of Pharmacy, Al-kitab University, Kirkuk, Iraq. \n* od54@leicester.ac.uk \n\n\n\n\n\n\n\nBackground: Antimitotic anticancer drugs, such as Taxol, \n\n\n\ndisrupt microtubule formation and prevent microtubule-\n\n\n\nkinetochore attachments to activate the mitotic checkpoint \n\n\n\n(also known as the Spindle Assembly Checkpoint). In \n\n\n\nresponse to mitotic checkpoint switch-on, a key cell cycle \n\n\n\nregulator cyclin-dependent kinase 1 (CDK1) is chronically \n\n\n\nactivated resulting in mitotically arrested cells. One \n\n\n\nconsequence of prolonged mitotic arrest is the initiation of \n\n\n\ncell death via a well-characterised signalling pathway called \n\n\n\nmitochondrial apoptosis. Objective: In this study, we aim to \n\n\n\nidentify the cytoplasmic signals that link mitotic checkpoint \n\n\n\nactivation to cell death. Methods: This study was conducted \n\n\n\nusing a variety of molecular and cell biology techniques, \n\n\n\nincluding subcellular fractionation, immunoprecipitation, \n\n\n\nwestern blotting, cell death assays, flow cytometry, \n\n\n\nimmunofluorescence microscopy and mass spectrometry. \n\n\n\nHuman cancer cell lines HeLa wild type, U2OS, HCT-116 \n\n\n\nwild type, HCT-116 BAK/BAX double knockout cells, and \n\n\n\ndiploid RPE1 cells were used. Results: This study discovered \n\n\n\npreviously unknown connections between CDK1 and \n\n\n\nproapoptotic proteins BAK and BAX. Our findings indicate \n\n\n\nthat activated CDK1 forms an apoptotic complex with the \n\n\n\npro-apoptotic proteins BAK and BAX during prolonged \n\n\n\nmitotic arrest. The phosphorylation of the mitochondrial \n\n\n\nbased anti-apoptotic proteins Bcl-2 and Bcl-xL and the \n\n\n\ninduction of cell death are dependent on BAK and BAX-\n\n\n\nmediated delivery of activated CDK1 to the mitochondrion. \n\n\n\nConclusions: The interactions between cell cycle regulator \n\n\n\nprotein CDK1 and key pro-apoptotic proteins BAK and BAX \n\n\n\nidentify the cytoplasmic signals that link mitotic checkpoint \n\n\n\nactivation to apoptosis.  \n\n\n\n\n\n\n\n\n\n\n\nAbstract 024 \n\n\n\n\n\n\n\nAntihyperglycemic Activity of \n\n\n\nStandardized Swietenia Macrophylla Seed \n\n\n\nEthanolic Extract in Type 2 Diabetic Rats \n \n\n\n\nMeyyammai Swaminathan1*, Mariam \n\n\n\nAhmad1, Khairul Niza Abd Razak1, Nor Adlin \n\n\n\nYusoff2, Gabriel Akyirem Akowuah3, Elaine \n\n\n\nHui-Chien Lee1, Syed Azhar Syed Sulaiman1, \n\n\n\nMun Fei, Yam1, Faradianna E. Lokman4, Sue \n\n\n\nHay, Chan6, Bey Hing, Goh7, Vikneswaran \n\n\n\nMurugaiyah1,5 \n \n\n\n\n1School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800, \nMalaysia \n2Advance Medical and Dental Institute, Universiti Sains Malaysia, 13200, \n\n\n\nMalaysia \n3Faculty of Pharmaceutical Sciences, University College Sedaya \n\n\n\nInternational, 56000, Malaysia \n4Department of Diabetes, Cardiovascular, Diabetes and Nutrition Research \nCentre, Institute for Medical Research, 50588, Malaysia \n5Centre for Drug Research, Universiti Sains Malaysia, 11800, Malaysia \n6Usains Biomics Laboratory, 11800, Malaysia \n7Monash University, 47500, Malaysia \n\n\n\n* meyyammaiswaminathan@gmail.com \n\n\n\n\n\n\n\nBackground: Swietenia macrophylla (S. macrophylla) \n\n\n\n(family Meliaceae) has been widely used traditionally as \n\n\n\nantioxidant, antidiabetic, antimicrobial and anti-\n\n\n\ninflammatory agents. Objective: Swietenia macrophylla \n\n\n\nseed ethanolic extract\u2019s (SMEE) antihyperglycemic activity \n\n\n\nwas investigated in type 2 diabetic (T2D) Goto-Kakizaki \n\n\n\n(GK) rats. Two limonoids, swietenine and 3,6-O,O-\n\n\n\ndiacetylswietenolide with antihyperglycemic properties in \n\n\n\nSMEE were quantified using HPLC method. Methods: Two \n\n\n\ndoses (250 and 500 mg/kg) were used for treatment. Oral \n\n\n\nglucose tolerance test (OGTT); body weight profile; and \n\n\n\nantihyperglycemic activity of SMEE on T2D GK rats were \n\n\n\nstudied. A reverse-phased analytical HPLC method was \n\n\n\ndeveloped for simultaneous identification and quantification \n\n\n\nof the two limonoids. Separation peaks were monitored at \n\n\n\nflow rate of 1.0ml/min with a low-pressure gradient elution \n\n\n\nwith mobile phase (A) water, 70 to 10 % (B) and acetonitrile, \n\n\n\n30 to 90 %, over 36 minutes and UV detection at 220 nm. \n\n\n\nResults: On day 15 of OGTT, the SMEE group at 500 mg/kg \n\n\n\nshowed lower fasting blood glucose levels. Results: \n\n\n\nAntihyperglycemic test displayed a better and sustained \n\n\n\nglucose regulation over 7 hours in the SMEE group on days \n\n\n\n1 and 8. Method validation of HPLC analysis attained good \n\n\n\nlinearity (r \u2265 0.9970) of calibration curves in the range of \n\n\n\n1.56 -200 \u03bcg/mL. The content of swietenine and 3,6-O, O-\n\n\n\ndiacetylswietenolide was 27.5 \u03bcg (2.75%) and 14.53 \u03bcg \n\n\n\n(1.45%) in 1 mg of SMEE. While LOD and LOQ were r \u2265 \n\n\n\n0.0975 and 1.5625 \u03bcg/mL for both swietenine and 3,6-O, O-\n\n\n\ndiacetylswietenolide. Conclusion: Quantification of \n\n\n\n\nmailto:od54@leicester.ac.uk\n\n\nmailto:meyyammaiswaminathan@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 140-181 \n\n\n\n\n\n\n\nResearch abstracts of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022 \n\n\n\nDOI:  10.52494/YOXJ1358 \n\n\n\n\n\n\n\n163 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nswietenine and 3,6-O,O-diacetylswietenolide from SMEE \n\n\n\nand the in-vivo investigations verifies the S. macrophylla \n\n\n\nseed\u2019s antidiabetic properties in T2D rats. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 025 \n\n\n\n\n\n\n\nIncreased In-vitro Binding of Di(5-Furfural) \n\n\n\nEther, A Degradant Of 5-\n\n\n\nHydroxymethylfurfural, With Endogenous \n\n\n\nMacromolecules: Experimental and \n\n\n\nTheoretical Approaches \n \n\n\n\nThomas, Olusegun Emmanuel*, Akin-Taylor \n\n\n\nAkintayo, Oduwole Rashidat  \n \nDept. of Pharmaceutical Chemistry, Faculty of Pharmacy, University of \n\n\n\nIbadan, Ibadan, Nigeria \n\n\n\n*seguntom@yahoo.com  \n\n\n\n\n\n\n\nBackground: Earlier studies have investigated the safety \n\n\n\n(including the DNA and albumin binding activities) of the \n\n\n\nfood additive, 5-hydroxymethylfurfural. In contrast, there is \n\n\n\na dearth of the safety assessment of its degradant, di(5-\n\n\n\nfurfural) ether, which may pose a greater risk as it has been \n\n\n\ndetected in parenteral solutions at concentrations greater than \n\n\n\nthose of the intact additive. Objective: The aim of this study \n\n\n\nwas a comparative in-vitro investigation of the binding \n\n\n\ninteractions of 5-hydroxymethylfurfural and di(5-furfural) \n\n\n\nether with albumin and ct-DNA. Materials and Methods: \n\n\n\nDi(5-furfural) ether was synthesised via thermal dehydration \n\n\n\nof 5-hydroxymethylfurfural. The binding of the compounds \n\n\n\nwith albumin and ct-DNA were investigated using UV \n\n\n\nspectroscopy, viscometry, molecular docking and DFT \n\n\n\ncalculations. Results: Photometric titrations showed that, \n\n\n\nwhen compared with 5-hydroxymethylfurfural, di(5-furfural) \n\n\n\nether induced more pronounced perturbations in the spectra \n\n\n\nof albumin and DNA. The binding constants of di(5-furfural) \n\n\n\nether to albumin and DNA respectively were 1.5 and 5 folds \n\n\n\ngreater than 5-hydroxymethylfurfural. Docking also \n\n\n\nconfirmed higher binding energies and stabilisation of di(5-\n\n\n\nfurfural) ether complexes with albumin and DNA. The \n\n\n\nincreased binding affinity of di(5-furfural) ether was \n\n\n\nattributed to its higher C/H ratio which facilitated an \n\n\n\nextensive network of hydrophobic interactions with Tyr149, \n\n\n\nLeu237, Ala290, Ile289, Arg194 residues of BSA Site I and \n\n\n\nminor groove of DNA. DFT calculations showed that the \n\n\n\nhigher electrophilicity of the di(5-furfural) ether might \n\n\n\nenhance its interaction with the negatively charged DNA \n\n\n\nbackbone. Conclusions: In comparison to 5-\n\n\n\nhydroxymethylfurfural, di(5-furfural) ether showed \n\n\n\nincreased binding and stability of resultant ligand-protein \n\n\n\ncomplexes formed with albumin and DNA. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 026 \n\n\n\n\n\n\n\nPharmacophore Modelling, Molecular \n\n\n\nDocking, and Molecular Dynamics \n\n\n\nSimulation to Identify Potent Inhibitors of \n\n\n\nAlpha-Synuclein Aggregation  \n\n\n\n\n\n\n\nSani Yahaya Najib1,2*, Yusuf Oloruntoyin \n\n\n\nAyipo1,3, Waleed Abdullah Ahmad Alananzeh1, \n\n\n\nMohd Nizam Mordi1 \n \n1Centre for Drug Research, Universiti Sains Malaysia, USM 11800, Pulau \n\n\n\nPinang, Malaysia \n2Department of Pharmaceutical and Medicinal Chemistry, Bayero \n\n\n\nUniversity Kano, PMB 3011, Kano Nigeria. \n3Department of Chemistry, Kwara State University, Malete, PMB 1530, \nIlorin, Nigeria \n\n\n\n* najibsani62@gmail.com  \n\n\n\n\n\n\n\nBackground: Aggregation of \u03b1-synuclein is strongly \n\n\n\nimplicated as an underlying pathogenesis of Parkinson\u2019s \n\n\n\ndisease (PD) and its inhibition has been demonstrated as one \n\n\n\nof the strategies PD treatments. However, the few inhibitors \n\n\n\nof \u03b1-synuclein applied in clinical conditions elicit unpleasant \n\n\n\nside effects, making a search for better candidates significant. \n\n\n\nObjectives: This study is aimed at identifying potent \n\n\n\ninhibitors of \u03b1-synuclein aggregation from natural product \n\n\n\ninterbioscreen (IBS) databases. Method: Using ligand-based \n\n\n\nPharmacophore modeling, Glide XP docking, molecular \n\n\n\ndynamics, and pk-CSM pharmacokinetics prediction \n\n\n\nparameters were applied in silico for identification of \n\n\n\npotential ant-PD compounds. Results: The top-ranked \n\n\n\npharmacophore model was validated with Gunner-Henry \n\n\n\n(GH) scoring method and enrichment factor (EF) of 0.87 and \n\n\n\n23.43 respectively, making it ideal model for database \n\n\n\nscreening. The Pharmacophore model with features \n\n\n\nHHHHHHDDDDA identified 100 hits from \u201c877,377 IBS \n\n\n\ndatabase. The top ranked docked compounds, STOCK2S-\n\n\n\n85121, STOCK3S-13122, STOCK2S-57139, STOCK75-\n\n\n\n07150, & STOCK4S-24924 demonstrated docking scores of \n\n\n\n-4.789, -4.451, -4.413, -4.365, & -4.227 compared to \n\n\n\nreference compound (levodopa) with docking scores of -\n\n\n\n3.556 kcal/mol respectively. Molecular dynamics via root \n\n\n\nmean square deviation and fluctuations further revealed \n\n\n\nSTOCK2S-85121 having better stability in the binding \n\n\n\npocket compared to other ligands. Conclusion: Therefore, \n\n\n\nSTOCK2S-85121 is recommended for further evaluation as \n\n\n\npotential anti-PD agent. \n\n\n\n \n\n\n\n\nmailto:*seguntom@yahoo.com\n\n\nmailto:najibsani62@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 140-181 \n\n\n\n\n\n\n\nResearch abstracts of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022 \n\n\n\nDOI:  10.52494/YOXJ1358 \n\n\n\n\n\n\n\n164 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 027 \n\n\n\n\n\n\n\nTheophylline Causes Regression of \n\n\n\nEndometriotic Implants in a Rat \n\n\n\nSurgical Model \n \n\n\n\nManal A. Abbas1,2*, Ahmad M. Disi3, Mutasem \n\n\n\nO. Taha4 \n \n1Faculty of Allied Medical Sciences, Al-Ahliyya Amman University, \nAmman 19328, Jordan \n2Pharmacological and Diagnostic Research Center, Al-Ahliyya \n\n\n\nAmman University, Amman 19328, Jordan \n3Faculty of Science, The University of Jordan, 11942 Amman, Jordan \n4Faculty of pharmacy, The University of Jordan, 11942 Amman, \n\n\n\nJordan \n* m.abbas@ammanu.edu.jo  \n\n\n\n\n\n\n\nBackground: Endometriosis is one of the most frequent \n\n\n\ndiseases in gynaecology. Currently therapies are \n\n\n\nunsatisfactory. Objectives: The present study evaluates the \n\n\n\neffectiveness of theophylline as a treatment for \n\n\n\nendometriosis. Methods: The effect of theophylline on \n\n\n\nregression of endometriotic implants was studied in a rat \n\n\n\nsurgical model. Two squares of 4 x 4 mm of open uterus \n\n\n\nwere sutured in the peritoneal cavity. After 28 days, the size \n\n\n\nof cyst was measured by a caliper and treatment started for \n\n\n\n21 days with theophylline. At the end of treatment cyst size \n\n\n\nwas measured again. Light and electron microscopic studies \n\n\n\nwere performed in addition to TUNEL assay for the \n\n\n\nassessment of apoptosis. Results: Theophylline 10 and 15 \n\n\n\nmg/kg reduced endometriotic cyst size by 52% and 66%, \n\n\n\nrespectively. Histologically, the stroma was highly \n\n\n\nvascularized especially around glandular tissue and heavily \n\n\n\ninfiltrated with inflammatory cells in animals that received \n\n\n\nvehicle as the only treatment. In ovarictomized rats, \n\n\n\nglandular tissue was highly reduced. In rats treated with \n\n\n\ntheophylline, glandular tissue within stroma of cysts was \n\n\n\nscarce, fibrosis was localized directly under the luminal \n\n\n\nepithelium and mixed inflammatory cells were seen in the \n\n\n\nstroma and in cyst lumen. No significant difference in mast \n\n\n\ncells degranulation in theophylline-treated group was \n\n\n\nencountered. Furthermore, apoptosis was detected in stroma \n\n\n\nof cysts of rats treated with theophylline. Ultrastructural \n\n\n\nstudies revealed active mast cells with reduced electron \n\n\n\ndensity of their granules in theophylline-treated and control \n\n\n\ngroups. Conclusions: Theophylline causes regression of \n\n\n\nendometriotic implants and increases apoptosis without \n\n\n\naffecting mast cell degranulation. \n\n\n\n\n\n\n\nAbstract 028 \n\n\n\n\n\n\n\nComplementary and Alternative Medicine \n\n\n\n(CAM) Use in Insomnia: Current Update on \n\n\n\nKnowledge, Attitude, and Perception (KAP) \n\n\n\nAmong the Community in Malaysia \n \n\n\n\nSiti Nur Afza Atirah Binti Zahari1, Syarifah \n\n\n\nSyamimi Putri Adiba Binti Syed Putera1*,  \n\n\n\nZakiah binti Noordin2,3 \n \n1 Department of Clinical Pharmacy and Pharmacy Practice, Faculty of \nPharmacy and Health Sciences, Universiti Kuala Lumpur Royal College of \n\n\n\nMedicine Perak, Malaysia \n2Department of Pharmacy Practice, Faculty of Pharmacy, Universiti \nTeknologi MARA Cawangan Selangor, Malaysia \n3Cardiology Therapeutics Research Group, Universiti Teknologi MARA, \n\n\n\nBandar Puncak Alam, Malaysia. \n* syarifah.syamimi@unikl.edu.my \n\n\n\n\n\n\n\nBackground: 10-30% of adults have chronic insomnia, \n\n\n\nwhile 9 out of 10 Malaysian have insomnia. CAM therapy \n\n\n\ncan be one of treatment for insomnia other than the \n\n\n\nconventional treatment. Objective: This study aims to \n\n\n\nevaluate the current update on KAP toward CAM therapy use \n\n\n\nin insomnia among the community in Malaysia. Method: A \n\n\n\nself-administered, face-validated online questionnaire was \n\n\n\ndistributed among 396 participants aged 18 years and above \n\n\n\nrecruited using convenience sampling between January and \n\n\n\nMay 2022. The questionnaire consists of 5 sections: \n\n\n\ndemographic, pattern usage of CAM therapy, knowledge, \n\n\n\nattitude, and perception of CAM therapy for insomnia. \n\n\n\nSection 1 and 2 consist of multiple-choice questions while \n\n\n\neach KAP part comprises 5-6 items Likert scale questions. \n\n\n\nThe overall score for each KAP section is calculated and the \n\n\n\nlevel is classified by using Bloom's cut-off point. Descriptive \n\n\n\nstatistics were performed using SPSS version 22 and the data \n\n\n\nwere presented in frequency and percentage. Results: Most \n\n\n\nof the respondents were single (81.3%), female (68.9%) \n\n\n\nuniversity students (74%) with bachelor's degree (63.4%). \n\n\n\nMost respondents have never experienced insomnia (58.3%) \n\n\n\nand thus never practiced CAM therapy for insomnia (82.3%). \n\n\n\nMusic-based intervention (n=36) and fixed sleeping patterns \n\n\n\n(n=55) are some reported CAM therapy practiced by \n\n\n\ninsomniac respondents. Results: it showed that participants \n\n\n\nhave a positive perception (53.8%) and good knowledge \n\n\n\n(61.6%) of CAM therapy and insomnia but a moderate \n\n\n\nattitude (50.3%) toward CAM therapy for insomnia. \n\n\n\nConclusions: CAM therapy is not widely practiced among \n\n\n\nMalaysian and health education programs aimed at \n\n\n\nimproving the public's understanding of CAM therapy for \n\n\n\ninsomnia is needed.  \n\n\n\n \n\n\n\n\nmailto:m.abbas@ammanu.edu.jo\n\n\nmailto:syarifah.syamimi@unikl.edu.my\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 140-181 \n\n\n\n\n\n\n\nResearch abstracts of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022 \n\n\n\nDOI:  10.52494/YOXJ1358 \n\n\n\n\n\n\n\n165 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 029 \n\n\n\n\n\n\n\nHealth Benefits of Honey: Knowledge, \n\n\n\nAttitude and Perception (KAP) Among the \n\n\n\nCommunity in Malaysia \n \n\n\n\nWan Nor Aidah Basirah binti Wan Ab \n\n\n\nRahman, Syarifah Syamimi Putri Adiba Binti \n\n\n\nSyed Putera*, Aina Amanina Binti Abdul Jalil \n \n\n\n\nDepartment of Clinical Pharmacy and Pharmacy Practice, Faculty of \n\n\n\nPharmacy and Health Sciences, Universiti Kuala Lumpur Royal College of \n\n\n\nMedicine Perak, Malaysia \n\n\n\n* syarifah.syamimi@unikl.edu.my \n\n\n\n\n\n\n\nBackground: According to current scientific research, honey \n\n\n\nmay be beneficial and protective in treating various medical \n\n\n\nillnesses. Objective: To evaluate the KAP toward the health \n\n\n\nbenefits of honey among the community in Malaysia. \n\n\n\nMethod: A cross-sectional study was conducted using a self-\n\n\n\nadministered, face-validated online questionnaire distributed \n\n\n\namong 400 participants aged 18 years and above recruited \n\n\n\nusing convenience sampling between January and May 2022. \n\n\n\nThe questionnaire consists of five domains: demographic \n\n\n\ncharacteristics, honey\u2019s usage patterns, knowledge, attitude, \n\n\n\nand perception of the health benefits of honey. Sections 1 and \n\n\n\n2 consist of multiple-choice questions, while each KAP part \n\n\n\ncomprises 2-7 items Likert scale questions. The overall score \n\n\n\nfor each KAP section is calculated, and the level is classified \n\n\n\nby using Bloom's cut-off point. The statistical analysis in \n\n\n\nmethods for this study was analyzed using the SPSS version \n\n\n\n23. Descriptive statistics were performed using SPSS version \n\n\n\n22, and the data were presented in frequency and percentage. \n\n\n\nResults: Most of the respondents were single (83.9%), \n\n\n\nfemale (58%) university students (36.5%) with bachelor's \n\n\n\ndegree (66%). Among Malaysian, Tualang (n=218) is the \n\n\n\nmost frequently consumed honey to suppress cough (n=342), \n\n\n\nwith an expenditure of more than RM60 per month (n=162). \n\n\n\nResults also showed that participants have good knowledge \n\n\n\n(n=185, 46.3%), an optimistic attitude (n=275, 68.8%), and a \n\n\n\npositive perception (n=276, 69%) toward the health benefit \n\n\n\nof honey. Conclusion: The majority of the study participants \n\n\n\nwere knowledgeable about honey, and awareness of its \n\n\n\nbenefit must be directed to the public. \n\n\n\n\n\n\n\nAbstract 030 \n\n\n\n\n\n\n\nKnowledge, Attitude, and Practice of \n\n\n\nCommunity Pharmacists Regarding \n\n\n\nSmuggled Medicines in Yemen \n \n\n\n\nMohammed Battah1,2*, Gamil Othman1, \n\n\n\nHamas Al-Qadhi1, Asma Al-Aghbari1, Heba \n\n\n\nAl-Maqtari1 \n \n\n\n\n1Department of Clinical Pharmacy and Pharmacy Practice, Faculty of \n\n\n\nPharmacy, University of Science and Technology, Sana\u2019a, Yemen \n2Department of Clinical Pharmacy, School of Pharmaceutical Sciences, \n\n\n\nUniversity Sains Malaysia, Gelugor, Malaysia \n* m.albattah@student.usm.my; mmalbattah@gmail.com \n\n\n\n\n\n\n\nBackground: Smuggling is a global problem with \n\n\n\ndetrimental effects on patients, community, and health \n\n\n\nsystem. Objective: This study aimed to assess community \n\n\n\npharmacists' knowledge, practice and attitude towards \n\n\n\nsmuggled medicines in Yemen. Method: A cross-sectional \n\n\n\nstudy was conducted among community pharmacists in \n\n\n\nYemen between February and August 2020. Besides \n\n\n\nsociodemographic variables, community pharmacists' \n\n\n\nknowledge, practice and attitude were evaluated. Factors \n\n\n\nassociated with knowledge of smuggled drug were analyzed \n\n\n\nusing SPSS with a significance level of P < 0.05. Results: A \n\n\n\ntotal of 430 questionnaires were distributed, and 400 \n\n\n\ncommunity pharmacists agreed to participate (93%). The \n\n\n\nmajority of participants were male (89%), had Bachelor's \n\n\n\ndegrees (66%), and had less than five-year experience (52%). \n\n\n\nParticipants demonstrated good knowledge about smuggled \n\n\n\nmedicines, which was significantly associated with \n\n\n\nparticipants' qualifications and years of experience. Notably, \n\n\n\nthe majority of participants (92%) admitted that smuggled \n\n\n\nmedicines are pervasive in Yemen. Although most \n\n\n\nparticipants (66%) were aware of the negative impact of \n\n\n\nsmuggled medicines on patients' health, they had a negative \n\n\n\nattitude and poor practices. The most frequently smuggled \n\n\n\ndrugs were anti-diabetic agents (42%), followed by \n\n\n\nantihypertensive agents (22%). Long-standing civil war in \n\n\n\nthe country is the leading factor behind medicines smuggling. \n\n\n\nOthers contributing factors are low economic status, \n\n\n\naffordability of smuggled medicines, and unavailability of \n\n\n\nlicensed medicines. Conclusion: Although their good \n\n\n\nknowledge regarding smuggled medicines, community \n\n\n\npharmacists in Yemen have a negative attitude and frequently \n\n\n\ndeal with smuggled medicines. Extensive work by health \n\n\n\nauthorities to increase the accessibility and affordability of \n\n\n\nmedicines is required. \n\n\n\n \n\n\n\n\nmailto:syarifah.syamimi@unikl.edu.my\n\n\nmailto:mmalbattah@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 140-181 \n\n\n\n\n\n\n\nResearch abstracts of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022 \n\n\n\nDOI:  10.52494/YOXJ1358 \n\n\n\n\n\n\n\n166 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 031 \n\n\n\n\n\n\n\nGram-Negative Bacteria Susceptibility to \n\n\n\nAntibiotics Stratified by Gender \n \n\n\n\nNehad J. Ahmad1,2*, Amer H. Khan1 \n \n\n\n\n1Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, \nUniversiti Sains Malaysia, George Town 11800, Penang, Malaysia \n2Clinical Pharmacy Department, College of Pharmacy, Prince Sattam Bin \n\n\n\nAbdulaziz University, Al-Kharj 16273, Saudi Arabia \n* nehad@student.usm.my;n.ahmed@psau.edu.sa  \n\n\n\n\n\n\n\nBackground: The use of antibiotics early in the course of \n\n\n\ntreating illnesses can reduce morbidity and save lives. On the \n\n\n\nother hand, improper antibiotic use promotes the emergence \n\n\n\nand spread of bacteria resistant to treatment, hastening the \n\n\n\ndevelopment of bacterial resistance. An antibiogram is an \n\n\n\neasy and accessible way to assess the bacterial \n\n\n\nsusceptibilities to different antibiotics. A hospital's \n\n\n\ncumulative antibiograms can mask discrepancies between \n\n\n\npatient demographics, hospital departments, or anatomical \n\n\n\nregions. Objective: The aim of the study was to describe the \n\n\n\ndifferences in gram-negative bacteria susceptibility of male \n\n\n\nand female patients in a public hospital in Qassim. Methods: \n\n\n\nThe study included reviewing the bacteria susceptibility \n\n\n\nresults that were collected from the laboratory department in \n\n\n\nthe hospital from January 2021 to December 2021. Results: \n\n\n\nTwo thousand four hundred seventy-two isolates were \n\n\n\ncollected in the hospital. More than 52% of the bacteria in \n\n\n\nmales and more than 58% of bacteria in females were gram-\n\n\n\nnegative bacteria. The most prevalent gram-negative bacteria \n\n\n\nin male patients were Klebsiella pneumoniae, Escherichia \n\n\n\ncoli, Acinetobacter baumannii, and Pseudomonas aeruginosa. \n\n\n\nThe most prevalent gram-negative bacteria in female patients \n\n\n\nwere Klebsiella pneumoniae, Escherichia coli, Pseudomonas \n\n\n\naeruginosa, and Acinetobacter baumannii. Conclusions: The \n\n\n\nsusceptibility of gram-negative bacteria to different \n\n\n\nantibiotics in female patients is different from males. So, it is \n\n\n\nimportant to assess the microbes that male and female \n\n\n\npatients have and to be aware of the bacterial isolates' \n\n\n\npatterns of antibiotic susceptibility before selecting the \n\n\n\nappropriate antibiotics. \n\n\n\n\n\n\n\nAbstract 032 \n\n\n\n\n\n\n\nDescriptive Analysis of Adverse Drug \n\n\n\nReactions Reports of Amoxicillin \n \n\n\n\nNehad J. Ahmed1,2*, and Amer H. Khan1 \n \n1Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, \nUniversiti Sains Malaysia, George Town 11800, Penang, Malaysia \n2Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin \n\n\n\nAbdulaziz University, Al-Kharj 16273, Saudi Arabia \n* n.ahmed@psau.edu.sa;  nehad@student.usm.my  \n\n\n\n\n\n\n\nBackground: Amoxicillin is one of the most antibiotics \n\n\n\nwhich is typically used for the treatment of bacterial \n\n\n\ninfections, particularly respiratory tract infections. It is well-\n\n\n\ntolerated but could cause several complaints such as nausea, \n\n\n\nvomiting, and diarrhoea. It could also cause rare but serious \n\n\n\nadverse events such as anaphylactic reactions. Objective: \n\n\n\nThe aim of the study was to identify the most common \n\n\n\nadverse events which are caused by amoxicillin. Methods: \n\n\n\nThe present study was a descriptive study based on the \n\n\n\nreports that were submitted to the World Health \n\n\n\nOrganization using the Vigi Access database. Results: It\u2019s \n\n\n\nfound that 143008 reports were received till July 2022. The \n\n\n\nresults found that about 49% of the reports were submitted \n\n\n\nin Asia. More than 59% of the patients were females.; and \n\n\n\ntheir age was between 18 and 64 years. The most reported \n\n\n\nadverse events were skin and subcutaneous tissue disorders \n\n\n\n(particularly rash and pruritis) (48%), gastrointestinal \n\n\n\nadverse events (such as diarrhoea, nausea, and vomiting) \n\n\n\n(12%), general disorders and administration problems (8%), \n\n\n\nand immune system disorders (7%). Conclusion: A regular \n\n\n\nevaluation of the safety of antibiotics such as amoxicillin \n\n\n\nshould be implemented to facilitate the development of \n\n\n\npolicies and guidelines to decrease the frequency of serious \n\n\n\nadverse events.  \n\n\n\n\nmailto:nehad@student.usm.my;n.ahmed@psau.edu.sa\n\n\nmailto:nehad@student.usm.my\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 140-181 \n\n\n\n\n\n\n\nResearch abstracts of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022 \n\n\n\nDOI:  10.52494/YOXJ1358 \n\n\n\n\n\n\n\n167 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 033 \n\n\n\n\n\n\n\nAssessment of Emotional Distress among \n\n\n\nHealth Care Professionals at Different \n\n\n\nHospitals in Sindh, Pakistan \n \n\n\n\nNarendar Kumar1, *, Syed Azhar Syed \n\n\n\nSulaiman1, and Shaib Muhammad2 \n \n1Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, \nUniversiti Sains Malaysia \n2Department of Pharmaceutics, Faculty of Pharmacy, University of Sindh, \n\n\n\nJamshoro, Pakistan \n* narendar.sharma87@gmail.com  \n\n\n\n\n\n\n\nBackground: During the coronavirus disease 2019 \n\n\n\n(COVID-19) pandemic, healthcare professionals (HCP) \n\n\n\nworked in a stressful environment, which affected their \n\n\n\nphysical and mental well beings. Furthermore, the fear of \n\n\n\nswift transmission, inadequate equipment at healthcare \n\n\n\nfacilities, and the non-serious attitudes of the public were \n\n\n\nthe key factors to cause emotional distress among HCPs. \n\n\n\nObjectives: The study aimed to determine the impact of \n\n\n\nCOVID-19 on healthcare professionals' concerns and \n\n\n\nemotional distress. Methods: A web-based a cross-\n\n\n\nsectional survey was conducted from October 1, 2020, to \n\n\n\nDecember 31, 2020. The questionnaire consisted of 16 \n\n\n\nitems and was designed using Google Form and the link \n\n\n\nwas promoted to HCPs through various social media \n\n\n\nplatforms including Facebook, Whatsapp, and Telegram. \n\n\n\nChi-squared and Kruskal Wallis tests were used to \n\n\n\ncompared emotional distress among different variables. \n\n\n\nResults: A total of 368 respondents included; physicians \n\n\n\n(56%) aged between 18 and 37 (79%), working in public \n\n\n\nsector hospitals (67%) for less than five years (64%). HCPs \n\n\n\nwere more concerned about their family members' health \n\n\n\n(72.0%) and 50.8% about their own (50.8%), whereas \n\n\n\n35.3% reported being emotionally distressed. Our findings \n\n\n\nsuggested that emotional distress was significantly \n\n\n\nassociated with years of experience (p = 0.048) and \n\n\n\nworking in the COVID-19 ward (p = 0.010). Conclusion: \n\n\n\nOur study concluded that the COVID-19 pandemic has \n\n\n\nincreased the psychological pressure on HCPs and stressed \n\n\n\nthem for their family's health. HCPs working in COVID-\n\n\n\n19 wards faced significant emotional distress compared \n\n\n\nwith HCPs from other wards. \n\n\n\n\n\n\n\nAbstract 034 \n\n\n\n\n\n\n\nPopulation-based knowledge, Attitude, and \n\n\n\nPerception Study for COVID-19 Vaccine in \n\n\n\nSindh, Pakistan \n \n\n\n\nNarendar Kumar1, Syed Azhar Syed \n\n\n\nSulaiman1, *, Furqan Khurshid Hashmi2 \n \n1Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, \nUniversiti Sains Malaysia \n2University College of Pharmacy, University of the Punjab, Allama Iqbal \n\n\n\nCampus, Lahore, Pakistan \n* sazhar.usm@gmail.com  \n\n\n\n\n\n\n\nBackground: COVID-19 vaccination is one of the most \n\n\n\neffective ways to immunize the population against COVID-\n\n\n\n19. However, there is vaccine hesitancy among the \n\n\n\npopulation in Pakistan. Objective: The aim of this study was \n\n\n\nto evaluate the knowledge, attitudes, perceptions, and \n\n\n\nwillingness to receive COVID-19 vaccines among people in \n\n\n\nSindh, Pakistan. Methods: An online survey was conducted \n\n\n\nin July 2021 using a validated survey questionnaire which \n\n\n\nwas developed using Google Forms. The questionnaire \n\n\n\nconsisted of 5 sections including demographic characteristics \n\n\n\n(5 items), knowledge (7 items), attitude (4 items), perception \n\n\n\n(5 items), and willingness for vaccination (1 item). The link \n\n\n\nwas forwarded to the public using the snowball sampling \n\n\n\ntechnique. Chi-squared test and Kruskal Wallis tests were \n\n\n\napplied using SPSS (v.22) to compare the knowledge and \n\n\n\nattitudes among different variables. Results: A total of 926 \n\n\n\nrespondents completely filled the questionnaire including; \n\n\n\nmales (59%), aged 18-31 years (67%), and belonged to \n\n\n\nHyderabad (38%). Majority of the respondents (60%) were \n\n\n\nuniversity graduates and doing a private job (35%). More \n\n\n\nthan half of the respondents had average knowledge and \n\n\n\nattitude towards COVID-19 vaccination (56% and 54%), \n\n\n\nrespectively. Around 77% of respondents believed that \n\n\n\neveryone should get vaccinated and that health care workers \n\n\n\nshould be given priority. The majority of respondents (81%) \n\n\n\nwere willing to be vaccinated against COVID-19. \n\n\n\nConclusion: Regardless of average knowledge, low positive \n\n\n\nattitude, perception about side effects of COVID-19 and poor \n\n\n\nhealthcare facilities, people were willing to get vaccinated.    \n\n\n\n \n\n\n\n\nmailto:narendar.sharma87@gmail.com\n\n\nmailto:sazhar.usm@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 140-181 \n\n\n\n\n\n\n\nResearch abstracts of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022 \n\n\n\nDOI:  10.52494/YOXJ1358 \n\n\n\n\n\n\n\n168 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 035 \n\n\n\n\n\n\n\nCauses of Drug Related Problems Among \n\n\n\nChronic Kidney Disease Patients with \n\n\n\nDiabetes Mellitus and/ or Hypertension in \n\n\n\nPrivate Hospital, Yemen \n \n\n\n\nEgbal Abdulrahman1, Amer Hayat Khan1*, \n\n\n\nElham Aldolimy2, Odai Alburaihi3, Omaima \n\n\n\nAlsubari3, Moath Aledressi3 \n \n1Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, \nUniversiti Sains Malaysia, 11800 Penang, Malaysia \n2Department of nephrology, Science and Technology Hospital, Sana\u2019a, \n\n\n\nYemen \n3Department of Clinical Pharmacy, School of pharmaceutical sciences, 21st \n\n\n\nSeptember university of medical sciences, Sana\u2019a, Yemen \n\n\n\n* dramer@usm.my  \n\n\n\n\n\n\n\nBackground: Chronic kidney disease (CKD) is a worldwide \n\n\n\nhealth issue. Drug-related problems (DRPs) result from the \n\n\n\ncoexistence of CKD and comorbidities, which increases \n\n\n\nhospital stay and healthcare costs as well as increasing the \n\n\n\nrisk of morbidity and mortality. Objective: Identify and \n\n\n\nevaluate the DRPs and their causes among chronic kidney \n\n\n\ndisease with Diabetes Mellitus (DM) and/or Hypertension \n\n\n\n(HTN). Methods: From 1 December 2021 to 28 February \n\n\n\n2022, a cross-sectional study was carried out at the \n\n\n\nnephrology department of Science and Technology Hospital, \n\n\n\nSana'a, Yemen. A total of 106 CKD patients with DM and/ \n\n\n\nor HTN were included in the study. Sociodemographic and \n\n\n\nclinical date was gathered from the medical records. The \n\n\n\nStatistical Package for the Social Sciences (SPSS) version \n\n\n\n23.0 was used for data descriptive analysis. Results: Most of \n\n\n\nthe included patients were males (74.5%) and non-elderly \n\n\n\n(54.7%). DRPs were found in 81.1% of recruited patients. A \n\n\n\ntotal of 233 DRPs were identified, with at least two DRPs \n\n\n\nidentified for each patient. DRPs with the highest prevalence \n\n\n\nwere drug selection (40%), dose selection (34.4%), and \n\n\n\ntreatment duration (5.6%). The most common cause of drug \n\n\n\nselection (48.6%) was inappropriate drug selection, and the \n\n\n\nmost common cause of dose selection (52.5%) was too low \n\n\n\ndose. Conclusions: DRPs are common in CKD patients with \n\n\n\ndiabetes and/or hypertension. As a result, awareness of DRPs \n\n\n\naids in identifying, resolving, and preventing potential DRPs, \n\n\n\nresulting in better patient care.  \n\n\n\n\n\n\n\nAbstract 036 \n\n\n\n\n\n\n\nAssessment of Mortality Risk Predictors \n\n\n\nAssociated with COVID-9 Infection in \n\n\n\nPakistani Patients: An Observational Study \n \n\n\n\nMuhammad Zeeshan Munir1,2*, Amer Hayat \n\n\n\nKhan2, Tahir Mehmood Khan1,3 \n \n\n\n\n1Institute of Pharmaceutical Sciences, University of Veterinary and Animal \nSciences, 54000 Syed Abdul Qadir Jillani (Out Fall) Road, Lahore \u2013 \n\n\n\nPakistan. \n2Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, \nUniversiti Sains Malaysia, Gelugor 11800, Penang, Malaysia. \n3School of Pharmacy, Monash University Malaysia Sdn Bhd, Jalan Lagoon \n\n\n\nSelatan, 45700 Banday Sunway, Selangor Malaysia. \n* Zeeshan.munir@uvas.edu.pk  \n\n\n\n\n\n\n\nBackground: Mortality predictor\u2019s data in Pakistani \n\n\n\nCOVID-19 patients is inadequate. Understanding \n\n\n\nrelationship between clinical features, treatment trajectories, \n\n\n\nand mortality is critical for establishing a foundation for \n\n\n\npatient care. Objective: The study aimed to examine \n\n\n\nCOVID-19 patients from March, 2021 until February, 2022 \n\n\n\nevaluating data such as patient demographics, comorbidities, \n\n\n\nclinical features, laboratory results, and drugs provided as \n\n\n\nmortality predictors related to COVID-19. Methods: In this \n\n\n\nretrospective observational study, data was acquired by \n\n\n\nevaluating the medical records of 1000 cases confirmed by \n\n\n\nPCR-test in Pakistani districts of Lahore and Sargodha. Chi-\n\n\n\nsquare and logistic regression analysis were performed using \n\n\n\nSPSS programme for statistical analysis. Results: Out of the \n\n\n\n1000 cases, 288 people died. Males and those > 40 years had \n\n\n\na greater mortality rate. 90.2% of those who were placed on \n\n\n\nmechanical ventilation perished (OR=124.267, CI95%, \n\n\n\n65.959-234.119). Most prevalent complaints were dyspnoea, \n\n\n\nfever, and cough, with a strong connection between SpO2 \n\n\n\n<95% (OR=3.234, CI95%, 1.554-6.728) RR >20 bpm \n\n\n\n(OR=2.595, CI95%, 1.203-5.597), and death. C-reactive \n\n\n\nprotein (OR=2.979, CI95%, 1.686-5.261) and d dimer \n\n\n\n(OR=1.659, CI95 %, 1.010-2.727) were found to be \n\n\n\nlaboratory predictors of death. Patients with renal (OR=2.344, \n\n\n\nCI95%, 1.384-3.968) or hepatic impairment (OR=1.555, \n\n\n\nCI95%, 0.962-2.513) were additionally at risk of dying. Only \n\n\n\nantivirals were substantially related with a decreased risk of \n\n\n\nmortality (OR=0.475, CI95%, 0.235-0.959) among all drugs \n\n\n\nadministered. Conclusion: Participants who died in the study \n\n\n\nwere older, male with indications of respiratory distress or \n\n\n\norgan failure, and had elevated CRP or D-dimer levels. All \n\n\n\nof the characteristics described here were associated with \n\n\n\ndeath in COVID-19 infection. \n\n\n\n \n\n\n\n\nmailto:dramer@usm.my\n\n\nmailto:Zeeshan.munir@uvas.edu.pk\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 140-181 \n\n\n\n\n\n\n\nResearch abstracts of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022 \n\n\n\nDOI:  10.52494/YOXJ1358 \n\n\n\n\n\n\n\n169 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 037 \n\n\n\n\n\n\n\nDevelopment And Validation of a \n\n\n\nGuideline-Guided Prognostic Model of \n\n\n\nMortality in Patients with First-Ever Acute \n\n\n\nIschemic Stroke  \n\n\n\n\n\n\n\nMustapha Mohammed1,2*, Hadzliana Zainal1, \n\n\n\nSiew Chin Ong3, Balamurugan Tangiisuran1, \n\n\n\nSabariah Noor Harun1, Siti Maisharah Sheikh \n\n\n\nGhadzi1, Norsima Nazifah Sidek4, Keng Lee \n\n\n\nYee5, Looi Irene6, Zariah Abdul Aziz4 \n \n1School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 \n\n\n\nGelugor, Pulau Pinang, Malaysia \n2Department of Clinical Pharmacy and Pharmacy Practice, Faculty of \n\n\n\nPharmaceutical Sciences, Ahmadu Bello University, 810107 Zaria, Kaduna, \n\n\n\nNigeria \n3Discipline of Social and Administrative Pharmacy, School of \n\n\n\nPharmaceutical Sciences, Universiti Sains Malaysia, 11800 Gelugor, Pulau \n\n\n\nPenang, Malaysia \n4Clinical Research Centre, Hospital Sultanah Nur Zahirah, 20400 Kuala \n\n\n\nTerengganu, Terengganu, Malaysia \n5National Institute of Health, Ministry of Health, 40170 Shah Alam, \nSelangor, Malaysia \n6Clinical Research Centre, Hospital Seberang Jaya, 3700 Permatang Pauh, \n\n\n\nPulau Pinang, Malaysia \n* mohammedmmrx@gmail.com  \n\n\n\n\n\n\n\nBackgrounds: Prognostic models help predict acute \n\n\n\nischemic stroke outcomes and can guide risk and care \n\n\n\nstratification. Objective: This study developed and validated \n\n\n\na guideline-guided prognostic model of mortality following \n\n\n\na first acute ischemic stroke. Methods: The study recruited \n\n\n\n899 patients with first-ever acute ischemic stroke from the \n\n\n\nMalaysian National Stroke Registry (NSR) from 2010 to \n\n\n\n2020 and followed up for three months. The NSR guideline-\n\n\n\nguided key performance indicators were thrombolytic \n\n\n\ntherapy, antiplatelet within 48 hrs, dysphagia screening, deep \n\n\n\nvenous thrombosis (DVT) prophylaxis, anticoagulants for \n\n\n\natrial fibrillation (AF), discharge on antiplatelets, discharge \n\n\n\non lipid-lowering agents, stroke education, and rehabilitation. \n\n\n\nMultivariate logistic regression was used to develop the \n\n\n\nguideline-guided prognostic model. The model was validated \n\n\n\nusing performance measures; the Hosmer-Lemeshow (H-S) \n\n\n\ngoodness-of-fit (calibration) and the area under the receiver \n\n\n\noperating characteristic (AUROC) curve (discrimination). \n\n\n\nResults: The guideline-guided factors that significantly \n\n\n\ndecreased the risk of mortality were antiplatelet within 48 hrs. \n\n\n\n(adjusted odds ratio, aOR, 0.40 [95% confidence interval, CI, \n\n\n\n0.19-0.81), dysphagia screening (aOR, 0.30 [95% CI, 0.15-\n\n\n\n0.61]), antiplatelets upon discharge (aOR, 0.17 [95% CI, \n\n\n\n0.08-0.35]), lipid-lowering agents upon discharge (aOR, 0.37 \n\n\n\n[95% CI, 0.17-0.82]), stroke education (aOR, 0.02 [95% CI, \n\n\n\n0.01-0.05]) and rehabilitation (aOR, 0.08 [95% CI, 0.04-\n\n\n\n0.16]). The validation performance of model was \n\n\n\nAUROC=0.941 (95% CI, 0.92-0.96), H-L test=4.35 \n\n\n\n(p=0.630), Omnibus test=142.53 (p<0.001) and Nagelkerke \n\n\n\nR2 0.741. Conclusion: The guideline-guided prognostic \n\n\n\nvariables predictive of mortality were antiplatelets within 48 \n\n\n\nhrs, dysphagia screening, antiplatelets upon discharge, lipid-\n\n\n\nlowering agents, stroke education and rehabilitation. The \n\n\n\nmodel demonstrated excellent performance, accurate \n\n\n\ndiscrimination and calibration with potential clinical utility. \n\n\n\n\n\n\n\nAbstract 038 \n\n\n\n\n\n\n\nEvaluation of The Impact of Antibiotic \n\n\n\nStewardship Program on Antibiotics \n\n\n\nUtilization as Surgical Prophylaxis at a \n\n\n\nSecondary Hospital in United Arab \n\n\n\nEmirates \n \n\n\n\nMaryam Salem Alkaabi1,2, Sabariah Noor \n\n\n\nHarun1, and Abubakar Sha\u2019aban1 \n \n1School of Pharmaceutical Sciences, Universiti Sains Malaysia, \nMalaysia.  \n2Dibba Hospital, Fujairah, United Arab Emirates  \n\n\n\n* Maryam.alkaabi@student.usm.my  \n\n\n\n\n\n\n\nBackground: Overuse or misuse of antibiotics, especially \n\n\n\nbroad-spectrum antibiotics, may result in nosocomial \n\n\n\ninfections, leading to increased mortality rate, extended \n\n\n\nhospital stay, and cost. The antibiotic stewardship program \n\n\n\n(ASP) is introduced to combat the irrational use of antibiotics. \n\n\n\nObjective: To evaluate the effectiveness of the newly \n\n\n\nimplemented surgical antibiotics prophylaxis (SAP) \n\n\n\nguidelines. Methods: This study was a retrospective, \n\n\n\nhospital-based study conducted over five years (2017 to \n\n\n\n2022), one year before and four years after implementation \n\n\n\nof ASP at Dibba hospital, United Arab Emirates. The study \n\n\n\nincluded adult patients who undergo surgical operations \n\n\n\nduring the study period. Results: Out of 3290 patients \n\n\n\nincluded in the study,1756 received SAP. The percentage of \n\n\n\npatients who received SAP improved from pre-ASP 53.6% \n\n\n\nto 56.7% four years post-ASP. The most frequently used SAP \n\n\n\nin pre-ASP was amoxicillin with clavulanic acid (decreased \n\n\n\nfrom 44% to 0% in t), in contrast to Cefazolin (increased \n\n\n\nfrom 0% to 83%). The appropriate selection of SAP was \n\n\n\nimproved from 42% to 97%, appropriate SAP timing \n\n\n\nincreased from 81% to 98%, appropriate SAP duration was \n\n\n\nnoticeably enhanced from 46% to 98%. The incidence of \n\n\n\nsurgical site infection (SSI) decreased from 34.82% in pre-\n\n\n\nASP to 7.99%, 17.91%, 5.40%, and 3.71% in the first, second, \n\n\n\nthird, and fourth post-ASP years, respectively. Conclusions: \n\n\n\nFour years Implementation of SAP guidelines have \n\n\n\nsignificantly improved the rational use of antibiotics \n\n\n\nresulting in improved clinical outcomes. \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:mohammedmmrx@gmail.com\n\n\nmailto:Maryam.alkaabi@student.usm.my\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 140-181 \n\n\n\n\n\n\n\nResearch abstracts of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022 \n\n\n\nDOI:  10.52494/YOXJ1358 \n\n\n\n\n\n\n\n170 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 039 \n\n\n\n\n\n\n\nClinicodemographic Characteristics \n\n\n\nIdentification of Malaysian Patients with \n\n\n\nRheumatoid Arthritis Using Biologic and \n\n\n\nTargeted Disease Modifying Anti \n\n\n\nRheumatoid Drugs \n \n\n\n\nNasreh Shamsi Poor Gheshmi1,*, Syed Azhar \n\n\n\nSyed Sulaiman1, Yaman Walid Kassab2 \n \n1School of Pharmaceutical Sciences, Universiti Sains Malaysia (USM), \nPenang, Malaysia \n2Faculty of Pharmacy, Syrian Private University, Damascus, Syria \n\n\n\n* nasreh@student.usm.my \n\n\n\n\n\n\n\nBackground: Rheumatoid arthritis (RA) is considered a \n\n\n\nsystemic inflammatory disease that can cause progressive \n\n\n\njoint destruction. The prevalence of RA is known to be 0.5 to \n\n\n\n1 percent. Biologic and targeted disease modifying anti \n\n\n\nrheumatic drugs (DMARDs) found to be effective in RA \n\n\n\ntreatment. Objective: This study aimed to identify the \n\n\n\ndemographic and clinical variables among Malaysian RA \n\n\n\npatients receiving biologic and targeted DMARDs. Method: \n\n\n\nWe conducted a retrospective cohort study at Serdang and \n\n\n\nPutrajaya Hospital from August 2021 until November 2021. \n\n\n\n215 patients were selected randomly. Data collection \n\n\n\nincluded demographic and clinical features at four different \n\n\n\ntimes intervals. Result: In our study we found that RA \n\n\n\npopulation included 66.5% females and 33.5% males, with a \n\n\n\nmean age of 54.67 years old. We demonstrated that 46.5% \n\n\n\nwere Malay, 38.6% Indian and 32 14.9% Chinese. 81.4% of \n\n\n\npatients had comorbidities that hypertension (49.8%) and \n\n\n\nosteoarthritis (46%) were common. Examination of data at \n\n\n\nbaseline indicated that 54% were biologic na\u00efve. Furthermore, \n\n\n\n59.3% of RA patients received monotherapy. The results \n\n\n\nshowed that 51.2%, received TNF inhibitor, whereas non-\n\n\n\nTNF inhibitors and targeted DMARDs was received by \n\n\n\n32.1%, and 16.7% patients respectively. We demonstrated \n\n\n\nthat the mean DAS28 ESR improved considerably across \n\n\n\ntime points, F (1, 214) = 4911.89, p < 0.001. Conclusion: \n\n\n\nThe results indicated that RA is a common disorder among \n\n\n\nMalaysian population and has a significant disease burden \n\n\n\nwhich females are more affected. Furthermore, we have \n\n\n\nobserved that there was a significant clinical response \n\n\n\nimprovement after initiation of biologic and targeted \n\n\n\nDMARDs. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 040 \n\n\n\n\n\n\n\nSafety Assessment of Biologic and Targeted \n\n\n\nDisease Modifying Anti Rheumatoid Drugs \n\n\n\nAmong Malaysian Patients with \n\n\n\nRheumatoid Arthritis \n \n\n\n\nNasreh Shamsi Poor Gheshmi1,*, Syed Azhar \n\n\n\nSyed Sulaiman1, and Yaman Walid Kassab2 \n \n1School of Pharmaceutical Sciences, Universiti Sains Malaysia (USM), \nPenang, Malaysia \n2Faculty of Pharmacy, Syrian Private University, Damascus, Syria \n\n\n\n* nasreh@student.usm.my \n\n\n\n\n\n\n\nBackground: Rheumatoid arthritis (RA) treatment with \n\n\n\nbiologic and targeted disease-modifying anti-rheumatic \n\n\n\ndrugs (bDMARDs, tDMARDs) showed a significant clinical \n\n\n\nimprovement, however these agents are associated with \n\n\n\nvarious adverse events (AEs), including infection, abnormal \n\n\n\nliver, and lipid function. Objective: To identify the safety \n\n\n\nissues of bDMARDs and tDMARDs among Malaysian RA \n\n\n\npatients. Methods: We conducted a retrospective cohort \n\n\n\nstudy of RA patients enrolled in Serdang and Putrajaya \n\n\n\nHospital from August 2021 until November 2021. 215 \n\n\n\npatients who received bDMARDs and tDMARDs were \n\n\n\nselected randomly. Data included demographic and clinical \n\n\n\nfeatures at four different times intervals. We used frequency \n\n\n\nand Friedman tests to analyse data. Result: This study \n\n\n\nincluded 66.5% females and 33.5% males with a mean age of \n\n\n\n54.6 \u00b1 10.162 years. Most of patients (83.3%) were treated \n\n\n\nwith bDMARDs, whereas 16.7% received tDMARDs. \n\n\n\nExamination of lipid profile indicated a significant increase \n\n\n\nin LDL level \u03c72 (3, n=215) =31.034, p<0.001 and TG level \n\n\n\n\u03c72 (3, n=215) =133.169, p<0.001. Inspection of the median \n\n\n\nvalues showed an increase in AST level from baseline \n\n\n\n(median=19) to 12 months post therapy (median=21) and \n\n\n\nALT level from baseline (median=15) to 12 months post \n\n\n\ntherapy (median=19), demonstrating a substantial impact of \n\n\n\nthese agents on liver profile enzymes including AST \u03c72 (3, \n\n\n\nn=215) =30.013, p<0.001 and ALT \u03c72 (3, n=215) =20.022, \n\n\n\np<0.001. Conclusion: Our analysis found a potential impact \n\n\n\nof these agents on liver and lipid profile. These findings will \n\n\n\nhelp healthcare providers to identify AEs of these agents to \n\n\n\nprevent or manage them well. \n\n\n\n\nmailto:nasreh@student.usm.my\n\n\nmailto:nasreh@student.usm.my\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 140-181 \n\n\n\n\n\n\n\nResearch abstracts of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022 \n\n\n\nDOI:  10.52494/YOXJ1358 \n\n\n\n\n\n\n\n171 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 041 \n\n\n\n\n\n\n\nExamining The efficacy of Biologic and \n\n\n\nTargeted Anti Rheumatic Drugs Among \n\n\n\nMalaysian Population with Rheumatoid \n\n\n\nArthritis \n \n\n\n\nNasreh Shamsi Poor Gheshmi1,*, Syed Azhar \n\n\n\nSyed Sulaiman1, Yaman Walid Kassab2 \n \n\n\n\n1School of Pharmaceutical Sciences, Universiti Sains Malaysia (USM), \n\n\n\nPenang, Malaysia \n2Faculty of Pharmacy, Syrian Private University, Damascus, Syria \n\n\n\n* nasreh@student.usm.my \n\n\n\n\n\n\n\nBackground: Rheumatoid arthritis (RA) is considered a \n\n\n\nsystemic inflammatory disease that can cause progressive \n\n\n\njoint destruction. Biologic and targeted disease modifying \n\n\n\nanti rheumatic drugs (bDMARDs, tDMARDs) showed an \n\n\n\nefficient impact in reducing disease activity score. Objective: \n\n\n\nTo investigate the effectiveness of bDMARDs and \n\n\n\ntDMARDs among Malaysian RA patients. Methods: We \n\n\n\nconducted a retrospective cohort study at Serdang and \n\n\n\nPutrajaya Hospital from August 2021 until November 2021. \n\n\n\n215 patients receiving bDMARDs and tDMARDs were \n\n\n\nselected randomly. Data collection included demographic \n\n\n\nand clinical features at four different times intervals. All data \n\n\n\nwere analysed by SPSS software using frequency and \n\n\n\nrepeated measure ANOVA tests. Results: A total of 66.5% \n\n\n\n(n=143) females and 33.5% (n=72) males with the mean age \n\n\n\nof 54.6 \u00b1 10.162 were enrolled. The pattern of DMARDs \n\n\n\nprescription shows that out of 215 patients, 83.3% (n=179) \n\n\n\nreceived bDMARDs, while 16.7% (n=36) were treated with \n\n\n\ntDMARDs. Efficacy was evaluated using disease activity \n\n\n\nscore of 28 joints (DAS28 ESR) at baseline and 3 different \n\n\n\ntimes intervals post therapy. We found that the mean DAS28 \n\n\n\nESR improved significantly across time points, F (1, 214) = \n\n\n\n4911.89, p < 0.001. The findings shows that the mean of \n\n\n\nDAS28 ESR statistically decreased from baseline (5.217 \u00b1 \n\n\n\n1.355) to 3 months (3.929 \u00b1 1.303; p < 0.001), 6 months \n\n\n\n(3.549 \u00b1 1.304; p < 0.001) and 12 months (3.189 \u00b1 1.076; p \n\n\n\n< 0.001). Conclusions: Findings from this observational \n\n\n\nstudy indicated a significant clinical response improvement \n\n\n\nafter initiation of bDMARDs and tDMARDs among RA \n\n\n\npatients. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 042 \n\n\n\n\n\n\n\nSolvent System Effect on The Viscosity and \n\n\n\nConductivity of Electrospinnable Polymer \n\n\n\nSolutions for Incorporation of Medicinal \n\n\n\nHerbal Extract  \n\n\n\n\n\n\n\nSiew Mei Tan, and Siok Yee Chan* \n\n\n\n \nSchool of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 \n\n\n\nMalaysia \n\n\n\n* sychan@usm.my \n\n\n\n\n\n\n\nBackground: The existence of an electrospun sheath layer \n\n\n\nacts as a promising protective layer and has the potential to \n\n\n\nmask the bitter taste of herbal extracts. Objective (s): The \n\n\n\naim of this research is to investigate the different solvent \n\n\n\nsystems used in affecting the viscosity and conductivity of \n\n\n\nthe electrospinnable polymer solutions, ultimately \n\n\n\ninfluencing the stability of the jet formation prior to fiber \n\n\n\ndeposition. Methods: The electrospinnable polymer \n\n\n\nsolutions were prepared using each solvent system of solely \n\n\n\nethanol and a combination of ethanol and dimethylacetamide \n\n\n\n(4:1) with Eudragit L100-55 and Eudragit L100 polymer \n\n\n\nblends in the ratio of 1:0, 1:1, 1:3, 1:5, and 0:1 respectively. \n\n\n\nThe viscosity and conductivity of all the aforementioned \n\n\n\npolymer solutions were measured. All the electrospinnable \n\n\n\npolymer solutions were electrospun with the core layer \n\n\n\nCarica papaya leaf extract in order to observe and capture the \n\n\n\nstability of jet formation during the electrospinning process \n\n\n\nusing a smartphone camera. Results: Eudragit polymers with \n\n\n\na solvent system comprising the combination of ethanol and \n\n\n\ndimethylacetamide (4:1) showed an increasing trend in both \n\n\n\nthe viscosity and conductivity of the spinnable solution, as \n\n\n\ncompared to those with ethanol solvent only. A more stable \n\n\n\njet was formed using the spinnable solution with a solvent \n\n\n\nsystem comprising of ethanol and dimethylacetamide. \n\n\n\nConclusions: The employed Eudragit sheath layer \n\n\n\nsuccessfully served as a carrier system for Carica papaya leaf \n\n\n\nextract. This study elucidates the solvent system effect on the \n\n\n\nviscosity and conductivity of the spinnable solutions for \n\n\n\nstable jet formation. \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:nasreh@student.usm.my\n\n\nmailto:sychan@usm.my\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 140-181 \n\n\n\n\n\n\n\nResearch abstracts of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022 \n\n\n\nDOI:  10.52494/YOXJ1358 \n\n\n\n\n\n\n\n172 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 043 \n\n\n\n\n\n\n\nOptimization of Polyhydroxyalkanoate \n\n\n\nMicroparticles for A High Encapsulation of \n\n\n\nRifapentine and Verapamil Using a Water-\n\n\n\nIn-Oil-In-Water Double Emulsion \n\n\n\nTechnique \n \n\n\n\nPriyanka Prakash1, K Sudesh Kumar2, and \n\n\n\nThaigarajan Parumasivam1* \n \n1School of Pharmaceutical Sciences, Universiti Sains Malaysia, Minden \n\n\n\n11800, Penang, Malaysia \n2School of Biological Sciences, Universiti Sains Malaysia, Minden 11800, \n\n\n\nPenang, Malaysia \n\n\n\n*thaigarp@usm.my \n\n\n\n\n\n\n\nBackground: The conventional WHO-consolidated \n\n\n\ntreatment for tuberculosis involves the consumption of four \n\n\n\nantibiotics for a lengthy six months. This often results in \n\n\n\nskipped treatments, which gives rise to drug-resistant \n\n\n\nMycobacterium tuberculosis. Thus, inhaled therapy using \n\n\n\nbiocompatible polyhydroxyalkanoates is a feasible option. \n\n\n\nObjective: To optimize poly(3-hydroxybutyrate-co-4-\n\n\n\nhydroxybutyrate-co-5-hydroxyvalerate) [P(3HB-co-4HB-\n\n\n\nco-5HV] microparticles of size 1 to 3 microns for a high \n\n\n\nencapsulation of anti-tubercular drugs rifapentine and \n\n\n\nverapamil, in combination, using a water-in-oil-in-water \n\n\n\ndouble emulsion technique. Methods: P(3HB-co-4HB-co-\n\n\n\n5HV) microparticles were formulated using a water-in-oil-in-\n\n\n\nwater (w1/o/w2) double emulsion method, where the \n\n\n\nparameters tested were the surfactant (w2-phase) types (i.e., \n\n\n\npolyvinyl alcohol, polyethylene glycol, Tween 80), \n\n\n\nsurfactant concentrations (i.e., 1%, 2%, 3%, 5%), surfactant \n\n\n\nvolumes (i.e., 10ml, 15ml, 20ml), internal water phase (w1) \n\n\n\nand oil phase (o) volumes (i.e., 0.5ml and 1ml, 1ml and \n\n\n\n1.5ml), P(3HB-co-4HB-co-5HV) mass (i.e., 20mg, 40mg, \n\n\n\n60mg, 80mg), and combined drug mass (i.e., 40mg, 80mg, \n\n\n\n120mg, 200mg, 320mg, 400mg). The encapsulation \n\n\n\nefficiency was determined using high-performance liquid \n\n\n\nchromatography. Results: The highest encapsulation \n\n\n\nefficiencies were obtained for rifapentine and verapamil in \n\n\n\npolyvinyl alcohol, with a concentration of 2% (77.15\u00b10.22% \n\n\n\nand 41.97\u00b13.10%, respectively), and a volume of 20ml \n\n\n\n(85.14\u00b12.25% and 56.33\u00b12.62%, respectively), with a 0.5ml \n\n\n\nw1-phase and 1.0ml o-phase (94.29\u00b10.57% and \n\n\n\n69.15\u00b11.52%. respectively), alongside a P(3HB-co-4HB-co-\n\n\n\n5HV) mass of 60mg (93.31\u00b11.18% and 71.13\u00b12.09%, \n\n\n\nrespectively), and a combined drug mass of 400mg (95\u00b10.51% \n\n\n\nand 74.07\u00b13.09%, respectively). Conclusion: The optimal \n\n\n\nconditions for a high encapsulation of verapamil and \n\n\n\nrifapentine in P(3HB-co-4HB-co-5HV) microparticles are \n\n\n\n200mg of verapamil in 0.5ml w1-phase, 200mg of rifapentine \n\n\n\nand 60mg of P(3HB-co-4HB-co-5HV) in 1ml o-phase, and \n\n\n\n20ml of 2% polyvinyl alcohol as the w2-phase. \n\n\n\nAbstract 044 \n\n\n\n\n\n\n\nAirway Smooth Muscles Relaxant and \n\n\n\nMast Cells Stabilizing Activity of Some \n\n\n\nMedicinal Plants Used in Managing \n\n\n\nAsthma in North-western Nigeria  \n\n\n\n\n\n\n\nIbrahim Mu\u2019azzamu Aliyu1*, Mohammed \n\n\n\nGarba Magaji1, Jamilu Ya\u2019u1, Nuhu \n\n\n\nMohammed Danjuma1, Sagir Mustapha1,2, \n\n\n\nMustapha Mohammed3,4, Zakiyyah Yakubu \n\n\n\nYahaya Ibrahim5  \n \n1Department of Pharmacology and Therapeutics, Ahmadu Bello University, \nZaria, Kaduna, Nigeria \n2Department of Pharmacology, School of Medical Sciences, Universiti Sains \nMalaysia, Health Campus, Kota Bharu, Kelantan, Malaysia \n3Department of Clinical Pharmacy and Pharmacy Practice, Ahmadu Bello \n\n\n\nUniversity, Zaria, Kaduna, Nigeria \n4 School of Pharmaceutical Sciences, Universiti Sains Malaysia, Gelugor, \n\n\n\nPulau Pinang, Malaysia \n5 Department of Pharmacognosy and Ethnomedicine, Usmanu Danfodiyo \nUniversity, Sokoto, Nigeria \n\n\n\n* ialiyu71@gmail.com  \n\n\n\n\n\n\n\nBackground: Cassia occidentalis whole plant (COWP), \n\n\n\nJatropha curcas leaves (JCL), Ximenia americana Santalales \n\n\n\nleaves (XAL), and Eucalyptus citriodora leaves (ECL) have \n\n\n\nbeen revealed to be widely used by locals of North-western \n\n\n\nNigeria for the management of asthma. Objective: This study \n\n\n\nwas aimed at providing a pharmacological rationale for the \n\n\n\nethnomedical use of these plants in the management of \n\n\n\nasthma. Methods: The four plants (COWP, JCL, XAL and \n\n\n\nECL) were extracted with 70% ethanol using cold maceration \n\n\n\nextraction for 72 hours and the resulting extracts were \n\n\n\nscreened using invitro models for their effects on the \n\n\n\nspontaneous contraction of isolated rabbit ileum strip; \n\n\n\nHistamine-induced pre-contracted isolated guinea pig ileum \n\n\n\nstrip; Histamine-induced pre-contracted isolated guinea pig \n\n\n\ntrachea chain; and on ovalbumin-induced peritoneal mast cell \n\n\n\ndegranulation in Wistar rats. Results: The ethanol extracts of \n\n\n\nCOWP, ECL, JCL, and XAL at 100 mg/mL remarkably \n\n\n\nrelaxed spontaneous contractions of isolated rabbit ileum. \n\n\n\nGreatest relaxation was obtained with XAL. The four plants\u2019 \n\n\n\nextracts significantly (p<0.05) inhibited histamine-induced \n\n\n\ncontractions of isolated guinea pig ileum. In addition, the \n\n\n\nextracts significantly inhibited (p<0.05) histamine-induced \n\n\n\ncontraction of isolated guinea pig trachea. The ethanol \n\n\n\nextracts of COWP and JCL exhibited mast cell stabilizing \n\n\n\neffect in ovalbumin-induced rat peritoneal mast cell \n\n\n\ndegranulation. However, ECL and XAL did not protect \n\n\n\nagainst ovalbumin-induced rat peritoneal mast cell \n\n\n\ndegranulation. Conclusions: The four plant extracts (COWP, \n\n\n\nECL, JCL, and XAL) possess broncho-relaxant activity, with \n\n\n\nonly COWP and JCL exhibiting mast cell stabilizing activity \n\n\n\nin laboratory animals. The findings support the claim for the \n\n\n\n\nmailto:*thaigarp@usm.my\n\n\nmailto:ialiyu71@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 140-181 \n\n\n\n\n\n\n\nResearch abstracts of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022 \n\n\n\nDOI:  10.52494/YOXJ1358 \n\n\n\n\n\n\n\n173 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\ntraditional use of the plants in inflammatory and allergic \n\n\n\nconditions including asthma. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 045 \n\n\n\n\n\n\n\nProtective Effect of Andrographolide On \u0392-\n\n\n\nAmyloid Induced Toxicity in Transgenic \n\n\n\nCaenorhabditis Elegans \n \n\n\n\nBoon-Keat Khor1, Wai-Lam Liew2, Chong-\n\n\n\nLew Lee2, Kit-Lam Chan2, Nurzalina A.K. \n\n\n\nKhan3, Kah-Hay Yuen3, Vikneswaran \n\n\n\nMurugaiyah1,4* \n \n1Discipline of Pharmacology, School of Pharmaceutical Sciences, \n2Discipline of Pharmaceutical Chemistry, School of Pharmaceutical \nSciences, \n3Discipline of Pharmaceutical Technology, School of Pharmaceutical \n\n\n\nSciences, \n4Centre for Drug Research, Universiti Sains Malaysia, 11800 Penang, \n\n\n\nMalaysia \n\n\n\n* vicky@usm.com  \n\n\n\n\n\n\n\nBackground: Alzheimer\u2019s disease is characterised by \n\n\n\nneuropathological hallmarks such as deposition of \u03b2-amyloid \n\n\n\nand neurofibrillary tangles. These misfolded by-products can \n\n\n\ntrigger toxicity to the neurons, leading to neuronal death and \n\n\n\nmemory loss. Objective: This study aims is to investigate the \n\n\n\nprotective effect of andrographolide, the major bioactive \n\n\n\nditerpene of Andrographis paniculata in the \u03b2-amyloid1-42-\n\n\n\ninduced phenotype and behaviour toxicity in transgenic C. \n\n\n\nelegans. Method: Transgenic C. elegans GMC101and \n\n\n\nCL2355, and their control strain CL2122 were used in the \n\n\n\nstudy. C. elegans GMC101, which expressed amyloid in \n\n\n\nmuscle was treated with andrographolide (0.1,1,10 \u03bcM) from \n\n\n\nthe egg stage and paralysis was scored 24 hr after upshifting \n\n\n\nthe cultured temperature to 25 \u00b0C. The detection of \u03b2-amyloid \n\n\n\nand reactive oxygen species was done using Thioflavin-T and \n\n\n\nDCFDA fluorescent dye. C. elegans CL2355 which \n\n\n\nexpressed amyloid in the pan-neuronal was treated with \n\n\n\nandrographolide (10 \u03bcM) from the egg stage and collected \n\n\n\nfor behaviour study at 36 hr after upshifting the temperature \n\n\n\nto 25 \u00b0C. 1-butanol was used as the attractant. Result: The \n\n\n\npresent study found that treatment with andrographolide (10 \n\n\n\n\u03bcM) significantly delayed the paralysis induced by \u03b2-amyloid \n\n\n\nin transgenic C. elegans GMC101. A lower amount of \u03b2-\n\n\n\namyloid and reactive oxygen species was detected in \n\n\n\ntransgenic C. elegans GMC101 treated with andrographolide. \n\n\n\nIn the behaviour study of transgenic C. elegans CL2355, the \n\n\n\nabnormalities induced by \u03b2-amyloid were ameliorated by \n\n\n\nandrographolide. Conclusion: These findings indicate that \n\n\n\nandrographolide is a potential lead for further development \n\n\n\nas a protective agent against \u03b2-amyloid1-42-induced \n\n\n\npathology in humans. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 046 \n\n\n\n\n\n\n\nIn-Silico Study of 2\u2010Phenoxy\u2010N\u2010(3,4,5\u2010\n\n\n\nTrimethoxyphenyl) Acetamide Against \n\n\n\nMutant p53 in Breast Cancer Drug \n\n\n\nDiscovery \n \n\n\n\nBakti Wahyu Saputra,  Jeffy Julianus* \n \n\n\n\nFaculty of Pharmacy, Universitas Sanata Dharma, Depok, Sleman 55282, \nYogyakarta, Indonesia \n\n\n\n* jeffry@usd.ac.id  \n\n\n\n\n\n\n\nBackground: Cancer is the major cause of death in the world \n\n\n\nwith approximately 10 million of death in 2020. Particularly, \n\n\n\nbreast cancer is the second leading cause of death in women \n\n\n\nafter lung cancer. p53 is a protein expressed by breast cancer \n\n\n\ncell, important for cancer cell apoptosis by regulating the \n\n\n\nexpression of ER\u03b1, an oestrogen receptor that signalling \n\n\n\nproliferation of breast cancer. Unfortunately, the p53 has \n\n\n\nbeen mutated leading to the uncontrol of ER\u03b1 expression \n\n\n\nalong with an inefficient effect of tamoxifen as ER\u03b1 \n\n\n\nantagonist. Objective: This study is aimed to investigate the \n\n\n\npotential effect of 2\u2010phenoxy\u2010N\u2010(3,4,5\u2010trimethoxyphenyl) \n\n\n\nacetamide as inducer of mutant p53 (PDB 2BIM) using in \n\n\n\nsilico study. Method: The in-silico study was carried out \n\n\n\nusing molecular docking method with AutoDock4 software. \n\n\n\nLamarckian genetic was used as the searching algorithm to \n\n\n\ncalculate the free energy of binding. The binding poses and \n\n\n\nchemical interactions were visualized using Biovia \n\n\n\nDiscovery Studio 2021. Results: The result shows free \n\n\n\nenergy of binding between ligand and protein is -7.24 \n\n\n\nkcal/mol demonstrating chemical interactions such as \n\n\n\nhydrogen bond with Ser116 and van der Waals interactions \n\n\n\nwith Leu114, Gly117, and Thr123. Conclusion: The ligand \n\n\n\nis potential to be mutant p53 inducer.  \n\n\n\n\n\n\n\n\n\n\n\nAbstract 047 \n\n\n\n\n\n\n\nPotential of N-(naphthalene-1-yl)-2-\n\n\n\nphenoxyacetamide as Mutant p53 \n\n\n\nReactivator: In silico Studies \n \n\n\n\nBryan Afela Wahono1, Jeffry Julianus1* \n \n\n\n\n1 Faculty of Pharmacy, Universitas Sanata Dharma, Campus 3, Paingan, \n\n\n\nMaguwoharjo, Depok, Sleman 55282, Yogyakarta, Indonesia \n* jeffry@usd.ac.id  \n\n\n\n\n\n\n\nBackground: Breast cancer is one of the main causes of \n\n\n\ndeath in women worldwide which luminal type A breast \n\n\n\ncancer is the most common case. Most of these cases have \n\n\n\nmutation in the p53 gene that inhibits the process of apoptosis \n\n\n\n\nmailto:vicky@usm.com\n\n\nmailto:jeffry@usd.ac.id\n\n\nmailto:jeffry@usd.ac.id\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 140-181 \n\n\n\n\n\n\n\nResearch abstracts of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022 \n\n\n\nDOI:  10.52494/YOXJ1358 \n\n\n\n\n\n\n\n174 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nin cancer cells. Objective: This study aims to evaluate \n\n\n\nbinding interaction between N-(naphthalene-1-yl)-2-\n\n\n\nphenoxyacetamide as the ligand with mutant p53 in the effort \n\n\n\nto find novel anti breast cancer. Method: The study was \n\n\n\ncarried out by docking mutant p53 (PDB: 2BIM) with ligand \n\n\n\nusing AutoDock 4.2. with Lamarckian Genetic at the \n\n\n\nsearching algorithm to calculate the binding energy. Results: \n\n\n\nThe type of chemical interaction is visualized using Biovia \n\n\n\nDiscovery Studio 2021. Results: they demonstrates free \n\n\n\nenergy of binding -7.52 Kcal/mol. This energy is contributed \n\n\n\nby conventional hydrogen bond with THR123, van der Waals \n\n\n\nwith LEU114, THR140, CYS141, pi-sigma with CYS124, \n\n\n\npi-lone pair with THR123, and pi-alkyl with ALA119, \n\n\n\nVAL122, and PRO142. Conclusion: The estimated \n\n\n\ninhibition constant (Ki) is 3.032 \u03bcM leading to a conclusion \n\n\n\nthat the ligand is potentially active to reactivate mutant p53, \n\n\n\nthere by it is a good lead compound for breast cancer drug. \n\n\n\n\n\n\n\nAbstract 048 \n\n\n\n\n\n\n\nEffects of Fenugreek Seeds on Some Blood \n\n\n\nParameters in Type 2 Diabetics Receiving \n\n\n\nMetformin and Glyburide \n \n\n\n\nRaghda Lahdo1*, Rafah Manafikhi2 \n \n1Department of biochemistry and microbiology, Faculty of Pharmacy, \n\n\n\nUniversity of Aleppo, Al-Wataniya Private University, Syria \n2Department of biochemistry and microbiology, Faculty of Pharmacy, \n\n\n\nUniversity of Aleppo, Syria \n\n\n\n*raghdals@yahoo.fr  \n\n\n\n\n\n\n\nBackground: Type 2 diabetes mellitus is a metabolic \n\n\n\ndisorder characterized by failure of glucose homeostasis with \n\n\n\ndisturbance of carbohydrate and fat metabolism caused by \n\n\n\nInsulin Resistance. To overcome this disturbance, treatment \n\n\n\nwith antidiabetic agents have been developed, and the interest \n\n\n\nin natural remedies have been increased. Recently the study \n\n\n\nof drug - food interactions in modifying treatment response \n\n\n\nis extensively investigated. Objectives: To evaluate the \n\n\n\neffects of natural substances such as Fenugreek on some \n\n\n\nblood parameters in patients with Type 2 Diabetes who were \n\n\n\ntreated with Metformin and Glyburide. Methods: The study \n\n\n\nlasted for 8 weeks, the patients were divided into 2 groups: \n\n\n\ngroup F (n=53) was given Fenugreek Seeds in the form of \n\n\n\nsoaked in boiled water at a dose of 10 g/day in combination \n\n\n\nwith their treatment, group C (control n=45) received their \n\n\n\ntreatment alone. Fasting Blood Sugar (FBS), Glycated \n\n\n\nHemoglobin (HbA1c), Triglyceride (TG), Total Cholesterol \n\n\n\n(TC), High-Density Lipoprotein Cholesterol (HDL-C), Low-\n\n\n\nDensity Lipoprotein Cholesterol (LDL-C) and Atherogenic \n\n\n\nIndex of Plasma (AIP) were measured at the beginning and \n\n\n\nat the end of the study. Results: Results showed a significant \n\n\n\ndecrease (p < 0.05) in HbA1c, TG and AIP levels in group F \n\n\n\nat week 8 in comparison with values at week 0 and in \n\n\n\ncomparison to group C. There was an insignificant decrease \n\n\n\n(p > 0.05) in FBS, TC and LDL-C levels. While no change in \n\n\n\nHDL-C levels was observed. The effect of Fenugreek could \n\n\n\nbe contributed to Galactomannan compound, which acts as \n\n\n\ninhibitor of intestinal Lipase, or to Saponins which inhibit the \n\n\n\naction of Bile Acids. Conclusions: The combination of \n\n\n\nFenugreek with antidiabetic agents (Metformin and \n\n\n\nGlyburide) had showed hypolipidemic effects, so it could be \n\n\n\na good addition in the management of patients with Type 2 \n\n\n\nDiabetes. \n\n\n\n\n\n\n\nAbstract 049 \n\n\n\n\n\n\n\nInvestigating The Relationship Between \n\n\n\nThyroid Disorders and Breast Cancer \n \n\n\n\nAya Zrek1, Anawar Shamout2, Raghda \n\n\n\nLahdo3* \n \n1Department of biochemistry and microbiology, Faculty of Pharmacy, \nUniversity of Aleppo, Syria \n2Department of Oncology, Faculty of Medicine/ University of Aleppo, Syria \n3Department of biochemistry and microbiology, Faculty of Pharmacy, \nUniversity of Aleppo, Al-Wataniya Private University, Syria \n\n\n\n*raghdals@yahoo.fr  \n\n\n\n\n\n\n\nBackground: Breast cancer is one of the most common \n\n\n\ninvasive cancers in women in the world, there are several \n\n\n\nfactors that may increase the chances of developing breast \n\n\n\ncancer. Thyroid disorders are also one of the most common \n\n\n\ndiseases. Due to the high prevalence and incidence of breast \n\n\n\ncancer and thyroid disorders, it was important to study the \n\n\n\nrelationship between these two diseases. Objectives: To \n\n\n\ninvestigate the relationship between Thyroid gland disorders \n\n\n\nand breast cancer in Aleppo Governorate, in order to \n\n\n\ndetermine if thyroid disorder is a predisposing risk factor for \n\n\n\nbreast cancer. Methods: Evaluation of thyroid gland function \n\n\n\nin patients with breast cancer and age-matched control \n\n\n\nwomen without breast or thyroid disease (35-75 year). Breast \n\n\n\ncancer patients (n=68), and healthy controls (n=25). Thyroid \n\n\n\nhormones (FT4, TSH) assays were determined. Results: This \n\n\n\nstudy showed that the mean values of TSH level in women \n\n\n\nwith breast cancer (3.7 \u00b13.56 \u03bclU/ml) was higher \n\n\n\nsignificantly than healthy (1.7 \u00b10.9 \u03bclU/ml), and there was \n\n\n\nnon-significant increase in mean values of FT4 level between \n\n\n\nwomen with breast cancer (1.17 \u00b10.20 ng/dl) and healthy (1.1 \n\n\n\n\u00b1 0.22 ng/dl). These Values were compatible with \n\n\n\nSubclinical Hypothyroidism. The percentage of those who \n\n\n\nhad subclinical hypothyroidism and were diagnosed with \n\n\n\nbreast cancer was (95.65%), which was higher significantly \n\n\n\nthan those who had subclinical hypothyroidism from healthy \n\n\n\ncontrols (4.35%). Conclusion: The results showed a \n\n\n\nsignificant relationship between breast cancer and \n\n\n\nSubclinical hypothyroidism. Therefore, Thyroid function \n\n\n\ndisorder could be considered as a risk factor for breast cancer, \n\n\n\nand early investigation of thyroid functions may contribute to \n\n\n\nreducing the progression and development of breast cancer. \n\n\n\n\nmailto:*raghdals@yahoo.fr\n\n\nmailto:*raghdals@yahoo.fr\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 140-181 \n\n\n\n\n\n\n\nResearch abstracts of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022 \n\n\n\nDOI:  10.52494/YOXJ1358 \n\n\n\n\n\n\n\n175 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 050 \n \n\n\n\nKnowledge, Attitude, And Practice \n\n\n\nAssessment Of Lung Cancer Risk Factors \n\n\n\nAmong Health Practitioners In Erbil, Iraq \n\n\n\n\n\n\n\nIbrahim M Abdulbaqi1,2*, Habibah A. \n\n\n\nWahab2*, Ibrahim Ahmed Moyasser1\u2020, \n\n\n\nShaheen Nozad Yousif1\u2020 \n\n\n\n \n1PractSol Research Group, College of Pharmacy, Al-Kitab University, Altun \n\n\n\nkupri, Kirkuk 36001, Iraq. \n2School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang \n\n\n\n11800, Malaysia. \n\n\n\n*ibrahim.m.abdulbaqi@uoalkitab.edu.iq;habibahw@usm.my  \n\u2020 Co-first authors \n\n\n\n\n\n\n\nBackground: Globally, lung cancer (LC) is the most \n\n\n\nprevalent cause of major cancer incidence and death in men. \n\n\n\nNationally, LC is at a 23.3% incidence as per the Iraq-Global \n\n\n\nCancer Observatory report in 2020. The mortality of LC is \n\n\n\nhigher in low- and middle-income countries compared to \n\n\n\ndeveloped high-income countries due to screening and early \n\n\n\ndetection. Lung cancer screening (LCS) with low-dose \n\n\n\ncomputed tomography (LDCT) is effective at reducing lung \n\n\n\ncancer mortality Objectives: This study assesses primary \n\n\n\ncare providers\u2019 (PCP) knowledge, attitudes, and practice \n\n\n\nrelated to LCS and the recent US Preventive Services Task \n\n\n\nForce guidelines in the public hospitals of Erbil, Iraq. \n\n\n\nMethods: Either hand-delivered self-filling or an online \n\n\n\nadopted questionnaire was used, which included \n\n\n\ndichotomous and five-point Likert-scale questions about \n\n\n\nproviders\u2019 clinical practice, knowledge (20 items), attitudes \n\n\n\n(5 items), and beliefs (4 items). The questionnaire was \n\n\n\nprovided in three languages: English, Kurdish, and Arabic. \n\n\n\nResults: Most of the participants (n = 150) were males \n\n\n\n(60.7%), with bachelor\u2019s degrees (62%), and a much lower \n\n\n\npercentage had higher education degrees (20%), among \n\n\n\nwhich (31.3%) were physicians, (23.3%) pharmacists, \n\n\n\nresidents (15.3%), and (11.3%) nurses. (47.3%) stated that \n\n\n\ntheir academic curriculum did not cover lung cancer in \n\n\n\ntraining/workshop/research mode. Interestingly, (71%) and \n\n\n\n(49%) preferred to receive treatment/screening in the private \n\n\n\nsector for LC, respectively. The majority had no clear \n\n\n\nknowledge and attitude toward the presence of \u201cguidelines\u201d \n\n\n\nfor screening referral and post-screening, while x-ray chest \n\n\n\nscreening was the dominating screening preference practice. \n\n\n\nConclusions: In terms of LC screening recommendations \n\n\n\nand post-screening guidelines, PCP are in need of sufficient \n\n\n\ntraining to make sharp decisions. Releasing national \n\n\n\nguidelines based on the USPSTF guidelines is a step forward. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 051 \n\n\n\n\n\n\n\nPrevalence of Tuberculosis Infection and \n\n\n\nTreatment Outcome in Babylon Province of \n\n\n\nIraq; A Retrospective Study \n  \n\n\n\nTaif Said Jasim1*, Amer Hayat Khan2, and \n\n\n\nNada Khazal K. Hindi3 \n  \n1 the Discipline of Microbiology, Universiti Sains Malaysia \n2 the Discipline of Clinical Pharmacy, Universiti Sains Malaysia \n\n\n\n3 the Discipline of Microbiology, Nursing of college\\University of Babylon \n\n\n\n* taifsaad747@gmail.com  \n\n\n\n\n\n\n\nBackground: About one-third of the world\u2019s population is \n\n\n\ninfected by tuberculosis. It mainly affects the lungs \n\n\n\n(pulmonary tuberculosis) and also can affect other sites of the \n\n\n\nbody (Extra-pulmonary tuberculosis). Objective: The main \n\n\n\npurpose of this study is to experience the prevalence of \n\n\n\ntuberculosis and the treatment outcome rate in Babylon of \n\n\n\nIraq. Methods: Collection of data from medical records of \n\n\n\ntuberculosis patients retrospectively was conducted at the \n\n\n\nhealth centre from January 2016 to March 2021 in the \n\n\n\nBabylon province of Iraq. This study focused on the \n\n\n\ncharacteristics of TB patients; age, gender, type of \n\n\n\nTuberculosis, and treatment outcome. Data analysis with \n\n\n\nSPSS version 26 by use (Frequencies and percentages Mean \n\n\n\nand SD, Pearson correlation, and Independent Sample t-test). \n\n\n\nResults: Total of tuberculosis patients (N= 1774) that \n\n\n\nregistered at medical records of a health centre in Babylon. \n\n\n\nWe found these results; female patients (n=948; 53.4%), as \n\n\n\ncompared with those who are male patients (n= 826; 46.6%). \n\n\n\nThe age group between 61 years old and older was recorded \n\n\n\nwith the highest percentage (n=359; 20.2%) and the less \n\n\n\npercentage of those who are <10 years old (n=122; 6.9%). \n\n\n\nSite of infection, pulmonary tuberculosis (n= 992; 56.0%) \n\n\n\nand extra-pulmonary tuberculosis (n= 782; 44.0%). \n\n\n\nTreatment outcome are complete (63.7%), cure (24.1%), \n\n\n\ndeath (3.1%), default (0.5%), fail (0.3%), transfer (0.1%) and \n\n\n\nother (8.1%). Which successful treatment percentage \n\n\n\n(87.8%), while unsuccessful treatment (12.1%). Conclusions: \n\n\n\nIn this study, we found that who is females infected with \n\n\n\ntuberculosis more than males. In addition, we found patients \n\n\n\ninfected with Tuberculosis who are 61 years old have the \n\n\n\nhighest percentage (n=359; 20.2%). While as for treatment \n\n\n\noutcomes, the successful treatment percentage (87.8%) and \n\n\n\nthe unsuccessful treatment percentage (12.1%) in Babylon \n\n\n\nprovince, Iraq. \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:*ibrahim.m.abdulbaqi@uoalkitab.edu.iq;habibahw@usm.my\n\n\nmailto:taifsaad747@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 140-181 \n\n\n\n\n\n\n\nResearch abstracts of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022 \n\n\n\nDOI:  10.52494/YOXJ1358 \n\n\n\n\n\n\n\n176 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 052 \n\n\n\n\n\n\n\nAdverse Drug Reactions in Hospitalised \n\n\n\nChildren with Chronic Kidney Disease in \n\n\n\nA Paediatric Tertiary Care Hospital of \n\n\n\nPakistan  \n\n\n\n\n\n\n\nAsma Fareed Khan1,2*, Amer Hayat Khan1, \n\n\n\nShahida Perveen2, Muhammad Tahir1,3 \n \n1Universiti Sains Malaysia, Pulau Pinang, Malaysia. \n2Children\u2019s Hospital & University of Child Health Sciences, Lahore, \nPakistan. \n3Superior University, Lahore, Pakistan. \n\n\n\n*asma.fareed@student.usm.my  \n\n\n\n\n\n\n\nBackground: Chronic kidney disease (CKD) in children is \n\n\n\nthe major cause of morbidity and mortality. Treatment of \n\n\n\npatients with CKD is specific and complex, therefore are at \n\n\n\nincreased risk of developing adverse drug reactions (ADRs). \n\n\n\nObjectives: To determine the incidence, causality, severity, \n\n\n\nand preventability of the ADRs in CKD paediatric patients. \n\n\n\nMethods: A Prospective observational study was conducted \n\n\n\non 50 paediatric CKD patients with stages 3\u20135 admitted to \n\n\n\nthe Nephrology ward of a tertiary care children\u2019s hospital for \n\n\n\ntwo months. Adverse drug reactions were recognized from \n\n\n\npatient reports, medical records, and interviewing parents \n\n\n\nand confirmed by the duty physician and nurse in charge. The \n\n\n\ncausality, preventability & severity were assessed using \n\n\n\nNaranjo Scale, Schumock and Thornton scale, and Hartwig \n\n\n\nand Seigel Scale respectively. Results: Out of 50 patients, \n\n\n\nADRs were observed in 11 patients, giving an incidence of \n\n\n\n22%. Out of 11, 8 were females (72.72%) while 4 were males \n\n\n\n(27.27%). The mean age was 10.5\u00b12.4 years. Patients have \n\n\n\nbeen prescribed 8 to 12 drugs. Female patients experienced \n\n\n\nthe majority of ADRs. Most common ADRs were due to \n\n\n\nantibacterial (72.72%). Most of the ADRs were probable \n\n\n\n(45.45%), followed by possible (27.27%) and definite \n\n\n\n(27.27%) ADRs. All ADRs were preventable. Most of the \n\n\n\nADRs (72.72%) were in the moderate category. Conclusion: \n\n\n\nThe study concluded that the frequency of ADRs increase \n\n\n\nwith polypharmacy. There is a need for active ADR reporting \n\n\n\nto improve drug safety in CKD paediatric patients. \n\n\n\nAbstract 053 \n\n\n\n\n\n\n\nDevelopment and Validation of RP-HPLC \n\n\n\nMethod for the Detection and \n\n\n\nQuantification of Tamoxifen in Pure, and \n\n\n\nLipid-Based Formulation  \n\n\n\n\n\n\n\nReem Abou Assi1,2, Chan Siok Yee1* \n \n1Thoughts Formulation Lab., School of Pharmaceutical Sciences, Universiti \n\n\n\nSains Malaysia, 11800 Malaysia \n2EDEN Research Group, Discipline of Pharmaceutical Technology, College \n\n\n\nof Pharmacy, Al-Kitab University, Altun kupri, Kirkuk, 36001, Iraq. \n\n\n\n* sychan@usm.my   \n \n\n\n\nBackground: The available HPLC-UV methods for the \n\n\n\ntamoxifen evaluation are expensive, complicated, time \n\n\n\nconsuming and their mobile phase is not compatible with \n\n\n\nlipid-based nanoformulations particularly in terms of \n\n\n\nparticipate formation. Objectives: developing and \n\n\n\nvalidating a simple, rapid, specific, and reproducible \n\n\n\nreverse phase HPLC\u2013UV method for quantifying \n\n\n\ntamoxifen in pure and lipid-based formulations for drug \n\n\n\nqualification, release study, and stability studies. Methods: \n\n\n\nThe separation was done using a reversed-phase Agilent\u00ae \n\n\n\nC18 (5\u03bcm x 4.6 mm x 150 mm) column, ammonium \n\n\n\nacetate buffer or solution (pH= 6.8 and 4.8 respectively) \n\n\n\nwith acetonitrile as mobile phase at different ratios (v/v%). \n\n\n\nThe system was operated isocratically at different flow \n\n\n\nrates and column temperatures. The sample injection \n\n\n\nvolume was 10 \u03bcl, with a 10 min/sample running time. \n\n\n\nResults: The final method\u2019s optimized conditions were \n\n\n\nammonium acetate buffer (pH = 4.8) and acetonitrile at \n\n\n\n30:70 (v/v%) with a flow rate of 0.7 ml/min at 45\u00b0C oven \n\n\n\ntemperature under 236 nm wavelength. Ammonium \n\n\n\nacetate buffer offers higher selectivity, while acetonitrile \n\n\n\nwas considered over methanol due to its lower noise under \n\n\n\nsuch UV detection wavelength. The linearity was observed \n\n\n\nover the concentration range of 0.2 - 5 \u03bcg/mL (R2 > \n\n\n\n0.9999). The limit of detection (LOD) and limit of \n\n\n\nquantification (LOQ) were 0.027 \u03bcg/ml and 0.082 \u03bcg/ml, \n\n\n\nrespectively. The developed method was confirmed to be \n\n\n\naccurate, and precise. Moreover, parameters of theoretical \n\n\n\nplates (N > 1500), tailing factor (T \u2264 1.5), and resolution \n\n\n\n(Rs > 3) were as per United States Pharmacopeia (USP). \n\n\n\nConclusions: A reverse phase HPLC\u2013UV method was \n\n\n\nsuccessfully developed for the quantification of tamoxifen \n\n\n\nin pure and in lipid-based formulation under various in-\n\n\n\nvitro and ex-vivo assays. \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:*asma.fareed@student.usm.my\n\n\nmailto:sychan@usm.my\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 140-181 \n\n\n\n\n\n\n\nResearch abstracts of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022 \n\n\n\nDOI:  10.52494/YOXJ1358 \n\n\n\n\n\n\n\n177 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 054 \n \n\n\n\nBreast Cancer Risk Factors Among Public \n\n\n\nand Health Practitioners in Kirkuk, Iraq: \n\n\n\nThe Evaluation of Knowledge, Attitude, \n\n\n\nAnd Practice \n \n\n\n\nIbrahim M Abdulbaqi1,2*, Habibah A. \n\n\n\nWahab2* Duha Arshad Shaker1\u2020, Baraah \n\n\n\nOmar Ayoub1\u2020 \n \n1PractSol Research Group, College of Pharmacy, Al-Kitab University, Altun \nkupri, Kirkuk 36001, Iraq. \n2School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang \n\n\n\n11800, Malaysia. \n*ibrahim.m.abdulbaqi@uoalkitab.edu.iq ; habibahw@usm.my   \n\n\n\n\u2020 Co-first authors \n\n\n\n\n\n\n\nBackground: Breast cancer (BC) is one of the most common \n\n\n\ncancers that cause death among women, ranking second \n\n\n\nworldwide and first in Iraq according to Word Health \n\n\n\nOrganization. It has different classes of hormonal or non-\n\n\n\nhormonal types that affects disease development by various \n\n\n\nmechanisms, which if not well detected at early-stage results \n\n\n\nin high rates of mortality. Objectives To measure knowledge \n\n\n\nand attitude about BC risk factors in Iraqi women, as well as \n\n\n\nthe importance of periodic examination, and early detection \n\n\n\nin treating BC among healthcare provider at public hospital \n\n\n\nin Kirkuk. Methods: Either hand-delivered self-filling or \n\n\n\nonline questionnaire was used which included dichotomous \n\n\n\nand five-point Likert-scale questions about public knowledge \n\n\n\n(30 items), attitudes (10 items), and healthcare providers\u2019 \n\n\n\nclinical practices (24 items), the questionnaire was provided \n\n\n\nin three languages English, Kurdish, and Arabic. Results: \n\n\n\nTotal sample size was n = 300, (45.33%) were medical \n\n\n\nstudents. Interestingly, (6.66%) of the participants had a BC \n\n\n\ncase, and (47.66%) know someone who has BC. (48.22%) of \n\n\n\nthe participant had their first period at the age of 11 \u2013 13 old, \n\n\n\nreflecting a high-risk factor among the population, while \n\n\n\n(43.56 %) had a positive attitude considering that breast \n\n\n\ncancer examination should start since puberty, and in a \n\n\n\nmonthly manner (51.78). Despite the fact that (27.11%) state \n\n\n\nthat self-examination is done via hand, yet majority were not \n\n\n\nsure how to conduct such examination reflecting knowledge \n\n\n\ngap. Interestingly, among health practitioners (61.33%) \n\n\n\ndeclare that they will refer to physician upon feeling any \n\n\n\nabnormality in breast tissue, yet, when asked to choose from \n\n\n\nthe clinical breast examination standard list, answers were \n\n\n\nnot precise. Conclusions: Women and health practitioner in \n\n\n\nIraq below the age 30 are in need of awareness campaign to \n\n\n\nunderstand their level of risk factors, and significantly impact \n\n\n\ntheir lives by early detections.   \n\n\n\nAbstract 055 \n \n\n\n\nA Simple (Rp-HPLC) Method for The \n\n\n\nDetection and Quantification of Docetaxel \n\n\n\nin Bulk and Liquid Crystals Nanocarriers \n\n\n\nand its Validation \n \n\n\n\nIbrahim M. Abdulbaqi 1,2*, Anan Yaghmur 3, \n\n\n\nYusrida Darwis1, Noratiqah Mohtar1, \n\n\n\nThaigarajan Parumasivam1, Habibah A. \n\n\n\nWahab1* \n \n1School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 \nMalaysia \n2College of Pharmacy, Al-Kitab University, Altun kupri, Kirkuk, 36001, Iraq. \n3Department of Pharmacy, Faculty of Health and Medical Sciences, \nUniversity of Copenhagen, Universitetsparken 2, DK-2100 Copenhagen \u00d8, \n\n\n\nDenmark \n\n\n\n*Habibahw@usm.my \n\n\n\n\n\n\n\nBackground: The available HPLC-UV methods for \n\n\n\nquantifying docetaxel evaluation are expensive, time-\n\n\n\nconsuming, and not designed to quantify the drug in lipid-\n\n\n\nbased formulations. Objective: To develop and validate a \n\n\n\nsimple reversed-phase high-performance liquid \n\n\n\nchromatography (RP-HPLC) method for the determination of \n\n\n\ndocetaxel in bulk and liquid crystals nano-formulation. \n\n\n\nMethods: The chromatographic conditions were optimized \n\n\n\nusing stainless steel reversed-phase Agilent\u00ae C18 with the \n\n\n\ndimensions of 150 mm x 4.6 mm ID x 5\u03bcm. The mobile phase \n\n\n\nconsisted of acetonitrile and ammonium acetate buffer (20 \n\n\n\nmmol/l, pH=6.5) in the ratio of (50:50 v/v). The flow rate was \n\n\n\nset at 1 ml/min, and the detection wavelength was 230 nm. \n\n\n\nThe column was maintained at 45 \u00b0C, and the injection \n\n\n\nvolume was 20 \u03bcl. Results: There was no peak interference \n\n\n\nfrom formulation excipients, diluents, impurities, or \n\n\n\ndissolution media, with the main peak of docetaxel at the \n\n\n\nretention time of 5.9 min, indicating the selectivity of the \n\n\n\nmethod. The limit of detection (LOD) and the limit of \n\n\n\nquantification (LOQ) were 0.0287 \u03bcg/ml and 0.0871 \u03bcg/ml, \n\n\n\nrespectively. The developed method was confirmed to be \n\n\n\nselective, precise, and accurate. Conclusion: A sensitive, \n\n\n\nsimple, specific HPLC\u2013UV method for determining \n\n\n\ndocetaxel in bulk and liquid crystals formulation was \n\n\n\nsuccessfully developed. The Statistical analysis confirmed \n\n\n\nthat the method was accurate, precise, and reproducible. The \n\n\n\nmethod could be used for the routine assay, content \n\n\n\nuniformity, and the in-vitro release studies of docetaxel from \n\n\n\nthe liquid crystals\u2019 formulations. \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:*ibrahim.m.abdulbaqi@uoalkitab.edu.iq\n\n\nmailto:habibahw@usm.my\n\n\nmailto:*Habibahw@usm.my\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 140-181 \n\n\n\n\n\n\n\nResearch abstracts of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022 \n\n\n\nDOI:  10.52494/YOXJ1358 \n\n\n\n\n\n\n\n178 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 056 \n\n\n\n\n\n\n\nAwareness About Relationship Between \n\n\n\nClimate Change and Health Hazards in \n\n\n\nIraqi Medical Students \n \n\n\n\nAisha Marwan Abd Al Majeed1, Sakar \n\n\n\nNajmadeen Mohammad1\u2020, Reem Abou Assi1,2*, \n\n\n\nSiok Yee Chan2* \n \n1EDEN Research Group, College of Pharmacy, Al-Kitab University, Altun \n\n\n\nKupri, Kirkuk, 36001, Iraq \n2Thoughts Formulation Lab., School of Pharmaceutical Sciences, Universiti \n\n\n\nSains Malaysia, 11800 Malaysia \n* reem.a.abouasi@uoalkitab.edu.iq; sychan@usm.my  \n\n\n\n\u2020 Co-first authors \n\n\n\n\n\n\n\nBackground: Climate change arguably represents one of the \n\n\n\ngreatest global health threats of our time. In 2019, the United \n\n\n\nNation Environment Programme ranked Iraq as the fifth most \n\n\n\nvulnerable country to climate change and desertification. \n\n\n\nClimate change is already affecting health in many ways, \n\n\n\nincluding causing death and disease as a result of frequent \n\n\n\nextreme weather events, such as heat waves, and dust storms. \n\n\n\nUnderstanding the level of the Iraqi medical students\u2019 \n\n\n\nawareness level about the relation of climate change and \n\n\n\nhealth issues can assist in addressing the gap of this critical \n\n\n\nissue Objectives: To measure the awareness among Iraqi \n\n\n\npharmacy students regarding climate change and its relation \n\n\n\nto health concerns. Methods: An online questionnaire \n\n\n\ncontains 17 items was designed containing dichotomous \n\n\n\nquestions and five-point Likert-scale questions. Results: The \n\n\n\ntotal number of participants were 106, majority (63.2%) \n\n\n\nfemales. While (93.4%) have heard of climate changes, most \n\n\n\nparticipant knew about it from internet (77.4%), and \n\n\n\ntelevision (61.3%). Although 76.4% of the participants are \n\n\n\naware that the climate change will impact their life, yet 58.5% \n\n\n\nonly stated that they are ready to do something about it, 38.7% \n\n\n\ndeclared that they are already taking action in this regard. \n\n\n\nInterestingly 47% of the participant are agreeing to the fact \n\n\n\nthat climate change can negatively impact humans\u2019 health, \n\n\n\nyet 79.2% of the participant agree that climate changes health \n\n\n\nwise impact is not limited to vulnerable categories (elderly, \n\n\n\ninfant). Suggested disease to escalate due to climate change \n\n\n\nis mainly respiratory diseases (Asthma, flu, cancer), as well \n\n\n\nas skin and infectious diseases. Conclusion: Students had \n\n\n\ntheoretical awareness regarding the health hazards of the \n\n\n\nclimate change, but this awareness in not translated into \n\n\n\naction. This could be initiated via national wide awareness \n\n\n\ncampaigns and some changes in the educational/academic \n\n\n\ncurriculum. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 057 \n \n\n\n\nNanocrystalline Cellulose (NCC) Isolation \n\n\n\nfrom Kapok Pulp Via Sulphuric Acid \n\n\n\nHydrolysis \n \n\n\n\nAbdulsalam Q. Almashhadani1*, Cheu Peng \n\n\n\nLeh2, Siok-Yee Chan1, Chong Yew Lee3, Choon \n\n\n\nFu Goh1* \n \n1Discipline of Pharmaceutical Technology, School of Pharmaceutical \n\n\n\nSciences, Universiti Sains Malaysia, 11800 Minden, Penang, Malaysia  \n2School of Industrial Technology, Universiti Sains Malaysia, 11800 Minden, \n\n\n\nPenang, Malaysia \n3School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 \n\n\n\nMinden, Penang, Malaysia \n\n\n\n* abdulsalamqahtan@student.usm.my  \n \n\n\n\nBackground: Nanocrystalline cellulose (NCC) is commonly \n\n\n\nisolated by sulphuric acid hydrolysis of cellulosic materials; \n\n\n\nhowever, the effects of hydrolysis conditions on NCC yield \n\n\n\nand properties of kapok pulp (Ceiba pentandra) are not fully \n\n\n\nunderstood. Objective: To understand the influence of acid \n\n\n\nhydrolytic reaction conditions (independent variables) on the \n\n\n\nNCC characteristics (dependent variables) from kapok pulp. \n\n\n\nMethods: A two-level factorial design approach was used to \n\n\n\nisolate NCC from kapok pulp and to study the NCC yield, \n\n\n\nparticle size, zeta potential and colour. The reaction factors \n\n\n\nwere acid concentration (50 and 60%w/w), reaction \n\n\n\ntemperature (50 and 80\u00b0C), reaction time (40 and 80 min), \n\n\n\nacid-to-pulp ratio (30 and 80 mL.g-1) and sonication time (5 \n\n\n\nand 20 min). Results: All obtained NCC were between 173.9 \n\n\n\nand 488 nm and exhibited a high zeta potential of-38.4 \u2013 -\n\n\n\n42.9 mV, which may be improved as reaction time and \n\n\n\ntemperature increase. The obtained data indicates that acid \n\n\n\nconcentration and reaction temperature mostly influence the \n\n\n\nNCC yield. Hydrolysis conducted at a high acid \n\n\n\nconcentration of 60%w/w combined with a reaction \n\n\n\ntemperature of 50\u00b0C resulted in a higher NCC yield (10.6 \u2013 \n\n\n\n16.5%) than that carried out at the same condition but at 80\u00b0C \n\n\n\n(6.0 \u2013 9.0%). The NCC colour depends on the acid \n\n\n\nconcentration and reaction temperature. Most reactions \n\n\n\ncarrying out at an acid concentration of 60%w/w at 80 \u00b0C \n\n\n\nresulted in a dark brown NCC colour, indicating that the NCC \n\n\n\nwas burned. Conclusions: The current study reveals that as \n\n\n\nacid concentration increases, the NCC yield increases and the \n\n\n\nNCC colour develops into a darker tint. On the other hand, a \n\n\n\nhigh reaction temperature (80\u00b0C) can enhance the zeta \n\n\n\npotential and increase the NCC colour but reduce the NCC \n\n\n\nyield. Furthermore, increasing reaction time can enhance zeta \n\n\n\npotential of NCC. \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:reem.a.abouasi@uoalkitab.edu.iq\n\n\nmailto:sychan@usm.my\n\n\nmailto:abdulsalamqahtan@student.usm.my\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 140-181 \n\n\n\n\n\n\n\nResearch abstracts of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022 \n\n\n\nDOI:  10.52494/YOXJ1358 \n\n\n\n\n\n\n\n179 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 058 \n \n\n\n\nIsolation and Chemical Structural \n\n\n\nCharacterisation of a Compound with \n\n\n\nWound Healing Activity from The \n\n\n\nEuphorbia hirta L. Extract \n \n\n\n\nDania F. Alsaffar1, Sura F. Alsaffar2, Nur \n\n\n\nHidaya kaz Abdula1* \n \n1School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, \n\n\n\nMalaysia. \n2Department of Biology, College of Science, Baghdad University, \n\n\n\nBaghdad, Iraq. \n* hidayahkaz@usm.my  \n\n\n\n\n\n\n\nBackground: Euphorbia hirta, a member of the \n\n\n\nEuphorbiaceae family, is wildly used in traditional medicine \n\n\n\nto treat a number of disease conditions in tropical and \n\n\n\nsubtropical countries. It has been identified to possess anti-\n\n\n\ninflammatory and wound healing effects. Objectives: The \n\n\n\naim of present study focuses on the isolation of the main \n\n\n\nactive compounds associated with wound healing activity of \n\n\n\nplant. Methods: The ariel part of E. hirta ground to a fine \n\n\n\npowder and sequentially extracted with n-hexane, \n\n\n\nchloroform, methanol, and water using serial exhaustive \n\n\n\nextraction (SEE) method. All extracts were assessed for \n\n\n\npotential wound healing activity by measuring the migration, \n\n\n\nproliferation, and viability of human fibroblast cells, Hs27. \n\n\n\nThe extract that shows the best wound healing activities were \n\n\n\nfurther fractionated using a bioactivity-guided approach, in \n\n\n\norder to identify the active compounds responsible for wound \n\n\n\nhealing. The structure elucidation of isolated compounds \n\n\n\nwere confirmed by IR, LC-MS/MS, NMR and HPLC. \n\n\n\nResults: The methanolic extract showed the highest \n\n\n\nproliferation and cells migration percent after 24-hour \n\n\n\ntreatment. The isolated compound was subsequently \n\n\n\nidentified as kaempeferol-3-O-glucoside (Astragalin). \n\n\n\nConclusion: This study provides a novel information to \n\n\n\nsupport the ethnomedicinal usage of E. hirta L as a wound \n\n\n\nhealer. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 059 \n\n\n\n \nMinocycline Improved Anxiety-Like \n\n\n\nBehaviour in Lipopolysaccharide (LPS)-\n\n\n\nInduced Neuroinflammation Rat\u2019s Model \n \n\n\n\nEntesar Yaseen Abdo Qaid1*, Rahimah \n\n\n\nZakaria2, Zuraidah Abdullah1, and Idris \n\n\n\nLong1\n \n\n\n\n1Biomedicine Programme, School of Health Sciences, Universiti Sains \nMalaysia, Kelantan, Malaysia \n2Physiology Department, School of Medical Sciences, Universiti Sains \n\n\n\nMalaysia, Kelantan, Malaysia \n* idriskk@usm.my  \n \n\n\n\nBackground: Minocycline has shown beneficial anxiolytic \n\n\n\neffects in various neuroinflammatory diseases. However, its \n\n\n\nanti-anxiety property in lipopolysaccharide (LPS)-induced \n\n\n\nneuroinflammation rat model has not been clearly understood. \n\n\n\nObjective: This study investigates the anxiolytic effects of \n\n\n\nminocycline and N-Methyl-D-Aspartate (NMDA) receptor \n\n\n\nantagonist (memantine) in LPS-induced neuroinflammation \n\n\n\nrat model. Methods: Male Sprague Dawley rats were divided \n\n\n\ninto 5 groups: (i) control, (ii) untreated LPS (iii) LPS treated \n\n\n\nwith 25 mg/kg minocycline, (iv) LPS treated with 50 mg/kg \n\n\n\nminocycline and (v) LPS treated with 10 mg/kg memantine. \n\n\n\nMinocycline (25 & 50 mg/kg) and memantine (10 mg/kg) \n\n\n\ntreatments were given intraperitoneally once daily for 14 \n\n\n\ndays, while LPS was injected once at day 5. Open field test \n\n\n\n(OFT) was performed to assess anxiety-like behaviour on \n\n\n\ndays 23 till days 28. The parameters used to assess anxiety \n\n\n\nare rearing frequency, time spent in the centre of the open \n\n\n\nfield and frequency of entries into the centre and grooming \n\n\n\nfrequency. Results: There was a significant decrease in \n\n\n\nrearing frequency, time spent in the centre of the open field \n\n\n\nand frequency of entries into the centre (p<0.05, p<0.05, \n\n\n\np<0.05) and increase in grooming frequency (p<0.05) in the \n\n\n\nLPS compared to control groups. Minocycline at both doses \n\n\n\nand memantine significantly increased rearing frequency, \n\n\n\ntime spent in the centre of the open field and frequency of \n\n\n\nentries into the centre (p<0.05, p<0.05, p<0.05) and \n\n\n\ndecreased grooming frequency (p<0.05) compared to LPS \n\n\n\ntreated group. Conclusion: Minocycline can attenuate \n\n\n\nanxiety-like behaviour in LPS injected rat comparable to \n\n\n\nmemantine. Thus, minocycline has beneficial preventive-\n\n\n\ntherapeutic effects for neuroinflammatory diseases such as \n\n\n\nAlzheimer\u2019s disease (AD) and Parkinson disease (PD). \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:hidayahkaz@usm.my\n\n\nmailto:idriskk@usm.my\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 140-181 \n\n\n\n\n\n\n\nResearch abstracts of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022 \n\n\n\nDOI:  10.52494/YOXJ1358 \n\n\n\n\n\n\n\n180 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 060 \n \n\n\n\nTo Produce and Characterise Inhalable \n\n\n\nNano- and Micro- Polyhydroxyalkanoate \n\n\n\n(PHA) Particles Containing Verapamil \n\n\n\nHydrochloride Using a Modified Water-in-\n\n\n\nOil-in-Water (W/O/W) Double Emulsion \n\n\n\nTechnique \n \n\n\n\nSowmya Ramachandran1, Thaigarajan \n\n\n\nParumasivam1*, and K Sudesh Kumar2 \n \n1School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang \n2School of Biological Sciences, Universiti Sains Malaysia, Penang \n\n\n\n* thaigarp@usm.my  \n\n\n\n\n\n\n\nBackground: Polyhydroxyalkanoates (PHA) have garnered \n\n\n\nsignificant attention as a depot in drug delivery due to their \n\n\n\nfavourable biocompatibility, biodegradability, and sustained \n\n\n\ndrug release properties. Objective: To produce optimised \n\n\n\ninhalable nano (size <500 nm) and micron (size 1-3\u03bcm) size \n\n\n\nP(3HB-co- 4HB-co-5HV-co-3HHx) particles using a water-\n\n\n\nin-oil-in-water (W1/O/W2) double emulsion technique for a \n\n\n\nhigh encapsulation of verapamil as a model drug. Methods: \n\n\n\nThe parameters tested were surfactant (polyvinyl alcohol-\n\n\n\nPVA) concentration (i.e., 1%, 3%, 5%), internal water phase \n\n\n\n(W1) and oil phase (O) , PHA mass (i.e., 20mg, 40mg, and \n\n\n\n60mg) and drug concentration (i.e., 20mg, 40mg, and 60mg). \n\n\n\nBased on statistics, surface methodology (RSM) using a \n\n\n\ncentral composite design was employed to optimise these \n\n\n\nvariables for a high drug loading and entrapment efficiencies \n\n\n\nof verapamil. Results: We found that the optimal conditions \n\n\n\nfor high drug loading (23.37\u00b112.22%) and entrapment \n\n\n\nefficiency (38.95\u00b120.37%) of P (3HB-co- 4HB-co-5HV-co-\n\n\n\n3HHx) nanoparticles are 60mg of verapamil in 0.5ml W1-\n\n\n\nphase, 40mg of PHA in 1ml O-phase and 1% PVA in 15ml \n\n\n\nW2-phase. On the other hand, for microparticles are 40mg of \n\n\n\nverapamil in 0.5ml W1-phase, 60mg of PHA in 1ml O-phase \n\n\n\nand 3% PVA in 15ml W2-phase which showed drug loading \n\n\n\nand entrapment efficiency of 18.09\u00b11.14% and 45.24\u00b12.86%, \n\n\n\nrespectively. Conclusion: In this study, we have reported \n\n\n\noptimal conditions to produce nano- and micro- P(3HB-co- \n\n\n\n4HB-co-5HV-co-3HHx) particles with high drug loading and \n\n\n\nencapsulation efficiency of verapamil. Further studies are \n\n\n\nbeing carried out to investigate the powder's dispersibility for \n\n\n\nthe application of pulmonary drug delivery.  \n\n\n\n\n\n\n\n\n\n\n\nAbstract 061 \n \n\n\n\nAnalysis of Increased AST and ALT in \n\n\n\nCOVID-19 Patients with Favipiravir \n \n\n\n\nSuharjono1*, Chairunnisa1, Mariyatul \n\n\n\nQibtiyah2, and Ariani Permatasari3 \n \n1Master of Clinical Pharmacy Programme, Faculty of Pharmacy, Universitas \n\n\n\nAirlangga \n2Department of Pharmacy, Dr.Soetomo General Hospital, Surabaya \n3Department of Pulmonology and Respiratory, Dr Soetomo General \n\n\n\nHospital, Surabaya \n* suharjono@ff.unair.ac.id   \n\n\n\n\n\n\n\nBackground: COVID-19 can be categorized as a pandemic \n\n\n\nand is the first pandemic caused by the SARS-CoV-2 virus. \n\n\n\nFavipiravir is one of the Emergency Use Authorization \n\n\n\nantiviral drugs for COVID-19. One of the most common side \n\n\n\neffects of Favipiravir is an increase in serum transaminase. \n\n\n\nFurthermore, there are other risk factors that can cause \n\n\n\nhepatotoxicities such as COVID-19 disease itself, sex, age, \n\n\n\ncomorbidities, and the potential hepatotoxicity drugs in \n\n\n\nCOVID-19 therapy. Objective: This study aims to evaluate \n\n\n\nthe effect of Favipiravir on increasing AST and ALT in \n\n\n\nCOVID-19 patients and the risk factors that can cause these \n\n\n\neffects. Methods: This study retrospectively on COVID-19 \n\n\n\npatients who received Favipiravir therapy in June-August \n\n\n\n2021 at Dr. Soetomo General Hospital, Surabaya. The total \n\n\n\nsample was 230 medical records. The results obtained where \n\n\n\npatients with gender male patients were 52.6% higher than \n\n\n\nfemale patients by 47.4%. Statistical analysis was performed \n\n\n\nwith SPSS version 26. Results: The prevalence of increases \n\n\n\nabove upper limit of normal between day-7 and day-14 in \n\n\n\nAST (16.5%) and ALT (24.3%). An increase \u22653-5 times \n\n\n\nupper limit of normal in AST (3.9%) and ALT (8.3%). \n\n\n\nALT >5 times upper limit of normal (5.2%). The risk factors \n\n\n\nfor sex, age, coronavirus symptoms, co-morbidities, and the \n\n\n\npotential hepatotoxic drugs tested in this study were not \n\n\n\nstatistically significant in increasing AST and ALT. Further \n\n\n\nresearch to determine the hepatotoxicity of use Favipiravir \n\n\n\nprospectively. Conclusions: Favipiravir could affect AST \n\n\n\nand ALT function and reversible. \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:suharjono@ff.unair.ac.id\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 8, Issue 2, Supplementary (2022), 140-181 \n\n\n\n\n\n\n\nResearch abstracts of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022 \n\n\n\nDOI:  10.52494/YOXJ1358 \n\n\n\n\n\n\n\n181 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 062 \n\n\n\n\n\n\n\nFormulation of Co-Enzyme Q10 Ternary \n\n\n\nInclusion Complexes Using \n\n\n\nBetacyclodextrin (\u0392cd) and Hydrophilic \n\n\n\nPolymers Silica Syloid Xdp/ Sodium \n\n\n\nAlginate) \n \n\n\n\nRabia Munir, SajidAsghar, Muhammad Irfan, \n\n\n\nIkramUllah Khan \n \n\n\n\nDepartment of pharmaceutics, Faculty of pharmaceutical Sciences, \nGovernment college university, Faisalabad, Punjab, Pakistan \n\n\n\n*haroonkhalid80@gmail.com; syedharoonkhalid@gcuf.edu.pk  \n\n\n\n\n\n\n\nBackground: Co-enzyme Q10 (CoQ10) is an insoluble, \n\n\n\npoorly permeable antioxidant with great biological value \n\n\n\nwhich act as anti-aging and anti-wrinkle agent. CoQ10 can \n\n\n\nquench the free radicals and helps in slowing the process of \n\n\n\naging. Objective: The present study was designed to evaluate \n\n\n\nthe effect of hydrophilic polymers silica Syloid (XDP) and \n\n\n\nsodium alginate on the complexation efficiency and \n\n\n\ndissolution of CoQ10 and beta cyclodextrin (\u03b2CD) complex. \n\n\n\nMethods: The binary inclusion complexes were prepared \n\n\n\nusing solvent evaporation, kneading and freeze-drying \n\n\n\nmethods at various W/W% drug and polymer ratios (1:1, 1:2 \n\n\n\nand 1:4). The addition of hydrophilic polymers (silica Syloid \n\n\n\nXDO and sodium alginate) at 0.5, 2.5, 5.0 and 10 % W/W \n\n\n\nmarkedly improved the complexation and solubilizing \n\n\n\nefficiency of \u03b2CD. The samples were further evaluated for \n\n\n\nphysicochemical evaluation and morphology Results: The \n\n\n\nbinary and ternary samples showed high stability constant \n\n\n\n(Ks) value and complexation efficiency (CE). The \n\n\n\ndissolution study results revealed significant enhancement in \n\n\n\nthe release of the binary inclusion complex and ternary \n\n\n\ninclusion complex compared to pure CoQ10. Fourier \n\n\n\ntransform infrared (FTIR) results confirm the complex \n\n\n\nformation. X-ray powder diffractometry (XRD) and scanning \n\n\n\nelectron microscopy (SEM) data revealed modification in the \n\n\n\nstructure of CoQ10. Conclusion: In conclusion, a remarkable \n\n\n\nenhancement in dissolution was attained due to marked \n\n\n\nimprovement in solubility through complexation of CoQ10 \n\n\n\nwith \u03b2CD and silica Syloid (XDP)/\u03b2CD. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\nmailto:*haroonkhalid80@gmail.com\n\n\nmailto:syedharoonkhalid@gcuf.edu.pk\n\n\n\n\n \nCover Vol8I2\n\n\nTable of content vol8I2 v2\n\n\n0.MJPI8vol2- editorial\n\n\n1.MJPI8vol2- proofread\n\n\n2.MJPI8vol2 -Proofread\n\n\n3.MJPI8vol2- proofread\n\n\n4.MJPI8vol2- proofread\n\n\n5.MJPI8vol2- proofread\n\n\n6.MJPI8vol2- proceedings\n\n\n7.MJPI8vol2- proceedings\n\n\n\n"
"\n\nMalaysian Journal of Pharmacy Volume 6 Issue 1 December 2020 \n \n\n\n\n\n\n\n\n13 \n\n\n\n\n\n\n\n*Corresponding author:  \n\n\n\nLee Kah Seng \n\n\n\nEmail: ksl.pharm@gmail.com \n\n\n\n\n\n\n\n\n\n\n\n1Faculty of Pharmacy, University of Cyberjaya, Cyberjaya, Selangor, \n\n\n\nMalaysia  \n2Pharmaceutical Services Division, Penang State Health Department, \n\n\n\nPenang, Malaysia \n3Pharmaceutical Services Division, Kelantan State Health Department, Kota \n\n\n\nBharu, Malaysia \n4Institute of Pharmaceutical Sciences, University of Veterinary and Animal \n\n\n\nSciences, Lahore, Pakistan \n5Faculty of Pharmacy, Universiti Teknologi MARA, Puncak Alam, Selangor, \n\n\n\nMalaysia \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n \nOriginal Research Article \n \n\n\n\nFolk Songs for Health Education: A Qualitative Exploratory \n\n\n\nStudy among Public and Pharmacy Enforcement Officers  \n \n\n\n\nKah Seng Lee1*, Muthu Kumar Murugiah2, Mohammad Aswady Adenan3, Tahir Mehmood Khan4,  \n\n\n\nChin Fen Neoh5, Yaman Walid Kassab1, Nur Akmar Taha1 and Zainol Akbar Zainal1 \n \n\n\n\n  \nArticle Info  \n\n\n\n \nReceived date: 16 Dec 2020 \n\n\n\nAccepted date: 28 Dec 2020 \n\n\n\nPublished date: 31 Dec 2020  \n\n\n\n\n\n\n\nKeywords:  \n\n\n\nDikir Farmasi, regulatory \n\n\n\naffair, health promotion, \n\n\n\nentertainment education   \n\n\n\nABSTRACT  \n\n\n\n\n\n\n\nDikir Farmasi (DF) is a new effort to expand and intensify the dissemination of information about \n\n\n\nthe regulation of the legitimate use of drugs and cosmetics. This study was aimed to explore the \n\n\n\nopinions of Pharmacy Enforcement Division staff and the general public regarding the quality and \n\n\n\nimpact of DF program as a health promotion tool in Malaysia. A qualitative study using semi-\n\n\n\nstructured interviews and focus group discussions (FGDs) were conducted at the Pharmacy \n\n\n\nEnforcement Department and three health clinics located at the city of Kota Bharu, Malaysia. The \n\n\n\ninterviews were audio recorded, translated and transcribed. Thematic analysis was performed to \n\n\n\nidentify the themes and sub-themes of the transcripts. Ethical approval was obtained from Ministry \n\n\n\nof Health Malaysia. All respondents provided a written consent for participation. Nine pharmacy \n\n\n\nofficers and 23 general public participated in this study. Five main themes emerged from the \n\n\n\ninformation gathered and analyzed: 1) language; 2) design; 3) content and delivery 4) costs and \n\n\n\nbenefits and 5) prospect of DF. Certain weaknesses of DF have been raised and the health authorities \n\n\n\ncould utilize this information for an improvement. Significant effort must be made to improve the \n\n\n\npublicity and dissemination of DF to ensure that it reaches the target population. Certain weaknesses \n\n\n\nof DF have been raised and the health authorities could utilize this information for an improvement. \n\n\n\nSignificant effort must be made to improve the publicity and dissemination of DF to ensure that it \n\n\n\nreaches the target population.    \n\n\n\n\n\n\n\n\n\n\n\nINTRODUCTION  \n\n\n\n\n\n\n\nHealth promotion is defined as \u201cthe process of enabling people \n\n\n\nto increase control over, and to improve, their health\u201d.[1] \n\n\n\nCommunicative acts, namely health communication, are \n\n\n\ndeemed as intervention efforts which are instrumental to \n\n\n\nchange public health promotion behaviors.[2] \n\n\n\n\n\n\n\nHealth messages nowadays are often conveyed in a complex \n\n\n\nmanner via electronic multi-media. People with low health \n\n\n\nliteracy particularly face difficulties in comprehending these \n\n\n\nmessages as they often lack of essential health-related \n\n\n\nbackground knowledge hindering them from understanding \n\n\n\nimportant information. [3, 4] This is aggravated by the fact that \n\n\n\nthese people can be chronically ill and less engaged in health \n\n\n\npreventive services.[5, 6] To convey heath messages \n\n\n\neffectively, strategic health communication techniques are \n\n\n\nimperative. One such techniques is entertainment education \n\n\n\n(EE).[7, 8]  \n\n\n\n\n\n\n\nEE embeds pro-social messages into entertainment programs to \n\n\n\ninfluence public attitudes, awareness and behaviors. [9] EE \n\n\n\noffers appealing stories where messages are imparted through \n\n\n\nprominent characters delivering interesting plots of which is \n\n\n\nnot usually found in the traditional persuasive models.[10] \n\n\n\n\nmailto:ksl.pharm@gmail.com\n\n\n\n\n\n\nK.S. Lee et al. Malaysian Journal of Pharmacy 6 (1) 2020 \n\n\n\n\n\n\n\n14 \n\n\n\n\n\n\n\nIn Malaysia, the Pharmacy Enforcement Department of \n\n\n\nKelantan has taken initiatives to promote health education via \n\n\n\na traditional musical form dikir barat, an innovative EE \n\n\n\napproach by introducing Dikir Farmasi (DF) as a means to \n\n\n\npromote health awareness to the public.[11] DF is a new effort \n\n\n\nto expand and intensify the dissemination of information about \n\n\n\nthe regulation of the legitimate use of drugs and cosmetics. The \n\n\n\njuxtaposition of elements of entertainment with an educational \n\n\n\nmessage facilitates pharmacy related messages to be \n\n\n\ncommunicated in a livelier manner. The DF project has been \n\n\n\ncreated to reach out to the Kelantanese people whom deem \n\n\n\ndikir barat as a popular local art, commonly performed during \n\n\n\nfestive and wedding celebrations.[12] In the early 90s, dikir \n\n\n\nbarat was an edutainment. [8]  It was is utilized as a vehicle for \n\n\n\nsocial commentary, to stimulate discussion on current issues \n\n\n\nand scenarios.[11, 13, 14]  \n\n\n\n\n\n\n\nDF combines the elements of dikir barat (a type of traditional \n\n\n\nfolk song rhythm) and traditional sketches from the state of \n\n\n\nKelantan, Malaysia.[15] The DF music album, entitled \u201cLet\u2019s \n\n\n\nuse registered medicine\u201d was produced in June 2011, \n\n\n\nconsisting of four sketches, namely 1) \u201cProcessing of illegal \n\n\n\ndrugs\u201d, 2) \u201cIntroduction to the service of the enforcement unit\u201d, \n\n\n\n3) \u201cRegistration of medication\u201d, and 4) \u201cIllegal cosmetics\u201d, as \n\n\n\nwell as three dikir songs, namely 1) \u201cUnderstanding the service \n\n\n\nof pharmaceutical services\u201d; 2)\u201cKnow your medication\u201d, and \n\n\n\n3) \u201cDrug information\u201d.(9)  The animation drama sketches and \n\n\n\nthe lyrics of songs were produced by the enforcement officers \n\n\n\nfrom the Protection and Consumer Awareness Unit. DF has \n\n\n\nbeen disseminated in the form of theatre performance, \n\n\n\nexhibition, social and printed media as well as through the \n\n\n\ninternet (YouTube) and , official Ministry of Health \n\n\n\nwebsite.[12, 16, 17], Google-Play.[15, 18, 19]The VCDs and \n\n\n\nCDs have been distributed to every health facilities department, \n\n\n\nto taxi drivers, bus conductors, hyper-malls, as well as to other \n\n\n\ngovernment agencies within the state of Kelantan.  \n\n\n\n\n\n\n\nTo the authors\u2019 best knowledge, no documented literature has \n\n\n\nbeen reported about the impacts of the DF public educational \n\n\n\ncampaign. This present study explores the opinions of \n\n\n\nPharmacy Enforcement Division staff and the general public in \n\n\n\nKelantan state of Malaysia. It elucidates the effectiveness and \n\n\n\nshortfalls of DF as health promotional tool and gather thoughts \n\n\n\nand suggestions for improving the program.  \n\n\n\n\n\n\n\n\n\n\n\nMETHOD  \n  \n\n\n\nStudy design \n\n\n\n\n\n\n\nQualitative study utilizing semi-structured interviews and focus \n\n\n\ngroups discussions (FGD). \n\n\n\n\n\n\n\nInclusion criteria:  \n\n\n\ni) Pharmacy enforcement officers at Kelantan Pharmacy \n\n\n\nEnforcement Department.  \n\n\n\nii) The general public:  \n\n\n\n\u2022 Kelantanese  \n\n\n\n\u2022 18 years old or above \n\n\n\n\u2022 With previous exposure to the DF programs  \n\n\n\n\n\n\n\nThe exclusion criteria are those not able to understand standard \n\n\n\nMalay and Kelantanese Malay languages and individuals who \n\n\n\nrefuse giving informed consent.  \n\n\n\n\n\n\n\nSetting \n\n\n\n\n\n\n\nThree health clinics in Kota Bharu, Kelantan were selected due \n\n\n\nto high daily frequency of patients' visit and diverse patients' \n\n\n\nstatistics in terms of gender, age and area of residence.  \n\n\n\n\n\n\n\nSampling \n\n\n\n\n\n\n\nUsing the convenience sampling method, the public \n\n\n\nparticipants were identified and approached to join the study by \n\n\n\na field researcher at the health clinics. The participants were \n\n\n\nrecruited until no new themes emerged from the interviews. \n\n\n\n\n\n\n\nStudy procedure \n\n\n\n\n\n\n\nNine pharmacy officers were included. 40 public individuals \n\n\n\nwere invited, 25 were interested to participate.  However, 2 out \n\n\n\nof 25 failed to participate due to busy routine. Participants were \n\n\n\nbriefed about the aim of study, researcher who did not represent \n\n\n\nany governmental agency and affiliate with DF program, their \n\n\n\nright to express and to withdraw from study with no penalty, \n\n\n\ngoody bag containing a T-shirt and a souvenir as \n\n\n\ncomplementary gifts. The study receives Ethical approval from \n\n\n\nthe Medical Research and Ethics Committee, Ministry of \n\n\n\nHealth Malaysia (NMRR-15-1041-23897). All volunteers had \n\n\n\nto provide an written informed consent form before \n\n\n\nparticipating in this study.  \n\n\n\n\n\n\n\nData Collection \n\n\n\n\n\n\n\nInterviews of pharmacy officers were conducted individually in \n\n\n\na private room at the Kelantan Pharmacy Enforcement \n\n\n\nDepartment. Focus group discussions and semi-structured \n\n\n\ninterviews were conducted with general public. Focus group \n\n\n\nparticipants were divided into three groups; two groups of \n\n\n\nadults and one group of high-school students (7-9 per group).  \n\n\n\n\n\n\n\nThe semi-structured interviews were conducted based on a \n\n\n\nprewritten interview guide, a schematic presentation of \n\n\n\nquestions or topics. The semi-structured interview guide were \n\n\n\ndeveloped through two rounds of panel discussion involving \n\n\n\npharmacy lecturer, personnel that involved in DF and two \n\n\n\neducation lecturers that had watched DF videos. The same \n\n\n\ninterview guide was used for both officers and the general \n\n\n\npublic. All the interviews and FGDs were carried out in \n\n\n\nseparate rooms. Each semi-structured interview lasted 40-60 \n\n\n\nminutes. Interviewees were encouraged to express additional \n\n\n\nviews at end of the interview.  \n\n\n\n\n\n\n\n\nK.S. Lee et al. Malaysian Journal of Pharmacy 6 (1) 2020 \n\n\n\n\n\n\n\n15 \n\n\n\n\n\n\n\nInterviewers' Background \n\n\n\n\n\n\n\nThe interviews were conducted by researchers with PhD and \n\n\n\nhave more than 5 years clinical and research experience. They \n\n\n\nhave been trained to conduct semi-structured interviews, \n\n\n\nqualitative research and thematic analysis. The research team \n\n\n\ncomprised of health administration and law enforcement \n\n\n\nofficers, academician and researchers.  \n\n\n\n\n\n\n\nData processing and analysis \n\n\n\n\n\n\n\nAll interviews and FGDs were audio recorded. The information \n\n\n\nwas translated into English by two experienced translators. A \n\n\n\nthird researcher (SB) was appointed to compare the audio-\n\n\n\nrecorded interviews and FGDs information against the \n\n\n\ntranscribed written copies. No field notes were taken.  \n\n\n\n\n\n\n\nThematic content analysis was used to identify patterns or \n\n\n\nregularities within the data. [16, 17] Two researchers \n\n\n\nindividually free coded the verbatim transcripts line by line. All \n\n\n\nsentences with the same code were reviewed to ensure \n\n\n\nconsistency of interpretation and to confirm additional coding \n\n\n\nlevels are needed. Homogeneity and heterogeneity between the \n\n\n\ncodes were assessed and had them grouped into a hierarchical \n\n\n\ntree structure. The interviews of pharmacy officers were coded \n\n\n\nseparately by another researcher. Similarly, the FGDs and the \n\n\n\ninterviews of general public were coded separately by two \n\n\n\nother researchers. All coded data was then reviewed \n\n\n\nindependently to determine inter-rater agreement. All \n\n\n\ndisagreements were discussed until a consensus was reached. \n\n\n\nNew codes were created, to capture the meaning of groups of \n\n\n\ninitial codes. This process resulted in a tree structure with \n\n\n\nseveral layers.  \n\n\n\n\n\n\n\nRepresentative participant quotes have been provided and the \n\n\n\nstudy results have been reported following the Consolidated \n\n\n\nCriteria for Reporting Qualitative Research (COREQ) \n\n\n\nchecklist.[20] (see supplementary file). \n\n\n\n\n\n\n\nRESULTS  \n \n\n\n\nAfter interviewing nine pharmacy officers (3 men; 6 women, \n\n\n\nwith a mean age of 30.3 years) from the Kelantan Pharmacy \n\n\n\nEnforcement Department, and 23 participants ((15 males; 8  \n\n\n\n\n\n\n\nfemales, with a mean age of 30.61 years) from the general \n\n\n\npublic, two researchers reached a consensus that saturation had \n\n\n\nbeen met. Five main themes were identified: 1) language ; 2) \n\n\n\ndesign ; 3) content and delivery ; 4) costs and benefits and 5) \n\n\n\nprospects of DF. Table 1 and 2 outlined the demographic \n\n\n\ninformation of the pharmacy officers and the general public \n\n\n\nparticipants, respectively. \n\n\n\n\n\n\n\n1. Language of DF \n\n\n\n\n\n\n\n1.1. Understandability \n\n\n\n\n\n\n\nDF is a health-information medium where information \n\n\n\nincluded should be direct and the language employed \n\n\n\nuncomplicated. For verification, respondents were asked if they \n\n\n\nfaced difficulties in understanding the DF contents. All \n\n\n\nrespondents, including the students, did not face problem in \n\n\n\nunderstanding the language since they are Kelantanese or \n\n\n\nresidents of Kelantan. Respondents expressed that the DF \n\n\n\ninformation could not be instantly grabbed at the first exposure.  \n\n\n\n\n\n\n\n1.2. Language as a barrier for non-Kelantanese  \n\n\n\n\n\n\n\nBoth pharmacy officers and the general public expressed \n\n\n\nconcern about the ability of non-Kelantanese to understand the \n\n\n\nKelantanese dialect. The respondents were however not keen \n\n\n\nto use standard Malay language claiming that if DF is expressed \n\n\n\nin non-Kelantanese dialect, DF will lose its charm. The use of \n\n\n\nMalay subtitles was recommended instead.  \n\n\n\n\n\n\n\n2. DF Design  \n\n\n\n\n\n\n\n2.1. Cultural significance    \n\n\n\n\n\n\n\nDF is culturally significant because the components used, dikir \n\n\n\nbarat and the sketches, are parts of Kelantanese cultural arts. \n\n\n\nHowever, one of the respondents indicated that DF as \n\n\n\nentertainment is not a new idea other than by means of modern \n\n\n\naudiovisual aids instead of traditional flyers.  \n\n\n\n\n\n\n\n2.2. The Dikir barat (songs) versus the sketches \n\n\n\n\n\n\n\nBoth the pharmacy officers and the general public preferred \n\n\n\nsketches over dikir as i) the sketches can be understood by all \n\n\n\nTable 1: Demographic information of the pharmacy officers \n \n\n\n\nID Age Gender Education Monthly household income (US Dollar) \n\n\n\nPO-1 29 Female Bachelor of pharmacy 1400-1700 \n\n\n\nPO-2 30 Female Bachelor of pharmacy 1400-1700 \n\n\n\nPO-3 31 Male Bachelor of pharmacy 1400-1700 \n\n\n\nPO-4 32 Female Bachelor of pharmacy 1400-1700 \n\n\n\nPO-5 30 Male Bachelor of pharmacy 1400-1700 \n\n\n\nPO-6 36 Female Master of pharmacy 1400-1700 \n\n\n\nPO-7 37 Female Bachelor of pharmacy 1400-1700 \n\n\n\nPO-8 35 Male Bachelor of pharmacy 1400-1700 \n\n\n\nPO-9 36 Male Bachelor of pharmacy 1400-1700 \n\n\n\n \n\n\n\n\n\n\n\n\nK.S. Lee et al. Malaysian Journal of Pharmacy 6 (1) 2020 \n\n\n\n\n\n\n\n16 \n\n\n\n\n\n\n\nage groups and by non-Kelantanese. ii) the visual effects of \n\n\n\nsketches felicitate learning.   \n\n\n\n\n\n\n\n2.3: Distracting nature of entertaining elements of DF \n\n\n\n\n\n\n\nUnlike pure entertainment, EE actively seek to change the \n\n\n\naudience\u2019s knowledge, attitude and behavior.21According to \n\n\n\nthe pharmacy officers and general public, the entertaining \n\n\n\naspects of DF hindered the delivery of educational messages.  \n\n\n\n\n\n\n\n3. DF content  \n\n\n\n\n\n\n\n3.1:  Length \n\n\n\n\n\n\n\nOfficers and certain public respondents highlighted that \n\n\n\nfrivolous elements such as unnecessary jokes or prelude scenes \n\n\n\nshould be minimized to reduce duration of DF videos. \n\n\n\n\n\n\n\n3.2: Additional content \n\n\n\n\n\n\n\nPharmacy legislations such as fines and punishment for \n\n\n\nconviction of offences should be included in DF to alert people \n\n\n\nfrom violating pharmacy-related laws. \n\n\n\n\n\n\n\nThe roles of Pharmacy Enforcement Division should be \n\n\n\nfeatured to promote public awareness and public-government \n\n\n\ncommunication on issues such as medicine registration.  \n\n\n\n\n\n\n\n3.3 Take-home message \n\n\n\n\n\n\n\nA mass media campaign cannot be effective unless the target \n\n\n\naudience is exposed to, attends to, and comprehends its \n\n\n\nmessage.22Through DF, the importance of medication \n\n\n\nregistration and administration methods were take-home \n\n\n\nmessages for the respondents.   \n\n\n\n\n\n\n\n4. Content and delivery  \n\n\n\n\n\n\n\n4.1: Poor dissemination and publicity \n\n\n\n\n\n\n\nDF has been in existence since 2009, but its implementation \n\n\n\nwas not as effective in accordance to officers and general public.  \n\n\n\n\n\n\n\n\u201cNo one has talked to me directly about matters regarding this \n\n\n\nDF. (PO-6)\u201d  \n\n\n\n\n\n\n\n \u201cErmm\u2026I\u2019m not sure\u2026because nobody has come to me and \n\n\n\nsay they know about DF. I never had such an encounter. I don\u2019t \n\n\n\nknow.(PO-3)\u201d \n\n\n\n\n\n\n\n \u201cThe dissemination is not widespread yet. It focuses more on \n\n\n\nthe urban areas and does not cover the rural areas. (R-16)\u201d \n\n\n\n\n\n\n\nCertain officers lamented that pharmacists lack awareness \n\n\n\nabout DF, so were some of them prior joining Pharmacy \n\n\n\nEnforcement Office. The pharmacists in the public and private \n\n\n\nsectors should be exposed to DF to enable them to translate the \n\n\n\nbenefits of DF to general public.   \n\n\n\n\n\n\n\n4.2: Communication mediums \n\n\n\n\n\n\n\nRespondents also highlighted internet connectivity and \n\n\n\naccessibility were barriers for general public to receive \n\n\n\ninformation of DF.  \n\n\n\n\n\n\n\n \u201cThe sketches have been available on YouTube\u00ae since 2011 \n\n\n\nbut they have only had 2000 views even though thousands of \n\n\n\nKelantanese are reported to have access to the internet. (R-2)\u201d \n\n\n\n\n\n\n\nRespondents expressed the need to have DF broadcasted \n\n\n\nthrough multiple communication mediums, such as social \n\n\n\nmedia, television, radio, billboards, and TV screen in \n\n\n\nsupermarket and pharmacies. \n\n\n\n\n\n\n\n4.3: The need for collaboration  \n\n\n\n\n\n\n\nCalls for collaboration between DF team and other parties, such \n\n\n\nas the National Antidrug Agency and the District or State \n\n\n\nEducation Department, were expressed. This is to equip school \n\n\n\nteachers with the more information on DF and to encourage DF \n\n\n\nlive performances in schools and universities.   \n\n\n\n\n\n\n\n4.4: Other recommendations \n\n\n\n\n\n\n\nMore promotional tours and educational events engaging \n\n\n\nyoung children should be conducted. Celebrity endorsements \n\n\n\nwere suggested by respondents. \n\n\n\n\n\n\n\n \u201cThis campaign should also start as early as in kindergarten \n\n\n\nbecause children are easier to educate than adults. (R-4)\u201d \n\n\n\n\n\n\n\n\u201cThe selection of performers is also important, for instance \n\n\n\nSabri Yunus. His fans will follow whatever he\u2019s doing. The \n\n\n\nsame goes for Halim Yazid. If other performers replace him \n\n\n\nthen the audience may not be interested to follow. (R-4)\u201d \n\n\n\n\n\n\n\n5. Costs and benefits \n\n\n\n\n\n\n\n5.1: Resources consumed \n\n\n\n\n\n\n\nCertain officers expressed concern about the cost effectiveness \n\n\n\nof DF. They doubted if the CDs distributed would be played. \n\n\n\nWhen applicable, one-to-one explanation and the use of apps \n\n\n\nwere recommended. Officers had also expressed the concern \n\n\n\nregarding the time and manpower that DF consumed, \n\n\n\nespecially for live performances requiring them to travel \n\n\n\ninterstates:  \n\n\n\n\n\n\n\n\u201cthe exhibitions really take too much of their time, and they \n\n\n\nalso have other jobs at their own stations...It\u2019s affecting their \n\n\n\nactual job. (PO-8)\u201d  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nK.S. Lee et al. Malaysian Journal of Pharmacy 6 (1) 2020 \n\n\n\n\n\n\n\n17 \n\n\n\n\n\n\n\n Table 2: Demographic information of the participants from general public \n\n\n\n\n\n\n\nID Age Gender Occupation Education Monthly \n\n\n\nhousehold \n\n\n\nincome \n\n\n\n(USD) \n\n\n\nLiving area \n\n\n\n(Rural/urban\n\n\n\n) \n\n\n\nCurrent \n\n\n\nmedical \n\n\n\nconditions \n\n\n\nMedicine received \n\n\n\nfrom \n\n\n\nNumber of \n\n\n\nmedicines \n\n\n\ncurrently taking \n\n\n\nInformation source on DF \n\n\n\nR-1 30 Male Government \n\n\n\nsector \n\n\n\nTertiary  240-480 Rural  NA Government NA Internet \n\n\n\nR-2 19 Female Student  Secondary NA Urban Allergy Private pharmacy 1 (yellow cream) NA \n\n\n\nR-3 25 Male Student Tertiary NA Urban NA Government health \n\n\n\nclinic \n\n\n\nNA Family/Friends \n\n\n\nR-4 32 Male Self-employed Secondary 240 Urban Asthma Pharmacy 1 Road banner/billboard \n\n\n\nR-5 30 Male Private sector Secondary 240 Rural None NA 1 (for cough) Family/ friends \n\n\n\nAdvertisement, internet, \n\n\n\nbrochure, banners \n\n\n\nR-6 20 Male Student  Tertiary NA Rural Allergic rhinitis Government clinic 0 Internet \n\n\n\nR-7 25 Male Self-employed Secondary  480-720 Urban None Government clinic NA Internet \n\n\n\nR-8 27 Male Self-employed Tertiary 240-480 Urban None NA NA Family/Friends \n\n\n\nR-9 30 Male Government \n\n\n\nsector  \n\n\n\nTertiary 240-480 Rural NA Government clinic NA Internet \n\n\n\nR-10 35 Female Government \n\n\n\nsector \n\n\n\nTertiary 480-720 Rural None Government hospital 0 Road tour \n\n\n\nR-11 18 Female Student Secondary NA Urban Short-\n\n\n\nsightedness \n\n\n\nPrivate hospital 2 Internet \n\n\n\nR-12 41 Male Self-employed Secondary 480-720 Rural None Government clinic \n\n\n\n/private pharmacy \n\n\n\n1 (Vitamin C) NA \n\n\n\nR-13 48 Female Housewife Secondary 240-480 Urban None Government /private \n\n\n\nclinic \n\n\n\n0 Family/friends \n\n\n\nR-14 19 Female Student Secondary 480-720 Urban None Hospital/Clinic 0 Teacher \n\n\n\nR-15 37 Female Self-employed Tertiary 1300 Urban None Hospital  0 Exhibitions \n\n\n\nR-16 35 Male Retired NA 240-480 Urban None None 0 Joint-performance with \n\n\n\nDikirFarmasi \n\n\n\nR-17 18 Female NA Secondary NA Urban Asthma NA NA Teacher \n\n\n\nR-18 43 Male Self-employed Secondary 1300 Urban None Government clinic 0 Family/friends \n\n\n\nR-19 37 Male Government Secondary 720-900 Rural Chronic back \n\n\n\npain \n\n\n\nGovernment hospital 3 Advertisement, Internet, \n\n\n\nBrochure \n\n\n\nR-20 40 Male Government NA 1300 Urban None Government \n\n\n\nhospital/Pharmacy \n\n\n\n0 Advertisement, Internet, \n\n\n\nBrochure \n\n\n\nR-21 23 Male Private Tertiary 240 Rural None None 0 Family/friends \n\n\n\nR-22 38 Male Government NA 480-720 Urban None None NA Advertisement, Internet, \n\n\n\nBrochure, banners, \n\n\n\nFamily/friends/ \n\n\n\nR-23 19 Female NA Secondary NA Urban Anemia Government clinic 0 Internet \n \n\n\n\n\n\n\n\n\nK.S. Lee et al. Malaysian Journal of Pharmacy 6 (1) 2020 \n\n\n\n\n\n\n\n18 \n\n\n\n\n\n\n\n\u201cif I have to do performance, have to join the performance, a \n\n\n\nlot of my time is being spent on training.. (PO-7)\u201d \n\n\n\n\n\n\n\n5.2: Behavioral change \n\n\n\n\n\n\n\nDF motivated general public to practise the health knowledge \n\n\n\nin their daily lives and to promoted behavioral change.  \n\n\n\nHowever, some respondents admitted failure in doing so.   \n\n\n\n\n\n\n\n\u201cThe information is very helpful but compliance to the \n\n\n\ninformation is difficult, especially among adults. (R-4)\u201d  \n\n\n\n\n\n\n\n\u201cDikir Farmasi is nice to listen to but to practice is the difficult \n\n\n\npart because I find it interesting to listen to but I don\u2019t practice \n\n\n\nthe knowledge. (R-5)\"   \n\n\n\n\n\n\n\nSome of the respondents, however, reported behavior change \n\n\n\nafter exposure to DF: \n\n\n\n\n\n\n\n\u201cBefore this I used to kept medication recklessly.... and didn\u2019t \n\n\n\nknow that medications can be contaminated. After listening to \n\n\n\nthe CD I will discard the medications. (R-7)\u201d  \n\n\n\n\n\n\n\n\u201cBefore this I used to buy medicines sold at the night market. \n\n\n\nI\u2019ve become more alert and check for registration of medicines \n\n\n\nafter being exposed to DF. (R-1)\u201d  \n\n\n\n\n\n\n\n6. DF Future \n\n\n\n\n\n\n\n6.1: Adaptability of DF over time \n\n\n\n\n\n\n\nThere were disagreements among the general public if DF \n\n\n\nshould adopt dikir or modern music.  \n\n\n\n\n\n\n\n\u201cThe suggestion to include K-Pop elements in dikir can be \n\n\n\nconsidered, but not to the point that the dikir loses its identity. \n\n\n\n(R-4)\u201d \n\n\n\n\n\n\n\nIn toto, the officers were given authority to fully promote DF. \n\n\n\nRespondents highlighted that further assessment on the impact \n\n\n\nand acceptance of DF among public needed to be conducted.  \n\n\n\nPessimistic comments to replace DF with new ideas were \n\n\n\nrecorded, although the options of replacements were not \n\n\n\nformulated:  \n\n\n\n\n\n\n\n\u201c\u2026.ermmm\u2026if I myself, ermm\u2026I will discontinue it, the dikir. \n\n\n\nBecause I myself, am not a huge fan of DF. Maybe\u2026think of \n\n\n\nother ideas\u2026.So far I cannot come up with other ideas. (PO-\n\n\n\n7)\u201d \n\n\n\n\n\n\n\n6.2: Impact and cost-effectiveness  \n\n\n\n\n\n\n\nThere is no known evidence investigating the impact versus \n\n\n\ncost effectiveness of the DF. No research reports the \n\n\n\nappropriateness and public acceptance level of DF. \n\n\n\n\n\n\n\nDISCUSSION  \n  \n\n\n\nThe aim of the study was to explore perspectives of nine \n\n\n\nPharmacy Enforcement Officers and reveal public perception \n\n\n\non DF. The findings of the study revealed that there is a trend \n\n\n\nin the field of health emphasizing on health promotion rather \n\n\n\nthan disease treatments.[20, 21] Health promotion incorporates \n\n\n\nappropriate self-management of medicine. Effective health \n\n\n\npromotion program requires to equip the public with relevant \n\n\n\nknowledge via health communications using advanced \n\n\n\ntechnologies.[20, 21] Officers need to be inculcated with \n\n\n\nappropriate health information for effective delivery to general \n\n\n\npublic.  \n\n\n\n\n\n\n\nAs reflected from the interviews, the Pharmacy Enforcement \n\n\n\nOfficers interviewed are apparently not able to appreciate the \n\n\n\nvalue of DF as a tool in health-promotion. Therefore, it is \n\n\n\nrecommended that the concept of health-promotion and how \n\n\n\nDF relates to it be discussed with the officers in helping them \n\n\n\nto appreciate the value and benefits of DF. It is worth \n\n\n\nmentioning that DF is available in both online and off-line and \n\n\n\na recent study indicated that both methods were found equally \n\n\n\neffective for delivering pharmacy education.[22] \n\n\n\n\n\n\n\nProper planning and evaluation of outcomes are important to \n\n\n\nensure the success of DF. Here we recommend the Precede-\n\n\n\nProceed Model.[23]The Precede-Proceed Model has been \n\n\n\nutilized in multiple preventive health promotion programs in \n\n\n\nAustralia including early health risk detection initiatives. Its \n\n\n\nsuccess has been validated through several rigorously \n\n\n\nevaluated clinical and field trials.[23]Basically, the model\u2019s \n\n\n\npremise is on rigorous population assessment prior to \n\n\n\ndevelopment of health intervention (Precede), and post-\n\n\n\nintervention evaluation (Proceed) to measure the effectiveness \n\n\n\nof the program. The study\u2019s findings point to some \n\n\n\nweaknesses of DF since the contents had not been subjected to \n\n\n\nthe Precede evaluation. DF is deemed to be too lengthy and \n\n\n\nthe entertainment elements are distracting. For example, the \n\n\n\nofficers lamented that DF activities are time-consuming and \n\n\n\ndisrupting to their other duties. To overcome this issue, we \n\n\n\nrecommend that a special portfolio be assigned to officers \n\n\n\nwhose scope of tasks are mainly focused on DF. This officer \n\n\n\nmay be given the responsibility of conducting the relevant \n\n\n\nresearch to assess the impact of DF. The appointed officer \n\n\n\nshould act as the head of all DF programs and attend all DF \n\n\n\nactivities to ensure smooth implementation. The majority of \n\n\n\nrespondents have generally pessimistic views on DF. Personal \n\n\n\nopinions do not necessarily reflect the objective reality as \n\n\n\npersonal views are dependent on the accuracy of the \n\n\n\nindividual\u2019s assessment. Contrary to what people tend to \n\n\n\nbelieve, personal views are often flawed due to biases that can \n\n\n\nprevent the people from arriving at accurate judgments or \n\n\n\ndecisions.[24] These biases may be attributed to the lack of \n\n\n\ninformation required to achieve accurate self-assessment. \n\n\n\nHowever, obtaining accurate information is not always an easy \n\n\n\nand straightforward task.[25] Effective communication \n\n\n\nstrategy is lacking in health education. The implementation of \n\n\n\n\n\n\n\n\nK.S. Lee et al. Malaysian Journal of Pharmacy 6 (1) 2020 \n\n\n\n\n\n\n\n19 \n\n\n\n\n\n\n\nstrategy should adopt theoretical framework that can adapt to \n\n\n\ncultural differences.[26-29] \n\n\n\n\n\n\n\nThis study also explored public\u2019s perception about DF. The \n\n\n\nrespondents lack exposure to DF despite the DF has been \n\n\n\npromoted in supermarket chains, private buses and taxis, 287 \n\n\n\nhealth facilities throughout Kelantan, the Ministry of Defence, \n\n\n\nthe Election Commission of Kelantan, the Department of \n\n\n\nInformation, the Universiti Malaysia Kelantan and Universiti \n\n\n\nTeknologi MARA Kelantan.[11] \n\n\n\n\n\n\n\nAnother main concern of the respondents was that information \n\n\n\nconveyed by DF may not translate into actual behavioral \n\n\n\nchange. The mass media are intensively employed in public \n\n\n\nhealth with vast sums spent annually for the production and \n\n\n\ndistribution of booklets, pamphlets, exhibits, newspaper \n\n\n\narticles, and radio and television programs in the hope that three \n\n\n\neffects might occur: the learning of correct health information, \n\n\n\nthe changing of health attitudes, and ultimately the change of \n\n\n\nbehavior. Changing behavior is the ultimate and highest \n\n\n\npriority in any public health campaign, but most of the mass \n\n\n\nmedia will change knowledge and awareness more easily than \n\n\n\nbehavior. [30] \n\n\n\n\n\n\n\nIn a meta-analysis, Shen et al. analyzed the results of 22 studies \n\n\n\nand concluded that EE messages had a significant small effect \n\n\n\non persuasion (r = .12) with a slightly stronger effect on health \n\n\n\nknowledge that on attitudes, intention, and behaviors. This \n\n\n\nsuggests that EE can be more effective in communication \n\n\n\nhealth-related information, especially in educating people \n\n\n\nabout a variety of health issues than changing attitudes and \n\n\n\nbehaviors.[10] \n\n\n\n\n\n\n\nStrengths and limitations of this study \n\n\n\n\n\n\n\nTo the best of our knowledge, no documented literature has \n\n\n\ninvestigated the conduct and organization of DF program (i.e. \n\n\n\nhealth promotion delivered in a pharmacy). In this study, a \n\n\n\ntotal of nine pharmacy enforcement officers from Kelantan \n\n\n\nPharmacy Enforcement Department and twenty three general \n\n\n\npublic participants from three different health clinics in Kota \n\n\n\nBharu, Kelantan presented multiple perspective regarding the \n\n\n\nquality and impact of DF. Two data collection methods (semi-\n\n\n\nstructured interviews and focus group discussions (FGDs)) \n\n\n\nwere used to generate data. \n\n\n\n\n\n\n\nIn term of weakness of the study, the respondents had only \n\n\n\nbeen interviewed once. Since DF is still being implemented, \n\n\n\nits progress still needs to be followed and the respondents \n\n\n\nshould be interviewed again after a specified timeframe to \n\n\n\nobserve for changes in their opinions. In addition, the team \n\n\n\nleader of DF has not been interviewed. The opinions of the \n\n\n\nteam leader will be valuable in order to have balanced views. \n\n\n\nThe second part of our study consisted of interviews of 23 \n\n\n\ngeneral public. While their opinions gave us very valuable \n\n\n\ninsights into different aspect of DF, they cannot represent and \n\n\n\nspeak for the whole population in Kelatan, Malaysia and other \n\n\n\nrural residents of Malaysia. Moreover, there is a chance that \n\n\n\nreporting bias exists since the interviews were conducted face-\n\n\n\nto-face which may have put some pressure on the respondents. \n\n\n\nFuture studies may include pharmacists from other settings \n\n\n\nsuch as hospital pharmacists or academician pharmacists since \n\n\n\nthey are also involved in health education and their opinions \n\n\n\ncan contribute to the betterment of DF. \n \n\n\n\nCONCLUSION  \n  \n\n\n\nDF represented an innovative health promotion platform for the \n\n\n\nKelantan Pharmacy Enforcement Division. It intensifies the \n\n\n\ndissemination degree of knowledge and information related to \n\n\n\ndrugs and cosmetics regulations to the public. In general, the \n\n\n\npublic has positive views on DF. This is reflected in their \n\n\n\nfavorable and optimistic comments on DF. However, certain \n\n\n\nweaknesses have been raised; significant effort must be made \n\n\n\nto improve the publicity and dissemination of DF to ensure that \n\n\n\nit reaches the target population and it is used to its optimum \n\n\n\npotential. The elements of entertainment and comedy provided \n\n\n\nextra value to education in an interesting and informal way. \n\n\n\nHowever, more research needs to be done in order to analyze \n\n\n\nthe actual impacts of DF and to evaluate its effectiveness versus \n\n\n\nits cost. It is hoped that DF can benefit from this study and more \n\n\n\ninnovations in health education are to be implemented in future. \n  \n\n\n\nACKNOWLEDGMENTS  \n  \n\n\n\nWe are thankful to Khadeeja Munawar, Long Chiau Ming, \n\n\n\nShahrzad Salmasi, Kong Chien Phang for interview \n\n\n\ntranscribing and language editing. \n\n\n\n\n\n\n\nCONFLICT OF INTERST \n  \n\n\n\nThe authors declare no conflict of interest.  \n\n\n\n\n\n\n\nREFERENCES  \n \n\n\n\n1. World Health Organisation, Milestones in Health Promotion: \nStatements from Global Conferences. 2009, WHO press: Geneva, \n\n\n\nSwitzerland  \n\n\n\n2. Rimal, R.N. and M.K. Lapinski, Why health communication is \nimportant in public health. 2009, World Health Organisation, . p. 247-\n\n\n\n247. \n\n\n\n3. Hamdan, N.K.A., et al., Knowledge and Perception of Facial Candling \nfor Allergic Rhinitis among University Staff and Students. Evidence-\n\n\n\nBased Complementary and Alternative Medicine, 2020. 2020. \n\n\n\n4. Choudhry, F.R., et al., Health literacy studies conducted in Australia: \na scoping review. International journal of environmental research and \n\n\n\npublic health, 2019. 16(7): p. 1112. \n\n\n\n5. Meppelink, C.S., et al., The Effectiveness of Health Animations in \nAudiences With Different Health Literacy Levels: An Experimental \n\n\n\nStudy. J Med Internet Res, 2015. 17(1). \n\n\n\n6. Berkman, N.D., et al., Low health literacy and health outcomes: an \nupdated systematic review. Ann Intern Med, 2011. 155(2): p. 97-107. \n\n\n\n7. Dikul, J. and R. Kiting, The Use of Folklore as Educational \n\n\n\nEntertainment Materials. 2019. \n8. Halid, R.I.R., Modernizing tradition: the media and dikir barat of \n\n\n\nKelantan. 2011. \n\n\n\n9. Lee, S.C., Integrating entertainment and critical pedagogy for \nmulticultural pre-service teachers: film watching during the lecture \n\n\n\nhours of higher education. Intercultural Education, 2019. 30(2): p. \n\n\n\n107-125. \n\n\n\n\n\n\n\n\nK.S. Lee et al. Malaysian Journal of Pharmacy 6 (1) 2020 \n\n\n\n\n\n\n\n20 \n\n\n\n\n\n\n\n10. Shen, F. and J. Han, Effectiveness of entertainment education in \n\n\n\ncommunicating health information: a systematic review. Asian J \n\n\n\nCommun, 2014. 24(6): p. 605-616. \n\n\n\n11. Bahri, S., et al., Dikir Farmasi: folk songs for health education. Arts \n\n\n\n& Health, 2016. 8(3): p. 272\u2013278. \n12. Pharmaceutical Services Division (Ministry of Health Malaysia), \n\n\n\nMedicine advertisement sketch- Dikir Farmasi 2. Available from: \n\n\n\nhttp://www.pharmacy.gov.my/v2/en/videos/sketsa-iklan-ubat-dikir-\nfarmasi-2.html. Accessed 17 April 2016. 2016. \n\n\n\n13. Lee, K.S., et al., Public perceptions on dikir farmasi: A qualitative \nexploratory study. Research in Social and Administrative Pharmacy, \n\n\n\n2017. 4(13): p. e36. \n\n\n\n14. Lee, K.S., et al., Folk songs for health education: Implementation and \nqualitative evaluation. Research in Social and Administrative \n\n\n\nPharmacy, 2017. 4(13): p. e36. \n\n\n\n15. Kelantan State Health Department, Dikir Farmasi Sketch \n(Pharmaceutical Services). Available from: \n\n\n\nhttps://www.youtube.com/watch?v=pl06Bd3HzR0. Accessed 17 \n\n\n\nApril 2016. 2015. \n16. Pharmaceutical Services Divisions, Pharmacy Enforcement Division, \n\n\n\nMinistry of Health Malaysia. Available from: \n\n\n\nhttp://www.pharmacy.gov.my/v2/en/content/pharmacy-enforcement-\ndivision.html. Accessed 15 April 2016. 2016. \n\n\n\n17. Pharmaceutical Services Division (Ministry of Health Malaysia), \n\n\n\nProduct Registration- Dikir Farmasi. Available from: \nhttp://www.pharmacy.gov.my/v2/en/videos/dikir-farmasi-jom-guna-\n\n\n\nubat-berdaftar.html. Accessed 17 April 2016. 2016. \n\n\n\n18. Kelantan State Health Department, Pharmacy Department. Available \nfrom: \n\n\n\nhttp://jknkelantan.moh.gov.my/v3/modules/AMS/article.php?storyid\n\n\n\n=17. Accessed 16 April 2016. 2016. \n19. Kelantan State Health Department, Dikir Farmasi Mobile Application. \n\n\n\nAvailable from: \n\n\n\nhttps://play.google.com/store/apps/details?id=air.DikirFarmasi&hl=e\nn. Accessed 16 April 2016. 2015. \n\n\n\n20. Kickbusch, I.S., Health literacy: addressing the health and education \n\n\n\ndivide. Health Promot Int, 2001. 16(3): p. 289-97. \n21. Kickbusch, I., Think health: what makes the difference? Health \n\n\n\nPromot Int, 1997. 12(4): p. 265-272. \n\n\n\n22. Lean, Q.Y., et al., Online versus classroom learning in pharmacy \neducation: Students' preference and readiness. Pharmacy Education, \n\n\n\n2020. 20: p. 19-27. \n\n\n\n23. Ackerson, L.K. and K. Viswanath, The social context of interpersonal \ncommunication and health. J Health Commun, 2009. 14 Suppl 1: p. \n\n\n\n5-17. \n\n\n\n24. Schafer, T., A. Tipandjan, and P. Sedlmeier, The functions of music \nand their relationship to music preference in India and Germany. Int J \n\n\n\nPsychol, 2012. 47(5): p. 370-80. \n\n\n\n25. Singhal, A., et al., Entertainment-education and social change: \nHistory, research, and practice. 2003: Routledge. \n\n\n\n26. Sorensen, K., et al., Health literacy and public health: a systematic \n\n\n\nreview and integration of definitions and models. BMC Public Health, \n2012. 12: p. 80. \n\n\n\n27. Appelt, K.C., et al., The Decision Making Individual Differences \n\n\n\nInventory and guidelines for the study of individual differences in \n\n\n\njudgment and decision-making research. Judgment and Decision \n\n\n\nMaking, 2011. 6(3): p. 252. \n\n\n\n28. Glanz, K. and D.B. Bishop, The role of behavioral science theory in \ndevelopment and implementation of public health interventions. Annu \n\n\n\nRev Public Health, 2010. 31: p. 399-418. \n\n\n\n29. Sam, D.L. and J.W. Berry, Acculturation when individuals and groups \nof different cultural backgrounds meet. Perspectives on Psychological \n\n\n\nScience, 2010. 5(4): p. 472-481. \n30. Ting, C.Y., et al., A Cross-Sectional Study on the Use of, Preference \n\n\n\nfor, and Perceived Reliability of Mass Media for Drug-Related \n\n\n\nInformation Among the General Public in Sarawak. Therapeutic \n\n\n\nInnovation & Regulatory Science, 2016. 51: p. 1-9. \n\n\n\n\n\n\n\n \n\n\n\n\nhttp://www.pharmacy.gov.my/v2/en/videos/sketsa-iklan-ubat-dikir-farmasi-2.html\n\n\nhttp://www.pharmacy.gov.my/v2/en/videos/sketsa-iklan-ubat-dikir-farmasi-2.html\n\n\nhttp://www.youtube.com/watch?v=pl06Bd3HzR0\n\n\nhttp://www.pharmacy.gov.my/v2/en/content/pharmacy-enforcement-division.html\n\n\nhttp://www.pharmacy.gov.my/v2/en/content/pharmacy-enforcement-division.html\n\n\nhttp://www.pharmacy.gov.my/v2/en/videos/dikir-farmasi-jom-guna-ubat-berdaftar.html\n\n\nhttp://www.pharmacy.gov.my/v2/en/videos/dikir-farmasi-jom-guna-ubat-berdaftar.html\n\n\nhttp://jknkelantan.moh.gov.my/v3/modules/AMS/article.php?storyid=17\n\n\nhttp://jknkelantan.moh.gov.my/v3/modules/AMS/article.php?storyid=17\n\n\n\n"
"\n\n\n\n\n\n\n\n\n\nMANAGEMENT OF MILD VALPROIC ACID TOXICITY WITH \nHEMODIALYSIS \u2013 A CASE REPORT \n\n\n\nChow NK*, Heng LM \n\n\n\nDepartment of Pharmacy, Hospital Kulim, Jalan Mahang, 09000 Kulim, Kedah, Malaysia. \n*Author for correspondence \n\n\n\nABSTRACT \n\n\n\nThe management of Valproic Acid (VPA) toxicity is mainly supportive treatment. Invasive \nmanagement such as hemodialysis (HD) and hemoperfusion were only used in isolated cases \nwhere patient is highly VPA toxic, which results in coma. We described a case of mild VPA \ntoxicity (VPA serum concentration 326.42mcg/mL), where the patient was successfully treated \nwith two hours of low-flux HD with no complication. While the guideline of indication of HD \nin VPA toxicity has yet to be published, low-flux HD can be an effective treatment in cases of \nmild VPA toxicity, if other supportive measures failed or not available. \n\n\n\nKEYWORDS: Valproic acid toxicity; hemodialysis; therapeutic drug monitoring; \npharmacokinetic \n\n\n\nINTRODUCTION \n\n\n\nValproic acid (2-propylpentanoic acid; VPA) is widely prescribed for the treatment of epilepsy, \nbipolar mood disorder (BMD), and for migraine prophylaxis. VPA toxicity is an uncommon \nproblem seen in clinical practice. However, due to its increased usage, accidental and \nintentional overdose can occur. Serious VPA toxicity may lead to coma, confusion, \nsomnolence, hallucinations, cerebral edema and even death. Currently, the VPA toxicity \nmanagement recommended include initial stabilization and resuscitation, decontamination, \npharmacologic therapy, hemodialysis (HD) or hemoperfusion. There are isolated case reports \nand systematic review regarding management of VPA toxicity, yet, a consensus guideline or \nprotocol is still not available. Hereby, we report a case of VPA toxicity successfully treated \nwith two hours of low-flux HD, resulting in a marked reduction of VPA serum concentration \nand toxicity symptoms subsided. \n\n\n\nCASE PRESENTATION \n\n\n\nA 30-year-old woman presented to the Emergency Department at 4.30am due to vomiting and \nexcessive drowsiness after multiple medications ingestion at around 2.30am. The empty \nmedications strips include missing of eight tablets paracetamol, ten tablets chlorpheniramine \nmaleate, ten tablets sodium valproate (Epilim\u00ae), and twenty tablets gabapentin. Patient has no \nunderlying epilepsy or psychiatric related illness, and denied high risk behaviour or history of \nsubstance abuse. The medications ingested were taken from her uncle who has BMD. Upon \nadmission, patient was not responding to call and pupils sluggish bilaterally (2mm/2mm). Vital \nsigns were normal with oxygen saturation 100% and blood glucose 5.7mmol/L.  \n\n\n\nMANAGEMENT AND OUTCOME \n\n\n\nPatient was given 50g oral activated charcoal (AC) at 6.45am but could only tolerate 25g. She \nwas then sent for brain computed tomography (CT) scan. The serum VPA concentration taken \nat 5 hours post ingestion for Therapeutic Drug Monitoring (TDM) measured by fluorescent \npolarization (Cobas Integra 400 plus analyzer, Roche Diagnostics (M) Sdn. Bhd.) was \n326.42mcg/mL (therapeutic range 50-100mcg/mL). Paracetamol, salicylic acid, phenytoin and \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\ncarbamazepine toxicity had also been ruled out. After CT scan, patient was noted to be drowsier \nwith Glasgow Coma Score (GCS) of 12/15, laboured breathing and was not respond to pain \nstimuli. The patient was then intubated, ventilated and sedated and was admitted to the \nintensive care unit. All the blood investigations were normal. Low-flux HD (via a right femoral \nvenous catheter) was performed for two hours with blood flow rate 150 mL/min and was \nuneventful. On the next day, the second TDM result (12 hours post HD) showed a marked \ndecrease in VPA level to 37.14mcg/mL (non-toxic). Patient had regained full GCS with normal \narterial blood gas (ABG) result. She was then extubated and referred to psychiatrist and allowed \nto discharge two days later with no complication. \n\n\n\nDISCUSSION \n\n\n\nThe classification of VPA toxicity is dose dependent. Mild: Dose >200mg/kg and having risk \nof CNS depression; moderate: >400mg/kg and having risk of multi-organ system toxicities; \nsevere: >750mg/kg and is potentially lethal. Maximum therapeutic dose is 60mg/kg/day.1 Since \nthe exact quantity of VPA ingested by the patient might not be accurate, we can only categorize \npatient based on the symptoms of CNS depression, which is mild toxicity. \n\n\n\nOverdose of gabapentin and chlorpheniramine maleate can cause subtle mental status changes \nand drowsiness too. However, only mild clinical effects have been documented following \nsignificant overdose of gabapentin and chlorpheniramine due to their benign side-effect profile. \nVPA has neither significant interaction nor synergism effect with both gabapentin and \nchlorpheniramine. \n\n\n\nThe time for the enteric-coated sodium valproate tablet to reach maximum concentration (Tmax) \nnormally occurs within 3-7 hours. In this case, deterioration of patient condition happened at \naround 5 hours post ingestion might be due to the high serum VPA concentration at Tmax. \n\n\n\nDecontamination with activated charcoal is best to be administered within 0.5-1 hour of VPA \ningestion for maximum effect. AC may still be indicated after one hour post ingestion for \nenteric coated preparation due to the potentially delayed absorption. As this patient was \nadmitted two hours post ingestion and could not tolerate AC, other modes of treatment are \nrequired. \n\n\n\nSome literatures had documented naloxone for the reversal of sedation and coma at VPA level \nof 487.8mcg/mL and in cases of opioid co-ingestion.2 Since this patient\u2019s condition was \nmanageable after intubation, naloxone was not given. On the other hand, L-carnitine is also \nsuggested for hyperammonemia associated with carnitine deficiency caused by long-term or \nhigh-dose VPA use. L-carnitine is not available in our setting and this patient had normal liver \nfunction tests with no hyperammonemia.  \n\n\n\nTherefore, the modes of treatment left to enhance elimination of VPA from the body available \nin our setting were HD and hemoperfusion. Despite the benefit of extracorporeal elimination \ntechniques is undeniable, the clear indication and method of the techniques in VPA toxicity is \nstill undefined. Charcoal hemoperfusion is proved to be more superior in clearing protein-\nbound and lipid soluble drugs, with equal effectiveness in clearing water soluble and small \nmolecule drugs if compared to HD.3 Since VPA is poorly water soluble (solubility in water \n1.3mg/mL at room temperature), charcoal hemoperfusion seems to be more eligible treatment \noption. However, it has limitation in terms of complications, such as thrombocytopenia, \nelectrolyte imbalance, disturbances in coagulation and technically and logistically more \ncomplicated. 3, 4 \n\n\n\nOn the other hand, VPA is a small molecule (MW 144.2) with about 90% plasma protein \nbinding. At supratherapeutic level, the binding sites may become saturated, causing the amount \nof free drug to increase rapidly.4 Low molecular weight and decreased protein binding during \ntoxicity make it ideal for removal through HD. With 2 hours of low-flux HD conducted, the \nVPA serum concentration was able to reduce by 88.6%.  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nRebound phenomenon was reported by a few studies, where a slight increase in VPA levels \nnoted after termination of HD.4, 5 This suggests that VPA may not follow single compartment \nkinetics at toxic concentration and redistribution from other body compartments may occur. In \norder to avoid rebound concentration of VPA after HD, repeated TDM level of VPA was \nscheduled at 12 hours post HD. \n\n\n\nCONCLUSION \n\n\n\nWe have shown in our patient that HD is effective to eliminate excess VPA concentration in \nacute poisoning case when supportive measures failed or not available. More studies are \nrequired to identify the recommended indication for HD based on VPA serum concentration \nand also weighing the risk and benefit of HD or hemoperfusion in different clinical situation. \nMore evidences are also needed regarding the TDM sampling time of VPA serum \nconcentration in acute toxicity cases, including the initial post ingestion sampling time and also \npost dialysis sampling time, by taking the rebound phenomenon into consideration. \n\n\n\nACKNOWLEDGEMENT \n\n\n\nThe authors would like to thank the Director General of Health Malaysia for his permission to \npublish this article. \n\n\n\nCONFLICT OF INTEREST \n\n\n\nThe authors affirm that this case report is original and have no conflict of interest to disclose. \n\n\n\nREFERENCES \n\n\n\n1. Truven Health Analytics. Micromedex Drug Information. Michigan: Truven Holding Corp; \n2017. \n\n\n\n2. Thanacoody HKR. Chronic valproic acid intoxication: reversal by naloxone. Emerg Med J \n2007; 24: 677\u2013678. \n\n\n\n3. Winchester JF. Hemoperfusion. In: Drukker W, Parsons FM, Maher JF, editors. \nReplacement of renal function by dialysis: a textbook of dialysis. Netherlands: Springer; \n1983: 305-322. \n\n\n\n4. Meek MF, Broekroelofs J, Yska JP, Egbers PHM, Boerma EC, van der Voort PHJ. Valproic \nacid intoxication: sense and non-sense of haemodialysis. The Journal of Medicine, \nNetherlands, October 2004; 62 (9): 333-336. \n\n\n\n5. Van der Wouden EA, Dekkers A, Kruis HME, van Geijlswijk IM, Tjan DHT, Feith GW. \nExtracorporeal elimination in acute valproate intoxication. BMJ Case Reports 2009. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n"
"\n\nMalaysian Journal of Pharmacy 2003;1(3):69-75  General article \n\n\n\n 69\n\n\n\nBrief History And Development Of Parenteral \nNutrition Support \n \nAhmad Fuad Shamsuddin \n \n\n\n\nDepartment of Pharmacy, Faculty of Allied Health Sciences, Universiti Kebangsaan Malaysia, \n50300 Kuala Lumpur, Malaysia.  \n \n \nABSTRACT \n \nPatients who are unable to use their gastrointestinal system for feeding purposes are \nnow usually started on parenteral nutrition. It is a therapeutic tool used in the \nclinical management of patients requiring special nutritional care both in the \nhospital, and at home (home parenteral nutrition). The idea of providing nutrients \nintravenously in humans was first realised when Sir Christopher Wren injected \nwine and ale in dogs way back in the middle of the 17th century. The historic \nexperiment initiated further investigation and studies on this novel approach to \nnutrition. Better understanding of the metabolic and pharmacological properties of \nthe macronutrients (protein, carbohydrates, and   lipid), the micronutrients (trace \nelements, and vitamins), and the electrolytes have made it possible to administer \nparenteral nutrition safely to all types of patients where it is indicated. Continuous \ndevelopment and improvement in the pharmaceutical presentations of these \nnutrients have helped to minimise the metabolic problems seen in the early days of \nparenteral nutrition administration.  Production of the single- or multilayered \nparenteral nutrition bags using materials which are inert and capable of reducing \noxygen permeability such as the combination of ethylenevinylacetate-polyvinylidine \nchloride has ensured better stability of the parenteral nutrition admixture.   The \nmulticompartmental bag has provided a much more simpler and convenient way of \ninitiating parenteral nutrition. The increase in knowledge, development and \nimprovement in parenteral nutrition support has made it possible to provide \nparenteral nutrition support at home.  \n \nKeywords: parenteral nutrition, enteral nutrition, macronutrients, micronutrients, \nconvenience bags \n \n \nINTRODUCTION \n \nParenteral nutrition (PN) is a relatively new \ntherapeutic tool used in the clinical management \nof patients.  Arguably, the era of modern clinical \nnutrition can be said to have dawned around 35 \nyears ago when Dudrick and colleagues reported \ntheir work on the successful administration of \nlong-term PN in an infant (1).  In Malaysia, PN \nservice was established in late 1986 at the \nKuantan General Hospital (Hospital Tengku  \n\n\n\n \n \nAmpuan Afzan, Kuantan, Pahang) (2), while \nBahari reported that formal parenteral nutrition \nrounds led by pharmacists were initiated at the \nuniversity hospital of Universiti Sains Malaysia \n(HUSM) a year later (3). \n \nPN is a mode of providing nutritional \nsupplement that involves the administration of \nnutrients through the intravenous route (viz par \n\n\n\n\n\n\n\n\nGeneral article: Development of parenteral nutrition support \n\n\n\n 70\n\n\n\nenteral).  It is also widely and affectionally \nknown as total parenteral nutrition or TPN, \nalthough intravenous nutrition, and artificial \nnutrition are accepted terms to convey the same \nmeaning. Hyperalimentation, that is the \nprovision of nutrients at high concentration \nintravenously, was the term used during the early \ndays of this novel nutritional approach (which, \nliterally, was the reason for most of the adverse \neffects of PN therapy back then!). Nowadays, the \nterm PN is widely used in the literature to denote \nthe administration of nutrients intravenously. \n \nBasically, PN is only indicated when the oral, or \nenteral route (i.e. the use of the gastrointestinal \nsystem) of nutrition cannot be established, or is \ninsufficient for the maintenance of the patient\u2019s \nnutritional requirements in relation to his/her \nclinical status. Partial parenteral nutrition  (PPN) \nis the concurrent intravenous administration of \nnutrients together with oral or enteral nutrition \nfor the same therapeutic objective.  \n \nThe dietary components of a standard PN \nregimen are the macronutrients (protein or amino \nacids, carbohydrate, and lipids or fats), the \nelectrolytes, the micronutrients (trace elements, \nand vitamins) and water. Carbohydrate, in the \nform of glucose or dextrose, and lipids are the \nmajor energy providers.  \n \nEarly work on intravenous nutrition \n \nThe main role and function of the major \ncomponents of the diet in human growth and \ndevelopment were recognised only around a \ncentury ago (4).  Nevertheless, the history of \nintravenous infusion of nutrients began in 1665, \nwhen Sir Christopher Wren injected wine and ale \nto dogs, and noted that intravenously \nadministered alcohol had the same effect as \nalcohol taken orally (5).  \n \nIndeed, investigators and clinicians have long \nrealised the importance of providing adequate \nnutrition to patients, more so to those with \ngastrointestinal problems. The intravenous route \nof nutrient administration was seen to be one \npossible avenue to venture into in the nutritional \nmanagement of patients who cannot consume \nfood orally. Ever since the historic experiment \nby Wren, various workers had experimented \nproviding nutrients such as carbohydrates and \nlipids in animals, and also humans in their effort \nto understand and develop this novel approach to \nnutrition.   \n\n\n\nStirius, in 1668, published a review on this \nsubject of intravenous experiments in which he \ndeduced that intravenous infusions were, or \ncould be applicable to nearly all disease states, \nexcept where pregnant women and newborn \nchildren were involved. These patients were \nconsidered by Stirius as difficult and bad \nsubjects to treat (6).  \n \nAlthough the deduction of Stirius still holds \nsome relevance today, advances in the \nknowledge and technical capabilities in the \nadministration of PN over the last two decades \nhave made it possible to administer intravenous \nnutrition even to pregnant mothers (7) and low \nbirth-weight neonates (8,9), the so called \ndifficult and bad subjects!  \n \nEarly results of intravenously administered \nnutrients were not promising because of the \nadverse effects associated, although the desired \noutcomes were also observed. These unwanted \neffects, caused by poor administration \ntechniques, and the use of crude compounds led \nto some of the work in this field of intravenous \nnutrition research being prematurely abandoned \n(10).  One such incident is the work of Friedrich \nin 1904, in which he administered what can be \nconsidered the first total PN in man, \nsubcutaneously. These infusions of peptone, fat, \nglucose and electrolytes were so painful that not \neven Dr. Friedrich wanted to pursue \ndevelopment in this area of research (10).  Also, \nit can be safely deduced that the lack of \npharmaceutical and microbiological knowledge \nmeant that problems of stability (incompatability \nand interactions included), and sterility were not \nrecognised and duly addressed during those early \nyears. \n \nIntravenous administration of proteins \n \nEver since the 19th century, protein has been seen \nto have an important role in the growth and \ndevelopment of humans (11).  The special nature \nof protein and its metabolism made it a challenge \nto find suitable ways of administering it \nintravenously. The first study in the intravenous \nadministration of proteins was made in goats in \nthe form of protein hydrolysates by Herriques \nand Andersen in 1913 (10). These hydrolysates \nwere products of the naturally occurring proteins \nsuch as fibrin and casein. Positive nitrogen \nbalanced was achieved, thus demonstrating the \nrole of intravenous protein hydrolysates as \npossible alternative to dietary protein in animals.  \n\n\n\n\n\n\n\n\nGeneral article: Development of parenteral nutrition support \n\n\n\n 71\n\n\n\nIt was only after 1937, when Elman published \nhis pioneering studies on the intravenous \ninfusion of protein hydrolysates in man (12), that \ninvestigations of complete intravenous nutrition \n(i.e. the intravenous administration carbohydrate, \nprotein, and lipids concurrently) were initiated \nworldwide. Due to serious complications such as \nhigh concentration of di- and tripeptides \nresulting from incomplete hydrolysis, poor \nutilisation of nitrogen, and hyperammonaemia \n(13), the use of protein hydrolysates in PN has \nnow been superseded by the more flexible \ncrystalline amino acids.   \n \nToday, various parenteral amino acid \npreparations for specific clinical states have been \ndeveloped and marketed such as Aminoplasmal \nHepa\uf6da (B.Braun Germany) for PN patients with \nliver dysfunction; Vaminolact\uf6da (Fresenius Kabi, \nSweden) and Promene\uf6da 10% (Baxter, UK) for \nneonates and infants, and Glamin\uf6da (Fresenius \nKabi, Sweden), which is an amino acid formula \nwith a higher concentration of glutamine. For \npatients with renal impairment, amino acid \nsolutions without electrolytes such as Vamin\uf6da 14 \nEF (Fresenius Kabi, Sweden) are recommended. \n \nIntravenous glucose infusion \n \nAt the turn of the century, in 1896, Beidl and \nKraus administered the first intravenous infusion \nof glucose solution in man, around 40 years after \nthe importance of glucose for metabolism was \nfirst demonstrated. 200-300 ml of a 10% glucose \nsolution was administered with no glucosuria \nobserved although severe fever resulted (10). \nGlucose infusion was recognised as the only \nsource of energy before the advent of a suitable \nlipid emulsion that could be safely administered \nintravenously in humans. In the desire to obtain \nhigher calorie supplement, higher concentrations \nof glucose solution were infused. Inevitably, vein \nirritation and thrombophlebitis ensued when high \nconcentrations of glucose solution were infused \nperipherally. These problems were overcome \nwhen Dudrick and co-workers showed that \nhigher concentrations of glucose could be \nadministered safely through the central veins in \ndogs (1). Ever since then, PN admixtures with \nhigh concentrations of glucose have been safely \nadministered in humans through the subclavian \nvein or the central intravenous route. \n \nEarly intravenous administration of lipids \n \nThe earliest published record of intravenous lipid \n\n\n\nadministration was made by Courten in 1712, \nwhen he infused 1 g per kg body weight of olive \noil in a dog. However, severe respiratory distress \nsymptoms were observed, and the dog eventually \ndied (10).  It was then assumed that all oils or \nfats, for that matter, should only be infused in a \nspecialised and suitable form. Further \ninvestigations by Menzel and Perco more than \n150 years later, also in dogs, showed that large \namounts of lipids could be administered \nintravenously without adverse effects (10).  \n \nThe interest in using lipids in PN led various \ninvestigators to work on lipid emulsions of \nvarious composition such as castor oil (14), olive \noil (15) and cottonseed oil (16). All these lipid \nemulsions caused side effects in humans such as \nnausea, vomiting and fever. Other serious \nadverse reactions notably liver damage, jaundice \nand bleeding tendency were also observed \nleading the United States of America to ban the \nusage of lipid emulsions for PN in 1964. During \nthis time in Europe, Schuberth and Wretlind \ndeveloped a safe and efficacious form of lipid \nemulsion from soybean oil using egg yolk \nphospholipids as the emulsifying agent (17). This \nlipid emulsion (consisting of long chain \ntriglycerides, LCT) marketed as Intralipid\uf6da \n(Fresenius Kabi, Sweden) became one of the \nmost widely used lipid emulsions in PN \nadministration until today. [N.B. intravenous \nlipid emulsions were subsequently reintroduced \nin the U.S. market in 1975 (18)].  \n \nToday, various concentrations (10, 20 and even \n30%), and composition of lipid emulsion (LCT, \nand combination of LCT and medium chain \ntriglycerides, MCT [Lipofundin\uf6da MCT/LCT, B. \nBraun Germany]) are used in PN therapy. \nInvestigations into the use of parenteral fish oil \nemulsion (n-3 fatty acids) (e.g. 10% Omegaven\uf6da \n\n\n\n[Fresenius, Germany]), and the re-emergence in \nthe use of olive oil in combination with soya \nbean (ClinOleic\uf6da 20% [Baxter, UK]) in the last \n10 years suggest new alternatives in the use of \nlipid emulsion in PN (19). \n \nElectrolytes and the micronutrients  in \nparenteral nutrition \n \nThe importance of salts in humans was realised \nwhen the blood chemistries of cholera patients \nwere investigated by O\u2019Shaughnessy in 1839, \nand Latta followed up these findings in the same \nyear by infusing, intravenously, solutions of the \nsalts that were found low in the blood of dying \n\n\n\n\n\n\n\n\nGeneral article: Development of parenteral nutrition support \n\n\n\n 72\n\n\n\ncholera patients. Majority of these patients \nremarkably recovered (20). Various \nconcentrations of sodium chloride infusions (e.g. \n0.9% sodium chloride, and 0.45% sodium \nchloride) are now used for parenteral fluid and \nelectrolyte therapy. These findings coupled with \nthe work of Beidl and Kraus in 1896 on the \ninfusions of glucose in humans led to the salt-\nglucose solutions which became the so-called \nstandard parenteral solution of the early part of \nthe 20th century (20). These solutions are now \nstill used as dextrose-saline combinations in \nintravenous fluid therapy in the various clinical \nsettings.  \n \nThe need to provide trace elements or the \nmicronutrients in PN came to light only around \n25 years ago when it was shown by Jeejeebhoy \nand co-workers that long-term PN caused \nchromium deficiency (21). Work by Buzzeti and \ncolleagues a few years later confirmed the \nexistence of hypocupraemia in a patient \nattributed to PN administration (22). Trace \nelements are now normally added in the PN \nadmixture in the form of standard trace element \npreparations such as Additrace\uf6da (Fresenius Kabi, \nSweden), Peditrace\uf6da (Fresenius Kabi, Sweden) \nand individual injections (e.g. zinc sulphate, and \nmagnesium sulphate injections) to supplement \nthe daily needs for these micronutrients.  \n \nThe importance of vitamins, another group of \nmicronutrients, in nutrition was first appreciated \nin the early part of the twentieth century when \nresearchers found that animals required more \nthan carbohydrate, protein, fat, minerals and \nwater to support life and growth (23). In the \nparenterally-fed malnourished patients, signs of \nvitamin deficiencies were observed in the blood \nlevels after a few days on vitamin-free PN (24). \nVitamins are now routinely added in the PN \nadmixture using various products such as \nmultiple vitamins preparations (Soluvit\uf6da, \nVitalipid\uf6da [Fresenius Kabi, Sweden]) which \nhave been developed based on the American \nMedical Association guidelines for vitamins for \nparenteral use (25). These vitamins can also be \nadded as individualised vitamin preparations \n(e.g.Vit K).  \n \nComplete intravenous provision of nutrients \nfrom a single bag \n \nOriginally, PN administration constituted the use \nof separate glass bottles. A 2-in-1 method was \nadopted where the amino acids solution and \n\n\n\nglucose were admixed together with the other \ncomponents of the PN regimen. Lipid emulsion \nwas administered from a separate bottle.  This \nsystem, which is still being adopted in some \nhospitals, requires two sets of intravenous \ntubings and infusion pumps leading to high cost \nand problems of sepsis, vein patency and lines \nmanagement (26).   \n \nIn the seventies, the All-in-One (AIO) system \nwas introduced by Solassol and colleagues to \nallow for the direct administration of PN in the \nambulatory patient (27). This system involved \nthe mixing of the main components of a PN \nregimen  (the amino acids, glucose and lipid \nemulsion and other nutrient components \u2013 the \nAIO admixture) in a single silicone rubber bag. \nThey showed that this admixture was stable and \nsafe to be administered to patients leading to a \nmore cost-effective and simple approach to PN \nadministration. This method has now been \nwidely accepted and is used worldwide although \nthe type of bags used has changed considerably. \n \nDevelopment of the PN bag \n \nWhen it was shown that mixing of the major \nnutrients was possible, the components of the PN \nadmixture (except lipids) were first mixed in \nbottles (26). The use of these bottles slowly lost \nfavour because of their bulkiness, and losses of \ncostly materials if they were inadvertently \ndropped and broken. \n \nIn light of this, a more flexible container was \nneeded leading to the use of polyvinyl chloride \n(PVC) bags.  However, it was later shown that \nthe use of PVC bags were not suitable due to \nadsorption of the components such as vitamin A \nto the bags (28, 29) and also the risk of \nplasticisers from the PVC matrix leaching out or \nbeing extracted by the contents of the admixture \n(30). Plasticisers can be extracted by the organic \ncontents of the admixtures such as the lipids and \nvitamins. \n \nThe practice of adding all the components \n(including lipid) of the PN regimen together (the \nAIO admixture) posed the inherent risk of \nphysicochemical stability problems. As the use \nof materials such as PVC will only compound \nthis problem, the ethylene-vinylacetate (EVA) \nbag which is more inert was introduced. The \nEVA bags possess advantageous thermoplastic \nproperties and favourable toxicological and \nbiocompatibility aspects (31). These bags are \n\n\n\n\n\n\n\n\nGeneral article: Development of parenteral nutrition support \n\n\n\n 73\n\n\n\nnow commonly used for the AIO admixtures. \n \nNowadays, multilayered bags have been \nintroduced to ensure a greater stability profile of \nthe PN admixture against oxidation. These bags \nconsist of multiple-layered plastic produced from \nthe combination of EVA-polyvinylidine chloride \n(PVDC) (32) or EVA-modified EVA ethylvinyl \nalcohol (EVOH) for example, which reduces the \npermeability of oxygen by 100 times compared \nto conventional EVA bags thus ensuring better \nstability of the admixture (33). \n \nFurther understanding of the physico-chemical \naspects of the PN regimens, and recent \ntechnological advances have led to the \ndevelopment of the prefilled multi-\ncompartmental bags for PN administration. The \nintroduction of these bags has provided easy \nmixing of the PN regimens and also provided a \nclose system which guarantees sterility of the \nadmixture. \n \n\n\n\nThe Easy-to-Mix System \n \nDuring the late eighties, an easy-to-mix (ETM) \nsystem was introduced to facilitate quick and \neasy mixing of PN regimens by pharmacy and \nnursing staff. This system comprises of a two-\nbottle system (VitrimixR [Fresenius Kabi, \nSweden]). One bottle contains a glucose-amino \nacid solution, whereas the lipid component is \ncontained in the other bottle. Compounding of a \nPN regimen (minus the micronutrients) involves \nthe simple transfer of the lipid emulsion into the \nglucose-amino acid solution via a tranfer pin. \nThis system has now been superseded by another \nETM system which was developed in the early \nnineties. \n \nThe new ETM system uses multi-compartmental \nEVA bags or the convenience bags (please refer \npreceding section) prefilled with the nutrients \nand electrolytes required for PN therapy.  These \nbags are presented as the double chamber \n(NutriflexR  [B Braun, Germany]), and triple \nchamber bags (KabivenR [Fresenius Kabi, \nSweden], Clinomel\uf6db [Baxter, UK]). The \nchambers are separated by various mechanisms \nsuch as a breakable port, peel-seal system, or a \npull-away flexible rod clamp.  In the double \nchamber bag, one compartment is filled with the \namino acids solution, while the other \ncompartment is filled with glucose based on a \nstandard nutritional regimen (the lipid \ncomponent is kept in a separated bottle, which is \nthen added to the system). In the triple-chamber \n\n\n\nbags, the third compartment is filled with the \nlipid emulsion. To use these bags, firm and \ngentle squeezing of the bag will break the \nintercompartmental seals; or the separating rod \nremoved, thus mixing the nutrients. Other \nnutrients such as the electrolytes, trace elements \nand vitamins can then be added based on the \ndaily allowances, and the bags are ready for \nadministration. The use of these bags, or the \nETM system ensure better stability of the AIO \nadmixtures and minimise the risk of \ncontamination during compounding.  \n \nHome Parenteral Nutrition \n \nHome parenteral nutrition (HPN) is the provision \nof parenteral nutrition at home. The need to \nprovide HPN was realised in the effort of \nreducing treatment cost due to long hospital stay, \nand to avoid hospital-acquired complications \n(e.g. infection) in the stabilised patients whose \nmain reason for continued hospitalisation is for \nPN therapy. With the increase in knowledge, \ndevelopment, and improvement in PN support, \nthe provision of HPN provides a comforting \nenvironment, and gives patients the freedom to \nreturn to normal activities such as work, and \neven travelling (34). HPN is indicated in patients \nwho have to rely on long-term PN such as those \nwith Crohn\u2019s disease and short bowel syndrome. \nHPN is also administered to patients suffering \nfrom acquired immunodeficiency syndrome \n(AIDS), chronic pancreatitis, hyperemesis \ngravidarum, and neoplasm (35).  \n \nHPN should be administered exclusively from an \nAIO admixture in a single bag. As such the \ncompounding of a stable admixture is usually \ncarried out by experienced pharmacy personnel \nin established centres. A patient needs only to \nattach the outlet port of the compounded bag, \naseptically, to the inserted catheter of the central \nroute (established by the surgeon in the hospital).  \nIt is common for the pharmacy department in the \nhospital where the patient has been treated to \nsupply compounded bags ready for use at home. \nStorage advice and correct use of the \ncompounded bags for HPN are usually provided \nby the pharmacist to these patients to avoid \nphysicochemical stability problems, and also \nclinical complications such as infection, and \nother metabolic derangements. Monitorings \nduring HPN administration by the nutritional \nsupport team help to provide safe and cost-\neffective nutritional therapy to these patients. \n\n\n\n\n\n\n\n\nGeneral article: Development of parenteral nutrition support \n\n\n\n 74\n\n\n\nCONCLUSION \n \nIn perspective, PN has now been accepted as part \nof the overall therapeutic management of the \nhospitalised patients when indicated. It is not \nonly limited to preventing starvation or \ncorrecting deficiencies (36). In more advanced \ncountries, the instigation or cessation of PN \ntherapy is subject to the same legal and moral \nconstraints as apply to other recognised therapies  \n\n\n\n37). Refinement and sophistication of techniques \nhave made optimal nutrition possible in virtually \nall patients regardless of the status of their \ngastrointestinal tract, or the presence of \ncomplicating metabolic disorders. Today, these \nadvances have also made home parenteral \nnutrition possible in stabilised patients who \nrequire this mode of nutritional support for a \nlonger period of time. \n\n\n\n\n\n\n\n***** \n \n\n\n\nREFERENCES \n \n1. Dudrick SJ, Wilmore, DW, Vars HM, Rhoads JE.  \n\n\n\nLong-termed parenteral nutrition with growth, \ndevelopment, and positive nitrogen balance. \nSurgery 1968; 64: 134-142. \n\n\n\n2. Hassan Y. Challenge to clinical pharmacy \npractice in Malaysia. Ann Pharmacotherapy  \n1993; 27: 1134 \u2013 1138. \n\n\n\n3. Bahari MB.  Total parenteral nutrition in \nMalaysia: an overview. Malays Pharm Soc J  \n1990: 23-26. \n\n\n\n4. Brown RO, Sacks, GS. Parenteral and enteral \nnutrition in adult patients. In Herfindal ET, \nGourley DR,  editors. Textbook of Therapeutics - \nDrug and Disease Management, 6th Ed. \nBaltimore: Williams & Wilkins; 1996. \n\n\n\n5. Annan GL. An exhibition of books on the growth \nof our knowledge of blood transfusions. Bull N N \nAcad Med   1938; 15: 623. \n\n\n\n6. Macht DI. The history of intravenous and \nsubcutaneous administration of drugs. J Amer \nMed Assoc 1916; 66: 856-860. \n\n\n\n7. Greenspoon JS, Safarik RH, Hayashi JT, Rosen \nDJ. Parenteral nutrition during pregnancy. Lack of \nassociation with idiopathic preterm labor or \npreeclampsia. .J Reprod Med  1994; 39:87-91. \n\n\n\n8. Saini J, MacMahon P, Morgan JB, Kovar IZ. \nEarly parenteral feeding of amino acids. Arch  \nDis Child 1989; 64: 1362-1366. \n\n\n\n9. Gilbertson N, Kovar IZ, Cox DJ, Crowe L, \nPalmer NT. Introduction of intravenous lipid \nadministration on the first day of life in the very \nlow birth weight neonate. J Pediatr 1991; 119: \n615-623. \n\n\n\n10. Wretlind A. Parenteral nutrition support: history, \npresent, and future. Plenary Lecture given at the \nXV International Congress of Nutrition, \nAdelaide, Sep 26 to Oct 1, 1993. \n\n\n\n11. Cuthbertson DJR,  Rennie MJ. Protein and amino \nacid metabolism in the whole body and in the \ntissues. In Payne-James J, Grimble G, Silk D, \neditors. Artificial  Nutrition Support in Clinical  \n\n\n\n\n\n\n\nPractice. 2nd  ed. London: Greenwich Medical \nMedia Ltd; 2001. \n\n\n\n12. Elman R. Amino acid content of the blood \nfollowing intravenous injection of hydrolyzed \ncasein. Proc Soc Exp Biol Med  1937; 37: 437-\n440. \n\n\n\n13. Vanderveen TW, Niemiec PW.  Parenteral \nnutrition. In Herfindal ET, Hirschman JL, editors. \nClinical Pharmacy and Therapeutics. 3rd ed. \nBaltimore, MD: William & Wilkins; 1984. \n\n\n\n14. Macht SD. Three hundred years of parenteral \nnutrition: The history of intravenous nutritional \ntherapy. Conneticut Med 1980; 44: 27-30. \n\n\n\n15. Meng HC, Early F. Study of complete parenteral \nalimentation in dogs. J Lab Clin Med 1949;  34: \n1121-1132. \n\n\n\n16. Geyer RP. Parenteral nutrition. Physiol Rev  \n1960;  40: 150-186. \n\n\n\n17. Schuberth O, Wretlind A. Intravenous infusion of \nfat emulsion and phosphatides and emulsifying \nagents. Acta Chir Scand Suppl 1961; 278: 1-21. \n\n\n\n18.  Driscoll DF. Clinical issues regarding the use of \ntotal nutrient admixtures. DICP Ann \nPharmacother 1990; 24: 296-303. \n\n\n\n19. Furst P, Kuhn KS, Stehle P. Parenteral nutrition \nsubstrates. In Payne-James J, Grimble G, Silk D, \neditors. Artificial  Nutrition Support in Clinical \nPractice. 2nd ed. London: Greenwich Medical \nMedia Ltd; 2001. \n\n\n\n20. Cosslett AG. Studies on the stability of lipid \nemulsions in total parenteral nutrition admixtures. \nIn The Thesis Submitted for the Degree of \nPhilosophiae Doctor, University of Wales. \nCardiff: Univ Wales, 1991. \n\n\n\n21. Jeejeebhoy KN, Chu RC, Marliss EB, Greenberg \nGR, Bruce-Robertson A. Chromium deficiency, \nglucose intolerance, and neuropathy reversed by \nchromium supplementation in a patient receiving \nlong-term total parenteral nutrition. Am J Clin \nNutr 1977; 30: 531-538. \n\n\n\n\n\n\n\n\nGeneral article: Development of parenteral nutrition support \n\n\n\n 75\n\n\n\n22. Bozzeti F, Inglese MG, Terno G, Pupa A, \nSequeira C, Migliavacca S. Hypocupremia in \npatients receiving total parenteral nutrition. JPEN  \n1983; 7: 563-566. \n\n\n\n23. Groff JL, Gropper SS. The water-soluble \nvitamins. In Groff JL, Gropper SS, editors. \nAdvanced Nutrition and Human Metabolism, 3rd \ned. CA, USA: Wadsworth/Thomson Learning; \n2000. \n\n\n\n24. Grant JP. Vitamin requirements. In Grant JP, \neditor. Handbook of Total Parenteral Nutrition 2nd \ned. Mexico:W.B. Saunders Company; 1992. \n\n\n\n25. American Medical Association Guidelines for \nMultivitamin preparations for parenteral use: A \nStatement by the Nutrition Advisory Group II. \nJPEN 1979; 3: 258-262. \n\n\n\n26. Silberman H.  Parenteral nutrition: The lipid \nsystem. In Silberman H. editor. Parenteral and \nEnteral Nutrition. 2nd ed. Connecticut: Appleton \n& Lange; 1989. \n\n\n\n27. Solassol C, Joyeux H, Pujol H, Romieu C. Long \nterm parenteral nutrition - an artificial gut. Int \nSurg 1976; 61: 266-270. \n\n\n\n28. Chiou WL, Moorhatch P. Interaction between \nvitamin A and plastic intravenous fluid bags. \nJAMA 1973; 223: 328. \n\n\n\n29. McKenna MC, Bieri JG. Loss of vitamin A from \nTPN solutions. Fed Proc 1980; 39: 561. \n\n\n\n30. Moisan JY. Effects of oxygen permeation and \nstabiliser migration on polymer degradation. In: \nComyn J, editor. Polymer Permeability. London: \nElsevier Applied Science Publishers Ltd.; 1985. \n\n\n\n31. Richards JH. The role of polymer permeability in \nthe control of drug release. In: Comyn J, editor. \nPolymer Permeability. London: Elsevier Applied \nScience Publishers Ltd.; 1985. \n\n\n\n32. Allwood MC, Hardy G, Sizer T. Effects of air \nand oxygen on parenteral admixtures - an \nunderrated risk? Nutrition 1996; 12: 222-223. \n\n\n\n33. Allwood MC. The stability of ascorbic acid in \nTPN mixtures stored in a multilayered bag. Clin \nNutr 1992; 11: 284-288. \n\n\n\n34. Jones B. Home parenteral nutrition. In: Payne-\nJames J, Grimble G, Silk D, editors. Artificial  \nNutrition Support in Clinical Practice. 2nd ed. \nLondon: Greenwich Medical Media Ltd; 2001. \n\n\n\n35. Kelly DG, Burnes JU. Home nutrition support. \nThe Gastroenterologist 1996; 4 (suppl 1): S29 \u2013 \nS39. \n\n\n\n36. Boullata JI. Parenteral nutrition:adjunctive or \nprimary role in gastrointestinal therapeutics? Nutr \nClin Prac 1998; 13:57-58. \n\n\n\n37. Macfie J. Ethics and nutrition. All-in-One \nnewsletter 1998; 22: 2-5. \n\n\n\n\n\n"
"\n\n\n\n\n\n\n\n\n\nSTABILITY OF EXTEMPORANEOUSLY COMPOUNDED CHLORAL \nHYDRATE ORAL SOLUTION  \n\n\n\nFreeda Thean1*, Chan LT2, Lucy Yeoh3, Yeap PC4 \n\n\n\n1Product Development, Winwa Medical Sdn. Bhd., Bukit Mertajam, Pulau Pinang, Malaysia. \n2Product Management, Winwa Medical Sdn. Bhd., Bukit Mertajam, Pulau Pinang, Malaysia. \n3Quality Control, Winwa Medical Sdn. Bhd., Bukit Mertajam, Pulau Pinang, Malaysia. \n4Product Development, BioScenergy International Sdn. Bhd., Kuala Lumpur, Wilayah \nPersekutuan, Malaysia. \n*Author for correspondence at freedathean@winwamedical.com \n\n\n\nABSTRACT \n\n\n\nThe objective of this study is to look into the stability of Chloral Hydrate 40 mg per ml \nformulated as oral solution in X-temp Oral Suspension System in order to select proper storage \nconditions and establish beyond-use date. X-temp is a novel oral, flavoured sugar-free \nextemporaneous compounding vehicle to assist in the preparation of extemporaneous dosage \nforms.  \n\n\n\nThe compounded solution of 40 mg/ml was prepared by dissolving chloral hydrate powder in \nX-temp vehicle. The solution was then packed in amber HDPE containers, and were stored at \nrefrigeration 5 \u00b1 3\u00b0C and room temperature 30\u00b0C. Physical, chemical and microbiological \nparameters were evaluated at predetermined time-points up to 180 days. Samples were tested \nusing a validated stability\u2013indicating assay. Chloral hydrate concentration was assayed by \nhigh-performance liquid chromatography (HPLC). \n\n\n\nThe stability results indicated that the solution remained unchanged in visual appearance or pH \nat both refrigeration and room temperature for up to 180 days. The HPLC results showed that \nall the stability studies maintained 90 \u2013 100% of initial drug concentration. There was no \nsubstantial changes in the microbiological stability. \n\n\n\nChloral hydrate solution prepared in X-temp Oral Suspension System was stable for up to 180 \ndays when stored at room temperature and refrigeration conditions. These results demonstrated \nthat X-temp is a suitable vehicle for extemporaneous compounding for chloral hydrate.  \n\n\n\nINTRODUCTION \n\n\n\nExtemporaneous preparation refers to a limited amount of a custom-made product prepared for \nan individual when medications and formulations are not commercially available in a suitable \ndosage that meet fully the clinical needs of a particular patient1. Extemporaneously prepared \ndrug formulation is essential to provide optimal pharmaceutical care to special patient \npopulations. \n\n\n\nThese include paediatric patients, patients who are unable to swallow solid dosage forms, \npatients who must receive medications via nasogastric or gastrostomy tubes and patients who \nrequire non-standard doses that are more easily and accurately measured by using a liquid \nformulation that allows for the dose to be reliable and reproducibly measured2. \n\n\n\nChildren, especially the younger age groups, may require age-appropriate formulations \nallowing for both safe and accurate dose administration. The most acceptable drug forms in \npaediatric population are oral liquids. Often, liquid formulation forms are not commercially \navailable due to many factors including small market size and physicochemical factors2. \n\n\n\nDue to convenience and availability of ingredients, commercially available tablets or capsules \nfor adults are often used to prepare extemporaneously oral liquids for children. Hence there \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nmay be potential interactions between the drug and the excipients of the solid dosage in the \nprepared oral liquid3. \n\n\n\nIn many practice setting, there is a lack of choice or availability of excipients such as \nsuspending agents, sweeteners, flavours and preservatives necessary for compounding \nextemporaneous solutions. Hence, pharmacists use commercial dispersing media to compound \nsyrups from an active substance or from tablets available on the market. Commercial vehicles \nare considered an excellent and convenient choice for compounding extemporaneous solutions \nas they contain a combination of suspending agents, sweeteners and flavours, stabilised with \npreservatives. \n\n\n\nCHLORAL HYDRATE \n\n\n\nUses and Administration \n\n\n\nChloral hydrate is a hypnotic and sedative. The active metabolite of chloral hydrate, \ntrichloroethanol enhances the GABA (gamma-amino-butyric acid) receptor complex to \nproduce its pharmacological effect4 and therefore has properties similar to those of the \nbenzodiazepines, non-benzodiazepines and barbiturates.  \n\n\n\nChloral hydrate is a widely used oral sedative hypnotic drug in paediatrics for the short term \nmanagement of insomnia. It has been used for sedation and as a sedative for premedication. \nDespite the availability of other sedatives such as midazolam and pentobarbital, it is one of the \nmost commonly used sedatives in the clinical setting5. It is easily administered with high \nsuccess rate and low prevalence of adverse reactions5. It is used especially to administer to \nchildren before diagnostic procedures such as computerised axial tomography scan and \nmagnetic resonance imaging that require patient immobility. It is also used in intensive care \nunits, paediatric emergency departments and dental surgery to reduce anxiety and stress \nprovoked by technological procedures, light and sound levels and the presence of strangers. It \nis a cheap, effective and safe drug that can be easily handled and administered when performing \nnasofibroscopy6. \n\n\n\nChloral hydrate is more effective than midazolam when it is used as a sleep inductor for \nelectroencephalogram recordings in children age one to five years old. A deeper level of \nsedation can be achieved compared with other sedative agents and children remain calmer \nwhen undergoing echocardiography6. Other traditional sedative agents (such as midazolam, \npropofol and ketamine) can produce untoward effects on the respiratory drive or can have \ncardiovascular side effects. These characteristics of chloral hydrate make it potentially useful \nin the treatment of infants who require sedation in a Paediatric Cardiac Intensive Care Unit \n(PCICU)5. \n\n\n\nFormulation \n\n\n\nAt present, there is no commercially available liquid formulation of chloral hydrate. Because \nof this shortage, it is prepared as an extemporaneous formulation in hospital pharmacies. The \n10% oral solution of chloral hydrate is found in the United States Pharmacopeia 30th edition \n(USP) while the Argentine Pharmacopeia (6th edition) has documented the 7% chloral hydrate \nsyrup. Flavoured syrups are widely preferred by paediatric patients because it can effectively \nmasks unpleasant taste and has good texture and palatability6. \n\n\n\nChloral hydrate (Figure 1) is a colorless, transparent or white crystals with an aromatic, \npenetrating and slightly acrid odour. It is very soluble in water and in olive oil. It is freely \nsoluble in alcohol, chloroform and ether.  \n\n\n\nIt volatilises slowly on exposure to air and melts at about 55\u00b0C. It is light sensitive, \ndecomposing upon exposure and has to be stored in air tight containers. A 10% solution in \nwater has a pH of 3.5 to 5.5.  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nFigure 1: Molecular Formula of Chloral Hydrate \n\n\n\n\n\n\n\nChloral hydrate has an unpleasant, caustic bitter taste and is corrosive to skin and mucous \nmembrane. The most frequent adverse effect is gastric irritation, abdominal distension and \nflatulence. Chloral hydrate is given by mouth as an oral liquid or as a gelatine capsule with \nchloral hydrate dissolved in a suitable vehicle. It should not be given as tablets because of the \nrisk of damage to the mucus membrane of the alimentary tract. Oral dosage forms should be \ntaken well diluted or with plenty of water or milk. Because of its unpleasant taste and its irritant \naction on the gastric mucosa, oral dosage is best avoided in gastritis7. \n\n\n\nFew stability studies of chloral hydrate liquid preparation have been conducted. Based on the \npH evaluation and decomposition products by capillary electrophoresis, Kakehi et. al.8 reported \nthat the content of chloral hydrate in syrup at room temperature of 30\u00b0C and 60\u00b0C, did not \nshow any substantial change over 3 months at both storage conditions. Stability study of chloral \nhydrate 40 mg/ml formulated in 50% simple syrup with pineapple flavour was reported by \nTaguchi et. al.9 The chloral hydrate concentration was found to be stable for at least 14 days \nwhen stored at cold and dark conditions but there was a loss of colour during the storage \nduration10. \n\n\n\nHence there is a need to develop a convenient liquid formulation in order to supply safe and \nreliable dosage for paediatrics. In this context, the objective of this work is to evaluate the \nphysical, chemical and microbiological stability of chloral hydrate compounded in a suitable \nliquid vehicle both under room and refrigeration conditions in plastic bottles to provide the \ninformation and data to assist the pharmacist to determine the shelf life of the chloral hydrate \nextemporaneously prepared in the hospital.  \n\n\n\nMATERIALS AND METHODS  \n\n\n\nFormulation and Study Design \n\n\n\nCurrently there is no commercially available liquid formulation of chloral hydrate. The \npreparation was prepared from the active pharmaceutical ingredient in powder sourced from \nFischer Scientific, Malaysia.  The commercial vehicle X-temp Oral Suspension system \nmarketed by Pharm-D Sdn. Bhd. Malaysia was selected to compound this preparation. The \ncommercial vehicle is formulated specifically to assist in extemporaneous preparation of oral \nliquid; syrup or non-soluble (suspended) aqueous dosage form. It is sweetened, orange flavour, \nsugar-free vehicle with suitable preservatives.  \n\n\n\nPreparation of Chloral Hydrate Oral Solution \n\n\n\nThe following procedure was performed for the preparation of chloral hydrate oral solution 40 \nmg per ml compounded from pure drug powder. A mortar and pestle was used for \ncompounding. First, the quantity of vehicle required was measured. The amount of chloral \nhydrate required is measured and placed into a mortar. A small amount of X-temp was used to \nlevigate the powder to form a smooth and uniform paste.   Under constant mixing, small amount \nof vehicle was gradually added to the paste to form a liquid. The blend was transferred to a \ngraduated container. Some vehicle was added to rinse the remaining drug from the mortar and \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\ntransferred to the graduated container. The remaining X-temp vehicle was incorporated to the \ngraduated container to achieve the final volume. \n\n\n\nThe chloral hydrate oral solution was bottled into 100 ml semi-transparent high-density \npolyethylene (HDPE) containers and was fitted with white polypropylene (PP) screw caps.  \n\n\n\nThirty two bottles of the oral solution were prepared. These are kept under two- predetermined \nconditions to simulate the dispensing conditions:  one group was stored at 5 \u00b1 3oC \n(refrigeration) and the rest of the samples was stored at 30 \u00b1 2oC / 75% RH \u00b1 5% RH (room \ntemperature) in the absence of light. All samples were labeled and kept for 180 days. \n\n\n\nSTABILITY EVALUATION  \n\n\n\nStability evaluation of a formulation should take into account its physical, chemical and \nmicrobiological stability. \n\n\n\nSamples of each storage condition were collected at intervals of 1, 14, 28, 60, 90, 120, 150 and \n180 days. Before taking the samples for analysis, the bottles were manually shaken for a few \nseconds.   \n\n\n\nPhysical Stability \n\n\n\nAt each time point, all samples were examined for obvious changes in colour, odour and clarity. \nPhysical stability was assessed by visual examination and defined as the absence of any change \nin appearance, colour, odour and visible particulate matters.  \n\n\n\nPhysical stability also includes compliance of the specific gravity according to in-house \nspecification of 1.02 \u2013 1.08 g/ml.  \n\n\n\nThe extemporaneous preparation is considered stable if physical characteristics have remained \nfairly unchanged. \n\n\n\nChemical Stability \n\n\n\nChemical stability was evaluated by high-performance liquid chromatography  (HPLC)  \nquantification and pH measurement. Chemical stability was determined following the \nconcentration of chloral hydrate in the samples. To be considered stable, the preparation had \nto retain a minimum of 90% of its initial drug dose and a pH value between 3.8 and 4.8.   \n\n\n\nAnalytical Method and Equipment \n\n\n\nChloral hydrate concentration was assayed using HPLC. The assay method was developed \naccording to the in-house HPLC method with reference to the British Pharmacopoeia (BP) \n201411. The HPLC system used for the analysis was an Agilent 1200 RRLC instrument with \nbinary pump SL, autosampler SL, DAD SL detector, Thermostat Column Compartment SL \nand chemstation. The chromatographic separation used was Zorbax Eclipse XDB-C18 (4.6 mm \nID x 150 mm, 5 \uf06dm). The DAD detector operated at 220 nm. The mobile phase consisted of a \nmixture of 80 volumes of 0.02M potassium dihydrogen phosphate (KH2PO4) phosphate buffer \nadjusted to pH 8.00 with orthophosphoric acid 85% or 10M potassium hydroxide (KOH) and \n20 volumes of acetonitrile. The mobile phase was delivered at a flow rate of 1ml/min.  \n\n\n\nAbout 2.5 ml of sample were prepared in duplicate and dissolved in 100 ml of mobile phase \nand further diluted to obtain final concentration of chloral hydrate 0.1 mg per ml. Equivalent \nstandard concentration of 0.1 mg per ml was prepared using same mobile phase. Both solutions \nwere filtered through 0.45 \uf06dm syringe filter before HPLC analysis and the injection volume as \n100 \uf06dL. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nThe HPLC method for the analysis of chloral hydrate in this study was validated in a former \nshort-term stability study of extemporaneously prepared chloral hydrate oral solution using the \nabove formulation. The validation of the analytical methods includes linearity, accuracy, \nspecificity, precision and system suitability (Table 1).  \n\n\n\nA range performed on the HPLC system has confirmed the linearity of the method \n(R2=0.99988) (Figure 2).  \n\n\n\nTable 1: Results of Analytical Method Validation \n\n\n\nTest Parameter Validation Results Acceptance Limits \n\n\n\nSpecificity \nIdentification  \nComparison with a known \nreference material \n \n \nAssay \nPlacebo/Matrix analysis \n\n\n\n \n \n\uf0a7 Positive result \n \n\uf0a7 No peaks at RT 3.7 min \n\n\n\n\n\n\n\n\uf0a7 No interfering peaks from \nexcipients were observed \n\n\n\n\uf0a7 Placebo effect = - 0.50% \nThe placebo effects were \nfound to be insignificant\n\n\n\n \n \n\uf0a7 Positive control: \n\n\n\nPositive result.  \n\uf0a7 Negative control: \n\n\n\nAbsence of peak at  \nRT 3.7 min \n\n\n\n\uf0a7 No interference from \nexcipients \n\n\n\n\uf0a7 Placebo Effect NMT \n1.5% \n\n\n\nLinearity & Range  \uf0a7 r2 = 0.9998810 \n\uf0a7 Y-Intercept at 100% \n\n\n\nworking  concentration = \n1.18%  \n\n\n\n\uf0a7 r\u00b2  \u2265 0.995 \n\uf0a7 Y-Intercept at 100% \n\n\n\nworking  concentration \n\u2264 2% \n\n\n\nAccuracy  \n9 determinations (3 \nreplicates/3 concentrations) \n\n\n\n \n\uf0a7 97.0%, 100.3%, 99.3%, \n\n\n\n98.3%, 97.6%, 97.0%, \n98.3%, 97.8%, 97.5% \n\n\n\n \n\uf0a7 % recovery within \n\n\n\n95%  to 105% \n\n\n\nPrecision (Repeatability) \n6 determinations at 100% \nworking concentration \n\n\n\n \n\uf0a7 RSD = 0.68% \n\n\n\n\n\n\n\n \n\uf0a7 RSD \u2264 2.0%  \n\n\n\nPrecision (Reproducibility) \n6 determinations at 100% \nworking concentration \n\n\n\n \n\uf0a7 RSD = 0.82% \n\n\n\n\n\n\n\n \n\uf0a7 RSD \u2264 2.0%  \n\n\n\nPrecision  \n(Intermediate Precision/ \nRuggedness) \n\n\n\n \n\uf0a7 RSD = 0.86% \n\n\n\n \n\uf0a7 RSD \u2264 2.0%  \n \n\n\n\nSystem Suitability  \na. System Precision \n \n\n\n\nb. Peak Performance \n\n\n\n \n\uf0a7 RSD = 0.90% \n \n\uf0a7 k' = 2.689 \n\uf0a7 Resolution > 2 \n\uf0a7 USP tailing factor = 1.414 \n\uf0a7 Column efficiency = 5205 \n\n\n\n \n\uf0a7 RSD  \u2264 2% \n \n\uf0a7 k' \u2265 1.5 \n\uf0a7 Resolution >2 \n\uf0a7 USP tailing factor < 2  \n\uf0a7 Column efficiency \u2265 \n\n\n\n2000 \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \nMicrobiological Stability \n\n\n\nMicrobiological stability of the chloral hydrate oral solution stored at 5\u00b0C and 30\u00b0C was carried \nout on day 1, 14, 28, 60, 90, 120, 150 and 180 to determine if they comply with the microbial \nattributes of non-sterile pharmaceutical products according to the BP 2014. The \nmicrobiological evaluation was determined based on total aerobic microbial count below 2 X \n102 cfu/g, total combined yeasts & moulds count below 2 X 10 cfu/g and absence of \nEscherichia coli (E. coli).  \n\n\n\nRESULTS AND DISCUSSION \n\n\n\nPhysicochemical Stability \n\n\n\nThroughout the study period, the results of the visual appearance and odour of the chloral \nhydrate oral solution remained unchanged at both temperatures (Table 2). Also, there were no \nnotable changes in pH and the specific gravity of the extemporaneous preparations at both \ntemperatures (Table 3). In fact, visual appearance, smell, taste and mouth feel are factors that \ncan influence patient acceptance and compliance, specifically in the paediatric patients and are \nimportant factors to consider in the development of a suitable extemporaneous preparation.  \n\n\n\n\n\n\n\nFigure 2 : Calibration Curve of the LC Assay Method \n\n\n\n-100\n\n\n\n0\n\n\n\n100\n\n\n\n200\n\n\n\n300\n\n\n\n0.10 0.20\n\n\n\n [mAU]\n\n\n\n [mg/ml]\n\n\n\n  y = 970.0758x + 1.1501\n\n\n\n  Conf(0)=[-0.7292 ; 3.0293]\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nTable 2: Visual Appearance and Odour of Chloral Hydrate Oral Solution \n\n\n\nVisual Appearance (Colour and Clarity) \n\n\n\nTime \n(Days) \n\n\n\n1 14 28 60 90 120 150 180 \n\n\n\n5\u00baC \nWhite to off-\n\n\n\nwhite & \nopaque \n\n\n\n\u221a \u221a \u221a \u221a \u221a \u221a \u221a \n\n\n\n30\u00baC \nWhite to off-\n\n\n\nwhite & \nopaque \n\n\n\n\u221a \u221a \u221a \u221a \u221a \u221a \u221a \n\n\n\nOdour \n\n\n\nTime \n(Days) \n\n\n\n1 14 28 60 90 120 150 180 \n\n\n\n5\u00baC Orange \u221a \u221a \u221a \u221a \u221a \u221a \u221a \n\n\n\n30\u00baC Orange \u221a \u221a \u221a \u221a \u221a \u221a \u221a \n\n\n\n\u221a = Conforms to Specification \n \n\n\n\nTable 3: pH and Specific Gravity of Chloral Hydrate Oral Solution \n\n\n\npH \n\n\n\nTime \n(Days) \n\n\n\n1 14 28 60 90 120 150 180 \n\n\n\n5\u00baC 4.086 4.100 4.092 3.960 4.137 4.118 4.142 4.093 \n\n\n\n30\u00baC 4.086 4.064 4.051 3.850 3.999 3.994 4.053 3.905 \n\n\n\nSpecific Gravity \n\n\n\nTime \n(Days) \n\n\n\n1 14 28 60 90 120 150 180 \n\n\n\n5\u00baC 1.0534 1.0540 1.0532 1.0531 1.0506 1.0531 1.0534 1.0611 \n\n\n\n30\u00baC 1.0534 1.0559 1.0522 1.0511 1.0506 1.0535 1.0516 1.0522 \n\n\n\nThe analytic results indicated that the chloral hydrate content in all samples assayed was above \n99% throughout the 180 days period for both temperatures (Table 4). During the study, little \nor no chloral hydrate loss occurred in the samples for both storage conditions (Figure 3).  \n\n\n\nTable 4: Percentage of Original Concentration of Chloral Hydrate Oral Solution \n\n\n\nAssay  \n\n\n\nTime \n(Days) \n\n\n\n1 14 28 60 90 120 150 180 \n\n\n\n5\u00baC 101.2% 101.1% 101.3% 101.4% 100.9% 100.1% 99.5% 100.7% \n\n\n\n30\u00baC 101.2% 102.2% 100.7% 101.1% 100.4% 99.0% 99.0% 100.7% \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nChloral hydrate is easily decomposed in alkaline solution yielding mostly chloroform and \nformic acid. Chloral hydrate is also known to be a light sensitive material. The stability of the \npreparation is due to the compatibility of chloral hydrate with the X-Temp vehicle and also the \nprotective nature of the amber plastic container which prevents light degradation. The X-temp \nvehicle has an average pH of 4.1 (slightly acidic) and is buffered with the Citric Acid \u2013 \nMonosodium Phosphate buffering system. The nature of the X-temp vehicle ensures that the \npH of the chloral hydrate solution remains slightly acidic and constant which is favourable \ntowards the stability of chloral hydrate.  \n\n\n\nThe pH remained within the range of 3.8 to 4.1, which suggests minimal or no chemical \ndegradation (Figure 4). This claim is further cemented by the relatively stable assay results \nthroughout the study period of 180 days.  \n\n\n\nFigure 3: Percentage of Original Concentration of Chloral Hydrate Oral Solution \n\n\n\nFigure 4: pH of Chloral Hydrate Oral Solution \n\n\n\n95\n\n\n\n96\n\n\n\n97\n\n\n\n98\n\n\n\n99\n\n\n\n100\n\n\n\n101\n\n\n\n102\n\n\n\n103\n\n\n\n104\n\n\n\n105\n\n\n\n1 14 28 60 90 120 150 180\n\n\n\nC\nhl\n\n\n\nor\nal\n\n\n\n H\nyd\n\n\n\nra\nte\n\n\n\n (\n%\n\n\n\n)\n\n\n\nTime (Days)\n\n\n\n5\u00baC 30\u00baC\n\n\n\n3.00\n\n\n\n4.00\n\n\n\n5.00\n\n\n\n1 14 28 60 90 120 150 180\n\n\n\npH\n\n\n\nTime (Days)\n\n\n\n5\u00baC 30\u00baC\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nMicrobiological Stability \n\n\n\nMicrobiological tests were negative in all samples throughout the study period. The microbial \nexamination test denoted the absence of microbial growth for the total viable aerobic count, \ntotal yeasts & moulds and the specific E. coli complying with official quality requirements. \nThe microbiological stability study showed that the microbial quality of the chloral hydrate \nsolution was within the established specifications during the 6 months study period for both \ntemperatures (Table 5 and 6). \n\n\n\nNo microbial contamination was observed in all samples. The total viable aerobic count was \nkept low and total yeasts & moulds count was minimal. E. coli was absent throughout the 180 \ndays period.  \n\n\n\nThese results revealed that the preservatives of the extemporaneous preparation were effective \nagainst microbes and the chloral hydrate oral solution remained microbiologically stable at \nboth temperatures. \n\n\n\nTable 5: Microbial Results of Chloral Hydrate Oral Solution (5\u00baC) \n\n\n\nTime (Days) \nTotal aerobic bacteria \n\n\n\n(NMT 200 cfu/g) \nTotal yeasts & moulds \n\n\n\n(NMT 20 cfu/g) \nE. coli \n\n\n\n(Absence in 1 g)\n1 < 10 cfu/g < 10 cfu/g Conforms \n14 < 10 cfu/g < 10 cfu/g Conforms \n28 < 10 cfu/g < 10 cfu/g Conforms \n60 < 10 cfu/g < 10 cfu/g Conforms \n90 < 10 cfu/g < 10 cfu/g Conforms \n120 < 10 cfu/g < 10 cfu/g Conforms \n150 < 10 cfu/g < 10 cfu/g Conforms \n180 < 10 cfu/g < 10 cfu/g Conforms \n\n\n\n\n\n\n\nTable 6: Microbial Results of Chloral Hydrate Oral Solution (30\u00baC) \n\n\n\nTime (Days) \nTotal aerobic bacteria \n\n\n\n(Not more than 200 cfu/g) \nTotal yeasts & moulds \n\n\n\n(NMT 20 cfu/g) \nE. coli \n\n\n\n(Absence in 1 g)\n\n\n\n1 < 10 cfu/g < 10 cfu/g Conforms \n\n\n\n14 < 10 cfu/g < 10 cfu/g Conforms \n\n\n\n28 < 10 cfu/g < 10 cfu/g Conforms \n\n\n\n60 < 10 cfu/g < 10 cfu/g Conforms \n\n\n\n90 < 10 cfu/g < 10 cfu/g Conforms \n\n\n\n120 < 10 cfu/g < 10 cfu/g Conforms \n\n\n\n150 < 10 cfu/g < 10 cfu/g Conforms \n\n\n\n180 < 10 cfu/g < 10 cfu/g Conforms \n \n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nCONCLUSION \n\n\n\nChloral hydrate oral solution 40 mg per ml was easily prepared from the active ingredient and \ncommercial compounding vehicle. According to serial qualitative assessment, the \ncompounding support the stability for at least 180 days, maintaining all quality attributes \nrequired. Chloral hydrate oral solution is physically, chemically and microbiologically stable \nunder refrigeration and room temperature for up to 180 days when packed in amber HDPE \nbottles with plastic screw cap. \n\n\n\nThe results from the stability studies showed that X-temp is a suitable compounding vehicle \nfor preparing extemporaneous liquid formulation of chloral hydrate. Besides offering a stable \nformulation, it has added advantage of alcohol-free, colorant-free and sugar-free.  \n\n\n\nThe extemporaneous preparation of chloral hydrate can now be conveniently prepared by \npharmacists in the hospital setting by using X-temp Oral Suspension System. It is supported \nby stability data and proven shelf life.  \n\n\n\nACKNOWLEDGEMENT \n\n\n\nThe authors wished to thank BioScenergy International Sdn. Bhd. for its financial support. \n\n\n\nREFERENCES \n\n\n\n1. Aquilina, A., 2013. The extemporaneous compounding of paediatric medicines at Mater \nDei Hospital. Journal of the Malta College of Pharmacy Practice 19 pp 28-30. \n\n\n\n2. Haywood, A. and Glass, B., 2007. Managing extemporaneous oral liquids in practice. \nJournal of Pharmacy Practice and Research, 37(2), pp 131-133. \n\n\n\n3. Haywood, A. and Glass, B.D., 2013. Liquid dosage forms extemporaneously prepared from \ncommercially available products\u2013Considering new evidence on stability. Journal of \nPharmacy & Pharmaceutical Sciences, 16(3), pp 441-455. \n\n\n\n4. Lu, J. and Greco, M.A., 2006. Sleep circuitry and the hypnotic mechanism of GABA A \ndrugs. Journal of Clinical Sleep Medicine, 2(2), pp S19-S26. \n\n\n\n5. Chen, M.L., Chen, Q., Xu, F., Zhang, J.X., Su, X.Y. and Tu, X.Z., 2017. Safety and efficacy \nof chloral hydrate for conscious sedation of infants in the pediatric cardiovascular intensive \ncare unit. Medicine, 96(1): e5842. \n\n\n\n6. Bustos-Fierro, C., Olivera, M.E., Jim\u00e9nez-Kairuz, \u00c1.F. and Manzo, P.G., 2013. Stability \nevaluation of 7% chloral hydrate syrup contained in mono and multi-dose bottles under \nroom and refrigeration conditions. Farm Hosp, 37 (1) pp 4-9. \n\n\n\n7. Sweetman, S.C., 2009. Martindale: The complete drug reference. 36th edition. London, \nUK: Pharmaceutical Press. \n\n\n\n8. Kakehi, K., Nakano, M., Nishiura, S., Tachibana, S., Ishida, S. and Taneda, M., 1999. \nExamination of the stability of chloral hydrate and its preparation by capillary \nelectrophoresis. Yakugaku Zasshi. Journal of the Pharmaceutical Society of Japan, 119(5), \npp 410-416. \n\n\n\n9. Taguchi, M., Horiuchi, T., Mimura, Y. and Adachi, I., 1999. Studies on Hospital \nPreparation, \u00abChloral Hydrate Syrup\u00bb. Jap J Hosp Pharm, 25, pp 546-551. \n\n\n\n10. Trissel L.A., 2009. Trissel\u2019s Stability of Compounded Formulations. 4th ed. Washington, \nDC: American Pharmaceutical Association, pp 118-119. \n\n\n\n11. British Pharmacopoeia Commission 2013. Microbiological examination of non-sterile \nproducts. In British Pharmacopoeia 2014 Vol IV. Appendix XVIB \u2013 London, The \nStationery Office.  \n\n\n\n \n\n\n\n\n\n"
"\n\nMalaysian Journal of Pharmacy Volume 8 Issue 2 (2022) \n \n\n\n\n\n\n\n\n\n\n\n\n32 \n\n\n\n\n\n\n\n*Correspondence: cjherng1205@yahoo.com.my \n\n\n\nDOI: 10.52494/RIPY4395 \n\n\n\nDepartment of Pharmacy, Hospital Ampang, Ministry of Health Malaysia, \nJalan Mewah Utara, Taman Pandan Mewah, 68000 Ampang Jaya, \n\n\n\nSelangor, Malaysia. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n Original Research Article \n\n\n\n\n\n\n\nCyclosporine use in post haematopoietic stem cell transplant: \n\n\n\nFactors affecting the initial cyclosporine concentration and its \n\n\n\nassociation with acute graft-versus-host-disease \n   \n\n\n\nChoi Jing Herng*, Nur Azrina Binti Muhamad Moosa , Suuria A/P Subramaniam , Lim V Co, Io Shir \n\n\n\nHwa \n\n\n\n \nArticle Info  \n\n\n\n \nReceived date: 14 Nov 2022  \nAccepted date: 03 Dec 2022 \n\n\n\nPublished date: 31 Dec 2022 \n\n\n\n \nKeywords: Haematopoietic \n\n\n\nstem cell transplant, graft-\n\n\n\nversus-host disease, \ncyclosporine \n\n\n\nABSTRACT  \n\n\n\n\n\n\n\nBackground: Cyclosporine (CSA) is required as a prophylaxis of graft-versus-host disease (GVHD) \n\n\n\nfollowing allogeneic haematopoietic stem cell transplant (HSCT). However, subtherapeutic CSA \n\n\n\nconcentration will increase the incidence of acute GVHD which is one of the major concerns. \n\n\n\nObjective: This study aims to identify the incidence of patients who achieved therapeutic initial CSA \n\n\n\nlevel with a standard intravenous CSA dose of 1.5 mg/kg BD, the occurrence of acute GVHD and \n\n\n\nfactors associated with subtherapeutic CSA initial concentration in post-HSCT patients. Method: A \n\n\n\nretrospective single-centred study was conducted which involved 69 patients who underwent \n\n\n\nallogeneic HSCT between January 2020 and December 2020 in Hospital Ampang. The factors \n\n\n\nassessed were patients\u2019 demographics, concurrent medications, liver and renal functions. Mann-\n\n\n\nWhitney test, Kruskal Wallis test and Spearman correlation test were used to identify the factors \n\n\n\nassociated with sub-therapeutic CSA initial concentration. Result: 17.4% had therapeutic initial CSA \n\n\n\nlevel (200-400 ng/mL) and among 69 patients, 37.7% of them developed acute GVHD post-\n\n\n\ntransplantation. Besides, only ethnicity and serum creatinine significantly affected the initial CSA \n\n\n\nlevels. There was no significant association between the initial CSA level and the occurrence of acute \n\n\n\nGVHD. Conclusion: With the standard intravenous CSA dose of 1.5 mg/kg BD, only 17.4% were \n\n\n\nable to achieve a therapeutic initial CSA level due to the drug pharmacokinetic variability in different \n\n\n\nindividuals. Hence, this study served as a baseline study for the future prospective clinical study to \n\n\n\ndevelop a population pharmacokinetic model in optimising the intravenous CSA dose to achieve the \n\n\n\ndesired therapeutic range and improve the transplant outcomes. \n\n\n\n\n\n\n\n\n\n\n\nINTRODUCTION  \n \n\n\n\nHaematopoietic stem cell transplant (HSCT) is a curative, \n\n\n\nhighly specialised treatment for managing numerous \n\n\n\nmalignant and non-malignant diseases [1]. This process \n\n\n\ninvolves the intravenous infusion of haematopoietic stem cells \n\n\n\nto replace the unhealthy blood cells and rebuild normal blood \n\n\n\ncell production. Although HSCT has been an effective \n\n\n\ntreatment option for haematologic diseases such as leukaemia \n\n\n\nand lymphoma, the procedure has potentially high treatment-\n\n\n\nrelated mortality, such as graft-versus-host disease (GVHD) \n\n\n\ndevelopment that happens in allogeneic HSCT where the \n\n\n\nrecipient T cells recognise the host as foreign [2]. This \n\n\n\nscenario directly affects by limiting the success of a potentially \n\n\n\ncurative transplant. Therefore, immunosuppressive treatment \n\n\n\nis required as a prophylaxis of GVHD following allogeneic \n\n\n\nHSCT. \n\n\n\n\n\n\n\nThe most common GVHD prophylaxis post-allogeneic HSCT \n\n\n\nhas been based on a calcineurin inhibitor, cyclosporine (CSA), \n\n\n\ntogether with a short course of methotrexate (MTX) [1]. \n\n\n\nDespite the long history of this regimen, there are uncertainties \n\n\n\nabout its dosing due to the narrow CSA therapeutic index and \n\n\n\nits complicated pharmacokinetics which show marked inter \n\n\n\n\nmailto:cjherng1205@yahoo.com.my\n\n\n\n\n\n\nHerng C.J.et al. Mal J Pharm 8 (2) 2022, 32-38 \n\n\n\n\n\n\n\n33 \n \n\n\n\nand intra-patient variability [3]. Hence, the dose, target blood \n\n\n\nlevel, and infusion schedule varies among facilities and \n\n\n\nprotocols, and different practices make data generalisation for \n\n\n\nspecific populations impossible [4]. \n\n\n\n\n\n\n\nMultiple studies have demonstrated that a subtherapeutic \n\n\n\ninitial CSA concentration would increase the incidence of \n\n\n\ngrade 2-4 and acute GVHD [2,5\u20137], which is a significant \n\n\n\ncomplication of HSCT and a major cause of treatment-related \n\n\n\nmortality [8]. There is no previous study conducted in \n\n\n\nMalaysia to address this issue. The current study aimed to \n\n\n\nidentify the incidence of patients who achieved therapeutic \n\n\n\ninitial CSA level with standard intravenous CSA dose, the \n\n\n\noccurrence of acute GVHD, and the factors associated with \n\n\n\nsubtherapeutic CSA initial concentrations in patients \n\n\n\nundergoing HSCT. \n\n\n\n\n\n\n\nMETHOD  \n\n\n\n\n\n\n\nThis study was conducted retrospectively at Hospital Ampang, \n\n\n\na tertiary hospital known as one of the largest haematology \n\n\n\ncentres in Malaysia where various types of chemotherapy and \n\n\n\ntransplantation are conducted, including allogeneic HSCT. \n\n\n\nThe study was carried out upon approval by the National \n\n\n\nMedical Research Register (NMRR) and Medical Research & \n\n\n\nEthics Committees of Malaysia (MREC) with ID NMRR-21-\n\n\n\n1705-60857. \n\n\n\n\n\n\n\nAll patients who undergoing allogeneic HSCT received \n\n\n\nintravenous CSA beginning on Day-1 of transplantation with \n\n\n\na dose of 3 mg/kg in 2 divided doses by intravenous infusion \n\n\n\nfor the prophylaxis of GVHD post-transplantation. Based on \n\n\n\nAmpang Hospital Haematology Protocol, the initial targeted \n\n\n\nconcentration of CSA should be around 200 ng/mL [9], and a \n\n\n\ntitration of 25 mg/dose will be given to the patient if the first \n\n\n\ndose of 3 mg/kg/day does not reach the therapeutic \n\n\n\nconcentration. The initial CSA level was resampled at least on \n\n\n\nthe third day after dose adjustment since the duration for CSA \n\n\n\nto reach a steady state was around 3-5 days. \n\n\n\n\n\n\n\nSince CSA requires therapeutic drug monitoring (TDM), a list \n\n\n\nof potential patients was identified from the Hospital Ampang \n\n\n\npatient TDM database. The patients\u2019 medical records were \n\n\n\ntraced using the patients\u2019 registration numbers and retrieved \n\n\n\nfrom the hospital medical record archive and the electronic-\n\n\n\nHospital Information System (e-His). Patient who underwent \n\n\n\nallogeneic HSCT and received intravenous CSA for the first \n\n\n\ntime between January 2020 and December 2020 in Hospital \n\n\n\nAmpang were included in the study while patients who have \n\n\n\nCSA allergy and paediatric patients aged 12 years old and \n\n\n\nbelow were excluded from the study.  \n\n\n\n\n\n\n\nThere were 71 HSCT patients on CSA for the first time within \n\n\n\nthe sampling period, and 69 of these patients met the study \n\n\n\ninclusion criteria. By setting the margin of error to 5% and a \n\n\n\nconfidence level of 95%, the Raosoft\u00ae sample size calculator \n\n\n\nwas used to calculate the sample size, and the recommended \n\n\n\nminimum sample size was 61 patients. Since the sample size \n\n\n\ncalculated was small, all 69 patients were included in our \n\n\n\nstudy. \n\n\n\n\n\n\n\nDemographic and clinical data of patients were obtained from \n\n\n\nboth e-HIS and hospital medical record archives over four \n\n\n\nmonths from August to November 2021. Patients\u2019 data, \n\n\n\nincluding age, gender, body weight, height, serum creatinine \n\n\n\n(SCr), alanine aminotransferase (ALT), concurrent \n\n\n\nmedications, CSA dose, initial CSA level, presence of acute \n\n\n\nGVHD and GVHD sites were collected. Serum creatinine and \n\n\n\nALT levels on Day-1 of transplantation were collected where \n\n\n\nintravenous CSA was administered on the same day. Only data \n\n\n\non antibiotics, antivirals and antifungals were recorded for \n\n\n\nconcurrent medications, as Stockley\u2019s Drug Interaction \n\n\n\nCheckers showed that these medications potentially interacted \n\n\n\nwith CSA. Data privacy and confidentiality were guaranteed \n\n\n\nas the names of patients were not collected, and the data \n\n\n\ncollected was kept on a password-protected database that only \n\n\n\nresearchers could access the database. \n\n\n\n\n\n\n\nThe primary outcome of this study was to identify the \n\n\n\nincidence of patients who achieved therapeutic initial CSA \n\n\n\nlevel with standard intravenous CSA dose and the occurrence \n\n\n\nof acute GVHD in post-transplantation patients. In addition, \n\n\n\nthe secondary outcome was to identify the factors associated \n\n\n\nwith sub-therapeutic initial CSA concentration in patients \n\n\n\nundergoing HSCT. The IBM SPSS\u00ae for Windows version 22 \n\n\n\nwas used for analysing the collected through statistical \n\n\n\nanalysis. Categorical data in our study included gender, \n\n\n\nethnicity, ALT level, concurrent medications, acute GVHD \n\n\n\nand its sites, while the numerical data included age, weight, \n\n\n\nheight, SCr and creatinine clearance (CrCL). The descriptive \n\n\n\nanalysis was then used to analyse the categorical and \n\n\n\nnumerical data and presented in terms of frequency, \n\n\n\npercentage, median and interquartile range. \n\n\n\n\n\n\n\nBefore inferential statistical analysis, the normality test was \n\n\n\nconducted and it was found that data generated in this study \n\n\n\nwere not normally distributed. Thus, non-parametric tests were \n\n\n\napplied for data analysis. To identify the factors associated with \n\n\n\nsub-therapeutic CSA initial concentration, the Mann-Whitney \n\n\n\ntest and Kruskal Wallis test were used to analyse the difference \n\n\n\nof median initial CSA levels between different groups of \n\n\n\ncategorical data, as mentioned above. In contrast, the Spearman \n\n\n\ncorrelation test was used for analysing the correlation between \n\n\n\nthe median initial CSA levels and different numerical data such \n\n\n\nas age, weight, height, and SCr. The strength of correlation was \n\n\n\nmeasured by the absolute value of correlation coefficient (r), \n\n\n\n0.00-0.19 was regarded as \u201cvery weak\u201d, 0.20-0.39 as \u201cweak\u201d, \n\n\n\n0.40-0.59 as \u201cmoderate\u201d, 0.60-0.79 as \u201cstrong\u201d and 0.8-1.0 as \n\n\n\n\n\n\n\n\nHerng C.J.et al. Mal J Pharm 8 (2) 2022, 32-38 \n\n\n\n\n\n\n\n34 \n \n\n\n\na \u201cvery strong\u201d correlation [10]. Besides, a Chi-square test was \n\n\n\napplied to identify the frequencies of acute GVHD between the \n\n\n\ntwo CSA level groups (<200 ng/mL and 200-400 ng/mL). A p-\n\n\n\nvalue of <0.05 for the two-tail test was considered statistically \n\n\n\nsignificant. \n\n\n\n\n\n\n\nRESULTS \n\n\n\n\n\n\n\nIn this study, the baseline demographic and clinical \n\n\n\ncharacteristics of 69 patients were collected, and the data were \n\n\n\nsummarised as shown in Table I. There were slightly more \n\n\n\nfemale patients than male patients, with 52.2% and 47.8%, \n\n\n\nrespectively. Besides, more than half of the patients were \n\n\n\nMalay (68.1%), followed by Chinese (18.8%), Indian (8.7%) \n\n\n\nand others (4.3%). The median age, weight and height of the \n\n\n\npatients were 32 years old (IQR: 22.00), 66 kg (IQR: 21.50) \n\n\n\nand 162 cm (IQR: 12.50).  \n\n\n\n \nTable I: Demographic and clinical characteristics of patients (n=69) \n \n\n\n\nDemographic and clinical characteristics n (%) \n\n\n\nGender   \nMale 33 (47.8) \n\n\n\nFemale 36 (52.2) \n\n\n\nEthnicity   \nMalay 47 (68.1) \n\n\n\nChinese 13 (18.8) \n\n\n\nIndian 6 (8.7) \nOthers 3 (4.3) \n\n\n\nAge (years) 32 (22.00)* \nWeight (kg) 66 (21.50)* \n\n\n\nHeight (cm) 162 (12.50)* \n\n\n\nALT (U/L)   \nNormal 56 (81.2) \n\n\n\nHigh 13 (18.8) \n\n\n\nSCr (umol/L) 49 (24.00)* \nCrCL (mL/min) 147 (103.50)* \n\n\n\nConcurrent antibiotics   \n\n\n\nCiprofloxacin 63 (91.3) \nCiprofloxacin & Sulfamethoxazole/Trimethoprim 6 (8.7) \n\n\n\nConcurrent antifungals   \n\n\n\nFluconazole 54 (78.3) \nAmphotericin 6 (8.7) \n\n\n\nMicafungin 9 (13.0) \n\n\n\nConcurrent antivirals   \nAcyclovir 63 (91.3) \n\n\n\nAcyclovir & Ganciclovir 6 (8.7) \n\n\n\nInitial CSA level (ng/mL)   \n<200 53 (76.8) \n\n\n\n200-400 12 (17.4) \n\n\n\n>400 4 (5.8) \nPresence of acute GVHD   \n\n\n\nYes 26 (37.7) \n\n\n\nNo 43 (62.3) \nGVHD site   \n\n\n\nSkin 7 (26.9) \n\n\n\nGut 7 (26.9) \nLiver 3 (11.5) \n\n\n\nOcular 1 (3.9) \n\n\n\n\u2267 2 sites 8 (30.8) \n\n\n\n* Median (IQR) \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nTable II: Factors associated with subtherapeutic initial CSA levels (n=69) \n\n\n\n\n\n\n\nDemographic and \n\n\n\nclinical \n\n\n\ncharacteristics \n\n\n\nInitial CSA level \n\n\n\n(ng/mL) \n\n\n\nSpearman \n\n\n\ncorrelation, \n\n\n\nr \n\n\n\np- \n\n\n\nvalue \nMedian (IQR) \n\n\n\nGender     \n\n\n\nMale 150.30 (99.25)  0.627b \n\n\n\nFemale 138.75 (103.98)   \nEthnicity     \n\n\n\nMalay 156.20 (105.00)  0.030a* \nChinese 103.40 (66.80)   \n\n\n\nIndian 132.15 (390.75)   \n\n\n\nOther 60.00 (77.50)   \nAge (years)   -0.061 0.619c \n\n\n\nWeight (kg)   0.168 0.167c \n\n\n\nHeight (cm)   0.060 0.624c \nALT (U/L)     \n\n\n\nNormal 138.75 (84.98)  0.061b \n\n\n\nHigh 184.50 (161.80)   \nSCr (umol/L)   0.257 0.033c* \n\n\n\nCrCL (mL/min)   -0.064 0.602c \n\n\n\n     \na Kruskal Walli\u2019s test. X2 statistics (df) = 8.975(3). Post hoc multiple \n\n\n\ncomparisons test: Malay vs Chinese, p = 0.039 (Bonferroni correction of \n\n\n\np-value) \nb Mann-Whitney test \nc Spearman correlation \n\n\n\n* The p-value of less than 0.05 (p<0.05) was considered to be significant \n\n\n\n\n\n\n\n\n\n\n\nA large portion of patients (81.2%) had normal ALT levels. \n\n\n\nThe median SCr value was reported as 49 umol/L (IQR: \n\n\n\n24.00), while the median CrCL value was 147 mL/min (IQR:  \n\n\n\n103.50). For concurrent medications, 91.3% of patients took \n\n\n\nciprofloxacin as antibiotic prophylaxis, and the rest took two \n\n\n\ntypes of antibiotics (ciprofloxacin and \n\n\n\nsulfamethoxazole/trimethoprim). This percentage distribution \n\n\n\nwas the same for patients who took different types of antivirals \n\n\n\n(acyclovir and ganciclovir). Meanwhile, 78.3%, 8.7% and \n\n\n\n13.0% of patients took fluconazole, amphotericin and \n\n\n\nmicafungin, respectively as anti fungal prophylaxis. \n\n\n\n\n\n\n\nFurthermore, a majority of patients (76.8%) had sub-\n\n\n\ntherapeutic initial CSA levels of <200 ng/mL while 17.4% \n\n\n\nachieved the therapeutic range of 200-400 ng/mL, followed by \n\n\n\n5.8% who achieved >400 ng/mL. Among 69 patients, 37.7% \n\n\n\nof them developed acute GVHD post-transplantation, and the \n\n\n\nGVHD sites reported were skin (26.9%), gut (26.9%), liver \n\n\n\n(11.5%), ocular (3.9%) and more than two areas (30.8%). \n\n\n\n\n\n\n\nOverall, the median initial CSA level was reported as 147.4 \n\n\n\nng/mL (IQR: 97.15), and the Mann-Whitney test was \n\n\n\nconducted to determine whether there was a difference in \n\n\n\ninitial CSA levels in patients with different demographics and \n\n\n\nclinical characteristics. Based on Table II, the results of the \n\n\n\nMann-Whitney test showed that there was no significant \n\n\n\ndifference in median initial CSA levels between male and \n\n\n\nfemale patients, z = -0.487, p-value = 0.627 and also between \n\n\n\nthose with normal and high ALT levels, z = -1.872, p-value =  \n\n\n\n0.061. Meanwhile, there was a significant difference in the \n\n\n\nmedian initial CSA levels among the four ethnicity groups (X2 \n\n\n\n\n\n\n\n\nHerng C.J.et al. Mal J Pharm 8 (2) 2022, 32-38 \n\n\n\n\n\n\n\n35 \n \n\n\n\nstatistics (df) = 8.975(3)). Post hoc analysis using multiple \n\n\n\ncomparisons showed that there was a significant difference in \n\n\n\nmedian initial CSA levels between Malay and Chinese groups \n\n\n\n(p-value= 0.030). P-value was Bonferroni adjusted. Malay \n\n\n\npatients had significantly higher median initial CSA levels \n\n\n\n(156.20 ng/mL (IQR= 105.00)) compared to Chinese patients \n\n\n\n(103.40 ng/mL (IQR= 66.80)). However, there was no \n\n\n\nsignificant difference between other ethnicity groups. \n\n\n\nFurthermore, the correlations between the initial CSA level \n\n\n\nand age, weight, height and CrCL of the patients were found \n\n\n\nto be very weak and statistically insignificant, with p-values of \n\n\n\n0.619, 0.167, 0.624 and 0.602, respectively. At the same time, \n\n\n\nthere was a weak positive correlation (r = 0.257) between the \n\n\n\ninitial CSA levels and SCr with a p-value of 0.033, which \n\n\n\nsuggested that the initial CSA levels increased significantly \n\n\n\nwith serum creatinine. \n\n\n\n\n\n\n\nBesides, the concurrent antibiotics, antifungals and antivirals \n\n\n\nthat the patient took along with intravenous CSA were also \n\n\n\nrecorded in this study for further analysis. The difference in \n\n\n\ninitial CSA level among patients taking the different groups of \n\n\n\nconcurrent medications was analysed through the Mann-\n\n\n\nWhitney and Kruskal Wallis tests respectively. The results of \n\n\n\nboth tests was summarised in Table III. There was no \n\n\n\nsignificant differences in initial CSA levels between different \n\n\n\nantibiotics, antifungals and antivirals groups with p-values of \n\n\n\nmore than 0.05. \n\n\n\n \nTable III: Difference between concurrent medications and initial CSA \n\n\n\nlevel (n=69) \n\n\n\n\n\n\n\nConcurrent \n\n\n\nmedications \n\n\n\nInitial CSA level \n\n\n\n(ng/mL) \np-\n\n\n\nvalue \nMedian (IQR) \n\n\n\nAntibiotics    \n\n\n\nCiprofloxacin 150.30 (113.60) 0.539a \n\n\n\nCiprofloxacin & \nSulfamethoxazole/Trimethoprim \n\n\n\n129.40 (38.32)  \n\n\n\nAntifungals    \n\n\n\nFluconazole 148.85 (89.63) 0.840b \nAmphotericin 130.90 (285.50)  \n\n\n\nMicafungin 147.40 (339.55)  \nAntivirals    \n\n\n\nAcyclovir 152.80 (109.30) 0.079a \n\n\n\nAcyclovir & Ganciclovir 121.60 (63.55)  \na Mann-Whitney test  b Kruskal Wallis test \n\n\n\n \nTable IV: Association between initial CSA level and presence of acute \n\n\n\nGVHD (n=69) \n\n\n\n\n\n\n\nPresence \n\n\n\nof acute \n\n\n\nGVHD \n\n\n\nInitial CSA level X2 \n\n\n\n(df) \n\n\n\np-value \n\n\n\n< 200 ng/mL, \n\n\n\nn (%) \n\n\n\n\u2267 200 ng/mL, \n\n\n\nn (%) \n\n\n\nYes 20 (76.9) 6 (23.1) 0.000 \n\n\n\n(1) \n\n\n\n>0.950a \n\n\n\nNo 33 (76.7) 10 (23.3)   \n\n\n\n     \naChi-square test \n\n\n\n\n\n\n\nIn this study, the number of patients who developed acute \n\n\n\nGVHD post-transplantation was also recorded, and its \n\n\n\nassociation with the initial CSA levels was identified through \n\n\n\na Chi-square test, and the result was tabulated in Table IV. \n\n\n\nAlthough the association was not statistically significant, X2 \n\n\n\n(1, n=69) = 0.000, p-value >0.950, there were 20 patients with \n\n\n\nan initial CSA level of <200 ng/mL (76.9%) developed acute \n\n\n\nGVHD as compared to only six patients with an initial CSA \n\n\n\nlevel of \u2267200 ng/mL (23.1%). \n\n\n\n\n\n\n\nDISCUSSION \n\n\n\n\n\n\n\nTo our knowledge, this is the first retrospective study \n\n\n\ninvestigating the factors affecting the initial CSA levels and \n\n\n\nits association with the occurrence of acute GVHD among the \n\n\n\nMalaysian allogeneic HSCT patients in Hospital Ampang, one \n\n\n\nof the well-known haematology centres where patients with \n\n\n\nhaematology-related illness are referred to here for various \n\n\n\nchemotherapy and transplantations. \n\n\n\n\n\n\n\nIn this study, with the current standard dose of intravenous \n\n\n\nCSA 1.5 mg/kg BD and the method of rounding the dose to \n\n\n\nthe nearest 25 mg, most of the patients (76.8%) had sub-\n\n\n\ntherapeutic initial CSA levels of <200 ng/mL and the least \n\n\n\nnumber of patients (5.8%) had achieved initial CSA levels \n\n\n\nof >400 ng/mL. Based on previous studies, demographic and \n\n\n\nclinical factors such as age, gender, liver and renal functions \n\n\n\nand drug-drug interactions were reported to contribute to \n\n\n\nDifferent initial CSA levels among each individual [11\u201313], \n\n\n\nand the influence of these factors in our study sample would \n\n\n\nbe discussed further in the following paragraphs. Besides, \n\n\n\nsampling error might also be one of the factors, as other study \n\n\n\nsuggested avoiding sampling or sample interpretation in the \n\n\n\nfirst hour of infusion where inconsistent results had been \n\n\n\nreported [14]. \n\n\n\n\n\n\n\nNext, factors affecting the initial CSA levels were also \n\n\n\nidentified in our study. Firstly, no significant difference in \n\n\n\ninitial CSA level was found between male and female HSCT \n\n\n\npatients (p-value = 0.627), and the current research supported \n\n\n\nthe results of 2 previous studies [11,15]. However, some \n\n\n\nresearchers have shown that gender significantly affects the \n\n\n\nCSA pharmacokinetics in solid organ transplant patients [16\u2013\n\n\n\n18]. These conflicting results of gender effect on initial CSA \n\n\n\nlevels might be explained by the interindividual variation of \n\n\n\nP-glycoprotein expression and CYP3A activity regardless of \n\n\n\ngender [16].  \n\n\n\n\n\n\n\nMoreover, it was reported in a previous study that clearance of \n\n\n\nCSA decreased with increasing age; therefore, initial CSA \n\n\n\nlevels varied across paediatric, adult and geriatric populations \n\n\n\n[13,16,19]. Nonetheless, age was not significantly correlated \n\n\n\nwith initial CSA level in this study and this outcome was \n\n\n\npossible because only the adult population with a median age \n\n\n\n\n\n\n\n\nHerng C.J.et al. Mal J Pharm 8 (2) 2022, 32-38 \n\n\n\n\n\n\n\n36 \n \n\n\n\nof 32 years old (IQR: 22.00) was involved in this study, and \n\n\n\nno significant difference was found among this population. \n\n\n\nPrevious studies supported our findings that age did not \n\n\n\nsignificantly affect the CSA pharmacokinetics compared to \n\n\n\nthe paediatric population [20,21]. \n\n\n\n\n\n\n\nThe correlation between initial CSA level and weight was also \n\n\n\nevaluated in this study, but it was found to be statistically \n\n\n\ninsignificant, which was opposed the previous studies that \n\n\n\nbody weight was significantly associated with CSA clearance \n\n\n\nand its level [14,21\u201324]. Consistently, height was \n\n\n\ninsignificantly correlated with the initial CSA level , parallel \n\n\n\nto other studies [11]. \n\n\n\n\n\n\n\nLimited studies were conducted to analyse ethnicity\u2019s \n\n\n\nassociation with CSA pharmacokinetics. In Malaysia, a \n\n\n\nretrospective study conducted among solid organ \n\n\n\ntransplantation patients did not show an effect of ethnicity on \n\n\n\nCSA pharmacokinetics [16]. However, a statistically \n\n\n\nsignificant difference in the initial CSA level between Malay \n\n\n\nand Chinese patients was demonstrated in our study. \n\n\n\nCurrently, evidence on the effect of CSA clearance among \n\n\n\ndifferent ethnicities in Malaysia is still lacking. However, it \n\n\n\nhad been previously demonstrated in a foreign study that CSA \n\n\n\nclearance was higher in white patients than in black and Asian \n\n\n\npatients, suggesting that different ethnic groups had different \n\n\n\nCSA levels [25]. \n\n\n\n\n\n\n\nBesides, the normal range of ALT was defined as between 4-\n\n\n\n36 U/L [26] and patients were classified into two groups \n\n\n\n(normal and high ALT levels). This finding was contrary to \n\n\n\nother studies which showed CSA was extensively metabolised \n\n\n\nby the liver and that liver function altered CSA \n\n\n\npharmacokinetics [11,12]. The difference in initial CSA level \n\n\n\nbetween normal and high ALT groups in this study was \n\n\n\nreported to be insignificant. \n\n\n\n\n\n\n\nFurthermore, the current study showed that initial CSA levels \n\n\n\nincreased significantly with SCr, which contrasts with \n\n\n\nprevious studies that reported an insignificant effect of SCr on \n\n\n\ninitial CSA levels [11,24,27]. Generally, SCr and CrCL \n\n\n\nyielded a reasonable estimation of renal function, but CrCL \n\n\n\nprovided a more accurate assessment as it was adjusted based \n\n\n\non parameters such as age, gender, body weight and height \n\n\n\n[28]. Due to limited patient numbers and short study duration \n\n\n\nin the current study, these parameters were not found to affect \n\n\n\nthe initial CSA level significantly; thus, CrCL showed a \n\n\n\nsimilar finding. \n\n\n\n\n\n\n\nIn addition, infections were the major cause of morbidity and \n\n\n\nmortality after transplantation; thus, antimicrobial agents were \n\n\n\nwidely used in patients who had received transplantation [29]. \n\n\n\nAs drug-drug interaction might affect the pharmacokinetics of \n\n\n\nCSA and its serum level, its influence on the initial CSA level \n\n\n\nwas also analysed statistically in this study. Nonetheless, the \n\n\n\ndifference in initial CSA levels between different antibiotics, \n\n\n\nantifungals and antivirals groups was statistically \n\n\n\ninsignificant. With the exception that antifungals such as \n\n\n\nmicafungin and antivirals showed a similar result to the \n\n\n\nprevious study [30], other groups of antimicrobial agents \n\n\n\nshowed opposing findings to previous studies and Stockley\u2019s \n\n\n\nDrug Interaction Checkers [14,20,30\u201332]. \n\n\n\n\n\n\n\nDuring data collection, although it was necessary to report the \n\n\n\ngrades of acute GVHD to determine its severity, only the \n\n\n\noccurrence site of acute GVHD was collected as the grade of \n\n\n\nacute GVHD was not recorded in patients\u2019 clinical notes and \n\n\n\nbed head tickets (BHT). The current study reported that among \n\n\n\n69 patients, 37.7% of them developed acute GVHD post-\n\n\n\ntransplantation and the acute GVHD area reported were skin \n\n\n\n(26.9%), gut (26.9%), liver (11.5%), ocular (3.9%) with \n\n\n\n30.8% patients reporting multiple sites involvement. The \n\n\n\nassociation between the initial CSA level and the presence of \n\n\n\nacute GVHD was also assessed in this study to justify the \n\n\n\nimpact of the initial CSA level in causing acute GVHD and \n\n\n\nfurther Deteriorating the patient\u2019s health. The result showed \n\n\n\nthat the association  was not statistically significant, which \n\n\n\nwas inconsistent with previous studies [4,33,34]. \n\n\n\n\n\n\n\nDespite the result being statistically insignificant, 76.9% of \n\n\n\npatients with an initial CSA level of <200 ng/mL developed \n\n\n\nacute GVHD compared to only 23.1% with an initial CSA \n\n\n\nlevel of \u2267200 ng/mL. Besides, a study reported that \n\n\n\nmaintaining CSA trough levels of \u2267200 ng/mL resulted in a \n\n\n\nlower incidence of acute GVHD in the following weeks and \n\n\n\nfound significant benefits of maintaining a higher serum \n\n\n\nconcentration of CSA in the minimisation of acute GVHD [5]. \n\n\n\nMoreover, it was essential to prevent acute GVHD as the cost \n\n\n\nof treating GVHD was much higher compared to the cost of \n\n\n\npreventing GVHD. GVHD as a retrospective analysis of \n\n\n\nhospital data reported higher hospital readmission rates and \n\n\n\nassociated costs following HSCT among patients with acute \n\n\n\nGVHD compared with those without GVHD, and the \n\n\n\nreadmission rate and costs increased with the severity of acute \n\n\n\nGVHD [35]. Another retrospective study summarised that \n\n\n\npatients with acute GVHD had a longer length of stay, a higher \n\n\n\nICU admission rate, and a higher median total cost compared \n\n\n\nwith patients with no GVHD during initial hospitalisation for \n\n\n\nHSCT and experienced higher rates of hospital readmission \n\n\n\nand inpatient mortality during the 100 days following HSCT \n\n\n\n[36]. \n\n\n\n\n\n\n\nOur study was limited by its retrospective nature and the fact \n\n\n\nthat it included patients from a single medical centre. \n\n\n\nDifferences in the composition of patient cohorts among \n\n\n\nvarious centres prevented us from making general conclusions \n\n\n\nregarding initial CSA levels, factors affecting it and its \n\n\n\nassociation with the occurrence of acute GVHD. Moreover, \n\n\n\n\nhttps://www.sciencedirect.com/topics/medicine-and-dentistry/graft-versus-host-disease\n\n\n\n\n\n\nHerng C.J.et al. Mal J Pharm 8 (2) 2022, 32-38 \n\n\n\n\n\n\n\n37 \n \n\n\n\ntime constraints limited our sample size as we only included \n\n\n\ndata in a year due to the time-consuming process of obtaining \n\n\n\nthe manual patient medical record from the hospital archive. \n\n\n\n\n\n\n\nCONCLUSION  \n\n\n\n\n\n\n\nIn conclusion, therapeutic drug monitoring was crucial in \n\n\n\ndesigning patient-specific CSA dosage regimens as with the \n\n\n\ncurrent standard dosing method. We found that there was only \n\n\n\na small portion of patients could achieve therapeutic initial \n\n\n\nCSA levels due to the drug pharmacokinetic variability in \n\n\n\ndifferent individuals. In this study, only ethnicity and SCr \n\n\n\nwere found to affect the initial CSA level significantly. \n\n\n\nHowever, our findings should not be generalised due to the \n\n\n\nlimitations of the small sample size from a single centre. Last \n\n\n\nbut not least, even though we did not prove the significant \n\n\n\nbenefits of maintaining an initial CSA level at the therapeutic \n\n\n\nrange in minimisation of acute GVHD, it served as a baseline \n\n\n\nstudy for a future prospective clinical study to develop a \n\n\n\npopulation pharmacokinetic model in optimising the \n\n\n\nintravenous CSA dose to achieve the desired therapeutic range \n\n\n\nand maximise the transplant outcomes. \n\n\n\n\n\n\n\n\n\n\n\nACKNOWLEDGEMENT \n\n\n\n\n\n\n\nWe would like to thank the Director General of Health \n\n\n\nMalaysia for his permission to publish this article. We would \n\n\n\nalso like to acknowledge Tuan Fauziah Binti Tuan Rosli, a \n\n\n\npharmacist at Hospital Ampang, for her assistance in this \n\n\n\nresearch\u2019s statistical analysis. \n\n\n\n\n\n\n\nREFERENCE \n \n\n\n\n[1] Davulcu EA, Vural F. Immunosuppressive agents in hematopoietic \n\n\n\nstem cell transplantation. 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Biol  Blood  Marrow  Transplant. \n\n\n\n2020;26(3):600\u20135. https://doi.org/10.1016/j.bbmt.2019.10.028  \n\n\n\n\nhttps://doi.org/10.3892%2Fetm.2020.8732\n\n\nhttps://doi.org/10.1177/1060028015577798\n\n\nhttps://pubmed.ncbi.nlm.nih.gov/19377217/\n\n\nhttps://doi.org/10.1111%2Fj.1365-2125.2008.03217.x\n\n\nhttps://doi.org/10.18773/au\n\n\nhttps://doi.org/10.1086/516138\n\n\nhttps://doi.org/10.5414/cp201738\n\n\nhttps://doi.org/10.1038/bmt.2009.316\n\n\nhttps://doi.org/10.1128%2FAAC.01489-12\n\n\nhttps://doi.org/10.1016/j.bbmt.2012.11.337\n\n\nhttps://doi.org/10.18632/oncotarget.10988\n\n\nhttps://doi.org/10.1111/ctr.12065\n\n\nhttps://doi.org/10.1016/j.bbmt.2019.10.028\n\n\n\n"
"\n\nMalaysian Journal of Pharmacy 2002;1(3): 63-68                                                           CPE article \n\n\n\n 63\n\n\n\nContinuing Pharmacy Education  \n \n\n\n\nManaging Cytotoxic Drugs \n \nAmiruddin Ahmad \n \nFaculty of Pharmacy, Universiti Teknologi MARA, Shah Alam, Selangor, Malaysia. \n \n \nABSTRACT \n \nCytotoxic drugs are used in the management of malignant diseases. They have been \nfound to be carcinogenic, teratogenic and mutagenic. There is growing concern that \nthe handling, preparation, administration and disposal of these substances may \nconstitute an occupational hazard. These guidelines aim to identify, and help avoid \nor minimize occupational exposure to cytotoxic drugs and related wastes within \nhealth care establishments. It is necessary that individuals involved in the use or \nhandling of cytotoxic drugs are made aware of associated matters relating to the \nsafe handling of such drugs. \n \nKeywords: cytotoxic drugs, occupational exposure, mutagenic, teratogenic, \ncarcinogenic \n \n \nINTRODUCTION \n \nCytotoxic drugs are therapeutic agents which are \nknown to be toxic to cells principally through \ntheir action on cell reproduction and are \nprimarily intended for the treatment of cancer. \nCurrently there is no established data for safe \nlevel of exposure to these drugs. While health \ncare establishment workers involved in the \nhandling of these group of drugs do not receive \ntherapeutic doses, there is concern that unless \nsuitable protective measures are in place, these \npersonnel may be subjected to low level doses in \nthe long term. \n \nOccupational exposure may occur through the \ninhalation of aerosols and drug particles, skin \nabsorption, ingestion and needle stick injuries \nresulting from: \n\u2022 transport of cytotoxic drugs \n\u2022 cytotoxic drug preparation and \n\n\n\nadministration \n\u2022 contamination of surfaces with cytotoxic \n\n\n\ndrugs \n\u2022 handling, transportation and disposal of \n\n\n\ncytotoxic waste (1-3). \n\n\n\n \n \nPersonnel likely to be involved in these \nprocesses are nurses, medical officers and \npharmacy staff. The greatest risk of occupational \nexposure to cytotoxic drugs is during their \npreparation and administration. The need for safe \nhandling of cytotoxic drugs is not confined to \ninjectable dosage forms only. For example, oral \ndosage forms may shed respirable dust, and \nwhen used to prepare oral suspensions, may \ndistribute dust and fragments. Other aspects of \npatient care such as spill and waste management \nmay also pose a risk of occupational exposure. \n \nPotential effects of exposure \n \nMany published studies are inconclusive and \nlittle is known of long term effects of exposure to \ncytotoxic drugs in health care workers. However, \nthere is sufficient evidence to indicate potential \nadverse effects as a result of occupational \nexposure (4-7). Studies have reported the \nfollowing effects amongst personnel preparing \nand administering cytotoxic drugs: \n\u2022 contact dermatitis, local toxic or allergic \n\n\n\n\n\n\n\n\nCPE article: Managing cytotoxic products \n\n\n\n 64\n\n\n\nreaction, which may result from direct \ncontact with skin or mucous membranes \n\n\n\n\u2022 cytogenetic abnormalities and mutagenic \nactivity related to biological uptake by \nexposed personnel \n\n\n\n\u2022 alteration to normal blood cell counts \n\u2022 excretion of the drugs or metabolites in the \n\n\n\nurine in exposed personnel \n\u2022 symptoms including abdominal pain, hair \n\n\n\nloss, nasal sores and vomiting \n\u2022 liver damage \n\u2022 foetal loss in exposed pregnant women and \n\n\n\nmalformation of the offspring of pregnant \nwomen \n\n\n\n \nAlthough the long term effects of occupational \nexposure to cytotoxic drugs are inconclusive, it \nis not appropriate to wait for indisputable \nevidence of harm. \n \nDrug preparation \n \nIn general, the principle focus of safety during \ncytotoxic drug preparation should be on: \n\u2022 education and training of personnel \n\u2022 control of the working environment \n\u2022 adoption of safe working procedure \n \nEducation and training of health professionals in \ncytotoxic drug preparation and handling is \nrecommended to ensure that safe work practices \nare understood, developed, implemented and \nmaintained. Use of cytotoxic drug safety cabinet, \npharmaceutical isolators and other appropriate \nequipment is recommended to facilitate safe \npreparation of cytotoxic drugs and to ensure that \nproducts, operator and working environment are \nprotected. In order to provide drug containment \nand aseptic manipulation, all preparation of \ncytotoxic drugs should take place in a separate, \ndedicated cytotoxic safety cabinet or in \npharmaceutical isolators. \n \nThe health care establishment management is \nresponsible for ensuring that personnel who are \ndesignated to perform cytotoxic drug preparation \nprocedures are provided with an accredited level \nof training, and that they have attained \nproficiency prior to undertaking preparation \nprocedures (8). Accredited training in drug \npreparation procedures should be undertaken \nprior to commencement of duties and when new \nequipment is introduced or procedures changed. \nProcedures should be in place to ensure that \naccredited staff are kept informed of new \n\n\n\ndevelopments, such as changes in technology \nand preparation procedures. Validation of \naccreditation criteria should occur at intervals no \ngreater than two years. \n \nPersonal Protective Equipment should be worn \nby personnel using an approved cytotoxic drug \nsafety cabinet to prepare cytotoxic drugs: \n\u2022 long sleeved coverall of impermeable \n\n\n\nmaterial, e.g. made from bonded \npolyethylene fibre with a closed front and \nelasticized cuff, with suitable head \nprotection \n\n\n\n\u2022 overshoes of a similar impermeable material \n\u2022 suitable respiratory protection \n\u2022 long PVC, surgical latex, or purpose \n\n\n\nmanufactured gloves \n \nSpecial precautions are required for the \nlaundering of used Personal Protective \nEquipment (garments) which may be \ncontaminated with cytotoxic drugs. The \nconditions required for the laundering of \npotentially contaminated items should be \nestablished to: \n\u2022 protect laundry personnel who are involved \n\n\n\nin this process from cytotoxic drug residue \n\u2022 prevent contamination of other materials \n\n\n\nbeing laundered \n\u2022 ensure the garments are decontaminated \n\n\n\nprior to sterilization or reuse \n \nAttention to occupationally related work practice \nwill maximize efficiency and productivity and \nminimize operator errors. Cytotoxic clean room \nequipment layout should be designed properly. \nTo determine appropriate work periods the entire \ntask should be assessed taking into consideration \nthe: \n\u2022 level of concentration and visual control \n\n\n\nrequired \n\u2022 precision of movements \n\u2022 design of equipment and availability of \n\n\n\nadjustable furniture, e.g. chairs, stools and \nfoot rests \n\n\n\n\u2022 aesthetic effects of the working environment \n \nDrugs and its storage area and equipment need to \nbe identified. Intravenous equipment and devices \ncontaining cytotoxic drugs should be clearly \nlabelled with a permanent, adhesive and \nrecognizable cytotoxic drug label. \n \nFor drug storage, the quantities of cytotoxic \ndrugs stored in pharmacy departments, wards, \n\n\n\n\n\n\n\n\nCPE article: Managing cytotoxic products \n\n\n\n 65\n\n\n\nclinics and satellite pharmacies should generally \nbe restricted to the quantities for short term use. \nA dedicated area for the storage of cytotoxic \ndrugs should be provided in pharmacy \ndepartments and storage areas. Use of a \ndedicated area facilitates quick and efficient \ncontainment and management of a spill. \n \nOral solid cytotoxic doses should be individually \npackaged. Automatic tablet counters, or other \nequipment which may generate particulate \nmatter, should not be used in the packaging of \ncytotoxic drugs. If a prepared therapy has to be \ntransported on-site, it should be in a transport \ncontainer which is of sufficient strength to \nprevent leakage of its contents and should be \nsecurely closed and labelled with cytotoxic \nwarnings. Cytotoxic drugs should not be \ntransported in pneumatic automated tube \nsystems. \n \nStandard operating procedures for the \npreparation of cytotoxic drugs should be \ndocumented and should include: \n\u2022 using specially dedicated equipment in a \n\n\n\npharmacy to provide containment of powder \nwhere there is a requirement for \ncompounding cytotoxic preparations \n\n\n\n\u2022 operational specifications for the use of \ncytotoxic drug preparation facilities \nincluding cytotoxic drug safety cabinet \n\n\n\n\u2022 initial and ongoing validation of operator \ncompetence \n\n\n\n\u2022 reconstitution procedures \n\u2022 routine and emergency cleaning and \n\n\n\ndecontamination protocol \n\u2022 spill management \n\u2022 maintenance and certification of equipment \n\n\n\nand facilities \n\u2022 availability of drug safety information \n\u2022 documentation and records \n\u2022 maintenance of daily records \n\u2022 labelling and packaging for transport \n\n\n\ninternally or externally \n \nHealth care establishments which are unable to \nprovide facilities, equipment and training to \nemployees, should not undertake to provide a \ncytotoxic drug service. Alternative arrangements \ncould include: \n\u2022 purchase and supply of the prepared \n\n\n\ncytotoxic drug in a single dose delivery unit. \n\u2022 establishment of supply arrangements with a \n\n\n\nhealth care institution which has the required \nfacilities, equipment and trained personnel \n\n\n\nto provide prepared cytotoxic drug doses. \n \nDrug administration \n \nNursing, medical and other personnel may be \ninvolved in administering oral, parenteral and \ntopical cytotoxic drugs. A number of factors \ninfluence their level of risk of exposure to \ncytotoxic drugs during administration. Exposure \nmay occur due to contamination from solid or \nliquid spills or splashes and needle stick injuries. \n \nMany factors contribute to the risk of exposure, \nincluding: \n\u2022 poor technique, improperly used or \n\n\n\ninappropriate equipment \n\u2022 patient behaviour, when it increases the \n\n\n\ndifficulty of administration, for example, if \nthe patient is uncooperative \n\n\n\n\u2022 the route of administration, for example, the \nrisk of splashes in the eyes of the operator or \nassistant during an intrathecal injection is \nincreased owing to the proximity of the face \nto the injection site \n\n\n\n\u2022 an inappropriate working environment \n \nIt is important that practitioners identify the level \nrisk, then use appropriate work practices and \nPersonal Protective Equipment to minimize the \nrisks. \n \nAll staff administering cytotoxic drugs should be \nappropriately trained (9) in the following aspects \nof cytotoxic drug handling and demonstrate \nproficiency prior to commencing duties: \n\u2022 potential occupational hazards \n\u2022 approved work practice \n\u2022 specialized operator techniques \n\u2022 waste containment and handling \n\u2022 spill management techniques \n\u2022 proper use of Personal Protective Equipment \n \nThe following Personal Protective Equipment \nshould be considered for use during \nadministration of cytotoxic drugs: \n\u2022 a particulate respirator type mask \n\u2022 a long sleeved gown of impermeable \n\n\n\nmaterial \n\u2022 safety spectacles or goggles \n\u2022 long PVC, surgical latex, or purpose \n\n\n\nmanufactured gloves \n \nPersonal Protective Equipment should be \nremoved following completion of procedures and \nappropriately cleaned or disposed of. \n\n\n\n\n\n\n\n\nCPE article: Managing cytotoxic products \n\n\n\n 66\n\n\n\nSpill management \n \nStrategically, small spills that occur on-site and \nduring transportation should be managed by the \nhealth care establishment. Procedures must \nspecify under what conditions emergency \nservices should become involved. Spill \ncontainment should be the principle role of \nhealth personnel in gross spill management, \npending the attendance of the emergency spill \nmanagement team. \n \nProcedures should be established for small spills. \nThe management should ensure that safe work \npractices are developed, understood, \nimplemented and maintained by all personnel \nwho handle cytotoxic drugs and who may be \ninvolved in spill management. Training in spill \ncontainment and decontamination procedures \nshould be provided to personnel likely to be \ninvolved in spill management including: \n\u2022 pharmacy personnel \n\u2022 store personnel \n\u2022 nursing and medical personnel \n\u2022 cleaners \n\u2022 waste collectors \n \nSpill kits should be located so that they are \nreadily available for immediate use at all sites \nwhere cytotoxic drugs and waste are handled, \nstored and transported. \n \nStandard operating procedures for spill \nmanagement should specify: \n\u2022 the trained personnel approved for spill \n\n\n\nmanagement \n\u2022 spill strategies for specific location, e.g. \n\n\n\nwards, or in transit \n\u2022 procedures for using decontamination \n\n\n\nsolutions \n\u2022 where and how to obtain decontamination \n\n\n\nsolutions \n\u2022 who is responsible for providing and \n\n\n\nmaintaining spill management supplies \n\u2022 the personnel protective equipment to be \n\n\n\nused \n \nWaste management \n \nCytotoxic waste includes any residual drug \nfollowing patient treatment and the material \nassociated with the preparation or administration \nof cytotoxic drugs such as sharps, syringes, IV \ninfusion sets and containers, ampoules, vials and \ndisposable gowns, caps and gloves and swabs \n\n\n\nand materials used to clean and contain spills. \nAll cytotoxic waste need proper identification, \nsegregation and containment. An easily \nidentifiable symbol that denotes cytotoxic \nmaterials can be used. Containers and plastic \nbags to contain cytotoxic waste should be: \n\u2022 of any selected colour, e.g. purple \n\u2022 marked  \u201cCYTOTOXIC WASTE\u201d \n\u2022 placed in a rigid-walled container for \n\n\n\ntransport to a designated storage area \n \nAll sharps should be: \n\u2022 placed in a rigid-walled containers \n\u2022 labelled  \u201cCYTOTOXIC SHARPS\u201d \n\u2022 disposed of according to recommended \n\n\n\nprocedures \n \nPersonnel management \n \nLittle is known about the long term effects of \noccupational exposure to low level doses of \ncytotoxic drugs. Therefore the primary focus of \nsafety during use of cytotoxic drugs must be on \nthe control of the working environment and safe \nwork practices. \n \nHowever, there are variables that need to be \nconsidered in determining occupational hazards \nof cytotoxic drugs to an individual: \n\u2022 chemical properties of the drugs \n\u2022 the susceptibility of the individuals to the \n\n\n\ndrug\u2019s toxic effects \n\u2022 cofactors such as dietary habits, smoking \n\n\n\nand natural or manmade environment \ncontamination \n\n\n\n\u2022 type of exposure, e.g. skin contact, \ninhalation, ingestion \n\n\n\n \nIt is important that the health status of employees \nis monitored. There is currently no biological \nhealth assessment technique that is sufficiently \nspecific to adequately predict the effects of \nexposure to cytotoxic drugs. Employers should \ninvestigate and use the most appropriate and \nrecent method of health surveillance available \nand ensure that baseline data are collected. \nRecords should be maintained of all health \nassessment and biological monitoring results \nrelated to occupational cytotoxic drug exposure. \nOne purpose of these records is to facilitate \nretrospective studies to assess risk of exposure to \nemployees. \n \nWhere any form of health surveillance is \nundertaken, confidentiality should be ensured. \nRequirements such as employee consent, record \n\n\n\n\n\n\n\n\nCPE article: Managing cytotoxic products \n\n\n\n 67\n\n\n\nretention and security should be achieved and \nmaintained. Employees should receive duplicates \nof health surveillance test as soon as available. \nEmployees who are pregnant, breast-feeding or \nplanning parenthood and involved in the \npreparation or administration of cytotoxic drugs \nshould be informed of the risks of reproductive \neffects and possible effects on foetal \ndevelopment. Personnel required to perform \nthese may elect to not to do so. In such cases \nappropriate and suitable alternative duties must \nbe provided. \n \nEmployees should report any effects of, or \nexposure to cytotoxic drugs related to handling \nof the drugs or contaminated waste. The report \nshould be made to the supervisor through the \nnormal workplace incident reporting procedures. \nAny near miss incident or accident involving the \nhandling of either cytotoxic drugs or waste, \nshould be investigated to determine the cause. \nAppropriate action to prevent a recurrence \nshould be determined and taken. A listing of \npersonnel approved to undertake cytotoxic drug \npreparation and administration should be \nmaintained. \n \nThe management is responsible for maintaining, \nin perpetuity (e.g. 25 years minimum), the \nfollowing records for employees handling \ncytotoxic drugs: \n\u2022 accreditation or training status and type and \n\n\n\nextent of training period \n\n\n\n\u2022 record of time spent in the preparation and \nadministration of cytotoxic drugs \n\n\n\n\u2022 activity logs including name of the drug and \nactivity undertaken) \n\n\n\n\u2022 protective equipment used (e.g. cytotoxic \ndrug safety cabinet, Personal Protective \nEquipment) \n\n\n\n\u2022 unusual equipment (e.g. for managing \nspills). \n\n\n\n \nIn view of the long latency for some toxic \neffects, each employee should receive, on \ntermination of employment, a statement \nindicating the cytotoxic drugs used and results of \nany biological monitoring carried out. \n \nCONCLUSION \n \nAlthough there are many reports and studies that \nhave been carried out to show the relationship \nbetween cytotoxic exposure and risk to health, it \nis still difficult to confirm it. This is perhaps due \nto the small sample size, difficulty in quantifying \nexposure or protection used and latency period \nbetween exposure and health effects. Despite \nthese limitations, there is enough information to \nwarrant prudent action when handling cytotoxic \ndrugs. Therefore, the safe handling of cytotoxic \ndrugs is an issue that must be addressed in health \ncare settings. \n \n\n\n\nSee next page for the CPE questions \n\n\n\n \n***** \n\n\n\n \nREFERENCES \n \n1. Curran CF, Luce JK. Accidental acute exposure to \n\n\n\ndoxorubicin. Cancer Nursing 1989; 12: 329-31. \n2. Anderson RW, Puckett WH, Dana WJ, et al. Risk \n\n\n\nof handling injectable antineoplastic agents. Am J \nHosp Pharm 1982; 39:17-23. \n\n\n\n3. Hirst M, Tse S, Mills DG, et al. Occupational \nexposure to cyclophosphamide. Lancet \n1984;1:186-88. \n\n\n\n4. Benhamou S, Callous F, Saneho-Garnier H, et al. \nMutagenicity in urine from nurses handling \ncytotoxic agents. Eur J Cancer Oncol 1986; \n22:1489-1493. \n\n\n\n5. Falck K, Crohn P, Sorsa M, et al. Mutagenicity in \nurine from nurses handling cytotoxic drugs. \nLancet 1979;1250-1251. \n\n\n\n\n\n\n\n6. Gibson JF, Gompertz D, Hedworth-Whitty RB. \nMutagenicity of urine from nurses handling \ncytotoxic drugs. Lancet 1984; 1: 100-101. \n\n\n\n7. Rodriquez P, Yap CY. Abnormal blood results \nfound in pharmacists preparing cytotoxics. Aust J \nHosp Pharmacy 1991;21:39. \n\n\n\n8. New South Wales Work Cover. Guidelines for \nhandling drugs and related waste in health care \nestablishments. 1995. 2edn. New South Wales \nGovernment. \n\n\n\n9. Moore TD, Hale KM, Cortese LM, et al. \nManaging employee apprehension toward \nhandling cytotoxic drugs. Am J Hosp Pharm \n1984;41:2618-2623.\n\n\n\n\n\n\n\n\nCPE article: Managing cytotoxic products \n\n\n\n 68\n\n\n\nFrom previous page \n \nContinuing Pharmacy Education questions: \n \nStudy the questions below and send your answers (only one of A, B, C and D is correct) to the MPS-CPE \nSecretariat at the Malaysian Pharmaceutical Society, P.O. Box 158, Jalan Sultan, 46710 Petaling Jaya, \nSelangor. You may earn up to 2 CPE points. \n \n \n1. The most common routes of occupational hazard from handling cytotoxic drugs are \n\n\n\nA. accidental injection, gastric absorption \nB. direct contact, gastric absorption \nC. inhalation, direct contact \nD. mucosal absorption, inhalation \n\n\n\n \n2.       Potential effects of exposure to cytotoxic drugs in health care personnel are \n\n\n\nA. contact dermatitis and cardiotoxicity \nB. foetal loss or malformation in pregnant women \nC. liver damage and phlebitis \nD. extravasation at the injection site \n\n\n\n \n3.      The greatest risk of occupational exposure of cytotoxic drugs is during \n\n\n\nA. preparation and transportation \nB. administration and disposal \nC. preparation and administration \nD. transportation and disposal \n\n\n\n \n4. The advantage of having a dedicated area for storage of cytotoxic drugs in pharmacy \n\n\n\ndepartments is to \nA. facilitate searching of stock \nB. facilitate quick and efficient containment and management of spill \nC. provide proper stock management \nD. provide better control and monitoring of cytotoxic drugs usage \n\n\n\n \n5. Standard operating procedures for preparation of cytotoxic drugs should include those \n\n\n\nbelow, EXCEPT \nA. documentation and record \nB. reconstitution procedures \nC. maintenance and certification of equipment \nD. potential hazard of cytotoxic drugs \n\n\n\n \n6. The following are the variables that can be considered in determining occupational hazards \n\n\n\nof cytotoxic drugs to health personnel, EXCEPT \nA. chemical properties of the drugs \nB. toxic effects of the cytotoxic drugs \nC. type of exposure \nD. cofactors such as dietary habit \n\n\n\n\n\n"
"\n\n\n\n\n\n\n\n\n\n\n\n\n\nPROCEEDINGS of \n\n\n\nMPS-NATIONAL PHARMACISTS \n\n\n\nCONVENTION 2021 \n\n\n\n\n\n\n\n8th-11th July 2021 \n\n\n\n \nVirtual Convention \n\n\n\nTheme: Exploration, inspiration ad transformation of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nEditors \n \n\n\n\nABUBAKAR SHA'ABAN \n\n\n\nAMER HAYAT KHAN \n\n\n\nAMIRAH MOHD GAZZALI \n\n\n\nBALAMURUGAN TANGIISURAN \n\n\n\nCHAN SIOK YEE \n\n\n\nDANG CHEE CHEAN \n\n\n\nHADZLIANA ZAINAL \n\n\n\nLONG CHIAU MING \n\n\n\nNUR HAFZAN MD HANAFIAH \n\n\n\nOOI GUAT SEE \n\n\n\nSINAN MOHAMMAD ABDULLAH AL-MAHMOOD  \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 7, Issue 1, Supplementary (2021), 49-77 \n\n\n\n50 \n \n\n\n\nResearch Presentation of National Pharmacy Convention 2021 \n\n\n\nDOI:  10.52494/UCML9733 \n \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\n\n\n\n\nACKNOWLEDGEMENT \n \n\n\n\nMalaysian Journal of Pharmacy sincerely appreciates the contributions of our reviewers to enable the peer-\n\n\n\nreviewed process and improve quality of the articles published as the proceedings of MPS-National Pharmacists \n\n\n\nConvention 2021. \nDr Abubakar Sha'aban \n\n\n\nAssoc. Prof Aisyah Saad Abdul Rahim \n\n\n\nDr Amer Hayat Khan \n\n\n\nDr Amirah Mohd Gazzali \n\n\n\nAssoc. Prof Balamurugan Tangiisuran \n\n\n\nProf Chua Siew Siang \n\n\n\nAssoc. Prof Chan Siok Yee \n\n\n\nMr Dang Chee Chean \n\n\n\nDr Omotayo Oladuntoye Fatokun \n\n\n\nDr Fatimatuzzahra' Abd. Aziz \n\n\n\nDr Gan Pou Wee \n\n\n\nDr Goh Choon Fu \n\n\n\nDr Hadzliana Zainal \n\n\n\nMr Kamarudin Ahmad \n\n\n\nMiss Lau Chee Lan \n\n\n\nAssoc. Prof Lee Ming Tatt \n\n\n\nAssoc. Prof Long Chiau Ming  \n\n\n\nDr Leong Siew Lian \n\n\n\nDr Noratiqah Mohtar \n\n\n\nDr Norny Syafinaz Ab Rahman \n\n\n\nDr Nur Aizati Athirah Daud \n\n\n\nDr Nur Hafzan Md Hanafiah \n\n\n\nDr Omotayo Oladuntoye Fatokun, \n\n\n\nDr Ooi Guat See \n\n\n\nDr Riyanto Teguh Widodo \n\n\n\nDr Sabariah Noor Harun \n\n\n\nDr Shairyzah Ahmad Hisham \n\n\n\nDr Sinan Mohammad Abdullah Al-Mahmood \n\n\n\nDr Siti Maisharah Sheikh Ghadzi \n\n\n\nAssoc. Prof Tan Ching Siang \n\n\n\nAssoc. Prof Tan Mei Lan \n\n\n\nDr Thaigarajan Parumasivam \n\n\n\nDr Wong Pei Se \n\n\n\nDr Yvonne Khoo \n\n\n\n\n\n\n\n\n\n\n\nPublisher:  \n\n\n\n\n\n\n\nMalaysian Pharmacists Society  \n\n\n\n16-2 Jalan OP 1/5, 1-Puchong Business Park  \n\n\n\nOff Jalan Puchong, 47160 Puchong, Malaysia  \n\n\n\n \n\u00a9 Malaysian Journal of Pharmacy \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 7, Issue 1, Supplementary (2021), 49-77 \n\n\n\n\n\n\n\n\n\n\n\n51 \n\n\n\n\n\n\n\nResearch Abstracts of National Pharmacy Convention 2021 \n\n\n\nDOI:  10.52494/UCML9733 \n \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 001 \n\n\n\n\n\n\n\nDevelopment and Evaluation of a \n\n\n\nMicrosphere Loaded Cream \n\n\n\nContaining Solanum Lycopersicum \n\n\n\nfor Tyrosinase Inhibition  \n \nTan Lee Fang*, Mogana Rajagopal, Sasikala \n\n\n\nChinnappan, Ashok Kumar Janakiraman1, \n\n\n\nVenkatalakshmi Ranganathan2, Yap Vi Lien1 \n\n\n\n \n1 Faculty of Pharmaceutical University, UCSI University, Malaysia. \n2 Department of Dosage Form Design, School of Pharmacy, MAHSA \nUniversity, Malaysia. \n\n\n\n\n\n\n\n*Correspondence: tanleefang2011@gmail.com \n \n\n\n\nIntroduction: Hyperpigmentation is a common skin disorder \n\n\n\ncaused by excessive melanin synthesis. Hydroquinone, the \n\n\n\ncurrent gold standard used for the treatment of \n\n\n\nhyperpigmentation disorders has been reported to cause \n\n\n\nseveral adverse effects. Medicated topical formulations are \n\n\n\ncommonly associated with irritation and allergic reactions. \n\n\n\nAlternatively, botanically-derived agents have gained \n\n\n\nincreased attention in the pursuit of novel effective \n\n\n\ndepigmenting agents with milder side effects. Solanum \n\n\n\nlycopersicum or tomato has been linked with numerous \n\n\n\nhealth benefits and its tyrosinase inhibitory activity has also \n\n\n\nbeen reported. However, the current botanical formulations \n\n\n\nhave been associated with ineffectiveness of skin penetration, \n\n\n\nshorter duration of action, less final quality, and lower \n\n\n\ndepigmenting effects. Controlled drug delivery achieved via \n\n\n\nmicrosponge system may help to overcome the obstacles \n\n\n\nwith enhanced stability and efficacy. Hence, a cream \n\n\n\nformulation incorporating tomato-loaded microspheres, \n\n\n\ncurrently unavailable in the market, would be the first and \n\n\n\npossibly a potential alternative for hyperpigmentation \n\n\n\ncontrol. Objective: The objectives are to formulate tomato \n\n\n\nmicrosphere loaded cream and to determine its tyrosinase \n\n\n\ninhibition activity. Method: Double emulsion technique was \n\n\n\nused for the formulation of microspheres. The microspheres \n\n\n\nwere evaluated for percentage yield, entrapment efficiency, \n\n\n\nloading capacity, surface morphology and drug-polymer \n\n\n\ninteraction. The drug-loaded microspheres were then \n\n\n\nincorporated into the water removable cream followed by \n\n\n\ndetermination of tyrosinase inhibitory activity. GraphPad \n\n\n\nPrism was used for the construction of results and \n\n\n\ndetermination of IC50. Result and Discussion: The 85.27% \n\n\n\nyield of tomato seed oil-loaded microspheres was prepared \n\n\n\nwith an entrapment efficiency of 65.85% and a loading \n\n\n\ncapacity of 21.95%. The formulated cream had desirable \n\n\n\norganoleptic characteristics. The mean pH of cream was 5.55 \n\n\n\n\u00b1 0.09 with comparable spreadability with commercial \n\n\n\nproducts. The tyrosinase inhibitory activity of the formulated \n\n\n\ncream was statistically significant compared with tomato \n\n\n\nseed oil (8.32 \u00b1 0.23 mg/mL) and blank cream (10.87 \u00b1 0.31 \n\n\n\nmg/mL) alone with the lowest IC50 value (26.85 \u00b1 0.24 \n\n\n\n\u03bcg/mL) but comparable to the positive control, kojic acid \n\n\n\n(1.65 \u00b1 0.50 \u03bcg/mL). Conclusion: Solanum lycopersicum \n\n\n\nmicrosphere loaded cream was successfully formulated with \n\n\n\na desirable in vitro tyrosinase inhibitory activity, suggesting \n\n\n\nits potential as an alternative for the treatment of \n\n\n\nhyperpigmentation disorders. \n\n\n\n\n\n\n\nReference \n \n\n\n\n[1] Nk V, Alam G. Formulation and characterization of floating microspheres of ibuprofen. \n\n\n\nInt J Res Pharm Sci. 2015;5(1):18\u201322. \n\n\n\n[2] El-Say KM. Maximizing the encapsulation efficiency and the bioavailability of \n\n\n\ncontrolled-release cetirizine microspheres using Draper\u2013Lin small composite design. \n\n\n\nDrug Des Devel Ther [Internet]. 2016 Feb 24 [cited 2020 Nov 16];10:825\u201339. Available \n\n\n\nfrom: /pmc/articles/PMC4771436/?report=abstract \n\n\n\n[3] Reddy MR, Soumyastutipatnaik. Design and in vitro characterization of flutrimazole \n\n\n\nmicrospheres loaded topical emulgel. Asian J Pharm Clin Res [Internet]. 2019 Jul 26 [cited \n\n\n\n2020 Nov 16];242\u201351. Available from: \n\n\n\nhttp://dx.doi.org/10.22159/ajpcr.2019.v12i9.34341 \n\n\n\n\n\n\n\nAbstract 002 \n\n\n\n\n\n\n\nExpectation and Perception of \n\n\n\nContract Pharmacists Regarding their \n\n\n\nPharmacy Career \n \nIzzati Yussof1*, Ong See Wan1, Teng Sook \n\n\n\nYee1, Dahlia Nadira Abd Manan1, Nazariah \n\n\n\nHaron1, Sahidah Said2 \n\n\n\n \n1 Pharmaceutical Services Division, Kuala Lumpur & Putrajaya Health \n\n\n\nDepartment, Kuala Lumpur, \n2 Pharmacy Department, National Cancer Institute, Putrajaya, Ministry of \nHealth Malaysia \n\n\n\n\n\n\n\n*Correspondence: izzati.yussof@gmail.com \n \n\n\n\nIntroduction: Ministry of Health (MOH) Malaysia \n\n\n\nintroduced the contract system for pharmacists to reduce \n\n\n\npharmacy graduates waiting period for the training program \n\n\n\nin government health facilities. Studies have been conducted \n\n\n\nto assess perception towards the training program in \n\n\n\ngovernment facilities [1,2] and the overall job satisfaction \n\n\n\namong pharmacists [3], but little is known about the \n\n\n\nperception of contract pharmacists following the new policy.  \n\n\n\nObjective: To explore contract pharmacists\u2019 expectation and \n\n\n\nperception of their pharmacy career in terms of future career \n\n\n\nplans and general perception of employability. Method: A \n\n\n\ncross-sectional study was conducted using a validated, self-\n\n\n\nadministered online questionnaire involving contract \n\n\n\npharmacists working in government health facilities within \n\n\n\nKuala Lumpur and Putrajaya. Data were collected in \n\n\n\nNovember and December 2020 and sent through facilities\u2019 \n\n\n\nemail. The questionnaire contains 24 main questions that \n\n\n\nassess career expectation and experience in job search using \n\n\n\n5-point Likert-type questions and an open-ended question for \n\n\n\n\nmailto:tanleefang2011@gmail.com\n\n\nmailto:izzati.yussof@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 7, Issue 1, Supplementary (2021), 49-77 \n\n\n\n52 \n \n\n\n\nResearch Presentation of National Pharmacy Convention 2021 \n\n\n\nDOI:  10.52494/UCML9733 \n \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nsuggestions to improve aspects of their training. Result and \n\n\n\nDiscussion: The response rate was 68.8% (n=97). Of the \n\n\n\nrespondents, 92.8% expressed a desire to work with MOH, \n\n\n\nbut only 24.7% were confident that they could obtain a \n\n\n\npermanent position within MOH, and only 27.8% believed \n\n\n\nthat they could secure any job offer. Among the respondents, \n\n\n\n35.1% (n=34) have started looking for alternative \n\n\n\nemployment, but only eight of them managed to secure a job \n\n\n\noffer. The respondents perceived community pharmacy as \n\n\n\nthe sector that offers the most job opportunities (88.5%). \n\n\n\nLong-term job security, work environment and opportunities \n\n\n\nfor career development were rated the three most essential \n\n\n\nfactors in choosing their career. Preference to work with the \n\n\n\ngovernment may be attributed to long-term job security being \n\n\n\nthe most crucial factor in career choice. Conclusion: The \n\n\n\ncontract system poses various challenges for the new \n\n\n\ngeneration of pharmacists. There was an excess of demand \n\n\n\nfor jobs in the government sector, with many uncertainties in \n\n\n\nemployment opportunities. Early career advice and broader \n\n\n\nexposure to pharmacy career pathways are essential to \n\n\n\nbroaden their career perspectives and equip them with the \n\n\n\nnecessary skills to adapt and develop new roles to keep up \n\n\n\nwith changing times. \n\n\n\n \nReference \n\n\n\n \n[1] Syed M Haq, A. H., Md Yusof, F. A., Chan, P. L., Chok, M. C. F., Phua, G. S. Y., Teoh, \n\n\n\nC. J., Yaacob, N., Azmi, Y., Osman, N. A., Paiman, A. F., Abu, S. F., Othman, N. A., Abd \n\n\n\nKadir, S. and Mokhtar Ahmad, K. 2018. The satisfaction and perception of Provisionally \n\n\n\nRegistered Pharmacists (PRP) towards their internship training in the Ministry of Health, \n\n\n\nMalaysia facilities: A national survey. Curr Pharm Teach Learn, 10(7), pp. 854-874. doi: \n\n\n\n10.1016/j.cptl.2018.04.005. \n\n\n\n[2] Phua, G., Teoh, C. and Khong, L. 2017. The Satisfaction and perception of intern \n\n\n\npharmacists towards their training in government hospitals in the Northern Region of \n\n\n\nMalaysia. Pharmacy Education, 17(1), pp. 15-23. \n\n\n\n[3] Janahiraman, S. and Paraidathathu, T. 2007. Job Satisfaction among Malaysian \n\n\n\nPharmacists'.  Malaysian Journal of Health Sciences, Malaysian Journal of Health \n\n\n\nSciences, vol. 5. \n\n\n\n\n\n\n\nAbstract 003 \n\n\n\n\n\n\n\nAn Evaluation on the Practices about \n\n\n\nthe Use of Paracetamol among \n\n\n\nParents in Treating their Children in \n\n\n\nPenang, Malaysia \n \nEe Theng Yeoh1, Angel Wei Ling Goh2*, Chee \n\n\n\nPing Chong3 \n\n\n\n \n1 Gleneagles Hospital Penang, 1, Jalan Pangkor, 10050 George Town, \n\n\n\nPulau Pinang \n2 Klinik Kesihatan Perai, Seberang Jaya, 13600 Perai, Pulau Pinang \n3 Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, \n\n\n\nUniversiti Sains Malaysia, 11800 Penang, Malaysia \n\n\n\n \n*Correspondence: angelgoh.1996@gmail.com \n\n\n\n\n\n\n\nIntroduction: Paracetamol is a common antipyretic used to \n\n\n\ntreat fever in people of all ages, including children. The \n\n\n\nwidespread availability of paracetamol over the counter has \n\n\n\nled to its usage by parents, often without proper consultation \n\n\n\nwith healthcare practitioners, putting children at risk of \n\n\n\nparacetamol poisoning. Objective: This study aims to \n\n\n\nevaluate the practices of paracetamol use among Malaysian \n\n\n\nparents in treating their children.  Method: This was a cross-\n\n\n\nsectional quantitative structured interview using a \n\n\n\nquestionnaire. Data was collected from a total of 93 parents \n\n\n\nfrom Penang, Malaysia, in August 2019. Result and \n\n\n\nDiscussion: Most parents were between age 26 to 40 years \n\n\n\n(67.7%) and had at least two children (74.2%). About 54.2% \n\n\n\nof parents had children between 4 - 9 years old. The majority \n\n\n\nof parents (87.1%) had used paracetamol to treat their \n\n\n\nchildren, with 77.9% of them using it for fever. \n\n\n\nApproximately half (53.1%) of the parents used paracetamol \n\n\n\nwhen their children\u2019s body temperatures were between \n\n\n\n37.5\u02daC \u2013 38\u02daC. Syrup (66.1%) and chewable tablets (20.2%) \n\n\n\nwere the most popular forms of paracetamol used to treat \n\n\n\nchildren. The parents mostly use paracetamol every 6-hourly \n\n\n\n(45.7%) and 4-hourly (38.3%). Among the 1 \u2013 3 years old \n\n\n\nchildren who used paracetamol syrup, 37.5% of them \n\n\n\nexceeded the recommended total daily dose. Conversely, \n\n\n\n64.7% of the children aged 10 \u2013 12 years who consumed \n\n\n\nparacetamol syrup were found to have below the \n\n\n\nrecommended total daily dose. Conclusion: In conclusion, \n\n\n\nthe practices of paracetamol usage among the parents need to \n\n\n\nbe improved to ensure better treatment outcomes for the \n\n\n\nchildren.  \n\n\n\n \nReference \n \n\n\n\n[1] Maison, P., Guillemot, D., Vauzelle-Kervroedan, F., Balkau, B., Sermet, C., Thibult, N., \n\n\n\nEschwege, E. 1998. Trends in aspirin, paracetamol and non-steroidal anti-inflammatory \n\n\n\ndrug use in children between 1981 and 1992 in France. European Journal of Clinical \n\n\n\nPharmacology, 54(8):659\u2013664. \n\n\n\n[2] Lenney, W. 2012. Paracetamol prescription by age or by weight? Archives of Disease in \n\n\n\nChildhood, 97:277-278 \n\n\n\n[3] Eyers, S., Fingleton, J., Eastwood, A., Perrin, K., Beasley, R. 2012. British National \n\n\n\nFormulary for Children: the risk of inappropriate paracetamol prescribing. Archives of \n\n\n\nDisease in Childhood, 97(3):279\u2013282. \n\n\n\n \n\n\n\n\nmailto:angelgoh.1996@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 7, Issue 1, Supplementary (2021), 49-77 \n\n\n\n53 \n \n\n\n\nResearch Presentation of National Pharmacy Convention 2021 \n\n\n\nDOI:  10.52494/UCML9733 \n \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 004 \n\n\n\n\n\n\n\nAntimicrobial Stewardship \n\n\n\nIntegrated Approach: An Outcome \n\n\n\nEvaluation in Perak (AMSIA Study) \n \nCheah Meng Fei1*, Yean Yi Lyn2, Lee Lay \n\n\n\nChin3, Ros Sakinah Kamaludin4, Ling Siew \n\n\n\nHong5, Chan Wai Seong Christopher6, Thong \n\n\n\nKah Shuen1, Ker Hong Bee7 \n\n\n\n \n1 Department of Pharmacy, Hospital Raja Permaisuri Bainun, Perak, \n\n\n\nMalaysia \n2 Department of Pharmacy, Hospital Taiping, Perak, Malaysia \n3 Department of Pharmacy, Hospital Teluk Intan, Perak, Malaysia \n4 Department of Pharmacy, Hospital Slim River, Perak, Malaysia \n5 Department of Pharmacy, Hospital Seri Manjung, Perak, Malaysia \n6 Clinical Research Centre, Hospital Taiping, Perak, Malaysia \n7 Department of Medicine, Hospital Raja Permaisuri Bainun, Perak, \nMalaysia \n\n\n\n\n\n\n\n*Correspondence: mfcheah85@hotmail.com \n \n\n\n\nIntroduction: The antimicrobial stewardship (AMS) \n\n\n\nprogram has been implemented in most public healthcare \n\n\n\nfacilities in Malaysia to promote judicious antimicrobial \n\n\n\nusage and minimize antimicrobial resistance. The AMS \n\n\n\nintegrated approach (AMSIA) was implemented by ward \n\n\n\npharmacists and the AMS team concurrently at five specialist \n\n\n\nhospitals in Perak to enhance several AMS initiatives. The \n\n\n\ninitiatives include creating an antibiotic quick reference \n\n\n\nguide, intravenous-to-oral conversion algorithm, \n\n\n\nengagements, and continuous medical education (CME) \n\n\n\nsessions with stakeholders. Objective: To evaluate the \n\n\n\nimpact of the AMSIA in terms of clinical outcomes among \n\n\n\npatients, and the antimicrobial cost savings based on the \n\n\n\nAMS recommendations provided. Method: This is a \n\n\n\nretrospective evaluation of the AMS database at the study \n\n\n\nhospitals comparing data between two phases before and \n\n\n\nafter implementing the AMSIA. Data from the AMS review \n\n\n\nforms were extracted and analyzed. Result and Discussion: \n\n\n\nA total of 544 cases were referred for AMS recommendations \n\n\n\nduring both phases. Of those recommendations, 474 (87.1%) \n\n\n\nwere accepted by the primary team. Most patients (76.7%) \n\n\n\nwere discharged well. Recommendations provided by ward \n\n\n\npharmacists were more likely to be accepted than those \n\n\n\noffered by the AMS team (p=0.022). There was no \n\n\n\nassociation between 30-day infection-related mortality \n\n\n\n(p>0.95) with acceptance of those recommendations. \n\n\n\nHowever, accepting the recommendations contributed to a \n\n\n\nshorter duration of antimicrobial therapy (p=0.001), a shorter \n\n\n\nlength of hospitalization (p<0.001), and a total antimicrobial \n\n\n\ncost saving of RM427.28, while rejection resulted in a cost \n\n\n\nincrement of RM2122.32 over the study period (p<0.001). \n\n\n\nThere were no differences in terms of the rate of acceptance \n\n\n\nof the recommendations as well as the clinical outcomes and \n\n\n\ncost savings between the study phases. Conclusion: AMS \n\n\n\nrecommendations resulted in cost savings, shorter \n\n\n\nhospitalizations, and duration of antimicrobial therapy \n\n\n\nwithout compromising patients\u2019 survival. Ward pharmacists \n\n\n\nplayed equally important roles as the AMS team in the AMS \n\n\n\nprogram.  \n\n\n\n \nReference \n \n\n\n\n[1] Policy statement on antimicrobial stewardship by the Society for Healthcare \n\n\n\nEpidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA), \n\n\n\nand the Pediatric Infectious Diseases Society (PIDS). Infection Control and Hospital \n\n\n\nEpidemiology. 2012;33(4):322-327. \n\n\n\n[2] Teo, J., Kwa, A. L., Loh, J., Chlebicki, M. P., Lee, W. The effect of a whole-system \n\n\n\napproach in an antimicrobial stewardship programme at the Singapore General Hospital. \n\n\n\nEuropean Journal of Clinical Microbiology and Infectious Diseases. 2012;31(6):947-955. \n\n\n\n[3] Liew, Y. X., Lee, W., Loh, J. C., Cai, Y., Tang, S. S., Lim, C. L., et al. Impact of an \n\n\n\nantimicrobial stewardship programme on patient safety in Singapore General Hospital. \n\n\n\nInternational Journal of Antimicrobial Agents. 2012;40(1):55-60. \n\n\n\n\n\n\n\nAbstract 005 \n\n\n\n\n\n\n\nImpact of an Antibiotic Stewardship \n\n\n\nProgram on the Use of Carbapenem \n\n\n\nin a Malaysian Tertiary Hospital \n \nAnitha Ramadas1*, Hwei Lin Teh1, Rahela \n\n\n\nAmbaras Khan1, Shan Lii Ching1, Rohana \n\n\n\nHassan1, Chee Loon Leong2, Farida Hanim \n\n\n\nIslahudin3 \n\n\n\n \n1 Department of Pharmacy, Hospital Kuala Lumpur \n\n\n\n2 Department of Medicine, Hospital Kuala Lumpur \n3 Faculty of Pharmacy, National University of Malaysia \n\n\n\n\n\n\n\n*Correspondence: ramadas.anitha@gmail.com \n\n\n\n\n\n\n\nIntroduction: Antimicrobial Stewardship (AMS) program \n\n\n\nhas been advocated to promote the rational use of antibiotic \n\n\n\nprescribing. However, the outcome of AMS in promoting the \n\n\n\njudicious use of carbapenem and minimising resistance is not \n\n\n\nwidely studied in Malaysia. Objective: To investigate the \n\n\n\ntypes of interventions made by the AMS team, its acceptance, \n\n\n\nand the impact on carbapenem consumption and \n\n\n\ncarbapenem-resistant Enterobacteriaceae (CRE) pattern. \n\n\n\nMethod: This was a retrospective study conducted in adult \n\n\n\nmedical wards of Kuala Lumpur General Hospital (HKL), \n\n\n\nwhere data were extracted from AMS form of patients \n\n\n\nreviewed by the HKL AMS team from January to December \n\n\n\n2016. Result and Discussion: The mean (SD) age of 169 \n\n\n\npatients included in this study was 59.2 (10.6) years, where \n\n\n\nalmost half were male. Ertapenem was the most prescribed \n\n\n\ncarbapenem (44.4%), followed by meropenem (34.3%) and \n\n\n\nimipenem/cilastatin (21.3%). Despite only 32% being \n\n\n\nempirically initiated, there were 68 cases (40.2%) classified \n\n\n\nas unjustified by the Antimicrobial Stewardship (AMS) team. \n\n\n\nOut of these, 39 cases (57%) were recommended to be \n\n\n\ndiscontinued, 25 cases (37%) to be de-escalated and 4 cases \n\n\n\n(6%) for changing/escalation. Acceptance rate was reported \n\n\n\n\nmailto:mfcheah85@hotmail.com\n\n\nmailto:ramadas.anitha@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 7, Issue 1, Supplementary (2021), 49-77 \n\n\n\n54 \n \n\n\n\nResearch Presentation of National Pharmacy Convention 2021 \n\n\n\nDOI:  10.52494/UCML9733 \n \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nto be around 73.5% (50 out of 68 cases). Post one year of \n\n\n\nAMS implementation, carbapenem consumption shown by \n\n\n\ndefined daily dose/1000 inpatient bed-days reduced \n\n\n\nsignificantly (33.7%; p<0.0001). Similarly, a notable \n\n\n\ndecrease in CRE cases (33.3%; p<0.0001) was seen post one \n\n\n\nyear of AMS initiation. Conclusion: In conclusion, AMS-\n\n\n\nguided interventions were shown to be a useful strategy to \n\n\n\nreduce non-judicious use of carbapenem in a tertiary hospital. \n\n\n\nIt was also able to demonstrate a reduction in carbapenem \n\n\n\nconsumption as well as CRE rates in the medical wards. \n\n\n\nTherefore, future long-term studies are required to assess \n\n\n\nlong-term effectiveness of AMS. \n\n\n\n\n\n\n\nReference \n\n\n\n \n[1] World Health Organization (WHO). Antimicrobial resistance: Global Report on \n\n\n\nSurveillance. WHO; 2014. \n\n\n\n[2] Shlaes DM, Gerding DN, John JF, Craig WA, Bornstein DL, Duncan RA, et al. Society \n\n\n\nfor Healthcare Epidemiology of America and Infectious Diseases Society of America Joint \n\n\n\nCommittee on the Prevention of Antimicrobial Resistance: Guidelines for the Prevention \n\n\n\nof Antimicrobial Resistance in Hospitals. Infect Control Hosp Epidemiol.1997;18(4):275\u2013\n\n\n\n91. \n\n\n\n[3] Protocol on Antimicrobial Stewardship Program in Healthcare Facilities. Ministry of \n\n\n\nHealth Malaysia; 2014 \n\n\n\n\n\n\n\nAbstract 006 \n\n\n\n\n\n\n\nFactors Affecting Adoption of \n\n\n\nElectronic Medical Record System at \n\n\n\nPrivate Hospitals in Klang Valley \n \nMariani Ahmad Nizaruddin1*, Shaharin Izhar \n\n\n\nAbd Rahman2, Syakinah Anian2,3 \n \n1 Department of Community Pharmacy Practice, Faculty of Pharmacy, \n\n\n\nUniversity of Cyberjaya, Selangor, Malaysia \n2 Faculty of Business and Technology, University of Cyberjaya, Selangor, \nMalaysia \n3 School of Business and Management, KPJ Healthcare University College, \n\n\n\nNegeri Sembilan, Malaysia \n \n\n\n\n*Correspondence: marianiahmadnizaruddin@yahoo.com \n\n\n\n\n\n\n\nIntroduction: Electronic Medical Record (EMR) is one of \n\n\n\nthe revolutionary digital technologies that has been able to \n\n\n\nproduce a system for seamless documentation workflow of \n\n\n\npatients and this revolution has brought parallel \n\n\n\ndevelopments that have not only structured the healthcare \n\n\n\nsystem but also provided better means of communication. \n\n\n\nThe continuous determination of EMR also depends on the \n\n\n\nadoption and support from the core user of this system. The \n\n\n\naim of the study is to explore the main factors that encourage \n\n\n\nthe adoption of EMR systems among the medical specialists \n\n\n\nin private hospitals by using The Unified Theory of \n\n\n\nAcceptance and Use of Technology (UTAUT) model. \n\n\n\nMethod: A cross-sectional survey was used to collect data \n\n\n\nfrom 95 respondents by using a quota sampling. The study \n\n\n\nused partial least square (PLS) method; a statistical analysis \n\n\n\ntechnique based on the structural equation modelling (SEM) \n\n\n\nto analyse the collected data. Result: There was a positive \n\n\n\nand moderate relationship between performance expectancy \n\n\n\nwith behavioural intention (\u03b2 = 0.581, T = 6.024). The factor \n\n\n\nof social influences (\u03b2 = 0.106, T = 1.267) was not significant \n\n\n\nwhile effort expectancy (\u03b2 = 0.174, T = 1.633) represented a \n\n\n\nlow significance and weak relationship. The relationship \n\n\n\nbetween facilitating condition and use behaviour was \n\n\n\nmoderate but of significant impact (\u03b2 = 0.392, T = 4.128). \n\n\n\nBehavioural intention influenced indicated (\u03b2 = 0.507, T = \n\n\n\n5.223) a moderate effect of intention toward the adoption of \n\n\n\nEMR. Conclusion: The findings suggest that healthcare \n\n\n\nproviders adopt EMR systems and improve the system via \n\n\n\ncustomization based on the needs or make it more user \n\n\n\nfriendly. The healthcare provider should consider technical \n\n\n\nsufficiency and training to facilitate the use of the EMR \n\n\n\nsystem.  \n\n\n\n \nReference \n\n\n\n\n\n\n\n[1] Hoque, R., & Sorwar, G. (2017). Understanding factors influencing the adoption of \n\n\n\nmHealth by the elderly: An extension of the UTAUT model. International Journal of \n\n\n\nMedical Informatics, 101, 75\u201384. https://doi.org/10.1016/j.ijmedinf.2017.02.002 \n\n\n\n[2] Dobrzykowski, D. D., & Tarafdar, M. (2015). Understanding information exchange in \n\n\n\nhealthcare operations: Evidence from hospitals and patients. Journal of Operations \n\n\n\nManagement, 36(1), 201\u2013214. https://doi.org/10.1016/j.jom.2014.12.003 \n\n\n\n[3] Cimperman, M., Makovec Bren\u010di\u010d, M., & Trkman, P. (2016). Analyzing older users\u2019 \n\n\n\nhome telehealth services acceptance behavior\u2014applying an Extended UTAUT model. \n\n\n\nInternational Journal of Medical Informatics, 90, 22\u201331. \n\n\n\nhttps://doi.org/10.1016/j.ijmedinf.2016.03.002 \n\n\n\n\n\n\n\n\n\n\n\nAbstract 007 \n\n\n\n\n\n\n\nPatterns of Prescription Medicines\u2019 \n\n\n\nSales through E-Marketplace in \n\n\n\nMalaysia and Associating Factors \n \nMarina Pilus, Noor Azline Ali, Malar Vily A/P \n\n\n\nVelisamy, Nurain Suleiman*, Farizul Mohd \n\n\n\nZain, Augustine Abraham Alphonsoes \n\n\n\n \nJohor Pharmaceutical Services Division, a/o Hospital Permai Lama, Jalan \nPersiaran Permai, 81200 Johor Bahru, Johor, Malaysia. \n\n\n\n\n\n\n\n*Correspondence: nurainsuleiman1985@yahoo.com \n \n\n\n\nIntroduction: Self-diagnose and obtaining various health \n\n\n\nproducts via the internet were extremely dangerous practices \n\n\n\nas it may increase the risks of patient injury or even death. \n\n\n\nObjective: This study aims to explore the patterns of \n\n\n\nprescription medicines\u2019 sales through e-marketplace \n\n\n\n(specifically: Shopee) in Malaysia as well as the associated \n\n\n\nfactors. Method: Cross-sectional study secondary data of \n\n\n\n983 Advertisement Screening Reports (reported from 1st \n\n\n\nJanuary 2020 \u2013 30th June 2020) in Johor State were collected. \n\n\n\nDescriptive statistics using frequency, percentages and/ bar \n\n\n\ncharts using Microsoft Excel 2013 were used to report the \n\n\n\npatterns of prescription medicines\u2019 sales through e-\n\n\n\nmarketplace (specifically: Shopee) in Malaysia based on \n\n\n\ntypes of prescription medicines that being advertised, \n\n\n\n\nmailto:marianiahmadnizaruddin@yahoo.com\n\n\nhttps://doi.org/10.1016/j.ijmedinf.2017.02.002\n\n\nhttps://doi.org/10.1016/j.jom.2014.12.003\n\n\nhttps://doi.org/10.1016/j.ijmedinf.2016.03.002\n\n\nmailto:nurainsuleiman1985@yahoo.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 7, Issue 1, Supplementary (2021), 49-77 \n\n\n\n55 \n \n\n\n\nResearch Presentation of National Pharmacy Convention 2021 \n\n\n\nDOI:  10.52494/UCML9733 \n \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nregistration status of prescription medicine that being \n\n\n\nadvertised as well as frequently violated Malaysia\u2019s law \n\n\n\nrelated to prescription medicine by sellers in Shopee. Factors \n\n\n\nassociated were explored by logistic regressions using IBM \n\n\n\nSPSS Version 22 via Simple (Enter Method) and Multiple \n\n\n\n(Backward Elimination (LR) Method). Result and \n\n\n\nDiscussion: 796 out of 852 (93.4%) prescription medicines\u2019 \n\n\n\nsamples were not registered with the Drug Control Authority, \n\n\n\nMalaysia\u2019s Health Ministry. Hormones (62.6%, while sex \n\n\n\nhormones which were anabolic steroids showed the highest \n\n\n\nfrequency; 58.3%) were the highest prescription medicines \n\n\n\nsold through the e-marketplace (specifically: Shopee) in \n\n\n\nMalaysia, while antibiotics, clomiphene (fertility drug), \n\n\n\nsibutramine (slimming pill) and prostaglandins and its \n\n\n\nsynthetic derivatives (abortion pill) denote 4.8%, 2.2%, \n\n\n\n1.8%, 0.4% respectively. The unregistered prescription \n\n\n\nmedicines were found to be the highest to violate Section \n\n\n\n13(a) of Poison Act 1952 which include 766 samples. \n\n\n\nMultiple logistic regression tests indicate that violation of \n\n\n\nSection 13 (a) of Poison Act 1952 (95%CI; 0.002, 0.058%; \n\n\n\np=0.000), Regulation 7(1)(a) of Control of Drug and \n\n\n\nCosmetic Regulations 1984 (95%CI; 194.694, 2726.963%; \n\n\n\np=0.000) and Section 4B of Malaysia Advertisement and \n\n\n\nSales Act 1956 (95%CI; 0.014, 0.260%; p=0.000) were the \n\n\n\npossible associated factors registration status prescription \n\n\n\nmedicines\u2019 sales through e-marketplace. Conclusion: The \n\n\n\nfindings in this study may give a brief idea for improving the \n\n\n\ncurrent practice in order to curb the freely illegal prescription \n\n\n\nmedicines\u2019 sales through e-marketplace (specifically: \n\n\n\nShopee) without the supervision of professionals.  \n\n\n\n \nReference \n\n\n\n \n[1] Fittler A, Vida RG, K\u00e1pl\u00e1r M, Botz L. Consumers turning to the internet pharmacy \n\n\n\nmarket: Cross-sectional study on the frequency and attitudes of Hungarian patients \n\n\n\npurchasing medications online. J Med Internet Res. 2018 Aug 22;20(8):e11115. \n\n\n\n[2] Aris NA. Ministry tracks thousands of online ads for illicit medicines. Free Malaysia \n\n\n\nToday. 2019 Apr 6 [cited 2020 Apr 6]. Available from: \n\n\n\nhttps://www.freemalaysiatoday.com/category/nation/2019/04/06/ministry-tracks-\n\n\n\nthousands-of-online-ads-for-illicit-medicines/ \n\n\n\n[3] Mackey TK, Nayyar G. Digital danger: A review of the global public health, patient \n\n\n\nsafety and cybersecurity threats posed by illicit online pharmacies. Br Med Bull. 2016 \n\n\n\nJun;118(1):110-26. \n\n\n\n\n\n\n\nAbstract 008 \n\n\n\n\n\n\n\nMedication Administration via \n\n\n\nEnteral Feeding Tubes: A Survey of \n\n\n\nNurses\u2019 Knowledge and Practice \n \nLaura Soon Cheau Ling1*, Pay Chyi Tong1, Le \n\n\n\nJun Chung1, Pamini Pilai2, Qing Liang Goh1, \n\n\n\nSze Ling Tan1 \n\n\n\n \n1 Department of Pharmacy, Hospital Queen Elizabeth II, Kota Kinabalu, \n\n\n\nSabah \n2 Clinical Research Centre, Hospital Queen Elizabeth II, Kota Kinabalu, \n\n\n\nSabah \n \n\n\n\n*Correspondence: laura_soon@hotmail.com \n\n\n\n\n\n\n\nIntroduction: Enteral feeding is a type of nutritional support \n\n\n\nfor critically ill patients who are unable to tolerate oral \n\n\n\nfeeding. It is vital to ensure that nurses practise proper \n\n\n\nadministration technique via enteral feeding tubes (EFT) to \n\n\n\nensure that medication can be delivered safely and \n\n\n\neffectively. Objective: This study aimed to assess \n\n\n\nknowledge and practice of nurses on medication \n\n\n\nadministration through EFT. Association between baseline \n\n\n\ncharacteristics and knowledge was also being explored. \n\n\n\nMethod: This was a cross-sectional, self-administered, \n\n\n\ncontent-validated, pre-tested questionnaire survey involving \n\n\n\nall nurses who worked in ward setting at Hospital Queen \n\n\n\nElizabeth II from August to December 2020. Result and \n\n\n\nDiscussion: A total of 409 questionnaires were sent out with \n\n\n\n252 responses received. Majority of respondents were female \n\n\n\n(n=240, 95.6%) with median working experience of 88 \n\n\n\nmonths (interquartile range of 44 months). Most nurses knew \n\n\n\nthat the immediate released dosage forms (n=237, 94.4%) \n\n\n\nshould be crushed and administered through EFT, but not the \n\n\n\nsublingual nitroglycerin (GTN) tablets (n=232, 92.8%) and \n\n\n\nnystatin suspension (n=212, 85.1%). About half of the nurses \n\n\n\nresponded incorrectly on the EFT administration of \n\n\n\nsustained-release medications (n=152, 60.6%), soft gelatin \n\n\n\ncapsules (n=111, 44.4%) and hard gelatin capsules (n=102, \n\n\n\n40.6%). In terms of practice, majority of the nurses would \n\n\n\nroutinely flush the EFT before (n=226, 90.4%) and after \n\n\n\n(n=245, 98.8%) the administration of medications. Only a \n\n\n\nsmall proportion of nurses (n=93, 37.5%) demonstrated good \n\n\n\npractice where they administer all medications separately all \n\n\n\nthe time. It was also worth noting that nurses from the \n\n\n\nintensive care setting had more correct responses on some of \n\n\n\nthe knowledge-based questions when compared to those \n\n\n\nfrom general ward setting (p<0.05). Conclusion: Knowledge \n\n\n\ngap and inconsistent practice may lead to suboptimal delivery \n\n\n\nof medication and potentially compromise patient outcomes. \n\n\n\nHence, continuous educational programs should be carried \n\n\n\nout to ensure safe and effective drug administration through \n\n\n\nEFT. \n\n\n\n \nReference \n \n\n\n\n[1] Critical Care Pharmacy Handbook 2013. First Edition. Malaysia: Pharmaceutical \n\n\n\nDivision, Ministry of Health Malaysia; 2013. \n\n\n\n[2] White R, Bradnam V. Handbook of Drug Administration via Enteral Feeding Tubes. \n\n\n\nThird edition. 2015. \n\n\n\n \n\n\n\n\nmailto:laura_soon@hotmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 7, Issue 1, Supplementary (2021), 49-77 \n\n\n\n56 \n \n\n\n\nResearch Presentation of National Pharmacy Convention 2021 \n\n\n\nDOI:  10.52494/UCML9733 \n \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 009 \n\n\n\n\n\n\n\nFactors Associated with Oral Anti-\n\n\n\nDiabetic Drugs Preventable Returned \n\n\n\nMedications Among Type II Diabetes \n\n\n\nMellitus Patients  \n \nWong Su Li*, Norharlina Sulaiman, Cheang \n\n\n\nChing Ye, Ng Kar Mun, Samuel Tan Meng \n\n\n\nHerng, Shazana Mohd Nawawi, Tan Soo Ling \n\n\n\n \nPejabat Kesihatan Daerah Klang, Selangor, Malaysia. \n\n\n\n\n\n\n\n*Correspondence: angelinewong13@gmail.com \n \n\n\n\nIntroduction: In Malaysia, Type II Diabetes Mellitus \n\n\n\n(T2DM) is estimated to have a 31.3% prevalence rate among \n\n\n\nthe adults by year 2025. Oral anti-diabetic drugs (OADs) are \n\n\n\nused to lower blood glucose level in T2DM treatment. In our \n\n\n\nsetting, OADs was recorded to have the highest returned \n\n\n\nmedication proportion (51.0%) as compared to other drugs. \n\n\n\nSubstantial proportion of returned OADs has raised our \n\n\n\nconcern in patients\u2019 medication taking behavior or drug \n\n\n\nrelated problems at home and their glycemic control.  \n\n\n\nObjective: This study aimed to investigate the factors \n\n\n\nassociated with preventable OADs returned to pharmacy and \n\n\n\nto identify reasons for the return. Method: This was a cross-\n\n\n\nsectional study conducted at public health clinics in Klang \n\n\n\ndistrict over a 4-week period. Patients with active \n\n\n\nprescriptions containing OADs were recruited using \n\n\n\nsystematic sampling method whereby they have given their \n\n\n\nconsent prior to the study and subsequently answered a \n\n\n\nvalidated questionnaire. From the unused OADs with \n\n\n\npotential return, patients are grouped into case (with return) \n\n\n\nand control (without return). The reasons for OADs return \n\n\n\ndivided into non-preventable (e.g., change to other \n\n\n\ntreatments) and preventable (e.g., non-compliance). Patients \n\n\n\nwith non-preventable reasons for return were excluded due to \n\n\n\nno interventions by pharmacists. Computed data were \n\n\n\nanalyzed using descriptive statistics and multiple logistic \n\n\n\nregressions. Result: Out of 168 patients interviewed, 43.4% \n\n\n\n(n=73) patients had preventable return, 13.7% (n=23) \n\n\n\npatients had non-preventable return and 42.9% (n=72) \n\n\n\npatients of the control group had no return. The main reasons \n\n\n\nfor returning were non-compliance (76.7%) and difficulty in \n\n\n\nfollowing instructions (21.9%). OADs return was \n\n\n\nsignificantly associated with the patient 's educational level \n\n\n\n(OR 0.038; p-value 5.472 with 95% confidence interval \n\n\n\n[1.097-27.296]) where 63.7% of them from lower education \n\n\n\nbackground.  Factors such as age, gender, T2DM diagnosis \n\n\n\nyears, polypharmacy, OADs pill burden and traditional \n\n\n\nmedicine taking showed no significant association with \n\n\n\nOADs return. Conclusion: Patient education level is a \n\n\n\nsignificant factor in preventable OADs return. By instilling \n\n\n\nbetter knowledge on the importance of patients\u2019 medication \n\n\n\ntaking, patients will be self-empowered to manage their \n\n\n\nmedication and disease better. Future study is recommended \n\n\n\nto assess the possible interventions such as providing \n\n\n\nsimplified education materials and utilizing patient teach-\n\n\n\nback method to improve patient\u2019s medication knowledge and \n\n\n\neventually, improving compliance and preventing \n\n\n\nunnecessary medication return.   \n\n\n\n \nReference \n\n\n\n \n[1] Clinical Practice Guidelines on Management of Type 2 Diabetes Mellitus. Ministry of \n\n\n\nHealth Malaysia. Health Technology Assessment Section Medical Development \n\n\n\nDivision (5 th ed): December 2015. p.16. \n\n\n\n[2] 2. National Strategic Plan for Non-communicable Disease. Ministry of Health Malaysia. \n\n\n\nNon-Communicable Disease (NCD) Section Disease Control Division (1st ed): 2016.p4. \n\n\n\n[3] 3. Return Your Medicine Program. [Internet] MOH Pharmaceutical Services \n\n\n\nProgramme. 2021 [cited 30 May 2021]. Available from: URL: \n\n\n\nhttps://www.pharmacy.gov.my/v2/en/content/return-your-medicines-program.html \n\n\n\n\n\n\n\nAbstract 011 \n\n\n\n\n\n\n\nPerception and Attitude of Malaysian \n\n\n\nCommunity Pharmacists Towards the \n\n\n\nImplementation of Telepharmacy \n \nWei Liang Ng, Wei Thing Sze \n\n\n\n \nFaculty of Pharmacy, SEGi University, 47810 Petaling Jaya, Selangor, \nMalaysia. \n\n\n\n\n\n\n\n*Correspondence: w_thing5142@hotmail.com \n \n\n\n\nIntroduction: Telepharmacy refers to the delivery of \n\n\n\npharmaceutical care through telecommunications to patients \n\n\n\nin locations where they may not have direct contact with a \n\n\n\npharmacist [1]. The role of community pharmacist has \n\n\n\nexpanded during the COVID-19 pandemic to provide \n\n\n\npharmaceutical care services remotely through telepharmacy \n\n\n\n[2]. This study aimed to assess Malaysian community \n\n\n\npharmacists\u2019 perception and attitude towards implementing \n\n\n\ntelepharmacy. Method: This cross-sectional study was \n\n\n\ncarried out using an online questionnaire. 217 community \n\n\n\npharmacists in Klang Valley were recruited through the \n\n\n\nconvenience sampling method. 5-point Likert scales were \n\n\n\nused to evaluate the respondent\u2019s perceived benefits, \n\n\n\nperceived barriers, and attitude towards the implementation \n\n\n\nof telepharmacy. Result: 37.8% of the respondents showed \n\n\n\npositive perception while 53.9% are moderately positive \n\n\n\ntowards the benefits of telepharmacy. Age (p=0.019) and \n\n\n\nfamiliarity with the term \u2018telepharmacy\u2019 (p=0.014) was \n\n\n\nshown to influence the perceived benefits on implementation \n\n\n\nof telepharmacy. On the other hand, only 8.3% of the \n\n\n\ncommunity pharmacists perceived low barriers in \n\n\n\ntelepharmacy implementation. Community pharmacists who \n\n\n\nhave a Master\u2019s qualification have lower perceived barriers \n\n\n\nof implementing telepharmacy, as compared to those with a \n\n\n\nBachelor\u2019s qualification (p=0.032). This may imply that \n\n\n\n\nmailto:angelinewong13@gmail.com\n\n\nmailto:w_thing5142@hotmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 7, Issue 1, Supplementary (2021), 49-77 \n\n\n\n57 \n \n\n\n\nResearch Presentation of National Pharmacy Convention 2021 \n\n\n\nDOI:  10.52494/UCML9733 \n \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nhigher education level may lead to a broader view and \n\n\n\nunderstanding of the barriers faced in implementing \n\n\n\ntelepharmacy. Overall, the respondents showed a positive \n\n\n\nattitude towards the implementation of telepharmacy. \n\n\n\nYounger community pharmacists were more likely to have a \n\n\n\npositive attitude towards the implementation of telepharmacy \n\n\n\n(p<0.001), which is consistent with the study done by Biruk \n\n\n\nand Abetu, where 56% of healthcare provider within the age \n\n\n\ngroup of 20-29 showed positive attitude towards \n\n\n\ntelemedicine [3]. Community pharmacists who were familiar \n\n\n\nwith the term \u2018telepharmacy\u2019 and have more years of working \n\n\n\nexperience were more likely to have a positive attitude \n\n\n\ntowards the implementation of telepharmacy (p<0.001). \n\n\n\nConclusion: In conclusion, most Malaysian community \n\n\n\npharmacists practicing in the urban area have shown positive \n\n\n\nperception towards the benefits of telepharmacy, and overall \n\n\n\npositive attitude towards its implementation. Nevertheless, \n\n\n\nthe perceived barriers towards its implementation are high. A \n\n\n\nseparate telemedicine education or training may be useful to \n\n\n\npromote the development of telemedicine to all the \n\n\n\npharmacists [4]. \n\n\n\n \nReference \n\n\n\n \n[1] S. Baldoni, F. Amenta, G. Ricci, Telepharmacy Services: Present Status and Future \n\n\n\nPerspectives: A Review, Medicina (Mex.). 55 (2019). \n\n\n\nhttps://doi.org/10.3390/medicina55070327. \n\n\n\n[2] A.E. Gross, C. MacDougall, Roles of the clinical pharmacist during the COVID-19 \n\n\n\npandemic, JACCP J. Am. Coll. Clin. Pharm. 3 (2020) 564\u2013566. \n\n\n\nhttps://doi.org/10.1002/jac5.1231. \n\n\n\n[3] K. Biruk, E. Abetu, Knowledge and Attitude of Health Professionals toward Telemedicine \n\n\n\nin Resource-Limited Settings: A Cross-Sectional Study in North West Ethiopia, J. \n\n\n\nHealthc. Eng. 2018 (2018) e2389268. https://doi.org/10.1155/2018/2389268. \n\n\n\n[4] S. Bali, Barriers to Development of Telemedicine in Developing Countries, in: T. F. \n\n\n\nHeston (Ed.), Telehealth, IntechOpen, 2019. https://doi.org/10.5772/intechopen.81723. \n\n\n\n\n\n\n\nAbstract 012 \n\n\n\n\n\n\n\nKnowledge, Attitude and Practice of  \n\n\n\nMalaysian Private Hospital \n\n\n\nPharmacists on Medication Review \n\n\n\nService \n \nWong Sze Ling, Sze Wei Thing \n \n\n\n\nFaculty of Pharmacy, SEGi University, 47810 Petaling Jaya, Selangor, \n\n\n\nMalaysia. \n \n\n\n\n*Correspondence: w_thing5142@hotmail.com \n\n\n\n\n\n\n\nBackground: Medication review is emerging as one of the \n\n\n\nvital components of medication management to prevent \n\n\n\nmedicine-related problems [1]. Studies have demonstrated a \n\n\n\nhigh prevalence of potentially inappropriate medication use \n\n\n\nin private aged care facilities [2]. Hence, there is a strong \n\n\n\nneed for medication review in the private healthcare system \n\n\n\nin Malaysia to ensure pharmaceutical safety and \n\n\n\neffectiveness. This study aimed to determine the knowledge, \n\n\n\nattitude, and practice of private hospital pharmacists on \n\n\n\nmedication review service in Malaysia. Method: This cross-\n\n\n\nsectional study was carried out from October to November \n\n\n\n2020 using an online questionnaire. Private hospital \n\n\n\npharmacists in Malaysia were invited to participate in a \n\n\n\nvalidated 36-items questionnaire. Descriptive statistics, \n\n\n\nSpearman\u2019s Rank Order Correlation test, Mann-Whitney U \n\n\n\ntest and Kruskal-Wallis H test were performed to analyze the \n\n\n\ndata. Result: Survey questionnaires were completed by 104 \n\n\n\nout of 226 private hospital pharmacists, giving a response \n\n\n\nrate of 46.0%. From the total number of responses obtained, \n\n\n\n80 pharmacists (76.9%) presented with a high level of \n\n\n\nknowledge on medication review, while 92 pharmacists \n\n\n\n(88.5%) had a positive attitude. Approximately two-third (n \n\n\n\n= 68, 65.4%) are providing medication review in the \n\n\n\npharmacy, whereas 45 of them (43.3%) did not obtain \n\n\n\npatient\u2019s medication history at the time of admission or as \n\n\n\nearly as possible. Besides, only 69 of the participants (66.3%) \n\n\n\nreconciled patient\u2019s medication with the prescribed \n\n\n\nmedicines, and less than half of the respondents (n = 47, \n\n\n\n45.2%) performed medication chart review throughout the \n\n\n\npatient\u2019s admission. Factors associated significantly with \n\n\n\npractice of medication review include age (p = 0.010) and \n\n\n\nyears of experience as a private hospital pharmacist (p = \n\n\n\n0.016).  The knowledge on medication review had a \n\n\n\nstatistically significant moderate positive correlation with \n\n\n\nattitude regarding medication review (p<0.001). Three major \n\n\n\nperceived challenges of implementing medication review \n\n\n\nwere lack of time (82.7%), insufficient training (79.8%) and \n\n\n\nlack of manpower (60.6%). Conclusion: Private hospital \n\n\n\npharmacists in Malaysia have a high level of knowledge, a \n\n\n\npositive attitude, and a fair practice regarding medication \n\n\n\nreview service. However, several challenges such as lack of \n\n\n\ntime, insufficient training and lack of manpower might \n\n\n\nobstruct the practice of medication review in private \n\n\n\nhospitals.  \n\n\n\n \nReference \n\n\n\n \n[1] Care (UK), N.C.C. for P. (2009) Reviewing Medicines [online] Royal College of General \n\n\n\nPractitioners (UK). available from <https://www.ncbi.nlm.nih.gov/books/NBK55429/> \n\n\n\n[13 July 2020]Mohamed Ibrahim O, Ibrahim RM, Abdel-Qader DH, Al Meslamani AZ, \n\n\n\nAl Mazrouei N. Evaluation of Telepharmacy Services in Light of COVID-19. Telemed E-\n\n\n\nHealth [Internet]. 2020 Oct 7 [cited 2020 Dec 17]; Available from: \n\n\n\nhttps://www.liebertpub.com/doi/10.1089/TMJ.2020.0283 \n\n\n\n[2] Hasan, S.S., Kow, C.S., Verma, R.K., Ahmed, S.I., Mittal, P., and Chong, D.W.K. (2017) \n\n\n\n\u2018An Evaluation of Medication Appropriateness and Frailty among Residents of Aged Care \n\n\n\nHomes in Malaysia: A Cross-Sectional Study\u2019. Medicine 96 (35), e7929S. Bali, Barriers \n\n\n\nto Development of Telemedicine in Developing Countries, in: T. F. Heston (Ed.), \n\n\n\nTelehealth, IntechOpen, 2019. https://doi.org/10.5772/intechopen.81723. \n\n\n\n \n\n\n\n\nhttps://doi.org/10.3390/medicina55070327\n\n\nhttps://doi.org/10.1002/jac5.1231\n\n\nhttps://doi.org/10.1155/2018/2389268\n\n\nmailto:w_thing5142@hotmail.com\n\n\nhttps://www.liebertpub.com/doi/10.1089/TMJ.2020.0283\n\n\nhttps://doi.org/10.5772/intechopen.81723\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 7, Issue 1, Supplementary (2021), 49-77 \n\n\n\n58 \n \n\n\n\nResearch Presentation of National Pharmacy Convention 2021 \n\n\n\nDOI:  10.52494/UCML9733 \n \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 013 \n\n\n\n\n\n\n\nPrevalence of Nosocomial Infections \n\n\n\nin Pediatrics High Dependency Unit \n\n\n\nand Neonatal Intensive Care Unit \n\n\n\nPatients, their Bacteriological Profile \n\n\n\nand Antimicrobial Susceptibility \n\n\n\nPattern in Tengku Ampuan Rahimah \n\n\n\nHospital: A Retrospective \n\n\n\nObservational Study \n \nSharmila Sathianathan, Adilah Mohd Fazli, \n\n\n\nTheeba Subramaniam, Azizul Hakim bin \n\n\n\nMohd Tobroni, Nur Atiqah Jaafar, Yap Qiao \n\n\n\nXin, Amirah Fareeza Yahaya \n \n\n\n\nPharmacy Department Tengku Ampuan Rahimah Hospital Klang, 41200 \nKlang, Selangor \n\n\n\n\n\n\n\n*Correspondence: shamrudr@gmail.com \n \n\n\n\nIntroduction: Nosocomial infections (NIs) represent serious \n\n\n\npublic health concern worldwide, and it is difficult to control \n\n\n\nespecially in developing countries, due to financial \n\n\n\nconstraints. The identification of pathogenic bacteria patterns \n\n\n\nand resistance trends in a facility is useful as a guide for the \n\n\n\nphysician in choosing proper empirical antibiotic therapy for \n\n\n\npatients, and this is even more important in pediatric \n\n\n\npopulations. Objective: To identify common pathogens \n\n\n\ncausing NIs in Neonatal Intensive Care Unit (NICU) and \n\n\n\nPediatrics High Dependency Unit (PHDU) HTAR, and the \n\n\n\nsusceptibility and resistance patterns of these pathogens. \n\n\n\nMethod: Single center study was carried out from January \n\n\n\n2018 until June 2020 which includes all neonates aged 72 \n\n\n\nhours of life and pediatrics that showed positive cultures who \n\n\n\nhave stayed in the facility for more than 48 hours.  The data \n\n\n\nwas collected from the Patients\u2019 Notification of Health Care \n\n\n\nAcquired Infection form and analyzed using SPSS version \n\n\n\n22. Result: Number of NIs in NICU were 33 (2018), 36 \n\n\n\n(2019) and 9 cases (2020) while NIs in PHDU were 3 (2018), \n\n\n\n5 (2019) and 0  (2020). Eye infection was the most common \n\n\n\ntype of NIs in the NICU for the year 2018 (39.4%), 2019 \n\n\n\n(44.4%) and 2020 (55.6%). In PHDU, the most common type \n\n\n\nof NIs were respiratory tract infections, 66.7% (2018) and \n\n\n\nblood-related infections, 80.0% (2019). 'Coagulase-negative \n\n\n\nstaphylococci (CONs), P. Aeruginosa and ESBL Klebsiella \n\n\n\nwere found to be the most common organisms isolated in \n\n\n\nNICU, with 24.2%, 27.8% and 27.8% cases in the year 2018, \n\n\n\n2019 and 2020, respectively. P. Aeruginosa was the most \n\n\n\ncommon isolates in 2018 (66.7%) and Staph. Aureus (60%) \n\n\n\nin 2019 for patients in PHDU. In NICU, CONs was \n\n\n\nsusceptible to chloramphenicol and resistant toward \n\n\n\nerythromycin; P. Aeruginosa was susceptible to gentamicin \n\n\n\nand ceftazidime but resistant toward imipenem. ESBL \n\n\n\nKlebsiella was susceptible to gentamicin but resistant to \n\n\n\nampicillin. The resistance and susceptibility patterns were \n\n\n\nunable to be established for PHDU cases. Conclusion: \n\n\n\nCommon organisms causing NIs in NICU HTAR are CONs, \n\n\n\nP. Aeruginosa and ESBL Klebsiella. This information will \n\n\n\nallow a more targeted choice of empirical antibiotics to \n\n\n\neliminate these potential bacteria causing NI in the NICU. \n\n\n\n \nReference \n\n\n\n \n[1] Choudhury, J., Mohanty, D., & Routray, S. S. (2016). Microbiological profile of \n\n\n\nNosocomial infections in the pediatric patients admitted to intensive care unit. 3(2), 100\u2013\n\n\n\n104. \n\n\n\n[2] Dalal, P., Gathwala, G., Gupta, M., & Singh, J. (2017). Bacteriological profile and \n\n\n\nantimicrobial sensitivity pattern in neonatal sepsis: a study from North India. International \n\n\n\nJournal of Research in Medical Sciences Dalal P et Al. Int J Res Med Sci, 5(4), 1541\u2013\n\n\n\n1545. https://doi.org/10.18203/2320-6012.ijrms20171261 \n\n\n\n[3] Degirmencioglu, H., Say, B., Tunay, Z. O., Saygan, S., & Oguz, S. S. (2017). \n\n\n\nEpidemiology and Susceptibility Patterns of Hospital-Acquired Conjunctivitis in a \n\n\n\nNeonatal Intensive Care Unit. https://doi.org/10.14744/ejmo.2017.21939 \n\n\n\n\n\n\n\nAbstract 014 \n\n\n\n\n\n\n\nFormulation and Evaluation of Solid \n\n\n\nLipid Nanoparticles Containing \n\n\n\nKappaphycus alvarezii Extract in A \n\n\n\nCosmetic Gel \n \nLim Ruo Xin1, Melbha Starlin Chellathurai1*, \n\n\n\nPalanirajan Vijayraj Kumar1, Shaik Ibrahim \n\n\n\nKhalivulla1, Teo Swee Sen2 \n\n\n\n \n1Faculty of Pharmaceutical Sciences, UCSI University, Kuala Lumpur, \n\n\n\nMalaysia 56000 \n2Faculty of Applied Sciences, UCSI University, Kuala Lumpur, Malaysia \n\n\n\n56000 \n\n\n\n\n\n\n\n*Correspondence: uranusshine@gmail.com \n\n\n\n\n\n\n\nIntroduction: Marine algal extracts have been used in the \n\n\n\nformulation of cosmetics for years. In this study, the \n\n\n\nchloroform, methanol, and water extracts of marine algal \n\n\n\nwere analyzed for their antibacterial and antifungal actions. \n\n\n\nThe extract with maximum antimicrobial activity was \n\n\n\nselected for the preparation of Solid Lipid Nanoparticles \n\n\n\n(SLNs). The prepared nanoparticles were suspended in a \n\n\n\ncosmetic gel. Objective: To formulate and evaluate the \n\n\n\ncosmetic gel containing SLNs of Kappaphycus alvarezii \n\n\n\n(KA) chloroform extract to localize the extract topically for \n\n\n\na longer duration to exert its antimicrobial properties. \n\n\n\nMethod: Disc-diffusion agar plate method was used to \n\n\n\nevaluate the antimicrobial activity towards Escherichia coli \n\n\n\n(Gram-negative), Staphylococcus aureus (Gram-positive) \n\n\n\nand Candida albicans (Fungi). The SLNs were prepared \n\n\n\nusing film hydration technique with ultrasonication. The \n\n\n\ndried SLNs were evaluated for its physical characteristics, \n\n\n\nZeta potential, and the duration taken to release the \n\n\n\n\nmailto:shamrudr@gmail.com\n\n\nmailto:uranusshine@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 7, Issue 1, Supplementary (2021), 49-77 \n\n\n\n59 \n \n\n\n\nResearch Presentation of National Pharmacy Convention 2021 \n\n\n\nDOI:  10.52494/UCML9733 \n \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nencapsulated extract for the antimicrobial activity. Carbopol \n\n\n\nand HPMC were chosen as the gelling agent after \n\n\n\ncompatibility studies with nanoparticle dispersions [1]. The \n\n\n\nformulated gel was analyzed for its pH, visual appearance, \n\n\n\nand in-vitro drug release. Result and Discussion: By \n\n\n\ncomparing the zone of inhibition, chloroform extract of KA \n\n\n\n(120 \u03bcg) showed maximum antimicrobial activity than \n\n\n\nmethanol and aqueous extracts. The SLNs prepared using \n\n\n\nchloroform extract showed a smaller cloudy and blurry zone \n\n\n\nof inhibition instead of a clear zone of inhibition. This result \n\n\n\nwas due to the low diffusion of encapsulated drugs through \n\n\n\nthe outer lipid layer of SLNs. SLNs showed a Zeta potential \n\n\n\nranging between \u201311.0 to \u201337.4 mV. The formulated gel \n\n\n\ncontaining SLNs of chloroform extract of KA had an average \n\n\n\npH value of 5.37, which was suitable to be used on human \n\n\n\nskin [2]. The maximum drug release was 60.28% over5 \n\n\n\nhours. Conclusion: In this study, algal extracts were \n\n\n\nsuccessfully encapsulated within the SLNs, and when applied \n\n\n\ntopically, the SLNs can reside on the surface of the skin for \n\n\n\nlocalized action for a prolonged duration. The Zeta potential \n\n\n\nobtained for the SLNs was approximately within the limit of \n\n\n\n\u201330 mV that yields a formulation with reasonably good \n\n\n\nphysical stability [3].  \n\n\n\n \nReference \n\n\n\n \n[1] Pandurangan D, Bodagala P, Palanirajan V, Govindaraj S. Formulation and evaluation of \n\n\n\nvoriconazole ophthalmic solid lipid nanoparticles in situ gel. Int J Pharm Investig. 2016 \n\n\n\n[2] Nieradko-Iwanicka B, Chrobok K, Skolarczyk J, Pekar J. What is the pH, Fe and Cl2 \n\n\n\ncontent of cosmetics we use? \u2013 a pilot study on safety of skin care products. Polish J Public \n\n\n\nHeal. 2018 \n\n\n\n[3] Shah R, Eldridge D, Palombo E, Harding I. Optimisation and stability assessment of solid \n\n\n\nlipid nanoparticles using particle size and zeta potential. J Phys Sci. 2014 \n\n\n\n\n\n\n\nAbstract 016 \n\n\n\n\n\n\n\nAwareness, Expectation and \n\n\n\nSatisfaction towards Ward Pharmacy \n\n\n\nServices among Patients in Medical \n\n\n\nWards: A Multi-Centre Study in \n\n\n\nPerak \n \n\n\n\nNg Chew Beng1, Choo Shea Jiun1*, Chang \n\n\n\nChee Tao2*, Ong Su Yin3, Maslinatasha \n\n\n\nMahmud4, Lee Lay Chin5, Chew Wei Yee6, \n\n\n\nNormi Hamdan7, Ros Sakinah Kamaludin8, \n\n\n\nThong Kah Shuen9 \n\n\n\n\n\n\n\n1 Pharmacy Department, Hospital Taiping \n2 Clinical Research Centre, Hospital Raja Permaisuri Bainun \n3 Perak Pharmaceutical Services Division, Ministry of Health Malaysia  \n4 Pharmacy Department, Hospital Parit Buntar \n5 Pharmacy Department, Hospital Teluk Intan \n6 Pharmacy Department, Hospital Selama \n7 Pharmacy Department, Hospital Seri Manjung \n8 Pharmacy Department, Hospital Slim River  \n9 Pharmacy Department, Hospital Raja Permaisuri Bainun \n\n\n\n\n\n\n\n*Correspondence: cc.sheajiun@gmail.com \n \n\n\n\nIntroduction: Patients\u2019 awareness and satisfaction towards \n\n\n\nward pharmacy services may influence perceptions towards \n\n\n\neffectiveness and safety of drugs. This subsequently affects \n\n\n\ntheir medication adherence and clinical outcome [1]. \n\n\n\nObjective: To evaluate awareness, expectation, and \n\n\n\nsatisfaction of ward pharmacy services among patients in \n\n\n\nmedical wards and determine their association with \n\n\n\ndemographic characteristics. Method: This was a cross-\n\n\n\nsectional study using a self-administered questionnaire. The \n\n\n\nstudy was conducted in the medical wards of fourteen Perak \n\n\n\nstate public hospitals from September-October 2020. In-\n\n\n\npatients aged \u226518 years old eligible for ward pharmacy \n\n\n\nservices were included. The questionnaire consist of four \n\n\n\ndomains: demographic characteristics, awareness, \n\n\n\nexpectation and satisfaction towards ward pharmacy \n\n\n\nservices. The awareness, expectation and satisfaction were \n\n\n\nevaluated using a 5-point Likert scale. A pilot study was \n\n\n\nconducted to establish the reliability of the questionnaire \n\n\n\n(Cronbach alpha > 0.7). Result and Discussion: 467 patients \n\n\n\nagreed to participate (response rate=83.8%), but only 441 \n\n\n\nwere included. The mean age of the patients was 54.9 years. \n\n\n\nMajority was male (56.2%), Malay (77.3%), with secondary \n\n\n\neducation (62.9%), rural residents (57.1%) and reported good \n\n\n\nmedication adherence (61.6%). The mean awareness score \n\n\n\nwas 49.6 out of 60 [2].  Patients were less aware of drug-drug \n\n\n\ninteraction (3.85 \u00b1 1.15) and proper medication storage (3.98 \n\n\n\n\u00b1 1.06). Elderly patients (\u03b2=-2.82, P < 0.001) obtained lower \n\n\n\nawareness scores.  Patients with tertiary education (\u03b2=3.87, \n\n\n\nP=0.001), rural residents (\u03b2=3.65, P<0.001) and with good \n\n\n\nmedication adherence (\u03b2=2.55, P=0.002) had higher \n\n\n\nawareness scores. The mean expectation score was 44.0 out \n\n\n\nof 50. The patient had a higher expectation of encountering a \n\n\n\npolite ward pharmacist (4.51 \u00b1 0.56). Patients with tertiary \n\n\n\neducation (\u03b2=1.86, P=0.024), rural residents (\u03b2=1.79, \n\n\n\nP=0.001) and with good medication adherence (\u03b2=1.48, \n\n\n\nP=0.006) demonstrated higher expectation. The mean \n\n\n\nsatisfaction score was 43.6 out of 50. The patients had high \n\n\n\nsatisfaction in the language used (4.45 \u00b1 0.57) and level of \n\n\n\nknowledge demonstrated (4.41 \u00b1 0.62) by the ward \n\n\n\npharmacists. Patients with tertiary education (\u03b2=2.16, \n\n\n\nP=0.009), rural residents (\u03b2=1.82, P=0.001) and with good \n\n\n\nadherence (\u03b2=1.44, P=0.009) towards medication \n\n\n\ndemonstrated higher satisfaction, while elderly patients (\u03b2=-\n\n\n\n1.17, P=0.031) had lower satisfaction towards ward \n\n\n\npharmacy services. Conclusion: Patients demonstrated good \n\n\n\nawareness, expectation, and satisfaction towards ward \n\n\n\npharmacy services in Perak state public hospitals. \n\n\n\n \nReference \n\n\n\n \n[1] Al-Arifi MN. Patients' perception, views and satisfaction with pharmacists' role as health \n\n\n\ncare provider in community pharmacy setting at Riyadh, Saudi Arabia. Saudi Pharm J. \n\n\n\n2012 oct;20(4):323- \n\n\n\n[2] Al\u2010Rashed, S.A., Wright, D.J., Roebuck, N., Sunter, W. and Chrystyn, .H. The value of \n\n\n\ninpatient pharmaceutical counselling to elderly patients prior to discharge. British Journal \n\n\n\nof Clinical Pharmacology, 2002: 54: 657-664 \n\n\n\n[3] Ayalew, M., Taye, K., Asfaw, D., Lemma, B., Dadi, F., Solomon, H., Tazeze, H., & Tsega, \n\n\n\nB. (2017). Patients\u2019/clients\u2019 expectation toward and satisfaction from pharmacy \n\n\n\nservices. Journal of Research in Pharmacy Practice, 6(1), 21.  \n\n\n\n\nmailto:cc.sheajiun@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 7, Issue 1, Supplementary (2021), 49-77 \n\n\n\n60 \n \n\n\n\nResearch Presentation of National Pharmacy Convention 2021 \n\n\n\nDOI:  10.52494/UCML9733 \n \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 018 \n\n\n\n\n\n\n\nExploring Barriers to Retention in \n\n\n\nMethadone Maintenance Therapy \n\n\n\namong Opioid Dependent Clients in \n\n\n\nKlang Health Clinics: A Qualitative \n\n\n\nStudy \n \nGeetaloshiny A/P Balasingam1, Raj Sharma \n\n\n\nA/L Chandrasekaran2 \n\n\n\n \n1 Klang District Health Department \n2 Kuala Selangor District Health Department \n \n\n\n\n*Correspondence: megeetaz@gmail.com \n \n\n\n\nIntroduction: Methadone maintenance therapy (MMT) was \n\n\n\ninitiated in Malaysia back in 2005 as part of the national \n\n\n\nHarm Reduction strategy. Despite proven benefits of \n\n\n\nmethadone in improving client\u2019s quality of life, issues such \n\n\n\nas non adherence and poor therapy retention rates remained \n\n\n\nas perturbing \u201cmysteries\u201d at Klang health care settings.  \n\n\n\nObjective:  This study was designed in unearthing client\u2019s \n\n\n\nperception of MMT and in identifying a confluence of multi- \n\n\n\ndimensional barriers faced by MMT clients  leading to \n\n\n\ntherapy defaults and proposed mitigation strategies. \n\n\n\nMethods: Heuristic qualitative mode using a transcendental \n\n\n\nphenomenological approach was selected. Data collection \n\n\n\nthrough audio taped, face to face in depth interviews (IDIs) \n\n\n\nin adherence to the COREQ-32 item checklist was carried out \n\n\n\nbetween November 2019 to January 2020 at three primary \n\n\n\nhealth care clinics (Pandamaran, Bandar Botanik, Bukit \n\n\n\nKuda) with existing MMT services. Informational saturation \n\n\n\nof salient themes was achieved through 24 participants (10 \n\n\n\nclients & 14 health care professionals) during the six stages \n\n\n\nof thematic analysis. Results & Discussion: 3 major themes \n\n\n\nand  25 subthemes significantly emerged as study findings. \n\n\n\nInitial theme on T1 : Perception towards methadone \n\n\n\nmaintenance therapy (MMT) displayed constructive benefits \n\n\n\nin the context of client\u2019s health status, enhanced social \n\n\n\nfunctioning within a benevolent health care institution. \n\n\n\nSecond theme vis-\u00e0-vis T2 : Drivers to therapy non-\n\n\n\nadherence were most commonly quoted from  the client\u2019s \n\n\n\ndomain in adherence to the theory of planned behaviour \n\n\n\n(TPB). Intrapersonal devoid of client's insights on the \n\n\n\nsignificance of methadone, worsened by the nature of \n\n\n\naddiction (lepas rindu and sulam menyulam) lead to one\u2019s \n\n\n\ndiminished self efficacy. Gaps due to volatile employment \n\n\n\nstatus, aggravated  by dysfunctional dynamics in their social \n\n\n\nsupport systems and exposure to unshielded  public \n\n\n\nopprobrium were equally reiterated. Additionally, patients \n\n\n\nsubjected to poorly regimented methadone doses with risks \n\n\n\nof co-infection morbidities faced superior strains in therapy \n\n\n\ncontinuation. Porous provider-client engagements with \n\n\n\nlimitations to MMT service flexibility, internal staff \n\n\n\nstigmatisation and interference from  private methadone \n\n\n\nsectors (new emergent subtheme) were justified. Robust \n\n\n\ntarget-oriented T3: Mitigation Strategies to Improve \n\n\n\nMethadone Therapy Outcomes were suggested in \n\n\n\ncompliance with the social ecological model of nested \n\n\n\nintervention planning. Conclusion: Implementation of client \n\n\n\ncentred correctional mechanisms are imperative in \n\n\n\naddressing the shift in drugs addiction paradigm from \n\n\n\ntraditional heroin agents to a myriad of stimulant types and \n\n\n\nnew psychoactive substances, whilst sustaining the noble role \n\n\n\nof methadone in the community.    \n\n\n\n \nReference \n\n\n\n \n[1] Aishwarya Vijay, Alexander R. Bazazi, M.Phil., Ilias Yee, M.B, Adeeba Kamarulzaman, \n\n\n\nFrederick L. Altice. (2015). Treatment Readiness, Attitudes Toward, and Experiences \n\n\n\nwith Methadone and Buprenorphine Maintenance Therapy Among People Who Inject \n\n\n\nDrugs in Malaysia. Journal of Substance Abuse Treatment, 54:29\u201336. \n\n\n\nhttp://dx.doi.org/10.1016/j.jsat.2015.01.014 \n\n\n\n[2] Fauziah I, Kumar N. Factors Effecting Drug Relapse in Malaysia: An Empirical Evidence. \n\n\n\nAsian Soc Sci., 5(17):37-42. \n\n\n\n[3] Heino St\u00f6ver. (2011). Barriers to Opioid Substitution Treatment Access, Entry and \n\n\n\nRetention: A Survey of Opioid Users, Patients in Treatment, and Treating and Non-\n\n\n\nTreating Physicians. Eur Addict Res., 17:44\u201354. doi: 10.1159/000320576 \n\n\n\n\n\n\n\nAbstract 019 \n\n\n\n\n\n\n\nExploring Local Challenges and \n\n\n\nSolution for Progress in Medication \n\n\n\nSupply through Ubat Melalui Pos \n\n\n\nServices during Nationwide \n\n\n\nMovement Control Order  \n \n\n\n\nMohd Dziehan Mustapa, Geetaloshiny A/P \n\n\n\nBalasingam, Ahmad Tirmidzi Harun, Nur      \n\n\n\nNadhrah bt Mohd Sabri, Prasannah A/P \n\n\n\nGovindan, Muhammad Fikri Mohd Fadli*, \n\n\n\nNur Fatin Sharmila binti Zulkipli \n\n\n\n \nPharmacy Unit, Klang District Health Department \n \n\n\n\n*Correspondence: megeetaz@gmail.com \n\n\n\n\n\n\n\nIntroduction:  Ubat Melalui Pos (UMP) is one of the value-\n\n\n\nadded services (VAS) majorly used during nationwide MCO \n\n\n\nto reduce patient\u2019s physical engagement at the local health \n\n\n\ncare  facilities. Objective: This study is aimed at identifying \n\n\n\nlocal challenges and solutions for progress in medication \n\n\n\nsupply through UMP services during nationwide MCO in  \n\n\n\npopulation dense Klang city. Methods: Retrospective cross-\n\n\n\nsectional study covering the health clinics in Klang district \n\n\n\nwas conducted from 18th March 2020 to 12th May 2020. \n\n\n\nParticipants were conveniently sampled based on their online \n\n\n\nrequests for UMP services through customised Google sheet \n\n\n\nfilling. A total of 403 participants were recruited. Inclusive \n\n\n\ncriteria for UMP were stable patients having at least one \n\n\n\n\nmailto:megeetaz@gmail.com\n\n\nmailto:megeetaz@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 7, Issue 1, Supplementary (2021), 49-77 \n\n\n\n61 \n \n\n\n\nResearch Presentation of National Pharmacy Convention 2021 \n\n\n\nDOI:  10.52494/UCML9733 \n \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\ntablet medication on their valid prescriptions. Patients on \n\n\n\ninsulin, inhalers and less postage friendly medications were \n\n\n\nexcluded from the study. Results & Discussion: \n\n\n\nDemographically from the active pool of 403 UMP requests \n\n\n\nreceived, (n=265, 65.8%) of them were from female patients. \n\n\n\nCommon challenges were mainly technical strains with \n\n\n\n(n=41, 10.17%) due to incomplete prescription attachment, \n\n\n\n(n=38, 9.43%) with expired prescription and (n=33, 8.19%) \n\n\n\nUMP requests for less postage friendly medication. \n\n\n\nGeographically, most UMP requests were from urbanised \n\n\n\nclinics in comparison to suburban counterparts. Ground \n\n\n\nbreaking analysis discovered that most applications of \n\n\n\nclient\u2019s UMP were performed by their inner social circle, in \n\n\n\ncomparison to (n=33, 8.19%) UMP requests successfully \n\n\n\ndelivered by the patients themselves. Robust approaches are \n\n\n\nrequired in improving primary care UMP services within our \n\n\n\nKlang vicinity. Acts in strengthening client\u2019s awareness with \n\n\n\nregards to UMP, in addition to inculcating positive familial \n\n\n\nsupport in medication seeking behaviours of vulnerable \n\n\n\ngeriatrics are necessary. Concerted health care \n\n\n\nteleconsultation for stabilised UMP clients, followed by \n\n\n\nvigorous health promotion campaigns through dignified \n\n\n\nsocial representatives (DUTA Kenali Ubat Anda) are \n\n\n\nencouraged. Additionally, introduction to subsidised UMP, \n\n\n\ninnovative Pharmacy Value Added Services (VAS) and \n\n\n\ntraining of trainers (TOT) are pivotal health promotion \n\n\n\nefforts in sustaining medication accessibility and availability \n\n\n\nat times of unprecedented crisis. Conclusion: UMP services \n\n\n\nare indeed beneficial in the context of prompt, efficient and \n\n\n\ncost effective mechanisms of medication supply. A handful \n\n\n\nof local challenges centred towards client\u2019s knowledge, \n\n\n\nattitude and practice to UMP requests are modifiable through \n\n\n\ntimely public health education towards the community.  \n \nReference \n\n\n\n \n[1] Benjamin C. LOH et al. (2017). Impact of value added services on patient waiting time at \n\n\n\nthe ambulatory pharmacy Queen Elizabeth Hospital. MyMedR, \n\n\n\n[2] Thompson, A. E., Anisimowicz, Y., Miedema, B., Hogg, W., Wodchis, W. P., & Aubrey-\n\n\n\nBassler, K. (2016). The influence of gender and other patient characteristics on health \n\n\n\ncare-seeking behaviour: a QUALICOPC study. BMC Family Practice  \n\n\n\n[3] Jae, E. C., Park, N., Wang, H., Fulk, J., & McLaughlin, M. (2010). Age differences in \n\n\n\nperceptions of online community participation among non-users: An extension of the \n\n\n\nTechnology Acceptance Model. Computers in Human Behavior, 1674-1684 \n\n\n\n\n\n\n\nAbstract 021 \n\n\n\n\n\n\n\nPre and Post Medical Deployment \n\n\n\nExperiences of Military Healthcare \n\n\n\nProfessionals \n \nMaj Mohammad Firdaus Yaacob1,2*, \n\n\n\nMohamed Azmi Ahmad Hassali1, Brig Gen A \n\n\n\nHalim Haji Basari2 \n\n\n\n \n1 School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 \n\n\n\nPenang, Malaysia \n\n\n\n2 Health Services Division, Malaysian Armed Forces Headquarters, Ministry \n\n\n\nof Defence, Jalan Tekpi, Off Jalan Padang Tembak, 50634 Kuala Lumpur, \nMalaysia. \n\n\n\n\n\n\n\n*Correspondence: firdausyaacob85@gmail.com \n\n\n\n\n\n\n\nIntroduction: Military field hospitals provide crucial \n\n\n\nmedical service for injured soldiers on the battlefield. \n\n\n\nAlthough war no longer becomes the primary displacement \n\n\n\nof the human population, natural and man-made disasters \n\n\n\ntake place. Inherited from the battlefield, military field \n\n\n\nhospitals currently continue to serve the disaster\u2019s victims \n\n\n\nand refugees. The healthcare professionals served in military \n\n\n\nfield hospitals face numerous challenges during field \n\n\n\noperation especially for the first timers. By sharing their \n\n\n\nprevious experiences perhaps, it will help military and other \n\n\n\norganizations for conducting medical deployment. \n\n\n\nObjective: This study is conducted to determine the pre and \n\n\n\npost medical deployment experiences of military healthcare \n\n\n\nprofessionals. Method: Semi-structured interviews were \n\n\n\nconducted with healthcare professionals who served in \n\n\n\nvarious field hospital deployments. Purposive and snowball \n\n\n\nsampling were employed to ensure a diverse group of \n\n\n\ninformants. The interviews are audio-recorded, transcribed \n\n\n\nverbatim, and data analyzed using thematic analysis. Data \n\n\n\ncollection, coding, and interpretation were carried out until \n\n\n\nthe saturation point was reached. Result and Discussion: \n\n\n\nTwenty-one respondents from different demographic \n\n\n\ncharacteristics were recruited. Seven major themes were \n\n\n\nidentified. Four themes emerged for pre deployment \n\n\n\nexperiences such as operation preparation, personal \n\n\n\npreparation (mental and family readiness), preventive \n\n\n\nmedicine (vaccination and medical check-up), and logistic \n\n\n\npreparation. Meanwhile, three themes emerged for post \n\n\n\nmedical deployment experiences such as operation \n\n\n\nwithdrawal, preventive medicine (mental and physical \n\n\n\ncheck-up), and logistic withdrawal. During the medical \n\n\n\ndeployment, challenges include harsh environment, extreme \n\n\n\nweather, different cultural and tasteless food which require \n\n\n\ntheir sacrifices, mental strength and physical endurance in \n\n\n\norder to accomplish the mission. Conclusion: Based on \n\n\n\nhealthcare professionals\u2019 experience, four things needed to \n\n\n\nbe done before a mission, namely preventive medicine, \n\n\n\noperation, personal and logistic preparations. Meanwhile, \n\n\n\nthree things needed to be done after a mission, namely \n\n\n\npreventive medicine, operation and logistic withdrawal. By \n\n\n\nunderstanding the experience before and after a mission, \n\n\n\norganisations may prepare more efficiently and improve the \n\n\n\nmedical service in the future deployment. \n\n\n\n \nReference \n\n\n\n \n[1] Thomas, A., 2013. Protecting People Displaced by Weather-related Disasters and Climate \n\n\n\nChange: Experience from the Field, Vermont Journal of Environmental Law, 15, 803-832. \n\n\n\n[2] Sharp, T., Yip, R., & Malone, J., 1994. US Military Forces and Emergency International \n\n\n\nHumanitarian Assistance. JAMA. 272(5), 386. \n\n\n\n[3] Smith, S. & Smith, K., 1995. Perioperative Perspective of a United Nations Humanitarian \n\n\n\nMission. AORN Journal. 62(6), 875-883 \n\n\n\n\n\n\n\n \n\n\n\n\nmailto:firdausyaacob85@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 7, Issue 1, Supplementary (2021), 49-77 \n\n\n\n62 \n \n\n\n\nResearch Presentation of National Pharmacy Convention 2021 \n\n\n\nDOI:  10.52494/UCML9733 \n \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 022 \n\n\n\n\n\n\n\nFactors Associated with Non-\n\n\n\nadherence to Medication among Type \n\n\n\nII Diabetes Mellitus Patients in A \n\n\n\nTertiary Hospital in Kelantan, \n\n\n\nMalaysia \n \n\n\n\nNazmi Liana Azmi*, Nurul Aida Md Rosly, \n\n\n\nTang Hock Chun, Anis Fariha Che Darof, Nor \n\n\n\nDini Zuki \n\n\n\n \nPharmacy Department, Raja Perempuan Zainab II, 15586 Kota Bharu, \n\n\n\nKelantan, Malaysia. \n\n\n\n\n\n\n\n*Correspondence: nazmiliana@moh.gov.my \n\n\n\n\n\n\n\nIntroduction: It is estimated that around the globe, 40% to \n\n\n\n50% of type II diabetes mellitus (T2DM) patients are not \n\n\n\nadherent to their medications. This is alarming as non-\n\n\n\nadherence can lead to worsening of health outcomes as well \n\n\n\nas unnecessary cost burden to the healthcare system. \n\n\n\nObjectives: The aim of the study is to determine the \n\n\n\nprevalence of non-adherence to medication and its associated \n\n\n\nfactors among T2DM patients treated in Raja Perempuan \n\n\n\nZainab II Hospital (HRPZ II), Kelantan. Method:  A cross-\n\n\n\nsectional survey was carried out among T2DM patients using \n\n\n\nconvenience sampling at the outpatient pharmacy from \n\n\n\nNovember 2018 to March 2019. A minimum sample size of \n\n\n\n189 subjects was estimated using a single mean formula. \n\n\n\nMedication Compliance Questionnaire (MCQ), a self-\n\n\n\nadministered validated instrument consisting of seven items, \n\n\n\nwas given to eligible patients to assess the level of medication \n\n\n\nadherence. Those with a score of less than 27 out of 28 were \n\n\n\nconsidered non-adherent. All data were gathered and \n\n\n\nanalyzed using IBM SPSS Statistics for Windows version \n\n\n\n25.0. Results and Discussion: A total of 200 patients were \n\n\n\nrecruited and they were mostly between the age of 40 to 60 \n\n\n\nyears old. The mean (SD) score for MCQ was 26.0 (1.6) with \n\n\n\nmore than halfare non-adherent (55.0%, n=110). It was noted \n\n\n\nthat the common reason for non-adherence was forgetfulness \n\n\n\nwith mean (SD) score of 3.35 (0.69). In the multiple logistic \n\n\n\nregression model, non-adherence was found to be associated \n\n\n\nwith marital status [AOR 4.50; 95% CI: 1.95-10.41, p < \n\n\n\n0.001], financial income [AOR 0.37; 95% CI: 0.19-0.73, \n\n\n\np=0.004] and types of diabetes medications [AOR 0.23; 95% \n\n\n\nCI: 0.12-0.44, p < 0.001) which were consistent with \n\n\n\nprevious findings. Conclusion: The prevalence of non-\n\n\n\nadherence to medication among T2DM patients was high in \n\n\n\nHRPZ II. It was observed that patients who were married, had \n\n\n\na low salary and were prescribed with insulin were more \n\n\n\nlikely to become non-adherent. Future intervention targeting \n\n\n\nthese subgroups should be designed within the facility to \n\n\n\nimprove adherence. \n\n\n\nReference \n\n\n\n \n[1] Kleinsinger F. (2018). The unmet challenge of medication nonadherence. The Permanente \n\n\n\njournal, 22, 18-033. doi:10.7812/TPP/18-033. \n\n\n\n[2] Kassahun, A., Gashe, F., Mulisa, E., & Rike, W. A. (2016). Nonadherence and factors \n\n\n\naffecting adherence of diabetic patients to anti-diabetic medication in Assela General \n\n\n\nHospital, Oromia Region, Ethiopia. Journal of pharmacy & bioallied sciences, 8(2), 124\u2013\n\n\n\n129. doi:10.4103/0975-7406.171696. \n\n\n\n[3] Ahmad, N. S., Ramli, A., Islahudin, F., & Paraidathathu, T. (2013). Medication adherence \n\n\n\nin patients with type 2 diabetes mellitus treated at primary health clinics in \n\n\n\nMalaysia. Patient preference and adherence, 7, 525\u2013530. doi:10.2147/PPA.S44698. \n\n\n\n\n\n\n\nAbstract 025 \n\n\n\n\n\n\n\nDiabetes-Related Quality of Life and \n\n\n\nits Determinants: A Single Centre \n\n\n\nAnalysis \n \nNazmi Liana Azmi*, Nurul Aida Md Rosly, \n\n\n\nTang Hock Chun, Anis Fariha Che Darof, Nor \n\n\n\nDini Zuki \n\n\n\n \nPharmacy Department, Raja Perempuan Zainab II, 15586 Kota Bharu, \nKelantan, Malaysia \n\n\n\n\n\n\n\n*Correspondence: nazmiliana@moh.gov.my \n \n\n\n\nIntroduction: Type 2 diabetes mellitus (T2DM) is a \n\n\n\ndevastating chronic disease which if uncontrolled, often leads \n\n\n\nto other serious health conditions. The debilitating \n\n\n\nconsequences such as retinopathy and nephropathy can \n\n\n\nsignificantly impact their quality of life (QoL). Objective: \n\n\n\nThe study was conducted to measure diabetes-related QoL \n\n\n\nand identify its determinants among T2DM patients \n\n\n\nattending Raja Perempuan Zainab II Hospital (HRPZ II), \n\n\n\nKelantan. Method:  In this cross-sectional study, a total of \n\n\n\n200 adult T2DM patients were recruited through \n\n\n\nconvenience sampling at the outpatient pharmacy from \n\n\n\nNovember 2018 to March 2019. Then, the revised version of \n\n\n\nDiabetes Quality of Life (DQOL) instrument containing 13 \n\n\n\nitems in Malay language was self-administered by eligible \n\n\n\nrespondents. A higher average score indicated a poorer QoL \n\n\n\nwith the possible range of score was between 13 to 65. \n\n\n\nStatistical Package for the Social Sciences (SPSS) software \n\n\n\nversion 25.0 for Windows was used to perform multiple \n\n\n\nlinear regression. Result and Discussion: The majority of \n\n\n\nT2DM patients were between the age of 40 to 60 years old. \n\n\n\nThe mean (SD) score for the overall revised DQOL was 25.5 \n\n\n\n(8.9) while each domain of \u201csatisfaction\u201d, \u201cimpact\u201d and \n\n\n\n\u201cworry\u201d had mean (SD) scores of 12.0 (5.0), 7.7 (3.4) and 5.9 \n\n\n\n(2.7), respectively. Stepwise regression model which \n\n\n\naccounted for 40% of the variability in QoL, showed that a \n\n\n\nhigher DQOL score was found to be associated with older \n\n\n\nage [\u03b2: -4.93 (95% CI: -7.18, -2.67), p<0.001], female gender \n\n\n\n[\u03b2: 4.69 (95% CI: 2.62, 6.77), p<0.001], married status [\u03b2: -\n\n\n\n8.34 (95% CI: -10.78, -5.89), p<0.001] and shorter disease \n\n\n\nduration [\u03b2:  -4.85 (95% CI: -7.03, -2.67), p<0.001). All four \n\n\n\nvariables were commonly reported to influence QoL in \n\n\n\n\nmailto:nazmiliana@moh.gov.my\n\n\nhttps://doi.org/10.4103/0975-7406.171696\n\n\nmailto:nazmiliana@moh.gov.my\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 7, Issue 1, Supplementary (2021), 49-77 \n\n\n\n63 \n \n\n\n\nResearch Presentation of National Pharmacy Convention 2021 \n\n\n\nDOI:  10.52494/UCML9733 \n \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nprevious literature. Interestingly, the current study observed \n\n\n\na contradiction to the previous finding whereby older patients \n\n\n\nin the current study had better QoL. Conclusion: The T2DM \n\n\n\npatients in HRPZ II showed satisfactory diabetes-related \n\n\n\nQoL. It seemed that the disease did affect their QoL but not \n\n\n\nto a great extent. More attention should be paid to male, \n\n\n\nsingle patients of working age and diagnosed with T2DM for \n\n\n\nover 10 years who are more likely to have poorer QoL score. \n\n\n\n \nReference \n \n\n\n\n[1] Trikkalinou, A., Papazafiropoulou, A. K., & Melidonis, A. (2017). Type 2 diabetes and \n\n\n\nquality of life. World journal of diabetes, 8(4), 120\u2013129. doi:10.4239/wjd.v8.i4.120 \n\n\n\n[2] Bujang, M. A., Adnan, T. H., Mohd Hatta, N., Ismail, M., & Lim, C. J. (2018). A revised \n\n\n\nversion of Diabetes Quality of Life instrument maintaining domains for satisfaction, \n\n\n\nimpact, and worry. Journal of diabetes research, 2018, 5804687. \n\n\n\ndoi:10.1155/2018/5804687 \n\n\n\n[3] Abedini, M .R., Bijari, B., Miri, Z., Emampour F. S., & Abbasi A. (2020). The quality of \n\n\n\nlife of the patients with diabetes type 2 using EQ-5D-5\u2009L in Birjand. Health Qual Life \n\n\n\nOutcomes,18, 18. Doi:10.1186/s12955-020-1277-8 \n\n\n\n\n\n\n\nAbstract 028 \n\n\n\n\n\n\n\nCarers\u2019 Perspectives on Home \n\n\n\nMedication Review conducted by \n\n\n\nMedical Outreach Team of a Hospital \n\n\n\nin Malaysia \n \nWei Chern Ang1,2, Jurisma Che Lah1, \n\n\n\nNursyafiqah Zulkepli1, Nursyamimi Sukri1, \n\n\n\nAmalina Rosedi1 \n\n\n\n \n1 Department of Pharmacy, Hospital Tuanku Fauziah, Perlis, Ministry of \n\n\n\nHealth Malaysia, 01000 Kangar, Perlis,. Malaysia. \n2 Clinical Research Centre, Hospital Tuanku Fauziah, Perlis, Ministry of \nHealth Malaysia, 01000 Kangar, Perlis, Malaysia. \n\n\n\n\n\n\n\n*Correspondence: wei.ang.1990@gmail.com \n \n\n\n\nIntroduction: Home Medication Review (HMR) is a \n\n\n\ncontinuation of patient care from health facilities to their \n\n\n\nhome to assess patients\u2019 pharmacotherapy by a \n\n\n\nmultidisciplinary team. Bedridden patients are the leading \n\n\n\ngroup receiving this service. To improve the provision of \n\n\n\nHMR, we need to understand carers\u2019 viewpoints of the \n\n\n\ncurrent service. Objective: To explore the carers\u2019 \n\n\n\nperspectives of HMR conducted by the medical outreach \n\n\n\nteam (MOT) of a Malaysian hospital. Method: A qualitative \n\n\n\nstudy was conducted among carers involved in the HMR \n\n\n\nprogramme for more than six months. Four themes \n\n\n\nidentified: understanding of the services, perceived benefits, \n\n\n\ndifficulties faced and suggestions for improvement. Carers \n\n\n\nare chosen as respondents as patients have impaired cognitive \n\n\n\nfunction or cannot communicate/cooperate in the interview. \n\n\n\nSubjects were recruited by purposive sampling from August \n\n\n\n2019 to December 2019. In-depth interviews were conducted \n\n\n\nat patients\u2019 homes, until data saturation. The audio recordings \n\n\n\nwere transcribed verbatim and afterwards subjected to \n\n\n\nthematic analysis. Results and Discussion: Nine carers were \n\n\n\ninterviewed. All respondents had  limited understanding of \n\n\n\nHMR although they claimed to be adequately counselled \n\n\n\nprior to admission into the programme. Carers\u2019 good \n\n\n\nunderstanding of the programme may improve patients\u2019 \n\n\n\npreparedness and lead them to be actively engaged in \n\n\n\ndecision making during the home care visits. The \n\n\n\nconvenience of not having to go to the hospital was perceived \n\n\n\nas the primary benefit. Healthcare providers were welcomed \n\n\n\nduring each visit. Recognising the presence of a pharmacist \n\n\n\nin the MOT was not a problem. There was a concern about \n\n\n\nrequiring them to refill medications from the hospital. Some \n\n\n\nparticipants suggested increasing the frequency of visits and \n\n\n\nhoped for more financial aids.   Conclusion: In this study, \n\n\n\ncarers\u2019 comprehension of HMR was generally poor although \n\n\n\nthey were satisfied with our HMR programme. Furthermore, \n\n\n\nseveral aspects of our HMR need to be strengthened to \n\n\n\nimprove patients\u2019 wellbeing. Despite HMR being \n\n\n\ntemporarily replaced by telemedicine during the current \n\n\n\npandemic, HMR remains relevant in the post-COVID-19 \n\n\n\nera.  \n\n\n\n \nReferences \n\n\n\n \n[1] Pharmacy Practice & Development Division MOH Malaysia (2019). Home Care Pharmacy \n\n\n\nServices Protocol, 2 \n\n\n\n[2] Chen TF et al. (2016). Drugs Aging. 33(3): 199-204. \n\n\n\n[3] Ahn J et al. (2015). Aust Fam Physician. 44:249-53. \n\n\n\n\n\n\n\nAbstract 029 \n\n\n\n\n\n\n\nInvestigation of the Moisturizing \n\n\n\nEffect of Cocoa Butter on Skin Cream \n \nTang Jia Wen*, Ashok Kumar Janakiraman, \n\n\n\nShiek Abdul Kadhar Mohamed Ebrahim \n\n\n\nHabibur Rahman \n \n\n\n\nFaculty of Pharmaceutical Sciences, UCSI University \n\n\n\n\n\n\n\n*Correspondence: 2014jiawen@gmail.com \n\n\n\n\n\n\n\nIntroduction: Cocoa butter (CB) is a natural product that has \n\n\n\nbeen incorporated as a moisturizer in various topical creams \n\n\n\nover the years. However, CB is not the main ingredient \n\n\n\ndespite numerous studies claimed about its moisturizing \n\n\n\ncapacity. [1] [2].  The chemical compositions of CB could \n\n\n\ncontribute to its potentiality as an occlusive agent that helps \n\n\n\nto maintain skin hydration [3].  Objective: The main \n\n\n\nobjective of this research was to investigate the effect of CB \n\n\n\nas the primary ingredient of skin moisturizing cream. \n\n\n\nMethod: The oil-in-water emulsions were prepared by \n\n\n\nadding an aqueous phase to the oil phase in several pre-\n\n\n\ndetermined proportions before subjecting to high-speed \n\n\n\nhomogenization. A total of 15 prototype formulations were \n\n\n\nprepared. The oil phase consisted of CB, beeswax and PEG \n\n\n\n200, whereas the aqueous phase included Poloxamer 188 and \n\n\n\n\nhttps://doi.org/10.4239/wjd.v8.i4.120\n\n\nhttps://doi.org/10.1155/2018/5804687\n\n\nmailto:wei.ang.1990@gmail.com\n\n\nmailto:2014jiawen@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 7, Issue 1, Supplementary (2021), 49-77 \n\n\n\n64 \n \n\n\n\nResearch Presentation of National Pharmacy Convention 2021 \n\n\n\nDOI:  10.52494/UCML9733 \n \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\ndistilled water. Other ingredients (Poloxamer 407, Cinnamon \n\n\n\nOil, Almond Oil and Vanillin) were added to enhance the \n\n\n\nproduct attributes. The developed cream formulations were \n\n\n\ncharacterized by pH, spreadability, in-vitro occlusivity, sun \n\n\n\nprotection factor (SPF), antioxidant activity using hydrogen \n\n\n\nperoxide method and antimicrobial activity by disc diffusion \n\n\n\nmethod. Result and Discussion: The physicochemical \n\n\n\nparameters of formulations S1-S14, i.e. pH, occlusion factor \n\n\n\nand spreadability were found to be in the range of 5-5.5, \n\n\n\n54.10-24.20, 0.850-2.917 cm respectively. The formulation, \n\n\n\nS14 showed the lowest occlusion factor (F=24.20), high \n\n\n\nspreadability (1.533 cm) and improved sun protection factor \n\n\n\n(SPF) of 25.4 and was found to be more effective compared \n\n\n\nwith the other prototype formulations. There was also a \n\n\n\ngeneral trend of increase in antioxidant activity when the \n\n\n\nconcentration of the sample increased. Besides, the S14 \n\n\n\nformulation showed greater inhibition against the S. aureus \n\n\n\nthan E. coli. The formulation, S14 was stable at the \n\n\n\naccelerated conditions (40 \u00b1 5\u00b0C, 75 \u00b1 5%) regarding color, \n\n\n\nliquefaction, pH and phase separation for three months. \n\n\n\nConclusion: To conclude, CB has the potential to be used as \n\n\n\nthe main ingredient of skin moisturizing cream due to its \n\n\n\noptimum pH, spreadability, occlusivity, SPF, antioxidant \n\n\n\nactivity and antimicrobial activity. However, clinical studies \n\n\n\nwere required to evaluate its further benefits in maintaining \n\n\n\nskin hydration in vivo. \n\n\n\n \nReference \n \n[1] Long-Term Ingestion of High Flavanol Cocoa Provides Photoprotection against UV-\n\n\n\nInduced Erythema and Improves Skin Condition in Women | The Journal of Nutrition | \n\n\n\nOxford Academic [Internet]. [cited 2020 Oct 14]. Available from: \n\n\n\nhttps://academic.oup.com/jn/article/136/6/1565/4664397 \n\n\n\n[2] A Real-World, Non-interventional Indian Study Evaluating Intensive Plant-Based Butter \n\n\n\nMoisturizing Cream in Psoriasis [Internet]. [cited 2020 Oct 14]. Available from: \n\n\n\nhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6704203/ \n\n\n\n[3] Cocoa butter and its alternatives: A review [Internet]. [cited 2020 Oct 14]. Available \n\n\n\nfrom: \n\n\n\nhttps://www.researchgate.net/publication/308523494_Cocoa_butter_and_its_alternatives\n\n\n\n_A_review \n\n\n\n\n\n\n\nAbstract 030 \n\n\n\n\n\n\n\nDevelopment of In vitro Dissolution \n\n\n\nMethod for Nateglinide Formulations \n \nKoh Siew Hua*, Ashok Kumar Janakiraman, \n\n\n\nShiek Abdul Kadhar Mohamed Ebrahim \n\n\n\nHabibur Rahman \n\n\n\n \nFaculty of Pharmaceutical Sciences, UCSI University, 56000 Cheras, \nKuala Lumpur, Malaysia \n\n\n\n\n\n\n\n*Correspondence: elisekoh.ksh78@gmail.com \n \n\n\n\nIntroduction: Nateglinide (NTG) is a derivative of D-\n\n\n\nphenylalanine, an agent that stimulates insulin secretion in \n\n\n\npancreatic \u03b2 cells. NTG is under BCS Class II drug, which is \n\n\n\ncharacterized by low solubility and high permeability. Thus, \n\n\n\nthe dissolution of NTG is a rate-determining step for \n\n\n\nbioavailability. For this reason, to correlate the in vivo \n\n\n\nperformance of NTG, the development of in vitro dissolution \n\n\n\nmethod is important. Objective: The objective was to \n\n\n\ndevelop an in vitro dissolution method for NTG formulations \n\n\n\nto correlate the in vitro-in vivo performance of NTG. \n\n\n\nMethod: Two formulations (tablets and capsules) were \n\n\n\nprepared and evaluated for their physical properties. The \n\n\n\ndissolution mediums were developed based on the solubility \n\n\n\nof NTG in different six dissolution mediums. The dissolution \n\n\n\nstudy for NTG tablets and capsules was investigated by using \n\n\n\nUSP Apparatus 2 (paddle) and USP Apparatus 1 (basket), \n\n\n\nrespectively. Each aliquot at predetermined intervals was \n\n\n\nfiltered through 0.45 \u00b5m syringe filter and measured using \n\n\n\nUV spectrophotometer. For each formulation sample, drug \n\n\n\nconcentrations were determined from the standard calibration \n\n\n\ncurve. Result and Discussion: The solubility of pure NTG \n\n\n\nin six different dissolution mediums were as follows: water \n\n\n\n(0.0748 mg/mL), 0.5% w/v SLS in water (1.1695 mg/mL), \n\n\n\n1% w/v SLS in water (1.0697 mg/mL), buffer pH 7.4 (1.8840 \n\n\n\nmg/mL), 0.5% w/v SLS in buffer pH 7.4 (2.5150 mg/mL), \n\n\n\nand 1% w/v SLS in buffer pH 7.4 (2.8259 mg/mL). The \n\n\n\nprepared NTG tablets showed the highest percentage of drug \n\n\n\ndissolved in 1% w/v SLS in buffer pH 7.4 (104.97%) whereas \n\n\n\nNTG capsules showed the highest percentage of drug \n\n\n\ndissolved in 0.5% w/v SLS in buffer pH 7.4 (105.46%). \n\n\n\nConclusion: Hence, 1% w/v SLS in buffer pH 7.4 and 0.5% \n\n\n\nw/v SLS in buffer pH 7.4 are suitable dissolution media for \n\n\n\nNTG tablets and capsules respectively. The in vitro drug \n\n\n\nrelease kinetic properties of NTG formulations can be used \n\n\n\nto provide the desired in vitro-in vivo correlation information.   \n\n\n\n \nReference \n\n\n\n \n[1] Tentolouris N, Voulgari C, Katsilambros N. A review of nateglinide in the management \n\n\n\nof patients with type 2 diabetes. Vascular Health and Risk Management. 2007 \n\n\n\nDec;3(6):797. \n\n\n\n[2] Papdiwal A, Sagar K, Pande V. Formulation and characterization of nateglinide \n\n\n\nnanosuspension by precipitation method. International Journal of Pharmaceutical \n\n\n\nSciences and Nanotechnology. 2014;7(4):2685-91. \n\n\n\n[3] Tsume Y, Mudie DM, Langguth P, Amidon GE, Amidon GL. The Biopharmaceutics \n\n\n\nClassification System: subclasses for in vivo predictive dissolution (IPD) methodology \n\n\n\nand IVIVC. European Journal of Pharmaceutical Sciences. 2014 Jun 16;57:152-63. \n\n\n\n\n\n\n\nAbstract 031 \n\n\n\n\n\n\n\nDrug Utilization Review in \n\n\n\nEmergency Department of Hospital \n\n\n\nTuanku Ampuan Najihah: A Major-\n\n\n\nSpecialist Hospital \n \nNurrul Salwa Saleh*, Chey Kok Yeat, Nur Ain \n\n\n\nFitria Mohd Rezazali \n\n\n\n \nDepartment of Pharmacy, Hospital Tuanku Ampuan Najihah, Kuala Pilah, \n\n\n\nNegeri Sembilan \n\n\n\n\n\n\n\n*Correspondence: htan.pric@gmail.com \n \n\n\n\n\nmailto:elisekoh.ksh78@gmail.com\n\n\nmailto:htan.pric@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 7, Issue 1, Supplementary (2021), 49-77 \n\n\n\n65 \n \n\n\n\nResearch Presentation of National Pharmacy Convention 2021 \n\n\n\nDOI:  10.52494/UCML9733 \n \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nIntroduction: Drug utilization review (DUR) is required to \n\n\n\ninitiate discussions on rational drug use. Furthermore, \n\n\n\nsuggestions and measures to improve prescribing habits can \n\n\n\nbe performed. Unfortunately, DUR in the emergency \n\n\n\ndepartments (ED) in Malaysia is rarely performed. \n\n\n\nObjective: This study aimed to identify the pattern of drug \n\n\n\nutilization among patients discharged from the ED in a \n\n\n\ntertiary hospital in Malaysia. Method: A one year \n\n\n\nretrospective drug utilization study was conducted in the ED \n\n\n\nof Hospital Tuanku Ampuan Najihah. A total of 833 patients \n\n\n\ndischarged prescriptions were reviewed to extract data on the \n\n\n\npattern of drug use excluding incomplete prescriptions and \n\n\n\npatients discharged from wards. The rationality of \n\n\n\nprescriptions was evaluated using WHO core indicators of \n\n\n\ndrug utilization. Result: The three most prescribed categories \n\n\n\nof drugs were respiratory (39%), analgesia (20%) and \n\n\n\ngastrointestinal (16%). The rationality of prescriptions was \n\n\n\naverage of 2.6% drugs per encounter, 15.7% antibiotics per \n\n\n\nencounter, essential drugs list or formulary was 100% of \n\n\n\ndrugs prescribed, and percentage of drugs prescribed by \n\n\n\ngeneric names was 66.8%. All drugs were found to be used \n\n\n\nrationally. The use of generic names was lower than the \n\n\n\nrecommended optimal level of 100%. Conclusion: The \n\n\n\nrational use of drugs in the ED, HTAN as a major specialist \n\n\n\nhospital was successful based on standard WHO prescribing \n\n\n\nindicators. However, there was a lack of generic names used \n\n\n\nduring prescribing.  \n\n\n\n \nReference \n\n\n\n \n[1] Kaur, Sharonjeet, et al. \"Drug utilization study in medical emergency unit of a tertiary \n\n\n\ncare hospital in North India.\" Emergency medicine international 2014 (2014) \n\n\n\n[2] Al-Niemat, Sahar I., et al. \"Drug use evaluation of antibiotics prescribed in a Jordanian \n\n\n\nhospital outpatient and emergency clinics using WHO prescribing indicators.\" Saudi \n\n\n\nmedical journal 29.5 (2008): 743-748 \n\n\n\n[3] Otoom S, Batieha A, Hadidi H, Hasan M, Al Saudi K. Evaluation of drug use in Jordan \n\n\n\nusing WHO prescribing indicators. \n\n\n\n[4] How to investigate drug use in health facilities: selected drug use indicators. Geneva, \n\n\n\nWorld Health Organization, 1993 (EDM Research Series No. 007). \n\n\n\n\n\n\n\nAbstract 032 \n\n\n\n\n\n\n\nCommunity Pharmacists\u2019 Perceptions \n\n\n\non Medication Review Service Model \n\n\n\nImplementation in Retail Setting in \n\n\n\nMalaysia \n \nMaali M*, Hatah E, Mohd Makmor-Bakry \n\n\n\n \nUniversity Kebangsaan Malaysia, 50300, Kuala Lumpur, Malaysia \n\n\n\n\n\n\n\n*Correspondence: p97973@siswa.ukm.edu.my \n\n\n\n\n\n\n\nIntroduction:  Pharmacists' roles have been evolving to \n\n\n\ninclude more patient-centered care services such as \n\n\n\nmedication review that help patients to get the most benefits \n\n\n\nout of the medication [1-3]. In Malaysia, although medication \n\n\n\nreview services have been established in the government \n\n\n\nhealth care settings, it is yet to be widely implemented in \n\n\n\ncommunity pharmacy setting. Since the two settings have \n\n\n\ndifferent patient population and orientation, it is important to \n\n\n\ndevelop the service model that specifically design for \n\n\n\ncommunity pharmacy. Hence, input from community \n\n\n\npharmacists and their stakeholders is important to propose a \n\n\n\nfeasible medication review service module in Malaysia. \n\n\n\nObjective: To explore the community pharmacists and their \n\n\n\nstakeholders\u2019 perceptions on the barriers, facilitators and \n\n\n\nstrategies for the implementation of a medication review \n\n\n\nservice model in Malaysia. Method: A focus group \n\n\n\ndiscussion with semi-structured interviews were conducted \n\n\n\namong purposively sampled community pharmacists. \n\n\n\nRespondents were continued to be recruited until saturation \n\n\n\nwas achieved in which no new coding or themes aroused \n\n\n\nfrom two consecutive interviews. The interview was video \n\n\n\nand audio-recorded and transcribed verbatim.  Data was \n\n\n\nanalysed using thematic analysis with ATLAS.ti version 8 \n\n\n\nsoftware and themes were classified according to the \n\n\n\nframework for implementation research on pharmacy \n\n\n\nservices [4]. Result and discussion: A total of 14 \n\n\n\npharmacists participated in this study. Among them, 9 \n\n\n\npharmacists were from independent pharmacies and the \n\n\n\nremaining from chain pharmacies. Participants reported 13 \n\n\n\nbarriers, 14 facilitators and 9 recommended strategies for \n\n\n\nmedication review service model in Malaysia. The main \n\n\n\nbarriers reported were absence of a structured service model \n\n\n\nand health care system that will support the service, lack of \n\n\n\nmonetary value and remuneration and pharmacist\u2019s poor \n\n\n\nknowledge, communication skills and lack of confidence to \n\n\n\nimplement the service. The current factors that were found to \n\n\n\nfacilitate future implementation of the service were the \n\n\n\navailability of other advanced services and medication \n\n\n\nreview that are currently being offered in some community \n\n\n\npharmacies, presence of well-trained pharmacists with \n\n\n\npassion to conduct the service. Recommended strategies \n\n\n\nincluded the need for a standardized model, fee and \n\n\n\ndocumentation system to guide pharmacists as well as the \n\n\n\nneed for accreditation and training for community \n\n\n\npharmacists. The service model suggested included engaging \n\n\n\ncustomers to the service through good communication and \n\n\n\neducation, appointment-based service, targeting customers \n\n\n\nwho benefit most and collaborating with doctors.  \n\n\n\nConclusion: The findings will help to guide the development \n\n\n\nof a medication review service model that is suitable for \n\n\n\nimplementation in the community pharmacy settings in \n\n\n\nMalaysia. \n\n\n\n \nReference \n \n\n\n\n[1] N. L. Bragazzi, M. Mansour, A. Bonsignore, and R. Ciliberti, \u201cThe Role of Hospital and \n\n\n\nCommunity Pharmacists in the Management of COVID-19: Towards an Expanded \n\n\n\nDefinition of the Roles, Responsibilities, and Duties of the Pharmacist,\u201d Pharmacy, vol. \n\n\n\n8, no. 3, p. 140, 2020. \n\n\n\n[2] T. L. Imfeld-Isenegger et al., \u201cCommunity pharmacist-led medication review procedures \n\n\n\nacross Europe: Characterization, implementation and remuneration,\u201d Res. Soc. Adm. \n\n\n\nPharm., vol. 16, no. 8, pp. 1057\u20131066, 2020. \n\n\n\n[3] E. Hatah, J. Tordoff, S. B. Duffull, and R. Braund, \u201cPharmacists\u2019 performance of clinical \n\n\n\ninterventions during adherence support medication reviews,\u201d Res. Soc. Adm. Pharm., vol. \n\n\n\n10, no. 1, pp. 185\u2013194, Jan. 2014. \n\n\n\n[4] G. M. Curran and S. J. Shoemaker, \u201cAdvancing pharmacy practice through \n\n\n\nimplementation science,\u201d Res. Soc. Adm. Pharm., vol. 13, no. 5, pp. 889\u2013891, 2017. \n\n\n\n \n\n\n\n\nmailto:p97973@siswa.ukm.edu.my\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 7, Issue 1, Supplementary (2021), 49-77 \n\n\n\n66 \n \n\n\n\nResearch Presentation of National Pharmacy Convention 2021 \n\n\n\nDOI:  10.52494/UCML9733 \n \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 033 \n\n\n\n\n\n\n\nEvaluation of Warfarin Related \n\n\n\nKnowledge and International \n\n\n\nNormalized Ratio (INR) Control \n\n\n\nAmong Atrial Fibrillation Patients in \n\n\n\nRural Area \n \nSiti Mariam Saha, Khadijah Shamsul Bahrain, \n\n\n\nChin Shu Juan, Dhivya P. Sandran* \n\n\n\n \nJabatan Farmasi, Hospital Tuanku Ampuan Najihah, Kuala Pilah, Negeri \n\n\n\nSembilan. \n \n\n\n\n*Correspondence: htan.pric@gmail.com \n \n\n\n\nIntroduction: INR control is important for warfarin patients \n\n\n\nto maintain the ideal anticoagulation effect of warfarin. \n\n\n\nWarfarin related knowledge affects INR control among \n\n\n\npatients where patients with higher warfarin related \n\n\n\nknowledge will have better control. Objective: This study \n\n\n\naimed to assess warfarin related knowledge and INR control \n\n\n\namong atrial fibrillation patients, and to identify the \n\n\n\nassociation between warfarin related knowledge and INR \n\n\n\ncontrol. Method: A cross-sectional survey was carried out \n\n\n\namong atrial fibrillation patients on warfarin therapy at the \n\n\n\nMedical Outpatient Department (MOPD) in Hospital Tuanku \n\n\n\nAmpuan Najihah (HTAN). A convenient sampling was used \n\n\n\nto recruit the subjects. A validated questionnaire which \n\n\n\nconsists of mainly 3 parts covering the demographic data, \n\n\n\nINR level and Oral Anticoagulation Knowledge (OAK) test. \n\n\n\nResult: A total of 133 subjects were recruited and the mean \n\n\n\nknowledge score of the subjects was 51.39 \u00b1 18.11 which \n\n\n\nindicates moderate level of warfarin related knowledge. Most \n\n\n\nof the subjects (95.5%) know the indication of warfarin. \n\n\n\nThere was a statistically significant difference for warfarin \n\n\n\nrelated knowledge between patient with different education \n\n\n\nlevel as determined by one-way ANOVA (p < 0.001). The \n\n\n\nmean time in therapeutic range (TTR) of our respondents is \n\n\n\n71.7% which indicates moderate INR control. Kruskal Wallis \n\n\n\ntest showed a significant difference in TTR (p < 0.001) and \n\n\n\npercentage of days in range (p = 0.004) with different \n\n\n\nwarfarin related knowledge levels. There was a significant \n\n\n\nrelationship between total knowledge score with TTR (r = \n\n\n\n0.268; p = 0.002) and anticoagulation knowledge and \n\n\n\npercentage of day in range (r = 0.233; p = 0.007). \n\n\n\nConclusion: Atrial fibrillation patients on warfarin therapy \n\n\n\nin HTAN were observed to have moderate warfarin related \n\n\n\nknowledge and moderate INR control. Warfarin related \n\n\n\nknowledge is significantly related to INR control.  \n\n\n\n \nReference \n\n\n\n\n\n\n\n[1] Adams, R. J. (2010). Improving health outcomes with better patient understanding and \n\n\n\neducation. Risk Management and Healthcare Policy, 3, 61\u201372. \n\n\n\nhttps://doi.org/10.2147/RMHP.S7500 \n\n\n\n[2] Baysal, E. & Midilli, T. S. 2018. Effects of structured patient education on knowledge \n\n\n\nlevel and inr control of patients receiving warfarin: Randomized controlled trial. Pakistan \n\n\n\nJournal of Medical Sciences 34(2): 240\u2013426. doi:10.12669/pjms.342.14216 \n\n\n\n[3] Hasan, S. S., Shamala, R., Syed, I. A., Basariah, N., Chong, D. W. K., Mei, T. K. & Chin, \n\n\n\nO. H. 2011. Factors affecting warfarin-related knowledge and INR control of patients \n\n\n\nattending physician- and pharmacist-managed anticoagulation clinics. Journal of \n\n\n\nPharmacy Practice 24(5): 485\u2013493. doi:10.1177/0897190011415684. \n\n\n\n\n\n\n\nAbstract 034 \n\n\n\n\n\n\n\nQuality and Quantity of Patient\u2019s \n\n\n\nOwn Medicine\u2019s Brought to Hospital \n\n\n\nTuanku Ampuan Najihah during \n\n\n\nAdmission: A Cross-Sectional Study \n \nZalikha Z, Hazlin N, Nurul N, Puvaneswari \n\n\n\nN*, Teo Kui Yuan \n\n\n\n \nPharmacy Department, Hospital Tuanku Ampuan Najihah, Kuala Pilah, \n\n\n\nNegeri Sembilan \n\n\n\n\n\n\n\n*Correspondence: htan.pric@gmail.com \n\n\n\n\n\n\n\nIntroduction: Patients\u2019 Own Medicines (POMs) is a \n\n\n\nrelatively recent programme in Malaysia, with its  \n\n\n\nmanagement guidelines first published in 2016. Studies \n\n\n\nrelating to the quantity and quality of POMs are limited in \n\n\n\nMalaysia. Objective: This study aimed to evaluate the \n\n\n\nquality and quantity of POMs brought by patients admitted \n\n\n\nto Hospital Tuanku Ampuan Najihah (HTAN). Method: A \n\n\n\ncross-sectional study was carried out among patients \n\n\n\nadmitted in the medical ward, in HTAN. Convenient \n\n\n\nsampling was applied and 170 respondents were recruited \n\n\n\nfrom the medical ward. Data was collected by interviewing \n\n\n\npatients using a structured data collection form by \n\n\n\ninvestigators. The parameters studied were the quality, \n\n\n\nquantity and socioeconomic characteristics that might \n\n\n\ninfluence the quality of POMs. Data were analysed using \n\n\n\nChi-Square tests to identify potential associated factors and \n\n\n\nSpearman\u2019s analysis to assess the correlation between the \n\n\n\nnumber of POMs and their usability. Result: Total number \n\n\n\nof patients who brought POMs were 170, and the calculated \n\n\n\ntotal number of POMs were 752. POMs brought by patients \n\n\n\nto HTAN were generally in good condition in which 93.7% \n\n\n\n(n=679) of POMs were usable while 6.3% (n=46) of POMs \n\n\n\nwere unusable. Out of 752 POMs, 87% were in good \n\n\n\ncondition, 98% were not expired and 72% of them were \n\n\n\nlabelled with batch number, expiry date and presented in \n\n\n\noriginal packaging. No significant associated factors was \n\n\n\nfound between POM\u2019s usability and patient\u2019s socioeconomic \n\n\n\ncharacteristics. There was a correlation between the number \n\n\n\nof medicines and the usability of POMs (R-value= -0.151, p-\n\n\n\nvalue= 0.049). Conclusion: Most of the POMs brought by \n\n\n\npatients are usable in the ward. Pill burden could be the \n\n\n\n\nmailto:htan.pric@gmail.com\n\n\nmailto:htan.pric@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 7, Issue 1, Supplementary (2021), 49-77 \n\n\n\n67 \n \n\n\n\nResearch Presentation of National Pharmacy Convention 2021 \n\n\n\nDOI:  10.52494/UCML9733 \n \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nreason for poor management of medicines at home. Future \n\n\n\nstudy shall include the cost and savings incurred of POMs.  \n\n\n\n \nReferences \n \n\n\n\n[1] Billups SJ, Malone DC, Carter BL. The relationship between drug therapy non-\n\n\n\ncompliance and patient characteristics, health-related quality of life, and healthcare costs. \n\n\n\nPharmacotherapy 2000;20:941-9 \n\n\n\n[2] Col N, Fanale JE, Kronholm P. The role of medication noncompliance and adverse drug \n\n\n\nreactions in hospitalizations of the elderly. Arch Intern Med 1990;150:841-5. \n\n\n\n[3] Coons SJ, Sheahan SL, Martin SS, Hendrick J, Robbins CA, Johnson JA. Predictors of \n\n\n\nmedication noncompliance in a sample of older adults. Clin Ther 1994;16:110-7. \n\n\n\n\n\n\n\nAbstract 035 \n\n\n\n\n\n\n\nPublic Knowledge and Practices \n\n\n\nRegarding Antibiotic Use: A \n\n\n\nNationwide Cross-Sectional Survey \n\n\n\nin Malaysia \n \nLai San Kong1*, Farida Islahudin1, Leelavathi \n\n\n\nMuthupalaniappen2, Wei Wen Chong1 \n\n\n\n \n1 Centre of Quality Management of Medicines, Faculty of Pharmacy, \n\n\n\nUniversiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia \n2 Department of Family Medicine, Medical Faculty, Universiti Kebangsaan \nMalaysia, Kuala Lumpur 50300, Malaysia. \n\n\n\n\n\n\n\n*Correspondence: laisan_kong@hotmail.com \n \n\n\n\nIntroduction: Antibiotic resistance is a global threat to \n\n\n\nIntroduction: Antibiotic resistance is a global threat to \n\n\n\nhuman health worldwide, and a major contributing factor is \n\n\n\nthe inappropriate use of antibiotics. There is a need for a \n\n\n\nnationwide study on the Malaysian general public to identify \n\n\n\nknowledge gaps regarding antibiotic use, its resistance, and \n\n\n\npractices related to antibiotic use. Objective: This \n\n\n\nnationwide study aimed to assess the knowledge of antibiotic \n\n\n\nuse and resistance, and to identify any inappropriate practices \n\n\n\nrelated to antibiotic use among the Malaysian general public. \n\n\n\nMethod: A cross-sectional survey was conducted, where \n\n\n\nMalaysians aged 18 years old and above from all states in \n\n\n\nMalaysia were recruited via quota sampling, followed by \n\n\n\nconvenient sampling. A validated self-administered \n\n\n\nquestionnaire was used to collect data. Result: A total of \n\n\n\n1971 respondents were recruited. Half of them had engaged \n\n\n\nin at least one inappropriate practice related to antibiotic use \n\n\n\n(56.6%), with the most common being not completing an  \n\n\n\nantibiotic course (48.8%). The mean total knowledge score \n\n\n\nwas 8.57 \u00b1 4.24 (range 0-20). The majority of the respondents \n\n\n\nwere unsure or incorrectly answered that antibiotics work on \n\n\n\nviral infections (79.1%) and colds and coughs (77.0%), and \n\n\n\n42.8% were unsure or incorrectly answered that antibiotics \n\n\n\ncould be stopped when symptoms improved. Most \n\n\n\nrespondents were unsure or wrongly answered that antibiotic \n\n\n\nresistance occurs when the body becomes resistant to \n\n\n\nantibiotics (90.2%), and antibiotic resistance is not an issue \n\n\n\nin Malaysia (62.9%). Respondents who had engaged in at \n\n\n\nleast one inappropriate practice related to antibiotic use were \n\n\n\nobserved to have lower mean total knowledge scores (8.11 \u00b1 \n\n\n\n4.00 versus 9.26 \u00b1 4.40, p<0.001). Respondents who reported \n\n\n\nhad ever not completed their antibiotic courses had \n\n\n\nsignificantly lower mean knowledge scores (8.09 \u00b1 3.93 \n\n\n\nversus 9.10 \u00b1 4.42, p<0.001). Conclusion: Important \n\n\n\nknowledge gaps on antibiotic use and resistance, and a high \n\n\n\nrate of non-completion of antibiotic courses were observed \n\n\n\namong the general public. Improving the knowledge of \n\n\n\nantibiotic use and resistance among the general public may \n\n\n\nbe a key strategy to correct misconceptions and promote the \n\n\n\nprudent use of antibiotics. \n\n\n\n \nReferences \n\n\n\n \n[1] Ventola CL. The antibiotic resistance crisis: part 1: causes and threats. Pharm Ther. \n\n\n\n2015;40:277\u201383. doi:Article. \n\n\n\n[2] Gualano MR, Gili R, Scaioli G, Bert F, Siliquini R. General population\u2019s knowledge and \n\n\n\nattitudes about antibiotics: A systematic review and meta-analysis. Pharmacoepidemiol \n\n\n\nDrug Saf. 2015;24:2\u201310. \n\n\n\n[3] Oh AL, Hassali M, Al-Haddad M, Syed Azhar S, Shafie A, Awaisu A. Public knowledge \n\n\n\nand attitudes towards antibiotic usage: a cross-sectional study among the general public in \n\n\n\nthe state of Penang, Malaysia. J Infect Dev Ctries. 2011;5:338\u201347. \n\n\n\n\n\n\n\nAbstract 036  \n\n\n\n\n\n\n\nA Study on Knowledge, Attitude and \n\n\n\nPractice on Medication Error \n\n\n\nReporting Among Healthcare \n\n\n\nPractitioners in a Primary Care \n\n\n\nSetting.  \n \nMuhamad Alif Hakimi Amran, Siti Masturina \n\n\n\nJusoh, Nik Noor Tasneim Nik Md Noordin, \n\n\n\nSyafawati Ramli \n\n\n\n \nPharmacy Unit, Klinik Kesihatan Pengkalan Chepa & Klinik Kesihatan \nBandar Kota Bharu. \n\n\n\n\n\n\n\n*Correspondence: tasneim02@gmail.com \n\n\n\n\n\n\n\nIntroduction: Medication error (ME) is a worldwide issue \n\n\n\naffecting the healthcare system. In Malaysia, a total of \n\n\n\n17357 medication error reports were submitted to the \n\n\n\nNational Medication Error Reporting System (MERS) in \n\n\n\n2016. However, the majority of the medication error reports \n\n\n\ncome from pharmacists.  Objective: To assess the \n\n\n\nknowledge, attitude and practice (KAP) on medication error \n\n\n\nreporting among healthcare practitioners working in \n\n\n\nprimary care settings under the District Health Office of \n\n\n\nKota Bharu.  Method: A cross-sectional survey was \n\n\n\nconducted between Nov 2020 and Jan 2021 using a web-\n\n\n\nbased self-administered questionnaire with 6 closed-ended \n\n\n\nquestions for each section: knowledge, attitude and practice. \n\n\n\nParticipants included healthcare practitioners (physicians, \n\n\n\npharmacists and nurses) working in the 20 primary care \n\n\n\nhealth clinics within Kota Bharu District. KAP toward \n\n\n\n\nmailto:laisan_kong@hotmail.com\n\n\nmailto:tasneim02@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 7, Issue 1, Supplementary (2021), 49-77 \n\n\n\n68 \n \n\n\n\nResearch Presentation of National Pharmacy Convention 2021 \n\n\n\nDOI:  10.52494/UCML9733 \n \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nmedication error reporting was assessed using three options \n\n\n\n(yes, no or maybe). Result and discussion: A total of 221 \n\n\n\nrespondents participated in the survey. Almost half (46%, \n\n\n\nn=101) of the healthcare professionals were not \n\n\n\nknowledgeable and 44% of them (n= 97) had negative \n\n\n\nattitudes towards medication error reporting. The \n\n\n\npharmacists had the highest proportion, 65% (n=26) of them \n\n\n\nwere knowledgeable and 73% (n=29) had a favorable \n\n\n\nattitude. Almost half of them (57%, n=126) have previous \n\n\n\nexperience in reporting ME. Among the listed variables, \n\n\n\nrespondents\u2019 attitude and practice of medication error \n\n\n\nreporting are significantly associated to gender with \n\n\n\np=0.002 and p=0.043, respectively. This data was found \n\n\n\nquite similar to the previous study. There was a weak \n\n\n\ncorrelation between knowledge-attitude (p<0.001, r=0.330) \n\n\n\nand attitude-practice (p<0.001, r=0.391). A moderate \n\n\n\ncorrelation was found between attitude-practice (p<0.001, \n\n\n\nr=0.561). Meanwhile, knowledge and practice show \n\n\n\nmoderate correlation and significance (p<0.001, r= 0.561).  \n\n\n\nConclusion: Our study revealed that knowledge, attitude \n\n\n\nand practice among the respondent are above borderline, i.e. \n\n\n\nmerely above 50%. Therefore, more efforts are needed to \n\n\n\nimprove the knowledge and attitude of the healthcare \n\n\n\nworkers. Educational talk, disseminating ME material or \n\n\n\ndisplaying a clear flow chart on the reporting process are \n\n\n\nsome of the examples that could be carried out.    \n\n\n\n \nReference \n\n\n\n\n\n\n\n[1] Alsulami, S. L., Sardidi, H. O., Almuzaini, R. S., Alsaif, M. A., Almuzaini, H. S., \n\n\n\nMoukaddem, A. K., & Kharal, M. S. (2019). Knowledge, attitude and practice on \n\n\n\nmedication error reporting among health practitioners in a tertiary care setting in Saudi \n\n\n\nArabia. Saudi Medical Journal, 40(3), 246\u2013251. \n\n\n\nhttps://doi.org/10.15537/smj.2019.3.23960 \n\n\n\n[2] Carandang, R. R., Resuello, D., Hocson, G. B., Respicio, K. M., & Reynoso, C. \n\n\n\n(2015).Knowledge, Attitude and Practices on Medication Error Reporting among Health \n\n\n\nPractitioners from Hospitals in Manila. Scholars Academic Journal of Pharmacy (Online) \n\n\n\nSch. Acad. J. Pharm, 4(5), 2320\u20134206. \n\n\n\n[3] Chiang, H. Y., Lin, S. Y., Hsu, S. C., & Ma, S. C. (2010). Factors determining hospital \n\n\n\nnurses\u2019 failures in reporting medication errors in Taiwan. Nursing Outlook, 58(1), 17\u201325. \n\n\n\nhttps://doi.org/10.1016/j.outlook.2009.06.001 \n\n\n\n\n\n\n\nAbstract 037 \n\n\n\n\n\n\n\nPrevalence of polymorphisms in \n\n\n\ngastrointestinal (GI) disorder-related \n\n\n\ngene, Tryptophan hydroxylase 1 \n\n\n\n(TPH1) among Healthy Malays \n \nRasmaizatul Akma Rosdi1, Nurfadhlina \n\n\n\nMusa2, Zalina Zahari3*, Mohd Khairi Zahri @ \n\n\n\nJohari4, Mulham Alfatama3, Khoo Boon Yin5 \n\n\n\n \n1 School of Health Sciences, Universiti Sains Malaysia, Health Campus, \n16150 Kubang Kerian, Kelantan, Malaysia \n2 Human Genome Center, School of Medical Sciences, Universiti Sains \n\n\n\nMalaysia, Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia \n3 Faculty of Pharmacy, Universiti Sultan Zainal Abidin, Besut Campus, \n\n\n\n22200 Besut, Terengganu, Malaysia \n\n\n\n4 Faculty of Health Sciences, Universiti Sultan Zainal Abidin, Gong Badak \n\n\n\nCampus, 21300 Kuala Nerus, Terengganu, Malaysia \n5 Institute for Research in Molecular Medicine (INFORMM), Universiti \n\n\n\nSains Malaysia, 11800 Gelugor, Penang, Malaysia \n\n\n\n \n*Correspondence: zalinazahari@unisza.edu.my \n\n\n\n\n\n\n\nIntroduction: Polymorphisms in the genes associated with \n\n\n\ngenetic disorders have shown variable prevalence among \n\n\n\ndifferent populations in the world. Today, the genetic \n\n\n\npolymorphisms database is considered a key to success in \n\n\n\nguiding treatment decision-making for genetic diseases. \n\n\n\nTryptophan hydroxylase 1 gene (TPH1) which encodes the \n\n\n\nenzyme that catalyzes the rate-limiting step in the serotonin \n\n\n\nor 5-hydroxytryptamine biosynthesis pathway, is one of the \n\n\n\nleading candidate genes associated with gastrointestinal (GI) \n\n\n\ndisorders. Objective: With these perspectives, this research \n\n\n\naimed to study the genotype distributions and allele \n\n\n\nfrequencies of two single nucleotide polymorphisms (SNPs) \n\n\n\nof TPH1 among healthy Malays in Malaysia. Method: \n\n\n\nNested allele-specific multiplex polymerase chain reaction \n\n\n\n(PCR) was performed on 404 archived Malays\u2019 DNAs to \n\n\n\ndetermine the distributions and frequencies of TPH1 SNPs; \n\n\n\nrs4537731 (A-6526G) and rs211105 (T18033757G). \n\n\n\nGenotyping results were confirmed through direct Sanger \n\n\n\nsequencing. Result and Discussion: The genotype \n\n\n\nfrequencies of A/A (A-6526G) and T/T (T1803375G) were \n\n\n\n51.49% and 59.16%, respectively. The heterozygous \n\n\n\nfrequency for A/G (A-6526G) was 36.39% and for T/G \n\n\n\n(T1803375G) was 33.66%. The homozygous variant was \n\n\n\nonly found in A-6526G with a frequency of 12.13%. \n\n\n\nConcurrently, the wild type allele frequencies appeared to be \n\n\n\nhigher than the mutant type in both SNPs with 69.7% to \n\n\n\n30.3% for rs4537731 and 76.0% to 24.0% for rs211105. The \n\n\n\nfindings from this study described low frequencies of TPH1 \n\n\n\nvariants rs4537731 and rs211105 among healthy Malays, to \n\n\n\nwhich the symptoms of irritable bowel syndrome and severe \n\n\n\nGI including bloating, diarrhea and watery stool can be \n\n\n\nattributed. However, more studies should be performed to \n\n\n\nsolidify the findings. For example, studies on Malaysian \n\n\n\npatients with GI disorders are recommended to determine the \n\n\n\nassociation of TPH1 polymorphisms to the condition, locally. \n\n\n\nConclusion: The genetic polymorphism data obtained from \n\n\n\nthis study is important to enhance our current knowledge on \n\n\n\nthe genetic profiles among healthy Malays. Such data can be \n\n\n\nused to explore more on the association of GI disorders and \n\n\n\nthe genetic variations of Malaysians in the future. \n\n\n\n \nReference \n\n\n\n \n[1] Ryo, K., Akiko, S., Takahisa, M., Manabu, I., Minoru, F., Hiroshi, M., & Ken, H. (2018). \n\n\n\nThe TPH1 rs211105 gene polymorphism affects abdominal symptoms and quality of life \n\n\n\nof diarrhea-predominant irritable bowel syndrome. Journal of Clinical Biochemistry and \n\n\n\nNutrition, 62(3), 270-276.   \n\n\n\n[2] Houssam, H., & Michael, C. (2017). Pharmacogenetics and the treatment of functional \n\n\n\ngastrointestinal disorders. Pharmacogenomics, 18(11), 1085-1094 \n\n\n\n[3] Magdalena, G., Jan, A. B., Ewa, W., Marcin, S., Monika, S-B., Dorota, F., Tadeusz,  D., \n\n\n\nAnna, J., Arleta, L., Ma\u0142gorzata, M., & Agata, M. (2017). Serotonin-related gene variants \n\n\n\nin patients with irritable bowel syndrome and depressive or anxiety disorders. \n\n\n\nGastroenterology Research and Practice, 1-9.  \n\n\n\n \n\n\n\n\nhttps://doi.org/10.15537/smj.2019.3.23960\n\n\nhttps://doi.org/10.1016/j.outlook.2009.06.001\n\n\nmailto:zalinazahari@unisza.edu.my\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 7, Issue 1, Supplementary (2021), 49-77 \n\n\n\n69 \n \n\n\n\nResearch Presentation of National Pharmacy Convention 2021 \n\n\n\nDOI:  10.52494/UCML9733 \n \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 038 \n\n\n\n\n\n\n\nThe Impact of Lithocholic Acid as A \n\n\n\nSurfactant on the Characteristics and \n\n\n\nCytocompatibility of Azithromycin \n\n\n\nLoaded Self-Emulsifying Drug \n\n\n\nDelivery System  \n \nReem Abou Assi1,2, Ibrahim M.Abdulbaqi 1,2, \n\n\n\nToh Seok Ming1, Chan Siok Yee1*, Habibah A. \n\n\n\nWahab1*, Yusrida Darwis 1* \n\n\n\n \n1 The Discipline of Pharmaceutical Technology, School of Pharmaceutical \n\n\n\nSciences, Universiti Sains Malaysia, 11800, Penang, Malaysia. \n2 The Discipline of Pharmaceutical Technology, College of Pharmacy, Al-\n\n\n\nKitab University, Altun kupri, Kirkuk, Iraq.  \n\n\n\n\n\n\n\n*Correspondence: sychan@usm.my \n\n\n\n\n\n\n\nIntroduction: The self-emulsifying drug delivery system \n\n\n\n(SEDDS) has emerged as an effective pharmaceutical \n\n\n\nstrategy for addressing the issue of poorly soluble drug \n\n\n\nbioavailability, specifically candidates belonging to BCS \n\n\n\nclasses II and IV including azithromycin (AZM, log p = 4). \n\n\n\nAside from oil, the main component in SEDDS is the \n\n\n\nsurfactant, which is presented in high concentrations leading \n\n\n\nto complex physiological interactions raising the possibility \n\n\n\nof toxicity. Surfactants derived from bile acid have transpired \n\n\n\nas an excellent choice of bio-compatible pharmaceutical \n\n\n\nexcipient. Unconjugated lithocholic acid (LA) has recently \n\n\n\nbeen reported to improve formulations\u2019 drug release and \n\n\n\nstability. Objective: To investigate LA as a safe and effective \n\n\n\nsurfactant in liquid SEDDS (L-SEDDS) and compare it with \n\n\n\nLA-free L-SEDDS and solid SEDDS (S-SEDDS) states of \n\n\n\nAZM. This is in terms of reduced particle size (PS), \n\n\n\ndispersity (\u0110), self-emulsification efficiency (T%), zeta \n\n\n\npotential charge in distilled water (DW), 0.1 mM HCl, and \n\n\n\nsimulated intestinal fluids (SIF), as well as cellular viability. \n\n\n\nMethod: L-SEDDS was formulated with Capryol 90\u00ae oil \n\n\n\n(22.22%), Tween 20\u00ae as surfactant and Transcutol HP\u00ae (2:1 \n\n\n\nratio) as co surfactant. S-SEDDS was produced by adsorbing \n\n\n\nthe L-SEDDS(s) to Aerosil 200\u00ae as a solid carrier (at 2:1 ratio \n\n\n\nof L-SEDDs to Aerosil 200\u00ae). In L-SEDDS, LA was \n\n\n\nincorporated at high (B-L-SEDDS3), medium (B-L-\n\n\n\nSEDDS2), and low (B-L-SEDDS1) concentrations of 7.75, \n\n\n\n3.6, and 1.03 mg/ml respectively. Later, AZM was loaded. \n\n\n\nMTT assay was performed on human Colon carcinoma cell \n\n\n\nlines. Result and Discussion: Significant reduction in PS \n\n\n\nand \u0110 values was observed upon the addition of LA (p<0.05) \n\n\n\nin both blank and loaded B-L-SEDDS and compared to LA-\n\n\n\nfree AZM-loaded liquid and solid SEDDSs, respectively. \n\n\n\nBesides, the size reduction was LA concentration-dependent \n\n\n\nand could be advantageous for drug absorption and lymphatic \n\n\n\nuptake, while the \u0110 reduction represents SEDDS improved \n\n\n\nhomogeneity. After the addition of LA, T% increased up to \n\n\n\n~ 100%, while ZP charges were negative in DW and SIF, \n\n\n\nwith charge shift to positive in HCl diluent. Almost all \n\n\n\nSEDDSs formulations exhibited good cytocompatibility (> \n\n\n\n~85%). Conclusion: LA is a potential surfactant for desired \n\n\n\nfeatures of SEDDS (PS, \u0110 and T%) with a good safety \n\n\n\nprofile. \n\n\n\n \nReference \n\n\n\n \n[1] Pavlovi\u0107, N. et al. (2018). Bile Acids and Their Derivatives as Potential Modifiers of Drug \n\n\n\nRelease and Pharmacokinetic Profiles. Frontier in pharmacology, 9,1283. \n\n\n\n[2] Wagle, S.R. et al. (2020). Pharmacological and Advanced Cell Respiration Effects, \n\n\n\nEnhanced by Toxic Human-Bile Nano-Pharmaceuticals of Probucol Cell-Targeting \n\n\n\nFormulations. Pharmaceutics,12(8), 708.  \n\n\n\n[3] Mathavan, S., et. al. (2016). A comprehensive study of novel microcapsules incorporating \n\n\n\ngliclazide and a permeation enhancing bile acid: Hypoglycemic effect in an animal model \n\n\n\nof Type-1 diabetes. Drug Delivery, 23(8), 2869\u20132880. \n\n\n\n\n\n\n\nAbstract 039 \n\n\n\n\n\n\n\nCOVID-19: Embracing the New \n\n\n\nNormal; Are We Ready for This? A \n\n\n\nCross-Sectional Study \n \nSherilyn Pak Cheng Suet1, Muhammad Junaid \n\n\n\nFarrukh1*, Hee Mei Qi1, Zikria Saleem2, \n\n\n\nMuhammad Salman2, Aziz ur Rahman1 \n\n\n\n \n1 Faculty of Pharmaceutical Sciences, UCSI University, 56000 Cheras, \nWilayah Persekutuan Kuala Lumpur, Malaysia. \n2 Department of Pharmacy Practice, Faculty of Pharmacy, The University of \nLahore, 1-Km Defense Road, Lahore, Pakistan. \n\n\n\n\n\n\n\n*Correspondence: sherilynpcs98@hotmail.com \n \n\n\n\nIntroduction: The rapid spread of Coronavirus brought fear \n\n\n\nand chaos to Malaysians. Amidst pandemic, educating, \n\n\n\nengaging, and mobilising the public to become active \n\n\n\nparticipants may help achieve public health emergency \n\n\n\npreparedness, reducing the overall population's vulnerability. \n\n\n\nHowever, false media information may mislead Malaysians, \n\n\n\nmaking it necessary to access Malaysians' baseline \n\n\n\nknowledge and preventive practices against COVID-19. \n\n\n\nObjective: The study aimed to evaluate the knowledge, \n\n\n\nattitude, perception and practices towards the prevention of \n\n\n\nCOVID-19 among the general public in Malaysia. Method: \n\n\n\nA cross-sectional study was conducted online among the \n\n\n\ngeneral public in Malaysia from June 2020 to August 2020. \n\n\n\nParticipants were conveniently recruited through multiple \n\n\n\nsocial media platforms to encourage nationwide \n\n\n\nparticipation. A patient-administered questionnaire was used \n\n\n\nto assess their knowledge, attitude and practice towards the \n\n\n\nprevention of COVID-19. Descriptive analysis, percentage, \n\n\n\nmean, and standard deviation were used to report \n\n\n\ndemographic characteristics, knowledge, attitude, and \n\n\n\npractice scores. For inferential analysis, t-test, ANOVA, \n\n\n\nPearson's correlation, Spearman's correlation, Chi-square test \n\n\n\nand binary logistic regression was used to analyse the \n\n\n\n\nmailto:sychan@usm.my\n\n\nmailto:sherilynpcs98@hotmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 7, Issue 1, Supplementary (2021), 49-77 \n\n\n\n70 \n \n\n\n\nResearch Presentation of National Pharmacy Convention 2021 \n\n\n\nDOI:  10.52494/UCML9733 \n \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\ndifferentiation, association and correlations of the study \n\n\n\nvariables. The confidence interval selected for this study was \n\n\n\n95%. Result: A total of 420 respondents participated in this \n\n\n\nsurvey. The majority of the participants (n=412, 98%) were \n\n\n\naware of COVID-19. Most participants learnt about the \n\n\n\npandemic through social media. About half of the \n\n\n\nparticipants had inadequate knowledge (45.5%) and a \n\n\n\nnegative attitude (43.3%). Participants residing in urban \n\n\n\nareas showed good preventive practices than those residing \n\n\n\nin rural areas (P<0.05).  There was a significant association \n\n\n\nbetween participant's attitudes and preventive practices \n\n\n\ntowards COVID-19, Where the majority of the participants \n\n\n\n(57.4%) who showed negative attitudes were more likely to \n\n\n\nfollow poor preventive practices. Malaysians each hold a \n\n\n\nperception that differs from individuals according to their \n\n\n\nmindsets, perspective and acceptance towards COVID-19. \n\n\n\nConclusion: Despite having good knowledge, participants \n\n\n\nwith a negative attitude towards COVID-19 were less likely \n\n\n\nto follow the preventive practices of COVID-19. The Public's \n\n\n\nmindset and willingness may play an important role in \n\n\n\ninfluencing their practices, giving them another perspective, \n\n\n\nwhich may change their perceptions. As a result, strategies \n\n\n\nshould be made to change the mindset of these vulnerable \n\n\n\ngroups through proper counselling and education. \n\n\n\n \nReference \n\n\n\n \n[1] DUCHARME J. World Health Organization Declares COVID-19 a 'Pandemic.'. TIME. \n\n\n\n2020.  \n\n\n\n[2] Singhal T. A Review of Coronavirus Disease-2019 (COVID-19). Indian J Pediatr. 2020; \n\n\n\n87(4): 281-286  \n\n\n\n[3] PFORDTEN D, AHMAD R. Covid-19: Current situation in Malaysia. The Star. 2020 \n\n\n\nMarch 23.  \n\n\n\n\n\n\n\nAbstract 041 \n\n\n\n\n\n\n\nA Study on Academic Stress Level \n\n\n\namong Undergraduate Pharmacy \n\n\n\nStudents \n \nGanesh Sritheran Paneerselvam*, Ng Hsu \n\n\n\nSyuen \n\n\n\n \nSchool of Pharmacy, Taylor\u2019s University, 47500 Subang Jaya, Selangor, \n\n\n\nMalaysia. \n \n\n\n\n*Correspondence: ganesh_alei@hotmail.com \n\n\n\n\n\n\n\nIntroduction: Pharmacy course has always been regarded as \n\n\n\na highly stressful program among university undergraduates. \n\n\n\nThis worsens tremendously during the Covid-19 pandemic \n\n\n\nwhen there is a sudden shift to e-learning. Objective: To \n\n\n\nexamine the severity of academic stress among pharmacy \n\n\n\nstudents and the factors affecting it. Method: A cross-\n\n\n\nsectional study using a convenient sampling technique was \n\n\n\nconducted among undergraduate pharmacy students in a \n\n\n\ntertiary university in Malaysia. A self-administered validated \n\n\n\nquestionnaire was distributed to the students through emails. \n\n\n\nThe questionnaire includes sociodemographic information \n\n\n\nand questions to examine the academic-related factors which \n\n\n\nrender student stress during the Covid-19 pandemic. All the \n\n\n\ndata were analysed using SPSS version 26.0. Result and \n\n\n\nDiscussion: Overall, 102 pharmacy students participated in \n\n\n\nthis study. The majority of the students face a moderate level \n\n\n\nof academic stress (63.8%), followed by severe stress \n\n\n\n(23.5%) and mild stress (12.7%). Academic factors, such as \n\n\n\nstruggling with difficult subjects through e-learning, feeling \n\n\n\nstressed when deadline submission is approaching, and \n\n\n\ndealing with high academic workloads might be the reasons \n\n\n\nfor stress. \n\n\n\nFurthermore, this study discovered that the year of study, \n\n\n\nespecially for students in year one and smoking, were two \n\n\n\nsignificant independent factors causing academic stress \n\n\n\namong students (P-value < 0.05). Conclusion: This study \n\n\n\nhighlights the worsening academic stress which could affect \n\n\n\nthe psychological well-being of the students. The mental \n\n\n\nhealth status of the students should not be neglected.  \n\n\n\nTherefore, school management needs to develop effective \n\n\n\ncounselling modules and intervention strategies to help \n\n\n\nstudents alleviate academic stress. \n\n\n\n \nReference \n\n\n\n \n[1] Grubic, N., Badovinac, S., & Johri, A. (2020). Student mental health in the midst of the \n\n\n\nCOVID-19 pandemic: A call for further research and immediate solutions. International \n\n\n\nJournal Of Social Psychiatry, 66(5), 517-518.  \n\n\n\n[2] Kamal, A. A., Shaipullah, N. M., Truna, L., Sabri, M., & Junaini, S. N. (2020). \n\n\n\nTransitioning to online learning during COVID-19 Pandemic: Case study of a Pre-\n\n\n\nUniversity Centre in Malaysia. International Journal of Advanced Computer Science and \n\n\n\nApplications, 11(6), 217\u2013223.  \n\n\n\n[3] Milic, M., Gazibara, T., Pekmezovic, T., Tepavcevic, D. K., Maric, G., Popovic, A., \n\n\n\nStevanovic, J., Patil, K. H., & Levine, H. (2020). Tobacco smoking and health-related \n\n\n\nquality of life among university students: Mediating effect of depression. PLoS ONE, \n\n\n\n15(1), 1\u201318.  \n\n\n\n\n\n\n\nAbstract 043 \n\n\n\n\n\n\n\nQualitative Analysis on \n\n\n\nInterprofessional Collaboration in \n\n\n\nthe Management of Paediatric \n\n\n\nBronchial Asthma: Challenges and \n\n\n\nSuggestions for Improvement \n \nKarniza Khalid1, Nurul Azima Mazlan2*, Wan \n\n\n\nNor Amalina Zainun2, Amalina Anuar1, \n\n\n\nNuqman Mursyid Ramli2, Ang Wei Chern1,2 \n \n1 Clinical Research Centre, Hospital Tuanku Fauziah, Perlis, Ministry of \n\n\n\nHealth Malaysia \n2 Department of Pharmacy, Hospital Tuanku Fauziah, Perlis, Ministry of \n\n\n\nHealth Malaysia \n\n\n\n\n\n\n\n*Correspondence: karniza@yahoo.com \n\n\n\n\n\n\n\nIntroduction: Multi-disciplinary healthcare providers need \n\n\n\nto move beyond task-based responsibility towards a more \n\n\n\n\nmailto:ganesh_alei@hotmail.com\n\n\nmailto:karniza@yahoo.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 7, Issue 1, Supplementary (2021), 49-77 \n\n\n\n71 \n \n\n\n\nResearch Presentation of National Pharmacy Convention 2021 \n\n\n\nDOI:  10.52494/UCML9733 \n \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\ncollaborative approach. Chronic childhood diseases such as \n\n\n\nbronchial asthma demanded effective multidisciplinary team \n\n\n\nmeetings to improve patient care. Objective: We aimed to \n\n\n\nexamine the interprofessional collaboration between \n\n\n\nphysician and pharmacist in the management of paediatric \n\n\n\nbronchial asthma, to explore the views and experiences of \n\n\n\nboth pharmacists and physicians on the important aspects of \n\n\n\npaediatric respiratory medication therapy adherence therapy \n\n\n\n(PRMTAC) and patient-centredness, and to identify barriers \n\n\n\nto shared decision-making in the management of paediatrics \n\n\n\nbronchial asthma. Method: The study involved a face-to-\n\n\n\nface interview involving the paediatrics medical team and \n\n\n\npharmacists involved with PRMTAC. The semi-structured \n\n\n\ninterview included four pharmacists and three paediatrics \n\n\n\nresidence from Hospital Tuanku Fauziah, Perlis, Malaysia. A \n\n\n\nfull audio recording was used for detailed data retrieval and \n\n\n\nverbatim transcription. The session was deemed completed \n\n\n\nonce all the probed questions have reached the thematic \n\n\n\nconclusion. Result and Discussion: There were three main \n\n\n\nthemes emerged: (i) The relevance and necessity of \n\n\n\nPRMTAC service to complement paediatric outpatient \n\n\n\nbronchial asthma management, (ii) the lack of \n\n\n\ncommunication between pharmacist-physician in outpatient \n\n\n\nbronchial asthma management, and (iii) recommendation for \n\n\n\nthe combined clinic in the management of outpatient \n\n\n\npaediatric bronchial asthma. PRMTAC services were rated \n\n\n\nas highly relevant in the management of outpatient bronchial \n\n\n\nasthma among all study respondents, irrespective of \n\n\n\nprofession. The detailed assessment of medication \n\n\n\ncompliance and technical demonstration provided by \n\n\n\nPRMTAC services were deemed fundamental in holistic \n\n\n\npatient care. The current clinical scenario demonstrates that \n\n\n\nthe pharmacist and paediatric medical team work \n\n\n\nindependently and in parallel rather than collaboratively\u2014\n\n\n\nsuch workflow challenges in tandem decision-making \n\n\n\nregarding patient-focused medication. The lack of interaction \n\n\n\nalso impedes sharing of ideas and new knowledge that could \n\n\n\nbenefit both parties in relation to the management of \n\n\n\noutpatient bronchial asthma. A combined clinic was \n\n\n\nsynonymously suggested to remedy this. Conclusion:  \n\n\n\nTherefore, proper planning regarding allocation of support \n\n\n\nsystem and mobilisation of human resources needs to be \n\n\n\ninstituted to realise the implementation of a nationwide \n\n\n\ncombined clinic in the management of paediatric bronchial \n\n\n\nasthma.  \n\n\n\n \nReference \n\n\n\n \n[1] Hoffmann, T. C., Montori, V. M., & Del Mar, C. 2014. The connection between evidence-\n\n\n\nbased medicine and shared decision making. Jama, 312(13), 1295-1296. \n\n\n\n[2] Kaplan, A., & Price, D. 2020. Treatment Adherence in Adolescents with Asthma. Journal \n\n\n\nof asthma and allergy, 13, 39. \n\n\n\n[3] Mercer, K., Burns, C., Guirguis, L., Chin, J., Dogba, M. J., Dolovich, L., ... & Grindrod, \n\n\n\nK. A. 2018. Physician and pharmacist medication decision-making in the time of \n\n\n\nelectronic health records: mixed-methods study. JMIR human factors, 5(3), e24.  \n\n\n\n[4] in serious mental illness. International journal of clinical pharmacy, 38(5), 1191-1199. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 044 \n\n\n\n\n\n\n\nViews, Barriers and Facilitators of \n\n\n\nPharmacists Regarding Trastuzumab \n\n\n\nBiosimilar in the Treatment of HER2+ \n\n\n\nBreast Cancer \n  \nYin Yen Wong1,2*, Pauline Siew Mei Lai1, Wan \n\n\n\nZamaniah Wan Ishak3, Renly Lim4 \n\n\n\n\n\n\n\n1 Department of Pharmacy, University Malaya Medical Centre, 59100 \nKuala Lumpur, Malaysia \n2 Department of Primary Care Medicine, Faculty of Medicine, University \n\n\n\nof Malaya, 50603 Kuala Lumpur, Malaysia \n3 Department of Clinical Oncology, Faculty of Medicine, University of \n\n\n\nMalaya, 50603 Kuala Lumpur, Malaysia \n3UniSA Clinical and Health Sciences, University of South Australia, \nAdelaide, Australia \n\n\n\n\n\n\n\n*Correspondence: yywong@ummc.edu.my \n \n\n\n\nIntroduction: Despite the introduction of trastuzumab \n\n\n\nbiosimilar in 2019 and scientific proof that biosimilar has no \n\n\n\nclinically meaningful difference from its originator, the \n\n\n\nuptake of trastuzumab biosimilar in one teaching hospital in \n\n\n\nMalaysia was still low in 2021.1,2 Therefore, we aimed to \n\n\n\nexplore the views, barriers and facilitators of pharmacists \n\n\n\nregarding trastuzumab biosimilar in the treatment of HER2+ \n\n\n\nbreast cancer.3,4  Method: This qualitative study was \n\n\n\nconducted from March to September 2020 at the University \n\n\n\nMalaya Medical Centre. Pharmacists involved in the \n\n\n\nprocurement, dispensing, and reconstitution of trastuzumab \n\n\n\nwas recruited. In-depth interviews were conducted in either \n\n\n\nEnglish or Malay, using a semi-structured topic guide. \n\n\n\nInterviews were audio-recorded, transcribed verbatim and \n\n\n\nanalysed using a thematic approach. Result and Discussion: \n\n\n\nEight out of 14 pharmacists agreed to participate. They were \n\n\n\n31-59 years of age with 6-34 years of work experience. Three \n\n\n\nthemes emerged from our data analysis: 1) Affordability of \n\n\n\ntrastuzumab biosimilar. The introduction of trastuzumab \n\n\n\nbiosimilar reduced the price of the originator. This allowed \n\n\n\npatients and healthcare professionals to choose which \n\n\n\ntrastuzumab they preferred. Some pharmacists did not like \n\n\n\nthe idea of having both options available in the pharmacy as \n\n\n\nthis complicated trastuzumab\u2019s inventory. 2) Efficacy and \n\n\n\nsafety of trastuzumab biosimilar and its originator. Most \n\n\n\npharmacists believed that trastuzumab biosimilar and its \n\n\n\noriginator had no clinically meaningful difference. However, \n\n\n\nthey were not confident in assuring doctors and patients on \n\n\n\nthe efficacy and safety of trastuzumab biosimilar due to lack \n\n\n\nof training. 3) Who should decide if trastuzumab biosimilar \n\n\n\nor the originator should be used. Pharmacists believed that \n\n\n\nthe decision lies with the doctor or the patient as they were \n\n\n\nnot directly involved in the management of breast cancer. \n\n\n\nConclusion: The price war between trastuzumab biosimilar \n\n\n\nand its originator has provided the option for doctors and \n\n\n\n\nmailto:yywong@ummc.edu.my\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 7, Issue 1, Supplementary (2021), 49-77 \n\n\n\n72 \n \n\n\n\nResearch Presentation of National Pharmacy Convention 2021 \n\n\n\nDOI:  10.52494/UCML9733 \n \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\npatients to choose between the two. Pharmacists believed that \n\n\n\ntrastuzumab biosimilar has no clinically meaningful \n\n\n\ndifference from its originator. However, they were not \n\n\n\nconfident in recommending trastuzumab biosimilar due to \n\n\n\nlack of training. Ultimately, they believed that the decision \n\n\n\nshould be made by either the doctors or the patients. \n\n\n\n \nReference \n\n\n\n  \n[1] Jacobs, I., et al. (2017). \"Biosimilars for the Treatment of Cancer: A Systematic Review \n\n\n\nof Published Evidence.\" BioDrugs 31(1): 1-36. \n\n\n\n[2] European Medicines Agency (2019). \"Biosimilar medicines: Overview \". Retrieved \n\n\n\nOctober 9, 2019, from https://www.ema.europa.eu/en/human-\n\n\n\nregulatory/overview/biosimilar-medicines-overview \n\n\n\n[3] Giuliani, R., et al. (2019). \"Knowledge and use of biosimilars in oncology: a survey by \n\n\n\nthe European Society for Medical Oncology.\" ESMO Open 4(2): e000460. \n\n\n\n[4] Aladul, M. I., et al. (2018). \"Healthcare professionals\u2019 perceptions and perspectives on \n\n\n\nbiosimilar medicines and the barriers and facilitators to their prescribing in UK: a \n\n\n\nqualitative study.\" BMJ Open 8(11): e023603. \n\n\n\n\n\n\n\nAbstract 045 \n\n\n\n\n\n\n\nEvaluation of Patient\u2019s Knowledge \n\n\n\nand Perception Regarding Generic \n\n\n\nand Innovator Drugs and its \n\n\n\nAssociated Factors Among Patients in \n\n\n\nPublic Health Clinics in Rembau \n\n\n\nDistrict \n \nNor Hamizah Othman1, Nur Fatin Afiqah \n\n\n\nOthman1, Nurul Farhanis Mohd Nasir1, \n\n\n\nNurliyana Mahirah Sulaiman1, Zaza Hulwanee \n\n\n\nMohd Zainee2 \n\n\n\n \n1 Klinik Kesihatan Pedas, Pharmacy Department \n2 Pejabat Kesihatan Daerah Rembau \n \n\n\n\n*Correspondence: norhamizahothman@gmail.com \n\n\n\n\n\n\n\nIntroduction: Healthcare costs are on the rise. Generic drugs \n\n\n\nare a cheaper alternative to innovator drugs. Thus, it is vital \n\n\n\nfor the public to have adequate and precise knowledge \n\n\n\nregarding innovator and generic drugs. Objective: The \n\n\n\nobjectives of this study were to describe the level of \n\n\n\nknowledge and perception regarding generic and innovator \n\n\n\ndrugs among patients in health clinics in Rembau district and \n\n\n\nto determine the relationship between patient\u2019s \n\n\n\nsociodemographic factors (age, gender, educational level, \n\n\n\nand income) and their level of knowledge and level of \n\n\n\nperception about generic and innovator drugs. Method: This \n\n\n\ncross-sectional study involved 368 outpatients who collected \n\n\n\ntheir medications at health clinics under Health Division of \n\n\n\nRembau District from September 2020 to November 2020. \n\n\n\nResult and Discussion: The term generic and innovator \n\n\n\ndrugs were only recognized by 49.4% (n=182) of the \n\n\n\nrespondents. Despite this, only 21.74% (n= 80) of the \n\n\n\nrespondents have good knowledge about generic drugs. Most \n\n\n\nof the surveyed patients obtained information about generic \n\n\n\ndrugs mainly from health care provider (44.3%) and \n\n\n\nelectronic media (33.4%).  Age [\u03c72 (1, n=368) = 4.995, p \n\n\n\n= .025], educational level [\u03c72 (1, n=368) = 9.180, p = .002] \n\n\n\nand income level [\u03c72 (1, n=368) = 17.505, p = .0001] are \n\n\n\nfactors associated with level of knowledge. As for perception \n\n\n\ntowards generic drugs, 56.8% (n=209) of the respondents \n\n\n\nhave a positive perception. About 43.2% believed that \n\n\n\ngeneric drugs are equal in quality. Almost half of the \n\n\n\nrespondents, 53.8%, agreed that generic drugs are cheaper; \n\n\n\nnonetheless, only 18.5% believe that it can help in reducing \n\n\n\nmedication cost. Factors found to be associated with level of \n\n\n\nperception are age [\u03c72 (1, n=368) = 5.484, p = .019] and \n\n\n\nincome level [\u03c72 (1, n=368) = 7.842, p = .005].  Conclusion: \n\n\n\nBased on this study, the knowledge on generic drugs are still \n\n\n\nlacking among patients in Rembau district. Nevertheless, \n\n\n\nmost of the patients have positive perceptions of generic \n\n\n\ndrugs. Therefore, educational and promotional activities on \n\n\n\ngeneric drugs should be emphasized to improve patient\u2019s \n\n\n\nknowledge on generic drugs and maintain the positive \n\n\n\nperception among the patients. \n\n\n\n \nReference \n\n\n\n \n[1] Alian A Alrasheedy, M. A.-T. (2014). Patient knowledge, perceptions, and acceptance of \n\n\n\ngeneric medicines: A Comprehensive Review of the Current Literature. Dove Press \n\n\n\nJournal, 29. \n\n\n\n[2] Babar ZU1, S. J. (2010). An evaluation of consumers' knowledge, perceptions and \n\n\n\nattitudes regarding generic medicines in Auckland. PubMed. \n\n\n\n[3] Hale Z., et al. Knowledge and attitudes of the pharmacists, prescribers and patients \n\n\n\ntowards generic drug use in Istanbul-Turkey. Pharmacy Practice (Granada) Journal. 2012 \n\n\n\nDecember 31. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3780497/ \n\n\n\n\n\n\n\nAbstract 046 \n\n\n\n\n\n\n\nMilitary Pharmacists\u2018 Roles in \n\n\n\nMedical Logistics & Supply Chain \n\n\n\nDuring COVID-19 Pandemic \n \nAmbok Delek NHN1, Basari AH2, Adnan MA.1, \n\n\n\nAbd Rahim NH1, Md Bohari MN1, Maseradi \n\n\n\nMER1 \n\n\n\n \n1 93 Depot Perubatan dan Pergigian Angkatan Tentera, Ministry of \n\n\n\nDefence, Malaysia \n2 Malaysian Armed Forces Health Services Division, Ministry of Defence, \nMalaysia \n\n\n\n\n\n\n\n*Correspondence: nur.nadzirah11@yahoo.com \n \n\n\n\nIntroduction: Coronavirus disease 2019 (COVID-19) \n\n\n\noutbreak has immensely impacted healthcare management \n\n\n\nglobally. Malaysia, in particular the Malaysian Armed Forces \n\n\n\n(MAF), has experienced shortage of vital medical supplies as \n\n\n\nmost of the pharmaceutical items, active pharmaceutical \n\n\n\ningredients, raw material for medical devices and medical \n\n\n\ndevices were heavily imported from other countries. In the \n\n\n\nMAF, military pharmacists play crucial roles in managing \n\n\n\n\nhttps://www.ema.europa.eu/en/human-regulatory/overview/biosimilar-medicines-overview\n\n\nhttps://www.ema.europa.eu/en/human-regulatory/overview/biosimilar-medicines-overview\n\n\nhttps://www.ema.europa.eu/en/human-regulatory/overview/biosimilar-medicines-overview\n\n\nmailto:norhamizahothman@gmail.com\n\n\nhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3780497/\n\n\nmailto:nur.nadzirah11@yahoo.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 7, Issue 1, Supplementary (2021), 49-77 \n\n\n\n73 \n \n\n\n\nResearch Presentation of National Pharmacy Convention 2021 \n\n\n\nDOI:  10.52494/UCML9733 \n \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nmedical logistics and supply chain. The pandemic has \n\n\n\nimplicated the ability of military pharmacists to provide \n\n\n\nstable and steadfast medical logistics support for the troops \n\n\n\nto combat the COVID-19 outbreak and to execute routine \n\n\n\noperational activities. Objective: To study the impacts of \n\n\n\nCOVID-19 pandemic on military pharmacists\u2019 roles during \n\n\n\nCOVID-19 pandemic. Result & Discussion: (1) \n\n\n\nDeployment need to Tawau Field Hospital which consists of \n\n\n\n100 beds (15 Oct 20 until 6th Jan 2021) as military pharmacist \n\n\n\nand also medical logistics officer to support Ministry of \n\n\n\nHealth, Tawau Hospital and treating non-COVID-19 patients \n\n\n\nparticularly medicine, general surgery, obstetrics and \n\n\n\ngynaecology, orthopaedic and paediatric services. \n\n\n\nResponsibility of military pharmacists was not limited to \n\n\n\ncontinuity of pharmacy services but also ensuring availability \n\n\n\nof medical assets and many other medical equipment \n\n\n\nthroughout the operation. (2) Agility needs to support PPEs \n\n\n\ndistribution for Operasi Penawar nationwide. Operasi \n\n\n\nPenawar is an operation by the MAF together with the Royal \n\n\n\nMalaysian Police during Movement Control Order (MCO). It \n\n\n\nwas started on 18th March until 3rd May 2020 for MCO 1.0. \n\n\n\nMilitary pharmacists\u2019 good networking skills had ensured \n\n\n\nsufficient and timely deliveries of PPEs nationwide including \n\n\n\nto East Malaysia within 5 hours after receiving the initial \n\n\n\ninstruction until the end of operation. (3) Increased need to \n\n\n\ncoordinate the distribution of PPEs, medicines and vaccines \n\n\n\nto ensure stock readiness at all MAF health facilities \n\n\n\nnationwide. There are 60% increment of logistics \n\n\n\ncommunication frequencies using the Royal Malaysia Air \n\n\n\nForces (RMAF) A400M and C-130 aircrafts to support East \n\n\n\nMalaysia. (4) Military pharmacists managed to increase 60% \n\n\n\nof PPE stocks sustainability rate in the MAF from 36.9% to \n\n\n\n96.4% in one month. Despite having difficulties to secure \n\n\n\nstocks during pandemic, Military pharmacists were able to \n\n\n\nmaintain PPE stocks sustainability rate above 90% from \n\n\n\nApril 2020 onwards. This was achieved by rigorous effort of \n\n\n\ndoing supplier mapping, identifying source of materials and \n\n\n\nshifting to other alternatives. Maintaining smart partnership \n\n\n\nalso contributed to the success of ensuring 100% PPE stocks \n\n\n\nsustainability. Conclusion: COVID-19 pandemic has really \n\n\n\nimpacted the conventional roles and tasks of military \n\n\n\npharmacists in the MAF. Despite ordinary roles and tasks, \n\n\n\nmilitary pharmacists must be agile and able to execute extra \n\n\n\ntasks without failed by practicing good networking skills \n\n\n\nwith other stakeholders and good management skills to \n\n\n\nprovide stable and steadfast medical logistics support for the \n\n\n\ntroops to combat the COVID-19 outbreak as well as to \n\n\n\nexecute routine operational activities. \n\n\n\n \nReference \n\n\n\n \n[1] Sharma et al. (2020) COVID-19: Impact on Health Supply Chain and Lessons to Be \n\n\n\nLearnt. Journal of Health Management 22(2) 248\u2013261. \n\n\n\n[2] Cohen, J. et al. (2020) Contributing factors to personal protective equipment shortages \n\n\n\nduring the COVID-19 pandemic. Preventive Medicine 141 :1-7. \n\n\n\n[3] Miller, FA et al. (2020) Vulnerability of the medical product supply chain-the wake up \n\n\n\ncall of Covid-19. BMJ Quality & Safety ; 30: 331\u2013335. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nAbstract 047  \n\n\n\n\n\n\n\nMetabolomics of Metformin in Urine \n\n\n\nSamples of Healthy Volunteers \n \nTee Khim Boon1,2, Luqman Ibrahim3, Najihah \n\n\n\nMohd Hashim4,5, Mohd Zuwairi Saiman6, Zaril \n\n\n\nHarza Zakaria2, Kasful Asra Sakika5,7, Syaza \n\n\n\nFatnin Hisham1,3, Azwa Mansor3, Hasniza \n\n\n\nZaman Huri1,8* \n\n\n\n \n1 Department of Clinical Pharmacy and Pharmacy Practice, Faculty of \nPharmacy, Universiti Malaya, Kuala Lumpur, Malaysia \n2 Ministry of Health Malaysia, Kuala Lumpur, Malaysia \n3 Department of Medicine, Faculty of Medicines, Universiti Malaya, Kuala \nLumpur, Malaysia  \n4 Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Universiti \n\n\n\nMalaya, Kuala Lumpur, Malaysia \n5 Centre for Natural Products Research and Drug Discovery Universiti \n\n\n\nMalaya, Kuala Lumpur, Malaysia \n6 Institute of Biological Science, Faculty of Science, Universiti Malaya, \n\n\n\nKuala Lumpur, Malaysia, \n7 Institute for Advanced Studies, Universiti Malaya, Kuala Lumpur, \nMalaysia, \n8 Clinical Investigation Centre, Universiti Malaya Medical Centre \n\n\n\n \n*Correspondence: kbtee81@yahoo.com \n\n\n\n\n\n\n\nIntroduction: Metformin is a first-line anti-diabetic agent \n\n\n\nthat has been widely used for treatment of type 2 diabetes \n\n\n\nmellitus (T2DM). The drug is responsible for increasing the \n\n\n\nglucose uptake in the liver and skeletal muscles, and \n\n\n\nsuppressing gluconeogenesis in the liver and interstitial \n\n\n\nglucose absorption. Non-targeted metabolomics is a \n\n\n\ncomprehensive investigation to identify the pharmacological \n\n\n\neffects and adverse effects of a medicine (1). Objective: The \n\n\n\nobjective of this study is to identify the metabolic pathways \n\n\n\nof metformin in urine samples of healthy subjects. Method: \n\n\n\nThe study is registered with ClinicalTrials.gov, approved by \n\n\n\nethics committee and performed in accordance to Malaysian \n\n\n\nGood Clinical Practice (2). Subjects who underwent at least \n\n\n\n10 hours fasting were given single doses of metformin \n\n\n\n1000mg tablet. Urine samples for six subjects at pre-dose and \n\n\n\nevery 4 hours post dose until 12 hours after oral \n\n\n\nadministration were analyzed using Liquid Chromatography \n\n\n\nMass Spectrometry Quadrupole Time-of-flight (LCMS-\n\n\n\nQTOF) with reverse phase column. Modified METLIN \n\n\n\nmethod (3) was used in the instrumental setting for global \n\n\n\nmetabolomic analysis in positive and negative modes. Pooled \n\n\n\nquality control samples and internal standards were spiked \n\n\n\ninto the samples to control the analysis and batch-to-batch \n\n\n\nconsistency. The chromatograms were further processed \n\n\n\nusing MetaboAnalyst software (4). Multivariate analysis and \n\n\n\nparametric statistical analysis were performed to identify \n\n\n\ncompounds. The compounds were paired with the Kyoto \n\n\n\n\nmailto:kbtee81@yahoo.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 7, Issue 1, Supplementary (2021), 49-77 \n\n\n\n74 \n \n\n\n\nResearch Presentation of National Pharmacy Convention 2021 \n\n\n\nDOI:  10.52494/UCML9733 \n \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nEncyclopedia of Genes and Genomes (KEGG) to predict the \n\n\n\nbiological perturbation involved after metformin absorption.   \n\n\n\nResult and discussion: From the untargeted metabolomic \n\n\n\nanalysis, metformin was found in all the post-dose urine \n\n\n\nsamples but not available in any pre-dose sample. Metformin \n\n\n\nwas absorbed and excreted through urine in healthy subjects. \n\n\n\nFigure 1 demonstrates the metabolic pathways for pre-dose \n\n\n\nversus 4-hour post-dose. In the 4-hour and 8-hour post-dose \n\n\n\nurine samples, urea cycle or amino group metabolism and \n\n\n\nglycine, serine, alanine and threonine metabolism are having \n\n\n\nsignificant biological perturbation in the control \n\n\n\nenvironment. Similar metabolic pathways were observed by \n\n\n\nstudy on T2DM subjects (5). Conclusion: Untargeted \n\n\n\nmetabolomic analysis in urine samples using LCMS-QTOF \n\n\n\nis able to identify biological perturbation of metformin. This \n\n\n\nemerging approach sheds light on the pharmacological \n\n\n\neffects of the drug during phase one clinical trials. \n\n\n\n  \nReference \n\n\n\n \n[1] Burt T, Nandal S. Pharmacometabolomics in Early\u2010Phase Clinical Development. Clinical \n\n\n\nand Translational Science. 2016;9(3):128-38. \n\n\n\n[2] NCCR. Malaysian Guideline for Good Clinical Practice. 4th ed2018. \n\n\n\n[3] Technologies A. MassHunter METLIN metabolite PCD/PCDL quick start guide USA: \n\n\n\nAgilent Technologies; 2014 [Available from: \n\n\n\nhttps://www.agilent.com/cs/library/usermanuals/Public/G6825-\n\n\n\n90008_MetlinPCDL_QuickStart.pdf. \n\n\n\n[4] Chong J, Wishart DS, Xia J. Using MetaboAnalyst 4.0 for Comprehensive and Integrative \n\n\n\nMetabolomics Data Analysis. Curr Protoc Bioinformatics. 2019;68(1):e86. \n\n\n\n[5] Aleidi SM, Dahabiyeh LA, Gu X, Al Dubayee M, Alshahrani A, Benabdelkamel H, et al. \n\n\n\nObesity Connected Metabolic Changes in Type 2 Diabetic Patients Treated With \n\n\n\nMetformin. Frontiers in pharmacology. 2021;11:616157-. \n\n\n\n\n\n\n\nAbstract 049 \n\n\n\n\n\n\n\nTransforming Pharmacy Education \n\n\n\nvia a Gamified Flipped Classroom \n\n\n\nApproach \n \nFaiza Naimat1,2, Siti Nur Adilah Mohd Yusdi1, \n\n\n\nMathumalar Loganathan Fahrni1,3* \n\n\n\n \n1 Faculty of Pharmacy, Universiti Teknologi MARA Selangor Branch, \n\n\n\nPuncak Alam Campus, 42300, Selangor Malaysia \n2 Management and Science University (MSU), Off Persiaran Olahraga, \n\n\n\nSelangor, Malaysia \n3 Collaborative Drug Discovery Research (CDDR) Group, Communities of \nResearch (Pharmaceutical and Life Sciences), Universiti Teknologi MARA \n\n\n\n(UiTM), Selangor Darul Ehsan, Malaysia  \n\n\n\n \n*Correspondence: drmalar@uitm.edu.my \n\n\n\n\n\n\n\nIntroduction: Pharmacy education in the 21st century has \n\n\n\nfast-transformed from the traditional classroom to flipped \n\n\n\nclassroom lessons where instructional videos are viewed \n\n\n\nprior and scheduled lessons have instead become  avenues for \n\n\n\nworking through problems. In collaborative learning, \n\n\n\nengagement is key. Methods: Using an open-source \n\n\n\napplication, QuizWhizzer,  two academic pharmacists \n\n\n\ntogether with an undergraduate developed an online, \n\n\n\ninteractive teaching and learning mode for \n\n\n\npharmacotherapeutics \u2013 a subject often considered \u2018dry\u2019 by \n\n\n\nstudents. Two or more players could engage in a competitive \n\n\n\ngame, where their goal is to answer as accurately as possible \n\n\n\nthe questions on cancer-associated thrombosis (CAT). \n\n\n\nQuestions were designed in sets of 10 seconds, with varying \n\n\n\ndegrees of difficulty: from easy, medium to difficult. The two \n\n\n\nacademic pharmacists reviewed and rated the reliability of \n\n\n\nquestions.  Pilot testing of undergraduates\u2019 perception was \n\n\n\ndone. A 4-item questionnaire, with a 5-point Likert scoring, \n\n\n\nwas distributed to 30 students who attempted QuizWhizzer. \n\n\n\nThese students had completed the course \u201cNeoplastic \n\n\n\ndisorders\u201d. Areas assessed were: engagement, evaluation of \n\n\n\nintellectual skills, problem-solving skills and motivation. A \n\n\n\nbivariate correlation was performed to evaluate the \n\n\n\ncorrelation between game scores and student perception. \n\n\n\nResults and discussion: The game is web-based and \n\n\n\ncompatible on all gadgets and operating systems. It used two \n\n\n\nconcepts of engagement: quiz and utilising a board game. \n\n\n\nScore keeping via a leaderboard meant that students \n\n\n\neffectively compete and positively challenge one another. \n\n\n\nWith every accurate answer, the student gets a turn to roll a \n\n\n\nvirtual dice, which will determine how far \u201cup the ladder\u201d he \n\n\n\nor she will proceed. Upon completion of each level, the \n\n\n\nplayer is to advance to a more complex level of difficulty \n\n\n\nthroughout the game. The player who reaches the top first, is \n\n\n\nawarded as the winner. It took the 30 students an average of \n\n\n\napproximately 30 minutes per pair to complete the game. The \n\n\n\naccompanying questionnaire was filled in within an average \n\n\n\n \nFigure I. Metabolic Pathways using Mummichog Enrichment Analysis \n\n\n\nfor pre-dose versus 4 hours post-dose urine samples. \n\n\n\n \n\n\n\n\nhttps://www.agilent.com/cs/library/usermanuals/Public/G6825-90008_MetlinPCDL_QuickStart.pdf\n\n\nhttps://www.agilent.com/cs/library/usermanuals/Public/G6825-90008_MetlinPCDL_QuickStart.pdf\n\n\nhttps://www.agilent.com/cs/library/usermanuals/Public/G6825-90008_MetlinPCDL_QuickStart.pdf\n\n\nhttps://www.agilent.com/cs/library/usermanuals/Public/G6825-90008_MetlinPCDL_QuickStart.pdf\n\n\nmailto:drmalar@uitm.edu.my\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 7, Issue 1, Supplementary (2021), 49-77 \n\n\n\n75 \n \n\n\n\nResearch Presentation of National Pharmacy Convention 2021 \n\n\n\nDOI:  10.52494/UCML9733 \n \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nof  2 minutes. From the student\u2019s feedback, the average \n\n\n\nscore  obtained was 20 out of 30 marks (70%, + 2.4). Students \n\n\n\n(100%) perceived the game as exciting and fun \n\n\n\n(engagement). Students (100%) rated the game as positive in \n\n\n\nhelping them solve problems. While a majority (86.7%) felt \n\n\n\nthat the game was challenging, promoted healthy competition \n\n\n\namong themselves to remain motivated, 4 students were not \n\n\n\nsatisfied with the feedback available in the game as it did not \n\n\n\nassist with enhancing their intellectual skills. Game scores \n\n\n\nand perception levels were found to be moderately positively \n\n\n\ncorrelated, r =0 .34, p = 0.032. The game can be rolled out to \n\n\n\nundergraduate students enrolled into a course on neoplastic \n\n\n\ndisorders in order to assess the effectiveness of the novel \n\n\n\nteaching and learning or assessment method. Conclusion: \n\n\n\nPreliminary evaluation of students\u2019  perceptions regarding \n\n\n\nQuizWhizzer, showed positive ratings in the aspects of \n\n\n\nengagement, assessing intellectual skills, problem-solving \n\n\n\nability, academic performance and motivation. Future \n\n\n\ndirections to include perceptions of educators to assess \n\n\n\nstudent knowledge and memory retention of the lessons \n\n\n\ndelivered via the flipped classroom approach are plausible. \n\n\n\n \nReference \n\n\n\n \n[1] Bakhuys Roozeboom M, Visschedijk G, Oprins E. The effectiveness of three serious \n\n\n\ngames measuring generic learning features. Br J Educ Technol [Internet]. 2017 Jan 1 [cited \n\n\n\n2020 Jun 24];48(1):83\u2013100. Available from: http://doi.wiley.com/10.1111/bjet.12342 \n\n\n\n[2] Liu EZF, Chen P-K. The Effect of Game-Based Learning on Students\u2019 Learning \n\n\n\nPerformance in Science Learning \u2013 A Case of \u201cConveyance Go.\u201d Procedia - Soc Behav \n\n\n\nSci. 2013 Nov;103:1044\u201351.    \n\n\n\n[3] Linehan C, Ben K, Lawson S, Chan GG. Practical, appropriate, empirically-validated \n\n\n\nguidelines for designing educational games. In: Conference on Human Factors in \n\n\n\nComputing Systems - Proceedings. 2011. p. 1979\u201388.  \n\n\n\n\n\n\n\n\n\n\n\nAbstract 050 \n\n\n\n\n\n\n\nEvaluation of Degradation Kinetics of \n\n\n\nFlibanserin Bulk Drug under \n\n\n\nOxidative Stresses \n \nKhor Mei Ann1, Liew Kai Bin2, Chew Yik \n\n\n\nLing1* \n\n\n\n \n1 Faculty of Pharmaceutical Sciences, UCSI University, 56000 Cheras, \n\n\n\nKuala Lumpur, Malaysia. \n2 Faculty of Pharmacy, Cyberjaya University College of Medical Sciences, \n63000 Cyberjaya, Selangor, Malaysia. \n\n\n\n\n\n\n\n*Correspondence: meiann980711@gmail.com \n \n\n\n\nIntroduction: Flibanserin was approved by the United State \n\n\n\nFood and Drug Administration (USFDA) as the first drug for \n\n\n\nthe treatment of hypoactive sexual desire disorder (HSDD). \n\n\n\nIt is also prescribed as a treatment for mental disorders such \n\n\n\nas Schizophrenia, depression, anxiety as well as Parkinson\u2019s \n\n\n\ndisease. Drug stability studies play an essential role in \n\n\n\npharmaceutical products to ensure its quality, safety and \n\n\n\nefficacy. Determination of degradation kinetics is extremely \n\n\n\ncrucial as it can be used to determine the half-life and shelf \n\n\n\nlife of the drugs under specific storage conditions. Objective: \n\n\n\nThe objectives of this study are to evaluate the degradation \n\n\n\nkinetics and to determine the half-life and shelf life of \n\n\n\nflibanserin bulk drug under oxidative stresses. Method: The \n\n\n\nstudy was conducted using oxidative stress on flibanserin. \n\n\n\nThe oxidising agents used were hydrogen peroxide (H2O2) \n\n\n\nand radical initiator, azobisisobutyronitrile (AIBN) at room \n\n\n\ntemperature and at 50\u00b0C, respectively. The analysis was \n\n\n\nperformed using High Performance Liquid Chromatography \n\n\n\n(HPLC) equipped with a Phenomenex C-18 column. The \n\n\n\nmobile phase used was acetonitrile:ammonium acetate buffer \n\n\n\n(60:40 ratio). The flow rate was set at 0.5 ml/min. The \n\n\n\ninjection volume was 10 \u00b5L. The detection wavelength used \n\n\n\nwas 250 nm. The time for each analysis was 20 minutes. \n\n\n\nResult and Discussion: Degradation of 62.45 % had been \n\n\n\nobserved after 8 hours treatment under H2O2 oxidation. A by-\n\n\n\nproduct was detected in the HPLC analysis. The degradation \n\n\n\nkinetics of flibanserin under H2O2 oxidation followed the \n\n\n\nfirst order kinetics. The half-life determined was 5.527 hours \n\n\n\nwhile the shelf life (t90% and t95%) was 0.837 hours and 0.409 \n\n\n\nhours, respectively. Free radical degradation of flibanserin \n\n\n\nwas observed to be 82.97 % following the first order kinetics. \n\n\n\nFour unknown by-products were detected. The half-life \n\n\n\nobtained was 2 days while the shelf life (t90% and t95%) \n\n\n\nobtained was 7.848 hours and 3.840 hours, respectively at \n\n\n\n50\u00b0C. Conclusion: Flibanserin was sensitive to H2O2 \n\n\n\noxidation and radical degradation. Both oxidation \n\n\n\ndegradation follows first order reaction. \n\n\n\n \nReference \n\n\n\n \n[1] Ferger B, Shimasaki M, Ceci A, Ittrich C, Allers KA, Sommer B. Flibanserin, a drug \n\n\n\nintended for treatment of hypoactive sexual desire disorder in pre-menopausal women, \n\n\n\naffects spontaneous motor activity and brain neurochemistry in female rats. Naunyn-\n\n\n\nSchmiedeberg's archives of pharmacology. 2010;381(6):573-9. \n\n\n\n[2] Brotto LA. The DSM diagnostic criteria for hypoactive sexual desire disorder in women. \n\n\n\nArchives of sexual behavior. 2010;39(2):221-39.Academy of Managed Care Pharmacy. \n\n\n\n2009. Drug Utilization Review. (online). \n\n\n\nhttp://www.amcp.org/WorkArea/DownloadAsset.aspx?id=9296 (last accessed 17th \n\n\n\nDecember 2017). \n\n\n\n[3] Lee HK. Forced Degradation Studies and Development of a Stability Indicating Method \n\n\n\nof Flibanserin Active Pharmaceutical Ingredient [Research Thesis]: UCSI University \n\n\n\n \n\n\n\n\nmailto:meiann980711@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 7, Issue 1, Supplementary (2021), 49-77 \n\n\n\n76 \n \n\n\n\nResearch Presentation of National Pharmacy Convention 2021 \n\n\n\nDOI:  10.52494/UCML9733 \n \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 051 \n\n\n\n\n\n\n\nEvaluation of a Local Protocol of \n\n\n\nVancomycin-Therapy in \n\n\n\nHaemodialysis Patients Based on \n\n\n\nTargeted Trough Level and \n\n\n\nExtrapolated Area Under the Curve in \n\n\n\na General Hospital  \n \nVithyah Nadaraja1*, Fazlollah Keshavarzi1, \n\n\n\nMuhammad Junaid Farrukh1, Yap Chuan \n\n\n\nSheng1, Aliza binti Alias2 \n\n\n\n \n1 Faculty of Pharmaceutical Sciences, University College Sedaya \n\n\n\nInternational (UCSI),56000 Kuala Lumpur, Malaysia \n2 Clinical Pharmacokinetic Department, Pharmacy Division, Hospital \nTengku Ampuan Rahimah Klang \n\n\n\n\n\n\n\n*Correspondence: vithyahn@gmail.com \n \n\n\n\nIntroduction: Recent published data from the 2020 IDSA \n\n\n\nguidelines on vancomycin dosing has no longer advocated \n\n\n\nthe use of trough concentrations as surrogate markers for \n\n\n\nclinical efficacy.  Protocols developed before the revised \n\n\n\ntargets may not reflect the true efficacy marker for \n\n\n\nvancomycin, which is AUC 400-600. Vancomycin exposure \n\n\n\nin haemodialysis patients is influenced by both patient \n\n\n\npharmacokinetic parameters and variables of the \n\n\n\nhaemodialysis units which reduces the likelihood of target \n\n\n\nattainment. Objective: To evaluate the clinical efficacy of \n\n\n\nlocal vancomycin dosing protocol in achieving target trough \n\n\n\nconcentration and area under the curve (AUC) among \n\n\n\nhaemodialysis patients in Hospital Tengku Ampuan Rahimah \n\n\n\n(HTAR). Method: Retrospective record review of eligible \n\n\n\nresearch participants according to previously validated data \n\n\n\ncollection form. The AUC of each individual was \n\n\n\nextrapolated via the use of a PK modelling software, \n\n\n\nPrecisePK. Chi-square test of independence was used to \n\n\n\ndetermine the association between trough concentrations to \n\n\n\nextrapolated AUC/MIC (minimum inhibitory concentration). \n\n\n\nA p-value of 0.05 was considered statistically significant. \n\n\n\nResult and Discussion: Eighty HD patients were included \n\n\n\nafter the screening, involving cases between December 2019 \n\n\n\nand January 2021. 62.5% of haemodialysis study patients \n\n\n\nshow AUC/MIC >800 (mean \u00b1 SD=2320.2 \u00b1 1418.2). The \n\n\n\ntrough concentrations across all four groups of AUC/MIC \n\n\n\n(<400; 400-600;600-800;>800) remain similar in \n\n\n\ndistribution. Chi square analysis between trough \n\n\n\nconcentrations and extrapolated AUC/MIC showed a lack of \n\n\n\nassociation (X2(6) = 11.370, p =0.51). AUC/MIC was heavily \n\n\n\ninfluenced by MIC of the infecting microorganism, (X2(12) \n\n\n\n= 164.93, p =0.00). Majority of MRSA cases were found in \n\n\n\nthe AUC/MIC> 800 with MIC values of 0.38\u03bcg/ml. \n\n\n\nConclusion: Exclusive trough guided dosing may not \n\n\n\ntranslate well in achieving the clinical efficacy of \n\n\n\nvancomycin in haemodialysis patients. Other contributing \n\n\n\nfactors such as MIC should be factored, as small MIC values \n\n\n\naccount for greater reciprocal AUC/MIC values. \n\n\n\nAUC/MIC > 800 in haemodialysis patients risks the loss of \n\n\n\nresidual kidney function. Preserving residual kidney function \n\n\n\nof HD patients serves as an important prognostic factor for \n\n\n\nreduced mortality in this patient population. \n\n\n\n \nReference \n\n\n\n \n[1] Rybak MJ, Le J, Lodise TP, Levine DP, Bradley JS, Liu C, et al. Therapeutic monitoring \n\n\n\nof vancomycin for serious methicillin-resistant Staphylococcus aureus infections: A \n\n\n\nrevised consensus guideline and review by the American Society of Health-System \n\n\n\nPharmacists, the Infectious Diseases Society of America, the Pediatric Infectious Diseases \n\n\n\nSociety, and the Society of Infectious Diseases Pharmacists. American Journal of Health-\n\n\n\nSystem Pharmacy. 2020.                                                                                                                  \n\n\n\n\n\n\n\nAbstract 052 \n\n\n\n\n\n\n\nKnowledge, Attitude & Practice of \n\n\n\nAlcohol Use among University \n\n\n\nStudents: A Cross-sectional Study \n \nIrene Lee Chin Ling*, Hee Mei Qi, \n\n\n\nMuhammad Junaid Farrukh \n \nFaculty of Pharmaceutical Sciences, UCSI University, 56000 Cheras, \n\n\n\nKuala Lumpur, Malaysia. \n\n\n\n \nCorrespondence: leechinlingirene@gmail.com \n\n\n\n\n\n\n\nIntroduction: Alcohol consumption is frequently reported \n\n\n\namong university students in many countries.  It is a social \n\n\n\nissue that should not be overlooked as they are the pillars of \n\n\n\nthe country\u2019s future. Objective: To study the knowledge, \n\n\n\nattitude, and practice of alcohol use among university \n\n\n\nstudents and to associate demographic variables with alcohol \n\n\n\nuse among university students in Kuala Lumpur. Method: A \n\n\n\ncross-sectional study was conducted and participants aged 18 \n\n\n\nto 30 years old were recruited using the convenience \n\n\n\nsampling method at UCSI University, Kuala Lumpur. The \n\n\n\nquestionnaire was validated by a panel of experts and a pilot \n\n\n\ntest was done among 37 university students to ensure the \n\n\n\nreliability. Data were collected between August and \n\n\n\nSeptember 2020 and analyzed by SPSS version 20. Result \n\n\n\nand Discussion: A total of 374 participants completed the \n\n\n\nsurvey. The findings showed that 54% of participants had \n\n\n\ngood knowledge of alcohol use while 46% of them had poor \n\n\n\nknowledge of alcohol use. About 54.3% of participants had a \n\n\n\npositive attitude towards alcohol use, while 45.7% of them \n\n\n\nhad negative attitude towards alcohol use. A total of 69% of \n\n\n\nparticipants started their first drink < 21 years old. Friends \n\n\n\ninfluenced alcohol use the most, followed by parents, \n\n\n\nsiblings, or relatives, and curiosity. Approximately 72% of  \n\n\n\nparticipants rarely consume alcohol. Also, 58.3% of the \n\n\n\nparticipants received a low level of harm from alcohol use \n\n\n\n\nmailto:vithyahn@gmail.com\n\n\nmailto:leechinlingirene@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 7, Issue 1, Supplementary (2021), 49-77 \n\n\n\n77 \n \n\n\n\nResearch Presentation of National Pharmacy Convention 2021 \n\n\n\nDOI:  10.52494/UCML9733 \n \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nwhile 22.7% of them received a high level of harm from \n\n\n\nalcohol use. The level of harm experienced was significantly \n\n\n\nassociated with gender, religion, course studied, and \n\n\n\nperceived parents\u2019 socioeconomic status with p-values \n\n\n\nshowed <0.05. Conclusion: Majority of the university \n\n\n\nstudents had good knowledge of basic alcohol information \n\n\n\nbut they had inadequate knowledge of standard drinking, \n\n\n\nbinge drinking, and heavy episodic drinking terms. More \n\n\n\nthan half of them had positive attitudes toward alcohol use \n\n\n\nand the majority of university students tend to experience a \n\n\n\nlow level of harm from alcohol use. Even though most of the \n\n\n\nuniversity students in the study rarely consume alcohol, \n\n\n\ninterventions to reduce alcohol consumption among \n\n\n\nuniversity students should not be disregarded. \n\n\n\n \nReference \n\n\n\n \n[1] Harmful use of alcohol [Internet]. WHO. [cited 2020 Jun 23]. Available from: \n\n\n\nhttp://www.emro.who.int/noncommunicable-diseases/causes/harmful-use-of-\n\n\n\nalcohol.html \n\n\n\n[2] National Health and Morbidity Survey 2019 [Internet]. The Malaysian Paediatric \n\n\n\nAssociation. 2019 [cited 2020 Nov 14]. Available from: https://mpaeds.my/national-\n\n\n\nhealth-and-morbidity-survey-2019/ \n\n\n\n[3] Alcohol Facts and Statistics [Internet]. National Institute on Alcohol Abuse and \n\n\n\nAlcoholism (NIAAA). [cited 2020 Nov 14]. Available from: \n\n\n\nhttps://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/alcohol-facts-and-\n\n\n\nstatistics \n\n\n\n[4] Mutalip MHBA, Naidu BBM, Kamaruddin RB, Hamid HABA, Ali NB, Ahmad NAB, et \n\n\n\nal. How Severe is Binge Drinking in Malaysia and Who are at Risk? J Alcohol Drug \n\n\n\nDepend. 2013;1(6).  \n\n\n\n[5] Mutalip MHBA, Kamarudin RB, Manickam M, Abd Hamid HAB, Saari RB. Alcohol \n\n\n\nconsumption and risky drinking patterns in Malaysia: Findings from NHMS 2011. \n\n\n\nAlcohol Alcohol. 2014;49(5):593\u2013599. \n\n\n\n \n\n\n\n\nhttp://www.emro.who.int/noncommunicable-diseases/causes/harmful-use-of-alcohol.html\n\n\nhttp://www.emro.who.int/noncommunicable-diseases/causes/harmful-use-of-alcohol.html\n\n\nhttps://mpaeds.my/national-health-and-morbidity-survey-2019/\n\n\nhttps://mpaeds.my/national-health-and-morbidity-survey-2019/\n\n\nhttps://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/alcohol-facts-and-statistics\n\n\nhttps://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/alcohol-facts-and-statistics\n\n\n\n"
"\n\nMalaysian Journal of Pharmacy 2003 1(3):59-62  Series \n\n\n\n 59\n\n\n\nMedication Safety Issues - 1 \n \nDavid Kong Chee Ming \n \n\n\n\nPharmacy Department, The Alfred Hospital, Commercial Road, Prahran, Victoria, Australia 3181 \nand Department of Pharmacy Practice, Victorian College of Pharmacy, Monash University, 381 \nRoyal Parade, Parkville, Victoria, Australia 3052. \n \n \nABSTRACT \n \nPreventing medical or medication errors is pivotal in quality patient care and safety. \nSignificantly, error prevention activities are multifactorial. These include, (i) \nenlisting staff creativity in improving safe practices, (ii) patient education, (iii) \nprovision of information leaflet, (iv) clarity in instructions, (v) application of failure \nmode and effects analysis, and (vi) care in approving access to medications. \n \nKeywords: medication safety, errors, patients care, prevention, safe practice \n \n \nINTRODUCTION \n \nMedication and medical errors are serious \nproblems throughout the world. It has been \nestimated that between 44,000 and 98,000 \nAmericans die each year as a consequence of \nmedical errors, with the annual financial cost \nestimated at approximately US$40 billion (1-3). \nIn Australia, the direct cost to the acute care \nsystem due to medication errors have been \nestimated to be between AUD$867 million to \nover AUD$1 billion annually (4,5). Importantly, a \nlarge proportion of medical errors or adverse drug \nevents are preventable errors (1-3, 6-9). \n \nAccordingly, the purpose of this series of articles \nis to increase the awareness of health \nprofessionals in Malaysia on preventable \nmedication or medical errors. The issues \nhighlighted in this article are drawn primarily \nfrom ISMP Medication Safety Alert!, and are used \nwith permission from the Institute for Safe \nMedication Practices, Pennsylvania, USA \n(www.ismp.org). It is our hope that this \ncontribution will result in safe medication or \nmedical practices and improved patient care.  \n \nSystems thinking; Tap into staff creativity to \nunleash innovation (10). \n \nA letter to the editor was published in the New \nEngland Journal of Medicine from a physician  \n\n\n\n \n \nwho suggested using metal detectors to prevent \nthe risk of injuries from metal objects during \nmagnetic resonance imaging (MRI) (11). \nUnfortunately, his suggestion was spurred by the \nrecent tragic death of a six-year-old child in New \nYork who suffered a skull fracture and \nintracranial haemorrhage after an oxygen tank \nwas pulled by the magnet into the machine at high \nspeed.  \n \nAs noted by the author, injuries from undetected \nor misplaced metal objects (e.g. IV drug poles, \nsandbags containing metal filings, defibrillators, \nwheelchairs, etc.) brought into MRI exam rooms \nare not uncommon. Yet, staff training and patient \nquestionnaires to detect metal implants remain the \nmost common methods used to prevent such \nincidents.  \n \nIn fact, education has been healthcare\u2019s bread and \nbutter for preventing errors and injuries. And \nwhile education may prevent some errors, its \nsuccess is limited because it relies heavily upon \nhuman memory and vigilance. More to the point, \neducation alone fails to change the system in a \nway that would make it impossible for people to \nmake mistakes.  \n \nMore effective solutions require systems thinking. \nThe suggestion to use highly sensitive \n\n\n\n\n\n\n\n\nSeries: Medication safety issues \n\n\n\n 60\n\n\n\nwalkthrough metal detectors (which are available \ncommercially for about US$2,000-$5,500 and \nrequire minimal maintenance) to prevent \naccidental introduction of a metal object into a \nMRI exam room is an excellent example of \nsystems thinking. This coupled with staff \neducation and patient screening has a high \nlikelihood of preventing injuries. But how did the \nphysician come up with such a powerful \nsuggestion? In retrospect, it seems so obvious. \nYet systems thinking is not as easy as it seems.  \n \nOur history of errors with potassium chloride \nconcentrate for injection in patient care units \ndemonstrates this very well. Until systems \nthinking prevailed, many organizations relied \nupon staff education and manufacturer label \nwarnings to prevent administration of potassium \nchloride concentrate without proper dilution. \nAlthough lessened, errors persisted until the \npharmaceutical industry manufactured premixed \nsolutions, physicians standardized potassium \nreplacement therapy to maximize use of \ncommercially available solutions, and vials of \npotassium chloride were removed from patient \ncare units. Unfortunately, it took years for the \nhealthcare industry to come up with and \nimplement such an effective system-based \nsolution that now seems so simple and intuitive.   \n \nTo become more proficient at systems thinking, \nmultidisciplinary teams must openly discuss \nmedication errors and refuse to settle for old \nfamiliar (and ineffective) ways of solving \nproblems. If education is identified as an error \nreduction strategy, we can\u2019t stop there. Instead of \njust building inspections into processes to detect \nerrors before they reach patients, we need to find \nways to actually prevent them. We must always \nask, \u201cAre there ways to make it impossible, not \njust unlikely, for people to make such a mistake?\u201d \nSystems thinking is the key needed to bridge the \ngap between understanding the causes of errors \nand selecting error reduction strategies that have \nthe greatest likelihood of success. With practice \nand a little creativity, we can become more skilful \nand innovative in identifying system-wide \nstrategies that work continuously and \nautomatically to prevent errors and injuries. \n \nEducating the patient \u2013 key to patient safety \n(12). \n \nEducation provided to patients while in the \nphysician\u2019s office can arm them with the \ninformation needed to prevent errors. A patient \n\n\n\nwas to receive methotrexate IV followed in an \nhour by fluorouracil IV as part of a treatment \nregimen for breast cancer. To reduce methotrexate \ntoxicity, her oncologist prescribed oral leucovorin \nrescue to be started 24 hours after the \nmethotrexate. He wrote the order as \"leucovorin \n25 mg, one every 6 hours x 6 doses starting 24 \nhours after chemotherapy.\" The pharmacy \nprovided the correct medication, but the directions \ntyped on the label were to \"Take one tablet every \n6 hours for 6 days starting 24 hours before \nchemotherapy.\"  The patient remembered what \nshe\u2019d heard in the doctor\u2019s office and called her \nphysician for clarification. Had she taken the drug \nas directed on the label, she would have negated \nthe therapeutic effect of the chemotherapy. \n \nFailure mode and effect analysis can help guide \nerror prevention efforts (12). \n \nToo often, marketing efforts, contractual \nagreements with purchasing groups or vendors, \nand cost serve as primary sources of information \nwhen making decisions about which medical \nproducts to purchase and use. Evaluation and \ninput from those who would be using the products \nmay not be sought and error potential may not be \nconsidered ahead of time. Later, this may lead to \nunforeseen problems in the hands of clinical \nusers.  \n \nThese pitfalls can be avoided by using a process \nknown as Failure Mode and Effects Analysis \n(FMEA) to examine the use of new products and \nthe design of new services and processes to \ndetermine points of potential failure and what \ntheir effect would be \u2013 before any error actually \nhappens. In this regard, FMEA differs from Root \nCause Analysis (RCA). RCA is a reactive \nprocess, employed after an error occurs, to \nidentify its underlying causes. In contrast, FMEA \nis a proactive process used to look more carefully \nand systematically at vulnerable areas or \nprocesses. FMEA can be employed before \npurchase and implementation of new services, \nprocesses or products to identify potential failure \nmodes so that steps can be taken to avoid errors \nbefore they occur.  \n \nHow can FMEA be used to reduce the risk of \nmedication errors? To cite just one example, an \ninterdisciplinary committee could use FMEA to \nassess new drugs being considered for the \nformulary. Here\u2019s how the process would work.  \n \n\u2022 Step 1: The committee would explore how \n\n\n\n\n\n\n\n\nSeries: Medication safety issues \n\n\n\n 61\n\n\n\nthe intended product would be procured and \nused, from acquisition through \nadministration. Who would prescribe the \ndrug and for what type of patient? Where \nwould the drug be stored? Who would \nprepare and dispense it? How would it be \nadministered?  \n\n\n\n\u2022 Step 2: Potential failure modes (how and \nwhere systems and processes may fail) would \nbe identified while considering how the \nproduct would be used. Could the drug be \nmistaken for another similarly packaged \nproduct? Does the label clearly express the \nstrength or concentration? Does the name \nsound or look like another drug on the \nformulary? Are dosing parameters complex? \nIs the administration process error prone?  \n\n\n\n\u2022 Step 3: Once failure modes have been \nidentified, staff would determine the \nlikelihood of making a mistake and the \npotential consequences of an error. What \nwould happen to the patient if the drug were \ngiven in the wrong dose, at the wrong time, \nto the wrong patient, by the wrong route, at \nthe wrong rate?  \n\n\n\n\u2022 Step 4: Staff would identify any preexisting \nprocesses in place that could help detect the \nerror before it reaches the patient, and \nevaluate their effectiveness based upon \nknowledge of human factors.  \n\n\n\n\u2022 Step 5: If failure modes could cause errors \nwith significant consequences, actions would \nbe taken to prevent the error, detect it before \nit reaches the patient, or minimize its \nconsequences. A few examples include using \nan alternative product; preparing the drug in \nthe pharmacy; standardizing drug \nconcentrations, order communication and \ndosing methods; using auxiliary warning \nlabels or computer alerts; and requiring entry \nof specific data into computer systems before \nprocessing orders. \n\n\n\n \nCare with what you write! (13). \n \nA hospital reported mix-ups between two \ndifferent \u201crubicin\u201d products (anthracyclines). A \nnurse called the pharmacy to report that the colour \nof the idarubicin dispensed from the pharmacy \nwas different than the colour of the dose she had \ngiven the day before. Further investigation \nrevealed that the patient had received \ndaunorubicin instead of idarubicin on the previous \nday because staff thought they were both the same \ndrug. With five different \u201crubicin\u201d products on \nthe market, each with similar names, and two with \n\n\n\nliposomal forms, mix-ups are not surprising.  To \navoid confusion, prepare a chart for the pharmacy \nand the oncology unit that displays all the \nanthracycline products by generic name, brand \nname(s), investigational drug name/identifier, and \nliposomal forms if available. Include dosing \ninformation if desired. By the way, we heard that \nthe \u201cRubicin\u201d family does not like to be identified \nby first name only. So don\u2019t use Val, Ida, Donna \nor Epi. Doc\u2019s full name should also be used.  \n \nCare with what you use and who has access to \nmedications (14). \n \nTIMENTIN\u00ae (ticarcillin and clavulanate \npotassium) 3.1 grams IV was ordered for a patient \nafter the pharmacy had closed. A nursing \nsupervisor went into pharmacy, but could only \nfind the pharmacy bulk package which contains \n31 grams. She selected two vials and brought \nthem to the patient care unit. A staff nurse \nassumed that each vial contained one dose. She \ngave the patient one vial at 1 am and another at 5 \nam. The patient developed seizures, acute renal \nfailure, congestive heart failure, and eventually \ndied. When questioned, both the supervisor and \nnurse said that they had misread the 31 grams as \n3.1 grams. For a time, a shortage of 3.1 gram \nTimentin vials resulted in availability of only the \n31 gram bulk containers in the pharmacy. Lesson \nto be learned: Patients are at risk when non-\npharmacists have complete access to a pharmacy \nafter hours. With current technology, planning, \nand cooperation from medical and nursing staff, \nnight access to the pharmacy can be eliminated, \neven in rural hospitals. If there\u2019s any chance that \nmedications packaged in pharmacy bulk packages \nmight somehow reach patient care areas, make \nsure that extra warnings are affixed to the \ncontainers.  \n \nDrug information leaflets in error prevention \n(15). \n \nDrug information leaflets handed to patients can \nhelp prevent errors. A verbal order was given to a \npharmacist for NOROXIN (norfloxacin) 400 mg \nbid x 5 days. However, the pharmacist heard, \ntranscribed, and dispensed NEURONTIN 400 \nmg instead. When the patient got home, he read \nthe leaflet and called the pharmacy to ask why \nhe\u2019d been given medicine for seizures instead of \nthe anticipated antibiotic for a urinary tract \ninfection. The prescription was clarified with the \npatient\u2019s physician and the error was corrected. \nWhile there are many ways that errors like this \n\n\n\n\n\n\n\n\nSeries: Medication safety issues \n\n\n\n 62\n\n\n\ncan be prevented, it\u2019s important to point out the \nvalue of patient information leaflets as a backup \nwhen other systems fail. Instruct patients about \nthe importance of seeking counselling from \n\n\n\npharmacists when obtaining prescriptions and \nreading leaflets when they are provided. Armed \nwith proper information, patients can be a strong \ndefence against errors. \n\n\n\n\n\n\n\n***** \n \n\n\n\nREFERENCES \n \n1. Kohn LT, Corrigan JM, Donaldson MS. To err is \n\n\n\nhuman: building a safer health care system. \nWashington DC: National Academy Press; 2000. \n\n\n\n2. Leape LL, Brennan TA, Laird NM, Lawthers AG, \nLocalio AR, Barnes BA, Hebert L, Newhouse JP, \nWeiler PC, Hiatt H. The nature of adverse events \nin hospitalized patients. N Engl J Med 1991; 324: \n377-84. \n\n\n\n3. Brennan TA, Leape LL, Laird NM, Hebert L, \nLocalio AR, Lawthers AG, Newhouse JP, Weiler \nPC, Hiatt HH. Incidence of adverse events and \nnegligence in hospitalized patients. N Engl J Med \n1991; 324: 370-76. \n\n\n\n4. Australian Health Minister\u2019s Advisory Council. \nThe final report of the Taskforce on quality in \nAustralian health care. Canberra: Australian \nGovernment Publishing Service; 1996. \n\n\n\n5. Australian Council for Safety and Quality in \nHealth Care. Safety First \u2013 Report to the \nAustralian Health Ministers\u2019 Conference. \nCanberra: Australian Government Publishing \nService; 2000. \n\n\n\n6. Lesar TS, Briceland L, Stein D. Factors related to \nerrors in medication prescribing.  \n\n\n\n \n \nJAMA 1997; 277: 312-317. \n\n\n\n7. Roughead EE, Gilbert AL, Primrose JG, Sansom \nLN. Drug-related hospital admissions: a review of \nAustralian studies published 1998 \u2013 1996. MJA \n1998: 168: 405-408. \n\n\n\n8. Hayward RA, Hofer TP. Estimating hospital \ndeaths due to medical errors. JAMA 2001; \n286:415-420. \n\n\n\n9. Bates D, Spell N, Cullen DC, Burdick E, Laird N, \nPetersen LA, Small SD, Sweitzer BJ, Leape LL. \nThe costs of adverse drug events in hospitalised \npatients: adverse drug events prevention study \ngroup. JAMA 1997; 277: 307-311. \n\n\n\n10. ISMP Medication Safety Alert! 2nd October 2001. \n11. Landrigan C. Preventable deaths and injuries \n\n\n\nduring magnetic resonance imaging. N Engl J \nMed. 2001;345:1000-1001. \n\n\n\n12. ISMP Medication Safety Alert! 17th October \n2001. \n\n\n\n13. ISMP Medication Safety Alert! 31st October \n2001. \n\n\n\n14. ISMP Medication Safety Alert! 23rd Jan 2002. \n15. ISMP Medication Safety Alert! 6th Feb 2002. \n\n\n\n \n\n\n\n\n\n"
"\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n325 \n \n\n\n\nPredictors of Herbal Utilization by Multiethnic Secondary Care Patients in Malaysia: a Cross \n\n\n\nSectional Survey  \nMohd Baidi Bahari and Saw June Tze \n\n\n\nSchool of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Pulau Pinang \n\n\n\nCorresponding Author:  Dr. Mohd Baidi Bin Bahari, e-mail: baidi@usm.my \n\n\n\n________________________________________________________________________________________ \n\n\n\nABATRACT \n\n\n\nThis study was carried out to determine the extent to which demographic characteristic and disease variables \n\n\n\nare significantly associated with herbal use. This study was a cross sectional survey conducted by structured \n\n\n\ninterview using a validated questionnaire. The subjects were selected using a convenience sampling of 250 \n\n\n\npatients attending medical wards in Penang Hospital.  Univariate and multivariate analysis were performed to \n\n\n\nexamine the predictors of herbal use. The result found 42.4% of participants (n=106) used herbal medicines, \n\n\n\nwith more than one third used herbs and conventional treatments concomitantly (67.9%).  A total of 76 \n\n\n\npatients (30.4%) used herbal medicines in the past 12 months, and 37 (14.8%) patients had ever been used \n\n\n\nherbs.  Multiple stepwise selection logistic regression modelling identified two significant determinants \n\n\n\n(P<0.05) of herbal use.  These were demographic factor, education attainment and disease variable, kidney \n\n\n\nproblem.   Study findings indicate that patients with higher education attainment are more likely to use herbal \n\n\n\nmedicines.  In contrast, those who suffer from kidney problems are associated with more than three times \n\n\n\ndecreased odds. \n\n\n\nKeywords: Herbal medicine, education, kidney problem, demographics, disease \n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011, pg 325 - 335 \n \n\n\n\n\n\n\n\nINTRODUCTION \n\n\n\nThere is a rapid growing interest in herbal use \n\n\n\nglobally.  The World Health Organization (WHO) \n\n\n\nestimates that 65%-80% of the world's population \n\n\n\nuse traditional medicine as their primary form of \n\n\n\nhealth care.\n1\n  According to WHO, up to 80% of the \n\n\n\npopulation in Africa depends on traditional \n\n\n\nmedicine for primary health care and in China, \n\n\n\nherbal medicines account for 30\u201350% of total \n\n\n\nmedicinal expenditure. On the other hand, more \n\n\n\nthan 50% of the populations have used \n\n\n\ncomplementary or alternative medicine at least \n\n\n\nonce In Europe, North America and other \n\n\n\nindustrialized regions.\n2\n  \n\n\n\nMany studies have reported high rate of herbal use \n\n\n\nin patient population.  In a recent survey \n\n\n\nperformed in a primary care setting in Alabama, \n\n\n\n26% were taking herbal products and the \n\n\n\ncombined rate of herbal and supplement intake \n\n\n\nwas 48%.\n3\n  A cross sectional survey on the use of \n\n\n\ncomplementary therapy by ambulatory patients \n\n\n\nfound that almost half of the patients (48.2%) used \n\n\n\nany vitamins or herbs.  As much as 16.4% of \n\n\n\npatients were using herbal products during the \n\n\n\nstudy, 18.3% within the past year, and 22.3% \n\n\n\never.\n4\n The most commonly used therapies among \n\n\n\nurban emergency department patients documented \n\n\n\nin a small study were massage (31%), \n\n\n\nchiropractory (30%), herbs (24%), and meditation \n\n\n\n(18%).\n5\n Studies in other patient populations have \n\n\n\nalso shown a significant prevalence of herbal \n\n\n\nuse.\n6,7\n\n\n\n Therefore, it is common for patients \n\n\n\nattending mainstream medical care to use herbs.  \n\n\n\nThese studies also supported the complementary \n\n\n\nrole of unorthodox medical therapies in health \n\n\n\npromotion and disease treatment among patient \n\n\n\npopulation. \n\n\n\nAs herbal medicine is a progressively regular form \n\n\n\nof complementary therapy used worldwide, the \n\n\n\n\nmailto:baidi@usm.my\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n326 \n \n\n\n\ncorrelates or predictors of such unconventional \n\n\n\ntherapy among patient population have been of \n\n\n\ngreat interest.  Numerous studies have examined \n\n\n\nthe association between the demographic \n\n\n\npredictors and herbal utilization. Although the \n\n\n\nfindings is not unanimous, some of the consistent \n\n\n\npredictors identified in the literature include being \n\n\n\nfemale \n8,9\n\n\n\n, middle age group (25-49 years) \n10\n\n\n\n, \n\n\n\nhigher education level \n3,11\n\n\n\n , wealthier \n12,13\n\n\n\n, and \n\n\n\nemployed. \n14\n\n\n\n Perceived poorer health status \n12,15\n\n\n\n, \n\n\n\nand chronic health problems \n5,16\n\n\n\n are also potential \n\n\n\ndeterminants of herbal use. \n\n\n\nUtilization of herbal medicines tends to be higher \n\n\n\nin some distinct patient population with specific \n\n\n\nmedical conditions such as cancer \n6, 17\n\n\n\n, arthritis \n18, \n\n\n\n19\n, human immunodeficiency virus (HIV) disease \n\n\n\n20\n, asthma \n\n\n\n7,21\n, and chronic pain \n\n\n\n10,12\n.  Recent \n\n\n\nsurvey reported an overall prevalence for herbal \n\n\n\npreparation use of 13% to 63% among cancer \n\n\n\npatients.\n17\n\n\n\n Asthma patients have long been known \n\n\n\nto use other forms of traditional therapies, \n\n\n\nincluding herbal medicines in addition to \n\n\n\nconventional treatment.  A 1997 UK postal survey \n\n\n\nof 4741 asthmatic patients in an asthma \n\n\n\norganization revealed that the one year prevalence \n\n\n\nof alternative therapy was 11% for herbal \n\n\n\ntherapy.\n22\n\n\n\n Besides, rheumatological problems \n\n\n\nconstituted the greatest percentage of cases being \n\n\n\ntreated by medical practitioners practicing Chinese \n\n\n\ntraditional medicine.\n20\n\n\n\n\n\n\n\nDespite there is well established prevalence \n\n\n\nestimates of herbal use in most developed \n\n\n\ncountries, similar studies in Malaysia are \n\n\n\nparticularly lacking.  Therefore, more information \n\n\n\non predictors of herbal utilization based on a \n\n\n\nrepresentative sample of patient population is \n\n\n\nrequired.  The study focuses on the herbal use \n\n\n\namong secondary care patients as this group of \n\n\n\npatients are usually associated with chronic illness \n\n\n\nand on long term multiple medications, thereby \n\n\n\npredisposing the increased risk of adverse effects \n\n\n\nand drug herb interactions. Information from study \n\n\n\nmay assist in evaluating potential determinants that \n\n\n\ninspire patients to turn to herbal therapies and \n\n\n\nfacilitate the design of future research on herbal \n\n\n\nusage.  Thus, using patient population that \n\n\n\nrepresents ethnic distribution in our society, we \n\n\n\naimed to describe the pattern of herbal utilization \n\n\n\nby multiethnic secondary care patients and \n\n\n\ndetermine the extent to which demographic \n\n\n\ncharacteristic and disease variables increase the \n\n\n\nlikelihood of herbal utilization.  We hypothesized \n\n\n\nthat demographic characteristic as well as presence \n\n\n\nof chronic medical problems are significantly \n\n\n\nassociated with herbal use. \n\n\n\nMETHOD \n\n\n\nSample \n\n\n\nA face to face interview using questionnaire was \n\n\n\ncarried out on patients in medical ward, Penang \n\n\n\nGeneral Hospital.  The study population consists \n\n\n\nof medical patients from cardiology, neurology, \n\n\n\ninfectious and nephrology wards.  A convenience \n\n\n\nsample was selected from all patients attending \n\n\n\nmedical ward, Hospital Pulau Pinang. All eligible \n\n\n\npatients presented during the study period were \n\n\n\nincluded for participation.  Patients were excluded \n\n\n\nif they were below 18 years, pregnant, unable to \n\n\n\ngive consent for any reason, such as having \n\n\n\nneurological problem or language barrier.  A cover \n\n\n\nletter explaining the purpose of the study was \n\n\n\nshown to the patients before the consent was \n\n\n\nobtained.  Participation was voluntary.  \n\n\n\nConcurrently, the medical record was reviewed for \n\n\n\ndemographic information, diagnoses, and \n\n\n\nmedications.  Overall, data were collected on 250 \n\n\n\npatients. \n\n\n\nQuestionnaire \n\n\n\nA questionnaire related to study framework was \n\n\n\ndesigned.  The questionnaire consists of four \n\n\n\nsections.  The first and second part of \n\n\n\nquestionnaire contained questions on demographic \n\n\n\nand socioeconomic background of respondents.  \n\n\n\nThe socio-demographic variables included \n\n\n\nemployment and lifestyle habits (smoking and \n\n\n\nalcohol consumption) in addition to age, gender, \n\n\n\nmarital status, education and income level.  The \n\n\n\nthird section elicits information on perceived \n\n\n\nhealth, current medical illness, drug regimen, \n\n\n\nfamily history and past medical history.  Patients \n\n\n\nwere asked to rate their physical health status, on a \n\n\n\nstandard 5 point Likert scale ranging from \n\n\n\nexcellent to poor.   Respondents were also asked \n\n\n\nwhether they had experienced any of a list of 14 \n\n\n\nhealth related problems within the past year (Table \n\n\n\n2).  The final section consisted of questions on the \n\n\n\nuse of herbal medicines, specifying name and \n\n\n\ndetails of the herbal medicine used.  Patients who \n\n\n\nuse herbal medicine was further classified under \n\n\n\ncurrent herbal user (past 12 months) and previous \n\n\n\nusers (beyond 1 year or ever been used).  Other \n\n\n\ninformations include duration, types of herbs used, \n\n\n\nregistration with Drug Control authority (DCA), \n\n\n\nMalaysia; and reason for their use (treatment of \n\n\n\nacute or chronic illness, health maintenance). \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n327 \n \n\n\n\nDefinition of herbal medicines \n\n\n\nThe terminology used for herbal medicines is non-\n\n\n\nstandard.  Most of the previous studies classify \n\n\n\nherbs under \u201cdietary supplement\u201d which also \n\n\n\nencompasses vitamins, minerals as in accordance \n\n\n\nwith DSHEA 1994 (Dietary Supplement Heath \n\n\n\nand education Act).  However, this study adopted \n\n\n\nthe definition of herbal medicines as stipulated in \n\n\n\nWorld Health Organisation (WHO) guidelines for \n\n\n\nthe appropriate use of herbal medicines in 1998.  \n\n\n\nAccording to the guidelines, herbal medicine is \n\n\n\ndefined as \u201cplant derived materials or products \n\n\n\nwith therapeutic or other human health benefits \n\n\n\nwhich contain either raw or processed ingredients \n\n\n\nfrom one or more plants\u201d.  Under this definition, \n\n\n\nthere are three kinds of herbal medicines, raw, \n\n\n\nprocessed plant materials and medicinal herbal \n\n\n\nproducts.  Raw plant material is defined as fresh or \n\n\n\ndry plant materials which are marketed whole or \n\n\n\nsimply cut into small pieces.   Processed plant \n\n\n\nmaterial is defined as plant materials treated \n\n\n\naccording to traditional procedures to improve \n\n\n\ntheir safety and efficacy, to facilitate their clinical \n\n\n\nuse, or to make medicinal preparations.  Medicinal \n\n\n\nherbal products is defined as finished, labelled \n\n\n\npharmaceutical products in dosage forms that \n\n\n\ncontain one or more of the following: powdered \n\n\n\nplant materials, extracts, purified extracts, or \n\n\n\npartially purified active substances isolated from \n\n\n\nplant materials.  Medicines containing plant \n\n\n\nmaterial combined with chemically defined active \n\n\n\nsubstances, including chemically defined, isolated \n\n\n\nconstituents of plants, are not considered to be \n\n\n\nherbal medicines. \n\n\n\nData analysis \n\n\n\nData were analyzed using the Statistical Package \n\n\n\nfor Social Sciences SPSS version 15.0.  \n\n\n\nDescriptive statistics were used to determine the \n\n\n\nprevalence of herbal use.  Pearson\u2019s Chi-square \n\n\n\ntest, and where necessary Fisher\u2019s exact test were \n\n\n\nused to determine the association between herbal \n\n\n\nuse and each of the independent variables related \n\n\n\nto demographic and medical/disease \n\n\n\ncharacteristics; a p value of \u2264 0.05 was considered \n\n\n\nto be statistically significant.  All tests were two \n\n\n\ntailed.  Variables found to be significantly \n\n\n\nassociated with herbal use on univariate analysis \n\n\n\nwere added in a   forward stepwise selection to \n\n\n\nconstruct the final model of predictor variables.\n23 \n\n\n\n\n\n\n\nFinally, the logistic model, which gives the \n\n\n\nprobability that the outcome (herbal use) occurs as \n\n\n\nan exponential function of the independent \n\n\n\nvariables (socio-demographic factors) will be \n\n\n\nderived.  Spearman rank correlation coefficient \n\n\n\nwas obtained in order to measure how strongly two \n\n\n\nindependent variables are related to one another.  \n\n\n\nRESULT \n\n\n\nDescriptive statistics \n\n\n\nThe final study population comprised 127 women \n\n\n\n(50.8%) and 123 men (49.2%).  The mean age was \n\n\n\n52.7 years (SD, 15.05; range, 18-86).  Malay \n\n\n\npatients made up 42.4% of respondents, followed \n\n\n\nby Chinese (34%), Indian (22.4%) and others \n\n\n\n(1.2%).  More than half of the patients\u2019 age fell \n\n\n\ninto age group 35-59 years (52.8%).  About 48.8 \n\n\n\n% of participants had education below secondary \n\n\n\nlevel and 61.6% reported to have a gross \n\n\n\nhousehold income in the lowest category (< \n\n\n\nRM1000).  Most of the patients were unemployed \n\n\n\n(58%) and for those who are employed, 62.5% \n\n\n\njoined private sector.    Table 1 summarizes socio-\n\n\n\ndemographic characteristics of the subjects \n\n\n\nincluded in the analysis. \n\n\n\nSocio-demographic characteristic and herbal use \n\n\n\nIn this study, almost half of the patients (42.4%, \n\n\n\nn=106) reported using herbs, predominantly men \n\n\n\n(47.2%).  More than one third used herbs and \n\n\n\nconventional treatments concomitantly (67.9%).  \n\n\n\nThe 12 months prevalence of herbal use was \n\n\n\n30.4% as compared to 14.8% of patients who had \n\n\n\never used it.  The proportions of herbal users \n\n\n\nvaried across ethnic group, with Chinese reported \n\n\n\nthe highest rate of herbal use (47.1%), followed by \n\n\n\nMalay (45.3%), and Indian (32.1%).  Patients in \n\n\n\nthe age group of 35-59 years were found to be \n\n\n\nmajor user of herbal medicines (47%).  Marital \n\n\n\nstatus and employment had no effect on herbal \n\n\n\nuse.  A substantially higher percentage of patients \n\n\n\nwith higher income level (> RM 3000) used herbal \n\n\n\nmedicines, as compared to lower income group, \n\n\n\nwith 72.7% and 41% respectively (not shown in \n\n\n\ndata).  However, lifestyle habit such as smoking \n\n\n\nand alcohol consumption had no significant effect \n\n\n\non herbal use (Table 1). \n\n\n\nMedical/ disease variables and herbal use \n\n\n\nTable 2 shows medical/disease variables \n\n\n\nassociated with herbal use.  The 5 most commonly \n\n\n\ncited medical problems were hypertension \n\n\n\n(60.8%); cardiovascular problems (55.2%); \n\n\n\ndiabetes mellitus (42.4%); kidney problems (26%); \n\n\n\nand infection (12.8%).  In this study, the \n\n\n\npercentage of herbal user was found to be higher \n\n\n\nin patients with the following medical illnesses: \n\n\n\nthyroid problem (83.3%), arthritis (70.6%), \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n328 \n \n\n\n\nchronic lung disease (66.7%), infection (53.1%), \n\n\n\ncancer (50%), and cardiovascular problems \n\n\n\n(47.1%).  On the other hand, 65.2% of patients \n\n\n\nhave family history of illness; and 88.4% of \n\n\n\npatients have past medical history.  However, \n\n\n\nneither family history of illness nor past medical \n\n\n\nhistory was associated with higher use of herbal \n\n\n\nmedicine.  In total, 74.4% of patients assessed \n\n\n\ntheir health as poor. A higher proportion of \n\n\n\npatients reported very poor and poor perceived \n\n\n\nhealth (44.7%) than of patients with fair or good \n\n\n\nuse herbal medicine.   \n\n\n\nUnivariate statistics \n\n\n\nUnivariate analysis showed that use of herbal \n\n\n\nmedicine correlated positively with \n\n\n\nsociodemographic characteristic such as education \n\n\n\n(p=0.002), income level (p=0.021) and smoking \n\n\n\nstatus (p=0.043).  Medical or disease variables that \n\n\n\nsignificantly associated with herbal use were \n\n\n\narthritis (p=0.029) and kidney problems \n\n\n\n(P=0.003).  The results of univariate analysis are \n\n\n\nshown in Table 3 (a) and (b). \n\n\n\n\n\n\n\nTable 1   Descriptive characteristics of the study population \n\n\n\nVariable No of patient (%) User (%) Non-user (%) \n    \n\n\n\nGender    \n\n\n\n         Male 123 (49.2) 58 (47.2) 65 (52.8) \n         Female 127 (50.8) 48 (37.8) 79 (62.2) \nAge (years)    \n          18-34 32 (12.8) 12 (37.5) 20 (62.5) \n          35-59 132 (52.8) 62 (47.0) 70 (53.0) \n          60-88 86 (34.4) 32 (37.2) 54 (62.8) \nEthnic/ race    \n          Malay 106 (42.4) 48 (45.3) 58 (54.7) \n          Chinese 85 (34.0) 40 (47.1) 45 (52.9) \n          Indian 56 (22.4) 18 (32.1) 38 (67.9) \n          Others 3 ( 1.2) 0 (0) 3 (100) \nReligion    \n          Islam 107(42.8) 49 (45.8) 58 (54.2) \n          Buddhist 83 (33.2) 39 (47.0) 44 (53.0) \n          Hinduism 56 (22.4) 18 (32.1) 38 (67.9) \n          Christianity 1 (0.4) 0 (0) 1(100) \n          Others 3 (1.2) 0 (0) 3 (100) \nMarital status    \n          Single 32 (12.8) 11 (34.4) 21 (65.6) \n          Married 215 (86.0) 93 (43.3) 122 (56.7) \n          Divorced 3 (1.2) 2 (66.7) 1(33.3) \nWorking status    \n          Working  79 (31.6) 35 (44.3) 44(55.7) \n          Not working 145 (58.0) 55 (37.9) 90 (62.1) \n          Retired 26 (10.4) 16 (61.5) 10 (38.5) \nEmployment    \n          Private 50 (62.5) 21(42.0) 29 (58.0) \n          Self-employed 8 (10.0) 5 (62.5) 3 (37.5) \n          Government 22 (27.5) 10 (45.5) 12 (54.5) \nIncome (monthly)    \n          <RM 1000 154 ( 61.6) 56 (36.4) 98 (63.6) \n          RM 1000-3000 85 (34.0) 42 (49.4) 43 (50.6) \n          RM 3000-5000 9 (3.6) 7 (77.8) 2 (22.2) \n          >RM 5000 2 (0.8) 1 (50.0) 1(50.0) \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n329 \n \n\n\n\nEducation level    \n          None 29 (11.6) 7 (24.1) 22 (75.9) \n          Primary 93 (37.2) 30 (32.3) 63 (67.7) \n          Secondary 104 (41.6) 56 (53.8) 48 (46.2) \n          Tertiary 24 (9.6) 13 (54.2) 11(45.8) \nSmoking    \n         Never 159 (63.6) 58 (36.5) 101(63.5) \n         Former 72 (28.8) 38 (52.8) 34 (47.2) \n        Current 19 (7.6) 10 (52.6) 9 (47.4) \nAlcohol    \n        Never 190 (76.0) 77 (40.5) 113 (59.5) \n        Former 47 (18.8) 26 (53.1) 21(46.9) \n        Current 13 (5.2) 3 (23.1) 10 (76.9) \nFamily History of Illness    \n         Yes 163 (65.2) 72 (44.2) 91 (55.8) \n         No 69 (27.6) 28 (40.6) 41 (59.4) \n         Unknown 18 (7.2) 6 (33.3) 12 (66.7) \nPast Medical History    \n          Yes 221 (88.4) 90 (40.7) 131 (59.3) \n          No 29 (11.6) 16 (55.2) 13 (44.8) \nDrug Allergy    \n          Yes 35 (14) 17 (48.6) 18 (51.4) \n          No 214 (85.6) 89 (41.6) 125 (58.4) \nPerceived Health    \n         Very poor 4 (1.6) 3 (75.0) 1 (25.0) \n         Poor 186 (74.4) 82 (44.1) 104 (55.9) \n         Fair 51(20.4) 18 (35.3) 33 (64.7) \n         Good \n \n\n\n\n9 (3.6) \n \n\n\n\n3 (33.3) \n \n\n\n\n6 (66.7) \n \n\n\n\n\n\n\n\n\n\n\n\nTo ascertain which of the demographic/ disease \n\n\n\nvariables were independently related to herbal use \n\n\n\namong medical patients, a logistic regression was \n\n\n\nconducted.  Each of these variables was dummy \n\n\n\ncoded and used as independent variables.   \n\n\n\nMultiple logistic regression model \n\n\n\nMultiple stepwise selection logistic regression \n\n\n\nmodelling resulted in the final selection of two \n\n\n\nsignificant determinants (p<0.05) of herbal use \n\n\n\namong medical patients.  These were: (i) education \n\n\n\nattainment (OR 4.06; 95% CI 1.47-11.26) and; (ii) \n\n\n\nkidney problem (OR 0.35; 95% CI 0.18-0.69).  \n\n\n\nElements strongly associated with herbal use on \n\n\n\nunivariate analysis such as income level, smoking \n\n\n\nstatus, and arthritis problem were no longer \n\n\n\nassociated with herbal use when controlled for \n\n\n\nother variables.  Table 4 indicates the adjusted \n\n\n\nodds ratios and 95% confidence intervals for the \n\n\n\nindependent variables that emerged as significant \n\n\n\npredictors. \n\n\n\nOn the other hand, the relationship between age \n\n\n\ngroups, income level, education and perceived \n\n\n\nhealth were investigated using Spearman rank \n\n\n\ncorrelation coefficient.  There was a weak, \n\n\n\nnegative correlation between age groups and \n\n\n\nincome level as well as education level (r= -0.227; \n\n\n\np<0.01 and r= -0.152; p<0.05 respectively).  \n\n\n\nSimilar observation was found between education \n\n\n\nand income level except there was a positive \n\n\n\ncorrelation between these two variables (r= 0.173; \n\n\n\np<0.01).  Table 5 presents the intercorrelations of \n\n\n\nhypothesized predictor variables and use of herbal \n\n\n\nmedicine. \n\n\n\nDISCUSSION \n\n\n\nHerbal use in survey sample was high and \n\n\n\ngenerally consistent with the western population.\n3, \n\n\n\n4\n The higher usage of herbal medicine in middle \n\n\n\naged patients reported in other studies is in \n\n\n\nagreement with our results.\n11, 14\n\n\n\n Unlike previous \n\n\n\nfindings \n8,9 \n\n\n\n, male patients were the predominant \n\n\n\nuser of herbal medicine in this study. Possible \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n330 \n \n\n\n\nexplanation for this discrepancy lies in the \n\n\n\nadoption of \u201cdietary supplement\u201d definition in \n\n\n\nprior studies, which also includes vitamins, herbs \n\n\n\nand functional food. Nevertheless, when the \n\n\n\ninfluences of all possible confounders were \n\n\n\nadjusted, gender was no longer related to an \n\n\n\nincreased use of herbal medicines.   \n\n\n\n\n\n\n\nTable 2   Medical /disease variables with herbal use \n\n\n\nVariables \n \n\n\n\nNo of patient  \n(%) \n\n\n\n              Herbal User \nDisease No Disease \n\n\n\nCurrent Medical Illness    \n\n\n\n          Thyroid problem 6 (2.4) 5  (83.3) 101 (41.4) \n          Arthritis  17 (6.8) 12 (70.6) 94 (40.3) \n          Chronic lung disease 9 (3.6) 6  (66.7) 100 (41.5) \n          Infection 32 (12.8) 17 (53.1) 89 (40.8) \n          Cancer 6 (2.4) 3  (50.0) 103 (42.2) \n          Cardiovascular 138 (55.2) 65 (47.1) 41 (36.6) \n          GI problem 20 (8) 9  (45.0) 97 (42.2) \n          Asthma 14 (5.6) 6  (42.9) 100 (42.4) \n          Hypertension 152 (60.8) 61 (40.1) 45 (45.9) \n          Neurological problem 13 (5.2) 5  (38.5) 101 (42.6) \n         Systemic Lupus  \n         Erythematous (SLE) \n\n\n\n11 (4.4) \n \n\n\n\n4  (36.4) \n \n\n\n\n102 (42.7) \n \n\n\n\n          Diabetes Mellitus 106 (42.4) 38 (35.8) 68 (47.2) \n          Kidney problem 65 (26.0) 17 (26.2) 89 (48.1) \n          Skin problem \n \n\n\n\n1 (0.4) \n \n\n\n\n0 (0) \n \n\n\n\n106 (42.6) \n \n\n\n\n\n\n\n\nAmong ethnic group, Chinese reported with higher \n\n\n\nrate of herbal use, which is in agreement with prior \n\n\n\nresearch.\n7\n The popularity of traditional medicine \n\n\n\namong Chinese remains undiminished despite the \n\n\n\nrapid modernization of mainstream medical care.  \n\n\n\nHerbal use has also been related to various health \n\n\n\nrelated behaviour pattern.  Former smokers and \n\n\n\ndrinkers used herbal medicine to a greater extent \n\n\n\nthan non-smokers as well as non-drinkers, which is \n\n\n\nin contrast to previously reported by Gregar.\n24\n\n\n\n\n\n\n\nHowever, when all the possible confounders were \n\n\n\ntaken into consideration, there was no significant \n\n\n\neffect on the outcome variables. \n\n\n\n\n\n\n\nMost common medical illness correlated with the \n\n\n\nherbal use in this study was thyroid problem, \n\n\n\nwhich is contrary to other reports.\n12, 19\n\n\n\n\n\n\n\nNonetheless, study has found that a large \n\n\n\npercentage of patients with arthritis, chronic lung \n\n\n\ndisease, and cancer used herbal medicines, which \n\n\n\ncorresponds well to other findings.\n17, 18, 25\n\n\n\n People \n\n\n\nwho resort to alternative treatment usually have \n\n\n\nchronic conditions for which modern medicines \n\n\n\nand synthetic drugs have failed to provide a \n\n\n\nsatisfactory solution.  Poor prognosis in cancer \n\n\n\n(paltiel 2001) and alleged non noxious effects of \n\n\n\nherbal medicine versus toxic chemotherapy \n\n\n\nregimen may create demands for natural \n\n\n\nsupplements including herbs.  Research indicated \n\n\n\nthat patient with arthritis are more likely to explore \n\n\n\nalternative medicine in coping with this \n\n\n\ndevastating disease, with an estimated 60-90% of \n\n\n\npersons with arthritis use complementary \n\n\n\ntherapy.\n26\n\n\n\n\n\n\n\nFrom the study, we did not observe any \n\n\n\nstatistically significant socio-demographic factors \n\n\n\nassociated with the herbal use except higher \n\n\n\neducation level.  This may be attributed to low \n\n\n\nsocioeconomic diversity within the study sample \n\n\n\nand resulting low variability among the \n\n\n\ndemographic variables. Based on the results from \n\n\n\nthe multiple logistic regressions, education \n\n\n\nemerged as an important predictor of herbal use.  \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n331 \n \n\n\n\nUnlike other Asian countries \n27, 28\n\n\n\n, education that \n\n\n\npredicted the use of herbal medicine is in basic \n\n\n\nagreement with that reported in Western countries \n8, 9\n\n\n\n but the new finding in this study is the kidney \n\n\n\nproblem, which requires further investigation.  \n\n\n\nEducation may enhance the chances that people \n\n\n\nexposed to diverse unconventional therapies, either \n\n\n\nby advertising media or personal reading of \n\n\n\nrelevant books.  However, a controversial saying is \n\n\n\nthat patients with lower education background are \n\n\n\nmore culture-bound \n28\n\n\n\n and less aware of the \n\n\n\nimportance of evidence based information, thus \n\n\n\nmore likely to conform to alternative therapy. \n\n\n\n\n\n\n\nTable 3(a)   Univariate analysis of factors associated with herbal use amongst                     \n\n\n\nmultiethnic secondary care patients (socio-demographic) \n\n\n\n\n\n\n\nVariables Total  Herbal Use, n (%) P-value \n\n\n\n\n\n\n\nGender    \n       Male 123 58 (47.2) 0.171 \n       Female 127 48 (37.8)  \nAge    \n       18-34 32 12 (37.5) 0.302 \n       35-59 132 62 (47.0)  \n       60-88 86 32 (37.2)  \nMarital status    \n       Single/divorced 35 13 (37.1) 0.621 \n       Married 215 93 (91.2)  \nEthnic     \n       Malay 106 48 (45.3) 0.442 \n       Chinese 85 40 (47.1)  \n       Indian  56 18 (32.1)  \nWorking status    \n       Working  79 35 (44.3) 0.074 \n       Not working 145 55 (37.9)  \n       Retired 26 16 (61.5)  \nEmployment    \n      Private 50 21 (42) 0.556 \n      Self-employed 8 5 (62.5)  \n      Government 22 10 (45.5)  \nIncome level    \n      \u2264 RM1000 154 56 (36.4) 0.021 \n      > RM1000 96 50 (52.1)  \nEducation    \n      None 29 7 (24.1) 0.002 \n      Primary 93 30 (32.3)  \n      Secondary 104 56 (53.8)  \n      Tertiary 24 13 (54.2)  \nSmoking status    \n     Never 159 58 (36.5) 0.043 \n     Former 72 38 (52.8)  \n     Current 19 10 (52.6)  \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n332 \n \n\n\n\nAlcohol status    \n     Never 190 77 (40.5) 0.065 \n     Former 47 26 (55.3)  \n     Current 13 3 (23.1)  \nSelf Perceived Health    \n     Very poor/ Poor 190 85 (44.7) 0.238 \n     Fair/ Good \n \n\n\n\n60 \n \n\n\n\n21 (35) \n  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nTable 3(b)    Univariate analysis of factors associated with herbal use amongst                    \n\n\n\nmultiethnic secondary care patients (disease/ current illness) \n\n\n\n\n\n\n\nVariables Total  Herbal Use, n (%)  P-value \n\n\n\n\n\n\n\n          Thyroid problem 6 5  (83.3) 0.086 \n          Arthritis  17 12 (70.6) 0.029 \n          Chronic lung disease 9 6  (66.7) 0.174 \n          Infection 32 17 (53.1) 0.261 \n          Cancer 6 3  (50.0) 0.7 \n          Cardiovascular 138 65 (47.1) 0.123 \n          GI problem 20 9  (45.0) 0.992 \n          Asthma 14 6  (42.9) 1 \n          Hypertension 152 61 (40.1) 0.44 \n          Neurological problem 13 5  (38.5) 0.994 \n         Systemic Lupus  \n         Erythematous (SLE) \n\n\n\n11 \n \n\n\n\n4  (36.4) \n \n\n\n\n0.764 \n \n\n\n\n          Diabetes Mellitus 106 38 (35.8) 0.095 \n          Kidney problem 65 17 (26.2) 0.003 \n          Skin problem \n \n\n\n\n1 \n \n\n\n\n0 (0) \n \n\n\n\n1 \n \n\n\n\n\n\n\n\nTable 4   Significant Predictors in the Multiple Logistic Regression (p<0.05) \n\n\n\nVariable    OR 95% CI     P -value \n\n\n\n\n\n\n\nEducation *   4.06 1.47-11.23      0.007 \n\n\n\nKidney problem \u2020   0.35 0.18-0.69       0.002 \n\n\n\n\n\n\n\nOR: Odds ratio; CI: confidence interval \n*Coded on a 4 point Likert scale \n\n\n\n\u2020Coded as dichotomous variable  \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n333 \n \n\n\n\n\n\n\n\n\n\n\n\nTable 5   Intercorrelations of hypothesized predictor variables and use of herbal medicine \n\n\n\nVariables \n\n\n\n\n\n\n\n1 2 3 4 \n\n\n\nAge groups \u2026    \n\n\n\nIncome level -0.227 *  \u2026   \n\n\n\nEducation level -0.152 \u2020 0.173 * \u2026  \n\n\n\nPerceived health -0.057 0.076 0.039 \u2026 \n\n\n\n\n\n\n\n\n\n\n\n* Correlation is significant at the .01 level (2-tailed) \n\n\n\n\u2020 Correlation is significant at the .05 level (2-tailed). \n\n\n\n\n\n\n\nOur study found an intriguing determinant of \n\n\n\nherbal disuse, which is kidney problem.  Patient \n\n\n\nwith kidney problem was three times less likely to \n\n\n\nuse herbal medicine.  The hypothesized \n\n\n\nexplanation is that patient with failing kidney \n\n\n\nfunction would not take the risk of more exposure \n\n\n\nto herbs as the \u201ctoxin-filtrating\u201d properties of \n\n\n\nkidney is well acknowledged.\n29\n\n\n\n This is further \n\n\n\nvalidated by the intrinsic functioning or properties \n\n\n\nof kidney, where active uptake by tubular cells and \n\n\n\nhigh concentration in the medullary region \n\n\n\nincreased the risk of kidney injury.\n30\n\n\n\n  Repetitive \n\n\n\nstringent warnings by clinicians against using any \n\n\n\nmedications other than those prescribed may also \n\n\n\naccount for decreased likelihood of herbal use.   \n\n\n\nVarious renal syndromes were reported after the \n\n\n\nuse of medicinal plants, including tubular necrosis, \n\n\n\nacute interstitial nephritis, hypertension, papillary \n\n\n\nnecrosis, and nephrolithiasis.\n30\n\n\n\n This alarming rate \n\n\n\nof published data on damaging effect of herbal \n\n\n\nextracts to kidney may in turn discourage the use \n\n\n\nof herbal medicines.  For example, the \n\n\n\nmineralcorticoid activity of licorice (Glycyrrhiza \n\n\n\nglabra) is manifested as headache, sodium and \n\n\n\nwater retention, hypokalemia, metabolic alkalosis, \n\n\n\nhypertension, heart failure, and suppression of the \n\n\n\nrenin-aldosterone system.\n30\n\n\n\n Many products contain \n\n\n\nsubstantial amount of glycyrrhizic acid; namely, \n\n\n\nhealth products (herbal cough mixtures, licorice \n\n\n\ntea, licorice root).\n31\n\n\n\n This compound can be found \n\n\n\nin 74% of Chinese herbal teas. \n32 \n\n\n\n\n\n\n\nHerbal medicine also may be hazardous for renal \n\n\n\npatients because of potential drug herb \n\n\n\ninteractions.  For example, the immunostimulating \n\n\n\neffect of Echinacea (Echinacea angustifolia), and \n\n\n\nlicorice (Glycyrrhiza glabra), may offset the \n\n\n\nimmunosuppressive effect of cyclosporine, a \n\n\n\ncommonly use drug in kidney transplant .\n33\n\n\n\n  This is \n\n\n\nparticularly important in our study as majority of \n\n\n\nthe kidney patients in our study sample suffered \n\n\n\nfrom end stage renal failure and awaiting for \n\n\n\nkidney transplant.  In addition, the effect of \n\n\n\ncyclosporine will be reduced if co administered \n\n\n\nwith St John\u2019s Wort (Hypericum perforatum), a \n\n\n\npotential inducer of liver enzymes as these two \n\n\n\nelements share the common metabolic pathway.\n34\n\n\n\n\n\n\n\nThe need for nephrologists and other caregivers to \n\n\n\nelicit information of herbal use among patients is \n\n\n\nwarranted despite the low frequency of herbal use \n\n\n\nin kidney patients verified in our study. \n\n\n\nCONCLUSION \n\n\n\nOur study results indicate that there is no single \n\n\n\ndeterminant of the present popularity of herbal \n\n\n\nmedicines exists.   Higher education level and \n\n\n\nkidney problems were significantly correlated with \n\n\n\nherbal utilization among secondary care patients \n\n\n\nwhen the influences of socio-demographic \n\n\n\ncharacteristic were adjusted.  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(2004) Factors associated with herbal use among urban \n\n\n\nmultiethnic primary care patients: a cross-sectional survey. BMC Complementary Alternative \n\n\n\nMedicine; 4:18. \n\n\n\n45. WHO. Traditional Medicine \u2013 Growing Needs and Potential. WHO Policy Perspective on Medicine \n\n\n\nNo.2 May 2002. WHO, Geneva. \n\n\n\n46. Wojcikowski K, Johnson DW, Gobe G. (2004) Medicinal herbal extracts \u2013 renal friend or foe? Part \n\n\n\ntwo: Herbal extracts with potential renal benefits. Nephrology; 9: 400-405. \n\n\n\n47. Zollman C, Vickers A. (1999) ABC of complementary medicine: What is complementary medicine? \n\n\n\nBMJ; 319: 693-696. \n\n\n\n \n\n\n\n\n\n"
"\n\nMalaysian Journal of Pharmacy 2002;1(2):45-50  Research Article \n\n\n\nNoncompliance with Prescription Writing \nRequirements and Prescribing Errors in an \nOutpatient Department \n \nKuan Mun Ni1, Chua Siew Siang1*, Mohamed Noor bin Ramli2 \n \n1Department of Pharmacy, Faculty of Medicine, University of Malaya, 50602 Kuala Lumpur \n2Outpatient Polyclinic Pharmacy Unit, Universiti Malaya Medical Centre, 59100 Kuala Lumpur, \n Malaysia.  \n \n*Author for correspondence\n \n \nABSTRACT \n \nNew prescriptions received by an outpatient pharmacy department of a teaching \nhospital were audited retrospectively for noncompliance with prescription writing \nrequirements as well as to identify the types of prescribing errors. Of the 397 \nprescriptions screened in a single day, 96.7% had one or more of the legal or \nprocedural requirements missing. These errors of omission, included prescriptions \nwithout the patient\u2019s age, date, clinic or department where the prescription was \nissued, route of administration, dose and frequency of the drug to be used, strength, \ndosage form and quantity of drug to be supplied.  Additionally, there were errors of \ncommission involving 8.4% of the prescribed drugs. A total of 39 drug-drug \ninteractions were identified; 15 were classified as potentially hazardous but could be \novercome with careful monitoring of the patients. The results of the present study \nshow a low compliance rate to the legal and procedural requirements in prescription \nwriting.  This indicates a need for pharmacy and medical educators to further \nemphasize the importance of writing clear and complete prescriptions.  It also calls \nfor the implementation of educational and monitoring programmes to bring more \nawareness to all concerned so as to reduce the rate of noncompliance and hence \nminimize the occurrence of prescribing errors.   \n \n\n\n\nKeywords: prescription screening, pharmacist, compliance, errors of omission, errors \nof commission \n \n \n \nINTRODUCTION \n \nThe screening of prescriptions and intervention \nprocess commences with the pharmacist\u2019s initial \nassessment for completeness and legality of the \nprescriptions. Prescription deficiencies formed a \nlarge proportion of errors identified in prescription \nscreening (1). This is mainly due to the attitude of \nsome prescribers who are always in a hurry and \nhence   unwilling  to  spend  a  little  more  time  in  \n\n\n\n \n \nwriting clear and complete prescriptions. However, \nthe extra time spent on the prescription will help to \nensure that the patient receives the treatment that is \nintended by the prescriber. Additionally, the \nprescriber will be well compensated for the extra \ntime taken by not having to answer enquiries from \nthe pharmacist (2).   \n \nErrors in prescribing may be classified into two \nmain types, errors of omission and errors of \n\n\n\n\n\n\n\n\nResearch article: Noncompliance with prescription writing requirements \n\n\n\ncommission.  Errors of omission are defined as \nprescriptions with essential information missing \nwhile errors of commission involve wrongly \nwritten information in the prescriptions (3). Errors \nof omission include absence or incomplete \nspecification of dosage form or strength, dose or \ndosage regimen, quantity or duration of drug to be \nsupplied as well as prescriptions that are illegible \nand prescriptions that violate legal requirements. \nWhereas, errors of commission include wrong \ndose or dosage regimen, wrong drug or its \nindication, wrong quantity or duration of therapy, \nincorrect patient\u2019s name on the prescription, \nduplicate therapy and drug-drug interactions.  \n \nNoncompliance with prescription writing \nrequirements involves mainly errors of omission.  \nA study by Ingrim and colleagues (4) in an \noutpatient pharmacy department found that the \noverall rate of prescription noncompliance was \n14.4%.  In this study, the pharmacists spent 16.3 \nhours each day correcting prescription errors. Most \nof the other studies in the literature focused more \non the prescribing errors that involved mainly \nerrors of commission as well as pharmacist \nintervention. This includes an audit on community \npharmacies that identified 153 prescriptions with \nerrors from a total of 5874 new prescriptions \n(2.6%) [1].  Other studies found the rate of \nprescribing errors between 2.6% to 15.4% or \nestimated as 2.87 to 4.9 per 1000 medication \norders (1, 5-11).   \n \nStudies on the types of prescribing errors in \nMalaysia appeared scarce in the literature. \nTherefore, the present study was conducted to \nevaluate the extent of noncompliance with \nprescription writing requirements as well as to \nidentify the types of prescribing errors.  \n \n \n\n\n\nMETHOD \n \nThis study was conducted in the Outpatient \nPharmacy Department (OPPD) of a major teaching \nhospital in Malaysia in 1998. This OPPD received \nan average of 1057 prescriptions per day during \nthe study period and was operated by one \nregistered pharmacist, 3 trainee pharmacists and 8 \npharmacy assistants.  \n \nThe study involved retrospective screening of new \nprescriptions received by the mentioned OPPD in a \nday. A researcher with pharmacy training but not a \nstaff of the OPPD, collected the prescriptions for a \nsingle day and screened them retrospectively.  Any \nprescription that did not comply with one or more \nof the legal or the hospital procedural requirements \n(12-13) would be considered as noncompliance \nand this was recorded in a standard form. These \nwere mainly errors of omission, including illegible \nprescriptions. A prescription would be considered \nas illegible in this part of the study if the researcher \ncould not read it.  Errors of commission that were \nrelated to the drugs prescribed were also recorded. \nAny drug-drug interaction was confirmed with \nstandard references (14-16).  \n \n \nRESULTS \n \nErrors of omission \n \nOf the 1057 prescriptions received on the day of \nthe study, only 397 new prescriptions were \nincluded in the study. Repeat prescriptions were \nexcluded as the prescriptions had to be returned to \nthe patients and hence were not available for \nevaluation. Of these prescriptions, 96.7% did not \nfollow at least one of the legal or procedural \nrequirements and these are classified as errors of \nomission  (Table 1 and 2).   \n\n\n\nTable 1:  Errors of omission that were related to the patient or prescriber or place of issue of the \nprescription ( n = 397).   \n \nErrors of Omission Frequency % \n\n\n\nPatient\u2019s name 0 0 \nAge 130 32.7 \nRegistration number 2 0.5 \nDate 68 17.1 \nPrescriber\u2019s name 7 1.8 \nPrescriber\u2019s signature 1 0.3 \nClinic or department 65 16.4 \nIllegible  28 7.1 \n\n\n\n\n\n\n\n\nResearch article: Noncompliance with prescription writing requirements \n\n\n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \nA total of 862 drugs were prescribed in these 397 \nprescriptions giving an average of 2.2 drugs per \nprescription. \n \nOf the 321 prescriptions with the gender of the \npatient indicated, about half  (50.8%) were for \nfemales and the other half (49.2%) for males.  \nFrom the prescriptions with the clinic or \ndepartment indicated, a majority of the \nprescriptions was from the outpatient polyclinic \n(79.2%), another 16.6% were from the wards and \n4.2% from units such as the Accident and \nEmergency Unit, Rehabilitation Unit, Radiology \nDepartment and Operation Theatre.  The \nresearcher who screened the prescriptions was \nunable to read 28 prescriptions (7%) but the \npharmacist-in-charge of the OPPD could not read \nonly three of these prescriptions (0.76%). \n \nTwo of the prescriptions did not contain the name \nof the drug required but were merely written as \n\u201csyrup mixture expectorant\u201d and \u201cantacid\u201d.  Only \n20% of the drugs prescribed had the route of \nadministration written and these involved mainly \ntopical or external preparations (73%).  Of the 485 \ndrugs prescribed without strength specifications, \n2.5% involved drugs with more than one strength \navailable.   \n \nA total of 314 drugs prescribed (36.4%) did not \nhave the dosage forms written on the prescription \nand 33.4% of these drugs have more than one \ndosage form available. These included salbutamol, \nparacetamol, cloxacillin, amoxycillin, bisacodyl, \nand betamethasone.  Of the 75 preparations with \nno dose indicated, six were oral rehydration salts, \ntwo were glyceryl trinitrate and two were GelusilR. \nThe others  involved  eye  products,  mouth  and  \n\n\n\nthroat  \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \npreparations, topical decongestants and nasal \npreparations, and ear products. Topical \npreparations such as creams or ointments where \ndose specification is not relevant were not \nincluded.   \n \nAdditionally, the quantity to be supplied was not \nindicated for 50 drugs. These include \ndermatologicals (n=10), analgesics and \nantipyretics (n=9), eye, ear, mouth and throat \npreparations (n=8), antacids and antiulcerants \n(n=6), and nasal preparations (n=4).  \n \nErrors of commission \n \nTable 3 shows the errors of commission detected \nin this study. The 27 drugs with wrongly written \ndosage form included Benadryl syrup instead of \nexpectorant for adult patients from 15 \nprescriptions. Others were nystatin and co-\ntrimoxazole being prescribed as syrups instead of \nsuspensions, cloxacillin, doxycyclin, phenytoin \nand ketoprofen being prescribed as tablets instead \nof capsules or sustained-release capsules.    \n \nA total of 39 drug-drug interactions were detected \nin 20 of the prescriptions (5%).  The groups of \ndrugs most commonly indicated were the beta-\nadrenergic blockers (n=13), antidiabetic agents \n(n=12), diuretics (n=10), calcium channel blockers \n(all 9 cases involved nifedipine), angiotensin-\nconverting enzyme (ACE) inhibitors (n=7), \ncorticosteroids (all six cases involved \nprednisolone) and cardiac glycosides (all five cases \ninvolved digoxin). Fifteen of these interactions \ncould be classified as potentially hazardous and \nshould be avoided if possible or appropriate \nmonitoring  and  precautions should  be taken (14).   \n\n\n\nTable 2:  Errors of omission that were related to the drug ( n = 862). \n \nErrors of Omission Frequency % \n\n\n\nDrug name  2 0.2 \nRoute of administration 690 80 \nDosage \n\u2022 Dose*  \n\n\n\n \n75 \n\n\n\n \n8.7 \n\n\n\n\u2022 Frequency 46 5.3 \n\u2022 Strength  485 56.3 \n\u2022 Dosage form 314 36.4 \n\u2022 Duration or number of doses  76 8.8 \nQuantity to supply  50 5.8 \n \n\n\n\n* cases not mandatory such as creams and ointment had been excluded. \n \n\n\n\n\n\n\n\n\nResearch article: Noncompliance with prescription writing requirements \n\n\n\n \n \n \n \n \n \n \n \n \n \n \nDISCUSSION \n \nErrors of omission \n\n\n\n \nOnly 13 out of the 397 prescriptions screened \ncomplied with all the legal requirements in the \nPoisons Act 1952 and also the procedural \nrequirements of the hospital surveyed.  This \nindicates a need for the hospital to further \nemphasize the necessity of writing clear and \ncomplete prescriptions.  Some useful pointers for \nprescription writing have been suggested (2, 17). \nThese included writing the patient\u2019s full name, \nprinting the name of drugs especially those newly \nmarketed medications and those infrequently \nprescribed agents, as well as indicating the strength \nand dosage form of all drugs prescribed even if \nonly single strength or dosage form is available.  \n \nThe rate of noncompliance to the legal or \nprocedural requirements varied from 80% of drugs \nprescribed with no indication of the route of \nadministration to 0.3% of prescriptions without the \nprescriber\u2019s signature. The seriousness of such \nnoncompliance depends on the types of errors of \nomission.  \n \nThe absence of the patient\u2019s age would not \nnormally prevent the dispensing of the \nprescription. It could be easily resolved with the \npatient or the holder of the prescription if required. \nWhereas, the absence of the prescriber\u2019s signature \nwould invalidate the prescription and cause \ninconvenience to the patient and staff involved. \nThis is especially crucial if the prescription was for \npsychotropic or dangerous drugs (controlled \ndrugs). \n \nThe omission of the strength or dosage form \nrequired may not pose any problem if the drug \nprescribed is available in single strength or dosage \nform. However, with the rapid advances in drug \ndevelopment, many drugs are increasingly \navailable in various strengths and dosage forms \nand hence this type of error  of  omission may pose  \n\n\n\n \n \n \n \n \n \n \n \n \n \n \nsome problems. For example, salbutamol is \navailable in the form of 2 or 4 mg tablets, 4 mg \nsustained-release tablets, syrups, inhalers, \neasyhaler inhalation powder, turbohaler, respirator \nsolutions, rotacaps, nebules and injections.  \n\n\n\n \nMost of the preparations prescribed with no \nindication of the dose to be used were external \npreparations such as eye or ear drops, except for \nthe prescriptions with oral rehydration salts, \nglyceryl trinitrate and GelusilR . The prescribers \nhad probably assumed that the pharmacy staff \nwould give the appropriate standard instructions. \nHowever, it should be emphasized that all oral \npreparations should be prescribed with specific \ndoses as the prescription has limited information \nfor the pharmacy staff to judge the prescriber\u2019s \nintention. \n \nIt appeared that the oral route of administration \nwas not usually specified in the prescription and \nthis was acceptable, although in some instances the \nroute specification may help to identify the \nunspecified dosage form. Drugs prescribed without \nindication of total quantity to be supplied involved \nanalgesics and antipyretics as well as antacids and \nulcer-healing agents. Although many of these \ndrugs may be given on \u201cas required\u201d basis, the \nprescriber is still the best judge on the total \nquantity to be supplied based on the patient\u2019s \nmedical requirement. Even for dermatological, \neye, ear, mouth or nasal preparations, an indication \nof the amount to be supplied is still necessary.   \n \nLegibility assessment is quite subjective and thus \nmay be biased in the study. Whether a prescription \nis legible or not depends on the assessor\u2019s \nfamiliarity with the handwriting of the prescriber \nas well as information provided in the prescription. \nThis has been demonstrated in the present study \nwhere the researcher could not read 28 \nprescriptions as compared to the pharmacist of the \nhospital who was unable to read only three \nprescriptions. However, it should be emphasized \nthat prescriptions should be easily read by anyone \n\n\n\nTable 3:  Errors of commission ( n = 862)   \n \nErrors of Commission Frequency % \n\n\n\nWrong strength  6 0.7 \nWrong dosage form 27 3.1 \nDrug-drug interactions 39 4.5 \n\n\n\nTotal errors of commission  72 8.4 \n \n\n\n\n\n\n\n\n\nResearch article: Noncompliance with prescription writing requirements \n\n\n\ninvolved in the dispensing activities since the \nprescriptions could be filled by any pharmacy \noutside the hospital.  This is especially important \nsince many drugs tend to have similar names such \nas LosecR and LasixR  or DaonilR and AmoxilR  \n(18). This type of error may be reduced if the \nindication of the drug prescribed or the medical \nproblem of the patient is also written in the \nprescription as suggested by Robinson (17). \nTherefore, all prescriptions should be clearly and \nadequately written and if possible printed to \nprevent such medication errors. The \nimplementation of electronic prescribing will \nprobably eliminate some of these problems.  \n\n\n\n \nErrors of commission \n \nErrors of commission represent a greater threat to \nthe patient\u2019s health than errors of omission, if it is \nnot identified and corrected.  If the strength of a \ndrug required is written wrongly, it may lead to \nmore serious consequences than if the strength is \nnot written at all.  If the drug is available as a fixed \namount in a certain dosage form only, then this \ntype of error could be easily identified and \nrectified. For example, if amoxycillin 400 mg is \nprescribed but amoxycillin is only available as 500 \nmg capsules, then most likely it is amoxycillin 500 \nmg that is required.    \n \nGenerally, a wrongly written dosage form does not \nlead to serious consequences unless the strength or \nthe frequency of use of that dosage form is also \ndifferent. For example, the strength of paracetamol \nsyrup is 120 mg per 5 ml while paracetamol \nsuspension is 250 mg per 5 ml.  Therefore, if the \nprescription for a one-year old child was written as \n\u201cParacetamol Suspension 5 ml 6 hourly\u201d, the child \nwould be given 250 mg of paracetamol per dose \ninstead of 120 mg. The pharmacy staff may be \naware of such error if the child\u2019s age is stated on \nthe prescription. However, if both tablet and \ncapsule contained 500mg paracetamol and were \ngiven the same frequency, it would not cause any \nmajor problem if either dosage form were \ndispensed.  \n \nAnother common error in dosage form is related to \nsustained-release (SR) tablets as also mentioned by \nother authors (19). Standard-release  dosage  forms  \n\n\n\nare usually given as 6 hourly, whereas, the SR \ntablets are given as 12 hourly.  For example, if \nketoprofen is prescribed to be taken two times a \nday without the \u201cSR\u201d, the standard-release tablets \nof 50mg may be dispensed instead of the intended \n200mg SR tablets, causing the patient to take an \nunder dose.  \n\n\n\n \nThe frequency of wrongly written dosage form \ncould be under-reported as the error may not be \ndetected even if the prescriber has written tablet \ninstead of capsule or suspension instead of syrup if \nboth the dosage forms are available.  Information \nsuch as the unit strength of the drug required may \nhelp to identify this type of error. This further \nemphasizes the importance of writing a \nprescription with complete details.  \n \nOf the 39 drug-drug interactions identified in the \npresent study, 15 could be classified as potentially \nhazardous but most of the consequences of \ninteractions could be overcome with careful \nmonitoring of the patients. However, the aim of \nreporting such drug-drug interactions is to bring \nawareness to the health care professionals so that \nappropriate precautions would be observed to \nminimize any adverse consequences.  \n \n \nCONCLUSION \n \nThe results of the present study show a low \ncompliance rate to the legal and procedural \nrequirements in prescription writing.  This \nindicates a need for pharmacy and medical \neducators to further emphasize the importance of \nwriting clear and complete prescriptions.  It also \ncalls for the imple mentation of educational and \nmonitoring programmes to bring more awareness \nto all concerned so as to reduce the rate of \nnoncompliance and hence minimize the occurrence \nof prescribing errors.   \n \n \nACKNOWLEDGMENTS \n \nThe authors wish to thank the staff of the \nOutpatient Polyclinic Pharmacy Unit, Universiti \nMalaya Medical Centre for their assistance and \ncooperation.\n\n\n\n\n\n\n\n***** \n \n\n\n\n\n\n\n\n\nResearch article: Noncompliance with prescription writing requirements \n\n\n\n \nREFERENCES \n \n1. Rupp MT, Schondelmeyer SW, Wilson GT, \n\n\n\nKrause JE. Documenting prescribing errors and \npharmacist interventions in community pharmacy \npractice. Am Pharm 1988; NS28 (9): 30-37. \n\n\n\n2. Cohen MR, Davis NM. Complete prescription \norders reduce medication errors. Am Pharm  1992; \nNS32: 24-25.  \n\n\n\n3. Rupp MT. Screening for prescribing errors. Am \nPharm 1991; NS31: 71-78. \n\n\n\n4. Ingrim NB, Hokanson JA, Guernsey BG, Doutre \nWH, Blair CW Jr, Verrett TJ. Physician \nnoncompliance with prescription writing \nrequirements. Am J Hosp Pharm 1983; 40: 414-\n417. \n\n\n\n5. Christensen DB, Campbell WH, Madsen S, \nHartzema AG, Nudelman PM. Documenting \noutpatient problem intervention activities of \npharmacists in an HMO. Med Care  1981; 19: 105-\n117. \n\n\n\n6. Folli HL, Poole RL, Benitz WE, Russo JC. \nMedication error prevention by clinical \npharmacists in two children\u2019s hospital. Pediatrics \n1987; 79: 718-722.  \n\n\n\n7. Morrill GB, Barreuther C. Screening discharged \nprescriptions. Am J Hosp Pharm 1988; 45: 1904-\n1905. \n\n\n\n8. Hawkey CJ, Hodgson S, Norman A, Daneshmend \nTK, Garner ST. Effect of reactive pharmacy \nintervention on quality of hospital prescribing. \nBMJ 1990; 300: 986-990.        \n\n\n\n \n \n9. Bates DW, Boyle DL, Vander Vliet MB, \n\n\n\nSchneider J, Leape LL. Relationship between \nmedication errors and adverse drug events. J Gen \nIntern Med 1995; 10: 199-205. \n\n\n\n10. Lesar TS, Briceland L, Stein DS. Factors related to \nerrors in medication prescribing. JAMA 1997; 277: \n312-317. \n\n\n\n11. Lesar TS, Lomaestro BM, Pohl H. Medication \nprescribing errors in a teaching hospital. A 9-year \nexperience. Arch Intern Med  1997; 157: 1569-76. \n\n\n\n12. Senarai ubat-ubatan. Kuala Lumpur: Pusat \nPerubatan Universiti Malaya; 1996. \n\n\n\n13. Poisons Act 1952 (Act 366). Kuala Lumpur: \nInternational Law Book Services; 1997.  \n\n\n\n14. British National Formulary. 40th ed. London: \nBritish Medical Association and the Royal \nPharmaceutical Society; September 1998. \n\n\n\n15. Reynolds JEF, editor.  Martindale, The Extra \nPharmacopoeia. 31st ed. London: Royal \nPharmaceutical Society; 1996. \n\n\n\n16. Stockley IH. Drug Interactions. 3rd ed.  London: \nBlackwell Scientific Publications; 1994.  \n\n\n\n17. Robinson A. An ounce of prevention could \neliminate most prescription-writing errors. Can \nMed Assoc J  1994; 151: 659-661. \n\n\n\n18. Aronson JK. Confusion over similar drug names: \nProblems and solutions. Drug Safety 1995; 12(3): \n155-160.   \n\n\n\n19. Lesar TS. Common prescribing errors. Ann Intern \nMed 1992; 117(6): 537-538. \n\n\n\n\n\n"
"\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n345 \n \n\n\n\nStudy of Aminoglycosides Use among In-patients at Hospital Kuala Lumpur \n\n\n\n \nEndang Kumolosasi\n\n\n\n1\n,  Siti Aishah Mohamad Nor\n\n\n\n1\n, Tengku Karmila Tengku Mohd Kamil\n\n\n\n1 \n\n\n\n\n\n\n\n1\nFaculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur. \n\n\n\n\n\n\n\nCorrespondence Author: Endang Kumolosasi, Email: e_kumolosasi@yahoo.co.id \n\n\n\n\n\n\n\n_________________________________________________________________________________ \n\n\n\n\n\n\n\nABSTRACT \n\n\n\n\n\n\n\nAminoglycosides are a group of antibiotics that have been widely used in treatment of infections especially \n\n\n\ncaused by gram negative bacteria. The purpose of this research was to study the aminoglycosides use among \n\n\n\nin-patients. This study was carried out retrospectively which included the patients 18 years and above who had \n\n\n\nreceived aminoglycosides therapy from July 2008 until December 2008. Patients with incomplete data were \n\n\n\nexcluded. A total of 104 patients were included in this study based on the inclusion criteria. The \n\n\n\naminoglycosides were used in patients who had normal renal function and also in patients who were in end \n\n\n\nstage renal failure. Gentamicin was the most frequently used (44.2%), followed by amikacin (33.7%), \n\n\n\nnetilmicin (13.4%) and the least frequently used was streptomycin (8.7%). The culture and sensitivity test had \n\n\n\nbeen performed only to 62% of patients. Indication was appropriate in 95.2% patients and was inappropriate \n\n\n\nin 4.8% patients (p<0.001). Appropriate doses were given to  59.6% patients and  37.4% patients had received \n\n\n\ninappropriate doses (p>0.05) and 5.8% patients were not assessable. Duration of therapy was appropriate in \n\n\n\n87.5% patients and there were 12.5% patients did not received therapy in appropriate duration (p<0.001). A \n\n\n\ntotal of 77(89.5%) cases of pharmacodynamic and 9(10.4%) cases of pharmacokinetic potential drug-drug \n\n\n\ninteractions between aminoglycosides and other drugs were identified. There were 3 cases had minor severity \n\n\n\nand the rest had moderate severity. Conclusion: The appropriateness of aminoglycosides use still needs to be \n\n\n\nimproved in order to ensure  their effectiveness and safety in clinical setting. \n\n\n\n\n\n\n\nKeywords:  aminoglycosides; antibiotic; infection treatment; drug use evaluation; drug interactions. \n\n\n\n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011, pg 345 - 355 \n\n\n\n\n\n\n\n\n\n\n\nINTRODUCTION \n\n\n\n\n\n\n\nAminoglycosides are active particularly against \n\n\n\naerobic, gram-negative bacteria and  also active \n\n\n\nagainst certain gram-positive organisms. The most \n\n\n\ncommonly used aminoglycoside was gentamicin \n\n\n\nbut amikacin may be particularly effective against \n\n\n\nresistant organisms\n1\n. Aminoglycosides exhibit\n\n\n\n\n\n\n\nconcentration-dependent bactericidal activity and \n\n\n\npostantibiotic\n \neffect that allows continued efficacy \n\n\n\neven when serum concentrations\n \n\n\n\nfall below \n\n\n\nexpected minimal inhibitory concentrations\n2\n\n\n\n. \n\n\n\n\n\n\n\nAminoglycosides are most frequently used \n\n\n\nclinically in empirical therapy of serious infections \n\n\n\nsuch as septicemia, nosocomial respiratory tract \n\n\n\ninfections, complicated urinary tract infections and \n\n\n\ncomplicated intra-abdominal infections caused by \n\n\n\naerobic gram-negative bacilli\n3\n. They are also used \n\n\n\nfor prophylaxis, especially against endocarditis\n1\n. \n\n\n\nHowever, in long-term treatment, once an \n\n\n\norganism had been identified and susceptibilities \n\n\n\nhad been determined, aminoglycosides were often \n\n\n\ndiscontinued in favor of less toxic antibiotic \n\n\n\noptions\n3\n \n\n\n\n\n\n\n\nSince aminoglycoside antibiotics were being \n\n\n\nintroduced into therapeutic practice in 1944, \n\n\n\ngentamicin and amikacin were the most commonly \n\n\n\nused antibiotics worldwide for the treatment of \n\n\n\ngram-negative bacterial infections. In many cases, \n\n\n\nthey have been the only effective antibiotics \n\n\n\nagainst bacterial strains resistant to other \n\n\n\nantibiotics. Aminoglycosides show poor degree of \n\n\n\noral absorption, thus intravenous administration is \n\n\n\nusually used\n4,5\n\n\n\n They are eliminated by glomerular \n\n\n\nfiltration and 3 to 5 % of the total dose is partially \n\n\n\nreabsorbed by proximal tubular cells\n6,4\n\n\n\n. \n\n\n\nThe usefulness of aminoglycosides for the \n\n\n\ntreatment of wide range of gram negative \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n346 \n \n\n\n\ninfections caused them to be widely prescribed, \n\n\n\nbut serious toxicity of these antibiotics had limited \n\n\n\ntheir use\n7\n. The prolonged and improper use of \n\n\n\naminoglycosides may cause development of \n\n\n\nresistance pathogens and also development of \n\n\n\nnephrotoxicity and ototoxicity. A review on the \n\n\n\nuse of these agents may give benefit for quality \n\n\n\nand safe use of aminoglycosides. Drug utilization \n\n\n\nevaluations are carried out  primarily aimed to \n\n\n\nimprove prescribing, and thus the quality of health \n\n\n\ncare, and also to minimize needless drug \n\n\n\nexpenditure. The optimal utilization of \n\n\n\naminoglycosides is important to minimize the \n\n\n\ndevelopment of resistance pathogen and minimize \n\n\n\ntoxicity. Therefore, it is necessary to evaluate the \n\n\n\nusage of aminoglycosides in the hospital settings \n\n\n\nto improve the quality use of these agents by \n\n\n\npromoting proper utilization\n8\n.  \n\n\n\n\n\n\n\nThe objective of this research is to study the use of \n\n\n\naminoglycoside antibiotics among in-patients \n\n\n\nincluding evaluation of the appropriateness of \n\n\n\nindication, dosing and duration of aminoglycosides \n\n\n\ntherapy and the possible drug interactions that \n\n\n\noccurred during the treatment.  \n\n\n\n\n\n\n\nMETHODOLOGY \n\n\n\n\n\n\n\nThis study was conducted retrospectively over a \n\n\n\nperiod of six months from July 2008 to December \n\n\n\n2008. The inclusive criteria for this study were the \n\n\n\npatients who received aminoglycosides within July \n\n\n\n2008 to December 2008 with the age 18 years and \n\n\n\nabove. The exclusive criterion was the patients \n\n\n\nwho had incomplete data. \n\n\n\n\n\n\n\nData were collected by using the collecting data \n\n\n\nforms that were included patient demographics \n\n\n\nsuch as registration number, age, gender, body \n\n\n\nweight, past medical history as well as therapeutic \n\n\n\ndata including indication, dose, duration, \n\n\n\nfrequency of aminoglycosides, concurrent \n\n\n\nmedication taken and laboratory data such as full \n\n\n\nblood count, culture and sensitivity test and renal \n\n\n\nfunction test. The sample size was calculated using \n\n\n\nKrejcie & Morgan 1970 sample size calculation \n\n\n\nand 104 patients were able to be included in this \n\n\n\nstudy. \n\n\n\n\n\n\n\nIn order to  assess the appropriateness of \n\n\n\naminoglycosides use, the guidelines for antibiotic \n\n\n\nuse were referred such as Hospital Antibiotic \n\n\n\nGuidelines 2008 and National Antibiotic \n\n\n\nGuidelines 2008. The guidelines provide relevant \n\n\n\ninformation on the use of aminoglycosides, \n\n\n\nincluding indication, dose, duration of therapy, in \n\n\n\nchoosing the aminoglycosides. The dosing was \n\n\n\nconsidered appropriate if it was within the dosing \n\n\n\nrange and being adjusted according to creatinine \n\n\n\nclearance, otherwise it was considered as \n\n\n\nsubtherapeutic or overdose. Meanwhile, the \n\n\n\nindication to use the drug was considered \n\n\n\nappropriate if it was given based on lab results \n\n\n\nwhich were microbiological culture and sensitivity \n\n\n\ntest or adhered to the indication as in the \n\n\n\nguidelines. Meanwhile, the duration of treatment \n\n\n\nwas considered appropriate if it was taken at least \n\n\n\n1 day for prophylaxis, at least 3 days for acute \n\n\n\ninfections and at least 2 months for tuberculosis \n\n\n\ntreated by streptomycin. The duration also was \n\n\n\nconsidered appropriate even though it was taken \n\n\n\nless than these stated durations but continued with \n\n\n\nother antibiotics based on culture and sensitivity \n\n\n\ntest. Drug interactions were assessed using the \n\n\n\nreference of Drug Interaction Analysis and \n\n\n\nManagement\n9\n\n\n\n.\n \nPharmacokinetic drug interactions \n\n\n\nwere assessed regarding to the effect of drug \n\n\n\naction on absorption, distribution, metabolism and \n\n\n\nelimination. Pharmacodynamic drug interactions \n\n\n\nwere assessed regarding to the enhancement of \n\n\n\neffect of other drugs in the body or reciprocally. \n\n\n\nClassification on severity of interactions had been \n\n\n\ndivided into 3 categories which are major, \n\n\n\nmoderate and minor. \n\n\n\n\n\n\n\nSTATISTICAL ANALYSIS  \n\n\n\n\n\n\n\nData were analyzed using Microsoft Excel 2007 \n\n\n\nand SPSS 16.0. The Chi- square test was used \n\n\n\nwhere appropriate. Data were presented in \n\n\n\ndescriptive form such as pie-chart, bar chart and \n\n\n\ntable. The statistical tests were performed using \n\n\n\n0.05 level of significance. \n\n\n\n\n\n\n\nRESULTS \n\n\n\n\n\n\n\nTable 1 showed a total of 104 in-patients who had \n\n\n\nbeen treated with aminoglycosides for various \n\n\n\ninfections within July 2008 until December 2008. \n\n\n\nMost of the patients included in this study were \n\n\n\nadults 73.1% and the elderly were 26.9% patients. \n\n\n\nThe patients consisted of 59.6 % male and 40.4 % \n\n\n\nfemale. The mean duration of hospitalization was \n\n\n\n27 \u00b1 24 days. Most of the patients had normal \n\n\n\nrenal function 53.8% and 9 patients (8.7%) were in \n\n\n\nend stage renal failure with the creatinine \n\n\n\nclearance less than 15 ml per minute. Meanwhile, \n\n\n\n6 patients (5.8%) and 12 patients (11.5%) were in \n\n\n\nstage 4 and stage 3 of renal failure respectively. \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n347 \n \n\n\n\nTable 1: Demographic data, duration of hospitalization and renal function status of  104 patients \n\n\n\nreceived aminoglycosides therapy. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n            NA: Not Assessable \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nFigure 1: Percentage of aminoglycosides use (N=104) \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n44.2% \n\n\n\n34.7% \n\n\n\n13.4% \n8.7% Gentamicin\n\n\n\nAmikacin\n\n\n\nNetilmicin\n\n\n\nStreptomycin\n\n\n\nVariable No. of patients \n\n\n\n (N=104) \n\n\n\n% of patients \n\n\n\nAge (years) \n\n\n\n        18-65 \n\n\n\n        >65 \n\n\n\n\n\n\n\n76  \n\n\n\n28  \n\n\n\n\n\n\n\n73.1 \n\n\n\n26.9 \n\n\n\nGender \n\n\n\n        Male \n\n\n\n        Female \n\n\n\n\n\n\n\n62 \n\n\n\n42 \n\n\n\n\n\n\n\n59.6 \n\n\n\n40.4 \n\n\n\n Race \n\n\n\n        Malay \n\n\n\n        Chinese \n\n\n\n        Indian \n\n\n\n        Others \n\n\n\n\n\n\n\n60  \n\n\n\n32  \n\n\n\n3  \n\n\n\n9  \n\n\n\n\n\n\n\n57.7 \n\n\n\n30.8 \n\n\n\n2.9 \n\n\n\n8.7 \n\n\n\nDuration of hospitalization (days) \n\n\n\n        Mean \u00b1 SD                 \n\n\n\n        Median (range) \n\n\n\n\n\n\n\n27 \u00b1 24 \n\n\n\n20 (2-113) \n\n\n\n\n\n\n\nRenal function status  \n\n\n\n(Creatinine clearance, ml/min) \n\n\n\n       \u2265 90 (stage 1) \n\n\n\n      60-89 (stage 2) \n\n\n\n      30-59 (stage 3) \n\n\n\n      15-29 (stage 4) \n\n\n\n      <15 (stage 5 or ESRF) \n\n\n\n      NA \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n56  \n\n\n\n19  \n\n\n\n12  \n\n\n\n6  \n\n\n\n9  \n\n\n\n2 \n\n\n\n\n\n\n\n\n\n\n\n53.8 \n\n\n\n18.3 \n\n\n\n11.5 \n\n\n\n5.8 \n\n\n\n8.7 \n\n\n\n1.9 \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n348 \n \n\n\n\nFigure 2: Number of patients received aminoglycosides for various types of diagnosis   (N=104) \n\n\n\n\n\n\n\n\n\n\n\nAmong four types of aminoglycosides used, the \n\n\n\nmost commonly prescribed was gentamicin (44.2 \n\n\n\n%), followed by amikacin (34.7 %) and netilmicin \n\n\n\n(13.4%). The least frequently prescribed was \n\n\n\nstreptomycin (8.7%). The results were shown in \n\n\n\nFigure 1. \n\n\n\n\n\n\n\nFigure 2 showed that gentamicin, amikacin and \n\n\n\nnetilmicin were most widely used to treat sepsis. In \n\n\n\ntuberculosis treatment, 9 patients were treated with \n\n\n\nstreptomycin and 1 patient was treated with \n\n\n\namikacin and gentamicin respectively. In \n\n\n\nrespiratory tract infection, urinary tract infection \n\n\n\nand meningitis, only gentamicin and amikacin \n\n\n\nwere used. Gentamicin was the only one \n\n\n\naminoglycoside that had been used in prophylaxis, \n\n\n\nand most of them were used in endocarditis \n\n\n\nprophylaxis following surgery procedure. The \n\n\n\naminoglycosides also were indicated for other \n\n\n\ndiagnosis such as infective endocarditis, \n\n\n\npanniculitis and infected wound. \n\n\n\n\n\n\n\nIn this study, 62% patients had performed culture \n\n\n\nand sensitivity test. There were 38% patients who \n\n\n\ndid not have culture and sensitivity results. The \n\n\n\npercentage of patients based on culture and \n\n\n\nsensitivity test were shown in Figure 3.  \n\n\n\n\n\n\n\n\n\n\n\nTable 2:  Range of aminoglycoside doses per day received by patients  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n15 \n\n\n\n5 \n2 2 1 \n\n\n\n12 \n9 \n\n\n\n22 \n\n\n\n8 \n\n\n\n1 1 \n1 \n\n\n\n2 \n\n\n\n12 \n\n\n\n2 \n\n\n\n9 \n\n\n\n0\n\n\n\n10\n\n\n\n20\n\n\n\n30\n\n\n\n40\n\n\n\n50\n\n\n\nSepsis Respiratory\n\n\n\ntract\n\n\n\ninfection\n\n\n\nUrinary tract\n\n\n\ninfection\n\n\n\nMeningitis TuberculosisProphylaxis Others\n\n\n\nN\no\n. \no\nf \n\n\n\np\na\nti\n\n\n\nen\nts\n\n\n\n\n\n\n\nTypes of diagnosis  \n\n\n\nGentamicin Amikacin Netilmicin Streptomycin\n\n\n\nDrug Patients` dose range \n\n\n\n(mg/kg/day) \n\n\n\nUsual dose therapeutic range \n\n\n\n(mg/kg/day) \n\n\n\nGentamicin 1 - 47.61 3 - 7 \n\n\n\nAmikacin 3.13 - 19.74 15 - 20 \n\n\n\nNetilmicin 2.14 - 8.04 3 - 7 \n\n\n\nStreptomycin 0.01mg - 1g/day 15 - 30mg/kg/day  \n\n\n\nor 1 - 2 g/day  \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n349 \n \n\n\n\nFigure 3: Percentage of patients based on culture and sensitivity (C & S) test (N=104) \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nTable 3:  Duration of aminoglycoside therapies  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nTable 4:  Appropriateness of aminoglycoside indications  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n62% \n\n\n\n38% \n\n\n\nPatients with C & S test Patients without C & S test\n\n\n\nDuration of therapy \n\n\n\n(days) \n\n\n\nNumber of patient \n\n\n\nN:104 \n\n\n\nPercentage of \n\n\n\npatient \n\n\n\n1-2 31 29.8 \n\n\n\n3-7 38 36.5 \n\n\n\n8-14 26 25 \n\n\n\n>14 9 8.7 \n\n\n\nTypes of \n\n\n\nAminoglycosides \n\n\n\nAppropriate Inappropriate Total (%)  \n\n\n\nNumber of \n\n\n\npatients \n\n\n\n%  of \n\n\n\npatients \n\n\n\nNumber \n\n\n\nof \n\n\n\npatients \n\n\n\n%  of \n\n\n\nPatients \n\n\n\n\n\n\n\nGentamicin    41 39.4 5 4.8 46 (44.2) \n\n\n\nAmikacin       35 33.7 - - 35 (33.7) \n\n\n\nNetilmicin      14 13.7 - - 14 (13.5) \n\n\n\nStreptomycin  9 8.7 - - 9 (8.7) \n\n\n\nTotal of patients         99 95.2 5 4.8 104 (100) \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n350 \n \n\n\n\nTable 2 showed that some doses of all types of \n\n\n\naminoglycosides had been used in subtherapeutic \n\n\n\ndose. Some doses of gentamicin, and netilmicin \n\n\n\nwere used in overdose. \n\n\n\n\n\n\n\nTable 3 showed that most of the patients (36.5%) \n\n\n\nhad received the aminoglycosides therapy for 3 to \n\n\n\n7 days.  There were 29.8% patients had received \n\n\n\naminoglycosides therapy for less than 3 days, and  \n\n\n\nmost of patients received aminoglycosides for \n\n\n\nprophylaxis following surgical procedure. Only 9 \n\n\n\npatients (8.7%) had received aminoglycosides for \n\n\n\nmore than 14 days.  \n\n\n\n\n\n\n\nGentamicin was appropriately indicated in 39.4% \n\n\n\npatients. However, there were 4.8% patients had \n\n\n\nreceived gentamicin for inappropriate indication. \n\n\n\nThe use of amikacin, netilmicin and streptomycin \n\n\n\nin all patients who received these antibiotics were \n\n\n\nappropriate. The results were shown in Table 4. \n\n\n\n\n\n\n\nTable 5 showed that 27(26%) patients had received \n\n\n\nappropriate dose of gentamicin. A total of 12 \n\n\n\n(11.5%) of patients were found to receive \n\n\n\ngentamicin in subtherapeutic dose and 4 (3.9%) \n\n\n\npatients had received more than therapeutic dose \n\n\n\nand 3 (2.9%) patients were not assessable. The \n\n\n\ndose of amikacin was given appropriately in \n\n\n\n19(18.3%) of patients. However, 14 (13.5%) \n\n\n\npatients had received subtherapeutic dose of \n\n\n\namikacin and 2 (1.9%) patients had received \n\n\n\namikacin in more than therapeutic dose . The 2 \n\n\n\n(1.9%) patients that received more than therapeutic \n\n\n\ndose of netilmicin and 9 (8.7%) patients had  \n\n\n\nappropriate doses, but subtherapeutic doses had \n\n\n\nbeen given to 3(2.9%) of patients. Dose of \n\n\n\nstreptomycin was given appropriately to 7 (6.7%) \n\n\n\npatients and 2 (1.9%) patients had received \n\n\n\nsubtherapeutic dose of streptomycin. \n\n\n\n\n\n\n\nDuration of therapy was found to be appropriate in \n\n\n\n43 (41.3%) patients for gentamicin, 33 (31.7%) \n\n\n\npatients for amikacin, 12 (11.5%) patients for \n\n\n\nnetilmicin and 3 (2.9%) patients for streptomycin. \n\n\n\nInappropriate duration of therapy was found in 3 \n\n\n\n(2.9%) patients for gentamicin, 2 (1.9%) patients \n\n\n\nfor amikacin, 2 (1.9%) patients for netilmicin and \n\n\n\n6 (5.8%) patients for streptomycin. The results \n\n\n\nwere shown in Table 6. \n\n\n\n\n\n\n\nTable 7 showed that the indication of the \n\n\n\naminoglycosides were appropriate in majority of \n\n\n\nthe patients (p<0.001). There were 99 (95.2%) of \n\n\n\npatients had appropriately indicated with \n\n\n\naminoglycosides and 5 (4.8%) patients were not \n\n\n\napproprietly indicated. The dose of \n\n\n\naminoglycosides was appropriate in 62 (59.6%) of \n\n\n\npatients and was found to be inappropriate in 39 \n\n\n\n(37.5%) patients (p>0.05). A total of 91 (87.5%) \n\n\n\npatients had been treated with appropriate duration \n\n\n\nof therapy. However, inappropriate duration had \n\n\n\nbeen occurred in 13 (12.5%) patients (p<0.001). \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nTable 5: Appropriateness of aminoglycoside doses  \n\n\n\nNote: Inappropriateness of doses: 38 (37.4%) of patients \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nTypes of \n\n\n\nAmino-\n\n\n\nglycosides \n\n\n\nAppropriate  Sub-\n\n\n\ntherapeutic  \n\n\n\nMore than \n\n\n\ntherapeutic \n\n\n\ndose  \n\n\n\n\n\n\n\nNot \n\n\n\nAssessable  \n\n\n\nTotal (%) \n\n\n\nNumber of     \n\n\n\npatients (%) \n\n\n\n\n\n\n\nNumber of     \n\n\n\npatients (%) \n\n\n\nNumber of     \n\n\n\npatients (%) \n\n\n\nNumber of      \n\n\n\npatients (%) \n\n\n\nGentamicin 27 (26) 12 (11.5) 4 (3.9) 3 (2.9) 46 (44.2) \n\n\n\nAmikacin 19 (18.3) 14 (13.5) 2 (1.9) - 35 (33.7) \n\n\n\nNetilmicin 9 (8.7) 3 (2.9) 2 (1.9) - 14 (13.5) \n\n\n\nStreptomycin 7 (6.7) 2 (1.9) - - 9 (8.7) \n\n\n\nTotal of patients 62 (59.6) 31 (29.8) 8 (7.6) 3 (2.9) 104 (100) \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n351 \n \n\n\n\nTable 6: Appropriateness of aminoglycoside durations  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nTable 7 showed that the indication of the \n\n\n\naminoglycosides were appropriate in majority of \n\n\n\nthe patients (p<0.001). There were 99 (95.2%) of \n\n\n\npatients had appropriately indicated with \n\n\n\naminoglycosides and 5 (4.8%) patients were not \n\n\n\napproprietly indicated. The dose of \n\n\n\naminoglycosides was appropriate in 62 (59.6%) of \n\n\n\npatients and was found to be inappropriate in 39 \n\n\n\n(37.5%) patients (p>0.05). A total of 91 (87.5%) \n\n\n\npatients had been treated with appropriate duration \n\n\n\nof therapy. However, inappropriate duration had \n\n\n\nbeen occurred in 13 (12.5%) patients (p<0.001). \n\n\n\n\n\n\n\nTable 8 showed that pharmacodynamic drug \n\n\n\ninteractions were predominant (89.5%) compared \n\n\n\nto pharmacokinetic interactions (10.5%). The cases \n\n\n\nof potential drug interactions were the highest \n\n\n\nbetween aminoglycosides and penicillin (44.2%). \n\n\n\nThe potential interactions between \n\n\n\naminoglycosides and cephalosporins were \n\n\n\n34(39.5%) cases. There were also 5 and 6 cases of \n\n\n\npotential interactions of aminoglycosides with \n\n\n\nvancomycin and non-steroidal antiiflammatory \n\n\n\ndrugs (NSAIDs) respectively. The potential \n\n\n\ninteractions of aminoglycosides with loop diuretics \n\n\n\nhad been identified only in 3 cases. The severity \n\n\n\nfor all these interactions is moderate except for \n\n\n\naminoglycosides and loop diuretics interactions, \n\n\n\nthe severity is minor. \n\n\n\n\n\n\n\nDISCUSSION \n \n\n\n\nNephrotoxicity is one of the major \n\n\n\naminoglycosides adverse effects\n4,7,10,11\n\n\n\nIn this study, \n\n\n\nsome patients who had received aminoglycosides \n\n\n\ntherapy were having renal impairment and renal \n\n\n\nfailure. They were more likely to get \n\n\n\nnephrotoxicity compared to patients with normal \n\n\n\nrenal function. Aminoglycoside associated \n\n\n\nnephrotoxicity appeared to be more common \n\n\n\namong patients with preexisting renal \n\n\n\nimpairment\n12\n\n\n\n. \n\n\n\n\n\n\n\nNephrotoxicity can occur  when the usual doses \n\n\n\nwere given to patients with underlying renal \n\n\n\ndisease. In order to prevent aminoglycoside-\n\n\n\ninduced nephrotoxicity in clinical practice, \n\n\n\naminoglycosides should be used as once daily dose \n\n\n\nrather than divided dose especially in high-risk \n\n\n\nindividuals. The combination of aminoglycosides \n\n\n\nwith other potential nephrotoxins such as \n\n\n\namphotericin, cisplatin, diuretics should be \n\n\n\navoided. During aminoglycoside therapy, adequate \n\n\n\nhydration must be ensured especially in the \n\n\n\nelderly. Besides that, the dose should be modified \n\n\n\naccording to individual glomerular filtration rate\n13\n\n\n\n. \n\n\n\n\n\n\n\n\n\n\n\nTable 7: Summary of appropriateness of aminoglycosides use  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n*There were significant differences (p<0.001). \n\n\n\nTypes of \n\n\n\nAmino-\n\n\n\nglycosides  \n\n\n\nAppropriate Inappropriate Total (%) \n\n\n\nNumber of \n\n\n\npatients \n\n\n\n% of patients  Number of \n\n\n\npatients \n\n\n\n% of \n\n\n\npatients  \n\n\n\nGentamicin   43 41.3 3 2.9 46 (44.2) \n\n\n\nAmikacin     33 31.7 2 1.9 35 (33.7) \n\n\n\nNetilmicin  12 11.5 2 1.9 14 (13.5) \n\n\n\nStreptomycin  3 2.9 6 5.8 9 (8.7) \n\n\n\nTotal of \n\n\n\npatients \n\n\n\n\n\n\n\n91 \n\n\n\n\n\n\n\n87.5 \n\n\n\n\n\n\n\n13 \n\n\n\n\n\n\n\n12.5 \n\n\n\n\n\n\n\n104 (100) \n\n\n\nCriteria  No. of patients (%)  \n\n\n\n    p value Appropriate Inappropriate Not Assessable Total \n\n\n\nIndication  99  (95.2) 5 (4.8) - 104 (100) 0.000* \n\n\n\nDose  62 (59.6) 39 (37.5) 3 (2.9) 104 (100) 0.486  \n\n\n\nDuration  91 (87.5) 13 (12.5) - 104 (100) 0.000* \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n352 \n \n\n\n\nTable 8: Potential drug-drug interactions between aminoglycosides and other drugs \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nAccording to Gonzalez and Spencer (1998), in \n\n\n\norder to minimize aminoglycosides toxicity, they \n\n\n\nshould only be used when their unique antibiotic \n\n\n\npotency is needed, such as treatment of infection in \n\n\n\ncritically ill patients, in nosocomial infections or \n\n\n\ninfections with organisms resistant to less toxic \n\n\n\ntherapies\n1\n. The clinician should change to a \n\n\n\npotentially less toxic antibiotic as soon as the \n\n\n\ninfecting organisms and its antibiotic sensitivities \n\n\n\nhave been determined. Potential risk factors that \n\n\n\npredispose to nephrotoxicity should be identified \n\n\n\nand corrected when possible. \n\n\n\n\n\n\n\nIn this study, the gentamicin was found to be the \n\n\n\nmost frequently prescribed compared to the other \n\n\n\ntypes of aminoglycosides. Amikacin mostly were \n\n\n\nprescribed by the doctor when the organisms were \n\n\n\nfound resistant to gentamicin. According to \n\n\n\nGonzalez and Spencer (1998), gentamicin was the \n\n\n\nmost commonly used aminoglycoside, but \n\n\n\namikacin may be particularly effective against \n\n\n\nresistant organisms\n1\n. Gallagher and MacDougall \n\n\n\n(2009) also stated that gentamicin and tobramycin \n\n\n\nwere the most widely used drugs and amikacin \n\n\n\nwas used when the pathogens resistant to these \n\n\n\nfirst two drugs\n14\n\n\n\n. Gentamicin remains the \n\n\n\naminoglycoside of choice in hospitals because of \n\n\n\nits low cost and less resistant among \n\n\n\nEnterobacteriaceae and Pseudomonas \n\n\n\naeruginosa\n15,16,17\n\n\n\n.Streptomycin was the least used \n\n\n\naminoglycoside as it was only used in hospital for \n\n\n\nthe treatment of tuberculosis. \n\n\n\n\n\n\n\nThe findings from this study showed that \n\n\n\naminoglycosides were indicated mostly for sepsis \n\n\n\nin this hospital. The aminoglycosides are useful in \n\n\n\nthe treatment of sepsis caused by aerobic gram-\n\n\n\nnegative bacilli\n11\n\n\n\n. Begg and Barclay (1995) also \n\n\n\nstated that aminoglycosides remain the drugs of \n\n\n\nchoice to treat septicaemia\n18\n\n\n\n. Based on the result, \n\n\n\namikacin was the antibiotic of choice in treating \n\n\n\nsepsis compared to the other types of \n\n\n\naminoglycosides. The study done by Francetic and \n\n\n\ncolleagues (2008) had revealed that the overall \n\n\n\nnumber of patients having gram-negative bacteria \n\n\n\nbloodstream infection was significantly reduced \n\n\n\nduring amikacin treatment, with the reduction of \n\n\n\nsepsis rate from 3.6% to 2.2%\n19\n\n\n\n.  \n\n\n\n\n\n\n\nCulture and sensitivity tests are the basis for the \n\n\n\nappropriate and optimal use of antibiotics in \n\n\n\ntreating various infections\n8\n. The selection of \n\n\n\nantibiotics will be more appropriate if the culture \n\n\n\nand sensitivity result were available. In this study, \n\n\n\nthe patients who had no culture and sensitivity \n\n\n\nresults were treated with aminoglycosides for \n\n\n\nempirical therapy. Although there were no culture \n\n\n\nand sensitivity result in a number of cases, the \n\n\n\nchoice of appropriate antibiotics are is still very \n\n\n\nimportant. This is because appropriate empirical \n\n\n\nantibiotic treatment was associated with a better \n\n\n\nsurvival and shortened duration of hospital stay in \n\n\n\npatients with bacterial infections\n20\n\n\n\n. \n\n\n\n\n\n\n\nThe indication of aminoglycosides in this study \n\n\n\nwas appropriate in most of the patients (95.2%). \n\n\n\nThese findings were similar to the results of \n\n\n\nRamesh and colleagues study (2002) that showed \n\n\n\nthe appropriateness of aminoglycosides indication \n\n\n\nwas high (72%)\n8\n. The indication was inappropriate \n\n\n\nin a few patients because  the same \n\n\n\naminoglycosides were still used in the patients \n\n\n\neven though the culture and sensitivity results \n\n\n\nshowed that the bacteria were already resistant to \n\n\n\nthose antibiotics. The indication was also \n\n\n\nDrug interaction \n\n\n\nAminoglycoside \n\n\n\nwith \n\n\n\nTypes of interaction Severity Number of \n\n\n\ninteraction \n\n\n\ncases(N:86) \n\n\n\n% of \n\n\n\ninteraction \n\n\n\ncases \n\n\n\nCephalosporins Pharmacodynamic Moderate 34 39.5 \n\n\n\nPenicillins Pharmacodynamic Moderate 38 44.2 \n\n\n\nVancomycin \n\n\n\n\n\n\n\nPharmacodynamic Moderate 5 5.8 \n\n\n\nTotal pharmacodynamic interactions \n\n\n\n\n\n\n\n77 89.5 \n\n\n\nLoop diuretics Pharmacokinetic Minor 3 3.5 \n\n\n\nNSAIDS \n\n\n\n\n\n\n\nPharmacokinetic Moderate 6 6.9 \n\n\n\nTotal pharmacokinetic interactions \n\n\n\n\n\n\n\n9 10.5 \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n353 \n \n\n\n\nconsidered inapproproate when the treatments \n\n\n\ngiven were not adhering to the guidelines. \n\n\n\n\n\n\n\nThere were a number of patients who received \n\n\n\nmore than therapeutic dose of  aminoglycosides. \n\n\n\nThese patients had higher risk of getting adverse \n\n\n\neffects as a study done by Zahid and colleagues \n\n\n\n(2007) concluded that aminoglycosides cause \n\n\n\nnephrotoxicity by producing damaging effects on \n\n\n\nrenal tubules especially at higher dose\n21\n\n\n\n. \n\n\n\nAccording to Sandhu and colleagues (2007), the \n\n\n\nnephrotoxicity was more likely to occur if large \n\n\n\ndoses are given over prolong periods\n13\n\n\n\n. Therefore, \n\n\n\nit should be used at the lowest dose and shortest \n\n\n\npossible course of therapy. Besides that, the dose \n\n\n\nappropriateness of 3 patients (2.9%) who had \n\n\n\nreceived gentamicin cannot be assessed because \n\n\n\nthere was no information about the serum \n\n\n\ncreatinine of these patients.  \n\n\n\n\n\n\n\nAccording to Sanford and Root (1999), there were \n\n\n\nalmost none for all studies of treatment of \n\n\n\ninfections with antimicrobial agents that had \n\n\n\nestablished the minimal duration of therapy for any \n\n\n\ninfection\n22\n\n\n\n. Mostly, the recommendations of \n\n\n\ntreatment duration are based on experiences either \n\n\n\nthe treatments are success, failure or relapse. Short \n\n\n\ncourse therapy is given for 3 to 14 days, \n\n\n\nintermediate courses is recommended for about 4 \n\n\n\nto 6 weeks for infections that are difficult to \n\n\n\neradicate such as endocarditis and long courses of \n\n\n\nmore than 6 months for the infections such as \n\n\n\ntuberculosis. \n\n\n\n\n\n\n\nThere was not much evidence-based information \n\n\n\non the appropriate duration of treatment for most \n\n\n\ninfectious diseases. In many infections, optimal \n\n\n\nduration is defined by the absence of relapse after \n\n\n\nan arbitrarily chosen number of days for example \n\n\n\nare 7, 10 and 14 days of treatment. Usually, the \n\n\n\nminimum duration required is not known\n23\n\n\n\n. The \n\n\n\noptimal duration for a course of antimicrobial \n\n\n\ntherapy is unknown and many studies are \n\n\n\ninvestigating the issue. Reduction in duration of \n\n\n\ntherapy reduced total antibiotic use and resistance. \n\n\n\nBesides that, it also reduced toxicity and costs\n24\n\n\n\n. \n\n\n\nAccording to Hedrick (2006), shorter duration of \n\n\n\nantibiotics therapy was associated with similar or \n\n\n\nfewer complications than prolonged therapy\n25\n\n\n\n. \n\n\n\n\n\n\n\nThe appropriateness of aminoglycosides duration \n\n\n\nis very important because of the narrow \n\n\n\ntherapeutic\n \nindex and its potential toxicity\n\n\n\n26,27\n. The \n\n\n\nreduction\n \n\n\n\nin the duration of aminoglycosides \n\n\n\ntherapy was associated\n \nwith a lower incidence of \n\n\n\nnephrotoxicity\n27\n\n\n\n. According to Kashuba and \n\n\n\ncolleagues (1999), the risk of nephrotoxicity\n \nand \n\n\n\nototoxicity can be minimized by shortening the \n\n\n\ncourses of aminoglycoside therapy\n28\n\n\n\n.  \n\n\n\n\n\n\n\nIn this study, the potential interaction cases \n\n\n\nbetween aminoglycosides and penicillins were the \n\n\n\nhighest. According to Beringer and Winter (2004), \n\n\n\ncabercillin, ticarcillin and related extended-\n\n\n\nspectrum penicillins chemically inactivate \n\n\n\ngentamicin and tobramycin in vitro\n29\n\n\n\n. This \n\n\n\ninactivation can become clinically significant in \n\n\n\nvivo in patients with renal failure. Nevertheless, in \n\n\n\nprevious studies, there was synergy between\n \nan \n\n\n\naminoglycoside and \u00df-lactam antibiotics in the\n \n\n\n\ntreatment of Pseudomonas aeruginosa infections\n30\n\n\n\n. \n\n\n\nBates and colleagues (2002) demonstrated that the \n\n\n\nuse of aminoglycoside followed by furosemide \n\n\n\nmay increase the risk for ototoxicity\n31\n\n\n\n.  \n\n\n\n\n\n\n\n\n\n\n\nCONCLUSION \n\n\n\n\n\n\n\nA total of 104 in-patients had been treated with \n\n\n\naminoglycosides for various infections within July \n\n\n\n2008 until December 2008. Based on this study, \n\n\n\nthe aminoglycosides were used in patients who had \n\n\n\nnormal renal function and also in patients who \n\n\n\nwere in renal diseases and in  end stage renal \n\n\n\nfailure. The culture and sensitivity test had been \n\n\n\nperformed only to 62% of patients. Inappropriate \n\n\n\nindication of aminoglycosides was found in 4.8% \n\n\n\npatients. A total of 37.4 % patients did not receive \n\n\n\nappropriate dose and most of them (29.8%) had \n\n\n\nreceived subtherapeutic while 7.6% had received \n\n\n\naminoglycosides in  more than therapeutic dose. \n\n\n\nThe duration of aminoglycosides therapy was \n\n\n\ninappropriate in 12.5% patients. There were 89.5% \n\n\n\ncases of pharmacodynamic and 10.5% cases of \n\n\n\npharmacokinetic potential aminoglycosides drug \n\n\n\ninteractions had been identified in this study. \n\n\n\nThere were 3 cases of potential interactions that \n\n\n\nhad minor severity and the others had moderate \n\n\n\nseverity. Based on the findings, the \n\n\n\nappropriateness of aminoglycosides use still needs \n\n\n\nto be improved.  \n\n\n\n\n\n\n\nACKNOWLEDGEMENT \n\n\n\n\n\n\n\nA special thanks to the Director of Hospital Kuala \n\n\n\nLumpur for giving us an opportunity to conduct a \n\n\n\nresearch project in this hospital. We wish to thank \n\n\n\nProf.Dr.P.T.Thomas for his suggestions for this \n\n\n\npublication. \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n354 \n \n\n\n\n\n\n\n\nREFERENCES  \n\n\n\n\n\n\n\n1. Gonzalez, L. S. & Spencer, J. P. Aminoglycosides: A Practical Review. American Family Physician 1998; \n\n\n\n58(8): 1811-1819. \n\n\n\n2. Contopoulos-Ioannidis, D. G. , Giotis, N. D.,  Baliatsa,\n \n D. V. &  Ioannidis, J. P. A. Extended-Interval \n\n\n\nAminoglycoside Administration for Children: A Meta analysis. Pediatrics 2004; 114(1):  111-118. \n\n\n\n3. Durante-Mangoni, E., Grammatikos, A., Utili, R. & Falagas, M. E. Do we still need the aminoglycosides? \n\n\n\nInternational Journal of Antimicrobia Agents. 2009; 33(3): 201-205. \n\n\n\n4. Martinez-Salgado, C., Lopez-Hernandez, F.  J., Lopez-Novoa, J. M. Glomerular nephrotoxicity of \n\n\n\naminoglycosides. 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Empiric antimicrobial therapy for severe sepsis in the intensive care unit: In \n\n\n\nearly, hit hard, out early. Current Anaesthesia & Critical Care. 2005; 16: 221\u2013230. \n\n\n\n25. Hedrick, T. L. Can we define the ideal duration of antibiotic therapy? Surg Infect (Larchmt). 2006; 7(5): 419-\n\n\n\n432. \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n355 \n \n\n\n\n26. Young, T. E. Aminoglycoside Therapy in Neonates with Particular Reference to Gentamicin. Neoreviews. \n\n\n\n2002; 3(12): 243-248. \n\n\n\n27. Zahar, J. R., Rioux, C., Girou, E., Hulin, A., Sauve, C., Bernier-Combes, A., Brun Buisson, C. & Lesprit, P. \n\n\n\nInappropriate prescribing of aminoglycosides: risk factors and impact of an antibiotic control team. Journal of \n\n\n\nAntimicrobial Chemotherapy. 2006; 58: 651\u2013656. \n\n\n\n28. Kashuba,\n \nA. D. M., Nafziger,\n\n\n\n \nA. N., Drusano,\n\n\n\n \nG. L. & Bertino, J. S. Optimizing Aminoglycoside Therapy for \n\n\n\nNosocomial Pneumonia Caused by Gram Negative Bacteria. Antimicrobial Agents and Chemotherapy. 1999; \n\n\n\n43(3): 623-629. \n\n\n\n29. Beringer, P. & Winter, M. E. Aminoglycoside Antibiotics. Dlm. Winter, M. E. (pnyt). Basic Clinical \n\n\n\nPharmacokinetics, 4\nth\n ed. USA: Lippincontt William & Wilkins. 2004. \n\n\n\n30. Mayer, I. & Nagy, E. Investigation of the synergic effects of aminoglycoside fluoroquinolone and third-\n\n\n\ngeneration cephalosporin combinations against clinical isolates of Pseudomonas spp. Journal of \n\n\n\nAntimicrobial Chemotherapy. 1999; 43(5): 651-657. \n\n\n\n\n\n\n\n31. Bates, D. E., Beaumont, S. J.  & Baylis, B. W. Ototoxicity induced by gentamicin and furosemide.  The \n\n\n\nAnnals of Pharmacotherapy. 2002; 36(3): 446-451.  \n\n\n\n\n\n\n\n \n\n\n\n\n\n"
"\n\nMalaysian Journal of Pharmacy 2001;1:9-14 CPE Article\n\n\n\n10\n\n\n\nContinuing Pharmacy Education\n\n\n\nBioethics\nAbu Bakar Abdul Majeed\n\n\n\nContinuing Pharmacy Education Chairman, Malaysian Pharmaceutical Society, c/o Institut\nKefahaman Islam Malaysia, No 2, Langgak Tunku off Jalan Duta, 50480 Kuala Lumpur\n\n\n\nABSTRACT\n\n\n\nBioethics was originally proposed in the early 1970s to denote \u2018the incorporation of\nbiological knowledge and human values\u2019. It is becoming more relevant in the\nbiological age. This paper looks at some of the biological issues that require an\nethical input. These include the Human Genome Project, human cloning and\nassisted reproductive technologies, contraception and abortion, organ donation and\ntransplantation, euthanasia, brain death, human embryonic cells and AIDS.\nExamples of issues that have been raised in this area: Who owns our genes? Can we\n\u2018design\u2019 our babies? Should humans be cloned? Can pregnancy be terminated? Is\nmercy killing all right? Is brain death equivalent to death? Can embryonic cells be\nused in experiments? While some have been settled, others still persist till today.\nThe numerous ethical questions pertaining to biology beg serious efforts on the part\nof ethical theorists to dig deep into their established principles. Similarly those\nworking within applied ethics cannot operate effectively without referring to\ntheoretical ethics. Hence thus far, many of the bioethical issues have been tackled. It\nis proposed that as a member of the health team, pharmacists too need to be well\nversed in issues pertaining to bioethics.\n\n\n\nKeywords: ethics, biotechnology, cloning, euthanasia, brain death\n\n\n\nINTRODUCTION\n\n\n\nA new revolution in the making\n\n\n\nThe 20th century was an auspicious century indeed.\nIt showcased numerous achievements in science\nand technology. This is especially true of research\nin the field of biology and its related discipline,\nbiotechnology. It is not an exaggeration to state\nthat so soon after the information revolution of the\nlast few decades, the dawn of the 21st century\nmarks the start of yet another revolution, the\nbiological revolution.\n\n\n\nAlthough advances in the various fields of  biology\n\n\n\nhave thus far resulted in major achievements, they\nalso pose an inventory of real and potential\nhazards, as well as create new ethical conundrums.\nAccording to Lemkow (1993), an American study\non \u201cPublic Perceptions of Biotechnology\u201d reveals\nthat the public accepts science and technology in\ngeneral (1). However, attitudes to biological\nresearch indicate certain ambivalence. Sixty-six\npercent felt that genetic engineering would\nimprove life compared with 92 percent for solar\nenergy and 51 percent for nuclear energy.\n\n\n\n\n\n\n\n\nCPE Article: Bioethics\n\n\n\n11\n\n\n\nHowever, 42 percent of the respondents said that it\nwas \u201cmorally wrong\u201d to change the genetic\nmakeup of human cells.\n\n\n\nIn a similar European study, the main ethical\nissues in science and technology centre on human\ngenetics (1). Apprehension and anxiety were\nexpressed about the manipulation of human\ngenetic material even when diagnostic benefits\ncould be demonstrated. While therapeutic and\ndiagnostic applications found much support, there\nwas concern about the use of genetic information,\nsuch as the social pressure to have an abortion in\nthe face of negative prenatal diagnostic\ninformation, although this does not necessarily\nrequire genetic engineering techniques. Concern\nwas also expressed about the requirement of\ngenetic information at work in relation to the right\nto privacy.\n\n\n\nA TIME/CNN telephone poll of 1,1015 adult\nAmericans conducted in early 2001 on the issue of\nhuman cloning, found that 90 percent of\nrespondents thought that human cloning is a bad\nidea (2). The reasons for opposing cloning are:\nreligious belief (34 percent), interference of human\ndistinctiveness and individuality (22 percent), fear\nof it being used to breed a superior race (22\npercent) and that the technology is dangerous (14\npercent). Further, 93 percent of respondents would\nnot want to have themselves cloned if they had the\nchance to do it.\n\n\n\nThe aim of this article is to look at several\ncontemporary biological issues that beg an ethical\ninput and to consider bioethical principles thus far\napplied to cope with some of these issues.\n\n\n\nHuman Genome Project\n\n\n\nThe Human Genome Project is aimed at figuring\nout what protein each gene produces and for what\npurpose. This human encyclopaedia may be used\nto identify diseased genes and design methods to\nsubstitute them with healthy ones. Hopefully, this\ntype of disease prevention envisaged by\nproponents of gene therapy will be able to deal\nwith many debilitating disorders such as\nAlzheimer\u2019s Disease, Parkinson\u2019s Disease and\nHuntington\u2019s Disease, problems that have been\nattributed to genetic malfunctions.\n\n\n\nOther spin-offs from the Human Genome Project\ninclude the ability to predetermine the baby\u2019s\nattributes, grow new tissues and organs for\ntransplantations, slow aging body parts and\n\n\n\nprepare more effective vaccines. However all these\nprocedures are not about to happen soon. In fact,\nnot only do several technical posers appear to be\ndaunting, the moral implications of the project are\nequally mind-boggling. First and foremost is of\ncourse the question of ownership. Who owns our\ngenes?\n\n\n\nThus, scientists have begun to patent whichever\nsections of the genome that they can lay their\nhands on (3). Patenting proponents insist on the\nneed to have such protection to ensure returns on\ntheir investment. Naturally ethicists have different\nopinions. Were the early anatomists granted\nentitlements to the various bodily organs they\ndiscovered? Galen could have staked claims to\nsome of our veins and arteries. Ibn Sina too should\nhave been granted rights to certain parts of the\nbrain.\n\n\n\nThe other question is whether the benefits of\ngenetic science research like the Human Genome\nProject could be distributed to the world\u2019s\npopulation in a just manner. While some\nresearchers prefer the human genome data to be\nfreely available, others want a premium be put for\nusing it. Therefore those who have had no part in\nthe venture at all will have to wait and see if they\ncan afford to pay for the information on human\ngenes, should they need it for research and\ndevelopment.\n\n\n\nSimilarly, on the application side of this type of\nresearch, since gene therapy involves a high cost,\nonly the minority already well supplied with\nmedical goods and services will be able to afford\nit. This will only widen the existing differentials in\nhealth status between different social classes, and\nfurther broaden the North-South divide in terms of\naccessibility to modern medical treatment.\n\n\n\nGenetic engineering and eugenics\n\n\n\nGenetic engineering may help doctors develop\nways to correct or compensate for some genetic\ndefects, perhaps even during conception. This will\nsurely give rise to ethical questions. Although at\nthis stage we are talking about preventing or\nprotecting our children from genetic diseases,\nartificial improvement of other traits of the\ndeveloping embryo would surely be sought not too\nlong in the future. This opens a whole new\npossibility of designing babies. Many agree that\ngenetic engineering must not be adopted as a\nmeans for changing the human genetic\nconstitution, in what is called the improvement of\n\n\n\n\n\n\n\n\nCPE Article: Bioethics\n\n\n\n12\n\n\n\nthe human breed, or in genetically tampering with\nthe human personality or interfering in human\ncompetence or individual responsibility.\n\n\n\nCloning, assisted reproductive technologies and\nsurrogacy\n\n\n\nIn 1997, there was a focus on the success of an\nanimal cloning procedure using matured, rather\nthan the usual embryonic cells (4). As this\nexperiment involved a large mammal, the\npossibility of cloning a human becomes real\nindeed. The greatest motivation of cloning\nexperiments described above is in finding ways of\nproviding infertile couples with the opportunity to\nsecure an offspring. But is human cloning\ndesirable? Should parents be allowed to clone a\nchild they lost? Should they clone to have twins at\ndifferent times? Should cloning be allowed to\nproduce vital organs for use to help others?\n\n\n\nThe birth of the first \u2018test tube baby\u2019 in 1978 marked\nyet another milestone in the history of reproductive\ntechnologies. In vitro fertilization became well\naccepted as a relatively-risk-free technique and by\n1990, there were more than 25,000 \u2018test-tube babies\u2019\nin the world. Related to artificial reproductive\ntechnologies are the issues of sperm banks and\nsurrogate motherhood. There are men who are not\nable to produce viable sperms for fertilization to\nhappen. The wife in this case, probably would need\nto request sperms from donors. In order to facilitate\nthis procedure, sperm banks have been established as\na resource centre to provide sperms on demand.\nThen there are women who are physiologically\nunable to conceive and nourish foetuses. Conception\nof embryos prepared in laboratories will have to be\ndone in a third party\u2019s womb, thus the term surrogate\nmotherhood. Surrogacy is considered a legal\nprocedure in some developed countries. Artificial\nreproductive technologies, though implemented\npreviously, still attract public attention as moral\nquestions with regard to these procedures keep\ncropping up.\n\n\n\nContraception and abortion\n\n\n\nThese are two biological issues that simply refuse\nto go away. Contraception is vital for family\nplanning. Various types of contraception are\navailable, either natural or artificial, and ethical\nissues that are still being debated today pertain to\nthe suitability and permissibility of these methods.\nAbortion in particular generates moral questions of\nenormous magnitude. At what stage of the embryo\ndoes life begin? Does it start with the very first\n\n\n\nbeat of the developing heart? And when this\nhappens, how does one justify terminating the\npregnancy?\n\n\n\nOrgan donation and transplantation\n\n\n\nNumerous ethical questions have been raised\nregarding tissue and organ transplantation\nprocedures. They include whether human beings\nhave the right to give away a part of their body\nsuch as the kidney or a portion of their liver,\nwhether it is all right to harvest body parts of a\ncadaver, and how available parts are assigned to\nthose who are in need of them. Although these\nissues may appear to be rather straightforward in\nsome of today\u2019s societies, there are still those who\nare unsure of how to deal with them.\n\n\n\nThen there is always the question of\nxenotransplantation, or transplantation using parts\nfrom animals. There may well be a lot of\nreservations among certain communities around\nthe world regarding the suitability and\npermissibility of this method. In any case, there are\ncontemporary ethical issues regarding \u201coffspring\ndonor\u201d where for reasons of genetic compatibility,\na couple decides to conceive a second child in the\nhope that he or she would become a donor for the\nfirst child who is in need of certain bodily parts,\nfor example, the bone marrow. And with the\ncoming of therapeutic cloning and new procedures\nlike organogenesis (where specific organs rather\nthan a whole human may be grown from\nembryonic stem cells), tougher ethical issues are\nbound to crop up.\n\n\n\nEuthanasia\n\n\n\nEuthanasia or mercy killing may be active or\npassive. Active euthanasia means patients are\ndeliberately killed, for example by injecting an\noverdose of sedatives. Active euthanasia is\nnormally voluntary, where a patient with a rational\nframe of mind requests and is granted death.\nPassive euthanasia happens when a patient is\ndeliberately allowed to die from whatever illness\nhe is suffering from, by refusing to perform\nsurgery, initiate heart resuscitation procedure, or\nadminister medication. Passive euthanasia may be\nvoluntary, when the patient consents to it, or non-\nvoluntary, when he does not express the desire to\ndie.\n\n\n\nEuthanasia has always been a prime issue in the\ndebate on the right to die. It, however, is legally\npermitted in at least one western nation, that is,\n\n\n\n\n\n\n\n\nCPE Article: Bioethics\n\n\n\n13\n\n\n\nHolland. In 1973, the Royal Dutch Medical\nAssociation approved guidelines for physician-\nassisted suicide (PAS), a form of euthanasia. These\nguidelines are: euthanasia must be done by a\nphysician; a second physician must concur with\nthe decision; death must be requested by the\npatient while competent; the request must be free\nof doubt, well-documented and repeated; the\nrequest must not have been coerced; the patient\u2019s\ncondition must be intolerable; and that, there must\nbe no way to improve the patient\u2019s lot.\n\n\n\nThe American Medical Association takes a very\ndifferent approach on PAS. Although active\neuthanasia is forbidden, passive euthanasia appears\nto be allowed. The practice of allowing patients to\ndie by not treating them, endorsed by thinkers as\nearly as Socrates, is an inescapable part of modern\nmedicine. Today more than 80% of people die in\nhospitals, and advances in medical technology\nhave made it possible to keep almost anyone alive\nindefinitely, even after they have no thought or\nfeeling or hope of recovery. The maintenance of\nlife by artificial means in such cases is deemed\npointless, as the hospitals would quickly be filled\nwith living corpses, leaving more deserving\npatients no beds. Thus, many would agree that it is\nethically acceptable to cease treatment and let such\npatients die (5).\n\n\n\nBrain death\n\n\n\nThe traditional criteria for determining death, until\nrecently, was the permanent cessation of heart and\nlung function. When a person stopped breathing\nand the heart stopped beating for more than a few\nminutes, that person was declared dead. The loss\nof oxygen to the brain would almost instantly\nproduce irreversible brain damage and loss of all\ncognitive function (6).\n\n\n\nHowever, the introduction of new medical\ntechnology, and most importantly of respirators,\nhas enabled modern medicine to continue\nartificially maintaining patients\u2019 heart and lung\nfunction. This can often save lives that previously\nwould have been lost. Sometimes, it may even\npermit the patient to recover a normal level of\nfunction.\n\n\n\nIn other cases, however, heart and lung function\ncan be restored or continued by these artificial\nmeans after brain function has been partially or\ncompletely destroyed, for example, from\nprolonged loss of oxygen or severe trauma of the\nbrain. Such possibilities have forced a rethinking\n\n\n\nof the traditional criteria for the determination of\ndeath. There is now an additional criterion for\ndeath, that is, the complete and irreversible loss of\nall brain function, or so-called brain death. The\nconcept of \u2018brain death\u2019 was first proposed in 1959\nby a team of French doctors. The criteria adopted\nfor brain death were coma, cessation of breathing,\nthe absence of brainstem and tendon reflexes, and\nthe absence of electroencephalographic (EEG)\nwaves. If these conditions persisted in the patient\nfor more than 24 hours, then he or she would be\npronounced dead, and the ventilator switched off,\neven though the heart might still be beating.\n\n\n\nFurther discussions led to the announcement at the\n22nd World Medical Assembly in Sydney in 1968,\nwhich in a nutshell stated that death had occurred\nif there were no means of saving the patient,\nregardless of whether some of his organs were still\nfunctioning. In the same year, the \u2018Harvard criteria\nto determine death\u2019 was introduced. In addition to\nthe original French criteria, the Harvard criteria\nstipulates that there must also be an absence of\npupil and spinal reflexes, no movement of the\npatient for an hour, and that breathing should cease\nthree minutes after switching off the ventilator (7).\n\n\n\nHuman embryonic cells\n\n\n\nMost recently in several countries, scientists and\npolicy-makers are revisiting the issue on the use of\nhuman stem cells and embryos for research. Stem\ncells have the capability of developing into any\ntype of tissue, as well as growing into human\nbeings. Thus, in the United States, current laws\nforbid the use of public funds to obtain stem cells\nfrom human embryos (8). In Germany, a human\nembryo is protected under the law from the\nfertilization to the implantation stage. Any\nresearch on or with human embryos is prohibited\nunless the embryo can be ascertained of an\nimmediate and direct benefit to it (9). But efforts\nare underway to reverse this situation (10). For\nexample, the American National Institute of Health\n(NIH) recently issued guidelines on funding of\nmedical research that makes use of human\nembryos (11). Similarly the British government\nhas allowed cloning of stem cells for scientific\nstudy of transplants. This study would help bolster\nthe prospect of therapeutic cloning that could\ndevelop new treatments for diseases such as\nAlzheimer\u2019s Disease and Parkinson\u2019s Disease.\n\n\n\nAcquired Immunodeficiency Syndrome (AIDS)\n\n\n\nThe human immunodeficiency virus (HIV) that\n\n\n\n\n\n\n\n\nCPE Article: Bioethics\n\n\n\n14\n\n\n\ncauses AIDS continues to be a major threat to the\nhealth of millions of people worldwide. Sadly\nthough, there is little sign that the disease is\nabating. Today it has been established that apart\nfrom the sharing of infected needles and blood\ntransfusion, indiscriminate sexual practices are the\nmain modes of HIV transmission. In view of the\ngravity of the situation, whatever means that can\nhelp to wipe out the scourge are strongly\nrecommended, regardless of whether they are of\npreventive, curative or palliative in nature.\n\n\n\nPrevention must be the primary strategy adopted to\nminimize the risk of HIV transmission. However,\nin relation to the compulsory HIV antigen or\nantibody screening that has been proposed for\nmembers of the high-risk groups, many ethical\nissues have to be surmounted. Is it morally correct\nto simply focus on the high-risk HIV-carriers, such\nas drug addicts, prostitutes, transsexuals and\nconvicts? In order to avoid transfusion of\ncontaminated blood, should donors, rather than the\nblood per se, be tested for HIV antibody or\nantigen? Should compulsory screening be imposed\non brides and bridegrooms to ensure that they are\nfree from HIV, thus preventing them from passing\non the virus to their potential spouses or later even\nto their offspring? These are no doubt difficult and\nchallenging questions. They must be dealt with\nextreme care and heartfelt concern for the parties\ninvolved. When it comes to ethics, there is always\nthe dilemma of choosing between the interests of\nthe community and those of the individual.\n\n\n\nEthics\n\n\n\nLet\u2019s turn now to the issue of ethics and how\nhumans have developed a system to tackle it.\nBertrand Russel elegantly describes ethics as \u201cin\norigin the art of recommending to others the\nsacrifices required for cooperation with oneself\u201d.\nEthics, or the study of morality, makes up one of\nthe four main divisions of philosophy. Here it is\nfurther subdivided into categories of meta-ethics or\ntheoretical ethics, that is the study of meanings of\nethical terms and the forms of ethical argument;\ndescriptive ethics, that deals with the study of\nmoral and ethical beliefs and customs of different\ncultures; normative ethics, which is the study of\nethical principles that have been accepted as norms\nor right behaviour; and applied ethics, that relates\nto the application of moral standards used in\ndecision-making to concrete rather than abstract\nconditions (12).\n\n\n\nThe various ethical questions pertaining to\n\n\n\nbiological sciences in the contemporary world are\nclear indications that the time has come when\nethical theorists can no longer ignore the problems\nof application. Similarly, those working within\napplied ethics can no longer operate effectively\nwithout taking theoretical considerations into\naccount. This is especially true where principles\nand codes appear to make conflicting claims on the\ncondition or situation under examination. When\nsuch conflicting claims occur it is referred to as an\nethical dilemma. When this occurs, we will have to\nresort to ethical reasoning that is, the process of\nanalysis in determining what is right or wrong, and\nwhat is the correct or more responsible choice in a\ngiven situation. It is also an examination of our\nmoral judgements, and an attempt to determine the\ngrounds on which these judgements are based.\n\n\n\nThe literature is filled with the various\nclassifications of ethical theories. For example,\nthey can be classified as, one, principle-based\ntheories (normative ethics), and two, virtue-based\ntheories (12). Principle-based theories are of either\nthe deontological or consequentialist\n(utilitarianism) types. The former relates to the\ntheory of obligation or duties, or rules and rights,\nwhile the latter links the rightness of an act to the\ngoodness of the state of affairs it brings about.\nJudgements made may be general or specific. They\nare all normative, they affirm or apply norms or\nstandards to making decisions. They must be\nuniversal, applicable to all relevant cases, impartial\nand objective. The procedure to implement\nprinciple-based ethical theory are, (i) identify\nethical principles, and (ii) evaluate ethical choices\nin terms of how well they fit with those principles.\n\n\n\nVirtue-based theories include communitarinism\nthat applies the Aristotelian approach where\npractical wisdom is employed in the reasoning\nprocess, the focus is on the uniqueness of each\nethical situation, and is based on shared\ncommunity values. It also includes relationalism\nthat emphasizes the values of love, family and\nfriendship inherent to the situation at hand. The\nprocedure to do this is by identifying the ethically\nvirtuous person, and evaluating ethical choices in\nterms of how well they exemplify the deliberations\nof the ethically virtuous person. This theory is very\nmuch situation-based.\n\n\n\nBioethics\n\n\n\nBioethics can be defined as the study of the\nrightness and wrongness of acts performed within\nthe life sciences, through the application of both\n\n\n\n\n\n\n\n\nCPE Article: Bioethics\n\n\n\n15\n\n\n\nethical theory and casuistry (case-study method) to\nthe complexity of development in the biological\nsciences. The bioethics practiced today mostly\nderives its rulings from the normative and\nsituational ethical principles. The word \u2018bioethics\u2019\nwas first coined by the oncologist Professor Van\nRensselaer Potter II in 1970 in an article entitled\n\u201cBioethics: The Science of Survival\u201d (13). After\ndoing much work in the field of cancer research\nwhere he managed to establish links between\ncertain types of cancer and environmental\npollutants, Potter argued that a science of survival\nmust be more than science alone. It should\nincorporate two ingredients, namely, biological\nknowledge and human values. Later, Potter (1975)\nrefined the definition of bioethics as a product of\ncross-fertilization between the two branches,\n\u201cmedical bioethics\u201d and \u201cecological\nbioethics\u201d(14). However, medical practitioners did\nnot generally accept these concepts. They\npreferred to redefine bioethics to mean clinical\nethics.\n\n\n\nAnd thus, from then on bioethics conjured a much\nnarrower meaning than its original scope and\nbreadth. And it is in this context that many of the\nrecent and contemporary discussions on issues\nrelated to health, life and death are being looked at.\nThis was particularly true during the era of\nheightened debates on reproductive sciences like\ncontraception and abortion in the 1950s and 1960s.\nAt  the  time,  the  founder-director of the Kennedy\n\n\n\nCenter of Ethics at Georgetown University,\nProfessor Andr\u00e9 Hellegers seized the opportunity\nto turn bioethics into an academic discipline that\nreflected the needs of the time. This was rather\neasily acceptable as bioethics can readily be\nidentified with the established field of medical\nethics. In essence medical ethics began with the\nadvent of medicine itself, that is, the \u2018Hippocrates\nOath\u2019. And then there was the anti-vivesectionist\nmovement (15) that was already influential in the\n19th century that helped to keep researchers who\nuse animals as subjects for experiments, on their\ntoes.\n\n\n\nCONCLUSION\n\n\n\nToday, bioethics is a full-fledged subject matter\nwith a number of international professional\nsocieties, and courses offered in universities\nthroughout the world. It will become even more\nimportant in the future. As a member of the\nprofessional healthcare team, pharmacists too need\nto be aware of the controversial issues pertaining\nto medical practice and how to deal with them.\nOne way in which this can be done is to refer to\nlong-established ethical guidelines. With this,\npharmacists can play an important role in\nalleviating patients\u2019 and their relatives\u2019 anxiety, as\nwell as clear their conscience on morally-\nchallenging issues.\n\n\n\nSee page 8 for the CPE question\n\n\n\n*****\nREFERENCES\n\n\n\n1. Lemkow L. Public attitudes to genetic engineering:\nSome European perspectives. Luxembourg: Office\nof Official Publications of the European\nCommunities; 1993.\n\n\n\n2. TIME/CNN Poll. TIME 2001 Feb. 26. p. 45.\n3. Thiele. Moral problems in the patenting of human\n\n\n\ngenes. Europ\u00e4ische Akadamie Newsletter 2000; 21:\n1-3.\n\n\n\n4. Campbell KHS, McWhir J, Ritchie WA, Wilmut I.\nSheep cloned by nuclear transfer from a cultured\ncell line. Nature 1997; 385:810-813.\n\n\n\n5. Beauchamp TL. Suicide. In: Regan T, editor.\nMatters of Life and Death. USA:McGraw-Hill Inc.\n\n\n\n6. Brock DW. Life and Death - philosophical essays\nin biomedical ethics. Cambridge: Cambridge\nUniversity Press; 1993.\n\n\n\n7. Jusoh MR. Mati otak - Perspektif doktor Islam\n(Brain-death - A Muslim Doctor\u2019s perspective). In:\nIbrahim I, editor. Islam dan Pemindahan Organ\n(Islam and organ transplantation). Kuala Lumpur:\n\n\n\nInstitute of Islamic Understanding Malaysia\n(IKIM); 1998.\n\n\n\n8. Shapiro HT. Ethical dilemmas and stem cell\nresearch. Science 1999;285:2065.\n\n\n\n9. Kaiser J. Stem cells as potential nerve therapy.\nScience 1999; 285:649-650.\n\n\n\n10. Abbot A. German researchers seek legal backing\nfor stem cell work. Nature 2000;404: 424.\n\n\n\n11. Zitner A. Embryo stem cell work could get public\nfunding, Los Angeles Times; 2000 Aug. 13.\n\n\n\n12. Beach R. The responsible conduct of research.\nWeinheim:VCH; 1996.\n\n\n\n13. Potter VR. Bioethics: the science of survival.\nPerspectives in Biology and Medicine 1970;14:127-\n153.\n\n\n\n14. Potter VR. Global Bioethics: Building on the\nLeopold Legacy. East Lansing:Michigan State\nUniversity Press; 1988.\n\n\n\n15. Koenig R. European researchers grapple with\nanimal rights. Science 1999;284:1604-1606.\n\n\n\n\n\n\n \nTable of Contents\n\n\n \nPHARMACY PRACTICE IN THE NEW MILLENNIUM\n\n\n \n\n\n \nContraception and abortion\n\n\nBrain death\n\n\n\n\n\n\nAnd thus, from then on bioethics conjured a much narrower meaning than its original scope and breadth. And it is in this context that many of the recent and contemporary discussions on issues related to health, life and death are being looked at. This wa\n\n\nCenter of Ethics at Georgetown University, Professor Andr\u00e9 Hellegers seized the opportunity to turn bioethics into an academic discipline that reflected the needs of the time. This was rather easily acceptable as bioethics can readily be identified with\n\n\n\n\n\n"
"\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n28 \n\n\n\n\n\n\n\nStability of Folic Acid in an Extemporaneously Prepared Oral \n\n\n\nSuspension \n \n\n\n\nLian T. Chan*, Lucy Yeoh \n\n\n\n\n\n\n\nWinwa Medical Sdn Bhd, Bukit Mertajam, Pulau Pinang, Malaysia. \n\n\n\n\n\n\n\n* Corresponding author \nMalaysian Journal of Pharmacy, Vol 1 Issue 10, 2012, 28 - 37                                               \n\n\n\n\n\n\n\n\n\n\n\nAbstract \n\n\n\n\n\n\n\nMany drugs are not available in suitable dosage forms for paediatric use and have to be \n\n\n\nextemporaneously prepared by pharmacist for the individual patient. This study is \n\n\n\nconducted to investigate the physicochemical and microbiological stability of an \n\n\n\nextemporaneous oral suspension containing 1mg/ml of folic acid. The oral suspension \n\n\n\nwas prepared using commercially available tablets and vehicle from the hospital. The \n\n\n\nfolic acid oral suspension was stored for 60 days at 4\u00baC (refrigeration) and 25\u00baC (room \n\n\n\ntemperature) protected from light. The physical, chemical and microbial stability were \n\n\n\nexamined at day 0, 14, 28 and 60. The content of folic acid was determined using HPLC-\n\n\n\nUV method. The analytical results showed that the content of folic acid was above 90% in \n\n\n\nall the samples tested throughout the study period. The visual appearance, colour, odour \n\n\n\nand pH remained fairly unchanged throughout the study period and the oral suspension \n\n\n\nwas not susceptible to microbial contamination. The results indicated that the \n\n\n\nextemporaneous formulation was stable at both temperatures and 60 days expiration date \n\n\n\ncould be recommended for this formulation. \n\n\n\n\n\n\n\nKeywords: Compunding, Extemporaneous preparation, Folic Acid, Stability, Shelf-life \n\n\n\n\n\n\n\n\n\n\n\nIntroduction \n \n\n\n\nPharmacist plays very important role in \n\n\n\npharmaceutical compounding in both \n\n\n\nhospital and community pharmacy \n\n\n\npractices. Pharmaceutical compounding \n\n\n\nknown as extemporaneous preparation is \n\n\n\nimportant to prepare pharmaceutical \n\n\n\nproduct that is not available in suitable \n\n\n\ndosage form to suit individual patient\u201fs \n\n\n\nneed.  The demand for this process is \n\n\n\nincreasing to provide the needed \n\n\n\nproducts by the patients and healthcare \n\n\n\npractitioners. Despite its important and \n\n\n\nuseful for patient, there are legitimate \n\n\n\nconcerns about the quality and safety of \n\n\n\ncompounded products as well as \n\n\n\nconcerns about overseeing the \n\n\n\npharmacies that compound them (1). \n\n\n\n\n\n\n\nMany drugs are often not available \n\n\n\ncommercially in suitable dosage forms \n\n\n\nfor paediatric and geriatric patients.  \n\n\n\nThese products have to be \n\n\n\nextemporaneously prepared by \n\n\n\npharmacist to suit individual need of the \n\n\n\npatient.  However, the information \n\n\n\nrelated to the extemporaneous \n\n\n\nformulations and the stability of the final \n\n\n\nproducts are lacking (2,3). The methods \n\n\n\nof extemporaneous preparation for the \n\n\n\nsame drug were significantly different \n\n\n\namong hospitals throughout Europe \n\n\n\n(2,4). There is no harmonization of \n\n\n\ncompounding methods and the \n\n\n\navailability of suitable licensed \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n29 \n\n\n\n\n\n\n\npaediatric products varied among \n\n\n\nEuropean countries (2,5). Due to the \n\n\n\npaucity of information, many \n\n\n\npharmacists are facing problems to find a \n\n\n\nfully validated formulation for \n\n\n\nextemporaneous preparation. When \n\n\n\ndeciding on whether to formulate an \n\n\n\nextemporaneous preparation in these \n\n\n\ncircumstances, the pharmacist must \n\n\n\nconsider the risk of withholding \n\n\n\ntreatment, as well as the risks inherent in \n\n\n\nextemporaneous formulation. \n\n\n\n\n\n\n\nThere are many reasons for the lack of \n\n\n\ncommercially available paediatric \n\n\n\nformulations. The overall size of the \n\n\n\npaediatric market is much smaller than \n\n\n\nfor adults. Therefore, the pharmaceutical \n\n\n\nindustry is reluctant to invest financially \n\n\n\nto seek drug licensing for infants and \n\n\n\nchildren unless a disease occurs \n\n\n\nexclusively or frequently in the \n\n\n\npaediatric population. In addition, the \n\n\n\nformulation has to have been adequately \n\n\n\nstudied in paediatric patients before it \n\n\n\ncan be registered (6). As such the \n\n\n\navailability of paediatric formulations \n\n\n\nvaries between countries and very few \n\n\n\nproducts are available in countries which \n\n\n\nconstitute a small market (7). \n\n\n\n\n\n\n\nWhen there is a need to undertake \n\n\n\nextemporaneous preparation, the \n\n\n\npharmacist must choose the best \n\n\n\nextemporaneous formula. Ideally, the \n\n\n\npharmacist should choose formulation \n\n\n\nused for extemporaneous preparation \n\n\n\nwith validated stability and proven shelf-\n\n\n\nlife (5,8). However, in the absent of \n\n\n\npublished data, stability studies should \n\n\n\nbe carried out on the formulations used \n\n\n\nin practice. The most stable formulation \n\n\n\nis then can be recommended as the \n\n\n\nstandard formula for all the hospitals.  \n\n\n\n\n\n\n\nFolic acid oral suspension is one of the \n\n\n\ncommonly prepared extemporaneous \n\n\n\noral preparations in hospital pharmacies \n\n\n\nand has been selected for this study. In \n\n\n\npaediatric, folic acid has been used as \n\n\n\nfolate supplement in neonates who have \n\n\n\nmegaloblastic anaemia due to folate \n\n\n\ndeficiency, haemolytic anaemia and \n\n\n\nprophylaxis of folate deficiency in \n\n\n\ndialysis (9). \n\n\n\n\n\n\n\nFolic acid (Figure 1) is a yellowish or \n\n\n\norange crystalline powder. It is \n\n\n\npractically insoluble in water and in \n\n\n\nmost organic solvents. It dissolves in \n\n\n\ndilute acids and in alkaline solutions. \n\n\n\nFolic acid is a member of the vitamin B \n\n\n\ngroup.  In the body, it will be reduced to \n\n\n\nform tetrahydrofolate, a coenzyme for \n\n\n\nvarious metabolic processes including \n\n\n\nthe synthesis of purine and pyrimidine \n\n\n\nnucleotides, and hence in the synthesis \n\n\n\nof DNA; it is also involved in some \n\n\n\namino-acid conversions, and in the \n\n\n\nformation and utilisation of formate (10). \n\n\n\n\n\n\n\nFigure 1: Folic Acid \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n30 \n\n\n\n\n\n\n\nA few extemporaneously prepared liquid \n\n\n\nformulations of folic acid have been \n\n\n\nreported in literatures. In a recent study, \n\n\n\na folic acid liquid preparation was \n\n\n\nprepared using folic acid powder and \n\n\n\ncombined solvents of sorbitol, glycerine \n\n\n\nand propylene glycol. The result from \n\n\n\nthis study showed that the liquid \n\n\n\npreparation was stable at pH range of 5 \n\n\n\nand 5.5 and no significant degradation \n\n\n\nwhen the liquid preparation was stored \n\n\n\nfor 2 years at room temperature (11). \n\n\n\nThe study did not mention about \n\n\n\nmicrobial stability of the liquid \n\n\n\npreparation and the use of preservative. \n\n\n\nIn another study, an oral suspension of \n\n\n\nfolic acid with a concentration of 50g/ml \n\n\n\nin glass container was physically and \n\n\n\nchemically stable, at least 14 days, when \n\n\n\nstored under refrigeration (2 to 8\u00baC) and \n\n\n\nunder light protection (12).The author \n\n\n\nacknowledged that an evaluation of the \n\n\n\nmicrobiologic stability of this kind of \n\n\n\nextemporaneous preparations (contain no \n\n\n\npreservatives) is critical to ensure safe \n\n\n\nuse in paediatric patients and is \n\n\n\nparticularly required for an \n\n\n\nextemporaneous oral formulation to be \n\n\n\nstored at room temperature over an \n\n\n\nextended period (12). \n\n\n\n\n\n\n\nThe folic acid powder in small doses can \n\n\n\nbe repacked into powder papers from \n\n\n\ncommercially available tablets or capsule \n\n\n\ncontents. In the survey conducted by \n\n\n\nTeixeira de Barros et al, folic acid \n\n\n\npowder papers were the most frequently \n\n\n\nprepared extemporaneous preparation in \n\n\n\nan oral powder form (14.7%) in \n\n\n\nPortuguese hospitals (4). This dosage \n\n\n\nform has its own limitations.  The \n\n\n\npowder need to be reconstituted \n\n\n\nimmediately prior to drug administration \n\n\n\nby the caregiver. Consequently, it will \n\n\n\nincrease the risk of inconsistency of the \n\n\n\npreparation for each dose (6,7). \n\n\n\n\n\n\n\nIn New Zealand, a survey conducted by \n\n\n\nKairuz et al. found that suspensions are \n\n\n\nthe most frequently compounded dosage \n\n\n\nform in a number of hospitals (13). In a \n\n\n\nsurvey conducted by Lowey and Jackson \n\n\n\nto established the top 50 \n\n\n\nextemporaneously prepared oral \n\n\n\npreparation in Yorkshire, the North-East \n\n\n\nand London, they found that the most \n\n\n\ncommonly prepared oral dosage forms \n\n\n\nwere aqueous suspensions (66.2 %) and \n\n\n\nsolutions (22.2 %) (8). At the same time, \n\n\n\nthey also found that the evidence base to \n\n\n\nsupport extemporaneous preparation was \n\n\n\ngenerally poor.  \n\n\n\nOral liquid preparations are often the \n\n\n\ndosage form of choice in paediatric and \n\n\n\ngeriatric population (14). Most problems \n\n\n\nassociated with the stability of these \n\n\n\npreparations have been attributed to the \n\n\n\ninteraction between drug substance and \n\n\n\nexcipients (tablet and formulation) rather \n\n\n\nthan the degradation of the drug \n\n\n\nsubstance by standard routes (14). An \n\n\n\nextensive survey of literature and \n\n\n\ninvestigation of 83 liquids \n\n\n\nextemporaneously prepared from \n\n\n\ncommercial available products revealed \n\n\n\nthat only 7.2% of these liquids exhibited \n\n\n\ninstability due to interactions between \n\n\n\nthe drug substance and the excipients \n\n\n\nrather than degradation of the active \n\n\n\npharmaceutical ingredient (6). \n\n\n\n\n\n\n\nTo address the lack of stability data on \n\n\n\nthe formulation faced by pharmacists in \n\n\n\nthe hospital practice, a liquid \n\n\n\nformulation using the commercial drug \n\n\n\nproduct and vehicle in the hospital \n\n\n\npractice should be prepared and the \n\n\n\nextemporaneous formulation can be \n\n\n\nvalidated. The formulation of the \n\n\n\nextemporaneous preparation should be \n\n\n\ndesigned as simple as possible. The \n\n\n\nresult from this study will provide the \n\n\n\nstability data and the protocol can be \n\n\n\nstandardized in the prescribing and \n\n\n\ncompounding practices among the \n\n\n\nhospitals to provide a safe, effective and \n\n\n\nquality extemporaneous preparation to \n\n\n\nthe patients. \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n31 \n\n\n\n\n\n\n\nThe objective of this study is to evaluate \n\n\n\nthe stability of extemporaneously \n\n\n\nprepared folic acid oral suspension at \n\n\n\n4\u00baC (refrigeration) and 25\u00baC (room \n\n\n\ntemperature) and to determine the shelf-\n\n\n\nlife and storage condition of the \n\n\n\nextemporaneous preparation. This \n\n\n\ninformation is important to ensure that \n\n\n\nthe extemporaneous preparation remains \n\n\n\nstable and efficacious during the course \n\n\n\nof their use. When there is supporting \n\n\n\nstability information of the specific \n\n\n\npreparation, the expiry date may be \n\n\n\nexceeded rather than a short 14 days \n\n\n\nshelf-life when stored at cold \n\n\n\ntemperature if limited information or no \n\n\n\nsupporting data available according to \n\n\n\nUSP 34-NF 29 Chapter <795>, \n\n\n\nPharmaceutical Compounding \u2013 \n\n\n\nNonsterile Preparations(15). \n\n\n\nDrug product stability encompasses \n\n\n\nchemical, physical, microbiological, \n\n\n\ntherapeutic and toxicological stability. \n\n\n\nStability studies should be performed for \n\n\n\ndesired drug concentration and in real \n\n\n\nstorage conditions (storage temperature, \n\n\n\nduration and type of container). The \n\n\n\nphysical stability is assessed from \n\n\n\nchanges in appearance, colour or odour, \n\n\n\nwhile the chemical stability is \n\n\n\ndetermined using an adequate analytical \n\n\n\nmethod for drug quantification. \n\n\n\nMicrobiological stability should be \n\n\n\nconducted in extemporaneous oral \n\n\n\nformulations containing no or \n\n\n\ninsufficient preservatives and be stored \n\n\n\nat room temperature over an extended \n\n\n\nperiod (7,12). \n\n\n\n\n\n\n\nMaterials and methods \n\n\n\n\n\n\n\nCommercial Drug and Vehicle \n\n\n\n\n\n\n\nSourcing the active pharmaceutical \n\n\n\ningredient in powder form is not always \n\n\n\npractical or possible thus commercially \n\n\n\navailable tablets are used in \n\n\n\ncompounding oral liquids. Similarly, the \n\n\n\nuse of commercially available vehicles \n\n\n\ncontaining a combination of sweeteners, \n\n\n\nflavours, suspending agents and \n\n\n\npreservatives is encouraged and is \n\n\n\nconsidered an excellent choice for \n\n\n\nmaking the extemporaneous \n\n\n\npreparation\u201fs simple for the \n\n\n\ninexperienced pharmacist (5). \n\n\n\nCommercial vehicles are considered a \n\n\n\nconvenient choice especially since \n\n\n\nvarious practice settings may not hold a \n\n\n\nwide variety of excipients (such as \n\n\n\nsuspending agents, flavours, sweeteners \n\n\n\nor preservatives) in stock (16). \n\n\n\n\n\n\n\nTablets containing 5mg of folic acid \n\n\n\n(Pharmaniaga Folic Acid 5mg Tablet) \n\n\n\nmanufactured by Duopharma (M) Sdn \n\n\n\nBhd, Malaysia were used for the \n\n\n\ncompounding of folic acid oral \n\n\n\nsuspension. X-temp Oral Suspension \n\n\n\nSystem marketed by Pharm-D Sdn Bhd, \n\n\n\nMalaysia was selected for this \n\n\n\nextemporaneous preparation. X-temp \n\n\n\nOral Suspension System contains \n\n\n\nspecialized suspending system \n\n\n\nformulated to assist in extemporaneous \n\n\n\npreparation of oral liquid, non-soluble \n\n\n\n(suspended), aqueous dosage form and is \n\n\n\norange flavoured, sweetened, sugar-free \n\n\n\nvehicle containing suitable preservatives.  \n\n\n\n\n\n\n\nExtemporaneous Preparation \n\n\n\nA folic acid oral suspension with the \n\n\n\nconcentration of 1mg/ml was prepared \n\n\n\nusing tablets containing 5mg of folic \n\n\n\nacid. Tablets were grounded to a fine \n\n\n\npowder in a mortar with a pestle. A \n\n\n\nportion of the vehicle was used to \n\n\n\nlevigate the fine powder and a uniform \n\n\n\npaste was prepared. Additional vehicle \n\n\n\nwas added to the mortar in small \n\n\n\nportions and then transferred to a \n\n\n\ngraduated container and more vehicles \n\n\n\nwere added to make the total volume \n\n\n\nrequired. \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n32 \n\n\n\n\n\n\n\nTwenty-four bottles of folic acid oral \n\n\n\nsuspension (1mg/ml) were packed into \n\n\n\n100ml semi-transparent plastic bottles \n\n\n\nand were fitted with white plastic screw \n\n\n\ncap. Twelve bottles were stored at 4 \u00b1 \n\n\n\n2\u00baC (refrigeration) and the other twelve \n\n\n\nbottles at 25 \u00b1 2\u00baC (room condition) in \n\n\n\nthe absence of light.  \n\n\n\n\n\n\n\nAnalytical Method \n\n\n\nThe content of folic acid was measured \n\n\n\nby HPLC-UV method after the \n\n\n\nextemporaneous preparation was made \n\n\n\nand throughout the stability study period. \n\n\n\nSamples were collected from each \n\n\n\nindividual bottle on days 0, 14, 28 and \n\n\n\n60. The assay method was developed \n\n\n\nwith the reference to the British \n\n\n\nPharmacopoeia 2009 and the content of \n\n\n\nfolic acid was set at 90 to 110% of the \n\n\n\nstated amount (17). An ASEAN \n\n\n\nreference standard of folic acid was \n\n\n\nobtained from National Pharmaceutical \n\n\n\nControl Bureau (NPCB). \n\n\n\n\n\n\n\nThe HPLC system used for the analysis \n\n\n\nwas an Agilent 1100 HPLC instrument \n\n\n\nwith quaternary pump, autosampler, \n\n\n\nUV/VIS detector and chemstation. The \n\n\n\nchromatographic separation used was \n\n\n\nZorbax Eclipse XDB-C18 (4.6mm ID x \n\n\n\n150mm, 5\uf06dm). The UV/VIS detector \n\n\n\noperated at 283nm. The mobile phase \n\n\n\nconsisted of a mixture of 93 volumes of \n\n\n\n0.05M potassium dihydrogen \n\n\n\northophosphate and 7 volumes of \n\n\n\nacetonitrile and then adjusted to pH 6 \n\n\n\nwith 5M sodium hydroxide. The mobile \n\n\n\nphase was delivered at a flow rate of \n\n\n\n2ml/min. Samples were filtered before \n\n\n\nHPLC analysis and the injection volume \n\n\n\nas 5\uf06dL.  \n\n\n\n\n\n\n\nPhysicochemical Stability Studies \n\n\n\nThe physical and chemical tests (such as \n\n\n\nvisual appearance, odour, pH and folic \n\n\n\nacid content) were assessed at time 0, 14, \n\n\n\n28 and 60 days during storage at both \n\n\n\ntemperatures. Prior to sample collection, \n\n\n\nthe bottles were agitated on a rotating \n\n\n\nmixer for 30 minutes. The oral \n\n\n\nsuspensions were examined at each \n\n\n\nsampling time for any change in \n\n\n\nappearance or odour. The pH was \n\n\n\nperiodically checked during storage at \n\n\n\nboth temperatures. The preparation is \n\n\n\nconsidered stable if physical \n\n\n\ncharacteristics have remained fairly \n\n\n\nunchanged and assay of folic acid has \n\n\n\nremained equal or above 90% of the \n\n\n\noriginal concentration during the storage \n\n\n\nperiod. \n\n\n\n\n\n\n\nMicrobiological Stability Studies \n\n\n\nMicrobiological stability of the folic acid \n\n\n\noral suspension stored at 4\u00baC and 25\u00baC \n\n\n\nwas studied at the interval of days 0, 14, \n\n\n\n28 and 60. The microbial limit of total \n\n\n\nbacteria, total fungi and E. Coli was \n\n\n\nmonitored to establish the \n\n\n\nmicrobiological quality of this \n\n\n\nextemporaneous preparation and test \n\n\n\nmethods was developed according to the \n\n\n\nBritish Pharmacopoeia 2010 for non-\n\n\n\nsterile products (18). \n\n\n\n\n\n\n\nResults and discussion \n\n\n\n\n\n\n\nPhysicochemical Stability \n\n\n\nThe visual appearance, odour and pH at \n\n\n\n4 \u00baC  and 25 \u00baC of the extemporaneous \n\n\n\npreparations remained the same (Table \n\n\n\n1,2 and 3).  In practice, the visual \n\n\n\nappearance, smell, taste and mouth feel \n\n\n\nof the pharmaceutical preparations will \n\n\n\ninfluence the patient\u201fs acceptance and \n\n\n\ncompliance, especially in the paediatric \n\n\n\npatients.  These factors are important to \n\n\n\nbe considered in the development of a \n\n\n\nsuitable oral extemporaneous preparation \n\n\n\n(5). \n\n\n\nThe folic acid concentration remained in \n\n\n\nthe extemporaneous preparations \n\n\n\ncollected at 0, 14, 28 and 60 days were \n\n\n\nall above 90% for both storage \n\n\n\nconditions (Figure 2). Although previous \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n33 \n\n\n\n\n\n\n\nstudy found that the rate of chemical \n\n\n\ndegradation usually increases with \n\n\n\ntemperature (7), this study showed no \n\n\n\nsignificant differences in the \n\n\n\nconcentration of folic acid remained in \n\n\n\nthe suspension in both storage \n\n\n\nconditions. (Figure 2). \n\n\n\n\n\n\n\nIn aqueous solution, folic acid is stable \n\n\n\nup to 10 hours at 100\u00baC, in a pH range of \n\n\n\n5 to 12 and protected from light. The \n\n\n\ndegradation rate increases at pH below 5 \n\n\n\n(19). However, this study found no \n\n\n\nsignificant degradation in the folic acid \n\n\n\nprepared in oral suspension dosage form \n\n\n\neven though the pH were consistently \n\n\n\nbelow 5 throughout 60 days. Drugs in \n\n\n\nsolution are more susceptible to \n\n\n\nchemical degradation than drugs in solid \n\n\n\nstate (such as suspensions), thus \n\n\n\nsuspensions are more stable than \n\n\n\nsolutions (7). This may explain why the \n\n\n\nfolic acid remained stable even at pH \n\n\n\nlower than 5. \n\n\n\n\n\n\n\n\n\n\n\nTable 1: Visual appearance of folic acid oral suspension \n \n\n\n\nTime (Days) 0 14  28 60 \n\n\n\n4\u00baC \n\n\n\nColour:  \n\n\n\norange yellow \n\n\n\nClarity:  \n\n\n\nopaque \n\n\n\nColour:  \n\n\n\norange yellow \n\n\n\nClarity:  \n\n\n\nopaque \n\n\n\nColour:  \n\n\n\norange yellow \n\n\n\nClarity:  \n\n\n\nopaque \n\n\n\nColour:  \n\n\n\ndarker orange \n\n\n\nClarity:  \n\n\n\nopaque \n\n\n\n25\u00baC \n\n\n\nColour:  \n\n\n\norange yellow \n\n\n\nClarity:  \n\n\n\nopaque \n\n\n\nColour:  \n\n\n\norange yellow \n\n\n\nClarity:  \n\n\n\nopaque \n\n\n\nColour:  \n\n\n\norange yellow \n\n\n\nClarity:  \n\n\n\nopaque \n\n\n\nColour:  \n\n\n\ndarker orange  \n\n\n\nClarity:  \n\n\n\nopaque \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nTable 2:Odour of folic acid oral suspension \n \n\n\n\nTime (Days) 0 14  28 60 \n\n\n\n4\u00baC Orange  Orange Orange Orange \n\n\n\n25\u00baC Orange Orange Orange Orange \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nTable 3:pH of folic acid oral suspension \n \n\n\n\nTime (Days) 0 14  28 60 \n\n\n\n4\u00baC 4.341 4.347 4.384 4.371 \n\n\n\n25\u00baC 4.341 4.348 4.369 4.374 \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n34 \n\n\n\n\n\n\n\nFigure 2:Stability of folic acid oral suspension at 4\u00baC and 25\u00baC \n \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nIt is important to understand that the \n\n\n\ntablet dosage forms used for \n\n\n\nextemporaneous preparations also \n\n\n\ncontain many other excipients.  These \n\n\n\nexcipients are compatible in the tablet \n\n\n\nform but may have the potential to \n\n\n\ninteract with both in solution or \n\n\n\nsuspension.  These excipients alter the \n\n\n\npH of the final product during storage \n\n\n\nand increase the degradation rate (7). \n\n\n\nConsequently, it may affect the stability \n\n\n\nof the drug and on the shelf-life of the \n\n\n\nfinal preparation (16).  \n\n\n\n\n\n\n\nMicrobiological Stability \nThe results from the microbiological \n\n\n\nstability study of folic acid oral \n\n\n\nsuspension showed that the microbial \n\n\n\nquality was within the established \n\n\n\nspecifications during the study period for \n\n\n\nboth temperatures (Table 4 and 5). The \n\n\n\ntotal viable aerobic count was kept low \n\n\n\nand total yeast and mould count was \n\n\n\nminimal. E. coli was absent throughout \n\n\n\nthe 60 days period. This result shows \n\n\n\nthat the preservatives used in this \n\n\n\nextemporaneous preparation were \n\n\n\neffective against bacteria and fungi and \n\n\n\nthe folic acid oral suspension is \n\n\n\nmicrobiologically stable. \n\n\n\n\n\n\n\nEffective preservative systems require \n\n\n\nrigorous evaluation which is seldom \n\n\n\nperformed on extemporaneous \n\n\n\nformulations. Many factors can reduce \n\n\n\nthe effectiveness of the preservative \n\n\n\nincluding use of contaminated materials, \n\n\n\nchemical degradation, binding of \n\n\n\npreservative to suspending agents or \n\n\n\ntablet excipients, incorrect storage or \n\n\n\nunhygienic use of the extemporaneous \n\n\n\npreparations (7). \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n90\n\n\n\n91\n\n\n\n92\n\n\n\n93\n\n\n\n94\n\n\n\n95\n\n\n\n96\n\n\n\n97\n\n\n\n98\n\n\n\n99\n\n\n\n100\n\n\n\n0 14 28 60\n\n\n\nFo\nlic\n\n\n\n A\nci\n\n\n\nd\n (\n\n\n\n%\n) \n\n\n\nTime (Days) \n\n\n\n4\u00b0C\n\n\n\n25\u00b0C\n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n35 \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nTable 4: Microbial results of folic acid oral suspension (4\u00baC) \n \n\n\n\nTime (Days) 0 14  28 60 \n\n\n\nTotal aerobic bacteria \n\n\n\n(Not more than \n\n\n\n200cfu/g) \n\n\n\n<10cfu/g <10cfu/g <10cfu/g <10cfu/g \n\n\n\nTotal yeast & mould \n\n\n\n(Not more than 20cfu/g) \n<10cfu/g <10cfu/g <10cfu/g <10cfu/g \n\n\n\nE. coli \n\n\n\n(Absence in 1g) \nConforms Conforms Conforms Conforms \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nTable 5: Microbial results of folic acid oral suspension (25\u00baC) \n \n\n\n\nTime (Days) 0 14  28 60 \n\n\n\nTotal aerobic bacteria \n\n\n\n(Not more than \n\n\n\n200cfu/g) \n\n\n\n<10cfu/g <10cfu/g <20cfu/g <20cfu/g \n\n\n\nTotal yeast & mould \n\n\n\n(Not more than 20cfu/g) \n<10cfu/g <10cfu/g <10cfu/g <10cfu/g \n\n\n\nE. coli \n\n\n\n(Absence in 1g) \nConforms Conforms Conforms Conforms \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 36 \n\n\n\nAs the physicochemical and \n\n\n\nmicrobiological stability results were \n\n\n\nwithin the acceptable specifications \n\n\n\nthroughout the study period, the study \n\n\n\nconcluded that the extemporaneous \n\n\n\nformulation of folic acid oral suspension \n\n\n\nis stable for up to 60 days when stored at \n\n\n\nboth 4\u00baC and 25\u00baC. The extemporaneous \n\n\n\npreparation of folic acid in the form of \n\n\n\nsuspension has a few advantages over \n\n\n\nsolution or oral powder. The insoluble \n\n\n\ndrugs such as folic acid may be more \n\n\n\npalatable and stable in suspension than \n\n\n\nsolution and the suspended insoluble \n\n\n\npowders are easy to swallow or \n\n\n\nadminister than the reconstitution of oral \n\n\n\npowder in water which may not form \n\n\n\nreadily into a suspension (20). The \n\n\n\nmethod of extemporaneous preparation \n\n\n\nin suspension form enables easy \n\n\n\nadministration of folic acid to paediatric \n\n\n\nwell as the patient compliance and \n\n\n\nacceptance will be much better than oral \n\n\n\npowder papers. \n\n\n\n\n\n\n\nThis information on formulation and \n\n\n\nstability data should be made accessible \n\n\n\nto both pharmacists and paediatricians so \n\n\n\nthat patients can receive the highest \n\n\n\nquality preparations. Although this study \n\n\n\nhave addressed some of the risks \n\n\n\nassociated with extemporaneous \n\n\n\ncompounding such as non-validated \n\n\n\nstability of the product, there are still \n\n\n\nother inherent risks in compounding \n\n\n\nwhich include using incorrect \n\n\n\nformulation and calculations, selecting \n\n\n\nincorrect drugs and using incorrect \n\n\n\nquantities (21).Therefore, proper \n\n\n\nguidelines that focus on the quality \n\n\n\nassurance and quality control practices \n\n\n\nshould be made available for every \n\n\n\ncompounding pharmacy in order to \n\n\n\ndeliver consistent, safe and quality \n\n\n\nproducts (1). \n\n\n\n\n\n\n\nAcknowledgements \n\n\n\n\n\n\n\nThe author wished to thank Caring \n\n\n\nPharmacy Sdn Bhd for its support in \n\n\n\nproviding the commercial products \n\n\n\nrequired for this stability study and \n\n\n\nBioScenergy International Sdn Bhd for \n\n\n\nits financial support. \n\n\n\n\n\n\n\n\n\n\n\nReferences \n\n\n\n\n\n\n\n1. Liva R. Quality assurance issues in compounding pharmacy. Integrative Medicine \n\n\n\n2006; 5(5):70-72. \n\n\n\n2. Brion F, Nunn AJ, Rieutord A. Extemporaneous (magistral) preparation of oral \n\n\n\nmedicines for children in European hospitals. Acta Paediatrica 2004; 92:486-490. \n\n\n\n3. Flores-Perez QAC, Flores-Perez J, Juarez-Olguin H, Barranco-Garduno LM. \n\n\n\nFrequency of drug consumption and lack of pediatric formulations. Acta Pediatrica de \n\n\n\nMexico 2008; 29(1):16-20. \n\n\n\n4. Teixeira de Barros CM, Almeida AJ. Extemporaneous formulations of oral paediatric \n\n\n\nmedicines in Portuguese hospitals. Journal of Hospital Pharmacy Practice \n\n\n\n2008;14:26-32 \n\n\n\n5. Jackson M, Lowey A. Handbook of Extemporaneous Preparation. United Kingdom: \n\n\n\nPharmaceutical Press; 2010. \n\n\n\n6. Glass BD, Haywood A. Stability considerations in liquid dosage forms \n\n\n\nextemporaneously prepared from commercially available products. J Pharm \n\n\n\nPharmaceut Sci 2006; 9(3):398-426. \n\n\n\n7. Woods DJ. Extemporaneous formulation of oral liquids \u2013 a guide. \n\n\n\nhttp://www.pharminfotech.co.nz/manual/Formulation/extemprep.pdf (5 November \n\n\n\n2009) \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 37 \n\n\n\n8. Lowey AR, Jackson MN. A survey of extemporaneous preparation in NHS trusts in \n\n\n\nYorkshire, the North-East and London. Hospital Pharmacist 2008; 15(6):217-219. \n\n\n\n9. BNF for Children. Section 9.1.2. Drugs used in megaloblastic anaemias. British \n\n\n\nMedical Association and Royal Pharmaceutical Society of Great Britain; 2009. \n\n\n\n10. Sweetman SC. Martindale: The Complete Drug Reference. 36\nth\n\n\n\n ed. United Kingdom: \n\n\n\nPharmaceutical Press; 2009. \n\n\n\n11. Vignesh M, Sivakumar M, Parkavi V, Selvakumar K, Joysa Ruby J. Stabilization of \n\n\n\nfolic acid in liquid dosage form: formulation development, method validation and \n\n\n\ncomparative analysis. International Journal of Pharmaceutical and Chemical \n\n\n\nSciences 2012; 1(1):332-338. \n\n\n\n12. Santos S, Sa A, Saiao A, Pecorelli C. Stability of folic acid in extemporaneous oral \n\n\n\nsuspension. Biopharmaceuticals Sciences 2005; 3(2):223-232. \n\n\n\n13. Kairuz T, Chhim S, Hasan F, Kumar K, Lal A, Patel R, Singh R, Dogra M, Garg S. \n\n\n\nExtemporaneous compounding in a sample of New Zealand hospitals: a retrospective \n\n\n\nsurvey. The New Zealand Medical Journal 2007; 120(1251):U2466. \n\n\n\n14. Haywood A, Glass B. Managing extemporaneous oral liquids in practice. Journal of \n\n\n\nPharmacy Practice and Research 2007; 37(2):131-133. \n\n\n\n15. United States Pharmacopeia and National Formulary (USP 34-NF 29). Chapter 795. \n\n\n\nPharmaceutical compounding \u2013 nonsterile preparations. Rockville, MD:United States \n\n\n\nPharmacopeial Convention, Inc.; 2011. \n\n\n\n16. Haywood A, Glass B. Paediatric mixtures. Australian Pharmacist 2010; 29(4):316-\n\n\n\n320. \n\n\n\n17. British Pharmacopoeia (2009). Volume III - Formulated preparations: specific \n\n\n\nmonographs folic acid tablets. London, England: British Pharmacopoeia Commission; \n\n\n\n2009. \n\n\n\n18. British Pharmacopoeia (2010). Volume IV. Appendix XVI B -Microbiological \n\n\n\nexamination of non-sterile products. London, England: British Pharmacopoeia \n\n\n\nCommission; 2010. \n\n\n\n19. Ball GFM. Vitamins in foods \u2013 analysis, bioavailability, and stability. CRC Press; \n\n\n\n2006. \n\n\n\n20. Langley C, Belcher D. Pharmaceutical compounding and dispensing. Pharmaceutical \n\n\n\nPress; 2008. \n\n\n\n21. Kairuz TE, Gargiulo D, Bunt C, Garg S. Quality, safety and efficacy in the \u201eoff-label\u201f \n\n\n\nuse of medicines. Current Drug Safety 2007; 2:89-95. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n"
"\n\n1\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nMALAYSIAN\nJOURNAL of PHARMACY\n\n\n\nA Publication of the Malaysian Pharmaceutical Society\n\n\n\nIn this issue:\n\n\n\n\u2022\t Cost\tAnalysis\ton\tTicagrelor\tUtilisation\tin\tthe\t\n\t Treatment\tof\tPatients\twith\tAcute\tCoronary\n Syndrome: A Preliminary Study\n\n\n\n\u2022\t Stability\tof\tan\tExtemporaneously\tPrepared\t\n\t Alcohol-Free\tPhenobarbitone\tOral\tSuspension\n\n\n\n\t Supplement\n\n\n\n\t Proceedings\tof\tthe\t12th\t\tMPS\tPharmacy\t\t \t\n\t Scientific\tConference\t2015\n\n\n\nPP12684/8/2008\nVol. 2 Issue 1. November 2015\n\n\n\n\n\n\n\n\ni\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nEDITORIAL BOARD\n\n\n\nMalaysian Journal of Pharmacy\nVol.2\tIssue\t1,\tNovember\t2015\n___________________________________________________________________________\n\n\n\nThe Official Journal of the Malaysian Pharmaceutical Society\n\n\n\n\t Editor-in-Chief:\t \t \t Assoc\tProf\tDr\tAsrul\tAkmal\tShafie\n\n\n\n\t Managing\tEditor:\t \t \t Mr\tHo\tRhu\tYann\n\n\n\n\t International\tAdvisory\tBoard:\t Assoc\tProf\tDr\tChua\tSiew\tSiang\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t \t \t \t Prof\tDr\tMohd\tBaidi\tBahari\t\t\n\n\n\n\t Associate\tEditors:\t\t \t \t Mr\tLam\tKai\tKun\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t \t Prof\tDr\tMohamed\tAzmi\tAhmad\tHassali\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t \t \t Assoc\tProf\tDr\tMohamad\tHaniki\tNik\tMohamed\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t \t Ms\tSyireen\tAlwi\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t \t Prof\tP\tT\tThomas\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t \t Dr\tWong\tTin\tWui\n\t \t \t \t \t \t Assoc\tProf\tDr\tVikneswaran\ta/l\tMurugaiyah\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t \t \t \t Prof\tDr\tYuen\tKah\tHay\n\n\n\nThe\tMalaysian\tJournal\tof\tPharmacy\tis\ta\tpublication\tof\tthe\tMalaysian\tPharmaceutical\tSociety.\t\nEnquiries\tare\tto\tbe\tdirected\tto\tthe\tpublisher\tat\tthe\tabove\taddress.\tThe\tPublisher\treserves\tcopy-\nright\tand\trenewal\ton\tall\tpublished\tmaterials,\tand\tsuch\tmaterial\tmay\tnot\tbe\treproduced\tin\tany\t\nform\twithout\tthe\twritten\tpermission\tof\tthe\tPublisher.\n\n\n\nPublisher:\n\n\n\nMalaysian Pharmaceutical Society\n16-2\tJalan\tOP\t1/5,\t1-Puchong\tBusiness\tPark\nOff\tJalan\tPuchong\n47160\tPuchong\nMalaysia\nTel:\t6-03-80791861\nFax:\t6-03-80700388\nHomepage:\twww.mps.org.my\nEmail:\tmps.online@gmail.com\n\n\n\nMalaysian Journal of Pharmacy,\n(the official journal of the Malaysian \nPharmaceutical Society)\nc/o\tSchool\tof\tPharmaceutical\tSciences\nUniversiti\tSains\tMalaysia\n11800\tPenang\nMALAYSIA.\nEmail:\tmaljpharm@gmail.com\n\n\n\n\n\n\n\n\nii\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nEditorial\n\t Pharmacists:\t\tMeeting\tthe\tneeds\tof\tthe\tcommunity\t \t\n   \nResearch Papers\n\t Cost\tAnalysis\ton\tTicagrelor\tUtilisation\tin\tthe\t\t \t\n\t Treatment\tof\tPatients\twith\tAcute\tCoronary\tSyndrome:\t\t\n A Preliminary Study\n\n\n\n\t Stability\tof\tan\tExtemporaneously\tPrepared\tAlcohol-\t\n\t Free\tPhenobarbitone\tOral\tSuspension\n\n\n\nPlenary\tLectures\t&\tConcurrent\tSymposium\n\n\n\nOral Presentations\n\n\n\nPoster Presentations\n\n\n\niii\n\n\n\n1\n\n\n\n12\n\n\n\n22\n\n\n\n31\n\n\n\n81\n\n\n\nTable of Contents\n\n\n\n\n\n\n\n\niii\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nEditorial\n___________________________________________________________________________\n\n\n\nPharmacists:  Meeting the needs of the community\n\n\n\nPT Thomas\nSchool\tof\tPharmacy,\tTaylor\u2019s\tUniversity,\t47500\tSubang\tJaya,\tSelangor,\tMalaysia\n\n\n\nAll\t statutory\tprofessions,\tby\tdefinition,\tare\tmandated\tand\tgiven\t the\tresponsibility\tby\tsociety\t\nto\t take\t care\t of\t their\t needs.\tThe\t needs\t of\t society\t will\t change\t due\t to\t industrialization,\t new\t\ntechnologies,\tclimate\tchange,\tprosperity\tor\tpoverty,\twar\tor\tpeace,\tenvironmental\tshifts\tand\tso\t\non.\t\tIt\tis\ttherefore\timperative\tthat\tprofessions\tare\taware\tof\tthese\tchanges\tand\ttuned\tto\tthe\tneeds\t\nof\tsociety\tprobably\teven\tbefore\tthe\tneeds\tbecome\tapparent.\n\n\n\nThe\tpharmacy\t profession\t is\t responding\t to\t changes\t in\t different\tways\t in\t various\t parts\t of\t the\t\ncountry.\t\tThe\tprofession\tis\tpracticed\tdifferently\tin\tdifferent\tcountries\tbecause\tthe\tneeds\tof\tthe\t\nsociety\tare\tdifferent.\t \t In\tmore\tadvanced\tand\tdeveloped\tcountries,\t the\tpharmacists\t are\tbeing\t\nincreasingly\tasked\tby\tsociety\tto\tprovide\tprimary\tcare.\t\tThus,\tin\tnumber\tof\tcountries,\tpharmacists\t\nare\tbeing\tasked\tto\tplay\ta\tlimited\tprescribing\trole,\tand\tto\tprovide\timmunisations\tand\temergency\t\ntreatment.\t\tIn\tother\tcountries\tpharmacists\tare\tbeing\tasked\tto\tplay\ta\tgreater\trole\tin\tquality\tuse\t\nof\tmedicines\tor\tcomprehensive\tmedication\tmanagement\tand\tare\tthus\tinvolved\tincreasingly\tin\t\nmedication\tuse\treviews,\tespecially\tin\tthe\telderly.\t\tIn\tMalaysia,\tpharmacists\tand\tpharmaceutical\t\nservices\tare\timproving\taccess\tto\tmedicines\tby\tservices\tsuch\tas\tdrive-thru\tpharmacies\tand\tsending\t\nmedicines\tby\tpost,\tand\talso\tattempting\tto\timprove\tadherence\tand\tquality\tuse\tof\tmedicines.\n\n\n\nWith\tgreat\tstrides\tbeing\tmade\tin\tthe\tunderstanding\tthe\thuman\tgenome\tand\tits\trole\tin\thealth\t\nand\tdisease,\tpersonalized\tmedicine\tmay\tnot\tbe\tthat\tfar\taway.\t\tPharmacists\twill\talso\tneed\tto\tfind\t\nways\tto\tmeet\tthe\tneeds\tof\tsocieties\tthat\tare\tstruck\tby\tnatural\tcalamities\tsuch\tas\tearthquakes\tand\t\nfloods\tand\talso\tthose\tthat\tare\travaged\tby\twar\tand\tstrife.\n\n\n\nAs\t they\t have\t always\t done,\t and\tmore\t so\t in\t an\t increasingly\t challenging\t global\t environment,\t\npharmacists\tneed\tto\tmake\tuse\tof\ttheir\ttraining\tand\teducation,\ttechnology\tand\tnew\tmedicines\t\nand\ttreatments\tand\tpossibly\teven\tmove\tfrom\tour\t\u201ccomfort\tzones\u201d\tto\trespond\tto\tthe\tneeds\tof\t\nsociety\tin\tappropriate\tand\tinnovative\tways.\n\n\n\n\n\n\n\n\n1\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nCost Analysis on Ticagrelor Utilisation in the Treatment of Patients \nwith Acute Coronary Syndrome: A Preliminary Study\n___________________________________________________________________________\n\n\n\nL Anchah1*, AYY Fong2,3, TK Ong3\n\n\n\n1\tDepartment\tof\tPharmacy,\tSarawak\tGeneral\tHospital\tHeart\tCentre,\t94300\tKota\tSamarahan,\t\nSarawak,\tMalaysia\n2\tClinical\tResearch\tCentre,\tSarawak\tGeneral\tHospital,\t93586\tKuching,\tSarawak,\tMalaysia\t\n3\tDepartment\tof\tCardiology,\tSarawak\tGeneral\tHospital\tHeart\tCentre,\t94300\tKota\tSamarahan,\t\nSarawak,\tMalaysia\n*\tContact\tfor\tcorrespondence,\tplease\temail:\tlawrenceanchah@gmail.com\n\n\n\nABSTRACT\nBackground:\tDual\t therapy\twith\t aspirin\t and\t clopidogrel\t is\t the\t standard\t treatment\t for\t acute\t\ncoronary\tsyndrome\t(ACS).\tDual\tantiplatelet\ttherapy\tplays\tan\timportant\trole\tin\treducing\tmajor\t\nacute,\tshort-\tand\tlong-term\tadverse\tclinical\toutcomes.\tCurrently,\tthe\teconomic\tevaluation\tof\t\nticagrelor,\t a\t reversible\t and\t direct-acting\t oral\t antagonist\t of\t adenosine\t diphosphate\t receptor\t\nP2Y12\tremains\tunknown.\n\n\n\nObjective:\tTo\tcompare\tthe\tannual\tcost\tof\tticagrelor\tversus\tbranded\tclopidogrel\tin\tpatients\twith\t\nACS\tfrom\ta\tMalaysian\thealth\tcare\tperspective.\n\n\n\nMethods:\tThe\tdata\trequired\t for\t this\tanalysis\twas\tobtained\t from\ta\t2007\tstudy\tcarried\tout\tby\t\nFong\tet\tal.\t in\tACS\tpatients\t(n=57).\tAssumptions\tused\tfor\tthe\tpresent\tanalysis\twere\tbased\ton\t\ndata\t from\t the\tCardiac\tRehabilitation\t Program\t (CRP)\t study,\t the\t Study\t of\t Platelet\t Inhibition\t\nand\tPatient\tOutcomes\t(PLATO)\tand\tthe\tNational\tCardiovascular\tDisease\tACS\t(NCVD\tACS)\t\nregistry\tof\tMalaysia.\tFor\tall\tcalculations,\tthe\tRinggit\tMalaysia\t(RM)\tcurrency\tand\tprices\tas\tof\t\n2007\twere\tconsidered.\t\n\n\n\nResults:\tThe\tcost\tof\tclopidogrel\ttreatment\tin\tpost-ACS\tpatients\tfor\t30\tdays\twas\tcalculated\tto\t\nbe\t RM1,381,340\t (n=2072;\t daily\t cost=RM5.50)\t and\t assuming\t treatment\t with\t ticagrelor,\t the\t\ncost\twould\t be\tRM1,554,000\t (daily\t cost=RM8.70).\t Based\t on\t PLATO\t and\tNCVD\tACS\t 2007,\t\nit\twas\t estimated\t that\tmajor\t adverse\t coronary\t event\t (MACE)\t in\t the\t form\tof\tunstable\t angina\t\n(UA)\twould\toccur\tin\tan\tadditional\t21\tpatients\ton\tclopidogrel,\twhich\tcould\thave\tbeen\tavoided\t\nwith\tticagrelor.\tExtrapolating\tcost\tdata\tfrom\tCRP\tstudy,\tit\twas\testimated\tthat\tthe\tannual\tcosts\t\nfor\t21\tadditional\tcases\tof\tUA\t in\t terms\tof\tannual\t treatment\tand\treadmission\twould\tbe\tmore\t\nthan\tRM400,000.\tTreatment\twith\tticagrelor\twould\tthereby\tbe\tassociated\twith\tlesser\tnumber\tof\t\nMACE\tthat\tcan\tbe\ttranslated\tin\tavoiding\tannual\tcosts\tof\ttreatment\tof\tUA\tand\tresult\tin\tannual\t\ncost\tsavings\tof\tRM238,856.\n\n\n\nConclusion:\tAlthough\tdirect\tcomparisons\twere\tnot\tmade,\tthis\tanalysis\tsuggests\tthat\tticagrelor\t\ntherapy\tmay\tbe\ta\tmore\tcost-saving\talternative\tto\tclopidogrel\tin\tMalaysian\tpatients\twith\tACS.\nKeywords:\t ticagrelor,\t clopidogrel,\t acute\t coronary\t syndrome,\t cost\t analysis,\t major\t adverse\t\ncoronary\tevent\n\n\n\nKeywords:\t ticagrelor,\t clopidogrel,\t acute\t coronary\t syndrome,\t cost\t analysis,\t major\t adverse\t\ncoronary\tevent\n\n\n\n\n\n\n\n\n2\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nINTRODUCTION\n___________________________________________________________________________\n\n\n\nAcute\t coronary\t syndrome\t (ACS)\t is\t an\t important\t cause\t of\t mortality\t and\t hospitalisation\t in\t\nMalaysia.\tIt\tencompasses\ta\trange\tof\tischaemic\theart\tdiseases,\tsuch\tas\tunstable\tangina\t(UA),\tnon-\nST-elevation\tmyocardial\tinfarction\t(NSTEMI)\tand\tST-elevation\tmyocardial\tinfarction\t(STEMI).\t\nIt\tmost\tcommonly\toccurs\tdue\tto\tthe\trupture,\tfissuring\tor\tulceration\tof\tan\tatherosclerotic\tplaque\t\nalong\twith\tthrombosis\tand\tcoronary\tvasospasm\t(1).\tAccording\tto\tthe\tNational\tCardiovascular\t\nDisease\tACS\t(NCVD\tACS)\treport\t2007\tand\t2008,\tthere\twere\t2851\tACS-related\tadmissions\tin\t\nMalaysia\tin\t2008,\tof\twhich\t54%\tpatients\twere\tadmitted\twith\tSTEMI,\t23%\twith\tNSTEMI\tand\t23%\t\nwith\tUA.\tACS\twas\tmore\tcommon\tin\tmales\tthan\tfemales,\twith\tthe\tformer\tconstituting\t75%\tof\t\nthe\tACS-related\tadmissions\tin\t2008.\tThe\tin-hospital\tmortality\trate\tassociated\twith\tACS\tduring\t\nthe\tperiod\tfrom\t2006\tthrough\t2008\twas\tbetween\t7%\tand\t8%\t(2).\tIn\tGRACE\tstudy,\tthe\tmedian\t\nage\tof\tACS\tpatients;\twith\tSTEMI\twas\t64\tyears,\twith\tNSTEMI\twas\t68\tyears,\tand\twith\tUA\twas\t66\t\nyears.\tHowever,\tin\tMalaysia\taccording\tto\tNCVD\tACS\treport\tfor\t2006,\t2007,\tand\t2008\tthe\tmedian\t\nage\tof\tACS\tpatients\twith\tSTEMI,\tNSTEMI\tand\twith\tUA\twere\tsame\tat\t59\tyears\tsuggesting\tthat\t\npeople\tare\tgetting\taffected\twith\tACS\tat\tan\tyounger\tage\twhen\tcompared\tto\tdeveloped\tcountries.\t\nHence,\tit\tis\tnecessary\tto\tstudy\tdifferent\ttreatment\tpatterns\talong\twith\tassociated\tcost\tto\tdevelop\t\ncost\tanalysis\tstrategies\tfor\tpatients\tof\tdifferent\tsocioeconomic\tbackgrounds\tin\tMalaysia\t(3).\n\n\n\nAcute\tcoronary\tsyndrome\tis\tcharacterised\tby\tpartial\tor\tcomplete\tblockage\tof\tepicardial\tcoronary\t\nartery,\t which\t occurs\t due\t to\t a\t platelet-rich\t thrombus.\t Since\t the\t prognosis\t of\t the\t condition\t\ndepends\ton\tthe\tactivity\tof\tplatelets,\tdual\tantiplatelet\ttherapy\tis\tconsidered\tnecessary\tto\tavoid\ta\t\nrepeat\tocclusion\tin\tthe\ttarget\tvessel\tafter\ta\tsuccessful\tpercutaneous\tcoronary\tintervention\t(PCI).\t\nUntil\t recently,\t aspirin\t and\t clopidogrel\twere\t the\t drugs\t forming\t the\t dual\t antiplatelet\t therapy.\t\nThe\tantiplatelet\tactivity\tof\tclopidogrel\tis\tdependent\ton\tthe\tformation\tof\tthe\tactive\tmetabolite\t\nfrom\tthe\tprodrug.\tVarious\tgenetic\tor\tnon-genetic\t factors\t influence\t this\tbioactivation,\twhich\t\ntakes\tplace\t in\t two\tmetabolic\treactions\t in\t the\t liver.\tAs\ta\tresult,\tclopidogrel\t is\tassociated\twith\t\nconsiderable\t interindividual\t variation\t in\t antiplatelet\t activity.\t Delayed\t and/or\t insufficient\t\nbioactivation\tcauses\tlow-\tor\tno-response,\tthereby\tleading\tto\tadverse\tcardiovascular\toutcomes,\t\nsuch\tas\tstent\tthrombosis,\trecurrent\tMI,\tor\tcardiovascular\tdeath\t(4).\tThe\tlimitations\tassociated\t\nwith\tclopidogrel\ttherapy\thave\topened\tavenues\tfor\tnew\tantiplatelet\tagents.\n\n\n\nTicagrelor,\tan\toral\tand\treversible\tinhibitor\tof\tthe\tP2Y12\treceptor,\tbelongs\tto\ta\tnovel\tchemical\t\nclass\t called\t cyclopentyl-triazolopyrimidine\t (5).\t It\t is\t a\t direct\t acting\t agent\t and\t has\t a\t quicker\t\nand\tmore\tpredictable\tonset\tof\t action\tcompared\twith\t clopidogrel\t (4,5).\tAlso,\t the\tmore\t rapid\t\nneutralisation\tof\tticagrelor\u2019s\teffect\tallows\tplatelets\tto\tresume\tfunction\tmore\tquickly\t(5).\n\n\n\nThe\tStudy\tof\tPlatelet\tInhibition\tand\tPatient\tOutcomes\t(PLATO)\twas\ta\tmulticentre,\trandomised,\t\ndouble-blind\t trial\t conducted\t in\t 18,624\t patients\t to\t assess\t the\t superiority\t of\t ticagrelor\t over\t\nclopidogrel\t in\t the\tprevention\tof\tvascular\tevents\tand\tdeath\t in\tpatients\twho\thad\tACS\twith\tor\t\nwithout\tST\televation.\tThis\t study\tdemonstrated\t that\t treatment\twith\t ticagrelor\twas\tassociated\t\nwith\ta\tsignificant\treduction\tin\tmortality\tfrom\tvascular\tcauses,\tmyocardial\tinfarction,\tor\tstroke\t\nas\tcompared\twith\tclopidogrel\twithout\tan\tincrease\tin\tthe\trate\tof\toverall\tmajor\tbleeding.\tHowever,\t\nan\tincrease\tin\tthe\trate\tof\tnon-procedure-related\tbleeding\twas\tnoted\twith\tticagrelor.\tBased\ton\t\nthe\tPLATO\ttrial,\tseveral\tsubgroup\tanalyses\twere\tconducted\tto\tevaluate\tthe\tefficacy\tof\tticagrelor\t\nin\tvarious\tpatient\tpopulations.\tThese\tanalyses\tdemonstrated\tbeneficial\teffects\tof\tticagrelor\tover\t\nclopidogrel\tin\tpatients\twith\tSTEMI\treferred\tfor\tprimary\tPCI,\tpatients\twith\tdiabetes,\tpatients\t\nundergoing\tcoronary\tartery\tbypass\tgraft,\tand\tpatients\twith\tchronic\tkidney\tdisease.\tThese\tresults\t\nprovided\tevidence\tfor\tinclusion\tof\tticagrelor\tin\tEuropean\tSociety\tof\tCardiology\tguidelines\tfor\t\n\n\n\n\n\n\n\n\n3\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nACS\twithout\tST\televation\tand\tmyocardial\trevascularisation\t(6).\n\n\n\nEconomic\t analyses\t from\t the\t PLATO\t trial\t and\t other\t studies\t that\t compared\t ticagrelor\t with\t\nclopidogrel\t in\t patients\twith\tACS,\t have\t suggested\t that\t ticagrelor\t therapy\tmay\t be\tmore\t cost-\neffective\tthan\tclopidogrel\t(7-10).\n\n\n\nThe\t present\t study\twas\t conducted\t to\t assess\t the\t cost\t savings\t of\t treatment\twith\t ticagrelor\t for\t\n30\tdays\tin\tMalaysian\tpatients\twith\tACS.\tThis\tstudy\tseeks\tto\tsupplement\texpert\topinion\twith\t\nempirical\tdata\tregarding\tthe\tnext\tpotential\talternative\tfor\tantiplatelet\ttherapy\tin\tACS.\n\n\n\nMETHODS\nThe\tstudy\thad\trecruited\tconsecutive\tpatients\tadmitted\twith\tACS\tat\tCardiac\tTertiary\tReferral\t\nCentre\t (CTRC),\t Sarawak\t General\t Hospital,\t Malaysia\t (n=57),\t which\t is\t currently\t known\t as\t\nSarawak\tGeneral\tHospital\tHeart\tCentre\tand\tat\tDistrict\tGeneral\tHospital\tSibu,\tMalaysia\t(n=32)\t\nfrom\t 1\t October\t 2007\t to\t 30\t November\t 2007.\t All\t patients\t attended\t routine\t pre-scheduled\t\noutpatient\tfollow-up\t30-days\tafter\thospital\tdischarge.\tFor\tthe\tpurpose\tof\tthis\tanalysis,\tbaseline\t\ncharacteristics\tand\tpatient\toutcomes\tat\t30\tdays\twere\tretrieved\tfrom\tthis\tstudy.\n\n\n\nANALYSIS OF COST SAVING\nThe\tcost\tdetails\tcaptured\tfor\tthis\tanalysis\tincluded\tcosts\tof\tall\tmedical\tand\tnon-medical\tsupplies\t\nand\tcosts\tincurred\tfrom\tthe\tperspective\tof\tthe\thealthcare\tprovider.\tFor\tthe\tpurpose\tof\tthis\tstudy,\t\nit\twas\tassumed\tthat\treducing\tthe\tnumber\tof\tevents\t(non-fatal\tmyocardial\tinfarction,\tnon-fatal\t\nstroke,\t severe\t recurrent\t ischaemia,\t UA\t or\t other\t vascular\t causes)\t will\t ultimately\t reduce\t the\t\noverall\tcost\tof\ttreatment.\t\n\n\n\nThe\tincurred\tcost\t in\t treatment\tof\ta\tdisease\tpossibly\t indicates\t the\tdisease\tburden\tand\tcan\tbe\t\nmeasured\tdescriptively\t through\ta\t cost\tof\t illness\t study,\twhich\t translates\t the\t entire\tburden\tof\t\nresources\t used\t in\t the\t treatment\t into\t a\t monetary\t value.\t Measuring\t the\t direct\t costs\t during\t\nhospitalisation\t and\tdischarge\twould\tbe\t the\tmost\t ideal\t approach\t to\t identify\tdirect\t economic\t\nburden\t to\t health\t care\t providers\t over\t a\t period\t of\t time.\t Based\t on\t the\t data\t obtained\t from\t\nCardiac\tRehabilitation\tProgram\t (CRP)\t study,\t the\t rate\t of\t hospitalisation\t resulting\t from\tACS\t\nwas\t estimated\t (11).\tThe\t direct\tmedical\t costs\t were\t calculated\t by\tmultiplying\t the\t number\t of\t\ninterventions\t(drug\tdoses,\tlaboratory\ttests,\tprocedures,\tconsumables,\tmedical\tequipments,\tand\t\nother\tinvestigations)\twith\tthe\tcost\tper\tintervention.\tThis\tdirect\tmedical\tcost\tcorrelates\twith\tthe\t\nnumber\tof\tinterventions\tnecessitating\thospital\tstay,\tclinical\texamination\tand\talso\ton\tthe\tlength\t\nof\tstay\twith\teach\tevent\tof\thospitalisation.\n\n\n\nSeveral\tsimplifying\tassumptions\tare\tmade\tto\tmaintain\ttransparency\tin\tthe\tmodel\tstructure.\tPost-\nACS,\ta\tpatient\tmay\tbe\tindicated\tfor\tcoronary\tartery\tbypass\tgraft\t(CABG),\telective\tsurgery\tfor\t\nPCI\tor\tmedications.\tPrices\tas\tof\t2007\tare\tconsidered\tfor\tcalculations\tand\tthe\tcurrency\tis\tRinggit\t\nMalaysia\t (RM).\tThe\teconomic\tevaluations\tare\tdone\t to\tcompare\t the\t two-treatment\t strategies\t\nbetween\tthose\tpatients\twith\tclopidogrel\tand\tto\tthose\tpatients\twho\tcould\thave\tbeen\topted\tto\t\nticagrelor\tas\tan\talternative\tADP\tinhibitor.\tThe\tprojected\tpotential\tcost\tsavings\tfor\ttreatments\t\nand\texpected\thealth\toutcomes\tof\tMACE\tare\tobtained\tby\tcomparing\tthe\ttwo\ttreatments\toption.\t\nAll\tdata\tused\tare\tbased\ton\ta\tsingle\tclinical\ttrial\tat\tCardiac\tTertiary\tReferral\tCentre\tand\tNCVD\t\ndatabase,\twhich\tare\tapplied\tto\tcompare\tthe\tcost\tand\tconsequences\tof\ttreatments.\tProbability\tof\t\nswitching\tto\tticagrelor\tin\tcost\tevaluation\tstrategies\twould\thelp\tto\testimate\tthe\texact\tcost\tsaving\t\nin\tinterventions\tand\ttreatment\toptions\tparticularly\tin\tlong-term\tdisease\tmanagement.\n\n\n\n\n\n\n\n\n4\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nBecause\ta\trange\tof\tcost\tof\ttreatments\tfor\tACS\twas\tused,\tthere\tis\tinevitably\tsome\tuncertainty\t\nin\testimated\tcosts\tincurred\tfor\tinterventions.\tSensitivity\tanalysis\twas\ttherefore\tconducted.\tThe\t\neffect\tof\ttreatment\tof\tMACE,\tcost\tof\tinterventions,\ttotal\tcost\ttreatment\tand\tother\tkey\tdata\tin\t\ncosts\tof\tmanaging\tACS\twere\ttested.\n\n\n\nRESULTS\nFor\t this\tanalysis,\tdata\trelated\t to\tpatients\trecruited\tonly\tat\tCTRC\tSarawak\twas\tconsidered\tas\t\ncost\tdetails\twere\tavailable\tonly\tfor\tthis\thospital.\tThe\tbaseline\tcharacteristics\tof\tthese\tpatients\tas\t\ncollected\tin\tthe\tstudy\tby\tFong\tet\tal.\thave\tbeen\toutlined\tin\tTable\t1\t(12).\n\n\n\n___________________________________________________________________________\n\n\n\n___________________________________________________________________________\n\n\n\nACS,\tacute\tcoronary\tsyndrome;\tCAD,\tcoronary\tartery\tdisease;\tCTRC,\tCardiac\tTertiary\tReferral\tCentre.\t\n\n\n\nThis\t study\t provided\t information\t on\t the\t occurrence\t rate\t of\t major\t adverse\t coronary\t events\t\n(MACE)\tduring\t the\tfirst\t30\tdays\tpost\tACS.\t In\t this\t study\t that\tbased\ton\tour\t local\t setting,\twe\t\nextracted\t and\t applied\t relevant\t information\t on\t cardiovascular\t death\t rate\t and\tUA\t incidences\t\nunto\tNCVD\tACS\tdatabase.\tAmong\tthe\t57\tpatients\trecruited,\t7\thad\ta\tMACE;\tof\twhich,\t4\twere\t\ncardiovascular\t deaths\t and\t 3\twere\tUA\t (Table\t 2).\tThis\t fraction\t 4\t over\t 7\t (4/7\tMACE)\t can\t be\t\nrelated\t to\t a\t similar\t approach\tpresented\t in\tNCVD\tACS\twhere\t cardiovascular\tdeath\t rate\twas\t\n10%.\tSimilarly,\tUA\twas\tseen\tin\ta\tfraction\tof\t3\tover\t7\tMACE\tor\tcorresponding\trate\t7.5%\tMACE\t\nin\tACS\tpatients\tpost\tadmission\tin\t30\tdays.\tThus,\tthe\tprevalence\trate\tof\ttotal\tMACE\tas\testimated\t\nfrom\tNCVD\tACS\t2007\twas\t17.5%\t(12).\n\n\n\n___________________________________________________________________________\n\n\n\n___________________________________________________________________________\n\n\n\nCTRC,\tCardiac\tTertiary\tReferral\tCentre;\tMACEs,\tmajor\tadverse\tcardiovascular\tevents.\n\n\n\nTable 1: Baseline characteristics of patients with ACS admitted to CTRC Sarawak General \nHospital, Malaysia\n\n\n\nTable 2: Patient outcome at 30 days\n\n\n\nMale\nAge\t(mean,\tyears)\nEthnic\tOrigin\n     Malay\n\t\t\t\t\tNon-Malay\tBumi\n\t\t\t\t\tChinese\nDiabetes\nHypertension\nSmoking\t(30\tdays)\nDyslipidaemia\nFamily\thistory\tof\tCAD\n\n\n\nCTRC\nInpatient\tmortality\n30-day\tMACEs\nInpatient\tangiography\nOutpatient,\telective\tangiography\n\n\n\nn=57\n41\n\n\n\n58\t\u00b1\t13\n\n\n\n23\n12\n22\n19\n37\n14\n16\n7\n\n\n\nn=57\n4\n3\n28\n5\n\n\n\nPercentage\n71.9\n\n\n\n40.4\n21.1\n38.6\n33.3\n64.9\n24.6\n28.1\n12.3\n\n\n\nPercentage\n7.0\n5.7\n49.1\n8.8\n\n\n\n\n\n\n\n\n5\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nFrom\tthe\tNCVD-ACS\treport\t2007\tand\t2008,\tit\twas\textrapolated\tthat\t65%\tof\tall\tpatients\twith\t\nACS\twho\t were\t admitted\t for\t treatment,\t received\t a\t daily\tmaintenance\t dose\t of\t an\t adenosine\t\ndiphosphate\t(ADP)\tantagonist\twith\tor\twithout\ta\tloading\tdose\t(2).\tIt\twas\tassumed\tthat\tthe\tADP\t\nantagonist\tgiven\tto\tpatients\twas\tclopidogrel\tas\tduring\tthat\tperiod\tthe\tevidence\trecommended\t\nclopidogrel\tand\tit\twas\talso\tthe\tonly\tstandard\tdrug\tavailable\t(13,\t14).\n\n\n\nAccording\t to\t the\tNCVD\tACS\t registry,\t there\twere\t 3,646\t cases\t of\tACS\t in\t 2007\t (2).\tOf\t these\t\npatients,\t2,072\tfulfilled\tthe\tinclusion\tcriteria\tused\tin\tthe\tPLATO\tstudy\tand\twere\tused\tfor\tall\tcost\t\ncalculations\tin\tthis\tanalysis.\tThe\tdaily\tcost\tof\tticagrelor\twas\thigher\tcompared\twith\tclopidogrel\t\n(RM8.70\tvs.\tRM5.50,\trespectively).\tThe\t30-day\tdrug\tcost\tof\tclopidogrel\ttreatment\tin\tMalaysian\t\npatients\t with\t ACS\twas\t calculated\t to\t be\t RM1,381,340.\t Using\t the\t same\t pool\t of\t patients\t and\t\nassuming\tthat\tticagrelor\twas\tused\tinstead\tof\tclopidogrel,\tthe\tcorresponding\tcosts\tof\ttreatment\t\nwith\tticagrelor\twould\tbe\tRM1,554,000.\tThe\tdifference\tin\tthe\tcosts\tof\tthe\ttwo\ttreatments\twould\t\nbe\tRM172,660\thigher\tfor\tticagrelor.\n\n\n\nThe\tPLATO\tstudy\tdemonstrated\tthat\tthere\twas\ta\trelative\trisk\treduction\t(RRR)\tof\t12.2%\tin\tthe\t\nprimary\tevent,\tfavouring\tthe\tticagrelor\tarm\tat\t30\tdays.\tThe\testimated\tMACE\tfrom\tNCVD\tACS\t\n2007\twas\t17.5%\tand\tthe\trate\tof\tMACE\tcould\thave\tbeen\treduced\tto\t15.4%\tif\tall\tthe\tACS\tpopulation\t\nin\t2007\twere\ttreated\twith\tticagrelor.\tBased\ton\tthis\tinformation,\tit\tis\testimated\tthat\t158\tpatients\t\nwere\thaving\tMACE\twhen\tusing\tclopidogrel\tand\tonly\t137\tMACE\twhen\tusing\tticagrelor.\n\n\n\nThus,\t there\t were\t 21\t additional\t cases\t of\t readmission\t due\t to\t UA\t with\t clopidogrel\t treatment\t\n(Figure\t1).\n\n\n\nTo\tcalculate\tthe\tcosts\tof\treadmission\tand\tmanagement\tof\t21\tpatients\twith\tUA,\tdata\tfrom\tCRP\t\nstudy\twas\t used.\t According\t to\t CRP\t study\t (11),\t the\t total\t direct\t cost\t for\t patients\t undergoing\t\nCABG\tduring\tthe\tsubsequent\t12-month\tfollow-up\tperiod\twas\testimated\tto\tbe\ta\tmedian\tvalue\t\nof\tRM53,562\tand\tthe\tcost\tfor\tpatients\ton\tinpatient\tcoronary\tangiography\tduring\tthe\tsubsequent\t\n12-month\tfollow-up\tperiod\twas\ta\tmedian\tvalue\tof\tRM16,620\twhich\twas\tthree\ttimes\tless\tthan\t\npatients\twho\thad\tundergone\tCABG\t(15).\tActivity\tbased\tcosting\t(ABC)\tmethod\twas\tused\t to\t\ndetermine\tthe\tdirect\tcost\tincluding\tconsumables,\tmedications\tand\tall\tother\toperational\tcosts\t\nassociated\twith\ttreatment.\tHowever,\tindirect\tcost\twas\tnot\tconsidered\tto\tdetermine\tthe\tcost\tfor\t\ntreatment.\t(Table\t3)\n\n\n\nFigure 1: Schematic representation of treatment options for unstable angina and \nprobabilities of clinical outcomes\n\n\n\nCABG,\tcoronary\tartery\tbypass\tgraft;\tPCI,\tpercutaneous\tcoronary\tintervention;\tUA,\tunstable\tangina.\n\n\n\n21\tpatients\twith UA\n57.9%\n\n\n\n1/3\n\n\n\n1/3\n\n\n\n1/3\n\n\n\n40.1%\n\n\n\nReadmission\nn=13\n\n\n\nPCI\nn=5\n\n\n\nCABG\nn=5\n\n\n\nWithout intervention\nn=3\n\n\n\nFollow-up\nn=8\n\n\n\nOutpatient\ntreatment\n\n\n\n\n\n\n\n\n6\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\n___________________________________________________________________________\n\n\n\n___________________________________________________________________________\nACS,\t acute\t coronary\t syndrome;\t CABG,\t coronary\t artery\t bypass\t graft;\t PCI,\t percutaneous\t coronary\t\nintervention;\tRM,\tRinggit\tMalaysia;\tUA,\tunstable\tangina\n\u2021\t\t\tDrug\tprices\tbased\ton\t2007\tmarket\tpricing.\n\u2020\u2020\tCost\tof\tpharmaceutical\texpenditure\tduring\tadmission\tfor\tquasi-experimental\tdesign\tin\tCRP\tstudy\t\t\n\t\t\t\t\t(n=104).\tOnly\tclopidogrel\t(Plavix\u00ae)\twas\tavailable\tand\tindicated\tfor\tthis\tACS\tgroup.\n\n\n\nTranslating\tthe\tfindings\tfrom\tthe\tstudy\tby\tFong\tet\tal.,\tof\tthe\t21\tpatients\treadmitted\twith\tUA,\t\nas\thigh\tas\t57.9%\t(13\tpatients)\twould\tbe\tplanned\t for\tor\tunderwent\tPCI\tor\tCABG\twithin\t30\t\ndays.\tIt\twas\tassumed\tthat\tan\tapproximately\tequal\tnumber\twould\tundergo\tPCI\twith\tdrug\teluting\t\nstent\t(1/3\u00d713\t\u2248\t5\tPCI\tprocedures),\tand\tCABG\t(1/3\u00d713\t\u2248\t5\tCABG)\tand\tthe\trest\twould\tbe\ton\t\noptimal\tmedical\ttherapy\talone.\tTherefore,\tthe\testimated\tannual\tcosts\tfor\t21\tcases\tof\tUA\tin\tterms\t\nof\t re-admissions\t and\t treatment\twould\t cost\t the\t health\t care\t provider\tmore\t than\tRM400,000.\t\nAlthough\t the\tdaily\t cost\tof\t ticagrelor\t treatment\t is\thigher,\t it\t is\t associated\twith\t lesser\tnumber\t\nof\treadmissions\twhen\tcompared\twith\tclopidogrel,\tthereby\tresulting\tin\tannual\tcost\tsavings\tof\t\nRM238,856\t(Table\t4).\n\n\n\n___________________________________________________________________________\n\n\n\n___________________________________________________________________________\n\n\n\nTable 3: Estimate direct cost of treatment for ACS patients in clopidogrel group\n\n\n\nPer\tpatient\tcost\tof\tdrugs\tduring\tadmission\tfor\tACS,\tmedian\t\n(range)\t\u2020\u2020\n\n\n\nEstimated\tper\tpatient\tcost\tof\toptimised\tmedical\ttherapy\tin\ta\t\nyear,\tmedian\t(range)\t\u2020\u2020\n\n\n\nFrom\thealth\tcare\tperspective\tthe\tannual\testimated\tdirect\tcosts\t\nper\tpatient\tfor\tthose\tundergoing\tCABG,\tmedian\t(range)\n\n\n\nFrom\thealth\tcare\tperspective,\tthe\tannual\testimated\tdirect\t\ncosts\tper\tpatient\tfor\tthose\tundergoing\tPCI,\tmedian\t(range)\n\n\n\nClopidogrel\tgroup\n(CRP\tstudy,\tn=104)\t\u2021\n\n\n\nRM\t1,078.45\t(95.44\u201313,559.11)\n\n\n\nRM\t2,731.91\t(1,365.26\u20135,976.96)\n\n\n\nRM\t53,562.25\t(46,538\u201361,542)\n\n\n\nRM\t16,620\t(4,565\u20139,182.68)\n\n\n\nTable 4: Distribution of the number of long-term prescription medications. (A) Daily cost \nof ADP inhibitors doses per day; (B) estimated cost of medical therapy in 30 days with \nADP inhibitors; (C) estimated cost of medical therapy for 2,072 patients from NCVD \nregistry; (D) the differences in 30 days between the two groups; (E) projected clinical \n\n\n\noutcomes (MACE) and cost incurred annually after 30 days treatment\n\n\n\n(A)\tDaily\tcost\tof\tADP\tinhibitors\t\u2021\n\n\n\n(B)\tEstimated\tper\tpatient\tcost\tof\tmedical\t\ntherapy\tfor\tfirst\t30\tdays\tafter\tdischarge\u2020\n\n\n\n(C)\tEstimated\tcost\tof\tmedical\ttherapy\tfor\t2,072\t\npatients\tfrom\tNCVD\tACS\tdatabase\tin\tfirst\t30\t\ndays\tafter\tdischarge#\n\n\n\n(D)\tDifference\tin\tcost\tof\tADP\tantagonist\t\ntherapy\tfor\t30\tdays\t(b-a)\n\n\n\n(E)\tEstimated\ttotal\tcosts\tincurred\tfor\ttreatments\t\nand\tinterventions\tof\t21\tpatients\twith\tUA\t\n\n\n\nClopidogrel group\u2020\u2020\n\n\n\nRM\t5.50\tper\tday\n\n\n\nRM\t666.67\n\n\n\nRM\t1,381,340\t(a)\n\n\n\n \nRM\t411,516*\t(d)\n\n\n\nTicagrelor\n\n\n\nRM\t8.70\tper\tday\n\n\n\nRM\t750\n\n\n\nRM\t1,554,000\t(b)\n\n\n\n \n-\n\n\n\nTicagrelor\n\n\n\nRM\t172,660\t(c)\n\n\n\n\n\n\n\n\n7\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nNCVD,\tNational\tCardiovascular\tDisease;\tUA,\tunstable\tangina;\tPCI,\tpercutaneous\tcoronary\tintervention;\t\nRM,\tRinggit\tMalaysia;\t$,\tUnited\tStates\tdollar.\n\u2021\tDrug\tprices\tbased\ton\t2007\tmarket\tpricing.\n\u2020\tThe\taverage\tmedical\tcost\tper\tpatient\tfor\tACS\tin\tfirst\t30\tdays\ttreatment\twith\tclopidogrel\twas\t$194.36\t\t\t\t\t\t\n\t\t\t($1=\tRM3.43).\n*\tApproximately\thigher\tnumbers\tof\tpatients\tundergo\tmedical\ttherapy,\tbut\tequal\tnumbers\tundergo\tPCI\t\t\n\t\t\tand\tCABG.\t\n\n\n\nOne-way\t sensitivity\t analyses\twere\tperformed\tby\t changing\t estimated\t costs\twithin\t a\t range\tof\t\npotentially\t reasonable\t values\t all\t treatment\t options\t (CABG,\t PCI\t or\t medication\t alone)\t and\t\nevaluating\twhether\tchanges\tin\ttreatment\toptions\tof\t21\tpatients\twith\tUA\tmodify\tincurred\tcost.\tIf\t\ntotal\tCABG\tintervention\tat\tthat\tyear\tescalates,\tthe\ttotal\tincurred\tcost\tof\ttreatment\twill\tdefinitely\t\nincrease.\tIt\tcan\tbe\tclearly\tseen\tthat\tthe\toverwhelming\tmajority\tof\tsimulation\tresults\tare\tlocated\t\nabove\tof\tRM400,000.\tThe\tmaximum\testimated\ttotal\tincurred\tcost\tof\ttreatments\tcould\treach\tto\t\nRM1.2\tmillion.\tThe\tanalysis\tshowed\tthat\teven\tif\twe\tdecrease\tthe\tnumber\tof\tmajor\tintervention\t\nlike\tCABG,\tit\twould\tnot\textensively\tdecrease\tthe\tcost\tof\ttreatments\tof\tMACE.\tThis\treflects\tthe\t\nsignificance\tof\tusing\tticagrelor\tand\tsuggests\ta\thigh\tprobability\tof\tcost\tavoidance\tin\tthe\ttreatment\t\nof\tMACE\t(Figure\t2).\t\n\n\n\nFigure 2: Sensitivity analysis: Influence of increase option of CABG in the total cost \nincurred in treatment of MACE.\n\n\n\nChanges in number of CABG intervention\n\n\n\n\n\n\n\n\n8\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nDISCUSSION\nAcute\tcoronary\tsyndrome,\twhich\twas\tinitially\tassociated\twith\tdeveloped\tcountries,\tis\ton\tthe\trise\t\nin\tAsia-Pacific\tcountries,\tincluding\tMalaysia\t(16,\t17).\tIn\torder\tto\treduce\tthe\trisk\tof\tdeveloping\t\nACS\tand\tcontrol\tthe\tassociated\tburden,\ta\tcomprehensive\taction\tplan\tis\trequired.\tTo\tthis\tend,\tthe\t\nNCVD\tACS\tregistry\twas\testablished\tin\t2006,\tto\tcapture\tdata\tof\tACS\tpatients\tin\tMalaysia\t(17).\t\nAccording\tto\tthe\tNCVD\tACS\treport\t2007\tand\t2008,\tACS\tis\taffecting\tthe\tMalaysian\tpopulation\t\nat\ta\tmuch\tyounger\tage\t (<50\tyears)\twhen\tcompared\twith\tfindings\t from\tGRACE.\tDuring\t the\t\nperiod\tfrom\t2006\tthrough\t2008,\tACS\twas\tassociated\twith\tin-hospital\tmortality\trates\tbetween\t\n7%\tand\t8%\t(2).\n\n\n\nThe\t availability\t of\t newer\t therapies\t has\t provided\t more\t alternatives\t to\t treating\t physicians.\t\nHowever,\tphysicians\tmust\tbe\tarmed\twith\tsufficient\tknowledge\tregarding\tnew\tdrugs\tin\torder\tto\t\nensure\ttheir\toptimal\tusage.\tThis\tincludes\tnot\tonly\tclinical\tdata\tregarding\tthe\tefficacy\tand\tsafety\t\nof\tthe\tdrug,\tbut\talso\tdata\ton\tits\tcost-effectiveness.\tThis\thelps\tin\tefficient\tutilisation\tof\tthe\tlimited\t\nhealth\tcare\tresources\tavailable\t(18).\n\n\n\nCost\tanalyses\tbased\ton\tthe\tPLATO\ttrial\thave\tbeen\tconducted\tto\tdetermine\tthe\tcost-effectiveness\t\nof\t12-month\tticagrelor\ttreatment\tin\tpatients\twith\tACS\tas\tcompared\twith\tclopidogrel\t(7,8).\tIn\t\none\tsuch\tanalysis\tconducted\tby\tNikolic\tet\tal.,\tticagrelor\ttreatment\twas\tassociated\twith\ta\tquality-\nadjusted\tlife\tyears\t(QALYs)\tgain\tof\t0.13\tand\tincreased\tcosts\tof\t\u20ac362,\tyielding\ta\tcost\tper\tQALY\t\ngained\tof\t\u20ac2753\tas\tcompared\tto\tgeneric\tclopidogrel.\tThe\tcost\tper\tlife\tyear\tgained\twas\t\u20ac2372.\t\nThe\tprice\tof\tgeneric\tclopidogrel\tconsidered\twas\t\u20ac0.06\tper\tday\t(lowest\tavailable\tprice\tas\tof\tJuly\t\n2011)\tand\tthat\tof\tticagrelor\twas\t\u20ac2.21\tper\tday\t(reimbursed\tprice\tin\tSweden).\tThe\tcost\tanalysis\tof\t\nticagrelor\twas\tuniform\tacross\tall\tsubgroups\tof\tACS\tpatients\u2014those\twith\tUA,\tSTEMI,\tNSTEMI,\t\nand\tthose\tplanned\tfor\tinvasive\tmanagement.\tThe\tstudy\tconcluded\tthat\tthe\tcost\tper\tQALY\tgained\t\nwith\t ticagrelor\t treatment\t in\t patients\twith\tACS\t for\t a\t 12-month\t period\t is\twithin\t the\t usually\t\naccepted\tlevels\tfor\tcost-effectiveness\t(8).\tAnother\tanalysis\tbased\ton\tthe\tPLATO\ttrial\tpublished\t\npreviously\thad\tshown\tsimilar\tresults.\tThe\tprice\tconsidered\tfor\tclopidogrel\tand\tticagrelor\tfor\tthis\t\nstudy\twas\t\u20ac0.17\tper\tday\tand\t\u20ac2.25\u20133.50\tper\tday,\trespectively\t(7).\n\n\n\nThe\t absence\t of\t similar\t data\t for\t countries\t in\t Asia,\t prompted\t Chin\t et\t al.\t performed\t a\t cost-\neffectiveness\t analysis\t of\t ticagrelor\t treatment\t in\t patients\t with\t ACS\t in\t Singapore.\tThis\t study\t\nwas\tbased\ton\tdata\tobtained\tfrom\tthe\tPLATO\ttrial.\tThe\tdaily\tcost\tof\tclopidogrel\tand\tticagrelor\t\nconsidered\twas\t1.05\tand\t6.00\tSingapore\tDollar\t($),\trespectively.\tThe\tQALY\tgained\twith\tticagrelor\t\nwas\t0.13\tat\ta\tlifetime\tincremental\tcost\tof\t$1328,\tyielding\ta\tcost\tper\tQALY\tof\t$10,136.\tThe\tstudy\t\ndemonstrated\t that\t even\t after\t considering\t the\t low\twillingness-to-pay\t threshold\t in\t Singapore\t\naccording\t to\t World\t Health\t Organisation\t standards,\t 12-month\t treatment\t with\t ticagrelor\t in\t\npatients\twith\tACS\tis\tlikely\tto\tbe\tfavorable.\tThe\tlower\thospitalisation-related\tcosts\twith\tticagrelor,\t\nmainly\tlower\tbed-days\tand\tlesser\tinterventions,\tcompensate\tpartly\tfor\tthe\thigher\tdrug\tcost\tof\t\nticagrelor\t(18).\n\n\n\nThese\tresults\tare\tsimilar\tto\tthe\tresults\tobtained\tin\tour\tstudy.\tOur\tstudy\talso\tdemonstrates\tthat\t\nin\tMalaysia,\t treatment\twith\t ticagrelor\t can\t result\t in\t annual\t cost\t savings\tof\tRM238,856\twhen\t\ncompared\twith\tclopidogrel.\tAlthough\tthere\tare\tshort-term\tcost\t savings\twith\tclopidogrel,\t the\t\ntrend\t clearly\t shows\t that\t readmission\t rates\t are\t higher,\t thereby\t increasing\t the\t overall\t cost\t of\t\ntreatment\tand\tcost\tburden\tin\tmanaging\tpatients\tin\tacute\tsetting.\n\n\n\nTo\tour\t knowledge,\t this\t cost\t analysis\t is\t the\t first\t of\t its\t kind\t to\t evaluate\t the\t cost\t of\t ticagrelor\t\ncompared\twith\tclopidogrel\tin\tMalaysian\tpatients\twith\tACS.\tIt\twas\tcarried\tout\tto\tsupplement\t\nthe\tclinical\tdata\ton\tticagrelor\tuse\tin\tMalaysia.\tIt\twas\tbased\ton\ttreatment\toutcomes\tof\tticagrelor\t\nfrom\tthe\tPLATO\ttrial,\tprevalence\tof\tACS\tin\tMalaysia\tfrom\tNCVD\tACS\tregistry\tand\ttreatment\t\noutcomes\tof\tclopidogrel\t in\tMalaysian\tpatients\t from\ta\t2-month\tstudy\t in\tCTRC\tSarawak.\tWe\n\n\n\n\n\n\n\n\n9\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nhope\tthat\tthis\tstudy\twill\tprovide\ta\tbasis\tfor\tfuture\tstudies\tthat\twill\testimate\tthe\tcost\tsaving\tof\t\nticagrelor\tby\tits\tactual\tuse\tin\tMalaysian\tpatients\twith\tACS.\tSuch\tstudies\twill\thelp\tguide\thospitals\t\nand\tphysicians\tto\tmake\tinformed\tdecisions\tregarding\tthe\tusage\tof\tticagrelor\tin\tpatients\twith\t\nACS.\t\n\n\n\nLIMITATION\nThis\tstudy\thas\tcertain\tlimitations.\tIt\tis\tlimited\tto\ta\tsingle\tcentre;\thowever,\tthe\tresults\tare\tlikely\t\nto\tbe\trelevant\tto\tcardiac\tcentres\toutside\tthe\tstate\talso\tin\tterms\tof\tintended\tmanagement\tstrategy\t\n(i.e.,\t medical,\t interventional,\t or\t surgical)\t and\t clinical\t events\t (19,\t 20).\t Certain\t assumptions,\t\nwhich\twere\tmade\tfor\tthis\tstudy,\tmay\taffect\tthe\trobustness\tof\tresults.\tAlso,\tclinical\toutcomes\tof\t\nticagrelor\t treatment\twere\tadapted\t from\tthe\tPLATO\tstudy\tand\textrapolated\t to\t the\tMalaysian\t\npopulation.\tThis\tmay\tagain\taffect\tthe\tresults\tof\tour\tanalysis\tas\ttreatment\toutcomes\tmay\tvary\tin\t\ndifferent\tpopulations.\t\n\n\n\nIt\t is\t also\t likely\t that\t the\t incurred\t costs\t for\t treatments\t and\t interventions\t for\t ACS\t were\t\nunderestimated\t in\t this\t analysis\t as\t only\t the\t perspective\t of\t the\t healthcare\t providers\u2019\t was\t\nconsidered.\tA\tcomplete\toverview\tof\tthe\tcost\tof\tticagrelor\ttreatment\tin\tpatients\twith\tACS\tcould\t\nhave\tbeen\tobtained,\tonly\tif\twe\tcould\tmeasure\tthe\tcosts\tincurred\tfrom\tthe\tsocietal\tperspective.\t\nIn\t addition,\t data\t for\t this\t analysis\t was\t retrieved\t from\t two\t clinical\t studies\t conducted\t at\t our\t\nlocal\t setting\t and\t the\t costs\t per\t survivor\t for\t post-ACS\t participants\t were\t estimated\tmanually\t\nfrom\t the\t anticipated\t records\t as\t the\t case\t note,\t prescription\t profile,\t laboratory\t investigation,\t\nand\t other\t relevant\t documents.\t The\t cost\t of\t branded\t clopidogrel\t was\t considered\t for\t this\t\nanalysis\tbecause\tonly\tthe\tbranded\tdrug\twas\tavailable\tin\tMalaysia\tin\tthe\tyear\t2007.\tThis\tmight\t\nhave\t implications\t on\t the\t cost\t savings\t derived\t from\t ticagrelor\t treatment\t in\t this\t analysis. \n\n\n\nCONCLUSION\nIn\tthis\tanalysis,\ta\tformal\tlink\twas\testablished\tbetween\tmeasures\tof\tcosts\tand\toutcomes\tof\tticagrelor\t\ntherapy,\t although\tdirect\t comparisons\t cannot\t be\tmade.\tThis\t economic\t analysis\t suggests\t that\t\nticagrelor\ttherapy\tmay\tbe\ta\tmore\tcost-saving\talternative\tto\tclopidogrel\t in\tMalaysian\tpatients\t\nwith\tACS.\tHowever,\ta\thead-to-head\tcomparison\tin\tlarger\tpopulation\tmay\tbe\trequired\tto\tfurther\t\nvalidate\tthe\tfindings\tof\tthis\tstudy.\n\n\n\nACKNOWLEDGMENTS\nOur\tappreciation\tand\tthanks\tto\tthe\tDirector-General\tof\tHealth\tMalaysia,\tfor\tpermission\tto\tshare\t\nand\tpublish\tthese\tfindings.\tWe\tare\tgrateful\tto\tDr\tMaggie\tSeldon,\tTiong\tLee\tLen\tand\tLana\tLai\t\nfor\tproviding\tsupport\tfor\tthe\tcost\tdetails\tused\tin\tthe\tstudy\tand\tto\tall\tindividuals\twho\tsupplied\t\npricing\tinformation.\n\n\n\nCONFLICT OF INTEREST\nNone declared.\n\n\n\nREFERENCES\n1.\t Azman\tWA,\tSim\tKH,\tet\tal.\tAnnual\tReport\tof\tthe\tNCVD-ACS\tRegistry\tMalaysia\t2006.\t\t\n\t National\tCardiovascular\tDisease\tDatabase\t(NCVD).\tAvailable\tat:\thttp://www.acrm.\t\n\t org.my/ncvd/documents/1stAnnualReport/20081013_ncvdACSReport.pdf.\tAccessed\t\t\n\t on:\tDecember\t16,\t2013.\n\n\n\n2.\t Azman\tWA,\tSim\tKH,\tet\tal.\tAnnual\tReport\tof\tthe\tNCVD-ACS\tRegistry\tMalaysia\t2007\t\t\n\t &\t2008.\tNational\tCardiovascular\tDisease\tDatabase\t(NCVD).\tAvailable\tat:\t\n\t http://www.acrm.org.my/ncvd/documents/report/acsReport_07-08/fullReport.pdf.\t\t\n\t Accessed\ton:\tDecember\t16,\t2013.\n\n\n\n\n\n\n\n\n10\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\n3.\t Steg\tPG,\tGoldberg\tRJ,\tGore\tJM,\tet\tal,.\tBaseline\tcharacteristics,\tmanagement\tpractices,\t\t\t\n\t and\tin-hospital\toutcomes\tof\tpatients\thospitalized\twith\tacute\tcoronary\tsyndromes\tin\tthe\t\n\t Global\tRegistry\tof\tAcute\tCoronary\tEvents\t(GRACE).\tAm\tJ\tCardiol.\t2002;90:358\u2013363.\n\n\n\n4.\t H\u00f6chtl\tT,\tSinnaeve\tPR,\tAdriaenssens\tT,\tet\tal.\tOral\tantiplatelet\ttherapy\tin\tacute\tcoronary\t\n\t syndromes:\tupdate\t2012.\tEur\tHeart\tJ\tAcute\tCardiovasc\tCare.\t2012;1:79\u201386.\n\n\n\n5.\t Roffi\tM,\tPatrono\tC,\t\tCollet\tJP,\tet\tal.\tESC\tGuidelines\tfor\tthe\tmanagement\tof\tacute\tcoronary\t\n\t syndromes\tin\tpatients\tpresenting\twithout\tpersistent\tST-segment\televation:\tThe\tTask\t\t\n\t Force\tfor\tthe\tmanagement\tof\tacute\tcoronary\tsyndromes\tin\tpatients\tpresenting\twithout\t\t\n\t persistent\tST-segment\televation\tof\tthe\tEuropean\tSociety\tof\tCardiology\t(ESC).\tEur\t\t\t\n\t Heart\tJ.\t2015\tAvailable\tat:\t\n\t http://eurheartj.oxfordjournals.org/ehj/early/2015/08/28/eurheartj.ehv320.full.pdf\t\t\t\n\t Accessed\ton:\tSeptember\t13,\t2015.\n\n\n\n6.\t Wallentin\tL,\tBecker\tRC,\tBudaj\tA,\tet\tal.\tTicagrelor\tversus\tclopidogrel\tin\tpatients\twith\t\t\n\t acute\tcoronary\tsyndromes.\tN\tEngl\tJ\tMed.\t2009;361:1045\u20131057\t\n\n\n\n7.\t Henriksson\tM,\tNikolic\tE,\tJanzon\tM,\tet\tal.\tPCV46\tLong-term\tcosts\tand\thealth\toutcomes\t\n\t of\ttreating\tacute\tcoronary\tsyndrome\tpatients\twith\tticagrelor\tbased\ton\tthe\tEU\tlabel:\tcost-\n\t effectiveness\tanalysis\tbased\ton\tthe\tPLATO\tstudy.\tValue\tHealth.\t2011;14:A40.\n\n\n\n8.\t Nikolic\tE,\tJanzon\tM,\tHauch\tO,\tet\tal.\tCost-effectiveness\tof\ttreating\tacute\tcoronary\t\t \t\n\t syndrome\tpatients\twith\tticagrelor\tfor\t12\tmonths:\tresults\tfrom\tthe\tPLATO\tstudy.\tEur\t\t\n\t Heart\tJ.\t2013;34:220\u2013228.\n\n\n\n9.\t Theidel\tU,\tAsseburg\tC,\tGiannitsis\tE,\tet\tal.\tCost-effectiveness\tof\tticagrelor\tversus\t\t \t\n\t clopidogrel\tfor\tthe\tprevention\tof\tatherothrombotic\tevents\tin\tadult\tpatients\twith\tacute\t\t\n\t coronary\tsyndrome\tin\tGermany.\tClin\tRes\tCardiol.\t2013;102:447\u2013458.\n\n\n\n10.\t Crespin\tDJ,\tFederspiel\tJJ,\tBiddle\tAK,\tet\tal.\tTicagrelor\tversus\tgenotype-driven\tantiplatelet\t\n\t therapy\tfor\tsecondary\tprevention\tafter\tacute\tcoronary\tsyndrome:\ta\tcost-effectiveness\t\t\n\t analysis.\tValue\tHealth.\t2011;14:483\u2013491.\t\n\n\n\n11.\t Anchah\tL,\tSim\tKH,\tIzham\tM,\tet\tal.\tThe\teconomic\tand\thumanistic\toutcomes\tof\tpost\t\t\n\t acute\tcoronary\tsyndrome\tin\tcardiac\trehabilitation\tprogram:\tA\tquasi-experimental\t\t\t\n\t design\tof\t12\tmonths\tfollow-up.\tNational\tHeart\tAssociation\tof\tMalaysia.\tAvailable\t\t \t\n\t at:\twww.e-mjm.org/2010/v65n3/National_Heart_Association_Abstracts.pdf.\tAccessed\t\t\n\t on:\tDecember\t16,\t2013.\n\n\n\n12.\t Fong\tAYY,\tTiong\tLL,\tWong\tJL,\tet\tal.\tImpact\tof\tan\tonsite\tcardiac\tcatheter\tlaboratory\n\t\t and\tpharmacotherapy\ton\tclinical\toutcomes\tof\tAcute\tCoronary\tSyndrome:\tA\tcomparison\t\n\t of\ta\tTertiary\tReferral\tCentre\twith\ta\tDistrict\tGeneral\tHospital.\tAvailable\tat:\t\n\t http://www.malaysianheart.org/files/151303501049f02201533ae.pdf.\tAccessed\ton:\t\t\t\n\t December\t16,\t2013.\n\n\n\n13.\t Hayasaka\tM,\tTakahashi\tY,\tNishida\tY,\tet\tal.\tComparative\teffect\tof\tclopidogrel\tplus\taspirin\t\n\t and\taspirin\tmonotherapy\ton\thematological\tparameters\tusing\tpropensity\tscore\tmatching.\t\n\t Vasc\tHealth\tRisk\tManag.\t2013;9:65\u201370.\n14.\t Yusuf\tS,\tZhao\tF,\tMehta\tSR\tet\tal.\tEffects\tof\tclopidogrel\tin\taddition\tto\taspirin\tin\tpatients\t\n\t with\tacute\tcoronary\tsyndromes\twithout\tST-segment\televation.\tN\tEngl\tJ\tMed.\t\t \t\n\t 2001;345:494\u2013502.\n\n\n\n\n\n\n\n\n11\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\n15.\t Anchah\tL,\tIzham\tM,\tSim\tKH,\tet\tal.\tCost-utility\tanalysis\tof\tthe\tmodified\tcardiac\t\t\n\t rehabilitation\tprogram:\tA\tpreference-based\ton\tSF-6D.\tMPS\tPharmacy\tScientific\t\t \t\n\t Conference\t2011.\tMalaysian\tJ\tPharmacy.\t2011;1(9).\n\n\n\n16.\t Chin\tSP,\tJeyaindran\tS,\tAzhari\tR,\tet\tal.\tAcute\tCoronary\tSyndrome\t(ACS)\tRegistry\t-\t\n\t Leading\tthe\tCharge\tfor\tNational\tCardiovascular\tDisease\t(NCVD)\tDatabase.\tMed\tJ\t\t\n\t Malaysia.\t2008;63(Suppl\tC):29\u201336.\n\n\n\n17.\t Lu\tHT,\tNordin\tRB.\tEthnic\tdifferences\tin\tthe\toccurrence\tof\tacute\tcoronary\tsyndrome:\t\t\n\t results\tof\tthe\tMalaysian\tNational\tCardiovascular\tDisease\t(NCVD)\tDatabase\tRegistry\t\t\n\t (March\t2006\t-\tFebruary\t2010).\tBMC\tCardiovasc\tDisord.\t2013;13:97.\t\n\n\n\n18.\t Chin\tCT,\tMellstrom\tC,\tChua\tTS,\tet\tal.\tLifetime\tcost-effectiveness\tanalysis\tof\tticagrelor\t\t\n\t in\tpatients\twith\tacute\tcoronary\tsyndromes\tbased\ton\tthe\tPLATO\ttrial:\tA\tSingapore\t\t\n\t Healthcare\tPerspective.\tSingapore\tMed\tJ.\t2013;54:169\u2013175.\n\n\n\n19.\t Hill\tSR,\tMitchell\tAS,\tHenry\tDA.\tProblems\twith\tthe\tinterpretation\tof\tpharmacoeconomic\t\n\t analyses:\tA\treview\tof\tsubmissions\tto\tthe\tAustralian\tPharmaceutical\tBenefits\tScheme.\t\t\n\t JAMA.\t2000;283:2116\u20132121.\n\n\n\n20.\t Bainey\tKR,\tNorris\tCM,\tGupta\tM.\tAltered\thealth\tstatus\tand\tquality\tof\tlife\tin\tSouth\tAsians\t\n\t with\tcoronary\tartery\tdisease.\tAm\tHeart\tJ.\t2011;162:501\u2013516.\n\n\n\n\n\n\n\n\n12\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\n\n\n\n\nStability of an Extemporaneously Prepared Alcohol-Free Phenobarbitone \nOral Suspension \n \nLian T. Chan*, Lucy Yeoh \n \nWinwa Medical Sdn Bhd, Bukit Mertajam, Pulau Pinang, Malaysia. \n \n* Contact for correspondence, please email: ltchan@winwamedical.com \n \n \n \nABSTRACT \n \nMany drugs used in paediatric are often not available in suitable dosage forms and have to be \nextemporaneously prepared by pharmacists to make them suitable for the body weight, body \nsurface area, or age of the children. Phenobarbitone is the main anti-epileptic drug (AED) for \nthe treatment of seizure in paediatric patients. The objective of this study is to evaluate the \nphysicochemical and microbiological stability of an extemporaneously prepared \nPhenobarbitone Oral Suspension using commercially available tablets and X-temp Oral \nSuspension System. The Phenobarbitone Oral Suspension (10mg/ml) was stored at 4\u00baC and \n30\u00baC / 75%RH protected from light and were examined at the interval of 0, 1, 2, 3 and 6 \nmonths. The content of Phenobarbitone was determined using a validated high-performance \nliquid chromatography (HPLC) method. The visual appearance, odour, pH and specific \ngravity remained fairly unchanged throughout the study period and the content of \nPhenobarbitone remained above 98% of the original concentration throughout the course of \nthe study for both temperatures. The extemporaneous preparation was not susceptible to \nmicrobial contamination. The results from the stability studies confirmed that X-temp Oral \nSuspension is a suitable suspending vehicle for preparing extemporaneous liquid formulation \nof Phenobarbitone Oral Suspension with the added advantage of alcohol-free, colourant-free \nand sugar-free. Based on the data collected, the shelf-life of this liquid formulation is at least \n6 months when stored at 4\u00baC (refrigeration) and 30\u00baC / 75%RH (room temperature).  \n \n \n\n\n\n \nINTRODUCTION \n \nThe pharmaceutical industry supplies oral solid dosage forms that are generally inadequate \nfor paediatric needs. Most licensed oral medicines are intended for adults and are presented \nas tablet or capsule formulations, often in a unit intended as a single adult dose. Some are \navailable as liquids, but have a concentration unsuitable for measuring the dose and \nadministering to the infant or young children (1).   \n \nMany drugs used in paediatrics are often not available in suitable dosage forms and have to \nbe extemporaneously prepared by pharmacists to make them suitable for the body weight, \nbody surface area, or age of the children. Paediatric patients are also more vulnerable to the \neffects of a medication error and may experience a more serious adverse drug reaction than \nan adult, due to the differences in weight or body surface area and because of the varying \nability to metabolize and excrete medications (2). \n \nPharmacists are often required to prepare the extemporaneous preparation and they also face \nthe challenge to choose an appropriate formula. Ideally, the pharmacist should choose \nformulation used for extemporaneous preparation with validated stability and proven shelf-\n\n\n\n\n\n\n\n\n13\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\n\n\n\n\nlife. However, the information related to the extemporaneous formulations and the stability of \nthe final products are lacking (3,4). When the stability data and validated formulations are not \navailable, further research should be carried out to validate the formulations used in practice \nwhenever possible and then the formulations should be standardized among all the hospitals \n(5).  \n \nPhenobarbitone is highly effective for all forms of epilepsy except typical absences in \npatients of all ages, including neonates. It is still a main anti-epileptic drug (AED) for \nneonatal and febrile seizures (if treatment is needed) and established convulsive status \nepilepticus. It is the main monotherapy AED in resource-poor countries (6).  \n \nPhenobarbitone exerts its anti-epileptic activity through multiple modes of action. Its primary \neffect is probably through its post-synaptic binding to GABAA receptors. It also blocks \nvoltage-sensitive sodium and potassium channels, reduces presynaptic calcium influx and \npossibly inhibits glutamate-mediated currents (6).  \n \nPhenobarbitone (Figure 1) is a white, odourless, glistening, small crystals or a white \ncrystalline powder. It may exhibit polymorphism. Soluble 1 in 1000 of water and 1 in 10 of \nalcohol; sparingly soluble in chloroform; soluble in ether and in solutions of fixed alkali \nhydroxides and carbonates. A saturated solution in water has a pH of about 5 (7). \n \n\n\n\nFigure 1: Phenobarbitone \n\n\n\n \n \nSince licensed medicines represent the \u2018gold standard\u2019 for quality, safety and efficacy, the \nunderlying general rule is that a licensed preparation is always preferable to a compounded \none (8). However, the currently available commercial oral liquid formulation of \nPhenobarbitone contains 14% (v/v) alcohol. The American Academy of Pediatrics (AAP) has \nraised the concern with regard to the alcohol content of various medications. AAP \nrecommended that nonprescription oral liquid preparations contain no more than 5% (v/v) \nalcohol because of the risk of harmful central nervous system adverse effects (9). \n \nPhenobarbitone Oral Suspension was prepared in hospital practice for the treatment of seizure \nin paediatric patients. Phenobarbitone has poor solubility (1 mg/ml) but it is freely soluble in \nethanol (100 mg/ml). Therefore, for this reason alcohol is often used in Phenobarbitone \nsolutions. For neonates, as well as for children who use Phenobarbitone for the treatment and \nprevention of seizures, there is a need for an easy to administer liquid oral dosage form of \nPhenobarbitone without alcohol (10, 11). In order to increase the solubility of \nPhenobarbitone, a cosolvent system without alcohol should be created using mixtures of \nvarious oral cosolvents. Sorbitol, glycerin, propylene glycol, and several polyethylene glycol \npolymers are cosolvents that are both useful and acceptable in the formulation of oral liquids \n(10). \n \nTo address this problem, a liquid formulation has to be developed whose suitability and \nstability must be optimized and shelf-life determined. This present study intends to provide \n\n\n\n\n\n\n\n\n14\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\n\n\n\n\nthe information and data to help the pharmacist to determine the shelf-life of the \nextemporaneous preparation of Phenobarbitone commonly prepared in the hospital.  \n \nThe use of commercially and universally available suspending bases is encouraged, \nparticularly where information on the stability of such bases is available in the literature (12). \nCommercial available oral liquid vehicles, such as X-temp Oral Suspension System are a \nconvenient choice for pharmacists, since many practice settings may not stock a wide variety \nof excipients and many of the stability studies in the literature on oral liquids prepared \nextemporaneously utilize these commercial vehicles (13). \n \nThe objective of this study is to evaluate the physicochemical and microbiological stability of \nextemporaneously prepared Phenorbarbitone Oral Suspension and to determine the shelf-life \nand storage condition of the extemporaneous preparation. This information is important to \nensure that the extemporaneous preparation remains stable and efficacious during the course \nof their use. \n \nMATERIALS AND METHODS \n \nCommercial Drug and Vehicle \nThe commercially available tablet, Phenobarbitone 30mg Tablet (in blister pack) \nmanufactured by Idaman Pharma Sdn Bhd was sourced for this study. X-temp Oral \nSuspension System marketed by Pharm-D Sdn Bhd was selected for this extemporaneous \npreparation. X-temp Oral Suspension System is an oral suspending system specially \nformulated to assist in extemporaneous preparation of oral liquid, non-soluble (suspended), \naqueous dosage forms. It is an orange flavoured, sweetened, alcohol-free, colourant-free, \nsugar-free vehicle containing suitable preservatives. Furthermore, it also contains cosolvents \n(sorbitol and glycerin) which is useful for this liquid formulation to increase the solubility of \npoorly water-soluble substances (10).  \n \nSample Preparation \nPhenobarbitone Oral Suspension containing 10mg/ml was prepared using the commercial \navailable tablets. The required numbers of tablet were grounded to a fine powder in a mortar \nwith a pestle. A portion of the vehicle was used to levigate the fine powder to form a uniform \npaste. Additional vehicle was added to the mortar in small portions and then transferred to a \ngraduated container and more vehicle was added to make the total volume required. \n \nThirty bottles of Phenobarbitone Oral Suspension (10mg/ml) were packed into 100ml amber \nhigh-density polyethylene (HDPE) plastic bottles and were fitted with white polypropylene \n(PP) screw caps. Twelve bottles were stored at 4 \u00b1 2\u00baC (refrigeration) and the other eighteen \nbottles at 30 \u00b1 2\u00baC / 75 \u00b1 5%RH (room condition) in the absence of light.  \n \nAnalytical Method and Equipment \nThe Phenobarbitone content in the oral suspension was assayed throughout the course of the \nstudy (0, 1, 2, 3 and 6 months) according to the in-house HPLC method with reference to the \nBritish Pharmacopoeia 2014. The analysis was performed using Agilent 1200 RRLC \ninstrument with UV/VIS detector and the content of Phenobarbitone was set at 90 to 110% of \nthe stated amount (14). The HPLC method for the analysis of Phenobarbitone in this study \nwas validated in another study for its specificity, linearity, accuracy, precision and system \nsuitability (Table 1). A range performed on the HPLC system has confirmed the linearity of \nthe method (R2 = 0.99999) (Figure 2).  \n \n\n\n\n\n\n\n\n\n15\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\n\n\n\n\nTable 1: Results of analytical method validation \nTest Parameter Validation Results Acceptance Limits \n\n\n\n \nSpecificity \nIdentification  \nComparison with a known \nreference material \n \nAssay \nPlacebo/Matrix analysis \n\n\n\n\t\n\t\n\u00a7 Positive result \n\u00a7 No peaks at RT 4 min \n\n\n\n\n\n\n\n\u00a7 No interfering peaks from diluent \nand placebo were observed \n\n\n\n\u00a7 Placebo effect = 0.43% \n\u00a7 The placebo effects were found to \n\n\n\nbe insignificant\t\n\t\n\n\n\n\t\n\t\n\u00a7 Positive control: Positive result \n\u00a7 Negative control: Absence of \n\n\n\npeak at RT 4 min \n \n\u00a7 No interference from \n\n\n\nexcipients \n\u00a7 Placebo effect NMT 1.5%\t\n\n\n\n \nLinearity & Range  \n\n\n\n \n\u00a7 r2 = 0.9999982 \n\u00a7 Intercept = 0.35% of the response \n\n\n\nof 100% working concentration\t\n\t\n\n\n\n \n\u00a7 r\u00b2 \u2265 0.995 \n\u00a7 Y-Intercept at 100% working \n\n\n\nconcentration \u2264 2%\t\n\n\n\n \nAccuracy  \n9 determination (3 \nreplicates/3 concentrations) \n\n\n\n\t\n\u00a7 98.1%, 98.2%, 98.7%, 98.5%, \n\n\n\n99.0%, 98.5%, 98.9%, 100.5%, \n99.1% \n\n\n\n\n\n\n\n\t\n\u00a7 % Recovery within 95% to \n\n\n\n105% \n\n\n\n \nPrecision (Repeatability) \n6 determinations at 100% \nworking concentration \n \n\n\n\n\t\n\u00a7 RSD = 0.66% \n\n\n\nCI = \u00b1 0.70% assayed \n\t\n\n\n\n\t\n\u00a7 RSD \u2264 2.0% & CI \n\n\n\n\n\n\n\n \nPrecision (Reproducibility) \n6 determinations at 100% \nworking concentration \n \n\n\n\n \n\u00a7 RSD = 0.50% \n\n\n\nCI = \u00b1 0.52% assayed \n \n\n\n\n \n\u00a7 RSD \u2264 2.0% & CI \n\n\n\n \nPrecision  \n(Intermediate Precision/ \nRuggedness) \n\n\n\n \n\u00a7 RSD in case of comparison = \n\n\n\n0.58% \n\u00a7 Mean difference = 0.34% \n \n\n\n\n \n\u00a7 RSD \u2264 2.0% & CI \n \n\u00a7 Mean difference \u00b1 2% & CI \n\n\n\n \nDetection Limit (LOD) \n \n\n\n\n \n\u00a7 LOD = 0.000225 mg/ml \n \n\n\n\n- \n\n\n\n \nQuantitation Limit (LOQ) \n \n \n\n\n\n \n\u00a7 LOQ = 0.000824 mg/ml \n \n\n\n\n- \n\n\n\n \nSystem Suitability  \na) System precision \n \n \nb) Peak performance \n\n\n\n \n \n\u00a7 RSD for peak response = 0.07% \n\u00a7 RSD for peak retention time = \n\n\n\n0.06% \n\u00a7 k' = 1.712 \n\u00a7 Resolution = 26.910 \n\u00a7 USP tailing factor = 1.017 \n\u00a7 Column efficiency, N = 13525 \n \n\n\n\n \n \n\u00a7 RSD \u2264 2% \n\n\n\n\n\n\n\n\u00a7 k' \u2264 1.5 \n\u00a7 Resolution >2 \n\u00a7 USP tailing factor < 2  \n\u00a7 Column efficiency, N \u2265 2000 \n\n\n\n\n\n\n\n\n\n\n\n\n\n16\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\n\n\n\n\nFigure 2: Calibration Curve of the LC assay method \n \n \n\n\n\n\n\n\n\n \nThe content of Phenobarbitone was measured by HPLC-UV method after the sample of \nextemporaneous preparation was made throughout the stability study period. Samples were \nremoved from each individual bottle on 0, 1, 2, 3 and 6 months. A working reference \nstandard of Phenobarbitone was obtained from British Pharmacopoeia Commission, United \nKingdom. \n \nThe HPLC system used for the analysis was an Agilent 1200 RRLC instrument with binary \npump SL, autosampler SL, DAD SL detector, Thermostat Column Compartment SL and \nchemstation. The chromatographic separation used was Zorbax Eclipse XDB-C18 (4.6mm ID \nx 150mm, 5\ufffdm). The DAD detector operated at 230nm. The mobile phase consisted of a \nmixture of 72 volumes of a mixture of 0.1M disodium hydrogen phosphate (Na2HPO4) and \n0.026M potassium dihydrogen phosphate (KH2PO4) phosphate buffer adjusted to pH 7 with \n10% (v/v) orthophosphoric acid 85% and 28 volumes of acetonitrile. The mobile phase was \ndelivered at a flow rate of 1ml/min. Samples were filtered before HPLC analysis and the \ninjection volume as 5\ufffdL. \n \nPhysicochemical Stability \nThe analyses of physical and chemical testing (such as visual appearance, odour, pH, specific \ngravity and active content) which could possibly change during storage were assessed at 0, 1, \n2, 3 and 6 months. Prior to sample removal, the bottles were agitated on a rotating mixer for \n30 minutes. The oral suspension was examined at each sample time for any change in \nappearance (colour and clarity) or odour. The pH was determined using a pH meter at initial \nand 1, 2, 3 and 6 months during storage for both temperatures. The preparation is considered \nstable if physical characteristics have remained fairly unchanged and the assay of \nPhenobarbitone content has remained equal or above 90% of the original concentration \nduring the study period. \n \n \n \n\n\n\n\n\n\n\n\n17\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\n\n\n\n\nMicrobiological Stability \nMicrobiological stability of the Phenobarbitone Oral Suspension stored at the two different \nstorage conditions (4\u00baC and 30\u00baC) was studied at the interval of 0, 1, 2, 3 and 6 months. The \nmicrobial limit test was designed according to the British Pharmacopoeia 2014 for non-sterile \nproducts to determine whether the total bacteria, total fungi and Escherichia coli (E. coli) in \nthe extemporaneous preparation complies with the established specifications for \nmicrobiological quality of this type of product (15). \n \nRESULTS AND DISCUSSION \n \nPhysicochemical Stability \nThe visual appearance and odour of the Phenobarbitone Oral Suspension remained the same \nthroughout the 6 months at 4\u00baC and 30\u00baC and no precipitation was observed in any of the \nsamples (Table 2). The results from this study also confirmed that the pH values and the \nspecific gravity of the extemporaneous preparations remained fairly constant at both \ntemperatures (Table 3).  \n \n\n\n\nTable 2: Visual appearance and odour of Phenobarbitone Oral Suspension \n\n\n\nVisual Appearance (Colour and Clarity) \nTime (Month) 0 1 2 3 6 \n\n\n\n4\u00baC White to off-\nwhite & opaque \n\n\n\nWhite to off-\nwhite & opaque \n\n\n\nWhite to off-\nwhite & opaque \n\n\n\nWhite to off-\nwhite & opaque \n\n\n\nWhite to off-\nwhite & opaque \n\n\n\n30\u00baC White to off-\nwhite & opaque \n\n\n\nWhite to off-\nwhite & opaque \n\n\n\nWhite to off-\nwhite & opaque \n\n\n\nWhite to off-\nwhite & opaque \n\n\n\nWhite to off-\nwhite & opaque \n\n\n\nOdour \nTime (Month) 0 1 2 3 6 \n\n\n\n4\u00baC Orange Orange Orange Orange Orange \n30\u00baC Orange Orange Orange Orange Orange \n\n\n\n \nTable 3: pH and specific gravity of Phenobarbitone Oral Suspension  \n\n\n\npH \nTime (Month) 0 1 2 3 6 \n\n\n\n4\u00baC 4.115 4.145 4.061 4.182 4.128 \n30\u00baC 4.115 4.159 4.151 4.182 4.105 \n\n\n\nSpecific Gravity \nTime (Month) 0 1 2 3 6 \n\n\n\n4\u00baC 1.0322 1.0284 1.0393 1.0427 1.0426 \n30\u00baC 1.0322 1.0323 1.0294 1.0423 1.0406 \n\n\n\n \nThe Phenobarbitone content in all the samples were above 98% throughout the 6 months for \nboth temperatures (Table 4) and were relatively stable in acidic pH. There were no \nsignificant differences in the assay results between the two storage conditions to establish any \npossibility of degradation during storage even though the rate of chemical degradation \nusually increases with temperatures (16). The chromatograms illustrated below showed that \nthe HPLC method to be selective for the purpose of this study with minimal interference from \nthe excipients in the formulation (Figure 3). The chromatograms of tested samples at the \ndifferent intervals throughout the stability study period revealed no other peak that could be \nattributed to a possible degradation compound. \n \n \n\n\n\n\n\n\n\n\n18\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\n\n\n\n\nTable 4: Concentration of Phenobarbitone Oral Suspension  \nAssay  \n\n\n\nTime (Month) 0 1 2 3 6 \n4\u00baC 98.5% 98.2% 98.8% 101.5% 102.2% \n\n\n\n30\u00baC 98.5% 99.9% 100.0% 100.7% 101.3% \n \n\n\n\nFigure 3: Chromatograms of Phenobarbitone standard solution and  \nPhenobarbitone Oral Suspension \n\n\n\n \nPhenobarbitone standard solution \n\n\n\n\n\n\n\n\n\n\n\nPhenobarbitone Oral Suspension \n \n\n\n\n\n\n\n\n \nThe above results confirmed that the temperature has little effect on the physical and \nchemical stabilities of the active content in the Phenobarbitone Oral Suspension. Storage in \nthe refrigerator may not be considered necessary.  \n \nMicrobiological Stability \nNo microbial contamination was observed in all samples of Phenobarbitone Oral Suspension \nduring the 6 months study period for both temperatures (Table 5) and the results confirmed \nthat the microbial quality was within the established test limits according to the British \nPharmacopoeia. The total viable aerobic bacteria count was kept low and total yeast and \nmould count was also low. E. coli was absent throughout the study period. These results \nshowed that the preservatives of the extemporaneous preparation were effective against \nbacteria and fungi and the Phenobarbitone Oral Suspension is microbiologically stable at both \ntemperatures for up to 6 months.  \n \n \n\n\n\n\n\n\n\n\n19\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\n\n\n\n\nTable 5: Microbial results of Phenobarbitone Oral Suspension \n\n\n\nMicrobial Limit (4\u00baC) \nTime (Month) 0 1 2 3 6 \n\n\n\nTotal aerobic \nmicrobial count <10cfu/g <10cfu/g <10cfu/g <10cfu/g <10cfu/g \n\n\n\nTotal yeast & \nmoulds count <10cfu/g <10cfu/g <10cfu/g <10cfu/g <10cfu/g \n\n\n\nEscherichia coli Conforms Conforms Conforms Conforms Conforms \n\n\n\nMicrobial Limit (30\u00baC) \nTime (Month) 0 1 2 3 6 \n\n\n\nTotal aerobic \nmicrobial count <10cfu/g <10cfu/g <10cfu/g <10cfu/g <10cfu/g \n\n\n\nTotal yeast & \nmoulds count <10cfu/g <10cfu/g <10cfu/g <10cfu/g <10cfu/g \n\n\n\nEscherichia coli Conforms Conforms Conforms Conforms Conforms \n\n\n\n \nCONCLUSIONS \n \nAn extemporaneously prepared Phenobarbitone Oral Suspension using X-temp Oral \nSuspension System is stable for at least 6 months when packed in amber HDPE bottle with \nplastic screw cap at 4\u00baC (refrigeration) and 30\u00baC / 75%RH (room condition). This liquid \nformulation is also microbiologically stable throughout the course of the study which is \ncritical for the safe use of extemporaneous preparations in paediatric patients. The results \nfrom the stability studies confirmed that X-temp Oral Suspension is a suitable suspending \nvehicle for preparing extemporaneous liquid formulation of Phenobarbitone Oral Suspension. \nThis formulation is not only stable but has the added advantage of alcohol-free, colourant-\nfree and sugar-free.  \n \nThe extemporaneous preparation of Phenobarbitone Oral Suspension can now be prepared \nwith ease by pharmacists in the hospital practice by using X-temp Oral Suspension System \nsupported by stability data and proven shelf-life. \n \nACKNOWLEDGEMENTS \n \nThe author wished to thank Pharm-D Sdn Bhd for its support in providing the commercial \nproducts required for this stability study and BioScenergy International Sdn Bhd for its \nfinancial support. \n \nREFERENCES \n \n1. Nunn AJ. Making medicines that children can take. Arch Dis Child 2003; 88:369-371. \n2. Benavides S, Huynh D, Morgan J, Briars L. Approach to the pediatric prescription in a \n\n\n\ncommunity pharmacy. J Pediatr Pharmacol Ther 2011; 16(4):298-307. \n3. Brion F, Nunn AJ, Rieutord A. Extemporaneous (magistral) preparation of oral medicines \n\n\n\nfor children in European hospitals. Acta Paediatrica 2004; 92:486-490. \n4. Flores-Perez QAC, Flores-Perez J, Juarez-Olguin H, Barranco-Garduno LM. Frequency \n\n\n\nof drug consumption and lack of pediatric formulations. Acta Pediatrica de Mexico 2008; \n29(1):16-20. \n\n\n\n5. Lowey AR, Jackson MN. A survey of extemporaneous preparation in NHS trusts in \nYorkshire, the North-East and London. Hospital Pharmacist 2008; 15(6):217-219. \n\n\n\n\n\n\n\n\n20\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\n\n\n\n\n6. Panayiotopoulos CP. A clinical guide to epileptic syndromes and their treatment. 2th ed. \nUnited Kingdom: Springer Healthcare Ltd; 2010. \n\n\n\n7. Sweetman SC. Martindale: The Complete Drug Reference. 36th ed. United Kingdom: \nPharmaceutical Press; 2009. \n\n\n\n8. Aquilina A. The extemporaneous compounding of paediatric medicines at Mater Dei \nHospital. Journal of the Malta College of Pharmacy Practice 2013: 19:28-30. \n\n\n\n9. Cober MP, Johnson CE. Stability of an extemporaneously prepared alcohol-free \nphenobarbital suspension. Am J Health-Syst Pharm 2007; 64(6):644-646. \n\n\n\n10. Jelveghari M, Nokhodchi A. Development and chemical stability studies of alcohol-free \nphenobarbital solution for use in paediatrics: a technical note. AAPS PharmSciTech 2008; \n9(3):939-943. \n\n\n\n11. Yska JP, Essink GW, Bosch FH, Lankhaar G, van Sorge AA. Oral bioavailability of a \nphenobarbital: a comparison of a solution in Myvacet 9-08, a suspension, and a tablet. \nPharm World Sci 2000; 22(2):67-71. \n\n\n\n12. Jackson M, Lowey A. Handbook of Extemporaneous Preparation. United Kingdom: \nPharmaceutical Press; 2010. \n\n\n\n13. Haywood A, Glass BD. Liquid dosage forms extemporaneously prepared from \ncommercially available products \u2013 considering new evidence of stability. J Pharm \nPharmaceut Sci 2013; 16(3):441-455. \n\n\n\n14. British Pharmacopoeia (2014). Volume I & II - Monographs: medicinal and \npharmaceutical substances. London, England: British Pharmacopoeia Commission; 2014. \n\n\n\n15. British Pharmacopoeia (2014). Volume V. Appendix XVI B - Microbiological \nexamination of non-sterile products. London, England: British Pharmacopoeia \nCommission; 2014. \n\n\n\n16. Woods DJ. Extemporaneous formulation of oral liquids \u2013 a guide. \nhttp://www.pharminfotech.co.nz/manual/Formulation/extemprep.pdf (5 November 2009). \n\n\n\n\n\n\n\n\n21\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nABSTRACT OF THE 12th MALAYSIAN PHARMACEUTICAL SOCIETY - \nPHARMACY SCIENTIFIC CONFERENCE 2015\n\n\n\nPharmacists: Meetings the Needs of Community\nDate:\t13th-15th\tNovember\t2015\n\n\n\n  Reviewers of Abstracts\n\n\n\n\t \tAssoc.\tProf.\tDr\tChua\tSiew\tSiang\n\t \tAssoc\tProf.\tWong\tKok\tThong\n\t \tProf.\tDr\tMohd\tBaidi\tBahari\n\t \tProf.\tDr\tMohd\tCairul\tIqbal\n\t \tBrig.\tGen.\tDato\u2019\tDr\tA\tHalim\tHj.\tBasari\n\t \tDr\tHeh\tChoon\tHan\n\t \tDr.\tJim\tChai\n\t \tDr\tJohn\tTiong\tJeh\tLung\n\t \tDr.\tJason\tLoo\tSiau\tEe\n\t \tDr\tKumarappan\tChidambaram\n\t \tDr\tNajihah\tMohd\tHashim\n\t \tMs\tNoorasyikin\tShamsuddin\n\t \tDr\tRozana\tOthman\n\t \tMs\tSyireen\tBinti\tAlwi\n\t \tMs\tWong\tPei\tNee\n\t \tDr.\tWong\tPei\tSe\n\n\n\n\n\n\n\n\n22\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nTABLE OF CONTENT \n\n\n\nPLENARY LECTURES \n\n\n\nNo Presenter Title \n\n\n\n1 Kenneth S. Ramos, \nProf \n\n\n\nIndividualized Therapy:  How Far Away Are We?  \n \n\n\n\n2 A Halim Hj Basari, \nBrigadier General \nDato\u2019 Dr \n\n\n\nAre Pharmacists' Ready for Disaster Relief ? \n \n\n\n\n3 Surakit Nathisuwan,  \nDr \n\n\n\nEducation of Pharmacists: Should we all be PharmDs? \n \n\n\n\n4 Asrul A Shafie,  \nAssoc. Prof. Dr \n\n\n\nRole of Health Economics in Pharmacy Practice in Malaysia  \n\n\n\n \nSYMPOSIUM LECTURES \n \nNo Presenter Title \n1 Irma N. Ramo, Dr \n\n\n\n \nEmerging Global Diseases: How Should Healthcare \nProfessionals Prepare? \n\n\n\n2 Mohamad Haniki \nNik Mohamed, \nAssoc. Prof. Dr \n\n\n\nInterprofessional Learning towards Collaborative Practice \n \n \n\n\n\n3 Habibah A Wahab, \nProf. Dr \n\n\n\nFusion of Knowledge Based and Natural Product Research \nto Meet the Needs of the Community \n\n\n\n4 Ng Shiow Fern, Dr \n \n\n\n\nA Closer Look at Biofilm-Targeted Wound Delivery \nSystems for the Treatment of Chronic Wound Infections \n\n\n\n\n\n\n\n\n\n\n\n\n\n23\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPLENARY 1\n___________________________________________________________________________\n\n\n\nIndividualized Therapy:  How Far Away Are We? \n\n\n\nKenneth S. Ramos\nDepartment of Medicine, University of Arizona Health Sciences, Arizona, United States  \n\n\n\nPrecision\t medicine\t has\t emerged\t as\t a\t healthcare\t delivery\t platform\t that\t emphasizes\t the\t\nindividualization\tof\tcare\tthrough\tthe\tintegration\tof\tnovel\ttechnologies\tand\tapproaches\tinto\tthe\t\ndiagnosis,\ttreatment\tand\tclinical\tmanagement\tof\tpatients\tand\tpopulations.\tA\tmajor\tdriver\thas\t\nbeen\t the\t sobering\t reality\t that\thealthcare,\t as\twe\tknow\t it\t today,\twill\tnot\tbe\t sustainable\t in\t the\t\nlong\t term\twithout\tnovel\tapproaches\t that\thelp\t to\taugment\tdiagnostic\tprecision\tand\taccuracy\t\nand\t that\t deliver\t targeted\t therapies\t that\t improve\t efficacy.\t Pharmacogenetic\t testing\t has\t been\t\nproposed\tas\ta\tmeans\tto\tindividualize\ttherapy\tand\toptimize\ttherapy\tand\tthis\tpresentation\twill\t\nhighlight\tthe\tstrengths\tof\tthis\tapproach\tand\tthe\tchallenges\tthat\tremain\tto\twidespread\tadoption\t\nof\tindividualized\tmodalities\tin\thealthcare\tdelivery.\n\n\n\n\n\n\n\n\n24\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPLENARY 2\n___________________________________________________________________________\n\n\n\nAre Pharmacists\u2019 Ready for Disaster Relief?\n\n\n\nA Halim Hj Basari\nHealth Services Division, Malaysian Armed Forces HQ, Ministry of Defence, Malaysia \n\n\n\nIt\t is\t inspiring\t to\tnote\t that\tpharmacists\t in\tMalaysia\thad\tbeen\t involved\t in\tdisaster\trelief\twork\t\nbe\tit\tnationally\tand\tinternationally.\tHowever\tmuch\tof\tthe\twork\tby\tthe\tmilitary\tand\temergency\t\npharmacists\tin\tmissions\tfor\tHumanitarian\tand\tDisaster\tRelief\t(HADR)\thad\tgone\tpretty\tmuch\t\nunnoticed.\t \tThis\t is\tbecause\tmuch\tof\t the\twork\twere\tdone\tby\t individuals\ton\ta\tvoluntary\tbasis\t\nand\tby\tthe\tNon-Governmental\tOrganizations\t(NGO)\tin\tan\tisolated\tmanner.\tPharmacists\tfrom\t\nthe\tmilitary\tand\tpublic\tservices\tsectors\thad\tcontributed\tin\tHADR\tbefore\tbut\tthese\tactions\tonly\t\nby\tthe\torders\tof\tthe\tNational\tSecurity\tCouncil.\tThere\tis\tno\treason\tto\tconfine\tHADR\tinitiatives\t\nonly\t to\t certain\t pharmacy\t quarters\t by\t certain\t orders.\tThere\t is\t a\t need\t of\t the\t community\t for\t\nthe\tpharmacist\tat\tlarge\tto\ttake\tstock\tof\tthe\timportance\tand\turgency\tof\tHADR\tinitiatives,\tthe\t\npharmacy\tassociations\tto\tadopt\tappropriate\tpolicies,\tthe\tpharmacy\tacademia\tor\tspecial\tinterest\t\ngroup\tto\tdevelop\ttheoretical\tframework\tand\tguidelines\tfor\tsuch\tactivities,\tthe\tunsung\tpharmacy\t\nheroes\t to\tdocument\t the\t challenges\t of\t various\tHADR\tmissions\t and\t for\t the\tpharmacy\t actors\t\nto\t share\t and\t present\t their\t lessons\t learnt\t for\t a\t better\t and\t holistic\t HADR\t approach.\t HADR\t\nmissions\tare\tnot\ttruly\tthe\tresponsibility\tof\tjust\tthe\tmilitary\tand\temergency\tpharmacists.\tIt\t is\t\nthe\t responsibility\t of\t all\t healthcare\t professionals\t especially\t pharmacists\t because\t they\t are\t the\t\ncustodian\tof\ta\tvery\tunique\tdiscipline\tfor\tthe\tcommunity\u2019s\tconsumption.\tTo\tbe\tready\tfor\tsuch\t\nHADR\tactivities\trequires\tthe\tappropriate\tknowledge,\tskills\tand\tattitude\t(KSA).\t\tThis\tKSA\tcan\t\nbe\t learnt\t and\tpharmacy\t associations\t can\t take\t the\t lead\t to\t create\t the\t appropriate\t strategy\t for\t\npharmacists\tto\tget\tmore\tinvolved\tin\talleviating\tdisaster\tvictims\u2019\tpharmaceutical\tcare,\thealthcare\t\nand basic humanitarian needs.\n\n\n\n\n\n\n\n\n25\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPLENARY 3\n___________________________________________________________________________\n\n\n\nEducation of Pharmacists: Should we all be PharmDs?\n\n\n\nSurakit Nathisuwan\nFaculty of Pharmacy, Mahidol University, Thailand \n\n\n\nDecades\tof\tdebate\thave\tbeen\tongoing\tabout\tto\twhat\textent\tand\tscope\tof\tpharmacy\teducation\t\nshould\t be.\t Recent\tmovement\t toward\t patient-oriented\t education\t for\t pharmacist\t leads\t to\t the\t\nexpansion\tand\tintegration\tof\tclinical\tpharmacy\tinto\tcore\tcompetency\tof\tpharmacy\teducation.\tA\t\ndivision\tbetween\tthose\twho\thave\ta\tvision\tof\t\u201cpharmacy\tas\ta\tclinical\tprofession\u201d\tand\tthose\twho\t\nsee\t\u201cclinical\tpharmacy\tas\ta\tspecialty\u201d\tstill\tlingers\tand\tprovoke\tintense\tdebates\tin\tmany\tcorners\t\nof\tthe\tworld.\t\n\n\n\nFor\tThailand,\tthe\tPharmacy\tCouncil\tissued\ta\tdecree\tto\tend\tits\tapproval\tfor\tthe\t5-year\tBachelor\tof\t\nScience\tcurriculum\tand\tdemanded\ta\tnationwide\tchange\ttoward\tthe\t6-year\tDoctor\tof\tPharmacy\t\n(PharmD)\t curriculum.\t Key\t reasons\t for\t such\t changes\t were\t exponential\t growth\t in\t scientific\t\ncontent,\tdemand\tfor\timprovement\tin\tpharmacy\tgraduate\treadiness\tto\twork\tand\ta\tdesire\tto\tpush\t\nfor\thigher\tstandard\tof\tpharmacy\tgraduate.\t\n\n\n\nMultiple\t intense\t debates\t and\t heated\t discussions\t during\t public\t hearings\t soon\t followed.\t\nOpponents\tof\t such\tmovement\talso\tprovided\tstrong\targuments.\tExample\tof\t those\targuments\t\nwere\tlimited\tavailability\tof\tqualified\tpreceptors,\timbalance\tof\tclinical\tfaculty\tmembers\tversus\t\nthose\t in\t basic\t sciences/product-oriented\t sciences,\t financial\t burden\t to\t parents\t for\t additional\t\nyear\tof\teducation,\tfear\tof\tindifference\tbetween\t5-year\tversus\t6-year\tgraduates\tand\tdifferential\t\ncompetitiveness\tof\tformer\tgraduates\tand\tnew\tgraduates.\tIt\twas\tclear\tthat\tthis\twas\ta\tcontroversial\t\nissue\tin\tThailand\u2019s\tpharmacy\tcircle.\t\n\n\n\nIn\tApril\t2015,\tthe\tfirst\tcohort\tof\t6-year\tpharmacy\tgraduates\tentered\tthe\tjob\tmarket\tnationwide.\t\nFeedback\tfrom\temployees\tstarted\tto\tflow\tin\tand\twill\tbe\tsystematically\tevaluated.\tOutputs\tfrom\t\nsuch\tevaluation\talong\twith\tfindings\tfrom\teducational\tcommittees\tsupervising\tnational\tlicensing\t\nexamination\tand\tpreceptors\tfeedbacks\twill\tbe\tinstrumental\tin\tthe\tcritical\tevaluation\tof\t6-year\t\ncurriculum\tof\tThailand.\t\n\n\n\nFor\tany\tnation,\tthe\tdecision\tto\tchange\tits\tprofessional\tdegree\tis\tcomplex\tin\tnature\tand\trequires\t\nthorough\t examination\t of\t key\t national\t context.\t In\t general,\t graduates\tmust\t possess\t the\t basic\t\nknowledge,\t skills,\t attitudes,\t and\t values\t to\t practice\t pharmacy,\t independently,\t at\t the\t time\t of\t\ngraduation.\tThe\tkey\tdiscussion\ttherefore\tlies\tin\tthe\tdesignation\tof\tscope\tof\tpharmacy\tpractice\t\nof\ta\tpharmacy\tgraduate\tentering\tinto\tpractice.\tSuch\tscope\twill\tvary\tfrom\tone\tsociety\tto\tanother.\t\nIf\tany\tchange\tis\tintended,\tpreparation\tand\treadiness\tfor\tsuch\tchange\tmust\tbe\tdone\tto\tensure\t\nsmooth\ttransition\tand\tsuccess\tto\tmeet\tthe\tchanging\tdemand\tof\tthe\tsociety.\t\n\n\n\n\n\n\n\n\n26\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPLENARY 4\n___________________________________________________________________________\n\n\n\nRole of Health Economics in Pharmacy Practice in Malaysia \n\n\n\nAsrul A Shafie \nSchool of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia\n\n\n\nIn\tthe\tage\tof\tincreasing\tcost\tof\thealthcare,\tchanging\tpharmacy\tpractice,\tageing\tpopulation,\tand\t\nsevere\tshortage\tof\thealthcare\thuman\tresources,\tnow\tmore\tthan\tever\tis\tan\turgent\tneed\tto\tassess\t\nthe\tscarce\tresources\tthat\twe\thave\tin\torder\tto\tproduce\tthe\tmaximum\toutput\tof\thealth.\tPharmacy\t\nprofessionals,\tpolicymakers\tand\tadministrators\tfrequently\tfound\tthemselves\tin\tthe\tcross\troad\t\nto\tdetermine\tthe\tgrowth,\tefficient\tuse,\tand\tallocation\tof\tresources.\tEconomic\tdiscipline\toffered\t\nnatural\tempirical\tsolution\tto\tthese\tthree\tcentral\tproblems\t\u2013\tfrom\tunderstanding\ttheir\texistence\t\nto\tlooking\tat\toptimizing\tits\tuse.\tPharmacy\tpractice\tin\tMalaysia\tneeds\tto\tembrace\tthe\tdiscipline\t\nnot\tonly\tto\tbe\tabreast\twith\tglobal\ttrend\tin\tapplying\tthe\ttool,\tbut\talso\tin\tsolving\tthe\tthree\tperennial\t\nproblems\tin\tthe\tsector:\tHow\tmuch\tresources\tare\twe\tusing\tto\tproduce\thealth?\tHow\tmuch\thealth\t\nare\twe\tusing?\tHow\tto\tget\tthe\tmaximum\thealth\tat\tthe\tlowest\tcost?.\tPrevious\tattempts\tto\tsolve\tthe\t\nthree\tquestions\twere\tunsuccessful\tbecause\tof\tthe\tfundamental\tanalytical\tweakness\tor\tinability\t\nto\ttranslate\tresearch\tfindings\tinto\tpractice.\tTherefore,\tthe\tobjective\tfor\tthis\taddress\tis\tthreefold:\t\nfirst\tis\tto\tgive\tan\toverview\tof\thealth\teconomic\tprinciples;\tsecond\tis\tto\texplore\tits\tpotential\tin\t\nsolving\t the\t problems,\t taking\t example\t of\t local\t and\t international\t evidences;\t and\t finally\t is\t to\t\nponder\tways\tto\tenhance\tits\trole\tin\tMalaysia\tpharmacy\tpractice\n\n\n\n\n\n\n\n\n27\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nSYMPOSIUM 1\n___________________________________________________________________________\n\n\n\nEmerging Global Diseases: How Should Healthcare Professionals Prepare?\n\n\n\nIrma N. Ramo\nUniversity of Arizona, Arizona, United States   \n\n\n\nDespite\t extraordinary\t advances\t in\t the\t development\t of\t new\t diagnostics,\t therapeutics,\t and\t\nvaccines,\t emerging\tand\t re-emerging\tdiseases\t continue\t to\tbe\t a\t challenge\t in\t the\t21st\t century.\t\nThe\temergence\tof\tcommunicable\tand\tnon-communicable\tdiseases\tis\tmultifactorial\tand\thighly\t\ncomplex,\tand\tdriven\tby\tthe\thuman\thost,\tmicroorganisms,\tand\tthe\tenvironment,\tto\tlist\ta\tfew.\t\nAmong\tthe\tmodern\tdemographic\tand\tecologic\tconditions\tthat\tfavor\tthe\tspread\tof\tdisease\tare\t\nthe\trapid\texpansion\tof\tpopulation\tgrowth;\t increasing\tpoverty\tand\turban\tmigration;\t frequent\t\nmovements\t across\t international\t boundaries\t by\t tourists,\t workers,\t immigrants,\t and\t refugees;\t\nalterations\tin\tthe\thabitats\tof\tanimals\tand\tarthropods\tthat\ttransmit\tdisease;\tincreasing\tnumbers\t\nof\t persons\twith\t impaired\t host\t defenses;\t and\t changes\t in\t the\tway\t that\t food\t is\t processed\t and\t\ndistributed.\n\n\n\nEmerging\tand\tre-emerging\tdiseases\tknow\tno\tphysical\tboundaries\tand\trepresent\ta\tthreat\tto\tall\t\nnations,\tcommunities,\tand\tindividuals\tregardless\tof\tage,\tsex,\tlifestyle,\tethnic\tbackground,\tand\t\neconomic\tstatus.\tOf\tnote\tin\tthis\tregard\tis\tthe\timportance\tof\thaving\ta\tstrong\tinfrastructure\tthat\t\nsupports\thealth\tdepartments,\tacademic\thealth\tcenters,\tfederal\tagencies,\thealth\tcare\tproviders,\t\npublic\thealth\tsystems\tand\tinternational\torganizations.\tA\tstrong\tinfrastructure\tshould\tinvolve\t\nnational\t and\t international\t collaborations\t to\t allow\t for\tdevelopment\tof\tbetter\t crafted\tplans\t to\t\nreduce\tthe\tmorbidity\tand\tmortality\tassociated\twith\tdisease.\t\t\n\n\n\nAs\thealth\tcare\tproviders\twe\tneed\tto\tbe\twell\tprepared\tto\trecognized\tand\taddress\tthe\tnegative\t\nhealth\toutcomes\tof\t emerging\tglobal\tdiseases\t impacting\t the\tworld.\t It\t is\t key\t to\t recognize\t the\t\nimportance\tof\tcommunication,\teducation,\tcultural\tawareness\tand\tinformation\texchange\twith\t\npatients\tand\ttheir\tcaregivers,\tprescribers,\tand\tother\thealthcare\tprofessionals.\tWorldwide,\tdue\t\npartly\tto\taccessibility,\taffordability\tand\ttrust,\tpharmacists\tare\toften\tthe\tfirst\tpoint\tof\tcontact\twith\t\nthe\thealthcare\tsystem.\t\tAs\tsuch,\tpharmacists\tplay\ta\tcentral\trole\tin\tthe\tprovision\tof\thealthcare,\tthe\t\nconduct\tof\tbiomedical\tresearch,\tand\tthe\timplementation\tof\tdisease\tprevention\tand\tmanagement\t\nstrategies\twithin\tthe\thealthcare\tsystem\tand\tbeyond.\n\n\n\n\n\n\n\n\n28\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nSYMPOSIUM 2\n___________________________________________________________________________\n\n\n\nInterprofessional Learning towards Collaborative Practice\n\n\n\nMohamad Haniki Nik Mohamed\nKulliyah of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang, Malaysia\n\n\n\nThe\t World\t Health\t Organization\t (WHO)\t defines\t interprofessional\t education\t (IPE)\t as\t the\t\noccurrence\tof\ttwo\t\tor\tmore\thealth\tor\tsocial\tprofessions\tlearning\tinteractively\tabout,\tfrom\tand\t\nwith\teach\tother,\tall\twith\tthe\tcommon\tgoal\tof\tenabling\teffective\tcollaboration\tand\timproving\t\npatient\thealth\toutcomes.\tIPE\tprepares\tstudents\ttowards\tcollborative\tpractice\tin\thealthcare\twhich\t\noccurs\twhen\tprofessionals\tfrom\tdifferent\tspecialties\tprovide\tcomprehensive\tservices\tby\tworking\t\nwith\tpatients,\ttheir\tfamilies,\tcarers\tand\tcommunities\tto\tdeliver\tthe\thighest\tquality\tof\tcare\tacross\t\nall\tsettings.\tIPE\tis\tapplicable\tto\thealthcare\tprofessional\tstudents\tin\tthe\tclassroom\tas\twell\tas\tin\t\nclinical\tplacements\tand\tthese\tefforts\tshould\tideally\tinvolve\tboth\tpresent\tand\tfuture\thealthcare\t\nworkers.\tInterprofessional\tinitiatives\tshould\tbegin\tbefore\tgraduation\tor\tregistration\t\tand\tshould\t\npersist\t through\t the\t course\t of\t the\t career\t via\t continuing\t professional\t development\t (CPD).\t\nProgressive\t practices\t and\t development\t are\t currently\t seen\t in\t Australia,\t part\t of\t Europe\t and\t\nNorth\tAmerica.\tHowever,\t in\tMalaysia,\t IPE\t is\tyet\t to\tbe\t implemented\tat\tmost\tof\t the\t teaching\t\ninstitutions.\tChallenges\t towards\t implementation\tof\t IPE\tneed\t to\tbe\t identified\tand\taddressed.\t\nReadiness\ttowards\tIPE\tamong\tstudents\tand\tlecturers\tof\tlocal\tuniversities\toffering\thealth-related\t\nprogrammes\tmust\tfirst\tbe\t assessed\t as\tbuy-in\t from\trelevant\t stakeholders\t is\t crucial\t to\t ensure\t\nsustainability.\t Last\t but\t not\t least,\t on-going\t research\t in\t IPE\t is\t needed\t to\t further\t strengthen\t\ncorrelation\tbetween\tIPE\twith\tpositive\tpatient\toutcomes.\t\n\n\n\n\n\n\n\n\n29\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nSYMPOSIUM 3\n___________________________________________________________________________\n\n\n\nFusion of Knowledge Based and Natural Product Research to Meet the Needs \nof the Community\n\n\n\nHabibah A Wahab\nSchool of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia\n\n\n\nNatural\tproducts\thave\tbeen\tconsistently\tsuccessful\tsources\tof\tnew\tdrugs.\tAs\ta\tcountry\tblessed\t\nwith\tmega-biodiversity,\tthe\tprospect\tfor\tdiscovering\tnew\tdrugs\tfrom\t15,500\tflowering\tspecies\t\ngrown\tin\tMalaysia,\tcoupled\twith\trich\tknowledge\tof\ttraditional\tuses\tof\therbal\tremedies\tcannot\t\nbe\tunderstated.\tHowever,\tto\tleverage\tthis\tbiodiversity\tfor\tdiscovering\tnew\tactive\tpharmaceutical\t\ningredients\tis\tstill\ta\tgreat\tchallenge.\tIn\trecent\tyears,\twe\tsee\tthe\ttremendous\tincrease\tin\tcommunity\t\ninterest\tin\tplant-centred\thealing.\tHowever,\tmany\tof\tthe\therbal\tproducts\tavailable\tin\tthe\tmarket\t\nstill\tlack\tdefinite\tand\tcomplete\tinformation\tabout\tthe\tcomposition\tof\textracts,\tespecially\ton\tthe\t\nsafety\tand\tefficacy\tof\tthe\tcompositions.\n\n\n\nIn\t meeting\t the\t need\t of\t the\t community,\t our\t pharmaceutical\t research\t will\t highlight\t the\t\ndevelopment\tof\tMyNature50000\tand\tCURINAP,\ta\tcentralised\tnatural\tproduct\tlibrary\tdeveloped\t\nin\tIPharm\tand\tUSM,\trespectively.\tThese\tlibraries\taim\tto\tfacilitate\tthe\tneed\tto\tshare\tour\tphysical\t\nlibrary\tof\tnatural\tproducts,\tknowledge,\texpertise\tand\texperience\tto\ttake\tnatural\tproduct\tresearch\t\nto\ta\tnew\tlevel.\tIn\taddition,\tan\tintegrated\tsystem,\tNADI\twhich\tmeans\t\u201cpulse\tof\tlife\u201d\tin\tMalay\t\nlanguage\tis\ta\tNatural\tBased\tDiscovery\tresource\thas\tbeen\tdeveloped\twith\tintended\taim\tas\ta\tone-\nstop\tcenter\tfor\tin\tsilico\tdrug\tdiscovery\tfrom\tnatural\tproducts.\tNADI\talso\tprovides\tphletora\ton\t\ninformation\tof\ttraditional\tknowledge\tin\tthe\tuse\tof\tmedicinal\therbs.\tThe\tlibrary\tand\tdatabase\u2019s\t\napplication\tin\tnatural\tproduct\tdrug\tdiscovery\twill\tbe\tdemonstrated\tthrough\tits\tapplication\tin\t\nthe\tdiscovery\tof\tnew\tpotential\tanti-infectives\t(e.g.\tin\tinfluenza\tand\tdengue\tinfections).\t\n\n\n\n\n\n\n\n\n30\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nSYMPOSIUM 4\n___________________________________________________________________________\n\n\n\nA Closer Look at Biofilm-Targeted Wound Delivery Systems for the Treatment \nof Chronic Wound Infections\n\n\n\nShiow-Fern Ng\nCentre for Drug Delivery Research, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala \nLumpur, Malaysia\n\n\n\nChronic\twounds\tare\tdefined\tas\t a\tbreak\t in\t the\t skin\tof\t at\t least\t six\tweeks\t that\t fail\t to\tprogress\t\nthrough\ta\tnormal\twound\thealing\tpath.\tBacteria\tare\tpresent\ton\tall\topen\twounds,\tand\tthe\twounds\t\nbecome\tclinically\t infected\twhen\t the\thost\tdefenses\tare\toverwhelmed.\t If\t a\twound\t infection\t is\t\nnot\tmanaged\tproperly,\t the\tbacteria\tmay\tmanifest\t into\tthe\tsystemic\tcirculation\tand\tcause\tthe\t\npatients\t to\t become\t septicaemic.\tWound\t infections\t are\t generally\t considered\t treatable\t by\t the\t\nadministration\tof\tantibiotics;\thowever,\tthis\tis\tnot\talways\teffective\tdue\tto\tthe\thigh-level\tantibiotic\t\nresistance\tfound\ttoday.\tIt\tis\tnow\testablished\tthat\tmicrobial\tbiofilms\tare\tlargely\tresponsible\tfor\t\nthe\trecalcitrance\tof\tmany\tinfections\tto\tconventional\tantimicrobial\ttherapy.\tBiofilm\tis\tdefined\t\nas\ta\tstructured\tcommunity\tof\tbacterial\tcells\tadhered\tto\ta\tsurface.\tOnce\tattached,\tthe\tbiofilm\t\nsecretes\tan\textracellular\tpolymeric\tsubstance\t(EPS)\tthat\tis\tnearly\timpervious\tto\thost\tdefenses\t\nand\tresistance\tto\tantibiotic\ttherapy.\tBacterial\tbiofilms\tare\tone\tof\tthe\treasons\twhy\tchronic\twound\t\ninfections\tdo\tnot\theal.\tResearch\tshows\tthat\tbiofilms\tdelay\twound\thealing\tsignificantly\tand\thave\t\nbeen\t identified\t in\t association\twith\t a\tnumber\tof\t chronic\twound,\t including\tdiabetic\twounds,\t\nvenous\tstasis\tulcers,\tand\tpressure\tsores.\tOne\tof\tthe\tstrategies\tto\tovercome\tthe\tbiofilm\tbarrier\t\nis\t the\t use\t antibiofilm\t agents.\tAntibiofilm\t agents\t are\t important\t in\t targeting\t the\t biofilm\t cells\t\nthrough\tinterfering\twith\tthe\tcommunication\tof\tcells,\t their\tmetabolism\tas\twell\tas\tdisrupt\t the\t\nprotective\tmatrix\tof\tbiofilm.\tIt\twas\tproposed\tthat\tthe\tefficacy\tof\tantibiotics\tfor\twound\tinfections\t\ncould\tbe\toptimised\tvia\tthe\tinhibition\tof\tbacterial\tbiofilm\tgrowth\tin\twounds.\tThe\tcombination\t\nof\tantibiofilm\tagent\tand\tantibiotics\tin\ta\twound\tdrug\tdelivery\tsystem\tmay\tbe\ta\tplausible\tstrategy\t\nin\twound\tinfection\tmanagement.\n\n\n\n\n\n\n\n\n31\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nORAL PRESENTATIONS \n\n\n\nClinical Pharmacy \n\n\n\nNo Presenting Author Title \n\n\n\nCPO 01 Abdul Nazer Ali, \nAssoc Prof \n\n\n\nKnowledge Evaluation on Human Papilloma Virus (HPV) \nInfection and HPV Vaccination among Parents \n\n\n\nCPO 02 Arwa Mohamed Amin \nMostafa, Ms \n\n\n\nThe Frequency of Clopidogrel High on Treatment Platelets \nReactivity (HTPR) among Coronary Artery Disease (CAD) \nPatients undergoing Interventional Angiographic Procedure  \n\n\n\nCPO 03 Hamza Mohamed \nAmin Mostafa, Mr \n\n\n\nIdentification of Alcohol-Dependence Biomarkers in Urine by \nusing Metabolomics Analysis \n\n\n\nCPO 04 Khoo Su Pei, Ms Prevalence, Risk Factors and Management of Hyperlipidemia \namong HIV-Infected Individuals Receiving Treatment \n\n\n\nCPO 05 Lau Yi Yeen, Ms Polypharmacy and Risk Factors among Older HIV-Infected \nIndividuals in University Malaya Medical Centre (UMMC) \n\n\n\nCPO 06 Lo Yoke Lin, Dr Application of Pharmacometrics in Hospitals \n\n\n\nCPO 07 Law Bee Keng, Ms Medication Discrepancies upon Discharge  among Adult Patients \nin Queen Elizabeth Hospital: A Pilot Study \n\n\n\nCPO 08 Lim Li Min, Ms Polypharmacy and Risk Factors among Urban Community-\nDwelling Elderly in Malaysia. \n\n\n\nCPO 09 Mohd Farizh bin Che \nPa, Mr \n\n\n\nPrevalence of Infection after Disease Modifying Antirheumatic \nDrugs (DMARDs) Treatment in Rheumatoid Arthritis Patients in \nNegeri Sembilan \n\n\n\nCPO 10 Nabila Perveen, Mdm A Study on the Herbal Drugs Utilization in Pregnant Women in \nTwo Hospitals of Sungai Petani, Kedah Darul Aman \n\n\n\nCPO 11 Negin Naderifar, Ms The Prevalence of Psychiatric Disorders among Patients Suffering \nfrom Nightmares \n\n\n\nCPO 12 Tahir Mehmood Khan, \nDr \n\n\n\nThe Use of Handheld Computers for Accessing Medical Mobile \nApplications and Investigative Tools (MAP-IT) Among \nPharmacists in Malaysia  \n\n\n\nCPO 13 Sim Szyuin, Ms Retrospective Analyses of Bleeding Associated with Novel Oral \nAnticoagulants (NOACs) in Patients in a University-Affiliated \nTertiary Care Hospital \n\n\n\nCPO 14 Nur Syafiqah Mohd \nJeffri, Ms \n\n\n\nPatient\u2019s Expectations of Methadone Maintenance Therapy \n(MMT) in an Urban Integrated Community-Based MMT Clinic \n\n\n\nCPO 15 Tan Yean Hoon, Ms The Impact of Fish Oil and Non-Fish Oil Based Lipid Emulsion \non Liver Function among Surgical Patients Requiring Parenteral \nNutrition (PN) in Hospital Selayang \n\n\n\n \n\n\n\n\n\n\n\n\n32\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPharmacy Practice / Social Pharmacy \n\n\n\nNo Presenting Author Title \n\n\n\nPPO 01 Siti Nadiah Abdul \nRahim, Mdm \n\n\n\nSkin Medications: The Impact of Specialized Counselling by \nPharmacists in Psoriasis Management \n\n\n\nPPO 02 Annushiah a/p Vasan \nThakumar, Ms \n\n\n\nHow Do Malaysians Define Health-Related Quality of Life \n(HRQoL)? \n\n\n\nPPO 03 Che Suraya Zin, Dr Patterns of Opioid Prescribing for Treating Pain in Patients with \nDifferent Age and Gender: A Retrospective Cross Sectional Study \n\n\n\nPPO 04 Dayana Nicholas, Ms Why Impaired Quality of Life in Epileptic Patients?: A Cross-\nSectional Study \n\n\n\nPPO 05 Ho Yiing Ee, Mdm Influences of a Pilot Pictogram-Incorporated Label for Liquid \nMedications on Understanding, Dosing Accuracy and Preferences \namong Caregivers in Malaysia \n\n\n\nPPO 06 Kang Pei Wen, Ms Knowledge of Students from Non-Medical Faculties of a Public \nUniversity on the Methods of Contraception \n\n\n\nPPO 07 Lua Pei Lin, Prof Feasibility and Acceptability of My Electronic Personal Health \nRecord Monitor (MY-ePHRM) \n\n\n\nPPO 08 Amrahi bin Buang, Mr Guidelines for Use of Non-Halal Medicines for Muslim Patients \n\n\n\nPPO 09 Ooi Guat See, Dr Assessment of Malaysian Community Pharmacists Involvement \nin Extended Pharmacy Services \n\n\n\nPPO 10 Mohd Ikhwan Bin \nHashim, Mr \n\n\n\nSetting Up a Hospital Based Nuclear Pharmacy Service- AMDI \nExperience \n\n\n\nPPO 11 Yeo Keh Hau, Mr Customers Satisfaction towards Community Pharmacists \nProfessional Practice in Malaysia \n\n\n\nPPO 12 Zaswiza Mohamad \nNoor, Dr \n\n\n\nOptimising Community Pharmacy Intervention in Managing \nSleep Disorders: Extended Roles of Community Pharmacists \n\n\n\nPPO 13  Shalini Sivadasan, Ms A Survey on Knowledge, Attitude and the Perception (KAP) of \nPharmacovigilance and Adverse Drug Reactions (ADRs) \nReporting among the Healthcare Students in a Private University  \n\n\n\n\n\n\n\n\n\n\n\n\n\n33\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPharmacy Education \n\n\n\nNo Presenting Author Title \n\n\n\nPEO 01 Long Chiau Ming, \nDr  \n\n\n\nImpact and Perception of E-learning: Pre-post Survey and \nEvaluations  \n\n\n\nPEO 02 Tahir Mehmood \nKhan, Dr \n\n\n\nPharmacy Students\u2019 Interprofessional Perceptions towards the \nPharmacy Profession \n\n\n\nPEO 03 Nor Ilyani Mohamed \nNazar, Dr \n\n\n\nStudents\u2019 readiness for and Perception towards Inter-Professional \nLearning: A Cross Sectional Study \n\n\n\nPharmaceutical Chemistry \n\n\n\nNo Presenting Author Title \n\n\n\nPCO 01 Ravichandran \nVeerasamy, Dr \n\n\n\nGreen Synthesis of Parkia speciosa Mediated Silver Nanoparticles \n- Characterization and Evaluation of Its Antibacterial and \nAntioxidant Potential \n\n\n\nPCO 02 Ayesha Fatima, Ms Combined Docking and Molecular Dynamics Provide Insights into \nthe Trypanosoma Purine Salvaging Pathway Inhibitors  \n\n\n\nPCO 03 Neeraj Kumar \nFuloria, Assoc Prof. \nDr \n\n\n\nEvidences of Antitubercular Potential of Novel Thiazolidinone \nDerivatives Bearing Chloroxylenol Moiety  \n\n\n\nPCO 04 Narendra Babu \nShivanagere \nNagojappa, Dr \n\n\n\nDesign and Synthesis of Acetylcholinesterase Inhibitors Targeting \nAlzheimer\u2019s Disease \n\n\n\nTraditional and Complementary Medicine \n\n\n\nNo Presenting Author Title \n\n\n\nTCMO 01 Gawry A/P \nParamasivam, Ms \n\n\n\nComplementary and Alternative Medicine (Cam) Use Among \nLiver Disorder Patients at an Outpatient Clinic in University \nMalaya Medical Centre \n\n\n\nTCMO 02 Soh Yee Cheng, Ms Perspective of Practitioners on Reflexology: A Qualitative \nApproach \n\n\n\n \n\n\n\n\n\n\n\n\n34\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPharmaceutical Technology \n\n\n\nNo Presenting Author Title \n\n\n\nPTO 01 Shalini Somasundaran \nReveenderan, Ms \n\n\n\nA Mechanistic Insight in Ketaconazole Soluplus Solid \nDispersions  \n\n\n\nMilitary Pharmacy \n\n\n\nNo Presenting Author Title \n\n\n\nMPO 01 Mohd Adlan Bin \nAdnan, Colonel \n\n\n\nThe Haiyan Super Typhoon in Philippines - Malaysian Military \nPharmacist Experience \n\n\n\nMPO 02 Mohammad Firdaus \nbin Yaacob, Major \n\n\n\nKelantan Flood: Role of Military Pharmacist in a Forward \nHospital \n\n\n\nMPO 03 Mohamad Halif bin \nMohamad Yusof, \nMajor \n\n\n\nA Drug Utilization Review of Selected Antibiotics in the Medical \nWards at Hospital Angkatan Tentera Tuanku Mizan \n\n\n\nPharmacology \n\n\n\nNo Presenting Author Title \n\n\n\nPGO 01 Pitchai Balakumar, \nAssoc Prof. Dr \n\n\n\nDifferential Effects of Pre and Post Treatments with Low-Dose \nDipyridamole in Aminoglycoside-Induced Nephrotoxicity in Rats \n\n\n\nPGO 02 Praveen Thaggikuppe \nKrishnamurthy, Dr \n\n\n\nA Glitazone with an Overall Glucose Control Potential: A \nSerendipitous Finding \n\n\n\nPGO 03 Subramani \nParasuraman, Dr \n\n\n\nEffect of Ursolic Acid on Olanzapine Induced Obesity in Sprague \nDawley Rats \n\n\n\nPGO 04 Yew Chow Ping, Mr In vitro Evaluation of the Anticancer Properties of the (1S, 2S)-1-\nPhenyl-2(Phenylamino)Propane-1,3-Diol Derivative (RB4) \n\n\n\nPGO 05 Md. Moklesur Rahman \nSarker, Assoc Prof \n\n\n\nShiitake Mushroom: Potential Glycemic Control Activity on \nAlloxan- and Glucocorticoid-Induced Diabetic Long-Evans Rats  \n\n\n\n \n\n\n\n\n\n\n\n\n35\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nCLINICAL PHARMACY\n___________________________________________________________________________\n\n\n\nCPO 01 \nMPSPSC2015000117\t(Oral)\n\n\n\nKnowledge Evaluation on Human Papilloma Virus (HPV) Infection and HPV Vaccination \namong Parents\n\n\n\nNA Ali1, S Sivadasan1, XR Ng1, MB Bahari1, A Sarriff2\n\n\n\n1Faculty of Pharmacy, AIMST University, Semeling, Kedah, Malaysia\n2School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia\n\n\n\nThe\tobjective\tof\tthis\tstudy\twas\tto\tassess\tthe\tknowledge,\tattitude\tand\tpractice\tregarding\tHPV\t\ninfection\tand\tvaccination\tamong\tthe\tparent\tpopulation\twith\tchildren\taged\t>9\tand\t<26\tyears\tin\t\nKedah\tstate,\tMalaysia.\tThe\tstudy\twas\tconducted\tusing\tpre-validated\tquestionnaire\tin\ttwo\tphases,\t\nfirst\t at\t baseline\t and\t second\t post\t intervention\t using\t educational\t pamphlets.\tThe\t completed\t\nquestionnaires\tfrom\tboth\tphases\twere\tanalysed\tusing\tSPSS\tversion\t20.\tA\ttotal\tof\t1000\tsurvey\t\nforms\twere\tdistributed\tin\tphase\t1\tand\t871\twere\tretrieved\tback\tgiving\ta\tresponse\trate\tof\t87.10%.\t\nIn\t Phase\t 2,\t the\t questionnaire\twas\t distributed\t to\t the\t phase\t I\t respondents\t among\twhich\t 619\t\nresponded\tgiving\ta\tresponse\trate\tof\t71.06%.\t\tThus,\ta\ttotal\tof\t619\tparticipants\twere\tincluded\tin\t\nPhase\tI\tand\tII\tof\tthe\tstudy.\tIt\twas\tfound\tthat\t266\t(43%)\tparticipants\twere\tmale\tand\t353\t(57%)\t\nwere\tfemale.\tOut\tof\tthe\t619\trespondents,\t55.57%\twere\tfrom\turban\tarea\tand\t44.43%\twere\tfrom\t\nrural\tarea.\tThe\tresults\talso\tshowed\tthat\t39\t(6.3%)\twere\tMalay,\t502\t(81.1%)\twere\tChinese,\t72\t\n(11.6%)\tIndians\tand\t6\t(1%)\twere\tfrom\tother\trace.\tThe\toverall\tscore\twas\ttabulated\tfor\tthe\t10\t\nknowledge\tbased\tquestions\tand\tit\twas\tfound\tthat\tonly\t28.11%\thad\texcellent\tknowledge\tin\tphase\t\nI\twhereas,\t72.4%\thad\texcellent\tknowledge\t in\tphase\t II.\tThe\tstudy\tconcludes\t that\ta\t short\tand\t\nfocused\teducation\tintervention\tcan\thelp\tliterate,\taffluent\tparent\tto\tmake\ta\tdecision\tregarding\t\nHPV\tvaccination\tfor\ttheir\tchildren.\n\n\n\n\n\n\n\n\n36\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nCLINICAL PHARMACY\n___________________________________________________________________________\n\n\n\nCPO 02 \nMPSPSC2015000025\t(Oral)\n\n\n\nThe Frequency of Clopidogrel High on Treatment Platelets Reactivity (HTPR) among \nCoronary Artery Disease (CAD) Patients undergoing Interventional Angiographic \nProcedure \n\n\n\nAMA Mostafa1, SC Lim1, MA SK Abdul Kader2, O Ismail2, DA Mohamed Noor1, KH Yuen1, \nB Ibrahim1\n\n\n\n1School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia\n2Cardiology Department, Hospital Pulau Pinang, Penang, Malaysia\n\n\n\nClopidogrel\tis\tan\tantiplatelet\tdrug\twhich\tis\tcrucial\tfor\tcoronary\tartery\tdisease\t(CAD)\tpatients\t\nundergoing\t interventional\t angiographic\t procedure,\t particularly\t those\t with\t stent\t placement.\t\nHowever,\tclopidogrel\tuse\tis\thindered\tby\tpatients\u2019\tvariable\tresponse.\tPatients\twith\tclopidogrel\t\nhigh\t on\t treatment\t platelets\t reactivity\t (HTPR)\tmight\t have\t recurrence\t of\t cardiac\t events\t and\t\ndeath.\tThis\tstudy\taimed\tto\tevaluate\tthe\tfrequency\tof\tclopidogrel\tHTPR\tamong\tCAD\tpatients\t\nundergoing\tinterventional\tangiographic\tprocedure\twith\tor\twithout\tstent\tplacement.\tA\ttotal\tof\t\n71\tCAD\tpatients\tplanned\t for\t interventional\tangiographic\tprocedure\twere\t recruited.\tPatients\t\nwere\t loaded\twith\tclopidogrel\t600mg\tand\ttheir\tplatelet\t function\ttesting\t(PFT)\twas\tdone\tafter\t\n6\thours\tof\tloading.\tThe\tPFT\twas\tassessed\tusing\tthe\tVerifyNow\tsystem\tP2Y12\ttesting\tkit.\tThe\t\ncutoff\tpoint\tof\tHTPR\twas\ta\tPRU\tvalue\tmore\tthan\t208.\tOut\tof\tthe\t71\tpatients,\t30\t(42.3%)\twere\t\nMalays,\t22\t(31.0%)\twere\tChinese\tand\t18\t(25.4%)\twere\tIndians.\tIn\tterms\tof\tgender,\t59\t(83.1%)\t\nwere\tmen.\tOf\tthe\tstudy\tsample,\t27\t(38%)\tpatients\twere\tsuffering\tfrom\tclopidogrel\tHTPR\tand\t\nthese\twere\t10/30\t(33.3%)\tof\t the\tMalay,\t9/22\t(40.9%)\tof\t the\tChinese\tand\t8/18\t(44.4%)\tof\t the\t\nIndian.\tAs\tHTPR\tmight\t lead\t to\t the\t recurrence\tof\t cardiac\tevents,\t the\t frequency\t indicated\t in\t\nthis\tstudy\tcould\tbe\tconsiderably\thigh.\tThe\tongoing\tidentification\tof\tgenetics\tand\tnon-genetics\t\nfactors\tassociated\twith\tthe\tHTPR\tand\tthe\tpharmacometabonomics\tanalysis\tof\tplasma\tand\turine\t\nfor\t identifying\t novel\t biomarkers\t of\t clopidogrel\t response\tmay\t help\t in\t finding\t the\t optimum\t\npersonalized\tantiplatelet\ttherapy.\n\n\n\n\n\n\n\n\n37\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nCLINICAL PHARMACY\n___________________________________________________________________________\n\n\n\nCPO 03 \nMPSPSC2015000002\t(Oral)\n\n\n\nIdentification of Alcohol-Dependence Biomarkers in Urine by using Metabolomics Analysis\n\n\n\nHMA Mostafa1, AMA Mostafa1, NH Arif2, CH Teh3, V Murugaiyah1, B Ibrahim1\n\n\n\n1School of Pharmaceutical Sciences, Universiti Sains Malaysia, Malaysia\n2Psychiatry Department, Hospital Pulau Pinang, Malaysia\n3Bruker (Malaysia) Sdn Bhd\n\n\n\nThe\tmain\tclinical\tmethods\tto\tdiagnose\tAlcohol-dependence\t(AD)\tin\tclinical\tpractice\tcurrently\t\ndepend\ton\tAD\tassessment\tquestionnaires\tand\tsome\tbiomarkers\tsuch\tas\tCarbohydrate-Deficient\t\nTransferrin\t(CDT)\tand\tGamma\tGlutamyl\tTransferase\t(GGT).\tThese\t two\tmethods\thave\tbeen\t\nshown\t to\t lack\t specificity\t and\t sensitivity.\t Metabolomics\t technique\t using\t nuclear\t magnetic\t\nresonance\t spectroscopy\t (NMR)\tof\turine\t can\thelp\tus\t identify\tnovel\t biomarkers\twhich\t could\t\nprovide\t a\t more\t accurate\t diagnosis\t of\t AD.\tTherefore,\t the\t aim\t of\t this\t stduy\t was\t to\t identify\t\nbiomarkers\t in\t urine\t which\t can\t discriminate\t between\t alcohol-dependent,\t social\t drinkers\t\nand\t controls\t using\tmetabolomics\t approach.\t Urine\t samples\t were\t collected\t from\t 30\t alcohol-\ndependent\t (mean\tage:\t45.7),\t54\tsocial\tdrinkers\t (mean\tage:\t39.5)\tand\t60\tcontrols\t (mean\tage:\t\n37.1).\tUrine\twas\tmixed\twith\t phosphate\t buffer\t and\t then\t analyzed\t using\tNMR\t spectroscopy.\t\nData\t analysis\t was\t done\t using\t multivariate\t analysis\t including\t principal\t component\t analysis\t\n(PCA)\t and\t orthogonal\t partial\t least\t square\t discriminate\t analysis\t (OPLS-DA)\t to\t develop\t a\t\nmodel\tto\tidentify\tAD\tbiomarkers.\tPCA-X\tplot\tshowed\ta\tsimilarity\tbetween\tsocial\tdrinkers\tand\t\ncontrol\t groups,\thowever,\t alcohol-dependent\t group\twas\t clearly\tdistinct\t from\t them.\tAfter\t the\t\ncombination\tof\tsocial\tdrinkers\tand\tcontrols\tgroups\tin\tone\tgroup,\tthe\tOPLS-DA\twas\tdone\tby\t\ncomparing\tthe\tcombined\tgroup\tto\tthe\talcohol-dependent\tgroup.\tThe\tOPLS-DA\tmodel\tshowed\ta\t\nclear\tseparation\tbetween\tthe\ttwo\tgroups\twith\t97.25%\tspecificity,\t86.21%\tsensitivity,\tand\t94.93%\t\naccuracy.\tIn\tconclusion,\tthe\tapplied\turine\tmetabolomics\ttechnique\twas\table\tto\tdifferentiate\twith\t\ngood\taccuracy\tbetween\talcohol-dependent\tand\tsocial\tdrinkers\tand\tcontrols.\tThe\tidentification\t\nof\tthe\tdiscriminating\tmetabolites\tis\tongoing.\n\n\n\n\n\n\n\n\n38\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nCLINICAL PHARMACY\n___________________________________________________________________________\n\n\n\nCPO 04 \nMPSPSC2015000052\t(Oral)\n\n\n\nPrevalence, Risk Factors and Management of Hyperlipidemia among HIV-Infected \nIndividuals Receiving Treatment\n\n\n\nSP Khoo1, SF Omar2, RI Azwa2, A Kamarulzaman2, R Rajasuriar1,2\n\n\n\n1Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia\n2Centre of Excellence for Research in AIDS (CERiA), Kuala Lumpur, Malaysia\n\n\n\nHyperlipidemia\t among\tHIV-infected\t individuals\t is\t a\t significant\t problem\t as\t it\t is\t associated\t\nwith\tan\t increased\trisk\tof\tmetabolic\t syndrome\tand\tcardiovascular\tdisease\t in\t this\tpopulation.\t\t\nManagement\t of\t hyperlipidemia\t in\t HIV-infected\t individuals\t is\t further\t complexed\t by\t the\t\nsignificant\t drug\t interactions\t between\t standard\t antiretrovirals\t (ART)\t and\t statins\t which\t are\t\ncommonly\t used\t to\t treat\t hyperlipidemia.\t This\t study\t aimed\t to\t determine\t the\t prevalence\t of\t\nhyperlipidemia\t in\tHIV-infected\t individuals,\t associated\t risk\t factors\t and\t treatment\t outcomes.\t\nThis\tretrospective\tstudy\twas\tconducted\tin\tUniversity\tof\tMalaya\tMedical\tCentre\tand\tincluded\t\n256\tpatients\treceiving\tART\tand\thad\tat\tleast\tone\tlipid\tprofile\tdone\tthroughout\ttheir\tfollow-up.\t\nThe\tprevalence\tfor\thyperlipidemia\twas\tassessed\tand\trisk\tfactors\twere\tanalysed\tusing\tmultivariate\t\nlogistic\tregression.\tTreatment\toutcomes\twere\tassessed\tby\tcalculating\tthe\tpercentage\tof\treduction/\nincrement\tfor\teach\tlipid\tparameter\tand\tachievement\tof\ttarget\tgoals.\tThe\tmajority\tof\tpatients\t\nwere\tmale\t(86.7%)\tand\tvirologically\tsuppressed\t(80.9%).\tThe\tprevalence\tof\thyperlipidemia\twas\t\nhigh\tin\tour\tcohort,\t74.6%\tand\tbody\tmass\tindex\t(p=0.006)\twas\tthe\tonly\trisk\tfactor\tassociated\t\nwith\t hyperlipidemia.\tUnlike\t other\t studies,\t we\t did\t not\t find\t increased\t age,\t current\t smoking,\t\nType\t2\tDiabetes\tMellitus,\tand\tthe\tuse\tof\tprotease\tinhibitors\tand\tefavirenz\tto\tbe\tassociated\twith\t\nhyperlipidemia\tin\tour\tcohort.\t\tMost\tof\tthe\tpatients\t(81.1%)\tachieved\ttheir\ttarget\tgoals\twithin\t\n12\tmonths\tof\tinitiating\tdrug\tor\tdietary\tinterventions.\tHyperlipidemia\twas\thighly\tprevalent\tin\t\ntreated\tHIV-infected\tpatients.\tAlthough\tmost\tpatients\t achieved\t their\t target\t treatment\t goals,\t\ngreater\tefforts\tto\tprevent\tthe\tdevelopment\tof\tthis\tdisease\tthrough\tlife-style\tchange\tis\twarranted.\t\t\t\n\n\n\n\n\n\n\n\n39\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nCLINICAL PHARMACY\n___________________________________________________________________________\n\n\n\nCPO 05 \nMPSPSC2015000051\t(Oral)\n\n\n\nPolypharmacy and Risk Factors Among Older HIV-Infected Individuals in University \nMalaya Medical Centre (UMMC)\n\n\n\nYY Lau1, S Ponampalavanar2,3, H Sulaiman2,3, A Kamarulzaman2,3, R Rajasuriar.1,3\n\n\n\n1Department of Pharmacy, University of Malaya, Kuala Lumpur, Malaysia\n2Infectious Diseases Unit, University Malaya Medical Centre, Kuala Lumpur, Malaysia\n3Centre of Excellence for Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia\n\n\n\nPolypharmacy\tamong\tolder\tindividuals\tis\ta\tserious\tissue\tas\tit\tis\tassociated\twith\tadverse\tdrug\t\nevents,\tnon-adherence\tand\tdrug-drug\tinteractions.\tPolypharmacy\tis\tof\tgreater\tconcern\tin\tthose\t\nwith\tHIV-infection\tdue\t to\t their\tburden\tof\tantiretroviral\tmedication\tand\t their\t increased\trisk\t\nof\tmultiple\tage-related\tcomorbidities.\tThe\taim\tof\tthis\tstudy\twas\tto\tidentify\tthe\tprevalence\tand\t\nrisk\tfactors\tof\tpolypharmacy,\tand\tprevalence\tof\tpotentially\tinappropriate\tmedications\t(PIMs)\t\nuse\t and\t drug-drug\t interactions\t (DDIs)\t among\t older\t HIV-infected\t patients\t in\t UMMC.\tWe\t\nretrospectively\treviewed\tthe\tmedical\trecords\tof\tall\tpatients\twho\twere\t\u226550\tyears\tand\twho\twere\ton\t\nactive\tfollow\tup\tat\tthe\tInfectious\tDiseases\tClinic\tin\tUniversity\tMalaya\tMedical\tCentre\t(UMMC).\t\nPolypharmacy\twas\tdefined\tas\tbeing\ton\t\u22655\tmedications,\tPIM\tuse\twas\tassessed\taccording\tto\tthe\t\nBEERS\tcriteria\tand\tDDIs\tby\tthe\tLexicomp\tdrug\tinteraction\tsoftware.\tLogistic\tregression\twas\tused\t\nto\tassess\trisk\tfactors\tassociated\twith\tpolypharmacy.\tA\ttotal\tof\t224\tpatients\twere\tincluded\twith\t\na\tmedian\t(interquartile\trange)\tage\tof\t55\t(52-59)\tyears.\tWe\tfound\t58.5%\tof\tpatients\texperienced\t\npolypharmacy,\t14%\twith\tCategory\tD\tor\tCategory\tX\tDDIs\tand\t5%\twith\tPIMs.\tThe\tmost\tcommon\t\nmedication\tclasses\tassociated\twith\tPIMs\twere\tanticholinergics\t(28%),\tbenzodiazepines\t(16%)\t\nand\talpha\tblockers\t(16%).\tIn\tmultivariate\tanalysis,\tthe\trisk\tfactors\tassociated\twith\tpolypharmacy\t\nwere\tsmoking,\tcurrent\tAIDS,\thepatitis\tB\tco-infection\tand\tincreasing\tnumber\tof\tcomorbidities\t\n(p<0.05\tfor\tall\tco-variates).\tA\thigh\tprevalence\tof\tpolypharmacy\twas\tfound\tin\tolder\tHIV-positive\t\nadults\tand\tthese\tpatients\twould\tbenefit\tfrom\tinterventions\tincluding\tformal\tmedication\treview\t\nservices\tto\timprove\tmedication\tutilisation.\n\n\n\n\n\n\n\n\n40\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nCLINICAL PHARMACY\n___________________________________________________________________________\n\n\n\nCPO 06\nMPSPSC2015000028\t(Oral)\n\n\n\nApplication of Pharmacometrics in Hospitals\n\n\n\nYL Lo1, LL Yeap1, YC Sow1,2\n\n\n\n1Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia\n2Faculty of Pharmacy, Universiti Teknologi MARA, Selangor, Malaysia \n\n\n\nPharmacometrics\t is\t the\t science\t which\t deals\t with\t quantitative\t description\t of\t disease,\t drug\t\neffects\tand\tvariability\tby\tintegrating\tand\tapplying\tmathematical\tand\tstatistical\tmodels\tjointly\tto\t\nfacilitate\tdecision\tmaking\tin\tdrug\tdevelopment.\tThe\trole\tof\tpharmacometrics\tin\tclinical\ttrials\t\nduring\t drug\t development\t is\t well\t recognized\t globally\t by\t pharmaceutical\tmanufacturers\t and\t\npharmaceutical\tcontrol\tand\tlicensing\tauthorities\tsuch\tas\tthe\tUS\tFood\tand\tDrug\tAdministration\t\nand\tthe\tEuropean\tMedicines\tAgency.\tSpecial\tpopulations\tsuch\tas\tchildren\tespecially\tpremature\t\nneonates,\t older\t adults\t and\tpregnant\twomen,\t however,\t are\t often\t excluded\t in\t the\tPhase\t II\t or\t\nPhase\tIII\tclinical\ttrials\tduring\tthe\tprocess\tof\tbringing\tnew\tdrugs\tto\tpatients.\tThe\tapplication\t\nof\t pharmacometrics\t has\t therefore\t gained\t popularity\t in\t healthcare\t facilities\t in\t recent\t years.\t\nPharmacokinetic-pharmacodynamic\t (PKPD)\t and\t disease\t progression\t modeling\t allows\t\nclinicians\tto\tunderstand\tbetter\tthe\tpharmacology\tof\ta\tdrug\tin\taltered\tphysiologic\tor\tpathologic\t\nstate\tand\tthe\tbiology\tof\tthe\tdisease\tof\tinterested.\tThis\tunderstanding\twill\tlead\tto\ta\tmore\tefficient\t\nuse\tof\tdrug\ttherapy.\tSince\tpharmacometrics\tis\tstill\ta\trelative\tnew\tfield\tin\tthis\tregion\tincluding\t\nMalaysia,\tthe\taim\tof\tthis\tpresentation\tis\tto\tgive\tan\tintroduction\tto\tpharmacometrics,\tto\tdescribe\t\ndifferent\t components\t of\t pharmacometrics\t and\t to\t discuss\t some\t examples\t of\t applications\t of\t\npharmacometrics\t in\tassessing\taltered\tpharmacokinetic\tparameters\t in\t special\tpopulations,\tor\t\nin\tpatients\t receiving\t treatments\t that\tmay\talter\t the\tPKPD\tof\t a\tdrug;\t and\t formulating\tdosing\t\nrecommendations,\t as\t well\t as\t linking\t biomarkers\t to\t outcome\t events\t using\t a\t modeling\t and\t\nsimulation\tapproach.\n\n\n\n\n\n\n\n\n41\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nCLINICAL PHARMACY\n___________________________________________________________________________\n\n\n\nCPO 07\nMPSPSC2015000012\t(Oral)\n\n\n\nMedication Discrepancies Upon Discharge Among Adult Patients in Queen Elizabeth \nHospital: A Pilot Study\n\n\n\nBK Law1, CP Chong2\n\n\n\n1Dept of Pharmacy, Queen Elizabeth Hospital, Sabah, Malaysia\n2School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia\n\n\n\nThis\tprospective\tobservational\tpilot\tstudy\twas\tconducted\tover\ta\t4-week\tduration\tin\ta\ttertiary\t\nreferral\thospital\tin\tKota\tKinabalu,\tSabah.\tThe\taim\twas\tto\tdetermine\tthe\tpercentage\tof\tmedication\t\ndiscrepancy\tupon\tdischarge\t(MDUD)\tin\tinternal\tmedicine\twards\tand\tto\tidentify\tthe\tpredictors\t\nfor\tMDUD.\tAlmost\thalf\tof\tthe\tstudy\tpopulation\t(49%)\twas\tfound\tto\thave\tMDUD\tand\t40%\twere\t\ndischarged\twith\tat\tleast\tone\tunintentional\tmedication\tdiscrepancy.\tThe\tmost\tcommon\ttype\tof\t\nunintentional\tMDUD\twas\tomission\t(42.5%),\t followed\tby\t incomplete\tprescription\t(20%)\tand\t\ninappropriate/incorrect\tdose\t(12.5%).\tNutrition\tand\tblood\twas\tthe\ttherapeutic\tclass\tthat\tmost\t\ninvolved\tin\tMDUD\t(37%),\tbut\t60.9%\tof\tit\twere\tintentionally\tmade\tby\tthe\tprescriber,\tfollowed\tby\t\ncardiovascular\tand\tgastrointestinal\tdrug\t(19%\tand\t16%,\trespectively)\tregardless\tof\tthe\tintention.\t\nThe\tonly\tpredictor\tfor\tMDUD\tand\tmedication\terror\twas\tthe\tnumber\tof\tdischarge\tmedications\t\n(adjusted\tOR:\t1.277,\t95%\tCI:\t1.083\tto\t1.507,\tp\t=\t0.004\tand\tadjusted\tOR:\t1.344,\t95%\tCI:\t1.0903\tto\t\n1.658,\tp\t=\t0.006,\trespectively).\tDifference\tin\tthe\tdefinition\tused\tfor\tthe\tpercentage\tand\ttypes\tof\t\nMDUD\tmade\tcomparison\tamong\tstudies\tdifficult.\tMulti-factorial\tcausation\tfor\tMDUD\tneeds\t\nto\t be\t investigated\t in\t order\t to\t determine\t the\t importance\t of\t clinical\t pharmacist\t in\t discharge\t\nprocess\tespecially\tin\ta\thospital\tsetting.\tThe\tproblem\tof\tunintentional\tMDUD\tis\tnot\tuncommon\t\nand\tmay\tlead\tto\tthe\tnegative\tclinical\timpact\tof\tpatient\u2019s\toutcome\tif\tit\tis\tnot\taddressed.\tAlmost\t\nhalf\tof\tthe\tpatients\twere\tdischarged\twith\tat\tleast\tone\tmedication\tdiscrepancy.\tLonger\tdischarge\t\nmedication\tlist\tresults\tin\ta\thigher\tchance\tof\tMDUD\tand\tmedication\terror.\n\n\n\n\n\n\n\n\n42\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nCLINICAL PHARMACY\n___________________________________________________________________________\n\n\n\nCPO 08\nMPSPSC2015000095\t(Oral)\n\n\n\nPolypharmacy and Risk factors Among Urban Community-Dwelling Elderly in Malaysia.\n\n\n\nLM Lim1, SB Kamaruzzaman2, SS Chua1, R Rajasuriar1,3\n\n\n\n1Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur,Malaysia\n2Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia\n3Centre of Excellence for Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia\n\n\n\nPolypharmacy\thas\tbeen\tassociated\twith\tincreased\tmorbidity\tand\tmortality\tin\telderly.\tThe\taim\t\nof\tthis\tstudy\twas\tto\tdetermine\tthe\tprevalence\tand\trisk\tfactors\tassociated\twith\tpolypharmacy,\t\npotentially\t inappropriate\t drug\t (PID)\t use\t and\t potential\t drug-drug\t interactions\t (PDDI)\t in\t a\t\ncohort\tof\turban\tcommunity-dwelling\telderly\tin\tMalaysia.\tThis\tstudy\tinvolved\tthe\tparticipants\t\nrecruited\t in\t the\tMalaysian\tElders\t Longitudinal\tResearch\t (MELoR)\t from\tNovember\t 2013\t to\t\nJune\t2014.\t Included\twere\t individuals\t aged\t55\tyears\tand\tabove,\t residing\t in\tKlang\tValley\tand\t\nwere\ton\tat\tleast\tone\tmedication.\tParticipants\twere\tinterviewed\tusing\ta\tstructured\tquestionnaire.\t\nPolypharmacy\twas\tdefined\tas\tconcurrent\tuse\tof\tfive\tor\tmore\tmedications.\tPID\tuse\twas\tanalysed\t\nbased\ton\tBEERS\tcriteria.\tPDDI\tincluded\tClass\tD\tor\tClass\tX\tinteractions\tassessed\tusing\tLexi-\nInteract\t drug\t interaction\t software.\t Risk\t factors\t associated\twith\t polypharmacy,\t PID\t use\t and\t\nPDDI\twere\tdetermined\tusing\tmultivariate\tlogistic\tregression.\tA\ttotal\tof\t505\tparticipants\twere\t\nincluded\tin\tthis\tstudy.\tThe\tmajority\twere\tIndians\t(39.8%)\tand\tfemales\t(56.2%).\tThe\tprevalence\t\nof\tpolypharmacy\twas\t49.9%.\tThe\trisk\tfactors\tassociated\twith\tit\twere\tolder\tage,\tIndian\tethnicity,\t\nmore\tthan\tone\tcomorbidities,\tpoorer\tself-rated\thealth\tstate\tand\thigher\tnumber\tof\tsupplements.\t\nThe\tprevalence\tof\tPID\tuse\twas\t16.6%\tand\tPDDI\twas\t24.8%,\twith\tincreasing\tnumber\tof\tdrugs\t\nbeing\tthe\tonly\tsignificant\trisk\tfactor\tfor\tboth\toutcomes.\tIn\tconclusion,\ta\tsignificant\tproportion\t\nof\t these\telderly\twere\texposed\t to\tpolypharmacy,\tPID\tuse\tand\tPDDI.\tThe\tuse\tof\t supplements\t\ncontributed\tsignificantly\tto\tpolypharmacy.\tMedication\treviews\tare\twarranted\tin\tthe\telderly\tto\t\nreduce\tpolypharmacy,\tPID\tuse\tand\tPDDI.\n\n\n\n\n\n\n\n\n43\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nCLINICAL PHARMACY\n___________________________________________________________________________\n\n\n\nCPO 09\nMPSPSC2015000064\t(Oral)\n\n\n\nPrevalence of Infection after Disease Modifying Antirheumatic Drugs (DMARDs) Treatment \nin Rheumatoid Arthritis Patients in Negeri Sembilan\n\n\n\nMF Che Pa1, H Mat Zaid1, NL Mohd Danil1, S Aziz Bahaman1, N Mohd Noor2\n\n\n\n1Department of Pharmacy, Hospital Tuanku Ja\u2019afar, Seremban, Negeri Sembilan, Malaysia\n2Department of Medical, Hospital Tuanku Ja\u2019afar, Seremban, Negeri Sembilan, Malaysia\n\n\n\nRheumatoid\tarthritis\t(RA)\tis\ta\tchronic\tinflammatory\tdisease\tassociated\twith\thigh\tmorbidity\tand\t\nat\tleast\ta\ttwofold\tincrease\tin\tmortality.\tThere\twere\treports\tof\tincreased\tinfection\tin\tRA\tpatients\t\non\tDisease\tModifying\tAntirheumatic\tDrugs\t (DMARDs),\t but\t limited\t studies\twere\t found\ton\t\nits\tprevalence\tin\tMalaysia.\tThe\taim\tof\tthe\tstudy\twas\tto\tdetermine\tthe\tprevalence\tof\tinfection\t\nafter\tDMARDs\ttreatment.\tThe\tobjectives\tof\tthe\tstudy\twas\tto\tdetermine\ttype\tof\tinfections\tand\t\nhospital\tadmission\tof\tRA\tpatients\ttreated\twith\tDMARDs.\tAn\tobservational\tretrospective\tstudy\t\nwas\tdone\ton\tall\tcurrent\tRA\tpatients\ton\tDMARDs\tattending\tRheumatology\tClinic\tin\tHospital\t\nTuanku\tJa\u2019afar,\tSeremban\t(HTJS)\tfrom\tJanuary\t1994\tto\tSeptember\t2014.\tThe\tdata\twere\tanalyzed\t\nusing\tSPSS\tversion\t22.0\tfor\tdescriptive\tstatistics\tand\tstatistical\tsignificance\twas\ttested\tusing\tChi\t\nsquare\ttest\t(p<0.05).\tPrevalence\tof\tinfections\twas\t86.6%\tamong\t180\tRA\tpatients\ton\tDMARDs,\t\nand\tthere\twere\t6.5%\tof\thospital\tadmissions\tdue\tto\tinfections.\tThe\tmost\tcommon\ttype\tof\tinfections\t\nwas\tupper\trespiratory\ttract\tinfection\t(URTI)\twith\t262\tevents\t(67.7%).\tPrevalence\tof\tinfection\t\nwith\tuse\tof\tdifferent\tDMARDs\twas\tcompared\tand\twas\tfound\tto\tbe\tstatistically\tsignificant.\tAs\t\na\tconclusion,\tthe\tprevalence\tof\tinfection\tin\tRA\tpatients\ton\tDMARDs\tis\thigh.\tRA\tpatients\ton\t\nDMARDs\tshould\tbe\tcounseled\ton\tprecautionary\tmeasures\tto\treduce\trisk\tof\tinfection.\n\n\n\n\n\n\n\n\n44\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nCLINICAL PHARMACY\n___________________________________________________________________________\n\n\n\nCPO 10\nMPSPSC2015000105\t(Oral)\n\n\n\nA Study on the Herbal Drugs Utilization in Pregnant Women in Two Hospitals of Sungai \nPetani, Kedah Darul Aman\n\n\n\nN Perveen1, NH Khan2, G June3, A Sharriff1\n\n\n\n1School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia\n2Faculty of Pharmacy, Quest International University Perak, Ipoh, Perak, Malaysia\n3Consultant Obstetrics and Gynaecology, Pantai Hospital, Sungai  Petani, Kedah, Malaysia\n\n\n\nMalaysia\tis\ta\tmultiracial\tnation\tconsisting\tof\tthree\tmain\traces\talong\twith\tother\tminority\tracial\t\ngroups.\tThe\t predominant\t race\t being\tMalays\t (50.2%),\t followed\t by\t Chinese\t (24%)\t and\t then\t\nIndians\t (7.0%).\tMalaysians\t consume\tapproximately\tRM1.2\tbillion\tworth\tof\t imported\therbal\t\nproducts\tannually.\tHerbal\tdrugs\tare\tpart\tof\tthe\tculture\tand\tbelief\tfor\tcure\tand\tmaintenance\tof\t\nhealth\tin\tMalaysia.\tA\ttotal\tof\t\t450\tpregnant\twomen\tfrom\tSultan\tAbdul\tHalim\tHospital\tand\tPantai\t\nHospital,\tSungai\tPetani,\tKedah,\tMalaysia\twere\tinterviewed.\tThe\tresults\tshowed\tthat\t85.8%\tof\tthe\t\nrespondents\tused\therbal\tdrugs.\tThe\thighest\tutilization\tof\therbal\tdrugs\twas\twithin\tage\tgroup\tof\t\n31-35\tyears\t(38.5%).\tLess\tqualified\trespondents\tutilized\tmore\therbal\tdrugs\t(49.9%)\tcompared\t\nto\t the\trest.\tWorking\trespondents\t (56.1%)\talso\tutilized\therbal\tdrugs\tmore\t than\tnon-working\t\nrespondents.\tOutpatient\trespondents\t(n=242,\t53.8%)\tutilized\tmore\therbal\tdrugs\tcompared\tto\t\nthe\t rest.\tRespondents\tutilized\therbal\tdrugs\t for\t vomiting\t and\t to\t ease\t labour:\t \t 33\t (6.1%)\t and\t\n21\t(3.9%),\trespectively.\t\tThe\tcost\teffectiveness\tand\ttime\tsaving\tfactors\twere\tstrongly\tagreed\tby\t\n223\t (49.6%)\t and\t209\t (46.4%)\t respondents,\t respectively.\tThe\t respondents\t from\tSultan\tAbdul\t\nHalim\tHospital,\t73.2%\tutilized\therbal\tdrugs\tcompared\tto\t26.8%\tfrom\tPantai\tHospital.\tMost\tof\t\nthe\trespondents\t(50.4%)\tused\texternal\tpreparations.\tMore\tthan\tone\ttype\tof\therbal\tdrugs\twas\t\nutilized\tby\t66\trespondents\t(14.7%).\tNutritional\tsupplements\twere\talso\tused\t\twith\therbal\tdrugs\t\nby\t219\t(48.7%)\t\trespondents.\t\t\n\n\n\n\n\n\n\n\n45\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nCLINICAL PHARMACY\n___________________________________________________________________________\n\n\n\nCPO 11\nMPSPSC2015000102\t(Oral)\n\n\n\nThe Prevalence of Psychiatric Disorders among Patients Suffering from Nightmares\n\n\n\nN Naderifar1, F Hashemian2, A Sharifi3, S Pashang4\n\n\n\n1School of Pharmacy, Islamic Azad University, Pharmaceutical Sciences Branch, Tehran, Iran\n2School of Pharmacy, Clinical Pharmacy Department, Islamic Azad University, Pharmaceutical \nSciences Branch, Tehran, Iran \n3Iranian Scientific Society of Clinical Hypnosis, Tehran, Iran\n4Psychology Department, Islamic Azad University, Pharmaceutical Sciences Branch, Tehran, Iran\n\n\n\nNightmares\tare\textremely\t frightening\tdreams\tby\twhich\t the\tperson\twakes\tup\twith\ta\tdetailed\t\nmemory\t (usually\t involving\t threats\t to\t survival\t or\t security)\t followed\t by\t a\t quick\t orientation\t\nafterward.\tWith\ta\tview\tto\tetiology,\tnightmares\tmight\tbe\tidiopathic\tor\tassociated\twith\tdisorders\t\nsuch\tas\tPost\tTraumatic\tStress\tDisorder\t(PTSD),\tNightmare\tdisorder,\tdrug\tinduced\tand\tsome\t\npsychiatric\tillnesses.\tGenetics\tand\tgender\tplay\tan\timportant\trole\tin\tthe\tprevalence\tof\tnightmare.\t\nThis\t study\t was\t conducted\t to\t assess\t the\t prevalence\t of\t psychiatric\t disorders\t among\t patients\t\ncomplaining\tof\tnightmares\tin\ta\tcounseling\tinstitute.\tDuring\tthe\t9\tmonths\tof\tinvestigation,\ta\ttotal\t\nof\t26\tpatients\tcomplained\tof\tnightmares,\tincluding\t4\tmales\tand\t22\tfemales\taged\t17\tto\t53\tyears.\t\nFour\tpatients\twere\ton\tpropranolol,\t a\tnonselective\tbeta\tblocker\t that\tmay\t induce\tnightmares.\t\nAll\tpatients\twere\tdiagnosed\tby\ta\tpsychiatrist\tas\tfollowed:\t7\tpatients\tdiagnosed\twith\tdepressive\t\ndisorder,\t5\twith\tmixed\tanxiety\tand\tdepressive\tdisorder,\t4\twith\tbipolar\tmood\tdisorder,\t3\twith\t\nnightmare\tdisorder,\t2\t \twith\tgeneralized\tanxiety\tdisorder,\t2\twith\tmigraine\theadaches,\t1\twith\t\nObsessive\tCompulsive\tDisorder,\t 1\t \twith\tClaustrophobia\t and\t1\twith\tConversion\tDisorder.\t It\t\nwas\tpreviously\tshown\tthat\t females\texperienced\tmore\tnightmares\tcompared\tto\tmales,\tmaybe\t\ndue\tto\tnormal\tdifferences\tin\tphysiological\tcharacteristics.\tIn\tthis\tstudy,\tmost\tof\tthe\tpsychiatric\t\npatients\twho\tcomplained\tof\tnightmares\twere\tthose\tdiagnosed\twith\tDepressive\tDisorder.\tThese\t\nresults\t may\t suggest\t further\t studies\t to\t determine\t appropriate\t pharmacological\t and/or\t non-\npharmacological\tinterventions\tfor\tthe\ttreatment\tof\tnightmares\tamong\tthis\tgroup\tof\tpatients.\n\n\n\n\n\n\n\n\n46\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nCLINICAL PHARMACY\n___________________________________________________________________________\n\n\n\nCPO 12\nMPSPSC2015000065\t(Oral)\n\n\n\nThe Use of Handheld Computers for Accessing Medical Mobile Applications and Investigative \nTools (MAP-IT) among Pharmacists in Malaysia \n\n\n\nNA Apidi1, DD Lee1, PSM Lai2, TM Khan3, LC Ming1,4 \n1Faculty of Pharmacy, Universiti Teknologi MARA (UiTM), PuncakAlam, Selangor, Malaysia\n2Department of Primary Care Medicine, University Malaya Primary Care Research Group \n(UMPCRG), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia\n3School of Pharmacy, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia\n4Brain Degeneration and Therapeutics Research Group, Pharmaceutical and Life Sciences CoRE, \nUiTM, Shah Alam, Selangor, Malaysia\n\n\n\nHandheld\t computers\t (HHCs)\t such\t as\t smartphones\t and\t tablets\t are\t providing\t a\t variety\t of\t\ndrug\t information\t(DI)\tapplications\tto\tassist\tpharmacist\u2019s\tdecision\tmaking\t in\tthe\tclinical\tand\t\nhospital\tsetting.\tThus,\tthe\tcurrent\tstudy\taimed\tto\tassess\tthe\tuse\tof\telectronic\tDI\tresources\tvia\t\nHHCs\tby\tpharmacists\tin\tMalaysia\tusing\tthe\tnewly\tdeveloped\tMedical\tMobile\tApplications\tand\t\nInvestigative\tTools\t(MAP-IT).\tThis\tstudy\talso\taimed\tto\tinvestigate\tthe\tpharmacists\u2019\tperception\t\ntowards\tthe\tDI\tcontent\tand\tfunctions\tof\tmobile\tmedical\tapplications.\tA\tconvenience\tsampling\t\nmethod\t was\t adopted\t to\t invite\t pharmacists\t (n=450)\t working\t in\t various\t sectors\t such\t as\t\nhospitals,\tdrug\tapproval\tauthority,\tand\tacademia\tto\tparticipate\tin\tthis\tonline\tsurvey.\tA\t36-item\t\nquestionnaire\twas\t administered\t and\t data\twere\t summarized\t and\t presented\t using\t descriptive\t\nstatistics.\tOverall,\t213\trespondents\t(95.1%)\twere\tactive\tHHCs\tusers\tin\ttheir\tdaily\tclinical\tpractice.\t\nAbout\t194\trespondents\t(86.6%)\tdisclosed\tthat\tthey\toften\tuse\tHHCs\tfor\tsearching\tDI.\tDosage\t\nrecommendations\t(n=198;\t88.4%),\tadverse\tdrug\treactions\t(n=153;\t68.3%),\tand\tdrug\tinteractions\t\n(n=146;\t 65.2%)\t were\t the\t most\t common\t DI\t retrieved.\t General\t dosage\t recommendation,\t\npediatric\tdosage\trecommendation\tand\tdosage\trecommendation\tfor\trenal\tfailure\twere\tranked\tas\t\nthe\tmost\timportant\tDI\tin\tmobile\tmedical\tapplication\tand\tthe\tmost\tpopular\tapplications\tused\t\nfor\tdrug\trelated\tmedical\tinformation\twas\tMicromedex\u00ae,\tfollowed\tby\tLexicomp\u00ae\tand\tMedscape\u00ae.\t\t\nIn\tconclusion,\tthe\tuse\tof\tHHCs\tof\tDI\tamong\tpharmacists\tin\tMalaysia\twas\thigh.\tGaining\taccess\t\nto\tthe\t latest\t information\ton\tdrugs\tand\tclinical\tpractice\twere\tregarded\tas\tthe\tmost\t important\t\nfunctions\tof\tthe\tmobile\tmedical\tapp.\n\n\n\n\n\n\n\n\n47\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nCLINICAL PHARMACY\n___________________________________________________________________________\n\n\n\nCPO 13\nMPSPSC2015000027\t(Oral)\n\n\n\nRetrospective Analyses of Bleeding Associated with Novel Oral Anticoagulants (NOACs) in \nPatients in a University-Affiliated Tertiary Care Hospital\n\n\n\nS Sim1, SA Beshir1, KH Chee2, YL  Lo1\n\n\n\n1Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia\n2Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia\n\n\n\nNovel\t oral\t anticoagulants\t (NOACs)\t are\t commonly\t used\t for\t the\t prevention\t or\t treatment\t\nof\t thromboembolic\t events.\t Despite\t their\t proven\t efficacy,\t significant\t bleeding\t risk\t remains\t\na\t concern.\tThe\tobjectives\t of\t this\t study\twere\t to\tdetermine\t the\t frequency,\t characteristics\t and\t\npredictors\t of\t bleeding\t events\t in\t patients\t receiving\tNOACs\t in\t a\t university-affiliated\t tertiary\t\ncare\thospital.\tThe\tdemographic,\tclinical\tdata,\tincluding\tbleeding\tepisodes,\tand\tlaboratory\ttest\t\nresults\t of\t patients\twho\t received\tNOAC\t therapy\t at\t the\tUniversity\t of\tMalaya\tMedical\tCentre\t\nwere\treviewed.\tData\twere\tcollected\tuntil\tthe\tdate\tof\tdeath\tor\tApril\t2015.\tThe\tprimary\toutcome\t\nmeasure\twas\t the\t presence\t or\t absence\t of\t a\t bleeding\t event\t after\t initiation\t of\tNOAC\t therapy.\t\nBleeding\t events\t were\t categorized\t as\tmajor\t bleeding,\t clinically\t relevant\tminor\t bleeding\t and\t\nminor\tbleeding,\tdepending\ton\tthe\tbleeding\tsites\tand\tthe\tseverity.\tA\ttotal\tof\t192\tpatients\twith\t\natrial\tfibrillation\tor\tvenous\tthromboembolism\treceiving\tNOAC\ttherapy\twere\trecruited.\tTwenty\t\nfour\t patients\t (12.5%)\t and\t 33\t bleeding\t events\t including\t two\t fatal\t cases\twere\t observed.\tNine\t\npatients\thad\trecurrent\tbleeding\tepisodes,\tbut\tnone\tof\tthem\tbled\tmore\tthan\ttwo\ttimes.\tBleeding\t\nsites\tmainly\tinvolved\tthe\tgastrointestinal\ttract.\tThe\tmedian\ttimes\tto\tthe\tfirst\tbleeding\tevent\tof\t\ndabigatran\tand\trivaroxaban\twere\t6\tand\t4\tmonths,\trespectively.\tLiver\tdisease\t(OR\t3.381;\t95%\t\nCI:1.298-8.273,\tp=0.012)\tand\trenal\timpairment\t(OR\t2.791;\t95%CI:1.149-6.780,\tp=0.023)\twere\t\nsignificant\tbleeding\trisk\tpredictors.\tNOAC-associated\tbleeding\tevents\tmay\tnot\tbe\tfrequent,\tbut\t\nthey\tcould\tbe\tfatal.\tTherefore,\tidentifying\tand\tclose\tmonitoring\tof\thigh\trisk\tpatients\twith\tliver\t\nor\trenal\timpairment\tare\tof\tvital\timportance.\n\n\n\n\n\n\n\n\n48\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nCLINICAL PHARMACY\n___________________________________________________________________________\n\n\n\nCPO 14\nMPSPSC2015000162\t(Oral)\n\n\n\nPatient\u2019s Expectations of Methadone Maintenance Therapy (MMT) in an Urban Integrated \nCommunity-Based MMT Clinic\n\n\n\nNS Mohd Jeffri1, AS Mohd Anuar1, S Alwi1, NA Mohd Salleh2, V Pillai2\n\n\n\n1Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia\n2Centre of Excellence Research in AIDs (CERiA), University of Malaya, Kuala Lumpur, Malaysia\n\n\n\nThis\tcross\tsectional\tsurvey\taimed\tto\texplore\tpatients\u2019\texpectations\tof\tmethadone\tmaintenance\t\ntherapy\t (MMT)\t and\t to\t investigate\t the\t impact\t of\t MMT\t on\t risk\t behaviors,\t housing\t and\t\nemployment\tstatus.\t\tA\ttotal\tof\t189\tpatients\tfrom\tan\turban\tintegrated\tcommunity-based\tMMT\t\nclinic\twere\trecruited\tto\tanswer\ta\tvalidated\tquestionnaire.\tThis\tstudy\tshowed\tthat\tpatients\twere\t\nhoping\tthat\tMMT\twould\thelp\tthem\tto\tcompletely\tstop\tusing\tillicit\tdrugs\t(98.4%),\tto\tget\tthem\t\na\tjob\t(83.1%)\tand\ta\tbetter\thousing\t(72%),\tto\tprovide\tthem\ta\tbetter\tquality\tof\tlife\tfor\tthemselves\t\nand\ttheir\tfamilies\t(98.4%),\tto\tprevent\tthem\tfrom\tgetting\tinvolved\tin\tcrime\t(95.8%)\tand\tto\treduce\t\nhigh\trisk\tactivities\tsuch\tas\tneedle\tsharing\t(93.1%).\t\tThese\texpectations\twere\tnot\tcorrelated\twith\t\nthe\tduration\tof\tMMT\tand\tthe\tpatients\u2019\tMMT\tdose.\t\tNone\tof\tthese\tpatients\tclaimed\tto\trevert\t\nback\tto\tneedle\tsharing\tactivities\tfor\tthe\tpast\tone\tmonth,\talthough\t27\t(14.3%)\tpatients\tstill\tuse\t\nillicit\tdrugs\toccasionally.\tThe\tnumber\tof\thomeless\tpatients\thas\treduced\tsignificantly\tfrom\t10.6%\t\nto\t0.6%\tsince\tstarted\ton\tMMT\tand\tthese\tpatients\thave\teither\tmoved\tback\tin\twith\tfamily\t(10\t\npatients)\tor\tbeing\taccepted\tto\tstay\tin\ta\tcontrolled\tenvironment\tsuch\tas\tCure\tand\tCare\tService\t\nCentre\t(CCSC)\thostels\t(6\tpatients).\tThe\tnumber\tof\tunemployment\talso\treduced\tsignificantly\t\nby\t17.5%\tfrom\t35%\tand\tmost\tof\tthese\tpatients\t(24\tpatients)\thave\tbeen\taccepted\tfor\tfull-time\t\nemployment\twith\t one\t patient\t continuing\t back\t his\t tertiary\t education.\t \tAs\t a\t conclusion,\t this\t\nstudy\tshowed\tthat\tMMT\tpatients\thave\thigh\texpectations\tand\tMMT\thas\timproved\ttheir\tsocial\t\nfunctions\tand\tquality\tof\tlife.\n\n\n\n\n\n\n\n\n49\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nCLINICAL PHARMACY\n___________________________________________________________________________\n\n\n\nCPO 15\nMPSPSC2015000077\t(Oral)\n\n\n\nThe Impact of Fish Oil and Non-Fish Oil Based Lipid Emulsion on Liver Function among \nSurgical Patients Requiring Parenteral Nutrition (PN) in Hospital Selayang\n\n\n\nYH Tan, NA Kamaruzaman, BL Toh,  ZL Zaki, YY Loh, N Abdul Wahab, Z Zakaria, Z Zahid\nHospital Selayang, Selangor, Malaysia\n\n\n\nThis\tretrospective\tstudy\taimed\tto\tinvestigate\tthe\timpact\tof\tfish\toil\tand\tnon-fish\toil\tbased\tlipid\t\nemulsion\t on\t liver\t function\t among\t surgical\t patients\t requiring\t parenteral\t nutrition\t (PN)\t in\t\nHospital\tSelayang.\tA\ttotal\tof\t205\tpatients\twho\twere\ton\tthe\tPN\tbag\tthroughout\tyear\t2013\t\twere\t\nincluded.\tElectronic\tmedical\trecords\twere\treviewed\tto\tobtain\tthe\tfollowing\tparameters:\tweight,\t\nheight,\tBMI,\tlength\tof\thospital\tstays\t(days),\tduration\ton\tPN\tbag\t(days),\ttype\tof\tPN\tbag\t(with\tor\t\nwithout\tfish\toil)\tand\tliver\tprofile\tincluding\tbilirubin,\tALP\tand\tALT.\tOur\tstudy\tshowed\tthat\tthere\t\nwere\tsignificant\tdifferences\tof\tthe\ttype\tof\tPN\tbag\ton\tbilirubin\tand\tALP\tbut\tnot\tALT\tlevels.\tAbout\t\n89.24%\tof\t the\t surgical\tpatients\twho\twere\ton\tPN\tbags\twithout\tfish\toil\t (p<\t0.05)\texperienced\t\nincrement\tin\tbilirubin,\tALP\tand\tALT\tlevels\twhen\tcompared\tto\tthe\tbaseline\tlevels.\tAbout\t90.04%\t\nof\tthe\tsurgical\tpatients\twho\twere\ton\tPN\tbags\twith\tfish\toil\t(p<0.05)\tshowed\ta\treduction\tin\tthe\t\nbilirubin,\tALP\tand\tALT\tlevels\twhen\tcompared\tto\tthe\tbaseline\tlevels.\tAlso,\tsignificant\tdifference\t\nwas\tobserved\t(p<0.05)\tin\tthe\tduration\tof\tparenteral\tnutrition\ton\tbilirubin,\tALP\tand\tALT\tlevels\t\nin\tsurgical\tpatients\treceiving\tboth\tPN\tbags\twith\tand\twithout\tfish\toil.\tAs\ta\tconclusion,\tPN\tbags\t\nwith\tfish\toil\tseem\tto\tshow\ta\tmore\tfavorable\teffect\ton\tthe\tliver\tprofiles.\t\n\n\n\n\n\n\n\n\n50\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPHARMACY PRACTICE / SOCIAL PHARMACY\n___________________________________________________________________________\n\n\n\nPPO 01\nMPSPSC2015000112\t(Oral)\n\n\n\nSkin Medications: The Impact of Specialized Counselling By Pharmacists in Psoriasis \nManagement\n\n\n\nMSA Kassim, SN Abdul Rahim, DT Yaziz, AE Esahak Ayub, SA Idrus\nPharmacy Department, Hospital Sultanah Bahiyah, Alor Setar, Kedah, Malaysia\n\n\n\nTreatment\t for\tpsoriasis\tdisease\t is\t complex.\tSuccessful\t treatment\tdepends\t largely\ton\tpatient\u2019s\t\ncapacity\tto\tmanage\this/her\tdisease\tand\tadherence\tto\tthe\tprescribed\tdrug\tregimen.\tLiteratures\t\nshow\tthat\tpharmacists\u2019\tinvolvement\tis\tminimal\tin\tthis\tarea,\tlargely\tdue\tto\ta\tlack\tof\tknowledge.\t\nThis\t study\t aimed\t to\t investigate\t the\t impact\t of\t psoriasis\t education\t on\t pharmacists\t and\t the\t\noutcome\tof\tspecialized\tpharmacist\tcounselling\ton\tpsoriasis\tpatients.\tThe\tcurrent\tstudy\twas\ta\t\nquasi-experimental\tstudy\twhich\tinvolved\tpsoriasis\tpatients\ton\ttopical\ttreatment,\twho\thad\ttheir\t\nfollow-up\tat\tthe\tskin\tclinic\tand\tpharmacists,\twho\tworked\tat\tthe\tPharmacy\tDepartment\tof\tHospital\t\nSultanah\tBahiyah.\tKnowledge\tof\tpharmacists\tbefore\tand\tone\tmonth\tafter\tthey\thave\tattended\ta\t\nseminar\ton\tpsoriasis\ttherapy\twas\tassessed\t(n=50).\tMeanwhile,\tselected\tpsoriasis\tpatients\twere\t\nassessed\tfor\tknowledge,\tmedication\tcompliance,\tand\thealth-related\tquality\tof\tlife\t(HQL)\tbefore\t\nand\tone\tmonth\tafter\tspecialized\tcounselling\tby\ttrained\tpharmacists.\tKnowledge\tof\tpharmacists\t\nimproved\tsignificantly\tafter\tthe\tseminar\t(p<0.0001).\tPatients\u2019\tknowledge,\tmedication\tcompliance\t\nand\tHQL\talso\timproved\tsignificantly\tpost\tspecialized\tcounselling\t(p\t<0.0001).\tThe\tfindings\tof\t\nthis\t study\t showed\t that\t psoriasis\t education\t significantly\t improved\t pharmacist\u2019\t knowledge\t in\t\nthis\tarea,\tand\tthere\twas\ta\tsignificant\timpact\tof\tpharmacists\u2019\t involvement\tin\tthe\tmanagement\t\nof\t psoriasis\t disease.\t Pharmacists\t can\t be\t trained\t further,\t and\t should\t be\t actively\t involved\t in\t\neducating\tpsoriasis\tpatients\talongside\tother\thealthcare\tproviders.\n\n\n\n\n\n\n\n\n51\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPHARMACY PRACTICE / SOCIAL PHARMACY\n___________________________________________________________________________\n\n\n\nPPO 02\nMPSPSC2015000104\t(Oral)\n\n\n\nHow Do Malaysians Define Health-Related Quality of Life (HRQoL)?\n\n\n\nA Vasan Thakumar, AA Shafie, CJ Lim\nSchool of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia\n\n\n\nThe\t usage\t of\t EuroQol\u2019s\t EQ-5D\t instrument\t has\t been\t rising\t in\t Malaysia.\t However,\t cultural\t\ndifferences\t between\tMalaysia\t and\t the\t countries\t involved\t in\t the\t development\t of\t the\t EQ-5D\t\ninstrument\tmay\trender\ta\tslightly\tvaried\tconcept\tin\tthe\tdefinition\tof\thealth-related\tquality\tof\tlife\t\n(HRQoL).\tIdentifying\tthese\tdifferences\tand\tsubsequently\tadding\tto\tthe\tEQ-5D\tinstrument\tas\t\nadditional\tdimensions,\tor\tbolt-ons\twill\taid\tin\tcapturing\tthe\tHRQoL\tneeds\tof\tMalaysians.\tThis\t\nstudy\taimed\tto\tstudy\tthe\tadequacy\tof\tEQ-5D-5L\tin\tdescribing\tthe\tHRQoL\tof\tMalaysians\tand\tto\t\nexplore\tpossible\tbolt-ons\tto\tsupplement\tthe\tcurrent\tinstrument.\tThis\tstudy\twas\tcarried\tout\tin\t\ntwo\tphases.\tIn\tphase\tone,\ttwo\tfocus\tgroup\tdiscussions\twere\temployed\tto\tgauge\tthe\tperception\t\nof\t Malaysians\t on\t the\t dimensions\t deemed\t suitable\t additions\t to\t the\t EQ-5D-5L\t instrument.\t\nThese\twere\t then\tstructured\t to\t the\tcurrent\tEQ-5D-5L\t format.\tPhase\t two\t involved\t testing\t the\t\nappropriateness\tof\tbolt-ons\tto\tthe\tEQ-5D\tdescriptive\tinstrument\tusing\ta\tcross-sectional\tsurvey\t\nof\t100\tgeneral\tpublic.\tA\ttotal\tof\t11\tbolt-ons\twere\tidentified\tincluding\tsleep,\tvitality,\thappiness,\t\nclose\t relationships,\t stress,\t mental\t abilities,\t social\t support,\t religion,\t vision,\t hearing,\t and\t\nspeaking.\tResults\tfrom\tthe\tsurvey\tshowed\tbolt-ons\t\u2018vitality\u2019\tand\t\u2018stress\u2019\tstood\tout\tfrom\tthe\tother\t\ndimensions\twith\t 70%\t (70)\t and\t 64%\t (64)\t participants\t reported\t facing\t problems\t respectively,\t\ndemonstrating\t potential\t HRQoL\t needs\t that\t the\t EQ-5D-5L\t instrument\tmight\t be\t lacking\t to\t\ncapture\tin\tMalaysians.\tThe\tHRQoL\tconcept\tof\tMalaysians\tmight\tbe\tseen\tto\tencompass\ta\twider\t\nscope\tthan\tcovered\tby\tthe\tEQ-5D\tinstrument\twith\tvitality\tand\tstress\thaving\tmost\tpotential\tfor\t\nbolt-ons in future studies.\n\n\n\n\n\n\n\n\n52\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPHARMACY PRACTICE / SOCIAL PHARMACY\n___________________________________________________________________________\n\n\n\nPPO 03\nMPSPSC2015000100\t(Oral)\n\n\n\nPatterns of Opioid Prescribing for Treating Pain in Patients with Different Age and Gender: \nA Retrospective Cross-sectional Study \n\n\n\nCS Zin1, NS Ab. Rahman1, CR Ismail1, LW Choy2\n\n\n\n1Kulliyah of Pharmacy, International Islamic University Malaysia, Kuantan Campus, Jalan Sultan \nAhmad Shah, Bandar Indera Mahkota, 25200 Kuantan, Pahang\n2Jabatan Farmasi, Hospital Tengku Ampuan Afzan (HTAA), Jalan Tanah Putih, 25100 Kuantan, \nPahang\n\n\n\nOpioid\tutilization\thas\tbeen\tincreasing\tover\tthe\tlast\tfew\tdecades\tand\tlittle\tis\tknown\tabout\tthe\t\npatterns\tof\topioid\tprescribing\tin\tdifferent\tgender\tand\tage.\tThis\tstudy\taimed\tto\tinvestigate\tpatterns\t\nof\t opioid\t prescribing\t for\t pain\t treatment\t in\t patients\twith\t different\t age\t and\t gender.\tA\t cross-\nsectional\tstudy\twas\tconducted\tat\tthe\tOutpatient\tPharmacy\tof\tHospital\tTengku\tAmpuan\tAfzan\t\nKuantan\t(HTAA).\tPrescription\trecords\tfor\tfour\topioids\t(dihydrocodeine,\t fentanyl,\tmorphine\t\nand\toxycodone)\t issued\tbetween\tJanuary\t2013\tand\tDecember\t2014\twere\texamined.\tOutcome\t\nmeasures\tincluded\tnumber\tof\tpatients\tand\tprescriptions,\tage,\tgender\tand\ttypes\tof\topioid.\tAll\t\nanalyses\twere\tperformed\tusing\tStata\t13\t(Stata\tCorp\tLP,\tTexas,\tUSA).\tOverall,\t270\tpatients\twere\t\nprescribed\twith\topioid\tanalgesics\tfrom\t2013\tto\t2014.\tOf\tthese,\t121\t(44.8%)\twere\twomen\tand\t\n149\t(55.2%)\twere\tmen.\tThe\tpredominant\tage\tgroups\tfor\twomen\tand\tmen\twere\t51-65\tand\t66-\n80\tyears\told,\trespectively.\tDuring\tthe\tsame\tperiod,\t481(44%)\tprescription\tfor\topioid\tanalgesics\t\nwere\tfor\twomen\tand\t612(56%)\tfor\tmen.\tOxycodone\twas\tthe\tmost\tfrequently\tprescribed\topioid\t\nin\t both\twomen\t and\tmen\t (39.5%\t vs\t 38.6%),\t especially\t for\t younger\t patients\t (<40\t years\t old),\t\nfollowed\t morphine\t (38%\t vs.\t 28.1%),\t dihydrocodeine\t (15%\t vs.\t 20.2%)\t and\t fentanyl\t (7.48%\t\nvs.13.1%).\tPrescriptions\tfor\topioid\tanalgesics\twere\tpredominant\tin\tmen\tcompared\tto\twomen\t\nprimarily\tfor\tage\tgroup\t66-80\tyears\told.\tOxycodone\twas\tthe\tmost\tfrequently\tprescribed\topioid\t\nin\tboth\tgenders\tand\tmostly\tin\tthe\tyounger\tpatients.\tFurther\tresearch\tis\trequired\tto\texplore\tthe\t\nindication\tof\topioid\tanalgesics\tand\tits\trelated\tclinical\toutcomes.\n\n\n\n\n\n\n\n\n53\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPHARMACY PRACTICE / SOCIAL PHARMACY\n___________________________________________________________________________\n\n\n\nPPO 04\nMPSPSC2015000141\t(Oral)\n\n\n\nWhy Impaired Quality of Life in Epileptic Patients: A Cross-sectional Study\n\n\n\nD Nicholas1,2, A Sarriff2, T Palanivelu3, MB Bahari1, K Nelson4\n\n\n\n1Department of Clinical Pharmacy & Pharmacy Practice, Faculty of Pharmacy, AIMST University, \nSemeling, Kedah, Malaysia\n2Department of Clinical Pharmacy, School of Pharmaceutical Sciences, University Sains Malaysia, \nPenang, Malaysia.\n3Department of Medicine, Hospital Sultan Abdhul Halim, Sungai Petani, Kedah, Malaysia.\n4AIMST Staff Apartment, AIMST University, Semeling, Kedah, Malaysia.\n\n\n\nQuality\tof\tlife\t(QoL)\tin\tpatients\twith\tepilepsy\tis\taffected\tby\tvarious\thealth\trelated\tfactors.\tThe\t\ncurrent\tcross-sectional\tstudy\twas\tcarried\tout\tto\tevaluate\tthe\tfactors\taffecting\tQoL\tand\tstrategies\t\nto\timprove\tQoL\tin\tepileptic\tpatients\tat\tvarious\tlocations\tin\tSungai\tPetani,\tKedah.\tParticipants\t\nwere\trecruited\tand\tinterviewed\tat\tsecondary\thealth\tcare\tcentres.\tA\ttotal\tof\t212\tepileptic\tpatients\t\nwere\t enrolled\t into\t the\t study\t with\t age\t range\t between\t 19\t to\t 80\t years.\t Each\t epileptic\t patient\t\ncompleted\ta\tstandard\tquestionnaire\t(QOLIE-31)\tin\tEnglish\tor\tMalay.\tPre-test\twas\tcarried\tout\t\nwith\t20\tparticipants;\tresults\tobtained\tfrom\tthe\tquestionnaire\tshowed\tan\tinternal\tconsistency\t\nreliability\tcoefficient\tof\t0.783\tfor\teach\tscale\tof\tthe\tquestions.\tThe\tstudy\tconcluded\tthat\tthe\teffects\t\nof\tmedications\twere\t the\tmost\t affected\tdomains\t in\t epileptic\t patients.\tThe\t lack\t of\t knowledge\t\namong\t epileptic\t patients\t had\t indirectly\t inflicted\tworries\t among\t the\tpatients,\twhere\tpatients\t\nworried\tand\tdoubted\ton\tthings\tthat\tthey\tdid\tnot\tunderstand.\tPatient\teducation\twas\tcarried\tout\t\nwith\tthe\tenrolled\tpatients\ton\tthe\timprovement\tof\tquality\tof\tlife.\tHealthcare\tprofessionals\tshould\t\nprovide\tfurther\teducation\tto\tpatients\twith\tepilepsy,\twho\tare\tunder\ttreatment\tand\tfollow-up.\n\n\n\n\n\n\n\n\n54\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPHARMACY PRACTICE / SOCIAL PHARMACY\n___________________________________________________________________________\n\n\n\nPPO 05\nMPSPSC2015000111\t(Oral)\n\n\n\nInfluences of a Pilot Pictogram-Incorporated Label for Liquid Medications on Understanding, \nDosing Accuracy and Preferences among Caregivers in Malaysia\n\n\n\nHK Chan, EA Mohd Nain, YE Ho, ZW Ng, LL Cheah\nPharmacy Department, Hospital Sultanah Bahiyah, ALor Setar, Kedah, Malaysia\n\n\n\nIn\tMalaysia,\tpatients\talways\trely\ton\tmedication\tlabels\tas\tthe\tonly\tsource\tof\twritten\tmedication\t\ninformation.\tThis\t pilot\t project\t aimed\t to\t assess\t the\t possible\t influences\t of\t a\t newly\t designed,\t\npictogram-incorporated\tlabel\ton\tcaregivers\tfor\tyoung\tchildren.\tThis\twas\ta\ttwo-arm\texperimental\t\nstudy\tundertaken\tin\ta\tstate\tgeneral\thospital,\twhich\tprimarily\tserves\tthe\tlocal\trural\tpopulation.\t\nThe\tstudy\tincluded\tcaregivers\t(N=63)\twith\tchildren\taged\t1\tmonth\tto\t8\tyears,\twho\treceived\ta\t\nliquid\tantibiotic.\tThey\twere\trandomized\tto\treceive\ta\tpictogram-incorporated\tlabel\t(intervention,\t\nn=32)\tor\tan\toriginal\ttext-only\tlabel\t(control,\tn=31)\talong\twith\tthe\tpharmacist\tverbal\teducation.\t\nFace-to-face\t interviews\t were\t conducted\t to\t assess\t their\t understanding\t about\t medication\t\ninstructions,\tdosing\taccuracy\tand\tpreferences\tfor\tthe\tnew\tlabel.\tThe\toverall\terror\trates\tfor\tboth\t\nunderstanding\tand\tdosing\taccuracy\tassessment\tranged\tfrom\t6.3\tto\t36.5%.\tIntervention\tgroup\t\nshowed\tfewer\terrors\tin\tknowledge\tassessment\ton\tdose\t(6.2%\tversus\t29%;\tp=0.017),\tduration\tof\t\ntreatment\t(6.2%\tversus\t35.5%;\tp=0.004)\tand\tstorage\tconditions\t(9.4%\tversus\t35.5%;\tp=0.013).\t\nPictogram-incorporated\t label\t significantly\t reduced\t measurement\t errors\t using\t oral\t syringes\t\n(odds\tratio:\t0.192\t[95%\tconfidence\tinterval:\t0.037,\t0.990]).\tA\tmajority\tof\tthe\tcaregivers\t(58.7%),\t\nparticularly\tthose\twith\tonly\tsecondary\teducation\tlevels\tor\tbelow,\texpressed\ttheir\tpreferences\tfor\t\nthe\tpictogram-incorporated\tlabel\tover\ttext-only\tlabel.\tUsed\twith\toral\tsyringes\tand\tpharmacist\t\nverbal\t education,\t pictogram-incorporated\t label\t resulted\t in\t improved\tmedication\t knowledge\t\nand\tdecreased\tdosing\t errors.\tHigh\tpreferences\t among\t caregivers\t supported\t its\t utility\t in\t the\t\nhospital\tpharmacy.\n\n\n\n\n\n\n\n\n55\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPHARMACY PRACTICE / SOCIAL PHARMACY\n___________________________________________________________________________\n\n\n\nPPO 06\nMPSPSC2015000088\t(Oral)\n\n\n\nKnowledge of Students from Non-Medical Faculties of a Public University on the Methods \nof Contraception\n\n\n\nPW Kang, SS Chua\nDepartment of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia\n\n\n\nThe\tWorld\tHealth\tOrganization\t estimated\t that\t 210\tmillion\tpregnancies\toccurred\t every\tyear\t\nof\twhich\t 38%\twere\tunwanted\tpregnancy\t and\t 22%\t resulted\t in\t abortion.\tMany\t contraceptive\t\nmethods\tand\tdevices\tare\tavailable\tand\ta\tbetter\tknowledge\tof\tthese\tbirth\tcontrol\tmethods\tmay\t\nreduce\t unwanted\t pregnancies,\t especially\t among\t adolescents.\t A\t cross-sectional\t study\t was\t\ncarried\t out\t among\t undergraduate\t students\t from\t non-medical\t faculties\t in\t the\t University\t of\t\nMalaya.\tA\tvalidated\tself-administered\tknowledge\tinstrument\twas\tused\tto\tcollect\tthe\tdata.\tOf\t\nthe\t402\trespondents,\tonly\t8.4%\twere\tconsidered\tto\thave\tadequate\tknowledge\ton\tthe\tmethods\t\nof\tcontraception.\tThe\tmean\tknowledge\tscore\t(standard\tdeviation)\tof\tthe\trespondents\twas\t25.0\t\n(16.8)\tout\tof\ta\tmaximum\tof\t100.\tThe\trespondents\tscored\thighest\tin\tBarrier\tMethods,\tfollowed\t\nby\t Natural\t Methods,\t Hormonal\t Methods\t and\t Intrauterine\t Devices.\t The\t main\t sources\t of\t\ninformation\ton\tcontraception\twere\tinternet\t(87.3%),\tteachers\t(70.9%)\tand\tfriends\t(67.4%).\tThe\t\nmost\tcommon\tmethods\tof\tcontraception\twhich\twere\tknown\tto\tthe\trespondents\twere\tcondoms\t\n(91.5%),\tabstinence\tmethod\t(72.4%)\tand\tinjections\t(63.2%).\tTalks\tby\thealthcare\tprofessionals\t\nwere\t considered\t as\t the\t most\t effective\t means\t of\t providing\t information\t on\t contraception.\t\nInsufficient\tknowledge\ton\tthe\tmethods\tof\tcontraception\tamong\tyoung\tadults\tsuch\tas\tuniversity\t\nstudents\t warranted\t the\t needs\t to\t strengthen\t reproductive\t health\t education\t programmes\t in\t\nMalaysia.\n\n\n\n\n\n\n\n\n56\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPHARMACY PRACTICE / SOCIAL PHARMACY\n___________________________________________________________________________\n\n\n\nPPO 07\nMPSPSC2015000153\t(Oral)\n\n\n\nFeasibility and Acceptability of My Electronic Personal Health Record Monitor (MY-\nePHRM)\n\n\n\nPL Lua & II Umar \nFaculty of Health Sciences, Universiti Sultan Zainal Abidin (UniSZA), Kuala Nerus, Terengganu, \nMalaysia.\n\n\n\nSmartphones\t could\t be\t used\t as\t a\t novel\t approach\t to\t improve\t medication\t adherence\t and\t\npatients\u2019\tbehaviour\tdue\tto\ttheir\twide\tcommunication\taccessibility\tand\tthe\tpossible\tprovision\t\nof\ta\trepository\tfor\thealth\tand\tmedication\tinformation.\tThis\tstudy\taimed\tto\tassess\tthe\tfeasibility\t\nand\tacceptability\tof\t the\tuse\tof\ta\tnewly-developed\tphone\tapplication,\tMy\tElectronic\tPersonal\t\nHealth\tRecord\tMonitor\t (My-ePHRM),\t for\tpersonal\thealth\t record\tmonitoring,\t as\twell\t as\t the\t\nfactors\tthat\tpredict\tits\tacceptability.\tA\tcross-sectional\tstudy\tusing\tstructured\tquestionnaire\twas\t\nconducted\ton\t363\tpotential\tusers\t(undergraduates\tof\ta\tpublic\tuniversity).\tStatistical\tanalyses\t\nwere\tperformed\tusing\tSPSS\t20.0.\tDescriptive\tstatistics\tand\tmultiple\tlogistic\tregression\tanalysis\t\nwere\temployed.\tMajority\twere\tfemales\t(69.7%)\twith\ta\tmean\tage\tof\t22\u00b11.7\tyears.\tMore\tthan\thalf\t\nof\tthe\trespondents\t(63.9%)\tagreed\tthat\tMy-ePHRM\twas\teasy\tto\toperate\tand\t50.7%\tthought\tthat\t\nthe\t language\tused\twas\tsimple\tand\teasy\t to\tunderstand.\tMost\trespondents\t (61.7%)\t found\tthat\t\nthe\t features\tof\tMy-ePHRM\twere\t attractive\t and\t52.1%\twould\t like\t to\town\t it.\tMajority\t agreed\t\nthat\tMy-ePHRM\tcould\tincrease\thealth\tknowledge\t(57.0%)\tand\tdrug\tknowledge\t(54.0%)\tas\twell\t\nas\timprove\tdrug\tadherence\t(56.5%).\tOverall,\tstudents\tbelieved\tthat\tit\twas\ta\tgood\tprogramme\t\nand\twould\t recommend\t it\t to\t others.\t Ethnicity,\t gender\t and\t current\t study\t programme\t of\t the\t\nrespondents\tdid\tnot\tpredict\tacceptance\ttowards\tMy-ePHRM.\tIn\tconclusion,\tMy-ePHRM\thas\t\nbeen\tshown\tto\tbe\tacceptable,\tsimple\tand\tpractical\tby\tits\ttarget\tusers\t-\toffering\ta\thuge\tpotential\t\nfor\tcustomers\tof\tcommunity\tpharmacies\tto\tdocument\tand\tmonitor\ttheir\tpersonal\thealth\trelated\t\nactivities.\n\n\n\n\n\n\n\n\n57\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPHARMACY PRACTICE / SOCIAL PHARMACY\n___________________________________________________________________________\n\n\n\nPPO 08\nMPSPSC2015000075\t(Oral)\n\n\n\nGuidelines for Use of Non-halal Medicines for Muslim Patients\n\n\n\nA Buang\nMalaysian Pharmaceutical Society, Wisma MPS, Puchong, Selangor, Malaysia\n\n\n\nFulfilling\tthe\tneeds\tof\ta\tMuslim\tpatient\tis\ta\tvery\tfundamental\taspect\tin\tpharmacotherapy.\tIn\tline\t\nwith\tthe\tprinciples\tof\tShariah,\tMuslims\tare\tnot\tallowed\tto\tuse\tmedicines\tthat\tcontain\tany\tparts\t\nor\tproducts\tof\tanimals\t(e.g.\tporcine\tand\tbovine\tsource)\tthat\tare\tnon-halal\tor\tnot\tslaughtered\t\naccording\t to\t Shariah\t law.\t At\t the\tmoment,\t there\t is\t no\t guiding\t principle\t for\t any\t healthcare\t\nprofessional\tto\tfollow.\tAs\tsuch,\tthe\tfollowing\tguidelines\tare\trecommended.\tAbsolutely\tno\tother\t\ncompounds\tfrom\thalal\tsources\tare\tavailable\tfor\tuse\tand\tthis\tmedicine\tmust\tbe\tclinically\tproven\t\nchoice\t in\t treating\t the\t patient\u2019s\t condition.\tClass\t 1\t recommendation\twith\t level\tA\t evidence\t is\t\nwarranted.\tTreatment\twith\t this\tmedicine\t is\t critical\t to\t the\twelfare\tof\t the\tpatient.\tPrescribing\t\nof\tthis\tmedicine\tis\trestricted\tto\tMuslim\tphysicians\twell\tversed\tin\tIslamic\tlaws.\tA\tnon-Muslim\t\nphysician\tneeds\tto\trefer\tto\tthe\tabove-mentioned\tphysicians\tregarding\tthe\tuse\tof\tthis\tmedicine;\t\nor\t the\tattending\tphysician\tmay\trefer\t to\tprevious\tcases\tregarding\tthe\tuse\tof\t this\tmedicine\ton\t\nMuslim\t patients.\tThe\t patient\t or\t relative\t must\t be\t well\t informed\t by\t the\t attending\t physician\t\nregarding\t the\tuse\tof\t this\tmedicine.\tThe\tpatient\tor\t relative\u2019s\t consent\t is\t absolutely\tessential.\t If\t\nnecessary,\ta\tconsent\tform\tmust\tbe\tcompleted\tin\tthe\tpatient\u2019s\tnotes.\tThis\tmedicine\tmay\tonly\tbe\t\nused\tfor\ta\tspecific\tperiod\tof\ttime\tas\tper\tattending\tphysician\u2019s\trecommendations.\tDuring\tlife-\nthreatening\tmedical\temergencies,\tthe\tattending\tphysician\tmay\tuse\tthis\tmedicine\twithout\tfirst\t\nobtaining\tthe\tpatient\u2019s\tconsent.\n\n\n\n\n\n\n\n\n58\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPHARMACY PRACTICE / SOCIAL PHARMACY\n___________________________________________________________________________\n\n\n\nPPO 09\nMPSPSC2015000074\t(Oral)\n\n\n\nAssessment of Malaysian Community Pharmacists Involvement in Extended Pharmacy \nServices\n\n\n\nGS Ooi1, MAA Hassali1, AA Shafie1, DCM Kong2, VSL Mak3\n\n\n\n1School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia.\n2Faculty of Pharmacy and Pharmaceutical Sciences, Victoria College of Pharmacy, Monash \nUniversity, Victoria, Australia.\n3School of Pharmacy, Monash University Malaysia, Selangor, Malaysia.\n\n\n\nRoles\tof\tcommunity\tpharmacists\t(CPs)\thave\tevolved\tin\tmany\tparts\tof\tthe\tworld.\tIn\tMalaysia,\t\nresearch\t on\t extended\t pharmacy\t services\t provided\t by\t CPs\t in\t Malaysia\t remains\t scarce.\t To\t\neffectively\tenhance\tthe\trole\tof\tCPs\tin\tMalaysia,\t it\t is\t important\tto\texplore\tthe\tviews\tof\tall\tthe\t\nkey\tstakeholders.\tThis\tstudy\texplored\tthe\tviews\tof\tthe\tCPs,\tgeneral\tpractitioners\t(GPs),\tpolicy\t\nmakers\tand\tconsumers\ttowards\tCPs\u2019\troles\tin\tthe\tMalaysian\thealthcare\tsystem.\tA\ttriangulation\t\nof\t qualitative\t and\t quantitative\t methods\t was\t used.\t The\t major\t themes\t identified\t included:\t\nbarriers\tto\tenhancing\tprofessional\troles,\ttrends\tof\tcommunity\tpharmacy\tpractice\tin\tMalaysia,\t\nimplementation\t of\t dispensing\t separation,\t consumers\u2019\t acceptance\t towards\t the\t roles\t of\t CPs,\t\nperspectives\tof\tGPs\ton\tthe\tcurrent\tpractice,\tknowledge\tand\tability\tof\tCPs\ttowards\tthe\tprovision\tof\t\nextended\tpharmacy\tservices,\tstrategies\tto\tovercome\tbarriers,\tand\tfuture\tdirection\tof\tcommunity\t\npharmacy\t practice.\t Two\t postal\t surveys\twere\t then\t conducted\t to\t explore\t the\t knowledge\t and\t\npreparedness\tof\tCPs\t(n=395)\tand\tthe\tperception\tof\tGPs\t(n=205)\ttowards\tcommunity\tpharmacy\t\npractice\tchange\tin\tMalaysia.\tAnalysis\tof\tthe\tresponses\treceived\tgenerated\tvaluable\tdata\tabout\t\nthe\tcurrent\tprovision\tof\t extended\tpharmacy\t services\tby\t the\tMalaysian\tCPs\tand\tmanaged\t to\t\nidentify\t barriers\t faced\t by\tCPs.\t In\t general,\tGPs\twere\t supportive\t towards\t the\t involvement\t of\t\nCPs\tin\textended\tpharmacy\tservices\tbut\tthey\twere\tuncertain\tabout\ttheir\tknowledge\tand\tskills.\t\nIn\t conclusion,\t this\t study\t has\t identified\t the\t current\t barriers\t towards\t the\t transformation\t of\t\ncommunity\tpharmacy\tpractice\tin\tMalaysia.\tFuture\tactions\tincluding\tplanning,\tdeveloping\tand\t\nimplementing\tnew\tpolicies\tare\tmuch\tneeded.\n\n\n\n\n\n\n\n\n59\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPHARMACY PRACTICE / SOCIAL PHARMACY\n___________________________________________________________________________\n\n\n\nPPO 10\nMPSPSC2015000060\t(Oral)\n\n\n\nSetting up A Hospital Based Nuclear Pharmacy Service - AMDI Experience\n\n\n\nH Mohd Ikhwan1, AM Mahayuddin2, AH Khadijah3, J Farakhdina3\n\n\n\n1Nuclear Pharmacy Unit, Pharmacy Section, Advanced Medical & Dental Institute, Universiti \nSains Malaysia\n2Oncological & Radiological Sciences Cluster, Advanced Medical & Dental Institute, Universiti \nSains Malaysia\n3Nuclear Medicine Unit, Radiology, Oncology and Nuclear Medicine Section, Advanced Medical & \nDental Institute, Universiti Sains Malaysia\n\n\n\nNuclear\tMedicine\tUnit\t (NMU)\tof\tAdvanced\tMedical\t&\tDental\t Institute\t (AMDI)\t started\t its\t\nclinical\tservices\tin\tAugust\t2014.\tThe\tprimary\tservices\tfocused\ton\tclinical\tdiagnostic\ttests,\tusing\t\nkit-based\tradiopharmaceuticals\t supported\tby\tAMDI\tNuclear\tPharmacy\tUnit\t (NPU).\tWithin\t\nthe\tunit,\t a\tpharmacist\twas\t identified\tas\t the\tpersonnel\t for\tplanning\tand\t setting\tup\t the\tNPU\t\nin\tcollaboration\twith\t the\tclinical\t specialists\t and\tphysicist.\tA\tpharmacist\twas\t involved\t in\t the\t\nplanning\tprocess\tuntil\t the\t full\t completion\tof\t the\tNMU.\tThese\t included\tbudgeting,\tplanning\t\nand\t identifying\t the\t essential\t equipment\t required\t to\t start\t the\t clinical\t services.\tA\t total\t of\t 24\t\nequipment\tlisted\tas\tthe\tbasic\trequirements\tfor\tthe\tservices\tto\tstart.\tThe\tmain\tchallenge\tat\tthis\t\nlevel\twas\tto\twork\tand\tadhere\tto\tthe\toutline\tgiven\tby\tthe\tguidelines,\tcertification\trequirements\t\nand\trules\tof\tthe\tregulatory\tbodies\twith\tthe\tamount\tof\tbudget\tthat\thad\tbeen\tdetermined\tearlier.\t\nThe\tcontribution\tof\t the\tpharmacist\tcontinued\t in\t the\tplanning\tand\tsetting\tup\tof\t the\tHotLab.\t\nThe\tworkflow\tand\tStandard\tOperating\tProcedure\t(SOP)\thad\tto\tbe\tprepared\tbefore\tthe\tservices\t\ncould\tcommenced.\tThe\tarrangement\tof\tthe\tHotLab\thad\tto\tbe\tclearly\tlaid\tout\tas\tthe\trooms\twere\t\nidentified\tbased\ton\ttheir\tfunctions.\tFurthermore,\tit\tis\talso\ta\tsterile\tand\tclean\tcomplex;\thence,\t\nthe\tknowledge\tof\tpharmacist\t in\t aseptic\t technique\t is\t essential.\t In\t conclusion,\t in\t setting\tup\ta\t\nNMU,\tthe\tpharmacist\tcan\tcontribute\tactively\t in\tplanning\tthe\tbudget,\tdeciding\tthe\tnecessary\t\nequipment,\ttraining\tof\tpersonnel\tas\twell\tas\testablishing\tthe\tworkflow\tand\tSOP\tof\tthe\tNPU.\n\n\n\n\n\n\n\n\n60\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPHARMACY PRACTICE / SOCIAL PHARMACY\n___________________________________________________________________________\n\n\n\nPPO 11\nMPSPSC2015000005\t(Oral)\n\n\n\nCustomers Satisfaction towards Community Pharmacists Professional Practice in Malaysia \n\n\n\nKH Yeo, WS Wan Zaid, A Jamil\nFaculty of Pharmacy, Cyberjaya University College of Medical Sciences, Selangor, Malaysia\n\n\n\nCommunity\tpharmacists\t are\t pharmacists\twho\tpractice\t in\t the\t community\t setting.\tCustomer\t\nsatisfaction\t was\t defined\t as\t the\t frequency\t of\t satisfactory\t customers\t towards\t the\t services\t\nprovided\tby\tcommunity\tpharmacists\tthrough\tpast\texperience.\tThe\tobjectives\tof\tthis\tstudy\twere\t\nto\tmeasure\t customer\u2019s\t level\t of\t satisfaction\t towards\t community\t pharmacists\t in\tMalaysia,\t to\t\nmeasure\tcommunity\tpharmacists\u2019\tprofessional\tpractice\tlevel,\tto\tcompare\tbetween\tcommunity\t\npharmacists\u2019\tprofessional\tpractice\tand\tcustomers\u2019\tsatisfaction\tlevel\tand\tto\tinvestigate\twhether\t\nthe\t type\t of\t pharmacy\t visited\t by\t the\t customers\t affected\t their\t satisfaction\t levels\t towards\t the\t\ncommunity\tpharmacists\u2019\tprofessional\tpractice.\tThis\tsurvey\twas\tcarried\tout\tthrough\ttwo\tways;\t\ndirect\tdistribution\tof\tquestionnaires\tand\tonline\tdistribution\tof\tquestionnaires.\tA\ttotal\tof\t271\t\nrespondents\t were\t involved\t in\t this\t study.\tThe\tmean\t level\t of\t Professional\t Practice\tmeasured\t\nwas\t3.62\t\u00b1\t0.68\t(n=271).\tThis\tindicated\tthat\tthe\tlevel\tof\tProfessional\tPractice\twas\tmoderately\t\nprofessional.\tThe\tmean\t level\t of\t Customers\u2019\t Satisfaction\tmeasured\twas\t 3.69\t \u00b1\t 0.68\t (n=271).\t\nThe\tstudies\trevealed\tthat\tmost\tof\tthe\tcustomers\twere\tmoderately\tsatisfied\twith\tthe\tcommunity\t\npharmacists.\tThere\twas\t a\t positive\t relationship\t between\tprofessional\t practice\t and\t customers\u2019\t\nsatisfaction.\tThere\twas\tno\tdifference\tin\tprofessional\tpractice\tlevels\tand\tcustomers\u2019\tsatisfaction\t\nlevel\tin\tdifferent\ttypes\tof\tpharmacy.\tOverall,\tthe\tsatisfaction\tlevel\tand\tpractice\tlevel\twere\tmoderate.\t\nMany\timprovements\tcan\tbe\tmade\tin\tthe\tcurrent\tcommunity\tpharmacists\u2019\tpractice.\tMore\tstudy\t\nwith\tlarger\tscale\tis\trecommended\tto\testablish\tan\tindex\tthat\treflects\tthe\tquality\tof\tpractice\tamong\t\ncommunity\tpharmacists.\tIt\tcan\talso\tbe\treferred\tto\tby\tpolicymakers\tin\testablishing\tgood\tpractice\t\nguidelines\tfor\tcommunity\tpharmacists.\n\n\n\n\n\n\n\n\n61\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPHARMACY PRACTICE / SOCIAL PHARMACY\n___________________________________________________________________________\n\n\n\nPPO 12\nMPSPSC2015000023\t(Oral)\n\n\n\nOptimising Community Pharmacy Intervention in Managing Sleep Disorders: Extended \nRoles of Community Pharmacists\n\n\n\nZ Mohamad Noor1, 2, AJ Smith2, 3, SS Smith4, LM Nissen5\n\n\n\n1Kulliyyah of Pharmacy, International Islamic University Malaysia, Pahang, Malaysia\n2School of Pharmacy, University of Queensland, Queensland, Australia\n3School of Pharmacy, University of Otago, Dunedin, New Zealand\n4Institute for Health and Biomedical Innovation and Centre of Accident Research and Road Safety, \nQueensland University of Technology, Queensland, Australia. \n5School of Clinical Sciences, Queensland University of Technology, Queensland, Australia.\n\n\n\nCommunity\tPharmacists\tare\tin\ta\tposition\tto\tprovide\tadvice\tand\tservices\tof\tsleep-related\tdisorders\t\nto\t the\t community.\t Interventions\t that\tmeasure\t sleep/wake\t objectively\t can\t assist\t pharmacists\t\nin\t consultation.\t This\t feasibility\t study\t was\t conducted\t to\t evaluate:\t (1)\t the\t effectiveness\t of\t a\t\ncommunity-pharmacy-based\u2019\tintervention,\t(2)\tthe\trole\tof\tactigraphs\tand\t(3)\tthe\textended\trole\tof\t\ncommunity\tpharmacists,\tin\tmanaging\tsleep\tdisorders.\tCustomers\twith\tsleeping\tdisorders\twere\t\nrecruited\tbased\ton\tconvenience\tsampling.\tThe\tintervention-care-group\t(ICG)\t(n=20)\treceived\t\nan\t\u2018intervention-package\u2019\tincluding:\ta\twrist-worn\tactigraph\t(to\tmeasure\tsleep/wake\tpatterns\tfor\t\n2-weeks),\ta\tsleep-diary,\tand\ttwo\tconsultations.\tActigraphy\tsleep-parameters\t(sleep\tefficiency%,\t\nSE%;\t total-sleep-time,\tTST;\t sleep-onset-latency,\t SOL)\twere\tdownloaded\t at\tweek-1\t (pre)\t and\t\nweek-2\t (post)\t for\t consultation\t use.\tThe\tusual-care-group\t (UCG)\t (n=21)\t received\t \u2018standard-\ncare\u2019\tfor\tsleeping\tdisorders.\tBoth\tgroups\tcompleted\tsleep-scale\tscores\t(Epworth\tSleepiness\tScale,\t\nESS;\tInsomnia\tSeverity\tIndex,\tISI)\tat\tbaseline\t(pre)\tand\tthe\tend-of-study\t(post).\tAll\tsubjects\t\nanswered\tLikert-type-scale\tquestionnaires\tto\tdetermine\ttheir\tunderstanding\tof\tsleep\tdisorders\t\nafter\tweek-2.\tFindings\tshowed\tsignificant\tdifferences\t(p<0.05)\twhen\tcomparing\tpre-\tand\tpost-\nISI\tmean\tscores\tin\tICG\tand\tpost-ISI\tmean\tscores\tbetween\tICG\tand\tUCG.\tFor\tSE%,\tan\tincrease\t\nof\t subjects\t rated\t \u2018good\t sleepers\u2019\t at\t post\u2013assessment\t in\t ICG.\t Actigraphy\t sleep-parameters\t\nmean\tscores\tshowed\tagreement\twith\tsleep-diaries.\tICG\tshowed\t35%\tof\tsubjects\thad\timproved\t\nunderstanding\tof\t sleep\tdisorders\tafter\tconsulting\t the\tpharmacist,\t compared\t to\tUCG\t(4.8%).\t\nISI\t scores\t offer\t insights\t into\t the\t development\t of\t community-pharmacy-based\t interventions,\t\nparticularly\tin\tindividuals\twith\tinsomnia.\tIt\talso\tdemonstrated\tthat\tactigraphs\tcould\tprovide\t\nobjective\tsleep/wake\tdata\tto\tassist\tcommunity\tpharmacists\tduring\tconsultations\ton\tsleep\thealth.\t\n\n\n\n\n\n\n\n\n62\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPHARMACY PRACTICE / SOCIAL PHARMACY\n___________________________________________________________________________\n\n\n\nPPO 13\nMPSPSC2015000086\t(Oral)\n\n\n\nA Survey on Knowledge, Attitude and the Perception (KAP) of Pharmacovigilance and \nAdverse Drug Reactions (ADRs) Reporting among the Healthcare Students in a Private \nUniversity \n\n\n\nS Sivadasan1, NA Abdul1, R Veerasamy1, M Kasi2, M Sellapan3\n\n\n\n1Faculty of Pharmacy, AIMST University, Kedah, Malaysia\n2Faculty of Applied Sciences, AIMST University, Kedah, Malaysia\n3Karpagam College of Pharmacy, Tamilnadu, India\n\n\n\nThis\t study\twas\t conducted\t to\tassess\t the\tknowledge\tand\tawareness\tof\tPharmacovigilance\tand\t\nADRs\treporting\tamong\thealthcare\tstudents\tfrom\tmedicine,\tdentistry,\tpharmacy\tand\tnursing\t\ncourses\t in\t a\t Malaysia\t private\t university.\t The\t study\t is\t necessary\t to\t assess\t the\t KAP\t among\t\nhealthcare\tstudents,\twho\tare\tresponsible\tand\tshould\thave\tthe\twillingness\tto\tbe\tinvolved\tin\tADRs\t\nreporting\tand\tmonitoring\tin\ttheir\tfuture\tpractice.\tA\tsurvey\tusing\ta\tpre-validated\tquestionnaire\t\nwas\t carried\t out\t among\t pre-final\t and\t final\t year\t students\t of\tmedicine,\t dental,\t pharmacy\t and\t\nnursing\tcourses.\tThe\tKAP\tquestionnaire\twas\tdesigned\tand\tpre-validated\tby\texperts\tin\tthe\tfield.\t\nThe\tKAP\tquestionnaire\tconsists\tof\ta\ttotal\tof\t29\tsurvey\titems\torganised\tinto\t2\tsections;\t15\titems\t\nrelated\tto\tknowledge\tand\t14\t items\trelated\tto\tattitude\tand\tperception\taspects.\tThe\tcompleted\t\nKAP\t questionnaires\t were\t analysed\t using\t SPSS\t software\t version\t 14.\t The\t questionnaire\t was\t\nadministered\tto\t629\tstudents,\tof\twhom\t331\twere\tmedical\tstudents,\t148\tpharmacy\tstudents,\t117\t\ndental\tstudents\tand\t33\tnursing\tstudents.\t\tA\ttotal\tof\t396\tstudents\tcompleted\tthe\tquestionnaire,\t\ngiving\ta\tresponse\trate\tof\t63%.\tOur\tstudy\tshows\tthat\tpharmacy\tstudents\thave\tbetter\tknowledge\t\nand\t understanding\t towards\t pharmacovigilance\t and\t ADRs\t reporting\t compared\t to\t medical,\t\ndental\tand\tnursing\tstudents.\tThe\tstudy\tsuggests\tthat\tthe\tmedical,\tdentistry\tand\tnursing\tstudents\t\nhave\ta\tpositive\tattitude\tand\tshould\tgain\tknowledge\ton\tADRs\treporting\tas\tthey\tare\tthe\tfuture\t\nimportant\thealthcare\tprofessionals\twho\twill\tbe\tresponsible\tfor\tpharmacovigilance\tactivities\tand\t\nADRs\treporting.\t\n\n\n\n\n\n\n\n\n63\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPHARMACY EDUCATION\n___________________________________________________________________________\n\n\n\nPEO 01 \nMPSPSC2015000062\t(Oral)\n\n\n\nImpact and Perception of E-learning: Pre-post Survey and Evaluations \n\n\n\nF Adib Azhari1, LC Ming1,2, TM Khan3\n\n\n\n1Faculty of Pharmacy, Universiti Teknologi MARA, Puncak Alam, Selangor, Malaysia\n2Brain Degeneration and Therapeutics Group, Pharmaceutical and Life Sciences CoRe, Universiti \nTeknologi MARA, Shah Alam, Selangor, Malaysia\n3School of Pharmacy, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia\n\n\n\nIncorporation\tof\te-learning\twas\tone\tof\tthe\tinitiatives\ttaken\tfor\tthe\tPrinciples\tof\tPathology,\ta\tcore\t\nsubject\tfor\tsecond\tyear\tBachelor\tof\tPharmacy\tprogramme.\tThis\tteaching\tinnovation\tused\tvarious\t\nonline\t learning\t activities\t following\t the\t social\t constructivist\t learning\t environment\t (SCLE).\t\nTherefore,\tthis\tstudy\twas\tto\texplore\tpharmacy\tstudents\u2019\tperception\ton\te-learning\tintervention\t\nin\t pathology\t subject\t and\t its\t effect\t on\t students\u2019\t academic\t achievement.\t The\t Constructivist\t\nOnline\tLearning\tEnvironment\tSurvey\t (COLLES)\twas\tused\t to\t assess\t students\u2019\tperception\ton\t\ne-learning\tapplication,\twhile\tpre-\tand\tpost-test\tassessment\twas\tused\tto\testimate\tthe\timpact\ton\t\nstudents\u2019\tacademic\tachievement\tfollowing\tthe\te-learning\tintervention.\tAll\tdata\twere\tanalysed\t\nusing\tSPSS\tv.\t 20.\tCorrelation\tanalysis\twas\t conducted\t to\tdetermine\t the\t relationship\tbetween\t\nperception\t on\t e-learning\t and\t increase\t in\t knowledge.\t A\t total\t of\t 196\t second\t year\t pharmacy\t\nstudents\tshowed\tpositive\tattitude\ttowards\tthe\tuse\tof\te-learning\tapplication.\tThe\tresults\tshowed\t\nthat\t\u201cReflection\u201d\t(3.98\t\u00b10.47)\tand\t\u201cTutor\tSupport\u201d\t(4.30\u00b10.34)\twere\tsignificantly\tincreased\tin\t\nactual\tCOLLES\tscore.\tStudents\u2019\tperception\ton\te-learning\twas\tnot\tcorrelated\twith\tknowledge\t\ngained\tpost\te-learning\tintervention.\tThe\tstudents\tfelt\tthat\te-learning\tcan\tbe\tbeneficial\tfor\tthem\t\nin\tterms\tof\tan\tincrease\tin\ttheir\tknowledge,\tteamwork\tand\tflexibility\tin\ttime\tof\tstudy.\tThe\tincrease\t\nin\t \u201cReflection\tand\tTutor\tSupport\u201d\t score\t indicates\t that\t the\tactivities\tprovided\thad\tdeveloped\t\nthe\t students\u2019\t critical\t thinking\tand\t there\twas\t immense\t lecturers\u2019\t involvement\t throughout\t the\t\ne-learning\tsession.\tThe\tresults\tfrom\tCOLLES\tillustrated\tthe\tdevelopment\tof\tSCLE\tin\tthe\tcourse.\t\nThe\tuse\tof\te-learning\tin\tpathology\tsubject\tcould\tenhance\tstudent\tlearning\texperience.\t\n\n\n\n\n\n\n\n\n64\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPHARMACY EDUCATION\n___________________________________________________________________________\n\n\n\nPEO 02 \nMPSPSC2015000063\t(Oral)\n\n\n\nPharmacy Students\u2019 Interprofessional Perceptions towards the Pharmacy Profession\n\n\n\nFA Nor Azizi1, M Abdul Hameed1,  CF Neoh1, LC Ming1,2, TM Khan3\n\n\n\n1Faculty of Pharmacy, Universiti Teknologi MARA, Puncak Alam, Selangor, Malaysia\n2Brain Degeneration and Therapeutics Group, Pharmaceutical and Life Sciences CoRe, Universiti \nTeknologi MARA, Shah Alam, Selangor, Malaysia\n3School of Pharmacy, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia\n\n\n\nInterprofessional\tskill\trevolves\twith\tinterconnected\tprofessional\tskills\tof\thealthcare\tprofessions.\t\nThis\tskill\tis\tessential\tto\tdeliver\tmore\teffective,\torganized\thealthcare\tand\twelfare\tservices.\tThis\t\nstudy\tcould\thelp\tto\timprove\tthe\tinterprofessional\ttraining\tamong\tpharmacy\tstudents.\tThis\tstudy\t\nwas\t conducted\t to\t investigate\t the\t perceptions\t of\t pharmacy\t students\t in\t Universiti\t Teknologi\t\nMARA\t(UiTM)\ttowards\tinterprofessional\tin\tthe\tpharmacy\tprofession\tin\tMalaysia.\tA\tvalidated\t\nquestionnaire\twith\t27\titems\twas\tused.\tA\tuniversal\tsampling\tmethod\twas\tadopted\tand\tall\tthe\t\npharmacy\t students\twere\t invited\t for\t their\tparticipation\t in\t this\t study.\tA\t total\t of\t 275\t students\t\nparticipated\tin\tthis\tstudy.\tThere\twas\tno\tsignificant\tdifference\tin\tthe\tinterprofessional\tperception\t\nbetween\tthe\tvariable\tgroups\texcept\t for\t the\tacademic\tyear\t(p\t<\t0.01),\thospital\tor\tcommunity\t\npharmacy\ttraining\t(p\t=\t0.003)\tand\tattendance\tto\ta\tseminar\tor\tconference\t(p\t=\t0.045)\twithin\tthe\t\nlast\tsix\tmonths.\tUnder\tthe\tguidance\tof\tthe\tpharmacist\tpreceptor,\tstudents\tlearnt\thow\tto\tengage\t\nin\tinterprofessional\trelationship\tand\tinteraction.\tHospital,\tcommunity\ttraining\tand\texposure\t\nto\t pharmacy\t scientific\t gathering\t enhance\t the\t attitude\t of\t students\t towards\t interprofessional\t\ncollaboration.\tThe\tfindings\tof\tthis\tstudy\tcall\tfor\ta\tcurriculum\tthat\talso\tfocuses\ton\tbehavioral\t\nand\tadministrative\taspects\tof\tthe\tpharmacy\tprofession.\n\n\n\n\n\n\n\n\n65\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPHARMACY EDUCATION\n___________________________________________________________________________\n\n\n\nPEO 03\nMPSPSC2015000132\t(Oral)\n\n\n\nStudents\u2019 Readiness for and Perception towards Inter-Professional Learning: A Cross \nSectional Study\n\n\n\nNI Mohamed Nazar, MG Ab Salam2, MA Abibullah, MF Md Taib, SNF Alauddin @ Muhd \nZahir, SS Syed Omar, NF Abdul Rashid, NNE Ramli, AN Abdul Hamid, NT Mustapa, MM \nElkami  \nPharmacy Practice Department, Kulliyyah of Pharmacy, International Islamic University Malaysia, \nKuantan, Malaysia\n \nCurrent\thealthcare\trelated\tissues\tand\tproblems\tare\tbecoming\tmore\tcomplex.\tComprehensive\t\npatient\tcare\tis\timpossible\tto\tbe\tachieved\tby\tclinicians\talone\tas\tthis\trequires\tinter-professional\t\napproach\t in\t the\t management.\tTherefore,\t it\t has\t been\t suggested\t that\t students\t in\t healthcare\t\nprofession\tshould\tbe\texposed\tto\tinter-professional\tlearning\t(IPL)\tduring\ttheir\tundergraduate\t\nyears.\tThe\tobjectives\tof\tthis\tstudy\twere\tto\tinvestigate\tthe\treadiness\tfor\tand\tthe\tperception\tof\tIPL\t\namong\thealthcare\tprofessional\t students\tof\t International\t Islamic\tUniversity\tMalaysia\t (IIUM).\t\nData\twas\tcollected\tusing\tan\testablished\tquestionnaire\tnamely,\tReadiness\tfor\tInter-professional\t\nLearning\tScale\t (RIPLS)\twhich\twas\tdistributed\t to\tfinal\tyear\t students\tof\t3\tmain\tprogrammes;\t\nMedicine,\tPharmacy\tand\tNursing.\tOut\tof\tthe\t122\tstudents,\ta\tmajority\tdenied\tbeing\texposed\t\nto\tIPL.\tTeamwork\tand\tcollaboration\tshowed\tthe\thighest\tmean\t(40.2\t+\t4.18)\tthat\tthe\tstudents\t\nhighly\tagreed\ton.\tFemale\tstudents\thave\tsignificantly\tlower\tnegative\tprofessional\tID\tcompared\t\nto\tthe\tmale\tstudents\t(p\t=\t0.011).\tThis\tsubdomain\talso\texhibited\tsignificant\tdifference\tin\tscores\t\nbetween\tcGPA\tresults\tof\tthe\tstudents.\tStudents\twith\thigh\tcGPA\t(3.50-4.00)\ttended\tto\thave\tlower\t\nnegative\tattitude\ttowards\tIPL\tcrossing\tprogrammes\t(p\t=\t0.009).\tThose\twho\thave\texposure\tto\t\nIPL\tshow\tsignificant\tpositive\tattitudes\ttowards\tIPL\tregardless\tof\tthe\tprogramme\t(p\t=\t0.032).\tThe\t\nstudy\tshows\tthat\tstudents\tfrom\tthe\tmedical\tprogramme\thave\tthe\tleast\texposure\tto\t\tIPL.\tGender\t\nand\t cGPA\t status\t of\t students\tmay\t also\t play\t an\t important\t role\t in\t determining\t their\t attitude\t\ntowards\tIPL.\tThere\tare\tstill\trooms\tfor\timprovement\tto\tnurture\treadiness\tamong\tthe\tstudents.\n\n\n\n\n\n\n\n\n66\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPHARMACEUTICAL CHEMISTRY\n___________________________________________________________________________\n\n\n\nPCO 01 \nMPSPSC2015000072\t(Oral)\n\n\n\nGreen Synthesis of Parkia speciosa Mediated Silver Nanoparticles - Characterization and \nEvaluation of its Antibacterial and Antioxidant Potential\n\n\n\nR Veerasamy1, S Sivadasan1, V Sethu2, H Rajak3                      \n1Faculty of Pharmacy, AIMST University, Semeling, Kedah, Malaysia\n2Faculty of Engineering, University of Nottingham, Semenyih, Selangor, Malaysia \n3SLT Institute of Pharmaceutical Sciences, Guru Ghasidas Vishwavidyalaya, Bilaspur, India\n \nGreen\tsynthesis\tof\t silver\tnanoparticles\tusing\tbiological\tentities\t is\tgaining\t interest\tbecause\tof\t\ntheir\tpotential\tapplications\tin\tnanomedicine\tand\tmaterial\tengineering.\tHerein,\twe\treport\tthe\t\ngreen\tsynthesis\tand\tcharacterization\tof\tsilver\tnanoparticles\t(PAgNPs)\tusing\tParkia\tspeciosa\tleaf\t\naqueous\textract.\tSynthesized\tPAgNPs\twere\tconfirmed\tby\tusing\tUV-visible\tspectrophotometer\t\nand\tthe\tvarious\treaction\tparameters\twere\toptimized.\tThe\tantibacterial\tactivity\tof\tPAgNPs\twas\t\nevaluated\tagainst\tStaphylococcus\taureus,\tPseudomonas\taeruginosa,\tEscherichia\tcoli\tand\tBacillus\t\nsubtilis.\tThe\t antioxidant\t activity\t of\t the\t silver\t nanoparticles\t was\t evaluated\t by\t 2,2-diphenyl-\n1-picrylhydrazyl\t (DPPH)\t radical\t scavenging\t method.\t The\t PAgNPs\t in\t solution\t has\t shown\t\nmaximum\tabsorption\tat\t410.5\tnm,\tspectrophotometrically.\tThe\toptimized\tparameters\tfor\tthis\t\nsynthesis\twere:\t temperature\t60\t\u00b1\t2\u00b0C,\tpH\t11,\t concentration\tof\t silver\tnitrate\t 6\tmM\taqueous\t\nsolution,\tvolume\tof\tleaf\textract\t1\tmL\tand\ttime\t2\tmin.\tThe\tscanning\telectron\tmicroscope\tand\t\ndynamic\tlight\tscattering\tanalysis\tconfirmed\tthe\taverage\tparticle\tsize\tof\t31\tnm\tand\t155.3\td.nm\t\n(polydispersity\tindex\tof\t0.381),\trespectively.\tX-ray\tdiffraction\tconfirmed\tthe\tcrystalline\tnature\tof\t\nthe\tPAgNPs,\tand\tenergy\tdispersive\tspectrometer\tauthorized\tthe\tpresence\tof\tsilver.\tFurther\tFTIR\t\nspectrum\tof\tPAgNPs\tauthorized\tthe\tpresence\tof\tphenolic\tcompounds,\tproteins\tand\tflavonoids\t\nwhich\tmay\thave\tpossibly\t influenced\tthe\treduction\tprocess\tand\tstabilization\tof\tnanoparticles.\t\nThe\tantibacterial\tstudy\tresults\tindicated\tthat\tthe\tPAgNPs\tshowed\tmoderate\tinhibitory\tactions\t\nthan\t the\t crude\tplant\t extract,\t demonstrating\t its\t antibacterial\t value\t against\t bacterial\t diseases.\t\nSynthesized\t silver\tnanoparticles\t showed\t significant\t antioxidant\t activity.\tThus,\t the\t significant\t\noutcome\t of\t this\t study\t would\t help\t to\t formulate\t value\t added\t herbal\t based\t nanomaterials\t in\t\nbiomedical\tand\tnanotechnology\tindustries.\n\n\n\n\n\n\n\n\n67\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPHARMACEUTICAL CHEMISTRY\n___________________________________________________________________________\n\n\n\nPCO 02 \nMPSPSC2015000087\t(Oral)\n\n\n\nCombined Docking and Molecular Dynamics Provide Insights into the Trypanosoma \nPurine Salvaging Pathway Inhibitors \n\n\n\nA Fatima1, CHH Hung2                  \n1Faculty of Medicine, Quest International University Perak, Ipoh, Perak, Malaysia\n2Faculty of Pharmaceutical Sciences, UCSI University, Cheras, Kuala Lumpur, Malaysia\n \nHuman\tAfrican\tTrypanosomiasis\tis\tendemic\tto\t37\tcountries\tof\tthe\tsub-Saharan\tAfrica.\tCaused\t\nby\ttwo\trelated\tspecies\tof\tTrypanosoma\tbrucei,\tit\tis\tclassified\tas\ta\tneglected\tdisease.\tPentamidine\t\nis\tthe\tonly\tavailable\ttherapy\tfor\tinhibiting\tthe\tP2\tadenosine\ttransporter\tinvolved\tin\tthe\tpurine\t\nsalvage\tpathway\tof\tthe\ttrypanosomatids,\twhich\thowever,\tsuffers\tfrom\tresistance,\ttoxicity,\tand\t\npublic\t inaccessibility.\tMalaysia\t is\t blessed\t with\t a\t great\t biodiversity\t that\t can\t be\t explored\t for\t\neffective,\tsafer\tand\tcheaper\talternatives.\t\tSeveral\tresearchers\thave\tpointed\tout\tthe\tusefulness\tof\t\nflavonoids\tas\ttrypanocidal\tdrugs\tbut\tits\tmechanism\tis\tunclear.\tThe\tobjective\tof\tthe\tpresent\tstudy\t\nwas\tto\tcombine\tcomputational\ttechniques\tof\tdocking\tand\tmolecular\tdynamics\tsimulations\tfor\t\nthe\tinvestigation\tof\tthe\tprobable\ttrypanocidal\tmechanism\tof\tflavonoids\tin\tthe\tpurine\tsalvage\t\npathway.\t Docking\t experiments\t were\t carried\t out\t on\t three\t flavonoids,\t namely\t kaempferol,\t\nquercetin\tand\tchrysin\twhich\tcould\tbe\tfound\tin\tseveral\tMalaysian\tplants.\tUsing\tthe\tAutodock\t\n4.2\tsoftware,\tthese\tthree\tcompounds\twere\tdocked\tto\tinosine-adenosine-guanosine\tnucleoside\t\nhydrolase\tand\t the\t inosine-guanosine\tnucleoside\thydrolase,\t the\tmajor\tenzymes\tof\t the\tpurine\t\nsalvage\tpathway.\tOur\tresults\tshowed\tthat\tall\tthe\tthree\tflavonoids\thave\thigh\taffinities\tfor\tboth\t\nhydrolases\t with\t binding\t energy\t ranging\t from\t -9.71\t to\t -8.41\t kcal/mol.\tMolecular\t dynamics\t\nstudies\tusing\tAMBER12\tprogram\twere\tfurther\tused\tto\telucidate\tthe\tmost\tsuitable\tlead\tof\tthe\t\nthree\tcompounds.\t\n\n\n\n\n\n\n\n\n68\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPHARMACEUTICAL CHEMISTRY\n___________________________________________________________________________\n\n\n\nPCO 03 \nMPSPSC2015000071\t(Oral)\n\n\n\nEvidences of Antitubercular Potential of Novel Thiazolidinone Derivatives Bearing \nChloroxylenol Moiety \n\n\n\nNK Fuloria, S Fuloria, K Balaji, KM Sundram               \nPharmaceutical Chemistry Unit, Faculty of Pharmacy, AIMST University, Semeling, Kedah, \nMalaysia. \n \nCurrent\t limitations\t with\t tuberculosis\t (TB)\t treatment\t in\t drugs,\t like\t drug-drug\t interactions,\t\ntoxicity,\t intolerance\t and\tpoor\tpatient\t compliance,\t as\twell\t as\thigh\tantitubercular\tpotential\tof\t\nthiazolidinones\t and\t alkylated\t phenolic\t derivatives\t challenged\t investigators\t to\t develop\tmore\t\nefficient\t anti-TB\t drugs.\t Scientific\t reports\t over\t anti-TB\t potential\t of\t alkylated\t phenols,\t and\t\nthiazolidinones\tinspired\tinvestigators\tto\tcarry\tout\tsynthesis\tand\texplore\tantitubercular\tprofile\t\nof\t some\tnovel\t thiazolidinones.\tTherefore,\t this\t study\twas\t aimed\t to\t synthesize\t and\tdetermine\t\nanti-TB\t potential\t of\t novel\t thiazolidinone\t derivatives\t of\t chloroxylenol.\t 4-thiazolidinone\t\nderivatives\t bearing\t chloroxylenol\t moiety\t were\t synthesized\t and\t evaluated\t for\t in-vitro\t anti-\ntubercular\t activity.\t 2-(4-chloro-3,5-dimethylphenoxy)acetohydrazide,\t derived\t from\t ethyl\t\n2-(4-chloro-3,5-dimethylphenoxy)acetate,\twas\tmade\tto\treact\twith\tdifferent\taromatic\taldehydes\t\nto\t offer\t N-substituted\t benzylidene-2-(4-chloro-3,5-dimethylphenoxy)acetohydrazide\t (3a-\ne).\t Further\t cyclization\t of\t compound\t (3a-e)\t with\t thioglycolic\t acid\t offered\t 3-((4-chloro-3,5-\ndimethylphenoxy)methylamino)-2-aryl-thiazolidin-4-one\t (4a-e).\t Synthesized\t compounds\t\nstructures\twere\tconfirmed\tby\tIR,\tNMR\tand\tmass\tspectra\tand\tnovel\tcompounds\twere\tfurther\t\nevaluated\tfor\tantitubercular\tpotential\tagainst\thuman\tvirulent\tH37RV\tstrain\tof\tM.\ttuberculosis.\t\nAll\tcompounds\t3a-e\tand\t4a-e\tstructures\twere\t in\tfull\tagreement\twith\tmass,\t1H-NMR\tand\tIR\t\nspectral\tdata.\tAmong\tsynthesized\tderivatives,\tcompounds\t3b,\t3d,\t4b\tand\t4d\tshowed\tpromising\t\nantitubercular\t activities.\t In\t conclusion,\t designed\t synthetic\t route\twas\tproven\t as\t efficient\t and\t\nproductive\tmethod\tfor\tthiazolidiones\tderivatives.\tSAR\tpattern\tof\tresults\tshow\timportance\tof\t\nsubstitution\tof\telectronegative\tgroup\tat\tpara\tposition\tof\tbenzene\tring\tto\tenhance\tantitubercular\t\nactivity\t of\t newer\t compounds.\t High\t antitubercular\t potential\t of\t compounds\t 3b,\t 3d,\t 4b,\t and\t\n4d,\tclaim\tthem\tsuitable\t for\t further\t in-vitro\tand\t in-vivo\tevaluations,\t for\tdevelopment\tof\tnew\t\nantimycobacterial for tuberculosis treatment. \n\n\n\n\n\n\n\n\n69\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPHARMACEUTICAL CHEMISTRY\n___________________________________________________________________________\n\n\n\nPCO 04\nMPSPSC2015000115\t(Oral)\n\n\n\nDesign and Synthesis of Acetylcholinesterase Inhibitors Targeting Alzheimer\u2019s Disease\n\n\n\nNBS Nagojappa1, SL Ting1, JNNS Chandra2, V Bantal3          \n1School of Pharmacy, Taylor\u2019s University Lakeside Campus, Subang Jaya, Malaysia\n2School of Pharmacy, Guru Nanak Institutions Technical Campus, Hyderabad, India\n3G. Pulla Reddy College of Pharmacy, Hyderabad, India\n \nAlzheimer\u2019s\t disease\t is\t an\t irreversible\t and\t progressive\t brain\t disorder\t that\t slowly\t destroys\t\nmemory,\tthinking\tskills\tand,\teventually,\tthe\tability\tto\tcarry\tout\tthe\tsimplest\ttasks.\tAt\tpresent,\t18\t\n`million\tpeople\tworldwide\tare\tsuffering\tfrom\tthe\tdisease.\tIn\tMalaysia,\tit\tis\testimated\tthat\tthere\t\nare\tcurrently\tabout\t50,000\tpeople\twith\tthe\tdisease.\tThe\tprominent\tstrategy\tin\tthe\ttreatment\tof\t\npatients\twith\tAlzheimer\u2019s\tdisease\tpatients\taims\tat\tthe\tpotentiation\tof\tacetylcholine\tin\tthe\tbrain\t\nby\tlowering\tits\tdegradation\trate.\tThis\tis\tachieved\tby\tadministering\tpotent\tacetylcholinesterase\t\n(AChE)\tinhibitors.\tSince\tthe\tuse\tof\tAChE\tinhibitors\tis\tthe\tmost\teffective\ttherapeutic\tapproach\t\nin\tAlzheimer\u2019s\tdisease\ttreatment,\tthe\tdemand\tfor\tnew\tAChE\tinhibitors\tis\thigh.\tSome\tliteratures\t\nreported\tthat\tpyridine/\tpiperidine\tanalogues\tcould\tbecome\teffective\tAChE\tinhibitors.\tIn\tthis\t\ncontext,\twe\tdesigned\tsome\tnew\tamide\tmolecules\tcontaining\tpyridine/\tpiperidine\tnucleus.\tThe\t\ndesigned\tmolecules\twere\tdocked\tinto\tthe\thuman\tAChE\tenzyme\tcomputationally\tto\tcheck\ttheir\t\nenzyme\tinhibitory\tactivity\tusing\tcomputer\taided\tdrug\tdesign\ttechniques.\tThe\tmolecules\twith\t\nvery\t good\t binding/\tmolecular\t interactions\twith\t the\t enzyme\twere\t chosen\t for\t synthesis.\tThe\t\nsynthesis\tof\tthe\tchosen\tmolecules\twas\tperformed\tby\tstandard\tamide\tsynthesis\tmethod\tusing\t\nEDCI,\tHOBt/\tHATU\tas\tcoupling\treagents.\tThe\tcompounds\twere\tcharacterized,\ttested\tfor\ttheir\t\nin-vitro\tAChE\tinhibitory\tactivity\tat\t100\tmicro\tmolar\tconcentrations\tto\tyield\ttwo\tmoderately\t\nactive\tmolecules.\tThe\tactive\tmolecules\tcould\tbecome\tlead\tmolecules\tfor\tthe\tfurther\tdevelopment\t\nof\tAChE\tinhibitors.\n\n\n\n\n\n\n\n\n70\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nTRADITIONAL AND COMPLEMENTARY MEDICINE\n___________________________________________________________________________\n\n\n\nTCMO 01 \nMPSPSC2015000020\t(Oral)\n\n\n\nComplementary and Alternative Medicine (CAM) Use among Liver Disorder Patients at an \nOutpatient Clinic in University Malaya Medical Centre\n\n\n\nG Paramasivam1, N Shamsuddin1, WK Chan2       \n1Department of Pharmacy, Faculty of Medicine, University of Malaya\n2Department of Medicine, Faculty of Medicine, University of Malaya\n\n\n\nThere\t were\t concerns\t over\t the\t use\t of\t Complementary\t and\t Alternative\tMedicine\t (CAM)\t by\t\npatients\t with\t liver\t diseases.\t Very\t few\t studies\t described\t the\t prevalence\t of\t CAM\t use\t in\t this\t\nspecific\tpopulation\tof\tpatients.\tThus,\tthe\tpresent\tstudy\tseeks\tto\tevaluate\tthe\tpattern\tof\tCAM\tuse\t\nand\tto\tdetermine\tthe\tassociation\tbetween\tsocio-demographic\tfactors\tand\tCAM\tuse\tamong\tliver\t\ndisorder\tpatients.\tA\tface\tto\tface\tinterview\twith\tpatients\twith\tliver\tdisorders\twas\tconducted\tin\t\na\tgastroenterology\tclinic\tat\tUniversity\tMalaya\tMedical\tCentre.\tOut\tof\t200\tpatients\tinterviewed\t\nin\tthe\tstudy,\tonly\t56\t(28%)\treported\tusing\tCAM.\tThe\tmost\tcommon\tform\tof\tCAM\tused\twas\t\ndietary\tsupplement\t(69.6%),\therbal\tmedicine\t(37.5%),\tspiritual\thealing\t(9.0%)\tand\tacupuncture\t\n(5.4%).\tOnly\t19.6%\t(n\t=\t11)\tof\tthe\tpatients\twere\ttaking\tCAM\tto\ttreat\ttheir\tliver\tconditions.\tNo\t\nsignificant\trelationships\twere\tfound\tbetween\tsocio-demographic\tfactors\tand\tCAM\tuse,\texcept\t\nfor\t education\t level\t (\u03c72\t=\t15.93,\t p\t<\t 0.001),\twhere\tpatients\twith\thigher\t education\t level\t used\t\nCAM\tmore\t than\t patients\twith\t low\t education\t level.\t Family\t and\t friends\t are\t the\tmain\t source\t\nof\t information\t about\tCAM\tuse\t in\t these\t patients\t (46.4%).\t Sixty\t one\t percent\t of\t respondents\t\ndid\tnot\tdisclose\ttheir\tCAM\tuse\tto\ttheir\tdoctors.\tThe\tpresent\tstudy\trevealed\tthe\tprevalence\tof\t\nCAM\tuse\tamong\t liver\tdisorder\tpatients\t is\t lower\t than\tthe\tprevalence\treported\t in\t the\tgeneral\t\npopulation.\tThis\tmay\trepresent\thigh\tawareness\tof\tpatients\tregarding\tCAM\tuse\tin\tview\tof\ttheir\t\nliver\tconditions.\t\n\n\n\n\n\n\n\n\n71\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nTRADITIONAL AND COMPLEMENTARY MEDICINE\n___________________________________________________________________________\n\n\n\nTCMO 02\nMPSPSC2015000067\t(Oral)\n\n\n\nPerspective of Practitioners on Reflexology: A Qualitative Approach\n\n\n\nNH Embong1, YC Soh1, LC Ming1,2\n\n\n\n1Faculty of Pharmacy, Universiti Teknologi MARA, Puncak Alam, Selangor, Malaysia\n2Brain Degeneration and Therapeutics Group, Pharmaceutical and Life Sciences CoRe, Universiti \nTeknologi MARA, Shah Alam, Selangor, Malaysia\n\n\n\nReflexology\tis\tthe\tsystematic\tpractice\tof\tapplying\tsome\tpressure\tto\tparticular\tpoints\ton\tthe\tfeet\t\nand\thands\tto\tgive\timpacts\ton\thealth\tof\tthe\trelated\tparts\tof\tthe\tbody.\tThe\tobjective\tof\tthe\tstudy\twas\t\nto\texplore\tthe\tpractitioners\u2019\tperspectives\tof\treflexology\tin\tMalaysia.\tData\twere\tcollected\tusing\t\nface-to-face\t semi-structured\t interviews\t with\t practitioners\t in\tMalaysia.\tThe\t interviews\t were\t\nconducted\tin\tMalay\tlanguage\tand\trecorded.\tInterview\tconversations\twere\ttranslated,\ttranscribed\t\nverbatim.\tResponses\trelating\tto\tdifferent\tthemes\twere\tidentified\tin\teach\tof\tthe\tinterviews\tand\t\na\tcoding\tframe\twas\tdeveloped.\tFor\teach\ttheme,\tthe\trelevant\tdata\tenabled\ta\tdescription\tof\tthe\t\nrange\tof\tviews\tand\texperiences.\tData\tcollection\tand\tanalysis\twere\tconducted\tconcurrently\tand\t\nrecruitment\twas\tstopped\twhen\tsaturation\thad\tbeen\treached.\tAll\trespondents\thad\tgiven\twritten\t\nconsent\tfor\ttheir\tparticipation.\tThe\tfindings\tshowed\tthat\treflexology\ttreatment\tnowadays\thas\t\nbeen\taccepted\tas\tone\tof\tthe\tways\tto\tmaintain\tgeneral\thealth.\tPractitioners\tbelieve\tthat\treflexology\t\nis\table\tto\tdetect\tsome\tproblems\tregarding\tto\tour\tbody\twhich\tcan\thelp\tcustomer\tto\tbe\taware\t\nof\this/her\tbody\thealth\tcondition\tand\tcan\tseek\t further\t treatment.\t If\tnot\tperformed\tcorrectly,\t\nthen\tit\tmay\tcause\tnegative\teffects\tand\tinduce\tcertain\tadverse\teffects.\tSome\tpractitioners\tvoiced\t\nconcern\ton\tthe\tabuse\tof\tcertain\treflexology\tcenters\tfor\tother\tillegal\tconducts.\tAs\tconclusion,\t\nempowering\tthe\tpractitioner\tas\tprofessional\twould\thelp\tgaining\tpublic\u2019s\ttrust\tand\tconfidence\t\non\ttheir\t treatment.\tStrict\tenforcement\tof\tregulation\trelated\t to\t illegal\tconducts\t in\treflexology\t\ncenters\twill\timprove\tpeople\u2019s\tperception\ttoward\tits\tpractice.\t\n\n\n\n\n\n\n\n\n72\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\n \n___________________________________________________________________________\n\n\n\nPTO 01 \nMPSPSC2015000082\t(Oral)\n\n\n\nA Mechanistic Insight in Ketaconazole Soluplus Solid Dispersions\n \nV Krishnamoorthy1, G Raju2, P Subramani1,  S Krishnan3, MN Muralidhar4, S Adnan Ali \nShah5, S Somsundaran Revendran1, L Gunasegaran1, LL Chia1 and SH Ong1\n\n\n\n1Faculty of Pharmacy, AIMST University, Semeling, Malaysia\n2Colloid Interface Science Centre, Centre of Excellence, Malaysian Rubber Board, Experiment \nStation, Sungai Buloh, Selangor, Malaysia \n3KMCH College of Pharmacy, Coimbatore, India\n4Spectroscopy Analytical Test Facility, Indian Institute of Science, Bengaluru, India \n5Faculty of Pharmacy, Universiti Teknologi Mara (UiTM), Puncak Alam, Selangor, Malaysia\n\n\n\nDrug\u2019s\tpoor\taqueous\tsolubility\t limits\t its\tbioavailability\tto\ta\tgreater\textent\tand\tits\ttherapeutic\t\nefficiency.\t Solid\t dispersion\t is\t one\t of\t the\t common\t approaches\t to\t improve\t aqueous\t solubility\t\nbut\t its\t instability\t is\ta\tmajor\tconcern\t in\t its\t commercialization.\tAn\t insight\thas\tbeen\tprovided\t\non\t issues\t related\t to\t the\t enhancement\t of\t solubility\t and\t instability\t of\t such\t dispersions\t by\t\nadvanced\t characterization\t techniques.\tThe\t aim\t was\t to\t provide\t the\t mechanical\t insight\t into\t\nsolubility\t enhancement\t and\t instability\t aspects\t of\t Ketoconazole-Soluplus\t solid\t dispersions.\t\nSolid\tdispersions\tprepared\tby\tsolvent\tevaporation\tmethod\tat\tvarying\tdrug:\tcarrier\tratios\twere\t\nevaluated\tby\tphase\t solubility\t studies,\t in\tvitro\tdissolution\t studies,\t kinetic\t analysis,\t solid\t state\t\ncharacterization\t studies\t and\t in\t situ\t perfusion\t studies.\t Phase\t solubility\t results\t indicated\t the\t\nsolubilizing\tefficiency\tof\tcarrier.\tA\tmarked\tincrease\tin\tsolubility\tand\tdissolution\trate\twas\tobserved\t\nin\tdispersions\tcompared\tto\tpure\tdrug.\tThe\tdrug\trelease\twas\tfound\tto\tfollow\tKorsemeyer-Peppas\t\nmodel.\tCrystalllinity\treduction\tin\tdispersions\twas\tconfirmed\tby\tXRD\tand\tDSC\tresults.\tParticle\t\nsize\tanalysis\tand\tSEM\tresults\tproved\tthe\tparticle\tsize\treduction\tin\tsamples.\tThe\tdrug-polymer\t\ninteraction\tstudies\trevealed\ta\tweak\tinteraction\tbetween\tdrug\tand\tcarrier.\tThe\twettability\tdata\tof\t\nsamples\tsuggested\tan\timproved\twettability.\tThe\tin-situ\tperfusion\tand\tpermeation\tstudy\tresults\t\nconfirmed\tthe\tabsorption\tpotential\tof\t the\tdispersions.\tThe\tresults\tshow\tthat\t the\tsolubility\tof\t\nKetoconazole\tcould\tbe\tmarkedly\timproved\tby\tusing\tSoluplus\t(SP)\tas\ta\tcarrier.\tIt\talso\tprovided\t\nmechanical\tinsights\tto\tunderstand\tthe\tissues\trelated\tto\tsolubility\tenhancement\tand\tits\tinstability.\t\n\n\n\n\n\n\n\n\n73\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nMILITARY PHARMACY\n___________________________________________________________________________\n\n\n\nMPO 01 \nMPSPSC2015000145\t(Oral)\n\n\n\nThe Haiyan Super Typhoon in Philippines - Malaysian Military Pharmacist Experience\n\n\n\nMA Adnan1, AH Basari2\n\n\n\n1Dept of Pharmacy, Tuanku Mizan Armed Forces Hospital, Ministry of Defence, Malaysia.\n2Health Services Division, Malaysian Armed Forces HQ, Ministry of Defence, Malaysia.\n\n\n\nOn\t8th\tNovember\t2013,\tthe\tstrongest\ttyphoon\thit\tthe\tPhilippines\tand\tclaimed\tmore\tthan\t6,300\t\nlives.\tMalaysian\tNational\tSecurity\tCouncil\testablished\tand\tdeployed\ta\tdisaster\trelief\tteam\twith\t\nmilitary\tpharmacist\tto\tprovide\tHADR\tto\tthe\tsurvivors\tin\tTacloban\tdistrict.\tThe\tobjectives\tare\tto\t\ndocument\tcommon\tdiseases\tafter\ttyphoon,\tto\tlist\tessential\tmedications\tand\tto\tshare\texperience\t\nduring\tthe\tmission.\tTop\t2\tclinical\tdiseases\twere\tupper\tand\tlower\trespiratory\tinfections\t(55%)\t\nand\tinfected\twounds\tand\tlacerations\t(14%).\tTop\t2\tage\tgroups\ttreated\twere\t18-65\tyear\told\t(55%)\t\nand\t1-12\tyear\told\t(33%).\tThe\t3\tfast\tmoving\tmedicines\twere\tdiphenhydramine\texpectorant,\toral\t\nrehydration\tsalt\tand\tcloxacillin\tcapsule.\tTyphoon\ttook\taway\tall\tmedicines\tfrom\tsurvivors\twith\t\nchronic\tdiseases\tand\tmajority\tcouldn\u2019t\tremember\ttheir\tmedicines.\tTherefore,\tlearning\tcommon\t\nlocal\twords\tmade\tdispensing\t and\t counselling\t easier\t especially\t to\t elderly\t survivors.\t Extreme\t\ntropical\tweather\tcontributed\tto\tnot\tonly\thigh\trespiratory\tillnesses\tbut\tcreated\tpharmamedlogistics\t\nissues\tespecially\tduring\toutreach\tprograms.\tCommunicable\tdiseases\tsuch\tas\tleptospirosis\tand\t\ndengue\tamplified\t2\tweeks\tafter\tthe\tdisaster.\tSurvivors\thad\tto\tlive\tin\tan\tarea\twithout\tclean\twater\t\nsupply\tand\tpoor\tsanitation.\tPharmacist\twas\tinvolved\tin\tsupplying\tclean\tand\tsafe\tdrinking\twater\t\nusing\tMalaysian\tinvention\tof\tField\tWater\tPurification\tSystem\tknown\tas\tJERNIH.\tIn\tconclusion,\t\nan\tincrease\tin\tpatients\twith\tinfected\twounds\tand\tlacerations\tshould\tbe\texpected\tin\twater-based\t\ndisaster\tsuch\tas\tthis.\tData\tcollected\tcan\tbe\tused\tto\timprove\tdisaster\tresponse\tprocedures\tin\tthe\t\nfuture.\tNetworking\twith\tother\tpharmacists,\tlocal\thealth\tauthorities\tand\tother\tvolunteers\thelped\t\nin\tcoordinating\tand\tsustaining\tpharmamedlogistics.\n\n\n\n\n\n\n\n\n74\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nMILITARY PHARMACY\n___________________________________________________________________________\n\n\n\nMPO 02 \nMPSPSC2015000150\t(Oral)\n\n\n\nKelantan Flood: Role of Military Pharmacist in a Forward Hospital\n \nMF Yaacob1, AH Basari2\n\n\n\n1Armed Forces Health Training Institute, Terendak Camp, Malacca, Malaysia. \n2Health Services Division, Malaysian Armed Forces HQ, Ministry of Defence, Malaysia.\n\n\n\nA\t big\t flood\t hit\tManek\t Urai\t last\t year\t causing\t the\t residents\t the\t biggest\t disaster\t in\t terms\t of\t\nloss\tof\thomes,\tclean\twater\tsupply,\telectricity\tand\tdamage\tto\tthe\tland\ttransportation\tnetwork,\t\ngovernment,\tpublic\tand\tprivate\tfacilities/equipment.\t\tKuala\tKrai\tHospital\t(KKH)\thad\tto\tclose\t\ntheir\toperation\t temporarily.\t \tThe\tMalaysian\tArmed\tForces\tHealth\tServices\twas\tgiven\torders\t\nto\tset\tup\ta\tLevel\tII\tForward\tHospital\t to\tprovide\thealthcare\tservices\tto\tthe\tflood\tvictims\tand\t\nsupport\t to\t the\t KKH.\t \t The\t Level\t II\t Forward\t Hospital\t offered\t outpatient/inpatient\t services,\t\nforward\tmobile\tmedical\tservices,\toperation\ttheatre,\tand\tspecialist\tservices\tsuch\tas\tanaesthetic,\t\nsurgery,\torthopaedic,\tobstetric\tgynaecology,\tand\tpaediatric.\t \tThese\tmedical\tservices\trequired\t\nits\tsupport\tand\tancillary\tservices\tsuch\tas\tpharmacy\tto\tmanage\tdispensing,\tcounselling,\tsupply\t\nchain\tand\tlogistics\tof\tthe\tmedicines/consumables\twhich\twere\tprescribed/used\tby\tthe\tmedical\t\nspecialists\tand\tofficers/staff.\t\tIn\taddition,\tlaboratory\tand\tradiological\tservices\twere\talso\tneeded\t\nfor\tdiagnostic\tpurposes.\t\tRescue\tworkers\tfaced\tgrave\tchallenges\tduring\tthe\tpost-flood\tperiod\t\ndue\t to\t limited\t land\tmobility\teither\t to\t rescue\t the\tvictims\tor\tdeliver\t the\tmedical\t services\tand\t\nsupplies\t forward.\t \tWithout\tclean\twater,\telectricity\tand\tproper\tshelter,\t the\tflood\tvictims\twere\t\nexposed\t to\t many\t health-related\t risks\t especially\t to\t the\t elderly,\t chronic\t patients,\t pregnant\t\nwomen\tand\tchildren.\tThey\tneeded\t immediate\t and\t sustainable\tmedical\t attention/services\ton\t\nsite.\t \t Electrical\t power\t blackout\t had\t shut\t down\t the\t communication\t towers\t resulting\t in\t both\t\nmobile\t and\t landline\t communication\t failure.\t \tMeanwhile,\t flood\t victims\t and\t rescue\t workers\t\nwere\texposed\tto\tthe\tvarious\tinfections/diseases\tsuch\tas\tskin\tand\twound\tinfections,\trespiratory\t\ninfections,\tand\tdiarrhoea.\n\n\n\n\n\n\n\n\n75\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nMILITARY PHARMACY\n___________________________________________________________________________\n\n\n\nMPO 03\nMPSPSC2015000034\t(Oral)\n\n\n\nA Drug Utilization Review of Selected Antibiotics in the Medical Wards at Hospital Angkatan \nTentera Tuanku Mizan\n\n\n\nMH Mohamad Yusof 1,2, MM Manan2, AH Basari1, MA Adnan3, N Moktar 3  \n1Pharmaceutical Services Division, Malaysian Armed Forces Health Services Headquarters, Kuala \nLumpur, Malaysia\n2Faculty of Pharmacy, Universiti Teknologi MARA, Puncak Alam, Malaysia\n3Tuanku Mizan Armed Forces Hospital, Wangsa Maju, Selangor, Malaysia\n\n\n\nThe\tMalaysian\tArmed\t Forces\tHealth\t Services\t conducted\t a\t retrospective\t study\t on\t antibiotic\t\nusage\tand\tpattern\tin\tthe\tmedical\twards\tof\tTuanku\tMizan\tArmed\tForces\tHospital\t(TMAFH).\t\nThe\tobjective\tof\tthe\tstudy\twas\tto\treview\tprescribed\tantibiotic\tutilization\tat\tthe\tmedical\twards\tof\t\nTMAFH.\tData\twas\tcollected\tfrom\tprescriptions\tand\tbed\tmedication\tcharts.\tThirteen\tindicators\t\ncreated\tby\tStrengthening\tPharmaceutical\tSystems\tProgram,\tABC\tand\tVEN\tanalysis\twere\tused\t\nin\tthe\tanalysis\tand\tcomparison\tof\tdata.\tThe\ttop\t5\tantibiotics\tthat\twere\tcommonly\tused\tin\t2014,\t\nbased\ton\t the\tDefined\tDaily\tDose\t (DDD)\twere\tCeftriaxone\t Inj\t (87.6),\tAugmentin\t Inj\t (52.4),\t\nAugmentin\tTab\t(42.1),\tAzithromycin\tInj\t(8.7)\tand\tAzithromycin\tTab\t(46.8).\tOnly\t31%\tof\tthe\t\nantibiotics\t were\t prescribed\t using\t their\t international\t nonproprietary\t names.\t Average\t costs\t\nof\t antibiotics\t incurred,\t according\t to\t 3\t different\t age\t groups\t were\t RM213.55\t (young\t adults),\t\nRM223.17\t (middle\t aged\t adults)\t and\t RM201.95\t (older\t adults),\t respectively.\t ABC\t analysis;\t\nClass\tA\t(5;\t19.2%),\tClass\tB\t(3;\t11.6%)\tand\tClass\tC\t(18;\t69.2%).\tVEN\tanalysis,\tVital\t(7;\t26.9%),\t\nEssential\t (6;\t 23.1%)\t and\t Non-essential\t (13;\t 50%).\t ABC-VEN\tmatrix;\t Category\t I\t medicines\t\n(11;\t42.3%),\tCategory\tII\t(6;\t23.1%)\tand\tCategory\tIII\t(9;\t34.6%).\tIn\tconclusion,\tdrug\tutilization\t\nreview\tis\tconsidered\tan\timportant\telement\tto\tensure\tthe\tsafe\tand\tappropriate\tuse\tof\tantibiotics,\t\nwhat\tmore\tin\tmilitary\tmedicine\twhere\tcombat\tenvironment\trequirement\tdictates\tthe\tmilitary\t\npharmaceutical\tcare\tto\tbe\tdifferent\tfrom\tthat\tof\tcivilian\tpractice.\tThe\tABC\tand\tVEN\tanalyses\t\nare\tgood\ttools\tto\tmanage\tantibiotics\tthat\trequire\thigher\tinventory\tcontrol\tmonitoring.\n\n\n\n\n\n\n\n\n76\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPHARMACOLOGY\n___________________________________________________________________________\n\n\n\nPGO 01 \nMPSPSC2015000048\t(Oral)\n\n\n\nDifferential Effects of Pre and Post Treatments with Low-Dose Dipyridamole in \nAminoglycoside-Induced Nephrotoxicity in Rats\n\n\n\nP Balakumar1, S Prajapati1, R Varatharajan1, SA Jayachristy2, K Sundram1, MB Bahari1\n\n\n\n1Faculty of Pharmacy, AIMST University, Semeling, Malaysia\n2Faculty of Medicine, AIMST University, Semeling, Malaysia\n\n\n\nThe\t current\t study\t was\t aimed\t to\t investigate\t the\t pretreatment\t and\t post-treatment\t effects\t of\t\nlow-dose\tdipyridamole\tin\tgentamicin-induced\tnephrotoxicity\tin\trats.\tRats\twere\tadministered\t\ngentamicin\t(100\tmg/kg/day,\tip)\tfor\t8\tdays.\tIn\tthe\tpretreatment\tprotocol,\tlow-dose\tdipyridamole\t\n(20\t mg/kg/day,\t po)\t treatment\t was\t started\t a\t day\t before\t the\t gentamicin\t administration\t and\t\ncontinued\tfor\t8\tdays.\tIn\tthe\tpost-treatment\tprotocol,\tgentamicin-administered\trats\twere\ttreated\t\nwith\t low-dose\t dipyridamole\t (20\tmg/kg/day,\t po)\t for\t 6\t days\t after\t the\t completion\t of\t 8th\t day\t\ngentamicin\tadministration\tprotocol.\tGentamicin-administered\trats\texhibited\trenal\t structural\t\nand\tfunctional\tchanges\tas\tassessed\tin\tterms\tof\ta\tsignificant\tincrease\tin\tserum\tcreatinine\tand\t\nurea\tand\tkidney\tweight\tto\tbody\tweight\tratio\tas\tcompared\tto\tnormal\trats.\tHematoxylin-eosin,\t\nperiodic\tacid\tSchiff,\tand\tMasson\ttrichrome\tstaining\trevealed\tdegenerative\tchanges\tin\tglomeruli\t\nand\ttubules\tin\tgentamicin-administered\trats.\tThese\trenal\tstructural\tand\tfunctional\tabnormalities\t\nwere\taccompanied\twith\televated\tserum\turic\tacid\tlevel,\tand\trenal\tinflammation\tas\tassessed\tin\t\nterms\tof\ta\tdecrease\tin\tinterleukin-10\tlevel.\tLow-dose\tdipyridamole\tpretreatment\tin\tgentamicin-\nadministered\trats\tafforded\ta\tnoticeable\trenoprotection\tby\tmarkedly\tpreventing\trenal\tstructural\t\nand\tfunctional\tabnormalities,\trenal\tinflammation\tand\tserum\turic\tacid\televation.\tOn\tthe\tother\t\nhand,\tlow-dose\tdipyridamole\tpost-treatment\tresulted\tin\tcomparatively\tless\trenoprotection.\tIn\t\naddition,\tlow-dose\tdipyridamole\tpost-treatment\tdid\tnot\tsignificantly\tprevent\turic\tacid\televation\t\nand\trenal\tinflammation.\tIn\tconclusion,\turic\tacid\televation\tand\trenal\tinflammation\tcould\tplay\ta\t\nkey\trole\tin\tgentamicin-induced\tnephrotoxicity.\tLow-dose\tdipyridamole\tpretreatment\tmarkedly\t\nprevented\t gentamicin-nephrotoxicity\twhile\t it\u2019s\t post-treatment\t resulted\t in\t comparatively\t less\t\nrenoprotection.\n\n\n\n\n\n\n\n\n77\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPHARMACOLOGY\n___________________________________________________________________________\n\n\n\nPGO 02 \nMPSPSC2015000010\t(Oral)\n\n\n\nA Glitazone with an Overall Glucose Control Potential: A Serendipitous Finding\n\n\n\nTK Praveen\nJSS College of Pharmacy, JSS University, Ootacamund, India\n\n\n\nIn\tour\tquest\tto\tdiscover\tand\tdevelop\tsome\tnovel\tglitazones\twith\tdual\tPPAR-alpha\tand\tgamma\t\nagonistic\tactivities\tfor\tthe\tmanagement\tof\tFasting\tBlood\tGlucose\t(FBG,\tPre-prandial)\tin\ttype\t2\t\ndiabetes\tmellitus,\twe\tdiscovered\ta\tmolecule,\t10b,\twith\tunusual\toverall\tglucose\tcontrol\tpotentials\t\nattributed\t to\t its\t fasting\tand\tpostprandial\tglucose\t lowering\tactivity.\tThe\tFBG\t lowering\teffects\t\nare\tevident\tfrom\tits\tin\tvitro\tPPAR-\talpha\tand\tgamma\tbinding\tability\tand\tits\tpositive\teffects\ton\t\nthe\t3T3-L1\tpre-adipocyte\tdifferentiation.\tIn\taddition,\tit\tshowed\ta\tsignificant\tantidiabetic\teffect\t\nagainst\tSTZ\tand\thigh\tfat\tdiet\tinduced\televation\tin\tbody\tweight,\tserum\tglucose,\ttriglyceride,\ttotal\t\ncholesterol\tlevels\tand\tretroperitoneal\tfat\tmass\tin\tmice.\tThe\tpostprandial\tglucose\tlowering\teffects\t\nare\t evident\t from\t its\t significant\t in\t vitro\t and\t in\t vivo\t (starch\t tolerance\t test)\t alpha\t glucosidase\t\ninhibition.\tA\tgood\toverall\tglucose\tcontrol,\tincluding\tboth\tFBG\tand\tpostprandial\thyperglycemia\t\nis\timportant\tto\tprevent\tthe\tcomplications\tof\ttype\t2\tdiabetes\tmellitus.\tThe\tmolecule,\t10b,\tshows\t\nsuch\tpotentials\tand\ttherefore\tmay\tshow\tbetter\tglycemic\tcontrol\twhen\tcompared\tto\tthe\texisting\t\ndrugs\tfor\tthe\ttreatment\tof\ttype\t2\tdiabetes\tmellitus.\n\n\n\n\n\n\n\n\n78\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPHARMACOLOGY\n___________________________________________________________________________\n\n\n\nPGO 03 \nMPSPSC2015000042\t(Oral)\n\n\n\nEffect of Ursolic Acid on Olanzapine Induced Obesity in Sprague Dawley Rats\n\n\n\nP Subramani1, MZ Khor1, EW Lim1, KH Chin1, B Subramani2, VC Parayil1, B Urmila3\n\n\n\n1Faculty of Pharmacy, AIMST University, Semeling, Malaysia\n2College of Pharmacy, Madras Medical College, Chennai, India\n3Faculty of Medicine, AIMST University, Semeling, Malaysia\n\n\n\nThis\tstudy\twas\tconducted\t to\tevaluate\t the\teffect\tof\tursolic\tacid,\ta\tpentacyclic\t triterpenoid\ton\t\nolanzapine\tinduced\tobesity\tin\trats.\tSprague-Dawley\t(SD)\trats\twere\tused\tfor\tthis\texperiment.\tThe\t\nanimals\twere\tdivided\tinto\tsix\tdifferent\tgroups:\tnormal\tcontrol,\tolanzapine\tcontrol,\tbetahistine\t\n(10\tmg/kg),\tursolic\tacid\t10,\t20\tand\t40\tmg/kg\ttreated\tgroups.\tAll\tthe\tdrugs\twere\tadministered\t\nonce\tdaily\tfor\t28\tdays\torally.\tExcept\tthe\tnormal\tcontrol\tgroup,\tall\tother\tanimals\twere\ttreated\t\nwith\tolanzapine\t4\tmg/kg\tintraperitoneally\tto\tinduce\tobesity.\tDuring\tthe\texperiment,\tanimal\u2019s\t\nhabit\tand\tbehaviour\tvariations\twere\tmonitored\tat\tregular\tintervals.\tAt\tthe\tend\tof\tthe\texperiment,\t\nblood\tsample\twere\tcollected\tfrom\tall\tthe\texperimental\tanimals\tfor\tbiochemical\tanalysis.\tPart\t\nof\tthe\tbrain,\tliver,\theart,\tlung\tand\tkidney\ttissues\twere\texcised\tfrom\tthe\tsacrificed\tanimals\tand\t\npreserved\t in\tneutral\t formalin\tfor\thistopathological\tstudies.\tUrsolic\tacid\tshowed\ta\tsignificant\t\nreduction\tin\tolanzapine\tinduced\tbody\tweight\tgain\ton\tthe\trats.\tIncrease\tin\tgrip\tstrength,\twater\t\nnavigation,\tmotor\tcoordination\tand\t locomotor\tactivity\twere\talso\tobserved\twith\ttreatment\tof\t\nursolic\tacid.\t\tCompare\tto\tursolic\tacid,\tbetahistine\tshowed\tbetter\ttolerance\tagainst\tolanzapine\t\ninduced\tbody\tweight\tgain.\tThis\tstudy\thas\tshown\tthe\tmetabolic\talteration\teffect\tof\tursolic\tacid\t\non\tolanzapine,\tan\tantipsychotic\tdrug\ttreated\tSD\trats.\t\n\n\n\n\n\n\n\n\n79\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPHARMACOLOGY\n___________________________________________________________________________\n\n\n\nPGO 04 \nMPSPSC2015000148\t(Oral)\n\n\n\nIn-Vitro Evaluation of the Anticancer Properties of the (1S, 2S)-1-Phenyl-2(Phenylamino) \nPropane-1, 3-Diol Derivative (RB4)\n\n\n\nCP Yew, CW Mai, CO Leong, LC Wong\nSchool of Pharmacy, International Medical University, Kuala Lumpur, Malaysia \n\n\n\nThe\t anticancer\t properties\t of\t a\t novel\t nitrogen\t mustard\t derivative,\t (1S,2S)-1-phenyl-2-\n(phenylamino)propane-1,3-diol\t (RB4)\t synthesized\t in\t collaboration\t with\t School\t of\t Applied\t\nSciences,\tNorthumbria\tUniversity\twere\tevaluated\tin\tvitro.\tThe\tanti-proliferative\teffects\tof\tRB4\t\nwere\tstudied\ton\tfifteen\tcancer\tcell\tlines\tnamely\tbreast\t(MCF-7,\tMDA-MB-231,\tMDA-MB-468,\t\nHCC38),\t colorectal\t (HT29,\t HCC2998,\t SW48,\t HCT116),\t lung\t (A549,\t NCI-H23,\t H1299)\t\nand\t nasopharyngeal\t (HK-1,\t SUNE-1,\t CNE-1,\t TWO-1)\t using\t CellTiter-Glo\u00ae\t Luminescent\t\nCell\tViability\tAssay.\tThe\tmorphological\t changes\t in\t cells\t treated\twith\tRB4\twere\tobserved\tby\t\nmicroscopic\tstudies.\tCell\tDeath\tDetection\tELISAPLUS\tkit\twas\tused\tto\tquantify\tthe\tdegree\tof\t\nnecrosis\t and\t apoptosis\t in\t cells\t treated\twith\tRB4\t at\t IC50\t value.\t Initial\t screening\twith\tfifteen\t\ncancer\tcell\tlines\tindicated\tthat\tcell\tviability\tof\tnasopharyngeal\tcancer\tcells\twere\tmost\taffected\t\nby\tRB4,\tparticularly\tSUNE-1\tcells.\tThe\tIC50\tvalue\tof\tRB4\tagainst\tSUNE-1\tcells\tobtained\tfrom\t\ndose\tresponse\tcurve\twas\t10.449\u00b10.56\u00b5M\twith\ta\tselectivity\tratio\tof\t4.004.\tUnder\tmicroscopic\t\nobservation,\ta\treduction\tin\tcell\tnumber\twas\tobserved\tin\tSUNE-1\tcells\ttreated\twith\t10\u00b5M\tRB4\t\ncompared\tto\tcontrol\tcells\t(1%\tDMSO).\tCell\tdeath\tinduced\tby\tRB4\twas\tthrough\tapoptosis\tas\ta\t4.5\t\nfold\tincrement\tin\tenrichment\tfactor\tof\tapoptosis\twas\tquantified\tafter\t72\thours\tof\tRB4\ttreatment.\t\nIn\tsummary,\tRB4\twas\tfound\tto\texhibit\tthe\thighest\tanticancer\tactivity\tagainst\tcancerous\tSUNE-1\t\ncells,\tas\twell\tas\tselectivity\tfor\tthat\tparticular\tnasopharyngeal\tcancer\tcell\tline.\tFurther\tstructural\t\nmodification\tof\tRB4\tcan\tbe\tcarried\tout\tin\tfuture\tstudies\tto\tenhance\tits\tanticancer\tproperty\tand\t\nimprove\tits\tselectivity\ttowards\tcancer\tcells.\t\t\n\n\n\n\n\n\n\n\n80\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPHARMACOLOGY\n___________________________________________________________________________\n\n\n\nPGO 05\nMPSPSC2015000037\t(Oral)\n\n\n\nShiitake Mushroom: Potential Glycemic Control Activity on Alloxan- and Glucocorticoid-\nInduced Diabetic Long-Evans Rats \n\n\n\nMM Rahman Sarker1,2, MATR Zihad1, M Islam1, M Ahmad Shah3, M Kifayatullah2, SK Das2,  \nM Nahar1, A Ghosh1, NE Ismail2 \n1Department of Pharmacy, School of Science, Primeasia University, Dhaka, Bangladesh\n2Faculty of Pharmacy, Lincoln University College, Petaling Jaya, Selangor, Malaysia \n3Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Lincoln University \nCollege, Petaling Jaya, Selangor, Malaysia\n\n\n\nShiitake\t (Lentinula\t edodes),\t an\t edible\t mushroom,\t is\t used\t as\t an\t alternative\t medicine\t for\t\ncenturies.\t It\t was\t reported\t to\t possess\t antitumour,\t immunomodulating,\t anti-inflammatory,\t\nhepatoprotective,\t and\t hypoglycaemic\t activities.\t Glucocorticoids\t indicated\t for\t arthritis\t\ntreatment\tinduce\thyperglycaemia\tin\tdiabetic\tpatients.\tHowever,\tno\treport\thas\tbeen\tpublished\t\non\t its\tactivity\t in\tglucocorticoid-induced\tdiabetes.\tTherefore,\t this\t study\twas\t to\t investigate\t it\u2019s\t\nantihyperglycaemic\t effect\t on\t alloxan-\t and\t glucocorticoid-induced\t diabetic\t rats.\t Diabetes\t\nwas\tinduced\tby\tAlloxan\t(150\tmg/kg,\tI.P.)\tto\tLong-Evans\trats.\tFollowing\tthree\tdays,\trats\twith\t\nplasma\tglucose\t>12\tmmoL/L\twere\t included\t in\t the\t study.\tMethanol\t extract\t (ME)\tof\tShiitake\t\nwas\tprepared\tby\tmaceration\tand\tdistillation\ttechniques\tand\tadministered\tat\t200,\t400,\t600\tand\t\n800\tmg/kg/day/P.O.\talong\twith\tmetformin\t(150\tmg/kg)\tfor\t7\tdays.\tAfter\t1-week\tinterval,\tthe\t\nrats\twere\tadministered\twith\tdexamethasone\t(2\tmg/kg,\tI.M.)\tfor\t3\tdays\tand\tfurther\ttreated\tfor\t7\t\ndays.\tME\tof\tShiitake\tmushroom\tdose-dependently\treduced\tfasting\tblood\tglucose\tlevels;\textract\t\ndoses\t400\tand\t800\tmg/kg\tsignificantly\treduced\tfasting\tglucose\ton\tday\t7\tby\t2.08\t&\t3.01\ttimes\t\nin\t alloxane-induced,\t and\t 1.75\t and\t 1.98\t times\t in\t steroid-\t induced\t diabetic\t rats,\t respectively.\t\nThe\tglucose\t lowering\t activity\t of\t the\t extract\twas\t comparable\t to\t that\t of\tmetformin.\tME\t (800\t\nmg/kg)\tsignificantly\tincreased\tplasma\tinsulin\tlevel\tin\talloxan-\t(p<0.001)\tand\tsteroid-induced\t\n(p<0.01)\tdiabetic\trats.\tThe\tstudy\tdemonstrated\tthat\tShiitake\tmushroom\tis\teffective\tto\treduce\t\nhyperglycaemia\t and\t induce\t insulin\t secretion\t in\t both\t alloxan-and\t corticosteroid-induced\t\ndiabetic\trats.\tIntake\tof\tShiitake\tas\tvegetable\tor\tas\tan\textract\twill\tbe\tbeneficial\tfor\tthe\tmanagement\t\nof diabetes. \n\n\n\n\n\n\n\n\n81\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPOSTER PRESENTATIONS \n\n\n\nClinical Pharmacy \n\n\n\nNo Presenting Author Title \n\n\n\nCPP 01 Muhammad Zahid Iqbal, \nDr \n\n\n\nGuideline Adherence and Prescribing Pattern for Diabetes Mellitus \nManagement with and without Co-Morbidities: A Malaysian Hospital \nPerspective \n\n\n\nCPP 02 Nahlah Elkudssiah \nIsmail, Assoc Prof. Dr \n\n\n\nSelf-Esteem and its Correlation with Asthma Control in Adult Asthma \nPatients \n\n\n\nCPP 03 Nahlah Elkudssiah \nIsmail, Assoc Prof. Dr \n\n\n\nImpact of Comorbidities on Asthma Severity and Asthma Control in \nAdult Asthma Patients \n\n\n\nCPP 04 Fann Zi Yin, Ms Clinical Management of Breast Cancer Patients who Received \nChemotherapy at the University of Malaya Medical Centre \n\n\n\nCPP 05 Ganesh Sritheran A/L \nPaneerselvam, Mr \n\n\n\nEvaluation of Pharmacist Interventions and Physicians Acceptance in \nRenal Transplant Patients in Medication Therapy Adherence Clinic \n(MTAC) \n\n\n\nCPP 06 Hoo Yee Yin, Ms A Retrospective Observational Study on Warfarin Use and Adverse \nOutcomes in Patients with Heart Valve Replacement  \n\n\n\nCPP 07 Law Kian Boon, Mr Fludarabine, Cytarabine plus Granulocyte Colony Stimulating Factor \n(FLAG) Might Improve Survival Outcomes Of Elderly Patients With \nAcute Myeloid Leukemia \n\n\n\nCPP 08 Eng Ker Loon, Mr Do We Need Rationalisation of Elderly Pharmacotherapy?  \n\n\n\nCPP 09 Masrahayu Binti \nMoydin, Mdm \n\n\n\nPharmacist\u2019s Interventions On Medication Use In Hospitalised Patient  \n\n\n\nCPP 10 Negin Naderifar, Ms A Review on Pharmacological Interventions for Treatment of Nightmare \nDisorder  \n\n\n\nCPP 11 Nur Farah Mohd Yazid, \nMs \n\n\n\nPhysicians\u2019 Perception, Expectations and Experience Working With \nWard Pharmacists in Public Hospitals in Selangor: An Online Survey  \n\n\n\nCPP 12 Siow Fui Shing, Ms Treatment Pathways of Breast Cancer Patients Treated at the University \nof Malaya Medical Centre \n\n\n\nCPP 13 Teng Jie Ying, Ms The Prevalence of Adverse Events due to Non-Steroidal Anti-\nInflammatory Drugs (NSAIDs) in Rheumatology Patients treated at the \nUniversity of Malaya Medical Centre \n\n\n\nCPP 14 Vijaya A/P Ponnusamy, \nMs \n\n\n\nPrevalence and Risk Assessment of Cardiovascular Disease, Chronic \nKidney Disease, Osteoarthritis, Retinopathy, Impotency and Cancer \namong Type 2 Diabetic Outpatients in Bangladesh \n\n\n\nCPP 15 Wan Azuati Binti Wan \nOmar, Ms \n\n\n\nA Prospective Evaluation of Venous Thromboembolism Prophylaxis \namong Surgical Patients at a Non-Academic Specialist Hospital \n\n\n\n \n\n\n\n\n\n\n\n\n82\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPharmacy Practice / Social Pharmacy \n\n\n\nNo Presenting Author Title \n\n\n\nPPP 01 Zaswiza Mohamad \nNoor, Dr \n\n\n\nCommunity Pharmacy Intervention in Managing Sleep Disorders: \nCustomer\u2019s Beliefs and Opinions \n\n\n\nPPP 02 Angela Lim Wen Huey, \nMs \n\n\n\nKnowledge, Attitude and Practice towards Leptospirosis Among \nMalaysian Wet Market Sellers  \n\n\n\nPPP 03 Yeoh Ching Ching, Ms Evaluation of Knowledge, Attitude and Perception of Medical, Dental and \nPharmacy Students in AIMST University on the Progress of Amyotrophic \nLateral Sclerosis (ALS) \n\n\n\nPPP 04 Chu Heng Lit, Mr Knowledge, Attitude and Perception of Japanese Encephalitis Among \nHealthcare Students of Medicine, Pharmacy and Dentistry of AIMST \nUniversity \n\n\n\nPPP 05 Chua Siew Siang, \nAssoc Prof. Dr \n\n\n\nPerception of Female Staff from Non-Medical Faculties of a Public \nUniversity towards Menopause and its Management  \n\n\n\nPPP 06 Mariani Ahmad \nNIzaruddin, Datin \n\n\n\nA Retrospective Study: Medication Enquiries by the Public at National \nPharmacy Call Centre (NPCC), Hospital Kuala Lumpur \n\n\n\nPPP 07 Deneshwary A/P Balu, \nMs \n\n\n\nKnowledge and Perception of Medicine, Dentistry and Pharmacy Students \nof AIMST University regarding Ebola Virus Disease (EVD) \n\n\n\nPPP 08 Dinesh Kumar A/L \nSubramaniam, Mr \n\n\n\nQuality of Life and Usage of Pain Killers among Chronic Pain Patients in \nHospital Tuanku Ampuan Najihah (HTAN) \n\n\n\nPPP 09 Nahlah Elkudssiah \nIsmail, Assoc Prof. Dr \n\n\n\nMeasurement of Stigmatisation Level towards Mental Illness Patients \namong Urban And Rural Communities \n\n\n\nPPP 10 Elaine Liew Li Fong, \nMs \n\n\n\nPatient or Care-Giver Knowledge Assessment for Home Administration \nof Subcutaneous Methotrexate \n\n\n\nPPP 11 Fadhilah Ismail, Ms Factors Associated with Prescription Opioid Overdose Deaths in Patients \nwith Non-Cancer Pain: A Literature Review \n\n\n\nPPP 12 Kee Soo Nin, Ms Knowledge, Attitudes, and Practices of Undergraduate Female Students in \na Private Tertiary Institution towards the Use of ECP  \n\n\n\nPPP 13 Khairiah Hashim, Mdm Quality of Life (QOL) and HAART Adherence among People Living with \nHIV (PLHIV): Is it Correlated? \n\n\n\nPPP 14 Khor Seau Ting, Mdm The Use of Medications in Pre-packed Sizes for Prescriptions from the \nEmergency Department of Hospital Sultanah Bahiyah \n\n\n\nPPP 15 Lua Pei Lin, Prof Health-Related Quality of Life Benefits for Epilepsy Patients and Family \nCaregivers via the Animated Epilepsy Educational Video (AnEEV) \n\n\n\nPPP 16 Lydia Lim Sung Min, \nMdm \n\n\n\nQuality of Care in Patients Discharged from Warfarin Clinic to Primary \nCare Upon Stabilization of Warfarin Therapy \n\n\n\nPPP 17 Masfiza Abdul Hamid, \nMdm \n\n\n\nA Study Assessing Knowledge on Insulin Injection Technique using Pen \nby Patients Attending Kota Setar District Health Clinic in Kedah \n\n\n\nPPP 18 May Khin Soe, Dr Basic Primary Care Approach: Providing Community with Education and \nHands on Training Regarding Diabetes Care \n\n\n\nPPP 19 Mazlina Amira Binti \nZamli, Ms \n\n\n\nA Cosmetovigilance Survey in Malaysia \n\n\n\nPPP 20 Muhamad Syaifullah \nBin Ismail, Mr \n\n\n\nPharmacy Students Perception and Preparedness towards the Provision of \nPharmaceutical Care: Findings from a Malaysian Public University \n\n\n\n \n\n\n\n\n\n\n\n\n83\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nNo Presenting Author Title \n\n\n\nPPP 21 Ng Yen Ping, Mr A Cross-Sectional Study on the Prevalence of Type 2 Diabetes, \nHypertension, Hypercholesterolemia and Obesity Among Population at \nSungai Petani, State of Kedah, Malaysia \n\n\n\nPPP 22 Norazila Abdul Ghani, \nMdm \n\n\n\nCost-Effectiveness Analysis of Antibiotics Treatment in Melioidosis in \nHospital Sultanah Bahiyah \n\n\n\nPPP 23 Norny Syafinaz Binti \nAb Rahman, Dr \n\n\n\nKnowledge, Attitude and Perceptions of Over-the-Counter (OTC) \nMedications Among non-Pharmacy Students: A Pilot Study \n\n\n\nPPP 24 Nur'Ain Balqis Binti \nAi, Ms \n\n\n\nAdverse Cosmetic Reactions among Malaysian \n\n\n\nPPP 25 Nurdiana Jamil, Mdm Knowledge and Practice of Community Pharmacists in Selangor and \nWilayah Persekutuan Kuala Lumpur on the Management of Childhood \nCommon Cough and Cold \n\n\n\nPPP 26 Pang Siow Fen, Ms Relationship between the Movement Disorder Society-Unified Parkinson \nDisease Rating Scale (MDS-UPDRS) Domains and the Health-Related \nQuality of Life (HRQoL) among Parkinson Patients in Hospital Tuanku \nAmpuan Najihah (HTAN), Kuala Pilah \n\n\n\nPPP 27 Perasna Mahendra \nVarma, Ms \n\n\n\nExploring the Halal Status of Antineoplastic and Immunomodulating \nAgents, and Nutritional and Dietary Supplements in Pusat Perubatan \nUniversiti Malaya (PPUM) and Hospital Angkatan Tentera Tuanku Mizan \n(HATTM) \n\n\n\nPPP 28 Samuel Ting Chuo \nYew, Mr \n\n\n\nThe Awareness of Royal Malaysian Custom Officers towards Counterfeit \nPharmaceutical Products and Roles of Pharmacy Enforcement Division \nOfficers in Sarawak \n\n\n\nPPP 29 Shairyzah Ahmad \nHisham, Mdm \n\n\n\nPerceptions on Barriers in Conducting Smoking Cessation Counselling \namong Practising Pharmacists in Klang Valley \n\n\n\nPPP 30 Sivakami Janahiraman, \nMdm \n\n\n\nPrescribing Error in Hospital Discharge Prescriptions: A Preliminary \nStudy \n\n\n\nPPP 31 Syaziayah Ahmad, \nMdm \n\n\n\nPrescribing Pattern of Human Albumin in Surgical Wards of Hospital \nSultanah Bahiyah \n\n\n\nPPP 32 Tan Boon Seng, Mr A Study on the Use of Non-Prescription Medicines in the Management of \nMinor Ailment among the Community Pharmacists in Penang \n\n\n\nPPP 33 Tay Yun Min, Mr Awareness towards Risk of Smoking and Attitude towards Cessation \nMeasures and Smoke-Free Campus among Students: A Prospective Study \n\n\n\nPPP 34 Wong Pui Mun, Ms Prescribing Pattern of Polymyxin B & E in Hospital Serdang  \n\n\n\nPPP 35 Seah Yong Zheng, Mr Response of Community Pharmacists to Complaints of Allergic Contact \nDermatitis  \n\n\n\nPPP 36 Yeo Hui Yee, Mdm Health, Economic Impact and Cost-Effectiveness of Future Dengue \nVaccination Program in Malaysia \n\n\n\nPPP 37 Teong Win Wei, Ms Job Satisfaction and Stress Levels among Community Pharmacists in \nKlang Valley \n\n\n\n \n\n\n\n\n\n\n\n\n84\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPharmacy Education \n\n\n\nNo Presenting Author Title \n\n\n\nPEP 01 Abdulkareem \nMohammed Al-Shami, \nMr \n\n\n\nInduction of a Pharmacoeconomics Course in Pharmacy Curriculum: \nPreliminary Findings from the Final Year Cohort \n\n\n\nPEP 02 Helena Sentiagoa, Ms Assessment of Inhalation Technique Using Dry Powder Inhaler \nAmong Third and Fourth Year Pharmacy Students in a Malaysian \nUniversity : Pre And Post Education \n\n\n\nPEP 03 Norny Syafinaz Binti Ab \nRahman, Dr \n\n\n\nHow Community Pharmacists Responded towards the Community \nPharmacy Attachment among Third Year Undergraduate Pharmacy \nStudents? A 3-Years Experience. \n\n\n\nPharmaceutical Chemistry \n\n\n\nNo Presenting Author Title \n\n\n\nPCP 01 Jong Yi Wen, Ms In Silico Pharmacophore Elucidation for Bicyclic Antagonists Of \nHuman A2A Adenosine Receptors and its Comparison with A3 \nAdenosine Receptor Bicyclic Antagonists \n\n\n\nPCP 02 Joyce Wong Xin Yi, Ms In Silico Pharmacophore Elucidation for Bicyclic Antagonists Of \nHuman A3 Adenosine Receptors and its Comparison with A2A \nAdenosine Receptor Bicyclic Antagonists \n\n\n\nPCP 03 Mohammad Gousuddin, \nMr \n\n\n\nStability Indicating RP-HPLC Method for Simultaneous Determination \nof Tramadol Hydrochloride and Aceclofenac in Dosage Form \n\n\n\nPCP 04 Muhamad Faris bin \nOsman, Mr \n\n\n\nPhenolic Content Screening and In-vitro Antioxidant Evaluation for \nRadical Scavenging Activity of Methanolic Cladodes Extract of \nOpuntia Cochenillifera (L.) Mill  \n\n\n\nPCP 05 Rabiatul Adawiyah \nDalim, Ms \n\n\n\nEffects of Methyl Jasmonate Elicitation on the Growth and Alkaloids \nContent of In vitro Cultures of Ruta Angustifolia (L.) Pers \n\n\n\nPCP 06 Thenmozhi Shanmugam, \nAssoc Prof \n\n\n\nHPTLC Fingerprint Analysis of Vitex Pinnata Linn. Leaves \n\n\n\nPCP 07 Gayathri Rajamanickam, \nMdm \n\n\n\nSynthesis and Cardioprotective Effects of Novel Series of Combination \nof Quinazoline-Thiadiazole against Isoproterenol-Induced Hypertrophy \n\n\n\nPCP 08 Natrah Binti Abd \nRahman, Ms  \n\n\n\nMolecular Dynamics Behaviour of One Third of the Site Reactivity of \nMicrosomal Prostaglandin E Synthase Type 1 Complexes with an \nOxicam Analog \n\n\n\nPCP 09 Ko Wei Cheng, Ms  Phytochemical Study on the Methanol Fraction Of Zingiber Officinale \n\n\n\nTraditional and Complementary Medicine \n\n\n\nNo Presenting Author Title \n\n\n\nTCMP \n01 \n\n\n\nNorazalina Mohd Zah, \nDr \n\n\n\nAntibacterial Activity of Extracts of Marine Brown Algae Padina \ngymnospora  \n\n\n\nTCMP \n02 \n\n\n\nChan Si Yan, Ms New Herbal Dispensing System: Herbal Preparation Process, Patients\u2019 \nand Prescribers\u2019 Acceptance \n\n\n\n \n\n\n\n\n\n\n\n\n85\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPharmaceutical Technology \n\n\n\nNo Presenting Author Title \n\n\n\nPTP 01 Abdullah Khan, Dr Development of Sustained Release Ophthalmic Delivery of \nPrulifloxacin Using in situ Gelling System \n\n\n\nPTP 02 Bibhu Prasad Panda, Dr Response Surface Methodology to Optimize Pyrilamine Maleate Fast \nDissolving Tablets Using Synergetic Disintegrants Approach \n\n\n\nPTP 03 Chua Hui Jen, Ms Development of Self-Emulsifying Drug Delivery System (S-SEDDS) \nfor Glibenclamide \n\n\n\nPTP 04 Hazrina Hadi, Dr Nanosuspension Technology in Salicylic Acid and its Particle Size \nCharacterization \n\n\n\nPTP 05 Hazrina Hadi, Dr Development and Characterization of Topical Caffeine Sunscreen \nFormulation \n\n\n\nPTP 06 Hazrina Hadi, Dr Formulation and Characterization of Resiquimod Microsponges \nLoaded Gel \n\n\n\nPTP 07 Qusro Bin Hassan, Mr In vitro and in vivo Evaluation of Formulated Piroxicam Subdermal \nImplants \n\n\n\nPTP 08 Satheesh Babu \nNatarajan, Dr \n\n\n\nFormulation of Stable Solid Dispersion Containing Artemether into \nFast Disintegrating Tablets \n\n\n\nPTP 09 Thong Li Ming, Ms The Influence of Drug Localisation within Solid Lipid Nanoparticles \n(SLNS) on the Cellular Uptake of Insulin-Containing SLNS \n\n\n\nPTP 10 Manimaran Sellappan, \nDr \n\n\n\nDevelopment and Screening of Certain Essential Oil Based Topical \nFormulations for their Antimicrobial Activity \n\n\n\nPTP 11 May Florence Dela \nCruz-Bacayo, Mdm \n\n\n\nIsolation and Ointment Formulation of a Semi-Purified Beta Carotene \nfrom Daucus carota L. and its Antimicrobial effect against \nStaphylococcus aureus \n\n\n\nMilitary Pharmacy \n\n\n\nNo Presenting Author Title \n\n\n\nMPP 01 Amirah Binti \nRahmatullah Khan, Ms \n\n\n\nValue-Added Services: Increasing Patient Utilization of Pharmaself \nAutomated Dispensing Unit 24 Hour (PADU24) in Tuanku Mizan \nArmed Force Hospital (TMAFH) \n\n\n\nMPP 02 Ahmad Muzakhir bin \nSulong, Second \nLieutenant \n\n\n\nIV Ceftriaxone Use in Tuanku Mizan Armed Forces Hospital \n\n\n\n \n\n\n\n\n\n\n\n\n86\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPharmacology \n\n\n\nNo Presenting Author Title \n\n\n\nPGP 01 AV Anita Gnana \nKumari, Dr \n\n\n\nAntiulcer Activity of Extracts of Hibiscus Vitifolius Root Extracts \n\n\n\nPGP 02 Chellappan Dinesh \nKumar, Dr \n\n\n\nThe Protective Effect of the Aqueous Extract of Auricularia Polytricha on \nParacetamol Induced Hepatotoxicity in Sprague-Dawley Rats  \n\n\n\nPGP 03 E.Thilagam, Prof Antioxidant Effect of Senna Surattensis Leaves Extract on Streptozotocin \nInduced Diabetic Rats \n\n\n\nPGP 04 J Anbu Jeba Sunilson, \nDr \n\n\n\nAnti-Inflammatory Activity of Sansevieria Trifasciata Leaves \n\n\n\nPGP 05 Kumarappan \nChidambaram, Dr \n\n\n\nPolyphenolic Extract of Ichnocarpus Frutescenes Leaves Modulates \nPeripheral Glucose Uptake Through GLUT Gene Transporters in \nExperimental Type 2 Diabetic Rats \n\n\n\nPGP 06 Md. Moklesur Rahman \nSarker, Assoc Prof \n\n\n\nAugmentation of Humoral Immunity by an Ayurvedic Herbal Preparation, \nAnantamul Salsa in vitro  \n\n\n\nPGP 07 Naveen Kumar H.S, Dr A Pharmacokinetic Study of Antimycobacterial N\u2019-\nhexadecanoylisonicotinohydrazide \n\n\n\nPGP 08 Rajavel Varatharajan, \nAssoc Prof \n\n\n\nEdaravone Attenuates Gentamicin-Induced Nephrotoxicity in Rats \n\n\n\nPGP 09 Sreemoy Kanti Das, Mr Phytochemical and Toxicity Study of Standardised Extract of Epipremnum \naureum in Rodents  \n\n\n\nPGP 10 Yeoh Peng Nam, Prof Do Opioid Receptors have a Role in the Anti-Motility Effect of Pandanus \nAmaryllifolius in the Guinea Pig Ileum?  \n\n\n\nPGP 11 Lim Xiang Yin, Ms In vitro Evaluation of Anticancer Properties of the (1R, 2R)-1-phenyl-2-\n(phenylamino)propane-1,3-diol Derivative (RB5) \n\n\n\nPGP 12 Nicole Lim Xiu Fern, \nMs \n\n\n\nIn vitro Evaluation of Anticancer Properties of N-((1S,2S)-1,3-dichloro-1-\nphenylpropan-2-yl)aniline Derivative (RB8) \n\n\n\nPGP 13 S Aravinth Vijay \nJesuraj, Mr \n\n\n\nAntiproliferative Activity of L-Glutaminase from Aeromonas Veronii on \nA549 and HT29 Cell Lines \n\n\n\nPGP 14 Tay Shun Ern, Mr In Vitro Evaluation of the Anticancer Properties of the N-((1R,2R)-1,3-\ndichloro-1-phenylpropan-2-yl)aniline Derivative (RB9) \n\n\n\nPGP 15 Venkateskumar \nKrishnamoorthy, Assoc \nProf \n\n\n\nBiological Screening of Malaysian Green Mussels (Perna Viridis)  \n\n\n\nPGP 16 Maryam Abbaspour \nBabaei, Ms \n\n\n\nNatural Compound 2,2'-Oxybis (4-allyl-1-methoxybenzene), Biseugenol \nB, from Litsea costalis Induces Apoptosis through Activation of Intrinsic, \nExtrinsic and NF-kB Signaling Pathways on Human Prostate Cancer PC3 \nCells in vitro \n\n\n\nPGP 17 Mashood Ahmad Shah, \nMr \n\n\n\nAntidiabetic and Lipid Lowering Potential of Brassica Oleracea Var. \nItalica in Type 2 Diabetic Sprague-Dawley (SD) Rats \n\n\n\n \n\n\n\n\n\n\n\n\n87\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nCLINICAL PHARMACY \n \nCPP 01  \nMPSPSC2015000053 (Poster) \n \nGuideline Adherence and Prescribing Pattern for Diabetes Mellitus Management with and \nwithout Co-Morbidities: a Malaysian Hospital Perspective \n \nMZ Iqbal1, 3, MS Iqbal2, S Prajapathi1, AH Khan3 \n\n\n\n1Faculty of Pharmacy, AIMST University, Kedah, Malaysia \n2Faculty of Pharmacy, MAHSA University, Selangor, Malaysia \n3School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia  \n   \nThis study aimed to evaluate the physician\u2019s adherence to the Malaysia Ministry of Health \nClinical Practice Guideline (CPG) 2009 for the treatment of diabetes mellitus with or without co-\nmorbidities. This cross-sectional study was carried out at a tertiary care hospital, Hospital Pulau \nPinang (HPP) Penang, Malaysia. A total of 51 physicians and 1020 patients' prescriptions written \nby these physicians were taken from the prescription record (20 prescriptions for each enrolled \nphysician). All 1020 patients were suffering from diabetes mellitus with or without co-\nmorbidities. These patients were recruited from different wards of the hospital. Depending on the \nrecommendations of the CPG 2009, the prescriptions were divided into adherent and non-\nadherent prescriptions. The overall good level of physician adherence was seen with respect to \nthe recommendations of CPG 2009 in all prescriptions. A statistically significant negative \nassociation (Effect size = 0.094, p-value = 0.003) was observed between diabetes mellitus \ncontrol and co-morbidities. CPG adherent had statistically weak negative association (Effect size \n= - 0.081, p-value = 0.010) with patients having co-morbidities. No statistically significant \nassociation was observed between CPG adherence and any other co-morbidity. The study \nexplored the several features of prescription pattern of physicians involved in the management of \ndiabetes mellitus with or without co-morbidities and recognised the need for improvement in \ntheir prescription pattern for treating diabetes mellitus. \n\n\n\n\n\n\n\n\n88\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nCPP 02  \nMPSPSC2015000134 (Poster) \n \nSelf-Esteem and Its Correlation with Asthma Control in Adult Asthma Patients \n \nNE Ismail1, 2, S Ahmad2, A I Ismail3, M A Mohd Zim3, W Akram2  \n1Faculty of Pharmacy, Lincoln University College, Petaling Jaya, Selangor, Malaysia  \n2Clinical BioPharmaceutics Research Group (CBRG), Pharmaceutical and Life Sciences CoRe, \nUniversiti Teknologi MARA, Puncak Alam, Selangor, Malaysia \n3Respiratory Unit, Faculty of Medicine, Universiti Teknologi MARA, Selangor, Malaysia \n \nPsychological and psychosocial factors influence asthma control and self-management of \nasthma. Self-esteem of adult asthma patients may contribute to achieve and maintain asthma \ncontrol. The objective of this study was to assess the self-esteem of the enrolled asthma patients \nand to determine its correlation with asthma control. This cross-sectional study enrolled 152 \nadult asthma patients from four respiratory specialist clinics in Selangor, Malaysia. The self-\nesteem was determined by using the translated Malay version of the 10-item Rosenburg self-\nesteem scale. The patients\u2019 responses were recorded on a 4-Likert like scale. Higher score \nreflected higher self-esteem. For asthma control, the Malay version of asthma control test (ACT) \nthat consisted of five items was used. Once the questionnaires were completed by the asthma \npatients, data were entered and analysed using SPSS\u00ae version 21. The mean age of the asthma \npatients was 52.03 (15.11) years and the majority were Malays [81 (53.3 %)]. The enrolled \nasthma patients showed moderate level of self-esteem [29.31 (3.29] whereas, the mean ACT \nscore ACT [17.58 (3.99)] showed that asthma was not well controlled. Furthermore, self-esteem \nshowed a low significant positive correlation with asthma control (r = 0.206, p = 0.008) using \nPearson correlation analysis. The enrolled asthma patients showed moderate self-esteem and \ntheir asthma was not well controlled. The significant positive correlation of self-esteem with \nasthma control suggested that psychosocial issues such as self-esteem should be considered when \nproviding patient education as this may help to achieve and maintain asthma control. \n\n\n\n\n\n\n\n\n89\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nCPP 03  \nMPSPSC2015000135 (Poster) \n \nImpact of Comorbidities on Asthma Severity and Asthma Control in Adult Asthma \nPatients \n \nNE Ismail1,2, S Ahmad2, AI Ismail3, MA Mohd Zim3, W Akram2, N Sajid Ali Bangash2, S \nAhmad Al. Abboud2 \n1Faculty of Pharmacy, Lincoln University College, Petaling Jaya, Selangor, Malaysia \n2Clinical BioPharmaceutics Research Group (CBRG), Pharmaceutical and Life Sciences CoRe, \nUniversiti Teknologi MARA, Puncak Alam, Selangor, Malaysia \n3Respiratory Unit, Faculty of Medicine, Universiti Teknologi MARA, Selangor, Malaysia \n \nThe management of asthma becomes more difficult in the presence of comorbidities in asthma \npatients. The aim of this study was to determine the impact of comorbidities on asthma severity \nand asthma control in asthma patients. In present study, 55 adult asthmatics were enrolled from \nthe respiratory clinics at Hospital Selayang and Hospital Sungai Buloh, both located in Selangor, \nMalaysia. Malaysian version of asthma control test (ACT) was administered to the asthma \npatients. The severity of asthma was assessed by using the lung function test by spirometry. The \nsocio-demographic data and comorbidities were recorded from patients\u2019 medical records. \nPatients were grouped into two categories; asthma patients without comorbidities and asthma \npatients with comorbidities. The data were extracted and entered in SPSS\u00ae version 21 for \nanalysis. The results of independent t-test showed that the mean score of asthma control was \nsignificantly higher in the group of asthma patients without comorbidities (20.17 \u00b1 3.70) than \nasthma patients with comorbidities (17.15 \u00b1 3.17; t = 2.959 (53), p = 0.005). Whereas, the mean \nFEV1 % values were not significantly different in the groups of asthma patients without \ncomorbidities (68.96 \u00b1 17.16) and patients with comorbidities (60.98 \u00b1 17.19; t = 1.698 (53), p = \n0.095). The findings of the study suggested that asthma patients with comorbidities need special \nconsiderations from the healthcare professionals for effective control of asthma. Furthermore, \nmultiple centre studies with greater sample size are recommended to ensure generalizability of \npresent study. \n\n\n\n\n\n\n\n\n90\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nCPP 04  \nMPSPSC2015000094 (Poster) \n \nClinical Management of Breast Cancer Patients who Received Chemotherapy at the \nUniversity of Malaya Medical Centre \n \nZY Fann1, M Dahlui2, NAM Taib3, FH Shabaruddin1 \n1Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia \n2Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, \nKuala Lumpur, Malaysia \n3Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia \n  \nBreast cancer is a common cancer, causing disease and treatment-related morbidity and \nmortality.  This study aimed to describe the characteristics and clinical management of a cohort \nof breast cancer patients who received chemotherapy from 2012 to 2014 at the University \nMalaya Medical Centre (UMMC). This retrospective study was based on patients\u2019 medical \nrecords. A total of 97 patients who met the inclusion criteria (mean age 53 years) were included. \nChemotherapy was given as adjuvant (93%, n=90) or neo-adjuvant (7%, n=7) treatment. Among \n91 patients who completed chemotherapy, 86 patients (95%) received only one regimen while \nfive (5%) were switched to another regimen mid-treatment. The most common chemotherapy \nregimens were FEC regimen (44%, n=43) and FEC+D regimen (40%, n=39) with 86% and 95% \nof patients receiving all six cycles of chemotherapy, respectively. Chemotherapy dose delay and \ndose reduction occurred in 21% and 9% of patients. Most patients (76%, n=74) received \nradiotherapy after chemotherapy treatment. Two of nine HER-2 receptor positive patients \nreceived trastuzumab after chemotherapy. The most frequent chemotherapy adverse events were \nhaematological particularly anaemia (53%, n=51) and neutropenia (44%, n=43), followed by \ngastrointestinal adverse events particularly nausea (45%, n=44), vomiting (39%, n=38) and \nmucositis (35%, n=34). Significant association was found between severe neutropenia and longer \nduration of chemotherapy treatment. The main radiotherapy-related adverse events were acute \n(55%, n=41) and delayed (8%, n=6) skin reactions. This study found that the delivery of \nchemotherapy and management of adverse events of breast cancer patients at UMMC were in \nline with published guidelines. \n   \n  \n  \n\n\n\n\n\n\n\n\n91\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nCPP 05  \nMPSPSC2015000099 (Poster) \n \nEvaluation of Pharmacist Interventions and Physicians Acceptance in Renal Transplant \nPatients in Medication Therapy Adherence Clinic (MTAC) \n \nGS Paneerselvam \nFaculty of Pharmacy, Cyberjaya University College of Medical Sciences, Malaysia  \n  \nRenal transplantation is an established treatment for end-stage renal disease. Poor adherence to \nrenal transplant medications due to side effects leads to allograft failure. Therefore, the \nobjectives of this study were to evaluate the pharmacist interventions, physician acceptance rates \nof the pharmacist recommendations and the patient\u2019s knowledge on their medications. This study \nwas done retrospectively in University-affiliated, inner-city, kidney transplant-medication \ntherapy adherence clinic (MTAC) in Selayang Hospital. Thirty two kidney transplant patients \nwere enrolled as subjects for this study. A pharmacotherapy evaluation-recommendation form \nwas used to collect the number of pharmacist interventions and physicians acceptance. The \nresults showed that physician\u2019s acceptance rate was 91.5% of pharmacist recommendations. \nThere was a strong linear correlation between the physicians acceptance of pharmacist \nintervention with the number of side effects after interventions (r=0.8; p<0.01). Additionally, \nthere was a significant improvement in patient\u2019s knowledge towards medications after the \npharmacist counselling session (p<0.01). As a conclusion, this study showed that clinical \npharmacists directly contribute to kidney transplant patient care besides showing positive \ninfluence on physician prescriptions and patient treatment outcomes as well as improved patient \nknowledge and adherence towards their medications to ensure allograft long-term survival.  \n  \n\n\n\n\n\n\n\n\n92\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nCPP 06  \nMPSPSC2015000033 (Poster) \n \nA Retrospective Observational Study on Warfarin Use and Adverse Outcomes in Patients \nwith Heart Valve Replacement  \n \nYY Hoo1, SM Chuah1, SF Syed Fadzli1, H Ishak1, SL Law1, NA Mohd Yunos1, KW Ng1, \nMA Muhammad Nor2 \n1Department of Pharmacy, Hospital Serdang, Selangor, Malaysia \n2Department of Cardiothoracic, Hospital Serdang, Selangor, Malaysia \n \nThe selection of the right warfarin dose during warfarin initiation in heart valve replacement \npatients is not a straightforward task and is commonly decided by the operating surgeon based on \nthe complexity of the surgery and the presence of arrhythmia during the recovery period. The \npresence of arrhythmias will delay removal of the pacing wire. Pacing wire removal can only be \nperformed when the INR is < 2.0 to avoid excessive bleeding at the pericardium. Additionally, \nthere is no data on the outcomes of patients initiated with warfarin both during hospitalisation \nand upon discharge. Therefore, the objectives of this study were to describe the warfarin \ninitiation practice and duration to reach target INR, and to assess the bleeding, thromboembolic \nand readmission rates in patients with valve replacement in a tertiary hospital. A retrospective \nuniversal sampling study was conducted on all heart valve replacement patients (n=58) of \nHospital Serdang in the year 2013, who met the study inclusion criteria with data retrieved from \nPatients\u2019 Medical Records. A majority of the patients were initiated on low dose warfarin. The \naverage duration to reach therapeutic INR is 6.11 days. The current practice demonstrated low \nbleeding (3.4%) and thromboembolic events (1.7%) with 4 out of 58 patients (6.9%) being \nreadmitted due to overwarfarinisation one year post discharge. The findings suggest that low \nwarfarin initiation dose (< 5 mg) reduces the rate of excessive anticoagulation and offer a stable \nachievement towards targeted therapeutic INR, in addition to low adverse outcomes. \n\n\n\n\n\n\n\n\n93\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nCPP 07  \nMPSPSC2015000054 (Poster) \n \nFludarabine, Cytarabine plus Granulocyte Colony Stimulating Factor (FLAG) Might \nImprove Survival Outcomes of Elderly Patients with Acute Myeloid Leukaemia \n \nKB Law1, KM Chang2, NA Hamzah3, KH Ng3 \n1Clinical Research Centre, Ministry of Health, Malaysia \n2Department of Haematology, Hospital Ampang, Ministry of Health, Malaysia \n3Institute of Mathematical Sciences, University of Malaya, Malaysia \n \nAcute Myeloid Leukaemia (AML) is highly heterogeneous, causing variable treatment responses \nespecially in elderly. The use of fludarabine, cytarabine plus granulocyte colony stimulating \nfactor (G-CSF), namely FLAG, presents a potential synergistic effect with acceptable toxicity \nprofile and could be used in elderly to improve survival outcome. Thus, this study aimed to \ninvestigate the role of FLAG as consolidating regimen in elderly patients diagnosed with AML. \nRetrospective cohort analysis of treatment data from 2008 to 2013 at Hospital Ampang was \ncarried out. Analysis included only patients more than 54 years old who received consolidating \nchemotherapy with FLAG, non-FLAG and mixed regimens. Of 183 patients who were diagnosed \nwith AML, only 48 patients entered remission after completion of induction therapy. Among \nthem, 18 patients (37.5%) were consolidated with only FLAG, 10 patients (20.8%) received non-\nFLAG, and 20 patients (41.7%) received mixed regimens. The median survival time improved \nmarkedly from non-FLAG (9.74 months) to FLAG (18.2 months), and then to mixed regimens \n(27.50 months). However, a test of equality on the survival distributions by log-rank test was not \nsignificant (\u03c7\u00b2 = 2.0383, df. = 2, p = 0.3609). Our data revealed an incremental trend in median \nsurvival time following the use of FLAG regimen, probably due to potential synergistic effect \nbetween fludarabin, cytarabine and G-CSF. In conclusion, the use of FLAG regimen might \nprolong survival of elder AML patients when used in conjunction with other regimens and \nshould continue to be studied. \n\n\n\n\n\n\n\n\n94\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nCPP 08  \nMPSPSC2015000004 (Poster) \n \nDo We Need Rationalisation of Elderly Pharmacotherapy?  \n \nM Kashyap1, SR Rajagopal2, KL Eng1, FM Goh1, D Sunderajan1 \n1Faculty of Pharmacy, AIMST University, Semeling, Malaysia \n2Faculty of Medicine, AIMST University, Semeling, Malaysia \n \nStudies on the rational use of drugs among Malaysian elderly are limited in the literature. \nTherefore, this study aimed to evaluate the prescription pattern specifically among elderly \noutpatients using the World Health Organisation (WHO) core prescribing indicators. \nPrescriptions of 142 outpatients, aged 60 years or above were evaluated prospectively using \nWHO core prescribing indicators. The average age \u00b1 SD of patients was 69.8\u00b17.4 years. On an \naverage, each patient had 1.6\u00b10.72 diagnoses. The most common disorder was \u2018Diseases of \ncirculatory system\u2019 (97%). The patients were prescribed an average of 4.7\u00b11.6 medications. Over \nhalf of the patients (79.5%) received more than five medications concurrently. The percentage of \ndrugs prescribed by generic name was only 22.12%. Antibiotic usage was 2.81% while 9.2% of \npatients were prescribed injections. The percentage of drugs prescribed from the National \nEssential Medicines List (4th edition) was 53.75%. In conclusion, the minimal prescription of \nantimicrobials and injections is a very positive reflection of good prescribing among elderly \noutpatients. However, a high prevalence of polypharmacy, low prescription by generic name and \nlow prescriptions from the essential drug list require rationalisation. This study is, to the best of \nour knowledge, the first set of results based on WHO prescribing indicators on Malaysian elderly \noutpatients. \n  \n\n\n\n\n\n\n\n\n95\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nCPP 09  \nMPSPSC2015000131 (Poster) \n \nPharmacist\u2019s Interventions on Medication Use in Hospitalised Patient  \n \nM Moydin, K Mohamad, MH Mohamad Jinal, MA Abdullah, NS Adnan, SA Awang \nLadin, WNF Wan Sharifuddin \nPharmacy Department, Hospital Kemaman, Terengganu, Malaysia \n \nMedication errors can be reduced or prevented by pharmacists\u2019 intervention while reviewing \npatients in the wards.  This study aimed to determine the types of pharmacists' intervention in \nhospitalised patients in Hospital Kemaman and to estimate the cost avoidance. This retrospective \nstudy examined all pharmacists' interventions recorded by ward pharmacists in Medical Male \n(MM), Medical Female (MF) and High-Dependency-Ward (HDW) over a one-year period. Data \nwere categorised as incomplete prescription, inappropriate regimen and miscellaneous. \nInterventions were rated based on the probability of adverse drug event (ADE) which would \nhave occurred in the absence of an intervention (0=low, 0.4=medium, 0.6=high). These scores \nwere then used to calculate cost avoidance. Data were analysed using descriptive analysis and \nchi-square test. A total of 1,481 prescribing errors were detected by the ward pharmacists. \nNinety-five percent (1,410) of interventions were accepted by the prescribers (p<0.05). \nInappropriate regimen, 71% (1,052) was the highest number of interventions made, where \nomission of medication was the common error for all the wards (p<0.05).  Cardiovascular \nmedications were the type of medications with the highest intervention in both the medical wards \n(MM, 26.1%; FM, 26.3%) while for the HDW was electrolyte, 19.6% (p<0.05). Most of \nthe interventions were categorised under low [50.4% (747)] or medium probability [48.2% (714) \nof ADE.  Estimation of ADE cost avoidance in this was RM50,419.39. Therefore, pharmacists \ninvolved in patient care in the wards can help to optimise drug therapy especially in omission \nerrors and thus save the cost of patient treatment. \n\n\n\n\n\n\n\n\n96\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nCPP 10  \nMPSPSC2015000101 (Poster) \n \nA Review on Pharmacological Interventions for Treatment of Nightmare Disorder  \n \nN Naderifar1, F Hashemian2                                                                                                                                                                 \n 1Pharmacy student, School of Pharmacy, Islamic Azad University, Pharmaceutical Sciences \nbranch, Tehran, Iran \n2School of Pharmacy, Clinical Pharmacy Department, Islamic Azad University, Pharmaceutical \nSciences branch, Tehran, Iran \n \nNightmares are extremely frightening dreams whereby the person wakes up with a detailed \nmemory followed by a quick orientation afterward. With a view to aetiology, nightmares might \nbe associated with disorders such as Posttraumatic Stress Disorder (PTSD), Nightmare Disorder, \nand some psychiatric illnesses. Nightmare Disorder is categorized as Parasomnic Disorders, \nwhich is usually associated with REM sleep and directly affects quality of sleep. Nocturnal \nawakenings with recall of intensive disturbing dreams lead to fear, anxiety and sadness of \nsleeper, resulting in insomnia, daytime sleepiness and fatigue. This paper presents the results of \nevaluations performed on articles related to medical treatment for nightmares. Nightmares are a \ncore feature of PTSD. Thus, most of the studies assessing efficacy of different medications are \nlimited to PTSD-associated nightmares. Clinical studies suggest that increased adrenergic \nactivity in the central nervous system contribute to PTSD-associated nightmares \npathophysiology. Therefore, prazosin recommended for treatment of nightmares in PTSD \npatients can significantly reduce nightmare frequency and severity. Numerous studies showed \nthat Prazosin is generally well tolerated although patient should monitor for orthostatic \nhypotension. Prazosin notably reduces trauma nightmares and improves sleep quality. Other \nmedications that have been studied for possible benefit to treat nightmares but with less \ndocumentation include: clonidine, trazodone, atypical antipsychotic, topiramate, low-dose \ncortisol, fluvoxamine, triazolame and nitrazepam, phenelzine, gabapentin, cyproheptadine and \nTCAs. In conclusion, prazosin is recommended as an effective medication to treat PTSD-\nassociated nightmares. However, further studies are required to demonstrate efficacy of prazosin \nto treat nightmare disorder, or any other type of nightmares. \n\n\n\n\n\n\n\n\n97\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nCPP 11  \nMPSPSC2015000016 (Poster) \n \nPhysicians\u2019 Perception, Expectations and Experience Working with Ward Pharmacists in \nPublic Hospitals in Selangor: An Online Survey  \n \nNF Mohd Yazid1, ZA Zainal1, NAH Jamaluddin1, MN Mohamad Alwi2, YS Lim3, SH \nMohd Jalil4, NA Abdullah5 \n1Department of Clinical Pharmacy, Faculty of Pharmacy, Cyberjaya University College of \nMedical Sciences, Selangor, Malaysia \n2Faculty of Medicine, Cyberjaya University College of Medical Sciences, Selangor, Malaysia \n3Department of Pharmacy, Hospital Ampang, Selangor, Malaysia \n4Department of Pharmacy, Hospital Selayang, Selangor, Malaysia \n5Department of Pharmacy, Hospital Tengku Ampuan Rahimah, Selangor, Malaysia. \n  \nPhysicians and ward pharmacists are important in a healthcare team. This study aimed to identify \nphysicians\u2019 perception, expectations and experience working with ward pharmacists in four \npublic hospitals in Selangor. Only 51 out of 248 physicians (20.6%) responded to the online \nsurvey. Physicians were mostly medical officers (63.0%), those between 20-39 years old (40.0%) \nand with 1-5 years of working experience (53.0%). Physicians have positive perception towards \nward pharmacist in minimizing medication errors (86.3%), in improving patient techniques on \nmedication devices (96.1%) and the ability of ward pharmacists to improve quality of medical \ncare (74.5%). This study also found that majority of the physicians expected ward pharmacists to \nassist them in designing patients\u2019 drug regimen (94.1%), identify any drug-related problems \n(98.1%), know the specific indications of the drugs (96.1%), advise on cost-effective drug \nalternatives (88.3%), and maintain a complete medication profile on patients (98.1%). All \nphysicians also agreed that ward pharmacists were reliable source of clinical drug information \nand 60.8% of them strongly agreed that they were regularly informed if there are any problems \nwith the prescriptions. A majority of the physicians (54.9%) interact with fully-registered \npharmacists more than 5 times per week to inquire about drug dosage (27.8%), drug availability \n(26.5%), side effects of drugs (22.2%) and drug alternatives (21.6%). There were no statistically \nsignificant (p>0.05) associations between physicians\u2019 gender, age, position and length of practice \nto their expectations of ward pharmacists. Overall, physicians have positive perception, \nexpectations and experience working with ward pharmacists.  \n\n\n\n\n\n\n\n\n98\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nCPP 12  \nMPSPSC2015000092 (Poster) \n \nTreatment Pathways of Breast Cancer Patients Treated at the University of Malaya \nMedical Centre \n \nFS Siow1, M Dahlui2, NAM Taib3, FH Shabaruddin1 \n1Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia \n2Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, \nKuala Lumpur, Malaysia \n3Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia \n \nBreast cancer is the most common cancer among women worldwide. Clinical management of \nbreast cancer requires a multidisciplinary approach with various treatment modalities. This study \naimed to describe patient characteristics and treatment pathways of a cohort of breast cancer \npatients who received treatment in 2012 to 2014 at the University of Malaya Medical Centre. \nThis retrospective study was based on patients\u2019 medical records. There were 178 patients who \nmet the inclusion criteria (mean age 56). Most patients had early stage breast cancer at diagnosis \n(71%, n=127). Nearly all had surgery (99%, n=176), followed by radiotherapy (60%, n=106) \nand/or chemotherapy (55%, n=97) as well as subsequent hormonal therapy (67%, n=119) and/or \ntrastuzumab monoclonal antibody (2%, n=4). The most common treatment pathway consists of \nsurgery, followed by chemotherapy, radiotherapy and finally hormone therapy. The incidence of \nadverse events caused by each treatment modality was generally consistent with published \nliterature. Most patients who had undergone surgery complained of post-operative pain at wound \nsite (77%, n=135). Anaemia (78% n=76) and skin hyperpigmentation (74%, n=78) were the most \nfrequent adverse events for chemotherapy and radiotherapy respectively. The incidence of hot \nflushes related to tamoxifen (7.0%, n=7) was lower than reported by other studies. This study \nfound that the management of breast cancer at the University of Malaya Medical Centre is in line \nwith recommendations by national and international guidelines.  \n  \n\n\n\n\n\n\n\n\n99\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nCPP 13  \nMPSPSC2015000093 (Poster) \n \nThe Prevalence of Adverse Events due to Non-Steroidal Anti-Inflammatory Drugs \n(NSAIDs) in Rheumatology Patients Treated at the University of Malaya Medical Centre \n \n JY Teng1, LSL Pok2, S Mahadeva2, FH Shabaruddin1 \n1Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia \n2Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia \n  \nNon-steroidal anti-inflammatory drugs (NSAIDs) are frequently used for rheumatology \nconditions. This study aimed to describe the prevalence of NSAIDs-related adverse events in \nrheumatology patients treated with at least one month of NSAIDs in 2010 to 2011. This \nretrospective study was based on patients\u2019 medical records at the University of Malaya Medical \nCentre (UMMC). There were 202 patients who met the inclusion criteria (mean age 57). A total \nof 4848 months of patient data were collected. Most patients were prescribed nonselective \nNSAIDs (58%, n=118), followed by 22% (n=44) prescribed COX-2 selective NSAIDs and 20% \n(n=40) switching between both classes of NSAIDs. Diclofenac sodium (75mg) was the most \ncommonly prescribed (58%, n=118), followed by celecoxib (200mg) (42%, n=84). The \nprevalence of NSAIDs-related adverse events was 15% (n=31 patients), with 16 patients (52%) \non nonselective NSAIDs, 9 (29%) on COX-2 selective NSAIDs and 6 (19%) switching between \nclasses. Of these, 30 patients had gastrointestinal adverse events; 26 had GI disturbances and \nGERD, 3 gastric ulcers and 1 upper gastrointestinal bleed. Clinical management of \ngastrointestinal events included endoscopy, outpatient clinic visits, pharmacotherapy with proton \npump inhibitors, hospitalisation and blood transfusion. Of the 171 patients who did not have \ngastrointestinal adverse events, 68 (40%) were on primary prophylaxis with gastroprotective \npharmacotherapy. There were no significant association between patient characteristics or the \nuse of different classes of NSAIDs and the prevalence of NSAIDs-related adverse events. In \nconclusion, the prevalence of NSAIDs-related adverse events in rheumatology patients treated at \nUMMC were comparable to published literature. \n\n\n\n\n\n\n\n\n100\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nCPP 14  \nMPSPSC2015000144 (Poster) \n \nPrevalence and Risk Assessment of Cardiovascular Disease, Chronic Kidney Disease, \nOsteoarthritis, Retinopathy, Impotency and Cancer among Type 2 Diabetic Outpatients in \nBangladesh \n \nMMR Sarker1, 2, H Imam1, Md. J Rana1, K Tarek1, V Ponnusamy2, NE Ismail 2 \n1Department of Pharmacy, School of Science, Primeasia University, Dhaka, Bangladesh \n2Faculty of Pharmacy, Lincoln University College, Petaling Jaya, Selangor, Malaysia \n \nThe prevalence of diabetes is increasing rapidly. Diabetes is burdened by the coexistence of \nseveral other chronic complications which shorten the life-span and quality of life of diabetic \npatients. The present study aimed to assess the prevalence and risks of diabetes related major \ncomplications, such as cardiovascular diseases (CVD), chronic kidney disease (CKD), liver \ndisease, osteoarthritis, retinopathy, impotency and cancer among type 2 diabetic outpatients in \nBangladesh. The study protocol was approved by the Ethical Committee for Human Studies of \nPrimeasia University, Dhaka, Bangladesh. Patients of any age with type 2 diabetes mellitus from \neither sex who were willingly to participate were included in the study. A total of 796 patients \nwere interviewed and their medical records screened. These patients were from the major \nhospitals and centres which provide dedicated treatment and services for diabetic patients in \nDhaka, Bangladesh. The prevalence of CVD, CKD, osteoarthritis, retinopathy, liver disease, \nhyperlipidaemia, obesity, impotency, and cancer were found to be 48.49, 11.81, 26.88, 14.07, \n2.76, 3.01, 1.76, 1.25, and 0.251%, respectively. The study showed that patients with diabetes for \n10 - 20 years had greater prevalence of CVD (30.15%), arthritis (21.36%) and retinopathy \n(8.04%) than those who had diabetes for 1 - 10 years (18.34, 5.52, and 6.06%, respectively). The \nrate of hyperlipidaemia (3.01%) and obesity (1.76%) were lower than that in other countries. The \nstudy concluded that hyperlipidaemia and obesity were not the major risk factors. Nevertheless, \nCVD, CKD, arthritis, and retinopathy were the major diseases associated with diabetes in \nBangladesh. \n\n\n\n\n\n\n\n\n101\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nCPP 15  \nMPSPSC2015000068 (Poster) \n \nA Prospective Evaluation of Venous Thromboembolism Prophylaxis among Surgical \nPatients at a Non-Academic Specialist Hospital \n \nWA Wan Omar, NAH Mohd Radzi, NH Hashim \nPharmacy Department, Taiping Hospital, Perak, Malaysia \n \nHospitalised surgical patients are at an increased risk for venous thromboembolism but previous \nstudies showed that thromboprophylaxis among surgical patients was suboptimal. The aim of \nthis study was to evaluate the use of venous thromboembolism prophylaxis in a general surgical \nward. This was a prospective observational study which involved patients aged >18 years \nadmitted to a general surgical ward in Hospital Taiping during December 2014. A data collection \nform which consisted of a set of criteria based on existing clinical practice guidelines was used to \ncollect data on demographic, patients at increased risk of developing venous thromboembolism, \nrisk of bleeding and prophylactic agent used. A total of 173 patients met the inclusion criteria \nand were reviewed, of which, 82% (142/173) of the patients were identified as at increased risk \nof developing venous thromboembolism. Mean age was 50.6 (SD 19.94) years and all were \nmales. Prophylaxis against venous thromboembolism was documented in 12.1 % (21/173) of the \npatients, or only 14.8% (21/142) of the total patients at increased risk. Fourteen patients received \npharmacological prophylaxis alone, four received mechanical prophylaxis alone and three \nreceived both type. Unfractionated heparin was the only pharmacological prophylaxis prescribed. \nAmong patients at increased risk of bleeding and having no contraindication to mechanical \nprophylaxis, only 10.1% (7/69) were prescribed with anti-embolism stockings. To conclude, this \nstudy showed a high proportion of patients at increased risk of developing venous \nthromboembolism did not received thromboprophylaxis during hospitalisation and \nunfractionated heparin remains the preferred pharmacological thromboprophylaxis in this \ninstitution. \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n\n\n\n\n\n102\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\n \n \nPHARMACY PRACTICE / SOCIAL PHARMACY \n \nPPP 01  \nMPSPSC2015000024 (Poster) \n \nCommunity Pharmacy Intervention in Managing Sleep Disorders: Customers\u2019 Beliefs and \nOpinions \n \nZ Mohamad Noor1, 2, AJ Smith2, 3 \n\n\n\n1Kulliyyah of Pharmacy, International Islamic University Malaysia, Pahang, Malaysia \n2School of Pharmacy, University of Queensland, Woolloongabba, Queensland, Australia \n3School of Pharmacy, University of Otago, Dunedin, New Zealand \n \nPharmacists are in a suitable position to give advice and provide services related to sleep \ndisorders to individuals who are unable to access sleep health centres easily. To improve the \nservice, it is important to identify the customers\u2019 point of views regarding the service and \nintervention. The study objectives were to: (1) identify opinions and beliefs of community \npharmacy general services and sleep health interventions, and (2) investigate the possible reasons \nfor attending a community pharmacy to seek help, amongst customers with sleep-related \ndisorders. A set of self-administered questionnaires was completed by a convenience sample of \ncustomers who visited community pharmacies for sleep-related disorders. The results showed \nthat four most influential reasons affecting customers\u2019 decisions to attend a community \npharmacy to seek help for sleep-related disorders were satisfaction with the previous services \nreceived from the pharmacy (95.1%), easily accessible premise (95.1%), belief that pharmacists \nalways treat them with courtesy and respect (93.6%), and belief that pharmacists often show \nconcern for customers (90.3%). Gender (female) and a higher education level were two main \ncharacteristics that influence decisions. Opinion of community pharmacists did not differ \nbetween those with more or less severe sleep disorders. Therefore, it was concluded that a \nvariety of reasons affected customers\u2019 decisions to attend a community pharmacy. However, \nthese were not related to the level of risks of sleep disorders. Those who seek help to improve \nsleep-related disorders from a community pharmacy had a high opinion of the pharmacist\u2019s \nattitudes toward customers.   \n\n\n\n\n\n\n\n\n103\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPPP 02  \nMPSPSC2015000138 (Poster) \n \nKnowledge, Attitude and Practice towards Leptospirosis among Malaysian Wet Market \nSellers \n \nNE Ismail 1, 2, S Ahmad2, MMR Sarker 1, AWH Lim 1, NA Ishak 2, N Husin 2, AN Johari 2 \n1Faculty of Pharmacy, Lincoln University College, Petaling Jaya, Selangor, Malaysia. \n2Clinical BioPharmaceutics Research Group (CBRG), Pharmaceutical and Life Sciences CoRe, \nUniversiti Teknologi MARA, Puncak Alam, Selangor, Malaysia  \n \nThe study assessed the level of knowledge, attitude and practice (KAP) towards leptospirosis \namong Malaysian wet market sellers, determined the correlation between measured KAP of \nleptospirosis as well as investigated the differences, association, correlation and predictors of \nselected study variables with KAP of leptospirosis. Respondents were given reliable and \nvalidated self-administered questionnaires, which consisted of socio-demographic, medical and \nsource of knowledge (11 items), knowledge (26 items), attitude (12 items) and practice (17 \nitems) toward leptospirosis. A majority of the respondents had moderate knowledge (51.4 %), \nunsatisfactory attitude score (90.0 %) but satisfactory practice score (64.3 %). There were \nsignificant associations between knowledge and highest completed level of education, \noccupation, and ever heard of leptospirosis. There were statistically significant differences in the \nmean scores of the knowledge of leptospirosis with gender, marital status, ethnicity, highest \ncompleted level of education, type of occupation, and whether they had ever heard of \nleptospirosis. For attitude mean scores, there was a significant difference found between attitude \nand number of year(s) working at wet market. Significant positive low correlation was observed \nbetween the attitude and practice of leptospirosis among wet market sellers. Two predictors that \nmade statistically significant contribution to knowledge score were the highest completed level \nof education, and ever heard of leptospirosis that had a negative relationship with the knowledge \nscore while the other had positive relationship. As an infectious disease, information on \nleptospirosis must be made available to the residents via various communication media. \n  \n\n\n\n\n\n\n\n\n104\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPPP 03  \nMPSPSC2015000080 (Poster) \n \nEvaluation of Knowledge, Attitude and Perception of Medical, Dental and Pharmacy \nStudents in AIMST University on the Progress of Amyotrophic Lateral Sclerosis (ALS) \n \nCC Yeoh1, MZ Iqbal1, MS Iqbal2, R Rathi3, S Prajapathi1 \n1Faculty of Pharmacy, AIMST University, Kedah, Malaysia \n2Faculty of Pharmacy, MAHSA University, Selangor, Malaysia \n3Faculty of Dentistry, AIMST University, Kedah, Malaysia    \n \nThe objective of the study was to evaluate the knowledge, attitude and perception of medical, \ndental and pharmacy students in AIMST University on the progress of Amyotrophic Lateral \nSclerosis (ALS). A cross-sectional observational study on a convenient random sample of 268 \nstudents from AIMST University was conducted by using pretested and validated questionnaires \nto gather information on the attitude, knowledge and perception of medical, pharmacy and dental \nstudents. Of the 268 respondents, 85 were male (31.7%). For the evaluation of attitude, a \nmajority of the respondents from all the three faculties had positive attitude. The results showed \nthat more female students (171, 93.4%) had positive attitude than the male students. For the \nevaluation of knowledge and perception, more male students (38.8%) had adequate knowledge \nthan female students (30.6%). Indian students (36.0%) had the most adequate knowledge on ALS \ndisease compared to other races. Among the Faculty of Medicine, Pharmacy and Dentistry, \nFaculty of Medicine (37.3%) had the most adequate knowledge compared to the other faculties. \nYear 3 and Year 4 respondents had almost the same percentage with adequate knowledge (33.7% \nand 33.8%, respectively).  In addition, non-hostellers (48.2%) had more adequate knowledge \nthan hostellers (26.5%). In the aspect of educational background, respondents from A-Level \n(57.1%) had the most adequate knowledge compared to other educational backgrounds. \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n\n\n\n\n\n105\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPPP 04  \nMPSPSC2015000079 (Poster) \n \nKnowledge, Attitude and Perception of Japanese Encephalitis among Healthcare Students \nof Medicine, Pharmacy and Dentistry of AIMST University \n \nHL Chu1, MZ Iqbal1, MS Iqbal2, R Rathi3 \n1Faculty of Pharmacy, AIMST University, Kedah, Malaysia \n2Faculty of Pharmacy, MAHSA University, Selangor, Malaysia \n3Faculty of Dentistry, AIMST University, Kedah, Malaysia   \n \nThe objective of the study was to evaluate the knowledge, attitude and perception of medical, \ndental and pharmacy students in AIMST University on the progress of Japanese Encephalitis.  A \ncross-sectional observational study was conducted on a convenient random sample of 252 \nstudents from AIMST University, using pretested and validated questionnaires to gather \ninformation. Out of the 252 respondents: 70 (27.8%) were from the Faculty of Medicine, 100 \n(39.7%) from Pharmacy and 82 (32.5%) from Dentistry. There were 75 (29.8%) male students. \nMale students (mean rank = 10.53\u00b12.91) were found to have less adequate knowledge than \nfemale students (mean rank = 11.02\u00b12.88). Indian students had the most adequate knowledge on \nJapanese encephalitis compared to the other races (mean rank = 33.25\u00b15.29). Students from the \nFaculty of Pharmacy had the most adequate knowledge compared to the other faculties (mean \nrank = 10.97\u00b12.81). Year 4 and Year 5 respondents had an almost same levels of knowledge \n(mean rank = 32.69\u00b14.84 and 32.99\u00b15.02, respectively). Non-hostellers (mean rank = \n31.93\u00b14.12) had less adequate knowledge than hostellers (mean rank = 32.70\u00b15.12). \nRespondents from A-Level (mean rank = 35.90\u00b15.56) had the most adequate knowledge. \nOverall, the students of AIMST University had good knowledge about Japanese encephalitis. \nThe pharmacy students had better knowledge compared to the other health-related faculties in \nthe university. \n\n\n\n\n\n\n\n\n106\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPPP 05  \nMPSPSC2015000158 (Poster) \n \nPerception of Female Staff from Non-Medical Faculties of a Public University towards \nMenopause and its Management  \n \nAN Aizuddin, SS Chua \nDepartment of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia \n \nStudies on the perception of women towards menopause and its management, especially with \nhormone replacement therapy (HRT) are still scarce in Malaysia. This study aimed to investigate \nthe perception and attitude of female staff in a public university towards menopause and its \nmanagement. A Perception Instrument on Menopause and Its Management (PIM) was developed \nand validated via a pilot study. The original PIM with 20 items was modified to 12 items (PIM-\n12) based on results of the pilot study. The Cronbach\u2019s alpha coefficient of this PIM-12 was \n0.834. A cross-sectional survey was conducted in 10 non-medical faculties using the PIM-12. A \ntotal of 300 questionnaires were returned. Generally, most of the respondents have positive \nperception on menopause and its management. A majority of the respondents (97%) disagreed \nthat a woman who has reached menopause means that she is dying and agreed that these women \ncan still have a normal life. However, 35.2% of the respondents agreed that women should not \ntake HRT because it has many side effects. The most common sources of information on \nmenopause and its management were the Internet, friends and family. Respondents with higher \nlevel of education have better perception regarding menopause and its management compared to \nthose with a lower level of education. The findings of this study provide an insight into the \nperception of women on menopause and its management. These can help healthcare providers to \nplan on strategies to educate the general public, especially adult women on menopause and the \nuse of HRT. \n\n\n\n\n\n\n\n\n107\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPPP 06  \nMPSPSC2015000009 (Poster) \n \nA Retrospective Study: Medication Enquiries by the Public at National Pharmacy Call \nCentre (NPCC), Hospital Kuala Lumpur \n \nMA Nizaruddin1 NS Mohd Salleh1, IA Jamaluddin2     \n1Faculty of Pharmacy, Cyberjaya University College of Medical Sciences, Cyberjaya, Malaysia \n2Department of Pharmacy, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia \n \nMalaysians spend a significant amount of money on health, but their understanding on the proper \nuse of medicines is still lacking. Previous studies done on medication enquiries at drug \ninformation centres manned by pharmacists mostly focused on healthcare providers' medication \nenquiries. There is insufficient analysed data on the public's medication enquiries, hence this \nstudy looked at the pattern of medication enquiries made by the public. The study was conducted \nin June 2014 and analysed retrospectively the National Pharmacy Call Centre (NPCC) \nmedication enquiry recording forms from January 2011 until June 2013. A total of 801 records \nmet the study criteria. Data was analysed descriptively. In 2011, the public comprised 22% of the \nenquirers, and this doubled in 2012. The highest enquiries were for traditional medicines \n(35.5%), medicine dose and administration (15.2%) and therapeutic use (14.9%). The main types \nof references used were personal knowledge (26.3%), the Internet (22.7%) and Micromedex \n(10.2%). A majority of the replies (87%) were answered using a single reference. Most replies \n(46%) were made within 1-2 hours. A majority of the enquiries involved the status of registered \nand unregistered medicines and their safety levels, especially the traditional medicines. \nPharmacists are at the forefront of providing satisfactory information on medicines to the public. \nIt is envisioned that pharmacists in other sectors such as community and industry advocate \nawareness of the NPCC. \n  \n  \n  \n\n\n\n\n\n\n\n\n108\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPPP 07  \nMPSPSC2015000078 (Poster) \n \nKnowledge and Perception of Medicine, Dentistry and Pharmacy Students of AIMST \nUniversity regarding Ebola Virus Disease (EVD) \n \nD Balu1, MZ Iqbal1, MS Iqbal2, R Rathi3 \n\n\n\n1Faculty of Pharmacy, AIMST University, Kedah, Malaysia \n2Faculty of Pharmacy, MAHSA University, Selangor, Malaysia \n2Faculty of Dentistry, AIMST University, Kedah, Malaysia   \n \nEbola Virus Disease (EVD) Outbreak is notified as Public Health Emergency of International \nImportance on 8th August, 2014 by the World Health organisation (WHO). The objective of the \nstudy was to evaluate the knowledge, attitude and perception of medical, dental and pharmacy \nstudents in AIMST University on the progress of EVD.  A cross-sectional observational study on \na convenient random sample of 273 students from AIMST University was conducted using \npretested and validated questionnaires. Non-parametric statistical analyses were performed; \nparticularly Kruskal Wallis and Mann-Whitney U tests to find any statistically significant \ndifference between variables. P-value <0.05 was considered as statistically significant. Out of \n273 respondents, 103(37.7) were males. For evaluation of knowledge and perception, female \nstudents (mean rank = 10.14\u00b13.06) have less adequate knowledge than male students (mean rank \n= 9.97\u00b12.96). Among the different races, Chinese students have the most adequate knowledge on \nEVD (mean rank = 10.08\u00b13.18). Faculty of Pharmacy has the most adequate knowledge \ncompared to the other faculties (mean rank = 10.45\u00b12.65).  Hostellers (mean rank = 9.89\u00b13.02) \nhave less adequate knowledge than non-hostellers (mean rank = 10.42\u00b12.90). Overall, the \nstudents of AIMST University have good knowledge about EVD. The pharmacy students have \ngood knowledge about EVD compared to other faculties in the university. Poor knowledge in \nthis study was due to poor motivation, education system and students' psychology. \n  \n\n\n\n\n\n\n\n\n109\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPPP 08  \nMPSPSC2015000124 (Poster) \n \nQuality of Life and Usage of Pain Killers among Chronic Pain Patients in Hospital Tuanku \nAmpuan Najihah (HTAN) \n \nEL Lim, CH Long, WH Lee, S Dinesh Kumar, N Basariah \nPharmacy Department, Hospital Tuanku Ampuan Najihah, Negeri Sembilan, Malaysia \n \nChronic pain is a major healthcare problem worldwide due to lack of understanding and \nawareness. The experience of pain has a deleterious impact on the quality of life (QoL) of \nindividuals. This study aimed to evaluate the QoL and usage of painkillers among chronic pain \npatients in Hospital Tuanku Ampuan Najihah (HTAN). A cross-sectional study was conducted in \nHTAN orthopedic clinic. A questionnaire consisted of five parts: personal details, medical \nhistory, pain score, QoL and usage of painkillers was used. A total of 48 subjects who presented \nwith chronic pain of more than one month were randomly chosen to answer the questionnaire \nduring their appointment visit. The correlations between pain score and each domain of QoL and \nstatistical differences between each domain of QoL versus different pain locations were tested. \nThe most commonly reported pain locations in this study were multiple pain locations (29.17%; \nn=14), low back pain (29.17%; n=14) and arthritis or joint disease (27.08%; n=13). Pain score is \nnegatively-correlated with all the domain of QoL. There was no significant difference between \nQoL of each domain and pain locations (p>0.05). Of the study subjects, 68.6% (n=35) were \nusing NSAIDs to control their pain. Adverse drug reactions were the most common drug-related \nproblem (63.6%; n=14). QoL of patients with chronic pain was negatively-correlated with the \npain score; the higher the pain score, the lower the QoL. There was no significant difference \nbetween QoL and pain locations.  \n\n\n\n\n\n\n\n\n110\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPPP 09  \nMPSPSC2015000136 (Poster) \n \nMeasurement of Stigmatisation Level towards Mental Illness Patients among Urban and \nRural Communities \n \nNE Ismail 1, 2, S Ahmad2, MMR Sarker 1, NA Ishak2, NS Husin2, AN Johari2 \n1Faculty of Pharmacy, Lincoln University College, Selangor, Malaysia.  \n2Clinical BioPharmaceutics Research Group (CBRG), Pharmaceutical and Life Sciences CoRe, \nUniversiti Teknologi MARA, Puncak Alam, Selangor, Malaysia.  \n \nThe present study determined the level of stigmatisation among urban and rural communities \ntowards mental illness patients, and investigated study variables that differentiate, associate, \ncorrelate and predict the level of stigmatisation and determined the validity and reliability of the \nstudy instruments. A 20-item self-administered bilingual questionnaire, which consisted of socio-\ndemographic and other questions (11 items) and an attribution questionnaire (AQ-9) (9 items; 9 \nstereotypes) were disseminated to urban (Shah Alam) and rural (Rembau) adults (\u2265 18 years \nold), who were able to speak and write Malay or English. Using Rasch analysis, the AQ-9 \ninstrument was found to be reliable and valid. Urban respondents had a significant higher pity \nlevel, and significant lower dangerousness stereotype, lower blame, lower anger, and lower \ncoercion compared to rural respondents. The mean scores obtained by women respondents were \nsignificantly higher than men in referring to dangerousness, fear, segregation and coercion \nstereotypes. The level of stigmatisation among urban and rural communities on mental illness \npatients was significantly associated to living area and gender of the respondents. The age of the \nrespondents showed a low negative correlation with the fear towards mental illness patients \namong urban and rural communities. Some predictors were found to be significant in a few \nstereotypes, including familiarity with mental illness (pity), gender and highest level of education \n(dangerousness), gender (fear), familiarity with schizophrenia (blame) and gender and living area \n(coercion). \n\n\n\n\n\n\n\n\n111\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPPP 10 \nMPSPSC2015000047 (Poster) \n \nPatient or Care-Giver Knowledge Assessment for Home Administration of Subcutaneous \nMethotrexate \n \nELF Liew, JS Tong, SY Sin1, CU Nabilah \nPharmacy Department, Selayang Hospital, Malaysia \n \nMethotrexate is increasingly used as a second-line agent for JIA. Methotrexate injection is \ntraditionally administered in the hospital setting instead of home-administration. This one-year \nstudy was aimed to determine the competency level of the patients or care givers in the home-\nadministration of subcutaneous methotrexate. This is a one-year study carried out in Selayang \nHospital. All subjects were on subcutaneous methotrexate weekly dosing. Subjects\u2019 socio-\ndemographic data were collected. A competency based teaching package was implemented by \nM.T.A.C. Paediatric Rheumatology Pharmacists during visit 1. Reassessment of the competency \nwas done based on the 13-step Patient Assessment Checklist. Distances and travelling costs were \nalso calculated. A total of 13 subjects (4 males; 9 females) with a mean age of 14 \u00b1 4.42 years \nwere studied. Five out of 13 subjects (mean age 17.60 \u00b1 4.34) were self-injecting while the other \n8 (mean age 11.75 \u00b1 2.77) were injected by care givers. Three (23%) out of 13 subjects made a \nmistake during the competency reassessment. None of the socio-demographics significantly \ninfluenced the competency of the subjects with p > 0.05 for each factor. The total travel savings \nper year were RM 16,663.7 (average RM1,281.82 per subject). The results of the study conclude \nthat 76.9% of subjects achieved a 100% score when reassessed on their methotrexate home \ninjections.  Each subject was estimated to save RM1,281.82 per year by doing home-\nadministrations. \n\n\n\n\n\n\n\n\n112\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPPP 11  \nMPSPSC2015000057 (Poster) \n \nFactors Associated with Prescription Opioid Overdose Deaths in Patients with Non-cancer \nPain: A literature Review \n \nF Ismail, CS Zin \nKulliyah of Pharmacy, International Islamic University Malaysia, Pahang, Malaysia \n  \nOpioid analgesics have increasingly been prescribed in the treatment of non-cancer pain, and this \ntrend has accompanied increasing rates of opioid overdose deaths (ODs).  Little is known about \nthe factors that may predispose an individual to being at risk for fatal overdose from prescription \nopioids. This review examined factors associated with prescription opioid overdose deaths in \npatients with non-cancer pain. A comprehensive literature search was conducted for studies \npublished from 2004 to 2014 using databases such as Science Direct, PubMed, Web of Science, \nCochrane's review and Scopus. Articles were included if they were original research studies \nwritten in English that reported deaths of prescription with an opioid overdose in patients with \nnon-cancer pain. A total of 18 studies met the inclusion criteria and were included. Findings \nfrom the review demonstrated that concomitant use of opioids with benzodiazepines \n(polysubstance use) was the main factor associated with opioid ODs. Codeine and oxycodone \nwere more commonly reported to cause opioid ODs and opioid doses of more than 100 mg per \nday in morphine equivalents have higher risk to cause ODs. Other factors included male patients, \nmiddle-aged and having mental illness. Prescription opioid overdose deaths were primarily \ncaused by concomitant use of opioid with benzodiazepines. Further research is required to \nexamine the trend and patterns of this co-prescribing. The guidelines on opioid prescribing and \neducation on opioids for both patients and physicians should be emphasized to reduce fatalities \nfrom an overdose while enhancing the safe prescribing of opioids. \n  \n  \n\n\n\n\n\n\n\n\n113\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPPP 12  \nMPSPSC2015000019 (Poster) \n \nKnowledge, Attitudes, and Practices of Undergraduate Female Students in a Private \nTertiary Institution towards the Use of ECP  \n \nSN Kee, SL Tan \nSchool of Pharmacy, Taylor\u2019s University, Selangor, Malaysia \n \nEmergency Contraceptive Pill (ECP) offers an alternative method of contraception when there \nhas been unprotected sexual intercourse or when there is a risk of contraceptive failure. \nUniversity students are at a stage of their lives where they are exposed to considerable pressures \nfrom their peers and may feel the need to set free from parental guidance. Youths are filled with \ncuriosity and may begin to explore their sexuality. ECP may have a role in reducing the \nincidence of unintended pregnancies among this high-risk group. This study aimed to assess the \nknowledge, attitudes and practices of undergraduate female students in a private tertiary \ninstitution for the use of ECP. In this descriptive cross-sectional study, subjects were recruited by \nstratified random sampling and divided into group A (health science students) and group B (non-\nhealth science students). Data about socio-demographics, knowledge, attitudes, and practices of \nECP were gathered using a pre-validated self-administered questionnaire. The response rate for \nthis study was 97.4%. It was found that knowledge of ECP among the students was generally \nlow. Group A and group B subjects who have good knowledge were reported to be 28.0% and \n12.7% respectively. Positive attitudes towards ECP were found in 65.3% of group A and 33.3% \nof group B students. Among the subjects surveyed, only 4.7% of them have used ECP \npreviously. Strategies are recommended to increase awareness of the practice of safe sex, with \nthe aim of widening the knowledge of students on contraception, including ECP, and reducing \nthe number of unwanted pregnancies. \n\n\n\n\n\n\n\n\n114\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPPP 13  \nMPSPSC2015000108 (Poster) \n \nQuality of life (QOL) and HAART adherence among people living with HIV (PLHIV): Is it \nCorrelated? \n \nK Hashim, BH Chew, NN Mohd Basyir, N Abdul Syukur, QH Ngoo, WC Ang, A \nKhairuddin \nPharmacy Department, Hospital Sultanah Bahiyah, Alor Setar, Kedah, Malaysia  \n  \nAdherence to antiretrovirals is the second strongest predictor of disease progression to AIDS and \ndeath rate after CD4 count. In outpatient clinics' settings, there is a negative correlation between \nviral load and QOL of PLHIV. This study aimed to assess the correlation between QOL among \nPLHIV and their adherence to HAART. This was a cross-sectional observational study. Patients \nwere recruited in the RV clinics using systematic random sampling technique. Recruited patients \nwere given a validated 31-item WHOQOL-BREF HIV questionnaire to assess their QOL. Their \nadherence was then assessed with 8-items MMAS. Among 72 studied patients, the mean age was \n42\u00b19.4 years and 62.5% were male. Based on the 8-items MMAS, 90.3% of the participants had \nmedium to high adherence and 9.7% had low adherence towards HAART, with a mean score \n(SD) of 7.3(0.89). The mean total scores (SD) for the 31-item WHOQOL-BREF HIV was \n86.1(11.88), the physical needs domain was 15.4(2.42), the psychological domain was \n14.4(2.26), the level of independence domain was 14.6(2.31), the relationships domain was \n14.1(2.81), the environment domain was 14.7(2.25) and the spirituality domain was 12.9(4.01). \nA negative and weak correlation between WHOQOL-BREF HIV and HAART adherence (-\n0.026) was detected. There was also no difference observed between socio-demographic \ncharacteristics among the studied population and their adherence towards HAART. Correlation \nbetween QOL and HAART adherence among PLHIV in this study was negligible. Therefore, \nthere is no significant relationship between these variables.  \n\n\n\n\n\n\n\n\n115\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPPP 14  \nMPSPSC2015000118 (Poster) \n \nThe Use of Medications in Pre-packed Sizes for Prescriptions from the Emergency \nDepartment of Hospital Sultanah Bahiyah \n \nG Phua, ST Khor, SN Md Yusof, SF Che Harun \nPharmacy Department, Sultanah Bahiyah Hospital, Alor Setar, Kedah, Malaysia \n \nMedication stockpiling can lead to adverse reactions, medication sharing and wastage.  In our \ninstitution, medication is prescribed electronically and the duration is electronically set as one \nweek by default, which is amendable by the prescriber. The current practice in the pharmacy \ndepartment is supplying pre-packed medicines for OTC prescriptions from the Emergency \nDepartment (ED); whereby the quantity supplied is less than that prescribed. The objective of \nthis study was to assess the feasibility of dispensing OTC medications packed in pre-set \nquantities by looking at the rate of revisits due to unresolved symptoms. This was a retrospective \nstudy where all electronic prescriptions from the ED containing OTC medications received \nduring the pharmacy\u2019s night shift over a span of 30 days were analysed. Prescriptions containing \nantibiotics and with no diagnoses stated were excluded. The prescriptions were followed up for \ntwo weeks to determine if there was a revisit in this period for the same ailment. The total \nnumber of prescriptions analysed were 304, with an average of 2.5 items per prescription. The \ncommon ailments requiring OTC medications were gastritis and upper respiratory tract infection. \nOf the 304 prescriptions analysed; only 24 patients (8%) revisited the ED for the same ailment. \nThe mean medication cost per prescription (RM6.80) and per dispensing in pre-packed size \n(RM3.90) translated to a saving of RM2.90 per prescription. This study revealed a low revisited \nrate to the ED due to unresolved symptoms, which may justify the dispensing of the pre-packed \nOTC medications in minor ailments. \n\n\n\n\n\n\n\n\n116\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPPP 15  \nMPSPSC2015000160 (Poster) \n \nHealth-related Quality of Life Benefits for Epilepsy Patients and Family Caregivers via the \nAnimated Epilepsy Educational Video (AnEEV) \n \n PL Lua1, NKW Khairuzzaman1, MN Abdul Rahman2, Z Abdul Aziz3, KF Lee4    \n1Faculty of Health Sciences, Universiti Sultan Zainal Abidin (UniSZA), Terengganu, Malaysia \n2Information Technology Centre, Universiti Sultan Zainal Abidin (UniSZA), Terengganu, \nMalaysia \n3Medicine & Neurology Department, Hospital Sultanah Nur Zahirah (HSNZ), Terengganu, \nMalaysia \n4Paediatrics Department, Hospital Sultanah Nur Zahirah (HSNZ), Terengganu, Malaysia \n \nReceiving an epilepsy diagnosis is often upsetting thus, healthcare providers should constantly \nensure that appropriate health education is imparted to both patients and their family caregivers \n(FCGs). This study intended to evaluate the impact of a new Animated Epilepsy Educational \nVideo (AnEEV) on the health-related quality of life (HRQoL) profiles of FCGs and their patients. \nThis randomized, controlled community trial included a sample of 131 epilepsy FCGs and 126 \npatients who were recruited from the Neurology and Paediatric Clinics of Hospital Sultanah Nur \nZahirah (HSNZ), Kuala Terengganu. Descriptive statistics and ANCOVA were employed for \ndata analyses (SPSS 17.0). HRQoL score between control group (CG) and intervention group \n(IG) were compared at pre-intervention and post-intervention. Majority of both FCGs and \npatients were female (53.4% and 53.2% respectively), educated at secondary school level and \nmost FCGs were parents (64.1%). At post-intervention, HRQoL profiles have improved \nsignificantly FCGs in IG particularly for Positive Adaptation, Mental Strain, Disease \nInformation, Patient Protection and Family\u2019s Interest (p < 0.05) after controlling for potential \nconfounders. Patient Protection demonstrated the largest effect size (d = 0.64). Accordingly, \nsignificant increments were also reported for IG patients in Seizure Worry, Overall Quality of \nLife, Emotional Well-Being and Overall Score (p < 0.05). The biggest effect size was recorded \nfor Emotional Well-Being (d = 0.66). Encouragingly, this newly-developed educational video \nseemed to offer an effective approach to empower knowledge for the improvement of HRQoL \namong patients and their FCGs. \n\n\n\n\n\n\n\n\n117\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPPP 16  \nMPSPSC2015000029 (Poster) \n \nQuality of Care in Patients Discharged from Warfarin Clinic to Primary Care upon \nStabilisation of Warfarin Therapy  \n \nLSM Lim1, CSB Choo1, K Kanthasamy1, SY Tan1, A Abraham1, RL Then1, YJ Puah1, MS \nMohamad Adzib1, S Radhakrishnan1, AR Ahmad Nizam1, NS Baharin2 \n\n\n\n1Department of Pharmacy, Hospital Tuanku Ja\u2019afar Seremban, Negeri Sembilan, Malaysia \n2Department of Pharmacy, Klinik Kesihatan Seremban, Negeri Sembilan, Malaysia \n\n\n\n \nHigh patient volume has led to many patients being discharged from hospital-based warfarin \nclinics to primary care. This study was conducted both prospectively and retrospectively to \ncompare the quality of anticoagulation care when patients were transitioned from an integrated \npharmacist-physician care to primary care upon stabilization of warfarin therapy. The primary \noutcome of the study was to monitor the differences in time in therapeutic range (TTR) of \ninternational normalized ratios (INRs) over a 3-month period upon transitioning from warfarin \nclinic to primary care. The secondary outcome was to assess incidences of major bleeding, major \nthromboembolism occurrences and hospitalization rates. Of the 33 patients recruited, only 16 \ncompleted the study. Significant reduction in anticoagulant control was observed upon \ntransitioning from warfarin clinic (Median TTR=100%) to primary care (Median TTR=68%) \n(p<0.05, Wilcoxon Signed-Rank Test). Using cross tabulation analysis, 94% of the patients had \nTTR values more than 75% (extremely good control of INR) and 6% had TTR values between \n60-75% before transitioning from warfarin clinic to primary care. After transition, 44% of the \npatients had TTR values more than 75%, with 19% having values between 60-75% and 38% \nhaving values less than 60%, indicating a drop in quality of care. There were no reported major \nbleeding, major thromboembolism occurrences and incidences of hospitalization in both groups \nwithin the 3 months. In conclusion, transition of patients from warfarin clinic to primary care \nwas associated with a significant reduction in INR control with no reported major bleeding, \nmajor thromboembolism occurrence and hospitalization. \n\n\n\n\n\n\n\n\n118\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPPP 17  \nMPSPSC2015000119 (Poster) \n \nA study Assessing Knowledge on Insulin Injection Technique using Pen by Patients \nattending Kota Setar District Health Clinic in Kedah \n \nM Abdul Hamid, LS Ng, NI Abd Halim, HS Chong, H Tahir \nPharmacy Department, Kota Setar District Health Clinic, Alor Setar, Kedah, Malaysia \n \nType 2 Diabetes Mellitus patients prescribed with insulin required the right technique of \ninjecting insulin. Insulin will be effective when injected into the fat layer that is beneath the skin. \nInsulin should not be injected too close to the outer layer (may cause lump, pain or redness) or \ntoo deep into the muscle (may lead to pain, and insulin will be absorbed too quickly). Timing of \ninsulin injection must be correct for the insulin to work efficiently. Therefore, the objective of \nthis study was to assess knowledge of patients on insulin injection technique. The study was \ncarried out from March until September 2014 at Simpang Kuala Health Clinic in Kedah.  \nEligible and consenting patients who attended the pharmacy counter were assessed on their \ninsulin injection technique. The guideline on insulin technique produced by the Pharmaceutical \nServices Division was used to assess patients\u2019 knowledge. Of the 420 patients assessed, 37.8% \nrotated the injection sites each time they injected their insulin.  However, 41% of the patients \nreported having bruises at the site of injection. In addition, 10% of the patients claimed to pinch \nthe skin when injecting the insulin. Single needle reused was 3.3% while 35% of the patients \ninjected insulin at the wrong time, 47% missed one of the three doses of rapid insulin, and 87% \nstored insulin in the refrigerator. This study revealed patients\u2019 knowledge on insulin technique. \nReassessment of the insulin technique is one of the parameters, which should be done by the \ndiabetes patients.   \n\n\n\n\n\n\n\n\n119\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPPP 18 \nMPSPSC2015000133 (Poster) \n \nBasic Primary Care Approach: Providing Community with Education and Hands on \nTraining Regarding Diabetes Care \n \nMK Soe1, NI Mohamed Nazar2       \n1Basic Medical Sciences Department, Kulliyyah of Pharmacy, International Islamic University \nMalaysia \n2Pharmacy Practice Department, Kulliyyah of Pharmacy, International Islamic University \nMalaysia \n \nThe alarmingly increase in rate of diabetes prevalence and unsatisfactory quality of care among \ndiabetes patients are major public health issues. In view of this, Kulliyyah of Pharmacy, IIUM \nhad conducted a \"Diabetes Education Workshop\u201d with hands-on training on handling diabetes-\nrelated devices. The aim of the workshop was mainly to educate the diabetes patients and \ncaregivers on primary patients' care for diabetes mellitus. The activities of the workshop \nincluded lecture by experienced healthcare providers and demonstration of devices and hands-on \ntraining by experienced lecturers and laboratory personals. Questionnaires were distributed to all \nparticipants to evaluate their background knowledge related to diabetes prior to the lectures and \ntraining. Moreover, the participants' RBS, FBS and other physiological parameters were also \nchecked and recorded. A total of 66 participants: 24 administrative staffs, 9 laboratory staffs \nfrom various faculties, 18 nurses, 14 caregivers and a pharmacist attended the workshop. They \nwere male 14 (21.2%) and female 52 (78.8%) and 61 (92.44%) Malay, 4 (6.1%) Chinese and \nonly one (1.5%) Indian. The mean BMI value was 24.92 \u00b14.66, mean RBS 6.63\u00b11.32 mmol/L, \nmean FBS 5.13\u00b10.52 mmol/L, mean SBP 113.94\u00b113.35 mmHg and mean DBP 74.13\u00b110.86 \nmmHg. Two male (3.3%) and 14 female (23.7%) were found to have abdominal obesity. Forty \nnine (74.2%) responded that they were satisfied with the knowledge and skills they gained from \nthe programme and requested to continue it in subsequent years. It was suggested that such \nuseful programme should be conducted in collaboration with other universities in the future. \n  \n\n\n\n\n\n\n\n\n120\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPPP 19  \nMPSPSC2015000070 (Poster) \n \nA Cosmetovigilance Survey in Malaysia \n \nMA Zamli, N Ai, AI Awadh, H Hadi \nKulliyah of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang, Malaysia \n \nDespite the high popularity of cosmetics use among consumers, there is still a lack of studies on \ncosmetovigilance in Malaysia. The cosmetic safety issues may be associated with the consumers\u2019 \nlevel of knowledge, practice, attitude, and perception. The aim of this study was to assess \ncosmetovigilance-related knowledge, practices, attitudes, and perceptions of consumers in \nMalaysia. A SurveyMonkey questionnaire which comprised of five sections: demographic \nprofile, knowledge on cosmetic safety, practice towards cosmetics, attitude towards cosmetic \nsafety, and perception towards cosmetics, was distributed to 552 consumers in Malaysia by \nsnowball sampling method from April to June 2015. The data was analyzed using Statistical \nPackage for Social Sciences (SPSS) version 20. The reliability coefficient for knowledge, \nattitude, and perception parts were 0.75, 0.71 and 0.66, respectively. The results of this study \nrevealed more than half of the respondents had poor knowledge (57.2%), attitudes (60.3%), and \nperceptions (59.2%) on cosmetics and its safety. Regardless, their practice towards cosmetics \nwas acceptable. Total knowledge score showed significant difference between gender (P<0.001) \nand monthly expenditure (P=0.001), while total attitude scores showed a statistical significance \ndifferences with respect to gender (P=0.008), age (P<0.001), marital status (P<0.001), education \n(P=0.014), occupation (P<0.001), income range (P=0.009) and monthly expenditure (P=0.013). \nIn conclusions, the levels of cosmetovigilance-related knowledge, practices, attitudes, and \nperceptions of consumers in Malaysia are still insufficient. The findings provided information to \nthe authorities to elevate the knowledge and attitude of consumers on cosmetovigilance issues \nand improve their practice and perception toward cosmetics. \n\n\n\n\n\n\n\n\n121\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPPP 20  \nMPSPSC2015000022 (Poster) \n \nPharmacy Students Perception and Preparedness towards the Provision of Pharmaceutical \nCare: Findings from a Malaysian Public University \n \nMS Ismail, AN Mat Azmi, AM Sabar, NR Mohd Said, NE Juhari, FNN Kamaruzzam, A \nAminuddin, S Jamshed \nKulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang, Malaysia \n \nPharmaceutical care is a core element of any healthcare system. In the International Islamic \nUniversity Malaysia (Kuantan campus), the pharmacy students were exposed to the concept of \npharmaceutical care (PC) since their first academic year. Therefore, it is imperative to explore \ntheir perception towards the provision of PC and the barriers, as well as their preparedness and \nopinion towards various PC activities. A cross-sectional study was conducted among third and \nfourth year pharmacy students. Standard Pharmaceutical Care Attitudes Survey (PCAS) was \nadopted from a pre-validated and pre-piloted questionnaire and modified according to the local \nsetting. Reliability of the modified instrument was found to be 0.897. In a classroom survey out \nof a total of 227 students, 211 responded (95%). Results depicted that the students have positive \nperception towards the provision of PC as well as its various activities (n=211; 100%). In their \nopinion, they were least prepared in managing pharmacy inventory (mean = 2.76). In addition, \nthey felt that one of the barriers that they might be facing in the implementation of PC is the lack \nof physicians\u2019 trust (mean = 4.14). This might presumably be related to their observation during \nhospital attachments (clinical clerkships), as well as their formal discussions with the senior \npharmacists during clinical clerkships. Therefore, it is recommended that the university should \nrelook into the curriculum and promote inter-professional collaboration among students \nthroughout the learning process. \n\n\n\n\n\n\n\n\n122\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPPP 21  \nMPSPSC2015000006 (Poster) \n \nA Cross-Sectional Study on the Prevalence of Type 2 Diabetes, Hypertension, \nHypercholesterolemia and Obesity among Population at Sungai Petani, state of Kedah, \nMalaysia \n \nYP Ng, K. Mandavi, BY Chai, HC Chew, FH Koh, KL Eng, R. Sunder, FM Goh \nFaculty of Pharmacy, AIMST University, Bedong, Kedah, Malaysia \n \nThis was a questionnaire based cross-sectional study to explore the prevalence of non-\ncommunicable diseases namely type 2 diabetes, hypertension, hypercholesterolemia and obesity \namong population of Sungai Petani (SP), Malaysia. General public from SP was conveniently \napproached from 12 to 28 February 2015 at three selected shopping malls. Descriptive statistics \nwere used for demographic characteristics while inferential statistics were used to measure the \nextent of association among the study variables. A total of 462 respondents age \u2265 18 years \nparticipated in this study, and it was dominated by Chinese (50.4%) at the age group of 18 to 29 \nyears old (43.9%). 42 out of 462 respondents (9.09%) reported to have type 2 diabetes; 75 \n(16.23%) having hypertension; 54 (11.69%) having hypercholesterolemia and 204 (44.16%) fell \nunder the categories of pre-obese and obese. Indian (45.24%) was the major race found to have \ntype 2 diabetes compared to the two other races (Malay and Chinese). However, Chinese were \nthe most reported to have hypertension (49.33%) and hypercholesterolemia (46.30%). Malay \nrace had the highest prevalence of pre-obese to obese (41.89%). A sharp increase in the \nprevalence of type 2 diabetes was observed in male of age group 30-39 years and female of 50-\n59 years. Hypertension and dyslipidaemia were dominated by both male and female of age \u226550 \nyears. In conclusion, approximately 1 in 11 adults had type 2 diabetes, 1 in 6 with hypertension \nand 1 in 9 with dyslipidaemia and almost 2 in 5 is pre-obese or obese among the population of \nSP. \n\n\n\n\n\n\n\n\n123\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPPP 22  \nMPSPSC2015000107 (Poster) \n \nCost-Effectiveness Analysis of Antibiotics Treatment in Melioidosis in Hospital Sultanah \nBahiyah \n \nN Abdul Ghani1, MR Abu Hassan2, XR Teh1, R Muhamad Fuzi1, KK Lim1, WL Tan3 \n1 Pharmacy Department, Hospital Sultanah Bahiyah, Kedah, Malaysia \n2 Medical Department, Hospital Sultanah Bahiyah, Kedah, Malaysia \n3 Kedah Clinical Research Centre, Kedah, Malaysia \n \nMelioidosis is a community-acquired sepsis, classically presented with pneumonia and multiple \nabscesses. The mortality rate of melioidosis is high. In treating melioidosis effectively, it requires \nan intensive phase of intravenous antibiotics treatment, mainly ceftazidime or meropenem, \nfollowed by oral eradication therapy. This study aimed to assess the most cost-effective \ntreatment of melioidosis in Hospital Sultanah Bahiyah. A retrospective cohort study was \nconducted on patients who had completed their melioidosis treatment from 2005-2012. Patients \nwere divided into two groups, receiving ceftazidime and meropenem, respectively. Cost data was \ncollected using activity-based-costing including the cost of medications, personnel, diagnostic \nlaboratory tests, diagnostic imaging, blood transfusion and hospitalization. Of the 540 patients \nscreened, only 58 (10.7%) met the inclusion criteria and were recruited. Of these patients, 65.5% \nhad received a regimen containing the combination of IV ceftazidime and oral therapy for a \nvariety of treatment durations, while 34.5% were receiving Injection meropenem and oral \ntherapy. Average cost/patient treated with ceftazidime and meropenem was RM6,727 and \nRM4,505, respectively. Cost-effectiveness ratio (CER) for ceftazidime group was \nRM8,520/survival rate while the CER for meropenem group was RM11,259/survival rate.  \nIncremental Cost-Effectiveness Analysis (ICER) calculated is RM5,706 per survival rate. In the \ntreatment of melioidosis, ceftazidime was found to be superior compared to meropenem, being \nmore effective and less costly. \n\n\n\n\n\n\n\n\n124\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPPP 23  \nMPSPSC2015000056 (Poster) \n \nKnowledge, Attitude and Perceptions of Over-the-Counter (OTC) Medications among \nNon-Pharmacy Students: A Pilot Study \n \nNS Ab Rahman, NH Marzuki, NN Azillah, MM Muhammad Muslih, AR Adenan, SS \nMohamad Hisham, SN Syed Roslie, N Md Jusoh, MF Ahmad Fakri, AI Abdul Ghani, R \nMohamad Elkalmi. \nInternational Islamic University Malaysia, Kuantan, Pahang, Malaysia \n\n\n\n \nSelf-medication using over-the-counter (OTC) products is very common worldwide. Although it \nis safe and effective to be used by the public, it still requires advice and assistance from \nhealthcare professionals such as the community pharmacists. The aim of this study was to assess \nnon-pharmacy students' knowledge, attitude and perceptions regarding over-the-counter (OTC) \nproducts at a public university in Malaysia. A cross-sectional study was conducted in November \n2014 among students in medical courses and science courses. A validated self-administered \nquestionnaire was distributed using convenience sampling to 200 students, with 190 \nquestionnaires successfully attempted (95%). Data was statistically analyzed using SPSS version \n20. There was a significant difference in the mean score for knowledge of OTC products \nbetween medical and science course students (p=0.001). More than half (51.6%) of the \nrespondents had good knowledge on how to use their OTC products in a safe way and 63.7% \n(n=121) of the respondents bought OTC medications from convenience stores. A majority \n(63.2%) of the respondents agreed that OTC medications are preferred because it is cheap and \neasily accessible. About 75.7% (n=144) of the respondents agreed that time constraint was the \nreason for them to use OTC products rather than seeking advice from doctors. The results of this \nstudy demonstrate that a majority of the non-pharmacy undergraduate students have basic \nknowledge of OTC medications. However, a larger scale, similar study is required to cover \ndifferent courses, colleges, universities as well as level of education to further establish the \nresults. \n\n\n\n\n\n\n\n\n125\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPPP 24 \nMPSPSC2015000069 (Poster) \n \nAdverse Cosmetic Reactions among Malaysian \n \nNB Ai , MA Zamli , AI Awadh , H Hadi \nKulliyah of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang, Malaysia \n \nConsumers often underestimate the occurrence of adverse cosmetic reactions; the incidence of \nmore severe reactions has been identified recently. The incidence of adverse cosmetic reactions \ncannot be minimized or prevented by regulations. However, its documentation might be helpful \nfor the authority in regulating the cosmetic products. The study aimed to assess the prevalence, \ntype of adverse cosmetic events and the measures adopted by those experiencing the adverse \ncosmetic events. A SurveyMonkey questionnaire comprised of two sections: (a) demographic \nprofile, (b) adverse cosmetic reaction was distributed to 552 consumers in Malaysia by snowball \nsampling method from April to June 2015. Statistical Package for Social Sciences (SPSS) \nversion 20 was used to analyze the data. The results of this study revealed that 29% (n= 160) of \nthe total respondents experienced adverse cosmetic events with eczema as the most frequent type \nof adverse cosmetic event. Facial area (n=178) was mostly affected as a consequence of products \nused on the face. After the incidents, 67 (41.1%) of the respondents chose to seek professional \nconsultation, and a majority of them preferred to just changed to other products. In conclusion, \nthe prevalence, types of adverse cosmetic events and the measures adopted were documented, \nand consumers were found to underestimate the incidence of adverse cosmetic reactions. More \nreliable cosmetovigilance system may be implemented to increase awareness on this matter. \n\n\n\n\n\n\n\n\n126\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPPP 25  \nMPSPSC2015000120 (Poster) \n \nKnowledge and Practice of Community Pharmacists in Selangor and Wilayah Persekutuan \nKuala Lumpur on the Management of Childhood Common Cough and Cold \n \nN Jamil, SW Ding, ZA Zainal \nCyberjaya University College of Medical Sciences, Cyberjaya, Selangor, Malaysia \n \nChildren are inherently prone to cough and cold, usually of viral aetiology. They are commonly \nmanaged with different cough and cold medications such as decongestants, expectorants, \nmucolytics, antihistamines and antitussives. However, various regulatory bodies had \nrecommended that cough, and cold products should not be used to treat children less than two \nyears of age due to potential life-threatening side effects that outweigh the benefit of giving these \nmedications. The objective of this study was to determine the knowledge and practice of \ncommunity pharmacists on the management of childhood cough and cold in the state of Selangor \nand Wilayah Persekutuan Kuala Lumpur, Malaysia. The study was conducted using a \nquestionnaire which assessed demographic data, knowledge and practice of community \npharmacists on the management of cough and cold. The community pharmacists had good \nknowledge levels (mean knowledge score of 73.5%) and professional counselling practice (mean \npractice score of 4.61). A majority of the community pharmacists do not dispense antibiotics \n(80%), frequently dispense antitussives (36%), antihistamines (44%) and antipyretics (38%), and \nvery frequently dispense mucolytics (39%) to children below 2 years old with cough and cold. \nBoth knowledge (p = 0.018) and practice level (p = 0.015) showed positive linear correlation \nwith the years of working experience. Community pharmacists in Selangor and Kuala Lumpur \nhad good knowledge and practice in the management of childhood common cough and cold, but \nknowledge on the use of cough and cold medicines in children below 2 years old could be \nimproved; especially in those with limited working experience. \n\n\n\n\n\n\n\n\n127\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPPP 26  \nMPSPSC2015000123 (Poster) \n \nRelationship Between the Movement Disorder Society-unified Parkinson\u2019s Disease Rating \nScale (MDS-UPDRS) Domains and the Health-related Quality of Life (HRQoL) among \nParkinson\u2019s Patients in Hospital Tuanku Ampuan Najihah (HTAN), Kuala Pilah \n \nTS Loh, SF Pang, HH Koay, N Basariah \nPharmacy Department, Hospital Tuanku Ampuan Najihah, Negeri Sembilan, Malaysia \n  \nStudies showed that Parkinson's disease (PD) has a significant negative impact on quality of life \n(QoL) in individuals with PD. This study aimed to assess the relationship between Movement \nDisorder Society-Unified Parkinson\u2019s disease rating scale (MDS-UPDRS) components and \nhealth-related quality of life (HRQoL) in PD patients in HTAN.  A cross-sectional study was \nconducted from February to June 2014. Eligible subjects were selected from patients of HTAN \nMedical Out-patient Department (MOPD) clinic. PD questionnaire \u2013 39 (PDQ-39) was used to \nassess the patient\u2019s QoL while MDS-UPDRS was used to assess the motor symptoms, non-motor \nsymptoms and motor complications experienced by patients. A data collection form was used to \ncollect patient\u2019s medical history and medications. Thirty-six subjects with mean age of \n65.58\u00b17.11 years and mean duration of disease of 6.75\u00b16.37 years participated in this study. The \nmean total score of PDQ-39 (PDQ-39SI) was 25.45\u00b117.87%, with the worst perception of QoL \nin the dimensions of \u201cMobility\u201d (42.50%) and \u201cActivities of Daily Living (ADL)\u201d (34.14%). A \nstrong positive correlation was found between PDQ-39SI and MDS-UPDRS motor and also non-\nmotor symptoms, with a correlation coefficients of 0.793 and 0.792, respectively. Only 30.6% of \nthe subjects experienced motor complications. PD patients in HTAN have good perception of \nHRQoL. The motor limitations related to mobility, and ADL present a significant association \nwith the perception of QoL by the subjects. The MDS-UPDRS motor and non-motor symptoms \nwere strongly correlated with the PDQ-39SI. \n  \n  \n\n\n\n\n\n\n\n\n128\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPPP 27 \nMPSPSC2015000017 (Poster) \n \nExploring the Halal Status of Antineoplastic and Immunomodulating Agents, and \nNutritional and Dietary Supplements in Pusat Perubatan Universiti Malaya (PPUM) and \nHospital Angkatan Tentera Tuanku Mizan (HATTM) \n \nP Mahendra Varma1, S Abdul Rahman1, A Buang2, AH Basari3, MA Adnan3, S Samsudin3,  \nZ Ismail4 \n1Department of Pharmacy Practice, Faculty of Pharmacy, Cyberjaya University College of \nMedical Sciences, Selangor, Malaysia \n2Department of Pharmacy, University Malaya Medical Centre, Kuala Lumpur, Malaysia \n3Pharmacy Branch, Health Services Division, Malaysian Armed Forces HQ, Ministry of \nDefence, Kuala Lumpur, Malaysia \n4School of Pharmaceutical Science, Universiti Sains Malaysia, Penang, Malaysia \n  \nHalal has become a global issue among the Muslim communities worldwide. Muslims have \nspecific requirements in the consumption of food and pharmaceuticals. With the rise of Muslim \npopulations, there is an increase in concern and demand for halal pharmaceuticals. However, \nthere is limited data on the halal status of available pharmaceutical products. This descriptive and \nexploratory study was aimed at determining the halal status of antineoplastic and \nimmunomodulating agents, and nutritional and dietary supplements in Pusat Perubatan Universiti \nMalaya (PPUM) and Hospital Angkatan Tentera Tuanku Mizan (HATTM). Data collection was \ndone by obtaining the medication leaflets and approaching the manufacturers. A data collection \nform was used to record the required particulars. Three statuses were used for categorisation; \nhalal, mushbooh and haram. Assessment was done by referring to standard pharmaceutical \nreferences and feedback from manufacturers. A total of 212 medications were assessed where \n136 were antineoplastic and immunomodulating agents, while 76 were nutritional and dietary \nsupplements. For antineoplastic and immunomodulating agents, majority were classified as \nmushbooh with 61.8%, followed by halal at 36.7% and haram with 1.5%. Nutritional and dietary \nsupplements had slightly more halal medications with a proportion of 51.3% compared to \nmushbooh of 48.7%. There were no haram medications found in this therapeutic class. Ethanol, \ngelatine and magnesium stearate were the commonest mushbooh ingredients. This study also \nshowed that manufacturers have the capability of producing halal pharmaceuticals as only few \ningredients are mushbooh. Cooperation from all parties is vital in using halal pharmaceuticals for \nthe benefit of mankind. \n  \n\n\n\n\n\n\n\n\n129\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPPP 28  \nMPSPSC2015000058 (Poster) \n \nThe Awareness of Royal Malaysian Custom Officers towards Counterfeit Pharmaceutical \nProducts and Roles of Pharmacy Enforcement Division Officers in Sarawak \n \nSTC Yew \nSarawak Pharmacy Enforcement Branch, Sarawak State Health Department, Ministry of Health, \nMalaysia \n \nCounterfeit pharmaceutical products (CPP) are described as a silent epidemic, which can cause \ndrug resistance and death. In Malaysia, the knowledge and awareness level of the Royal \nMalaysian Customs (RMC) towards the CPP and roles of the Pharmacy Enforcement Division \n(PED) officers at custom ports are crucial in combating the entering of CPP. A questionnaire \nwith 30 items using 5-point Likert scale was developed based on Poisons Act 1952, Sale of \nDrugs Act 1952 and Guideline of Importation Screening. Face validity and construct validity \nwere examined with pre-test and exploratory factor analysis. A total of 110 RMC respondents \n(48.9% response rate) were included for data analysis. The mean scores (standard deviation) of \nknowledge of PED officers towards CPP were 4.06 (0.808) and 4.16 (0.777), respectively. On \nthe other hand, the mean scores (standard deviation) of awareness level towards CPP and roles of \nPED officers were 4.12 (0.967) and 4.21 (0.785), respectively. These findings implied that the \nknowledge and awareness of RMC officers towards CPP and roles of PED officers were \nsufficient (mean value range from 4.06 to 4.21) to curb the entering of CPP with the \ncollaboration of PED officers and yet still having room for improvement. Future researches are \nsuggested to include the practice as a dependent variable to examine whether the increment in \nthe knowledge and awareness level would have a positive impact on the actual practice in \ncombating the importation of counterfeit pharmaceutical products. \n\n\n\n\n\n\n\n\n130\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPPP 29 \nMPSPSC2015000097 (Poster) \n \nPerceptions on Barriers in Conducting Smoking Cessation Counselling among Practicing \nPharmacists in Klang Valley \n \nSC Huong, S Ahmad Hisham, M Mohamad \nFaculty of Pharmacy, Cyberjaya University College of Medical Sciences (CUCMS), Cyberjaya, \nMalaysia \n \nPrior studies have reported low pharmacists' participation in smoking cessation services. This \nsuggests the existence of potential barriers, which prevent pharmacists from providing smoking \ncessation counselling to customers/patients. The study was conducted to identify the perceived \nbarriers encountered by pharmacists in providing smoking cessation counselling and strategies to \novercome the barriers. A quantitative survey was conducted where 125 hospital, primary care \nand community pharmacists were recruited using convenience sampling. A self-administered \nquestionnaire was distributed through MPS bulletin and emails. Of the respondents, 59.2% had \nreceived smoking cessation training, and 23.2% were certified smoking cessation service \nproviders (CSCSP). However, 18.4% had never provided smoking cessation counselling and \nonly 16.8% had performed smoking cessation counselling once a week or more. Unreadiness of \nsmokers to quit smoking was perceived as a central barrier, followed by unavailability of NRT \nproducts and time constraint. Community pharmacists were concerned about jeopardising their \nrelationships with customers (p=0.006), while hospital and primary care pharmacists perceived \ninadequate staff (p=0.035), lack of knowledge and training (p=0.014), and lack of confidence \n(p=0.017) as significantly more important barriers. They also perceived improved knowledge \n(p=0.002), implementing smoking cessation as part of pharmacists\u2019 standard services (p=0.004) \nand providing private counselling areas (p=0.004) as better approaches to overcome the barriers. \nAlthough a majority were trained and possessed positive attitude towards smoking cessation, \nmany do not actively provide the service. Steps to address perceived barriers must be taken to \nincrease pharmacists\u2019 involvement in smoking cessation services. \n\n\n\n\n\n\n\n\n131\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPPP 30  \nMPSPSC2015000106 (Poster) \n \nPrescribing Error in Hospital Discharge Prescriptions: A Preliminary Study \n \nS Janahiraman, CY Tay, NM Jaafar, AF Abdul Latif, N Nagesvararao, SF Ahmadi, G \nSilvarajah, S Ahmad  \nPharmacy Department, Hospital Kuala Lumpur, Malaysia \n \nHospital discharge is a transitional period of care from hospital to home where patients are at \nhigh risk of medication discrepancies owing to the errors in discharge prescriptions. The main \naim of this study was to assess the prevalence and most common types of prescribing error \nduring hospital discharge as well as to determine the classification of medicines with prescribing \nerrors. Medical patients discharged from 5 active wards for a period of 2 weeks were identified. \nMedication discrepancies were evaluated in terms of prescribing errors through comparison of \npatient\u2019s medication charts and medication drug history with the actual discharge prescriptions. \nOut of 107 patients discharged, 96 were included in the study. The study revealed that 1 in 3 \nprescriptions had at least one prescribing error with a total number of 45 errors detected. Drug \nomission, duration and dosage regime accounted for more than 80% of prescribing errors. The \ntop 3 classes of drugs associated with errors were cardiovascular, nutrition and blood disorder, \nand anti-infectives. An understanding on the types and frequencies of error can help prescribers \nto be more vigilant and take the necessary measures to prevent it. Continuous professional \neducation and structured medication training are suggested strategies to reduce prescribing \nerrors.  \n  \n\n\n\n\n\n\n\n\n132\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPPP 31 \nMPSPSC2015000110 (Poster) \n \nPrescribing Pattern of Human Albumin in Surgical Wards of Hospital Sultanah Bahiyah \n \nN Abdul Ghani, S Ahmad, IS Romli, AB Ismail, B Ismail \nPharmacy Department, Hospital Sultanah Bahiyah, Kedah, Malaysia \n \nHuman albumin is a very expensive colloid solution. It is indicated mainly as plasma expander \nfor volume replacement therapy. However, human albumin has been widely prescribed when it is \nnot indicated, especially for correcting hypoalbuminemia. This study consisted of two parts; 1) \nEvaluation of the prescribing pattern, and (2) Assessment of prescribers\u2019 knowledge on the use \nof human albumin.  An observational study was conducted on all medical officers and specialists \nin surgical wards. A validated questionnaire was designed in order to assess the knowledge and \nperceptions of the healthcare professionals towards the usage of human albumin. The usage data \nof human albumin between November 2013 and January 2014 were retrieved and compared with \nthe usage between August 2014 and October 2014. Seventeen doctors participated in this study. \nMost of the respondents had good knowledge of human albumin with an average score of 70%. \nHowever, 76.5% of the respondents thought that hypoalbuminemia was an appropriate indication \nto use human albumin, which contradicted the Ministry of Health Drug Formulary. There was a \ndecrease in the trend of human albumin usage after the knowledge assessment and also after a \ncontinuing medical education (CME) session given to the prescribers. The percentage of human \nalbumin used by surgical wards before and after the intervention was 44.76% and 29.27%, \nrespectively. Most of the participants have good knowledge about the usage of human albumin. \nThe data showed that human albumin usage reduced significantly after the knowledge \nassessment and CME session.  \n\n\n\n\n\n\n\n\n133\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPPP 32 \nMPSPSC2015000114 (Poster) \n \nA Study on the Use of Non-Prescription Medicines in the Management of Minor Ailment \namong the Community Pharmacists in Penang \n \nBS Tan, CP Chong, A Sarriff \nSchool of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia \n \nNon-prescription medicines use is becoming more prevalent in community setting and are used \nto treat many minor ailments either as a primary or adjunctive therapy. The objective of this \nstudy was to evaluate the common type of minor ailments managed by the community \npharmacists and the total charges imposed on the consumers, such as medication prices, \nconsultation fees or any additional service charges. This was a cross-sectional survey using a \nself-completed anonymous data collection form. Data was collected across the first ten requests \nfor minor ailment management for adult consumers encountered by the pharmacist. Responses \nwere received from 38 pharmacies (response rate 14.9%). Majority of the pharmacists were \nfemale (76%). Approximately half (51%) of the respondents were practicing in single-outlet \nindependent pharmacies while another 30% and 19% were from multi-outlet independent \npharmacies and chain pharmacies, respectively. Most of the pharmacists were part owner and \nmanager (38%) or employee (38%). Majority of the pharmacies were located in urban area \n(76%) while 24% were in rural area. The mean (SD) working experiences of the pharmacists \nwere 11.60 (7.50) years. The most common minor ailments handled by the pharmacists was \nrespiratory related (26.7%; 104 cases), skin diseases 18.5% (72 cases), and gastro-intestinal \ndiseases 17.2% (67 cases). The mean (SD) cost of medicines to the consumers was RM 19.49 \n(RM24.97) and ranged from RM 2.00 to RM 370.00, according to type of disease. All the \npharmacists did not charge consultation fee or additional fee on the consumers. \n\n\n\n\n\n\n\n\n134\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPPP 33  \nMPSPSC2015000085 (Poster) \n \nAwareness towards Risk of Smoking and Attitude towards Cessation Measures and \nSmoke-free Campus among Students: A Prospective Study \n \nYM Tay1, WZ Low1, SX Leow1, NA Abdul1, R Veerasamy1, M Doraisingam2, S Sivadasan1  \n1Faculty of Pharmacy, AIMST University, Semeling, Kedah, Malaysia \n2School of General and Foundation Studies, AIMST University, Semeling, Kedah, Malaysia \n \nA survey was carried out to investigate the prevalence, awareness of smoking risk factors among \nprivate university students and their approach towards contributing to a smoke free campus. A \npre-validated questionnaire which consisted of 41 questions, organised into seven sections was \nused. The survey data were analysed using SPSS statistical software package version 20. About \n70.2% of the participants were in the age range of 19-21 years. Only about 8.6% of the \nparticipants responded that they have smoked even just a few puffs of which male participants \n(61.9%) were more than female participants (38.1%). Peer influence, stress relieves, and \nboredom relief were rated as important smoking motives. There was a high percentage of \nparticipants among smokers who looked for information through various sources. Students \nbetween the age group 25-27 years had excellent awareness about the risks of smoking. In the \npresent study, the average age during initiation of smoking was between 19-21 years, and a \nminority persist to be a smoker. The most common reasons or motives for smoking were peer \ninfluence followed by stress relief and to improve concentration. Students between 25-27 years \nhave excellent awareness, and most students had positive attitude towards a smoke-free campus. \nAlthough their awareness and attitudes towards smoking were remarkable, a smoke-free campus \nhas yet to be achieved. Students suggested installing smoke detectors, imposing fines, conduct an \nanti-smoking campaign, etc. We conclude that a smoking cessation program, educational \nintervention or counseling sessions would help the smokers to be concerned about their health. \n  \n\n\n\n\n\n\n\n\n135\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPPP 34  \nMPSPSC2015000050 (Poster) \n \nPrescribing Pattern of Polymyxin B & E in Hospital Serdang  \n \nPM Wong,  YS Foo, CY Leong, NH Munawar, NF Zolkifli, RN Zainal Abidin \nDepartment of Pharmacy, Hospital Serdang, Malaysia \n \nPolymyxin B and Polymyxin E are important treatments for multi drug resistant (MDR) infection \nin hospitals. Hospital Serdang is one of the highest users of Polymyxin in Malaysia. In view of \nthe lack of newer antibiotics for the treatment of MDRs, it is important to use Polymyxin \njudiciously to avoid Polymyxin resistance. The objective of this study was to determine the \nprescribing pattern of Polymyxin B & E in Hospital Serdang as well as the incidence of \nnephrotoxicity. This is a cross-sectional retrospective study conducted between January 2012 and \nApril 2014. All prescriptions and inpatient\u2019s record with Polymyxin B & E were reviewed. A \ntotal of 207 patients were prescribed with Polymyxin, in which 115 patients on Polymyxin B and \n92 patients on Polymyxin E.  Polymyxin was mainly used for ventilator-associated pneumonia, \nand most specimens were from the tracheal aspirate (57%) with MRO Acinetobacter (97.6%) \nbeing the most common organism isolated. The median duration of treatment for Polymyxin B \nwas three days, and Polymyxin E was four days. Overall percentage of nephrotoxicity was higher \nin Polymyxin E (35%) compared to Polymyxin B (25%). The results were not statistically \nsignificant (p=0.107). The high usage of Polymyxin is thus justified due to the high incidence of \nMRO Acinetobacter, which are only sensitive to Polymyxin. However, nephrotoxicity occurs \ncommonly and warrants frequent monitoring of the renal function. \n\n\n\n\n\n\n\n\n136\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPPP 35 \nMPSPSC2015000098 (Poster) \n \nResponse of Community Pharmacists to Complaints of Allergic Contact Dermatitis  \n \nYZ Seah, PT Thomas, PN Wong \nSchool of Pharmacy, Taylor\u2019s University, Selangor, Malaysia \n \nAllergic contact dermatitis (ACD) is a relatively common skin complaint seen in the community \npharmacy setting, and its key treatment lies in the avoidance of allergens and treatment with \ntopical corticosteroids. Treatment usually starts with a low potency topical corticosteroid (TC). \nThe current study aimed to investigate consultation provided by community pharmacists to \ncomplaints of ACD and types of treatment that were recommended. A standardized scenario of \nsymptoms and duration of ACD was designed and performed using a simulated patient method. \nThe researcher used the standard scenario during the visit to 117 randomly selected community \npharmacies located in Kuala Lumpur.  The study has a response rate of 83.6%. It was found that \nalmost all (>97%) of the pharmacists asked at least one question before recommending \ntreatment. Only 30% of the community pharmacists recommended TC as the only treatment. On \nan average, community pharmacists asked two questions before recommending any treatment \nand provided two counselling points. It was also observed that younger pharmacists tended to \nprovide more counselling as compared to older pharmacists (P < 0.05). As the response of \ncommunity pharmacists to ACD displayed rooms for improvement, intervention such as training \nprogrammes should be developed to create awareness among pharmacists in playing a more \nactive role in patient counseling, especially on the management of dermatitis. \n\n\n\n\n\n\n\n\n137\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPPP 36 \nMPSPSC2015000035 (Poster) \n \nHealth, Economic Impact and Cost -effectiveness of Future Dengue Vaccination Program \nin Malaysia \n \nHY Yeo1, AA Shafie1, L Coudeville2, LD Steinberg2, BS Gill3, R Jahis3, HSS Amar-Singh4 \n1School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia \n2Sanofi Pasteur, Lyon, France \n3Disease Control Division, Ministry of Health, Putrajaya, Malaysia \n4Paediatrics Department, Hospital Raja Permaisuri Bainun Ipoh, Perak, Malaysia \n \nMalaysia is currently experiencing dengue epidemic activity. We employed a dynamic \ntransmission model to evaluate the potential cost-effectiveness, health and economic impact of \nthe vaccine in Malaysia. The model was calibrated with Malaysia specific epidemiological data \nand vaccine efficacy data from phase-III clinical studies. The outcomes were evaluated over a \n10-year period from healthcare provider perspective. Two vaccination strategies were simulated: \ntargeted-hotspots (THS, covered population in 6 districts) and nationwide (NW, covered all \npopulations). Both strategies comprised of routinely vaccinated children (13 years old) and a \ncatch-up cohort age 14-30 over 1-year. Probabilistic and univariate sensitivity analyses on key-\nparameters were conducted to examine uncertainty in the model and assumptions. All costs were \nexpressed in 2013 USD. The model predicted that dengue vaccination under the THS would \nprevent 448,124 [95%CI: 292, 875-632, 375]] dengue cases, 509 [95%CI: 335-707] dengue-\nrelated deaths, 11,785 [95%CI: 7, 888-16, 329]] life years lost and 16,751 [95%CI: 11, 128-23, \n281]] DALYs. Nationwide vaccination would prevent 1,060,222 [95%CI: 694, 181-1, 490, 929]] \ndengue cases, 1,202 [95%CI: 797-1, 672]] dengue-related deaths, 27,834 [95%CI: 18, 756-38, \n501]] life years lost and 39,584 [95%CI: 26, 464-54, 968]] DALYs. Total treatment costs saved \nfor THS and NW strategies were USD163, 859,846 [95%CI: 109,093,124-235,805,776] and \nUSD386, 962,641 [95%CI: 257, 410, 189-557, 347, 377], respectively. The cost-effective \nthreshold values for THS and NW strategies were USD87.49 [95%CI: 59.52-116.33] and \nUSD35.22 [95%CI: 23.67-47.54], respectively. In conclusion, vaccination would significantly \nreduce dengue disease and economic burden in Malaysia, especially if it is introduced during the \ncurrent epidemic. It is cost-effective if it is priced at or below its cost-effective threshold value. \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n\n\n\n\n\n138\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPPP 37 \nMPSPSC2015000162 (Poster) \n \nJob Satisfaction and Stress Levels among Community Pharmacists in Klang Valley \n \nWW Teong, WW Chong \nFaculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia. \n \nCommunity pharmacists are one of the most accessible health professionals whose aims are to \nensure safe and effective use of medicines. However, poor job satisfaction and high stress levels \nmay negatively impact pharmacists\u2019 job performance and increase medication errors. This study \nwas conducted to evaluate job satisfaction and stress levels among community pharmacists in the \nKlang Valley, Malaysia. A cross-sectional survey was conducted using validated questionnaires \nto assess the demographic data of pharmacist respondents, pharmacists\u2019 work activities and \nindices of job satisfaction and stress level. A sample of 282 community pharmacists was selected \nfrom 9 districts of Klang Valley using stratified-random clustered sampling. Descriptive and \ninferential statistics were used to analyse data. In addition, written responses to an open-ended \nquestion about challenges to the pharmacy profession in Malaysia were analysed thematically. \nThe results indicated that the level of job satisfaction among pharmacists was moderate, with a \nmean score of 3.33 + 0.44 (range: 1-5 points). Stress levels among pharmacists also appeared to \nbe at moderate level, with a mean score of 1.84 + 0.44 (range: 0-4 points). Factors that \ncontributed to the highest level of stress among community pharmacists were patient care \nresponsibility and job conflict. Lack of dispensing separation, price war and under-recognition \non professional roles by the general public were the main challenges identified to the pharmacy \nprofession. In conclusion, the job satisfaction and stress level of community pharmacists in \nMalaysia appeared to be moderate. However, action needs to be taken to address the challenges \nidentified to the pharmacy profession in Malaysia.  \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n\n\n\n\n\n139\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPHARMACY EDUCATION \n\n\n\nPEP 01  \nMPSPSC2015000015 (Poster) \n \nInduction of a Pharmacoeconomics Course in Pharmacy Curriculum: Preliminary \nFindings from the Final Year Cohort \n \nA Mohammed Al-Shami1, S Jamshed1, AA Shafie2  \n1 Kulliyyah of Pharmacy, International Islamic University Malaysia, Pahang, Malaysia \n2Discipline of Social and Administrative Pharmacy, School of Pharmaceutical \nSciences,  Universiti Sains Malaysia, Penang, Malaysia \n \nEscalating healthcare costs and pharmaceutical spending continue to evolve rapidly.  With the \naim of curtailing the cost of treatment, there is an increased demand of understanding and \napplying the pharmacoeconomics principles. In view of this, we developed and implemented a 2-\ncredit hour pharmacoeconomics module which constitutes didactic lectures, literature review \nworkshops, and assignments in our final year cohort of pharmacy students. This study aimed to \nassess the views and attitudes of final year pharmacy students about the concepts and application \nof Pharmacoeconomics. A cross-sectional survey was performed among a final year cohort of 99 \nstudents in October 2013. A pre-validated, 15-item, questionnaire was used to assess the students \nviews and attitudes towards this course.  All the final year cohort of students (28 males and 71 \nfemales) responded to the survey. Three-fourth of the students (n= 76; 76.6 %) strongly agreed to \nhave little knowledge of pharmacoeconomics before this course.  Majority of the students (n=65; \n65.5%) strongly agreed that the class exercises helped them to understand the course material. A \nlarge majority (n=61; 61.61%) strongly disagreed to evaluate the pharmacoeconomics literature \nconfidently. Majority (n=62; 62.62%) expressed their intention to apply pharmacoeconomics \nprinciples in their professional practice. Majority (n=75; 75.75 %) expressed their desire work as \na hospital pharmacist. in conclusion, the students expressed that they learnt  about the basic \nconcepts of pharmacoeconomics principles and expressed positive attitude towards the learning \nof application of pharmacoeconomics principles. It  is recommended that the \npharmacoeconomics principles to be introduced early into the pharmacy curriculum. \n  \n\n\n\n\n\n\n\n\n140\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPEP 02  \nMPSPSC2015000143 (Poster) \n \nAssessment of Inhalation Technique Using Dry Powder Inhaler among Third and Fourth \nYear Pharmacy Students in a Malaysian University: Pre and Post Education \n \nNE Ismail1,2, S Ahmad2, H Sentiagoa1, NA Ishak2, NS Husin2, AN Johari2 \n1Faculty of Pharmacy, Lincoln University College, Petaling Jaya, Selangor, Malaysia. \n2Clinical BioPharmaceutics Research Group (CBRG), Pharmaceutical and Life Sciences CoRe, \nUniversiti Teknologi MARA, Puncak Alam, Selangor, Malaysia. \n \nThis study determined the dry powder inhaler (DPI) mainly turbuhaler (T) and accuhaler (A) \ntechniques among third and fourth year pharmacy students pre- and post- education. The selected \nstudy variables that differentiate, associate, correlate, and predict the scoring of inhaler \ntechniques when using DPI were also investigated. The study recruited 233 pharmacy students (n \n= 114 Year 3 students) from the Faculty of Pharmacy, UiTM Puncak Alam. Part one self-\nadministered questionnaire consisted of basic socio-demographic items. The pharmacy students \nwere asked to demonstrate the inhalation techniques for two devices verbally (pre-education). If \nthere was any mistake, short education was given by the researcher and after that they were \nasked to demonstrate the inhalation techniques again (post-education). These sessions were audio \nrecorded by the researcher and transferred to the checklist of A-T techniques for scoring. There \nwere significant differences of A and T scores between pre- and post-education among Year 3, \nYear 4 and all the students. There were significant differences in the marks of T and A between \nmales and females in both pre- and post- education. For Year 4 pharmacy students, there were \nsignificant association between different level of cGPA and T score pre-education, gender and T \nscore post-education, gender and A score pre-education. The students' cGPA and confidence in \nusing T was a predictor for T score pre-education. There was only a significant low positive \ncorrelation between age of the respondent and T score in pre-education. \n\n\n\n\n\n\n\n\n141\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPEP 03  \nMPSPSC2015000103 (Poster) \n \nHow Community Pharmacists Responded Towards the Community Pharmacy Attachment \namong Third Year Undergraduate Pharmacy Students? A 3-Year Experience \n \nNS Ab Rahman,  SHB ShaikhRahmanBux, CR Ismail  \nKulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang, Malaysia \n \nExperiential learning has become one of the learning methods in higher education institution. A \n6-week community pharmacy attachment has been implemented for year 3 undergraduate \nstudents of Faculty of Pharmacy at the IIUM since 2013. However, it is unclear how community \npharmacist responded to the programme. This study aimed to explore the community \npharmacists' perceptions and views towards the community pharmacy attachment among third \nyear undergraduate students. This cross sectional study was conducted among community \npharmacists whom were involved in the community pharmacy attachment programme. A post-\nplacement evaluation form containing items on administration and support, student's supervision \nand pharmacist's practicing skill was administered. The data were analyzed descriptively using \nSPSS version 20. A total of 157 community pharmacists completed the evaluation form, which \nconsisted of 47(29.9%) in year 2013 and 55(35%) for each year 2014 and 2015.  A majority \n(87.9%) of the community pharmacists said that they were able to supervise students without \ncompromising their service commitments. More than 90% reported that supervising students was \nstimulating and the majority said it has helped to develop their pharmacy practice skills. \nAlthough a few suggested the attachment period to be shortened, most of the community \npharmacists supported the 6-week period as well as visit by the university preceptor. Overall, the \nresults of this study demonstrate that community pharmacy attachment help to develop pharmacy \npractice skill among both community pharmacists and students. \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n\n\n\n\n\n142\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\n\n\n\n\nPHARMACEUTICAL CHEMISTRY \n\n\n\nPCP 01  \nMPSPSC2015000152 (Poster) \n \nIn Silico Pharmacophore Elucidation for Bicyclic Antagonists of Human A2A Adenosine \nReceptors and Its Comparison with A3 Adenosine Receptor Bicyclic Antagonists \n \nYW Jong1, PK Deb2, G Pastorin3, SL Cheong2  \n1Department of Pharmacy Practice, School of Pharmacy, International Medical University, \nMalaysia \n2Department of Pharmaceutical Chemistry, School of Pharmacy, International Medical \nUniversity, Malaysia \n3Department of Pharmacy, National University of Singapore, Singapore \n  \nIn the past decades, many studies have reported the potential therapeutic role of human A2A \nadenosine receptor (hA2AAR) antagonists as anti-parkinsonism agent. In the present study, a 3D-\nQSAR pharmacophore model has been developed to determine the important structural \nrequirements of bicyclic hA2AAR antagonists for effective binding with the hA2AAR. A dataset \nconsisting of 157 pyrimidine derivatives were selected in this QSAR study. Hypothesis \nAAADR.104 is chosen as the best pharmacophore hypothesis with good alignment and \nstatistically significant QSAR results (R2 = 0.8364, SD = 0.3719, F = 153.4, RMSE = 0.377, Q2 \n= 0.8218, Pearson-R = 0.9191). Furthermore, a newly synthesized hA2AAR antagonist has been \nincluded in the test set to further validate the predictive ability of the QSAR model; the results \nshowed good correlation between the experimental and predicted hA2AAR binding affinity. \nAdditionally, the so-obtained pharmacophore features of hA2AAR bicyclic antagonists were also \ncompared with that of the hA3AR bicyclic antagonists. One of the hydrogen bond acceptors and \nthe aromatic ring are located on the bicyclic scaffolds of hA2AAR antagonists, whereas for \nhA3AR antagonists, these features are located on the side chain. Additionally, hydrogen bond \ndonor features for both hA2A and hA3AR antagonists are found located on the side chain. In \nconclusion, this QSAR pharmacophore model can be prospectively used to facilitate structural \noptimization of the newly synthesized lead compounds and rational design of new A2A adenosine \nreceptor bicyclic antagonists as anti-parkinsonism agents.  \n  \n  \n\n\n\n\n\n\n\n\n143\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPCP 02  \nMPSPSC2015000151 (Poster) \n \nIn Silico Pharmacophore Elucidation for Bicyclic Antagonists of Human A3 Adenosine \nReceptors and Its Comparison with A2A Adenosine Receptor Bicyclic Antagonists \n \nXY Wong1, PK Deb2, G Pastorin3, SL Cheong2  \n1Department of Pharmacy Practice, School of Pharmacy, International Medical University, \nMalaysia \n2Department of Pharmaceutical Chemistry, School of Pharmacy, International Medical \nUniversity, Malaysia \n3Department of Pharmacy, National University of Singapore, Singapore \n                                                                                                                         \nFour subtypes of human adenosine receptors are known, classified as A1, A2A, A2B and A3. \nThey regulate a wide range of physiological functions in our body. The human A3 adenosine \nreceptor (hA3AR) antagonists were recently discovered as potential therapeutic agents in many \ndiseases, particularly in glaucoma, inflammatory diseases and cancer. To date, most of the \nQSAR analyses on hA3AR antagonists were focused mainly on tricyclic scaffold of hA3 \nantagonists but not much on the bicyclic derivatives. Therefore, ligand-based 3D-QSAR \npharmacophore model was generated to understand the important structural features for ligand \nbinding of bicyclic hA3AR antagonists. Fifty-one hA3AR bicyclic antagonists, including 9-\nalkylpurines, 7-oxo-thiazolopyrimidine-7-one, triazolotriazines, 2-phenylpyrazolopyrimidin-7-\none, and 2-arylpyrazolopyrimidin-7-amino derivatives, with binding affinity (Ki) ranging from \n3.2 to 3200 nM were employed in this study. The best hypothesis AADR.32 based on three PLS \nfactors has demonstrated statistically significant parameters, exhibiting good predictive ability \n(R2=0.8360, SD=0.2886, F=62.9, RMSE=0.3009, Q2=0.8298, Pearson-R=0.9117). A four-site \npharmacophore model with two acceptors (A), one donor (D) and one aromatic ring (R) was \ndeveloped. The predictive power of the model was further confirmed with an external test \ncompound involving a newly synthesized hA3AR antagonist. Furthermore, the so-obtained \npharmacophore features of hA3AR bicyclic antagonists were also compared with that of the \nhA2AAR bicyclic antagonists. Results have revealed the importance of side chain substituents \nand bicyclic scaffold towards binding affinity at the respective receptors. In conclusion, the 3D-\nQSAR model constructed provides useful structural information for future design and \ndevelopment of new compounds as potent and selective hA3AR bicyclic antagonists. \n  \n\n\n\n\n\n\n\n\n144\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPCP 03  \nMPSPSC2015000036 (Poster) \n \nStability Indicating RP-HPLC Method for Simultaneous Determination of Tramadol \nHydrochloride and Aceclofenac in Dosage Form \n \nM Gousuddin, P Sengupta, M Ahamad Shah, NE Ismail  \nFaculty of Pharmacy, Lincoln University College, Selangor, Malaysia \n \nAssessment of stability of pharmaceutical product is very important to ensure the therapeutic \nefficacy of drugs. The high performance liquid chromatography assay method was used for the \ndetermination of tramadol hydrochloride (TMH) and aceclofenac (ACF) in a commercial \ntablet formulation. The separation was performed by chromatography analysis on a \nPhenomenex Gemini C18 (250 mm X 4.6 mm i.d., 5 \u00b5m particle size) column. The mobile \nphase consisted of 0.01 M-ammonium acetate buffer pH 6.5-acetonitrile (65:35, v/v). The \nflow rate monitored at 1.0 ml/min and the injection volume was 20 \u00b5l. UV detection was \nperformed at 270 nm. TMH, ACF, and their combination drug product were analyzed under \nhydrolytic, thermal, and oxidative stress conditions, and the stressed samples were also analyzed \nby the proposed method. The described method was linear over the range of 0.015-0.060 mg/ml \nand 0.040-0.160 mg/ml for TMH and ACF, respectively. The mean recoveries were 99.76 and \n98.12% for TMH and ACF, respectively. The intermediate precision data obtained according to \nICH guidelines. The calculated value of correlation coefficient was found 0.999. The method \nwas statistically validated for its linearity, precision and accuracy for routine analysis.  \n\n\n\n\n\n\n\n\n145\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPCP 04  \nMPSPSC2015000055 (Poster) \n \nPhenolic Content Screening and In-Vitro Antioxidant Evaluation for Radical Scavenging \nActivity of Methanolic Cladodes Extract of Opuntia Cochenillifera (L.) Mill  \n \nMF Osman1, SZ Mat So'ad 2 \n\n\n\n1Kulliyyah of Pharmacy, International Islamic University Malaysia Kuantan, Pahang, Malaysia  \n2Department of Pharmaceutical Chemistry, Kulliyyah of Pharmacy, International Islamic \nUniversity Malaysia Kuantan, Pahang, Malaysia \n \nOpuntia cochenilifera is a tropical cactus from the family Cactaceae. It is commonly planted as \nan ornamental plant in Malaysia.The objectives of this study were to screen for phenolic content, \noptimize chromatographic system for thin layer chromatography (TLC) analysis and evaluate the \nantioxidant activity of methanolic cladodes extract of Opuntia cochenillifera (L.) Mill. by using \nDPPH radical scavenging method. Observation of the chromatograms under visible light showed \nthat the best compounds separation was achieved with the chromatographic system of \nchloroform-methanol with ratio 90:10. The presence of phenolic compounds were detected by \nstaining the chromatogram with 10% methanolic ferric chloride reagent. At the highest \nconcentration tested (1 mg/mL), methanolic cladodes extract of Opuntia cochenillifera showed \n41.5% DPPH radical inhibition in comparison with gallic acid, which showed 95.2% DPPH \nradical inhibition. The results clearly indicated that the free radical scavenging activity of \nmethanolic cladodes extract of Opuntia cochenillifera was lower than the standard gallic acid. \nThe current study provides important baseline information to explore the potential use of \nOpuntia cochenillifera as an ingredient in local nutraceutical and cosmeceutical products. \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n\n\n\n\n\n146\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPCP 05 \nMPSPSC2015000073 (Poster) \n \nEffects of Methyl Jasmonate Elicitation on the Growth and Alkaloids Content of In Vitro \nCultures of Ruta Angustifolia (L) Pers \n \nR Adawiyah Dalim \nDepartment of Pharmaceutical Chemistry, Kulliyyah of Pharmacy, International Islamic \nUniversity Malaysia, Kuantan, Pahang, Malaysia \n \nAn in vitro plant culture is an alternative method for plant to grow in a sterile condition and \nunder controlled nutritional and environmental conditions. This method has become a potential \nmethod in the area of plant propagation, plant improvement, production of secondary metabolites \nand others. This method is a useful method for natural product research and pharmaceutical \nindustries to overcome the scarcity of natural resources in particular aiming for bioactive \ncompound of interest. Therefore, this research study was carried out to investigate the influence \nof MeJa elicitation towards the growth of callus as well as production of alkaloids by in vitro \nmicroshoot culture of Ruta angustifolia specifically arborinine and skimmianine. Results show \nthat MeJa strongly cause the change of the growth of the callus and physiologically increase the \nproduction of alkaloids by the microshoot. As a conclusion, MeJa elicitation of R. augustifolia is \na potential method that can affect the growth of the plant and alkaloids production. \n\n\n\n \n\n\n\n\n\n\n\n\n147\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPCP 06  \nMPSPSC2015000084 (Poster) \n \nHPTLC Fingerprint Analysis of Vitex Pinnata Linn Leaves  \n \nU Subasini1, S Thenmozhi 2 \n1Department of Pharmacology, International Medical School, Management and Science \nUniversity,, Selangor, Malaysia; \n2Department of Pharmacognosy, Swamy Vivekanandha College of Pharmacy, Tamil Nadu, \nIndia. \n  \nThis study aimed to determine the flavonoids, saponins, steroids and phenolic compounds of \nhydroalcoholic extract of Vitex pinnata Linn. (Synonym: Malayan Teak) leaves using HPTLC \ntechnique. The extract was tested to determine the presence of various phytoconstituents like \ncarbohydrates, glycosides, alkaloids, flavonoids, saponins, terpenoids, steroids, tannins, protein \nand amino acids. A CAMAG HPTLC system equipped with LINOMAT 5 applicator, TLC \nscanner 3, REPROSTAR 3 and WIN CATS-1.3.4 software were used. Mobile phases in the \ndifferent compositions were used for high resolution. The reports of qualitative phytochemical \nscreening confirmed the presence of carbohydrates, phenols, saponins, flavanoids, terpenoids, \nsteroids and tannins. The extract showed the presence of 13 different types of flavonoids with 13 \ndifferent Rf values in the range of 0.01 to 0.97. The reports of saponin illustrated the presence of \n12 types of saponins with 12 types of Rf value ranging from 0.01 to 0.92. The reports of phenolic \nprofile showed the presence of 15 types of phenolic compounds with 15 different Rf values in \nthe range of 0.02 to 0.94, and the reports of steroid profile demonstrated the presence of 7 types \nof steroids with 7 types of Rf value ranging from 0.02 to 0.53. It can be concluded that the \npresent study can be used to evaluate the medicinal plant Vitex pinnata from the adulterant. \nHPTLC fingerprint analysis was developed to help in proper identification and quantification of \nmarker compounds. By isolating and identifying the marker compounds, new drugs can be \nformulated to treat various diseases. \n\n\n\n\n\n\n\n\n148\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPCP 07  \nMPSPSC2015000040 (Poster) \n \nSynthesis and Cardioprotective Effects of Novel Series of Combination of Quinazoline -\nThiadiazole Against Isoproterenol-Induced Hypertrophy \n \nG Rajamanickam1, S Selvaraj 2, T Rajendran 3, MMR Sarker1 , NE Ismail1 \n  1Faculty of Pharmacy, Lincoln University College, Selangor, Malaysia. \n 2Faculty of Medicine, Lincoln University College, Selangor, Malaysia.         \n  3Department of Pharmaceutical Chemistry, S.S.M.college of Pharmacy, Tamilnadu, India. \n  \nCardiac hypertrophy is very common and can affect people of any age. It leads to ischemic heart \ndisease, heart failure and it is one of the foremost causes of cardiac morbidity and \nmortality. Quinazoline and thiadiazole derivatives have caused universal concerns due to their \nwidely and distinct biopharmaceutical activities. This study was designed to synthesize \ncombinations of quinazoline-thiadiazole series of compounds and to evaluate their preventive \nrole in isoproterenol-induced cardiac hypertrophy in male Wistar rats. The equimolar amount of \n2-substituted quinazolin-4(3H)-one and 5-substituted-1,3,4-thiadiazol-2-amine in methanolic \nsolution with formaldehyde reacted through Mannich reaction to produce the novel series of 3-\n[(5-Substituted-1,3,4-thiadiazole-2-yl amino) methyl]-2-substituted-quinazolin-4(3H)-one by \nmicrowave and conventional methods. The structure and purity of compounds were confirmed \nby TLC, IR, MS, and NMR studies. Isoproterenol (5 mg/kg body weight) was injected \nsubcutaneously once daily for 14 days to induce cardiac hypertrophy, which increased heart \nweight to body weight ratio, cardiac wall thickness and myocytes diameter. The intraperitoneal \nadministration of synthesized compounds (20 mg/kg body weight/once a day for 14 days) along \nwith isoproterenol showed significant reversal of cardiac hypertrophy. Histological studies and \nImage analysis software were used to confirm the findings. Regarding the mechanisms \nunderlying the cardioprotective effect of the compounds, they might function as antagonists of \nadrenergic stimulation caused by isoproterenol. The present study showed that the synthesised \ncompounds were able to prevent cardiac hypertrophy caused by continuous exposure to \nisoproterenol in rats. \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n\n\n\n\n\n149\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\n \nPCP 08 \nMPSPSC2015000163 (Poster) \n \nMolecular Dynamics Behaviour of One Third of the Site Reactivity of Microsomal \nProstaglandin E Synthase Type 1 Complexes with an Oxicam Analog \n \nN Abd Rahman, KW Lam \nFaculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia \n \nMicrosomal prostaglandin E synthase type 1 (mPGES-1) is a terminal transmembrane enzyme \ninvolved in the synthesis of prostaglandin E2 (PGE2), a powerful biological mediator of \ninflammation. The objective of the study was to analyze the conformation changes of mPGES-1 \nstructure when it complexes with an oxicam analog, 13j, a selective mPGES-1 inhibitor. The \nstability and binding affinity of the inhibitor in the active site of mPGES-1 was also determined. \nIn this study, a series of 20 ns molecular dynamics simulation (MD) was performed by using \nGROMACS 5.0 package with the GROMOS96 54a7 force field. An open conformation of \nmPGES-1 was embedded into 1-palmitoyl,2-oleoyl-sn-glycero-3-phosphacholine (POPC) \nphospholipid bilayer. All simulations were run under constant pressure (1 bar), temperature (300 \nK) and with periodic boundary conditions. Based on our observation, pocket monomer 1 was \noccupied by inhibitor causing it inaccessible to the substrate. Root Mean Square Deviation \n(RMSD) of the mPGES-1 backbone revealed that the protein-inhibitor complex was stable as the \nsystem converged to equilibrium state at 3 \u00c5. Besides, hydrogen bonds (H-bonds) analysis \nrevealed that five amino acid residues formed attractive electrostatic interaction with the \ninhibitor. Amino acid residues are Tyr117, His113, Arg126, Arg70 and Asn74. This shows that \nthe protein-inhibitor complex is stable and has strong binding affinity throughout simulations. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n150\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\n\n\n\n\nPCP 09 \nMPSPSC2015000164 (Poster) \n \nPhytochemical Study on the Methanol Fraction of Zingiber Officinale \n \nWC Ko, J Jalil \nFaculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia \n\n\n\nZingiber officinale belongs to family Zingiberaceae and is locally known as zanjabil (Arabic), \naadu (gujarati), shunti (Kannada), allam (Telugu), inji (Tamil and Malayalam), alay (Marathi), \naduwa (Nepali), and adrak (Hindi and Urdu). This species is widely distributed in India, China, \nMalaysia and Thailand. The rhizome of ginger has long been used in Ayurvedic and traditional \nChinese medicine to treat a wide range of ailments including gastrointestinal disorders, mainly \nnausea and vomiting associated with motion sickness and pregnancy, abdominal spasm, as well \nas respiratory and rheumatic disorders. This research study was conducted with the objective to \nextract, isolate and purify chemical constituents from methanol fraction of rhizomes of Z. \nofficinale then determine the chemical structures of compounds identified. The rhizome part of \nZ. officinale was collected then the rhizomes of Z. officinale in powder forms were extracted \nwith methanol by cold maceration. This was followed by removal of tannin from crude extract \nwhich was carried out using diethyl ether. Methanol fraction was separated and isolated using \nthin layer chromatography and column chromatography to yield pure compound. Structure \nelucidation was carried out using ultraviolet (UV) spectroscopy, infrared (IR) spectroscopy, mass \nspectroscopy (MS) and one-dimensional proton nuclear magnetic resonance spectroscopy (1H-\nNMR), carbon-13 nuclear magnetic resonance spectroscopy (13C-NMR )  as well as comparison \nwith literature. Saponins had been isolated from methanol fraction of rhizomes of Z. officinale \nand characterized. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n151\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\n\n\n\n\n\n\n\n\nTRADITIONAL AND COMPLEMENTARY MEDICINE \n\n\n\nTCMP 01  \nMPSPSC2015000126 (Poster) \n \nAntibacterial Activity of Extracts of Marine Brown Algae Padina Gymnospora  \n \nN Mohd Zah, AV Anita Gnana Kumari, J Anbu Jeba Sunilson  \nSchool of Pharmacy, KPJ Healthcare University College, Negeri Sembilan, Malaysia \n  \nMarine organisms are potentially prolific sources of highly bioactive secondary metabolites that \nmight represent useful leads in the development of new active antimicrobial agents. No reports \nhave been published to explore the possible antimicrobial activity of marine algae from the Port \nDickson Sea. The present study aimed to scientifically evaluate the antibacterial activity of the \nbrown marine algae, Padina gymnospora (Dictyoceae family) collected from coastal region of \nPort Dickson against the selected microorganisms. The powdered green algae were extracted \nsuccessively with acetone, chloroform, ethanol and distilled water for 48 h using the Soxhlet \napparatus. The extracts were concentrated using rotary vacuum evaporator. All the extracts were \nevaluated for their antimicrobial activity by cup-plate method against Gram positive bacteria \nsuch as Streptococcus pneumoniae, Staphylococcus aureus and Gram negative bacteria such as \nEscherichia coli, Pseudomonas aeruginosa. The antibacterial activity was assessed by measuring \nthe diameter of inhibition zone. All the experiments were carried out in triplicate. The ethanol \nextract of P. gymnospora was found to possess the maximum antibacterial activity against the \npathogens at the concentration of 10mg/mL which was comparable with standard drug \nstreptomycin (50mcg/mL). The findings suggest that the ethanol extract of P. gymnospora \ncontain active phytoconsitituents responsible for potent antibacterial activity. The present study \nproposes the importance of isolation of these phytoconstituents and investigation of possible \nmechanism of action to develop novel antibacterial agent from P. gymnospora.  \n  \n\n\n\n\n\n\n\n\n152\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nTCMP 02  \nMPSPSC2015000008 (Poster) \n \nNew Herbal Dispensing System: Herbal Preparation Process, Patients\u2019 and Prescribers\u2019 \nAcceptance \n \nSY Chan 1,2, WN Nik Nabil1,2, RJ Lim1 \n1Traditional & Complementary Medicine Unit, National Cancer Institute, Malaysia. \n2Pharmacy Department, National Cancer Institute, Malaysia. \n   \nThe Traditional and Complementary Medicine (T&CM) Unit, National Cancer Institute (NCI) \nprovides herbal treatment to cancer patients. Previously, patients who received herbal treatment \nwould mix the dispensed herbs at home, creating compliance issue and risk of administration \nerrors. A new herbal dispensing system was introduced: pharmacists prepared the combination of \nprescribed herbs and supply the pre-mixed herbs sachets to the patients. The objectives of this \nstudy were to assess the new herbal preparation process on the preparation time and cost; and \nalso the acceptance of the new system among patients and prescribers. Preparation time and cost \nof the prescribed herbs was collected from 1st March to 30th April 2015 from patients\u2019 \nelectronic medical records in the T&CM Unit, NCI. Feedback forms were used to assess \npatients\u2019 and prescriber\u2019s acceptance of the new herbal system. Data were entered into and \nanalysed using Microsoft Excel. A total of 228 herbal patients received 2,236 herbs during the \nstudy period. The new herbal dispensing system had longer mean preparation time (14\u00b18 \nminutes) but lower mean cost per prescription (RM118.76\u00b180.35) than the old system. Of the 50 \npatients who provided feedback, 72% preferred the new system, 96% considered the waiting \ntime as acceptable and 78% agreed that their compliance had been enhanced. Both herbal \nprescribers regarded the new system had improved the patient\u2019s compliance and the expected \nherbal effects. In conclusion, although the new herbal dispensing system increases the patients\u2019 \nwaiting time, it reduces the herb cost per patient and improves patient\u2019s compliance.  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n153\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPHARMACEUTICAL TECHNOLOGY \n\n\n\nPTP 01  \nMPSPSC2015000129 (Poster) \n \nDevelopment of Sustained Release Ophthalmic Delivery of Prulifloxacin Using in situ \nGelling System \n \nA Khan, Q Hassan, J Anbu Jeba Sunilson \nSchool of Pharmacy, KPJ Healthcare University College, Negeri Sembilan, Malaysia \n \nDelivery of drugs to the eye to achieve and maintain therapeutic concentrations remains a \nchallenge due to the dilution and drainage of most commonly used conventional dosage forms \nsuch as solutions from the eye. This limitation of conventional dosage forms can be overcome by \nusing in situ gel forming ophthalmic drug delivery systems prepared from polymers that exhibit \nreversible liquid \u2013 gel phase transitions. This may result in better ocular availability of the drug. \nThe purpose of this work was to develop an ophthalmic drug delivery system based on the \nconcept of ion activated in situ gelation for prulifloxacin, an antibacterial agent.  Sodium \nalginate was used as a gelling agent. It formed a gel in the presence of divalent cation in the \nlacrimal fluid. HPMC E50, LV was incorporated as the viscosity enhancing agent. Formulation \nF4  containing sodium alginate (0.8%w/v), HPMC (0.02%w/v) with drug (0.3%w/v) and other \nformulation ingredients was found to be promising as it showed viscosity of 45 cps at 20 rpm \nand 74.63% drug release at the end of 8 hours. The developed formulations were therapeutically \nefficacious, stable, non-irritant and provided sustained release of the drug over an 8 hour period. \nThus it may be concluded that the developed in situ gelling system may be a suitable alternative \nfor the ophthalmic delivery of prulifloxacin. \n  \n\n\n\n\n\n\n\n\n154\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPTP 02 \nMPSPSC2015000140 (Poster) \n \nResponse Surface Methodology to Optimize Pyrilamine Maleate Fast Dissolving Tablets \nUsing Synergetic Disintegrants Approach \n \nBP Panda, CJ Yew \nDepartment of Pharmaceutical Technology, School of Pharmacy, Taylors University, Selangor, \nMalaysia \n \nPharmaceutical formulation development of fast dissolving tablets (FDTs) involves significant \namount of time and efforts to get an optimized dosage form. It is scientifically essential to \nexplore the design of experiments and response surface methodology concept to optimize FDT \nformulation with minimum amount of time and effort. The present research encompassed the \nformulation and optimization of pyrilamine maleate FDTs by employing synergic effects of a \nsuper disintegrant and a subliming agent. In optimization of pyrilamine maleate FDT, central \ncomposite design was applied to study the effect of disintegrant as independent variables that is, \ncroscarmellose as a super disintegrant, and menthol as a subliming agent. Pyrilamine maleate \nFDT were prepared by direct compression method on Rimek Mini Press-I using flat 8-mm \npunches and characterized for the dependent variables like disintegration time and cumulative \npercent drug released after 30 minutes. Optimization study by response surface analysis revealed \nthat 5% of croscarmellose and 20% menthol was found to be optimum which disintegrated in 28 \nsecs and cumulative percent drug released was 98.9% at 30 minutes. A checkpoint formulation \nwas prepared to prove the validity of the evolved mathematical model. The results of study \nsuggest that synergic effect of croscarmellose as a super disintegrant and menthol as a subliming \nagent employed with systematic experimental design approach has greater impetus in \noptimization of pyrilamine maleate FDT.  \n  \n\n\n\n\n\n\n\n\n155\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPTP 03  \nMPSPSC2015000090 (Poster) \n \nDevelopment of Self-Emulsifying Drug Delivery System (S-SEDDS) for Glibenclamide \n \nHJ Chua1, SS Patro2  \n1Taylor's University, Selangor, Malaysia \n2School of Pharmacy, Taylor's University, Selangor, Malaysia \n \nGlibenclamide (GBD) is one of the most prescribed long-acting antihyperglycaemic agent used \nin the treatment of Type 2 diabetes mellitus. GBD is a poorly soluble drug which results in low \nbioavailability. Therefore, the objective of the study was to develop a solid self-nano emulsifying \ndrug delivery system (S-SNEDDS) to improve the solubility and dissolution rate of GBD. Liquid \nSNEDDS was prepared using Maisine-35-1 as oil, Cremophor RH40 as surfactant, and PEG 400 \nas cosurfactant.  Ternary phase diagrams were constructed to identify the self-nano \nemulsification region. Based on the phase diagrams, few formulations containing 10-25% of oil \nwere prepared by simple mixing and vortexing. These formulations were adsorbed onto Neusilin \nUS2 to produce solid SNEDDS and were evaluated for drug content, globule size, zeta potential \nand in vitro drug release. The viscosity of liquid SNEDDS was low and inferred to be suitable \nfor fast absorption of drug. DSC and FTIR studies were also performed and the results indicated \nthat there were no incompatibilities between GBD and the components in the SNEDDS. The \nprepared formulations exhibited a globule size ranging from 14.14 to 45.36 nm. In vitro \ndissolution profiles showed that dissolution rate of GBD from liquid and solid SNEDDS was \nmuch greater when compared to the pure drug and the marketed tablet. Thus, this study indicated \nthat the solid SNEDDS could be used as a potential drug carrier for GBD with improved \nsolubility and dissolution rate.  \n  \n  \n  \n  \n  \n\n\n\n\n\n\n\n\n156\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPTP 04  \nMPSPSC2015000030 (Poster) \n \nNanosuspension Technology in Salicylic Acid and Its Particle Size Characterization \n \nH Hadi, H N Khalid, A I Awadh \nFaculty of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang, Malaysia \n \nSalicylic acid  (SA) is known to have keratolytic activity for the treatment of skin related disease \nsuch as acne and psoriasis. However, it usually causes side effects such as skin irritation. Also, \nSA is poorly soluble in water making it difficult to formulate. This study aimed to explore the \nuse of nanosuspension technology in enhancing the solubility of SA in aqueous solutions and to \nprovide a control release to decrease the side effects of salicylic acid by reducing its particle size \ninto nanometer scale. This research project focused on the use of oil-in-water emulsification \nfollowed by solvent evaporation technique. The use of different amounts of ethyl acetate was \nevaluated. This technique was chosen as it has high drug solubilization and capable of producing \nlarge scale because of simple manufacturing method and using low-cost materials. The \nmanipulation of different amount of organic solvent, ethyl acetate has an impact on the particle \nsize. Results showed that an increase in the amount of ethyl acetate produced smaller average \nparticle size. However, the particle size increased after the process of centrifugation and freeze-\ndrying. The percentage yield of the final products was low (below 25%). The study has shown \nthat it is possible to reduce the particle size of SA to a nano-sized diameter. Thus the solubility of \nsalicylic acid can be enhanced. However, more extensive research should be done to provide a \nmore concrete conclusion. An improved understanding of the formulation factors will further \nadvance the value of nanosuspension in topical drug delivery. \n\n\n\n\n\n\n\n\n157\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPTP 05  \nMPSPSC2015000031 (Poster) \n \nDevelopment and Characterization of Topical Caffeine Sunscreen Formulation \n \nH Hadi, N A Rosli, Z A Hamid, A I Awadh  \nFaculty of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang, Malaysia \n \nThe prominent property of caffeine as a natural sunscreen has received recent interests in \nresearch on topical formulations incorporating this organic compound. The main objective of this \npaper was to evaluate the behaviour of caffeine in a broad-spectrum sprayable sunscreen \npreparation. Two types of sunscreen formulations were developed with and without the presence \nof 2% caffeine. Parameters that may influence the formulation stability were assessed. This \nincluded organoleptic tests (appearance, colour, thickness, feel), physical tests (rheology and \ncentrifugal phase separation) and chemical test (pH measure). Findings in both formulations \nwere similar for organoleptic test parameters. Immediately after preparation, both formulations \nappeared as whitish fluid with low viscosity of almost watery-like. Upon spraying a small \namount on the hand, the texture was smooth and easily spreadable on the skin. The conditions \nremained stable with similar findings even after 7 days of storage at room temperature. The pH \nvalues were all alkaline approximately at room temperature. The addition of 10% sodium \nhydroxide into the formulation contributed mainly to the measured alkalinity. Thus, caffeine did \nnot significantly change the pH of the formulation. Both formulations produced almost the same \nresults whereby they behaved like non-viscous Newtonian fluids. The findings also indicate that \nno phase separation of all triplicate samples with and without 2% caffeine. It can be concluded \nthat caffeine has the potential to be used in topical sunscreen formulations as caffeine helps in \nenhancing activities of UV filters without affecting formulation stability. \n\n\n\n\n\n\n\n\n158\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPTP 06  \nMPSPSC2015000032 (Poster) \n \nFormulation and Characterization of Resiquimod Microsponges Loaded Gel \n \nH Hadi, A Zaiter, A I Awadh \nFaculty of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang, Malaysia \n \nThe aim of this study was to incorporate microponges loaded with resiquimod in gel dosage \nform. Microsponges were prepared by emulsion solvent evaporation method using \ndichloromethane (DCM), ethylacetate (EA), and chloroform in dispersed phase which were \nincorporated into different gels. 0.5% w/w Carbopol\u00ae 934 (polyacrylic acid) powder was \ndispersed into deionized water under constant stirring with a glass rod. 0.2% and 0.02% w/w of \nmethylparaben and propylparaben were used as preservative in the gel. The dispersion was \nneutralized using 10% sodium hydroxide (2% w/w). Topical microsponges gel formulations \nwere prepared by incorporation of microsponges into the gel. A 0.03% w/w of resiquimod loaded \nmicrosponges was incorporated into the gel. Control gels which contained resiquimod only were \nprepared under the same conditions. Microsponges prepared by 2.5 mL of DCM, 1 mL of \nchloroform or 5 mL of EA in the dispersion phase were selected and coded as F1, F2 and F3. To \nstudy the compatibility of gel excipients along with microsponges, Attenuated Total Reflectance \n\u2013 Fourier Transform Infrared (ATR-FTIR) spectroscopy and FESEM microscopy were used. The \nATR-FTIR spectrums of different formulations (F1, F2, and F3) are identical. F4 spectrum \nwhich contained empty microsponges loaded gel had no additional or missed peaks when \ncompared against spectrums of other formulations. The integrity and surface morphology \nremained similar when compared to original microsponges observed under FESEM microscopy. \nTherefore, it can be concluded that there was no chemical interaction between resiquimod-loaded \nmicrosponges and gel excipients as shown in ATR-FTIR spectrum and FESEM microscope. \n\n\n\n\n\n\n\n\n159\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPTP 07 \nMPSPSC2015000130 (Poster) \n \nIn Vitro and In Vivo Evaluation of Formulated Piroxicam Subdermal Implants \n \nQ Hassan, A Khan, J Anbu Jeba Sunilson \nSchool of Pharmacy, KPJ Healthcare University College, Negeri Sembilan, Malaysia \n \nPiroxicam is a non-steroidal anti-inflammatory drug (NSAID) used to relieve pain and \ninflammation. It is also used in long-term conditions like rheumatoid arthritis and ankylosing \nspondylitis. The drug has also been investigated for its efficacy in post-operative pain \nmanagement and was found to be significantly effective. Therefore, the present study aimed to \ndevelop Piroxicam subdermal implants for post-operative pain management using biodegradable \npolymers viz., gelatin and sodium alginate and glycerine as plasticizers The prepared implants \nwere evaluated for various formulation parameters such as thickness, weight variation, content \nuniformity, sterility testing, in-vitro release, and drug excipient interaction studies using IR \nspectroscopy. In-vitro release of implants was carried out in phosphate buffer pH 7.4. In-vivo \nstudies in animals were carried out for polymer-tissue compatibility at subdermal region. \nFormulation F3 and F4 contained a gelatin: sodium alginate ratio of 40:60 and 50:50 respectively \nwere found to sustain the drug release for up to 5 days (89%) and 6 days (91%) respectively \nwhen treated with formaldehyde for 12 hours. In-vivo studies in rabbits for polymer tissue \ncompatibility depicted no changes in tissue configuration histo-pathologically, suggesting \ncompatibility with the surrounding tissues of subdermal region. IR spectrum of the formulation \nsuggested no chemical interaction between the polymers and drug. The study concludes that \npiroxicam implants is a viable option for sustained drug release in post-operative pain \nmanagement and this may improve patient compliance. \n  \n\n\n\n\n\n\n\n\n160\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPTP 08 \nMPSPSC2015000046 (Poster) \n \nFormulation of Stable Solid Dispersion Containing Artemether into Fast Disintegrating \nTablets \n \nSB Natarajan1, NE Ismail1, MM Rahman1, VSN Moorhty2                                                                           \n1Faculty of Pharmacy, Lincoln University College, Malaysia \n2Department of Pharmaceutics, Karpagam College of Pharmacy, Coimbatore, India. \n   \nMalaria is the most prevalent infectious disease in the world which affects around 600 million \npeoples every year. Artemether (ARM) belongs to artemisinin family and is the active \ncomponent of the qinghao Chinese herbs, known as Artemisia annua used for the treatment of \nmalarial infection. The aim of this study was to design stable artemether by solid dispersion \n(ARM-SD) technique using various polymeric carriers including povidone, copovidone and \nsoluplus. The physical stability of ARM-SD was investigated by using Powder-XRD technique \nand related substance was evaluated by HPLC method. Secondly the optimized stable ARM-SD \nwere fabricated into fast-disintegrating tablet (FDT) by direct compression method and evaluated \nfor weight variation, wetting time, disintegration time, hardness and friability. In vitro drug \nrelease studies were performed for RDTs at phosphate buffer (pH 1.2 and 6.8) as \ndissolution   medium. The Related Substance (RS)/impurities was absent in ARM/Povidone \nwhich was confirmed by HPLC and X-RD studies. It was concluded that ARM/Povidone (1:8) \nwas the most stable solid dispersion under elevated temperature and/or humidity. FDTs of \nARM/Povidone (1:8) solid dispersion exhibited fast disintegration times (45\u00b13 sec), sufficient \nhardness (1.5 \u00b10.08 MPa), and onset of drug dissolution (42\u00b11.5% of ARM dissolved in 10 min), \nand these properties were found to be retained with different storage condition. We have \nsuccessfully optimized the drug/excipient ratio of the stable solid dispersion and FDT \ncomposition that possessed rapid disintegration and satisfactory drug dissolution in order to \nachieve enhanced therapeutic effectiveness. \n\n\n\n\n\n\n\n\n161\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPTP 09 \nMPSPSC2015000076 (Poster) \n \nThe Influence of Drug Localisation Within Solid Lipid Nanoparticles (SLNs) on the \nCellular Uptake of Insulin-Containing SLNs \n \nLM Thong1, CJ Roberts2, N Billa1  \n1School of Pharmacy, Faculty of Science, University of Nottingham Malaysia Campus, Malaysia \n2School of Pharmacy, University of Nottingham, Nottingham, United Kingdom \n \nImproved bioavailability is key to a successful nanoparticulate oral delivery system. It is strongly \ninfluenced by the drug uptake process across the gastrointestinal epithelium. Previously, we have \nsuccessfully fabricated insulin-containing SLNs which conformed to two different insulin \nlocalisation models, namely the solid solution model (Model A) and the core-shell model with a \ndrug-enriched shell (Model B). The purpose of this study was to investigate the propensity of \nthese insulin-containing SLNs, being differentiated by the location of the drug payload, to be \ntaken up by the human intestinal Caco-2 cell line. The cellular uptake of both these formulations \nwere evaluated over a treatment duration of 90 minutes. The cells were examined under an \ninverted microscope at half hourly intervals. The cells exposed to insulin-free SLNs appeared to \nbe confluent and morphologically similar to those untreated cells, indicating that the lipid \nnanoparticulate carrier itself was non-toxic. Free insulin solution at high concentration (100 \n\u00b5g/ml) caused instant cell death as early as 30 minutes of treatment. Interestingly, cells treated \nwith Model A showed cell shrinkage and detachment within 30 minutes. In contrary, cells treated \nwith Model B remained confluent throughout. These distinctive differences were noted with \nrespect to the extent of cell death due to the exposure of the cells to a high concentration of \ninsulin following the uptake of these insulin-containing SLNs into the cells, indicating that \nModel A showed a better propensity for cellular uptake. Therefore, cellular uptake can be \ninfluenced by drug localisation within SLNs, which eventually affects drug bioavailability. \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n\n\n\n\n\n162\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPTP 10 \nMPSPSC2015000121 (Poster) \n \nDevelopment and Screening of Certain Essential Oil Based Topical Formulations for their \nAntimicrobial Activity \n \nM Sellappan, KZ Hong \nSchool of Pharmacy, Taylor's University, Selangor, Malaysia \n  \nEssential oils have been traditionally used for various purposes for many years. The most notable \nuse is their antimicrobial activity. Oregano and geranium oil have shown good antimicrobial \nactivity compared to other essential oils and thus have been chosen as candidates for this \nresearch. There is currently no cream formulation in the market consisting of these two oils. This \nstudy aimed to develop an antibacterial or antifungal cream formulation containing oregano oil, \ngeranium oil and a mixture of both. Different concentrations of the oil in the cream formulation \nwere made to ascertain the effectiveness of their antimicrobial activity. A zone of inhibition \ntesting was conducted using prepared cream formulations against Staphylococcus aureus, \nBacillus subtilis, Pseudomonas aeruginosa, Escherichia coli, Candida albicans and \nCryptococcus neoformans. The prepared formulations were subjected to physical evaluations \nlike glittiness, extrudability and pH. The results of all physical evaluations are found to be within \nthe limit and complies the pharmacopoeia standards. Cream formulation containing 10% oregano \noil has shown superior antimicrobial activity against Candida albicans and Cryptococcus \nneoformans as compared to the standard cream, miconazole. Oregano oil has promising \nantifungal properties; however further testing are required before it can establish itself as an \nantifungal cream in the market.  \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n\n\n\n\n\n163\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPTP 11 \nMPSPSC2015000137 (Poster) \n \nIsolation and Ointment Formulation of a Semi-Purified Beta Carotene from Daucus carota \nL. and its Antimicrobial effect against Staphylococcus aureus \n \nMFD Cruz-Bacayo, EM Faller \nSchool of Pharmacy, Management & Science University, Shah Alam, Malaysia \n \nCarrot (Daucus carota L) is one of the richest source of beta-carotene that enhances the immune \nsystem. Carrot contains a variety of phytochemicals such as retinol, carotenoids, provitamin A \n(a,\u00df and cryptoxanthin) and a good health protective effects. The study would like to determine \nthe antimicrobial activity of semi-purified beta-carotene extract formulated as ointment. The \nsemi-purified beta-carotene was isolated from plant source (carrot) using column \nchromatography. The physicochemical properties were identified. The antimicrobial property of \nthe extract and the formulated ointment was evaluated using agar diffusion method against \nStaphylococcus aureus (ATCC 9144). It was observed that the semi-purified extract exhibited a \nconcentration value of 5.776\u00b10.221ppm (absorbance at 436 nm) and soluble in organic solvents \n(ether, chloroform and acetone). Moreover, the semi-purified beta-carotene extract showed \npositive results in Bate-Smith-Metcalf test and Wilstatter-cyanidin test, indicating the presence \nof colouring pigments. Evaluation of antimicrobial activity of the extract revealed moderate to \ngood zone of inhibition against S. aureas (10mm). Formulated ointment has significant \ninhibitory effects (12mm) compared with standard beta-carotene cr\u00e8me (7mm) and erythromycin \nointment (25mm).  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n164\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nMILITARY PHARMACY \n\n\n\nMPP 01  \nMPSPSC2015000159 (Poster) \n \nValue-Added Services: Increasing Patient Utilization of Pharmaself Automated Dispensing \nUnit 24 Hour (PADU24) in Tuanku Mizan Armed Force Hospital (TMAFH) \n \nA Rahmatullah Khan1, MA Adnan1, AH Basari2, MA Mat Rahim3, MH Muhammad \nYusof3 \n1Department of Pharmacy, Tuanku Mizan AFH, Kuala Lumpur, Malaysia \n2Division of Health Services, MAF HQ, Kuala Lumpur, Malaysia \n3Medical and Dental AFD, Kuala Lumpur, Malaysia \n \nPADU24 is a new, first in Malaysia, free of charge service offered in the Outpatient Department \n(OPD) of TMAFH, which was installed in March 2015. It serves patients with partial medication \nsupplies to get their subsequent supplies through the machine at any time without the need to \nqueue at the counter. This project aimed to increase the utilization of PADU24 service, to \nimprove patient satisfaction with OPD services by reducing the waiting time, and to improve the \nQuality Use of Medicines (QUM). A retrospective cohort study of services utilized between \nApril and August 2015 was conducted. In addition, patient self-administered questionnaires were \nemployed to identify awareness and barriers to use the service; staff questionnaires were used to \nevaluate staff\u2019 comprehension of the standard operating procedure (SOP) and readiness to \nprovide the service. Intervention was then conducted after the factors of under-utilization of the \nservice were determined, including service promotion through banners and pamphlets. For \npharmacy staff, continuous medication education (CME) was conducted to increase their \nunderstanding of the SOP and to improve motivation in providing the service. Also, post-\ninterventional telephone interview was conducted with a random sample of patients, using a 10-\nstatement questionnaire. Patients' waiting time was then analysed, before and after the service, to \nexamine the effect of PADU24, which indirectly affects patients\u2019 satisfaction towards OPD \nservice. The results of increasing patient utilization of PADU24 and increase patient satisfaction \nwith OPD service were expected with a reduction in patient waiting time. \n  \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n\n\n\n\n\n165\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\n \nMPP 02 \nMPSPSC2015000154 (Poster) \n \nIV Ceftriaxone Use in Tuanku Mizan Armed Forces Hospital \n \nAM Sulong1, MA Adnan1, MA Mat Rahim2, MH Mohamad Yusof2, AH Basari3 \n1Department of Pharmacy, Tuanku Mizan AFH, Ministry of Defence, Malaysia \n2Armed Forces Medical & Dental Depot, MAF HQ, Ministry of Defence, Malaysia \n3Health Services Division, MAF HQ, Ministry of Defence, Malaysia \n \nIV Ceftriaxone is widely prescribed by the physicians in Tuanku Mizan Armed Forces Hospital \n(TM AFH). It has become the most frequently prescribed IV antibiotic in the hospital, recording \na distinctive high number of prescription orders. Almost 400 patients were prescribed with IV \nCeftriaxone from the first half of 2015, two-times higher than the second most prescribed IV \nantibiotic, ampicillin/sulbactam. The wide use of third-generation cephalosporin, including \nceftriaxone, has been associated with the emergence of extended-spectrum beta-lactamases \n(ESBLs), presenting concerns for bacterial resistance in therapeutics. Therefore, the high number \nof recorded prescriptions raise an issue whether those prescribed IV Ceftriaxone are \nappropriately utilized. This retrospective study reviewed the IV ceftriaxone use in TM AFH, \ncomparing it with the guidelines proposed by the National Antibiotic Guideline (NAG). Data \nwere collected from the bed head ticket archive of all  the patients who were prescribed with IV \nceftriaxone from March to June 2015, and the appropriateness of the use were determined \naccording to the guideline. Treatment of respiratory tract infection accounted for 47% of the use \nwhile surgical prophylaxis recorded 18%. The overall rate of concordance with indications \nrecommended in guideline was 48% which is considered as low. Potential areas for intervention \ninclude empirical treatment of respiratory tract infection and use in surgical prophylaxis. \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n\n\n\n\n\n166\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\n\n\n\n\nPHARMACOLOGY \n\n\n\nPGP 01  \nMPSPSC2015000125 (Poster) \n\n\n\nAntiulcer Activity of Extracts of Hibiscus Vitifolius Root Extracts \n\n\n\nAVA Gnana Kumari, JJS Anbu, K Anandarajagopal \nSchool of Pharmacy, KPJ Healthcare University College, Nilai, Malaysia \n \nHibiscus vitifolius (Malvaceae) is traditionally used by the people of Kerala, India for the \ntreatment of gastric ulcers. The root paste is given orally for the treatment of stomach infections. \nThe present study was aimed to scientifically evaluate the folklore claim of H. vitifolius root \nagainst Helicobacter pylori induced ulcers in experimental animals. Petroleum ether, chloroform, \nmethanol and aqueous extracts of H. vitifolius roots were obtained successively by cold \nmaceration technique. Twelve groups of Wistar rats were used to evaluate the antiulcer activity. \nGroup I served as control whereas, gastric ulcers were induced in group II \u2013 XII using acetic \nacid.  After 24 hours of ulcer induction, the animals in group III \u2013 XII were inoculated \nintragastrically with 1mL of H. pylori twice a day for 7 days. The extracts (200 and 400 mg/kg \nb.wt) and the standard drug, were administered to the respective groups twice a day from 3rd day \nof ulcer induction, for 14 consecutive days. After the treatment, the animals were sacrificed and \nthe stomachs were removed for evaluation of gastric lesions. The ulcerated area and the healing \nrate were measured. Treatment with methanol extract (200 and 400 mg/kg) significantly reduced \nthe ulcerated area compared to the other extracts. Histopathological studies supported the \nprotective effect of the extract. The findings suggest that the methanol extract of H. vitifolius \npossesses antiulcer effects which may be due to the presence of various active phytocompounds \nin the plant and this justifies the folklore claim.  \n  \n  \n  \n\n\n\n\n\n\n\n\n167\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPGP 02  \nMPSPSC2015000011 (Poster) \n\n\n\nThe Protective Effect of the Aqueous Extract of Auricularia Polytricha on Paracetamol \nInduced Hepatotoxicity in Sprague-Dawley Rats  \n\n\n\nC Dinesh Kumar1, G Sivamalar1, B Shaminiswary1, C Mayuren1, K Purushotham2, G \nGaurav1,4, D Kamal1,3, C Jestin1 \n 1School of Pharmacy, International Medical University, Kuala Lumpur, Malaysia \n2 School of Medicine, International Medical University, Kuala Lumpur, Malaysia \n3School of Biomedical Sciences & Pharmacy, University of Newcastle, Newcastle, Australia \n4School of Medicine & Public Health, University of Newcastle, Newcastle, Australia  \n \nThe aqueous extract of Auricularia polytricha (Auriculaiaceae) was investigated for its \nprotective action against paracetamol induced hepatotoxicity in Sprague Dawley male rats. The \nextract in doses of 250 mg/kg and 500 mg/kg p.o. was administered for a period of 14 days. \nHepatotoxicity was induced in rats using paracetamol with a dose of 2 g/kg p.o. on the 14th day \nof the study. Immediately after 48 hours of paracetamol administration, blood was withdrawn \nfrom the retro orbital sinuses of the experimental rats and the serum was separated for further \nanalysis. The liver biomarkers namely aspartate transaminase (AST), alanine transaminase \n(ALT), alkaline phosphatase (ALP), lactate dehydrogenase (LDH), total bilirubin (TB), total \nprotein (TP), triglycerides (TG) and cholesterol were determined in the serum samples. All \nestimations were performed as per existing standard procedures. Key findings showed that \nparacetamol significantly (P < 0.001) increased the serum AST, ALT, ALP, LDH, TB, TG and \ncholesterol levels whereas decreased the TP levels. However, extract treatment significantly (P \n<0.001 to P <0.05) reversed the effects of paracetamol by showing a significant decrease in AST, \nALT, ALP, LDH, TB, TG and cholesterol levels and increased the levels of TP in a dose \ndependent manner. The standard drug, silymarin produced a significant (P <0.001) decrease in \nthe levels of AST, ALT, ALP, LDH, TB, TG and cholesterol while increasing the levels of TP. \nThe results indicate that the aqueous extract of A. polytricha have protective action against \nparacetamol induced hepatotoxicity in animal model. \n\n\n\n\n\n\n\n\n168\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPGP 03  \nMPSPSC2015000091 (Poster) \n\n\n\nAntioxidant Effect of Senna Surattensis Leaves Extract on Streptozotocin Induced Diabetic \nRats \n\n\n\nE Thilagam1, CT Kumarappan2, SC Mandal1 \n1Department of Pharmaceutical Technology, Jadavpur University, Kolkata, India \n2School of Pharmacy, Taylor\u2019s University, Subang Jaya, Malaysia \n \nSenna surattensis (Burmf.) of family Caesalpiniaceae is a common medicinal herb native to \ntropical Asia which is frequently used in folk medicine to treat various chronic diseases \nparticularly for diabetes mellitus. In the present study, the leaves of S. surattensis was used to \nevaluate its antioxidant and glucose lowering effect in Strepozotocin-nicotinamide induced \ndiabetic rats. Leaves of S. surattensis were extracted with ethanol and the crude extract (EESS) \nwas used for the treatment of diabetic rats. After 21 days of drug treatment, all the animals were \nsacrificed and antioxidant parameters were estimated in the liver and kidney tissues. All of the \nantioxidant parameters and blood glucose were compared with the diabetic control group. The \nprogression of diabetes was significantly reduced with EESS treatment. In treated rats, both \ndoses of EESS induced a significant reduction in serum glucose. Furthermore, EESS treatment \nincreased antioxidant levels in liver and kidney tissues, with concomitant decreases in levels of \nthiobarbituric acid-reactive (Lipid peroxidation) substances. The results of the present study \nindicate that ethanol extract of S. surattensis leaves possesses anti-hyperglycemic and \nantioxidant effect  and may be employed in protecting tissues against the oxidative damage \ninduced by diabetes mellitus. \n\n\n\n\n\n\n\n\n169\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPGP 04  \nMPSPSC2015000127 (Poster) \n \nAnti-inflammatory Activity of Sansevieria Trifasciata Leaves \n \nJJS Anbu, K Abdullah, K Anandarajagopal, A Fazalda  \nSchool of Pharmacy, KPJ Healthcare University College, Nilai, Malaysia \n \nTraditional medicines play an important role to combat serious ailments. Decoction of \nSansevieria trifasciata leaves (Ruscaceae) is used for inflammatory conditions in traditional \nChines medicine. The present study aimed to evaluate the traditional claim of anti-inflammatory \neffect of S. trifasciata leaves. The dried powdered of S. trifasciata leaves were extracted \nseparately with petroleum ether, methanol and distilled water for 6 days by cold maceration \ntechnique. The anti-inflammatory activity of the extracts was evaluated by carrageenan induced \npaw edema method using plethysmometer. Thirty minutes after the administration of extract and \nstandard drug diclofenac sodium, 0.1 mL of carrageenan suspension (1 %, V/V in normal saline) \nwas injected into the left hind paw sub-plantar region of control and test animals to induce the \npaw edema. The paw volume was measured immediately using plethysmometer (initial paw \nvolume), and thereafter the paw volume was measured every one hour for three hours. The anti-\ninflammatory activity was measured in terms of percentage inhibition of edema.  All the extracts \nof S. trifasciata leaves (200 mg/kg, p.o) exhibited anti-inflammatory activity (52.4-84.6% \nprotection) against carrageenan induced paw edema when compared with the standard drug \ndiclofenac sodium. The methanol extract showed highly significant (p<0.001) anti-inflammatory \nactivity followed by aqueous extract (p<0.01) and petroleum ether extract (p<0.05). The present \nstudy scientifically supports the traditional use of S. trifasciata leaves for the treatment of \ninflammation. These findings suggest the necessity of isolation of active chemical constituents \nand to find out the possible mechanism of action. \n  \n\n\n\n\n\n\n\n\n170\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPGP 05  \nMPSPSC2015000142 (Poster) \n\n\n\nPolyphenolic Extract of Ichnocarpus Frutescenes Leaves Modulates Peripheral Glucose \nUptake through GLUT Gene Transporters in Experimental Type 2 Diabetic Rats \n\n\n\nCT Kumarappan1, MJ Cini 2, MF Fazlin2, SC Mandal3 \n\n\n\n1School of Pharmacy, Taylor\u2019s University, Subang Jaya, Malaysia \n2School of Pharmacy, University Technologi Mara (UiTM), Puncak Alam, Malaysia \n3Department of Pharmaceutical Technology, Jadavpur University, Kolkata, India \n \nThe overall objective of this investigation was to characterize the antidiabetic effects of \npolyphenol extract (PPE) of Ichnocarpus frutescens in Streptozotocin (STZ)-Nicotinamide \ntreated eats at cellular and molecular levels. The positive findings corroborate its use for the \nprevention and treatment of diabetes mellitus in Ayurveda medicines. The total polyphenol \nextract of the plant leaf was tested for its antidiabetic activity for 30 days on the cellular and \nmolecular expression of glucose transporters in STZ (STZ; 45 mg/kg in 0.1 M citrate buffer, pH \n4.5, ip)-Nicotinamide (120 mg/kg, ip) induced diabetic rats. Glucose metabolism by the \nhepatocytes and adipocytes were analyzed by quantitative RT-PCR to gauge the levels of PCK1 \nand GLUT2 in the hepatocytes, and GLUT4 in the adipocytes. Daily oral administration of PPE \nsignificantly modified the fasting blood glucose (FBG) and glucogenesis process through \nGLUT2 and GLUT4 transporters. The exvivo study on glucose uptake by isolated hemi-\ndiaphragm revealed that glucose uptake mediated by PPE was significantly higher (43.65 \u00b13.60 \nmg/g tissue weight/30 min, p<0.05) that that of insulin (17.25\u00b12.25). The upregulation of \nGLUT2 revealed that increased glucose transport and the down regulation of PCK1 showed \ninvolvement of PPE in regulating gluconeogenesis in diabetic rats. The present investigation \nsuggests that the antidiabetic effect of PPE of I.frutescens is mediated through modulation of \nhepatic and adipocyte GLUT transporters in STZ-Nicotinamide induced Type II diabetic rats. It \nalso explains and confirms the basis for its traditional use by tribal community of southern India. \n\n\n\n\n\n\n\n\n\n\n\n\n\n171\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPGP 06  \nMPSPSC2015000038 (Poster) \n \nAugmentation of Humoral Immunity by an Ayurvedic Herbal Preparation, Anantamul \nSalsa In vitro  \n \nMM Rahman Sarker1,2, MS Kabir Choudhuri3, SA Vijay Jesuraj2, R Gayathri2, MM \nShahimi2,  N Satheesh Babu2,  NE Ismail2  \n1Division of Pharmaceutical Sciences, Okayama University, Okayama, Japan \n2Faculty of Pharmacy, Lincoln University College, Petaling Jaya, Malaysia \n3Department of Pharmacy, Jahangirnagar University, Dhaka, Bangladesh \n \nAnantamul Salsa (ANS), a polyherbal Ayurvedic preparation, is traditionally used for the \ntreatment of gonorrhea, syphilis, leprosy, skin diseases, blood poisoning and gout. Scientific \nreports on its therapeutic value specially, immunomodulating effect, has not been found. \nTherefore, the study evaluated the immunostimulating potential of ANS in vitro by measuring \nIgM production and splenocytes proliferation. Freshly prepared BALB/c mice splenocytes were \ntreated with 0.25, 0.5, 0.75, 1, 1.5, 2, 3, and 4% (v/v) of ANS in culture at 37 \u00baC and 5% CO2 for \n5 days. IgM production and cells proliferations were determined by ELISA and MTT methods, \nrespectively. The possibility of bacterial endotoxin (LPS) contamination in ANS was assessed by \nadding polymyxin B (PMB) during culture. ANS at 0.50-1.5% significantly augmented IgM \nproductions; the highest IgM enhancement was two-times higher at a dose of 0.50% compared to \ncontrol. ANS at 0.50, 0.75, 1.0, 1.5, 2.0 and 3.0% stimulated splenocytes proliferations by 1.98, \n1.64, 2.21, 2.0, 2.27 and 1.78 times, respectively. The IgM production ability of ANS was not \nretarded by PMB treatment. The study demonstrated that IgM production ability of ANS was not \ndue to the presence of bacterial endotoxin, rather owing to bioactive chemical(s) in ANS. \nHowever, higher doses of ANS (4%) showed cytotoxicity which resulted in a drastic decline of \nviable cells and consequently decreased IgM production. This is the preliminary and first report \non the immunostimulating potential of ANS. Anantamul Salsa may be useful in strengthening \nimmune responses in conditions of insufficient or impaired immunity. \n \n\n\n\n\n\n\n\n\n172\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPGP 07  \nMPSPSC2015000116 (Poster) \n\n\n\nA Pharmacokinetic Study of Antimycobacterial N\u2019-hexadecanoylisonicotinohydrazide \n\n\n\nHS Naveen Kumar1, AS Mohammed Ali2, V Gantala3, M Zaini Asmawi 2, I Pazilah2,  \nS Amirin2            \n1School of Pharmacy, Taylor\u2019s University, Subang Jaya, Malaysia \n2School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia \n3InvaGen Pharmaceuticals, New York, United States of America \n \nTuberculosis (TB) remains one of the major global health problems and causes serious illness \namong millions of people in each year. The emergence of multi-drug resistant and extensive \ndrug-resistant strains of M. tuberculosis, where TB patients are co-infected with human \nimmunodeficiency virus (HIV), poses a serious threat. In spite of the increasing worldwide \nincidence of TB, no new drugs have been brought to the market over the past four decades. \nTherefore, an attempt was made to synthesize new and effective isoniazid (INH) derivatives. In \nour previous studies, we identified N'-hexadecanoylisonicotinohydrazide (compound 2k) as \npotential antimycobacterial compound with minimum inhibitory concentration (MIC) of 0.1 \u00b5M \nand lethal dose (LD50) >5000 mg/kg. The pharmacokinetic study (PK) of compound 2k was \nconducted using N'-octadecanoylisonicotinohydrazide (compound 2m) as an internal standard. \nAn analytical method using HPLC and UV detection was developed for the estimation of the \ncompound 2k in plasma using solid phase extraction technique. The method was successfully \nvalidated and applied to evaluate the PK of compound 2k after oral and intravenous (I.V) \nadministration. Following I.V administration to the rats, the compound 2k was eliminated \ngradually from the body and mean half-life was 18.62 hours with larger volume of distribution \n(Vd), 274.32\u00b125.86 mL/kg compared to INH. After oral administration, compound 2k was \nabsorbed rapidly with the tmax of 1.92 hour and the absorption was incomplete with the calculated \nabsolute oral availability of 0.112%. This study will be helpful in understanding the PK of \npotential lipophilic drug candidates. \n  \n\n\n\n\n\n\n\n\n173\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPGP 08  \nMPSPSC2015000096 (Poster) \n\n\n\nEdaravone Attenuates Gentamicin-Induced Nephrotoxicity in Rats \n\n\n\nV Rajavel, HJ Lee, ZK Tan, WJ Lim \nFaculty of Pharmacy, AIMST University, Semeling, Malaysia. \n\n\n\nGentamicin is an antibiotic that exhibits a broad spectrum of activity. Use of gentamicin is now \nlimited due to its potential to induce nephrotoxicity by selective accumulation in the kidney. \nEdaravone is a potent anti-oxidant. It scavenges free radicals strongly, protecting the cells \nagainst oxidative stress. Therefore, this study was conducted to test the mentioned hypothesis of \nedaravone in gentamicin-induced nephrotoxicity in rats. Various parameters including animal \nbody weight, kidney weight, body weight to kidney ratio, serum creatinine, serum urea and \nhistopathology were analysed in nephrotoxic animals (induced with gentamicin 100 mg/kg/body \nweight, ip) with and without edaravone (10 mg/kg/body weight ip). Gentamicin control rats \nshowed that body weight and kidney weight decreased, while kidney weight to body weight \nratio, serum creatinine and serum urea increased significantly compared with the normal control \nrats. Moreover, marked renal histopathological abnormalities such as glomerulosclerosis, \nglomerular hypertrophy, tubular cell degeneration and renal arteriolar hyalinization were seen in \nthe gentamicin control rats. Edaravone attenuated the biochemical analyses such as, serum \ncreatinine and serum urea in treated rats. It also significantly reduced the kidney weight to body \nweight ratio. Renal histopathological abnormalities in the edaravone treated rats were reduced \ncompared with gentamicin control rats. Edaravone per se group did not show any toxicity to the \nrats. This study suggests that edaravone ameliorated renal structural and functional abnormalities \nassociated with gentamicin induced experimental nephrotoxicity. It was concluded that \nedaravone reduces nephrotoxicity caused by gentamicin. \n\n\n\n \n\n\n\n\n\n\n\n\n174\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPGP 09  \nMPSPSC2015000044 (Poster) \n\n\n\nPhytochemical and Toxicity Study of Standardized Extract of Epipremnum Aureum in \nRodents  \n\n\n\nKD Sreemoy, S Pinaki, RSM Moklesur, NE Ismail \nFaculty of Pharmacy, Lincoln University College, Petaling Jaya, Malaysia  \n \nEpipremnum aureum (Araceae) is commonly known as money plant, having indoor air pollution \nremoving capacity. The present study aimed to explore the acute and sub-chronic toxicity of \norally administered standardised ethanolic extract of E. aureum using Sprague Dawley rats. The \nphytochemical analysis of plant extract was performed using thin layer chromatography and \nstandard phytochemical screening techniques. In the 14-day acute toxicity study, the animals \nwere divided into four groups and each group received a dose of (50, 500, 2000) mg/kg except \ncontrol group which receives only 1% carboxymethyl cellulose. In case of sub chronic toxicity, \nthe animals were fed with extract (100, 600, and 1000 mg/kg per day for 28 days. The \nparameters measured included organ weight, biochemical test, haematological test and \nhistopathological observations. The qualitative TLC analysis and phytochemical screening \nrevealed the presence of tannins, saponins, terpinoids, flavonoids, phytosterols, glycosides and \nalkaloids along with few phenolic acids.  Acute oral administration of E. aureum did not show \nany mortality, CNS and ANS toxicities. Similarly, in subchronic toxicity studies, E. aureum did \nnot showed any significant differences between the control and extract treated groups in terms of \ntheir organ weight, haematological and biochemical parameters. Histopathological examination \ndid not reveal any remarkable and treatment related changes.  A no-observed adverse-effect level \nfor extract is 2000\u2009mg/kg under the conditions of this study. Therefore, the extract could be \nconsidered as safe at the doses administered since they did not provoke toxic effects. \n\n\n\n\n\n\n\n\n175\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPGP 10  \nMPSPSC2015000157 (Poster) \n\n\n\nDo Opioid Receptors Have a Role in the Anti-motility Effect of Pandanus Amaryllifolius in \nthe Guinea Pig Ileum?  \n\n\n\nPN Yeoh, KY Koh, YS Chen \nSchool of Pharmacy & School of Basic Medical Sciences, International Medical University, \nKuala Lumpur, Malaysia. \n\n\n\nPandanus amaryllifolius (PA), from Pandanaceae family, widely distributed in south-east Asia, \nis commonly used as a flavouring agent in cooking. An earlier study showed that the ethanolic \nextract of PA has anti-histaminergic and anticholinergic activity on the guinea pig ileum. This \nstudy investigated the effects of PA on opioid receptors in the guinea pig ileum. The isolated \nguinea pig ileum, suspended in organ baths containing aerated Krebs solution at 36.9\u00b0C was \nstimulated electrically. Different doses of morphine were injected into the organ baths in the \npresence of different doses of PA or selected antagonists, atropine, mepyramine or naloxone. The \ncontractions of the tissues were recorded using Powerlab. PA (1.0mg/mL, 2.5 mg/mL, 5.0 \nmg/mL and 10.0mg/mL) reduced the amplitude of contractions following repeated supra-\nmaximum stimulation, in the absence and presence of 10-7M mepyramine, 10-8M atropine and \n2.0\u00b5g/mL naloxone. Administration of naloxone (1.0 \u00b5g/mL and 2.0 \u00b5g/mL) which reversed the \nreduction of the amplitude of contractions due to 10 \u00b5g/mL of morphine, did not reverse the \neffect of PA, indicating no involvement of opioid receptors. The ethanolic extract of PA did not \ninteract with opioid receptors. Further studies should be conducted to determine the role of other \ntypes of receptors that could be involved in the action of PA on ileum. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n176\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\n \nPGP 11 \nMPSPSC2015000146 (Poster) \n \nIn Vitro Evaluation of Anticancer Properties of the (1R, 2R)-1-phenyl-2-\n(phenylamino)propane-1,3-diol Derivative (RB5) \n \nXY Lim, CW Mai, CO Leong, LC Wong \nSchool of Pharmacy, International Medical University, Kuala Lumpur, Malaysia \n  \nA series of novel nitrogen mustard derivatives was previously synthesised in collaboration with \nthe School of Applied Sciences, Northumbria University. One of the compounds, RB5, was \nevaluated for its anti-cancer activities in vitro. Cell proliferation assay was carried out against \nfifteen cancer cell lines; breast (MCF-7, MDA-MB-231, MDA-MB-468, HCC38), colon (HT-29, \nHT116, SW48, HCC2998), lung (A549, NCI-H23, NCI-H1299) and nasopharyngeal (HK1, \nSUNE1, CNE1, TWO1) using luciferase assay. Dose response curves for RB5 against \nnasopharyngeal cancer cells were constructed. Morphological changes in SUNE1 and NP460 \n(normal nasopharyngeal) cells treated with RB5 were observed by microscopic studies. Lastly, \nCell Death Detection ELISAPLUS kit was used to quantify the degree of necrosis and apoptosis in \ntreated SUNE1 cells. Cell proliferation assay showed that RB5 displayed more potent \ncytotoxicity than 5-fluorouracil on several cancer cell lines, particularly nasopharyngeal. Among \nnasopharyngeal cancer cells, RB5 displayed the highest potency towards SUNE1 with IC50 value \nof 12.35 \u00b1 3.55 \u00b5M. The selectivity of RB5 was assessed against SUNE1 and NP460 cells and \nwas found to induce selective cancer cell death as indicated by selectivity index of 1.70 and by \ncomparison of both dose response curves. Microscopic studies showed a decline in the number \nof viable treated SUNE1 cells but not in NP460 cells which further supported the notion that \nRB5 was selective for SUNE1 cells. RB5 was established to induce apoptosis in cancer cells via \nimmunoassay. The promising cytotoxicity and selectivity of RB5 makes it a potential lead \ncompound for anti-cancer drug design. \n  \n\n\n\n\n\n\n\n\n177\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPGP 12 \nMPSPSC2015000147 (Poster) \n \nIn Vitro Evaluation of Anticancer Properties of N-((1S,2S)-1,3-dichloro-1-phenylpropan-2-\nyl)aniline Derivative (RB8) \n \nNXF Lim, LC Wong, CW Mai, CO Leong  \nSchool of Pharmacy, International Medical University, Kuala Lumpur, Malaysia \n \nA series of nitrogen mustard derivatives was synthesized in collaboration with School of Applied \nSciences, Northumbria University. Among the derivatives, RB8 was selected for anticancer \nevaluation in this study. RB8 was screened for anticancer activity against 15 human cancer cell \nlines; breast (MCF-7, MDA-MB-231, MDA-MB-468, HCC38), colorectal (HT29, HCT116, \nSW48, HCC2998), lung (A549, H23, H1299) and nasopharyngeal (HK-1, SUNE-1, CNE-1, \nTWO-1) using cell viability assay. Dose response curves for percentage of cell viability of \nnasopharyngeal cancer (NPC) cells against RB8 were constructed. Morphological changes to \nSUNE-1 and its isogenic normal cell (NP460) upon treatment with negative control (1% DMSO) \nand 10\u00b5M RB8 were evaluated by microscopic studies. The mode of cancer cell death induced \nby RB8 was elucidated using Cell Death Detection ELISAPLUS kit. Results were analysed by \nANOVA followed by a post-hoc (Dunnett\u2019s) test with p<0.05 level of significance. RB8 \ndemonstrated more potent anticancer activity than 5-fluorouracil particularly on NPC cells. \nSUNE-1 cells had the lowest IC50 value (9.71 \u00b5M \u00b1 0.47) and highest selectivity ratio (2.14) \nupon RB8 treatment. Microscopic studies demonstrated reduction in cell number and cell \nshrinkage with SUNE-1 after 48 hours of RB8 treatment compared to 1% DMSO. No significant \nmorphological changes in NP460 cells for both groups were observed after 72 hours. RB8 \ninduces apoptotic cell death based on higher enrichment factor in apoptosis of up to 10.47 folds \ncompared to 1% DMSO while no changes were observed in necrosis. The promising cytotoxicity \nand selectivity of RB8 warrants further study on this compound. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n178\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPGP 13 \nMPSPSC2015000045 (Poster) \n \nAntiproliferative Activity of L-Glutaminase from Aeromonas Veronii on A549 and HT29 \nCell Lines \n \nSAV Jesuraj1, 2, NE Ismail1, MMR Sarker1, MJ Praya1, M Ravikumar3 \n1Faculty of Pharmacy, Lincoln University College, Petaling Jaya, Malaysia \n2Centre for Pharmaceutical Sciences, JNT University, Hyderabad, Telengana, India \n3Faculty of Pharmacy, Geethanjali College of Pharmacy, Keesara, Telengana, India \n \nRecently, L-glutaminase has attracted much attention because of its therapeutic and industrial \napplication. This enzyme catalyzes the deamination of L-glutamine to L-glutamic acid and \nammonium ions. It is found to be a potent drug for lymphocytic leukemia. We produced L-\nglutaminase from Aeromonas veronii by optimizing the physical and nutrient factors by \nsubmerged fermentation. The enzyme was purified and isolated from the medium by ammonium \nprecipitation followed by dialysis. Antiproliferative activity of L-glutaminase was assessed on \nA549 (human alveolar adenocarcinoma) and HT 29 (human colon) cancer cell lines. The cancer \ncell lines were treated with different concentrations of the enzyme (ranging from 5 to 80\u00b5g/mL) \nand cultured for 24 hours and cell viability was determined by MTT assay. DNA fragmentation \nanalysis was carried out to analyze the impact of the enzyme over the cell lines. The DNA of the \novernight treated cell lines was isolated using Purelink Genomic DNA isolation kit and subjected \nto gel electrophoresis in ethidium bromide prestained 1.5% agarose gel. It was viewed and \nphotographed by Gel imager. The antiproliferative activity of the enzyme on A549 was \nsignificantly higher than HT 29 cell lines (p<0.001). The IC50 of the enzyme was found to be \n35.9\u00b10.4 and 52.36\u00b10.39 \u00b5g/mL for A549 and HT29 cell lines, respectively. The DNA \nfragmentation patterns characterize the damage caused by the enzyme. The significant DNA \ncleavage implied apoptosis which was higher with A549 than HT 29 cells. \n  \n\n\n\n\n\n\n\n\n179\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPGP 14 \nMPSPSC2015000149 (Poster) \n \nIn Vitro Evaluation of the Anticancer Properties of the N-((1R,2R)-1,3-dichloro-1-\nphenylpropan-2-yl)aniline Derivative (RB9) \n \nSE Tay, LC Wong, CW Mai, CO Leong  \nSchool of Pharmacy, International Medical University, Kuala Lumpur, Malaysia. \n   \nA novel nitrogen mustard derivative, RB9, was synthesised in collaboration with the School of \nApplied Sciences, Northumbria University and was evaluated for anticancer activity. Fifteen \ncancer cell lines (MCF7, MDA-MB-231, MDA-MB-4678, HCC38, HT29, HCT116, SW48, \nHCC2998, A549, H23, H1299, HK1, SUNE-1, CNE-1, TWO1) were treated with RB9, 5-\nfluorouracil (positive control) and 1% DMSO (negative control). The anticancer activity of RB9 \nwas evaluated using luminescent cell viability assay. The morphological changes in cells treated \nwith RB9 were observed by microscopic studies. Cell Death Detection ELISAPLUS kit was used \nto determine the mode of cell death induced by RB9. Data obtained were analysed using one-\nway ANOVA, post-hoc Dunnett\u2019s test and independent sample t-test. RB9 was most potent \ntowards nasopharyngeal cancer cell lines. The lowest IC50 value (10.16 \u00b1 0.51\u00b5M) and highest \nselectivity ratio (1.96) was observed in SUNE-1 cells. RB9 halted growth of SUNE-1 cells at the \n24th hour and the number of cells was observed to decrease compared to negative control group \nas indicated by microscopic studies. However, RB9 did not cause significant changes on the \ngrowth and number of normal nasopharyngeal NP460 cells in both groups. RB9 induced \napoptotic cell death rather than necrosis on SUNE-1 cells as it induced apoptotic markers of up \nto 2.97 folds compared to negative control group while there was no significant changes in \nnecrotic markers. In conclusion, RB9 exhibits promising anticancer properties. However, further \nstructural modification is required to improve its cytotoxicity towards cancer cells. \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n\n\n\n\n\n180\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPGP 15 \nMPSPSC2015000109 (Poster) \n \nBiological Screening of Malaysian Green Mussels (Perna Viridis)  \n \nV Krishnamoorthy1, P Subramani1, V Palanimuthu1, R Veersamy1, A Tan2, S Revendran1, \nL Gunasegaran1, LC Ling1 and HO Suat1 \n1Faculty of Pharmacy, AIMST University, Kedah, Malaysia \n2School of Biological Sciences , Universiti Sains Malaysia, Penang, Malaysia \n \nOcean is an exceptional reservoir and richest source of unique novel biomolecules with \ndiversified applications. Green mussels (Perna Viridis) have been widely reported as a \nbiomarker in assessing marine pollution and investigated for its bioadhesive mechanisms with \nfew works reporting on its therapeutic activity. An attempt has been made in this work to explore \nthe biological potential of Malaysian green mussel and its commercial utilization. Mussel \nsamples were collected from floating structures and shore defense walls in and around Penang, \nauthenticated and maintained under aerated conditions in simulated sea water. The shells were \ncracked open and whole body of the animals were removed and washed with autoclaved distilled \nwater. The whole body with soft tissues were excised and homogenized in a homogenizer. The \nhomogenate was macerated with methanol for period of 48 hours and precipitated by using ice \ncold acetone. The precipitate was washed repeatedly with organic solvent and dried to give a \nresidue. The residue was screened for antibacterial activity against six bacterial strains viz. \nEscherichia coli, Pseudomonas aeruginosa, Streptococcus pyogene, Klebsiella pneumoniae, \nBacillus subtilis and Vibrio cholera using standard agar disc diffusion method. The results \nproved that the extracts exhibited a significant activity against Gram negative bacteria rather than \nthe Gram positive ones. Physicochemical characterization of the extract was carried out by \nsolubility studies, X-ray Diffraction (XRD), Differential Scanning Calorimetry (DSC) and FT-IR \nanalysis. The results proved that more studies are imminent to unlock the biopotential of \nMalaysian green mussels.    \n \n \n \n \n \n  \n\n\n\n\n\n\n\n\n181\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPGP 16 \nMPSPSC2015000161 (Poster) \n\n\n\nNatural Compound 2,2'-Oxybis (4-allyl-1-methoxybenzene), Biseugenol B, from Litsea \ncostalis Induces Apoptosis through Activation of Intrinsic, Extrinsic and NF-kB Signaling \nPathways on Human Prostate Cancer PC3 Cells In Vitro \n\n\n\nM Abbaspour Babaei , H Zaman Huri \nDepartment of Pharmacy. University of Malaya, Kuala Lumpur, Malaysia \n                                                                                                        \nApoptosis is the central cellular process in the pathogenesis of cancer. The main cause of cancer \noriginates through uncontrolled cell proliferation and inhibition of cell apoptosis pathways. \nProstate cancer is the second most common type of cancer and fifth leading cause of cancer-\nrelated death in men globally. This study evaluated the efficacy of biseugenol B, isolated from \nLitsea costalis bark, to inhibit PC3 human prostate cancer cell and identify the apoptosis \nsignaling pathways responsible for its toxicity in vitro. Biseugenol B-induced cell viability was \nevaluated using MTT assay. The apoptosis-induction effect of biseugenol b detected using \nAnnexin V and cell cycle arrest analysis using flow cytometry. The protein expression levels of \nBax, Bcl2 and Hsp70 were detected by western blotting. The mechanisms of apoptosis are \ninvestigated by measuring the levels of caspase-7, -8 and -9 and NF-kB. The results showed that \nbiseugenol B-induced apoptosis in PC3 cells was mediated by apoptosis signals that regulate \nMMP through the release of cytochrome c from mitochondria to cytosol, resulted in down-\nregulation of Bcl2 and up-regulating of bax. The release of cytochrome c also resulted in \ncaspase-9 activating which consequently activated caspase-7, leading to apoptosis. This form of \napoptosis is associated with the intrinsic pathway and inhibition of NF-kB translocation from the \ncytoplasm to the nucleus whereas, activating of caspase-8 via death-cell receptor is closely \nrelated to extrinsic apoptosis signaling pathway. In conclusion, biseugenol B has potential for \nfuture chemoprevention studies, which may lead to the discovery of more cancer management \nstrategies. \n  \n\n\n\n\n\n\n\n\n182\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nPGP 17  \nMPSPSC2015000041 (Poster) \n \nAntidiabetic and Lipid Lowering Potential of Brassica Oleracea var. Italica in Type 2 \nDiabetic Sprague-Dawley (SD) Rats \n \nM Ahmad Shah1, MM Rahman Sarker2, M Gousuddin2 \n1Department of Biomedical Sciences, Faculty of Medicine & Health Sciences, Lincoln University \nCollege, Petaling Jaya, Selangor, Malaysia \n2Faculty of Pharmacy, Lincoln University College, Petaling Jaya, Selangor, Malaysia \n \nIt has been reported that Brassica oleracea var. Italica (family Brassiceae) exhibited \nantimicrobial and anticancer properties but antidiabetic activities have not yet been extensively \nexplored. The present study was designed to investigate the antidiabetic and lipid lowering \npotential of Brassica oleracea var. Italica in type 2 diabetic Sprague-Dawley (SD) rats. Type 2 \ndiabetes mellitus was induced in SD rats with high fat diet and injecting a low dose of \nstreptozocin. Diabetic rats were treated with Brassica oleracea var. Italica ethanol extracts at the \ndoses of 200, 400, 600, and 800 mg/kg of body weight for 28 days. Metformin was used as a \nstandard antidiabetic drug. Fasting blood glucose, oral glucose tolerance, glycated haemoglobin, \nserum insulin, triglycerides, total cholesterol, high density lipoprotein cholesterol and low \ndensity lipoprotein cholesterol were determined from the serum by using standard kits. After \n28th day, daily administration of Brassica oleracea var. Italica in diabetic treated SD rats \nshowed improvement in body weight and water intakes compared to diabetic control rats. \nMoreover, Brassica oleracea var. Italica extract showed potent lipid lowering activities in this \nstudy. The extract significantly reduced the serum triglyceride (P<0.01), total cholesterol \n(P<0.001) and low density lipoprotein cholesterol (P<0.001) and increases high density \nlipoprotein cholesterol (P<0.01) and serum insulin (P<0.001).The study demonstrated that \nethanol extract of Brassica oleraceae possessed potential antidiabetic and lipid lowering \nactivities. Therefore, the administration of Brassica oleraceae as vegetable or its extract would \nbe beneficial for the management of hyperglycaemia and hyperlipidaemia. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n"
"\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nMal J Pharm . Volume 1 Issue 7 . June 2009 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of Pharmacy \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nA Publication of Malaysian Pharmacists Society \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nCamScanner\n\n\n\n\nhttps://v3.camscanner.com/user/download\n\n\n\n\n\n\nCamScanner\n\n\n\n\nhttps://v3.camscanner.com/user/download\n\n\n\n\n\n\nCamScanner\n\n\n\n\nhttps://v3.camscanner.com/user/download\n\n\n\n\n\n\nCamScanner\n\n\n\n\nhttps://v3.camscanner.com/user/download\n\n\n\n\n\n\nCamScanner\n\n\n\n\nhttps://v3.camscanner.com/user/download\n\n\n\n\n\n\nCamScanner\n\n\n\n\nhttps://v3.camscanner.com/user/download\n\n\n\n\n\n\nCamScanner\n\n\n\n\nhttps://v3.camscanner.com/user/download\n\n\n\n\n\n\nCamScanner\n\n\n\n\nhttps://v3.camscanner.com/user/download\n\n\n\n\n\n\nCamScanner\n\n\n\n\nhttps://v3.camscanner.com/user/download\n\n\n\n\n\n\nCamScanner\n\n\n\n\nhttps://v3.camscanner.com/user/download\n\n\n\n\n\n\nCamScanner\n\n\n\n\nhttps://v3.camscanner.com/user/download\n\n\n\n\n\n\nCamScanner\n\n\n\n\nhttps://v3.camscanner.com/user/download\n\n\n\n\n\n\nCamScanner\n\n\n\n\nhttps://v3.camscanner.com/user/download\n\n\n\n\n\n\nCamScanner\n\n\n\n\nhttps://v3.camscanner.com/user/download\n\n\n\n\n\n\nCamScanner\n\n\n\n\nhttps://v3.camscanner.com/user/download\n\n\n\n\n\n\nCamScanner\n\n\n\n\nhttps://v3.camscanner.com/user/download\n\n\n\n\n\n\nCamScanner\n\n\n\n\nhttps://v3.camscanner.com/user/download\n\n\n\n\n\n\nCamScanner\n\n\n\n\nhttps://v3.camscanner.com/user/download\n\n\n\n\n\n\nCamScanner\n\n\n\n\nhttps://v3.camscanner.com/user/download\n\n\n\n\n\n\nCamScanner\n\n\n\n\nhttps://v3.camscanner.com/user/download\n\n\n\n\n\n\nCamScanner\n\n\n\n\nhttps://v3.camscanner.com/user/download\n\n\n\n\n\n\nCamScanner\n\n\n\n\nhttps://v3.camscanner.com/user/download\n\n\n\n\n\n\nCamScanner\n\n\n\n\nhttps://v3.camscanner.com/user/download\n\n\n\n\n\n\nCamScanner\n\n\n\n\nhttps://v3.camscanner.com/user/download\n\n\n\n\n\n\nCamScanner\n\n\n\n\nhttps://v3.camscanner.com/user/download\n\n\n\n\n\n\nCamScanner\n\n\n\n\nhttps://v3.camscanner.com/user/download\n\n\n\n\n\n\nCamScanner\n\n\n\n\nhttps://v3.camscanner.com/user/download\n\n\n\n\n\n\nCamScanner\n\n\n\n\nhttps://v3.camscanner.com/user/download\n\n\n\n\n\n\nCamScanner\n\n\n\n\nhttps://v3.camscanner.com/user/download\n\n\n\n\n\n\nCamScanner\n\n\n\n\nhttps://v3.camscanner.com/user/download\n\n\n\n\n \nCover Vol1I7 2009\n\n\nMJP Vol 1 Issue 7 2009-Table of content\n\n\nMJP Vol 1 Issue 7 2009-1\n\n\nMJP Vol 1 Issue 7 2009-2\n\n\nMJP Vol 1 Issue 7 2009-3\n\n\nMJP Vol 1 Issue 7 2009-4\n\n\n\n"
"\n\nMalaysian Journal of Pharmacy Volume 8 Issue 1 (2022) \n \n\n\n\n\n\n\n\n38 \n\n\n\n\n\n\n\n*Correspondence: hueymiin@moh.gov.my \n1 Department of Pharmacy, Hospital Sultan Haji Ahmad Shah \nJalan Maran, Temerloh, 28000 Pahang, Malaysia \n2 Faculty of Pharmacy, Universiti Kebangsaan Malaysia, 50300 Kuala \n\n\n\nLumpur, Federal Territory of Kuala Lumpur, Malaysia.  \n \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n Case Report \n\n\n\n\n\n\n\nBeware of Triple Whammy  \n \n\n\n\nHuey Miin Cheah1*, Farida Hanim Islahudin2 \n\n\n\n\n\n\n\n \nArticle Info  \n\n\n\n \nReceived date: 18 Nov 2021  \n\n\n\nAccepted date: 10 May 2022 \n\n\n\nPublished date: 30 Jun 2022 \n\n\n\n\n\n\n\nKeywords: Acute renal failure; \n\n\n\ndiuretic; RAAS; NSAID; triple \n\n\n\nwhammy.  \n\n\n\nABSTRACT  \n\n\n\n\n\n\n\nThe term \u201ctriple whammy\u201d refers to a drug interaction following the concurrent use of angiotensin-\n\n\n\nconverting enzyme inhibitors or angiotensin-II receptor blockers, diuretics and non-steroidal anti-\n\n\n\ninflammatory drugs, the combination of which greatly increases the odds of acute kidney injury. \n\n\n\nHere, we report a case of a 66-year-old gentleman who was admitted into a tertiary care hospital for \n\n\n\nelective orthopaedic intervention. He had previously been prescribed sacubitril/valsartan and \n\n\n\nfrusemide and had newly been started on celecoxib during hospitalisation. Upon the initiation of \n\n\n\ncelecoxib, a mild increase in his serum creatinine was immediately observed, and this occurrence is \n\n\n\nbelieved to be due to the \u201ctriple whammy\u201d combination. The combination of perindopril, frusemide \n\n\n\nand celecoxib continued to be overlooked throughout his hospitalisation. He was subsequently \n\n\n\nplanned to be discharged with celecoxib on top of his existing chronic medications. However, upon \n\n\n\ndischarge, the dispensing pharmacist took notice of the drug interaction and successfully intervened \n\n\n\nto withhold celecoxib. \n\n\n\n\n\n\n\n\n\n\n\nINTRODUCTION  \n\n\n\n\n\n\n\n\u201cTriple whammy\u201d refers to a drug interaction following the \n\n\n\nconcurrent use of angiotensin-converting enzyme inhibitors \n\n\n\n(ACEIs) or angiotensin-II receptor blockers (ARB), diuretics \n\n\n\nand non-steroidal anti-inflammatory drugs (NSAID). \n\n\n\nIndividually, they pose a relatively small risk of acute kidney \n\n\n\ninjury (AKI), but in combination, the risk increases \n\n\n\nsubstantially [1]. \n\n\n\n\n\n\n\nThe combined use of NSAID, diuretics and ACEIs or ARBs \n\n\n\ncan potentiate AKI due to their compounding effects on \n\n\n\nreduced renal blood flow and glomerular filtration rate. \n\n\n\nIndividually, ACEIs and ARBs inhibit angiotensin II-mediated \n\n\n\nefferent arteriolar vasoconstriction, whilst NSAID inhibits \n\n\n\nprostaglandin-mediated afferent arteriolar vasodilation, both of \n\n\n\nwhich are capable of reducing blood flow to the kidney. \n\n\n\nDiuretics act by increasing the excretion of water and sodium \n\n\n\nfrom the body, decreasing the plasma volume. This plasma \n\n\n\nvolume reduction, when occurring in tandem with a reduced \n\n\n\nblood flow through the use of both ACEIs or ARBs and \n\n\n\nNSAIDs in combination, could increase the risk of AKI [1,2]. \n\n\n\n\n\n\n\nIn this paper, we report a case of an overlooked triple whammy \n\n\n\nin an inpatient setting. \n\n\n\n\n\n\n\nCASE DESCRIPTION  \n\n\n\n\n\n\n\nA 66-year-old gentleman was referred for hospital admission \n\n\n\nfrom an orthopaedic clinic for wound debridement and ray \n\n\n\namputation of the big toe and third toe of his left leg. Foot \n\n\n\nexamination in the clinic revealed a non-infected wound of the \n\n\n\nleft foot with dry gangrene at the big and third toes. \n\n\n\n\n\n\n\nThe baseline laboratory investigations at the clinic were as \n\n\n\nfollows: white blood cell count 7.1 x 109 / L, haemoglobin 14 \n\n\n\ng / dL, platelet 342 x 109 / L, urea 7.4 mmol / L, sodium 138 \n\n\n\nmmol / L, potassium 5.42 mmol / L, chloride 106 mmol / L and \n\n\n\ncreatinine 105 \ud835\udf7bmol / L. The patient\u2019s coagulation profile was \n\n\n\nnormal, and his body temperature reading was normal at 37\u2103. \n\n\n\nIn terms of cardiovascular parameters, his systolic blood \n\n\n\npressure was 107 mmHg, with a diastolic blood pressure of 65 \n\n\n\nmmHg, and a pulse rate of 59 beats per minute. His respiratory \n\n\n\nrate was 20 breaths per minute, with SpO2 of 100% under room \n\n\n\nair. Furthermore, he had a pain score of 1 out of 10, a capillary \n\n\n\n\n\n\n\n\nCheah H.M. and Islahudin F.H. Mal J Pharm 8 (1) 2022, 38-41 \n\n\n\n\n\n\n\n39 \n\n\n\n\n\n\n\nblood glucose level of 9.6 mmol / L and a mean arterial pressure \n\n\n\nof 79. \n\n\n\n\n\n\n\nHe had a documented medical history of type 2 diabetes \n\n\n\nmellitus, hypertension, bronchial asthma, myocardial \n\n\n\ninfarction, and bilateral peripheral vascular disease. \n\n\n\nMeanwhile, his medication history included dual anti-platelets, \n\n\n\nsimvastatin, sacubitril/valsartan, trimetazidine, frusemide, \n\n\n\nbisoprolol, isosorbide mononitrate, empagliflozin, sublingual \n\n\n\nglyceryl trinitrate and insulins. However, the prescriber had \n\n\n\nbeen unaware of his medication history and only continued \n\n\n\naspirin (100mg, once daily), frusemide (40mg, once daily), \n\n\n\ninsulin (short-acting, 16IU, three times daily), insulin \n\n\n\n(intermediate-acting, 16IU, at night), perindopril (2mg, once \n\n\n\ndaily) and atorvastatin (40mg, once daily) in the ward. \n\n\n\nMeanwhile, intravenous amoxicillin plus clavulanate (1200mg, \n\n\n\nthree times daily), paracetamol (1000mg, four times daily) and \n\n\n\ncelecoxib (200mg, when required) were also started as \n\n\n\nprophylactic antibiotic and analgesics. Wound debridement \n\n\n\nand ray amputation were performed on the second day of \n\n\n\nadmission with no complications. \n\n\n\n\n\n\n\nOn the first day of admission, he developed hyperkalaemia \n\n\n\n(potassium 6.31 mmol / L) along with a mild increase in serum \n\n\n\ncreatinine from 105 to 121\ud835\udf7bmol / L after just a single dose of \n\n\n\ncelecoxib. A lytic cocktail was given, and consequently, his \n\n\n\npotassium was reduced to 4.43 mmol / L. \n\n\n\n\n\n\n\nThe mild AKI had gone unnoticed until the third day of \n\n\n\nadmission during a morning review by the specialist. The \n\n\n\nspecialist reportedly ordered that an urgent renal profile be \n\n\n\nobtained, which came back with the following results: urea 8.4 \n\n\n\nmmol / L, sodium 135 mmol / L, potassium 4.29 mmol / L, \n\n\n\nchloride 102 mmol / L and creatinine 108 \ud835\udf7bmol / L. A total of \n\n\n\nthree doses of celecoxib had been given throughout the \n\n\n\nhospitalisation. \n\n\n\n\n\n\n\nDuring his admission, he had also developed episodes of \n\n\n\nhypertension urgency, with recorded systolic blood pressure \n\n\n\nreadings being in the range of 190 to 195 mmHg. To alleviate \n\n\n\nthis issue, short-acting antihypertensives were given \n\n\n\nimmediately. In the process, the inadvertent omission of the \n\n\n\npatient\u2019s antihypertensives (bisoprolol, sacubitril / valsartan, \n\n\n\nisosorbide mononitrate) remained unnoticed. On the third day \n\n\n\nof admission, it was noted that the patient had one episode of \n\n\n\nhypoglycaemia due to a missed meal after the insulin injection \n\n\n\nat night. Insulin was then withheld in the morning that followed \n\n\n\nbut restarted at a lower dose at midday since the patient\u2019s \n\n\n\nglucose level rose to 12.8 mmol / L before lunch. \n\n\n\n\n\n\n\nThe patient was discharged on the fourth day of admission in \n\n\n\nan afebrile state with the following oral medications: \n\n\n\namoxicillin plus clavulanate, celecoxib and paracetamol. The \n\n\n\ndispensing pharmacist noticed the triple whammy combination \n\n\n\nand intervened. The intervention was agreed upon by the \n\n\n\nprescriber, and celecoxib was withheld. \n\n\n\n\n\n\n\nDISCUSSION \n\n\n\n\n\n\n\nThe term \u201ctriple whammy\u201d was first coined by Merlin C \n\n\n\nThomas in 2000 following the observation that two patients \n\n\n\ndemonstrated signs of kidney injury following the concurrent \n\n\n\nuse of ACEIs or ARB, diuretics and NSAID. In a literal sense, \n\n\n\n\u201ctriple whammy\u201d bears the meaning of three simultaneous, \n\n\n\ndeleterious blows with a compounded effect [2]. Since the \n\n\n\nestablishment of the term, similar reports of \u201ctriple whammy\u201d \n\n\n\nhad appeared worldwide involving a reduced creatinine \n\n\n\nclearance in patients taking the three medicines together \n\n\n\n[3,4,5,6], with fatality rates allegedly being as high as 10%, as \n\n\n\nreported by the Australian Adverse Drug Reactions Advisory \n\n\n\nCommittee (ADRAC) [6]. Several risk factors for renal failure \n\n\n\nin \u201ctriple whammy\u201d cases were identified, including old age, \n\n\n\nchronic kidney disease, dehydration, digoxin toxicity, acute \n\n\n\nillness and the recent addition of an NSAID to the existing \n\n\n\nACEIs/ARB and diuretics regimen [7]. \n\n\n\n\n\n\n\nThe prevalence of detected \u201ctriple whammy\u201d occurrences in \n\n\n\nMalaysia is 0.5% [8], which is a figure that corresponds to \n\n\n\nfindings from New Zealand (0.2%) [9]and Japan (0.3%) [10]. \n\n\n\nDespite the relatively low prevalence, \u201ctriple whammy\u201d drugs \n\n\n\n(when used individually or in combination) are involved in \n\n\n\nover 50% of cases involving iatrogenic AKI reported to the \n\n\n\nADRAC [6]. Moreover, a previous survey conducted at a \n\n\n\ngovernment-funded district hospital located in the central part \n\n\n\nof Klang Valley, Malaysia found that 40.1% of outpatient \n\n\n\nprescriptions contained both ACEIs and diuretics [8]. This \n\n\n\nsuggests the possibility that undetected \u201ctriple whammy\u201d cases \n\n\n\nmay be higher than anticipated, especially since the availability \n\n\n\nand widespread use of NSAIDs for pain or fever, particularly \n\n\n\nwithout appropriate screening, can potentially place patients \n\n\n\nwho are on antihypertensives such as ACEi, ARB and diuretics \n\n\n\nat risk of AKI following its use. \n\n\n\n\n\n\n\nAt the point of writing, available evidence does not suggest that \n\n\n\na particular NSAID is more beneficial than another in terms of \n\n\n\nposing a lesser risk for AKI. All NSAIDs pose a risk to renal \n\n\n\nfailure following both short-term (adjusted odds ratio, OR 1.82; \n\n\n\n95% CI 1.68 - 1.98) and long-term usage (adjusted OR 1.86; \n\n\n\n95% CI 1.72 - 2.01) [11]. Of all the NSAIDs, ibuprofen \n\n\n\n(adjusted OR 1.69; 95% CI 1.35 - 2.11), indomethacin \n\n\n\n(adjusted OR 2.15; 95% CI 1.66 - 2.78) and sulindac (adjusted \n\n\n\nOR 1.85; 95% CI 1.06 - 3.24) are found to be more likely to \n\n\n\nresult in AKI as compared to celecoxib, a selective \n\n\n\ncyclooxygenase-2 (COX-2) inhibitor [12]. Although several \n\n\n\nobservational studies had concluded that celecoxib \n\n\n\noutperformed non-selective NSAIDs [11,12,13,14] with \n\n\n\nregards to AKI risks, the risk difference across NSAIDs was \n\n\n\nnot statistically significant, and with overlapping confidence \n\n\n\n\n\n\n\n\nCheah H.M. and Islahudin F.H. Mal J Pharm 8 (1) 2022, 38-41 \n\n\n\n\n\n\n\n40 \n\n\n\n\n\n\n\nintervals. In fact, compared to non-NSAIDs users, a celecoxib-\n\n\n\nuser is associated with adjusted odds 1.54 (95% CI 1.14 - 2.09), \n\n\n\nmeloxicam-user with adjusted odds 1.27 (95% CI 0.36 - 4.45), \n\n\n\nnaproxen-user with adjusted odds 2.42 (95% CI 1.52 - 3.85), \n\n\n\nrofecoxib-user with adjusted odds 2.31 (95% CI 1.73 - 3.08) \n\n\n\nand users of other non-selective COX inhibitors with adjusted \n\n\n\nodds 2.3 (95% CI 1.6 - 3.32). [13]. In addition, care should also \n\n\n\nbe exercised when interpreting the results as misclassification \n\n\n\nbias might follow with the use of prescription database analysis \n\n\n\nsince the usage of over-the-counter medications cannot be \n\n\n\nidentified. Therefore, there is no conclusive evidence pointing \n\n\n\ntowards the superiority of one NSAID over the other class in \n\n\n\nterms of selectivity or duration of action. \n\n\n\n\n\n\n\nWith regards to the case reported in this study, the patient \n\n\n\nshowed an acute increase in creatinine level, but the increment \n\n\n\ndid not fulfil the requisite level to be defined as an incident of \n\n\n\nAKI, with respect to definitions set by the Risk, Injury, Failure, \n\n\n\nLoss, End-Stage (RIFLE) criteria, the Acute Kidney Injury \n\n\n\nNetwork (AKIN) or the Kidney Disease Improving Global \n\n\n\nOutcomes (KDIGO). The 15.2% increase in serum creatinine \n\n\n\nwas probably attributed to the ingestion of \u201ctriple whammy\u201d \n\n\n\ncombination, which may have been exacerbated by his \n\n\n\nunderlying heart failure as another risk factor for AKI. \n\n\n\nFortunately, however, his serum creatinine readings recovered \n\n\n\nto his baseline serum creatinine after two days, coinciding with \n\n\n\nthe withdrawal of celecoxib from the regime. Despite this, it \n\n\n\ncannot be doubted that the combination of \u201ctriple whammy\u201d \n\n\n\ndrugs presents an independent risk factor for AKI [2,3,5,10]. \n\n\n\nTherefore, in more unfortunate situations as far as the currently \n\n\n\nreported case is concerned, such as if a slight change in \n\n\n\nhaemodynamic parameters were to occur (such as in \n\n\n\nhypoperfusion), a full-blown lethal complication could have \n\n\n\nensued. In fact, Lapi et al. demonstrated that a \u201ctriple whammy\u201d \n\n\n\ncould increase the risk of AKI by 31%, with the highest risk of \n\n\n\nAKI occurrence being within 30 days after the commencement \n\n\n\nof the combination therapy [15]. \n\n\n\n\n\n\n\nPatients above 65 years of age, such as in this case, are \n\n\n\nespecially susceptible to this drug interaction. In fact, it has \n\n\n\nbeen found that, of all the outpatient prescriptions with a \n\n\n\ncombination of ACEI and diuretics, 21.7% of them consist of \n\n\n\nelderly patients [8]. Moreover, common chronic medical \n\n\n\nillnesses such as chronic kidney disease, type 2 diabetes \n\n\n\nmellitus, hypertension, heart failure and arthritis are more \n\n\n\nprevalent with increasing age. Unsurprisingly, people with one \n\n\n\nor more of the above medical conditions are more likely to take \n\n\n\none or all the \u201ctriple whammy\u201d medicines. Elderly patients are \n\n\n\nalso noted to have less-than-sufficient renal function, which \n\n\n\ncould also predispose them to an increased risk of AKI [16]. \n\n\n\n\n\n\n\nIn this case, the patient is treated with ACEIs or ARB for their \n\n\n\nrenal and cardio-protective effects, likely on account of his \n\n\n\ndiabetes and prior history of myocardial infarction. Steps \n\n\n\nshould be taken to review the use of frusemide and celecoxib. \n\n\n\nSince the patient\u2019s reported pain score at discharge was 1 to 2 \n\n\n\n(from a scale of 10), which was by no means high, the use of \n\n\n\ncelecoxib was brought into question for this case, prompting \n\n\n\nthe pharmacist to suggest paracetamol as a maintenance \n\n\n\ntherapy to replace celecoxib. Meanwhile, frusemide was left \n\n\n\nintact until his next visit to the cardiologist to reassess its \n\n\n\nnecessity. \n\n\n\n\n\n\n\nA few other steps could have been taken to improve \n\n\n\npharmaceutical care in this case. Firstly, the hypertensive \n\n\n\nepisodes observed in this patient could have been avoided if his \n\n\n\npre-admission antihypertensives were reinstated in a timely \n\n\n\nmanner. Furthermore, pharmacists should record the \n\n\n\nmedication history of patients within 24 hours of admission. \n\n\n\nThe complete medication history should also be made available \n\n\n\nfor all healthcare professionals to ensure a smooth transition of \n\n\n\ncare. The \u201ctriple whammy\u201d combination, as it occurs in this \n\n\n\ncase, could have been avoided if more careful attention is given \n\n\n\nby pharmacists on the patient\u2019s medical records. Finally, the \n\n\n\npatient\u2019s insulin therapy should be given more emphasis, and \n\n\n\nhis meals should be given more attention in order to avoid \n\n\n\nhypoglycaemia following a reduction in oral intake during \n\n\n\nhospitalisation. \n\n\n\n\n\n\n\nCONCLUSION  \n \n\n\n\nIn conclusion, pharmacists play a significant role in patient care \n\n\n\nas medication experts and the guardian of medication safety. \n\n\n\nPharmacists should always pay attention to ensure that \n\n\n\nmedications are screened on admission, during hospitalisation \n\n\n\nand on discharge to ascertain the appropriateness of \n\n\n\nmedications in each stage. This could aid in reducing drug \n\n\n\ninteractions and adverse reactions, while also allowing for the \n\n\n\nprovision of appropriate advice to prescribers in order to reduce \n\n\n\nrisk of potential pitfalls and prevent medication misadventure. \n\n\n\n\n\n\n\nACKNOWLEDGEMENT \n\n\n\n\n\n\n\nWe would like to thank the Director General of Health \n\n\n\nMalaysia for the permission to publish this article. \n\n\n\n\n\n\n\nCONFLICT OF INTEREST \n \n\n\n\nThe authors have no conflicts of interest to declare. This \n\n\n\nresearch did not receive any specific grant from funding \n\n\n\nagencies in public, commercial or not-for-profit sectors. \n\n\n\n\n\n\n\nREFERENCE \n \n\n\n\n[1] Prieto-Garc\u00eda L, Pericacho M, Sancho-Mart\u00ednez SM, et al. \n\n\n\nMechanisms of triple whammy acute kidney injury. Pharmacol Ther. \n\n\n\n2016;167:132-145. https://doi.org/10.1016/j.pharmthera.2016.07.011 \n\n\n\n\nhttps://doi.org/10.1016/j.pharmthera.2016.07.011\n\n\n\n\n\n\nCheah H.M. and Islahudin F.H. Mal J Pharm 8 (1) 2022, 38-41 \n\n\n\n\n\n\n\n41 \n\n\n\n\n\n\n\n[2] Thomas MC. Diuretics, ACE inhibitors and NSAIDs \u2013 the triple \n\n\n\nwhammy. Med J Aust. 2000;172:184\u20135.  \n\n\n\nhttps://doi.org/10.5694/j.1326-5377.2000.tb125548.x \n\n\n\n[3] Loboz KK, Shenfield GM. Drug combinations and impaired renal \n\n\n\nfunction -- the 'triple whammy'. Br J Clin Pharmacol. 2005;59(2):239-\n\n\n\n243. https://doi.org/10.1111/j.0306-5251.2004.2188.x \n\n\n\n[4] Gareri P, Ruotolo G, Castagna A, Manfredi V, Merante A. A Fatal \n\n\n\nCase of Triple Whammy in an Elderly Patient. J Gerontol Geriatr Res. \n\n\n\n2015;4(204):2. https://doi.org/10.4172/2167-7182.1000204 \n\n\n\n[5] Fournier J-P, Sommet A, Durrieu G, Poutrain J-C, Lapeyre-Mestre M, \n\n\n\nMontastruc J-L. More on the \u201cTriple Whammy\u201d: antihypertensive \n\n\n\ndrugs, non- steroidal anti-inflammatory agents and acute kidney \n\n\n\ninjury-a case/non-case study in the French pharmacovigilance \n\n\n\ndatabase. Ren Fail. 2014;36(7):1166-68.  \n\n\n\nhttps://doi.org/10.3109/0886022X.2014.917943 \n\n\n\n[6] Australian Adverse Drug Reactions Advisory Committee. ACE \n\n\n\ninhibitor, diuretic and NSAID: a dangerous combination. Aust Adv \n\n\n\nDrug React Bull 2003; 22(4):14-15. \n\n\n\n[7] Australian Adverse Drug Reactions Advisory Committee. Beware the \n\n\n\ntriple whammy! Aust Adv Drug React Bull 2006; 25(5):18 \n\n\n\n[8] Zulkifly HH, Mat Zaid H, Kassab YW, Long CM,  Ismail NE & \n\n\n\nShaharuddin S. Occurrence of the triple whammy in an outpatient \n\n\n\nclinic of a tertiary hospital. Indian Journal of Pharmaceutical \n\n\n\nEducation and Research. 2016; 50(Suppl. 2):S39-44  \n\n\n\nhttps://researchmgt.monash.edu/ws/portalfiles/portal/351157031/345\n\n\n\n104575_oa.pdf \n\n\n\n[9] kamura-Kho A, Chuah QY, Chin P, Doogue M. Rarely a triple \n\n\n\nwhammy in general medicine. New Zealand Medical Journal. \n\n\n\n2018;131(1476): 92-95. \n\n\n\nhttps://journal.nzma.org.nz/journal-articles/rarely-a-triple-whammy-\n\n\n\nin-general-medicine \n\n\n\n[10] Imai S, Momo K, Kashiwagi H, Miyai T, Sugawara M, Takekuma Y. \n\n\n\nA cross-sectional exploratory survey on occurrence of triple-whammy \n\n\n\nprescription pattern in Japan. Int J Clin Pharm. 2020;42(5):1369-1373. \n\n\n\nhttps://doi.org/10.1007/s11096-020-01088-z \n\n\n\n[11] Lafrance JP, Miller DR. Selective and non-selective non-steroidal \n\n\n\nanti-inflammatory drugs and the risk of acute kidney injury. \n\n\n\nPharmacoepidemiol Drug Saf. 2009 Oct;18(10):923-31. \n\n\n\nhttps://doi.org/10.1002/pds.1798 \n\n\n\n[12] Winkelmayer WC, Waikar SS, Mogun H, Solomon DH. Nonselective \n\n\n\nand cyclooxygenase-2-selective NSAIDs and acute kidney injury. Am \n\n\n\nJ Med. 2008 Dec;121(12):1092-8. \n\n\n\nhttps://doi.org/10.1016/j.amjmed.2008.06.035 \n\n\n\n[13] Schneider V, L\u00e9vesque LE, Zhang B, Hutchinson T, Brophy JM. \n\n\n\nAssociation of selective and conventional nonsteroidal \n\n\n\nantiinflammatory drugs with acute renal failure: A population-based, \n\n\n\nnested case-control analysis. Am J Epidemiol. 2006 Nov \n\n\n\n1;164(9):881-9. https://doi.org/10.1016/j.amjmed.2008.06.035 \n\n\n\n[14] Chou CI, Shih CJ, Chen YT, Ou SM, Yang CY, Kuo SC, Chu D. \n\n\n\nAdverse Effects of Oral Nonselective and cyclooxygenase-2-Selective \n\n\n\nNSAIDs on Hospitalization for Acute Kidney Injury: A Nested Case-\n\n\n\nControl Cohort Study. Medicine (Baltimore). 2016 Mar;95(9):e2645. \n\n\n\nhttps://doi.org/10.1097/MD.0000000000002645 \n\n\n\n[15] Lapi F, Azoulay L, Yin H, Nessim SJ, Suissa S. Concurrent use of \n\n\n\ndiuretics, angiotensin converting enzyme inhibitors, and angiotensin \n\n\n\nreceptor blockers with non-steroidal anti-inflammatory drugs and risk \n\n\n\nof acute kidney injury: nested case-control study. BMJ. 2013 Jan \n\n\n\n8;346:e8525. https://doi.org/10.1136/bmj.e8525 \n\n\n\n[16] Musso CG, Oreopoulos DG. Aging and physiological changes of the \n\n\n\nkidneys including changes in glomerular filtration rate. Nephron \n\n\n\nPhysiology. 2011;119(Suppl. 1):S1-5.  \n\n\n\nhttps://doi.org/10.1159/000328010 \n\n\n\n \n\n\n\n\nhttps://doi.org/10.5694/j.1326-5377.2000.tb125548.x\n\n\nhttps://doi.org/10.1111/j.0306-5251.2004.2188.x\n\n\nhttps://doi.org/10.4172/2167-7182.1000204\n\n\nhttps://doi.org/10.3109/0886022X.2014.917943\n\n\nhttps://researchmgt.monash.edu/ws/portalfiles/portal/351157031/345104575_oa.pdf\n\n\nhttps://researchmgt.monash.edu/ws/portalfiles/portal/351157031/345104575_oa.pdf\n\n\nhttps://journal.nzma.org.nz/journal-articles/rarely-a-triple-whammy-in-general-medicine\n\n\nhttps://journal.nzma.org.nz/journal-articles/rarely-a-triple-whammy-in-general-medicine\n\n\nhttps://doi.org/10.1007/s11096-020-01088-z\n\n\nhttps://doi.org/10.1002/pds.1798\n\n\nhttps://doi.org/10.1016/j.amjmed.2008.06.035\n\n\nhttps://doi.org/10.1016/j.amjmed.2008.06.035\n\n\nhttps://doi.org/10.1097/MD.0000000000002645\n\n\nhttps://doi.org/10.1136/bmj.e8525\n\n\nhttps://doi.org/10.1159/000328010\n\n\n\n"
"\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 15 \n\n\n\nEvaluation of the Tablet Splitting Practices among Malaysian \n\n\n\nCommunity Pharmacists. \n\n\n\nChee Ping Chong*\n1\n, Mohamed Azmi Hassali\n\n\n\n2 \n, Mohd Baidi Bahari\n\n\n\n3\n, \n\n\n\n\n\n\n\n \n1\nDiscipline of Clinical Pharmacy, \n\n\n\n2\nDiscipline of Social and Administrative Pharmacy, \n\n\n\nSchool of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Minden, Penang, \n\n\n\nMalaysia \n3\nProfessor, Faculty of Pharmacy, AIMST Universiti, 08100 Bidong, Kedah, Malaysia \n\n\n\n\n\n\n\n\n\n\n\n* Corresponding author \nMalaysian Journal of Pharmacy, Vol 1 Issue 10, 2012, 12 - 27                                               \n\n\n\n\n\n\n\nAbstract \n\n\n\n\n\n\n\nTablet splitting practices have been shown to reduce the medication cost in many \n\n\n\ncountries. This study was aimed to evaluate the tablet splitting practices among \n\n\n\ncommunity pharmacists in Penang, Malaysia. A two-month cross-sectional descriptive \n\n\n\nsurvey was carried out in forty randomly chosen community pharmacies in Penang. The \n\n\n\npharmacists were required to document all their tablet splitting recommendations during \n\n\n\nthe study period.  The data collected includes the appropriateness of the tablet splitting \n\n\n\nrecommendations by pharmacists; the extent of communication between pharmacists and \n\n\n\nphysicians when recommending tablet splitting; the physicians\u201f and patients\u201f acceptance \n\n\n\ntowards the tablet splitting; and the documentation of cost-saving achieved from the tablet \n\n\n\nsplitting.  The result showed that the tablet splitting was recommended by 31.0% of the \n\n\n\npharmacists who receives prescriptions eligible for this practice. Tablets of patent-\n\n\n\nprotected innovator brands were more likely to be recommended for splitting. Majority \n\n\n\n(92.9%) of the splitting recommendations were appropriate except two cases which \n\n\n\ninvolve unscored combination tablet. The pharmacists requested consent from the \n\n\n\nphysicians for 42.9% of the splitting recommendations and majority (91.7%) of the \n\n\n\nrequests were accepted. Meanwhile, the patients\u201f acceptance rate for splitting \n\n\n\nrecommendation was 82.1%. Through acceptance of tablet-splitting, the patients\u201f monthly \n\n\n\nexpenses on drugs reduced by 36.5% and this correspond to a monthly saving of \n\n\n\nRM39.05 (US$10.30, US$1.00 = RM 3.80) per patient.  The study concluded that the \n\n\n\ntablet splitting is not a common practice among the community pharmacists, however \n\n\n\nboth the physicians and patients highly accept pharmacists\u201f suggestion on splitting. The \n\n\n\nfindings also revealed that tablet splitting can be used as a cost-containment measure for \n\n\n\npatient as well.  \n\n\n\n\n\n\n\nArticle Keywords: tablet splitting, community pharmacist, physician, patient, cost-\n\n\n\nsaving  \n\n\n\nIntroduction \n\n\n\nRecently, increase in countries\u201f \n\n\n\nexpenditures on prescription drugs has \n\n\n\nbecome a worldwide dilemma. In \n\n\n\nMalaysia, the government fully \n\n\n\nsubsidizes the drugs expenditure in \n\n\n\npublic hospital. However, the \n\n\n\ngovernment subsidized cost for drugs in \n\n\n\npublic hospital increased from RM 200 \n\n\n\nmillion in 1995 to RM 800 million in \n\n\n\n2005 with an annual increment of 10%-\n\n\n\n15%, thus this had affected the \n\n\n\ngovernment\u201fs ability to sustain \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 16 \n\n\n\npharmaceutical financing in the future \n\n\n\n(1,2). Besides, 56% of Malaysian \n\n\n\nconsumers perceived drugs in private \n\n\n\nsector as expensive and 68% urged that \n\n\n\nprices should be reduced (3). The high \n\n\n\ndrugs cost may generate prescription \n\n\n\nnon-compliance and thus in return will \n\n\n\nfurther increase healthcare costs (4).  \n\n\n\n\n\n\n\nMany studies highlighted that tablet \n\n\n\nsplitting resulted in significant cost-\n\n\n\nsaving (5-10). For instance, introduction \n\n\n\nof tablet splitting by a health plan in \n\n\n\nNorth Caroline generated annual savings \n\n\n\nof US$342,000 (5). However, tablet \n\n\n\nsplitting is contraindicated for extended \n\n\n\nrelease formulation and enteric-coated \n\n\n\ntablet (11-14). Unscored tablet and \n\n\n\ncombination tablet are generally not \n\n\n\nmean to be split, but some tablets \n\n\n\nwithout scoring may be split easily with \n\n\n\ntablet-splitting device (11-12). \n\n\n\nUnacceptable weight variation can be \n\n\n\nresulted from tablet splitting and may be \n\n\n\nclinical significant for narrow \n\n\n\ntherapeutic drug (15-17). Therefore, this \n\n\n\npractice only suitable for drugs with \n\n\n\nwide therapeutic range and long half life \n\n\n\n(7,12,14-18). Previous studies had shown \n\n\n\nthat majority of the patients\u201f compliance \n\n\n\nwas not hindered after introduction of \n\n\n\ntablet splitting (19-21). Nevertheless, \n\n\n\ntablet splitting is not suitable for \n\n\n\ncognitively and functionally impaired \n\n\n\npatients who could lead to confusion and \n\n\n\nincorrect dosing (13,14).       \n\n\n\n\n\n\n\nIn the current context of pharmacy \n\n\n\npractice in Malaysia, there is no \n\n\n\ndispensing separation policy been \n\n\n\nimplemented between private general \n\n\n\npractitioners and community \n\n\n\npharmacists. There is also no tablet-\n\n\n\nsplitting guideline for health \n\n\n\nprofessionals in Malaysia. Under these \n\n\n\ncircumstances, little is known about the \n\n\n\npharmacist\u201fs tablet splitting practices \n\n\n\nand the response of physician and patient \n\n\n\ntoward the splitting recommendation.  \n\n\n\n\n\n\n\nAim of the study \n\n\n\n\n\n\n\nThis study aims to document the tablet \n\n\n\nsplitting practices among Malaysian \n\n\n\ncommunity pharmacists with the focus \n\n\n\non the appropriateness of the tablet \n\n\n\nsplitting recommendations; the extent of \n\n\n\ncommunication between pharmacists and \n\n\n\nphysicians while recommending tablet \n\n\n\nsplitting; the physicians\u201f and patients\u201f \n\n\n\nacceptance towards the tablet splitting; \n\n\n\nand the cost-saving resulted from the \n\n\n\ntablet splitting practices.  \n\n\n\n\n\n\n\nMethod \n\n\n\n\n\n\n\nThis is a cross-sectional descriptive \n\n\n\nsurvey study using a self-completed data \n\n\n\nform for pharmacists to fill in. This data \n\n\n\nform was modified from the data \n\n\n\ncollection form obtained from previous \n\n\n\nstudy undertaken in Scotland (22). This \n\n\n\ndata form has been tested for face and \n\n\n\ncontent validity by five pharmacy \n\n\n\nacademics and 10 pharmacists. The \n\n\n\nsample of the form is shown in \n\n\n\nAppendix 1.  \n\n\n\n\n\n\n\nThe population of community \n\n\n\npharmacists in Penang state was \n\n\n\nstratified into urban and rural area. The \n\n\n\nsampling frame was the pharmacies list \n\n\n\nprovided by State Pharmacy \n\n\n\nEnforcement Department. Thirty and ten \n\n\n\noutlets were randomly chosen from the \n\n\n\nurban and rural area respectively and \n\n\n\nresulted in total of 40 community \n\n\n\npharmacies as the sample.  \n\n\n\n\n\n\n\nThis study includes patients who brought \n\n\n\nprescriptions written in branded or \n\n\n\ngeneric name to the community \n\n\n\npharmacies. These drugs are available in \n\n\n\nvarious strengths which are eligible for \n\n\n\ntablet splitting. The pharmacists were \n\n\n\nrequested to document their tablet \n\n\n\nsplitting recommendation to the patient, \n\n\n\nincluding the brand name of the drug \n\n\n\ninvolved, the strength, the dosage \n\n\n\nregimen, the cost and selling price of the \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 17 \n\n\n\ndrug, the decision either to consult or not \n\n\n\nconsult the physician with regards to \n\n\n\nsplitting recommendations, and \n\n\n\nphysician and patient\u201fs acceptance \n\n\n\ntoward the recommendation made. \n\n\n\nPatients who have a risk that tablet \n\n\n\nsplitting will impair their understanding \n\n\n\nand compliance to therapy were \n\n\n\nexcluded from the study.   \n\n\n\n\n\n\n\nThe researcher sent the data form by \n\n\n\npersonal visit to the selected outlets and \n\n\n\ndetail explanations was given to the \n\n\n\npharmacists. The participation of this \n\n\n\nstudy was strictly voluntary and no \n\n\n\npersonal data of the participants were \n\n\n\nreported. The duration of data collection \n\n\n\nwas 2 months period from 22\nnd\n\n\n\n February \n\n\n\n2005 to 22\nnd\n\n\n\n April 2005. Follow-up and \n\n\n\ndata collection were done by monthly \n\n\n\npersonal visit by the researcher. All the \n\n\n\ncollected data was entered into SPSS\n\u00ae\n \n\n\n\nversion 11.5 for analysis.  \n\n\n\n\n\n\n\nResults \n\n\n\n\n\n\n\nFrom the chosen sample of forty \n\n\n\npharmacies (one pharmacist in each \n\n\n\noutlet), 34 pharmacists (85.0%) agreed \n\n\n\nto participate in this study. At the end of \n\n\n\nthe study, only 9 (26.5%) pharmacists \n\n\n\ninvolved in tablet-splitting practices. \n\n\n\nFive pharmacists (14.7%) did not receive \n\n\n\nany prescription eligible for tablet \n\n\n\nsplitting. The remaining 20 pharmacists \n\n\n\n(58.8%) did not recommend tablet \n\n\n\nsplitting although they have the \n\n\n\nopportunity to do so. In another words, \n\n\n\namong the 29 pharmacists which \n\n\n\nreceived prescriptions eligible for tablet \n\n\n\nsplitting, only 31.0% (9 pharmacists) \n\n\n\nrecommended tablet splitting to their \n\n\n\npatients. \n\n\n\n\n\n\n\nTotal numbers of patients involved in \n\n\n\ntablet splitting recommendation were 28. \n\n\n\nThere were 28 items involved and one \n\n\n\nitem was considered as one case of tablet \n\n\n\nsplitting recommendation. Besides, the \n\n\n\ncases involved 13 drugs and 17 products \n\n\n\nwith different strength (Table 1).  \n\n\n\n\n\n\n\nAnalysis of tablet splitting practices \n\n\n\nMajority of the cases involved \n\n\n\nantihyperlipidemia (42.8%) and \n\n\n\ncardiovascular drugs (42.8%), followed \n\n\n\nby antibiotic (3.6%), erectile dysfunction \n\n\n\n(3.6%), gout (3.6%) and diabetic \n\n\n\nmellitus (3.6%). Almost all (96.4%) of \n\n\n\nthe cases involved Class B Poison which \n\n\n\nunder the Malaysian Poison Law 1952 \n\n\n\ncan only be sold with a prescription from \n\n\n\na registered medical, dental or veterinary \n\n\n\npractitioners. Only one case (3.6%) \n\n\n\ninvolved Class C Poison which under the \n\n\n\nMalaysian Poison Law can be sold \n\n\n\nwithout a prescription by a registered \n\n\n\npharmacist in a registered pharmacy \n\n\n\npremise.  \n\n\n\n\n\n\n\nAmong the tablet splitting \n\n\n\nrecommendations, 57.2% involved \n\n\n\npatent-protected innovator brands, \n\n\n\nfollowed by 32.2% of off-patent \n\n\n\ninnovator brands which equivalent \n\n\n\ngeneric products were available as of the \n\n\n\ndate of this research. Only 10.6% of the \n\n\n\ncases involved generic products. Zocor\n\u00ae\n\n\n\n\n\n\n\n(Simvastatin) was the most popular drug \n\n\n\ninvolved in tablet splitting \n\n\n\nrecommendation which consist of 28.6% \n\n\n\nof the cases and followed by Lipitor\n\u00ae\n\n\n\n\n\n\n\n(Atorvastatin) (10.7%) and Norvasc\n\u00ae\n\n\n\n\n\n\n\n(Amlodipine) (10.7%) (Table 1). \n\n\n\n\n\n\n\nDetail analysis noticed one unique case \n\n\n\nof generic substitution occurred \n\n\n\nconcurrently with tablet splitting. In this \n\n\n\ncase, the patient accepted to change the \n\n\n\ntherapy from Zocor\n\u00ae\n\n\n\n (Simvastatin) \n\n\n\n20mg, one tablet daily to Vascor\n\u00ae\n\n\n\n\n\n\n\n(manufactured by CCM \n\n\n\nPharmaceuticals, a local generic \n\n\n\ncompany) 40mg half tablet daily (Table \n\n\n\n1). This unique case saved RM62.55 \n\n\n\n(US$16.50) per month (28 days) for the \n\n\n\npatient with RM47.60 (US$12.55) of the \n\n\n\ncost-saving was gained from the generic \n\n\n\nsubstitution (Zocor\n\u00ae\n 20mg, 28 tablets \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 18 \n\n\n\ncost RM93.35; Zocor\n\u00ae\n\n\n\n 40mg, 14 tablets \n\n\n\ncost RM78.40; Vascor\n\u00ae\n\n\n\n 40mg, 14 tablets \n\n\n\ncost RM30.80; RM3.80 = US$1.00). \n\n\n\nThere was another unique case involved \n\n\n\nsimplified the patient\u201fs treatment \n\n\n\nthrough tablet splitting.  In this case, the \n\n\n\npatient agreed to change the regime of \n\n\n\nApo-Allopurinol\n\u00ae\n (Allopurinol) 100mg, \n\n\n\none and a half tablet daily to become \n\n\n\nApo-Allopurinol\n\u00ae\n 300mg, half tablet \n\n\n\ndaily (Table 1). This recommendation \n\n\n\nresulted in monthly cost-saving of \n\n\n\nRM7.80 (US$2.05) to the patient (Apo-\n\n\n\nAllopurinol\n\u00ae\n 100mg, 42 tablets cost \n\n\n\nRM15.60; Apo-Allopurinol\n\u00ae\n 300mg, 14 \n\n\n\ntablets cost RM7.80). \n\n\n\n\n\n\n\nIn the present study, it was noted that \n\n\n\nmodified release formulation, enteric-\n\n\n\ncoated tablet and narrow therapeutic \n\n\n\nindex drugs were not involved in the \n\n\n\nsplitting recommendations made. \n\n\n\nNevertheless, only 32.1% (9 of 28) of \n\n\n\nthe recommendations involved scored \n\n\n\ntablets with single wide therapeutic \n\n\n\ndrugs which are suitable for splitting \n\n\n\n(Table 1). The remaining 67.9% (19 of \n\n\n\n28) of the cases involved unscored \n\n\n\ntablets which need further evaluation on \n\n\n\nits divisibility. All the unscored tablets \n\n\n\nhave symmetrical shape and can be split \n\n\n\ninto two equal halve using appropriate \n\n\n\nsplitting device. Majority (92.9%) of the \n\n\n\nunscored tablet cases involved single \n\n\n\nwide therapeutic drug except two cases \n\n\n\ninvolved combination tablet which were \n\n\n\nCo-Diovan\n\u00ae\n and Fortzaar\n\n\n\n\u00ae\n. Two drugs \n\n\n\nin a combination tablet may not evenly \n\n\n\ndistribute throughout the tablet and \n\n\n\nsplitting may not produce equal dose \n\n\n\n(12). However, the pharmacist requested \n\n\n\nconsent from the physician when \n\n\n\nrecommending splitting of Co-Diovan\n\u00ae\n\n\n\n\n\n\n\nand Fortzaar\n\u00ae\n\n\n\n and these \n\n\n\nrecommendations was agreed by the \n\n\n\nphysician. Analysis shown the \n\n\n\nmanufacturer of Co-Diovan\n\u00ae\n (Novartis) \n\n\n\ndisallowed splitting by indicating it is \n\n\n\n\u201cnon-divisible\u201d in the product leaflet. \n\n\n\nMeanwhile, for all other cases, the \n\n\n\nproduct leaflet provides information on \n\n\n\nthe tablet characteristics but does not \n\n\n\nprovide any information about its \n\n\n\ndivisibility. As the product leaflet for \n\n\n\nFortzaar\n\u00ae\n do not include any information \n\n\n\nregarding its divisibility, the researcher \n\n\n\nhad contacted the manufacturer of \n\n\n\nFortzaar\n\u00ae\n (MSD Malaysia branch) to \n\n\n\nclarify this issue and found that it can\u201ft \n\n\n\nbe split. Further analysis on the unscored \n\n\n\ntablets shows Cozaar\n\u00ae\n and Zocor\n\n\n\n\u00ae\n tablet \n\n\n\nare formulated with a scored  line on the \n\n\n\nlower strength tablet (Cozaar\n\u00ae\n 50mg and \n\n\n\nZocor\n\u00ae\n 10mg) but are unscored for the \n\n\n\nhigher strength tablet (Cozaar\n\u00ae\n 100mg \n\n\n\nand Zocor\n\u00ae\n 20mg onwards). Besides, \n\n\n\nstudies has shown that tablet splitting for \n\n\n\nsimvastatin and atorvastatin is effective \n\n\n\nand safe (7,18). \n\n\n\n\n\n\n\nExtent of communication between \n\n\n\npharmacists and physicians \n\n\n\nOverall, the pharmacists requested \n\n\n\nconsent from the physician for 42.9% of \n\n\n\nthe splitting recommendations. Further \n\n\n\nanalysis shown 33.3% of the \n\n\n\nantihyperlipidemia agent cases and \n\n\n\n41.7% of the cardiovascular drug cases \n\n\n\nwas recommended with reference to the \n\n\n\nphysicians. Besides, 33.3% and 47.4% of \n\n\n\ncases involved scored and unscored \n\n\n\ntablet involved consultation with \n\n\n\nphysicians respectively but the \n\n\n\ndifferences in these percentages were not \n\n\n\nstatistical significant (Fisher\u201fs Exact \n\n\n\nTest, p = 0.687). \n\n\n\n\n\n\n\nPhysicians and patients\u2019 acceptance \n\n\n\nThe physicians\u201f acceptance rate for \n\n\n\ntablet splitting recommendations was \n\n\n\n91.7% with only one case involved \n\n\n\nTenormin\n\u00ae\n 100mg was rejected. In fact, \n\n\n\nthe entire cases involved unscored tablet \n\n\n\nwas accepted by the physicians.   \n\n\n\n\n\n\n\nThe overall patients\u201f acceptance rate for \n\n\n\nsplitting recommendations was 82.1%. \n\n\n\nMajority of the patients accepted the  \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 19 \n\n\n\n \nTherapeutic group Drug \n\n\n\n(generic name) \n\n\n\nPatient\u2019s initial regime \n\n\n\n(Product name & dose) \n\n\n\nTablet splitting \n\n\n\nrecommendation \n\n\n\n(Product name & dose) \n\n\n\nManufacturer \n\n\n\n(Country of origin)* \n\n\n\nMedication \n\n\n\ncharacteristics*\u2020 \n\n\n\n\n\n\n\nNo of \n\n\n\ncase (%) \n\n\n\n1.Antihyperlipidemia 1. Simvastatin 1. Zocor\n\u00ae\n 10mg, 1 tab ON \u2021 Zocor\n\n\n\n\u00ae\n 20mg, \u00bd tab ON  \u2021 Merck Sharp & Dohme (Australia) Unscored 5(17.9) \n\n\n\n  2. Zocor\n\u00ae\n 20mg, 1 tab ON \u2021 Zocor\n\n\n\n\u00ae\n 40mg, \u00bd tab ON  \u2021 Merck Sharp & Dohme (Australia) Unscored 3(10.7) \n\n\n\n  3. Zocor\n\u00ae\n 20mg 1 tab ON  \u2021 Vascor\n\n\n\n\u00ae\n 40mg, \u00bd tab ON\u2551  CCM Pharmaceuticals (Local) Scored 1(3.6) \n\n\n\n\n\n\n\n 2. Atorvastatin 1. Lipitor\n\u00ae\n 20mg, 1 tab ON \u00a7  Lipitor\n\n\n\n\u00ae\n 40mg, \u00bd tab ON \u00a7 Pfizer (USA) Unscored 2(7.1) \n\n\n\n  2. Lipitor\n\u00ae\n 10mg, 1 tab ON \u00a7 Lipitor\n\n\n\n\u00ae\n 20mg, \u00bd tab ON \u00a7 Pfizer (USA)  Unscored 1(3.6) \n\n\n\n\n\n\n\n2. Cardiovascular \n\n\n\ndisease \n\n\n\n1. Amlodipine  1. Norvasc\n\u00ae\n 5mg 1 tab od \u00a7 Norvasc\n\n\n\n\u00ae\n 10mg, \u00bd tab od \u00a7 Pfizer (USA) Scored 3(10.7) \n\n\n\n  .      \n\n\n\n 2. Atenolol 1. Tenormin\n\u00ae\n 50mg 1 tab od \u2021 Tenormin\n\n\n\n\u00ae\n 100mg \u00bd tab od \u2021 AstraZeneca (Sweden) Scored 1(3.6) \n\n\n\n  2. Apo-Atenol\n\u00ae\n 50mg 1 tab od \u2551 Apo-Atenol\n\n\n\n\u00ae\n 100mg \u00bd tab \n\n\n\nod\u2551 \n\n\n\nApotex (Canada) Scored 1(3.6) \n\n\n\n\n\n\n\n 3. Losartan & \n\n\n\nHydrochlorothiazide \n\n\n\n1. Hyzaar\n\u00ae\n (50/12,5) 1 tab od \u00a7 Fortzaar\n\n\n\n\u00ae\n (100/25) \u00bd ab od \u00a7 Merck Sharp & Dohme (Australia) Unscored 2 (7.1) \n\n\n\n\n\n\n\n 4. Valsartan 1. Diovan\n\u00ae\n 80mg, 1 tab od \u00a7 Diovan\n\n\n\n\u00ae \n160mg, \u00bd tab od \u00a7 Novartis (Switzerland) Scored 2(7.1) \n\n\n\n\n\n\n\n 5. Felodipine  1. Plendil\n\u00ae\n 2.5mg 1 tab od \u00a7 Plendil\n\n\n\n\u00ae\n 5mg \u00bd tab od \u00a7 AstraZeneca (Sweden) Unscored 1(3.6) \n\n\n\n .       \n\n\n\n 6.Losartan  1.Cozaar\n\u00ae\n 50m  1 tab od \u00a7 Cozaar\n\n\n\n\u00ae\n 100mg \u00bd tab od \u00a7 Merck Sharp & Dohme (Australia) Unscored 1(3.6) \n\n\n\n\n\n\n\n 7. Valsartan & \n\n\n\nHydrochlorothiazide \n\n\n\n1.Co-Diovan\n\u00ae\n (80/12,5) 1 tab od \n\n\n\n\u00a7 \n\n\n\nCo-Diovan\n\u00ae\n (160/25) \u00bd tab od \n\n\n\n\u00a7 \n\n\n\nNovartis (Switzerland) Unscored 1(3.6) \n\n\n\n\n\n\n\n3. Antibiotic 1.Cefuroxime 1. Zinnat\n\u00ae\n 125mg 1 tab bd \u00a7 Zinnat\n\n\n\n\u00ae\n 250mg \u00bd tab bd \u00a7 GlaxoSmithKline (UK)  Unscored 1(3.6) \n\n\n\n\n\n\n\n4. Erectile dysfunction 1. Sildenafil citrate 1. Viagra\n\u00ae\n 50mg 1 tab prn \u00a7 Viagra\n\n\n\n\u00ae\n 100mg \u00bd tab prn \u00a7 Pfizer (USA) Unscored 1(3.6) \n\n\n\n\n\n\n\n5. Gout  1. Allopurinol 1. Apo-Allopurinol\n\u00ae\n 100mg 1.5 \n\n\n\ntab od\u2551 \n\n\n\nApo-Allopurinol\n\u00ae\n 300mg \u00bd \n\n\n\ntab od\u2551 \n\n\n\nApotex (Canada) Scored 1(3.6) \n\n\n\n\n\n\n\n6. Oral antidiabetic \n\n\n\nagents \n\n\n\n1. Rosiglitazone  1. Avandia\n\u00ae\n 4mg 1 tab od \u00a7 Avandia\n\n\n\n\u00ae\n 8mg \u00bd tab od \u00a7 GlaxoSmithKline (UK) Unscored 1(3.6) \n\n\n\nTotal      28(100.0) \n\n\n\n* Manufacturer and medication characteristics for products involved in tablet splitting recommendation.  \n\n\n\n\u2020The medication characteristic of product sold in Malaysia only. The same product that sold in other countries may have different characteristics.  \n\n\n\n\u2021Off-patent innovator brand as of April 2005. Equivalent generic products available in the market.  \n\n\n\n\u00a7Patent-protected innovator brand as of April 2005. Equivalent generic products not available in the market.  \n\n\n\n\u2551Generic product.  \n\n\n\nTable 1: Tablet Splitting Recommendations by Community Pharmacists \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 20 \n\n\n\nTable 2: Physicians\u2019 and Patients\u2019 Acceptance towards the Tablet Splitting Recommendation. \n\n\n\n\n\n\n\n No. of Cases (%) \n\n\n\nPharmacist consult physician 12 (42.9) \n\n\n\n    Physician accepted     11 (91.7) \n\n\n\n        Patient accepted             11 (100.0) \n\n\n\n        Patient do not accepted       0 (0.0) \n\n\n\n    Physician do not accepted  1 (8.3) \n\n\n\n        Patient accepted        0 (0.0) \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 21 \n\n\n\nrecommendations involved anti-\n\n\n\nhyperlipidemia agents (83.3%) and \n\n\n\ncardiovascular drugs (75.0%). \n\n\n\nMeanwhile, the patients\u201f acceptance rate \n\n\n\nfor scored and unscored tablet were   \n\n\n\n66.7% and 89.5% respectively but there \n\n\n\nwas no statistical differences noted with \n\n\n\nthis regard (Fisher\u201fs Exact Test, p = \n\n\n\n0.290). The patients refused to accept \n\n\n\nsplitting recommendation in five cases \n\n\n\nwhich involve Tenormin\n\u00ae\n 100mg, \n\n\n\nNorvasc\n\u00ae\n 10mg, Apo-Atenol\n\n\n\n\u00ae\n 100mg, \n\n\n\nZocor\n\u00ae\n\n\n\n 20mg and Zocor\n\u00ae\n\n\n\n 40mg \n\n\n\nrespectively. For cases involve \n\n\n\nconsultation with prescriber, 91.7% of \n\n\n\nthe cases was accepted by the patients \n\n\n\n(Table 2). Further analysis shows that \n\n\n\nthe patients strictly (100.0%) followed \n\n\n\nthe decisions of the physicians. In \n\n\n\ncontrast, 75.0% of cases without \n\n\n\ninforming the physicians were accepted \n\n\n\nby the patients. Nevertheless, there was \n\n\n\nno statistical significant difference noted \n\n\n\nin term of patients\u201f acceptance rate \n\n\n\nbetween cases involved consultation \n\n\n\nwith the physicians and cases without \n\n\n\ninforming the physicians (Fisher\u201fs Exact \n\n\n\nTest, p = 0.355). (Insert Table 2 here)  \n\n\n\n\n\n\n\nPharmacists\u2019 cost-saving through the \n\n\n\ntablet splitting recommendation \n\n\n\nThe cost-saving was calculated for 21 \n\n\n\nsuccessful tablet splitting \n\n\n\nrecommendation cases. Five cases which \n\n\n\nrefused by the patients and the Co-\n\n\n\nDiovan\n\u00ae\n and Fortzaar\n\n\n\n\u00ae\n case which not \n\n\n\nallowed to be split were excluded. The \n\n\n\ntotal cost for these 21 cases was \n\n\n\nRM2071.30 (US$545.10) and \n\n\n\nRM1236.55 (US$325.40) respectively \n\n\n\nbefore and after the splitting \n\n\n\nrecommendation. This means the \n\n\n\npharmacists expenses on stocks \n\n\n\npurchasing were reduced by 40.3% or \n\n\n\nRM834.75 (US$219.70) through the \n\n\n\nsplitting recommendation.  \n\n\n\n\n\n\n\nPharmacists\u2019 monthly cost-saving (per \n\n\n\n28 days) for chronic cases \n\n\n\nThere were 19 successful cases which \n\n\n\ninvolved chronic diseases like \n\n\n\nhyperlipidemia, cardiovascular diseases \n\n\n\nand diabetic mellitus. The costs of drugs \n\n\n\nfor these cases have been converted to \n\n\n\nmonthly cost (per 28 days). The total \n\n\n\nmonthly cost was RM1586.40 \n\n\n\n(US$417.45) before the splitting \n\n\n\nrecommendation and reduced by 35.3% \n\n\n\nto RM 1026.70 (US$270.20) after the \n\n\n\nrecommendation. Total amount of cost-\n\n\n\nreduction was RM559.70 (US$147.25).  \n\n\n\n\n\n\n\nPatients\u2019 cost-saving through tablet \n\n\n\nsplitting \n\n\n\nFrom the 21 cases which accepted by the \n\n\n\npatients, total cost to the patient before \n\n\n\ntablet splitting was RM2483.00 \n\n\n\n(US$653.40). After tablet splitting, the \n\n\n\npatients\u201f total expenses reduced to \n\n\n\nRM1595.00 (US$419.75). This resulted \n\n\n\nin cost-saving of RM888.00 \n\n\n\n(US$233.65), which was 35.8% from the \n\n\n\noriginal cost.  \n\n\n\n\n\n\n\nPatients\u2019 monthly cost-saving (per 28 \n\n\n\ndays) for chronic cases \n\n\n\nFrom the 19 chronic cases within the two \n\n\n\nmonths study, the initial total monthly \n\n\n\ncost of the patients was RM2034.25 \n\n\n\n(US$535.35), and declined to \n\n\n\nRM1292.35 (US$340.10) after the tablet \n\n\n\nsplitting. Consequently, the monthly \n\n\n\ncost-saving achieved was RM741.90 \n\n\n\n(US$195.25). The percentage of monthly \n\n\n\ncost-saving was 36.5% and average \n\n\n\nmonthly cost-saving per patient was \n\n\n\nRM39.05 (US$10.30).  \n\n\n\n\n\n\n\n\n\n\n\nDiscussions \n\n\n\n\n\n\n\nFor a period of 2 months, only 28 tablet \n\n\n\nsplitting recommendations were \n\n\n\nperformed by 31.0% of the pharmacists \n\n\n\nthat encounter with opportunities for this \n\n\n\npractice. This finding revealed that tablet \n\n\n\nsplitting is not a common practice among \n\n\n\nthe community pharmacists. Tablets of \n\n\n\npatent-protected innovator brands were \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 22 \n\n\n\nmore likely to be recommended for \n\n\n\nsplitting than the multi-brands drugs. \n\n\n\nTherefore, the pharmacists may tend to \n\n\n\nrecommend tablet splitting when cheaper \n\n\n\ngenerics are not available. This further \n\n\n\nsupported by the concurrent generic \n\n\n\nsubstitution study which observed 158 \n\n\n\ngeneric substitution recommendations \n\n\n\nfrom the same group of pharmacists \n\n\n\n(23). The combination of tablet splitting \n\n\n\nand generic substitution is a good cost-\n\n\n\ncontainment strategy as shown in the \n\n\n\ncase of converting Zocor\n\u00ae\n 20mg, one \n\n\n\ntablet daily to Vascor\n\u00ae\n 40mg, half tablet \n\n\n\ndaily. The cost-saving achieved was \n\n\n\nfour-fold higher than using tablet \n\n\n\nsplitting alone with 76.1% of the cost-\n\n\n\nsaving was contributed by generic \n\n\n\nsubstitution.  \n\n\n\n\n\n\n\nOverall, majority (92.9%) of the tablet \n\n\n\nsplitting recommendations were \n\n\n\nappropriate as there were no sustained-\n\n\n\nrelease, enteric-coated or narrow \n\n\n\ntherapeutic drugs involved and the \n\n\n\ntablets involved mostly contain single \n\n\n\nwide therapeutic drugs. Although \n\n\n\nmajority of the recommendations \n\n\n\ninvolved unscored tablets, their \n\n\n\nsymmetrical shapes enable them to be \n\n\n\nsplit into fairly equal halve by using \n\n\n\nproper device. Besides, studies shown \n\n\n\nthat splitting of tablets contain single \n\n\n\nwide therapeutic drug are clinically \n\n\n\nappropriate (7,12,18). Only two cases \n\n\n\ninvolved unscored combination tablet \n\n\n\n(Co-Diovan\n\u00ae\n and Fortzaar\n\n\n\n\u00ae\n) were not \n\n\n\nsuitable for splitting. The manufacturers \n\n\n\ndisallowed splitting of these combination \n\n\n\ntablets because no study being conducted \n\n\n\nto evaluate patient clinical outcome after \n\n\n\nthe splitting of Co-Diovan\n\u00ae\n and \n\n\n\nFortzaar\n\u00ae\n tablets. Another interesting \n\n\n\nfinding was only 9.1% (1 of 11) of the \n\n\n\nmanufacturer product leaflets of the \n\n\n\nunscored split tablets has information on \n\n\n\ndivisibility. This observation was \n\n\n\nconsistent with a finding from primary \n\n\n\ncare centers in Germany where minority \n\n\n\n(22.5%) of the product leaflet of the \n\n\n\nunscored split tablets contained \n\n\n\ninformation about the divisibility (11). \n\n\n\nHence, the pharmacists and physicians \n\n\n\nhave limited information on tablet \n\n\n\nsplitting and this may resulted in \n\n\n\ninappropriate splitting recommendation. \n\n\n\nThe shape of Zocor\n\u00ae\n and Cozaar\n\n\n\n\u00ae\n tablets \n\n\n\nwhich are unscored in their higher \n\n\n\nstrength are irrational. The \n\n\n\nmanufacturers should scored all \n\n\n\nstrengths of medications which are \n\n\n\nclinical appropriate for splitting. A study \n\n\n\nin USA also observed many tablets are \n\n\n\nscored only in their lower strengths and \n\n\n\nurged that manufacturer s be compelled \n\n\n\nto score all strengths of medication (10).\n \n\n\n\n\n\n\n\nIn this study, the pharmacists tend not to \n\n\n\nconsult the physicians when \n\n\n\nrecommending tablet splitting. However, \n\n\n\nhigher percentage of unscored tablet \n\n\n\ncases involve consultation with \n\n\n\nphysicians as compared to cases which \n\n\n\ninvolved scored tablets. These shown the \n\n\n\npharmacists may tend to obtain consent \n\n\n\nfrom the prescribers for more critical \n\n\n\ncases. From physicians\u201f perspective, \n\n\n\nmajority of the physicians agreed with \n\n\n\nsplitting recommendations by \n\n\n\npharmacists. This result was consistent \n\n\n\nwith other study in which consultation \n\n\n\nbetween pharmacist and physician \n\n\n\nimproved the cost-effectiveness of \n\n\n\nprescribing (24).\n \nMeanwhile, majority of \n\n\n\nthe patients agreed to split their tablet \n\n\n\nand surprisingly, the acceptance rate for \n\n\n\nunscored tablet was even higher than \n\n\n\nscored tablet (89.5% versus 66.7%). The \n\n\n\nhigh acceptance rate may due to the \n\n\n\nbenefit of cost-saving. Besides, majority \n\n\n\nof patients (75.0%) accepted the \n\n\n\npharmacists\u201f recommendations which \n\n\n\nwithout a consent from the physician. \n\n\n\nThis showed that the Malaysian \n\n\n\npharmacists\u201f professional judgment was \n\n\n\nhighly valued by the consumers. \n\n\n\nNevertheless, the patients\u201f acceptance \n\n\n\nrate was higher (91.7%) for cases \n\n\n\ninvolved consultation with the \n\n\n\nphysicians. This indicated that co-\n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 23 \n\n\n\noperations between pharmacists and \n\n\n\nphysicians are very important in \n\n\n\nimproving patients\u201f treatment.  \n\n\n\n\n\n\n\nThe present study also showed that tablet \n\n\n\nsplitting may not only reduce patients\u201f \n\n\n\nexpenses on drugs, but it also can reduce \n\n\n\npharmacists\u201f inventory costs. The \n\n\n\npatients\u201f monthly cost-saving of 36.5% \n\n\n\nwas lower than 61.3% of cost-saving \n\n\n\nachieved from concurrent generic \n\n\n\nsubstitution study (23).\n \n\n\n\nHowever, this \n\n\n\nrelatively small amount of cost-saving \n\n\n\nwill become a huge amount when \n\n\n\naccumulated in long term. In addition, \n\n\n\nthis study also highlighted that while \n\n\n\nperforming dispensing, the pharmacists \n\n\n\nare capable to helping the patients reduce \n\n\n\ntheir expenses on drugs while \n\n\n\nmaintaining the efficacy of treatment.  \n\n\n\n\n\n\n\nStudy limitations \n\n\n\n\n\n\n\nThe relatively small sample size limited \n\n\n\nthe generalization of the study findings. \n\n\n\nThe 34 pharmacies involved in this study \n\n\n\nrepresented 21.0% of total 165 \n\n\n\npharmacies in Penang state and 2.3% of \n\n\n\ntotal 1500 pharmacies in whole \n\n\n\nMalaysia. The duration of two months \n\n\n\nstudy was also not sufficient to collect \n\n\n\nenough tablet splitting cases. Besides, \n\n\n\nthere was no follow-up on the outcome \n\n\n\nof patients involved in tablet splitting \n\n\n\nparticularly those involved unscored and \n\n\n\ncombination tablets. Based on this study,  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nthere is a need to conduct a larger study \n\n\n\nin Malaysia, using the similar \n\n\n\nmethodology, with longer duration and \n\n\n\ndocumented follow-up on the outcome \n\n\n\nof patients involved in tablet splitting \n\n\n\nprocess in order to give a clear picture of \n\n\n\ntablet splitting practices among \n\n\n\nMalaysian community pharmacists.  \n\n\n\n\n\n\n\nConclusions \n\n\n\n\n\n\n\nAlthough tablet splitting is not a popular \n\n\n\npractice among the community \n\n\n\npharmacists, both the physicians and \n\n\n\npatients were highly accepted the \n\n\n\nsplitting recommendations by the \n\n\n\npharmacists and it resulted in significant \n\n\n\ncost-saving. There is a need to develop a \n\n\n\ntablet-splitting guideline for health \n\n\n\nprofessionals in order to avoid \n\n\n\ninappropriate splitting recommendation. \n\n\n\nFurthermore, the manufacturers should \n\n\n\nscore all the tablets of medications which \n\n\n\nare clinically appropriate for splitting. \n\n\n\nSufficient information on divisibility \n\n\n\nmust also be provided on the medication \n\n\n\nproduct leaflet.  \n\n\n\n\n\n\n\nAcknowledgements:  \n\n\n\nWe are grateful to all the pharmacists \n\n\n\nwho voluntarily participated in this \n\n\n\nstudy.   \n\n\n\nFunding: There is no funding provided \n\n\n\nfor this research  \n\n\n\nConflict of Interest: None\n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n24 \n\n\n\n\n\n\n\nReferences \n\n\n\n1. Lek CS. Health Plan to be modelled after Socso. 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Advantage and disadvantage of split tablets given \n\n\n\nto patients. J  Chin Clin Med 2007; 7(2); Available from: \n\n\n\nhttp://www.cjmed.net/html/2007727_118.html  (Cited 8 September 2008). \n\n\n\n\n\n\n\n7. Gee M, Hasson NK, Hahn T, Ryono R. Effects of a tablet-splitting program in \n\n\n\npatients taking HMG-CoA reductase inhibitor: analysis of clinical effects, patient \n\n\n\nsatisfaction, compliance, and cost avoidance. J Manag Care Pharm 2002; 8 \n\n\n\n(6):453-458.  \n\n\n\n\n\n\n\n8. Dobscha SK, Anderson TA, Hoffman WF, Winterbottom LM, Turner EH, \n\n\n\nSnodgrass LS, Hauser P. Strategies to decrease costs of prescribing selective \n\n\n\nserotonin reuptake inhibitors at a VA medical center. Psychiatr Serv 2003; 54(2): \n\n\n\n195-200. \n\n\n\n\n\n\n\n9. Stafford RS, Radley DC, The potential of pill splitting to achieve cost savings. Am \n\n\n\nJ  Manag Care 2002; 8: 706-712. \n\n\n\n\n\n\n\n10. Cohen CI, Cohen SI. Potential cost savings from pill splitting of newer \n\n\n\npsychotropic medications. Psychiatr Serv 2000; 51(4): 527-529. \n\n\n\n\n\n\n\n11. Quinzler R, Gasse C, Schneider A, Kaufmann-Kolle P. Szecsenyi J, Haefeli WE. \n\n\n\nThe frequency of inappropriate tablet splitting in primary care. Eur J Clin \n\n\n\nPharmacol 2006; 62(12):1065-1073.  \n\n\n\n\n\n\n\n12. Noviasky J, Lo V, Luft DD, Saseen J. Clinical inquiries. Which medications can \n\n\n\nbe split without compromising efficacy and safety? J Fam Pract 2006; 55(8): 707-\n\n\n\n708. \n\n\n\n \n\n\n\n\nhttp://202.144.202.76/new_mps/cfm/localnews_view.cfm?id=714\n\n\nhttp://www.cjmed.net/html/2007727_118.html\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n25 \n\n\n\n\n\n\n\n13. Bachynsky J, Wiens C, Melnychuk K. The practice of splitting tablets. Cost and \n\n\n\ntherapeutic aspects. Pharmacoeconomics 2002; 20(5):339-346. \n\n\n\n\n\n\n\n14. Marriott JL, Nation RL. Splitting tablets. Australian Prescriber 2002; 25(6): 133-\n\n\n\n135. \n\n\n\n\n\n\n\n15. McDevitt JT, Gurst AH, Chen Y. Accuracy of tablet splitting. Pharmacotherapy \n\n\n\n1998; 18(1):193-197.  \n\n\n\n\n\n\n\n16. Rosenberg JM, Nathan JP, Plakogiannis F. Weight variability of pharmacist-\n\n\n\ndispensed split tablets. J Am Pharm Assoc 2002; 42(2):200-205. \n\n\n\n\n\n\n\n17. Teng J, Song CK, Williams RL, Polli JE. Lack of medication dose uniformity in \n\n\n\ncommonly split tablets. J Am Pharm Assoc 2002; 42(2) 195-199.  \n\n\n\n\n\n\n\n18. Duncan MC, Castle SS, Streetman DS. Effect of tablet splitting on serum \n\n\n\ncholesterol concentrations. Ann Pharmacother 2002; 36(2): 205-209. \n\n\n\n\n\n\n\n19. Fawell NG, Cookson TL, Scranton SS. Relationship between tablet splitting and \n\n\n\ncompliance, drug acquisition cost, and patient acceptance. Am J Health Syst \n\n\n\nPharm 1999; 56(24):2542-2545. \n\n\n\n\n\n\n\n20. Vuchetich PJ, Garis RI, Jorgensen AMD. Evaluation of cost savings to a state \n\n\n\nMedicaid program following a Sertraline tablet-splitting program. J Am Pharm \n\n\n\nAssoc 2003; 43(4): 497-502.  \n\n\n\n\n\n\n\n21. Weissman EM, Dellenbaugh C. Impact of splitting risperidone tablets on \n\n\n\nmedication adherence and on clinical outcomes for patients with schizophrenia. \n\n\n\nPsychiatr Serv 2007; 58(2): 201-206. \n\n\n\n\n\n\n\n22. Generic prescribing and rationalization of tablet strength. Pharmacy audit support \n\n\n\npack. RPSGB Scotland. April 2000; Available from: \n\n\n\nhttp://www.rpsgb.org.uk/pdfs/generic.pdf  (Cited  1 October 2004).  \n\n\n\n\n\n\n\n23. Chong CP, Bahari MB, Hassali MA. A pilot study on generic medicine \n\n\n\nsubstitution practices among community pharmacists in the State of Penang, \n\n\n\nMalaysia. Pharmacoepidemiol Drug Saf 2008; 17:82-89.  \n\n\n\n\n\n\n\n24. Leach RH, Wakeman A. An evaluation of the effectiveness of community \n\n\n\npharmacists working with GPs to increase the cost-effectiveness of prescribing. \n\n\n\nThe Pharm J 1999; 263(7057): 206-209.  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\nhttp://www.rpsgb.org.uk/pdfs/generic.pdf\n\n\n\n"
"\n\nIn this issue:\n\n\n\nSupplement\n\u2022 Proceedings of the 9th National Pharmacy R&D \n\n\n\nConference 2016\n\n\n\nMALAYSIAN\nJOURNAL of PHARMACY\n\n\n\nA Publication of the Malaysian Pharmaceutical Society\n\n\n\nPP12684/8/2008\nVol. 2 Issue 2. August 2016\n\n\n\n\n\n\n\n\nIn this issue:\n\n\n\nSupplement\n\u2022 Proceedings of the 9th National Pharmacy R&D \n\n\n\nConference 2016\n\n\n\nMALAYSIAN\nJOURNAL of PHARMACY\n\n\n\nA Publication of the Malaysian Pharmaceutical Society\n\n\n\nPP12684/8/2008\nVol. 2 Issue 2. August 2016\n\n\n\n\n\n\n\n\nIn this issue:\n\n\n\nSupplement\n\u2022 Proceedings of the 9th National Pharmacy R&D \n\n\n\nConference 2016\n\n\n\nMALAYSIAN\nJOURNAL of PHARMACY\n\n\n\nA Publication of the Malaysian Pharmaceutical Society\n\n\n\nPP12684/8/2008\nVol. 2 Issue 2. August 2016\n\n\n\n\n\n\n\n\nEDITORIAL BOARD\n\n\n\nMalaysian Journal of Pharmacy\nVol. 2 Issue 2. August 2016\n\n\n\nThe Official Journal of the Malaysian Pharmaceutical Society\n\n\n\n\t Editor-in-Chief:\t \t \t Assoc\tProf\tDr\tAsrul\tAkmal\tShafie\n\n\n\n Managing Editor:   Mr Ho Rhu Yann\n\n\n\n International Advisory Board: Assoc Prof Dr Chua Siew Siang\n Prof Dr Mohd Baidi Bahari   \n\n\n\n Associate Editors:   Mr Lam Kai Kun\n                                                    Prof Dr Mohamed Azmi Ahmad Hassali\n                                                    Assoc Prof Dr Mohamad Haniki Nik Mohamed\n                                                   Ms Syireen Alwi\n                                                      Prof P T Thomas\n                                                     Dr Wong Tin Wui\n                                                 Assoc Prof Dr Vikneswaran a/l Murugaiyah\n                                                     Prof Dr Yuen Kah Hay\n\n\n\nPublisher:\n\n\n\nMalaysian Pharmaceutical Society\n16-2 Jalan OP 1/5, 1-Puchong Business Park\nOff Jalan Puchong\n47160 Puchong\nMalaysia\nTel: 6-03-80791861\nFax: 6-03-80700388\nHomepage: www.mps.org.my\nEmail: mps.online@gmail.com\n\n\n\nMalaysian Journal of Pharmacy\n(the official journal of the Malaysian\nPharmaceutical Society)\nc/o School of Pharmaceutical Sciences\nUniversiti Sains Malaysia\n11800 Penang\nMALAYSIA\nEmail: maljpharm@gmail.com\n\n\n\nThe Malaysian Journal of Pharmacy is a publication of the Malaysian Pharmaceutical Society. \nEnquiries are to be directed to the publisher at the above address. The Publisher reserves copy- \nright and renewal on all published materials, and such material may not be reproduced in any form \nwithout the written permission of the Publisher.\n\n\n\n\n\n\n\n\nTable of Contents\n\n\n\nEditorial\n\u2022 Cross-disciplinary Research Fostering Holistic Healthcare 1\n\n\n\nList of oral presentations 3\n\n\n\nAbstracts of oral presentations 8\n\n\n\nList of poster presentations 50\n\n\n\nAbstracts of poster presentations 52\n\n\n\n\n\n\n\n\n\n\n\n\n1\n\n\n\nMALAYSIAN JOURNAL OF PHARMACY Vol. 2. Issue 2. August 2016\n\n\n\nEditorial \n\n\n\nCross-disciplinary Research Fostering Holistic Healthcare\nDr. Lawrence Anchah\nSarawak Heart Centre, Kota Samarahan, \nSarawak, Malaysia\n\n\n\nPharmacists play an important role in the multidisciplinary healthcare team who focus \non pharmaceutical care issues. This is more apparent in hospitals and clinics, not forgetting \nthose in community services. As our profession is increasingly focusing on holistic healthcare, \ngood communication skill is crucial to provide guidance, counselling, education and know-how \nto meet the patient needs. Hence, future pharmacists are expected to undertake social pharmacy \nprogressively\tin\ttheir\tpractices\tto\tfulfill\tboth\tpharmaceutical\tand\tsocial\tneeds.\t\n\n\n\nIn our current practices, medication non-adherence and pharmacy practice pattern are \ntwo common areas of discussion in our quest for providing better pharmaceutical care. Although \npatients\u2019 adherence to their medications is close to 100% during admission (which is a Morisky \nScore of 8/8 or similar scale), there is a group of patients who are not adhere to their medication \nregime soon after discharge due to many reasons. It is challenging to resolve these issues during \nhospitalisation as patients are unable to assimilate the information provided during adherence \ncounselling or during bedside dispensing activities. Hence, activities such as home medication \nreview enable pharmacists to deliver better pharmaceutical care by working together with the \npatients and their caregivers. Pharmacists should take one step forward to break the over-the-\ncounter barrier and serve the community by working together with other healthcare professionals \nfrom different specialties. This cross-disciplinary approach is able to reduce the risks of treatment \nfailure as well as drug wastages.\n\n\n\nAs we move towards providing better pharmacy services, the next challenging arena \nin clinical pharmacy nowadays is to provide personalized treatment. One of the examples is  \npharmacogenetics.\tThe\tbenefits\tof\tpharmacogenetics\tin\tindividualised\tpatient\tcare\tare\tundisputed.\t\nHowever arguments still exist if one should opt for conventional empiric dosing strategy each \ntime we encounter \u2018tailored-to-patients\u2019 needs. In the past, individualised pharmacogenetic-guided \ndosing is beyond our reach. This new approach of pharmacogenetics can bring a major impact in \ndose prediction particularly in warfarin and Noval Oral Anticoagulants (NOACs) therapies and \nthus\tpossibly\timprove\tsafety\tand\tcost\teffectiveness\tof\tthe\ttherapies.\tThe\tcost\tand\tbenefit\tof\troutine\t\ngenotyping may take several more years for Malaysian practitioners to achieve a consensus. Until \nthen, empiric-based dosing strategy is here to stay in our current clinical practice. Clearly a cross-\ndisciplinary research is needed to work towards this direction.\n\n\n\nAs the healthcare continues to evolve, healthcare professionals should not be restricted by \ntheir\town\tdisciplines\tand\tshould\tmove\tbeyond\ttheir\tfields\tand\texplore\tnew\tcollaborative\tmodels\t\nwith other healthcare professionals. The primary focus of such cross-disciplinary initiatives should \nbe creating a network to support relatively clear-cut research goals in addressing the complex \nhealthcare issues. By developing the cross-disciplinary teams, this may help support translational \nresearch and, by extension, the evidence for practices in fostering holistic healthcare.\n\n\n\n\n\n\n\n\nMALAYSIAN JOURNAL OF PHARMACY Vol. 2. Issue 2. August 2016\n\n\n\n2\n\n\n\nABSTRACT OF THE 9TH NATIONAL PHARMACY RESEARCH & \nDEVELOPMENT CONFERENCE 2016\n\n\n\nAcknowledgements\n\n\n\nThe editorial board would like to thank the Director General of Health, Malaysia for permission to \npublish the abstracts in this journal.\n\n\n\n \nCross-Disciplinary Research: Fostering Holistic Healthcare \nDate: 8-10th August 2016\n\n\n\nReviewers of Abstracts\n\n\n\nDr Lawrence Ak Anchah\nDr Hasenah Ali\nMr Leong Weng Choy\nDr Liau Siow Yen\nMr Hj Ridhwan Abdullah\nDr Norkasihan Ibrahim\nMdm Norazila Abd. Ghani\nMdm Noorazlinda Yaacob\nProf Yeoh Peng Nam\nAssoc\tProf\tDr\tAsrul\tAkmal\tShafie\nAssoc Prof Dr Nahlah Elkudssiah Ismail\nDr Azuana Ramli\nDr Zaitulhusna Md Safee\nDr Syamhanin Adnan\nMdm Manjulaa Devi Subramanian\nMdm Ching Shan Lii \nMdm Farizan Abdul Ghaffar\nMdm\tSarah\tDiyana\tMohd\tShafie\n\n\n\n\n\n\n\n\n3\n\n\n\nMALAYSIAN JOURNAL OF PHARMACY Vol. 2. Issue 2. August 2016\n\n\n\nLIST OF ORAL PRESENTATIONS\n\n\n\nNo Presenting authors Title \nOP1-1 Liau Siow Yen Cytochrome P-450 Polymorphisms and its Relationship to \n\n\n\nClopidogrel Response\nOP1-2 Fann Zi Yinn Benzodiazepine Utilization among Patients with Depressi3on \n\n\n\nin Teluk Intan Hospital\nOP1-3 Lee Sung Nying SL GTN: Assessment of Cardiac Patients\u2019 Knowledge and \n\n\n\nUse at Balik Pulau Hospital\nOP1-4 Benjamin Loh Chuan Ching Impact of Value Added Services (VAS) on Patient Waiting \n\n\n\nTime at Ambulatory Pharmacy Queen Elizabeth Hospital\nOP1-5 Raja Mohd Khairul Anuar bin \n\n\n\nRaja Ismail\nStudy\t of\t Knowledge\t Identification\t and\t Safe-Handling\t\nPractices of Cytotoxic Drug among Nurses in Raja \nPerempuan Zainab II Hospital (HRPZ II)\n\n\n\nOP1-6 King Teck Long High Prevalence of Aspirin Resistance in High Risk \nCoronary Artery Disease Patients and its Risk Factors\n\n\n\nOP1-7 Chan Huan Keat Pictogram-Based Labeling for Pediatric Liquid \nMedications: Impact on Caregivers\u2019 Dosing Accuracy, \nUnderstanding and Preferences in the Sultanah Bahiyah \nHospital, Alor Setar\n\n\n\nOP1-8 Norhayati Mustapha The Impact of Integrated Educational Programme on \nKnowledge, Attitude and Practices among HIV-Patient \nCaregivers\n\n\n\nOP1-9 Voon Ooi Tche Improvement of Asthma Clinical Outcomes in Pharmacist-\nLed Respiratory Medication Adherence Clinic (RMTAC)\n\n\n\nOP1-10 Goh See Yik The Capability of the Generic Pharmaceutical Industry in \nMalaysia: A Nationwide Study\n\n\n\nOP1-11 Chua Yi Wen Prevalence of Prescribing Error at Outpatient Clinic and \nPhysician Clinic in Teluk Intan Hospital\n\n\n\nOP1-12 Siti Qurasyiah binti Abd \nHamid\n\n\n\nA Comparison Study on the Prescribing Error in Discharge \nPrescription from Medical Ward in a Regional Referral \nHospital\n\n\n\nOP1-13 Hamiza Binti Aziz Medication Adherence among Patients Receiving \nSubsidized Medication: Does the Rate Differ to Self-\nPaying Patients?\n\n\n\nOP1-14 Wong Wei Wei Safety-Related Knowledge, Attitude and Practices of \nNurses Handling Cytotoxic Anticancer Drugs in Duchess \nof Kent Hospital\n\n\n\nOP1-15 Sze Wei Thing Impact of Pharmacist Initiated Antimicrobial Stewardship \nStrategies on Early Intravenous to Oral Antibiotics Switch \nPractice in District Hospitals\n\n\n\nOP1-16 Nadia Abdul Shukur Quality of Life and HAART Adherence among People \nLiving with HIV (PLHIV)\n\n\n\nOP1-17 Lukman Nul Hakim bin Md \nKhairi\n\n\n\nRisk Factors and Clinical Outcomes of Patients with \nMultidrug Resistant Acinetobacter Baumannii Infection in \nIntensive Care Unit of HSNZ, Kuala Terengganu\n\n\n\nOP1-18 Arifah Nadiah binti Ahmad A Cross Sectional Survey on Self Medication Practice and \nAwareness among Public Attending Pasir Mas Kelantan, \nHospital\n\n\n\n\n\n\n\n\nMALAYSIAN JOURNAL OF PHARMACY Vol. 2. Issue 2. August 2016\n\n\n\n4\n\n\n\nNo Presenting authors Title \nOP1-19 Loh Khai Lean Patients\u2019 Belief, Knowledge and Adherence to Rheumatoid \n\n\n\nArthritis Medication Pre and Post Pharmacist Counselling: \nA Pilot Study\n\n\n\nOP1-20 Melissa Lim Siaw Han CYP4F2 Gene Polymorphism and Warfarin Maintenance \nDose in a Multiethnic Borneo Population on Long Term \nWarfarin Therapy\n\n\n\nOP1-21 Chow Li Wei Doctors\u2019s Perceptions and Expectations of the Role of \nClinical Pharmacists in a Regional Referral Hospital\n\n\n\nOP1-22 Chong Pei Feng The Prevalence of Polypharmacy in Elderly in the Medical \nWard of a Malaysian Governement Hospital.\n\n\n\nOP1-23 Tan Xin Yi Evaluation of Completion Rates, Medication Cost and \nAdverse Drug Reactions Related to Tuberculosis Treatment \nin Melaka\n\n\n\nOP1-24 \u2018Afifah\tbinti\tChe\tEmbi A Study of Factors Associated with Wound Healing in \nDiabetic Foot Ulcer Patients in Teluk Intan Hospital\n\n\n\nOP1-25 Wan Norshahadah binti Wan \nShamsuddin\n\n\n\nQuality of Life Outcomes Following Six Months of \nMethadone Maintenance Therapy in Health Clinics\n\n\n\nOP1-26 Gillian Phua Revisit Rates with the Use of Pre-packed Medication at the \nEmergency Department of a Tertiary Hospital.\n\n\n\nOP1-27 Nur Syuhada Ismail Antiepiletic Drug Utilisation and Quality of Life of \nEpilepsy Patients in Melaka Hospital\n\n\n\nOP1-28 Sugendiren a/l Segeran Appropriateness and Cost Impact of Intravenous (IV) \nProton Pump Inhibitors (PPI) Use in non-Intensive Care \nUnit (non-ICU) Setting in Hospital Putrajaya\n\n\n\nOP1-29 Chuah Ying Qi Use, Behaviour and Understanding of Consumers towards \nDietary Supplements\n\n\n\nOP1-30 Geetha Sandre Mohanan Public Perception and Belief of Generic Versus Branded \nMedication: A Cross-Sectional Study in Hospital Slim \nRiver, Malaysia\n\n\n\nOP1-31 Lee Soik Fun Illness Perception and Metabolic Control HbA1c in Patient \nwith Type 2 Diabetes Mellitus\n\n\n\nOP1-32 Shamadevi Pasupathi Parents and Prescribers Attitude and Knowledge towards \nPaediatric Cough and Cold Products in Keningau Hospital, \nSabah\n\n\n\nOP1-33 Lee Jie Min The Impact of Pharmacist-Led Patient Education \nProgramme on Quality of Bowel Preparation for \nColonoscopy: A Preliminary Finding\n\n\n\nOP1-34 Azrina Binti Abul Aziz The Emergence of Multi-Drug Resistant (MDR) \nAcinetobacter Baumanii Infection: Risk Factors and \nOutcomes among Patients in Intensive Care Unit Kulim \nHospital\n\n\n\nOP1-35 Lim Yehan @ Evelyn Lim Deferasirox Compliance and Cost Saving Among Children \nwith Thalassaemia: A One Year Retrospective Analysis\n\n\n\nOP1-36 Toh Yi Siang Evaluating the Frequency of Errors in Preparation and \nAdministration of Intravenous Medications in Pediatric \nWards of Sultanah Nur Zahirah Hospital, Kuala Terengganu\n\n\n\nOP1-37 Aziz Ur Rahman Evaluating Perceived Effectiveness and Safety towards \nElectronic Cigarette among Malaysian Vapers\n\n\n\n\n\n\n\n\n5\n\n\n\nMALAYSIAN JOURNAL OF PHARMACY Vol. 2. Issue 2. August 2016\n\n\n\nNo Presenting authors Title \nOP1-38 Ng Siok Shen Comparison\t of\t Efficacy\t and\t Safety\t of\t Streptokinase\t and\t\n\n\n\nTenecteplase in Patients with ST-Segment Elevated Acute \nMyocardial Infarction (STEMI) in Melaka Hospital\n\n\n\nOP1-39 Nurhamizah Noor Rahim Outcome Evaluation of Dipeptidyl Peptidase 4 (DPP4) \nInhibitor and Its Combination on Glycemic Control of \nType 2 Diabetes Mellitus Patients at Putrajaya Hospital\n\n\n\nOP1-40 Sia Xin Ni Green Bag Medication Review: Improving Adherence \nthrough Patient Empowerment\n\n\n\nOP1-41 Lee Lay Chin Perception towards the Acceptability of HPV Vaccination \namong Women Aged 18-45 Years Old in Teluk Intan \nHospital, Perak\n\n\n\nOP1-42 Suharzelim Abu Bakar An Investigational Study on Synthesis Yield of FDG \nPutra Injection in GMP Radiopharmaceutical Preparation-\nCyclotron Facility, National Cancer Institute\n\n\n\nOP2-1 Muhamad Aizuddin bin \nRoszali\n\n\n\nThe Use of Complementary and Alternative Medicine in \nPaediatric Patients\n\n\n\nOP2-2 Chan Pui Lim Co-Morbid Hypertension, Diabetes Mellitus or \nDyslipidemia among Patients Prescribed with Second \nGeneration Antipsychotic: A Comparison Study between \nAripiprazole, Quetiapine and Clozapine based on Pharmacy \nPrescription Database\n\n\n\nOP2-3 Gopi Muniandy Pre-Post Study on Knowledge of Topical Corticosteroids \namong Psoriasis Patients: Experience from Hospital \nMelaka\n\n\n\nOP2-4 Tew Mei Mei The Outcomes and Cost-Effectiveness Analysis of Type II \nDiabetes Management of Public Healthcare Facilities in \nthe State of Kedah\n\n\n\nOP2-5 Adam Henry Sivapatham Prevalence of Food Products Adulterated with Appetite \nSuppressants or Male Sexual Performance Enhancers \nand its Association with Price in Central Industrial Zone, \nMalaysia\n\n\n\nOP2-6 Kristine Lee Sheh Fuen Pharmacists\u2019 Barriers and Attitudes towards Research in \nKota Kinabalu: A Qualitative Study\n\n\n\nOP2-7 Ros Sakinah Kamaludin An Antibiotic Point Prevalence Evaluation in Perak \nSpecialist Hospitals\n\n\n\nOP2-8 Mohd Hanif Mustafa A Pilot Study: Experience, Knowledge and Perception of \nPatients towards the Frequent Brand Switching of Generic \nMedicines\n\n\n\nOP2-9 Jerry Liew Ee Siung An Evaluation of Effectiveness and Safety of Current \nInsulin Infusion Protocol in Intensive Care Unit: A \nProspective Cohort Study\n\n\n\nOP2-10 Chong Wan Choon Hyperphosphatemia among Hemodialysis Patients \non Calcium Carbonate in Sibu, Sarawak: Patients\u2019 \nCharacteristics, Knowledge and Adherence of Phosphate \nBinder\n\n\n\nOP2-11 Cheah Meng Fei Willingness to Pay for Pharmacist-Provided Dispensing \nServices in Sabah, Malaysia\n\n\n\n\n\n\n\n\nMALAYSIAN JOURNAL OF PHARMACY Vol. 2. Issue 2. August 2016\n\n\n\n6\n\n\n\nNo Presenting authors Title \nOP2-12 Nur Atiqah Anwa Effects of Psychosocial Intervention on Quality of Life \n\n\n\namong Patients Receiving Methadone Therapy in Hulu \nTerengganu Hospital\n\n\n\nOP2-13 Nurulain binti Md M. Ramli Barriers to Medication Error Reporting Among Healthcare \nProfessionals in Sultanah Fatimah Hospital, Muar\n\n\n\nOP2-14 Manjulaa Devi Subramaniam Vancomycin Initial Dosing among Adult Dialysis (VIDAD) \nPatients in a Tertiary Care Hospital\n\n\n\nOP2-15 Chua Qian Hui Prescription Pattern and Prevalence of Potentially \nInappropriate Prescribing (PIP) for Geriatric Patients in \nSpecialist Clinics, Sultan Haji Ahmad Shah Hospital\n\n\n\nOP2-16 Chan Suet Yee The Compliance and Problems Encountered in Taking \nEye Medications among Glaucoma Patients in Regional-\nReferral Hospital\n\n\n\nOP2-17 Chiew Siow Yeh Factors Affecting the Outcome of Methadone Maintenance \nTherapy in Zone Kepong\n\n\n\nOP2-18 Chan Huan Keat Closed-System Transfer Device for Antineoplastic Drug \nPreparation in the Sultanah Bahiyah Hospital, Alor Setar: \nIs Cost Saving Possible?\n\n\n\nOP2-19 Suzana Mustafa Impact of CYP2B6 Polymorphism, Clinical Factors and \nMethadone on Nevirapine Concentrations in HIV Patients\n\n\n\nOP2-20 Umi Solehah binti Sa\u2019ad Evaluation of Adherence among Acute Coronary Syndrome \n(ACS) Patients and Assessment of Knowledge and Use of \nSublingual Glyceryl Trinitrate (GTN) in Melaka Hospital\n\n\n\nOP2-21 Tan Bee Kean Assessment\t of\t Patients\u2019\tAdherence\t to\t Medication\t Refill\t\nthrough Medication Appointment Card\n\n\n\nOP2-22 Wong Su Li Seizure Control among Epilepsy Patients through Epilepsy \nReview Service in Primary Care Setting\n\n\n\nOP2-23 Mohd Shainol Azmar bin \nKassim\n\n\n\nImpact of Specialized Counselling by Pharmacists in \nPsoriasis Management\n\n\n\nOP2-24 Azman bin Mohammad Perceptions of Type 2 Diabetes Mellitus Patients towards \nInsulin Therapy in District Specialist Hospital\n\n\n\nOP2-25 Sivaraj Raman Effect of an Education Programme on Attitude, Knowledge, \nAwareness and Coping Mechanism in Epilepsy (EPACE)\n\n\n\nOP2-26 Jasmine Bok Lai Hoong Awareness of Adverse Drug Reactions (ADR) Reporting \namong Physicians in Pejabat Kesihatan Daerah Timur Laut \n(PKTL), Penang\n\n\n\nOP2-27 Lau Boon Tiang Patient\u2019s Perception, Practice of Complementary and \nAlternative Medicine, and Beliefs about Medicines for the \nManagement of Epilepsy\n\n\n\nOP2-28 Thong Kah Shuen An Evaluation on Pharmacokinetic Data of  Aminogylcosides \nin a Tertiary Hospital of Perak State\n\n\n\nOP2-29 Mohd Shakrie Palan Abdullah Formulation of Sterile Colloidal Plasma Expander Using \nExtracted Gelatine from Shank and Toes of the Common \nFarm Chicken - Gallus Gallus Domesticus\n\n\n\nOP2-30 Ong Sook Yee A Study on Awareness and Perceived Barriers of Self-\nMonitoring of Blood Glucose among Diabetic Patients in \nBukit Mertajam Hospital\n\n\n\n\n\n\n\n\n7\n\n\n\nMALAYSIAN JOURNAL OF PHARMACY Vol. 2. Issue 2. August 2016\n\n\n\nNo Presenting authors Title \nOP2-31 Teoh Cherh Yun Audit on Antibiotic Prescribing for Upper Respiratory \n\n\n\nTract Infection in Primary Healthcare Facilities in Kedah\nOP2-32 Tea Ming Hui Antibiotic Prescribing by Primary Care Physician for \n\n\n\nPaediatrics with Acute Respiratory Infection\nOP2-33 Low Hui Xin Impact of Pharmacists\u2019 Involvement in Home Medication \n\n\n\nReview among Stroke Patients\nOP2-34 Gan Yan Nee Patient Satisfaction towards Pharmacy Services in \n\n\n\nGovernment Health Clinics in Klang Valley\nOP2-35 Norirmawath binti Saharuddin Clinical and Cost Outcome After Two Years Implementation  \n\n\n\nof Antimicrobial Stewardship Programme at Major \nSpecialist Hospital in Malaysia (CCOAS)\n\n\n\nOP2-36 Mohd \u2018Izzat bin Ismorning Validation of Questionnaire to Study Public Knowledge \nand Perceptions towards Childhood Vaccination\n\n\n\nOP2-37 Lim Kok Eng An Audit of Surgical Antibiotic Prophylaxis in Taiping \nHospital\n\n\n\nOP2-38 Lim Yen Li Retrospective Review on Glycaemic Control after \nSwitching\t from\t Original\t Gliclazide\t Modified-Release\t\n(MR)\tto\tGeneric\tGliclazide\tModified-Release\t(MR)\t30mg\n\n\n\nOP2-39 Zulaikha binti Badrul Hisham Knowledge, Attitude and Perceptions regarding Islamic \nMedicine among Muslim Patients with Chronic Disease\n\n\n\nOP2-40 Mohd Farizh bin Che Pa Tuberculosis Incidence after Completion of Isoniazid \nProphylaxis Therapy in Retroviral Disease Patients\n\n\n\nOP2-41 Nurniza binti Nisbar Adverse Drug Reactions of Anti-Tuberculosis Drugs \namong Tuberculosis Patients Treated in Sg. Buloh Hospital\n\n\n\nOP2-42 Cheah Meng Fei Public Perception towards the Role of Pharmacists: A \nCross-Sectional Pilot Study in the State of Sabah, Malaysia\n\n\n\n\n\n\n\n\nMALAYSIAN JOURNAL OF PHARMACY Vol. 2. Issue 2. August 2016\n\n\n\n8\n\n\n\nOP1-1 (Oral)\nCYTOCHROME P-450 POLYMORPHISMS AND ITS RELATIONSHIP TO CLOPIDOGREL RESPONSE\n\n\n\nLiau SY1, Liew HB2, Lim SC3, Yuen KH3\n\n\n\n1Department of Pharmacy, Hospital Queen Elizabeth II, Kota Kinabalu, 2Department of Cardiology, Hospital Queen \nElizabeth II, Kota Kinabalu, 3School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang\n\n\n\nINTRODUCTION: Dual antiplatelet therapy is the standard therapy for patients with acute coronary syndrome (ACS) and \npost percutaneous coronary intervention (PCI) patients. Inter-individual variability exists in clopidogrel response, and this \nhas been attributed to CYP2C19 polymorphisms.\nOBJECTIVES: To determine the relationship between genetic polymorphisms of CYP2C19 and effect of clopidogrel on \nplatelet function.\nMETHOD: Cross-sectional study was conducted at Sabah Heart Centre, Kota Kinabalu, among the population of Sabah. \nPatients with ACS and those who had undergone PCI were prescribed standard loading dose of 300mg Clopidogrel and 300mg \nAspirin, followed by 75mg and 150mg maintenance dose respectively. Platelet function was measured by VerifyNow\u00ae and \nreported as platelet reactivity unit (PRU). A cut-off of PRU<230 was used as adequacy of platelet inhibition. Retesting \nwas performed among those who showed initial resistance, after repeat loading and higher maintenance, to determine true \nresistance. Genotyping for CYPC19*2 and CYPC19*3 alleles was performed by PCR method using forward and reverse \nprimers. CYP2C19 polymorphisms were expressed as good (wild type), intermediate (heterozygotes) and poor metabolizers \n(homozygotes). Differences in mean PRU between the metabolizer status were analysed using one-way ANOVA; and \nassociation between clopidogrel response and metabolizer status were analysed using chi square.\nRESULTS: Total of 430 patients. Mean age 56.7 year; 85.8% male; mean PRU 170.2. Among these, 18.1% (n=78) have \ninitial on-treatment reactivity (OTR) with mean PRU 264; after reloading, 32% (n=23) has persistent OTR. In terms of \ngenotype, 46% were good metabolizers, 44.4% intermediate metabolizers and 9.5% poor metabolizers. Good metabolizers \nhas\tsignificant\t lower\tmedian\tPRU\tas\tcompared\tto\t intermediate\tand\tpoor\tmetabolizer.\tHowever,\tno\tassociation\tbetween\t\nclopidogrel response and metabolizer status was found.\nCONCLUSION: Our study showed lower prevalence of clopidogrel resistance among Sabah population. Good metabolizer \nhas\tsignificantly\thigher\tplatelet\tinhibition\twith\tclopidogrel,\talthough\tclopidogrel\tresponsiveness\twas\tnot\tassociated\twith\t\ngenotype.\n\n\n\nKEYWORDS: clinical pharmacy, Sabah, clopidogrel, platelet reactivity unit, resistance\n\n\n\nOP1-2 (Oral)\nBENZODIAZEPINE UTILIZATION AMONG PATIENTS WITH DEPRESSION IN TELUK INTAN HOSPITAL\n\n\n\nYee FL, Fann ZY, Ong ST, Saik HL\nDepartment of Pharmacy, Hospital Teluk Intan, Perak\n\n\n\nINTRODUCTION: Benzodiazepine is given as sedative-hypnotic medication, as an adjunct to antidepressants, for \ndepressed patients who exhibit insomnia or anxiety features. In other countries, prescribing long-term benzodiazepines to \npatients is common. There is scarce data describing benzodiazepine use among depressed patients in Malaysia.\nOBJECTIVES: To describe prescribing pattern of benzodiazepines among depressed patients in Hospital Teluk Intan.\nMETHOD: A retrospective, cross-sectional study was conducted among patients, based on patient medical record review \nwho were diagnosed with depression from 1st January 2008 until 30th Jun 2015 and had at least 6 months of follow-up at \npsychiatry clinic. Benzodiazepine dose prescribed was converted to diazepam equivalent dose. Descriptive statistic was \nused to present demographic data and the prescribed doses of benzodiazepines. Inferential statistics was used to explore the \nassociation between demographic data and benzodiazepine utilization.\nRESULTS: Among 99 patients who met the inclusion criteria (mean age=48.1), 56% of patients were female. Half of the \npatients were Chinese (56%), followed by Malay (27%) and Indian (17%). Median duration of depression was 2.55 years. \nSSRI was the most prescribed antidepressant (n=64, 65%), while alprazolam was the most prescribed benzodiazepine (n=59, \n60%). Median duration of benzodiazepine use was 485.11 days. Median daily dose of benzodiazepine was 4.896mg, in terms \nof diazepam equivalent dose. Only 24 patients had benzodiazepine use not exceeding 90 days, and 19 patients with duration \nnot\texceeding\t60\tdays.\t95%\tof\tpatients\tused\tlow\tdose\tbenzodiazepine\t(<15mg).\tThere\twas\ta\tsignificant\tpositive\tcorrelation\t\nbetween\tduration\tof\tdepression\tand\tbenzodiazepine\tduration,\twhile\ta\tsignificant\tnegative\tcorrelation\tbetween\tduration\tof\t\ndepression and benzodiazepine dose.\nCONCLUSION:  Although the benzodiazepine dose prescribed was low, most were on prolonged duration of benzodiazepines \nin combination with antidepressants, which did not follow guideline recommendations. Further research needs to be done to \njustify the need of prolonged use of benzodiazepines among depressed patients in Malaysia.\n\n\n\nKEYWORDS: pharmacy practice, Perak, benzodiazepine, depression, utilization\n \n\n\n\n\n\n\n\n\n9\n\n\n\nMALAYSIAN JOURNAL OF PHARMACY Vol. 2. Issue 2. August 2016\n\n\n\nOP1-3 (Oral)\nSL GTN: ASSESSMENT OF CARDIAC PATIENTS\u2019 KNOWLEDGE AND USE AT BALIK PULAU HOSPITAL\n\n\n\nNasira A., Nurul AMN, Lee SN\nDepartment of Pharmacy, Hospital Balik Pulau, Pulau Pinang \n\n\n\nINTRODUCTION: Coronary heart disease contributes to one of the highest mortality in Malaysia. Sublingual glyceryl \ntrinitrate (SLGTN) is a life-saving medication in acute coronary syndrome, hence, adherence to SLGTN is important. \nOBJECTIVES: The objectives of the study were to assess the knowledge and the use of SLGTN among cardiac patients \nin\tHospital\tBalik\tPulau\tand\tto\tinvestigate\tthe\tpatients\u2019\tdemographic\tand\tclinical\tfactors\tthat\tinfluence\tthe\tknowledge\tand\t\nthe use of SLGTN. \nMETHOD: A cross-sectional study was carried out via a validated questionnaire adopted from The Sublingual Nitroglycerin \nInterview Schedule (SNIS) for a period of 2 months. The survey was conducted among eligible consented patients in \nHospital Balik Pulau who were prescribed with SLGTN. Patients\u2019 knowledge score ranged from 0 to 7; score 0 to 3 (poor \nknowledge), score 4 to 5 (moderate knowledge) and score 6 to 7 (high knowledge). Meanwhile, for the use subscale ranged \n0-5; score 0 to 3 (poor adherence) and score 4 to 5 (good adherence). All data was analysed using SPSS. Chi square test \nwas used to analyse the relationship between demographic data and clinical factors with level of knowledge and adherence. \nRESULTS: Out of 37 respondents, 62.2% were elderly above 60 years old. Almost three-quarter (70.3%) of the respondents \nhad poor knowledge score and more than half (56.8%) had poor adherence score. Out of the demographic factors (age, \ngender, ethnic, education level) and clinical factors (duration taking SLGTN and previous counselling) analysed, only \nduration\t of\t taking\t SLGTN\thad\t significant\t relationship\twith\t level\t of\t adherence\t (p=\t 0.048)\t .\tThere\t is\t also\t a\t significant\t\ncorrelation between patients\u2019 knowledge and adherence level (p= 0.007). \nCONCLUSION: Cardiac patients in Hospital Balik Pulau have low knowledge and adherence level in the use of SLGTN. \nPharmacist intervention may need to be carried out to improve patient knowledge and adherence to SL GTN. \n\n\n\nKEYWORDS: pharmacy practice, Pulau Pinang, sublingual glyceryl trinitrate, knowledge, adherence\n\n\n\nOP1-4 (Oral)\nIMPACT OF VALUE ADDED SERVICES (VAS) ON PATIENT WAITING TIME AT AMBULATORY PHARMACY \nQUEEN ELIZABETH HOSPITAL\n\n\n\nLoh BCC, Wah KF, Teo CAL, Khairudin MN, Fairuz F, Liew ES\nDepartment of Ambulatory Pharmacy, Queen Elizabeth Hospital, Kota Kinabalu\n\n\n\nINTRODUCTION: Value-added service (VAS) is an innovative dispensing system created to provide alternative means \nof collecting drug supply from hospital. This in turn reduces the necessity for patient to come to pharmacy counter, thus \nreducing the burden of dispensing at ambulatory pharmacy.\nOBJECTIVES: To evaluate the impact of VAS on patient waiting time at ambulatory pharmacy, Queen Elizabeth Hospital.\nMETHOD: A pre- and post-study design was conducted from September 2014 till June 2015 at ambulatory pharmacy. \nDuring pre-intervention phase, baseline data of parameters were collected retrospectively. Then, VAS promotional campaign \nwas carried out for six months. Outcomes were evaluated comparing pre- and post-intervention phase. Primary outcome was  \npatient waiting time measured by percentage of prescription served in less than 30 minutes. Linear regression analysis was \nused to determine the impact of VAS towards patient waiting time.\nRESULTS: An increase in VAS registration (20.9% vs 35.7%, p<0.001) was observed after the promotional campaign. With \nthis, the mean percentage of prescription served in less than 30 minutes increase from 83.2% \u00b1 15.9 to 90.3% \u00b1 11.5, p=0.001. \nAfter controlling for covariates, it was found that patient waiting time was affected by the number of pharmacy counters \n(b=0.1125, 95% CI 0.0631, 0.1620, p<0.001), the number of prescriptions (b=0.0008, 95% CI 0.0004, 0.0011, p<0.001), \nthe\tnumber\tof\trefill\tprescriptions\t(b=0.0004,\t95%\tCI\t0.0002,\t0.0007,\tp<0.001)\tand\tthe\tnumber\tof\tpharmacy\ttechnicians\t\n(b=-0.0349, 95% CI -0.0548, -0.0150, p=0.001). An increase in the percentage of VAS registration was associated with a \nreduction\tin\tthe\tnumber\tof\trefill\tprescriptions\t(b=-2.9838,\t95%\tCI\t-4.2289,\t-1.7388,\tp<0.001).\nCONCLUSION: Waiting time at ambulatory pharmacy improved with VAS registration. The impact of VAS on waiting \ntime\tresulted\tfrom\ta\treduction\tin\tthe\tnumber\tof\trefill\tprescriptions.\n\n\n\nKEYWORDS: pharmacy health policy, Sabah, ambulatory pharmacy, Value Added Services, patient waiting time\n \n\n\n\n\n\n\n\n\nMALAYSIAN JOURNAL OF PHARMACY Vol. 2. Issue 2. August 2016\n\n\n\n10\n\n\n\nOP1-5 (Oral)\nSTUDY OF KNOWLEDGE IDENTIFICATION AND SAFE-HANDLING PRACTICES OF CYTOTOXIC DRUG \nAMONG NURSES IN RAJA PEREMPUAN ZAINAB II HOSPITAL (HRPZ II)\n\n\n\nSiti NAG, Muhamad SMN, Noor HON, Raja MKA, Tuan NKT\nDepartment of Pharmacy, Hospital Raja Perempuan Zainab II, Kelantan\n\n\n\nINTRODUCTION: An increasing trend of cytotoxic drug use, mainly in cancer treatment, has increased the occupational \nexposure. It is very important for individuals handling chemotherapy agents, especially oncology nurses to have adequate \nknowledge as the safety net for themselves and patients. Lack of knowledge in chemotherapy administrations breaches \npractice and threatens the safety of the handlers as well as the patients.\nOBJECTIVES: To evaluate the safe handling of cytotoxic drug among nurses and their compliance with safety policy while \nhandling cytotoxic drugs.\nMETHOD: A cross sectional study involving nurses in the wards, which handle patients on cytotoxic drugs was conducted \nfor 2 months from October to November 2015). A validated questionnaire was distributed using convenience sampling \nmethod. Data was analysed by using SPSS software package version 22.\nRESULTS: A total of 127 questionnaires were distributed with a response rate of 59.8%. Mean age of respondent was \n36.9\u00b17.9) years with good nursing experience (13.6\u00b17.1). However, most respondents lack nursing experience in \nadministration of chemotherapy agents (2.4\u00b13.4). Non-oncology ward (0.74\u00b10.77) showed better chemotherapy exposure \nknowledge\tcompared\tto\toncology\tward\t(0.63\u00b10.14)\twith\tstatistically\tsignificant\t(p=0.008).\tOncology\tward\t(2.49\u00b10.50)\thas\t\nstatistically\tsignificant\t(p=0.002)\tlower\tperceived\trisk\tcompared\tto\tnon-oncology\tward\t(2.96\u00b10.48).\nCONCLUSION: The knowledge of cytotoxic exposure and compliance with safety policy of cytotoxic drugs among nurses \nin HRPZ II was still low and unsatisfactory. Hence, there is a need to improve the knowledge and the practice of safe \nhandling of cytotoxic drugs among nurses. \n\n\n\nKEYWORDS: pharmacy practice, Kelantan, cytotoxic drug, knowledge\n\n\n\nOP1-6 (Oral)\nHIGH PREVALENCE OF ASPIRIN RESISTANCE IN HIGH RISK CORONARY ARTERY DISEASE PATIENTS \nAND ITS RISK FACTORS\n\n\n\nKing TL1,2, Chan JKM3, Tan CSY1,2, Ku MY1,2, Tan SSN1,2, Tiong LL1,2, Lim MSH1,2, Fong AYY2,4\n\n\n\n1Department of Pharmacy, Sarawak Heart Centre, Kota Samarahan, Sarawak, 2Clinical Research Centre, Sarawak General \nHospital, Kuching, Sarawak, 3Department of Cardiothoracic Surgery, Sarawak Heart Centre, Kota Samarahan, Sarawak, \n4Department of Cardiology, Sarawak Heart Centre, Kota Samarahan, Sarawak\n\n\n\nINTRODUCTION: Aspirin resistance (AspR) is not uncommon in coronary artery disease (CAD) patients. AspR might \nindicate inadequate cardiovascular protection from aspirin via inhibition of COX-1 dependent pathway.\nOBJECTIVES: This study aimed to assess the prevalence of AspR in high risk CAD patients admitted for elective coronary \nartery bypass grafting (CABG) and the associated risk factors.\nMETHOD: Elective CABG patients who took aspirin daily for at least seven days were recruited prior to operation from \nNovember 2015 to February 2016. Platelet reactivity level was measured using multiple electrode aggregometry (MEA) \nassay\tand\texpressed\tas\tAU*min.\tPatients\twith\tMEA\treading\tabove\t300\tAU*min\twere\tidentified\tas\tAspR.\tDemographics,\t\ncomorbidities, laboratory data, and concomitant medication list were obtained from patients\u2019 outpatient medical folder. \nMultiple\tlogistic\tregression\tanalysis\twas\tused\tto\tdetermine\tthe\tsignificant\trisk\tfactors\tof\tAspR.\nRESULTS:\tOut\t of\t 30\t subjects\t recruited,\t 14\t (46.7%)\twere\t identified\t as\t aspirin\t resistant.\tThe\tmean\tMEA\t reading\twas\t\n330.8\u00b1145.7 AU*min. Patient with AspR were more likely to be diabetic (64.3 vs 25.0%, p=0.03), had higher white blood \ncell (WBC) count (9.3\u00b12.1 vs 7.8\u00b11.0 x109/L, p=0.02) and higher body mass index (BMI) (29.7\u00b15.0 vs 26.4\u00b13.3, p=0.04). \nMultiple\tlogistic\tregression\tanalysis\tshowed\tthat\tWBC\tcount\t(OR\t1.94,\t95%\tCI;\t1.02-3.69,\tp=0.04)\twas\tthe\tonly\tsignificant\t\nrisk factors of AspR.\nCONCLUSION: There was a high prevalence of AspR among the high risk CAD patient admitted for elective CABG. \nHigher WBC count was associated with aspirin resistance in this group of patients.\n\n\n\nKEYWORDS: clinical pharmacy, Sarawak, aspirin resistance, coronary artery disease, coronary artery bypass grafting\n \n\n\n\n\n\n\n\n\n11\n\n\n\nMALAYSIAN JOURNAL OF PHARMACY Vol. 2. Issue 2. August 2016\n\n\n\nOP1-7 (Oral)\nPICTOGRAM-BASED LABELLING FOR PEDIATRIC LIQUID MEDICATIONS: IMPACT ON CAREGIVERS\u2019 \nDOSING ACCURACY, UNDERSTANDING AND PREFERENCES IN THE SULTANAH BAHIYAH HOSPITAL, \nALOR SETAR\n\n\n\nChan HK, Nain EAM, Ho YY, Ng ZW, Cheah LL\nDepartment of Pharmacy, Sultanah Bahiyah Hospital, Alor Setar, Kedah\n\n\n\nINTRODUCTION: The Malaysian children\u2019s caregivers have been generally shown to have limited health literacy and \ndifficulty\tin\tcomprehending\tmedication\tlabels.\nOBJECTIVES: To assess the impact of a computer-generated, pictogram-based drug labels used for pediatric liquid \nmedications on dosing accuracy, understanding of instructions and preferences among caregivers.\nMETHOD: This was a two-armed, randomised controlled trial undertaken at the outpatient pharmacy of Sultanah Bahiyah \nHospital, Alor Setar. Sixty-three caregivers receiving liquid antibiotic preparations for children aged 1 month to 8 years were \nrecruited. They were randomised to receive either a pictogram-based drug label (intervention, n=32) or a text-only drug label \n(control, n=31) along with verbal instructions by pharmacists. Their ability to accurately measure the doses by using oral \nsyringes was observed, and their understanding of medication instructions and preferences for labels to be received were \nexamined using a structured interview guide.\nRESULTS: Majority of the participants were Malay (93.7%) and had only secondary education or below (85.7%). \nPhenoxymethylpenicillin and Cefuroxime made up 88.9% of liquid medications received by them. The pictogram-based \ndrug\tlabel\tsignificantly\treduced\tthe\trisk\tof\tdosing\terrors\t(unadjusted\tOR:\t0.192;\t95%\tCI:\t0.037,\t0.990).\tCompared\twith\tthe\t\ncontrol group, the intervention group also demonstrated better understanding of medication instructions, especially of drug \nstorage conditions (90.6% vs 64.5%, p=0.013) and duration of treatment (93.8% vs 64.5%, p=0.004). After being shown \nboth labels at the end of assessment, most participants (58.7%), particularly those with only secondary education or below, \nexpressed their preferences for the pictogram-based drug labels.\nCONCLUSION: The use of the pictogram-based drug label resulted in fewer dosing errors and improved understanding \nof medication instructions among children\u2019s caregivers. Future studies should further investigate its usefulness in other \npediatric dosage forms, particularly among caregivers with low education levels.\n\n\n\nKEYWORDS: pharmacy practice, Kedah, paediatrics, drug labelling, pictographic interventions\n\n\n\nOP1-8 (Oral)\nTHE IMPACT OF INTEGRATED EDUCATIONAL PROGRAMME ON KNOWLEDGE, ATTITUDE AND \nPRACTICES (KAP) AMONG HIV-PATIENT CAREGIVERS\n\n\n\nNorhayati M1, Lua PL2, Ahmad KAR3, Noridah N4\n\n\n\n1Department of Pharmacy, Hospital Raja Perempuan Zainab II, Kota Bharu, Kelantan, 2Faculty of Health Sciences, Universiti Sultan \nZainal Abidin (UniSZA), Kuala Terengganu, Terengganu, 3Infectious Disease Clinic, Hospital Sultanah Nur Zahirah (HSNZ), Kuala \nTerengganu, Terengganu, 4Infectious Disease Clinic, Hospital Raja Perempuan Zainab II, Kota Bharu, Kelantan\n\n\n\nINTRODUCTION: Knowledge\tabout\tHIV/AIDS\thas\tbeen\tidentified\tas\ta\tpowerful\ttool\tto\tprevent\tthe\ttransmission\tof\tthis\tdisease.\t\nHowever, majority of KAP studies have been directed at young adult, adolescents and healthcare workers. Hence, little is known \nabout KAP if health education is focused on their caregivers.\nOBJECTIVES: This study was to investigate the impact of the integrated educational intervention on HIV-patient caregivers\u2019 KAP \ntowards HIV/AIDS and antiretroviral therapy.\nMETHOD: A randomized, controlled open-label trial based on convenience sampling was conducted in the Infectious Disease \nClinic of three public hospitals located in the states of Kelantan, Terengganu and Pahang. They were randomised into intervention \n(IG) and control (CG) groups. The CG was supplied with only printed brochure while IG received an additional counselling session \nand eight-weekly educational SMS. Upon written consents, subjects completed the Malay Knowledge, Attitudes and Practices \n(KAP)\ttowards\tHIV/AIDS\tand\tantiretroviral\ttherapy\ttwice\t(first\tduring\tbaseline\tand\tsecond\tafter\ttwo\tmonths).\tData\tanalysis\twas\t\ncarried out using SPSS 20 employing descriptive and repeated measures of covariance.\nRESULTS:\tOne\thundred\tand\tfifteen\tcaregivers\twere\tenrolled\t(mean\tage=36.4\tyears,\tfemale=54.1%,\tmarried=73.9%).\tFrom\twithin\t\ngroup\tcomparison,\tthere\twas\tsignificant\tdifference\tof\tmean\tscores\twithin\teach\tgroup\tbased\ton\ttime.\tBesides,\tfrom\ttest\tof\tbetween-\nsubject\teffects,\tthere\twere\tsignificant\tdifferences\tof\tmean\tKAP\tscores\tbetween\tthe\tcontrol\tand\tintervention\tgroups\tregardless\tof\ttime.\t\nAfter\tcontrolling\tfor\tage\ton\trepeated\tmeasurements,\tmean\tscores\tshowed\tsignificant\tdifference\tbetween\tcontrol\tand\tintervention\t\ngroup in 2nd time assessment (after intervention).\nCONCLUSION: Delivering education through three integrated tools is more effective to improve KAP of caregivers. Thus, \nevidence on the effectiveness of integrated educational system in enhancing HIV-patient caregivers\u2019 KAP is now apparent.\n\n\n\nKEYWORDS: pharmacy practice, Kelantan, Terengganu, Pahang, HIV-patient caregivers, knowledge attitudes and practices\n\n\n\n\n\n\n\n\nMALAYSIAN JOURNAL OF PHARMACY Vol. 2. Issue 2. August 2016\n\n\n\n12\n\n\n\nOP1-9 (Oral)\nIMPROVEMENT OF ASTHMA CLINICAL OUTCOMES IN PHARMACIST-LED RESPIRATORY \nMEDICATION ADHERENCE CLINIC (RMTAC)\n\n\n\nOH AL, Voon OT, Saba J\nDepartment of Pharmacy, Sarawak General Hospital, Kuching, Sarawak\n\n\n\nINTRODUCTION: The pharmacist-led Respiratory Medication Therapy Adherence Clinic (RMTAC) operates in \nconjunction with the Respiratory Clinic to optimize asthma control through asthma education, medication counselling, \nadherence assessment and pharmaceutical care intervention on medication-related problems.\nOBJECTIVES: To evaluate the clinical outcomes in terms of asthma control, inhaler technique, medication understanding \nand adherence among asthmatic patients enrolled in the RMTAC.\nMETHOD: Patients who were enrolled and had completed at least 4 visits at RMTAC from 2013 to 2014 were \nretrospectively reviewed. Asthma control was assessed using the Asthma Control Test (ACT, maximum score=25) and \nmedication\tadherence\twas\tbased\ton\tModified\tMorisky\tMedication\tAdherence\tScale\t(maximum\tscore=8).\tInhaler\ttechnique\t\nand medication understanding were graded based on criteria set by study pharmacists with maximum scores of 6 and 4 \nrespectively. The clinical outcomes from visit 1 to 4 were analysed using repeated measures of ANOVA or Friedman test \nwhere\tappropriate,\twith\tp<0.05\tconsidered\tas\tsignificant.\tPost-hoc\tanalysis\twas\tconducted\twith\tthe\tBonferroni\tmethod\tto\t\nlook for the differences of clinical outcomes at visit 1 to 2, visit 2 to 3 and visit 3 to 4.\nRESULTS:\tThe\t clinical\t outcomes\t among\t63\t patients\t had\t significantly\t improved\t from\tvisit\t 1\t to\t 4.\tThese\twere\t shown\t\nin asthma control (p<0.001), medication adherence (p=0.008), inhaler technique (p<0.001) and medication understanding \n(p=0.001).\tPost-hoc\tanalysis\thad\tshown\tthat\tasthma\tcontrol\tand\tinhaler\ttechnique\twere\tsignificantly\timproved\tfrom\tvisit\t\n2 to 3, with mean ACT 19.8 (SD=3.83) vs. 21.5 (SD=2.61) and inhaler technique scoring of median=6 (IQR=0.5) vs. \nmedian=6\t(IQR=0)\trespectively,\tboth\twith\tp=0.001.\tNo\tsignificant\tdifference\tfor\tmedication\tadherence\tand\tunderstanding\t\nwas observed at level of visits tested, nonetheless, both achieved maximum score of median=8 (IQR=0) and median=4 \n(IQR=0)\trespectively\tat\tfinal\tvisit.\t\nCONCLUSION: Pharmacists\u2019 involvement in RMTAC alongside doctors\u2019 management had shown an overall improvement \nin asthma clinical outcomes.\n\n\n\nKEYWORDS: clinical pharmacy, Sarawak, pharmacist, asthma, respiratory medication therapy adherence clinic\n\n\n\nOP1-10 (Oral)\nTHE CAPABILITY OF THE GENERIC PHARMACEUTICAL INDUSTRY IN MALAYSIA: A NATIONWIDE \nSTUDY\n\n\n\nGoh SY, Wong HK, Wong ZY\nDepartment of Pharmacy, Hospital Teluk Intan, Perak\n\n\n\nINTRODUCTION: Generic pharmaceutical products are a major contributor to a country\u2019s economy. To date, no research \nhas been conducted to explore the capabilities of Malaysian generic pharmaceutical companies.\nOBJECTIVES: To explore the capability of local generic pharmaceutical companies in producing generic prescription and \nnon-prescription medicines.\nMETHOD: A cross-sectional nationwide study was conducted from October 2015 to January 2016. Data was gathered using \nthe Survey Monkey\u00ae online survey software. An invitation letter containing the online link to the questionnaire was mailed \nto members of the Malaysian Organization of Pharmaceutical Industries (MOPI) (N=26) licensed in manufacturing generic \nprescription and non-prescription medicines in Malaysia. Non-MOPI generic manufacturers as of October 2015 and MOPI \nmembers manufacturing products other than the products mentioned were excluded. The data was analysed descriptively.\nRESULTS: The usable response rate was 53.8% (n=14/26). Among the 14 respondents, 57.1% (n=8) were fully locally-\nowned companies. The majority of the surveyed companies (n=13) had an R&D unit. 64.3% (n=9) outsourced R&D \nactivities, mainly bioequivalence (BE) studies where 57.1% (n=8) and 42.9% (n=6) outsourced to a local and foreign BE \ninstitution respectively. The surveyed companies were capable of manufacturing most dosage forms. Chemists (mean = 14) \nand pharmacists (mean = 5) were the top-employed professionals. Most companies were compliant to GMP (n=14), GLP \n(n=13) and GSP (n=11). However, the current generic product registration period (mean = 2.00) and QUEST 3 online system \nfor new generic product registration (mean = 2.21) were the top two MOH drug utilization strategies with the lowest level \nof satisfaction. \nCONCLUSION: Malaysia generic pharmaceutical companies are capable of manufacturing quality generic products. \nHowever, they had expressed mixed perceptions on the effectiveness of government policies in promoting the use of generic \nmedicines. As such, this exploratory study could serve as valuable guidance for the improvement of such policies.\n\n\n\nKEYWORDS: pharmacy health policy, Malaysia, pharmaceutical industry, capability, generic \n\n\n\n\n\n\n\n\n13\n\n\n\nMALAYSIAN JOURNAL OF PHARMACY Vol. 2. Issue 2. August 2016\n\n\n\nOP1-11 (Oral)\nPREVALENCE OF PRESCRIBING ERROR AT OUTPATIENT CLINIC AND PHYSICIAN CLINIC IN TELUK \nINTAN HOSPITAL\n\n\n\nLim HG, Chua YW, Ong WC\nHospital Teluk Intan, Perak\n\n\n\nINTRODUCTION: Prescribing errors occurring in hospitals are the main concern especially in outpatient pharmacy \ndepartment.\tPharmacists\twho\tscreen\tthe\tprescriptions\thas\tto\tcall\tand\tre-confirm\terrors\toccurred\tby\tdoctors;\tit\tis\tinefficient,\t\ntime consuming and it slows down the dispensing process. There is a lack of study pertaining to the prevalence of prescribing \nerrors occurring at the outpatient and physician clinics.\nOBJECTIVES: To determine the prevalence and the most common type of prescribing errors at the outpatient and physician \nclinics in Hospital Teluk Intan.\nMETHOD: A cross sectional study was conducted using prescriptions received from outpatient pharmacy in Hospital Teluk \nIntan. Two groups of prescriptions were collected from outpatient clinic and physician clinic in July 2015. Descriptive \nanalysis was used to calculate prevalence of prescribing errors and to determine the most common type of errors occurred \nat both clinic.\nRESULTS: A total of 153 prescriptions were collected from outpatient clinic and physician clinic respectively. The average \nnumber of medications per prescription from physician clinic and outpatient clinic were 3.68 and 6.33 respectively. The \nprevalence of prescribing errors from physician clinic and outpatient clinic were 22% and 39% respectively. The most \ncommon error from outpatient clinic was no dosage form indicated (n=26), followed by no dose written on prescription \n(n=19). Similarly, no dosage form indicated was also the most common type of error in physician clinic (n=16) followed by \nno dosing frequency indicated (n=6).\nCONCLUSION: The prevalence of prescribing errors at outpatient clinic was higher than that at physician clinic. Future \nstudy is suggested to apply interventions at outpatient clinic to reduce prescribing errors.\n\n\n\nKEYWORDS: pharmacy practice, Perak, prescribing errors, prevalence\n\n\n\nOP1-12 (Oral)\nA COMPARISON STUDY ON THE PRESCRIBING ERROR IN DISCHARGE PRESCRIPTION FROM MEDICAL \nWARD IN A REGIONAL REFERRAL HOSPITAL\n\n\n\nSiti QAH, Tan XF, Doris G\nHospital Raja Permaisuri Bainun, Ipoh, Perak\n\n\n\nINTRODUCTION: Errors are common among discharge prescriptions and are preventable. However, errors occuring \nduring\tafter\toffice\thour\t(AOH)\tmight\tbe\tmissed\tdue\tto\thigh\tturnover\tand\tunderstaffed.\nOBJECTIVES: To compare the prevalence and type of prescribing errors in medical ward\u2019s discharge prescriptions.\nMETHOD: A prospective study was conducted for 3 weeks in April 2015, in Hospital Raja Permaisuri Bainun. All \nthe discharge prescriptions from medical wards were included and recorded into self-developed data collection forms. \nPrescribing errors detected were divided into OH and AOH errors. The categories of prescribers were recorded as house \nofficer,\tmedical\tofficer\tand\tspecialist.\tChi-square\ttest\twas\tdone\tthrough\tSPSS\tversion\t19.0\tto\tdetermine\tthe\trelationship.\nRESULTS: A total of 263 prescriptions during OH and 264 prescriptions during AOH were collected. Errors were \ndetected in 24.7% of OH and 23.9% of AOH prescriptions. Error rates were similar during OH and AOH, which were 1 \nin\t3\tprescriptions.\tHowever,\tall\terrors\tduring\tOH\tprescriptions\thave\tbeen\trectified\tby\tward\tpharmacist,\tupon\tcollection\tof\t\nmedication. Ommission of drug and dose (19.3% each) were the most frequent error happened during OH and ommission \nof\tdose\t(18.5%)\twas\tthe\tmost\tfrequent\terror\tduring\tAOH.\tThere\twere\tsignificant\trelationship\tbetween\tthe\ttypes\tof\terror\t\ndetected and time of which the prescriptions were written. Omission of drug (4.0 %, [p=0.006]) and wrong drug (6.5%, \n[p=0.019]) were most detected during OH as compared to AOH. The most common drug involved in error was warfarin (5 \nprescriptions), with omission of duration being the most frequent (3), followed by wrong dose and frequency. The rates of \nprescribing\terror\tfor\thouse\tofficers\tand\tmedical\tofficers\twere\tsimilar\t(34%)\tand\thigher\tthan\tspecialists.\nCONCLUSION: The rates of prescribing error were the same during OH and AOH, however drug omission and wrong drug \nerrors could not be detected during AOH and might cause harm to patient.\n\n\n\nKEYWORDS: pharmacy practice, Perak, prescribing error, after hour, discharge prescription\n \n\n\n\n\n\n\n\n\nMALAYSIAN JOURNAL OF PHARMACY Vol. 2. Issue 2. August 2016\n\n\n\n14\n\n\n\nOP1-13 (Oral)\nMEDICATION ADHERENCE AMONG PATIENTS RECEIVING SUBSIDIZED MEDICATION: DOES THE \nRATE DIFFER FROM SELF-PAYING PATIENTS?\n\n\n\nHamiza A1,2, Ernieda H1, Mohd Makmor B1, Farida I1\n\n\n\n1Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur, 2Pharmacy Division, \nMinistry of Health, Jalan Universiti, Petaling Jaya, Selangor\n\n\n\nINTRODUCTION: Poor adherence to medication prescribed attributable to uncontrolled chronic illness such as diabetes, \nhypertension, heart disease and others that may cause serious complications and increased cost of medications.\nOBJECTIVES:\tThis\tstudy\taimed\t to\tevaluate\t the\t rate\tof\tmedication\tadherence\tand\tfactors\t that\tpossibly\tmay\t influence\t\nadherence to medication between chronic disease patients with medication subsidies and those who are self-paying.\nMETHOD: This was an observational study of patients with chronic disease that received subsidized medications and \nself-paying their medications. Respondents who agreed to participate in this study were provided with a medication bottle \nthat comes with a computer chip embedded in the cap of the bottle and an electronic monitoring system that records each \ntime the cap is removed, which is called Medication Event Monitoring Systems (MEMS). Adherence rate was measured \nobjectively using MEMS. Patient\u2019s medication adherence was modelled using multiple logistic regression and only variable \nwith P-value < 0.25 were included in the analysis.\nRESULTS: Of 112 respondents only 97 respondents were suitable for data analysis. The mean age of respondents were \n55.26\u00b110.76. The mean adherence score for subsidized respondents was 74.1\u00b127.05 and 83.02\u00b117.77 for self-pay respondents. \nThere\tis\tno\tsignificant\tassociation\tbetween\tMEMS\tscore\tand\tthe\tpayment\tmethods.\tIn\tthe\tmedication\tadherence\tmodel,\tonly\t\nrespondents\twho\tcounselled\tby\tpharmacist\thad\tsignificant\tassociation\twith\tmedication\tadherence.\nCONCLUSION: When we evaluated the rate of medication adherence, the mean adherence rate showed no differences \nbetween\tboth\tgroups.\tOnly\tmedication\tcounselling\thad\tsignificant\tinfluences\ton\tpatients\tadherence.\tFuture\tstudy\tshould\t\nfocus of patients\u2019 perception on medication adherence to improve medication adherence among patients. Ideally, these study \ncould also be conducted using qualitative method to explore and have better understanding of the factors that may contribute \nto medication adherence.\n\n\n\nKEYWORDS: pharmacy health policy, medication adherence, subsidized medication, self-pay medication\n\n\n\nOP1-14 (Oral)\nSAFETY-RELATED KNOWLEDGE, ATTITUDE AND PRACTICES OF NURSES HANDLING CYTOTOXIC \nANTICANCER DRUGS IN DUCHESS OF KENT HOSPITAL (HDOK)\n\n\n\nWong WW1, Oi AC2, Chiar YS3, Ooi BW4\n\n\n\n1Hospital Duchess of Kent, Sabah, 2Hospital Baling, Kedah, 3Hospital Sabak Bernam, Selangor, 4Klinik Kesihatan \nPenampang, Kota Kinabalu, Sabah\n\n\n\nINTRODUCTION: The recent establishment of pharmacy cytotoxic drug reconstitution service in HDOK is expected to lead \nto increasing number of patients receiving chemotherapy in this hospital and results in increased exposure to nurses handling the \ncytotoxic drugs.\nOBJECTIVES: This study aimed to evaluate change in nurses\u2019 safety-related knowledge, attitude and practices in handling \ncytotoxic drugs after a series of pharmacist-based interventions.\nMETHOD: This prospective interventional study with a before and after design recruited all nurses (n=87) in 6 wards who are \ninvolved in cytotoxic drug administration to answer a self- administered, validated questionnaire adapted from a previous study. \nA self-developed performance checklist was then used by investigators to assess the compliance of all these wards with the \nrecommended\tsafety\tmeasures.\tThere\twas\ta\tgap\tof\t2\tmonths\tintervention\tperiod\tbetween\tfirst\t(pre)\tand\tsecond\t(post)\tassessment.\t\nInterventions included Continuing Nurse Education, establishment of Standard Operating Procedure, distribution of spill kit to \nwards,\tspillage\tmanagement\tbriefing\tand\tsupply\tof\tchemo\tgloves\tfor\tadministration.\nRESULTS: The median age of nurses was 26 (6.0). Most of them were female (96%). The mean knowledge score of nurses \nwas\tsignificantly\tincreased\tfrom\t49.32\t\u00b1\t10.58\tto\t57.14\t\u00b1\t12.18\tout\tof\t100\t(p<0.001)\tpost-intervention.\tOnly\tone\titem\tdisplayed\t\nsignificant\tchange\tin\tthe\tcorrect\tattitude\tof\tnurses\tpost-intervention\t(57.5%\tto\t73.5%,\tp=0.044),\twhile\tno\tchanges\thave\tbeen\t\ndetected\tin\tother\titems.\tOverall,\tthe\tmedian\tpractice\tscore\tamong\tthe\twards\twas\timproved\tsignificantly\tfor\ttransportation\t(from\t\n5 (2) to 6 (2), p=0.035), spillage (from 4 (3) to 8.5 (3), p=0.001) and waste disposal of cytotoxic drugs in wards (from 1 (1) to 3 \n(1), p=0.004).\nCONCLUSION: The pharmacist-based interventions improved the knowledge and safe practices of nurses in cytotoxic drug \nhandling,\thowever\tdifference\tin\tattitude\twas\tnot\tfound\tto\tbe\tstatistically\tsignificant.\tMore\texperiences\tand\tpractices\tare\tneeded\t\nfor change in nurses\u2019 attitude.\n\n\n\nKEYWORDS: pharmacy practice, Sabah, cytotoxic drugs, occupational exposure, pharmacist-based intervention\n\n\n\n\n\n\n\n\n15\n\n\n\nMALAYSIAN JOURNAL OF PHARMACY Vol. 2. Issue 2. August 2016\n\n\n\nOP1-15 (Oral)\nIMPACT OF PHARMACIST INITIATED ANTIMICROBIAL STEWARDSHIP STRATEGIES ON EARLY \nINTRAVENOUS TO ORAL ANTIBIOTICS SWITCH PRACTICE IN DISTRICT HOSPITALS\n\n\n\nSze WT, Kong MC, Lau C, Ubong W\nDepartment of Pharmacy, Hospital Mukah, Sarawak\n\n\n\nINTRODUCTION: Antimicrobial stewardship (AMS) is established in most of the Malaysian tertiary hospitals, but it \nhas not been fully introduced to district hospitals. Early intravenous to oral (IV-PO) antibiotics switch, which is one of the \nimportant elements in AMS is not well implemented.\nOBJECTIVES: This study aimed to evaluate the impact of pharmacist initiated AMS strategies on early IV-PO antibiotics \nswitch practice in Sarawak district hospitals.\nMETHOD: This study was a before and after cross-sectional interventional study conducted in medical wards of 9 Sarawak \ndistrict hospitals from May to August 2015. In pre-intervention phase, pharmacists performed conventional practice of \nreviewing medication charts and verbally informed the prescribers on eligible IV-PO switches. In post-intervention phase, \npharmacists introduced the doctors on IV-PO switch protocol. Clinical intervention forms which contained switch criteria \nand oral antibiotic recommendation were attached on case notes when patients were eligible for switch. Stickers of IV-PO \nswitch were applied at prescriptions to serve as reminders.\nRESULTS: 72 patients taking 79 courses of antibiotics and 76 patients taking 77 courses were recruited into the pre-\nintervention phase and post-intervention phase respectively. Timeliness of IV-PO switching improved by 1.53 days in the \npost-intervention phase (p< 0.001; 95%CI 1.26-2.00 days). Mean duration of IV antibiotics in the post-intervention phase \nwas shorter than the pre-intervention phase (2.81\u00b11.77 vs. 4.05\u00b12.81 days; p< 0.001). The proportion of IV-PO switches \nthat\twere\tonly\tperformed\tupon\tdischarge\treduced\tsignificantly\tin\tthe\tpost-intervention\tphase\t(31.2%\tvs.\t82.3%,\tp<0.001).\t\nLength of hospital stay in the post-intervention phase was shortened by 1.44 days compared to the pre-intervention phase \n(p=0.001).\tMedian\t antibiotic\t cost\t savings\twere\t significantly\t higher\t in\t the\t post-intervention\t phase\t (RM21.96\u00b123.23\t vs.\t\nRM13.1\u00b153.76; p=0.025).\nCONCLUSION: Pharmacist initiated AMS strategies in district hospitals are successful in improving timeliness of IV-PO \nswitch, reducing duration of IV, reducing length of hospitalization, and increasing antibiotic cost savings.\n\n\n\nKEYWORDS: pharmacy practice, Sarawak, antimicrobial stewardship, iv to oral switch, antibiotics\n\n\n\nOP1-16 (Oral)\nQUALITY OF LIFE AND HAART ADHERENCE AMONG PEOPLE LIVING WITH HIV (PLHIV)\n\n\n\nHashim K, Chew BH, Mohd BNN, Abdul SN, Ngoo QH, Ang WC, Khairuddin A\nDepartment of Pharmacy, Hospital Sultanah Bahiyah, Alor Setar, Kedah\n\n\n\nINTRODUCTION: Adherence to antiretroviral is the second strongest predictor of disease progression to AIDS and death \nrate, after CD4 count being the strongest predictor. In outpatient clinics settings, there is a negative correlation of viral load \nand QOL of PLHIV.\nOBJECTIVES: This study aimed to assess the correlation between QOL among PLHIV and their adherence to HAART.\nMETHOD: This was a cross-sectional observational study. Patients were recruited in RV clinic using systematic random \nsampling. Recruited patients were given a validated 31-item WHOQOL-BREF HIV questionnaire to assess their QOL. \nTheir\tadherence\twas\tthen\tassessed\twith\t8-items\tMorisky\tMedication\tAdherence\tScale\t(MMAS).\tThe\tsignificance\tlevel\tof\t\ncorrelation was then calculated using Spearman correlation.\nRESULTS: Among 72 studied patients, the mean age was 42 \u00b1 9.4 years and 62.5% were male. Based on 8-items MMAS, \n90.3% of the participants had medium to high adherence and 9.7% had low adherence to HAART, with a mean score of \n7.3(SD 0.89). The mean total scores for 31-item WHOQOL-BREF HIV are 86.1(SD 11.88). 15.4(SD 2.42) was scored \nfor the physical needs domain, 14.4(SD 2.26) for the psychological domain, 14.6(SD 2.31) for the level of independence \ndomain, 14.1(SD 2.81) for the relationships domain, 14.7(SD 2.25) for the environment domain, and 12.9(SD 4.01) for the \nspirituality domain. A negative and weak correlation between WHOQOL-BREF HIV and HAART adherence (-0.026) was \nreported in this study. There was also no difference observed between socio-demographic characteristics among studied \npopulation in their adherence to HAART.\nCONCLUSION: Correlation between QOL and HAART adherence among PLHIV in this study was negligible. Therefore \nthere\tis\tno\tsignificant\trelationship\tbetween\tthese\tvariables.\n\n\n\nKEYWORDS: pharmacy practice, QOL, HAART, adherence\n\n\n\n\n\n\n\n\nMALAYSIAN JOURNAL OF PHARMACY Vol. 2. Issue 2. August 2016\n\n\n\n16\n\n\n\nOP1-17 (Oral)\nRISK FACTORS AND CLINICAL OUTCOMES OF PATIENTS WITH MULTIDRUG RESISTANT \nACINETOBACTER BAUMANNII INFECTION IN INTENSIVE CARE UNIT OF HOSPITAL SULTANAH NUR \nZAHIRAH (HSNZ), KUALA TERENGGANU\n\n\n\nLukman Nul HMK, Nabilah HA, Nur RMN, Pooranimah T, Roslina B, Siti HR\nDepartment of Pharmacy, Hospital Sultanah Nur Zahirah, Kuala Terengganu, Terengganu\n\n\n\nINTRODUCTION: Outbreaks with the multidrug resistant (MDR) strain of Acinetobacter baumannii have emerged as a \nmajor problem in the intensive care unit (ICU) worldwide, contributing to high mortality rate and increased length of stay \nin ICUs.\nOBJECTIVES: This study aimed to investigate the incidence of MDR A. baumannii nosocomial infection in HSNZ ICU, \nthe contributory risk factors and the clinical outcomes in terms of mortality and length of hospital stay.\nMETHOD: This retrospective cohort study was conducted at Hospital Sultanah Nur Zahirah, Kuala Terengganu. Data \nbetween 1st January 2013 till 31st May 2015 were retrieved from Infectious Controlled Disease Unit and Hospital Information \nSystem. Control group was set as patients who were infected with the non-MDR strain of the pathogen.\nRESULTS: There were 53 cases of A. baumannii infection isolated from various types of biological specimens. The incidence \nof MDR A. baumannii\tinfection\twas\t15.2\tepisodes\tper\t1,000\thospital\tadmissions.\tBy\tusing\tunivariate\tanalysis,\tsignificantly\t\nindependent factors associated with MDR A. baumannii infection were previous use of beta lactam/beta lactamase inhibitor \n(p=0.021)\tand\tvancomycin\t(p=0.03)\tantibiotics.\tThe\toverall\tmortality\trate\twas\tfound\tto\tbe\tsignificantly\thigher\tin\tpatients\t\nwith MDR A. baumannii than the control group (p=0.01). \nCONCLUSION: As MDR A. baumannii infection is associated with high mortality rate, proper use of antibiotics and \naggressive infection control strategies has to be implemented in order to reduce or prevent MDR Acinetobacter infection and \nits adverse effects on hospitalized patients.\n\n\n\nKEYWORDS: clinical pharmacy, Terengganu, Acinetobacter, MDR, risk factor\n\n\n\nOP1-18 (Oral)\nA CROSS SECTIONAL SURVEY ON SELF MEDICATION PRACTICE AND AWARENESS AMONG PUBLIC \nATTENDING PASIR MAS HOSPITAL, KELANTAN\n\n\n\nArifah NA, Mursyida A, Chee SW, Chua WL\nDepartment of Pharmacy, Hospital Pasir Mas, Kelantan\n\n\n\nINTRODUCTION: Nowadays, self-medication is increasingly prevalent worldwide. Consumers empowered with better \nhealth knowledge have more alternatives and choices to make informed decisions regarding their health. This phenomenon \nalso contributes in an increasing trend of self-medication practice worldwide. However, inappropriate practice of self-\nmedication especially that involves the use of antibiotic may contribute to antibiotic resistance.\nOBJECTIVES: This study was conducted to evaluate self-medication practice among public and to assess public awareness \nof self-medication.\nMETHOD: A cross-sectional study was carried out in Outpatient Pharmacy Unit, Hospital Pasir Mas using a validated \nstructured questionnaire from June to August 2015. Respondents were selected randomly and a total of 300 respondents \nwere recruited. Questionnaires were self-administered by the respondents, facilitated by the data collectors. Questionnaire \nwas administered in Malay. Data analysis was done using SPSS software version 20. Descriptive analysis was conducted.\nRESULTS: Majority of the respondents were female (51.30%, n=154) and were between the age of 31 to 50 years old \n(36.70%). Most of them were Malay (91%), with secondary education (47.30%) and working in the private sector (34.30%). \nOf the 300 participants, 54.3% (n=163) practiced self-medication and (45.3%, n=136) self-medicated cough medication. \n78%\t(n=181)\tof\tthe\tparticipants\twho\tself-medicated\tusually\tobtained\tinformation\tfrom\thealthcare\tofficers\tor\tpharmacists.\t\nOnly 47.7% (n=143) realised that adverse drug reactions may happen and only 37.3% (n=112) was aware of food-drug and \ndrug-drug interactions. Less than 40% of the participants read their medical labels and expiry dates.\nCONCLUSION: Self-medication practice is prevalent in Pasir Mas district but inappropriate practice is unsafe. Thus, \neducation on proper use of medication and proper practice of self-medication needs to be emphasised to ensure quality use \nof medicines.\n\n\n\nKEYWORDS: pharmacy education, Kelantan, self-medication, practice, awareness\n\n\n\n\n\n\n\n\n17\n\n\n\nMALAYSIAN JOURNAL OF PHARMACY Vol. 2. Issue 2. August 2016\n\n\n\nOP1-19 (Oral)\nPATIENTS\u2019 BELIEF, KNOWLEDGE AND ADHERENCE TO RHEUMATOID ARTHRITIS MEDICATION PRE \nAND POST PHARMACIST COUNSELLING: A PILOT STUDY\n\n\n\nLoh KL1, Looi KL2, Sabri NM1, Krishnan DG3, Anuar A1\n\n\n\n1Department of Pharmacy, Hospital Pulau Pinang, Pulau Pinang, 2Department of Pharmacy, Hospital Balik Pulau, Pulau \nPinang, 3Department of Pharmacy, Bayan Baru Health Clinic, Pulau Pinang, 4Department of Pharmacy, Hospital Tuanku \nFauziah, Perlis \n\n\n\nINTRODUCTION: Adherence to medications among patients with RA ranges from 30% to 80%. Beliefs about illness and \nknowledge\tabout\tthe\tmedications\tinfluence\tadherence\tto\tthe\ttreatment.\tIt\tis\timportant\tfor\tpatients\tto\thave\tgood\tadherence\t\nto\ttheir\tRA\tmedications\tin\torder\tto\timprove\tthe\tefficacy\tof\tthe\ttreatment.\nOBJECTIVES: The objective of the study was to assess the impact of pharmacists\u2019 counselling on patient\u2019s belief, \nknowledge\tand\tadherence\tto\tRA\tmedications\tand\tto\tevaluate\tthe\tdifferences\tafter\tfirst\tand\tsecond\tcounselling\tsessions.\nMETHOD: The subjects for this prospective study were recruited from Rheumatology Clinic, Hospital Pulau Pinang from \nMay to July 2014. Patient\u2019s belief, knowledge and adherence to RA medication pre and post counselling was assessed at \nbaseline, T0; 1 month, T1 and 2 months, T2 using the Beliefs about Medicines Questionnaire (BMQ), medications dosage, \nfrequency, indication and time (DFIT) and Morisky Medication Adherence Scale (MMAS). p value of < 0.05 was considered \nstatistically\tsignificant.\nRESULTS: A total of 22 patients with mean age 58, SD=2.37 completed three visits. Majority of the patients were female \n(91%) and median duration of treatment of 3.5 years, IQR 2.0-8.5. BMQ results showed that effect of counselling on \npatient\u2019s\tbelief\twas\tnot\tstatistically\tsignificant.\tResult\tfrom\tDFIT\t(T0: median 100, IQR 75-100; T1: median 100, IQR 97-\n100; T2: median 100, IQR 100-100) and MMAS (T0: median 5.38, IQR 4-8; T1: median 8, IQR 7-8; T2: median 8, IQR 8-8) \nshowed that patient\u2019s knowledge and adherence pre and post counselling (T0T1 and T0T2)\twere\tsignificantly\tdifferent.\tThere\t\nwere\tno\tstatistically\tsignificant\tdifference\tin\tDFIT\tand\tMMAS\tbetween\tT1 and T2.\nCONCLUSION: This study showed that pharmacists\u2019 counselling improved patient\u2019s knowledge and adherence to their \nRA medications.\n\n\n\nKEYWORDS: pharmacy practice, Pulau Pinang, rheumatoid arthritis, belief, knowledge\n\n\n\nOP1-20 (Oral)\nCYP4F2 GENE POLYMORPHISM AND WARFARIN MAINTENANCE DOSE IN A MULTIETHNIC BORNEO \nPOPULATION ON LONG TERM WARFARIN THERAPY\n\n\n\nLim MSH1,2, Anchah L1, Tiong LL1,2, Ku MY1,2, Tan SSN1,2, King TL1,2, Tan CSY1,2, Hwang SS4, Fong AYY2,3, Ong TK3\n\n\n\n1Department of Pharmacy, Sarawak Heart Centre, Kota Samarahan, Sarawak, 2Clinical Research Centre, Sarawak General \nHospital, Kuching, Sarawak, 3Department of Cardiology, Sarawak Heart Centre, Kota Samarahan, Sarawak, 4Faculty of \nEngineering and Science, Sarawak Campus, Swinburne University of Technology, Kuching, Sarawak\n\n\n\nINTRODUCTION: Warfarin, the most commonly prescribed anticoagulant, exhibits large inter-individual variability in \ndose requirement. Polymorphism in the gene encoding CYP4F2 (rs2108622) may partly explain the variability in warfarin \nmaintenance dose through alteration of Vitamin K metabolism. The association of CYP4F2 gene polymorphism with \nwarfarin maintenance dose in our multi-ethnic population is unknown.\nOBJECTIVES: This study aimed to assess the prevalence and association of CYP4F2 gene polymorphism with warfarin \nmaintenance dose in our multi-ethnic population.\nMETHOD: Gene variations in VKORC1 and CYP4F2 were analysed in 178 patients treated with warfarin. The average daily \nwarfarin dosage, S- and R- warfarin plasma concentration and INR was used as pharmacokinetic and pharmacodynamics indices. \nGenotyping was conducted using Taqman Assays and all statistical analysis was performed using SPSS v17.0 for windows.\nRESULTS: There were 101 (56.7%) male patients. The mean (SD) age was 56.98 (8.46) years with a mean (SD) daily \nwarfarin dose of 2.81(1.04) mg. There were 109 patients with CYP4F2 CC genotype group, 61 with CT genotype and 8 \nwith\tTT\tgenotype.\tThere\twas\tno\tsignificant\tdifference\tin\twarfarin\tmaintenance\tdose\t(2.79\tvs\t2.56\tvs\t3.54mg,\tp=0.106),\t\nS-warfarin and R-warfarin plasma concentration (p=0.774 and p=0.789, respectively) in all 3 genotype groups. Compared to \nthe\tpreviously\tstudied\tVKORC1\t(rs9923231)\tgene\tpolymorphism,\tthere\twere\tsignificant\tdifferences\tin\twarfarin\tmaintenance\t\ndose, S-warfarin and R-warfarin plasma concentration (p<0.001, p=0.039 and p=0.029, respectively) in all 3 genotype \ngroups.\tThere\twere\tno\tsignificant\tdifference\tin\tINR\tat\tthe\tpoint\tof\trecruitment\tfor\tCYP4F2\tand\tVKORC1\t(p=0.810\tand\t\np=0.471, respectively) in all 3 genotype groups. \nCONCLUSION:\tCYP4F2\tgene\tpolymorphism\tdid\tnot\tsignificantly\taffect\twarfarin\tmaintenance\tdose,\tS-warfarin\tand\tR-warfarin\t\nplasma\tconcentration\tand\tINR\tin\tour\tmulti-ethnic\tBorneo\tpopulation\tstudy.\tA\tlarger\tsample\tsize\tis\twarranted\tto\tvalidate\tthis\tfinding.\n\n\n\nKEYWORDS: pharmacy education, Sarawak, CYP4F2, warfarin, VKORC1\n\n\n\n\n\n\n\n\nMALAYSIAN JOURNAL OF PHARMACY Vol. 2. Issue 2. August 2016\n\n\n\n18\n\n\n\nOP1-21 (Oral)\nDOCTOR\u2019S PERCEPTIONS AND EXPECTATIONS OF THE ROLE OF CLINICAL PHARMACISTS IN A \nREGIONAL REFERRAL HOSPITAL\n\n\n\nChow LW, Chew LS, Hoo FW, Kong KL, Cheah SL\nDepartment of Pharmacy, Hospital Raja Permaisuri Bainun Ipoh, Perak\n\n\n\nINTRODUCTION: Collaboration among healthcare professionals can be established by understanding each other\u2019s roles \nand needs. This is to achieve optimal outcomes for the patients.\nOBJECTIVES: The study was to investigate the perceptions and expectations of doctors towards the roles of clinical \npharmacists in a regional referral hospital.\nMETHOD: A cross-sectional study was conducted from September until October 2014. Respondents included all doctors \nfrom wards with permanent clinical pharmacists for at least one year. Structured questionnaire which consisted of 3 sections \nnamely doctors\u2019 perceptions, expectations and experience were distributed. Chi square was used for statistical analysis.\nRESULTS: A pilot study was conducted among 10 doctors. The Cronbach\u2019s alphas for the 3 sections were 0.876, 0.845 \nand 0.863. 200 questionnaires were distributed. Response rate was 53%. The respondents were from medical (44.3%), \npediatric\t (25.5%),\t surgical\t (16%)\t and\t intensive\t care\t units\t (14.2%).\tDoctors\t including\t house\t officers\t (30.2%),\tmedical\t\nofficers\t(34.9%),\tspecialists\t(16.0%)\tand\tconsultants\t(18.9%),\twere\tcomfortable\twith\tpharmacists\u2019\troles\tin\tidentifying\tand\t\npreventing prescription errors (83%), providing patient education (82.1%), designing and monitoring pharmacotherapeutic \nregimens (76.4%) as well as monitoring outcomes of pharmacotherapeutic regimens and plans (76.4%). 15.1% of respondents \ndisagreed that pharmacists should assist patients in selecting non-prescription medications. 85% of respondents agreed that \npharmacists were reliable sources of drug information. 32.1% disagreed that pharmacists routinely inform them about cost-\neffective\tdrug\talternatives.\tThere\twere\tno\tstatistically\tsignificant\tassociations\tbetween\tthe\tpositions\tand\tdisciplines\tof\tthe\t\ndoctors\twith\tall\tthe\tfindings.\nCONCLUSION: Majority of doctors appeared to be comfortable with most of the pharmacists\u2019 roles in providing \npharmaceutical care, but not to the extent of providing direct medication suggestion to patient. Through this study, we can \nfocus on the areas that need to be strengthened in order to improve the collaboration between doctors and pharmacists.\n\n\n\nKEYWORDS: pharmacy practice, perception, expectation, clinical pharmacists\n\n\n\nOP1-22 (Oral)\nTHE PREVALENCE OF POLYPHARMACY IN THE ELDERLY IN MEDICAL WARDS OF A MALAYSIAN \nGOVERNMENT HOSPITAL\n\n\n\nChong PF, Tee LC, Idham IM\nDepartment of Pharmacy, Hospital Sungai Buloh, Sungai Buloh, Selangor\n\n\n\nINTRODUCTION: Polypharmacy was common in elderly patients. To date, there is a lack of study on polypharmacy in \nelderly patients in Malaysia including factors associated to polypharmacy. \nOBJECTIVES: The study aimed to investigate the prevalence of polypharmacy in medical wards of Hospital Sungai Buloh.\nMETHOD: A retrospective study was conducted in Hospital Sungai Buloh which involved 314 patients aged 65 years old \nand above. Data was collected for 6 months periods, from January 2014 to August 2014. Student t-test was used to compare \nmean between continuous variable. Pearson Chi-square was used to examine the difference in the allocation of categorical \nvariables between patient with and without polypharmacy. Univariate logistic regression model was used to evaluate the \nfactors\tassociated\tto\tpolypharmacy\twhich\texpressed\tas\todds\tratio\tand\t95%\tconfidence\tinterval.\nRESULTS:\tPrevalence\tof\tpolypharmacy\tin\telderly\tpatients\tsignificantly\tincreased\tfrom\t63.7%\t(admission)\t to\t70.7%\tat\t\ndischarge (p <0.001). The most frequently used drugs were cardiovascular drugs. The median (IQR) duration of hospital stay \nwas\t3\t(2-5)\tdays.\tThere\twas\ta\tsignificant\tassociation\tbetween\tduration\tof\thospital\tstay\twith\tthe\tnumber\tof\tdrugs\tat\tdischarge\t\n(p=0.012). Charlson index score, diabetes mellitus, hypertension, chronic renal failure (CRF), ischemic heart disease (IHD), \ndyslipidemia,\theart\tfailure\tand\tnumber\tof\tdiagnoses\thad\tsignificant\tassociation\twith\tpolypharmacy\tat\tadmission.\tBesides,\t\nCharlson index score, number of drugs at admission, diabetes mellitus, IHD, CRF, hypertension and age 65-69 years old had \nsignificant\tassociation\twith\tpolypharmacy\tat\tdischarge.\nCONCLUSION: Polypharmacy was common in elderly patients in our institution medical wards. Hence, physicians and \npharmacists\tplay\tan\t important\t role\t in\t reviewing\tpatient\tprofiles\tand\toptimising\tdrug\t therapy\t to\t improve\tdrug\t safety\t in\t\nelderly patients.\n\n\n\nKEYWORDS: pharmacy practice, Selangor, polypharmacy, elderly, medical wards\n \n\n\n\n\n\n\n\n\n19\n\n\n\nMALAYSIAN JOURNAL OF PHARMACY Vol. 2. Issue 2. August 2016\n\n\n\nOP1-23 (Oral)\nEVALUATION OF COMPLETION RATES, MEDICATION COST AND ADVERSE DRUG REACTIONS \nRELATED TO TUBERCULOSIS TREATMENT IN MELAKA\n\n\n\nNoorazlinda Y1, Nursahjohana MS2, Chew SF3, Tan XY2,\tMohd\tHafiz\tS1, Ng SK3, Nor Saadah H3\n\n\n\n1Pharmaceutical Services Division, Melaka, 2Department of Pharmacy, Hospital Jasin, Melaka 3Department of Pharmacy, \nHospital Melaka\n\n\n\nINTRODUCTION: Tuberculosis is ranked as the second leading cause of death worldwide. The annual incidence \nrate reported in Malaysia shows an increasing trend, but the treatment success rate has declined over the years despite \nimplementation of Direct Observed Treatments (DOTS).\nOBJECTIVES: To determine the completion rates, medication cost and types of adverse drug reactions related to anti-\ntuberculosis treatment among patients in Hospital Melaka.\nMETHOD: A case-control study was conducted by involving newly-diagnosed tuberculosis patients attending treatment \nin\tChest\tClinic,\tHospital\tMelaka\tbetween\tyears\t2013\tto\t2014.\tControl\twas\tdefined\tas\tthose\twho\tcompleted\ttuberculosis\t\ntreatment;\twhereas\tcases\twere\tdefined\tas\tdefaulters,\t those\twho\tdied,\t failed\tor\twas\t resistant\t to\t treatment.\tPatients\twere\t\nselected using simple random sampling using list of patients\u2019 names from tuberculosis database registry.\nRESULTS: A total of 100 patients were selected with ratio 1:1. Among those who completed treatment, 46% patients were \nconfirmed\t to\thave\t fully\t recovered.\tAbout\t88%\tdeath\tand\t12%\tdefaulted\t from\t treatment\twere\tobserved\t in\t cases\tgroup.\t\nThe mean duration for patients to complete anti-tuberculosis treatment was 226 days. Factors associated with incomplete \ntreatment were mean body weight (AOR 0.95; 95% CI 0.91, 0.99), bloody sputum (AOR 4.94; 95% CI 1.16, 21.02) and \nhaving past medical history (AOR 2.86; 95% CI 1.07, 7.65). Treatment cost using combined Akurit-4 capsule (RM 419.77) \nduring intensive phase was slightly lower compared to separate pills regimen (RM 502.60). Three patients developed adverse \ndrug reactions including drug induced hepatitis and gout attack.\nCONCLUSION:\tHalf\tproportion\tof\tthe\tpatients\twho\tcompleted\tanti-tuberculosis\ttreatment\twere\tconfirmed\tto\thave\tfully\t\nrecovered. Effective measures should be taken to ensure the completion of tuberculosis treatment with minimal adverse drug \nreactions towards patient. Combination pills regimen may serve as an alternative to minimize treatment cost.\n\n\n\nKEYWORDS: clinical pharmacy, Melaka, tuberculosis\n\n\n\nOP1-24 (Oral)\nA STUDY OF FACTORS ASSOCIATED WITH WOUND HEALING IN DIABETIC FOOT ULCER PATIENTS IN \nTELUK INTAN HOSPITAL\n\n\n\nOng GT, Ng ST, Beh CH, Embi AC\nDepartment of Pharmacy, Hospital Teluk Intan, Perak\n\n\n\nINTRODUCTION: Diabetic foot ulcer (DFU) may be a life threatening complication if adequate management is not \nreceived. There are mixed results from the literature on the effect of comorbidity, dressing used and glycaemic control on \nthe wound healing in diabetic foot ulcer.\nOBJECTIVES: To identify the factors contributing to wound healing in diabetic foot ulcer patients attending orthopaedic clinic.\nMETHOD: A retrospective case control study was conducted in Hospital Teluk Intan from December 2015 until March \n2016. The data was collected through a data collection form. The patients\u2019 medical records were retrieved from the medical \nrecord\toffice\tto\tcollect\ttheir\tsocio-demographic\tdata\tand\tdiabetic\tfoot\tulcer\tmanagement\tdata\tfor\tthe\tpast\tsix\tmonths.\nRESULTS: There were 120 patients with improvement in wound healing while 36 patients with no improvement in wound \nhealing.\tBetween\tthe\ttwo\tgroups,\tthere\twas\tno\tsignificant\tdifference\tin\twound\thealing\tin\tterms\tof\tage,\tgender\tand\tethnicity.\t\nIn the group with improvement in wound healing (n=120), our study found that Povidone (n=71) was the most frequently \nused\tdressing\t in\t the\tfirst\tmonth\tof\tDFU\tmanagement.\tFor\t the\t second\tmonth,\tDermasyn\u00ae and Dermasyn\u00ae combination \n(n=82) was the highest prescribed dressing as well as subsequent months. Both dressing compliance and glycaemic control \nshowed\tsignificant\timprovement\tin\twound\thealing\tat\tan\todds\tratio\tof\t5.297\t(p<0.001) and 3.448 (p<0.001) respectively.\nCONCLUSION:\tOur\tstudy\tfound\tthat\tglycaemic\tcontrol\tand\tdressing\tcompliance\tare\tfactors\tthat\tsignificantly\timprove\t\nwound healing among DFU patients.\n\n\n\nKEYWORDS: pharmacy practice, Perak, Diabetic Foot Ulcer (DFU), factors affecting wound healing\n \n\n\n\n\n\n\n\n\nMALAYSIAN JOURNAL OF PHARMACY Vol. 2. Issue 2. August 2016\n\n\n\n20\n\n\n\nOP1-25 (Oral)\nQUALITY OF LIFE OUTCOMES FOLLOWING SIX MONTHS OF METHADONE MAINTENANCE THERAPY \nIN HEALTH CLINICS\n\n\n\nWan NWS1, Nurhanis M2, Nurul EA2, Suzilawani Z1, Ahmad SA3, Rozida Y1, Dir RK3\n\n\n\n1Department of Pharmacy, Klinik Kesihatan Bandar Kuala Krai, Kelantan, 2Department of Pharmacy, Klinik Kesihatan \nManek Urai, Kelantan, 3Department of Pharmacy, Hospital Kuala Krai, Kelantan\n\n\n\nINTRODUCTION: Methadone Maintenance Therapy (MMT) is one of the drug substitution therapies. Aside from its role \nin harm reduction against HIV infection, MMT programme may potentially enhance clients\u2019 quality of life (QOL).\nOBJECTIVES: To identify the outcomes of MMT programme on clients\u2019 QOL after 6 months of treatment and to explore \nfactors that may be associated with changes in their QOL.\nMETHOD: In this retrospective report review, 58 subjects from 2 government MMT clinics were selected from the \ndistrict of Kuala Krai, Kelantan, Malaysia. The score from the WHO Quality of Life questionnaire (WHOQOL-BREF), \nat\tbaseline\tand\t6\tmonths\tafter\ttherapy\twere\tcollected\tand\tinvolved\tfive\tdomains;\tgeneral\thealth,\tphysical,\tpsychological,\t\nsocial relationship and environment. Patient characteristics collected were age, race, education level, way of administration, \nduration of treatment, employment status, marital status, HIV status, Hepatitis B status, Hepatitis C status and drug urine test \nresult. We used SPSS version 18 for statistical analysis.\nRESULTS:\tThere\twas\tsignificant\timprovement\tin\tall\tfive\tdomains\tof\tQOL,\tafter\t6\tmonths\tof\tMMT\t(p<0.001).\tHighest\t\neducation\tlevel\thad\ta\tsignificant\teffect\ton\tgeneral\thealth\tdomain\t(p=0.008).\tMarital\tstatus\tand\tHIV\tstatus\thad\ta\tsignificant\t\neffect on psychological domain (p=0.019, p=0.009) and social domain (p=0.036, p=0.017) respectively. Hepatitis B showed \na\tsignificant\teffect\tin\tall\tdomains\tof\tQOL\twhich\twere\tgeneral\thealth\t(p=0.018),\tphysical\t(p=0.007),\tpsychological\t(p=0.008),\t\nsocial (p=0.012) and environment (p=0.002). Duration of treatment, employment status, way of administration, drug urine \ntest\tresult\tand\tHepatitis\tC\tdid\tnot\tshow\tany\tsignificant\teffect\tin\tall\tdomains\tof\tQOL.\nCONCLUSION:\tThere\twas\ta\tsignificant\timprovement\tin\tthe\tQOL\tof\tMMT\tclients\twho\tstayed\tin\tthe\tprogramme\tfor\tat\tleast\t\n6 months in the district of Kuala Krai, Kelantan, Malaysia.\n\n\n\nKEYWORDS: pharmacy practice, Kelantan, methadone, quality of life\n\n\n\nOP1-26 (Oral)\nREVISIT RATES WITH THE USE OF PRE-PACKED MEDICATIONS AT THE EMERGENCY DEPARTMENT \nOF A TERTIARY HOSPITAL\n\n\n\nPhua G, Khor ST, Md Yusof SN, Che Harun SF\nDepartment of Pharmacy, Hospital Sultanah Bahiyah, Alor Setar, Kedah\n\n\n\nINTRODUCTION: Emergency departments in Malaysian government hospitals do not only handle major cases, but \nalso minor ailments requiring prescribing of over-the-counter (OTC) medications. Such medications are packed in pre-\ndetermined\tsizes\tin\tpharmacy\tfor\tease\tof\tfilling\tand\tdispensing.\nOBJECTIVES: To determine the revisit rate to the emergency department due to unresolved symptoms in those receiving \npre-packed medications.\nMETHOD: Past electronic prescriptions from the emergency department were generated and reviewed individually. \nAll prescriptions containing OTC medicines were followed up and examined for two weeks to identify all revisits to the \nemergency department.\nRESULTS: Of the 401 patients analysed, only 8 patients revisited the emergency department with the same diagnosis on \nboth\tvisits.\tThe\trevisit\tmay\tbe\tdue\t to\t insufficient\tmedication\tsupply\tbased\ton\t the\t time\t interval\tbetween\tvisits\t (average\t\n5.5 days). Hence, the revisit rate is estimated at 2%. The low revisit rate may be due to the diagnosis itself, as minor \nailments only require OTC medications and not hospitalisation. The use of pre-packed medication also saved MYR2.62 on \nmedication cost per prescription.\nCONCLUSION: Patients prescribed with OTC medications from the emergency department have low revisit rate. Dispensing \npre-packed medications saves on medication expenditure and may be suitable for pharmacies to handle prescriptions for \nOTC medications.\n\n\n\nKEYWORDS: pharmacy practice, revisit, emergency department, medication\n \n\n\n\n\n\n\n\n\n21\n\n\n\nMALAYSIAN JOURNAL OF PHARMACY Vol. 2. Issue 2. August 2016\n\n\n\nOP1-27 (Oral)\nANTIEPILEPTIC DRUG UTILISATION AND QUALITY OF LIFE OF EPILEPSY PATIENTS IN MELAKA \nHOSPITAL\n\n\n\nIsmail NS, Wee CW, Iskandar M, Chew SY, Tan YY\nDepartment of Pharmacy, Hospital Melaka, Melaka\n\n\n\nINTRODUCTION: Epilepsy is a common and chronic disorder of brain. Measuring the quality of life (QOL) of epilepsy \npatients is increasingly recognized as an important component of clinical management.\nOBJECTIVES: The aim of this study was to get an insight into the utilization of antiepileptic drugs (AED) in Hospital \nMelaka (HM) and to investigate the relationship between patients\u2019 QOL and treatment groups.\nMETHOD: Patients were interviewed in this cross-sectional study using English and Malay translated version of the QOL \nin Epilepsy Scale-31 (QOLIE 31) over nine-month period. Analysis of covariance was used for data analysis.\nRESULTS: A total of 92 adults with epilepsy attending the outpatient clinic and neurology clinic of HM were interviewed. \nGeneralized\tepilepsy\twere\t the\tmost\t common\t (81.5%)\tclassification\tof\t seizure,\t followed\tby\tpartial\t seizure\t (16.3%)\tand\t\nunclassified\t seizure\t (2.2%).\t 60.9\t%\t of\t the\t patients\t were\t on\t monotherapy,\t 27.2%\t on\t dual\tAED\twhile\t only\t 10.9%\t on\t\npolytherapy. Valproate (62%) was the most frequently prescribed AED, followed by Carbamazepine (30.4%), Phenytoin \n(27.2%), Lamotrigine (19.6%), Levetiracetam (5.4%) and Topiramate (1.1%). Older generation of AED (75%) was the \nmost common used AED. The highest sub-scale score for QOLIE 31 was the overall QOL with a mean of 69.3\u00b120.1 and the \nlowest was seizure worry with 53.2 \u00b1 26.6. All the sub-scale of QOLIE-31 shown no correlation with types of therapy (p= \n0.876) and generation of AED (p= 0.147). \nCONCLUSION: Most epilepsy patients were maintained with monotherapy and the most prescribed AED is Valproate. \nThis\tstudy\tconfirms\tthe\ttypes\tof\ttherapy\tand\tthe\tgeneration\tof\tAED\tused\twill\tnot\taffect\tthe\tQOL\tof\tthe\tpatients.\n\n\n\nKEYWORDS: pharmacy practice, Melaka, QOLIE31, antiepileptic drug, quality of life\n\n\n\nOP1-28 (Oral)\nAPPROPRIATENESS AND COST IMPACT OF INTRAVENOUS (IV) PROTON PUMP INHIBITORS (PPI) USE \nIN NON-INTENSIVE CARE UNIT (NON-ICU) SETTING IN PUTRAJAYA HOSPITAL\n\n\n\nSiti MMT, Nadiah GZ, Hazrin MR, Devi NP \nDepartment of Pharmacy, Hospital Putrajaya, Wilayah Persekutuan Putrajaya\n\n\n\nINTRODUCTION: Proton Pump Inhibitor (PPI) is used for the treatment and prophylaxis of acid peptic conditions. The \nincreased use of PPI over the past several years has raised concerns related to their inappropriate utilisation and associated \ncost. IV PPI use among patients in non-ICU wards is potentially associated with the inappropriate indication and length of \ntherapy during hospital stay.\nOBJECTIVES: This study aimed to assess clinical and cost impact of IV PPI use in non-ICU patients by assessing the \nappropriateness of initiation of IV PPI, conversion from IV to oral PPI and determining the cost impact associated with the \nuse of IV PPI.\nMETHOD: A descriptive cross-sectional study was conducted in Hospital Putrajaya from January to May 2015. Hospitalised \npatients on IV PPI and aged more than 18 years old were recruited via convenience sampling. \nRESULTS: A total of 110 patients were included. IV PPI was found to be appropriate initiated in 60% (n=66) of the patients. \nIn the appropriate group, 56.1% (n=37) of the patients were prescribed with IV PPI due to UGIB, 30.3% (n=20) of the \npatients\tfor\tstress\tulcer\tprophylaxis,\t10.6%\t(n=7)\tof\tthe\tpatients\tfor\ttreatment\tof\tGastroesophageal\tReflux\tDisease\tand\t3.0%\t\n(n=2)\tof\tthe\tpatients\tfor\tunjustified\tuse.\tMajority\tof\tthe\tpatients\t(n=50)\twere\tcandidates\tbeing\tswitched\tto\toral\tdosage\tform\t\nduring their hospitalisation but only 60% (n=30) were actually switched. Inappropriate initiation of PPIs via the IV route was \nmore likely to take place in surgical wards than in medical wards (39.2% vs 34.0%, p-value = 0.007). \nCONCLUSION: One third of the patients were not appropriately initiated with IV PPI and 53.7% of the patients were not \nswitched to oral form when indicated. The cost analysis associated with the appropriateness of IV PPI use as well as the route \nof administration of PPI revealed a possible saving up to RM7,409.32.\n\n\n\nKEYWORDS: clinical pharmacy, Putrajaya, proton pump inhibitors, non-ICU\n \n\n\n\n\n\n\n\n\nMALAYSIAN JOURNAL OF PHARMACY Vol. 2. Issue 2. August 2016\n\n\n\n22\n\n\n\nOP1-29 (Oral)\nUSE, BEHAVIOUR AND UNDERSTANDING OF CONSUMERS TOWARDS DIETARY SUPPLEMENTS\n\n\n\nChuah YQ, Paraidathathu T\nSchool of Pharmacy, Taylor\u2019s University, Selangor, Malaysia\n\n\n\nINTRODUCTION: As people become more conscious of their health and the need to maintain health, there may be an \nincrease\tin\tthe\tconsumption\tof\tdietary\tsupplements.\tThis\tis\tespecially\ttrue\tof\taffluent\tsocieties.\tDietary\tsupplements\tcover\t\na range of products and include vitamin and mineral supplements.\nOBJECTIVES:\tThis\tstudy\taimed\tto\tdetermine\tthe\tprevalence\tof\tuse\tof\tdietary\tsupplements,\tto\tprofile\tthe\tusers\tof\tdietary\t\nsupplements in terms of their demographic characteristics and to compare between users and non-users in terms of their \nperceptions towards dietary supplements.\nMETHOD: Convenience sampling was employed for this study and data was collected using a self-administered seven-\npage questionnaire. The survey was conducted at bus stations, LRT stations and shopping malls in Selangor and Penang over \na 6-week period. The data was analysed using chi-square, principal component analysis, t-test and ANOVA.\nRESULTS: A total of 402 respondents completed the questionnaire. About 64% (n=259) of the respondents used dietary \nsupplements and the main reason was for maintaining overall health (28.6%). The most commonly used supplements were \nvitamin\tC,\tomega\tfish\toil\tand\tmultivitamin.\tBlackmores\twas\tthe\tmost\tcommon\tbrand\tused.\tThe\tresults\tshowed\tthat\tthere\t\nwere\tno\tstatistically\tsignificant\trelationship\tbetween\tdemographic\tvariables\tand\tuse\tof\tdietary\tsupplements\texcept\tfor\ta\t\ndecreased use of dietary supplements with those who drank alcohol (p=0.007). By using principal component analysis, belief \nand\tconcern\tof\tconsumers\ttowards\tdietary\tsupplements\twere\tidentified.\tUsers\tof\tdietary\tsupplements\thad\ta\tstronger\tand\t\nbelief in dietary supplements as compared to non-users (p<0.001).\nCONCLUSION: As compared to other studies, this study did not show an association between the usage of dietary \nsupplements with gender, age and self-perceived health status. Future research could probably look at the use of dietary \nsupplements and its impact, if any, on health status.\n\n\n\nKEYWORDS: pharmacy education, Selangor, Penang, dietary supplements, behaviour\n\n\n\nOP1-30 (Oral)\nPUBLIC PERCEPTION AND BELIEF OF GENERIC VERSUS BRANDED MEDICATION: A CROSS-\nSECTIONAL STUDY IN SLIM RIVER HOSPITAL, MALAYSIA\n\n\n\nSandre MG, Nazirmuddin NI, Hashim MH, Ahmad NA, Low YX, Cheong JW \nDepartment of Pharmacy, Hospital Slim River, Perak\n\n\n\nINTRODUCTION: Medications can be categorised into branded or generic. According to United State Food and Drug \nAdministration (US FDA), generic medication is identical or bioequivalent to a branded medication,in dosage form, safety, \nstrength, route of administration, quality, performance characteristics and intended usage. However, it is important for \npatients\tto\thave\tsufficient\tknowledge\tabout\tthe\tmedications\tthat\tthey\tconsume.\t\nOBJECTIVES: This study aimed to identify patients\u2019 knowledge and perception towards generic and branded medications \nand its associations with demographics factors.\nMETHOD: A cross-sectional study was conducted from April 2015 to August 2015 in Hospital Slim River. Patients who \nvisited outpatients pharmacy were conveniently selected for this study. A self-administered questionnaire was given to the \npatients after having obtained their consent. The questionnaire contained patient\u2019s demographic data, patient\u2019s knowledge, \nperception and preference of the medication.\nRESULTS: A total of 230 patients participated in this study. 134 (58.3%) patients knew the term \u2018generic medicine\u2019 and \nmajority perceived that the availability of generic medication is to help reduce the medicine cost. 75 (32.6%) patients \nanswered that generic medicine is as effective as branded medicine and 94 (40.9 %) believed that generic medicine is as \nsafe as branded medication. 128 (55.7 %) patients perceived that generic is cheaper than branded medication. 109 (47.4%) \npreferred to be prescribed with generic medication.\nCONCLUSION: Based on this study, generic medications are well accepted among patients. However, knowledge of generic \nmedication is lacking among Malaysian patients. Education and awareness of the use of generic medications are required to \nsupport the implementation of generic medication policies in Malaysia. \n\n\n\nKEYWORDS: pharmacy education, Perak, generic, branded, medication\n \n\n\n\n\n\n\n\n\n23\n\n\n\nMALAYSIAN JOURNAL OF PHARMACY Vol. 2. Issue 2. August 2016\n\n\n\nOP1-31 (Oral)\nILLNESS PERCEPTION AND METABOLIC CONTROL (HBA1C) IN PATIENT WITH TYPE 2 DIABETES \nMELLITUS\n\n\n\nLee SF, Teh XR, Ong SL, James RP, Malar LS\nDepartment of Pharmacy, Hospital Selama, Perak\n\n\n\nINTRODUCTION: Despite the availability of a wide selection of antidiabetic treatments, many Type 2 DM patients still \ndo not have controlled glucose level. Besides pharmacological intervention, patients\u2019 implicit beliefs about their illness can \nbe the best target for health intervention. Thus, we conducted a quantitative study to explore how patients\u2019 illness perception \n(IP) affects their metabolic control.\nOBJECTIVES: To evaluate the associations between IP dimensions and metabolic control (HbA1c) of Type 2 DM patients \nin Hospital Selama and to identify patients\u2019 perception on the DM causal factors. \nMETHOD: A cross-sectional study was conducted in outpatient department Hospital Selama from October to December \n2015. A total of 200 Type 2 DM patients were recruited by using simple random sampling. Self-administered validated \nquestionnaire consisted of three sections was used. Data were analysed by using SPSS version 18. The associations between \neight IP dimensions and HbA1c were evaluated by multiple linear regressions. P value less than 0.05 was considered \nstatistically\tsignificant.\t\nRESULTS: Data from 200 respondents were analysed with mean age of 57.7 years old (SE, 9.8). Majority were females \n(64.5%), Malays (86%), with education level of primary school (43.5%), and with family diabetes history (53.5%). Median \nduration of illness is 5 years (IQR=7) and HbA1c level is 8.15% (IQR=3.1).The mean score of eight IP dimensions is 33.7 \n(SE,\t8.43)\tout\tof\ttotal\tscore\tof\t80.\tUsing\tmultiple\tlinear\tregression,\tHbA1c\twas\tfound\tto\tbe\tsignificantly\tassociated\twith\tIP\t\ndimension of identity symptom 0.221 (95% CI: 0.083, 0.358). 79% of the patients rank diet and eating behavior as the main \nfactor for DM.\nCONCLUSION:\tIP\tdimension\tof\tidentity\tsymptom\tsignificantly\tcorrelates\twith\tDM\tmetabolic\tcontrol.\tBy\tunderstanding\t\npatients\u2019 IP, healthcare providers can focus on behavioural approach in managing DM patients. Steps need to be taken to \neducate the patients about the importance of diet control in managing or preventing DM.\n\n\n\nKEYWORDS: clinical pharmacy, Perak, diabetes mellitus, illness perception, metabolic control\n\n\n\nOP1-32 (Oral)\nPARENTS\u2019 AND PRESCRIBERS\u2019 ATTITUDE AND KNOWLEDGE TOWARDS PAEDIATRIC COUGH AND \nCOLD PRODUCTS IN KENINGAU HOSPITAL, SABAH\n\n\n\nPasupathi S, Shak WSW, Raman S, Chia ML\nDepartment of Pharmacy, Hospital Keningau, Sabah\n\n\n\nINTRODUCTION: Despite\twidespread\tuse,\tthere\thas\tbeen\tinsufficient\tevidence\tsupporting\tsafety\tand\tefficacy\tof\tcough\t\nand cold products (CACP) for use in children. This was further consolidated by the Food and Drug Administration (FDA) \nwho\tissued\ta\twarning\ton\tthe\tusage.\tHowever\tseveral\tstudies\tshowed\tthat\tsuch\tpractices\tare\tstill\tprevalent\tdue\tto\tinsufficient\t\nknowledge and awareness.\nOBJECTIVES:\tTo\tassess\tthe\tattitude\tand\tknowledge\tof\tparents\tand\tprescribers\tin\tterms\tof\tsafety\tand\tefficacy\tof\tCACP.\nMETHOD: This was a cross-sectional study carried out among parents and prescribers in Hospital Keningau. All outpatient \nprescriptions with a diagnosis of upper respiratory tract infection, cold or cough were collected and analysed for a period of \none week to identify the most prescribed products. This was followed by administering an adapted CACP Status Survey to \nparents collecting medications and all the prescribers in our setting.\nRESULTS: A total of 120 completed survey forms were collected from the respondents (90 parents and 30 prescribers). \nBased on 300 prescriptions analysed, syrup diphenhydramine was the most commonly used for children below two years old \n(12.5%)\twhile\tfor\tchildren\tfrom\ttwo\tto\tfive\tyears\told,\tsyrup\tchlorpheniramine\t(54.9%)\thad\tthe\thighest\tusage.\tOnly\t62.2%\tof\t\nparents were aware of the side effects. However 90.5% of prescribers claimed that parents were informed of the side effects. \n57.4% of prescribers claimed that they were pressured to prescribe CACP by the parents, but only 16.7% of parents agreed \nthey pressured them. There was a clear association between the respondents with awareness on FDA regulation (X2=34.21, \np<0.001), CACP effectiveness (X2=23.02, p<0.001) and safety (X2=12.27, p<0.001). Prescribers were more likely to agree \nthat CACP are not effective (80.0%) and not safe (83.3%) as compared to parents.\nCONCLUSION: Usage of CACP is still prevalent in our setting. This is most likely to be contributed by a lack of knowledge \nand attitude among parents, and presumed pressure on prescribers.\n\n\n\nKEYWORDS: pharmacy practice, Sabah, cough and cold products, knowledge, attitude\n \n\n\n\n\n\n\n\n\nMALAYSIAN JOURNAL OF PHARMACY Vol. 2. Issue 2. August 2016\n\n\n\n24\n\n\n\nOP1-33 (Oral)\nTHE IMPACT OF PHARMACIST-LED PATIENT EDUCATION PROGRAMME ON THE QUALITY OF BOWEL \nPREPARATION FOR COLONOSCOPY: A PRELIMINARY FINDING\n\n\n\nSivakami J1, Lim WL1, Tay CY1, Lee JM1, Chew CK2, Zakry OY3, Irina I3, Razali I3\n\n\n\n1Department of Pharmacy, Hospital Kuala Lumpur, 2National Clinical Research Centre, Hospital Kuala Lumpur, 3Department \nof Surgery, Hospital Kuala Lumpur\n\n\n\nINTRODUCTION: Inadequate bowel preparation prior to colonoscopy leads to poor quality of visualization.\nOBJECTIVES: The main objective of this study is to evaluate the impact of pharmacist-led patient education programme \non the quality of bowel preparation.\nMETHOD: An interim analysis of observer-blinded, prospective, randomised, controlled trial was conducted in an outpatient \nsurgical clinic of a tertiary referral centre. Forty one out of 312 subjects were successfully enrolled and randomly assigned to \none of two groups. The control group received the standard written and verbal instructions for colonoscopy. The intervention \ngroup were assigned to an intensive and structured pharmacist-led education including provision of a validated booklet. \nSubjects were required to complete a questionnaire before colonoscopy. An attending blinded, endoscopist will determine \nthe quality of bowel preparation using the validated Boston Bowel Preparation Scale.\nRESULTS: Demographic data were comparable between the two groups. The education intervention group revealed higher \nproportion (100%) of good quality bowel preparation (BBPS score >5) as compared to control group (38.9%). A difference \nof\t61.1%\tbetween\t these\t two\tgroups\twas\t statistically\t significant\t (p<\t0.001).\tThe\tmedian\t total\t score\tof\t the\tcolonoscopy\t\nevaluation\tfor\tinterventional\tgroup\t(7)\tis\tsignificantly\thigher\tthan\tthe\tcontrol\tgroup\t(5)\twith\tp=0.001.\nCONCLUSION: Our preliminary analysis showed positive effect of pharmacist-led educational intervention on the quality \nof bowel preparation.\n\n\n\nKEYWORDS: pharmacy practice, bowel preparation, patient education, colonoscopy\n\n\n\nOP1-34 (Oral)\nTHE EMERGENCE OF MULTI-DRUG RESISTANT (MDR) ACINETOBACTER BAUMANII INFECTION: RISK \nFACTORS AND OUTCOMES AMONG PATIENTS IN INTENSIVE CARE UNIT KULIM HOSPITAL\n\n\n\nAzrina AA1, Jaya MR1, Chua KB2\n\n\n\n1Department of Pharmacy, Hospital Kulim, Kedah, 2Department of Anaesthesiology, Hospital Kulim, Kedah\n\n\n\nINTRODUCTION: Acinetobacter baumannii\t (AB)\tposes\t a\t significant\t health\t threat\t to\t hospitalised\tpatients,\t especially\t\nthose in intensive care units (ICU). \nOBJECTIVES: This study aimed to determine the risk factors and outcomes associated with the emergence of multi-drug \nresistant (MDR) Acinetobacter baumanii infections.\nMETHOD: A retrospective matched case-control study was conducted in ICU Hospital Kulim from January 2013 to \nDecember 2013. Case patient (with AB infection) and control patient (without AB infection) were matched for age, sex, \nseverity of illness (SAPS II score), location during ICU stay and admission date in ratio 1:1. \nRESULTS: Among 31 episodes of MDR AB infection isolated during the study period, only 20 cases were able being matched \nwith\tcontrols.\tSimple\tlogistic\tregression\tanalysis\tidentified\tfour\tindependent\trisk\tfactors\tassociated\twith\tMDR\tAcinetobacter \nbaumanii\tinfection:\tlength\tof\tstay\tin\tintensive\tcare\tunit\tprior\tthe\tinfection\t(odds\tratio\tOR=0.81,\t95%\tconfidence\tinterval\t\nCI(0.66-0.99; p=0.04), duration of ventilator support(OR=0.76, 95%CI=0.65-0.90; p=0.0009), prior carbapenem utilization \n(OR=0.21, 95%CI=0.05-0.83; p=0.027), and recent invasive procedure such as dialysis (OR=5.67,95%CI=1.25-25.61; \np=0.02), tracheostomy (OR=8.5,95%CI=1.86-38.81; p=0.006) and in-dwelling femoral catheter (OR=7.36,95%CI=1.34-\n40.55;p=0.02). The mortality (OR=0.08, 95% CI=0.02-0.37; p=0.01) and length of ICU stay after infection (OR=0.72, 95% \nCI=0.58-0.91;\tp=0.005)\twere\tidentified\tas\toutcome\tof\tMDR\tAB\tinfection.\nCONCLUSION: MDR AB infections increase mortality rate and prolong ICU stay. By identifying the risk factors associated \nwith the emergence of MDR AB infections, development of control measure can be taken in order to reduce the emergence \nof multidrug resistant organism.\n\n\n\nKEYWORDS: clinical pharmacy, Kedah, multi-drug resistant, risk factor\n \n\n\n\n\n\n\n\n\n25\n\n\n\nMALAYSIAN JOURNAL OF PHARMACY Vol. 2. Issue 2. August 2016\n\n\n\nOP1-35 (Oral)\nDEFERASIROX COMPLIANCE AND COST SAVING AMONG CHILDREN WITH THALASSAEMIA: A ONE \nYEAR RETROSPECTIVE ANALYSIS\n\n\n\nLim YH1, R. Retha R1, Teh SY1, Subramaniam T1, Sin YB2, Ng WK3\n\n\n\n1Department of Pharmacy, Seberang Jaya Hospital, Pulau Pinang, 2Department of Pharmacy, Klinik Kesihatan Berapit, \nPulau Pinang, 3Department of Pharmacy, Hospital Kepala Batas, Pulau Pinang\n\n\n\nINTRODUCTION: Compliance assessment is an essential component of monitoring deferasirox therapy in children due to \nthe disease complication and high cost of the medication. Pharmacists play a vital role in assessing deferasirox compliance \nand providing education. Pill count is a well-established method for assessing compliance in antiretroviral therapy, but not \ncommonly practiced for deferasirox therapy.\nOBJECTIVES: To evaluate deferasirox compliance among thalassaemia children with pill count method and to identify \nthe\treasons\tcontributing\tto\tnon-compliance.\tWe\talso\tintend\tto\tdetermine\ttotal\tsaving\tof\tdeferasirox\tthrough\trefill\tmethod\t\nby pharmacists.\nMETHOD: A retrospective study was performed on thalassaemia children prescribed with deferasirox that had at least 10 \nfollow-ups\twith\tpharmacy\tcounselling\tunit,\tHospital\tSeberang\tJaya\tin\t2013.\tPatients\u2019\tmonthly\tdeferasirox\trefill\trecords\twere\t\nobtained and patients\u2019 compliance was assessed with pill count method. Reasons for their non-compliance were explored. \nCost-saving\tanalysis\twas\tperformed\ton\tthe\tcost\tof\tdeferasirox\tsaved\tthrough\trefill\tmethod.\tDescriptive\tanalysis\twas\tused\tto\t\ndetermine patients\u2019 compliance rate and reasons for their non-compliance.\nRESULTS: A total of 22 thalassaemia children with mean age of 9.1\u00b1 3.2 years were enrolled in the study. Majority (81.9%, \nn= 18) were on deferoxamine before deferasirox therapy. All patients were prescribed deferasirox with recommended dose \nranged 20-30mg/kg daily. Majority (86.4%, n=19) were in good compliance category (compliance rate > 80%). Reasons for \nnon-compliance were mainly (63.6%, n=14) attributed to non-drug related illnesses such as fever, cough and nausea. Only \n27.3%\t(n=6)\twere\tcaused\tby\tdrug\trelated\tside\teffects.\tTotal\tsaving\tof\tdeferasirox\tthrough\trefill\tmethod\tby\tpharmacists\twas\t\nRM 48,282.20/year.\nCONCLUSION: Majority of thalassaemia children in Hospital Seberang Jaya are compliant with deferasirox therapy. The \nintervention\tperformed\tthrough\trefill\tmethod\thas\ta\tpositive\tfinancial\timpact\ton\tcost-saving\tof\tdeferasirox.\n\n\n\nKEYWORDS: pharmacy practice, Penang, deferasirox, compliance, cost saving\n\n\n\nOP1-36 (Oral)\nEVALUATING THE FREQUENCY OF ERRORS IN PREPARATION AND ADMINISTRATION OF INTRAVENOUS \nMEDICATIONS IN PEDIATRIC WARDS OF SULTANAH NUR ZAHIRAH HOSPITAL, KUALA TERENGGANU\n\n\n\nToh YS, Low CW, Hashim H, Jusoh M, Alwi NH, Wee WY\nDepartment of Pharmacy, Hospital Sultanah Nur Zahirah, Kuala Terengganu, Terengganu\n\n\n\nINTRODUCTION: Medication error is a preventable event that can occur at any stage of drug delivery process: prescribing, \ndispensing and administration. Intravenous (IV) medication therapy is associated with higher rates of error compared to \norally administered medication, commonly during preparation and administration.\nOBJECTIVES: We aimed to determine the types and frequency of medication preparation and administration errors and \nto identify those risk factors.\nMETHOD: This is a prospective study. The data was collected by observing nurses during preparation and administration \nof medications in four paediatric wards from February to August 2015. The main criteria observed were compatible diluent, \ndose,\tfinal\tconcentrations\tand\tinfusion\trates.\tThe\trelationship\tbetween\tthe\toccurrence\tof\terrors\tand\tpotential\trisk\tfactors\t\nwere analysed using logistic regression model.\nRESULTS: A total of 330 events of IV preparations and administrations by 68 staff nurses were observed and evaluated. \n108 errors were encountered in 21.2% (n=70) of the total observations. The most common types of error were administration \nof\tIV\tdoses\tat\ta\thigher\tfinal\tconcentration\tand\tadministration\trate\thigher\tthan\tthe\trecommended\trate\t(38%)\trespectively,\t\nfollowed by wrong choice of diluent (20.3%) and dose deviation (3.7%). Cefotaxime (44.4%) was the most common \nmedication\tassociated\twith\terror.\tThere\twas\ta\tstatistically\tsignificant\tdifference\tin\tthe\toccurrence\tof\terror\twith\tthe\tnumber\t\nof IV medications prepared by staff nurses; increase in the number of medication preparations impose 1.5 times higher in \nrisk for errors to happen (95% CI; 1.177, 1.916, p=0.001).\nCONCLUSION: High percentage of error observed in this study emphasises the need to improve nurses\u2019 knowledge and \nadherence to the standard protocols for IV medication preparation and administration.\n\n\n\nKEYWORDS: pharmacy practice, Terengganu, intravenous administration, medication errors\n \n\n\n\n\n\n\n\n\nMALAYSIAN JOURNAL OF PHARMACY Vol. 2. Issue 2. August 2016\n\n\n\n26\n\n\n\nOP1-37 (Oral)\nEVALUATING PERCEIVED EFFECTIVENESS AND SAFETY TOWARDS ELECTRONIC CIGARETTE \nAMONG MALAYSIAN VAPERS\n\n\n\nAziz-ur-R1, Mohamad HNM1, Syed M2, Shazia J1\n\n\n\n1Department of Pharmacy Practice, Kulliyyah of pharmacy International Islamic University of Malaysia (IIUM), Pahang, \n2Department of Pharmaceutical Technology, Kulliyyah of pharmacy International Islamic University of Malaysia (IIUM), \nPahang\n\n\n\nINTRODUCTION: Electronic cigarette (e-cig) is a newly emergent substitute for smoking. The interest and usage of \ne-cigarettes among consumers increase globally and Malaysia is no exception. The paucity of local data on e-cigarette use, \nsuggests the need to do a quantitative survey.\nOBJECTIVES: This study aimed to evaluate the experiences perceived by Malaysian vapers towards e-cig.\nMETHOD: 220 vapers using e-cig for last month with or without tobacco use were enrolled for the study and grouped \ninto single user (e-cig user who has completely substituted smoking with e-cig) and dual user (e-cig user who partially has \nsubstituted smoking with e-cig and is still using tobacco cigarette) based on self-reported quitting along with measurement of \nExhaled\tCarbon\tmonoxide\t(eCO).\tBoth\tusers\u2019\tperceived\tbenefits\tand\tundesirable\tresponses\ttowards\tvaping\twere\tevaluated\t\nby using a quantitative research questionnaire that consisted of demographic characteristic of participants, reasons to initiate \ne-cigarette and questions related to evaluating effectiveness and safety of e-cig.\nRESULTS: 31.8% vapers quit smoking with the support of e-cig as compared to 67.35% dual users. Moreover dual users \nshowed\tsignificant\treduction\tin\t tobacco\tcigarette\tuse\tbefore\tand\tafter\te-cig\tuse\tfrom\ta\tmedian\tof\t20\tto\t5\tcigarettes\tper\t\nday (P=<0.001). Adverse and withdrawal symptoms that were observed more in dual users included coughing, breathing \nproblems\tand\tcraving,\twhereas\tsignificant\tvomiting,\tfever\tand\tincrease\tin\tappetite\tcases\twere\tdetected\tamong\tsingle\tusers.\nCONCLUSION: With the help of e-cig, a positive smoking cessation rate is shown among Malaysian vapers whereas \nreduction\tin\ttobacco\tcigarette\tconsumption\tis\tobserved\tin\te-cig\tdual\tusers.\tSignificant\tundesirable\tcases\tof\tvomiting,\tfever\t\nand increase in appetite cases are noticed in single users. Nevertheless further conventional studies over extended period are \nwarranted\tto\tconfirm\tits\tlong\tterm\tsafety\tand\teffectiveness\tamong\tMalaysian\tpopulation.\n\n\n\nKEYWORDS: pharmacy practice, Pahang, electronic cigarette, smoking, carbon monoxide\n\n\n\nOP1-38 (Oral)\nCOMPARISON OF EFFICACY AND SAFETY OF STREPTOKINASE AND TENECTEPLASE IN PATIENTS \nWITH ST-SEGMENT ELEVATED ACUTE MYOCARDIAL INFARCTION (STEMI) IN MELAKA HOSPITAL\n\n\n\nNg SS, Lim TH, Tan SP, Yap RA, Tay EP\nDepartment of Pharmacy, Hospital Melaka, Melaka\n\n\n\nINTRODUCTION: The treatment of ST-segment elevated acute myocardial infarction (STEMI) has improved vastly due \nto reperfusion strategies using thrombolytic agents. Despite wide use of streptokinase (SK) and tenecteplase (TNK) for \nSTEMI treatment in local setting, direct comparison studies between both agents were scarce.\nOBJECTIVES: This\tstudy\taimed\tto\tcompare\tthe\tefficacy\tand\tsafety\tof\tSK\tand\tTNK\tamong\tSTEMI\tpatients\tin\tHospital\tMelaka.\nMETHOD: A retrospective study was conducted among STEMI patients treated with SK and TNK in Hospital Melaka \nfrom January 2014 to Jun 2015. SK patients were matched to TNK patients using \u2018Propensity Score Matching\u2019 to balance \nthe covariates between both groups. Primary endpoints were ST-segment resolution, prevalence of side effects and all-cause \nmortality. Results were analysed via SPSS Version 23 and R Statistical Package 3.10 by using Independent t-test, Chi-Square \nTest and Fisher\u2019s Exact Test.\nRESULTS: Among 265 STEMI patients treated with thrombolytic agents, 35 SK patients (mean age 56 \u00b1 10.8 years) were \nmatched to 35 TNK patients (mean age 57 \u00b1 11.5 years). Resolutions of ST-segment elevation were same in both groups \n(80%\tSK\tvs\t80%\tTNK).\tCommon\tside\teffects\tidentified\twere\tbleeding\t(20%\tSK\tvs\t14.3%\tTNK)\tand\thypotension\t(17.1%\t\nSK\tvs\t5.6%\tTNK).\tThe\tprevalence\tof\tboth\tside\teffects\tin\tthe\ttwo\tgroups\tdid\tnot\tdiffer\tsignificantly\t(Bleeding,\tp=0.526;\t\nhypotension, p=0.259). Heart failure (2.9% TNK) and bradycardia (5.7% TNK) were observed in TNK patients only. The \nmortality\trate\tof\tboth\tgroups\t(17.1%\tSK\tvs\t25.7%\tTNK)\tdid\tnot\tdiffer\tsignificantly\t(p=0.382).\nCONCLUSION: Streptokinase is as effective and safe as tenecteplase in STEMI treatment based on our small study size.\n\n\n\nKEYWORDS: clinical pharmacy, Melaka, STEMI, thrombolytic, thrombolytic agents  \n\n\n\n\n\n\n\n\n27\n\n\n\nMALAYSIAN JOURNAL OF PHARMACY Vol. 2. Issue 2. August 2016\n\n\n\nOP1-39 (Oral)\nOUTCOME EVALUATION OF DIPEPTIDYL PEPTIDASE 4 (DPP4) INHIBITOR AND ITS COMBINATION ON \nGLYCEMIC CONTROL OF TYPE 2 DIABETES MELLITUS PATIENTS AT PUTRAJAYA HOSPITAL\n\n\n\nNoor Rahim N1, Haron N1, Abd. Aziz N2, Hassan Y2\n\n\n\n1Hospital Putrajaya, Wilayah Persekutuan Putrajaya, 2Faculty of Pharmacy, Universiti Teknologi MARA, Selangor\n\n\n\nINTRODUCTION: Dipeptidyl Peptidase 4 Inhibitor (DPP4-I) is a relatively new antidiabetic agent, hence studies on \nglycemic outcome among Malaysian population is still lacking. Up to date, there is no study conducted in Putrajaya Hospital \nto examine the outcome of DPP4-I and its combination on glycemic control among Type 2 Diabetes Mellitus (T2DM) \npatients, response towards DPP4-I and predictors for HbA1c reduction. \nOBJECTIVES: To evaluate the glycemic outcome at week 16, 32 and 52; to determine adverse drug reactions (ADR) \narising from DPP4-I; and to evaluate predictors for HbA1c reduction at week 52. \nMETHOD: A retrospective observational study was conducted on 184 T2DM patients that were prescribed with DPP4-I. \nPaired t-test, ANOVA and linear regression analysis were conducted accordingly. \nRESULTS:\t39.1%\tof\tstudy\tsubjects\tmanaged\tto\tattain\ta\tHbA1c\tvalue\t\u22647.0%\tafter\t52\tweeks\tof\ttherapy\twith\tDPP4-I\tand\tits\t\ncombinations. The mean HbA1c reduction was 0.7% compared to baseline. 70.7% were responsive to the DPP4-I treatment. \nUnresponsive\tgroup\tattained\tonly\ta\t0.2%\tHbA1c\treduction\tat\taround\tweek\t16\tcompared\tto\tsignificant\tHbA1c\treduction\t\n(0.8-0.9%) attained by responsive group. 2.7% adverse drug reactions related to DPP4-I were reported. Baseline HbA1c \nvalues, HbA1c changes at around week 16 and age were found to be the predictors for HbA1c reduction at week 52. \nCONCLUSION: The addition of DPP4-I demonstrated moderate glycemic reduction in T2DM patients. Outcome towards \nDPP4-I treatment at week 52 may be predicted by observing HbA1c changes at around week 16 of the therapy.\n\n\n\nKEYWORDS: clinical pharmacy, Putrajaya, DPP4 inhibitor, diabetes mellitus\n\n\n\nOP1-40 (Oral)\nGREEN BAG MEDICATION REVIEW: IMPROVING ADHERENCE THROUGH PATIENT EMPOWERMENT\n\n\n\nSia XN, Ch\u2019ng LY, Narayanan J, Armugam A, Mahmud O, Mansor AA, Jayaraman L, Lim PY, Tan SY \nDepartment\tof\tPharmacy,\tGombak\tDistrict\tHealth\tOffice,\tSelangor\n\n\n\nINTRODUCTION: NNon-adherence\tto\tlong-term\tmedication\treflects\ta\tmajor\tflaw\tin\thealthcare\tdelivery\tsystem\tworldwide\t\nwhich results in poor clinical outcome and soaring healthcare cost. Several efforts including providing medication bag \nand conducting Medicines Use Review (MUR) have individually shown improvement in patients\u2019 self-empowerment and \nmedicine-taking behaviour.\nOBJECTIVES: This study integrated both ideas to determine if Green Bag Medication Review improves adherence to \nmedication.\nMETHOD: A prospective, non-comparative community trial involving patients with chronic diseases was conducted from \nSeptember\t2013\ttill\tJune\t2014\tacross\t6\tclinics\tunder\tGombak\tDistrict\tHealth\tOffice.\tPatients\twith\tprescriptions\tcontaining\t\nmore than 4 items and validity more than a month were selected via computer generated random sampling. Patients who \nprovided consent for enrolment were given a green bag to store medications and underwent 3 sessions of medication review \nwith a pharmacist on monthly basis to identify and resolve any non-adherence or medication-related issue. Medication \nreconciliation was carried out with medication review which was conducted as semi-structured interview and counseling \nbased\ton\tan\tadapted\tMUR\tform.\tAdherence\tlevel\twas\tassessed\twith\t8-items\tModified\tMorisky\tAdherence\tScale\t(MMAS)\t\nduring baseline and all interventions, which was later analysed using paired-t test.\nRESULTS: Mean MMAS of 301 patients was improved by 12.5%. It was increased from baseline mean\u00b1s.d. of 5.9\u00b11.4 \n(low adherence) to 6.4\u00b11.4 (medium adherence), 6.8\u00b11.3 (medium adherence), and 6.9\u00b11.2 (medium adherence) after 3 \ncontinuous interventions. Mean difference between baseline and 3 interventions were 0.5 (95% CI: 0.3 to 0.6, p<0.001), \n0.9\t(95%\tCI:\t0.7\tto\t1.0,\tp<0.001)\tand\t1.0\t(95%\tCI:\t0.9\tto\t1.1,\tp<0.001).\tThe\tfinal\tintervention\tyielded\tan\tincrement\tin\tthe\t\nnumber of highly adherent patient by 3.8 fold and a reduction in the number of poorly adherent patient by 2.2 fold.\nCONCLUSION:\tGreen\tBag\tMedication\tReview\tsignificantly\timproved\tadherence\tamong\tpatients\twith\tchronic\tdiseases.\n\n\n\nKEYWORDS: pharmacy education, Selangor, adherence, green medication bag\n \n\n\n\n\n\n\n\n\nMALAYSIAN JOURNAL OF PHARMACY Vol. 2. Issue 2. August 2016\n\n\n\n28\n\n\n\nOP1-41 (Oral)\nPERCEPTION TOWARDS THE ACCEPTABILITY OF HPV VACCINATION AMONG WOMEN AGED 18-45 \nYEARS OLD IN TELUK INTAN HOSPITAL, PERAK\n\n\n\nChua CH, Cheong WK, Lee LC\nDepartment of Pharmacy, Hospital Teluk Intan, Perak\n\n\n\nINTRODUCTION: Cervical cancer is the second most common female cancer in Malaysia. HPV vaccination has been \nintroduced worldwide to women as preventive measure for cervical cancer. Nevertheless little in public does know its \nexistence and importance.\nOBJECTIVES: To determine the factors associated with the acceptability among woman aged 18-45 years old towards \nHPV vaccination.\nMETHOD: A cross-sectional study was conducted in Hospital Teluk Intan by using validated questionnaire. Questionnaire \nwas distributed randomly to female aged 18-45 at O&G ward in Hospital Teluk Intan. Respondent\u2019s demographic data, level \nof knowledge and acceptability of HPV vaccination were assessed. Demographic data, level of knowledge and acceptability \ntowards HPV vaccination was analysed by using descriptive statistics. The association between demographic data and \nacceptability were analysed using Pearson chi-square test.\nRESULTS:\tA\ttotal\tof\t140\tfemale\trespondents\thad\tfilled\tin\tthe\tquestionnaire.\tThere\twere\t83.6%\tof\trespondents\twho\thad\t\nnever received HPV vaccine. Among the respondents, 79.3% of the respondents wanted to take HPV vaccination and half \nof them were willing to pay for it. Majority of the respondents were highly educated; 64.3% studied at college or University \nlevel. Out of 140 respondents, 30.7% were healthcare professionals, 27.9% unemployed, 27.1% non-healthcare professionals \nand\t14.3%\tstudents.\tThe\tsignificant\tvalue\tfor\teducational\tstatus\tand\toccupational\tstatus\tof\tthe\trespondents\twith\tacceptability\t\nof HPV vaccination were p=0.001(<0.05) and p=0.013(<0.05) respectively. Most of the respondents (30%) did not accept \nHPV vaccination due to affordability and side effects of the vaccine. Unawareness of the present of HPV vaccine and belief \nof\tnot\tbeing\tat\trisk\tof\tinfection\twere\tsignificantly\tassociated\twith\tacceptability.\nCONCLUSION: The respondents\u2019 acceptability is high but level of knowledge on HPV vaccination is moderate. Healthcare \nteams are encouraged to raise the awareness of HPV vaccination among the public.\n\n\n\nKEYWORDS: pharmacy education, Perak, HPV vaccination, acceptability, perception\n\n\n\nOP1-42 (Oral)\nAN INVESTIGATIONAL STUDY ON SYNTHESIS YIELD OF FDG PUTRA INJECTION IN GMP \nRADIOPHARMACEUTICAL PREPARATION-CYCLOTRON FACILITY, NATIONAL CANCER INSTITUTE\n\n\n\nSuharzelim AB , Zarif Naim MA, Noratikah MA\nNuclear Pharmacy Unit, Department of Pharmacy, Institut Kanser Negara \n\n\n\nINTRODUCTION: Synthesis\tof\tFDG\tPutra\tInjection\tinvolve\tproduction\tof\tF-18\tfluoride\tfrom\tcyclotron\twhere\timpurities\t\nin this solution could not be ignored. Consequently, it will lead to a low synthesis yield (End of Synthesis Yield <40%) of \nour registered radiopharmaceutical product; FDG Putra Injection or F-18 Fluorodeoxyglucose.\nOBJECTIVES:\tThis\tstudy\taimed\tto\tinvestigate\tthe\tparameters\tthat\tmay\tinfluence\tsynthesis\tyield\tof\tFDG\tPutra\tInjection\t\nfrom 2008 to 2015 in GMP Radiopharmaceutical Preparation-Cyclotron Facility, Institut Kanser Negara.\nMETHOD: Investigated parameters including target pressure, current applied, bombardment time and radioactivity delivered \nwere obtained from each production batch report data and analysed using Statistical Package of Social Science (SPSS). \nRESULTS:\tBased\ton\tthe\tstandardized\tBeta\tCoefficients,\tthe\teffect\tof\tbeam\twidth\thad\tthe\thighest\timpact\ton\tthe\tsynthesis\t\nyield\t(n=\t700)\tover\tother\tparameters.\tLow\tsynthesis\tyield\twas\tdue\tto\timpurities\tpresent\tin\tF-18\tfluoride\tion\tas\ta\tresult\tof\t\ncyclotron bombardment process.\nCONCLUSION:\tAmongst\tparameters\tthat\thave\tbeen\tinvestigated,\tadherence\tto\trecommended\tspecification\tbeam\twidth\t\n(10-20%) has to be main factor to be looked into when operating a cyclotron system to produce a desired synthesis yield.\n\n\n\nKEYWORDS: pharmacy research, Putrajaya, FDG, cyclotron, impurities\n \n\n\n\n\n\n\n\n\n29\n\n\n\nMALAYSIAN JOURNAL OF PHARMACY Vol. 2. Issue 2. August 2016\n\n\n\nOP2-1 (Oral)\nTHE USE OF COMPLEMENTARY AND ALTERNATIVE MEDICINE IN PAEDIATRIC PATIENTS\n\n\n\nMuhamad AR, Nurul FS, Wang TH, Sia ZK, Tea MH\nDepartment of Pharmacy, Hospital Sultanah Nora Ismail, Batu Pahat, Johor\n\n\n\nINTRODUCTION: There is no published data on the use of CAM among paediatric patients in Malaysia.\nOBJECTIVES: The aim of this study was to investigate the use of CAM among paediatric patients.\nMETHOD: This was a descriptive, cross-sectional survey involving 400 paediatric patients receiving treatment at inpatient \nand outpatient clinics in Hospital Sultanah Nora Ismail.\nRESULTS: During the study period, 92 patients (23%) used at least one type of CAM with an average 1.4 types of CAM \nper patient. Patients aged above 4 years old (n=40, 39.2%) had the highest usage of CAM (p<0.05) and parents aged more \nthan 30 years old were more likely to introduce their child to CAM (p<0.05). Dietary and herbal approaches (75.2%) were \nthe most highly used CAM used among the paediatric patients as compared to other CAM modalities. The main reason \npatients were given CAM by their parents was to enhance overall health or immune system. Most of the parents (n=69, \n80.2%) spent less than RM50 out of pocket expenditure on CAM. A total of 65.1% of parents who introduced CAM to their \nchildren obtained information from friends and family. Most of the parents (52.3%) procured their CAM from community \npharmacy. Despite this, 87.0% of the parents did not consult physicians or pharmacists before introducing CAM to their \nchildren. Furthermore, 62% of the CAM users administered CAM concurrently with their conventional medications and \n87.0% of their attending physician were not aware that the patients were using CAM concurrently with their conventional \nmedications.\nCONCLUSION: The use of CAM is common in paediatric patients. Physicians and pharmacists attending to paediatric \npatients should actively review the history of CAM use. Some of the conventional drugs prescribed may have strong drug \ninteraction with the CAM if administered concurrently.\n\n\n\nKEYWORDS: pharmacy practice, Johor, complementary therapies, paediatric\n\n\n\nOP2-2 (Oral)\nCO-MORBID HYPERTENSION, DIABETES MELLITUS OR DYSLIPIDEMIA AMONG PATIENTS \nPRESCRIBED WITH SECOND GENERATION ANTIPSYCHOTIC: A COMPARISON STUDY BETWEEN \nARIPIPRAZOLE, QUETIAPINE AND CLOZAPINE BASED ON PHARMACY PRESCRIPTION DATABASE\n\n\n\nNg CG1, Chan PL2, Said MA3\n\n\n\n1Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia, 2Pharmaceutical \nServices Division, Ministry of Health, Petaling Jaya, Malaysia, 3Julius Centre University of Malaya, Department of Social \nand Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia\n\n\n\nINTRODUCTION: Second generation antipsychotic (SGA) was linked to increased risk of metabolic syndrome. The risk \nvaries between different SGA. \nOBJECTIVES: We aimed to study the risk of metabolic syndrome by examining the co-prescription of antihypertensive, \nantidiabetic and lipid lowering drugs in patients prescribed with either aripiprazole, quetiapine or clozapine. \nMETHOD: This is a retrospective cohort study based on the prescription records of a teaching hospital. Prescription records \nbetween January 1, 2013 and December 31, 2014 for psychiatric unit were extracted. Patients with at least one prescription \nof any antipsychotic were included. The odds of antihypertensive, antidiabetic and lipid lowering drugs co-prescription in \npatients with either aripiprazole, quetiapine or clozapine were calculated.\nRESULTS: Of the 1742 study subjects, 88 patients were prescribed with aripiprazole, 175 patients with clozapine and \n124 patients with quetiapine. Patients prescribed with quetiapine had highest odds co-prescribed with antihypertensive \n(OR=1.71, 95% CI=1.11, 2.63), antidiabetic drugs (OR=1.81, 95% CI=1.11, 2.95) and lipid lowering drugs (OR=1.94, 95% \nCI=1.19,3.16). There were higher odds of co-prescription of antihypertensive (OR=1.54, 95% CI=1.05, 2.25), antidiabetic \ndrugs (OR=1.69, 95% CI=1.10,2.59) and lipid lowering drugs (OR=1.90, 95% CI=1.24,2.91) in patients with clozapine. \nHowever, there were no increase of odds of co-prescription of the three agents in patients with aripiprazole. \nCONCLUSION: We need to monitor the risk of metabolic syndrome in patients treated with SGA. Aripiprazole has lower \nrisk of metabolic syndrome. \n\n\n\nKEYWORDS: pharmacy practice, Kuala Lumpur, aripiprazole, antipsychotic, metabolic syndrome\n \n\n\n\n\n\n\n\n\nMALAYSIAN JOURNAL OF PHARMACY Vol. 2. Issue 2. August 2016\n\n\n\n30\n\n\n\nOP2-3 (Oral)\nPRE-POST STUDY ON KNOWLEDGE OF TOPICAL CORTICOSTEROIDS AMONG PSORIASIS PATIENTS: \nEXPERIENCE FROM MELAKA HOSPITAL\n\n\n\nMuniandy G, How SP, Lim SY, Abd Ghapar SM, Hassan HA\nDepartment of Pharmacy, Hospital Melaka\n\n\n\nINTRODUCTION: Topical corticosteroids are commonly used in psoriasis patients. The aim of this study was to identify \nfactors affecting the adherence and the impact of educational material on patients\u2019 level of knowledge on topical steroid \napplication.\nOBJECTIVES: To assess the knowledge and adherence pre- and post-intervention and to identify the common factors \nwhich are associated with adherence.\nMETHOD: A pre-and-post study was conducted among psoriasis patients in Hospital Melaka. Patients with at least one \ntopical corticosteroid agent with mild to moderate psoriasis were included. Questionnaires administered by interviewers \nwere used to obtain demographic data and to assess patients\u2019 knowledge and adherence of topical steroids. An educational \nmaterial\twas\tused\tin\tparallel\tto\tthe\tquestionnaire\tduring\tthe\tfirst\tvisit.\tAfter\ta\tmonth,\tpatients\twere\treassessed\twith\tthe\tsame\t\nquestionnaires. Study was conducted starting from November 2015 to January 2016. Data was analysed using SPSS paired \nt-test.\nRESULTS: A\ttotal\tof\t31\tpatients\tparticipated\tin\tthis\tstudy.\tPatients\u2019\tknowledge\timproved\tsignificantly\tafter\tthe\tintervention\t\nwith education material with the mean knowledge score increased from 45.16 to 85.48 (p<0.001). Patients\u2019 knowledge \non the method of application had improved tremendously with an increment of 60.6%. Patients\u2019 adherence was found to \nhave\timproved\tsignificantly\twith\tthe\tmean\tMMAS\tscore\tfrom\t4.26\tto\t5.65\t(p<0.001).\tUnclear\tinstructions\tof\tapplication,\t\nforgetfulness and inadequate supply were found to be major factors affecting adherence.\nCONCLUSION: The present study indicated that patients\u2019 knowledge is enhanced with guided education material. Clear \ninstructions of topical steroid applications are crucial in improving patients\u2019 adherence.\n\n\n\nKEYWORDS: pharmacy practice, Melaka, topical steroids, psoriasis, adherence\n\n\n\nOP2-4 (Oral)\nTHE OUTCOMES AND COST-EFFECTIVENESS ANALYSIS OF TYPE II DIABETES MANAGEMENT OF \nPUBLIC HEALTHCARE FACILITIES IN THE STATE OF KEDAH\n\n\n\nKhong LB1, Abdul Ghani N2, Othman M3, Teoh CJ4, Yusof F2, Tew MM5, Mohammed NS6, Lim ES2, Lim CW7, Yin YY1, \nYusoff Azmi NS8\n\n\n\n1Pharmaceutical Services Division, Kedah, 2Department of Pharmacy, Hospital Sultanah Bahiyah, Kedah, 3Department of \nPharmacy, Hospital Sultan Abdul Halim, Kedah, 4Department of Pharmacy, Hospital Seberang Jaya, Pulau Pinang, 5Clinical \nResearch Centre, Hospital Sultan Abdul Halim, Kedah, 6Clinical Research Centre, Hospital Sultanah Bahiyah, Kedah \n7National Pharmaceutical Control Bureau, 8Medical Department, Hospital Sultanah Bahiyah, Kedah\n\n\n\nINTRODUCTION: Diabetes mellitus cases continue to rise in Malaysia. With prevalence of 15.2% in 2011, the complexity \nof treating diabetes with its complication has huge economic impact on government as Malaysia\u2019s healthcare is heavily \nsubsidized. Despite this, data on cost, outcomes and complications of Diabetes Mellitus (DM) care management particularly \nKedah are still scarce. \nOBJECTIVES: We aimed to compare the treatment outcomes and cost of DM management between primary, secondary \nand tertiary care in MOH healthcare facilities.\nMETHOD: This is a retrospective cohort study involving 390 diabetic patients randomly selected from nine hospitals and \nfourteen health clinics in Kedah. Consented patients were interviewed for their socio-demographic, compliance level and \nHRQOL status. Patients\u2019 records were reviewed to collect data on hospital admission, physical examination, laboratory \nresults, diagnostic tests, complications and co-morbidities. The cost data was analysed from provider perspective using \nactivity-based costing. Primary outcome was the achievement of HbA1c control. \nRESULTS: Secondary care had the highest percentage of HbA1c control (19.6%) followed by primary care (18.7%). Only \n7.8%\tof\tthe\tpatients\tin\ttertiary\tcare\tachieved\ttargeted\tHbA1c,\twhich\twas\tsignificantly\tlower\t(p<0.05),\tcompared\tto\tsecondary\t\ncare.\tOnly\ttwo\tfactors\tsignificantly\taffected\tHbA1c\tlevel;\tinsulin\ttherapy\t(p=0.001)\tand\tpatients\u2019\tliving\tstatus\t(p=0.016).\t45%\t\nof patient were on insulin with 24% regularly performed SMBG. 31% of patients highly adhered to their medications. Highest \nprevalence of comorbidities were hypertension (84%) and dyslipidemia (74%) whereas the most common complication was \nperipheral neuropathy (30%). Annual DM related management cost per patient for tertiary care was MYR1,638 which was \nsignificantly\thigher\t(p<0.001)\tcompared\tto\tsecondary\tcare\t(MYR744)\tand\tprimary\tcare\t(MYR863).\nCONCLUSION: Secondary care has the highest percentage of HbA1c target achieved with the lowest cost compared to \ntertiary care (ICER MYR74).\n\n\n\nKEYWORDS: pharmacy health policies, Kedah, diabetes mellitus, cost analysis\n\n\n\n\n\n\n\n\n31\n\n\n\nMALAYSIAN JOURNAL OF PHARMACY Vol. 2. Issue 2. August 2016\n\n\n\nOP2-5 (Oral)\nPREVALENCE OF FOOD PRODUCTS ADULTERATED WITH APPETITE SUPPRESSANTS OR MALE \nSEXUAL PERFORMANCE ENHANCERS AND ITS ASSOCIATION WITH PRICE IN CENTRAL INDUSTRIAL \nZONE, MALAYSIA\n\n\n\nSalimin A1, Azis MA1, Sivapatham AH1, Abu BNS1, Muhammad A1, Zainal MS2, Halimi MI2, Mohamad NMN3, Noor ZH4, \nYudin S5, Ismail I5, MohdThani AAF6\n\n\n\n1Pharmacy Enforcement Division, Pharmaceutical Services Department, Kuala Lumpur State Health Department, 2Pharmacy \nEnforcement Division, Pharmaceutical Services Department, Malacca State Health Department, 3Pharmacy Enforcement \nDivision, Pharmaceutical Services Department, Negeri Sembilan State Health Department, 4Pharmacy Enforcement \nDivision, Pharmaceutical Services Department, Penang State Health Department, 5Pharmacy Enforcement Division, \nPharmaceutical Services Department, Selangor State Health Department, 6Pharmacy Enforcement Division, Pharmaceutical \nServices Department, Ministry of Health\n\n\n\nINTRODUCTION: There is a growing nationwide trend of food adulterated with phosphodiesterase-5 inhibitors (PDE-5 \nInhibitors)\tor\tappetite\tsuppressants.\tIn\tKuala\tLumpur,\titems\tconfiscated\tfrom\t2011\tto\t2013\tworth\tapproximately\tMYR1.5\t\nmillion were food products containing scheduled poison.\nOBJECTIVES: The objectives were to determine the prevalence of selected scheduled poison in food products and to \nestablish an association between price and these products.\nMETHOD: A cross-sectional study was conducted utilising purposive sampling of which food products with high index of \nsuspicion\taccording\tto\tset\tcriteria\twere\tsampled.\tFood\tproducts\tincluded\tboth\tfood\tand\tdrinks\tas\tdefined\tin\tFood\tAct\t1983.\t\nAll samples were obtained from 1 January 2012 to 30 June 2013 at retail outlets in Central Industrial Zone (i.e. Kuala Lumpur, \nSelangor, Penang, Malacca and Negeri Sembilan). The samples included food products distributed or manufactured in Malaysia. \nData\twas\tcollected\tusing\tspecific\tforms\tand\tsamples\twere\tcategorised\taccording\tto\tindication\tand\ttype.\tAnalysis\twas\tdone\tvia\t\nMicrosoft Excel (version 2010) while Chi-square (x2) and Pearson Correlation were performed using SPSS (version 17).\nRESULTS: Of 85 food product samples, 31 (36.5%) contained scheduled poison. Four out of 35 samples in the appetite suppressants \narm (11.4%) and 27 out of 50 samples in the PDE-5 inhibitors arm (54.0%) were found to contain scheduled poison. It was found \nthat\tthere\twas\ta\tsignificant\tpositive\tassociation\t(r\t=\t0.336)\tbetween\tprice\tand\tthe\tpresence\tof\tscheduled\tpoison\t(p\t=\t0.002).\nCONCLUSION: One third of the sampled food products were found to contain scheduled poison. This study shows that the \nchance of food products being adulterated with scheduled poison increases with selling price.\n\n\n\nKEYWORDS: pharmacy health policies, scheduled poison, adulteration\n\n\n\nOP2-6 (Oral)\nPHARMACISTS\u2019 BARRIERS AND ATTITUDES TOWARDS RESEARCH IN KOTA KINABALU: A \nQUALITATIVE STUDY\n\n\n\nLee KSF1, Tan SL2, Abdul Halim Zaki I2, Liau SY2\n\n\n\n1Department of Pharmacy, Queen Elizabeth I Hospital, Kota Kinabalu, 2Department of Pharmacy, Queen Elizabeth II \nHospital, Kota Kinabalu\n\n\n\nINTRODUCTION: Pharmacists play important roles in improving the healthcare system through clinical research. Despite \nhaving a large number of pharmacists working in public services in Sabah, it is reported during the National Research and \nDevelopment Committee Meeting that only 54% of the facilities in Sabah were involved in research in the year 2014.\nOBJECTIVES: The objective of this study was to explore the attitudes, perceptions and barriers faced by pharmacists in Kota \nKinabalu towards conducting research and to identify potential ways to increase the involvement of pharmacists in research.\nMETHOD: This was an in-depth face-to-face interview qualitative study. A total of 9 pharmacists from public services in \nKota Kinabalu were selected using purposive sampling and were interviewed until saturation of themes was reached. The \npharmacists were asked about their attitudes, barriers in conducting research and ideas to overcome these barriers using an \ninterview guide. Interview sessions were audiotaped and notes were taken by the researchers. Thematic analysis of the notes \nand audiotaped transcripts were conducted by the researchers.\nRESULTS:\tTwo\tthemes\twere\tidentified\tin\tpharmacists\u2019\tattitudes\ttowards\tresearch:\tperspective\tand\tperception\tof\tthe\tpurpose\tof\t\nresearch. Some of the interviewees expressed that they were not interested in doing research as they underestimated or undervalued \nthe importance of doing research. Perception, communication, resources and skill and knowledge were found to be the barriers to \npharmacists\u2019 participation in research. Ideas were suggested by the interviewees to overcome the barriers to participation.\nCONCLUSION: The interviewees were not aware of the importance of participation in research towards improving health \ncare system. Time needed to be involved in research was noted as one of the barriers for all interviewees. Practical strategies \nwere suggested to overcome the barriers and these strategies should be considered when promoting research participation.\n\n\n\nKEYWORDS: pharmacy practice, Sabah, research, attitudes, barriers\n\n\n\n\n\n\n\n\nMALAYSIAN JOURNAL OF PHARMACY Vol. 2. Issue 2. August 2016\n\n\n\n32\n\n\n\nOP2-7 (Oral)\nAN ANTIBIOTIC POINT PREVALENCE EVALUATION IN PERAK SPECIALIST HOSPITALS\n\n\n\nNorirmawath S1, Doris GV1, Oh HL1, Normi H2, Ng CB3, Chan YY4, Paula TSS5, Thong KS1, Sakinah R1\n\n\n\n1Department of Pharmacy, Raja Permaisuri Bainun Hospital Ipoh, Perak, 2Department of Pharmacy, Seri Manjung, Hospital \nSeri Manjung, Perak, 3Department of Pharmacy, Taiping Hospital Taiping, Perak, 4Department of Pharmacy, Teluk Intan \nHospital Teluk Intan, Perak, 5Department of Pharmacy, Slim River Hospital Slim River, Perak\n\n\n\nINTRODUCTION: Evidences showed that overall rate of antimicrobial resistance correlates with the use of antimicrobials. \nIn response to the increment of antibiotic utilisation at Perak Specialist Hospitals, an antibiotic point prevalence study was \ndone in order to investigate the antimicrobial prescribing pattern in the state.\nOBJECTIVES:\tThe\taim\tof\tthis\tstudy\twas\tto\tevaluate\tantibiotic\tprescribing\tpattern\tin\thospitalised\tpatients\tat\tfive\tspecialist\t\nhospitals in Perak. \nMETHOD: A single-day point prevalence survey was conducted in July 2015. The survey enrolled all hospitalised patients \nat\tfive\tspecialist\thospitals\t(Raja\tPermaisuri\tBainun\tHospital,\tTaiping\tHospital,\tSeri\tManjung\tHospital,\tTeluk\tIntan\tHospital\t\nand Slim River Hospital) in Perak and data on patients on antibiotics were collected using a pre-designed form. Difference \nin proportion was compared using chi-square test. A multivariate logistic regression was used to determine the association \nbetween appropriate antibiotic use and demographics variables.\nRESULTS: Out of 1758 patients surveyed, 755 (42.9%) patients were on antibiotics. Majority of the patients receiving \nantibiotics were male (52.7%) and from medical wards (41.7%). Hospital Slim River had the highest number of patients \non antibiotic (55.3%). Patients received a total of 1017 antibiotics with most of them receiving single antibiotics (67.1%). \nAntibiotics were mostly started empirically (84.5%). The most prescribed antibiotic class was cephalosporin (31.4%). A \ntotal\tof\t337\t(44.6%)\tpatients\twere\tidentified\tto\tbe\tgiven\tantibiotic\tinappropriately.\tThe\tmost\tcommon\tcause\tof\tinappropriate\t\nantibiotic prescribing among these patients was improper choice of antibiotics.\nCONCLUSION: Around half of the patients admitted to specialist hospitals in Perak are on antibiotics. The appropriateness \nof\tantibiotic\tutilisation\twas\tsignificantly\tdifferent\tbetween\tthe\twards.\n\n\n\nKEYWORDS: pharmacy practice, Perak, antibiotic, point prevalence\n\n\n\nOP2-8 (Oral)\nA PILOT STUDY: EXPERIENCE, KNOWLEDGE AND PERCEPTION OF PATIENTS TOWARDS FREQUENT \nBRAND SWITCHING OF GENERIC MEDICINES\n\n\n\nTeo LK, Lim PC, Tang SXL, Mustafa MH, Idris NIF, Anwar FA, Ooi AMS\nPharmacy\tEnforcement\tUnit,\tPenang\tBranch\tOffice,\tPenang\n\n\n\nINTRODUCTION: There has been frequent brand switching of generic medicines in Hospital Pulau Pinang. This may \ncause some confusion among patients.\nOBJECTIVES: To study the experience, knowledge and perception of patients towards frequent brand switching of generic \nmedicines.\nMETHOD: A cross-sectional pilot study using convenience sampling was conducted at the main outpatient pharmacy \nin Hospital Pulau Pinang in October 2014. One hundred forty patients were recruited in this study. All p value <0.05 was \nconsidered\tstatistically\tsignificant.\nRESULTS:\tOut\tof\t140\tpatients,\t93\tpatients\texperienced\treceiving\tmedicines\twith\tdifferent\tbrands.\t64.5%\tpatients\tidentified\t\nmedicines by shape, size and colour. After brand switching, 14.9% patients experienced missed dose, 11.3% stopped their \nmedicines and 5.7% doubled their doses. In terms of patients\u2019 knowledge, 3.6% patients knew that same medicine might be \navailable in different brands but 73.4% patients were unaware that different brands might have different inactive substances. \nIn terms of perception, 54.4% of patients felt that it was easier to remember brand name whereas 34.8% thought that there \nwere differences in effectiveness between brands. Majority (63.6%) of patients preferred not to have switch of brands for \ntheir\tmedicines.\tPatients\twith\tlower\teducation\tlevel\tsignificantly\tidentified\ttheir\tmedicines\tby\tshape,\tsize\tor\tcolor,\tcompared\t\nto those with higher education level.\nCONCLUSION: This pilot study revealed that frequent brand switching of generic medicines led to missed dose, omission \nand double dosing of medicines.\n\n\n\nKEYWORDS: pharmacy practice, Penang, generic drugs, brand switching\n \n\n\n\n\n\n\n\n\n33\n\n\n\nMALAYSIAN JOURNAL OF PHARMACY Vol. 2. Issue 2. August 2016\n\n\n\nOP2-9 (Oral)\nAN EVALUATION OF EFFECTIVENESS AND SAFETY OF CURRENT INSULIN INFUSION PROTOCOL IN \nINTENSIVE CARE UNIT: A PROSPECTIVE COHORT STUDY\n\n\n\nJerry ESL1, Law BK1, Chua YW1, Khoo TM2\n\n\n\n1Department of Pharmacy, Queen Elizabeth Hospital, 2Intensive Care Unit, Queen Elizabeth Hospital\n\n\n\nINTRODUCTION: Poor glycaemic control is associated with poor outcomes in critically ill patients. Various insulin \nprotocols have been suggested, however implementation can be challenging and clinical outcomes have been inconsistent.\nOBJECTIVES: To evaluate effectiveness and safety of current insulin infusion protocol in critically ill patients targeting \nblood glucose levels of 6.2-10 mmol/L and to identify factors associated with degree of glucose control.\nMETHOD: A prospective cohort study was conducted in an adult general intensive care unit. All adult patients who \nreceived insulin infusion managed at physicians\u2019 discretion were recruited over a 24-month period (April 2013-2015) and \nfollowed\tup\tthroughout\tICU\tstays.\tEffectiveness\twas\tassessed\tby\tpercentage\tof\ttime\tspent\twithin\tpredefined\tglycaemic\t\nrange and safety was measured by episode of hypoglycaemia. Linear regression was used to determine factors affecting \ndegree of glucose control.\nRESULTS: 110 critically ill adult patients with 7841 glucose measurements were recruited. The mean blood glucose \nmeasurement was 83 per patient. The mean percentage of time spent in the 0-2.2, 2.3-4.3, 4.4-6.1, 6.2-10.0 and >10.0 \nmmol/L range was 0.04% (95% CI: 0.03-0.11), 0.81% (95% CI: 0.46-1.16), 7.25% (95% CI: 5.66-8.83), 55.83% (95%CI: \n52.15-59.52) and 36.9% (95% CI: 32.24-41.66), respectively. Hypoglycaemia (<4.0 mmol/L) was detected 136 times (1.7%) \nin 48 patients (43%) with a maximum of 15 hypoglycaemic events in one patient. The lowest hypoglycaemia value detected \nwas\t1.5\tmmol/L.\tIn\tthe\tfinal\tregression\tmodel,\thigh\tHbA1C\tvalue\tand\tconcurrent\tsteroid\ttherapy\tare\tassociated\twith\tlower\t\nmean percentage of time within desired range (6.2-10.0 mmol/L).\nCONCLUSION: The effectiveness of current insulin infusion protocol in maintaining blood glucose within 6.2-10.0 mmol/L \nprovides an acceptable performance at 55.89% of the time. Though half (43%) of the patients experienced hypoglycaemia, \nnumber of hypoglycaemia events are low (136/7841, 1.7%). Patients with high HbA1C value and concurrent steroid therapy \nare associated with poor glucose control.\n\n\n\nKEYWORDS: clinical pharmacy, Sabah, insulin infusion protocol, Intensive Care Unit\n\n\n\nOP2-10 (Oral)\nHYPERPHOSPHATEMIA AMONG HEMODIALYSIS PATIENTS ON CALCIUM CARBONATE IN SIBU, \nSARAWAK: PATIENTS\u2019 CHARACTERISTICS, KNOWLEDGE AND ADHERENCE TO PHOSPHATE BINDER\n\n\n\nChong WC1, Sarriff A2\n\n\n\n1Department of Pharmacy, Hospital Umum Sarawak, Sarawak, 2Discipline of Clinical Pharmacy, School of Pharmaceutical \nScience, Universiti Sains Malaysia, Pulau Pinang\n\n\n\nINTRODUCTION: Hyperphosphatemia is common among hemodialysis patients. Prolonged hyperphosphatemia is \nassociated with higher risk of mineral bone disorder, cardiovascular disease and mortality. Other than dialysis and phosphate \ndiet restriction, phosphate binder such as calcium carbonate is used to control serum phosphate level. However, high non-\nadherence rate is reported among phosphate binders users.\nOBJECTIVES: The study aimed to determine the correlation between patients\u2019 knowledge, adherence to calcium carbonate \nand phosphate level.\nMETHOD: This cross-sectional study, which involved face-to-face interview with a total of 146 regular hemodialysis \npatients from government, non-government organization and private hemodialysis centers in Sibu was conducted by using \ntwo validated questionnaires from 24/11 to 5/12/2014. Phosphate level, knowledge score and adherence to calcium carbonate \nwere examined in this study.\nRESULTS: The prevalence of hyperphosphatemia among hemodialysis patients on calcium carbonate in Sibu, Sarawak \nwas 43.9% with non-adherence rate of 67.1%. Only 2.7% of them had scored 100 points in calcium knowledge in terms of \nindication, proper ways of ingestion, interaction with hematinics and management of missed dose. Adherence to phosphate \nbinder\tand\tphosphate\tlevel\twere\tnot\tsignificantly\taffected\tby\tknowledge\tscore\t(X2\t=\t5.377,\tp\t=\t0.251).\tHowever,\tphosphate\t\nlevel\t was\t significant\t higher\t among\t patients\twith\t low\t adherence\t (1.92\t \u00b1\t 0.58mmol/L)\t than\t those\twith\t high\t adherence\t\n(1.38\u00b10.45mmol/L) (F = 16.34, p = 0.001). Negative correlation was found between Morisky scores and serum phosphate \nlevel among the studied hemodialysis patients (r = -0.443). Sociodemographic and disease background did not affect \nhyperphosphatemia\tsignificantly.\nCONCLUSION: Hyperphosphatemia among hemodialysis patients may correlate with low adherence to calcium carbonate \nbut knowledge of calcium carbonate does not affect adherence and phosphate level.\n\n\n\nKEYWORDS: clinical pharmacy, Sarawak, hyperphosphatemia, calcium carbonate, haemodialysis patients\n \n\n\n\n\n\n\n\n\nMALAYSIAN JOURNAL OF PHARMACY Vol. 2. Issue 2. August 2016\n\n\n\n34\n\n\n\nOP2-11 (Oral)\nWILLINGNESS TO PAY FOR PHARMACIST-PROVIDED DISPENSING SERVICES IN SABAH, MALAYSIA\n\n\n\nCheah MF1, Tan YP1, Aishah MS2\n\n\n\n1Department of Pharmacy, Hospital Tawau, Sabah, 2Department of Pharmacy, Hospital Mesra Bukit Padang, Sabah\n\n\n\nINTRODUCTION: Pharmacists play an important role in healthcare delivery. Over the years, their role had shifted from \nproduct-oriented to patient-oriented. However, pharmacists in Malaysia do not charge customers dispensing fee due to the \nnon-separated prescribing/dispensing practice and limited roles of community pharmacists in Malaysia.\nOBJECTIVES: This study aimed to assess the willingness to pay (WTP) for pharmacist-provided dispensing services \namong the public in the state of Sabah, Malaysia.\nMETHOD: This was a questionnaire-based cross-sectional study conducted from September 2014 to June 2015 in three \nmajor cities in Sabah, Malaysia, namely Kota Kinabalu, Sandakan and Tawau. Respondents were conveniently selected \nfrom three strata, namely public facilities, community setting and general public. They were presented with a description of \nthe difference in prescribing and dispensing activities, pharmacists\u2019 roles in dispensing service, the risk of medication errors \nin prescriptions and its consequences, the involvement of pharmacists\u2019 interventions to reduce the risk of medication errors, \nand a hypothetical scenario that dispensing separation had been implemented in community pharmacy setting in Malaysia. \nThe contingent valuation interview was then conducted to assess their WTP.\nRESULTS: A total of 647 respondents were interviewed. 358 of the respondents (55.3%) were willing to pay for pharmacist-\nprovided dispensing services. The minimum and maximum WTP amounts were RM1.00 and RM100.00, respectively, with \na median (IQR) amount of RM5.00 (IQR RM5.00).\nCONCLUSION: More than half of the respondents valued pharmacist-provided dispensing services and were willing to \npay RM5.00 for the services. However, the impact of public understanding of pharmacist-provided dispensing services on \nWTP and its amount were not assessed in this study. Nevertheless, providing education to the public regarding the role of \npharmacists in dispensing services is important in order to improve the public acceptance of such practice which will be \nimplemented in the near future.\n\n\n\nKEYWORDS: pharmacy health policies, Sabah, willingness to pay, pharmacist-provided dispensing services\n\n\n\nOP2-12 (Oral)\nEFFECTS OF PSYCHOSOCIAL INTERVENTION ON QUALITY OF LIFE AMONG PATIENTS RECEIVING \nMETHADONE THERAPY IN HULU TERENGGANU HOSPITAL\n\n\n\nNur Atiqah A, Nur Fajrina Z, Siti Norfatihah MP\nDepartment of Pharmacy, Hospital Hulu Terengganu, Terengganu\n\n\n\nINTRODUCTION: Specifically,\tpsychological\tintervention\twas\tdefined\tas\tnon-pharmacological\tintervention\tcarried\tout\tin\t\ngrouping emphasizing on four domains of quality of life; physical, psychological, social and environment. It is a continuation \nof previous study entitled \u201cQuality Of Life in Patient Receiving Methadone Therapy in Hospital Hulu Terengganu\u201d by Lyam \net al. (2013).\nOBJECTIVES: This study aimed to 1) assess the impact of implementation of psychosocial intervention on quality of life \nof patients and 2) evaluate the effect of psychosocial intervention on quality of life of four domains; physical, psychological, \nsocial and environment.\nMETHOD: Respondents from Hospital Hulu Terengganu must be involved in all psychosocial intervention; \u201cKursus Ibadah\u201d \nand psychosocial counselling conducted. The respondents then answered WHOQOL-BREF after 1 month of intervention \n(include 4 domains; 26 items; Likert-type responses 1-5; higher score \u2013 better QoL outcome). Data was analysed via SPSS \n19; employing non-parametric tests.\nRESULTS: A total of 51 patients were included in this study. Each domain showed an increment in the mean subsequent \nto intervention. Social domain showed the highest increment of 12.26 (pre-intervention = 58.17 & post-intervention = \n70.43) followed by psychological domain with an increment of 8.32 (pre-intervention = 62.27 & post-intervention = \n70.59), environment with an increment of 7.42 (pre-intervention = 60.05 & post-intervention = 67.47) and physical with an \nincrement\tof\t5.5\t(pre-intervention\t=\t63.90\t&\tpost-intervention\t=\t69.40).\tThese\tincrements\twere\tstatistically\tsignificant\twith\t\np= 0.000 for social domain, 0.004 for psychological domain, 0.001 for environment domain and 0.023 for physical domain.\nCONCLUSION: The psychosocial intervention in addition to MMT programme implemented in the rural Terengganu \npopulation is considered successful and could generate long term positive impacts on QOL.\n\n\n\nKEYWORDS: pharmacy practice, Terengganu, quality of life, methadone maintenance therapy, psychosocial intervention\n\n\n\n \n\n\n\n\n\n\n\n\n35\n\n\n\nMALAYSIAN JOURNAL OF PHARMACY Vol. 2. Issue 2. August 2016\n\n\n\nOP2-13 (Oral)\nBARRIERS TO MEDICATION ERROR REPORTING AMONG HEALTHCARE PROFESSIONALS IN \nSULTANAH FATIMAH HOSPITAL, MUAR\n\n\n\nNurulain MR, Zaitun MS, Er PS, Lim KY, Nithya S, Noraini S, Tan LH\nDepartment of Pharmacy, Hospital Pakar Sultanah Fatimah, Muar, Johor\n\n\n\nINTRODUCTION: Medication error reporting is an important measure to prevent medication error incidents in a healthcare \nsystem and can serve as an important tool for improving patient safety. \nOBJECTIVES: This study aimed to identify the barriers to medication error reporting among different healthcare \nprofessionals in HPSF, including doctors, pharmacists, nurses, medical assistants and pharmacist assistants.\nMETHOD:\t This\t research\t project\t was\t a\t cross-sectional\t study\t using\t questionnaires\t designed\t specifically\t to\t assess\t the\t\nsubject\u2019s barriers to medication error reporting. The barriers were grouped into \u201cfear of the consequences of medication error \nreporting\u201d, \u201cmanagerial factors\u201d and \u201cprocess of reporting\u201d. A Likert scale ranging from 1 (unlikely) to 5 (likely) was used to \ndescribe the barriers to reporting a medication error. The survey was analysed by using Statistical Package for Social Science \n(SPSS) software. Kruskal-Wallis test was used to analyse the relationship between occupation and barriers, job experience \nand barriers, training attended and barriers, and also training attended and knowledge on medication error reporting form.\nRESULTS: The overall response rate was 84% (100% for pharmacists, 94% for nurses, 90.9% for assistant pharmacists, \n73.5% for doctors and 63.4% for medical assistants). Majority of the respondents felt that \u201cmanagerial factors\u201d were \nlikely to be the barriers that restrict them from reporting a medication error. \u201cFear of the consequences of reporting\u201d and \n\u201cmanagerial\tfactor\u201d\tshowed\tsignificant\tdifference\tin\tdifferent\toccupation\tand\tjob\texperience.\t\u201cProcess\tof\treporting\u201d\tshowed\t\nno\tsignificant\tdifference\twith\tall\tfactors.\tTest\ton\t\u201ctraining\tattended\u201d\tversus\t\u201cknowledge\ton\tmedication\terror\treporting\tform\u201d\t\nshowed\tno\tsignificant\tdifference.\nCONCLUSION: The study results showed that managerial factors and fear of process of reporting had the major role in \nthe refusal of reporting medication errors. Different approaches therefore should be considered in designing a strategic and \neffective system of medication error reporting which in turn improves patient safety.\n\n\n\nKEYWORDS: pharmacy practice, Johor, medication error reporting, barriers\n\n\n\nOP2-14 (Oral)\nVANCOMYCIN INITIAL DOSING AMONG ADULT DIALYSIS (VIDAD) PATIENTS IN A TERTIARY CARE \nHOSPITAL\n\n\n\nManjulaa DS, Fateha K, Siti SMS, Ching SL, Anitha R, NurulHizwani A\nDepartment of Pharmacy, Hospital Kuala Lumpur\n\n\n\nINTRODUCTION: Serum\tvancomycin\tconcentrations\t (SVC)\tvaried\tsignificantly\tamong\tchronic\tdialysis\tpatients\twho\t\nreceived\ta\tstandard\t1000mg\tregardless\tof\tbody\tweight\tand\tnon-standardised\ttime-to-first-sampling\t(TTFS).\nOBJECTIVES: To identify the weight-based initial dose of vancomycin prescribed. To study the TTFS following initial \ndose\tof\tvancomycin.\tTo\tassess\tthe\tSVC\tat\tthe\tfirst\tsampling\tfollowing\tthe\tinitial\tdose.\tTo\tidentify\tfactors\taffecting\tSVC\tat\t\nfirst\tsampling.\nMETHOD: Retrospective observational study was conducted at nephrology and general medical wards in Hospital Kuala \nLumpur. Data were collected using convenient sampling method from September 2015 to February 2016. Subjects were \nend-stage renal disease (ESRD) patients on dialysis, aged 18 years and above who received intravenous vancomycin as \nempirical\tor\tdefinitive\ttreatment.\tMultiple\tlinear\tregression\twas\tconducted\tto\tidentify\tfactors\taffecting\tSVC.\nRESULTS:\t Forty\t nine\t subjects\t fulfilled\t the\t criteria\t and\t the\tmean\t initial\t dose\t of\t vancomycin\t prescribed\twas\t 20.2\u00b15.8\t\nmg/kg.\tThe\tmean\tTTFS\twas\t26.2\u00b112.8\thours.\tThe\tmean\tSVC\tattained\tfrom\tthe\tfirst\tsampling\tirrespective\tof\tTTFS\twas\t\n9.74\u00b14.91\u00b5mol/L. Eighty percent of subjects with TTFS of 24-48 hours (n=25) and 45.8% of TTFS within 24 hours(n=24) \nfailed\tto\tachieve\tSVC\tof\t10.4umol/L\tand\tabove.\tThere\twas\ta\tsignificant\tlinear\trelationship\tbetween\tinitial\tdose\t(mg/kg),\t\nTTFS (hours) and the resulting SVC (\u00b5mol/L) achieved. An increase in initial dose by 1mg/kg results in 0.418\u00b5mol/L (95% \nCI, 0.208, 0.629, p<0.001) increase of SVC. The SVC dropped by 0.135\u00b5mol/L (95% CI, -0.230, -0.040, p=0.006) when \nTTFS\twas\tdelayed\tby\tan\thour.\tThe\tfinal\tmodel\tequation\twas\tobtained\tto\tbe:\tSVC\t(\u00b5mol/L)\t=\t[0.418(initial\tdose\tin\tmg/\nkg) \u2013 0.135(TTFS)] + 4.843\nCONCLUSION: An initial dose of 1000mg is not suitable for all dialysis patients leading to variable SVCs. Weight-based \ninitial dose and TTFS are important determinants of SVCs in dialysis patients.\n\n\n\nKEYWORDS: clinical pharmacy, Kuala Lumpur, vancomycin, dosing, renal dialysis \n \n\n\n\n\n\n\n\n\nMALAYSIAN JOURNAL OF PHARMACY Vol. 2. Issue 2. August 2016\n\n\n\n36\n\n\n\nOP2-15 (Oral)\nPRESCRIPTION PATTERN AND PREVALENCE OF POTENTIALLY INAPPROPRIATE PRESCRIBING (PIP) \nFOR GERIATRIC PATIENTS IN SPECIALIST CLINICS, SULTAN HAJI AHMAD SHAH HOSPITAL\n\n\n\nChua QH, Sharifah NS, Ahmad S, Lim JA, Fatimah AMF\nDepartment Of Pharmacy, Hospital Sultan Haji Ahmad Shah, Pahang \n\n\n\nINTRODUCTION: The life expectancy is becoming longer and the geriatric population in Malaysia is expected to increase \nto 9.5% in the year 2020. Geriatric population have more co-morbidities and are prescribed with more medications, making \nappropriate prescribing a challenging task to healthcare practitioners. Potentially inappropriate prescribing (PIP) and \npotential prescribing omissions (PPOs) can be detected through the use of screening tools.\nOBJECTIVES: To determine the prescribing pattern for geriatric patients at specialist clinics, HoSHAS, and to describe the \nprevalence of PIP and PPOs based on the START (Screening Tool to Alert doctors to Right Treatment, 2007) and STOPP \n(Screening Tool of Older Persons\u2019 potentially inappropriate Prescriptions, 2008) criteria.\nMETHOD: This was a cross-sectional study. Prescriptions for patients aged 65 and above who attended the Specialist \nClinics in HoSHAS and received their last supply of medication in December 2013 were collected and screened through \nusing the START/STOPP criteria.\nRESULTS: Out of the 209 prescriptions screened, 27.1% has ophthalmic diagnosis, followed by cardiovascular (25.8%). \nAverages\tof\t3.45\u00b12.393\tmedications\twere\tprescribed\tper\tprescription,\twith\t26.46%\thaving\tfive\tmedications\tor\tmore.\tOverall,\t\n5.15% of the prescriptions had at least one PIP based on both STOPP/START criteria. The positive correlation between total \nnumber\tof\tmedications\tper\tprescription\tand\ttotal\tnumber\tof\tPIP\twas\tstatistically\tsignificant\t(rs(8)\t=\t.206,\tp\t=\t.000).\t\nCONCLUSION: Prescriptions containing ophthalmic and cardiovascular medications were the most common prescriptions \namong geriatric patients in HoSHAS. PIP is more likely to occur when more medications are prescribed and START/STOPP \ncriteria can be used as a tool of detection.\n\n\n\nKEYWORDS: clinical pharmacy, Pahang, inappropriate prescribing, geriatrics\n\n\n\nOP2-16 (Oral)\nTHE COMPLIANCE AND PROBLEMS ENCOUNTERED IN TAKING EYE MEDICATIONS AMONG \nGLAUCOMA PATIENTS IN REGIONAL-REFERRAL HOSPITAL\n\n\n\nLow JW, Chan SY, Hoo FW, Lee SH\nDepartment of Pharmacy, Hospital Raja Permaisuri Bainun, Ipoh, Perak\n\n\n\nINTRODUCTION: Estimated eye drops compliance in glaucoma patients ranges variably from 5% to 80%. Understanding \nand improvement of compliance can assist in delivering better outcome.\nOBJECTIVES: The aim of the study was to explore the compliance and to identify the problems encountered during eye \ndrops administration among glaucoma patients.\nMETHOD: This was a one year cross-sectional study conducted at an outpatient setting. Patients who received glaucoma \neye drops were conveniently sampled and interviewed using a validated Brief Medication Questionnaire. Compliance scores \nranged from 0 to 5, with scores of 1 and below indicated compliance. Problems in applying eye drops were graded as \u2018hard\u2019 \nand \u2018not hard\u2019. Data collected was analysed using SPSS version 20.\nRESULTS: Of 100 subjects interviewed, 69 of them were Chinese and 56 were males; mean age was 67.6 (SD+10.4). A \nmajority of the subjects (44%) were on two types of glaucoma medications. Overall compliance rate was 75%, mean score \nwas\t 0.86\t (SD+1.09).\tThere\twas\t no\t significant\t association\t between\t compliance\twith\t socio-demographic\t characteristics.\t\nThe most frequent problems reported were \u2018eye drops fall on cheeks\u2019 (45%), \u2018too many drops coming out\u2019 (42%), and \n\u2018getting\tthe\teye\tmedications\trefilled\tin\ttime\u2019\t(25%).\tPatients\tprescribed\twith\t4\ttypes\tor\tmore\tglaucoma\teye\tdrops\twere\t7\t\ntimes more likely being non-compliant (OR: 7.56; 95%CI: 1.316-43.370, p=0.023). Multivariate logistic regression analysis \nconfirmed\tsignificant\teffects\tof\t\u2018difficulty\tin\tremembering\u2019\t(OR:\t31.02;\t95%\tCI:\t5.28-182.13,\tp=0.001)\tand\t\u2018reading\tlabels\t\n& identifying the bottles\u2019 (OR: 3.59; 95%CI: 1.00-12.84, p=0.05) in affecting compliance.\nCONCLUSION: Majority of the patients were found to be compliant. Compliance can be improved by having complete \nand effective labelling, provision of special aids for ease of drop applications and medication calendar.\n\n\n\nKEYWORDS: pharmacy practice, compliance, eye drops, glaucoma\n \n\n\n\n\n\n\n\n\n37\n\n\n\nMALAYSIAN JOURNAL OF PHARMACY Vol. 2. Issue 2. August 2016\n\n\n\nOP2-17 (Oral)\nFACTORS AFFECTING THE OUTCOME OF METHADONE MAINTENANCE THERAPY IN ZONE KEPONG\n\n\n\nChiew SY1, Wong MX1, Yap LS2, Raya AA1, Chow YN3, Bala V4\n\n\n\n1Department of Pharmacy, Pejabat Kesihatan Kepong, Wilayah Persekutuan Kuala Lumpur; 2Department of Pharmacy, \nKlinik Kesihatan Jinjang, Wilayah Persekutuan Kuala Lumpur, 3Department of Pharmacy, Klinik Kesihatan Batu, Wilayah \nPersekutuan Kuala Lumpur, 4Department of Pharmacy, Klinik Kesihatan Sentul, Wilayah Persekutuan Kuala Lumpur\n\n\n\nINTRODUCTION: In Malaysia, Methadone Maintenance Therapy (MMT) was started since 2005 as one of the \u201cHarm \nReduction\u201d programme which aim to reduce blood-borne infection from needle sharing among opioid abusers. However, \nmore than half of the MMT patients in Kepong were still having positive urine test in 2015.\nOBJECTIVES: The objective was to identify the factors affecting the outcome of methadone maintenance therapy in Zone Kepong.\nMETHOD: A retrospective, observational study based on records of MMT patients from two methadone clinics in Kepong \nwas\tconducted.\tPatients\twho\tfulfilled\tthe\tstudy\tcriteria\twere\tincluded.\tDemographic\tdata,\thistory\tof\taddiction,\tmethadone\t\ntreatment details and urine test results throughout a one-year period of 2014 were obtained. Statistical analysis was conducted \nto\tanalyse\t the\tassociation\tbetween\tvarious\t factors\tand\tgood\t treatment\toutcome\twhich\twas\tdefined\tas\t less\t than\t20%\tof\t\npositive urine samples.\nRESULTS:\tA\ttotal\tof\t154\tpatients\twere\treviewed,\t48.7%\tof\tthem\thad\tachieved\tgood\ttreatment\toutcome.\tFactors\tidentified\tto\t\naffect treatment outcome consisted of methadone dosage, take-away privilege, duration of addiction and frequency of doctor\u2019s \nappointment.\tNo\tsignificant\tassociation\twas\tfound\tbetween\toutcome\tand\tdemographic\tdata\t(age,\tgender,\trace),\tage\tat\tonset\t\nof addiction, types of illicit drugs and duration of treatment. Patients with methadone dosage of 40-80 mg/day had poorer \noutcome (odds ratio [OR]=3.86; CI=0.07,0.9, p=0.029) compared to those with doses less than 40 mg/day. Patient who \nwere\tallowed\ttake-away\tdoses\t(unsupervised\tadministration)\thad\tsignificantly\tbetter\toutcome\t(OR=14.02;\tCI=5.9,\t33.3,\t\np<0.001). While odds of better outcome was higher with longer duration of addiction (OR=1.04; CI=1.01, 1.08, p=0.029).\nCONCLUSION:\tThis\tstudy\tidentified\tthat\ttake-away\tprivilege,\tlower\tmethadone\tdoses\tand\tincrease\tin\tduration\tof\taddiction\t\nwere associated with better outcome of methadone maintenance therapy.\n\n\n\nKEYWORDS: pharmacy practice, Kuala Lumpur, methadone maintenance therapy, treatment outcome\n\n\n\nOP2-18 (Oral)\nCLOSED-SYSTEM TRANSFER DEVICE FOR ANTINEOPLASTIC DRUG PREPARATION IN THE SULTANAH \nBAHIYAH HOSPITAL, ALOR SETAR: IS COST SAVING POSSIBLE?\n\n\n\nChan HK1, Lim YM1, Hassali MA2, Lim CJ2, Saleem F2\n\n\n\n1Department of Pharmacy, Sultanah Bahiyah Hospital, Alor Setar, Kedah, 2Discipline of Social and Administrative Pharmacy, \nSchool of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang\n\n\n\nINTRODUCTION: Besides reducing the risk of occupational exposure to cytotoxic hazards, the PhaSeal\u00ae closed-system \ntransfer device (CSTD) has been shown to save costs by extending beyond-use dates (BUDs) of opened vials of antineoplastic \ndrugs for up to seven days. \nOBJECTIVES: To evaluate the total material cost incurred by its use in a Malaysian government-funded hospital.\nMETHOD: A list of vial stability of 29 antineoplastic drugs commonly used in the Sultanah Bahiyah Hospital, Alor Setar, \nwas compiled. The amount of materials used, including drugs, infusion bottles, the PhaSeal\u00ae CSTD and other consumables, \nwas recorded on a daily basis from 1st of October to 31st of December 2015. Calculation of total cost was based on the actual \nacquisition costs, and it was then compared with that of a hypothetical scenario, in which conventional syringe-needle sets \nwere used to compound the same amount of preparations.\nRESULTS: The use of the PhaSeal\u00ae CSTD incurred a total drug preparation cost of MYR 383,634.52 (US$ 92,072.28) \nover the three-month study period, representing an average of MYR 170.50 (US$ 40.92) per preparation, and an estimated \nannual cost of MYR 1,534,538.08 (US$ 368,289.14). Compared with conventional syringe-needle approach, it is estimated \nto lead to an additional spending of MYR 148,627.68 (US$ 35,670.64) yearly. Preparation of three brand-name drugs \n(bortezomib, pemetrexed and liposomal doxorubicin) made up more than half of the total cost, indicating that cost saving \nby reducing drug wastage using the PhaSeal\u00ae CSTD is potentially realisable if these drugs are more frequently prescribed.\nCONCLUSION: As opposed to previous studies, cost saving by using the PhaSeal\u00ae CSTD was not observed, although \nthere\twas\ta\tnoticeable\treduction\tof\tdrug\twastage\tachieved\tby\textending\tBUDs\tof\tunfinished\tvials.\tFuture\tstudies\tshould\t\nfurther assess the possibility of cost saving, especially in healthcare settings where high-cost antineoplastic drugs are \ncommonly used.  \n\n\n\nKEYWORDS: pharmacy health policies, Kedah, antineoplastic agents, closed-system transfer device, cost savings\n\n\n\n\n\n\n\n\nMALAYSIAN JOURNAL OF PHARMACY Vol. 2. Issue 2. August 2016\n\n\n\n38\n\n\n\nOP2-19 (Oral)\nIMPACT OF CYP2B6 POLYMORPHISM, CLINICAL FACTORS AND METHADONE ON NEVIRAPINE \nCONCENTRATIONS IN HIV PATIENTS\n\n\n\nMustafa S1,2, Wan YWN2, Tan SC2, Mustafa M1, Abd Rahman AK3, Low LL4, Hassan NB2\n\n\n\n1Hospital Raja Perempuan Zainab II, Kota Bharu, Kelantan, 2Universiti Sains Malaysia, Kubang Kerian, Kelantan, 3Hospital \nSultanah Nur Zahirah, Kuala Terengganu, Terengganu, 4Hospital Sultanah Bahiyah, Alor Star, Kedah\n\n\n\nINTRODUCTION: Comprehensive information on the effects of drug metabolizing enzyme cytochrome P450 2B6 \n(CYP2B6) polymorphisms, clinical factors, and methadone interaction on nevirapine concentrations in HIV patients is \nunavailable.\nOBJECTIVES: This study was conducted to explore the possible association of CYP2B6 polymorphisms, clinical factors, \nand methadone with nevirapine plasma concentrations amongst Malaysian HIV patients. \nMETHOD: In total, 112 patients treated with 200 mg twice daily nevirapine-based antiretroviral therapy, 17 of whom \nreceived methadone were included in the study. Blood samples were drawn at pre-dose, 0.5, 1.0, 1.5, 2.0, 3.0, 4.0 and \n8.0 hours after nevirapine morning dose. Nevirapine plasma concentrations were determined by high performance liquid \nchromatography with UV detector. The pharmacokinetic parameters of nevirapine were modelled using non-parametric \npharmacokinetics analysis with Pmetrics software. The minimum (Cmin) and the maximum (Cmax) plasma concentration \nof nevirapine were obtained from visual inspection of the concentration-time curves. Three single nucleotide polymorphisms \n(SNPs) within CYP2B6 were genotyped.\nRESULTS: Allele frequency of CYP2B6 *2, *4, *6 and *9 in the study were 4.0%, 14.3%, 27.2% and 6.3% respectively. \nWhen compared to CYP2B6*1/*1, elevated Nevirapine Cmax was found to be associated with CYP2B6*1/*2 (p= 0.013), \nCYP2B6*6/*6\t(p=0.033)\tand\tCYP2B6*6/*9\t(p=0.016).\tHigher\tCmin\twas\talso\tobserved\tin\tthe\tgenotypes\tbut\tsignificant\t\ndifference\tobserved\tonly\twith\tCYP2B6*6/*9\t(p=0.021).\tThere\twas\tsignificant\tlinear\trelationship\tbetween\tliver\tfunction\t\n(ALT, ALP and AST levels) and Nevirapine concentrations (p<0.05). Nevirapine clearance was increased in patients \nconcomitantly administered with Methadone (p=0.046). As shown by multivariate analysis, variability in Nevirapine \nconcentrations\twas\tsignificantly\tassociated\twith\tCYP2B6\tpolymorphism,\tliver\tfunction\tand\tmethadone\tintake.\nCONCLUSION: The variability in the nevirapine exposure is associated with genetic and non-genetic factors. Results of \nthis study suggest that knowledge of the CYP2B6 polymorphism is useful in identifying HIV-infected patients at risk for \nhigher Nevirapine concentrations.\n\n\n\nKEYWORDS: pharmacy research, HIV, nevirapine, CYP2B6\n\n\n\nOP2-20 (Oral)\nEVALUATION OF ADHERENCE AMONG ACUTE CORONARY SYNDROME (ACS) PATIENTS AND ASSESSMENT \nOF KNOWLEDGE AND USE OF SUBLINGUAL GLYCERYL TRINITRATE (GTN) IN MELAKA HOSPITAL\n\n\n\nSa\u2019ad US, Cheong LW, Sapiyan SN, Wan Ismail WI\nDepartment of Pharmacy, Hospital Melaka, Melaka\n\n\n\nINTRODUCTION: Adherence to recommended medications for the secondary prevention of ACS is crucial to reduce \nsubsequent disease-related events. It is also essential to have a good knowledge of S/L GTN as it is the standard treatment \nfor angina pain control.\nOBJECTIVES: To determine medication adherence, knowledge and use of sublingual GTN therapy among ACS patients \nadmitted to medical wards in Hospital Melaka. \nMETHOD: This was a cross-sectional survey, using validated 8 item, Morisky Medication Adherence Scale (MMAS-8) and \nknowledge and use of sublingual GTN questionnaire. The study involved old ACS patients receiving sublingual GTN warded \nin medical wards Hospital Melaka. Eight items were used to calculate each subject\u2019s medication adherence, knowledge score \nof S/L GTN and six items were used to calculate score in the use of S/L GTN. PASW version 18 was used for data analysis.\nRESULTS: Of the 30 patients, 53% reported high adherence to their medications, all of them knew the indication of \nsublingual GTN, however only 60% of them knew the mechanism of action of GTN. 93.3% knew the proper storage of the \ntablets. 5 patients (16.7%) did not know the maximum number of tablets that could be taken during each angina episode. \n36.7% of patients were not aware of the need to replace S/L GTN every 8 weeks after opening. Majority (63.3%) of the \npatients demonstrated lack of knowledge with regards to the use of sublingual GTN as prevention of chest pain. 67% of \npatients showed poor score in the use of S/L GTN therapy. And most patients (56.6%) did not keep their S/L GTN away \nfrom body heat.\nCONCLUSION: Majority of patients have high adherence to their medication. There were only 30% of patients with high \nknowledge scores, and only 33% of patients were reported to high score in the use of S/L GTN. \n\n\n\nKEYWORDS: clinical pharmacy, Melaka, acute coronary syndrome, morisky medication adherence scale, sublingual \nglyceryl trinitrate (GTN)\n\n\n\n\n\n\n\n\n39\n\n\n\nMALAYSIAN JOURNAL OF PHARMACY Vol. 2. Issue 2. August 2016\n\n\n\nOP2-21 (Oral)\nASSESSMENT OF PATIENTS\u2019 ADHERENCE TO MEDICATION REFILL THROUGH MEDICATION \nAPPOINTMENT CARD\n\n\n\nLee LS, Teoh KW, Tan BK, Tan SC, Nurul A\nDepartment of Pharmacy, Pejabat Kesihatan Daerah Seberang Perai Selatan, Pulau Pinang\n\n\n\nINTRODUCTION: A\tcustomer\tsatisfaction\tsurvey\tshowed\t that\tnot\tall\tpatients\twere\tsatisfied\twith\t the\tcurrent\twaiting\t\ntime.\tTherefore,\ta\tmedication\trefill\tmethod\tcalled\tthe\t\u2018Appointment\tCard\tSystem\u2019\twas\tintroduced\tin\tour\tsetting\tsince\t2013.\t\nHowever, we found high percentage of defaulters in this system.\nOBJECTIVES:\tTo\tassess\tpatients\u2019\tadherence\tto\tmedication\trefill\tthrough\tAppointment\tCard\tSystem\tand\tfactors\taffecting\t\ntheir\t non-adherence.\tWe\t also\t intend\t to\t evaluate\t the\t association\t between\t patients\u2019\tmedication\t refill\t adherence\t and\t their\t\noccupations and transportation methods to our healthcare settings.\nMETHOD: This multi-centered cross sectional study was conducted in 4 health clinics under Pejabat Kesihatan Daerah \nSeberang Perai Selatan. Eligible patients were registered from 1st October to 31st December 2013. The prescriptions \nwith\ta\tminimum\tof\t2\tmonths\tduration\tand\tconsisted\tof\tfive\tor\tmore\titems\twith\ta\tminimum\tof\ttwo\trecorded\titems\twere\t\nincluded in the study. The details of patient\u2019s next visit were recorded along with factors contributing to non-adherence in \nthe data collection form. Descriptive analysis was used to illustrate socio-demographic data and Fisher\u2019s exact test used for \nassociation.\tp<0.05\twas\tconsidered\tstatistically\tsignificant.\nRESULTS:\tOut\tof\t63\trespondents,\t43%\tpatients\twere\tnon-adherent\tto\ttheir\tmedication\trefill\tthrough\tAppointment\tCard\t\nSystem.\tContributory\tfactors\t identified\twere\t\u2018patient\tstill\thaving\tmedication\tbalance\tat\thome\t(29.6%)\u2019,\t \u2018busy\t(22.2%)\u2019,\t\n\u2018forgetfulness\t(22.2%)\u2019\tand\t\u2018transportation\tproblem\t(26%)\u2019.\tWe\tfound\tonly\ttransportation\tmethod\thad\tsignificant\tassociation\t\nwith\ttheir\tmedication\trefill\tadherence\t(p=0.0195),\tin\twhich\tpatients\twho\tcame\twith\town\ttransport\thad\thigher\tadherence\tto\t\nmedication\trefill\t(58.7%).\t\nCONCLUSION:\tPatients\u2019\ttransportation\tproblem\tremains\tone\tof\tthe\tmost\tdifficult\tissues\tto\ttackle.\tAdaptation\tof\tnewer\t\napproach\tthrough\t\u201cUbat\tMelalui\tPos\u201d\tis\tthe\tnext\tstep\tin\tour\thealth\tclinics\tto\timprove\tpatients\u2019\trefill\tmedication\tadherence.\n\n\n\nKEYWORDS:\tpharmacy\tpractice,\tSeberang\tPerai,\tadherence,\tmedication\tappointment\tcard,\tmedication\trefill\n\n\n\nOP2-22 (Oral)\nSEIZURE CONTROL AMONG EPILEPSY PATIENTS THROUGH EPILEPSY REVIEW SERVICE IN PRIMARY \nCARE SETTING\n\n\n\nWong SL, Cheang CY, AR Hanum MAR, Norharlina S, Ng KM\nDepartment of Pharmacy, Pejabat Kesihatan Daerah Klang, Selangor\n\n\n\nINTRODUCTION: Epilepsy is a debilitating disease affecting more than 200,000 people in Malaysia. A pilot study \nconducted in our setting revealed that only 9.6% of epilepsy patients had their seizure well-controlled. Epilepsy Review \nService (ERS) is a pharmacist-initiated effort in collaboration with other healthcare professionals to improve health \noutcomes\t among\t epilepsy\t patients.\t ERS\t consists\t of\t restructured\tworkflow\tof\t patient\t care,\t newly\t implemented\tSeizure\t\nDiary, Therapeutic Drug Monitoring (TDM) Guide and Epilepsy Counselling Guide.\nOBJECTIVES: The primary objective of the study was to determine the percentage of patients that had improvement in \nseizure\tcontrol\tafter\timplementing\tERS.\tSpecific\tobjective\twas\tto\tidentify\tareas\tfor\timprovement\tto\tensure\tlong\tterm\tand\t\ncommunity focused approach to manage epilepsy patients in primary care settings.\nMETHOD: A cross-sectional study of 156 patients from three clinics within Klang district was conducted from January \n2014 to May 2015. The retrieved data was in the form of a self-constructed data collection form, medical records and patient \nself-recorded seizure frequency before and after the interventions.\nRESULTS: Seizure control improvement among epilepsy patients increased from a baseline of 9.6% to 37.8% at 6 months \nand 52.6% at 12 months. The mean monthly seizure frequency dropped from 1.95 (SD, 2.04) or median of 1.0 (range, 0-10) \nat the baseline to 1.91 (SD, 2.02) or median 1.0 (range, 0-7) at 6 months and 0.94 (SD, 1.30) or median 1.0 (range 0-7) at 12 \nmonths. Before implementation of ERS, there were delayed completion of TDM cases (40.6%), lack of counselling related \nto epilepsy issues (21.8%), lack of medication side effects (5.1%) and drug interactions (20.5%) review. Post-intervention \nshowed increment in the completion of TDM cases within 72 hours (84.1%), counselling done (89.3%), medication side \neffects (77.9%) and drug interactions (82.1%) reviewed.\nCONCLUSION: Implementation of ERS improved epilepsy patient care and monitoring practice provided by pharmacists \nin primary care setting.\n\n\n\nKEYWORDS: clinical pharmacy, Klang, seizure, epilepsy review service \n \n\n\n\n\n\n\n\n\nMALAYSIAN JOURNAL OF PHARMACY Vol. 2. Issue 2. August 2016\n\n\n\n40\n\n\n\nOP2-23 (Oral)\nIMPACT OF SPECIALISED COUNSELLING BY PHARMACISTS IN PSORIASIS MANAGEMENT\n\n\n\nKassim MSA, Abdul Rahim SN, Yaziz DT, Esahak Ayub AE, Idrus SA\nDepartment of Pharmacy, Hospital Sultanah Bahiyah, Kedah\n\n\n\nINTRODUCTION: Psoriasis treatment is complex, and the treatment success depends largely on the patients\u2019 capacity to \nmanage their disease and adherence to the prescribed drug regimen. Literatures showed that pharmacists\u2019 involvement is \nminimal in this area largely due to lack of knowledge.\nOBJECTIVES: This study aimed to investigate impact of psoriasis education on pharmacists and outcome of specialised \npharmacist counselling on psoriasis patients.\nMETHOD: This is a quasi-experimental study involving psoriasis patients on topical treatment with follow-ups at skin clinic \nand pharmacists working at Pharmacy Department HSB. Knowledge was assessed among 50 pharmacists before and one \nmonth after attending a seminar on psoriasis therapy. Meanwhile, selected psoriasis patients were assessed for knowledge, \nmedication compliance, and health-related quality of life (HQL) before and one month after specialised counselling by \ntrained pharmacists.\nRESULTS:\tKnowledge\tof\tpharmacist\t improved\tsignificantly\tafter\t the\tseminar\t (p<0.0001).\tAs\t for\tpatients\u2019\tknowledge,\t\ncompliance\tand\tHQL,\tthere\twas\ta\tsignificant\timprovement\tpost\tspecialised\tcounselling\t(p\t<0.0001).\nCONCLUSION:\tThe\tdata\tproved\tthat\tpsoriasis\teducation\tsignificantly\timproved\tpharmacist\u2019\tknowledge\tin\tthis\tarea,\tand\t\nthere\twas\ta\tsignificant\timpact\tof\tpharmacist\tinvolvement\tin\tmanagement\tof\tpsoriasis\tdisease.\tAs\tsuch,\tpharmacists,\twho\tare\t\nresponsible for dispensing topical a well as systemic medications to psoriasis patients, can be trained further, and should be \nactively involved in educating psoriasis patients alongside other health care providers.\n\n\n\nKEYWORDS: pharmacy practice, psoriasis, counselling, quality of life\n\n\n\nOP2-24 (Oral)\nPERCEPTIONS OF TYPE 2 DIABETES MELLITUS PATIENTS TOWARDS INSULIN THERAPY IN DISTRICT \nSPECIALIST HOSPITAL\n\n\n\nChiew SC1, Ling SH2, Teh JR3, Chuah SP4, Nadia M5, Azman M5, Chooi KC6\n\n\n\n1Clinical Research Centre, Hospital Seri Manjung, Perak, 2Department of Pharmacy, Seberang Perak Health Clinic, Perak, \n3Department of Pharmacy, Hospital Bentong, Pahang, 4Department of Pharmacy, Kampung Gajah Health Clinic, Perak, \n5Department of Pharmacy, Hospital Seri Manjung, Perak, 6Medical Department, Hospital Seri Manjung, Perak\n\n\n\nINTRODUCTION: Diabetes mellitus is a complex, chronic illness that is growing predominantly worldwide. Insulin \ntherapy is warranted in Type 2 Diabetes Mellitus (T2DM) patients to achieve good glycaemic control and prevent diabetes-\nrelated complications.\nOBJECTIVES: This study aimed to determine the willingness of Hospital Seri Manjung patients to accept insulin therapy \nif\tprescribed,\tpatients\u2019\tperceptions\tand\tsignificant\tpredictors\tof\tpatients\u2019\twillingness.\nMETHOD: This cross-sectional study (July-October 2014) was conducted among T2DM patients aged 18 years and above \nwho were on at least 1 oral anti-diabetic agent and insulin na\u00efve. Dementia, cognitive impairment and psychiatric patients \nwere excluded. Patient demographic, patients\u2019 willingness to accept insulin therapy and their perceptions were captured by \nadopting\ta\tvalidated\tself-administered/assisted\tquestionnaire\tand\tpresented\tas\tdescriptive\tstatistics.\tSignificant\tpredictors\tof\t\npatients\u2019 willingness to accept insulin therapy were analysed by Multiple Logistic Regression.\nRESULTS: A total of 182 out of 285 patients participated would resist if insulin was initiated. There were 6 major barriers \nto\tinsulin\tusage\tidentified\tin\tunivariate\tanalysis.\tAfter\tadjusting\tall\tfactors,\tonly\t2\tbarriers\twere\tfound\tto\tbe\tsignificant.\t\nPatients who felt that injecting insulin would be painful were 2.14 times less willing to accept insulin if prescribed (95% CI: \n1.29-3.56,\tp=0.003).\tPatients\tunconfident\tin\tmanaging\tinsulin\ttherapy\twere\t1.97\ttimes\tless\twilling\tto\taccept\tinsulin\t(95%\t\nCI: 1.18-3.28, p= 0.009).\nCONCLUSION: Refusal rate of insulin therapy if prescribed was 63.9%. Patients were unwilling to accept therapy due to \nseveral\tmisconceptions.\tPatients\twho\tperceived\tthat\tinsulin\tinjection\twas\tpainful\tand\twere\tunconfident\tin\tmanaging\tinsulin\t\ntherapy were approximately twice less willing to accept insulin therapy.\n\n\n\nKEYWORDS: Pharmacy Practice, perceptions, insulin, diabetes\n \n\n\n\n\n\n\n\n\n41\n\n\n\nMALAYSIAN JOURNAL OF PHARMACY Vol. 2. Issue 2. August 2016\n\n\n\nOP2-25 (Oral)\nEFFECT OF AN EDUCATION PROGRAMME ON ATTITUDE, KNOWLEDGE, AWARENESS AND COPING \nMECHANISM IN EPILEPSY (EPACE)\n\n\n\nRaman S1, Chang CW1, Heng JJE1, Malandi R1, Wong MCH2, Loh BCC2, Wong SW3\n\n\n\n1Department of Pharmacy, Hospital Keningau, Sabah, 2Department of Pharmacy, Hospital Tambunan, Sabah, 3Department \nof Pharmacy, Hospital Tenom, Sabah\n\n\n\nINTRODUCTION: Epilepsy has not been adequately addressed as a public health concern. This is often attributed by its \ncomplex disease process, social stigma plus meagre knowledge level. Knowledge is essential because patients with limited \nknowledge often exhibit increased risks of complications of seizures. Attitude, knowledge and awareness (AKA) alone were \nshown in several studies to be inadequate to deal with epilepsy. In these scenarios, coping strategies were shown to go hand \nin\thand\twith\tAKA\tprogamme\tto\tinfluence\tpatients\u2019\tquality\tof\tlife\tand\tpsychosocial\tadjustment.\nOBJECTIVES: To evaluate the effect of an education programme on AKA and coping mechanism in epilepsy.\nMETHOD: This was a prospective, pre/post experimental study conducted among adult patients with epilepsy in outpatient \npharmacy setting using convenience sampling. All participants received an education programme lasting around 30 minutes \nusing a validated counselling material and were asked to evaluate their satisfaction towards the education programme. \nParticipants\twere\trequired\tto\tcomplete\ta\tvalidated\tmodified\tMalay\tAKA\tEpilepsy\tquestionnaire\tin\t0,\t1,\t3\tand\t6\tmonths\tafter\t\nthe education programme and Malay Brief COPE-27 in 0 and 1 month after the programme.\nRESULTS:\t 22\t participants\twere\t recruited.\tTotal\tAKA\t score\t of\t participants\t showed\t a\t significant\t increase\t (Mean\t score\t\ndifference=16.3, p=0.021) at 6 months post-intervention. This was mainly contributed by knowledge (Mean score \ndifference=8.9, p=0.009) and attitude (Mean score difference=5.6, p=0.040). Religion was the most preferred coping \nmechanism (82.5%), followed by instrumental support, emotional support, active coping and acceptance (75.0% respectively). \nOnly\tthree\tdomains\tshowed\tsignificant\tdifferences\tafter\tthe\teducational\tprogramme:\t(Planning:\t62.5%\tvs\t77.5%,\tp=0.026;\t\nDenial: 57.5% vs 37.5%, p=0.004; Venting: 62.5 vs 52.5, p=0.004)\nCONCLUSION:\tThe\tepilepsy\teducation\tprogramme\twas\tbeneficial\tin\tterms\tof\timproving\tknowledge\tand\tattitude.\tThese\t\nimprovements were also shown to be able to help patients with their coping strategies.\n\n\n\nKEYWORDS: pharmacy practice, AKA, epilepsy, EPACE\n\n\n\nOP2-26 (Oral)\nAWARENESS OF ADVERSE DRUG REACTIONS (ADR) REPORTING AMONG PHYSICIANS IN PEJABAT \nKESIHATAN DAERAH TIMUR LAUT (PKTL), PENANG\n\n\n\nJasmine BLH1, Josephine TSY2, Karen OJL2, Jolene TLL1\n\n\n\n1Department of Pharmacy, Klinik Kesihatan Bandar Baru Air Itam, 2Department of Pharmacy, Klinik Kesihatan Sungai Dua\n\n\n\nINTRODUCTION: Reporting adverse drug reactions (ADR) spontaneously is considered as a cornerstone of \npharmacovigilance. However, under-reporting of ADR is a common problem in PKTL.\nOBJECTIVES: This study aimed to assess the awareness of  ADR reporting among physicians from all clinics in PKTL and \nto get an insight into the causes of under-reporting of ADR.\nMETHOD: A cross-sectional study was carried out via validated questionnaires adapted from Rakesh and Anil (2013). The \nquestionnaires\twere\tdistributed\tto\t42\tphysicians\tfrom\tJuly\tto\tSeptember\t2014.\tMicrosoft\tExcel\tworksheet\t(Microsoft\tOffice\t\n2007) was used for result analysis.\nRESULTS: All 42 physicians responded to the questionnaires. 88% of the physicians were aware that ADR should be \nreported\t by\t them\t and\t 90.48%\t feel\t that\tADR\t reporting\t and\tmonitoring\t system\twould\t benefit\t the\t patients.\t 95%\t of\t the\t\nphysicians were aware that pharmacist could be the right person to assist them in ADR reporting. However, 92.9% of \nphysicians\tfelt\tthat\tthey\twere\tinadequately\ttrained\tin\tADR\treporting.\t\u2018Busy\tschedule\t(69%)\u2019,\t\u2018difficult\tto\tpinpoint\tsuspected\t\ndrug (59.5%)\u2019, \u2018do not know the exact authority to report ADRs (33.3%)\u2019 and \u2018lack of incentives (28.6%)\u2019 were some of the \nreasons for under-reporting of ADRs.\nCONCLUSION: It was observed that physicians were aware of ADR reporting but there was an inadequacy in knowledge \nof how to report them. More awareness of ADR reporting system should be created.\n\n\n\nKEYWORDS: pharmacy practice, adverse drug reaction, pharmacovigilance, ADR reporting system\n \n\n\n\n\n\n\n\n\nMALAYSIAN JOURNAL OF PHARMACY Vol. 2. Issue 2. August 2016\n\n\n\n42\n\n\n\nOP2-27 (Oral)\nPATIENT\u2019S PERCEPTION, PRACTICE OF COMPLEMENTARY AND ALTERNATIVE MEDICINE, AND \nBELIEFS ABOUT MEDICINES FOR THE MANAGEMENT OF EPILEPSY\n\n\n\nLau BT1, Adyani MR1, Tan HJ2, Mohd MB1\n\n\n\n1Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, 2Division of Neurology, Department of Medicine, \nFaculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur\n\n\n\nINTRODUCTION: In Malaysia, the prevalence of traditional and complementary medicines ever used in the life-time of \ncommunity-dwelling residents was 69.4%. However, information regarding this therapy among epilepsy patients was scarce.\nOBJECTIVES: This study was conducted to assess patient\u2019s perception and practice of complementary and alternative \nmedicine, as well as their beliefs about medicines for the management of epilepsy.\nMETHOD: This cross-sectional study was conducted in Neurology Clinic of Universiti Kebangsaan Malaysia Medical \nCentre from February to July 2015. Convenience sampling method was used to recruit epilepsy patients into the study.\nRESULTS: A total of 61 patients completed the questionnaire distributed to them, yielding 89.7% response rate. Majority \nof the respondents were <30 years old, Malay, single, employed, had lower monthly income, and on monotherapy of anti-\nepileptic drugs. 52.5% respondents had negative general perception of complementary and alternative medicines, and \n42.6% of total respondents used the therapy. The Necessity-Concerns Differential score was 0.37+/- SD 0.768. Bivariable \nanalysis\tshowed\temployment\tstatus\tand\tgeneral\tperception\twere\tsignificantly\tassociated\twith\tthe\tuse\tof\tcomplementary\t\nand\talternative\tmedicines\t(\u03c72\t=\t5.111,\tp\t=\t0.024;\t\u03c7\u00b2\t=\t8.548,\tp\t=\t0.003\trespectively).\tThere\twas\talso\tsignificant\tassociation\t\nbetween education levels and Necessity-Concerns Differential score [t (59) = 2.425, p = 0.018]. Multiple logistic regression \nsuggested\tthat\trespondents\u2019\tgeneral\tperception\tand\temployment\tstatus\tsignificantly\tinfluenced\tthe\tuse\tof\tcomplementary\t\nand alternative medicines. Adjusted odds ratios for employed status and positive general perception were 3.792 (95% CI \n1.167-12.317) and 5.389 (95% CI 1.675-17.340), respectively.\nCONCLUSION: Majority of the epilepsy patients had negative general perception of complementary and alternative \nmedicines, were non-user of the therapy, and were convinced of the necessity of anti-epileptic drugs. The use of complementary \nand\talternative\tmedicines\twas\tinfluenced\tby\tgeneral\tperception\tand\temployment\tstatus\tof\tpatients\tin\tthis\tstudy.\n\n\n\nKEYWORDS: pharmacy practice, complementary and alternative medicine, traditional medicine, epilepsy\n\n\n\nOP2-28 (Oral)\nAN EVALUATION ON PHARMACOKINETIC DATA OF AMINOGYLCOSIDES IN A TERTIARY HOSPITAL \nOF PERAK STATE\n\n\n\nThong KS1, Chong CP2\n\n\n\n1Department of Pharmacy, Hospital Raja Permaisuri Bainun, Perak, 2School of Pharmaceutical Sciences, Universiti Sains \nMalaysia, Penang\n\n\n\nINTRODUCTION: Therapeutic drug monitoring is frequently used to individualize dosing of aminoglycosides to avoid \ntoxicity and drug resistance. However, whether the initiation of dosage recommendation based on the general population \npharmacokinetic data is optimum for various populations remained debatable.\nOBJECTIVES: This study aimed to determine the adult pharmacokinetic data for aminoglycosides in local population.\nMETHOD: A retrospective cross sectional study of aminoglycosides therapeutic drug monitoring cases for 2014 in Hospital \nRaja Permaisuri Bainun, Ipoh was conducted. Pharmacokinetic data was calculated in the Excel spreadsheet and the data \nwas analysed by using SPSS.\nRESULTS: A total of 380 cases were recruited. The Vd of aminoglycosides was 0.3761L/kg (n=380, IQR=0.22), which \nwas\tsignificant\thigher\tthan\tthe\tgeneral\tpopulation\tdata\t0.25L/kg\t(p<0.05).\tKe\tand\tCL\tof\taminoglycosides\tdid\tnot\tshow\tany\t\nsignificant\tdifference\tfrom\tthe\tgeneral\tpopulation.\t15.5\t%\tof\ttotal\t380\tcases\twere\twithin\trange\tof\tmaximum\tand\tminimum\t\nconcentration of aminoglycosides, but 74.5% of total 380 cases were subtherapeutic at the maximum concentration of \naminoglycosides. Larger Vd was needed to predict a larger dose of aminoglycosides to achieve therapeutic level. Chinese \nhad highest Vd (Vd=0.4081L/kg, IQR=0.23) (p<0.05) among the other ethnicity. Male had higher Vd (Vd=0.4018 L/kg, \nIQR=0.23) and CL (CL=0.10 L/kg/hr, IQR=0.06) compared to female (p<0.05). In hematological malignancy patients, CL \n(CL=0.11L/kg/hr, IQR=0.07) was higher compared to the non-hematological malignancy patients (p<0.05) but there was \nno difference in the Vd. There was no difference in the Vd of aminoglycosides in different age groups. However, the CL of \naminoglycosides was lower in the age group above 41 years old.\nCONCLUSION: There were differences between pharmacokinetic data for aminoglycosides in this study population and \nthat\tof\tgeneral\tpopulation.\tThese\tfindings\tare\thelpful\tin\tdeterming\taminoglycosides\tinitial\tdosing\tand\tavoid\tinappropriate\t\nantibiotic dosing and drug resistance.\n\n\n\nKEYWORDS: clinical pharmacy, aminoglycosides, pharmacokinetic data, therapeutic drug monitoring\n \n\n\n\n\n\n\n\n\n43\n\n\n\nMALAYSIAN JOURNAL OF PHARMACY Vol. 2. Issue 2. August 2016\n\n\n\nOP2-29 (Oral)\nFORMULATION OF STERILE COLLOIDAL PLASMA EXPANDER USING EXTRACTED GELATINE FROM \nSHANK AND TOES OF THE COMMON FARM CHICKEN - GALLUS GALLUS DOMESTICUS\n\n\n\nAbdullah MSP1,6*, Noordin MI1, Ismail SIM2, Mustapha NM3, Jasamai M4, Shamsuddin AF5\n\n\n\n1Department of Pharmacy, Faculty of Medicine, University of Malaya, Malaysia, 2Ain Medicare Sdn. Bhd, Kawasan Perindustrian \nPengkalan Chepa 2, Kota Bharu Kelantan, Malaysia, 3Department of Pharmacy, Raja Perempuan Zainab II Hospital, Kota Bharu, \nKelantan, Malaysia, 4Drug and Herbal Research Centre, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda \nAbdul Aziz, Kuala Lumpur, Malaysia, 5Centre for Drug Delivery Research, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, \nKuala Lumpur, Malaysia, 6Pharmacy Enforcement Branch, State Pharmaceutical Services Division, Kota Bharu, Malaysia\n\n\n\nINTRODUCTION: Gelatine being a biopolymer has various applications in the pharmaceutical industry as a stabilizer, \ngelling agent, suspending agent, binding agent, viscosity-increasing agent and in vaginal drug delivery. Recent controversial \nadvances regarding intravenous colloidal plasma expander, has shown that gelatin type plasma expander has better advantage \ndue to its low molecular weight, cost effectiveness and comparatively wider safety (GRAS) compared to other similar \ncategories of colloidal group such as hexaethylstarch (HES), albumin or fresh frozen plasma. The only disadvantage is when \ngiven in large amount, it interferes with the coagulation mechanism of blood whereas crystalloids would cause edema.\nOBJECTIVES: The aim of this study was to evaluate and characterise shank and toes of Gallus gallus domesticus as an \nalternative gelatine source in the formulation of intravenous colloidal plasma expander.\nMETHOD: CST gelatin was made from halal CST by extraction method and was used in the formulation of colloidal CST \ngelatine plasma expander. The physical characterisations were conducted such as inspection of the appearance of the solution, \ngelatine determination, pH determination, osmolarity determination, sodium ion determination and chloride ion determination.\nRESULTS: Ten formulations of CST plasma expanders were developed based on the commercially available bovine-based \n(BS) colloidal formulations out of which 5 formulations showed similar physical appearance to the market product. The other \nformulations showed cloudy white to yellow appearance which might be due to the high presence of glycine and glutamine.\nCONCLUSION: CST gelatine obtained for plasma expander formulations complies with the standard pharmacopoeia \nrequirements. These formulations have characteristics and properties which are similar to BS gelatin and commercially \navailable\tcolloidal\tplasma\texpanders.\tThis\t is\tbeneficial\t for\t the\tpoultry\t industry\twhereby\tunconsumed\tby-products\t such\t\nas CST can be processed into valuable commercial gelatine thus maximising the utilisation of waste products. The CST \ngelatine can also be used in pharmaceutical applications and cosmetics.\n\n\n\nKEYWORDS: pharmacy research, gelatine, plasma expander, colloidal, biomaterial\n\n\n\nOP2-30 (Oral)\nA STUDY ON AWARENESS AND PERCEIVED BARRIERS TO SELF-MONITORING OF BLOOD GLUCOSE \nAMONG DIABETIC PATIENTS IN BUKIT MERTAJAM HOSPITAL\n\n\n\nChoong YC1, Nadarajah K1, Ong SY2, Baizura S2, Asyiqeen SN2, Tan EV3\n\n\n\n1Department of Pharmacy, Hospital Bukit Mertajam, Pulau Pinang, 2Department of Pharmacy, Hospital Seberang Jaya, \nPulau Pinang, 3Department of Pharmacy, Hospital Pulau Pinang\n\n\n\nINTRODUCTION: Self-monitoring of blood glucose (SMBG) and glycosylated haemoglobin (HbA1c) is important for \ndiabetic patients to manage their blood glucose. This is important as a well-controlled glycaemic level will decrease the \nrisks of long-term complications. SMBG is found to be crucial to patients as it provides real-time information on patients\u2019 \nglucose level while HbA1c does not, consequently giving immediate feedback on the patients\u2019 glucose level and thus allows \nthe patients to self-adjust their daily diet, physical activities and medications.\nOBJECTIVES: The objective of this study was to evaluate the awareness and perceived barriers to SMBG among diabetic \npatients in Hospital Bukit Mertajam, Pulau Pinang.\nMETHOD: Face-to-face interview was conducted with structured bi-lingual (Bahasa Malaysia and English) questionnaire \namong diabetes patients admitted to medical wards in Hospital Bukit Mertajam, Pulau Pinang from the period of August \nto October 2012. Respondents aged more than 18 years old treated with insulin alone or in combination with Oral \nHypoglycaemic Agents (OHA) were included. Descriptive statistics were used to analyse the data.\nRESULTS: A total of 48 eligible patients were interviewed. 40 (83.3%) of them were aware of SMBG and 38 (83.3%) of \nthem thought that SMBG was useful in diabetes management. From the 40 patients who were aware of SMBG, only 24 \npatients (60%) practised it and 16 patients (40%) did SMBG at least once a week. However, only 37.5% recorded their \nSMBG\tresults\tin\ta\tbook\tto\tbe\treviewed\tby\thealthcare\tprofessionals.\tPerceived\tbarriers\tidentified\tto\tSMBG\twere\t\u2018fear\tof\t\nneedle prick\u2019, \u2018inconvenience\u2019, \u2018cost of the strips\u2019 and \u2018patients felt unnecessary.\u2019\nCONCLUSION: In conclusion, the majority of patients were aware of SMBG, but various perceived barriers prevent them \nfrom adopting the practice of SMBG.\n\n\n\nKEYWORDS: pharmacy practice, Pulau Pinang, self-monitoring blood glucose, oral hypoglycaemic agents (OHA), diabetes\n\n\n\n\n\n\n\n\nMALAYSIAN JOURNAL OF PHARMACY Vol. 2. Issue 2. August 2016\n\n\n\n44\n\n\n\nOP2-31 (Oral)\nAUDIT ON ANTIBIOTIC PRESCRIBING FOR UPPER RESPIRATORY TRACT INFECTION IN PRIMARY \nHEALTHCARE FACILITIES IN KEDAH\n\n\n\nTeoh CY1, Aizamin A2, Habshoh H2, Mahani K3, Alyani MM1\n\n\n\n1Pejabat Kesihatan Daerah Kota Star, Kedah, 2Pejabat Kesihatan Daerah Kuala Muda, Kedah, 3Pejabat Kesihatan Daerah \nSik, Kedah\n\n\n\nINTRODUCTION: Indiscrimate use of antibiotics is one of the major factors leading to antimicrobial resistance which has \nposed a threat to public health worldwide. Hence, clinical audits are necessary to assess the extent of judicious antibiotic use, \nespecially in primary healthcare settings.\nOBJECTIVES: This research aimed to assess the appropriateness of antibiotic prescribing for URTI (based on clinical \nindications) in health clinics with resident Family Medicine Specialists in Kedah. The audit also evaluated the choices of \nantibiotics prescribed and their regime, as compared to a specially-designed reference which combined recommendations \nfrom local antibiotic guideline and expert reviews.\nMETHOD:\tAll\tprescriptions\twith\ta\tdiagnosis\tof\tURTI\t(specifically\tacute\tpharyngitis,\tacute\trhinosinusitis,\tand\tacute\totitis\t\nmedia) were screened retrospectively from 23rd until 27th August 2015. Case notes for each prescription were then retrieved \nand\treviewed\tby\tMedical\tOfficers\tfor\tthe\tclinical\tindications\tand\tthe\tnecessity\tof\tprescribing\tantibiotics,\twhile\tpharmacist\t\nreviewed the antibiotic regime for those who were prescribed antibiotics.\nRESULTS: 2,749 cases were being studied from 24 participating Health Clinics in Kedah. Out of the total, 944 cases \nwere prescribed antibiotics, while among them 591 cases were indicated for antibiotics. Out of the 591 cases, only 302 \ncases adhered to the antibiotic regime recommended by local antibiotic guideline. Another 1,735 prescriptions were not \nindicated for antibiotics and had no antibiotics prescribed as well. Amoxicillin were found to be the most common antibiotic \nprescribed for acute pharyngitis/tonsillitis and acute otitis media, while Erythromycin stood as the common choice in acute \nrhinosinusitis. Overall, 2,039 prescriptions (74.17%) adhered to the treatment guideline for URTI.\nCONCLUSION: This study suggested that more aggressive approach to increase the awareness to curb antimicrobial \nresistance via judicious use of antibiotics should be in place. Prompt information dissemination about the updates of local \nantibiotic guideline is essential as most of the prescribers are not aware of the exclusion of Erythromycin from the choice \nof antibiotics for URTI cases.\n\n\n\nKEYWORDS: clinical pharmacy, Kedah, antibiotics, audit, upper respiratory tract infection\n\n\n\nOP2-32 (Oral)\nANTIBIOTIC PRESCRIBING BY PRIMARY CARE PHYSICIAN FOR PAEDIATRICS WITH ACUTE \nRESPIRATORY INFECTION\n\n\n\nTea MH, Tang WL, Azhan F\nDepartment of Pharmacy, Hospital Sultanah Nora Ismail, Batu Pahat, Johor \n\n\n\nINTRODUCTION: Acute Respiratory infections (ARI) are common infection diseases in childhood. Despite predominantly \nviral in origin and self-limiting, antibiotics were frequently prescribed to treat the infections. This may contribute to the \nemergence and spread of antibiotic-resistant bacteria in communities.\nOBJECTIVES: To study the antibiotics prescribed in primary care settings for paediatric patients with ARI.\nMETHOD: A cross-sectional study was conducted for a duration of 2 months involving 131 patients who visited general practitioners \n(GPs) for ARI prior to hospital admission. Information regarding GP visit was collected from patients. The GPs were further \ncontacted through telephone. Information on the diagnosis and drugs prescribed to patient were collected. The appropriateness of \nthe drugs prescribed were further evaluated by a pharmacist and a paediatrician based on the choice, dose, duration and frequency.\nRESULTS: Of 131 patients, 96 patients were prescribed at least one antibiotic. The overall prescribing was 73.3% (95% \nCI;\t 65.9-80.7).\tHowever\t 39\tpatients\twas\t excluded\t for\t further\t evaluation\tdue\t to\t insufficient\t information\t from\t the\tGPs.\t\nOnly 57 patients with complete information on antibiotic were tabulated and analysed. Majority of the patients (40.3%) \nwere\tdiagnosed\twith\tpharyngotonsillitis,\t35.1%\twith\tpneumonia,\t15.8%\twith\tunspecified\tARI\tand\t8.8%\twith\tbronchiolitis.\t\nThe most commonly prescribed antibiotics were Cephalexin (31.1%), Amoxycilin/Clavulanate (18%), Amoxycilin \n(13.1%), Azithromycin (11.5%), and Cefaclor 11.5%. More than three quarters (80.3%) of the antibiotics were found to \nbe inappropriate due to inappropriate dose (52.6%), inappropriate duration (49.1%), inappropriate frequency (22.8%) or \ninappropriate choice (10.5%).\nCONCLUSION: There is a widespread use of broad spectrum antibiotics in pediatric patients with ARI in primary care \nsettings. The frequency of inappropriate antibiotic prescribing is alarmingly high. There should be more continuous education \nfor the prescribers and the public in the future to raise the awareness of the disease and the treatment of ARI.\n\n\n\nKEYWORDS: clinical pharmacy, respiratory tract infection, antibiotics, pneumonia, acute respiratory infection\n\n\n\n\n\n\n\n\n45\n\n\n\nMALAYSIAN JOURNAL OF PHARMACY Vol. 2. Issue 2. August 2016\n\n\n\nOP2-33 (Oral)\nIMPACT OF PHARMACISTS\u2019 INVOLVEMENT IN HOME MEDICATION REVIEW AMONG STROKE PATIENTS\n\n\n\nLow HX, Wan Nurul Najihah WAW, Tee W, Nor Azeida MS, Norsima Nazifah S\nDepartment of Pharmacy, Hospital Sultanah Nur Zahirah, Kuala Terengganu, Terengganu\n\n\n\nINTRODUCTION: Home medication review (HMR) is a continuity of patient care from ward and MTAC to patients\u2019 \nhome. HMR helps to promote optimal and quality use of medication at patients\u2019 home. It is very important to help improve \npatients \u2018and caregiver\u2019 knowledge and understanding about medicines.\nOBJECTIVES: The objectives were to determine the effectiveness of pharmacists\u2019 intervention on patients\u2019 blood pressure \nand glucose level pre- and post-HMR and also to determine the effectiveness of HMR by reviewing compliance pre- and \npost-HMR\nMETHOD: This pre-post study was conducted from January to June 2015 which involved post stroke patients who \nunderwent HMR services in HSNZ. Patients were referred by Home Care Staff Nurses or physicians. Only those who \nunderwent at least 2 sessions of HMR were chosen for this study as the effects of pharmacists\u2019 intervention needed to \nbe observed and recorded. Patients\u2019 blood pressure and glucose reading pre and post-HMR were recorded together with \npharmacists\u2019\tintervention.\tModified\tMorisky\tAdherence\tScale\t(MMMAS)\twas\tused\tto\tassess\tpatients\u2019\tcompliance.\tData\t\nwas\tanalysed\tby\tusing\tSPSS\tv.\t21\twith\tp<0.05\tconsidered\tas\tstatistical\tsignificant\nRESULTS: A total of 50 patients with mean age 63.4 \u00b1 11.9 years old were included in this study. 86.0% of patient had \nhypertension\tas\trisk\tfactor\tand\t56.0%\tof\tthem\thad\tdiabetes\tmellitus.\tThere\twas\ta\tsignificant\treduction\tof\tSBP\tduring\tHMR\t\nfrom 149.5 mmHg to 144.6 mmHg (p = 0.007). A reduction was also seen in mean blood glucose from 9.01mmol/L to \n8.59mmol/L\t(p=0.031).\tMMMAS\tin\tpatients\twas\talso\tfound\tto\tbe\timproved\tsignificantly\t(p=0.011)\nCONCLUSION: Pharmacists\u2019 involvement and intervention during HMR visits helps in the reduction of blood pressure in \npatients treated with antihypertensive agents and also helps in reducing blood glucose level. Medication compliance is also \nimproved with the involvement of pharmacists.\n\n\n\nKEYWORDS: pharmacy practice, home care, home medication review, stroke\n\n\n\nOP2-34 (Oral)\nPATIENT SATISFACTION TOWARDS PHARMACY SERVICES IN GOVERNMENT HEALTH CLINICS IN \nKLANG VALLEY\n\n\n\nGan YN1, Aniza I2, Norfazilah A2\n\n\n\n1Department of Pharmacy, Hospital Putrajaya, Kuala Lumpur, 2Department of Community Health, Universiti Kebangsaan \nMalaysia Medical Centre (UKMMC), Kuala Lumpur\n\n\n\nINTRODUCTION: With the expansion of pharmacy services in public healthcare, continual evaluation of patient \nsatisfaction must be carried out as it is an important indicator of service quality. There is currently no published research on \nthis matter in Malaysia.\nOBJECTIVES:\tTo\tdetermine\t the\t level\tof\tpatient\t satisfaction\t towards\tpharmacy\t services\t and\t its\t influencing\t factors\t in\t\ngovernment health clinics in Klang Valley, Malaysia.\nMETHOD: A cross-sectional study was conducted among 400 patients visiting the pharmacy in 3 randomly selected \ngovernment health clinics who were recruited using systematic random sampling. Data was collected using a validated self-\nadministered questionnaire in Bahasa Melayu of which patient satisfaction was assessed in 3 dimensions (administrative \ncompetency, technical competency and convenient location). Descriptive statistics, simple linear regression and multiple \nlinear regression were used for data analysis.\nRESULTS: The response rate was 83.3% (400/480). Total mean score for patient satisfaction was found to be 7.56 (1.32) \n(range\t=\t1\t to\t10).\t5\tfactors\twere\tfound\tto\thave\tsignificant\tassociation\twith\tpatient\tsatisfaction:\tage,\t level\tof\teducation,\t\nfrequency of visit to pharmacy, self-perceived health status, and patients\u2019 general knowledge of pharmacists. Older patients \nand those with higher education were found to have lower mean score for patient satisfaction. Patients who visited the \npharmacy more than once in the past 3 months; those who perceived themselves in better health status; and those who had \nmore correct general knowledge of pharmacists expressed higher mean score for patient satisfaction.\nCONCLUSION:\tThis\tstudy\tprovides\tan\t insight\t into\t the\tprofile\tof\tpatients\tvisiting\t the\tpharmacy\t in\tgovernment\thealth\t\nclinics and these patients expressed relatively high level of patient satisfaction towards pharmacy services. Efforts should \nbe focused on improving public\u2019s understanding of pharmacists\u2019 expertise and services provided in order to maximise \nprofessional capacity of pharmacists and increase public\u2019s recognition for pharmacy services.\n\n\n\nKEYWORDS: pharmacy practice, patient satisfaction, pharmacy services, government health clinics\n \n\n\n\n\n\n\n\n\nMALAYSIAN JOURNAL OF PHARMACY Vol. 2. Issue 2. August 2016\n\n\n\n46\n\n\n\nOP2-35 (Oral)\nCLINICAL AND COST OUTCOME AFTER TWO YEARS IMPLEMENTATION OF ANTIMICROBIAL \nSTEWARDSHIP PROGRAMME AT MAJOR SPECIALIST HOSPITAL IN MALAYSIA (CCOAS)\n\n\n\nNorirmawath S, Doris GV, Ng WY, Thong KS\nDepartment of Pharmacy, Raja Permaisuri Bainun Hospital, Ipoh, Perak \n\n\n\nINTRODUCTION: Antimicrobial stewardship programme (ASP) in Malaysia has been implemented in most major \nspecialist hospital in all states with the development of the ASP Protocol.\nOBJECTIVES: To demonstrate the recommendations done, cost saving impacts and acceptance of the intervention done \nby the ASP team.\nMETHOD: This study was conducted in a major specialist hospital by a retrospective review of ASP Documentation \nSheet from 2014 until 2015. The ASP team comprised infectious disease (ID) physicians, pharmacists and microbiologists. \nMedication charts sent to pharmacy were reviewed weekly by ASP pharmacists. Cases reviewed were those on controlled \nantibiotics, inappropriate dosage regimen, and inappropriate combination of antibiotics and prolonged duration of antibiotics. \nA recommendation acceptance rate was estimated retrospectively using an in-depth chart audit of recommendation based \non ASP documentations as well as pharmacy records and doctors\u2019 notes. Patient outcome after 30 days and cost saving \nfollowing recommendations were also recorded in the APS Documentation Sheet.\nRESULTS: A total of 226 cases were referred to ASP team. 182 (80.5%) of ASP recommendations were accepted. A total \nof 248 recommendations were made, of which discontinuation of antibiotic was the most common recommendation (n=96, \n38.7%), followed by change of antibiotic based on culture (n=65, 26.2%) and change of antibiotic based on guideline \n(n=45, 18.1%). Average cost saving per patient in the recommendation acceptance group was RM133.83. Average extra cost \nincurred per patient due to non-recommendation acceptance was RM106.74. \nCONCLUSION: Acceptance to the ASP recommendations is high and overall, results in cost saving.\n\n\n\nKEYWORDS: clinical pharmacy, antibiotic, antimicrobial stewardship programme\n\n\n\nOP2-36 (Oral)\nVALIDATION OF QUESTIONNAIRE TO STUDY PUBLIC KNOWLEDGE AND PERCEPTIONS TOWARDS \nCHILDHOOD VACCINATION\n\n\n\nIsmorning MI, Razak NA, Zainoddin S1, Md Radzi SS\nDepartment of Pharmacy, Hospital Tuanku Fauziah, Perlis\n\n\n\nINTRODUCTION: Ministry of Health Malaysia had reported a relatively high percentage in childhood immunisation \ncoverage\t in\t 2012.\tHowever,\t poor\t knowledge\t of\t vaccinations\tmight\t cause\t caregivers\t to\t be\t easily\t influenced\t by\t others,\t\nresulting in negative perceptions towards vaccinations. \nOBJECTIVES: This study was done to develop and validate a questionnaire to assess knowledge and perceptions towards \nchildhood vaccination among the public.\nMETHOD: Fourty-seven questions were constructed based on literature review and Malaysian Clinical Practice Guideline \nfor Childhood Immunisation. The questionnaire consisted of 4 parts; A) Demography, B) Knowledge, C) Perceptions, \nand D) Knowledge Seeking Behaviour. The Knowledge and Perceptions sections were in the form of Likert scale. The \nquestionnaire\twas\trevised\tafter\tthe\tcontent\twas\treviewed\tby\tseven\texperts\tin\trelated\tfields.\tA\tgroup\tof\trandomly\tselected\t\nsubjects reviewed the questionnaire to ensure that the questions were comprehensible by the general public, changes were \nmade and the improved questionnaire was re-distributed to the same group. The questionnaire was then distributed to 190 \nrespondents which consisted of the general public and staffs of Hospital Tuanku Fauziah, to test its construct validity and \nreliability. Using statistical tests, a few questions were omitted.\nRESULTS: Construct validity was tested for Knowledge (17 questions) and Perceptions (17 questions) using factor analysis. \nThen, questions with communalities value < 0.5 were deleted from both sections, three and four respectively. Keiser-Meyer-\nOlkin test and Bartlett\u2019s test results for knowledge were 0.771 and <0.001 respectively, and for Perception were 0.752 and \n<0.001 respectively. Reliability of the questionnaire was assessed using Cronbach\u2019s Alpha and it was found to be 0.760 and \n0.715, for Knowledge and Perceptions respectively.\nCONCLUSION: The questions for Knowledge and Perceptions were validated for content validity, face validity and \nconstruct validity. Whereas, questions for Knowledge Seeking Behaviour were validated using content validity only as they \nare open ended questions.\n\n\n\nKEYWORDS: pharmacy practice, vaccination, paediatric, validation, perception\n \n\n\n\n\n\n\n\n\n47\n\n\n\nMALAYSIAN JOURNAL OF PHARMACY Vol. 2. Issue 2. August 2016\n\n\n\nOP2-37 (Oral)\nAN AUDIT OF SURGICAL ANTIBIOTIC PROPHYLAXIS IN TAIPING HOSPITAL\n\n\n\nNg CB, Azni AA, Lim KE, Beh XY, Madhuri S, Nor Eleen NH\nDepartment of Pharmacy, Hospital Taiping, Perak\n\n\n\nINTRODUCTION:\t Inappropriate\t use\t of\t antibiotics\t in\t surgical\t prophylaxis\t might\t reduce\t treatment\t efficacy,\t increase\t\nhealthcare cost and result in antibiotic resistance. From the national antibiotic usage among Malaysian government hospitals \nin 2014, Hospital Taiping was one of heavy users of cefoperazone. From our observation, this antibiotic was commonly used \nin surgical antibiotic prophylaxis.\nOBJECTIVES: This study was conducted to evaluate the use of antibiotics in current surgical antibiotic prophylaxis \npractice in Hospital Taiping in terms of choice, timing and duration of prophylactic antibiotic.\nMETHOD: An observational audit on all patients undergoing surgery from all disciplines except dental and ophthalmology \nwas conducted in March 2015 over a 4-week (every Monday-Friday) duration. Patients undergoing dirty and contaminated \nprocedures, with positive culture or having active infection at time of operation were excluded. All relevant data on surgical \nantibiotic prophylaxis was collected from patients\u2019 case notes, anaesthetic notes and medication charts in the wards. The \ndata was analysed descriptively.\nRESULTS: 197 cases with clean and clean-contaminated surgery were reviewed. 60% (n=118) of cases were given \nprophylactic antibiotics; with most having received single prophylactic agent (77%, n=91). From 145 antibiotics prescribed, \ncefoperazone was the most frequently used pre-operative antibiotic, involving 77 (53.1%) cases 82% (n=119) of prophylactic \nantibiotics were administered within an hour prior to incision. 87 cases continued antibiotic post-operatively whereas 22 \ncases had no antibiotic prophylaxis but antibiotics were only started post operation. Out of the 87 patients administered with \nantibiotics post-operatively, 43 (49%) of the patients were given prophylactic antibiotics more than 24 hours post operation. \nThe reasons of antibiotic continuation were usually not stated in the doctors\u2019 notes.\nCONCLUSION: This audit revealed a shortcoming in the choice of antimicrobial agent, timing of administration and \ntotal duration of surgical antibiotic prophylaxis in Hospital Taiping. This necessitates further improvement in terms of \ndocumentation for continuation, and protocols underlining antibiotic administration.\n\n\n\nKEYWORDS: clinical pharmacy, antibiotic, surgical prophylaxis, cefoperazone\n\n\n\nOP2-38 (Oral)\nRETROSPECTIVE REVIEW ON GLYCAEMIC CONTROL AFTER SWITCHING FROM ORIGINAL \nGLICLAZIDE MODIFIED-RELEASE (MR) TO GENERIC GLICLAZIDE MODIFIED-RELEASE (MR) 30MG\n\n\n\nLim YL1, Lim PC1, Chan YM2, Tan YX2, Nor NM3, Wahab FA4, Kamarudin NF5\n\n\n\n1Department of Pharmacy, Hospital Pulau Pinang, Pulau Pinang, 2Pharmacy\tEnforcement\tUnit,\tPenang\tBranch\tOffice,\tPulau\t\nPinang, 3Department of Pharmacy, Bandar Tun Razak Health Clinic, Pahang, 4Department of Pharmacy, Air Hitam Health \nClinic, Kedah, 5Department of Pharmacy, Jeli Health Clinic, Kelantan\n\n\n\nINTRODUCTION:\tGeneric\tdrugs\tare\tassumed\tto\thave\tsimilar\tefficacy\tas\toriginal\tdrugs\tthrough\tbioequivalent\tstudies.\tIn\t\npublic health institutions, a change from original to generic drug is common especially after patency ends for its lower cost. \nHowever\thealthcare\tprofessionals\tand\tpatients\tstill\tquery\tthe\tefficacy\tof\tgeneric\tdrugs.\nOBJECTIVES: The aim of this study was to evaluate the glycaemic control, dose and cost when switching from original \nto generic Gliclazide MR.\nMETHOD: A retrospective study was conducted in Hospital Pulau Pinang by retrieving patient records of those on \nGliclazide MR from Endocrine Unit. From February 2012 onwards the supply of Gliclazide MR was switched to generic. \nHence data from December 2011 to August 2012 were reviewed. Data of patients taking Gliclazide MR at baseline before \nthe switch, and at 3 months and 6 months after the switch were included.\nRESULTS: A total of 63 patient data with a mean age of 57 were reviewed. Glycaemic control of patients on Gliclazide \nMR deteriorated after switching to generic with HbA1c increasing over time. [Baseline HbA1c: 7.1 (IQR6.6-8.4); post 3 \nmonths\tHbA1c:\t7.35\t(IQR\t6.6-8.0);\tpost\t6\tmonths\tHbA1c:\t7.2\t(IQR\t6.7-8.6)].\tA\tsignificantly\thigher\tdose\tincrement\tof\t7.8%\t\nof generic Gliclazide MR was noted at post 6 months in comparison to baseline (p=0.033). However, the cost of generic \nGliclazide\tMR\twas\tfound\tto\tbe\tsignificantly\tlower\tafter\tbrand\tswitching\t(p<0.01)\twith\t48%\tcost\treduction.\nCONCLUSION: Despite\t a\t significantly\t higher\t dose\t of\t generic\t Gliclazide\tMR,\t the\t HbA1c\t continued\t to\t significantly\t\nincrease\twith\ttime\t(p=0.029).\tEfficacy\tprofile\tof\tgeneric\tmedicines\tshould\tbe\treviewed\tto\tensure\tequal\tglycaemic\tcontrol\t\neven though it may be available at a lower cost.\n\n\n\nKEYWORDS: clinical pharmacy, Pulau Pinang, gliclazide, diabetes mellitus, generic medicine\n \n\n\n\n\n\n\n\n\nMALAYSIAN JOURNAL OF PHARMACY Vol. 2. Issue 2. August 2016\n\n\n\n48\n\n\n\nOP2-39 (Oral)\nKNOWLEDGE, ATTITUDE AND PERCEPTIONS REGARDING ISLAMIC MEDICINE AMONG MUSLIM \nPATIENTS WITH CHRONIC DISEASE\n\n\n\nFairul EF, Norfauziah H, Noor Syuhada S, Zulaikha BH\nDepartment of Pharmacy, Hospital Teluk Intan, Perak\n\n\n\nINTRODUCTION: Practice of Islamic medicine is not widely acknowledged in Malaysia even by Muslim patients compared \nto other complementary and alternatives medicines and there are also no statistical data on Islamic medicine in Malaysia.\nOBJECTIVES: This study was conducted to evaluate the knowledge, attitude and perceptions of Islamic medicine among \nMuslim patients for the treatment of chronic diseases.\nMETHOD: A cross sectional study was conducted among patients with chronic diseases aged 20 to 60 years old in outpatient \npharmacy at Hospital Teluk Intan using a validated, self-administered questionnaire. A systematic random sampling was \nused in the selection of sample. Spearman correlation was used to analyse the relationship between knowledge-attitude, \nknowledge-perceptions and attitude-perceptions of respondents.\nRESULTS: From 334 questionnaires distributed, only 318 were returned; 51.6% were male and 48.4% were female. Mean \nknowledge score was 7.42\u00b11.50 (out of 9); mean attitude and perception scores were 27.06\u00b13.79 (out of 35) and 32.26\u00b14.41 \n(out of 40) respectively. Mean for overall knowledge, attitude and perception (KAP) was 66.75\u00b18.02 out of maximum \npossible\tscore\tof\t84.\tPositive\tsignificant\tcorrelation\twas\treported\tbetween\tknowledge\tand\tattitude\t(r=0.223,\tp<0.001)\tand\t\nbetween knowledge and perception (r=0.128, p=0.022). There was a positive and strong correlation between attitude and \nperception (r=0.62) and p<0.001. Majority of respondents (66.8%) chose lack of exposure to Islamic medicine as the main \nbarrier for them to get the treatment.\nCONCLUSION: In conclusion, majority of the respondents possess good knowledge, have positive attitude and positive \nperception towards Islamic medicine. More programmes should be developed in the future to enhance exposure of Islamic \nmedicine to the public.\n\n\n\nKEYWORDS: pharmacy practice, knowledge, attitude, perception, Islamic medicine\n\n\n\nOP2-40 (Oral)\nTUBERCULOSIS INCIDENCE AFTER COMPLETION OF ISONIAZID PROPHYLAXIS THERAPY IN \nRETROVIRAL DISEASE PATIENTS\n\n\n\nChe Pa MF1, Aminurrahman UH1, Cheah HM1, Koh KC2\n\n\n\n1Department of Pharmacy, Hospital Tuanku Ja\u2019afar, Seremban, Negeri Sembilan, 2Department of Internal Medicine, \nInternational Medical University (IMU)\n\n\n\nINTRODUCTION: Isoniazid prophylaxis therapy (IPT) is a proven intervention to prevent tuberculosis (TB) among \nretroviral disease (RVD) patients. The implementation of IPT is recommended by the Ministry of Health Malaysia since \n2012. However, there are few data in local setting regarding this implementation and its effectiveness.\nOBJECTIVES: To measure the level of uptake of IPT and TB incidence after the completion of IPT.\nMETHOD: A retrospective observational study was conducted in Infectious Disease Clinic, Hospital Tuanku Ja\u2019afar, \nSeremban, Negeri Sembilan. All 289 patients were screened through medical documents throughout November 2011 until \nMay 2015. 123 patients who received oral isoniazid 5mg/kg daily as isoniazid prophylaxis therapy (IPT) were selected. TB \nincidence was calculated in person-years using Cox regression analysis.\nRESULTS: A total of 123 (42.6%) patients received IPT out of 289 RVD patients between November 2011 and May 2015. \n78% completed 6-month IPT. The overall TB incidence was 2.2 per 100 person-years (95%CI, 2.05 to 2.35). Patients who \ninitiated IPT before antiretroviral therapy had TB incidence of 14 per 100 person-years while those who initiated IPT after \nantiretroviral therapy was 1.6 per 100 person-years (p=0.0251).\nCONCLUSION:\tIPT\tmay\tbe\tbeneficial\tamong\tRVD\tpatients\tin\tpreventing\tincidence\tof\tTB\tespecially\tafter\tantiretroviral\t\ntherapy has been started.\n\n\n\nKEYWORDS: clinical pharmacy, Negeri Sembilan, tuberculosis, isoniazid, retroviral disease\n \n\n\n\n\n\n\n\n\n49\n\n\n\nMALAYSIAN JOURNAL OF PHARMACY Vol. 2. Issue 2. August 2016\n\n\n\nOP2-41 (Oral)\nADVERSE DRUG REACTIONS OF ANTI-TUBERCULOSIS DRUGS AMONG TUBERCULOSIS PATIENTS \nTREATED IN SG. BULOH HOSPITAL\n\n\n\nNisbar N1, Abd. Aziz N2, Koh HM3\n\n\n\n1Department of Pharmacy, Hospital Putrajaya, Putrajaya, 2 Faculty of Pharmacy, Universiti Teknologi MARA (UiTM), \nCampus Puncak Alam, Selangor, 3Department of Pharmacy, Hospital Sg. Buloh, Selangor\n\n\n\nINTRODUCTION: The data obtained from this study will help to uncover the statistical characteristics of Malaysian \npatients treated for Tuberculosis. It will also estimate the burden in dealing with ADRs of anti-TB drugs in Hospital Sg. \nBuloh and identify the risk factors or other variables that leads to ADRs of anti-TB drugs.\nOBJECTIVES: To analyse and assess ADRs induced by anti-TB drugs, systems involvement, causality and severity. To \nidentify the risk factors and predictors associated with ADRs induced by anti-TB drugs in the study population. To observe \nthe management of the ADRs in the study population.\nMETHOD: A retrospective observational record review study was conducted among 160 patients who were in-patients and/\nor out-patients clinically diagnosed with TB on the follow-up at Infectious Disease Unit in Hospital Sg. Buloh and received \nanti- tuberculosis regimen according to the protocol of TB treatment. Descriptive statistics, simple and multiple logistic \nregression were used for analysis.\nRESULTS: One third of the patients experienced ADR and half of the subjects experienced ADRs within short period of \ntime\t(within\tthe\tfirst\t14\tdays).\tHalf\tof\tthe\tsubjects\thad\t\u201cpossible\u201d\tcausal\treactions\twhereas\ttwo\tthirds\tof\tthose\tsuffering\tfrom\t\nan\tADR\texperienced\ta\tsevere\treaction.\tSeven\tfactors\twere\tidentified\tas\tpossible\tpredictors\tincluding\tage\tbetween\t41\tto\t50\t\nyears (p =0. 041), age between 51 to 60 years (p=0.101), female gender (p=0.234), Malay ethnicity (p =.242), drug allergy \n(p=0.225), pulmonary-TB (p =0.160), intensive phase regime with HREZ (p=0.027) and maintenance phase regime with \nHR\t(p\t=0.020).\tFinal\tanalysis\twith\tmultiple\tlogistic\tregression\thowever\tshowed\tthat\tfactors\tincluded\twere\tnot\tsignificantly\t\nassociated with ADRs\nCONCLUSION: The\tfindings\twould\tfacilitate\tphysicians\tto\tscreen\tand\tmake\tprompt\tdetection\tof\tthese\tADRs,\tprovide\t\nearly management and counselling which will improve the outcomes of TB treatment.\n\n\n\nKEYWORDS: clinical pharmacy, adverse drug reactions, anti-tuberculosis drugs, tuberculosis, anti-retroviral\n\n\n\nOP2-42 (Oral)\nPUBLIC PERCEPTION TOWARDS THE ROLE OF PHARMACISTS: A CROSS-SECTIONAL PILOT STUDY \nIN THE STATE OF SABAH, MALAYSIA\n\n\n\nCheah MF1, Tan YP1, Aishah MS2\n\n\n\n1Department of Pharmacy, Hospital Tawau, Sabah, 2Department of Pharmacy, Hospital Mesra Bukit Padang, Sabah\n\n\n\nINTRODUCTION: Pharmacists play an important role in healthcare delivery. Over the years, their role has shifted from \nproduct-oriented to patient-oriented. However, studies conducted in Malaysia to evaluate public perception towards the roles \nof pharmacists are still scarce.\nOBJECTIVES: This study aimed to assess the perceptions of the public towards the role of pharmacists in the state of \nSabah, Malaysia.\nMETHOD: This was a questionnaire-based cross-sectional study conducted from September 2014 to June 2015 in three \nmajor cities in Sabah, Malaysia, namely Kota Kinabalu, Sandakan and Tawau. Respondents were conveniently selected from \nthree strata, namely public facilities, community setting and general public. They were interviewed based on a questionnaire \nto assess their perceptions towards the role of pharmacists.\nRESULTS: A total of 647 respondents were interviewed. 61.4 % of the respondents agreed that pharmacists knew more \nabout their medications, side effects and how to use the medications than their doctors. However, more than half of \nthe respondents (54.4%) perceived that pharmacists\u2019 role was just to supply medications and 66.6% of the respondents \nperceived that pharmacists\u2019 job was to follow doctors\u2019 directions. 89.0% of the respondents appreciated and complied with \nthe counselling points given by their pharmacists. 85.0% of the respondents hoped that pharmacists could play more roles \nin healthcare in the future. 40.0% of the respondents agreed that community pharmacists were just business people who \nsold\tproducts\tin\ttheir\tpharmacies.\tThe\tmost\tinfluential\tfactor\tinfluencing\trespondents\u2019\tperception\ttowards\tpharmacists\twas\t\nthe\tfriendliness\tof\tthe\tpharmacists\t(89.4%)\twhile\tthe\tleast\tinfluential\twas\tthe\twaiting\ttime\tof\tless\tthan\t30\tminutes\t(76.1%).\nCONCLUSION: Respondents in this study showed variations in their views of the pharmacy profession. Hence, to improve \nthe\tpharmacy\tpractice,\tefforts\tshould\tbe\ttaken\tto\taddress\tthe\tidentified\tshortcomings\tand\tto\tpromote\tthe\troles\tof\tpharmacists\t\nto the general public.\n\n\n\nKEYWORDS: pharmacy practice, Sabah, public perception, pharmacist\u2019s role\n\n\n\n\n\n\n\n\nMALAYSIAN JOURNAL OF PHARMACY Vol. 2. Issue 2. August 2016\n\n\n\n50\n\n\n\nLIST OF POSTER PRESENTATIONS\n\n\n\nNo Presenting authors Title \nPP1 Cheong Jia Yi Antibiotics Use in In-Ward Management of Paediatric \n\n\n\nAcute Gastroenteritis\nPP2 Saidatul Noraishah binti \n\n\n\nBiden\nA Study on the Cost of Medicines Per Prescription at Out-\nPatient Pharmacy of Public Hospitals in Malaysia\n\n\n\nPP3 Zanariah Abu Bakar Patient Satisfaction and Medication Adherence Assessment \nin Diabetes Medication Therapy Adherence Clinic \n(DMTAC)\n\n\n\nPP4 Teow Wei Chien A Survey on Service Delivery of Ubat Melalui Pos \n1Malaysia (UMP1M) in Public Health Facilities\n\n\n\nPP5 Chua Yee Min Adherence and Drug Attitude of People with Schizophrenia \ntowards Antipsychotics and Related Medicines in \nOutpatient Clinic of Hospital Permai Johor Bahru\n\n\n\nPP6 Tan Li Hun Prevalence\t of\t Side\t Effects\t Profile\t of\t Clozapine\t and\t its\t\nContributing Factors among Patients Attending Outpatient \nClinic Permai Hospital\n\n\n\nPP8 Siow Chee Chen Multiple Prescriptions among Chronic Illness Patients in \nThree Major Public Healthcare Facilities in Melaka: An \nOverview\n\n\n\nPP9 Tee Lik Siang Factors Affecting Defaulter Rate among Methadone Patient \nin Methadone Maintenance Therapy Clinic in Melaka: A \nMulticentre Study\n\n\n\nPP10 Liew Mei Yao Lipid Tolerability in Very Low Birth Weight (VLBW) \nInfants Receiving Intravenous Lipid\n\n\n\nPP11 Sarah\tDiyana\tbinti\tShafie Investigating Dropouts and Discontinuation Medicines by \nPost 1Malaysia (UMP1M) and Delivery\n\n\n\nPP12 Liaw Vern Xi A\tRetrospective\tAnalysis\tof\tthe\tAdditionof\tFenofibrate\tto\t\nStatin Therapy in Patients with Combined Hyperlipidemia\n\n\n\nPP13 Tan Guo Hong Antibiotic Use in the Outpatient Department at District \nHospital in Kedah\n\n\n\nPP14 Nur Maisarah binti Abu Bakar Drug Prescribing Pattern and Glucose Control in Type 2 \nDiabetes Mellitus Patients in Three Clinics\n\n\n\nPP15 Fahmishukran Amir bin \nArshad\n\n\n\nTobacco-Use Survey among Hospital Staff and Their \nPerceptions Toward Smoking Cessation Services\n\n\n\nPP16 Oh Ai Ling Importance of Medication History Assessment by \nPharmacists in Reducing Medication Error\n\n\n\nPP17 Ching Min Wei Conversion of Biosimilar Insulins: Patient Preference and \nClinical Outcomes\n\n\n\nPP18 Hoo Kien Heng A Prospective Study on Factors Leading to Uncontrolled \nDiabetes Mellitus among Patients Admitted to Segamat \nHospital, Johor\n\n\n\nPP19 Fitriah Cahyani Che Wil Knowledge in the Preparation and Administration of \nIntravenous Medication among Nurses in Surgical Wards \nat Raja Perempuan Zainab II Hospital, Kelantan\n\n\n\nPP20 Mohd Shainol Azmar bin \nKassim\n\n\n\nImpact of Health Literacy towards the Understanding and \nPreferences of Prescription Drug Labels among Adults at \nOutpatient Pharmacy Sultanah Bahiyah Hospital\n\n\n\nPP21 Maznuraini binti Zainuddin Expanding Role of Outpatient Pharmacy: A Pharmacy Care \nProgramme\n\n\n\n\n\n\n\n\n51\n\n\n\nMALAYSIAN JOURNAL OF PHARMACY Vol. 2. Issue 2. August 2016\n\n\n\nNo Presenting authors Title \nPP22 Sarah\tDiyana\tbinti\tShafie Assessment of Clinical Outcomes of Warfarin Therapy in \n\n\n\nTwo Models of Anticoagulation Services\nPP23 Ranita Kirubakaran Awareness of Breast Cancer among Surgical Female \n\n\n\nPatients in Sultan Abdul Halim Hospital\nPP24 Nurul Nabilla Huda binti \n\n\n\nMohamad Surahman\nQuantity and Quality of Patients\u2019 Own Medications \nBrought during Admission: A Study from District Hospital \nPerspective\n\n\n\nPP25 Siti Hamisah Said Association Between Knowledge and Medication \nAdherence among Hypertensive Patients in Raja Perempuan \nZainab II Hospital, Kelantan\n\n\n\nPP26 Nazif Salihin bin Ahmad \nImran\n\n\n\nKnowledge, Attitudes, and Practice of Pharmacists and \nDoctors Toward Nutrition Support\n\n\n\nPP27 Chin Shin Chee Evaluation\t of\t The\t Risk\t Factors\t for\t Efficacy\t and\t\nNephrotoxicity of Polymyxin for Treatment of Multidrug \nResistant Acinetobacter spp. in Kajang Hospital\n\n\n\nPP28 Rosnani Ab Rahman Antibiotic Sensitivity Pattern of Bacteria Isolated from \nOrthopaedic Surgical Ward in Kuala Krai Hospital\n\n\n\nPP29 Mohd Fauzan bin Sahimi Medication Reconciliation in The Ambulatory Pharmacy \nSetting in HPSF Muar\n\n\n\nPP30 Dahlia binti Md Shah Revisiting Medication Administration Errors in Medical \nWard at Melaka Hospital\n\n\n\nPP31 Jurisma binti Che Lah Assessment of Adherence and Belief among HIV Patients \nto Highly Active Antiretroviral Therapy (HAART) in \nRVDMTAC Tuanku Fauziah Hospital\n\n\n\nPP32 Mohd Firdaus bin Abdul Aziz Development of In-house Radiolabeling Process of \nLutetium-177-labelled Somatostatin Analogues Using \nHEPES Buffer System\n\n\n\nPP33 Sarikha binti Komeng Adherence to Disease Modifying Anti-Rheumatic Drugs \nin Rheumatic Arthritis Patients and Associated Factors for \nNon-adherence\n\n\n\nPP34 Lim Wei Ching Level of Patient\u2019s Knowledge on Warfarin Therapy and \nAnticoagulation Control in Alor Gajah Hospital\n\n\n\nPP35 Mohemmad Redzuan bin \nMohemmad Rizal\n\n\n\nEvaluation on Knowledge and Perception Regarding Food-\nDrug Interaction among Patient at Rompin Healthcare \nClinics\n\n\n\nPP36 Lydia Lim Sung Min Quality of Care in Patients Discharged from Warfarin Clinic \nto Primary Care Upon Stabilization of Warfarin Therapy\n\n\n\nNC1 Samuel Ting Chuo Yew Developing a Model on Consumers\u2019 Purchase and Use of \nHealth Product: A Grounded Theory Approach (CONBE-\nHEPRO)\n\n\n\nNC2 Nor Hasni Haron A National Point Prevalence Study of Antibiotic Utilisation \namong Hospitals in Malaysia\n\n\n\nNC3 Noraini Mohamad Impact of Pharmacist-Managed Clinic on Medication \nAdherence and Glycaemic Control of Type 2 Diabetes \nPatients in Malaysia : A Randomised Controlled Study\n\n\n\nNC4 Sahimi binti Mohamed The Development and validation of anticoagulant \nknowledge questionnaire: A Rasch Analysis\n\n\n\n\n\n\n\n\nMALAYSIAN JOURNAL OF PHARMACY Vol. 2. Issue 2. August 2016\n\n\n\n52\n\n\n\nPP1 (Poster)\nANTIBIOTICS USE IN IN-WARD MANAGEMENT OF PAEDIATRIC ACUTE GASTROENTERITIS\n\n\n\nCheong JY1, Nurul Hidayah S1, Chan MF1, Hong LC1, Siti HJ1, Nur AA1, Fatimah ZR1, Nurul AA1, Shahidatul AS1, Selva KS2\n\n\n\n1Department of Pharmacy, Hospital Tengku Ampuan Afzan, Kuantan, Pahang, 2Department of Pediatric, Hospital Tengku \nAmpuan Afzan, Kuantan, Pahang\n\n\n\nINTRODUCTION: The use of antibiotics in pediatric acute gastroenteritis (AGE) is mostly based on patients\u2019 clinical \npresentations\tprior\tto\tdefinite\tlaboratory\tresults.\tThe\tempirical\tuse\tof\tantibiotics\tin\tthese\tpatients\tremains\tan\tarea\tof\tinterest.\nOBJECTIVES: This study aimed to describe the pre-admission management of AGE patients and to determine the \nassociations between the use of empirical antibiotics with clinical presentations upon admission, pathogens isolated, and \npatients\u2019 outcomes.\nMETHOD: All AGE patients admitted to Paediatric General Wards, Hospital Tengku Ampuan Afzan were recruited over 4 \nmonths (November 2015-February 2016). Data were extracted from patients\u2019 case notes. The data were analysed using IBM \nStatistical package for the social sciences (SPSS).\nRESULTS: A total of 79 patients were included with mean (SD) age of 3.3 (2.8) years. There were 17 patients (21.5%) \nwho received antibiotics. For patients who seek pre-admission consultations, oral rehydration salt (ORS) (n=21, 46%) \nand antibiotics (n= 10, 22%) were prescribed. The empirical antibiotics given in the ward were based on the common \npathogens. The common reasons to prescribe antibiotics were temperature spikes (n=10, 52.9%), positive cultures (n=5, \n29.4%) followed by increased white cell counts (n=3, 17.7 %). Positive cultures reported among patients with antibiotics \nwas 6.3% from the total AGE admissions. The median (IQR) days of hospitalization of patients who received antibiotics \nwas longer compared to those patients who did not receive antibiotics, (3 (6) vs 3 (1) days) (Z=-3.3, p=0.001). There was \nsignificant\tassociation\tbetween\tantibiotics\tgiven\tand\tcomplication\tof\tsecondary\tbacteraemia\t(p=\t0.04).\nCONCLUSION: The pre-admission management of AGE patients was not ideal with the under use of ORS where \nrehydration is important in AGE management. Empirical antibiotics were mostly started due to fever. The use of antibiotics \nsignificantly\tlengthens\tthe\thospitalization\twith\tlow\tpercentage\tof\tpositive\tcultures.\n\n\n\nKEYWORDS: clinical pharmacy, paediatric, acute gastroenteritis, antibiotics\n\n\n\nPP2 (Poster)\nA STUDY ON THE COST OF MEDICINES PER PRESCRIPTION AT OUT-PATIENT PHARMACY OF PUBLIC \nHOSPITALS IN MALAYSIA\n\n\n\nNoraishah BS,\tSyarina\tPNA,\tJegatheswaran\tP,\tSalbiah\tMS,\tFatkhiah\tHK,\tSufiza\tAN\nPharmaceutical Service Division, Ministry of Heath Malaysia\n\n\n\nINTRODUCTION: Continuous escalation of medicines expenditure has become a burden to the government as a payer \nfor social health welfare in many countries including Malaysia. Hospitals are the main distributor of medicines to people, \ntherefore, the major expenditures of medicines occur largely through hospitals.\nOBJECTIVES: This study aimed to determine the trend of medicines cost and number of items per prescription at out-\npatient pharmacy of public hospitals in Malaysia.\nMETHOD: A cross-sectional study was conducted at the out-patient pharmacy of 89 public hospitals. The prescription \nwas\tsampled\twithin\tfive\tworking\tdays\ton\tthe\tthird\tweek\tof\tJuly\tin\t2012\tand\t2014\trespectively\tusing\tsystematic\trandom\t\nsampling. A total of 18,301 prescriptions (acute=8,381; chronic=9,920) were collected in 2012 and 18,611 prescriptions \n(acute=8,276; chronic=10,335) in 2014. Data were analysed using descriptive statistics. Results were expressed in median \n(IQR). All cost was reported as cost of prescription per visit.\nRESULTS: The median medicines cost for acute treatment was RM6.57 (12.96) in 2012 and RM6.79 (13.50) in 2014. \nThe median medicines cost for chronic treatment was RM51.08 (121.40) in 2012 and RM57.52 (136.50) 2014. The median \nmedicines cost per prescription by different types of hospital showed some inclination from 2012 to 2014 except for acute \nprescriptions in major specialist hospitals (-2.44%) and chronic prescriptions in minor specialist hospitals (-15.06%). Non-\nspecialist hospitals reported the highest median number of medicines for chronic prescriptions in both years (4 items) while \nother types of hospital resulted with 3 medicines per prescription except for major specialist hospital in 2012 (2 items). \nCONCLUSION: The\tmedian\tmedicines\tcost\tfor\tacute\ttreatment\tin\t2012\tand\t2014\tdid\tnot\tshow\tany\tsignificant\tchanges\t\nwhereas for chronic treatment there was 12.61% of increment in 2012 to 2014. The number of medicines per prescription \nranges from 2 to 4 from 2012 to 2014. \n\n\n\nKEYWORDS: pharmacy health policies, medicines cost, out-patient, public hospitals\n\n\n\n\n\n\n\n\n53\n\n\n\nMALAYSIAN JOURNAL OF PHARMACY Vol. 2. Issue 2. August 2016\n\n\n\nPP3 (Poster)\nPATIENT SATISFACTION AND MEDICATION ADHERENCE ASSESSMENT IN DIABETES MEDICATION \nTHERAPY ADHERENCE CLINIC (DMTAC)\n\n\n\nZanariah AB1, Loganathan M2, Md. Said SN1, Md. Saman K4, Tahir Z5 \n1Department of Pharmacy, Hospital Sultanah Aminah, Johor, 2Department of Pharmacy Practice and Clinical Pharmacy, \nUniversiti Teknologi MARA, Selangor, 4Department of Pharmacy, Hospital Pakar Sultanah Fatimah, Johor, 5Department of \nPharmacy, Hospital Sultanah Nora Ismail, Johor\n\n\n\nINTRODUCTION: The measurement of patient satisfaction and adherence are indeed important in disease management \nservices\tespecially\tin\tchronic\tdisease\tas\ta\tmean\tof\tservice\tbenefit\tand\tquality\tassurance.\nOBJECTIVES: This study aims to determine the satisfaction and adherence of diabetes mellitus patients at the DMTAC \nand to determine the relationship between patient satisfaction and adherence.\nMETHOD: The questionnaires were guided administered by the researcher and consists of three sections. 1) Socio-\ndemographic, medical and medication history and clinical parameters, 2) Patient Satisfaction with Pharmaceutical Care \nQuestionnaire (PSPCQ) and 3) The eight-item Morisky Medication Adherence Scale (MMAS). 165 patients from Hospital \nSultanah Aminah, Hospital Sultanah Nora Ismail and Hospital Pakar Sultanah Fatimah who had received counselling at \nDMTAC were recruited. Data were analysed with SPSS 18.0, using the descriptive statistics and non-parametric tests.\nRESULTS:\tThe\tmajority\twere\tfemale\t(50.9%),\taged\t\u2265\t60\tyears\t(40.0%),\tMalay\t(72.7%),\thad\tsecondary\teducation\tlevel\t\n(55.2%) and were unemployed (56.4%). Most of the patients had at least 4 visits (60.6%), had diabetes for more than 5 years \n(80.0%),\ton\tboth\toral\tand\tinsulin\t(55.2%)\tand\thad\t2\tcomorbidities\t(43.0%).\t87%\tof\tpatients\twere\tsatisfied\twith\tDMTAC\t\nservice\t(score\t60-100)\twith\tmean\tscores\tof\t76.8\tand\t26.1%\thad\thigh\tadherence\t(score=8).\tThere\twas\ta\tsignificant\t(p<0.01),\t\npositive fair correlation (rs=0.377) between satisfaction and adherence.\nCONCLUSION: This study leads to better understanding on which area of satisfaction and adherence needs to be emphasised \non patients at DMTAC. Such information was important in designing interventions to enhance patient satisfaction and \nadherence.\n\n\n\nKEYWORDS: pharmacy practice, morisky medication adherence scale, adherence, pharmaceutical care\n\n\n\nPP4 (Poster)\nA SURVEY ON SERVICE DELIVERY OF UBAT MELALUI POS 1MALAYSIA (UMP1M) IN PUBLIC HEALTH \nFACILITIES\n\n\n\nTeow WC1, Khoo VSM2, Liew KH2\n\n\n\n1Department of Pharmacy, Klinik Kesihatan Petaling Bahagia, Kuala Lumpur, 2Department of Pharmacy, Klinik Kesihatan \nTanglin, Kuala Lumpur\n\n\n\nINTRODUCTION: The Ubat Melalui Pos 1Malaysia (UMP1M) service was introduced to reduce waiting time at the \npharmacy, ensure continuity of medication supply and increase compliance. However, patients who utilize UMP1M may \nface\tproblems\tsuch\tas\tdelayed\tdeliveries,\tinability\tto\tunderstand\tmedications\tand\tdelivery\tof\tinsufficient\tmedications.\nOBJECTIVES: The\tmain\tobjective\twas\tto\tevaluate\tthe\tservice\tdelivery\tof\tUMP1M.\tSpecific\tobjectives\twere\tto\tdetermine\t\npatients\u2019 satisfaction level with UMP1M, to identify factors impacting satisfaction towards UMP1M and to identify factors \nof improvement.\nMETHOD: A multi-centred, cross-sectional study was conducted using a self-administered questionnaire from May to \nSeptember 2014. Data was analysed using SPSS version 20.\nRESULTS: A total of 332 questionnaires were distributed and 222 were answered. The median rating of UMP1M was 9. \nMajority\tof\tthe\tpatients\t(97.3%)\twere\tsatisfied\twith\tUMP1M.\tIt\twas\tfound\tthat\t98.6%\tof\tpatients\twould\tuse\tUMP\t1M\tin\t\nfuture and 97.7% would recommend it to others. This study found that 9.9% had experienced delayed deliveries while 12.6% \nhad\treceived\tinsufficient\tmedications.\tOnly\t2.3\t%\thad\tresponded\tthat\ttheir\tmedications\thad\tbeen\tdelivered\tto\tthe\twrong\t\naddress. Punctuality in delivery (p=0.001) and delivery to the correct address (p=0.016) were found to statistically impact \nsatisfaction towards UMP1M (p<0.05).\nCONCLUSION: Participants\twere\tsatisfied\twith\tUMP1M.\tFactors\taffecting\tsatisfaction\twere\tpunctuality\tin\tdelivery\tand\t\ndelivery to the correct address. Careful planning of delivery dates can help prevent delays in delivery. Counterchecking of \nparcels should be compulsory and caution should be exercised when noting down patients\u2019 addresses.\n\n\n\nKEYWORDS: pharmacy practice, pharmacy value added service, UMP\t1Malaysia,\tsatisfaction\tlevel,\tmedication\trefill\n\n\n\n\n\n\n\n\nMALAYSIAN JOURNAL OF PHARMACY Vol. 2. Issue 2. August 2016\n\n\n\n54\n\n\n\nPP5 (Poster)\nADHERENCE AND DRUG ATTITUDE OF PEOPLE WITH SCHIZOPHRENIA TOWARDS ANTIPSYCHOTICS \nAND RELATED MEDICINES IN OUTPATIENT CLINIC OF PERMAI HOSPITAL JOHOR BAHRU\n\n\n\nChua YM1, Zuraidah MZ2, Ng CK2, Abdul Hakim N2\n\n\n\n1Hospital Pakar Sultanah Fatimah, Muar, Johor, 2Hospital Permai Johor Bahru, Johor\n\n\n\nINTRODUCTION: Studies have shown non-adherence is a common behavior with about 20% to 56% schizophrenic \npatients are not adherent to their medicines resulting in higher rate of involuntary detention, longer hospital admissions and \nslower recovery from psychotic symptoms. MMAS-8 is a self-reported questionnaire related to medicine-taking behavior. \nScores less than 6 were considered low adherence, between 6 to 7 were moderately adherent and score of 8 was considered \nhigh adherence. DAI-30 is a 30 item self report instrument and sum of the scores will result in either positive or negative \ntotal score.\nOBJECTIVES: To understand the adherence and drug attitude of schizophrenic patients in Johor Bahru towards \nantipsychotics and related medicines as well as their association with sociodemographic factors.\nMETHOD: A questionnaire-based cross-sectional study was carried out using MMAS-8 and DAI-30 to measure adherence \nand\t drug\t attitude\t respectively.\t Participants\t that\t fit\t the\t inclusion\t and\t exclusion\t criteria\t were\t approached\t to\t answer\t the\t\nquestionnaire. Association between demographic data and both adherence and drug attitude were analysed. Statistical \nanalyses were performed using SPSS 22.0.\nRESULTS: 95 patients participated in the study and median (IQR) age was 37 (19). Participants were predominantly \nmale (n=65, 68.4%); of Chinese ethnic group (n= 49, 51.6%); and had educational level of up to secondary school (n= 64, \n67.4%). Median (IQR) for MMAS-8 was 5.75 (3.75) and for DAI-30 was 12.00 (16.0). Participants in the study mostly \nhave\tlow\tadherence\tbut\tpositive\tattitude\ttowards\ttheir\tmedicines.\tThere\twas\tno\tstatistically\tsignificant\tcorrelation\tbetween\t\nsociodemography with adherence and drug attitude.\nCONCLUSION: No association was found between sociodemographic factors and medicine adherence and drug attitude. \nSubsequent larger scale research should be carried out to understand the sociodemographic factors that affect adherence and \ndrug attitude to improve the treatment outcome of schizophrenic patients.\n\n\n\nKEYWORDS: pharmacy practice, Johor, adherence, schizophrenia, antipsychotics\n\n\n\nPP6 (Poster)\nPREVALENCE OF SIDE EFFECTS PROFILE OF CLOZAPINE AND ITS CONTRIBUTING FACTORS AMONG \nPATIENTS ATTENDING OUTPATIENT CLINIC PERMAI HOSPITAL\n\n\n\nTan LH, Wong AL, Chua WW, Liong PZ\nDepartment of Pharmacy, Hospital Permai Johor Bahru, Malaysia\n\n\n\nINTRODUCTION: Superiority of clozapine renders it to remain as the mainstay treatment of resistant schizophrenia (TRS) \nbut its use is limited by the wide range of adverse effects, with a potential negative impact on compliance. However, their \nprevalence in the local setting has received little attention in the literature and not being well-studied.\nOBJECTIVES: The study was designed to investigate the prevalence of various side effects in patients with TRS taking \nclozapine as well as its relationship with various contributing factors particularly total daily dose, patients\u2019 age and \nconcomitant medication.\nMETHOD: This was a 6-month cross-sectional study which recruited all TRS patients attending clozapine clinic in HPJB. \nPatients was interviewed and assessed for side effects when attending clozapine clinic by pharmacists. Data obtained was then \nused to examine the occurrence of clinically important categories of side effects, explicitly gastrointestinal, cardiovascular, \ncentral nervous system, metabolic, haematological, nocturnal enuresis and others. On top of that, statistical analysis was \nconducted\tto\tdetermine\tthe\tfactors\tinfluencing\tthe\tprevalence.\nRESULTS: Of 86 patients, 93% experienced side effects with 86% of them suffered from more than one. Most frequent \nadverse effects were hyper salivation (67.4%), sedation (65.1%), dry mouth (47.7%), postural hypotension (41.9%) and \nweight gain (41.9%), No patient suffered from extrapyramidal side effects, agranulocytosis) and myocarditis in this study. A \nsignificant\trelationship\twas\tfound\tbetween\tsedation\tand\tpolypharmacy\twith\ta\tp-value\t<0.05.\tPatient\twho\twas\ton\tmultiple\t\nCNS drugs were more prone to experience sedation as a side effect.\nCONCLUSION: Clozapine adverse effects are common and potentially life-threatening. Along with the availability of \ngeneral\tside\teffects\tprofile,\texistence\tand\tco-operation\tof\ta\tmultidisciplinary\tteam\tsimilar\tto\tclozapine\tclinic\tin\tthe\tstudy\t\nallows early detection, monitoring and intervention to maximize patients\u2019 care.\n\n\n\nKEYWORDS: clinical pharmacy, Johor, clozapine, antipsychotics\n\n\n\n\n\n\n\n\n55\n\n\n\nMALAYSIAN JOURNAL OF PHARMACY Vol. 2. Issue 2. August 2016\n\n\n\nPP8 (Poster)\nMULTIPLE PRESCRIPTIONS AMONG CHRONIC ILLNESS PATIENTS IN THREE MAJOR PUBLIC \nHEALTHCARE FACILITIES IN MELAKA: AN OVERVIEW\n\n\n\nSiow CC1, Saidatul RI1, Noorazlinda Y1, Siti MMA3, Esha DS1, Bong WK1, Gan CL2, Khairiyah A4, Jalil I4\n\n\n\n1Department of Pharmacy, Hospital Melaka, Melaka 2Department of Medicine, Hospital Melaka, Melaka 3Department of \nPharmacy, Hospital Alor Gajah, Melaka 4Klinik Kesihatan Peringgit, Melaka\n\n\n\nINTRODUCTION: Frequent hospital admissions, changing of regimen and receiving treatment from multidisciplinary \nteam are common among chronic patients. This may lead to receiving multiple prescriptions with duplicating medicine.\nOBJECTIVES: To determine the percentage of multiple prescriptions and to compare behaviours among patients with \nduplicating medicine and non-duplicating medicine.\nMETHOD: A cross sectional study was conducted among adult patients with chronic illnesses attending government \nhealthcare facilities in Klinik Pakar Perubatan Hospital Melaka (HM), Klinik Kesihatan Peringgit (KKP) and Hospital Alor \nGajah (HAG). Systematic random sampling was applied. Patient with even waiting number at the pharmacy in either of \nthe three facilities were selected. Self-administered questionnaire were given to the consented subjects with ample time to \nanswer each of the questions. SPSS version was used to analyse the data.\nRESULTS: A total of 920 patients answered the questionnaire, where 410 (44.6%) patients from HM, 158 (17.2%) from \nHAG and 352 (38.3%) patients from KKP. The overall prevalence of multiple prescriptions was 130 (14%) patients, with \n17.5% in HM, 16.1% in KKP and 2.5% in HAG. Patients with duplicating medicine are more likely to lost their prescriptions, \nmultiple admissions, do not have individual patient care book and feel necessary to keep excessive medicines at home \ncompared to those with non-duplicating medicine (p<0.001).\nCONCLUSION: Multiple prescriptions with duplicating medicines are an alarming issue that may need to be addressed \nby all healthcare team members. Treatment plan should be reviewed by emphasizing on the importance of past medication \nclerking.\n\n\n\nKEYWORDS: pharmacy practice; Melaka, duplicate medications\n\n\n\nPP9 (Poster)\nFACTORS AFFECTING DEFAULTER RATE AMONG METHADONE PATIENT IN METHADONE \nMAINTENANCE THERAPY CLINIC IN MELAKA: A MULTICENTRE STUDY\n\n\n\nNoorazlinda Y1, Tee LS2, Puah RE1, Ooi YJ3, Lim WC4\n\n\n\n1Bahagian Perkhidmatan Farmasi, Jabatan Kesihatan Negeri Melaka, 2Klinik Kesihatan Durian Tunggal Melaka, 3Klinik \nKesihatan Ayer Molek Melaka, 4Jabatan Farmasi Hospital Alor Gajah, Melaka\n\n\n\nINTRODUCTION: Patient retention is crucial in methadone maintenance programme. Patient factors, programme factors \nand\tcommunity\tfactors\tmay\tinfluence\tcontinuity\tof\tpatient\tin\tthis\tprogramme.\nOBJECTIVES: To identify factors associated with defaulter among methadone patient in Methadone Maintenance Therapy \nClinic in Melaka and to determine time duration they get defaulted.\nMETHOD: A case control study was conducted among patients who undergone Methadone Maintenance Programme in \nMinistry of Health facilities in Negeri Melaka from 31st July 2013 to 31st July 2014. Sample included only patients who \nhad been enrolled in treatment for at least 90 days. Patients who are temporarily referred,transfer out patients,those with \nincomplete 20% of interest data were excluded. Using list of eligible methadone\u2019s patients name for each facilities, simple \nrandom sampling was applied using PASW Version 20.Medical records for selected patients were retrospectively reviewed \nusing\tspecified\tdata\tcollection\tform.\nRESULTS: Of the sample of 290 patients, 63 participants were defaulted and 227 are still active during study duration. \nAlmost half of the patients had abuse more than one drug, a smoker and take alcohol.Factors associated with defaulter were \namphetamine use (Adjusted OR: 6.97, 95% CI; 2.00,24.26, p=0.002) those without take away dose privilege (Adjusted OR: \n2.58, 95% CI; 1.08, 6.14, p=0.032) and percentages day of missed dose during follow-up period (Adjusted OR: 1.06, 95% \nCI;\t1.03,\t1.09,\tp=\t0.06).\tAfter\talmost\t9\tweeks,\tdefaulter\tpatients\ttend\tto\tmissed\ttheir\tfirst\tmethadone\tdose.\tMean\tduration\t\nfor patient to get defaulted after joined this programme were 71 weeks.\nCONCLUSION: Drop out were more likely after 1.37 years of treatment. Take away dose privilege, previous amphetamine \nuse\tand\thigher\tnumber\tof\tmissed\tdose\tduring\ttreatment\tserve\tas\tsignificant\tassociated\tfactors\tfor\tdefaulter\tin\tmethadone\t\nmaintenance\tprogramme.\tRetention\trates\twould\tbe\tsignificantly\timproved\tby\ta\tchange\tin\tthe\ttreatment\tstrategies.\n\n\n\nKEYWORDS: pharmacy practice; Melaka; methadone maintenance \n\n\n\n\n\n\n\n\nMALAYSIAN JOURNAL OF PHARMACY Vol. 2. Issue 2. August 2016\n\n\n\n56\n\n\n\nPP10 (Poster)\nLIPID TOLERABILITY IN VERY LOW BIRTH WEIGHT (VLBW) INFANTS RECEIVING INTRAVENOUS LIPID\n\n\n\nLiew MY, Omar ZM, Ahmad KNA, Law XM, Lim SH, Tan WN\nDepartment of Pharmacy, Serdang Hospital, Selangor \n\n\n\nINTRODUCTION: Lipid is one of the crucial components in parenteral nutrition as it contains high energy density in a \nrelatively low volume as compared to protein and carbohydrate. Lipid infusion decreases carbon dioxide production compared \nwith carbohydrate and helps to improve net-nitrogen balance. In contrast, lipid might increase the risk of hyperbilirubinemia, \ncholestasis and thrombocytopenia.\nOBJECTIVES: To determine the tolerability of lipids and possible complications following lipid infusion among VLBW \ninfants in Neonatal Intensive Care Unit (NICU), Serdang Hospital.\nMETHOD: This is a prospective observational study done from July 2014-December 2015. Subjects on intravenous \nlipid\twere\tdivided\tinto\t2\tgroups\tbased\ton\tbirth\tweight\t(Group\t\u22651000g\tand\tGroup\t<1000g).\tSerum\ttriglyceride\tlevel\twas\t\nmeasured after lipid infusion reached 3g/kg/day. Complications were collected from clinical notes through hospital eHIS \nsystem. Analysis was done using Mann-Whitney U-Test and Spearman\u2019s rho correlation by SPSS version 19.\nRESULTS: 35 eligible subjects were recruited into each arm. The median gestation age and birth weight were (30weeks, \n1140g)\tin\tgroup\t\u22651000g\tand\t(27weeks,\t800g)\tin\tgroup\t<1000g\trespectively.\tOn\taverage,\tsubjects\ttook\t6\tdays\tto\treach\tlipid\t\ninfusion\tof\t3g/kg/day.\tThe\tmean\t triglyceride\t level\t for\tgroup\t\u22651000g\twas\t1.88mmol/L,\t compared\twith\t2.36mmol/L\t for\t\ngroup\t<1000g.\tThere\tis\ta\tsignificant\tdifference\tbetween\tbirth\tweight\tand\tthe\ttriglyceride\tlevel\t(p=0.007)\twith\tan\tinverse\t\ncorrelation\t(r=\t-0.418).\tBilirubin\ttrends\tand\tplatelet\tcounts\twere\tnot\tsignificantly\tcorrelated\tbetween\tthe\tgroups.\tNone\tof\t\nthe subjects developed cholestasis during the study. \nCONCLUSION: Infants\tweighed\t\u22651000g\tshow\tbetter\ttolerance\tto\tlipid\tinfusion.\tTriglyceride\tlevel\tshould\tbe\tmonitored\t\nearlier\tin\tinfants\tweighed\t<1000g.\tLipid\tis\tgenerally\twell\ttolerated\twithout\tcausing\tsignificant\tcomplications.\n\n\n\nKEYWORDS: clinical pharmacy; Selangor; lipid; TPN; VLBW\n\n\n\nPP11 (Poster)\nINVESTIGATING DROPOUTS AND DISCONTINUATION MEDICINES BY POST 1MALAYSIA (UMP1M) AND \nDELIVERY\n\n\n\nSamsuri\tZ,\tAfifi\tM,\tHanin\tS,\tShafie\tSD\nDepartment of Pharmacy, Hospital Kajang, Selangor\n\n\n\nINTRODUCTION: Value added services offered by outpatient pharmacy department in MOH facilities which assists \npatients\tto\tobtain\ttheir\tmedication\tefficiently.\tNevertheless\tthere\tare\tpatients\twho\thad\tderegistered\tor\tterminated\tthe\tservices.\t\nPresence\tof\tdropouts\twhile\tusing\tthese\tservices\tmay\treflect\tweaknesses\tin\tthe\tcurrent\tsystem.\nOBJECTIVES: To investigate the factors contributing to dropouts or discontinuation of Ubat Melalui Pos 1Malaysia \n(UMP1M) and Speed \u2013 Collect services provided by Outpatient Pharmacy Hospital Kajang.\nMETHOD: 72 subjects who are inactive for more than 6 months were involved in this study. Subjects were interviewed \nvia phone call and feedbacks were sampled using interviewer administered questionnaire. Content and face validity were \napplied to examine the appropriateness of questions.\nRESULTS: Out of 43 inactive patients in the Speed \u2013 Collect service, 12 patients (27.9%) has changed their follow \u2013 up \nto other places while three of the inactive patients (4.7%) had passed away. Reasons for discontinuation of the service \nwere\tmedication\twas\tnot\tprepared\tdespite\tearlier\tnotification\t(28.6%),\tSMS\twere\tnot\treplied\t(21.4%),\tunanswered\tphone\t\ncalls and the medication could not be collected on the designated date (17.8%), limited time to collect the medications \n(14.2%) and transport problems (3.6%). On the other hand 56.3% of respondents indicated that reasons for discontinuation \nin UMP1M services were due to unreasonable fees and 37.5% claimed that they do not understand or does not have clear \ninstructions when medications were delivered via postage, 25% indicated that the medication supply arrived later than \nthe pharmacy appointment date and 6.3% indicated that medication received is defective, expired and medication is not \ncollected\tat\tthe\tpost\toffice/collection\tcentre.\nCONCLUSION: The current Speed \u2013 Collect and UMP1M requires further improsvement to increase patients\u2019 satisfaction.\n\n\n\nKEYWORDS: pharmacy practice; Selangor; UMP1M; value added services\n\n\n\n\n\n\n\n\n57\n\n\n\nMALAYSIAN JOURNAL OF PHARMACY Vol. 2. Issue 2. August 2016\n\n\n\nPP12 (Poster)\nA RETROSPECTIVE ANALYSIS OF THE ADDITION OF FENOFIBRATE TO STATIN THERAPY IN PATIENTS \nWITH COMBINED HYPERLIPIDAEMIA\n\n\n\nLiaw VX, Ong JTJ, Nurul HAA, Siti NAAS\nDepartment of Pharmacy, Hospital Serdang, Selangor\n\n\n\nINTRODUCTION: Statins\t are\t the\t current\t drug\t of\t choice\t for\t the\t treatment\t of\t hyperlipidaemia\twhile\t fibrates\t are\t for\t\nhypertriglyceridemia.\t In\t patients\twith\t combined\t hyperlipidaemia,\t the\t addition\t of\t fenofibrate\t to\t statin\t therapy\t has\t been\t\nreported to be very effective in lowering both triglycerides (TG) and low-density lipoprotein cholesterol (LDL-c). However, \nsafety\tof\tco-administration\tof\tstatin\twith\tfenofibrate\thas\tbeen\ta\tgreat\tconcern.\nOBJECTIVES: This\t study\t aimed\t to\t analyse\t the\t efficacy\t and\t safety\t of\t the\t addition\t of\t fenofibrate\t to\t statin\t therapy\t in\t\ncombined hyperlipidaemia treatment.\nMETHOD: This is a retrospective study involving 70 patients from cardiology clinic at Hospital Serdang with a diagnosis \nof combined hyperlipidaemia. These patients were assigned accordingly to their statin group. The effect of treatment on \nTotal Cholesterol (TC), LDL cholesterol, high-density lipoprotein cholesterol (HDL-c), and TG was recorded after 6 months \nof\taddition\tof\tfenofibrate.\tMoreover,\tAlanine\tAminotransferase\t(ALT),\tAlkaline\tPhosphatase\t(ALP)\t&\tSerum\tCreatinine\t\n(SCr) were recorded to access the safety of combination therapy. Any side effect occurred during combination therapy were \nalso recorded.\nRESULTS: The\taddition\tof\tfenofibrate\tto\tsimvastatin\tand\tatorvastatin\twas\tassociated\twith\tsignificantly\tgreater\treduction\t\nin\tTG\t(23.32\u00b1\t33.5%,\tp<0.001)\tas\twell\t as\t significantly\tgreater\t increase\t in\tHDL-c\t (19.67\u00b1\t25.04%,\tp<0.001).\tNone\tof\t\nthe\t patients\t experienced\t a\t clinically\t significant\t increase\t in\t hepatic\t liver\t transaminase\t and\t serum\t creatinine.\tNo\t patient\t\nexperienced clinical myopathy or rhabdomyolysis.\nCONCLUSION: Combination\tof\tstatin\tand\tfenofibrate\tis\teffective\tand\tsafe\tfor\tthe\ttreatment\tof\tpatients\twith\tcombined\t\nhyperlipidemia.\n\n\n\nKEYWORDS: clinical\tpharmacy;\tSelangor;\thyperlipidemia;\tstatin-fenofibrate\tcombination\n\n\n\nPP13 (Poster)\nANTIBIOTIC USE IN THE OUTPATIENT DEPARTMENT AT DISTRICT HOSPITAL IN KEDAH\n\n\n\nTan GH, Seah HK, Lim H, Low QW\nHospital Sik, Kedah\n\n\n\nINTRODUCTION: Antimicrobial resistance is currently a major global threat. Indiscriminate outpatient antibiotic use is \nknown to facilitate the resistance development.\nOBJECTIVES: To assess the antibiotics prescribing practices in the outpatient department of a district government-funded \nhospital.\nMETHOD: A cross-sectional, descriptive study was conducted at Hospital Sik, Kedah, Malaysia between May 2015 and \nJuly 2015. Prescriptions involving patients aged more than 12 years old were screened for percentage of antibiotic prescribed. \nOf these, prescriptions containing at least one oral antibiotic were analysed for antibiotic prescribing rate by diagnosis, \nproportion\tof\tselected\tantibiotics\tprescribed\tfor\tspecific\tdiagnoses;\tand\tadherence\tto\tMalaysia\tNational\tAntibiotic\tGuideline\t\n2008\t(NAG)\tusing\tthe\tWorld\tHealth\tOrganisation\t(WHO)\tDaily\tDefined\tDose\t(DDD)\tmethodology.\nRESULTS: A total of 8,312 prescriptions which met the inclusion criteria were screened. Of these, 662 (7.96%) prescriptions \ncontained at least one oral antibiotic. Forty-nine (7.4%) and seven (1.06%) of the antibiotic prescriptions were found to have \nno diagnosis recorded and illegible diagnoses respectively. Antibiotic prescribing rates for upper respiratory tract infections \n(URTI), skin or soft tissue infections (STI) and urinary tract infection (UTI) were n=289 (37.77%), n=143 (66.51%), and \nn=82 (83.67%) respectively. The most commonly prescribed antibiotic was erythromycin ethylsuccinate (31.72%), in which \nn=189 (87.9%) of the usage was for URTI. This was followed by cloxacillin (14.83%) and amoxicillin/clavulanate (11.75%). \nGood adherence to the dosage recommended by NAG based on the calculated DDD was observed for URTI, STI and UTI \nindications. However, for leptospirosis, doxycycline was prescribed longer than the NAG recommended duration. Moreover, \nsome antibiotics were used for indications not stated in NAG, such as doxycycline for URTI.\nCONCLUSION: This study did not detect any systematic non-adherence to dosage recommendations for URTI, STI and \nUTI. However, inappropriate antibiotic use was observed. Hence, there is an urgent need for antimicrobial stewardship \nprograms in outpatient department of district hospital.\n\n\n\nKEYWORDS: pharmacy practice; Kedah; antibiotic use; outpatient; district hospital\n\n\n\n\n\n\n\n\nMALAYSIAN JOURNAL OF PHARMACY Vol. 2. Issue 2. August 2016\n\n\n\n58\n\n\n\nPP14 (Poster)\nDRUG PRESCRIBING PATTERN AND GLUCOSE CONTROL IN TYPE 2 DIABETES MELLITUS PATIENTS \nIN THREE CLINICS\n\n\n\nChe ANF1, Shoksi NA2, Abu BNM3, Mustapha NM4\n\n\n\n1Department of Pharmacy, Klinik Kesihatan Mahligai, Bachok, Kelantan, 2Department of Pharmacy, Klinik Kesihatan Balai, \nBachok, Kelantan, 3Department of Pharmacy, Klinik Kesihatan Bachok, Kelantan, 4Department of Pharmacy, Hospital Raja \nPerempuan Zainab II, Kota Bharu, Kelantan\n\n\n\nINTRODUCTION: Prevalence of diabetes in Malaysia has increased almost twofold from 11.6% in 2006 to 22.6% in 2013. \nOBJECTIVES: This\tstudy\tmainly\taimed\tto\tassess\tthe\tsignificance\tof\tdrug\tprescribing\tpattern\ttowards\tglycemic\tcontrol\t\nin diabetes patients and to compare the glycemic control between patients who receive OHA alone, insulin alone, and \ncombination of insulin and OHA therapy.\nMETHOD: This cross-sectional study was held in three Health Clinics which were Klinik Kesihatan Bachok, Klinik \nKesihatan\tBalai\tand\tKlinik\tKesihatan\tMahligai.\tThe\tdata\twas\tcollected\tfrom\tmedical\trecord\tof\tdiabetic\tpatients\tand\tfilled\t\ninto the data collection form. Chi-square test was performed to determine the relationship between groups of OHA alone, \ninsulin alone, and combination of insulin and OHA therapy and the glycemic control.\nRESULTS: The data comprised of 390 patients; 173 of male patients and 217 of female patients. The patients had a median \nage of 59 years old. Biguanides were the most commonly prescribed class of OHA (38.46%) followed by biguanides plus \nsulphonylureas (33.59%). Patients were mostly on OHA alone with 53.33%, followed by OHA plus insulin (40.26%) and \ninsulin only (6.41%). Most of the patients had poor glycemic control (82.31%) whereas those with good glycemic control \nwere\tonly\t17.69%.\tThe\tmedian\tHbA1c\tlevel\twas\t8.6%.\tData\tanalysis\tshowed\tthere\twas\ta\tsignificant\tdifference\tbetween\t\ngroups of OHA alone, insulin alone, and combination of insulin and OHA therapy and the glycemic control. \nCONCLUSION: Our study showed that OHA is still the preferred choice over OHA and insulin or insulin only. In \nachieving\toptimal\tglycemic\tcontrol,\tthe\tefficacy\tof\tanti-diabetic\tdrugs\twas\tonly\t17.69%;\ttherefore\tintensification\tof\tcurrent\t\ndrug\ttreatment\tas\twell\tas\tplanning\tmultiple\tdrug\tintervention\twith\tlifestyle\tmodification\tis\tnecessary\tto\tprevent\tdiabetic\t\ncomplications.\n\n\n\nKEYWORDS: pharmacy practice; Kelantan; diabetes mellitus; prescribing pattern\n\n\n\nPP15 (Poster)\nTOBACCO-USE SURVEY AMONG HOSPITAL STAFF AND THEIR PERCEPTIONS TOWARD SMOKING \nCESSATION SERVICES\n\n\n\nArshad FA, Teng SY, Mohd Mokhtar NN, Mohd Pilus N\nDepartment of Pharmacy, Hospital Putrajaya, Wilayah Persekutuan Putrajaya\n\n\n\nINTRODUCTION: In Malaysia, more than 10,000 Malaysians die from smoking-related illness every year. Most ironical \nand unfortunate fact is that healthcare providers also have a tendency to smoke.\nOBJECTIVES: The aim of this study is to identify the prevalence of tobacco smoking among hospital staffs and their \nperceptions towards smoking cessation services.\nMETHOD: This study was conducted among male staffs working in Hospital Putrajaya by using self-administered \nquestionnaire.\nRESULTS: A total of 200 male staffs with the mean age of 29 years old were participated in this study. Majority of the \nrespondents was Malay (80.5%) followed by Indian (9.5%) and Chinese (8%). Smoking prevalence was the highest among \nthe least educated. 98% of respondents are aware of the dangerous of smoking, 92% recognizes the dangerous of second \nhand smoking while 68.5% agreed that the religion forbids smoking. As for attitude assessment towards smoking cessation \nprogrammes, 77% of them agreed that banning of smoking in public area while 70% imposing penalty will helps reducing \nsmoking prevalence among Malaysians. Moreover, 65% of the respondents disagreed that smoking will makes them popular. \nAddiction\tto\tciggarete\tis\tidentified\tas\tthe\tmost\tchallenging\tbarrier\ttowards\tsmoking\tcessation\t(63%).\t\nCONCLUSION: This study shows that 73% of the respondents are non-smokers meanwhile 13.5% of total respondents are \nsmokers\tand\tex-smokers\trespectively.\tThere\twere\tno\tstatistically\tsignificant\tdifference\t(p\t>\t0.05)\tof\tknowledge,\tattitude\tand\t\nperception among smoker, ex-smoker and non-smoker.\n\n\n\nKEYWORDS: pharmacy practice; Putrajaya; cigarettes; healthcare providers\n\n\n\n\n\n\n\n\n59\n\n\n\nMALAYSIAN JOURNAL OF PHARMACY Vol. 2. Issue 2. August 2016\n\n\n\nPP16 (Poster)\nIMPORTANCE OF MEDICATION HISTORY ASSESSMENT BY PHARMACISTS IN REDUCING MEDICATION \nERROR\n\n\n\nOh AL, Tan AGHK, Chieng IYY, Ho HY, Law KE, Chung LWC, Parveen KG, Yong YK\nDepartment of Pharmacy, Sarawak General Hospital, Sarawak\n\n\n\nINTRODUCTION: Medication history assessment is an integral part of the medication reconciliation process which \nserves to screen for drug allergies, adverse drug reactions and to prevent prescribing errors, such as duplication or omission \nof medications. An accurate medication history during hospital admission will ensure continuity of care throughout the \nadmission, especially in patients with comorbidities.\nOBJECTIVES: This study aimed to evaluate the importance of pharmacist-acquired medication history assessment in \nreducing medication errors.\nMETHOD: A prospective cohort study was conducted in the medical wards over a four-month period which targeted newly \nadmitted patients with at least one prescribed medication. Medication history was assessed using the Medication History \nAssessment Form within 24 hours or as soon after admission as possible. Comparisons were made between pharmacist-\nacquired\t medication\t history\t and\t in-patient\t prescription\t charts\t to\t detect\t discrepancies,\t which\t were\t then\t verified\t with\t\nphysicians whether they were \u201cintentional\u201d or \u201cunintentional\u201d. Unintentional discrepancies were categorised as omission, \ncommission, substitution, and dose- or frequency-related, after which the pharmacists would intervene appropriately. The \npotential\tseverities\tof\tpatient\tharm\twhich\tcould\thave\tbeen\tcaused\tby\tunintentional\tdiscrepancies\twere\tclassified\tto\teither\t\n\u201cnon-significant,\t\u201csignificant\u201d,\t\u201cserious\u201d\tor\t\u201clife-threatening\u201d.\nRESULTS: A total of 390 patients were included in this study. Out of 990 discrepancies detected, 135 (13.6%) were \nunintentional. Over three quarters, n=107 (79.3%) of unintentional discrepancies were medication omission, followed by \ndosing\t errors,\t n=13\t (9.6%).\tAmong\t these\t discrepancies,\t n=119\t (88.2%)\twere\t considered\t \u201csignificant\u201d\t or\t \u201cserious\u201d\t but\t\nnone were \u201clife-threatening\u201d. Of all pharmaceutical interventions done on unintentional discrepancies, n=112 (83%) were \naccepted\tand\trectified\taccordingly.\nCONCLUSION: Pharmacists play a vital role in medication history assessment which potentially reduces medication \nerrors.\n\n\n\nKEYWORDS: clinical pharmacy; Sarawak; medication history; medication reconciliation; medication error\n\n\n\nPP17 (Poster)\nCONVERSION OF BIOSIMILAR INSULINS: PATIENT PREFERENCE AND CLINICAL OUTCOMES\n\n\n\nChing MW, Sabastian SS, Vellu RR, Ang SC\nDepartment of Pharmacy, Putrajaya Hospital, Federal Territory of Putrajaya \n\n\n\nINTRODUCTION: Biosimilar insulins were manufactured in different delivery pens with different features and designs. \nTherefore, patient\u2019s preference and acceptability towards different insulin pens plays important factor in adherence to insulin \ninjections and thus affecting glycemic control and treatment outcome.\nOBJECTIVES: The study is aimed to evaluate patient\u2019s preference for Novopen versus Insuman Allstar pen and their \nclinical outcomes when converting between biosimilar insulin in patients with type 2 diabetes mellitus (T2DM).\nMETHOD: This was a cross-sectional observational survey using validated questionnaires from published journals. All \nT2DM patients converted from Novopen to Insuman Allstar pen were conveniently sampled. Diabetes outcomes indicators \nwere taken from patient\u2019s medical record 4-6 months post conversion.\nRESULTS: Majority of the patients preferred Insuman Allstar pen compared to Novopen in term of basic design (p<0.05). \n75% claimed that Insuman pen is lighter and easier to carry compared to Novopen. In-depth technical survey revealed that \n85.2% preferred Novopen due to ease of pushing down the injecting button (p<0.01) and 99.5% of patients were more \nconfident\twith\tNovopen\tin\tthe\tability\tto\tset\tand\tadminister\t the\tcorrect\tdose\tcompared\tto\tInsuman\tAllstar\tpen\t(p<0.01).\t\nThere was no statistically difference in patient\u2019s HbA1C before (mean 8.98%; SD 1.73) and after (mean 9.08%; SD 1.94) \nconversion.\tThe\tstudy\treported\tno\tsignificant\tchanges\tat\tpre\tand\tpost\tconversion\tin\tterms\tof\tfasting\tblood\tglucose\t(mean\t\n8.54mmol/L; SD 3.73 versus mean 8.48mmol/L; SD 3.53) and total daily dose of insulin (mean 80.18IU; SD 45.67 versus \nmean 80.95IU; SD 43.70).\nCONCLUSION: Most patients preferred Insuman Allstar pen to Novopen in terms of basic design while in-depth technical \nusability\tsurvey\trevealed\tstatistically\tsignificant\tpreference\ttowards\tNovopen.\tThe\tstudy\tshowed\tthat\tthere\twas\tno\tdifference\t\nin glycemic outcomes when switching between biosimilar insulins.\n\n\n\nKEYWORDS: clinical pharmacy; Putrajaya; insulin pens \n\n\n\n\n\n\n\n\nMALAYSIAN JOURNAL OF PHARMACY Vol. 2. Issue 2. August 2016\n\n\n\n60\n\n\n\nPP18 (Poster)\nA PROSPECTIVE STUDY ON FACTORS LEADING TO UNCONTROLLED DIABETES MELLITUS AMONG \nPATIENTS ADMITTED TO SEGAMAT HOSPITAL, JOHOR\n\n\n\nTan JJ, Guok L, Lau KH, Hoo KH\nDepartment of Pharmacy, Hospital Segamat, Johor\n\n\n\nINTRODUCTION: Uncontrolled Diabetes Mellitus (DM) is related to various complications in terms of nephropathy, \nneuropathy, cardiovascular event, retinopathy and death. By identifying the commonalities among uncontrolled type II \nDM\tpatients,\tthe\tleading\tfactors\tcontributing\tto\tloss\tof\tglycemic\tcontrol\tare\table\tto\tbe\tmodified\tto\treduce\thospitalization\t\nincidence, morbidity, mortality rate and improve patients\u2019 quality of life.\nOBJECTIVES: This study is to identify the common factors of uncontrolled diabetes mellitus contribute to patient\u2019s \nadmission to hospital.\nMETHOD: This prospective study was done at Hospital Segamat for 6 months from Dec 2013 till May 2014. Any diabetic \npatients\tadmitted\t to\tadult\tmedical\tward\tand\tICU\twith\tuncontrolled\tDM\twere\tgiven\tquestionnaires\t to\tfind\tout\t the\tmain\t\ncommon reasons leading to uncontrolled diabetes mellitus. Data was then analysed using chi-squared test.\nRESULTS: A total of 74 patients were recruited and questionnaires collected shown that 73% of subjects are non-\ncompliance to their anti-diabetic regimen with the main reason of forgetfulness (53%), afraid of pain (31%) and uncertain \non administration methods (9%). In addition, it was found that patients who were previously counselled on insulin injection \ntechnique in their own mother tongue performed good demonstration technique, p<0.05. From lifestyle aspect, 76% patients \ndid not comply with diabetic diet and only 8 patients exercise. Regarding patients\u2019 awareness, 81% had poor awareness on \ndiabetic complications and importance of glycemic control which related proportionally to their appointment with doctor in \naddition to blood glucose monitoring frequency, p<0.05.\nCONCLUSION: There are several factors leading to uncontrolled diabetes mellitus including poor awareness on disease \ncondition\tas\twell\tas\tSMBG,\tcompliance,\tcomorbidities\tand\tlifestyle\tmodification.\tFurther\twork\tinvolving\timplementation\t\nof\teducation\tand\tmodified\tspecialized\tcounselling\tsession\tcan\tbe\tdone\tto\treduce\tthe\tincidence\tof\tDM\tadmission\tin\tSegamat\t\nHospital.\n\n\n\nKEYWORDS: pharmacy practice; Johor; diabetes mellitus\n\n\n\nPP19 (Poster)\nKNOWLEDGE IN THE PREPARATION AND ADMINISTRATION OF INTRAVENOUS MEDICATION AMONG \nNURSES IN SURGICAL WARDS AT RAJA PEREMPUAN ZAINAB II HOSPITAL, KELANTAN\n\n\n\nChe WFC, Muhammad NS, Wan AR, Mustapha NM\nDepartment of Pharmacy, Raja Perempuan Zainab II Hospital, Kota Bharu, Kelantan\n\n\n\nINTRODUCTION: Life threatening errors have been associated with intravenous (IV) medications.\nOBJECTIVES: To assess the knowledge on the preparation and administration of IV medications among nurses in surgical \nwards at Hospital Raja Perempuan Zainab II.\nMETHOD: A cross sectional study was conducted by using self-administered validated questionnaire. The questionnaires \nconsist of 2 parts namely, the knowledge in the preparation of IV medications and the knowledge in the administration of \nIV medications.\nRESULTS: Regarding the knowledge in preparation of IV medications, it was found that more than 50% of the respondents \nanswered\t correctly\t for\t general\t statement\t (statement\t 1\t to\t statement\t 7).\t Similar\t findings\t were\t obtained\t regarding\t the\t\nknowledge in the administration of IV medications where respondent answered well in the general statement (statement 10, \n11, 12 and 15) except for statement 14 in which 62.7% of nurses answered wrongly. Less than 50% of respondents obtained \ncorrect answer for calculation and dosing of IV medications.\nCONCLUSION: It can be concluded that staff nurses in surgical wards who were involved in this study had an average \nlevel of knowledge in the preparation and administration of IV medication. Training programmes for staff nurses should \nemphasise on the skills in the calculation and dosing of IV medications.\n\n\n\nKEYWORDS: pharmacy practice; Kelantan; intravenous administration \n\n\n\n\n\n\n\n\n61\n\n\n\nMALAYSIAN JOURNAL OF PHARMACY Vol. 2. Issue 2. August 2016\n\n\n\nPP20 (Poster)\nIMPACT OF HEALTH LITERACY TOWARDS THE UNDERSTANDING AND PREFERENCES OF \nPRESCRIPTION DRUG LABELS AMONG ADULTS AT OUTPATIENT PHARMACY SULTANAH BAHIYAH \nHOSPITAL\n\n\n\nKassim MSA, Rahim ASN, Jelani ALH, Shabudin AA, Hong YW, Kok YS\nDepartment of Pharmacy, Hospital Sultanah Bahiyah, Alor Setar, Kedah\n\n\n\nINTRODUCTION: Literature on association between health literacy and understanding of prescription drug label is still \nscarce in Malaysia.\nOBJECTIVES: This study aimed to examine the associations between patients\u2019 health literacy level and socio demographic \nfactors with understanding of prescription drug labels and label format preferences, respectively.\nMETHOD: Adult subjects were recruited from Outpatient Pharmacy HSB from June to August 2015. Their health literacy \nlevels were assessed using Rapid Estimate of Adult Literacy in Medicine-Revised (REALM-R), Malay language version. \nRespondents\twere\tscored\tif\tthey\tcan\tcorrectly\tstate\tthe\tdose,\tfrequency,\tand\ttiming\tfor\tfive\tdrug\tlabels,\twith\tmean\tscore\t\ncalculated to represent understanding level. Their attentiveness to extra information on the labels and ability to correctly \nshow the number of Tablet Amlodipine to take daily were also assessed. Finally they were asked on preference between two \ndrug\tlabel\tformats\t\u2013\tlabel\tA\tshowed\tthe\tdose\tand\tfrequency,\twhile\tlabel\tB\tshowed\thow\tmuch\tdrug\tto\ttake\tat\ta\tspecific\ttime.\nRESULTS: There were 208 respondents involved, who were mostly male, aged between 18-29 years old, of Malay ethnicity, \nsecondary school educated, working in private sector, earning monthly household income between RM 1000-2000 and not \non any medication. For each drug label, more than 85% respondents scored full marks of three, with mean score of 2.85 \n(SD 0.252), but most did not notice the extra information. Meanwhile, 97.6% were able to demonstrate the correct number \nof tablet Amlodipine to take daily. Majority respondents (56.2%) prefer label B because easier to comprehend. There were \nsignificant\tassociations\tbetween\teach\trespondents\u2019\thealth\tliteracy\tlevel\tand\tsocio\tdemographic\tfactors\twith\tunderstanding\t\nof prescription drug labels and label format preferences, respectively.\nCONCLUSION: There is a need to improvise prescription drug label format so to highlight the extra essential information \nand to suit patients from different health literacy levels and socio-demographic backgrounds.\n\n\n\nKEYWORDS: pharmacy practice; Kedah; health literacy; drug labels\n\n\n\nPP21 (Poster)\nEXPANDING ROLE OF OUTPATIENT PHARMACY: A PHARMACY CARE PROGRAMME\n\n\n\nZainuddin M, Mohamad NA, Ng TW, Mohammad FV, Ainsha SNA\nHospital Sultanah Nur Zahirah, Kuala Terengganu, Terengganu\n\n\n\nINTRODUCTION: Medication\t wastage\t has\t a\t huge\t impact\t in\t terms\t of\t financial\t cost\t or\t environmental.\t Poor\t patient\t\nunderstanding of own medications was considered as the factor causing noncompliance which leads to medicine wastage.\nOBJECTIVES: This study aimed to evaluate the effectiveness of medication card to improve patient\u2019s knowledge on \nmedications and the amount of cost saving achieved through drug reconciliation.\nMETHOD: An interventional study was conducted at the Outpatient Pharmacy Department, Hospital Sultanah Nur Zahirah \nfrom\tJanuary\t2014\tto\tJune\t2014.\tPatients\twho\tfulfilled\tthe\tfollowing\tcriteria\twere\tselected\tby\tconvenient\tsampling:\tchronic\t\ndiseases, on at least three medicines and with at least two months duration of prescription. A pocket-sized medication card \ncontaining patient\u2019s demographic details, list of current medications and indications for each medication was prepared \nand given to patients during dispensing. Patient\u2019s knowledge on own medications was determined by Dose, Frequency, \nIndication and Method of Administration (DFIT) score before and after the Pharmacy Care Programme. Cost saving was \ncalculated by deducting cost of full supplied medications with cost of medications through this programme. \nRESULTS: A total of 92 patients were included (male: 54.3%; mean age= 59 years old). Baseline means DFIT score was \n75.14%\tand\tfound\tto\tbe\tsignificantly\timproved\tafter\tthe\tPharmacy\tCare\tProgramme\t(p<\t0.001).\tA\ttotal\tof\tRM\t2488.93\t\nwas\tsaved\tthrough\tthis\tprogramme.\tA\ttotal\tof\t453\texpired\tmedications\twere\tidentified\twhich\tincluded\tanti-diabetics,\tanti-\nhypertensives and cardiovascular medication.\nCONCLUSION:\tThe\t introduction\tof\tPharmacy\tCare\tProgramme\thas\tsignificantly\t improved\tpatient\u2019s\tunderstanding\ton\t\nmedications and has reduced the cost of medication supply. Hence, this programme can be implemented.\n\n\n\nKEYWORDS: pharmacy practice; Terengganu; pharmacy care program, DFIT score, cost reduction\n\n\n\n\n\n\n\n\nMALAYSIAN JOURNAL OF PHARMACY Vol. 2. Issue 2. August 2016\n\n\n\n62\n\n\n\nPP22 (Poster)\nASSESSMENT OF CLINICAL OUTCOMES OF WARFARIN THERAPY IN TWO MODELS OF \nANTICOAGULATION SERVICES\n\n\n\nChin SC, Shafie\tSD, Koon HL, Ee LC, Ying WH, Muhamad Noor SNA\nDepartment of Pharmacy, Hospital Kajang, Selangor\n\n\n\nINTRODUCTION: Quality of anticoagulation control is commonly expressed by time spent in the therapeutic international \nnormalized ratio range (TTR). It is important to ensure optimal outcome during therapy because the high variability of INR \nis associated with adverse outcomes.\nOBJECTIVES: To assess the clinical outcomes of warfarin therapy in Warfarin MTAC and usual care clinic in Hospital \nKajang.\nMETHOD: A cross-sectional study with 78 randomly sampled patients from physician (MOPD)- and pharmacist (MTAC)-\nmanaged anticoagulation clinics was carried out from May 2013 to May 2014. The primary outcome was the percentage \nof time patients\u2019 INR was in the therapeutic range (TTR). Secondary outcomes were the percentage of time in therapeutic \nrange within \u00b1 0.2 units of the recommended range (expanded TTR), episodes of haemorrhagic and thromboembolic \ncomplications, patients\u2019 compliance and defaulter rate.\nRESULTS: The majority of warfarin patients were male patients (45.5% in MTAC vs. 64.4% in MOPD) with Malays \npatients as the main population. The TTR was 66.6% for MTAC and 45.5% for MOPD patients (p<0.001). The expanded \nTTR\tfor\tMTAC\twas\t79%\tand\t55.8%\tfor\tMOPD\t(p<0.001).\tThere\twas\tno\tsignificant\tdifference\tbetween\tMTAC\tand\tMOPD\t\npatients\t in\t terms\tof\tcomplications\tof\twarfarin\t therapy.\tThe\tcompliance\tscore\tshowed\tsignificant\tdifference\twith\tMTAC\t\npatients\tscored\t1.45\tand\tMOPD\tpatients\tscored\t2.29(p=0.002).\tThe\tdefaulter\trate\twas\tsignificantly\tlower\tin\tMTAC\t(3%)\t\nvs. MOPD (22%) (p=0.038).\nCONCLUSION: The\t pharmacist-managed\t anticoagulation\t programme\t achieved\t significantly\t better\t INR\t control\t as\t\nmeasured by the percentage of time patients\u2019 INR values kept in both the therapeutic and expanded range, compliance score, \nand defaulter rate. It also offers a safe and effective programme that is important in a multidisciplinary setting with respect \nto growing service needs of patients.\n\n\n\nKEYWORDS: clinical pharmacy; Selangor; MTAC WARFARIN; TTR; INR\n\n\n\nPP23 (Poster)\nAWARENESS OF BREAST CANCER AMONG SURGICAL FEMALE PATIENTS IN SULTAN ABDUL HALIM \nHOSPITAL\n\n\n\nRanita K, Teoh CJ, Leong YY, Ng WC\nDepartment of Pharmacy, Hospital Sultan Abdul Halim, Sungai Petani, Kedah\n\n\n\nINTRODUCTION: Breast cancer is the commonest cancer among women worldwide. About one in nineteen women in \nMalaysia are at risk, compared to one in eight in Europe and the United States.\nOBJECTIVES: To assess patients\u2019 knowledge of risk factors, symptoms and methods of screening of breast cancer. To \ndetermine their perception towards the disease treatment outcomes.\nMETHOD: A cross-sectional survey using validated self-administered questionnaire was conducted among 119 consecutive \nsurgical female patients admitted from 1st of September 2015 to 8th of October 2015 in Hospital Sultan Abdul Halim, \nKedah. Patients were required to answer 8 questions on demographic characteristics, 22 questions on knowledge of breast \ncancer and 5 questions related to their perception towards breast cancer treatment outcomes. Data was analysed using \nGeneral linear regression and Spearman\u2019s correlation with Statistical Package for Social Science (SPSS) version 20. \nRESULTS: Mean (SD) age was 40.6 (15.1) years and majority of the patients were Malay, 106(89.1%). Mean score for \ngeneral knowledge, risk factors and symptoms of breast cancer were 50.2(24.0%), 43.0(22.9%) and 64.4(28.4%) respectively. \nMean total knowledge score was 52.1(19.7%). 80(67.2%) and 55(46.2%) of patients were aware of self breast examination \nand clinical breast examination recommendations respectively. Generally, patients had positive perceptions towards breast \ncancer\ttreatment\toutcomes.\tHowever,\tmajority\t(59.7%)\tthink\tthat\tit\tis\ta\tlong\tand\tpainful\tprocess.\tKnowledge\twas\tsignificantly\t\nbetter among married patients with spouse (p=0.046), those with personal history of breast cancer (p=0.022) and with personal \nmonthly\tincome\t(p=0.001)\twith\tthe\tcoefficient\tof\tdetermination,\tR2=0.16.\tSpearman\u2019s\tcorrelation\ttest\tshowed\ta\tsignificant\t\npositive relationship between monthly personal income and breast cancer awareness (r = 0.343, p <0.001).\nCONCLUSION: Overall, awareness of breast cancer among patients is poor. Thus, there is a need for awareness programmes \nto educate women about breast cancer and to promote early detection of breast cancer.\n\n\n\nKEYWORDS: pharmacy education; Kedah; breast cancer; risk factors; symptoms\n\n\n\n\n\n\n\n\n63\n\n\n\nMALAYSIAN JOURNAL OF PHARMACY Vol. 2. Issue 2. August 2016\n\n\n\nPP24 (Poster)\nQUANTITY AND QUALITY OF PATIENTS\u2019 OWN MEDICATIONS BROUGHT DURING ADMISSION:  \nA STUDY FROM DISTRICT HOSPITAL PERSPECTIVE\n\n\n\nMohd Surahman NNH, Woo YP, Jemu MS, Pan HC, Yap DFS\nDepartment of Pharmacy, Hospital Enche\u2019 Besar Hajjah Khalsom, Kluang, Johor\n\n\n\nINTRODUCTION: Patients\u2019\tOwn\tMedications\t(POMs)\tis\tdefined\tas\tthe\tmedications\tthat\tpatient\tbrings\tinto\tthe\thospital\t\nduring admission to the wards. Local guidelines encourage the use of POMs if deemed suitable as it minimizes medication \nwastage, promotes budget saving and assists in the generation of more precise medication history that may improve \nprescribing accuracy. However, POMs are not necessarily to be re-usable and safe. To date, Malaysian data pertinent to the \nprevalence of patients who bring POMs during their admission and the inspection on the usability of POMs is scarce. \nOBJECTIVES: This study was conducted to assess the quantity and quality of POMs brought to the hospital during \nadmission. The association between patients\u2019 sociodemographic data and the quality of POMs was also explored. \nMETHOD: A cross-sectional study was conducted among medical inpatients in Kluang Hospital. The quantity of POMs \n(number of patients who brought POMs upon admission and the number of POMs brought) and quality of POMs (intact \npackaging, storage, expiration date, physical or chemical deterioration and labelling) were evaluated by adapting structured \ndata collection sheets. POMs that meet all the criteria on quality were regarded to be safe for in-hospital use.\nRESULTS: From November 2015 to January 2016, 106 patients were recruited in the study and 327 POMs were assessed. \nIn total, 60.4% (n=64) of patients brought POMs to the hospital. Of which, only 59.3% (n\u2019=194) of POMs were considered \nsafe\tfor\tin-hospital\tuse.\tA\tsignificant\tassociation\twas\tobserved\tbetween\tgender\tand\tthe\tquality\tof\tPOMs\t(c2= 6.69; p=0.01). \nCONCLUSION: A moderate prevalence of patients brought their POMs upon admission and only half of the POMs \nwere deemed safe for use. Incorporating proactive strategies to encourage patients to bring their POMs and establishing \ninstitutional\tpolicies\tto\taddress\tthe\tsafe\tand\tefficient\tuse\tof\tPOMs\tis\tstrongly\tindicated.\n\n\n\nKEYWORDS: pharmacy practice; Johor; patients\u2019 own medication; admission\n\n\n\nPP25 (Poster)\nASSOCIATION BETWEEN KNOWLEDGE AND MEDICATION ADHERENCE AMONG HYPERTENSIVE \nPATIENTS IN RAJA PEREMPUAN ZAINAB II HOSPITAL, KELANTAN\n\n\n\nSaid SH, Azmi NL, Mohamed NNS, Nyew SC, Chia SL, Mustapha NHA\nDepartment of Pharmacy, Hospital Raja Perempuan Zainab II, Kota Bharu, Kelantan\n\n\n\nINTRODUCTION: There is an increasing trend on the prevalence of hypertension among the adult population aged 30 \nyears and above in Malaysia from 32.9% in National Health and Morbidity Survey (NHMS) II to 42.6% in NHMS III survey. \nHowever, limited information is available with regards to patients\u2019 knowledge on their hypertension treatment and attitude \nto treatment.\nOBJECTIVES: The\tspecific\tobjective\tfor\tthis\tresearch\tis\tto\tidentify\tthe\tdegree\tof\thypertension-related\tknowledge\tand\tanti-\nhypertensive medication adherence among patients. Besides, it is to determine the association between patients\u2019 knowledge \non hypertension and anti-hypertensive medication adherence.\nMETHOD: A cross-sectional study was carried out with 117 hypertensive patients admitted in three medical wards \nin Hospital Raja Perempuan Zainab II, Kota Bharu. Besides demographic and disease related questions, two validated \nquestionnaires (Hypertension Fact Questionnaire and 8-Items Morisky Medication Adherence Scale) were used for data \ncollection.\nRESULTS: Out of 117 patients, 78 patients (66.7%) had average knowledge of hypertension. However, 63 patients \n(53.8%) achieved poor adherence to anti-hypertensive regime. 19 patients out of the study showed good adherence to anti-\nhypertensive\tregimen.\tCorrelation\tcoefficient\tbetween\ttotal\tscore\tof\tknowledge\tand\ttotal\tscore\tof\tadherence\twas\t28.3%\t\n(p<0.001), indicating a proportional association between knowledge and level of medication adherence.\nCONCLUSION: Our study concluded that patients\u2019 level of knowledge about hypertension was average and had poor \nadherence\t to\t antihypertensive\t regimen.\t Thus,\t educating\t patient\t about\t the\t benefits\t of\t antihypertensive\t medication\t and\t\nclarifying doubts regarding treatment regime should results in better adherence to antihypertensive medications.\n\n\n\nKEYWORDS: pharmacy practice; Kelantan; knowledge; adherence; hypertension\n\n\n\n\n\n\n\n\nMALAYSIAN JOURNAL OF PHARMACY Vol. 2. Issue 2. August 2016\n\n\n\n64\n\n\n\nPP26 (Poster)\nKNOWLEDGE, ATTITUDES, AND PRACTICE OF PHARMACISTS AND DOCTORS TOWARD NUTRITION \nSUPPORT\n\n\n\nNazif SAI, Shahida K, Fatin AMZ, Noor HO\nDepartment of Pharmacy, Hospital Raja Perempuan Zainab II, Kota Bharu, Kelantan\n\n\n\nINTRODUCTION: Malnutrition is an acute or chronic state of nutrition in varying degrees of malnutrition with or without \ninflammatory\tactivity\tled\tto\ta\tchange\tin\tbody\tcomposition\tand\tdiminished\tfunction.\tNutritional\tsupport\tplays\tan\tintegral\tpart\t\nin\tthe\ttreatment\tand\thas\ta\tnumber\tof\tclinical\tbenefits.\tInsufficient\teducation\tand\tknowledge\tabout\tnutrition\twas\tidentified\t\nas the second major barrier for proper nutritional care.\nOBJECTIVES: To evaluate the knowledge, attitudes and practices (KAP) toward nutrition support in Hospital Raja \nPerempuan Zainab II (HRPZ II) between healthcare providers.\nMETHOD: A cross-sectional study of doctors and pharmacists working at HRPZ II that were involved in nutritional support \nfrom October 2015 \u2013 January 2016 were conducted. A validated self-administered questionnaire was distributed to doctors \nand pharmacists through convenience sampling method. \nRESULTS: Total of 117 respondents (57 doctors; 60 pharmacists) from various grades completed the questionnaire with \nresponse rate of 72%. 83 respondents were local graduates and 70.9% of respondents were less than 5 years in service. More \npharmacists\t (93.3%)\thave\ta\tbetter\tknowledge\t than\t the\tdoctors\t (80.7%)\tbut\t statistically\tnot\t significant.\tLocal\tgraduates\t\nhave higher (85.5%) average knowledge compared to overseas graduate (67.6%). In addition, both pharmacists and doctors \nhave\tambivalent\tattitude\ttoward\tnutrition\tsupport\t(46.7%\tvs.\t52.6%).\tSignificantly\tmore\tdoctors\t(91.2%)\tthan\tpharmacists\t\n(70.0%) did screening patient\u2019s nutrition status on admission. \nCONCLUSION: Overall, both doctors and pharmacist showed average knowledge and ambivalence attitude toward \nnutrition support with good nutrition practice.\n\n\n\nKEYWORDS: pharmacy practice; Kelantan; nutrition support; malnutrition\n\n\n\nPP27 (Poster)\nEVALUATION OF THE RISK FACTORS FOR EFFICACY AND NEPHROTOXICITY OF POLYMYXIN FOR \nTREATMENT OF MULTIDRUG RESISTANT ACINETOBACTER SPP. IN KAJANG HOSPITAL\n\n\n\nChin SC,\tShafie\tSD,\tSamudi\tAN,\tRamalingam\tT\nDepartment of Pharmacy, Hospital Kajang, Selangor\n\n\n\nINTRODUCTION: Polymyxins are reserved for salvage therapy of infections caused by multidrug resistant Acinetobacter \nbaumannii.\tNumerous\tstudies\thave\t investigated\ton\t the\tefficacy\tand\tsafety\tprofile\tof\tpolymyxins\t for\tmultidrug\tresistant\t\nAcinetobacter Baumannii.\nOBJECTIVES: This study describes outcomes including mortality and nephrotoxicity for patients with MDR Acinetobacter \nbaumannii infections who were treated with colistin monotherapy with its associated risk factors.\nMETHOD: We retrospectively reviewed the medical records of patients with MDR resistant Acinetobacter infections \nwho received colistin monotherapy from 2012 to 2016. The clinical, microbiology and history of antimicrobials data were \ncollected.\tThe\trisk\tfactors\tfor\ttreatment\tfailure\twere\tidentified\tby\tlogistic\tregression.\nRESULTS: A total of 40 patients were included in the analysis. There were only 35% (n=14) of patients achieved clinical \ncure\tas\tdefined\tby\tclinician-documented\timprovement\tin\tsigns\tand\tsymptoms\tof\tinfections\twhereas\t37.1%\t(n=13)\tof\tpatients\t\ndeveloped nephrotoxicity. APACHE II score was found to be an independent risk factor for mortality (OR=1.272; p=0.003) \namong all other risk factors such as age, impaired renal function, days of ventilation, diabetes, hypertension and sepsis were \nnot found to increase the risk of mortality. Patients with comorbidity such as hypertension (OR=4.815; p=0.046) or diabetes \n(OR=1.272;\tp=0.034)\thave\tsignificantly\thigher\trisk\tof\tdeveloping\tnephrotoxicity.\tOther\trisk\tfactors\tsuch\tas\tage,\timpaired\t\nrenal function, days of ventilation, and sepsis were not found to increase the risk of nephrotoxicity.\nCONCLUSION: From this study it could not be concluded that mortality in patients treated with colistin was ineffective \npartly because a higher APACHE II score prior to treatment might affect patients\u2019 prognosis. More samples may be needed \nto predict mortality and nephrotoxicity associated with colistin therapy.\n\n\n\nKEYWORDS: clinical pharmacy; Selangor; polymixin; colistin; nephrotoxicity\n\n\n\n\n\n\n\n\n65\n\n\n\nMALAYSIAN JOURNAL OF PHARMACY Vol. 2. Issue 2. August 2016\n\n\n\nPP28 (Poster)\nANTIBIOTIC SENSITIVITY PATTERN OF BACTERIA ISOLATED FROM ORTHOPAEDIC SURGICAL WARD \nIN KUALA KRAI HOSPITAL\n\n\n\nRosnani AR, Ahmad SA, Muhammad IAA, Low CR, Yong YK, Yit TL, Dir RMK\nDepartment of Pharmacy, Hospital Kuala Krai, Kelantan\n\n\n\nINTRODUCTION: Orthopedic and surgical infection are common in hospitals and emergence of high antibiotic resistance \namong\tbacterial\tpathogens\thas\tmade\tthe\tmanagement\tof\tthe\tinfections\tdifficult.\tIt\tis\tknown\tthat\tspecific\ttherapeutic\toptions\t\nmainly depends on data from antibiotic susceptibility tests.\nOBJECTIVES: To determine the antibiotic sensitivity pattern of bacteria isolated from patients in orthopedic/surgical ward \nof Hospital Kuala Krai (HKK).\nMETHOD: A cross-sectional study was carried out based on reports of bacteria isolates from the ortho/surgical wards of \nHKK from January 2012 till December 2014. All samples were collected aseptically and plated right after the collection. The \ndata was generated using \u201cWhonet\u2019\u2019 software and analysed by SPSS Version 18.\nRESULTS: Bacterial growth was seen in 707 of the patients and involved 778 of bacterial isolates. The most frequently \nisolated bacteria were Staphylococcus aureus (24.4%), Escherichia coli (16.8%), Pseudomonas aeruginosa (15.1%) and \nKlebsiella pneumonia (14.1%). Drug resistance of Staphylococcus aureus showed the highest rate towards Penicillin G \nwhile Escherichia coli and Klebsiella pneumonia had the highest rate to Co-Trimoxazole. Vancomycin remained as the \nmost sensitive antibiotic towards MRSA while Meropenem had highest sensitivity towards Escherichia coli and Klebsiella \npneumonia. Amikacin remain its absolute sensitivity towards Pseudomonas aeruginosa. Increasing resistant rate of gram \nnegative bacteria was seen towards Cephalosporin but at a rate of <30%.\nCONCLUSION: Staphylococcus aureus, Escherichia coli and Pseudomonas aeruginosa were then common isolated bacteria. \nCephalosporin remains as the drug of choice in orthopedic and surgical infections due to its moderate resistance rate.\n\n\n\nKEYWORDS: clinical pharmacy; Kelantan; antibiotic sensitivity pattern; orthopaedic ward; surgical ward\n\n\n\nPP29 (Poster)\nMEDICATION RECONCILIATION IN THE AMBULATORY PHARMACY SETTING IN HPSF MUAR\n\n\n\nSiti AMR, Mohd Fauzan S, Helwa H, Ng SS, Isabel Lau SY, Lau CH, Heng SL\nDepartment of Pharmacy, Hospital Pakar Sultanah Fatimah, Muar, Johor\n\n\n\nINTRODUCTION: Medications are vital for patient care; however, they may result in fatal mortality and morbidity when \ntaken incorrectly. Medication reconciliation is a format process of creating the most complete and latest list of patients\u2019 \ncurrent medications and comparing the list to the patients\u2019 prescriptions, records or medication orders. \nOBJECTIVES: The goal of this study is to describe medication error incidence and the prevalence of prescribed medication \ndiscrepancies and patient regimen differences.\nMETHOD: This cross-sectional study involves a descriptive study of prescribing practises. A systemic sampling method \nwas adopted where every 10th of the prescriptions form Medical Outpatient Clinic was collected. A total of 300 prescriptions \nwere studied. All the patients\u2019 details and relevant information including the demographic data, visit history, past medication \nhistory, medication adherence and other relevant data were recorded in the Data Collection Form.\nRESULTS: Among\t 300\t prescriptions,\t 146\t were\t identified\t with\tmedication\t discrepancies.\t From\t the\t discrepancies,\t 38\t\nwere\tconfirmed\twith\tmedication\terrors.\t10\terrors\twere\tidentified\tin\tpatient\u2019s\tnew\tprescriptions,\t3\terrors\twere\tidentified\tin\t\nPatient\u2019s record book and 5 other errors were found in the computerized dispensing system. Meanwhile, the remaining 20 \nerrors\tconsist\tof\tpatient\u2019s\town\tmistakes.\tThere\twere\tno\tstatistically\tsignificant\tdifferences\tbetween\tmedication\tdiscrepancies\t\nwith prescribers experience (p=0.156), patients\u2019 adherence level (p=0.694), motivation level (p=0.670) or even knowledge \nscale (p=0.565).\nCONCLUSION: The prevalence of medication discrepancies in an ambulatory pharmacy setting in HPSF Muar is 48.7%. \nDespite\tthe\tinsignificance\tof\tthe\tresults,\tthis\tstudy\treflects\tthe\tpresence\tof\tmedication\terrors\tin\tambulatory\tcare\tsetting\tand\t\ndue to the vulnerabilities for medication errors in the hospital, medication reconciliation rises to be a major component of \nsafe patient-care. Pharmacists, often being the last healthcare professionals seen by patients have a major responsibility in \npreventing medication errors.\n\n\n\nKEYWORDS: pharmacy practice; Johor; medication reconciliation; ambulatory pharmacy; medication discrepancies\n\n\n\n\n\n\n\n\nMALAYSIAN JOURNAL OF PHARMACY Vol. 2. Issue 2. August 2016\n\n\n\n66\n\n\n\nPP30 (Poster)\nREVISITING MEDICATION ADMINISTRATION ERRORS IN MEDICAL WARD AT MELAKA HOSPITAL\n\n\n\nShah MD1, Manan MM2\n\n\n\n1Department of Pharmacy, Hospital Alor Gajah, Melaka, 2Faculty of Pharmacy, Universiti Teknologi MARA\n\n\n\nINTRODUCTION: Medication errors commonly detected and stopped in the early stages of medication processing \n(prescribing and preparing the medication). However, medication administration itself has less safeguard mechanisms \nagainst errors. \nOBJECTIVES: The study aimed to examine the frequency, type and factors contributing to medication administration \nerrors.\nMETHOD: Prospective, non-intervention study using the disguised direct observation technique was used for detecting \nmedication administration errors in six medical wards in a public hospital. All drugs supplied from ward pharmacy were \nscreened and corrected before reached the ward. The observation was made by clinical pharmacist in the designated wards \nduring administration of drug on three drug rounds per day for the duration of 14 working days from September to December \n2014. Multiple logistic regressions were applied to determine the associated factors in error rate.\nRESULTS: The current administration rate is 11.5% (76/659), was lower compared to the previous study in 2009 (48%). \nHowever if time error is excluded, then the rate is higher (9.3%) as compared to 2009 (4.9%). The most frequent drug \nadministration errors by category were technique error, 53.9% (41/76) followed by wrong time errors, 19.7% (15/76), and \nomission errors, 18.4% (14/76). In multivariate analysis, ward, Anatomical Therapeutic Chemical (ATC) class, and number \nof patient under nurse\u2019s care were associated factors to MAE rate.\nCONCLUSION: Higher administration error rate (nearly 1 in every 9 doses) in the current study indicates the need to \nreview\tthe\tcurrent\tdrug\tadministration\tprocedures\tby\tthe\tnurses.\tThe\thigher\tpercentage\tof\tidentified\terrors\tmust\tbe\tviewed\t\nseriously and the collaboration among all healthcare professionals is essential to ensure consistent quality of care and safety \nof patients.\n\n\n\nKEYWORDS: pharmacy practice; Melaka; medication administration errors; medication errors\n\n\n\nPP31 (Poster)\nASSESSMENT OF ADHERENCE AND BELIEF AMONG HIV PATIENTS TO HIGHLY ACTIVE \nANTIRETROVIRAL THERAPY (HAART) IN RVDMTAC TUANKU FAUZIAH HOSPITAL\n\n\n\nSyed ASS, Chong JL, Che Lah J\nDepartment of Pharmacy, Hospital Tuanku Fauziah, Kangar, Perlis\n\n\n\nINTRODUCTION: Beliefs\t about\tmedications\t and\t perception\t on\t their\t benefits\t have\t a\t high\t influence\t on\t the\t patients\u2019\t\nmedication taking behaviour. \nOBJECTIVES: This study was to determine the relationship between the patients\u2019 belief to HAART and the level of control \nof their disease and their adherence.\nMETHOD: A cross sectional study was carried out over 17 week\u2019s period (13 May 2015 till 2 September 2015) at the \nRetroviral Medication Therapy Adherence Clinic. Morisky Medication Adherence Scale (MMAS-8) and Beliefs about \nmedicines questionnaire (BMQ) were used to measure patients\u2019 adherence and belief towards their medications.\nRESULTS:\tA\ttotal\tof\t80\tpatients\tmet\tthe\tcriteria\twith\tthe\tresponse\trate\tof\t74%.\tThere\twas\ta\tstatistical\tsignificant\tmoderate\t\nnegative\tcorrelation\tbetween\tBMQ\tspecific\tnecessity\tscores\tand\tBMQ\tspecific\tconcern\tscores.\tOnly\t16%\tof\tpatients\thad\t\nlow adherence to their HAART which was in conjunction with the 17% of the patients who did not have their HIV viral \ncounts\tunder\tcontrolled.\tA\tstatistical\tsignificant\tdifference\twas\tfound\tbetween\tthe\tpatients\u2019\tBMQ\tspecific\tnecessity\tscores\t\nand the level of control of their disease (HIV viral load).\nCONCLUSION: The patient\u2019s beliefs about the necessity of their HAART would lead to good adherence and satisfactory \ndisease control. They would become less concerned about the potential adverse effects if they had positive beliefs in their \nmedications. \n\n\n\nKEYWORDS: pharmacy practice; Perlis; RVD MTAC; BMQ; MMAS-8\n\n\n\n\n\n\n\n\n67\n\n\n\nMALAYSIAN JOURNAL OF PHARMACY Vol. 2. Issue 2. August 2016\n\n\n\nPP32 (Poster)\nDEVELOPMENT OF IN-HOUSE RADIOLABELLING PROCESS OF LUTETIUM-177-LABELLED \nSOMATOSTATIN ANALOGUES USING HEPES BUFFER SYSTEM\n\n\n\nMuhammad SAH1, Mohamad FAA2, Mohamad HAR1, Noridayu R2, Mohd Khairul NCAH1\n\n\n\n1Department of Pharmacy, National Cancer Institute, Putrajaya 2Department of Nuclear Medicine, National Cancer Institute, \nPutrajaya \n\n\n\nINTRODUCTION: Peptide Receptor Radionuclide Therapy (PRRT) with Lutetium-177 (177Lu)-labelled somatostatin \nanalogues are now the therapy option for patients who have failed to respond to conventional medical therapy. The \nsomatostatin analogues being used for this therapy are DOTATATE and DOTATOC, all of which are labelled via the DOTA \nchelator to 177Lu.\nOBJECTIVES: Radiolabelling\tand\tpurification\tof\tthese\tradiopharmaceuticals\tcan\tsuccessfully\tbe\tcarried\tout\tmanually\tin\t\nthe laboratory. Recent reports have claimed a superior performance of HEPES buffer in comparison to alternative buffer \nsystems for 177Lu labelling in aqueous media. In this paper we report radiolabelling study on Lu3+/HEPES system (HEPES=N-\n2-hydroxyethylpiperazine-N\u2019-2-ethanesulfonic acid) performed with the aim of elucidating a potential contribution of \nHEPES in the 177Lu radiolabelling process.\nMETHOD: Small-scale radiolabelling (5.32 \u2013 8.99 mCi) of 177Lu-DOTATATE (n=2) and 177Lu-DOTATOC (n=2) were \nperformed by adding approximately 125 mcg of peptide to a 177Lu chloride solution. The solution was buffered by HEPES \nbuffer to pH 4.0 and was heated at 100\u00b0C for 20 minutes. As comparison, a duplicate radiolabelling solution (3.33 \u2013 \n3.71mCi) of 177Lu-DOTATATE (n=2) and 177Lu-DOTATOC (n=2) were prepared using sodium acetate (NaOAc) buffer \nsystem (buffered to pH 5.0). Radiochemical purity was assessed by radio-thin-layer chromatography systems.\nRESULTS: Radiochemical purity of 177Lu radiolabelled complexes using HEPES and NaOAc buffer system was 98.25% \n(n=4) and 98.93% (n=4), respectively.\nCONCLUSION: Radiolabelling process of 177Lu with somatostatin analogues by using HEPES buffer system was \ncomparable with NaOAc buffer system. HEPES buffer system appears suitable for use in clinical preparations of 177Lu \nradiolabelled complexes in our institution.\n\n\n\nKEYWORDS: pharmacy education; Putrajaya; lutetium; radiolabelling\n\n\n\nPP33 (Poster)\nADHERENCE TO DISEASE MODIFYING ANTI-RHEUMATIC DRUGS IN RHEUMATIC ARTHRITIS \nPATIENTS AND ASSOCIATED FACTORS FOR NON-ADHERENCE\n\n\n\nKomeng S2, Goon WX2, Puvaneswari N2, Sindumathi R2, Mohd Noor N1\n\n\n\n1Department of Medicine, Unit of Rheumatology Hospital Tuanku Ja\u2019afar Seremban, Negeri Sembilan 2Department of \nPharmacy, Hospital Tuanku Jaafar Seremban, Negeri Sembilan\n\n\n\nINTRODUCTION: The adherence rate of Rheumatoid Arthritis (RA) patients to Disease Modifying Anti-Rheumatic \nDrugs (DMARDs) in Malaysia is unknown. Previous studies in Caucasian populations showed adherence rates ranging \nfrom 20% to 50%.\nOBJECTIVES: To assess adherence rate and factors associated with non-adherence to DMARDs in RA patients in Hospital \nTuanku Ja\u2019afar Seremban (HTJS).\nMETHOD: A cross-sectional study was conducted with RA patients who presented to Rheumatology Clinic, HTJS between \nOctober to December 2014. Assessment tools were Compliance Questionnaires of Rheumatology (CQR), Health Assessment \nQuestionnaire Disability Index (HAQ-DI) and Beliefs in Medicine Questionnaires (BMQ). Disease activities were assessed \nvia DAS28-ESR.\nRESULTS: A total of 123 completed questionnaires were analysed. Based on DAS28-ESR, n=65 (52.8%) of the respondents \nhad moderate disease activity with mean (SD) of 4.40 (\u00b11.40). The HAQ-DI score median (IQR) was 0.75 (1.25) and \nthe median (IQR) for duration of disease was 8 (8). Adherence rates to DMARDs in our study were n=6 (149.6%). The \ncorrelations\t between\t adherence,\t HAQ-DI\t (r\t =\t -0.20)\t and\t BMQ\t specific\t (r=\t -0.19)\t are\t weak\t but\t both\t are\t statistically\t\nsignificant\t(p<0.05).\tAge,\tgender,\tethnicity,\teducation\tlevel,\tmarital\tstatus,\temployment\tstatus,\thousehold\tincome,\tnumber\t\nof\tDMARDs,\tdisease\tduration\tand\tdisease\tactivity\tshowed\tno\tsignificant\tcorrelation\tto\tadherence.\nCONCLUSION: The adherence rate in our patients was comparable to Caucasian populations and non-adherence was \nassociated with poor functional status and negative belief in necessity of medication.\n\n\n\nKEYWORDS: pharmacy practice; Negeri Sembilan; adherence; rheumatoid arthritis; DMARDs\n\n\n\n\n\n\n\n\nMALAYSIAN JOURNAL OF PHARMACY Vol. 2. Issue 2. August 2016\n\n\n\n68\n\n\n\nPP34 (Poster)\nLEVEL OF PATIENT\u2019S KNOWLEDGE ON WARFARIN THERAPY AND ANTICOAGULATION CONTROL IN \nALOR GAJAH HOSPITAL\n\n\n\nTeo YH, Puspa Rajah N, Md Ali SM, Karunanithy P, Lim WC\nDepartment of Pharmacy, Hospital Alor Gajah, Melaka\n\n\n\nINTRODUCTION: Warfarin\tis\tan\tanticoagulant\tagent\tused\tin\tthe\tprevention\tand\ttreatment\tof\tatrial\tfibrillation,\tprosthetic\t\nheart valves and transient ischemic attacks. This study was done to investigate patient\u2019s understanding on their warfarin \ntherapy\tand\timpact\tof\tknowledge\ton\ttreatment\tefficacy.\t\nOBJECTIVES: To determine patients\u2019 knowledge on warfarin therapy as well as to determine the correlation between \npatients\u2019 level of warfarin therapy knowledge and their INR control. \nMETHOD: A cross sectional study was done at Pharmacy Hospital Alor Gajah, Melaka from April 2015 to September \n2015. Study involved 55 patients who were on warfarin therapy and recruited to do a self-administered questionnaire (Oral \nAnticoagulation Knowledge test, OAK) in English or Malay version. Patients\u2019 warfarin knowledge was categorised as \nhigh (>75%), moderate (50-75%) and poor (<50%). Meanwhile INR stability control was calculated by percentage of \nnumber visit where INR within range divided by the total number visits to clinic and was represented by poor control \n(<60%), moderate control (60-75%) and good control (>75%). The correlation between patient\u2019s warfarin knowledge and \nINR control was determined by Spearman correlation analysis.\nRESULTS: The mean (SD) of OAK score was 11.80 (2.5). Overall, 43 patients had moderate warfarin knowledge while 9 \npatients had poor knowledge and only 3 patients had high knowledge. On the other hand, 37 patients had poor INR control, \nwhile\t15\tpatients\thad\tgood\tINR\tcontrol.\tAnalysis\tshowed\tno\tsignificant\tcorrelation\tbetween\tpatient\u2019s\twarfarin\tknowledge\t\nand INR control. \nCONCLUSION: Most of the patients in Hospital Alor Gajah who were on warfarin therapy had moderate knowledge on \nwarfarin\tas\twell\tas\thaving\tpoor\tINR\tcontrol.\tNo\tsignificant\tcorrelation\twas\tobserved\tbetween\tpatient\u2019s\twarfarin\tknowledge\t\nand their INR control. There are still many improvements that need to be done and important points to be emphasised when \ncounselling patients on warfarin therapy.\n\n\n\nKEYWORDS: pharmacy practice; Melaka; warfarin; knowledge; anticoagulation control\n\n\n\nPP35 (Poster)\nEVALUATION ON KNOWLEDGE AND PERCEPTION REGARDING FOOD-DRUG INTERACTION AMONG \nPATIENT AT ROMPIN HEALTHCARE CLINICS\n\n\n\nShahiri AG1, Farhana S2, Julia AB3, Fadzilah MD1, Redzuan MR4, Norazmi MN2, Izzati MY1, Soon LM5\n\n\n\n1Department of Pharmacy, Klinik Kesihatan Rompin, Pahang 2Department of Pharmacy, Klinik Kesihatan Bandar Tun Razak, \nMuadzam Shah, Pahang 3Department of Pharmacy, Klinik Kesihatan Perwira Jaya, Muadzam Shah, Pahang 4Department of \nPharmacy, Klinik Kesihatan Tanjung Gemok, Rompin, Pahang 5Department of Pharmacy, Klinik Kesihatan Perantau Damai, \nMuadzam Shah, Pahang\n\n\n\nINTRODUCTION: Food and drug interactions may increase or reduce the drug effect. The interaction affects the drug \nbioavailability and varies according to the dosage, age, sex and overall health conditions.\nOBJECTIVES: To assess the knowledge and perception regarding food-drug interaction among patient as well as to \ndetermine the source of information and identify appropriate medium for public health promotion regarding food-drug \ninteraction.\nMETHOD: A cross sectional multi-centered study was conducted at the Pharmacy of Pejabat Kesihatan Daerah Rompin. A \nvalidated, self-administered questionnaires were given to the respondent while they wait for their medications to be prepared. \nSample was selected using convenience sampling. The minimum and maximum score for knowledge and perception are \n0-14 and 0-50. The association was checked by Chi-square and Fisher\u2019s exact test. The Spearman\u2019s correlation was applied \nand\tCohen\u2019s\tCriteria\twas\tused\tto\tinterpreted\tcorrelation.\tP\tvalue\tof\t0.05\tor\tless\twas\ttaken\tas\tstatistically\tsignificant.\nRESULTS: A total of 400 respondents, 166 male (41.5%) and 234 (58.5%) female responded to the questionnaire. Out of \nthe maximum possible score of 14, the mean knowledge was 6.985 (SD\u00b10.385) and respondents scored 50% on knowledge \nscore. Out of the maximum possible score of 50, the mean perception score was 37.59 (SD\u00b12.42) and respondent scored \n75%\ton\tperception.\tThere\twas\ta\tsignificant,\tpositive\tand\tfair\tcorrelation\tfor\tknowledge\tand\tperception\t(r=0.339,\tp<0.001).\t\nThe most common source of information among the respondent are pharmacy advertisement (33%) and newspaper (24.3%). \nAn appropriate medium for promotion; healthcare campaign (33.5%) and educational campaign (31.8%) were suggested by \nthe respondent to promote food-drug interaction among public.\nCONCLUSION: Respondents have good knowledge and positive perception regarding food-drug interaction. A good source \nof information and promotion helps to create understanding and awareness regarding food-drug interaction among society.\n\n\n\nKEYWORDS: pharmacy practice; Pahang; food-drug interaction; knowledge; perception\n\n\n\n\n\n\n\n\n69\n\n\n\nMALAYSIAN JOURNAL OF PHARMACY Vol. 2. Issue 2. August 2016\n\n\n\nPP36 (Poster)\nQUALITY OF CARE IN PATIENTS DISCHARGED FROM WARFARIN CLINIC TO PRIMARY CARE UPON \nSTABILIZATION OF WARFARIN THERAPY\n\n\n\nLim LSM1, Choo CSB1, Kanthasamy K1, Tan SY1, Abraham A1, Then RL1, Puah YJ1, Mohamad AMS1, Radhakrishnan S1, \nAhmad NAR1, Baharin NS2\n\n\n\n1Department of Pharmacy, Hospital Tuanku Ja\u2019afar Seremban, Negeri Sembilan, 2Department of Pharmacy, Klinik Kesihatan \nSeremban, Negeri Sembilan\n\n\n\nINTRODUCTION: High patient volume has led to many patients being discharged from hospital-based warfarin clinics to \nprimary care. This study was conducted to compare the quality of anticoagulation care when patients were transitioned from \nan integrated pharmacist-physician care to primary care upon stabilization of warfarin therapy.\nOBJECTIVES: The primary outcome was to evaluate the differences in time in therapeutic range (TTR) of international \nnormalized ratios (INRs) over a 3-month period in both facilities. The secondary outcome was to assess the incidences of \nmajor bleeding, major thromboembolism occurrences and hospitalization rates.\nMETHOD: A cross-sectional study was conducted in Warfarin Clinic, Hospital Tuanku Ja\u2019afar Seremban (HTJS) and \nKlinik Kesihatan Seremban (KKS) from September 2014 to April 2015. All patients who were eligible for discharge and \nconsented to the study were included in the study, whereupon data was collected for 3 months in each facility.\nRESULTS: Of\tthe\t33\tpatients\trecruited,\tonly\t16\tcompleted\tthe\tstudy.\tSignificant\treduction\tin\tanticoagulant\tcontrol\twas\t\nobserved upon transitioning from warfarin clinic (Median TTR=100%) to primary care (Median TTR=68%) (p<0.05, \nWilcoxon Signed-Rank Test). Using cross tabulation analysis, 94% of the patients had TTR values more than 75% (extremely \ngood control of INR) and 6% had TTR values between 60-75% before transitioning from warfarin clinic to primary care. \nAfter transition, 44% of the patients had TTR values more than 75%, with 19% having values between 60-75% and 38% \nhaving values less than 60%, indicating a drop in anticoagulation control. There were no reported major bleeding, major \nthromboembolism occurrences and incidences of hospitalization in both groups within the 3 months respectively.\nCONCLUSION: In\tconclusion,\ttransition\tof\tpatients\tfrom\twarfarin\tclinic\tto\tprimary\tcare\twas\tassociated\twith\ta\tsignificant\t\nreduction in INR control with no reported major bleeding, major thromboembolism occurrence and hospitalization.\n\n\n\nKEYWORDS: pharmacy practice; Melaka; anticoagulation care; integrated pharmacist-physician care; primary care \n\n\n\n\n\n\n\n\nMALAYSIAN JOURNAL OF PHARMACY Vol. 2. Issue 2. August 2016\n\n\n\n70\n\n\n\nNC1 (Poster)\nDEVELOPING A MODEL ON CONSUMERS\u2019 PURCHASE AND USE OF HEALTH PRODUCT: A GROUNDED \nTHEORY APPROACH (CONBE-HEPRO)\n\n\n\nTing S1, Ismail M2, Idris SF2, Sethiaram MR2, Sidek A3, Abu Seman S4, Mohd Zaki MS5, Sohot MS5, Md Ghazali MZ6, Lim \nQH6, Tang R7, Ting H8 \n1Cawangan Penguatkuasa Farmasi Sarawak, Sarawak, 2Bahagian Penguatkuasaan Farmasi, KKM, 3Cawangan Penguatkuasa \nFarmasi Kelantan, 4Cawangan Penguatkuasa Farmasi Kedah, 5Cawangan Penguatkuasa Farmasi Perak, 6Cawangan \nPenguatkuasa Farmasi Kuala Lumpur, 7Cawangan Penguatkuasa Farmasi Melaka, 8Institute of Borneo Studies, Universiti \nMalaysia Sarawak \n\n\n\nINTRODUCTION: Healthcare industry is among the most dynamic and rapidly growing industries in Malaysia. Due to \nthe enormous consumption of healthcare products, the Ministry of Health (MOH) Malaysia has developed a comprehensive \nNational Strategy for Quality Use of Medicines-Consumers (QUM-C) to promote QUM through effective self-care practices. \nNotwithstanding the effort, little is known about consumers\u2019 purchase and use of healthcare products. Hence, the what and \nwhy of acquiring these products remain a matter requiring serious attention. \nOBJECTIVES:\tDue\tto\tthe\tlack\tof\tempirical\tfindings\tpertaining\tto\tthe\tsubject\tmatter\tin\tthe\tMalaysian\tcontext,\tthe\tpresent\t\nstudy uses the grounded theory approach to develop a model to articulate the underlying factors of such purchase and use.\nMETHOD: Qualitative interview was administered using theoretical sampling strategy to ensure that theoretical saturation \nwas\tachieved\twith\tthe\tsample.\tPharmacy\tEnforcement\tDivision\tofficers\twere\ttrained\tto\tperform\tinterview,\ttranscription\tand\t\nanalysis.\t120\tMalaysian\tconsumers\twere\tinterviewed\tin\tthe\tfirst\tphase\tand\t48\tin\tthe\tsecond.\tAll\tinterviews\twere\trecorded,\t\ntranscribed and analysed via open, axial and selective coding procedures. \nRESULTS:\tThe\tfindings\treveal\tthat\tthe\tevaluation\tof\tproduct\tattributes\tis\tthe\tdeterminant\tof\tpurchase\tand\tuse.\tSuch\teffect,\t\nin turn, is moderated by personal factor, such as personality, and facilitating conditions, such as mode of delivery. The need \nfor healthcare products and knowledge about them are constructed as the antecedents in the model. Additionally, personal \nexperience and recommendation after use as well as the preceding factors are found to be recursive.\nCONCLUSION: The study proposes a holistic model which explicates the antecedents of purchase and use of healthcare \nproducts. It provides insights into the acquiring of both registered and unregistered products. By making known actual behaviour in \ncontemporary setting, it serves as an essential guideline to policy makers and relevant stakeholders to perpetuate QUM-C efforts.\n\n\n\nKEYWORDS: health product; consumer behaviour; the grounded theory\n\n\n\nNC2 (Poster)\nA NATIONAL POINT PREVALENCE STUDY OF ANTIBIOTIC UTILISATION AMONG HOSPITALS IN \nMALAYSIA\n\n\n\nHaron NH1, Jamal JA2, Tan CC3, Alivi R4\n\n\n\n1Pharmaceutical Services Division, Ministry of Health, 2Department of Pharmacy, Hospital Tengku Ampuan Afzan, Pahang, \n3Department of Pharmacy, Hospital Sultanah Aminah, Johor Bahru, 4Department of Pharmacy, Hospital Sultan Ismail, Johor Bahru\n\n\n\nINTRODUCTION: Appropriate use of antibiotic is one of the control measures to limit the emergence and transmission \nof antibiotic resistant bacteria. Limited data is currently available to describe recent antimicrobial prescribing practices in \nMalaysia. \nOBJECTIVES: The aims of this study is to identify the prevalence of antibiotic utilization in hospitalized patients, in \nMalaysia, and also to further describe the antibiotic prescribing practices.\nMETHOD: This is a multi-centre, one-day point prevalence study, involving 14 state hospitals and 5 tertiary hospitals \nacross Malaysia. All patients admitted on the survey day, treated with antibiotics, were included. A data collection form was \nused to obtain required information on prevalence and antibiotic prescribing practices.\nRESULTS: A total of 11,801 patients were reviewed. Of these, 5,169 patients (43.8%) were receiving antibiotic, with 74.2% \nof them received single antibiotic. Three commonly prescribed class of antibiotic were cephalosporin (29.2%), \u00df-lactam/\u00df-\nlactamase inhibitor (25.0%) and penicillin (14.6%). Of the prescribed antibiotics, 79% were for empiric, while 14% were \nfor\tdefinitive\ttreatment.\tThe\tuse\tfor\tsurgical\tand\tnon-surgical\tprophylaxis\twas\tminimal,\t5%\tand\t2%\trespectively.\tFor\tthe\t\nempiric treatment (n=4,914), 72% had a clinical sample sent prior to antibiotic initiation.\nCONCLUSION: The prevalence of antibiotic prescribed in the study population can be considered as high. Overall, \nthe antibiotic prescribing practices was similar to other regions. However, a larger scale study on the appropriateness of \nantibiotic prescribing practices is required, to provide further information, which can assist in quality improvement on \nantibiotic prescribing practices for health-care facilities across Malaysia. \n\n\n\nKEYWORDS: clinical pharmacy; Malaysia; prevalence; antibiotic utilisation\n\n\n\n\n\n\n\n\n71\n\n\n\nMALAYSIAN JOURNAL OF PHARMACY Vol. 2. Issue 2. August 2016\n\n\n\nNC3 (Poster)\nIMPACT OF PHARMACIST-MANAGED CLINIC ON MEDICATION ADHERENCE AND GLYCAEMIC \nCONTROL OF TYPE 2 DIABETES PATIENTS IN MALAYSIA: A RANDOMISED CONTROLLED STUDY\n\n\n\nMohamad N1, Ting A2, Loganathan NK3, Awang @ Rozalli IA4, Tan MW1, Lee SL5\n\n\n\n1Pharmaceutical Services Division, 2Pharmacy Department, Hospital Umum Sarawak, 3Department of Pharmacy, Hospital \nKuala Lumpur, 4Department of Pharmacy, Hospital Sultanah Nurzahirah, Terengganu, 5Department of Pharmacy, Hospital \nSultanah Aminah, Johor\n\n\n\nINTRODUCTION: Diabetes Medication Therapy Adherence Clinic (DMTAC) is an ambulatory care service which \nemphasises on diabetes management operated by pharmacists in the Ministry of Health (MOH) Malaysia. \nOBJECTIVES: The purpose of this 9 months randomized-controlled study is to evaluate the impact of pharmacist-managed \nMedication Therapy Adherence Clinic (MTAC) on medication adherence and glycemic control in adult patients with Type \n2 Diabetes in 15 MOH hospitals. \nMETHOD:\tA\ttotal\tof\t393\tpatients\twith\ttype\t2\tdiabetes\tmellitus,\tpoor\tmedication\tadherence\t(Modified\tMorisky\tMedication\t\nAdherence\t Score,\tMMMAS\t <\t 6)\t and\t poor\t glycemic\t control\t (HbA1c\t \u2265\t 8.0%)\t were\t recruited.\t The\t intervention\t group\t\n(standard care plus DMTAC services) (n=187) and the control group (standard care only) (n=206). Patients enrolled in the \nintervention group were scheduled with 4 DMTAC visits within 8 months. Outcomes were measured at baseline and at 9 \nmonths (pre and post DMTAC). \nRESULTS:\tMMMAS\tof\tintervention\tgroup\tincreased\tsignificantly\tby\t2.3\tscores\t(p<0.01)\tversus\t0.74\tscores\t(p<0.902)\tin\t\ncontrolled\tgroup.\tIntervention\tgroup\talso\tshowed\ta\tsignificant\treduction\tof\tHbA1c\tby\t1.0%\t(p<0.01)\tcompared\tto\t0.02%\t\n(p<0.902) among control group. An increased of MMMAS by 1 score reduced HbA1c by 0.174% (p=0.032). \nCONCLUSION:\t Study\t showed\t that\t pharmacist-managed\t DMTAC\t resulted\t in\t significant\t improvement\t in\t medication\t\nadherence and glycemic control of type 2 diabetes patients. \n\n\n\nKEYWORDS: clinical pharmacy; Malaysia; pharmacist; glycaemic control; diabetes medication therapy adherence clinic\n\n\n\nNC4 (Poster)\nTHE DEVELOPMENT AND VALIDATION OF ANTICOAGULATION KNOWLEDGE QUESTIONNAIRE: \nA RASCH ANALYSIS\n\n\n\nSahimi M1,2, Tariq Abdul Razak1, Rosnani Hasim3\n\n\n\n1International Islamic University Malaysia, Pahang, 2Hospital Tengku Ampuan Afzan, Kuantan, Pahang, 3Cyberjaya \nUniversity College of Medical Sciences, Cyberjaya\n\n\n\nINTRODUCTION: Almost a decade since the validation of anticoagulant questionnaire took place, no instrument was \ndeveloped in Malaysia to assess anticoagulant knowledge (AK). \nOBJECTIVES: Therefore, this study aimed to develop and validate an instrument to assess patients\u2019 knowledge about \nanticoagulant (KAC-Q) among Malaysia population. \nMETHOD: The content validity index (CVI) was calculated to ensure the content validity. Internal consistency reliability \nwas assessed using Kuder\u2013Richardson 20 (KR-20) and test-retest reliability. The construct validity was assessed using \ndiscriminant validity and correlation between the patients\u2019 knowledge and time within therapeutic range (TTR). A Rasch \nmodel\t(RM)\twas\tused\tto\tassess\tKR-20,\tthe\tdifficulties\tof\tthe\tKAC-Q\tand\tthe\tability\tof\tpatients\tto\tanswer\tthe\tKAC-Q.\tA\t\nSPSS was used to test the validity, test-retest reliability and the correlation. \nRESULTS: Patients (n=107), 70% male and mean \u00b1 SD age of 60.45\u00b19.04 years. All items have I-CVI=1.00 and met the \nacceptable value of CVI. The KAC -Q had good reliability (KR-20=0.77) and high items reliability (KR-20=0.93). Fifty-\nsix patients were repeated the KAC-Q test within 7 to 35 days and test\u2013retest reliability was acceptable, with an intraclass \ncorrelation\tcoefficient\tof\t0.93.\tThe\t40\titems\tof\tKAC-Q\twere\teasy\tto\tendorse\tand\tpatients\thave\thigher\tchance\tto\tanswer\tit\t\ncorrectly.\tThe\tKAC-Q\thave\tsufficient\titems\tto\tmeasure\tthe\tAK.\tAll\tsubscales\tof\tKAC-Q\thad\tlow\tcorrelation\t(r<0.9)\tand\t\nmet the requirements for discriminant validity. A strong positive correlation between the level of patients\u2019 knowledge and \nthe TTR (rs=0.61) supported the validity of KAC-Q.\nCONCLUSION:\tThe\tKAC-Q\tappears\tto\tfit\tthe\tRM\tand\tin\tconclusion,\tthe\t40\titems\tof\tKAC-Q\thave\tgood\treliability\tand\t\ngood construct validity and are able to determine the levels of patients\u2019 knowledge about anticoagulant.\n\n\n\nKEYWORDS: anticoagulation, knowledge, validation, rasch model\n\n\n\n\n\n\n\n\nNOTES\n\n\n\n\n\n\n\n\nNOTES\n\n\n\n\n\n\n\n\nUSE YOUR MEDICINE WISELYUSE YOUR MEDICINE WISELY\nIt can heal as well as harmIt can heal as well as harm\n\n\n\n\n\n\n\n\nAll generic medicines approved by the Drug Control Authority (DCA), Ministry of Health Malaysia \nundergo a stringent approval process. From specification and quality to manufacturing and \n\n\n\nlabelling, all requirements must meet DCA\u2019s strict and high standards and only manufacturers \nthat comply are allowed to produce generic medicines.\n\n\n\nYOU CAN TRUST DCA APPROVED GENERIC MEDICINES \n\n\n\nWE HAVE CONFIDENCE IN \nGENERIC MEDICINES\n\n\n\nSTRINGENT APPROVAL PROCESS\n\n\n\nFor more information, please visit www.bpfk.gov.my or call \nNational Pharmacy Call Centre (NPCC) 1-800-88-6722\n\n\n\nGENERIC\nMEDICINES\n\n\n\n Registration by DCA\n Requirement on Safety, \n\n\n\nEfficacy & Quality\n Post-Marketing Surveillance\n Bioequivalence Studies\n GMP Facilities\n Finished Product Quality \n\n\n\nControl\n Stability Studies\n\n\n\nINNOVATORS\nMEDICINES\n\n\n\n Registration by DCA\n Requirement on Safety, \nEfficacy & Quality\n Post-Marketing Surveillance\n Clinical Studies\n GMP Facilities\n Finished Product Quality \nControl\n Stability Studies\n\n\n\nSAFETY, EFFICACY, QUALITY\n\n\n\n\n\n\n\n\n\n\n\n\nFurther information on the product are available on request\n1. Foster SmPC\n2. Fabbri et al. Expert Opin Pharmacother 2008; 9(3): 479-490\n3. Contoli et al. Allergy 2010; 65(2): 141-151\n4. De Backer et al. J Aerosol Med Pulm Drug Deliv 2010; 23(3): 137-148\n5. Vos W et al. Respiration 2013;86(5): 393-401\n6. Huchon et al. Respir Med 2009; 103: 41-49\n* when compared to conventional beclometasone dipropionate\n\n\n\n\n\n\n\n\n\n"
"\n\nMalaysian Journal of Pharmacy Volume 7 Issue 2 (2021) \n \n\n\n\n\n\n\n\n74 \n\n\n\n\n\n\n\n\n\n\n\n*Correspondence: micmicvongchon@gmail.com, \n\n\n\nChio_2001_2@hotmail.com \n\n\n\n1Department of cardiology, Centro Hospitalar Conde de S\u00e3o Janu\u00e1rio, \n\n\n\nHealth Bureau, Macau SAR Government, China \n\n\n\n2 Division of Pharmacy, Centro Hospitalar Conde de S\u00e3o Janu\u00e1rio, Health \n\n\n\nBureau, Macau SAR Government , China \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n Case Report \n\n\n\n\n\n\n\nUse of Alirocumab for the Secondary Prevention of \n\n\n\nCardiovascular Disease in a Patient with End-stage Renal \n\n\n\nDisease on hemodialysis  \n \n\n\n\nIo Chon Vong2*, Man Fong Chu1, Weng Chio Tam1*, M\u00e0rio \u00c9vora1, Weng Chio2  \n\n\n\n\n\n\n\n \nArticle Info  \n\n\n\n \nReceived date: 13 Oct 2021  \n\n\n\nAccepted date: 7 Dec 2021 \n\n\n\nPublished date: 31 Dec 2021 \n\n\n\n\n\n\n\nKeywords: PCSK9 inhibitor, \n\n\n\nalirocumab, hemodialysis, \n\n\n\nLDL-C, chronic kidney disease. \n\n\n\nABSTRACT  \n\n\n\n\n\n\n\nIntroduction:  Cardiovascular diseases (CVDs) are quite prevalent globally, with atherosclerotic \n\n\n\nbeing a predominant CVD in Asia. Well-controlled low-density lipoprotein cholesterol (LDL-C) \n\n\n\nlevel is crucial in both primary and secondary prevention of these conditions, particularly in patients \n\n\n\nwith chronic kidney disease (CKD). Lipid management in this setting is a major concern for \n\n\n\nphysicians and patients. Here, we report the case of a man with previous hypertension, type 2 diabetes \n\n\n\nmellitus, dyslipidemia, peripheral artery disease, CKD, heart failure, and coronary artery disease post \n\n\n\nmultiple stent implantations. He was initiated on rosuvastatin treatment, during which he developed \n\n\n\nrhabdomyolysis, and subsequently received regular hemodialysis. Since the patient was at a very high \n\n\n\nrisk of cardiovascular events and adverse drug reactions, treatment with alirocumab (a proprotein \n\n\n\nconvertase subtilisin / kexin type 9 inhibitor) was initiated for further controlling LDL-C level. \n\n\n\nAlthough there is a lack of evidence on the use of alirocumab in patients on hemodialysis, the drug \n\n\n\ndemonstrated a favorable efficacy and safety profile in our patient. \n\n\n\n\n\n\n\n\n\n\n\nINTRODUCTION  \n  \n\n\n\nCardiovascular diseases (CVDs) are common in the general \n\n\n\npopulation worldwide. Of these, atherosclerotic CVDs \n\n\n\n(ASCVDs) are predominant in Asia [1]. Ensuring adequate \n\n\n\ncontrol of low-density lipoprotein cholesterol (LDL-C) is one \n\n\n\nof the most important strategies in both primary and secondary \n\n\n\nprevention of these conditions. It is estimated that long-term \n\n\n\nLDL-C reduction (over 40 years) might even be associated with \n\n\n\na reduction in cardiovascular mortality by 50% \u2013 55% [2]. \n\n\n\nTraditionally, statins have been the main treatment for \n\n\n\nhypercholesterolemia and the cornerstone of ASCVD \n\n\n\nprevention. However, certain factors, such as intolerance or \n\n\n\ndrug\u2013drug interactions, might restrict their use [3]. \n\n\n\nFurthermore, in adults on dialysis, Kidney Disease : Improving \n\n\n\nGlobal Outcomes guideline recommends avoiding initiation of \n\n\n\nstatins or statin/ezetimibe combinations. However, there is no \n\n\n\nrecommendation to stop therapy in dialysis patients who are \n\n\n\nalready receiving statins or statin/ezetimibe combinations [4]. \n\n\n\nRecently, a new drug class of proprotein convertase subtilisin / \n\n\n\nkexin type 9 (PCSK9) inhibitors has been increasingly used, \n\n\n\nand these agents can decrease LDL-C in a dose-dependent \n\n\n\nmanner by as much as 70% and by as much as 60% in statin-\n\n\n\ntreated patients [5]. Currently, two PCSK9 inhibitors (i.e., \n\n\n\nalirocumab and evolocumab) are commercially available. \n\n\n\nThese are fully humanized monoclonal antibodies indicated for \n\n\n\nsecondary prevention of cardiovascular events. Nevertheless, \n\n\n\nevidence on the use of these agents in patients with end-stage \n\n\n\nrenal disease (ESRD, defined as estimated glomerular filtration \n\n\n\nrate [eGFR] of < 15 mL / min / 1.73 m2) or those requiring \n\n\n\nhemodialysis (HD) is limited. In addition, relevant dosage \n\n\n\nrecommendation has not been provided in manufacturer\u2019s \n\n\n\nlabeling or international guidelines, as this aspect has not yet \n\n\n\nbeen studied. Here, we report the case of a man with \n\n\n\ndyslipidemia, multiple comorbidities, and chronic kidney \n\n\n\ndisease (CKD) on regular HD treated with alirocumab.    \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nVong I.C. et al. Mal J Pharm 7 (2) 2021, 74-76 \n\n\n\n\n\n\n\n75 \n\n\n\n\n\n\n\nCASE PRESENTATION \n \n\n\n\nA 60-year-old man with a history of hypertension, type 2 \n\n\n\ndiabetes mellitus, dyslipidemia, peripheral artery disease, \n\n\n\nchronic kidney disease, heart failure, and coronary artery \n\n\n\ndisease after multiple stent implantations presented with lower \n\n\n\nlimb edema and chronic diabetic wound ulcer. As the patient \n\n\n\nwas at a very high risk of future cardiovascular events, \n\n\n\nsecondary prevention with high-intensity statin therapy was \n\n\n\nindicated. He was prescribed rosuvastatin 20 mg / day with an \n\n\n\neGFR of 102 min / mL / 1.73 m2 (calculated by CKD \n\n\n\nEpidemiology Collaboration equation). However, his renal \n\n\n\nfunction declined gradually throughout the treatment course, \n\n\n\nand he unexpectedly developed rhabdomyolysis after 9-year \n\n\n\nuse of rosuvastatin and started undergoing HD. As a result, we \n\n\n\ndiscontinued the statin; however, total cholesterol and LDL-C \n\n\n\nlevels were still 7.1 and 5.2 mmol/L, respectively. Under such \n\n\n\ncircumstances observed in our patient, PCSK9 inhibitors might \n\n\n\nefficiently control LDL-C level, although there is a lack of \n\n\n\nevidence on the use of this agent in patients with stage 5 CKD \n\n\n\non HD. As a result, we initiated alirocumab at a dose of 75 mg \n\n\n\nevery 4 weeks. After 3 months of treatment, the patient\u2019s LDL-\n\n\n\nC level was 3.29 mmol / L. However, as the LDL-C target (<1.4 \n\n\n\nmmol / L, European Society of Cardiology guideline) was not \n\n\n\nachieved, we up-titrated the dosing interval of alirocumab to 75 \n\n\n\nmg every 2 weeks. Three months later, LDL-C level decreased \n\n\n\nto 2.5 mmol / L but eventually increased to 3.29 mmol / L. \n\n\n\nIncidentally, the triglyceride level had significantly decreased. \n\n\n\nThus, we decided to maintain the current dose of alirocumab, \n\n\n\nand the patient denied any adverse drug reactions. In the most \n\n\n\nrecent follow-up, patient\u2019s ischemic heart disease has been \n\n\n\nstable. Moreover, coronary angiography revealed patent stents \n\n\n\nwithout significant stenosis. The dynamic variation in the lipid \n\n\n\nprofile before and after alirocumab treatment is summarized in \n\n\n\nTable I below. \n\n\n\nDISCUSSION \n \n\n\n\nAs PCSK9 monoclonal antibodies are composed of proteins \n\n\n\nand carbohydrates, elimination is expected to occur via \n\n\n\nsaturable binding to PCSK9 enzyme and nonsaturable \n\n\n\nproteolysis of small peptides and amino acids. In addition, \n\n\n\nmonoclonal antibodies are not eliminated by the kidneys but by \n\n\n\nthe reticuloendothelial system; therefore, a significant \n\n\n\nalteration in exposure in patients with renal impairment is not \n\n\n\nexpected [6]. However, alirocumab is unlikely to be filtrated \n\n\n\nvia hemodialysis owing to the small pore size of the \n\n\n\nhemodialysis filter. Moreover, relevant available data on \n\n\n\npatients with severe renal impairment are limited; in these \n\n\n\npatients, the exposure to alirocumab was approximately 2-fold \n\n\n\nhigher compared with that in subjects with normal renal \n\n\n\nfunction [7]. Hence, we set the initial dosing frequency of \n\n\n\nalirocumab to 75 mg every 4 weeks, which was up-titrated as \n\n\n\nneeded. \n\n\n\n\n\n\n\nSuboptimal responders to PCSK9 inhibitors are defined as \n\n\n\nindividuals with < 50% \u2013 60% LDL-C reduction after \n\n\n\ntreatment. As described in our case, after increasing the initial \n\n\n\ndosing frequency to 75 mg every 2 weeks, LDL-C level \n\n\n\nreduced to 36% \u2013 52% from that at the baseline. Impaired renal \n\n\n\nfunction may be responsible for the suboptimal response to \n\n\n\nPCSK9 inhibitors in patients with ESRD. Moreover, without \n\n\n\nuse of statins cannot increase the PCSK9 levels and may \n\n\n\ncorrelate with the suboptimal clinical response [8]. \n\n\n\n\n\n\n\nIn the present case, a significant decrease was noted in \n\n\n\ntriglyceride level. PCSK9 may play a role in the metabolism of \n\n\n\ntriglyceride-rich lipoproteins in patients on hemodialysis [9]. \n\n\n\nHowever, further studies are warranted to confirm this finding. \n\n\n\n\n\n\n\nCONCLUSION  \n \n\n\n\nLipid management is a key component of the secondary \n\n\n\nprevention of CVDs. Although data on the use of PCSK9 \n\n\n\ninhibitors in patients with dialysis are lacking, our case report \n\n\n\nrevealed that alirocumab is safe and effective in these patients. \n\n\n\nHowever, further investigations (e.g. clinical trials) are \n\n\n\nrequired to validate this finding. \n\n\n\n\n\n\n\nACKNOWLEDGEMENT \n  \n\n\n\nThe authors appreciate the Macau health bureau for permission \n\n\n\nto publish this article. \n\n\n\n\n\n\n\nCONFLICT OF INTEREST \n  \n\n\n\nThe authors declare no conflict of interest. This case report did \n\n\n\nnot receive any specific grant from funding agencies in the \n\n\n\npublic, commercial or not-for-profit sectors. \n\n\n\nTable I. Lipid profile before and after treatment with alirocumab \n\n\n\n\n\n\n\nParameters \nBefore \n\n\n\nTreatment \n\n\n\nAfter Treatment \n\n\n\n150 mg every \n\n\n\n4 weeks \n\n\n\n150 mg every \n\n\n\n2 weeks \n\n\n\nJul \n\n\n\n2020 \n\n\n\nAug \n\n\n\n2020 \n\n\n\nSept \n\n\n\n2020 \n\n\n\nJan \n\n\n\n2021 \n\n\n\nFeb \n\n\n\n2021 \n\n\n\nSCr \n\n\n\n(\u00b5mol/L) \n529 626 517 413 555 459 \n\n\n\nTotChol \n\n\n\n(mmol/L) \n7.1 5.2 4.2 5.2 4.3 5.2 \n\n\n\nLDL-C \n\n\n\n(mmol/L) \n5.17 3.07 2.45 3.29 2.5 3.29 \n\n\n\nHDL-C \n\n\n\n(mmol/L) \n1.08 1.07 0.72 1.36 1.23 1.46 \n\n\n\nTG \n\n\n\n(mmol/L) \n1.87 2.33 2.27 1.2 1.25 1.0 \n\n\n\n\n\n\n\nSCr-Serum creatinine; TotChol-Total cholesterol; LDL-C-Low-density \n\n\n\nlipoprotein cholesterol; HDL-C-High-density lipoprotein cholesterol;  \n\n\n\nTG -triglyceride \n\n\n\n\n\n\n\n\nVong I.C. et al. Mal J Pharm 7 (2) 2021, 74-76 \n\n\n\n\n\n\n\n76 \n\n\n\n\n\n\n\n\n\n\n\nREFERENCE \n \n\n\n\n[1] Zhao D, Liu J, Wang M, Zhang XG, Zhou MG. Epidemiology of \n\n\n\ncardiovascular disease in China: current features and implications. Nat \n\n\n\nRev Cardiol. 2018 Nov 22;16(4):203\u201312. \n\n\n\nhttps://doi.org/10.1038/s41569-018-0119-4 \n\n\n\n[2] Banach M, Penson PE. Statins and LDL-C in secondary prevention\u2014\n\n\n\nso much progress, so far to go. JAMA Netw Open. 2020 Nov \n\n\n\n2;3(11):e2025675. \n\n\n\nhttps://doi.org/10.1001/jamanetworkopen.2020.25675  \n\n\n\n[3] Alonso R, Cuevas A, Cafferata A. Diagnosis and management of \n\n\n\nstatin intolerance. J Atheroscler Thromb. 2019 Mar 1;26(3):207\u2013215. \n\n\n\nhttps://doi.org/10.5551/jat.RV17030 \n\n\n\n[4] Kidney Disease: Improving Global Outcomes (KDIGO) Lipid Work \n\n\n\nGroup. KDIGO Clinical Practice Guideline for Lipid Management in \n\n\n\nChronic Kidney Disease. Kidney Inter 2013; 3:259\u2013305. \n\n\n\n[5] Robinson JG, Farnier M, Krempf M, et al. Efficacy and safety of \n\n\n\nalirocumab in reducing lipids and cardiovascular events. N Engl J \n\n\n\nMed. 2015 Apr;372(16):1489\u20131499. \n\n\n\nhttps://doi.org/10.1056/NEJMoa1501031 \n\n\n\n[6] Alirocumab (Praluent) injection US Food & Drug Administration \n\n\n\nPrescribing information revised October, 2015 \n\n\n\nhttps://dailymed.nlm.nih.gov/dailymed/getFile.cfm?setid=446f6b5c-\n\n\n\n0dd4-44ff-9bc2-c2b41f2806b4&type=pdf&name=446f6b5c-0dd4-\n\n\n\n44ff-9bc2-c2b41f2806b4 (Accessed on March 06, 2017). \n\n\n\n[7] Alirocumab (Praluent) Summary of Product Characteristics. European \n\n\n\nMedicines Agency (June 18, 2020 version) \n\n\n\n[8] Nozue T. Lipid lowering therapy and circulating PCSK9 \n\n\n\nconcentration. J Atheroscler Thromb. 2017 Sep 1;24(9):895\u2013907. \n\n\n\nhttps://doi.org/10.5551/jat.RV17012  \n\n\n\n[9] Baragetti A, Grejtakova D, Casula M, et al, Proprotein Convertase \n\n\n\nSubtilisin-Kexin type-9 (PCSK9) and triglyceride-rich lipoprotein \n\n\n\nmetabolism: facts and gaps. Pharmacol Res. 2018 Apr;130:1\u201311. \n\n\n\nhttps://doi.org/10.1016/j.phrs.2018.01.025  \n\n\n\n \n\n\n\n\nhttps://doi.org/10.1038/s41569-018-0119-4\n\n\nhttps://doi.org/10.1001/jamanetworkopen.2020.25675\n\n\nhttps://doi.org/10.5551/jat.RV17030\n\n\nhttps://doi.org/10.1056/NEJMoa1501031\n\n\nhttps://dailymed.nlm.nih.gov/dailymed/getFile.cfm?setid=446f6b5c-0dd4-44ff-9bc2-c2b41f2806b4&type=pdf&name=446f6b5c-0dd4-44ff-9bc2-c2b41f2806b4%20(Accessed%20on%20March%2006,%202017).\n\n\nhttps://dailymed.nlm.nih.gov/dailymed/getFile.cfm?setid=446f6b5c-0dd4-44ff-9bc2-c2b41f2806b4&type=pdf&name=446f6b5c-0dd4-44ff-9bc2-c2b41f2806b4%20(Accessed%20on%20March%2006,%202017).\n\n\nhttps://dailymed.nlm.nih.gov/dailymed/getFile.cfm?setid=446f6b5c-0dd4-44ff-9bc2-c2b41f2806b4&type=pdf&name=446f6b5c-0dd4-44ff-9bc2-c2b41f2806b4%20(Accessed%20on%20March%2006,%202017).\n\n\nhttps://doi.org/10.5551/jat.RV17012\n\n\nhttps://doi.org/10.1016/j.phrs.2018.01.025\n\n\n\n"
"\n\nMalaysian Journal of Pharmacy Volume 7 Issue 1 (2021) \n \n\n\n\n\n\n\n\n\n\n\n\n22 \n\n\n\n\n\n\n\n*Correspondence: shirlie_chai@yahoo.com \n\n\n\n\n\n\n\n1 Pharmacy Department, Miri Hospital, Ministry of Health Malaysia, \n\n\n\nSarawak \n2 Clinical Research Centre Miri, Ministry of Health Malaysia, Sarawak \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n Original Research Article \n\n\n\n\n\n\n\nPharmacy Value-Added Services: Experience in a Malaysian \n\n\n\nPublic Hospital \n \n\n\n\nEmily Shin Ni Chung1, Shin Mei Sim1, Sui Fern Wong1, Shirlie Chai1,2*, Kamarudin Ahmad1,2 \n\n\n\n\n\n\n\n \nArticle Info  \n\n\n\n \nReceived date:   8 Feb 2021 \n\n\n\nAccepted date: 21 Apr 2021 \n\n\n\nPublished date: 30 June 2021 \n\n\n\n\n\n\n\nKeywords: value-added, \n\n\n\npharmacy, awareness, usage, \n\n\n\nsatisfaction, willingness \n\n\n\n\n\n\n\nABSTRACT  \n\n\n\n\n\n\n\nThe Pharmacy value-added services (PVAS) has been implemented in Malaysian public hospitals to \n\n\n\nfacilitate the collection of follow-up medications. In specific, PVAS include Integrated Drug \n\n\n\nDispensing System, Medicine by Post, Drive-Through Pharmacy, and many more. While past studies \n\n\n\nexamined the satisfaction towards PVAS and its impact on patients\u2019 waiting time, little explored the \n\n\n\nawareness and the experience of patients towards each type of PVAS. This study aims to explore the \n\n\n\npatient\u2019s awareness on PVAS, adoption of PVAS, their satisfaction towards PVAS, and willingness \n\n\n\nto adopt PVAS. This was a cross-sectional study conducted in January 2020.  We invited the eligible \n\n\n\npatients or their family members to participate in the study. Respondents recruited at the Outpatient \n\n\n\nPharmacy Department of Miri Hospital using convenient sampling. A questionnaire in the Malay \n\n\n\nlanguage was developed and content validated to gather information on the demographic data, \n\n\n\nawareness on PVAS, adoption of PVAS, satisfaction towards PVAS, and willingness to adopt PVAS. \n\n\n\nA list of PVAS was included for the respondents to select the types they were aware of and used \n\n\n\nbefore. Results were presented as frequencies, percentages, mean and standard deviation. A total of \n\n\n\n398 respondents participated in the study. Majority of the respondents (70.1%) were aware that PVAS \n\n\n\noffered in Miri Hospital. However, about a third of the respondents (31.4%) had experience using \n\n\n\nPVAS. The most commonly used PVAS was Appointment Card Dispensing System (49.6%) and that \n\n\n\nwith the least usage was Local Partial Medication Supply Service (2.4%). The Drive-Through \n\n\n\nPharmacy has the greatest satisfaction score, 4.40 (SD=0.70), whereas Call-and-Collect Service was \n\n\n\nthe least satisfied, 3.88 (SD=0.91). Majority of the respondents (86.2%), specifically 95.8% of the \n\n\n\nexperienced PVAS user and 90.1% of inexperienced group, were willing to adopt PVAS to collect \n\n\n\ntheir follow-up medications. The Drive-thru Pharmacy, which has the greatest awareness and \n\n\n\nsatisfaction yet low usage, should be further promoted for greater adoption. Besides, such PVAS \n\n\n\nshould be expanded to other healthcare facilities. \n\n\n\n\n\n\n\nINTRODUCTION  \n  \n\n\n\nPharmacy value-added services (PVAS) is a nationwide, \n\n\n\ngovernment-funded initiative introduced by the Pharmaceutical \n\n\n\nServices Division (PSD), Ministry of Health Malaysia (MOH) \n\n\n\nsince 2003 [1]. In the Malaysian context, PVAS defined as a \n\n\n\nrange of innovative and creative services provided by the \n\n\n\npharmacy to optimise patient-oriented pharmaceutical care, \n\n\n\nthrough ensuring the continuity of medicines supply, reducing \n\n\n\nwaiting time and travelling cost [1]. According to the National \n\n\n\nSurvey on the Use of Medicines (NSUM) 2015, 30.3% of \n\n\n\nMalaysians have chronic diseases that necessitate long term \n\n\n\nmedication use [2]. In the government healthcare facilities, a \n\n\n\npolicy under the Quality Use of Medicines (QUM) pharmacy \n\n\n\npractice guideline has been in place since 2011, where \n\n\n\nmedications for prescriptions longer than one month will only \n\n\n\nbe supplied monthly [3].  \n\n\n\n\n\n\n\nThe successful implementation of the policy allowed \n\n\n\nmonitoring of patient compliance, untoward effects of \n\n\n\nmedications, reducing drug wastage and the risk of medication \n\n\n\nerror caused by misuse of excessive medication supply by \n\n\n\nunintended individuals. However, these advantages come at the \n\n\n\n\n\n\n\n\nChung, E.S.N. et al. Mal J Pharm 7 (1) 2021, 22-27 \n\n\n\n\n\n\n\n23 \n\n\n\n\n\n\n\nexpense of increased patient load and waiting time at the \n\n\n\noutpatient pharmacy. Furthermore, transportation issues and \n\n\n\nthe cost incurred from a repetitive visit to the outpatient \n\n\n\npharmacy for monthly medication supply are factors that affect \n\n\n\npatient satisfaction [4]. In a study conducted in Taiwan showed \n\n\n\nthat difficulty in finding a parking in the hospital was one of \n\n\n\nthe reasons cited to failure to regular medicine refill [5]. \n\n\n\nTherefore, the introduction of PVAS aims to improve the \n\n\n\nhealthcare accessibility and dispensing system by reducing \n\n\n\nwaiting time, improving patient convenience and satisfaction, \n\n\n\nand ensuring continuity of medication supply.  \n\n\n\n\n\n\n\nIn Malaysia, PVAS refers to a group of innovative services \n\n\n\nprovided by over 500 government healthcare facilities [1]. \n\n\n\nLarger facilities may provide more types of PVAS whereas \n\n\n\nsmaller facilities have at least one to two types of these services \n\n\n\n[1]. In this context, follow-up prescriptions are also known as \n\n\n\nrefill prescriptions or partial supply prescriptions, and the terms \n\n\n\nused interchangeably. PVAS programmes include Integrated \n\n\n\nDrug Dispensing System (SPUB), Medicine by Post (UMP), \n\n\n\nDrive-Through Pharmacy, Appointment Card Dispensing \n\n\n\nSystem, Call-and-Collect Service, SMS-and-Collect Service, \n\n\n\nFax-and-Collect Service, Email-and-Collect Service, Collect-\n\n\n\nLater Service, Local Partial Medication Supply Service \n\n\n\n(PPUSS) and Locker4U (1, 4). The following paragraph \n\n\n\nillustrates some of the most common types of PVAS. \n\n\n\n\n\n\n\nSPUB enables medicines collection of patients\u2019 follow-up \n\n\n\nsupply at any MOH health facility listed under the SPUB \n\n\n\nDirectory throughout Malaysia. With the service, patients are \n\n\n\nable to select the facility, which is convenient and preferred for \n\n\n\ntheir medication collection [6]. UMP service engages the \n\n\n\nnational courier service, Poslaju to deliver the medicine to the \n\n\n\npatients\u2019 preferred location with pre-determined postal charges \n\n\n\n[6]. Conversely, patients who prefer to self-collect their \n\n\n\nmedicine, Drive-Through Pharmacy is the convenient \n\n\n\nalternative. The conventional waiting process at the pharmacy \n\n\n\ncounters skipped and dispensing of the prepacked medication \n\n\n\ntypically takes place at the dedicated Drive-Through counter or \n\n\n\nkiosk which does not require patients to exit their vehicles \n\n\n\n[1][6]. Both UMP and Drive-Through Pharmacy could help to \n\n\n\nease the long waiting time and parking space constraints. \n\n\n\n\n\n\n\nOther PVAS options include Call-and-Collect Service, SMS-\n\n\n\nand-Collect Service, Fax-and-Collect Service and Email-and-\n\n\n\nCollect Service, which require the patients\u2019 notification, for \n\n\n\ninstance via making a phone call or sending a SMS, to inform \n\n\n\npharmacy of the expected collection date, whereas the Collect-\n\n\n\nLater Service involves pre-notifying the pharmacy over the \n\n\n\ncounter. In contrast, for Appointment Card Dispensing System, \n\n\n\nthe pharmacy determines the collection date and prepares the \n\n\n\nrefill medicine before the date. Meanwhile, Local Partial \n\n\n\nMedication Supply Service and Locker4U deliver the prepared \n\n\n\nmedicine to a predetermined collection centre or place the \n\n\n\nmedicine in a locker, and allow the patients to collect at their \n\n\n\nconvenience.  \n\n\n\n\n\n\n\nThe Pharmaceutical Services Programme has actively \n\n\n\norganised campaigns to introduce and promote the adoption of \n\n\n\nPVAS. The key performance indicator for government \n\n\n\nfacilities is 20% or more of the follow-up prescriptions \n\n\n\ndispensed via PVAS [7]. Despite the large monetary \n\n\n\ninvestment and human resources involvement, the adoption \n\n\n\nrate of PVAS was considerably low at its inception [1]. In 2013, \n\n\n\nPVAS employed in merely approximately 10% of 10 million \n\n\n\nfollow-up prescriptions in the government healthcare facilities \n\n\n\n[1]. In the subsequent year, the number of prescriptions \n\n\n\ndispensed via PVAS has increased to 1.2 million, but it was still \n\n\n\nfar from reaching the target (8). Besides the usual promotional \n\n\n\nactivities, the government organised competitions and giving \n\n\n\nspecial awards to encourage active implementation among the \n\n\n\nfacilities [9]. With continuous effort and promotion, PSD \n\n\n\ndocumented nearly 4 million follow-up prescriptions dispensed \n\n\n\nvia PVAS in the country, amounting 22.29% of the total \n\n\n\nfollow-up prescriptions in 2019 [7] [10]. However, there are \n\n\n\nopportunities for further improvement. Therefore, this study \n\n\n\naims to explore the patient\u2019s awareness on PVAS, adoption of \n\n\n\nPVAS, their satisfaction towards PVAS, and willingness to \n\n\n\nadopt PVAS. Ultimately, this study aims to improve pharmacy \n\n\n\nservice and patient care, which is in line with the objectives of \n\n\n\nPSD. \n\n\n\n\n\n\n\nMETHOD  \n  \n\n\n\nStudy Design and Participants \n\n\n\n\n\n\n\nWe conducted a single-centred, cross-sectional study in one of \n\n\n\nthe major, government-subsidized hospital in Sarawak state of \n\n\n\nMalaysia. All patients or their family members, who aged 18 \n\n\n\nyears and above, understood the Malay language, who \n\n\n\ncollected their first or subsequent partial supply of chronic \n\n\n\nmedications in Miri Hospital, were eligible for participation in \n\n\n\nthe study. We excluded staff who assisted in collecting \n\n\n\nmedication for daycare or home visit patients. Convenience \n\n\n\nsampling method applied to recruit respondents who met the \n\n\n\neligibility criteria. This study is registered with National \n\n\n\nMedical Research Registry (NMRR-19-4193-49452) and was \n\n\n\napproved by Medical Research Ethics Committee, Ministry of \n\n\n\nHealth, Malaysia. \n\n\n\n\n\n\n\nWe administered several close-ended questions to acquire \n\n\n\ninformation on respondents\u2019 demographics, their awareness on \n\n\n\nPVAS, adoption of PVAS, their satisfaction towards PVAS and \n\n\n\nwillingness to adopt PVAS. The demographic data include age, \n\n\n\ngender, race, education level, monthly household income, and \n\n\n\ntravelling duration from the house to the hospital. A list of \n\n\n\nPVAS included for the respondents to select the types they \n\n\n\nwere aware of and used before. Respondents who used PVAS \n\n\n\n\n\n\n\n\nChung, E.S.N. et al. Mal J Pharm 7 (1) 2021, 22-27 \n\n\n\n\n\n\n\n24 \n\n\n\n\n\n\n\nbefore were required to rate their satisfaction level using a five-\n\n\n\npoint Likert scale, which ranges from 1 (very dissatisfied) to 5 \n\n\n\n(very good). Besides, the open-ended questions allowed the \n\n\n\nrespondents to express their opinion about PVAS and the \n\n\n\nreasons they are unwilling to adopt PVAS. In the current study, \n\n\n\nthe monthly household income categorisation were: (i) low \n\n\n\nincome group (B40) with monthly household income less than \n\n\n\nRM 4,850, (ii) mid income group (M40) with monthly \n\n\n\nhousehold income between RM 4,850 and RM 10,959, and (iii) \n\n\n\nhigh income group (T20) with monthly household income of \n\n\n\nRM 10,960 or more (11). For the employment status, an \n\n\n\nemployer refers to a person who hires employee to work, \n\n\n\nwhereas the self-employed refers to a person who works for \n\n\n\noneself. The questions were in the Malay language. \n\n\n\n\n\n\n\nWe invited the eligible respondents, obtained written informed \n\n\n\nconsent and distributed the questionnaire over the pharmacy \n\n\n\ncounter. The respondents returned the completed \n\n\n\nquestionnaires during medication collection at the dispensing \n\n\n\ncounter. It took approximately 10-15 minutes to complete the \n\n\n\nquestionnaire. \n\n\n\n\n\n\n\nThe current study is part of a larger study which the minimum \n\n\n\nsample size was based on. Sample size calculation using the \n\n\n\nG*Power software version 3.1.9.4 showed that 395 respondents \n\n\n\nrequired to obtain a power of 80% at a type I error level of 0.05 \n\n\n\n[12]. The total number of respondents was raised to account for \n\n\n\na 10% dropout and unusable data, hence the required sample \n\n\n\nsize was 439 respondents. \n\n\n\n\n\n\n\nStatistical Analysis \n\n\n\n\n\n\n\nWe conducted analysis using SPSS version 21. The \n\n\n\ndemographic characteristics of respondents described as \n\n\n\nfrequencies and percentages for categorical variables. \n\n\n\nNumerical variables, for example, age, was presented as mean \n\n\n\nand standard deviation (SD), or median and interquartile range \n\n\n\n(IQR) if non-normally distributed. The findings are descriptive \n\n\n\nin nature and no formal statistical hypothesis testing involved. \n\n\n\n\n\n\n\nRESULT \n \n\n\n\nDemographic Characteristics \n\n\n\n\n\n\n\nA total of 440 questionnaires distributed, and 398 respondents \n\n\n\ncompleted and returned them, yielding a response rate of \n\n\n\n90.45%. Table I summarises the demographic characteristics of \n\n\n\nthe respondents. The age of respondents in this study ranged \n\n\n\nfrom 18 to 85 years old, with mean (SD) age of 42.48 (14.32) \n\n\n\nand they were predominantly female (57.3%). Most of the \n\n\n\nrespondents were Chinese (30.4%), from the low-income group \n\n\n\n(B40). \n\n\n\n\n\n\n\n\n\n\n\nAwareness on PVAS \n\n\n\n\n\n\n\nMost respondents (70.1%) were aware of PVAS (Table II). \n\n\n\nDrive-Through Pharmacy and UMP were the most commonly \n\n\n\nknown services among the 279 respondents who were aware of \n\n\n\nPVAS, with the percentage of 67.0% and 59.5% respectively \n\n\n\n(Table II). PPUSS was the least known (3.9%) among \n\n\n\nrespondents who were aware of PVAS, followed by SPUB \n\n\n\n(12.5%). \n\n\n\n\n\n\n\nTable I. Demographic Characteristics (n=398) \n\n\n\n\n\n\n\nVariables Mean (SD) \n\n\n\nAge (years) 42.48 (14.32) \n\n\n\nTravelling Duration to Hospital \n\n\n\n(minutes) \n\n\n\n35.57 (34.28) \n\n\n\n\n\n\n\nVariables Number, n (%) \n\n\n\nGender  \n\n\n\n Male 170 (42.7) \n\n\n\n Female 228 (57.3) \n\n\n\nEthnicity  \n\n\n\n Malay 78 (19.6) \n\n\n\n Chinese 121 (30.4) \n\n\n\n Iban 110 (27.6) \n\n\n\n Kayan 20 (5.0) \n\n\n\n Melanau 14 (3.5) \n\n\n\n Others 53 (13.32) \n\n\n\n Not reported 2 (0.5) \n\n\n\nEducation Level  \n\n\n\n University 69 (17.3) \n\n\n\n College 50 (12.6) \n\n\n\n Vocational 28 (7.0) \n\n\n\n Secondary School 194 (48.7) \n\n\n\n Primary School 31 (7.8) \n\n\n\n No Formal Education 22 (5.5) \n\n\n\n Not reported 4 (1.0) \n\n\n\nEmployment Status  \n\n\n\n Employer  13 (3.3) \n\n\n\n Government Servant 54 (13.6) \n\n\n\n Private Employee 102 (25.6) \n\n\n\n Self-Employed 54 (13.6) \n\n\n\n Unemployed 138 (34.7) \n\n\n\n Retiree 33 (8.3) \n\n\n\n Not reported 4 (1.0) \n\n\n\nHousehold Income  \n\n\n\n High Income (T40) 5 (1.3) \n\n\n\n Medium Income (M40) 47 (11.8) \n\n\n\n Low Income (B40) 325 (81.7) \n\n\n\n Not reported 21 (5.3) \n\n\n\n* Percentages may not total 100 because of rounding \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nChung, E.S.N. et al. Mal J Pharm 7 (1) 2021, 22-27 \n\n\n\n\n\n\n\n25 \n\n\n\n\n\n\n\nAdoption of PVAS  \n\n\n\n\n\n\n\nMore than half of the respondents (68.3%) had no experience \n\n\n\nof using PVAS for the collection of their follow-up medication \n\n\n\nsupply (Table II). Among the 125 PVAS users, the most \n\n\n\ncommonly adopted PVAS was Appointment Card Dispensing \n\n\n\nSystem (49.6%) (Table II). UMP was the second most used \n\n\n\nPVAS (24.8%) among the PVAS users, whereas PPUSS was \n\n\n\nleast adopted (2.4%). \n\n\n\n\n\n\n\nSatisfaction Towards PVAS \n\n\n\n\n\n\n\nTable III shows the satisfaction score of respondents who have \n\n\n\nexperience using PVAS. Overall, respondents were satisfied \n\n\n\nwith their experience. The mean (SD) satisfaction scores for \n\n\n\nDrive-Through Pharmacy, Collect-Later Service, and PPUSS \n\n\n\nare 4.40 (0.70), 4.38 (0.50), 4.33 (1.16) respectively. \n\n\n\nNevertheless, there were 11 Drive-Through Pharmacy users \n\n\n\nonly in this study. Among the three respondents who was \n\n\n\nPPUSS users, two of them rated the service as \u2018very good\u201d and \n\n\n\none of them is satisfied with the service. \n\n\n\n\n\n\n\nWillingness to Adopt PVAS \n\n\n\n\n\n\n\nA large percentage of respondents (86.2%) were willing to \n\n\n\nadopt PVAS while only 7.5% said no to the service. In \n\n\n\nparticular, 95.8% of the experienced PVAS user and 90.1% of \n\n\n\ninexperienced group, respectively were willing to adopt PVAS \n\n\n\nto collect their follow-up medications. However, 7.5% (n=30) \n\n\n\nof the respondents were unwilling to adopt PVAS. \n\n\n\n\n\n\n\nDISCUSSION  \n  \n\n\n\nThis study provides the essential information on the \n\n\n\nimplementation of PVAS in a public hospital in Sarawak.  In \n\n\n\nthis study, majority of the respondents (70.1%) were aware of \n\n\n\nPVAS. This result contrasts the findings of Tan et al., which \n\n\n\nreported that a large number of patients were not aware of the \n\n\n\nexistence and benefits of PVAS via face-to-face interview [13]. \n\n\n\nThe improved awareness could be as a result from the active \n\n\n\npromotion over years. Patients\u2019 awareness on PVAS and their \n\n\n\nbenefits is undeniably crucial in the adoption of this program. \n\n\n\nLack of awareness is the important factor that impedes patients\u2019 \n\n\n\nintention to use PVAS [13]. \n\n\n\n\n\n\n\nDrive-Through Pharmacy and UMP were the two most \n\n\n\ncommonly known PVAS in this study. Although Drive-\n\n\n\nThrough Pharmacy is newly launched in Miri Hospital, the \n\n\n\npublic has high awareness compared to other PVAS. This could \n\n\n\nbe possibly due to the effective promotion, including the local \n\n\n\nnewspapers and social media platforms. On the other hand, \n\n\n\nUMP gained popularity during the COVID-19 lockdown \n\n\n\nimplemented in March 2020 nationwide as it does not require \n\n\n\ntravelling and physically present at the pharmacy, hence \n\n\n\nreducing social contact. Moreover, MOH and the national \n\n\n\ncourier service worked to provide free shipping of medicine to \n\n\n\npatients\u2019 home during the period to ensure the constant access \n\n\n\nto medical needs.  Therefore, the awareness on the PVAS is \n\n\n\nhigher. Medication Locker was the PVAS with least awareness \n\n\n\namong our respondents (0.4%). At the time of writing,  the \n\n\n\nservice is in the planning stage in our hospital. However, the \n\n\n\nservice is available in some other government facilities [14] \n\n\n\n[15]. It is important to note that the service offered may differ \n\n\n\nfrom one facility to the other. Therefore, explanation is crucial \n\n\n\nto avoid misconception. \n\n\n\n\n\n\n\nAmong the PVAS users, we found Appointment Card \n\n\n\nDispensing System as the most commonly used PVAS and that \n\n\n\nwith the least usage is Local Partial Medication Supply Service. \n\n\n\nDespite the considerably high awareness among the \n\n\n\nTable II. Awareness and Adoption of types of PVAS services (n=398) \n\n\n\n\n\n\n\nTypes of PVAS \nAwareness Adoption \n\n\n\nAware Unaware Experienced No Experience \n\n\n\nSPUB 35 (12.5) 244 (87.5) 7 (5.6) 118 (94.4) \n\n\n\nUMP 166 (59.5) 113 (40.5) 31 (24.8) 94 (75.2) \n\n\n\nCall-and-Collect Service 93 (33.3) 186 (66.7) 28 (22.4) 97 (77.6) \n\n\n\nCollect-Later Service 59 (21.1) 220 (78.9) 24 (19.2) 101 (80.8) \n\n\n\nDrive-Through Pharmacy 187 (67.0) 92 (33.0) 11 (8.8) 114 (91.2) \n\n\n\nAppointment Card \n\n\n\nDispensing System \n106 (38.0) 173 (62.0) 62 (49.6) 63 (50.4) \n\n\n\nPPUSS 11 (3.9) 268 (96.1) 3 (2.4) 122 (97.6) \n\n\n\nMedication Locker 2 (0.7) 277 (99.3)   \n\n\n\nOthers 1 (0.4) 278 (99.6)   \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nTable III. Satisfaction Towards PVAS \n\n\n\n\n\n\n\nSatisfaction Score Mean (SD) \n\n\n\nSPUB n=7 4.29 (0.95) \n\n\n\nUMP n=31 4.12 (0.95) \n\n\n\nCall-and-Collect Service n=28 3.88 (0.91) \n\n\n\nCollect-Later Service, n=24 4.38 (0.50) \n\n\n\nDrive-Through Pharmacy, n=11 4.40 (0.70) \n\n\n\nAppointment Card Dispensing System, n=62 4.16 (0.85) \n\n\n\nPPUSS, n=3 4.33 (1.16) \n\n\n\n \n\n\n\n\n\n\n\n\nChung, E.S.N. et al. Mal J Pharm 7 (1) 2021, 22-27 \n\n\n\n\n\n\n\n26 \n\n\n\n\n\n\n\nrespondents (70.1%), 31.4% of them adopted PVAS. Hence, \n\n\n\nthere is a mismatch in the proportion of those who aware and \n\n\n\nthose who adopt the service. This result reflects that awareness \n\n\n\nis not the sole factor that contributes to PVAS adoption.  \n\n\n\n\n\n\n\nIn the open-ended question which explore refusal to adopt \n\n\n\nPVAS, one of the reasons cited was the poor understanding of \n\n\n\nthe service. They refused to adopt PVAS as they did not fully \n\n\n\nunderstand how it works and were not given a proper \n\n\n\nintroduction to this program. Some stated that they were \n\n\n\nfamiliar to the conventional over-the-counter collection method \n\n\n\nand would like to remain as such. Furthermore, another \n\n\n\nrespondent quoted that he preferred self-collection. The reasons \n\n\n\nare similar to the belief that the sense of unfamiliarity and little \n\n\n\ncontrol over patients\u2019 situation [1]. In another study, the \n\n\n\nresearchers argued that the presence of pharmacist during the \n\n\n\ncollection of medications may be essential and necessary to \n\n\n\nsome patients, mainly when there is a concern of medication \n\n\n\nerror or insufficient drug supply [13]. Patients may feel \n\n\n\nstressful and insecure especially when receiving different or \n\n\n\nunexpected medications via UMP and PPUSS when there is no \n\n\n\npharmacist available for them to consult [13]. This could \n\n\n\nhappen especially when there is a brand change. Therefore, this \n\n\n\ncould hinder the adoption of the service. \n\n\n\n\n\n\n\nIn the current study, a small number of respondents thought that \n\n\n\nPVAS is not required as it was more convenient to self-collect \n\n\n\ntheir refilled medicine due to the short distance to hospital. \n\n\n\nSome cited that they were not ready to adopt the new service. \n\n\n\nOne of the PVAS users revealed unpleasant experience from \n\n\n\nprevious (UMP) use, in which he failed to receive his follow-\n\n\n\nup medications through PVAS. The finding is similar to one \n\n\n\nstudy which reported that the confidence and intention to use \n\n\n\nUMP may lower as the delay in delivery by the national courier \n\n\n\nservice causes uncertainty and disappointment [13]. One of the \n\n\n\nrespondents reported the absence of recipient during medicine \n\n\n\ndelivery contributed to the refusal to adopt PVAS. It may be \n\n\n\ninconvenient to wait for the delivery as the delivery time is \n\n\n\nunknown. As discussed in a previous study, negative feelings \n\n\n\nor unpleasant experience with PVAS is one of the barriers that \n\n\n\naffect PVAS adoption and remains a significant challenge to \n\n\n\novercome [13].  \n\n\n\n\n\n\n\nWe also observed that Drive-Through Pharmacy has the \n\n\n\ngreatest satisfaction score, 4.40 (SD=0.70), whereas Call-and-\n\n\n\nCollect Service is the least satisfied, 3.88 (SD=0.91). Although \n\n\n\nCall-and-Collect is one of the most popular PVAS among the \n\n\n\nrespondents, the satisfaction score is the lowest. This could be \n\n\n\ndue to the difficulty in telephone line engagement as frequently \n\n\n\ncomplained by many patients. Due to the limited phone line and \n\n\n\nhigh usage due to hectic daily works. Nonetheless, previous \n\n\n\nstudies reported higher satisfaction score with PVAS in general \n\n\n\nwhen compared to conventional over the counter medication \n\n\n\ncollection method [16] [17].  \n\n\n\nWhen commenting opinion on PVAS, most respondents gave \n\n\n\npositive notes on PVAS, acknowledging it as an excellent \n\n\n\nprogram. They acknowledged that PVAS smoothens their \n\n\n\nfollow-up medication collection process as it is convenient, \n\n\n\nefficient, time-saving, and reduces their waiting time at the \n\n\n\npharmacy counter. Some respondents commented that PVAS \n\n\n\ncould reduce the risk of infectious disease transmission as they \n\n\n\ndo not need to visit the hospital frequently. It could save the \n\n\n\nfuel cost for the respondents too. \n\n\n\n\n\n\n\nTherefore, in this study, most respondents (86.2%) were \n\n\n\nwilling to adopt PVAS. 95.8% of the experienced PVAS users \n\n\n\nand 90.1% of inexperienced respondents, respectively were \n\n\n\nwilling to adopt PVAS to collect their follow-up medications. \n\n\n\nThis could be translated into future adoption of PVAS if \n\n\n\nintention to adopt is successful instilled. Although constant \n\n\n\npromotion could be useful, Tan et al. postulated that the \n\n\n\nadvantages of PVAS and how it works should be clearly \n\n\n\nconveyed to instill the intention to adopt these services [13]. \n\n\n\nWithout a clear intention, PVAS adoption will be limited as \n\n\n\nintentions are the precursors of behaviour [13]. Hence, it is \n\n\n\ncrucial for the promotional activities to enhance the \n\n\n\nunderstanding of the PVAS, besides increasing the awareness \n\n\n\namong patients. Therefore, the role of pharmacists is very much \n\n\n\ncrucial in assisting patients in selecting the type of PVAS that \n\n\n\nsuits their needs and provide help to overcome problems which \n\n\n\narise during the PVAS adoption. \n\n\n\n\n\n\n\nThis study has some limitations. Firstly, this was a single-centre \n\n\n\nstudy, the local population characteristics and need may differ \n\n\n\nfrom another population. Hence generalisation of the results \n\n\n\ncould be possible in a population which is similar to our study \n\n\n\nsample. In addition, the PVAS users in each subgroup was too \n\n\n\nsmall, therefore, not meaningful to perform inferences for their \n\n\n\nsatisfaction scores. Further studies using stratified sampling \n\n\n\nmethod may be appropriate for direct comparison of \n\n\n\nsatisfaction scores among types of PVAS. \n\n\n\n\n\n\n\nCONCLUSION  \n  \n\n\n\nThis study suggested that most respondents were aware of \n\n\n\nPVAS with a total of 31.4% of the respondents were its users. \n\n\n\nAmong the PVAS, Appointment Card Dispensing System \n\n\n\nservice were the most used PVAS while Drive-Through \n\n\n\nPharmacy and UMP were the most known PVAS. Respondents \n\n\n\nalso indicated the highest satisfaction score for Drive-Through \n\n\n\nPharmacy, and lowest for Call-and-Collect Service. Drive-thru \n\n\n\nPharmacy has the greatest awareness and satisfaction yet low \n\n\n\nusage, hence there is a need to further promote the PVAS for \n\n\n\ngreater adoption. Besides, such PVAS should also be expanded \n\n\n\nto other healthcare facilities.  \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nChung, E.S.N. et al. Mal J Pharm 7 (1) 2021, 22-27 \n\n\n\n\n\n\n\n27 \n\n\n\n\n\n\n\nACKNOWLEDGMENT \n  \n\n\n\nWe wish to acknowledge all respondents for spending their \n\n\n\ntime in this study. The authors would also like to thank the \n\n\n\nDirector General of Health Malaysia, for his permission to \n\n\n\npublish this paper. \n\n\n\n\n\n\n\nCONFLICT OF INTEREST \n  \n\n\n\nThe authors declare that there is no conflict of interest. \n\n\n\n\n\n\n\nREFERENCE \n \n\n\n\n[1] Tan CLH, Gan VBY. Pharmacy Value Added Services: Early \n\n\n\nBegininings, Current Implementation, and Challenges from the \n\n\n\nMalaysian Experience. Indian Journal of Pharmaceutical Education \n\n\n\nand Research 2016;50(3):335-43. \n\n\n\n[2] Pharmaceutical Services Division. A National Survey on the Use of \n\n\n\nMedicines by Malaysian Consumers (NSUM) 2015. \n\n\n\n[3] Loh BC, Wah KF, Teo CA, Khairuddin NM, Fairuz FB, Liew JE. \n\n\n\nImpact of value added services on patient waiting time at the \n\n\n\nambulatory pharmacy Queen Elizabeth Hospital. Pharm Pract \n\n\n\n(Granada). 2017;15(1):846. \n\n\n\n[4] Pharmaceutical Services Division. Garis Panduan Perkhidmatan \n\n\n\nTambah Nilai Farmasi. 2016. \n\n\n\n[5] Lin Y-F, Lin Y-M, Sheng L-H, Chien H-Y, Chang T-J, Zheng C-M, \n\n\n\net al. First drive-through pharmacy services in Taiwan. Journal of the \n\n\n\nChinese Medical Association. 2013;76(1):37-41. \n\n\n\n[6] Lin Y-F, Lin Y-M, Sheng L-H, Chien H-Y, Chang T-J, Zheng C-M, \n\n\n\net al. First drive-through pharmacy services in Taiwan. Journal of the \n\n\n\nChinese Medical Association. 2013;76(1):37-41. \n\n\n\n[7] Pharmaceutical Services Programme. Statistics Report of \n\n\n\nPharmaceutical Services Programme 2019. 2020. \n\n\n\n[8] Pharmaceutical Services Programme. Annual Report of \n\n\n\nPharmaceutical Services Programme 2014. \n\n\n\n[9] Pharmaceutical Services Programme. Annual Report of Pharmacy \n\n\n\nProgramme 2015. \n\n\n\n[10] Pharmaceutical Services Programme. Annual Report of \n\n\n\nPharmaceutical Services Programme 2019. \n\n\n\n[11] Department of Statistics Malaysia. Siaran Akhbar Laporan Survei \n\n\n\nPendapatan Isi Rumah & Kemudahan Asas 2019. \n\n\n\n[12] Allegemeine Psychologie und Arbeitspsychologie. G*Power: \n\n\n\nStatistical Power Analyses for Windows and Mac. D\u00fcsseldorf: \n\n\n\nHeinrich Heine University D\u00fcsseldorf; 2019. \n\n\n\n[13] Tan CLH, Hassali MA, Saleem F, Shafie AA, Aljadhay H, Gan VBY. \n\n\n\nBuilding intentions with the theory of planned behaviour: a qualitative \n\n\n\nassessment of salient beliefs about pharmacy value added services in \n\n\n\nMalaysia. Health Expectations. 2015(19):1215-25. \n\n\n\n[14] Zainal Z, Hashim N, Musa M, Rahim SS, Hisham N, Yen CK. \n\n\n\nPharmacy Bulletin. Accessed on 13 March 2021. Available from:     \n\n\n\nhttp://htintan.moh.gov.my/index.php/penerbitan/muat-turun-\n\n\n\nborang/category/19-farmasi?download=207:buletin-farmasi-2017. \n\n\n\n[15] 15. HRPZII's Locker4U Service Receives Overwhelming Response. \n\n\n\nAccessed on 13 March 2021. Available from:     \n\n\n\nhttps://www.thesundaily.my/archive/hrpziis-locker4u-service-\n\n\n\nreceives-overwhelming-response-ETARCH472120. \n\n\n\n[16] Lau BT, Abdul-Rani NNA, Ng SY, Wong SN. Satisfaction of patients \n\n\n\nreceiving value added-services compared to traditional counter service \n\n\n\nfor prescription refills in Malaysia. Pharmacy Practice 2018;16(1):1-\n\n\n\n6. \n\n\n\n[17] Chan HK, Shahabudin NA, Ghani NA, Hassali MA. Satisfaction with \n\n\n\ntraditional counter versus value\u2010added services for prescription claims \n\n\n\nin a Malaysian Tertiary Hospital. Journal of Pharmaceutical Health \n\n\n\nServices Research. 2015;6(1):61-8. \n\n\n\n\n\n"
"\n\nMalaysian Journal of Pharmacy Volume 8 Issue 1 (2022) \n \n\n\n\n\n\n\n\n32 \n\n\n\n\n\n\n\n\n\n\n\n*Correspondence: davidcct.crc@gmail.com, \n\n\n\npm_lee2010@hotmail.com \n\n\n\n1 Pharmacy Department, Hospital Raja Permaisuri Bainun, Ipoh, 30450 \n\n\n\nIpoh, Perak, Malaysia. \n2 Medical Department, Hospital Raja Permaisuri Bainun, Ipoh, 30450 Ipoh, \nPerak, Malaysia. \n3 Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ipoh, 30450 \nIpoh, Perak, Malaysia \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n Short Communication \n\n\n\n\n\n\n\nHyperlipidemia Post Initiation of Nilotinib among Chronic \n\n\n\nMyeloid Leukemia Patients in a Tertiary Hospital of Malaysia \n \n\n\n\nPooi-Mun Lee1, Kamini Kirubamoorthy2, Chee-Tao Chang3* \n\n\n\n\n\n\n\n \nArticle Info  \n\n\n\n \nReceived date: 13 Apr 2022 \n\n\n\nAccepted date: 10 May 2022 \n\n\n\nPublished date: 30 Jun 2022 \n\n\n\n\n\n\n\nKeywords: Chronic myeloid \n\n\n\nleukemia, nilotinib, \n\n\n\nhyperlipidemia, statin, \n\n\n\ntreatment outcome.  \n\n\n\nABSTRACT  \n\n\n\n\n\n\n\nIntroduction: Nilotinib is effective in patients with chronic myeloid leukemia (CML), but is also \n\n\n\nassociated with hyperlipidemia, which can be a risk factor for atherosclerotic vascular events.  \n\n\n\nObjective: To determine the completeness in monitoring the fasting lipid profile (FLP), changes in \n\n\n\nlipid levels before and after the initiation of nilotinib, and changes in lipid levels after statin therapy. \n\n\n\nMethod: This was a retrospective cohort study that included all patients with CML in the chronic or \n\n\n\naccelerated phase, who were receiving follow up under the haematology clinic of a regional referral \n\n\n\nhospital in the state of Perak, Malaysia. Patients who had been prescribed nilotinib from the beginning \n\n\n\nof January 2010 to June 2020 were included in the study, including patients who were still on \n\n\n\ntreatment as well as those who, despite having their treatment discontinued during the observation \n\n\n\nperiod, still followed up in the clinic. The monitoring of FLP was defined as either \u201ccomplete\u201d (with \n\n\n\nboth pre-initiation and post-initiation FLP available); or \u201cincomplete\u201d (with either one of pre-\n\n\n\ninitiation or post-initiation FLP available); or \u201cnot ordered\u201d. An LDL level of \u2265 2.6 mmol / L was \n\n\n\nconsidered suboptimal. Since the changes in FLP parameters were found to not be normally \n\n\n\ndistributed, the data were evaluated using the Wilcoxon test, whereby a two-tailed p-value of P < \n\n\n\n0.05 was considered statistically significant. Result: 61 patients who met the inclusion criteria were \n\n\n\nincluded. The FLP test was not ordered in 16 patients, incomplete in 33 patients and complete in 11 \n\n\n\npatients (18%). Patients who had completed the test displayed a significant increase in median HDL, \n\n\n\nLDL, and total cholesterol level from 1.27 to 1.46 mmol / L (p = 0.009), 2.10 to 3.30 mmol / L (p = \n\n\n\n0.003) and 3.90 to 5.33 mmol / L (p = 0.005) respectively after the initiation of nilotinib. Statin was \n\n\n\nprescribed to 6 patients with a baseline mean LDL of 4.77 mmol / L, whereby the mean LDL was \n\n\n\nsignificantly reduced by 1.82 mmol / L (p = 0.003) after treatment. Conclusion: Patients experienced \n\n\n\na significant increase in total cholesterol and LDL levels with nilotinib. Treatment with statin has \n\n\n\nelicited a significant reduction in LDL. Only a small proportion of patients received complete FLP \n\n\n\nmonitoring, which warrants attention from the health authority.   \n\n\n\n\n\n\n\n\n\n\n\nINTRODUCTION  \n\n\n\n\n\n\n\nChronic myeloid leukemia (CML) is a clonal disease of \n\n\n\nhaematopoietic stem cells secondary to the chromosomal \n\n\n\ntranslocation of chromosomes 9 and 22, which forms the \n\n\n\nPhiladelphia (Ph) chromosome, further resulting in the \n\n\n\nformation of the hybrid BCR-ABL fusion gene and its \n\n\n\noncogenic product, BCR-ABL kinase. Deregulated tyrosine \n\n\n\nkinase activity plays a central role in the pathogenesis of CML \n\n\n\n[1]. \n\n\n\n\n\n\n\nThe approval of the first-generation tyrosine kinase inhibitor \n\n\n\n(TKI), imatinib, in 2001 revolutionized the treatment of CML \n\n\n\npatients [2]. Imatinib had demonstrated superior efficacy \n\n\n\ncompared to the standard therapy consisting of cytarabine and \n\n\n\ninterferon, which resulted in a median survival period of only \n\n\n\n\nmailto:davidcct.crc@gmail.com\n\n\n\n\n\n\nLee P.et al. Mal J Pharm 8 (1) 2022, 32-37 \n\n\n\n\n\n\n\n33 \n\n\n\n\n\n\n\nabout 6 years [3]. Treatment with TKIs renders CML less \n\n\n\nsevere, and into a similar state as to chronic disease, with a life \n\n\n\nexpectancy comparable to that of the general population [4]. \n\n\n\nHowever, the use of imatinib was forced to be discontinued in \n\n\n\nsome patients who developed intolerable adverse events (AE) \n\n\n\nor disease resistance [5]. Later, more potent second-generation \n\n\n\nTKIs such as nilotinib, dasatinib, bosutinib, and ponatinib were \n\n\n\napproved [6]. Nilotinib was shown to induce a better major \n\n\n\nmolecular response (MMR) and a lower rate of disease \n\n\n\nprogression compared to imatinib [7-8]. \n\n\n\n\n\n\n\nConsidering how patients may require lifelong TKI treatment, \n\n\n\nits safety profile is important. Namely, myelosuppression, \n\n\n\ncardiac and arterial vascular occlusive events, QT \n\n\n\nprolongation, pancreatitis, hepatotoxicity, electrolyte \n\n\n\nabnormalities, haemorrhage, and fluid retention were some of \n\n\n\nthe more serious AEs that are associated with nilotinib [9]. \n\n\n\nFurthermore, other AEs that were commonly reported in \n\n\n\nclinical trials included rash, pruritus, headache, nausea, fatigue, \n\n\n\nalopecia, myalgia, and upper abdominal pain [9]. \n\n\n\n\n\n\n\nHyperlipidemia is a major risk factor for cardiovascular \n\n\n\ndiseases [10] and was reported to be associated with the use of \n\n\n\nnilotinib [9]. Indeed, the ENESTnd study reported an increase \n\n\n\nin total cholesterol and low-density lipoprotein (LDL) within \n\n\n\nthree months of treatment [11]. Meanwhile, a study conducted \n\n\n\nby Rea et al. also discovered a significant increase in both high-\n\n\n\ndensity lipoprotein (HDL) and LDL within 3 months of \n\n\n\nnilotinib treatment [12]. In a separate study, an elevation of \n\n\n\ntotal cholesterol and triglycerides (TG) was found in 28% and \n\n\n\n12% of patients who were treated with nilotinib, compared to \n\n\n\nan increase of total cholesterol and TG in only 4% and 8% of \n\n\n\npatients respectively when treated with imatinib [9]. \n\n\n\nFurthermore, a study in Poland revealed that metabolic adverse \n\n\n\neffects related to glucose and lipid metabolism as well as \n\n\n\nvascular events such as myocardial infarction and ischemic \n\n\n\nstroke were significantly more frequent in the nilotinib group \n\n\n\ncompared to the dasatinib group [13] \n\n\n\n\n\n\n\nAim of the study \n\n\n\n\n\n\n\nIn the local setting, the monitoring of lipid profile and \n\n\n\ntreatment-related complications of second-generation TKIs \n\n\n\nhave not been adequately investigated in real-life settings. \n\n\n\nTherefore, we aimed to evaluate the occurrence of \n\n\n\nhyperlipidemia associated with nilotinib use and the \n\n\n\ncompleteness of fasting lipid profile monitoring among CML \n\n\n\npatients who were receiving follow up in the haematology \n\n\n\nclinic of a regional referral hospital in the state of Perak, \n\n\n\nMalaysia. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nMETHOD \n\n\n\n\n\n\n\nThis was a retrospective cohort study that involved all patients \n\n\n\nwho started with nilotinib. All such patients were proven to \n\n\n\nhave the Philadelphia chromosome (Ph+) CML and were \n\n\n\ndiagnosed with either chronic-phrase CML (< 10% blasts in \n\n\n\nperipheral blood and bone marrow) or accelerated-phase CML \n\n\n\n(10% \u2013 19% blasts in peripheral blood and bone marrow) based \n\n\n\non classifications set by the World Health Organization [14]. \n\n\n\nPatients with Ph + acute lymphoblastic leukaemia (ALL) and \n\n\n\nthose transferred to other hospitals were excluded. \n\n\n\n\n\n\n\nA list of CML patients, who had been prescribed nilotinib from \n\n\n\nthe beginning of January 2010 to June 2020, was retrieved from \n\n\n\nthe pharmacy\u2019s dispensing records. Patients who were \n\n\n\nprescribed nilotinib but had their nilotinib treatment withdrawn \n\n\n\nor discontinued during the observation period, whilst still \n\n\n\nattending follow up sessions in the clinic, were also included. \n\n\n\nAll patients received proprietary nilotinib (Tasigna\u00ae).   \n\n\n\n\n\n\n\nThere were 152 CML outpatients who obtained TKI (imatinib, \n\n\n\nnilotinib, and ponatinib) at the study centre during the study \n\n\n\nperiod, up to 1st June 2019, of which, 65 CML patients were \n\n\n\nprescribed nilotinib according to the pharmacy dispensing \n\n\n\nrecord, and all such patients were included in the study. \n\n\n\n\n\n\n\nThe medical records of the patients were then traced from the \n\n\n\nhaematology clinic, and the samples were collected using \n\n\n\nconsecutive sampling. A standard data collection form was \n\n\n\nused to collect demographic and clinical data from paper-based \n\n\n\nand electronic medical records. The progress of the patients \n\n\n\nwas followed from the initiation of nilotinib up to June 2020. \n\n\n\n\n\n\n\nThe molecular response of the patients was determined based \n\n\n\non their BCR\u2013ABL1 transcript levels, whereby a major \n\n\n\nmolecular response (MMR) is defined as a BCR \u2013 ABL1 \n\n\n\ntranscript level of \u2264 0.1% [6]. The patient\u2019s FLP prior to \n\n\n\ninitiation of nilotinib and at least one month after initiation was \n\n\n\ntraced. Dyslipidemia was defined as having total cholesterol \n\n\n\ngreater than 5.2 mmol / L, LDL greater than 2.6 mmol / L, TG \n\n\n\ngreater than 1.7 mmol / L, and HDL less than 1.45 mmol / L in \n\n\n\nmen and less than 1.2 mmol / L in women.  \n\n\n\n\n\n\n\nThe monitoring of FLP was defined as either \u201ccomplete\u201d (with \n\n\n\nboth pre-initiation and post-initiation FLP available), or \n\n\n\n\u201cincomplete\u201d (either one of pre-initiation or post-initiation FLP \n\n\n\navailable) or \u201cnot ordered\u201d. Furthermore, the use of statin and \n\n\n\nthe subsequent changes in FLP after initiation of statin were \n\n\n\nevaluated. However, in situations whereby patients had been on  \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nLee P.et al. Mal J Pharm 8 (1) 2022, 32-37 \n\n\n\n\n\n\n\n34 \n\n\n\n\n\n\n\na lipid-lowering agent prior to the initiation of nilotinib, the \n\n\n\nlipid profile of such patients were excluded from the analysis \n\n\n\nof changes in lipid profile.   \n\n\n\n\n\n\n\nStatistical analysis was performed using SPSS\u00ae (version 20.0). \n\n\n\nThe demographic characteristics of the patients, co-\n\n\n\nmorbidities, MMR and TKI treatment history were \n\n\n\ndescriptively reported. Categorical data were presented as \n\n\n\nfrequencies and percentage values, while continuous data were \n\n\n\nreported in the form of mean \u00b1 standard deviation (SD) or \n\n\n\nmedian (interquartile range [IQR]) if they were not normally \n\n\n\ndistributed. \n\n\n\n\n\n\n\nAll patients with partially missing data as well as patients who \n\n\n\nbecame lost to follow-up were included if they had complete \n\n\n\nrecords for nilotinib initiation and FLP results. In this \n\n\n\nexperiment, hyperlipidemia associated with nilotinib presents \n\n\n\nitself as changes in total cholesterol, HDL, LDL and TG before \n\n\n\nand after nilotinib. The changes in FLP were not normally \n\n\n\ndistributed and were therefore evaluated using the Wilcoxon \n\n\n\ntest. A two-tailed p-value of P < 0.05 was considered \n\n\n\nstatistically significant. \n\n\n\n\n\n\n\nRESULTS \n \n\n\n\nOf the 65 patients who were treated with nilotinib, 4 patients \n\n\n\nwere excluded; 1 patient had been transferred to other hospital \n\n\n\nfor care and the remaining 3 patients were diagnosed with \n\n\n\nPhiladelphia positive (Ph+) ALL.  Most of the patients were \n\n\n\nmale (50.8%), with a mean age at diagnosis of 42 \u00b115.8 years. \n\n\n\nThe mean age at the time of nilotinib initiation was 44 \u00b115.8 \n\n\n\nyears.  Most of the patients (88.5%) were diagnosed to be at the \n\n\n\nchronic phase of CML at the time of diagnosis (Table I). \n\n\n\n\n\n\n\n Nilotinib was administered as a first-line TKI to only 9 patients \n\n\n\n(14.8%), 2 of which were diagnosed with CML in the \n\n\n\naccelerated phase. The majority of patients (n = 52, 85.2%) \n\n\n\nswitched to nilotinib as the second-line therapy due to several \n\n\n\nreasons as illustrated in Figure I. A total of 33 patients (54.1%) \n\n\n\nachieved MMR with a median of 9 months (IQR 17.3 months). \n\n\n\nNilotinib was withheld in 18 patients (29.5%), including two \n\n\n\npatients who were diagnosed with cerebrovascular accident \n\n\n\n(CVA) after 3 years of nilotinib. Of the two patients with CVA, \n\n\n\none patient had normal FLP, while the other had been on statin \n\n\n\ntherapy before the initiation of nilotinib. \n\n\n\n\n\n\n\nThere were 16 patients (26.2%) who had not been tested for \n\n\n\nFLP, while an incomplete FLP was observed in 33 patients (6 \n\n\n\npatients only had pre-initiation FLP levels, while 27 patients \n\n\n\nonly had post-initiation FLP levels). A total of 12 (19.7%) \n\n\n\npatients underwent complete FLP monitoring, with their FLP  \n\n\n\n\n\n\n\n\n\n\n\nrecorded for both pre-initiation and post-initiation (Table II), of \n\n\n\nwhich 11 of the 12 patients had a significant increase in median \n\n\n\nHDL, LDL and total cholesterol levels from 1.27 to 1.46 mmol \n\n\n\n/ L (Z: -2.599, p = 0.009), 2.10 to 3.30 mmol / L (Z: -2.937, p \n\n\n\n= 0.003) and 3.90 to 5.33 mmol / L (Z: -2.805, p = 0.005) \n\n\n\nrespectively. However, the triglyceride levels of patients were \n\n\n\nreported to have a non-significant reduction from 1.59 to 1.35 \n\n\n\nmmol / L (Z: -0.459, p = 0.646). \n\n\n\nStatin was prescribed to 12 patients (19.7%), with a mean pre-\n\n\n\ntreatment LDL of 4.77 mmol/L. The use of statin with a median \n\n\n\nduration of 95 days significantly reduced the mean LDL by \n\n\n\n1.82 mmol / L, resulting in a mean of 2.95 mmol / L (t = 2.966, \n\n\n\nP = 0.003). However, the reduction in LDL did not meet the \n\n\n\noptimal cut-off level for high CV risk patients, which was \u2264 2.6 \n\n\n\nmmol / L [15]. \n\n\n\n\n\n\n\n\n\n\n\nTable I. Patient Socio-demographic and Clinical Characteristics (n = 61) \n\n\n\n\n\n\n\nCharacteristics  Number (%) \n\n\n\nGender   \n\n\n\n   Male  31 (50.8) \n\n\n\n   Female  30 (49.2) \n\n\n\nAge at diagnosis, years  \n\n\n\n   Mean 42.0  \n\n\n\n   Range 8 - 76  \n\n\n\nEthnicity   \n\n\n\n   Malay  36 (59.0) \n\n\n\n   Chinese  16 (26.2) \n\n\n\n   Indian  9 (14.8) \nCo-morbidities   \n\n\n\n   Diabetes mellitus  10 (16.4) \n\n\n\n   Hypertension  15 (24.6) \n   Chronic kidney diseases  2 (3.3) \n\n\n\nCML phase at diagnosis  \n\n\n\n   Chronic  54 (88.5) \n   Accelerated  7 (11.5) \n\n\n\nNilotinib as   \n\n\n\n   1st line TKI  9 (14.8) \n   2nd line TKI  52 (85.2) \n\n\n\nReasons of switching nilotinib as 2nd line (n = 52) \n\n\n\n   Suboptimal response 31 (59.6) \n\n\n\n   Intolerance with imatinib 11 (21.2) \n\n\n\n   Loss of MMR  6 (11.5) \n   Disease progression   3 (5.8) \n\n\n\n   Unknown  1 (1.9) \n\n\n\nMMR   \n\n\n\n   Yes  33 (54.1) \n\n\n\n   No  28 (45.9) \n\n\n\nReasons of stopping nilotinib  (n = 18) \n   Mutation that resistant to nilotinib 6(33.3) \n\n\n\n- T315i  4 (22.2) \n\n\n\n- E255K  1 (5.6) \n- Y253H  1 (5.6) \n\n\n\n   Defaulted follow up    5 (27.8) \n\n\n\n   Suboptimal response 3 (16.7) \n   Cerebrovascular accident 2 (11.1) \n\n\n\n   Death  2 (23.9) \n\n\n\n\n\n\n\nCML: Chronic myeloid leukemia; MMR: Major molecular response; TKI: \n\n\n\nTyrosine kinase inhibitor \n\n\n\n \n\n\n\n\n\n\n\n\nLee P.et al. Mal J Pharm 8 (1) 2022, 32-37 \n\n\n\n\n\n\n\n35 \n\n\n\n\n\n\n\nDISCUSSION \n\n\n\n\n\n\n\nIn general, we found that nilotinib was associated with a \n\n\n\nsignificant increase in total cholesterol, LDL, and HDL, but a \n\n\n\nnon-significant reduction in TG. Notably, the proportion of \n\n\n\npatients with suboptimal LDL level had increased from 23.5% \n\n\n\n(n = 8) to 77.8% (n = 28) after starting nilotinib. The results \n\n\n\nwere very similar to an earlier study in which there was an \n\n\n\nincrease in the proportion of patients with suboptimal LDL at \n\n\n\n12 months of treatment from 48.1% to 88.9% [12]. Another \n\n\n\nstudy revealed that the incidence of hyperlipidemia with \n\n\n\nnilotinib therapy was 74.6%, which was significantly higher \n\n\n\nthan that with dasatinib (46.4%) [16].  Similarly, our study \n\n\n\nshowed a high proportion of patients with newly-occurring \n\n\n\nhyperlipidemia or worsening lipid profile. These findings, \n\n\n\nhowever, are in contrast with some clinical trials that report an \n\n\n\nincrease in patients with suboptimal LDL of about 26.7% and \n\n\n\n27.6% for nilotinib 300 mg twice daily and 400 mg twice daily \n\n\n\n[11]. \n\n\n\n\n\n\n\nOur study found that slightly more than a quarter of patients did \n\n\n\nnot have their baseline FLP recorded prior to the initiation of \n\n\n\nnilotinib, indicating an inadequate FLP monitoring. In that \n\n\n\nregard, it is noteworthy that the current local clinical practice \n\n\n\nguideline does not require physicians to perform a baseline \n\n\n\nFLP. This fact prompts physicians to use clinical judgement \n\n\n\nand experience in deciding on whether or not to initiate a \n\n\n\nbaseline FLP measurement [15]. Several common factors that \n\n\n\ninfluence the decision of physicians in such a scenario include \n\n\n\npatient age, comorbidity status, and risk of developing \n\n\n\natherosclerotic cardiovascular diseases [17]. \n\n\n\n\n\n\n\nConsistent with the main cohort, we observed a significant \n\n\n\nincrease in total cholesterol, LDL, HDL, and a non-significant \n\n\n\nreduction in TG among the subgroup of patients with pre-\n\n\n\ninitiation and post-FLP monitoring. This was in congruence \n\n\n\nwith a Czech study, whereby the total cholesterol, LDL, HDL \n\n\n\nhad increased significantly from 4.5 (2.8 - 6.9)  to 5.5 (3.9 - 6.8) \n\n\n\nmmol / L, 2.7 (1.4 - 5.4) to 3.0 (2.0 - 4.4) mmol / L, 1.0 (0.4 - \n\n\n\n1.8) to 1.5 (1.0 - 2.8) mmol / L, respectively, while TG was \n\n\n\nsignificantly reduced from 1.95 (0.8 - 4.8) to 1.32 (0.6 - 5.9) \n\n\n\nmmol/L during the first year of nilotinib treatment [18]. \n\n\n\nHowever, disparate evidence seems to suggest that both LDL \n\n\n\nand HDL elevation can be observed as early as 3 months of \n\n\n\nnilotinib initiation among those with CML in the chronic phase \n\n\n\n[12]. \n\n\n\nTherefore, in light of several findings mentioned earlier, FLP \n\n\n\ninvestigation should be recommended before initiation as well \n\n\n\nTable II. Monitoring of Fasting Lipid Profile \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nNumber \n\n\n\n(%) \n\n\n\nBaseline \n\n\n\n(mmol/L) \n\n\n\nAfter \n\n\n\nnilotinib \n\n\n\n(mmol/L) \n\n\n\np-\n\n\n\nvalue \n\n\n\nPre-\n\n\n\ntreatment \n\n\n\ninitiation \n\n\n\nonly \n\n\n\n6 (9.8) \n\n\n\nLDL: 1.90 \n\n\n\n(IQR 1.08) \n\n\n\nNA NA \n\n\n\nHDL: 1.14 \n\n\n\n(IQR 0.73) \nTC: 3.78 \n\n\n\n(IQR 1.78) \n\n\n\nTG: 1.37 \n(IQR 1.82) \n\n\n\n\n\n\n\nPre and \n\n\n\npost \n\n\n\ntreatment \n\n\n\ninitiation \n\n\n\n*11 \n(19.7) \n\n\n\nLDL:  2.10 \n(IQR 1.00) \n\n\n\nLDL: 3.30 \n(IQR 1.77) \n\n\n\n0.003 \n\n\n\nHDL: 1.27 \n\n\n\n(IQR 0.66) \n\n\n\nHDL: 1.46 \n\n\n\n(IQR 0.42) \n0.009 \n\n\n\nTC: 3.90 \n\n\n\n(IQR 1.30) \n\n\n\nTC: 5.33 \n\n\n\n(IQR 1.63) \n0.005 \n\n\n\nTG: 1.59 \n(IQR 0.79) \n\n\n\nTG: 1.35 \n(IQR 0.71) \n\n\n\n0.646 \n\n\n\n\n\n\n\nPost-\n\n\n\ntreatment \n\n\n\ninitiation \n\n\n\nonly \n\n\n\n#25 \n(44.3) \n\n\n\nNA \n\n\n\nLDL: 3.50 \n\n\n\n(IQR 1.85) \n\n\n\nNA \n\n\n\nHDL: 1.46 \n\n\n\n(IQR 0.75) \nTC: 5.30 \n\n\n\n(IQR 1.70) \n\n\n\nTG: 1.27 \n(IQR 0.96) \n\n\n\n\n\n\n\nNo \n\n\n\nfasting \n\n\n\nlipid \n\n\n\nprofile \n\n\n\nordered \n\n\n\n16 \n(26.2) \n\n\n\nNA  NA \n\n\n\n \n*Total patient with pre and post FLP was 12. One patient was excluded \n\n\n\ndue to pre-existing statin use. \n\n\n\n\n\n\n\n#Total patient with post FLP was 27. One patient was excluded due to \n\n\n\nthe LDL repeated less than 1 month after initiation of nilotinib; and one \n\n\n\npatient with pre-existing statin use. \n\n\n\n\n\n\n\nNote: Among the 16 patients (27.6%) with at least one FLP ordered \n\n\n\nbefore initiation of nilotinib, 23.5% of them had suboptimal LDL \n\n\n\n(median LDL: 2.05 mmol/L, IQR 0.93 mmol / L). Among the 36 patients \n\n\n\n(60.7%) with at least one FLP ordered after initiation of nilotinib, 77.8% \n\n\n\nhad suboptimal LDL (median LDL: 3.30 mmol / L, IQR 1.67 mmol / L).  \n\n\n\nAbbreviations: LDL: high-density lipoprotein; HDL: high-density \n\n\n\nlipoprotein; TC: total cholesterol; TG: triglycerides; NA: not applicable. \n\n\n\n\n\n\n\nFigure I. Reasons of Switching Nilotinib as Second Line TKI (n = 52) \n\n\n\n\n\n\n\n\nLee P.et al. Mal J Pharm 8 (1) 2022, 32-37 \n\n\n\n\n\n\n\n36 \n\n\n\n\n\n\n\nas after three months and after six months of nilotinib initiation, \n\n\n\nfollowed subsequently by a yearly follow-up [19]. \n\n\n\nCardiovascular risk stratification, supplemented with a baseline \n\n\n\nFLP, should be planned for all patients prior to the initiation of \n\n\n\nnilotinib [20]. The use of the Framingham general \n\n\n\ncardiovascular risk scores [21]can also be used to predict the \n\n\n\nrisk of developing a cardiovascular event in such patients, \n\n\n\namong other steps such as setting an optimal level of LDL, \n\n\n\nwhich would allow the guiding of patient selection and \n\n\n\nintensity of monitoring. It is believed that these steps would \n\n\n\nminimize treatment-limiting complications and improve \n\n\n\ntreatment outcomes [11] \n\n\n\n\n\n\n\nIn addition, health education is important to empower patients \n\n\n\ntowards actively participating in managing his or her treatment.  \n\n\n\nAn example of such an event can be seen in a local pharmacy \n\n\n\ncare program with dedicated pharmacists was implemented to \n\n\n\neducate patients on the disease, treatment-related issues and \n\n\n\nadherence. It allowed physicians and pharmacists to counsel \n\n\n\nhigh-risk CML patients who started with nilotinib, \n\n\n\nincorporating educational modules on healthy lifestyle and diet, \n\n\n\nweight management, smoking cessation, and engagement in \n\n\n\nphysical activities [10]. \n\n\n\n\n\n\n\nAmong the 12 patients who started statin therapy, the LDL \n\n\n\nlevel was significantly reduced from 4.77 mmol / L to 2.95 \n\n\n\nmmol / L (SD\u00b11.49 mmol / L). Nevertheless, it is important to \n\n\n\nnote that the initiated statin therapy had not been properly \n\n\n\nmonitored for patient adherence or the appropriateness of the \n\n\n\nstatin used. Furthermore, the degree of LDL lowering subjected \n\n\n\nto the dose of statin used. High density statin (atorvastatin 40-\n\n\n\n80mg) or moderate density statin (atorvastatin 10-20mg) is \n\n\n\nassociated with a 50% and above or 30 - 49% of LDL lowering \n\n\n\neffect [22].  The importance of statin therapy in nilotinib \n\n\n\ntherapy is indubitable. In fact, a study by Rea et al. reported \n\n\n\nthat the use of statin among patients with elevated LDL after \n\n\n\ninitiation of nilotinib had significantly reduced the LDL level \n\n\n\nby 2.22 mmol / L [12]. It is evident that timely intervention with \n\n\n\nstatin can effectively reduce cholesterol level [11], lowering the \n\n\n\nrisk of atherosclerosis and cardiovascular diseases. However, it \n\n\n\nis necessary to exercise caution before statin initiation to avoid \n\n\n\nany potential drug-drug interactions with nilotinib [9]. \n\n\n\nFurthermore, the use of second-generation statins that is not \n\n\n\nmetabolized by CYP3A4 such as rosuvastatin and pravastatin \n\n\n\nis preferred, as nilotinib may inhibit the metabolism of first-\n\n\n\ngeneration statins such as simvastatin [23] \n\n\n\n\n\n\n\nA limitation of this study lies in the fact that this was merely a \n\n\n\nsingle-centre study with a small sample size. Furthermore, \n\n\n\nbaseline characteristics such as body mass index (BMI), \n\n\n\ncomorbidity status, diet, physical activities were not evaluated, \n\n\n\nand we were therefore unable to determine the predictors of \n\n\n\nhyperlipidemia. Prospective studies should investigate baseline \n\n\n\nFLP for patients have been started on nilotinib, while also \n\n\n\nascertaining the presence of risk factors including age, smoking \n\n\n\nstatus, and medical history. Scheduled FLP monitoring should \n\n\n\nbe established on conjunction to identifying risk factor in order \n\n\n\nto better understand the causality between the incidence of \n\n\n\nhyperlipidemia and nilotinib therapy. The long-term \n\n\n\ncardiovascular outcomes of nilotinib treatment, including the \n\n\n\ndevelopment of cardiovascular diseases, should also be \n\n\n\nevaluated. Finally, the current study also did not evaluate the \n\n\n\ntype of statin used or its corresponding dose, and neither was it \n\n\n\nable to analyze temporal trends pertaining to the lipid-lowering \n\n\n\neffect or the patients\u2019 adherence. Hence, the ability of statin \n\n\n\ntherapy to improve the FLP outcomes of patients in the context \n\n\n\nof this experiment cannot be truly elucidated on account of the \n\n\n\nlack of information.  \n\n\n\n\n\n\n\nCONCLUSION \n\n\n\n\n\n\n\nA significant increase in total cholesterol and LDL levels is \n\n\n\nobserved in patients treated with nilotinib. Statin therapy is \n\n\n\nshown to elicit a significant reduction in LDL. However, only \n\n\n\na small proportion of patients received complete FLP \n\n\n\nmonitoring. The findings suggest that routine FLP monitoring \n\n\n\nat baseline and after initiation are crucial in minimizing \n\n\n\ntreatment-limiting complications and optimising treatment \n\n\n\noutcomes. \n\n\n\n\n\n\n\nACKNOWLEDGEMENT \n\n\n\n\n\n\n\nWe would like to thank the Director General of Health \n\n\n\nMalaysia for his permission to publish this article. We would \n\n\n\nlike to thanks to thanks Madam Normi Kamaruzaman, Chief \n\n\n\nPharmacist and Dr. Doris George, Head of Section of \n\n\n\nPharmacotherapy in Raja Permaisuri Bainun Hospital. We \n\n\n\nwould like to also thanks staff nurses from the Haematology \n\n\n\nClinic in Raja Permaisuri Bainun Hospital who assisted in data \n\n\n\ncollection; research officers from Clinical Research Centre \n\n\n\nRaja Permaisuri Bainun Hospital who guided in proposal \n\n\n\ndevelopment, data analysis and writing of the manuscript. \n\n\n\n\n\n\n\nCONFLICT OF INTEREST \n\n\n\n\n\n\n\nThe authors declare no conflict of interest. This case report did \n\n\n\nnot receive any specific grant from funding agencies in the \n\n\n\npublic, commercial or not-for-profit sectors. \n\n\n\n\n\n\n\nREFERENCE \n \n\n\n\n[1] Mauro MJ, Druker BJ. STI571: targeting BCR-ABL as therapy for \n\n\n\nCML. 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Blood, \n\n\n\nThe Journal of the American Society of Hematology. 2011 Feb \n\n\n\n24;117(8):e75-87. https://doi.org/10.1182/blood-2010-07-294330 \n\n\n\n \n\n\n\n\nhttps://doi.org/10.1056/NEJM199403243301204\n\n\nhttps://doi.org/10.1056/NEJMoa022457\n\n\nhttps://doi.org/10.1056/NEJMoa062867\n\n\nhttps://doi.org/10.1007/s00277-015-2322-2\n\n\nhttps://doi.org/10.1182/blood-2007-03-080689\n\n\nhttps://doi.org/10.1038/leu.2012.134\n\n\nhttps://doi.org/10.3324/haematol.2014.104075\n\n\nhttps://doi.org/10.1038/leu.2016.5\n\n\nhttps://doi.org/10.3324/haematol.2014.104075\n\n\nhttps://doi.org/10.3109/10428194.2014.994205\n\n\nhttps://doi.org/10.1182/blood-2016-03-643544\n\n\nhttps://www.moh.gov.my/moh/resources/Penerbitan/CPG/CARDIOVASCULAR/4.pdf\n\n\nhttps://www.moh.gov.my/moh/resources/Penerbitan/CPG/CARDIOVASCULAR/4.pdf\n\n\nhttps://doi.org/10.1080/03007995.2017.1399870\n\n\nhttps://doi.org/10.1186/s12944-015-0037-y\n\n\nhttps://doi.org/10.1080/10428194.2019.1672054\n\n\nhttps://doi.org/10.1200/JCO.2015.62.4718\n\n\nhttp://www.ema.europa.eu/docs/en_GB/document_library/EPARProduct_Information/human/000798/WC500034394.pdf\n\n\nhttp://www.ema.europa.eu/docs/en_GB/document_library/EPARProduct_Information/human/000798/WC500034394.pdf\n\n\nhttps://doi.org/10.1007/s11886-020-01331-z\n\n\nhttps://doi.org/10.1182/blood-2010-07-294330\n\n\n\n"
"\n\nMalaysian Journal of Pharmacy 2001;1:15-21 Research Article\n\n\n\n16\n\n\n\nCareer Choice of Malaysian Pharmacy\nStudents: A Preliminary Analysis\nAb Fatah Ab Rahman1, Mohamed Izham Mohamed Ibrahim1*, Zuraidah Mohd\nYusoff1, Mohd Baidi Bahari1 & Rusli Ismail2\n\n\n\n1School of Pharmaceutical Sciences, 11800 Universiti Sains Malaysia, Penang, Malaysia.\n2Department of Pharmacology, School of Medical Sciences, Universiti Sains Malaysia, 16150\nKelantan, Malaysia.\n\n\n\n*Author for correspondence\n\n\n\nABSTRACT\n\n\n\nA cross-sectional study was conducted among pharmacy students to determine\nfactors influencing their choice of work place and to evaluate whether a one-year\nhospital pre-registration training programme had any effect on these choices.\nQuestionnaires were distributed to graduating students at the School of\nPharmaceutical Sciences, Universiti Sains Malaysia.  The questionnaires were again\nsent to the same group of students by post at the end of their pre-registration\ntraining year. The response rate during the follow-up stage was 46%.  Results\nindicated that students in the survey were more interested in independent and chain\ncommunity pharmacies compared to other practice settings.  Students\u2019 choices of\nfirst place of practice appeared to be influenced by both intrinsic and extrinsic job\nfactors.  Our findings did not show major changes in students\u2019 preferences for\npractice sites before and after the hospital pre-registration period.  This information\nis expected to be useful for pharmacy employers.\n\n\n\nKey words: pharmacy, career choice, job factor, workplace, Malaysia\n\n\n\nINTRODUCTION\n\n\n\nChanges within the pharmacy profession over the\npast 15 \u2013 20 years have been inspiring. Pharmacy\nis expected to continue to be an exciting and\ninnovative field in the coming new systems of\nhealth care. It will provide new roles and\nopportunities for pharmacists to serve the health\ncare needs of the society. Therefore, future\npharmacists need to make wise decisions regarding\neducational and professional preparedness,\nkeeping in mind the mobility and flexibility of\ncareer positions.\n\n\n\nUntil 1995, there was only one pharmacy school in\n\n\n\nMalaysia. Pharmacy students at Universiti Sains\nMalaysia (USM) undergo a 4-year academic\nprogramme towards a Bachelor of Pharmacy\ndegree. The curriculum for the first three years\nconsists of basic pharmaceutical science subjects\nunder the general categories of pharmaceutical\nchemistry, pharmaceutical technology, physiology\nand pharmacology. Students are exposed to\nclinical pharmacy curriculum during their fourth\nacademic year (1). They  spend an average of 20\nhours per week at a university hospital for their\nclinical attachments. They rotate through various\nclinical pharmacy services, medical and surgical-\n\n\n\n\n\n\n\n\nResearch article: Career choice of Malaysian pharmacy students\n\n\n\n17\n\n\n\nbased attachments, including attachments at\nvarious community pharmacy outlets. After\ngraduating, they undergo a one-year training\nprogramme at a recognized pharmacy institution\nbefore they are registered with the Malaysian\nPharmacy Board.  This training is also known as\npre-registration training, similar to that practised in\nthe United Kingdom.\n\n\n\nAs a preliminary study, we decided to evaluate\npharmacy students\u2019 choices of practice sites upon\ngraduation and the factors influencing these\nchoices. Since this coincided with the compulsory\none-year pre-registration training programme, we\nwere also interested to see whether this training\nhad any influence on the students\u2019 choices. We\nbelieve that this information will be useful to\npotential employers when recruiting newly\nregistered pharmacists.\n\n\n\nMETHODS\n\n\n\nSurvey questionnaires were distributed to 71\ngraduating pharmacy students at USM after their\nfinal examinations. The questionnaires asked for\ndemographic data, preference of practice sites,\nprevious experience or work, and whether any of\ntheir immediate family members were health\nprofessionals. Students were also asked to rate the\nimportance of identified factors (2), which they\nthought would affect their preference of practice\nsites. These were rated on the Likert scale of 1 to 5\n(1 =  extremely   important,   5  =  extremely\nunimportant). These questionnaires were designed\n\n\n\nin the national language (i.e., Malay). To\ndetermine its clarity, the questionnaire was pre-\ntested on hospital pharmacists and Master of\nClinical Pharmacy students at the university.  For\nsome questions, students were allowed to check\nmore than one answer. Towards the end of the one-\nyear pre-registration training, another\nquestionnaire was mailed to the same batch of\nstudents to their respective home addresses.\n\n\n\nData were analysed using the Statistical Package\nfor Social Sciences (SPSS) Version 7.5 (SPSS Inc.,\nIll).  Descriptive data are presented as percentages.\nDiscrete data were analysed by chi-square or\nFisher\u2019s Exact tests. Significance level chosen for\nstatistical testing was 0.05.\n\n\n\nRESULTS\n\n\n\nAll 71 final year students (100%) took part in the\nfirst evaluation (before pre-registration). Thirty-\nthree responded after pre-registration training\ngiving a response rate of 46%. All students\nunderwent a one-year period of pre-registration\ntraining at government hospitals.\n\n\n\nDemographic data\n\n\n\nThe mean age of students at the time of graduation\nwas 24.3 years old and nearly two-thirds were\nfemales. Malay students constituted approximately\nhalf of the graduating class. The number of\nrespondents before and after pre-registration\ntraining based on gender and race were not\nstatistically significant (Table 1).\n\n\n\nTable 1.  Demographic data of students who responded to both surveys.\n\n\n\nBefore pre-registration\n(n=71)\n\n\n\nAfter pre-registration\n(n=33)\n\n\n\nChi-Square Test/Fisher\u2019s\nExact Test\n\n\n\nGender\n   Male\n   Female\n\n\n\n24 (34%)\n46 (65%)\n\n\n\n12 (36%)\n19 (58%)\n\n\n\nP=0.661 (NS)\n\n\n\nRace\n   Malay\n   Chinese\n   Indian\n   Other\n\n\n\n37 (52%)\n23 (32%)\n7 (10%)\n2 (3%)\n\n\n\n15 (45%)\n12 (36%)\n2 (6%)\n2 (6%)\n\n\n\nP=0.839 (NS)\n\n\n\nNote:  The total percentages are not equal to 100 due to missing values\n           NS=not significant\n\n\n\n\n\n\n\n\nResearch article: Career choice of Malaysian pharmacy students\n\n\n\n18\n\n\n\nMajority of students did not have a family member\n(defined as parents or siblings) as a health\nprofessional.  Five however, had a pharmacist,\nthree had doctors, one had a dentist, four had\nnurses, one had a pharmacy technician and one had\na medical assistant among their family members.\n\n\n\nRelationship between gender and race with\ndesired place of work\n\n\n\nThe most common preferred place of work in\ndecreasing order was, independent community\npharmacy, chain community pharmacy,\ngovernment hospital, private hospital, and\npharmaceutical industry (Table 2).\n\n\n\nWhen grouped according to three major places of\nwork (i.e. hospital pharmacy, community\npharmacy, industry), over 60% of female students\nplanned on going into community pharmacy, and\njust under 30% planned on pursuing hospital work.\nAmong male students, about 50% preferred\ncommunity pharmacy, and about 30% planned to\nenter hospital pharmacy practice. The differences\nbetween gender preferences were not statistically\nsignificant (p>0.05).\n\n\n\n Community pharmacy was the first choice among\n87% Chinese students and 58.3% of the Malay\nstudents (Table 3).  On the other hand, about 36%\nof the Malay students chose hospital pharmacy as\ncompared to about 4 % of the Chinese students.\nIndian students were relatively equally divided in\ntheir choice of desired places of work. The\ndifferences between races in terms of their desired\nplaces of work were not statistically significant\n(p>0.05).\n\n\n\nRelationships between previous working\nexperiences with the desired place of work\n\n\n\nTable 4 shows that 60.6% students had experience\nworking at pharmacies or drug stores; 43.7% at\nhospital pharmacies and 5.6% at pharmaceutical\nindustries. When results for independent and chain\ncommunity pharmacies were combined to give an\noverall picture of the choice for community\npharmacy practice, a total of 43 students (61%)\npreferred to work at this site. Of these, 29 (67%)\nhad worked at a pharmacy or drug store\npreviously, 20 (46%) at a hospital pharmacy, and 2\n(5%) in the pharmaceutical industry.\n\n\n\nTable 2.  Relationship between gender and desired place of work (first survey).\n\n\n\nMale\nN (%)\n\n\n\nFemale\nN (%)\n\n\n\nTotal\nN (%)\n\n\n\nFisher\u2019s Exact Test\n\n\n\nGovernment hospital 1 (4.3) 11 (23.9) 12 (17.4) 0.06 (NS)\n\n\n\nPrivate hospital 6 (26.1) 2 (4.3) 8 (11.6)\n\n\n\nIndependent community\npharmacy\n\n\n\n7 (30.4) 17 (37.0) 24 (34.8)\n\n\n\nChain community\npharmacy\n\n\n\n5 (21.7) 14 (30.4) 19 (27.5)\n\n\n\nPharmaceutical industry 2 (8.7) 2 (4.3) 4 (5.8)\n\n\n\nPostgraduate studies 1 (4.3) 0 1 (1.4)\n\n\n\nOthers 1 (4.3) 0 1 (1.4)\n\n\n\nTotal 23 (100) 46 (100) 69 (100)\n\n\n\nNote: The total number of students are not equal to 71 due to missing values.\nThe percentages are based on the number of students responded on the items\nNS=not significant\n\n\n\n\n\n\n\n\nResearch article: Career choice of Malaysian pharmacy students\n\n\n\n19\n\n\n\nTable 3.  Relationship between race and desired place of work (first survey).\n\n\n\nMalay\nN (%)\n\n\n\nChinese\nN (%)\n\n\n\nIndian\nN (%)\n\n\n\nOther\nN (%)\n\n\n\nTotal\nN (%)\n\n\n\nFisher\u2019s\nExact Test\n\n\n\nGovernment hospital 9 (25.0) 1 (4.3) 1 (14.3) 1 (33.3) 12 (17.4) 0.06 (NS)\n\n\n\nPrivate hospital 4 (11.1) 0 (0) 2 (28.6) 2 (66.6) 8 (11.6)\n\n\n\nIndependent community\npharmacy\n\n\n\n11 (30.5) 12 (52.2) 1 (14.3) 0 24 (34.8)\n\n\n\nChain community\npharmacy\n\n\n\n10 (27.8) 8 (34.8) 1 (14.3) 0 19 (27.5)\n\n\n\nPharmaceutical industry 2 (5.6) 1 (4.3) 1 (14.3) 0 4 (5.8)\n\n\n\nPostgraduate studies 0 0 1 (14.3) 0 1 (1.4)\n\n\n\nOther 0 1 (4.3) 0 0 1 (1.4)\n\n\n\nTotal 36 (100) 23 (100) 7 (100) 3 (100) 69 (100)\n\n\n\nNote: The total number of students are not equal to 71 due to missing values\nThe percentages are based on the number of students responded on the items\n NS=not significant\n\n\n\nTable 4.  Relationship between previous working experiences with the desired place of work (first\nsurvey).\n\n\n\nDesired place of workaPrevious\nworking\n\n\n\nexperience\nb\n\n\n\nGovernment\nhospital\n\n\n\nN (%)\n\n\n\nPrivate\nhospital\n\n\n\nN (%)\n\n\n\nIndependent\ncommunity\npharmacy\nN (%)\n\n\n\nChain\ncommunity\npharmacy\nN (%)\n\n\n\nPharmaceu\n-tical\nindustry\nN (%)\n\n\n\nPost\ngraduate\nstudies\nN (%)\n\n\n\nOther\n\n\n\nN(%)\n\n\n\nTotal\n\n\n\nN(%)\nPharmacy/\ndrug store\n     Yes\n      No\n\n\n\n7 (16.3)\n6 (21.4)\n\n\n\n6 (14.0)\n3 (10.7)\n\n\n\n16 (37.2)\n8 (28.6)\n\n\n\n13 (30.2)\n6 (21.4)\n\n\n\n1 (2.3)\n3 (10.7)\n\n\n\n0\n13 (3.6)\n\n\n\n0\n1 (3.6)\n\n\n\n43 (100)\n28 (100)\n\n\n\nHospital\npharmacy\n     Yes\n     No\n\n\n\n4 (12.9)\n9 (22.5)\n\n\n\n5 (16.1)\n4 (10.0)\n\n\n\n8 (25.8)\n16 (40.0)\n\n\n\n12 (38.7)\n7 (17.5)\n\n\n\n2 (6.5)\n2 (5.0)\n\n\n\n0\n1 (0.03)\n\n\n\n0\n1 (0.03)\n\n\n\n31 (100)\n40 (100)\n\n\n\nPharmaceu-\ntical\nindustry\n     Yes\n     No\n\n\n\n1 (25.0)\n12 (17.9)\n\n\n\n1 (25.0)\n8 (11.9)\n\n\n\n1 (25.0)\n23 (34.3)\n\n\n\n1 (25.0)\n18 (26.9)\n\n\n\n0\n4 (6.0)\n\n\n\n0\n1 (1.5)\n\n\n\n0\n1 (1.5)\n\n\n\n4 (100)\n67 (100)\n\n\n\na\n only one practice choice was allowed\n\n\n\nb\n each student may choose more than one answer\n\n\n\n\n\n\n\n\nResearch article: Career choice of Malaysian pharmacy students\n\n\n\n20\n\n\n\nSimilarly, when results for government and private\nhospitals were combined as hospital pharmacy\npractice, a total of 22 students (31%) preferred to\nwork at this site. Of these, 13 (59%) had\npreviously worked at pharmacies or drug-stores, 9\n(41%) at hospital pharmacies and 2 (9%) at\nindustry-based pharmacies.\n\n\n\nThus, the majority of those who preferred\ncommunity pharmacy had previous experience at\npharmacies or drug-stores. On the other hand,\namong those who preferred hospital pharmacy as\ntheir future place of work, only 41% had previous\nexperience with hospital work.\n\n\n\nOf the four  students who preferred industry-based\npharmacies, one had worked at a pharmacy or a\ndrug-store and two at hospital pharmacies. None\nworked at industry-based pharmacies before.\n\n\n\nDesired place of work/practice before and after\npre-registration training\n\n\n\nTable 5 demonstrates the students\u2019 desired places\nof work before and after pre-registration training.\nThe majority showed interest in community\npharmacy (i.e., independent and chain) both before\nand after the training (61% and 57%, respectively).\nThe percentages of students who chose hospital\nsetting (combined both government and private\nsettings) before and after pre-registration period\nwere 31% and 24%, respectively. Only a small\npercentage chose pharmaceutical industry. Overall,\nthe results did not show major changes in students\u2019\n\n\n\npreferences for practice sites before and after the\npre-registration training. However, overall results\nshowed a drop in percentages for most practice\nsites.\n\n\n\nFactors affecting practice choices\n\n\n\nThe top ten factors that students believed affected\ntheir choices of future practice sites before pre-\nregistration training were desire for a satisfying\nand self-fulfilling position, job security,\nopportunity for advancement, salary, sense of\naccomplishment, opportunity to use one\u2019s abilities\nand education, opportunity to serve the\ncommunity, geographic location, nature of work\nand employer\u2019s policies (Table 6).  Except for\nemployer\u2019s policies, these remained in the top ten\ncategories of factors even after the pre-registration\ntraining period. None of the changes in ratings\nwhich occurred after the pre-registration period\nwere statistically significant.\n\n\n\nDISCUSSION\n\n\n\nThere was not much difference between the\nproportion of female and male students in our\nstudent population as compared to recent\nenrollments in the US schools of pharmacy (3).\nThe majority of our students did not have any\nfamily member working as a health professional.\n\n\n\nParents might exert significant influence on\nstudents\u2019 decision to choose pharmacy as a career\n\n\n\nTable 5.  Respondents desired place of work before and after pre-registration training\n\n\n\nDesired place of work Before pre-registration\n(n=71)\n\n\n\nAfter pre-registration\n(n=33)\n\n\n\nIndependent community Pharmacy 24 (34%) 7 (21%)\n\n\n\nChain community Pharmacy 19 (27%) 12 (36%)\n\n\n\nGovernment hospital 13 (18%) 4 (12%)\n\n\n\nPrivate hospital 9 (13%) 4 (12%)\n\n\n\nPharmaceutical industry 4 (6%) 1 (3%)\n\n\n\nPostgraduate studies 1 (1%) 1 (3%)\n\n\n\nOthers 1 (1%) 3 (9%)\n\n\n\nNote:  The total percentages are not equal to 100 due to missing values\n\n\n\n\n\n\n\n\nResearch article: Career choice of Malaysian pharmacy students\n\n\n\n21\n\n\n\n(4), but our results showed that this factor was not\namong the ten most important factors (Table 6) in\ninfluencing their choice of field work as a\npharmacist.\n\n\n\nIt is interesting to see that government and private\nhospital practices were less favoured by students\ncompared to independent or chain community\npharmacies. These choices were similar to those\nreported by others (2,4). The findings may\npartially explain the consistently low  \u201cfilling rate\u201d\nfor the positions of pharmacist in government\nhospitals. In 1995, the Malaysian Ministry of\nHealth (MOH) annual report showed that of the\n570 positions for staff pharmacists available at\ngovernment hospitals, only 341 were filled (5).\nThis trend has been consistent for the last few\nyears where the \u201cfilling rate\u201d was only around 60%\n(6,7).\n\n\n\nStudies on gender difference in preference for\npractice sites have shown conflicting results (4,8).\nOur results showed that only about one-third of the\ntotal number of female students would like to go\ninto hospital pharmacy practice. However,\nintended  and  actual practice settings tend to\ndiffer.   In   fact,  among   pharmacy   practitioners,\n\n\n\ninvestigators have shown a growing trend of\nsimilarity in gender distributions of practice\nsettings (9, 10).  It is interesting to see from our\nfindings that community pharmacy practice\nseemed to be more favourable among Chinese\nstudents whereas hospital pharmacy practice\nseemed to be more favourable among Malay\nstudents. This tendency for a difference in racial\npreference of practice sites needs to be further\nexplored.\n\n\n\nApproximately half of our students had previous\nexperiences either at hospital pharmacies,\ncommunity pharmacies or drug stores.  Previous\nexperience at a hospital pharmacy did not have\nmuch effect on students\u2019 preference to practise at\nhospitals (29%).  On the other hand, previous\nexperience at a pharmacy or drug-store might have\ninfluenced many students (67%) on their\npreference to practise at a community pharmacy.\nIn general, regardless of whether students had\nprevious working experience or not, the\ncommunity pharmacy setting was the most desired\nplace of work.\n\n\n\nFactors known as intrinsic factors are associated\nwith good feelings about a job, and that bad\n\n\n\nTable 6.  Top ten rating of respondents\u2019 perception of factors affecting choice of future workplace\n\n\n\nFactors\nBefore pre-registration\nmean (SD)\n\n\n\nAfter pre-\nregistration\nmean (SD)\n\n\n\nStudent\u2019s\nt-test\n\n\n\n1 Desire for a satisfying and self-\nfulfilling position\n\n\n\n1.6 (0.6) 1.7 (0.9) NSa\n\n\n\n2 Job security 1.6 (0.8) 1.9 (1.0) NSa\n\n\n\n3 Opportunity for advancement 1.6 (0.7) 1.6 (0.9) NSa\n\n\n\n4 Salary 1.7 (0.7) 1.8 (0.7) NSa\n\n\n\n5 Sense of accomplishment 1.8 (0.8) 1.7 (0.7) NSa\n\n\n\n6 Opportunity to use one\u2019s abilities\nand education\n\n\n\n1.8 (0.8) 1.5 (0.8) NSa\n\n\n\n7 Opportunity to serve community 1.8 (0.7) 1.8 (0.7) NSa\n\n\n\n8 Geographic location 1.8 (0.8) 1.8 (0.8) NSa\n\n\n\n9 Nature of work 1.9 (0.8) 1.8 (0.8) NSa\n\n\n\n10 Employer\u2019s policies 1.9 (0.8) 2.1 (0.9) NSa\n\n\n\na  All comparisons were not significantly different at alpha level of 0.05\n\n\n\n\n\n\n\n\nResearch article: Career choice of Malaysian pharmacy students\n\n\n\n22\n\n\n\nfeelings are associated with extrinsic factors.\nIntrinsic factors include the nature of work, desire\nfor a satisfying and self-fulfilling position,\nopportunity for advancement, sense of\naccomplishment, opportunity to use one\u2019s abilities\nand education, and opportunity to serve the\ncommunity.  Extrinsic factors include job security,\nsalary, geographic location, availability of\nposition, working conditions, influence of family,\nfriends or professors, and employer\u2019s policies.  As\nreported by others (1,11), the results from our\nsurvey showed that a combination of these job\nfactors were involved in students\u2019 selection of\npractice sites. Although six out of ten were\nintrinsic factors, this may change once in the\nprofession. Other factors may also affect\npharmacists\u2019 choice of current practice sites (12)\nand most of them can be considered as extrinsic\nfactors (e.g. income potential, and influence of\nspouse).\n\n\n\nOur findings showed that hospital pre-registration\nexperience did not have a major effect on the\nchoice of practice sites.  In one study, it was found\nthat although the percentage of students who\nparticipated in a hospital internship programme\nwas high, there was a lower percentage of students\nwho selected a career in hospital pharmacies when\ncompared to community pharmacies (11). The\nauthors  suggested  that  the  activities students  did\n\n\n\nduring their internship might not be viewed as\npersonally rewarding by many of them. This might\nhave influenced their lack of preference for\nhospital pharmacy practice. Hospital pre-\nregistration in our setting may not be similar to\nhospital internship programme practised in the US\nbut suggestions to improve students\u2019 experience in\nhospital setting (11) may be applicable to ours.\nThis includes providing a more structured\nprogramme which provides emphasis in the\noperations, administration and patient - oriented\npharmaceutical services to enable students to\nexperience hospital pharmacy practice in greater\ndepth.\n\n\n\nCONCLUSION\n\n\n\nThis survey provides some insights into the\nreasons why pharmacy graduates choose their first\nsite of practice.  An understanding of the factors\nthat influence graduates\u2019 practice-site choices is\nimportant if employers wish to design effective\nstrategies to employ future pharmacists. Our\nfindings did not show major changes in students\u2019\npreferences for practice sites before and after the\nhospital pre-registration period.  Speculation that\nstudents would be more inclined toward hospital\npractice because of additional clinical education in\ntheir final year is not supported by our data.\n\n\n\n*****\nREFERENCES\n\n\n\n1. Hassan Y. Challenge to clinical pharmacy practice\nin Malaysia. Ann Pharmacother 1993;27:1134-8.\n\n\n\n2. Besier JL, Jang R. Factors affecting practice-area\nchoices by pharmacy students in the Midwest. Am\nJ Hosp Pharm 1992;49:598-602.\n\n\n\n3. Meyer SM. The pharmacy student population:\napplications received 1995-96, degrees conferred\n1995-96, fall 1996 enrollments. Am J Pharm Educ\n1997;61:63s - 74s.\n\n\n\n4. Rascati KL. Career choice, plans, and commitment\nof pharmacy students. Am J Pharm Educ\n1989;53:228 - 234.\n\n\n\n5. Malaysian Ministry of Health. Pharmaceutical\nservices resources. In: Annual Report. Kuala\nLumpur: Ministry of Health; 1995. p 155.\n\n\n\n6. Malaysian Ministry of Health. Hospital pharmacy.\nIn:  Annual Report. Kuala Lumpur: Ministry of\nHealth; 1993. p 7.\n\n\n\n7. Malaysian Ministry of Health. Health manpower.\n\n\n\nIn: Annual Report. Kuala Lumpur: Ministry of\nHealth; 1994. p 10.\n\n\n\n8. Ferguson JA, Roller L. Career aspirations\ncompared by gender and generation status:\npreliminary analysis of pharmacy students. Am J\nPharm Educ 1986;50:39-43.\n\n\n\n9. Lurvey P. Pharmacist career patterns:  a\nlongitudinal study of practice settings. Am J\nPharm Educ 1992;56:114 - 123.\n\n\n\n10. Lee M, Fjortoft N. Gender differences in attitudes\nand practice patterns of pharmacists. Am J Pharm\nEduc 1993; 57:313 - 319.\n\n\n\n11. Carter EA, Segal R. Factors influencing\npharmacists\u2019 selection of their first practice\nsetting. Am J Hosp Pharm 1989;46:2294-2300.\n\n\n\n12. Scott DM, Neary TJ, Thilliander T, et al.  Factors\naffecting pharmacists\u2019 selection of rural or urban\npractice sites in Nebraska. Am J Hosp Pharm\n1992;49:1941-1945.\n\n\n\n\n\n\n \nTable of Contents\n\n\n \nCenter of Ethics at Georgetown University, Professor Andr\u00e9 Hellegers seized the opportunity to turn bioethics into an academic discipline that reflected the needs of the time. This was rather easily acceptable as bioethics can readily be identified with\n\n\n \nABSTRACT\n\n\nKey words: pharmacy, career choice, job factor, workplace, Malaysia\n\n\n \n\n\n \n\n\n \nINTRODUCTION\n\n\nMETHODS\n\n\nRESULTS\n\n\n\n\n\n\nDISCUSSION\n\n\n\n\n\n\n\n\n\n"
"\n\n\n\n\n\n i \n\n\n\nMalaysian Journal of Pharmacy \nVolume 1 Number 3 April 2003 \n \nThe Official Journal of the Malaysian Pharmaceutical Society \n \n \n\n\n\nEditor-in-Chief: Dr. Yew Su Fong \n\n\n\n\n\n\n\nAssociate Editors: Assoc. Prof. Dr. Abas bin Hj Hussin \n\n\n\n Dr. Ab Fatah bin Haji Ab Rahman \n\n\n\n Prof. Dr. Abu Bakar Abdul Majeed \n\n\n\n Prof. Dr. Aishah bte Adam  \n\n\n\n Assoc. Prof. Dr. Chung Lip Yong \n\n\n\n Prof. Dr. Mohd. Isa bin Abdul Majid  \n\n\n\n Mr. John Chang \n\n\n\n Assoc. Prof. Dr. Mohamed Izham bin Mohamed Ibrahim \n\n\n\n Assoc. Prof. Dr. Mustafa Ali Mohd. \n\n\n\n Assoc. Prof. Dr. Paraidathathu Thomas a/l P.G. Thomas \n\n\n\n Mr. Wong Kok Thong \n\n\n\n Mr. Wong Sie Sing \n\n\n\n Prof. Dr. Yuen Kah Hay \n\n\n\n\n\n\n\nPublisher: Malaysian Pharmaceutical Society \n\n\n\n5-B Lorong Rahim Kajai 13 \n\n\n\nTaman Tun Dr Ismail \n\n\n\n60000 Kuala Lumpur \n\n\n\nMalaysia  \n\n\n\nTel: 03-77291409 \n\n\n\nFax: 03-77263749 \n\n\n\nHomepage: www.mps.org.my \n\n\n\nEmail: mspharm@po.jaring.my \n\n\n\n \n \n \n \nThe Malaysian Journal of Pharmacy is a bi-annual publication of the Malaysian Pharmaceutical Society. \nEnquiries are to be directed to the Publisher at the above address or the Editor-in-Chief at the Pharmacy \nDepartment, Faculty of Allied Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul \nAziz, 53100 Kuala Lumpur. The Publisher reserves copyright and renewal on all published materials, and \nsuch material may not be reproduced in any form without the written permission of the Publisher.  \n\n\n\n\n\n\n\n\n\n\n\n\n ii \n\n\n\nTable of Contents \n \n\n\n\nEditorial  \nWriting for publication: Avoiding bias or \nperception of bias \nAb Fatah Ab Rahman \n\n\n\n53 \n\n\n\n  \nInvited Review   \n\n\n\nThe full extent of alcoholism: A worldwide \neconomic and social tragedy \nAI Wertheimer, NM Chaney \n\n\n\n54 \n\n\n\n  \nSeries  \n\n\n\nMedication safety issues - 1 \nDCM Kong \n\n\n\n59 \n\n\n\n  \nContinuing Pharmacy Education  \n\n\n\nManaging cytotoxic drugs \nA Amiruddin \n\n\n\n63 \n\n\n\n  \nGeneral Article  \n\n\n\nBrief history and development of parenteral \nnutrition support \nAF Shamsuddin \n\n\n\n69 \n\n\n\n  \nResearch Papers  \n\n\n\nAwareness of hepatitis A and hepatitis B \namong residents in Kuala Lumpur and \nSelangor \nCL Ho, H Rashwan \n\n\n\n76 \n\n\n\n  \nOutpatient prescription intervention \nactivities by pharmacists in a teaching \nhospital \nSS Chua, MN Kuan, MN Ramli \n\n\n\n86 \n\n\n\n  \nInstructions to Authors 91 \n  \n\n\n\n \n\n\n\n\n\n\n\n\nEditorial \n\n\n\n 53\n\n\n\nEditorial  \n \n \n\n\n\nWriting for Publication :  \nAvoiding Bias or Perception of Bias  \n\n\n\n\n\n\n\nIn its first three issues, the Malaysian Journal of Pharmacy has received and published \ndifferent types of articles.  Although different people read the Journal for different \nreasons, information published in it has the potential to influence the daily practice of \nmany pharmacy practitioners.  Readers expect to get up-to-date and unbiased information \nfrom it.  Thus, the authors, reviewers and the editors have the responsibility of ensuring \nthat articles published are free of bias.   \n \nThe existence of bias may be related to personal, commercial, political, academic or \nfinancial interest of an individual or individuals involved in the publication of the paper.  \nThis issue has been addressed in the Guidelines on Good Publication Practice (1).  \nFinancial relationships are the most easily recognised, and they may exist with \npharmaceutical companies, government or other agencies.  As such, the Guidelines \nrequire authors and reviewers to disclose these interests to editors.  Many journals have \ndone so by revising their editorial policies, requiring authors to declare any financial \nrelationships that might have biased their judgement in relation to the submitted paper (2 \n\u2013 5).  \n \nFailure to disclose conflicts of interest may be due to the authors mistakenly overlooking \nthe financial support, or believing that it had not influenced the paper, or deliberately \nconcealing the information (2).  Bias may be more difficult to detect in review articles \ncompared to original research (4).  Even without any financial support, the paper may \nstill be perceived to be biased.  To avoid ambiguity, some journals require authors to \nexplicitly state whether potential conflicts do or do not exist (4, 6).   \n \nPublishing the authors\u2019 source of financial support will allow the reader to make an \ninformed judgement regarding its significance.  However, the decision to publish such \ndisclosure lies with the editorial board.  More importantly, the authors themselves must \nbe aware about issues relating to conflicts of interest in order to avoid bias or perception \nof bias in the paper submitted for publication.   \n \n\n\n\nAb Fatah Ab Rahman \n \nReferences \n1. Committee on Publication Ethics (COPE).  Guidelines on Good Publication Practice.  J \n\n\n\nPostgrad Med 2000; 46: 217-21. \n2. Johnston KW, Rutherford RB.  Failure to disclose competitive interests.  J Vasc Surg 2000; \n\n\n\n31: 1306. \n3. Campbell P.  Declaration of financial interests.  Nature 2001; 412: 751. \n4. Davidoff F, DeAngelis CD, Drazen JM et al.  Sponsorship, authorship, and accountability.  \n\n\n\nLancet 2001; 358: 854-856. \n5. Drazen JM, Curfman GD.  Financial associations of authors.  N Engl J Med 2002; 346: 1901-\n\n\n\n1902. \n6. Information for Authors.  Ann Int Med  2002; 136: Z1 \u2013 Z6. \n \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy 2003; 1(3):54-58  Invited review \n\n\n\n 54\n\n\n\nThe Full Extent of Alcoholism:  \nA Worldwide Economic and Social Tragedy \n \nAlbert I. Wertheimer, Nicole M. Chaney \n \nSchool of Pharmacy, Temple University, Philadelphia, PA 19140, USA. \n \n \nABSTRACT \n \nAlcohol abuse affects many people directly or indirectly all over the world.  \nAlcoholism often causes major damage and can also lead to death.  It seems as \nthough people underestimate the prevalence of alcohol abuse and the damage done \nby alcohol abuse.  Loss of labour, birth defects, liver cirrhosis, and damage from \nvehicle accidents, are a small portion of the damage caused by alcohol abuse.  The \ndamage caused by alcohol abuse affects people physically, emotionally, and \neconomically.  All this damage is preventable.  Treatment for this problem is \navailable, but the effects differ among patients.  Pharmacotherapy and cognitive \nbehavioural therapy are used separately or collectively.  Results can vary depending \nupon the treatment and patient.  The pharmacist plays an important role in the lives \nof alcoholic patients.  Pharmacists can notice a patient\u2019s behaviour, notice their \nprescription patterns, and most importantly, the pharmacist is a knowledgeable \nmentor that many patients look up to.  Feeling comfortable with and trusting the \npharmacist is very important for the patient.  Patients may come to the pharmacist \nwith their problems, and the pharmacist should be able to offer sound medical \nadvice. \n \nKeywords: alcoholism, total cost of alcohol abuse, pharmacist intervention, \npharmacotherapy for alcohol abuse, alcohol treatment \n \n \nINTRODUCTION \n \nWhen we think about the most prevalent life \nthreatening, debilitating, and harmful diseases, we \nthink of AIDS, diabetes, heart disease, depression, \nand others.  Very few people acknowledge or are \naware of the complete effect of alcoholism, and \nhow it affects individuals, families, friends, \nstrangers, co-workers and society in general.  \nAlcoholism is a worldwide problem of chronic \ndrinking that affects all aspects of one\u2019s life.  We \nhear about drunk drivers, automobile accidents \nand domestic violence associated with \nalcoholism, but rarely do we look beyond the \nindividual or family perspective, it is a \npreventable massive expense to individuals, \ngovernments and society.  We probably don\u2019t take  \n\n\n\n \n \nthe consequences seriously enough because \nalcoholic beverages are sold openly everywhere \nand drinking is very much embedded in most \ncultures and societies. Let us look at the facts. \n \nIt has been found that alcohol dependence affects \n7.5% of the US population.  That represents \napproximately 14 million Americans.  \nAlcoholism, untreated and treated, causes \nphysical, emotional, and economic damage.  The \nextent as to how many people are affected on a \ndaily basis by this disease is innumerable.  First, \nwe will take a look at how individuals are \naffected. From the loss of earnings to the medical \nexpenses, alcoholism can certainly cost an \n\n\n\n\n\n\n\n\n  Invited review: The full extent of alcoholism \n\n\n\n 55\n\n\n\nalcoholic an immense amount of money.  It has \nbeen found that almost two thirds of the costs of \nalcohol abuse are a result of loss of labour (1). \n\n\n\nAlcohol related problems cost the alcohol abusers \nabout $66.8 billion, which is 45% of the annual \ntotal cost of alcohol abuse just in the USA. The \nactual cost that abusers pay may actually be less \nthan this figure, this is due to the fact that their \nfamily members and others pick up some of the \ncost (2). \n \nThere are many health problems associated with \nalcohol abuse.  The most prevalent health \nproblems are gastrointestinal.  Gastrointestinal \npain, bloating, nausea, and vomiting are all \nassociated with alcohol abuse.  Alcohol decreases \nthe rate of gastric emptying, increases gastric \nsecretions, and also damages the gastric mucosa.  \nGastritis and ulcers are common, and with heavy \ndrinkers, pancreatitis is prevalent.  The liver is the \norgan most affected by alcohol.  Liver problems \nare associated with upper-right quadrant pain.  \nThere are many liver disorders such as cirrhosis, \nhepatitis, cholestasis, and portal hypertension (3). \nAlcohol-related liver disease (ALD) is the most \nprevalent liver disease in the United States, and \npatients with this disease make up the largest \nportion of liver transplant recipients, almost 27% \nin 1995. Almost 20% of ALD patients require a \nliver transplant.  The demand for human liver \ndonations is much greater than the supply \navailable in the United States.  In 2000 only 4934 \npatients received liver transplants, by April of \n2001, there were 17,520 Americans waiting for a \nliver transplant (4). \n  \nAlcohol abuse affects the entire body, it causes \nmany cardiovascular, haematological, \ngynaecologic, metabolic, and central nervous \nsystem problems.  Hypertension, stroke, sudden \ndeath and heart failure are common \ncardiovascular disorders associated with alcohol \nabuse.  Long-term alcohol abuse can suppress the \nproduction of leukocytes, erythrocytes and \nplatelets.  Anaemia is very common, as are many \nvitamin deficiencies that are due to poor \nabsorption and poor intake of vitamins.  The fact \nthat over half the alcoholic\u2019s caloric intake is \nalcohol further displays the problem, which \ncauses electrolyte imbalances and also \nmalnutrition.  Alcoholism also affects \nneurological function, decreasing memory, motor \nskills, and affecting neuron transmittance.  \nAlcoholism affects all aspects of the abuser, both \nphysically and mentally.  Not only can alcohol \nabuse result in physical problems, it can result in \n\n\n\npsychological disorders also.  Depression affects \napproximately 33% of problem drinkers.  \nDepression affects the response of patients to \ntreatment and also their relapse rate.  The high \nrelapse rate results from negative emotional states \nand recurrent relapses may cause a feeling of \nhelplessness, causing drinkers to feel that their \ndrinking is out of control and that they will never \nbe able to stop drinking (5). \n\n\n\n \nAlcoholism and the side effects associated with it \noften lead to sudden and early death.  Not only \ndoes alcoholism affect the abuser, non-abusers are \nalso affected, it has been shown that alcohol abuse \ncosts non-abusers $81.2 billion annually in the \nUSA.  Family members and household members \nare affected immensely.  Non-abuser victims are \ndirectly responsible for 6% of the alcohol related \ncosts, but indirectly much more, with taxpayers \npicking up the bill that the government has to pay.   \n \nIn addition to adults and children being affected \nby alcohol abuse, foetuses are also affected by \nalcohol abuse.  Almost 5,000 babies are born each \nyear with Foetal Alcohol Syndrome (FAS).  This \nis approximately one in every 750 births. The rate \nof FAS is much higher in Native Americans, than \nthat of Caucasian or African-Americans. A child \nwith FAS may have a variety of problems, such as \npre-natal and post-natal developmental problems, \nvarious facial malformations, various organ \nmalformations, and also central nervous system \nproblems.  Foetal Alcohol Effects (FAE) occurs \nin 3-5 out of 1,000 live births and it results in \nmilder symptoms, such as low birth weight.  \nFoetal Alcohol Effects results from pregnant \nmothers who drink less alcohol than those with \nFAS children.  Treatment of infants, children and \nadults with FAS in 1992 cost over $1.9 billion.  It \ncosts about $1.4 million to treat a FAS affected \nchild throughout his life.  Additional healthcare, \neducation, attention, etc. are factors affecting the \ncost of a FAS child to their family, private \ninsurers, Health Maintanance Organisations, and \nthe government (6).  This disease is completely \npreventable, yet alcohol exposure is the most \ncommon cause for birth defects.  Alcohol abuse \nduring and prior to a pregnancy affects the \ndevelopment of the foetus during pregnancy and \nfor the remainder of its life (7). \n\n\n\n \nEmployers are affected by this disease with lost \nproductivity costing them about $66.7 billion per \nyear (2). Lost earnings and decreased wages \nrepresent the lower productivity of an alcohol \nabuser.  When workers perform below their \n\n\n\n\n\n\n\n\n  Invited review: The full extent of alcoholism \n\n\n\n 56\n\n\n\nability level it results in decreased profits.    \n \n\n\n\nThe government is also affected by this major \ndisorder, paying about $13.6 billion dollars in \ndamage due to alcohol related accidents, \nincarcerating alcohol abusers, court costs, crime \nrelated costs, etc. They also accept 38.6% of the \ncomplete costs of alcohol abuse (2). \n\n\n\n \nHealth Maintenance Organisations and private \ninsurers pay 10.2% of alcohol related abuse costs \n(2).  Life insurance policies pay about $12,000 per \ndeath for the approximately 106,600 deaths per \nyear where alcohol is responsible.   \n\n\n\n \nVarious physical damages are caused and related \nto alcohol abuse.  Alcohol related motor vehicle \ndamage is approximated at $13.6 billion; this \nincludes vehicle and road damage, court costs, \nand insurance administration.   \n\n\n\n \nVictims of violent and non-violent crimes are \naffected primarily in the form of lost earnings, the \nlosses are estimated at $1 billion.  Property crime \nrelated to alcohol abuse is estimated at $427 \nmillion, this represents lost cash and property.  \nTogether alcohol and drug abuse related property \ncrimes, represent 30% of the value of total \nproperty crimes.   \n\n\n\n \nApproximately 140,000 alcohol related criminals \nare incarcerated annually, causing a major \ndecrease in productivity.  About $5.4 billion \ndollars are lost annually due to incarceration of \nalcohol related criminals; this loss of prospective \nproductivity affects the economy greatly. \nAlthough this primarily is a loss to the inmate, it \nis also a loss to the government and to the society \nwith the loss of potential tax revenue and the cost \nof keeping the inmate incarcerated, which is \napproximately $12,000 per year.   \n\n\n\n \nThere are many additional disorders that result \nfrom alcoholism, which are additional factors in \nthe cost of alcoholism.  Depression, as described \npreviously, is one of the major adverse concerns \nof problematic alcohol abuse.   \n \nTreatment \n \nThere are many different treatments for \nalcoholism, from detoxification to drug therapy \nand counselling.  Treatment varies depending \nupon the length of illness, additional amount of \nalcohol-related problems, and whether or not the \npatient really wants to overcome his addiction.  \n\n\n\nMore than 700,000 people receive treatment \neveryday (8).  Patients are either treated on an \ninpatient or outpatient setting.  13.5% of treated \npatients receive residential treatment, and 86.5% \nof patients receive outpatient treatment.  The \ncommonly used behavioural treatments are \ncognitive-behavioural therapy, motivational \nenhancement therapy, and Alcoholics Anonymous \nsessions.  These treatments have an equal amount \nof effectiveness, as shown in the Project MATCH \ntrial (9).  Often, pharmacotherapy can supplement \nthese treatments.  These treatments can be very \ncostly, but when factoring in the damage that a \nlifetime of problem drinking can cause, treatment \nappears to be quite a bargain.   \n \nDetoxification is the first step of treatment for \nmany patients.  It is a form of medically assisted \nwithdrawal from alcohol.  Medication is often \nrequired to prevent seizures and hypertension.   \nAfter an extended period of heavy alcohol abuse \npeople usually experience many alcohol \nwithdrawal symptoms.   Detoxification is \nintended to manage the medical and \npsychological symptoms of alcohol withdrawal.  \nPatients can be treated by detoxification, in either \nan inpatient or outpatient setting (10).  Price \nvaries from centre to centre, but for example, at \nThe Healing Centre in Raleigh, North Carolina, it \ncosts $261 per day for a detoxification bed, $200-\n$500 per day for emergency services, and $58 per \nday for detention services.  Treating alcohol-\nrelated problems costs society much less than if \nleft untreated.    \n\n\n\n \nIn the 1980s, alcoholism and other addiction \nproblems were thought of as physical problems, \nwith treatment mainly focused on detoxification.  \nMore recent research and a greater knowledge of \nbrain biology have evolved addiction treatment to \nfocus on lifetime abstinence.  Long-term \nprograms such as twelve-step and mutual help \nprograms focus on lifetime abstinence and \npreventing relapse.  Alcoholics Anonymous (AA) \nis one the oldest and most popular of the self-help \ngroups for addicts.  Established in 1935 and \ncurrently having over 2 million members, AA is \nclinically proven to reduce problem drinking and \nrelapses and also results in a higher level of social \nfunctioning.  AA is a very cost-effective \ntreatment; the program is free to those who want \nto stop drinking.  Donations are accepted and \nappreciated as they are used to off-set costs of \nmeeting places and coffee.  After the success of \nthis twelve-step program, many private inpatient \ntreatments have based their treatment on the \n\n\n\n\n\n\n\n\n  Invited review: The full extent of alcoholism \n\n\n\n 57\n\n\n\nideals of AA (11). \n \n\n\n\nNaltrexone is an opioid antagonist approved by \nthe Food and Drug Administration as an adjunct \ntherapy to be used along with conventional \npsychosocial therapies for alcohol abuse.  \nAlthough naltrexone is not a magic answer for \nalcoholics, as an additional therapy it greatly \nreduces relapses.  The Brown University Center \nfor Alcohol and Addictions Studies recently \nembarked upon a 5-year study of the effect of \nnaltrexone on heavy social drinkers in their social \nenvironment (12).  COMBINE is a recent study in \nprogress that combines pharmacological and \nbehavioural therapies for alcohol abuse.  The \ncompletion of this study will provide researchers \nin this field with information to treat alcoholic \npatients more successfully (13). \n\n\n\n \nReview: \n \nAlcohol abuse has been recorded before \nagriculture was known.  In the prehistoric period, \npeople used whatever was available to create a \nfermented drink.  Over the centuries alcohol has \nevolved from basic ethanol to wine and beer.  The \nuse and abuse of these alcoholic beverages began \nto increase in the 15th century.  In London prices \nwere raised on alcoholic beverages to discourage \nits use.  It wasn\u2019t until the mid-nineteenth century \nthat chronic alcohol abuse was studied.  Some \nearly treatments for alcohol abuse included \napomorphine and emetine, which induced \nvomiting upon the consumption of alcohol.  \nPhysicians eventually focused on prophylaxis \nsince positive cures seemed nearly impossible \n(14). \n \n\n\n\nCurrent treatment of alcoholism involves private \nrehabilitation, drug therapy, counselling services, \nAlcoholics Anonymous, etc. Private rehabilitation \nhas had a large increase since the 1970s, where \nthe number of beds in private rehabilitation \nfacilities quadrupled from 1978-1984.  Many \nprivate insurance companies and the federal \ngovernment bear the cost of this treatment, which \nis approximately $18,000 per hospital stay.  This \nis a major burden on our healthcare system.  It has \nbeen found that patients who undergo lengthy \ninpatient, residential treatments are no better off \nin overcoming their addiction than those left on \ntheir own for treatment.  In a study done by \nGeorge Vaillant, 95% of those treated as an \ninpatient at an urban hospital had a relapse.  In \nanother study done by Helzer et al., findings \nshowed that 93% of the patients at an inner-city \n\n\n\nhospital were either dead or still abusing alcohol \nfive to seven years after treatment.  Those treated \nat a private rehabilitation facility are more likely \nto show better results (15). \n \n\n\n\nThe best treatment for alcoholism is one that \nteaches life skills without alcohol.  Programs need \nto incorporate training in stress management, life \nskills, social and negotiation skills, job skills, and \nwork habits (15). In addition to these \npsychological and social treatments, recent drug \ntherapy has produced some positive and \nproductive results. Naltrexone, an opioid \nantagonist, decreases alcohol consumption by \nblocking the receptors in the brain that encourage \ndrinking behaviour.  Clinical trials done in the \nearly 1990s have shown that naltrexone, in \naddition to psychosocial treatments, effectively \nreduces craving and relapse rates in alcoholic \npatients.  It costs approximately $100/month for \nthe average dosage of 50mg/day.  Dosages may \nbe adjusted on an individual basis (12). \n \nWhat can the pharmacist do? \n \nDepending on the circumstances of pharmacy \npractice in different countries, there are several \navenues open to the pharmacist.  The first step in \nany treatment is problem recognition and the \npharmacist may be in a position to notice \nexcessive sales and use of elixirs or other alcohol-\ncontaining medicines.  The pharmacist may want \nto discuss this with the patient or a relative of the \npatient.  The pharmacist can promise confidential \ntreatment and service, and have information \navailable for referrals to alcoholism treatment \nclinics.   \n \nBeyond such recognition of the problem, one can \nassume that an innocent patient question as to the \nexistence of OTC products to help people with \u201ca \ndrinking problem\u201d might be a lead to offer help.   \n \nThe next task for the pharmacist is that of \neducator/counsellor and referral agent.  The \npatient needs to know that competent help is \navailable, and where, and what it might involve, \nand cost.  It would be advisable if the pharmacist \ncould ascertain if health insurance may pay for \nsome or all of the fees.  A wise pharmacist might \nattempt to seize the moment by making an \nappointment for the patient at such a clinic. \n \nThorough pharmaceutical service calls for the \npharmacist to follow-up periodically with the \npatient, probably by telephone, or in-person, and \n\n\n\n\n\n\n\n\n  Invited review: The full extent of alcoholism \n\n\n\n 58\n\n\n\nfor encouragement to be offered while lauding the \nalready completed steps for the patient. \n \nThe pharmacist can check that patient\u2019s profile in \nthe future to see that medications containing \nalcohol are avoided.  As newer therapies and \ntechniques become known, the pharmacist should \ntake it upon him or herself to stay up-to-date, in  \n\n\n\norder to offer the best and latest information to \ntheir patients. \n \nPerhaps even 80% to 90% of patients will ignore \nthe pharmacist\u2019s advice, but the successfully \ntreated 10 to 20% make that activity worthwhile \nand valuable to all concerned parties. \n\n\n\n\n\n\n\n\n\n\n\n***** \n \n\n\n\nREFERENCES \n \n1. Feng W, Zhou W, Butler JS, Booth B, French M. \n\n\n\nThe impact of problem drinking on employment. \nHealth Economics 2001; 10:509-521. \n\n\n\n2. National Institute on Drug Abuse, \n(www.nida.nih.gov) \n\n\n\n3. Stein M. Medical consequences of substance \nabuse. Psychiatric Clinics of North America 1999; \n22:352-370. \n\n\n\n4. DiMartini, Weinrieb R, Fireman M. Liver \ntransplantation in patients with alcohol and other \nsubstance use disorders. Psychiatric Clinics of \nNorth America 2002; 25:195-209. \n\n\n\n5. Siddharthan G, Hough M, Sitharthan T, Kavanagh \nD. The alcohol helplessness scale and its \nprediction of depression among problem drinkers. \nJournal of Clinical Psychology 2001; 57:1445-\n1457. \n\n\n\n6. National Institute on Alcohol Abuse and \nAlcoholism (www.niaaa.nih.gov) \n\n\n\n7. Thackray H, Tifft C. Fetal Alcohol Syndrome, \nPediatrics in Review 2001; 22:47-55. \n\n\n\n8. National Institute on Alcohol Abuse and \nAlcoholism. Alcohol alert, estimating the  \n\n\n\n\n\n\n\neconomic cost of alcohol abuse 1991, No. 11 PH \n293. \n\n\n\n9. Fuller R, Hiller-Sturmhofel S. Alcoholism \ntreatment in the United States: An overview.. \nAlcohol Research and Health 1999; 23:69-77. \n\n\n\n10. Williams, S. Introducing an in-patient treatment \nfor alcohol detoxification into a community \nsetting. J Clin Nursing 2001; 10:635-642. \n\n\n\n11. Chappel J, DuPont R. Twelve-step and mutual-\nhelp programs for addictive disorders, Psychiatric \nClinics of North America 1999; 22:425-446. \n\n\n\n12. Kranzler HR, Amin H, Modesto-Lowe V, Oncken \nC. Pharmacologic treatments for drug and alcohol \ndependence, Psychiatric Clinics of North America \n1999; 22:401-423. \n\n\n\n13. Bean P, Mattson M. Combined behavioral and \npharmacologic treatments of alcoholism. \nAmerican Clinical Laboratory 2001; 20: 8-11. \n\n\n\n14. Sourina, J. A History of Alcoholism. London:Basil \nBlackwell Ltd; 1990. \n\n\n\n15. Peele, S. What we now know about treating \nalcoholism and other addictions. The Harvard \nMental Health Letter 1991; 5-7. \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy 2003 1(3):59-62  Series \n\n\n\n 59\n\n\n\nMedication Safety Issues - 1 \n \nDavid Kong Chee Ming \n \n\n\n\nPharmacy Department, The Alfred Hospital, Commercial Road, Prahran, Victoria, Australia 3181 \nand Department of Pharmacy Practice, Victorian College of Pharmacy, Monash University, 381 \nRoyal Parade, Parkville, Victoria, Australia 3052. \n \n \nABSTRACT \n \nPreventing medical or medication errors is pivotal in quality patient care and safety. \nSignificantly, error prevention activities are multifactorial. These include, (i) \nenlisting staff creativity in improving safe practices, (ii) patient education, (iii) \nprovision of information leaflet, (iv) clarity in instructions, (v) application of failure \nmode and effects analysis, and (vi) care in approving access to medications. \n \nKeywords: medication safety, errors, patients care, prevention, safe practice \n \n \nINTRODUCTION \n \nMedication and medical errors are serious \nproblems throughout the world. It has been \nestimated that between 44,000 and 98,000 \nAmericans die each year as a consequence of \nmedical errors, with the annual financial cost \nestimated at approximately US$40 billion (1-3). \nIn Australia, the direct cost to the acute care \nsystem due to medication errors have been \nestimated to be between AUD$867 million to \nover AUD$1 billion annually (4,5). Importantly, a \nlarge proportion of medical errors or adverse drug \nevents are preventable errors (1-3, 6-9). \n \nAccordingly, the purpose of this series of articles \nis to increase the awareness of health \nprofessionals in Malaysia on preventable \nmedication or medical errors. The issues \nhighlighted in this article are drawn primarily \nfrom ISMP Medication Safety Alert!, and are used \nwith permission from the Institute for Safe \nMedication Practices, Pennsylvania, USA \n(www.ismp.org). It is our hope that this \ncontribution will result in safe medication or \nmedical practices and improved patient care.  \n \nSystems thinking; Tap into staff creativity to \nunleash innovation (10). \n \nA letter to the editor was published in the New \nEngland Journal of Medicine from a physician  \n\n\n\n \n \nwho suggested using metal detectors to prevent \nthe risk of injuries from metal objects during \nmagnetic resonance imaging (MRI) (11). \nUnfortunately, his suggestion was spurred by the \nrecent tragic death of a six-year-old child in New \nYork who suffered a skull fracture and \nintracranial haemorrhage after an oxygen tank \nwas pulled by the magnet into the machine at high \nspeed.  \n \nAs noted by the author, injuries from undetected \nor misplaced metal objects (e.g. IV drug poles, \nsandbags containing metal filings, defibrillators, \nwheelchairs, etc.) brought into MRI exam rooms \nare not uncommon. Yet, staff training and patient \nquestionnaires to detect metal implants remain the \nmost common methods used to prevent such \nincidents.  \n \nIn fact, education has been healthcare\u2019s bread and \nbutter for preventing errors and injuries. And \nwhile education may prevent some errors, its \nsuccess is limited because it relies heavily upon \nhuman memory and vigilance. More to the point, \neducation alone fails to change the system in a \nway that would make it impossible for people to \nmake mistakes.  \n \nMore effective solutions require systems thinking. \nThe suggestion to use highly sensitive \n\n\n\n\n\n\n\n\nSeries: Medication safety issues \n\n\n\n 60\n\n\n\nwalkthrough metal detectors (which are available \ncommercially for about US$2,000-$5,500 and \nrequire minimal maintenance) to prevent \naccidental introduction of a metal object into a \nMRI exam room is an excellent example of \nsystems thinking. This coupled with staff \neducation and patient screening has a high \nlikelihood of preventing injuries. But how did the \nphysician come up with such a powerful \nsuggestion? In retrospect, it seems so obvious. \nYet systems thinking is not as easy as it seems.  \n \nOur history of errors with potassium chloride \nconcentrate for injection in patient care units \ndemonstrates this very well. Until systems \nthinking prevailed, many organizations relied \nupon staff education and manufacturer label \nwarnings to prevent administration of potassium \nchloride concentrate without proper dilution. \nAlthough lessened, errors persisted until the \npharmaceutical industry manufactured premixed \nsolutions, physicians standardized potassium \nreplacement therapy to maximize use of \ncommercially available solutions, and vials of \npotassium chloride were removed from patient \ncare units. Unfortunately, it took years for the \nhealthcare industry to come up with and \nimplement such an effective system-based \nsolution that now seems so simple and intuitive.   \n \nTo become more proficient at systems thinking, \nmultidisciplinary teams must openly discuss \nmedication errors and refuse to settle for old \nfamiliar (and ineffective) ways of solving \nproblems. If education is identified as an error \nreduction strategy, we can\u2019t stop there. Instead of \njust building inspections into processes to detect \nerrors before they reach patients, we need to find \nways to actually prevent them. We must always \nask, \u201cAre there ways to make it impossible, not \njust unlikely, for people to make such a mistake?\u201d \nSystems thinking is the key needed to bridge the \ngap between understanding the causes of errors \nand selecting error reduction strategies that have \nthe greatest likelihood of success. With practice \nand a little creativity, we can become more skilful \nand innovative in identifying system-wide \nstrategies that work continuously and \nautomatically to prevent errors and injuries. \n \nEducating the patient \u2013 key to patient safety \n(12). \n \nEducation provided to patients while in the \nphysician\u2019s office can arm them with the \ninformation needed to prevent errors. A patient \n\n\n\nwas to receive methotrexate IV followed in an \nhour by fluorouracil IV as part of a treatment \nregimen for breast cancer. To reduce methotrexate \ntoxicity, her oncologist prescribed oral leucovorin \nrescue to be started 24 hours after the \nmethotrexate. He wrote the order as \"leucovorin \n25 mg, one every 6 hours x 6 doses starting 24 \nhours after chemotherapy.\" The pharmacy \nprovided the correct medication, but the directions \ntyped on the label were to \"Take one tablet every \n6 hours for 6 days starting 24 hours before \nchemotherapy.\"  The patient remembered what \nshe\u2019d heard in the doctor\u2019s office and called her \nphysician for clarification. Had she taken the drug \nas directed on the label, she would have negated \nthe therapeutic effect of the chemotherapy. \n \nFailure mode and effect analysis can help guide \nerror prevention efforts (12). \n \nToo often, marketing efforts, contractual \nagreements with purchasing groups or vendors, \nand cost serve as primary sources of information \nwhen making decisions about which medical \nproducts to purchase and use. Evaluation and \ninput from those who would be using the products \nmay not be sought and error potential may not be \nconsidered ahead of time. Later, this may lead to \nunforeseen problems in the hands of clinical \nusers.  \n \nThese pitfalls can be avoided by using a process \nknown as Failure Mode and Effects Analysis \n(FMEA) to examine the use of new products and \nthe design of new services and processes to \ndetermine points of potential failure and what \ntheir effect would be \u2013 before any error actually \nhappens. In this regard, FMEA differs from Root \nCause Analysis (RCA). RCA is a reactive \nprocess, employed after an error occurs, to \nidentify its underlying causes. In contrast, FMEA \nis a proactive process used to look more carefully \nand systematically at vulnerable areas or \nprocesses. FMEA can be employed before \npurchase and implementation of new services, \nprocesses or products to identify potential failure \nmodes so that steps can be taken to avoid errors \nbefore they occur.  \n \nHow can FMEA be used to reduce the risk of \nmedication errors? To cite just one example, an \ninterdisciplinary committee could use FMEA to \nassess new drugs being considered for the \nformulary. Here\u2019s how the process would work.  \n \n\u2022 Step 1: The committee would explore how \n\n\n\n\n\n\n\n\nSeries: Medication safety issues \n\n\n\n 61\n\n\n\nthe intended product would be procured and \nused, from acquisition through \nadministration. Who would prescribe the \ndrug and for what type of patient? Where \nwould the drug be stored? Who would \nprepare and dispense it? How would it be \nadministered?  \n\n\n\n\u2022 Step 2: Potential failure modes (how and \nwhere systems and processes may fail) would \nbe identified while considering how the \nproduct would be used. Could the drug be \nmistaken for another similarly packaged \nproduct? Does the label clearly express the \nstrength or concentration? Does the name \nsound or look like another drug on the \nformulary? Are dosing parameters complex? \nIs the administration process error prone?  \n\n\n\n\u2022 Step 3: Once failure modes have been \nidentified, staff would determine the \nlikelihood of making a mistake and the \npotential consequences of an error. What \nwould happen to the patient if the drug were \ngiven in the wrong dose, at the wrong time, \nto the wrong patient, by the wrong route, at \nthe wrong rate?  \n\n\n\n\u2022 Step 4: Staff would identify any preexisting \nprocesses in place that could help detect the \nerror before it reaches the patient, and \nevaluate their effectiveness based upon \nknowledge of human factors.  \n\n\n\n\u2022 Step 5: If failure modes could cause errors \nwith significant consequences, actions would \nbe taken to prevent the error, detect it before \nit reaches the patient, or minimize its \nconsequences. A few examples include using \nan alternative product; preparing the drug in \nthe pharmacy; standardizing drug \nconcentrations, order communication and \ndosing methods; using auxiliary warning \nlabels or computer alerts; and requiring entry \nof specific data into computer systems before \nprocessing orders. \n\n\n\n \nCare with what you write! (13). \n \nA hospital reported mix-ups between two \ndifferent \u201crubicin\u201d products (anthracyclines). A \nnurse called the pharmacy to report that the colour \nof the idarubicin dispensed from the pharmacy \nwas different than the colour of the dose she had \ngiven the day before. Further investigation \nrevealed that the patient had received \ndaunorubicin instead of idarubicin on the previous \nday because staff thought they were both the same \ndrug. With five different \u201crubicin\u201d products on \nthe market, each with similar names, and two with \n\n\n\nliposomal forms, mix-ups are not surprising.  To \navoid confusion, prepare a chart for the pharmacy \nand the oncology unit that displays all the \nanthracycline products by generic name, brand \nname(s), investigational drug name/identifier, and \nliposomal forms if available. Include dosing \ninformation if desired. By the way, we heard that \nthe \u201cRubicin\u201d family does not like to be identified \nby first name only. So don\u2019t use Val, Ida, Donna \nor Epi. Doc\u2019s full name should also be used.  \n \nCare with what you use and who has access to \nmedications (14). \n \nTIMENTIN\u00ae (ticarcillin and clavulanate \npotassium) 3.1 grams IV was ordered for a patient \nafter the pharmacy had closed. A nursing \nsupervisor went into pharmacy, but could only \nfind the pharmacy bulk package which contains \n31 grams. She selected two vials and brought \nthem to the patient care unit. A staff nurse \nassumed that each vial contained one dose. She \ngave the patient one vial at 1 am and another at 5 \nam. The patient developed seizures, acute renal \nfailure, congestive heart failure, and eventually \ndied. When questioned, both the supervisor and \nnurse said that they had misread the 31 grams as \n3.1 grams. For a time, a shortage of 3.1 gram \nTimentin vials resulted in availability of only the \n31 gram bulk containers in the pharmacy. Lesson \nto be learned: Patients are at risk when non-\npharmacists have complete access to a pharmacy \nafter hours. With current technology, planning, \nand cooperation from medical and nursing staff, \nnight access to the pharmacy can be eliminated, \neven in rural hospitals. If there\u2019s any chance that \nmedications packaged in pharmacy bulk packages \nmight somehow reach patient care areas, make \nsure that extra warnings are affixed to the \ncontainers.  \n \nDrug information leaflets in error prevention \n(15). \n \nDrug information leaflets handed to patients can \nhelp prevent errors. A verbal order was given to a \npharmacist for NOROXIN (norfloxacin) 400 mg \nbid x 5 days. However, the pharmacist heard, \ntranscribed, and dispensed NEURONTIN 400 \nmg instead. When the patient got home, he read \nthe leaflet and called the pharmacy to ask why \nhe\u2019d been given medicine for seizures instead of \nthe anticipated antibiotic for a urinary tract \ninfection. The prescription was clarified with the \npatient\u2019s physician and the error was corrected. \nWhile there are many ways that errors like this \n\n\n\n\n\n\n\n\nSeries: Medication safety issues \n\n\n\n 62\n\n\n\ncan be prevented, it\u2019s important to point out the \nvalue of patient information leaflets as a backup \nwhen other systems fail. Instruct patients about \nthe importance of seeking counselling from \n\n\n\npharmacists when obtaining prescriptions and \nreading leaflets when they are provided. Armed \nwith proper information, patients can be a strong \ndefence against errors. \n\n\n\n\n\n\n\n***** \n \n\n\n\nREFERENCES \n \n1. Kohn LT, Corrigan JM, Donaldson MS. To err is \n\n\n\nhuman: building a safer health care system. \nWashington DC: National Academy Press; 2000. \n\n\n\n2. Leape LL, Brennan TA, Laird NM, Lawthers AG, \nLocalio AR, Barnes BA, Hebert L, Newhouse JP, \nWeiler PC, Hiatt H. The nature of adverse events \nin hospitalized patients. N Engl J Med 1991; 324: \n377-84. \n\n\n\n3. Brennan TA, Leape LL, Laird NM, Hebert L, \nLocalio AR, Lawthers AG, Newhouse JP, Weiler \nPC, Hiatt HH. Incidence of adverse events and \nnegligence in hospitalized patients. N Engl J Med \n1991; 324: 370-76. \n\n\n\n4. Australian Health Minister\u2019s Advisory Council. \nThe final report of the Taskforce on quality in \nAustralian health care. Canberra: Australian \nGovernment Publishing Service; 1996. \n\n\n\n5. Australian Council for Safety and Quality in \nHealth Care. Safety First \u2013 Report to the \nAustralian Health Ministers\u2019 Conference. \nCanberra: Australian Government Publishing \nService; 2000. \n\n\n\n6. Lesar TS, Briceland L, Stein D. Factors related to \nerrors in medication prescribing.  \n\n\n\n \n \nJAMA 1997; 277: 312-317. \n\n\n\n7. Roughead EE, Gilbert AL, Primrose JG, Sansom \nLN. Drug-related hospital admissions: a review of \nAustralian studies published 1998 \u2013 1996. MJA \n1998: 168: 405-408. \n\n\n\n8. Hayward RA, Hofer TP. Estimating hospital \ndeaths due to medical errors. JAMA 2001; \n286:415-420. \n\n\n\n9. Bates D, Spell N, Cullen DC, Burdick E, Laird N, \nPetersen LA, Small SD, Sweitzer BJ, Leape LL. \nThe costs of adverse drug events in hospitalised \npatients: adverse drug events prevention study \ngroup. JAMA 1997; 277: 307-311. \n\n\n\n10. ISMP Medication Safety Alert! 2nd October 2001. \n11. Landrigan C. Preventable deaths and injuries \n\n\n\nduring magnetic resonance imaging. N Engl J \nMed. 2001;345:1000-1001. \n\n\n\n12. ISMP Medication Safety Alert! 17th October \n2001. \n\n\n\n13. ISMP Medication Safety Alert! 31st October \n2001. \n\n\n\n14. ISMP Medication Safety Alert! 23rd Jan 2002. \n15. ISMP Medication Safety Alert! 6th Feb 2002. \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy 2002;1(3): 63-68                                                           CPE article \n\n\n\n 63\n\n\n\nContinuing Pharmacy Education  \n \n\n\n\nManaging Cytotoxic Drugs \n \nAmiruddin Ahmad \n \nFaculty of Pharmacy, Universiti Teknologi MARA, Shah Alam, Selangor, Malaysia. \n \n \nABSTRACT \n \nCytotoxic drugs are used in the management of malignant diseases. They have been \nfound to be carcinogenic, teratogenic and mutagenic. There is growing concern that \nthe handling, preparation, administration and disposal of these substances may \nconstitute an occupational hazard. These guidelines aim to identify, and help avoid \nor minimize occupational exposure to cytotoxic drugs and related wastes within \nhealth care establishments. It is necessary that individuals involved in the use or \nhandling of cytotoxic drugs are made aware of associated matters relating to the \nsafe handling of such drugs. \n \nKeywords: cytotoxic drugs, occupational exposure, mutagenic, teratogenic, \ncarcinogenic \n \n \nINTRODUCTION \n \nCytotoxic drugs are therapeutic agents which are \nknown to be toxic to cells principally through \ntheir action on cell reproduction and are \nprimarily intended for the treatment of cancer. \nCurrently there is no established data for safe \nlevel of exposure to these drugs. While health \ncare establishment workers involved in the \nhandling of these group of drugs do not receive \ntherapeutic doses, there is concern that unless \nsuitable protective measures are in place, these \npersonnel may be subjected to low level doses in \nthe long term. \n \nOccupational exposure may occur through the \ninhalation of aerosols and drug particles, skin \nabsorption, ingestion and needle stick injuries \nresulting from: \n\u2022 transport of cytotoxic drugs \n\u2022 cytotoxic drug preparation and \n\n\n\nadministration \n\u2022 contamination of surfaces with cytotoxic \n\n\n\ndrugs \n\u2022 handling, transportation and disposal of \n\n\n\ncytotoxic waste (1-3). \n\n\n\n \n \nPersonnel likely to be involved in these \nprocesses are nurses, medical officers and \npharmacy staff. The greatest risk of occupational \nexposure to cytotoxic drugs is during their \npreparation and administration. The need for safe \nhandling of cytotoxic drugs is not confined to \ninjectable dosage forms only. For example, oral \ndosage forms may shed respirable dust, and \nwhen used to prepare oral suspensions, may \ndistribute dust and fragments. Other aspects of \npatient care such as spill and waste management \nmay also pose a risk of occupational exposure. \n \nPotential effects of exposure \n \nMany published studies are inconclusive and \nlittle is known of long term effects of exposure to \ncytotoxic drugs in health care workers. However, \nthere is sufficient evidence to indicate potential \nadverse effects as a result of occupational \nexposure (4-7). Studies have reported the \nfollowing effects amongst personnel preparing \nand administering cytotoxic drugs: \n\u2022 contact dermatitis, local toxic or allergic \n\n\n\n\n\n\n\n\nCPE article: Managing cytotoxic products \n\n\n\n 64\n\n\n\nreaction, which may result from direct \ncontact with skin or mucous membranes \n\n\n\n\u2022 cytogenetic abnormalities and mutagenic \nactivity related to biological uptake by \nexposed personnel \n\n\n\n\u2022 alteration to normal blood cell counts \n\u2022 excretion of the drugs or metabolites in the \n\n\n\nurine in exposed personnel \n\u2022 symptoms including abdominal pain, hair \n\n\n\nloss, nasal sores and vomiting \n\u2022 liver damage \n\u2022 foetal loss in exposed pregnant women and \n\n\n\nmalformation of the offspring of pregnant \nwomen \n\n\n\n \nAlthough the long term effects of occupational \nexposure to cytotoxic drugs are inconclusive, it \nis not appropriate to wait for indisputable \nevidence of harm. \n \nDrug preparation \n \nIn general, the principle focus of safety during \ncytotoxic drug preparation should be on: \n\u2022 education and training of personnel \n\u2022 control of the working environment \n\u2022 adoption of safe working procedure \n \nEducation and training of health professionals in \ncytotoxic drug preparation and handling is \nrecommended to ensure that safe work practices \nare understood, developed, implemented and \nmaintained. Use of cytotoxic drug safety cabinet, \npharmaceutical isolators and other appropriate \nequipment is recommended to facilitate safe \npreparation of cytotoxic drugs and to ensure that \nproducts, operator and working environment are \nprotected. In order to provide drug containment \nand aseptic manipulation, all preparation of \ncytotoxic drugs should take place in a separate, \ndedicated cytotoxic safety cabinet or in \npharmaceutical isolators. \n \nThe health care establishment management is \nresponsible for ensuring that personnel who are \ndesignated to perform cytotoxic drug preparation \nprocedures are provided with an accredited level \nof training, and that they have attained \nproficiency prior to undertaking preparation \nprocedures (8). Accredited training in drug \npreparation procedures should be undertaken \nprior to commencement of duties and when new \nequipment is introduced or procedures changed. \nProcedures should be in place to ensure that \naccredited staff are kept informed of new \n\n\n\ndevelopments, such as changes in technology \nand preparation procedures. Validation of \naccreditation criteria should occur at intervals no \ngreater than two years. \n \nPersonal Protective Equipment should be worn \nby personnel using an approved cytotoxic drug \nsafety cabinet to prepare cytotoxic drugs: \n\u2022 long sleeved coverall of impermeable \n\n\n\nmaterial, e.g. made from bonded \npolyethylene fibre with a closed front and \nelasticized cuff, with suitable head \nprotection \n\n\n\n\u2022 overshoes of a similar impermeable material \n\u2022 suitable respiratory protection \n\u2022 long PVC, surgical latex, or purpose \n\n\n\nmanufactured gloves \n \nSpecial precautions are required for the \nlaundering of used Personal Protective \nEquipment (garments) which may be \ncontaminated with cytotoxic drugs. The \nconditions required for the laundering of \npotentially contaminated items should be \nestablished to: \n\u2022 protect laundry personnel who are involved \n\n\n\nin this process from cytotoxic drug residue \n\u2022 prevent contamination of other materials \n\n\n\nbeing laundered \n\u2022 ensure the garments are decontaminated \n\n\n\nprior to sterilization or reuse \n \nAttention to occupationally related work practice \nwill maximize efficiency and productivity and \nminimize operator errors. Cytotoxic clean room \nequipment layout should be designed properly. \nTo determine appropriate work periods the entire \ntask should be assessed taking into consideration \nthe: \n\u2022 level of concentration and visual control \n\n\n\nrequired \n\u2022 precision of movements \n\u2022 design of equipment and availability of \n\n\n\nadjustable furniture, e.g. chairs, stools and \nfoot rests \n\n\n\n\u2022 aesthetic effects of the working environment \n \nDrugs and its storage area and equipment need to \nbe identified. Intravenous equipment and devices \ncontaining cytotoxic drugs should be clearly \nlabelled with a permanent, adhesive and \nrecognizable cytotoxic drug label. \n \nFor drug storage, the quantities of cytotoxic \ndrugs stored in pharmacy departments, wards, \n\n\n\n\n\n\n\n\nCPE article: Managing cytotoxic products \n\n\n\n 65\n\n\n\nclinics and satellite pharmacies should generally \nbe restricted to the quantities for short term use. \nA dedicated area for the storage of cytotoxic \ndrugs should be provided in pharmacy \ndepartments and storage areas. Use of a \ndedicated area facilitates quick and efficient \ncontainment and management of a spill. \n \nOral solid cytotoxic doses should be individually \npackaged. Automatic tablet counters, or other \nequipment which may generate particulate \nmatter, should not be used in the packaging of \ncytotoxic drugs. If a prepared therapy has to be \ntransported on-site, it should be in a transport \ncontainer which is of sufficient strength to \nprevent leakage of its contents and should be \nsecurely closed and labelled with cytotoxic \nwarnings. Cytotoxic drugs should not be \ntransported in pneumatic automated tube \nsystems. \n \nStandard operating procedures for the \npreparation of cytotoxic drugs should be \ndocumented and should include: \n\u2022 using specially dedicated equipment in a \n\n\n\npharmacy to provide containment of powder \nwhere there is a requirement for \ncompounding cytotoxic preparations \n\n\n\n\u2022 operational specifications for the use of \ncytotoxic drug preparation facilities \nincluding cytotoxic drug safety cabinet \n\n\n\n\u2022 initial and ongoing validation of operator \ncompetence \n\n\n\n\u2022 reconstitution procedures \n\u2022 routine and emergency cleaning and \n\n\n\ndecontamination protocol \n\u2022 spill management \n\u2022 maintenance and certification of equipment \n\n\n\nand facilities \n\u2022 availability of drug safety information \n\u2022 documentation and records \n\u2022 maintenance of daily records \n\u2022 labelling and packaging for transport \n\n\n\ninternally or externally \n \nHealth care establishments which are unable to \nprovide facilities, equipment and training to \nemployees, should not undertake to provide a \ncytotoxic drug service. Alternative arrangements \ncould include: \n\u2022 purchase and supply of the prepared \n\n\n\ncytotoxic drug in a single dose delivery unit. \n\u2022 establishment of supply arrangements with a \n\n\n\nhealth care institution which has the required \nfacilities, equipment and trained personnel \n\n\n\nto provide prepared cytotoxic drug doses. \n \nDrug administration \n \nNursing, medical and other personnel may be \ninvolved in administering oral, parenteral and \ntopical cytotoxic drugs. A number of factors \ninfluence their level of risk of exposure to \ncytotoxic drugs during administration. Exposure \nmay occur due to contamination from solid or \nliquid spills or splashes and needle stick injuries. \n \nMany factors contribute to the risk of exposure, \nincluding: \n\u2022 poor technique, improperly used or \n\n\n\ninappropriate equipment \n\u2022 patient behaviour, when it increases the \n\n\n\ndifficulty of administration, for example, if \nthe patient is uncooperative \n\n\n\n\u2022 the route of administration, for example, the \nrisk of splashes in the eyes of the operator or \nassistant during an intrathecal injection is \nincreased owing to the proximity of the face \nto the injection site \n\n\n\n\u2022 an inappropriate working environment \n \nIt is important that practitioners identify the level \nrisk, then use appropriate work practices and \nPersonal Protective Equipment to minimize the \nrisks. \n \nAll staff administering cytotoxic drugs should be \nappropriately trained (9) in the following aspects \nof cytotoxic drug handling and demonstrate \nproficiency prior to commencing duties: \n\u2022 potential occupational hazards \n\u2022 approved work practice \n\u2022 specialized operator techniques \n\u2022 waste containment and handling \n\u2022 spill management techniques \n\u2022 proper use of Personal Protective Equipment \n \nThe following Personal Protective Equipment \nshould be considered for use during \nadministration of cytotoxic drugs: \n\u2022 a particulate respirator type mask \n\u2022 a long sleeved gown of impermeable \n\n\n\nmaterial \n\u2022 safety spectacles or goggles \n\u2022 long PVC, surgical latex, or purpose \n\n\n\nmanufactured gloves \n \nPersonal Protective Equipment should be \nremoved following completion of procedures and \nappropriately cleaned or disposed of. \n\n\n\n\n\n\n\n\nCPE article: Managing cytotoxic products \n\n\n\n 66\n\n\n\nSpill management \n \nStrategically, small spills that occur on-site and \nduring transportation should be managed by the \nhealth care establishment. Procedures must \nspecify under what conditions emergency \nservices should become involved. Spill \ncontainment should be the principle role of \nhealth personnel in gross spill management, \npending the attendance of the emergency spill \nmanagement team. \n \nProcedures should be established for small spills. \nThe management should ensure that safe work \npractices are developed, understood, \nimplemented and maintained by all personnel \nwho handle cytotoxic drugs and who may be \ninvolved in spill management. Training in spill \ncontainment and decontamination procedures \nshould be provided to personnel likely to be \ninvolved in spill management including: \n\u2022 pharmacy personnel \n\u2022 store personnel \n\u2022 nursing and medical personnel \n\u2022 cleaners \n\u2022 waste collectors \n \nSpill kits should be located so that they are \nreadily available for immediate use at all sites \nwhere cytotoxic drugs and waste are handled, \nstored and transported. \n \nStandard operating procedures for spill \nmanagement should specify: \n\u2022 the trained personnel approved for spill \n\n\n\nmanagement \n\u2022 spill strategies for specific location, e.g. \n\n\n\nwards, or in transit \n\u2022 procedures for using decontamination \n\n\n\nsolutions \n\u2022 where and how to obtain decontamination \n\n\n\nsolutions \n\u2022 who is responsible for providing and \n\n\n\nmaintaining spill management supplies \n\u2022 the personnel protective equipment to be \n\n\n\nused \n \nWaste management \n \nCytotoxic waste includes any residual drug \nfollowing patient treatment and the material \nassociated with the preparation or administration \nof cytotoxic drugs such as sharps, syringes, IV \ninfusion sets and containers, ampoules, vials and \ndisposable gowns, caps and gloves and swabs \n\n\n\nand materials used to clean and contain spills. \nAll cytotoxic waste need proper identification, \nsegregation and containment. An easily \nidentifiable symbol that denotes cytotoxic \nmaterials can be used. Containers and plastic \nbags to contain cytotoxic waste should be: \n\u2022 of any selected colour, e.g. purple \n\u2022 marked  \u201cCYTOTOXIC WASTE\u201d \n\u2022 placed in a rigid-walled container for \n\n\n\ntransport to a designated storage area \n \nAll sharps should be: \n\u2022 placed in a rigid-walled containers \n\u2022 labelled  \u201cCYTOTOXIC SHARPS\u201d \n\u2022 disposed of according to recommended \n\n\n\nprocedures \n \nPersonnel management \n \nLittle is known about the long term effects of \noccupational exposure to low level doses of \ncytotoxic drugs. Therefore the primary focus of \nsafety during use of cytotoxic drugs must be on \nthe control of the working environment and safe \nwork practices. \n \nHowever, there are variables that need to be \nconsidered in determining occupational hazards \nof cytotoxic drugs to an individual: \n\u2022 chemical properties of the drugs \n\u2022 the susceptibility of the individuals to the \n\n\n\ndrug\u2019s toxic effects \n\u2022 cofactors such as dietary habits, smoking \n\n\n\nand natural or manmade environment \ncontamination \n\n\n\n\u2022 type of exposure, e.g. skin contact, \ninhalation, ingestion \n\n\n\n \nIt is important that the health status of employees \nis monitored. There is currently no biological \nhealth assessment technique that is sufficiently \nspecific to adequately predict the effects of \nexposure to cytotoxic drugs. Employers should \ninvestigate and use the most appropriate and \nrecent method of health surveillance available \nand ensure that baseline data are collected. \nRecords should be maintained of all health \nassessment and biological monitoring results \nrelated to occupational cytotoxic drug exposure. \nOne purpose of these records is to facilitate \nretrospective studies to assess risk of exposure to \nemployees. \n \nWhere any form of health surveillance is \nundertaken, confidentiality should be ensured. \nRequirements such as employee consent, record \n\n\n\n\n\n\n\n\nCPE article: Managing cytotoxic products \n\n\n\n 67\n\n\n\nretention and security should be achieved and \nmaintained. Employees should receive duplicates \nof health surveillance test as soon as available. \nEmployees who are pregnant, breast-feeding or \nplanning parenthood and involved in the \npreparation or administration of cytotoxic drugs \nshould be informed of the risks of reproductive \neffects and possible effects on foetal \ndevelopment. Personnel required to perform \nthese may elect to not to do so. In such cases \nappropriate and suitable alternative duties must \nbe provided. \n \nEmployees should report any effects of, or \nexposure to cytotoxic drugs related to handling \nof the drugs or contaminated waste. The report \nshould be made to the supervisor through the \nnormal workplace incident reporting procedures. \nAny near miss incident or accident involving the \nhandling of either cytotoxic drugs or waste, \nshould be investigated to determine the cause. \nAppropriate action to prevent a recurrence \nshould be determined and taken. A listing of \npersonnel approved to undertake cytotoxic drug \npreparation and administration should be \nmaintained. \n \nThe management is responsible for maintaining, \nin perpetuity (e.g. 25 years minimum), the \nfollowing records for employees handling \ncytotoxic drugs: \n\u2022 accreditation or training status and type and \n\n\n\nextent of training period \n\n\n\n\u2022 record of time spent in the preparation and \nadministration of cytotoxic drugs \n\n\n\n\u2022 activity logs including name of the drug and \nactivity undertaken) \n\n\n\n\u2022 protective equipment used (e.g. cytotoxic \ndrug safety cabinet, Personal Protective \nEquipment) \n\n\n\n\u2022 unusual equipment (e.g. for managing \nspills). \n\n\n\n \nIn view of the long latency for some toxic \neffects, each employee should receive, on \ntermination of employment, a statement \nindicating the cytotoxic drugs used and results of \nany biological monitoring carried out. \n \nCONCLUSION \n \nAlthough there are many reports and studies that \nhave been carried out to show the relationship \nbetween cytotoxic exposure and risk to health, it \nis still difficult to confirm it. This is perhaps due \nto the small sample size, difficulty in quantifying \nexposure or protection used and latency period \nbetween exposure and health effects. Despite \nthese limitations, there is enough information to \nwarrant prudent action when handling cytotoxic \ndrugs. Therefore, the safe handling of cytotoxic \ndrugs is an issue that must be addressed in health \ncare settings. \n \n\n\n\nSee next page for the CPE questions \n\n\n\n \n***** \n\n\n\n \nREFERENCES \n \n1. Curran CF, Luce JK. Accidental acute exposure to \n\n\n\ndoxorubicin. Cancer Nursing 1989; 12: 329-31. \n2. Anderson RW, Puckett WH, Dana WJ, et al. Risk \n\n\n\nof handling injectable antineoplastic agents. Am J \nHosp Pharm 1982; 39:17-23. \n\n\n\n3. Hirst M, Tse S, Mills DG, et al. Occupational \nexposure to cyclophosphamide. Lancet \n1984;1:186-88. \n\n\n\n4. Benhamou S, Callous F, Saneho-Garnier H, et al. \nMutagenicity in urine from nurses handling \ncytotoxic agents. Eur J Cancer Oncol 1986; \n22:1489-1493. \n\n\n\n5. Falck K, Crohn P, Sorsa M, et al. Mutagenicity in \nurine from nurses handling cytotoxic drugs. \nLancet 1979;1250-1251. \n\n\n\n\n\n\n\n6. Gibson JF, Gompertz D, Hedworth-Whitty RB. \nMutagenicity of urine from nurses handling \ncytotoxic drugs. Lancet 1984; 1: 100-101. \n\n\n\n7. Rodriquez P, Yap CY. Abnormal blood results \nfound in pharmacists preparing cytotoxics. Aust J \nHosp Pharmacy 1991;21:39. \n\n\n\n8. New South Wales Work Cover. Guidelines for \nhandling drugs and related waste in health care \nestablishments. 1995. 2edn. New South Wales \nGovernment. \n\n\n\n9. Moore TD, Hale KM, Cortese LM, et al. \nManaging employee apprehension toward \nhandling cytotoxic drugs. Am J Hosp Pharm \n1984;41:2618-2623.\n\n\n\n\n\n\n\n\nCPE article: Managing cytotoxic products \n\n\n\n 68\n\n\n\nFrom previous page \n \nContinuing Pharmacy Education questions: \n \nStudy the questions below and send your answers (only one of A, B, C and D is correct) to the MPS-CPE \nSecretariat at the Malaysian Pharmaceutical Society, P.O. Box 158, Jalan Sultan, 46710 Petaling Jaya, \nSelangor. You may earn up to 2 CPE points. \n \n \n1. The most common routes of occupational hazard from handling cytotoxic drugs are \n\n\n\nA. accidental injection, gastric absorption \nB. direct contact, gastric absorption \nC. inhalation, direct contact \nD. mucosal absorption, inhalation \n\n\n\n \n2.       Potential effects of exposure to cytotoxic drugs in health care personnel are \n\n\n\nA. contact dermatitis and cardiotoxicity \nB. foetal loss or malformation in pregnant women \nC. liver damage and phlebitis \nD. extravasation at the injection site \n\n\n\n \n3.      The greatest risk of occupational exposure of cytotoxic drugs is during \n\n\n\nA. preparation and transportation \nB. administration and disposal \nC. preparation and administration \nD. transportation and disposal \n\n\n\n \n4. The advantage of having a dedicated area for storage of cytotoxic drugs in pharmacy \n\n\n\ndepartments is to \nA. facilitate searching of stock \nB. facilitate quick and efficient containment and management of spill \nC. provide proper stock management \nD. provide better control and monitoring of cytotoxic drugs usage \n\n\n\n \n5. Standard operating procedures for preparation of cytotoxic drugs should include those \n\n\n\nbelow, EXCEPT \nA. documentation and record \nB. reconstitution procedures \nC. maintenance and certification of equipment \nD. potential hazard of cytotoxic drugs \n\n\n\n \n6. The following are the variables that can be considered in determining occupational hazards \n\n\n\nof cytotoxic drugs to health personnel, EXCEPT \nA. chemical properties of the drugs \nB. toxic effects of the cytotoxic drugs \nC. type of exposure \nD. cofactors such as dietary habit \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy 2003;1(3):69-75  General article \n\n\n\n 69\n\n\n\nBrief History And Development Of Parenteral \nNutrition Support \n \nAhmad Fuad Shamsuddin \n \n\n\n\nDepartment of Pharmacy, Faculty of Allied Health Sciences, Universiti Kebangsaan Malaysia, \n50300 Kuala Lumpur, Malaysia.  \n \n \nABSTRACT \n \nPatients who are unable to use their gastrointestinal system for feeding purposes are \nnow usually started on parenteral nutrition. It is a therapeutic tool used in the \nclinical management of patients requiring special nutritional care both in the \nhospital, and at home (home parenteral nutrition). The idea of providing nutrients \nintravenously in humans was first realised when Sir Christopher Wren injected \nwine and ale in dogs way back in the middle of the 17th century. The historic \nexperiment initiated further investigation and studies on this novel approach to \nnutrition. Better understanding of the metabolic and pharmacological properties of \nthe macronutrients (protein, carbohydrates, and   lipid), the micronutrients (trace \nelements, and vitamins), and the electrolytes have made it possible to administer \nparenteral nutrition safely to all types of patients where it is indicated. Continuous \ndevelopment and improvement in the pharmaceutical presentations of these \nnutrients have helped to minimise the metabolic problems seen in the early days of \nparenteral nutrition administration.  Production of the single- or multilayered \nparenteral nutrition bags using materials which are inert and capable of reducing \noxygen permeability such as the combination of ethylenevinylacetate-polyvinylidine \nchloride has ensured better stability of the parenteral nutrition admixture.   The \nmulticompartmental bag has provided a much more simpler and convenient way of \ninitiating parenteral nutrition. The increase in knowledge, development and \nimprovement in parenteral nutrition support has made it possible to provide \nparenteral nutrition support at home.  \n \nKeywords: parenteral nutrition, enteral nutrition, macronutrients, micronutrients, \nconvenience bags \n \n \nINTRODUCTION \n \nParenteral nutrition (PN) is a relatively new \ntherapeutic tool used in the clinical management \nof patients.  Arguably, the era of modern clinical \nnutrition can be said to have dawned around 35 \nyears ago when Dudrick and colleagues reported \ntheir work on the successful administration of \nlong-term PN in an infant (1).  In Malaysia, PN \nservice was established in late 1986 at the \nKuantan General Hospital (Hospital Tengku  \n\n\n\n \n \nAmpuan Afzan, Kuantan, Pahang) (2), while \nBahari reported that formal parenteral nutrition \nrounds led by pharmacists were initiated at the \nuniversity hospital of Universiti Sains Malaysia \n(HUSM) a year later (3). \n \nPN is a mode of providing nutritional \nsupplement that involves the administration of \nnutrients through the intravenous route (viz par \n\n\n\n\n\n\n\n\nGeneral article: Development of parenteral nutrition support \n\n\n\n 70\n\n\n\nenteral).  It is also widely and affectionally \nknown as total parenteral nutrition or TPN, \nalthough intravenous nutrition, and artificial \nnutrition are accepted terms to convey the same \nmeaning. Hyperalimentation, that is the \nprovision of nutrients at high concentration \nintravenously, was the term used during the early \ndays of this novel nutritional approach (which, \nliterally, was the reason for most of the adverse \neffects of PN therapy back then!). Nowadays, the \nterm PN is widely used in the literature to denote \nthe administration of nutrients intravenously. \n \nBasically, PN is only indicated when the oral, or \nenteral route (i.e. the use of the gastrointestinal \nsystem) of nutrition cannot be established, or is \ninsufficient for the maintenance of the patient\u2019s \nnutritional requirements in relation to his/her \nclinical status. Partial parenteral nutrition  (PPN) \nis the concurrent intravenous administration of \nnutrients together with oral or enteral nutrition \nfor the same therapeutic objective.  \n \nThe dietary components of a standard PN \nregimen are the macronutrients (protein or amino \nacids, carbohydrate, and lipids or fats), the \nelectrolytes, the micronutrients (trace elements, \nand vitamins) and water. Carbohydrate, in the \nform of glucose or dextrose, and lipids are the \nmajor energy providers.  \n \nEarly work on intravenous nutrition \n \nThe main role and function of the major \ncomponents of the diet in human growth and \ndevelopment were recognised only around a \ncentury ago (4).  Nevertheless, the history of \nintravenous infusion of nutrients began in 1665, \nwhen Sir Christopher Wren injected wine and ale \nto dogs, and noted that intravenously \nadministered alcohol had the same effect as \nalcohol taken orally (5).  \n \nIndeed, investigators and clinicians have long \nrealised the importance of providing adequate \nnutrition to patients, more so to those with \ngastrointestinal problems. The intravenous route \nof nutrient administration was seen to be one \npossible avenue to venture into in the nutritional \nmanagement of patients who cannot consume \nfood orally. Ever since the historic experiment \nby Wren, various workers had experimented \nproviding nutrients such as carbohydrates and \nlipids in animals, and also humans in their effort \nto understand and develop this novel approach to \nnutrition.   \n\n\n\nStirius, in 1668, published a review on this \nsubject of intravenous experiments in which he \ndeduced that intravenous infusions were, or \ncould be applicable to nearly all disease states, \nexcept where pregnant women and newborn \nchildren were involved. These patients were \nconsidered by Stirius as difficult and bad \nsubjects to treat (6).  \n \nAlthough the deduction of Stirius still holds \nsome relevance today, advances in the \nknowledge and technical capabilities in the \nadministration of PN over the last two decades \nhave made it possible to administer intravenous \nnutrition even to pregnant mothers (7) and low \nbirth-weight neonates (8,9), the so called \ndifficult and bad subjects!  \n \nEarly results of intravenously administered \nnutrients were not promising because of the \nadverse effects associated, although the desired \noutcomes were also observed. These unwanted \neffects, caused by poor administration \ntechniques, and the use of crude compounds led \nto some of the work in this field of intravenous \nnutrition research being prematurely abandoned \n(10).  One such incident is the work of Friedrich \nin 1904, in which he administered what can be \nconsidered the first total PN in man, \nsubcutaneously. These infusions of peptone, fat, \nglucose and electrolytes were so painful that not \neven Dr. Friedrich wanted to pursue \ndevelopment in this area of research (10).  Also, \nit can be safely deduced that the lack of \npharmaceutical and microbiological knowledge \nmeant that problems of stability (incompatability \nand interactions included), and sterility were not \nrecognised and duly addressed during those early \nyears. \n \nIntravenous administration of proteins \n \nEver since the 19th century, protein has been seen \nto have an important role in the growth and \ndevelopment of humans (11).  The special nature \nof protein and its metabolism made it a challenge \nto find suitable ways of administering it \nintravenously. The first study in the intravenous \nadministration of proteins was made in goats in \nthe form of protein hydrolysates by Herriques \nand Andersen in 1913 (10). These hydrolysates \nwere products of the naturally occurring proteins \nsuch as fibrin and casein. Positive nitrogen \nbalanced was achieved, thus demonstrating the \nrole of intravenous protein hydrolysates as \npossible alternative to dietary protein in animals.  \n\n\n\n\n\n\n\n\nGeneral article: Development of parenteral nutrition support \n\n\n\n 71\n\n\n\nIt was only after 1937, when Elman published \nhis pioneering studies on the intravenous \ninfusion of protein hydrolysates in man (12), that \ninvestigations of complete intravenous nutrition \n(i.e. the intravenous administration carbohydrate, \nprotein, and lipids concurrently) were initiated \nworldwide. Due to serious complications such as \nhigh concentration of di- and tripeptides \nresulting from incomplete hydrolysis, poor \nutilisation of nitrogen, and hyperammonaemia \n(13), the use of protein hydrolysates in PN has \nnow been superseded by the more flexible \ncrystalline amino acids.   \n \nToday, various parenteral amino acid \npreparations for specific clinical states have been \ndeveloped and marketed such as Aminoplasmal \nHepa\uf6da (B.Braun Germany) for PN patients with \nliver dysfunction; Vaminolact\uf6da (Fresenius Kabi, \nSweden) and Promene\uf6da 10% (Baxter, UK) for \nneonates and infants, and Glamin\uf6da (Fresenius \nKabi, Sweden), which is an amino acid formula \nwith a higher concentration of glutamine. For \npatients with renal impairment, amino acid \nsolutions without electrolytes such as Vamin\uf6da 14 \nEF (Fresenius Kabi, Sweden) are recommended. \n \nIntravenous glucose infusion \n \nAt the turn of the century, in 1896, Beidl and \nKraus administered the first intravenous infusion \nof glucose solution in man, around 40 years after \nthe importance of glucose for metabolism was \nfirst demonstrated. 200-300 ml of a 10% glucose \nsolution was administered with no glucosuria \nobserved although severe fever resulted (10). \nGlucose infusion was recognised as the only \nsource of energy before the advent of a suitable \nlipid emulsion that could be safely administered \nintravenously in humans. In the desire to obtain \nhigher calorie supplement, higher concentrations \nof glucose solution were infused. Inevitably, vein \nirritation and thrombophlebitis ensued when high \nconcentrations of glucose solution were infused \nperipherally. These problems were overcome \nwhen Dudrick and co-workers showed that \nhigher concentrations of glucose could be \nadministered safely through the central veins in \ndogs (1). Ever since then, PN admixtures with \nhigh concentrations of glucose have been safely \nadministered in humans through the subclavian \nvein or the central intravenous route. \n \nEarly intravenous administration of lipids \n \nThe earliest published record of intravenous lipid \n\n\n\nadministration was made by Courten in 1712, \nwhen he infused 1 g per kg body weight of olive \noil in a dog. However, severe respiratory distress \nsymptoms were observed, and the dog eventually \ndied (10).  It was then assumed that all oils or \nfats, for that matter, should only be infused in a \nspecialised and suitable form. Further \ninvestigations by Menzel and Perco more than \n150 years later, also in dogs, showed that large \namounts of lipids could be administered \nintravenously without adverse effects (10).  \n \nThe interest in using lipids in PN led various \ninvestigators to work on lipid emulsions of \nvarious composition such as castor oil (14), olive \noil (15) and cottonseed oil (16). All these lipid \nemulsions caused side effects in humans such as \nnausea, vomiting and fever. Other serious \nadverse reactions notably liver damage, jaundice \nand bleeding tendency were also observed \nleading the United States of America to ban the \nusage of lipid emulsions for PN in 1964. During \nthis time in Europe, Schuberth and Wretlind \ndeveloped a safe and efficacious form of lipid \nemulsion from soybean oil using egg yolk \nphospholipids as the emulsifying agent (17). This \nlipid emulsion (consisting of long chain \ntriglycerides, LCT) marketed as Intralipid\uf6da \n(Fresenius Kabi, Sweden) became one of the \nmost widely used lipid emulsions in PN \nadministration until today. [N.B. intravenous \nlipid emulsions were subsequently reintroduced \nin the U.S. market in 1975 (18)].  \n \nToday, various concentrations (10, 20 and even \n30%), and composition of lipid emulsion (LCT, \nand combination of LCT and medium chain \ntriglycerides, MCT [Lipofundin\uf6da MCT/LCT, B. \nBraun Germany]) are used in PN therapy. \nInvestigations into the use of parenteral fish oil \nemulsion (n-3 fatty acids) (e.g. 10% Omegaven\uf6da \n\n\n\n[Fresenius, Germany]), and the re-emergence in \nthe use of olive oil in combination with soya \nbean (ClinOleic\uf6da 20% [Baxter, UK]) in the last \n10 years suggest new alternatives in the use of \nlipid emulsion in PN (19). \n \nElectrolytes and the micronutrients  in \nparenteral nutrition \n \nThe importance of salts in humans was realised \nwhen the blood chemistries of cholera patients \nwere investigated by O\u2019Shaughnessy in 1839, \nand Latta followed up these findings in the same \nyear by infusing, intravenously, solutions of the \nsalts that were found low in the blood of dying \n\n\n\n\n\n\n\n\nGeneral article: Development of parenteral nutrition support \n\n\n\n 72\n\n\n\ncholera patients. Majority of these patients \nremarkably recovered (20). Various \nconcentrations of sodium chloride infusions (e.g. \n0.9% sodium chloride, and 0.45% sodium \nchloride) are now used for parenteral fluid and \nelectrolyte therapy. These findings coupled with \nthe work of Beidl and Kraus in 1896 on the \ninfusions of glucose in humans led to the salt-\nglucose solutions which became the so-called \nstandard parenteral solution of the early part of \nthe 20th century (20). These solutions are now \nstill used as dextrose-saline combinations in \nintravenous fluid therapy in the various clinical \nsettings.  \n \nThe need to provide trace elements or the \nmicronutrients in PN came to light only around \n25 years ago when it was shown by Jeejeebhoy \nand co-workers that long-term PN caused \nchromium deficiency (21). Work by Buzzeti and \ncolleagues a few years later confirmed the \nexistence of hypocupraemia in a patient \nattributed to PN administration (22). Trace \nelements are now normally added in the PN \nadmixture in the form of standard trace element \npreparations such as Additrace\uf6da (Fresenius Kabi, \nSweden), Peditrace\uf6da (Fresenius Kabi, Sweden) \nand individual injections (e.g. zinc sulphate, and \nmagnesium sulphate injections) to supplement \nthe daily needs for these micronutrients.  \n \nThe importance of vitamins, another group of \nmicronutrients, in nutrition was first appreciated \nin the early part of the twentieth century when \nresearchers found that animals required more \nthan carbohydrate, protein, fat, minerals and \nwater to support life and growth (23). In the \nparenterally-fed malnourished patients, signs of \nvitamin deficiencies were observed in the blood \nlevels after a few days on vitamin-free PN (24). \nVitamins are now routinely added in the PN \nadmixture using various products such as \nmultiple vitamins preparations (Soluvit\uf6da, \nVitalipid\uf6da [Fresenius Kabi, Sweden]) which \nhave been developed based on the American \nMedical Association guidelines for vitamins for \nparenteral use (25). These vitamins can also be \nadded as individualised vitamin preparations \n(e.g.Vit K).  \n \nComplete intravenous provision of nutrients \nfrom a single bag \n \nOriginally, PN administration constituted the use \nof separate glass bottles. A 2-in-1 method was \nadopted where the amino acids solution and \n\n\n\nglucose were admixed together with the other \ncomponents of the PN regimen. Lipid emulsion \nwas administered from a separate bottle.  This \nsystem, which is still being adopted in some \nhospitals, requires two sets of intravenous \ntubings and infusion pumps leading to high cost \nand problems of sepsis, vein patency and lines \nmanagement (26).   \n \nIn the seventies, the All-in-One (AIO) system \nwas introduced by Solassol and colleagues to \nallow for the direct administration of PN in the \nambulatory patient (27). This system involved \nthe mixing of the main components of a PN \nregimen  (the amino acids, glucose and lipid \nemulsion and other nutrient components \u2013 the \nAIO admixture) in a single silicone rubber bag. \nThey showed that this admixture was stable and \nsafe to be administered to patients leading to a \nmore cost-effective and simple approach to PN \nadministration. This method has now been \nwidely accepted and is used worldwide although \nthe type of bags used has changed considerably. \n \nDevelopment of the PN bag \n \nWhen it was shown that mixing of the major \nnutrients was possible, the components of the PN \nadmixture (except lipids) were first mixed in \nbottles (26). The use of these bottles slowly lost \nfavour because of their bulkiness, and losses of \ncostly materials if they were inadvertently \ndropped and broken. \n \nIn light of this, a more flexible container was \nneeded leading to the use of polyvinyl chloride \n(PVC) bags.  However, it was later shown that \nthe use of PVC bags were not suitable due to \nadsorption of the components such as vitamin A \nto the bags (28, 29) and also the risk of \nplasticisers from the PVC matrix leaching out or \nbeing extracted by the contents of the admixture \n(30). Plasticisers can be extracted by the organic \ncontents of the admixtures such as the lipids and \nvitamins. \n \nThe practice of adding all the components \n(including lipid) of the PN regimen together (the \nAIO admixture) posed the inherent risk of \nphysicochemical stability problems. As the use \nof materials such as PVC will only compound \nthis problem, the ethylene-vinylacetate (EVA) \nbag which is more inert was introduced. The \nEVA bags possess advantageous thermoplastic \nproperties and favourable toxicological and \nbiocompatibility aspects (31). These bags are \n\n\n\n\n\n\n\n\nGeneral article: Development of parenteral nutrition support \n\n\n\n 73\n\n\n\nnow commonly used for the AIO admixtures. \n \nNowadays, multilayered bags have been \nintroduced to ensure a greater stability profile of \nthe PN admixture against oxidation. These bags \nconsist of multiple-layered plastic produced from \nthe combination of EVA-polyvinylidine chloride \n(PVDC) (32) or EVA-modified EVA ethylvinyl \nalcohol (EVOH) for example, which reduces the \npermeability of oxygen by 100 times compared \nto conventional EVA bags thus ensuring better \nstability of the admixture (33). \n \nFurther understanding of the physico-chemical \naspects of the PN regimens, and recent \ntechnological advances have led to the \ndevelopment of the prefilled multi-\ncompartmental bags for PN administration. The \nintroduction of these bags has provided easy \nmixing of the PN regimens and also provided a \nclose system which guarantees sterility of the \nadmixture. \n \n\n\n\nThe Easy-to-Mix System \n \nDuring the late eighties, an easy-to-mix (ETM) \nsystem was introduced to facilitate quick and \neasy mixing of PN regimens by pharmacy and \nnursing staff. This system comprises of a two-\nbottle system (VitrimixR [Fresenius Kabi, \nSweden]). One bottle contains a glucose-amino \nacid solution, whereas the lipid component is \ncontained in the other bottle. Compounding of a \nPN regimen (minus the micronutrients) involves \nthe simple transfer of the lipid emulsion into the \nglucose-amino acid solution via a tranfer pin. \nThis system has now been superseded by another \nETM system which was developed in the early \nnineties. \n \nThe new ETM system uses multi-compartmental \nEVA bags or the convenience bags (please refer \npreceding section) prefilled with the nutrients \nand electrolytes required for PN therapy.  These \nbags are presented as the double chamber \n(NutriflexR  [B Braun, Germany]), and triple \nchamber bags (KabivenR [Fresenius Kabi, \nSweden], Clinomel\uf6db [Baxter, UK]). The \nchambers are separated by various mechanisms \nsuch as a breakable port, peel-seal system, or a \npull-away flexible rod clamp.  In the double \nchamber bag, one compartment is filled with the \namino acids solution, while the other \ncompartment is filled with glucose based on a \nstandard nutritional regimen (the lipid \ncomponent is kept in a separated bottle, which is \nthen added to the system). In the triple-chamber \n\n\n\nbags, the third compartment is filled with the \nlipid emulsion. To use these bags, firm and \ngentle squeezing of the bag will break the \nintercompartmental seals; or the separating rod \nremoved, thus mixing the nutrients. Other \nnutrients such as the electrolytes, trace elements \nand vitamins can then be added based on the \ndaily allowances, and the bags are ready for \nadministration. The use of these bags, or the \nETM system ensure better stability of the AIO \nadmixtures and minimise the risk of \ncontamination during compounding.  \n \nHome Parenteral Nutrition \n \nHome parenteral nutrition (HPN) is the provision \nof parenteral nutrition at home. The need to \nprovide HPN was realised in the effort of \nreducing treatment cost due to long hospital stay, \nand to avoid hospital-acquired complications \n(e.g. infection) in the stabilised patients whose \nmain reason for continued hospitalisation is for \nPN therapy. With the increase in knowledge, \ndevelopment, and improvement in PN support, \nthe provision of HPN provides a comforting \nenvironment, and gives patients the freedom to \nreturn to normal activities such as work, and \neven travelling (34). HPN is indicated in patients \nwho have to rely on long-term PN such as those \nwith Crohn\u2019s disease and short bowel syndrome. \nHPN is also administered to patients suffering \nfrom acquired immunodeficiency syndrome \n(AIDS), chronic pancreatitis, hyperemesis \ngravidarum, and neoplasm (35).  \n \nHPN should be administered exclusively from an \nAIO admixture in a single bag. As such the \ncompounding of a stable admixture is usually \ncarried out by experienced pharmacy personnel \nin established centres. A patient needs only to \nattach the outlet port of the compounded bag, \naseptically, to the inserted catheter of the central \nroute (established by the surgeon in the hospital).  \nIt is common for the pharmacy department in the \nhospital where the patient has been treated to \nsupply compounded bags ready for use at home. \nStorage advice and correct use of the \ncompounded bags for HPN are usually provided \nby the pharmacist to these patients to avoid \nphysicochemical stability problems, and also \nclinical complications such as infection, and \nother metabolic derangements. Monitorings \nduring HPN administration by the nutritional \nsupport team help to provide safe and cost-\neffective nutritional therapy to these patients. \n\n\n\n\n\n\n\n\nGeneral article: Development of parenteral nutrition support \n\n\n\n 74\n\n\n\nCONCLUSION \n \nIn perspective, PN has now been accepted as part \nof the overall therapeutic management of the \nhospitalised patients when indicated. It is not \nonly limited to preventing starvation or \ncorrecting deficiencies (36). In more advanced \ncountries, the instigation or cessation of PN \ntherapy is subject to the same legal and moral \nconstraints as apply to other recognised therapies  \n\n\n\n37). Refinement and sophistication of techniques \nhave made optimal nutrition possible in virtually \nall patients regardless of the status of their \ngastrointestinal tract, or the presence of \ncomplicating metabolic disorders. Today, these \nadvances have also made home parenteral \nnutrition possible in stabilised patients who \nrequire this mode of nutritional support for a \nlonger period of time. \n\n\n\n\n\n\n\n***** \n \n\n\n\nREFERENCES \n \n1. Dudrick SJ, Wilmore, DW, Vars HM, Rhoads JE.  \n\n\n\nLong-termed parenteral nutrition with growth, \ndevelopment, and positive nitrogen balance. \nSurgery 1968; 64: 134-142. \n\n\n\n2. Hassan Y. Challenge to clinical pharmacy \npractice in Malaysia. Ann Pharmacotherapy  \n1993; 27: 1134 \u2013 1138. \n\n\n\n3. Bahari MB.  Total parenteral nutrition in \nMalaysia: an overview. Malays Pharm Soc J  \n1990: 23-26. \n\n\n\n4. Brown RO, Sacks, GS. Parenteral and enteral \nnutrition in adult patients. In Herfindal ET, \nGourley DR,  editors. Textbook of Therapeutics - \nDrug and Disease Management, 6th Ed. \nBaltimore: Williams & Wilkins; 1996. \n\n\n\n5. Annan GL. An exhibition of books on the growth \nof our knowledge of blood transfusions. Bull N N \nAcad Med   1938; 15: 623. \n\n\n\n6. Macht DI. The history of intravenous and \nsubcutaneous administration of drugs. J Amer \nMed Assoc 1916; 66: 856-860. \n\n\n\n7. Greenspoon JS, Safarik RH, Hayashi JT, Rosen \nDJ. Parenteral nutrition during pregnancy. Lack of \nassociation with idiopathic preterm labor or \npreeclampsia. .J Reprod Med  1994; 39:87-91. \n\n\n\n8. Saini J, MacMahon P, Morgan JB, Kovar IZ. \nEarly parenteral feeding of amino acids. Arch  \nDis Child 1989; 64: 1362-1366. \n\n\n\n9. Gilbertson N, Kovar IZ, Cox DJ, Crowe L, \nPalmer NT. Introduction of intravenous lipid \nadministration on the first day of life in the very \nlow birth weight neonate. J Pediatr 1991; 119: \n615-623. \n\n\n\n10. Wretlind A. Parenteral nutrition support: history, \npresent, and future. Plenary Lecture given at the \nXV International Congress of Nutrition, \nAdelaide, Sep 26 to Oct 1, 1993. \n\n\n\n11. Cuthbertson DJR,  Rennie MJ. Protein and amino \nacid metabolism in the whole body and in the \ntissues. In Payne-James J, Grimble G, Silk D, \neditors. Artificial  Nutrition Support in Clinical  \n\n\n\n\n\n\n\nPractice. 2nd  ed. London: Greenwich Medical \nMedia Ltd; 2001. \n\n\n\n12. Elman R. Amino acid content of the blood \nfollowing intravenous injection of hydrolyzed \ncasein. Proc Soc Exp Biol Med  1937; 37: 437-\n440. \n\n\n\n13. Vanderveen TW, Niemiec PW.  Parenteral \nnutrition. In Herfindal ET, Hirschman JL, editors. \nClinical Pharmacy and Therapeutics. 3rd ed. \nBaltimore, MD: William & Wilkins; 1984. \n\n\n\n14. Macht SD. Three hundred years of parenteral \nnutrition: The history of intravenous nutritional \ntherapy. Conneticut Med 1980; 44: 27-30. \n\n\n\n15. Meng HC, Early F. Study of complete parenteral \nalimentation in dogs. J Lab Clin Med 1949;  34: \n1121-1132. \n\n\n\n16. Geyer RP. Parenteral nutrition. Physiol Rev  \n1960;  40: 150-186. \n\n\n\n17. Schuberth O, Wretlind A. Intravenous infusion of \nfat emulsion and phosphatides and emulsifying \nagents. Acta Chir Scand Suppl 1961; 278: 1-21. \n\n\n\n18.  Driscoll DF. Clinical issues regarding the use of \ntotal nutrient admixtures. DICP Ann \nPharmacother 1990; 24: 296-303. \n\n\n\n19. Furst P, Kuhn KS, Stehle P. Parenteral nutrition \nsubstrates. In Payne-James J, Grimble G, Silk D, \neditors. Artificial  Nutrition Support in Clinical \nPractice. 2nd ed. London: Greenwich Medical \nMedia Ltd; 2001. \n\n\n\n20. Cosslett AG. Studies on the stability of lipid \nemulsions in total parenteral nutrition admixtures. \nIn The Thesis Submitted for the Degree of \nPhilosophiae Doctor, University of Wales. \nCardiff: Univ Wales, 1991. \n\n\n\n21. Jeejeebhoy KN, Chu RC, Marliss EB, Greenberg \nGR, Bruce-Robertson A. Chromium deficiency, \nglucose intolerance, and neuropathy reversed by \nchromium supplementation in a patient receiving \nlong-term total parenteral nutrition. Am J Clin \nNutr 1977; 30: 531-538. \n\n\n\n\n\n\n\n\nGeneral article: Development of parenteral nutrition support \n\n\n\n 75\n\n\n\n22. Bozzeti F, Inglese MG, Terno G, Pupa A, \nSequeira C, Migliavacca S. Hypocupremia in \npatients receiving total parenteral nutrition. JPEN  \n1983; 7: 563-566. \n\n\n\n23. Groff JL, Gropper SS. The water-soluble \nvitamins. In Groff JL, Gropper SS, editors. \nAdvanced Nutrition and Human Metabolism, 3rd \ned. CA, USA: Wadsworth/Thomson Learning; \n2000. \n\n\n\n24. Grant JP. Vitamin requirements. In Grant JP, \neditor. Handbook of Total Parenteral Nutrition 2nd \ned. Mexico:W.B. Saunders Company; 1992. \n\n\n\n25. American Medical Association Guidelines for \nMultivitamin preparations for parenteral use: A \nStatement by the Nutrition Advisory Group II. \nJPEN 1979; 3: 258-262. \n\n\n\n26. Silberman H.  Parenteral nutrition: The lipid \nsystem. In Silberman H. editor. Parenteral and \nEnteral Nutrition. 2nd ed. Connecticut: Appleton \n& Lange; 1989. \n\n\n\n27. Solassol C, Joyeux H, Pujol H, Romieu C. Long \nterm parenteral nutrition - an artificial gut. Int \nSurg 1976; 61: 266-270. \n\n\n\n28. Chiou WL, Moorhatch P. Interaction between \nvitamin A and plastic intravenous fluid bags. \nJAMA 1973; 223: 328. \n\n\n\n29. McKenna MC, Bieri JG. Loss of vitamin A from \nTPN solutions. Fed Proc 1980; 39: 561. \n\n\n\n30. Moisan JY. Effects of oxygen permeation and \nstabiliser migration on polymer degradation. In: \nComyn J, editor. Polymer Permeability. London: \nElsevier Applied Science Publishers Ltd.; 1985. \n\n\n\n31. Richards JH. The role of polymer permeability in \nthe control of drug release. In: Comyn J, editor. \nPolymer Permeability. London: Elsevier Applied \nScience Publishers Ltd.; 1985. \n\n\n\n32. Allwood MC, Hardy G, Sizer T. Effects of air \nand oxygen on parenteral admixtures - an \nunderrated risk? Nutrition 1996; 12: 222-223. \n\n\n\n33. Allwood MC. The stability of ascorbic acid in \nTPN mixtures stored in a multilayered bag. Clin \nNutr 1992; 11: 284-288. \n\n\n\n34. Jones B. Home parenteral nutrition. In: Payne-\nJames J, Grimble G, Silk D, editors. Artificial  \nNutrition Support in Clinical Practice. 2nd ed. \nLondon: Greenwich Medical Media Ltd; 2001. \n\n\n\n35. Kelly DG, Burnes JU. Home nutrition support. \nThe Gastroenterologist 1996; 4 (suppl 1): S29 \u2013 \nS39. \n\n\n\n36. Boullata JI. Parenteral nutrition:adjunctive or \nprimary role in gastrointestinal therapeutics? Nutr \nClin Prac 1998; 13:57-58. \n\n\n\n37. Macfie J. Ethics and nutrition. All-in-One \nnewsletter 1998; 22: 2-5. \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy 2003;1(3) 76-85  Research article  \n\n\n\n 76\n\n\n\nAwareness of Hepatitis A and Hepatitis B \namong Residents in Kuala Lumpur and \nSelangor \n \nHo Chiew Lim, Hesham Rashwan* \n \n\n\n\nDepartment of Pharmacy, Faculty of Allied Health Sciences, Universiti Kebangsaan Malaysia, \n50300 Kuala Lumpur, Malaysia.  \n \n* Author for correspondence, email heshrash@medic.ukm.my \n \n \nABSTRACT \n \nA survey was carried out to assess the level of knowledge and vaccination coverage \nof hepatitis A and B among 753 subjects (>12 years of age) from rural areas, town \nareas, undergraduates and healthcare workers. The main objective of the study was \nto assess the relationship between the extent of hepatitis A and B knowledge and \nvaccination status of the participants. A questionnaire was distributed and \ncompleted by the subjects. The results showed that the overall level of knowledge \namong the public was low compared to healthcare workers and undergraduates. \nThe hepatitis A vaccination coverage was very low among all the groups (<8%). The \nhepatitis B vaccination coverage was generally low among the groups of non-\nhealthcare workers (<35%) and higher among healthcare workers (65.6%). There \nwas a strong correlation between the extent of knowledge of hepatitis A and B and \nthe status of vaccination among the participants (p<0.01). The study concluded that \nhealth education on hepatitis A and B should be provided and vaccination \nprogrammes should be held more frequently among the public, especially in rural \nareas. \n \n\n\n\nKeywords: hepatitis, healthcare workers, knowledge, survey, vaccination \n \n \nINTRODUCTION \n \nHepatitis A and B continue to be a major health \nproblem in Malaysia and also worldwide. \nAlthough hepatitis B and A vaccines were \napproved in late 1981 (1) and in 1992 (2), \nrespectively, hepatitis A and B continue to be the \nmost frequently reported vaccine-preventable \ndiseases. Data from Ministry of Health Malaysia \n(2000) (3) indicated that the incidence of viral \nhepatitis was 1 326 cases with 13 fatalities in \n1991 and this was reduced to 686 cases with 7 \nfatalities in 1995. The average incidence rate \nfrom 1991 to 1995 was about 4.2 per 100,000 \npopulation.   As   most   of   the   infections   are  \n\n\n\n \n \nasymptomatic and subclinical, it is almost certain \nthat cases of hepatitis are under-reported. \nAccording to the Malaysian Liver Foundation \n(1999) (4), there are 2.4 million hepatitis B virus \n(HBV) carriers in Malaysia, and they will \ncontinue to be the source of HBV infection to the \nothers. \n \nBoth hepatitis A virus (HAV) and hepatitis B \nvirus (HBV) infections may result in a wide \nspectrum of clinical outcomes, ranging from \nsilent anicteric infection to subclinical disease \nand classical icteric hepatitis to fulminant hepatic \n\n\n\n\n\n\n\n\nResearch article: Awareness of hepatitis  \n\n\n\n 77\n\n\n\nfailure with coma and occasionally death (5). \nHepatitis A will not lead to long term \ncomplications, and most of the patients recover \nwithin two months from the onset of illness (6), \nhowever, acute liver failure due to severe \nhepatitis A is well documented and no specific \ndrug treatment is available (7). Exposure to \nHBV, particularly in early in life, may also result \nin an asymptomatic carrier state that can progress \nto chronic active hepatitis, cirrhosis of the liver \nand eventually hepatocellular carcinoma (8). As \nboth infections can spread from person to person, \nthe key control of HAV and HBV infections is \nimmunoprophylaxis. \n \nThis study was carried out to determine the level \nof knowledge and the vaccination coverage of \nboth hepatitis A and B in different groups of \npopulation, including the general public, \nhealthcare workers and undergraduates. The \nrelationship between the extent of hepatitis A \nand B knowledge and vaccination status of the \nparticipants was assessed. Hopefully this study \ncan provide the information relevant to the \ndevelopment of the vaccination strategies for \nboth hepatitis A and B and contribute to the \nelimination of hepatitis A and B in Malaysia. \n \nMETHOD \n \nStudy design  \n \nThe study was conducted from January to July \n2000 in Kuala Lumpur and Selangor. A cross-\nsectional survey was carried out to identify the \nlevel of knowledge of hepatitis A and B and the \nvaccination coverage among the population \nthrough questionnaires. \n \nStudy population \n \nThe study population consisted of subjects above \n12 years of age. The study population was made \nup from four groups: (I) residents from rural \nareas i.e. Kampung Nakhoda and  Sungai Tua \nBahru, Selayang, Selangor Darul Ehsan; (II) \nresidents from town areas who were mainly from \nSerdang, Sri Kembangan, Balakong, Cheras, \nKajang and Bangi; (III) healthcare workers from \nthe nephrology unit and blood bank, Hospital  \nKuala Lumpur; and (IV) undergraduates from \nFaculty of Dentistry and Faculty of Allied Health \nSciences, Universiti Kebangsaan Malaysia \n(UKM). Sampling was on voluntary basis. \n \n\n\n\nQuestionnaires \n \nQuestionnaires were presented in English and \nMalay. The survey was carried out in divided \nsessions. Participants were given a questionnaire \nand explanation was provided to assist them in \ncompleting the questionnaire. Participants who \nwere illiterate were interviewed with \nunderstandable language. The information \nobtained through the questionnaires included \nage, gender, race, occupation, education level, \nhousehold income, knowledge about hepatitis A \nand B, awareness of vaccination for hepatitis A \nand B, awareness of blood testing for hepatitis A \nand B virus, and family members\u2019 or subject\u2019s \nprevious diagnosis of hepatitis.  \n \nAfter completing the questionnaires, participants \nwere given brochures about hepatitis A and B. \nBrochures in different languages, including \nMalay, English, and Chinese were available. \nPosters about prevention of hepatitis A and B \nwere also exhibited. Participants were \nencouraged to seek vaccination for both hepatitis \nA and B. All the brochures and posters were \nprovided by SmithKline Beecham Sdn. Bhd \n(now known as GlaxoSmithKline Sdn. Bhd.). \n\n\n\n \nStatistical analysis \n \nData were analysed using Statistical Package for \nSocial Sciences (SPSS) version 9.05. Descriptive \nstatistics, including frequencies and percentages, \nwere calculated for each item on the \nquestionnaires; cases with missing data were \nexcluded. In addition, comparisons of the level \nof knowledge on the diseases and vaccination \nrate among four groups of subjects were made by \ndescriptive analysis. \n \nIn order to enable further assessment on the \nrelationship between the extent of knowledge \nand the vaccination status of hepatitis A and/or B \namong the participants, answers to \nquestionnaires were marked. One mark was \ngiven to each correct answer and the total mark \nwas 15. The subjects were classified into three \ngroups based on their overall knowledge about \nhepatitis A and B. The classification is as \nfollowing: \n\n\n\n \nDegree of knowledge Score of correct \n\n\n\nanswers \nLow \u2264 5 \nIntermediate 6-10 \nHigh \u2265 11 \n\n\n\n\n\n\n\n\nResearch article: Awareness of hepatitis  \n\n\n\n 78\n\n\n\nChi-squared test (testing of independence) was \nperformed to evaluate the correlation of the \nextent of knowledge and receiving hepatitis A \nand/or B vaccine(s) among the participants. The \ntwo parameters were considered not independent \nif the p value was less than 0.01. \n \nRESULTS \n \nA total of 753 subjects were enrolled in the \nsurvey from 4 study groups: (I) residents from \nrural areas i.e. Kampung Nakhoda and Sungai \nTua Bahru, Selayang, Selangor Darul Ehsan \n(n=165) with a mean age of 37.7\u00b112.1; (II) \nresidents from town areas (n=206), mainly from \nSerdang, Sri Kembangan, Balakong, Cheras, \nKajang and Bangi with a mean age of 24.8\u00b18.2; \n(III) healthcare workers (HCWs) (n=194) from \nthe nephrology unit (64.0%) and blood bank \n(36.0%) from Hospital Kuala Lumpur with a \nmean age of 32.3\u00b193.2 and mean working period \nof 98 months; and (IV) undergraduates (n=188) \nfrom the Faculty of Dentistry (24.5%) and \nFaculty of Allied Health Sciences (75.5%), \nUniversiti Kebangsaan Malaysia (UKM) with a \nmean age of 22.1\u00b11.9. \n \nGenerally, the mean age of the participants from \nrural areas and HCWs were higher than the \nparticipants from town areas and undergraduates. \nFemale participants outnumbered males. Most of  \n\n\n\nthe residents from the rural areas, HCWs and \nundergraduates were Malays (97.6%, 84.3% and \n73.5%, respectively). However, the percentage of \nMalay and Chinese participants from town areas \nwere almost equal, with 49.5% and 47.5%, \nrespectively.  \n \nMost of the participants from rural areas (59.4%) \nhad secondary education, however, most of the \nparticipants from town areas (67.8%) had tertiary \neducation. There was an almost equal percentage \nof HCWs with secondary education and tertiary \neducation. 41.5% and 40.4% of the participants \nfrom rural areas were from low and middle \nincome groups, respectively. For those from \ntown areas, 29.3%, 42.5%, and 28.2% were from \nlow, middle and high income groups, \nrespectively. Most of the HCWs were in the \nmiddle income group (69.1%), while most of the \nundergraduates were from the low (36.5%) and \nmiddle (37.7%) income groups. Demographic \ndetails of the subjects are shown in Table 1. \n \nKnowledge of hepatitis A and B \n \nA high proportion of undergraduates (85.0%) \nhad knowledge on hepatitis compared to the \npublic from town areas (63.6%) and rural areas \n(52.7%). Most of the public knew about the \ndiseases through the mass media; \nundergraduates, however, acquired knowledge of \nthe diseases through formal education. All \n\n\n\nTable 1: Demographic data of patients. \n \nGroups Public from \n\n\n\nrural areas (%) \nPublic from \n\n\n\ntown areas (%) \nHealth care \nworkers (%) \n\n\n\nUndergraduates \n(%) \n\n\n\nTotal subjects \n(%) \n\n\n\nNo. of subjects (n) 165 206 194 188 753 \nMean age (years) 37.67 24.75 32.29 22.06 28.87 \nGender \n   Male \n   Female \n\n\n\n \n63 (38.2) \n102 (61.8) \n\n\n\n \n84 (40.8) \n122 (59.2) \n\n\n\n \n33 (17.3) \n158 (82.7) \n\n\n\n \n45 (24.3) \n140 (75.7) \n\n\n\n \n225 (30.1) \n522 (69.9) \n\n\n\nRace \n   Malay \n   Chinese \n   Indian \n   Others \n\n\n\n \n161 (97.6) \n\n\n\n2 (1.2) \n1 (0.6) \n1 (0.6) \n\n\n\n \n102 (49.5) \n98 (47.5) \n\n\n\n3 (1.5) \n3 (1.5) \n\n\n\n \n161 (84.3) \n10 (5.2) \n18 (9.4) \n2 (1.1) \n\n\n\n \n136 (73.5) \n30 (16.2) \n12 (6.5) \n7 (3.8) \n\n\n\n \n560 (75.0) \n140 (18.7) \n34 (4.6) \n13 (1.7) \n\n\n\nEducation level \n   Primary school \n   Secondary school \n   College/University \n\n\n\n \n25 (15.6) \n95 (59.4) \n40 (25.0) \n\n\n\n \n8 (3.9) \n\n\n\n58 (28.3) \n139 (67.8) \n\n\n\n \n11 (6.1) \n81 (45.3) \n87 (48.6) \n\n\n\n\n\n\n\n188 (100) \n\n\n\n \n44 (6.0) \n\n\n\n235 (32.1) \n453 (61.9) \n\n\n\nFamily monthly income \n   <RM 1000 \n   RM 1000-2500 \n   RM 2500-4000 \n   >RM 4000 \n\n\n\n \n39 (41.5) \n38 (40.4) \n\n\n\n9 (9.6) \n8 (8.5) \n\n\n\n \n53 (29.3) \n77 (42.5) \n28 (15.5) \n23 (12.7) \n\n\n\n \n48 (27.0) \n123 (69.1) \n\n\n\n5 (2.8) \n2 (1.1) \n\n\n\n \n55 (36.5) \n57 (37.7) \n27 (17.9) \n12 (7.9) \n\n\n\n \n195 (32.3) \n295 (48.8) \n69 (11.4) \n45 (7.5) \n\n\n\nNote: The total number of respondents does not equal 753 due to missing values. \n The percentages are based on the number of subjects who responded to the items. \n\n\n\n \n\n\n\n\n\n\n\n\nResearch article: Awareness of hepatitis  \n\n\n\n 79\n\n\n\nTable 2: Knowledge about hepatitis (hep.) A and B among respondents. \n \n\n\n\nPublic Knowledge about hep. A or B \nRural areas \n\n\n\n(%) \nTown areas \n\n\n\n(%) \n\n\n\nHealthcare \nworkers (%) \n\n\n\nUndergraduates \n(%) \n\n\n\nTotal (%) \n\n\n\nKnow about hepatitis. \n   Yes \n       Through media \n       Education \n       Family \n       Friends \n       Healthcare workers \n   No \n   Not sure \n\n\n\n \n87 (52.7) \n\n\n\n66 (76.7) \n17 (20.0) \n10 (11.6) \n13 (15.1) \n10 (11.6) \n\n\n\n51 (30.9) \n27 (16.4) \n\n\n\n \n131 (63.6) \n\n\n\n78 (59.5) \n45 (34.4) \n18 (13.7) \n17 (13.0) \n\n\n\n   9 (6.9) \n20 (9.7) \n55 (26.7) \n\n\n\n \n- \n \n \n \n \n- \n- \n\n\n\n \n159 (85.0) \n\n\n\n   54 (34.0) \n     140 (88.1) \n\n\n\n10 (6.3) \n  21 (13.2) \n      5 (3.1) \n\n\n\n2 (1.1) \n26 (13.9) \n\n\n\n \n377 (63.4) \n\n\n\n\n\n\n\n55 (9.2) \n163 (27.4) \n\n\n\nKnowledge of organ affected \n   Liver \n   Heart \n   Kidneys \n   Brain \n   Not sure \n\n\n\n \n78 (50.3) \n27 (17.4) \n10 (6.5) \n3 (1.9) \n\n\n\n43 (27.7) \n\n\n\n \n143 (69.4) \n31 (15.0) \n23 (11.2) \n\n\n\n6 (2.9) \n20 (9.7) \n\n\n\n \n190 (99.0) \n\n\n\n1 (0.5) \n22 (11.5) \n2 (1.0) \n1 (0.5) \n\n\n\n \n186 (100.0) \n\n\n\n0 (0.0) \n0 (0.0) \n0 (0.0) \n0 (0.0) \n\n\n\n \n579 (78.3) \n59 (8.0) \n55 (7.4) \n11 (1.5) \n64 (8.7) \n\n\n\nKnowledge of spreading by virus \n   Yes \n   No \n   No sure \n\n\n\n \n81 (50.3) \n15 (9.3) \n65 (40.4) \n\n\n\n \n120 (58.5) \n19 (9.3) \n66 (32.2) \n\n\n\n \n176 (95.1) \n\n\n\n5 (2.7) \n4 (2.2) \n\n\n\n \n182 (96.8) \n\n\n\n0 (0.0) \n6 (3.2) \n\n\n\n \n559 (75.6) \n39 (5.3) \n\n\n\n141 (19.1) \nKnowledge of causing jaundice \n   Yes \n   No  \n   Not sure \n\n\n\n \n84 (52.2) \n14 (8.7) \n63 (39.1) \n\n\n\n \n107 (52.7) \n10 (4.9) \n86 (42.4) \n\n\n\n \n190 (99.0) \n\n\n\n2 (1.0) \n0 (0.0) \n\n\n\n \n164 (87.7) \n\n\n\n3 (1.6) \n20 (10.7) \n\n\n\n \n545 (73.4) \n29 (3.9) \n\n\n\n169 (22.7) \nKnowledge of transmission of hep. A through \nfood & water \n   Yes \n   No \n   Not sure  \n\n\n\n\n\n\n\n68 (42.5) \n22 (13.8) \n70 (43.7) \n\n\n\n\n\n\n\n100 (48.6) \n26 (12.6) \n80 (38.8) \n\n\n\n\n\n\n\n177 (91.8) \n8 (4.1) \n8 (4.1) \n\n\n\n\n\n\n\n147 (79.0) \n4 (2.2) \n\n\n\n35 (18.8) \n\n\n\n\n\n\n\n492 (60.2) \n60 (7.4) \n\n\n\n265 (32.4) \nKnowledge of mode of hep. B transmission \n   Blood \n   Saliva \n   Sexual \n   Mother to child \n   Casual contact \n   Not sure \n\n\n\n \n94 (60.6) \n34 (21.9) \n26 (16.8) \n42 (27.1) \n8 (5.2) \n\n\n\n38 (24.5) \n\n\n\n \n106 (51.7) \n60 (29.3) \n35 (17.1) \n63 (30.7) \n13 (6.3) \n20 (9.8) \n\n\n\n \n180 (93.8) \n80 (41.7) \n99 (51.6) \n\n\n\n106 (55.2) \n2 (1.0) \n1 (0.5) \n\n\n\n \n168 (89.8) \n87 (46.5) \n\n\n\n140 (72.9) \n112 (58.3) \n\n\n\n14 (7.3) \n0 (0.0) \n\n\n\n \n548 (74.2) \n261 (35.3) \n300 (40.6) \n323 (43.7) \n37 (5.0) \n59 (8.0) \n\n\n\nKnowledge of complications of hep. B \n   Liver damage \n   Liver cancer \n   Death \n   Heart disease \n   Kidney failure \n\n\n\n \n86 (55.1) \n44 (28.2) \n33 (21.2) \n22 (14.1) \n27 (17.3) \n\n\n\n \n114 (55.9) \n57 (28.9) \n62 (30.4) \n20 (9.8) \n23 (11.3) \n\n\n\n \n158 (82.7) \n112 (58.6) \n49 (25.7) \n4 (2.1) \n6 (3.1) \n\n\n\n \n172 (93.5) \n113 (61.4) \n96 (52.2) \n4 (2.2) \n8 (4.3) \n\n\n\n \n530 (72.1) \n326 (44.3) \n240 (32.7) \n50 (6.8) \n64 (8.7) \n\n\n\nKnowledge of treatment availability for hep. B \n   Yes  \n   No \n   Not sure \n\n\n\n \n82 (50.9) \n32 (19.9) \n47 (29.2) \n\n\n\n \n94 (46.1) \n51 (25.0) \n59 (28.9) \n\n\n\n \n105 (56.4) \n63 (33.9) \n18 (9.7) \n\n\n\n \n86 (51.5) \n63 (37.7) \n18 (10.8) \n\n\n\n \n367 (51.1) \n209 (29.1) \n142 (19.8) \n\n\n\nKnowledge of availability of hep. A vaccine \n   Yes  \n   No \n   Not sure \n\n\n\n \n91 (56.5) \n24 (14.9) \n46 (28.6) \n\n\n\n \n137 (66.5) \n14 (6.8) \n55 (26.7) \n\n\n\n \n107 (57.5) \n63 (33.9) \n16 (8.6) \n\n\n\n \n153 (81.8) \n\n\n\n4 (2.1) \n30 (16.1) \n\n\n\n \n488 (65.9) \n105 (14.2) \n147 (19.9) \n\n\n\nKnowledge of availability of hep. B vaccine \n   Yes  \n   No \n   Not sure \n\n\n\n \n91 (56.5) \n24 (14.9) \n46 (28.6) \n\n\n\n \n133 (64.6) \n17 (8.2) \n56 (27.2) \n\n\n\n \n183 (94.3) \n\n\n\n5 (2.6) \n6 (3.1) \n\n\n\n \n175 (93.1) \n\n\n\n1 (0.5) \n12 (6.4) \n\n\n\n \n582 (77.7) \n47 (6.3) \n\n\n\n120 (16.0) \nKnowledge of number of shots in a full course \nof hep. B vaccination \n   1X \n   2X \n   3X \n   4X \n   Not sure \n\n\n\n\n\n\n\n19 (13.4) \n27 (19.0) \n34 (23.9) \n3 (2.1) \n\n\n\n59 (41.6) \n\n\n\n\n\n\n\n19 (9.5) \n46 (22.9) \n111 (55.1) \n\n\n\n7 (3.5) \n18 (9.0) \n\n\n\n\n\n\n\n4 (2.2) \n8 (4.4) \n\n\n\n167 (91.3) \n3 (1.6) \n1 (0.5) \n\n\n\n\n\n\n\n9 (5.0) \n8 (4.4) \n\n\n\n155 (86.1) \n1 (0.6) \n7 (3.9) \n\n\n\n\n\n\n\n51 (7.2) \n89 (12.6) \n467 (66.2) \n14 (2.0) \n85 (12.0) \n\n\n\nNote: The total number of respondents does not equal 753 due to missing values. \n The percentages are based on the number of subjects responded to the items. \n\n\n\n\n\n\n\n\nResearch article: Awareness of hepatitis  \n\n\n\n 80\n\n\n\n the undergraduates and almost all the HCWs \nknew that hepatitis would affect the liver \ncompared to only 69.4% and 50.3% of the public \nfrom town areas and from rural areas, \nrespectively. A relatively high percentage of the \nundergraduates and HCWs knew that some types \nof hepatitis are caused by viruses and can cause \njaundice compared to only about 50% of the \npublic with that knowledge.  \n \nHCWs (91.8%) were superior in knowing that \nfood and water are the sources of transmission of \nhepatitis A, followed by undergraduates (79.0%), \nparticipants from town areas (48.6%), and those \nfrom rural areas (42.5%). Blood is generally \nmore acknowledged as a transmission mode of \nhepatitis B among the participants with 93.8% \nfor HCWs, 89.8% for undergraduates, 60.6% for \nthose from rural areas, and 51.7% for those from \ntown areas. Generally, half of the HCWs and \nundergraduates recognised that sexual, mother to \nchild and saliva as transmission modes of \nhepatitis B, compared to a relatively low \npercentage (<30%) of the public.  \n\n\n\n \nUndergraduates were superior to the other \ngroups in knowing liver damage (93.5%), liver \ncancer (61.4%) and death (52.2%) as the \ncomplications of hepatitis B, followed by HCWs \nwith 82.7%, 58.6% and 25.7, respectively; \nparticipants from town areas with 55.9%, 28.9% \nand 30.4%, respectively; and those from rural \nareas with 55.1%, 28.2% and 21.2%, \nrespectively.  31.4% and 21.1% of the public \nfrom rural areas and town areas, respectively, \nsaid that hepatitis B can cause complications of \nheart disease and renal failure, which is not \ncorrect. \n\n\n\n \nThe availability of hepatitis A and B vaccines \nwas generally well known among HCWs and \nundergraduates (81.7%), with the exception that \nonly 57.5% of HCWs knew about the availability \nof hepatitis A vaccine. About half of the \nparticipants from town and rural areas knew \nabout the availability of hepatitis A and B \nvaccines. Details of the knowledge about \nhepatitis A and B among the four different \ngroups are shown in Table 2. \n \nVaccination coverage of hepatitis A and B \n \nMajority of the participants were not vaccinated \nfor hepatitis A with only 7.8% of the participants \nfrom town areas, 3.6% of the participants from \nrural areas, 3.2% of the HCWs and none of the \n\n\n\nundergraduates was vaccinated for hepatitis A. \nFrom the total of those who received the \nvaccination, 100% of the HCWs had received the \nfull course of the vaccination. However, all the \nparticipants from rural areas and 31.2% of those \nfrom town areas, who had received the hepatitis \nA vaccination could not remember the number of \ndoses taken. \n \n65.6% of the HCWs were vaccinated against \nhepatitis B compared to a relatively low \npercentage of participants from town areas \n(31.6%), undergraduates (21.9%), and those \nfrom rural areas (13.9%). From those who had \nreceived the vaccination, 73.0% of HCWs, \n56.9% of those from town areas and 39.0% of \nundergraduates had fulfilled the 3- dose \nvaccination course. However, a relatively low \npercentage of them, ranging from 5% to 19.5%, \nhad received the vaccine in the last five years. \nMost of the HCWs were exposed to blood or \nbody fluids of patients everyday (>90%) and \nonly 6% of them were not exposed to blood or \nbody fluids of patients.  \n\n\n\n \nInvestigation on the previous diagnosis of \nhepatitis of the subjects or their household \nmembers showed that the average prevalence of \nhepatitis infection for subjects or their household \nmembers was 6.6% with the highest prevalence \namong participants from rural areas (9.3%), \nfollowed by participants from town areas (8.3%), \nundergraduates (8.0%), and HCWs (1.0%). \nHepatitis B was the major type of infection.  \n\n\n\n \nA relatively small proportion of participants \nfrom rural areas (17.2%), participants from town \nareas (25.7%), and undergraduates (19.8%) have \nhad a blood test conducted before, compared to \nHCWs (67.7%). Again, hepatitis B was the more \ncommon disease tested for. Details of the results \nare shown in Table 3. \n \nAssociation between the extent of knowledge \nand the vaccination status among the study \npopulation \n \nFigures 1 and 2 depict the level of knowledge \nand vaccination status for hepatitis A and/or B \namong the subjects of different groups, \nrespectively. Figure 3 shows the association \nbetween the level of knowledge and vaccination \nstatus. There was a strong association between \nthe level of knowledge and vaccination status \namong the study population. For those with a \nlow level of knowledge, only a small proportion \n\n\n\n\n\n\n\n\nResearch article: Awareness of hepatitis  \n\n\n\n 81\n\n\n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \nof them (17.0%) had been vaccinated against \nhepatitis A and/or B. In contrast, a higher \nproportion of those with intermediate or high \nlevel of knowledge had been vaccinated, i.e. \n41.8% and 42.5%, respectively. In conclusion, the \nlevel of knowledge and vaccination status were \nsignificantly dependent in this study  (p<0.01). \n \nDISCUSSION \n \nThe overall level of knowledge about hepatitis A \nand B was generally poor among the general \npublic. In comparison, HCWs and undergraduates \nhad far better knowledge about hepatitis A and B \n(Table 2) as they had a higher level of education \nand were more exposed to health information. \nParticipants from town areas had slightly better \nlevel of knowledge about hepatitis A and B than \nthose  from rural areas  which could be  attributed \n\n\n\n  \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \nto the fact that a higher number of them had \ntertiary education compared to participants from  \nrural areas (Table 1). This agreed with the \nfindings of the study of Wiecha (9) and Taylor et \nal. (10) that there is a significant association \nbetween the level of knowledge about hepatitis B \nand the education level. \n \nBoth of the groups from rural and town areas \nwere poor in recognising the modes of \ntransmission of both hepatitis A and B. \nAwareness of the transmission modes is \nimportant, so that effective preventive measures \ncould be taken such as modification of lifestyles \nand vaccination against hepatitis A and B. \n\n\n\n \nIn East and Southeast Asian countries, 30 to 50% \nof all chronic infections among children result \nfrom  perinatal  transmission  and  9 500  infants \n\n\n\nTable 3: Vaccination of hepatitis A & B coverage among respondents. \n \n\n\n\nPublic  \nRural areas \n\n\n\n(%) \nTown areas \n\n\n\n(%) \n\n\n\nHealthcare \nworkers (%) \n\n\n\nUndergraduates \n(%) \n\n\n\nTotal (%) \n\n\n\nEver received hepatitis A vaccine \n   Yes \n     Dose: 1X \n               2X \n               cannot remember \n   No \n   Not sure \n\n\n\n \n6 (3.6) \n\n\n\n0 (0.0) \n0 (0.0) \n\n\n\n   6 (100.0) \n139 (84.3) \n20 (12.1) \n\n\n\n \n16 (7.8) \n\n\n\n4 (25.0) \n7 (43.8) \n5 (31.2) \n\n\n\n134 (65.0) \n56 (27.2) \n\n\n\n \n6 (3.2) \n\n\n\n0 (0.0) \n    6 (100.0) \n\n\n\n0 (0.0) \n157 (83.5) \n25 (13.3) \n\n\n\n \n0 (0.0) \n \n \n \n148 (79.1) \n39 (20.9) \n\n\n\n \n28 (3.7) \n\n\n\n4 (14.3) \n13 (46.4) \n11 (39.3) \n\n\n\n578 (77.5) \n140 (18.8) \n\n\n\nEver received hepatitis B vaccine \n   Yes \n     Dose: 1X \n             2X \n             3X \n             cannot remember \n \n     Time: <5 years ago \n                5-10 years ago \n                >10 years ago \n               cannot remember \n   No \n   Not sure \n\n\n\n \n23 (13.9) \n\n\n\n    2 (10.0) \n0 (0.0) \n0 (0.0) \n\n\n\n   18 (90.0) \n \n\n\n\n1 (5.0) \n0 (0.0) \n1 (5.0) \n\n\n\n18 (90.0) \n124 (75.2) \n18 (10.9) \n\n\n\n \n65 (31.6) \n\n\n\n9 (13.9) \n10 (15.4) \n37 (56.9) \n9 (13.8) \n\n\n\n \n8 (12.3) \n\n\n\n12 (18.5) \n3 (4.6) \n\n\n\n42 (64.6) \n87 (42.2) \n54 (26.2) \n\n\n\n \n126 (65.6) \n\n\n\n11 (8.7) \n18 (14.3) \n92 (73.0) \n\n\n\n5 (4.0) \n \n\n\n\n24 (19.0) \n21 (16.7) \n\n\n\n8 (6.3) \n73 (57.9) \n\n\n\n55 (28.7) \n11 (5.7) \n\n\n\n \n41 (21.9) \n\n\n\n3 (7.3) \n1 (2.5) \n\n\n\n16 (39.0) \n21 (51.2) \n\n\n\n \n8 (19.5) \n\n\n\n12 (29.3) \n8 (19.5) \n\n\n\n13 (31.7) \n117 (62.6) \n29 (15.5) \n\n\n\n \n255 (34.0) \n\n\n\n25 (9.9) \n29 (11.5) \n\n\n\n145 (57.5) \n53 (21.1) \n\n\n\n \n41 (16.3) \n45 (17.9) \n20 (7.9) \n\n\n\n146 (57.9) \n383 (51.1) \n112 (14.9) \n\n\n\nHousehold member or subject \never had hepatitis  \n   Yes \n      hepatitis A \n      hepatitis B \n      hepatitis C \n   No \n   Not sure \n\n\n\n \n \n15 (9.3) \n\n\n\n0 (0.0) \n15 (100.0) \n\n\n\n0 (0.0) \n146 (90.1) \n1 (0.6) \n\n\n\n \n \n17 (8.3) \n\n\n\n3 (17.6) \n13 (76.5) \n\n\n\n           1 (5.9) \n184 (89.3) \n5 (2.4) \n\n\n\n \n \n2 (1.0) \n\n\n\n             0 (0.0) \n          2 (100.0) \n\n\n\n            0 (0.0) \n188 (98.0) \n2 (1.0) \n\n\n\n \n \n15 (8.0) \n\n\n\n           2 (13.3) \n           13 (86.7) \n\n\n\n        0 (0.0) \n162 (86.6) \n10 (5.4) \n\n\n\n\n\n\n\n49 (6.6) \n \n \n \n\n\n\n680 (91.0) \n18 (2.4) \n\n\n\nEver had blood test for hepatitis  \n   Yes  \n      hepatitis A \n      hepatitis B \n      cannot remember \n   No \n   Not sure \n\n\n\n \n28 (17.2) \n\n\n\n0 (0.0) \n27 (96.4) \n\n\n\n1 (3.6) \n135 (82.8) \n0 (0.0) \n\n\n\n \n49 (25.7) \n\n\n\n   9 (18.4) \n45 (91.8) \n\n\n\n0 (0.0) \n137 (71.7) \n5 (2.6) \n\n\n\n \n86 (67.7) \n\n\n\n23 (26.7) \n77 (89.5) \n\n\n\n0 (0.0) \n37 (29.1) \n4 (3.2) \n\n\n\n \n35 (19.8) \n\n\n\n2 (5.7) \n34 (97.1) \n\n\n\n1(2.9) \n136 (76.8) \n6 (3.4) \n\n\n\n \n198 (30.1) \n\n\n\n\n\n\n\n445 (67.6) \n15 (2.3) \n\n\n\nNote: The total number of respondents does not equal 753 due to missing values. \n The percentages are based on the number of subjects who  responded to the items. \n\n\n\n\n\n\n\n\nResearch article: Awareness of hepatitis  \n\n\n\n 82\n\n\n\n\n\n\n\nFigure 1. Level of knowledge among the different subject groups. \n\n\n\n73 60\n26\n\n\n\n68\n106\n\n\n\n32\n3\n\n\n\n82\n109\n\n\n\n6\n54\n\n\n\n128\n150\n\n\n\n302 295\n\n\n\n0\n50\n\n\n\n100\n150\n200\n250\n300\n350\n\n\n\nlow intermediate high\n\n\n\nLevel of knowledge\n\n\n\nN\nu\n\n\n\nm\nb\n\n\n\ner\n o\n\n\n\nf \nsu\n\n\n\nb\nje\n\n\n\nct\ns\n\n\n\nResidents from rural areas\n\n\n\nResidents from town areas\n\n\n\nHealthcare workers\n\n\n\nUndergraduates\n\n\n\nTotal\n\n\n\n\n\n\n\n27\n\n\n\n120\n\n\n\n17\n\n\n\n73 78\n46\n\n\n\n125\n\n\n\n55\n7\n\n\n\n41\n\n\n\n106\n\n\n\n24\n\n\n\n266\n\n\n\n359\n\n\n\n94\n\n\n\n0\n50\n\n\n\n100\n150\n200\n250\n300\n350\n400\n\n\n\nYes No Not sure\n\n\n\nVaccination status\n\n\n\nN\nu\n\n\n\nm\nb\n\n\n\ner\n o\n\n\n\nf \nsu\n\n\n\nb\nje\n\n\n\nct\ns Residents from rural areas\n\n\n\nResidents from town areas\n\n\n\nHealthcare workers\n\n\n\nUndergraduates\n\n\n\nTotal\n\n\n\n\n\n\n\nFigure 2. Hepatitis A and/or B vaccination coverage among subjects in different groups. \n\n\n\nFigure 3: Association of the extent of knowledge with hepatitis A and/or B vaccination \nstatus (n=719, p< 0.01) \n \n\n\n\n17.0 15.4\n\n\n\n63.3\n\n\n\n19.7\n\n\n\n42.841.8\n\n\n\n50.4\n\n\n\n7.1\n\n\n\n42.5\n\n\n\n0\n10\n20\n30\n40\n50\n60\n70\n\n\n\nYes No Not sure\n\n\n\nVaccination Status\n\n\n\nS\nu\n\n\n\nb\nje\n\n\n\nct\ns \n\n\n\n(%\n)\n\n\n\nlow\n\n\n\nintermediate\n\n\n\nhigh\n\n\n\nLevel of \nknowledge\n\n\n\n \n\n\n\n\n\n\n\n\nResearch article: Awareness of hepatitis  \n\n\n\n 83\n\n\n\n would become infected if prophylaxis is not \nprovided (11). Understanding the possibility of \nHBV transmission from mothers to babies would \nenable women to be more aware about the \nimportance of hepatitis B surface antigen \n(HBsAg) screening, so that prophylactic measures \ncould be taken to protect the babies from HBV \ninfection. \n\n\n\n \nWith the successful implementation of the \nnational childhood immunisation programme \nagainst hepatitis B in Malaysia, sexual \ntransmission would inevitably emerge as the \nleading cause of HBV infection among healthy \nsusceptible adolescents and adults as in the West. \nSo, the public should be aware that their sexual \nbehaviour could lead to HBV infection.  \n \nAwareness of the complications of hepatitis B is \nalso important, so that people would realise about \nthe importance of taking preventive measures, \nespecially vaccination against the disease. \nUnfortunately, most of the public did not know \nthat hepatitis B can lead to severe complications \nof liver cancer and death (Table 2).  \n \nMalaysia had incorporated hepatitis B vaccination \ninto the national immunisation programme since \n1989. According to Ministry of Health Malaysia \n(12), the vaccination coverage among babies is \n98.3% for first dose, 91.6% for second dose and \n89.6% for third dose. However, there is no data \navailable about the rate of hepatitis A or B \nvaccination among adults in Malaysia. According \nto the results in this study, the overall vaccination \ncoverage was very low for hepatitis A (3.7%) and \nlow for hepatitis B (34.0%). Only about 2% of the \ntotal study population received both hepatitis A \nand B vaccines (not shown in results). The results \nalso implicated that most of the subjects who had \nbeen vaccinated, did not complete the course of \nvaccination and also did not follow-up on their \nimmunisation status. Preventive strategies against \nthe diseases, especially vaccination programmes, \nshould be developed and taken aggressively to \nimprove the vaccination coverage among the \nadults. \n\n\n\n \nA study by Chen et al. (13) and Hsu et al. (14) \nshowed that after a nationwide mass vaccination \nprogramme was launched in Taiwan in July 1984, \nthe HBsAg prevalence decreased markedly from \nthe year 1984 to 1994. Chang et al. (15) reported \nthat after the implementation of nationwide \nhepatitis B immunisation programmes, the annual \nincidence of hepatocellular carcinoma in children \n\n\n\nhad declined. So, immunisation programmes have \nproven effective not only in controlling hepatitis \nB infection, but also in controlling hepatocellular \ncarcinoma in Taiwan.  \n\n\n\n \nA low vaccination rate among participants from \nrural areas was probably due to the low level of \nknowledge about the diseases and the availability \nof the vaccines. Compared to those from rural \nareas, vaccination coverage of participants from \ntown areas was slightly better probably as they \nhad a higher level of knowledge about hepatitis A \nand B.  However, undergraduates, who had a high \nlevel of knowledge, had a very low vaccination \ncoverage for both hepatitis A (none) and hepatitis \nB (21.9%) (Table 3). This might be due to their \ndependence on parents or study loans for financial \nassistance.  \n\n\n\n \nHCWs are always at the risk of HBV infection \nbecause of the occupational exposure to blood \nborne pathogens (16). Risk increases with \npercutaneous exposures involving deeper \npenetration, larger volume of blood, high viral \ntitres and repeated or prolonged exposures (16-\n18). It is noteworthy to mention that in this study \nmost of the HCWs (over 90%) were exposed to \nblood and other body fluids of patients everyday, \nhowever, only about two thirds of them received \nthe hepatitis B vaccine and only 73% of them \ncompleted the 3-dose course. \n\n\n\n \nOnly six of the total number of HCWs in this \nstudy received the hepatitis A vaccine (Table 3). \nThis might be due to the fact that HAV is not a \nblood-borne pathogen and that the disease is \nusually self-limiting and non-fatal. So, there is \nless emphasis on the risk of hepatitis A among the \nHCWs and this was proven by a lower percentage \nof HCWs (57.5%) knowing about the availability \nof the hepatitis A vaccine compared to the \nhepatitis B vaccine (94.3%) (Table 2). Although \nHAV generally will not be transmitted through \nblood or blood products, however, prevention of \nhepatitis A is potentially important among HCWs \nand particular care should be required when \nnursing patients with diarrhoea (19). \n\n\n\n \nConsidering the long-term consequences of HBV \ninfection, the health of the HCWs is at risk. The \nhealth of the general population is also at risk \nconsidering the transmission risk of the virus to \nthe patients treated by the infected HCWs. In \n1991, the Centers For Disease Control And \nPrevention (CDC) estimated that during the past \n20 years more than 300 patients in the USA had \n\n\n\n\n\n\n\n\nResearch article: Awareness of hepatitis  \n\n\n\n 84\n\n\n\nbeen infected with HBV \u2018in association with \ntreatment\u2019 by infected HCWs (20).  \n\n\n\n \nOver 80% of 84 nurses and 26 physicians from \nfive St. Louis-area hospitals agreed that every \nhospital employee should get the hepatitis B \nvaccine (17). Mahoney et al. (21) showed that the \nnumber of infections among HCWs declined from \n17 000 in 1983 to 400 in 1995 after the \nimplementation of hepatitis B vaccination and \nbarrier precautions for blood exposure. So, all \nHCWs should be vaccinated against hepatitis B. \n \nThis study revealed a strong correlation between \nthe extent of knowledge and vaccination status of \nhepatitis A and/or B among the participants \n(p<0.01) (Figure 3). Similar studies by \nAdebamowo & Ajuwan (22) and Kamolraranakul \net al. (23) showed that the overall level of \nknowledge about HBV infection was deemed \npoor and lack of knowledge on HBV infection \nwas one of the reasons that leads to non-\nimmunisation.  \n \nLimitations  \n \nThere are some limitations to the findings in this \nstudy. Firstly, the study only involved certain \ngroups of the population from particular \nresidential areas or working places, so the results \nmay not represent the general population in \nMalaysia. Secondly, by using the convenience \nsampling based on voluntary basis, the proportion \nof races, gender, age, numbers of subjects were \nnot the same in each group, thus potentially \nintroducing bias into the analysis. Thirdly, all data \nwere self-reported and the validity of the \nresponses were not evaluated. Fourthly, the \nhistory of vaccination and blood tests was based \non the ability to recall and this might introduce  \ninaccuracy in recording of the data. Fifth, the \ninclusion  of  13-16  year old  subjects could have  \n\n\n\ncaused a problem of irreliability of information. \nLastly, people with a low literacy level may have \nhad difficulty with comprehension and tended not \nto answer the questions, especially those \nregarding knowledge of the disease.  \n \nCONCLUSION \n \nGenerally the degree of knowledge about hepatitis \nA and B among the public was low. \nUndergraduates and HCWs had a high degree of \nknowledge about hepatitis A and B. The overall \nvaccination coverage for hepatitis A and B was \npoor and the vaccination rate for hepatitis B was \nhigher than hepatitis A. Not all the HCWs were \nvaccinated against hepatitis B as they were \nsupposed to be. Most of them who received the \nhepatitis B vaccine did not follow up on their \nimmunisation status. Quite a number of the public \ndid not know their immunisation status. The \nextent of knowledge is a crucial factor in \ndetermining the vaccination status of the \nparticipants (p<0.01). \n \nThe results of this study showed that more \nattention should be addressed at providing health \neducation on hepatitis A and B to the public, \nparticularly those in the rural areas. Large scale \nnationwide awareness programmes, campaigns, \nand vaccination programmes should be carried \nout frequently in various states, especially in rural \nareas. More specific educational efforts should \nstart before launching vaccination programmes in \norder to increase acceptance. As most of the \npublic got to know about hepatitis through the \nmass media, information about the disease and its \npreventive measures can be broadcasted to the \npublic through television, radio, newspapers and \nmagazines. HCWs and undergraduates should be \nroutinely immunised before starting work in \nhealth institutes, especially in hospitals. \n \n\n\n\n\n\n\n\n***** \n \nREFERENCES \n \n1. Margolis, HS. Testimony of Harold S. Margolis \n\n\n\nMay 18, 1999. \nhttp://www.cdc.gov/ncidod/disease/hepatitis/marg\nolis.htm. (18 Nov. 1999). \n\n\n\n2. Advisory Committee on Immunization Practices \n(ACIP). Prevention of hepatitis A through active \nor passive immunization: Recommendations of the \nACIP. 1999; 1-37. \n\n\n\n \n \n3. Kementerian Kesihatan Malaysia.  Kawalan \n\n\n\nPenyakit Kesihatan. 2000; 37-38. \n4. Malaysian Liver Foundation.  Useful information: \n\n\n\nhepatitis B. 1999. http://www.liver.org.my/ (18 \nNov. 1999). \n\n\n\n5. Galasso GJ, Whitley RJ, Merigan TC. Antiviral \nagents and human viral diseases. 4th ed. U.S.: \nLippincott-Raven; 1997. \n\n\n\n\n\n\n\n\nResearch article: Awareness of hepatitis  \n\n\n\n 85\n\n\n\n6. Tong, MJ, EI-Farra NS, Grew MI. Clinical \nmanifestations of hepatitis A: recent experience in \na community teaching hospital. J Infect Dis 1995; \n171 (Suppl 1): S15-18. \n\n\n\n7. Shah U, Habib Z. Liver failure attributable to \nhepatitis A virus infection in a developing country. \nPediatrics 1999; 105:436-438. \n\n\n\n8. Moradpour D, Wands JR.  Understanding hepatitis \nB virus infection. N Engl J Med 1995; 332: 1092-\n1093. \n\n\n\n9. Wiecha, JM. Differences in knowledge of hepatitis \nB among Vietnamese, African-American, \nHispanic and White adolescents in Worcester, \nMassachusetts. Pediatrics 1999; 104: 1212-1216. \n\n\n\n10. Taylor VM, Jackson JC, Pineda M, Pham P, \nFischer M, Yasui Y.  Hepatitis B knowledge \namong Vietnamese immigrants: implications for \nprevention of hepatocellular carcinoma. J Cancer \nEduc 2000; 15:51-55. \n\n\n\n11. Plotkin SA, Orenstein WA. Vaccines. 3rd ed.  U.S.: \nW.B. Saunders Company; 1999. \n\n\n\n12. Kementerian Kesihatan Malaysia. Laporan \nTahunan. 1994; 47-49. \n\n\n\n13. Chen H, Chang M, Ni Y, Hsu H, Lee P, Lee C, \nChen D.  Seroepidemiology of hepatitis B virus \ninfection in children: ten years mass vaccination in \nTaiwan. JAMA 1996; 276: 906-908. \n\n\n\n14. Hsu H, Lu C, Lee S, Lin S, Chen D.  \nSeroepidemiolgic survey for hepatitis B virus \ninfection in Taiwan: the effect of hepatitis mass \nimmunization. J Infect Dis 1999; 179: 367-370. \n\n\n\n15. Chang M, Chen C, Lai M, Hsu H, Wu T, Kong, \nM, Liang D, Shau W, Chen, D. Universal hepatitis \nB vaccination in Taiwan and the incidence of \nhepatocellular carcinoma in children. N Engl J  \n\n\n\n Med. 1997; 336: 1855-1859.  \n16. Belo AC. Distribution of hepatitis B virus markers \n\n\n\namong surgical specialties in Lagos, Nigeria. \nTrans R Soc Trop Med Hyg  2000; 94: 53-54. \n\n\n\n17. Jeffe DB, Mutah S, L\u2019Ecuyer PB, Kim LE, Singal \nRB, Evanoff BA, Fraser VJ. Healthcare worker\u2019s \nattitudes and compliance with universal \nprecautions: gender, occupation, and specialty \ndifferences. Infect Control Hosp Epidemiol 1997; \n18: 710-712. \n\n\n\n18. Fry DE. Hepatitis: risks for the surgeon. Am \nSurgeon 2000; 66: 178-183. \n\n\n\n19. Smith S, Weber S, Wiblin T, Nettleman M. Cost-\neffectiveness of hepatitis A vaccination in \nhealthcare workers. Infect Control Hosp Epidemiol \n1997; 18: 688-691. \n\n\n\n20. Ristinen E, Mamtani R. Ethics of transmission of \nhepatitis B virus by health-care workers. The \nLancet 1998; 352: 1381-1383.  \n\n\n\n21. Mahoney FJ, Stewart K, Hu H, Coleman P, Alter \nM. Progress toward the elimination of hepatitis B \nvirus transmission among health care workers in \nthe United States. Arch Intern Med. 1997; 157: \n2601-2605. \n\n\n\n22. Adebamowo CA, Ajuwan A. The immunization \nstatus and level of knowledge about hepatitis B \nvirus infection among Nigerian surgeons. West Afr \nJ Med 1997; 16:93-96. \n\n\n\n23. Kamolraranakul P, Ungtavorn P, Israsena S & \nSakulramrung R. The influence of dissemination \nof information on the changes of knowledge, \nattitude and acceptance of hepatitis B vaccination \namong hospital personnel in Chulalongkorn. \nPublic Health 1994; 108:49-53. \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy 2003;1(3):86-90  Research article \n\n\n\n 86\n\n\n\nOutpatient Prescription Intervention \nActivities by Pharmacists in a Teaching \nHospital \n \nChua Siew Siang1*, Kuan Mun Ni1, Mohamed Noor bin Ramli2 \n \n\n\n\n1Department of Pharmacy, Faculty of Medicine, University of Malaya, 50602 Kuala Lumpur \n2Outpatient Polyclinic Pharmacy Unit, Universiti Malaya Medical Centre, 59100 Kuala Lumpur  \nMalaysia \n \n*Author for correspondence  \n \nABSTRACT \n \nPrescriptions with prescribing errors received by an outpatient pharmacy of a \nteaching hospital were sampled. The types of pharmacist interventions on \nproblematic prescriptions and its outcome were identified and documented. From a \ntotal of 6340 prescriptions processed by the outpatient pharmacy in a one-week \nperiod, 43 prescriptions (0.68%) required interventions by the pharmacy staff. \nThese included 54% of the prescriptions that were incomplete or inadequately \nwritten  (errors of omission) and 46% that contained the wrong drug, dose regimen, \nstrength and dosage form (errors of commission). A total of 62 types of action were \ntaken by the pharmacy staff to resolve the 43 problematic prescriptions. These \ninclude contacting the prescribers concerned (24.2%), clarifying with the patient or \nhis/her representative (19.4%), contacting the prescriber\u2019s nurse (17.7%) and \nchecking the patient\u2019s appointment or identity card (4.8%).  Of the 43 problematic \nprescriptions, 48.8% were clarified without any change and dispensed while 32.6% \nwere changed and dispensed. The study reinforces the importance of prescription \nscreening and interventions by pharmacists in minimising preventable adverse \nevents attributed to medication errors. It also emphasizes the necessity of \ninterdisciplinary communication and cooperation in identifying and resolving \nprescribing errors and irregularities in order to achieve optimal therapeutic \noutcomes for the patient. \n \nKeywords: prescription, pharmacist, intervention, errors of omission, errors of \ncommission \n \n \n \nINTRODUCTION \n \nThe dispensing \u201cchain\u201d may be conceptualised \nas a sequence of interrelated, interdependent, and \nat least historically, interdisciplinary activities \nthat result in the delivery of the prescription drug \nand appropriate drug-use information to the \npatient (1). \n\n\n\n \n \nA study showed that 99% of the 137 general \npractitioners surveyed agreed that pharmacists \nhave a role to play in the screening of \nprescriptions for possible problems (2). Most \npharmacists would probably agree that the \nscreening of prescriptions is one of the \n\n\n\n\n\n\n\n\nResearch article: Outpatient prescription intervention activities by pharmacists \n\n\n\n 87\n\n\n\nprofessional responsibilities assumed by every \npharmacist but the degree to which prescription \nscreening is performed varies greatly among \ndifferent drug-delivery systems and even among \ndifferent pharmacists\u2019 practices. Thus, \nprescription screening represents a legitimate \nvalue-added pharmaceutical service in practice, \nif not in principle (3).  \n \nMany studies had identified and documented \nproblems associated with prescribing errors. The \nextent of such errors varied from 2.6% to 15.4% \nor estimated as 2.87 to 4.9 per 1000 medication \norders (1, 4-11).  An audit on community \npharmacies found that 2.6% of the prescriptions \nrequired active pharmacist intervention to \nresolve a prescribing error (1). Another study \nconducted in outpatient pharmacies found that \napproximately 4 per 100 dispensed prescriptions \nhad problems and required pharmacists \nintervention (5). In 44% of the intervention, the \noutcome was a change in drug, strength or \ndirections of drug use (5).    \n \nMost prescription interventions by pharmacists \nhave a limited potential for medical harm \nalthough it may be inappropriate in some \ninstances as mentioned by Hawkey and \ncolleagues (7). However, it should be noted that \na small number of detected prescribing errors \nhave a major potential for medical harm if not \ncorrected and hence, the importance of \npharmacist interventions is not overemphasized. \nThe ultimate goal for combining the unique \nknowledge and competencies of both medical \nand pharmaceutical professionals is to achieve \noptimal therapeutic outcomes and quality of life \nfor the patient. Therefore, both professions have \na definite role to play and should work hand-in-\nhand towards achieving this common goal.  \n \nAlthough most pharmacists in Malaysia are \ninvolved in prescription screening and \ninterventions to varying degree, documentation \nof such activities appeared scarce in the \nliterature. Therefore, the present study was \nconducted to identify and document the types of \npharmacist intervention and its outcome on \nproblematic prescriptions.   \n \nMETHOD \n \nThis study was conducted over a one-week \nperiod in May 1998 in the Outpatient Pharmacy \nDepartment (OPPD) of a large teaching hospital \nin Malaysia. This OPPD received an average of \n\n\n\n1057 prescriptions per day during the study \nperiod and was run by one registered pharmacist, \n3 trainee pharmacists and 8 pharmacy assistants.  \n \nThe study sampled problematic prescriptions \nreceived by the OPPD within the one-week \nperiod (excluding the Sunday). Senior pharmacy \nassistants act as the front line for the screening of \nprescriptions received by this OPPD. Any \nproblematic prescriptions would be referred to \nthe trainee pharmacist or the pharmacist.  The \nresearcher would then record the type of \nintervention made by the pharmacy staff and its \noutcome prospectively. A standard format \nrecommended by Rupp (3) was used to record all \nthe data. Reasons for pharmacist intervention \nwere classified according to the types of \nprescribing errors used by Rupp (3), that is errors \nof omission and errors of commission.   \n \nRESULTS \n \nOf the 6340 prescriptions received by the OPPD \nduring the one-week sampling period (excluding \nthe Sunday), 43 required intervention by the \npharmacy staff. This gives an overall \nintervention rate of 0.68% and an average of 7.2 \nprescriptions intervened per day.  \n\n\n\n \nA total of 50 different errors were identified in \nthe 43 prescriptions with an average of 1.2 errors \nper prescription. Most of the prescriptions had \none error (37 prescriptions) while another 5 had \n2 errors and 1 prescription had 3 errors. These \nerrors are classified as in Table 1 with examples \nfor each type of errors. Violation of legal or \nprocedural requirements such as absence of the \nprescriber\u2019s name or signature, registration \nnumber for psychotropic agents and patient \nparticulars are also included. The prescription \nintervened in the category of drug therapy \nmonitoring was due to a possibility of \nhypokalaemia from the use of LasixR without the \nconcurrent use of Slow KR.   \n\n\n\n \nA total of 62 types of action were taken by the \npharmacy staff to resolve the 43 problematic \nprescriptions, giving an average of 1.4 actions \nper problematic prescription. These include \ncontacting the prescribers concerned (24.2%), \nclarifying with the patient or his/her \nrepresentative (19.4%), contacting the \nprescriber\u2019s nurse (17.7%) and checking the \npatient\u2019s appointment or identity card (4.8%).  \n \nOf the 43 problematic prescriptions, 48.8% were \n\n\n\n\n\n\n\n\nResearch article: Outpatient prescription intervention activities by pharmacists \n\n\n\n 88\n\n\n\nTable 1:  Classification of reasons for pharmacist intervention. \n \n\n\n\nReasons for pharmacist \nintervention  \n\n\n\nFrequency \n(%, n=50)  \n\n\n\nExamples \n\n\n\nErrors of omission   \nQuantity to supply not specified   9 (18) T. Pantoprazole 40mg bd \n\n\n\nT. Daonil 5mg bd \nT. Imipramine 25mg on \nMorphine Mixture 10mg tds \n \n\n\n\nDose / regimen not specified   5 (10) Glibenclamide od x 12/52 \n\u2018O\u2019 Cephalexin 250mg x 1/12 \n \n\n\n\nForm / strength not specified   4 (8) Dipyridamole 1 tab od x 16/52 \nHumulin 10 IU tds x 1/52  \nZocor  1 daily x 3 mths \n \n\n\n\nNo signature or name of \nprescriber \n\n\n\n  2 (4)  \n\n\n\nNo registration number   1 (2)  \nNo patient\u2019s name   1 (2)    \nIllegible   5 (10) Patient\u2019s name \n\n\n\nCaptopril 0.25 daily x 2/52 \nSy. Prednisolone 25mg tds \nHCT (hydrocortisone or \nhydrochlorothiazide) \n \n\n\n\n      Subtotal 27 (54)  \n\n\n\nErrors of commission   \nWrong dose / regimen 12 (24) Famotidine 200mg \n\n\n\nDiamicron 1 gm tds \nMetformin 80mg bd \nThyroxine 200mcg bd \nLisinopril 10mg tds \nNuelin 5mg on \nBactrim 250mg bd x 1/52. \nPrednisolone 60mg/m2 \n130mg x 28 days \n \n\n\n\nRequired strength not available   5 (10) Prothiaden 100mg nocte x 16/52 (only \n75mg available) \n \n\n\n\nWrong drug / indication   1 (2) Magnesium sulphate (should be \nmagnesium trisilicate) \n \n\n\n\nWrong dosage form   2 (4) Humulin R 8IU tds x 8/52 (should be \npenfill) \n \n\n\n\nDose did not correlate with \nquantity \n\n\n\n  1 (2) Methotrexate 25mg ( 1 tab) should be \n10 tablets \n \n\n\n\nRequired brand not available   1 (2) Sy. Vermox 5ml stat \n \n\n\n\nPossible side effects / toxicity   1 (2) Lasix given without Slow KR \n \n\n\n\n     Subtotal 23 (46)  \n\n\n\nTotal  50 (100)  \n \n\n\n\n\n\n\n\n\nResearch article: Outpatient prescription intervention activities by pharmacists \n\n\n\n 89\n\n\n\nclarified without any change and dispensed while \n32.6% were changed and dispensed. Three \nprescriptions were dispensed as written and this \nincluded the prescription where addition of Slow \nKR was suggested for the patient on LasixR. The \nother two prescriptions involved methotrexate 5 \nmg daily and a prescription with three different \ntypes of syrups for a baby. Two patients were \nsent back to the clinics concerned with their \nproblematic prescriptions but did not return \nwhile the prescribers for another two \nprescriptions could not be contacted. One \nprescription was not dispensed as the strength \nrequested by the prescriber was not available in \nthe hospital and the patient was asked to buy it \nfrom another pharmacy.  \n \nDISCUSSION \n \nThe rate of omission errors (54%) and \ncommission errors (46%) obtained in this study \nare comparable to that reported by Rupp and \ncolleagues (1), with 51% and 29%, respectively. \nIt should be emphasized that one of the main \nerrors in the present study involved wrong dose \nor regimen prescribed (24%). The study by Rupp \nand colleagues (1) showed similar results. This \nerror of commission could lead to fatal \nconsequences if left unidentified and \nuncorrected. For example, famotidine was \nprescribed as 200 mg instead of 20 mg. This \nrepresents a 10 times overdose if the error has \nnot been detected. Decimal points in drug dosage \nshould also be clearly written especially for drug \nwith a wide dose range such as prednisolone that \nmay be prescribed as 2.5mg or 25mg, depending \non the condition of the patient.  Additionally, \ndrugs with similar names often cause confusion \nas in the case of magnesium sulphate being \nprescribed instead of magnesium trisilicate.  \nAronson (12) had suggested some measures to \nminimize such confusion. \n \nFrom the results of the study, the proportion of \nprescription interventions appeared small \n(0.68%) compared to other studies where \nintervention rate of 2.6 and 2.9% had been \nrecorded (1, 7). Some problematic prescriptions \nespecially those with errors of omission may \nhave been dispensed with some assumptions and \nhence no pharmacist intervention was \ndocumented. The possibility of some \nprescriptions with errors being dispensed to the \npatients without being detected could not be \nruled out. The utilisation of information \ntechnology via computerization of prescription \n\n\n\nscreening and electronic prescribing may \nminimise such occurrence. However, the \nstandardization of processes and the expanded \nuse of the expertise of pharmacists through better \nintegration of the health care team are just as \nimportant. \n \nThe pharmacist or trainee pharmacist had to \ncontact the prescriber or the prescriber\u2019s nurse 26 \ntimes to resolve 23 problematic prescriptions \n(53% of the 43 problematic prescriptions). This \nemphasizes the importance of interdisciplinary \ncommunication and cooperation in identifying \nand resolving prescribing errors and \nirregularities.  The community pharmacists in the \nstudy by Rupp and colleagues (1) had to contact \nthe prescriber or prescriber\u2019s assistants to resolve \n80% of the problematic prescriptions. This \nhigher rate could be explained by the difference \nin the sampling frame between the two studies. \nThe present study involved prescription \nscreening by the pharmacy staff who were more \nfamiliar with the prescribing habits of the \nprescribers in the same hospital. Therefore, the \npharmacy staff could resolve a higher proportion \nof the problems encountered without contacting \nthe prescribers than the community pharmacists \nin the study by Rupp and colleagues (1) who \nreceived prescriptions from many different \nclinics and hospitals. \n\n\n\n \nThe results also showed that the prescribers \nsubsequently changed 32.6% of the problematic \nprescriptions identified by the pharmacy staff.  \nAnother 48.8% of the prescriptions were \nclarified without any change and dispensed. This \nis comparable to the study by Rupp and \ncolleagues (1) that showed similar outcome \ndescription of 32% and 53.8%, respectively. \nThese results further support the importance of \npharmacist intervention in minimising \npreventable adverse events attributed to \nmedication errors.  \n\n\n\n \nAlthough the present study was conducted in \nonly one hospital, research of such nature could \nprovide an invaluable database for future \nreference and for identifying specific individual \nand institutional deficiencies in prescribing. \nConsequently, appropriate design and \nimplementation of strategic educational \nprogrammes or institutional procedures could be \ndeveloped to eliminate the occurrence of such \npreventable medication errors and to limit the \nrisk to patients.   \n\n\n\n \n\n\n\n\n\n\n\n\nResearch article: Outpatient prescription intervention activities by pharmacists \n\n\n\n 90\n\n\n\nCONCLUSION \n \nThe study reinforces the importance of \nprescription screening and interventions by \npharmacists in minimising preventable adverse \nevents attributed to medication errors.  It also \nemphasizes the necessity of interdisciplinary \ncommunication and cooperation in identifying \nand resolving prescribing errors and irregularities \n\n\n\nin order to achieve optimal therapeutic outcomes \nfor the patient. \n \nACKNOWLEDGEMENT \n \nThe authors wish to thank the staff of the \nOutpatient Polyclinic Pharmacy Unit, Universiti \nMalaya Medical Centre for their assistance and \ncooperation.\n\n\n\n\n\n\n\n***** \n \n\n\n\nREFERENCES \n \n1. Rupp MT, Schondelmeyer SW, Wilson GT, \n\n\n\nKrause JE. Documenting prescribing errors and \npharmacist interventions in community pharmacy \npractice. Am Pharm  1988; NS28: 30-37. \n\n\n\n2. Ellis BC, Dovey SM, Collins DM, Tilyard MW, \nClark DWJ. General practitioners\u2019 views on the \nrole of the community pharmacist. N Z Med J \n1992; 105: 403-405. \n\n\n\n3. Rupp MT. Screening for prescribing errors. Am \nPharm 1991; NS31: 71-78. \n\n\n\n4. Bates DW, Boyle DL, Vander Vliet MB, \nSchneider J, Leape LL. Relationship between \nmedication errors and adverse drug events. J Gen \nIntern Med 1995; 10: 199-205. \n\n\n\n5. Christensen DB, Campbell WH, Madsen S, \nHartzema AG, Nudelman PM. Documenting \noutpatient problem intervention activities of \npharmacists in an HMO. Med Care 1981; 19: 105-\n117. \n\n\n\n6. Folli HL, Poole RL, Benitz WE, Russo JC. \nMedication error prevention by clinical \npharmacists in two children\u2019s hospital.  \n\n\n\n \n \nPediatrics 1987; 79: 718-722.  \n\n\n\n7. Hawkey CJ, Hodgson S, Norman A, Daneshmend \nTK, Garner ST. Effect of reactive pharmacy \nintervention on quality of hospital prescribing. \nBMJ 1990; 300: 986-990.        \n\n\n\n8. Ingrim NB, Hokanson JA, Guernsey BG, Doutre \nWH, Blair CW Jr, Verrett TJ. Physician \nnoncompliance with prescription writing \nrequirements. Am J Hosp Pharm 1983; 40: 414-\n417. \n\n\n\n9. Morrill GB, Barreuther C. Screening discharged \nprescriptions. Am J Hosp Pharm 1988; 45: 1904-\n1905. \n\n\n\n10. Lesar TS, Briceland L, Stein DS. Factors related to \nerrors in medication prescribing. JAMA 1997; 277: \n312-317. \n\n\n\n11. Lesar TS, Lomaestro BM, Pohl H. Medication \nprescribing errors in a teaching hospital. A 9-year \nexperience. Arch Intern Med 1997; 157: 1569-76. \n\n\n\n12. Aronson JK. Confusion over similar drug names: \nProblems and solutions. Drug Safety 1995; 12(3): \n155-160.  \n\n\n\n\n\n\n\n\n\n\n\n\n 91\n\n\n\nMalaysian Journal of Pharmacy \nInstructions to Authors  \n\n\n\n \nInstructions to Authors \nAuthors will greatly assist the editors if the instructions below are followed. \n \n1. Preparation of manuscripts \nq Articles in English will be given priority over those in Bahasa Malaysia.  \nq Type papers double spaced, using Times New Roman font size 12 throughout the text, legends, tables \n\n\n\nand references, on A4 sized paper. \nq Number all pages. 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"\n\nMalaysian Journal of Pharmacy Volume 7 Issue 2 (2021) \n \n\n\n\n\n\n\n\n7 \n\n\n\n\n\n\n\n*Correspondence: davidcct.crc@gmail.com \n\n\n\n                               rouwei90@hotmail.com \n\n\n\n1Pharmacy Department, Hospital Raja Permaisuri Bainun, Ministry of \n\n\n\nHealth. Jalan Raja Ashman Shah, 30450, Ipoh, Perak, Malaysia.  \n2Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of \nHealth. Jalan Raja Ashman Shah, 30450, Ipoh, Perak, Malaysia. \n3Medical Department, Hospital Raja Permaisuri Bainun, Ministry of Health \n\n\n\nJalan Raja Ashman Shah, 30450, Ipoh, Perak, Malaysia. \n4Clinical Research Centre, Hospital Sultanah Bahiyah, Ministry of Health \n\n\n\nJalan Kerinchi Gerbang Kerinchi Lestari 59200 Kuala Lumpur \nMalaysia \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n Original Article \n\n\n\n\n\n\n\nEffectiveness of Pharmacist-Led Audit-and-Feedback \n\n\n\nIntervention in Promoting Appropriate Third-Generation \n\n\n\nCephalosporin Use at a Tertiary Public Hospital in Malaysia \n \n\n\n\nRou Wei Tan1*, Kah Shuen Thong1, Chee Tao Chang2*, Joo Thye Cheng3, Huan Keat Chan4, Meng \n\n\n\nFei Cheah1 \n\n\n\n\n\n\n\n \nArticle Info  \n\n\n\n \nReceived date: 27 May 2021  \n\n\n\nAccepted date: 14 Jul 2021 \n\n\n\nPublished date: 31 Dec 2021 \n\n\n\n\n\n\n\nKeywords: Cephalosporins, \n\n\n\nantimicrobial stewardship, \n\n\n\nfeedback, inappropriate \n\n\n\nprescribing, non-adherence, \n\n\n\nMalaysia \n\n\n\nABSTRACT  \n\n\n\n\n\n\n\nObjective: This study aimed to determine the effectiveness of a pharmacist-led audit-and-feedback \n\n\n\nintervention in promoting the appropriate prescribing of third-generation cephalosporins and timely \n\n\n\nculture and sensitivity (C&S) testing in patients admitted to a neurosurgical ward. Method: This \n\n\n\nquasi-experimental study was conducted from July 2019 to August 2020 in a tertiary public hospital \n\n\n\nin Malaysia. In the pre-intervention phase, seventy patients who have received treatment with third-\n\n\n\ngeneration cephalosporins were examined by a ward pharmacist. The use of a cephalosporin was \n\n\n\ndeemed to be appropriate only if it was in line with either the National Antimicrobial Guidelines \n\n\n\n2019 or the recommendations made by the Antimicrobial Stewardship team. The availability of C&S \n\n\n\ntest performed before the first dose of cephalosporin was also studied. As an intervention, the findings \n\n\n\nwere presented and discussed in a 2-hour feedback session. Subsequently, the post-intervention audit \n\n\n\nwas performed in the same manner as in the pre-intervention phase. The primary outcome measures \n\n\n\nwere the proportion of cases with appropriate use of cephalosporin and timely C&S testing. The \n\n\n\nvariables were analysed descriptively. Pearson\u2019s chi-square test was used to assess the differences in \n\n\n\nappropriateness of antibiotics use and C&S testing, in the pre- and post-intervention cohorts. Result: \n\n\n\nSeventy cases were studied in the pre- and another seventy in post-intervention phases. The \n\n\n\nproportion of cases with appropriate use of third-generation cephalosporin increased significantly \n\n\n\nfrom 77.1% (54 / 70) to 95.8% (67 / 70) following the intervention (p = 0.001). The proportion of \n\n\n\ncases with a C&S test performed timely also increased significantly from 38.6% (27 / 70) to 58.6% \n\n\n\n(41 / 70) (p = 0.018). Conclusion: The pharmacist-led audit-and-feedback intervention was effective \n\n\n\nin improving the appropriateness of the prescribing of third-generation cephalosporins and timely \n\n\n\nculture and sensitivity testing, indicating the antimicrobial stewardship strategy had produced a \n\n\n\npositive outcome. \n\n\n\n\n\n\n\n\n\n\n\nINTRODUCTION  \n\n\n\n\n\n\n\nThird-generation cephalosporins have broad spectrum of \n\n\n\nantimicrobial activities and are able to cross the blood-brain \n\n\n\nbarrier. This gives rise to their high usage as the empirical \n\n\n\ntreatment of neurosurgical complications [1,2], which is \n\n\n\noften linked to antimicrobial resistance in nosocomial \n\n\n\npathogens [3]. As a result, the treatment options for \n\n\n\ninfections caused by gram-negative bacteria have become \n\n\n\nlimited [4].  \n\n\n\n\nmailto:davidcct.crc@gmail.com\n\n\nmailto:rouwei90@hotmail.com\n\n\n\n\n\n\nTan R.W. et al. Mal J Pharm 7 (2) 2021, 7-12 \n\n\n\n\n\n\n\n8 \n\n\n\n\n\n\n\nIn Asia, ceftriaxone is the most widely used third-generation \n\n\n\ncephalosporin, prescribed for 59.1% to 81.8% of hospitalized \n\n\n\npatients [5,6]. Most of the time, it was used as the empirical \n\n\n\ntreatment [7], including in neurosurgical wards [8]. \n\n\n\nCefoperazone / sulbactam came in second, mainly prescribed \n\n\n\nfor those with sepsis [9]. \n\n\n\n\n\n\n\nIn Malaysia, the cephalosporin usage reached 650 defined daily \n\n\n\ndose/ 1000 patient-days in 2016. Slightly less than 80% of the \n\n\n\ncases had cephalosporins used as the empirical treatment, \n\n\n\n13.6% for microbiologically confirmed diseases and 5.7% as \n\n\n\nsurgical prophylaxis [10]. However, the use of antibiotics in \n\n\n\nwards was commonly found to be inconsistent with the \n\n\n\nrecommendations in the National Antimicrobial Guideline \n\n\n\n(NAG) [11]. Another study also related to the inappropriate \n\n\n\nantibiotic prescribing to growing antimicrobial resistance and \n\n\n\nmortality in hospitalized patients [12]. It is believed that the \n\n\n\nmost effective way to combat antimicrobial resistance is \n\n\n\nthrough the rational use of antibiotics [13]. \n\n\n\n\n\n\n\nThe Antimicrobial Stewardship (AMS) Program was launched \n\n\n\nby the Ministry of Health (MOH) to promote the appropriate \n\n\n\nprescribing of antibiotics in Malaysia. It is run by a \n\n\n\nmultidisciplinary team in each hospital, which includes \n\n\n\ninfectious disease physicians, clinical microbiologists and ward \n\n\n\npharmacists [14]. One of the important activities of the AMS \n\n\n\nteam is to perform audits and provide feedback [15], with the \n\n\n\naim to correct the inappropriate practice in antibiotic use [16]. \n\n\n\n\n\n\n\nTogether with the AMS program, the NAG was introduced to \n\n\n\nguide the prescribers in antibiotic use. In public health \n\n\n\ninstitutions in Malaysia, prescribers are expected to follow the \n\n\n\nrecommendations of the NAG when it comes to antibiotic use. \n\n\n\nThe adherence to the NAG could be evaluated in several \n\n\n\naspects, including the drug selection, the regimen used, and the \n\n\n\npurpose of treatment. Meanwhile, the AMS team served as an \n\n\n\nimportant point of reference when a clinical condition is not \n\n\n\nable to capture by the NAG.  \n\n\n\n\n\n\n\nIn the Raja Permaisuri Bainun Hospital located in northern \n\n\n\nMalaysia, the 38-bed neurosurgical ward recorded the highest \n\n\n\nusage of ceftriaxone, with a defined daily dose of 189.11 / 1000 \n\n\n\nbed days between January and June 2019. This study aimed to \n\n\n\nevaluate the effectiveness of an audit-and-feedback \n\n\n\nintervention in promoting the appropriate prescribing of third-\n\n\n\ngeneration cephalosporins and timely culture and sensitivity \n\n\n\n(C&S) testing among patients admitted to this ward. \n\n\n\n\n\n\n\nMETHOD  \n\n\n\n\n\n\n\nThis was a quasi-experimental study conducted in Raja \n\n\n\nPermaisuri Bainun Hospital, a tertiary public hospital in the \n\n\n\nPerak state of Malaysia, from July 2019 until August 2020. The \n\n\n\naudit consisted of pre-intervention, feedback and post-\n\n\n\nintervention phases. The patients included were those who \n\n\n\nwere admitted to the neurosurgical ward during the pre- and \n\n\n\npost-intervention of the audit and received treatment with one \n\n\n\nof the three commonly used third-generation cephalosporin \n\n\n\n(ceftriaxone, cefoperazone / sulbactam and ceftazidime). The \n\n\n\nsample size required in each phase was estimated based on a \n\n\n\nprevious study, which reported that the proportions of \n\n\n\nprescriptions showing an appropriate use of empirical \n\n\n\nantibiotics were 61.7% and 83.8% before and after an \n\n\n\nintervention, respectively [15]. With a confidence level of 95% \n\n\n\nand a power of 80%, the calculated sample size for the pre- and \n\n\n\npost-intervention phases was 63. To account for 10% of cases \n\n\n\nwith incomplete information, 70 cases were studied in both \n\n\n\nphases.  \n\n\n\n\n\n\n\nPre-intervention phase (1st July - 31st October 2019) \n\n\n\n\n\n\n\nA ward pharmacist, who was also the AMS pharmacist, \n\n\n\ncollected data of patients treated with the third-generation \n\n\n\ncephalosporin between 1st July and 31st October 2019 during \n\n\n\nroutine ward round prospectively. The data collection and \n\n\n\nassessment were conducted at the point when the first dose of \n\n\n\na cephalosporin was administered prior to any interventions \n\n\n\nmade by the ward pharmacist. The information gathered \n\n\n\nincluded the types of antibiotics, their dosage and frequency, \n\n\n\nduration and the diagnosis of patients. In this context, \n\n\n\ninappropriate prescribing referred to the use of a cephalosporin \n\n\n\nnot in line with either the NAG or recommendations of the \n\n\n\nAMS team, in term of drug selection, dose and frequency; and \n\n\n\ntreatment duration. In a case that a condition was not captured \n\n\n\nby the NAG, the prescribers were expected to seek advices \n\n\n\nfrom the AMS team. Also, the prescribers were expected to \n\n\n\nperform a C&S test right before the first dose of a \n\n\n\ncephalosporin was given.  \n\n\n\n\n\n\n\nIntervention phase (13th December 2019)  \n\n\n\n\n\n\n\nThe audit findings were then presented in a 2-hour feedback \n\n\n\nsession, in which all the cases of inappropriate prescribing were \n\n\n\ndiscussed. The feedback session was led by the hospital AMS \n\n\n\nteam, which consisted of AMS pharmacists, clinical \n\n\n\nmicrobiologists and infectious disease physicians. The \n\n\n\nattendees included neurosurgeons and medical officers from \n\n\n\nthe neurosurgical department. The audit feedback was \n\n\n\npresented by the ward AMS pharmacist and the discussion \n\n\n\nemphasized the need to use cephalosporins according to the \n\n\n\nrecommendations of the NAG (Table I), as well as to perform \n\n\n\nC&S testing right before empirical treatment was initiated.  \n\n\n\n\n\n\n\nThe neurosurgical team agreed to the above recommendations, \n\n\n\nwith an exception given to the use of ceftriaxone at their \n\n\n\ndiscretion in patients who had a basilar skull fracture \n\n\n\ncomplicated with cerebrospinal fluid (CSF) leak. \n\n\n\n\n\n\n\n\nTan R.W. et al. Mal J Pharm 7 (2) 2021, 7-12 \n\n\n\n\n\n\n\n9 \n\n\n\n\n\n\n\n\n\n\n\nPost-intervention phase (15th December 2019 - 31st August \n\n\n\n2020) \n\n\n\n\n\n\n\nThe post-intervention audit was performed in the same manner \n\n\n\nas in the pre-intervention phase. No staff change took place \n\n\n\nthroughout the audit period. To minimize the Hawthorne effect \n\n\n\n[17], only the head of neurosurgical department was informed \n\n\n\non the conduct of the audit. Only one ward pharmacist was \n\n\n\ninvolved in the data collection and assessment in order to \n\n\n\nensure the internal reliability of the assessment.  \n\n\n\n\n\n\n\nThe statistical analysis was performed using the SPSS for \n\n\n\nWindows (Version 20.0. Armonk, NY: IBM Corp). The \n\n\n\ncategorical variables were described as frequencies and \n\n\n\npercentages, and continuous variables as mean with standard \n\n\n\ndeviation (SD). The independent t-test was used to assess the \n\n\n\ndifferences in age and length of stay, while the Pearson\u2019s chi-\n\n\n\nsquare tests was used to assess the differences in gender, \n\n\n\nclinical diagnosis, antibiotics use, events of readmission and \n\n\n\nmortality, total prescribing issues, C&S testing and type of \n\n\n\ntreatment involved in pre- and post-intervention phase. The \n\n\n\nstatistical significance of the test was indicated by a p-value  \n\n\n\n< 0.05.  \n\n\n\n\n\n\n\nThe ethics approval for this study was obtained from the \n\n\n\nMedical Research and Ethics Committee (MREC) under the \n\n\n\nMOH, Malaysia [(Registration number: NMRR-19-804-47375 \n\n\n\n(IIR), approval number: KKM/NIHSEC/P19-945(10).] \n\n\n\n\n\n\n\nRESULT  \n\n\n\n\n\n\n\nA total of 140 cases were examined in the pre- and post-\n\n\n\nintervention phases, 70 cases in pre-intervention and 70 in post-\n\n\n\nintervention. No differences in the distributions of age (t = \n\n\n\n-0.037, p = 0.759) and gender (X2 = 0.150, p = 0.847) were \n\n\n\nobserved between two phases. The clinical diagnoses between \n\n\n\nthe two cohorts were significantly different (X2 = 20.376, p = \n\n\n\n0.002). Presumed meningitis was the most common conditions \n\n\n\nin both cohorts, with 44 (62.9%) and 40 (57.2%) patients in the \n\n\n\npre- and post-intervention phases, respectively.  Hospital-\n\n\n\nacquired pneumonia was found to be more common in the pre-\n\n\n\nintervention phase (n = 6,8.6%), while more patients had brain \n\n\n\nabscess in the post-intervention phase (n = 9,12.9%). \n\n\n\nCeftriaxone was the most commonly prescribed third-\n\n\n\ngeneration cephalosporin. It was given to 63 (89.9%) and 68 \n\n\n\n(97.1%) patients before and after intervention, respectively \n\n\n\n(Table II). There were no significant differences in length of \n\n\n\nstay (t = -1.874, p = 0.063), thirty-day readmission (X2 = 0.890, \n\n\n\np = 0.822) and thirty-day mortality (X2 = 0.226, p = 0.698) \n\n\n\nbetween the two groups of patients.  \n\n\n\n\n\n\n\nThe proportion of cases with an appropriate use of third-\n\n\n\ngeneration cephalosporins had significantly increased from \n\n\n\n77.1% (54 / 70) to 95.8% (67 / 70) following the intervention \n\n\n\n(X2 = 10.291, p = 0.001). Common issues detected in the pre-\n\n\n\nintervention phase included an inappropriate selection of \n\n\n\nantibiotics (n = 13 / 70, 18.7%) and an inappropriate treatment \n\n\n\nduration (n = 1 / 70, 1.4%). Of the 13 cases with an \n\n\n\ninappropriate antibiotic selection, five were open skull fracture \n\n\n\nand six were hospital-acquired pneumonia. After the \n\n\n\nintervention, an inappropriate selection of antibiotics was only \n\n\n\nobserved in two cases (Table III). Additionally, there were \n\n\n\nthree cases (2 before the intervention and 1 after the \n\n\n\nintervention) in which the use of antibiotics was not \n\n\n\nrecommended in the NAG and the prescriber did not consult \n\n\n\nthe AMS team beforehand. \n\n\n\n\n\n\n\nThe proportion of cases with C&S test performed timely also \n\n\n\nincreased significantly from 38.6% (27 / 70) to 58.6% (41 / 70) \n\n\n\nfollowing the intervention (X2 = 5.605, p = 0.018) (Table III.). \n\n\n\n\n\n\n\nDISCUSSION \n\n\n\n\n\n\n\nThis study shows that pharmacist-led audit-and-feedback \n\n\n\nintervention can serve as an effective approach to improve the \n\n\n\nappropriateness of third-generation cephalosporins prescribing \n\n\n\nin a hospital. It could also be used to promote the practice of \n\n\n\nperforming the C&S tests timely, which are essential to guide \n\n\n\nthe rational use of antibiotics in the ward. Meanwhile, the 30-\n\n\n\nday mortality, 30-day readmission and length of stay in hospital \n\n\n\nwas similar in both groups of patients. In a previous study, it \n\n\n\nwas found that a more comprehensive and intensive modules in \n\n\n\nmultiple sessions could reduce the length of stay [18]. The \n\n\n\nsingle session educational intervention in this study may be \n\n\n\ninadequate to elicit significant change in clinical outcomes, and \n\n\n\nthis may explain the similar mortality, readmission and length \n\n\n\nof stay among patients in the pre- and post-intervention cohorts.\n\n\n\nTable I. Summary Note of Recommended Treatment for Several \n\n\n\nCommon Conditions in a Neurosurgical Ward (Adapted from the \n\n\n\nNational Antimicrobial Guideline 2019)  \n\n\n\n\n\n\n\nConditions  Recommended treatment \n\n\n\nIntracranial trauma and open \n\n\n\nfracture \n\n\n\nIV Cefuroxime 1.5g TDS + IV \n\n\n\nMetronidazole 500mg TDS/PO \n\n\n\nMetronidazole 400mg TDS \n\n\n\nDepressed skull fracture and \npenetrating craniocerebral \n\n\n\ninjury \n\n\n\nIV Ceftriaxone 2g BD + IV \nMetronidazole 500mg TDS/PO \n\n\n\nMetronidazole 400mg TDS \n\n\n\nAspiration pneumonia IV Amoxycillin/Clavulanic Acid \n\n\n\n1.2g TDS  \n\n\n\nHospital-acquired \npneumonia \n\n\n\ni. Early onset \n\n\n\n\n\n\n\nii. Late onset \n\n\n\n\n\n\n\n\n\n\n\ni. IV Amoxycillin / Clavulanic \n\n\n\nAcid 1.2 g TDS \n\n\n\nii. IV Piperacillin / Tazobactam \n\n\n\n4.5g QID or IV Cefepime 2g \n\n\n\nTDS \n\n\n\n\n\n\n\nNote: IV=intravenous, TDS=three times daily, PO=per os (orally), \n\n\n\nBD=two times daily, QID=four times daily \n\n\n\n\n\n\n\n\nTan R.W. et al. Mal J Pharm 7 (2) 2021, 7-12 \n\n\n\n\n\n\n\n10 \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nAs it would be expected, ceftriaxone emerged as the most \n\n\n\ncommonly prescribed third-generation cephalosporin in the \n\n\n\nward. In both the pre- and post-intervention phases, most \n\n\n\npatients received it as the empirical treatment for presumed \n\n\n\nbacterial meningitis. A previous study supported such a \n\n\n\npractice, suggesting that prompt treatment for presumptive \n\n\n\nmeningitis with broad-spectrum antibiotics could lower the risk \n\n\n\nof mortality [19]. The latest evidence also recommends the use \n\n\n\nof either ceftriaxone or cefotaxime as the empirical treatment \n\n\n\nfor the same condition [20]. It is noteworthy that we did not \n\n\n\nseek to change the existing practice but advocated for the use \n\n\n\nof antibiotics with a narrow spectrum of antimicrobial activities \n\n\n\nfor other clinical conditions, such as intracranial trauma and \n\n\n\nopen skull fracture, as recommended by the NAG (Table I). \n\n\n\nIt was also found that six patients with hospital-acquire \n\n\n\npneumonia and one patient with aspiration pneumonia were \n\n\n\ntreated with cefoperazone / sulbactam. However, the NAG \n\n\n\nrecommends the use of amoxicillin/ clavulanate for early onset \n\n\n\nof both the conditions instead [20]. Such discrepancies were \n\n\n\nhighlighted in the feedback session, and the appropriate drug \n\n\n\nselections for both the conditions were discussed. The \n\n\n\nprescribers adhered to this recommendation in the post-\n\n\n\nintervention phase, and no patient received cefoperazone / \n\n\n\nsulbactam for similar conditions. This suggests the prescribers \n\n\n\nhave high level of acceptance towards evidence-based \n\n\n\nrecommendations made by the AMS team.  \n\n\n\nTable II. Characteristics of Patients in the Pre-and Post-Intervention Phase \n\n\n\n\n\n\n\nCharacteristics Pre-intervention (n, %) Post-intervention (n, %) P-value \n\n\n\nAge (mean \u00b1 SD) 36.4 \u00b1 16.52 37.3 \u00b1 18.63 0.759* \n\n\n\n\n\n\n\nGender \n   \n\n\n\nMale 53 (75.7) 51 (72.9) 0.847** \n\n\n\nFemale 17 (24.3) 19 (27.1)  \n\n\n\n\n\n\n\nClinical Diagnosis \n   \n\n\n\nPresumed meningitis (total) 44 (62.9) 40 (57.2) 0.002** \n\n\n\n     SSI with osteomyelitic changes 13 (18.6) 9 (12.9)  \n\n\n\n     Pneumocephalus 13 (18.6) 21 (30.0)  \n\n\n\n     Depressed skull fracture 11 (15.7) 2 (2.9)  \n\n\n\n     Inner & outer skull fracture 3 (4.3) 3 (4.3)  \n\n\n\n     Basilar skull fracture with CSF leak 4 (5.7) 5 (7.1)  \n\n\n\nBrain abscess 1 (1.4) 9 (12.9)  \n\n\n\nClosed skull fracture 1 (1.4) 1 (1.4)  \n\n\n\nOpen skull fracture 5 (7.2) -  \n\n\n\nSurgical chemoprophylaxis 3 (4.3) -  \n\n\n\nHospital acquired pneumonia 6 (8.6) -  \n\n\n\nConfirmed meningitis 4 (5.8) 10 (14.3)  \n\n\n\nVentriculitis - 1 (1.4)  \n\n\n\nCommunity acquired pneumonia - 1 (1.4)  \n\n\n\nInfected VP shunt 1 (1.4) 3 (4.3)  \n\n\n\nSubdural empyema 1 (1.4) 4 (5.7)  \n\n\n\nOccult sepsis 1 (1.4) -  \n\n\n\nCerebral Toxoplasmosis    1 (1.4) -  \n\n\n\nPenetrating injury 1 (1.4) -  \n\n\n\nScalp abscess - 1 (1.4)  \n\n\n\nAspiration pneumonia 1 (1.4) -  \n\n\n\n\n\n\n\nAntibiotics used \n   \n\n\n\nCeftriaxone  63 (90) 68 (97.2) 0.007** \n\n\n\nCefoperazone/sulbactam  7 (10) -  \n\n\n\nCeftazidime  - 2 (2.8)  \n\n\n\n\n\n\n\nLength of stay, mean (SD) \n11.79 (11.26) 16.23 (16.33) 0.063* \n\n\n\n\n\n\n\nThirty days readmission \n4 (5.7) 7 (10.0) 0.822** \n\n\n\n\n\n\n\nThirty days mortality \n3 (4.3) 4 (5.7) 0.698** \n\n\n\n\n\n\n\nNote: SSI=surgical site infection.  \n\n\n\n*Independent t-test   \n\n\n\n**Pearson\u2019s chi-square test. Significant value was set at p<0.05. \n\n\n\n\n\n\n\n\nTan R.W. et al. Mal J Pharm 7 (2) 2021, 7-12 \n\n\n\n\n\n\n\n11 \n\n\n\n\n\n\n\n\n\n\n\nThere were also a few cases of basilar skull fracture \n\n\n\ncomplicated with CSF leak in both phases, for which \n\n\n\nantimicrobial treatment is not recommended by the NAG. \n\n\n\nHowever, the neurosurgical team raised their concern that the \n\n\n\nCSF leak could elevate the risk of meningitis. A consensus was \n\n\n\nreached in the feedback session that such a practice was \n\n\n\nacceptable. This shows a good example that the AMS team \n\n\n\ncould play an integral role in providing timely and relevant \n\n\n\nadvices when a condition is not captured by the NAG [15]. \n\n\n\nSimilar conditions were also witnessed for cases of mastoid \n\n\n\nfracture, occult sepsis and close skull fracture.  \n\n\n\n\n\n\n\nIn the pre-intervention phase, only 27 out of 70 (38.6%) \n\n\n\npatients had the C&S test performed timely. Ideally, the C&S \n\n\n\ntest is to be performed before the initiation of antimicrobial \n\n\n\ntreatment [22]. However, such a practice is often hindered by \n\n\n\nthe complexity lumbar puncture (LP) procedure, as patients \n\n\n\nneed to undergo a CT scan first and those with septic shock are \n\n\n\nunfit for the procedure [22]. Right after the feedback session, \n\n\n\nwe observed a significant increase in the number of C&S tests \n\n\n\nperformed timely. Previous study reported that physicians \n\n\n\ndemonstrated distrust towards culture and sensitivity results, as \n\n\n\nit occasionally contradicted with patients\u2019 clinical \n\n\n\npresentations [23]. Our educational audit-and-feedback session \n\n\n\nemphasized on the choice of narrow spectrum antibiotics to \n\n\n\nprevent antimicrobial resistance. This might have created \n\n\n\nawareness on the importance of timely C&S testing, led to \n\n\n\nincreased C&S tests post-intervention. \n\n\n\n\n\n\n\nThis was the first local study evaluating the effectiveness of an \n\n\n\naudit-and-feedback intervention in improving third generation \n\n\n\ncephalosporins use among patients admitted in the \n\n\n\nneurosurgical ward. Nevertheless, as this was a single center \n\n\n\nstudy, the findings are not generalizable to other clinical \n\n\n\nsettings. This was also a one-off audit, and thus the \n\n\n\nsustainability of the change in prescribing patterns could not be \n\n\n\nevaluated.  \n\n\n\n\n\n\n\nCONCLUSION  \n\n\n\n\n\n\n\nThe pharmacist-led audit-feedback intervention was shown to \n\n\n\nbe effective in improving the appropriateness of the third-\n\n\n\ngeneration cephalosporins use and timely C&S testing, \n\n\n\nindicating the antimicrobial stewardship strategy had produced \n\n\n\nTable III. Findings of pre- and post-intervention audits \n\n\n\n\n\n\n\nCharacteristics Pre-intervention (n, %) Post-intervention (n, %) P-value \n\n\n\nPrescribing Issues (Total) 16 (22.9) 3 (4.3) 0.001 ** \n\n\n\nInappropriate drug selection 13 (18.7) 2 (2.8) 0.003 ** \n\n\n\nInappropriate treatment duration 1 (1.4) - - \n\n\n\nIndication not stated in NAG*     2 (2.8) 1 (1.4) 0.559 ** \n\n\n\n\n\n\n\nConditions involved \n\n\n\n\n\n\n\nMastoid fracture 1 (6.3) - N/A \n\n\n\nOpen skull fracture 5 (31.3) -  \n\n\n\nSurgical prophylaxis 1 (6.3) -  \n\n\n\nCerebral toxoplasmosis 1 (6.3) -  \n\n\n\nOccult sepsis 1 (6.3) -  \n\n\n\nHospital acquired pneumonia 6 (37.2) -  \n\n\n\nAspiration pneumonia 1 (6.3) -  \n\n\n\nClose skull fracture - 1 (33.3)  \n\n\n\nCommunity acquired pneumonia - 1 (33.3)  \n\n\n\nScalp abscess - 1 (33.3)  \n\n\n\n\n\n\n\nCulture and sensitivity test \n\n\n\n\n\n\n\nNot done timely 43 (61.4) 29 (41.4) 0.018 ** \n\n\n\nDone timely 27 (38.6) 41 (58.6)  \n\n\n\n     CSF 7 (10.0) 22 (31.5)  \n\n\n\n     Blood  7 (10.0) 1 (1.4)  \n\n\n\n     Tissue 8 (11.4) 14 (20.0)  \n\n\n\n     Swab 5 (7.2) 4 (5.7)  \n\n\n\n\n\n\n\nType of treatment involved \n\n\n\n\n\n\n\nEmpirical  67 (95.7) 69 (98.6) 0.245 ** \n\n\n\nSurgical Prophylaxis 3 (4.3) -  \n\n\n\nDefinitive  - 1 (1.4)  \n\n\n\n\n\n\n\nNote: * Antibiotics choice were not outlined in NAG and the prescriber did not consult the AMS team timely.  \n\n\n\n          ** Pearson Chi-square test. Significant value was set at p < 0.05. \n\n\n\n\n\n\n\n\nTan R.W. et al. Mal J Pharm 7 (2) 2021, 7-12 \n\n\n\n\n\n\n\n12 \n\n\n\n\n\n\n\na positive outcome. Further studies assessing the sustainability \n\n\n\nof the improvement are warranted. \n\n\n\n\n\n\n\nACKNOWLEDGEMENT  \n\n\n\n\n\n\n\nThere was no funding obtained for this work.  \n\n\n\n\n\n\n\nCONFLICT OF INTEREST   \n\n\n\n\n\n\n\nThis study has no conflict of interest. This research did not \n\n\n\nreceive any specific grant from funding agencies in public, \n\n\n\ncommercial or not-for-profit sectors. \n\n\n\n\n\n\n\nREFERENCE   \n \n\n\n\n[1] Buang SS, Haspani MS. Risk factors of neurosurgical site infections \n\n\n\nafter a neurosurgical procedure: a prospective, observational study at \n\n\n\nHospital Kuala Lumpur. Medical Journal of Malaysia. 2012; 67(4): \n\n\n\n393-86.  \n\n\n\n[2] Guruja MP, Sarah A, Samaga L, Joshi H, Nair S, Shastry CS. \n\n\n\nCephalosporin utilization evaluation in a university teaching hospital: \n\n\n\na prospective study. Journal of Drug Delivery and Therapeutics. 2013; \n\n\n\n3(2): 83-87. https://doi.org/10.22270/jddt.v3i2.399 \n\n\n\n[3] Mc Gowan JE, Tenover FC. Control of antimicrobial resistance in the \n\n\n\nhealth care system. infectious disease clinics of North America. 1997; \n\n\n\n11(2):297\u2013311.  https://doi.org/10.1016/s0891-5520(05)70357-3 \n\n\n\n[4] Park SH. Third generation cephalosporin resistance in gram-negative \n\n\n\nbacteria in the community: a growing public health concern. Korean \n\n\n\nJournal of International Medicine. 2014; 29(1): 27-30.  \n\n\n\nhttps://doi.org/10.3904/kjim.2014.29.1.27 \n\n\n\n[5] Abou-Shaaban, Ali AA, Rao PG, Majid A. Drug utilization review \n\n\n\nof cephalosporins in a secondary care hospital in United Arab \n\n\n\nEmirates. International Journal of Clinical Pharmacy. 2016; 38(6): \n\n\n\n1367-1371. https://doi.org/10.1007/s11096-016-0392-4 \n\n\n\n[6] Naveen V, Siddiq A, Chandana G. A study of drug utilization pattern \n\n\n\nof cephalosporins in general medicine and surgical inpatient \n\n\n\ndepartment. International Journal of Current Pharmaceutical \n\n\n\nResearch. 2018; 10(3): 33-36. \n\n\n\nhttps://doi.org/10.22159/ijcpr.2018v10i3.27225  \n\n\n\n[7] Sileshi, A., Tenna, A., Feyissa, M., & Shibeshi, W. (2016). Evaluation \n\n\n\nof ceftriaxone utilization in medical and emergency wards of Tikur \n\n\n\nAnbessa specialized hospital: A prospective cross-sectional study. \n\n\n\nBMC Pharmacology & Toxicology, 17. \n\n\n\nhttps://doi.org/10.1186/s40360-016-0057-x \n\n\n\n[8] Opanga SA, Nimrod JA, Faith AO, Kimani AM. Patterns of \n\n\n\nantimicrobial use in neurosurgical ward of Kenyatta National \n\n\n\nHospital. African Journal of Pharmacology and Therapeutics. 2016; \n\n\n\n5(4): 241-246   \n\n\n\n[9] Sharma MS, Suri A, Chandra SP, Kale SS, Kapil A, Sharma BS, \n\n\n\nMahapatra AK. Cost and usage pattern of antibiotics in a tertiary care \n\n\n\nof neurosurgical unit. Indian Journal of Neurosurgery. 2012; 1(1): 41-\n\n\n\n7. https://doi.org/10.4103/2277-9167.94370 \n\n\n\n[10] Malaysian Action Plan on Antimicrobial Resistance, 2017-2021. \n\n\n\nMinistry of Health Malaysia and Ministry of Agriculture and Agro-\n\n\n\nbased Industry Malaysia. \n\n\n\nhttps://www.moh.gov.my/moh/resources/Penerbitan/Garis%20Pandu\n\n\n\nan/Garis%20panduan%20Umum%20(Awam)/National_Action_Plan\n\n\n\n_-_FINAL_29_june.pdf \n\n\n\n[11] Lim MK, Lai PS, Ponnampalavanar SS, Syed Omar SF, Taib NA, \n\n\n\nYusof MY, Italiano CM, Kong DC, Kamarulzaman A. Antibiotics in \n\n\n\nsurgical wards: use or misuse? A newly industrialized country's \n\n\n\nperspective. J Infect Dev Ctries. 2015 Nov 30;9(11):1264-71. \n\n\n\nhttps://doi.org/10.3855/jidc.6731 \n\n\n\n[12] Gillani, S. W., Sulaiman, A. S., & Nejad, F. B. (2010). Inpatient care \n\n\n\nand microbial surveillance during year 2007-2008; retrospective \n\n\n\nevaluation of hospital-acquired pneumonia (HAP) in General Hospital \n\n\n\nPulau Pinang, Malaysia. International Journal of Food Safety, \n\n\n\nNutrition and Public Health, 3(1), 27\u201332. \n\n\n\nhttps://doi.org/10.1504/IJFSNPH.2010.032032 \n\n\n\n[13] Parulekar L, Soman R, Singhal T, Rodrigues C, Dastur FD, et al. How \n\n\n\ngood is compliance with surgical antibiotic prophylaxis guidelines in \n\n\n\na tertiary care private hospital in India? A prospective study. Indian \n\n\n\nJournal of Surgery .2009; 71: 15-18.   \n\n\n\nhttps://doi.org/10.1007/s12262-009-0004-9 \n\n\n\n[14] Ministry of Health Malaysia. Protocol on antimicrobial stewardship \n\n\n\nprogram in healthcare facilities. 2014. \n\n\n\nhttps://www.pharmacy.gov.my/v2/en/documents/protocol-\n\n\n\nantimicrobial-stewardship-program-healthcare-facilities.html \n\n\n\n[15] H\u00f8gli JU, Garcia BH, Skjold F, Skogen V, Sm\u00e5brekke L. An audit-\n\n\n\nand-feedback intervention study increased adherence to antibiotic \n\n\n\nprescribing guidelines at a Norwegian hospital. BMC Infect Dis. 2016 \n\n\n\nFeb 27;16:96. https://doi.org/10.1186/s12879-016-1426-1 \n\n\n\n[16] Ivers, N., Jamtvedt, G., Flottorp, S., Young, J. M., Odgaard\u2010Jensen, J., \n\n\n\nFrench, S. D., O\u2019Brien, M. A., Johansen, M., Grimshaw, J., & Oxman, \n\n\n\nA. D. Audit-and-feedback: Effects on professional practice and \n\n\n\nhealthcare outcomes. Cochrane Database of Systematic Reviews. \n\n\n\n2012 Jun 13;(6)CD000259. \n\n\n\nhttps://doi.org/10.1002/14651858.CD000259.pub3 \n\n\n\n[17] McCambridge J, Witton J, Elbourne DR. Systematic review of the \n\n\n\nHawthorne effect: new concepts are needed to study research \n\n\n\nparticipation effects. J Clin Epidemiol. 2014 Mar; 67(3):267-77.  \n\n\n\nhttps://doi.org/10.1016/j.jclinepi.2013.08.015 \n\n\n\n[18] Manheim LM, Feinglass J, Hughes R, Martin GJ, Conrad K, Hughes \n\n\n\nEF. Training house officers to be cost conscious. Effects of an \n\n\n\neducational intervention on charges and length of stay. Med Care. \n\n\n\n1990 Jan;28(1):29-42.  \n\n\n\nhttps://doi.org/10.1097/00005650-199001000-00005 \n\n\n\n[19] Proulx N, Frechette D, Toye B, Chan J, Kravcik S. Delays in the \n\n\n\nadministration of antibiotics are associated with mortality from adult \n\n\n\nacute bacterial meningitis. QJM 2005; 98: 291\u20138. \n\n\n\nhttps://doi.org/10.1093/qjmed/hci047 \n\n\n\n[20] Ministry of Health Malaysia, National Antimicrobial Guidelines \n\n\n\n(2019).https://www.pharmacy.gov.my/v2/sites/default/files/documen\n\n\n\nt-upload/national-antimicrobial-guideline-2019-full-version-3rd-\n\n\n\nedition.pdf \n\n\n\n[21] Young, N., & Thomas, M. (2018). Meningitis in adults: Diagnosis and \n\n\n\nmanagement. Internal Medicine Journal, 48(11), 1294\u20131307. \n\n\n\nhttps://doi.org/10.1111/imj.14102 \n\n\n\n[22] McGill F, Heyderman RS, Michael BD, Defres S, Beeching NJ, \n\n\n\nBorrow R et al. The UK joint specialist societies guideline on the \n\n\n\ndiagnosis and management of acute meningitis and meningococcal \n\n\n\nsepsis in immunocompetent adults. J Infect 2016; 72: 405\u201338. \n\n\n\nhttps://doi.org/10.1016/j.jinf.2016.01.007 \n\n\n\n[23] Rolfe, R., Kwobah, C., Muro, F. et al. Barriers to implementing \n\n\n\nantimicrobial stewardship programs in three low- and middle-income \n\n\n\ncountry tertiary care settings: findings from a multi-site qualitative \n\n\n\nstudy. Antimicrob Resist Infect Control 10, 60 (2021). \n\n\n\nhttps://doi.org/10.1186/s13756-021-00929-4 \n\n\n\n \n\n\n\n\nhttps://doi.org/10.22270/jddt.v3i2.399\n\n\nhttps://doi.org/10.1016/s0891-5520(05)70357-3\n\n\nhttps://doi.org/10.3904/kjim.2014.29.1.27\n\n\nhttps://doi.org/10.1007/s11096-016-0392-4\n\n\nhttps://doi.org/10.22159/ijcpr.2018v10i3.27225\n\n\nhttps://doi.org/10.1186/s40360-016-0057-x\n\n\nhttps://doi.org/10.4103/2277-9167.94370\n\n\nhttps://www.moh.gov.my/moh/resources/Penerbitan/Garis%20Panduan/Garis%20panduan%20Umum%20(Awam)/National_Action_Plan_-_FINAL_29_june.pdf\n\n\nhttps://www.moh.gov.my/moh/resources/Penerbitan/Garis%20Panduan/Garis%20panduan%20Umum%20(Awam)/National_Action_Plan_-_FINAL_29_june.pdf\n\n\nhttps://www.moh.gov.my/moh/resources/Penerbitan/Garis%20Panduan/Garis%20panduan%20Umum%20(Awam)/National_Action_Plan_-_FINAL_29_june.pdf\n\n\nhttps://doi.org/10.3855/jidc.6731\n\n\nhttps://doi.org/10.1504/IJFSNPH.2010.032032\n\n\nhttps://doi.org/10.1007/s12262-009-0004-9\n\n\nhttps://www.pharmacy.gov.my/v2/en/documents/protocol-antimicrobial-stewardship-program-healthcare-facilities.html\n\n\nhttps://www.pharmacy.gov.my/v2/en/documents/protocol-antimicrobial-stewardship-program-healthcare-facilities.html\n\n\nhttps://doi.org/10.1186/s12879-016-1426-1\n\n\nhttps://doi.org/10.1002/14651858.CD000259.pub3\n\n\nhttps://doi.org/10.1016/j.jclinepi.2013.08.015\n\n\nhttps://doi.org/10.1097/00005650-199001000-00005\n\n\nhttps://doi.org/10.1093/qjmed/hci047\n\n\nhttps://www.pharmacy.gov.my/v2/sites/default/files/document-upload/national-antimicrobial-guideline-2019-full-version-3rd-edition.pdf\n\n\nhttps://www.pharmacy.gov.my/v2/sites/default/files/document-upload/national-antimicrobial-guideline-2019-full-version-3rd-edition.pdf\n\n\nhttps://www.pharmacy.gov.my/v2/sites/default/files/document-upload/national-antimicrobial-guideline-2019-full-version-3rd-edition.pdf\n\n\nhttps://doi.org/10.1111/imj.14102\n\n\nhttps://doi.org/10.1016/j.jinf.2016.01.007\n\n\nhttps://doi.org/10.1186/s13756-021-00929-4\n\n\n\n"
"\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nMal J Pharm . Volume 7 Issue 1 . June 2021 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of Pharmacy \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nA Publication of Malaysian Pharmacists Society \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Volume 7 Issue 1 June 2021 \n \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\n\n\n\n\nEditorial Board  \n\n\n\n\n\n\n\nEditor-in chief        : Assoc. Prof. Dr. Chan Siok Yee \n\n\n\nManaging Editor   : Assoc. Prof. Dr. Long Chiau Ming  \n\n\n\nAssociate Editors   : Prof. Dr. Habibah Abdul Wahad \n\n\n\n  Prof. Dr. Mohd Cairul Iqbal Mohd Amin \n\n\n\n  Prof. Dr. Wong Ting Wui \n\n\n\n  Prof. Dr. Lua Pei Lin \n\n\n\n  Prof. Dr. Chua Siew Siang  \n\n\n\n  Assoc. Prof. Dr. Asrul Asrul Akmal Shafie \n\n\n\n  Assoc. Prof. Dr. Mohd Makmor Bakry \n\n\n\n  Assoc. Prof. Dr. Mohamad Haniki Nik Mohamed  \n\n\n\n  Assoc. Prof. Dr. Mogana Sundari A/P Rajagopal  \n\n\n\n  Assoc. Prof. Dr. Tan Ching Siang \n\n\n\n  Assoc. Prof. Dr. Vikneswaran A/L Murugaiyah \n\n\n\n  Assoc. Prof. Dr. Aisyah Saad Abdul Rahim \n\n\n\n  Assoc. Prof. Dr. Lawrence Anchah  \n\n\n\n  Assistant Prof. Dr. Liew Kai Bin  \n\n\n\n  Dr. Toh Seok Ming  \n\n\n\n  Dr. June Choon Wai Yee \n\n\n\n  Dr. Liau Siao Yen \n\n\n\n  Dr. Syireen Alwi  \n\n\n\nDr. Nour Hanah Binti Othman \n\n\n\n  Dr. Mohd Shahezwan Abd Wahab \n\n\n\n  Mr. Kamarudin Ahmad \n\n\n\n  Mrs. Reem Abou Assi \n\n\n\nAdvisory Board : Emeritus Professor Dr. Yuen Kah Hay \n\n\n\nEmeritus Professor Dr. Paraidathathu Thomas A/L P.G. Thomas \n\n\n\nProf. Dr. Mohd Baidi Bahari  \n\n\n\nMr. Amrahi Buang  \n\n\n\nDr. Sheng Qi \n\n\n\nAssoc. Prof. Dr. Alberto Beradi  \n\n\n\nAssoc. Prof. Dr. Lorina Bisharat \n\n\n\nPublisher:    \n\n\n\nMalaysian Pharmacists Society  \n\n\n\n16-2 Jalan OP 1/5, 1-Puchong Business Park  \n\n\n\nOff Jalan Puchong  \n\n\n\n47160 Puchong, Malaysia  \n\n\n\nTel: 6-03-80791861  \n\n\n\nFax: 6-03-80700388  \n\n\n\nHomepage: www.mps.org.my  \n\n\n\nEmail: maljpharm@gmail.com  \n\n\n\n\n\n\n\nThe Malaysian Journal of Pharmacy is a publication of the Malaysian Pharmacists Society. Enquiries are to be \n\n\n\ndirected to the publisher at the above address. The Publisher reserves copy- right and renewal on all published \n\n\n\nmaterials, and such material may not be reproduced in any form without the written permission of the Publisher. \n\u00a9 Malaysian Journal of Pharmacy \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Volume 7 Issue 1 June 2021 \n \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\n\n\n\n\nTable of Content \n\n\n\n \nLetter  \n\n\n\n\n\n\n\nAntifungal Treatment of Mucormycosis Associated with COVID-19 \nChia Siang Kow*, Syed Imran Ahmed, Syed Shahzad Hasan \n\n\n\n1-2 \n\n\n\n\n\n\n\nShort communication  \n\n\n\n\n\n\n\nClinical Pharmacist in a COVID-19 Hospital- A Malaysian Experience \nLay Ting Pee*, Hairos Izha Rosli, Pei Feng Chong \n\n\n\n3-6 \n\n\n\n\n\n\n\nCase Study  \n\n\n\n\n\n\n\nWarfarin - Fenofibrate Interaction: Hospital Kuala Lumpur Experience \nChew Ken Wey, Evelyn Chee Li Ching*, Naga Jothy Nagesvararao, Nirmala Jagan \n\n\n\n7-10 \n\n\n\n\n\n\n\nMonotherapy with Lopinavir/Ritonavir or in Combination with Interferon \n\n\n\nBeta-1b in Patients with Non-severe COVID-19 Disease: A Clinical Case \n\n\n\nSeries \nKuok Leong Ng*, Weng Chio, Io Chon Vong*, Chan Chan Si, Veng Va Chau, Si Man Wong, \n\n\n\nTou Chan Cheong, Iok Tong Wong \n\n\n\n11-15 \n\n\n\n\n\n\n\nOriginal Research Articles  \n\n\n\n\n\n\n\nImpact of Medication Reconciliation by Clinical Pharmacist during Hospital \n\n\n\nAdmission of Patients with Chronic Kidney Disease (CKD) Stage IV-V in \n\n\n\nHospital Raub, Pahang \nChen Tze Seong \n\n\n\n16-21 \n\n\n\n\n\n\n\nPharmacy Value-Added Services: Experience in a Malaysian Public Hospital \nEmily Shin Ni Chung, Shin Mei Sim, Sui Fern Wong, Shirlie Chai*, Kamarudin Ahmad \n\n\n\n22-27 \n\n\n\n\n\n\n\nAnalgesic Dosing Behaviours in Patients with Chronic, Non-Cancer Pain: \n\n\n\nDoes it Affect the Pain Control? \nMohamad Akmal Bin Harun, Nurul Fateeha Binti Ahmad, Cheah Huey Miin* \n\n\n\n28-33 \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Volume 7 Issue 1 June 2021 \n \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\n\n\n\n\n \nUtilization of Anti-peptic Ulcer Drugs at an Outpatient Pharmacy Setting of a \n\n\n\nPrivate Hospital in Malaysia \nPuvithra Ravi Sundram, Ching Siang Tan*, Shashidharan Menon, H. Jaasminerjiit Kaur*, Kah \n\n\n\nSeng Lee, Abdullah Khan, Anandarajagopal Kalusalingam, Khang Wen Goh, Pit Wei Ng \n\n\n\n \n34-42 \n\n\n\n\n\n\n\nThe Effect of Pharmacist's Interventions on Anaemia Management among \n\n\n\nContinuous Ambulatory Peritoneal Dialysis Patients in Terengganu Tertiary \n\n\n\nHospital \nChui Wei Fong*, Wan Najiah Wan Mokhtar, Norlaila Kartina Malini Mamat, Muhammad Zaidi \n\n\n\nSattar, Zaiha Harun, Tengku Nur Izzati Tengku Abdul Kadir \n\n\n\n43-48 \n\n\n\n\n\n\n\nSupplementary  \n\n\n\n\n\n\n\nProceedings of MPS-National Pharmacists Convention 2021 \nEditors: Abubakar Sha'aban, Amer Hayat Khan, Amirah Mohd Gazzali, Balamurugan \n\n\n\nTangiisuran, Chan Siok Yee*, Dang Chee Chean, Hadzliana Zainal, Long Chiau Ming, Nur \n\n\n\nHafzan Md Hanafiah, Ooi Guat See, Sinan Mohammad Abdullah Al-Mahmood \n\n\n\n49-78 \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Volume 7 Issue 1 (2021) \n \n\n\n\n\n\n\n\n1 \n\n\n\n\n\n\n\n*Correspondence: chiasiang.kow@monash.edu  \n1School of Postgraduate Studies, International Medical University, Kuala \n\n\n\nLumpur, Malaysia \n2School of Pharmacy, Monash University Malaysia, Bandar Sunway, \n\n\n\nSelangor, Malaysia \n3School of Pharmacy, University of Lincoln, Lincolnshire, United Kingdom \n4Department of Pharmacy, University of Huddersfield, Huddersfield, \n\n\n\nUnited Kingdom  \n5School of Biomedical Sciences and Pharmacy, University of Newcastle, \n\n\n\nCallaghan, Australia \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n \nLetter \n\n\n\n\n\n\n\nAntifungal Treatment of Mucormycosis Associated with \n\n\n\nCOVID-19 \n \n\n\n\nChia Siang Kow1,2*, Syed Imran Ahmed3, Syed Shahzad Hasan4,5 \n\n\n\n \nMucormycosis is an angioinvasive fungal infection due to fungi \n\n\n\nof the order Mucorales. The prognosis from mucormycosis can \n\n\n\nbe poor despite early diagnosis and aggressive therapy. The \n\n\n\nsystematic review and meta-analysis by Muthu and colleagues \n\n\n\n[1] investigated the rate of mortality in patients with pulmonary \n\n\n\nmucormycosis. While there had been a significant decrease in \n\n\n\nthe mortality rate over time, the recent (2010-2020) rate of \n\n\n\nmortality is still substantial, in which about one in two patients \n\n\n\n(49.8%; 95% confidence interval 43.2% to 56.3%) with \n\n\n\npulmonary mucormycosis died from the disease. Yet, patients \n\n\n\noriginated from the lower-middle-income countries had a \n\n\n\nhigher mortality rate, in which about three in four patients \n\n\n\n(71.5%; 95% confidence interval 58.7% to 84.3%) with \n\n\n\npulmonary mucormycosis died from the disease. Indeed, there \n\n\n\nhas been a recent surge in the occurrence of mucormycosis in \n\n\n\nlower-middle-income countries,  especially in India. As raised \n\n\n\nby Szarpak [2], the increased incidence with a fairly severe \n\n\n\ncourse of mycormycosis was reported in patients with a history \n\n\n\nof coronavirus disease 2019 (COVID-19) and received \n\n\n\nsystemic corticosteroid therapy.  \n\n\n\n\n\n\n\nThe presence of multiple risk factors in patients with COVID-\n\n\n\n19, along with the additional immunosuppression caused by \n\n\n\nsystemic corticosteroids, predispose the occurrence of \n\n\n\nmucormycosis, which could negate the mortality benefits \n\n\n\noffered by systemic corticosteroids in this patient population \n\n\n\n[3]. Common risk factors include the presence of diabetes \n\n\n\nmellitus, particularly with ketoacidosis. Noteworthily, the \n\n\n\nmanagement of patients with mucormycosis, which is \n\n\n\nconsidered rare before the COVID-19 pandemic, had not been \n\n\n\noptimal as described in a case report [4]. Optimal antifungal \n\n\n\ntherapy is of utmost importance considering the substantial rate \n\n\n\nof mortality.   \n\n\n\n\n\n\n\nIntravenous amphotericin B is the drug of choice for initial \n\n\n\ntherapy of mucormycosis; a lipid formulation of amphotericin \n\n\n\nB (liposomal amphotericin B or amphotericin B lipid) is \n\n\n\npreferred to reduce the risk of nephrotoxicity. In a meta-\n\n\n\nanalysis of five randomized trials, the incidence of \n\n\n\nnephrotoxicity was significantly lower with liposomal \n\n\n\namphotericin B compared with amphotericin B deoxycholate \n\n\n\n(15% versus 33%; relative risk = 0.48; 95% confidence interval \n\n\n\n0.36 to 0.64) [6]. The usual starting dose for amphotericin B is \n\n\n\n5 mg/kg daily, which can be increased up to 10 mg/kg daily to \n\n\n\ncontrol the infection. \n\n\n\n\n\n\n\nWhile amphotericin B is generally considered the first-line \n\n\n\nagent for the treatment of mucormycosis. Posaconazole or \n\n\n\nisavuconazole is used as step-down therapy for patients who \n\n\n\nhave responded to amphotericin B. Therefore, once patients \n\n\n\nrespond and are deemed suitable for discharge, they could be \n\n\n\ninitiated with either one of the aforementioned antifungal \n\n\n\nagents. Posaconazole and isavuconazole are broad-spectrum \n\n\n\nazoles that are active in vitro against the pathogens of \n\n\n\nmucormycosis. A systematic review [7] of 96 case reports of \n\n\n\npatients with mucormycosis reported a response rate of 72.9% \n\n\n\nwith posaconazole. On the other hand, isavuconazole has been \n\n\n\nevaluated in a multicenter open-label single-arm study that \n\n\n\nincluded a total of 37 patients with mucormycosis [8]. When \n\n\n\nthe researchers compared patients, who received isavuconazole \n\n\n\nwith their contemporary counterparts who received \n\n\n\namphotericin B (the majority received a lipid formulation), it \n\n\n\nwas observed that the weighted all-cause mortality was similar \n\n\n\n\n\n\n\n\nKow, C.S. et al. Mal J Pharm 7 (1) 2021, 1-2 \n\n\n\n\n\n\n\n2 \n\n\n\n\n\n\n\nin those who received isavuconazole (33%) and in those who \n\n\n\nreceived amphotericin B followed by posaconazole (41%). \n\n\n\nPosaconazole (delayed-release tablets) can be dosed at 300 mg \n\n\n\nevery 12 hours on the first day, then 300 mg once daily, with \n\n\n\nno dosage adjustment necessary for patients with a decline in \n\n\n\nrenal function. Whereas isavuconazole can be loaded at a dose \n\n\n\nof 200 mg every 8 hours for 2 days, followed by a maintenance \n\n\n\ndose of 200 mg orally once daily starting 12 to 24 hours after \n\n\n\nthe last loading dose.  \n\n\n\n\n\n\n\nAntifungal therapy should be continued until clinical resolution \n\n\n\nof the signs and symptoms, as well as resolution of radiographic \n\n\n\nsigns of mucormycosis. Perhaps in the context where there is a \n\n\n\nwidespread outbreak of mucormycosis, the use of systemic \n\n\n\ncorticosteroids should be more judicious in patients at high risk, \n\n\n\nsuch as those with diabetes, keeping in mind that systemic \n\n\n\ncorticosteroids could aggravate hyperglycemia. The use of \n\n\n\nintravenous pulse methylprednisolone therapy for as short as \n\n\n\nthree days to limit its side effects can be considered [9]. \n\n\n\nBesides, baricitinib, a Janus kinase inhibitor, which has proven \n\n\n\nmortality benefits, can be considered as an alternative to \n\n\n\nsystemic corticosteroids in patients with COVID-19 [10]. \n\n\n\n\n\n\n\nREFERENCE \n \n\n\n\n[1] Muthu V, Agarwal R, Dhooria S, et al. Has the mortality from \n\n\n\npulmonary mucormycosis changed over time? A systematic review \n\n\n\nand meta-analysis. Clin Microbiol Infect. 2021;27(4):538-549.  \n\n\n\n[2] Szarpak L. Mucormycosis - a serious threat in the COVID-19 \n\n\n\npandemic? [published online ahead of print, 2021 May 21]. J Infect. \n\n\n\n2021;S0163-4453(21)00257-7.  \n\n\n\n[3] Kow CS, Hasan SS. Corticosteroid-related in-hospital hyperglycemia: \n\n\n\ndoes it negate mortality benefits in COVID-19? [published online \n\n\n\nahead of print, 2020 Sep 18]. Clin Infect Dis. 2020;ciaa1423.  \n\n\n\n[4] Garg D, Muthu V, Sehgal IS, et al. Coronavirus Disease (Covid-19) \n\n\n\nAssociated Mucormycosis (CAM): Case Report and Systematic \n\n\n\nReview of Literature. Mycopathologia. 2021;186(2):289-298. \n\n\n\n[5] Rajendra Santosh AB, Muddana K, Bakki SR. Fungal Infections of \n\n\n\nOral Cavity: Diagnosis, Management, and Association with COVID-\n\n\n\n19 [published online ahead of print, 2021 Mar 27]. SN Compr Clin \n\n\n\nMed. 2021;1-12  \n\n\n\n[6] Mistro S, Maciel Ide M, de Menezes RG, Maia ZP, Schooley RT, \n\n\n\nBadar\u00f3 R. Does lipid emulsion reduce amphotericin B nephrotoxicity? \n\n\n\nA systematic review and meta-analysis. Clin Infect Dis. \n\n\n\n2012;54(12):1774-1777.  \n\n\n\n[7] Vehreschild JJ, Birtel A, Vehreschild MJ, et al. Mucormycosis treated \n\n\n\nwith posaconazole: review of 96 case reports. Crit Rev Microbiol. \n\n\n\n2013;39(3):310-324.  \n\n\n\n[8] Marty FM, Ostrosky-Zeichner L, Cornely OA, et al. Isavuconazole \n\n\n\ntreatment for mucormycosis: a single-arm open-label trial and case-\n\n\n\ncontrol analysis. Lancet Infect Dis. 2016;16(7):828-837.  \n\n\n\n[9] Hasan SS, Kow CS, Mustafa ZU, Merchant HA. Does \n\n\n\nmethylprednisolone reduce the mortality risk in hospitalized COVID-\n\n\n\n19 patients? A meta-analysis of randomized control trials [published \n\n\n\nonline ahead of print, 2021 May 4]. Expert Rev Respir Med. \n\n\n\n2021;10.1080/17476348.2021.1925546.  \n\n\n\n[10] Marconi VC, Ramanan AV, de Bono S, Kartman CE, Krishnan V, \n\n\n\nLiao R, Piruzeli ML, Goldman JD, Alatorre-Alexander J, de Cassia \n\n\n\nPellegrini R, Estrada V. Baricitinib plus Standard of Care for \n\n\n\nHospitalized Adults with COVID-19. Preprint. medRxiv. \n\n\n\n2021;2021.04.30.21255934  \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Volume 7 Issue 1 (2021) \n \n\n\n\n\n\n\n\n3 \n\n\n\n\n\n\n\n*Correspondence: layting118@gmail.com Department of Pharmacy, Sungai Buloh Hospital, Selangor, Malaysia \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n Short Communication \n\n\n\n\n\n\n\nClinical Pharmacist in a COVID-19 Hospital- A Malaysian \n\n\n\nExperience \n \n\n\n\nLay Ting Pee*, Hairos Izha Rosli, Pei Feng Chong \n\n\n\n\n\n\n\n  \nArticle Info  \n\n\n\n \nReceived date: 16 March 2021 \n\n\n\nAccepted date: 16 June 2021 \n\n\n\nPublished date: 30 June 2021 \n\n\n\n\n\n\n\nKeywords: Clinical Pharmacy, \n\n\n\nCOVID-19 Pandemic, SARS-\n\n\n\nCOV-2, Malaysia \n\n\n\nABSTRACT  \n\n\n\n\n\n\n\nThe coronavirus disease 2019 (COVID-19) pandemic has hugely affected healthcare services, \n\n\n\nparticularly pharmacy services in a COVID-19 hospital. Before the COVID-19 outbreak, clinical \n\n\n\npharmacists routinely reviewed patients\u2019 medications upon ward admission, actively participated in \n\n\n\nward rounds and partook in transitional care activities focusing on medication reconciliation and \n\n\n\npatient education in the wards. However, in order to limit contact with COVID patients, hospital \n\n\n\npharmacy department reacted promptly by establishing remote clinical pharmacy services in order to \n\n\n\nsustain the quality of inpatient pharmaceutical care. This commentary describes the challenges faced \n\n\n\nby clinical pharmacists in a Malaysian hospital as we continue to provide clinical pharmacy services \n\n\n\namidst the new norm.   \n\n\n\n\n\n\n\nINTRODUCTION  \n \n\n\n\nCoronavirus Disease 2019 (COVID-19) was caused by severe \n\n\n\nacute respiratory syndrome coronavirus 2 (SARS-CoV-2) and \n\n\n\nwas first identified in December 2019 in Wuhan, China [1].  \n\n\n\nThe virus is thought to have been transmitted by respiratory \n\n\n\ndroplets and contact routes. Droplets transmission can occur \n\n\n\nwhen an infected person with symptoms (e.g. coughing or \n\n\n\nsneezing) is in close contact (less than 1 m) with another person \n\n\n\n[2]. Infected droplets may also contaminate surfaces and \n\n\n\nobjects and a person may get infected by touching \n\n\n\ncontaminated surfaces or objects and then touching their eyes, \n\n\n\nnose or mouth [3]. Mild symptoms of COVID-19 includes \n\n\n\nfever, fatigue, myalgia, cough, sore throat, runny nose, \n\n\n\nsneezing or gastrointestinal symptoms (nausea, vomiting, \n\n\n\nabdominal pain, diarrhea). Critically, it can progress to acute \n\n\n\nrespiratory distress syndrome (ARDS) and may result in shock, \n\n\n\nencephalopathy, myocardial injury, heart failure, coagulation \n\n\n\ndysfunction and acute kidney injury [4].  \n\n\n\n\n\n\n\nAccording to the World Health Organization (WHO), as of 18 \n\n\n\nApril 2021, the total number of confirmed COVID-19 cases \n\n\n\nstood approximately 141 million cases with 3 million reported \n\n\n\ndeaths worldwide [5]. In Malaysia, the total number of cases \n\n\n\nare 375,054 with 1378 reported deaths [6]. In order to reduce \n\n\n\nthe spread of COVID-19, Malaysian government implemented \n\n\n\nstaggered movement control order starting from 18 March 2020 \n\n\n\ntill early 2021 [7]. In addition to that, the Malaysian Ministry \n\n\n\nof Health and the National Security Council have been actively \n\n\n\nurging the public to stay at home, practice social distancing, \n\n\n\nfrequent hand hygiene and to wear mask at all times [8]. \n\n\n\nIn combating COVID-19, the Ministry of Health has \n\n\n\ndesignated several hospitals and facilities to be COVID-19 \n\n\n\nreferral and screening centres for centralized and standardized \n\n\n\ninpatient treatment [9]. For the state of Selangor, Hospital \n\n\n\nSungai Buloh (HSgB) is the designated hospital to handle \n\n\n\nCOVID-19 cases [10]. HSgB is a 620-bedded hospital serving \n\n\n\nas the centre of excellence for infectious diseases, emergency \n\n\n\nand trauma, neurosurgery, maxilla-facial surgery, burn and \n\n\n\nplastic surgery and also orthopaedic and traumatology. HSgB \n\n\n\nessentially covers Gombak, Petaling and Kuala Selangor \n\n\n\ndistricts where these make up to 40% of the Selangor \n\n\n\npopulation or approximately 2.18 million populations [11]. As \n\n\n\nof 14 April 2021, Selangor has amassed a total of 121358 cases, \n\n\n\nthe highest in Malaysia with 350 deaths [12]. To date, HSgB \n\n\n\nhas treated a total of 44100 cases, with 267 mortalities [13]. \n\n\n\n\n\n\n\nHSgB\u2019s clinical pharmacy service consists of 19 full time ward \n\n\n\npharmacists in the following wards: neonatal intensive care \n\n\n\nunit, cardiac care unit, intensive care unit, medical wards (male \n\n\n\nand female), infectious disease wards, orthopedic male ward, \n\n\n\nsurgical male ward, obstetrics and gynecology wards, \n\n\n\nneurosurgical ward and paediatric wards. Routinely before the \n\n\n\nCOVID-19 pandemic, clinical pharmacists would review the \n\n\n\nappropriateness of medications by clerking patients\u2019 case notes, \n\n\n\nactively participate in ward rounds with physicians, partake in \n\n\n\n\n\n\n\n\n\n\n\n\nPee, L.T. et al. Mal J Pharm 7 (1) 2021, 3-6 \n\n\n\n\n\n\n\n4 \n\n\n\n\n\n\n\ntransitional care activities focusing on medication \n\n\n\nreconciliation, dispense patients\u2019 discharge medications at \n\n\n\nbedside and also handled patients\u2019 medication counseling and \n\n\n\neducation in the wards.  \n\n\n\n\n\n\n\nChallenges but now the new norm \n\n\n\n\n\n\n\nAs soon as HSgB was declared as a COVID hospital, we \n\n\n\nswiftly changed our usual ways of daily duties, to better support \n\n\n\nthe pharmacy department and hospital as a whole. Our routine \n\n\n\nchanged to adapt the \u201cnew norm\u201d way of life, to avoid 3Cs \n\n\n\n(crowded places, confined spaces and close conversation) and \n\n\n\nto practice 3Ws (wash, wear and warn). Some of the challenges \n\n\n\nthat we faced were staggered working hours to ensure social \n\n\n\ndistancing is practiced, limited assessment of patients in the \n\n\n\nward with no participation in clinical rounds with the \n\n\n\nphysicians, inadequate evidence for COVID-19 treatment, \n\n\n\nmedication administration and charting accuracy in the wards, \n\n\n\nlack of assessment in patients\u2019 own medication history and the \n\n\n\nmedication availability during their admission, and the \n\n\n\nincreasing involvement albeit lack of experience, in clinical \n\n\n\ntrials with the physicians. \n\n\n\n\n\n\n\nStaggered working hours and work from home (WFH) \n\n\n\nschedule \n\n\n\n\n\n\n\nIn order to promote social distancing and less crowding at our \n\n\n\nwork places, we had to rapidly rearrange our work force, and at \n\n\n\nthe same time ensure adequate support to the entire pharmacy \n\n\n\nand hospital services. We utilized a pairing system among \n\n\n\nclinical pharmacists whereby one of the pair will be present at \n\n\n\nwork and the partner will be contactable via phone during WFH \n\n\n\nhours. Effective communication and proper passing over had \n\n\n\nensured that patients continuously received the best possible \n\n\n\npharmaceutical care needed.  \n\n\n\n\n\n\n\nLimited assessment in inpatient pharmaceutical care \n\n\n\n\n\n\n\nIn order to limit contact with COVID-19 patients and to prevent \n\n\n\nunnecessary use of Personal Protective Equipment (PPE), we \n\n\n\nhave resorted to remote inpatient review by clerking patients at \n\n\n\npharmacy workstations instead of traditionally in the wards. \n\n\n\nMedication reviews are done through a local area network via \n\n\n\nelectronic Hospital Information System (eHIS). On the other \n\n\n\nhand, medication-related interventions identified by clinical \n\n\n\npharmacists are communicated to the wards via telephone.  In \n\n\n\naddition, tele-pharmaceutical strategies have also been \n\n\n\nimplemented for patient care [14, 15]. Such strategies include \n\n\n\nremote communication through phone or video call to obtain \n\n\n\npatients\u2019 medication history and medication counseling. \n\n\n\nFurthermore, instructional videos for medical device \n\n\n\ncounseling such as insulin pen and inhalers are first sent to \n\n\n\npatients\u2019 smart phones for self-viewing. Once patients have \n\n\n\nviewed the instructional video, pharmacists will proceed to \n\n\n\nmake a video call to the patient for further assessment and \n\n\n\nclarification.  \n\n\n\n\n\n\n\nAnother challenge faced by clinical pharmacists was \n\n\n\nverification of medication administration in the wards. Prior to \n\n\n\nthe COVID-19 pandemic, most of the wards in HSgB fully \n\n\n\nutilized the electronic medication administration charting \n\n\n\nsystem. With this system, clinical pharmacists would normally \n\n\n\nverify that medication administrations were done properly and \n\n\n\naccurately in the ward. However during the pandemic, the \n\n\n\nwards employed a hybrid medication administration system of \n\n\n\nboth electronic as well as manual charting. The addition of \n\n\n\nmanual charting has been implemented as there has been extra \n\n\n\nnursing staff employed from other health facilities to cater to \n\n\n\nthe large volume of patients and unfortunately, these nurses are \n\n\n\nunfamiliar with the hospital\u2019s electronic system. The clinical \n\n\n\npharmacists thus have an added role to ensure that manual \n\n\n\ncharting of medication administration is done properly and \n\n\n\naccurately in the wards. Moreover, patients are warded in \n\n\n\nisolation rooms and staffs entering these rooms are restricted to \n\n\n\npreserve PPE supplies. Hence, for patients who are well and \n\n\n\nindependent, medications for the day are dispensed to patient\u2019s \n\n\n\nbedside and then self-administered by patients. With this new \n\n\n\nchange in practice, clinical pharmacists face difficulties by \n\n\n\nensuring that medications are indeed delivered to patients and \n\n\n\nthe manual charting are recorded accurately by the nurses. \n\n\n\n\n\n\n\nAvailability of patient\u2019s own medication \n\n\n\n\n\n\n\nDuring the COVID-19 season, we see heterogeneity of patients \n\n\n\nbeing admitted to the wards. Some patients have their \n\n\n\nunderlying co-morbidities followed up in private health \n\n\n\nfacilities and some of their prescribed medications are not \n\n\n\nreadily available under the public hospital medication \n\n\n\nformulary. These patients will therefore need their home \n\n\n\nmedications delivered to them directly during their inpatient \n\n\n\nstay for self-administration.  With this challenging logistic \n\n\n\nissue in hand, clinical pharmacists have to liaise with patients\u2019 \n\n\n\nfamily members to ensure that complete patients\u2019 home \n\n\n\nmedications are brought to the hospital soonest possible. \n\n\n\n\n\n\n\nAntiviral stewardship, use of novel experimental agents and \n\n\n\ninvolvement in clinical trials \n\n\n\n\n\n\n\nMost of the drugs which are currently being prescribed such as \n\n\n\nFavipiravir, Remdesivir, Tocilizumab and interferon, are either \n\n\n\nprescribed for experimental, compassionate or off-labelled use. \n\n\n\nAs an infectious disease (ID) hospital, clinical pharmacists \n\n\n\nwere actively practicing antimicrobial stewardship to ensure \n\n\n\neffective and judicial use of antimicrobials. However, at the \n\n\n\nstart of COVID-19 outbreak in Malaysia in February 2020, we \n\n\n\nhad to quickly adjust our direction to antiviral stewardship due \n\n\n\n\n\n\n\n\n\n\n\n\nPee, L.T. et al. Mal J Pharm 7 (1) 2021, 3-6 \n\n\n\n\n\n\n\n5 \n\n\n\n\n\n\n\nto the increased usage of antivirals in COVID-19 treatment. \n\n\n\nAntiviral stewardship has thus far helped in the development of \n\n\n\nlocal treatment protocol on repurposed antivirals, which \n\n\n\ncurrently guides practitioners in the best recommended doses \n\n\n\nand treatment regimes. On the other hand, this stewardship also \n\n\n\nhelps to monitor and manage drug shortages due to supply \n\n\n\nchain interruptions.  \n\n\n\n\n\n\n\nThe use of novel experimental agents proved to be an \n\n\n\nunprecedented and arduous decision based on their lack of \n\n\n\nclinical evidence in treating COVID-19, which is to be \n\n\n\nexpected. For the ease of all health practitioners in HSgB, the \n\n\n\nclinical pharmacists have been working hand-in-hand with \n\n\n\npharmacy resources and information unit and the ID physicians \n\n\n\nin creating a local, quick and comprehensive COVID-19 \n\n\n\ntreatment guide. In addition, medications used for COVID-19 \n\n\n\nis not readily available in our local setting hence challenging us \n\n\n\nto race against time in providing the most efficient treatment, \n\n\n\nespecially to the critically ill patients. Up until this moment in \n\n\n\nfacing this adversity, clinical pharmacists have been working \n\n\n\ntogether closely with inpatient and procurement pharmacists to \n\n\n\nensure the availability and timely supply of COVID-19 drugs \n\n\n\nare sustained.  \n\n\n\n\n\n\n\nThe pandemic also created opportunities for clinical \n\n\n\npharmacists to be involved in esteemed and renowned clinical \n\n\n\ntrials such as the Solidarity Trial initiated by WHO and \n\n\n\nSTORM Study initiated by the Malaysian Ministry of Health.    \n\n\n\n\n\n\n\nDISCUSSION  \n \n\n\n\nClinical pharmacist contributed to a great extent in current \n\n\n\npandemic, from administrative tasks to pharmaceutical \n\n\n\ninterventions by optimizing medication therapy in severe and \n\n\n\ncritically ill COVID-19 patients.  Overall, with the help of \n\n\n\ntechnology and collaboration from all other healthcare givers, \n\n\n\nclinical pharmacists were able to carry out our tasks the best we \n\n\n\npossibly could in these unprecedented times. We were able to \n\n\n\ncarry out our basic core duties of patient clerking remotely and \n\n\n\ngiving patient education and counseling virtually. However, in \n\n\n\nterm of inpatient medication reconciliation, this effort was \n\n\n\nlargely limited due to the instability of COVID-19 patients \n\n\n\nparticularly in patients with category 4 and above. We also \n\n\n\nencountered some difficulties when contacting family member \n\n\n\nor caregivers for medication reconciliation. Clinical \n\n\n\npharmacists\u2019 involvement in the antimicrobial stewardship \n\n\n\ncould have been further enhanced to ensure judicious use of \n\n\n\nantibiotic with the increased use of antibiotic in COVID-19 \n\n\n\npatients. This effort would require extended collaboration with \n\n\n\nother healthcare givers who are pre-occupied with patient-care \n\n\n\nnow.   \n\n\n\n\n\n\n\nThis commentary describes the main activities and challenges \n\n\n\nfaced by clinical pharmacists during the first wave of the \n\n\n\nCOVID-19 pandemic. Considering the lessons learnt, future \n\n\n\neffort should look into efficacy and safety of virtual patient \n\n\n\ncare, the impact of COVID-19 on patient pharmaceutical care \n\n\n\nas well as healthcare-related cost-saving in middle income \n\n\n\ncountry.  \n\n\n\n\n\n\n\nCONCLUSION  \n \n\n\n\nIn summary, we as clinical pharmacists in a COVID-19 \n\n\n\nhospital faced an unprecedented and challenging situation since \n\n\n\nthe pandemic began globally. We needed to act swiftly and \n\n\n\nproactively in response to the Covid-19 outbreak in order to \n\n\n\nsustain the quality of patient care and continue to adapt the new \n\n\n\nnorm as a way of work and life.  We learnt the importance of a \n\n\n\ncontingency plan to cater for sudden changes in usual practice, \n\n\n\nsuch as a pandemic of a novel virus. We need to be versatile \n\n\n\nand ever ready to accept and adapt to new changes. Last but not \n\n\n\nleast, teamwork is important to achieve a greater good for the \n\n\n\nbest patient care during the COVID-19 pandemic.   \n\n\n\n\n\n\n\nACKNOWLEDGMENT \n  \n\n\n\nWe would like to thank the Director General of Health \n\n\n\nMalaysia for his permission to publish this article.  \n\n\n\n\n\n\n\nCONFLICT OF INTEREST \n \n\n\n\n The authors declare no conflict of interest.  \n\n\n\n\n\n\n\nREFERENCE \n \n[1] World Health Organization [Internet] Newsroom. WHO Timeline- \n\n\n\nCOVID-19. [cited 2020 June 4]. Available from \n\n\n\nhttps://www.who.int/news-room/detail/27-04-2020-who-timeline---\n\n\n\ncovid-19. \n\n\n\n[2] World Health Organization [Internet] Newsroom. Modes of \n\n\n\ntransmission of virus causing COVID-19: implications for IPC \n\n\n\nprecaution recommendations. [cited 2020 June 4]. Available from: \n\n\n\nhttps://www.who.int/emergencies/diseases/novel-coronavirus-2019. \n\n\n\n[3] Ministry of Health, Malaysia [Internet]. COVID-19: Management \n\n\n\nGuideilnes for Workplaces. March 2020. [cited 2020 June 16]. \n\n\n\nAvailable from: https//covid-19.moh.gov.my/garis-panduan/garis-\n\n\n\npanduan-kkm. \n\n\n\n[4] Yuki K, Fujiogi M, Koutsogiannaki S. COVID-19 pathophysiology: \n\n\n\nA review. Clin Immunol. 2020 Jun: 215:108427.doi: \n\n\n\n10.1016/j.clim.2020.108427. Epub 2020 Apr 20. PMID: \n\n\n\n32325252;PMCID: PMC7169933.  \n\n\n\n[5] World Health Organization [Internet]. Coronavirus disease (COVID-\n\n\n\n19) dashboard. [cited 2021 April 18]. Available from: \n\n\n\nhttps//covid19.who.int/ \n\n\n\n[6] Department of Statistics Malaysia [Internet]. COVID-19 Current \n\n\n\nSituation in Malaysia. [cited 2021April 18]. Available from: \n\n\n\nhttps://ukkdosm.github.io/covid-19.  \n\n\n\n[7] Majlis Keselamatan Negara [Internet]. COVID-19. [cited 2020 June \n\n\n\n4]. Available from: https//www.mkn.gov.my/web/ms/covid-19/ \n\n\n\n\n\n\n\n\n\n\n\n\nPee, L.T. et al. Mal J Pharm 7 (1) 2021, 3-6 \n\n\n\n\n\n\n\n6 \n\n\n\n\n\n\n\n[8] Ministry of Health, Malaysia [Internet]. Infografik. [cited 2020 June \n\n\n\n4]. Available from: https://covid-19.moh.gov.my/infografik \n\n\n\n[9] Song Z, Hu Y, Zheng S, Yang L, Zhao R. Hospital Pharmacists\u2019 \n\n\n\nPharmaceutical Care for Hospitalized Patients with COVID-19: \n\n\n\nRecommendations and Guidance from Clinical Experience. Res \n\n\n\nSocial Adm Pharm. 2020 Apr 3:S1551-7411(20)30314-4. \n\n\n\nDoi:10.1016/j.sapharm.2020.03.027. Epub ahead of print PMID: \n\n\n\n32273253; PMCID:PMC7129111. \n\n\n\n[10] Ministry of Health, Malaysia [Internet]: Senarai Hospital COVID dan \n\n\n\nPusat Saringan. March 2020 [ cited 2020 June 4]. Available from: \n\n\n\nhttps://covid-19.moh.gov.my/ \n\n\n\n[11] Hospital Sungai Buloh [Internet]. Background. [cited 2020 June 12]. \n\n\n\nAvailable from: \n\n\n\nhttps//hsgbuloh.moh.gov.my/index.php/ms/mengenai-kami/latar-\n\n\n\nbelakang. \n\n\n\n[12] Department of Statistic Malaysia [Internet]. COVID-19 Current \n\n\n\nSituation in Malaysia. [cited 2021April 14]. Available form: \n\n\n\nhttps://ukkdosm.github.io/covid-19. \n\n\n\n[13] Crisis Preparedness and Response Centre, Hospital Sungai Buloh.  \n\n\n\n[14] Li H, Zheng S, Liu F, Liu W, Zhao R. Fighting against COVID-19: \n\n\n\nInnovative strategies for clinical pharmacists. Res Social Adm Pharm. \n\n\n\n2020 Apr 6: S1551-7411(20)30328-4. \n\n\n\ndoi:10.1016/j.sapharm.2020.04.003. Epub ahead of print. PMID: \n\n\n\n32278766; PMCID: PMC7194937. \n\n\n\n[15] Bukhari N., Rasheed H., Nayyer B., Babar Z.U.D. Pharmacists at the \n\n\n\nfrontline beating the COVID-19 pandemic. J of Pharm Policy and \n\n\n\nPract. 2020:13(1):8.doi:10.1186/s40545-020-00210-w. \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Volume 7 Issue 1 (2021) \n \n\n\n\n\n\n\n\n7 \n\n\n\n\n\n\n\n*Correspondence: evelyncheelc@gmail.com \n\n\n\n\n\n\n\n1 Pharmacy Department, Hospital Kuala Lumpur, Malaysia \n2 Pharmacy Department, Hospital Selayang, Malaysia \n3 Primary Care Medicine Department, University Malaya, Malaysia \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n Case Study \n\n\n\n\n\n\n\nWarfarin - Fenofibrate Interaction: Hospital Kuala Lumpur \n\n\n\nExperience \n \n\n\n\nChew Ken Wey1, Evelyn Chee Li Ching1*, Naga Jothy Nagesvararao1,2, Nirmala Jagan1,3 \n\n\n\n\n\n\n\n  \nArticle Info  \n\n\n\n \nReceived date: 31 Dec 2020 \n\n\n\nAccepted date:  1 May 2021 \n\n\n\nPublished date: 30 June 2021 \n\n\n\n\n\n\n\nKeywords: warfarin, \n\n\n\nfenofibrate, interaction, INR  \n\n\n\nABSTRACT  \n\n\n\n\n\n\n\nCase reports in western populations reported that fenofibrate enhances the anticoagulatory effect of \n\n\n\nwarfarin. We are reporting ten cases of warfarin-fenofibrate interaction among Malaysian patients\u2019 \n\n\n\ncases that were managed at the anticoagulation clinic of Hospital Kuala Lumpur. Patients taking \n\n\n\nwarfarin and micronized fenofibrate 145mg daily concurrently between the year 2014 to 2018 were \n\n\n\nidentified in May 2018. Ten active patients were included, and the relevant data were retrieved \n\n\n\nretrospectively. All patients received warfarin for stroke prevention in atrial fibrillation (AF), with a \n\n\n\ntarget international normalised ratio (INR) of 2 to 3. No dose adjustment was done upon initiation of \n\n\n\nfenofibrate. Warfarin doses were adjusted to achieve the targeted range but fenofibrate was not \n\n\n\ndiscontinued. Eight patients had INR levels above the target range when INR being reassessed \n\n\n\nbetween 20 to 62 days after initiation of fenofibrate. Their weekly warfarin doses were between \n\n\n\n17.5mg-46.5mg. Baseline INR ranged between 1.6 -3.1. Percentage of dose reduction ranged \n\n\n\nbetween 5%-60%. Four of the patients were on other concurrent interacting medications such as statin \n\n\n\nand levothyroxine. Only one patient, whose case was with an INR 3.1 before initiation of fenofibrate, \n\n\n\nrequired admission for hematoma (INR 12). Two patients had INR within the target range, and INR \n\n\n\nwere assessed at 14 and 21 days after fenofibrate initiation. Their weekly warfarin doses were \n\n\n\nbetween 24.5mg and 26.5mg while baseline INR was 2.8 and 1.9 respectively. Interaction between \n\n\n\nfenofibrate and warfarin may increase INR among Malaysian patients, thus close monitoring of INR \n\n\n\nis warranted. Empirical warfarin dose reduction may be considered upon initiation of this drug \n\n\n\ncombination for patients with AF. The next INR reassessment date should be arranged not later than \n\n\n\nthree weeks after initiation of fenofibrate.   \n\n\n\n\n\n\n\nINTRODUCTION  \n  \n\n\n\nWarfarin has been the most commonly prescribed oral \n\n\n\nanticoagulant in the management of atrial fibrillation (AF), \n\n\n\nvenous thromboembolism and valvular heart disease, despite \n\n\n\nthe emergence of direct oral anticoagulants (DOACs). This has \n\n\n\nled to a high number of patients referred to anticoagulant \n\n\n\nclinics for warfarin therapy. The management of warfarin is \n\n\n\nchallenging because the drug has a narrow therapeutic index \n\n\n\nand is accompanied by drug-drug, drug-food, and drug-disease \n\n\n\ninteractions that may influence the anticoagulant effects. This \n\n\n\nmay lead to a change in patients\u2019 international normalized ratio \n\n\n\n(INR) and poses a risk of bleeding or thrombosis. \n\n\n\n\n\n\n\nIn Malaysia, fenofibrate is prescribed for patients with mixed \n\n\n\ndyslipidaemia and hypertriglyceridemia as well as patients \n\n\n\nwith mild to moderate hypercholesterolemia who are statin \n\n\n\nintolerant [1]. According to the Malaysian Statistics on \n\n\n\nMedicines 2011 \u2013 2014, there was an increasing trend of \n\n\n\nprescribing fenofibrates in the public sector [2].  The \n\n\n\nprevalence of dyslipidaemia in a patient with AF is 46.3% \n\n\n\naccording to International AF Registry therefore co-\n\n\n\nadministration of warfarin and fenofibrate by patients is \n\n\n\nbecoming more common [3]. \n\n\n\n\n\n\n\nFenofibrate had been reported to have major interaction with \n\n\n\nwarfarin from case reports [4-6]. These case reports showed a \n\n\n\nsignificant increase in INR upon initiation of fenofibrate in \n\n\n\npatients whose warfarin therapy had been stabilized [4-6]. An \n\n\n\nincrease in INR values will place the patients at higher risk of \n\n\n\nbleeding and/or hospitalization due to over-warfarinization. In \n\n\n\norder to address the issue, warfarin dose reduction or \n\n\n\n\n\n\n\n\nChew, K.W. et al. Mal J Pharm 7 (1) 2021, 7-10 \n\n\n\n\n\n\n\n8 \n\n\n\n\n\n\n\ndiscontinuation of fenofibrate are the options that had been \n\n\n\ndiscussed [4].  Different values of total warfarin dose reduction \n\n\n\nupon initiation of fenofibrate had been concluded from these \n\n\n\nreports [4-6].   \n\n\n\n\n\n\n\nThe mechanism of interaction between warfarin and \n\n\n\nfenofibrate is not clearly understood. One of the postulated \n\n\n\nmechanisms proposed is that the metabolism of either or both \n\n\n\nfenofibrate and (R)-enantiomer of warfarin, which are \n\n\n\nmetabolized via CYP 3A4 enzymes will be delayed, hence \n\n\n\nleading to the reduction in the clearance of warfarin [7]. On the \n\n\n\nother hand, fenofibrate inhibits CYP 2C9, a cytochrome that \n\n\n\nmetabolizes the (S)-enantiomer of warfarin, thereby reducing \n\n\n\nwarfarin elimination [7]. Pea F and Furlanut M. (2001) \n\n\n\nsuggested that the interaction is due to fenofibrate affecting the \n\n\n\ncoagulation synthesis factor by altering receptor synthesis [8]. \n\n\n\nLastly, it had been proposed that fenofibrate displaces warfarin \n\n\n\nfrom its protein-binding sites, hence enhancing the \n\n\n\nhypoprothrombinaemia effects [9]. \n\n\n\n\n\n\n\nCurrently, limited published data is describing warfarin-\n\n\n\nfenofibrate interaction among the multiracial Malaysian \n\n\n\npopulation. Genetic variations in CYP2C9 lead to the \n\n\n\nvariations in the response in warfarin metabolism [10]. Zhao et \n\n\n\nal showed that there are genetic variations of CYP2C9 in \n\n\n\ndifferent Singapore ethnics groups, namely Malay, Chinese, \n\n\n\nand Indian, which are similar to the Malaysian population [11]. \n\n\n\nThe details on the effect of warfarin-fenofibrate interaction in \n\n\n\nthe Malaysian population are scarce. We report ten cases of \n\n\n\nwarfarin-fenofibrate interaction among patients managed at \n\n\n\nHospital Kuala Lumpur (HKL), Malaysia. This clinic is co-\n\n\n\nmanaged by medical officers and clinical/ trained pharmacists \n\n\n\nto optimise anticoagulation therapy. \n\n\n\n\n\n\n\nMETHOD  \n  \n\n\n\nThe HKL Anticoagulation Registry was screened to identify \n\n\n\npatients prescribed with warfarin and fenofibrate concurrently, \n\n\n\nbetween 2014 and 2018. The relevant clinical information \n\n\n\nretrieved from the medical notes includes: demographic data, \n\n\n\nINR before and after initiation of fenofibrate, weekly warfarin \n\n\n\ndose before and after initiation of fenofibrate, concurrent \n\n\n\nmedications and incidences of bleeding. Incidences of bleeding \n\n\n\ninclude hematoma, gastrointestinal bleeding (GIB) and \n\n\n\nintracranial haemorrhage (ICH). Only incidences of bleeding \n\n\n\nthat were documented by the medical practitioners in the case \n\n\n\nnotes were considered. Results were limited to active adults of \n\n\n\nat least 18 years old who started on both warfarin and \n\n\n\nfenofibrate concurrently between 2014 and 2018.  \n\n\n\n\n\n\n\nPatients with missing needed data for the study, pregnant and \n\n\n\nlactating mothers were excluded. The study received approval \n\n\n\nfrom the National Medical Research Registration (NMRR-19-\n\n\n\n2171-48579). \n\n\n\n\n\n\n\nRESULT \n\n\n\n\n\n\n\nTen patients who fulfilled the inclusion criteria were identified \n\n\n\nduring screening. All 10 patients received Micronized \n\n\n\nFenofibrate 145mg (Lipantyl Penta\u00ae by Abbott) and a mixed \n\n\n\nbrand of warfarin between 2014 and 2018. The 10 patients \n\n\n\nreceived warfarin for the indication of stroke prevention in AF, \n\n\n\nwith a target INR of 2 to 3. Six of the patients were male. The \n\n\n\ndemographic data, baseline INR, and weekly warfarin dose \n\n\n\nprior to initiation of fenofibrate of patients are presented in \n\n\n\nTable I. Patients ranged from 46- to 76-year-olds. The baseline \n\n\n\nINR ranged from 1.6 to 3.1 with the weekly doses of warfarin \n\n\n\nbetween 17.5 mg to 46.5 mg.  \n\n\n\n\n\n\n\nDetails of the study data are presented in Table II. After \n\n\n\ninitiation of fenofibrate, only two patients had their INR levels \n\n\n\nmaintained within the target range while 8 patients had INR \n\n\n\nabove the target range. No adjustment to the weekly warfarin \n\n\n\ndose was made upon initiation of fenofibrate in all 10 patients. \n\n\n\nFenofibrate was not discontinued in all 10 patients. \n\n\n\n\n\n\n\nFor the 8 patients who had INR above the target range, their \n\n\n\nlevels were reassessed between 20 to 62 days after initiation of \n\n\n\nfenofibrate. Weekly warfarin doses were between 17.5mg to \n\n\n\n46.5mg with baseline INR between 1.6 and 3.1 upon initiation \n\n\n\nTable I: Demographic data, baseline INR and weekly warfarin dose prior to initiation of fenofibrate of patients \n\n\n\n\n\n\n\nNo Age (years) Gender Ethnicity INR before initiation of \n\n\n\nFenofibrate (Pre) \n\n\n\nINR within \n\n\n\nrange (Pre) \n\n\n\nWeekly Warfarin dose before \n\n\n\ninitiation of Fenofibrate (mg) \n\n\n\n1 68 Female Indian 2.8 Yes 24.5 \n\n\n\n2 51 Male Punjabi 2.9 Yes 46.5 \n\n\n\n3 67 Male Chinese 1.6 No 27.0 \n\n\n\n4 59 Male Indian 1.8 No 28.0 \n\n\n\n5 69 Male Malay 1.9 No 26.5 \n\n\n\n6 55 Female Indian 2.0 Yes 17.5 \n\n\n\n7 68 Female Malay 1.8 No 39.5 \n\n\n\n8 46 Male Malay 3.1 No 46.5 \n\n\n\n9 76 Female Chinese 2.0 Yes 17.5 \n\n\n\n10 61 Male Chinese 2.5 Yes 17.5 \n\n\n\n \n\n\n\n\n\n\n\n\nChew, K.W. et al. Mal J Pharm 7 (1) 2021, 7-10 \n\n\n\n\n\n\n\n9 \n\n\n\n\n\n\n\nof fenofibrate. Warfarin doses were adjusted by the prescribers \n\n\n\nto achieve the target range. The percentages of weekly warfarin \n\n\n\ndose dosage adjustment to achieve the targeted ranged between \n\n\n\n5% to 60%.  \n\n\n\n\n\n\n\nFour of the 8 patients were on other concurrent interacting \n\n\n\nmedications such as statin and levothyroxine. Patient 2, patient \n\n\n\n3, and patient 8 had fenofibrate initiated to substitute \n\n\n\ngemfibrozil. Patient 2 had simvastatin initiated on the same day \n\n\n\nas fenofibrate. This patient required 30% of the weekly \n\n\n\nwarfarin dosage adjustment to achieve the targeted range. \n\n\n\nPatient 3 had simvastatin changed to atorvastatin on the day of \n\n\n\nfenofibrate initiation. This patient required 7% changes in the \n\n\n\nweekly warfarin dosage after initiation of fenofibrate to \n\n\n\nachieve the targeted INR range. \n\n\n\n\n\n\n\nPatient 8 had an INR of 12 on the 26th days after the initiation \n\n\n\nof fenofibrate and required ward admission for hematoma. \n\n\n\nFenofibrate was not stopped but the weekly warfarin dose was \n\n\n\nreduced by 32% to achieve the targeted INR range. The \n\n\n\nlevothyroxine dose for patient 10 was increased from 75mcg to \n\n\n\n100mcg on the day of initiation of fenofibrate. \n\n\n\n\n\n\n\nTwo patients who had INR within their targeted range were \n\n\n\nreassessed at 14 and 21 days after initiation of fenofibrate. \n\n\n\nTheir weekly warfarin doses were between 24.5mg and 26.5mg \n\n\n\nwhile the baseline INR were 2.8 and 1.9 respectively. \n\n\n\n\n\n\n\nDISCUSSION  \n  \n\n\n\nEight patients were reported to have INR above the targeted \n\n\n\nrange. This is similar to the previously published case reports \n\n\n\n[4-6], whereby warfarin \u2013 fenofibrate interaction led to an \n\n\n\nincrease in INR for most of patients. The degree of changes \n\n\n\nvaried with reported case reports and among the multi-ethnic \n\n\n\npatients in this case series. The overall weekly warfarin dose \n\n\n\nreduction from baseline was highest among the Indians (2 \n\n\n\npatients; 5% & 60%), followed by Chinese (3 patients, ranging \n\n\n\nbetween 7% to 40%) and the lowest in Malays (2 patients; 14% \n\n\n\n& 32%, respectively). It is unclear whether the genetic \n\n\n\nvariations of CYP2C9 in different ethnicities contribute to the \n\n\n\nresult. \n\n\n\n\n\n\n\nHalf of the patients required reduction of 30% or more of their \n\n\n\nweekly warfarin dose to achieve the target INR range. One \n\n\n\npatient (Patient 8) had reported hematoma after initiation of \n\n\n\nfenofibrate. The effect of fenofibrate in warfarin could \n\n\n\npotentially influence the INR of 12 and resulted in a hematoma. \n\n\n\nPrevious studies had reported that the risk of major bleeding is \n\n\n\nhigh when INR is above 9 [12-13]. Our results were aligned \n\n\n\nwith previous published case reports that required up to 41% \n\n\n\nwarfarin dose reduction to maintain a therapeutic INR after \n\n\n\ninitiation of fenofibrate [4]. \n\n\n\n\n\n\n\nTwo of the patients had INR maintained within the target range \n\n\n\n14 and 21 days after initiation of fenofibrate. The other eight \n\n\n\npatients\u2019 INR was above the target range of 20 to 62 days after \n\n\n\nTable II: Detail data of patients after initiation of Micronized Fenofibrate 145mg. \n\n\n\n\n\n\n\nPatient \n\n\n\nNo \n\n\n\nWeekly \n\n\n\nWarfarin \n\n\n\ndose*(mg) \n\n\n\nTime to \n\n\n\nreassessment of \n\n\n\nINR\u2e38 (days) \n\n\n\nINR \u2e38 INR within \n\n\n\nrange \n\n\n\n(post) \n\n\n\nAdjusted \n\n\n\nWeekly \n\n\n\nWarfarin dose \n\n\n\n\u2e38(post) (mg) \n\n\n\nPercentage of \n\n\n\nweekly Warfarin \n\n\n\ndose reduction \n\n\n\n(%) \n\n\n\n\n\n\n\nRemarks \n\n\n\n1 24.5 21 2.8 Yes 24.5 No change - \n\n\n\n2 46.5 30 5.1 No 31.5 32 Gemfibrozil was substituted with \n\n\n\nfenofibrate \n\n\n\nSimvastatin was initiated on the \n\n\n\nsame day. \n\n\n\n3 27.0 57 3.6 No 25.0 7 Gemfibrozil was substituted with \n\n\n\nfenofibrate \n\n\n\nSimvastatin was substituted with \n\n\n\natorvastatin. \n\n\n\n4 28.0 62 3.4 No 26.5 5 - \n\n\n\n5 26.5 14 2.7 Yes 26.5 No change - \n\n\n\n6 17.5 30 7.3 No 7.0 60 - \n\n\n\n7 39.5 28 5.9 No 34.0 14 - \n\n\n\n8 46.5 26 12.0 No 31.5 32 Gemfibrozil substituted with \n\n\n\nfenofibrate. \n\n\n\nPatient was warded due to \n\n\n\nhematoma & elevated INR (12.0) \n\n\n\nduring the follow up in \n\n\n\nanticoagulation clinic. \n\n\n\n9 17.5 39 4.65 No 11.5 34  \n\n\n\n10 17.5 20 5.7 No 10.5 40 Levothyroxine dose was increased \n\n\n\nfrom 75 mcg once daily to 100 mcg \n\n\n\nonce daily. \n\n\n\n\n\n\n\n*Before initiation of Fenofibrate, \u2e38After initiation of Fenofibrate  \n\n\n\n\n\n\n\n\nChew, K.W. et al. Mal J Pharm 7 (1) 2021, 7-10 \n\n\n\n\n\n\n\n10 \n\n\n\n\n\n\n\ninitiation of fenofibrate. The degree of INR elevation in these \n\n\n\npatients may be affected by the duration of INR reassessment \n\n\n\nafter initiation of fenofibrate and concurrent interacting \n\n\n\nmedications. Our results indicated that the potential for the \n\n\n\nonset of interaction between warfarin and fenofibrate occurs \n\n\n\nafter 3 weeks. \n\n\n\n\n\n\n\nThree patients had their lipid-lowering fibric acid derivatives \n\n\n\nswitched from gemfibrozil to fenofibrate. Two of them (Patient \n\n\n\n2 and Patient 8) required 32% weekly warfarin dose reduction \n\n\n\nto achieve the target INR range, patient 8 eventually required \n\n\n\nto be warded due to hematoma. Another patient (Patient 3) \n\n\n\nrequired only 7% weekly warfarin dose reduction, however the \n\n\n\npatient\u2019s simvastatin (Known to cause an increase in INR when \n\n\n\nused concomitantly with warfarin) had been switched to \n\n\n\natorvastatin (No interaction with warfarin) on the same day as \n\n\n\ninitiation of fenofibrate [14]. The lower magnitude of \n\n\n\nfenofibrate-warfarin interaction for patient 3 may be affected \n\n\n\nby the switching of statins. Further investigation is needed to \n\n\n\nreview the contribution of these confounding factors towards \n\n\n\nthe degree of interaction between warfarin and fenofibrate. \n\n\n\n\n\n\n\nThere are potential limitations to consider in our case series. \n\n\n\nThe data were collected retrospectively without a control \n\n\n\ngroup. We were unable to assess the patient\u2019s adherence to the \n\n\n\nprescribed medication. Concurrent factors such as concurrent \n\n\n\nmedications and a mixed brand of warfarin used by patients \n\n\n\nmay have affected the outcome of the data. \n\n\n\n\n\n\n\nCONCLUSION  \n  \n\n\n\nEmpiric warfarin dosage reduction and close monitoring of \n\n\n\npatient\u2019s INR can be considered after initiation of fenofibrate \n\n\n\nbased on authors\u2019 experience. Individual patient characteristics \n\n\n\nsuch as concurrent medications and patient\u2019s adherence to \n\n\n\nprescribed medications should be considered when \n\n\n\ndetermining the extent of empiric warfarin dosage reduction. \n\n\n\nThe next INR reassessment date should be arranged not later \n\n\n\nthan three weeks after initiation of fenofibrate.  \n\n\n\n\n\n\n\nOur data showed that the overall weekly warfarin dose \n\n\n\nreduction after initiation of fenofibrate varied among the multi-\n\n\n\nethnic patients. The effect of different ethnicities on the degree \n\n\n\nof interaction between warfarin and fenofibrate requires further \n\n\n\ninvestigation. \n\n\n\n\n\n\n\nACKNOWLEDGMENT \n  \n\n\n\nWe would like to thank the Director General of Health \n\n\n\nMalaysia for his permission to publish this article. We would \n\n\n\nalso want to express our gratitude to Hospital Kuala Lumpur \n\n\n\n(HKL) Pharmacy Department and HKL Research & \n\n\n\nDevelopment Committee for their encouragement and support. \n\n\n\n\n\n\n\nCONFLICT OF INTEREST \n  \n\n\n\nThere is no conflict of interest.  \n\n\n\n\n\n\n\nREFERENCE \n \n\n\n\n[1] Clinical Practice Guideline: Management of Dyslipidaemia, 5th ed. \n\n\n\nMalaysia: Ministry of Health; 2017 July. Fibric Acid Derivatives \n\n\n\n(Fibrates); p.56.2. Rimal RN, Lapinski MK. Why health \n\n\n\ncommunication is important in public health: World Health \n\n\n\nOrganisation, , 2009:247-47. \n\n\n\n[2] Chok CFM and Chan LY. Malaysian Statistics on Medicines 2011 \u2013 \n\n\n\n2014. Malaysia: Ministry of Health Malaysia: Pharmaceutical \n\n\n\nServices Division. p254 \n\n\n\n[3] Alam M., Bandeali SJ., Shahzad SA., Lakkis N. Real-life Global \n\n\n\nSurvey Evaluating Patients with Atrial Fibrillation (REALISE-AF): \n\n\n\nResults of an International Observation Registry. Expert Rev. \n\n\n\nCardiovasc. Ther. 2012; 10(3), 283\u2013291. \n\n\n\n[4] Breault RR, Klakowicz A, George-Phillips KL, Bungard TJ. Warfarin \n\n\n\nDosing After Initiation of Fenofibrate. CJHP. 2005; 58 (1): 31-33. \n\n\n\n[5] Kim KY, Mancano MA. Fenofibrate potentiates warfarin effects. Ann \n\n\n\nPharmacotherapy 2003;37:212-215 \n\n\n\n[6] Aldridge MA, Ito MK. Fenofibrate and warfarin interaction. \n\n\n\nPharmacotherapy 2001; 21(7):886-889. \n\n\n\n[7] Nahar R, Sazena R, Deb R, Parakh R, Shad S, et al. CYP2C9, \n\n\n\nVKORC1, CYP4F2, ABCB1 and F5 variants: Influence on quality of \n\n\n\nlong-term anticoagulation. Pharmacological Reports. 2014; 66: 243-\n\n\n\n249. \n\n\n\n[8] Pea F, Furlanut M. Pharmacokinetic Aspects of Treating Infections in \n\n\n\nthe Intensive Care Unit: Focus on Drug Interactions. Clin \n\n\n\nPharmacokinet 2001; 40 (11): 833-868. \n\n\n\n[9] Aldridge MA, Ito MK. Fenofibrate and warfarin interaction. \n\n\n\nPharmacotherapy 2001;21(7):886-9. \n\n\n\n[10] Yin T, Miyata T. Warfarin dose and the pharmacogenomics of \n\n\n\nCYP2C9 and VKORC1- Rationale and perspectives. Thrombosis \n\n\n\nResearch. 2007; 120: 1\u201310 \n\n\n\n[11] Zhao F, Loke C, Rankin SC, Guo JY, Lee HS, et al. Novel CYP2C9 \n\n\n\ngenetic variants in Asian subjects and their influence on maintenance \n\n\n\nwarfarin dose. Clin Pharmacol Ther. 2004;76 (3): 210-219. \n\n\n\n[12] Gracia DA, Regan Susan, Crowther M, Hylek EM. The risk of \n\n\n\nhaemorrhage among patients with warfarin-associated coagulopathy. \n\n\n\nJournal of the American College of Cardiology. 2006; 47 (4): 804-\n\n\n\n808. \n\n\n\n[13] Pagano MB, Chandler WL. Bleeding risk and response to therapy in \n\n\n\npatients with INR higher than 9. Am J Clin Pathol. 2012; 138: 546-\n\n\n\n550    \n\n\n\n[14] Wiggins, B. S., Saseen, J. J., Page, R. L., 2nd, Reed, B. N., Sneed, K., \n\n\n\nKostis, J. B., Lanfear, D., Virani, S., Morris, P. B., & American Heart \n\n\n\nAssociation Clinical Pharmacology Committee of the Council on \n\n\n\nClinical Cardiology; Council on Hypertension; Council on Quality of \n\n\n\nCare and Outcomes Research; and Council on Functional Genomics \n\n\n\nand Translational Biology (2016). Recommendations for \n\n\n\nManagement of Clinically Significant Drug-Drug Interactions With \n\n\n\nStatins and Select Agents Used in Patients With Cardiovascular \n\n\n\nDisease: A Scientific Statement From the American Heart \n\n\n\nAssociation. Circulation, 134(21), e468\u2013e495. \n\n\n\nhttps://doi.org/10.1161/CIR.0000000000000456 \n\n\n\n\n\n\n\n \n\n\n\n\nhttps://doi.org/10.1161/CIR.0000000000000456\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Volume 7 Issue 1 (2021) \n \n\n\n\n\n\n\n\n11 \n\n\n\n\n\n\n\n*Correspondence: ivan@ssm.gov.mo; \n\n\n\nmicmicvongchon@gmail.com \n\n\n\n\n\n\n\n\n\n\n\n1 Department of Administration, Centro Hospitalar Conde de S\u00e3o Janu\u00e1rio, \n\n\n\nHealth Bureau, Macao SAR Government, China \n2 Division of Pharmacy, Centro Hospitalar Conde de S\u00e3o Janu\u00e1rio, Health \n\n\n\nBureau, Macao SAR Government, China \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n Case Studies \n\n\n\n\n\n\n\nMonotherapy with Lopinavir/Ritonavir or in Combination \n\n\n\nwith Interferon Beta-1b in Patients with Non-severe COVID-19 \n\n\n\nDisease: A Clinical Case Series \n \nKuok Leong Ng1*, Weng Chio2, Io Chon Vong2*, Chan Chan Si2, Veng Va Chau2, Si Man Wong2, Tou \n\n\n\nChan Cheong2, Iok Tong Wong2 \n\n\n\n\n\n\n\n  \nArticle Info  \n\n\n\n \nReceived date: 19 April 2021 \n\n\n\nAccepted date: 1 June 2021 \n\n\n\nPublished date: 30 June 2021 \n\n\n\n\n\n\n\nKeywords:  \n\n\n\nLopinavir/ritonavir, Interferon \n\n\n\nbeta-1b, COVID-19, PCR, \n\n\n\nLength of hospitalization, \n\n\n\nMacau \n\n\n\nABSTRACT  \n\n\n\n\n\n\n\nThe outbreak of Coronavirus Disease 2019 (COVID-19), caused by severe acute respiratory \n\n\n\nsyndrome (SARS) coronavirus (SARS-CoV-2), has infected and killed millions of people worldwide. \n\n\n\nIt has substantially increased the burden on healthcare system. However, the optimal approach to \n\n\n\ntreatment of COVID-19 is uncertain. \u201cOff-label\u201d use of lopinavir/ritonavir (LPV/r) and interferons, \n\n\n\nparticularly interferon beta (IFN-\u03b2), were the most suggested at the early stage. Although the United \n\n\n\nStates National Institutes of Health\u2019s (NIH) COVID-19 guidelines do not recommend the use of both \n\n\n\nmedications for the treatment of COVID-19 in hospitalized patients, their roles in patients with non-\n\n\n\nsevere disease are still unclear. Macau, a famous city for tourism, had 46 COVID-19 confirmed cases \n\n\n\nas of 2020. In this retrospective review, we summarized clinical and laboratory features of 39 \n\n\n\nCOVID-19 patients admitted in the Centro Hospitalar Conde de S\u00e3o Janu\u00e1rio (CHCSJ), of whom all \n\n\n\ndid not receive oxygen therapy or ventilatory support during hospitalization. Of note, 12 (30.8%) of \n\n\n\nthem were asymptomatic. The most common symptoms were fever and cough upon admission. They \n\n\n\nwere all treated with LPV/r \u00b1 IFN-\u03b2-1b plus supportive care. The mean length of hospitalization was \n\n\n\n26.6 (SD \u00b1 12.6) days with LPV/r monotherapy, whereas 27.8 (SD \u00b1 10.1) days with LPV/r/IFN-\u03b2-\n\n\n\n1b combination therapy (p=0.65). The percentage of 28-day negative results for polymerase chain \n\n\n\nreaction (PCR) test were 67.9% (19 of 28) with monotherapy and 63.6% (7 of 11) with combination \n\n\n\ntherapy (p=0.80). No fatal case was reported and all patients discharged successfully. No beneficial \n\n\n\nclinical outcome was observed with the addition of IFN-\u03b2-1b to LPV/r-based therapy. Further studies \n\n\n\nare warranted to confirm these findings. \n\n\n\n\n\n\n\nINTRODUCTION  \n  \n\n\n\nAt the end of 2019, a novel coronavirus was identified as the \n\n\n\ncause of atypical pneumonia in Wuhan, a city in the Hubei \n\n\n\nProvince of China and quickly spread in a number of countries. \n\n\n\nIn February 2020, the World Health Organization (WHO) \n\n\n\nnamed the disease COVID-19, which stands for coronavirus \n\n\n\ndisease 2019 [1]. The virus that causes COVID-19 is called \n\n\n\nsevere acute respiratory syndrome coronavirus 2 (SARS-CoV-\n\n\n\n2). As of Dec, 2020, it has infected more than 79 million \n\n\n\npatients with over 1.7 million deaths globally [2]. Moreover, \n\n\n\nhealthcare professionals are now facing a big challenge, in \n\n\n\nparticular on the treatment and the burden on the health care \n\n\n\nsystem. However, the optimal approach to treatment of \n\n\n\nCOVID-19 remains uncertain. Lopinavir/ritonavir (LPV/r) and \n\n\n\ninterferon beta (IFN-\u03b2), in particular interferon beta-1b were \n\n\n\nthe most proposed treatment options in off-label use at the early \n\n\n\nstage of pandemic due to modest activity in vitro against \n\n\n\nSARS-CoV and Middle East respiratory syndrome (MERS)-\n\n\n\nCoV. Although the United States National Institutes of \n\n\n\nHealth\u2019s (NIH) COVID-19 guidelines in Oct, 2020 [3] did not \n\n\n\nrecommend the use of both medications for treating COVID-\n\n\n\n19 in hospitalized patients, their roles in patients with non-\n\n\n\nsevere disease are still unclear. Macau, a Special \n\n\n\n\nmailto:ivan@ssm.gov.mo\n\n\nmailto:micmicvongchon@gmail.com\n\n\n\n\n\n\nNg, K.L. et al. Mal J Pharm 7 (1) 2021,11-15 \n\n\n\n\n\n\n\n12 \n\n\n\n\n\n\n\nAdministrative Region of the People\u2019s Republic of China \n\n\n\nreported a total of 46 COVID-19 cases in 2020. Among them, \n\n\n\nover 80 % were non-severe meaning that they did not need \n\n\n\noxygenation or mechanical ventilatory support during \n\n\n\nhospitalization. In this retrospective study, we collected data \n\n\n\nfrom 39 patients with COVID-19 admitted to the Centro \n\n\n\nHospitalar Conde de S\u00e3o Janu\u00e1rio (CHCSJ), which is the \n\n\n\ndesignated hospital for managing all COVID-19 patients in \n\n\n\nMacau SAR, China. All patients were treated with LPV/r \n\n\n\nmonotherapy or in combination with IFN-\u03b2-1b plus supportive \n\n\n\ncare. This study was to observe whether any clinical benefit \n\n\n\nexists by adding IFN-\u03b2-1b to LPV/r-based therapy compared \n\n\n\nwith LPV/r monotherapy.  \n\n\n\n\n\n\n\nMETHOD  \n  \n\n\n\nStudy design and participants \n\n\n\n\n\n\n\nEthical approval (document no. 0067/DAH/N/2020) was \n\n\n\nobtained from the ethical committee of Centro Hospitalar \n\n\n\nConde de S\u00e3o Janu\u00e1rio, Macau Health Bureau, Macau SAR, \n\n\n\nChina. Eligibility criteria for this study were patients with \n\n\n\nconfirmed COVID-19 disease and hospitalized at CHCSJ, \n\n\n\nwhile fulfilled the below clinical classification of non-severe \n\n\n\ndisease, and received LPV/r for a median of 21 days \u00b1 IFN-\u03b2-\n\n\n\n1b for a median of 14 days plus supportive care (i.e. \n\n\n\nsymptomatic drug treatment as well as general inpatient care \n\n\n\nincluding daily vital signs monitoring and regular biochemistry \n\n\n\ntests). We reviewed the details from medical records including \n\n\n\ndemographics, past medical history, laboratory results, \n\n\n\nradiological findings, clinical management, length of \n\n\n\nhospitalization and time to completed negative result for \n\n\n\npolymerase chain reaction (PCR) test.   \n\n\n\n\n\n\n\nPCR assay for SARS-CoV-2 \n\n\n\n\n\n\n\nSamples were mainly taken from nasopharyngeal swabs (NPS) \n\n\n\nin all patients. The extraction of nucleic acid from samples was \n\n\n\nperformed using EasyMag in accordance with the \n\n\n\nmanufacturer's instructions (bioMerieux, France). Extracted \n\n\n\nnucleic acid samples were tested for SARS-CoV-2 with qRT-\n\n\n\nPCR using a commercial SARS-CoV-2 (previously known as \n\n\n\n2019- nCoV) ORF1ab/N Gene Nucleic acid detection kit \n\n\n\n(BioGerm, China) and the LightCycler 480 real-time PCR \n\n\n\nsystem (Roche, Switzerland) in accordance with \n\n\n\nmanufacturer's instructions.  \n\n\n\n\n\n\n\nDefinitions for clinical classification \n\n\n\n\n\n\n\nAccording to the United States National Institutes of Health\u2019s \n\n\n\n(NIH) COVID-19 guidelines [3], severe illness is defined as \n\n\n\nindividuals who have SpO2 <94% on room air at sea level, a \n\n\n\nratio of arterial partial pressure of oxygen to fraction of inspired \n\n\n\noxygen (PaO2/FiO2) <300 mm Hg, respiratory frequency >30 \n\n\n\nbreaths/min, or lung infiltrates >50%. Whereas critical illness \n\n\n\nrefers to individuals who have respiratory failure, septic shock, \n\n\n\nand/or multiple organ dysfunction. In this study, we defined \n\n\n\nnon-severe COVID-19 disease patients as those who were \n\n\n\nasymptomatic or presymptomatic, mild illness with signs and \n\n\n\nsymptoms compatible with upper respiratory tract infection \n\n\n\n(e.g. isolated low-grade fever, cough, rhinorrhea or myalgia), \n\n\n\nmoderate illness that exhibited lower respiratory tract infection \n\n\n\n(e.g. pneumonia or bronchitis) but did not present with hypoxia \n\n\n\n(oxygen saturation \u2264 94 percent on room air) or need for \n\n\n\noxygenation or mechanical ventilatory support during \n\n\n\nhospitalization. \n\n\n\n\n\n\n\nCOVID treatments \n\n\n\n\n\n\n\nAll included patients with no contraindications received LPV/r \n\n\n\n(400 mg/100 mg) twice daily for a median of 21 days. Besides, \n\n\n\nthey were given either azithromycin 500mg daily or \n\n\n\nlevofloxacin 500-750mg daily as prophylactic agent for \n\n\n\nsecondary bacterial infection. Patients with an early onset of \n\n\n\nillness (within 7 days) were given interferon beta-1b 250mcg \n\n\n\n(8 million IU) subcutaneously every other day for a median of \n\n\n\n14 days when the drug was available in Macau.  Symptomatic \n\n\n\ntreatments (e.g. antipyretics, antihistamines and expectorants, \n\n\n\netc.) were given when required. The standard biochemistry, \n\n\n\nimaging tests were systematically performed upon admission. \n\n\n\n\n\n\n\nCriteria for discharge  \n\n\n\n\n\n\n\nPatients with completed negative result for PCR assay (i.e. two \n\n\n\nconsecutive negative nasopharyngeal samples) were \n\n\n\ntransferred to other units for medical observation then \n\n\n\ndischarged in the absence of relapse.  \n\n\n\n\n\n\n\nMeasured Outcomes \n\n\n\n\n\n\n\nWe interpreted the collected data including the length of \n\n\n\nhospitalization and the percentage of 28-day negative result for \n\n\n\nPCR test via nasopharyngeal swabs. \n\n\n\n\n\n\n\nData and statistical analyses \n\n\n\n\n\n\n\nPatients\u2019 data are presented as absolute value, percentage, mean \n\n\n\n\u00b1 SD or median ((interquartile rage (IQR)). Continuous \n\n\n\nvariables and categorical variables were compared using the \n\n\n\nMann-Whitney U test and \u03c7\u00b2 test, respectively; P value of less \n\n\n\nthan 0.05 was considered statistically significant. All tables \n\n\n\nwere generated by JASP 0.14.1. \n\n\n\n \n\n\n\n\n\n\n\n\nNg, K.L. et al. Mal J Pharm 7 (1) 2021,11-15 \n\n\n\n\n\n\n\n13 \n\n\n\n\n\n\n\n Table I Demographic and clinical characteristics of the patients at admission \n\n\n\n\n\n\n\nCharacteristics  Lopinavir + ritonavir \n\n\n\n(n=28) \n\n\n\nLopinavir + ritonavir + interferon beta-\n\n\n\n1b (n=11) \n\n\n\nAge, median (IQR) \u2014 yr 24.5 (18.5) 44.0 (20.0) \n\n\n\n<18y \u2014 no. (%) 6 (21.4) 0 (0.0) \n\n\n\n18 to 59 y \u2014 no. (%) 21 (75.0) 11 (100.0) \n\n\n\n\u226560 y \u2014 no. (%) 1 (3.6) 0 (0.0) \n\n\n\nMale \u2014 no. (%) 16 (57.1) 8 (72.7) \n\n\n\nComorbidity \u2014 no. (%)  \n\n\n\nDiabetes mellitus  0 (0.0) 2 (18.2) \n\n\n\nHypertension 2 (7.1) 4 (36.4) \n\n\n\nCardiovascular disease  1 (3.6) 0 (0.0) \n\n\n\nCurrent smoker \u2014 no. (%) 2 (7.1) 2 (18.2) \n\n\n\nEx-smoker \u2014 no. (%) 4 (14.3) 3 (27.3) \n\n\n\nTime between onset of symptoms and hospitalization, median (IQR) \u2014 \n\n\n\ndays \n\n\n\n1.5 (8.0) 1.0 (5.5) \n\n\n\nSigns and symptoms \u2014 no. (%)  \n\n\n\nFever,    \n\n\n\nBody temperature \u226537.5\u2103 (%) 10 (35.7) 3 (27.3) \n\n\n\nBody temperature, median (IQR) \u2014\u2103 37.0 (0.9) 37.3 (1.2) \n\n\n\nCough  8 (28.6) 4 (36.4) \n\n\n\nSore throat 3 (10.7) 6 (54.5) \n\n\n\nMyalgia  3 (10.7) 1 (9.1) \n\n\n\nDiarrhea, \u22653 times/day  3 (10.7) 0 (0.0) \n\n\n\nHeadache  3 (10.7) 0 (0.0) \n\n\n\nRhinorrhea  3 (10.7) 1 (9.1) \n\n\n\nDizziness 2 (7.1) 1 (9.1) \n\n\n\nAbdominal pain 0 (0.0) 1 (9.1) \n\n\n\nLoss of smell  1 (3.6) 0 (0.0) \n\n\n\nRespiratory rate \u2265 24/min (%) 0 (0.0) 0 (0.0) \n\n\n\nSerum creatinine, median (IQR) \u2014 umol/L 67.5 (22.3) 77.0 (14.0) \n\n\n\nWhite cell count, median (IQR) \u2014 x109/L 5.4 (3.6) 5.2 (3.8) \n\n\n\nLymphocyte count, median (IQR) \u2014 x109/L 1.6 (0.9) 1.3 (0.6) \n\n\n\nAspartate transaminase, median (IQR) \u2014 U/L 20.0 (6.0) 33.0 (11.5) \n\n\n\nAlanine transaminase, median (IQR) \u2014 U/L 15.0 (25.0) 26.0 (38.0) \n\n\n\nLactate dehydrogenase, median (IQR) \u2014 U/L 166.5 (53.3) 176.0 (88.0) \n\n\n\nC-reactive protein, median (IQR) \u2014 mg/dL 0.1 (0.3) 0.3 (0.5) \n\n\n\n\n\n\n\nTable II Treatment and outcome \n\n\n\n\n\n\n\nOutcomes Lopinavir + ritonavir \n\n\n\n(n=28) \n\n\n\nLopinavir + ritonavir + interferon \n\n\n\nbeta-1b (n=11) \n\n\n\nDeath, no. (%) 0 (0.0) 0 (0.0) \n\n\n\nDischarged, no. (%) 28 (100.0) 11 (100.0) \n\n\n\n28-day negative result for PCR assay, no. (%) 19 (67.9) 7 (63.6) \n\n\n\nTime for completed negative PCR result, days   \n\n\n\nMean \u00b1 SD 25.7 \u00b1 14.5 25.5 \u00b1 5.4 \n\n\n\nMin \u2013 Max 6 - 63 18 - 33 \n\n\n\nLength of stay in hospital, days   \n\n\n\n        Mean \u00b1 SD 26.6 \u00b1 12.6 27.8 \u00b1 10.1 \n\n\n\n        Min - Max 6 - 61 12 - 47 \n\n\n\nPossible adverse events, no. (%)   \n\n\n\n     Dermatologic  2 (7.1) 4 (36.4) \n\n\n\n     Gastrointestinal  19 (67.9) 8 (72.7) \n\n\n\n     Endocrine and metabolic 3 (10.7) 2 (18.2) \n\n\n\n     Hepatic 1 (3.6) 0 (0.0) \n\n\n\n     Central nervous system 4 (14.3) 0 (0.0) \n\n\n\n     Neuromuscular and skeletal  0 (0.0) 1 (9.1) \n\n\n\n\n\n\n\n \n\n\n\n\nhttps://en.wikipedia.org/wiki/Aspartate_transaminase\n\n\nhttps://en.wikipedia.org/wiki/Alanine_transaminase\n\n\n\n\n\n\nNg, K.L. et al. Mal J Pharm 7 (1) 2021,11-15 \n\n\n\n\n\n\n\n14 \n\n\n\n\n\n\n\nRESULT \n \n\n\n\nA total of 46 patients were reviewed, seven patients did not \n\n\n\nfulfil the inclusion criteria. Therefore, 39 patients were lastly \n\n\n\nrecruited which accounted for 85% of the confirmed COVID-\n\n\n\n19 cases in Macau in 2020. Of note, 12 (30.8%) of them were \n\n\n\nasymptomatic. 28 patients were treated with LPV/r \n\n\n\nmonotherapy and 11 patients were treated with LPV/r/IFN-\u03b2-\n\n\n\n1b combination therapy. All patients received treatment on the \n\n\n\nday of admission, and successfully discharged in the end. The \n\n\n\nmedian age of patients was 24.5 years old (IQR 18.5) for the \n\n\n\nLPV/r monotherapy group; 44 years old (IQR 20.0) for the \n\n\n\nLPV/r/IFN-\u03b2-1b combination group. The most common \n\n\n\nsymptoms were fever and cough (with the exception of sore \n\n\n\nthroat in the combination group) in both groups at admission. \n\n\n\nThe median time between onset of symptoms and \n\n\n\nhospitalization was 1.5 day (IQR 8.0) for the monotherapy \n\n\n\ngroup and 1.0 day (IQR 5.5) for the combination group (Table \n\n\n\nI). The mean length of hospitalization was 26.6 (SD \u00b1 12.6) \n\n\n\ndays with LPV/r monotherapy whereas 27.8 (SD \u00b1 10.1) days \n\n\n\nwith LPV/r/IFN-\u03b2-1b combination therapy (p=0.65). The \n\n\n\npercentage of 28-day negative results for PCR test were 67.9% \n\n\n\n(19 of 28) with monotherapy and 63.6% (7 of 11) with \n\n\n\ncombination therapy (p=0.80). The most common adverse \n\n\n\nevents   possibly related to medications include diarrhea and \n\n\n\nskin rash. Those were minor and treated accordingly (Table II). \n\n\n\nThere was a potential risk of interaction with the disease and \n\n\n\nother drugs.  \n\n\n\n\n\n\n\nDISCUSSION  \n  \n\n\n\nIn this retrospective review, no beneficial clinical effect was \n\n\n\nobserved in hospitalized patients with COVID-19 with the \n\n\n\naddition of injectable IFN-\u03b2-1b (given within 7 days of \n\n\n\nsymptom onset) to oral protease inhibitor (LPV/r)-based \n\n\n\ntherapy. On the contrary, a multicenter, open-label, \n\n\n\nrandomized, phase 2 trial conducted in Hong Kong, over 80% \n\n\n\nincluded patients with mild to moderate disease, compared 14 \n\n\n\ndays of triple antiviral therapy (n = 86) (LPV/r [400 mg/100 mg \n\n\n\nq12h], ribavirin [400 mg q12h], IFN-\u03b2-1b [8 million IU x 3 \n\n\n\ndoses q48h]) with LPV/r alone (n = 41). Results showed that \n\n\n\ntriple therapy significantly shortened the duration of viral \n\n\n\nshedding and hospital stay in patients with mild-to-moderate \n\n\n\nCOVID-19, the median time of combination therapy from the \n\n\n\nbeginning of study treatment to negative nasopharyngeal swab \n\n\n\n(7 days [IQR 5\u201311]) than the control group (12 days [IQR 8\u2013\n\n\n\n15]; hazard ratio 4.37 [95% CI 1.86\u201310.24], p=0.0010) [4]. \n\n\n\nAnother retrospective cohort study demonstrated that ribavirin \n\n\n\ntherapy compared with supportive therapy in severe COVID-\n\n\n\n19, was not associated with improved negative conversion time \n\n\n\nfor SARS-CoV-2 test and was not associated with an improved \n\n\n\nmortality rate5. Compared with our findings without ribavirin, \n\n\n\nthe mean time to negative result was approximately 25 days \n\n\n\nbetween the two groups. Owing to small sample size and lack \n\n\n\nof control group, the results of our study could not draw a \n\n\n\nconclusion on how effective is LPV/r in non-severe COVID-19 \n\n\n\npatients. It is worth noting that the patients\u2019 age in the \n\n\n\ncombination group ranged from 18-59 years old. We postulated \n\n\n\nthat these patients may have better immune response so that the \n\n\n\nresults may be affected. In addition, most cases were imported \n\n\n\nfrom different parts of the world, the genotype or phenotype of \n\n\n\ndifferent viral variants they carried might interfere with the \n\n\n\nfindings.  \n\n\n\n\n\n\n\nAt present, the COVID-19 pandemic has caused a huge burden \n\n\n\nto the economy and healthcare system around the world. \n\n\n\nHealthcare professionals work under stress every day. In \n\n\n\nMacau, CHCSJ, the designated hospital for treating COVID-19 \n\n\n\noffered adequate resources for in-hospital care and isolation \n\n\n\nwards throughout the outbreak even for asymptomatic patients. \n\n\n\nAs a matter of fact, there are no clear criteria for hospital \n\n\n\nadmission with COVID-19. The criteria may vary with the \n\n\n\navailability of hospital resources. Nonetheless, according to the \n\n\n\nUS National Institutes of Health (NIH) COVID-19 Treatment \n\n\n\nGuidelines Panel3, most patients with mild illness can be \n\n\n\nmanaged in an ambulatory care setting or at home. Therefore, \n\n\n\nwe believed that some of our non-severe cases may be treated \n\n\n\nin the outpatient setting in principle. Although several \n\n\n\ninternational guidelines against the use of LPV/r in hospitalized \n\n\n\npatient based on the results from multiple clinical trials [6-8], \n\n\n\nits role in the outpatient setting is being investigated. Therefore, \n\n\n\nour findings may provide an important reference for future \n\n\n\ninvestigation in such situation.  \n\n\n\n\n\n\n\nCONCLUSION \n\n\n\n\n\n\n\nThis series illustrated that no clinical benefit was observed with \n\n\n\nthe addition of IFN-\u03b2-1b to LPV/r-based therapy plus general \n\n\n\nsupportive care in hospitalized COVID-19 patient. In addition, \n\n\n\nit may also provide important information for the use of LPV/r \n\n\n\nin outpatient settings. In fact, more powerful evidences are \n\n\n\nwarranted to confirm these findings. \n\n\n\n\n\n\n\nCONFLICT OF INTEREST \n \n\n\n\nThe author declares no conflict of interest. This research did \n\n\n\nnot receive any specific grant from funding agencies in the \n\n\n\npublic, commercial or not-for-profit sectors. \n\n\n\n\n\n\n\nACKNOWLEDGEMENT \n \n\n\n\nWe appreciate all the clinical, technical and paramedical staffs \n\n\n\nin Macau for their support in this big challenge. \n\n\n\n\n\n\n\nREFERENCE \n \n\n\n\n[1] World Health Organization. Director-General's remarks at the media \n\n\n\nbriefing on 2019-nCoV on 11 February 2020. Available from: \n\n\n\n\n\n\n\n\nNg, K.L. et al. Mal J Pharm 7 (1) 2021,11-15 \n\n\n\n\n\n\n\n15 \n\n\n\n\n\n\n\nhttp://www.who.int/dg/speeches/detail/who-director-general-s-\n\n\n\nremarks-at-the-media-briefing-on-2019-ncov-on-11-february-2020/. \n\n\n\n[2] World Health Organization. Coronavirus disease 2019 (COVID-19) \n\n\n\nsituation report. Dec 29, 2020. Available from: \n\n\n\nhttps://www.who.int/publications/m/item/weekly-epidemiological-\n\n\n\nupdate---29-december-2020/. \n\n\n\n[3] US Department of Health and Human Services (HHS) Panel on \n\n\n\nCOVID-19 Treatment Guidelines. Coronavirus disease 2019 \n\n\n\n(COVID-19) treatment guidelines. Available from: \n\n\n\nhttps://www.covid19treatmentguidelines.nih.gov/. \n\n\n\n[4] Hung IFN, Lung KC, Keung EY, Liu R, Chung TWH, Chu MY, et al. \n\n\n\nTriple combination of interferon beta-1b, lopinavir\u2013ritonavir, and \n\n\n\nribavirin in the treatment of patients admitted to hospital with COVID-\n\n\n\n19: an open-label, randomised, phase 2 trial, Lancet. 2020 May 8;395: \n\n\n\n1695\u2013704.  \n\n\n\n[5] Tong S, Su Y, Yu Y, Wu C, Chen JL, Wang SH, et al. Ribavirin \n\n\n\ntherapy for severe COVID-19: a retrospective cohort study. \n\n\n\nInternational Journal of Antimicrobial Agents. 2020;106114.  \n\n\n\n[6] RECOVERY Collaborative Group. Lopinavir-ritonavir in patients \n\n\n\nadmitted to hospital with COVID-19 (RECOVERY): a randomised, \n\n\n\ncontrolled, open-label, platform trial. Lancet. 2020 Oct 24; 396: 1345\u2013\n\n\n\n52. \n\n\n\n[7] World Health Organization. Solidarity Trial Consotium. Repurposed \n\n\n\nAntiviral drugs for COVID-19-Interim WHO Solidarity Trial Results. \n\n\n\nN Engl J Med. 2021 Feb 11; 384:497-511.  \n\n\n\n[8] Cao B, Wang YM, Wen DN, Liu W, Wang JL, Fan GH, et al. A Trial \n\n\n\nof Lopinavir\u2013Ritonavir in Adults Hospitalized with Severe Covid-19. \n\n\n\nEngl J Med. 2020 May 7; 382:1787-1799. \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Volume 7 Issue 1 (2021) \n \n\n\n\n\n\n\n\n16 \n\n\n\n\n\n\n\n*Correspondence: farmasihraub@gmail.com \n\n\n\n\n\n\n\nDepartment of Pharmacy, Hospital Raub, Ministry of Health Malaysia  \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n Original Research Article \n\n\n\n\n\n\n\nImpact of Medication Reconciliation by Clinical Pharmacist \n\n\n\nduring Hospital Admission of Patients with Chronic Kidney \n\n\n\nDisease (CKD) Stage IV-V in Hospital Raub, Pahang \n \n\n\n\nChen Tze Seong \n\n\n\n\n\n\n\n  \nArticle Info  \n\n\n\n \nReceived date: 16 Feb 2021 \n\n\n\nAccepted date: 8 June 2021 \n\n\n\nPublished date: 30 June 2021 \n\n\n\n\n\n\n\nKeywords:  \n\n\n\nmedication reconciliation, \n\n\n\nhospital admission, clinical \n\n\n\npharmacist, CKD stage IV-V  \n\n\n\nABSTRACT  \n\n\n\n\n\n\n\nMedication errors are more likely to occur during patient\u2019s transition of care. There was very little \n\n\n\ninformation about impact of medication reconciliation activities done for patients with chronic kidney \n\n\n\ndisease (CKD) Stage IV-V during admission stage in Malaysian Primary Hospitals. The objective of \n\n\n\nthis study is to evaluate the impact of clinical pharmacist\u2019s medication reconciliation activities during \n\n\n\nhospital admission of patients with CKD stage IV-V. This cross-sectional study was carried out in \n\n\n\ntwo multidisciplinary wards (male & female ward) in Hospital Raub, Pahang over 12 months with \n\n\n\nethical approval. A clinical pharmacist was assigned to enroll potential study subjects in both wards. \n\n\n\nPatients over 18 years old who had previous history of CKD Stage IV-V were included in the study \n\n\n\nafter obtaining informed consent. Medication reconciliation was carried out by the clinical \n\n\n\npharmacist within 24 working hours during the admission of study subjects. All detected medication \n\n\n\ndiscrepancies were further classified as \u201cintended\u201d or \u201cunintended\u201d after discussion with the \n\n\n\nprescribing medical officer. The Severity Level of each unintended medication discrepancy was rated \n\n\n\nby a visiting medical specialist. Twelve patients with CKD stage V were recruited to the study. A \n\n\n\ntotal of 49 medication discrepancies were identified and most (89.8%) were found to be unintended. \n\n\n\nThe most common unintended medication discrepancy identified was omission error.  Most of the \n\n\n\nunintended medication discrepancies (59.1%) was rated as \u201cNo potential harm\u201d, while 40.9% were \n\n\n\nrated as \u201cPotential for monitoring and/or Intervention to preclude harm\u201d. None of the unintended \n\n\n\nmedication discrepancy was rated as \u201cPotential harm\u201d. In conclusion, medication discrepancies were \n\n\n\ncommon during admission of patients with late-stage chronic kidney disease in a primary hospital. \n\n\n\nMedication reconciliation performed by clinical pharmacist during admission has a potential role in \n\n\n\npreventing potential harms that may arise from unintentional medication discrepancies. \n\n\n\n\n\n\n\nINTRODUCTION  \n  \n\n\n\nChronic Kidney Disease (CKD) is indicated as gradual \n\n\n\ndeterioration of renal function over time and CKD can cause \n\n\n\nmajor health complications [1]. It was reported that 10-13% of \n\n\n\nthe population in China, Taiwan, and Japan have CKD [2].  \n\n\n\nBesides, Asian population has a higher prevalence of CKD as \n\n\n\ncompared to American population [3]. \n\n\n\n\n\n\n\nAccording to a nationwide population-based cross-sectional \n\n\n\nstudy conducted by Saminathan et al. [4] from September 2017 \n\n\n\nto June 2018, the prevalence of respondents with stage I, stage \n\n\n\nII, stage III, stage IV and stage V CKD in Malaysia were \n\n\n\n3.85%, 4.82%, 6.48%, 0.25% and 0.08% respectively in 2018 \n\n\n\n[4], as compared to 4.16%, 2.05%, 2.26%, 0.24% and 0.36% \n\n\n\nrespectively from a similar study which included only \n\n\n\nrespondents from West Malaysia in 2011 [5]. Saminathan et al. \n\n\n\nstated that out of all respondents with CKD, only 5% of them \n\n\n\nwere aware of their diagnosis [4]. \n\n\n\n\n\n\n\nPatients with CKD are considered as a complex population. \n\n\n\nAccording to study conducted by Manley et al., patients with \n\n\n\nend stage renal failure undergoing haemodialysis were \n\n\n\nprescribed an average of 12 medications [6]. Medication errors \n\n\n\nare more likely to occur during patient\u2019s transition of care [7]. \n\n\n\nBesides, incidence of adverse drug reactions increases with \n\n\n\n\n\n\n\n\n\n\n\n\nChen T.S. Mal J Pharm 7 (1) 2021, 16-21 \n\n\n\n\n\n\n\n17 \n\n\n\n\n\n\n\nincreasing number of medications used and worsening of renal \n\n\n\nfunction [8]. \n\n\n\n\n\n\n\nMedication reconciliation is defined as the process of \n\n\n\ncomparing a patient\u2019s medication list ordered by prescriber to \n\n\n\npatient\u2019s previous medications during transition of care [9]. \n\n\n\nBased on data from Buckley et al.,  medication discrepancies \n\n\n\nduring hospital admission are common and accounted for up to \n\n\n\n67% of all hospitalised patients [10]. An unintentional \n\n\n\nmedication discrepancy occurs when prescribers omitted, \n\n\n\nchanged, or added a medication unintentionally [11]. Any \n\n\n\nunintentional medication discrepancy has the potential to \n\n\n\nbecome a medication error and cause patient harm [11].   \n\n\n\n\n\n\n\nA systematic review from Tam et al. showed that inaccurate or \n\n\n\nincomplete medication orders during patient\u2019s admission \n\n\n\naccounted for 27% of total hospital medication errors [12]. \n\n\n\nObtaining accurate medication histories during patient\u2019s \n\n\n\nadmission is crucial to improve medication safety as errors in \n\n\n\nmedication history taking may lead to inappropriate drug \n\n\n\ntherapy for hospitalised patients [12].  \n\n\n\n\n\n\n\nBased on a study conducted by Hassali et al., 90.1% of \n\n\n\nrespondents consisting of 86 General Practitioners in the \n\n\n\nPenang State agreed that medication reconciliation can be a \n\n\n\npractical strategy in improving medication safety [13]. \n\n\n\nMedication Reconciliation was announced as 2005 National \n\n\n\nPatient Safety Goal #8 by the Joint Commission [9]. According \n\n\n\nto the safety goal, medication reconciliation should be \n\n\n\nimplemented in all patient care settings [9].  \n\n\n\n\n\n\n\nThere was only one similar study in Malaysia done by Islahudin \n\n\n\net al. for medication reconciliation during admission of patients \n\n\n\nto healthcare facilities [14].  The study found out that \n\n\n\nmedication reconciliation tool identified more medication \n\n\n\ndiscrepancies than standard medication history taking during \n\n\n\npatient admissions in a tertiary hospital [14]. \n\n\n\n\n\n\n\nThe objective of this study was to evaluate the impact of clinical \n\n\n\npharmacist\u2019s medication reconciliation activities during \n\n\n\nhospital admission of patients with CKD stage IV-V. To date \n\n\n\nthere was very little information about impact of medication \n\n\n\nreconciliation activities done for specific populations (eg. Late-\n\n\n\nStage CKD patients) during admission stage in Malaysian \n\n\n\nPrimary Hospitals. The primary outcome of this study was the \n\n\n\nnumber of medication discrepancies detected during the \n\n\n\nadmission of patients with CKD stage IV-V over the study \n\n\n\nperiod. As compared to the similar study conducted by \n\n\n\nIslahudin et al. [14], we also evaluated the \u201cseverity level of \n\n\n\neach unintended medication discrepancy if left undetected\u201d, \n\n\n\nwhich was the secondary outcome of this study. \n\n\n\n\n\n\n\nMETHOD  \n  \n\n\n\nThis was a cross-sectional study to determine the number of \n\n\n\nunintended medication discrepancies identified through \n\n\n\nmedication reconciliation activities performed by a clinical \n\n\n\npharmacist during admission of patient with CKD stage IV-V \n\n\n\nin multidisciplinary wards.  \n\n\n\n\n\n\n\nThis study was carried out in two multidisciplinary wards (male \n\n\n\n& female ward) in Hospital Raub over a period of 12 months \n\n\n\nfrom 24th May 2018 to 23rd May 2019. Hospital Raub is a \n\n\n\nprimary hospital with 89 beds and multidisciplinary wards \n\n\n\ncomprise 56 beds. This study protocol was approved by the \n\n\n\nMedical Research and Ethics Committee (MREC), Ministry of \n\n\n\nHealth Malaysia [Reference numbers: KKM.NIHSEC.P18-\n\n\n\n469(5) for initial ethical approval and KKM/NIHSEC/P18-\n\n\n\n469(9) for subsequent annual ethical renewal]. \n\n\n\n\n\n\n\nThe mean of total admission of patients to these \n\n\n\nmultidisciplinary wards in Hospital Raub from 2015-2017 were \n\n\n\n3569 patients. As there was no study regarding prevalence of \n\n\n\nCKD patients admitted to ward, prevalence data from the study \n\n\n\nconducted by Hooi et al. [5] was used as it was the first study \n\n\n\nshowing prevalence of CKD by stages in Malaysia, and newer \n\n\n\nprevalence data was yet to be reported in early 2018, when this \n\n\n\nstudy was initiated. According to Hooi et al., total percentage \n\n\n\nof noninstitutionalized adult patients with CKD stage IV-V in \n\n\n\nWest Malaysia in 2011 was 0.60% [5]. \n\n\n\n\n\n\n\nThe sample size of this study was calculated using the \u201cSample \n\n\n\nSize for Frequency\u201d calculator from openepi.com [15]. After \n\n\n\nentering population size as 100,000 people, anticipated \n\n\n\nfrequency (in percentage) is calculated as 0.60%, confidence \n\n\n\nlimits as 5%, and design effect as 1. A sample size of 12 study \n\n\n\nsubjects was required for 97% confidence level [15]. \n\n\n\nConvenient sampling method was used to recruit study \n\n\n\nsubjects. \n\n\n\n\n\n\n\nPatients over 18 years old who had previous history of CKD \n\n\n\nand with estimated Glomerular Filtration Rate (eGFR) of less \n\n\n\nthan 30ml/min/1.73m2  upon admission were included in our \n\n\n\nstudy. On the other hand, patients/caregivers who were \n\n\n\nunresponsive or unwilling to communicate with clinical \n\n\n\npharmacist were excluded from this study. Besides, patients \n\n\n\nwho were diagnosed as having Acute Kidney Injury (AKI) by \n\n\n\nward Medical Officer (MO) during the time of admission were \n\n\n\nalso excluded. Acute Kidney Injury is diagnosed when Serum \n\n\n\nCreatinine (SCr) level increases \u226526.5 \u03bcmol/l from baseline \n\n\n\nvalue or patient\u2019s urine output is < 0.5 ml/kg/h for 6 hours [16]. \n\n\n\n\n\n\n\nThe Modification of Diet in Renal Disease (MDRD) formula \n\n\n\nwas used in estimating Glomerular Filtration Rate (GFR) for \n\n\n\nrenal function assessment and drug dosage adjustment in this \n\n\n\n\n\n\n\n\n\n\n\n\nChen T.S. Mal J Pharm 7 (1) 2021, 16-21 \n\n\n\n\n\n\n\n18 \n\n\n\n\n\n\n\nstudy. The eGFR Calculator mobile app (version 2.3) from the \n\n\n\nNational Kidney Foundation (NKF) was used to calculate \n\n\n\nestimated GFR for each study subject [17]. \n\n\n\n\n\n\n\nThis study focused on medication reconciliation activities \n\n\n\nconducted by a clinical pharmacist in detecting and resolving \n\n\n\nany unintended medication discrepancies within 24 hours post-\n\n\n\nadmission of Late-Stage CKD patients. Patients that were \n\n\n\nadmitted on weekends or public holidays were reviewed within \n\n\n\n24 hours on the subsequent first working day. A clinical \n\n\n\npharmacist (also as the investigator in this study) was assigned \n\n\n\nto cover both multidisciplinary ward on working days to screen \n\n\n\neach newly admitted patient to determine potential participant \n\n\n\nfor this study. The clinical pharmacist informed each eligible \n\n\n\npatient that there would be no harm to participate in this study, \n\n\n\nas no invasive procedure or interventional product was to be \n\n\n\nintroduced to him/her. Each participant was informed that he or \n\n\n\nshe would not be reimbursed for participation in the study. \n\n\n\nEvery eligible patient who agreed to take part in the study was \n\n\n\nrequired to complete the patient information leaflet/informed \n\n\n\nconsent form. \n\n\n\n\n\n\n\nAfter the patient or caregiver had completed the consent form, \n\n\n\nthe clinical pharmacist determined the patient\u2019s actual stage of \n\n\n\nCKD by entering the patient\u2019s age, gender, and serum \n\n\n\ncreatinine level in the \u201cMDRD Study Equation\u201d section of the \n\n\n\neGFR Calculator mobile app [17]. Patients with an estimated \n\n\n\nGFR greater than 30ml/min/1.73m2 were excluded from the \n\n\n\nstudy. After that, using a data collection form adapted from the \n\n\n\nMedication History Assessment Form (CP1) [18], the clinical \n\n\n\npharmacist conducted an interview with the patient or caregiver \n\n\n\nto obtain the patient\u2019s demographic information, past medical \n\n\n\nhistory, history of drug allergy and past medication history. The \n\n\n\nlist of medication history generated by the clinical pharmacist \n\n\n\nwas used to compare to the list of medications prescribed \n\n\n\nduring admission, and all medication discrepancies were \n\n\n\ndocumented.  \n\n\n\n\n\n\n\nThe clinical pharmacist then contacted corresponding \n\n\n\nprescribing Medical Officer (MO) regarding the detected \n\n\n\nmedication discrepancies and inquired whether each \n\n\n\ndiscrepancy was intended or unintended. Unintended \n\n\n\nmedication discrepancy was determined when the MO \n\n\n\nindicated that the difference between the patients\u2019 previous \n\n\n\nmedication list and the medication list prescribed at the time of \n\n\n\npatient admission was unintentional. Then, the clinical \n\n\n\npharmacist requested ward MO to make corrections on ward \n\n\n\nmedication chart if the medication discrepancies were found to \n\n\n\nbe unintended or erroneous. The medication reconciliation \n\n\n\nprocess was considered complete once interventions were done \n\n\n\nfor each unintended medication discrepancy.  \n\n\n\n\n\n\n\nIn order to evaluate severity level of each unintended \n\n\n\nmedication discrepancy if left undetected, a visiting medical \n\n\n\nspecialist was invited to rate each medication discrepancy \n\n\n\nbased on the 3 Severity levels (Table I). The severity levels \n\n\n\nratings for medication discrepancies were adapted from the \n\n\n\npotential harm ratings from Gleason et al, 2010 [19].  The \n\n\n\ndefinition of each Severity Level and Categories of Medication \n\n\n\nErrors involved in each level were adapted from the National \n\n\n\nCoordinating Council for Medication Error Reporting and \n\n\n\nPrevention (NCC MERP) Index for Categorizing Medication \n\n\n\nErrors [20].   \n\n\n\n\n\n\n\nThe data collected was analysed descriptively with \u2018Statistical \n\n\n\nPackage for the Social Sciences\u2019 (SPSS for Windows) version \n\n\n\n21. For categorical variables, results were presented as \n\n\n\nfrequency and its percentage whereas results for numerical \n\n\n\nvariables were presented as Mean \u00b1 Standard Deviation (SD) \n\n\n\nor Median \u00b1 Interquartile Range (IQR). Only descriptive \n\n\n\nstatistics were used in this study. \n\n\n\n\n\n\n\nRESULT \n \n\n\n\nTwelve patients with CKD stage IV-V were recruited to the \n\n\n\nstudy. Details of sociodemographic and baseline characteristics \n\n\n\nof the study population are summarized in Table II. All \n\n\n\nTable I: Severity Level Ratings for Medication Discrepancies \n \n\n\n\nSeverity Level of Medication \n\n\n\nDiscrepancy [19] \n\n\n\nDefinition [20] * Category of Medication Errors [20] \n\n\n\ninvolved in each Level* \n\n\n\n\n\n\n\nLevel 1 No Potential harm Category C:  An error reached the patient but did not result in patient harm \n\n\n\n\n\n\n\nLevel 2 Potential for monitoring and/or \n\n\n\nIntervention to preclude harm \n\n\n\n\n\n\n\nCategory D:  An error reached the patient, monitoring and/or intervention \n\n\n\nis required to preclude harm. \n\n\n\n\n\n\n\nLevel 3 Potential harm Category E:  An error reached the patient and may have caused temporary \n\n\n\nharm to the patient, intervention is required. \n\n\n\n\n\n\n\nCategory F:  An error reached the patient and may have caused temporary \n\n\n\nharm to the patient and may necessitate initial or prolonged hospitalization. \n\n\n\n\n\n\n\n*Adapted from the National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP)  (www.nccmerp.org) \n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\nChen T.S. Mal J Pharm 7 (1) 2021, 16-21 \n\n\n\n\n\n\n\n19 \n\n\n\n\n\n\n\nrecruited patients were evaluated as having CKD Stage V. \n\n\n\nAmong all patients recruited, two patients (16.7%) had no \n\n\n\nmedication discrepancies. This study identified a total of 49 \n\n\n\nmedication discrepancies, and in which 44 (89.8%) \n\n\n\ndiscrepancies were found to be unintended. Details of different \n\n\n\ntypes of unintended medication discrepancies are shown in \n\n\n\nTable III. \n\n\n\n \nTable II: Demographic Data of the Study Population  (n = 12) \n\n\n\n\n\n\n\nCharacteristics Value \n\n\n\nGender, number (%)  \n\n\n\n  Male 7 (58.3) \n\n\n\n  Female 5 (41.7) \n\n\n\nMedian age (years) 65.5 (10.8) \n\n\n\nStage of CKD, number (%)  \n\n\n\n  Stage IV 0 (0.0) \n\n\n\n  Stage V 12 (100.0) \n\n\n\nMean (SD) number of medications prescribed on \n\n\n\nadmission  \n7.2 (3.8) \n\n\n\nMean (SD) number of regular medications before \n\n\n\nadmission \n9.0 (2.3) \n\n\n\n\u00a7Source of medication history,  \n\n\n\nnumber (%) \n \n\n\n\nPharmacy Information System (PhIS) record 11 (91.7) \n\n\n\nPatient\u2019s current outpatient prescription 6 (50.0) \n\n\n\nPatient\u2019s own medication  4 (33.3) \n\u00a7Cumulative percentage > 100% as some patients had >1 source of medication \n\n\n\nhistory. \n\n\n\n\n\n\n\nMedications for Bone and Mineral Disease was found to be the \n\n\n\nmost common medication class involved in unintended \n\n\n\nmedication discrepancies during admission, followed by \n\n\n\nVitamins/Iron supplements, Antihypertensives and \n\n\n\nAntidiabetic Agents (Table IV). Among all the unintentional \n\n\n\nmedication discrepancies, 59.1% were judged as Severity \n\n\n\nLevel 1 (no potential harm if left undetected), while 40.9% \n\n\n\nwere judged as Severity Level 2 (potential for monitoring \n\n\n\nand/or intervention to preclude harm if left undetected). No \n\n\n\nunintended medication discrepancy was classified as Severity \n\n\n\nLevel 3 (potential harm to patient if left undetected).  \n\n\n\n \nTable III: Types of Unintended Medication Discrepancies Identified (n = \n\n\n\n44) \n\n\n\n\n\n\n\nType of Discrepancy Number (%)\u0394 \n\n\n\nOmitted Drug 34 (77.3) \n\n\n\nWrong Dose 6 (13.6) \n\n\n\nWrong Frequency 2 (4.5) \n\n\n\nWrong Drug 2 (4.5) \n\n\n\n\u0394 Percentages may not add up to 100% due to rounding. \n\n\n\n\n\n\n\nTable IV: Medication Class Involved in Unintended Medication \n\n\n\nDiscrepancies (n = 44) \n\n\n\n\n\n\n\nMedication Class Number (%)\u0394 \n\n\n\nMedications for Bone and Mineral Disease 11 (25.0) \n\n\n\nOther (Vitamin/ Iron) Supplements 8 (18.2) \n\n\n\nAntihypertensives 7 (15.9) \n\n\n\nAntidiabetic Agents 6 (13.6) \n\n\n\nMedications for Stress Ulcer Prophylaxis/ Gastritis 4 (9.1) \n\n\n\nCholesterol-Lowering Agents 3 (6.8) \n\n\n\nDiuretics 2 (4.5) \n\n\n\nAntiplatelets 2 (4.5) \n\n\n\nThyroid Replacement Medications 1 (2.3) \n\n\n\n\u0394 Percentages may not add up to 100% due to rounding. \n \n\n\n\n\n\n\n\nDISCUSSION  \n \n\n\n\nNone of the patient recruited in this study was classified under \n\n\n\nCKD Stage IV. This might be due to more patients with CKD \n\n\n\nStage V were admitted during the study period. A study \n\n\n\nconducted by Go et al. found out that there was a graded \n\n\n\nassociation between lower levels of estimated GFR and the \n\n\n\nrisks of hospitalization [21].   \n\n\n\n\n\n\n\nMost of the medication discrepancies were found to be \n\n\n\nunintended. The result in this study showed that the most \n\n\n\ncommon medication discrepancy identified during admission \n\n\n\nof patient was omission error, follow by wrong dose, and then \n\n\n\nby wrong frequency. This coincides with the similar study \n\n\n\ninvolving eligible patients admitted to the Orthopedic Service \n\n\n\n[22]. The most common interventions done in this study was \n\n\n\naddition of the omitted medications. This result is consistent \n\n\n\nwith the findings of other similar studies which also recruited \n\n\n\npatient from other disciplines [14,23\u201325]. \n\n\n\nMost of the unintended medication discrepancies (59.1%) was \n\n\n\njudged as Severity Level 1, which indicates that the \n\n\n\ndiscrepancies were unlikely to cause harm if left undetected. \n\n\n\nThis result agrees with the findings from a similar study from \n\n\n\nCornish et al., where eligible patients admitted to the general \n\n\n\ninternal medicine clinical teaching units in a tertiary care \n\n\n\nteaching hospital were recruited [25]. The study found that \n\n\n\n61.4% of the unintended medication discrepancies were \n\n\n\nconsidered as unlikely to cause harm [25].  \n\n\n\n\n\n\n\nAnother finding from this study showed that 40.9% of the \n\n\n\nunintended medication discrepancies were deemed to have the \n\n\n\npotential to cause harm & monitoring and intervention may \n\n\n\nhave been required to preclude harm (Severity Level 2). This \n\n\n\n\n\n\n\n\n\n\n\n\nChen T.S. Mal J Pharm 7 (1) 2021, 16-21 \n\n\n\n\n\n\n\n20 \n\n\n\n\n\n\n\nfinding is in agreement with the systematic review conducted \n\n\n\nby Tam et al., where limited data suggested that 11-50% of \n\n\n\nmedication history errors at admission to hospital were \n\n\n\nclinically important [12]. Besides that, this data also coincides \n\n\n\nwith the findings from other studies, where more than 30% of \n\n\n\nthe unintended medication discrepancies were deemed to have \n\n\n\npotential to cause moderate harm [23,25]. There is no \n\n\n\nmedication discrepancy classified as Severity Level 3 in this \n\n\n\nstudy. On the contrary, the study from Cornish et al. revealed \n\n\n\nthat 5.7% of the identified medication discrepancies were \n\n\n\njudged to have the potential to result in severe discomfort or \n\n\n\nclinical deterioration [25]. \n\n\n\n\n\n\n\nAll recommendations proposed were accepted by the MO who \n\n\n\ndid the admission with acceptance rate of 100%. Other studies \n\n\n\ninvolving medication reconciliation on admission also showed \n\n\n\nthat most recommendations by pharmacy team regarding the \n\n\n\nunintended discrepancies were accepted [14,22,23]. \n\n\n\n\n\n\n\nIn this study, more than 1 source of medication list were \n\n\n\nobtained from several patients as different sources of \n\n\n\nmedication can be used to ensure the accuracy of patient\u2019s \n\n\n\nmedication history [23]. This is important for those who are \n\n\n\nunder follow up at different disciplines/facilities. The main \n\n\n\nsource of medication list used in this study is the Pharmacy \n\n\n\nInformation System (PhIS) [26].  \n\n\n\n\n\n\n\nSince 2016, PhIS had been implemented in most healthcare \n\n\n\nfacilities in PAHANG State [26]. The PhIS system shows the \n\n\n\ncomplete current medication record for patients who are under \n\n\n\nfollow up in Hospital Raub, including the regular medications \n\n\n\nfrom other Ministry of Health (MOH) facilities if patient opted \n\n\n\nthe Integrated Drug Dispensing System (SPUB), a Value-\n\n\n\nAdded Service (VAS) where patients can obtain the next drug \n\n\n\nsupply of active prescriptions from any of the MOH health \n\n\n\nfacilities listed in the MOH's SPUB Directory through a \n\n\n\nnationwide referral system [26,27].  \n\n\n\n\n\n\n\nPhIS system is accessible in emergency department and all \n\n\n\nwards in Hospital Raub. Patient\u2019s latest medication list from \n\n\n\noutpatient/ specialist clinics can be retrieved by clinical \n\n\n\npharmacist from PhIS during ward round, thus improving the \n\n\n\naccuracy of the medication history taking as some patients \n\n\n\nmight leave their regular medications at home while some \n\n\n\nmight bring incomplete medication list to ward. \n\n\n\n\n\n\n\nThis study showed that PhIS system was underutilized among \n\n\n\nmedical officers in Hospital Raub Emergency Department \n\n\n\nthroughout the study period as most patients\u2019 complete \n\n\n\nmedication lists were obtained from PhIS by the clinical \n\n\n\npharmacist and yet the most common unintended discrepancy \n\n\n\nwas omission of patient\u2019s regular medication. Further \n\n\n\ninvestigations are required to determine the root cause of PhIS \n\n\n\nunderutilization by medical officers during admission of \n\n\n\npatients in Hospital Raub. \n\n\n\n\n\n\n\nLimitations \n\n\n\n\n\n\n\nThis study only involved small sample of patients from a \n\n\n\nprimary hospital, so the result might not be generalized to other \n\n\n\nareas with bigger population. Besides, all recruited patients in \n\n\n\nthis study were classified under CKD Stage V, thus the result \n\n\n\nmight not be generalized to population with higher \n\n\n\nhospitalization rate of patients with CKD Stage IV. The \n\n\n\npotential harm of each unintended medication discrepancy was \n\n\n\njudged by only one visiting medical specialist, and there was \n\n\n\npossibility that other medical specialist might have different \n\n\n\njudgement on some of the medication discrepancies. \n\n\n\n\n\n\n\nCONCLUSION \n  \nMedication discrepancies were common during admission of \n\n\n\npatients with late-stage chronic kidney disease in a primary \n\n\n\nhospital. Medication reconciliation performed by clinical \n\n\n\npharmacist during admission has a potential role in preventing \n\n\n\npotential harms that may arise from unintentional medication \n\n\n\ndiscrepancies. \n\n\n\n\n\n\n\nCONFLICT OF INTEREST \n \n\n\n\nThe author declares no conflict of interest. This research did \n\n\n\nnot receive any specific grant from funding agencies in the \n\n\n\npublic, commercial or not-for-profit sectors. \n\n\n\n\n\n\n\nACKNOWLEDGEMENT \n \n\n\n\nThe author would like to thank the Director General of Health \n\n\n\nMalaysia for his permission to publish this article. \n\n\n\n\n\n\n\nREFERENCE \n \n[1] NKF. The National Kidney Foundation: Kidney Disease [Internet]. \n\n\n\nThe National Kidney Foundation. 2019 [cited 2020 Jan 24]. Available \n\n\n\nfrom: https://www.kidney.org/atoz/content/about-chronic-kidney-\n\n\n\ndisease \n\n\n\n[2] Stenvinkel P. Chronic kidney disease: A public health priority and \n\n\n\nharbinger of premature cardiovascular disease. Vol. 268, Journal of \n\n\n\nInternal Medicine. 2010. p. 456\u201367.  \n\n\n\n[3] Zhang Q-L, Rothenbacher D. Prevalence of chronic kidney disease in \n\n\n\npopulation-based studies: systematic review. 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Available from: \n\n\n\nhttps://apps.apple.com/my/app/egfr-calculators/id483182385?l=ms \n\n\n\n[18] Pharmaceutical Services Division, Ministry of Health Malaysia. \n\n\n\nAppendix C1: Medication History Assessment Form (CP1). In: Renal \n\n\n\nPharmacy Service Guideline. Petaling Jaya: Pharmaceutical Services \n\n\n\nDivision, Ministry of Health Malaysia; 2011. p. 42\u20133.  \n\n\n\n[19] Gleason KM, McDaniel MR, Feinglass J, Baker DW, Lindquist L, \n\n\n\nLiss D, et al. Results of the medications at transitions and clinical \n\n\n\nhandoffs (match) study: An analysis of medication reconciliation \n\n\n\nerrors and risk factors at hospital admission. J Gen Intern Med. \n\n\n\n2010;25(5):441\u20137.  \n\n\n\n[20] NCC MERP. Categorizing Medication Errors [Internet]. NCC MERP. \n\n\n\n2001 [cited 2017 Dec 9]. Available from: \n\n\n\nhttp://www.nccmerp.org/types-medication-errors \n\n\n\n[21] Go AS, Chertow GM, Fan D, Mcculloch CE, Hsu C-Y. Chronic \n\n\n\nKidney Disease and the Risks of Death, Cardiovascular Events, and \n\n\n\nHospitalization. N Engl J Med [Internet]. 2004;351(13):1296\u2013305. \n\n\n\nAvailable from: www.nejm.org \n\n\n\n[22] Moriel MC, Pardo J, Catal\u00e0 RM, Segura M. Prospective Study on \n\n\n\nConciliation of Medication in Orthopaedic Patients. Farm Hosp \n\n\n\n(English Ed. 2008;32(2):65\u201370.  \n\n\n\n[23] Karaoui LR, Chamoun N, Fakhir J, Abi Ghanem W, Droubi S, Diab \n\n\n\nMarzouk AR, et al. Impact of pharmacy-led medication reconciliation \n\n\n\non admission to internal medicine service: Experience in two tertiary \n\n\n\ncare teaching hospitals. BMC Health Serv Res. 2019;19(1):493.  \n\n\n\n[24] Patel R, Butler K, Garrett D, Badger N, Cheoun D, Hallman L. The \n\n\n\nimpact of a pharmacist\u2019s participation on hospitalists\u2019 rounds. Hosp \n\n\n\nPharm. 2010;45(2):129\u201334.  \n\n\n\n[25] Cornish PL, Knowles SR, Marchesano R, Tam V, Shadowitz S, \n\n\n\nJuurlink DN, et al. Unintended Medication Discrepancies at the Time \n\n\n\nof Hospital Admission. Arch Intern Med. 2005;165:424\u20139.  \n\n\n\n[26] thesundaily.my. PhIS to provide better pharmacy system for patients \n\n\n\n[Internet]. 2016 [cited 2020 Jan 18]. Available from: \n\n\n\nhttps://www.thesundaily.my/archive/1713039-JSARCH352297 \n\n\n\n[27] Pharmaceutical Services Programme, Ministry of Health Malaysia. \n\n\n\nSistem Pendispensan Ubat Bersepadu (SPUB) | Program \n\n\n\nPerkhidmatan Farmasi [Internet]. 2018 [cited 2020 Jan 18]. Available \n\n\n\nfrom: https://www.pharmacy.gov.my/v2/ms/entri/sistem-\n\n\n\npendispensan-ubat-bersepadu-spub.html \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Volume 7 Issue 1 (2021) \n \n\n\n\n\n\n\n\n\n\n\n\n22 \n\n\n\n\n\n\n\n*Correspondence: shirlie_chai@yahoo.com \n\n\n\n\n\n\n\n1 Pharmacy Department, Miri Hospital, Ministry of Health Malaysia, \n\n\n\nSarawak \n2 Clinical Research Centre Miri, Ministry of Health Malaysia, Sarawak \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n Original Research Article \n\n\n\n\n\n\n\nPharmacy Value-Added Services: Experience in a Malaysian \n\n\n\nPublic Hospital \n \n\n\n\nEmily Shin Ni Chung1, Shin Mei Sim1, Sui Fern Wong1, Shirlie Chai1,2*, Kamarudin Ahmad1,2 \n\n\n\n\n\n\n\n \nArticle Info  \n\n\n\n \nReceived date:   8 Feb 2021 \n\n\n\nAccepted date: 21 Apr 2021 \n\n\n\nPublished date: 30 June 2021 \n\n\n\n\n\n\n\nKeywords: value-added, \n\n\n\npharmacy, awareness, usage, \n\n\n\nsatisfaction, willingness \n\n\n\n\n\n\n\nABSTRACT  \n\n\n\n\n\n\n\nThe Pharmacy value-added services (PVAS) has been implemented in Malaysian public hospitals to \n\n\n\nfacilitate the collection of follow-up medications. In specific, PVAS include Integrated Drug \n\n\n\nDispensing System, Medicine by Post, Drive-Through Pharmacy, and many more. While past studies \n\n\n\nexamined the satisfaction towards PVAS and its impact on patients\u2019 waiting time, little explored the \n\n\n\nawareness and the experience of patients towards each type of PVAS. This study aims to explore the \n\n\n\npatient\u2019s awareness on PVAS, adoption of PVAS, their satisfaction towards PVAS, and willingness \n\n\n\nto adopt PVAS. This was a cross-sectional study conducted in January 2020.  We invited the eligible \n\n\n\npatients or their family members to participate in the study. Respondents recruited at the Outpatient \n\n\n\nPharmacy Department of Miri Hospital using convenient sampling. A questionnaire in the Malay \n\n\n\nlanguage was developed and content validated to gather information on the demographic data, \n\n\n\nawareness on PVAS, adoption of PVAS, satisfaction towards PVAS, and willingness to adopt PVAS. \n\n\n\nA list of PVAS was included for the respondents to select the types they were aware of and used \n\n\n\nbefore. Results were presented as frequencies, percentages, mean and standard deviation. A total of \n\n\n\n398 respondents participated in the study. Majority of the respondents (70.1%) were aware that PVAS \n\n\n\noffered in Miri Hospital. However, about a third of the respondents (31.4%) had experience using \n\n\n\nPVAS. The most commonly used PVAS was Appointment Card Dispensing System (49.6%) and that \n\n\n\nwith the least usage was Local Partial Medication Supply Service (2.4%). The Drive-Through \n\n\n\nPharmacy has the greatest satisfaction score, 4.40 (SD=0.70), whereas Call-and-Collect Service was \n\n\n\nthe least satisfied, 3.88 (SD=0.91). Majority of the respondents (86.2%), specifically 95.8% of the \n\n\n\nexperienced PVAS user and 90.1% of inexperienced group, were willing to adopt PVAS to collect \n\n\n\ntheir follow-up medications. The Drive-thru Pharmacy, which has the greatest awareness and \n\n\n\nsatisfaction yet low usage, should be further promoted for greater adoption. Besides, such PVAS \n\n\n\nshould be expanded to other healthcare facilities. \n\n\n\n\n\n\n\nINTRODUCTION  \n  \n\n\n\nPharmacy value-added services (PVAS) is a nationwide, \n\n\n\ngovernment-funded initiative introduced by the Pharmaceutical \n\n\n\nServices Division (PSD), Ministry of Health Malaysia (MOH) \n\n\n\nsince 2003 [1]. In the Malaysian context, PVAS defined as a \n\n\n\nrange of innovative and creative services provided by the \n\n\n\npharmacy to optimise patient-oriented pharmaceutical care, \n\n\n\nthrough ensuring the continuity of medicines supply, reducing \n\n\n\nwaiting time and travelling cost [1]. According to the National \n\n\n\nSurvey on the Use of Medicines (NSUM) 2015, 30.3% of \n\n\n\nMalaysians have chronic diseases that necessitate long term \n\n\n\nmedication use [2]. In the government healthcare facilities, a \n\n\n\npolicy under the Quality Use of Medicines (QUM) pharmacy \n\n\n\npractice guideline has been in place since 2011, where \n\n\n\nmedications for prescriptions longer than one month will only \n\n\n\nbe supplied monthly [3].  \n\n\n\n\n\n\n\nThe successful implementation of the policy allowed \n\n\n\nmonitoring of patient compliance, untoward effects of \n\n\n\nmedications, reducing drug wastage and the risk of medication \n\n\n\nerror caused by misuse of excessive medication supply by \n\n\n\nunintended individuals. However, these advantages come at the \n\n\n\n\n\n\n\n\nChung, E.S.N. et al. Mal J Pharm 7 (1) 2021, 22-27 \n\n\n\n\n\n\n\n23 \n\n\n\n\n\n\n\nexpense of increased patient load and waiting time at the \n\n\n\noutpatient pharmacy. Furthermore, transportation issues and \n\n\n\nthe cost incurred from a repetitive visit to the outpatient \n\n\n\npharmacy for monthly medication supply are factors that affect \n\n\n\npatient satisfaction [4]. In a study conducted in Taiwan showed \n\n\n\nthat difficulty in finding a parking in the hospital was one of \n\n\n\nthe reasons cited to failure to regular medicine refill [5]. \n\n\n\nTherefore, the introduction of PVAS aims to improve the \n\n\n\nhealthcare accessibility and dispensing system by reducing \n\n\n\nwaiting time, improving patient convenience and satisfaction, \n\n\n\nand ensuring continuity of medication supply.  \n\n\n\n\n\n\n\nIn Malaysia, PVAS refers to a group of innovative services \n\n\n\nprovided by over 500 government healthcare facilities [1]. \n\n\n\nLarger facilities may provide more types of PVAS whereas \n\n\n\nsmaller facilities have at least one to two types of these services \n\n\n\n[1]. In this context, follow-up prescriptions are also known as \n\n\n\nrefill prescriptions or partial supply prescriptions, and the terms \n\n\n\nused interchangeably. PVAS programmes include Integrated \n\n\n\nDrug Dispensing System (SPUB), Medicine by Post (UMP), \n\n\n\nDrive-Through Pharmacy, Appointment Card Dispensing \n\n\n\nSystem, Call-and-Collect Service, SMS-and-Collect Service, \n\n\n\nFax-and-Collect Service, Email-and-Collect Service, Collect-\n\n\n\nLater Service, Local Partial Medication Supply Service \n\n\n\n(PPUSS) and Locker4U (1, 4). The following paragraph \n\n\n\nillustrates some of the most common types of PVAS. \n\n\n\n\n\n\n\nSPUB enables medicines collection of patients\u2019 follow-up \n\n\n\nsupply at any MOH health facility listed under the SPUB \n\n\n\nDirectory throughout Malaysia. With the service, patients are \n\n\n\nable to select the facility, which is convenient and preferred for \n\n\n\ntheir medication collection [6]. UMP service engages the \n\n\n\nnational courier service, Poslaju to deliver the medicine to the \n\n\n\npatients\u2019 preferred location with pre-determined postal charges \n\n\n\n[6]. Conversely, patients who prefer to self-collect their \n\n\n\nmedicine, Drive-Through Pharmacy is the convenient \n\n\n\nalternative. The conventional waiting process at the pharmacy \n\n\n\ncounters skipped and dispensing of the prepacked medication \n\n\n\ntypically takes place at the dedicated Drive-Through counter or \n\n\n\nkiosk which does not require patients to exit their vehicles \n\n\n\n[1][6]. Both UMP and Drive-Through Pharmacy could help to \n\n\n\nease the long waiting time and parking space constraints. \n\n\n\n\n\n\n\nOther PVAS options include Call-and-Collect Service, SMS-\n\n\n\nand-Collect Service, Fax-and-Collect Service and Email-and-\n\n\n\nCollect Service, which require the patients\u2019 notification, for \n\n\n\ninstance via making a phone call or sending a SMS, to inform \n\n\n\npharmacy of the expected collection date, whereas the Collect-\n\n\n\nLater Service involves pre-notifying the pharmacy over the \n\n\n\ncounter. In contrast, for Appointment Card Dispensing System, \n\n\n\nthe pharmacy determines the collection date and prepares the \n\n\n\nrefill medicine before the date. Meanwhile, Local Partial \n\n\n\nMedication Supply Service and Locker4U deliver the prepared \n\n\n\nmedicine to a predetermined collection centre or place the \n\n\n\nmedicine in a locker, and allow the patients to collect at their \n\n\n\nconvenience.  \n\n\n\n\n\n\n\nThe Pharmaceutical Services Programme has actively \n\n\n\norganised campaigns to introduce and promote the adoption of \n\n\n\nPVAS. The key performance indicator for government \n\n\n\nfacilities is 20% or more of the follow-up prescriptions \n\n\n\ndispensed via PVAS [7]. Despite the large monetary \n\n\n\ninvestment and human resources involvement, the adoption \n\n\n\nrate of PVAS was considerably low at its inception [1]. In 2013, \n\n\n\nPVAS employed in merely approximately 10% of 10 million \n\n\n\nfollow-up prescriptions in the government healthcare facilities \n\n\n\n[1]. In the subsequent year, the number of prescriptions \n\n\n\ndispensed via PVAS has increased to 1.2 million, but it was still \n\n\n\nfar from reaching the target (8). Besides the usual promotional \n\n\n\nactivities, the government organised competitions and giving \n\n\n\nspecial awards to encourage active implementation among the \n\n\n\nfacilities [9]. With continuous effort and promotion, PSD \n\n\n\ndocumented nearly 4 million follow-up prescriptions dispensed \n\n\n\nvia PVAS in the country, amounting 22.29% of the total \n\n\n\nfollow-up prescriptions in 2019 [7] [10]. However, there are \n\n\n\nopportunities for further improvement. Therefore, this study \n\n\n\naims to explore the patient\u2019s awareness on PVAS, adoption of \n\n\n\nPVAS, their satisfaction towards PVAS, and willingness to \n\n\n\nadopt PVAS. Ultimately, this study aims to improve pharmacy \n\n\n\nservice and patient care, which is in line with the objectives of \n\n\n\nPSD. \n\n\n\n\n\n\n\nMETHOD  \n  \n\n\n\nStudy Design and Participants \n\n\n\n\n\n\n\nWe conducted a single-centred, cross-sectional study in one of \n\n\n\nthe major, government-subsidized hospital in Sarawak state of \n\n\n\nMalaysia. All patients or their family members, who aged 18 \n\n\n\nyears and above, understood the Malay language, who \n\n\n\ncollected their first or subsequent partial supply of chronic \n\n\n\nmedications in Miri Hospital, were eligible for participation in \n\n\n\nthe study. We excluded staff who assisted in collecting \n\n\n\nmedication for daycare or home visit patients. Convenience \n\n\n\nsampling method applied to recruit respondents who met the \n\n\n\neligibility criteria. This study is registered with National \n\n\n\nMedical Research Registry (NMRR-19-4193-49452) and was \n\n\n\napproved by Medical Research Ethics Committee, Ministry of \n\n\n\nHealth, Malaysia. \n\n\n\n\n\n\n\nWe administered several close-ended questions to acquire \n\n\n\ninformation on respondents\u2019 demographics, their awareness on \n\n\n\nPVAS, adoption of PVAS, their satisfaction towards PVAS and \n\n\n\nwillingness to adopt PVAS. The demographic data include age, \n\n\n\ngender, race, education level, monthly household income, and \n\n\n\ntravelling duration from the house to the hospital. A list of \n\n\n\nPVAS included for the respondents to select the types they \n\n\n\nwere aware of and used before. Respondents who used PVAS \n\n\n\n\n\n\n\n\nChung, E.S.N. et al. Mal J Pharm 7 (1) 2021, 22-27 \n\n\n\n\n\n\n\n24 \n\n\n\n\n\n\n\nbefore were required to rate their satisfaction level using a five-\n\n\n\npoint Likert scale, which ranges from 1 (very dissatisfied) to 5 \n\n\n\n(very good). Besides, the open-ended questions allowed the \n\n\n\nrespondents to express their opinion about PVAS and the \n\n\n\nreasons they are unwilling to adopt PVAS. In the current study, \n\n\n\nthe monthly household income categorisation were: (i) low \n\n\n\nincome group (B40) with monthly household income less than \n\n\n\nRM 4,850, (ii) mid income group (M40) with monthly \n\n\n\nhousehold income between RM 4,850 and RM 10,959, and (iii) \n\n\n\nhigh income group (T20) with monthly household income of \n\n\n\nRM 10,960 or more (11). For the employment status, an \n\n\n\nemployer refers to a person who hires employee to work, \n\n\n\nwhereas the self-employed refers to a person who works for \n\n\n\noneself. The questions were in the Malay language. \n\n\n\n\n\n\n\nWe invited the eligible respondents, obtained written informed \n\n\n\nconsent and distributed the questionnaire over the pharmacy \n\n\n\ncounter. The respondents returned the completed \n\n\n\nquestionnaires during medication collection at the dispensing \n\n\n\ncounter. It took approximately 10-15 minutes to complete the \n\n\n\nquestionnaire. \n\n\n\n\n\n\n\nThe current study is part of a larger study which the minimum \n\n\n\nsample size was based on. Sample size calculation using the \n\n\n\nG*Power software version 3.1.9.4 showed that 395 respondents \n\n\n\nrequired to obtain a power of 80% at a type I error level of 0.05 \n\n\n\n[12]. The total number of respondents was raised to account for \n\n\n\na 10% dropout and unusable data, hence the required sample \n\n\n\nsize was 439 respondents. \n\n\n\n\n\n\n\nStatistical Analysis \n\n\n\n\n\n\n\nWe conducted analysis using SPSS version 21. The \n\n\n\ndemographic characteristics of respondents described as \n\n\n\nfrequencies and percentages for categorical variables. \n\n\n\nNumerical variables, for example, age, was presented as mean \n\n\n\nand standard deviation (SD), or median and interquartile range \n\n\n\n(IQR) if non-normally distributed. The findings are descriptive \n\n\n\nin nature and no formal statistical hypothesis testing involved. \n\n\n\n\n\n\n\nRESULT \n \n\n\n\nDemographic Characteristics \n\n\n\n\n\n\n\nA total of 440 questionnaires distributed, and 398 respondents \n\n\n\ncompleted and returned them, yielding a response rate of \n\n\n\n90.45%. Table I summarises the demographic characteristics of \n\n\n\nthe respondents. The age of respondents in this study ranged \n\n\n\nfrom 18 to 85 years old, with mean (SD) age of 42.48 (14.32) \n\n\n\nand they were predominantly female (57.3%). Most of the \n\n\n\nrespondents were Chinese (30.4%), from the low-income group \n\n\n\n(B40). \n\n\n\n\n\n\n\n\n\n\n\nAwareness on PVAS \n\n\n\n\n\n\n\nMost respondents (70.1%) were aware of PVAS (Table II). \n\n\n\nDrive-Through Pharmacy and UMP were the most commonly \n\n\n\nknown services among the 279 respondents who were aware of \n\n\n\nPVAS, with the percentage of 67.0% and 59.5% respectively \n\n\n\n(Table II). PPUSS was the least known (3.9%) among \n\n\n\nrespondents who were aware of PVAS, followed by SPUB \n\n\n\n(12.5%). \n\n\n\n\n\n\n\nTable I. Demographic Characteristics (n=398) \n\n\n\n\n\n\n\nVariables Mean (SD) \n\n\n\nAge (years) 42.48 (14.32) \n\n\n\nTravelling Duration to Hospital \n\n\n\n(minutes) \n\n\n\n35.57 (34.28) \n\n\n\n\n\n\n\nVariables Number, n (%) \n\n\n\nGender  \n\n\n\n Male 170 (42.7) \n\n\n\n Female 228 (57.3) \n\n\n\nEthnicity  \n\n\n\n Malay 78 (19.6) \n\n\n\n Chinese 121 (30.4) \n\n\n\n Iban 110 (27.6) \n\n\n\n Kayan 20 (5.0) \n\n\n\n Melanau 14 (3.5) \n\n\n\n Others 53 (13.32) \n\n\n\n Not reported 2 (0.5) \n\n\n\nEducation Level  \n\n\n\n University 69 (17.3) \n\n\n\n College 50 (12.6) \n\n\n\n Vocational 28 (7.0) \n\n\n\n Secondary School 194 (48.7) \n\n\n\n Primary School 31 (7.8) \n\n\n\n No Formal Education 22 (5.5) \n\n\n\n Not reported 4 (1.0) \n\n\n\nEmployment Status  \n\n\n\n Employer  13 (3.3) \n\n\n\n Government Servant 54 (13.6) \n\n\n\n Private Employee 102 (25.6) \n\n\n\n Self-Employed 54 (13.6) \n\n\n\n Unemployed 138 (34.7) \n\n\n\n Retiree 33 (8.3) \n\n\n\n Not reported 4 (1.0) \n\n\n\nHousehold Income  \n\n\n\n High Income (T40) 5 (1.3) \n\n\n\n Medium Income (M40) 47 (11.8) \n\n\n\n Low Income (B40) 325 (81.7) \n\n\n\n Not reported 21 (5.3) \n\n\n\n* Percentages may not total 100 because of rounding \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nChung, E.S.N. et al. Mal J Pharm 7 (1) 2021, 22-27 \n\n\n\n\n\n\n\n25 \n\n\n\n\n\n\n\nAdoption of PVAS  \n\n\n\n\n\n\n\nMore than half of the respondents (68.3%) had no experience \n\n\n\nof using PVAS for the collection of their follow-up medication \n\n\n\nsupply (Table II). Among the 125 PVAS users, the most \n\n\n\ncommonly adopted PVAS was Appointment Card Dispensing \n\n\n\nSystem (49.6%) (Table II). UMP was the second most used \n\n\n\nPVAS (24.8%) among the PVAS users, whereas PPUSS was \n\n\n\nleast adopted (2.4%). \n\n\n\n\n\n\n\nSatisfaction Towards PVAS \n\n\n\n\n\n\n\nTable III shows the satisfaction score of respondents who have \n\n\n\nexperience using PVAS. Overall, respondents were satisfied \n\n\n\nwith their experience. The mean (SD) satisfaction scores for \n\n\n\nDrive-Through Pharmacy, Collect-Later Service, and PPUSS \n\n\n\nare 4.40 (0.70), 4.38 (0.50), 4.33 (1.16) respectively. \n\n\n\nNevertheless, there were 11 Drive-Through Pharmacy users \n\n\n\nonly in this study. Among the three respondents who was \n\n\n\nPPUSS users, two of them rated the service as \u2018very good\u201d and \n\n\n\none of them is satisfied with the service. \n\n\n\n\n\n\n\nWillingness to Adopt PVAS \n\n\n\n\n\n\n\nA large percentage of respondents (86.2%) were willing to \n\n\n\nadopt PVAS while only 7.5% said no to the service. In \n\n\n\nparticular, 95.8% of the experienced PVAS user and 90.1% of \n\n\n\ninexperienced group, respectively were willing to adopt PVAS \n\n\n\nto collect their follow-up medications. However, 7.5% (n=30) \n\n\n\nof the respondents were unwilling to adopt PVAS. \n\n\n\n\n\n\n\nDISCUSSION  \n  \n\n\n\nThis study provides the essential information on the \n\n\n\nimplementation of PVAS in a public hospital in Sarawak.  In \n\n\n\nthis study, majority of the respondents (70.1%) were aware of \n\n\n\nPVAS. This result contrasts the findings of Tan et al., which \n\n\n\nreported that a large number of patients were not aware of the \n\n\n\nexistence and benefits of PVAS via face-to-face interview [13]. \n\n\n\nThe improved awareness could be as a result from the active \n\n\n\npromotion over years. Patients\u2019 awareness on PVAS and their \n\n\n\nbenefits is undeniably crucial in the adoption of this program. \n\n\n\nLack of awareness is the important factor that impedes patients\u2019 \n\n\n\nintention to use PVAS [13]. \n\n\n\n\n\n\n\nDrive-Through Pharmacy and UMP were the two most \n\n\n\ncommonly known PVAS in this study. Although Drive-\n\n\n\nThrough Pharmacy is newly launched in Miri Hospital, the \n\n\n\npublic has high awareness compared to other PVAS. This could \n\n\n\nbe possibly due to the effective promotion, including the local \n\n\n\nnewspapers and social media platforms. On the other hand, \n\n\n\nUMP gained popularity during the COVID-19 lockdown \n\n\n\nimplemented in March 2020 nationwide as it does not require \n\n\n\ntravelling and physically present at the pharmacy, hence \n\n\n\nreducing social contact. Moreover, MOH and the national \n\n\n\ncourier service worked to provide free shipping of medicine to \n\n\n\npatients\u2019 home during the period to ensure the constant access \n\n\n\nto medical needs.  Therefore, the awareness on the PVAS is \n\n\n\nhigher. Medication Locker was the PVAS with least awareness \n\n\n\namong our respondents (0.4%). At the time of writing,  the \n\n\n\nservice is in the planning stage in our hospital. However, the \n\n\n\nservice is available in some other government facilities [14] \n\n\n\n[15]. It is important to note that the service offered may differ \n\n\n\nfrom one facility to the other. Therefore, explanation is crucial \n\n\n\nto avoid misconception. \n\n\n\n\n\n\n\nAmong the PVAS users, we found Appointment Card \n\n\n\nDispensing System as the most commonly used PVAS and that \n\n\n\nwith the least usage is Local Partial Medication Supply Service. \n\n\n\nDespite the considerably high awareness among the \n\n\n\nTable II. Awareness and Adoption of types of PVAS services (n=398) \n\n\n\n\n\n\n\nTypes of PVAS \nAwareness Adoption \n\n\n\nAware Unaware Experienced No Experience \n\n\n\nSPUB 35 (12.5) 244 (87.5) 7 (5.6) 118 (94.4) \n\n\n\nUMP 166 (59.5) 113 (40.5) 31 (24.8) 94 (75.2) \n\n\n\nCall-and-Collect Service 93 (33.3) 186 (66.7) 28 (22.4) 97 (77.6) \n\n\n\nCollect-Later Service 59 (21.1) 220 (78.9) 24 (19.2) 101 (80.8) \n\n\n\nDrive-Through Pharmacy 187 (67.0) 92 (33.0) 11 (8.8) 114 (91.2) \n\n\n\nAppointment Card \n\n\n\nDispensing System \n106 (38.0) 173 (62.0) 62 (49.6) 63 (50.4) \n\n\n\nPPUSS 11 (3.9) 268 (96.1) 3 (2.4) 122 (97.6) \n\n\n\nMedication Locker 2 (0.7) 277 (99.3)   \n\n\n\nOthers 1 (0.4) 278 (99.6)   \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nTable III. Satisfaction Towards PVAS \n\n\n\n\n\n\n\nSatisfaction Score Mean (SD) \n\n\n\nSPUB n=7 4.29 (0.95) \n\n\n\nUMP n=31 4.12 (0.95) \n\n\n\nCall-and-Collect Service n=28 3.88 (0.91) \n\n\n\nCollect-Later Service, n=24 4.38 (0.50) \n\n\n\nDrive-Through Pharmacy, n=11 4.40 (0.70) \n\n\n\nAppointment Card Dispensing System, n=62 4.16 (0.85) \n\n\n\nPPUSS, n=3 4.33 (1.16) \n\n\n\n \n\n\n\n\n\n\n\n\nChung, E.S.N. et al. Mal J Pharm 7 (1) 2021, 22-27 \n\n\n\n\n\n\n\n26 \n\n\n\n\n\n\n\nrespondents (70.1%), 31.4% of them adopted PVAS. Hence, \n\n\n\nthere is a mismatch in the proportion of those who aware and \n\n\n\nthose who adopt the service. This result reflects that awareness \n\n\n\nis not the sole factor that contributes to PVAS adoption.  \n\n\n\n\n\n\n\nIn the open-ended question which explore refusal to adopt \n\n\n\nPVAS, one of the reasons cited was the poor understanding of \n\n\n\nthe service. They refused to adopt PVAS as they did not fully \n\n\n\nunderstand how it works and were not given a proper \n\n\n\nintroduction to this program. Some stated that they were \n\n\n\nfamiliar to the conventional over-the-counter collection method \n\n\n\nand would like to remain as such. Furthermore, another \n\n\n\nrespondent quoted that he preferred self-collection. The reasons \n\n\n\nare similar to the belief that the sense of unfamiliarity and little \n\n\n\ncontrol over patients\u2019 situation [1]. In another study, the \n\n\n\nresearchers argued that the presence of pharmacist during the \n\n\n\ncollection of medications may be essential and necessary to \n\n\n\nsome patients, mainly when there is a concern of medication \n\n\n\nerror or insufficient drug supply [13]. Patients may feel \n\n\n\nstressful and insecure especially when receiving different or \n\n\n\nunexpected medications via UMP and PPUSS when there is no \n\n\n\npharmacist available for them to consult [13]. This could \n\n\n\nhappen especially when there is a brand change. Therefore, this \n\n\n\ncould hinder the adoption of the service. \n\n\n\n\n\n\n\nIn the current study, a small number of respondents thought that \n\n\n\nPVAS is not required as it was more convenient to self-collect \n\n\n\ntheir refilled medicine due to the short distance to hospital. \n\n\n\nSome cited that they were not ready to adopt the new service. \n\n\n\nOne of the PVAS users revealed unpleasant experience from \n\n\n\nprevious (UMP) use, in which he failed to receive his follow-\n\n\n\nup medications through PVAS. The finding is similar to one \n\n\n\nstudy which reported that the confidence and intention to use \n\n\n\nUMP may lower as the delay in delivery by the national courier \n\n\n\nservice causes uncertainty and disappointment [13]. One of the \n\n\n\nrespondents reported the absence of recipient during medicine \n\n\n\ndelivery contributed to the refusal to adopt PVAS. It may be \n\n\n\ninconvenient to wait for the delivery as the delivery time is \n\n\n\nunknown. As discussed in a previous study, negative feelings \n\n\n\nor unpleasant experience with PVAS is one of the barriers that \n\n\n\naffect PVAS adoption and remains a significant challenge to \n\n\n\novercome [13].  \n\n\n\n\n\n\n\nWe also observed that Drive-Through Pharmacy has the \n\n\n\ngreatest satisfaction score, 4.40 (SD=0.70), whereas Call-and-\n\n\n\nCollect Service is the least satisfied, 3.88 (SD=0.91). Although \n\n\n\nCall-and-Collect is one of the most popular PVAS among the \n\n\n\nrespondents, the satisfaction score is the lowest. This could be \n\n\n\ndue to the difficulty in telephone line engagement as frequently \n\n\n\ncomplained by many patients. Due to the limited phone line and \n\n\n\nhigh usage due to hectic daily works. Nonetheless, previous \n\n\n\nstudies reported higher satisfaction score with PVAS in general \n\n\n\nwhen compared to conventional over the counter medication \n\n\n\ncollection method [16] [17].  \n\n\n\nWhen commenting opinion on PVAS, most respondents gave \n\n\n\npositive notes on PVAS, acknowledging it as an excellent \n\n\n\nprogram. They acknowledged that PVAS smoothens their \n\n\n\nfollow-up medication collection process as it is convenient, \n\n\n\nefficient, time-saving, and reduces their waiting time at the \n\n\n\npharmacy counter. Some respondents commented that PVAS \n\n\n\ncould reduce the risk of infectious disease transmission as they \n\n\n\ndo not need to visit the hospital frequently. It could save the \n\n\n\nfuel cost for the respondents too. \n\n\n\n\n\n\n\nTherefore, in this study, most respondents (86.2%) were \n\n\n\nwilling to adopt PVAS. 95.8% of the experienced PVAS users \n\n\n\nand 90.1% of inexperienced respondents, respectively were \n\n\n\nwilling to adopt PVAS to collect their follow-up medications. \n\n\n\nThis could be translated into future adoption of PVAS if \n\n\n\nintention to adopt is successful instilled. Although constant \n\n\n\npromotion could be useful, Tan et al. postulated that the \n\n\n\nadvantages of PVAS and how it works should be clearly \n\n\n\nconveyed to instill the intention to adopt these services [13]. \n\n\n\nWithout a clear intention, PVAS adoption will be limited as \n\n\n\nintentions are the precursors of behaviour [13]. Hence, it is \n\n\n\ncrucial for the promotional activities to enhance the \n\n\n\nunderstanding of the PVAS, besides increasing the awareness \n\n\n\namong patients. Therefore, the role of pharmacists is very much \n\n\n\ncrucial in assisting patients in selecting the type of PVAS that \n\n\n\nsuits their needs and provide help to overcome problems which \n\n\n\narise during the PVAS adoption. \n\n\n\n\n\n\n\nThis study has some limitations. Firstly, this was a single-centre \n\n\n\nstudy, the local population characteristics and need may differ \n\n\n\nfrom another population. Hence generalisation of the results \n\n\n\ncould be possible in a population which is similar to our study \n\n\n\nsample. In addition, the PVAS users in each subgroup was too \n\n\n\nsmall, therefore, not meaningful to perform inferences for their \n\n\n\nsatisfaction scores. Further studies using stratified sampling \n\n\n\nmethod may be appropriate for direct comparison of \n\n\n\nsatisfaction scores among types of PVAS. \n\n\n\n\n\n\n\nCONCLUSION  \n  \n\n\n\nThis study suggested that most respondents were aware of \n\n\n\nPVAS with a total of 31.4% of the respondents were its users. \n\n\n\nAmong the PVAS, Appointment Card Dispensing System \n\n\n\nservice were the most used PVAS while Drive-Through \n\n\n\nPharmacy and UMP were the most known PVAS. Respondents \n\n\n\nalso indicated the highest satisfaction score for Drive-Through \n\n\n\nPharmacy, and lowest for Call-and-Collect Service. Drive-thru \n\n\n\nPharmacy has the greatest awareness and satisfaction yet low \n\n\n\nusage, hence there is a need to further promote the PVAS for \n\n\n\ngreater adoption. Besides, such PVAS should also be expanded \n\n\n\nto other healthcare facilities.  \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nChung, E.S.N. et al. Mal J Pharm 7 (1) 2021, 22-27 \n\n\n\n\n\n\n\n27 \n\n\n\n\n\n\n\nACKNOWLEDGMENT \n  \n\n\n\nWe wish to acknowledge all respondents for spending their \n\n\n\ntime in this study. The authors would also like to thank the \n\n\n\nDirector General of Health Malaysia, for his permission to \n\n\n\npublish this paper. \n\n\n\n\n\n\n\nCONFLICT OF INTEREST \n  \n\n\n\nThe authors declare that there is no conflict of interest. \n\n\n\n\n\n\n\nREFERENCE \n \n\n\n\n[1] Tan CLH, Gan VBY. Pharmacy Value Added Services: Early \n\n\n\nBegininings, Current Implementation, and Challenges from the \n\n\n\nMalaysian Experience. Indian Journal of Pharmaceutical Education \n\n\n\nand Research 2016;50(3):335-43. \n\n\n\n[2] Pharmaceutical Services Division. A National Survey on the Use of \n\n\n\nMedicines by Malaysian Consumers (NSUM) 2015. \n\n\n\n[3] Loh BC, Wah KF, Teo CA, Khairuddin NM, Fairuz FB, Liew JE. \n\n\n\nImpact of value added services on patient waiting time at the \n\n\n\nambulatory pharmacy Queen Elizabeth Hospital. Pharm Pract \n\n\n\n(Granada). 2017;15(1):846. \n\n\n\n[4] Pharmaceutical Services Division. Garis Panduan Perkhidmatan \n\n\n\nTambah Nilai Farmasi. 2016. \n\n\n\n[5] Lin Y-F, Lin Y-M, Sheng L-H, Chien H-Y, Chang T-J, Zheng C-M, \n\n\n\net al. First drive-through pharmacy services in Taiwan. Journal of the \n\n\n\nChinese Medical Association. 2013;76(1):37-41. \n\n\n\n[6] Lin Y-F, Lin Y-M, Sheng L-H, Chien H-Y, Chang T-J, Zheng C-M, \n\n\n\net al. First drive-through pharmacy services in Taiwan. Journal of the \n\n\n\nChinese Medical Association. 2013;76(1):37-41. \n\n\n\n[7] Pharmaceutical Services Programme. Statistics Report of \n\n\n\nPharmaceutical Services Programme 2019. 2020. \n\n\n\n[8] Pharmaceutical Services Programme. Annual Report of \n\n\n\nPharmaceutical Services Programme 2014. \n\n\n\n[9] Pharmaceutical Services Programme. Annual Report of Pharmacy \n\n\n\nProgramme 2015. \n\n\n\n[10] Pharmaceutical Services Programme. Annual Report of \n\n\n\nPharmaceutical Services Programme 2019. \n\n\n\n[11] Department of Statistics Malaysia. Siaran Akhbar Laporan Survei \n\n\n\nPendapatan Isi Rumah & Kemudahan Asas 2019. \n\n\n\n[12] Allegemeine Psychologie und Arbeitspsychologie. G*Power: \n\n\n\nStatistical Power Analyses for Windows and Mac. D\u00fcsseldorf: \n\n\n\nHeinrich Heine University D\u00fcsseldorf; 2019. \n\n\n\n[13] Tan CLH, Hassali MA, Saleem F, Shafie AA, Aljadhay H, Gan VBY. \n\n\n\nBuilding intentions with the theory of planned behaviour: a qualitative \n\n\n\nassessment of salient beliefs about pharmacy value added services in \n\n\n\nMalaysia. Health Expectations. 2015(19):1215-25. \n\n\n\n[14] Zainal Z, Hashim N, Musa M, Rahim SS, Hisham N, Yen CK. \n\n\n\nPharmacy Bulletin. Accessed on 13 March 2021. Available from:     \n\n\n\nhttp://htintan.moh.gov.my/index.php/penerbitan/muat-turun-\n\n\n\nborang/category/19-farmasi?download=207:buletin-farmasi-2017. \n\n\n\n[15] 15. HRPZII's Locker4U Service Receives Overwhelming Response. \n\n\n\nAccessed on 13 March 2021. Available from:     \n\n\n\nhttps://www.thesundaily.my/archive/hrpziis-locker4u-service-\n\n\n\nreceives-overwhelming-response-ETARCH472120. \n\n\n\n[16] Lau BT, Abdul-Rani NNA, Ng SY, Wong SN. Satisfaction of patients \n\n\n\nreceiving value added-services compared to traditional counter service \n\n\n\nfor prescription refills in Malaysia. Pharmacy Practice 2018;16(1):1-\n\n\n\n6. \n\n\n\n[17] Chan HK, Shahabudin NA, Ghani NA, Hassali MA. Satisfaction with \n\n\n\ntraditional counter versus value\u2010added services for prescription claims \n\n\n\nin a Malaysian Tertiary Hospital. Journal of Pharmaceutical Health \n\n\n\nServices Research. 2015;6(1):61-8. \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Volume 7 Issue 1 (2021) \n \n\n\n\n\n\n\n\n\n\n\n\n28 \n\n\n\n\n\n\n\n*Correspondence: hueymiin@moh.gov.my \n\n\n\n\n\n\n\n1 Pharmacy Department, Hospital Kuala Lipis, Kuala Lipis, Pahang, Malaysia  \n2 Pharmacy Department, Hospital Sultan Haji Ahmad Shah, Temerloh, Pahang \n\n\n\nMalaysia.   \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n Original Research Article \n\n\n\n\n\n\n\nAnalgesic Dosing Behaviours in Patients with Chronic, Non-\n\n\n\nCancer Pain: Does it Affect the Pain Control? \n \n\n\n\nMohamad Akmal Bin Harun1, Nurul Fateeha Binti Ahmad1, Cheah Huey Miin2* \n\n\n\n\n\n\n\n  \nArticle Info  \n\n\n\n \nReceived date: 30 Dec 2020 \n\n\n\nAccepted date:   3 Feb 2021 \n\n\n\nPublished date: 30 June 2021 \n\n\n\n\n\n\n\nKeywords: Chronic pain, pain \n\n\n\ncontrol, pain management \n\n\n\nindex, brief pain inventory, \n\n\n\nanalgesic, Malaysia  \n\n\n\nABSTRACT  \n\n\n\n\n\n\n\nChronic pain has a significant impact on sufferers\u2019 quality of life. Furthermore, treatment \n\n\n\ninadequacies are often reported in the literatures. This study aims to investigate the prevalence of the \n\n\n\ndifferent dosing behaviors in analgesics use in chronic, non-cancer pain and their correlation to pain \n\n\n\ncontrol. This is a cross-sectional study and a convenience sampling method was applied. Brief Pain \n\n\n\nInventory- Short Form and Pain Management Index was computed to assess pain control. Statistical \n\n\n\nanalysis was performed with Pearson chi-square test and alpha value was set at 0.05. A total of 127 \n\n\n\npatients were analyzed. 70.9% of the patients reported inadequate pain control with their prescribed \n\n\n\nanalgesic(s). 88.2% patients only took oral analgesics whenever they felt the pain while 11.8% \n\n\n\npatients took around-the-clock despite the absence of pain. Among them, 11.8-34.7% of patients did \n\n\n\nnot follow their prescriber\u2019s instruction for oral and topical analgesic use respectively. However, no \n\n\n\nstatistically significant result was found between the dosing behaviors and pain control (p>0.95). It \n\n\n\nwas also reported that 98% of patients were not aware of the maximum daily dose of their prescribed \n\n\n\nanalgesic(s). The prevalence of \u2018as needed\u2019 dosing is higher than around-the-clock dosing in the \n\n\n\nmanagement of chronic, non-cancer pain, with deviation from the prescribed instructions between \n\n\n\n11.8-34.7%. However, those differences were not significantly associated with the pain control.  \n\n\n\n\n\n\n\nINTRODUCTION  \n  \n\n\n\nPain is often a symptom reported by patients suffering from \n\n\n\nvarious clinical conditions. The International Association for \n\n\n\nthe Study of Pain (IASP) defines pain as an 'unpleasant sensory \n\n\n\nand emotional experience associated with actual or potential \n\n\n\ntissue damage' [1]. Pain should not be viewed as merely a \n\n\n\nsymptom, as pain can persist for a long period of time even after \n\n\n\nan underlying injury or disease has resolved. When the pain \n\n\n\npersists for at least three months, it is categorized as chronic \n\n\n\npain, and the cause can be cancerous or non-cancerous origins.  \n\n\n\n\n\n\n\nAmong Asian adults, Malaysia has one of the lowest \n\n\n\nprevalence of chronic pain at 7.1%, in comparison to Northern \n\n\n\nIraq (72%), Cambodia (48%) and Singapore (8.7%). However, \n\n\n\nthe pain prevalence is notably higher among the geriatric \n\n\n\npopulation (42 to 90.8%) [2].  \n\n\n\n\n\n\n\nPain should not be overlooked. This is because people with \n\n\n\nchronic pain were often reported to have a poor quality of life \n\n\n\ndue to immobility, disability, disturbed sleep, isolation, \n\n\n\nanxiety, frustration, depression, poor appetite and nutrition, \n\n\n\nincreased susceptibility to disease, dependence on medication, \n\n\n\nand long-term medical care [3-6]. Specifically, for chronic non-\n\n\n\ncancer pain (CNCP), it was found that as much as 80.8% of \n\n\n\npatients whose activities of daily living were affected by pain \n\n\n\n[7], further highlighting the inadequacy of pain management in \n\n\n\nthis patient cohort. \n\n\n\n\n\n\n\nPain management starts with pain assessment since the choice \n\n\n\nof analgesic will be different based on the pain score. Pain \n\n\n\nassessment can be performed with Numerical Rating Scale \n\n\n\n(NRS), which uses an 11-point scale. Pain can range from none \n\n\n\n(score zero) to the worst pain ever possible (score ten).[8] After \n\n\n\nthe determination of a pain score, the next step in pain \n\n\n\nmanagement is analgesic selection. To guide analgesic \n\n\n\nselection, National Health Service (NHS) United Kingdom \n\n\n\n\n\n\n\n\nHarun, M.A. et al. Mal J Pharm 7 (1) 2021, 28-33 \n\n\n\n\n\n\n\n29 \n\n\n\n\n\n\n\n(UK) devised a treatment guideline for CNCP. In the guideline, \n\n\n\nit was recommended that every treatment should start with \n\n\n\nparacetamol, and this medication should be added to a \n\n\n\nsubsequent regimen for its synergistic effect. If the pain \n\n\n\npersists, or not properly controlled, non-steroidal anti-\n\n\n\ninflammatory drugs (NSAIDs) or weak opioids can be \n\n\n\nprescribed. If the NSAIDs or weak opioids are still ineffective, \n\n\n\na more powerful opioid like morphine or fentanyl should be \n\n\n\ngiven to the patient [9].  \n\n\n\n\n\n\n\nCNCP treatment is mostly based on the principles behind the \n\n\n\nWorld Health Organization (WHO) analgesic ladder [10], \n\n\n\nwhich was originally developed for cancer pain management. \n\n\n\nBecause of this origin, the majority of institutional guidelines, \n\n\n\nreviews, and training manuals advocate the effectiveness of \n\n\n\nregular analgesic in both cancerous and non-cancerous chronic \n\n\n\npain [9,11-14]. Unfortunately, in Malaysia, it was found that \n\n\n\nonly 4.2 to 4.4% of the population take their analgesic regularly \n\n\n\nin chronic pain [15-16], which is lower than a chronic pain \n\n\n\nprevalence of 7.1% in the country. Therefore, this study was \n\n\n\ninitiated to investigate the prevalence of the different dosing \n\n\n\nbehaviors in analgesics use in CNCP outpatients and their \n\n\n\ncorrelation to pain control.  \n\n\n\n\n\n\n\nMETHOD  \n  \n\n\n\nStudy design \n \n\n\n\nThis was a single-center, cross-sectional study conducted in the \n\n\n\noutpatient pharmacy department of Kuala Lipis Hospital in \n\n\n\nMalaysia. Convenience sampling was used to recruit study \n\n\n\nparticipants. Possible sampling bias was minimized by \n\n\n\nconsistently recruiting patients during their clinic \n\n\n\nappointments, which are 8 a.m. to 1 p.m. from Mondays to \n\n\n\nFridays, excluding public holidays. \n\n\n\n\n\n\n\nSample Size Estimation \n \n\n\n\nWith an estimated prevalence of chronic pain at 7.1% [2], a \n\n\n\nconfidence level of 95%, and a confidence limit of 5%, a \n\n\n\nminimum sample size of 101 was calculated to provide \u226580% \n\n\n\npower [17]. After considering a possible 15% dropout rate, the \n\n\n\nfinal calculated sample size was 117 subjects. \n\n\n\n\n\n\n\nStudy Subjects \n\n\n\n\n\n\n\nAll patients who presented to the outpatient pharmacy with a \n\n\n\nvalid prescription were screened for eligibility. Patients who \n\n\n\ntook at least one analgesic for a minimum of three months, as \n\n\n\nverified by the pharmacy dispensing record, were invited for \n\n\n\nstudy participation. We excluded patients who were less than \n\n\n\neighteen years old, pregnant women, and those with a diagnosis \n\n\n\nof cancer-related pain. \n\n\n\n\n\n\n\nMeasurement of Outcomes \n \n\n\n\nAll study subjects were assisted by researchers to fill in a \n\n\n\nquestionnaire. The questionnaire consisted of three sections. \n\n\n\nThe first section consisted of baseline demographic \n\n\n\ncharacteristics of study subjects such as gender, age, race, \n\n\n\noccupational status, and pain diagnosis. The second section was \n\n\n\nabout study subjects' pain management details such as the \n\n\n\nprescribed analgesic(s) (name and dosage form), dose, actual \n\n\n\ndose taken for each analgesic, and whether they used over-the-\n\n\n\ncounter (OTC) analgesic and complementary medicines. If the \n\n\n\nprescribed instruction of the analgesics was \u2018as needed\u2019, we \n\n\n\nfurther investigated if the respondents can correctly identify the \n\n\n\nmaximum allowable daily dose. Information for the second \n\n\n\nsection was first extracted from medical records and pharmacy \n\n\n\ndispensing record, before verbally verified with the patients. \n\n\n\nThe third part was the Brief Pain Inventory- Short Form (BPI-\n\n\n\nsf) to assess pain among study subjects. BPI-sf is a 9-item self-\n\n\n\nadministered questionnaire and is chosen for this study due to \n\n\n\nits ability to assess the totality of pain experience (minimum, \n\n\n\nmaximum, average and current pain score) [18]. The patient is \n\n\n\nasked to rate their worst, least, average, and current pain \n\n\n\nintensity, list current treatments and their perceived \n\n\n\neffectiveness. The Malay version of the BPI previously \n\n\n\nvalidated in local population [19] was used in this study. A pilot \n\n\n\ntest of fourteen patients gave a Cronbach\u2019s alpha value of \n\n\n\n0.677. \n\n\n\n\n\n\n\nWe used the pain management index (PMI) to assess the \n\n\n\nadequacy of pain control. The index is constructed upon the \n\n\n\npatient's worst pain level in the last twenty-four hours \n\n\n\nrecategorized as zero (no pain), one (pain score one to three, \n\n\n\nmild pain), two (pain score four to seven, moderate pain), or \n\n\n\nthree (pain score eight to ten, severe pain). To compute the \n\n\n\nindex, the new pain level was then subtracted from the most \n\n\n\npotent level of their prescribed analgesic categorized as zero \n\n\n\n(no analgesic drug), one (non-opioid), two (a weak opioid), or \n\n\n\nthree (a strong opioid). Ranging from -3 (a patient with severe \n\n\n\npain receiving no analgesic) to +3 (a patient receiving \n\n\n\nmorphine or an equivalent and reporting no pain), a score of \n\n\n\nzero and higher (positive value) indicated acceptable pain \n\n\n\ncontrol with analgesic while a negative value suggested \n\n\n\nsuboptimal pain control [20-21]. The index was computed with \n\n\n\nMicrosoft Excel function and the accuracy of calculation was \n\n\n\nthen manually cross-checked by the researchers. \n\n\n\n\n\n\n\nTwo dosing categories, regular or as needed, were used to \n\n\n\ninvestigate the prevalence of dosing deviation. The dosing \n\n\n\nbehavior was classified as regular if the patient took analgesics \n\n\n\nat a fixed interval (once daily or several times a week) despite \n\n\n\nthe absence of pain. On the other hand, if analgesics were used \n\n\n\nonly in the presence of pain sensation, the dosing behavior was \n\n\n\nclassified as \u2018as needed\u2019. \n\n\n\n \n\n\n\n\n\n\n\n\nHarun, M.A. et al. Mal J Pharm 7 (1) 2021, 28-33 \n\n\n\n\n\n\n\n30 \n\n\n\n\n\n\n\nStatistical Analysis \n \n\n\n\nData was analyzed using IBM SPSS Statistics for Windows, \n\n\n\nVersion 21 (IBM Corp. Released 2012. IBM SPSS Statistics \n\n\n\nfor Windows, Version 21.0. Armonk, NY: IBM Corp.). \n\n\n\nDescriptive statistic was used to summarize the demographic \n\n\n\ndata in mean, standard deviation (SD), and proportion. Pain \n\n\n\nscore was presented in median and interquartile range (IQR). \n\n\n\nPearson chi-square and fisher's exact test were used to study the \n\n\n\nrelationship between the dosing deviation and PMI. All the p-\n\n\n\nvalues were two-tailed and statistical significance was defined \n\n\n\nas p < 0.05. \n\n\n\n\n\n\n\nEthics Approval  \n \n\n\n\nThe study was registered under Malaysia National Medical \n\n\n\nResearch Registry (NMRR-16-1880-32144) and approved by \n\n\n\nthe Medical Research and Ethics Committee Malaysia \n\n\n\n((6)KKM/NIHSEC/P16-1549). All participants provided \n\n\n\nwritten informed consent before enrolment, and the study was \n\n\n\nconducted in accordance with the Declaration of Helsinki.  \n\n\n\n\n\n\n\nRESULT \n \n\n\n\nStudy Subjects \n\n\n\n\n\n\n\nWe approached a total of 130 patients. Three patients refused \n\n\n\nto participate in the survey due to time constraints. One hundred \n\n\n\nand twenty-seven (97.7%) outpatients with CNCP participated \n\n\n\nin the study and were included in the final data analysis. Of \n\n\n\nthese patients, forty-eight (37.8%) were male, and seventy-nine \n\n\n\n(62.2%) were female. The mean (\u00b1 SD) age was 55 (\u00b112.8) \n\n\n\nyears. Majority of the patients were Malay (58.3%), followed \n\n\n\nby Indian (33.1%), Chinese (7.9%) and Siamese (0.8%). Most \n\n\n\nof them were in full-time employment (68.5%), while 30.7% \n\n\n\nwere unemployed at the time of the interview. As shown in \n\n\n\nTable I, the most frequent pain diagnosis was osteoarthritis \n\n\n\n(31.5%), followed by cervical or lumbar degenerative disease \n\n\n\n(28.3%) and pelvic inflammatory disease (11.8%). Pain \n\n\n\ndiagnoses such as fibromyalgia, bone fracture, spinal stenosis, \n\n\n\nand anterior cruciate ligament injury were collectively grouped \n\n\n\nunder the category of 'others' due to the relatively low \n\n\n\nfrequency in our study subjects. \n\n\n\n\n\n\n\nFor pain management, most of the patients had been prescribed \n\n\n\na combination of oral and topical analgesic (74.8%). Of note, a \n\n\n\ntremendous 80.3% of the patients needed at least two \n\n\n\nanalgesics for pain control, and only 19.7% of them were \n\n\n\ntreated with just an analgesic. NSAIDs, especially celecoxib \n\n\n\nand weak opioid tramadol, were the most frequent oral \n\n\n\nanalgesics prescribed by our doctors, with a total combined \n\n\n\nfrequency of 73.2%. On the other hand, topical NSAIDs \n\n\n\n(diclofenac and ketoprofen) were also the most frequently \n\n\n\nprescribed topical analgesic in our study subjects. \n\n\n\nTable I: Baseline characteristics of study patients (N=127) (a) \n\n\n\ndemographic data and (b) Analgesic regimen \n\n\n\n\n\n\n\n(a) (a) Demographic characteristics \n\n\n\n\n\n\n\nVariable Mean (\u00b1SD) \n\n\n\nAge  \n\n\n\n 54 (\u00b112.8) \n\n\n\n\n\n\n\nVariable Number (%) \n\n\n\nGender  \n\n\n\nFemale  79 (62.2%) \n\n\n\nMale 48 (37.8%) \n\n\n\n\n\n\n\nRace  \n\n\n\nMalay  74 (58.3 %) \n\n\n\nIndian  42 (33.1%) \n\n\n\nChinese 10 (7.9%) \n\n\n\nSiamese 1 (0.8%) \n\n\n\n\n\n\n\nOccupational status  \n\n\n\nEmployed  88 (69.3%) \n\n\n\nUnemployed/Retired  39 (30.7%) \n\n\n\n\n\n\n\nDiagnosis of Chronic Pain  \n\n\n\nOsteoarthritis 40 (31.5%) \n\n\n\nCervical/Lumbar degenerative disease 36 (28.3%) \n\n\n\nPelvic inflammatory disease 15 (11.8%) \n\n\n\nLower back pain 7 (5.5%) \n\n\n\nMusculoskeletal injury 3 (2.4%) \n\n\n\nRheumatoid arthritis 3 (2.4%) \n\n\n\nCervical/Lumbar radiculopathy 3 (2.4%) \n\n\n\nCarpal tunnel syndrome 3 (2.4%) \n\n\n\nSupraspinatus inflammation 3 (2.4%) \n\n\n\nOthers 14 (11.2%) \n\n\n\n\n\n\n\n(b) (b) Analgesic regimens  \n\n\n\n\n\n\n\nVariable Number (%) \n\n\n\nDosage form of analgesic  \n\n\n\nOral only 32 (25.2%) \n\n\n\nTopical only 0 (0%) \n\n\n\nCombination (Oral +Topical) 95 (74.8%) \n\n\n\n\n\n\n\nNumber of analgesics  \n\n\n\n1 25 (19.7%) \n\n\n\n2 77 (60.6%) \n\n\n\n3 22 (17.3%) \n\n\n\nMore than 3 3 (2.4%) \n\n\n\n\n\n\n\nType of ORAL analgesic  \n\n\n\nNSAIDs 47 (37%) \n\n\n\nTramadol 46 (36.2%) \n\n\n\nGabapentin 1 (0.8%) \n\n\n\nParacetamol  1 (0.8%) \n\n\n\nCombination  32 (25.2%) \n\n\n\n\n\n\n\nType of TOPICAL analgesic  \n\n\n\nNSAIDs 66 (52%) \n\n\n\nMethyl salicylate ointment 28 (22%) \n\n\n\nCombination 1 (0.8%) \n\n\n\n\n\n\n\nAdditional OTC analgesic from community pharmacy \n\n\n\nYes  16 (12.6%) \n\n\n\nNo 111 (87.4%) \n\n\n\n\n\n\n\nComplementary medicines  \n\n\n\nYes  19 (15%) \n\n\n\nNo 108 (85%) \n\n\n\nNSAIDs: Non-steroidal anti-inflammatory drugs; OTC: over the counter \n\n\n\n\n\n\n\n\n\n\n\n\n\nHarun, M.A. et al. Mal J Pharm 7 (1) 2021, 28-33 \n\n\n\n\n\n\n\n31 \n\n\n\n\n\n\n\nIn addition to medication supply from the hospital, 12.6% of \n\n\n\npatients bought OTC analgesics from a community pharmacy \n\n\n\nto supplement their prescription medicines, and nineteen (15%) \n\n\n\npatients practiced traditional and complementary medicines \n\n\n\nsuch as massage, acupuncture, meditation, and cupping as part \n\n\n\nof their pain management. \n\n\n\n\n\n\n\nPain Assessment  \n\n\n\n\n\n\n\nOn average, patients reported their worst pain score at eight out \n\n\n\nof ten, while the least pain score was one out of ten (Fig. 1). \n\n\n\nThe median percentage of pain relief from the prescribed \n\n\n\nanalgesic(s) was seventy percent. With regards to the location \n\n\n\nof pain, 33.9% of patients experienced pain at more than one \n\n\n\nbody part, 31.5% at trunk regions, 29.9% at lower limb(s), and \n\n\n\nonly 4.7% at upper limb(s). \n\n\n\n\n\n\n\nPrevalence of Different Analgesic Dosing Behaviors      \n\n\n\n\n\n\n\nAn analysis of the prescribing pattern for oral analgesics \n\n\n\nshowed that 95.3% of prescribers annotated \u2018as needed\u2019 dosing. \n\n\n\nMeanwhile, 88.2% of patients took their oral analgesic(s) 'as \n\n\n\nneeded'. (Table II) The study showed cases of discrepancy \n\n\n\nbetween the prescribed dose and the actual dose taken, but the \n\n\n\nfrequency was minimal. For oral analgesics, only fifteen \n\n\n\n(11.8%) patients did not take their analgesic according to the \n\n\n\nprescribed instruction. Meanwhile, about one-third (34.7%) of \n\n\n\npatients applied topical analgesics regularly despite being \n\n\n\ninstructed to apply only 'as needed' (Table II). We also \n\n\n\ndiscovered an alarming 98.4% of patients did not know the \n\n\n\nmaximum allowable daily dose of the analgesic(s) prescribed \n\n\n\nto them when instructed to take as needed.   \n\n\n\n\n\n\n\nPMI and Pain Control \n\n\n\n\n\n\n\nOur study demonstrated that as high as 70.9% of patients were \n\n\n\nunder-treated for their chronic pain, represented by negative \n\n\n\nPMI as shown in Table III. No significant relationship was \n\n\n\nfound between the dosing deviation with PMI; whether taking \n\n\n\nit via oral analgesics (p=0.534), topical analgesics (p=0.767), \n\n\n\nor the combination routes (p>0.95) (Table III).  \n\n\n\n\n\n\n\nDISCUSSION  \n  \n\n\n\nFrom this study, we observed a discrepancy in analgesic use \n\n\n\nbetween the prescribed dose and the actual dose taken by \n\n\n\npatients. There were 11.8% and 34.7% of patients who did not \n\n\n\nfollow their prescriber's instruction when using oral and topical \n\n\n\nanalgesics. Earlier results of a qualitative study in 2006 also \n\n\n\nproved the existence of self-dosing behavior in analgesic use \n\n\n\n[22]. \n\n\n\n\n\n\n\nRegardless, the self-dosing behavior especially in the \n\n\n\nconsumption of oral analgesics was not apparent in our study. \n\n\n\n88.2% of patients took oral analgesic(s) 'as needed', which \n\n\n\naligned with 95.3% of the 'as needed' prescribed instruction. \n\n\n\nHowever, the matching preference of both prescribers and the \n\n\n\npatients in our study subjects was far from good news. Current \n\n\n\nrecommendations advocated regular administration of \n\n\n\nanalgesics in chronic pain management [9,11-14], but only \n\n\n\n4.7% of the prescriptions were written for 'regular dosing', \n\n\n\n \nFig. I: Pain scores reported by 127 study patients as collected from Brief \n\n\n\nPain Inventory-Short Form (BPI-sf) \n\n\n\nTable III: Percentage of patients with negative and positive PMI scores \n\n\n\nbased on deviation of oral and topical analgesic dosing   \n\n\n\n\n\n\n\nDosing Deviation Pain Management Index (PMI) \n\n\n\nPositive Negative Total p-value \n\n\n\nOral only \n\n\n\nYes \n\n\n\nNo \n\n\n\n\n\n\n\n1  \n\n\n\n9  \n\n\n\n\n\n\n\n1  \n\n\n\n21  \n\n\n\n\n\n\n\n2  \n\n\n\n30  \n\n\n\n\n\n\n\n0.534a \n\n\n\nTotal 10  22  32   \n\n\n\nTopical only \n\n\n\nYes \n\n\n\nNo \n\n\n\n\n\n\n\n10  \n\n\n\n 17  \n\n\n\n\n\n\n\n23 \n\n\n\n45  \n\n\n\n\n\n\n\n33 \n\n\n\n62 \n\n\n\n\n\n\n\n0.767b \n\n\n\nTotal 27  68  95   \n\n\n\nOverall \n\n\n\nYes \n\n\n\nNo \n\n\n\n\n\n\n\n4  \n\n\n\n33  \n\n\n\n\n\n\n\n11  \n\n\n\n79  \n\n\n\n\n\n\n\n15  \n\n\n\n112  \n\n\n\n\n\n\n\n>0.95a \n\n\n\nTotal 37 \n\n\n\n(29.1%) \n\n\n\n90 \n\n\n\n(70.9%) \n\n\n\n127 \n\n\n\n(100%) \n\n\n\n\n\n\n\naFisher's exact test bPearson chi-square test \n\n\n\n\n\n\n\nTable II: Analgesic dosing behaviors among patients (N=127) \n\n\n\n\n\n\n\nType of \n\n\n\nAnalgesics \n\n\n\nPrescriber Instruction, \n\n\n\nN (%) \n\n\n\nPatient Dosing, N (%) Total \n\n\n\nAs \n\n\n\nNeeded \n\n\n\nRegular As \n\n\n\nNeeded \n\n\n\nRegular  \n\n\n\nOral 121 (95.3) 6 (4.7) 112 (88.2) 15 \n\n\n\n(11.8) \n\n\n\n127 \n\n\n\nTopical 94 (98.9) 1 (1.1) 61 (64.2) 34 \n\n\n\n(35.8) \n\n\n\n95 \n\n\n\n \n\n\n\n\n\n\n\n\nHarun, M.A. et al. Mal J Pharm 7 (1) 2021, 28-33 \n\n\n\n\n\n\n\n32 \n\n\n\n\n\n\n\nhighlighting a guideline non-adherence in chronic pain \n\n\n\nmanagement among our healthcare professionals. \n\n\n\n\n\n\n\nPain control was not found to be significantly associated with \n\n\n\ndosing deviation (p>0.95). Negative PMI, an indication of poor \n\n\n\npain control with analgesics, was the major observation in our \n\n\n\npatients, regardless of whether they followed or deviated from \n\n\n\nthe prescribed dose. Hence, additional analgesic should be \n\n\n\nadded to the existing regimen for better pain control. In the \n\n\n\nstudy, none of the patients was prescribed a strong opioid, \n\n\n\ndespite the fact that a few patients reported their worst pain \n\n\n\nscore at 10, the highest pain score. In Kuala Lipis Hospital, \n\n\n\nstrong opioids are reserved for cancer patients. Thus, the \n\n\n\nstrongest analgesic available for CNCP patients in our setting \n\n\n\nis weak opioids. The prescribing practice will need to be \n\n\n\nreviewed following the results of the study, as the majority of \n\n\n\nCNCP patients in our study subjects were inadequately treated. \n\n\n\nStrong opioids should be used to manage severe pain, based on \n\n\n\nthe WHO analgesic ladder [10] and local guidelines [23].  \n\n\n\n\n\n\n\nThe most frequently prescribed oral analgesics in our setting \n\n\n\nwere celecoxib and tramadol. Other oral analgesics that were \n\n\n\nprescribed to our patients were paracetamol and diclofenac. \n\n\n\nGabapentin and pregabalin were also used as adjuvants in \n\n\n\nneuropathic pain. There were no prescribing records found for \n\n\n\nstrong opioids in the management of CNCP. Celecoxib, a \n\n\n\nselective cyclooxygenase-2 inhibitor, was the most commonly \n\n\n\nprescribed analgesic within the family of NSAIDs due to its \n\n\n\nbetter gastrointestinal safety profile. It was also well-accepted \n\n\n\namong doctors in Malaysia due to the general belief that \n\n\n\ncelecoxib is more efficacious than conventional NSAIDs in \n\n\n\nreducing pain and inflammation [24]. On the other hand, the \n\n\n\nonly weak opioids in our hospital formulary are tramadol and \n\n\n\ndihydrocodeine. Since dihydrocodeine is classified as a \n\n\n\ndangerous drug and hence more stringent prescribing criteria, \n\n\n\nthe cheap and easily accessible tramadol is a popular add-on \n\n\n\noption for CNCP patients whose pain is uncontrolled with \n\n\n\nNSAIDs and paracetamol.  \n\n\n\n\n\n\n\nIt was shown in our study that 98% of CNCP patients did not \n\n\n\nknow the maximum allowable daily dose of analgesic(s) which \n\n\n\nthey were taking. They claimed to take their analgesic(s) as \n\n\n\nneeded without knowing the maximum allowable quantity per \n\n\n\nday. This situation is alarming as it can increase the risk of \n\n\n\nmedication misuse and accidental overdose. In fact, an \n\n\n\nAustralian report on injury research and statistics revealed that \n\n\n\nparacetamol, a type of analgesic, was accountable for the 2nd \n\n\n\nhighest pharmaceutical poisoning cases (11%, n=718) [25]. \n\n\n\nNot only that, but the deficiency in patient knowledge about \n\n\n\nparacetamol use was also highlighted in a few descriptive and \n\n\n\ncross-sectional studies [26-28]. Therefore, the knowledge gap \n\n\n\namong patients on the safe use of analgesics could be an \n\n\n\nopportunity for pharmacists to play a bigger role in preventing \n\n\n\ncases of pharmaceutical poisoning. However, a hospital survey \n\n\n\non the counseling practice of pharmacists showed \n\n\n\ndisappointing results. The survey confirmed that less than half \n\n\n\nof the pharmacists provided counseling and precautionary \n\n\n\nwarnings when dispensing paracetamol [29].  Therefore, \n\n\n\npharmacists need to do more in educating patients about the \n\n\n\nsafe use of not just paracetamol but of all analgesics in pain \n\n\n\nmanagement.  \n\n\n\n\n\n\n\nBesides the conventional analgesics, traditional and \n\n\n\ncomplementary medicines are gaining popularity and have \n\n\n\nbecome one of the popular alternatives in chronic pain \n\n\n\nmanagement. It was found that 69.4% of the Malaysian \n\n\n\npopulation used traditional and complementary medicines \n\n\n\nthroughout their life, and 55.6% of them used them annually \n\n\n\n[30]. In our study, nineteen (15%) patients sourced traditional \n\n\n\nand complementary medicines such as massage, acupuncture, \n\n\n\nmeditation, and cupping; and reported efficacy from these \n\n\n\nalternatives. The positive experience with traditional and \n\n\n\ncomplementary medicines is also demonstrated overseas. In \n\n\n\nfact, a patient survey in Singapore found that as much as 72% \n\n\n\nof patients reported better pain relief with complementary \n\n\n\nmedicines [31]. Gathering from the current evidence, \n\n\n\ntraditional and complementary medicines can become an \n\n\n\neffective alternative approach in chronic pain management, \n\n\n\nespecially among those patients who found limited pain relief \n\n\n\nfrom their current analgesics. However, they should be guided \n\n\n\nby informed healthcare professionals during the selection \n\n\n\nprocess so as not to fall victims to unscrupulous dealers, which \n\n\n\neventually may give rise to other health complications. \n\n\n\n\n\n\n\nCONCLUSION  \n \n\n\n\nThe prevalence of \u2018as needed\u2019 dosing is higher than around-the-\n\n\n\nclock dosing in the management of chronic, non-cancer pain, \n\n\n\nwith deviation from the prescribed instructions between 11.8-\n\n\n\n34.7%. However, those differences were not significantly \n\n\n\nassociated with the pain control. Our study highlighted that \n\n\n\npoor pain control in CNCP patients was due to fundamental \n\n\n\nerror at the prescribing stage, starting from inappropriate \n\n\n\nanalgesic choice and description of dosage frequency. Poor \n\n\n\npain control was impacted less by patients deviating from \n\n\n\nprescribing instructions. \n\n\n\n\n\n\n\nACKNOWLEDGMENT \n  \n\n\n\nWe would like to thank the Director-General of Health \n\n\n\nMalaysia for his permission to publish this article. We would \n\n\n\nalso like to express our gratitude to Georgia Bolden-Strestik, \n\n\n\nTan Jee Aik and Yap Pei Qi for helping to proofread the \n\n\n\nmanuscript. \n\n\n\n\n\n\n\nCONFLICT OF INTEREST \n  \n\n\n\nNone declared. \n\n\n\n\n\n\n\n\nHarun, M.A. et al. Mal J Pharm 7 (1) 2021, 28-33 \n\n\n\n\n\n\n\n33 \n\n\n\n\n\n\n\nREFERENCE \n \n[1] Merskey H, Bogduk N. 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J Health Commun. 2011;16(Suppl 3): 256\u201367. \n\n\n\n[28] Wolf MS, King J, Jacobson K, et al. Risk of unintentional overdose \n\n\n\nwith non-prescription acetaminophen products. J Gen Intern Med. \n\n\n\n2012;27(12): 1587\u201393. \n\n\n\n[29] Ali I, Khan AU, Khan J, et al. Survey of hospital pharmacists' \n\n\n\nknowledge regarding acetaminophen dosing, toxicity, product \n\n\n\nrecognition and counselling practices. J Pharm Health Serv Res. \n\n\n\n2017;8(1):39\u201343.  \n\n\n\n[30] Siti ZM, Tahir A, Farah Al, et al. Use of traditional and \n\n\n\ncomplementary medicine in Malaysia: a baseline study. Complement \n\n\n\nTherapies in Med. 2009;17(5-6):292-9. \n\n\n\n[31] Tan MG, Win MT, Khan SA. The use of complementary and \n\n\n\nalternative medicine in chronic pain patients in Singapore: a single-\n\n\n\ncentre study. Ann Acad Med Singapore. 2013;42(3):133-7. \n\n\n\n \n\n\n\n\nhttp://www.wales.nhs.uk/sites3/Documents/814/PainLadder-ABHBNov2012.pdf\n\n\nhttp://www.wales.nhs.uk/sites3/Documents/814/PainLadder-ABHBNov2012.pdf\n\n\nhttp://www.masp.org.my/index.cfm?menuid=33\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Volume 7 Issue 1 (2021) \n \n\n\n\n\n\n\n\n\n\n\n\n34 \n\n\n\n\n\n\n\n*Correspondence: ucn.jaasminerjit@kpjuc.edu.my, \n\n\n\ntcsiang@kpjuc.edu.my \n\n\n\n\n\n\n\n1 School of Pharmacy, KPJ Healthcare University College, Nilai, Malaysia \n2 Faculty of Pharmacy, University of Cyberjaya, Selangor, Malaysia \n3 Faculty of Computing and Engineering, Quest International University, \n\n\n\nIpoh, Perak, Malaysia \n 4 Department of Pharmacy, National University Hospital, Singapore \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n Original Research Article \n\n\n\n\n\n\n\nUtilization Review of Anti-peptic Ulcer Drugs at an Outpatient \n\n\n\nPharmacy Setting of a Private Hospital in Malaysia \n \n\n\n\nPuvithra Ravi Sundram 1, Ching Siang Tan 1*, Shashidharan Menon 1, H. Jaasminerjiit Kaur 1*, \n\n\n\nKah Seng Lee 2, Abdullah Khan 1, Anandarajagopal Kalusalingam 1, Khang Wen Goh 3, Pit Wei \n\n\n\nNg4 \n\n\n\n\n\n\n\n \nArticle Info  \n\n\n\n \nReceived date:  23 Dec 2020 \n\n\n\nAccepted date: 12 May 2021 \n\n\n\nPublished date: 30 June 2021 \n\n\n\n\n\n\n\nKeywords: \n\n\n\nPharmacoepidemiology, peptic \n\n\n\nulcer diseases, gastrointestinal \n\n\n\ntract, prescribing pattern, \n\n\n\nDefined Daily Dose \n\n\n\nABSTRACT \n\n\n\n\n\n\n\nAnti-peptic ulcer drugs (APUDs) such as proton pump inhibitors (PPI), H2 receptor antagonists \n\n\n\n(H2A), antacids are widely prescribed. This study is aimed to describe the utilisation pattern of \n\n\n\nAPUDs based on WHO Defined Daily Dose (DDD) and identify most commonly used APUD in the \n\n\n\nselected hospital. A retrospective study was carried out in outpatient of the selected hospital for year \n\n\n\n2017. Sample size was calculated using Raosoft. DDD of APUDs and direct drug cost were \n\n\n\ncalculated. Data were collected through electronic medical record by retrieving patients\u2019 registration \n\n\n\nnumber. Inclusion criteria were patients above 18 years old and APUDs prescribed for \n\n\n\ngastrointestinal related indications. A total of 160 prescriptions were randomly selected for data \n\n\n\nanalysis. Based on the DDD calculated, Rabeprazole 20mg was most prescribed drug among PPI \n\n\n\n(n=33), while Maalox is most prescribed drug among the antacids (n=23). Based on the DDD \n\n\n\ncalculated, Pantoprazole 20mg recorded highest rates per user per day about 1.26 DDD / user / day \n\n\n\nwhile antacids, Actal reported highest usage rate with 7.11 DDD / user / day. Besides, there are 5.4 \n\n\n\ndays supplied per user for this drug. Dexlansoprazole 60mg is the most expensive drug among all the \n\n\n\nPPI listed in hospital formulary. It has 18.5 days supplied/user, which is the second shortest duration \n\n\n\nof treatment among all the other PPIs. In contrast, omeprazole 20mg is the lowest cost PPI but the \n\n\n\nduration supplied per user is longer resulting in higher total cost of therapy. In conclusion, PPIs were \n\n\n\nthe most commonly prescribed.  \n\n\n\n\n\n\n\nINTRODUCTION  \n  \n\n\n\nPeptic ulcer disease (PUD) has been common ailment, where \n\n\n\nannual incident report stated 0.03% to 0.17% were diagnosed \n\n\n\nby medical examiner and treated as outpatient and 0.03% to \n\n\n\n0.17% during hospital stay. The incidence of PUD has decline \n\n\n\non recent time in some countries, this is attributed to the \n\n\n\ndecrease in Helicobacter pylori infection, particularly in \n\n\n\nWestern populations [1]. Asian countries recorded lower peptic \n\n\n\nacid disorder prevalence rate compared to advance nation \n\n\n\nmeanwhile Malaysian recorded prevalence 9.5% for duodenal \n\n\n\nulcer and 9.4% gastric ulcer respectively [2]. \n\n\n\n\n\n\n\nReports on prevalence and incidence of peptic ulcer secondary \n\n\n\nto geographical variation exists with differences in relative \n\n\n\noccurrences of duodenal and gastric ulcers. Ethnic variations \n\n\n\non peptic ulcer incidence has been reported on the pattern of \n\n\n\npeptic ulcer in Malaysia from endoscopic data at University \n\n\n\nMedical unit at Kuala Lumpur that states Chinese of both \n\n\n\ngender have a higher susceptibility to peptic ulcer [3]. \n\n\n\n\n\n\n\nAnti-Peptic Ulcer Drugs (APUDs) such as H2-receptor \n\n\n\nantagonists (H2RA), proton pump inhibitors (PPI), and \n\n\n\nantacids are commonly used by medical partitioner, on other \n\n\n\nhand synthetic prostaglandins and cytoprotective agents has \n\n\n\nbeen promptly used by  gastroenterologist in private clinics. \n\n\n\nBesides peptic ulcer disorder this agents are also used in \n\n\n\n\n\n\n\n\nSundram, P.R. et al. Mal J Pharm 7 (1) 2021, 34-42 \n\n\n\n\n\n\n\n35 \n\n\n\n\n\n\n\ntreatment non-ulcer dyspepsia and heartburns. These group \n\n\n\ndrugs are co-prescribed as prophylaxis agents during \n\n\n\nnonsteroidal anti-inflammatory drugs (NSAIDs), steroids, anti-\n\n\n\nplatelet and anticoagulation therapy [4]. Many physicians had \n\n\n\nraised concern regarding adverse events due to long-term acid \n\n\n\nsuppression therapy. n other hand with PUD drug endoscopic \n\n\n\nstudy reveal 30% of patient suffered with peptic ulcer whom \n\n\n\nco-prescribed NSAIDs [5]. Therefore, there is a need to \n\n\n\ndevelop a policy on APUD and drug formulary.  \n\n\n\n\n\n\n\nCommon acid suppressants used in gastrointestinal disorders \n\n\n\nare PPI and H2RA. The trend of drug consumption in Malaysia \n\n\n\nhas transformed significantly from H2RA to PPI and currently, \n\n\n\nthere are overconsumption of PPI [6]. A huge number of \n\n\n\npatients, as many as 90% in one study consume these drugs \n\n\n\nwith no appropriate guideline-based indication [7]. Since PPIs \n\n\n\nare easily available, this makes them one of the most widely \n\n\n\nprescribed medications; thus irrational use and unnecessary \n\n\n\nexposure prone to happen. Long-term consumption of a proton \n\n\n\npump inhibitor may lead to gastric carcinoids and increases the \n\n\n\nrisk of hip fractures [8]. Moreover, PPIs are costly thereby \n\n\n\nincreasing the economic burden on the patients. PPI over usage \n\n\n\nhas become very critical, where this study need to be \n\n\n\ncommenced in order to provide a better understanding in \n\n\n\nhealthcare sector [9]. \n\n\n\n\n\n\n\nAccording to Kandasami, the total cost of PUD patient \n\n\n\nprescription surges as more than half of patients suffering from \n\n\n\npeptic ulcers are usually associated with comorbidities that \n\n\n\nnecessitates treatment [10]. Although the prevalence of acid \n\n\n\nrelated disorders in Malaysia is in the region of 8-10%, , only \n\n\n\n0.6% of the population have been prescribed with medications \n\n\n\nfor acid related diseases by Malaysian Society of \n\n\n\nGastroenterology and Hepatology. This shows that there is a \n\n\n\ntreatment gap. Therefore, there is a need to standardise \n\n\n\ntreatment algorithms for acid related disorders in Malaysia and \n\n\n\nthe important role of anti-peptic ulcer drugs in the management \n\n\n\nof acid related disorders needs to be clearly defined. \n\n\n\n\n\n\n\nThe over-prescribing of APUD highlighted the importance of \n\n\n\nthe need to examine the current utilization and appropriateness \n\n\n\nof the anti-peptic ulcer drugs. The outcome of this study will be \n\n\n\nbeneficial to develop a policy on APUD usage and drug \n\n\n\nformulary at the selected hospital. Drug utilization review may \n\n\n\nhelp the prescribers to interpret, understand, and expand the \n\n\n\nprescribing, administration and usage of the medication. This \n\n\n\nmay directly have a positive impact on patient health and \n\n\n\nfinancial status.   \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nMETHOD \n \n\n\n\nOverview of Research Design \n\n\n\n\n\n\n\nA retrospective observational study on drug utilization of anti-\n\n\n\npeptic ulcer drugs had been carried out in the outpatient \n\n\n\ndepartment of a private hospital located at Seremban, Negeri \n\n\n\nSembilan Malaysia. A retrospective study design that trace \n\n\n\ninformation backwards was used. The selected hospital uses \n\n\n\nKPJ Clinical Information System (KCIS) and Hospital \n\n\n\nInformation Technology System (HITS) which is the \n\n\n\nElectronic Medical Record (EMR).  \n\n\n\n\n\n\n\nKCIS creates a boundless communication among the \n\n\n\nhealthcare professionals which manages the clinical aspects of \n\n\n\nthe hospital, while HITS is a system of the hospital \n\n\n\nmanagement that integrates all patients\u2019 information since the \n\n\n\npatient been registered until billing from KPJ Annual Report. \n\n\n\nThese systems are used to obtain data that are needed for this \n\n\n\nstudy. Inclusion and exclusion criteria were applied to select \n\n\n\nthe appropriate drug utilisation data. \n\n\n\n\n\n\n\nPatient selection criteria \n\n\n\n\n\n\n\nPrescriptions from newly registered patients as well as regular \n\n\n\nfollow-up patients were included in the study according to the \n\n\n\ninclusion and exclusion criteria. Prescriptions that fulfilled the \n\n\n\nfollowing inclusion and exclusion criteria adopted from \n\n\n\nliterature were included [11]. \n\n\n\n\n\n\n\nInclusion criteria  \n\n\n\n\n\n\n\n\u2022 Prescription with patient more than age of 18 years old \n\n\n\nreceiving anti-peptic ulcer drugs. \n\n\n\n\u2022 Pharmacologically treated for peptic ulcer with or \n\n\n\nwithout comorbidities. \n\n\n\n\n\n\n\nExclusion criteria  \n\n\n\n\n\n\n\n\u2022 The prescription with incomplete patient data for data \n\n\n\ncollection form. \n\n\n\n\u2022 Non-KPJ prescriptions. \n\n\n\n\n\n\n\nSampling Method \n\n\n\n\n\n\n\nThe sampling technique that has been used in this study were \n\n\n\nblock randomization as well as convenience sampling. Block \n\n\n\nrandomization method was used to randomize subjects into \n\n\n\ngroups that result in equal sample sizes.  Then, in order to \n\n\n\nchoose the sample, convenience sampling was used. \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nSundram, P.R. et al. Mal J Pharm 7 (1) 2021, 34-42 \n\n\n\n\n\n\n\n36 \n\n\n\n\n\n\n\nSample study \n\n\n\n\n\n\n\nThe sample size required for this study was estimated based on \n\n\n\na formula stated by Daniel [12]. For this study, the significance \n\n\n\nlevel was set at \u03b1 = 0.05 (two tailed) and 95% degree of \n\n\n\nconfidence interval (CI) fixed in the calculation sample size by \n\n\n\nusing the formula as stated above. The minimum sample size \n\n\n\ncalculated was 138 patients with peptic ulcer from the \n\n\n\noutpatient department. \n\n\n\n\n\n\n\nVariable Definition  \n\n\n\n\n\n\n\nThe KPJ Clinical Information System (KCIS) was used to \n\n\n\naccess the list of all patients that are previously prescribed with \n\n\n\nanti-peptic ulcer drugs in 2017 and record in a data collection \n\n\n\nform. Only prescriptions that met the inclusion and exclusion \n\n\n\ncriteria were included in this study. So, these patients\u2019 \n\n\n\nprescriptions records were retrieved between January till \n\n\n\nDecember 2017 by using their medical record number (MRN) \n\n\n\nor identification card number (IC). \n\n\n\n\n\n\n\nThe following data were collected for each prescription: \n\n\n\nDemographic data which includes the age, sex and weight of \n\n\n\npatient, diagnosis and relevant prescription data. This includes \n\n\n\nthe name of medication, pharmacological class, dose \n\n\n\nprescribed, dosage regimen which includes frequency and route \n\n\n\nof administration and number of drugs per prescription. The \n\n\n\ncollected prescriptions were evaluated based on criteria of \n\n\n\nprescription and standard guideline on DDD. \n\n\n\n\n\n\n\nThe prescription was assessed based on the following criteria, \n\n\n\nnumber of drugs prescribed, number prescribed in generics, \n\n\n\ndose strength, dosage of drug and duration of therapy. \n\n\n\nMeanwhile, the guideline on DDD that was used as the main \n\n\n\nreference in this study are CPG of Non-variceal Upper \n\n\n\nGastrointestinal Bleeding and National Drug Formulary. \n\n\n\n\n\n\n\nDefined Daily Dose Formula \n\n\n\n\n\n\n\nThe Defined Daily Dose (DDD) for a drug is its assumed \n\n\n\naverage maintenance dose per day for a drug used as a main \n\n\n\nindication in adults as WHO guideline (Eq. 1).  \n\n\n\n \n\ud835\udc47\ud835\udc5c\ud835\udc61\ud835\udc4e\ud835\udc59 \ud835\udc37\ud835\udc37\ud835\udc37\ud835\udc60\n\n\n\n=\n\ud835\udc37\ud835\udc5c\ud835\udc60\ud835\udc4e\ud835\udc54\ud835\udc52 \ud835\udc53\ud835\udc5c\ud835\udc5f\ud835\udc5a \ud835\udc60\ud835\udc61\ud835\udc5f\ud835\udc52\ud835\udc5b\ud835\udc54\ud835\udc61\u210e \u00d7  \ud835\udc44\ud835\udc62\ud835\udc4e\ud835\udc5b\ud835\udc61\ud835\udc56\ud835\udc61\ud835\udc66 \ud835\udc5c\ud835\udc53 \ud835\udc51\ud835\udc5f\ud835\udc62\ud835\udc54 \ud835\udc51\ud835\udc56\ud835\udc60\ud835\udc5d\ud835\udc52\ud835\udc5b\ud835\udc60\ud835\udc52\ud835\udc51\n\n\n\n\ud835\udc4a\ud835\udc3b\ud835\udc42 \ud835\udc4e\ud835\udc60\ud835\udc60\ud835\udc56\ud835\udc54\ud835\udc5b\ud835\udc52\ud835\udc51 \ud835\udc37\ud835\udc37\ud835\udc37 \ud835\udc53\ud835\udc5c\ud835\udc5f \ud835\udc61\u210e\ud835\udc52 \ud835\udc51\ud835\udc5f\ud835\udc62\ud835\udc54\n (\ud835\udc38\ud835\udc5e. 1) \n\n\n\n\n\n\n\n\n\n\n\nTo provides a rough estimate of the proportion of the \n\n\n\npopulation treated daily with a specific drug, rates per residents \n\n\n\nper day is calculated using Eq.2. \n\n\n\n\n\n\n\n\ud835\udc37\ud835\udc37\ud835\udc37\ud835\udc60 \ud835\udc5d\ud835\udc52\ud835\udc5f \ud835\udc51\ud835\udc4e\ud835\udc66 \ud835\udc5d\ud835\udc52\ud835\udc5f 1000 \ud835\udc5f\ud835\udc52\ud835\udc60\ud835\udc56\ud835\udc51\ud835\udc52\ud835\udc5b\ud835\udc61\ud835\udc60\n\n\n\n=\n\ud835\udc37\ud835\udc37\ud835\udc37\ud835\udc37\ud835\udc60 \ud835\udc5d\ud835\udc52\ud835\udc5f \ud835\udc66\ud835\udc52\ud835\udc4e\ud835\udc5f  \n\n\n\n30 \ud835\udc51\ud835\udc4e\ud835\udc66\ud835\udc60 \u00d7  30,000 \ud835\udc5f\ud835\udc52\ud835\udc60\ud835\udc56\ud835\udc51\ud835\udc52\ud835\udc5b\ud835\udc61\ud835\udc60\n\u00d7 1000  (\ud835\udc38\ud835\udc5e. 2) \n\n\n\n\n\n\n\nTo determine whether the DDD is close to the average daily \n\n\n\nmaintenance dose for the drug's main indication (as determined \n\n\n\nby WHO), the rates per user per day is calculated (Eq.3) \n\n\n\n\n\n\n\n\ud835\udc37\ud835\udc37\ud835\udc37\ud835\udc60 \ud835\udc5d\ud835\udc52\ud835\udc5f \ud835\udc51\ud835\udc4e\ud835\udc66 \ud835\udc5d\ud835\udc52\ud835\udc5f \ud835\udc62\ud835\udc60\ud835\udc52\ud835\udc5f =\n\ud835\udc37\ud835\udc37\ud835\udc37\ud835\udc37\ud835\udc60 \ud835\udc5d\ud835\udc52\ud835\udc5f \ud835\udc66\ud835\udc52\ud835\udc4e\ud835\udc5f  \n\n\n\n30 \ud835\udc51\ud835\udc4e\ud835\udc66\ud835\udc60 \u00d7  \ud835\udc41\ud835\udc62\ud835\udc5a\ud835\udc4f\ud835\udc52\ud835\udc5f \ud835\udc5c\ud835\udc53 \ud835\udc62\ud835\udc60\ud835\udc52\ud835\udc5f\ud835\udc60\n  (\ud835\udc38\ud835\udc5e. 3) \n\n\n\n\n\n\n\nUse of DDDs Clinically \n\n\n\n\n\n\n\nA clinical measure can also be calculated to help interpret the \n\n\n\nDDDs/user/day value which assumes dispensation to users \n\n\n\nover an entire year. This can be done in two steps: \n\n\n\n\n\n\n\nFirstly, an intermediate rate of the number of days supplied per \n\n\n\nuser is calculated by summing the number of days supplied \n\n\n\nrecorded on each prescription claim and dividing by the number \n\n\n\nof users. \n\n\n\n\n\n\n\nSecondly, the measure of how the drug is actually being used \n\n\n\nwas calculated by dividing the rate of the DDDs per user by the \n\n\n\nrate of the number of days supplied per user which is also \n\n\n\nknown as DDDs / day supplied. \n\n\n\n\n\n\n\nOutcome Parameter  \n\n\n\n\n\n\n\nThe DDD between the standardized DDD by WHO were \n\n\n\ncompared with DDD based on the drugs prescribed by the \n\n\n\nprescribers and patient\u2019s characteristics. The DDD/1,000 \n\n\n\ninhabitants/day which expressed as DDD methodology and the \n\n\n\ndrug classification system, Anatomical Therapeutic Chemical \n\n\n\n(ATC) were used in estimating the usage of APUD in the \n\n\n\nselected private hospital. Data of DDD of APUD in the selected \n\n\n\nhospital were then analysed and compared to the standard DDD \n\n\n\nof WHO classification of ATC/DDD.  \n\n\n\n\n\n\n\nEthical Consent \n\n\n\n\n\n\n\nThe ethical approval for this study was obtained from the \n\n\n\nResearch Ethic Committee of KPJ University College, Nilai, \n\n\n\nMalaysia (KPJUC/RMC/BPH/EC/2017/100). This approval \n\n\n\nhas been obtained before conducting the study. All data \n\n\n\nobtained were used solely for research and be kept confidential. \n\n\n\n \n\n\n\n\n\n\n\n\nSundram, P.R. et al. Mal J Pharm 7 (1) 2021, 34-42 \n\n\n\n\n\n\n\n37 \n\n\n\n\n\n\n\nRESULT  \n \n\n\n\nPatients\u2019 selection and description \n\n\n\n\n\n\n\nThe prescription data that have met all the inclusion criteria \n\n\n\nwere critically analysed. From the total outpatient prescriptions \n\n\n\nin 2017, 200 prescriptions were found matched the criteria \n\n\n\nbased on the studies requirement and 22 prescriptions were \n\n\n\nexcluded due to the diagnosis as Helicobacter pylori positive. \n\n\n\nHowever, due to some incomplete data were found, only 160 \n\n\n\nprescriptions were finally chosen.  \n\n\n\n\n\n\n\nDemographic Characteristics of Patients \n\n\n\n\n\n\n\nTable I shows the demographic characteristics of the \n\n\n\npopulations in this study and depicts that the most common age \n\n\n\ngroup in which APUDs were prescribed in both male and \n\n\n\nfemale was 50-59 years 31.88% (n=51) whereas the least age \n\n\n\ngroup prescribed with APUDs are below 20 years, 3.13% \n\n\n\n(n=5). The prescriptions of these drugs were slightly more \n\n\n\namong male patients 55% (N = 88) compared to female patients \n\n\n\n45% (n=72). The major ethnicity found to be prescribed the \n\n\n\nmost were Malay 63.75% (n=102) followed by Chinese \n\n\n\n18.75% (n=30) and Indian 17.50% (n=28). \n\n\n\n\n\n\n\nPatterns of Anti-Peptic Ulcer Drugs Utilization \n\n\n\n\n\n\n\nIn this study, the number of drugs prescribed varied according \n\n\n\nto the severity of patient condition and requirement of therapy. \n\n\n\nDrugs prescribed per prescription among 160 patients ranged \n\n\n\nfrom 1 to 2 types of drug products.  \n\n\n\n\n\n\n\nTable II illustrates the utilization pattern of anti-peptic ulcer \n\n\n\ndrugs according to their classification and it reveals that most \n\n\n\ncommon class of anti-peptic ulcer drug prescribed to adult \n\n\n\npopulation in that corresponding hospital setting was proton \n\n\n\npump inhibitors which accounted for 82% (n=159) followed by \n\n\n\nAntacids about 18% (n=35) and no usage of H2 antagonist. \n\n\n\n\n\n\n\nThe drug utilization was further examined specifically based on \n\n\n\neach type of drug products.  PPI was the one most commonly \n\n\n\nprescribed drug class, 17% (n=33) was contributed by \n\n\n\nrabeprazole 20mg whereas the least usage of drug under the PPI \n\n\n\ncategory is pantoprazole 40mg, about 6.7% (n=13).  Besides, \n\n\n\nthe main PPI prescribed by consultant is rabeprazole 20mg \n\n\n\nwhile the most frequent PPI prescribed by medical officers is \n\n\n\npantoprazole 20mg. The distribution of anti-peptic ulcer drugs \n\n\n\nutilization varied based on the strength of medication. The \n\n\n\nhighest maximum usage of antacids is Zellox suspension, about \n\n\n\n11.9% (n=23) whereas the least prescribed is Actal tablet about \n\n\n\n2.6% (n=5).   \n\n\n\n\n\n\n\nFigure I demonstrates 40% (n=64) of prescriptions \n\n\n\nadministered combination of anti-peptic ulcer drugs whereas \n\n\n\n60% (n=96) of them administered a single APUD. The highest \n\n\n\nnumber of samples administering single group of APUDs are \n\n\n\nfrom the age group of 50 to 59 years old. \n\n\n\n\n\n\n\nFrequency of anti-peptic ulcer drugs prescriptions from various \n\n\n\ndepartment are illustrated in Figure II. It shows that out of the \n\n\n\n160 prescriptions of APUDs, most number of outpatient \n\n\n\nprescriptions were found in general surgery department 26.9% \n\n\n\n(n=43) followed by 23.1% (n=37) from general medicine \n\n\n\ndepartment. On the other hand, APUDs were least prescribed \n\n\n\nin urology, otorhinolaryngology (ENT) and obstetrics and \n\n\n\nTable I. Gender and ethnicity of population based on age category \n\n\n\n\n\n\n\nCategory \n\n\n\nNumber of APUDs prescriptions, n (%) \n\n\n\nMale \n\n\n\nn=88 \n\n\n\nFemale \n\n\n\nn=72 \n\n\n\nAge category \n\n\n\nBelow 20 2 (1.25) 3 (1.9) \n\n\n\n20 to 29 2 (1.25) 4 (2.5) \n\n\n\n30 to 39 12 (7.5) 12 (7.5) \n\n\n\n40 to 49 27 (16.9) 16 (10) \n\n\n\n50 to 59 30 (18.8) 21 (13.1) \n\n\n\nAbove 60 15 (9.4) 16 (10) \n\n\n\nEthnicity \n\n\n\nMalay  59 (36.9) 43 (26.9) \n\n\n\nChinese 16 (10) 14 (8.8) \n\n\n\nIndian 13 (8.1) 15 (9.4) \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nTable II. Frequency of anti-peptic ulcer drug prescribed by medical \n\n\n\nofficer and consultant. \n\n\n\n\n\n\n\nDrug \n\n\n\nClassification \n\n\n\nDrugs Consultant Medical \n\n\n\nofficer  \n\n\n\nProton pump \n\n\n\ninhibitor  \n\n\n\n(82%, N=159) \n\n\n\nDexlansoprazole 60 mg  28 0 \n\n\n\nEsomeprazole 40mg 27 2 \n\n\n\nOmeprazole 20mg 21 6 \n\n\n\nPantoprazole 20mg 18 11 \n\n\n\nPantoprazole 40mg 9 4 \n\n\n\nRabeprazole 20mg  31 2 \n\n\n\nAntacid (18%, \n\n\n\nN=35) \n\n\n\nActal Tablet  5 0 \n\n\n\nMaalox Suspension  17 6 \n\n\n\nZellox Suspension  6 1 \n\n\n\n\n\n\n\n \nFigure I. Percentage of sample administering combination of anti-\n\n\n\npeptic ulcer drugs \n\n\n\n \n\n\n\n\n\n\n\n\nSundram, P.R. et al. Mal J Pharm 7 (1) 2021, 34-42 \n\n\n\n\n\n\n\n38 \n\n\n\n\n\n\n\ngynaecology.There are two different categories of physicians \n\n\n\ncommonly prescribe APUDs in the particular hospital which \n\n\n\nlocal and internationally educated physicians. Education \n\n\n\nbackground of a physician, indirectly related to the type of \n\n\n\nAPUDs prescribed by the physician. Consultants from local \n\n\n\nand oversea education background for specialist training prefer \n\n\n\ndifferent types APUDs for their patients. The most of APUDs \n\n\n\nprescribed by consultants form local universities are \n\n\n\nesomeprazole 40mg, 10.3% (n=20) whereas consultants from \n\n\n\noversea universities prefer rabeprazole 20mg, 11.9% (n=23). In \n\n\n\nthis hospital, all of the medical officers are from local \n\n\n\nuniversities and the highest number of APUDs prescribed by \n\n\n\nmedical officers from local universities are pantoprazole 20mg, \n\n\n\n5.7% (n=11). \n\n\n\n\n\n\n\nDemographic variables and types of anti-peptic ulcer drugs \n\n\n\nprescribed \n\n\n\n\n\n\n\nThe frequency of anti-peptic ulcer drugs prescribed varies \n\n\n\naccording to the age categories of patients. Table III show the \n\n\n\ndiverse number of APUDs prescribed to the different age \n\n\n\ncategories of patients. The most commonly APUD prescribed \n\n\n\nfor patients below 20 years is Pantoprazole 20mg, 1.5% (n=3) \n\n\n\nand two types of APUDs are among 20 to 29 years old patients, \n\n\n\npantoprazole 20mg and Omeprazole 20mg, 1.03% (n=2). Next, \n\n\n\nOmeprazole 20mg is the maximum usage of drug among 30 to \n\n\n\n39 years old, 3.09% (n=6) whereas among 40 to 49 years old \n\n\n\npatients is esomeprazole 40mg, 6.2% (n=12). The highest \n\n\n\namount of APUD accounted among 50 to 59 years old patients \n\n\n\nis rabeprazole 20mg, 6.7% (n=13) however among the age \n\n\n\ngroup of more than 60 years are two different APUDs, \n\n\n\nomeprazole 20mg and dexlansoprazole 60mg about 3.6% \n\n\n\n(n=7). Furthermore, the highest APUDs users belongs to age \n\n\n\ngroup of 50 to 59 years old.\n\n\n\nDefined Daily Dose (DDD) of Anti-Peptic Ulcer Drugs \n\n\n\n(APUDs) \n\n\n\n\n\n\n\nTable IV shows the results obtained from the calculation of \n\n\n\nDDDs / days supplied per user of APUDs at the selected \n\n\n\nhospital. Based on the DDD calculated, pantoprazole 20mg was \n\n\n\nthe most prescribed drug among proton pump inhibitors (PPI) \n\n\n\nwhereas Actal tablets has the highest usage among the antacids. \n\n\n\nThere are differences in all the anti-peptic ulcer drugs usage \n\n\n\nalthough the difference among APUDs are significantly low. \n\n\n\nAlthough ranitidine from H2 antagonist is available in the drug \n\n\n\nformulary of the hospital, it is never been prescribed during the \n\n\n\nstudy period. Besides, there is a clear comparison among unit \n\n\n\nprice of APUDs and it shows that dexlansoprazole 60mg is the \n\n\n\nhighest cost PPI whereas Maalox 250ml is the highest cost \n\n\n\nantacid available.  \n\n\n\n\n\n\n\nDISCUSSION  \n \n\n\n\nDemographic Characteristics of Patients \n\n\n\n\n\n\n\nIn this retrospective study, a total of 160 prescriptions were \n\n\n\nreviewed as per the inclusion and exclusion criteria. In term of \n\n\n\ngender of the patients receiving the prescriptions, there are \n\n\n\nhigher population of male patients, around 55 % and 45% are \n\n\n\nfemale patients. According to Department of Statistics \n\n\n\nMalaysia, there are 1.12 million of total populations in Negeri \n\n\n\nSembilan and there are slightly more males (555,935) residents \n\n\n\nin the state capital city of Seremban. Cigarette smoking may \n\n\n\nlead to decrease in the circulating growth factor as well as rise \n\n\n\nof free radical production in gastric mucosa and it becomes the \n\n\n\nprominent factor of peptic ulcer disease [13]. Although \n\n\n\nsmoking data was not available in this study, however the \n\n\n\nhigher number of male patients is possibly related to increased \n\n\n\nsmoking habit. \n\n\n\n\n\n\n\n\n\n\n\n  \nFigure II. Distribution of anti-peptic ulcer drug prescriptions of the study in outpatient department \n\n\n\n0 5 10 15 20 25 30\n\n\n\nGeneral Surgery\n\n\n\nGeneral Medicine\n\n\n\nNeurology\n\n\n\nAccident & Emergency\n\n\n\nCardiology\n\n\n\nOrthopaedic\n\n\n\nObstetric & Gynaecology\n\n\n\nNephrology\n\n\n\nENT\n\n\n\nUrology\n\n\n\nFrquency of APUDs prescriptions (%)\n\n\n\n\n\n\n\n\nSundram, P.R. et al. Mal J Pharm 7 (1) 2021, 34-42 \n\n\n\n\n\n\n\n39 \n\n\n\n\n\n\n\nAmong Malay, Chinese and Indian ethnics, there are greater \n\n\n\nnumber of Malay patients in this study and it is due to a vast \n\n\n\ndifference in the distribution of ethnic groups in Negeri \n\n\n\nSembilan: Malay (61.35%), Chinese (23.2%) and Indian \n\n\n\n(15.45%). Ethnicity predisposition differences does not alter \n\n\n\nthe gastric acid secretion among peptic acid patients. The \n\n\n\nfrequency of anti-peptic ulcer drugs usage increases with age \n\n\n\nas depicted in Table 1 whereby the highest number of  APUDs \n\n\n\nprescribed in both male and female was in the 50-59 years age \n\n\n\ngroup. Study has confirmed that age group is not a risk factor \n\n\n\nof peptic ulcer disease, however, stress due to numerous health \n\n\n\ncomplications in this age group is described as the main source \n\n\n\nof peptic ulcers, which are termed as stress induced ulcers [13]. \n\n\n\nEvidence has suggested that Helicobacter pylori infection plays \n\n\n\na major contributory role in peptic ulcer disease and \n\n\n\npreliminary studies have reported that the incidence of \n\n\n\nHelicobacter pylori infection increases with age [14]. \n\n\n\n\n\n\n\nAnti-Peptic Ulcer Drugs Utilization Patterns \n\n\n\n\n\n\n\nAccording to Narayanan, management of peptic ulcer disease \n\n\n\n(PUD) has improved tremendously following the \n\n\n\nadministration of proton pump inhibitors and therapy for \n\n\n\nHelicobacter pylori eradication [15]. This revealed from the \n\n\n\ndecline in the incidence of Helicobacter pylori-associated PUD, \n\n\n\nand the lower percentage of Helicobacter pylori infection, \n\n\n\nparticularly in complicated PUD. Table 2 shows the variety and \n\n\n\nproportion of anti-peptic ulcer drugs found in the study \n\n\n\nprescriptions. Most common class of anti-peptic ulcer drug \n\n\n\nprescribed was PPIs followed by antacids with no usage of H2 \n\n\n\nantagonist. Of all these drugs, rabeprazole 20mg was \n\n\n\nprescribed the most whereas the least prescribed was \n\n\n\npantoprazole 40mg. The maximum usage of antacids in the \n\n\n\nhospital is Zellox suspension 100mL whereas the least usage is \n\n\n\nActal tablet.  Ranitidine was the only H2 blocker that was found \n\n\n\nin the hospital but there is no any usage of ranitidine during the \n\n\n\nstudy period. A recent meta-analysis displayed the effectives of \n\n\n\nPPI therapy by a drop of re-bleeding rate and frequency of \n\n\n\nsurgery in patients with upper gastrointestinal bleeding \n\n\n\nfollowing successful endoscopic therapy, compared to H2RA \n\n\n\ntherapy. [16] Additionally, PPIs were superior to H2RAs for \n\n\n\nprevention of LDA-associated GI erosion or ulcer as according \n\n\n\nto another meta-analysis [16]. \n\n\n\n\n\n\n\nFigure I demonstrates higher population are administering \n\n\n\nsingle group of APUD, primarily PPIs whereas only 40% of \n\n\n\nthem are prescribed combination of APUDs. Irrational use of \n\n\n\nPPIs alone should be avoided because few studies proved that \n\n\n\nthe usage of PPIs alone can cause detrimental to the consumers. \n\n\n\nIn two randomized controlled trials (RCTs), it is evident on the \n\n\n\npresence of dyspepsia in 20% to 44% of healthy volunteers \n\n\n\nafter discontinuation of four to eight weeks of PPI therapy. \n\n\n\nFurthermore, as according to a systemic review, long-term \n\n\n\npractice of PPIs for more than two years is linked with an \n\n\n\nincreased risk of vitamin B12 deficiency due to the alteration \n\n\n\nof intragastric pH levels.  Observational data based systemic \n\n\n\nreviews and meta-analyses shown a connection between \n\n\n\nchronic PPI usage with the risk of fractures in both male and \n\n\n\nTable III. Distribution of anti-peptic ulcer drugs prescriptions according to patients\u2019 age \n\n\n\n\n\n\n\nAnti-peptic ulcer drugs \nPatient\u2019s Age Group (n) \n\n\n\n<20 20-29 30-39 40-49 50-59 60> \n\n\n\nActal Tablet  1  1 1 2  \n\n\n\nDexlansoprazole 60 mg   1 2  10 7 \n\n\n\nEsomeprazole 40mg   5 12 8 4 \n\n\n\nMaalox Suspension    1 1 4 1 \n\n\n\nOmeprazole 20mg  2 6 4 8 7 \n\n\n\nPantoprazole 20mg 3 2 5 8 8 3 \n\n\n\nPantoprazole 40mg 1 1 2 1 4 4 \n\n\n\nRabeprazole 20mg   1 4 9 13 6 \n\n\n\nZellox Suspension 100ml 2 1 4 5 8 3 \n\n\n\n\n\n\n\nTable IV. DDD/day supplied and unit price of each anti-peptic ulcer drugs \n\n\n\n\n\n\n\n\n\n\n\n Type of APUDs \n\n\n\n\n\n\n\nWHO DDD Rates per \n\n\n\nresidents per \n\n\n\nyear \n\n\n\nRates per user \n\n\n\nper day \n\n\n\nIntermediate \n\n\n\nrate \n\n\n\nClinical \n\n\n\nmeasure \n\n\n\nUnit price \n\n\n\n(RM) \n\n\n\nPantoprazole 20mg 2 DDD 0.12 1.26 17.76 0.07 4.60 \n\n\n\nPantoprazole 40mg 1 DDD 0.04 0.82 22.38 0.04 6.00 \n\n\n\nDexlansoprazole 60mg 0.5 DDD 0.03 0.32 18.50 0.02 8.50 \n\n\n\nEsomeprazole 40mg 0.75 DDD 0.08 0.86 30.10 0.03 2.80 \n\n\n\nOmeprazole 20mg 1 DDD 0.09 0.95 28.37 0.03 1.00 \n\n\n\nRabeprazole 20mg 1 DDD 0.11 1.01 30.33 0.03 5.10 \n\n\n\nActal tablets 11.11 DDD 0.12 7.11 5.40 1.32 1.30 \n\n\n\nZellox 100ml 0.38 DDD 0.03 0.37 11.05 0.03 30.00 \n\n\n\nMaalox 250ml 0.13 DDD 0.04 0.15 8.86 0.02 37.50 \n\n\n\nPantoprazole 20mg 2 DDD 0.12 1.26 17.76 0.07 4.60 \n\n\n\n \n\n\n\n\n\n\n\n\nSundram, P.R. et al. Mal J Pharm 7 (1) 2021, 34-42 \n\n\n\n\n\n\n\n40 \n\n\n\n\n\n\n\nfemale patients. Whereas, this connection has not seen with the \n\n\n\nuse of H2 receptor antagonists [17]. Alternatively, a H2 \n\n\n\nantagonist or over-the-counter antacids should be tried before \n\n\n\nprescribing the most potent PPIs because according to table 3, \n\n\n\nhighest number of population administering single group of \n\n\n\nAPUDs are from the age group of 50 to 59 years old and \n\n\n\naccording to a nationwide case-control study from New \n\n\n\nZealand, estimated there were about 20 cases of acute \n\n\n\ninterstitial nephritis per year among every 100 000 current PPI \n\n\n\nusers with more than 60 years old [18]. Thus, as an early \n\n\n\npreventive measure, it is better to prescribe H2 antagonist for \n\n\n\npatients with the age group of more than 50 years old. \n\n\n\n\n\n\n\nFigure II shows that out of the 160 prescriptions of APUDs, \n\n\n\nmost prescriptions were from general surgery department \n\n\n\nfollowed by general medicine department. On the other hand, \n\n\n\nAPUDs were least prescribed in nephrology and \n\n\n\notorhinolaryngology (ENT). This observation was justified in \n\n\n\naccordance to a study done at North India where the surgeon \n\n\n\nmay prescribe acid reducers such as H2 Antagonists and PPIs \n\n\n\nto ease any discomforts after surgery. Likewise, it has been \n\n\n\nproven that a standardised prescribing of APUDs after surgery \n\n\n\nlead to significant reduction in postoperative complications \n\n\n\nsuch as postoperative pain, nausea and vomiting [19]. \n\n\n\nSimilarly, high utilization of these APUDs was also seen in \n\n\n\ngeneral medicine department because the use of PPI according \n\n\n\nto FDA is indicated as in cases of evident GI diseases comprise \n\n\n\nof treatment of symptomatic gastroesophageal reflux disease \n\n\n\n(GERD), maintenance treatment of erosive esophagitis, \n\n\n\neradication of Helicobacter pylori infection, healing and \n\n\n\nmaintenance of gastric ulcers, prevention and treatment of \n\n\n\nNSAID-induced gastric ulcers and treatment of hypersecretory \n\n\n\ncondition as Zollinger-Ellison syndrome [20]. \n\n\n\n\n\n\n\nThis study also indicated that rabeprazole 20mg is the most \n\n\n\nprescribed PPI in the hospital and followed by esomeprazole \n\n\n\n40mg because rabeprazole and esomeprazole increase cure \n\n\n\nrates compared to pantoprazole, omeprazole and lansoprazole, \n\n\n\nthe first generation PPIs. This advantage of new-generation \n\n\n\nPPIs has been reported earlier in reviews and retrospective \n\n\n\nstudies and these new PPIs has been reported to affect \n\n\n\neradication rates due to the higher acid inhibition power. \n\n\n\nMeanwhile, the clinical advantage may be restricted from a \n\n\n\ncost-effective perspective due to higher prices of rabeprazole \n\n\n\nand esomeprazole when compared with omeprazole [21]. In \n\n\n\ncontrast, pantoprazole 40mg has the minimum usage amongst \n\n\n\nall the PPI. The results of a comparative study on esomeprazole \n\n\n\n40mg versus pantoprazole 40mg illustrates a therapeutic \n\n\n\nadvantage of esomeprazole 40 mg over pantoprazole 40 mg by \n\n\n\nproviding healing of erosive esophagitis (EE). This result \n\n\n\npredicted as the healing of EE is inversely related to gastric \n\n\n\nacidity, and esomeprazole has been shown to deliver a greater \n\n\n\nsuppression of gastric acidity than standard doses of all other \n\n\n\nPPIs [22]. \n\n\n\nMcNicholl, states that five studies compared the eradication \n\n\n\nrates of rabeprazole versus esomeprazole [21]. The comparison \n\n\n\nwas not heterogeneous and found no statistically significant \n\n\n\ndifferences. Rabeprazole has the eradication rates about 76.7% \n\n\n\nwhile esomeprazole shows 78.7%. According to a meta-\n\n\n\nanalysis, CYP2C19 phenotype is not affected by the \n\n\n\neradication rates of esomeprazole and rabeprazole, while first-\n\n\n\ngeneration PPIs demonstrates a clearer tendency towards lower \n\n\n\neradication rates in patients. Meanwhile, majority APUDs \n\n\n\nprescribed by medical officers from local universities are \n\n\n\nPantoprazole 20mg because it was approved by FDA in 2000 \n\n\n\nfor the treatment of erosive esophagitis associated with GERD \n\n\n\nand PUD plus it is one of the few PPIs existing in multiple \n\n\n\ndosage forms. According to Mathews, pantoprazole has an \n\n\n\nexcellent safety profile, is as effective as other PPIs, and has a \n\n\n\nlow incidence of drug interactions when evaluated over 100 \n\n\n\nclinical trials. Pantoprazole has also been presented as a safe \n\n\n\nand effective among special patient populations, such as the \n\n\n\nelderly and those with renal or moderate liver disease [23]. \n\n\n\n\n\n\n\nDefined Daily Dose (DDD) and unit price of APUDs \n\n\n\n\n\n\n\nIn order to avoid recurrences of both symptoms and mucosal \n\n\n\nlesions, PPI is one of the mandatory maintenance therapy. \n\n\n\nTable IV clearly demonstrates DDD / day supplied for all the \n\n\n\nAPUDs used and the result justified that APUDs over usage did \n\n\n\nnot occur in this hospital. This demonstrates that several \n\n\n\npatients discontinue PPI therapy after redeeming their first \n\n\n\nprescription, whereas only a minority administer PPI \n\n\n\ncontinuously. Based on the DDD calculated, Pantoprazole \n\n\n\n20mg reported highest rates per user per day among proton \n\n\n\npump inhibitors (PPI) about 1.26 DDD / user / day. The \n\n\n\nmaximum usage of this drug can be due to the compulsory \n\n\n\ntriple regimen inclusive of pantoprazole for Helicobacter pylori \n\n\n\neradication. Furthermore, administration of the slow-release \n\n\n\npantoprazole results in the significantly faster onset of action \n\n\n\ntaking place compared to the administration in a form without \n\n\n\nretarding such release [24]. In addition, Actal reported highest \n\n\n\nrates per user per day among the antacids, which is about 7.11 \n\n\n\nDDD / user / day. This can be seen clearly due to the lowest \n\n\n\ncost among all the antacids available in this hospital. Besides, \n\n\n\nthere are 5.4 days supplied per user for this drug which shows \n\n\n\nmuch less duration than the other two different antacids. Thus, \n\n\n\nit is known as cost effective drug which indirectly reduce \n\n\n\nburden for the patients. \n\n\n\n\n\n\n\nAccording to Table IV, dexlansoprazole 60mg is the most \n\n\n\nexpensive drug among all the PPI listed in hospital formulary \n\n\n\nand it has 18.5 days supplied / user, which is the second shortest \n\n\n\nduration of treatment among all the other PPIs. This is because, \n\n\n\ndexlansoprazole is a modified-release drug because the active \n\n\n\ningredients are manufactured in the form of two types of \n\n\n\ngranules, which are released from capsule twice, at dissimilar \n\n\n\npH values. One part of the drug dose, is released in the proximal \n\n\n\n\n\n\n\n\nSundram, P.R. et al. Mal J Pharm 7 (1) 2021, 34-42 \n\n\n\n\n\n\n\n41 \n\n\n\n\n\n\n\nduodenum at more acidic pH, significantly at pH level of 5.5 \n\n\n\nwhile the second part of drug dose are released in the distal \n\n\n\nsmall intestine at the lesser acidic pH, significantly at the pH of \n\n\n\n6.75. This twofold release mechanism enable the drug to attain \n\n\n\ntwo peak serum concentrations of the drug. Therefore, this \n\n\n\nmodified release drug ensures the longer drug retention period \n\n\n\nin the circulation as well as the most dominant inhibitory effect \n\n\n\non the proton pump inhibitors. Besides, numerous clinical trials \n\n\n\nstates that dexlansoprazole has a good safety profile and hardly \n\n\n\nproduces adverse reactions which usually do not require drug \n\n\n\ndiscontinuation because safety profile of dexlansoprazole at \n\n\n\ndoses of 30, 60 and 90 mg plus oral administration has been \n\n\n\nassessed in clinical trials covering a period of 1 year [25]. In \n\n\n\ncontrast, omeprazole 20mg is the lowest cost PPI but the \n\n\n\nduration supplied per user is longer resulting in higher total cost \n\n\n\nof therapy. Thus, dexlansoprazole could potentially the most \n\n\n\ncost-effective PPI although the single capsule is most \n\n\n\nexpensive among all the other PPIs. \n\n\n\n\n\n\n\nCONCLUSION  \n  \n\n\n\nIn conclusion, the obtained result of utilization of all anti-peptic \n\n\n\nulcer drugs in the selected hospital is lower as compared to \n\n\n\nWHO DDD.  However, this might not show an underutilization \n\n\n\nof anti-peptic ulcer drugs but may be due to a lower number of \n\n\n\nsamples collected, which cannot be used to reflect the overall \n\n\n\nutilization.  Next, most common class of anti-peptic ulcer drug \n\n\n\nprescribed in this studies were Proton Pump Inhibitors which \n\n\n\naccounted for 97% followed by Antacids about 32.5% and no \n\n\n\nusage of H2 Antagonist. Based on the DDD calculated, \n\n\n\nPantoprazole 20mg was the most prescribed drug among PPI, \n\n\n\nabout 1.26 DDD / user / day. Actal is the most commonly used \n\n\n\ndrug among the antacids, which is about 7.11 DDD / user / day. \n\n\n\nThe distribution of anti-peptic ulcer drug prescriptions in \n\n\n\noutpatient department was highest used in general surgery \n\n\n\n26.9% and general medicine 23.1% department. \n\n\n\nDexlansoprazole 60mg is the most expensive drug among all \n\n\n\nthe PPI listed in hospital formulary. It has 18.5 days \n\n\n\nsupplied/user, which is the second shortest duration of \n\n\n\ntreatment among all the other PPIs. In contrast, omeprazole \n\n\n\n20mg is the lowest cost PPI but the duration supplied per user \n\n\n\nis longer resulting in higher total cost of therapy. Based on the \n\n\n\nWHO DDD, it was found that Pantoprazole 20mg and Actel \n\n\n\ntablet had highest DDD with 0.12 per 1000 residents per day. \n\n\n\n\n\n\n\nCONFLICT OF INTEREST \n  \n\n\n\nThe authors declare that there is no conflict of interest. \n\n\n\n\n\n\n\nREFERENCE \n \n\n\n\n[1] Sung J, Kuipers E, El\u2010Serag H. Systematic review: the global \n\n\n\nincidence and prevalence of peptic ulcer disease. Alimentary \n\n\n\npharmacology & therapeutics. 2009;29(9):938-46. \n\n\n\n[2] Mary Chok Chiew Fong AIAS. MALAYSIAN STATISTICS ON \n\n\n\nMEDICINES. Malaysia: Pharmaceutical Services Programme \n\n\n\nMinistry of Health Malaysia; 2015. \n\n\n\n[3] Goh KL. Prevalence of and risk factors for Helicobacter pylori \n\n\n\ninfection in a multi\u2010racial dyspeptic Malaysian population undergoing \n\n\n\nendoscopy. Journal of gastroenterology and hepatology. \n\n\n\n1997;12(6):S29-S35. \n\n\n\n[4] Chandran P, Prakasam KA, Jayachandran A, Mary A. TO ANALYSE \n\n\n\nTHE RISK FACTOR AND DRUG UTILIZATION REVIEW OF \n\n\n\nPEPTIC ULCER DISEASE IN A TERTIARY CARE HOSPITAL. \n\n\n\n2019. \n\n\n\n[5] Hawkey CJ, Karrasch JA, Szczepanski L, Walker DG, Barkun A, \n\n\n\nSwannell AJ, et al. Omeprazole compared with misoprostol for ulcers \n\n\n\nassociated with nonsteroidal antiinflammatory drugs. New England \n\n\n\nJournal of Medicine. 1998;338(11):727-34. \n\n\n\n[6] Oh AL, Tan AG, Phan HS, Lee BC, Jumaat N, Chew SP, et al. \n\n\n\nIndication of acid suppression therapy and predictors for the \n\n\n\nprophylactic use of protonpump inhibitors vs. histamine-2 receptor \n\n\n\nantagonists in a Malaysian tertiary hospital. Pharmacy practice. \n\n\n\n2015;13(3). \n\n\n\n[7] Raj S. Peptic ulcer disease in Kelantan: an underdiagnosed condition? \n\n\n\nThe Medical journal of Malaysia. 1991;46(2):183-6. \n\n\n\n[8] Cheung KS, Leung WK. 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J Dent \n\n\n\nMed Sci. 2015;14(7):40-6. \n\n\n\n[14] Graham DY, Malaty HM, Evans DG, Evans Jr DJ, Klein PD, Adam \n\n\n\nE. Epidemiology of Helicobacter pylori in an asymptomatic \n\n\n\npopulation in the United States: effect of age, race, and socioeconomic \n\n\n\nstatus. Gastroenterology. 1991;100(6):1495-501. \n\n\n\n[15] Narayanan M, Reddy KM, Marsicano E. Peptic ulcer disease and \n\n\n\nHelicobacter pylori infection. Missouri medicine. 2018;115(3):219. \n\n\n\n[16] Zhang Y-S, Li Q, He B-S, Liu R, Li Z-J. Proton pump inhibitors \n\n\n\ntherapy vs H2 receptor antagonists therapy for upper gastrointestinal \n\n\n\nbleeding after endoscopy: a meta-analysis. World Journal of \n\n\n\nGastroenterology: WJG. 2015;21(20):6341. \n\n\n\n[17] Benmassaoud A, McDonald EG, Lee TC. 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Meta\u2010\n\n\n\nanalysis: esomeprazole or rabeprazole vs. first\u2010generation pump \n\n\n\ninhibitors in the treatment of H elicobacter pylori infection. \n\n\n\nAlimentary pharmacology & therapeutics. 2012;36(5):414-25. \n\n\n\n\n\n\n\n\nSundram, P.R. et al. Mal J Pharm 7 (1) 2021, 34-42 \n\n\n\n\n\n\n\n42 \n\n\n\n\n\n\n\n[22] Labenz J, Armstrong D, Lauritsen K, Katelaris P, Schmidt S, Sch\u00fctze \n\n\n\nK, et al. A randomized comparative study of esomeprazole 40 mg \n\n\n\nversus pantoprazole 40 mg for healing erosive oesophagitis: the EXPO \n\n\n\nstudy. Alimentary pharmacology & therapeutics. 2005;21(6):739-46. \n\n\n\n[23] Mathews S, Reid A, Tian C, Cai Q. An update on the use of \n\n\n\npantoprazole as a treatment for gastroesophageal reflux disease. \n\n\n\nClinical and experimental gastroenterology. 2010;3:11. \n\n\n\n[24] GEORGE S, inventorOral pharmaceutical composition with delayed \n\n\n\nrelease of active ingredient for pantoprazole1995. \n\n\n\n[25] Skrzyd\u0142o-Radoma\u0144ska B, Radwan P. Dexlansoprazole\u2013a new-\n\n\n\ngeneration proton pump inhibitor. Przeglad gastroenterologiczny. \n\n\n\n2015;10(4):191. \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Volume 7 Issue 1 (2021) \n \n\n\n\n\n\n\n\n\n\n\n\n43 \n\n\n\n\n\n\n\n*Correspondence: fongcwei@gmail.com \n1Department of Pharmacy, Hospital Sultanah Nur Zahirah, Jalan Sultan \n\n\n\nMahmud, 20400 Kuala Terengganu, Terengganu, Malaysia. \n2Department of Nephrology, Hospital Sultanah Nur Zahirah, Jalan Sultan \n\n\n\nMahmud, 20400 Kuala Terengganu, Terengganu, Malaysia.   \n \n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n Original Research Article \n\n\n\n\n\n\n\nThe Effect of Pharmacist's Interventions on Anaemia \n\n\n\nManagement among Continuous Ambulatory Peritoneal \n\n\n\nDialysis Patients in Terengganu Tertiary Hospital \n \n\n\n\nChui Wei Fong1*, Wan Najiah Wan Mokhtar1, Norlaila Kartina Malini Mamat1, Muhammad Zaidi \n\n\n\nSattar1, Zaiha Harun2, Tengku Nur Izzati Tengku Abd Kadir1 \n\n\n\n\n\n\n\n \nArticle Info  \n\n\n\n \nReceived date:   3 May 2021 \n\n\n\nAccepted date: 24 June 2021 \n\n\n\nPublished date: 30 June 2021 \n\n\n\n\n\n\n\nKeywords: Anaemia, peritoneal \n\n\n\ndialysis, erythropoietin, \n\n\n\npharmacist, haemoglobin \n\n\n\n\n\n\n\nABSTRACT  \n\n\n\n\n\n\n\nPharmacist\u2019s interventions in anaemia management have been shown to improve clinical and \n\n\n\neconomic outcomes. To determine the outcome of hemoglobin (Hb) level after the implementation \n\n\n\nof ESA monitoring card and counselling, a prospective, single-blinded randomised controlled study \n\n\n\ninvolved patients attending the CAPD clinic in Terengganu tertiary hospital, Malaysia was carried \n\n\n\nout. Intervention group received ESA injection counselling based on a validated checklist and ESA \n\n\n\nmonitoring card, while the standard care group only received standard care. Result showed a total of \n\n\n\n118 eligible patients with 68 of them in the standard care group and 50 patients in the intervention \n\n\n\ngroup with an average age of 50.8 (\u00b114.57) and 49.4 (\u00b113.69) years, respectively. Mean Hb showed \n\n\n\nsignificant improvement in both standard care and interventional groups with p<0.001. Intervention \n\n\n\ngroup had a higher percentage increment in mean Hb 6.7% compared to standard care group 5.9%. \n\n\n\nHowever, mean difference Hb between standard care and interventional group after at least 1 month \n\n\n\nof interventions was not significant with 0.59 (\u00b11.78) and 0.692 (\u00b11.68) respectively (p=0.764). In \n\n\n\nconclusion, pharmacist\u2019s interventions, including counselling and ESA monitoring card may help in \n\n\n\nimproving Hb level in CAPD patients. \n\n\n\n\n\n\n\nINTRODUCTION  \n  \n\n\n\nAnaemia is a common complication among chronic kidney \n\n\n\ndisease (CKD) patients and, its prevalence rises with \n\n\n\ndecreasing estimated glomerular filtration [1]. Anaemia in \n\n\n\nCKD presents as normochromic, normocytic and associated \n\n\n\nwith symptoms such as fatigue, shortness of breath, insomnia, \n\n\n\nand headache [2]. Inadequate erythropoietin production is the \n\n\n\nmost common cause of anaemia [1\u20133]. It contributes to reduced \n\n\n\nquality of life and is associated with cardiovascular disease, \n\n\n\nhospitalisation, cognitive impairment, and mortality [4]. \n\n\n\n\n\n\n\nErythropoietin stimulating agent (ESA) and iron \n\n\n\nsupplementation are the standard treatment for anaemia among \n\n\n\nend stage renal failure (ESRF) patients in Malaysia. Each \n\n\n\npatient is treated according to the haemoglobin (Hb) target with \n\n\n\nthe lowest effective ESA dose while avoiding large fluctuations \n\n\n\nin Hb levels or prolonged periods out of target Hb [5]. Studies \n\n\n\nhave shown the beneficial effects of anaemia treatment, such as \n\n\n\nimproved quality of life protection against cardiovascular \n\n\n\ndisease, morbidity, mortality, and hospitalisation rates \n\n\n\nreduction [6]. However, anaemia management in ESRF \n\n\n\npatients is complex, and there are barriers to effective anaemia \n\n\n\ntreatment, including patient non-adherence to the treatment \n\n\n\nregimen, lack of familiarity with clinical practice guidelines for \n\n\n\nanaemia treatment, and complexity of patients with CKD [7]. \n\n\n\nIn addition, managing renal anaemia with ESA and iron \n\n\n\nreplacement poses clinical challenges, including maintaining \n\n\n\nstable Hb levels within narrow target ranges, balancing iron and \n\n\n\nESA dosages, and optimising the erythropoietin response with \n\n\n\nthe lowest possible effective ESA dose [8]. Therefore, a \n\n\n\nmultidisciplinary approach is necessary to overcome the \n\n\n\nchallenges and barriers in anaemia treatment. Pharmacist \n\n\n\nclinical activities in anaemia management, including providing \n\n\n\n\n\n\n\n\nFong C.W. et al. Mal J Pharm 7 (1) 2021, 43-48 \n\n\n\n\n\n\n\n44 \n\n\n\n\n\n\n\ndrug information to the physician, compiling guidelines for \n\n\n\nproper use of ESA and iron, dosing and monitoring ESA \n\n\n\ntherapy, patient education had effectively improved Hb level, \n\n\n\nand compliance with ESA use criteria [8\u201310].  \n\n\n\n\n\n\n\nThe effectiveness of a treatment depends on patient adherence \n\n\n\nand proper ESA injection technique. Inadequate knowledge on \n\n\n\nESA injection can influence patient medication adherence. \n\n\n\nHowever, we have limited data on patient medication \n\n\n\nknowledge and ESA injection technique. Besides, one of the \n\n\n\nkey performance indicators (KPI) in our nephrology \n\n\n\ndepartment is that at least 70% of continuous ambulatory \n\n\n\nperitoneal dialysis (CAPD) patients achieved the target Hb \n\n\n\nlevel (10g/dl), but we did not meet the KPI to date. Despite \n\n\n\nrenal pharmacists have been part of renal team and participate \n\n\n\nin the treatment of CKD, there is no relevant study on the \n\n\n\neffectiveness of renal pharmacy service in Malaysia. Therefore, \n\n\n\nwe would like to investigate the effectiveness of interventions \n\n\n\nby pharmacists in optimising anaemia management in CAPD \n\n\n\npatients. The main objective of this study was to investigate the \n\n\n\neffect of pharmacist interventions on Hb outcome in CAPD \n\n\n\npatients receiving subcutaneous (SC) ESA.  \n\n\n\n\n\n\n\nMETHOD  \n  \n\n\n\nStudy Design and Setting \n\n\n\n\n\n\n\nThis is a prospective, single-blinded randomised controlled \n\n\n\nstudy. The study was conducted for 6 months in the CAPD \n\n\n\nclinic of Terengganu tertiary hospital, Malaysia. The \n\n\n\nrecruitment and data collection was performed from March to \n\n\n\nAugust 2017. The setting for pharmacist educational \n\n\n\nintervention consisted of a private counselling room in the \n\n\n\nCAPD clinic. The study was approved by Medical Research \n\n\n\nand Ethics Committee, Ministry of Health Malaysia (MOH) \n\n\n\nMalaysia (KKM.NIHSEC.P17-1202). Informed consent was \n\n\n\nobtained from all individual participants included in the study. \n\n\n\n\n\n\n\nParticipants and randomisation  \n\n\n\n\n\n\n\nBased on the study done by Wei Yang et al., the sample size \n\n\n\nrequired for detecting difference of mean Hb is 0.5g/dl with \n\n\n\npower of study =80%, and type 1 error at 0.05 was 48 subjects \n\n\n\nfor both intervention group and standard care subjects [11].  A \n\n\n\ntotal of 55 subjects for each arm were included in this study by \n\n\n\nconsidering a dropout rate of 10%. Participants randomised \n\n\n\ninto the interventional group and standard care with a 1:2 ratio \n\n\n\nusing simple randomisation technique. For the allocation of the \n\n\n\nparticipants, a list of all CAPD patients was created in the \n\n\n\nsoftware of SPSS Version 22 by one pharmacist and then a \n\n\n\nrandomisation sequence was created using this computer-\n\n\n\ngenerated list of numbers into both interventional and control \n\n\n\ngroups. Three pharmacists involved in patient enrollment. \n\n\n\nPatient did not know which group they are in as this is a single-\n\n\n\nblinded study.  \n\n\n\n\n\n\n\nResearch tool \n\n\n\n\n\n\n\n\u2022 ESA monitoring card initiative from the MOH Malaysia \n\n\n\nto properly monitor Hb level in dialysis patients with \n\n\n\nESA therapy. Physician updated the latest Hb level and \n\n\n\nESA dose on the ESA card for each appointment. ESA \n\n\n\ncard consists of ESA dose titration and monitoring \n\n\n\nparameter guidelines developed based on KDIGO \n\n\n\nclinical practice guideline for anaemia in CKD 2012 to \n\n\n\nassist the physician in adjusting ESA dose and \n\n\n\nmonitoring. Adjustment of ESA dose was based on \n\n\n\npatient current Hb level, rate of change in Hb \n\n\n\nconcentration, current ESA dose and clinical \n\n\n\ncircumstances [12]. ESA monitoring card is attached as \n\n\n\nAppendix 1. \n\n\n\n\u2022 Counselling checklist for ESA injection initiative from \n\n\n\nMOH Malaysia is intended as a reference document for \n\n\n\npharmacist or nursing staff to counsel patients \n\n\n\nprescribed with ESA. Counselling checklist is attached \n\n\n\nas Appendix 2. \n\n\n\n\u2022 Data collection form was used to collect information \n\n\n\nregarding the patient's social demographic data, medical \n\n\n\nhistory, current ESA dose, current medications, \n\n\n\nlaboratory parameters, and medication adherence.We \n\n\n\nincluded CAPD patients above 18 years old who \n\n\n\nattended CAPD clinic, received SC erythropoietin beta \n\n\n\ninjection and been taught on ESA injection technique by \n\n\n\nCAPD nurse. Excluded patients including who received \n\n\n\nblood transfusion two weeks before recruitment and \n\n\n\nwithin the study period; pregnant patient and cancer \n\n\n\npatient. \n\n\n\n\n\n\n\nStandard care \n\n\n\n\n\n\n\nThe standard care of patients consisted of physician-patient \n\n\n\nmeetings in the CAPD clinic. Patients who are newly \n\n\n\nprescribed ESA injection referred to CAPD nurse for ESA \n\n\n\ninjection technique related education. Patients collected their \n\n\n\nmonthly ESA injection from the hemodialysis unit and self-\n\n\n\ninjected ESA at home. Patients in the standard care group did \n\n\n\nnot receive intervention from pharmacists. \n\n\n\n\n\n\n\nIntervention  \n\n\n\n\n\n\n\nPatients in the intervention group received standard care of \n\n\n\nphysician-patient meetings and pharmacist interventions. \n\n\n\nIntervention group patients were required to attend hospital at \n\n\n\nthe baseline, three months, and six months during the \n\n\n\nintervention. Patients' follow-up visits were arranged according \n\n\n\nto patient-physician appointment to reduce dropout. At the \n\n\n\nbaseline visit, demographic data; current medication; current \n\n\n\n\n\n\n\n\nFong C.W. et al. Mal J Pharm 7 (1) 2021, 43-48 \n\n\n\n\n\n\n\n45 \n\n\n\n\n\n\n\nESA dose; laboratory parameters such as Hb level, iron status, \n\n\n\nserum ferritin, TSAT, and TIBC level were collected. On each \n\n\n\nfollow-up visit, patients were assessed on ESA injection \n\n\n\nknowledge based on ESA counselling checklist, including its \n\n\n\nfunction, dose of injection, side effects, storage, and  ESA \n\n\n\ntransport from hospital to home, injection technique and \n\n\n\nadherence. Patients were required to answer all questions in \n\n\n\nESA checklist correctly; any wrong answer given was \n\n\n\nconsidered inadequate knowledge. Pharmacists provided \n\n\n\ncounselling and education for patients with inadequate \n\n\n\nknowledge or wrong injection techniques to improve their \n\n\n\nknowledge or injection technique. Monitoring of laboratory \n\n\n\nparameter and ESA dose were performed, and any intervention \n\n\n\nwas spoken to the nephrology physician. \n\n\n\n\n\n\n\nOutcome measures \n\n\n\n\n\n\n\nPrimary outcome of the study was Hb level. The target Hb in \n\n\n\nour setting is 10-12g/dl. Monitoring of Hb level, iron status, \n\n\n\nserum ferritin, TSAT, TIBC level was performed every 3 \n\n\n\nmonths as recommended by Kidney Disease Improving Global \n\n\n\nOutcome (KDIGO) anaemia guideline for CKD 2012. \n\n\n\n\n\n\n\nSecondary outcome of the study was the adherence to ESA \n\n\n\ninjection post-intervention. Adherence to ESA injection was \n\n\n\nassessed based on the ESA sticker. The patient was required to \n\n\n\ndetach the sticker from the ESA injection syringe before use \n\n\n\nand paste it on the CAPD booklet as evidence of use. \n\n\n\nPharmacists calculated the number of ESA injections dispensed \n\n\n\nfor the patient last month and the total number of stickers found \n\n\n\non the CAPD booklet. The total doses missed was inferred from \n\n\n\nthe sticker count observed from the CAPD booklet. A patient \n\n\n\nis defined as adhering to ESA injection if the adherence score \n\n\n\n(Eq.1) is \u226590% [13]. \n\n\n\n \n\ud835\udc34\ud835\udc51\u210e\ud835\udc52\ud835\udc5f\ud835\udc52\ud835\udc5b\ud835\udc50\ud835\udc52 \ud835\udc60\ud835\udc50\ud835\udc5c\ud835\udc5f\ud835\udc52 \n\n\n\n=\n\ud835\udc47\ud835\udc5c\ud835\udc61\ud835\udc4e\ud835\udc59 \ud835\udc51\ud835\udc5c\ud835\udc60\ud835\udc52\ud835\udc60 \ud835\udc51\ud835\udc56\ud835\udc60\ud835\udc5d\ud835\udc52\ud835\udc5b\ud835\udc60\ud835\udc52\ud835\udc51 \u2212  \ud835\udc47\ud835\udc5c\ud835\udc61\ud835\udc4e\ud835\udc59 \ud835\udc51\ud835\udc5c\ud835\udc60\ud835\udc52 \ud835\udc5a\ud835\udc56\ud835\udc60\ud835\udc60\ud835\udc52\ud835\udc51\n\n\n\n\ud835\udc47\ud835\udc5c\ud835\udc61\ud835\udc4e\ud835\udc59 \ud835\udc51\ud835\udc5c\ud835\udc60\ud835\udc52 \ud835\udc51\ud835\udc56\ud835\udc60\ud835\udc5d\ud835\udc52\ud835\udc5b\ud835\udc60\ud835\udc52\ud835\udc51 \n (\ud835\udc38\ud835\udc5e. 1) \n\n\n\n\n\n\n\nData analyses \n\n\n\n\n\n\n\nAll data were analysed using IBM\u00ae Statistical Package for \n\n\n\nSocial Sciences version 22.0 (IBM corp. 2013).  Baseline \n\n\n\ncharacteristics of both groups were compared using \n\n\n\nIndependent t-test for continuous variables, Person chi-square, \n\n\n\nand Fisher-exact for categorical variable. Comparison of mean \n\n\n\ndifference in Hb was performed using Independent t-test and \n\n\n\nPaired t-test. All statistical tests with p-values of <0.05 denote \n\n\n\nstatistical significance. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nRESULT \n \n\n\n\nDemographic and Clinical Characteristics \n\n\n\n\n\n\n\nOf the 146 eligible patients, 50 patients were randomised to the \n\n\n\nintervention group, and 70 patients were randomised into the \n\n\n\nstandard care group. 2 patients dropped out of the study due to \n\n\n\ndeceased. A total of 118 patients completed the study. Figure I. \n\n\n\nshows the trial flow diagram prepared according to CONSORT \n\n\n\nguidelines. The average ages were 50.8 (\u00b114.57) and 49.4 \n\n\n\n(\u00b113.69) years in the standard care and interventional groups. \n\n\n\nGender was found to be approximately equal, and subjects were \n\n\n\npredominantly Malay in both groups. Details of patient \n\n\n\ncharacteristics are shown in Table I. There was no significant \n\n\n\ndifference in the baseline demographic and clinical \n\n\n\ncharacteristics of participants.  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nFigure I. Trial flow diagram in accordance with CONSORT guidelines \n\n\n\n(CONSORT, Consolidated Standards of Reporting Trials) \n\n\n\n Eligible patients (n=146) \n\n\n\nExcluded (n=26) \n\n\n\n\u27a2 Not meeting inclusion \n\n\n\ncriteria \n\n\n\n\n\n\n\n Randomized (n=120)  \n\n\n\nStandard care group (n=70) Intervention group (n=50) \n\n\n\nDeceased (n=2)  \n\n\n\n\n\n\n\nCompleted study (n=50) \n\n\n\nCompleted study (n=68) \n\n\n\nTable I: Demographic data and clinical characteristics (N=118) \n\n\n\n\n\n\n\nCharacteristics \n\n\n\nStandard \n\n\n\nCare Group \n\n\n\n(n = 68) \n\n\n\nInterventional \n\n\n\nGroup \n\n\n\n(n=50) \n\n\n\nP-\n\n\n\nValue* \n\n\n\nAge, mean (SD), year 50.8 (14.5) 49.4 (13.6) 0.593 \n\n\n\nGender, n (%)    \n\n\n\nMale  34 (28.8) 23 (19.6) \n0.404a \n\n\n\nFemale 34 (28.8) 27 (22.8) \n\n\n\nEthnicity, n (%)    \n\n\n\nMalay 68 (57.6) 49 (41.6) \n0.347b \n\n\n\nChinese 0 1 (0.8) \n\n\n\nBody weight, mean \n\n\n\n(SD), kg \n60.9 (13.8) 60.7 (12.5) 0.957 \n\n\n\nTransferrin \n\n\n\nsaturation, mean \n\n\n\n(SD), % \n\n\n\n30.7 (13.4) 29.3 (10.3) 0.541 \n\n\n\n\n\n\n\n*Independent t-test, a Pearson chi-square, b Fisher-exact tests were used \n\n\n\n \n\n\n\n\n\n\n\n\nFong C.W. et al. Mal J Pharm 7 (1) 2021, 43-48 \n\n\n\n\n\n\n\n46 \n\n\n\n\n\n\n\nHb level in pre-and post-intervention for standard care and \n\n\n\ninterventional groups \n\n\n\n\n\n\n\nMean Hb showed significant improvement in both standard \n\n\n\ncare and interventional groups with p<0.001 (Table II). The \n\n\n\nintervention group had a higher increment in mean Hb (6.7%) \n\n\n\nthan the standard care group (5.9%). However, the mean \n\n\n\ndifference Hb between standard care and interventional group \n\n\n\nafter at least one month of interventions was found to be not \n\n\n\nsignificant with 0.59 (\u00b11.78) and 0.692 (\u00b11.68) respectively \n\n\n\n(p=0.764) using Independent T-test (Table III).  \n\n\n\n\n\n\n\nAdherence to ESA administration post-intervention for \n\n\n\nstandard care and interventional groups \n\n\n\n\n\n\n\nThe intervention group had higher adherence to ESA \n\n\n\nadministration (76%) than the standard care group (66.1%) \n\n\n\npost-intervention. No significant difference was found between \n\n\n\nthe standard care and intervention group (p=0.309) using Chi-\n\n\n\nsquare test (Table IV).   \n\n\n\n\n\n\n\nDISCUSSION  \n  \n\n\n\nSevere anaemia (Hb< 9.0g/dl) is associated with increased risks \n\n\n\nof cardiac complications, such as left ventricular hypertrophy \n\n\n\nand cardiovascular disease, and low quality of life [14]. \n\n\n\nCorrection of anaemia has been associated with improved \n\n\n\nhealth-related quality of life, including physical functioning \n\n\n\nand fatigue [15]. With the increasing health care cost over the \n\n\n\npast several years, pharmacists have a critical role in providing \n\n\n\nthe most cost-effective and beneficial pharmaceutical care in \n\n\n\nanaemia treatment. Available studies reported the benefits and \n\n\n\nimpact of pharmacy services in anaemia management. A study \n\n\n\nconducted showed that active participation of pharmacists in \n\n\n\nanaemia management significantly improved mean Hb level \n\n\n\n[8,16]. Other studies reported that pharmacist education \n\n\n\nprogram led to significant Hb improvement. [17,18].  \n\n\n\n\n\n\n\nOur study demonstrated that intervention group showed \n\n\n\nsignificant improvement in mean Hb, but the mean difference \n\n\n\nHb was statistically non-significance against the standard care \n\n\n\ngroup. Likewise, previous studies also did not show significant \n\n\n\ndifferences in haemoglobin outcome between standard care and \n\n\n\npharmacist intervention group [10,18]. The lack of significance \n\n\n\nwas explained by achievement of haemoglobin target was very \n\n\n\nhigh in standard group compared with other studies [10]. Study \n\n\n\nby Mateti et al. reported that the insignificant result was due to \n\n\n\nboth control and intervention group had achieved the optimal \n\n\n\nHb level of 10g/dl, and increasing the target Hb above the target \n\n\n\nrange had no benefit [18]. In our study, the insignificant result \n\n\n\ncould be due to lack of blinding in pharmacist activities such as \n\n\n\ncounselling and ESA card, which may increase overall patient \n\n\n\ncare by healthcare providers. Besides, similar physicians who \n\n\n\nattended patient\u2019s follow-up visits in both control and \n\n\n\ninterventional groups may lead to bias. Deficiency of vitamin \n\n\n\nB12, folic acid, and iron are associated with anaemia [12]. \n\n\n\nAdherence to oral iron and different dietary intake could be \n\n\n\nfactors affecting haemoglobin level. However, our study lacks \n\n\n\ndata on patient adherence to oral iron and dietary pattern, so a \n\n\n\ndefinite conclusion cannot be draw.  \n\n\n\n\n\n\n\nESA injection adherence compliance was a common problem \n\n\n\nin peritoneal dialysis patients.  Peritoneal dialysis patients are \n\n\n\ngenerally taught to self-administered SC ESA at home. Two \n\n\n\nstudies showed that adherence rates with self-administered \n\n\n\nESA ranged between 45% and 65% (non - adherence defined \n\n\n\nas less than 90% use of prescribed dose) [13,19].  This low \n\n\n\npercentage revealed the difficulty of PD patients to adherence \n\n\n\nwith this treatment. In our study, we assessed patient adherence \n\n\n\nto ESA administration post-intervention. The result showed \n\n\n\nthat the intervention group had a higher percentage of \n\n\n\nadherence to ESA administration than the standard group; \n\n\n\nhowever, there was no significant difference between the \n\n\n\ngroups. Medication teaching emphasising patient adherence is \n\n\n\nan area in which pharmacists can positively affect patient care. \n\n\n\nTable II. Mean Hb of pre and post-intervention for standard care and \n\n\n\ninterventional group \n\n\n\n\n\n\n\nCharacteristic \n\n\n\nPre \n\n\n\nintervention \n\n\n\nmean Hb \n\n\n\n(SD), g/dL \n\n\n\nPost \n\n\n\ninterventions \n\n\n\nmean Hb \n\n\n\n(SD), g/dL \n\n\n\nCI P-\n\n\n\nValue* \n\n\n\nStandard Care \n\n\n\nGroup  \n\n\n\n(n = 68) \n\n\n\n9.84 (\u00b11.89) 10.44 (\u00b11.91) -1.02, -\n\n\n\n0.16 \n\n\n\n<0.001 \n\n\n\nInterventional \n\n\n\nGroup (n=50) \n\n\n\n9.74 (\u00b11.68) 10.43 (\u00b11.90) -1.17, -\n\n\n\n0.21 \n\n\n\n<0.001 \n\n\n\n\n\n\n\n*Paired t-test was used \n\n\n\n\n\n\n\nTable III. Mean difference Hb for standard care and interventional \n\n\n\ngroup \n\n\n\n\n\n\n\nCharacteristic \nMean difference \n\n\n\nHb (SD), g/dL \nCI P-Value* \n\n\n\nStandard Care \n\n\n\nGroup  \n\n\n\n(n = 68) \n\n\n\n0.594 (\u00b11.78) -0.74, \n\n\n\n0.54 0.764 \n\n\n\nInterventional \n\n\n\nGroup (n=50) \n\n\n\n0.69 (\u00b11.68) -0.73, \n\n\n\n0.54 \n \n\n\n\n\n\n\n\n*Independent t-test was used \n\n\n\n\n\n\n\nTable IV. Adherence to ESA administration between both groups \n\n\n\n\n\n\n\nCharacteristic Yes (n, %) No (n,%) P-Value* \n\n\n\nStandard Care \n\n\n\nGroup  \n\n\n\n(n = 68) \n\n\n\n45 (66.1) 23 (33.9) 0.309 \n\n\n\nInterventional \n\n\n\nGroup (n=50) \n\n\n\n38 (76) 12 (24)  \n\n\n\n\n\n\n\n*Chi-square test \n \n\n\n\n \n\n\n\n\n\n\n\n\nFong C.W. et al. Mal J Pharm 7 (1) 2021, 43-48 \n\n\n\n\n\n\n\n47 \n\n\n\n\n\n\n\nEducational interventions by pharmacists had significantly \n\n\n\nimproved hemodialysis patients medication knowledge and \n\n\n\nmedication adherence [20,21]. One study reported that \n\n\n\npharmacist educational programme consisting of medical and \n\n\n\ntherapeutic information, information on injection device, \n\n\n\ntraining of pen, self-injection of the first dose in front of \n\n\n\npharmacists resulted in a higher level of adherence and leading \n\n\n\nto optimal Hb level within 2 months [17]. These strengthen the \n\n\n\nimportance of patient education and medication teaching by \n\n\n\npharmacists to improve adherence, achieve patient self-care, \n\n\n\nand attain therapeutic goals. However, this study has \n\n\n\nlimitations. First, a short duration of the study was a limitation \n\n\n\nto draw a conclusion about the service's long-term \n\n\n\neffectiveness or to assess the clinical impact of the service. \n\n\n\nBesides, this was a single institutional study, and the result may \n\n\n\nnot be generalisable to other practice settings. Future studies \n\n\n\nwith similar design can be conducted at multiple centres to \n\n\n\nproduce more reliable and generalisable results. \n\n\n\n\n\n\n\nCONCLUSION  \n  \n\n\n\nPharmacist's interventions, including ESA injection \n\n\n\ncounselling and ESA monitoring card may help in improving \n\n\n\nHb level of CAPD patients. \n\n\n\n\n\n\n\nACKNOWLEDGMENT \n  \n\n\n\nWe want to thank the Director-General of Health Malaysia for \n\n\n\nhis permission to publish this article and the Head of Pharmacy \n\n\n\nDepartment and CAPD nurses in Hospital Sultanah Nur \n\n\n\nZahirah, Kuala Terengganu, Malaysia, for their contribution \n\n\n\nand support throughout this study. \n\n\n\n\n\n\n\nCONFLICT OF INTEREST \n  \n\n\n\nAuthors declared no conflict of interest.  \n\n\n\n\n\n\n\nREFERENCE \n \n\n\n\n[1] Fishbane S, Spinowitz B. Update on Anemia in ESRD and Earlier \n\n\n\nStages of CKD: Core Curriculum 2018. Am J Kidney Dis. 2018 Mar \n\n\n\n1;71(3):423\u201335.  \n\n\n\n[2] Hazin MAA. 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Impact of clinical pharmacist provided education on \n\n\n\nmedication knowledge and adherence of hemodialysis patients in a \n\n\n\nSouth Indian university hospital. Asian J Pharm Clin Res. \n\n\n\n2013;6(SUPPL.4):24\u20137.  \n\n\n\n \n\n\n\n\n\n\n\n\nFong C.W. et al. Mal J Pharm 7 (1) 2021, 43-48 \n\n\n\n\n\n\n\n48 \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nPROCEEDINGS of \n\n\n\nMPS-NATIONAL PHARMACISTS \n\n\n\nCONVENTION 2021 \n\n\n\n\n\n\n\n8th-11th July 2021 \n\n\n\n \nVirtual Convention \n\n\n\nTheme: Exploration, inspiration ad transformation of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nEditors \n \n\n\n\nABUBAKAR SHA'ABAN \n\n\n\nAMER HAYAT KHAN \n\n\n\nAMIRAH MOHD GAZZALI \n\n\n\nBALAMURUGAN TANGIISURAN \n\n\n\nCHAN SIOK YEE \n\n\n\nDANG CHEE CHEAN \n\n\n\nHADZLIANA ZAINAL \n\n\n\nLONG CHIAU MING \n\n\n\nNUR HAFZAN MD HANAFIAH \n\n\n\nOOI GUAT SEE \n\n\n\nSINAN MOHAMMAD ABDULLAH AL-MAHMOOD  \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 7, Issue 1, Supplementary (2021), 49-78 \n\n\n\n50 \n\n\n\n\n\n\n\nResearch Presentation of National Pharmacy Convention 2021 \n\n\n\nDOI:  10.52494/UCML9733 \n \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\n\n\n\n\nACKNOWLEDGEMENT \n \n\n\n\nMalaysian Journal of Pharmacy sincerely appreciates the contributions of our reviewers to enable the peer-\n\n\n\nreviewed process and improve quality of the articles published as the proceedings of MPS-National Pharmacists \n\n\n\nConvention 2021. \nDr Abubakar Sha'aban \n\n\n\nAssoc. Prof Aisyah Saad Abdul Rahim \n\n\n\nDr Amer Hayat Khan \n\n\n\nDr Amirah Mohd Gazzali \n\n\n\nAssoc. Prof Balamurugan Tangiisuran \n\n\n\nProf Chua Siew Siang \n\n\n\nAssoc. Prof Chan Siok Yee \n\n\n\nMr Dang Chee Chean \n\n\n\nDr Omotayo Oladuntoye Fatokun \n\n\n\nDr Fatimatuzzahra' Abd. Aziz \n\n\n\nDr Gan Pou Wee \n\n\n\nDr Goh Choon Fu \n\n\n\nDr Hadzliana Zainal \n\n\n\nMr Kamarudin Ahmad \n\n\n\nMiss Lau Chee Lan \n\n\n\nAssoc. Prof Lee Ming Tatt \n\n\n\nAssoc. Prof Long Chiau Ming  \n\n\n\nDr Leong Siew Lian \n\n\n\nDr Noratiqah Mohtar \n\n\n\nDr Norny Syafinaz Ab Rahman \n\n\n\nDr Nur Aizati Athirah Daud \n\n\n\nDr Nur Hafzan Md Hanafiah \n\n\n\nDr Omotayo Oladuntoye Fatokun, \n\n\n\nDr Ooi Guat See \n\n\n\nDr Riyanto Teguh Widodo \n\n\n\nDr Sabariah Noor Harun \n\n\n\nDr Shairyzah Ahmad Hisham \n\n\n\nDr Sinan Mohammad Abdullah Al-Mahmood \n\n\n\nDr Siti Maisharah Sheikh Ghadzi \n\n\n\nAssoc. Prof Tan Ching Siang \n\n\n\nAssoc. Prof Tan Mei Lan \n\n\n\nDr Thaigarajan Parumasivam \n\n\n\nDr Wong Pei Se \n\n\n\nDr Yvonne Khoo \n\n\n\n\n\n\n\n\n\n\n\nPublisher:  \n\n\n\n\n\n\n\nMalaysian Pharmacists Society  \n\n\n\n16-2 Jalan OP 1/5, 1-Puchong Business Park  \n\n\n\nOff Jalan Puchong, 47160 Puchong, Malaysia  \n\n\n\n \n\u00a9 Malaysian Journal of Pharmacy \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 7, Issue 1, Supplementary (2021), 49-77 \n\n\n\n\n\n\n\n\n\n\n\n51 \n\n\n\n\n\n\n\nResearch Abstracts of National Pharmacy Convention 2021 \n\n\n\nDOI:  10.52494/UCML9733 \n \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 001 \n\n\n\n\n\n\n\nDevelopment and Evaluation of a \n\n\n\nMicrosphere Loaded Cream \n\n\n\nContaining Solanum Lycopersicum \n\n\n\nfor Tyrosinase Inhibition  \n \nTan Lee Fang*, Mogana Rajagopal, Sasikala \n\n\n\nChinnappan, Ashok Kumar Janakiraman1, \n\n\n\nVenkatalakshmi Ranganathan2, Yap Vi Lien1 \n\n\n\n \n1 Faculty of Pharmaceutical University, UCSI University, Malaysia. \n2 Department of Dosage Form Design, School of Pharmacy, MAHSA \n\n\n\nUniversity, Malaysia. \n\n\n\n\n\n\n\n*Correspondence: tanleefang2011@gmail.com \n\n\n\n\n\n\n\nIntroduction: Hyperpigmentation is a common skin disorder \n\n\n\ncaused by excessive melanin synthesis. Hydroquinone, the \n\n\n\ncurrent gold standard used for the treatment of \n\n\n\nhyperpigmentation disorders has been reported to cause \n\n\n\nseveral adverse effects. Medicated topical formulations are \n\n\n\ncommonly associated with irritation and allergic reactions. \n\n\n\nAlternatively, botanically-derived agents have gained \n\n\n\nincreased attention in the pursuit of novel effective \n\n\n\ndepigmenting agents with milder side effects. Solanum \n\n\n\nlycopersicum or tomato has been linked with numerous \n\n\n\nhealth benefits and its tyrosinase inhibitory activity has also \n\n\n\nbeen reported. However, the current botanical formulations \n\n\n\nhave been associated with ineffectiveness of skin penetration, \n\n\n\nshorter duration of action, less final quality, and lower \n\n\n\ndepigmenting effects. Controlled drug delivery achieved via \n\n\n\nmicrosponge system may help to overcome the obstacles \n\n\n\nwith enhanced stability and efficacy. Hence, a cream \n\n\n\nformulation incorporating tomato-loaded microspheres, \n\n\n\ncurrently unavailable in the market, would be the first and \n\n\n\npossibly a potential alternative for hyperpigmentation \n\n\n\ncontrol. Objective: The objectives are to formulate tomato \n\n\n\nmicrosphere loaded cream and to determine its tyrosinase \n\n\n\ninhibition activity. Method: Double emulsion technique was \n\n\n\nused for the formulation of microspheres. The microspheres \n\n\n\nwere evaluated for percentage yield, entrapment efficiency, \n\n\n\nloading capacity, surface morphology and drug-polymer \n\n\n\ninteraction. The drug-loaded microspheres were then \n\n\n\nincorporated into the water removable cream followed by \n\n\n\ndetermination of tyrosinase inhibitory activity. GraphPad \n\n\n\nPrism was used for the construction of results and \n\n\n\ndetermination of IC50. Result and Discussion: The 85.27% \n\n\n\nyield of tomato seed oil-loaded microspheres was prepared \n\n\n\nwith an entrapment efficiency of 65.85% and a loading \n\n\n\ncapacity of 21.95%. The formulated cream had desirable \n\n\n\norganoleptic characteristics. The mean pH of cream was 5.55 \n\n\n\n\u00b1 0.09 with comparable spreadability with commercial \n\n\n\nproducts. The tyrosinase inhibitory activity of the formulated \n\n\n\ncream was statistically significant compared with tomato \n\n\n\nseed oil (8.32 \u00b1 0.23 mg/mL) and blank cream (10.87 \u00b1 0.31 \n\n\n\nmg/mL) alone with the lowest IC50 value (26.85 \u00b1 0.24 \n\n\n\n\u03bcg/mL) but comparable to the positive control, kojic acid \n\n\n\n(1.65 \u00b1 0.50 \u03bcg/mL). Conclusion: Solanum lycopersicum \n\n\n\nmicrosphere loaded cream was successfully formulated with \n\n\n\na desirable in vitro tyrosinase inhibitory activity, suggesting \n\n\n\nits potential as an alternative for the treatment of \n\n\n\nhyperpigmentation disorders. \n\n\n\n\n\n\n\nReference \n \n\n\n\n[1] Nk V, Alam G. Formulation and characterization of floating microspheres of ibuprofen. \n\n\n\nInt J Res Pharm Sci. 2015;5(1):18\u201322. \n\n\n\n[2] El-Say KM. Maximizing the encapsulation efficiency and the bioavailability of \n\n\n\ncontrolled-release cetirizine microspheres using Draper\u2013Lin small composite design. \n\n\n\nDrug Des Devel Ther [Internet]. 2016 Feb 24 [cited 2020 Nov 16];10:825\u201339. Available \n\n\n\nfrom: /pmc/articles/PMC4771436/?report=abstract \n\n\n\n[3] Reddy MR, Soumyastutipatnaik. Design and in vitro characterization of flutrimazole \n\n\n\nmicrospheres loaded topical emulgel. Asian J Pharm Clin Res [Internet]. 2019 Jul 26 [cited \n\n\n\n2020 Nov 16];242\u201351. Available from: \n\n\n\nhttp://dx.doi.org/10.22159/ajpcr.2019.v12i9.34341 \n\n\n\n\n\n\n\nAbstract 002 \n\n\n\n\n\n\n\nExpectation and Perception of \n\n\n\nContract Pharmacists Regarding their \n\n\n\nPharmacy Career \n \nIzzati Yussof1*, Ong See Wan1, Teng Sook \n\n\n\nYee1, Dahlia Nadira Abd Manan1, Nazariah \n\n\n\nHaron1, Sahidah Said2 \n\n\n\n \n1 Pharmaceutical Services Division, Kuala Lumpur & Putrajaya Health \n\n\n\nDepartment, Kuala Lumpur, \n2 Pharmacy Department, National Cancer Institute, Putrajaya, Ministry of \n\n\n\nHealth Malaysia \n\n\n\n\n\n\n\n*Correspondence: izzati.yussof@gmail.com \n\n\n\n\n\n\n\nIntroduction: Ministry of Health (MOH) Malaysia \n\n\n\nintroduced the contract system for pharmacists to reduce \n\n\n\npharmacy graduates waiting period for the training program \n\n\n\nin government health facilities. Studies have been conducted \n\n\n\nto assess perception towards the training program in \n\n\n\ngovernment facilities [1,2] and the overall job satisfaction \n\n\n\namong pharmacists [3], but little is known about the \n\n\n\nperception of contract pharmacists following the new policy.  \n\n\n\nObjective: To explore contract pharmacists\u2019 expectation and \n\n\n\nperception of their pharmacy career in terms of future career \n\n\n\nplans and general perception of employability. Method: A \n\n\n\ncross-sectional study was conducted using a validated, self-\n\n\n\nadministered online questionnaire involving contract \n\n\n\npharmacists working in government health facilities within \n\n\n\nKuala Lumpur and Putrajaya. Data were collected in \n\n\n\nNovember and December 2020 and sent through facilities\u2019 \n\n\n\nemail. The questionnaire contains 24 main questions that \n\n\n\nassess career expectation and experience in job search using \n\n\n\n5-point Likert-type questions and an open-ended question for \n\n\n\n\nmailto:tanleefang2011@gmail.com\n\n\nmailto:izzati.yussof@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 7, Issue 1, Supplementary (2021), 49-78 \n\n\n\n52 \n\n\n\n\n\n\n\nResearch Presentation of National Pharmacy Convention 2021 \n\n\n\nDOI:  10.52494/UCML9733 \n \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nsuggestions to improve aspects of their training. Result and \n\n\n\nDiscussion: The response rate was 68.8% (n=97). Of the \n\n\n\nrespondents, 92.8% expressed a desire to work with MOH, \n\n\n\nbut only 24.7% were confident that they could obtain a \n\n\n\npermanent position within MOH, and only 27.8% believed \n\n\n\nthat they could secure any job offer. Among the respondents, \n\n\n\n35.1% (n=34) have started looking for alternative \n\n\n\nemployment, but only eight of them managed to secure a job \n\n\n\noffer. The respondents perceived community pharmacy as \n\n\n\nthe sector that offers the most job opportunities (88.5%). \n\n\n\nLong-term job security, work environment and opportunities \n\n\n\nfor career development were rated the three most essential \n\n\n\nfactors in choosing their career. Preference to work with the \n\n\n\ngovernment may be attributed to long-term job security being \n\n\n\nthe most crucial factor in career choice. Conclusion: The \n\n\n\ncontract system poses various challenges for the new \n\n\n\ngeneration of pharmacists. There was an excess of demand \n\n\n\nfor jobs in the government sector, with many uncertainties in \n\n\n\nemployment opportunities. Early career advice and broader \n\n\n\nexposure to pharmacy career pathways are essential to \n\n\n\nbroaden their career perspectives and equip them with the \n\n\n\nnecessary skills to adapt and develop new roles to keep up \n\n\n\nwith changing times. \n\n\n\n \nReference \n\n\n\n \n[1] Syed M Haq, A. H., Md Yusof, F. A., Chan, P. L., Chok, M. C. F., Phua, G. S. Y., Teoh, \n\n\n\nC. J., Yaacob, N., Azmi, Y., Osman, N. A., Paiman, A. F., Abu, S. F., Othman, N. A., Abd \n\n\n\nKadir, S. and Mokhtar Ahmad, K. 2018. The satisfaction and perception of Provisionally \n\n\n\nRegistered Pharmacists (PRP) towards their internship training in the Ministry of Health, \n\n\n\nMalaysia facilities: A national survey. Curr Pharm Teach Learn, 10(7), pp. 854-874. doi: \n\n\n\n10.1016/j.cptl.2018.04.005. \n\n\n\n[2] Phua, G., Teoh, C. and Khong, L. 2017. The Satisfaction and perception of intern \n\n\n\npharmacists towards their training in government hospitals in the Northern Region of \n\n\n\nMalaysia. Pharmacy Education, 17(1), pp. 15-23. \n\n\n\n[3] Janahiraman, S. and Paraidathathu, T. 2007. Job Satisfaction among Malaysian \n\n\n\nPharmacists'.  Malaysian Journal of Health Sciences, Malaysian Journal of Health \n\n\n\nSciences, vol. 5. \n\n\n\n\n\n\n\nAbstract 003 \n\n\n\n\n\n\n\nAn Evaluation on the Practices about \n\n\n\nthe Use of Paracetamol among \n\n\n\nParents in Treating their Children in \n\n\n\nPenang, Malaysia \n \nEe Theng Yeoh1, Angel Wei Ling Goh2*, Chee \n\n\n\nPing Chong3 \n\n\n\n \n1 Gleneagles Hospital Penang, 1, Jalan Pangkor, 10050 George Town, \n\n\n\nPulau Pinang \n2 Klinik Kesihatan Perai, Seberang Jaya, 13600 Perai, Pulau Pinang \n3 Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, \n\n\n\nUniversiti Sains Malaysia, 11800 Penang, Malaysia \n\n\n\n\n\n\n\n*Correspondence: angelgoh.1996@gmail.com \n\n\n\n\n\n\n\nIntroduction: Paracetamol is a common antipyretic used to \n\n\n\ntreat fever in people of all ages, including children. The \n\n\n\nwidespread availability of paracetamol over the counter has \n\n\n\nled to its usage by parents, often without proper consultation \n\n\n\nwith healthcare practitioners, putting children at risk of \n\n\n\nparacetamol poisoning. Objective: This study aims to \n\n\n\nevaluate the practices of paracetamol use among Malaysian \n\n\n\nparents in treating their children.  Method: This was a cross-\n\n\n\nsectional quantitative structured interview using a \n\n\n\nquestionnaire. Data was collected from a total of 93 parents \n\n\n\nfrom Penang, Malaysia, in August 2019. Result and \n\n\n\nDiscussion: Most parents were between age 26 to 40 years \n\n\n\n(67.7%) and had at least two children (74.2%). About 54.2% \n\n\n\nof parents had children between 4 - 9 years old. The majority \n\n\n\nof parents (87.1%) had used paracetamol to treat their \n\n\n\nchildren, with 77.9% of them using it for fever. \n\n\n\nApproximately half (53.1%) of the parents used paracetamol \n\n\n\nwhen their children\u2019s body temperatures were between \n\n\n\n37.5\u02daC \u2013 38\u02daC. Syrup (66.1%) and chewable tablets (20.2%) \n\n\n\nwere the most popular forms of paracetamol used to treat \n\n\n\nchildren. The parents mostly use paracetamol every 6-hourly \n\n\n\n(45.7%) and 4-hourly (38.3%). Among the 1 \u2013 3 years old \n\n\n\nchildren who used paracetamol syrup, 37.5% of them \n\n\n\nexceeded the recommended total daily dose. Conversely, \n\n\n\n64.7% of the children aged 10 \u2013 12 years who consumed \n\n\n\nparacetamol syrup were found to have below the \n\n\n\nrecommended total daily dose. Conclusion: In conclusion, \n\n\n\nthe practices of paracetamol usage among the parents need to \n\n\n\nbe improved to ensure better treatment outcomes for the \n\n\n\nchildren.  \n\n\n\n \nReference \n \n\n\n\n[1] Maison, P., Guillemot, D., Vauzelle-Kervroedan, F., Balkau, B., Sermet, C., Thibult, N., \n\n\n\nEschwege, E. 1998. Trends in aspirin, paracetamol and non-steroidal anti-inflammatory \n\n\n\ndrug use in children between 1981 and 1992 in France. European Journal of Clinical \n\n\n\nPharmacology, 54(8):659\u2013664. \n\n\n\n[2] Lenney, W. 2012. Paracetamol prescription by age or by weight? Archives of Disease in \n\n\n\nChildhood, 97:277-278 \n\n\n\n[3] Eyers, S., Fingleton, J., Eastwood, A., Perrin, K., Beasley, R. 2012. British National \n\n\n\nFormulary for Children: the risk of inappropriate paracetamol prescribing. Archives of \n\n\n\nDisease in Childhood, 97(3):279\u2013282. \n\n\n\n \n\n\n\n\nmailto:angelgoh.1996@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 7, Issue 1, Supplementary (2021), 49-78 \n\n\n\n53 \n\n\n\n\n\n\n\nResearch Presentation of National Pharmacy Convention 2021 \n\n\n\nDOI:  10.52494/UCML9733 \n \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 004 \n\n\n\n\n\n\n\nAntimicrobial Stewardship \n\n\n\nIntegrated Approach: An Outcome \n\n\n\nEvaluation in Perak (AMSIA Study) \n \nCheah Meng Fei1*, Yean Yi Lyn2, Lee Lay \n\n\n\nChin3, Ros Sakinah Kamaludin4, Ling Siew \n\n\n\nHong5, Chan Wai Seong Christopher6, Thong \n\n\n\nKah Shuen1, Ker Hong Bee7 \n\n\n\n \n1 Department of Pharmacy, Hospital Raja Permaisuri Bainun, Perak, \n\n\n\nMalaysia \n2 Department of Pharmacy, Hospital Taiping, Perak, Malaysia \n3 Department of Pharmacy, Hospital Teluk Intan, Perak, Malaysia \n4 Department of Pharmacy, Hospital Slim River, Perak, Malaysia \n5 Department of Pharmacy, Hospital Seri Manjung, Perak, Malaysia \n6 Clinical Research Centre, Hospital Taiping, Perak, Malaysia \n7 Department of Medicine, Hospital Raja Permaisuri Bainun, Perak, \n\n\n\nMalaysia \n\n\n\n\n\n\n\n*Correspondence: mfcheah85@hotmail.com \n\n\n\n\n\n\n\nIntroduction: The antimicrobial stewardship (AMS) \n\n\n\nprogram has been implemented in most public healthcare \n\n\n\nfacilities in Malaysia to promote judicious antimicrobial \n\n\n\nusage and minimize antimicrobial resistance. The AMS \n\n\n\nintegrated approach (AMSIA) was implemented by ward \n\n\n\npharmacists and the AMS team concurrently at five specialist \n\n\n\nhospitals in Perak to enhance several AMS initiatives. The \n\n\n\ninitiatives include creating an antibiotic quick reference \n\n\n\nguide, intravenous-to-oral conversion algorithm, \n\n\n\nengagements, and continuous medical education (CME) \n\n\n\nsessions with stakeholders. Objective: To evaluate the \n\n\n\nimpact of the AMSIA in terms of clinical outcomes among \n\n\n\npatients, and the antimicrobial cost savings based on the \n\n\n\nAMS recommendations provided. Method: This is a \n\n\n\nretrospective evaluation of the AMS database at the study \n\n\n\nhospitals comparing data between two phases before and \n\n\n\nafter implementing the AMSIA. Data from the AMS review \n\n\n\nforms were extracted and analyzed. Result and Discussion: \n\n\n\nA total of 544 cases were referred for AMS recommendations \n\n\n\nduring both phases. Of those recommendations, 474 (87.1%) \n\n\n\nwere accepted by the primary team. Most patients (76.7%) \n\n\n\nwere discharged well. Recommendations provided by ward \n\n\n\npharmacists were more likely to be accepted than those \n\n\n\noffered by the AMS team (p=0.022). There was no \n\n\n\nassociation between 30-day infection-related mortality \n\n\n\n(p>0.95) with acceptance of those recommendations. \n\n\n\nHowever, accepting the recommendations contributed to a \n\n\n\nshorter duration of antimicrobial therapy (p=0.001), a shorter \n\n\n\nlength of hospitalization (p<0.001), and a total antimicrobial \n\n\n\ncost saving of RM427.28, while rejection resulted in a cost \n\n\n\nincrement of RM2122.32 over the study period (p<0.001). \n\n\n\nThere were no differences in terms of the rate of acceptance \n\n\n\nof the recommendations as well as the clinical outcomes and \n\n\n\ncost savings between the study phases. Conclusion: AMS \n\n\n\nrecommendations resulted in cost savings, shorter \n\n\n\nhospitalizations, and duration of antimicrobial therapy \n\n\n\nwithout compromising patients\u2019 survival. Ward pharmacists \n\n\n\nplayed equally important roles as the AMS team in the AMS \n\n\n\nprogram.  \n\n\n\n \nReference \n \n\n\n\n[1] Policy statement on antimicrobial stewardship by the Society for Healthcare \n\n\n\nEpidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA), \n\n\n\nand the Pediatric Infectious Diseases Society (PIDS). Infection Control and Hospital \n\n\n\nEpidemiology. 2012;33(4):322-327. \n\n\n\n[2] Teo, J., Kwa, A. L., Loh, J., Chlebicki, M. P., Lee, W. The effect of a whole-system \n\n\n\napproach in an antimicrobial stewardship programme at the Singapore General Hospital. \n\n\n\nEuropean Journal of Clinical Microbiology and Infectious Diseases. 2012;31(6):947-955. \n\n\n\n[3] Liew, Y. X., Lee, W., Loh, J. C., Cai, Y., Tang, S. S., Lim, C. L., et al. Impact of an \n\n\n\nantimicrobial stewardship programme on patient safety in Singapore General Hospital. \n\n\n\nInternational Journal of Antimicrobial Agents. 2012;40(1):55-60. \n\n\n\n\n\n\n\nAbstract 005 \n\n\n\n\n\n\n\nImpact of an Antibiotic Stewardship \n\n\n\nProgram on the Use of Carbapenem \n\n\n\nin a Malaysian Tertiary Hospital \n \nAnitha Ramadas1*, Hwei Lin Teh1, Rahela \n\n\n\nAmbaras Khan1, Shan Lii Ching1, Rohana \n\n\n\nHassan1, Chee Loon Leong2, Farida Hanim \n\n\n\nIslahudin3 \n\n\n\n \n1 Department of Pharmacy, Hospital Kuala Lumpur \n\n\n\n2 Department of Medicine, Hospital Kuala Lumpur \n3 Faculty of Pharmacy, National University of Malaysia \n\n\n\n\n\n\n\n*Correspondence: ramadas.anitha@gmail.com \n\n\n\n\n\n\n\nIntroduction: Antimicrobial Stewardship (AMS) program \n\n\n\nhas been advocated to promote the rational use of antibiotic \n\n\n\nprescribing. However, the outcome of AMS in promoting the \n\n\n\njudicious use of carbapenem and minimising resistance is not \n\n\n\nwidely studied in Malaysia. Objective: To investigate the \n\n\n\ntypes of interventions made by the AMS team, its acceptance, \n\n\n\nand the impact on carbapenem consumption and \n\n\n\ncarbapenem-resistant Enterobacteriaceae (CRE) pattern. \n\n\n\nMethod: This was a retrospective study conducted in adult \n\n\n\nmedical wards of Kuala Lumpur General Hospital (HKL), \n\n\n\nwhere data were extracted from AMS form of patients \n\n\n\nreviewed by the HKL AMS team from January to December \n\n\n\n2016. Result and Discussion: The mean (SD) age of 169 \n\n\n\npatients included in this study was 59.2 (10.6) years, where \n\n\n\nalmost half were male. Ertapenem was the most prescribed \n\n\n\ncarbapenem (44.4%), followed by meropenem (34.3%) and \n\n\n\nimipenem/cilastatin (21.3%). Despite only 32% being \n\n\n\nempirically initiated, there were 68 cases (40.2%) classified \n\n\n\nas unjustified by the Antimicrobial Stewardship (AMS) team. \n\n\n\nOut of these, 39 cases (57%) were recommended to be \n\n\n\ndiscontinued, 25 cases (37%) to be de-escalated and 4 cases \n\n\n\n(6%) for changing/escalation. Acceptance rate was reported \n\n\n\n\nmailto:mfcheah85@hotmail.com\n\n\nmailto:ramadas.anitha@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 7, Issue 1, Supplementary (2021), 49-78 \n\n\n\n54 \n\n\n\n\n\n\n\nResearch Presentation of National Pharmacy Convention 2021 \n\n\n\nDOI:  10.52494/UCML9733 \n \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nto be around 73.5% (50 out of 68 cases). Post one year of \n\n\n\nAMS implementation, carbapenem consumption shown by \n\n\n\ndefined daily dose/1000 inpatient bed-days reduced \n\n\n\nsignificantly (33.7%; p<0.0001). Similarly, a notable \n\n\n\ndecrease in CRE cases (33.3%; p<0.0001) was seen post one \n\n\n\nyear of AMS initiation. Conclusion: In conclusion, AMS-\n\n\n\nguided interventions were shown to be a useful strategy to \n\n\n\nreduce non-judicious use of carbapenem in a tertiary hospital. \n\n\n\nIt was also able to demonstrate a reduction in carbapenem \n\n\n\nconsumption as well as CRE rates in the medical wards. \n\n\n\nTherefore, future long-term studies are required to assess \n\n\n\nlong-term effectiveness of AMS. \n\n\n\n\n\n\n\nReference \n\n\n\n \n[1] World Health Organization (WHO). Antimicrobial resistance: Global Report on \n\n\n\nSurveillance. WHO; 2014. \n\n\n\n[2] Shlaes DM, Gerding DN, John JF, Craig WA, Bornstein DL, Duncan RA, et al. Society \n\n\n\nfor Healthcare Epidemiology of America and Infectious Diseases Society of America Joint \n\n\n\nCommittee on the Prevention of Antimicrobial Resistance: Guidelines for the Prevention \n\n\n\nof Antimicrobial Resistance in Hospitals. Infect Control Hosp Epidemiol.1997;18(4):275\u2013\n\n\n\n91. \n\n\n\n[3] Protocol on Antimicrobial Stewardship Program in Healthcare Facilities. Ministry of \n\n\n\nHealth Malaysia; 2014 \n\n\n\n\n\n\n\nAbstract 006 \n\n\n\n\n\n\n\nFactors Affecting Adoption of \n\n\n\nElectronic Medical Record System at \n\n\n\nPrivate Hospitals in Klang Valley \n \nMariani Ahmad Nizaruddin1*, Shaharin Izhar \n\n\n\nAbd Rahman2, Syakinah Anian2,3 \n \n1 Department of Community Pharmacy Practice, Faculty of Pharmacy, \n\n\n\nUniversity of Cyberjaya, Selangor, Malaysia \n2 Faculty of Business and Technology, University of Cyberjaya, Selangor, \n\n\n\nMalaysia \n3 School of Business and Management, KPJ Healthcare University College, \n\n\n\nNegeri Sembilan, Malaysia \n\n\n\n\n\n\n\n*Correspondence: marianiahmadnizaruddin@yahoo.com \n\n\n\n\n\n\n\nIntroduction: Electronic Medical Record (EMR) is one of \n\n\n\nthe revolutionary digital technologies that has been able to \n\n\n\nproduce a system for seamless documentation workflow of \n\n\n\npatients and this revolution has brought parallel \n\n\n\ndevelopments that have not only structured the healthcare \n\n\n\nsystem but also provided better means of communication. \n\n\n\nThe continuous determination of EMR also depends on the \n\n\n\nadoption and support from the core user of this system. The \n\n\n\naim of the study is to explore the main factors that encourage \n\n\n\nthe adoption of EMR systems among the medical specialists \n\n\n\nin private hospitals by using The Unified Theory of \n\n\n\nAcceptance and Use of Technology (UTAUT) model. \n\n\n\nMethod: A cross-sectional survey was used to collect data \n\n\n\nfrom 95 respondents by using a quota sampling. The study \n\n\n\nused partial least square (PLS) method; a statistical analysis \n\n\n\ntechnique based on the structural equation modelling (SEM) \n\n\n\nto analyse the collected data. Result: There was a positive \n\n\n\nand moderate relationship between performance expectancy \n\n\n\nwith behavioural intention (\u03b2 = 0.581, T = 6.024). The factor \n\n\n\nof social influences (\u03b2 = 0.106, T = 1.267) was not significant \n\n\n\nwhile effort expectancy (\u03b2 = 0.174, T = 1.633) represented a \n\n\n\nlow significance and weak relationship. The relationship \n\n\n\nbetween facilitating condition and use behaviour was \n\n\n\nmoderate but of significant impact (\u03b2 = 0.392, T = 4.128). \n\n\n\nBehavioural intention influenced indicated (\u03b2 = 0.507, T = \n\n\n\n5.223) a moderate effect of intention toward the adoption of \n\n\n\nEMR. Conclusion: The findings suggest that healthcare \n\n\n\nproviders adopt EMR systems and improve the system via \n\n\n\ncustomization based on the needs or make it more user \n\n\n\nfriendly. The healthcare provider should consider technical \n\n\n\nsufficiency and training to facilitate the use of the EMR \n\n\n\nsystem.  \n\n\n\n \nReference \n\n\n\n\n\n\n\n[1] Hoque, R., & Sorwar, G. (2017). Understanding factors influencing the adoption of \n\n\n\nmHealth by the elderly: An extension of the UTAUT model. International Journal of \n\n\n\nMedical Informatics, 101, 75\u201384. https://doi.org/10.1016/j.ijmedinf.2017.02.002 \n\n\n\n[2] Dobrzykowski, D. D., & Tarafdar, M. (2015). Understanding information exchange in \n\n\n\nhealthcare operations: Evidence from hospitals and patients. Journal of Operations \n\n\n\nManagement, 36(1), 201\u2013214. https://doi.org/10.1016/j.jom.2014.12.003 \n\n\n\n[3] Cimperman, M., Makovec Bren\u010di\u010d, M., & Trkman, P. (2016). Analyzing older users\u2019 \n\n\n\nhome telehealth services acceptance behavior\u2014applying an Extended UTAUT model. \n\n\n\nInternational Journal of Medical Informatics, 90, 22\u201331. \n\n\n\nhttps://doi.org/10.1016/j.ijmedinf.2016.03.002 \n\n\n\n\n\n\n\n\n\n\n\nAbstract 007 \n\n\n\n\n\n\n\nPatterns of Prescription Medicines\u2019 \n\n\n\nSales through E-Marketplace in \n\n\n\nMalaysia and Associating Factors \n \nMarina Pilus, Noor Azline Ali, Malar Vily A/P \n\n\n\nVelisamy, Nurain Suleiman*, Farizul Mohd \n\n\n\nZain, Augustine Abraham Alphonsoes \n\n\n\n \nJohor Pharmaceutical Services Division, a/o Hospital Permai Lama, Jalan \n\n\n\nPersiaran Permai, 81200 Johor Bahru, Johor, Malaysia. \n\n\n\n\n\n\n\n*Correspondence: nurainsuleiman1985@yahoo.com \n\n\n\n\n\n\n\nIntroduction: Self-diagnose and obtaining various health \n\n\n\nproducts via the internet were extremely dangerous practices \n\n\n\nas it may increase the risks of patient injury or even death. \n\n\n\nObjective: This study aims to explore the patterns of \n\n\n\nprescription medicines\u2019 sales through e-marketplace \n\n\n\n(specifically: Shopee) in Malaysia as well as the associated \n\n\n\nfactors. Method: Cross-sectional study secondary data of \n\n\n\n983 Advertisement Screening Reports (reported from 1st \n\n\n\nJanuary 2020 \u2013 30th June 2020) in Johor State were collected. \n\n\n\nDescriptive statistics using frequency, percentages and/ bar \n\n\n\ncharts using Microsoft Excel 2013 were used to report the \n\n\n\npatterns of prescription medicines\u2019 sales through e-\n\n\n\nmarketplace (specifically: Shopee) in Malaysia based on \n\n\n\ntypes of prescription medicines that being advertised, \n\n\n\n\nmailto:marianiahmadnizaruddin@yahoo.com\n\n\nhttps://doi.org/10.1016/j.ijmedinf.2017.02.002\n\n\nhttps://doi.org/10.1016/j.jom.2014.12.003\n\n\nhttps://doi.org/10.1016/j.ijmedinf.2016.03.002\n\n\nmailto:nurainsuleiman1985@yahoo.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 7, Issue 1, Supplementary (2021), 49-78 \n\n\n\n55 \n\n\n\n\n\n\n\nResearch Presentation of National Pharmacy Convention 2021 \n\n\n\nDOI:  10.52494/UCML9733 \n \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nregistration status of prescription medicine that being \n\n\n\nadvertised as well as frequently violated Malaysia\u2019s law \n\n\n\nrelated to prescription medicine by sellers in Shopee. Factors \n\n\n\nassociated were explored by logistic regressions using IBM \n\n\n\nSPSS Version 22 via Simple (Enter Method) and Multiple \n\n\n\n(Backward Elimination (LR) Method). Result and \n\n\n\nDiscussion: 796 out of 852 (93.4%) prescription medicines\u2019 \n\n\n\nsamples were not registered with the Drug Control Authority, \n\n\n\nMalaysia\u2019s Health Ministry. Hormones (62.6%, while sex \n\n\n\nhormones which were anabolic steroids showed the highest \n\n\n\nfrequency; 58.3%) were the highest prescription medicines \n\n\n\nsold through the e-marketplace (specifically: Shopee) in \n\n\n\nMalaysia, while antibiotics, clomiphene (fertility drug), \n\n\n\nsibutramine (slimming pill) and prostaglandins and its \n\n\n\nsynthetic derivatives (abortion pill) denote 4.8%, 2.2%, \n\n\n\n1.8%, 0.4% respectively. The unregistered prescription \n\n\n\nmedicines were found to be the highest to violate Section \n\n\n\n13(a) of Poison Act 1952 which include 766 samples. \n\n\n\nMultiple logistic regression tests indicate that violation of \n\n\n\nSection 13 (a) of Poison Act 1952 (95%CI; 0.002, 0.058%; \n\n\n\np=0.000), Regulation 7(1)(a) of Control of Drug and \n\n\n\nCosmetic Regulations 1984 (95%CI; 194.694, 2726.963%; \n\n\n\np=0.000) and Section 4B of Malaysia Advertisement and \n\n\n\nSales Act 1956 (95%CI; 0.014, 0.260%; p=0.000) were the \n\n\n\npossible associated factors registration status prescription \n\n\n\nmedicines\u2019 sales through e-marketplace. Conclusion: The \n\n\n\nfindings in this study may give a brief idea for improving the \n\n\n\ncurrent practice in order to curb the freely illegal prescription \n\n\n\nmedicines\u2019 sales through e-marketplace (specifically: \n\n\n\nShopee) without the supervision of professionals.  \n\n\n\n \nReference \n\n\n\n \n[1] Fittler A, Vida RG, K\u00e1pl\u00e1r M, Botz L. Consumers turning to the internet pharmacy \n\n\n\nmarket: Cross-sectional study on the frequency and attitudes of Hungarian patients \n\n\n\npurchasing medications online. J Med Internet Res. 2018 Aug 22;20(8):e11115. \n\n\n\n[2] Aris NA. Ministry tracks thousands of online ads for illicit medicines. Free Malaysia \n\n\n\nToday. 2019 Apr 6 [cited 2020 Apr 6]. Available from: \n\n\n\nhttps://www.freemalaysiatoday.com/category/nation/2019/04/06/ministry-tracks-\n\n\n\nthousands-of-online-ads-for-illicit-medicines/ \n\n\n\n[3] Mackey TK, Nayyar G. Digital danger: A review of the global public health, patient \n\n\n\nsafety and cybersecurity threats posed by illicit online pharmacies. Br Med Bull. 2016 \n\n\n\nJun;118(1):110-26. \n\n\n\n\n\n\n\nAbstract 008 \n\n\n\n\n\n\n\nMedication Administration via \n\n\n\nEnteral Feeding Tubes: A Survey of \n\n\n\nNurses\u2019 Knowledge and Practice \n \nLaura Soon Cheau Ling1*, Pay Chyi Tong1, Le \n\n\n\nJun Chung1, Pamini Pilai2, Qing Liang Goh1, \n\n\n\nSze Ling Tan1 \n\n\n\n \n1 Department of Pharmacy, Hospital Queen Elizabeth II, Kota Kinabalu, \n\n\n\nSabah \n2 Clinical Research Centre, Hospital Queen Elizabeth II, Kota Kinabalu, \n\n\n\nSabah \n\n\n\n\n\n\n\n*Correspondence: laura_soon@hotmail.com \n\n\n\n\n\n\n\nIntroduction: Enteral feeding is a type of nutritional support \n\n\n\nfor critically ill patients who are unable to tolerate oral \n\n\n\nfeeding. It is vital to ensure that nurses practise proper \n\n\n\nadministration technique via enteral feeding tubes (EFT) to \n\n\n\nensure that medication can be delivered safely and \n\n\n\neffectively. Objective: This study aimed to assess \n\n\n\nknowledge and practice of nurses on medication \n\n\n\nadministration through EFT. Association between baseline \n\n\n\ncharacteristics and knowledge was also being explored. \n\n\n\nMethod: This was a cross-sectional, self-administered, \n\n\n\ncontent-validated, pre-tested questionnaire survey involving \n\n\n\nall nurses who worked in ward setting at Hospital Queen \n\n\n\nElizabeth II from August to December 2020. Result and \n\n\n\nDiscussion: A total of 409 questionnaires were sent out with \n\n\n\n252 responses received. Majority of respondents were female \n\n\n\n(n=240, 95.6%) with median working experience of 88 \n\n\n\nmonths (interquartile range of 44 months). Most nurses knew \n\n\n\nthat the immediate released dosage forms (n=237, 94.4%) \n\n\n\nshould be crushed and administered through EFT, but not the \n\n\n\nsublingual nitroglycerin (GTN) tablets (n=232, 92.8%) and \n\n\n\nnystatin suspension (n=212, 85.1%). About half of the nurses \n\n\n\nresponded incorrectly on the EFT administration of \n\n\n\nsustained-release medications (n=152, 60.6%), soft gelatin \n\n\n\ncapsules (n=111, 44.4%) and hard gelatin capsules (n=102, \n\n\n\n40.6%). In terms of practice, majority of the nurses would \n\n\n\nroutinely flush the EFT before (n=226, 90.4%) and after \n\n\n\n(n=245, 98.8%) the administration of medications. Only a \n\n\n\nsmall proportion of nurses (n=93, 37.5%) demonstrated good \n\n\n\npractice where they administer all medications separately all \n\n\n\nthe time. It was also worth noting that nurses from the \n\n\n\nintensive care setting had more correct responses on some of \n\n\n\nthe knowledge-based questions when compared to those \n\n\n\nfrom general ward setting (p<0.05). Conclusion: Knowledge \n\n\n\ngap and inconsistent practice may lead to suboptimal delivery \n\n\n\nof medication and potentially compromise patient outcomes. \n\n\n\nHence, continuous educational programs should be carried \n\n\n\nout to ensure safe and effective drug administration through \n\n\n\nEFT. \n\n\n\n \nReference \n \n\n\n\n[1] Critical Care Pharmacy Handbook 2013. First Edition. Malaysia: Pharmaceutical \n\n\n\nDivision, Ministry of Health Malaysia; 2013. \n\n\n\n[2] White R, Bradnam V. Handbook of Drug Administration via Enteral Feeding Tubes. \n\n\n\nThird edition. 2015. \n\n\n\n \n\n\n\n\nmailto:laura_soon@hotmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 7, Issue 1, Supplementary (2021), 49-78 \n\n\n\n56 \n\n\n\n\n\n\n\nResearch Presentation of National Pharmacy Convention 2021 \n\n\n\nDOI:  10.52494/UCML9733 \n \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 009 \n\n\n\n\n\n\n\nFactors Associated with Oral Anti-\n\n\n\nDiabetic Drugs Preventable Returned \n\n\n\nMedications Among Type II Diabetes \n\n\n\nMellitus Patients  \n \nWong Su Li*, Norharlina Sulaiman, Cheang \n\n\n\nChing Ye, Ng Kar Mun, Samuel Tan Meng \n\n\n\nHerng, Shazana Mohd Nawawi, Tan Soo Ling \n\n\n\n \nPejabat Kesihatan Daerah Klang, Selangor, Malaysia. \n\n\n\n\n\n\n\n*Correspondence: angelinewong13@gmail.com \n\n\n\n\n\n\n\nIntroduction: In Malaysia, Type II Diabetes Mellitus \n\n\n\n(T2DM) is estimated to have a 31.3% prevalence rate among \n\n\n\nthe adults by year 2025. Oral anti-diabetic drugs (OADs) are \n\n\n\nused to lower blood glucose level in T2DM treatment. In our \n\n\n\nsetting, OADs was recorded to have the highest returned \n\n\n\nmedication proportion (51.0%) as compared to other drugs. \n\n\n\nSubstantial proportion of returned OADs has raised our \n\n\n\nconcern in patients\u2019 medication taking behavior or drug \n\n\n\nrelated problems at home and their glycemic control.  \n\n\n\nObjective: This study aimed to investigate the factors \n\n\n\nassociated with preventable OADs returned to pharmacy and \n\n\n\nto identify reasons for the return. Method: This was a cross-\n\n\n\nsectional study conducted at public health clinics in Klang \n\n\n\ndistrict over a 4-week period. Patients with active \n\n\n\nprescriptions containing OADs were recruited using \n\n\n\nsystematic sampling method whereby they have given their \n\n\n\nconsent prior to the study and subsequently answered a \n\n\n\nvalidated questionnaire. From the unused OADs with \n\n\n\npotential return, patients are grouped into case (with return) \n\n\n\nand control (without return). The reasons for OADs return \n\n\n\ndivided into non-preventable (e.g., change to other \n\n\n\ntreatments) and preventable (e.g., non-compliance). Patients \n\n\n\nwith non-preventable reasons for return were excluded due to \n\n\n\nno interventions by pharmacists. Computed data were \n\n\n\nanalyzed using descriptive statistics and multiple logistic \n\n\n\nregressions. Result: Out of 168 patients interviewed, 43.4% \n\n\n\n(n=73) patients had preventable return, 13.7% (n=23) \n\n\n\npatients had non-preventable return and 42.9% (n=72) \n\n\n\npatients of the control group had no return. The main reasons \n\n\n\nfor returning were non-compliance (76.7%) and difficulty in \n\n\n\nfollowing instructions (21.9%). OADs return was \n\n\n\nsignificantly associated with the patient 's educational level \n\n\n\n(OR 0.038; p-value 5.472 with 95% confidence interval \n\n\n\n[1.097-27.296]) where 63.7% of them from lower education \n\n\n\nbackground.  Factors such as age, gender, T2DM diagnosis \n\n\n\nyears, polypharmacy, OADs pill burden and traditional \n\n\n\nmedicine taking showed no significant association with \n\n\n\nOADs return. Conclusion: Patient education level is a \n\n\n\nsignificant factor in preventable OADs return. By instilling \n\n\n\nbetter knowledge on the importance of patients\u2019 medication \n\n\n\ntaking, patients will be self-empowered to manage their \n\n\n\nmedication and disease better. Future study is recommended \n\n\n\nto assess the possible interventions such as providing \n\n\n\nsimplified education materials and utilizing patient teach-\n\n\n\nback method to improve patient\u2019s medication knowledge and \n\n\n\neventually, improving compliance and preventing \n\n\n\nunnecessary medication return.   \n\n\n\n \nReference \n\n\n\n \n[1] Clinical Practice Guidelines on Management of Type 2 Diabetes Mellitus. Ministry of \n\n\n\nHealth Malaysia. Health Technology Assessment Section Medical Development \n\n\n\nDivision (5 th ed): December 2015. p.16. \n\n\n\n[2] 2. National Strategic Plan for Non-communicable Disease. Ministry of Health Malaysia. \n\n\n\nNon-Communicable Disease (NCD) Section Disease Control Division (1st ed): 2016.p4. \n\n\n\n[3] 3. Return Your Medicine Program. [Internet] MOH Pharmaceutical Services \n\n\n\nProgramme. 2021 [cited 30 May 2021]. Available from: URL: \n\n\n\nhttps://www.pharmacy.gov.my/v2/en/content/return-your-medicines-program.html \n\n\n\n\n\n\n\nAbstract 011 \n\n\n\n\n\n\n\nPerception and Attitude of Malaysian \n\n\n\nCommunity Pharmacists Towards the \n\n\n\nImplementation of Telepharmacy \n \nWei Liang Ng, Wei Thing Sze \n\n\n\n \nFaculty of Pharmacy, SEGi University, 47810 Petaling Jaya, Selangor, \n\n\n\nMalaysia. \n\n\n\n\n\n\n\n*Correspondence: w_thing5142@hotmail.com \n\n\n\n\n\n\n\nIntroduction: Telepharmacy refers to the delivery of \n\n\n\npharmaceutical care through telecommunications to patients \n\n\n\nin locations where they may not have direct contact with a \n\n\n\npharmacist [1]. The role of community pharmacist has \n\n\n\nexpanded during the COVID-19 pandemic to provide \n\n\n\npharmaceutical care services remotely through telepharmacy \n\n\n\n[2]. This study aimed to assess Malaysian community \n\n\n\npharmacists\u2019 perception and attitude towards implementing \n\n\n\ntelepharmacy. Method: This cross-sectional study was \n\n\n\ncarried out using an online questionnaire. 217 community \n\n\n\npharmacists in Klang Valley were recruited through the \n\n\n\nconvenience sampling method. 5-point Likert scales were \n\n\n\nused to evaluate the respondent\u2019s perceived benefits, \n\n\n\nperceived barriers, and attitude towards the implementation \n\n\n\nof telepharmacy. Result: 37.8% of the respondents showed \n\n\n\npositive perception while 53.9% are moderately positive \n\n\n\ntowards the benefits of telepharmacy. Age (p=0.019) and \n\n\n\nfamiliarity with the term \u2018telepharmacy\u2019 (p=0.014) was \n\n\n\nshown to influence the perceived benefits on implementation \n\n\n\nof telepharmacy. On the other hand, only 8.3% of the \n\n\n\ncommunity pharmacists perceived low barriers in \n\n\n\ntelepharmacy implementation. Community pharmacists who \n\n\n\nhave a Master\u2019s qualification have lower perceived barriers \n\n\n\nof implementing telepharmacy, as compared to those with a \n\n\n\nBachelor\u2019s qualification (p=0.032). This may imply that \n\n\n\n\nmailto:angelinewong13@gmail.com\n\n\nmailto:w_thing5142@hotmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 7, Issue 1, Supplementary (2021), 49-78 \n\n\n\n57 \n\n\n\n\n\n\n\nResearch Presentation of National Pharmacy Convention 2021 \n\n\n\nDOI:  10.52494/UCML9733 \n \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nhigher education level may lead to a broader view and \n\n\n\nunderstanding of the barriers faced in implementing \n\n\n\ntelepharmacy. Overall, the respondents showed a positive \n\n\n\nattitude towards the implementation of telepharmacy. \n\n\n\nYounger community pharmacists were more likely to have a \n\n\n\npositive attitude towards the implementation of telepharmacy \n\n\n\n(p<0.001), which is consistent with the study done by Biruk \n\n\n\nand Abetu, where 56% of healthcare provider within the age \n\n\n\ngroup of 20-29 showed positive attitude towards \n\n\n\ntelemedicine [3]. Community pharmacists who were familiar \n\n\n\nwith the term \u2018telepharmacy\u2019 and have more years of working \n\n\n\nexperience were more likely to have a positive attitude \n\n\n\ntowards the implementation of telepharmacy (p<0.001). \n\n\n\nConclusion: In conclusion, most Malaysian community \n\n\n\npharmacists practicing in the urban area have shown positive \n\n\n\nperception towards the benefits of telepharmacy, and overall \n\n\n\npositive attitude towards its implementation. Nevertheless, \n\n\n\nthe perceived barriers towards its implementation are high. A \n\n\n\nseparate telemedicine education or training may be useful to \n\n\n\npromote the development of telemedicine to all the \n\n\n\npharmacists [4]. \n\n\n\n \nReference \n\n\n\n \n[1] S. Baldoni, F. Amenta, G. Ricci, Telepharmacy Services: Present Status and Future \n\n\n\nPerspectives: A Review, Medicina (Mex.). 55 (2019). \n\n\n\nhttps://doi.org/10.3390/medicina55070327. \n\n\n\n[2] A.E. Gross, C. MacDougall, Roles of the clinical pharmacist during the COVID-19 \n\n\n\npandemic, JACCP J. Am. Coll. Clin. Pharm. 3 (2020) 564\u2013566. \n\n\n\nhttps://doi.org/10.1002/jac5.1231. \n\n\n\n[3] K. Biruk, E. Abetu, Knowledge and Attitude of Health Professionals toward Telemedicine \n\n\n\nin Resource-Limited Settings: A Cross-Sectional Study in North West Ethiopia, J. \n\n\n\nHealthc. Eng. 2018 (2018) e2389268. https://doi.org/10.1155/2018/2389268. \n\n\n\n[4] S. Bali, Barriers to Development of Telemedicine in Developing Countries, in: T. F. \n\n\n\nHeston (Ed.), Telehealth, IntechOpen, 2019. https://doi.org/10.5772/intechopen.81723. \n\n\n\n\n\n\n\nAbstract 012 \n\n\n\n\n\n\n\nKnowledge, Attitude and Practice of  \n\n\n\nMalaysian Private Hospital \n\n\n\nPharmacists on Medication Review \n\n\n\nService \n \nWong Sze Ling, Sze Wei Thing \n \n\n\n\nFaculty of Pharmacy, SEGi University, 47810 Petaling Jaya, Selangor, \n\n\n\nMalaysia. \n\n\n\n\n\n\n\n*Correspondence: w_thing5142@hotmail.com \n\n\n\n\n\n\n\nBackground: Medication review is emerging as one of the \n\n\n\nvital components of medication management to prevent \n\n\n\nmedicine-related problems [1]. Studies have demonstrated a \n\n\n\nhigh prevalence of potentially inappropriate medication use \n\n\n\nin private aged care facilities [2]. Hence, there is a strong \n\n\n\nneed for medication review in the private healthcare system \n\n\n\nin Malaysia to ensure pharmaceutical safety and \n\n\n\neffectiveness. This study aimed to determine the knowledge, \n\n\n\nattitude, and practice of private hospital pharmacists on \n\n\n\nmedication review service in Malaysia. Method: This cross-\n\n\n\nsectional study was carried out from October to November \n\n\n\n2020 using an online questionnaire. Private hospital \n\n\n\npharmacists in Malaysia were invited to participate in a \n\n\n\nvalidated 36-items questionnaire. Descriptive statistics, \n\n\n\nSpearman\u2019s Rank Order Correlation test, Mann-Whitney U \n\n\n\ntest and Kruskal-Wallis H test were performed to analyze the \n\n\n\ndata. Result: Survey questionnaires were completed by 104 \n\n\n\nout of 226 private hospital pharmacists, giving a response \n\n\n\nrate of 46.0%. From the total number of responses obtained, \n\n\n\n80 pharmacists (76.9%) presented with a high level of \n\n\n\nknowledge on medication review, while 92 pharmacists \n\n\n\n(88.5%) had a positive attitude. Approximately two-third (n \n\n\n\n= 68, 65.4%) are providing medication review in the \n\n\n\npharmacy, whereas 45 of them (43.3%) did not obtain \n\n\n\npatient\u2019s medication history at the time of admission or as \n\n\n\nearly as possible. Besides, only 69 of the participants (66.3%) \n\n\n\nreconciled patient\u2019s medication with the prescribed \n\n\n\nmedicines, and less than half of the respondents (n = 47, \n\n\n\n45.2%) performed medication chart review throughout the \n\n\n\npatient\u2019s admission. Factors associated significantly with \n\n\n\npractice of medication review include age (p = 0.010) and \n\n\n\nyears of experience as a private hospital pharmacist (p = \n\n\n\n0.016).  The knowledge on medication review had a \n\n\n\nstatistically significant moderate positive correlation with \n\n\n\nattitude regarding medication review (p<0.001). Three major \n\n\n\nperceived challenges of implementing medication review \n\n\n\nwere lack of time (82.7%), insufficient training (79.8%) and \n\n\n\nlack of manpower (60.6%). Conclusion: Private hospital \n\n\n\npharmacists in Malaysia have a high level of knowledge, a \n\n\n\npositive attitude, and a fair practice regarding medication \n\n\n\nreview service. However, several challenges such as lack of \n\n\n\ntime, insufficient training and lack of manpower might \n\n\n\nobstruct the practice of medication review in private \n\n\n\nhospitals.  \n\n\n\n \nReference \n\n\n\n \n[1] Care (UK), N.C.C. for P. (2009) Reviewing Medicines [online] Royal College of General \n\n\n\nPractitioners (UK). available from <https://www.ncbi.nlm.nih.gov/books/NBK55429/> \n\n\n\n[13 July 2020]Mohamed Ibrahim O, Ibrahim RM, Abdel-Qader DH, Al Meslamani AZ, \n\n\n\nAl Mazrouei N. Evaluation of Telepharmacy Services in Light of COVID-19. Telemed E-\n\n\n\nHealth [Internet]. 2020 Oct 7 [cited 2020 Dec 17]; Available from: \n\n\n\nhttps://www.liebertpub.com/doi/10.1089/TMJ.2020.0283 \n\n\n\n[2] Hasan, S.S., Kow, C.S., Verma, R.K., Ahmed, S.I., Mittal, P., and Chong, D.W.K. (2017) \n\n\n\n\u2018An Evaluation of Medication Appropriateness and Frailty among Residents of Aged Care \n\n\n\nHomes in Malaysia: A Cross-Sectional Study\u2019. Medicine 96 (35), e7929S. Bali, Barriers \n\n\n\nto Development of Telemedicine in Developing Countries, in: T. F. Heston (Ed.), \n\n\n\nTelehealth, IntechOpen, 2019. https://doi.org/10.5772/intechopen.81723. \n\n\n\n \n\n\n\n\nhttps://doi.org/10.3390/medicina55070327\n\n\nhttps://doi.org/10.1002/jac5.1231\n\n\nhttps://doi.org/10.1155/2018/2389268\n\n\nmailto:w_thing5142@hotmail.com\n\n\nhttps://www.liebertpub.com/doi/10.1089/TMJ.2020.0283\n\n\nhttps://doi.org/10.5772/intechopen.81723\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 7, Issue 1, Supplementary (2021), 49-78 \n\n\n\n58 \n\n\n\n\n\n\n\nResearch Presentation of National Pharmacy Convention 2021 \n\n\n\nDOI:  10.52494/UCML9733 \n \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 013 \n\n\n\n\n\n\n\nPrevalence of Nosocomial Infections \n\n\n\nin Pediatrics High Dependency Unit \n\n\n\nand Neonatal Intensive Care Unit \n\n\n\nPatients, their Bacteriological Profile \n\n\n\nand Antimicrobial Susceptibility \n\n\n\nPattern in Tengku Ampuan Rahimah \n\n\n\nHospital: A Retrospective \n\n\n\nObservational Study \n \nSharmila Sathianathan, Adilah Mohd Fazli, \n\n\n\nTheeba Subramaniam, Azizul Hakim bin \n\n\n\nMohd Tobroni, Nur Atiqah Jaafar, Yap Qiao \n\n\n\nXin, Amirah Fareeza Yahaya \n \n\n\n\nPharmacy Department Tengku Ampuan Rahimah Hospital Klang, 41200 \n\n\n\nKlang, Selangor \n\n\n\n\n\n\n\n*Correspondence: shamrudr@gmail.com \n\n\n\n\n\n\n\nIntroduction: Nosocomial infections (NIs) represent serious \n\n\n\npublic health concern worldwide, and it is difficult to control \n\n\n\nespecially in developing countries, due to financial \n\n\n\nconstraints. The identification of pathogenic bacteria patterns \n\n\n\nand resistance trends in a facility is useful as a guide for the \n\n\n\nphysician in choosing proper empirical antibiotic therapy for \n\n\n\npatients, and this is even more important in pediatric \n\n\n\npopulations. Objective: To identify common pathogens \n\n\n\ncausing NIs in Neonatal Intensive Care Unit (NICU) and \n\n\n\nPediatrics High Dependency Unit (PHDU) HTAR, and the \n\n\n\nsusceptibility and resistance patterns of these pathogens. \n\n\n\nMethod: Single center study was carried out from January \n\n\n\n2018 until June 2020 which includes all neonates aged 72 \n\n\n\nhours of life and pediatrics that showed positive cultures who \n\n\n\nhave stayed in the facility for more than 48 hours.  The data \n\n\n\nwas collected from the Patients\u2019 Notification of Health Care \n\n\n\nAcquired Infection form and analyzed using SPSS version \n\n\n\n22. Result: Number of NIs in NICU were 33 (2018), 36 \n\n\n\n(2019) and 9 cases (2020) while NIs in PHDU were 3 (2018), \n\n\n\n5 (2019) and 0  (2020). Eye infection was the most common \n\n\n\ntype of NIs in the NICU for the year 2018 (39.4%), 2019 \n\n\n\n(44.4%) and 2020 (55.6%). In PHDU, the most common type \n\n\n\nof NIs were respiratory tract infections, 66.7% (2018) and \n\n\n\nblood-related infections, 80.0% (2019). 'Coagulase-negative \n\n\n\nstaphylococci (CONs), P. Aeruginosa and ESBL Klebsiella \n\n\n\nwere found to be the most common organisms isolated in \n\n\n\nNICU, with 24.2%, 27.8% and 27.8% cases in the year 2018, \n\n\n\n2019 and 2020, respectively. P. Aeruginosa was the most \n\n\n\ncommon isolates in 2018 (66.7%) and Staph. Aureus (60%) \n\n\n\nin 2019 for patients in PHDU. In NICU, CONs was \n\n\n\nsusceptible to chloramphenicol and resistant toward \n\n\n\nerythromycin; P. Aeruginosa was susceptible to gentamicin \n\n\n\nand ceftazidime but resistant toward imipenem. ESBL \n\n\n\nKlebsiella was susceptible to gentamicin but resistant to \n\n\n\nampicillin. The resistance and susceptibility patterns were \n\n\n\nunable to be established for PHDU cases. Conclusion: \n\n\n\nCommon organisms causing NIs in NICU HTAR are CONs, \n\n\n\nP. Aeruginosa and ESBL Klebsiella. This information will \n\n\n\nallow a more targeted choice of empirical antibiotics to \n\n\n\neliminate these potential bacteria causing NI in the NICU. \n\n\n\n \nReference \n\n\n\n \n[1] Choudhury, J., Mohanty, D., & Routray, S. S. (2016). Microbiological profile of \n\n\n\nNosocomial infections in the pediatric patients admitted to intensive care unit. 3(2), 100\u2013\n\n\n\n104. \n\n\n\n[2] Dalal, P., Gathwala, G., Gupta, M., & Singh, J. (2017). Bacteriological profile and \n\n\n\nantimicrobial sensitivity pattern in neonatal sepsis: a study from North India. International \n\n\n\nJournal of Research in Medical Sciences Dalal P et Al. Int J Res Med Sci, 5(4), 1541\u2013\n\n\n\n1545. https://doi.org/10.18203/2320-6012.ijrms20171261 \n\n\n\n[3] Degirmencioglu, H., Say, B., Tunay, Z. O., Saygan, S., & Oguz, S. S. (2017). \n\n\n\nEpidemiology and Susceptibility Patterns of Hospital-Acquired Conjunctivitis in a \n\n\n\nNeonatal Intensive Care Unit. https://doi.org/10.14744/ejmo.2017.21939 \n\n\n\n\n\n\n\nAbstract 014 \n\n\n\n\n\n\n\nFormulation and Evaluation of Solid \n\n\n\nLipid Nanoparticles Containing \n\n\n\nKappaphycus alvarezii Extract in A \n\n\n\nCosmetic Gel \n \nLim Ruo Xin1, Melbha Starlin Chellathurai1*, \n\n\n\nPalanirajan Vijayraj Kumar1, Shaik Ibrahim \n\n\n\nKhalivulla1, Teo Swee Sen2 \n\n\n\n \n1Faculty of Pharmaceutical Sciences, UCSI University, Kuala Lumpur, \n\n\n\nMalaysia 56000 \n2Faculty of Applied Sciences, UCSI University, Kuala Lumpur, Malaysia \n\n\n\n56000 \n\n\n\n\n\n\n\n*Correspondence: uranusshine@gmail.com \n\n\n\n\n\n\n\nIntroduction: Marine algal extracts have been used in the \n\n\n\nformulation of cosmetics for years. In this study, the \n\n\n\nchloroform, methanol, and water extracts of marine algal \n\n\n\nwere analyzed for their antibacterial and antifungal actions. \n\n\n\nThe extract with maximum antimicrobial activity was \n\n\n\nselected for the preparation of Solid Lipid Nanoparticles \n\n\n\n(SLNs). The prepared nanoparticles were suspended in a \n\n\n\ncosmetic gel. Objective: To formulate and evaluate the \n\n\n\ncosmetic gel containing SLNs of Kappaphycus alvarezii \n\n\n\n(KA) chloroform extract to localize the extract topically for \n\n\n\na longer duration to exert its antimicrobial properties. \n\n\n\nMethod: Disc-diffusion agar plate method was used to \n\n\n\nevaluate the antimicrobial activity towards Escherichia coli \n\n\n\n(Gram-negative), Staphylococcus aureus (Gram-positive) \n\n\n\nand Candida albicans (Fungi). The SLNs were prepared \n\n\n\nusing film hydration technique with ultrasonication. The \n\n\n\ndried SLNs were evaluated for its physical characteristics, \n\n\n\nZeta potential, and the duration taken to release the \n\n\n\n\nmailto:shamrudr@gmail.com\n\n\nmailto:uranusshine@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 7, Issue 1, Supplementary (2021), 49-78 \n\n\n\n59 \n\n\n\n\n\n\n\nResearch Presentation of National Pharmacy Convention 2021 \n\n\n\nDOI:  10.52494/UCML9733 \n \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nencapsulated extract for the antimicrobial activity. Carbopol \n\n\n\nand HPMC were chosen as the gelling agent after \n\n\n\ncompatibility studies with nanoparticle dispersions [1]. The \n\n\n\nformulated gel was analyzed for its pH, visual appearance, \n\n\n\nand in-vitro drug release. Result and Discussion: By \n\n\n\ncomparing the zone of inhibition, chloroform extract of KA \n\n\n\n(120 \u03bcg) showed maximum antimicrobial activity than \n\n\n\nmethanol and aqueous extracts. The SLNs prepared using \n\n\n\nchloroform extract showed a smaller cloudy and blurry zone \n\n\n\nof inhibition instead of a clear zone of inhibition. This result \n\n\n\nwas due to the low diffusion of encapsulated drugs through \n\n\n\nthe outer lipid layer of SLNs. SLNs showed a Zeta potential \n\n\n\nranging between \u201311.0 to \u201337.4 mV. The formulated gel \n\n\n\ncontaining SLNs of chloroform extract of KA had an average \n\n\n\npH value of 5.37, which was suitable to be used on human \n\n\n\nskin [2]. The maximum drug release was 60.28% over5 \n\n\n\nhours. Conclusion: In this study, algal extracts were \n\n\n\nsuccessfully encapsulated within the SLNs, and when applied \n\n\n\ntopically, the SLNs can reside on the surface of the skin for \n\n\n\nlocalized action for a prolonged duration. The Zeta potential \n\n\n\nobtained for the SLNs was approximately within the limit of \n\n\n\n\u201330 mV that yields a formulation with reasonably good \n\n\n\nphysical stability [3].  \n\n\n\n \nReference \n\n\n\n \n[1] Pandurangan D, Bodagala P, Palanirajan V, Govindaraj S. Formulation and evaluation of \n\n\n\nvoriconazole ophthalmic solid lipid nanoparticles in situ gel. Int J Pharm Investig. 2016 \n\n\n\n[2] Nieradko-Iwanicka B, Chrobok K, Skolarczyk J, Pekar J. What is the pH, Fe and Cl2 \n\n\n\ncontent of cosmetics we use? \u2013 a pilot study on safety of skin care products. Polish J Public \n\n\n\nHeal. 2018 \n\n\n\n[3] Shah R, Eldridge D, Palombo E, Harding I. Optimisation and stability assessment of solid \n\n\n\nlipid nanoparticles using particle size and zeta potential. J Phys Sci. 2014 \n\n\n\n\n\n\n\nAbstract 015 \n\n\n\n\n\n\n\nPharmacist-assisted Transition of \n\n\n\nCare versus Standard of Care towards \n\n\n\nEffect on Healthcare Resource \n\n\n\nUtilization among Patients from \n\n\n\nMedical Wards \n \nDiana Yap Fui Sing*, Nur Alyaa Khairudin, \n\n\n\nNurul Dinah Afiqah Sabarudin, Wong Sin Wei \n\n\n\n \nPharmacy Department, Hospital Enche\u2019 Besar Hajjah Khalsom, Kluang, \n\n\n\nJohor, Malaysia \n\n\n\n\n\n\n\n*Correspondence: pay_anaid@yahoo.com \n\n\n\n\n\n\n\nIntroduction: Suboptimal patient care transition upon \n\n\n\ndischarge may potentially increase subsequent healthcare \n\n\n\nsystem utilization. Preserving the resources from the \n\n\n\npredictable overwhelmed healthcare system use under \n\n\n\nCOVID-19 landscape is important. The pharmacist-assisted \n\n\n\ntransition of care is a transformational service approach to \n\n\n\nsupport patient care continuum after discharge before the \n\n\n\nnext healthcare facility visit. Objective: This study aimed to \n\n\n\ncompare the effect of pharmacist-assisted transition of care \n\n\n\nversus standard of care towards healthcare resource \n\n\n\nutilization among patients from medical wards. Method: A \n\n\n\ncluster randomized controlled study was conducted among \n\n\n\nmedical ward patients in a Malaysian secondary care public \n\n\n\nhospital from July 2019 to December 2019. Consented \n\n\n\npatients were stratified into two clusters and randomized to \n\n\n\nan intervention or control group. The sample size was \n\n\n\nestimated by using the two-proportions method. The \n\n\n\nintervention group received pharmacist-assisted discharge \n\n\n\nmedication reconciliation, bedside discharge medication \n\n\n\ndelivery with counselling and a timely post-discharge phone \n\n\n\ncall. The control group followed the standard discharge \n\n\n\nprocess with medication collection at the ambulatory \n\n\n\npharmacy without a post-discharge phone call. Study \n\n\n\nendpoints included pharmacy first refill persistency, \n\n\n\nresolution rate on unintended discharge medication \n\n\n\ndiscrepancies with associated medication cost-savings and \n\n\n\n30-days all-cause rehospitalization. The study endpoints \n\n\n\nwere compared using the Chi-square test, Mann-Whitney U \n\n\n\ntest or Kaplan Maier curve, where appropriate. Result and \n\n\n\nDiscussion: A total of 168 patients with 84 patients in each \n\n\n\narm was recruited. The intervention resulted in a higher \n\n\n\npharmacy first refill persistency (70.2% versus 50.0%, \n\n\n\np<0.05), indicating a lower subsequent unscheduled \n\n\n\npharmacy refill rate. Under the intervention, a consistent rate \n\n\n\nof resolution from unintended medication discrepancies \n\n\n\n(100.0%, IQR 0 versus 100.0%, IQR 67; p<0.05) was \n\n\n\ndemonstrated that corresponded to medication cost-savings \n\n\n\nof RM6.80 per prescription over control group. Unplanned \n\n\n\nrehospitalization was not significantly different between the \n\n\n\ngroupsbut towards a trend of 10% reduction after the \n\n\n\nintervention. Conclusion: Pharmacist-assisted transition of \n\n\n\ncare demonstrated a promising effect towards reducingthe  \n\n\n\nhealthcare resource use compared to standard care. Future \n\n\n\nstudies to explore its implementation across institutions is \n\n\n\nwarranted to facilitate service expansion, particularly in the \n\n\n\npost-pandemic era. \n\n\n\n \nReference \n\n\n\n \n[1] Tran T et al. Impact of pharmacist discharge counselling on hospital readmission and \n\n\n\nemergency department visit. Journal of Hospital Administration. 2017; 6(2):68-73. \n\n\n\n[2] Herzik KA, Bethishou L. The impact of COVID-19 on pharmacy transitions of care \n\n\n\nservices. Research in Social and Administrative Pharmacy. 2020; 17(2021): 1908-1912. \n\n\n\n[3] Nguyen PA et al. Impact of a pharmacy-driven transitions-of-care program on \n\n\n\npostdischarge healthcare utilization at a national comprehensive cancer centre. Am J \n\n\n\nHealth-Syst Pharm. 2018; 75(18): 1386-1393.  \n\n\n\n \n\n\n\n\nmailto:pay_anaid@yahoo.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 7, Issue 1, Supplementary (2021), 49-78 \n\n\n\n60 \n\n\n\n\n\n\n\nResearch Presentation of National Pharmacy Convention 2021 \n\n\n\nDOI:  10.52494/UCML9733 \n \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 016 \n\n\n\n\n\n\n\nAwareness, Expectation and \n\n\n\nSatisfaction towards Ward Pharmacy \n\n\n\nServices among Patients in Medical \n\n\n\nWards: A Multi-Centre Study in \n\n\n\nPerak \n \n\n\n\nNg Chew Beng1, Choo Shea Jiun1*, Chang \n\n\n\nChee Tao2*, Ong Su Yin3, Maslinatasha \n\n\n\nMahmud4, Lee Lay Chin5, Chew Wei Yee6, \n\n\n\nNormi Hamdan7, Ros Sakinah Kamaludin8, \n\n\n\nThong Kah Shuen9 \n\n\n\n\n\n\n\n1 Pharmacy Department, Hospital Taiping \n2 Clinical Research Centre, Hospital Raja Permaisuri Bainun \n3 Perak Pharmaceutical Services Division, Ministry of Health Malaysia  \n4 Pharmacy Department, Hospital Parit Buntar \n5 Pharmacy Department, Hospital Teluk Intan \n6 Pharmacy Department, Hospital Selama \n7 Pharmacy Department, Hospital Seri Manjung \n8 Pharmacy Department, Hospital Slim River  \n9 Pharmacy Department, Hospital Raja Permaisuri Bainun \n\n\n\n\n\n\n\n*Correspondence: cc.sheajiun@gmail.com \n\n\n\n\n\n\n\nIntroduction: Patients\u2019 awareness and satisfaction towards \n\n\n\nward pharmacy services may influence perceptions towards \n\n\n\neffectiveness and safety of drugs. This subsequently affects \n\n\n\ntheir medication adherence and clinical outcome [1]. \n\n\n\nObjective: To evaluate awareness, expectation, and \n\n\n\nsatisfaction of ward pharmacy services among patients in \n\n\n\nmedical wards and determine their association with \n\n\n\ndemographic characteristics. Method: This was a cross-\n\n\n\nsectional study using a self-administered questionnaire. The \n\n\n\nstudy was conducted in the medical wards of fourteen Perak \n\n\n\nstate public hospitals from September-October 2020. In-\n\n\n\npatients aged \u226518 years old eligible for ward pharmacy \n\n\n\nservices were included. The questionnaire consist of four \n\n\n\ndomains: demographic characteristics, awareness, \n\n\n\nexpectation and satisfaction towards ward pharmacy \n\n\n\nservices. The awareness, expectation and satisfaction were \n\n\n\nevaluated using a 5-point Likert scale. A pilot study was \n\n\n\nconducted to establish the reliability of the questionnaire \n\n\n\n(Cronbach alpha > 0.7). Result and Discussion: 467 patients \n\n\n\nagreed to participate (response rate=83.8%), but only 441 \n\n\n\nwere included. The mean age of the patients was 54.9 years. \n\n\n\nMajority was male (56.2%), Malay (77.3%), with secondary \n\n\n\neducation (62.9%), rural residents (57.1%) and reported good \n\n\n\nmedication adherence (61.6%). The mean awareness score \n\n\n\nwas 49.6 out of 60 [2].  Patients were less aware of drug-drug \n\n\n\ninteraction (3.85 \u00b1 1.15) and proper medication storage (3.98 \n\n\n\n\u00b1 1.06). Elderly patients (\u03b2=-2.82, P < 0.001) obtained lower \n\n\n\nawareness scores.  Patients with tertiary education (\u03b2=3.87, \n\n\n\nP=0.001), rural residents (\u03b2=3.65, P<0.001) and with good \n\n\n\nmedication adherence (\u03b2=2.55, P=0.002) had higher \n\n\n\nawareness scores. The mean expectation score was 44.0 out \n\n\n\nof 50. The patient had a higher expectation of encountering a \n\n\n\npolite ward pharmacist (4.51 \u00b1 0.56). Patients with tertiary \n\n\n\neducation (\u03b2=1.86, P=0.024), rural residents (\u03b2=1.79, \n\n\n\nP=0.001) and with good medication adherence (\u03b2=1.48, \n\n\n\nP=0.006) demonstrated higher expectation. The mean \n\n\n\nsatisfaction score was 43.6 out of 50. The patients had high \n\n\n\nsatisfaction in the language used (4.45 \u00b1 0.57) and level of \n\n\n\nknowledge demonstrated (4.41 \u00b1 0.62) by the ward \n\n\n\npharmacists. Patients with tertiary education (\u03b2=2.16, \n\n\n\nP=0.009), rural residents (\u03b2=1.82, P=0.001) and with good \n\n\n\nadherence (\u03b2=1.44, P=0.009) towards medication \n\n\n\ndemonstrated higher satisfaction, while elderly patients (\u03b2=-\n\n\n\n1.17, P=0.031) had lower satisfaction towards ward \n\n\n\npharmacy services. Conclusion: Patients demonstrated good \n\n\n\nawareness, expectation, and satisfaction towards ward \n\n\n\npharmacy services in Perak state public hospitals. \n\n\n\n \nReference \n\n\n\n \n[1] Al-Arifi MN. Patients' perception, views and satisfaction with pharmacists' role as health \n\n\n\ncare provider in community pharmacy setting at Riyadh, Saudi Arabia. Saudi Pharm J. \n\n\n\n2012 oct;20(4):323- \n\n\n\n[2] Al\u2010Rashed, S.A., Wright, D.J., Roebuck, N., Sunter, W. and Chrystyn, .H. The value of \n\n\n\ninpatient pharmaceutical counselling to elderly patients prior to discharge. British Journal \n\n\n\nof Clinical Pharmacology, 2002: 54: 657-664 \n\n\n\n[3] Ayalew, M., Taye, K., Asfaw, D., Lemma, B., Dadi, F., Solomon, H., Tazeze, H., & Tsega, \n\n\n\nB. (2017). Patients\u2019/clients\u2019 expectation toward and satisfaction from pharmacy \n\n\n\nservices. Journal of Research in Pharmacy Practice, 6(1), 21.  \n\n\n\n\n\n\n\nAbstract 018 \n\n\n\n\n\n\n\nExploring Barriers to Retention in \n\n\n\nMethadone Maintenance Therapy \n\n\n\namong Opioid Dependent Clients in \n\n\n\nKlang Health Clinics: A Qualitative \n\n\n\nStudy \n \nGeetaloshiny A/P Balasingam1, Raj Sharma \n\n\n\nA/L Chandrasekaran2 \n\n\n\n1 Klang District Health Department \n2 Kuala Selangor District Health Department \n\n\n\n\n\n\n\n*Correspondence: megeetaz@gmail.com \n\n\n\n\n\n\n\nIntroduction: Methadone maintenance therapy (MMT) was \n\n\n\ninitiated in Malaysia back in 2005 as part of the national \n\n\n\nHarm Reduction strategy. Despite proven benefits of \n\n\n\nmethadone in improving client\u2019s quality of life, issues such \n\n\n\nas non adherence and poor therapy retention rates remained \n\n\n\nas perturbing \u201cmysteries\u201d at Klang health care settings.  \n\n\n\nObjective:  This study was designed in unearthing client\u2019s \n\n\n\nperception of MMT and in identifying a confluence of multi- \n\n\n\ndimensional barriers faced by MMT clients  leading to \n\n\n\ntherapy defaults and proposed mitigation strategies. \n\n\n\nMethods: Heuristic qualitative mode using a transcendental \n\n\n\nphenomenological approach was selected. Data collection \n\n\n\n\nmailto:cc.sheajiun@gmail.com\n\n\nmailto:megeetaz@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 7, Issue 1, Supplementary (2021), 49-78 \n\n\n\n61 \n\n\n\n\n\n\n\nResearch Presentation of National Pharmacy Convention 2021 \n\n\n\nDOI:  10.52494/UCML9733 \n \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nthrough audio taped, face to face in depth interviews (IDIs) \n\n\n\nin adherence to the COREQ-32 item checklist was carried out \n\n\n\nbetween November 2019 to January 2020 at three primary \n\n\n\nhealth care clinics (Pandamaran, Bandar Botanik, Bukit \n\n\n\nKuda) with existing MMT services. Informational saturation \n\n\n\nof salient themes was achieved through 24 participants (10 \n\n\n\nclients & 14 health care professionals) during the six stages \n\n\n\nof thematic analysis. Results & Discussion: 3 major themes \n\n\n\nand  25 subthemes significantly emerged as study findings. \n\n\n\nInitial theme on T1 : Perception towards methadone \n\n\n\nmaintenance therapy (MMT) displayed constructive benefits \n\n\n\nin the context of client\u2019s health status, enhanced social \n\n\n\nfunctioning within a benevolent health care institution. \n\n\n\nSecond theme vis-\u00e0-vis T2 : Drivers to therapy non-\n\n\n\nadherence were most commonly quoted from  the client\u2019s \n\n\n\ndomain in adherence to the theory of planned behaviour \n\n\n\n(TPB). Intrapersonal devoid of client's insights on the \n\n\n\nsignificance of methadone, worsened by the nature of \n\n\n\naddiction (lepas rindu and sulam menyulam) lead to one\u2019s \n\n\n\ndiminished self efficacy. Gaps due to volatile employment \n\n\n\nstatus, aggravated  by dysfunctional dynamics in their social \n\n\n\nsupport systems and exposure to unshielded  public \n\n\n\nopprobrium were equally reiterated. Additionally, patients \n\n\n\nsubjected to poorly regimented methadone doses with risks \n\n\n\nof co-infection morbidities faced superior strains in therapy \n\n\n\ncontinuation. Porous provider-client engagements with \n\n\n\nlimitations to MMT service flexibility, internal staff \n\n\n\nstigmatisation and interference from  private methadone \n\n\n\nsectors (new emergent subtheme) were justified. Robust \n\n\n\ntarget-oriented T3: Mitigation Strategies to Improve \n\n\n\nMethadone Therapy Outcomes were suggested in \n\n\n\ncompliance with the social ecological model of nested \n\n\n\nintervention planning. Conclusion: Implementation of client \n\n\n\ncentred correctional mechanisms are imperative in \n\n\n\naddressing the shift in drugs addiction paradigm from \n\n\n\ntraditional heroin agents to a myriad of stimulant types and \n\n\n\nnew psychoactive substances, whilst sustaining the noble role \n\n\n\nof methadone in the community.    \n\n\n\n \nReference \n\n\n\n \n[1] Aishwarya Vijay, Alexander R. Bazazi, M.Phil., Ilias Yee, M.B, Adeeba Kamarulzaman, \n\n\n\nFrederick L. Altice. (2015). Treatment Readiness, Attitudes Toward, and Experiences \n\n\n\nwith Methadone and Buprenorphine Maintenance Therapy Among People Who Inject \n\n\n\nDrugs in Malaysia. Journal of Substance Abuse Treatment, 54:29\u201336. \n\n\n\nhttp://dx.doi.org/10.1016/j.jsat.2015.01.014 \n\n\n\n[2] Fauziah I, Kumar N. Factors Effecting Drug Relapse in Malaysia: An Empirical Evidence. \n\n\n\nAsian Soc Sci., 5(17):37-42. \n\n\n\n[3] Heino St\u00f6ver. (2011). Barriers to Opioid Substitution Treatment Access, Entry and \n\n\n\nRetention: A Survey of Opioid Users, Patients in Treatment, and Treating and Non-\n\n\n\nTreating Physicians. Eur Addict Res., 17:44\u201354. doi: 10.1159/000320576 \n\n\n\n\n\n\n\nAbstract 019 \n\n\n\n\n\n\n\nExploring Local Challenges and \n\n\n\nSolution for Progress in Medication \n\n\n\nSupply through Ubat Melalui Pos \n\n\n\nServices during Nationwide \n\n\n\nMovement Control Order  \n \n\n\n\nMohd Dziehan bin Mustapa, Geetaloshiny A/P \n\n\n\nBalasingam, Ahmad Tirmidzi bin Harun, Nur      \n\n\n\nNadhrah bt Mohd Sabri, Prasannah A/P \n\n\n\nGovindan, Muhammad Fikri bin Mohd Fadli, \n\n\n\nNur Fatin Sharmila binti Zulkipli \n\n\n\n \nPharmacy Unit, Klang District Health Department \n\n\n\n\n\n\n\n*Correspondence: megeetaz@gmail.com \n\n\n\n\n\n\n\nIntroduction:  Ubat Melalui Pos (UMP) is one of the value-\n\n\n\nadded services (VAS) majorly used during nationwide MCO \n\n\n\nto reduce patient\u2019s physical engagement at the local health \n\n\n\ncare  facilities. Objective: This study is aimed at identifying \n\n\n\nlocal challenges and solutions for progress in medication \n\n\n\nsupply through UMP services during nationwide MCO in  \n\n\n\npopulation dense Klang city. Methods: Retrospective cross-\n\n\n\nsectional study covering the health clinics in Klang district \n\n\n\nwas conducted from 18th March 2020 to 12th May 2020. \n\n\n\nParticipants were conveniently sampled based on their online \n\n\n\nrequests for UMP services through customised Google sheet \n\n\n\nfilling. A total of 403 participants were recruited. Inclusive \n\n\n\ncriteria for UMP were stable patients having at least one \n\n\n\ntablet medication on their valid prescriptions. Patients on \n\n\n\ninsulin, inhalers and less postage friendly medications were \n\n\n\nexcluded from the study. Results & Discussion: \n\n\n\nDemographically from the active pool of 403 UMP requests \n\n\n\nreceived, (n=265, 65.8%) of them were from female patients. \n\n\n\nCommon challenges were mainly technical strains with \n\n\n\n(n=41, 10.17%) due to incomplete prescription attachment, \n\n\n\n(n=38, 9.43%) with expired prescription and (n=33, 8.19%) \n\n\n\nUMP requests for less postage friendly medication. \n\n\n\nGeographically, most UMP requests were from urbanised \n\n\n\nclinics in comparison to suburban counterparts. Ground \n\n\n\nbreaking analysis discovered that most applications of \n\n\n\nclient\u2019s UMP were performed by their inner social circle, in \n\n\n\ncomparison to (n=33, 8.19%) UMP requests successfully \n\n\n\ndelivered by the patients themselves. Robust approaches are \n\n\n\nrequired in improving primary care UMP services within our \n\n\n\nKlang vicinity. Acts in strengthening client\u2019s awareness with \n\n\n\nregards to UMP, in addition to inculcating positive familial \n\n\n\nsupport in medication seeking behaviours of vulnerable \n\n\n\ngeriatrics are necessary. Concerted health care \n\n\n\nteleconsultation for stabilised UMP clients, followed by \n\n\n\nvigorous health promotion campaigns through dignified \n\n\n\n\nmailto:megeetaz@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 7, Issue 1, Supplementary (2021), 49-78 \n\n\n\n62 \n\n\n\n\n\n\n\nResearch Presentation of National Pharmacy Convention 2021 \n\n\n\nDOI:  10.52494/UCML9733 \n \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nsocial representatives (DUTA Kenali Ubat Anda) are \n\n\n\nencouraged. Additionally, introduction to subsidised UMP, \n\n\n\ninnovative Pharmacy Value Added Services (VAS) and \n\n\n\ntraining of trainers (TOT) are pivotal health promotion \n\n\n\nefforts in sustaining medication accessibility and availability \n\n\n\nat times of unprecedented crisis. Conclusion: UMP services \n\n\n\nare indeed beneficial in the context of prompt, efficient and \n\n\n\ncost effective mechanisms of medication supply. A handful \n\n\n\nof local challenges centred towards client\u2019s knowledge, \n\n\n\nattitude and practice to UMP requests are modifiable through \n\n\n\ntimely public health education towards the community.  \n \nReference \n\n\n\n \n[1] Benjamin C. LOH et al. (2017). Impact of value added services on patient waiting time at \n\n\n\nthe ambulatory pharmacy Queen Elizabeth Hospital. MyMedR, \n\n\n\n[2] Thompson, A. E., Anisimowicz, Y., Miedema, B., Hogg, W., Wodchis, W. P., & Aubrey-\n\n\n\nBassler, K. (2016). The influence of gender and other patient characteristics on health \n\n\n\ncare-seeking behaviour: a QUALICOPC study. BMC Family Practice  \n\n\n\n[3] Jae, E. C., Park, N., Wang, H., Fulk, J., & McLaughlin, M. (2010). Age differences in \n\n\n\nperceptions of online community participation among non-users: An extension of the \n\n\n\nTechnology Acceptance Model. Computers in Human Behavior, 1674-1684 \n\n\n\n\n\n\n\nAbstract 021 \n\n\n\n\n\n\n\nPre and Post Medical Deployment \n\n\n\nExperiences of Military Healthcare \n\n\n\nProfessionals \n \nMaj Mohammad Firdaus Yaacob1,2*, \n\n\n\nMohamed Azmi Ahmad Hassali1, Brig Gen A \n\n\n\nHalim Haji Basari2 \n\n\n\n \n1 School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 \n\n\n\nPenang, Malaysia \n2 Health Services Division, Malaysian Armed Forces Headquarters, Ministry \n\n\n\nof Defence, Jalan Tekpi, Off Jalan Padang Tembak, 50634 Kuala Lumpur, \n\n\n\nMalaysia. \n\n\n\n\n\n\n\n*Correspondence: firdausyaacob85@gmail.com \n\n\n\n\n\n\n\nIntroduction: Military field hospitals provide crucial \n\n\n\nmedical service for injured soldiers on the battlefield. \n\n\n\nAlthough war no longer becomes the primary displacement \n\n\n\nof the human population, natural and man-made disasters \n\n\n\ntake place. Inherited from the battlefield, military field \n\n\n\nhospitals currently continue to serve the disaster\u2019s victims \n\n\n\nand refugees. The healthcare professionals served in military \n\n\n\nfield hospitals face numerous challenges during field \n\n\n\noperation especially for the first timers. By sharing their \n\n\n\nprevious experiences perhaps, it will help military and other \n\n\n\norganizations for conducting medical deployment. \n\n\n\nObjective: This study is conducted to determine the pre and \n\n\n\npost medical deployment experiences of military healthcare \n\n\n\nprofessionals. Method: Semi-structured interviews were \n\n\n\nconducted with healthcare professionals who served in \n\n\n\nvarious field hospital deployments. Purposive and snowball \n\n\n\nsampling were employed to ensure a diverse group of \n\n\n\ninformants. The interviews are audio-recorded, transcribed \n\n\n\nverbatim, and data analyzed using thematic analysis. Data \n\n\n\ncollection, coding, and interpretation were carried out until \n\n\n\nthe saturation point was reached. Result and Discussion: \n\n\n\nTwenty-one respondents from different demographic \n\n\n\ncharacteristics were recruited. Seven major themes were \n\n\n\nidentified. Four themes emerged for pre deployment \n\n\n\nexperiences such as operation preparation, personal \n\n\n\npreparation (mental and family readiness), preventive \n\n\n\nmedicine (vaccination and medical check-up), and logistic \n\n\n\npreparation. Meanwhile, three themes emerged for post \n\n\n\nmedical deployment experiences such as operation \n\n\n\nwithdrawal, preventive medicine (mental and physical \n\n\n\ncheck-up), and logistic withdrawal. During the medical \n\n\n\ndeployment, challenges include harsh environment, extreme \n\n\n\nweather, different cultural and tasteless food which require \n\n\n\ntheir sacrifices, mental strength and physical endurance in \n\n\n\norder to accomplish the mission. Conclusion: Based on \n\n\n\nhealthcare professionals\u2019 experience, four things needed to \n\n\n\nbe done before a mission, namely preventive medicine, \n\n\n\noperation, personal and logistic preparations. Meanwhile, \n\n\n\nthree things needed to be done after a mission, namely \n\n\n\npreventive medicine, operation and logistic withdrawal. By \n\n\n\nunderstanding the experience before and after a mission, \n\n\n\norganisations may prepare more efficiently and improve the \n\n\n\nmedical service in the future deployment. \n\n\n\n \nReference \n\n\n\n \n[1] Thomas, A., 2013. Protecting People Displaced by Weather-related Disasters and Climate \n\n\n\nChange: Experience from the Field, Vermont Journal of Environmental Law, 15, 803-832. \n\n\n\n[2] Sharp, T., Yip, R., & Malone, J., 1994. US Military Forces and Emergency International \n\n\n\nHumanitarian Assistance. JAMA. 272(5), 386. \n\n\n\n[3] Smith, S. & Smith, K., 1995. Perioperative Perspective of a United Nations Humanitarian \n\n\n\nMission. AORN Journal. 62(6), 875-883 \n\n\n\n\n\n\n\nAbstract 022 \n\n\n\n\n\n\n\nFactors Associated with Non-\n\n\n\nadherence to Medication among Type \n\n\n\nII Diabetes Mellitus Patients in A \n\n\n\nTertiary Hospital in Kelantan, \n\n\n\nMalaysia \n \n\n\n\nNazmi Liana Azmi*, Nurul Aida Md Rosly, \n\n\n\nTang Hock Chun, Anis Fariha Che Darof, Nor \n\n\n\nDini Zuki \n\n\n\n \nPharmacy Department, Raja Perempuan Zainab II, 15586 Kota Bharu, \n\n\n\nKelantan, Malaysia. \n\n\n\n\n\n\n\n*Correspondence: nazmiliana@moh.gov.my \n\n\n\n\n\n\n\nIntroduction: It is estimated that around the globe, 40% to \n\n\n\n50% of type II diabetes mellitus (T2DM) patients are not \n\n\n\nadherent to their medications. This is alarming as non-\n\n\n\n\nmailto:firdausyaacob85@gmail.com\n\n\nmailto:nazmiliana@moh.gov.my\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 7, Issue 1, Supplementary (2021), 49-78 \n\n\n\n63 \n\n\n\n\n\n\n\nResearch Presentation of National Pharmacy Convention 2021 \n\n\n\nDOI:  10.52494/UCML9733 \n \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nadherence can lead to worsening of health outcomes as well \n\n\n\nas unnecessary cost burden to the healthcare system. \n\n\n\nObjectives: The aim of the study is to determine the \n\n\n\nprevalence of non-adherence to medication and its associated \n\n\n\nfactors among T2DM patients treated in Raja Perempuan \n\n\n\nZainab II Hospital (HRPZ II), Kelantan. Method:  A cross-\n\n\n\nsectional survey was carried out among T2DM patients using \n\n\n\nconvenience sampling at the outpatient pharmacy from \n\n\n\nNovember 2018 to March 2019. A minimum sample size of \n\n\n\n189 subjects was estimated using a single mean formula. \n\n\n\nMedication Compliance Questionnaire (MCQ), a self-\n\n\n\nadministered validated instrument consisting of seven items, \n\n\n\nwas given to eligible patients to assess the level of medication \n\n\n\nadherence. Those with a score of less than 27 out of 28 were \n\n\n\nconsidered non-adherent. All data were gathered and \n\n\n\nanalyzed using IBM SPSS Statistics for Windows version \n\n\n\n25.0. Results and Discussion: A total of 200 patients were \n\n\n\nrecruited and they were mostly between the age of 40 to 60 \n\n\n\nyears old. The mean (SD) score for MCQ was 26.0 (1.6) with \n\n\n\nmore than halfare non-adherent (55.0%, n=110). It was noted \n\n\n\nthat the common reason for non-adherence was forgetfulness \n\n\n\nwith mean (SD) score of 3.35 (0.69). In the multiple logistic \n\n\n\nregression model, non-adherence was found to be associated \n\n\n\nwith marital status [AOR 4.50; 95% CI: 1.95-10.41, p < \n\n\n\n0.001], financial income [AOR 0.37; 95% CI: 0.19-0.73, \n\n\n\np=0.004] and types of diabetes medications [AOR 0.23; 95% \n\n\n\nCI: 0.12-0.44, p < 0.001) which were consistent with \n\n\n\nprevious findings. Conclusion: The prevalence of non-\n\n\n\nadherence to medication among T2DM patients was high in \n\n\n\nHRPZ II. It was observed that patients who were married, had \n\n\n\na low salary and were prescribed with insulin were more \n\n\n\nlikely to become non-adherent. Future intervention targeting \n\n\n\nthese subgroups should be designed within the facility to \n\n\n\nimprove adherence. \n\n\n\n \nReference \n\n\n\n \n[1] Kleinsinger F. (2018). The unmet challenge of medication nonadherence. The Permanente \n\n\n\njournal, 22, 18-033. doi:10.7812/TPP/18-033. \n\n\n\n[2] Kassahun, A., Gashe, F., Mulisa, E., & Rike, W. A. (2016). Nonadherence and factors \n\n\n\naffecting adherence of diabetic patients to anti-diabetic medication in Assela General \n\n\n\nHospital, Oromia Region, Ethiopia. Journal of pharmacy & bioallied sciences, 8(2), 124\u2013\n\n\n\n129. doi:10.4103/0975-7406.171696. \n\n\n\n[3] Ahmad, N. S., Ramli, A., Islahudin, F., & Paraidathathu, T. (2013). Medication adherence \n\n\n\nin patients with type 2 diabetes mellitus treated at primary health clinics in \n\n\n\nMalaysia. Patient preference and adherence, 7, 525\u2013530. doi:10.2147/PPA.S44698. \n\n\n\n\n\n\n\nAbstract 025 \n\n\n\n\n\n\n\nDiabetes-Related Quality of Life and \n\n\n\nits Determinants: A Single Centre \n\n\n\nAnalysis \n \nNazmi Liana Azmi*, Nurul Aida Md Rosly, \n\n\n\nTang Hock Chun, Anis Fariha Che Darof, Nor \n\n\n\nDini Zuki \n\n\n\n \nPharmacy Department, Raja Perempuan Zainab II, 15586 Kota Bharu, \n\n\n\nKelantan, Malaysia \n\n\n\n\n\n\n\n*Correspondence: nazmiliana@moh.gov.my \n\n\n\n\n\n\n\nIntroduction: Type 2 diabetes mellitus (T2DM) is a \n\n\n\ndevastating chronic disease which if uncontrolled, often leads \n\n\n\nto other serious health conditions. The debilitating \n\n\n\nconsequences such as retinopathy and nephropathy can \n\n\n\nsignificantly impact their quality of life (QoL). Objective: \n\n\n\nThe study was conducted to measure diabetes-related QoL \n\n\n\nand identify its determinants among T2DM patients \n\n\n\nattending Raja Perempuan Zainab II Hospital (HRPZ II), \n\n\n\nKelantan. Method:  In this cross-sectional study, a total of \n\n\n\n200 adult T2DM patients were recruited through \n\n\n\nconvenience sampling at the outpatient pharmacy from \n\n\n\nNovember 2018 to March 2019. Then, the revised version of \n\n\n\nDiabetes Quality of Life (DQOL) instrument containing 13 \n\n\n\nitems in Malay language was self-administered by eligible \n\n\n\nrespondents. A higher average score indicated a poorer QoL \n\n\n\nwith the possible range of score was between 13 to 65. \n\n\n\nStatistical Package for the Social Sciences (SPSS) software \n\n\n\nversion 25.0 for Windows was used to perform multiple \n\n\n\nlinear regression. Result and Discussion: The majority of \n\n\n\nT2DM patients were between the age of 40 to 60 years old. \n\n\n\nThe mean (SD) score for the overall revised DQOL was 25.5 \n\n\n\n(8.9) while each domain of \u201csatisfaction\u201d, \u201cimpact\u201d and \n\n\n\n\u201cworry\u201d had mean (SD) scores of 12.0 (5.0), 7.7 (3.4) and 5.9 \n\n\n\n(2.7), respectively. Stepwise regression model which \n\n\n\naccounted for 40% of the variability in QoL, showed that a \n\n\n\nhigher DQOL score was found to be associated with older \n\n\n\nage [\u03b2: -4.93 (95% CI: -7.18, -2.67), p<0.001], female gender \n\n\n\n[\u03b2: 4.69 (95% CI: 2.62, 6.77), p<0.001], married status [\u03b2: -\n\n\n\n8.34 (95% CI: -10.78, -5.89), p<0.001] and shorter disease \n\n\n\nduration [\u03b2:  -4.85 (95% CI: -7.03, -2.67), p<0.001). All four \n\n\n\nvariables were commonly reported to influence QoL in \n\n\n\nprevious literature. Interestingly, the current study observed \n\n\n\na contradiction to the previous finding whereby older patients \n\n\n\nin the current study had better QoL. Conclusion: The T2DM \n\n\n\npatients in HRPZ II showed satisfactory diabetes-related \n\n\n\nQoL. It seemed that the disease did affect their QoL but not \n\n\n\nto a great extent. More attention should be paid to male, \n\n\n\nsingle patients of working age and diagnosed with T2DM for \n\n\n\nover 10 years who are more likely to have poorer QoL score. \n\n\n\n \n\n\n\n\nhttps://doi.org/10.4103/0975-7406.171696\n\n\nmailto:nazmiliana@moh.gov.my\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 7, Issue 1, Supplementary (2021), 49-78 \n\n\n\n64 \n\n\n\n\n\n\n\nResearch Presentation of National Pharmacy Convention 2021 \n\n\n\nDOI:  10.52494/UCML9733 \n \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n \nReference \n \n\n\n\n[1] Trikkalinou, A., Papazafiropoulou, A. K., & Melidonis, A. (2017). Type 2 diabetes and \n\n\n\nquality of life. World journal of diabetes, 8(4), 120\u2013129. doi:10.4239/wjd.v8.i4.120 \n\n\n\n[2] Bujang, M. A., Adnan, T. H., Mohd Hatta, N., Ismail, M., & Lim, C. J. (2018). A revised \n\n\n\nversion of Diabetes Quality of Life instrument maintaining domains for satisfaction, \n\n\n\nimpact, and worry. Journal of diabetes research, 2018, 5804687. \n\n\n\ndoi:10.1155/2018/5804687 \n\n\n\n[3] Abedini, M .R., Bijari, B., Miri, Z., Emampour F. S., & Abbasi A. (2020). The quality of \n\n\n\nlife of the patients with diabetes type 2 using EQ-5D-5\u2009L in Birjand. Health Qual Life \n\n\n\nOutcomes,18, 18. Doi:10.1186/s12955-020-1277-8 \n\n\n\n\n\n\n\nAbstract 028 \n\n\n\n\n\n\n\nCarers\u2019 Perspectives on Home \n\n\n\nMedication Review conducted by \n\n\n\nMedical Outreach Team of a Hospital \n\n\n\nin Malaysia \n \nWei Chern Ang1,2, Jurisma Che Lah1, \n\n\n\nNursyafiqah Zulkepli1, Nursyamimi Sukri1, \n\n\n\nAmalina Rosedi1 \n\n\n\n \n1 Department of Pharmacy, Hospital Tuanku Fauziah, Perlis, Ministry of \n\n\n\nHealth Malaysia, 01000 Kangar, Perlis,. Malaysia. \n2 Clinical Research Centre, Hospital Tuanku Fauziah, Perlis, Ministry of \n\n\n\nHealth Malaysia, 01000 Kangar, Perlis, Malaysia. \n\n\n\n\n\n\n\n*Correspondence: wei.ang.1990@gmail.com \n\n\n\n\n\n\n\nIntroduction: Home Medication Review (HMR) is a \n\n\n\ncontinuation of patient care from health facilities to their \n\n\n\nhome to assess patients\u2019 pharmacotherapy by a \n\n\n\nmultidisciplinary team. Bedridden patients are the leading \n\n\n\ngroup receiving this service. To improve the provision of \n\n\n\nHMR, we need to understand carers\u2019 viewpoints of the \n\n\n\ncurrent service. Objective: To explore the carers\u2019 \n\n\n\nperspectives of HMR conducted by the medical outreach \n\n\n\nteam (MOT) of a Malaysian hospital. Method: A qualitative \n\n\n\nstudy was conducted among carers involved in the HMR \n\n\n\nprogramme for more than six months. Four themes \n\n\n\nidentified: understanding of the services, perceived benefits, \n\n\n\ndifficulties faced and suggestions for improvement. Carers \n\n\n\nare chosen as respondents as patients have impaired cognitive \n\n\n\nfunction or cannot communicate/cooperate in the interview. \n\n\n\nSubjects were recruited by purposive sampling from August \n\n\n\n2019 to December 2019. In-depth interviews were conducted \n\n\n\nat patients\u2019 homes, until data saturation. The audio recordings \n\n\n\nwere transcribed verbatim and afterwards subjected to \n\n\n\nthematic analysis. Results and Discussion: Nine carers were \n\n\n\ninterviewed. All respondents had  limited understanding of \n\n\n\nHMR although they claimed to be adequately counselled \n\n\n\nprior to admission into the programme. Carers\u2019 good \n\n\n\nunderstanding of the programme may improve patients\u2019 \n\n\n\npreparedness and lead them to be actively engaged in \n\n\n\ndecision making during the home care visits. The \n\n\n\nconvenience of not having to go to the hospital was perceived \n\n\n\nas the primary benefit. Healthcare providers were welcomed \n\n\n\nduring each visit. Recognising the presence of a pharmacist \n\n\n\nin the MOT was not a problem. There was a concern about \n\n\n\nrequiring them to refill medications from the hospital. Some \n\n\n\nparticipants suggested increasing the frequency of visits and \n\n\n\nhoped for more financial aids.   Conclusion: In this study, \n\n\n\ncarers\u2019 comprehension of HMR was generally poor although \n\n\n\nthey were satisfied with our HMR programme. Furthermore, \n\n\n\nseveral aspects of our HMR need to be strengthened to \n\n\n\nimprove patients\u2019 wellbeing. Despite HMR being \n\n\n\ntemporarily replaced by telemedicine during the current \n\n\n\npandemic, HMR remains relevant in the post-COVID-19 \n\n\n\nera.  \n\n\n\n \nReferences \n\n\n\n \n[1] Pharmacy Practice & Development Division MOH Malaysia (2019). Home Care Pharmacy \n\n\n\nServices Protocol, 2 \n\n\n\n[2] Chen TF et al. (2016). Drugs Aging. 33(3): 199-204. \n\n\n\n[3] Ahn J et al. (2015). Aust Fam Physician. 44:249-53. \n\n\n\n\n\n\n\nAbstract 029 \n\n\n\n\n\n\n\nInvestigation of the Moisturizing \n\n\n\nEffect of Cocoa Butter on Skin Cream \n \nTang Jia Wen*, Ashok Kumar Janakiraman, \n\n\n\nShiek Abdul Kadhar Mohamed Ebrahim \n\n\n\nHabibur Rahman \n \n\n\n\nFaculty of Pharmaceutical Sciences, UCSI University \n\n\n\n\n\n\n\n*Correspondence: 2014jiawen@gmail.com \n\n\n\n\n\n\n\nIntroduction: Cocoa butter (CB) is a natural product that has \n\n\n\nbeen incorporated as a moisturizer in various topical creams \n\n\n\nover the years. However, CB is not the main ingredient \n\n\n\ndespite numerous studies claimed about its moisturizing \n\n\n\ncapacity. [1] [2].  The chemical compositions of CB could \n\n\n\ncontribute to its potentiality as an occlusive agent that helps \n\n\n\nto maintain skin hydration [3].  Objective: The main \n\n\n\nobjective of this research was to investigate the effect of CB \n\n\n\nas the primary ingredient of skin moisturizing cream. \n\n\n\nMethod: The oil-in-water emulsions were prepared by \n\n\n\nadding an aqueous phase to the oil phase in several pre-\n\n\n\ndetermined proportions before subjecting to high-speed \n\n\n\nhomogenization. A total of 15 prototype formulations were \n\n\n\nprepared. The oil phase consisted of CB, beeswax and PEG \n\n\n\n200, whereas the aqueous phase included Poloxamer 188 and \n\n\n\ndistilled water. Other ingredients (Poloxamer 407, Cinnamon \n\n\n\nOil, Almond Oil and Vanillin) were added to enhance the \n\n\n\nproduct attributes. The developed cream formulations were \n\n\n\ncharacterized by pH, spreadability, in-vitro occlusivity, sun \n\n\n\nprotection factor (SPF), antioxidant activity using hydrogen \n\n\n\nperoxide method and antimicrobial activity by disc diffusion \n\n\n\nmethod. Result and Discussion: The physicochemical \n\n\n\nparameters of formulations S1-S14, i.e. pH, occlusion factor \n\n\n\nand spreadability were found to be in the range of 5-5.5, \n\n\n\n\nhttps://doi.org/10.4239/wjd.v8.i4.120\n\n\nhttps://doi.org/10.1155/2018/5804687\n\n\nmailto:wei.ang.1990@gmail.com\n\n\nmailto:2014jiawen@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 7, Issue 1, Supplementary (2021), 49-78 \n\n\n\n65 \n\n\n\n\n\n\n\nResearch Presentation of National Pharmacy Convention 2021 \n\n\n\nDOI:  10.52494/UCML9733 \n \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\n54.10-24.20, 0.850-2.917 cm respectively. The formulation, \n\n\n\nS14 showed the lowest occlusion factor (F=24.20), high \n\n\n\nspreadability (1.533 cm) and improved sun protection factor \n\n\n\n(SPF) of 25.4 and was found to be more effective compared \n\n\n\nwith the other prototype formulations. There was also a \n\n\n\ngeneral trend of increase in antioxidant activity when the \n\n\n\nconcentration of the sample increased. Besides, the S14 \n\n\n\nformulation showed greater inhibition against the S. aureus \n\n\n\nthan E. coli. The formulation, S14 was stable at the \n\n\n\naccelerated conditions (40 \u00b1 5\u00b0C, 75 \u00b1 5%) regarding color, \n\n\n\nliquefaction, pH and phase separation for three months. \n\n\n\nConclusion: To conclude, CB has the potential to be used as \n\n\n\nthe main ingredient of skin moisturizing cream due to its \n\n\n\noptimum pH, spreadability, occlusivity, SPF, antioxidant \n\n\n\nactivity and antimicrobial activity. However, clinical studies \n\n\n\nwere required to evaluate its further benefits in maintaining \n\n\n\nskin hydration in vivo. \n\n\n\n \nReference \n \n[1] Long-Term Ingestion of High Flavanol Cocoa Provides Photoprotection against UV-\n\n\n\nInduced Erythema and Improves Skin Condition in Women | The Journal of Nutrition | \n\n\n\nOxford Academic [Internet]. [cited 2020 Oct 14]. Available from: \n\n\n\nhttps://academic.oup.com/jn/article/136/6/1565/4664397 \n\n\n\n[2] A Real-World, Non-interventional Indian Study Evaluating Intensive Plant-Based Butter \n\n\n\nMoisturizing Cream in Psoriasis [Internet]. [cited 2020 Oct 14]. Available from: \n\n\n\nhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6704203/ \n\n\n\n[3] Cocoa butter and its alternatives: A review [Internet]. [cited 2020 Oct 14]. Available \n\n\n\nfrom: \n\n\n\nhttps://www.researchgate.net/publication/308523494_Cocoa_butter_and_its_alternatives\n\n\n\n_A_review \n\n\n\n\n\n\n\nAbstract 030 \n\n\n\n\n\n\n\nDevelopment of In vitro Dissolution \n\n\n\nMethod for Nateglinide Formulations \n \nKoh Siew Hua*, Ashok Kumar Janakiraman, \n\n\n\nShiek Abdul Kadhar Mohamed Ebrahim \n\n\n\nHabibur Rahman \n\n\n\n \nFaculty of Pharmaceutical Sciences, UCSI University, 56000 Cheras, \n\n\n\nKuala Lumpur, Malaysia \n\n\n\n\n\n\n\n*Correspondence: elisekoh.ksh78@gmail.com \n\n\n\n\n\n\n\nIntroduction: Nateglinide (NTG) is a derivative of D-\n\n\n\nphenylalanine, an agent that stimulates insulin secretion in \n\n\n\npancreatic \u03b2 cells. NTG is under BCS Class II drug, which is \n\n\n\ncharacterized by low solubility and high permeability. Thus, \n\n\n\nthe dissolution of NTG is a rate-determining step for \n\n\n\nbioavailability. For this reason, to correlate the in vivo \n\n\n\nperformance of NTG, the development of in vitro dissolution \n\n\n\nmethod is important. Objective: The objective was to \n\n\n\ndevelop an in vitro dissolution method for NTG formulations \n\n\n\nto correlate the in vitro-in vivo performance of NTG. \n\n\n\nMethod: Two formulations (tablets and capsules) were \n\n\n\nprepared and evaluated for their physical properties. The \n\n\n\ndissolution mediums were developed based on the solubility \n\n\n\nof NTG in different six dissolution mediums. The dissolution \n\n\n\nstudy for NTG tablets and capsules was investigated by using \n\n\n\nUSP Apparatus 2 (paddle) and USP Apparatus 1 (basket), \n\n\n\nrespectively. Each aliquot at predetermined intervals was \n\n\n\nfiltered through 0.45 \u00b5m syringe filter and measured using \n\n\n\nUV spectrophotometer. For each formulation sample, drug \n\n\n\nconcentrations were determined from the standard calibration \n\n\n\ncurve. Result and Discussion: The solubility of pure NTG \n\n\n\nin six different dissolution mediums were as follows: water \n\n\n\n(0.0748 mg/mL), 0.5% w/v SLS in water (1.1695 mg/mL), \n\n\n\n1% w/v SLS in water (1.0697 mg/mL), buffer pH 7.4 (1.8840 \n\n\n\nmg/mL), 0.5% w/v SLS in buffer pH 7.4 (2.5150 mg/mL), \n\n\n\nand 1% w/v SLS in buffer pH 7.4 (2.8259 mg/mL). The \n\n\n\nprepared NTG tablets showed the highest percentage of drug \n\n\n\ndissolved in 1% w/v SLS in buffer pH 7.4 (104.97%) whereas \n\n\n\nNTG capsules showed the highest percentage of drug \n\n\n\ndissolved in 0.5% w/v SLS in buffer pH 7.4 (105.46%). \n\n\n\nConclusion: Hence, 1% w/v SLS in buffer pH 7.4 and 0.5% \n\n\n\nw/v SLS in buffer pH 7.4 are suitable dissolution media for \n\n\n\nNTG tablets and capsules respectively. The in vitro drug \n\n\n\nrelease kinetic properties of NTG formulations can be used \n\n\n\nto provide the desired in vitro-in vivo correlation information.   \n\n\n\n \nReference \n\n\n\n \n[1] Tentolouris N, Voulgari C, Katsilambros N. A review of nateglinide in the management \n\n\n\nof patients with type 2 diabetes. Vascular Health and Risk Management. 2007 \n\n\n\nDec;3(6):797. \n\n\n\n[2] Papdiwal A, Sagar K, Pande V. Formulation and characterization of nateglinide \n\n\n\nnanosuspension by precipitation method. International Journal of Pharmaceutical \n\n\n\nSciences and Nanotechnology. 2014;7(4):2685-91. \n\n\n\n[3] Tsume Y, Mudie DM, Langguth P, Amidon GE, Amidon GL. The Biopharmaceutics \n\n\n\nClassification System: subclasses for in vivo predictive dissolution (IPD) methodology \n\n\n\nand IVIVC. European Journal of Pharmaceutical Sciences. 2014 Jun 16;57:152-63. \n\n\n\n\n\n\n\nAbstract 031 \n\n\n\n\n\n\n\nDrug Utilization Review in \n\n\n\nEmergency Department of Hospital \n\n\n\nTuanku Ampuan Najihah: A Major-\n\n\n\nSpecialist Hospital \n \nNurrul Salwa Saleh*, Chey Kok Yeat, Nur Ain \n\n\n\nFitria Mohd Rezazali \n\n\n\n \nDepartment of Pharmacy, Hospital Tuanku Ampuan Najihah, Kuala Pilah, \n\n\n\nNegeri Sembilan \n\n\n\n\n\n\n\n*Correspondence: htan.pric@gmail.com \n\n\n\n\n\n\n\nIntroduction: Drug utilization review (DUR) is required to \n\n\n\ninitiate discussions on rational drug use. Furthermore, \n\n\n\nsuggestions and measures to improve prescribing habits can \n\n\n\nbe performed. Unfortunately, DUR in the emergency \n\n\n\ndepartments (ED) in Malaysia is rarely performed. \n\n\n\nObjective: This study aimed to identify the pattern of drug \n\n\n\nutilization among patients discharged from the ED in a \n\n\n\ntertiary hospital in Malaysia. Method: A one year \n\n\n\nretrospective drug utilization study was conducted in the ED \n\n\n\n\nmailto:elisekoh.ksh78@gmail.com\n\n\nmailto:htan.pric@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 7, Issue 1, Supplementary (2021), 49-78 \n\n\n\n66 \n\n\n\n\n\n\n\nResearch Presentation of National Pharmacy Convention 2021 \n\n\n\nDOI:  10.52494/UCML9733 \n \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nof Hospital Tuanku Ampuan Najihah. A total of 833 patients \n\n\n\ndischarged prescriptions were reviewed to extract data on the \n\n\n\npattern of drug use excluding incomplete prescriptions and \n\n\n\npatients discharged from wards. The rationality of \n\n\n\nprescriptions was evaluated using WHO core indicators of \n\n\n\ndrug utilization. Result: The three most prescribed categories \n\n\n\nof drugs were respiratory (39%), analgesia (20%) and \n\n\n\ngastrointestinal (16%). The rationality of prescriptions was \n\n\n\naverage of 2.6% drugs per encounter, 15.7% antibiotics per \n\n\n\nencounter, essential drugs list or formulary was 100% of \n\n\n\ndrugs prescribed, and percentage of drugs prescribed by \n\n\n\ngeneric names was 66.8%. All drugs were found to be used \n\n\n\nrationally. The use of generic names was lower than the \n\n\n\nrecommended optimal level of 100%. Conclusion: The \n\n\n\nrational use of drugs in the ED, HTAN as a major specialist \n\n\n\nhospital was successful based on standard WHO prescribing \n\n\n\nindicators. However, there was a lack of generic names used \n\n\n\nduring prescribing.  \n\n\n\n \nReference \n\n\n\n \n[1] Kaur, Sharonjeet, et al. \"Drug utilization study in medical emergency unit of a tertiary \n\n\n\ncare hospital in North India.\" Emergency medicine international 2014 (2014) \n\n\n\n[2] Al-Niemat, Sahar I., et al. \"Drug use evaluation of antibiotics prescribed in a Jordanian \n\n\n\nhospital outpatient and emergency clinics using WHO prescribing indicators.\" Saudi \n\n\n\nmedical journal 29.5 (2008): 743-748 \n\n\n\n[3] Otoom S, Batieha A, Hadidi H, Hasan M, Al Saudi K. Evaluation of drug use in Jordan \n\n\n\nusing WHO prescribing indicators. \n\n\n\n[4] How to investigate drug use in health facilities: selected drug use indicators. Geneva, \n\n\n\nWorld Health Organization, 1993 (EDM Research Series No. 007). \n\n\n\n\n\n\n\nAbstract 032 \n\n\n\n\n\n\n\nCommunity Pharmacists\u2019 Perceptions \n\n\n\non Medication Review Service Model \n\n\n\nImplementation in Retail Setting in \n\n\n\nMalaysia \n \nMaali M*, Hatah E, Mohd Makmor-Bakry \n\n\n\n \nUniversity Kebangsaan Malaysia, 50300, Kuala Lumpur, Malaysia \n\n\n\n\n\n\n\n*Correspondence: p97973@siswa.ukm.edu.my \n\n\n\n\n\n\n\nIntroduction:  Pharmacists' roles have been evolving to \n\n\n\ninclude more patient-centered care services such as \n\n\n\nmedication review that help patients to get the most benefits \n\n\n\nout of the medication [1-3]. In Malaysia, although medication \n\n\n\nreview services have been established in the government \n\n\n\nhealth care settings, it is yet to be widely implemented in \n\n\n\ncommunity pharmacy setting. Since the two settings have \n\n\n\ndifferent patient population and orientation, it is important to \n\n\n\ndevelop the service model that specifically design for \n\n\n\ncommunity pharmacy. Hence, input from community \n\n\n\npharmacists and their stakeholders is important to propose a \n\n\n\nfeasible medication review service module in Malaysia. \n\n\n\nObjective: To explore the community pharmacists and their \n\n\n\nstakeholders\u2019 perceptions on the barriers, facilitators and \n\n\n\nstrategies for the implementation of a medication review \n\n\n\nservice model in Malaysia. Method: A focus group \n\n\n\ndiscussion with semi-structured interviews were conducted \n\n\n\namong purposively sampled community pharmacists. \n\n\n\nRespondents were continued to be recruited until saturation \n\n\n\nwas achieved in which no new coding or themes aroused \n\n\n\nfrom two consecutive interviews. The interview was video \n\n\n\nand audio-recorded and transcribed verbatim.  Data was \n\n\n\nanalysed using thematic analysis with ATLAS.ti version 8 \n\n\n\nsoftware and themes were classified according to the \n\n\n\nframework for implementation research on pharmacy \n\n\n\nservices [4]. Result and discussion: A total of 14 \n\n\n\npharmacists participated in this study. Among them, 9 \n\n\n\npharmacists were from independent pharmacies and the \n\n\n\nremaining from chain pharmacies. Participants reported 13 \n\n\n\nbarriers, 14 facilitators and 9 recommended strategies for \n\n\n\nmedication review service model in Malaysia. The main \n\n\n\nbarriers reported were absence of a structured service model \n\n\n\nand health care system that will support the service, lack of \n\n\n\nmonetary value and remuneration and pharmacist\u2019s poor \n\n\n\nknowledge, communication skills and lack of confidence to \n\n\n\nimplement the service. The current factors that were found to \n\n\n\nfacilitate future implementation of the service were the \n\n\n\navailability of other advanced services and medication \n\n\n\nreview that are currently being offered in some community \n\n\n\npharmacies, presence of well-trained pharmacists with \n\n\n\npassion to conduct the service. Recommended strategies \n\n\n\nincluded the need for a standardized model, fee and \n\n\n\ndocumentation system to guide pharmacists as well as the \n\n\n\nneed for accreditation and training for community \n\n\n\npharmacists. The service model suggested included engaging \n\n\n\ncustomers to the service through good communication and \n\n\n\neducation, appointment-based service, targeting customers \n\n\n\nwho benefit most and collaborating with doctors.  \n\n\n\nConclusion: The findings will help to guide the development \n\n\n\nof a medication review service model that is suitable for \n\n\n\nimplementation in the community pharmacy settings in \n\n\n\nMalaysia. \n\n\n\n \nReference \n \n\n\n\n[1] N. L. Bragazzi, M. Mansour, A. Bonsignore, and R. Ciliberti, \u201cThe Role of Hospital and \n\n\n\nCommunity Pharmacists in the Management of COVID-19: Towards an Expanded \n\n\n\nDefinition of the Roles, Responsibilities, and Duties of the Pharmacist,\u201d Pharmacy, vol. \n\n\n\n8, no. 3, p. 140, 2020. \n\n\n\n[2] T. L. Imfeld-Isenegger et al., \u201cCommunity pharmacist-led medication review procedures \n\n\n\nacross Europe: Characterization, implementation and remuneration,\u201d Res. Soc. Adm. \n\n\n\nPharm., vol. 16, no. 8, pp. 1057\u20131066, 2020. \n\n\n\n[3] E. Hatah, J. Tordoff, S. B. Duffull, and R. Braund, \u201cPharmacists\u2019 performance of clinical \n\n\n\ninterventions during adherence support medication reviews,\u201d Res. Soc. Adm. Pharm., vol. \n\n\n\n10, no. 1, pp. 185\u2013194, Jan. 2014. \n\n\n\n[4] G. M. Curran and S. J. Shoemaker, \u201cAdvancing pharmacy practice through \n\n\n\nimplementation science,\u201d Res. Soc. Adm. Pharm., vol. 13, no. 5, pp. 889\u2013891, 2017. \n\n\n\n \n\n\n\n\nmailto:p97973@siswa.ukm.edu.my\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 7, Issue 1, Supplementary (2021), 49-78 \n\n\n\n67 \n\n\n\n\n\n\n\nResearch Presentation of National Pharmacy Convention 2021 \n\n\n\nDOI:  10.52494/UCML9733 \n \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 033 \n\n\n\n\n\n\n\nEvaluation of Warfarin Related \n\n\n\nKnowledge and International \n\n\n\nNormalized Ratio (INR) Control \n\n\n\nAmong Atrial Fibrillation Patients in \n\n\n\nRural Area \n \nSiti Mariam Saha, Khadijah Shamsul Bahrain, \n\n\n\nChin Shu Juan, Dhivya P. Sandran* \n\n\n\n \nJabatan Farmasi, Hospital Tuanku Ampuan Najihah, Kuala Pilah, Negeri \n\n\n\nSembilan. \n\n\n\n\n\n\n\n*Correspondence: htan.pric@gmail.com \n\n\n\n\n\n\n\nIntroduction: INR control is important for warfarin patients \n\n\n\nto maintain the ideal anticoagulation effect of warfarin. \n\n\n\nWarfarin related knowledge affects INR control among \n\n\n\npatients where patients with higher warfarin related \n\n\n\nknowledge will have better control. Objective: This study \n\n\n\naimed to assess warfarin related knowledge and INR control \n\n\n\namong atrial fibrillation patients, and to identify the \n\n\n\nassociation between warfarin related knowledge and INR \n\n\n\ncontrol. Method: A cross-sectional survey was carried out \n\n\n\namong atrial fibrillation patients on warfarin therapy at the \n\n\n\nMedical Outpatient Department (MOPD) in Hospital Tuanku \n\n\n\nAmpuan Najihah (HTAN). A convenient sampling was used \n\n\n\nto recruit the subjects. A validated questionnaire which \n\n\n\nconsists of mainly 3 parts covering the demographic data, \n\n\n\nINR level and Oral Anticoagulation Knowledge (OAK) test. \n\n\n\nResult: A total of 133 subjects were recruited and the mean \n\n\n\nknowledge score of the subjects was 51.39 \u00b1 18.11 which \n\n\n\nindicates moderate level of warfarin related knowledge. Most \n\n\n\nof the subjects (95.5%) know the indication of warfarin. \n\n\n\nThere was a statistically significant difference for warfarin \n\n\n\nrelated knowledge between patient with different education \n\n\n\nlevel as determined by one-way ANOVA (p < 0.001). The \n\n\n\nmean time in therapeutic range (TTR) of our respondents is \n\n\n\n71.7% which indicates moderate INR control. Kruskal Wallis \n\n\n\ntest showed a significant difference in TTR (p < 0.001) and \n\n\n\npercentage of days in range (p = 0.004) with different \n\n\n\nwarfarin related knowledge levels. There was a significant \n\n\n\nrelationship between total knowledge score with TTR (r = \n\n\n\n0.268; p = 0.002) and anticoagulation knowledge and \n\n\n\npercentage of day in range (r = 0.233; p = 0.007). \n\n\n\nConclusion: Atrial fibrillation patients on warfarin therapy \n\n\n\nin HTAN were observed to have moderate warfarin related \n\n\n\nknowledge and moderate INR control. Warfarin related \n\n\n\nknowledge is significantly related to INR control.  \n\n\n\n \nReference \n\n\n\n\n\n\n\n[1] Adams, R. J. (2010). Improving health outcomes with better patient understanding and \n\n\n\neducation. Risk Management and Healthcare Policy, 3, 61\u201372. \n\n\n\nhttps://doi.org/10.2147/RMHP.S7500 \n\n\n\n[2] Baysal, E. & Midilli, T. S. 2018. Effects of structured patient education on knowledge \n\n\n\nlevel and inr control of patients receiving warfarin: Randomized controlled trial. Pakistan \n\n\n\nJournal of Medical Sciences 34(2): 240\u2013426. doi:10.12669/pjms.342.14216 \n\n\n\n[3] Hasan, S. S., Shamala, R., Syed, I. A., Basariah, N., Chong, D. W. K., Mei, T. K. & Chin, \n\n\n\nO. H. 2011. Factors affecting warfarin-related knowledge and INR control of patients \n\n\n\nattending physician- and pharmacist-managed anticoagulation clinics. Journal of \n\n\n\nPharmacy Practice 24(5): 485\u2013493. doi:10.1177/0897190011415684. \n\n\n\n\n\n\n\nAbstract 034 \n\n\n\n\n\n\n\nQuality and Quantity of Patient\u2019s \n\n\n\nOwn Medicine\u2019s Brought to Hospital \n\n\n\nTuanku Ampuan Najihah during \n\n\n\nAdmission: A Cross-Sectional Study \n \nZalikha Z, Hazlin N, Nurul N, Puvaneswari \n\n\n\nN*, Teo Kui Yuan \n\n\n\n \nPharmacy Department, Hospital Tuanku Ampuan Najihah, Kuala Pilah, \n\n\n\nNegeri Sembilan \n\n\n\n\n\n\n\n*Correspondence: htan.pric@gmail.com \n\n\n\n\n\n\n\nIntroduction: Patients\u2019 Own Medicines (POMs) is a \n\n\n\nrelatively recent programme in Malaysia, with its  \n\n\n\nmanagement guidelines first published in 2016. Studies \n\n\n\nrelating to the quantity and quality of POMs are limited in \n\n\n\nMalaysia. Objective: This study aimed to evaluate the \n\n\n\nquality and quantity of POMs brought by patients admitted \n\n\n\nto Hospital Tuanku Ampuan Najihah (HTAN). Method: A \n\n\n\ncross-sectional study was carried out among patients \n\n\n\nadmitted in the medical ward, in HTAN. Convenient \n\n\n\nsampling was applied and 170 respondents were recruited \n\n\n\nfrom the medical ward. Data was collected by interviewing \n\n\n\npatients using a structured data collection form by \n\n\n\ninvestigators. The parameters studied were the quality, \n\n\n\nquantity and socioeconomic characteristics that might \n\n\n\ninfluence the quality of POMs. Data were analysed using \n\n\n\nChi-Square tests to identify potential associated factors and \n\n\n\nSpearman\u2019s analysis to assess the correlation between the \n\n\n\nnumber of POMs and their usability. Result: Total number \n\n\n\nof patients who brought POMs were 170, and the calculated \n\n\n\ntotal number of POMs were 752. POMs brought by patients \n\n\n\nto HTAN were generally in good condition in which 93.7% \n\n\n\n(n=679) of POMs were usable while 6.3% (n=46) of POMs \n\n\n\nwere unusable. Out of 752 POMs, 87% were in good \n\n\n\ncondition, 98% were not expired and 72% of them were \n\n\n\nlabelled with batch number, expiry date and presented in \n\n\n\noriginal packaging. No significant associated factors was \n\n\n\nfound between POM\u2019s usability and patient\u2019s socioeconomic \n\n\n\ncharacteristics. There was a correlation between the number \n\n\n\nof medicines and the usability of POMs (R-value= -0.151, p-\n\n\n\nvalue= 0.049). Conclusion: Most of the POMs brought by \n\n\n\npatients are usable in the ward. Pill burden could be the \n\n\n\n\nmailto:htan.pric@gmail.com\n\n\nmailto:htan.pric@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 7, Issue 1, Supplementary (2021), 49-78 \n\n\n\n68 \n\n\n\n\n\n\n\nResearch Presentation of National Pharmacy Convention 2021 \n\n\n\nDOI:  10.52494/UCML9733 \n \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nreason for poor management of medicines at home. Future \n\n\n\nstudy shall include the cost and savings incurred of POMs.  \n\n\n\n \nReferences \n \n\n\n\n[1] Billups SJ, Malone DC, Carter BL. The relationship between drug therapy non-\n\n\n\ncompliance and patient characteristics, health-related quality of life, and healthcare costs. \n\n\n\nPharmacotherapy 2000;20:941-9 \n\n\n\n[2] Col N, Fanale JE, Kronholm P. The role of medication noncompliance and adverse drug \n\n\n\nreactions in hospitalizations of the elderly. Arch Intern Med 1990;150:841-5. \n\n\n\n[3] Coons SJ, Sheahan SL, Martin SS, Hendrick J, Robbins CA, Johnson JA. Predictors of \n\n\n\nmedication noncompliance in a sample of older adults. Clin Ther 1994;16:110-7. \n\n\n\n\n\n\n\nAbstract 035 \n\n\n\n\n\n\n\nPublic Knowledge and Practices \n\n\n\nRegarding Antibiotic Use: A \n\n\n\nNationwide Cross-Sectional Survey \n\n\n\nin Malaysia \n \nLai San Kong1*, Farida Islahudin1, Leelavathi \n\n\n\nMuthupalaniappen2, Wei Wen Chong1 \n\n\n\n \n1 Centre of Quality Management of Medicines, Faculty of Pharmacy, \n\n\n\nUniversiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia \n2 Department of Family Medicine, Medical Faculty, Universiti Kebangsaan \n\n\n\nMalaysia, Kuala Lumpur 50300, Malaysia. \n\n\n\n\n\n\n\n*Correspondence: laisan_kong@hotmail.com \n\n\n\n\n\n\n\nIntroduction: Antibiotic resistance is a global threat to \n\n\n\nIntroduction: Antibiotic resistance is a global threat to \n\n\n\nhuman health worldwide, and a major contributing factor is \n\n\n\nthe inappropriate use of antibiotics. There is a need for a \n\n\n\nnationwide study on the Malaysian general public to identify \n\n\n\nknowledge gaps regarding antibiotic use, its resistance, and \n\n\n\npractices related to antibiotic use. Objective: This \n\n\n\nnationwide study aimed to assess the knowledge of antibiotic \n\n\n\nuse and resistance, and to identify any inappropriate practices \n\n\n\nrelated to antibiotic use among the Malaysian general public. \n\n\n\nMethod: A cross-sectional survey was conducted, where \n\n\n\nMalaysians aged 18 years old and above from all states in \n\n\n\nMalaysia were recruited via quota sampling, followed by \n\n\n\nconvenient sampling. A validated self-administered \n\n\n\nquestionnaire was used to collect data. Result: A total of \n\n\n\n1971 respondents were recruited. Half of them had engaged \n\n\n\nin at least one inappropriate practice related to antibiotic use \n\n\n\n(56.6%), with the most common being not completing an  \n\n\n\nantibiotic course (48.8%). The mean total knowledge score \n\n\n\nwas 8.57 \u00b1 4.24 (range 0-20). The majority of the respondents \n\n\n\nwere unsure or incorrectly answered that antibiotics work on \n\n\n\nviral infections (79.1%) and colds and coughs (77.0%), and \n\n\n\n42.8% were unsure or incorrectly answered that antibiotics \n\n\n\ncould be stopped when symptoms improved. Most \n\n\n\nrespondents were unsure or wrongly answered that antibiotic \n\n\n\nresistance occurs when the body becomes resistant to \n\n\n\nantibiotics (90.2%), and antibiotic resistance is not an issue \n\n\n\nin Malaysia (62.9%). Respondents who had engaged in at \n\n\n\nleast one inappropriate practice related to antibiotic use were \n\n\n\nobserved to have lower mean total knowledge scores (8.11 \u00b1 \n\n\n\n4.00 versus 9.26 \u00b1 4.40, p<0.001). Respondents who reported \n\n\n\nhad ever not completed their antibiotic courses had \n\n\n\nsignificantly lower mean knowledge scores (8.09 \u00b1 3.93 \n\n\n\nversus 9.10 \u00b1 4.42, p<0.001). Conclusion: Important \n\n\n\nknowledge gaps on antibiotic use and resistance, and a high \n\n\n\nrate of non-completion of antibiotic courses were observed \n\n\n\namong the general public. Improving the knowledge of \n\n\n\nantibiotic use and resistance among the general public may \n\n\n\nbe a key strategy to correct misconceptions and promote the \n\n\n\nprudent use of antibiotics. \n\n\n\n \nReferences \n\n\n\n \n[1] Ventola CL. The antibiotic resistance crisis: part 1: causes and threats. Pharm Ther. \n\n\n\n2015;40:277\u201383. doi:Article. \n\n\n\n[2] Gualano MR, Gili R, Scaioli G, Bert F, Siliquini R. General population\u2019s knowledge and \n\n\n\nattitudes about antibiotics: A systematic review and meta-analysis. Pharmacoepidemiol \n\n\n\nDrug Saf. 2015;24:2\u201310. \n\n\n\n[3] Oh AL, Hassali M, Al-Haddad M, Syed Azhar S, Shafie A, Awaisu A. Public knowledge \n\n\n\nand attitudes towards antibiotic usage: a cross-sectional study among the general public in \n\n\n\nthe state of Penang, Malaysia. J Infect Dev Ctries. 2011;5:338\u201347. \n\n\n\n\n\n\n\nAbstract 036  \n\n\n\n\n\n\n\nA Study on Knowledge, Attitude and \n\n\n\nPractice on Medication Error \n\n\n\nReporting Among Healthcare \n\n\n\nPractitioners in a Primary Care \n\n\n\nSetting.  \n \nMuhamad Alif Hakimi Amran, Siti Masturina \n\n\n\nJusoh, Nik Noor Tasneim Nik Md Noordin, \n\n\n\nSyafawati Ramli \n\n\n\n \nPharmacy Unit, Klinik Kesihatan Pengkalan Chepa & Klinik Kesihatan \n\n\n\nBandar Kota Bharu. \n\n\n\n\n\n\n\n*Correspondence: tasneim02@gmail.com \n\n\n\n\n\n\n\nIntroduction: Medication error (ME) is a worldwide issue \n\n\n\naffecting the healthcare system. In Malaysia, a total of \n\n\n\n17357 medication error reports were submitted to the \n\n\n\nNational Medication Error Reporting System (MERS) in \n\n\n\n2016. However, the majority of the medication error reports \n\n\n\ncome from pharmacists.  Objective: To assess the \n\n\n\nknowledge, attitude and practice (KAP) on medication error \n\n\n\nreporting among healthcare practitioners working in \n\n\n\nprimary care settings under the District Health Office of \n\n\n\nKota Bharu.  Method: A cross-sectional survey was \n\n\n\nconducted between Nov 2020 and Jan 2021 using a web-\n\n\n\nbased self-administered questionnaire with 6 closed-ended \n\n\n\nquestions for each section: knowledge, attitude and practice. \n\n\n\nParticipants included healthcare practitioners (physicians, \n\n\n\npharmacists and nurses) working in the 20 primary care \n\n\n\nhealth clinics within Kota Bharu District. KAP toward \n\n\n\n\nmailto:laisan_kong@hotmail.com\n\n\nmailto:tasneim02@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 7, Issue 1, Supplementary (2021), 49-78 \n\n\n\n69 \n\n\n\n\n\n\n\nResearch Presentation of National Pharmacy Convention 2021 \n\n\n\nDOI:  10.52494/UCML9733 \n \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nmedication error reporting was assessed using three options \n\n\n\n(yes, no or maybe). Result and discussion: A total of 221 \n\n\n\nrespondents participated in the survey. Almost half (46%, \n\n\n\nn=101) of the healthcare professionals were not \n\n\n\nknowledgeable and 44% of them (n= 97) had negative \n\n\n\nattitudes towards medication error reporting. The \n\n\n\npharmacists had the highest proportion, 65% (n=26) of them \n\n\n\nwere knowledgeable and 73% (n=29) had a favorable \n\n\n\nattitude. Almost half of them (57%, n=126) have previous \n\n\n\nexperience in reporting ME. Among the listed variables, \n\n\n\nrespondents\u2019 attitude and practice of medication error \n\n\n\nreporting are significantly associated to gender with \n\n\n\np=0.002 and p=0.043, respectively. This data was found \n\n\n\nquite similar to the previous study. There was a weak \n\n\n\ncorrelation between knowledge-attitude (p<0.001, r=0.330) \n\n\n\nand attitude-practice (p<0.001, r=0.391). A moderate \n\n\n\ncorrelation was found between attitude-practice (p<0.001, \n\n\n\nr=0.561). Meanwhile, knowledge and practice show \n\n\n\nmoderate correlation and significance (p<0.001, r= 0.561).  \n\n\n\nConclusion: Our study revealed that knowledge, attitude \n\n\n\nand practice among the respondent are above borderline, i.e. \n\n\n\nmerely above 50%. Therefore, more efforts are needed to \n\n\n\nimprove the knowledge and attitude of the healthcare \n\n\n\nworkers. Educational talk, disseminating ME material or \n\n\n\ndisplaying a clear flow chart on the reporting process are \n\n\n\nsome of the examples that could be carried out.    \n\n\n\n \nReference \n\n\n\n\n\n\n\n[1] Alsulami, S. L., Sardidi, H. O., Almuzaini, R. S., Alsaif, M. A., Almuzaini, H. S., \n\n\n\nMoukaddem, A. K., & Kharal, M. S. (2019). Knowledge, attitude and practice on \n\n\n\nmedication error reporting among health practitioners in a tertiary care setting in Saudi \n\n\n\nArabia. Saudi Medical Journal, 40(3), 246\u2013251. \n\n\n\nhttps://doi.org/10.15537/smj.2019.3.23960 \n\n\n\n[2] Carandang, R. R., Resuello, D., Hocson, G. B., Respicio, K. M., & Reynoso, C. \n\n\n\n(2015).Knowledge, Attitude and Practices on Medication Error Reporting among Health \n\n\n\nPractitioners from Hospitals in Manila. Scholars Academic Journal of Pharmacy (Online) \n\n\n\nSch. Acad. J. Pharm, 4(5), 2320\u20134206. \n\n\n\n[3] Chiang, H. Y., Lin, S. Y., Hsu, S. C., & Ma, S. C. (2010). Factors determining hospital \n\n\n\nnurses\u2019 failures in reporting medication errors in Taiwan. Nursing Outlook, 58(1), 17\u201325. \n\n\n\nhttps://doi.org/10.1016/j.outlook.2009.06.001 \n\n\n\n\n\n\n\nAbstract 037 \n\n\n\n\n\n\n\nPrevalence of polymorphisms in \n\n\n\ngastrointestinal (GI) disorder-related \n\n\n\ngene, Tryptophan hydroxylase 1 \n\n\n\n(TPH1) among Healthy Malays \n \nRasmaizatul Akma Rosdi1, Nurfadhlina \n\n\n\nMusa2, Zalina Zahari3*, Mohd Khairi Zahri @ \n\n\n\nJohari4, Mulham Alfatama3, Khoo Boon Yin5 \n\n\n\n \n1 School of Health Sciences, Universiti Sains Malaysia, Health Campus, \n\n\n\n16150 Kubang Kerian, Kelantan, Malaysia \n2 Human Genome Center, School of Medical Sciences, Universiti Sains \n\n\n\nMalaysia, Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia \n3 Faculty of Pharmacy, Universiti Sultan Zainal Abidin, Besut Campus, \n\n\n\n22200 Besut, Terengganu, Malaysia \n\n\n\n4 Faculty of Health Sciences, Universiti Sultan Zainal Abidin, Gong Badak \n\n\n\nCampus, 21300 Kuala Nerus, Terengganu, Malaysia \n5 Institute for Research in Molecular Medicine (INFORMM), Universiti \n\n\n\nSains Malaysia, 11800 Gelugor, Penang, Malaysia \n\n\n\n\n\n\n\n*Correspondence: zalinazahari@unisza.edu.my \n\n\n\n\n\n\n\nIntroduction: Polymorphisms in the genes associated with \n\n\n\ngenetic disorders have shown variable prevalence among \n\n\n\ndifferent populations in the world. Today, the genetic \n\n\n\npolymorphisms database is considered a key to success in \n\n\n\nguiding treatment decision-making for genetic diseases. \n\n\n\nTryptophan hydroxylase 1 gene (TPH1) which encodes the \n\n\n\nenzyme that catalyzes the rate-limiting step in the serotonin \n\n\n\nor 5-hydroxytryptamine biosynthesis pathway, is one of the \n\n\n\nleading candidate genes associated with gastrointestinal (GI) \n\n\n\ndisorders. Objective: With these perspectives, this research \n\n\n\naimed to study the genotype distributions and allele \n\n\n\nfrequencies of two single nucleotide polymorphisms (SNPs) \n\n\n\nof TPH1 among healthy Malays in Malaysia. Method: \n\n\n\nNested allele-specific multiplex polymerase chain reaction \n\n\n\n(PCR) was performed on 404 archived Malays\u2019 DNAs to \n\n\n\ndetermine the distributions and frequencies of TPH1 SNPs; \n\n\n\nrs4537731 (A-6526G) and rs211105 (T18033757G). \n\n\n\nGenotyping results were confirmed through direct Sanger \n\n\n\nsequencing. Result and Discussion: The genotype \n\n\n\nfrequencies of A/A (A-6526G) and T/T (T1803375G) were \n\n\n\n51.49% and 59.16%, respectively. The heterozygous \n\n\n\nfrequency for A/G (A-6526G) was 36.39% and for T/G \n\n\n\n(T1803375G) was 33.66%. The homozygous variant was \n\n\n\nonly found in A-6526G with a frequency of 12.13%. \n\n\n\nConcurrently, the wild type allele frequencies appeared to be \n\n\n\nhigher than the mutant type in both SNPs with 69.7% to \n\n\n\n30.3% for rs4537731 and 76.0% to 24.0% for rs211105. The \n\n\n\nfindings from this study described low frequencies of TPH1 \n\n\n\nvariants rs4537731 and rs211105 among healthy Malays, to \n\n\n\nwhich the symptoms of irritable bowel syndrome and severe \n\n\n\nGI including bloating, diarrhea and watery stool can be \n\n\n\nattributed. However, more studies should be performed to \n\n\n\nsolidify the findings. For example, studies on Malaysian \n\n\n\npatients with GI disorders are recommended to determine the \n\n\n\nassociation of TPH1 polymorphisms to the condition, locally. \n\n\n\nConclusion: The genetic polymorphism data obtained from \n\n\n\nthis study is important to enhance our current knowledge on \n\n\n\nthe genetic profiles among healthy Malays. Such data can be \n\n\n\nused to explore more on the association of GI disorders and \n\n\n\nthe genetic variations of Malaysians in the future. \n\n\n\n \nReference \n\n\n\n \n[1] Ryo, K., Akiko, S., Takahisa, M., Manabu, I., Minoru, F., Hiroshi, M., & Ken, H. (2018). \n\n\n\nThe TPH1 rs211105 gene polymorphism affects abdominal symptoms and quality of life \n\n\n\nof diarrhea-predominant irritable bowel syndrome. Journal of Clinical Biochemistry and \n\n\n\nNutrition, 62(3), 270-276.   \n\n\n\n[2] Houssam, H., & Michael, C. (2017). Pharmacogenetics and the treatment of functional \n\n\n\ngastrointestinal disorders. Pharmacogenomics, 18(11), 1085-1094 \n\n\n\n[3] Magdalena, G., Jan, A. B., Ewa, W., Marcin, S., Monika, S-B., Dorota, F., Tadeusz,  D., \n\n\n\nAnna, J., Arleta, L., Ma\u0142gorzata, M., & Agata, M. (2017). Serotonin-related gene variants \n\n\n\nin patients with irritable bowel syndrome and depressive or anxiety disorders. \n\n\n\nGastroenterology Research and Practice, 1-9.  \n\n\n\n \n\n\n\n\nhttps://doi.org/10.15537/smj.2019.3.23960\n\n\nhttps://doi.org/10.1016/j.outlook.2009.06.001\n\n\nmailto:zalinazahari@unisza.edu.my\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 7, Issue 1, Supplementary (2021), 49-78 \n\n\n\n70 \n\n\n\n\n\n\n\nResearch Presentation of National Pharmacy Convention 2021 \n\n\n\nDOI:  10.52494/UCML9733 \n \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 038 \n\n\n\n\n\n\n\nThe Impact of Lithocholic Acid as A \n\n\n\nSurfactant on the Characteristics and \n\n\n\nCytocompatibility of Azithromycin \n\n\n\nLoaded Self-Emulsifying Drug \n\n\n\nDelivery System  \n \nReem Abou Assi1,2, Ibrahim M.Abdulbaqi 1,2, \n\n\n\nToh Seok Ming1, Chan Siok Yee1*, Habibah A. \n\n\n\nWahab1*, Yusrida Darwis 1* \n\n\n\n \n1 The Discipline of Pharmaceutical Technology, School of Pharmaceutical \n\n\n\nSciences, Universiti Sains Malaysia, 11800, Penang, Malaysia. \n2 The Discipline of Pharmaceutical Technology, College of Pharmacy, Al-\n\n\n\nKitab University, Altun kupri, Kirkuk, Iraq.  \n\n\n\n\n\n\n\n*Correspondence: sychan@usm.my \n\n\n\n\n\n\n\nIntroduction: The self-emulsifying drug delivery system \n\n\n\n(SEDDS) has emerged as an effective pharmaceutical \n\n\n\nstrategy for addressing the issue of poorly soluble drug \n\n\n\nbioavailability, specifically candidates belonging to BCS \n\n\n\nclasses II and IV including azithromycin (AZM, log p = 4). \n\n\n\nAside from oil, the main component in SEDDS is the \n\n\n\nsurfactant, which is presented in high concentrations leading \n\n\n\nto complex physiological interactions raising the possibility \n\n\n\nof toxicity. Surfactants derived from bile acid have transpired \n\n\n\nas an excellent choice of bio-compatible pharmaceutical \n\n\n\nexcipient. Unconjugated lithocholic acid (LA) has recently \n\n\n\nbeen reported to improve formulations\u2019 drug release and \n\n\n\nstability. Objective: To investigate LA as a safe and effective \n\n\n\nsurfactant in liquid SEDDS (L-SEDDS) and compare it with \n\n\n\nLA-free L-SEDDS and solid SEDDS (S-SEDDS) states of \n\n\n\nAZM. This is in terms of reduced particle size (PS), \n\n\n\ndispersity (\u0110), self-emulsification efficiency (T%), zeta \n\n\n\npotential charge in distilled water (DW), 0.1 mM HCl, and \n\n\n\nsimulated intestinal fluids (SIF), as well as cellular viability. \n\n\n\nMethod: L-SEDDS was formulated with Capryol 90\u00ae oil \n\n\n\n(22.22%), Tween 20\u00ae as surfactant and Transcutol HP\u00ae (2:1 \n\n\n\nratio) as co surfactant. S-SEDDS was produced by adsorbing \n\n\n\nthe L-SEDDS(s) to Aerosil 200\u00ae as a solid carrier (at 2:1 ratio \n\n\n\nof L-SEDDs to Aerosil 200\u00ae). In L-SEDDS, LA was \n\n\n\nincorporated at high (B-L-SEDDS3), medium (B-L-\n\n\n\nSEDDS2), and low (B-L-SEDDS1) concentrations of 7.75, \n\n\n\n3.6, and 1.03 mg/ml respectively. Later, AZM was loaded. \n\n\n\nMTT assay was performed on human Colon carcinoma cell \n\n\n\nlines. Result and Discussion: Significant reduction in PS \n\n\n\nand \u0110 values was observed upon the addition of LA (p<0.05) \n\n\n\nin both blank and loaded B-L-SEDDS and compared to LA-\n\n\n\nfree AZM-loaded liquid and solid SEDDSs, respectively. \n\n\n\nBesides, the size reduction was LA concentration-dependent \n\n\n\nand could be advantageous for drug absorption and lymphatic \n\n\n\nuptake, while the \u0110 reduction represents SEDDS improved \n\n\n\nhomogeneity. After the addition of LA, T% increased up to \n\n\n\n~ 100%, while ZP charges were negative in DW and SIF, \n\n\n\nwith charge shift to positive in HCl diluent. Almost all \n\n\n\nSEDDSs formulations exhibited good cytocompatibility (> \n\n\n\n~85%). Conclusion: LA is a potential surfactant for desired \n\n\n\nfeatures of SEDDS (PS, \u0110 and T%) with a good safety \n\n\n\nprofile. \n\n\n\n \nReference \n\n\n\n \n[1] Pavlovi\u0107, N. et al. (2018). Bile Acids and Their Derivatives as Potential Modifiers of Drug \n\n\n\nRelease and Pharmacokinetic Profiles. Frontier in pharmacology, 9,1283. \n\n\n\n[2] Wagle, S.R. et al. (2020). Pharmacological and Advanced Cell Respiration Effects, \n\n\n\nEnhanced by Toxic Human-Bile Nano-Pharmaceuticals of Probucol Cell-Targeting \n\n\n\nFormulations. Pharmaceutics,12(8), 708.  \n\n\n\n[3] Mathavan, S., et. al. (2016). A comprehensive study of novel microcapsules incorporating \n\n\n\ngliclazide and a permeation enhancing bile acid: Hypoglycemic effect in an animal model \n\n\n\nof Type-1 diabetes. Drug Delivery, 23(8), 2869\u20132880. \n\n\n\n\n\n\n\nAbstract 039 \n\n\n\n\n\n\n\nCOVID-19: Embracing the New \n\n\n\nNormal; Are We Ready for This? A \n\n\n\nCross-Sectional Study \n \nSherilyn Pak Cheng Suet1, Muhammad Junaid \n\n\n\nFarrukh1*, Hee Mei Qi1, Zikria Saleem2, \n\n\n\nMuhammad Salman2, Aziz ur Rahman1 \n\n\n\n \n1 Faculty of Pharmaceutical Sciences, UCSI University, 56000 Cheras, \n\n\n\nWilayah Persekutuan Kuala Lumpur, Malaysia. \n2 Department of Pharmacy Practice, Faculty of Pharmacy, The University of \n\n\n\nLahore, 1-Km Defense Road, Lahore, Pakistan. \n\n\n\n\n\n\n\n*Correspondence: sherilynpcs98@hotmail.com \n\n\n\n\n\n\n\nIntroduction: The rapid spread of Coronavirus brought fear \n\n\n\nand chaos to Malaysians. Amidst pandemic, educating, \n\n\n\nengaging, and mobilising the public to become active \n\n\n\nparticipants may help achieve public health emergency \n\n\n\npreparedness, reducing the overall population's vulnerability. \n\n\n\nHowever, false media information may mislead Malaysians, \n\n\n\nmaking it necessary to access Malaysians' baseline \n\n\n\nknowledge and preventive practices against COVID-19. \n\n\n\nObjective: The study aimed to evaluate the knowledge, \n\n\n\nattitude, perception and practices towards the prevention of \n\n\n\nCOVID-19 among the general public in Malaysia. Method: \n\n\n\nA cross-sectional study was conducted online among the \n\n\n\ngeneral public in Malaysia from June 2020 to August 2020. \n\n\n\nParticipants were conveniently recruited through multiple \n\n\n\nsocial media platforms to encourage nationwide \n\n\n\nparticipation. A patient-administered questionnaire was used \n\n\n\nto assess their knowledge, attitude and practice towards the \n\n\n\nprevention of COVID-19. Descriptive analysis, percentage, \n\n\n\nmean, and standard deviation were used to report \n\n\n\ndemographic characteristics, knowledge, attitude, and \n\n\n\npractice scores. For inferential analysis, t-test, ANOVA, \n\n\n\nPearson's correlation, Spearman's correlation, Chi-square test \n\n\n\nand binary logistic regression was used to analyse the \n\n\n\n\nmailto:sychan@usm.my\n\n\nmailto:sherilynpcs98@hotmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 7, Issue 1, Supplementary (2021), 49-78 \n\n\n\n71 \n\n\n\n\n\n\n\nResearch Presentation of National Pharmacy Convention 2021 \n\n\n\nDOI:  10.52494/UCML9733 \n \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\ndifferentiation, association and correlations of the study \n\n\n\nvariables. The confidence interval selected for this study was \n\n\n\n95%. Result: A total of 420 respondents participated in this \n\n\n\nsurvey. The majority of the participants (n=412, 98%) were \n\n\n\naware of COVID-19. Most participants learnt about the \n\n\n\npandemic through social media. About half of the \n\n\n\nparticipants had inadequate knowledge (45.5%) and a \n\n\n\nnegative attitude (43.3%). Participants residing in urban \n\n\n\nareas showed good preventive practices than those residing \n\n\n\nin rural areas (P<0.05).  There was a significant association \n\n\n\nbetween participant's attitudes and preventive practices \n\n\n\ntowards COVID-19, Where the majority of the participants \n\n\n\n(57.4%) who showed negative attitudes were more likely to \n\n\n\nfollow poor preventive practices. Malaysians each hold a \n\n\n\nperception that differs from individuals according to their \n\n\n\nmindsets, perspective and acceptance towards COVID-19. \n\n\n\nConclusion: Despite having good knowledge, participants \n\n\n\nwith a negative attitude towards COVID-19 were less likely \n\n\n\nto follow the preventive practices of COVID-19. The Public's \n\n\n\nmindset and willingness may play an important role in \n\n\n\ninfluencing their practices, giving them another perspective, \n\n\n\nwhich may change their perceptions. As a result, strategies \n\n\n\nshould be made to change the mindset of these vulnerable \n\n\n\ngroups through proper counselling and education. \n\n\n\n \nReference \n\n\n\n \n[1] DUCHARME J. World Health Organization Declares COVID-19 a 'Pandemic.'. TIME. \n\n\n\n2020.  \n\n\n\n[2] Singhal T. A Review of Coronavirus Disease-2019 (COVID-19). Indian J Pediatr. 2020; \n\n\n\n87(4): 281-286  \n\n\n\n[3] PFORDTEN D, AHMAD R. Covid-19: Current situation in Malaysia. The Star. 2020 \n\n\n\nMarch 23.  \n\n\n\n\n\n\n\nAbstract 041 \n\n\n\n\n\n\n\nA Study on Academic Stress Level \n\n\n\namong Undergraduate Pharmacy \n\n\n\nStudents \n \nGanesh Sritheran Paneerselvam*, Ng Hsu \n\n\n\nSyuen \n\n\n\n \nSchool of Pharmacy, Taylor\u2019s University, 47500 Subang Jaya, Selangor, \n\n\n\nMalaysia. \n\n\n\n\n\n\n\n*Correspondence: ganesh_alei@hotmail.com \n\n\n\n\n\n\n\nIntroduction: Pharmacy course has always been regarded as \n\n\n\na highly stressful program among university undergraduates. \n\n\n\nThis worsens tremendously during the Covid-19 pandemic \n\n\n\nwhen there is a sudden shift to e-learning. Objective: To \n\n\n\nexamine the severity of academic stress among pharmacy \n\n\n\nstudents and the factors affecting it. Method: A cross-\n\n\n\nsectional study using a convenient sampling technique was \n\n\n\nconducted among undergraduate pharmacy students in a \n\n\n\ntertiary university in Malaysia. A self-administered validated \n\n\n\nquestionnaire was distributed to the students through emails. \n\n\n\nThe questionnaire includes sociodemographic information \n\n\n\nand questions to examine the academic-related factors which \n\n\n\nrender student stress during the Covid-19 pandemic. All the \n\n\n\ndata were analysed using SPSS version 26.0. Result and \n\n\n\nDiscussion: Overall, 102 pharmacy students participated in \n\n\n\nthis study. The majority of the students face a moderate level \n\n\n\nof academic stress (63.8%), followed by severe stress \n\n\n\n(23.5%) and mild stress (12.7%). Academic factors, such as \n\n\n\nstruggling with difficult subjects through e-learning, feeling \n\n\n\nstressed when deadline submission is approaching, and \n\n\n\ndealing with high academic workloads might be the reasons \n\n\n\nfor stress. \n\n\n\nFurthermore, this study discovered that the year of study, \n\n\n\nespecially for students in year one and smoking, were two \n\n\n\nsignificant independent factors causing academic stress \n\n\n\namong students (P-value < 0.05). Conclusion: This study \n\n\n\nhighlights the worsening academic stress which could affect \n\n\n\nthe psychological well-being of the students. The mental \n\n\n\nhealth status of the students should not be neglected.  \n\n\n\nTherefore, school management needs to develop effective \n\n\n\ncounselling modules and intervention strategies to help \n\n\n\nstudents alleviate academic stress. \n\n\n\n \nReference \n\n\n\n \n[1] Grubic, N., Badovinac, S., & Johri, A. (2020). Student mental health in the midst of the \n\n\n\nCOVID-19 pandemic: A call for further research and immediate solutions. International \n\n\n\nJournal Of Social Psychiatry, 66(5), 517-518.  \n\n\n\n[2] Kamal, A. A., Shaipullah, N. M., Truna, L., Sabri, M., & Junaini, S. N. (2020). \n\n\n\nTransitioning to online learning during COVID-19 Pandemic: Case study of a Pre-\n\n\n\nUniversity Centre in Malaysia. International Journal of Advanced Computer Science and \n\n\n\nApplications, 11(6), 217\u2013223.  \n\n\n\n[3] Milic, M., Gazibara, T., Pekmezovic, T., Tepavcevic, D. K., Maric, G., Popovic, A., \n\n\n\nStevanovic, J., Patil, K. H., & Levine, H. (2020). Tobacco smoking and health-related \n\n\n\nquality of life among university students: Mediating effect of depression. PLoS ONE, \n\n\n\n15(1), 1\u201318.  \n\n\n\n\n\n\n\nAbstract 043 \n\n\n\n\n\n\n\nQualitative Analysis on \n\n\n\nInterprofessional Collaboration in \n\n\n\nthe Management of Paediatric \n\n\n\nBronchial Asthma: Challenges and \n\n\n\nSuggestions for Improvement \n \nKarniza Khalid1, Nurul Azima Mazlan2*, Wan \n\n\n\nNor Amalina Zainun2, Amalina Anuar1, \n\n\n\nNuqman Mursyid Ramli2, Ang Wei Chern1,2 \n \n1 Clinical Research Centre, Hospital Tuanku Fauziah, Perlis, Ministry of \n\n\n\nHealth Malaysia \n2 Department of Pharmacy, Hospital Tuanku Fauziah, Perlis, Ministry of \n\n\n\nHealth Malaysia \n\n\n\n\n\n\n\n*Correspondence: karniza@yahoo.com \n\n\n\n\n\n\n\nIntroduction: Multi-disciplinary healthcare providers need \n\n\n\nto move beyond task-based responsibility towards a more \n\n\n\n\nmailto:ganesh_alei@hotmail.com\n\n\nmailto:karniza@yahoo.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 7, Issue 1, Supplementary (2021), 49-78 \n\n\n\n72 \n\n\n\n\n\n\n\nResearch Presentation of National Pharmacy Convention 2021 \n\n\n\nDOI:  10.52494/UCML9733 \n \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\ncollaborative approach. Chronic childhood diseases such as \n\n\n\nbronchial asthma demanded effective multidisciplinary team \n\n\n\nmeetings to improve patient care. Objective: We aimed to \n\n\n\nexamine the interprofessional collaboration between \n\n\n\nphysician and pharmacist in the management of paediatric \n\n\n\nbronchial asthma, to explore the views and experiences of \n\n\n\nboth pharmacists and physicians on the important aspects of \n\n\n\npaediatric respiratory medication therapy adherence therapy \n\n\n\n(PRMTAC) and patient-centredness, and to identify barriers \n\n\n\nto shared decision-making in the management of paediatrics \n\n\n\nbronchial asthma. Method: The study involved a face-to-\n\n\n\nface interview involving the paediatrics medical team and \n\n\n\npharmacists involved with PRMTAC. The semi-structured \n\n\n\ninterview included four pharmacists and three paediatrics \n\n\n\nresidence from Hospital Tuanku Fauziah, Perlis, Malaysia. A \n\n\n\nfull audio recording was used for detailed data retrieval and \n\n\n\nverbatim transcription. The session was deemed completed \n\n\n\nonce all the probed questions have reached the thematic \n\n\n\nconclusion. Result and Discussion: There were three main \n\n\n\nthemes emerged: (i) The relevance and necessity of \n\n\n\nPRMTAC service to complement paediatric outpatient \n\n\n\nbronchial asthma management, (ii) the lack of \n\n\n\ncommunication between pharmacist-physician in outpatient \n\n\n\nbronchial asthma management, and (iii) recommendation for \n\n\n\nthe combined clinic in the management of outpatient \n\n\n\npaediatric bronchial asthma. PRMTAC services were rated \n\n\n\nas highly relevant in the management of outpatient bronchial \n\n\n\nasthma among all study respondents, irrespective of \n\n\n\nprofession. The detailed assessment of medication \n\n\n\ncompliance and technical demonstration provided by \n\n\n\nPRMTAC services were deemed fundamental in holistic \n\n\n\npatient care. The current clinical scenario demonstrates that \n\n\n\nthe pharmacist and paediatric medical team work \n\n\n\nindependently and in parallel rather than collaboratively\u2014\n\n\n\nsuch workflow challenges in tandem decision-making \n\n\n\nregarding patient-focused medication. The lack of interaction \n\n\n\nalso impedes sharing of ideas and new knowledge that could \n\n\n\nbenefit both parties in relation to the management of \n\n\n\noutpatient bronchial asthma. A combined clinic was \n\n\n\nsynonymously suggested to remedy this. Conclusion:  \n\n\n\nTherefore, proper planning regarding allocation of support \n\n\n\nsystem and mobilisation of human resources needs to be \n\n\n\ninstituted to realise the implementation of a nationwide \n\n\n\ncombined clinic in the management of paediatric bronchial \n\n\n\nasthma.  \n\n\n\n \nReference \n\n\n\n \n[1] Hoffmann, T. C., Montori, V. M., & Del Mar, C. 2014. The connection between evidence-\n\n\n\nbased medicine and shared decision making. Jama, 312(13), 1295-1296. \n\n\n\n[2] Kaplan, A., & Price, D. 2020. Treatment Adherence in Adolescents with Asthma. Journal \n\n\n\nof asthma and allergy, 13, 39. \n\n\n\n[3] Mercer, K., Burns, C., Guirguis, L., Chin, J., Dogba, M. J., Dolovich, L., ... & Grindrod, \n\n\n\nK. A. 2018. Physician and pharmacist medication decision-making in the time of \n\n\n\nelectronic health records: mixed-methods study. JMIR human factors, 5(3), e24.  \n\n\n\n[4] in serious mental illness. International journal of clinical pharmacy, 38(5), 1191-1199. \n\n\n\n\n\n\n\n\n\n\n\nAbstract 044 \n\n\n\n\n\n\n\nViews, Barriers and Facilitators of \n\n\n\nPharmacists Regarding Trastuzumab \n\n\n\nBiosimilar in the Treatment of HER2+ \n\n\n\nBreast Cancer \n  \nYin Yen Wong1,2*, Pauline Siew Mei Lai1, Wan \n\n\n\nZamaniah Wan Ishak3, Renly Lim4 \n\n\n\n\n\n\n\n1 Department of Pharmacy, University Malaya Medical Centre, 59100 \n\n\n\nKuala Lumpur, Malaysia \n2 Department of Primary Care Medicine, Faculty of Medicine, University \n\n\n\nof Malaya, 50603 Kuala Lumpur, Malaysia \n3 Department of Clinical Oncology, Faculty of Medicine, University of \n\n\n\nMalaya, 50603 Kuala Lumpur, Malaysia \n3UniSA Clinical and Health Sciences, University of South Australia, \n\n\n\nAdelaide, Australia \n\n\n\n\n\n\n\n*Correspondence: yywong@ummc.edu.my \n\n\n\n\n\n\n\nIntroduction: Despite the introduction of trastuzumab \n\n\n\nbiosimilar in 2019 and scientific proof that biosimilar has no \n\n\n\nclinically meaningful difference from its originator, the \n\n\n\nuptake of trastuzumab biosimilar in one teaching hospital in \n\n\n\nMalaysia was still low in 2021.1,2 Therefore, we aimed to \n\n\n\nexplore the views, barriers and facilitators of pharmacists \n\n\n\nregarding trastuzumab biosimilar in the treatment of HER2+ \n\n\n\nbreast cancer.3,4  Method: This qualitative study was \n\n\n\nconducted from March to September 2020 at the University \n\n\n\nMalaya Medical Centre. Pharmacists involved in the \n\n\n\nprocurement, dispensing, and reconstitution of trastuzumab \n\n\n\nwas recruited. In-depth interviews were conducted in either \n\n\n\nEnglish or Malay, using a semi-structured topic guide. \n\n\n\nInterviews were audio-recorded, transcribed verbatim and \n\n\n\nanalysed using a thematic approach. Result and Discussion: \n\n\n\nEight out of 14 pharmacists agreed to participate. They were \n\n\n\n31-59 years of age with 6-34 years of work experience. Three \n\n\n\nthemes emerged from our data analysis: 1) Affordability of \n\n\n\ntrastuzumab biosimilar. The introduction of trastuzumab \n\n\n\nbiosimilar reduced the price of the originator. This allowed \n\n\n\npatients and healthcare professionals to choose which \n\n\n\ntrastuzumab they preferred. Some pharmacists did not like \n\n\n\nthe idea of having both options available in the pharmacy as \n\n\n\nthis complicated trastuzumab\u2019s inventory. 2) Efficacy and \n\n\n\nsafety of trastuzumab biosimilar and its originator. Most \n\n\n\npharmacists believed that trastuzumab biosimilar and its \n\n\n\noriginator had no clinically meaningful difference. However, \n\n\n\nthey were not confident in assuring doctors and patients on \n\n\n\nthe efficacy and safety of trastuzumab biosimilar due to lack \n\n\n\nof training. 3) Who should decide if trastuzumab biosimilar \n\n\n\nor the originator should be used. Pharmacists believed that \n\n\n\nthe decision lies with the doctor or the patient as they were \n\n\n\nnot directly involved in the management of breast cancer. \n\n\n\nConclusion: The price war between trastuzumab biosimilar \n\n\n\nand its originator has provided the option for doctors and \n\n\n\n\nmailto:yywong@ummc.edu.my\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 7, Issue 1, Supplementary (2021), 49-78 \n\n\n\n73 \n\n\n\n\n\n\n\nResearch Presentation of National Pharmacy Convention 2021 \n\n\n\nDOI:  10.52494/UCML9733 \n \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\npatients to choose between the two. Pharmacists believed that \n\n\n\ntrastuzumab biosimilar has no clinically meaningful \n\n\n\ndifference from its originator. However, they were not \n\n\n\nconfident in recommending trastuzumab biosimilar due to \n\n\n\nlack of training. Ultimately, they believed that the decision \n\n\n\nshould be made by either the doctors or the patients. \n\n\n\n \nReference \n\n\n\n  \n[1] Jacobs, I., et al. (2017). \"Biosimilars for the Treatment of Cancer: A Systematic Review \n\n\n\nof Published Evidence.\" BioDrugs 31(1): 1-36. \n\n\n\n[2] European Medicines Agency (2019). \"Biosimilar medicines: Overview \". Retrieved \n\n\n\nOctober 9, 2019, from https://www.ema.europa.eu/en/human-\n\n\n\nregulatory/overview/biosimilar-medicines-overview \n\n\n\n[3] Giuliani, R., et al. (2019). \"Knowledge and use of biosimilars in oncology: a survey by \n\n\n\nthe European Society for Medical Oncology.\" ESMO Open 4(2): e000460. \n\n\n\n[4] Aladul, M. I., et al. (2018). \"Healthcare professionals\u2019 perceptions and perspectives on \n\n\n\nbiosimilar medicines and the barriers and facilitators to their prescribing in UK: a \n\n\n\nqualitative study.\" BMJ Open 8(11): e023603. \n\n\n\n\n\n\n\nAbstract 045 \n\n\n\n\n\n\n\nEvaluation of Patient\u2019s Knowledge \n\n\n\nand Perception Regarding Generic \n\n\n\nand Innovator Drugs and its \n\n\n\nAssociated Factors Among Patients in \n\n\n\nPublic Health Clinics in Rembau \n\n\n\nDistrict \n \nNor Hamizah Othman1, Nur Fatin Afiqah \n\n\n\nOthman1, Nurul Farhanis Mohd Nasir1, \n\n\n\nNurliyana Mahirah Sulaiman1, Zaza Hulwanee \n\n\n\nMohd Zainee2 \n\n\n\n \n1 Klinik Kesihatan Pedas, Pharmacy Department \n2 Pejabat Kesihatan Daerah Rembau \n\n\n\n\n\n\n\n*Correspondence: norhamizahothman@gmail.com \n\n\n\n\n\n\n\nIntroduction: Healthcare costs are on the rise. Generic drugs \n\n\n\nare a cheaper alternative to innovator drugs. Thus, it is vital \n\n\n\nfor the public to have adequate and precise knowledge \n\n\n\nregarding innovator and generic drugs. Objective: The \n\n\n\nobjectives of this study were to describe the level of \n\n\n\nknowledge and perception regarding generic and innovator \n\n\n\ndrugs among patients in health clinics in Rembau district and \n\n\n\nto determine the relationship between patient\u2019s \n\n\n\nsociodemographic factors (age, gender, educational level, \n\n\n\nand income) and their level of knowledge and level of \n\n\n\nperception about generic and innovator drugs. Method: This \n\n\n\ncross-sectional study involved 368 outpatients who collected \n\n\n\ntheir medications at health clinics under Health Division of \n\n\n\nRembau District from September 2020 to November 2020. \n\n\n\nResult and Discussion: The term generic and innovator \n\n\n\ndrugs were only recognized by 49.4% (n=182) of the \n\n\n\nrespondents. Despite this, only 21.74% (n= 80) of the \n\n\n\nrespondents have good knowledge about generic drugs. Most \n\n\n\nof the surveyed patients obtained information about generic \n\n\n\ndrugs mainly from health care provider (44.3%) and \n\n\n\nelectronic media (33.4%).  Age [\u03c72 (1, n=368) = 4.995, p \n\n\n\n= .025], educational level [\u03c72 (1, n=368) = 9.180, p = .002] \n\n\n\nand income level [\u03c72 (1, n=368) = 17.505, p = .0001] are \n\n\n\nfactors associated with level of knowledge. As for perception \n\n\n\ntowards generic drugs, 56.8% (n=209) of the respondents \n\n\n\nhave a positive perception. About 43.2% believed that \n\n\n\ngeneric drugs are equal in quality. Almost half of the \n\n\n\nrespondents, 53.8%, agreed that generic drugs are cheaper; \n\n\n\nnonetheless, only 18.5% believe that it can help in reducing \n\n\n\nmedication cost. Factors found to be associated with level of \n\n\n\nperception are age [\u03c72 (1, n=368) = 5.484, p = .019] and \n\n\n\nincome level [\u03c72 (1, n=368) = 7.842, p = .005].  Conclusion: \n\n\n\nBased on this study, the knowledge on generic drugs are still \n\n\n\nlacking among patients in Rembau district. Nevertheless, \n\n\n\nmost of the patients have positive perceptions of generic \n\n\n\ndrugs. Therefore, educational and promotional activities on \n\n\n\ngeneric drugs should be emphasized to improve patient\u2019s \n\n\n\nknowledge on generic drugs and maintain the positive \n\n\n\nperception among the patients. \n\n\n\n \nReference \n\n\n\n \n[1] Alian A Alrasheedy, M. A.-T. (2014). Patient knowledge, perceptions, and acceptance of \n\n\n\ngeneric medicines: A Comprehensive Review of the Current Literature. Dove Press \n\n\n\nJournal, 29. \n\n\n\n[2] Babar ZU1, S. J. (2010). An evaluation of consumers' knowledge, perceptions and \n\n\n\nattitudes regarding generic medicines in Auckland. PubMed. \n\n\n\n[3] Hale Z., et al. Knowledge and attitudes of the pharmacists, prescribers and patients \n\n\n\ntowards generic drug use in Istanbul-Turkey. Pharmacy Practice (Granada) Journal. 2012 \n\n\n\nDecember 31. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3780497/ \n\n\n\n\n\n\n\nAbstract 046 \n\n\n\n\n\n\n\nMilitary Pharmacists\u2018 Roles in \n\n\n\nMedical Logistics & Supply Chain \n\n\n\nDuring COVID-19 Pandemic \n \nAmbok Delek NHN1, Basari AH2, Adnan MA.1, \n\n\n\nAbd Rahim NH1, Md Bohari MN1, Maseradi \n\n\n\nMER1 \n\n\n\n \n1 93 Depot Perubatan dan Pergigian Angkatan Tentera, Ministry of \n\n\n\nDefence, Malaysia \n2 Malaysian Armed Forces Health Services Division, Ministry of Defence, \n\n\n\nMalaysia \n\n\n\n\n\n\n\n*Correspondence: nur.nadzirah11@yahoo.com \n\n\n\n\n\n\n\nIntroduction: Coronavirus disease 2019 (COVID-19) \n\n\n\noutbreak has immensely impacted healthcare management \n\n\n\nglobally. Malaysia, in particular the Malaysian Armed Forces \n\n\n\n(MAF), has experienced shortage of vital medical supplies as \n\n\n\nmost of the pharmaceutical items, active pharmaceutical \n\n\n\ningredients, raw material for medical devices and medical \n\n\n\ndevices were heavily imported from other countries. In the \n\n\n\nMAF, military pharmacists play crucial roles in managing \n\n\n\n\nhttps://www.ema.europa.eu/en/human-regulatory/overview/biosimilar-medicines-overview\n\n\nhttps://www.ema.europa.eu/en/human-regulatory/overview/biosimilar-medicines-overview\n\n\nhttps://www.ema.europa.eu/en/human-regulatory/overview/biosimilar-medicines-overview\n\n\nmailto:norhamizahothman@gmail.com\n\n\nhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3780497/\n\n\nmailto:nur.nadzirah11@yahoo.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 7, Issue 1, Supplementary (2021), 49-78 \n\n\n\n74 \n\n\n\n\n\n\n\nResearch Presentation of National Pharmacy Convention 2021 \n\n\n\nDOI:  10.52494/UCML9733 \n \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nmedical logistics and supply chain. The pandemic has \n\n\n\nimplicated the ability of military pharmacists to provide \n\n\n\nstable and steadfast medical logistics support for the troops \n\n\n\nto combat the COVID-19 outbreak and to execute routine \n\n\n\noperational activities. Objective: To study the impacts of \n\n\n\nCOVID-19 pandemic on military pharmacists\u2019 roles during \n\n\n\nCOVID-19 pandemic. Result & Discussion: (1) \n\n\n\nDeployment need to Tawau Field Hospital which consists of \n\n\n\n100 beds (15 Oct 20 until 6th Jan 2021) as military pharmacist \n\n\n\nand also medical logistics officer to support Ministry of \n\n\n\nHealth, Tawau Hospital and treating non-COVID-19 patients \n\n\n\nparticularly medicine, general surgery, obstetrics and \n\n\n\ngynaecology, orthopaedic and paediatric services. \n\n\n\nResponsibility of military pharmacists was not limited to \n\n\n\ncontinuity of pharmacy services but also ensuring availability \n\n\n\nof medical assets and many other medical equipment \n\n\n\nthroughout the operation. (2) Agility needs to support PPEs \n\n\n\ndistribution for Operasi Penawar nationwide. Operasi \n\n\n\nPenawar is an operation by the MAF together with the Royal \n\n\n\nMalaysian Police during Movement Control Order (MCO). It \n\n\n\nwas started on 18th March until 3rd May 2020 for MCO 1.0. \n\n\n\nMilitary pharmacists\u2019 good networking skills had ensured \n\n\n\nsufficient and timely deliveries of PPEs nationwide including \n\n\n\nto East Malaysia within 5 hours after receiving the initial \n\n\n\ninstruction until the end of operation. (3) Increased need to \n\n\n\ncoordinate the distribution of PPEs, medicines and vaccines \n\n\n\nto ensure stock readiness at all MAF health facilities \n\n\n\nnationwide. There are 60% increment of logistics \n\n\n\ncommunication frequencies using the Royal Malaysia Air \n\n\n\nForces (RMAF) A400M and C-130 aircrafts to support East \n\n\n\nMalaysia. (4) Military pharmacists managed to increase 60% \n\n\n\nof PPE stocks sustainability rate in the MAF from 36.9% to \n\n\n\n96.4% in one month. Despite having difficulties to secure \n\n\n\nstocks during pandemic, Military pharmacists were able to \n\n\n\nmaintain PPE stocks sustainability rate above 90% from \n\n\n\nApril 2020 onwards. This was achieved by rigorous effort of \n\n\n\ndoing supplier mapping, identifying source of materials and \n\n\n\nshifting to other alternatives. Maintaining smart partnership \n\n\n\nalso contributed to the success of ensuring 100% PPE stocks \n\n\n\nsustainability. Conclusion: COVID-19 pandemic has really \n\n\n\nimpacted the conventional roles and tasks of military \n\n\n\npharmacists in the MAF. Despite ordinary roles and tasks, \n\n\n\nmilitary pharmacists must be agile and able to execute extra \n\n\n\ntasks without failed by practicing good networking skills \n\n\n\nwith other stakeholders and good management skills to \n\n\n\nprovide stable and steadfast medical logistics support for the \n\n\n\ntroops to combat the COVID-19 outbreak as well as to \n\n\n\nexecute routine operational activities. \n\n\n\n \nReference \n\n\n\n \n[1] Sharma et al. (2020) COVID-19: Impact on Health Supply Chain and Lessons to Be \n\n\n\nLearnt. Journal of Health Management 22(2) 248\u2013261. \n\n\n\n[2] Cohen, J. et al. (2020) Contributing factors to personal protective equipment shortages \n\n\n\nduring the COVID-19 pandemic. Preventive Medicine 141 :1-7. \n\n\n\n[3] Miller, FA et al. (2020) Vulnerability of the medical product supply chain-the wake up \n\n\n\ncall of Covid-19. BMJ Quality & Safety ; 30: 331\u2013335. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nAbstract 047  \n\n\n\n\n\n\n\nMetabolomics of Metformin in Urine \n\n\n\nSamples of Healthy Volunteers \n \nTee Khim Boon1,2, Luqman Ibrahim3, Najihah \n\n\n\nMohd Hashim4,5, Mohd Zuwairi Saiman6, Zaril \n\n\n\nHarza Zakaria2, Kasful Asra Sakika5,7, Syaza \n\n\n\nFatnin Hisham1,3, Azwa Mansor3, Hasniza \n\n\n\nZaman Huri1,8* \n\n\n\n \n1 Department of Clinical Pharmacy and Pharmacy Practice, Faculty of \n\n\n\nPharmacy, Universiti Malaya, Kuala Lumpur, Malaysia \n2 Ministry of Health Malaysia, Kuala Lumpur, Malaysia \n3 Department of Medicine, Faculty of Medicines, Universiti Malaya, Kuala \n\n\n\nLumpur, Malaysia  \n4 Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Universiti \n\n\n\nMalaya, Kuala Lumpur, Malaysia \n5 Centre for Natural Products Research and Drug Discovery Universiti \n\n\n\nMalaya, Kuala Lumpur, Malaysia \n6 Institute of Biological Science, Faculty of Science, Universiti Malaya, \n\n\n\nKuala Lumpur, Malaysia, \n7 Institute for Advanced Studies, Universiti Malaya, Kuala Lumpur, \n\n\n\nMalaysia, \n8 Clinical Investigation Centre, Universiti Malaya Medical Centre \n\n\n\n\n\n\n\n*Correspondence: kbtee81@yahoo.com \n\n\n\n\n\n\n\nIntroduction: Metformin is a first-line anti-diabetic agent \n\n\n\nthat has been widely used for treatment of type 2 diabetes \n\n\n\nmellitus (T2DM). The drug is responsible for increasing the \n\n\n\nglucose uptake in the liver and skeletal muscles, and \n\n\n\nsuppressing gluconeogenesis in the liver and interstitial \n\n\n\nglucose absorption. Non-targeted metabolomics is a \n\n\n\ncomprehensive investigation to identify the pharmacological \n\n\n\neffects and adverse effects of a medicine (1). Objective: The \n\n\n\nobjective of this study is to identify the metabolic pathways \n\n\n\nof metformin in urine samples of healthy subjects. Method: \n\n\n\nThe study is registered with ClinicalTrials.gov, approved by \n\n\n\nethics committee and performed in accordance to Malaysian \n\n\n\nGood Clinical Practice (2). Subjects who underwent at least \n\n\n\n10 hours fasting were given single doses of metformin \n\n\n\n1000mg tablet. Urine samples for six subjects at pre-dose and \n\n\n\nevery 4 hours post dose until 12 hours after oral \n\n\n\nadministration were analyzed using Liquid Chromatography \n\n\n\nMass Spectrometry Quadrupole Time-of-flight (LCMS-\n\n\n\nQTOF) with reverse phase column. Modified METLIN \n\n\n\nmethod (3) was used in the instrumental setting for global \n\n\n\nmetabolomic analysis in positive and negative modes. Pooled \n\n\n\nquality control samples and internal standards were spiked \n\n\n\ninto the samples to control the analysis and batch-to-batch \n\n\n\nconsistency. The chromatograms were further processed \n\n\n\nusing MetaboAnalyst software (4). Multivariate analysis and \n\n\n\nparametric statistical analysis were performed to identify \n\n\n\ncompounds. The compounds were paired with the Kyoto \n\n\n\n\nmailto:kbtee81@yahoo.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 7, Issue 1, Supplementary (2021), 49-78 \n\n\n\n75 \n\n\n\n\n\n\n\nResearch Presentation of National Pharmacy Convention 2021 \n\n\n\nDOI:  10.52494/UCML9733 \n \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nEncyclopedia of Genes and Genomes (KEGG) to predict the \n\n\n\nbiological perturbation involved after metformin absorption.   \n\n\n\nResult and discussion: From the untargeted metabolomic \n\n\n\nanalysis, metformin was found in all the post-dose urine \n\n\n\nsamples but not available in any pre-dose sample. Metformin \n\n\n\nwas absorbed and excreted through urine in healthy subjects. \n\n\n\nFigure 1 demonstrates the metabolic pathways for pre-dose \n\n\n\nversus 4-hour post-dose. In the 4-hour and 8-hour post-dose \n\n\n\nurine samples, urea cycle or amino group metabolism and \n\n\n\nglycine, serine, alanine and threonine metabolism are having \n\n\n\nsignificant biological perturbation in the control \n\n\n\nenvironment. Similar metabolic pathways were observed by \n\n\n\nstudy on T2DM subjects (5). Conclusion: Untargeted \n\n\n\nmetabolomic analysis in urine samples using LCMS-QTOF \n\n\n\nis able to identify biological perturbation of metformin. This \n\n\n\nemerging approach sheds light on the pharmacological \n\n\n\neffects of the drug during phase one clinical trials. \n\n\n\n  \nReference \n\n\n\n \n[1] Burt T, Nandal S. Pharmacometabolomics in Early\u2010Phase Clinical Development. Clinical \n\n\n\nand Translational Science. 2016;9(3):128-38. \n\n\n\n[2] NCCR. Malaysian Guideline for Good Clinical Practice. 4th ed2018. \n\n\n\n[3] Technologies A. MassHunter METLIN metabolite PCD/PCDL quick start guide USA: \n\n\n\nAgilent Technologies; 2014 [Available from: \n\n\n\nhttps://www.agilent.com/cs/library/usermanuals/Public/G6825-\n\n\n\n90008_MetlinPCDL_QuickStart.pdf. \n\n\n\n[4] Chong J, Wishart DS, Xia J. Using MetaboAnalyst 4.0 for Comprehensive and Integrative \n\n\n\nMetabolomics Data Analysis. Curr Protoc Bioinformatics. 2019;68(1):e86. \n\n\n\n[5] Aleidi SM, Dahabiyeh LA, Gu X, Al Dubayee M, Alshahrani A, Benabdelkamel H, et al. \n\n\n\nObesity Connected Metabolic Changes in Type 2 Diabetic Patients Treated With \n\n\n\nMetformin. Frontiers in pharmacology. 2021;11:616157-. \n\n\n\n\n\n\n\nAbstract 049 \n\n\n\n\n\n\n\nTransforming Pharmacy Education \n\n\n\nvia a Gamified Flipped Classroom \n\n\n\nApproach \n \nFaiza Naimat1,2, Siti Nur Adilah Mohd Yusdi1, \n\n\n\nMathumalar Loganathan Fahrni1,3* \n\n\n\n \n1 Faculty of Pharmacy, Universiti Teknologi MARA Selangor Branch, \n\n\n\nPuncak Alam Campus, 42300, Selangor Malaysia \n2 Management and Science University (MSU), Off Persiaran Olahraga, \n\n\n\nSelangor, Malaysia \n3 Collaborative Drug Discovery Research (CDDR) Group, Communities of \n\n\n\nResearch (Pharmaceutical and Life Sciences), Universiti Teknologi MARA \n\n\n\n(UiTM), Selangor Darul Ehsan, Malaysia  \n\n\n\n\n\n\n\n*Correspondence: drmalar@uitm.edu.my \n\n\n\n\n\n\n\nIntroduction: Pharmacy education in the 21st century has \n\n\n\nfast-transformed from the traditional classroom to flipped \n\n\n\nclassroom lessons where instructional videos are viewed \n\n\n\nprior and scheduled lessons have instead become  avenues for \n\n\n\nworking through problems. In collaborative learning, \n\n\n\nengagement is key. Methods: Using an open-source \n\n\n\napplication, QuizWhizzer,  two academic pharmacists \n\n\n\ntogether with an undergraduate developed an online, \n\n\n\ninteractive teaching and learning mode for \n\n\n\npharmacotherapeutics \u2013 a subject often considered \u2018dry\u2019 by \n\n\n\nstudents. Two or more players could engage in a competitive \n\n\n\ngame, where their goal is to answer as accurately as possible \n\n\n\nthe questions on cancer-associated thrombosis (CAT). \n\n\n\nQuestions were designed in sets of 10 seconds, with varying \n\n\n\ndegrees of difficulty: from easy, medium to difficult. The two \n\n\n\nacademic pharmacists reviewed and rated the reliability of \n\n\n\nquestions.  Pilot testing of undergraduates\u2019 perception was \n\n\n\ndone. A 4-item questionnaire, with a 5-point Likert scoring, \n\n\n\nwas distributed to 30 students who attempted QuizWhizzer. \n\n\n\nThese students had completed the course \u201cNeoplastic \n\n\n\ndisorders\u201d. Areas assessed were: engagement, evaluation of \n\n\n\nintellectual skills, problem-solving skills and motivation. A \n\n\n\nbivariate correlation was performed to evaluate the \n\n\n\ncorrelation between game scores and student perception. \n\n\n\nResults and discussion: The game is web-based and \n\n\n\ncompatible on all gadgets and operating systems. It used two \n\n\n\nconcepts of engagement: quiz and utilising a board game. \n\n\n\nScore keeping via a leaderboard meant that students \n\n\n\neffectively compete and positively challenge one another. \n\n\n\nWith every accurate answer, the student gets a turn to roll a \n\n\n\nvirtual dice, which will determine how far \u201cup the ladder\u201d he \n\n\n\nor she will proceed. Upon completion of each level, the \n\n\n\nplayer is to advance to a more complex level of difficulty \n\n\n\nthroughout the game. The player who reaches the top first, is \n\n\n\nawarded as the winner. It took the 30 students an average of \n\n\n\napproximately 30 minutes per pair to complete the game. The \n\n\n\naccompanying questionnaire was filled in within an average \n\n\n\n \nFigure I. Metabolic Pathways using Mummichog Enrichment Analysis for \n\n\n\npre-dose versus 4 hours post-dose urine samples. \n\n\n\n \n\n\n\n\nhttps://www.agilent.com/cs/library/usermanuals/Public/G6825-90008_MetlinPCDL_QuickStart.pdf\n\n\nhttps://www.agilent.com/cs/library/usermanuals/Public/G6825-90008_MetlinPCDL_QuickStart.pdf\n\n\nhttps://www.agilent.com/cs/library/usermanuals/Public/G6825-90008_MetlinPCDL_QuickStart.pdf\n\n\nhttps://www.agilent.com/cs/library/usermanuals/Public/G6825-90008_MetlinPCDL_QuickStart.pdf\n\n\nmailto:drmalar@uitm.edu.my\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 7, Issue 1, Supplementary (2021), 49-78 \n\n\n\n76 \n\n\n\n\n\n\n\nResearch Presentation of National Pharmacy Convention 2021 \n\n\n\nDOI:  10.52494/UCML9733 \n \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nof  2 minutes. From the student\u2019s feedback, the average \n\n\n\nscore  obtained was 20 out of 30 marks (70%, + 2.4). Students \n\n\n\n(100%) perceived the game as exciting and fun \n\n\n\n(engagement). Students (100%) rated the game as positive in \n\n\n\nhelping them solve problems. While a majority (86.7%) felt \n\n\n\nthat the game was challenging, promoted healthy competition \n\n\n\namong themselves to remain motivated, 4 students were not \n\n\n\nsatisfied with the feedback available in the game as it did not \n\n\n\nassist with enhancing their intellectual skills. Game scores \n\n\n\nand perception levels were found to be moderately positively \n\n\n\ncorrelated, r =0 .34, p = 0.032. The game can be rolled out to \n\n\n\nundergraduate students enrolled into a course on neoplastic \n\n\n\ndisorders in order to assess the effectiveness of the novel \n\n\n\nteaching and learning or assessment method. Conclusion: \n\n\n\nPreliminary evaluation of students\u2019  perceptions regarding \n\n\n\nQuizWhizzer, showed positive ratings in the aspects of \n\n\n\nengagement, assessing intellectual skills, problem-solving \n\n\n\nability, academic performance and motivation. Future \n\n\n\ndirections to include perceptions of educators to assess \n\n\n\nstudent knowledge and memory retention of the lessons \n\n\n\ndelivered via the flipped classroom approach are plausible. \n\n\n\n \nReference \n\n\n\n \n[1] Bakhuys Roozeboom M, Visschedijk G, Oprins E. The effectiveness of three serious \n\n\n\ngames measuring generic learning features. Br J Educ Technol [Internet]. 2017 Jan 1 [cited \n\n\n\n2020 Jun 24];48(1):83\u2013100. Available from: http://doi.wiley.com/10.1111/bjet.12342 \n\n\n\n[2] Liu EZF, Chen P-K. The Effect of Game-Based Learning on Students\u2019 Learning \n\n\n\nPerformance in Science Learning \u2013 A Case of \u201cConveyance Go.\u201d Procedia - Soc Behav \n\n\n\nSci. 2013 Nov;103:1044\u201351.    \n\n\n\n[3] Linehan C, Ben K, Lawson S, Chan GG. Practical, appropriate, empirically-validated \n\n\n\nguidelines for designing educational games. In: Conference on Human Factors in \n\n\n\nComputing Systems - Proceedings. 2011. p. 1979\u201388.  \n\n\n\n\n\n\n\n\n\n\n\nAbstract 050 \n\n\n\n\n\n\n\nEvaluation of Degradation Kinetics of \n\n\n\nFlibanserin Bulk Drug under \n\n\n\nOxidative Stresses \n \nKhor Mei Ann1, Liew Kai Bin2, Chew Yik \n\n\n\nLing1* \n\n\n\n \n1 Faculty of Pharmaceutical Sciences, UCSI University, 56000 Cheras, \n\n\n\nKuala Lumpur, Malaysia. \n2 Faculty of Pharmacy, Cyberjaya University College of Medical Sciences, \n\n\n\n63000 Cyberjaya, Selangor, Malaysia. \n\n\n\n\n\n\n\n*Correspondence: meiann980711@gmail.com \n\n\n\n\n\n\n\nIntroduction: Flibanserin was approved by the United State \n\n\n\nFood and Drug Administration (USFDA) as the first drug for \n\n\n\nthe treatment of hypoactive sexual desire disorder (HSDD). \n\n\n\nIt is also prescribed as a treatment for mental disorders such \n\n\n\nas Schizophrenia, depression, anxiety as well as Parkinson\u2019s \n\n\n\ndisease. Drug stability studies play an essential role in \n\n\n\npharmaceutical products to ensure its quality, safety and \n\n\n\nefficacy. Determination of degradation kinetics is extremely \n\n\n\ncrucial as it can be used to determine the half-life and shelf \n\n\n\nlife of the drugs under specific storage conditions. Objective: \n\n\n\nThe objectives of this study are to evaluate the degradation \n\n\n\nkinetics and to determine the half-life and shelf life of \n\n\n\nflibanserin bulk drug under oxidative stresses. Method: The \n\n\n\nstudy was conducted using oxidative stress on flibanserin. \n\n\n\nThe oxidising agents used were hydrogen peroxide (H2O2) \n\n\n\nand radical initiator, azobisisobutyronitrile (AIBN) at room \n\n\n\ntemperature and at 50\u00b0C, respectively. The analysis was \n\n\n\nperformed using High Performance Liquid Chromatography \n\n\n\n(HPLC) equipped with a Phenomenex C-18 column. The \n\n\n\nmobile phase used was acetonitrile:ammonium acetate buffer \n\n\n\n(60:40 ratio). The flow rate was set at 0.5 ml/min. The \n\n\n\ninjection volume was 10 \u00b5L. The detection wavelength used \n\n\n\nwas 250 nm. The time for each analysis was 20 minutes. \n\n\n\nResult and Discussion: Degradation of 62.45 % had been \n\n\n\nobserved after 8 hours treatment under H2O2 oxidation. A by-\n\n\n\nproduct was detected in the HPLC analysis. The degradation \n\n\n\nkinetics of flibanserin under H2O2 oxidation followed the \n\n\n\nfirst order kinetics. The half-life determined was 5.527 hours \n\n\n\nwhile the shelf life (t90% and t95%) was 0.837 hours and 0.409 \n\n\n\nhours, respectively. Free radical degradation of flibanserin \n\n\n\nwas observed to be 82.97 % following the first order kinetics. \n\n\n\nFour unknown by-products were detected. The half-life \n\n\n\nobtained was 2 days while the shelf life (t90% and t95%) \n\n\n\nobtained was 7.848 hours and 3.840 hours, respectively at \n\n\n\n50\u00b0C. Conclusion: Flibanserin was sensitive to H2O2 \n\n\n\noxidation and radical degradation. Both oxidation \n\n\n\ndegradation follows first order reaction. \n\n\n\n \nReference \n\n\n\n \n[1] Ferger B, Shimasaki M, Ceci A, Ittrich C, Allers KA, Sommer B. Flibanserin, a drug \n\n\n\nintended for treatment of hypoactive sexual desire disorder in pre-menopausal women, \n\n\n\naffects spontaneous motor activity and brain neurochemistry in female rats. Naunyn-\n\n\n\nSchmiedeberg's archives of pharmacology. 2010;381(6):573-9. \n\n\n\n[2] Brotto LA. The DSM diagnostic criteria for hypoactive sexual desire disorder in women. \n\n\n\nArchives of sexual behavior. 2010;39(2):221-39.Academy of Managed Care Pharmacy. \n\n\n\n2009. Drug Utilization Review. (online). \n\n\n\nhttp://www.amcp.org/WorkArea/DownloadAsset.aspx?id=9296 (last accessed 17th \n\n\n\nDecember 2017). \n\n\n\n[3] Lee HK. Forced Degradation Studies and Development of a Stability Indicating Method \n\n\n\nof Flibanserin Active Pharmaceutical Ingredient [Research Thesis]: UCSI University \n\n\n\n \n\n\n\n\nmailto:meiann980711@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 7, Issue 1, Supplementary (2021), 49-78 \n\n\n\n77 \n\n\n\n\n\n\n\nResearch Presentation of National Pharmacy Convention 2021 \n\n\n\nDOI:  10.52494/UCML9733 \n \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nAbstract 051 \n\n\n\n\n\n\n\nEvaluation of a Local Protocol of \n\n\n\nVancomycin-Therapy in \n\n\n\nHaemodialysis Patients Based on \n\n\n\nTargeted Trough Level and \n\n\n\nExtrapolated Area Under the Curve in \n\n\n\na General Hospital  \n \nVithyah Nadaraja1*, Fazlollah Keshavarzi1, \n\n\n\nMuhammad Junaid Farrukh1, Yap Chuan \n\n\n\nSheng1, Aliza binti Alias2 \n\n\n\n \n1 Faculty of Pharmaceutical Sciences, University College Sedaya \n\n\n\nInternational (UCSI),56000 Kuala Lumpur, Malaysia \n2 Clinical Pharmacokinetic Department, Pharmacy Division, Hospital \n\n\n\nTengku Ampuan Rahimah Klang \n\n\n\n\n\n\n\n*Correspondence: vithyahn@gmail.com \n\n\n\n\n\n\n\nIntroduction: Recent published data from the 2020 IDSA \n\n\n\nguidelines on vancomycin dosing has no longer advocated \n\n\n\nthe use of trough concentrations as surrogate markers for \n\n\n\nclinical efficacy.  Protocols developed before the revised \n\n\n\ntargets may not reflect the true efficacy marker for \n\n\n\nvancomycin, which is AUC 400-600. Vancomycin exposure \n\n\n\nin haemodialysis patients is influenced by both patient \n\n\n\npharmacokinetic parameters and variables of the \n\n\n\nhaemodialysis units which reduces the likelihood of target \n\n\n\nattainment. Objective: To evaluate the clinical efficacy of \n\n\n\nlocal vancomycin dosing protocol in achieving target trough \n\n\n\nconcentration and area under the curve (AUC) among \n\n\n\nhaemodialysis patients in Hospital Tengku Ampuan Rahimah \n\n\n\n(HTAR). Method: Retrospective record review of eligible \n\n\n\nresearch participants according to previously validated data \n\n\n\ncollection form. The AUC of each individual was \n\n\n\nextrapolated via the use of a PK modelling software, \n\n\n\nPrecisePK. Chi-square test of independence was used to \n\n\n\ndetermine the association between trough concentrations to \n\n\n\nextrapolated AUC/MIC (minimum inhibitory concentration). \n\n\n\nA p-value of 0.05 was considered statistically significant. \n\n\n\nResult and Discussion: Eighty HD patients were included \n\n\n\nafter the screening, involving cases between December 2019 \n\n\n\nand January 2021. 62.5% of haemodialysis study patients \n\n\n\nshow AUC/MIC >800 (mean \u00b1 SD=2320.2 \u00b1 1418.2). The \n\n\n\ntrough concentrations across all four groups of AUC/MIC \n\n\n\n(<400; 400-600;600-800;>800) remain similar in \n\n\n\ndistribution. Chi square analysis between trough \n\n\n\nconcentrations and extrapolated AUC/MIC showed a lack of \n\n\n\nassociation (X2(6) = 11.370, p =0.51). AUC/MIC was heavily \n\n\n\ninfluenced by MIC of the infecting microorganism, (X2(12) \n\n\n\n= 164.93, p =0.00). Majority of MRSA cases were found in \n\n\n\nthe AUC/MIC> 800 with MIC values of 0.38\u03bcg/ml. \n\n\n\nConclusion: Exclusive trough guided dosing may not \n\n\n\ntranslate well in achieving the clinical efficacy of \n\n\n\nvancomycin in haemodialysis patients. Other contributing \n\n\n\nfactors such as MIC should be factored, as small MIC values \n\n\n\naccount for greater reciprocal AUC/MIC values. \n\n\n\nAUC/MIC > 800 in haemodialysis patients risks the loss of \n\n\n\nresidual kidney function. Preserving residual kidney function \n\n\n\nof HD patients serves as an important prognostic factor for \n\n\n\nreduced mortality in this patient population. \n\n\n\n \nReference \n\n\n\n \n[1] Rybak MJ, Le J, Lodise TP, Levine DP, Bradley JS, Liu C, et al. Therapeutic monitoring \n\n\n\nof vancomycin for serious methicillin-resistant Staphylococcus aureus infections: A \n\n\n\nrevised consensus guideline and review by the American Society of Health-System \n\n\n\nPharmacists, the Infectious Diseases Society of America, the Pediatric Infectious Diseases \n\n\n\nSociety, and the Society of Infectious Diseases Pharmacists. American Journal of Health-\n\n\n\nSystem Pharmacy. 2020.                                                                                                                  \n\n\n\n\n\n\n\nAbstract 052 \n\n\n\n\n\n\n\nKnowledge, Attitude & Practice of \n\n\n\nAlcohol Use among University \n\n\n\nStudents: A Cross-sectional Study \n \nIrene Lee Chin Ling*, Hee Mei Qi, \n\n\n\nMuhammad Junaid Farrukh \n \n\n\n\nFaculty of Pharmaceutical Sciences, UCSI University, 56000 Cheras, \n\n\n\nKuala Lumpur, Malaysia. \n\n\n\n\n\n\n\nCorrespondence: leechinlingirene@gmail.com \n\n\n\n\n\n\n\nIntroduction: Alcohol consumption is frequently reported \n\n\n\namong university students in many countries.  It is a social \n\n\n\nissue that should not be overlooked as they are the pillars of \n\n\n\nthe country\u2019s future. Objective: To study the knowledge, \n\n\n\nattitude, and practice of alcohol use among university \n\n\n\nstudents and to associate demographic variables with alcohol \n\n\n\nuse among university students in Kuala Lumpur. Method: A \n\n\n\ncross-sectional study was conducted and participants aged 18 \n\n\n\nto 30 years old were recruited using the convenience \n\n\n\nsampling method at UCSI University, Kuala Lumpur. The \n\n\n\nquestionnaire was validated by a panel of experts and a pilot \n\n\n\ntest was done among 37 university students to ensure the \n\n\n\nreliability. Data were collected between August and \n\n\n\nSeptember 2020 and analyzed by SPSS version 20. Result \n\n\n\nand Discussion: A total of 374 participants completed the \n\n\n\nsurvey. The findings showed that 54% of participants had \n\n\n\ngood knowledge of alcohol use while 46% of them had poor \n\n\n\nknowledge of alcohol use. About 54.3% of participants had a \n\n\n\npositive attitude towards alcohol use, while 45.7% of them \n\n\n\nhad negative attitude towards alcohol use. A total of 69% of \n\n\n\nparticipants started their first drink < 21 years old. Friends \n\n\n\ninfluenced alcohol use the most, followed by parents, \n\n\n\nsiblings, or relatives, and curiosity. Approximately 72% of  \n\n\n\nparticipants rarely consume alcohol. Also, 58.3% of the \n\n\n\nparticipants received a low level of harm from alcohol use \n\n\n\n\nmailto:vithyahn@gmail.com\n\n\nmailto:leechinlingirene@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  \n\n\n\nVolume 7, Issue 1, Supplementary (2021), 49-78 \n\n\n\n78 \n\n\n\n\n\n\n\nResearch Presentation of National Pharmacy Convention 2021 \n\n\n\nDOI:  10.52494/UCML9733 \n \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nwhile 22.7% of them received a high level of harm from \n\n\n\nalcohol use. The level of harm experienced was significantly \n\n\n\nassociated with gender, religion, course studied, and \n\n\n\nperceived parents\u2019 socioeconomic status with p-values \n\n\n\nshowed <0.05. Conclusion: Majority of the university \n\n\n\nstudents had good knowledge of basic alcohol information \n\n\n\nbut they had inadequate knowledge of standard drinking, \n\n\n\nbinge drinking, and heavy episodic drinking terms. More \n\n\n\nthan half of them had positive attitudes toward alcohol use \n\n\n\nand the majority of university students tend to experience a \n\n\n\nlow level of harm from alcohol use. Even though most of the \n\n\n\nuniversity students in the study rarely consume alcohol, \n\n\n\ninterventions to reduce alcohol consumption among \n\n\n\nuniversity students should not be disregarded. \n\n\n\n \nReference \n\n\n\n \n[1] Harmful use of alcohol [Internet]. WHO. [cited 2020 Jun 23]. Available from: \n\n\n\nhttp://www.emro.who.int/noncommunicable-diseases/causes/harmful-use-of-\n\n\n\nalcohol.html \n\n\n\n[2] National Health and Morbidity Survey 2019 [Internet]. The Malaysian Paediatric \n\n\n\nAssociation. 2019 [cited 2020 Nov 14]. Available from: https://mpaeds.my/national-\n\n\n\nhealth-and-morbidity-survey-2019/ \n\n\n\n[3] Alcohol Facts and Statistics [Internet]. National Institute on Alcohol Abuse and \n\n\n\nAlcoholism (NIAAA). [cited 2020 Nov 14]. Available from: \n\n\n\nhttps://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/alcohol-facts-and-\n\n\n\nstatistics \n\n\n\n[4] Mutalip MHBA, Naidu BBM, Kamaruddin RB, Hamid HABA, Ali NB, Ahmad NAB, et \n\n\n\nal. How Severe is Binge Drinking in Malaysia and Who are at Risk? J Alcohol Drug \n\n\n\nDepend. 2013;1(6).  \n\n\n\n[5] Mutalip MHBA, Kamarudin RB, Manickam M, Abd Hamid HAB, Saari RB. Alcohol \n\n\n\nconsumption and risky drinking patterns in Malaysia: Findings from NHMS 2011. \n\n\n\nAlcohol Alcohol. 2014;49(5):593\u2013599. \n\n\n\n \n\n\n\n\nhttp://www.emro.who.int/noncommunicable-diseases/causes/harmful-use-of-alcohol.html\n\n\nhttp://www.emro.who.int/noncommunicable-diseases/causes/harmful-use-of-alcohol.html\n\n\nhttps://mpaeds.my/national-health-and-morbidity-survey-2019/\n\n\nhttps://mpaeds.my/national-health-and-morbidity-survey-2019/\n\n\nhttps://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/alcohol-facts-and-statistics\n\n\nhttps://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/alcohol-facts-and-statistics\n\n\n\n"
"\n\nMalaysian Journal of Pharmacy 2003; 1(3):54-58  Invited review \n\n\n\n 54\n\n\n\nThe Full Extent of Alcoholism:  \nA Worldwide Economic and Social Tragedy \n \nAlbert I. Wertheimer, Nicole M. Chaney \n \nSchool of Pharmacy, Temple University, Philadelphia, PA 19140, USA. \n \n \nABSTRACT \n \nAlcohol abuse affects many people directly or indirectly all over the world.  \nAlcoholism often causes major damage and can also lead to death.  It seems as \nthough people underestimate the prevalence of alcohol abuse and the damage done \nby alcohol abuse.  Loss of labour, birth defects, liver cirrhosis, and damage from \nvehicle accidents, are a small portion of the damage caused by alcohol abuse.  The \ndamage caused by alcohol abuse affects people physically, emotionally, and \neconomically.  All this damage is preventable.  Treatment for this problem is \navailable, but the effects differ among patients.  Pharmacotherapy and cognitive \nbehavioural therapy are used separately or collectively.  Results can vary depending \nupon the treatment and patient.  The pharmacist plays an important role in the lives \nof alcoholic patients.  Pharmacists can notice a patient\u2019s behaviour, notice their \nprescription patterns, and most importantly, the pharmacist is a knowledgeable \nmentor that many patients look up to.  Feeling comfortable with and trusting the \npharmacist is very important for the patient.  Patients may come to the pharmacist \nwith their problems, and the pharmacist should be able to offer sound medical \nadvice. \n \nKeywords: alcoholism, total cost of alcohol abuse, pharmacist intervention, \npharmacotherapy for alcohol abuse, alcohol treatment \n \n \nINTRODUCTION \n \nWhen we think about the most prevalent life \nthreatening, debilitating, and harmful diseases, we \nthink of AIDS, diabetes, heart disease, depression, \nand others.  Very few people acknowledge or are \naware of the complete effect of alcoholism, and \nhow it affects individuals, families, friends, \nstrangers, co-workers and society in general.  \nAlcoholism is a worldwide problem of chronic \ndrinking that affects all aspects of one\u2019s life.  We \nhear about drunk drivers, automobile accidents \nand domestic violence associated with \nalcoholism, but rarely do we look beyond the \nindividual or family perspective, it is a \npreventable massive expense to individuals, \ngovernments and society.  We probably don\u2019t take  \n\n\n\n \n \nthe consequences seriously enough because \nalcoholic beverages are sold openly everywhere \nand drinking is very much embedded in most \ncultures and societies. Let us look at the facts. \n \nIt has been found that alcohol dependence affects \n7.5% of the US population.  That represents \napproximately 14 million Americans.  \nAlcoholism, untreated and treated, causes \nphysical, emotional, and economic damage.  The \nextent as to how many people are affected on a \ndaily basis by this disease is innumerable.  First, \nwe will take a look at how individuals are \naffected. From the loss of earnings to the medical \nexpenses, alcoholism can certainly cost an \n\n\n\n\n\n\n\n\n  Invited review: The full extent of alcoholism \n\n\n\n 55\n\n\n\nalcoholic an immense amount of money.  It has \nbeen found that almost two thirds of the costs of \nalcohol abuse are a result of loss of labour (1). \n\n\n\nAlcohol related problems cost the alcohol abusers \nabout $66.8 billion, which is 45% of the annual \ntotal cost of alcohol abuse just in the USA. The \nactual cost that abusers pay may actually be less \nthan this figure, this is due to the fact that their \nfamily members and others pick up some of the \ncost (2). \n \nThere are many health problems associated with \nalcohol abuse.  The most prevalent health \nproblems are gastrointestinal.  Gastrointestinal \npain, bloating, nausea, and vomiting are all \nassociated with alcohol abuse.  Alcohol decreases \nthe rate of gastric emptying, increases gastric \nsecretions, and also damages the gastric mucosa.  \nGastritis and ulcers are common, and with heavy \ndrinkers, pancreatitis is prevalent.  The liver is the \norgan most affected by alcohol.  Liver problems \nare associated with upper-right quadrant pain.  \nThere are many liver disorders such as cirrhosis, \nhepatitis, cholestasis, and portal hypertension (3). \nAlcohol-related liver disease (ALD) is the most \nprevalent liver disease in the United States, and \npatients with this disease make up the largest \nportion of liver transplant recipients, almost 27% \nin 1995. Almost 20% of ALD patients require a \nliver transplant.  The demand for human liver \ndonations is much greater than the supply \navailable in the United States.  In 2000 only 4934 \npatients received liver transplants, by April of \n2001, there were 17,520 Americans waiting for a \nliver transplant (4). \n  \nAlcohol abuse affects the entire body, it causes \nmany cardiovascular, haematological, \ngynaecologic, metabolic, and central nervous \nsystem problems.  Hypertension, stroke, sudden \ndeath and heart failure are common \ncardiovascular disorders associated with alcohol \nabuse.  Long-term alcohol abuse can suppress the \nproduction of leukocytes, erythrocytes and \nplatelets.  Anaemia is very common, as are many \nvitamin deficiencies that are due to poor \nabsorption and poor intake of vitamins.  The fact \nthat over half the alcoholic\u2019s caloric intake is \nalcohol further displays the problem, which \ncauses electrolyte imbalances and also \nmalnutrition.  Alcoholism also affects \nneurological function, decreasing memory, motor \nskills, and affecting neuron transmittance.  \nAlcoholism affects all aspects of the abuser, both \nphysically and mentally.  Not only can alcohol \nabuse result in physical problems, it can result in \n\n\n\npsychological disorders also.  Depression affects \napproximately 33% of problem drinkers.  \nDepression affects the response of patients to \ntreatment and also their relapse rate.  The high \nrelapse rate results from negative emotional states \nand recurrent relapses may cause a feeling of \nhelplessness, causing drinkers to feel that their \ndrinking is out of control and that they will never \nbe able to stop drinking (5). \n\n\n\n \nAlcoholism and the side effects associated with it \noften lead to sudden and early death.  Not only \ndoes alcoholism affect the abuser, non-abusers are \nalso affected, it has been shown that alcohol abuse \ncosts non-abusers $81.2 billion annually in the \nUSA.  Family members and household members \nare affected immensely.  Non-abuser victims are \ndirectly responsible for 6% of the alcohol related \ncosts, but indirectly much more, with taxpayers \npicking up the bill that the government has to pay.   \n \nIn addition to adults and children being affected \nby alcohol abuse, foetuses are also affected by \nalcohol abuse.  Almost 5,000 babies are born each \nyear with Foetal Alcohol Syndrome (FAS).  This \nis approximately one in every 750 births. The rate \nof FAS is much higher in Native Americans, than \nthat of Caucasian or African-Americans. A child \nwith FAS may have a variety of problems, such as \npre-natal and post-natal developmental problems, \nvarious facial malformations, various organ \nmalformations, and also central nervous system \nproblems.  Foetal Alcohol Effects (FAE) occurs \nin 3-5 out of 1,000 live births and it results in \nmilder symptoms, such as low birth weight.  \nFoetal Alcohol Effects results from pregnant \nmothers who drink less alcohol than those with \nFAS children.  Treatment of infants, children and \nadults with FAS in 1992 cost over $1.9 billion.  It \ncosts about $1.4 million to treat a FAS affected \nchild throughout his life.  Additional healthcare, \neducation, attention, etc. are factors affecting the \ncost of a FAS child to their family, private \ninsurers, Health Maintanance Organisations, and \nthe government (6).  This disease is completely \npreventable, yet alcohol exposure is the most \ncommon cause for birth defects.  Alcohol abuse \nduring and prior to a pregnancy affects the \ndevelopment of the foetus during pregnancy and \nfor the remainder of its life (7). \n\n\n\n \nEmployers are affected by this disease with lost \nproductivity costing them about $66.7 billion per \nyear (2). Lost earnings and decreased wages \nrepresent the lower productivity of an alcohol \nabuser.  When workers perform below their \n\n\n\n\n\n\n\n\n  Invited review: The full extent of alcoholism \n\n\n\n 56\n\n\n\nability level it results in decreased profits.    \n \n\n\n\nThe government is also affected by this major \ndisorder, paying about $13.6 billion dollars in \ndamage due to alcohol related accidents, \nincarcerating alcohol abusers, court costs, crime \nrelated costs, etc. They also accept 38.6% of the \ncomplete costs of alcohol abuse (2). \n\n\n\n \nHealth Maintenance Organisations and private \ninsurers pay 10.2% of alcohol related abuse costs \n(2).  Life insurance policies pay about $12,000 per \ndeath for the approximately 106,600 deaths per \nyear where alcohol is responsible.   \n\n\n\n \nVarious physical damages are caused and related \nto alcohol abuse.  Alcohol related motor vehicle \ndamage is approximated at $13.6 billion; this \nincludes vehicle and road damage, court costs, \nand insurance administration.   \n\n\n\n \nVictims of violent and non-violent crimes are \naffected primarily in the form of lost earnings, the \nlosses are estimated at $1 billion.  Property crime \nrelated to alcohol abuse is estimated at $427 \nmillion, this represents lost cash and property.  \nTogether alcohol and drug abuse related property \ncrimes, represent 30% of the value of total \nproperty crimes.   \n\n\n\n \nApproximately 140,000 alcohol related criminals \nare incarcerated annually, causing a major \ndecrease in productivity.  About $5.4 billion \ndollars are lost annually due to incarceration of \nalcohol related criminals; this loss of prospective \nproductivity affects the economy greatly. \nAlthough this primarily is a loss to the inmate, it \nis also a loss to the government and to the society \nwith the loss of potential tax revenue and the cost \nof keeping the inmate incarcerated, which is \napproximately $12,000 per year.   \n\n\n\n \nThere are many additional disorders that result \nfrom alcoholism, which are additional factors in \nthe cost of alcoholism.  Depression, as described \npreviously, is one of the major adverse concerns \nof problematic alcohol abuse.   \n \nTreatment \n \nThere are many different treatments for \nalcoholism, from detoxification to drug therapy \nand counselling.  Treatment varies depending \nupon the length of illness, additional amount of \nalcohol-related problems, and whether or not the \npatient really wants to overcome his addiction.  \n\n\n\nMore than 700,000 people receive treatment \neveryday (8).  Patients are either treated on an \ninpatient or outpatient setting.  13.5% of treated \npatients receive residential treatment, and 86.5% \nof patients receive outpatient treatment.  The \ncommonly used behavioural treatments are \ncognitive-behavioural therapy, motivational \nenhancement therapy, and Alcoholics Anonymous \nsessions.  These treatments have an equal amount \nof effectiveness, as shown in the Project MATCH \ntrial (9).  Often, pharmacotherapy can supplement \nthese treatments.  These treatments can be very \ncostly, but when factoring in the damage that a \nlifetime of problem drinking can cause, treatment \nappears to be quite a bargain.   \n \nDetoxification is the first step of treatment for \nmany patients.  It is a form of medically assisted \nwithdrawal from alcohol.  Medication is often \nrequired to prevent seizures and hypertension.   \nAfter an extended period of heavy alcohol abuse \npeople usually experience many alcohol \nwithdrawal symptoms.   Detoxification is \nintended to manage the medical and \npsychological symptoms of alcohol withdrawal.  \nPatients can be treated by detoxification, in either \nan inpatient or outpatient setting (10).  Price \nvaries from centre to centre, but for example, at \nThe Healing Centre in Raleigh, North Carolina, it \ncosts $261 per day for a detoxification bed, $200-\n$500 per day for emergency services, and $58 per \nday for detention services.  Treating alcohol-\nrelated problems costs society much less than if \nleft untreated.    \n\n\n\n \nIn the 1980s, alcoholism and other addiction \nproblems were thought of as physical problems, \nwith treatment mainly focused on detoxification.  \nMore recent research and a greater knowledge of \nbrain biology have evolved addiction treatment to \nfocus on lifetime abstinence.  Long-term \nprograms such as twelve-step and mutual help \nprograms focus on lifetime abstinence and \npreventing relapse.  Alcoholics Anonymous (AA) \nis one the oldest and most popular of the self-help \ngroups for addicts.  Established in 1935 and \ncurrently having over 2 million members, AA is \nclinically proven to reduce problem drinking and \nrelapses and also results in a higher level of social \nfunctioning.  AA is a very cost-effective \ntreatment; the program is free to those who want \nto stop drinking.  Donations are accepted and \nappreciated as they are used to off-set costs of \nmeeting places and coffee.  After the success of \nthis twelve-step program, many private inpatient \ntreatments have based their treatment on the \n\n\n\n\n\n\n\n\n  Invited review: The full extent of alcoholism \n\n\n\n 57\n\n\n\nideals of AA (11). \n \n\n\n\nNaltrexone is an opioid antagonist approved by \nthe Food and Drug Administration as an adjunct \ntherapy to be used along with conventional \npsychosocial therapies for alcohol abuse.  \nAlthough naltrexone is not a magic answer for \nalcoholics, as an additional therapy it greatly \nreduces relapses.  The Brown University Center \nfor Alcohol and Addictions Studies recently \nembarked upon a 5-year study of the effect of \nnaltrexone on heavy social drinkers in their social \nenvironment (12).  COMBINE is a recent study in \nprogress that combines pharmacological and \nbehavioural therapies for alcohol abuse.  The \ncompletion of this study will provide researchers \nin this field with information to treat alcoholic \npatients more successfully (13). \n\n\n\n \nReview: \n \nAlcohol abuse has been recorded before \nagriculture was known.  In the prehistoric period, \npeople used whatever was available to create a \nfermented drink.  Over the centuries alcohol has \nevolved from basic ethanol to wine and beer.  The \nuse and abuse of these alcoholic beverages began \nto increase in the 15th century.  In London prices \nwere raised on alcoholic beverages to discourage \nits use.  It wasn\u2019t until the mid-nineteenth century \nthat chronic alcohol abuse was studied.  Some \nearly treatments for alcohol abuse included \napomorphine and emetine, which induced \nvomiting upon the consumption of alcohol.  \nPhysicians eventually focused on prophylaxis \nsince positive cures seemed nearly impossible \n(14). \n \n\n\n\nCurrent treatment of alcoholism involves private \nrehabilitation, drug therapy, counselling services, \nAlcoholics Anonymous, etc. Private rehabilitation \nhas had a large increase since the 1970s, where \nthe number of beds in private rehabilitation \nfacilities quadrupled from 1978-1984.  Many \nprivate insurance companies and the federal \ngovernment bear the cost of this treatment, which \nis approximately $18,000 per hospital stay.  This \nis a major burden on our healthcare system.  It has \nbeen found that patients who undergo lengthy \ninpatient, residential treatments are no better off \nin overcoming their addiction than those left on \ntheir own for treatment.  In a study done by \nGeorge Vaillant, 95% of those treated as an \ninpatient at an urban hospital had a relapse.  In \nanother study done by Helzer et al., findings \nshowed that 93% of the patients at an inner-city \n\n\n\nhospital were either dead or still abusing alcohol \nfive to seven years after treatment.  Those treated \nat a private rehabilitation facility are more likely \nto show better results (15). \n \n\n\n\nThe best treatment for alcoholism is one that \nteaches life skills without alcohol.  Programs need \nto incorporate training in stress management, life \nskills, social and negotiation skills, job skills, and \nwork habits (15). In addition to these \npsychological and social treatments, recent drug \ntherapy has produced some positive and \nproductive results. Naltrexone, an opioid \nantagonist, decreases alcohol consumption by \nblocking the receptors in the brain that encourage \ndrinking behaviour.  Clinical trials done in the \nearly 1990s have shown that naltrexone, in \naddition to psychosocial treatments, effectively \nreduces craving and relapse rates in alcoholic \npatients.  It costs approximately $100/month for \nthe average dosage of 50mg/day.  Dosages may \nbe adjusted on an individual basis (12). \n \nWhat can the pharmacist do? \n \nDepending on the circumstances of pharmacy \npractice in different countries, there are several \navenues open to the pharmacist.  The first step in \nany treatment is problem recognition and the \npharmacist may be in a position to notice \nexcessive sales and use of elixirs or other alcohol-\ncontaining medicines.  The pharmacist may want \nto discuss this with the patient or a relative of the \npatient.  The pharmacist can promise confidential \ntreatment and service, and have information \navailable for referrals to alcoholism treatment \nclinics.   \n \nBeyond such recognition of the problem, one can \nassume that an innocent patient question as to the \nexistence of OTC products to help people with \u201ca \ndrinking problem\u201d might be a lead to offer help.   \n \nThe next task for the pharmacist is that of \neducator/counsellor and referral agent.  The \npatient needs to know that competent help is \navailable, and where, and what it might involve, \nand cost.  It would be advisable if the pharmacist \ncould ascertain if health insurance may pay for \nsome or all of the fees.  A wise pharmacist might \nattempt to seize the moment by making an \nappointment for the patient at such a clinic. \n \nThorough pharmaceutical service calls for the \npharmacist to follow-up periodically with the \npatient, probably by telephone, or in-person, and \n\n\n\n\n\n\n\n\n  Invited review: The full extent of alcoholism \n\n\n\n 58\n\n\n\nfor encouragement to be offered while lauding the \nalready completed steps for the patient. \n \nThe pharmacist can check that patient\u2019s profile in \nthe future to see that medications containing \nalcohol are avoided.  As newer therapies and \ntechniques become known, the pharmacist should \ntake it upon him or herself to stay up-to-date, in  \n\n\n\norder to offer the best and latest information to \ntheir patients. \n \nPerhaps even 80% to 90% of patients will ignore \nthe pharmacist\u2019s advice, but the successfully \ntreated 10 to 20% make that activity worthwhile \nand valuable to all concerned parties. \n\n\n\n\n\n\n\n\n\n\n\n***** \n \n\n\n\nREFERENCES \n \n1. Feng W, Zhou W, Butler JS, Booth B, French M. \n\n\n\nThe impact of problem drinking on employment. \nHealth Economics 2001; 10:509-521. \n\n\n\n2. National Institute on Drug Abuse, \n(www.nida.nih.gov) \n\n\n\n3. Stein M. Medical consequences of substance \nabuse. Psychiatric Clinics of North America 1999; \n22:352-370. \n\n\n\n4. DiMartini, Weinrieb R, Fireman M. Liver \ntransplantation in patients with alcohol and other \nsubstance use disorders. Psychiatric Clinics of \nNorth America 2002; 25:195-209. \n\n\n\n5. Siddharthan G, Hough M, Sitharthan T, Kavanagh \nD. The alcohol helplessness scale and its \nprediction of depression among problem drinkers. \nJournal of Clinical Psychology 2001; 57:1445-\n1457. \n\n\n\n6. National Institute on Alcohol Abuse and \nAlcoholism (www.niaaa.nih.gov) \n\n\n\n7. Thackray H, Tifft C. Fetal Alcohol Syndrome, \nPediatrics in Review 2001; 22:47-55. \n\n\n\n8. National Institute on Alcohol Abuse and \nAlcoholism. Alcohol alert, estimating the  \n\n\n\n\n\n\n\neconomic cost of alcohol abuse 1991, No. 11 PH \n293. \n\n\n\n9. Fuller R, Hiller-Sturmhofel S. Alcoholism \ntreatment in the United States: An overview.. \nAlcohol Research and Health 1999; 23:69-77. \n\n\n\n10. Williams, S. Introducing an in-patient treatment \nfor alcohol detoxification into a community \nsetting. J Clin Nursing 2001; 10:635-642. \n\n\n\n11. Chappel J, DuPont R. Twelve-step and mutual-\nhelp programs for addictive disorders, Psychiatric \nClinics of North America 1999; 22:425-446. \n\n\n\n12. Kranzler HR, Amin H, Modesto-Lowe V, Oncken \nC. Pharmacologic treatments for drug and alcohol \ndependence, Psychiatric Clinics of North America \n1999; 22:401-423. \n\n\n\n13. Bean P, Mattson M. Combined behavioral and \npharmacologic treatments of alcoholism. \nAmerican Clinical Laboratory 2001; 20: 8-11. \n\n\n\n14. Sourina, J. A History of Alcoholism. London:Basil \nBlackwell Ltd; 1990. \n\n\n\n15. Peele, S. What we now know about treating \nalcoholism and other addictions. The Harvard \nMental Health Letter 1991; 5-7. \n\n\n\n\n\n"
"\n\n1\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nCost Analysis on Ticagrelor Utilisation in the Treatment of Patients \nwith Acute Coronary Syndrome: A Preliminary Study\n___________________________________________________________________________\n\n\n\nL Anchah1*, AYY Fong2,3, TK Ong3\n\n\n\n1\tDepartment\tof\tPharmacy,\tSarawak\tGeneral\tHospital\tHeart\tCentre,\t94300\tKota\tSamarahan,\t\nSarawak,\tMalaysia\n2\tClinical\tResearch\tCentre,\tSarawak\tGeneral\tHospital,\t93586\tKuching,\tSarawak,\tMalaysia\t\n3\tDepartment\tof\tCardiology,\tSarawak\tGeneral\tHospital\tHeart\tCentre,\t94300\tKota\tSamarahan,\t\nSarawak,\tMalaysia\n*\tContact\tfor\tcorrespondence,\tplease\temail:\tlawrenceanchah@gmail.com\n\n\n\nABSTRACT\nBackground:\tDual\t therapy\twith\t aspirin\t and\t clopidogrel\t is\t the\t standard\t treatment\t for\t acute\t\ncoronary\tsyndrome\t(ACS).\tDual\tantiplatelet\ttherapy\tplays\tan\timportant\trole\tin\treducing\tmajor\t\nacute,\tshort-\tand\tlong-term\tadverse\tclinical\toutcomes.\tCurrently,\tthe\teconomic\tevaluation\tof\t\nticagrelor,\t a\t reversible\t and\t direct-acting\t oral\t antagonist\t of\t adenosine\t diphosphate\t receptor\t\nP2Y12\tremains\tunknown.\n\n\n\nObjective:\tTo\tcompare\tthe\tannual\tcost\tof\tticagrelor\tversus\tbranded\tclopidogrel\tin\tpatients\twith\t\nACS\tfrom\ta\tMalaysian\thealth\tcare\tperspective.\n\n\n\nMethods:\tThe\tdata\trequired\t for\t this\tanalysis\twas\tobtained\t from\ta\t2007\tstudy\tcarried\tout\tby\t\nFong\tet\tal.\t in\tACS\tpatients\t(n=57).\tAssumptions\tused\tfor\tthe\tpresent\tanalysis\twere\tbased\ton\t\ndata\t from\t the\tCardiac\tRehabilitation\t Program\t (CRP)\t study,\t the\t Study\t of\t Platelet\t Inhibition\t\nand\tPatient\tOutcomes\t(PLATO)\tand\tthe\tNational\tCardiovascular\tDisease\tACS\t(NCVD\tACS)\t\nregistry\tof\tMalaysia.\tFor\tall\tcalculations,\tthe\tRinggit\tMalaysia\t(RM)\tcurrency\tand\tprices\tas\tof\t\n2007\twere\tconsidered.\t\n\n\n\nResults:\tThe\tcost\tof\tclopidogrel\ttreatment\tin\tpost-ACS\tpatients\tfor\t30\tdays\twas\tcalculated\tto\t\nbe\t RM1,381,340\t (n=2072;\t daily\t cost=RM5.50)\t and\t assuming\t treatment\t with\t ticagrelor,\t the\t\ncost\twould\t be\tRM1,554,000\t (daily\t cost=RM8.70).\t Based\t on\t PLATO\t and\tNCVD\tACS\t 2007,\t\nit\twas\t estimated\t that\tmajor\t adverse\t coronary\t event\t (MACE)\t in\t the\t form\tof\tunstable\t angina\t\n(UA)\twould\toccur\tin\tan\tadditional\t21\tpatients\ton\tclopidogrel,\twhich\tcould\thave\tbeen\tavoided\t\nwith\tticagrelor.\tExtrapolating\tcost\tdata\tfrom\tCRP\tstudy,\tit\twas\testimated\tthat\tthe\tannual\tcosts\t\nfor\t21\tadditional\tcases\tof\tUA\t in\t terms\tof\tannual\t treatment\tand\treadmission\twould\tbe\tmore\t\nthan\tRM400,000.\tTreatment\twith\tticagrelor\twould\tthereby\tbe\tassociated\twith\tlesser\tnumber\tof\t\nMACE\tthat\tcan\tbe\ttranslated\tin\tavoiding\tannual\tcosts\tof\ttreatment\tof\tUA\tand\tresult\tin\tannual\t\ncost\tsavings\tof\tRM238,856.\n\n\n\nConclusion:\tAlthough\tdirect\tcomparisons\twere\tnot\tmade,\tthis\tanalysis\tsuggests\tthat\tticagrelor\t\ntherapy\tmay\tbe\ta\tmore\tcost-saving\talternative\tto\tclopidogrel\tin\tMalaysian\tpatients\twith\tACS.\nKeywords:\t ticagrelor,\t clopidogrel,\t acute\t coronary\t syndrome,\t cost\t analysis,\t major\t adverse\t\ncoronary\tevent\n\n\n\nKeywords:\t ticagrelor,\t clopidogrel,\t acute\t coronary\t syndrome,\t cost\t analysis,\t major\t adverse\t\ncoronary\tevent\n\n\n\n\n\n\n\n\n2\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nINTRODUCTION\n___________________________________________________________________________\n\n\n\nAcute\t coronary\t syndrome\t (ACS)\t is\t an\t important\t cause\t of\t mortality\t and\t hospitalisation\t in\t\nMalaysia.\tIt\tencompasses\ta\trange\tof\tischaemic\theart\tdiseases,\tsuch\tas\tunstable\tangina\t(UA),\tnon-\nST-elevation\tmyocardial\tinfarction\t(NSTEMI)\tand\tST-elevation\tmyocardial\tinfarction\t(STEMI).\t\nIt\tmost\tcommonly\toccurs\tdue\tto\tthe\trupture,\tfissuring\tor\tulceration\tof\tan\tatherosclerotic\tplaque\t\nalong\twith\tthrombosis\tand\tcoronary\tvasospasm\t(1).\tAccording\tto\tthe\tNational\tCardiovascular\t\nDisease\tACS\t(NCVD\tACS)\treport\t2007\tand\t2008,\tthere\twere\t2851\tACS-related\tadmissions\tin\t\nMalaysia\tin\t2008,\tof\twhich\t54%\tpatients\twere\tadmitted\twith\tSTEMI,\t23%\twith\tNSTEMI\tand\t23%\t\nwith\tUA.\tACS\twas\tmore\tcommon\tin\tmales\tthan\tfemales,\twith\tthe\tformer\tconstituting\t75%\tof\t\nthe\tACS-related\tadmissions\tin\t2008.\tThe\tin-hospital\tmortality\trate\tassociated\twith\tACS\tduring\t\nthe\tperiod\tfrom\t2006\tthrough\t2008\twas\tbetween\t7%\tand\t8%\t(2).\tIn\tGRACE\tstudy,\tthe\tmedian\t\nage\tof\tACS\tpatients;\twith\tSTEMI\twas\t64\tyears,\twith\tNSTEMI\twas\t68\tyears,\tand\twith\tUA\twas\t66\t\nyears.\tHowever,\tin\tMalaysia\taccording\tto\tNCVD\tACS\treport\tfor\t2006,\t2007,\tand\t2008\tthe\tmedian\t\nage\tof\tACS\tpatients\twith\tSTEMI,\tNSTEMI\tand\twith\tUA\twere\tsame\tat\t59\tyears\tsuggesting\tthat\t\npeople\tare\tgetting\taffected\twith\tACS\tat\tan\tyounger\tage\twhen\tcompared\tto\tdeveloped\tcountries.\t\nHence,\tit\tis\tnecessary\tto\tstudy\tdifferent\ttreatment\tpatterns\talong\twith\tassociated\tcost\tto\tdevelop\t\ncost\tanalysis\tstrategies\tfor\tpatients\tof\tdifferent\tsocioeconomic\tbackgrounds\tin\tMalaysia\t(3).\n\n\n\nAcute\tcoronary\tsyndrome\tis\tcharacterised\tby\tpartial\tor\tcomplete\tblockage\tof\tepicardial\tcoronary\t\nartery,\t which\t occurs\t due\t to\t a\t platelet-rich\t thrombus.\t Since\t the\t prognosis\t of\t the\t condition\t\ndepends\ton\tthe\tactivity\tof\tplatelets,\tdual\tantiplatelet\ttherapy\tis\tconsidered\tnecessary\tto\tavoid\ta\t\nrepeat\tocclusion\tin\tthe\ttarget\tvessel\tafter\ta\tsuccessful\tpercutaneous\tcoronary\tintervention\t(PCI).\t\nUntil\t recently,\t aspirin\t and\t clopidogrel\twere\t the\t drugs\t forming\t the\t dual\t antiplatelet\t therapy.\t\nThe\tantiplatelet\tactivity\tof\tclopidogrel\tis\tdependent\ton\tthe\tformation\tof\tthe\tactive\tmetabolite\t\nfrom\tthe\tprodrug.\tVarious\tgenetic\tor\tnon-genetic\t factors\t influence\t this\tbioactivation,\twhich\t\ntakes\tplace\t in\t two\tmetabolic\treactions\t in\t the\t liver.\tAs\ta\tresult,\tclopidogrel\t is\tassociated\twith\t\nconsiderable\t interindividual\t variation\t in\t antiplatelet\t activity.\t Delayed\t and/or\t insufficient\t\nbioactivation\tcauses\tlow-\tor\tno-response,\tthereby\tleading\tto\tadverse\tcardiovascular\toutcomes,\t\nsuch\tas\tstent\tthrombosis,\trecurrent\tMI,\tor\tcardiovascular\tdeath\t(4).\tThe\tlimitations\tassociated\t\nwith\tclopidogrel\ttherapy\thave\topened\tavenues\tfor\tnew\tantiplatelet\tagents.\n\n\n\nTicagrelor,\tan\toral\tand\treversible\tinhibitor\tof\tthe\tP2Y12\treceptor,\tbelongs\tto\ta\tnovel\tchemical\t\nclass\t called\t cyclopentyl-triazolopyrimidine\t (5).\t It\t is\t a\t direct\t acting\t agent\t and\t has\t a\t quicker\t\nand\tmore\tpredictable\tonset\tof\t action\tcompared\twith\t clopidogrel\t (4,5).\tAlso,\t the\tmore\t rapid\t\nneutralisation\tof\tticagrelor\u2019s\teffect\tallows\tplatelets\tto\tresume\tfunction\tmore\tquickly\t(5).\n\n\n\nThe\tStudy\tof\tPlatelet\tInhibition\tand\tPatient\tOutcomes\t(PLATO)\twas\ta\tmulticentre,\trandomised,\t\ndouble-blind\t trial\t conducted\t in\t 18,624\t patients\t to\t assess\t the\t superiority\t of\t ticagrelor\t over\t\nclopidogrel\t in\t the\tprevention\tof\tvascular\tevents\tand\tdeath\t in\tpatients\twho\thad\tACS\twith\tor\t\nwithout\tST\televation.\tThis\t study\tdemonstrated\t that\t treatment\twith\t ticagrelor\twas\tassociated\t\nwith\ta\tsignificant\treduction\tin\tmortality\tfrom\tvascular\tcauses,\tmyocardial\tinfarction,\tor\tstroke\t\nas\tcompared\twith\tclopidogrel\twithout\tan\tincrease\tin\tthe\trate\tof\toverall\tmajor\tbleeding.\tHowever,\t\nan\tincrease\tin\tthe\trate\tof\tnon-procedure-related\tbleeding\twas\tnoted\twith\tticagrelor.\tBased\ton\t\nthe\tPLATO\ttrial,\tseveral\tsubgroup\tanalyses\twere\tconducted\tto\tevaluate\tthe\tefficacy\tof\tticagrelor\t\nin\tvarious\tpatient\tpopulations.\tThese\tanalyses\tdemonstrated\tbeneficial\teffects\tof\tticagrelor\tover\t\nclopidogrel\tin\tpatients\twith\tSTEMI\treferred\tfor\tprimary\tPCI,\tpatients\twith\tdiabetes,\tpatients\t\nundergoing\tcoronary\tartery\tbypass\tgraft,\tand\tpatients\twith\tchronic\tkidney\tdisease.\tThese\tresults\t\nprovided\tevidence\tfor\tinclusion\tof\tticagrelor\tin\tEuropean\tSociety\tof\tCardiology\tguidelines\tfor\t\n\n\n\n\n\n\n\n\n3\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nACS\twithout\tST\televation\tand\tmyocardial\trevascularisation\t(6).\n\n\n\nEconomic\t analyses\t from\t the\t PLATO\t trial\t and\t other\t studies\t that\t compared\t ticagrelor\t with\t\nclopidogrel\t in\t patients\twith\tACS,\t have\t suggested\t that\t ticagrelor\t therapy\tmay\t be\tmore\t cost-\neffective\tthan\tclopidogrel\t(7-10).\n\n\n\nThe\t present\t study\twas\t conducted\t to\t assess\t the\t cost\t savings\t of\t treatment\twith\t ticagrelor\t for\t\n30\tdays\tin\tMalaysian\tpatients\twith\tACS.\tThis\tstudy\tseeks\tto\tsupplement\texpert\topinion\twith\t\nempirical\tdata\tregarding\tthe\tnext\tpotential\talternative\tfor\tantiplatelet\ttherapy\tin\tACS.\n\n\n\nMETHODS\nThe\tstudy\thad\trecruited\tconsecutive\tpatients\tadmitted\twith\tACS\tat\tCardiac\tTertiary\tReferral\t\nCentre\t (CTRC),\t Sarawak\t General\t Hospital,\t Malaysia\t (n=57),\t which\t is\t currently\t known\t as\t\nSarawak\tGeneral\tHospital\tHeart\tCentre\tand\tat\tDistrict\tGeneral\tHospital\tSibu,\tMalaysia\t(n=32)\t\nfrom\t 1\t October\t 2007\t to\t 30\t November\t 2007.\t All\t patients\t attended\t routine\t pre-scheduled\t\noutpatient\tfollow-up\t30-days\tafter\thospital\tdischarge.\tFor\tthe\tpurpose\tof\tthis\tanalysis,\tbaseline\t\ncharacteristics\tand\tpatient\toutcomes\tat\t30\tdays\twere\tretrieved\tfrom\tthis\tstudy.\n\n\n\nANALYSIS OF COST SAVING\nThe\tcost\tdetails\tcaptured\tfor\tthis\tanalysis\tincluded\tcosts\tof\tall\tmedical\tand\tnon-medical\tsupplies\t\nand\tcosts\tincurred\tfrom\tthe\tperspective\tof\tthe\thealthcare\tprovider.\tFor\tthe\tpurpose\tof\tthis\tstudy,\t\nit\twas\tassumed\tthat\treducing\tthe\tnumber\tof\tevents\t(non-fatal\tmyocardial\tinfarction,\tnon-fatal\t\nstroke,\t severe\t recurrent\t ischaemia,\t UA\t or\t other\t vascular\t causes)\t will\t ultimately\t reduce\t the\t\noverall\tcost\tof\ttreatment.\t\n\n\n\nThe\tincurred\tcost\t in\t treatment\tof\ta\tdisease\tpossibly\t indicates\t the\tdisease\tburden\tand\tcan\tbe\t\nmeasured\tdescriptively\t through\ta\t cost\tof\t illness\t study,\twhich\t translates\t the\t entire\tburden\tof\t\nresources\t used\t in\t the\t treatment\t into\t a\t monetary\t value.\t Measuring\t the\t direct\t costs\t during\t\nhospitalisation\t and\tdischarge\twould\tbe\t the\tmost\t ideal\t approach\t to\t identify\tdirect\t economic\t\nburden\t to\t health\t care\t providers\t over\t a\t period\t of\t time.\t Based\t on\t the\t data\t obtained\t from\t\nCardiac\tRehabilitation\tProgram\t (CRP)\t study,\t the\t rate\t of\t hospitalisation\t resulting\t from\tACS\t\nwas\t estimated\t (11).\tThe\t direct\tmedical\t costs\t were\t calculated\t by\tmultiplying\t the\t number\t of\t\ninterventions\t(drug\tdoses,\tlaboratory\ttests,\tprocedures,\tconsumables,\tmedical\tequipments,\tand\t\nother\tinvestigations)\twith\tthe\tcost\tper\tintervention.\tThis\tdirect\tmedical\tcost\tcorrelates\twith\tthe\t\nnumber\tof\tinterventions\tnecessitating\thospital\tstay,\tclinical\texamination\tand\talso\ton\tthe\tlength\t\nof\tstay\twith\teach\tevent\tof\thospitalisation.\n\n\n\nSeveral\tsimplifying\tassumptions\tare\tmade\tto\tmaintain\ttransparency\tin\tthe\tmodel\tstructure.\tPost-\nACS,\ta\tpatient\tmay\tbe\tindicated\tfor\tcoronary\tartery\tbypass\tgraft\t(CABG),\telective\tsurgery\tfor\t\nPCI\tor\tmedications.\tPrices\tas\tof\t2007\tare\tconsidered\tfor\tcalculations\tand\tthe\tcurrency\tis\tRinggit\t\nMalaysia\t (RM).\tThe\teconomic\tevaluations\tare\tdone\t to\tcompare\t the\t two-treatment\t strategies\t\nbetween\tthose\tpatients\twith\tclopidogrel\tand\tto\tthose\tpatients\twho\tcould\thave\tbeen\topted\tto\t\nticagrelor\tas\tan\talternative\tADP\tinhibitor.\tThe\tprojected\tpotential\tcost\tsavings\tfor\ttreatments\t\nand\texpected\thealth\toutcomes\tof\tMACE\tare\tobtained\tby\tcomparing\tthe\ttwo\ttreatments\toption.\t\nAll\tdata\tused\tare\tbased\ton\ta\tsingle\tclinical\ttrial\tat\tCardiac\tTertiary\tReferral\tCentre\tand\tNCVD\t\ndatabase,\twhich\tare\tapplied\tto\tcompare\tthe\tcost\tand\tconsequences\tof\ttreatments.\tProbability\tof\t\nswitching\tto\tticagrelor\tin\tcost\tevaluation\tstrategies\twould\thelp\tto\testimate\tthe\texact\tcost\tsaving\t\nin\tinterventions\tand\ttreatment\toptions\tparticularly\tin\tlong-term\tdisease\tmanagement.\n\n\n\n\n\n\n\n\n4\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nBecause\ta\trange\tof\tcost\tof\ttreatments\tfor\tACS\twas\tused,\tthere\tis\tinevitably\tsome\tuncertainty\t\nin\testimated\tcosts\tincurred\tfor\tinterventions.\tSensitivity\tanalysis\twas\ttherefore\tconducted.\tThe\t\neffect\tof\ttreatment\tof\tMACE,\tcost\tof\tinterventions,\ttotal\tcost\ttreatment\tand\tother\tkey\tdata\tin\t\ncosts\tof\tmanaging\tACS\twere\ttested.\n\n\n\nRESULTS\nFor\t this\tanalysis,\tdata\trelated\t to\tpatients\trecruited\tonly\tat\tCTRC\tSarawak\twas\tconsidered\tas\t\ncost\tdetails\twere\tavailable\tonly\tfor\tthis\thospital.\tThe\tbaseline\tcharacteristics\tof\tthese\tpatients\tas\t\ncollected\tin\tthe\tstudy\tby\tFong\tet\tal.\thave\tbeen\toutlined\tin\tTable\t1\t(12).\n\n\n\n___________________________________________________________________________\n\n\n\n___________________________________________________________________________\n\n\n\nACS,\tacute\tcoronary\tsyndrome;\tCAD,\tcoronary\tartery\tdisease;\tCTRC,\tCardiac\tTertiary\tReferral\tCentre.\t\n\n\n\nThis\t study\t provided\t information\t on\t the\t occurrence\t rate\t of\t major\t adverse\t coronary\t events\t\n(MACE)\tduring\t the\tfirst\t30\tdays\tpost\tACS.\t In\t this\t study\t that\tbased\ton\tour\t local\t setting,\twe\t\nextracted\t and\t applied\t relevant\t information\t on\t cardiovascular\t death\t rate\t and\tUA\t incidences\t\nunto\tNCVD\tACS\tdatabase.\tAmong\tthe\t57\tpatients\trecruited,\t7\thad\ta\tMACE;\tof\twhich,\t4\twere\t\ncardiovascular\t deaths\t and\t 3\twere\tUA\t (Table\t 2).\tThis\t fraction\t 4\t over\t 7\t (4/7\tMACE)\t can\t be\t\nrelated\t to\t a\t similar\t approach\tpresented\t in\tNCVD\tACS\twhere\t cardiovascular\tdeath\t rate\twas\t\n10%.\tSimilarly,\tUA\twas\tseen\tin\ta\tfraction\tof\t3\tover\t7\tMACE\tor\tcorresponding\trate\t7.5%\tMACE\t\nin\tACS\tpatients\tpost\tadmission\tin\t30\tdays.\tThus,\tthe\tprevalence\trate\tof\ttotal\tMACE\tas\testimated\t\nfrom\tNCVD\tACS\t2007\twas\t17.5%\t(12).\n\n\n\n___________________________________________________________________________\n\n\n\n___________________________________________________________________________\n\n\n\nCTRC,\tCardiac\tTertiary\tReferral\tCentre;\tMACEs,\tmajor\tadverse\tcardiovascular\tevents.\n\n\n\nTable 1: Baseline characteristics of patients with ACS admitted to CTRC Sarawak General \nHospital, Malaysia\n\n\n\nTable 2: Patient outcome at 30 days\n\n\n\nMale\nAge\t(mean,\tyears)\nEthnic\tOrigin\n     Malay\n\t\t\t\t\tNon-Malay\tBumi\n\t\t\t\t\tChinese\nDiabetes\nHypertension\nSmoking\t(30\tdays)\nDyslipidaemia\nFamily\thistory\tof\tCAD\n\n\n\nCTRC\nInpatient\tmortality\n30-day\tMACEs\nInpatient\tangiography\nOutpatient,\telective\tangiography\n\n\n\nn=57\n41\n\n\n\n58\t\u00b1\t13\n\n\n\n23\n12\n22\n19\n37\n14\n16\n7\n\n\n\nn=57\n4\n3\n28\n5\n\n\n\nPercentage\n71.9\n\n\n\n40.4\n21.1\n38.6\n33.3\n64.9\n24.6\n28.1\n12.3\n\n\n\nPercentage\n7.0\n5.7\n49.1\n8.8\n\n\n\n\n\n\n\n\n5\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nFrom\tthe\tNCVD-ACS\treport\t2007\tand\t2008,\tit\twas\textrapolated\tthat\t65%\tof\tall\tpatients\twith\t\nACS\twho\t were\t admitted\t for\t treatment,\t received\t a\t daily\tmaintenance\t dose\t of\t an\t adenosine\t\ndiphosphate\t(ADP)\tantagonist\twith\tor\twithout\ta\tloading\tdose\t(2).\tIt\twas\tassumed\tthat\tthe\tADP\t\nantagonist\tgiven\tto\tpatients\twas\tclopidogrel\tas\tduring\tthat\tperiod\tthe\tevidence\trecommended\t\nclopidogrel\tand\tit\twas\talso\tthe\tonly\tstandard\tdrug\tavailable\t(13,\t14).\n\n\n\nAccording\t to\t the\tNCVD\tACS\t registry,\t there\twere\t 3,646\t cases\t of\tACS\t in\t 2007\t (2).\tOf\t these\t\npatients,\t2,072\tfulfilled\tthe\tinclusion\tcriteria\tused\tin\tthe\tPLATO\tstudy\tand\twere\tused\tfor\tall\tcost\t\ncalculations\tin\tthis\tanalysis.\tThe\tdaily\tcost\tof\tticagrelor\twas\thigher\tcompared\twith\tclopidogrel\t\n(RM8.70\tvs.\tRM5.50,\trespectively).\tThe\t30-day\tdrug\tcost\tof\tclopidogrel\ttreatment\tin\tMalaysian\t\npatients\t with\t ACS\twas\t calculated\t to\t be\t RM1,381,340.\t Using\t the\t same\t pool\t of\t patients\t and\t\nassuming\tthat\tticagrelor\twas\tused\tinstead\tof\tclopidogrel,\tthe\tcorresponding\tcosts\tof\ttreatment\t\nwith\tticagrelor\twould\tbe\tRM1,554,000.\tThe\tdifference\tin\tthe\tcosts\tof\tthe\ttwo\ttreatments\twould\t\nbe\tRM172,660\thigher\tfor\tticagrelor.\n\n\n\nThe\tPLATO\tstudy\tdemonstrated\tthat\tthere\twas\ta\trelative\trisk\treduction\t(RRR)\tof\t12.2%\tin\tthe\t\nprimary\tevent,\tfavouring\tthe\tticagrelor\tarm\tat\t30\tdays.\tThe\testimated\tMACE\tfrom\tNCVD\tACS\t\n2007\twas\t17.5%\tand\tthe\trate\tof\tMACE\tcould\thave\tbeen\treduced\tto\t15.4%\tif\tall\tthe\tACS\tpopulation\t\nin\t2007\twere\ttreated\twith\tticagrelor.\tBased\ton\tthis\tinformation,\tit\tis\testimated\tthat\t158\tpatients\t\nwere\thaving\tMACE\twhen\tusing\tclopidogrel\tand\tonly\t137\tMACE\twhen\tusing\tticagrelor.\n\n\n\nThus,\t there\t were\t 21\t additional\t cases\t of\t readmission\t due\t to\t UA\t with\t clopidogrel\t treatment\t\n(Figure\t1).\n\n\n\nTo\tcalculate\tthe\tcosts\tof\treadmission\tand\tmanagement\tof\t21\tpatients\twith\tUA,\tdata\tfrom\tCRP\t\nstudy\twas\t used.\t According\t to\t CRP\t study\t (11),\t the\t total\t direct\t cost\t for\t patients\t undergoing\t\nCABG\tduring\tthe\tsubsequent\t12-month\tfollow-up\tperiod\twas\testimated\tto\tbe\ta\tmedian\tvalue\t\nof\tRM53,562\tand\tthe\tcost\tfor\tpatients\ton\tinpatient\tcoronary\tangiography\tduring\tthe\tsubsequent\t\n12-month\tfollow-up\tperiod\twas\ta\tmedian\tvalue\tof\tRM16,620\twhich\twas\tthree\ttimes\tless\tthan\t\npatients\twho\thad\tundergone\tCABG\t(15).\tActivity\tbased\tcosting\t(ABC)\tmethod\twas\tused\t to\t\ndetermine\tthe\tdirect\tcost\tincluding\tconsumables,\tmedications\tand\tall\tother\toperational\tcosts\t\nassociated\twith\ttreatment.\tHowever,\tindirect\tcost\twas\tnot\tconsidered\tto\tdetermine\tthe\tcost\tfor\t\ntreatment.\t(Table\t3)\n\n\n\nFigure 1: Schematic representation of treatment options for unstable angina and \nprobabilities of clinical outcomes\n\n\n\nCABG,\tcoronary\tartery\tbypass\tgraft;\tPCI,\tpercutaneous\tcoronary\tintervention;\tUA,\tunstable\tangina.\n\n\n\n21\tpatients\twith UA\n57.9%\n\n\n\n1/3\n\n\n\n1/3\n\n\n\n1/3\n\n\n\n40.1%\n\n\n\nReadmission\nn=13\n\n\n\nPCI\nn=5\n\n\n\nCABG\nn=5\n\n\n\nWithout intervention\nn=3\n\n\n\nFollow-up\nn=8\n\n\n\nOutpatient\ntreatment\n\n\n\n\n\n\n\n\n6\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\n___________________________________________________________________________\n\n\n\n___________________________________________________________________________\nACS,\t acute\t coronary\t syndrome;\t CABG,\t coronary\t artery\t bypass\t graft;\t PCI,\t percutaneous\t coronary\t\nintervention;\tRM,\tRinggit\tMalaysia;\tUA,\tunstable\tangina\n\u2021\t\t\tDrug\tprices\tbased\ton\t2007\tmarket\tpricing.\n\u2020\u2020\tCost\tof\tpharmaceutical\texpenditure\tduring\tadmission\tfor\tquasi-experimental\tdesign\tin\tCRP\tstudy\t\t\n\t\t\t\t\t(n=104).\tOnly\tclopidogrel\t(Plavix\u00ae)\twas\tavailable\tand\tindicated\tfor\tthis\tACS\tgroup.\n\n\n\nTranslating\tthe\tfindings\tfrom\tthe\tstudy\tby\tFong\tet\tal.,\tof\tthe\t21\tpatients\treadmitted\twith\tUA,\t\nas\thigh\tas\t57.9%\t(13\tpatients)\twould\tbe\tplanned\t for\tor\tunderwent\tPCI\tor\tCABG\twithin\t30\t\ndays.\tIt\twas\tassumed\tthat\tan\tapproximately\tequal\tnumber\twould\tundergo\tPCI\twith\tdrug\teluting\t\nstent\t(1/3\u00d713\t\u2248\t5\tPCI\tprocedures),\tand\tCABG\t(1/3\u00d713\t\u2248\t5\tCABG)\tand\tthe\trest\twould\tbe\ton\t\noptimal\tmedical\ttherapy\talone.\tTherefore,\tthe\testimated\tannual\tcosts\tfor\t21\tcases\tof\tUA\tin\tterms\t\nof\t re-admissions\t and\t treatment\twould\t cost\t the\t health\t care\t provider\tmore\t than\tRM400,000.\t\nAlthough\t the\tdaily\t cost\tof\t ticagrelor\t treatment\t is\thigher,\t it\t is\t associated\twith\t lesser\tnumber\t\nof\treadmissions\twhen\tcompared\twith\tclopidogrel,\tthereby\tresulting\tin\tannual\tcost\tsavings\tof\t\nRM238,856\t(Table\t4).\n\n\n\n___________________________________________________________________________\n\n\n\n___________________________________________________________________________\n\n\n\nTable 3: Estimate direct cost of treatment for ACS patients in clopidogrel group\n\n\n\nPer\tpatient\tcost\tof\tdrugs\tduring\tadmission\tfor\tACS,\tmedian\t\n(range)\t\u2020\u2020\n\n\n\nEstimated\tper\tpatient\tcost\tof\toptimised\tmedical\ttherapy\tin\ta\t\nyear,\tmedian\t(range)\t\u2020\u2020\n\n\n\nFrom\thealth\tcare\tperspective\tthe\tannual\testimated\tdirect\tcosts\t\nper\tpatient\tfor\tthose\tundergoing\tCABG,\tmedian\t(range)\n\n\n\nFrom\thealth\tcare\tperspective,\tthe\tannual\testimated\tdirect\t\ncosts\tper\tpatient\tfor\tthose\tundergoing\tPCI,\tmedian\t(range)\n\n\n\nClopidogrel\tgroup\n(CRP\tstudy,\tn=104)\t\u2021\n\n\n\nRM\t1,078.45\t(95.44\u201313,559.11)\n\n\n\nRM\t2,731.91\t(1,365.26\u20135,976.96)\n\n\n\nRM\t53,562.25\t(46,538\u201361,542)\n\n\n\nRM\t16,620\t(4,565\u20139,182.68)\n\n\n\nTable 4: Distribution of the number of long-term prescription medications. (A) Daily cost \nof ADP inhibitors doses per day; (B) estimated cost of medical therapy in 30 days with \nADP inhibitors; (C) estimated cost of medical therapy for 2,072 patients from NCVD \nregistry; (D) the differences in 30 days between the two groups; (E) projected clinical \n\n\n\noutcomes (MACE) and cost incurred annually after 30 days treatment\n\n\n\n(A)\tDaily\tcost\tof\tADP\tinhibitors\t\u2021\n\n\n\n(B)\tEstimated\tper\tpatient\tcost\tof\tmedical\t\ntherapy\tfor\tfirst\t30\tdays\tafter\tdischarge\u2020\n\n\n\n(C)\tEstimated\tcost\tof\tmedical\ttherapy\tfor\t2,072\t\npatients\tfrom\tNCVD\tACS\tdatabase\tin\tfirst\t30\t\ndays\tafter\tdischarge#\n\n\n\n(D)\tDifference\tin\tcost\tof\tADP\tantagonist\t\ntherapy\tfor\t30\tdays\t(b-a)\n\n\n\n(E)\tEstimated\ttotal\tcosts\tincurred\tfor\ttreatments\t\nand\tinterventions\tof\t21\tpatients\twith\tUA\t\n\n\n\nClopidogrel group\u2020\u2020\n\n\n\nRM\t5.50\tper\tday\n\n\n\nRM\t666.67\n\n\n\nRM\t1,381,340\t(a)\n\n\n\n \nRM\t411,516*\t(d)\n\n\n\nTicagrelor\n\n\n\nRM\t8.70\tper\tday\n\n\n\nRM\t750\n\n\n\nRM\t1,554,000\t(b)\n\n\n\n \n-\n\n\n\nTicagrelor\n\n\n\nRM\t172,660\t(c)\n\n\n\n\n\n\n\n\n7\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nNCVD,\tNational\tCardiovascular\tDisease;\tUA,\tunstable\tangina;\tPCI,\tpercutaneous\tcoronary\tintervention;\t\nRM,\tRinggit\tMalaysia;\t$,\tUnited\tStates\tdollar.\n\u2021\tDrug\tprices\tbased\ton\t2007\tmarket\tpricing.\n\u2020\tThe\taverage\tmedical\tcost\tper\tpatient\tfor\tACS\tin\tfirst\t30\tdays\ttreatment\twith\tclopidogrel\twas\t$194.36\t\t\t\t\t\t\n\t\t\t($1=\tRM3.43).\n*\tApproximately\thigher\tnumbers\tof\tpatients\tundergo\tmedical\ttherapy,\tbut\tequal\tnumbers\tundergo\tPCI\t\t\n\t\t\tand\tCABG.\t\n\n\n\nOne-way\t sensitivity\t analyses\twere\tperformed\tby\t changing\t estimated\t costs\twithin\t a\t range\tof\t\npotentially\t reasonable\t values\t all\t treatment\t options\t (CABG,\t PCI\t or\t medication\t alone)\t and\t\nevaluating\twhether\tchanges\tin\ttreatment\toptions\tof\t21\tpatients\twith\tUA\tmodify\tincurred\tcost.\tIf\t\ntotal\tCABG\tintervention\tat\tthat\tyear\tescalates,\tthe\ttotal\tincurred\tcost\tof\ttreatment\twill\tdefinitely\t\nincrease.\tIt\tcan\tbe\tclearly\tseen\tthat\tthe\toverwhelming\tmajority\tof\tsimulation\tresults\tare\tlocated\t\nabove\tof\tRM400,000.\tThe\tmaximum\testimated\ttotal\tincurred\tcost\tof\ttreatments\tcould\treach\tto\t\nRM1.2\tmillion.\tThe\tanalysis\tshowed\tthat\teven\tif\twe\tdecrease\tthe\tnumber\tof\tmajor\tintervention\t\nlike\tCABG,\tit\twould\tnot\textensively\tdecrease\tthe\tcost\tof\ttreatments\tof\tMACE.\tThis\treflects\tthe\t\nsignificance\tof\tusing\tticagrelor\tand\tsuggests\ta\thigh\tprobability\tof\tcost\tavoidance\tin\tthe\ttreatment\t\nof\tMACE\t(Figure\t2).\t\n\n\n\nFigure 2: Sensitivity analysis: Influence of increase option of CABG in the total cost \nincurred in treatment of MACE.\n\n\n\nChanges in number of CABG intervention\n\n\n\n\n\n\n\n\n8\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nDISCUSSION\nAcute\tcoronary\tsyndrome,\twhich\twas\tinitially\tassociated\twith\tdeveloped\tcountries,\tis\ton\tthe\trise\t\nin\tAsia-Pacific\tcountries,\tincluding\tMalaysia\t(16,\t17).\tIn\torder\tto\treduce\tthe\trisk\tof\tdeveloping\t\nACS\tand\tcontrol\tthe\tassociated\tburden,\ta\tcomprehensive\taction\tplan\tis\trequired.\tTo\tthis\tend,\tthe\t\nNCVD\tACS\tregistry\twas\testablished\tin\t2006,\tto\tcapture\tdata\tof\tACS\tpatients\tin\tMalaysia\t(17).\t\nAccording\tto\tthe\tNCVD\tACS\treport\t2007\tand\t2008,\tACS\tis\taffecting\tthe\tMalaysian\tpopulation\t\nat\ta\tmuch\tyounger\tage\t (<50\tyears)\twhen\tcompared\twith\tfindings\t from\tGRACE.\tDuring\t the\t\nperiod\tfrom\t2006\tthrough\t2008,\tACS\twas\tassociated\twith\tin-hospital\tmortality\trates\tbetween\t\n7%\tand\t8%\t(2).\n\n\n\nThe\t availability\t of\t newer\t therapies\t has\t provided\t more\t alternatives\t to\t treating\t physicians.\t\nHowever,\tphysicians\tmust\tbe\tarmed\twith\tsufficient\tknowledge\tregarding\tnew\tdrugs\tin\torder\tto\t\nensure\ttheir\toptimal\tusage.\tThis\tincludes\tnot\tonly\tclinical\tdata\tregarding\tthe\tefficacy\tand\tsafety\t\nof\tthe\tdrug,\tbut\talso\tdata\ton\tits\tcost-effectiveness.\tThis\thelps\tin\tefficient\tutilisation\tof\tthe\tlimited\t\nhealth\tcare\tresources\tavailable\t(18).\n\n\n\nCost\tanalyses\tbased\ton\tthe\tPLATO\ttrial\thave\tbeen\tconducted\tto\tdetermine\tthe\tcost-effectiveness\t\nof\t12-month\tticagrelor\ttreatment\tin\tpatients\twith\tACS\tas\tcompared\twith\tclopidogrel\t(7,8).\tIn\t\none\tsuch\tanalysis\tconducted\tby\tNikolic\tet\tal.,\tticagrelor\ttreatment\twas\tassociated\twith\ta\tquality-\nadjusted\tlife\tyears\t(QALYs)\tgain\tof\t0.13\tand\tincreased\tcosts\tof\t\u20ac362,\tyielding\ta\tcost\tper\tQALY\t\ngained\tof\t\u20ac2753\tas\tcompared\tto\tgeneric\tclopidogrel.\tThe\tcost\tper\tlife\tyear\tgained\twas\t\u20ac2372.\t\nThe\tprice\tof\tgeneric\tclopidogrel\tconsidered\twas\t\u20ac0.06\tper\tday\t(lowest\tavailable\tprice\tas\tof\tJuly\t\n2011)\tand\tthat\tof\tticagrelor\twas\t\u20ac2.21\tper\tday\t(reimbursed\tprice\tin\tSweden).\tThe\tcost\tanalysis\tof\t\nticagrelor\twas\tuniform\tacross\tall\tsubgroups\tof\tACS\tpatients\u2014those\twith\tUA,\tSTEMI,\tNSTEMI,\t\nand\tthose\tplanned\tfor\tinvasive\tmanagement.\tThe\tstudy\tconcluded\tthat\tthe\tcost\tper\tQALY\tgained\t\nwith\t ticagrelor\t treatment\t in\t patients\twith\tACS\t for\t a\t 12-month\t period\t is\twithin\t the\t usually\t\naccepted\tlevels\tfor\tcost-effectiveness\t(8).\tAnother\tanalysis\tbased\ton\tthe\tPLATO\ttrial\tpublished\t\npreviously\thad\tshown\tsimilar\tresults.\tThe\tprice\tconsidered\tfor\tclopidogrel\tand\tticagrelor\tfor\tthis\t\nstudy\twas\t\u20ac0.17\tper\tday\tand\t\u20ac2.25\u20133.50\tper\tday,\trespectively\t(7).\n\n\n\nThe\t absence\t of\t similar\t data\t for\t countries\t in\t Asia,\t prompted\t Chin\t et\t al.\t performed\t a\t cost-\neffectiveness\t analysis\t of\t ticagrelor\t treatment\t in\t patients\t with\t ACS\t in\t Singapore.\tThis\t study\t\nwas\tbased\ton\tdata\tobtained\tfrom\tthe\tPLATO\ttrial.\tThe\tdaily\tcost\tof\tclopidogrel\tand\tticagrelor\t\nconsidered\twas\t1.05\tand\t6.00\tSingapore\tDollar\t($),\trespectively.\tThe\tQALY\tgained\twith\tticagrelor\t\nwas\t0.13\tat\ta\tlifetime\tincremental\tcost\tof\t$1328,\tyielding\ta\tcost\tper\tQALY\tof\t$10,136.\tThe\tstudy\t\ndemonstrated\t that\t even\t after\t considering\t the\t low\twillingness-to-pay\t threshold\t in\t Singapore\t\naccording\t to\t World\t Health\t Organisation\t standards,\t 12-month\t treatment\t with\t ticagrelor\t in\t\npatients\twith\tACS\tis\tlikely\tto\tbe\tfavorable.\tThe\tlower\thospitalisation-related\tcosts\twith\tticagrelor,\t\nmainly\tlower\tbed-days\tand\tlesser\tinterventions,\tcompensate\tpartly\tfor\tthe\thigher\tdrug\tcost\tof\t\nticagrelor\t(18).\n\n\n\nThese\tresults\tare\tsimilar\tto\tthe\tresults\tobtained\tin\tour\tstudy.\tOur\tstudy\talso\tdemonstrates\tthat\t\nin\tMalaysia,\t treatment\twith\t ticagrelor\t can\t result\t in\t annual\t cost\t savings\tof\tRM238,856\twhen\t\ncompared\twith\tclopidogrel.\tAlthough\tthere\tare\tshort-term\tcost\t savings\twith\tclopidogrel,\t the\t\ntrend\t clearly\t shows\t that\t readmission\t rates\t are\t higher,\t thereby\t increasing\t the\t overall\t cost\t of\t\ntreatment\tand\tcost\tburden\tin\tmanaging\tpatients\tin\tacute\tsetting.\n\n\n\nTo\tour\t knowledge,\t this\t cost\t analysis\t is\t the\t first\t of\t its\t kind\t to\t evaluate\t the\t cost\t of\t ticagrelor\t\ncompared\twith\tclopidogrel\tin\tMalaysian\tpatients\twith\tACS.\tIt\twas\tcarried\tout\tto\tsupplement\t\nthe\tclinical\tdata\ton\tticagrelor\tuse\tin\tMalaysia.\tIt\twas\tbased\ton\ttreatment\toutcomes\tof\tticagrelor\t\nfrom\tthe\tPLATO\ttrial,\tprevalence\tof\tACS\tin\tMalaysia\tfrom\tNCVD\tACS\tregistry\tand\ttreatment\t\noutcomes\tof\tclopidogrel\t in\tMalaysian\tpatients\t from\ta\t2-month\tstudy\t in\tCTRC\tSarawak.\tWe\n\n\n\n\n\n\n\n\n9\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\nhope\tthat\tthis\tstudy\twill\tprovide\ta\tbasis\tfor\tfuture\tstudies\tthat\twill\testimate\tthe\tcost\tsaving\tof\t\nticagrelor\tby\tits\tactual\tuse\tin\tMalaysian\tpatients\twith\tACS.\tSuch\tstudies\twill\thelp\tguide\thospitals\t\nand\tphysicians\tto\tmake\tinformed\tdecisions\tregarding\tthe\tusage\tof\tticagrelor\tin\tpatients\twith\t\nACS.\t\n\n\n\nLIMITATION\nThis\tstudy\thas\tcertain\tlimitations.\tIt\tis\tlimited\tto\ta\tsingle\tcentre;\thowever,\tthe\tresults\tare\tlikely\t\nto\tbe\trelevant\tto\tcardiac\tcentres\toutside\tthe\tstate\talso\tin\tterms\tof\tintended\tmanagement\tstrategy\t\n(i.e.,\t medical,\t interventional,\t or\t surgical)\t and\t clinical\t events\t (19,\t 20).\t Certain\t assumptions,\t\nwhich\twere\tmade\tfor\tthis\tstudy,\tmay\taffect\tthe\trobustness\tof\tresults.\tAlso,\tclinical\toutcomes\tof\t\nticagrelor\t treatment\twere\tadapted\t from\tthe\tPLATO\tstudy\tand\textrapolated\t to\t the\tMalaysian\t\npopulation.\tThis\tmay\tagain\taffect\tthe\tresults\tof\tour\tanalysis\tas\ttreatment\toutcomes\tmay\tvary\tin\t\ndifferent\tpopulations.\t\n\n\n\nIt\t is\t also\t likely\t that\t the\t incurred\t costs\t for\t treatments\t and\t interventions\t for\t ACS\t were\t\nunderestimated\t in\t this\t analysis\t as\t only\t the\t perspective\t of\t the\t healthcare\t providers\u2019\t was\t\nconsidered.\tA\tcomplete\toverview\tof\tthe\tcost\tof\tticagrelor\ttreatment\tin\tpatients\twith\tACS\tcould\t\nhave\tbeen\tobtained,\tonly\tif\twe\tcould\tmeasure\tthe\tcosts\tincurred\tfrom\tthe\tsocietal\tperspective.\t\nIn\t addition,\t data\t for\t this\t analysis\t was\t retrieved\t from\t two\t clinical\t studies\t conducted\t at\t our\t\nlocal\t setting\t and\t the\t costs\t per\t survivor\t for\t post-ACS\t participants\t were\t estimated\tmanually\t\nfrom\t the\t anticipated\t records\t as\t the\t case\t note,\t prescription\t profile,\t laboratory\t investigation,\t\nand\t other\t relevant\t documents.\t The\t cost\t of\t branded\t clopidogrel\t was\t considered\t for\t this\t\nanalysis\tbecause\tonly\tthe\tbranded\tdrug\twas\tavailable\tin\tMalaysia\tin\tthe\tyear\t2007.\tThis\tmight\t\nhave\t implications\t on\t the\t cost\t savings\t derived\t from\t ticagrelor\t treatment\t in\t this\t analysis. \n\n\n\nCONCLUSION\nIn\tthis\tanalysis,\ta\tformal\tlink\twas\testablished\tbetween\tmeasures\tof\tcosts\tand\toutcomes\tof\tticagrelor\t\ntherapy,\t although\tdirect\t comparisons\t cannot\t be\tmade.\tThis\t economic\t analysis\t suggests\t that\t\nticagrelor\ttherapy\tmay\tbe\ta\tmore\tcost-saving\talternative\tto\tclopidogrel\t in\tMalaysian\tpatients\t\nwith\tACS.\tHowever,\ta\thead-to-head\tcomparison\tin\tlarger\tpopulation\tmay\tbe\trequired\tto\tfurther\t\nvalidate\tthe\tfindings\tof\tthis\tstudy.\n\n\n\nACKNOWLEDGMENTS\nOur\tappreciation\tand\tthanks\tto\tthe\tDirector-General\tof\tHealth\tMalaysia,\tfor\tpermission\tto\tshare\t\nand\tpublish\tthese\tfindings.\tWe\tare\tgrateful\tto\tDr\tMaggie\tSeldon,\tTiong\tLee\tLen\tand\tLana\tLai\t\nfor\tproviding\tsupport\tfor\tthe\tcost\tdetails\tused\tin\tthe\tstudy\tand\tto\tall\tindividuals\twho\tsupplied\t\npricing\tinformation.\n\n\n\nCONFLICT OF INTEREST\nNone declared.\n\n\n\nREFERENCES\n1.\t Azman\tWA,\tSim\tKH,\tet\tal.\tAnnual\tReport\tof\tthe\tNCVD-ACS\tRegistry\tMalaysia\t2006.\t\t\n\t National\tCardiovascular\tDisease\tDatabase\t(NCVD).\tAvailable\tat:\thttp://www.acrm.\t\n\t org.my/ncvd/documents/1stAnnualReport/20081013_ncvdACSReport.pdf.\tAccessed\t\t\n\t on:\tDecember\t16,\t2013.\n\n\n\n2.\t Azman\tWA,\tSim\tKH,\tet\tal.\tAnnual\tReport\tof\tthe\tNCVD-ACS\tRegistry\tMalaysia\t2007\t\t\n\t &\t2008.\tNational\tCardiovascular\tDisease\tDatabase\t(NCVD).\tAvailable\tat:\t\n\t http://www.acrm.org.my/ncvd/documents/report/acsReport_07-08/fullReport.pdf.\t\t\n\t Accessed\ton:\tDecember\t16,\t2013.\n\n\n\n\n\n\n\n\n10\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\n3.\t Steg\tPG,\tGoldberg\tRJ,\tGore\tJM,\tet\tal,.\tBaseline\tcharacteristics,\tmanagement\tpractices,\t\t\t\n\t and\tin-hospital\toutcomes\tof\tpatients\thospitalized\twith\tacute\tcoronary\tsyndromes\tin\tthe\t\n\t Global\tRegistry\tof\tAcute\tCoronary\tEvents\t(GRACE).\tAm\tJ\tCardiol.\t2002;90:358\u2013363.\n\n\n\n4.\t H\u00f6chtl\tT,\tSinnaeve\tPR,\tAdriaenssens\tT,\tet\tal.\tOral\tantiplatelet\ttherapy\tin\tacute\tcoronary\t\n\t syndromes:\tupdate\t2012.\tEur\tHeart\tJ\tAcute\tCardiovasc\tCare.\t2012;1:79\u201386.\n\n\n\n5.\t Roffi\tM,\tPatrono\tC,\t\tCollet\tJP,\tet\tal.\tESC\tGuidelines\tfor\tthe\tmanagement\tof\tacute\tcoronary\t\n\t syndromes\tin\tpatients\tpresenting\twithout\tpersistent\tST-segment\televation:\tThe\tTask\t\t\n\t Force\tfor\tthe\tmanagement\tof\tacute\tcoronary\tsyndromes\tin\tpatients\tpresenting\twithout\t\t\n\t persistent\tST-segment\televation\tof\tthe\tEuropean\tSociety\tof\tCardiology\t(ESC).\tEur\t\t\t\n\t Heart\tJ.\t2015\tAvailable\tat:\t\n\t http://eurheartj.oxfordjournals.org/ehj/early/2015/08/28/eurheartj.ehv320.full.pdf\t\t\t\n\t Accessed\ton:\tSeptember\t13,\t2015.\n\n\n\n6.\t Wallentin\tL,\tBecker\tRC,\tBudaj\tA,\tet\tal.\tTicagrelor\tversus\tclopidogrel\tin\tpatients\twith\t\t\n\t acute\tcoronary\tsyndromes.\tN\tEngl\tJ\tMed.\t2009;361:1045\u20131057\t\n\n\n\n7.\t Henriksson\tM,\tNikolic\tE,\tJanzon\tM,\tet\tal.\tPCV46\tLong-term\tcosts\tand\thealth\toutcomes\t\n\t of\ttreating\tacute\tcoronary\tsyndrome\tpatients\twith\tticagrelor\tbased\ton\tthe\tEU\tlabel:\tcost-\n\t effectiveness\tanalysis\tbased\ton\tthe\tPLATO\tstudy.\tValue\tHealth.\t2011;14:A40.\n\n\n\n8.\t Nikolic\tE,\tJanzon\tM,\tHauch\tO,\tet\tal.\tCost-effectiveness\tof\ttreating\tacute\tcoronary\t\t \t\n\t syndrome\tpatients\twith\tticagrelor\tfor\t12\tmonths:\tresults\tfrom\tthe\tPLATO\tstudy.\tEur\t\t\n\t Heart\tJ.\t2013;34:220\u2013228.\n\n\n\n9.\t Theidel\tU,\tAsseburg\tC,\tGiannitsis\tE,\tet\tal.\tCost-effectiveness\tof\tticagrelor\tversus\t\t \t\n\t clopidogrel\tfor\tthe\tprevention\tof\tatherothrombotic\tevents\tin\tadult\tpatients\twith\tacute\t\t\n\t coronary\tsyndrome\tin\tGermany.\tClin\tRes\tCardiol.\t2013;102:447\u2013458.\n\n\n\n10.\t Crespin\tDJ,\tFederspiel\tJJ,\tBiddle\tAK,\tet\tal.\tTicagrelor\tversus\tgenotype-driven\tantiplatelet\t\n\t therapy\tfor\tsecondary\tprevention\tafter\tacute\tcoronary\tsyndrome:\ta\tcost-effectiveness\t\t\n\t analysis.\tValue\tHealth.\t2011;14:483\u2013491.\t\n\n\n\n11.\t Anchah\tL,\tSim\tKH,\tIzham\tM,\tet\tal.\tThe\teconomic\tand\thumanistic\toutcomes\tof\tpost\t\t\n\t acute\tcoronary\tsyndrome\tin\tcardiac\trehabilitation\tprogram:\tA\tquasi-experimental\t\t\t\n\t design\tof\t12\tmonths\tfollow-up.\tNational\tHeart\tAssociation\tof\tMalaysia.\tAvailable\t\t \t\n\t at:\twww.e-mjm.org/2010/v65n3/National_Heart_Association_Abstracts.pdf.\tAccessed\t\t\n\t on:\tDecember\t16,\t2013.\n\n\n\n12.\t Fong\tAYY,\tTiong\tLL,\tWong\tJL,\tet\tal.\tImpact\tof\tan\tonsite\tcardiac\tcatheter\tlaboratory\n\t\t and\tpharmacotherapy\ton\tclinical\toutcomes\tof\tAcute\tCoronary\tSyndrome:\tA\tcomparison\t\n\t of\ta\tTertiary\tReferral\tCentre\twith\ta\tDistrict\tGeneral\tHospital.\tAvailable\tat:\t\n\t http://www.malaysianheart.org/files/151303501049f02201533ae.pdf.\tAccessed\ton:\t\t\t\n\t December\t16,\t2013.\n\n\n\n13.\t Hayasaka\tM,\tTakahashi\tY,\tNishida\tY,\tet\tal.\tComparative\teffect\tof\tclopidogrel\tplus\taspirin\t\n\t and\taspirin\tmonotherapy\ton\thematological\tparameters\tusing\tpropensity\tscore\tmatching.\t\n\t Vasc\tHealth\tRisk\tManag.\t2013;9:65\u201370.\n14.\t Yusuf\tS,\tZhao\tF,\tMehta\tSR\tet\tal.\tEffects\tof\tclopidogrel\tin\taddition\tto\taspirin\tin\tpatients\t\n\t with\tacute\tcoronary\tsyndromes\twithout\tST-segment\televation.\tN\tEngl\tJ\tMed.\t\t \t\n\t 2001;345:494\u2013502.\n\n\n\n\n\n\n\n\n11\n\n\n\nMalaysian Journal of Pharmacy Vol 2, Issue 1, November 2015\n\n\n\n15.\t Anchah\tL,\tIzham\tM,\tSim\tKH,\tet\tal.\tCost-utility\tanalysis\tof\tthe\tmodified\tcardiac\t\t\n\t rehabilitation\tprogram:\tA\tpreference-based\ton\tSF-6D.\tMPS\tPharmacy\tScientific\t\t \t\n\t Conference\t2011.\tMalaysian\tJ\tPharmacy.\t2011;1(9).\n\n\n\n16.\t Chin\tSP,\tJeyaindran\tS,\tAzhari\tR,\tet\tal.\tAcute\tCoronary\tSyndrome\t(ACS)\tRegistry\t-\t\n\t Leading\tthe\tCharge\tfor\tNational\tCardiovascular\tDisease\t(NCVD)\tDatabase.\tMed\tJ\t\t\n\t Malaysia.\t2008;63(Suppl\tC):29\u201336.\n\n\n\n17.\t Lu\tHT,\tNordin\tRB.\tEthnic\tdifferences\tin\tthe\toccurrence\tof\tacute\tcoronary\tsyndrome:\t\t\n\t results\tof\tthe\tMalaysian\tNational\tCardiovascular\tDisease\t(NCVD)\tDatabase\tRegistry\t\t\n\t (March\t2006\t-\tFebruary\t2010).\tBMC\tCardiovasc\tDisord.\t2013;13:97.\t\n\n\n\n18.\t Chin\tCT,\tMellstrom\tC,\tChua\tTS,\tet\tal.\tLifetime\tcost-effectiveness\tanalysis\tof\tticagrelor\t\t\n\t in\tpatients\twith\tacute\tcoronary\tsyndromes\tbased\ton\tthe\tPLATO\ttrial:\tA\tSingapore\t\t\n\t Healthcare\tPerspective.\tSingapore\tMed\tJ.\t2013;54:169\u2013175.\n\n\n\n19.\t Hill\tSR,\tMitchell\tAS,\tHenry\tDA.\tProblems\twith\tthe\tinterpretation\tof\tpharmacoeconomic\t\n\t analyses:\tA\treview\tof\tsubmissions\tto\tthe\tAustralian\tPharmaceutical\tBenefits\tScheme.\t\t\n\t JAMA.\t2000;283:2116\u20132121.\n\n\n\n20.\t Bainey\tKR,\tNorris\tCM,\tGupta\tM.\tAltered\thealth\tstatus\tand\tquality\tof\tlife\tin\tSouth\tAsians\t\n\t with\tcoronary\tartery\tdisease.\tAm\tHeart\tJ.\t2011;162:501\u2013516.\n\n\n\n\n\n"
"\n\nPP12684/8/2008\nVol. 1 Issue 10. October 2012\n\n\n\nMALAYSIAN\nJOURNAL of PHARMACY\n\n\n\nA Publication of the Malaysian Pharmaceutical Society\n\n\n\nM\nA\n\n\n\nL\nA\n\n\n\nY\nSIA\n\n\n\nN\n JO\n\n\n\nU\nR\n\n\n\nN\nA\n\n\n\nL\n O\n\n\n\nF PH\nA\n\n\n\nR\nM\n\n\n\nA\nC\n\n\n\nY\nV\n\n\n\nol. 1  Issue 10\n\n\n\nIn this issue:\n\n\n\n\u2022      Assessment of Malaysian Clinical Practice Guideline\n\n\n\n\u2022      Evaluation of Tablet Splitting Practice Among Malaysian \n       Community Pharmacists\n\n\n\n\u2022      Stability of Folic Acid in an Extemporaneously Prepared \n       Oral Suspension\n\n\n\n\u2022     Self-Medication Practice Among Malaysian Consumer \n       \u2013 a Questionnaire-Based Study\n\n\n\nSupplement\n\n\n\nAbstracts From the Malaysian Pharmaceutical Society \nPharmacy Scientific Conference 2012 \n\n\n\n\n\n\n\n\ni \n \n\n\n\n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy \n\n\n\nVol. 1 Issue 10, 2012 \n\n\n\n\n\n\n\nThe Official Journal of the Malaysian Pharmaceutical Society \n\n\n\nEditor-in-Chief: Prof. Dr. Mohd Baidi bin Bahari \n\n\n\n\n\n\n\nAssociate Editors: Prof. Dr. Abu Bakar bin Abdul Majeed \n\n\n\n Prof. Dr. Aishah bte Adam \n\n\n\n Assoc. Prof. Dr. Ab. Fatah bin Hj. Ab. Rahman \n\n\n\n Prof. Dr. Chung Lip Yong \n\n\n\n Prof. Dato\u2019 Dr. Mohd. Isa bin Abdul Majid \n\n\n\n Prof. Dr. Yuen Kah Hay \n\n\n\n Prof. Dr. Paraidathathu Thomas a/l P.G. Thomas \n\n\n\n Mr. John Chang \n\n\n\n Mr. Lam Kai Kun \n\n\n\n\n\n\n\nPublisher: Malaysian Pharmaceutical Society \n\n\n\n16-2, Jalan OP 1/5 \n\n\n\n1-Puchong Business Park \n\n\n\nOff Jalan Puchong \n\n\n\n47160 Puchong \n\n\n\nSelangor Darul Ehsan \n\n\n\nTel: 603-80791861 \n\n\n\nFax: 603-80700388 \n\n\n\nHomepage: www.mps.org.my \n\n\n\nEmail: mspharm@po.jaring.my  \n\n\n\n\n\n\n\nThe Malaysian Journal of Pharmacy is a publication of the Malaysian Pharmaceutical \n\n\n\nSociety. Enquiries are to be directed to the Publisher at the above address.  The Publisher \n\n\n\nreserves copyright and renewal on all published materials, and such material may not be \n\n\n\nreproduced in any form without the written permission of the Publisher. \n\n\n\n\n\n\n\n \n\n\n\n\nhttp://www.mps.org.my/\n\n\nmailto:mspharm@po.jaring.my\n\n\n\n\n\n\nii \n \n\n\n\n\n\n\n\n\n\n\n\nTable of content \n\n\n\n\n\n\n\nEditorial \n \n  iii \n\n\n\nResearch Papers \n \n Assessment of Malaysian Clinical Practice Guidelines  \n\n\n\nB. Rugayah, M.D. Noormah, M.M. Mohamed, S.F.K. Shahnaz  \n\n\n\n\n\n\n\n1 - 14 \n\n\n\n Evaluation of The Tablet Splitting Practices Among Malaysian \n\n\n\nCommunity Pharmacists. \n\n\n\n \nC. P. Chong, M.A. Hassali\n\n\n\n \n, M.B. Bahari\n\n\n\n. \n\n\n\n\n\n\n\n15 - 27 \n\n\n\n Stability of Folic Acid in an Extemporaneously Prepared Oral \n\n\n\nSuspension \n\n\n\n\n\n\n\nLian T. Chan, Lucy Yeoh  \n\n\n\n\n\n\n\n28 - 37 \n\n\n\n Self-Medication Practices Among Malaysian Consumer: A \n\n\n\nQuestionnaire-Based Study \n\n\n\n \nG.S. Ooi, C.P. Chong, M.B. Bahari \n \n\n\n\n38 - 47 \n\n\n\nSupplement \n \n Abstracts from the Malaysian Pharmaceutical Society - Pharmacy \n\n\n\nScientific Conference 2012 \n\n\n\n\n\n\n\n48 - 128 \n\n\n\nInstruction to Author \n   \n Please refer to webpage www.mps.org.my for the latest update  \n\n\n\n\n\n\n\n \n\n\n\n\nhttp://www.mps.org.my/\n\n\n\n\n\n\niii \n \n\n\n\nEditorial \n \n\n\n\n\n\n\n\n\n\n\n\nHealth care costs have been growing rapidly in the past several decades, in some countries \n\n\n\nthe total health care expenditure per capita has increased three to fourfold.  The total health \n\n\n\ncare expenditure in Malaysia also has increased from USD 128 in 2000 to USD 367 in 2010 \n\n\n\n(WHO, 2010), about threefold increase in 10 years.  Next year (2013) the government has \n\n\n\nallocated 19.2 billion dollars on health sector, an increase of 15% from the year 2012.  This \n\n\n\namount covers slightly more than half of the expected total health care expenditure of the \n\n\n\ncountry. Thus patients and private health financing bodies have to contribute to the deficit.   \n\n\n\nThe primary drivers for the increase in health care cost include the changes in diseases \n\n\n\npattern and the escalation of drug\u2019s price.  Improvements in the socioeconomic and \n\n\n\ntechnology advancement have influence the life style of the public, and subsequently, the \n\n\n\nincident of life style associated diseases (Gupta et al., 2012).  The use of tobacco, unhealthy \n\n\n\ndiet, insufficient physical exercise and overuse of alcohol contributed to the increase in \n\n\n\nobesity, diabetes, cardiovascular, cancers, respiratory diseases, mental illness and other non \n\n\n\ncommunicable diseases.   \n\n\n\nAnother contributor to the health care cost is the increase in the price of the drugs.  The drug \n\n\n\nprices in Malaysia were higher compared to international reference price, by about 15 to 16 \n\n\n\ntimes higher for innovator drugs and 6 to 7 times higher for generic drugs (ZUD Barber et \n\n\n\nal., 2007).  Due to the price difference, most patients and prescribers have shifted to the use \n\n\n\nof generic drugs (CC Ping et al., 2008), however, the price of the generic drugs in Malaysia \n\n\n\nalso varied depending on the number of generic brands and geographical location (O Fatokun \n\n\n\net al., 2011). \n\n\n\nTo regulate the drug price, the Malaysian Pharmaceutical Services Division has published \n\n\n\nMedicine Price List which includes the recommended retail price for Non Essential Drugs \n\n\n\nand Private Sector Retail Price List in 2010 and 2011.  The effect of these published lists on \n\n\n\nthe price of drug that a patient has to pay is yet to be evaluated.  Until a health policy is \n\n\n\nformulated and enforced to control and regulate the price of drug in this country, the public \n\n\n\nwill continue to face an ever increasing drug cost.  \n\n\n\n\n\n\n\n\n\n\n\nEditor-in-Chief \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 1 \n\n\n\nAssessment of Malaysian Clinical Practice Guidelines  \n\n\n\nB. Rugayah M.P.H. \n1\n. M.D. Noormah M.Sc\n\n\n\n1\n, M.M. Mohamed Ph.D*\n\n\n\n2\n, S.F.K. \n\n\n\nShahnaz \n3 \n\n\n\n1\nMalaysian Health Technology Assessment Section, Ministry of Health Malaysia. \n\n\n\n2\nUniversity Teknologi Mara, Puncak Alam Campus, Selangor. \n\n\n\n3\nHospital Tengku Ampuan Rahimah \n\n\n\n* Corresponding author \nMalaysian Journal of Pharmacy, Vol 1 Issue 10, 2012, 1-14                                               \n\n\n\n\n\n\n\nAbstract \n\n\n\n\n\n\n\nThe Ministry of Health Malaysia (MOH) coordinates the development of Clinical \n\n\n\nPractice Guidelines (CPGs) in Malaysia, in collaboration with the Academy of Medicine \n\n\n\nof Malaysia (AMM). This study assessed the methodological quality of 29 Malaysian \n\n\n\nnational CPGs which were developed since 2000 to 2003 using Appraisal of Guidelines \n\n\n\nfor Research & Evaluation (AGREE) Instrument. The study showed high score for only \n\n\n\ndomains on Scope & Purpose as well as Clarity & Presentation (68%, 75% respectively). \n\n\n\n\n\n\n\nKeywords: clinical practice guidelines, AGREE instrument, appraisal of guidelines, \n\n\n\nMalaysian CPGs. \n\n\n\n\n\n\n\nIntroduction \n\n\n\n\n\n\n\nAssessment of the national Malaysian \n\n\n\nClinical Practice Guidelines (AMCPG) \n\n\n\nusing Appraisal of Guidelines for \n\n\n\nResearch & Evaluation (AGREE) \n\n\n\nInstrument was proposed to study the \n\n\n\nmethodological quality in the \n\n\n\ndevelopment of Clinical Practice \n\n\n\nGuidelines (CPGs) in Malaysia.  \n\n\n\n\n\n\n\nThe Ministry of Health (MOH) \n\n\n\ncoordinates the development of \n\n\n\nevidence-based CPGs in Malaysia. This \n\n\n\nwas a collaborative effort between \n\n\n\nMinistry of Health Malaysia (MOH) and \n\n\n\nAcademy of Medicine Malaysia (AMM). \n\n\n\nThe goal of the CPG development was to \n\n\n\nincrease quality in the delivery of health \n\n\n\ncare services based on clinical evidence \n\n\n\nwith scientific rigor.  \n\n\n\n\n\n\n\nThis (AMCPG) Project was found to be  \n\n\n\nworthy to be conducted in Malaysia, in \n\n\n\nview of the fact that Malaysia had \n\n\n\ndeveloped several CPGs. An evaluation \n\n\n\nof these developed CPGs could provide \n\n\n\nmore information in improving the \n\n\n\ndevelopment of evidence-based CPGs in \n\n\n\nMalaysia. It is believed that evidence-\n\n\n\nbased CPGs can help improve the \n\n\n\ndelivery of health care, although proof to \n\n\n\nsuch claim has not been consistently \n\n\n\ndemonstrated. \n\n\n\n\n\n\n\nEvaluation of the CPG can be \n\n\n\ncategorized into three levels\n3, 4, 5 \n\n\n\nnamely: \n\n\n\n1) Examination of the process of \n\n\n\nguideline development, dissemination \n\n\n\nand implementation; 2) Measurement of \n\n\n\nthe extent of implementation of the \n\n\n\nguideline and 3) Assessment of \n\n\n\nguidelines effect on patient outcomes \n\n\n\nand health care utilization.  Another way \n\n\n\nof evaluation was to classify into two \n\n\n\nlevels, namely quality of the CPG and \n\n\n\nlater its effectiveness. Good \n\n\n\ndevelopment methodology using current \n\n\n\nbest evidence will determine the quality \n\n\n\nof the CPG. A \u201cgood quality guideline\u201d \n\n\n\nis the one that ultimately leads to \n\n\n\nimprove patient outcome. However, the \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 2 \n\n\n\nquality of a guideline is indirectly \n\n\n\nmeasured by assessing in whatever \n\n\n\ndegree guideline producers minimized \n\n\n\npotential biases that could occur in the \n\n\n\ndevelopment process and affect validity \n\n\n\nof its recommendations \n6, 7, and 8\n\n\n\n. Wrong \n\n\n\nrecommendations affect the health \n\n\n\nprofessionals\u201f credibility on guidelines, \n\n\n\nand consequently, limit their adoption. \n\n\n\n\n\n\n\nIn 1999, Shaneyfelt et al. assessed \n\n\n\nquality of CPG published in Medline \n\n\n\nbetween 1985 and 1997 by using \n\n\n\nsystematically developed instrument. \n\n\n\nThe majority of 279 assessed guidelines \n\n\n\ndid not meet the pre-established \n\n\n\nmethodological standards, being rigour \n\n\n\nof recommendations as one of the most \n\n\n\ndeficiently reported \n6, 9\n\n\n\n. Similar results \n\n\n\nwere reported by Cluzeau et al. \n6, 10\n\n\n\n, \n\n\n\nGrilli et al. \n6,11\n\n\n\n and Graham et al. \n6,12 \n\n\n\nin \n\n\n\n1999, 2000 and 2001 respectively. In \n\n\n\n2003 the AGREE collaboration \n\n\n\n(currently the AGREE Research Trust) \n\n\n\npublished the results of the first \n\n\n\ninternational project aimed at developing \n\n\n\nand validating a generic instrument for \n\n\n\nguidelines assessment\n7,8\n\n\n\n. This instrument \n\n\n\nhas been translated to different \n\n\n\nlanguages and extending its use \n\n\n\nthroughout the world. In recent years, \n\n\n\nseveral studies showed methodological \n\n\n\ndeficiencies of using the AGREE \n\n\n\ninstrument in guideline development\n6,13-\n\n\n\n15\n \n\n\n\n\n\n\n\nIn Malaysia, although many different \n\n\n\ninstitutions are interested in CPG \n\n\n\ndevelopment, there is no information \n\n\n\nabout the quality of the guidelines \n\n\n\nproduced. The purpose of this research \n\n\n\nwas to describe trends in guidelines \n\n\n\nproduction in Malaysia and to assess \n\n\n\ntheir quality by using the AGREE \n\n\n\ninstrument. \n\n\n\n\n\n\n\nMaterials and methods \n\n\n\n\n\n\n\nA cross-sectional study was undertaken \n\n\n\nin 2004 to describe guidelines \n\n\n\nproduction in Malaysia between years \n\n\n\n2000-2003. Documents were considered \n\n\n\nas CPG if: 1) they included explicit \n\n\n\nrecommendations targeted to health \n\n\n\nprofessional or health providers \n\n\n\ndecision-making in managing diseases or \n\n\n\ncondition, 2) the scope included related \n\n\n\nto screening and primary prevention, \n\n\n\nand/or diagnosis, and/or treatment and/or \n\n\n\nsecondary prevention and/or \n\n\n\nrehabilitation; 3) they contained \n\n\n\ndescription of participants or responsible \n\n\n\ninstitutions and bibliographic references; \n\n\n\n4) they were produced and diffused in \n\n\n\nthe period of study (January 2000 to \n\n\n\nDecember 2003) and could be freely \n\n\n\naccessed. The exclusion criteria were: 1) \n\n\n\nguidelines targeted to patients (patients \n\n\n\n\u201eguidelines) and/or exclusively oriented \n\n\n\nto health services organization and not to \n\n\n\nclinical decision-making for managing \n\n\n\ndiseases or conditions; 2) guidelines for \n\n\n\nwhich it was not possible to determine if \n\n\n\na systematic process was applied in their \n\n\n\ndevelopment such as documents that \n\n\n\nlacked an explanation of the guideline \n\n\n\ndevelopment methodology that had been \n\n\n\nused or documents diffused as brief \n\n\n\nreports which only contained a set of \n\n\n\nrecommendations or documents referred \n\n\n\nto as guidelines, but were undertaken by \n\n\n\nonly one author without any reference to \n\n\n\nthe methodology applied); 3) guidelines \n\n\n\nwhose year of development could not be \n\n\n\nestablished as it was not stated and last \n\n\n\nbut not least 4) guidelines that were not \n\n\n\nproduced by a Malaysian institution \n\n\n\n(adapted guidelines were included only \n\n\n\nwhen the adaptation process was \n\n\n\nexplicitly explained). \n\n\n\n\n\n\n\nAll guidelines registered by the Health \n\n\n\nTechnology Assessment units (HTA) in \n\n\n\nMOH and AMM between January 2000 \n\n\n\nand December 2003 were selected for \n\n\n\nthis study. The original published CPGs \n\n\n\nor a photocopy of the original CPGs \n\n\n\nwere retrieved from the HTA unit, the \n\n\n\nchairman of the guideline developers \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 3 \n\n\n\ngroup/or downloaded from the Ministry \n\n\n\nof Health Malaysia website. \n\n\n\n\n\n\n\nQuality guideline assessment was \n\n\n\nperformed using the AGREE instrument. \n\n\n\nThis instrument was the instrument of \n\n\n\nchoice as it covers practically all the \n\n\n\nrelevant dimensions of the evidence-\n\n\n\nbased guideline development process. In \n\n\n\naddition, it has been internationally \n\n\n\nvalidated. The AGREE has fewer items \n\n\n\nand uses a numerical scale that facilitates \n\n\n\nthe analysis \n8, 16,17\n\n\n\n.  \n\n\n\n\n\n\n\nA total of four appraisers were invited to \n\n\n\nparticipate voluntarily in the assessment \n\n\n\nphase. To be considered eligible, \n\n\n\nprofessionals should have had at least \n\n\n\none of the following criteria: a) previous \n\n\n\nclinical epidemiology background; and \n\n\n\nb) knowledge on guidelines \n\n\n\ndevelopment. The professionals who \n\n\n\naccepted the invitation and fulfilled the \n\n\n\neligibility criteria were trained in the use \n\n\n\nof the AGREE instrument. A learning \n\n\n\nprogram was developed in two stages: I. \n\n\n\nSelf-reading of the tool-kit: all \n\n\n\nparticipants were provided with the \n\n\n\nEnglish version of the AGREE \n\n\n\ninstrument, the English version of the \n\n\n\nTraining Manual. II. Pilot assessment - \n\n\n\none CPG was assessed independently by \n\n\n\nall professionals.  \n\n\n\n\n\n\n\nAll of the 29 copies of the CPGs \n\n\n\nretrieved were given to each appraiser to \n\n\n\nbe appraised within one month. A data \n\n\n\ncollection form designed on an Excel \n\n\n\nsheet, accompanied by a user-guide on \n\n\n\nthe AGREE instrument were given to \n\n\n\neach appraiser. Results of assessments \n\n\n\nwere returned to the researcher team by \n\n\n\nmail. No assessor received any \n\n\n\nhonorarium. \n\n\n\n\n\n\n\nAGREE consists of 23 key items \n\n\n\norganized in six domains. Each domain \n\n\n\nis intended to capture a separate \n\n\n\ndimension of guideline quality. Domain \n\n\n\n1: Scope and purpose (items 1-3) is \n\n\n\nconcerned with the overall aim of the \n\n\n\nguideline, the specific clinical questions \n\n\n\nand the target patient population. \n\n\n\nDomain 2: Stakeholder involvement \n\n\n\n(items 4-7) focuses on the extent to \n\n\n\nwhich the guideline represents the views \n\n\n\nof its intended users. Domain 3: Rigor of \n\n\n\ndevelopment (items 8-14) relates to the \n\n\n\nprocess used to gather and synthesize the \n\n\n\nevidence, the methods to formulate the \n\n\n\nrecommendations and to update them. \n\n\n\nDomain 4: Clarity and presentation \n\n\n\n(items 15-18) deals with the language \n\n\n\nand format of the guideline. Domain 5: \n\n\n\nApplicability (items 19-21) pertains to \n\n\n\nthe likely organizational, behavioral and \n\n\n\ncost implications of applying the \n\n\n\nguideline. Domain 6: Editorial \n\n\n\nindependence (items 22-23) is concerned \n\n\n\nwith the independence of the \n\n\n\nrecommendations and acknowledgement \n\n\n\nof possible conflict of interest from the \n\n\n\nguideline development group. \n\n\n\n\n\n\n\nEach item is rated on a 4-point scale \n\n\n\nranging from 4 \u201eStrongly Agree\u201f to 1 \n\n\n\n\u201estrongly Disagree\u201f, with two mid points: \n\n\n\n3 \u201eAgree\u201f and 2 \u201eDisagree\u201f. The scale \n\n\n\nmeasures the extent to which a criterion \n\n\n\n(item) has been fulfilled. \u201eStrongly \n\n\n\nAgree\u201f means that  the appraiser was \n\n\n\nconfident that the criterion has been fully \n\n\n\nmet, and if the appraiser was  confident \n\n\n\nthat the criterion has not been fulfilled at \n\n\n\nall or if there is no information available \n\n\n\nthen he/she should answer \u201eStrongly \n\n\n\nDisagree\u201f.  If the appraiser was unsure \n\n\n\nthat a criterion had been fulfilled, for \n\n\n\nexample because the information was \n\n\n\nunclear or because only some of the \n\n\n\nrecommendations fulfill the criterion, \n\n\n\nthen he/she should answer \u201eAgree\u201f or \n\n\n\n\u201eDisagree\u201f, depending on the extent to \n\n\n\nwhich he/she thought the issue had been \n\n\n\naddressed. \n\n\n\n\n\n\n\nAccording to the AGREE Collaboration  \n\n\n\nthe domain scores of each CPG were \n\n\n\nindividually considered. Scores of \n\n\n\nindividual items in each domain were \n\n\n\n\nhttp://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2572637#B16\n\n\nhttp://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2572637#B17\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 4 \n\n\n\nsummed and standardized as a \n\n\n\npercentage of the maximum possible \n\n\n\nscore for that domain, taking into \n\n\n\naccount the number of appraisers. \n\n\n\nDomain scores can be calculated by \n\n\n\nsumming up all the scores of the \n\n\n\nindividual items in a domain and by \n\n\n\nstandardizing the total as a percentage of \n\n\n\nthe maximum possible score for that \n\n\n\ndomain \n6\n. \n\n\n\n\n\n\n\nThe internal consistency of each domain \n\n\n\nwas evaluated using Cronbach's alpha. \n\n\n\nThe Reliability between appraisers was \n\n\n\ndetermined for each question and each \n\n\n\ndomain of the AGREE. Intraclass \n\n\n\ncorrelation coefficients (ICC) were \n\n\n\ncalculated within each pair of appraisers \n\n\n\nand across the pool of appraisers. ICCs \n\n\n\nand Cronbach's alpha values above 0.75 \n\n\n\nwere considered to represent good \n\n\n\nreliability while values at 0.40\u20130.75 \n\n\n\nwere considered moderate and value of \n\n\n\n<0.40 was of poor reliability. \n\n\n\n\n\n\n\n\n\n\n\nResults \n\n\n\n\n\n\n\nA total of 29 documents were retrieved \n\n\n\neither from HTA unit or chairman of the \n\n\n\nguideline developers group or from the \n\n\n\nMOH or AMM websites. All the 29 \n\n\n\nCPGs were published locally. The \n\n\n\nfinancial sponsor for all these CPGs was \n\n\n\nmainly MOH.  There were no \n\n\n\npharmaceutical drug companies \n\n\n\ninfluencing our researches. Those \n\n\n\ndeveloping the CPGs consist of a \n\n\n\nmixture of professionals mainly from the \n\n\n\nuniversities and private professional \n\n\n\nbodies like the AMM. The development \n\n\n\nprocess usually took about 1 to 2 years. \n\n\n\n\n\n\n\nAll the 29 documents fulfilled the \n\n\n\ninclusion criteria. All the 29 CPGs were \n\n\n\nassessed by 4 assessors. On the item \n\n\n\nScope and purpose, only thirteen \n\n\n\nguidelines (13/29) covered diagnosis, \n\n\n\nnine guidelines (9/29) covered \n\n\n\nmanagement, four guidelines (4/29) \n\n\n\ncovered treatment, one guideline (1/29) \n\n\n\ncovered prevention and one (1/29) \n\n\n\nguideline covered screening. \n\n\n\n\n\n\n\nCPG production was found to increase \n\n\n\nfrom year 2001 to year 2003 (Figure 1). \n\n\n\nMinistry of Health was the principal \n\n\n\nCPG producer during this period of time. \n\n\n\nA CPG should be strongly recommended \n\n\n\nif it was rated high (3 or 4) on the \n\n\n\nmajority of items and most domain \n\n\n\nscores were above 60% indicating the \n\n\n\nCPG had a high overall quality.  A CPG \n\n\n\nshould be recommended with provisos or \n\n\n\nalterations if it was rated high (3 or 4) or \n\n\n\nlow (1 or 2) on a similar of items  and \n\n\n\nmost domain scores were between 30% \n\n\n\nand 60% indicating the CPG had a \n\n\n\nmoderate overall quality. A CPG should \n\n\n\nnot be recommended if it was rated low \n\n\n\n(1 or 2) on the majority of items and \n\n\n\nmost domain scores were below 30% \n\n\n\nindicating the CPG had a low overall \n\n\n\nquality. \n\n\n\n\n\n\n\nDomains corresponding to Clarity and \n\n\n\nPresentation (overall score was 75%) \n\n\n\nand Scope and Purpose (overall score \n\n\n\nwas 68%) (Figure 2) were high. The \n\n\n\nmajority of the CPG assessed received \n\n\n\nmoderate scores in nearly all domains \n\n\n\nsuch as Editorial Independence (the \n\n\n\noverall score was 56%), Stakeholder \n\n\n\nInvolvement (the overall score was 50%) \n\n\n\nand for Rigor of Development (the \n\n\n\noverall score was 48%). However for \n\n\n\nApplicability (the overall score was \n\n\n\n26%) the score was low. In comparison \n\n\n\nto the results of the other domains, \n\n\n\nClarity and Presentation was the best \n\n\n\nscored and applicability was the worst \n\n\n\nscored aspect of the 29 CPGs. \n\n\n\n\n\n\n\nThere was no statistically significant \n\n\n\ndifference observed in the standardized \n\n\n\ndomain scores corresponding to \n\n\n\nApplicability and Editorial \n\n\n\nIndependence. Statistically significant  \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 5 \n\n\n\nFigure 1: Total number of CPG produced per year \n\n\n\n\n\n\n\n\n\n\n\ndifferences were observed among scores \n\n\n\ncorresponding to the Scope and Purpose, \n\n\n\nClarity and Presentation, Stakeholder \n\n\n\nInvolvement and Rigor of Development \n\n\n\n(Figure 3 and table 2). \n\n\n\n\n\n\n\nSince the distribution of the items scored \n\n\n\nwere skewed, the median value was used \n\n\n\nwhich can be a good way to determine \n\n\n\nan approximate average. Analysis by \n\n\n\nitem showed median values lower than 3 \n\n\n\nin 13 of the 23 items of the AGREE \n\n\n\ninstrument: 2 items received the lowest \n\n\n\npossible score (1) (table 1). \n\n\n\n\n\n\n\n\n\n\n\nThe Malaysian CPGs did show \n\n\n\nsignificant improvement from 2000 to \n\n\n\n2003 for Scope & Purpose; Rigor & \n\n\n\nDevelopment, Stakeholder involvement \n\n\n\nand Applicability using AGREE (Fig. 4 ) \n\n\n\nHowever Clarity and presentation and \n\n\n\nEditorial independence showed lowering \n\n\n\nin values from 2002 to 2003. \n\n\n\n\n\n\n\nInter-rater reliability is an estimation \n\n\n\nbased on the correlation of scores \n\n\n\nbetween/among two or more raters who  \n\n\n\n\n\n\n\nrate the same item, scale, or instrument \n\n\n\nand Intraclass correlation coefficient \n\n\n\n(ICC) was used to measure the inter-rater \n\n\n\nreliability of the four appraisers. It may \n\n\n\nalso be used to assess test-retest \n\n\n\nreliability. ICC may be conceptualized as \n\n\n\nthe ratio of between-groups variance to \n\n\n\ntotal variance. ICC measured the extent \n\n\n\nto which there was agreement \n\n\n\nconsistency among the appraisers. When \n\n\n\ninterpreting ICC <0.4 represents poor \n\n\n\nreliability, 0.40 -0.75 represents fair to \n\n\n\ngood reliability and >0.75 represents \n\n\n\nexcellent reliability. For the domain, \n\n\n\nRigor of Development (ICC=0.67`) and \n\n\n\nScope & Purpose (ICC= 0.60) the score \n\n\n\nwas moderate (Table 3). The ICC for the \n\n\n\nother domains in the Malaysian CPGs \n\n\n\nwas low (ICC \u2264 0.40). \n\n\n\n\n\n\n\nCronbach\u201fs alpha being the most \n\n\n\ncommon form of internal consistency \n\n\n\nreliability coefficient, was used to \n\n\n\nmeasure the extent to which item \n\n\n\nresponses correlate with each other.  \n\n\n\nAlternatively, it can be interpreted as the \n\n\n\ncorrelation of the observed scale with all \n\n\n\n0\n\n\n\n2\n\n\n\n4\n\n\n\n6\n\n\n\n8\n\n\n\n10\n\n\n\n12\n\n\n\nYear2000 Year2001 Year2002 Year2003\n\n\n\nTotal number of CPG\n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 6 \n\n\n\npossible other scales measuring the same \n\n\n\nthing and using the same number of it. \n\n\n\n\n\n\n\nFor the domain, Rigor of Development \n\n\n\n(Cronbach\u201fs alpha = 0.68) and Scope & \n\n\n\nPurpose (Cronbach\u201fs alpha = 0.63), the \n\n\n\nscore was moderate (Table 3). \n\n\n\nCronbach\u201fs alpha for the other domains \n\n\n\nin the Malaysian CPGs were low \n\n\n\n(Cronbach\u201fs alpha \u2264 0.40). \n\n\n\n\n\n\n\nThere seems to be variability of \n\n\n\nindividual scores between the appraisers \n\n\n\non items of the AGREE instrument and \n\n\n\nsome of the variability may be due to \n\n\n\ndifferences in interpretation of several \n\n\n\nitems where the instructions were broad.  \n\n\n\n \nFigure 2: Results of analysis of the 29 CPGs on the six AGREE instrument domains \n\n\n\n                                   Scope           Participation          Rigour              Clarity               Applicability      Independence\n\n\n\n\n\n\n\ndifferences were observed among scores \n\n\n\ncorresponding to the Scope and Purpose, \n\n\n\nClarity and Presentation, Stakeholder \n\n\n\nInvolvement and Rigor of Development \n\n\n\n(Figure 3 and table 1). \n\n\n\n\n\n\n\nSince the distribution of the items scored \n\n\n\nwere skewed, the median value was used \n\n\n\nwhich can be a good way to determine \n\n\n\nan approximate average. Analysis by \n\n\n\nitem showed median values lower than 3 \n\n\n\nin 13 of the 23 items of the AGREE \n\n\n\ninstrument: 2 items received the lowest \n\n\n\npossible score (1) (table 2). \n\n\n\n\n\n\n\n\n\n\n\nThe Malaysian CPGs did show \n\n\n\nsignificant improvement from 2000 to \n\n\n\n2003 for Scope & Purpose; Rigor & \n\n\n\nDevelopment, Stakeholder involvement \n\n\n\nand Applicability using AGREE (Fig. 4 ) \n\n\n\nHowever Clarity and presentation and \n\n\n\nEditorial independence showed lowering \n\n\n\nin values from 2002 to 2003. \n\n\n\n\n\n\n\nInter-rater reliability is an estimation \n\n\n\nbased on the correlation of scores \n\n\n\nbetween/among two or more raters who \n\n\n\nrate the same item, scale, or instrument \n\n\n\nand Intraclass correlation coefficient \n\n\n\n(ICC) was used to measure the inter-rater \n\n\n\nreliability of the four appraisers. It may \n\n\n\nalso be used to assess test-retest \n\n\n\nreliability. ICC may be conceptualized as \n\n\n\nthe ratio of between-groups variance to \n\n\n\ntotal variance. ICC measured the extent \n\n\n\nto which there was agreement \n\n\n\nconsistency among the appraisers. When \n\n\n\nIndependenceApplicabilityClarityRigourparticipationScope\n\n\n\n100\n\n\n\n80\n\n\n\n60\n\n\n\n40\n\n\n\n20\n\n\n\n0\n\n\n\n3\n\n\n\n18\n\n\n\n16\n\n\n\nS\nta\n\n\n\nn\nd\n\n\n\na\nrd\n\n\n\niz\ne\n\n\n\nd\n d\n\n\n\no\nm\n\n\n\na\nin\n\n\n\n s\nco\n\n\n\nre\ns \n\n\n\n(%\n) \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 7 \n\n\n\ninterpreting ICC <0.4 represents poor \n\n\n\nreliability, 0.40 - 0.75 represents fair to \n\n\n\ngood reliability and >0.75 represents \n\n\n\nexcellent reliability. For the domain, \n\n\n\nRigor of Development (ICC=0.67`) and \n\n\n\nScope & Purpose (ICC= 0.60) the score  \n\n\n\nwas moderate (Table 3). The ICC for the \n\n\n\nother domains in the Malaysian CPGs \n\n\n\nwas low (ICC \u2264 0.40). \n\n\n\n\n\n\n\nCronbach\u201fs alpha was also used to test \n\n\n\nfor internal consistency\n\n\n\n \nFigure 3: Temporal evolution of the median standardized score for each AGREE \n\n\n\ninstrument domain \n\n\n\n\n\n\n\nTable 1: Comparison of the CPG quality according to independent variables \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n       Median [ Interquartile range] of standardized domain scores \n\n\n\nScope Participation Rigour Clarity Applicability independence \n\n\n\n2000-03 (n=29) 58% (49%) 52% (11%) 52% (33%) 79% (20%) 22% (13%) 50 (17%) \n\n\n\nYear 2000 (n=5) 47% (11%) 40% (20%) 27% (20%) 67% (29%) 19% (10%) 50% (19%) \n\n\n\nYear 2001 (n=10) 51% (8%) 46% (9%) 38% (16%) 67% (24%) 22% (15%) 50% (22%) \n\n\n\nYear 2002 ( N=4) 90% (40%) 54% (10%) 62% (13%) 92% (8%) 32% (29%) 56% (35%) \n\n\n\nYear 2003 (n=10) 99% (15%) 56% (7%) 66% (8%) 82% (8%) 25% (7%) 52% (11%) \n\n\n\nP value 0.000 0.000 0.000 0.002 0.413 0.904 \n\n\n\n \nreliability coefficient to measure the \n\n\n\nextent to which item responses correlate \n\n\n\nwith each other.  Alternatively, it can be \n\n\n\ninterpreted as the correlation of the \n\n\n\nobserved scale with all possible other \n\n\n\nscales measuring the same thing and \n\n\n\nusing the same number of it. When \n\n\n\ninterpreting Cronbach's alpha \n\n\n\nmagnitudes:  <0.4 represents poor \n\n\n\nreliability, 0.40 -0.75 represents fair to \n\n\n\ngood reliability and >0.75 represents \n\n\n\nexcellent reliability. For the domain, \n\n\n\nRigor of Development (Cronbach\u201fs alpha \n\n\n\n= 0.68) and Scope & Purpose \n\n\n\n(Cronbach\u201fs alpha = 0.63), the score was \n\n\n\nmoderate (Table 3). Cronbach\u201fs alpha \n\n\n\nfor the other domains in the Malaysian \n\n\n\nCPGs were low (Cronbach\u201fs alpha \u2264 \n\n\n\n0.40). \n\n\n\n\n\n\n\n0\n\n\n\n20\n\n\n\n40\n\n\n\n60\n\n\n\n80\n\n\n\n100\n\n\n\n120\n\n\n\nyear 2000 year 2001 year 2002 year 2003\n\n\n\nScope\n\n\n\nParticipation\n\n\n\nRigour\n\n\n\nClarity\n\n\n\nApplicability\n\n\n\nIndependence\n\n\n\nM\ne\n\n\n\nd\nia\n\n\n\nn\n o\n\n\n\nf \nth\n\n\n\ne \nst\n\n\n\na\nn\n\n\n\nd\na\n\n\n\nrd\niz\n\n\n\ned\n s\n\n\n\nco\nre\n\n\n\n f\no\n\n\n\nr \nea\n\n\n\nch\n d\n\n\n\no\nm\n\n\n\na\nin\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 8 \n\n\n\nThere seems to be variability of \n\n\n\nindividual scores between the appraisers \n\n\n\non items of the AGREE instrument and  \n\n\n\n\n\n\n\n\n\n\n\nsome of the variability may be due to \n\n\n\ndifferences in interpretation of several \n\n\n\nitems where the instructions were broad. \n\n\n\n\n\n\n\n\n\n\n\nTable 2: Scores by Item of the AGREE instrument \n\n\n\nDomain and items of the AGREE instrument Median \n\n\n\nValue \n\n\n\nInterq\n\n\n\nuartile \n\n\n\nRange \n\n\n\nDomain 1: Scope and Purpose \n\n\n\n1. The overall objectives of the guideline is (are) specifically \n\n\n\ndescribed \n\n\n\n3 2 \n\n\n\n2. The clinical question(s) covered by the guideline is (are) \n\n\n\nspecifically described \n\n\n\n3 2 \n\n\n\n3. The patients to whom the guideline is meant to apply are \n\n\n\nspecifically described \n\n\n\n4 1 \n\n\n\nDomain 2: Stakeholder involvement \n\n\n\n4. The guideline development group includes individuals from \n\n\n\nall the relevant professional groups \n\n\n\n4 1 \n\n\n\n5. The patients\u201f views and preferences have been sought 1 1 \n\n\n\n6. The target users of the guideline are clearly defined 3 1 \n\n\n\n7. The guideline has been piloted among end uders 1 2 \n\n\n\nDomain 3: Rigour of Development \n\n\n\n8. The systematic methods were used to search for evidence 2 2 \n\n\n\n9. The criteria for selecting the evidence are clearly described 2 3 \n\n\n\n10. The methods used for formulating the recommendations are \n\n\n\nclearly described \n\n\n\n2 2 \n\n\n\n11. The health benefits, side effects and risks  have been \n\n\n\nconsidered in formulating the recommendations \n\n\n\n3 2 \n\n\n\n12. There is an explicit link between the recommendations and \n\n\n\nthe  supporting evidence \n\n\n\n3 2 \n\n\n\n13. The guideline has been externally reviewed by experts prior \n\n\n\nto its publication \n\n\n\n2 2 \n\n\n\n14. A procedure for updating the guideline is provided 2 2.25 \n\n\n\nDomain 4 : Clarity and Presentation \n\n\n\n15. The recommendations are specific and unambiguous 4 1 \n\n\n\n16. The different options for management of the condition are \n\n\n\nclearly presented \n\n\n\n4 1 \n\n\n\n17. Key recommendations are clearly identifiable 3 1 \n\n\n\n18. The guideline is supported with tools for application \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n3 2 \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 9 \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nFigure 4: Results of 4 Reviewers based on AGREE instrument \n\n\n\n\n\n\n\n\n\n\n\nDiscussion \n\n\n\n\n\n\n\nThe results of the study showed that \n\n\n\nthrough the years, development of \n\n\n\nguidelines in Malaysia had progressively \n\n\n\nincreased. The quality of guidelines in \n\n\n\nMalaysia was practically unknown. To \n\n\n\nour knowledge, this was the first \n\n\n\nguideline appraisal in Malaysia. From \n\n\n\nthis research, the quality of the 29 \n\n\n\nMalaysian guidelines was far from ideal: \n\n\n\nscores were moderate and low in all \n\n\n\ndomains.  \n\n\n\n\n\n\n\nVariability of individual scores between \n\n\n\nthe appraisers on items of the AGREE \n\n\n\ninstrument, was noted as evidenced by \n\n\n\nthe low Cronbach\u201fs alpha and ICC. On \n\n\n\nthe other hand, the Argentinean study, by \n\n\n\nMar\u00eda Eugenia Esandi and Zulma Ortiz \n\n\n\net al, ICC and Cronbach's alpha for each \n\n\n\ndomain were in all cases moderate or \n\n\n\nhigh (0.46\u20130.74), except for Editorial \n\n\n\nIndependence which showed very low \n\n\n\nvalues. \n\n\n\n\n\n\n\nFirst, low quality could have been the \n\n\n\nresult of the absence of an explicit policy  \n\n\n\n0%\n\n\n\n10%\n\n\n\n20%\n\n\n\n30%\n\n\n\n40%\n\n\n\n50%\n\n\n\n60%\n\n\n\n70%\n\n\n\n80%\n\n\n\n90%\n\n\n\n100%\n\n\n\n1 2 3 4 5 6\n\n\n\nAGREE DOMAIN\n\n\n\nPE\nR\n\n\n\nC\nEN\n\n\n\nTA\nG\n\n\n\nE\n\n\n\nYEAR 2000\n\n\n\nYEAR 2001\n\n\n\nYEAR 2002\n\n\n\nYEAR 2003\n\n\n\nDomain 5: Applicability \n\n\n\n19. The potential organizational barriers in applying the \n\n\n\nrecommendations have been discussed \n\n\n\n2 1 \n\n\n\n20. The potential cost implications of applying the \n\n\n\nrecommendations have been considered \n\n\n\n2 1 \n\n\n\n21. The guideline presents key review criteria for monitoring and \n\n\n\n/ or audit purposes \n\n\n\n2 1 \n\n\n\nDomain 6: Editorial Independence \n\n\n\n22. The guideline is editorially independent from the funding \n\n\n\nbody \n\n\n\n3 2 \n\n\n\n23. Conflicts of interest of guideline development members have \n\n\n\nbeen recorded \n\n\n\n2 2 \n\n\n\n1) Scope & Purpose   \n2) Stakeholder \nInvolvement  \n3) Rigor & Development  \n4) Clarity & Presentation  \n5) Applicability  \n6) Editorial \n\n\n\nIndependence  \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 10 \n\n\n\nTABLE 3: Reliability Scores of the AGREE instrument \n\n\n\n Single rater ICC \n\n\n\n(95% CI) \n\n\n\nReliability Measures \n\n\n\nAverage of raters ICC \n\n\n\n(95% CI) \n\n\n\nCronbach alpha P value \n\n\n\nScope 0.27  (0.17 to 0.38) 0.60 (0.44 to 0.71) 0.63 0.00 \n\n\n\nParticipation 0.05 (0.003 to 0.10) 0.19 (- 0.12 to 0.43) 0.34 0.00 \n\n\n\nRigour 0.20 (0.14 to 0.27) 0.67 (0.57 to 0.75) 0.68 0.00 \n\n\n\nClarity 0.1 (0.04 to 0.18) 0.36 (0.1 to 0.55) 0.43 0.00 \n\n\n\nApplicability 0.12 (0.04 to 0.21) 0.36 (0.13 to 0.53) 0.39 0.00 \n\n\n\nEditorial \n\n\n\nIndependence \n\n\n\n-0.80 (-0.16 to 0.01) - 0.3 (-1.3 to 0.2) - 0.33 0.96 \n\n\n\n \nfor guidelines production (especially \n\n\n\ndevelopment of evidence-based CPGs) \n\n\n\nand evaluation during the period under \n\n\n\nassessment. There was also no clear \n\n\n\nguidance on the integration of multiple \n\n\n\nstakeholders. Most of the guidelines did \n\n\n\nnot have enough multidisplinary \n\n\n\nrepresentatives in the development \n\n\n\nprocess. In order to balance the interests, \n\n\n\npreferences and knowledge of different \n\n\n\nstakeholders whose participation in the \n\n\n\nguideline development process is \n\n\n\nrequired, a more integrated approach is \n\n\n\nrequired. \n\n\n\n\n\n\n\nSecondly, low quality scores of the \n\n\n\nMalaysia guidelines could be explained \n\n\n\nby a slower penetration and \n\n\n\nconsolidation of the evidence-based \n\n\n\nmedicine concept in comparison to \n\n\n\ndeveloped countries. Before the year \n\n\n\n2002, the awareness of evidence-based \n\n\n\nmedicine concept amongst the healthcare \n\n\n\npractitioners was still low in Malaysia. \n\n\n\nIn the United States, the Consensus \n\n\n\nDevelopment Program at the National \n\n\n\nInstitute of Health developed its first \n\n\n\nguideline in 1977. In the last 30 years, all \n\n\n\nthese organizations have accumulated a \n\n\n\nvast experience in guideline \n\n\n\ndevelopment, dissemination and \n\n\n\nimplementation. Currently, principles of \n\n\n\nevidence-based-medicine dominate \n\n\n\nalmost all of these national guideline \n\n\n\nprograms. The creation of international  \n\n\n\n\n\n\n\nnetworks, like the Guidelines \n\n\n\nInternational Network (G-I-N), as well \n\n\n\nas the establishment of projects like the \n\n\n\nAGREE, have clearly contributed to the \n\n\n\nimprovement and standardization of \n\n\n\nthese processes in the participating \n\n\n\ncountries. Contrastingly, Malaysia, did \n\n\n\nnot take part in any of these activities \n\n\n\nexcept until recently. Diffusion and \n\n\n\ndissemination of appropriate methods for \n\n\n\nevidence-based guidelines development \n\n\n\nis limited in Malaysia. This study found \n\n\n\nthat until 2003, this process was not \n\n\n\nsystematized and the development of \n\n\n\nCPGs still relied heavily on the opinion \n\n\n\nof experts. The manual development of \n\n\n\nevidence-based CPGs was drafted in \n\n\n\n2003. \n\n\n\n\n\n\n\nThirdly, limited accessibility to updated \n\n\n\nbiomedical literature can negatively \n\n\n\nimpact on the use of relevant and \n\n\n\nimportant evidence to support guidelines \n\n\n\nrecommendations. Most of the \n\n\n\ngovernment facilities had very limited \n\n\n\naccessibility to current biomedical \n\n\n\nliterature due to the financial constrain. \n\n\n\nEven after the broad agreement on the \n\n\n\nneed for systematic reviews to inform \n\n\n\nrecommendations, this type of evidence \n\n\n\nwas rarely referred in Malaysian \n\n\n\nguidelines. Therefore, networking \n\n\n\nactivities between guideline producers \n\n\n\nshould also be promoted.  \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 11 \n\n\n\nAnother factor that could have \n\n\n\ninfluenced the quality of Malaysian \n\n\n\nguidelines is the lack of economical and \n\n\n\nhuman resources devoted to guideline \n\n\n\nproduction. Since the cost of producing \n\n\n\nevidence-based guidelines is relatively \n\n\n\nhigh, a systematic methodology to adapt \n\n\n\ninternational guidelines would be an \n\n\n\nefficient way of improving not only the \n\n\n\nquantity but also their quality \n18\n\n\n\n. \n\n\n\nInternationally developed guidelines can \n\n\n\nbe adapted to the local context, \n\n\n\nrepresenting a considerable saving of \n\n\n\nmoney. However, an explicit and \n\n\n\nsystematic adaptation process should be \n\n\n\nperformed as guidelines' applicability \n\n\n\nand transferability can be strongly \n\n\n\ninfluenced by different factors, such as \n\n\n\npopulation needs (prevalence of disease, \n\n\n\nbaseline risk status), setting (availability \n\n\n\nof resources) and other factors that \n\n\n\nmodify translation of recommendations \n\n\n\ninto practice \n19\n\n\n\n.  \n\n\n\n\n\n\n\nAlthough many of the Malaysian \n\n\n\nguidelines were classified as evidence-\n\n\n\nbased, a thorough review of their quality \n\n\n\nutilizing the AGREE instrument led to \n\n\n\nthe authors to recommend the guidelines \n\n\n\nonly with provisos or alterations. \n\n\n\nOverall, almost all the guidelines \n\n\n\nperformed poorly with respect to \n\n\n\napplicability. Most of the guidelines \n\n\n\nfailed to address issues of barriers to \n\n\n\nimplementation, monitoring criteria, and \n\n\n\nevidence of pilot testing.  \n\n\n\n\n\n\n\nOn the other hand, the study on the \n\n\n\nclinical practice guidelines in Argentina \n\n\n\n(1994\u20132004) \n7\n by Mar\u00eda Eugenia Esandi \n\n\n\nand Zulma Ortiz et al. scored lower in \n\n\n\nthe overall standardized scores.  Overall \n\n\n\nstandardized score for each domain \n\n\n\nwere: Scope & Purpose (overall score \n\n\n\nwas 39%); Stakeholder Involvement \n\n\n\n(overall score was 13%); Rigor & \n\n\n\nDevelopment (overall score was 10%); \n\n\n\nClarity and presentation (overall score \n\n\n\nwas 42%); Applicability (overall score \n\n\n\nwas 6%); Editorial Independence \n\n\n\n(overall score was 0%). \n\n\n\n\n\n\n\nOne of the key factors regarding the \n\n\n\nadequacy of the guidelines pertains to \n\n\n\nthe rigor of development. Many of the \n\n\n\nguidelines did not clearly delineate the \n\n\n\nliterature review methodology used or \n\n\n\nthe mechanism by which \n\n\n\nrecommendations were formulated. This \n\n\n\nstep is crucial in determining whether the \n\n\n\nrecommendations were truly based on \n\n\n\nevidence or in understanding how \n\n\n\nevidence was synthesized. \n\n\n\n\n\n\n\nAs in the evidence-based decision \n\n\n\nmaking, patient preferences and \n\n\n\nexperiences should be factored into \n\n\n\ndecisions regarding clinical care, \n\n\n\nespecially in diseases such as cancer in \n\n\n\nwhich treatments can have significant \n\n\n\nmorbidity and can impact on quality of \n\n\n\nlife. All guideline committees should \n\n\n\nhave patient representatives and all \n\n\n\nliterature reviews specifically addresses \n\n\n\nquality of life when available. \n\n\n\n\n\n\n\nFinally, findings of this assessment \n\n\n\nhighlighted the need of improving the \n\n\n\nreporting of the editorial independence \n\n\n\nof guideline producers. Practically none \n\n\n\nof the Malaysian guideline reported \n\n\n\nconflict of interests or funding sources. \n\n\n\nLack of transparency was also reported \n\n\n\nby Papanikolaou et al. in an evaluation \n\n\n\nof 191 published guidelines: only 7 \n\n\n\n(3.7%) disclosed potential conflicts of \n\n\n\ninterest \n20\n\n\n\n. In the case of the Malaysian \n\n\n\nguidelines, omission could have been \n\n\n\nunintentional or, on the contrary, \n\n\n\nintentional (financial ties might have \n\n\n\nexisted in some situations and \n\n\n\ndeliberately hidden by guideline \n\n\n\nauthors). However, regardless of the \n\n\n\nintent of guideline developers' actions, \n\n\n\nexplicit declaration of conflict of \n\n\n\ninterests at the beginning of the process \n\n\n\nis strongly recommended by most \n\n\n\ninternational organizations as a way of \n\n\n\nreducing the probability of biased \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 12 \n\n\n\nrecommendations and increasing \n\n\n\nguidelines' credibility \n21\n\n\n\n. \n\n\n\n\n\n\n\nThere were several limitations noted in \n\n\n\nour study.  It should be noted that in the \n\n\n\nAGREE instrument, the appraiser have \n\n\n\nto choose from four categories (1, 2, 3, \n\n\n\n4) for his /her evaluation.  Secondly, \n\n\n\nbecause we relied on materials reported \n\n\n\nin the published versions of the \n\n\n\nguidelines, our findings could be \n\n\n\naffected not only by the quality of the \n\n\n\nguidelines themselves but also by the \n\n\n\nquality of the reporting process. It was \n\n\n\npossible that in some cases, guideline \n\n\n\ndevelopers used appropriate techniques \n\n\n\nbut did not report them. We attempted to \n\n\n\nminimize this by including in our \n\n\n\nevaluation any background on \n\n\n\nsupporting articles if they were available. \n\n\n\nHowever we feel that just as in other \n\n\n\nmedical reports, documentation of \n\n\n\nmethods used is important, and if \n\n\n\nexplicitly stated can help determine the \n\n\n\nvalidity of recommendations. Thirdly, \n\n\n\nusing the AGREE instrument, the inter-\n\n\n\nrater reliability was only poor to \n\n\n\nmoderate. Some of the variability may \n\n\n\nbe due to differences in interpretation of \n\n\n\nseveral items where the instructions were \n\n\n\nbroad. Another potential limitation of the \n\n\n\nAGREE instrument concerns the validity \n\n\n\nof the responses to the question on the \n\n\n\noverall assessment of the guideline. \n\n\n\nAlthough the reviewers were instructed \n\n\n\nto consider the domain scores when \n\n\n\nmaking a decision about whether or not \n\n\n\nto recommend the guideline, no clear \n\n\n\nrules were established. \n\n\n\n\n\n\n\nIn Malaysia most practitioners, before \n\n\n\nthe year 2003, were not clear of \n\n\n\nprocesses involves in evidence-based \n\n\n\nmedicine approach. Most were still \n\n\n\ndoing with consensus-consulting and \n\n\n\nagreeing to expert opinions. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nTo our knowledge this is the first time a \n\n\n\nstudy of this kind has been undertaken in \n\n\n\nMalaysia. Its execution was the first step \n\n\n\nin the building a network of \n\n\n\nprofessionals interested in improving \n\n\n\nevidence-based CPG development, \n\n\n\ndissemination and implementation in the \n\n\n\ncountry. Its findings have been found to \n\n\n\nbe very useful in improving the \n\n\n\nmethodological quality of developing \n\n\n\nCPGs in Malaysia.           \n\n\n\n\n\n\n\nConclusion \n\n\n\n\n\n\n\nThis study was one of the firsts that \n\n\n\nsystematically employed the AGREE \n\n\n\ninstrument for the critical assessment of \n\n\n\nguidelines produced in Malaysia. The \n\n\n\nAGREE instrument can serve as a model \n\n\n\nto identify improvement opportunities in \n\n\n\nthe guidelines development process of \n\n\n\nMalaysia. In this sense, this research \n\n\n\nshows the low quality of guidelines \n\n\n\nproduced and points out areas to which \n\n\n\ntraining initiatives should be oriented. \n\n\n\n\n\n\n\nA review of the current Malaysian \n\n\n\nguidelines demonstrates that many of the \n\n\n\nclinical topics of interest have been \n\n\n\nconsidered by at least one guideline. \n\n\n\nNone covers all the necessary elements. \n\n\n\nFurthermore, although these guidelines \n\n\n\nmay accurately reflect clinical practice, \n\n\n\nfew adhere to the standards set forth by \n\n\n\nthe AGREE instrument. \n\n\n\n\n\n\n\nSeveral approaches could be used to \n\n\n\nimprove the quality of guidelines. The \n\n\n\nguideline producers could become \n\n\n\nfamiliar with guideline development \n\n\n\nstandards that have been established and \n\n\n\nmake greater efforts to incorporate them \n\n\n\ninto guidelines, strive to widely adopt \n\n\n\nand use them. \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 13 \n\n\n\n\n\n\n\nAcknowledgement \n\n\n\n\n\n\n\nThis research project was sponsored by \n\n\n\nthe Small Research Grant, Government \n\n\n\nof Malaysia (Project Code: MRG-2004-\n\n\n\n5) \n\n\n\n\n\n\n\nWe would like to thank the following for \n\n\n\ncontributing their precious idea and \n\n\n\nadvice to lead us to the successful write \n\n\n\nup of this project: \n\n\n\n\n\n\n\n\uf0b7 Dato\u201fDr. Zaki Morad, Director of \n\n\n\nClinical Research Centre HKL \n\n\n\n\uf0b7 Dr Sivalal,  Unit Head of Health \n\n\n\nTechnology Assessment \n\n\n\n\uf0b7 Dr Jamaiyah Haniff, Principal \n\n\n\nAssisstant Diector, Clinical Research \n\n\n\nCentre \n\n\n\n\uf0b7 Dr Rusilawati  Jawdin, Principal \n\n\n\nAssisstant Diector, Health \n\n\n\nTechnology Assessment unit \n\n\n\n\uf0b7 Matron Jaya Devi, Health \n\n\n\nTechnology Assessment Unit \n\n\n\n\uf0b7 Dr Maizun Mohd Zain, Principal \n\n\n\nAssisstant Diector, Evidence-based \n\n\n\nmedicine Unit \n\n\n\n\n\n\n\nReferences \n\n\n\n\n\n\n\n1. 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Marfa Eugenia Esandi, Zulma Ortiz, Evelina Chapman et al, Production nad quality \n\n\n\nof clinical practice guidelines in Argentina (1994 \u2013 2004); a cross-sectional study, \n\n\n\nImplementation Science 2008, 3:43 doi:10.1186/1748-5908-3-43. \n\n\n\n8. The AGREE Collaboration. Development and validation of an international appraisal \n\n\n\ninstrument for assessing the quality of clinical practice guidelines: the AGREE \n\n\n\nproject. Qual Saf Health Care. 2003;12:18\u201323. doi: 10.1136/qhc.12.1.18. \n\n\n\n9. Shaneyfelt T, Mayo-Smith M, Rothwangl J. Are Guidelines following guidelines? \n\n\n\nThe methodological quality of Clinical Practice Guidelines in the peer-review medical \n\n\n\nliterature. Jama. 1999;285:1900\u20131905. doi: 10.1001/jama.281.20.1900. \n\n\n\n10. Cluzeau F, Littlejohns P, Grimshaw J, Feder G, Moran S. Development and \n\n\n\napplication of a generic methodology to assess the quality of clinical guidelines. \n\n\n\nInternational Journal for Quality in Health Care. 1999;11:21\u201328. doi: \n\n\n\n10.1093/intqhc/11.1.21. \n\n\n\n11. Grilli R, Magrin N, Penna A, Mura G, Liberati A. Practice guidelines developed by \n\n\n\nspecialty societies: the need for a critical appraisal. Lancet. 2000;355:103\u2013106. doi: \n\n\n\n10.1016/S0140-6736(99)02171-6. \n\n\n\n12. Graham I, Beardall S, Carter A, Glennie J, Hebert P, Tetroe J, McAlister F, Visentin \n\n\n\nS, Anderson G. What is the quality of drug therapy in Canada? CMAJ. 2001;165:157\u2013\n\n\n\n163.] \n\n\n\n\nhttp://www.acadmed.org.my/html/index.shtml\n\n\nhttp://www.acadmed.org.my/html/index.shtml\n\n\nhttp://www.agreecollaboration.org/\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 14 \n\n\n\n13. Harpole L, Kelley MJ, Schreiber G, Toloza EM, Kolimaga J, McCrory DC. \n\n\n\nAssessment of the Scope and Quality of Clinical Practice Guidelines in Lung Cancer. \n\n\n\nCHEST. 2003;123:7S\u201320S. doi: 10.1378/chest.123.1_suppl.7S. \n\n\n\n14. Navarro Puerto MA, Ruiz Romero F, Reyes Dom\u00ednguez A, Guti\u00e9rrez Ibarlucea I, \n\n\n\nHermosilla Gago T, Alonso Ortiz del R\u00edo C, et al. \u00bfLas Gu\u00edas que nos gu\u00edan son \n\n\n\nfiables? Evaluaci\u00f3n de las Gu\u00edas de Pr\u00e1ctica Cl\u00ednica Espa\u00f1olas. Rev Cl\u00edn Esp. \n\n\n\n2005;11:533\u201340. \n\n\n\n15. MacDermid JC, Brooks D, Solway S, Switzer-McIntyre S, Brosseau L, Graham ID. \n\n\n\nReliability and validity of the AGREE instrument used by physical therapists in \n\n\n\nassessment of clinical practice guidelines. BMC Health Services Research. 2005;5:5\u2013\n\n\n\n18. doi: 10.1186/1472-6963-5-18. \n\n\n\n16. Rico Iturrioz R, Gutierrez-Ibarluzea I, Asua Batarrita J, Navarro Puerto MA, Reyes \n\n\n\nDom\u00ednguez A, Mar\u00edn Le\u00f3n I, Briones P\u00e9rez de la Blanca E. Valoraci\u00f3n de escalas y \n\n\n\ncriterios para la evaluaci\u00f3n de Gu\u00edas de Pr\u00e1ctica Cl\u00ednica. Rev Esp Salud P\u00fablica. \n\n\n\n2004;78:457\u2013467. \n\n\n\n17. Vlayen J, Aertgeerts B, Hannes K, Sermeus W, Ramaekers D. A systematic review of \n\n\n\nappraisal tools for clinical practice guidelines: multiple similarities and one common \n\n\n\ndeficit. Int J Qual Health Care. 2005;17:235\u2013242. doi: 10.1093/intqhc/mzi027. \n\n\n\n18. Graham ID, Harrison MB, Brouwers M, Davies BL, Dunn S. Facilitating the Use of \n\n\n\nEvidence in Practice: Evaluating and Adapting Clinical Practice Guidelines for Local \n\n\n\nUse by Health Care Organizations. JOGNN. 2002;31:599\u2013611. \n\n\n\n19. Sch\u00fcnemann HJ, Fretheim A, Oxman AD. Improving the Use of Research Evidence \n\n\n\nin Guideline Development: 13. Adaptation, applicability and transferability. Health \n\n\n\nRes Policy Syst. 2006;4:25. doi: 10.1186/1478-4505-4-25.  \n\n\n\n20. Papanikolaou GN, Baltogianni MS, Contopoulos-Ioannidis DS, Haidich AB, \n\n\n\nGiannakakis IA, Ioannidis JPA. Reporting of conflicts of interest in guidelines of \n\n\n\npreventive and therapeutic interventions. BMC Medical Research Methodology. \n\n\n\n2001;1:3. doi: 10.1186/1471-2288-1-3.  \n\n\n\n21. Boyd E, Bero L. Improving the Use of Research Evidence in Guideline Development: \n\n\n\n4. Managing conflicts of interest. Health Res Policy Syst. 2006;4:16. doi: \n\n\n\n10.1186/1478-4505-4-16.  \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 15 \n\n\n\nEvaluation of the Tablet Splitting Practices among Malaysian \n\n\n\nCommunity Pharmacists. \n\n\n\nChee Ping Chong*\n1\n, Mohamed Azmi Hassali\n\n\n\n2 \n, Mohd Baidi Bahari\n\n\n\n3\n, \n\n\n\n\n\n\n\n \n1\nDiscipline of Clinical Pharmacy, \n\n\n\n2\nDiscipline of Social and Administrative Pharmacy, \n\n\n\nSchool of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Minden, Penang, \n\n\n\nMalaysia \n3\nProfessor, Faculty of Pharmacy, AIMST Universiti, 08100 Bidong, Kedah, Malaysia \n\n\n\n\n\n\n\n\n\n\n\n* Corresponding author \nMalaysian Journal of Pharmacy, Vol 1 Issue 10, 2012, 12 - 27                                               \n\n\n\n\n\n\n\nAbstract \n\n\n\n\n\n\n\nTablet splitting practices have been shown to reduce the medication cost in many \n\n\n\ncountries. This study was aimed to evaluate the tablet splitting practices among \n\n\n\ncommunity pharmacists in Penang, Malaysia. A two-month cross-sectional descriptive \n\n\n\nsurvey was carried out in forty randomly chosen community pharmacies in Penang. The \n\n\n\npharmacists were required to document all their tablet splitting recommendations during \n\n\n\nthe study period.  The data collected includes the appropriateness of the tablet splitting \n\n\n\nrecommendations by pharmacists; the extent of communication between pharmacists and \n\n\n\nphysicians when recommending tablet splitting; the physicians\u201f and patients\u201f acceptance \n\n\n\ntowards the tablet splitting; and the documentation of cost-saving achieved from the tablet \n\n\n\nsplitting.  The result showed that the tablet splitting was recommended by 31.0% of the \n\n\n\npharmacists who receives prescriptions eligible for this practice. Tablets of patent-\n\n\n\nprotected innovator brands were more likely to be recommended for splitting. Majority \n\n\n\n(92.9%) of the splitting recommendations were appropriate except two cases which \n\n\n\ninvolve unscored combination tablet. The pharmacists requested consent from the \n\n\n\nphysicians for 42.9% of the splitting recommendations and majority (91.7%) of the \n\n\n\nrequests were accepted. Meanwhile, the patients\u201f acceptance rate for splitting \n\n\n\nrecommendation was 82.1%. Through acceptance of tablet-splitting, the patients\u201f monthly \n\n\n\nexpenses on drugs reduced by 36.5% and this correspond to a monthly saving of \n\n\n\nRM39.05 (US$10.30, US$1.00 = RM 3.80) per patient.  The study concluded that the \n\n\n\ntablet splitting is not a common practice among the community pharmacists, however \n\n\n\nboth the physicians and patients highly accept pharmacists\u201f suggestion on splitting. The \n\n\n\nfindings also revealed that tablet splitting can be used as a cost-containment measure for \n\n\n\npatient as well.  \n\n\n\n\n\n\n\nArticle Keywords: tablet splitting, community pharmacist, physician, patient, cost-\n\n\n\nsaving  \n\n\n\nIntroduction \n\n\n\nRecently, increase in countries\u201f \n\n\n\nexpenditures on prescription drugs has \n\n\n\nbecome a worldwide dilemma. In \n\n\n\nMalaysia, the government fully \n\n\n\nsubsidizes the drugs expenditure in \n\n\n\npublic hospital. However, the \n\n\n\ngovernment subsidized cost for drugs in \n\n\n\npublic hospital increased from RM 200 \n\n\n\nmillion in 1995 to RM 800 million in \n\n\n\n2005 with an annual increment of 10%-\n\n\n\n15%, thus this had affected the \n\n\n\ngovernment\u201fs ability to sustain \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 16 \n\n\n\npharmaceutical financing in the future \n\n\n\n(1,2). Besides, 56% of Malaysian \n\n\n\nconsumers perceived drugs in private \n\n\n\nsector as expensive and 68% urged that \n\n\n\nprices should be reduced (3). The high \n\n\n\ndrugs cost may generate prescription \n\n\n\nnon-compliance and thus in return will \n\n\n\nfurther increase healthcare costs (4).  \n\n\n\n\n\n\n\nMany studies highlighted that tablet \n\n\n\nsplitting resulted in significant cost-\n\n\n\nsaving (5-10). For instance, introduction \n\n\n\nof tablet splitting by a health plan in \n\n\n\nNorth Caroline generated annual savings \n\n\n\nof US$342,000 (5). However, tablet \n\n\n\nsplitting is contraindicated for extended \n\n\n\nrelease formulation and enteric-coated \n\n\n\ntablet (11-14). Unscored tablet and \n\n\n\ncombination tablet are generally not \n\n\n\nmean to be split, but some tablets \n\n\n\nwithout scoring may be split easily with \n\n\n\ntablet-splitting device (11-12). \n\n\n\nUnacceptable weight variation can be \n\n\n\nresulted from tablet splitting and may be \n\n\n\nclinical significant for narrow \n\n\n\ntherapeutic drug (15-17). Therefore, this \n\n\n\npractice only suitable for drugs with \n\n\n\nwide therapeutic range and long half life \n\n\n\n(7,12,14-18). Previous studies had shown \n\n\n\nthat majority of the patients\u201f compliance \n\n\n\nwas not hindered after introduction of \n\n\n\ntablet splitting (19-21). Nevertheless, \n\n\n\ntablet splitting is not suitable for \n\n\n\ncognitively and functionally impaired \n\n\n\npatients who could lead to confusion and \n\n\n\nincorrect dosing (13,14).       \n\n\n\n\n\n\n\nIn the current context of pharmacy \n\n\n\npractice in Malaysia, there is no \n\n\n\ndispensing separation policy been \n\n\n\nimplemented between private general \n\n\n\npractitioners and community \n\n\n\npharmacists. There is also no tablet-\n\n\n\nsplitting guideline for health \n\n\n\nprofessionals in Malaysia. Under these \n\n\n\ncircumstances, little is known about the \n\n\n\npharmacist\u201fs tablet splitting practices \n\n\n\nand the response of physician and patient \n\n\n\ntoward the splitting recommendation.  \n\n\n\n\n\n\n\nAim of the study \n\n\n\n\n\n\n\nThis study aims to document the tablet \n\n\n\nsplitting practices among Malaysian \n\n\n\ncommunity pharmacists with the focus \n\n\n\non the appropriateness of the tablet \n\n\n\nsplitting recommendations; the extent of \n\n\n\ncommunication between pharmacists and \n\n\n\nphysicians while recommending tablet \n\n\n\nsplitting; the physicians\u201f and patients\u201f \n\n\n\nacceptance towards the tablet splitting; \n\n\n\nand the cost-saving resulted from the \n\n\n\ntablet splitting practices.  \n\n\n\n\n\n\n\nMethod \n\n\n\n\n\n\n\nThis is a cross-sectional descriptive \n\n\n\nsurvey study using a self-completed data \n\n\n\nform for pharmacists to fill in. This data \n\n\n\nform was modified from the data \n\n\n\ncollection form obtained from previous \n\n\n\nstudy undertaken in Scotland (22). This \n\n\n\ndata form has been tested for face and \n\n\n\ncontent validity by five pharmacy \n\n\n\nacademics and 10 pharmacists. The \n\n\n\nsample of the form is shown in \n\n\n\nAppendix 1.  \n\n\n\n\n\n\n\nThe population of community \n\n\n\npharmacists in Penang state was \n\n\n\nstratified into urban and rural area. The \n\n\n\nsampling frame was the pharmacies list \n\n\n\nprovided by State Pharmacy \n\n\n\nEnforcement Department. Thirty and ten \n\n\n\noutlets were randomly chosen from the \n\n\n\nurban and rural area respectively and \n\n\n\nresulted in total of 40 community \n\n\n\npharmacies as the sample.  \n\n\n\n\n\n\n\nThis study includes patients who brought \n\n\n\nprescriptions written in branded or \n\n\n\ngeneric name to the community \n\n\n\npharmacies. These drugs are available in \n\n\n\nvarious strengths which are eligible for \n\n\n\ntablet splitting. The pharmacists were \n\n\n\nrequested to document their tablet \n\n\n\nsplitting recommendation to the patient, \n\n\n\nincluding the brand name of the drug \n\n\n\ninvolved, the strength, the dosage \n\n\n\nregimen, the cost and selling price of the \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 17 \n\n\n\ndrug, the decision either to consult or not \n\n\n\nconsult the physician with regards to \n\n\n\nsplitting recommendations, and \n\n\n\nphysician and patient\u201fs acceptance \n\n\n\ntoward the recommendation made. \n\n\n\nPatients who have a risk that tablet \n\n\n\nsplitting will impair their understanding \n\n\n\nand compliance to therapy were \n\n\n\nexcluded from the study.   \n\n\n\n\n\n\n\nThe researcher sent the data form by \n\n\n\npersonal visit to the selected outlets and \n\n\n\ndetail explanations was given to the \n\n\n\npharmacists. The participation of this \n\n\n\nstudy was strictly voluntary and no \n\n\n\npersonal data of the participants were \n\n\n\nreported. The duration of data collection \n\n\n\nwas 2 months period from 22\nnd\n\n\n\n February \n\n\n\n2005 to 22\nnd\n\n\n\n April 2005. Follow-up and \n\n\n\ndata collection were done by monthly \n\n\n\npersonal visit by the researcher. All the \n\n\n\ncollected data was entered into SPSS\n\u00ae\n \n\n\n\nversion 11.5 for analysis.  \n\n\n\n\n\n\n\nResults \n\n\n\n\n\n\n\nFrom the chosen sample of forty \n\n\n\npharmacies (one pharmacist in each \n\n\n\noutlet), 34 pharmacists (85.0%) agreed \n\n\n\nto participate in this study. At the end of \n\n\n\nthe study, only 9 (26.5%) pharmacists \n\n\n\ninvolved in tablet-splitting practices. \n\n\n\nFive pharmacists (14.7%) did not receive \n\n\n\nany prescription eligible for tablet \n\n\n\nsplitting. The remaining 20 pharmacists \n\n\n\n(58.8%) did not recommend tablet \n\n\n\nsplitting although they have the \n\n\n\nopportunity to do so. In another words, \n\n\n\namong the 29 pharmacists which \n\n\n\nreceived prescriptions eligible for tablet \n\n\n\nsplitting, only 31.0% (9 pharmacists) \n\n\n\nrecommended tablet splitting to their \n\n\n\npatients. \n\n\n\n\n\n\n\nTotal numbers of patients involved in \n\n\n\ntablet splitting recommendation were 28. \n\n\n\nThere were 28 items involved and one \n\n\n\nitem was considered as one case of tablet \n\n\n\nsplitting recommendation. Besides, the \n\n\n\ncases involved 13 drugs and 17 products \n\n\n\nwith different strength (Table 1).  \n\n\n\n\n\n\n\nAnalysis of tablet splitting practices \n\n\n\nMajority of the cases involved \n\n\n\nantihyperlipidemia (42.8%) and \n\n\n\ncardiovascular drugs (42.8%), followed \n\n\n\nby antibiotic (3.6%), erectile dysfunction \n\n\n\n(3.6%), gout (3.6%) and diabetic \n\n\n\nmellitus (3.6%). Almost all (96.4%) of \n\n\n\nthe cases involved Class B Poison which \n\n\n\nunder the Malaysian Poison Law 1952 \n\n\n\ncan only be sold with a prescription from \n\n\n\na registered medical, dental or veterinary \n\n\n\npractitioners. Only one case (3.6%) \n\n\n\ninvolved Class C Poison which under the \n\n\n\nMalaysian Poison Law can be sold \n\n\n\nwithout a prescription by a registered \n\n\n\npharmacist in a registered pharmacy \n\n\n\npremise.  \n\n\n\n\n\n\n\nAmong the tablet splitting \n\n\n\nrecommendations, 57.2% involved \n\n\n\npatent-protected innovator brands, \n\n\n\nfollowed by 32.2% of off-patent \n\n\n\ninnovator brands which equivalent \n\n\n\ngeneric products were available as of the \n\n\n\ndate of this research. Only 10.6% of the \n\n\n\ncases involved generic products. Zocor\n\u00ae\n\n\n\n\n\n\n\n(Simvastatin) was the most popular drug \n\n\n\ninvolved in tablet splitting \n\n\n\nrecommendation which consist of 28.6% \n\n\n\nof the cases and followed by Lipitor\n\u00ae\n\n\n\n\n\n\n\n(Atorvastatin) (10.7%) and Norvasc\n\u00ae\n\n\n\n\n\n\n\n(Amlodipine) (10.7%) (Table 1). \n\n\n\n\n\n\n\nDetail analysis noticed one unique case \n\n\n\nof generic substitution occurred \n\n\n\nconcurrently with tablet splitting. In this \n\n\n\ncase, the patient accepted to change the \n\n\n\ntherapy from Zocor\n\u00ae\n\n\n\n (Simvastatin) \n\n\n\n20mg, one tablet daily to Vascor\n\u00ae\n\n\n\n\n\n\n\n(manufactured by CCM \n\n\n\nPharmaceuticals, a local generic \n\n\n\ncompany) 40mg half tablet daily (Table \n\n\n\n1). This unique case saved RM62.55 \n\n\n\n(US$16.50) per month (28 days) for the \n\n\n\npatient with RM47.60 (US$12.55) of the \n\n\n\ncost-saving was gained from the generic \n\n\n\nsubstitution (Zocor\n\u00ae\n 20mg, 28 tablets \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 18 \n\n\n\ncost RM93.35; Zocor\n\u00ae\n\n\n\n 40mg, 14 tablets \n\n\n\ncost RM78.40; Vascor\n\u00ae\n\n\n\n 40mg, 14 tablets \n\n\n\ncost RM30.80; RM3.80 = US$1.00). \n\n\n\nThere was another unique case involved \n\n\n\nsimplified the patient\u201fs treatment \n\n\n\nthrough tablet splitting.  In this case, the \n\n\n\npatient agreed to change the regime of \n\n\n\nApo-Allopurinol\n\u00ae\n (Allopurinol) 100mg, \n\n\n\none and a half tablet daily to become \n\n\n\nApo-Allopurinol\n\u00ae\n 300mg, half tablet \n\n\n\ndaily (Table 1). This recommendation \n\n\n\nresulted in monthly cost-saving of \n\n\n\nRM7.80 (US$2.05) to the patient (Apo-\n\n\n\nAllopurinol\n\u00ae\n 100mg, 42 tablets cost \n\n\n\nRM15.60; Apo-Allopurinol\n\u00ae\n 300mg, 14 \n\n\n\ntablets cost RM7.80). \n\n\n\n\n\n\n\nIn the present study, it was noted that \n\n\n\nmodified release formulation, enteric-\n\n\n\ncoated tablet and narrow therapeutic \n\n\n\nindex drugs were not involved in the \n\n\n\nsplitting recommendations made. \n\n\n\nNevertheless, only 32.1% (9 of 28) of \n\n\n\nthe recommendations involved scored \n\n\n\ntablets with single wide therapeutic \n\n\n\ndrugs which are suitable for splitting \n\n\n\n(Table 1). The remaining 67.9% (19 of \n\n\n\n28) of the cases involved unscored \n\n\n\ntablets which need further evaluation on \n\n\n\nits divisibility. All the unscored tablets \n\n\n\nhave symmetrical shape and can be split \n\n\n\ninto two equal halve using appropriate \n\n\n\nsplitting device. Majority (92.9%) of the \n\n\n\nunscored tablet cases involved single \n\n\n\nwide therapeutic drug except two cases \n\n\n\ninvolved combination tablet which were \n\n\n\nCo-Diovan\n\u00ae\n and Fortzaar\n\n\n\n\u00ae\n. Two drugs \n\n\n\nin a combination tablet may not evenly \n\n\n\ndistribute throughout the tablet and \n\n\n\nsplitting may not produce equal dose \n\n\n\n(12). However, the pharmacist requested \n\n\n\nconsent from the physician when \n\n\n\nrecommending splitting of Co-Diovan\n\u00ae\n\n\n\n\n\n\n\nand Fortzaar\n\u00ae\n\n\n\n and these \n\n\n\nrecommendations was agreed by the \n\n\n\nphysician. Analysis shown the \n\n\n\nmanufacturer of Co-Diovan\n\u00ae\n (Novartis) \n\n\n\ndisallowed splitting by indicating it is \n\n\n\n\u201cnon-divisible\u201d in the product leaflet. \n\n\n\nMeanwhile, for all other cases, the \n\n\n\nproduct leaflet provides information on \n\n\n\nthe tablet characteristics but does not \n\n\n\nprovide any information about its \n\n\n\ndivisibility. As the product leaflet for \n\n\n\nFortzaar\n\u00ae\n do not include any information \n\n\n\nregarding its divisibility, the researcher \n\n\n\nhad contacted the manufacturer of \n\n\n\nFortzaar\n\u00ae\n (MSD Malaysia branch) to \n\n\n\nclarify this issue and found that it can\u201ft \n\n\n\nbe split. Further analysis on the unscored \n\n\n\ntablets shows Cozaar\n\u00ae\n and Zocor\n\n\n\n\u00ae\n tablet \n\n\n\nare formulated with a scored  line on the \n\n\n\nlower strength tablet (Cozaar\n\u00ae\n 50mg and \n\n\n\nZocor\n\u00ae\n 10mg) but are unscored for the \n\n\n\nhigher strength tablet (Cozaar\n\u00ae\n 100mg \n\n\n\nand Zocor\n\u00ae\n 20mg onwards). Besides, \n\n\n\nstudies has shown that tablet splitting for \n\n\n\nsimvastatin and atorvastatin is effective \n\n\n\nand safe (7,18). \n\n\n\n\n\n\n\nExtent of communication between \n\n\n\npharmacists and physicians \n\n\n\nOverall, the pharmacists requested \n\n\n\nconsent from the physician for 42.9% of \n\n\n\nthe splitting recommendations. Further \n\n\n\nanalysis shown 33.3% of the \n\n\n\nantihyperlipidemia agent cases and \n\n\n\n41.7% of the cardiovascular drug cases \n\n\n\nwas recommended with reference to the \n\n\n\nphysicians. Besides, 33.3% and 47.4% of \n\n\n\ncases involved scored and unscored \n\n\n\ntablet involved consultation with \n\n\n\nphysicians respectively but the \n\n\n\ndifferences in these percentages were not \n\n\n\nstatistical significant (Fisher\u201fs Exact \n\n\n\nTest, p = 0.687). \n\n\n\n\n\n\n\nPhysicians and patients\u2019 acceptance \n\n\n\nThe physicians\u201f acceptance rate for \n\n\n\ntablet splitting recommendations was \n\n\n\n91.7% with only one case involved \n\n\n\nTenormin\n\u00ae\n 100mg was rejected. In fact, \n\n\n\nthe entire cases involved unscored tablet \n\n\n\nwas accepted by the physicians.   \n\n\n\n\n\n\n\nThe overall patients\u201f acceptance rate for \n\n\n\nsplitting recommendations was 82.1%. \n\n\n\nMajority of the patients accepted the  \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 19 \n\n\n\n \nTherapeutic group Drug \n\n\n\n(generic name) \n\n\n\nPatient\u2019s initial regime \n\n\n\n(Product name & dose) \n\n\n\nTablet splitting \n\n\n\nrecommendation \n\n\n\n(Product name & dose) \n\n\n\nManufacturer \n\n\n\n(Country of origin)* \n\n\n\nMedication \n\n\n\ncharacteristics*\u2020 \n\n\n\n\n\n\n\nNo of \n\n\n\ncase (%) \n\n\n\n1.Antihyperlipidemia 1. Simvastatin 1. Zocor\n\u00ae\n 10mg, 1 tab ON \u2021 Zocor\n\n\n\n\u00ae\n 20mg, \u00bd tab ON  \u2021 Merck Sharp & Dohme (Australia) Unscored 5(17.9) \n\n\n\n  2. Zocor\n\u00ae\n 20mg, 1 tab ON \u2021 Zocor\n\n\n\n\u00ae\n 40mg, \u00bd tab ON  \u2021 Merck Sharp & Dohme (Australia) Unscored 3(10.7) \n\n\n\n  3. Zocor\n\u00ae\n 20mg 1 tab ON  \u2021 Vascor\n\n\n\n\u00ae\n 40mg, \u00bd tab ON\u2551  CCM Pharmaceuticals (Local) Scored 1(3.6) \n\n\n\n\n\n\n\n 2. Atorvastatin 1. Lipitor\n\u00ae\n 20mg, 1 tab ON \u00a7  Lipitor\n\n\n\n\u00ae\n 40mg, \u00bd tab ON \u00a7 Pfizer (USA) Unscored 2(7.1) \n\n\n\n  2. Lipitor\n\u00ae\n 10mg, 1 tab ON \u00a7 Lipitor\n\n\n\n\u00ae\n 20mg, \u00bd tab ON \u00a7 Pfizer (USA)  Unscored 1(3.6) \n\n\n\n\n\n\n\n2. Cardiovascular \n\n\n\ndisease \n\n\n\n1. Amlodipine  1. Norvasc\n\u00ae\n 5mg 1 tab od \u00a7 Norvasc\n\n\n\n\u00ae\n 10mg, \u00bd tab od \u00a7 Pfizer (USA) Scored 3(10.7) \n\n\n\n  .      \n\n\n\n 2. Atenolol 1. Tenormin\n\u00ae\n 50mg 1 tab od \u2021 Tenormin\n\n\n\n\u00ae\n 100mg \u00bd tab od \u2021 AstraZeneca (Sweden) Scored 1(3.6) \n\n\n\n  2. Apo-Atenol\n\u00ae\n 50mg 1 tab od \u2551 Apo-Atenol\n\n\n\n\u00ae\n 100mg \u00bd tab \n\n\n\nod\u2551 \n\n\n\nApotex (Canada) Scored 1(3.6) \n\n\n\n\n\n\n\n 3. Losartan & \n\n\n\nHydrochlorothiazide \n\n\n\n1. Hyzaar\n\u00ae\n (50/12,5) 1 tab od \u00a7 Fortzaar\n\n\n\n\u00ae\n (100/25) \u00bd ab od \u00a7 Merck Sharp & Dohme (Australia) Unscored 2 (7.1) \n\n\n\n\n\n\n\n 4. Valsartan 1. Diovan\n\u00ae\n 80mg, 1 tab od \u00a7 Diovan\n\n\n\n\u00ae \n160mg, \u00bd tab od \u00a7 Novartis (Switzerland) Scored 2(7.1) \n\n\n\n\n\n\n\n 5. Felodipine  1. Plendil\n\u00ae\n 2.5mg 1 tab od \u00a7 Plendil\n\n\n\n\u00ae\n 5mg \u00bd tab od \u00a7 AstraZeneca (Sweden) Unscored 1(3.6) \n\n\n\n .       \n\n\n\n 6.Losartan  1.Cozaar\n\u00ae\n 50m  1 tab od \u00a7 Cozaar\n\n\n\n\u00ae\n 100mg \u00bd tab od \u00a7 Merck Sharp & Dohme (Australia) Unscored 1(3.6) \n\n\n\n\n\n\n\n 7. Valsartan & \n\n\n\nHydrochlorothiazide \n\n\n\n1.Co-Diovan\n\u00ae\n (80/12,5) 1 tab od \n\n\n\n\u00a7 \n\n\n\nCo-Diovan\n\u00ae\n (160/25) \u00bd tab od \n\n\n\n\u00a7 \n\n\n\nNovartis (Switzerland) Unscored 1(3.6) \n\n\n\n\n\n\n\n3. Antibiotic 1.Cefuroxime 1. Zinnat\n\u00ae\n 125mg 1 tab bd \u00a7 Zinnat\n\n\n\n\u00ae\n 250mg \u00bd tab bd \u00a7 GlaxoSmithKline (UK)  Unscored 1(3.6) \n\n\n\n\n\n\n\n4. Erectile dysfunction 1. Sildenafil citrate 1. Viagra\n\u00ae\n 50mg 1 tab prn \u00a7 Viagra\n\n\n\n\u00ae\n 100mg \u00bd tab prn \u00a7 Pfizer (USA) Unscored 1(3.6) \n\n\n\n\n\n\n\n5. Gout  1. Allopurinol 1. Apo-Allopurinol\n\u00ae\n 100mg 1.5 \n\n\n\ntab od\u2551 \n\n\n\nApo-Allopurinol\n\u00ae\n 300mg \u00bd \n\n\n\ntab od\u2551 \n\n\n\nApotex (Canada) Scored 1(3.6) \n\n\n\n\n\n\n\n6. Oral antidiabetic \n\n\n\nagents \n\n\n\n1. Rosiglitazone  1. Avandia\n\u00ae\n 4mg 1 tab od \u00a7 Avandia\n\n\n\n\u00ae\n 8mg \u00bd tab od \u00a7 GlaxoSmithKline (UK) Unscored 1(3.6) \n\n\n\nTotal      28(100.0) \n\n\n\n* Manufacturer and medication characteristics for products involved in tablet splitting recommendation.  \n\n\n\n\u2020The medication characteristic of product sold in Malaysia only. The same product that sold in other countries may have different characteristics.  \n\n\n\n\u2021Off-patent innovator brand as of April 2005. Equivalent generic products available in the market.  \n\n\n\n\u00a7Patent-protected innovator brand as of April 2005. Equivalent generic products not available in the market.  \n\n\n\n\u2551Generic product.  \n\n\n\nTable 1: Tablet Splitting Recommendations by Community Pharmacists \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 20 \n\n\n\nTable 2: Physicians\u2019 and Patients\u2019 Acceptance towards the Tablet Splitting Recommendation. \n\n\n\n\n\n\n\n No. of Cases (%) \n\n\n\nPharmacist consult physician 12 (42.9) \n\n\n\n    Physician accepted     11 (91.7) \n\n\n\n        Patient accepted             11 (100.0) \n\n\n\n        Patient do not accepted       0 (0.0) \n\n\n\n    Physician do not accepted  1 (8.3) \n\n\n\n        Patient accepted        0 (0.0) \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 21 \n\n\n\nrecommendations involved anti-\n\n\n\nhyperlipidemia agents (83.3%) and \n\n\n\ncardiovascular drugs (75.0%). \n\n\n\nMeanwhile, the patients\u201f acceptance rate \n\n\n\nfor scored and unscored tablet were   \n\n\n\n66.7% and 89.5% respectively but there \n\n\n\nwas no statistical differences noted with \n\n\n\nthis regard (Fisher\u201fs Exact Test, p = \n\n\n\n0.290). The patients refused to accept \n\n\n\nsplitting recommendation in five cases \n\n\n\nwhich involve Tenormin\n\u00ae\n 100mg, \n\n\n\nNorvasc\n\u00ae\n 10mg, Apo-Atenol\n\n\n\n\u00ae\n 100mg, \n\n\n\nZocor\n\u00ae\n\n\n\n 20mg and Zocor\n\u00ae\n\n\n\n 40mg \n\n\n\nrespectively. For cases involve \n\n\n\nconsultation with prescriber, 91.7% of \n\n\n\nthe cases was accepted by the patients \n\n\n\n(Table 2). Further analysis shows that \n\n\n\nthe patients strictly (100.0%) followed \n\n\n\nthe decisions of the physicians. In \n\n\n\ncontrast, 75.0% of cases without \n\n\n\ninforming the physicians were accepted \n\n\n\nby the patients. Nevertheless, there was \n\n\n\nno statistical significant difference noted \n\n\n\nin term of patients\u201f acceptance rate \n\n\n\nbetween cases involved consultation \n\n\n\nwith the physicians and cases without \n\n\n\ninforming the physicians (Fisher\u201fs Exact \n\n\n\nTest, p = 0.355). (Insert Table 2 here)  \n\n\n\n\n\n\n\nPharmacists\u2019 cost-saving through the \n\n\n\ntablet splitting recommendation \n\n\n\nThe cost-saving was calculated for 21 \n\n\n\nsuccessful tablet splitting \n\n\n\nrecommendation cases. Five cases which \n\n\n\nrefused by the patients and the Co-\n\n\n\nDiovan\n\u00ae\n and Fortzaar\n\n\n\n\u00ae\n case which not \n\n\n\nallowed to be split were excluded. The \n\n\n\ntotal cost for these 21 cases was \n\n\n\nRM2071.30 (US$545.10) and \n\n\n\nRM1236.55 (US$325.40) respectively \n\n\n\nbefore and after the splitting \n\n\n\nrecommendation. This means the \n\n\n\npharmacists expenses on stocks \n\n\n\npurchasing were reduced by 40.3% or \n\n\n\nRM834.75 (US$219.70) through the \n\n\n\nsplitting recommendation.  \n\n\n\n\n\n\n\nPharmacists\u2019 monthly cost-saving (per \n\n\n\n28 days) for chronic cases \n\n\n\nThere were 19 successful cases which \n\n\n\ninvolved chronic diseases like \n\n\n\nhyperlipidemia, cardiovascular diseases \n\n\n\nand diabetic mellitus. The costs of drugs \n\n\n\nfor these cases have been converted to \n\n\n\nmonthly cost (per 28 days). The total \n\n\n\nmonthly cost was RM1586.40 \n\n\n\n(US$417.45) before the splitting \n\n\n\nrecommendation and reduced by 35.3% \n\n\n\nto RM 1026.70 (US$270.20) after the \n\n\n\nrecommendation. Total amount of cost-\n\n\n\nreduction was RM559.70 (US$147.25).  \n\n\n\n\n\n\n\nPatients\u2019 cost-saving through tablet \n\n\n\nsplitting \n\n\n\nFrom the 21 cases which accepted by the \n\n\n\npatients, total cost to the patient before \n\n\n\ntablet splitting was RM2483.00 \n\n\n\n(US$653.40). After tablet splitting, the \n\n\n\npatients\u201f total expenses reduced to \n\n\n\nRM1595.00 (US$419.75). This resulted \n\n\n\nin cost-saving of RM888.00 \n\n\n\n(US$233.65), which was 35.8% from the \n\n\n\noriginal cost.  \n\n\n\n\n\n\n\nPatients\u2019 monthly cost-saving (per 28 \n\n\n\ndays) for chronic cases \n\n\n\nFrom the 19 chronic cases within the two \n\n\n\nmonths study, the initial total monthly \n\n\n\ncost of the patients was RM2034.25 \n\n\n\n(US$535.35), and declined to \n\n\n\nRM1292.35 (US$340.10) after the tablet \n\n\n\nsplitting. Consequently, the monthly \n\n\n\ncost-saving achieved was RM741.90 \n\n\n\n(US$195.25). The percentage of monthly \n\n\n\ncost-saving was 36.5% and average \n\n\n\nmonthly cost-saving per patient was \n\n\n\nRM39.05 (US$10.30).  \n\n\n\n\n\n\n\n\n\n\n\nDiscussions \n\n\n\n\n\n\n\nFor a period of 2 months, only 28 tablet \n\n\n\nsplitting recommendations were \n\n\n\nperformed by 31.0% of the pharmacists \n\n\n\nthat encounter with opportunities for this \n\n\n\npractice. This finding revealed that tablet \n\n\n\nsplitting is not a common practice among \n\n\n\nthe community pharmacists. Tablets of \n\n\n\npatent-protected innovator brands were \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 22 \n\n\n\nmore likely to be recommended for \n\n\n\nsplitting than the multi-brands drugs. \n\n\n\nTherefore, the pharmacists may tend to \n\n\n\nrecommend tablet splitting when cheaper \n\n\n\ngenerics are not available. This further \n\n\n\nsupported by the concurrent generic \n\n\n\nsubstitution study which observed 158 \n\n\n\ngeneric substitution recommendations \n\n\n\nfrom the same group of pharmacists \n\n\n\n(23). The combination of tablet splitting \n\n\n\nand generic substitution is a good cost-\n\n\n\ncontainment strategy as shown in the \n\n\n\ncase of converting Zocor\n\u00ae\n 20mg, one \n\n\n\ntablet daily to Vascor\n\u00ae\n 40mg, half tablet \n\n\n\ndaily. The cost-saving achieved was \n\n\n\nfour-fold higher than using tablet \n\n\n\nsplitting alone with 76.1% of the cost-\n\n\n\nsaving was contributed by generic \n\n\n\nsubstitution.  \n\n\n\n\n\n\n\nOverall, majority (92.9%) of the tablet \n\n\n\nsplitting recommendations were \n\n\n\nappropriate as there were no sustained-\n\n\n\nrelease, enteric-coated or narrow \n\n\n\ntherapeutic drugs involved and the \n\n\n\ntablets involved mostly contain single \n\n\n\nwide therapeutic drugs. Although \n\n\n\nmajority of the recommendations \n\n\n\ninvolved unscored tablets, their \n\n\n\nsymmetrical shapes enable them to be \n\n\n\nsplit into fairly equal halve by using \n\n\n\nproper device. Besides, studies shown \n\n\n\nthat splitting of tablets contain single \n\n\n\nwide therapeutic drug are clinically \n\n\n\nappropriate (7,12,18). Only two cases \n\n\n\ninvolved unscored combination tablet \n\n\n\n(Co-Diovan\n\u00ae\n and Fortzaar\n\n\n\n\u00ae\n) were not \n\n\n\nsuitable for splitting. The manufacturers \n\n\n\ndisallowed splitting of these combination \n\n\n\ntablets because no study being conducted \n\n\n\nto evaluate patient clinical outcome after \n\n\n\nthe splitting of Co-Diovan\n\u00ae\n and \n\n\n\nFortzaar\n\u00ae\n tablets. Another interesting \n\n\n\nfinding was only 9.1% (1 of 11) of the \n\n\n\nmanufacturer product leaflets of the \n\n\n\nunscored split tablets has information on \n\n\n\ndivisibility. This observation was \n\n\n\nconsistent with a finding from primary \n\n\n\ncare centers in Germany where minority \n\n\n\n(22.5%) of the product leaflet of the \n\n\n\nunscored split tablets contained \n\n\n\ninformation about the divisibility (11). \n\n\n\nHence, the pharmacists and physicians \n\n\n\nhave limited information on tablet \n\n\n\nsplitting and this may resulted in \n\n\n\ninappropriate splitting recommendation. \n\n\n\nThe shape of Zocor\n\u00ae\n and Cozaar\n\n\n\n\u00ae\n tablets \n\n\n\nwhich are unscored in their higher \n\n\n\nstrength are irrational. The \n\n\n\nmanufacturers should scored all \n\n\n\nstrengths of medications which are \n\n\n\nclinical appropriate for splitting. A study \n\n\n\nin USA also observed many tablets are \n\n\n\nscored only in their lower strengths and \n\n\n\nurged that manufacturer s be compelled \n\n\n\nto score all strengths of medication (10).\n \n\n\n\n\n\n\n\nIn this study, the pharmacists tend not to \n\n\n\nconsult the physicians when \n\n\n\nrecommending tablet splitting. However, \n\n\n\nhigher percentage of unscored tablet \n\n\n\ncases involve consultation with \n\n\n\nphysicians as compared to cases which \n\n\n\ninvolved scored tablets. These shown the \n\n\n\npharmacists may tend to obtain consent \n\n\n\nfrom the prescribers for more critical \n\n\n\ncases. From physicians\u201f perspective, \n\n\n\nmajority of the physicians agreed with \n\n\n\nsplitting recommendations by \n\n\n\npharmacists. This result was consistent \n\n\n\nwith other study in which consultation \n\n\n\nbetween pharmacist and physician \n\n\n\nimproved the cost-effectiveness of \n\n\n\nprescribing (24).\n \nMeanwhile, majority of \n\n\n\nthe patients agreed to split their tablet \n\n\n\nand surprisingly, the acceptance rate for \n\n\n\nunscored tablet was even higher than \n\n\n\nscored tablet (89.5% versus 66.7%). The \n\n\n\nhigh acceptance rate may due to the \n\n\n\nbenefit of cost-saving. Besides, majority \n\n\n\nof patients (75.0%) accepted the \n\n\n\npharmacists\u201f recommendations which \n\n\n\nwithout a consent from the physician. \n\n\n\nThis showed that the Malaysian \n\n\n\npharmacists\u201f professional judgment was \n\n\n\nhighly valued by the consumers. \n\n\n\nNevertheless, the patients\u201f acceptance \n\n\n\nrate was higher (91.7%) for cases \n\n\n\ninvolved consultation with the \n\n\n\nphysicians. This indicated that co-\n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 23 \n\n\n\noperations between pharmacists and \n\n\n\nphysicians are very important in \n\n\n\nimproving patients\u201f treatment.  \n\n\n\n\n\n\n\nThe present study also showed that tablet \n\n\n\nsplitting may not only reduce patients\u201f \n\n\n\nexpenses on drugs, but it also can reduce \n\n\n\npharmacists\u201f inventory costs. The \n\n\n\npatients\u201f monthly cost-saving of 36.5% \n\n\n\nwas lower than 61.3% of cost-saving \n\n\n\nachieved from concurrent generic \n\n\n\nsubstitution study (23).\n \n\n\n\nHowever, this \n\n\n\nrelatively small amount of cost-saving \n\n\n\nwill become a huge amount when \n\n\n\naccumulated in long term. In addition, \n\n\n\nthis study also highlighted that while \n\n\n\nperforming dispensing, the pharmacists \n\n\n\nare capable to helping the patients reduce \n\n\n\ntheir expenses on drugs while \n\n\n\nmaintaining the efficacy of treatment.  \n\n\n\n\n\n\n\nStudy limitations \n\n\n\n\n\n\n\nThe relatively small sample size limited \n\n\n\nthe generalization of the study findings. \n\n\n\nThe 34 pharmacies involved in this study \n\n\n\nrepresented 21.0% of total 165 \n\n\n\npharmacies in Penang state and 2.3% of \n\n\n\ntotal 1500 pharmacies in whole \n\n\n\nMalaysia. The duration of two months \n\n\n\nstudy was also not sufficient to collect \n\n\n\nenough tablet splitting cases. Besides, \n\n\n\nthere was no follow-up on the outcome \n\n\n\nof patients involved in tablet splitting \n\n\n\nparticularly those involved unscored and \n\n\n\ncombination tablets. Based on this study,  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nthere is a need to conduct a larger study \n\n\n\nin Malaysia, using the similar \n\n\n\nmethodology, with longer duration and \n\n\n\ndocumented follow-up on the outcome \n\n\n\nof patients involved in tablet splitting \n\n\n\nprocess in order to give a clear picture of \n\n\n\ntablet splitting practices among \n\n\n\nMalaysian community pharmacists.  \n\n\n\n\n\n\n\nConclusions \n\n\n\n\n\n\n\nAlthough tablet splitting is not a popular \n\n\n\npractice among the community \n\n\n\npharmacists, both the physicians and \n\n\n\npatients were highly accepted the \n\n\n\nsplitting recommendations by the \n\n\n\npharmacists and it resulted in significant \n\n\n\ncost-saving. There is a need to develop a \n\n\n\ntablet-splitting guideline for health \n\n\n\nprofessionals in order to avoid \n\n\n\ninappropriate splitting recommendation. \n\n\n\nFurthermore, the manufacturers should \n\n\n\nscore all the tablets of medications which \n\n\n\nare clinically appropriate for splitting. \n\n\n\nSufficient information on divisibility \n\n\n\nmust also be provided on the medication \n\n\n\nproduct leaflet.  \n\n\n\n\n\n\n\nAcknowledgements:  \n\n\n\nWe are grateful to all the pharmacists \n\n\n\nwho voluntarily participated in this \n\n\n\nstudy.   \n\n\n\nFunding: There is no funding provided \n\n\n\nfor this research  \n\n\n\nConflict of Interest: None\n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n24 \n\n\n\n\n\n\n\nReferences \n\n\n\n1. Lek CS. Health Plan to be modelled after Socso. 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Advantage and disadvantage of split tablets given \n\n\n\nto patients. J  Chin Clin Med 2007; 7(2); Available from: \n\n\n\nhttp://www.cjmed.net/html/2007727_118.html  (Cited 8 September 2008). \n\n\n\n\n\n\n\n7. Gee M, Hasson NK, Hahn T, Ryono R. Effects of a tablet-splitting program in \n\n\n\npatients taking HMG-CoA reductase inhibitor: analysis of clinical effects, patient \n\n\n\nsatisfaction, compliance, and cost avoidance. J Manag Care Pharm 2002; 8 \n\n\n\n(6):453-458.  \n\n\n\n\n\n\n\n8. Dobscha SK, Anderson TA, Hoffman WF, Winterbottom LM, Turner EH, \n\n\n\nSnodgrass LS, Hauser P. Strategies to decrease costs of prescribing selective \n\n\n\nserotonin reuptake inhibitors at a VA medical center. Psychiatr Serv 2003; 54(2): \n\n\n\n195-200. \n\n\n\n\n\n\n\n9. Stafford RS, Radley DC, The potential of pill splitting to achieve cost savings. Am \n\n\n\nJ  Manag Care 2002; 8: 706-712. \n\n\n\n\n\n\n\n10. Cohen CI, Cohen SI. Potential cost savings from pill splitting of newer \n\n\n\npsychotropic medications. Psychiatr Serv 2000; 51(4): 527-529. \n\n\n\n\n\n\n\n11. Quinzler R, Gasse C, Schneider A, Kaufmann-Kolle P. Szecsenyi J, Haefeli WE. \n\n\n\nThe frequency of inappropriate tablet splitting in primary care. Eur J Clin \n\n\n\nPharmacol 2006; 62(12):1065-1073.  \n\n\n\n\n\n\n\n12. Noviasky J, Lo V, Luft DD, Saseen J. Clinical inquiries. Which medications can \n\n\n\nbe split without compromising efficacy and safety? J Fam Pract 2006; 55(8): 707-\n\n\n\n708. \n\n\n\n \n\n\n\n\nhttp://202.144.202.76/new_mps/cfm/localnews_view.cfm?id=714\n\n\nhttp://www.cjmed.net/html/2007727_118.html\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n25 \n\n\n\n\n\n\n\n13. Bachynsky J, Wiens C, Melnychuk K. The practice of splitting tablets. Cost and \n\n\n\ntherapeutic aspects. Pharmacoeconomics 2002; 20(5):339-346. \n\n\n\n\n\n\n\n14. Marriott JL, Nation RL. Splitting tablets. Australian Prescriber 2002; 25(6): 133-\n\n\n\n135. \n\n\n\n\n\n\n\n15. McDevitt JT, Gurst AH, Chen Y. Accuracy of tablet splitting. Pharmacotherapy \n\n\n\n1998; 18(1):193-197.  \n\n\n\n\n\n\n\n16. Rosenberg JM, Nathan JP, Plakogiannis F. Weight variability of pharmacist-\n\n\n\ndispensed split tablets. J Am Pharm Assoc 2002; 42(2):200-205. \n\n\n\n\n\n\n\n17. Teng J, Song CK, Williams RL, Polli JE. Lack of medication dose uniformity in \n\n\n\ncommonly split tablets. J Am Pharm Assoc 2002; 42(2) 195-199.  \n\n\n\n\n\n\n\n18. Duncan MC, Castle SS, Streetman DS. Effect of tablet splitting on serum \n\n\n\ncholesterol concentrations. Ann Pharmacother 2002; 36(2): 205-209. \n\n\n\n\n\n\n\n19. Fawell NG, Cookson TL, Scranton SS. Relationship between tablet splitting and \n\n\n\ncompliance, drug acquisition cost, and patient acceptance. Am J Health Syst \n\n\n\nPharm 1999; 56(24):2542-2545. \n\n\n\n\n\n\n\n20. Vuchetich PJ, Garis RI, Jorgensen AMD. Evaluation of cost savings to a state \n\n\n\nMedicaid program following a Sertraline tablet-splitting program. J Am Pharm \n\n\n\nAssoc 2003; 43(4): 497-502.  \n\n\n\n\n\n\n\n21. Weissman EM, Dellenbaugh C. Impact of splitting risperidone tablets on \n\n\n\nmedication adherence and on clinical outcomes for patients with schizophrenia. \n\n\n\nPsychiatr Serv 2007; 58(2): 201-206. \n\n\n\n\n\n\n\n22. Generic prescribing and rationalization of tablet strength. Pharmacy audit support \n\n\n\npack. RPSGB Scotland. April 2000; Available from: \n\n\n\nhttp://www.rpsgb.org.uk/pdfs/generic.pdf  (Cited  1 October 2004).  \n\n\n\n\n\n\n\n23. Chong CP, Bahari MB, Hassali MA. A pilot study on generic medicine \n\n\n\nsubstitution practices among community pharmacists in the State of Penang, \n\n\n\nMalaysia. Pharmacoepidemiol Drug Saf 2008; 17:82-89.  \n\n\n\n\n\n\n\n24. Leach RH, Wakeman A. An evaluation of the effectiveness of community \n\n\n\npharmacists working with GPs to increase the cost-effectiveness of prescribing. \n\n\n\nThe Pharm J 1999; 263(7057): 206-209.  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\nhttp://www.rpsgb.org.uk/pdfs/generic.pdf\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n26 \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nAPPENDIX 1: \n\n\n\nData collection forms \n\n\n\n\n\n\n\nDat\n\n\n\ne  \n\n\n\nPatient  \n\n\n\nMedicatio\n\n\n\nn \n\n\n\nRecord \n\n\n\n(PMR) \n\n\n\nNo. \n\n\n\nPrescriptio\n\n\n\nn details \n\n\n\n(drug \n\n\n\nname, \n\n\n\nform, dose \n\n\n\nand \n\n\n\nquantity) \n\n\n\nProposed \n\n\n\nchange  \n\n\n\nto \n\n\n\nprescriptio\n\n\n\nn details\n1 \n\n\n\n(drug \n\n\n\nname, \n\n\n\nform, dose \n\n\n\nand \n\n\n\nquantity) \n\n\n\nPrescribe\n\n\n\nr \n\n\n\ninformed\n\n\n\n? \n\n\n\nYes/No \n\n\n\n(If \n\n\n\nrelevant) \n\n\n\nPrescriber \n\n\n\nacceptance\n\n\n\n? \n\n\n\nYes/No \n\n\n\n(If \n\n\n\nrelevant) \n\n\n\nPatient \n\n\n\nacceptance\n\n\n\n? \n\n\n\nYes/No \n\n\n\n(If \n\n\n\nrelevant) \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n1. Tablet splitting recommendation. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nCONFIDENTIAL \n\n\n\nA)       Data collection form Tablet splitting in community pharmacy \n\n\n\nCONFIDENTIAL \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n27 \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nDate Patient  \n\n\n\nPMR \n\n\n\nno. \n\n\n\nCost of current \n\n\n\nprescription item  \n\n\n\nCost of new \n\n\n\nprescription item  \n\n\n\nSaving per item \n\n\n\nper script  \n\n\n\nSaving per 28 days  \n\n\n\n(long term therapy)\n1 \n\n\n\nCost \n\n\n\nprice \n\n\n\n(A) \n\n\n\nSelling \n\n\n\nprice \n\n\n\n(B) \n\n\n\nCost  \n\n\n\nprice \n\n\n\n(C) \n\n\n\nSelling \n\n\n\nprice \n\n\n\n(D) \n\n\n\nCost  \n\n\n\nprice \n\n\n\n(A-C) \n\n\n\nSelling \n\n\n\nprice \n\n\n\n(B-D) \n\n\n\nCost  price Selling \n\n\n\nprice \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n1. To calculate cost saving per month:          Cost saving x 28  \n\n\n\n                                                                   No. of days on prescription \n\n\n\n\n\n\n\n\n\n\n\nB) Form for  estimating cost saving  Tablet splitting in community pharmacy                                                                                                \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n28 \n\n\n\n\n\n\n\nStability of Folic Acid in an Extemporaneously Prepared Oral \n\n\n\nSuspension \n \n\n\n\nLian T. Chan*, Lucy Yeoh \n\n\n\n\n\n\n\nWinwa Medical Sdn Bhd, Bukit Mertajam, Pulau Pinang, Malaysia. \n\n\n\n\n\n\n\n* Corresponding author \nMalaysian Journal of Pharmacy, Vol 1 Issue 10, 2012, 28 - 37                                               \n\n\n\n\n\n\n\n\n\n\n\nAbstract \n\n\n\n\n\n\n\nMany drugs are not available in suitable dosage forms for paediatric use and have to be \n\n\n\nextemporaneously prepared by pharmacist for the individual patient. This study is \n\n\n\nconducted to investigate the physicochemical and microbiological stability of an \n\n\n\nextemporaneous oral suspension containing 1mg/ml of folic acid. The oral suspension \n\n\n\nwas prepared using commercially available tablets and vehicle from the hospital. The \n\n\n\nfolic acid oral suspension was stored for 60 days at 4\u00baC (refrigeration) and 25\u00baC (room \n\n\n\ntemperature) protected from light. The physical, chemical and microbial stability were \n\n\n\nexamined at day 0, 14, 28 and 60. The content of folic acid was determined using HPLC-\n\n\n\nUV method. The analytical results showed that the content of folic acid was above 90% in \n\n\n\nall the samples tested throughout the study period. The visual appearance, colour, odour \n\n\n\nand pH remained fairly unchanged throughout the study period and the oral suspension \n\n\n\nwas not susceptible to microbial contamination. The results indicated that the \n\n\n\nextemporaneous formulation was stable at both temperatures and 60 days expiration date \n\n\n\ncould be recommended for this formulation. \n\n\n\n\n\n\n\nKeywords: Compunding, Extemporaneous preparation, Folic Acid, Stability, Shelf-life \n\n\n\n\n\n\n\n\n\n\n\nIntroduction \n \n\n\n\nPharmacist plays very important role in \n\n\n\npharmaceutical compounding in both \n\n\n\nhospital and community pharmacy \n\n\n\npractices. Pharmaceutical compounding \n\n\n\nknown as extemporaneous preparation is \n\n\n\nimportant to prepare pharmaceutical \n\n\n\nproduct that is not available in suitable \n\n\n\ndosage form to suit individual patient\u201fs \n\n\n\nneed.  The demand for this process is \n\n\n\nincreasing to provide the needed \n\n\n\nproducts by the patients and healthcare \n\n\n\npractitioners. Despite its important and \n\n\n\nuseful for patient, there are legitimate \n\n\n\nconcerns about the quality and safety of \n\n\n\ncompounded products as well as \n\n\n\nconcerns about overseeing the \n\n\n\npharmacies that compound them (1). \n\n\n\n\n\n\n\nMany drugs are often not available \n\n\n\ncommercially in suitable dosage forms \n\n\n\nfor paediatric and geriatric patients.  \n\n\n\nThese products have to be \n\n\n\nextemporaneously prepared by \n\n\n\npharmacist to suit individual need of the \n\n\n\npatient.  However, the information \n\n\n\nrelated to the extemporaneous \n\n\n\nformulations and the stability of the final \n\n\n\nproducts are lacking (2,3). The methods \n\n\n\nof extemporaneous preparation for the \n\n\n\nsame drug were significantly different \n\n\n\namong hospitals throughout Europe \n\n\n\n(2,4). There is no harmonization of \n\n\n\ncompounding methods and the \n\n\n\navailability of suitable licensed \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n29 \n\n\n\n\n\n\n\npaediatric products varied among \n\n\n\nEuropean countries (2,5). Due to the \n\n\n\npaucity of information, many \n\n\n\npharmacists are facing problems to find a \n\n\n\nfully validated formulation for \n\n\n\nextemporaneous preparation. When \n\n\n\ndeciding on whether to formulate an \n\n\n\nextemporaneous preparation in these \n\n\n\ncircumstances, the pharmacist must \n\n\n\nconsider the risk of withholding \n\n\n\ntreatment, as well as the risks inherent in \n\n\n\nextemporaneous formulation. \n\n\n\n\n\n\n\nThere are many reasons for the lack of \n\n\n\ncommercially available paediatric \n\n\n\nformulations. The overall size of the \n\n\n\npaediatric market is much smaller than \n\n\n\nfor adults. Therefore, the pharmaceutical \n\n\n\nindustry is reluctant to invest financially \n\n\n\nto seek drug licensing for infants and \n\n\n\nchildren unless a disease occurs \n\n\n\nexclusively or frequently in the \n\n\n\npaediatric population. In addition, the \n\n\n\nformulation has to have been adequately \n\n\n\nstudied in paediatric patients before it \n\n\n\ncan be registered (6). As such the \n\n\n\navailability of paediatric formulations \n\n\n\nvaries between countries and very few \n\n\n\nproducts are available in countries which \n\n\n\nconstitute a small market (7). \n\n\n\n\n\n\n\nWhen there is a need to undertake \n\n\n\nextemporaneous preparation, the \n\n\n\npharmacist must choose the best \n\n\n\nextemporaneous formula. Ideally, the \n\n\n\npharmacist should choose formulation \n\n\n\nused for extemporaneous preparation \n\n\n\nwith validated stability and proven shelf-\n\n\n\nlife (5,8). However, in the absent of \n\n\n\npublished data, stability studies should \n\n\n\nbe carried out on the formulations used \n\n\n\nin practice. The most stable formulation \n\n\n\nis then can be recommended as the \n\n\n\nstandard formula for all the hospitals.  \n\n\n\n\n\n\n\nFolic acid oral suspension is one of the \n\n\n\ncommonly prepared extemporaneous \n\n\n\noral preparations in hospital pharmacies \n\n\n\nand has been selected for this study. In \n\n\n\npaediatric, folic acid has been used as \n\n\n\nfolate supplement in neonates who have \n\n\n\nmegaloblastic anaemia due to folate \n\n\n\ndeficiency, haemolytic anaemia and \n\n\n\nprophylaxis of folate deficiency in \n\n\n\ndialysis (9). \n\n\n\n\n\n\n\nFolic acid (Figure 1) is a yellowish or \n\n\n\norange crystalline powder. It is \n\n\n\npractically insoluble in water and in \n\n\n\nmost organic solvents. It dissolves in \n\n\n\ndilute acids and in alkaline solutions. \n\n\n\nFolic acid is a member of the vitamin B \n\n\n\ngroup.  In the body, it will be reduced to \n\n\n\nform tetrahydrofolate, a coenzyme for \n\n\n\nvarious metabolic processes including \n\n\n\nthe synthesis of purine and pyrimidine \n\n\n\nnucleotides, and hence in the synthesis \n\n\n\nof DNA; it is also involved in some \n\n\n\namino-acid conversions, and in the \n\n\n\nformation and utilisation of formate (10). \n\n\n\n\n\n\n\nFigure 1: Folic Acid \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n30 \n\n\n\n\n\n\n\nA few extemporaneously prepared liquid \n\n\n\nformulations of folic acid have been \n\n\n\nreported in literatures. In a recent study, \n\n\n\na folic acid liquid preparation was \n\n\n\nprepared using folic acid powder and \n\n\n\ncombined solvents of sorbitol, glycerine \n\n\n\nand propylene glycol. The result from \n\n\n\nthis study showed that the liquid \n\n\n\npreparation was stable at pH range of 5 \n\n\n\nand 5.5 and no significant degradation \n\n\n\nwhen the liquid preparation was stored \n\n\n\nfor 2 years at room temperature (11). \n\n\n\nThe study did not mention about \n\n\n\nmicrobial stability of the liquid \n\n\n\npreparation and the use of preservative. \n\n\n\nIn another study, an oral suspension of \n\n\n\nfolic acid with a concentration of 50g/ml \n\n\n\nin glass container was physically and \n\n\n\nchemically stable, at least 14 days, when \n\n\n\nstored under refrigeration (2 to 8\u00baC) and \n\n\n\nunder light protection (12).The author \n\n\n\nacknowledged that an evaluation of the \n\n\n\nmicrobiologic stability of this kind of \n\n\n\nextemporaneous preparations (contain no \n\n\n\npreservatives) is critical to ensure safe \n\n\n\nuse in paediatric patients and is \n\n\n\nparticularly required for an \n\n\n\nextemporaneous oral formulation to be \n\n\n\nstored at room temperature over an \n\n\n\nextended period (12). \n\n\n\n\n\n\n\nThe folic acid powder in small doses can \n\n\n\nbe repacked into powder papers from \n\n\n\ncommercially available tablets or capsule \n\n\n\ncontents. In the survey conducted by \n\n\n\nTeixeira de Barros et al, folic acid \n\n\n\npowder papers were the most frequently \n\n\n\nprepared extemporaneous preparation in \n\n\n\nan oral powder form (14.7%) in \n\n\n\nPortuguese hospitals (4). This dosage \n\n\n\nform has its own limitations.  The \n\n\n\npowder need to be reconstituted \n\n\n\nimmediately prior to drug administration \n\n\n\nby the caregiver. Consequently, it will \n\n\n\nincrease the risk of inconsistency of the \n\n\n\npreparation for each dose (6,7). \n\n\n\n\n\n\n\nIn New Zealand, a survey conducted by \n\n\n\nKairuz et al. found that suspensions are \n\n\n\nthe most frequently compounded dosage \n\n\n\nform in a number of hospitals (13). In a \n\n\n\nsurvey conducted by Lowey and Jackson \n\n\n\nto established the top 50 \n\n\n\nextemporaneously prepared oral \n\n\n\npreparation in Yorkshire, the North-East \n\n\n\nand London, they found that the most \n\n\n\ncommonly prepared oral dosage forms \n\n\n\nwere aqueous suspensions (66.2 %) and \n\n\n\nsolutions (22.2 %) (8). At the same time, \n\n\n\nthey also found that the evidence base to \n\n\n\nsupport extemporaneous preparation was \n\n\n\ngenerally poor.  \n\n\n\nOral liquid preparations are often the \n\n\n\ndosage form of choice in paediatric and \n\n\n\ngeriatric population (14). Most problems \n\n\n\nassociated with the stability of these \n\n\n\npreparations have been attributed to the \n\n\n\ninteraction between drug substance and \n\n\n\nexcipients (tablet and formulation) rather \n\n\n\nthan the degradation of the drug \n\n\n\nsubstance by standard routes (14). An \n\n\n\nextensive survey of literature and \n\n\n\ninvestigation of 83 liquids \n\n\n\nextemporaneously prepared from \n\n\n\ncommercial available products revealed \n\n\n\nthat only 7.2% of these liquids exhibited \n\n\n\ninstability due to interactions between \n\n\n\nthe drug substance and the excipients \n\n\n\nrather than degradation of the active \n\n\n\npharmaceutical ingredient (6). \n\n\n\n\n\n\n\nTo address the lack of stability data on \n\n\n\nthe formulation faced by pharmacists in \n\n\n\nthe hospital practice, a liquid \n\n\n\nformulation using the commercial drug \n\n\n\nproduct and vehicle in the hospital \n\n\n\npractice should be prepared and the \n\n\n\nextemporaneous formulation can be \n\n\n\nvalidated. The formulation of the \n\n\n\nextemporaneous preparation should be \n\n\n\ndesigned as simple as possible. The \n\n\n\nresult from this study will provide the \n\n\n\nstability data and the protocol can be \n\n\n\nstandardized in the prescribing and \n\n\n\ncompounding practices among the \n\n\n\nhospitals to provide a safe, effective and \n\n\n\nquality extemporaneous preparation to \n\n\n\nthe patients. \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n31 \n\n\n\n\n\n\n\nThe objective of this study is to evaluate \n\n\n\nthe stability of extemporaneously \n\n\n\nprepared folic acid oral suspension at \n\n\n\n4\u00baC (refrigeration) and 25\u00baC (room \n\n\n\ntemperature) and to determine the shelf-\n\n\n\nlife and storage condition of the \n\n\n\nextemporaneous preparation. This \n\n\n\ninformation is important to ensure that \n\n\n\nthe extemporaneous preparation remains \n\n\n\nstable and efficacious during the course \n\n\n\nof their use. When there is supporting \n\n\n\nstability information of the specific \n\n\n\npreparation, the expiry date may be \n\n\n\nexceeded rather than a short 14 days \n\n\n\nshelf-life when stored at cold \n\n\n\ntemperature if limited information or no \n\n\n\nsupporting data available according to \n\n\n\nUSP 34-NF 29 Chapter <795>, \n\n\n\nPharmaceutical Compounding \u2013 \n\n\n\nNonsterile Preparations(15). \n\n\n\nDrug product stability encompasses \n\n\n\nchemical, physical, microbiological, \n\n\n\ntherapeutic and toxicological stability. \n\n\n\nStability studies should be performed for \n\n\n\ndesired drug concentration and in real \n\n\n\nstorage conditions (storage temperature, \n\n\n\nduration and type of container). The \n\n\n\nphysical stability is assessed from \n\n\n\nchanges in appearance, colour or odour, \n\n\n\nwhile the chemical stability is \n\n\n\ndetermined using an adequate analytical \n\n\n\nmethod for drug quantification. \n\n\n\nMicrobiological stability should be \n\n\n\nconducted in extemporaneous oral \n\n\n\nformulations containing no or \n\n\n\ninsufficient preservatives and be stored \n\n\n\nat room temperature over an extended \n\n\n\nperiod (7,12). \n\n\n\n\n\n\n\nMaterials and methods \n\n\n\n\n\n\n\nCommercial Drug and Vehicle \n\n\n\n\n\n\n\nSourcing the active pharmaceutical \n\n\n\ningredient in powder form is not always \n\n\n\npractical or possible thus commercially \n\n\n\navailable tablets are used in \n\n\n\ncompounding oral liquids. Similarly, the \n\n\n\nuse of commercially available vehicles \n\n\n\ncontaining a combination of sweeteners, \n\n\n\nflavours, suspending agents and \n\n\n\npreservatives is encouraged and is \n\n\n\nconsidered an excellent choice for \n\n\n\nmaking the extemporaneous \n\n\n\npreparation\u201fs simple for the \n\n\n\ninexperienced pharmacist (5). \n\n\n\nCommercial vehicles are considered a \n\n\n\nconvenient choice especially since \n\n\n\nvarious practice settings may not hold a \n\n\n\nwide variety of excipients (such as \n\n\n\nsuspending agents, flavours, sweeteners \n\n\n\nor preservatives) in stock (16). \n\n\n\n\n\n\n\nTablets containing 5mg of folic acid \n\n\n\n(Pharmaniaga Folic Acid 5mg Tablet) \n\n\n\nmanufactured by Duopharma (M) Sdn \n\n\n\nBhd, Malaysia were used for the \n\n\n\ncompounding of folic acid oral \n\n\n\nsuspension. X-temp Oral Suspension \n\n\n\nSystem marketed by Pharm-D Sdn Bhd, \n\n\n\nMalaysia was selected for this \n\n\n\nextemporaneous preparation. X-temp \n\n\n\nOral Suspension System contains \n\n\n\nspecialized suspending system \n\n\n\nformulated to assist in extemporaneous \n\n\n\npreparation of oral liquid, non-soluble \n\n\n\n(suspended), aqueous dosage form and is \n\n\n\norange flavoured, sweetened, sugar-free \n\n\n\nvehicle containing suitable preservatives.  \n\n\n\n\n\n\n\nExtemporaneous Preparation \n\n\n\nA folic acid oral suspension with the \n\n\n\nconcentration of 1mg/ml was prepared \n\n\n\nusing tablets containing 5mg of folic \n\n\n\nacid. Tablets were grounded to a fine \n\n\n\npowder in a mortar with a pestle. A \n\n\n\nportion of the vehicle was used to \n\n\n\nlevigate the fine powder and a uniform \n\n\n\npaste was prepared. Additional vehicle \n\n\n\nwas added to the mortar in small \n\n\n\nportions and then transferred to a \n\n\n\ngraduated container and more vehicles \n\n\n\nwere added to make the total volume \n\n\n\nrequired. \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n32 \n\n\n\n\n\n\n\nTwenty-four bottles of folic acid oral \n\n\n\nsuspension (1mg/ml) were packed into \n\n\n\n100ml semi-transparent plastic bottles \n\n\n\nand were fitted with white plastic screw \n\n\n\ncap. Twelve bottles were stored at 4 \u00b1 \n\n\n\n2\u00baC (refrigeration) and the other twelve \n\n\n\nbottles at 25 \u00b1 2\u00baC (room condition) in \n\n\n\nthe absence of light.  \n\n\n\n\n\n\n\nAnalytical Method \n\n\n\nThe content of folic acid was measured \n\n\n\nby HPLC-UV method after the \n\n\n\nextemporaneous preparation was made \n\n\n\nand throughout the stability study period. \n\n\n\nSamples were collected from each \n\n\n\nindividual bottle on days 0, 14, 28 and \n\n\n\n60. The assay method was developed \n\n\n\nwith the reference to the British \n\n\n\nPharmacopoeia 2009 and the content of \n\n\n\nfolic acid was set at 90 to 110% of the \n\n\n\nstated amount (17). An ASEAN \n\n\n\nreference standard of folic acid was \n\n\n\nobtained from National Pharmaceutical \n\n\n\nControl Bureau (NPCB). \n\n\n\n\n\n\n\nThe HPLC system used for the analysis \n\n\n\nwas an Agilent 1100 HPLC instrument \n\n\n\nwith quaternary pump, autosampler, \n\n\n\nUV/VIS detector and chemstation. The \n\n\n\nchromatographic separation used was \n\n\n\nZorbax Eclipse XDB-C18 (4.6mm ID x \n\n\n\n150mm, 5\uf06dm). The UV/VIS detector \n\n\n\noperated at 283nm. The mobile phase \n\n\n\nconsisted of a mixture of 93 volumes of \n\n\n\n0.05M potassium dihydrogen \n\n\n\northophosphate and 7 volumes of \n\n\n\nacetonitrile and then adjusted to pH 6 \n\n\n\nwith 5M sodium hydroxide. The mobile \n\n\n\nphase was delivered at a flow rate of \n\n\n\n2ml/min. Samples were filtered before \n\n\n\nHPLC analysis and the injection volume \n\n\n\nas 5\uf06dL.  \n\n\n\n\n\n\n\nPhysicochemical Stability Studies \n\n\n\nThe physical and chemical tests (such as \n\n\n\nvisual appearance, odour, pH and folic \n\n\n\nacid content) were assessed at time 0, 14, \n\n\n\n28 and 60 days during storage at both \n\n\n\ntemperatures. Prior to sample collection, \n\n\n\nthe bottles were agitated on a rotating \n\n\n\nmixer for 30 minutes. The oral \n\n\n\nsuspensions were examined at each \n\n\n\nsampling time for any change in \n\n\n\nappearance or odour. The pH was \n\n\n\nperiodically checked during storage at \n\n\n\nboth temperatures. The preparation is \n\n\n\nconsidered stable if physical \n\n\n\ncharacteristics have remained fairly \n\n\n\nunchanged and assay of folic acid has \n\n\n\nremained equal or above 90% of the \n\n\n\noriginal concentration during the storage \n\n\n\nperiod. \n\n\n\n\n\n\n\nMicrobiological Stability Studies \n\n\n\nMicrobiological stability of the folic acid \n\n\n\noral suspension stored at 4\u00baC and 25\u00baC \n\n\n\nwas studied at the interval of days 0, 14, \n\n\n\n28 and 60. The microbial limit of total \n\n\n\nbacteria, total fungi and E. Coli was \n\n\n\nmonitored to establish the \n\n\n\nmicrobiological quality of this \n\n\n\nextemporaneous preparation and test \n\n\n\nmethods was developed according to the \n\n\n\nBritish Pharmacopoeia 2010 for non-\n\n\n\nsterile products (18). \n\n\n\n\n\n\n\nResults and discussion \n\n\n\n\n\n\n\nPhysicochemical Stability \n\n\n\nThe visual appearance, odour and pH at \n\n\n\n4 \u00baC  and 25 \u00baC of the extemporaneous \n\n\n\npreparations remained the same (Table \n\n\n\n1,2 and 3).  In practice, the visual \n\n\n\nappearance, smell, taste and mouth feel \n\n\n\nof the pharmaceutical preparations will \n\n\n\ninfluence the patient\u201fs acceptance and \n\n\n\ncompliance, especially in the paediatric \n\n\n\npatients.  These factors are important to \n\n\n\nbe considered in the development of a \n\n\n\nsuitable oral extemporaneous preparation \n\n\n\n(5). \n\n\n\nThe folic acid concentration remained in \n\n\n\nthe extemporaneous preparations \n\n\n\ncollected at 0, 14, 28 and 60 days were \n\n\n\nall above 90% for both storage \n\n\n\nconditions (Figure 2). Although previous \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n33 \n\n\n\n\n\n\n\nstudy found that the rate of chemical \n\n\n\ndegradation usually increases with \n\n\n\ntemperature (7), this study showed no \n\n\n\nsignificant differences in the \n\n\n\nconcentration of folic acid remained in \n\n\n\nthe suspension in both storage \n\n\n\nconditions. (Figure 2). \n\n\n\n\n\n\n\nIn aqueous solution, folic acid is stable \n\n\n\nup to 10 hours at 100\u00baC, in a pH range of \n\n\n\n5 to 12 and protected from light. The \n\n\n\ndegradation rate increases at pH below 5 \n\n\n\n(19). However, this study found no \n\n\n\nsignificant degradation in the folic acid \n\n\n\nprepared in oral suspension dosage form \n\n\n\neven though the pH were consistently \n\n\n\nbelow 5 throughout 60 days. Drugs in \n\n\n\nsolution are more susceptible to \n\n\n\nchemical degradation than drugs in solid \n\n\n\nstate (such as suspensions), thus \n\n\n\nsuspensions are more stable than \n\n\n\nsolutions (7). This may explain why the \n\n\n\nfolic acid remained stable even at pH \n\n\n\nlower than 5. \n\n\n\n\n\n\n\n\n\n\n\nTable 1: Visual appearance of folic acid oral suspension \n \n\n\n\nTime (Days) 0 14  28 60 \n\n\n\n4\u00baC \n\n\n\nColour:  \n\n\n\norange yellow \n\n\n\nClarity:  \n\n\n\nopaque \n\n\n\nColour:  \n\n\n\norange yellow \n\n\n\nClarity:  \n\n\n\nopaque \n\n\n\nColour:  \n\n\n\norange yellow \n\n\n\nClarity:  \n\n\n\nopaque \n\n\n\nColour:  \n\n\n\ndarker orange \n\n\n\nClarity:  \n\n\n\nopaque \n\n\n\n25\u00baC \n\n\n\nColour:  \n\n\n\norange yellow \n\n\n\nClarity:  \n\n\n\nopaque \n\n\n\nColour:  \n\n\n\norange yellow \n\n\n\nClarity:  \n\n\n\nopaque \n\n\n\nColour:  \n\n\n\norange yellow \n\n\n\nClarity:  \n\n\n\nopaque \n\n\n\nColour:  \n\n\n\ndarker orange  \n\n\n\nClarity:  \n\n\n\nopaque \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nTable 2:Odour of folic acid oral suspension \n \n\n\n\nTime (Days) 0 14  28 60 \n\n\n\n4\u00baC Orange  Orange Orange Orange \n\n\n\n25\u00baC Orange Orange Orange Orange \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nTable 3:pH of folic acid oral suspension \n \n\n\n\nTime (Days) 0 14  28 60 \n\n\n\n4\u00baC 4.341 4.347 4.384 4.371 \n\n\n\n25\u00baC 4.341 4.348 4.369 4.374 \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n34 \n\n\n\n\n\n\n\nFigure 2:Stability of folic acid oral suspension at 4\u00baC and 25\u00baC \n \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nIt is important to understand that the \n\n\n\ntablet dosage forms used for \n\n\n\nextemporaneous preparations also \n\n\n\ncontain many other excipients.  These \n\n\n\nexcipients are compatible in the tablet \n\n\n\nform but may have the potential to \n\n\n\ninteract with both in solution or \n\n\n\nsuspension.  These excipients alter the \n\n\n\npH of the final product during storage \n\n\n\nand increase the degradation rate (7). \n\n\n\nConsequently, it may affect the stability \n\n\n\nof the drug and on the shelf-life of the \n\n\n\nfinal preparation (16).  \n\n\n\n\n\n\n\nMicrobiological Stability \nThe results from the microbiological \n\n\n\nstability study of folic acid oral \n\n\n\nsuspension showed that the microbial \n\n\n\nquality was within the established \n\n\n\nspecifications during the study period for \n\n\n\nboth temperatures (Table 4 and 5). The \n\n\n\ntotal viable aerobic count was kept low \n\n\n\nand total yeast and mould count was \n\n\n\nminimal. E. coli was absent throughout \n\n\n\nthe 60 days period. This result shows \n\n\n\nthat the preservatives used in this \n\n\n\nextemporaneous preparation were \n\n\n\neffective against bacteria and fungi and \n\n\n\nthe folic acid oral suspension is \n\n\n\nmicrobiologically stable. \n\n\n\n\n\n\n\nEffective preservative systems require \n\n\n\nrigorous evaluation which is seldom \n\n\n\nperformed on extemporaneous \n\n\n\nformulations. Many factors can reduce \n\n\n\nthe effectiveness of the preservative \n\n\n\nincluding use of contaminated materials, \n\n\n\nchemical degradation, binding of \n\n\n\npreservative to suspending agents or \n\n\n\ntablet excipients, incorrect storage or \n\n\n\nunhygienic use of the extemporaneous \n\n\n\npreparations (7). \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n90\n\n\n\n91\n\n\n\n92\n\n\n\n93\n\n\n\n94\n\n\n\n95\n\n\n\n96\n\n\n\n97\n\n\n\n98\n\n\n\n99\n\n\n\n100\n\n\n\n0 14 28 60\n\n\n\nFo\nlic\n\n\n\n A\nci\n\n\n\nd\n (\n\n\n\n%\n) \n\n\n\nTime (Days) \n\n\n\n4\u00b0C\n\n\n\n25\u00b0C\n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n35 \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nTable 4: Microbial results of folic acid oral suspension (4\u00baC) \n \n\n\n\nTime (Days) 0 14  28 60 \n\n\n\nTotal aerobic bacteria \n\n\n\n(Not more than \n\n\n\n200cfu/g) \n\n\n\n<10cfu/g <10cfu/g <10cfu/g <10cfu/g \n\n\n\nTotal yeast & mould \n\n\n\n(Not more than 20cfu/g) \n<10cfu/g <10cfu/g <10cfu/g <10cfu/g \n\n\n\nE. coli \n\n\n\n(Absence in 1g) \nConforms Conforms Conforms Conforms \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nTable 5: Microbial results of folic acid oral suspension (25\u00baC) \n \n\n\n\nTime (Days) 0 14  28 60 \n\n\n\nTotal aerobic bacteria \n\n\n\n(Not more than \n\n\n\n200cfu/g) \n\n\n\n<10cfu/g <10cfu/g <20cfu/g <20cfu/g \n\n\n\nTotal yeast & mould \n\n\n\n(Not more than 20cfu/g) \n<10cfu/g <10cfu/g <10cfu/g <10cfu/g \n\n\n\nE. coli \n\n\n\n(Absence in 1g) \nConforms Conforms Conforms Conforms \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 36 \n\n\n\nAs the physicochemical and \n\n\n\nmicrobiological stability results were \n\n\n\nwithin the acceptable specifications \n\n\n\nthroughout the study period, the study \n\n\n\nconcluded that the extemporaneous \n\n\n\nformulation of folic acid oral suspension \n\n\n\nis stable for up to 60 days when stored at \n\n\n\nboth 4\u00baC and 25\u00baC. The extemporaneous \n\n\n\npreparation of folic acid in the form of \n\n\n\nsuspension has a few advantages over \n\n\n\nsolution or oral powder. The insoluble \n\n\n\ndrugs such as folic acid may be more \n\n\n\npalatable and stable in suspension than \n\n\n\nsolution and the suspended insoluble \n\n\n\npowders are easy to swallow or \n\n\n\nadminister than the reconstitution of oral \n\n\n\npowder in water which may not form \n\n\n\nreadily into a suspension (20). The \n\n\n\nmethod of extemporaneous preparation \n\n\n\nin suspension form enables easy \n\n\n\nadministration of folic acid to paediatric \n\n\n\nwell as the patient compliance and \n\n\n\nacceptance will be much better than oral \n\n\n\npowder papers. \n\n\n\n\n\n\n\nThis information on formulation and \n\n\n\nstability data should be made accessible \n\n\n\nto both pharmacists and paediatricians so \n\n\n\nthat patients can receive the highest \n\n\n\nquality preparations. Although this study \n\n\n\nhave addressed some of the risks \n\n\n\nassociated with extemporaneous \n\n\n\ncompounding such as non-validated \n\n\n\nstability of the product, there are still \n\n\n\nother inherent risks in compounding \n\n\n\nwhich include using incorrect \n\n\n\nformulation and calculations, selecting \n\n\n\nincorrect drugs and using incorrect \n\n\n\nquantities (21).Therefore, proper \n\n\n\nguidelines that focus on the quality \n\n\n\nassurance and quality control practices \n\n\n\nshould be made available for every \n\n\n\ncompounding pharmacy in order to \n\n\n\ndeliver consistent, safe and quality \n\n\n\nproducts (1). \n\n\n\n\n\n\n\nAcknowledgements \n\n\n\n\n\n\n\nThe author wished to thank Caring \n\n\n\nPharmacy Sdn Bhd for its support in \n\n\n\nproviding the commercial products \n\n\n\nrequired for this stability study and \n\n\n\nBioScenergy International Sdn Bhd for \n\n\n\nits financial support. \n\n\n\n\n\n\n\n\n\n\n\nReferences \n\n\n\n\n\n\n\n1. Liva R. Quality assurance issues in compounding pharmacy. Integrative Medicine \n\n\n\n2006; 5(5):70-72. \n\n\n\n2. Brion F, Nunn AJ, Rieutord A. Extemporaneous (magistral) preparation of oral \n\n\n\nmedicines for children in European hospitals. Acta Paediatrica 2004; 92:486-490. \n\n\n\n3. Flores-Perez QAC, Flores-Perez J, Juarez-Olguin H, Barranco-Garduno LM. \n\n\n\nFrequency of drug consumption and lack of pediatric formulations. Acta Pediatrica de \n\n\n\nMexico 2008; 29(1):16-20. \n\n\n\n4. Teixeira de Barros CM, Almeida AJ. Extemporaneous formulations of oral paediatric \n\n\n\nmedicines in Portuguese hospitals. Journal of Hospital Pharmacy Practice \n\n\n\n2008;14:26-32 \n\n\n\n5. Jackson M, Lowey A. Handbook of Extemporaneous Preparation. United Kingdom: \n\n\n\nPharmaceutical Press; 2010. \n\n\n\n6. Glass BD, Haywood A. Stability considerations in liquid dosage forms \n\n\n\nextemporaneously prepared from commercially available products. J Pharm \n\n\n\nPharmaceut Sci 2006; 9(3):398-426. \n\n\n\n7. Woods DJ. Extemporaneous formulation of oral liquids \u2013 a guide. \n\n\n\nhttp://www.pharminfotech.co.nz/manual/Formulation/extemprep.pdf (5 November \n\n\n\n2009) \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 37 \n\n\n\n8. Lowey AR, Jackson MN. A survey of extemporaneous preparation in NHS trusts in \n\n\n\nYorkshire, the North-East and London. Hospital Pharmacist 2008; 15(6):217-219. \n\n\n\n9. BNF for Children. Section 9.1.2. Drugs used in megaloblastic anaemias. British \n\n\n\nMedical Association and Royal Pharmaceutical Society of Great Britain; 2009. \n\n\n\n10. Sweetman SC. Martindale: The Complete Drug Reference. 36\nth\n\n\n\n ed. United Kingdom: \n\n\n\nPharmaceutical Press; 2009. \n\n\n\n11. Vignesh M, Sivakumar M, Parkavi V, Selvakumar K, Joysa Ruby J. Stabilization of \n\n\n\nfolic acid in liquid dosage form: formulation development, method validation and \n\n\n\ncomparative analysis. International Journal of Pharmaceutical and Chemical \n\n\n\nSciences 2012; 1(1):332-338. \n\n\n\n12. Santos S, Sa A, Saiao A, Pecorelli C. Stability of folic acid in extemporaneous oral \n\n\n\nsuspension. Biopharmaceuticals Sciences 2005; 3(2):223-232. \n\n\n\n13. Kairuz T, Chhim S, Hasan F, Kumar K, Lal A, Patel R, Singh R, Dogra M, Garg S. \n\n\n\nExtemporaneous compounding in a sample of New Zealand hospitals: a retrospective \n\n\n\nsurvey. The New Zealand Medical Journal 2007; 120(1251):U2466. \n\n\n\n14. Haywood A, Glass B. Managing extemporaneous oral liquids in practice. Journal of \n\n\n\nPharmacy Practice and Research 2007; 37(2):131-133. \n\n\n\n15. United States Pharmacopeia and National Formulary (USP 34-NF 29). Chapter 795. \n\n\n\nPharmaceutical compounding \u2013 nonsterile preparations. Rockville, MD:United States \n\n\n\nPharmacopeial Convention, Inc.; 2011. \n\n\n\n16. Haywood A, Glass B. Paediatric mixtures. Australian Pharmacist 2010; 29(4):316-\n\n\n\n320. \n\n\n\n17. British Pharmacopoeia (2009). Volume III - Formulated preparations: specific \n\n\n\nmonographs folic acid tablets. London, England: British Pharmacopoeia Commission; \n\n\n\n2009. \n\n\n\n18. British Pharmacopoeia (2010). Volume IV. Appendix XVI B -Microbiological \n\n\n\nexamination of non-sterile products. London, England: British Pharmacopoeia \n\n\n\nCommission; 2010. \n\n\n\n19. Ball GFM. Vitamins in foods \u2013 analysis, bioavailability, and stability. CRC Press; \n\n\n\n2006. \n\n\n\n20. Langley C, Belcher D. Pharmaceutical compounding and dispensing. Pharmaceutical \n\n\n\nPress; 2008. \n\n\n\n21. Kairuz TE, Gargiulo D, Bunt C, Garg S. Quality, safety and efficacy in the \u201eoff-label\u201f \n\n\n\nuse of medicines. Current Drug Safety 2007; 2:89-95. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 38 \n\n\n\nSelf-medication practices among Malaysian consumer: A questionnaire-\n\n\n\nbased study \n\n\n\nGuat See Ooi\n1\n, Chee Ping Chong*\n\n\n\n2\n, Mohd Baidi Bahari\n\n\n\n3 \n\n\n\n\n\n\n\n1\nDiscipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains \n\n\n\nMalaysia, 11800 Minden, Penang, Malaysia \n2\nLecturer, Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, \n\n\n\nUniversiti Sains Malaysia, 11800 Minden, Penang, Malaysia \n3\nProfessor, Faculty of Pharmacy, AIMST University, 08100 Bedong, Kedah, Malaysia \n\n\n\n\n\n\n\n*Corresponding author: \n\n\n\nMalaysian Journal of Pharmacy, Vol 1 Issue 10, 2012, 38 - 47                                                \n\n\n\n\n\n\n\nAbstract \n\n\n\n\n\n\n\nThis study was carried out to assess the prevalence of self-medication practice among \n\n\n\nMalaysian consumers who visit to community pharmacies. The data was collected using \n\n\n\nstructured questionnaires which were randomly distributed to 500 consumers who visited \n\n\n\nto 10 conveniently selected community pharmacies in Sungai Petani, Kedah between \n\n\n\nAugust to October 2007.  Out of the 500 questionnaire distributed, 105 responses were \n\n\n\nreceived for a response rate of 21.0%. Approximately 45% of the respondents have \n\n\n\npracticed self-medication in the preceding six months. The respondents mainly practiced \n\n\n\nself-medication for fever (35.2%), colds and flu (35.2%) and cough (31.4%). The most \n\n\n\npopular classes of medicines used by the consumers were analgesic/NSAIDs (32.4%), \n\n\n\ncold and flu medicines (23.8%) and antacids (18.1%). Only 27.6% of respondents were \n\n\n\nconfident in self-managing medications or dietary supplements.  The consumers mostly \n\n\n\nagreed that more advice on medications should be given by pharmacist (75.2%) and \n\n\n\npharmacist has high level of professionalism on medication (65.7%). The study \n\n\n\nconcluded that the practice of self-medication mostly involved management of minor \n\n\n\nailments using non-prescription and over-the-counter medicines.  \n\n\n\n\n\n\n\nKeywords: self-medication, consumer, community pharmacy, pharmacist, minor ailment \n\n\n\n\n\n\n\nIntroduction: \n\n\n\nSelf-medication is a common practice \n\n\n\namong the consumers, particularly for \n\n\n\nthose in developing countries (1). It can \n\n\n\nbe considered as the most common form \n\n\n\nof self-care in health. It is defined as the \n\n\n\nuse of a drug product for the treatment of \n\n\n\na disease or symptom or for the disease \n\n\n\nprevention or promotion of health, \n\n\n\nwithout a professional prescription (2) or \n\n\n\nobtaining and consuming medicines \n\n\n\nwithout the advice of a physician or \n\n\n\npharmacist either for diagnosis, \n\n\n\nprescription or surveillance of a \n\n\n\ntreatment (1).\n  \n\n\n\nOver the last decade, the economical, \n\n\n\npolitical, and cultural factors have \n\n\n\ncontributed to a constant increase in self-\n\n\n\nmedication worldwide, leading this \n\n\n\npractice into a major public health \n\n\n\nconcern. The huge amount of medicines \n\n\n\ncurrently available in the market does \n\n\n\nnot equate with an improvement in \n\n\n\nquality of life (2). The main concerns \n\n\n\nregarding self-medication are the risk of \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 39 \n\n\n\ninadequate use of drugs and the \n\n\n\noccurrence of side-effects and accidents \n\n\n\nrelated to this practice (2). For instance, \n\n\n\nthe use of non-prescription medications \n\n\n\nand dietary supplements by elderly \n\n\n\npatients in USA has causes concern (3). \n\n\n\nThis geriatric population uses more \n\n\n\nprescription medications and have higher \n\n\n\npotential risk of developing harmful \n\n\n\nmedication-related problems than the \n\n\n\nyounger adults. Various reports have \n\n\n\nshown that 40% to 87% of community-\n\n\n\ndwelling adults older than 65 years were \n\n\n\nusing at least one OTC product regularly \n\n\n\nand 5.7% were taking five or more non-\n\n\n\nprescription medications and/or dietary \n\n\n\nsupplements daily (3).  \n\n\n\n\n\n\n\nPatients turn to purchase medicines \n\n\n\nfrequently through drugstore sales \n\n\n\npersonnel, in an attempt to save time and \n\n\n\nmoney on a medical appointment that \n\n\n\nfails to meet their expectations (2). \n\n\n\nSeveral studies have documented that \n\n\n\ncommunity pharmacies are not the only \n\n\n\nsites where medicines are bought and \n\n\n\nsold, they are also places where \n\n\n\ninformation and advice on health \n\n\n\nproblems and treatment is sought (4). \n\n\n\nSome studies have found that it is fairly \n\n\n\nroutine for the patient to seek the advice \n\n\n\nof pharmacists and medicine shop \n\n\n\nattendants for common ailments. Such \n\n\n\nconsultations are convenient; they save \n\n\n\ntime, money and the opportunity cost of \n\n\n\nwaiting to be seen by a doctor (4).\n  \n\n\n\nSince medicines are widely used in the \n\n\n\npopulation to reduce morbidity and \n\n\n\nmortality (3), it is important to ensure \n\n\n\nthat the non-prescription medicines and \n\n\n\nOTC are used appropriately during self-\n\n\n\nmedication. The patient\u201fs self-\n\n\n\nmedication practice must be evaluated to \n\n\n\nprovide the information which enables \n\n\n\nhealth care providers to educate the \n\n\n\npatients on issues around self-\n\n\n\nmedication. In order to maximize the \n\n\n\ntherapeutic outcome and provide safe \n\n\n\nand quality medical care, a better \n\n\n\nunderstanding of the patient demand and \n\n\n\nfactors affecting patient\u201fs self-\n\n\n\nmedication practices is required. \n\n\n\nNevertheless, currently there is lack of \n\n\n\nstudy on self-medication and factors \n\n\n\ncontributing to consumer\u201fs practice of \n\n\n\nself-medication with community \n\n\n\npharmacies services in Malaysia. Thus, a \n\n\n\nstudy is warranted to investigate the \n\n\n\npractices of self-medication with \n\n\n\ncommunity pharmacies in Malaysia. \n\n\n\nConsequently, strategies and action plans \n\n\n\ncan be developed to improve the \n\n\n\ncommunity pharmacy services on the \n\n\n\nissue around consumer self-medication. \n\n\n\nTherefore, this study was carried out to \n\n\n\nobtain baseline data on self-medication \n\n\n\npractices among the Malaysian \n\n\n\nconsumers and factors influencing self-\n\n\n\nmedication. \n\n\n\n\n\n\n\nMethod \n\n\n\nThis is a cross-sectional descriptive \n\n\n\nstudy using a structured questionnaire. \n\n\n\nThe questionnaire was adapted and \n\n\n\nmodified from a survey instrument \n\n\n\nformulated by Shankar et al. (1). The \n\n\n\nquestionnaire was designed in three \n\n\n\ndifferent languages (English, Malay and \n\n\n\nMandarin) to cater for the language \n\n\n\nproficiency differences among the \n\n\n\nMalaysian consumers. The questionnaire \n\n\n\nwas initially examined by an expert for \n\n\n\nits face and content validity. \n\n\n\nSubsequently, internal consistency and \n\n\n\nreliability were tested by assigning 20 \n\n\n\ncustomers to answer the questionnaire. \n\n\n\nThe consumers consisted of Malay, \n\n\n\nChinese and Indian who visited a \n\n\n\ncommunity pharmacy in the state of \n\n\n\nPenang, Malaysia.  A Cronbach\u201fs alpha \n\n\n\nof 0.73 was obtained (value of > 0.70 is \n\n\n\nconsidered acceptable reliability).  \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 40 \n\n\n\nThis final questionnaire comprised of 5 \n\n\n\nsections. The first section contained \n\n\n\nquestions on demographic and \n\n\n\nsocioeconomic background of \n\n\n\nrespondents. The second section \n\n\n\ncontained questions on distance from \n\n\n\nresidency to nearest pharmacy, type of \n\n\n\npharmacy the respondents used to visit \n\n\n\nand frequency of visit. The third section \n\n\n\nassesses the consumer self-medication \n\n\n\npractice for the past 6 months, reason for \n\n\n\nnot consulting doctor, main use of the \n\n\n\nmedicines and main symptoms that \n\n\n\nbeing experienced. The forth section was \n\n\n\nthe details of medicine taken and \n\n\n\nmedical conditions that had been \n\n\n\nsuffered. The last section was to assess \n\n\n\nthe consumer's opinion towards self-\n\n\n\nmedication. Respondents were requested \n\n\n\nto describe the level of agreement on \n\n\n\nself-medication based on 10 statements \n\n\n\nwhich formulated in a 5-point Likert \n\n\n\nscale (1 = Strongly disagree; 2 = \n\n\n\nDisagree; 3 = Not sure; 4 = Agree; 5 = \n\n\n\nStrongly agree).  \n\n\n\n\n\n\n\nA convenient sample of 10 community \n\n\n\npharmacies in Sungai Petani city, state of \n\n\n\nKedah, Malaysia was chosen as the \n\n\n\nstudy stations. The study population \n\n\n\nconsisted of consumers who visited to \n\n\n\nthe selected pharmacies. The consumers \n\n\n\nmust be aged over 18 years and literate. \n\n\n\nA total of 500 questionnaires were sent \n\n\n\nby personal visit by the researcher (Ooi \n\n\n\nGS) to the selected pharmacies and detail \n\n\n\nexplanation had been given to the \n\n\n\npharmacists-in-charged. The \n\n\n\nquestionnaires were then randomly \n\n\n\ndistributed to the consumers who visited \n\n\n\nto the selected pharmacies by the \n\n\n\npharmacists-in-charged. The respondents \n\n\n\nwere requested to complete the \n\n\n\nquestionnaire and returned it to the \n\n\n\npharmacists before they leave the \n\n\n\npharmacy. Participation in this study was \n\n\n\nstrictly voluntary and written informed \n\n\n\nconsent was obtained from the \n\n\n\nrespondents. Once the completed \n\n\n\nquestionnaire was received, all \n\n\n\nidentifying information had been \n\n\n\nremoved to protect anonymity.  \n\n\n\n\n\n\n\nData analysis  \n\n\n\n\n\n\n\nData analysis was performed by using \n\n\n\nSPSS version 15.0. Chi-square statistic \n\n\n\nwas used to investigate differences in the \n\n\n\nconsumers' tendency to practice self-\n\n\n\nmedication between different groups of \n\n\n\nconsumers (age, gender, race, martial \n\n\n\nstatus, educational level, monthly \n\n\n\nincome and insurance coverage), based \n\n\n\non their responses to question 3A: \u201cHave \n\n\n\nyou purchased medicines of your own \n\n\n\nwithout consulting either a doctor or a \n\n\n\npharmacist in the preceding six \n\n\n\nmonths?\u201d. The sub-groups with less than \n\n\n\nten respondents were excluded from the \n\n\n\nanalysis. Odds ratio were calculated for \n\n\n\nvariables which showed significant \n\n\n\ndifferences based on Chi-square \n\n\n\nanalysis. Student t-test was used to \n\n\n\ninvestigate differences between \n\n\n\nconsumers' monthly health care \n\n\n\nexpenditure between those who practiced \n\n\n\nself-medication and those who did not \n\n\n\npractice in this way. A significant level \n\n\n\nof less than 0.05 was used for all \n\n\n\nanalytical statistic analysis.  \n\n\n\n\n\n\n\nResults \n\n\n\nDemographic characteristics \n\n\n\n Of the 500 questionnaire \n\n\n\ndistributed, 105 responses were received \n\n\n\nfor a response rate of 21.0%. The \n\n\n\nrespondents were mostly female (57.1%) \n\n\n\nand aged between 20-29 years old \n\n\n\n(31.4%). In terms of ethnicity, the \n\n\n\nmajority of the respondents were \n\n\n\nChinese (57.1%). Approximately two-\n\n\n\nthird (64.8%) of the respondents were \n\n\n\nmarried and around half (51.5%) were \n\n\n\neither graduated from primary or \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 41 \n\n\n\nsecondary school. Most of the \n\n\n\nrespondents were employed (86.7%) \n\n\n\nwith a monthly income within RM1,500-\n\n\n\nRM5,000 (47.6%). Around six out of ten \n\n\n\n(57.0%) of the respondents spent RM0-\n\n\n\nRM99 per month on health care and only \n\n\n\n7.7% spent RM300 and above (Table 1). \n\n\n\n\n\n\n\nTable 1: Demographic characteristics of the responding consumers \n\n\n\n\n\n\n\nCharacteristic n % Characteristic n % \n\n\n\nAge group   Educational level   \n\n\n\n20-29 33 31.4 Primary or secondary 54 51.5 \n\n\n\n30-39 24 22.9 Collage/Technical school 20 19.0 \n\n\n\n40-49 20 19.0 University 30 28.6 \n\n\n\n\u2265 50 28 26.6 No formal education 1 1.0 \n\n\n\n\n\n\n\nGender   Monthly income (RM)   \n\n\n\nMale 45 42.9 < 800 16 15.2 \n\n\n\nFemale 60 57.1 800-1500 20 19.0 \n\n\n\n   1500-3000 25 23.8 \n\n\n\nRace   3000-5000 25 23.8 \n\n\n\nMalay 26 24.8 > 5000 5 4.8 \n\n\n\nChinese 60 57.1 Unemployed 4 3.8 \n\n\n\nIndian 18 17.1 Retired 10 9.5 \n\n\n\nOthers 1 1.0    \n\n\n\n   Monthly health care expenditure (RM)   \n\n\n\nMarital status   0-99 60 57.0 \n\n\n\nSingle 36 34.3 100-199 24 22.9 \n\n\n\nMarried 68 64.8 200-299 13 12.4 \n\n\n\nWidowed 1 1.0 \u2265300 8 7.7 \n\n\n\n\n\n\n\n\n\n\n\nDetails of pharmacy visit \n\n\n\n Majority of the respondents \n\n\n\n(81.0%) were able to assess the nearest \n\n\n\npharmacy from residency within 15 \n\n\n\nminutes (Table 2). The respondents \n\n\n\nvisited independent pharmacy (63.8%) \n\n\n\nmore frequently than chain pharmacy \n\n\n\n(36.2%).  Most of the respondents \n\n\n\n(51.4%) visit to pharmacies once or \n\n\n\ntwice a month.  \n\n\n\n\n\n\n\nSelf-medication for the preceding six \n\n\n\nmonths \n\n\n\n Approximately 45% of the \n\n\n\nrespondents have practiced self-\n\n\n\nmedication in the preceding six months \n\n\n\n(Table 3). The purchased medicines were \n\n\n\nmainly for their own used (84.8%), \n\n\n\nfollowed by for their parents (25.7%) \n\n\n\nand children (24.8%). The respondents \n\n\n\nmainly experience fever (35.2%), colds \n\n\n\nand flu (35.2%) and cough (31.4%). \n\n\n\nAllopathic medicines (73.3%) and \n\n\n\nsupplements (67.6%) were \n\n\n\npredominantly used by the respondents. \n\n\n\nRespondents' main reasons for not \n\n\n\nconsulting a doctor including do not \n\n\n\nthink it is necessary to do so (52.4%) and \n\n\n\nfeel expensive (34.3%). Majority \n\n\n\n(95.2%) of the respondents purchased \n\n\n\ntheir medicines from pharmacy. When \n\n\n\nspecifically looking at the main use of \n\n\n\nthe purchased medicines, the \n\n\n\nrespondents mostly used it for treatment \n\n\n\n(69.5%) and health maintenance \n\n\n\n(36.2%).  \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 42 \n\n\n\nTable 2: Details of pharmacy visit among the responding consumers \n\n\n\n\n\n\n\nSurvey question n % \n\n\n\n2A. Distance from residency to nearest pharmacy   \n\n\n\n< 5 min 32 30.5 \n\n\n\n5-15 min 53 50.5 \n\n\n\n15-30 min 15 14.3 \n\n\n\n> 30 min 5 4.8 \n\n\n\n\n\n\n\n2B. Which types of pharmacy do you visit most?   \n\n\n\nChain (has 4 or more stores under common ownership) 38 36.2 \n\n\n\nIndependent (has 3 or fewer stores under common ownership) 67 63.8 \n\n\n\n\n\n\n\n2C. How frequent do you visit pharmacy?   \n\n\n\nMore than once a week 6 5.7 \n\n\n\nOnce a week 8 7.6 \n\n\n\nTwice a month 23 21.9 \n\n\n\nOnce a month 31 29.5 \n\n\n\nOnce every 2-3 months 16 15.2 \n\n\n\nOnce every 6 months 13 12.4 \n\n\n\nOnce a year 8 7.6 \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nDifferences in the tendency of self-\n\n\n\nmedication between different \n\n\n\ndemographic groups \n\n\n\n\n\n\n\n Chi-square analysis showed no \n\n\n\nsignificant differences (p > 0.05) in the \n\n\n\ntendency of self-medication between \n\n\n\nconsumers with different age, gender, \n\n\n\nrace, martial status, educational level and \n\n\n\nmonthly income.  However, consumers \n\n\n\nwith insurance coverage were 3.45 times \n\n\n\n(Odds ratio) more tend to practice self-\n\n\n\nmedication than those without insurance \n\n\n\ncoverage (chi-square value X\n2 \n\n\n\n(1) = 8.20, \n\n\n\np = 0.004).  \n\n\n\n\n\n\n\nThe mean monthly health care \n\n\n\nexpenditure among consumers who \n\n\n\npracticed self-medication (RM127.02 \u00b1 \n\n\n\n140.45) was slightly higher than those \n\n\n\nwho consulted with doctor or pharmacist \n\n\n\nwhen purchasing medicines (RM91.29 \u00b1 \n\n\n\n115.23). However, t-test analysis showed \n\n\n\nthat the different was not significant (p = \n\n\n\n0.122).  \n\n\n\n\n\n\n\n Medical condition of the respondents \n\n\n\n\n\n\n\n Around 58% of the responding \n\n\n\nconsumers do not have underlying \n\n\n\nmedical condition (Table 4). For those \n\n\n\nwho have one underlying disease \n\n\n\n(34.3%),   the main conditions were \n\n\n\nallergy (9.5%), hypertension (5.7%) and \n\n\n\ndiabetes (4.8%). About 8% of the \n\n\n\nrespondents have two underlying \n\n\n\nmedical conditions, which \n\n\n\npredominantly were hypertension and \n\n\n\ndiabetes (2.9%).  \n\n\n\n\n\n\n\nDetails of medicines taken during self-\n\n\n\nmedication \n\n\n\n\n\n\n\n The three most popular classes of \n\n\n\nallophatic drugs used by the respondents \n\n\n\nduring self-medication were \n\n\n\nanalgesic/NSAIDs (32.4%), cold & flu \n\n\n\nmedicines (23.8%) and gastrointestinal \n\n\n\nmedications/antacids (18.1%). When \n\n\n\nassessing the type of supplements \n\n\n\nnormally used during self-medication, \n\n\n\nvitamin C (30.5%), multivitamin \n\n\n\n(25.7%) and fish oil/Omega 3 (10.5%) \n\n\n\nwere the most popular supplements \n\n\n\n(Table4).                                               \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 43 \n\n\n\n\n\n\n\nTable 3: Self-medication for the preceding six months among the responding consumers \n \n\n\n\nSurvey question n % \n\n\n\n3A. Have you purchased medicines of your own without consulting either a \n\n\n\ndoctor or a pharmacist in the preceding six months? \n\n\n\n\n\n\n\nYes 47 44.8 \n\n\n\nNo 58 55.2 \n\n\n\n\n\n\n\n3B. To whom is the medicine meant for?*   \n\n\n\nSelf 89 84.8 \n\n\n\nParents 27 25.7 \n\n\n\nChildren 26 24.8 \n\n\n\nSpouse 13 12.4 \n\n\n\nOthers 6 5.7 \n\n\n\nMissing data 1 1.0 \n\n\n\n\n\n\n\n3C. What was the main symptoms did you experience?*   \n\n\n\nFever 37 35.2 \n\n\n\nColds and flu 37 35.2 \n\n\n\nCough 33 31.4 \n\n\n\nHeadache/migraine 30 28.6 \n\n\n\nGastric pain 27 25.7 \n\n\n\nMuscle pain 23 21.9 \n\n\n\nSore throat 21 20.0 \n\n\n\nStomach discomfort 19 18.1 \n\n\n\nAllergic 11 10.5 \n\n\n\nOthers 13 12.4 \n\n\n\n\n\n\n\n3D. What type of medicine(s) did you use?*   \n\n\n\nAllopathic (modern) medicines 77 73.3 \n\n\n\nSupplements 71 67.6 \n\n\n\nCosmetics 48 45.7 \n\n\n\nHerbal medicines 36 34.3 \n\n\n\nNutritional products 8 7.5 \n\n\n\nMissing data 1 1.0 \n\n\n\n\n\n\n\n3E. What was your main reason for not consulting a doctor?*   \n\n\n\nNot necessary 55 52.4 \n\n\n\nExpensive 36 34.3 \n\n\n\nInconvenience 14 13.3 \n\n\n\nFar 7 6.7 \n\n\n\nNot effective 4 3.8 \n\n\n\nOthers 10 9.5 \n\n\n\n\n\n\n\n3F. Which type of premises does you usually go to purchase your \n\n\n\nmedication?* \n\n\n\n\n\n\n\nPharmacy 100 95.2 \n\n\n\nChinese medical hall 11 10.5 \n\n\n\nMedical hall 4 3.8 \n\n\n\nMalay traditional clinic 3 2.9 \n\n\n\nOthers 3 2.9 \n\n\n\n\n\n\n\n3G. State the main use of the medicines that you purchased on your own:*   \n\n\n\nTreatment 73 69.5 \n\n\n\nHealth maintenance 38 36.2 \n\n\n\nPrevention 19 18.1 \n\n\n\nOthers 2 1.9 \n\n\n\nMissing data 2 1.9 \n\n\n\nNote: *The respondent (n = 105) can answer more than one answer \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 44 \n\n\n\n \nTable 4: Medical condition of the respondents and details of medicines taken during self-\n\n\n\nmedication \n\n\n\n\n\n\n\nSurvey item n % \n\n\n\n4A. Medical condition of the responding consumers   \n\n\n\nConsumer without underlying medical condition 61 58.1 \n\n\n\nConsumer with one underlying  medical condition 36 34.3 \n\n\n\nAllergy 10 9.5 \n\n\n\nHypertension 6 5.7 \n\n\n\nDiabetes 5 4.8 \n\n\n\nGastric 3 2.9 \n\n\n\nCardiovascular disease 3 2.9 \n\n\n\nMigraine/headache 2 1.9 \n\n\n\nDysmenorrhoea / Period pain 2 1.9 \n\n\n\nHyperlipidemia 1 1.0 \n\n\n\nOthers 4 3.8 \n\n\n\nConsumer with two underlying medical conditions 8 7.6 \n\n\n\nHypertension & Diabetes 3 2.9 \n\n\n\nHypertension & hyperlipidemia  2 1.9 \n\n\n\nAllergy & Gastric 1 1.0 \n\n\n\nDiabetes & cardiovascular disease 1 1.0 \n\n\n\nGastric & others 1 1.0 \n\n\n\n\n\n\n\n4B. Class of allophatic / modern drug(s)  normally used  \n\n\n\nby the responding consumers during self-medication* \n\n\n\n\n\n\n\nAnalgesics or NSAIDs 34 32.4 \n\n\n\nCold & flu 25 23.8 \n\n\n\nGastrointestinal medications / antacids 19 18.1 \n\n\n\nCardiovascular medications 17 16.2 \n\n\n\nAllergy medications 16 15.2 \n\n\n\nDiabetes medications 10 9.5 \n\n\n\nAntibiotics 6 5.7 \n\n\n\nOthers 1 1.0 \n\n\n\n\n\n\n\n4C. Class of herbal medicine(s) normally used by the  \n\n\n\nresponding consumers during self-medication* \n\n\n\n\n\n\n\nChinese herbal medicines 20 19.0 \n\n\n\nMalay herbal medicines 11 10.5 \n\n\n\nIndian herbal medicines 5 4.8 \n\n\n\n\n\n\n\n4D. Type of supplements normally used by the responding  \n\n\n\nconsumers during self-medication* \n\n\n\n\n\n\n\nVitamin C 32 30.5 \n\n\n\nMultivitamin 27 25.7 \n\n\n\nFish oil / Omega 3 11 10.5 \n\n\n\nVitamin B complex 8 7.6 \n\n\n\nCalcium 8 7.6 \n\n\n\nVitamin A, C & E 7 6.7 \n\n\n\nEvening primose oil 6 5.7 \n\n\n\nVitamin E 4 3.8 \n\n\n\nOthers 15 14.3 \n\n\n\nNotes: *The respondent (n = 105) can answer more than one answer \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 45 \n\n\n\nConsumers\u2019 opinion towards self-\n\n\n\nmedication \n\n\n\n\n\n\n\n The respondents\u201f responses \n\n\n\ntowards questions assessing their opinion \n\n\n\non self-medication were shown in Table \n\n\n\n5. Majority of the consumers (69.5%) \n\n\n\nwere either strongly disagreed or \n\n\n\ndisagreed that prescription medication \n\n\n\ncan be purchased without professional\u201fs \n\n\n\nassistance. Only 27.6% of respondents \n\n\n\nwere confident in self-managing \n\n\n\nmedications/dietary supplements. \n\n\n\nAdditionally, approximately one in every \n\n\n\nthree consumers were either strongly \n\n\n\nagreed or agreed that non-prescription \n\n\n\nmedications/dietary supplements can be \n\n\n\npurchased without assistance. Most of \n\n\n\nthe respondents (62.9%) held positive \n\n\n\nopinion that non-prescription \n\n\n\nmedications/dietary supplements help \n\n\n\nmaintain health. The consumers mostly \n\n\n\nagreed that more advice on \n\n\n\nmedications/dietary supplements should \n\n\n\nbe given by pharmacists (75.2%) and \n\n\n\npharmacist has high level of \n\n\n\nprofessionalism on medications (65.7%). \n\n\n\nHowever, the responding consumers \n\n\n\npredominantly held a neutral opinion \n\n\n\nabout whether more prescription \n\n\n\nmedicines should be switched to \n\n\n\npharmacy or over-the-counter status \n\n\n\n(45.7%). Around half of the respondents \n\n\n\n(53.4%) expressed disagreement upon \n\n\n\nthe sharing of medicines among family \n\n\n\nmembers as compared to 16.2% who in \n\n\n\nfavour with this practice. Majority of the \n\n\n\nconsumers disagreed that the leftover \n\n\n\nmedicines stored at home can be used \n\n\n\nwhen needed (78.1%). The consumers \n\n\n\ngenerally disagreed that originally \n\n\n\nprescribed dosage can be changed \n\n\n\naccording to their own judgment \n\n\n\n(80.0%).  \n \n\n\n\nTable 5: Responding consumers\u2019 opinion towards self-medication \n\n\n\n\n\n\n\nSurvey question/Statement Frequency (%) \n\n\n\n1 2 3 4 5 Missing \n\n\n\ndata \n\n\n\n1. Prescription medications can be purchased \n\n\n\nwithout professional\u201fs assistance. \n \n\n\n\n42 \n\n\n\n(40.0) \n\n\n\n31 \n\n\n\n(29.5) \n\n\n\n23 \n\n\n\n(21.9) \n\n\n\n8 \n\n\n\n(7.6) \n\n\n\n1 \n\n\n\n(1.0) \n\n\n\n0 \n\n\n\n(0.0) \n\n\n\n2. I am confident in self-managing \n\n\n\nmedications/dietary supplements. \n \n\n\n\n7 \n\n\n\n(6.7) \n\n\n\n16 \n\n\n\n(15.2) \n\n\n\n53 \n\n\n\n(50.5) \n\n\n\n19 \n\n\n\n(18.1) \n\n\n\n10 \n\n\n\n(9.5) \n\n\n\n0 \n\n\n\n(0.0) \n\n\n\n\n\n\n\n3. Non-prescription medications/dietary \n\n\n\nsupplements can be purchased without assistance. \n \n\n\n\n13 \n\n\n\n(12.4) \n\n\n\n24 \n\n\n\n(22.9) \n\n\n\n33 \n\n\n\n(31.4) \n\n\n\n24 \n\n\n\n(22.9) \n\n\n\n11 \n\n\n\n(10.5) \n\n\n\n0 \n\n\n\n(0.0) \n\n\n\n4. More advice on medications/dietary supplements \n\n\n\nshould be given by pharmacist. \n \n\n\n\n2 \n\n\n\n(1.9) \n\n\n\n3 \n\n\n\n(2.9) \n\n\n\n20 \n\n\n\n(19.0) \n\n\n\n40 \n\n\n\n(38.1) \n\n\n\n39 \n\n\n\n(37.1) \n\n\n\n1 \n\n\n\n(1.0) \n\n\n\n5. I think non-prescription medications/dietary \n\n\n\nsupplements help maintain health. \n \n\n\n\n5 \n\n\n\n(4.8) \n\n\n\n8 \n\n\n\n(7.6) \n\n\n\n26 \n\n\n\n(24.8) \n\n\n\n40 \n\n\n\n(38.1) \n\n\n\n26 \n\n\n\n(24.8) \n\n\n\n0 \n\n\n\n(0.0) \n\n\n\n6. I think pharmacist has high level of \n\n\n\nprofessionalism on medications. \n \n\n\n\n2 \n\n\n\n(1.9) \n\n\n\n11 \n\n\n\n(10.5) \n\n\n\n23 \n\n\n\n(21.9) \n\n\n\n32 \n\n\n\n(30.5) \n\n\n\n37 \n\n\n\n(35.2) \n\n\n\n0 \n\n\n\n(0.0) \n\n\n\n7. Medicines can be shared among family members \n \n\n\n\n32 \n\n\n\n(30.5) \n\n\n\n24 \n\n\n\n(22.9) \n\n\n\n32 \n\n\n\n(30.5) \n\n\n\n15 \n\n\n\n(14.3) \n\n\n\n2 \n\n\n\n(1.9) \n\n\n\n0 \n\n\n\n(0.0) \n \n\n\n\n8. The leftover medicines stored at home can be \n\n\n\nused anytime when needed. \n \n\n\n\n47 \n\n\n\n(44.8) \n\n\n\n35 \n\n\n\n(33.3) \n\n\n\n16 \n\n\n\n(15.2) \n\n\n\n6 \n\n\n\n(5.7) \n\n\n\n1 \n\n\n\n(1.0) \n\n\n\n0 \n\n\n\n(0.0) \n\n\n\n9. Originally prescribed dosage can be changed \n\n\n\naccording to my own judgement. \n \n\n\n\n47 \n\n\n\n(44.8) \n\n\n\n37 \n\n\n\n(35.2) \n\n\n\n15 \n\n\n\n(14.3) \n\n\n\n5 \n\n\n\n(4.8) \n\n\n\n1 \n\n\n\n(1.0) \n\n\n\n0 \n\n\n\n(0.0) \n\n\n\n10. More prescription (doctor) medications should \n\n\n\nbe switched to pharmacy or over-the-counter status. \n \n\n\n\n6 \n\n\n\n(5.7) \n\n\n\n21 \n\n\n\n(20.0) \n\n\n\n48 \n\n\n\n(45.7) \n\n\n\n13 \n\n\n\n(12.4) \n\n\n\n17 \n\n\n\n(16.2) \n\n\n\n0 \n\n\n\n(0.0) \n\n\n\nNote: 1 = Strongly disagree; 2 = Disagree; 3 = Not sure; 4 = Agree; 5 = Strongly agree \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 46 \n\n\n\nDiscussion \n\n\n\n\n\n\n\nThis study revealed that self-medication \n\n\n\npractices were prevalent among the \n\n\n\nMalaysian consumers who visited \n\n\n\ncommunity pharmacy. About 45% of the \n\n\n\nsurveyed respondents had purchased \n\n\n\nmedicines without consulting either a \n\n\n\ndoctor or pharmacist in the previous six \n\n\n\nmonths. This percentage was lower \n\n\n\ncompared with a recent study undertaken \n\n\n\namong consumers in Kuala Lumpur, the \n\n\n\ncapital city of Malaysia where 62.7% \n\n\n\nhad practiced self-medication in the \n\n\n\npreceding week (5). However, the \n\n\n\nprevalence of self-medication in the \n\n\n\npresent study was slightly higher than \n\n\n\nstudy findings from Jordan (42.5%) (6) \n\n\n\nand Southwest Ethiopia (39.2%)(7).  \n\n\n\n\n\n\n\nConsumers from different demographic \n\n\n\nbackground found to have no significant \n\n\n\ndifferences in their tendency of self-\n\n\n\nmedication. The only factor which \n\n\n\nindicated higher probability for \n\n\n\npractising self-medication among the \n\n\n\nconsumers was insurance coverage. \n\n\n\nHowever, the present study did not \n\n\n\nevaluate the reasons behind this \n\n\n\nobservation. Around half of the \n\n\n\nresponding consumers expressed \u201cnot \n\n\n\nnecessary\u201d as their main reason for not \n\n\n\nconsulting a doctor. This finding may be \n\n\n\ndue to the fact that the respondents \n\n\n\nmostly performed self-treatment for \n\n\n\nminor ailments like fever, cold and flu \n\n\n\nand cough which can be managed by \n\n\n\nnon-prescription medicines. Study from \n\n\n\nother countries also found similar trend \n\n\n\nwhere consumers were confident with \n\n\n\nself-medication for minor ailments. For \n\n\n\ninstance, a recent study in Canada found \n\n\n\nadolescents\u201f self-administration of \n\n\n\nacetaminophen for pain is common with \n\n\n\n50% to 75% of junior high students \n\n\n\nreporting that they use acetaminophen \n\n\n\nfor pain relief without first checking with \n\n\n\nany healthcare provider (8). \n\n\n\nNevertheless, self-treatment practice \n\n\n\nwithout proper information given may \n\n\n\nincrease risk of misuse or over-\n\n\n\nconsumption of non-prescription \n\n\n\nmedicines. The Malaysian consumers \n\n\n\nshould be educated on the dangers of \n\n\n\nself-medication and advised doing it \n\n\n\nonly for minor ailments and to seek \n\n\n\nmedical treatment if unsure (5).  \n\n\n\n\n\n\n\nThe present study highlighted the \n\n\n\nimportant role of community pharmacist \n\n\n\nin providing advice and professional \n\n\n\nconsultation to the consumers who \n\n\n\npractice self-medication. Majority of the \n\n\n\nsurveyed consumers viewed that more \n\n\n\nadvice on medications should be \n\n\n\nprovided by pharmacists. Further, the \n\n\n\nrespondents generally viewed \n\n\n\npharmacists as having high level of \n\n\n\nprofessionalism on medication. \n\n\n\nTherefore, community pharmacists must \n\n\n\nbe equipped themselves with the skills of \n\n\n\neducating the consumers on the \n\n\n\nappropriate and quality use of non-\n\n\n\nprescription and over-the-counter \n\n\n\nmedicinal products. Indeed, educational \n\n\n\nintervention by pharmacist is needed to \n\n\n\ncorrect the inappropriate practices \n\n\n\nobserved among some consumers in the \n\n\n\npresent study,  for instance, the sharing \n\n\n\nof medicines among family members \n\n\n\nand the keeping of leftover medications. \n\n\n\nThe development of professional \n\n\n\nstandards of practice among the \n\n\n\ncommunity pharmacists is needed in the \n\n\n\narea of self-medication (5). This could \n\n\n\nbe achieved via structured training and \n\n\n\nestablishment of guidelines to assist the \n\n\n\ncommunity pharmacists in providing \n\n\n\nprofessional consultation to the \n\n\n\nconsumers with regards to self-\n\n\n\nmedication.  \n\n\n\n\n\n\n\nStudy limitation \n\n\n\n\n\n\n\nThe selection bias cannot be ruled out \n\n\n\ndue to the convenience sampling and \n\n\n\nself-reported information obtained in the \n\n\n\npresent study. The small sample size and \n\n\n\nlow response rate further reduced the \n\n\n\ngeneralisability of the study findings. \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 47 \n\n\n\nFuture study should include a larger \n\n\n\nrepresentative sample size of the \n\n\n\nMalaysian consumers who visit to \n\n\n\ncommunity pharmacies.  \n\n\n\n\n\n\n\nConclusion \n\n\n\n\n\n\n\nSelf-medication is prevalent in Sungai \n\n\n\nPetani with approximately 45% of \n\n\n\nsurveyed consumers using some form of \n\n\n\nself-medication in the past 6 months of \n\n\n\nthe study. The practice of self-\n\n\n\nmedication mostly involved management \n\n\n\nof minor ailments using non-prescription \n\n\n\nand over-the-counter medicinal products. \n\n\n\nPharmacist is responsible to limit the \n\n\n\npotential risks involved in self-\n\n\n\nmedication by educating the consumers \n\n\n\nregarding the medicines and its \n\n\n\nappropriate use, and instructions to \n\n\n\nreceived medical treatment if they are \n\n\n\nunsure. \n\n\n\n\n\n\n\n\n\n\n\nReferences \n\n\n\n1. Shankar PR, Partha P, Shenoy N. Self-medication and non-doctor prescription \n\n\n\npractices in Pkhara valley, Western Nepal: a questionnaire-based study. BMC Fam Pract \n\n\n\n2002;3:17. \n\n\n\n\n\n\n\n2. Filho AIdL, Lima-Costa MF, Uch\u00f4a E. Bambui Project: a qualitative approach to \n\n\n\nself-medication. Cad Sa\u00fade P\u00fablica, Rio de Janeiro. 2004;20(6):1661-1669. \n\n\n\n\n\n\n\n3. Langford BJ, Jorgenson D, Kwan D, Papoushek C. Implementation of a self-\n\n\n\nadministered questionnaire to identify patients at risk for medication-related problems in \n\n\n\na family health center. Pharmacotherapy. 2006;26(2):260-268. \n\n\n\n\n\n\n\n4. Kamat VR, Nichter M. Pharmacies, self-medication and pharmaceutical \n\n\n\nmarketing in Bombay, India. Soc Sci Med 1998;47(6):779-794. \n\n\n\n\n\n\n\n5. Hassali MA, Shafie AA, Al-Qazaz H, Tambyappa J, Palaian S, Hariraj V. Self-\n\n\n\nmedication practices among adult population attending community pharmacies in \n\n\n\nMalaysia: an exploratory study. Int J Clin Pharm 2011;33:794-799. \n\n\n\n\n\n\n\n6. Yousef AM, Al-Bakri AG, Bustanji Y, Wazaify M. Self-medication patterns in \n\n\n\nAmman, Jordan. Pharm World Sci 2008;30:24-30. \n\n\n\n\n\n\n\n7. Suleman S, Katsela A, Mekonnen Z. Assessment of self-medication practices in \n\n\n\nAssendabo town, Jimma zone, southwestern Ethiopia. Res Social Adm Pharm 2009;5:76-\n\n\n\n81. \n\n\n\n\n\n\n\n8. Laura PS, Jennifer PK, Cindy D, Karen MW, Michael SW. Misunderstanding and \n\n\n\npotential unintended misuse of acetaminophen among adolescents and young adults. J \n\n\n\nHealth Commun 2011;16(Suppl 3):256-267. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 48 \n\n\n\nABSTRACTS FROM THE MALAYSIAN PHARMACEUTICAL \n\n\n\nSOCIETY PHARMACY SCIENTIFIC CONFERENCE 2012 \n \n\n\n\n31\nst\n October \u2013 2\n\n\n\nnd\n November, 2012, Istana Hotel, Kuala Lumpur \n\n\n\n\n\n\n\nPHARMACY: LEADING & MANAGING CHANGE \n\n\n\n\n\n\n\nJointly organised by the Malaysian Pharmaceutical Society, the Department of Pharmacy \n\n\n\nof the University of Malaya and the Pharmaceutical Services Division of the Ministry of \n\n\n\nHealth, Malaysia \n\n\n\n\n\n\n\nADVISORS: Datuk Nancy Ho  \n\n\n\nDato\u201f Eisah bt Abdul Rahman \n\n\n\n\n\n\n\nORGANISING COMMITTEE \n\n\n\n\n\n\n\nAssoc. Prof. Dr. Mohamed Ibrahim \n\n\n\nNoordin (Chairperson of Organising \n\n\n\nCommittee) \n\n\n\nAssoc. Prof. Datin Dr. Zoriah Aziz  \n\n\n\n(Deputy chairperson) \n\n\n\nPn. Syireen Alwi \n\n\n\nDr. Hasniza Zaman Huri \n\n\n\nMr Lam Kai Kun \n\n\n\nDr. Faizah Safina Bakrin \n\n\n\nProf. Dr. Chung Lip Yong \n\n\n\nDr. Reena Rajasuriar \n\n\n\nDr. Rozana Othman \n\n\n\nDr. Najihah Mohd Hashim \n\n\n\nDr. Fatiha Hana Shabaruddin \n\n\n\nDr. Shaik Nyamathulla \n\n\n\nMr. John Chang \n\n\n\nAssoc. Prof. Dr. Chua Siew Siang \n\n\n\nPn. Noraini bt Mohamad \n\n\n\nMs. Noor Liyana Yusup \n\n\n\nDr. Michael James Christopher Buckle  \n\n\n\nDr. Lo Yoke Lin \n\n\n\nAssoc. Prof. Dr. Khalit Mohamad \n\n\n\nDrs. Riyanto Teguh Widodo \n\n\n\nAssoc. Prof. Dr. Syam Mohan Murali \n\n\n\nMohan \n\n\n\nMr. Aditya Arya \n\n\n\nPn Nurul Adilla @ Hayat bt Jamaluddin \n\n\n\nDr. Leong Kok Hoong \n\n\n\nDr. Behnam Kamalidehghan \n\n\n\nMs. Chung Wen Wei \n\n\n\n\n\n\n\nREVIEWERS OF ABSTRACTS \n\n\n\n\n\n\n\nProf. Dr. Chung Lip Yong (Chairperson \n\n\n\nof Scientific Committee) \n\n\n\nDr. Reena Rajasuriar \n\n\n\nAssoc. Prof. Dr. Syam Mohan Murali \n\n\n\nMohan \n\n\n\nDr. Shaik Nyamathulla \n\n\n\nAssoc. Prof. Dr. Chua Siew Siang \n\n\n\nAssoc. Prof. Datin Dr. Zoriah Aziz \n\n\n\nDatin Junaidah Amir \n\n\n\nPn. Syireen Alwi \n\n\n\nDr. Hasniza Zaman Huri \n\n\n\nDr. Najihah Mohd Hashim \n\n\n\nDr. Fatiha Hana Shabaruddin \n\n\n\nDr. Lo Yoke Lin \n\n\n\nMs Lee Hong Gee, Mary \n\n\n\nDrs. Riyanto Teguh Widodo \n\n\n\nDr. Leong Kok Hoong \n\n\n\nDr. Michael James Christopher Buckle  \n\n\n\nDr. Rozana Othman \n\n\n\nMr. Aditya Arya \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 49 \n\n\n\n\n\n\n\nTABLE OF CONTENT: ORAL PRESENTATIONS \n\n\n\nPHARMACY EDUCATION \n\n\n\nNo Presenting Author Title \n\n\n\nOPE1 H S Sue Assessing Stress among Undergraduate \n\n\n\nPharmacy Students in University of Malaya \n\n\n\nOPE2 T L King Evaluation of Multimedia and Conventional \n\n\n\nCounselling in Metered Dose Inhaler (MDI) \n\n\n\nTechnique Education and Time-efficiency in Sibu \n\n\n\nHospital \n\n\n\nOPE3 S Q Jamshed Perception of Nurses towards Generic Medicines: \n\n\n\nQualitative Groundwork \n\n\n\nOPE4 H G Lee It is Not as Simple as I Thought: Motivating \n\n\n\nStudents to Learn Non-Prescription Preparations \n\n\n\nMore Effectively through Action Research  \n\n\n\nOPE5 O Q B Al-lela Pharmacy Students\u201f Assessment of an Objective \n\n\n\nStructured Clinical Examination (OSCE) in \n\n\n\nInternational Islamic University Malaysia (IIUM) \n\n\n\nOPE6 N J Chong Honey Compared to Silver Sulphadiazine \n\n\n\nDressing for Acute Wounds: A Systematic \n\n\n\nReview \n\n\n\n\n\n\n\nCLINICAL PHARMACY & PHARMACY PRACTICE \n\n\n\nNo Presenting Author Title \n\n\n\nOPP1 Q L Goh The Incidence and Clinical Management of \n\n\n\nAdverse Events Due to FOLFOX Chemotherapy \n\n\n\nin Colorectal Cancer Patients \n\n\n\nOPP2 Y T Chong Adverse Events Profile and Clinical Management \n\n\n\nof Malaysian Breast Cancer Patients on \n\n\n\nFEC+Docetaxel Chemotherapy  \n\n\n\nOPP3 A Jamunarani Can the Community Pharmacists Detect Drug \n\n\n\nRelated Problems (DRPs)?  \n\n\n\nOPP4 N K Chow Outcome of Pharmacist Involvement in the \n\n\n\nTherapeutic Management of Rheumatoid \n\n\n\nArthritis Patients in Hospital Sultanah Bahiyah \n\n\n\n(HSB)  \n\n\n\nOPP5 C Z Ngua De-escalation of Carbapenem Therapy in \n\n\n\nSarawak General Hospital (SGH): How Far Do \n\n\n\nWe Put It Into Practice?  \n\n\n\nOPP6 R Rajah An Evaluation on Over the Counter Medications \n\n\n\n(OTC) and Vitamins Use Among Pregnant \n\n\n\nWomen: A Single Center Study from Malaysia \n\n\n\nOPP7 W Y Lim Medication Reconciliation during Hospital \n\n\n\nAdmission and Discharge: Evaluating \n\n\n\nDiscrepancies \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 50 \n\n\n\nNo Presenting Author Title \n\n\n\nOPP8 L H Pang Causality Assessment of Spontaneous Adverse \n\n\n\nDrug Reaction Reports: Comparison of the \n\n\n\nResults Obtained from Published Algorithms \n\n\n\nwith WHO-UMC System \n\n\n\nOPP9 S Y Wong The Effect of Hibiscus sabdariffa on Blood \n\n\n\nLipids: A Systematic Review \n\n\n\nOPP10 C C Khoo Evaluation of Parents\u201f Perception toward \n\n\n\nAntibiotics Prescribing for Treating Their \n\n\n\nChildren in Emergency Department, Hospital \n\n\n\nKepala Batas \n\n\n\nOPP11 A H Mohd Yahaya Health-related Quality of Life (HRQoL) Among \n\n\n\nNon-prescription Medicine Customers in \n\n\n\nMalaysia  \n\n\n\nOPP12 C P Chong Health Screenings and Assessment of Social-\n\n\n\neconomic Status among Aboriginal Peoples \n\n\n\n(Orang Asli) in Kampung Air Bah, Grik, State of \n\n\n\nPerak, Malaysia \n\n\n\nOPP13 P T Wan Comparison Studies of Clinical Status \n\n\n\nImprovement and Weight Gain Among \n\n\n\nPremature Infants in Hospital Sultanah Bahiyah \n\n\n\n(HSB) Who Had Received Soybean-oil Based \n\n\n\nEmulsion and Fish-oil-enriched Emulsion in \n\n\n\nTotal Parenteral Nutrition (TPN)  \n\n\n\nOPP14 N Jagan Cardiac and Behavioural Impact of Cardiac \n\n\n\nRehabilitation Medication Therapy Adherence \n\n\n\nClinic on Post-myocardial Infarction Patients  \n\n\n\n\n\n\n\nPHARMACEUTICAL CHEMISTRY / PHARMACOLOGY / TRADITIONAL & \n\n\n\nCOMPLEMENTARY MEDICINE \n\n\n\n\n\n\n\nNo Presenting Author Title \n\n\n\nOPM1 C Y Lee Functionalized Aurones as Inducers of \n\n\n\nNAD(P)H:Quinone Oxidoreductase 1 (NQO1) \n\n\n\nthat Activate AhR-XRE and Nrf2-ARE \n\n\n\nSignalling Pathways: Synthesis, Evaluation and \n\n\n\nSAR \n\n\n\nOPM2 C W Mai Synthesis and Evaluation of Benzalacetophenone \n\n\n\nDerivatives in Inhibiting Human Colorectal \n\n\n\nCancer Proliferation through Peroxisome \n\n\n\nProliferator-activated Receptor Gamma (PPARg)  \n\n\n\nOPM3 M M Said Development of A New Two-Tier Method for \n\n\n\nDrug Pre-Screening Analysis; A Spectral \n\n\n\nDatabase Study  \n\n\n\nOPM4 P Mittal Pharmacodynamic Interaction Potential of \n\n\n\nGlimepiride with Ginger in Type 2 Diabetic Rats \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 51 \n\n\n\nNo Presenting Author Title \n\n\n\nOPM5 I E Ridzwan A Systematic Approach to Evaluate the Receptor \n\n\n\nProfiles of a Novel Opioid Ligand with a Mixed \n\n\n\nAgonist/Antagonist Activity Using a Vas \n\n\n\nDeferens Assay  \n\n\n\nOPM6 M A S Heyam Gastroprotective Effect of Dictamnine Against \n\n\n\nEthanol Induced Stomach Ulceration  \n\n\n\nOPM7 P N Yeoh Effect of Treatment Duration of Morinda \n\n\n\ncitrifolia Fruit Juice on Blood Coagulation and \n\n\n\nLiver Functions in the Rat  \n\n\n\nOPM8 H Y Tee The Anti-Cholinergic and Anti-Adrenergic \n\n\n\nEffects of Radix saussurea on the Contraction of \n\n\n\nthe Rat Ileal Smooth Muscle and Frog Cardiac \n\n\n\nMuscle  \n\n\n\nOPM9 S Golbabapour Gastroprotective Study of Mucuna pruriens on \n\n\n\nExperimentally Induced Gastric Hemorrhagic \n\n\n\nMucosal Lesions in Rats  \n\n\n\nOPM10 B Y K Chung Extraction, Phytochemical Screening and \n\n\n\nHypoglycemic Effects of Aquilaria malaccensis \n\n\n\n(Gaharu) Leaves  \n\n\n\nOPM11 N S AL-Wajeeh Investigation of the In Vitro Antioxidant \n\n\n\nActivities and In Vivo Acute Toxicity of Ethanol \n\n\n\nExtract of Vitex pubescens  \n\n\n\nOPM12 M Hajrezaie Animal Study of Schiff Base Derived Copper (II) \n\n\n\nComplex in Acute Gastric Lesions  \n\n\n\nOPM13 N Al-Henhena Evaluation of Chemopreventive Effects of \n\n\n\nAndrographis paniculata on Azoxymethane-\n\n\n\nInduced Colorectal Cancer in Rats  \n\n\n\n\n\n\n\nPHARMACEUTICAL TECHNOLOGY \n\n\n\nNo Presenting Author Title \n\n\n\nOPT1 G S Shantha Kumar Effect of Polymers on Buccoadhesive Compacts \n\n\n\nof Enalapril Maleate  \n\n\n\nOPT2 V Mishra Acetazolamide loaded Dendrimer based Nano-\n\n\n\nArchitectures for Effective Glaucoma \n\n\n\nManagement  \n\n\n\nOPT3 K Dua Dissolution Enhancement of Ursodeoxycholic \n\n\n\nAcid (UDCA) by Complexation with Glucosyl-\u03b2-\n\n\n\nCyclodextrin-Choline Dichloride Coprecipitate  \n\n\n\nOPT4 H Katas Synthesis of Chitosan Nanoparticles Conjugated \n\n\n\nwith TAT-Peptide as a New Potential Delivery \n\n\n\nSystem for siRNA  \n\n\n\nOPT5 A Khan Development of Transdermal Patches for the \n\n\n\nEffective Delivery of Antihypertensive Agent \n\n\n\nOPT6 A Abdellah Public Awareness Towards Pharmaceutical Good \n\n\n\nManufacturing Practice in Malaysia \n\n\n\nOPT7 N H Khan Investigation of In-vitro Bioadhesive Properties \n\n\n\nof Natural Gums \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 52 \n\n\n\nTABLE OF CONTENT: POSTER PRESENTATIONS \nCLINICAL PHARMACY \n\n\n\nNo Presenting Author Title \n\n\n\nPCP1 W M Ong Utilization of Beta Blockers Post-myocardial \n\n\n\nInfarction \n\n\n\nPCP2 M H Hairul A Study of the Effect of Administration of \n\n\n\nParenteral Nutrition on Body Weights of \n\n\n\nPremature Infants in Kuala Lumpur Hospital  \n\n\n\nPCP3 A L Oh Antibiotic Usage in Surgical Prophylaxis: A \n\n\n\nProspective Surveillance at Surgical Wards of \n\n\n\nSarawak General Hospital \n\n\n\nPCP4 N A Ibrahim Characteristics, Risk and Outcome of Neonates \n\n\n\nPrescribed with Empiric Antibiotic Therapy in the \n\n\n\nPrevention of Early Onset Sepsis in Hospital \n\n\n\nPulau Pinang \n\n\n\nPCP5 N A N Ismail Evaluation of Drug Treatment in Patients with \n\n\n\nStatus Epilepticus  \n\n\n\nPCP6 C P Chong A One Day Community Health Screening \n\n\n\nConducted at SRJK(T) Sungai Pinang, State of \n\n\n\nPenang, Malaysia \n\n\n\nPCP7 Ilina Azrin J Study on Liver Enzymes among Surgical Patients \n\n\n\nReceiving Parenteral Nutrition: A Pilot Study \n\n\n\nPCP8 Rosmaliah A A Study on Pharmaceutical Interventions in \n\n\n\nMedical Wards, Kuala Lumpur Hospital \n\n\n\nPCP9 A A Mohammed Evaluation of Knowledge, Practice and \n\n\n\nAdherence to Asthma Guidelines among General \n\n\n\nPractitioners (GPs) and Community Pharmacists \n\n\n\n(CPs) in the State of Penang, Malaysia \n\n\n\nPCP10 M A Nawab Khan Assessment of Blood Sampling Time of \n\n\n\nGentamicin from Patients at Tertiary Care \n\n\n\nHospital \n\n\n\nPCP11 J C Voon Adherence to Iron Chelation Therapy in \n\n\n\nTransfusion-dependent Thalassaemia Patients in \n\n\n\nSarawak: Preliminary Findings \n\n\n\nPCP12 K Koo Health-Related Quality of Life in Transfusion-\n\n\n\nDependent Thalassaemia Patients with Iron \n\n\n\nChelation Therapy in Sarawak: A Preliminary \n\n\n\nReport \n\n\n\nPCP13 M A Hameed Barriers to Medication Adherence among Adult \n\n\n\nAsthmatics Attending Medication Therapy \n\n\n\nAdherence Clinic in a Tertiary Care Public \n\n\n\nHospital \n\n\n\nPCP14 N A Abdul Mutalib Outcome of the First Home Based Self \n\n\n\nAdministration of Subcutaneous Methotrexate \n\n\n\n(HOSAM) Program in Malaysia \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 53 \n\n\n\nNo Presenting Author Title \n\n\n\nPCP15 N I M Nazar Daily Clinical Dose Poorly Predicts Trough \n\n\n\nSerum Methadone Concentration (Ctrough) in \n\n\n\nPatients Undergo Methadone Maintenance \n\n\n\nTherapy (MMT) with Good Adherence \n\n\n\nPCP16 Nurulhayati A Jamal Adherence of Inhaled Corticosteroid (ICS) in \n\n\n\nAsthmatic Adult in Hospital Sultanah Nur \n\n\n\nZahirah (HSNZ) \n\n\n\nPCP17 Mirza R Baig Antidiabetic Medications and Glycemic Control \n\n\n\nin Type 2 Diabetic Patients of Sub-urban Hospital \n\n\n\nof Malaysia  \n\n\n\nPCP18 J L Lee Unlicensed and Off-label Use of Medicines in \n\n\n\nHospitalized Children in the Critical Care Units \n\n\n\nof Universiti Kebangsaan Malaysia Medical \n\n\n\nCenter \n\n\n\nPCP19 B K Tan Health Beliefs and Perception of Breast Cancer \n\n\n\nPatients in Relation to the Usage of Herbal \n\n\n\nMedicines \n\n\n\n\n\n\n\nPHARMACY PRACTICE & PHARMACY EDUCATION \n\n\n\nNo Presenting Author Title \n\n\n\nPPP1 W M Ong Medication Errors in Intravenous Drug \n\n\n\nPreparation and Administration in Selayang \n\n\n\nHospital  \n\n\n\nPPP2 H C Yong Attitude of Pharmacy Personnel in Sarawak \n\n\n\ntowards Cytotoxic Drug Reconstitution  \n\n\n\nPPP3 E P Tay Hospital Melaka: Cough and Cold Medicine \n\n\n\nUsage in Paediatric Patients  \n\n\n\nPPP4 N Ramlee Adverse Drug Reaction Reported in Hospital \n\n\n\nUniversiti Sains Malaysia (HUSM)  \n\n\n\nPPP5 P L Lua Ensuring Medication Adherence: The Role of \n\n\n\nHIV/AIDS Family Caregivers  \n\n\n\nPPP6 C Y Ting Customer Satisfaction towards Retail Pharmacy \n\n\n\nServices in Sarawak  \n\n\n\nPPP7 Noorazlinda Y Factors Associated with Defaulted Patient in \n\n\n\nMethadone Maintenance Programme in Hospital \n\n\n\nMelaka  \n\n\n\nPPP8 Nazedah I A Survey on Public Attitudes and Knowledge of \n\n\n\nContact Lens Use in Puncak Alam Selangor  \n\n\n\nPPP9 Nazedah I Methadone Maintenance Therapy Clinic in \n\n\n\nMalaysia: Out-of-pocket costs  \n\n\n\nPPP10 A F Yusoff Pattern of Usage of Herbal Medicine among \n\n\n\nHypertensive Patients in Hospital Seri Manjung  \n\n\n\nPPP11 Y C Soh Barriers to Practising Pharmaceutical Care in \n\n\n\nMalaysia: Views from Community Pharmacists  \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 54 \n\n\n\nNo Presenting Author Title \n\n\n\nPPP12 K S Tan Unused Medicines among Older Adults in \n\n\n\nUniversiti Kebangsaan Malaysia Medical Centre  \n\n\n\nPPP13 Z Shahirah Beliefs and Adherence about Medicines among \n\n\n\nPsoriasis Patients in Government Hospitals  \n\n\n\nPPP14 M Anwar Self Medication Practice Assessment in Rural \n\n\n\nArea: Puncak Alam, Kuala Selangor  \n\n\n\nPPP15 S Sadeeqa Evaluating Knowledge, Attitude & Perception \n\n\n\nRegarding Halal Pharmaceuticals, Among \n\n\n\nCommunity Pharmacists in Malaysia  \n\n\n\nPPP16 Y C Soh Pharmaceutical Care Provision: Are Community \n\n\n\nPharmacists in Malaysia Ready?  \n\n\n\nPPP17 Y S Wong Factors Influencing the Role of Community and \n\n\n\nHospital Pharmacists in Malaysia  \n\n\n\nPPP18 Kavidha Mohan Study on the Impact of Colour Coded Syringe \n\n\n\nLabels (CCSL) for Emergency Drugs in Hospital \n\n\n\nKuala Lumpur (EDHKL)  \n\n\n\nPPP19 Abdul Ghani N Economic Evaluation of Methadone Maintenance \n\n\n\nTherapy (MMT) and Long-Term Residential \n\n\n\nTreatment (LTRT) Program for Drug Abuse \n\n\n\nPatients in the State of Penang and Kedah, \n\n\n\nMalaysia  \n\n\n\nPPP20 M A Nawab Khan Perception of Public and Undergraduates towards \n\n\n\nFear and Exclusion of People with Mental Illness  \n\n\n\nPPP21 S K May The Outcome of Continuous Assessments on \n\n\n\nUndergraduate Pharmacy Students\u201f Performance  \n\n\n\n\n\n\n\nPHARMACEUTICAL CHEMISTRY / PHARMACOLOGY / TRADITIONAL & \n\n\n\nCOMPLEMENTARY MEDICINE \n\n\n\n\n\n\n\nNo Presenting Author Title \n\n\n\nPPM1 C W Mai Betulinic Acid Inhibits Toll-like Receptor-4 \n\n\n\n(TLR4) Dimerisation and Its Molecular \n\n\n\nInteractions  \n\n\n\nPPM2 Anandarajagopal Novel 1,4-Benzothiazine Derivatives as \n\n\n\nAntimicrobial Agents: Synthesis, \n\n\n\nCharacterization and Evaluation \n\n\n\nPPM3 E E Mubarak Chemical Composition and Antimicrobial \n\n\n\nActivity of Eucalyptus Camaldulensis Dehnh \n\n\n\nEssential Oil from Malaysia  \n\n\n\nPPM4 W L Chong Energies Evaluation in the Binding of the \n\n\n\nMonoclonal Antibody 1A1D-2 Complexed with \n\n\n\nDomain III of the Viral Envelope Glycoprotein E \n\n\n\nof DENV  \n\n\n\nPPM5 A Fatima Molecular Characterization of the K-ras Protein \n\n\n\nin Lung Cancer  \n\n\n\nPPM6 A G Kumari Anti Helicobacter pylori Activity of Hibiscus \n\n\n\nvitifolius in Ulcerated Albino Rats  \n\n\n\nPPM7 R A Rahman Analgesic and Antipyretic Activity of Manihot \n\n\n\nesculenta crantz Extracts  \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 55 \n\n\n\nPPM8 A M Saleem Involvement of Opioidergic and Serotonergic \n\n\n\nPathways in the Analgesic Activity of Cissus \n\n\n\nquadrangularis L. (Patah Tulang) Stem Extract in \n\n\n\nMice  \n\n\n\nPPM9 P Hassandarvish Investigation of Gastro-Protective Activity of \n\n\n\nSchiff Bases Complexes and their Mechanisms  \n\n\n\nPPM10 L Z A Salim Anti-leukemia Effect of Thymoquinone Isolated \n\n\n\nfrom Nigella sativa  \n\n\n\nPPM11 M Taher Study on Antidiabetic Plants Cocktail Containing \n\n\n\nAndrographis paniculata, Cinnamomum \n\n\n\nburmannii and Tinospora crispa  \n\n\n\nPPM12 Y Pan In Vitro Effect of Various Herbal Active \n\n\n\nConstituents on Cytochrome P450 2E1  \n\n\n\nPPM13 A M Saleem Analgesic Activity of Cissus quadrangularis \n\n\n\n(Patah Tulang) Stem Extracts in Mice \n\n\n\nPPM14 A M Saleem Antibacterial Activity of Methanolic Extract of \n\n\n\nClinacanthus nutans (Sabah Snake Grass) Leaf  \n\n\n\nPPM15 A J Sunilson Hepatoprotective Activity of Swietenia \n\n\n\nmacrophylla Fractions in CCl4 Intoxicated Rats  \n\n\n\nPPM16 S E A Saad Analgesic Effect of Ruta graveolens in Albino \n\n\n\nMice and Rats  \n\n\n\nPPM17 A K Balaraman Antidiabetic Effect of Steroidal Compound \n\n\n\nIsolated from Melothria maderaspata  \n\n\n\nPPM18 S C Ng Effects of Hopea Extracts on Human Colorectal \n\n\n\nCancer Cell Proliferation via Induction of \n\n\n\nApoptosis \n\n\n\nPPM19 Y S Chia Inhibition of Human Estrogen Dependent Breast \n\n\n\nCarcinoma Proliferation by Hopea odorata and \n\n\n\nHopea ponga \n\n\n\nPPM20 L Y Foong In Vitro Cytotoxic Effects of Hopea odorata and \n\n\n\nHopea ponga on Estrogen Independent Breast \n\n\n\nCancer  \n\n\n\nPPM21 K H Tan Antiproliferative Property of Hopea odorata and \n\n\n\nHopea ponga Extracts on Human Cervical Cancer \n\n\n\nCells  \n\n\n\nPPM22 P K Boey Antiproliferative Activity of Hopea ponga and \n\n\n\nHopea odorata Leaves and Stem Bark on \n\n\n\nLeukemia Cancer Cell Lines (CEMss)  \n\n\n\nPPM23 F Y Tan The Cytotoxic Activities of Hopea odorata and \n\n\n\nHopea ponga Extracts on Human Ovarian Cancer \n\n\n\nCells  \n\n\n\n\n\n\n\n\n\n\n\nPHARMACEUTICAL TECHNOLOGY \n\n\n\nNo Presenting Author Title \n\n\n\nPPT1 A R Tapas Preparation of Carvedilol Spherical Crystals \n\n\n\nHaving Solid Dispersion Structure by the \n\n\n\nEmulsion Solvent Diffusion Method and \n\n\n\nEvaluation of Its in vitro Characteristics  \n\n\n\nPPT2 R Sheshala Comparative Evaluation of Different \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 56 \n\n\n\nSpreadability Techniques on Extemporaneously \n\n\n\nPrepared Cocos nucifera Topical Dosage Forms  \n\n\n\nPPT3 B H Ng Erosion and Dissolution Performance of \n\n\n\nIntermediate Molecular Weight HPMC \n\n\n\nControlled Release Polymers  \n\n\n\nPPT4 K Dua Aqueous Solubility Enhancement of \n\n\n\nKetoconazole Using Solid Dispersion and \n\n\n\nComplexation Technique \n\n\n\nPPT5 M Razavi Formulation and Evaluation of Gastroretentive \n\n\n\nMatrix Tablets of Metformin Hydrochloride with \n\n\n\nXanthan and Tamarind Gum  \n\n\n\nPPT6 S Rajesh Formulation and In-vitro Evaluation of Matrix \n\n\n\nType Transdermal Patches of Captopril  \n\n\n\nPPT7 N S Ashikin Wan \n\n\n\nHussin \n\n\n\nEffect of Polymer Concentration on Plasticity of \n\n\n\nHot Air-Dried Guluronate- and Mannuronate-\n\n\n\nRich Alginate Films \n\n\n\nPPT8 A Abdellah People Perception towards Impact of Good \n\n\n\nManufacturing Practice Implementation in \n\n\n\nMalaysia \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 57 \n\n\n\n\n\n\n\nORAL PRESENTATIONS \n\n\n\n\n\n\n\nPHARMACY EDUCATION \n\n\n\n\n\n\n\n \nOPE1 (000044) \n\n\n\n\n\n\n\nAssessing Stress among Undergraduate Pharmacy Students in University of Malaya \n\n\n\n\n\n\n\nH S Sue, Z Aziz \n\n\n\nDepartment of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur \n\n\n\n\n\n\n\nHealth care students including pharmacy students are believed to experience a higher \n\n\n\nlevel of stress as compared to their age-matched peers. However, stress among pharmacy \n\n\n\nstudents in Malaysia has not been well documented. This cross-sectional study aimed to \n\n\n\ndetermine the prevalence and sources of stress among the undergraduate pharmacy \n\n\n\nstudents in the University of Malaya (UM). All UM pharmacy students (n = 273) \n\n\n\ncompleted a well validated measure, the Derogatis Stress Profile. The response rate was \n\n\n\n100%. Our findings showed that although these students did not demonstrate significant \n\n\n\nlevels of stress, their perceived stress levels were significantly higher (mean = 53.55 \u00b1 \n\n\n\n7.87; p < 0.001) than the general population. Academic-related stress was rated as the \n\n\n\nmost common source of stress. Stress was significantly associated with ethnicity and \n\n\n\nplace of stay, with Malay students and students living off-campus having higher levels of \n\n\n\nstress. There was a significant negative correlation between stress and grade point \n\n\n\naverage (GPA) (r = -0.159, p = 0.009) indicating that as stress levels increases, students \n\n\n\nGPA decreases. Second year students were found to be the most stressed although stress \n\n\n\nlevels did not significantly differ across academic years. Thus, targeted interventions may \n\n\n\nbe an effective way of dealing with stress during the transition from second year to third \n\n\n\nyear training. \n\n\n\n\n\n\n\n \nOPE2 (000051) \n\n\n\n\n\n\n\nEvaluation of Multimedia and Conventional Counselling in Metered Dose Inhaler \n\n\n\n(MDI) Technique Education and Time-efficiency in Sibu Hospital \n\n\n\n\n\n\n\nT L King, E K Y Kho, Y H Tiong, S N Julaihi, A I S Ting \n\n\n\nPharmacy Department, Sibu Hospital, Sibu, Sarawak \n\n\n\n\n\n\n\nMultimedia has shown to be a useful tool in medical device education. This study \n\n\n\nevaluated whether recorded counselling on touchscreen computer, that is multimedia \n\n\n\ncounselling is as effective and time-efficient in promoting patient understanding of \n\n\n\nmetered dose inhaler (MDI) with or without valved-holding chamber (VHC) technique as \n\n\n\nconventional way. MDI users were recruited and randomly allocated into either \n\n\n\nmultimedia or conventional counselling group. Inhalation technique was assessed before \n\n\n\nand after counselling using checklists. Time spent to reach perfect inhalation technique \n\n\n\nwas recorded to determine the time-efficiency of the counselling methods. Both \n\n\n\nmultimedia and conventional groups showed significant improvement with average of \n\n\n\n44.3% (standard deviation (SD): 22.1; P<0.001) and 26.9% (SD: 17.6; P<0.001), \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 58 \n\n\n\nrespectively in the inhaler technique score. However, there was no significant difference \n\n\n\nin the technique improvement between both groups (P=0.122). Similarly, there was no \n\n\n\nsignificant difference between time spent in both groups to reach perfect inhalation \n\n\n\ntechnique (14.3 minutes, SD: 7.8 vs 11.5 minutes, SD: 5.3; P=0.114). In conclusion, both \n\n\n\nmultimedia and conventional counselling improved patient MDI (with or without VHC) \n\n\n\ntechnique significantly. Both counselling methods had similar effectiveness and time-\n\n\n\nefficiency in MDI (with or without VHC) technique education. \n\n\n\n\n\n\n\n \nOPE3 (000074) \n\n\n\n\n\n\n\nPerception of Nurses towards Generic Medicines: Qualitative Groundwork \n\n\n\n\n\n\n\nS Q Jamshed \n1\n, M A Hassali \n\n\n\n2\n, Ibrahim M I M \n\n\n\n3\n, S H Shamsudin \n\n\n\n1\n, O Q B Al-lela \n\n\n\n1\n, R \n\n\n\nM Elkalmi \n1\n, A I Awadh \n\n\n\n1\n, M J Siddiqui \n\n\n\n1\n \n\n\n\n1\n Pharmacy Practice, Kulliyyah of Pharmacy, IIUM, Kuantan campus, Pahang, Malaysia \n\n\n\n2\n DSAP, School of Pharmaceutical Sciences, USM, Penang, Malaysia \n\n\n\n3\n College of Pharmacy, Qatar University, Doha, Qatar \n\n\n\n\n\n\n\nNursing is a major supporter of the health care system in Pakistan. The study is aimed to \n\n\n\nexplore nurses\u201f views towards generic medicines and their substitution. The study was \n\n\n\nconducted among nurses of two medical wards in a large private sector, tertiary care \n\n\n\nhospital (700-bed) in Karachi, Pakistan. Nurses who agreed to participate were \n\n\n\ninterviewed personally (n=11) using a semi-structured interview guide. The tape recorded \n\n\n\ninterviews were held during the summers of 2009 in the hospital. Thematic analysis of the \n\n\n\ninterviews identified four major themes: Understanding of the terms \u201cgeneric medicine\u201d, \n\n\n\n\u201cswitching between the medicines\u201d, \u201cquality of locally manufactured generics\u201d, and \n\n\n\n\u201cinformation about locally manufactured generic medicines\u201d. None of the respondents \n\n\n\nshowed understanding about generic medicines and they understand the term generic \n\n\n\nmedicines as locally manufactured medicines available only by their chemical names in \n\n\n\nthe market. Nearly all the respondents reported frequent switching between those \n\n\n\nmedicines that contain the same active compound of similar potency. More than half of \n\n\n\nthe respondents raised doubts about the safety and efficacy issues in locally manufactured \n\n\n\nmedicines. All the respondents suggested to be better informed about locally \n\n\n\nmanufactured generic medicines. Understanding about generic medicines is lacking \n\n\n\namong nurse. Nurses expressed their suspicion about locally manufactured generics and \n\n\n\ntherefore incorporation of generic medicine information in nursing education is required \n\n\n\nto build trust for locally manufactured medicines. \n\n\n\n\n\n\n\n \nOPE4 (000100) \n\n\n\n\n\n\n\nIt is Not as Simple as I Thought: Motivating Students to Learn Non-Prescription \n\n\n\nPreparations More Effectively through Action Research \n\n\n\n\n\n\n\nH G Lee \n\n\n\nDepartment of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur \n\n\n\n\n\n\n\nAs a diligent lecturer, spending time finding resources and effective methods to transfer \n\n\n\nknowledge to students is hard work. Spurring and motivating students in taking up and \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 59 \n\n\n\nmaintaining their interest in an elective course on Non-Prescription Preparations is not an \n\n\n\neasy task, as this course is not commonly chosen by the pharmacy students as one of their \n\n\n\nelective courses due to various reasons. Hence, action research was conducted as the \n\n\n\nresearch technique to improve on the teaching method, hoping that the course will \n\n\n\nbecome more interesting for students to sign up in future. Series of written feedback and \n\n\n\none verbal feedback were obtained from the students enrolled in the course using \"Start-\n\n\n\nStop-Continue\" theme. Students were free to give feedback and suggestion on whether to \n\n\n\nstart, to stop or to continue with the new teaching method employed and new course \n\n\n\ncontent incorporated into the course. No doubt, action research methodology requires a \n\n\n\nlot of patience and effort to conduct as it requires constant improvement and continuous \n\n\n\nchange throughout the whole research period. Furthermore, a lot of persuasion is needed \n\n\n\nto encourage students to speak up. Meanwhile, as the researcher who is also the lecturer, \n\n\n\nit was almost impossible to teach the students and carry out observation concurrently. \n\n\n\nThis oral presentation will discuss how the researcher practiced flexibility and the \n\n\n\nchallenges faced when conducting this action research in motivating students to learn \n\n\n\nNon-Prescription Preparations more effectively and in an enjoyable learning environment. \n\n\n\n\n\n\n\n \nOPE5 (000026) \n\n\n\n\n\n\n\nPharmacy Students\u2019 Assessment of an Objective Structured Clinical Examination \n\n\n\n(OSCE) in International Islamic University Malaysia (IIUM) \n\n\n\n\n\n\n\nO Q B Al-lela, R M Elkalmi, S H Shamsudin, A I Awadh, A M Al-shami, S Q \n\n\n\nJamshed \n\n\n\nPharmacy Practice Department, Kulliyyah of Pharmacy, International Islamic University \n\n\n\nMalaysia (IIUM), 25200 Kuantan, Pahang \n\n\n\n\n\n\n\nAn Objective Structured Clinical Examination (OSCE) is an objective method of \n\n\n\nassessing students\u201f clinical, practical and technical skills. The aim of this study is to \n\n\n\ndetermine the effectiveness of an OSCE for assessing 4th year pharmacy students\u201f skills \n\n\n\nin International Islamic University Malaysia (IIUM). Six OSCE stations (5 active and one \n\n\n\nrest stations) were designed and implemented in the 2011-2012 academic year as part of \n\n\n\nthe assessment methods for a clinical pharmacy course. The broad competencies tested in \n\n\n\nthe OSCE included: demonstration of the correct technique of measuring blood pressure \n\n\n\n(station 1), screening and validation of a prescription (station 2), identification and \n\n\n\nresolution of Drug Related Problems (DRPs) (station 3), demonstration of the correct \n\n\n\ntechnique of blood glucose testing (station 4), and improving glycaemic control (station \n\n\n\n5). After all the students completed the OSCE, they filled a questionnaire containing \n\n\n\nitems on understanding written instructions, difficulty of the tasks, degree of learning \n\n\n\ngained and needed, adequacy of time given to accomplish tasks and the appropriateness \n\n\n\nof reference materials used. More than 50% of the students felt that the written \n\n\n\ninstructions provided at the second station were difficult to understand. Approximately \n\n\n\n70% of the examinees felt that the fifth station were difficult. A majority of the students \n\n\n\nfelt that a higher degree of learning was needed to accomplish the fifth station. About 50 \n\n\n\nto 60% of the students reported that the 10 minutes allocated for completing fourth and \n\n\n\nlast stations (station 5) was inadequate. Clearer instructions at OSCE stations, sufficient \n\n\n\ntime and higher degree of learning should be provided for students. \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 60 \n\n\n\n \nOPE6 (000023) \n\n\n\n\n\n\n\nHoney Compared to Silver Sulphadiazine Dressing for Acute Wounds: A Systematic \n\n\n\nReview \n\n\n\n\n\n\n\nN J Chong \n1\n, Z Aziz \n\n\n\n2\n, S F Abu \n\n\n\n3\n \n\n\n\n1 \nFaculty of Pharmacy, Mahsa University College, 50490 Kuala Lumpur \n\n\n\n2 \nDepartment of Pharmacy, Faculty of Medicine, University of Malaya, 50603 Kuala \n\n\n\nLumpur \n3 \n\n\n\nPharmaceutical Services Division, Ministry of Health Malaysia, 46350 Selangor \n\n\n\n\n\n\n\nWhile both honey and silver sulphadiazine dressing (SSD) are commonly used for acute \n\n\n\nwounds, their relative effectiveness remains unclear. The aim of this review was to \n\n\n\ncompare the effectiveness of honey to SSD. We searched the Cochrane Central Register \n\n\n\nof Controlled trials, MEDLINE, EMBASE, EBSCOhost and other databases without date \n\n\n\nor language restriction for randomised controlled trials (RCTs) that compared the \n\n\n\neffectiveness of honey with SSD for acute wounds. We also checked the reference lists of \n\n\n\nincluded studies and related reviews for additional studies. Two reviewers extracted and \n\n\n\nsummarised details of eligible trials and assessed the methodological quality of each trial \n\n\n\nusing the Cochrane risk of bias tool assessments independently. From the initial 1028 \n\n\n\nsearch titles obtained, we identified eight eligible RCTs involving 649 patients. Only six \n\n\n\nout of the eight trials reported quantifiable outcome. Overall, the risk of bias in the \n\n\n\nincluded trials was fair. Pooled analysis showed that honey compared to SSD \n\n\n\nsignificantly reduced healing time for (i) superficial thickness wound [WMD -4.62 (95% \n\n\n\nCI: -7.37 to -1.88) and (ii) partial thickness wounds, [WMD -2.76 (95% CI: -4.36 to -\n\n\n\n1.15)]. While the results provide marginal evidence that honey is superior to SSD in term \n\n\n\nof shorter healing time for acute wound, additional robust trials is needed before a firm \n\n\n\nconclusion can be made. \n\n\n\n\n\n\n\n\n\n\n\nCLINICAL PHARMACY & PHARMACY PRACTICE \n\n\n\n\n\n\n\n \nOPP1 (000012) \n\n\n\n\n\n\n\nThe Incidence and Clinical Management of Adverse Events Due to FOLFOX \n\n\n\nChemotherapy in Colorectal Cancer Patients \n\n\n\n\n\n\n\nQ L Goh \n1\n, A Z Bustam \n\n\n\n2\n , F H Shabaruddin \n\n\n\n1\n \n\n\n\n1\n Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur \n\n\n\n2\n Department of Oncology, Faculty of Medicine, University of Malaya, Kuala Lumpur \n\n\n\n\n\n\n\nFOLFOX chemotherapy has become the standard regimen for advanced colorectal cancer \n\n\n\n(CRC) but data on its adverse events profile within clinical practice, particularly in \n\n\n\nMalaysia, are scarce. This study aimed to describe the incidence and clinical management \n\n\n\nof FOLFOX-related adverse events (AEs) in CRC patients at a tertiary-care referral \n\n\n\nhospital in Malaysia. Chemotherapy records from mid-2007 to mid-2011 were screened \n\n\n\nto identify patients who received FOLFOX chemotherapy. Data were collected for 111 \n\n\n\npatients who met the inclusion criteria, from the start of FOLFOX chemotherapy up to 1 \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 61 \n\n\n\nyear post-treatment. Grades 3&4 FOLFOX-related AEs, graded according to NCI \n\n\n\nCTCAE v4.0 definitions, occurred in 45% of patients, with the key AEs being \n\n\n\nneutropaenia (41%), thrombocytopaenia (5%), anaemia (5%), diarrhoea (4%) and \n\n\n\nneuropathy (2%). Chemotherapy dose delays and dose reductions due to AEs occurred in \n\n\n\n66% and 32% of patients, respectively. AEs also led to chemotherapy discontinuation \n\n\n\n(6%) and treatment-related deaths (2%). Clinical management of AEs varied between \n\n\n\npatients, with symptomatic approaches generally employed based on clinical judgement. \n\n\n\nNo statistically significant association was found between clinical characteristics of \n\n\n\npatients and grades 3&4 FOLFOX-related AEs. The incidence of haematological \n\n\n\nFOLFOX-related AEs observed were similar to published data from clinical trials of \n\n\n\nFOLFOX chemotherapy but were lower for non-haematological AEs, likely due to \n\n\n\nincomplete documentation. Wide variations of clinical management strategies for \n\n\n\nFOLFOX-related AEs were observed. To optimise patient safety and clinical outcomes, \n\n\n\nthorough documentation of all chemotherapy-related AEs and the development of \n\n\n\ninstitution-specific treatment protocols on the clinical management of chemotherapy-\n\n\n\nrelated AEs are recommended.  \n\n\n\n\n\n\n\n \nOPP2 (000015) \n\n\n\n\n\n\n\nAdverse Events Profile and Clinical Management of Malaysian Breast Cancer \n\n\n\nPatients on FEC+Docetaxel Chemotherapy \n\n\n\n\n\n\n\nY T Chong \n1\n, A Z Bustam \n\n\n\n2\n, F H Shabaruddin \n\n\n\n1\n \n\n\n\n1\n Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur \n\n\n\n2\n Clinical Oncology Unit, University of Malaya Medical Center, Kuala Lumpur \n\n\n\n\n\n\n\nSequential chemotherapy with fluorouracil, epirubicin and cyclophosphamide followed \n\n\n\nby docetaxel (FEC+docetaxel) has led to improved clinical outcomes in breast cancer \n\n\n\npatients, but there is currently little data describing its adverse events profile within \n\n\n\nclinical practice. This study aimed to describe the adverse events profile and clinical \n\n\n\nmanagement of breast cancer patients on FEC+docetaxel chemotherapy in a Malaysian \n\n\n\ntertiary-care hospital. Chemotherapy records from 2007 to 2011 were reviewed to identify \n\n\n\npatients who received FEC+docetaxel chemotherapy. Data were collected for 201 patients \n\n\n\nwho met the inclusion criteria. Adverse events (AEs) due to FEC+docetaxel \n\n\n\nchemotherapy were graded according to NCI CTCAE v4.0. The highest incidences for \n\n\n\nhaematological AEs were neutropaenia (48%), anaemia (20%) and febrile neutropaenia \n\n\n\n(18%), and for non-haematological AEs were nausea and vomiting (54%), nausea only \n\n\n\n(34%), and oral mucositis (34%). Chemotherapy dose delay, dose reduction and \n\n\n\ndiscontinuation due to AEs occurred in 33%, 28% and 9% of patients respectively. \n\n\n\nHaematological AEs were generally managed with chemotherapy dose delays or \n\n\n\nreductions, prophylaxis with GCSF and antibiotics, blood transfusions and haematinics. \n\n\n\nWide variations of symptomatic clinical management strategies for non-haematological \n\n\n\nAEs were given to 84% of patients, generally based on clinical judgement. The incidence \n\n\n\nof FEC+docetaxel-related AEs differed from published data from clinical trials but direct \n\n\n\ncomparisons were not possible due to incomplete documentation and grading of AEs in \n\n\n\nthe study population\u201fs medical records. To optimise patient safety and clinical outcomes, \n\n\n\nthorough documentation of chemotherapy-related AEs and the development of \n\n\n\ninstitution-specific treatment protocols on the clinical management of chemotherapy-\n\n\n\nrelated AEs are recommended. \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 62 \n\n\n\n \nOPP3 (000108) \n\n\n\n\n\n\n\nCan the Community Pharmacists Detect Drug Related Problems (DRPs)? \n\n\n\n\n\n\n\nA Jamunarani, A Sariff  \n\n\n\nSchool of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang \n\n\n\n\n\n\n\nPharmacists are making improvements in pharmaceutical care, especially detecting drug \n\n\n\nrelated problems (DRPs). The study was aimed to develop a checklist to detect DRP \n\n\n\namong patients with allergy. The study involved preliminary phase which involved study \n\n\n\nliterature, preliminary survey and adaptation of validated questionnaire and PCNE \n\n\n\nchecklist from previous studies. Then the created checklist was tested in Phase 1 where it \n\n\n\nwas used in a community pharmacy to get it validated. Four professionals agreements, \n\n\n\npredictive values, sensitivity and specificity tests were done to validate the checklist. This \n\n\n\nvalidated checklist was then field tested in Phase 2 which consisted of two groups to test \n\n\n\nthe reliability of the checklist. Results: During Preliminary Phase, some inputs which \n\n\n\nwere based on patients own experience of DRPs differed from the PCNE checklist. \n\n\n\nPrevalence of DRPs detected was 12.96%. In Phase 1, significant DRPs (p<0.05) were \n\n\n\ntherapy failure, untreated indication and in need of additional therapy whereas significant \n\n\n\ncauses of DRPs (p<0.05) were food/drug interaction, dispensing error and polypharmacy. \n\n\n\nIn Phase 2, Group1 (with validated checklist) obtained results similar to Phase 1 whereas \n\n\n\nGroup 2 (without validated checklist) was unable to detect DRPs. Discussions: The study \n\n\n\nmanaged to develop a checklist which can be used as a detection method for DRPs among \n\n\n\npatients with allergy. There were similarities of DRP types and causes correlation \n\n\n\nstatistics with studies from other countries. This study revealed that improvement had to \n\n\n\nbe made in DRPs detection methods to improve pharmaceutical care and help community \n\n\n\npharmacists play a major role in our healthcare system. \n\n\n\n\n\n\n\n \nOPP4 (000018) \n\n\n\n\n\n\n\nOutcome of Pharmacist Involvement in the Therapeutic Management of \n\n\n\nRheumatoid Arthritis Patients in Hospital Sultanah Bahiyah (HSB) \n\n\n\n\n\n\n\nM S Jayaraman, S N A  Rahim, K S Tan, N K Chow \nPharmacy Department, Hospital Sultanah Bahiyah, Alor Setar, Kedah \n\n\n\n\n\n\n\nThis study aimed to evaluate the outcome of pharmacist involvement in the therapeutic \n\n\n\nmanagement of rheumatoid arthritis (RA) patients at the rheumatology clinic in Hospital \n\n\n\nSultanah Bahiyah (HSB). A prospective interventional study was conducted from July to \n\n\n\nNovember 2011. Patients were recruited at the rheumatology clinic with two subsequent \n\n\n\nmonthly follow ups at the specialist clinic pharmacy. Assessments at entry and at 2 \n\n\n\nmonths included quality of life (QOL) using SF-12 questionnaire and symptoms of RA. \n\n\n\nMedication adherence, drug knowledge, and adverse drug reaction (ADR) were \n\n\n\nalso assessed. At each encounter, patients were counselled on medication adherence and \n\n\n\ninterventions highlighted to physicians where necessary. Data was analysed using SPSS \n\n\n\nVersion 16 with statistical tests which included Friedman\u201fs test (RA symptom, pain score, \n\n\n\nadherence), Wilcoxon Signed Rank test (knowledge), Pearson chi-square (ADR), and \n\n\n\npaired t-test (quality of life). Thirty-four RA patients were recruited but only \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 63 \n\n\n\n30 completed two months of follow up. At the end of follow-up, significant improvement \n\n\n\nin medication adherence and knowledge were observed with 54.7% reduction in mean \n\n\n\nMorisky score (p = 0.006) and 11.2% increase in knowledge score (p<0.05), respectively. \n\n\n\nThere was a significant reduction of complaints of ADR at the end of follow-up. In \n\n\n\nquality of life assessments, physical component scores showed a significant increase of \n\n\n\n5.70% (p = 0.04) while mental component scores increased 0.62%, though this was not \n\n\n\nstatistically significant (p = 0.81). This showed that pharmacist intervention had a positive \n\n\n\nimpact on therapy management of RA patients. \n\n\n\n \nOPP5 (000096) \n\n\n\n\n\n\n\nDe-escalation of Carbapenem Therapy in Sarawak General Hospital (SGH): How \n\n\n\nFar Do We Put It Into Practice? \n\n\n\n\n\n\n\nC Z Ngua \n1\n, P C S Tan \n\n\n\n2\n, H H Chua \n\n\n\n3\n, E Norzalina \n\n\n\n2\n \n\n\n\n1 \nDepartment of Pharmacy, Sarawak General Hospital, Sarawak \n\n\n\n2 \nDepartment of Anaesthesiology & Intensive Care, Sarawak General Hospital, Sarawak \n\n\n\n3 \nDepartment of Medicine, Sarawak General Hospital, Sarawak \n\n\n\n\n\n\n\nDe-escalation of antibiotics is one of the strategies in an antibiotic stewardship \n\n\n\nprogramme to reduce the overuse of antimicrobials and prevent the emergence of \n\n\n\nmultidrug resistant organisms. Our objectives were to study the empirical versus targeted \n\n\n\nuse of carbapenems (meropenem, imipenem and ertapenem) in SGH, to determine the \n\n\n\nrate of de-escalation in empirical therapy, to identify factors associated with absence of \n\n\n\nde-escalation and to suggest measures to overcome barriers to its implementation. All \n\n\n\npatients more than 12 years old who received more than one dose of carbapenems from \n\n\n\nApril to August 2012 were identified from computerised in-patient pharmacy records. \n\n\n\nSite of infection, regime and course of antibiotics, culture and sensitivity (C&S) results \n\n\n\nwere determined from their medical records. Failure of de-escalation was defined as the \n\n\n\ncontinued usage of carbapenems without de-escalation to a narrower spectrum antibiotic \n\n\n\nfollowing the availability of C&S results. Out of the 65 identified cases, 42 prescriptions \n\n\n\n(64.6%) were empirical and the rest were definite therapy. Of the empirical therapy, eight \n\n\n\npatients were excluded from the study giving the rate of de-escalation of 44.1% (15 \n\n\n\ncases). Mean days of therapy to de-escalation was 5.53 days whereas mean days from the \n\n\n\nreported date of C&S results to de-escalation was 2.62 days. Absence of de-escalation in \n\n\n\nthe remaining 19 cases (55.9%) was mainly attributed to the unavailability of C&S results \n\n\n\nas guidance (57.9%). The practice of de-escalation of carbapenem therapy in SGH is \n\n\n\nconsidered satisfactory but can be improved with the recent introduction of an \n\n\n\ninstitutional antibiotic policy to create awareness of antibiotic de-escalation. \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 64 \n\n\n\n \nOPP6 (000024) \n\n\n\n\n\n\n\nAn Evaluation on Over the Counter Medications (OTC) and Vitamins Use Among \n\n\n\nPregnant Women: A Single Center Study from Malaysia \n\n\n\n\n\n\n\nR Rajah, A Sariff, C P Chong \n\n\n\nDiscipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains \n\n\n\nMalaysia, Pinang \n\n\n\n\n\n\n\nGlobally, over-the-counter (OTC) medications and vitamins utilization have increased in \n\n\n\npregnant women. However, little is known about such practice among the Malaysian \n\n\n\nobstetric population. This study aimed to evaluate the utilization of OTC medications and \n\n\n\nvitamins among the Malaysian pregnant women. This was a cross-sectional survey \n\n\n\nconducted via face-to-face interview using validated and pilot-tested structured \n\n\n\nquestionnaire from the period of April-May 2012. A total of 181 pregnant women who \n\n\n\nattended follow-up at Seberang Jaya Health Clinic were approached. Chi-square test and \n\n\n\nodd ratio were used to assess the impact of demographic characteristics on the use of \n\n\n\nOTC medications. A total of 175 pregnant women (96.6%) agreed to be interviewed. \n\n\n\nSlightly more than half (54.9%) of the respondents had used OTC medications, mostly to \n\n\n\ntreat fever (24%) and flu (20.6%). Paracetamol was the most commonly utilized product \n\n\n\nfollowed by topical analgesics. All respondents had used at least one vitamin. Among the \n\n\n\nmost commonly consumed vitamins were folic acid, vitamin C, vitamin B and iron. The \n\n\n\nmain reasons for using vitamins were to improve general health (57.1%) and immune \n\n\n\nsystem (51.4%). The tendency of OTC medications use were noted more in working \n\n\n\n(OR:2.80; CI:1.36-5.79) and higher educated pregnant women (OR:2.04; CI:1.11-3.75). \n\n\n\nBesides, the usage of such products were significantly higher in 3\nrd \n\n\n\ntrimester than 1st \n\n\n\ntrimester (OR:2.89; CI:1.24-6.50). In conclusion, the use of OTC medications and \n\n\n\nvitamins are prevalent among Malaysian pregnant women. Therefore, integrated \n\n\n\nmonitoring and education are the core of safe use of any products during pregnancy. \n\n\n\n\n\n\n\n \nOPP7 (000028) \n\n\n\n\n\n\n\nMedication Reconciliation during Hospital Admission and Discharge: Evaluating \n\n\n\nDiscrepancies \n\n\n\n\n\n\n\nW Y Lim, H F Hoo \n\n\n\nDepartment of Pharmacy, Hospital Seri Manjung, Perak \n\n\n\n\n\n\n\nLack of medication reconciliation at transition points of care is associated with \n\n\n\ndiscrepancy-related errors.  This study aims to determine the clinical impact of \n\n\n\nunintentional medication discrepancies in the medical wards of Hospital Seri Manjung.  \n\n\n\nAll patients admitted from March-June 2010 were included in this study.  Patients were \n\n\n\nexcluded if they were readmitted, discharged during weekends or public holidays, \n\n\n\ntransferred to another hospital or intra-hospital ward, died, or absconded.  At admission, \n\n\n\npatients\u201f medication histories were obtained by pharmacists and compared with ward \n\n\n\nprescriptions.  Upon discharge, patients\u201f discharge prescriptions were evaluated for \n\n\n\nunintended discrepancies. Discrepancies were clarified with the prescribers and \n\n\n\ndocumented. Severity of the discrepancy was classified as minor, significant, serious, and \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 65 \n\n\n\nlife-threatening errors.  Of the total 1242 potential study subjects identified, 400 patients \n\n\n\nwere excluded based on exclusion criteria, and 342 patients had incomplete data.  Out of \n\n\n\n500 subjects studied, 170 (34%) had at least 1 unintended discrepancy; the remaining 330 \n\n\n\nhad either intended discrepancy or no discrepancy.  A total of 206 unintended \n\n\n\ndiscrepancies were identified.  Overall rate of unintended discrepancies was 0.41 per \n\n\n\npatient.  Most discrepancies occurred at admission (130, 76.5%) compared to discharge \n\n\n\n(60, 35.3%).  The most common discrepancy at admission (44.7%) and discharge (20.6%) \n\n\n\nwas drug omission.  The most frequent medication class associated with discrepancies \n\n\n\nwas antihypertensive drugs (32.3%).  Majority of the discrepancies at admission (57.6%) \n\n\n\nand discharge (27.6%) were significant errors, while 9 (5.3%) patients experienced life-\n\n\n\nthreatening errors.  Unintended discrepancies at admission were 2 times higher than at \n\n\n\ndischarge.  Medication reconciliation by pharmacists may help to prevent unintended \n\n\n\ndiscrepancies. \n\n\n\n\n\n\n\n \nOPP8 (000038) \n\n\n\n\n\n\n\nCausality Assessment of Spontaneous Adverse Drug Reaction Reports: Comparison \n\n\n\nof the Results Obtained from Published Algorithms with WHO-UMC System \n\n\n\n\n\n\n\nL H Pang \n1\n, Z Aziz \n\n\n\n1\n, Shaik Abdul Rahman S \n\n\n\n2 \n \n\n\n\n1\n Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur \n\n\n\n2\n National Pharmaceutical Control Bureau, Ministry of Health, Kuala Lumpur \n\n\n\n\n\n\n\nA major issue in pharmacovigilance is that it is difficult to establish causal association \n\n\n\nbetween suspected drugs and the adverse drug reactions (ADRs). Causality assessment of \n\n\n\nADRs is important in order to provide early warning signals and evaluate risk-benefit \n\n\n\nratio of drugs. The aim of this study was to evaluate the agreement between causality \n\n\n\nassessments of ADRs obtained from two published algorithms with WHO-Uppsala \n\n\n\nMonitoring Centre (WHO-UMC) system. All ADR reports submitted between 2007 to \n\n\n\nAugust 2011 involving cardiovascular drugs were retrieved from the database of the \n\n\n\nMalaysian Adverse Drugs Reactions Advisory Committee (MADRAC). We selected at \n\n\n\nrandom ten percent (n = 506) of the total reports retrieved. Based on the information \n\n\n\nprovided in the ADR report form, we determined the causality assessment with two \n\n\n\npublished algorithms and compared with the WHO-UMC system. The degree of \n\n\n\nagreement between WHO-UMC system with both algorithms was poor (\uf06b = 0.181; p < \n\n\n\n0.001 for Naranjo and \uf06b oh & Li). Both algorithms presented \n\n\n\nhigh rates of sensitivity (99.6% for Naranjo and 91.3% for Koh & Li) but low rates of \n\n\n\nspecificity (both were 0%) due to poor quality reports. Our study highlights the need to \n\n\n\nimprove the quality and standard of reporting so that algorithms could be used to have \n\n\n\nmore objective causality assessments compared to the WHO-UMC system. \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 66 \n\n\n\n \nOPP9 (000043) \n\n\n\n\n\n\n\nThe Effect of Hibiscus sabdariffa on Blood Lipids: A Systematic Review \n\n\n\n\n\n\n\nS Y Wong, Z Aziz \n\n\n\nDepartment of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur \n\n\n\n\n\n\n\nHibiscus sabdariffa is claimed to be effective in lowering blood lipids, however the \n\n\n\nevidence of its effectiveness is still not clearly defined. The aim of this study was to \n\n\n\nevaluate the effect of Hibiscus sabdariffa on lipid profiles. Electronic databases including \n\n\n\nCochrane Central Register of Controlled Trials, MEDLINE, and publisher databases were \n\n\n\nsearched up to June 2012 for randomized controlled trials (RCTs) of Hibiscus sabdariffa \n\n\n\nfor dyslipidemia. Journal papers and conference proceedings were also searched. The risk \n\n\n\nof bias of included studies was assessed and statistical pooling of the results from similar \n\n\n\nstudies was undertaken. Four RCTs assessing effect of Hibiscus sabdariffa on \n\n\n\ndyslipidemia, involving 312 participants were considered eligible for inclusion. These \n\n\n\nstudies varied in terms of the doses of Hibiscus sabdariffa used, controls, and duration of \n\n\n\ntrials. Hibiscus sabdariffa did not produce any statistically significant reduction in total \n\n\n\ncholesterol levels [WMD 12.8; 95% CI -10.9736.57], triglyceride levels [WMD -4.35; \n\n\n\n95% CI -29.2620.56] or an increase in high density lipoprotein levels [WMD 0.59; 95% \n\n\n\nCI -2.533.71] when compared to its control. As pooled studies are of poor to moderate \n\n\n\nquality, firm conclusion cannot be made at present on the beneficial effects of Hibiscus \n\n\n\nsabdariffa on blood lipids. \n\n\n\n\n\n\n\n \nOPP10 (000045) \n\n\n\n\n\n\n\nEvaluation of Parents\u2019 Perception toward Antibiotics Prescribing for Treating Their \n\n\n\nChildren in Emergency Department, Hospital Kepala Batas \n\n\n\n\n\n\n\nC C Khoo \n1\n, S Md. Yusof \n\n\n\n1\n, M Saedon \n\n\n\n1\n, A A Ismet Amir \n\n\n\n1\n, C P Hor \n\n\n\n2\n \n\n\n\n1\n Department of Pharmacy, Hospital Kepala Batas, Pulau Pinang \n\n\n\n2 \nDepartment of Medicine, Hospital Kepala Batas, Pulau Pinang \n\n\n\n\n\n\n\nThe lack of knowledge and awareness on appropriate antibiotic usage may contribute to \n\n\n\nantibiotic over-prescription hence contributing towards antibiotic resistance. This study \n\n\n\naimed to evaluate parental beliefs and practices towards antibiotics prescription for their \n\n\n\nchildren. This cross-sectional study took place at the pharmacy unit and involved parents \n\n\n\nwho were collecting medication(s) for their out-patients children. A one-page \n\n\n\nquestionnaire was used.  Analysis was performed using SPSS Version 16.0. Majority of \n\n\n\nthe respondents were Malay (93.7%), followed by Chinese (2.6%) and Indian (2.6%). The \n\n\n\nmost common reasons for parents to bring their children to Emergency Department were \n\n\n\nfever, cough and flu. More parents with educational level up to secondary schooling and \n\n\n\nbelow (86.2%) significantly believed that antibiotics were free of side effects, compared \n\n\n\nto (those who attained tertiary education (13.8%) (c\n2\n=6.4, p=0.041). Parents who believed \n\n\n\nthat antibiotics can cure all infections were more likely to demand for antibiotics \n\n\n\nprescription to treat their children (c\n2\n=8.723, p=0.013) and more likely to comply with the \n\n\n\nantibiotics regimen for their children (c\n2\n=9.431, p=0.009). This study has shown that \n\n\n\nparental perception and attitude influence the antibiotic prescribing practice to some \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 67 \n\n\n\nextent. It is essential to raise awareness among parents to facilitate appropriate antibiotic \n\n\n\nprescribing practice. Such interventions include distribution of pamphlets and counselling \n\n\n\non rational antibiotic use by pharmacists during dispensing sessions. \n\n\n\n\n\n\n\n \nOPP11 (000057) \n\n\n\n\n\n\n\nHealth-related Quality of Life (HRQoL) Among Non-prescription Medicine \n\n\n\nCustomers in Malaysia \n\n\n\n\n\n\n\nA A Shafie,  M A Hassali, A H Mohd Yahaya \n\n\n\nDiscipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, \n\n\n\nUniversiti Sains Malaysia, Penang \n\n\n\n\n\n\n\nThis study was aimed to assess the health-related quality of life (HRQoL) among non-\n\n\n\nprescription medicine customers in Malaysia and the factors that affected it. A nationwide \n\n\n\ncross-sectional survey was conducted among pharmacy customers in 59 randomly \n\n\n\nselected community pharmacies in Malaysia. The self-administered questionnaire \n\n\n\nincludes the EuroQoL EQ-5D, the EQ-VAS, non-prescription medicines purchased and \n\n\n\nquestions related to demographics. Data were analyzed using the multivariate analysis of \n\n\n\nvariance and multiple logistic regression.  A total of 2729 customers enrolled in this study \n\n\n\nwith a mean EQ-5D score of 0.92 (SD = 0.15) and mean EQ-VAS score of 69.92 (SD = \n\n\n\n24.80). In comparison to Malaysian adult population, non-prescription medicines \n\n\n\ncustomers have lower mean EQ-5D score (t = -4.49, p < 0.01) and EQ-VAS score (t = -\n\n\n\n25.87, p < 0.01). We found that pain/discomfort (25.6%) and anxiety/depression (13.7%) \n\n\n\nwere the major HRQoL problems. Locality, age, ethnicity, household income per month, \n\n\n\ntype of occupation and type of non-prescription medicine purchased were associated with \n\n\n\nthe health status of non-prescription medicine customers [F(22, 5286) = 2.555, Wilks \n\n\n\nLambda = 0.979, p < 0.01]. In conclusion the HRQoL of non-prescription medicine \n\n\n\ncustomers is lower compared to general Malaysian population. The HRQoL is affected by \n\n\n\ntheir age, ethnicity, locality, types of occupation, household income and types of non-\n\n\n\nprescription medicine purchased. \n\n\n\n \nOPP12 (000062) \n\n\n\n\n\n\n\nHealth Screenings and Assessment of Social-economic Status among Aboriginal \n\n\n\nPeoples (Orang Asli) in Kampung Air Bah, Grik, State of Perak, Malaysia \n\n\n\n\n\n\n\nC P Chong, C F Kiew, M B Bahari \n\n\n\nDiscipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains \n\n\n\nMalaysia, Penang \n\n\n\n\n\n\n\nHealth screenings of Orang Asli population in remote areas provide insights on their \n\n\n\nquality of life as they are disadvantaged groups with limited accessibility to healthcare \n\n\n\nservices. A health campaign was conducted in Kampung Air Bah, Perak on 16th April \n\n\n\n2011 whereby screening tests and interviews for assessment of social-economic status \n\n\n\nwere performed in two different sessions. Of the 57 subjects screened in the first session, \n\n\n\nonly 12.3% were obese (BMI \u2265 27.5kg/m\n2\n) while 8.3% and 20.0% of male and female \n\n\n\nrespectively had high body fat percentage. The prevalence of diabetes mellitus (7.0%) and \n\n\n\nhypertension (12.3%) was low among the population. However, three subjects were found \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 68 \n\n\n\nto have high blood sugar which warranted for further diagnostic investigations. In the \n\n\n\nsecond session, 53.8% of the 13 subjects interviewed were uneducated. Majority (69.2%) \n\n\n\nof the subjects were working with an average monthly income of RM 550. Approximately \n\n\n\n31% of the subjects consumed less than 3 meals per day. Around 56% of them obtained \n\n\n\ntreatment from government clinics or hospitals when sick and their average monthly \n\n\n\nhealthcare expenditure was RM 55. Utilization of herbs as medicines were found to be \n\n\n\nhigh among the population and 84.6% of subjects thought that traditional medicines do \n\n\n\nnot pose harms. The subjects screened were generally in good health. However, their \n\n\n\neducations should be emphasized for a better future considering their current poor income \n\n\n\nand quality of life. Further research on the traditional medicines utilization among the \n\n\n\npopulation is warranted for better understanding of the impact on their health. \n\n\n\n\n\n\n\n \nOPP13 (000068) \n\n\n\n\n\n\n\nComparison Studies of Clinical Status Improvement and Weight Gain Among \n\n\n\nPremature Infants in Hospital Sultanah Bahiyah (HSB) Who Had Received \n\n\n\nSoybean-oil Based Emulsion and Fish-oil-enriched Emulsion in Total Parenteral \n\n\n\nNutrition (TPN) \n\n\n\n\n\n\n\nN A Ghani, P T Wan, P Subramaniam, P B Lim, S Shaharruddin \n\n\n\nDepartment of Pharmacy, Hospital Sultanah Bahiyah, Alor Setar, Kedah \n\n\n\n\n\n\n\nINTRODUCTION: Fat emulsions are one of the essential components of parenteral \n\n\n\nnutrition regime. Soybean-oil based emulsion is a conventional lipid emulsion based on \n\n\n\nsoybean oil only. Fish-oil-enriched emulsion is a newer formulation consisting of soybean \n\n\n\noil, medium chain triglycerides, olive oil and fish oil. Soybean-oil based emulsion has \n\n\n\nbeen totally replaced by fish-oil-enriched emulsion for neonates receiving TPN in \n\n\n\nneonatal intensive care unit (NICU), HSB in 2011. However, the clinical outcomes of \n\n\n\nneonates receiving TPN with either soybean-oil based emulsion or fish-oil-enriched \n\n\n\nemulsion, have not been assessed or compared before. OBJECTIVE: To examine and \n\n\n\ncompare the outcomes of neonates receiving TPN with either fish-oil-enriched emulsion \n\n\n\nor soybean-oil based emulsion in HSB. METHODS: This is a retrospective clinical study \n\n\n\nconducted in HSB. SMOFLIPID\n\u00ae\n 20% was used as fish-oil-enriched emulsion and \n\n\n\nINTRALIPID\n\u00ae\n 20% soybean-oil based emulsion. Data were traced from electronic-\n\n\n\nHospital Information Service (e-HIS) and patients\u201f clinical notes. The data collected were \n\n\n\nanalyzed descriptively using Microsoft\n\u00ae\n Excel, and statistically using SPSS 16.0. \n\n\n\nDifferences in baseline or changes in each variable (e.g. total bilirubin, AST, ALP, etc) \n\n\n\nwere analyzed using independent t-test and Mann-Whitney U test. Statistical significance \n\n\n\nwas set at p<0.05. RESULTS AND DISCUSSION: A total of 60 neonates were included \n\n\n\nin this study: 27 males and 33 females. Among them 21 weighed between 500 \u2013 1000g \n\n\n\nand 39 weighed between1000 \u2013 1500g. Indirect bilirubin (p=0.046) and ALP level \n\n\n\n(p=0.013) were found to significantly reduced after receiving fish oil-enriched emulsion \n\n\n\nas compared to soybean-oil based emulsion. The mean of TPN administration days for \n\n\n\nsoybean-oil based emulsion was 11 days whereas for fish-oil enriched emulsion, was 9 \n\n\n\ndays. There were no significant differences in clinical status improvement or weight gain \n\n\n\namong premature neonates in HSB who had received soybean-oil based emulsion or fish-\n\n\n\noil-enriched emulsion. CONCLUSION: Fish-oil-enriched emulsion was found to be \n\n\n\nbeneficial for neonates with high indirect bilirubin and ALP level compared with \n\n\n\nsoybean-oil based emulsion. \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 69 \n\n\n\n \nOPP14 (000071) \n\n\n\n\n\n\n\nCardiac and Behavioural Impact of Cardiac Rehabilitation Medication Therapy \n\n\n\nAdherence Clinic on Post-myocardial Infarction Patients \n\n\n\n\n\n\n\nN Jagan \n1\n, A Mhd Ali \n\n\n\n2\n, S Ahmad \n\n\n\n3\n, J Sinnadurai \n\n\n\n4\n, F Ariffin \n\n\n\n1\n \n\n\n\n1\n Department of Pharmacy, Hospital Kuala Lumpur, Kuala Lumpur \n\n\n\n2\n Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur \n\n\n\n3\n Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur \n\n\n\n4\n Department of Medicine, Hospital Kuala Lumpur, Kuala Lumpur \n\n\n\n\n\n\n\nCoronary heart disease that commonly manifests as myocardial infarction (MI) is the \n\n\n\nsingle largest but preventable cause of disability and premature death globally and in \n\n\n\nMalaysia. Cardiac Rehabilitation Medication Therapy Adherence Clinic (CR-MTAC) in \n\n\n\nHospital Kuala Lumpur is the first of its kind led by pharmacists to manage post-MI \n\n\n\npatients. CR-MTAC patients were assessed for medication adherence, counseled on non-\n\n\n\npharmacotherapy and pharmacotherapy approaches and given medication supply in the \n\n\n\nclinic itself. These services, however, were not given at Usual Care (UC). Drug related \n\n\n\nissues were also identified and solved along with drug information provision. This \n\n\n\nstudy is aimed to evaluate the clinical and behavioural impact of pharmacist-managed \n\n\n\nCardiac Rehabilitation MTAC on post-MI patients compared to UC. This cross-sectional, \n\n\n\nobservational study was conducted between January and April 2011. A total of 45 \n\n\n\npatients from CR-MTAC and 43 patients from UC were randomly selected and medical \n\n\n\nrecords were evaluated retrospectively for two years. Baseline patient characteristics were \n\n\n\nsimilar between both groups. CR-MTAC was associated with a significant mean \n\n\n\nreduction in low-density lipoprotein cholesterol (LDL-c) (-0.98 \u00b1 0.87mmol/L) and total \n\n\n\ncholesterol level (-1.04 \u00b1 1.04mmol/L) compared to UC (-0.32 \u00b1 0.73mmol/L and -0.14 \u00b1 \n\n\n\n0.84mmol/L, respectively) (p<0.01). CR-MTAC showed significant increment in \n\n\n\npercentages of patients achieving target lipid goals for all the lipid parameters while UC \n\n\n\nonly had significant improvement for LDL-c target goal and target lipid profile (p<0.05, \n\n\n\nwithin-group comparisons). Only six patients in each group achieved target lipid profile \n\n\n\n(all the target lipid goals). CR-MTAC and Usual Care patients who did not achieve the \n\n\n\nprimary LDL-c target goal had similar average doses of simvastatin equivalents, which \n\n\n\nimplied failure to achieve the target goal may be associated with medication non-\n\n\n\nadherence. CR-MTAC demonstrated a statistically significant higher percentage of \n\n\n\nadherent patients (Modified Morisky Scale (MMS): 86.7%, \u201eA Single Question\u201f (ASQ): \n\n\n\n95.6%) compared to UC (MMS: 41.9, ASQ: 53.5%) (p<0.01). Better medication \n\n\n\nadherence was associated with lower LDL-c levels and higher reductions (p<0.01). In \n\n\n\nconclusion, CR-MTAC showed statistically significant positive clinical and behavioural \n\n\n\nimpact on post-MI patients compared to UC. \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 70 \n\n\n\nPHARMACEUTICAL CHEMISTRY / PHARMACOLOGY / TRADITIONAL & \n\n\n\nCOMPLEMENTARY MEDICINE \n\n\n\n\n\n\n\n \nOPM1 (000008) \n\n\n\n\n\n\n\nFunctionalized Aurones as Inducers of NAD(P)H:Quinone Oxidoreductase 1 \n\n\n\n(NQO1) that Activate AhR-XRE and Nrf2-ARE Signalling Pathways: Synthesis, \n\n\n\nEvaluation and SAR \n\n\n\n\n\n\n\nC Y Lee \n1\n, E H Chew \n\n\n\n2\n, M L Go \n\n\n\n2\n \n\n\n\n1 \nSchool of Phamaceutical Sciences, Universiti Sains Malaysia, 11800 Penang, Malaysia \n\n\n\n2 \nDepartment of Pharmacy, National University of Singapore, 18 Science Drive 4, 117543 \n\n\n\nSingapore \n\n\n\n\n\n\n\nThe chemopreventive potential of functionalized aurones and related compounds as \n\n\n\ninducers of NAD(P)H:quinone oxidoreductase 1 (NQO1, EC 1.6.99.2) are described.   \n\n\n\nSeveral 4,6-dimethoxy and 5-hydroxyaurones induced NQO1 activity of Hepa1c1c7 cells \n\n\n\nby 2 fold at submicromolar concentrations, making these the most potent inducers to be \n\n\n\nidentified from this class.  Mechanistically, induction of NQO1 was mediated by the \n\n\n\nactivation of AhR/XRE and Nrf2/ARE pathways, indicating that aurones may be mixed \n\n\n\nactivators of NQO1 induction or agents capable of exploiting the proposed cross-talk \n\n\n\nbetween the AhR and Nrf2 gene batteries.  QSAR analysis by partial least squares \n\n\n\nprojection to latent structures (PLS) identified size parameters, in particular those \n\n\n\nassociated with non-polar surface areas, as an important determinant of induction activity.  \n\n\n\nThese were largely determined by the substitution on rings A and B. A stereoelectronic \n\n\n\nrole for the exocyclic double bond as reflected in the ELUMO term was also identified.  The \n\n\n\nelectrophilicity of the double bond or its effect on the conformation of the target \n\n\n\ncompound are possible key features for induction activity. These findings provide the \n\n\n\nlead for the future development of aurones as cancer chemopreventive agents. \n\n\n\n \nOPM2 (000032) \n\n\n\n\n\n\n\nSynthesis and Evaluation of Benzalacetophenone Derivatives in Inhibiting Human \n\n\n\nColorectal Cancer Proliferation through Peroxisome Proliferator-activated \n\n\n\nReceptor Gamma (PPARg) \n\n\n\n\n\n\n\nC W Mai \n1\n, Y Marzieh \n\n\n\n2\n, N A Rahman \n\n\n\n2\n, C O Leong \n\n\n\n3\n, Y B Kang \n\n\n\n1\n, M R Pichika \n\n\n\n1\n \n\n\n\n1\n Department of Pharmaceutical Chemistry. School of Pharmacy. International Medical \n\n\n\nUniversity, Kuala Lumpur \n2\n Drug Design and Development Research Group, Department of Chemistry, University \n\n\n\nof Malaya, Kuala Lumpur \n3\n Department of Life Science. School of Pharmacy, International Medical University, \n\n\n\nKuala Lumpur \n\n\n\n\n\n\n\nSeveral lead compounds which suppress cancer proliferation through peroxisome \n\n\n\nproliferator-activated reactor gamma (PPARg) were previously identified. A series of 46 \n\n\n\nbenzalacetophenone derivatives, containing various electron withdrawing and/or donating \n\n\n\nfunctional groups on aromatic rings were synthesised and evaluated for their activity on \n\n\n\nhuman colon cancer (HT-29) cell lines. We found that 25 of the 46 synthesised \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 71 \n\n\n\ncompounds had IC50 less than 100 \u00b5M. Structure-activity relationship studies revealed \n\n\n\nthat the presence of electron withdrawing groups on either of the aromatic rings or both \n\n\n\nincreased the potency of these compounds. In silico molecular docking also supported \n\n\n\nthis finding and  indicated that benzalacetophenone derivatives to interact with the \n\n\n\nPPARg ligand-binding domain. PPARg knockdown studies confirmed the PPARg \n\n\n\nactivity of benzalacetophenone derivatives. Therefore, our findings suggest that the \n\n\n\ncolorectal cancer antiproliferative effects of benzalacetophenones are to be mediated \n\n\n\nthrough activation of PPARg. \n\n\n\n\n\n\n\n \nOPM3 (000082) \n\n\n\n\n\n\n\nDevelopment of A New Two-Tier Method for Drug Pre-Screening Analysis; A \n\n\n\nSpectral Database Study \n\n\n\n\n\n\n\nM M Said \n1\n, S Gibbons \n\n\n\n2\n, A C Moffat \n\n\n\n2\n, M Z Loh \n\n\n\n2\n \n\n\n\n1 \nFaculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, \n\n\n\n50300 Kuala Lumpur, Malaysia \n2\n UCL School of Pharmacy, 29-39 Brunswick Square, London WC1N 1AX, UK \n\n\n\n\n\n\n\nThis research was initiated as part of the fight against the public health problems of rising \n\n\n\ncounterfeit, substandard, and poor quality medicines and herbal products. A simple, quick \n\n\n\nand cost-effective drug screening procedure using incremental near infra-red (NIR) \n\n\n\nspectral database of common medicines in combination with principal component \n\n\n\nanalysis (PCA) was developed to facilitate drug analysis without depending on standard \n\n\n\ncompounds or products from manufacturers. The novelty of the approach is demonstrated \n\n\n\nby this two-tier method which allowed applications in product identification, drug quality \n\n\n\nstudy, herbal analysis, and the detection of counterfeit and adulterated medicines. The \n\n\n\nNIR spectra database consisted of almost 4000 spectra from 15 types of medicines and 3 \n\n\n\ntypes of herbal preparations, acquired and stored in the database throughout the study. \n\n\n\nThe optimization works on the database produced a search strategy using correlation and \n\n\n\nfirst derivative correlation algorithms on the full spectrum. The cut-off points of the hit \n\n\n\nquality index (HQI) were determined to classify the unknown sample in four categories; \n\n\n\nsimilar batch/ match (Type 1, <0.0001), same brand/different batch (Type 2, <0.01), same \n\n\n\ntype of medicine/ different brand (Type 3, <0.1) and different type of medicines (Type 4, \n\n\n\n>0.2). This method was proven successful when challenged firstly using simple \n\n\n\ncompound drugs followed by complex mixtures of herbal preparations and then using \n\n\n\nalleged counterfeit and adulterated samples. This method has allowed samples to be \n\n\n\nidentified without known background information which was difficult to do using other \n\n\n\nNIR qualitative techniques that required reference products for comparison. \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 72 \n\n\n\n \nOPM4 (000030) \n\n\n\n\n\n\n\nPharmacodynamic Interaction Potential of Glimepiride with Ginger in Type 2 \n\n\n\nDiabetic Rats \n\n\n\n\n\n\n\nP Mittal \n1,2\n\n\n\n, V Juyal \n3\n \n\n\n\n1 \nDepartment of Pharmacy Practice, School of Pharmacy, International Medical \n\n\n\nUniversity, 57000 Kuala Lumpur, Malaysia \n2 \n\n\n\nDepartment of Pharmaceutical Sciences, Kumaun University, Bhimtal, Nainital, \n\n\n\nUttarakhand, 263136, India \n3 \n\n\n\nUttarakhand Technical University, Dehradun, Uttarakhand, 248007, India \n\n\n\n\n\n\n\nCertain foods, dietary supplements and specific nutrients in food stuff, if ingested \n\n\n\nconcurrently with some drugs, may affect the overall pharmacodynamics, \n\n\n\npharmacokinetics and therapeutic efficacy of the medications. These effects may lead to \n\n\n\ntreatment failure or severe adverse effects. Therefore, it is important to evaluate the \n\n\n\neffects of individual food on drug efficiencies to avoid harmful effects. The present study \n\n\n\nwas aimed to evaluate pharmacodynamic interaction potential of glimepiride with ginger \n\n\n\n(Zingiber officinale). Type 2 diabetes mellitus was induced in overnight fasted Wistar rats \n\n\n\nby streptozotocin and nicotinamide. Six groups of rats viz. group 1 (normal control), \n\n\n\ngroup 2 (diabetic control), group 3 (standard) and group 4, group 5, group 6 (groups \n\n\n\nhaving standard drug glimepiride with aqueous extract of ginger i.e. 125 mg/kg, 250 \n\n\n\nmg/kg and 500 mg/kg body weight, respectively) were employed in study and each group \n\n\n\ncontains seven animals. The blood glucose, cholesterol, triglycerides and HDL levels \n\n\n\nwere estimated from 1st to 28th day, demonstrated significant reduction in such \n\n\n\nbiochemical parameters and showed hypoglycaemic and anti-hyperlipidaemic potential \n\n\n\nwith co-administration of glimepiride and ginger at a dose of 250 mg/kg and 500 mg/kg \n\n\n\nbody as compared to glimepiride alone (p<0.05).  As in this study; use of glimepiride \n\n\n\nwith ginger treatment not only resulted in glycaemic control but also provide beneficial \n\n\n\nhypolipidaemic effects in diabetic rats. This study revealed that a drug interaction may \n\n\n\nalso provide some beneficial effects. \n\n\n\n\n\n\n\n \nOPM5 (000055) \n\n\n\n\n\n\n\nA Systematic Approach to Evaluate the Receptor Profiles of a Novel Opioid Ligand \n\n\n\nwith a Mixed Agonist/Antagonist Activity Using a Vas Deferens Assay \n\n\n\n\n\n\n\nI E Ridzwan \n1\n, S M Husbands \n\n\n\n2\n, C P Bailey \n\n\n\n2\n \n\n\n\n1 \nKulliyyah of Pharmacy, International Islamic University Malaysia (IIUM), Kuantan, \n\n\n\nPahang, Malaysia \n2 \n\n\n\nDepartment of Pharmacy and Pharmacology, University of Bath, United Kingdom \n\n\n\n\n\n\n\nBefore the discovery of the cell-cultured based assays, the isolated tissues have been \n\n\n\nwidely used to evaluate the pharmacological activities of the opioid-related drugs at the \n\n\n\ndifferent types of opioid receptors. Despite providing a more physiological environment, \n\n\n\nthe isolated tissues assay also can be used to study the pharmacodynamics of drug-\n\n\n\nreceptor interaction such as drug reversibility. The aim of this study is to explain the \n\n\n\nsystematic methods of evaluating the pharmacological profiles of a novel opioid ligand \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 73 \n\n\n\n(with a mixed agonist/antagonist activities) and also to discuss the strategies of \n\n\n\noptimizing the experimental techniques using the isolated tissues. In this project, we had \n\n\n\nsuccessfully characterized few ligands using different assay systems ([\n35\n\n\n\nS]GTP\u03b3S, \n\n\n\nreceptor binding assay and isolated tissues) at different types of opioid receptors (\u03bc-, \u03ba- \n\n\n\nand NOP). Using the vas deferens tissues (rat vas deferens (\u03bc- and NOP) and mouse vas \n\n\n\ndeferens (\u03ba-), few ligands have been further evaluated to measure their binding affinities \n\n\n\n(KB) and potencies (pA2) at each individual opioid receptors. These parameters were \n\n\n\ncalculated using Schild analysis and Schild equation. While the binding affinities of the \n\n\n\nligands are comparable (< 30 fold difference), none of the ligands shows efficacy in the \n\n\n\nvas deferens compared to the [\n35\n\n\n\nS]GTP\u03b3S assay (eg: BU10136, partial agonist \n\n\n\n([\n35\n\n\n\nS]GTP\u03b3S, \u03bc-), antagonist (rat vas deferens, \u03bc-). From our experiments, we have \n\n\n\nconcluded that the isolated tissues assay is a good alternative to measure the receptor \n\n\n\nbinding affinities of a mixed agonist/antagonist opioid besides giving additional \n\n\n\ninformation about the drug behaviours at the receptor levels. \n\n\n\n\n\n\n\n \nOPM6 (000118) \n\n\n\n\n\n\n\nGastroprotective Effect of Dictamnine Against Ethanol Induced Stomach Ulceration \n\n\n\n\n\n\n\nM A S Heyam \n1\n, N M Hashim \n\n\n\n1\n, S Mohan \n\n\n\n1\n, A H A Hadi \n\n\n\n2\n, M A Abdulla \n\n\n\n3\n, P \n\n\n\nHassandarvish \n3\n, S I Abdelwahab \n\n\n\n4\n, M M E Taha \n\n\n\n4\n, M Rahmani \n\n\n\n5\n \n\n\n\n1\n Department of Pharmacy, Faculty of Medicine, University of Malaya, 50603 Kuala \n\n\n\nLumpur \n2 \n\n\n\nDepartment of\n \nChemistry, Faculty of Medicine, University of Malaya, 50603 Kuala \n\n\n\nLumpur \n3 \n\n\n\nDepartment of Molecular Medicine, Faculty of Medicine, University of Malaya, 50603 \n\n\n\nKuala Lumpur \n4 \n\n\n\nMedical Research Centre, Jazan University, P.O. Box 114 Jazan, Saudi Arabia \n5 \n\n\n\nDepartment of Chemistry, University Putra Malaysia, Serdang, Selangor, Malaysia \n\n\n\n\n\n\n\nDictamnine (DC) is a naturally occurring furoquinoline alkaloid which was isolated from \n\n\n\nleaves of Melicope latifolia T.G Hartley (Rutaceae). In the present study we have \n\n\n\nevaluated the antiulcer property of dictamnine (DC) against ethanol induced gastric ulcers \n\n\n\nin animal model by gross microscopic lesions and histological evaluation were taken in \n\n\n\nconsideration. Experimental groups were orally pre-treated with two different doses of \n\n\n\nDC in 5% Tween 80 solution. Ulcer control groups were pre-treated with vehicle solution \n\n\n\nand reference group was orally pre-treated with 20 mg/kg Omeprazole. After 30 min, all \n\n\n\ngroups received absolute ethanol to generate gastric mucosal injury. After an additional \n\n\n\n30 min, all rats were sacrificed and ulcer areas of gastric wall were determined. \n\n\n\nHistological studies of gastric wall of ulcer control group revealed severe damage of \n\n\n\ngastric mucosa, along with edema and leucocyte infiltration of sub-mucosal layer \n\n\n\ncompared to rats pre-treated with either omeprazole or DC. Serum levels of creatinine and \n\n\n\nliver enzymes aspartate (AST) and alanine transaminases (ALT), in the rats exposed to \n\n\n\nethanol induced ulceration have been altered. Administration of DC modulates the acute \n\n\n\nalterations of AST, ALT and creatinine level. The level of gastroprotection of DC 5mg/kg \n\n\n\nand 10mg/kg doses was 88.13% and 56.35%, respectively. This finding suggests that DC \n\n\n\npromotes ulcer protection as ascertained by the comparative decreases in ulcer areas, \n\n\n\nreduction of edema and leucocyte infiltration of the sub mucosal layer. \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 74 \n\n\n\n \nOPM7 (000136) \n\n\n\n\n\n\n\nEffect of Treatment Duration of Morinda citrifolia Fruit Juice on Blood Coagulation \n\n\n\nand Liver Functions in the Rat \n\n\n\n\n\n\n\nP N Yeoh \n1\n, A Ramadas \n\n\n\n1\n, A Tay \n\n\n\n2\n, J W Mak \n\n\n\n2\n, V Ramachandran \n\n\n\n2\n \n\n\n\n1\n School of Pharmacy, International Medical University, Kuala Lumpur \n\n\n\n2\n School of Medical Sciences, International Medical University, Kuala Lumpur \n\n\n\n\n\n\n\nMorinda citrifolia , noni or mengkudu have traditionally been used as a herbal remedy for \n\n\n\nmany conditions and is believed to have extensive therapeutic properties, including an \n\n\n\nanticoagulant effect. We have found the fruit juice from a commercial source (McC) to \n\n\n\nprolong the coagulation profile of human volunteers when ingested for 6 weeks with \n\n\n\ntransient effect on liver enzymes. Studies reported by others on liver toxicity were \n\n\n\ninconclusive. The objective of this study was to determine the treatment duration of McC \n\n\n\non the blood coagulation and liver functions in the rat. Nine groups of 6 rats each were \n\n\n\norally fed daily, either saline or the McC (0.5mL/kg or 1mL/kg) for 7, 14 or 21 days. \n\n\n\nBlood coagulation was assessed with clotting time (CT), thrombin time (TT), \n\n\n\nprothrombin time (PT) and activated partial thromboplastin time (aPTT). Liver function \n\n\n\nwas assessed by serum aspartate transaminase, alanine transaminase and gamma-glutamyl \n\n\n\ntransferase and liver histology. Means + SEM were compared between groups using \n\n\n\nANOVA and T test. The results show a prolongation of clotting time, TT, PT and aPTT \n\n\n\nsignificant difference in coagulation time between study groups and control. No \n\n\n\nsignificant change in the levels of liver enzymes or liver histology was noted. Treatment \n\n\n\nwith McC (0.5mL/kg) in rats seemed to optimally affect blood coagulation. The findings \n\n\n\nshowed that McC affects coagulation profile in the rat at the doses studied without \n\n\n\ncausing any toxicity on the liver. \n\n\n\n\n\n\n\n \nOPM8 (000039) \n\n\n\n\n\n\n\nThe Anti-Cholinergic and Anti-Adrenergic Effects of Radix saussurea on the \n\n\n\nContraction of the Rat Ileal Smooth Muscle and Frog Cardiac Muscle \n\n\n\n\n\n\n\nR Sugunan\n1\n, H Y Tee \n\n\n\n2\n \n\n\n\n1 \nSchool of Science, Monash University Sunway Campus, Selangor \n\n\n\n2 \nFaculty of Medicine, SEGi Univeristy, Selangor \n\n\n\n\n\n\n\nRadix saussurea is a medicinal herb that is widely used in traditional chinese medicine to \n\n\n\ntreat a variety of gastrointestinal problems. Several in vitro and in vivo pharmacological \n\n\n\nstudies have demonstrated that the herb has significant antagonistic activity on various \n\n\n\nmuscle types. Due to the multiple biological activity of the herb, it therefore has immense \n\n\n\npotential to be developed into a potential therapeutic agent. This study investigates the \n\n\n\nanti-cholinergic and anti-adrenergic effects of Radix saussurea on the ileal smooth \n\n\n\nmuscle of the rat and the cardiac muscle of the frog heart. This provides some insight to \n\n\n\nthe antagonistic effects of the herb and explain its use in traditional medicinal system to \n\n\n\ntreat a variety of illnesses. Isolated tissue preparations were used to observe any \n\n\n\nsignificant antagonistic effects of the crude extract of Radix saussurea on smooth muscle \n\n\n\nand cardiac muscle. The contractions of the tissue preparations were measured using a \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 75 \n\n\n\nforce transducer and the readings obtained were recorded with a PowerLab program. \n\n\n\nANOVA was performed on all the data to establish the significance of the results. In both \n\n\n\nthe isolated rat ileum and frog heart preparations, the Radix saussurea extracts \n\n\n\ndemonstrated significant antagonism on the action of acetylcholine and adrenaline on the \n\n\n\nrat ileal smooth muscle and frog cardiac muscle. The ANOVA test confirmed that the \n\n\n\ncrude extract produced significant antagonism on the acetylcholine and adrenaline \n\n\n\ninduced effects of the smooth muscle and cardiac muscle. The crude extract demonstrated \n\n\n\neither a competitive-reversible or a non-competitive type of antagonism on the rat ileal \n\n\n\nsmooth muscle and frog cardiac muscle. As the exact type of antagonism could not be \n\n\n\nconfirmed in this study, further research is required to establish this relationship. \n\n\n\n\n\n\n\n \nOPM9 (000116) \n\n\n\n\n\n\n\nGastroprotective Study of Mucuna pruriens on Experimentally Induced Gastric \n\n\n\nHemorrhagic Mucosal Lesions in Rats \n\n\n\n\n\n\n\nS Golbabapour \n1\n, M Hajrezaie \n\n\n\n1\n, P Hassandarvish \n\n\n\n1\n, A H Hadi \n\n\n\n2\n, N Majid \n\n\n\n3\n, M A \n\n\n\nAbdulla \n1\n \n\n\n\n1 \nDepartment of Molecular Medicine, Faculty of Medicine, University of Malaya, 50603 \n\n\n\nKuala Lumpur \n2 \n\n\n\nDepartment of Chemistry, University of Malaya, 50603 Kuala Lumpur \n3 \n\n\n\nInstitute of Biological Sciences, Faculty of Science, University of Malaya, 50603 Kuala \n\n\n\nLumpur \n\n\n\n\n\n\n\nMucuna pruriens is a traditional medicinal plant. The investigation was carried out to \n\n\n\nevaluate the  gastroprotective effects of ethanolic extract of M. pruriens leaves against \n\n\n\nethanol induced gastric mucosal injuries in rats. Rats were divided into 8 groups. The \n\n\n\nnegative control and the ulcer control groups were orally administered with \n\n\n\ncarboxymethylcellulose (CMC). The extract control groups received 500 mg/kg of the \n\n\n\nextract. The reference group was orally administered with 20 mg/kg of omeprazole. The \n\n\n\nexperimental groups received 62.5, 125, 250 and 500mg/kg of the extract by oral \n\n\n\nadministration, respectively. After 1 h, CMC was given to the negative control and the \n\n\n\nextract control groups, orally. The other groups received absolute ethanol. Rats were \n\n\n\nsacrificed after 1h. The gastric wall mucus, ulcer areas and histology and \n\n\n\nimmunohistochemistry of the gastric wall were assessed. Prostaglandin E2 (PGE2), \n\n\n\nsuperoxide dismutase (SOD) and malondialdehyde (MDA) content also were measured. \n\n\n\nThe ulcer control group exhibited significant mucosal injuries with decreased gastric wall \n\n\n\nmucus and severe damage to the gastric mucosa compared with the experimental groups. \n\n\n\nThe extract causes upregulation of Hsp70 protein, down-regulation of Bax protein and \n\n\n\nintense periodic acid schiff (PAS) uptake of glandular portion of stomach. A significant \n\n\n\nincrease in antioxidant defence enzymes (PGE2 and SOD) in the gastric mucosal \n\n\n\nhomogenate was observed, while MDA was significantly decreased. The acute toxicity \n\n\n\ntest did not showed any signs of toxicity or mortality. The results suggest that plant \n\n\n\nextract affords protection against ethanol-induced hemorrhagic mucosal lesions and \n\n\n\nsuggested the applicability as a gastroprotective agent. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 76 \n\n\n\n \nOPM10 (000129) \n\n\n\n\n\n\n\nExtraction, Phytochemical Screening and Hypoglycemic Effects of Aquilaria \n\n\n\nmalaccensis (Gaharu) Leaves \n\n\n\n\n\n\n\nB Y K Chung \n1\n, K K Peh \n\n\n\n1\n, L H Cheng \n\n\n\n2\n \n\n\n\n1 \nSchool of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang \n\n\n\n2\n School of Industrial Technology, Universiti Sains Malaysia, Penang \n\n\n\n\n\n\n\nThe objective of this study was to perform preliminary screening to identify the \n\n\n\nphytochemical groups in Aquilaria malaccensis (Gaharu) leaves and also to investigate its \n\n\n\nhypgoglycemic effects on rats.  The leaves were extracted with water in maceration at \n\n\n\n60\no\nC. Different fractions were administered to rats to investigate the hypoglycemic effect \n\n\n\nby Intra-Peritoneal Glucose Tolerance Test (IPGTT). Preliminary phytochemical \n\n\n\nscreening carried out on the aqueous and ethanolic extracts of A. malaccensis leaves \n\n\n\nconfirmed the presence of tannin, glycoside, saponin, alkaloid, anthraquinone, terpenoid \n\n\n\nand flavonoid. The proximate analysis showed a moisture content of 9.83% implied that \n\n\n\nthe plant can be stored for longer period with lower chances of microbial attack or \n\n\n\ngrowth. The water soluble extractive value of 44.72% was higher than the alcohol soluble \n\n\n\nextractive value of 23.66%. The total ash value of 8.79% implied that the plant had low \n\n\n\ninorganic components probably as salts or complexes and a high organic component. \n\n\n\nWater-soluble ash content was 8.93%. The low acid-insoluble ash of 1.01% suggested \n\n\n\nthat a large portion of the ash content is acid soluble and hence may be physiologically \n\n\n\nimportant as salts in the body when consumed. It is also indicative of high digestibility of \n\n\n\nthe plant when eaten. The extracts exhibited glucose lowering effects which are \n\n\n\ncomparable to Metformin and Glibenclamide at 30 and 45 minutes after intra-peritoneal \n\n\n\ninjection of glucose. The results showed that A. malaccensis leaves might possess \n\n\n\nmedicinal and therapeutic value.  \n\n\n\n\n\n\n\n \nOPM11 (000114) \n\n\n\n\n\n\n\nInvestigation of the In Vitro Antioxidant Activities and In Vivo Acute Toxicity of \n\n\n\nEthanol Extract of Vitex pubescens \n\n\n\n\n\n\n\nN S AL-Wajeeh, M A Abdulla, S M Noor \n\n\n\nDepartment of Molecular Medicine, Faculty of Medicine, University of Malaya, Kuala \n\n\n\nLumpur \n\n\n\n\n\n\n\nThe traditional medicinal plant Vitex pubescens (V. pubescens) was evaluated for \n\n\n\nantioxidants properties. The ethanol extract of plant leaves was used in determination of \n\n\n\nferric-reducing /antioxidant power (FRAP),  the 2,2-diphenyl-1-picrylhydrazyl (DPPH) \n\n\n\nradical-scavenging assays, the total phenolic content (TPC), total flavonoid content \n\n\n\n(TFC). The results exhibited antioxidant activities. In this study, the acute toxicity of V. \n\n\n\npubescens was investigated in vivo. Both sexes of Sprague Dawley (SD) rats were \n\n\n\nadministered with high and low doses. The crude extract did not produce toxic symptoms \n\n\n\nin rats. \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 77 \n\n\n\n \nOPM12 (000122) \n\n\n\n\n\n\n\nAnimal Study of Schiff Base Derived Copper (II) Complex in Acute Gastric Lesions \n\n\n\n\n\n\n\nM Hajrezaie \n1\n, S Golbabapour \n\n\n\n1\n, P Hassandarvish \n\n\n\n1\n, N S Gwaram \n\n\n\n2\n, A H Hadi \n\n\n\n2\n, H \n\n\n\nMohd Ali \n2\n, S I Abdelwahab \n\n\n\n3\n, N Abdul Majid \n\n\n\n4\n, M A Abdulla \n\n\n\n1\n \n\n\n\n1 \nDepartment of Molecular Medicine, Faculty of Medicine, University of Malaya, 50603 \n\n\n\nKuala Lumpur \n2 \n\n\n\nDepartment of Chemistry, University of Malaya, 50603 Kuala Lumpur \n3 \n\n\n\nDepartment of Pharmacy, University of Malaya, 50603 Kuala Lumpur \n4 \n\n\n\nInstitute of Biological Science, Faculty of Science, University of Malaya, 50603 Kuala \n\n\n\nLumpur \n\n\n\n\n\n\n\nCopper is an essential element in various metabolisms. The investigation was carried out \n\n\n\nto evaluate acute gastroprotective effects of the Copper (II) complex against ethanol-\n\n\n\ninduced superficial hemorrhagic mucosal lesions in rats. Rats were divided into 7 groups. \n\n\n\nGroup 1 and 2 were orally administered with Tween 20. Group 3 was orally administered \n\n\n\nwith 20 mg/kg omeprazole. Groups 4-7 received 10, 20, 40 and 80 mg/kg of the Copper \n\n\n\n(II) complex, respectively. Tween 20 was given orally to group 1 and absolute ethanol \n\n\n\nwas given orally to groups 2-7, respectively. Rats were sacrificed after 1 h. Group 2 \n\n\n\nexhibited severe superficial hemorrhagic mucosal lesions. Gastric wall mucus was \n\n\n\nsignificantly preserved by the pre-treatment complex. The results had showed that \n\n\n\nsignificant increase in glutathione (GSH), superoxide dismutase (SOD), nitric oxide (NO) \n\n\n\nand Prostaglandin E2 (PGE2) activities and decrease in malondialdehyde (MDA) level. \n\n\n\nHistology showed marked reduction of hemorrhagic mucosal lesions in groups 4-7. \n\n\n\nImmunohistochemical staining showed up-regulation of Hsp70 and down-regulation of \n\n\n\nBax proteins. PAS staining of groups 4-7 showed intense stain uptake of gastric mucosa. \n\n\n\nThe gastroprotective effect of the Copper (II) complex may possibly be due to \n\n\n\npreservation of gastric wall mucus, increase in PGE2 synthesis, GSH, NO and SOD up-\n\n\n\nregulation of Hsp70 protein, decrease in MDA level and down-regulation of Bax protein. \n\n\n\n\n\n\n\n \nOPM13 (000124) \n\n\n\n\n\n\n\nEvaluation of Chemopreventive Effects of Andrographis paniculata on \n\n\n\nAzoxymethane-Induced Colorectal Cancer in Rats \n\n\n\n\n\n\n\nN Al-Henhena, A A Mahmood, Y Rozaida \n\n\n\nDepartment of Molecular Medicine, Faculty of Medicine, University of Malaya, Kuala \n\n\n\nLumpur \n\n\n\n\n\n\n\nCancers of colon and rectum are among the most common cancers in Malaysia. About \n\n\n\n3600 new cases are diagnosed every year. Andrographis paniculata is a grass leaves used \n\n\n\nin traditional Malaysian medicine. It has a broad range of pharmacological use. Aim of \n\n\n\nthe study was to evaluate the antiproliferative activity of the crude extract of \n\n\n\nAndrographis paniculata on azoxymethane (AOM) induced colon cancer in rats. Male \n\n\n\nSprague Dawley rats were divided into 5 equal number groups. Two groups were orally \n\n\n\nadministrated of leaf crude extract by different doses of received colon-specific \n\n\n\ncarcinogen, azoxymethane (AOM). Another three groups are induced non treated, \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 78 \n\n\n\nfluorouracil treated, and none induced non treated groups . After sacrificing, colons were \n\n\n\nexamined for lesion, aberrant crypt foci (ACF). Andrographis paniculata significantly \n\n\n\nreduced the numbers of ACF and aberrant crypts. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nPHARMACEUTICAL TECHNOLOGY \n\n\n\n\n\n\n\n \nOPT1 (000002) \n\n\n\n\n\n\n\nEffect of Polymers on Buccoadhesive Compacts of Enalapril Maleate \n\n\n\n\n\n\n\nG S Shantha Kumar \n1\n, R Narayanacharyulu \n\n\n\n2\n, G Divaka \n\n\n\n1\n, K Roopa \n\n\n\n1\n \n\n\n\n1\n Department of Pharmaceutics, Acharya & B.M. Reddy College of Pharmacy, \n\n\n\nSoldevanahalli, Chikkabanavara(Post), Bangalore-560090, Karnataka, India \n2\n Department of Pharmaceutics, NGSM institute of Pharmaceutical sciences, Paneer, \n\n\n\nMangalore-575018, Karnataka, India \n\n\n\n\n\n\n\nThe buccal route has long been advocated as a possible route of delivery of drugs having \n\n\n\npoor oral bioavailability because of high first pass metabolism or degradation in the \n\n\n\ngastrointestinal tract. The purpose of this research is to develop and evaluate \n\n\n\nbuccacoadhesive compacts (BC\u201fs) of Enalapril maleate using Carbopol 934P and \n\n\n\ndifferent viscosity grades of HPMC. The effects of polymer types, proportion and \n\n\n\ncombination were studied based on the drug release rate, release mechanism and \n\n\n\nmucoadhesive strength of the prepared formulations. BC\u201fs were made by direct \n\n\n\ncompression and characterized for physical parameters, ex vivo residence, stability studies \n\n\n\nin human saliva and mechanism of release. Relative antihypertensive activity and in vivo \n\n\n\nmucoadhesion studies of the optimized formulation were evaluated in rabbits. Results of \n\n\n\nthe physical characteristics were found within limits. Drug release, mucoadhesive \n\n\n\nstrength and swelling index were found to be dependent upon polymer types, proportion \n\n\n\nand viscosity. The formulations prepared using HPMC100KM showed maximum \n\n\n\nmucoadhesion. The release mechanism of most formulations was found to be of \n\n\n\nanomalous non-Fickian type. In vivo antihypertensive studies of the selected formulation \n\n\n\nin rabbits demonstrated significant reduction in hypertension. In vivo mucoadhesion \n\n\n\nstudies showed that the designed tablets adhered well to the buccal mucosa for more than \n\n\n\n8 hours without causing any discomfort. The stability studies revealed that there is no \n\n\n\nsignificant decrease in the drug content of Formulation 2 (F2). It may be concluded that \n\n\n\nthe designed buccoadhesive controlled release tablets have the potential to overcome the \n\n\n\ndisadvantage of poor and erratic oral bioavailability. \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 79 \n\n\n\n \nOPT2 (000011) \n\n\n\n\n\n\n\nAcetazolamide loaded Dendrimer based Nano-Architectures for Effective Glaucoma \n\n\n\nManagement \n\n\n\n\n\n\n\nV Mishra, N K Jain \n\n\n\nPhamaceutics Research Laboratory, Department of Pharmaceutical Sciences, Dr. H. S. \n\n\n\nGour Central University, Sagar (M.P.), India \n\n\n\n\n\n\n\nGlaucoma is becoming an increasingly important cause of blindness. The challenging \n\n\n\nobjective for pharmaceutical formulators is to develop topically effective ocular delivery \n\n\n\nsystem with improved ocular drug retention and reduced systemic side effects. The \n\n\n\npresent  investigation  was  aimed  to  formulate  and  evaluate  the  potential  of  poly \n\n\n\n(propylene imine) (PPI) dendrimers as nano-carriers for ocular delivery of acetazolamide \n\n\n\n(ACZ) in the treatment of glaucoma. PPI dendrimers were synthesized by divergent \n\n\n\napproach taking ethylenediamine as dendrimer core. The prepared plain and drug loaded \n\n\n\ndendrimers were characterized by different parameters such as TEM, SEM, NMR and \n\n\n\nFT-IR spectroscopy. Entrapment efficiency, in vitro drug release kinetics, effect of drug-\n\n\n\ndendrimer system on surface morphology of RBCs and hemolytic toxicity were also \n\n\n\ndetermined. In vivo studies included the determination of ocular irritation index, ocular \n\n\n\nresidence time and intra-ocular pressure (IOP) reduction profile. In vivo study revealed \n\n\n\nthat in lower concentrations the aqueous solutions of formulations were weakly irritant to \n\n\n\nthe eye. The sustained and prolonged reduction in IOP is probably due to the slow, as \n\n\n\nwell as controlled release of drug from formulations. This shows that drug entrapped in \n\n\n\ndendrimers can be used for higher retention in ocular cul-de sac. The PPI dendrimer \n\n\n\nbased formulation seems to be promising candidate to develop as ophthalmic vehicle with \n\n\n\nprolonged ocular drug residence time and IOP lowering effect in treatment of glaucoma, \n\n\n\nmore safely, both in vitro and in vivo. \n\n\n\n\n\n\n\n \nOPT3 (000021) \n\n\n\n\n\n\n\nDissolution Enhancement of Ursodeoxycholic Acid (UDCA) by Complexation with \n\n\n\nGlucosyl-\u03b2-Cyclodextrin-Choline Dichloride Coprecipitate \n\n\n\n\n\n\n\nK Dua, A Gorajana \n\n\n\nDepartment of Pharmaceutical Technology, School of Pharmacy, International Medical \n\n\n\nUniversity, 57000 Kuala Lumpur \n\n\n\n\n\n\n\nThe objective of the present investigation is to study the in vitro dissolution effects of \n\n\n\ncholine dichloride (CDC) co-precipitation of glucosyl-\u03b2-cyclodextrin (G1-\u03b2-CD) \n\n\n\nmolecular inclusion complexed ursodeoxycholic acid (UDCA). The molecular inclusion \n\n\n\ncomplexes of UDCA with Gl-\u03b2-CD co-precipitated with CDC were prepared using \n\n\n\ndifferent methods. Physicochemical characterization and in vitro dissolution of pure drug, \n\n\n\nphysical mixtures and inclusion complexes were carried out. Phase solubility studies of \n\n\n\nUDCA-Gl-\u03b2-CD systems in water at 25 \u00b0C exhibited typical AL \u2013type solubility curve. \n\n\n\nLow values of standard deviation in drug content of cyclodextrin inclusion complexes \n\n\n\nindicated uniform drug distribution. The average particle size of the Gl-\u03b2-CD complexes \n\n\n\nwas found to be within the range of 56.2 \u00b5m to 77.5 \u00b5m. The scanning electron \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 80 \n\n\n\nmicroscopy revealed the appearance of binary systems as agglomerates, exhibiting the \n\n\n\namorphous nature of the multi-component systems. FT-IR spectroscopy and DSC studies \n\n\n\nindicated no interaction between UDCA and Gl-\u03b2-CD-CDC. Molecular inclusion \n\n\n\ncomplexes of ursodeoxycholic acid with co-precipitated Gl-\u03b2-CD showed considerable \n\n\n\nincrease in the dissolution rate in comparison with physical mixture and pure drug in \n\n\n\n0.1N HCl, pH 1.2 and phosphate buffer, pH 7.4. Dissolution enhancement was attributed \n\n\n\nto the formation of water soluble inclusion complexes with the precipitated form of Gl-\u03b2-\n\n\n\nCD. The in vitro release from all the formulations was best described by first order \n\n\n\nkinetics followed by Higuchi release model. In conclusion, due to the dual phenomenon \n\n\n\nof co-precipitation and formation of stable molecular inclusion complex of UDCA with \n\n\n\nGl-\u03b2-CD in the presence of CDC, the dissolution profile was enhanced significantly, \n\n\n\nwhich in turn have potential to produce a faster onset of action and assists in dose \n\n\n\nreduction.  \n\n\n\n\n\n\n\n \nOPT4 (000037) \n\n\n\n\n\n\n\nSynthesis of Chitosan Nanoparticles Conjugated with TAT-Peptide as a New \n\n\n\nPotential Delivery System for siRNA \n\n\n\n\n\n\n\nH Katas, N N Shamiha N Dzulkefli, S Sahudin \n\n\n\nCentre for Drug Delivery Research, Faculty of Pharmacy, Universiti Kebangsaan \n\n\n\nMalaysia, 50300 Kuala Lumpur \n\n\n\n\n\n\n\nChitosan nanoparticles (CN) have shown to protect siRNA from enzymatic degradation.  \n\n\n\nSuccessful delivery of siRNA into cells however is hampered by its low cellular uptake. \n\n\n\nIn this study, Tat-peptide (Tat) was conjugated to CN as Tat has the ability to penetrate \n\n\n\ncell membrane. CN was prepared using the ionic gelation method. CN was then \n\n\n\nconjugated with Tat (CN-Tat) via disulfide linkage by adding N-succinimidyl 3-(2-\n\n\n\npiridyldithio) propionate (SPDP) and a reducing agent, dithiothreitol (DTT). CN was \n\n\n\nconjugated with Tat at various Tat to CN weight ratios, from 0.008:1 to 0.125:1. Particle \n\n\n\nsize of the resultant CN-Tat was less than 756 \u00b176 nm with surface charge varied from \n\n\n\n+0.3 \u00b1 2 to +1.7 \u00b1 0.2 mV, depending on the Tat to CN weight ratio. HPLC and Raman \n\n\n\nanalysis showed that Tat was successfully conjugated onto CN via disulfide linkage as the \n\n\n\npeak for S-S bond appeared at 545.52 cm\n-1\n\n\n\n. siRNA entrapment efficiency of CN-Tat was \n\n\n\n85% and siRNA was strongly bound to CN-Tat as determined by UV-spectrometer and \n\n\n\ngel electrophoresis, respectively. CN-Tat was relatively non-toxic to living cells with \n\n\n\npercent of V79 cell viability of more than 90%. The gene silencing study on GAPDH \n\n\n\nshowed higher knockdown of the targeted gene by the siRNA-CN-Tat compared to \n\n\n\nsiRNA-CN. Hence, CN-Tat has great potential as a safe and efficient carrier into cells for \n\n\n\nsiRNA and possibly RNAi-based therapeutic agents. \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 81 \n\n\n\n \nOPT5 (000080) \n\n\n\n\n\n\n\nDevelopment of Transdermal Patches for the Effective Delivery of Antihypertensive \n\n\n\nAgent \n\n\n\n\n\n\n\nA Khan, A J Sunilson, Q B Hassan, R A Rahman \n\n\n\nSchool of Pharmacy, KPJ University College, Kota Seriemas, 71800 Nilai, Negeri \n\n\n\nSembilan \n\n\n\n\n\n\n\nThe aim of the present study was to develop transdermal patches of Carvedilol, a non-\n\n\n\nselective beta blocker used in the treatment of arterial hypertension, ischemic heart \n\n\n\ndisease and heart failure with an improved permeation by incorporating natural \n\n\n\npermeation enhancers. Patches of Carvedilol were prepared with different ratios of \n\n\n\nEudragit RL 100 (ERL) and Eudragit RS 100 (ERS) using eucalyptus oil and rice bran oil \n\n\n\nas permeation enhancers by employing solvent casting technique. Patches were prepared \n\n\n\nwith and without (control) incorporating permeation enhancers and all the prepared \n\n\n\npatches were evaluated for their physico-chemical characteristics like morphology, \n\n\n\nthickness, weight variation, folding endurance, drug content and water vapor transmission \n\n\n\n(WVT)  studies. The DSC and IR results suggested that the drug and polymers are \n\n\n\ncompatible. The prepared patches were found to be smooth, flexible and transparent. The \n\n\n\nweight and drug content of all the patches (n=17 \u00b1 0.225) were found uniform. SEM \n\n\n\nstudies indicated the uniform distribution of drug in the patches and WVT through \n\n\n\npatches followed zero order kinetics. Ex vivo drug permeation study was carried out \n\n\n\nthrough rat abdominal skin using Keshary-Chein diffusion cell in phosphate buffer of pH \n\n\n\n7.4 for 24 h and analyzed for the concentration of drug using U.V. spectrophotometer at \n\n\n\n241 nm. The various permeation parameters such as flux, permeability co-efficient and \n\n\n\nenhancement ratio were determined. Among the two permeation enhancers studied, \n\n\n\neucalyptus oil showed the greater enhancement ratio. Patches containing eucalyptus oil \n\n\n\n(FE1), showed maximum flux as well as more drug release, than the other formulations. It \n\n\n\nwas observed that 90.52 % of drug was released at the end of 24 h and flux was \n\n\n\n3.941\u00d7103 mg/cm\n2\n/h.  Similarly, patches containing rise bran oil (FR1) exhibited flux \n\n\n\nvalue of 3.316\u00d7103 mg/cm\n2\n/h. and drug release (82.51%) at the end of 24 h. The \n\n\n\nformulations FE1 and FR1 showed promising results and the non-allergic nature of the \n\n\n\npatches were confirmed by skin irritation test on rats. The rate of drug release \n\n\n\ncorresponded best to first order kinetics (0.9760 to 0.9942) and mechanism of drug \n\n\n\nrelease was non\u2013Fickian diffusion controlled and followed super case II mechanism. The \n\n\n\npatches developed in this study could be viable alternative for effective delivery of \n\n\n\nCarvedilol.  \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 82 \n\n\n\n \nOPT6 (000097) \n\n\n\n\n\n\n\nPublic Awareness Towards Pharmaceutical Good Manufacturing Practice in \n\n\n\nMalaysia \n\n\n\n\n\n\n\nA Abdellah, M I Noordin  \n\n\n\nDepartment of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur \n\n\n\n\n\n\n\nGood Manufacturing Practice (GMP) in Pharmaceuticals is a concept to ascertain quality, \n\n\n\nsafety and efficacy of manufactured drugs. This study was aimed to know the awareness \n\n\n\namong Malaysian public towards Pharmaceutical GMP. A public survey questionnaire \n\n\n\nwas prepared by Likert scale method, study was conducted in Kuala Lumpur, Penang and \n\n\n\nKota Baru upon Faculty ethical committee approval. Respondents of 20 to 60 years old \n\n\n\nwith the education background from secondary school to university level, as well as \n\n\n\nuneducated were selected randomly. The data obtained was analyzed using SPSS \n\n\n\nstatistical software version 16. About 544 respondents participated in the study. The \n\n\n\nresults showed that only 23 % of the sample population had an idea about Pharmaceutical \n\n\n\nGMP and 65 % were aware of the existence of the regulatory body called the National \n\n\n\nPharmaceutical Control Bureau. Pertaining to the quality matters, only 7 % understand \n\n\n\nthe information on the medicine package, 94 % checks the expiry date, and 70 % ignored \n\n\n\nthe problems related to the use of medicines in the country. The results also showed that a \n\n\n\nlarge number (94 %) of respondents kept medicines at home, 23 % kept medicines for \n\n\n\nmore than six months and 29 % did not read the recommended storage conditions. \n\n\n\nStatistically P value (0.014) and Cross tab results indicated that the higher the \n\n\n\nqualification the greater the GMP awareness. The finding in this study suggests a lack of \n\n\n\nawareness among public is mainly due to poor information about medicine handling. \n\n\n\nThere is a need to balance and sustain the demand and supply to reduce stockpiling of \n\n\n\nmedicines at home.  \n\n\n\n\n\n\n\n \nOPT7 (000098) \n\n\n\n\n\n\n\nInvestigation of In-vitro Bioadhesive Properties of Natural Gums \n\n\n\n\n\n\n\nN H Khan, Y Darwis, K K Peh \n\n\n\nSchool of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Minden, Penang \n\n\n\n\n\n\n\nThe objective of this study was to investigate the in-vitro bioadhesive properties of \n\n\n\nnatural gums, namely Konjac Gum 32H, Konjac Gum 40H, Tara Gum, Xanthan Gum, \n\n\n\nand their combinations. In-vitro bioadhesive strength and work of adhesion were \n\n\n\ninvestigated using Texture analyser by employing two different biological membranes, \n\n\n\ncow intestine and chicken pouch. Flat tablets of 10 mm diameter were prepared, by direct \n\n\n\ncompression method using pure gums and their combination in ratios mentioned below. \n\n\n\nSeven different time points (1, 2, 3, 5, 7, 9 and 11 min.) were employed to study the \n\n\n\nimpact of contact time on bioadhesive strength.  Different gums produced significantly \n\n\n\ndifferent bioadhesion strength in the order of Xanthan Gum > Konjac Gum 40H > Konjac \n\n\n\nGum 40H+Xanthan Gum (1:1) > Konjac Gum 32H+Xanthan Gum (1:1) > Konjac Gum \n\n\n\n40H+Xanthan Gum+Tara Gum (1:1:1) > Konjac Gum 32H+Xanthan Gum+Tara Gum \n\n\n\n(1:1:1) > Konjac Gum 32H > Xanthan Gum+Tara Gum (1:1) > Konjac Gum 40H+Tara \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 83 \n\n\n\nGum (1:1) > Konjac Gum 32H+Tara Gum (1:1) > Tara Gum. It was observed that the \n\n\n\nbioadhesion strength was enhanced when the contact time was increased in chronological \n\n\n\norder of 1 < 2 < 3 < 5 < 7 < 9 < 11 min., and the results obtained are statistically \n\n\n\nsignificant (p < 0.05) when analyzed using ANOVA.  It was concluded that different \n\n\n\nnatural polymers, their combination produced different bioadhesion strength and the two \n\n\n\ngums, Xanthan and Konjac 40H can be used in bioadhesive drug delivery. There was no \n\n\n\nsignificant difference between the bioadhesive values of two membranes used in the \n\n\n\nstudy.  \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 84 \n\n\n\nPOSTER PRESENTATIONS \n\n\n\n\n\n\n\nCLINICAL PHARMACY \n\n\n\n\n\n\n\n \nPCP1 (000003) \n\n\n\n\n\n\n\nUtilization of Beta Blockers Post-myocardial Infarction \n\n\n\n\n\n\n\nW M Ong \n1\n, R Reena \n\n\n\n1\n, C Z Sulaiman \n\n\n\n2\n, W A Wan Ahmad \n\n\n\n3 \n\n\n\n1\n Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur \n\n\n\n2\n Pharmacy Unit, University Malaya Medical Centre (UMMC), Kuala Lumpur \n\n\n\n3\n Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur \n\n\n\n\n\n\n\nBeta blockers have been widely studied in post-myocardial infarction (MI) patients. Beta \n\n\n\nblockers provide both morbidity and mortality benefits for these patients. Despite this, \n\n\n\nmany studies have highlighted that beta blockers are still often underused or used at \n\n\n\nsuboptimal dosages. This was a retrospective observational study conducted between \n\n\n\n2005-2006 with the objectives of estimating the proportion of post-MI patients who were \n\n\n\nreceiving beta-blocker therapy in University Malaya Medical Centre (UMMC), assessing \n\n\n\nthe number of post-MI patients receiving beta blockers at optimal dosages and \n\n\n\ndetermining the factors associated with beta-blocker prescribing in post-MI patients. 315 \n\n\n\ncase notes of post-MI patients were reviewed. Majority of them were male, Malay and \u2264 \n\n\n\n65 years old. 77.5% of patients were prescribed beta blockers by the end of the 12-months \n\n\n\nstudy period. However, dosages were optimized in only 39.3% of patients. Reasons for \n\n\n\nnot increasing the dosages within the study period were typically not due to the presence \n\n\n\nof contraindications to beta blockers. Elderly (> 65 years old), ejection fraction (EF) < \n\n\n\n40%, a history of cerebrovascular accident (CVA) or mild asthma, use of calcium channel \n\n\n\nblocker (CCB), digoxin or anti-asthmatic agents were all significantly associated with a \n\n\n\nreduced rate of beta-blocker prescribing post-MI. In conclusion, overall utilization of \n\n\n\nbeta-blocker therapy post-MI in UMMC patients was satisfactory. However, more effort \n\n\n\nshould be placed in improving its use in specific patient populations. Initiatives to \n\n\n\noptimize the dosage of beta blockers to recommended dosages that matched those in \n\n\n\nclinical trials with proven mortality benefits will also need to be intensified. \n\n\n\n\n\n\n\n \nPCP2 (000005) \n\n\n\n\n\n\n\nA Study of the Effect of Administration of Parenteral Nutrition on Body Weights of \n\n\n\nPremature Infants in Kuala Lumpur Hospital \n\n\n\n\n\n\n\nM H Hairul, L T Ng, L L Christine Lau, M Hafiz \nDepartment of Pharmacy, Kuala Lumpur Hospital, Kuala Lumpur \n\n\n\n\n\n\n\nImpaired growth in premature infants such as low body weight and immature immune \n\n\n\nsystem, can increase their vulnerability to infectious diseases and their need for ventilator \n\n\n\nsupport. With parenteral nutrition (PN) supplementation, premature infants show a greater \n\n\n\nweight gain. The objectives of this study are to measure the changes in body weight of \n\n\n\npremature infants after receiving parenteral nutrition support, and to assess the impact of \n\n\n\namino acid and calories intake on weight gain of premature infants. A prospective study \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 85 \n\n\n\ndesign with convenience sampling was conducted in Special-Care Nursery (SCN) ward in \n\n\n\nKuala Lumpur Hospital from December 2010 to April 2011. Forty six preterm infants \n\n\n\n(gestational age <37 weeks) were included in the study. The weights of these subjects \n\n\n\nbefore starting PN, on Day 1 and Day 7 of PN administration, as well as calorie intake \n\n\n\nand protein intake on Day 1 and Day 7 of PN were computed. Data were analysed \n\n\n\nstatistically using Friedman ANOVA, Wilcoxon Signed Rank test and Spearman\u201fs test, \n\n\n\nwhere appropriate, with p<0.05 indicating statistical significance. The mean weight \n\n\n\nbefore starting PN was 1.13 \u00b1 0.38 kg at postnatal age of 4.22 \u00b1 4.70 days of life. The \n\n\n\nbody weight is significantly increased by PN support (Day 1 = 0.98 \u00b1 0.29 kg, Day 7 = \n\n\n\n1.02 \u00b1 0.30 kg; p=0.001). There is no significant correlation between protein intake and \n\n\n\nweight gain (Protein intake on Day 1 versus weight gain on Day 7, r = -0.101; p=0.523). \n\n\n\nIn addition, there is no significant correlation between calorie intake and weight gain \n\n\n\n(Calorie intake on Day 1 versus weight gain on Day 7, r = 0.200; p=0.204). This study \n\n\n\ndoes not resemble other studies due to only a small sample size. This study shows that \n\n\n\nparenteral nutrition supplementation will increase the body weight of premature infants. \n\n\n\n\n\n\n\n \nPCP3 (000007) \n\n\n\n\n\n\n\nAntibiotic Usage in Surgical Prophylaxis: A Prospective Surveillance at Surgical \n\n\n\nWards of Sarawak General Hospital \n\n\n\n\n\n\n\nA L Oh \n1\n, L M Goh \n\n\n\n1\n, N A Nik Azim \n\n\n\n2\n, C S Tee \n\n\n\n2\n, C W S Phung \n\n\n\n2\n  \n\n\n\n1 \nDepartment of Pharmacy, Sarawak General Hospital, Kuching, Sarawak \n\n\n\n2 \nDepartment of Surgical, Sarawak General Hospital, Kuching, Sarawak \n\n\n\n\n\n\n\nThe widespread and inappropriate use of broad spectrum antibiotics in surgical \n\n\n\nprophylaxis has led to reduced treatment efficacy, increased healthcare cost and antibiotic \n\n\n\nresistance. This study was conducted with the aim to improve the quality of antibiotic \n\n\n\nusage and to study the adherence to the national antibiotic guideline on surgical \n\n\n\nprophylaxis. A three-month prospective observational study was conducted in the surgical \n\n\n\nwards of Sarawak General Hospital (SGH) from 1st July till 30th September 2011. Data \n\n\n\ncollection was facilitated using a standardised surveillance form. Each patient was \n\n\n\nreviewed for up to 30 days post-operatively to determine the occurrence of surgical site \n\n\n\ninfection (SSI). A total of 87 cases were included within the study period. Nearly 60% of \n\n\n\nthe present cohort were females with the mean age of 54.2 (SD=14.7). The majority of \n\n\n\ncases were clean-contaminated wounds (60.9%) namely hepatobiliary cases (37.9%) \n\n\n\nfollowed by colorectal cases (19.5%). The most frequently used antibiotic was \n\n\n\nCefoperazone (63.2%). The choices of antibiotics in 78.2% of the cases were consistent \n\n\n\nwith the guidelines. Around 80% of prophylactic antibiotics were given within 1 hour \n\n\n\nbefore operation and 77% were discontinued within 24 hours post-operatively. Of those \n\n\n\nwho received continued therapy for >24 hours, the majority (60%) were for unknown \n\n\n\nreasons. SSI was documented in 13.8% of the total cases studied. However, there was no \n\n\n\nsignificant association between timing of surgical prophylaxis with incidence of SSI \n\n\n\n(X\n2\n=3.628, p=0.258). Areas of non-concordance to the guidelines require further \n\n\n\nexploration to ensure appropriate use of antibiotics in surgical prophylaxis. \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 86 \n\n\n\n \nPCP4 (000014) \n\n\n\n\n\n\n\nCharacteristics, Risk and Outcome of Neonates Prescribed with Empiric Antibiotic \n\n\n\nTherapy in the Prevention of Early Onset Sepsis in Hospital Pulau Pinang \n\n\n\n\n\n\n\nN A Ibrahim, M M Manan, N A Aziz \n\n\n\nDepartment of Pharmacy Practice, Faculty of Pharmacy, Universiti Teknologi MARA, \n\n\n\nPuncak Alam, Selangor \n\n\n\n\n\n\n\nObjectives: To describe the characteristics and outcome of neonates treated with empiric \n\n\n\nantibiotic for suspected early onset sepsis (EOS). Methods: This was a cross-sectional \n\n\n\nstudy conducted in Hospital Pulau Pinang. Records of neonatal patients admitted within \n\n\n\n72 hours of life and prescribed with empirical antibiotic therapy for suspected EOS were \n\n\n\nreviewed. Results/Discussion: 302 cases met the inclusion criteria. Cases were divided \n\n\n\ninto gestational age (premature= <36 weeks; term= \u226537 weeks) and birth weight (Low \n\n\n\nbirth weight (LBW), <2.5 kg; normal body weight (NBW), \u22652.5 kg) groups. Premature \n\n\n\n(n=162) and LBW (n=149) neonates had significantly higher incidence of prolonged \n\n\n\nrupture of membrane (>18 hours) and required higher antibiotic therapy during \n\n\n\npregnancy, perinatal steroid, surfactant and longer hospital stay (p=0.001). More than \n\n\n\n86% of premature and LBW neonates were diagnosed with respiratory distress syndrome, \n\n\n\ncongenital pneumonia and presumed sepsis. Term (n=138) and NBW (n=153) neonates \n\n\n\nhad significantly higher incidence of meconium stained amniotic fluid and perinatal \n\n\n\nasphyxia which was associated with a higher manifestation of seizures (p=0.001) and \n\n\n\nhigher diagnosis of meconium aspirate syndrome. The incidence of confirmed EOS was \n\n\n\n2.98%. C-penicillin plus gentamicin regimen was the standard therapy prescribed in all \n\n\n\ngroups and started within 24 hours of life with a median treatment duration of 3 days. \n\n\n\n80% of term and 78% of NBW neonates were discharged well while 61% of premature \n\n\n\nand 64% of LBW neonates required referrals. Conclusions: Both gestational age and \n\n\n\nbirth weight groups presented mainly with respiratory symptoms. The standard empiric \n\n\n\nantibiotic regimen prescribed was effective to treat EOS. \n\n\n\n \nPCP5 (000042) \n\n\n\n\n\n\n\nEvaluation of Drug Treatment in Patients with Status Epilepticus \n\n\n\n\n\n\n\nN A N Ismail \n1\n, A F A Rahman \n\n\n\n2\n \n\n\n\n1\n Department of Pharmacy, Hospital Raja Perempuan Zainab II, Kota Bharu, Kelantan \n\n\n\n2\n Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains \n\n\n\nMalaysia, Kota Bharu, Kelantan \n\n\n\n\n\n\n\nDespite significant improvements in the diagnosis and treatment of status epilepticus (SE) \n\n\n\nover the past years, it is still associated with a significant morbidity and mortality. The \n\n\n\nobjectives of this study were to evaluate trends of drug treatment for SE in Hospital \n\n\n\nUniversiti Sains Malaysia (HUSM), to determine outcome associated with SE and to \n\n\n\nevaluate drug related-complications during treatment. A retrospective review of medical \n\n\n\nrecords of all patients who were admitted in HUSM between January 2007 and December \n\n\n\n2011 was done whereby 85 patients with 123 cases of SE are included in this study. There \n\n\n\nwere 64.4% of children and 73.1% of adult have no previous history of SE. Diazepam, \n\n\n\nphenytoin, phenobarbitone and midazolam were the drugs that commonly used for SE in \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 87 \n\n\n\nHUSM. The use of newer antiepileptic drugs (AEDs) like valproic acid, levetiracetam and \n\n\n\npropofol were minimal. The most common group of AED used was combination of \n\n\n\ndiazepam and phenytoin. About 36% of SE episodes were successfully treated with drugs \n\n\n\nfrom first-line treatment. In 32% episodes of SE, first-line of treatment was already given \n\n\n\nat other health facilities. The odd of children having SE aborted using first-line of \n\n\n\ntreatment is 0.677 times less than those of adult. There were 19 cases of ADR reported \n\n\n\nduring this study. The highest was sedation which was associated with the use of \n\n\n\ndiazepam. The risk of children getting ADR was 35.3% less than adult group. As \n\n\n\nconclusion, even without significant differences, the chances of children having SE \n\n\n\naborted with first-line of drug treatment and the risk of them getting ADR was less than \n\n\n\nadult. \n\n\n\n\n\n\n\n \nPCP6 (000063) \n\n\n\n\n\n\n\nA One Day Community Health Screening Conducted at SRJK(T) Sungai Pinang, \n\n\n\nState of Penang, Malaysia \n\n\n\n\n\n\n\nC F Kiew, C P Chong \n\n\n\nDiscipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains \n\n\n\nMalaysia, Penang \n\n\n\n\n\n\n\nNon-communicable diseases are raising much concern in Malaysia owing to changing \n\n\n\nlifestyles parallel to economic development. This can be intervened by community health \n\n\n\nscreening (CHS) which allows early detections, preventions and reductions of chronic \n\n\n\ndiseases and its risk factors. A one day health screening was conducted in April 2012 at \n\n\n\nSRJK(T) Jalan Sungai Pinang, Penang. A convenient sample of the general public was \n\n\n\nrecruited for screening tests such as body mass index, body fat percentage, blood \n\n\n\ncholesterol and blood pressure. Out of 76 participants recruited, 54.5% and 48.2% of \n\n\n\nmale and female, respectively were obese (BMI > 27.5 kg/m\n2\n). Body fat percentage was \n\n\n\nhigh in 71.4% and 67.3%, respectively of male and female. High visceral fat \n\n\n\naccumulation (\u2265 15) was found in 22% of the participants. Around 8% of the participants \n\n\n\nhad high cholesterol levels (> 6.5 mmol/L), in which 3 of them were newly discovered \n\n\n\nhypercholesterolemia cases from the present screening. The prevalence of diabetes \n\n\n\nmellitus (40.4 %) and hypertension (42.1%) was high among our participants. \n\n\n\nInformation and counselling given by the trained healthcare providers during the health \n\n\n\nscreening helps the public to take necessary measures to reduce risk factors while \n\n\n\npreventing complication resulting from these chronic diseases. Furthermore, referrals to \n\n\n\nhealthcare institutions can be recommended for those with high risks and clinical \n\n\n\nmanifestation of such illnesses. In conclusion, CHS is an important health promotion \n\n\n\napproaches which benefits the general public while reducing national health cost burden. \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 88 \n\n\n\n \nPCP7 (000064) \n\n\n\n\n\n\n\nStudy on Liver Enzymes among Surgical Patients Receiving Parenteral Nutrition: A \n\n\n\nPilot Study \n\n\n\n\n\n\n\nIlina Azrin J, Mohd Haz Hairul A, Noridayu T, Nur Wahida Z, Tikfu Gee \n\n\n\nDepartment of Nutrition Support Team, Kuala Lumpur Hospital, Kuala Lumpur \n\n\n\n\n\n\n\nLipid is indicated as a source of calories and essential fatty acids for patient requiring \n\n\n\nparenteral nutrition (PN). Source of fat in parenteral lipid emulsions is one of the \n\n\n\ncontributors in developing hepatobiliary complications. The objectives of this research \n\n\n\nare to monitor liver enzyme in patient on PN and to compare liver enzymes alanine \n\n\n\ntransaminase (ALT) and alkaline phosphatase (ALP) among patient receiving different \n\n\n\nlipid in PN postsurgery; long chain triglycerides (LCT) and lipid enriched with fish oil. A \n\n\n\nprospective study design with convenience sampling was conducted in surgical ward \n\n\n\nHospital Kuala Lumpur from January 2012 until June 2012. Eight postsurgical patients \n\n\n\nreceiving PN after surgery were included in the study. The level of liver enzymes ALT \n\n\n\nand ALP before starting PN (Day 0), on Day 2, Day 9 and Day 12 were computed. Data \n\n\n\nwas analysed statistically using T-test, with p<0.05 indicating statistical significance. The \n\n\n\nmean age and body weight are 62+/-7.51 years old and 55+/-13.20 kg for lipid enriched \n\n\n\nwith fish oil, and 56+/-8.94 years old and 54+/-12.33 kg for LCT. Base line ALT and \n\n\n\nALP for lipid enriched with fish oil are 7.00+/-2.65 mmol/l and 77.67+/-41.77 mmol/l \n\n\n\nrespectively. Meanwhile for LCT base line ALT and ALP are 18.60+/-9.40 mmol/l and \n\n\n\n91.60+/-37.25 mmol/l respectively. The level of ALT is significantly difference on Day \n\n\n\n12 between lipid enriched with fish oil (39.33+/-8.62 mmol/l) and LCT (9.50+/-2.12 \n\n\n\nmmol/l) with p<0.05. There was significant difference for ALT (Day 0: 7.00+/-2.65 \n\n\n\nmmol/l, Day 12: 39.33+/-8.62 mmol/l) and ALP (Day 0: 77.67+/-41.77 mmol/l, Day 12: \n\n\n\n228.67+/-65.62 mmol/l) in lipid enriched with fish oil group on Day 0 and Day 12 with \n\n\n\np<0.05. This study showed that parenteral nutrition with different lipids will derange the \n\n\n\nlevel of liver enzymes (ALT and ALP) in postsurgical patient. \n\n\n\n\n\n\n\n \nPCP8 (000065) \n\n\n\n\n\n\n\nA Study on Pharmaceutical Interventions in Medical Wards, Kuala Lumpur \n\n\n\nHospital \n\n\n\n\n\n\n\nHadijah M T, Rosmaliah A, Fateha K, Nurkhodrulnada M L, Pang M S, Wan \n\n\n\nNazuha W R, Vun P, Nurul Ashikin J, Lim L, Chew C Z, Nur Wahida Z, Fauziah I, \n\n\n\nAinun I \n\n\n\nDepartment of Pharmacy, Hospital Kuala Lumpur, Kuala Lumpur \n\n\n\n\n\n\n\nIn the clinical setting whereby a number of medications are prescribed to treat serious \n\n\n\nconditions, pharmacists play an important role by doing pharmaceutical interventions \n\n\n\nsuch as monitoring and identifying drug related problems. Thus, the aim of this study is to \n\n\n\nanalyse clinical pharmacist interventions and evaluate their benefits at Kuala Lumpur \n\n\n\nHospital. The objectives of this study are to determine the common types of accepted \n\n\n\ninterventions done by clinical pharmacists, then to identify the common drug class \n\n\n\ninvolved subsequently to evaluate the clinical significance of the interventions based on \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 89 \n\n\n\nseverity of outcome. From 2nd to 21st April 2012, 127 accepted interventions were \n\n\n\nrandomly collected in retrospective manner from three female medical wards. However, \n\n\n\nonly 67 interventions with complete data were analysed. The interventions were then \n\n\n\nevaluated by two independent reviewers to determine the significance of each \n\n\n\nintervention based on the severity of outcome. From this study, the type of intervention \n\n\n\nthat has the highest frequency is inappropriate dose/frequency (43%) followed by \n\n\n\ninappropriate drug (38.8%). One-third of the interventions done involved the use of \n\n\n\nantibiotics. While 15.9% of the interventions are related to nutrition and blood system \n\n\n\nfollowed by cardiovascular system (13.0%). With moderate agreement (Kappa = 0.41) \n\n\n\nbetween the two reviewers, 57 out of 67 interventions done by clinical pharmacists has \n\n\n\nclinical significance whereby 50.7% has major/moderate possible clinical outcome. From \n\n\n\nthis study, although clinical pharmacists did not necessarily save lives, they did bring \n\n\n\nabout change, which directly improved the quality of patient care. \n\n\n\n\n\n\n\n \nPCP9 (000081) \n\n\n\n\n\n\n\nEvaluation of Knowledge, Practice and Adherence to Asthma Guidelines among \n\n\n\nGeneral Practitioners (GPs) and Community Pharmacists (CPs) in the State of \n\n\n\nPenang, Malaysia \n\n\n\n\n\n\n\nA A Mohammed, B Ibrahim, M B Bahari, M A Hassali \n\n\n\nSchool of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang \n\n\n\n\n\n\n\nBackground: Asthma worldwide is under-diagnosed and under-treated, creating a burden \n\n\n\nto individuals and families. Adhering to evidence-based guidelines, in diagnosis and \n\n\n\nmedical intervention, may raise the asthma control to optimal levels. The objective of this \n\n\n\nstudy was to assess and compare the knowledge, practice and adherence of general \n\n\n\npractitioners (GPs) and community pharmacists (CPs) in Penang, Malaysia to asthma \n\n\n\nmanagement guidelines. Methods: A survey research, through cross-sectional, \n\n\n\ndescriptive study using a validated self- administered questionnaire consisting of 30 \n\n\n\nquestions, divided into 3 categories covering the main aspects of asthma knowledge, \n\n\n\nclinical practice and guidelines adherence. The questionnaires, with a self-addressed \n\n\n\nstamped envelope for return, were mailed to 236 CPs and 300 GPs. Out of 536 \n\n\n\nquestionnaires sent, 60 respondents (28 CPs and 32 GPs) completed the questionnaire. \n\n\n\nResults: There was no significant difference in knowledge (p=0.933) between the CPs \n\n\n\nand GPs (mean correct answers= 65.9% and 67.2% respectively). The percentages of \n\n\n\ncorrect answers of both groups to recent guidelines-derived questions were: 11% CPs and \n\n\n\n9% for asthma classification, and 48% CPs and 44% GPs for guideline-based treatment. \n\n\n\nIn terms of practice, the GPs had better management strategies than CPs as indicated by \n\n\n\ntheir choice of answers as \u201ealways\u201f or \u201every often\u201f to practice based on guidelines. A \n\n\n\nsignificantly higher number of GPs (71.9%) mentioned they follow guidelines compared \n\n\n\nto CPs (46.4%). Conclusion: Overall, the knowledge on asthma was moderately above \n\n\n\naverage for both GPs and CPs. The results demonstrated that though most participants \n\n\n\nclaimed they adhere to guidelines, but their knowledge was still lacking on most recent \n\n\n\nasthma guidelines. \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 90 \n\n\n\n \nPCP10 (000086) \n\n\n\n\n\n\n\nAssessment of Blood Sampling Time of Gentamicin from Patients at Tertiary Care \n\n\n\nHospital \n\n\n\n\n\n\n\nM A Nawab Khan, M Manan, S Shaharuddin, N E Ismail, R A Abdul Manaf \n\n\n\nClinical Pharmaceutics Research Group (CPRG) & Inhalational Delivery Research Unit \n\n\n\n(IDRU), Faculty of Pharmacy, Universiti Teknologi MARA (UiTM), Puncak Alam \n\n\n\nCampus, 42300 Bandar Puncak Alam, Selangor \n\n\n\n\n\n\n\nGentamicin is an aminoglycoside antibiotic used to treat many types of infections, \n\n\n\nespecially those caused by Gram-negative bacteria. Monitoring blood levels of \n\n\n\ngentamicin are important because it has a narrow therapeutic index. A retrospective study \n\n\n\nwas conducted from January 2011 until July 2011 at HTAR, a tertiary care hospital to \n\n\n\nassess appropriateness of gentamicin use and monitoring. There were 30 patients who \n\n\n\nfulfilled the inclusion criteria. The majority of patients were aged between 18 \u2013 65 years \n\n\n\nold, 23 males (77%) and 25 Malays (83%). The mean weight and creatinine clearance \n\n\n\nwas 67.47 kg and 154.31 ml/min, respectively. Pneumonia was the highest indication for \n\n\n\ngentamicin use, 6 (20%); while sepsis was the lowest, 1 (3%). Eighty percent of patients \n\n\n\nreceived gentamicin for an appropriate indication while 20% had no clear indication \n\n\n\nnoted in their records. Further assessment of TDM forms for completeness found 13 \n\n\n\npatients (54%) had completely filled forms while 11 patients (46%) forms were \n\n\n\nincompletely filled. Of the completed TDM forms, only 2 patients had appropriate pre \n\n\n\nand post sampling time and concentrations of trough and peak within the recommended \n\n\n\ntherapeutic ranges. TDM forms for 10 out of the 13 patients recorded wrong sampling \n\n\n\ntimes.  80% of gentamicin use assessed in this study in HTAR had an appropriate \n\n\n\nindication. However, 46% of TDM forms were incompletely filled leading to potential \n\n\n\nwastage of sample and time. A greater involvement of pharmacists and nurses are needed \n\n\n\nto improve the use of gentamicin antibiotics. \n\n\n\n\n\n\n\n \nPCP11 (000088) \n\n\n\n\n\n\n\nAdherence to Iron Chelation Therapy in Transfusion-dependent Thalassaemia \n\n\n\nPatients in Sarawak: Preliminary Findings \n\n\n\n\n\n\n\nJ C Voon \n1\n, C M Ling \n\n\n\n1\n, G B Ong \n\n\n\n2\n, L P Chew \n\n\n\n3\n, K Koo \n\n\n\n4\n, X L Goh \n\n\n\n5\n, C T Ko \n\n\n\n1 \n \n\n\n\n1\n Oncology Pharmacy Unit, Department of Pharmacy, Sarawak General Hospital, \n\n\n\nKuching, Sarawak \n2\n Department of Paediatric, Sarawak General Hospital, Kuching \n\n\n\n3\n Department of Medicine, Sarawak General Hospital, Kuching \n\n\n\n4\n Pharmacy Unit, Institute of Paediatrics, Hospital Kuala Lumpur, Kuala Lumpur \n\n\n\n5\n In-Patient Pharmacy, Department of Pharmacy, Sarawak General Hospital, Kuching \n\n\n\n\n\n\n\nAdherence to iron chelation therapy (ICT) is vital for disease management and quality of \n\n\n\nlife in transfusion-dependent thalassaemia patients.  However, adherence to ICT in \n\n\n\nSarawak is not much understood.  This cross-sectional study examines the level of \n\n\n\nadherence to ICT and its influencing factors.  Interview using a questionnaire with \n\n\n\ndichotomous scale was conducted on thalassaemia patients of 6 years and above in all \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 91 \n\n\n\nSarawak government hospitals.  To date, 69 patients were recruited via universal \n\n\n\nsampling method.  Forty-one patients completed the survey prior to this abstract writing.  \n\n\n\nOnly 34% of patients reported no missed dose of ICT in the past 4 weeks before the \n\n\n\nsurvey.  In terms of satisfaction with ICT, 56% and 37% who missed dose claimed that \n\n\n\nICT administration is too frequent and very time-consuming, respectively.  Almost 30% \n\n\n\nmissed dose as they do not want to feel different from their friends.  Pertaining to belief in \n\n\n\nICT, 33% missed dose because they think that nothing will happen if they do not take \n\n\n\nICT.  As side effects of ICT are concerned, up to 48% missed dose for the drugs cause \n\n\n\ndiscomfort and pain.  Only 15% missed dose due to lack of psychosocial support.  \n\n\n\nAccessibility to ICT medications is not a reason of missing dose. Given a chance, 73% \n\n\n\nexpressed preference over oral medication(s) to injections. These preliminary results \n\n\n\nshowed that self-reported adherence to ICT is considerably low. The main reasons of \n\n\n\nmissing dose appear to be dissatisfaction with the current ICT and side effects of ICT. \n\n\n\n\n\n\n\n \nPCP12 (000089) \n\n\n\n\n\n\n\nHealth-Related Quality of Life in Transfusion-Dependent Thalassaemia Patients \n\n\n\nwith Iron Chelation Therapy in Sarawak: A Preliminary Report \n\n\n\n\n\n\n\nK Koo \n1\n, C M Ling \n\n\n\n2\n, G B Ong \n\n\n\n3\n, L P Chew \n\n\n\n4\n, X L Goh \n\n\n\n5\n, J C Voon \n\n\n\n2\n, C T Ko \n\n\n\n2 \n \n\n\n\n1\n Pharmacy Unit, Institute of Paediatrics, Hospital Kuala Lumpur, Kuala Lumpur \n\n\n\n2\n Oncology Pharmacy Unit, Department of Pharmacy, Sarawak General Hospital, \n\n\n\nKuching, Sarawak \n3\n Department of Paediatric, Sarawak General Hospital, Kuching \n\n\n\n4\n Department of Medicine, Sarawak General Hospital, Kuching \n\n\n\n5\n In-Patient Pharmacy, Department of Pharmacy, Sarawak General Hospital, Kuching \n\n\n\n\n\n\n\nThalassaemia patients require life-long regular blood transfusion accompanied with iron \n\n\n\nchelation therapy (ICT).  Therefore, patients\u201f perception about their own health during the \n\n\n\ntreatment is of paramount importance to ensure achievement of the treatment goals.  This \n\n\n\nprospective study evaluates health-related quality of life (HRQoL) in transfusion-\n\n\n\ndependent thalassaemia patients with ICT in Sarawak government hospitals.  Patients of 6 \n\n\n\nyears and above were enrolled for 5 monthly follow-ups.  During first clinic visit, MOS \n\n\n\nSF-36 Health Survey Questionnaire (Malaysia Version, 1.0 \u2013 7/94) was administered via \n\n\n\ninterview.  To date, 51 eligible subjects have completed the survey.  The mean age was \n\n\n\n17 \u00b1 8 years and 65% were male patients.  Mean scores with SD for 8 health domains \n\n\n\nwere 88.82 \u00b1 9.47 (physical functioning), 70.59 \u00b1 35.60 (role physical), 79.39 \u00b1 21.35 \n\n\n\n(bodily pain), 64.22 \u00b1 18.79 (general health), 69.61 \u00b1 15.68 (vitality), 81.86 \u00b1 17.56 \n\n\n\n(social functioning), 72.55 \u00b1 36.94 (role-emotional) and 76.47 \u00b1 11.94 (mental health).  \n\n\n\nCompared to Malaysian general population of 18-29 years, these patients scored \n\n\n\nsubstantially lower in physical health components, particularly in the domain of role \n\n\n\nphysical.  In contrast, they demonstrated higher scores in vitality and mental health.  This \n\n\n\nearly result shows that Sarawak transfusion-dependent thalassaemia patients are yet to \n\n\n\nachieve quality of life as good as the general population if not better, despite the current \n\n\n\ntreatments.  However, stronger mental health component might be a possible factor that \n\n\n\naffects their willingness to receive medical treatments and adherence to ICT. \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 92 \n\n\n\n \nPCP13 (000092) \n\n\n\n\n\n\n\nBarriers to Medication Adherence among Adult Asthmatics Attending Medication \n\n\n\nTherapy Adherence Clinic in a Tertiary Care Public Hospital \n\n\n\n\n\n\n\nM A Hameed, N E Ismail, M N A Che Mohamed Safri, M A Nawab Khan \n\n\n\nClinical Pharmaceutics Research Group (CPRG), Inhalational Delivery Research Unit \n\n\n\n(IDRU) & Biomedical Analysis Lab (BAL), Faculty of Pharmacy, Universiti Teknologi \n\n\n\nMARA (UiTM), 42300 Bandar Puncak Alam, Selangor \n\n\n\n\n\n\n\nMedication regimen for asthma care is predominantly vulnerable to adherence problems \n\n\n\ndue to their duration, the use of multiple medications mostly delivered as inhalation and \n\n\n\nthe periods of symptom remission. A prospective cross-sectional questionnaire-based \n\n\n\nstudy was conducted among adult asthmatics attending Medication Therapy Adherence \n\n\n\nClinic of asthma (MTAC-asthma) in a tertiary care public hospital, Hospital Selayang, \n\n\n\nSelangor, Malaysia, to determine the medication adherence level and associated barriers. \n\n\n\nPost approval, from October until November 2011, questionnaires comprised of 30 items \n\n\n\nincluding socio-demographic, medication adherence measurement level (> 10 scores: \n\n\n\ngood adherence) and 6 studied domain barriers toward medication adherence were \n\n\n\ndirectly disseminated to 45 recruited adult asthmatics (\u2265 21 years old). Data were then \n\n\n\nrecorded and descriptively analysed using IBM SPSS version 17.0. Majority of the \n\n\n\nrespondents were between 36 to 50 years old, female (51.1%), Malay (64.4%), and \n\n\n\ncompleted diploma (33.3%) from any formal higher educational institution. About 55.6% \n\n\n\nof the respondents possessed good medication adherence. This study highlighted therapy \n\n\n\nregimen complexity, risks of medication side effects, and lack of general knowledge \n\n\n\nregarding medication adherence as barriers that contributed toward poor medication \n\n\n\nadherence level in 44.4% of the asthmatics (\u2264 10 scores). Contrary, patient-prescriber \n\n\n\ntrust, patients\u201f cognitive functions and social supports from family and peers contributed \n\n\n\nto the good medication adherence. Effective communication between health professionals \n\n\n\nand asthmatics during asthma education is essential to enhance patients\u201f medication \n\n\n\nadherence hence improve disease condition subsequently quality of life and care. \n\n\n\n \nPCP14 (000093) \n\n\n\n\n\n\n\nOutcome of the First Home Based Self Administration of Subcutaneous \n\n\n\nMethotrexate (HOSAM) Program in Malaysia \n\n\n\n\n\n\n\nS P Tang \n1\n, N Mat Ariffin \n\n\n\n2\n, Elaine Liew \n\n\n\n2\n, C C Chuah \n\n\n\n2\n, R Mohd Din \n\n\n\n2\n, S C Lim \n\n\n\n1\n, \n\n\n\nW T Cham \n1\n, N A Abdul Mutalib \n\n\n\n2\n, S Y Lau \n\n\n\n2\n  \n\n\n\n1\n Paediatric Rheumatology Unit, Hospital Selayang, Selangor \n\n\n\n2\n Department of Pharmacy, Hospital Selayang, Selangor \n\n\n\n\n\n\n\nThis study aimed to assess the outcome of a home based self-administration of \n\n\n\nsubcutaneous methotrexate (HOSAM) programme in Hospital Selayang. A retrospective \n\n\n\nreview of the medical records of all paediatric rheumatology patients in Hospital \n\n\n\nSelayang who were offered the HOSAM programme was conducted. Data collected \n\n\n\nincluded patient characteristics and reported direct outcome measures namely correct \n\n\n\ninjection techniques, correct handling of the drug and occurrence of spillage plus indirect \n\n\n\nmeasures via blood investigation results. Twenty five patients were offered and 16 (12 \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 93 \n\n\n\nfemales, 4 males) enrolled in the HOSAM programme. Of the 16 patients, 12 had juvenile \n\n\n\nidiopathic arthritis, 2 juvenile dermatomyositis, 1 scleroderma and 1 Takayasu\u201fs disease. \n\n\n\nMean duration on subcutaneous methotrexate (SQ MTX) was 38.4 months (0.7-90.3) \n\n\n\nwith a mean of 3 (range 1-9) programme follow-up visits. Parents administered SQ MTX \n\n\n\nin 11 patients (mean age 9.8 years, range 3.6-18.5) whilst 5 patients self-administered \n\n\n\n(mean age 14.0 years, range 9.8-15.2). Of the 11 parents, 4 were homemakers and all had \n\n\n\nat least secondary school education. There were no adverse outcomes reported (n=15), \n\n\n\nwith all reporting correct injection techniques, correct handling of drugs (including \n\n\n\nstorage, transportation, and disposal of drug and used syringes) and no incidences of \n\n\n\nspillage. There were also no abnormal full blood counts or liver function tests which may \n\n\n\nindirectly indicate MTX toxicity potentially from wrong dosage. This study found that \n\n\n\nSQ MTX can be administered safely by a patient or parent at home in a pre-selected \n\n\n\ngroup of patients given appropriate education and support as demonstrated in our \n\n\n\nHOSAM program, which was the first in Malaysia \n\n\n\n\n\n\n\n \nPCP15 (000094) \n\n\n\n\n\n\n\nDaily Clinical Dose Poorly Predicts Trough Serum Methadone Concentration \n\n\n\n(Ctrough) in Patients Undergo Methadone Maintenance Therapy (MMT) with Good \n\n\n\nAdherence \n\n\n\n\n\n\n\nN I M Nazar \n1,4\n\n\n\n, H L Sim \n1\n , R Ismail \n\n\n\n1\n, R Musa \n\n\n\n2\n, A Z A Bakar \n\n\n\n3\n \n\n\n\n1 \nInstitute for Research in Molecular Medicine, Universiti Sains Malaysia, Malaysia \n\n\n\n2 \nDept. of Psychiatry, Kulliyyah of Medicine, International Islamic University Malaysia, \n\n\n\nMalaysia \n3 \n\n\n\nDept. of Psychiatry, Hospital Tengku Ampuan Afzan, Kuantan, Ministry of Health, \n\n\n\nMalaysia \n4 \n\n\n\nDept. of Pharmacy Practice, Kulliyyah of Pharmacy, International Islamic University \n\n\n\nMalaysia, Malaysia \n\n\n\n\n\n\n\nMethadone maintenance therapy (MMT) has been used in patients with opioid use \n\n\n\ndisorder as one of the harm-reduction approaches to prevent the wide spread of HIV- \n\n\n\nrelated risks such as needle sharing behaviour and illicit drug use. With low costs \n\n\n\ncalculated per patient, MMT has been put top priority on reducing opioid dependencies in \n\n\n\nMalaysia. However, the dosing strategy of this therapy, in certain circumstances was open \n\n\n\nto doubt. With the hypothesis of a personalized methadone therapy, methadone Ctrough \n\n\n\nmay possibly be a surrogate marker for such purpose. Accordingly, we conducted a 9-\n\n\n\nmonth prospective study to assess the relationship between Ctrough and Dose (D) of \n\n\n\nmethadone. After obtaining approval from the institutional ethics committee, 115 patients \n\n\n\nwere recruited. Two ml of the trough blood samples were taken and centrifuged within 4 \n\n\n\nhours at 10x1000 rpm for 5 minutes. The resulting serum samples were kept at -20\u00b0C \n\n\n\nuntil analysis. The methadone concentrations were determined by using Methadone \n\n\n\nELISA kit. Study subjects were requested to come for another 2 more follow- ups each at \n\n\n\na 3-month interval. Blood samples were taken as previously prescribed. The initial \n\n\n\ncorrelation analysis reveals a significant positive correlation between methadone C trough \n\n\n\nand daily clinical dose (D) in all follow-ups, with r values ranging between 0.403and \n\n\n\n0.406 (p < 0.005). Further regression analysis reveals that the coefficient of \n\n\n\ndetermination, r\n2\n was poor with only 15-17% of the variability in Ctrough can be explained \n\n\n\nby the changes in clinical doses (p < 0.005). Based on these results, we conclude that \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 94 \n\n\n\ndaily clinical dose poorly predicts methadone Ctrough for the purpose of dosing adjustment \n\n\n\nand monitoring of MMT. \n\n\n\n\n\n\n\n \nPCP16 (000103) \n\n\n\n\n\n\n\n Adherence of Inhaled Corticosteroid (ICS) in Asthmatic Adult in Hospital Sultanah \n\n\n\nNur Zahirah (HSNZ) \n\n\n\n\n\n\n\nN A Dalila, W N Najihah, Y F Chieng, Nurulhayati A Jamal, N Aizahakiki, N Fatina \nDepartment of Pharmacy, Hospital Sultanah Nur Zahirah, 20400, Jalan Sultan Mahmud, \n\n\n\nKuala Terengganu \n\n\n\n\n\n\n\nRegular use of either concurrent therapy (ICS and Short Acting Beta Agonist alone) or \n\n\n\ncombination therapy (ICS with Long Acting Beta Agonist) can improve asthma \n\n\n\nsymptoms and prevent exacerbations. Study objectives were to assess and compare \n\n\n\nadherence between asthmatic patients using combination and concurrent therapies, to \n\n\n\ninvestigate the relationship between the underuse of ICS and asthma control and to assess \n\n\n\nthe factors of non-adherence of ICS. This cross sectional study was carried out via \n\n\n\nvalidated questionnaires in four different stations of pharmacy at Hospital Sultanah Nur \n\n\n\nZahirah from April to May 2012. Inhalation technique was assessed. Other assessment \n\n\n\ntools included Modified Morisky Adherence Scale and Asthma Control Test (ACT). The \n\n\n\ndata was analyzed using SPSS version 20. A total of 71 patients were included in this \n\n\n\nstudy. Asthmatic patients receiving combination therapy had higher adherence rate (n = \n\n\n\n34, 26.5%) then those receiving concurrent therapy (n = 37, 18.9%). Highest percentage \n\n\n\nof  ICS underuse (taking less puff (dose) or time (frequency) or both that presribed) was \n\n\n\nfound in patient with asthma duration greater than 10 years (48%). A non parametric test \n\n\n\nusing Mann-Whitney Test showed that there was significant difference of ICS underuse \n\n\n\nand duration of asthma p = 0.05. Significant difference was also found in inhalation \n\n\n\ntechnique between combination and concurrent therapy (p = 0.03<0.05), and between the \n\n\n\nICS underuse and Modified Morisky Scale (P < 0.05). However, there was no significant \n\n\n\ndifference of ICS underuse and ACT score (p=0.932; > 0.05). The most prominent reason \n\n\n\nfor ICS underuse was forgetfulness (27.1%). \n\n\n\n\n\n\n\n \nPCP17 (000110) \n\n\n\n\n\n\n\nAntidiabetic Medications and Glycemic Control in Type 2 Diabetic Patients of Sub-\n\n\n\nurban Hospital of Malaysia \n\n\n\n\n\n\n\nMirza R Baig \n1\n, Siew Lin C \n\n\n\n1\n, Natasha C S \n\n\n\n1\n, Rushita N \n\n\n\n1\n, Datchayani R \n\n\n\n2\n, Norazira \n\n\n\nKassim \n2\n \n\n\n\n1\n Unit of Clinical Pharmacy, AIMST University, Kedah \n\n\n\n2\n Pharmacy, Hospital Sultan Abdul Halim, Kedah \n\n\n\n\n\n\n\nDiabetes has become a highly prevalent health problem in Malaysia and uncontrolled \n\n\n\ndiabetes may leads to complications. Extensive medication review is essential in view of \n\n\n\nmultiple medications that the patients received. This study investigated patterns of \n\n\n\nantidiabetic treatment and attainment of glycemic control among individuals with type 2 \n\n\n\ndiabetic patients of sub-urban hospital in Malaysia. A cross sectional descriptive study \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 95 \n\n\n\nwas conducted retrospectively from the electronic database of the Hospital Sultan Abdul \n\n\n\nHalim, Sungai Petani. A standard data collection form was designed to collect \n\n\n\ninformation on the patients demographic data and drug utilization pattern for commonly \n\n\n\nprescribed antidiabetic drugs. Data was analysed by using SPSS version 14.0. Bon \n\n\n\nFerroni test was applied to assess the significant difference between the groups. A total of \n\n\n\n300 diabetic patients\u201f medical data were taken into consideration for this study. Malay \n\n\n\ndiabetic patient contributes to the highest percentage with 56.3% followed by Indian and \n\n\n\nChinese with 31.3% and 11.3%, respectively. The most preferred drug for the \n\n\n\nmonotherapy was found to be metformin with 57.7% prescriptions, followed by 33.7% \n\n\n\nwith gliclazide and 9% with insulin therapy. The most common combination therapy \n\n\n\ngiven for the patients were found to be metformin and gliclazide followed by metformin \n\n\n\nand insulin. All the anti-diabetic drugs used had more or less the same outcome with no \n\n\n\nsignificance difference in FBS and HBA1c values. The FBS and HBA1c values (in \n\n\n\nmmol/L) for metformin, gliclazide, metformin+gliclazide, metformin+glibenclamide \n\n\n\nwere 7.52, 7.68, 8.62, 7.56 and 7.33, 8.09, 8.27, 7.81, respectively. Most of the patients \n\n\n\nfailed to attain the HbA1c target for glycemic control. \n\n\n\n\n\n\n\n \nPCP18 (000111) \n\n\n\n\n\n\n\nUnlicensed and Off-label Use of Medicines in Hospitalized Children in the Critical \n\n\n\nCare Units of Universiti Kebangsaan Malaysia Medical Center \n\n\n\n\n\n\n\nJ L Lee \n1\n, N Mohamed Shah \n\n\n\n2\n, J Ismail \n\n\n\n3\n  \n\n\n\n1\n Department of Pharmacy, Tengku Ampuan Rahimah Hospital, Selangor  \n\n\n\n2\n Faculty of Pharmacy, National University of Malaysia, Kuala Lumpur  \n\n\n\n3\n Department of Pediatrics, Universiti Kebangsaan Malaysia Medical Center, Kuala \n\n\n\nLumpur \n\n\n\nUnlicensed and off-label use of medicine in pediatrics has been a widespread \n\n\n\nphenomenon and the extent of such use has been quantified in many international studies. \n\n\n\nTo date, the extent of this practice has not been reported in Malaysia. The objective of \n\n\n\nthis study is to determine the extent of unlicensed and off-label use of medicine in \n\n\n\nhospitalized children in the critical care units of Universiti Kebangsaan Malaysia Medical \n\n\n\nCenter. A prospective, observational exploratory study was conducted over an eight-week \n\n\n\nperiod on the medicines prescribed to all children admitted to the critical care units at this \n\n\n\ninstitution. Licensing and off-label status of all medicines prescribed were determined \n\n\n\nusing the database prepared by the National Pharmaceutical Control Bureau and local \n\n\n\ndrug compendium, MIMS Malaysia. A total of 194 patients were admitted to the units \n\n\n\nduring the study period, 168 of whom received one or more prescriptions. Of the total \n\n\n\n1295 prescriptions, 353 (27.3%) were unlicensed and 442 (34.1%) were off-label use. \n\n\n\nBased on the number of admissions who received one or more prescriptions, 44.0% \n\n\n\nreceived at least one unlicensed prescription and 82.1% received at least one off-label \n\n\n\nprescription. A multivariate logistic regression analysis showed that children below the \n\n\n\nage of two years, longer length of hospital stay and the more number of medicines \n\n\n\nprescribed were most likely to receive an unlicensed and/or off-label medicine. In \n\n\n\nconclusion, there is a high prevalence of unlicensed and off-label prescribing in children \n\n\n\nadmitted to the critical care units of this institution. \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 96 \n\n\n\n \nPCP19 (000119) \n\n\n\n\n\n\n\nHealth Beliefs and Perception of Breast Cancer Patients in Relation to the Usage of \n\n\n\nHerbal Medicines \n\n\n\n\n\n\n\nM F Chan, S W Yeong, B K Tan \n\n\n\nFaculty of Pharmaceutical Sciences, UCSI University, Kuala Lumpur \n\n\n\n\n\n\n\nHerbal medicine is widely used by cancer patients although its effect is not well-\n\n\n\ndocumented. Cancer patients are drawn to the benefits of herbal medicine based on \n\n\n\nanecdotal evidence. We aimed to investigate the health belief of cancer patient and \n\n\n\npredictors of their herb taking behaviour. This study was designed as a cross sectional \n\n\n\nsurvey. Breast cancer patients were recruited from a single centre via telephone interview. \n\n\n\nA structured questionnaire consists of the subject\u201fs general characteristic, herbal medicine \n\n\n\nusage and 7 constructs of health belief was administered to each subject. A total of 60 \n\n\n\npatients completed the questionnaire, response rate 92%. 67% of the patients reported \n\n\n\nusing herbal medicine while on cancer treatment and 58% did not reveal it to their \n\n\n\nclinicians. Except for marital status, p = 0.040, no association was found between \n\n\n\ndemographic characteristics and the use of herbal medicine, but significant differences \n\n\n\nwere found in health belief scores between herbal medicine user and non-user in 3 out of \n\n\n\n7 constructs, where herbal medicine users perceived greater benefits and personal \n\n\n\nmodifying variables and less barrier to access of herbal medicine compared to non users, \n\n\n\nz = -3.51; -2.19; 3.57, p < 0.001; = 0.03; < 0.001, respectively. Logistic regression \n\n\n\nindicated patients\u201f perceived benefit and perceived susceptibility/ vulnerability to breast \n\n\n\ncancer are predictive of herbal medicine use. This study confirmed that a substantial \n\n\n\nproportion of breast cancer patients in Malaysia utilize herbal medicine, often without \n\n\n\ninforming their clinicians. Breast cancer patients\u201f health belief provides insights into their \n\n\n\nherb taking behaviour.  \n\n\n\n\n\n\n\n\n\n\n\nPHARMACY PRACTICE & PHARMACY EDUCATION \n\n\n\n\n\n\n\n \nPPP1 (000004) \n\n\n\n\n\n\n\nMedication Errors in Intravenous Drug Preparation and Administration in \n\n\n\nSelayang Hospital  \n \n\n\n\nW M Ong, S Subasyini, F Othman\n \n\n\n\nDepartment of Pharmacy, Selayang Hospital, Selangor \n\n\n\n\n\n\n\nMedications given via intravenous (IV) route provide rapid drug delivery to the body. It \n\n\n\nallows easy control of the amount of drug delivered as well as maintenance of drug levels. \n\n\n\nIV therapy is a complex process requiring proper drug preparation before administration \n\n\n\nto the patient. Therefore, errors occurring at any stage can cause harmful clinical \n\n\n\noutcomes, which may lead to morbidity and mortality. This was a prospective \n\n\n\nobservational study to estimate the percentage of medication errors in preparing and \n\n\n\nadministering IV medicines to the patients, and to determine associated factors and to \n\n\n\nidentify strategies in reducing these errors. A total of 341 (97.7%) errors were identified \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 97 \n\n\n\nfrom 349 IV drug preparations and administrations. The most common errors were the \n\n\n\nvial tap was not swabbed during pre-preparation and injecting of bolus doses faster than \n\n\n\nthe recommended administration rate. There was one incident of wrong drug attempted. \n\n\n\nErrors were significantly more likely to occur during administration time at 8.00 am and \n\n\n\nwhen bolus drugs were given. No significant associations were found between number of \n\n\n\nnurses in the ward or IV drugs to be prepared and administered with medication errors. \n\n\n\nErrors could be reduced with proper guidelines on IV procedures, more common use of \n\n\n\nIV infusion control devices and full concentration during the process. In conclusion, \n\n\n\nawareness among the nursing staff and training needs should be addressed to reduce the \n\n\n\nrate of medication errors. Standard IV procedures should be abided and this needs the \n\n\n\ncooperation and active participation of all healthcare professionals as well as the nursing \n\n\n\nstaff. \n\n\n\n\n\n\n\n \nPPP2 (000010) \n\n\n\n\n\n\n\nAttitude of Pharmacy Personnel in Sarawak towards Cytotoxic Drug Reconstitution \n\n\n\n\n\n\n\nH C Yong, C M Ling , M H Law , C Y Ngu , G K Phua , F Ahmad Faiz , Y \n\n\n\nNurulhusna Syuhaidah \n\n\n\nOncology Pharmacy Unit, Department of Pharmacy, Sarawak General Hospital, \n\n\n\nKuching, Sarawak \n\n\n\n\n\n\n\nIn Sarawak, delivery of cancer patient care faces geographical challenges. Some patients \n\n\n\ncannot afford high cost of traveling to obtain chemotherapy due to long distance from \n\n\n\nhome to tertiary hospital. Therefore Sarawak State Health Department has planned to \n\n\n\nestablish cytotoxic drugs reconstitution (CDR) services in district hospitals. Readiness of \n\n\n\npharmacy staff to render the service determines success of this plan. We investigated their \n\n\n\nattitude towards CDR services and possible factors that influence their attitude. A 2-\n\n\n\nmonth cross-sectional survey was conducted in 66 Ministry of Health institutions in \n\n\n\nSarawak using self-administered questionnaire (Cronbach\u201fs alpha, \u03b1 = 0.544). \n\n\n\nQuestionnaires were posted to all pharmacists and pharmacy assistants (N = 720). 545 \n\n\n\n(79.6%) responded to this survey. 41% of respondents denied the fact that CDR is \n\n\n\npharmacist's responsibility. 42% felt that working in CDR is stressful. 51% did not feel \n\n\n\nsafe even with personal protective equipments. 75% thought that CDR poses higher \n\n\n\noccupational exposure risk to cytotoxic drugs compared with other pharmacy activities. \n\n\n\nMore senior staff and pharmacy assistants showed less favourable attitude towards CDR \n\n\n\nservices (X\n2 \n\n\n\n= 30.071, df = 2, p = 0.001; X\n2\n = 6.547, df = 2, p = 0.038 respectively). This \n\n\n\ncould be attributed to lack of awareness on safe handling of cytotoxic drugs. It is \n\n\n\nimportant to instil correct perception about handling cytotoxic drugs. Overall, pharmacy \n\n\n\npersonnel lacks good attitude towards CDR. However, as we strive to cultivate good \n\n\n\nattitude towards CDR via training, we are optimistic for the success in making CDR \n\n\n\nservices available at all district hospitals in the next five years. \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 98 \n\n\n\n \nPPP3 (000013) \n\n\n\n\n\n\n\nHospital Melaka: Cough and Cold Medicine Usage in Paediatric Patients \n\n\n\n\n\n\n\nW S Ng, E P Tay \n\n\n\nPharmacy Department Hospital Melaka, Melaka \n\n\n\n\n\n\n\nThe Food and Drug Administration (FDA) had issued a warning against safety usage of \n\n\n\ncough and cold medicine (CCM) in children under two years old. In fact, the rationale for \n\n\n\nusing CCM in this group of patients has been repeatedly reviewed. This study aims to \n\n\n\ndescribe the usage of CCM among paediatric patients in Hospital Melaka. This is a \n\n\n\ndescriptive study involving retrospective screening of outpatient prescriptions received \n\n\n\nfrom May to June 2011. A total of 36368 outpatient presciptions were screened. Out of \n\n\n\nthis, 10.25% were for paediatric patients. 17.79% of this paediatrics\u201f prescriptions contain \n\n\n\nCCM. A majority of the CCM was prescribed by the Emergency & Trauma Department \n\n\n\n(ETD), 45.40%, and to patients between 2-6 years old (40.61%) followed by 7-11 years \n\n\n\nold (39.82%) and less than 2 years old (13.57%). Chlorpheniramine (35.75%) and \n\n\n\ntripolidine (18.25%) were the most commonly used CCMs among paediatric patients. The \n\n\n\nusage of CCMs among paediatric patients in Hospital Melaka warrants further action. \n\n\n\nApproximately one out of every five paediatric patients was prescribed with a CCM, with \n\n\n\na majority of them aged less than the recommended age which is six years old. \n\n\n\n\n\n\n\n \nPPP4 (000019) \n\n\n\n\n\n\n\nAdverse Drug Reaction Reported in Hospital Universiti Sains Malaysia (HUSM) \n\n\n\n\n\n\n\nN S Ibrahim, N Ramlee, N A Awang Lah, N A Rosemi, R Azuralaily Ibrahim \n\n\n\nPharmacy Department, Hospital Universiti Sains Malaysia, 16150, Kubang Kerian, \n\n\n\nKelantan \n\n\n\n\n\n\n\nAdverse drug reactions (ADRs) are a major health concern during medication therapy. \n\n\n\nEarly detection of ADRs may prevent morbidity and mortality. The aim of this study was \n\n\n\nto evaluate the ADR reports submitted to the Research and Drug Information Unit, \n\n\n\nDepartment of Pharmacy, Hospital Universiti Sains Malaysia (HUSM). All ADR report \n\n\n\nforms received by the unit from January 2004 until June 2012 were retrospectively \n\n\n\nreviewed. For each of the ADR report, a causality assessment was made based on the \n\n\n\nNaranjo\u201fs algorithm. All data were analyzed descriptively. From 90 reports evaluated, the \n\n\n\nmajority of the reports were received from doctors (67.8%) whilst pharmacists \n\n\n\ncontributed the rest. Slightly more than half of the reports were reported to cause \n\n\n\nmoderate reaction, followed by mild reaction (32%) and severe reaction (14.5%). At the \n\n\n\ntime of reporting about two third of patients recovered. The causality assessment for \n\n\n\nabout half of the ADR reports was categorized as \u201cprobable.\u201d Most of the reactions \n\n\n\n(60.9%) subsided after stopping the drug or reducing the drug dose. Most of the \n\n\n\nprescribers did not reintroduce the drug. Anti-infective agents, particularly cephalosporin \n\n\n\ngroup were recorded as the highest drug related to ADRs (34.4%). The most common \n\n\n\norgan-system affected was the skin (32.8%), followed by central nervous system (15.3%) \n\n\n\nand cardiovascular system (12.2%). This report should increase the awareness and \n\n\n\nencourage healthcare professional to report ADRs. \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 99 \n\n\n\n \nPPP5 (000034) \n\n\n\n\n\n\n\nEnsuring Medication Adherence: The Role of HIV/AIDS Family Caregivers \n\n\n\n\n\n\n\nP L Lua \n1\n, M Norhayati \n\n\n\n1\n, A K Abdul Rahman \n\n\n\n2\n \n\n\n\n1 \nCentre for Clinical and Quality of Life Studies (CCQoLS), Faculty of Medicine and \n\n\n\nHealth Sciences, Universiti Sultan Zainal Abidin (UniSZA), Kuala Terengganu, \n\n\n\nTerengganu \n2\n Hospital Sultanah Nur Zahirah, Kuala Terengganu, Terengganu \n\n\n\n\n\n\n\nAdherence to combined antiretroviral therapy (ART) has been shown to be a determining \n\n\n\nfactor in controlling viral replication and maintaining immunologic function as well as \n\n\n\nsurvival in HIV-positive individuals. This preliminary qualitative investigation intended \n\n\n\nto explore and describe the role of HIV/AIDS family caregivers in managing patients\u201f \n\n\n\nmedication. A convenient sample of family caregivers of HIV/AIDS patients was enrolled \n\n\n\nfrom Hospital Sultanah Nur Zahirah, Kuala Terengganu whereby semi-structured \n\n\n\ninterviews were used to gather data. Results were transcribed and translated into English \n\n\n\nbefore being subjected to analysis using NVivo software. Twelve caregivers consented \n\n\n\nparticipation (age range = 18.0 - 81.0; female = 75.0%, mother/wife = 50.0%; married = \n\n\n\n83.3%; \u2264 primary school = 50.0%; self-employed = 66.7%). Currently, most patients had \n\n\n\nbeen prescribed with a combination of antiretroviral drugs for less than one year. One of \n\n\n\nthe major findings was ensuring medication adherence; whereby working schedules had \n\n\n\nto be altered and constant reminders needed to be given to ensure patients continue to \n\n\n\nconsume their medications. Interestingly, caregivers also attempted to seek traditional \n\n\n\ntreatment in addition to conventional treatment for their family members. Several \n\n\n\ncaregivers also mistakenly thought that the antiretroviral drugs were definite cures for \n\n\n\ntheir family member\u201fs HIV/AIDS problem. In conclusion, caregivers could play a pivotal \n\n\n\nrole in promoting and improving patient adherence to antiretroviral medications. \n\n\n\n\n\n\n\n \nPPP6 (000036) \n\n\n\n\n\n\n\nCustomer Satisfaction towards Retail Pharmacy Services in Sarawak \n\n\n\n\n\n\n\nC Y Ting, M H Law, M Jivanti, N Norlizawati, I Hafizah \n\n\n\nPharmacy Enforcement Division Sarawak, Sarawak State Health Department, Sarawak \n\n\n\n\n\n\n\nCustomer satisfaction serves as an indicator of health-care services quality and a predictor \n\n\n\nof patients\u201f health-related behavior. This cross-sectional study evaluated the satisfaction \n\n\n\nlevel of customers towards retail pharmacy services in Sarawak. A survey using a self-\n\n\n\nadministrated questionnaire adopted from a previous study was conducted at public areas \n\n\n\nof Sarawak with a total participation of 420 respondents. (Response rate 93%). Mean \n\n\n\nsatisfaction score (\u00b1S.D.) of General Services, Intervention Services and Cognitive \n\n\n\nServices were 31.55 (\u00b14.0), 29.62 (\u00b15.2), 28.02 (\u00b13.9) respectively. Results revealed that \n\n\n\nrespondents were moderately satisfied (Prorated score ranging from 60-80%) with the \n\n\n\nservices provided by retail pharmacies. Other findings included 55% of respondents were \n\n\n\nnot satisfied with pricing of medication and less than half of respondents were satisfied \n\n\n\nwith the medication information provided. Customers who visited pharmacy regularly \n\n\n\nand seek advice from pharmacist were reported to have significantly higher satisfaction \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 100 \n\n\n\nlevel towards intervention services. (t = 4.206, P = 0.003; t = 2.966, p = 0.003). Malay \n\n\n\nethnic customers were found to have greater satisfaction level toward all three types of \n\n\n\nservices provided (p < 0.05). Further studies are needed to examine aspects influencing \n\n\n\nsatisfaction level in order to formulate effective strategies to provide a more holistic \n\n\n\npatient centered approach. \n\n\n\n\n\n\n\n \nPPP7 (000040) \n\n\n\n\n\n\n\nFactors Associated with Defaulted Patient in Methadone Maintenance Programme \n\n\n\nin Hospital Melaka \n\n\n\n\n\n\n\nNoorazlinda Y, Suk Fun T, Amsyar A, Mei Sze C \n\n\n\nDepartment of Pharmacy, Hospital Melaka, Melaka \n\n\n\n\n\n\n\nRetaining patients in methadone maintenance programme is crucial. However there are \n\n\n\ndefaulters in the programme. This study was aimed to identify factors associated with \n\n\n\ndefaulting maintenance treatment, as part of ongoing evaluation and improvement in \n\n\n\ntreatment policy. An unmatched case control study (1:2) was conducted among patients \n\n\n\nwho undergone Methadone Maintenance Programme in Hospital Melaka from 1\nst\n January \n\n\n\n2008 to 31\nst \n\n\n\nDecember 2010. Cases were classified as defaulter patients, while controls \n\n\n\nwere those who are still active for more than 90 days during the study period. Both cases \n\n\n\nand controls were selected based on specified inclusion and exclusion criteria. Medical \n\n\n\nrecords of selected patients were retrospectively reviewed using a data collection form. A \n\n\n\ntotal of 175 patients were included in this study, which comprised of 60 cases and 115 \n\n\n\ncontrols. Factors associated with defaulting were distance from clinic to home [Adjusted \n\n\n\nOR 1.10, 95% CI (1.03, 1.17), p-value 0.004], living alone [Adjusted OR 5.23, 95% CI \n\n\n\n(1.36, 20.19), p-value 0.010], alcoholic [Adjusted OR 14.13, 95% CI (2.24, 89.33), p-\n\n\n\nvalue 0.005], history of abuse among family member [Adjusted OR 12.93, 95% CI (2.59, \n\n\n\n64.56) p-value 0.002], number of individual counselling attended during treatment \n\n\n\n[Adjusted OR 0.56, 95% CI (0.36, 0.85), p-value 0.007] and those without take away \n\n\n\ndose privilege [Adjusted OR 31.16, 95% CI (2.27, 427.01), p-value 0.010]. Validity of \n\n\n\nthe model was good (AUC-ROC= 0.94; overall correctly percentage (88.3%); and \n\n\n\nHosmer-Lemeshow p-value = 0.084).This study suggest that retention rates would be \n\n\n\nsignificantly improved by a change in the treatment strategies. \n\n\n\n\n\n\n\n \nPPP8 (000053) \n\n\n\n\n\n\n\nA Survey on Public Attitudes and Knowledge of Contact Lens Use in Puncak Alam \n\n\n\nSelangor \n\n\n\n\n\n\n\nNurul Nadia J S \n1\n, Mohamed M M \n\n\n\n1\n, Salmiah M A \n\n\n\n2\n, Nazedah I \n\n\n\n1\n \n\n\n\n1 \nFaculty of Pharmacy, Universiti Teknologi MARA, Selangor\n\n\n\n\n\n\n\n2 \nSchool of Pharmacy, Taylors University, Selangor \n\n\n\n\n\n\n\nIssues of poor public knowledge and attitudes on contact lens use are of concern because \n\n\n\nof the reported complications such as infective keratitis and papillary conjunctivitis. This \n\n\n\nstudy was aimed to describe on public attitudes and knowledge on the use of contact lens. \n\n\n\nThis survey utilized questionnaires by Tajunisah et al., 2008. Respondents were residents \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 101 \n\n\n\nof Puncak Alam, Selangor who were users of contact lens and age group of at least 15 \n\n\n\nyears old. The respondents were divided into three groups of different educational level; \n\n\n\nsecondary, intermediate and degree levels. The questionnaires comprised of three parts:  \n\n\n\ndemographic details, contact lens wear, and practice of hygiene and care of contact lens, \n\n\n\nknowledge of contact lens wear complications. The study was conducted from September \n\n\n\nto November 2011. Demographic data was descriptively described and non-parametric \n\n\n\ntest was used to test for significance. A total of 84 respondents completed the \n\n\n\nquestionnaires of which 95% of them were female and 76.2% were between 26 and 25 \n\n\n\nyears old. The study showed 95.2% and 3.6% were students and professionals, \n\n\n\nrespectively. The findings showed that respondents with higher education level had better \n\n\n\nunderstanding about the use, hygiene and care and complications towards lens use. \n\n\n\nHowever, no significance differences were found when knowledge and attitudes were \n\n\n\ncompared among age, gender and occupations. The study revealed that most users did \n\n\n\nabide to instructions on contact lens use. Knowledge on lens use, hygiene and \n\n\n\ncomplications was more apparent in those with higher education level.  \n\n\n\n\n\n\n\n \nPPP9 (000054) \n\n\n\n\n\n\n\nMethadone Maintenance Therapy Clinic in Malaysia: Out-of-pocket costs \n\n\n\n\n\n\n\nMohamed Mansor M \n1\n, Salmiah M A \n\n\n\n2\n, Sara J \n\n\n\n1\n, Nazedah I \n\n\n\n1\n, Shazwani S \n\n\n\n1\n \n\n\n\n1\n Department of Pharmacy Practice, Universiti Teknologi MARA, Selangor \n\n\n\n2\n School of Pharmacy, Taylors University, Selangor \n\n\n\n\n\n\n\nOut-of-pocket (OOP) payments may burden Methadone Maintenance Clinic patients. \n\n\n\nSince treatment is fully subsidized by the government, financial constraint might lead to \n\n\n\npatients being made to pay or be given incentive for inconvenience of therapy. This study \n\n\n\nthus evaluates the characteristic and commitment of methadone therapy in patients in \n\n\n\nterms of OOP cost, Willingness To Pay (WTP) and Willingness To Accept (WTA) \n\n\n\nconcept. This was a survey utilizing the questionnaire by Borisova & Goodman (2003) on \n\n\n\nthe OOP, WTP and WTA concept was conducted on patients at a government methadone \n\n\n\nclinic between 2\nth\n\n\n\n February 2010 and 1\nth\n\n\n\n April 2010. The subjects were selected by \n\n\n\nconvenient sampling based on the predetermined set of inclusion and exclusion criteria. \n\n\n\nTheir medical records from year 2009 \u2013 2011 were also reviewed and recorded. Forty \n\n\n\nadult patient\u201fs records were selected, most were male (90%) and Malay (60%) was the \n\n\n\npredominant group. Patients were group into 3 income groups; \u2264 RM 1000, \u2265 RM 1000 - \n\n\n\n\u2264 RM 2000 and \u2265 RM 3000. The average OOP cost per month was RM 391.30 (s.d., RM \n\n\n\n337.50) which is about 35% of employed patient\u201fs monthly income. The wide variation \n\n\n\ncould be attributed by high inter-individual and significant differences between patients in \n\n\n\nterms of transport, times taken to clinic, cost per trip and weekly household income (p = \n\n\n\n<0.05). Patients with income of less than RM 1000 showed the highest tendency to pay \n\n\n\nfor treatment, asked for the least money for inconvenience, and many are unwilling to \n\n\n\naccept any payments. These findings showed that WTP and WTA is less of a concern for \n\n\n\npatients in the low-income group. To conclude, OOP payment is not a treatment barrier \n\n\n\nfor most of the Malaysian Methadone Maintenance Therapy patients although many are \n\n\n\nthe urban poor category. \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 102 \n\n\n\n \nPPP10 (000061) \n\n\n\n\n\n\n\nPattern of Usage of Herbal Medicine among Hypertensive Patients in Hospital Seri \n\n\n\nManjung \n\n\n\n\n\n\n\nA F Yusoff, E X F Chen, S F Hor, J K Ong, A Muhammad \n\n\n\nDepartment of Pharmacy, Seri Manjung Hospital, Perak \n\n\n\n\n\n\n\nThere is a growing interest in herbal medicine among Malaysians and only  a few  related \n\n\n\nstudies were carried out. Therefore,  it is important to study the demographic data of \n\n\n\nhypertensive patients who used herbal medicine and to identify the factors contributing to \n\n\n\nits usage. A cross sectional survey involving face-to-face interview with hypertensive \n\n\n\npatients in Hospital Seri Manjung was conducted from February-March 2012. The \n\n\n\ncalculated sample size was 377. Patients were randomly selected and questioned based on \n\n\n\nstructured questionnaires and 364 respondents were included in the analysis. The study \n\n\n\nshowed 103 (28.3%) respondents used herbal medicine whereby 52 (50.5%) were male \n\n\n\nand 51 (49.5%) were female. There were 3.5% more male herbal medicine users \n\n\n\n(p=0.458). However, 30.1% of the users belong to the age groups of 51-60 and 61-70 \n\n\n\n(p=0.686). About 54.4% of the users were those who completed secondary school \n\n\n\n(p=0.182). The same goes for income and HM use (p=0.769), whereby 60.4% of HM \n\n\n\nusers perceived their health to be fair while 2.9% as very poor (p=0.769). About 48.5% \n\n\n\nand 47.6% of patients used HM for maintaining their general health  and  treating specific \n\n\n\nconditions, respectively. There were 21 patients (42.6%) claimed to use it for \n\n\n\nhypertension while 51.5% of the respondents were influenced by their friends. The \n\n\n\ndemographic data of users were identified to be mostly male, of secondary school level \n\n\n\neducation, belonging to the age groups of 51-60 and 61-70 and those who perceived their \n\n\n\nhealth to be fair. However, none of the factors significantly affect herbal medicine usage \n\n\n\nin our study. \n\n\n\n\n\n\n\n \nPPP11 (000072) \n\n\n\n\n\n\n\nBarriers to Practising Pharmaceutical Care in Malaysia: Views from Community \n\n\n\nPharmacists \n\n\n\n\n\n\n\nY C Soh \n1\n, A Sarriff \n\n\n\n2  \n\n\n\n1 \nFaculty of Pharmacy, Universiti Teknologi MARA, Puncak Alam, Selangor Darul Ehsan \n\n\n\n2 \nSchool of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang\n\n\n\n\n\n\n\n\n\n\n\nWith the increasing competition of community pharmacies and the recently proposed \n\n\n\nrestructuring of national healthcare system (\"1Care for 1Malaysia\"), offering \n\n\n\ncomprehensive pharmaceutical care services becomes the key point to the survival and \n\n\n\ndevelopment of community pharmacies in Malaysia. However, local community \n\n\n\npharmacies have minimal focus on nondispensing-related pharmaceutical care services. \n\n\n\nTherefore, a pilot study was conducted to identify the perceived barriers to practising \n\n\n\npharmaceutical care within community pharmacies. All community pharmacists (n=173) \n\n\n\npractising in the state of Penang, Malaysia were sent a questionnaire by mail, employing \n\n\n\nthe modified Dillman Total Design Survey Method. The instrument contained questions \n\n\n\nto evaluate the community pharmacists\u201f level of agreement using a 5-point Likert-type \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 103 \n\n\n\nresponse scale. Of the 173 community pharmacists, 94 returned the questionnaire \n\n\n\n(response rate=54.3%) following 4 contacts (3 mail-outs and a walk-in collection) with \n\n\n\nthe respondents. Majority of the respondents were young (\u226440years) (n=39, 83%), female \n\n\n\n(n=60, 63.8%) and self-employed (n=48, 51.1%) community pharmacists. The top 5 \n\n\n\nperceived barriers for implementation of pharmaceutical care were insufficient time \n\n\n\n(n=78, 82.9%), pharmacists\u201f level of understanding of pharmaceutical care (n=70, \n\n\n\n74.5%), lack of access to patient medical records (n=69, 73.4%), lack of reimbursement \n\n\n\nsystem (n=62, 66%) and lack of motivated personnel such as pharmacy assistants (n=60, \n\n\n\n63.8%). In conclusion, a range of barriers need to be addressed before comprehensive \n\n\n\npharmaceutical care can be integrated into community pharmacy practice in Malaysia. \n\n\n\nThese barriers could be overcome through empowerment of community pharmacists by \n\n\n\ncontinuing professional development, revision of current pharmacy curriculum and \n\n\n\navailability of resources. \n\n\n\n\n\n\n\n \nPPP12 (000083) \n\n\n\n\n\n\n\nUnused Medicines among Older Adults in Universiti Kebangsaan Malaysia Medical \n\n\n\nCentre \n\n\n\n\n\n\n\nK S Tan, N A Taha \n\n\n\nFaculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur \n\n\n\nOlder adults are the leading consumers of medicines. Nevertheless, the inclination among \n\n\n\nthe seniors to have medicines underutilized may implicate significant loss of resources. \n\n\n\nTo date, data from available studies were scarce to describe the wastage due to unused \n\n\n\nmedicines among older adults in Malaysia. This preliminary study aimed to evaluate the \n\n\n\nextent of unused medicines among Malaysian veterans and its possible contributing \n\n\n\nfactors. Sixty-four patients aged 60 years and above attending the Primary Care Clinic of \n\n\n\nUniversiti Kebangsaan Malaysia Medical Centre (UKMMC) were recruited by \n\n\n\nconvenient sampling between April to June 2012. The subjects were surveyed to identify \n\n\n\nhoarding of unused medicines. The excessive medicines were collected from the \n\n\n\nconsenting subjects for inspection and quantification. Only 22% of participants (n = 14) \n\n\n\nvolunteered to return their unused medicines, while the others denied hoarding of \n\n\n\nexcessive medicines or refused to have them surrendered. Thirty-seven types of \n\n\n\nmedicines were collected totalling to 6,645 pills. Majority of the medicines returned (22 \n\n\n\ntypes) were drugs for cardiovascular diseases, particularly antihypertensive agents and \n\n\n\nlipid-lowering drugs. Total cost of medicines wastage computed was RM 2,406.67, with \n\n\n\nan average of RM 171.90 per patient. Non-adherence to prescribed medicines, \n\n\n\ndiscrepancies in supply of medications, and purposive hoarding of medications were the \n\n\n\ncommon reasons for accumulation of unused medicines among the participants. In \n\n\n\nconclusion, wastage due to unused medicines among elderly patients may be a hidden \n\n\n\ntruth that needs to be addressed to prevent adversities of health and financial outcomes. \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 104 \n\n\n\n \nPPP13 (000084) \n\n\n\n\n\n\n\nBeliefs and Adherence about Medicines among Psoriasis Patients in Government \n\n\n\nHospitals \n\n\n\n\n\n\n\nZ Shahirah \n1\n, M Mansor \n\n\n\n2\n, M A Salmiah \n\n\n\n3\n, R Rohna \n\n\n\n4\n, T Tarita \n\n\n\n5 \n \n\n\n\n1\n Department of Pharmacy, Selayang Hospital, Selangor \n\n\n\n2\n Faculty of Pharmacy, UiTM, Puncak Alam, Selangor \n\n\n\n3\n School of Pharmacy, Taylor\u2019s University, Selangor \n\n\n\n4\n Department of Dermatology, Selayang Hospital, Selangor \n\n\n\n5\n Department of Medicine, UPM & Serdang Hospital, Selangor \n\n\n\n\n\n\n\nPsoriasis is a chronic skin disease that affects an individual\u201fs quality of life. Beliefs about \n\n\n\nmedicines have been identified as one of the contributor of patient\u201fs non-adherence. This \n\n\n\nstudy was to examine patients\u201f beliefs in medicines and its relationship towards \n\n\n\nadherence among psoriasis patients.  \n\n\n\nA cross sectional survey was carried out among psoriasis patients at the dermatology \n\n\n\noutpatient clinic in Selayang and Serdang hospitals. Data were collected using patients\u201f \n\n\n\ndata form and validated \u201cBeliefs about Medicines Questionnaires (BMQs)\u201d and \u201cMorisky \n\n\n\nMedication Adherence Scale-8 Questionnaires\u201d. Descriptive and parametric statistics \n\n\n\nwere employed for data analysis. Multivariable logistic regression was used to determine \n\n\n\npredictors of self-reported medication adherence. A total of 146 psoriasis patients were \n\n\n\ninvolved which comprised of 47.9% (n = 70) male and 52.1% (n = 76) female. Most of \n\n\n\nthe characteristics between the two hospitals are similar. Most of the patients (79.5%) had \n\n\n\nreported low medication adherence (MMAS < 2). The results from BMQs showed the \n\n\n\nmean of necessity score (mean \u00b1 S.D., 17.31 \u00b1 4.191) slightly outweighs the concern \n\n\n\nscore (Mean \u00b1 S.D., 15.90 \u00b1 4.191).  Forty five percent (45.0%) of patients had necessity \n\n\n\nscale outweighing concern score (43.1%).  A positive correlation was found in necessity \n\n\n\nbeliefs compared with other types of beliefs about medicines.  Multivariate analysis has \n\n\n\nidentified factors associated with low self-reported adherence are age, necessity beliefs \n\n\n\nand harm beliefs. The study showed that most of the psoriatic patients have poor \n\n\n\nadherence and medication beliefs which are correlated to their age, necessity and harm \n\n\n\nbeliefs. Thus, improving their beliefs\u201f about the prescribed medicines is critical so as to \n\n\n\nensure patients\u201f has no negative beliefs about medicines. \n\n\n\n\n\n\n\n \nPPP14 (000107) \n\n\n\n\n\n\n\nSelf Medication Practice Assessment in Rural Area: Puncak Alam, Kuala Selangor \n\n\n\n\n\n\n\nJ Permala \n1\n, M Shafiq \n\n\n\n2\n, M Anwar \n\n\n\n1\n \n\n\n\n1\n Department of Pharmacy Practice, Faculty of Pharmacy, UiTM, Selangor \n\n\n\n2\n Department of Pharmacy, Hospital Queen Elizabeth, Kota Kinabalu, Sabah \n\n\n\n\n\n\n\nSelf medication is commonly practiced by individuals who prescribed medications to \n\n\n\nthemselves without the guidance and supervision of medical practitioners. Self \n\n\n\nmedication can actually serves as a useful behaviour to treat minor ailments but in certain \n\n\n\ncases can cause serious implications with the possibility of fatal consequences. This study \n\n\n\nwas aimed to investigate the extent of self medication practice among the rural population \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 105 \n\n\n\nin the vicinity of Puncak Alam. Validated questionnaires were distributed to 200 over \n\n\n\nrespondents in Puncak Alam who regularly has the habit to self medicate. Data collected \n\n\n\nwas analyzed through SPSS version18. From the statistical analysis data, it was found \n\n\n\nthat the three ailments most commonly treated through self medication were headache \n\n\n\n(77%); flu, fever, cough (58%); stomach ache (45%). How an individual perceived the \n\n\n\nseriousness of an ailment he or she experienced contributed largely to the practice of self \n\n\n\nmedication. Many instances, particular ailments that may be considered serious and \n\n\n\nrequires medical practitioner's attention is ignored and self medicated. 68.5% of the \n\n\n\nrespondent perceived that their illnesses are not serious and could be resolved through \n\n\n\nself medication. Meanwhile, 62% of the respondents resort to self medication blaming \n\n\n\ncost as the major factor. Majority of the respondents (85%) claimed that they were \n\n\n\nsatisfied with the results of their self medication. From these data obtained, we can see \n\n\n\nthat self medication is becoming a norm with the rural population and it is essential that \n\n\n\npharmacists understand the paramount importance of guided self medication to avoid any \n\n\n\nfatal implications. \n\n\n\n\n\n\n\n \nPPP15 (000109) \n\n\n\n\n\n\n\nEvaluating Knowledge, Attitude & Perception Regarding Halal Pharmaceuticals, \n\n\n\nAmong Community Pharmacists in Malaysia \n\n\n\n\n\n\n\nS Sadeeqa, A Sarriff, I Masood \n\n\n\nSchool of Pharmaceutical Sciences, Universiti Sains Malaysia, Pinang \n\n\n\n\n\n\n\nThis was a cross sectional, postal survey using a structure , self-administered \n\n\n\nquestionnaires to evaluate the knowledge, attitude & perceptions (KAP) regarding \n\n\n\n\u201chalalness\u201d of pharmaceuticals, among community pharmacists across Malaysia, in April-\n\n\n\nJune 2012. Questionnaires were sent to 542 systematic randomly selected pharmacists \n\n\n\nfrom a list of 1536 registered Pharmacies. A total of 175 responded to questionnaires with \n\n\n\na response rate of 32%. Inclusion criteria were registered pharmacists with Malaysian \n\n\n\nPharmacy Council. Study settings included randomly selected, community pharmacies in \n\n\n\nMalaysia. Data was analysed by using SPSS version 18. Results revealed that community \n\n\n\npharmacists have a good knowledge and positive attitude and perceptions about \n\n\n\n\u201chalalness\u201d of pharmaceuticals. Mean knowledge score out of maximum possible 9 scores \n\n\n\nwas 7.94 \u00b1 1.42, mean attitude score out of maximum possible 45 scores was 36.65 \u00b1 \n\n\n\n6.96 while mean perception score out of maximum possible 60 scores was 51.9 \u00b1 6.07. \n\n\n\nMean overall KAP score out of maximum possible 114 was 96.19 \u00b1 12.33. There was a \n\n\n\nsignificant, positive, and good (0.5-0.75) correlation between knowledge and attitude (r = \n\n\n\n0.515, p<0.001), excellent (>0.75) correlation between attitude and perception (r = 0.753, \n\n\n\np < 0.001) and fair (0.25 - 0.5) correlation between knowledge and perceptions (r = 0.458, \n\n\n\np < 0.001) This means that better the knowledge respondents have on halal \n\n\n\npharmaceuticals, the better their perception & attitude is towards halal pharmaceuticals. P \n\n\n\nvalue of 0.05 or less was taken as statistically significant. \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 106 \n\n\n\n \nPPP16 (000125) \n\n\n\n\n\n\n\nPharmaceutical Care Provision: Are Community Pharmacists in Malaysia Ready? \n\n\n\n\n\n\n\nY C Soh \n1\n, A Sarriff  \n\n\n\n2\n \n\n\n\n1\n Faculty of Pharmacy, Universiti Teknologi MARA, Puncak Alam, Selangor Darul Ehsan \n\n\n\n2\n School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang \n\n\n\n\n\n\n\nIn line with the proposed restructuring of Malaysian healthcare system, greater emphasis \n\n\n\non pharmaceutical care provision in community pharmacy will be targeted. Therefore, a \n\n\n\ncross-sectional survey was conducted to investigate the readiness of Malaysian \n\n\n\ncommunity pharmacists to provide pharmaceutical care services. Special focus was on the \n\n\n\nattitudes and general understanding of pharmaceutical care concept by Malaysian \n\n\n\ncommunity pharmacists. Data were collected with a postal questionnaire which was sent \n\n\n\nto all community pharmacists (n=173) practicing in the state of Penang, Malaysia. Of 173 \n\n\n\ncommunity pharmacists, 94 returned the questionnaire (response rate=54.3%). \n\n\n\nRespondents were primarily younger (\u226440years) (n=39, 83%), female (n=60, 63.8%) and \n\n\n\nself-employed (n=48, 51.1%) community pharmacists. This study demonstrated that \n\n\n\ncommunity pharmacists in the state of Penang, Malaysia had a reasonable understanding \n\n\n\nof pharmaceutical care concept. In general, pharmaceutical care concept was better \n\n\n\nunderstood by employee pharmacists than the pharmacy owners (P=0.035). Over 90% of \n\n\n\nthe respondents were aware of the pharmaceutical care practice in various settings, \n\n\n\npharmacists\u201f role and primary aim of pharmaceutical care concept. A high proportion of \n\n\n\nrespondents (n=82, 87.2%) think that there is a need for continuing professional \n\n\n\ndevelopment on pharmaceutical care. 80.8 % (n=76) of them fully support pharmaceutical \n\n\n\ncare concept and believed that pharmaceutical care requires major up-skilling of clinical \n\n\n\nknowledge. 41.5 % (n=39) had reserve about the other health professionals\u201f support for \n\n\n\npharmacists\u201f pharmaceutical care role. In conclusion, Malaysian community pharmacists \n\n\n\nhad expressed a willingness to implement pharmaceutical care practice but several actions \n\n\n\nare required to facilitate its implementation. \n\n\n\n\n\n\n\n \nPPP17 (000127) \n\n\n\n\n\n\n\nFactors Influencing the Role of Community and Hospital Pharmacists in Malaysia \n\n\n\n\n\n\n\nC S Cheng, W M Lau, Y S Wong \n\n\n\nJeffrey Cheah School of Medicine & Health Sciences, Monash University Malaysia, \n\n\n\nSelangor \n\n\n\n\n\n\n\nThe professional roles of pharmacists have been cited as influential in guiding the career \n\n\n\nchoices of pharmacy graduates in Malaysia. However, the leadership and the moral \n\n\n\nreasoning of the pharmacists themselves also influence their role as pharmacists. As such, \n\n\n\nthe views of leaders of the profession would provide insights into identifying key factors \n\n\n\nwhich contributes towards the evolution of pharmacy practice in Malaysia. Semi \n\n\n\nstructured tape recorded interviews were conducted with 3 senior hospital pharmacists \n\n\n\nand 2 senior community pharmacists to elucidate these factors. The participants were \n\n\n\ninvited by the supervisor of the research project to be interviewed and were then \n\n\n\ninterviewed by an undergraduate student with the supervisor. The interviews were coded \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 107 \n\n\n\nand transcribed. Qualitative research principles were used to identify and list the \n\n\n\nemerging themes which are considered to influence the role of pharmacist in Malaysia. \n\n\n\nThe factors were identified and categorized into themes. All the information collected \n\n\n\nfrom the interviews pinpoints the factors which influence the role of hospital and \n\n\n\ncommunity pharmacist. The factors then are categorized into 5 themes: Prescriber related \n\n\n\nfactors; Patients related factors; Junior Pharmacist related factors; Malaysian health \n\n\n\nsystem issues; Pharmacy or hospital setting issues. Due to the different working \n\n\n\nbackground and experience of each participant, various factors were mentioned which \n\n\n\ninfluenced the role of pharmacists in different setting in Malaysia with a future prospect \n\n\n\nin rural pharmacy setting. \n\n\n\n\n\n\n\n \nPPP18 (000020) \n\n\n\n\n\n\n\nStudy on the Impact of Colour Coded Syringe Labels (CCSL) for Emergency Drugs \n\n\n\nin Hospital Kuala Lumpur (EDHKL) \n\n\n\n\n\n\n\nKavidha Mohan \n1 \n, Kasturee \n\n\n\n1\n,\n \nFudziah Ariffin \n\n\n\n1\n, Radin Adriana H R T \n\n\n\n2\n,\n \n Sarah A K \n\n\n\n2\n, Abu Hassan A H A \n\n\n\n2\n  \n\n\n\n1\n Pharmacy Department, Hospital Kuala Lumpur, Kuala Lumpur  \n\n\n\n2 \nEmergency & Trauma Department Hospital Kuala Lumpur (EDHKL), Kuala Lumpur \n\n\n\n\n\n\n\nMedication errors involving injectables is an on-going issue among healthcare teams in \n\n\n\ncritical care areas such as Emergency Department (ED). Labeling of injectables is an \n\n\n\nintegral part of drug preparation. Colour Coded Syringe Label (CCSL) utilises colour to \n\n\n\ndifferentiate classes of drugs, providing visual cues to reduce the risk of interclass errors \n\n\n\nand prevent accidental syringe swapping. This was a prospective observational study \n\n\n\nconducted at EDHKL for a period of 1 year (March 2011 till Febuary 2012). \n\n\n\nThe objective of the study was to analyse the effect of CCSL in terms of user interface \n\n\n\nand compliance to labeling requirements. A total of 120 clinical staff from EDHKL \n\n\n\nparticipated in the study. Data collection was divided into 3 parts; (i) assessment of \n\n\n\nknowledge, experience and current practice methods of drug preparation prior to CCSL, \n\n\n\n(ii) compliance audit and (iii) identifying drawbacks and level of staff acceptance. 75.8% \n\n\n\nof respondents agreed that similar packaging of drugs contributed to medication errors in \n\n\n\nEDHKL. 71% of labelling procedures carried out were compliant to the requirements and \n\n\n\nprocedures of CCSL usage protocol. 95% of clinical staff in EDHKL wanted the use of \n\n\n\nCCSL to continue due to various reasons such as convenience of use and quicker/timely \n\n\n\ndrug preparation. CCSL was well accepted by the clinical staff in EDHKL, as reflected in \n\n\n\nthe audit which showed a 71% compliance rate and  the feedback questionnaire during the \n\n\n\npost introduction of CCSL. Suggestions for improvements of the CCSL was to provide \n\n\n\nseparate labels for bolus and infusion drugs.  \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 108 \n\n\n\n \nPPP19 (000041) \n\n\n\n\n\n\n\nEconomic Evaluation of Methadone Maintenance Therapy (MMT) and Long-Term \n\n\n\nResidential Treatment (LTRT) Program for Drug Abuse Patients in the State of \n\n\n\nPenang and Kedah, Malaysia \n\n\n\n\n\n\n\nAbdul Ghani N \n1\n, Shafie A A \n\n\n\n2\n, Hassali M A \n\n\n\n2\n \n\n\n\n1 \nHospital Sultanah Bahiyah, Alor Star, Kedah \n\n\n\n2\n School of Pharmaceutical Sciences, Universiti Sains Malaysia, Pulau Pinang \n\n\n\n\n\n\n\nMMT Programme was launched in Malaysia in 2005 as an alternative to LTRT for drug \n\n\n\nabuse patients. Both are fully funded by the government but little is known about which \n\n\n\nalternative is more efficient and should be preferred. The economic evaluation was based \n\n\n\non data from cross-sectional HRQoL and retrospective cost studies involving 400 opiate-\n\n\n\ndependent patients. Consenting patients were interviewed to collect their socio-\n\n\n\ndemographic data, drug consumption history, HRQoL status and opiate treatment \n\n\n\nevaluation using data collection forms and the EQ-5D, EQ-VAS, WHOQOL-BREF and \n\n\n\nOTI instruments. Cost data were collected using activity-based-costing and DATCAP \n\n\n\ninstrument from the healthcare providers perspective. Mean EQ-5D score was \n\n\n\nsignificantly higher among MMT participants (mean = 0.78, SD = 0.19) compared to \n\n\n\nthose in LTRT (mean = 0.71, SD = 0.23, p < 0.05). The capital cost for MMT program \n\n\n\nwas MYR 26,035 and LTRT was MYR6,724,575. Monthly cost to provide MMT \n\n\n\nprogram for one patient was MYR 156, which was significantly lower (P < 0.0001) than \n\n\n\nLTRT program (MYR 1024). Very good fit regression model was produced with adjusted \n\n\n\nR\n2\n of 0.77 (F10,174 = 62.462, p < 0.00005). The results showed that after controlling for \n\n\n\nother factors, patients with severe pain had higher cost by 140%. The CER of MMT \n\n\n\n(MYR 2426/QALY) is dominant with lower cost and higher outcome compared to LTRT \n\n\n\n(MYR 18863/QALY). The calculated ICER was \u2013MYR 413983/QALY. This study \n\n\n\nshowed that MMT treatment for patients with substance use disorder resulted in better \n\n\n\nHRQoL. This analysis suggested that MMT is highly cost-effective compared to LTRT \n\n\n\nwith the expected saving of MYR12419/patient/year. Sensitivity analyses conducted \n\n\n\nfound that the results were robust to changes in the model parameters. \n\n\n\n\n\n\n\n \nPPP20 (000090) \n\n\n\n\n\n\n\nPerception of Public and Undergraduates towards Fear and Exclusion of People \n\n\n\nwith Mental Illness \n\n\n\n\n\n\n\nN E Ismail, H Samsudin, M A Nawab Khan, M A Hameed \n\n\n\nClinical Pharmaceutics Research Group (CPRG), Inhalational Delivery Research Unit \n\n\n\n(IDRU) & Biomedical Analysis Lab (BAL), Faculty of Pharmacy, Universiti Teknologi \n\n\n\nMARA (UiTM), Puncak Alam Campus, 42300 Bandar Puncak Alam, Selangor \n\n\n\n\n\n\n\nA survey using self administered questionnaires was conducted to assess the perception \n\n\n\nlevel of fear and exclusion towards people with mental illness among public (P) and \n\n\n\nundergraduates (UG) in Shah Alam and Puncak Alam, Selangor, Malaysia. The study was \n\n\n\nconducted from July to September 2009. The questionnaire items were comprised of \n\n\n\nsocio-demography and 8 negative attitudes with response using 5 Likert\u201fs scale ratings: \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 109 \n\n\n\nstrongly agree to strongly disagree (Cronbach\u201fs alpha: 0.68). 463 questionnaire forms \n\n\n\nwere disseminated to targeted population (age more than 18 years old). 400 \n\n\n\nquestionnaires (n = 200 UG) were returned and completed (response rate: 82.0% UG; \n\n\n\n91.0% P). Data were analysed using IBM SPSS version 14.0. Descriptive and inferential \n\n\n\nstatistics such as independent student t-test were widely used to establish differences of \n\n\n\nperceptions between 2 study groups. A p-value of < 0.05 was considered as significant. \n\n\n\nMajority of respondents were in younger age of life (18 - 23 years old) with mean (\u00b1SD) \n\n\n\nage of 29.6 (\u00b113.6) years old, female, single, Malay, Muslim, graduated and attending \n\n\n\nany formal higher educational institution, employed and had household monthly income \n\n\n\nof < RM 1500. There were significant differences between UG and P in items, locating \n\n\n\nmental health facilities in a residential area downgrades the neighbourhood (p = 0.008) \n\n\n\nand people with mental illness are a burden on society (p < 0.001) with both high level of \n\n\n\ndisagreement (58.5% UG vs. 41.0% P; 37.0% UG vs. 45.0% P, respectively). Educational \n\n\n\nlevel, race and gender significantly influenced the positive perception level of fear and \n\n\n\nexclusion towards people with mental illness. \n\n\n\n\n\n\n\n \nPPP21 (000095) \n\n\n\n\n\n\n\nThe Outcome of Continuous Assessments on Undergraduate Pharmacy Students' \n\n\n\nPerformance \n\n\n\n\n\n\n\nS K May \n1\n, H M Tin \n\n\n\n2\n \n\n\n\n1\n Basic Medical Sciences Department, Faculty of Pharmacy, International Islamic \n\n\n\nUniversity Malaysia, Kuantan, Pahang \n2\n Community Dentistry Department, Faculty of Dentistry, International Islamic \n\n\n\nUniversity Malaysia, Kuantan \n\n\n\n\n\n\n\nMid semester examination (MSE) was abolished and replaced by continuous assessments \n\n\n\n(CA) in Kulliyyah of Pharmacy, International Islamic University Malaysia in 2010. The \n\n\n\noverall score of CA and MSE contribute 40% of the total score. This study examined the \n\n\n\noutcome of CA on the students\u201f academic performance in Medical Biochemistry. We \n\n\n\nstudied the impact of CA on overall students\u201f performance before and after curriculum \n\n\n\nchanges. A retrospective desktop study was done by using the records of students\u201f \n\n\n\nperformance. Total 373 students from two different groups were included. Group I \n\n\n\nconsisted of 175 students who had taken the MSE under the old curriculum whereas \n\n\n\nGroup II consisted of 198 students. Both groups received the same structure of questions \n\n\n\nfor the end semester exam (ESE). The comparative analyses of scoring in CA versus \n\n\n\nMSE and cross analysis of final grading in accordance with academic years were done. \n\n\n\nGroup II achieved better results with CA (27.91\u00b13.28) than group I (23.91\u00b1 3.41) with \n\n\n\nMSE [p <0.05]. The ESE result in group II (67.84\u00b17.2) was significantly higher than that \n\n\n\nof group I (61.56\u00b18.52) [p<0.05]. A total of 8 students (4.6%) from Group I failed but no \n\n\n\nfailure from Group II. Thus, CA assists the students in improving their grades at the ESE. \n\n\n\nThis CA is not favoured by the students as they have to work hard to meet the \n\n\n\ncommitments but it has more credibility than MSE in evaluating students\u201f study progress. \n\n\n\nIn conclusion, the new system of assessment of CA is more applicable and beneficial to \n\n\n\nthe students than the MSE. \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 110 \n\n\n\nPHARMACEUTICAL CHEMISTRY / PHARMACOLOGY / TRADITIONAL & \n\n\n\nCOMPLEMENTARY MEDICINE \n\n\n\n\n\n\n\n \nPPM1 (000033) \n\n\n\n\n\n\n\nBetulinic Acid Inhibits Toll-like Receptor-4 (TLR4) Dimerisation and Its Molecular \n\n\n\nInteractions \n\n\n\n\n\n\n\nC W Mai, Y B Kang, M R Pichika \n\n\n\nDepartment of Pharmaceutical Chemistry, School of Pharmacy, International Medical \n\n\n\nUniversity, Kuala Lumpur \n\n\n\n\n\n\n\nBetulinic acid is commonly known for its health benefits to mankind. It is also reported to \n\n\n\nsuppress immune response by down regulating the pro-inflammatory cytokines makes it \n\n\n\nto be a potential molecule for further investigation. However its specific target in immune \n\n\n\nsystem remains to be identified. One of the recently characterised proteins that play a key \n\n\n\nrole in autoimmune disorders is Toll-like receptor-4 (TLR-4). Homodimerisation of TLR-\n\n\n\n4/MD-2 complexes which are stimulated by pathogens will result in life threatening \n\n\n\nimmune responses. Therefore, in this study we evaluated the effect of betulinic acid on \n\n\n\nTLR-4/MD-2 homodimerisation and its molecular interactions with TLR-4. HEK-293 \n\n\n\ncells transfected with TLR-4/MD-2; lipopolysaccharide (LPSEc) from Escherichia coli, a \n\n\n\nknown agonist of TLR-4 were used to evaluate the effect of betulinic acid on \n\n\n\nhomodimerisation. The effect of betulinic acid on homodimerisation in the presence of \n\n\n\nLPSEc was determined. The results revealed that betulinic acid is preventing \n\n\n\nhomodimerisation. To further understand the molecular interactions between betulinic \n\n\n\nacid and TLR-4/MD-2, we have performed molecular docking studies. The majority of \n\n\n\nthe interactions between betulinic acid and TLR-4/MD-2 are through MD-2, a unique \n\n\n\nprotein that only associate with TLR-4 but not with other toll-like receptors. These results \n\n\n\nare suggesting that betulinic acid might be selective towards TLR-4 compared to other \n\n\n\nTLRs. This suggests that betulinic acid could specifically prevent TLR-4 over-activation \n\n\n\nthrough disturbing the homodimerisation of TLR-4/MD-2 complexes and thus able to \n\n\n\nprevent life threatening immune responses in autoimmune disorders. \n\n\n\n\n\n\n\n \nPPM2 (000079) \n\n\n\n\n\n\n\nNovel 1,4-Benzothiazine Derivatives as Antimicrobial Agents: Synthesis, \n\n\n\nCharacterization and Evaluation \n\n\n\n\n\n\n\nAnandarajagopal \n1\n, Sampathkumar \n\n\n\n2\n, A J Sunilson \n\n\n\n1\n, A G Kumari \n\n\n\n1\n \n\n\n\n1 \nSchool of Pharmacy, KPJ University College, Kota Seriemas, Nilai, Negeri Sembilan, \n\n\n\nMalaysia \n2 \n\n\n\nDepartment of Pharmaceutical Chemistry, Arulmigu Kalasalingam College of \n\n\n\nPharmacy, Krishnankoil, Tamil Nadu, India \n\n\n\n\n\n\n\nDespite the increase in microbial infections, therapeutic options are very limited and are \n\n\n\noften unsatisfactory because of high toxicity and an inability to eradicate infections. The \n\n\n\nchemistry of heterocyclic compounds has been an interesting field for the development of \n\n\n\nnew medicinal compounds. Different classes of benzothiazine compounds possess an \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 111 \n\n\n\nextensive spectrum of pharmacological activities such as analgesic, anti-inflammatory, \n\n\n\nanticonvulsant, antiulcer, anticancer, antibacterial and antifungal. In this study, a series of \n\n\n\nnovel 1,4-benzothiazine derivatives were synthesized and evaluated for their antibacterial \n\n\n\nand antifungal properties. Oxidative cyclization of 2-amino thiophenol with ethyl \n\n\n\nchloroacetate yielded 1,4-benzothiazine-3-(2H)-one which was refluxed with hydrazine \n\n\n\nhydrate in methanol to form 3-hydrazino benzothiazine and finally refluxed with different \n\n\n\nketones to form  3-substituted benzylideno hydrazino benzothiazines. The synthesized \n\n\n\ncompounds were confirmed by melting point and TLC and their structures were \n\n\n\nestablished by various analytical techniques such as IR and \n1\nHNMR spectral studies. All \n\n\n\nthe newly synthesized compounds exhibited moderate to good antibacterial and antifungal \n\n\n\nactivities. \n\n\n\n\n\n\n\n \nPPM3 (000120) \n\n\n\n\n\n\n\nChemical Composition and Antimicrobial Activity of Eucalyptus Camaldulensis \n\n\n\nDehnh Essential Oil from Malaysia \n\n\n\n\n\n\n\nE E Mubarak \n1,2\n\n\n\n, R M Taha \n1\n , S Mohajer \n\n\n\n1\n \n\n\n\n1\n Institute of Biological Sciences, Faculty of Science, University of Malaya, Kuala \n\n\n\nLumpur, Malaysia \n2\n Faculty of Pure and applied Sciences, International University of Africa, Khartoum, \n\n\n\nSudan \n\n\n\n\n\n\n\nEucalyptus are important plants containing essential oil widely used in cosmetic, \n\n\n\npharmaceutical and food industries. Chemical composition and biological activity of \n\n\n\nessential oils are determined by a number of genetic factors, climate, time of harvesting, \n\n\n\nthe plant age and others. Although they are native to Australia and Tasmania, Eucalyptus \n\n\n\nspecies have been cultivated worldwide and yet have not been commonly grown in \n\n\n\nMalaysia. The objectives of this study were to investigate the chemical and biological \n\n\n\nactivity of E. camaldulensis grown in Malaysia. An investigation of the oil constituents of \n\n\n\nthe fresh, crushed leaves of E. camaldulensis Dehnh grown in University of Malaya \n\n\n\ncompound, was carried out. The oil was extracted by hydrodistillation and the chemical \n\n\n\ncomposition was analyzed by GC-MS. The essential oil yield was 1.33% dried weight, a \n\n\n\nrelatively higher content of essential oil. Majority of the oil components were identified. \n\n\n\nThe oil was highly rich in monoterpenes. Four major compounds were dominated in the \n\n\n\noil. Terpinene is the main component of the essential oil. Its relative content was 63.8% \n\n\n\nfollowed by o-Cymene, Terpinen-4-ol and Terpinolene (22.5%, 9.5% and 1.3%, \n\n\n\nrespectively). However, other Eucalyptus oil components such as 1,8-cineole, \u00b1-pinene \n\n\n\nand \u00b1-phellandrene were found to be in very low concentrations in the oil (0.71%, 0.44% \n\n\n\nand 0.02%). Antibacterial screening tests against different bacterial species revealed that \n\n\n\nthe oil has potent inhibitive effects. The results showed that these valuable oils can be \n\n\n\nproduced commercially in Malaysia environment. \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 112 \n\n\n\n \nPPM4 (000123) \n\n\n\n\n\n\n\nEnergies Evaluation in the Binding of the Monoclonal Antibody 1A1D-2 Complexed \n\n\n\nwith Domain III of the Viral Envelope Glycoprotein E of DENV \n\n\n\n\n\n\n\nW L Chong \n1\n, S M Zain \n\n\n\n1\n, N Abd. Rahman \n\n\n\n1\n, R B Othman \n\n\n\n2\n, V S Lee \n\n\n\n1,3\n \n\n\n\n1\n Drug Design & Development Research Group (DDDRG), Department of Chemistry, \n\n\n\nFaculty of Science, University of Malaya, Kuala Lumpur, Malaysia \n2 \n\n\n\nDepartment of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur, \n\n\n\nMalaysia \n3 \n\n\n\nComputational Simulation and Modeling Laboratory (CSML), Center of Excellence in \n\n\n\nPhysics (ThEP), CHE, Ministry of Education, Bangkok, Thailand \n\n\n\n\n\n\n\nDengue is endemic and has a high fatality rate. Reported cases of illness have been \n\n\n\nincreasing over the past years in tropical regions. Even though there are a few vaccines \n\n\n\nbeing currently evaluated, development of an antibody as a treatment would also be a \n\n\n\ngood treatment option. Antibody 1A1D-2 has been reported as having a neutralizing \n\n\n\neffect on DENV type 1, 2 and 3. In this study, computational assisted modeling was \n\n\n\ncarried out to investigate the importance of specific residues in the binding site of the \n\n\n\nmonoclonal antibody 1A1D-2 complexed with domain III of the viral envelope \n\n\n\nglycoprotein E of DENV 2 using the Discovery Studio 2.5. The interaction energy was \n\n\n\nfound to be relatively low (negative), indicating a stable system and thus a likely binding \n\n\n\ninteraction. The interaction energy of the heavy chain of the antibody was found to be \n\n\n\nlower than the light chain by about ~170 kcal/mol with CHARMM force field. Besides, \n\n\n\nexamining the interactions of the residues in the heavy chain and the light chain with the \n\n\n\nfragment complex under 3\u00c5 indicated that more amino acid residues are involved in \n\n\n\nbinding with the heavy chain which implies a vital role of the heavy chain upon binding. \n\n\n\nSpecific residues located in the complementary determining regions (CDRs) and their \n\n\n\ninteraction energies with the viral envelope glycoprotein E were identified. \n\n\n\n\n\n\n\n \nPPM5 (000067) \n\n\n\n\n\n\n\nMolecular Characterization of the K-ras Protein in Lung Cancer \n\n\n\n\n\n\n\nA Fatima, H F Yee \n\n\n\nDepartment of Pharmaceutical Technology, Faculty of Pharmaceutical Sciences, UCSI \n\n\n\nUniversity, Kuala Lumpur \n\n\n\n\n\n\n\nComputational experimental strategies of modeling and docking are becoming pivotal in \n\n\n\nthe new drug screening process. The methods are fast and reliable enough to identify \n\n\n\npossible hits for old and emerging diseases. K-ras protein mutations at codon 12 and 13 \n\n\n\nhave been implicated to play a critical role in development and progression in non small \n\n\n\ncell lung cancer (NSCLC). The purpose of this study was to analyse the key mutations \n\n\n\noccurring in the K-ras protein by developing models of the mutated K-ras protein using \n\n\n\nModeller. RMSD values from the Swiss PDB viewer, DOPE score generated by \n\n\n\nModeller, and Ramachandran plots obtained from PROCHECK were used to assess the \n\n\n\npredicted models of mutated K-ras protein in its active and inactive forms. Docking was \n\n\n\nperformed with Autodock Vina 4.2 on a reported crystal structure of the K-ras protein \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 113 \n\n\n\n(4dsn.pdb) with reported potentially active compounds from Malaysian herbs. Phytol, \n\n\n\nhexadecane, hexadecanoic acid and pheophorbide found in T. flagelliforme were selected \n\n\n\nfor docking studies. The selected ligands were found to have a high binding affinity for \n\n\n\nthe SOS pocket, an important binding site on the K-ras protein. \n\n\n\n\n\n\n\n \nPPM6 (000076) \n\n\n\n\n\n\n\nAnti Helicobacter pylori Activity of Hibiscus vitifolius in Ulcerated Albino Rats \n\n\n\n\n\n\n\nA G Kumari, A J Sunilson, R A Rahman, Anandarajagopal, A Khan \n\n\n\nSchool of Pharmacy, KPJ University College, Kota Seriemas, 71800 Nilai, Negeri \n\n\n\nSembilan \n\n\n\n\n\n\n\nThe root of Hibiscus vitifolius (Malvaceae) is traditionally used for the treatment of ulcer \n\n\n\nand different type of microbial infections. The study was designed to evaluate anti \n\n\n\nHelicobacter pylori activity of H. vitifolius roots extracts in ulcerated rats. On the basis of \n\n\n\nphytochemical screening of various extracts of H. vitifolius, methanol extract (ME) was \n\n\n\nselected to assess anti Helicobacter pylori since it was found to be rich in \n\n\n\nphytoconstituents. The extract showed no sign of acute toxicity up to a dose level of 2000 \n\n\n\nmg/kg b.wt. All male Wistar rats were divided into five groups (n=6). Group-I served as \n\n\n\nnormal control whereas group-II induced with acetic acid and inoculated with H. pylori. \n\n\n\nGroup-III and IV induced with acetic acid and inoculated with H. pylori and treated with \n\n\n\nME at a dose of 200 and 400 mg/kg b.wt., respectively. Group\u2013V served as standard and \n\n\n\nreceived combination of Amoxicillin (50 mg/kg b.wt.), Clarithromycin (25 mg/kg b.wt.) \n\n\n\nand Omeprazole (20 mg/kg b.wt.) orally. After 14 days treatment, the blood was collected \n\n\n\nand the stomachs were removed. Administration of ME (400 mg/kg b.wt.) in ulcerated \n\n\n\nrats showed the significant (p<0.001) reduction in ulcerated area. The level of IL-1\u00df was \n\n\n\nsignificantly (p<0.01) decreased and the level of IL-10 was significantly (p<0.01) \n\n\n\nincreased when compared with H. pylori induced ulcerated rats. The biochemical \n\n\n\nobservations were supported by histopathological examination of stomach sections. These \n\n\n\nfindings conclude that methanol extract of H. vitifolius possesses significant anti \n\n\n\nHelicobacter pylori activity and supports its traditional claim. \n\n\n\n\n\n\n\n \nPPM7 (000078) \n\n\n\n\n\n\n\nAnalgesic and Antipyretic Activity of Manihot esculenta crantz Extracts \n\n\n\n\n\n\n\nR A Rahman \n1\n, A J Sunilson \n\n\n\n1\n, Z Zakaria \n\n\n\n2\n \n\n\n\n1\n School of Pharmacy, KPJ University College, Kota Seriemas, Nilai, Negeri Sembilan \n\n\n\n2\n PPPJJ, Universiti Sains Malaysia, Penang \n\n\n\n\n\n\n\nThe study was carried out to investigate the analgesic and antipyretic activities of leaves \n\n\n\nand tubers extracts of the plant Manihot esculenta crantz. The antipyretic activity was \n\n\n\ndetermined using brewer\u201fs yeast induced pyrexia method while analgesic activity was \n\n\n\ncarried out by two different models such as hot plate and tail immersion methods in Swiss \n\n\n\nalbino rats. Dried powdered plant materials were subjected to successive solvent \n\n\n\nmaceration with acetone, methanol and water.  The phytochemical studies revealed the \n\n\n\npresence of alkaloids, glycosides, flavonoids, phenolic compounds, saponins, steroids and \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 114 \n\n\n\ncarbohydrates in all the three extracts. The extracts at a dose of 200 mg/kg body weight \n\n\n\nwere subjected to analgesic and antipyretic activities. The methanol extract of the leaves \n\n\n\nand tubers showed a significant (p<0.001) analgesic activity which was compared with \n\n\n\nstandard drug, diclofenac sodium 10 mg/kg. The antipyretic activity of the methanol \n\n\n\nextracts of M. esculenta also significantly (p<0.001) reduced the elevated body \n\n\n\ntemperature in albino rats which was well compared with paracetamol 150 mg/kg. This \n\n\n\nfindings support the ethnomedical use of Manihot esculenta crantz in the treatment of \n\n\n\npain and fever. \n\n\n\n\n\n\n\n \nPPM8 (000113) \n\n\n\n\n\n\n\nInvolvement of Opioidergic and Serotonergic Pathways in the Analgesic Activity of \n\n\n\nCissus quadrangularis L. (Patah Tulang) Stem Extract in Mice \n\n\n\n\n\n\n\nT W Nie, A M Saleem, S Rajesh, A F Khursiah, R Shamala \n\n\n\nFaculty of Pharmaceutical Sciences, UCSI University, No.1, Jalan Menara Gading, UCSI \n\n\n\nHeights, Cheras 56000, Kuala Lumpur \n\n\n\n\n\n\n\nCissus quadrangularis L. (Vitaceae) is an edible plant, indigenous to Asia and Africa. It \n\n\n\nexhibited good fracture healing property and analgesic effect in rodents. Our previous \n\n\n\nstudy indicated that the chloroform extract of stem had potent analgesic activity in hot \n\n\n\nplate experiment than the methanolic extract. Hence, in this study, the mechanism of \n\n\n\nanalgesic activity of chloroform extract of stem of C. quadrangularis was explored in hot \n\n\n\nplate experiment in mice. The powdered stem of C. quadrangularis was extracted with \n\n\n\nchloroform and the extract was dried to semisolid residue. The residue was suspended in \n\n\n\n10% tween 20 in normal saline and administered (300 mg/kg, i.p. at 0 min) to albino mice \n\n\n\nafter pretreatment with naloxone (opioid antagonist, 1 mg/kg, i.p. at -15 min), p-\n\n\n\nchlorophenylalanine methyl ester (pCPA, inhibitor of serotonin synthesis) (100 mg/kg, \n\n\n\ni.p. once daily for three days) and phentolamine (alpha blocker, 20 mg/kg, i.p. at -15 \n\n\n\nmin). Morphine sulphate (3 mg/kg, i.p. at 0 min) was administered after pretreatment with \n\n\n\nnaloxone (1 mg/kg, i.p. at -15 min). The response time in seconds was measured at -15, 0, \n\n\n\n15, 30, 45, 60, 75 and 90 minutes in hot plate test. The data were analysed by one-way \n\n\n\nANOVA followed by Dunnett\u201fs test. Analgesic activity was observed significantly (p < \n\n\n\n0.05) in the group pretreated with phentolamine but not in the groups pretreated with \n\n\n\nnaloxone and pCPA. These results suggest that the analgesic activity of C. \n\n\n\nquadrangularis in mice might involve opioidergic and serotonergic pathways. \n\n\n\n\n\n\n\n \nPPM9 (000115) \n\n\n\n\n\n\n\nInvestigation of Gastro-Protective Activity of Schiff Bases Complexes and their \n\n\n\nMechanisms \n\n\n\n\n\n\n\nP Hassandarvish \n1\n, M Hajrezaie \n\n\n\n1\n, S Golbabapour \n\n\n\n1\n, S N Gwaram \n\n\n\n2\n, M A Abdulla \n\n\n\n1\n, \n\n\n\nH Mohd Ali \n2\n, S I Abdelwahab \n\n\n\n3\n \n\n\n\n1 \nDepartment of Molecular Medicine, University of Malaya Kuala Lumpur, Malaysia \n\n\n\n2 \nDepartment of Chemistry, University of Malaya, Kuala Lumpur, Malaysia \n\n\n\n3 \nMedical Research Center, Faculty of Medicine, Jazan University, Jazan, Kingdom of \n\n\n\nSaudi Arabia \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 115 \n\n\n\n\n\n\n\nSchiff bases have regularly been used as chelating ligands in organization chemistry. \n\n\n\nSchiff base with donors (N, O, S, etc) have formation similarities with neutral biological \n\n\n\nsystems and because of presence of amine group are utilized in elucidating the \n\n\n\nmechanism of conversion of racemisation reaction in biological system. They show \n\n\n\nbiological activities including antibacterial, antifungal anti-diabetic antitumor, anti-\n\n\n\nproliferative anticancer herbicidal and anti-inflammatory activities. Therefore, this study \n\n\n\nwas conducted to investigate the gastro-protective activity of some Schiff bases \n\n\n\ncompounds and their mechanisms of the compounds for treatment. The compounds were \n\n\n\ntested on SD rat for anti-ulcer activity by using ethanol inducing ulcer. The study showed \n\n\n\nall the Schiff bases metal complex possessed very good activity as a gastro protective \n\n\n\nagent and even better than the drug control (omeprazole). The immunochemistry assays \n\n\n\nshowed that the PGE2 (Prostaglandin) interfere to protect the stomach from ethanol to \n\n\n\ninduce ulcer by producing more mucus compare to ulcer control (Ethanol group). The \n\n\n\nbiochemistry assays (anti-oxidant enzymes) showed that for all the compounds, the \n\n\n\noxidative stress donor (MDA) reduced sharply compared to ulcer control. Catalase \n\n\n\nenzyme the first defensive anti-oxidant enzyme against oxidative stress donor was \n\n\n\nincreased for compounds LPSVoSo4, CdGH and LPACdCl2 but there were no changes \n\n\n\nof catalase level for compounds LPACdSCN and LPSDphSnCl2. However nitric oxide \n\n\n\n(NO) assay showed opposite result compared to catalase assay except for compound \n\n\n\nCdGH which the NO level was high. Superoxide dismutase was increased for all \n\n\n\ncompounds which was one of the line for protecting the tissue and cells from superoxide. \n\n\n\n\n\n\n\n \nPPM10 (000121) \n\n\n\n\n\n\n\nAnti-leukemia Effect of Thymoquinone Isolated from Nigella sativa \n\n\n\n\n\n\n\nL Z A Salim, S Mohan, R Othman \n\n\n\nDepartment of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur \n\n\n\n\n\n\n\nNigella sativa is an annual flowering plant with pale blue to white flowers and a large \n\n\n\nfruit. It has various synonyms names such as Black cumin, Black caraway, Black onion \n\n\n\nseed, Black seed, Fennel flower, Roman coriander and Kalonji. It has been used in \n\n\n\ndifferent countries in Asia, Middle East and Africa as traditional herb against \n\n\n\ninflammation, asthma, cough, influenza and cancer. There were numerous studied on the \n\n\n\nanti-cancer properties of thymoquinone (TQ) on different cell lines and in animal model. \n\n\n\nBut the effect of this compound on lymphoblastyoid leukemia is not established yet. This \n\n\n\nstudy aimed to evaluate the anti-leukemic effect of thymoquinone (TQ) isolated from this \n\n\n\nplant using CEMss cells as an in vitro model. The results showed that treatment with TQ \n\n\n\ninhibited the cell growth in CEMss significantly. The mode of cell death was confirmed \n\n\n\nby DNA laddering as well as AO/PI fluorescent staining and Annexin V flow cytometric \n\n\n\nstaining. The cell death was closely associated with the cell cycle arrest at G0/G1 phase. \n\n\n\nIn addition the expression of Bax, Bcl2 and HSP 70 proteins were observed by western \n\n\n\nblotting. The caspase 3, 8 and 9 were significantly elevated by the treatment. The results \n\n\n\nobtained from the present study had clearly showed that the TQ has the potential to be \n\n\n\ndeveloped as anti-leukemic agent. The mode of cell death was found to be via apoptosis. \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 116 \n\n\n\n \nPPM11 (000009) \n\n\n\n\n\n\n\nStudy on Antidiabetic Plants Cocktail Containing Andrographis paniculata, \n\n\n\nCinnamomum burmannii and Tinospora crispa \n\n\n\n\n\n\n\nM Taher \n1\n, M Z A M Amiroudine \n\n\n\n1\n, Tg M F Syafiq Tg Zakaria \n\n\n\n1\n, W M Azizi Wan \n\n\n\nSulaiman \n1\n, D Susanti \n\n\n\n2\n, S JA Ichwan \n\n\n\n3\n \n\n\n\n1 \nKulliyyah of Pharmacy, International Islamic University Malaysia, Jalan Istana, Bandar \n\n\n\nIndera Mahkota, Pahang, 25200, Malaysia \n2 \n\n\n\nKulliyyah of Science, International Islamic University Malaysia, Jalan Istana, Bandar \n\n\n\nIndera Mahkota, Pahang \n3 \n\n\n\nKulliyyah of Dentistry, International Islamic University Malaysia, Jalan Istana, Bandar \n\n\n\nIndera Mahkota, Pahang \n\n\n\n\n\n\n\nThe present study was aimed to investigate antidiabetic potential of the mixture of \n\n\n\nAndrgraphis paniculata, Cinnamomum burmannii and Tinospora crispa (ACT) in the  in \n\n\n\nvitro and in vivo studies. In in vitro method, the effect of ACT on lipid accumulation of \n\n\n\n3T3-L1 adipocytes was analyzed by using Oil Red O staining. 2-Deoxy-D-[\n3\nH] glucose \n\n\n\nwas used to measure glucose uptake activity. In the in vivo study, a set dose of ACT (500, \n\n\n\n125 and 75 mg/kg b.w., respectively) were administered to both normal and \n\n\n\nstreptozotocin induced diabetic male Sprague-Dawley rats. The blood glucose levels were \n\n\n\nmeasured at 0, 3, 7, and 10 days after oral administration of ACT. Result of cell based \n\n\n\nstudy showed that ACT induced triglyceride accumulation in 3T3-L1 cells at relatively \n\n\n\nsmall concentration in a dose-dependent manner. In addition, 2-deoxy-D-[\n3\nH] glucose \n\n\n\nuptake activities were significantly different at dose 50 \u00b5g/mL (P < 0.05 compared to \n\n\n\nbasal). Gene expression analysis using quantitative RT-PCR showed that adipocytes-\n\n\n\ntreated with ACT significantly increased the expression levels of PPAR\u03b3 which regulate \n\n\n\nthe adipogenesis process and its target gene GLUT4 that involve in glucose uptake when \n\n\n\ncompared to the basal. The result of in vivo study demonstrated, ACT exhibited blood \n\n\n\nglucose lowering effects in streptozotocin induced diabetic rats.  Taken together, the in \n\n\n\nvitro and in vivo results indicate that mixture of ACT possesses antihyperglycemic \n\n\n\nactivity. \n\n\n\n\n\n\n\n \nPPM12 (000027) \n\n\n\n\n\n\n\nIn Vitro Effect of Various Herbal Active Constituents on Cytochrome P450 2E1 \n\n\n\n\n\n\n\nY Pan \n1\n, B A Abd-Rashid \n\n\n\n2\n, Z Ismail \n\n\n\n2\n, R Ismail \n\n\n\n3\n, J W Mak \n\n\n\n1\n, C E Ong \n\n\n\n4\n \n\n\n\n1\n School of Medical Sciences, International Medical University, Bukit Jalil, 57000 Kuala \n\n\n\nLumpur \n2\n Herbal Medicine Research Unit, Division of Biochemistry, Institute for Medical \n\n\n\nResearch, 50588 Kuala Lumpur \n3\n Pharmacogenetics Research Group, Institute for Research in Molecular Medicine, \n\n\n\nUniversiti Sains Malaysia, 16150 Kubang Kerian, Kelantan \n4\n Jeffrey Cheah School of Medicine and Health Sciences, Monash University Sunway \n\n\n\nCampus, 46150 Bandar Sunway, Selangor \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 117 \n\n\n\nCytochrome P450 (CYP) enzymes are responsible for metabolism of various internal or \n\n\n\nexternal substances including a great number of clinically used medications. CYP2E1 is a \n\n\n\nmember of this mixed-function oxidase system which has been widely studied because of \n\n\n\nits metabolism of ethanol, activation of procarinogens, and its clear relevance to \n\n\n\nalcoholism, diabetes, and other maladies. Herbal medicines are often consumed in \n\n\n\ncombination with conventional drugs, which raises the potential of drug-herb interactions. \n\n\n\nIn this study, nine known active constituents (eurycoumanone from Eurycoma longifolia; \n\n\n\nandrographolide from Andrographis paniculata; asiaticoside, asiatic acid and madecassic \n\n\n\nacid from Centella asiatica; eupatorin, sinensetin, caffeic acid and rosmarinic acid from \n\n\n\nOrthosiphon stamineus) were examined with regard to their effects on CYP2E1 activity \n\n\n\nin vitro. Fluorescence-based enzyme assay was established and 7-methoxy-4-\n\n\n\n(trifluoromethyl)-coumarin (7-MFC) was selected as a CYP2E1 substrate. The herbal \n\n\n\ncompounds were investigated at various concentrations (ranging from 0 to 250 \u00b5M). The \n\n\n\nresults indicate that no significant effects were observed for all compounds investigated \n\n\n\nexcept for madecassic acid and eupatorin (IC50 values of 13.7 and 100.0 \u00b5M \n\n\n\nrespectively). Inhibition by these two compounds was considered only moderate as the \n\n\n\nIC50 values were much higher than the typical concentrations observed for the two \n\n\n\ncompounds in blood circulation. Thus, clinically significant interactions due to co-\n\n\n\nadministering any of the nine substances and CYP2E1 substrates are unlikely if similar \n\n\n\nresults were acquired from in vivo assays. \n\n\n\n\n\n\n\n \nPPM13 (000060) \n\n\n\n\n\n\n\nAnalgesic Activity of Cissus quadrangularis (Patah Tulang) Stem Extracts in Mice \n\n\n\n\n\n\n\nT W Nie, A M Saleem, S Rajesh \n\n\n\nFaculty of Pharmaceutical Sciences, UCSI University, UCSI Heights, Cheras, 56000 \n\n\n\nKuala Lumpur \n\n\n\n\n\n\n\nCissus quadrangularis L. (Vitaceae) is an edible plant, indigenous to Asia and Africa. It \n\n\n\nis reported to have bone fracture healing property and analgesic effect in rodents. \n\n\n\nHowever, the previous study on analgesic effect used only alcoholic extract and hot plate \n\n\n\ntest. Hence, the present study was designed to expand the study on analgesic activity by \n\n\n\nincluding tail flick test and using two successively extracted extracts. The powdered dried \n\n\n\nstem of C. quadrangularis was successively extracted with chloroform and methanol. The \n\n\n\ndried extracts were suspended in 10% tween 80 in normal saline and administered (i.p.) to \n\n\n\nseparate groups of albino mice at the doses of 75, 150 and 300 mg/kg. Morphine sulphate \n\n\n\n(3 mg/kg, i.p.) was used as the positive control. In both tests, the response time in seconds \n\n\n\nwas measured at -15, 0, 15, 30, 45, 60, 75 and 90 minutes. The data were analysed by \n\n\n\none-way ANOVA followed by Dunnett\u201fs test as the post hoc test. The yield of \n\n\n\nchloroform extract was 1.87% w/w and that of methanol extract was 4.23% w/w. \n\n\n\nChloroform extract showed significant (p < 0.05) analgesic effect at the doses of 75, 150 \n\n\n\nand 300 mg/kg in hot plate and tail flick tests. Methanol extract showed significant (p < \n\n\n\n0.05) analgesic effect at the dose of 300 mg/kg in hot plate and at the doses of 150 and \n\n\n\n300 mg/kg in tail flick tests. The present study indicates that chloroform extract is more \n\n\n\npotent than methanol extract in inducing analgesic effect in mice. \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 118 \n\n\n\n \nPPM14 (000066) \n\n\n\n\n\n\n\nAntibacterial Activity of Methanolic Extract of Clinacanthus nutans (Sabah Snake \n\n\n\nGrass) Leaf \n\n\n\n\n\n\n\nH S Yang, P Madhavan, A M Saleem, G A Akowuah \n\n\n\nFaculty of Pharmaceutical Sciences, UCSI University, UCSI Heights, Cheras 56000, \n\n\n\nKuala Lumpur \n\n\n\n\n\n\n\nClinacanthus nutans (Acanthaceae) is a medicinal herb traditionally used against skin and \n\n\n\ngastrointestinal infections. C. nutans exhibited several bioactivities including antibacterial \n\n\n\neffects against P. acnes and S. epidermidis. Our present study aimed at exploring the \n\n\n\nantibacterial effect of methanolic leaf extract of C. nutans against Propionibacterium \n\n\n\nacnes, Staphylococcus aureus, Staphylococcus epidermidis, Bacillus cereus and \n\n\n\nEscherichia coli. The powdered dried leaf was extracted with methanol. The dried extract \n\n\n\nwas reconstituted in 10% DMSO v/v and tested at the concentrations of 0.1, 0.2, 0.39, \n\n\n\n0.78, 1.56, 3.15, 6.25 and 12.5 mg/mL in a 96-well microplate by microdilution method. \n\n\n\nAbsorbance was taken with ELISA plate reader at 630 nm. Data were analysed by one-\n\n\n\nway ANOVA followed by Tukey\u201fs multiple comparison test as the post hoc test. \n\n\n\nErythromycin and chloramphenicol were used as the positive controls. Methanolic leaf \n\n\n\nextract of C. nutans showed significant (p < 0.05) antimicrobial activity against S. aureus, \n\n\n\nS. epidermidis and E. coli. Methanolic leaf extract of C. nutans did not show any \n\n\n\nsignificant activity against P. acnes and B. cereus at the concentrations employed in the \n\n\n\nstudy. S. epidermidis showed high susceptibility amongst all the three susceptible \n\n\n\norganisms. The ineffectiveness of methanolic leaf extract of C. nutans against P. acnes is \n\n\n\ndifferent from previous reports and needs further exploration. Further studies are required \n\n\n\nto identify the bioactive compounds from C. nutans and their antibacterial mechanism of \n\n\n\naction. \n\n\n\n\n\n\n\n \nPPM15 (000075) \n\n\n\n\n\n\n\nHepatoprotective Activity of Swietenia macrophylla Fractions in CCl4 Intoxicated \n\n\n\nRats \n\n\n\n\n\n\n\nA J Sunilson, Anandarajagopal, A Khan, A G Kumari \n\n\n\nSchool of Pharmacy, KPJ University College, Kota Seriemas, Nilai, Negeri Sembilan \n\n\n\n\n\n\n\nThe fruit of Swietenia macrophylla King (Meliaceae) also called \u201cSky Fruit\u201d and it is \n\n\n\ntraditionally claimed by Orang Asli, Sarawak, Malaysia for the treatment of diabetes and \n\n\n\njaundice. In a previous study, methanol extract of S. macrophylla reported a significant \n\n\n\n(P<0.05) hepatoprotective activity at a dose of 400 mg/kg b.wt. The aim of the present \n\n\n\nstudy was to evaluate the hepatoprotective effect of n-butanol, ethylacetate and n-hexane \n\n\n\nfractions of S. macrophylla in CCl4-induced hepatotoxic albino rats. The fractions \n\n\n\nshowed no signs of acute toxicity up to a dose level of 1000 mg/kg b.wt. The ethyl acetate \n\n\n\nfraction at an oral dose of 200 mg/kg b.wt. exhibited a significant (P < 0.001) protective \n\n\n\neffect as shown by lowering serum levels of glutamic oxaloacetic transaminase, glutamic \n\n\n\npyruvic transaminase, alkaline phosphatase, total cholesterol and total bilirubin and \n\n\n\nincreasing the levels of total protein and albumin levels as compared to silymarin (100 \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 119 \n\n\n\nmg/kg b.wt.). These biochemical observations were supported by histopathological \n\n\n\nexamination of liver sections. The phytochemical nature of the ethyl acetate fraction \n\n\n\nreveals the presence of carbohydrates, amino acids, alkaloids, steroids, phenolic \n\n\n\ncompounds, flavonoids and glycosides. Thus, it could be concluded that ethyl acetate \n\n\n\nfraction possesses significant hepatoprotective property which may be due to the presence \n\n\n\nof flavonoids and phenolic compounds. \n\n\n\n\n\n\n\n \nPPM16 (000104) \n\n\n\n\n\n\n\nAnalgesic Effect of Ruta graveolens in Albino Mice and Rats \n\n\n\n\n\n\n\nS E A Saad \n1\n, S S Ahmed \n\n\n\n1\n, S M Aburawi \n\n\n\n1\n, A M M Khalf \n\n\n\n2\n, S M O Al-sharif \n\n\n\n2\n, I L \n\n\n\nFong \n3\n, M N El-attug \n\n\n\n1\n \n\n\n\n1 \nSchool of  Pharmacy, Tripoli University, Libya \n\n\n\n2 \nSchool of pharmacy, Zawia University, Libya \n\n\n\n3 \nDepartment of Cancer Studies and Molecular Medicine, University of Leicester, UK \n\n\n\n\n\n\n\nAim of the present study was to investigate the analgesic effect of Ruta graveolens by \n\n\n\nusing thermal and chemical induced pain; and to confirm the traditional medicinal use of \n\n\n\nthe plant as analgesic and anti-inflammatory agent. The antinociceptive and anti-\n\n\n\ninflammatory effects of orally administered alcoholic extract of Ruta graveolens (whole \n\n\n\nplant) was studied with hot plate (thermally induced pain) method in albino rats and mice, \n\n\n\nwith acetic acid (chemically induced pain) in albino mice and with paw formaldehyde \n\n\n\ninduced edema in albino mice. The Ruta graveolens alcoholic extract treated animals \n\n\n\nshowed  significant increase in hot plate reaction time, complete protection of animals \n\n\n\nagainst acetic acid writhing and a significant decrease in paw edema compared to control \n\n\n\nanimals (n = 6). These results confirm the traditional use of Ruta graveolens for painful \n\n\n\nand inflammatory conditions. It is therefore concluded that the Ruta graveolens contains \n\n\n\ncompound(s) which may act as both non-opioid (aspirin like) and opioid (morphine like) \n\n\n\nanalgesics and have nonsteroidal anti-inflammatory drugs like action. \n\n\n\n\n\n\n\n \nPPM17 (000128) \n\n\n\n\n\n\n\nAntidiabetic Effect of Steroidal Compound Isolated from Melothria maderaspata \n\n\n\n\n\n\n\nA K Balaraman, V Venu, M Muthappan \n\n\n\nFaculty of Pharmacy, ASEAN Metropolitan University College of Health Sciences, 43200 \n\n\n\nCheras, Selangor \n\n\n\nMelothria maderaspata were successively extracted using different solvents in an \n\n\n\nincreasing order of polarity. The methanol fraction of M. maderaspatana was \n\n\n\nconcentrated and the residual amount of methanol was removed in vacuo. The residue \n\n\n\nwas washed with diethyl ether, hexane, chloroform and the finally dissolved in methanol.  \n\n\n\nThe methanol solution was filtered and the filtrate was poured into excess of diethyl ether \n\n\n\nwhereby a light brown color mass was precipitated. The precipitate was separated by \n\n\n\nfiltration and purified by repeating of dissolution in methanol and precipitation with \n\n\n\ndiethyl ether. The isolation of the reported compound was done by following appropriate \n\n\n\nchromatography and spectral methods and interpreted efficiently. The spectral data (UV, \n\n\n\nIR, MS, NMR proton and carbon) and their interpretation led us to the conclusion that the \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 120 \n\n\n\nisolated chemical constituent was found to be a steroidal lactone that contain a \n\n\n\ncyclopentanoperhydrophenanthrene ring system with a total of 28 carbons in the whole \n\n\n\nstructure. The molecular formula of this compound obtained from Mass spectra revealed \n\n\n\nits\u201f molecular weight to be 457.89 and molecular formula C28H38O5. The compound \n\n\n\nshowed a marked positive activity in enhancing oral glucose tolerance of normal and \n\n\n\ndiabetic animals. \n\n\n\n\n\n\n\n \nPPM18 (000130) \n\n\n\n\n\n\n\nEffects of Hopea Extracts on Human Colorectal Cancer Cell Proliferation via \n\n\n\nInduction of Apoptosis \n\n\n\n\n\n\n\nS C Ng, C W Mai, R Srinivasan, M R Pichika \n\n\n\nSchool of Pharmacy, International Medical University, Bukit Jalil, 57000 Kuala Lumpur \n\n\n\n\n\n\n\nHopea is one of the largest genus belongs to the family of Dipterocarpaceae, which \n\n\n\nconsisting of over 100 species. However, there are limited studies had been performed on \n\n\n\nbiological activities of Hopea ponga and Hopea odorata. Therefore, this study was \n\n\n\nundertaken to determine the antiproliferative activities of Hopea ponga and Hopea \n\n\n\nodorata (leaves and stem bark) on human colorectal cancer cell lines, HT29. In this study, \n\n\n\na total of 16 extracts from four different extraction solvents (hexane, ethylacetate, \n\n\n\nmethanol and water) were tested for their antiproliferative activities via 3-(4,5-\n\n\n\nDimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. The potency of the \n\n\n\nextracts of Hopea ponga and Hopea odorata were compared using IC50 value, the \n\n\n\nconcentration with 50% inhibition of cancer cells proliferation. Ethyl acetate extracts for \n\n\n\nboth leaves and stem bark of Hopea ponga and Hopea odorata shown good \n\n\n\nantiproliferative activities on HT29 cells. The IC50 of ethyl acetate extracts of leaves and \n\n\n\nstem bark of Hopea ponga were 20.11 \u00b1 2.53 \u03bcg/ml and 20.21 \u00b1 10.95 \u03bcg/ml \n\n\n\nrespectively. While IC50 of ethyl acetate extract of Hopea odorata stem bark was 13.13 \u00b1 \n\n\n\n4.20 \u03bcg/ml which exhibits strongest antiproliferative activity on HT29 cells among 16 \n\n\n\nextracts. The mode of colorectal cancer cell death was found to be apoptosis. Therefore \n\n\n\nthese extracts exhibit good antiproliferative activities which might be potential cytotoxic \n\n\n\nagents against human colorectal cancer. Hence further studies will be warranted to \n\n\n\ndetermine the underlying antiproliferative and apoptosis pathway. \n\n\n\n\n\n\n\n \nPPM19 (000131) \n\n\n\n\n\n\n\nInhibition of Human Estrogen Dependent Breast Carcinoma Proliferation by Hopea \n\n\n\nodorata and Hopea ponga \n\n\n\n\n\n\n\nY S Chia, C W Mai, R Srinivasan, M R  Pichika \n\n\n\nSchool of Pharmacy, International Medical University, 57000 Kuala Lumpur \n\n\n\n\n\n\n\nHopea is one of the main genus of Dipterocarpaceae and it is widely distributed from \n\n\n\nmainland of South-East Asia toward Peninsular Malaysia. Hopea is locally known as \n\n\n\nmerawan hitam or pengarawan. Hopea genus has been reported to have anticancer \n\n\n\nactivity, antimicrobial activity and antioxidant. However, there are limited studies of \n\n\n\nHopea odorata and Hopea ponga on estrogen dependent breast cancer. Hence, the aim of \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 121 \n\n\n\nthis study was to determine the anti-proliferative activities of the leaves and stem bark of \n\n\n\nHopea odorata and Hopea ponga extracts (hexane, ethyl acetate, methanol and water) on \n\n\n\nestrogen receptor dependent breast cancer cells (MCF-7). Anti-proliferative activities \n\n\n\nwere determined using the MTT assay. The extracts were first prepared by soxhlet \n\n\n\nextraction using solvents with different polarity. The potency of each extracts of H. \n\n\n\nodorata and H. ponga were compared using the IC50, the concentration with 50% growth \n\n\n\ninhibition. Hexane extract from leaves of H. odorata and the ethyl acetate extract from \n\n\n\nthe leaves of H.ponga exhibited the most potent inhibition on cell proliferation, with IC50 \n\n\n\nwere 83.775 \u00b1 3.061 \u00b5g/mL and 27.713 \u00b1 13.159 \u00b5g/mL respectively. The extracts were \n\n\n\nalso found to be selective toward cancerous cells and sparing the non-cancerous cells. \n\n\n\nApart from that, the apoptosis induction activities by these extracts were confirmed \n\n\n\nthrough fluorescence microscopic examination and apoptosis kit. In conclusion, ethyl \n\n\n\nacetate extract from leaves of H. ponga exhibits the most potent antiproliferative activity \n\n\n\nagainst human estrogen dependent cancer. \n\n\n\n\n\n\n\n \nPPM20 (000132) \n\n\n\n\n\n\n\nIn Vitro Cytotoxic Effects of Hopea odorata and Hopea ponga on Estrogen \n\n\n\nIndependent Breast Cancer \n\n\n\n\n\n\n\nL Y Foong, C W Mai, R Srinivasan, M R Pichika \n\n\n\nSchool of Pharmacy, International Medical University, 57000 Kuala Lumpur \n\n\n\n\n\n\n\nEstrogen receptor (ER) negative breast cancers are generally unresponsive to \n\n\n\nconventional anticancer therapy and have poorer prognosis as compared to ER-positive \n\n\n\nbreast cancers. In recent years, natural products are widely explored in the search of new \n\n\n\nanticancer agents. Hopea, locally known as merawan hitam, belongs to the family of \n\n\n\nDipterocarpaceae which contains a variety of resveratrol oligomers. Resveratrol \n\n\n\noligomers were reported to have antiproliferative effect on cancer cells. Where no \n\n\n\nreported traditional use of Hopea ponga is available, resins of Hopea odorata stem bark \n\n\n\nwas reported to have medicinal properties in treating sores and wounds.  However, no \n\n\n\nscientific evidence was published on evaluation of antiproliferative activity of leaves and \n\n\n\nstem bark of H. odorata and H. ponga tested on human breast cancer. Therefore, \n\n\n\nantiproliferative effects of extracts (hexane, ethyl acetate, methanol, water) from leaves \n\n\n\nand stem bark of H. odorata and H. ponga on the ER-negative breast cancer cells (MDA-\n\n\n\nMB-231) were investigated using cell viability test. The antiproliferative activities of the \n\n\n\nplant extracts were compared using IC50 value, 50% inhibitory concentration. Among the \n\n\n\n16 extracts tested, hexane extract of H. odorata leaves and ethyl acetate extract of H. \n\n\n\nponga leaves had the most potent antiproliferative activities, with the IC50 of 64.68 \u00b1 \n\n\n\n12.8\u03bcg/mL and 18.82 \u00b1 1.48\u03bcg/mL respectively. Apoptosis induction effect was \n\n\n\nconfirmed under microscopic observation and apoptotic assay kit. In conclusion, extracts \n\n\n\nof H. odorata and H. ponga do exert antiproliferative activities on ER negative breast \n\n\n\ncancer which may be a potential agent in treating ER-negative human breast cancer. \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 122 \n\n\n\n \nPPM21 (000133) \n\n\n\n\n\n\n\nAntiproliferative Property of Hopea odorata and Hopea ponga Extracts on Human \n\n\n\nCervical Cancer Cells \n\n\n\n\n\n\n\nK H Tan, C W Mai, R Srinivasan, M R Pichika \n\n\n\nSchool of Pharmacy, International Medical University, 57000 Kuala Lumpur \n\n\n\n\n\n\n\nHopea, the main genus of Dipterocarpaceae, is widely distributed in the South East Asia. \n\n\n\nActive constituents are found in Dipterocarpaceae such as vaticanol G, hemlesyanol C, \n\n\n\nascorbic acid, hopheaphenol etc. Dipterocarpaceae exhibits some biological activity for \n\n\n\ninstance antibacterial, anticancer, antihepatotoxic and anti-HIV. There is limited literature \n\n\n\non the antiproliferative activity of stem barks of Hopea odorata on human cervical cancer \n\n\n\nand there is no any scientific report on the antiproliferative activity of Hopea ponga on \n\n\n\nhuman cervical cancer. Thus, the aim of this study was to determine the antiproliferative \n\n\n\nactivities of hexane, ethyl acetate, methanol and water extracts of leaves and stem bark of \n\n\n\nHopea odorata and Hopea ponga on human cervical (HeLa) cancer cell line through in \n\n\n\nvitro cytotoxic (MTT) assay. The extracts of Hopea odorata and Hopea ponga was \n\n\n\nprepared by sequential extraction with hexane, ethyl acetate, methanol and water in a \n\n\n\nsoxhlet extractor. The IC50 (concentration required to inhibit 50% of cell growth) is used \n\n\n\nto compare the potency of different extracts of Hopea odorata and Hopea ponga. In \n\n\n\nHopea odorata, the most potent extracts was hexane extract of leaves (IC50:102.94 \u00b1 1.83 \n\n\n\n\u03bcg/mL), while in Hopea ponga, the most potent extracts was ethyl acetate extract of \n\n\n\nleaves (IC50: 32.37 \u00b1 1.94 \u03bcg/mL). Methanol and water extracts from stem barks of \n\n\n\nHopea odorata and Hopea ponga was found to have IC50 more than 250 \u03bcg/mL. \n\n\n\nApoptosis is confirmed through microscopic examination and commercial available \n\n\n\napoptosis kit. In conclusion, ethyl acetate extract of leaves show the most potent result \n\n\n\nand further investigations are required to be done. \n\n\n\n\n\n\n\n \nPPM22 (000134) \n\n\n\n\n\n\n\nAntiproliferative Activity of Hopea ponga and Hopea odorata Leaves and Stem Bark \n\n\n\non Leukemia Cancer Cell Lines (CEMss) \n\n\n\n\n\n\n\nP K Boey, C W Mai, S Ramamurthy, M R Pichika \n\n\n\nInternational Medical University, 57000 Kuala Lumpur \n\n\n\n\n\n\n\nHopea genus is widely distributed in the tropical rain forest such as Malaysia. Scientific \n\n\n\nreports had shown that it produces resveratrol oligomer that exhibits variety of biological \n\n\n\nactivities, such as antibacterial, anti-inflammatory, anticancer and antioxidant. Hopea \n\n\n\nodorata showed significant cytotoxicity activities against a few cancer cell lines, however \n\n\n\nleukemic cell line is yet to be studied. Since Hopea ponga reported to have antioxidant \n\n\n\nand antibacterial effect, it is promising that it may also exhibits cytotoxicity activities. \n\n\n\nTherefore, the objective of this study was to determine the antiproliferative activities of \n\n\n\nHopea ponga and Hopea odorata (stems and leaves) extracts on CEMss cancer cell lines \n\n\n\nthrough MTT assay. The extracts were prepared by sequential extraction using soxhlet \n\n\n\nextractor extracted with hexane, ethyl acetate, methanol and water which followed by \n\n\n\ndrying step using the rotary evaporator. Antiproliferative activities by ethyl acetate \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 123 \n\n\n\nextracts of the Hopea ponga leaves was found to be the most potent extract in the dose \n\n\n\nresponse curve on CEMss which exhibited IC50 of 9.184 \u03bcg/mL. Apoptosis of the CEMSS \n\n\n\nwas examined through microscope and Cell Death Detection ELISAPLUS (Roche, \n\n\n\nGermany) kit. Further investigations are required for the determination of mechanism of \n\n\n\naction of the particular extracts in human. Thus, it can be concluded that ethyl acetate \n\n\n\nextracts of the Hopea ponga leaves is the most potent extract in this study which could be \n\n\n\nthe potential candidate in against leukemia. \n\n\n\n\n\n\n\n \nPPM23 (000135) \n\n\n\n\n\n\n\nThe Cytotoxic Activities of Hopea odorata and Hopea ponga Extracts on Human \n\n\n\nOvarian Cancer Cells \n\n\n\n\n\n\n\nF Y Tan, C W Mai, S Ramamurthy, M R Pichika \n\n\n\nSchool of Pharmacy, International Medical University, 57000 Kuala Lumpur \n\n\n\n\n\n\n\nHopea genus belonging to the Dipterocarpaceae family is widely distributed throughout \n\n\n\nPeninsular Malaysia. They are known to produce a wide range of resveratrol oligomers \n\n\n\nwhich have shown to have anticancer activities. The aim of this study is to determine the \n\n\n\nantiproliferative activities of Hopea odorata (H. odorata) (stem bark and leaves) and \n\n\n\nHopea ponga (H. ponga) (stem bark and leaves) extracts (hexane, ethyl acetate, methanol \n\n\n\nand water) on the ovarian cancer cell lines (CaOV3) using viability studies of cells in \n\n\n\nculture. National Cancer Registry reported ovarian cancer as the fourth most common \n\n\n\ncancer in women in Malaysia. Although chemotherapy is the preferred treatment \n\n\n\nmodality, chemoresistance severely limits treatment success with evidence suggesting the \n\n\n\nderegulation in key apoptotic pathways as a factor. However, there is still no reported \n\n\n\nstudy on the cytotoxic activities of H. odorata and H. ponga extracts on human ovarian \n\n\n\ncancer cells. Potency of different extracts was compared using IC50, which represents the \n\n\n\nconcentration of extracts required for 50% of cells inhibition. The results demonstrated \n\n\n\nthat for H. odorata, the most potent extract against CaOV3 cells was hexane extract of H. \n\n\n\nodorata leaves with IC50 of 50.14 \u00b5g/mL while ethyl acetate extract of H. ponga leaves \n\n\n\nwas found to be most potent at IC50 of 130.44 \u00b5g/mL. Apoptosis was found to be the \n\n\n\nmechanism of cancer cells death by observing under fluorescence microscope and \n\n\n\nconfirmed using an apoptosis induction kit. Thus, hexane extract of H. odorata leaves has \n\n\n\na potential in the treatment of human ovarian cancer. \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 124 \n\n\n\nPHARMACEUTICAL TECHNOLOGY \n\n\n\n\n\n\n\n \nPPT1 (000006) \n\n\n\n\n\n\n\nPreparation of Carvedilol Spherical Crystals Having Solid Dispersion Structure by \n\n\n\nthe Emulsion Solvent Diffusion Method and Evaluation of Its in vitro Characteristics \n\n\n\n\n\n\n\nA R Tapas, P S Kawtikwar, D M Sakarkar \n\n\n\nSudhakarrao Naik Institute of Pharmacy, Pusad-445204, District Yavatmal, \n\n\n\nMaharashtra, India \n\n\n\n\n\n\n\nSpherical crystallization (SC) is a promising alternative for improving micromeritic \n\n\n\nproperties and dissolution rate of active pharmaceutical ingredients. In the present work, \n\n\n\nspherical agglomerates of carvedilol (CAR) were prepared by emulsion solvent diffusion \n\n\n\n(ESD) method using methanol, water and dichloromethane as good solvent, poor solvent \n\n\n\nand bridging liquid respectively. Agglomerates were prepared using Poloxamer F68 and \n\n\n\nF127 as hydrophilic polymers. The agglomerates were characterized by fourier transform \n\n\n\ninfrared spectroscopy (FTIR), differential scanning calorimetry (DSC), powder X-ray \n\n\n\ndiffraction (PXRD) and scanning electron microscopy (SEM), and were evaluated for \n\n\n\nflowability, solubility and drug release. CAR agglomerates exhibited significantly \n\n\n\nimproved micromeritic properties, solubility as well as dissolution behaviors in \n\n\n\ncomparison with pure CAR crystals. Differential scanning calorimetric and powder X-ray \n\n\n\ndiffraction studies confirm that the formulation process altered the crystalline nature of \n\n\n\ncarvedilol. \n\n\n\n\n\n\n\n \nPPT2 (000022) \n\n\n\n\n\n\n\nComparative Evaluation of Different Spreadability Techniques on \n\n\n\nExtemporaneously Prepared Cocos nucifera Topical Dosage Forms \n\n\n\n\n\n\n\nK Dua, L T Ying, L S Hui, A Gorajana, R Sheshala \n\n\n\nDepartment of Pharmaceutical Technology, School of Pharmacy and Allied Health \n\n\n\nSciences, International Medical University, 57000 Kuala Lumpur \n\n\n\n\n\n\n\nThe rheological properties of topical preparations influence the performance of drug \n\n\n\ndelivery systems. The spreadability is an important parameter for uniform and convenient \n\n\n\napplication of topical preparation in relation to patient compliance. The therapeutic \n\n\n\nefficiency of a formulation also depends on its spreading value. Keeping the significance \n\n\n\nof spreadability in mind, the objective of the present study was to prepare Cocos nucifera \n\n\n\ntopical dosage forms using two different dermatological bases by fusion technique and to \n\n\n\ncarry out a comparative evaluation of the spreadability of these extemporaneously \n\n\n\nprepared formulations using two different techniques [Method I and Method II]. The \n\n\n\nspreadability results of the formulations obtained with method I and method II ranged \n\n\n\nfrom 0.43 to 12.09 g.cm/sec and 18.67 to 25.33 mm, respectively. The results exhibited \n\n\n\ndifference in spreadability results indicating the lack of reproducibility of the methods \n\n\n\nemployed and the necessity for standardization for routine assessment of spreadability \n\n\n\nparameter for semi-solid preparations. The studies also demonstrated the suitability of \n\n\n\ncarbopol gel base as a suitable dermatological base for use in a Cocos nucifera topical \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 125 \n\n\n\nformulation as it possessed good spreadability characteristics thereby providing assurance \n\n\n\nfor better therapeutic efficacy.  \n\n\n\n \nPPT3 (000048) \n\n\n\n\n\n\n\nErosion and Dissolution Performance of Intermediate Molecular Weight HPMC \n\n\n\nControlled Release Polymers \n\n\n\n\n\n\n\nB H Ng \n1\n, E Pinto \n\n\n\n2\n, A Pittman \n\n\n\n2\n, W W Harcum \n\n\n\n2\n, D Tewari \n\n\n\n2\n, T D\u00fcrig \n\n\n\n2\n \n\n\n\n1\n Affiliate of Ashland Inc., Shah Alam, Selangor, Malaysia \n\n\n\n2\n Ashland Specialty Ingredients, Ashland Research Center, Wilmington DE, USA \n\n\n\n\n\n\n\nDissolution and erosion of intermediate molecular weight (MW) HPMC grades \n\n\n\n(BenecelTM HPMC K250 PH PRM, K750 PH PRM, and K1500 PH PRM) were \n\n\n\nevaluated against equivalent viscosity HPMC blends of different MW HPMC. \n\n\n\nFormulations with 25% drug, glipizide and carbamazepine (insoluble) and theophylline \n\n\n\n(soluble), 30% polymer, and 44.5% micro crystalline cellulose were wet granulated with \n\n\n\nwater. Tablets of 400 mg weight were compressed after drying, milling and lubrication \n\n\n\nwith addition of 0.5% magnesium stearate. Dissolution, erosion and swelling studies were \n\n\n\ncarried out in USP apparatus I (phosphate buffer pH 6.8 for carbamazepine and \n\n\n\ntheophylline; pH 7.5 with 0.1% polysorbate 80 for glipizide). The time to 50% drug \n\n\n\nrelease, t50% for low soluble glipizide and carbamazepine (n=3) of HPMC K750 was \n\n\n\n9.5-11 hrs and 8-10 hrs, respectively with standard deviations (SD) < 5%. Tablets of 750 \n\n\n\ncps HPMC blend had slower and more variable drug release with t50% of 10-15 hrs and \n\n\n\n7-12 hrs, respectively with SD of up to 10%. In contrast, t50% for soluble theophylline \n\n\n\nwas 5.5-6.5 hrs with SD < 5% for both HPMC K750 and the 750 cps HPMC blend. \n\n\n\nSimilar trends were observed with HPMC K1500 and HPMC K250. Erosion and swelling \n\n\n\nprofiles for low soluble glipizide and carbamazepine with new intermediate MW grades \n\n\n\nwere less variable (8% SD) compared to equivalent viscosity HPMC blends (18% SD). \n\n\n\nLess variability of erosion and swelling profiles was observed with soluble theophylline \n\n\n\nwith both the intermediate MW HPMC grades and similar viscosity blends. Both average \n\n\n\nMW and MW distribution are important for matrix erosion and swelling. Bimodally \n\n\n\ndistributed blends results in slower release and more variability than the unimodal custom \n\n\n\nHPMC grades. MW distribution is of less importance for soluble drugs.  \n\n\n\n\n\n\n\n \nPPT4 (000049) \n\n\n\n\n\n\n\nAqueous Solubility Enhancement of Ketoconazole Using Solid Dispersion and \n\n\n\nComplexation Technique \n\n\n\n\n\n\n\nS Kumar \n1\n, P Sharma \n\n\n\n1\n, A Kauts \n\n\n\n1\n, K Dua \n\n\n\n2\n \n\n\n\n1\n Department of Pharmaceutics, D.J. College of Pharmacy, Modinagar, U.P., India \n\n\n\n2 \nDepartment of Pharmaceutical Technology, School of Pharmacy, International Medical \n\n\n\nUniversity, Bukit Jalil, Kuala Lumpur 57000, Malaysia \n\n\n\n\n\n\n\nDissolution is the rate limiting step for drugs with poor aqueous solubility which in turn \n\n\n\naffects their therapeutic activity. Ketoconazole is a poorly water soluble drug which is \n\n\n\nclassified as class II drug under biopharmaceutics classification scheme. Keeping this fact \n\n\n\nin mind, the aim of the present study was designed to prepare inclusion complexes and \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 126 \n\n\n\nsolid dispersions of ketoconazole (KET) in order to enhance its dissolution. The phase \n\n\n\nsolubility studies were carried out by the method described by Higuchi and Connors. The \n\n\n\nsolid dispersions of MCC and soluble starch were prepared using solvent evaporation \n\n\n\nmethod, whereas inclusion complexes with \u03b2-cyclodextrin (\u03b2-CD) were prepared by co-\n\n\n\nevaporation method. The prepared formulations were evaluated for percentage yield, drug \n\n\n\ncontent, thermal characteristics, X-Ray diffraction pattern, SEM analysis and in-vitro \n\n\n\ndrug release. The solubility of ketoconazole at 25 \u00b0C was found to be 15.972 \u03bcg/ml. The \n\n\n\nstability constant value was found to be 883.9 M\n-1\n\n\n\n which indicated the stability of KET-\n\n\n\n\u03b2CD complexes at 1:1 molar ratio. Inclusion complexes at 1:3 molar ratios showed fastest \n\n\n\ndissolution rate (83.60 % after 120 minutes) in distilled water. Solid dispersion of \n\n\n\nketoconazole with MCC and soluble starch showed better dissolution at 1:10 weight ratio \n\n\n\n(74.49 % and 63.62 % respectively). The studies showed that solubility and dissolution \n\n\n\nrate of ketoconazole were distinctively increased in the prepared binary mixtures \n\n\n\ncompared to pure ketoconazole. The order of increase in dissolution rate with different \n\n\n\ncarriers was \u03b2-CD > MCC > soluble starch. Increase in solubility and dissolution rate was \n\n\n\nascribed due to the conversion of crystalline form into partially amorphous form and \n\n\n\nreduction in particle size with surface adsorption of drug onto carrier as shown by PXRD \n\n\n\npattern and SEM analysis. The study concluded that addition of carriers such as \u03b2-CD and \n\n\n\nMCC to ketoconazole was able to improve its dissolution rate. \n\n\n\n\n\n\n\n \nPPT5 (000069) \n\n\n\n\n\n\n\nFormulation and Evaluation of Gastroretentive Matrix Tablets of Metformin \n\n\n\nHydrochloride with Xanthan and Tamarind Gum \n\n\n\n\n\n\n\nM Razavi, S Nyamathulla, M I Noordin \n\n\n\nDepartment of Pharmacy, Faculty of Medicine, University of Malaya, 50603 Kuala \n\n\n\nLumpur \n\n\n\n\n\n\n\nGastroretentive floating drug delivery systems (GRFDDS) were often designed to prolong \n\n\n\nthe gastric residence time of drugs with absorption window in the upper parts of \n\n\n\ngastrointestinal tract to improve their bioavailability. GRFDDS offer continuous input of \n\n\n\ndrug at its site of absorption due to their ability to float on gastric contents over prolonged \n\n\n\nperiod of time. The aim of the present study was to develop optimal gastroretentive drug \n\n\n\ndelivery system for Metformin HCl. Metformin HCl, an antidiabetic drug, with \n\n\n\nabsorption window in the stomach, has oral bioavailability of around 50 %, probably due \n\n\n\nto its poor absorption from lower gastrointestinal tract. The present study was to \n\n\n\nformulate Metformin HCl matrix tablets with natural release retardants like xanthan and \n\n\n\ntamarind gum (Tamarind Kernel Powder). The gastroretentive matrix tablets of \n\n\n\nMetformin HCl were prepared using xanthan and tamarind gum in different ratios, \n\n\n\nsodium bicarbonate was used as gas generating agent for buoyancy. Four formulations, \n\n\n\nTKP 2, TKP 3, TKP 4 and TKP 5 were prepared using tamarind gum:xanthan in the ratios \n\n\n\nof 4:1, 3:2, 2:3, 1:4, whereas TKP 1 and TKP 6 were prepared using only tamarind gum \n\n\n\nand xanthan respectively. The matrix tablets were prepared by wet granulation method \n\n\n\nwith 1 % w/v xanthan as binder solution and evaluated for pharmacopoeial requirements. \n\n\n\nAll the prepared formulations exhibited good tablet characteristics with a floating lag time \n\n\n\nof < 1 min. The drug release profiles of the matrix tablets indicated the inability of \n\n\n\ntamarind gum to control the release when used alone. However, TKP 3 has short floating \n\n\n\nlag time (< 30 sec), and was found to have an optimum release of 99.29% in 10 h. The \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 127 \n\n\n\ndissolution data was fitted to popular mathematical models to assess the mechanism of \n\n\n\ndrug release, TKP 3 showed predominant zero order release (r = 0.9518) and Higuchi \n\n\n\ndiffusion (r = 0.9930). It is concluded therefore that TKP 3 with tamarind gum and \n\n\n\nxanthan (3:2) has optimum Metformin HCl release in 10 h. \n\n\n\n\n\n\n\n \nPPT6 (000073) \n\n\n\n\n\n\n\nFormulation and In-vitro Evaluation of Matrix Type Transdermal Patches of \n\n\n\nCaptopril \n\n\n\n\n\n\n\nS Rajesh, N L Tai, A M Saleem, M Balamurugan \n\n\n\nDepartment of Pharmaceutical Technology, Faculty of Pharmaceutical Sciences, UCSI \n\n\n\nUniversity, 56000 Kuala Lumpur \n\n\n\n\n\n\n\nCaptopril is an angiotensin converting enzyme (ACE) inhibitor and there is a need for an \n\n\n\nalternative to the oral route due to its reduced oral absorption and short elimination half-\n\n\n\nlife. This study was aimed to design and evaluate matrix-type transdermal patches of \n\n\n\ncaptopril. Polymers used were hydroxypropyl methylcellulose (HPMC) and polyethylene \n\n\n\nglycol (PEG) 400. Menthol and aloe vera were used as permeation enhancers. Matrix type \n\n\n\ntransdermal patches of captopril were prepared by moulding technique. Eight \n\n\n\nformulations (F1-F8) were prepared by varying the ratios of polymers and enhancers. The \n\n\n\nFTIR results showed no abnormal peaks and thus it was concluded that no incompatibility \n\n\n\nbetween the drug and polymers. Skin irritation was studied by modified Draize test and \n\n\n\nthe results showed no noticeable irritation on rabbit skin, indicating the skin compatibility \n\n\n\nof drug as well as polymer matrix. The uniformity of drug content was evidenced by low \n\n\n\nS.D values (\u00b1 0.012 to \u00b1 0.057). High folding endurance (>280) revealed that the \n\n\n\nprepared films were having good flexibility. The weight of the patches was uniform and \n\n\n\nthickness varied from 0.0533 to 0.1267 mm. In vitro permeation through excised rat skin \n\n\n\nwas carried out using modified Franz diffusion cell and the results showed that film (F6) \n\n\n\ncontaining HPMC and PEG 400 (1:1) with menthol as  a permeation enhancer \n\n\n\ndemonstrated the highest drug release (90.04%) at 24 hours (p < 0.05). In conclusion the \n\n\n\ndeveloped captopril transdermal patches showed good in-vitro drug release. However, \n\n\n\nfurther in-vivo studies are required to explore these findings.  \n\n\n\n\n\n\n\n \nPPT7 (000099) \n\n\n\n\n\n\n\nEffect of Polymer Concentration on Plasticity of Hot Air-Dried Guluronate- and \n\n\n\nMannuronate-Rich Alginate Films \n\n\n\n\n\n\n\nN S Ashikin Wan Hussin \n1,2,4\n\n\n\n, T W Wong \n1, 2 \n\n\n\n, C L Law \n3\n \n\n\n\n1 \nParticle Design Research Group, Faculty of Pharmacy, Universiti Teknologi MARA \n\n\n\nMalaysia, 42300 Puncak Alam, Selangor \n2 \n\n\n\nNon-Destructive Biomedical and Pharmaceutical Research Centre, Universiti Teknologi \n\n\n\nMARA Malaysia, 42300  Puncak Alam, Selangor \n3 \n\n\n\nSchool of Chemical and Environment Engineering, The University of Nottingham, \n\n\n\nMalaysia Campus, 43500 Semenyih, Selangor \n4 \n\n\n\nKPJ International University College of Nursing and Health Sciences, Persiaran Kota \n\n\n\nSeriemas, 71800 Nilai, Negeri Sembilan \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 128 \n\n\n\n\n\n\n\nThe present study investigates the plasticity of hot air-dried guluronate-rich (MG) and \n\n\n\nmannuronate-rich (MC) alginate films prepared from 2 and 4 % (w/w) alginate solutions, \n\n\n\nwhich contained the same amount of polymer, keeping the content of solid polymer in all \n\n\n\nfilms at 0.4 g through hot-air drying at 60 \u02daC for the use as transdermal drug delivery \n\n\n\nsystem. These films were subjected to thermomechanical, differential scanning \n\n\n\ncalorimetry, fourier transform infrared, moisture content, viscosity and polymer \n\n\n\nmolecular weight analysis. It was found that the film plasticity increased when diluted \n\n\n\nalginate solution and MC were employed in film preparation. This was due to a decrease \n\n\n\nin polymer-polymer interaction at high strength domains of the matrix involving C-H, O-\n\n\n\nH, C-O and/or C=O moiety of the alginate, attributing to plasticization effect of water and \n\n\n\nease of molecular rearrangement of the MC.  \n\n\n\n\n\n\n\n \nPPT8 (000126) \n\n\n\n\n\n\n\nPeople Perception towards Impact of Good Manufacturing Practice Implementation \n\n\n\nin Malaysia \n\n\n\n\n\n\n\nA Abdellah, M I Noordin  \n\n\n\nDepartment of Pharmacy, Faculty of Medicine, University of Malaya, 50603Kuala \n\n\n\nLumpur \n\n\n\n\n\n\n\nImproving the actual performance of the Pharmaceutical Good Manufacturing Practice \n\n\n\n(GMP) to ensure quality, safety and efficacy of medicines is an important task for health \n\n\n\nsystems. Health policy makers have the responsibility for the care of the people whose \n\n\n\nperception plays a crucial role in the evaluation of health policies and systems. Therefore, \n\n\n\nthis study was intended to assess the perception of the general public concerning the \n\n\n\nquality and affordability of Malaysian manufactured medicines. Questionnaires were \n\n\n\ndesigned following Likert scale method, validated and reliability test was conducted. As \n\n\n\nmany as 600 questionnaires were distributed either personally, by post or email within \n\n\n\nthree states in Malaysia through random sampling methodology. Out of which 550 were \n\n\n\nreturned, 544 (90.6%) were usable. The age of the respondents was between 20 to 60 \n\n\n\nyears. They were either educated or uneducated. The results were analysed using (SPSS) \n\n\n\nsoftware version 16. The results indicate that the majority (65.1%) are satisfied with the \n\n\n\nquality of manufactured medicines in Malaysia. Further, 66% of the respondents are \n\n\n\ncontented with the price. Some (45%) prefer the locally manufactured medicines than \n\n\n\nimported ones and only few (2.6%) have complained about it. However, there has been \n\n\n\nconcern about the escalating prices and hence, the need for proper price regulation as \n\n\n\nascertained by majority (88.9%). The study found that product brand name does not \n\n\n\nsignificantly influence acceptance of use although of the perception that medicine quality \n\n\n\nis directly proportional to the price. This study also suggests that the acceptability and use \n\n\n\nof generic medicines increase affordability in addition to the positive impact of GMP \n\n\n\nimplementation in Malaysia on the medicine quality.  \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n"
"\n\n\n\n\n\n\n\n\n\nCost-Effectiveness Analysis of a Behavioral Risk Factor Reduction Program at a \n\n\n\nWorksite: Experience From a  Public University in Malaysia \n \n\n\n\nSiow Yen Liau* BPharm, PhD\n1\n, Asrul A Shafie  BPharm, PhD\n\n\n\n2\n, Mohamed Azmi A Hassali  BPharm, \n\n\n\nPhD\n2\n, Mohamed Izham Mohamed Ibrahim BPharm, PhD\n\n\n\n3 \n\n\n\n \n1\n Pharmacy Department, Hospital Queen Elizabeth 2, Kota Kinabalu, Sabah \n\n\n\n2\n School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia \n\n\n\n3\n Social and Administrative Pharmacy, College of Pharmacy, Qatar University, Doha, Qatar \n\n\n\n\n\n\n\n* Contact for correspondence, please email: siowyenliau@yahoo.com \n\n\n\n\n\n\n\nABSTRACT \nObjectives: The objectives of this study were to determine the cost of a behavioral risk factor \n\n\n\nreduction program at the worksite  and to compare the cost-effectiveness of the program with a \n\n\n\ncontrol group.  Methodology: This was a quasi-experimental study conducted among employees of \n\n\n\nUniversiti  Sains Malaysia. The program targeted five primary risk factors (RF). Participants in the \n\n\n\nintervention program were subjected to schedule individualized counseling and seminars during the 6-\n\n\n\nmonth follow-up. Participants in the control group underwent health screening. Cost-effectiveness \n\n\n\nanalysis was conducted from the payer\u2019s perspective to determine the cost of 1% increase in \n\n\n\nproportion of participants who reach ideal targets for the RF. One-way sensitivity analysis was also \n\n\n\nconducted. Results: A total 136 participants were recruited in this study. At 6-month follow-up, \n\n\n\nsignificantly higher proportion of participants in the intervention group reached target for fruit and \n\n\n\nvegetable intake (P \uf03c 0.001) and physical activity (P = 0.017). The costs of the intervention program \n\n\n\nand control group were estimated to be MYR304.52 (USD92.28) and MYR169.90 (USD51.48)  per \n\n\n\nparticipant respectively. The incremental cost-effectiveness ratio (ICER) of all the RF were lower \n\n\n\nthan the World Health Organization recommendation based on the CHOICE analyses for relative \n\n\n\ncost-effectiveness of an intervention. Body mass index and alcohol consumption reported negative \n\n\n\nICER which indicated control dominant. Sensitivity analyses showed that ICER was reported to be \n\n\n\nmost sensitive to the change in participants\u2019 salary. Conclusion: The proposed health promotion \n\n\n\nprogram was shown to be cost-effective in modifying most of the behavioral RF.  \n\n\n\n\n\n\n\nKeywords: behavioural, cost-effectiveness analysis, risk factors \n \n\n\n\n\n\n\n\nBACKGROUND \nOver the years, the life expectancy of the Malaysian population has increased and coupled with the \n\n\n\nadoption of western lifestyle, the prevalence of cardiovascular risk factors has also increased[1-2]. \n\n\n\nThis increased resulted in an increased in the prevalence of cardiovascular (CV) and its related \n\n\n\ndiseases[3]. Cardiovascular and its related diseases required long-term medical treatment. \n\n\n\n\n\n\n\nModification of risk factors (RFs) is crucial in order to curb the rise of CV disease. In Malaysia, \n\n\n\nnumerous CV prevention program has been initiated by various parties. These included the \n\n\n\nindividualized and community-wide strategies. Community-wide strategies are widely used but its \n\n\n\neffectiveness is questionable. Individualized counseling on RF modification provides personalized \n\n\n\ninformation to individuals and is believed to produce better outcome. However, the implementation in \n\n\n\nreal world scenario of such a program is questionable because individualized health promotion \n\n\n\nprogram is time, manpower and resources consuming.  \n\n\n\n\n\n\n\nThis health promotion program incorporated both behavioral and educational aspects of lifestyle \n\n\n\nmodification strategies, with an emphasis on the five modifiable RF. The aim of the health promotion \n\n\n\nprogram was to correct an array of cardiovascular risk factor behaviors simultaneously. The emphasis \n\n\n\nof this program was empowerment, which aimed to help participants to develop the knowledge, skills, \n\n\n\n\nmailto:siowyenliau@yahoo.com\n\n\n\n\n\n\nattitude and self-awareness required to take up the responsibility for their own health. The \n\n\n\nintervention program included stage-matched motivational and behavioral strategies based on the \n\n\n\nTranstheoretical Model (TTM). These were applied to the five modifiable RFs, namely smoking, \n\n\n\nunhealthy diet, excessive alcohol consumption, physical inactivity, and obesity and being overweight. \n\n\n\nIt was assumed that changes to a primary RF will bring positive changes to the secondary RF. \n\n\n\n\n\n\n\nIn Malaysia, public healthcare sector was heavily subsidized by the government. The rise in CV and \n\n\n\nits related diseases has dramatic impact on healthcare expenses as well as employees\u2019 absenteeism \n\n\n\nfrom work. With the limited resources for healthcare, priority setting is important to identify the \n\n\n\ntreatment (intervention) which gives maximum health gain within a limited budget. Thus evaluation \n\n\n\nof cost and benefit of a health promotion program can support decision-makers in effective budget \n\n\n\ndeployment. Moreover, the cost-effectiveness analysis of the health promotion program provided an \n\n\n\ninsight on the affordability of this program.  \n\n\n\n\n\n\n\nThe objective of this study was to compare the cost-effectiveness of a behavioral RF reduction \n\n\n\nprogram at the worksite versus health screening alone in achieving the ideal target for five primary \n\n\n\ncardiovascular risk factors. \n\n\n\n\n\n\n\nMETHODOLOGY \nThis was a quasi-experimental study carried out from October 2009 to July 2010 at Universiti  Sains \n\n\n\nMalaysia (USM). Participants for the intervention and control group were recruited among the \n\n\n\nemployees of Engineering Campus and main campus of USM respectively.  \n\n\n\n\n\n\n\nThis prospective lifestyle interventional study targeted five primary RF namely smoking, excessive \n\n\n\nalcohol consumption, physical inactivity, inadequate fruit and vegetable intake and \n\n\n\noverweight/obesity. Participants in the intervention group were required to attend scheduled \n\n\n\nindividualized counseling and seminars during the 6-month follow-up. Individualized counseling was \n\n\n\nbased on a standardized and validated (using Delphi method) counseling protocol. The frequencies of \n\n\n\nthe individualized counseling sessions were bimonthly for the first month and monthly thereafter. \n\n\n\nTwo seminars were held during the 6-month program targeted on the two main RF i.e. physical \n\n\n\ninactivity and unhealthy diet. The health educator was trained on providing counseling on RF \n\n\n\nmanagement based on the TTM and motivational interviewing principles. Control group participants \n\n\n\nunderwent health screening and the results of this health screening were mailed to them within one \n\n\n\nweek. No involuntary changes were made to their lifestyle. Figure 1 display the flow of the study. \n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\nFigure 1: Flow of the study \n\n\n\n \nParticipants for both the intervention and control group fulfilled pre-set inclusion and exclusion \n\n\n\ncriteria prior to enrollment into the study. The inclusion criteria were no previous CV disease/events \n\n\n\nand not currently on medication for treatment of hypertension, diabetes or dyslipidemia. Participants \n\n\n\nshould have at least one cardiovascular risk factor. Employees who were pregnant, history of severe \n\n\n\nrenal or liver disease and who were currently enrolled in any other lifestyle changes program were \n\n\n\nexcluded from this study.  \n\n\n\n\n\n\n\nData on current RF status were collected using the WHO STEPS instrument for chronic disease risk \n\n\n\nfactors surveillance questionnaires[4]. Behavioral RF status was self-reported. The same instruments \n\n\n\nand measurements were used throughout the study to reduce variability between the instruments and \n\n\n\nmeasurements made for the various obesity indexes. Physical measurements made included height, \n\n\n\nweight and waist circumference (WC). Height and weight were measured using a stadiometer. Waist \n\n\n\ncircumference was measured using a fiberglass measuring tape taken between the inferior margin of \n\n\n\nthe last rib and the crest of the ilium in a horizontal plane. Hip circumference measurement was taken \n\n\n\naround the pelvis at the point of maximal protrusion of the buttocks while patient stand with feet 25 \n\n\n\ncm to 30 cm apart with weight evenly distributed[5].  \n\n\n\n\n\n\n\n\n\n\n\nUSM \n\n\n\nControl Intervention \n\n\n\nBaseline \n\n\n\nevaluation (n=69) \n\n\n\n3-months \n\n\n\nevaluation (n=53) \n\n\n\n6-months \n\n\n\nevaluation (n=54) \n\n\n\nBaseline \n\n\n\nevaluation (n=67) \n\n\n\nMonthly individualized counseling (based on \n\n\n\nvalidated counseling protocol) by principal \n\n\n\ninvestigator (30-45 min per session) \n\n\n\n6-months \n\n\n\nevaluation (n=54) \n\n\n\nMonthly individualized counseling \n\n\n\nHealthy eating seminar \n\n\n\nby dietician (1.5hr)  \n\n\n\nResults of \n\n\n\nscreening \n\n\n\n(baseline) \n\n\n\nmailed to \n\n\n\nparticipants   \n\n\n\nPhysical activity seminar by \n\n\n\nacademician (1.5 hr)  \n\n\n\n\n\n\n\n\nCost-effectiveness analysis was conducted from the perspective of the university, as payer of \n\n\n\nhealthcare for its employees. Both direct and absenteeism costs were included in the costing analysis. \n\n\n\nResearch-related costs were excluded from the analysis. These included cost for awareness program \n\n\n\nand incentives paid to the participants. Costs of hospital admission and medications were also \n\n\n\nexcluded in the analysis because analysis was done until the day the participants were admitted for \n\n\n\nany CV events or started on medications. Micro-costing was carried out wherever possible. In cases \n\n\n\nwhere micro-costing cannot be done, expert opinion of panel or the closet estimates were used[6]. \n\n\n\n\n\n\n\nResource consumed in health and productivity sector were accounted in the cost as follows (Table 1). \n\n\n\nThe costs of the building (or space) and equipment used during the intervention were annuitized over \n\n\n\nthe useful life of the building (or space) and equipment which was estimated to be between 5 and 20 \n\n\n\nyears at a 5% discount rate. It was assumed that there was no resale value for the equipment after the \n\n\n\nuseful life of the equipment. The estimated \u2018equivalent annual cost\u2019 (EAC) was derived by taking into \n\n\n\naccount the depreciation aspect and the opportunity cost aspect of the capital cost. The costs and \n\n\n\noutcomes of the intervention program were not discounted because only 6-month outcomes were \n\n\n\ntaken into consideration during analysis.  \n\n\n\n\n\n\n\nTable 1. Resource consumed for the behavioral risk factor reduction program at the worksite. \n\n\n\nMeasure Cost  Data source \n\n\n\nActivity 1: Counseling by health educator \n\n\n\nCounseling and \n\n\n\nscreening by \n\n\n\nhealth educator \n\n\n\nDuration of counseling and \n\n\n\nscreening \n\n\n\nDetail recorded during study period. \n\n\n\nSalary of health educator \n\n\n\n(pharmacist) \n\n\n\nBased on Ministry of Health starting salary (excluding \n\n\n\nallowances) for pharmacist (Grade P1T4).  \n\n\n\nSpace for \n\n\n\ncounseling \n\n\n\nBuilding cost  Data obtained from university\u2019s Development Department. \n\n\n\nThe cost was reported as cost per square feet. \n\n\n\nUseful life years Estimated to be 20 years. \n\n\n\nDiscount rate Estimated to be 5%. \n\n\n\nAnnual maintenance Data obtained from Faber Medi Serve cleansing and linen \n\n\n\nservices for Duchess of Kent Hospital, Sandakan, Sabah. The \n\n\n\ncost was divided by two (assuming cost of cleansing and \n\n\n\nlinen services were equally distributed). The cost was \n\n\n\nreported as cost per square feet. \n\n\n\nUtilities Data obtained from monthly electricity bill for Duchess of \n\n\n\nKent Hospital, Sandakan, Sabah. The cost was reported as \n\n\n\ncost per square feet. \n\n\n\nEquipment Purchase price for electronic \n\n\n\nblood pressure machine, \n\n\n\nmeasuring tape, laptop, \n\n\n\nprinter, tables and chairs \n\n\n\nActual acquisition price. \n\n\n\nPurchase price for table, chair Government tender price. \n\n\n\nResale value Assume to be nil at the end of useful life years. \n\n\n\nUseful life years  5 years except for table (10 years)  \n\n\n\nDiscount rate  5%. \n\n\n\n \nMeasure Cost  Data source \n\n\n\nCounseling \n\n\n\nmaterial \n\n\n\nRoad to healthy heart booklet Actual printing cost. \n\n\n\nStationeries (papers and pens) Actual acquisition price. \n\n\n\nPrinting of forms Actual printing cost. \n\n\n\nLaboratory tests Fasting blood glucose and full \n\n\n\nlipid profile \n\n\n\nAverage price quoted by Pro Medic Laboratory Sdn. Bhd. \n\n\n\nOthers Toner for printer Actual acquisition price. \n\n\n\nActivity 2: Seminars \n\n\n\nSpace  Seminar room, utility, one tea \n\n\n\nbreak, audio-visual \n\n\n\nequipment, tables and chairs \n\n\n\nPrice quoted by USAINS Group of Companies for \n\n\n\nconducting seminar. \n\n\n\n\n\n\n\n\nHonorarium for \n\n\n\nspeakers \n\n\n\nTwo speakers Actual amount paid. \n\n\n\nActivity 3: Training of health educator \n\n\n\nSpace  Seminar room, utility, one tea \n\n\n\nbreak, audio-visual \n\n\n\nequipment, tables and chairs \n\n\n\nPrice quoted by USAINS Group of Companies for \n\n\n\nconducting seminar. \n\n\n\nHonorarium  Five speakers Actual amount paid. \n\n\n\nTraveling \n\n\n\nexpenses for \n\n\n\nspeaker \n\n\n\nTaxi fare for airport transfer \n\n\n\nand air fare  \n\n\n\nActual amount paid. \n\n\n\nActivity 4: Loss of productivity \n\n\n\nLoss of \n\n\n\nproductivity \n\n\n\nAbsenteeism from work Number of days absent from work and salary of the \n\n\n\nadministrative clerk.  \n\n\n\n\n\n\n\n \nThe costs of the intervention and control group were summed based on the following equation. \n\n\n\n\n\n\n\nAverage total cost per participant = Average variable cost + Average fixed cost \n\n\n\n\n\n\n\n\n\n\n\nAverage variable cost = \u2211 cost of program per participanti / number of participants \n\n\n\n\n\n\n\n= (\u2211 cost of counselingi / number of participants) + counseling material + [\u2211 \n\n\n\n(laboratory charges x number of testi) / number of participants)] + [\u2211 \n\n\n\n(participant daily salary x days of medical sick leavei) / number of \n\n\n\nparticipants)] \n\n\n\n\n\n\n\n= [\u2211 (cost of health educator per minute + cost of space per minute + cost of \n\n\n\nmaintenance per minute + cost of electricity per minute + cost of \n\n\n\nequipment per minute) x duration of counselingi/ number of \n\n\n\nparticipants] + counseling material + [\u2211 (laboratory charges x \n\n\n\nnumber of testi) / number of participants)] + [\u2211 (participant daily \n\n\n\nsalary x days of medical sick leavei) / number of participants)] \n\n\n\n\n\n\n\nAverage fixed cost  = \u2211 (cost for stationeries + printing charges + seminars + training) / number \n\n\n\nof participants \n\n\n\n\n\n\n\nOne-way sensitivity analysis was conducted by varying the cost of three parameters to test the \n\n\n\nrobustness of the results obtained. These parameters were the salary of health educators, the salary of \n\n\n\nthe participants and cost of renting of seminar room. These parameters were chosen due to the \n\n\n\nestimated costs used in the initial evaluation. In this study, the intervention was conducted by a \n\n\n\npharmacist. However, other healthcare professionals who frequently conduct such programs are \n\n\n\nmedical officers, dieticians or nurses. Therefore, the health educator\u2019s salary was varied between the \n\n\n\nhighest and the lowest salary of these professions, based on the starting salary as quoted by the Public \n\n\n\nService Department, Malaysia. Secondly, the cost of the medical sick leave of the base case analysis \n\n\n\nwas calculated based on the salary of an administrative clerk, which was the occupation of the \n\n\n\nmajority of the participants. However, there were participants of other occupation groups in this \n\n\n\nprogram. Therefore, the highest and the lowest salary of these professions were used in the sensitivity \n\n\n\nanalysis. Finally, the cost of the seminar room and tea break can vary depending on the place \n\n\n\noccupied and the food ordered.  \n\n\n\n\n\n\n\nThe primary outcome measure was to examine the intervention effects in terms of the prevalence of \n\n\n\nindividuals meeting healthy lifestyle recommendations after intervention. Given that there are four \n\n\n\nprimary outcome measures, a range of sample-size estimates based on the intervention effects \n\n\n\nobtained from previous studies was calculated. The required sample size was calculated using the \n\n\n\n \n\n\n\n\n\n\n\n\nformula for finding the sample size for studies about proportions in two groups assuming a Type I \n\n\n\nerror of 0.05 and a power of 80%[7].  \n\n\n\n\n\n\n\nIt was assumed that the achievement of fruit and vegetable intake in the intervention group was 33.0% \n\n\n\nas compared with 13.0% in the control group; physical activity was 90.0% in the intervention group \n\n\n\nas compared with 71.0% in the control group[7]; smoking cessation rates were 17.0% for the \n\n\n\nintervention group as compared with 2.3% in the control group[8] and a higher compliance with \n\n\n\nrecommendations for the control group (30.0% vs 26.0%) was reported for alcohol consumption[7]. \n\n\n\nAfter taking into considerations a 20% drop-out rate, the required sample size was between 58 and \n\n\n\n118 in each group. \n\n\n\n\n\n\n\nPre-determined criterion to define whether a change has successfully reach its target or not, were \n\n\n\nbased on the targets adopted from the Malaysian clinical practice guidelines[5, 9-14]. The outcome \n\n\n\nmeasure for this study was the cost per 1% increase in proportion of participants who reach the ideal \n\n\n\ntargets for the RF. Approval from the Joint Ethics Committee of the School of Pharmaceutical \n\n\n\nSciences, USM-Lam Wah Ee Hospital was obtained prior to the commencement of the study. \n\n\n\n\n\n\n\nAll data were analyzed using statistical software SPSS package version-16. A two-tailed P-value \uf03c \n\n\n\n0.05 was considered statistically significant. Baseline sociodemographic and RF characteristics \n\n\n\nbetween intervention and control groups were reported using simple descriptive statistics. Continuous \n\n\n\nvariables were expressed in mean and standard deviation or median and inter-quartile range for \n\n\n\ncontinuous variables. Discrete variables were expressed in proportion. Differences in the proportion \n\n\n\nof participants reaching target for each RF were compared using chi square test (or Fisher exact test).  \n\n\n\n\n\n\n\nRESULTS \nA total 136 participants were recruited into the study with 69 participants (50.7%) in the intervention \n\n\n\ngroup and 67 participants (49.3%) in the control group. At 6-month follow-up, 78.3% (n = 54) and \n\n\n\n91.1% (n = 61) of the participants completed final evaluation. Majority of the participants were \n\n\n\nfemale and of Malay ethnic origin. The mean age was 36.92 (SD = 9.14) years. There was no \n\n\n\nsignificant difference between intervention and control group in terms of sex and ethnicity. \n\n\n\n\n\n\n\nThe RFs were categorized into reaching target and not reaching target and were compared between \n\n\n\nintervention and control groups (Table 2). At baseline, there was no significant difference in the \n\n\n\nproportion of participants reaching the target for any of the RF. However, at 6-month follow-up, \n\n\n\nsignificantly higher proportion of participants in the intervention group reached the target for fruit and \n\n\n\nvegetable intake (P \uf03c 0.001) and physical activity (P = 0.017).  \n\n\n\n\n\n\n\nA total of 69 participants in the intervention group were entered into the analyses. The cost of the \n\n\n\nintervention program was estimated to be MYR304.52 (USD92.28) per participant.  \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nTable 2. Comparison of proportion of participants reaching risk factors target \n\n\n\nRisk factor Group Baseline \n\n\n\n(n, %) \n\n\n\nP-value 3-month \n\n\n\n(n, %) \n\n\n\nP-\n\n\n\nvalue \n\n\n\n6-month \n\n\n\n(n, %) \n\n\n\nP-\n\n\n\nvalue \n\n\n\n  Yes No  Yes No  Yes No  \n\n\n\nSmoking  Int 65 \n\n\n\n(94.2) \n\n\n\n4  \n\n\n\n(5.8) \n\n\n\n0.743\nb\n 50 \n\n\n\n(94.3) \n\n\n\n3 \n\n\n\n(5.7) \n\n\n\n- 52 \n\n\n\n(96.3) \n\n\n\n2 \n\n\n\n(3.7) \n\n\n\n0.683\nb\n \n\n\n\nControl  62 \n\n\n\n(92.5) \n\n\n\n5  \n\n\n\n(7.5) \n\n\n\n  57 \n\n\n\n(93.4) \n\n\n\n4 \n\n\n\n(6.6) \n\n\n\nAlcohol \n\n\n\nconsumption \n\n\n\nInt 67 \n\n\n\n(97.1) \n\n\n\n2  \n\n\n\n(2.9) \n\n\n\n1.000\nb\n 51 \n\n\n\n(96.2) \n\n\n\n2 \n\n\n\n(3.8) \n\n\n\n- 52 \n\n\n\n(96.3) \n\n\n\n2 \n\n\n\n(3.7) \n\n\n\n0.218\nb\n \n\n\n\nControl  66 \n\n\n\n(98.5) \n\n\n\n1  \n\n\n\n(1.5) \n\n\n\n  61 \n\n\n\n(100.0) \n\n\n\n0 \n\n\n\n(0) \n\n\n\nFruit and \n\n\n\nvegetable intake \n\n\n\nInt 3 \n\n\n\n(4.3) \n\n\n\n66 \n\n\n\n(95.7) \n\n\n\n0.322\nb\n 11 \n\n\n\n(20.8) \n\n\n\n42 \n\n\n\n(79.2) \n\n\n\n- 19 \n\n\n\n(35.2) \n\n\n\n35 \n\n\n\n(64.8) \n\uf03c0.001\n\n\n\na\n \n\n\n\nControl  6 \n\n\n\n(9.0) \n\n\n\n61 \n\n\n\n(91.0) \n\n\n\n  5 \n\n\n\n(8.2) \n\n\n\n56 \n\n\n\n(91.8) \n\n\n\nPhysical activity Int 13 \n\n\n\n(18.8) \n\n\n\n56 \n\n\n\n(81.2) \n\n\n\n0.096\na\n 13 \n\n\n\n(24.5) \n\n\n\n40 \n\n\n\n(75.5) \n\n\n\n- 13 \n\n\n\n(24.5) \n\n\n\n40 \n\n\n\n(75.5) \n\n\n\n0.017\na\n \n\n\n\nControl  6 \n\n\n\n(9.0) \n\n\n\n61 \n\n\n\n(91.0) \n\n\n\n  5 \n\n\n\n(8.2) \n\n\n\n56 \n\n\n\n(91.8) \n\n\n\nBody mass \n\n\n\nindex \n\n\n\nInt 23 \n\n\n\n(33.3) \n\n\n\n46 \n\n\n\n(66.7) \n\n\n\n0.308\na\n 18 \n\n\n\n(34.0) \n\n\n\n35 \n\n\n\n(66.0) \n\n\n\n- 20 \n\n\n\n(37.0) \n\n\n\n34 \n\n\n\n(63.0) \n\n\n\n0.503\na\n \n\n\n\nControl  17 \n\n\n\n(25.4) \n\n\n\n50 \n\n\n\n(74.6) \n\n\n\n  18 \n\n\n\n(31.0) \n\n\n\n40 \n\n\n\n(69.0) \n\n\n\nWaist \n\n\n\ncircumference \n\n\n\nInt 33 \n\n\n\n(47.8) \n\n\n\n36 \n\n\n\n(52.2) \n\n\n\n0.081\na\n 35 \n\n\n\n(66.0) \n\n\n\n18 \n\n\n\n(34.0) \n\n\n\n- 29 \n\n\n\n(54.7) \n\n\n\n24 \n\n\n\n(45.3) \n\n\n\n0.089\na\n \n\n\n\nControl  42 \n\n\n\n(62.7) \n\n\n\n25 \n\n\n\n(37.3) \n\n\n\n  31 \n\n\n\n(53.4) \n\n\n\n27 \n\n\n\n(46.6) \n\n\n\nWaist-hip ratio Int 53 \n\n\n\n(76.8) \n\n\n\n16 \n\n\n\n(23.2) \n\n\n\n0.747\na\n 48 \n\n\n\n(90.6) \n\n\n\n5 \n\n\n\n(9.4) \n\n\n\n- 47 \n\n\n\n(88.7) \n\n\n\n6 \n\n\n\n(11.3) \n\n\n\n0.181\na\n \n\n\n\nControl  53 \n\n\n\n(79.1) \n\n\n\n14 \n\n\n\n(20.9) \n\n\n\n  46 \n\n\n\n(79.3) \n\n\n\n12 \n\n\n\n(20.7) \n\n\n\n\u03b1 value = 0.05; \na\n chi square; \n\n\n\nb\n Fisher Exact test; Int = intervention;  \n\n\n\n\n\n\n\nSimilar estimation and calculation was used to calculate the cost of the control group. The time spent \n\n\n\non screening for baseline and 6-month evaluation was taken into consideration of cost calculation. \n\n\n\nSince no active intervention was provided to the control group, laptop and printer were considered not \n\n\n\nutilized by this group of participant. They were also not provided with the counseling material and \n\n\n\ntherefore its cost was excluded from this analysis for the control group. It was estimated that the \n\n\n\nscreening of the control group used up one ream of A4 paper and one pen with a total cost of \n\n\n\nMYR18.50. The printing cost over the 6-month was MYR356.00 (108 pages for 66 participants at \n\n\n\nMYR0.05 per page). The cost of seminars and training of health educator was also excluded from this \n\n\n\nanalysis. Initially there were 67 participants in the control group. However, three of the participants \n\n\n\nwere transferred to another institution and data on their medical sick leave and 6-month evaluation \n\n\n\nwere not available. Therefore, they were excluded from these analyses giving a total of 64 participants \n\n\n\nin the control group. The cost of screening for the control group was estimated to be MYR169.90 \n\n\n\n(USD51.48) per participant. Therefore, the differences in cost between intervention and control group \n\n\n\nparticipant was MYR134.62 (USD40.79) per participant.  \n\n\n\n\n\n\n\nCost-effectiveness Analysis of Proportion of Participants Reaching Risk Factors Target \n\n\n\nThe summary of the cost-effectiveness ratio (CER) and incremental cost-effectiveness ratio (ICER) \n\n\n\nfor the proportion of participants reaching target for each RF was presented in Table 3. Cost-\n\n\n\neffectiveness ratio provides information on the cost of 1% increase in the proportion of participants \n\n\n\nreaching target for each RF. It can be seen that within the intervention group, alcohol consumption \n\n\n\nworsen with a negative CER. Similarly, three RFs (fruit and vegetable intake, physical activity and \n\n\n\nWC) produced negative CER for the control group.   \n\n\n\n \n\n\n\n\n\n\n\n\nTable 3. Cost-effectiveness ratio and incremental cost-effectiveness ratio for proportion of \n\n\n\nparticipants reaching target for each risk factor \n\n\n\n Intervention Control  \n\n\n\n Baseline \n\n\n\n(a) (%) \n\n\n\n6-\n\n\n\nmonth \n\n\n\n(b) \n\n\n\n(%) \n\n\n\n(b) \u2013 \n\n\n\n(a) \n\n\n\nCER Baseline \n\n\n\n(a) (%) \n\n\n\n6-\n\n\n\nmonth \n\n\n\n(b) \n\n\n\n(%) \n\n\n\n(b) \u2013 \n\n\n\n(a) \n\n\n\nCER ICER \n\n\n\nSmoking   94.2 96.3 2.1 14,500.95 92.5 93.4 0.9 18,877.78 11,218.33 \n\n\n\nAlcohol \n\n\n\nconsumption  \n\n\n\n97.1 96.3 -0.8 -38,065.00 98.5 100.0 1.5 11,326.67 CD \n\n\n\nFruit and \n\n\n\nvegetable \n\n\n\nintake \n\n\n\n4.3 35.2 30.9 985.50 9.0 8.2 -0.8 -\n\n\n\n21,237.50 \n\n\n\n424.67 \n\n\n\nPhysical \n\n\n\nactivity \n\n\n\n18.8 24.5 5.7 5342.46 9.0 8.2 -0.8 -\n\n\n\n21,237.50 \n\n\n\n2071.08 \n\n\n\nBody mass \n\n\n\nindex \n\n\n\n33.3 37.0 3.7 8230.27 25.4 31.0 5.6 3033.93 CD \n\n\n\nWaist \n\n\n\ncircumference \n\n\n\n47.8 54.7 6.9 4413.33 62.7 53.4 -9.3 -1826.88 830.99 \n\n\n\nWaist-hip \n\n\n\nratio \n\n\n\n76.8 88.7 11.9 2558.99 79.1 79.3 0.2 84,950.00 1150.60 \n\n\n\nCD = control dominant; CER = cost-effectiveness ratio; ICER = incremental cost-effectiveness ratio \n\n\n\n\n\n\n\nIncremental cost-effectiveness ratio is defined as the ratio of change in cost of an intervention as \n\n\n\ncompared to the control group to the change in outcomes between the two groups[15]. A negative \n\n\n\nratio indicated that the control group was dominant in increasing the proportion of participants \n\n\n\nreaching target. This was seen with body mass index (BMI) and alcohol consumption. \n\n\n\n\n\n\n\nSensitivity analyses were conducted to test the robustness of the cost-effectiveness model. Three \n\n\n\nparameters were varied between their maximum and minimum values. These were the salary of the \n\n\n\nhealth educator, salary of participants for productivity cost estimation and cost of conducting \n\n\n\nseminars.  \n\n\n\n\n\n\n\nThe cost per participant for the intervention and control groups was recalculated based on the \n\n\n\nvariation of the pre-set parameters in the sensitivity analysis. The incremental costs vary from -\n\n\n\nMYR79.57 (USD24.11) (cost per participant in the control group higher than intervention group) to \n\n\n\nMYR144.49 (USD43.78). This was summarized in Table 4. \n\n\n\n\n\n\n\n\n\n\n\nTable 4. Cost of the program (intervention and control) during sensitivity analysis \n\n\n\n Cost of program / per \n\n\n\nparticipant \n\n\n\n(Intervention) (MYR) \n\n\n\nCost of program \n\n\n\nper participant \n\n\n\n(Control) (MYR) \n\n\n\nIncremental cost \n\n\n\n(intervention \u2013 \n\n\n\ncontrol) (MYR) \n\n\n\nBase case analysis 304.52 169.90 134.62 \n\n\n\nSensitivity analysis 1: health educator \n\n\n\nsalary maximum \n\n\n\n308.47 171.02 137.45 \n\n\n\nSensitivity analysis 2: health educator \n\n\n\nsalary minimum \n\n\n\n288.36 165.28 123.08 \n\n\n\nSensitivity analysis 3: participant \n\n\n\nsalary maximum (for estimation of \n\n\n\nabsenteeism) \n\n\n\n482.76 562.33 -79.57 \n\n\n\nSensitivity analysis 4: participant \n\n\n\nsalary minimum (for estimation of \n\n\n\nabsenteeism) \n\n\n\n296.33 151.84 144.49 \n\n\n\nSensitivity analysis 5: seminar cost \n\n\n\nmaximum \n\n\n\n314.53 169.90 144.63 \n\n\n\n\n\n\n\n\nSensitivity analysis 6: seminar cost \n\n\n\nminimum \n\n\n\n294.53 169.90 124.63 \n\n\n\n\n\n\n\nCost-effectiveness ratio and ICER were calculated for each RF and for each of the parameters which \n\n\n\nwas included in the sensitivity analysis. Subsequently, the percentage change from the base case \n\n\n\nanalysis in the ICER was calculated.  \n\n\n\n\n\n\n\nThe sensitivity of the change in parameters varied. Although the cost of the health educator made up \n\n\n\nof 18% of the total cost of the program, varying this cost to the medical officer\u2019s salary did not affect \n\n\n\nthe results as much as varying it to the salary of the staff nurse. Hence employing staff nurse to \n\n\n\nconduct the intervention is more cost-effective. Secondly, varying the cost of the rental for the \n\n\n\nseminar room did not have much effect on the ICER. In contrast, varying the participants\u2019 salary \n\n\n\nbetween the minimum (salary of general worker) and maximum (lecturer) have tremendous effect on \n\n\n\nthe ICER. This salary was used to calculate the cost of medical sick leave taken by the participants. \n\n\n\nThere was more than 150% change when the participants\u2019 salary was adjusted to the maximum, in \n\n\n\nfavor of the intervention group. When the salary was adjusted to the minimum, the cost difference \n\n\n\nincreased from base case analysis resulting in an increased in percentage change in ICER. This can be \n\n\n\nobserved from the tornado diagram as presented in Figure 2.  \n\n\n\n\n\n\n\n\n\n\n\nFigure 2: Tornado diagram of the percentage change in ICER for proportion of participants reaching \n\n\n\nRF target \n\n\n\n\n\n\n\nSimilarly, ICER was recalculated by varying the two main outcomes, namely physical activity and \n\n\n\nadequate fruit and vegetable intake. It was found that by varying proportion of participants achieving \n\n\n\ntarget RF, the ICER achieved was still less than MYR30,000. \n\n\n\n-8.57 \n\n\n\n-7.42 \n\n\n\n7.33 \n\n\n\n2.10 \n\n\n\n7.44 \n\n\n\n-159.11 \n\n\n\n-180 -160 -140 -120 -100 -80 -60 -40 -20 0 20\n\n\n\nPercentage change in ICER \n\n\n\nP\na\n\n\n\nra\nm\n\n\n\ne\nte\n\n\n\nrs\n v\n\n\n\na\nri\n\n\n\ne\nd\n\n\n\n\n\n\n\nminimum maximum\n\n\n\nParticipant's salary \n\n\n\nCost of seminar \n\n\n\nHealth educator \n\n\n\n\n\n\n\n\nDiscussion \nThe aim of this study was to conduct cost-effectiveness analysis on the effect of a worksite health \n\n\n\npromotion program on achieving RF targets. Significant improvement of the intervention on the \n\n\n\nproportion of participants reaching the targets was found in fruit and vegetable intake and physical \n\n\n\nactivity. Most of the studies reviewed reported significant higher proportion of participants in the \n\n\n\nintervention groups meeting the target for physical activity and fruit and vegetable intake except for \n\n\n\nstudies reported by Jimmy et al. (2005) (physical activity) and Hardcastle et al. (2008) (fruit and \n\n\n\nvegetable intake)[7, 16-19].  \n\n\n\n\n\n\n\nThe effect of health promotion program on the prevalence of smoking was not consistent. Our study \n\n\n\nreported no significant difference between the two groups. This was supported by studies reported \n\n\n\nelsewhere[18, 20-24]. However, the numbers of smokers might be too small to detect any differences \n\n\n\nduring analyses. \n\n\n\n\n\n\n\nThe intervention program was more costly than the control, with a differential cost of MYR134.62 \n\n\n\n(USD40.79) per participant in six months. The differential costs between health promotion program \n\n\n\nand screening along differed widely in existing studies, depending on the duration, intensity and type \n\n\n\nof intervention. It ranged from USD41.09 to EUR430 (USD612.42)[25-27]. \n\n\n\n\n\n\n\nIt is not feasible to compare the CER and ICER calculated from this study to the studies reported \n\n\n\nelsewhere. Most of the studies had modeled the effect of the intervention to final outcomes such as \n\n\n\nlife-years gained and quality-adjusted life years.  \n\n\n\n\n\n\n\nThe ICER of the various obesity indexes produced different results. The disproportionate achievement \n\n\n\nof target RF between BMI, WC and waist-hip ratio (WHR) between intervention and control group \n\n\n\nwas unexpected and was not supported by the studies reviewed. A reduction in body weight is \n\n\n\nfrequently reported to correspond with reduction in abdominal obesity (reported as WC and \n\n\n\nWHR)[28-30]. The only exception was a study by Hassan et al. (2011) which reported a significant \n\n\n\nreduction in WC and hip circumference but not BMI after a 6-month program targeted on diet and \n\n\n\nindividualized physical activity[31].  \n\n\n\n\n\n\n\nDespite the negative ICER for alcohol consumption, the number of participants who achieved targets \n\n\n\nfor alcohol consumption was too small to make any general conclusion on the effect of the program. \n\n\n\n\n\n\n\nThe other RF consistently showed positive ICER for both the outcomes. The calculated ICER were \n\n\n\nmuch lower than the World Health Organization recommendation based on the CHOICE analyses for \n\n\n\nrelative cost-effectiveness of an intervention, whereby an ICER of less than MYR30,000 \n\n\n\n(USD9090.91) is considered cost-effectiveness for public policy intervention in Malaysia[32]. \n\n\n\n\n\n\n\nA review of the literature found numerous economic evaluation which reported positive results from \n\n\n\nthe intervention (including worksite intervention). Smoking cessation program which utilized \n\n\n\nremuneration or nicotine-replacement therapy was more cost-effective than usual counseling \n\n\n\nalone[33]. Sevick et al. (2000) reported the cost-effectiveness of lifestyle intervention as compared \n\n\n\nwith structured program in terms of physical activity, BP and weight[34]. In 2007, Sevick et al (2007) \n\n\n\nreported that it was more cost effective to use printed letters than phone to improve physical activity \n\n\n\nlevel[35]. However, other studies also reported no superiority of intervention on the economic \n\n\n\noutcomes on the RFs[27, 36]. Almost all of the economic evaluation of worksite intervention program \n\n\n\nreported in reduction in absenteeism[27, 37-38]. \n\n\n\n\n\n\n\nThe sensitivity analyses showed that the ICER was most resistant to change in the cost of seminar \n\n\n\n(both minimizing and maximizing the cost) and also maximizing the salary of the health educator. In \n\n\n\ncontrast, the ICER was most sensitive to the participant\u2019s salary, whereby the maximum possible \n\n\n\nsalary resulted in approximately 150% change in ICER as compared to the base case model. These \n\n\n\nresults showed that it is possible to further improve the incremental cost of CER by utilizing a staff \n\n\n\n\n\n\n\n\nnurse trained in conducting this program. Training should be emphasizing in order to ensure \n\n\n\nstandardization of counseling given. More importantly, the sensitivity analyses results also showed \n\n\n\nthat salary of the participants greatly impact the ICER. The participants\u2019 salary in the base model was \n\n\n\nbased on the salary of an administrative clerk. This salary was used to calculate the cost of medical \n\n\n\nsick leave. This can be explained by the fact that the number of medical sick leave days taken by the \n\n\n\nparticipants in the intervention group (n = 1.03 days) was lower than the control group (n = 2.27 days) \n\n\n\neven though this difference did not reach statistical significance (Mann-Whitney test, P = 0.175). A \n\n\n\npublic university consisted of several positions with different salary scheme. If this program is \n\n\n\nconducted in a large scale, involving large number of participants, it is expected to be more cost-\n\n\n\neffective. \n\n\n\n\n\n\n\nThe results from this analysis have to be taken with some caution. This study looked into the \n\n\n\nintermediate outcomes related to the individual RF. Despite not addressing the mortality and \n\n\n\nmorbidity over lifetime, these intermediate outcomes (behavioral changes) were deemed clinically \n\n\n\nrelevant. Numerous studies have reported the correlation between these intermediate outcomes and \n\n\n\nmortality and morbidity[15]. Furthermore, the behavioral RF status was self-reported and is subjected \n\n\n\nto recall bias. Moreover, participation in the program is voluntary and non-random. Therefore, it was \n\n\n\nexpected participants with higher intention to change was enrolled in the program. \n\n\n\n\n\n\n\n\n\n\n\nCONCLUSIONS \n\n\n\nIn conclusion, this program was shown to be cost-effective in modifying most of the behavioral RF, \n\n\n\nmost notable physical activity and fruit and vegetable intake. Cost-effectiveness of the program would \n\n\n\nbe increased with recruitment of high-risk individuals with higher baseline risk. Secondly, by \n\n\n\nrecruiting a higher number of participants into the program, the cost of the intervention can be \n\n\n\nreduced. As such it is recommended that this program be extended throughout the worksite \n\n\n\nparticularly targeted at high-risk individuals. \n\n\n\n\n\n\n\n\n\n\n\nCONFLICT OF INTEREST \nThe authors declared no conflict of interest in conducting and writing this research.  \n\n\n\n\n\n\n\nACKNOWLEDGEMENT \nI would like to thank the staff from the Health Unit of Engineering Campus, USM for their continuous \n\n\n\nsupport during the course of this study. This research was financially supported by Universiti  Sains \n\n\n\nMalaysia Research University [1001/PFARMASI/813018]; and Healthy Campus Grant 2008. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nREFERENCES \n1. Ministry of Health. MyNCDS-1 report.  Putrajaya: Ministry of Health, Malaysia; 2007 [cited \n\n\n\n2008 30 January ]; Available from: www.dph.gov.my/ncd/surveillance/index. \n\n\n\n2. 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Obesity. 2009;17(n3s):S34-S8. \n\n\n\n31. Hassan NE-M, Zak ST, El-Masry S, et al. Impact of balanced caloric diet and physical activity \n\n\n\non body composition and fat distribution of obese Egyptian adolescent girls Maced J Med Sci. \n\n\n\n2011;4:17-24. \n\n\n\n32. World Health Organization. CHOosing Interventions that are Cost Effective (WHO-CHOICE): \n\n\n\nCost-effectiveness thresholds.  Geneva: World Health Organization; 2005 [cited 2011 3rd April]; \n\n\n\nAvailable from: http://www.who.int/choice/costs/CER_thresholds/en/index.html. \n\n\n\n33. Salize HJ, Merkel S, Reinhard I, et al. Cost-effective primary care-based strategies to improve \n\n\n\nsmoking cessation: more value for money. Arch Intern Med. 2009 February 9, 2009;169:230-5. \n\n\n\n34. Sevick MA, Dunn AL, Morrow MS, et al. Cost-effectiveness of lifestyle and structured exercise \n\n\n\ninterventions in sedentary adults: Results of project ACTIVE. Am J Prev Med. 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"\n\nMalaysian Journal of Pharmacy Volume 8 Issue 2 (2022) \n \n\n\n\n\n\n\n\n27 \n\n\n\n\n\n\n\n*Correspondence: stephanietan@ppukm.ukm.edu.my \n\n\n\nDOI: 10.52494/EHEI1319 \n\n\n\nPharmacy Department, Hospital Canselor Tuanku Muhriz, Universiti \n\n\n\nKebangsaan Malaysia \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n Original Research Article \n\n\n\n\n\n\n\nAn Evaluation of Medication Adherence to Tyrosine Kinase \n\n\n\nInhibitors Among Chronic Myeloid Leukemia Patients \n\n\n\nUnderwent Medication Therapy Adherence Clinic in a \n\n\n\nMalaysian Tertiary Hospital \n \n\n\n\nStephanie Wai Yee Tan*, Sarah Anne Robert, Lay Yen Gan, Suet Yin Chin, Chee Lan Lau, Aisya \n\n\n\nNabilah Abd Rahman, Kiew Bing Pau, Shue Hong Kong, Farah Waheeda Tajurudin, Mei Kuen Yin, \n\n\n\nSheah Lin Ghan, Nur Jannah Azman, Pooi Wan Mok, Xin Yun Chua, Poy Kei Lye, Rozita Mohd \n\n\n\nIdris, Nur Liyana Saharudin, Dexter Van Dort \n\n\n\n\n\n\n\n \nArticle Info  \n\n\n\n \nReceived date: 19 Apr 2022 \n\n\n\nAccepted date: 05 Dec 2022 \n\n\n\nPublished date: 31 Dec 2022 \n\n\n\n\n\n\n\nKeywords: chronic myeloid \n\n\n\nleukemia; tyrosine kinase \n\n\n\ninhibitor; medication \n\n\n\nadherence \n\n\n\nABSTRACT  \n\n\n\n\n\n\n\nIntroduction: The treatment of chronic phase chronic myeloid leukemia (CML) has changed \n\n\n\ndramatically within the last two decades with the emergence of tyrosine kinase inhibitors (TKI). \n\n\n\nTreatment adherence to long-term TKI is pivotal to improving clinical outcomes in CML patients. \n\n\n\nObjective: To evaluate medication adherence to TKI and contributory variables affecting medication \n\n\n\nadherence among CML patients underwent Medication Therapy Adherence Clinic (MTAC). \n\n\n\nMethod: This was a single-centre cross-sectional study conducted between January and December \n\n\n\n2021. Malaysia Medication Adherence Assessment Tool (MyMAAT) was employed to assess \n\n\n\nmedication adherence among CML MTAC patients. Descriptive statistics were used to summarise \n\n\n\nadherence information. Fisher\u2019s exact test was performed to examine relationships between TKI \n\n\n\nadherence level, demographic and clinical variables. Result: Records of 41 patients (61% male, 39% \n\n\n\nfemale) at average age of 51 years old (range = 26 to 75) were analysed. They had been taking \n\n\n\nimatinib (48.8%) and nilotinib (51.2%) for an average of 6.3 years (range = 17 days to 18 years). \n\n\n\nOverall, 90% of the patients were adherent (MyMAAT score \u2265 54) to their TKI treatment (95% of \n\n\n\npatients on imatinib, 86% of patients on nilotinib). Medication adherence to TKI was not significantly \n\n\n\ninfluenced by demographic variables (i.e. age, gender) and clinical variables (i.e. years on TKI, \n\n\n\nnumber of TKI pills per day, type of TKI therapy). Conclusion: Majority of the CML MTAC patients \n\n\n\n(90%) were adherent to their TKI therapy. Adherence scores were not affected by the demographics \n\n\n\nand clinical variables investigated in this study. This affirms the role of pharmacists in implementing \n\n\n\nan individualised and comprehensive intervention strategy. \n\n\n\n\n\n\n\nINTRODUCTION  \n \n\n\n\nChronic myeloid leukaemia (CML) is a clonal \n\n\n\nmyeloproliferative disease characterised by the presence of the \n\n\n\nPhiladelphia chromosome and its fusion gene, BCR-ABL. \n\n\n\nBCL-ABL oncogene codes for an oncoprotein which in turn \n\n\n\nstimulates myeloid cells proliferation [1]. According to the \n\n\n\nMalaysian National Cancer Registry Report 2007\u20132011, there \n\n\n\nwere 573 CML patients in Malaysia at the time of reporting, \n\n\n\nwhich accounts for 12.5% of total leukaemia cases in the \n\n\n\ncountry [2].  \n\n\n\n\n\n\n\nThe advent of tyrosine kinase inhibitor (TKI) targeting the \n\n\n\nBCL-ABL oncoprotein has transformed the treatment \n\n\n\nlandscape of this previously fatal disease by augmenting \n\n\n\ndisease response and reducing treatment-related morbidity. \n\n\n\n\nmailto:stephanietan@ppukm.ukm.edu.my\n\n\n\n\n\n\nTan W.Y. et al. Mal J Pharm 8 (2) 2022, 27-31 \n\n\n\n\n\n\n\n\n\n\n\n28 \n\n\n\n\n\n\n\nImatinib, nilotinib and ponatinib are the TKIs currently \n\n\n\nregistered in Malaysia. The majority of CML patients in \n\n\n\nMalaysia gain access to TKI therapy under the Malaysia Patient \n\n\n\nAssistance Programme (MYPAP), a public-private partnership \n\n\n\nlaunched by a pharmaceutical company in collaboration with \n\n\n\nthe Ministry of Health [3]. \n\n\n\n\n\n\n\nAlthough treatment outcome for CML patients has markedly \n\n\n\nimproved owing to the emergence of these oral targeted \n\n\n\ntherapies, the suboptimal response is still reported in a \n\n\n\nsubgroup of patients [4]. Apart from the development of \n\n\n\ngenetic mutations and poor access to medication, poor \n\n\n\nadherence to TKI is also one of the factors contributing to \n\n\n\nsuboptimal response and treatment failure [5][6]. \n\n\n\n\n\n\n\nMedication adherence can be defined as the extent to which the \n\n\n\npatient\u2019s actions meet the prescriber\u2019s recommendations or \n\n\n\nexpectations [7]. For long-term conditions, it is estimated that \n\n\n\n30-50% of prescribed medicines are not taken as \n\n\n\nrecommended. A meta-analysis found that between a quarter to \n\n\n\none-third of CML patients were not adhering to their TKI \n\n\n\ntherapy [8]. \n\n\n\n\n\n\n\nThe CML Medication Therapy Adherence Clinic (MTAC) is a \n\n\n\nservice provided by the Pharmacy Department of Hospital \n\n\n\nCanselor Tuanku Muhriz (HCTM UKM). Interviews, \n\n\n\nindividualised counselling, and medication adherence \n\n\n\nassessment are carried out by pharmacists during MTAC to \n\n\n\noptimise TKI therapy and enhance patients\u2019 adherence to \n\n\n\nprescribed treatment. All CML MTAC pharmacists underwent \n\n\n\none training session on theory and one practical session in an \n\n\n\nactual clinic setting. \n\n\n\n\n\n\n\nTo date, there has been a lack of local studies focusing on \n\n\n\nmedication adherence among CML patients treated with TKIs. \n\n\n\nThis study aims to evaluate medication adherence to TKI \n\n\n\namong CML MTAC patients and explore the possible variables \n\n\n\nassociated with TKI adherence in a tertiary hospital in \n\n\n\nMalaysia. \n\n\n\n\n\n\n\nMATERIAL AND METHOD \n \n\n\n\nStudy Design and Population \n\n\n\n\n\n\n\nThis cross-sectional study included adult patients who attended \n\n\n\nCML MTAC between January 2021 to December 2021 \n\n\n\n(totalling 16 sessions) conducted by 15 pharmacists on a \n\n\n\nrotation basis. The CML MTAC is held fortnightly in \n\n\n\nconjunction with CML outpatient clinics. Patients recruited are \n\n\n\ndiagnosed with chronic- or accelerated-phase CML, are on \n\n\n\nactive treatment with either imatinib or nilotinib for \u2265 2 weeks \n\n\n\nand  can arrive 30 minutes earlier than their assigned time for \n\n\n\ntheir doctor\u2019s appointments. Total population sampling was \n\n\n\nemployed. As part of the MTAC workflow, patients\u2019 \n\n\n\nmedication adherence was evaluated using the Malaysia \n\n\n\nMedication Adherence Assessment Tool (MyMAAT), a 12-\n\n\n\nitem, bilingual (English and Malay), a self-administered \n\n\n\nquestionnaire consisting of 5 constructs. [9] Each question is a \n\n\n\n5-point Likert item from \"strongly disagree\" to \"strongly \n\n\n\nagree\u201d.  The MyMAAT score was the sum of the marks for the \n\n\n\nindividual items ranging between 12 and 60. Medication \n\n\n\nadherence was categorised as good adherence (MyMAAT \n\n\n\nscore \u226554) and moderate/poor adherence (MyMAAT score \n\n\n\n<54). The scores were documented manually on the patient\u2019s \n\n\n\npharmaceutical care form. \n\n\n\n\n\n\n\nThe sample size was calculated using Cochran\u2019s equation. This \n\n\n\nstudy requires 41 samples to represent the population size of 45 \n\n\n\nat a 5% confidence interval with an alpha of 0.05, a power of \n\n\n\n0.8 and an estimated proportion of 0.5. \n\n\n\n\n\n\n\nData Analysis \n\n\n\n\n\n\n\nStatistical analysis was performed using SPSS\u00ae (version 26). \n\n\n\nPower and sample size calculations were performed using \n\n\n\nG*Power 3.1.9.4. the demographic characteristics of the \n\n\n\npatients (age and gender) were obtained from the hospital \n\n\n\ninformation system. Clinical characteristics (type of TKI, dose \n\n\n\nand frequency, TKI pills per day, duration on TKI treatment) \n\n\n\nwere retrieved from the hospital's e-prescribing system. \n\n\n\nDescriptive statistics were used to summarise the adherence \n\n\n\ninformation retrieved from pharmaceutical care forms. \n\n\n\nMedication adherence was assessed during every MTAC visit. \n\n\n\nIf there were two MyMAAT scores available in our records for \n\n\n\nthe same patient within the study period, the latest score was \n\n\n\nused for data analysis. Hence, the medication adherence \n\n\n\nmeasured represented the patient\u2019s adherence after at least one \n\n\n\nsession of MTAC.  Fisher\u2019s exact test was employed to \n\n\n\nexamine the association between patients\u2019 demographic and \n\n\n\nclinical variables with medication adherence towards TKI \n\n\n\ntherapy. A two-tailed p-value of <0.05 was considered as \n\n\n\nstatistically significant. \n\n\n\n\n\n\n\nPost-hoc Analysis  \n\n\n\n\n\n\n\nThe internal consistency of MyMAAT was tested using \n\n\n\nCronbach\u2019s alpha (Cronbach\u2019s alpha = 0.787). The required \n\n\n\nsample size for Fisher\u2019s exact test to achieve the power of 0.8, \n\n\n\nwith \u03b1=0.05 was 808 (404 per group). \n\n\n\n\n\n\n\nRESULT  \n \n\n\n\nOf the 45 patient records retrieved from the CML MTAC, 41 \n\n\n\npatients were included in the final analysis. A total of 4 patients \n\n\n\nwere excluded due to incomplete data (n=3) and funding issues \n\n\n\nleading to interruption of drug supply (n=1). \n\n\n\n\n\n\n\n\nTan W.Y. et al. Mal J Pharm 8 (2) 2022, 27-31 \n\n\n\n\n\n\n\n\n\n\n\n29 \n\n\n\n\n\n\n\nAdherence to TKI treatment \n\n\n\n\n\n\n\nOverall, 90% (n=37) of the study population showed good \n\n\n\nadherence to TKI treatment. As shown in Figure 1, amongst \n\n\n\npatients receiving imatinib (n=20) and nilotinib (n=21), 95% \n\n\n\nand 86% of them demonstrated good medication adherence, \n\n\n\nrespectively. \n\n\n\n\n\n\n\n \nFigure I. Adherence to TKI Treatment Among CML MTAC Patients \n\n\n\n\n\n\n\nDemographic and Clinical Variables \n\n\n\n\n\n\n\nTable I shows the demographic and clinical variables of the 41 \n\n\n\npatients analysed. 41.5% (n=17) of the patients were elderly, \n\n\n\naged at least 60 years old. 82.4% (n=14) of the elderly patients \n\n\n\nshowed good adherence. The number of male patients recruited \n\n\n\n(n=25, 61.0%) was higher than that of female patients (n=16, \n\n\n\n39.0%). A greater proportion of males (n=24, 96.0%) showed \n\n\n\ngood adherence compared to their female counterparts (n=13, \n\n\n\n81.2%). The majority of the patients (n=31, 75.6%) had been \n\n\n\non TKI treatment for less than 10 years with 87.1% (n=27) of \n\n\n\nthem showing a good adherence. Meanwhile, 100% (n=10) of \n\n\n\npatients on TKI treatment for more than 10 years demonstrated \n\n\n\ngood adherence. Most of the patients (n=25, 61.0%) were \n\n\n\ntaking only one to two tablets per day for their CML treatment \n\n\n\nwith 84% (n=21) of them demonstrating good adherence. 39% \n\n\n\n(n=16) of the study population were taking three to four tablets \n\n\n\nper day and all of them showed good adherence. \n\n\n\n\n\n\n\nAmongst all the demographic and clinical variables analysed, \n\n\n\nthere was no significant difference (p-value > 0.05) observed \n\n\n\nacross the subjects in terms of adherence towards TKI \n\n\n\ntreatment. \n\n\n\n\n\n\n\n\n\n\n\nTable I: Association between demographic and clinical characteristics of patients (n=41) with adherence to TKI treatment \n\n\n\n\n\n\n\nCharacteristic Frequency Percentage Adherence Level Frequency (Percentage) p-value \n\n\n\nGood Moderate/Poor \n\n\n\nAge* Mean = 51 Range = 26-75    \n\n\n\n<60 years 24 58.5 23 (95.8) 1 (4.2) 0.29 \n\n\n\n\u226560 years 17 41.5 14 (82.4) 3 (17.6)  \n\n\n\n\n\n\n\nGender      \n\n\n\nMale 25 61.0 24 (96.0) 1 (4.0) 0.28 \n\n\n\nFemale 16 39.0 13 (81.2) 3 (18.8)  \n\n\n\n\n\n\n\nYears on TKI Treatment* Mean = 6.3 Range=17days-18 years    \n\n\n\n<10 years 31 75.6 27 (87.1) 4 (12.9) 0.56 \n\n\n\n\u226510 years 10 24.4 10 (100.0) 0 (0.0)  \n\n\n\n\n\n\n\nType of TKI      \n\n\n\nImatinib 20 48.8 19 (95.0) 1 (5.0) 0.61 \n\n\n\nNilotinib 21 51.2 18 (85.7) 3 (14.3)  \n\n\n\n\n\n\n\nDosing Frequency      \n\n\n\nOnce a day 20 48.8 19 (95.0) 1 (5.0) 0.61 \n\n\n\nTwice a day 21 51.2 18 (85.7) 3 (14.3)  \n\n\n\n\n\n\n\n\n\n\n\nTKI Pill(s) per Day      \n\n\n\n1-2 25 61.0 21 (84.0) 4 (16.0) 0.14 \n\n\n\n3-4 16 39.0 16 (100.0) 0 (0.0)  \n\n\n\n\n\n\n\n*at the time of adherence evaluation \n\n\n\nGood adherence (MyMAAT score \u226554), Moderate/Poor adherence (MyMAAT score <54) \n\n\n\n\n\n\n\n\nTan W.Y. et al. Mal J Pharm 8 (2) 2022, 27-31 \n\n\n\n\n\n\n\n\n\n\n\n30 \n\n\n\n\n\n\n\nDISCUSSION \n \n\n\n\nThe substantially higher number of male CML patients \n\n\n\nrecruited in the study is consistent with the male/female ratio \n\n\n\nof 1.2\u20131.7 demonstrated in epidemiology studies. [10] The \n\n\n\nsimilar amount of imatinib and nilotinib patients recruited is in \n\n\n\ncongruence with the MYPAP allocation of 1:1 for these TKIs \n\n\n\nat our institution. \n\n\n\n\n\n\n\nThe study population demonstrated relatively better adherence \n\n\n\ntowards TKI treatment as a whole compared to another local \n\n\n\nstudy conducted among CML patients. [11] Patients on \n\n\n\nimatinib treatment showed higher medication adherence \n\n\n\nprobably due to a better tolerance profile. Compared to other \n\n\n\nTKIs, imatinib showed better tolerability due to fewer drug-\n\n\n\nrelated adverse effects and its convenience with once-daily \n\n\n\ndosing [12]. More optimal adherence among the patients in this \n\n\n\nstudy might be the effect of participation in CML MTAC. All \n\n\n\npatients in this study were active MTAC patients who have \n\n\n\nattended at least 1 session of MTAC prior to data collection. \n\n\n\nThe beneficial effects of medication management services on \n\n\n\nTKI adherence and clinical outcome were demonstrated in a \n\n\n\nnumber of studies. [13] A randomised controlled trial done in \n\n\n\ntwo Malaysian hospitals found that pharmacist-led \n\n\n\ninterventions resulted in significantly better medication \n\n\n\nadherence and faster achievement of major molecular response, \n\n\n\nespecially during the early months after treatment initiation. \n\n\n\n[14] \n\n\n\n\n\n\n\nTKI-specific clinical factors like the number of TKI pills per \n\n\n\nday and dosing frequency were not associated with TKI \n\n\n\nadherence in this study. TKI adherence can be affected by the \n\n\n\ntotal pill burden per day contributed by medications used to \n\n\n\ntreat other concomitant diseases. Concomitant drug burden was \n\n\n\nidentified by Efficace F et al. to be one of the predictors of \n\n\n\ntreatment non-adherence in patients on long-term imatinib \n\n\n\ntherapy. [15] Another group of predictors which was not \n\n\n\nexplored in the present study is drug-related issues like \n\n\n\nsideeffects of TKI. Lee PM et al. found a significant association \n\n\n\nbetween nausea and vomiting experienced by CML patients \n\n\n\nand patient adherence in a Malaysian hospital. [11] \n\n\n\n\n\n\n\nMyMAAT is a relatively new tool developed to assess \n\n\n\nmedication adherence and validated among the diabetic \n\n\n\npopulation (Cronbach alpha = 0.910). [9] It is widely utilised \n\n\n\nby pharmacists in Malaysian hospitals for various patient \n\n\n\npopulations and is included in various MTAC protocols. [16] \n\n\n\n[17] To the best of our knowledge, this is the first study that \n\n\n\nutilises MyMAAT to assess medication adherence in CML \n\n\n\npatients. Apart from assessing overall adherence based on the \n\n\n\ntotal score, pharmacists can identify domains in which the \n\n\n\npatients showed suboptimal scoring and provide follow-up \n\n\n\ncounselling and/or education tailored to individual patients. \n\n\n\nCompared to the most widely used MMAS-8 which involves a \n\n\n\nfixed charge per form used, MyMAAT is more economical. \n\n\n\n[18] Other commonly used adherence assessment methods like \n\n\n\npill count and medication possession ratio require patients to \n\n\n\nbring their medications to every clinic visit and have the \n\n\n\navailability of complete dispensing records respectively. These \n\n\n\nare less convenient to be employed for day-to-day practice for \n\n\n\nMTAC service. \n\n\n\n\n\n\n\nA pilot study to test the feasibility of MyMAAT in CML \n\n\n\npatients was not carried out as data was collected \n\n\n\nretrospectively from MTAC records where MyMAAT was \n\n\n\nalready incorporated into the clinic workflow. Post-hoc \n\n\n\nreliability analysis shows acceptable internal consistency of \n\n\n\nMyMAAT (Cronbach alpha = 0.787) in our study population. \n\n\n\nValidation of the tool in CML population could be done in \n\n\n\nfuture studies with a larger sample size. \n\n\n\n\n\n\n\nOne of the limitations of this study is the small sample size as \n\n\n\nit was a single-centre study targeting a relatively uncommon \n\n\n\ndisease. The study population consisted of patients who \n\n\n\nattended MTAC throughout 2021 during the coronavirus \n\n\n\npandemic. They might be more health-conscious and more \n\n\n\nadherent to their treatment. This study also did not include \n\n\n\npatients who defaulted clinic appointments. The final sample \n\n\n\nsize of 41 was able to represent the study population and reflect \n\n\n\nthe overall medication adherence level. However, post-hoc \n\n\n\nanalysis demonstrated that the sample size was inadequate to \n\n\n\nachieve desirable power to detect the association of different \n\n\n\nvariables and medication adherence (if any). \n\n\n\n\n\n\n\nDespite attending regular physician consultations and \n\n\n\ncounselling sessions by pharmacists, 10% of the patients \n\n\n\nshowed suboptimal adherence which has no association with \n\n\n\ncertain demographics and clinical variables. This highlights \n\n\n\nother factors or gaps in service that require further approaches. \n\n\n\nFurther studies could be done prospectively to explore other \n\n\n\nfactors like socioeconomic status, access to medication, drug-\n\n\n\nrelated issues, education level as well as concomitant diseases \n\n\n\nand medications that might influence TKI adherence. \n\n\n\n\n\n\n\nCONCLUSION  \n \n\n\n\nMajority of the CML MTAC patients (90%) were adherent to \n\n\n\ntheir long-term TKI treatment. This affirms the role of \n\n\n\npharmacists in implementing an individualised and \n\n\n\ncomprehensive intervention strategy to optimise TKI treatment \n\n\n\nand resolve drug-related issues during MTAC service. \n\n\n\nAdherence scores were not affected by the demographics and \n\n\n\nclinical variables investigated in this study. Future studies \n\n\n\ninvolving a larger sample size are warranted to identify factors \n\n\n\nassociated with adherence to TKI therapy. \n\n\n\n \n\n\n\n\n\n\n\n\nTan W.Y. et al. Mal J Pharm 8 (2) 2022, 27-31 \n\n\n\n\n\n\n\n\n\n\n\n31 \n\n\n\n\n\n\n\nCONFLICT OF INTEREST \n  \n\n\n\nThe authors declare no conflict of interest. \n\n\n\n\n\n\n\nACKNOWLEDGEMENT \n  \n\n\n\nThere was no funding obtained for this work. We thank all our \n\n\n\ncolleagues especially staff from the Outpatient Pharmacy Unit \n\n\n\nin ensuring correct use and sufficient supply of patients\u2019 TKI \n\n\n\nmedications as well as staff from CML Outpatient Clinic in \n\n\n\nfacilitating pharmacists to run CML MTAC smoothly. \n\n\n\n\n\n\n\nREFERENCE \n \n\n\n\n[1] National Comprehensive Cancer Network. Clinical Practice \n\n\n\nGuidelines in Oncology: Chronic Myeloid Leukemia V.2.2022.2021 \n\n\n\n[cited 2022 Feb 5] Available from: \n\n\n\nhttps://www.nccn.org/professionals/physician_gls/pdf/cml.pdf. \n\n\n\n[2] Azizah Ab M NSIT, Noor Hashimah A, Asmah Z.A, Mastulu W. \n\n\n\nMalaysian National Cancer Registry Report 2011 [cited 2022 Feb 5] \n\n\n\nAvailable from: https://www.crc.gov.my/wp-\n\n\n\ncontent/uploads/documents/report/MNCRRrepor2007-2011.pdf.  \n\n\n\n[3] Ministry of Health Malaysia. National Strategic Plan for Cancer \n\n\n\nControl Programme 2016-2020, 1st ed. [cited 2022 Feb 5] Available \n\n\n\nfrom: https://www.iccp-portal.org/plans/national-strategic-plan-\n\n\n\ncancer-control-programme \n\n\n\n[4] Deininger M, O\u2019Brien SG, Guilhot F, Goldman JM, Hochhaus A, \n\n\n\nHughes TP, et al. 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[cited 2022 Oct 28] Available from: \n\n\n\nhttp://www.moriskyscale.com/mmas-license-pricing.html#/ \n\n\n\n \n\n\n\n\nhttps://www.nccn.org/professionals/physician_gls/pdf/cml.pdf\n\n\nhttps://www.crc.gov.my/wp-content/uploads/documents/report/MNCRRrepor2007-2011.pdf.\n\n\nhttps://www.crc.gov.my/wp-content/uploads/documents/report/MNCRRrepor2007-2011.pdf.\n\n\nhttps://www.iccp-portal.org/plans/national-strategic-plan-cancer-control-programme\n\n\nhttps://www.iccp-portal.org/plans/national-strategic-plan-cancer-control-programme\n\n\nhttps://doi.org/10.1182/blood.V114.22.1126.1126\n\n\nhttps://doi.org/10.1182/blood-2010-10-309807\n\n\nhttps://doi.org/10.1200/JCO.2009.26.3087\n\n\nhttps://doi.org/10.1182/blood.V128.22.3610.3610\n\n\nhttps://doi.org/10.1371/journal.pone.0241909\n\n\nhttps://doi.org/10.3389/fonc.2020.580759\n\n\nhttps://doi.org/10.1007/s11096-020-01070-9\n\n\nhttps://doi.org/10.1186/s12885-019-6039-9\n\n\nhttps://doi.org/10.2147/PPA.S269355.\n\n\nhttps://doi.org/10.1007/s00520-019-05133-0\n\n\nhttps://doi.org/10.1007/s00520-019-05133-0\n\n\nhttps://doi.org/10.1038/bjc.2012.348.\n\n\nhttps://phisportal.moh.gov.my/sites/default/files/phis_attachments_39556/U.%20MANUAL_MTAC-12th%20E.pdf\n\n\nhttps://phisportal.moh.gov.my/sites/default/files/phis_attachments_39556/U.%20MANUAL_MTAC-12th%20E.pdf\n\n\nhttp://www.moriskyscale.com/mmas-license-pricing.html%23/\n\n\n\n"
"\n\n\n\n\n\n\n\n\n\nSERIAL DRAMA: SEVEN STEPS TO AVOID FALLING FOUL OF FALSIFIED \nMEDICINES DIRECTIVE (FMD) \n\n\n\nDavison M* \n\n\n\nrfxcel Corporation, 12667 Alcosta Boulevard, Suite 375, San Ramon, California 94583, the \nUnited States of America. \n*Author for correspondence \n\n\n\nINTRODUCTION \n\n\n\nThe Falsified Medicines Directive (FMD) imposes strict serialisation requirements on \npharmaceutical manufacturers, distributors and dispensers. This article outlines everything you \nneed to know and what you need to do for a seamless serialisation process \u2013 before regulators \nremove your right to trade. \n\n\n\nPharmaceutical manufacturers are currently the main actors in a serial drama where getting \ntheir lines right is paramount. Well, four lines of data, to be precise; in (and next to) DataMatrix \nbarcodes applied to every pack of prescription medicines. The introduction of serialisation, \ndesigned to ensure the authenticity and traceability of individual medicines, promises to \nimprove patient safety and create exciting opportunities for digital health. But there is a twist \nin the plot. Failure to comply with the EU regulation that mandates it means you cannot legally \nship your product. No barcode, no trade. That is when a serial drama turns into a tragedy. And \ntime is running out to be ready. \n\n\n\nThe unfolding story of the Falsified Medicines Directive (FMD), which was first introduced in \n2011, is into its final episodes. The denouement arrives on February 9, 2019, when the \nDirective is fully enforced and the penalties for non-compliance officially come into play. FMD \nis an attempt to prevent inauthentic, substandard or harmful medicines entering the supply \nchain. It imposes strict serialisation, traceability and verification requirements on \npharmaceutical manufacturers and their associated wholesalers, distributors and contract \nmanufacturers. In particular, it mandates companies to print a unique identifier on the \npackaging of prescription medicines. Furthermore, companies are not just responsible for the \ndata that goes on the packaging, they are responsible for submitting it to the central data hub \nthat will enable pharmacists to authenticate products before they dispense them. It is a complex \nundertaking that could be easily underestimated - but not if you understand some key steps.  \n\n\n\nThe implementation of serialisation is not an overnight task \u2013 it encompasses processes that \nhave multiple touch-points across global organisations, partner networks and the wider supply \nchain. Yet despite this \u2013 and despite the enormous implications of getting it wrong \u2013 many \ncompanies are still some distance from being fit for purpose. Indeed, in some organisations, \nthe Directive has not yet hit their radar. It needs to \u2013 because the clock is ticking. But all is not \nlost. Here are seven steps to successful serialisation. \n\n\n\n1: GET EXECUTIVE BUY-IN \n\n\n\nThe significance of serialisation is often underestimated. It is typically considered a production \nissue and punted to manufacturing as an operational challenge. Yet serialisation is a board level \nissue, with ramifications that could directly affect business performance. Indeed, it is not a \nmanufacturing cost \u2013 it is a business continuity risk that touches every aspect of an \norganisation. So the first step towards serialisation \u2013 one that is often overlooked \u2013 is to appoint \nan executive sponsor, ideally with board level oversight, to lead a holistic strategy. \nImplementation will naturally be delegated to project teams, but executive leadership will be \ncrucial to making things happen quickly. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n2: ASSEMBLE A MULTI-DISCIPLINARY TEAM \n\n\n\nMulti-disciplinary engagement is essential. Many organisations do not understand all their \nbusiness processes in sufficient detail to overlay serialisation. It is therefore vital that a multi-\ndisciplinary team (MDT) is convened at the earliest opportunity to map the process flow of the \nbusiness and establish a roadmap of how serialisation can be applied across multiple \norganisational boundaries. An MDT should actively engage representatives from \nmanufacturing, supply chain, information technology, legal/regulatory and partner/contract \nmanagement. \n\n\n\n3: ESTABLISH LONG-TERM USER REQUIREMENTS TO ENSURE YOU RE \n\u2018FUTURE READY\u2019 \n\n\n\nThe next step is to define your user requirements and establish a template for the solution that \nwill help ensure you are compliant. You must consider immediate and long-term factors. For \nexample, which markets do you currently ship product to and which do you plan to target in \nthe future? Which products in both your portfolio and your pipeline will need to be coded? Is \nthere a potential future requirement to be able to track and trace products as they journey \nthrough the supply chain? Regulations, from FMD to the US Drug Supply Chain Security Act \n(DSCSA), differ from country to country and are constantly evolving. Take the opportunity to \nbecome \u2018future ready\u2019 by creating a design template that does not just focus on FMD but is \nflexible enough to be interoperable and implementable between national systems and provides \nthe flexibility to adapt to change as it happens. \n\n\n\n4: UNDERSTAND THE DATA IMPLICATIONS OF FMD \n\n\n\nThe barcodes required for FMD must include 4 lines of data; Global Trade Item Number \n(GTIN), serial number, batch number and expiry date. Some countries require a fifth element, \nusually for national reimbursement purposes. These datasets often live in disparate systems \nwithin organisations. The master data \u2013 including GTINs \u2013 is fixed information that is \ncommonly stored in an enterprise resource planning (ERP) system. Although that data does not \nchange, it still requires attention to ensure it is clean and accurate when uploaded to the \nrepositories. In terms of variable data, the processes required to generate serial numbers, \ntransfer them to production and ensure they are used appropriately are complex. Managing that \nimmensity of numbers throughout the supply chain lifecycle is hugely important; mistakes can \nlead to expensive delays, medicines shortages and loss of revenue. Serialisation software is \ntherefore an essential requirement to help you maintain control of all aspects of fixed and \nvariable data. \n\n\n\n5: CHOOSE THE RIGHT SOFTWARE \n\n\n\nThere are numerous factors to consider when selecting software: \n\n\n\nQuality \n\n\n\nSerialisation should not be divorced from the founding principle of Good Manufacturing \nPractice (GMP) \u2013 quality. GMP guidelines, as well as data integrity advice from regulators \nsuch as the UK MHRA, state that users of computer systems must always be in control. \nHowever, multi-tenant serialisation solutions (where multiple independent entities share the \nsame instance of a software solution) can sometimes impose software updates without prior \ndialogue, leaving users out of control. The potential impact on quality is significant. Passive \nacceptance of change is not an option. Multi-tenant solutions require license-holding \ncompanies to ensure that risk assessment processes are in place to monitor and adapt to change. \nBy contrast, the most effective solutions allow users to maintain control of their specific \nsoftware instance and to dictate the timing, relevance and nature of upgrades. \n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nData Validation \n\n\n\nAn effective solution will focus on both connectivity and data integrity. Some systems \nconcentrate on enabling a connection and flow of data across and between organisations but \nare blind to data quality. Companies should never assume that the data entering, or generated \nwithin, their systems is clean, tidy and accurate. Internal data checks are essential. The best \nsolutions routinely monitor data to detect human error, inaccuracy and duplication. Smart \nsolution providers validate data flowing through a system \u2013 in some cases up to 70 data \nvalidation checks on incoming records to ensure its integrity - essentially preventing bad data \nentering the EU hub. \n\n\n\nNetwork connectivity \n\n\n\nIt is not enough to ensure your own business is ready: your partners must be ready too. With \noutsourcing now common across the industry, it is important that the software you use connects \nall parties to a single version of the truth. The most effective solution providers connect your \nentire partner network as standard. This means more than just having a potential connection \u2013 \nit means working with you and your partners to make sure that data really flows.  \n\n\n\n6: CHOOSE THE RIGHT PARTNER \n\n\n\nIt is important to find a vendor that can partner with you to design responsive solutions that go \nbeyond technology. Certification of your vendor by the European Medicines Verification \nOrganisation (EMVO) is a pre-requisite if you want to be compliant. In addition, a partner \nshould be a recognised provider with experience, credibility and evidence that shows it can \nimplement effectively within tight timeframes. A good partner will be committed to your \nsuccess, keeping you abreast of fluctuating global regulations, and collaborating with you to \ncustomise solutions that adapt to changes in your business and the wider marketplace. \n\n\n\n7: ACT NOW \n\n\n\nThe complexities of serialisation mean that a failure to act now could make it extremely \ndifficult to complete implementation in time for the FMD deadline. Moreover, with the fees \nfor registering with EMVO and other affiliate repositories set to increase in June, the internal \ncosts of your project will inevitably rise if you wait. However, the biggest price of non-\ncompliance will be your inability to ship product. So why risk it?  \n\n\n\nAct now and you can prevent your serial drama becoming a tragedy. \n\n\n\nCONFLICT OF INTEREST \n\n\n\nThe author is the Head of Operations in the European Union (EU) for rfxel Corporation.  \n\n\n\n\n\n\n\n\n\n\n"
"\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n256 \n\n\n\nInfluences of Patient-Related Factors in Diabetes Management Among Non-\n\n\n\nInsulin-Treated Type 2 Diabetics \n\n\n\n\n\n\n\nYap Li Swan*  \n\n\n\n2383, Taman L.G.L., Jalan Merbuk, 24000 Kemaman, Terengganu. \n\n\n\n*Corresponding Author \n\n\n\nMalaysian Journal of Pharmacy 2008: 1( 6): 256- 267                                               \n\n\n\n\n\n\n\n\n\n\n\nAbstract \n\n\n\n\n\n\n\nStudy was conducted to investigate the influences of patient-related factors in \n\n\n\ndiabetic management among non-insulin-treated type 2 diabetics in Outpatient \n\n\n\nDepartment, Hospital Kemaman. Convenience interview has been conducted, \n\n\n\nfollowed by further review of outpatient cards. Data collected from 29 subjects \n\n\n\nwas analyzed by using SPSS Version 11. The inclusive criteria were patients \n\n\n\ndiagnosed with diabetes for at least one year and on oral hypoglycemic agent. \n\n\n\nPatients on insulin treatment were excluded. The efficacy parameter was the \n\n\n\nfasting blood glucose level. 86.2% of study population were non-smokers. 41.4% \n\n\n\nconsumed alternative medicines concurrently with antidiabetic medications. \n\n\n\nMajority of the subjects practiced lifestyle modifications, 62.1% in the form of \n\n\n\nroutine exercise and 79.3% dietary modifications. 24.1% and 20.7% received \n\n\n\ncounseling before being put on diabetic medications and on lifestyle \n\n\n\nmodifications respectively. Many diabetics have poor understanding on their \n\n\n\nmedications. Only 27.6% have their fasting blood glucose level \u2264 7mmol/L \n\n\n\nduring the study duration. 72.4% patients claimed to have good compliance to the \n\n\n\nmedications prescribed. Study revealed that patients had better glycaemic control \n\n\n\nif they had better understanding/knowledge about the medications, had better \n\n\n\ncompliance, practice lifestyle modifications and had been counseled before. \n\n\n\nOther variables (age, smoking and concurrent use of alternative medicines) failed \n\n\n\nto demonstrate significant effect on glycaemic control. This study revealed \n\n\n\nproblems such as non-optimal glycaemic control, insufficient patients\u2019 \n\n\n\nknowledge about the disease and medications, and inadequate compliance in \n\n\n\ndiabetic population. Pharmacists can help the community to manage diabetes \n\n\n\nbetter. This information is expected to be useful for pharmacists in improving \n\n\n\ntheir roles.  \n\n\n\n\n\n\n\nKey Words: Type 2 diabetes, blood glucose level, lifestyle modifications, \n\n\n\ncounseling, compliance  \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n257 \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nIntroduction \n\n\n\n\n\n\n\nDiabetes is a worldwide common \n\n\n\nchronic disorder. In ASEAN region, \n\n\n\nit is estimated that 7 million people \n\n\n\nare affected by diabetes mellitus (1). \n\n\n\nIn Malaysia, diabetes is one of the \n\n\n\nmost prevalent chronic illnesses \n\n\n\nwhich contribute to ill health and \n\n\n\npremature mortality.  The prevalence \n\n\n\nis about 8% (2). Diabetes occurs \n\n\n\nwhen the pancreas fails to produce \n\n\n\nadequate insulin or when the body \n\n\n\ncannot utilize the insulin effectively \n\n\n\n(insulin resistance). It is a syndrome \n\n\n\ncharacterized by hyperglycaemia \n\n\n\ntogether with other metabolic \n\n\n\nabnormalities (e.g. disturbance in \n\n\n\nlipid and protein metabolism).  \n\n\n\n\n\n\n\nEssentially, diabetes mellitus is \n\n\n\ncategorized into 2 groups: type 1 \n\n\n\ndiabetes and type 2 diabetes. \n\n\n\nAccording to American Diabetes \n\n\n\nAssociation (ADA), 90-95% of \n\n\n\npatients diagnosed with diabetes are \n\n\n\ntype 2 (3).  \n\n\n\n\n\n\n\nType 2 Diabetes Mellitus \n\n\n\n\n\n\n\nType 2 diabetes is also known as \n\n\n\nadult-onset diabetes due to its \n\n\n\nrelatively late onset compare with \n\n\n\ntype 1 diabetes. The disorder occurs \n\n\n\nas a result of impaired insulin \n\n\n\nsecretion; tissue resistance to insulin \n\n\n\nor due to increase hepatic glucose \n\n\n\noutput. The long-term consequences \n\n\n\nof diabetes account for the majority \n\n\n\nof morbidity and mortality. Chronic \n\n\n\nsequelaes of diabetes always link \n\n\n\nwith poor diabetes control. Glucose \n\n\n\ntoxicity as a result of uncontrolled \n\n\n\nhyperglycemia appears to contribute \n\n\n\nto the development and progression \n\n\n\nof microvascular complications \n\n\n\n(retinopathy, nephropathy and \n\n\n\nneuropathy). Diabetes is also the risk \n\n\n\nfactor for macrovascular \n\n\n\nimplications (e.g. cardiovascular, \n\n\n\ncerebral vascular and peripheral \n\n\n\nvascular systems). (4) \n\n\n\n\n\n\n\nCurrently there is no known cure for \n\n\n\ndiabetes but the disease can be \n\n\n\ncontrolled enabling the patient to \n\n\n\nlead a healthy and productive life. \n\n\n\nThe primary goal of diabetes \n\n\n\nmanagement is to bring the glucose \n\n\n\nlevel as close to normal value as \n\n\n\npossible. There are five major \n\n\n\ncomponents in the management of \n\n\n\ndiabetes mellitus: diet, exercise, \n\n\n\neducation, oral hypoglycemic agents \n\n\n\nand insulin. In addition, monitoring \n\n\n\nof glycaemic control and \n\n\n\nmanagement of complications \n\n\n\nshould also be emphasized. Good \n\n\n\nglycaemic control prevents/delays \n\n\n\nshort term as well as the long term \n\n\n\ndiabetic complications.  \n\n\n\n\n\n\n\nObjectives \n\n\n\n\n\n\n\nGeneral objectives \n\n\n\n\n\n\n\n\uf0b7 To investigate the influence of \n\n\n\npatient-related factors in diabetes \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n258 \n\n\n\nmanagement in non-insulin-\n\n\n\ntreated type 2 diabetics (in \n\n\n\noutpatient department of the \n\n\n\nHospital Kemaman).  \n\n\n\n\uf0b7 To analyze and determine factors \n\n\n\nwhich might affect the glycaemic \n\n\n\ncontrol. \n\n\n\n\n\n\n\nSpecific objectives \n\n\n\n\n\n\n\n\uf0b7 To determine patients\u2019 \n\n\n\nunderstanding/ knowledge \n\n\n\ntowards oral hypoglycaemic \n\n\n\nagents in non-insulin treated type \n\n\n\n2 diabetics.  \n\n\n\n\uf0b7 To investigate the patients\u2019 \n\n\n\ncompliance to the diabetes \n\n\n\ncontrol. \n\n\n\n\uf0b7 To analyze the roles of lifestyle \n\n\n\nmodifications on diabetes \n\n\n\nmanagement. \n\n\n\n\uf0b7 To investigate the roles of \n\n\n\ncounseling on diabetes \n\n\n\nmanagement. \n\n\n\n\uf0b7 To identify the barriers towards \n\n\n\neffective glycaemic control and \n\n\n\nsteps to overcome the barriers.  \n\n\n\n\uf0b7 To recognize pharmacists roles \n\n\n\nin improving glucose \n\n\n\nmanagement in diabetic patients.  \n\n\n\n\n\n\n\nDefinitions \n\n\n\n\n\n\n\na) Diabetes mellitus \n\n\n\n\n\n\n\n In practice, diagnosis of \n\n\n\ndiabetes mellitus must be confirmed \n\n\n\nby the measurement of venous \n\n\n\nplasma glucose. Malaysian Clinical \n\n\n\nPractice Guidelines stated that the \n\n\n\ndiagnosis value of diabetes is as \n\n\n\nfollow: \n\n\n\n\n\n\n\nFasting Plasma Venous Glucose Random Plasma Venous Glucose \n\n\n\n\u2265 7.0 mmol/L \u2265 11.1 mmol/L \n\n\n\n\n\n\n\n\n\n\n\nIn asymptomatic patient, 2 abnormal \n\n\n\nglucose values are required to \n\n\n\nconfirm the diagnosis of diabetes \n\n\n\nwhereas for patient presents with \n\n\n\nsymptom(s), only one abnormal \n\n\n\nglucose value is diagnostic.[5] \n\n\n\n\n\n\n\nb) Efficacy Parameter of \n\n\n\nGlycaemic Control \n\n\n\nMany quality indicators have been \n\n\n\nproposed to measure different \n\n\n\naspects \n\n\n\nof diabetes management. In this \n\n\n\nstudy, the efficacy parameter used is \n\n\n\nthe fasting blood glucose level.  \n\n\n\n\n\n\n\nEfficacy Parameter Indicators \n\n\n\nTarget Glycaemic Control \nFasting  \n\n\n\n\n\n\n\n4.4 \u2013 6.1 mmol/L \n\n\n\n\n\n\n\n*The glycaemic control is considered not achieved if the fasting plasma glucose \n\n\n\nis > 7.0 mmol/L.  \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n259 \n\n\n\nc) Understanding / Knowledge of \n\n\n\nMedications Taken \n\n\n\n\n\n\n\nPatients\u2019 knowledge of the \n\n\n\nmedications taken (oral \n\n\n\nhypoglycemic agents, OHA) is \n\n\n\nexpected to be one of the factors \n\n\n\naffecting glycaemic control. In this \n\n\n\nstudy, several questions regarding \n\n\n\nmedications taken had been \n\n\n\nforwarded to the patients to assess \n\n\n\ntheir understanding about the oral \n\n\n\nhypoglycaemic agents consumed. \n\n\n\n\n\n\n\nBelow are some of the questions asked: \n\n\n\n\n\n\n\nUnderstanding / Knowledge of \n\n\n\nMedication Name \n\uf0b7 Do you know the name (Brand Name / \n\n\n\nGeneric Name) of the medications taken? \n\n\n\n\uf0b7 How do you recognize your medications? \n\n\n\nUnderstanding / Knowledge of \n\n\n\nMedication Indications \n\uf0b7 What this particular medication is \n\n\n\nindicated for? \n\n\n\n\uf0b7 How this OHA agent acts on the blood \n\n\n\nglucose level? \n\n\n\nUnderstanding / Knowledge of \n\n\n\nMedication Dosage & \n\n\n\nAdministration \n\n\n\n\uf0b7 How is the medication(s) taken? Dose & \n\n\n\nfrequency \n\n\n\n\uf0b7 Pre or post prandial? \n\n\n\n\uf0b7 What do you do when you miss a dose? \n\n\n\nUnderstanding / Knowledge of \n\n\n\nMedications Storage \n\uf0b7 Where do you keep your medicines? \n\n\n\n\uf0b7 What storage condition do you think might \n\n\n\naffect the medication\u2019s efficacy? \n\n\n\n\n\n\n\nEach section counted for 1 mark: \n\n\n\n\n\n\n\nLevel of understanding/ knowledge Marks \n\n\n\nPoor 0-1 \n\n\n\nModerate 2-3 \n\n\n\nGood 4 \n\n\n\n\n\n\n\nd) Compliance \n\n\n\n\n\n\n\nType 2 diabetic patients usually \n\n\n\nwere on oral hypoglycaemic agent(s) \n\n\n\neither on mono- or poly- therapy. \n\n\n\nPatients have to take their \n\n\n\nmedication(s) in multiple daily \n\n\n\ndosing in order to achieve good \n\n\n\nglycaemic control. Compliance to \n\n\n\nmedications, therefore, plays an \n\n\n\nessential role to ensure blood \n\n\n\nglucose level is well-controlled. In \n\n\n\nthis study, 6 following questions \n\n\n\nwere asked to evaluate the \n\n\n\ncompliance. Each question counted \n\n\n\nfor 1 mark. \n\n\n\n\n\n\n\n\uf0b7 How are the medications taken? \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n260 \n\n\n\n\uf0b7 Have you ever forgotten to take \n\n\n\nyour medications? How often?  \n\n\n\n\uf0b7 How frequent are you delayed in \n\n\n\ntaking daily medications? \n\n\n\n\uf0b7 What do you do when you miss a \n\n\n\ndose? \n\n\n\n\uf0b7 When do you come for follow up \n\n\n\n/ refill? \n\n\n\n\uf0b7 Do you share the medications \n\n\n\nwith some one else? \n\n\n\n\n\n\n\nThe interviewer would then \n\n\n\ncategorize patients into poor, \n\n\n\nmoderate or good compliance based \n\n\n\non the patient\u2019s score. \n\n\n\n\n\n\n\nLevel of compliance Marks \n\n\n\nPoor 0-2 \n\n\n\nModerate 3-4 \n\n\n\nGood 5-6 \n\n\n\n\n\n\n\nMethodology \n\n\n\n\n\n\n\nA descriptive study has been carried \n\n\n\nout between Jan \u2013 March 2007. \n\n\n\nSample was selected via \n\n\n\nconvenience sampling among \n\n\n\npatients who were on oral \n\n\n\nhypoglycemic agent(s). The data \n\n\n\ncollection was performed in two \n\n\n\nstages. In the first stage, patients \n\n\n\nwere interviewed and data were \n\n\n\nrecorded in a data collection form \n\n\n\nspecially designed for this study \n\n\n\n(Appendix).  Subsequently, \n\n\n\noutpatient cards of the same patients \n\n\n\nwere reviewed to complete \n\n\n\ninformation.  \n\n\n\n\n\n\n\nThe data was subsequently analyzed \n\n\n\nby using SPSS Version 11.  \n\n\n\nDescriptive data were presented in \n\n\n\npercentage and Pearson Correlation \n\n\n\ntest was used to evaluate the \n\n\n\nrelationship between the fasting \n\n\n\nplasma glucose and patient\u2019s factors.  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nInclusion criteria \n\n\n\n\n\n\n\n\uf0b7 Patient is on at least one type \n\n\n\nof oral hypoglycemic agent.  \n\n\n\n\n\n\n\nExclusion criteria \n\n\n\n\n\n\n\n\uf0b7 Patient newly diagnosed with \n\n\n\ndiabetes mellitus (less than 1 \n\n\n\nyear). \n\n\n\n\uf0b7 Patient on insulin treatment \n\n\n\n\n\n\n\nResult and discussion \n\n\n\n\n\n\n\nIn this study, an overall of 29 \n\n\n\npatients with type 2 diabetes in \n\n\n\noutpatient department had been \n\n\n\napproached to assess the effect of \n\n\n\nseveral patient-related factors (which \n\n\n\nare expected to affect the body \n\n\n\nglycaemic control) on body blood \n\n\n\nglucose level. The study population \n\n\n\nconsists of 27 (93.1%) Malays and 2 \n\n\n\n(6.9%) Chinese with 8 (27.6%) of \n\n\n\nthe population were male and 21 \n\n\n\n(72.4%) were female. The \n\n\n\npopulation has the mean age of \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n261 \n\n\n\n54.93 \u00b110 and the mean of 7.38 \n\n\n\nyears diagnosed with diabetes \n\n\n\nmellitus. [Table 1] \n\n\n\n\n\n\n\nTable 1. Patient Demographics Data \n \n\n\n\n\n\n\n\nParameters N \n\n\n\n\n\n\n\nNumber of patients \n\n\n\nNumber of OHA prescribed per patient \n\n\n\n     Mean \n\n\n\nYears diagnosed with diabetes mellitus \n\n\n\n     Mean \n\n\n\n29 \n\n\n\n\n\n\n\n1.85 \n\n\n\n\n\n\n\n7.38 \n\n\n\nSex \n\n\n\n     Male (%) \n\n\n\n     Female (%) \n\n\n\n\n\n\n\n8 (27.6%) \n\n\n\n21 (72.4%) \n\n\n\nAge, (years) \n\n\n\n     Mean (SD) \n\n\n\n     Median (range) \n\n\n\n\n\n\n\n54.93 (\u00b110.392) \n\n\n\n53 (31-75) \n\n\n\nRace \n\n\n\n     Malay (%) \n\n\n\n     Chinese (%) \n\n\n\n\n\n\n\n27 (93.1%) \n\n\n\n2 (6.9%) \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nMost of the patients were non-\n\n\n\nsmokers (86.2%). 41.4% of the \n\n\n\npopulation consumed alternative \n\n\n\nmedications concurrently with \n\n\n\nantidiabetic medications. Lifestyle \n\n\n\nmodifications, as part of diabetes \n\n\n\nmanagement, practiced by majority \n\n\n\nof the population, with 62.1% \n\n\n\npatients claimed exercise routinely \n\n\n\nand 79.3% patients controlled their \n\n\n\ndaily dietary intake. \n\n\n\n\n\n\n\nApproximately one quarter of the \n\n\n\npopulation received counseling on \n\n\n\ndiabetes prior to the study (24.1% \n\n\n\nand 20.7% patients received \n\n\n\ncounseling before being put on \n\n\n\ndiabetic medications and lifestyle \n\n\n\nmodifications respectively). There \n\n\n\nare many patients out there who still \n\n\n\ndo not completely understand about \n\n\n\nthe medications prescribed to them. \n\n\n\nGood glycaemic control is the \n\n\n\nprimary goal in diabetes \n\n\n\nmanagement. The results, \n\n\n\nnevertheless, demonstrated a non-\n\n\n\noptimal control of blood glucose \n\n\n\nlevel. Only 27.6% have their fasting \n\n\n\nblood glucose level \u22647mmol/L \n\n\n\nduring the study duration. More than \n\n\n\n70% (72.4%) patients claimed to \n\n\n\nhave good compliance to the \n\n\n\nmedications prescribed. Some \n\n\n\npatients acknowledge moderate-poor \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n262 \n\n\n\ncompliance due to personal \n\n\n\ndisability, old age, multiple drug \n\n\n\nregimen and other problems. Table 2 \n\n\n\nlisted the variables that might affect \n\n\n\nthe glycaemic control. \n\n\n\n\n\n\n\nTable 2 : Variables Which Might Affect Glycaemic Control \n \n\n\n\n\n\n\n\nVariables N (%) \n\n\n\n\n\n\n\nSmoking \n\n\n\n     Not smoking (%) \n\n\n\n     Smoking (%) \n\n\n\n\n\n\n\n25 (86.2%) \n\n\n\n4 (13.8%) \n\n\n\nAlternative medications \n\n\n\n     Not take alternative medications (%) \n\n\n\n     Take alternative medications (%) \n\n\n\n\n\n\n\n17 (58.6%) \n\n\n\n12 (41.4%) \n\n\n\nLifestyle modifications \n\n\n\n     No routine exercise (%) \n\n\n\n     Routine exercise (%) \n\n\n\n\n\n\n\n     No dietary control (%) \n\n\n\n     Dietary control (%) \n\n\n\n\n\n\n\n11 (37.9%) \n\n\n\n18 (62.1%) \n\n\n\n\n\n\n\n6 (20.7%) \n\n\n\n23 (79.3%) \n\n\n\nCounseling on medications \n\n\n\n     No counseling given before (%) \n\n\n\n     Counseling given before (%) \n\n\n\n\n\n\n\n22 (75.9%) \n\n\n\n7 (24.1%) \n\n\n\nCounseling on lifestyle modifications \n\n\n\n     No counseling given before (%) \n\n\n\n     Counseling given before (%) \n\n\n\n\n\n\n\n23 (79.3%) \n\n\n\n6 (20.7%) \n\n\n\nUnderstanding / Knowledge of the medications taken  \n\n\n\n\n\n\n\nUnderstanding / Knowledge of medications name \n\n\n\n     No (%) \n\n\n\n     Yes (%) \n\n\n\nUnderstanding / Knowledge of medications indications \n\n\n\n     No (%) \n\n\n\n     Yes (%) \n\n\n\nUnderstanding / Knowledge of medications dosage & \n\n\n\nadministration \n\n\n\n     No (%) \n\n\n\n     Yes (%) \n\n\n\nUnderstanding / Knowledge of medications storage \n\n\n\n     No (%) \n\n\n\n     Yes (%) \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n18 (62.1%) \n\n\n\n11 (37.9%) \n\n\n\n\n\n\n\n4 (13.8%) \n\n\n\n25 (86.2%) \n\n\n\n\n\n\n\n\n\n\n\n7 (24.1%) \n\n\n\n22 (75.9%) \n\n\n\n\n\n\n\n9 (31.0%) \n\n\n\n20 (69.0%) \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n263 \n\n\n\nCompliance \n\n\n\n     Poor (%) \n\n\n\n     Moderate (%) \n\n\n\n     Good (%) \n\n\n\n\n\n\n\n3 (10.3%) \n\n\n\n5 (17.2%) \n\n\n\n21 (72.4%) \n\n\n\nGlycaemic control -Fasting blood glucose level \n\n\n\n     Not-controlled (FBG > 7mmol/L) (%) \n\n\n\n     Well-controlled (FBG \u2264 7mmol/L) (%) \n\n\n\n\n\n\n\n21 (72.4%) \n\n\n\n8 (27.6%) \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nPatient-related factors have always \n\n\n\nbeen identified as the determining \n\n\n\nfactors towards good glycaemic \n\n\n\ncontrol. Gycaemic control, therefore, \n\n\n\nis expected to be improved if these \n\n\n\ndetermining factors are improved.  It \n\n\n\nis expected that blood glucose level \n\n\n\nmight achieve well-controlled level \n\n\n\nif the following criteria are met: \n\n\n\n\n\n\n\n\uf0b7 younger age (expected to be \n\n\n\nmore aware of the importance of \n\n\n\nself-care and have better \n\n\n\nunderstanding about the \n\n\n\nmedications taken) \n\n\n\n\uf0b7 non-smoker \n\n\n\n\uf0b7 has better understanding about \n\n\n\nthe medications taken \n\n\n\n\uf0b7 has good compliance to the \n\n\n\nmedications taken \n\n\n\n\uf0b7 counseling on medications and \n\n\n\nlifestyle modifications given \n\n\n\nbefore being put on diabetic \n\n\n\nmedication(s) \n\n\n\n\uf0b7 practices lifestyle modifications, \n\n\n\ninvolving dietary control and \n\n\n\nroutine involvement in physical \n\n\n\nexercise \n\n\n\n\n\n\n\nConcurrent use of alternative \n\n\n\nmedicine is also expected to \n\n\n\ninfluence the diabetic control. \n\n\n\n\n\n\n\nTable 3 showed the correlation \n\n\n\nbetween the patient\u2019s factors and the \n\n\n\nfasting plasma glucose.  The results \n\n\n\nrevealed that fasting blood glucose \n\n\n\nlevel had no significant correlation \n\n\n\nwith patients\u2019 age.  Positive \n\n\n\ncorrelations found to be established \n\n\n\nbetween fasting blood glucose level \n\n\n\nand patients\u2019 understanding / \n\n\n\nknowledge towards oral \n\n\n\nhypoglycaemic agents. Patients had \n\n\n\ntheir blood glucose level better \n\n\n\ncontrolled when they had higher \n\n\n\nknowledge of the indications, dosage \n\n\n\n& administration and storage of the \n\n\n\nmedications. Patients\u2019 knowledge \n\n\n\nabout the name of the medications, \n\n\n\nhowever, did not improve the \n\n\n\nglycaemic control significantly.  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n264 \n\n\n\nTable 3. Correlation Between Fasting Blood Glucose & Patient\u2019s Factors \n \n\n\n\n Correlation \n\n\n\ncoefficient \n\n\n\nP-value \n\n\n\nAge 0.323 NS \n\n\n\nUnderstanding / Knowledge of \n\n\n\nmedications name \n\n\n\n-0.005 NS \n\n\n\nUnderstanding / Knowledge of \n\n\n\nmedications indications \n\n\n\n0.023 <0.05 \n\n\n\nUnderstanding / Knowledge of \n\n\n\nmedications dosage & administration \n\n\n\n0.348 <0.05 \n\n\n\nUnderstanding / Knowledge of \n\n\n\nmedications storage \n\n\n\n0.247 <0.05 \n\n\n\nCompliance 0.223 <0.05 \n\n\n\nCounseling on medication before 0.193 <0.05 \n\n\n\nCounseling on lifestyle modification \n\n\n\nbefore \n\n\n\n0.066 <0.05 \n\n\n\nExercise 0.050 <0.05 \n\n\n\nDietary Control 0.125 <0.05 \n\n\n\nSmoking -0.247 NS \n\n\n\nAlternative medications -0.049 NS \n\n\n\n\n\n\n\nP<0.05 \u2013 Significant \n\n\n\nNS \u2013 Non-significant  \n\n\n\n\n\n\n\nStudy also showed that better \n\n\n\nmedication compliance produced \n\n\n\nbetter glycaemic control. This result \n\n\n\nwas parallel with the findings from \n\n\n\nDuff EM; O'Connor A and friends \n\n\n\nstating that there was an inverse \n\n\n\nrelationship between self-care scores \n\n\n\nand HbA1c% (6).  In Duff\u2019s study, \n\n\n\nself-care practices included weight \n\n\n\ncontrol, exercise and medication \n\n\n\ncompliance.  \n\n\n\n\n\n\n\nLifestyle modifications including \n\n\n\nroutine exercise and dietary control \n\n\n\nappeared to influence the fasting \n\n\n\nblood glucose level positively. \n\n\n\nPatients who practiced lifestyle \n\n\n\nmodifications were found to have \n\n\n\nbetter glycaemic control. The \n\n\n\nparallel results was demonstrated by \n\n\n\nSone H ; Katagiri A and friends who \n\n\n\nconcluded that lifestyle modification \n\n\n\nhad a small but significant \n\n\n\nimproving effect on glycaemic \n\n\n\ncontrol (7). \n\n\n\n\n\n\n\nIn addition, this study found that the \n\n\n\nrelationship between counseling \n\n\n\ngiven before and the extent of \n\n\n\nglycaemic control. It was found that \n\n\n\npatients who had been counseled \n\n\n\nbefore whether on lifestyle \n\n\n\nmodifications or medications or both \n\n\n\npresented with better blood glucose \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n265 \n\n\n\ncontrol. This finding was \n\n\n\ncorresponded to the finding by \n\n\n\nKirk A and friends.(8) The \n\n\n\nresearchers concluded that physical \n\n\n\nactivity counseling was effective in \n\n\n\npromoting physical activity in \n\n\n\npeople with Type 2 diabetes. The \n\n\n\ncounseling improved glycaemic \n\n\n\ncontrol in these patients. One of the \n\n\n\nproblems highlighted here is that \n\n\n\nonly a minority of the population has \n\n\n\nbeen counseled before and has \n\n\n\nsufficient knowledge about the \n\n\n\ndisease and medications taken. \n\n\n\nCounseling will help patients \n\n\n\nunderstand the management of \n\n\n\ndiabetes better and therefore, \n\n\n\nimprove the compliance and \n\n\n\nglycemic control.  \n\n\n\n\n\n\n\nIt was found that no significant \n\n\n\ncorrelation between smoking and \n\n\n\nfasting blood glucose levels. In other \n\n\n\nwords, there was no significant \n\n\n\ndifference in glycaemic control \n\n\n\nbetween smoker and non-smoker. \n\n\n\nHowever the expectation that non-\n\n\n\nsmokers would have better blood \n\n\n\nglucose control, can not be \n\n\n\nconfirmed in this study due to the \n\n\n\nlimitation in sample size. Only 4 out \n\n\n\nof 29 in the study population were \n\n\n\nsmokers.  \n\n\n\n\n\n\n\nThe study also failed to demonstrate \n\n\n\nany correlation between the \n\n\n\nconsumption of alternative \n\n\n\nmedications and the fasting blood \n\n\n\nglucose level. About half of the \n\n\n\nstudy populations (41.4%) were \n\n\n\ntaking alternative medicines \n\n\n\nconcurrently with oral \n\n\n\nhypoglycaemic agents with the \n\n\n\nbeliefs that the alternative \n\n\n\napproaches will aid in their \n\n\n\nglycaemic control. Akar kayu, \n\n\n\npegaga and traditional medicines \n\n\n\nwere among those taken by these \n\n\n\npatients. The beliefs that the \n\n\n\nconsumption of alternative \n\n\n\nmedication helps in the management \n\n\n\nof glycaemic control, however, was \n\n\n\nnot confirmed in this study. The role \n\n\n\nof alternative medicines in diabetes \n\n\n\ncontrol is still under investigation. \n\n\n\nNot much established clinical data is \n\n\n\navailable for alternative medicines \n\n\n\nuse. Larger-scale and more \n\n\n\ncomprehensive study on the use of \n\n\n\nalternative medicines in diabetes \n\n\n\nmanagement should be carried out in \n\n\n\nthe future.  \n\n\n\n\n\n\n\nThis study managed to demonstrate \n\n\n\nsome significant results but the \n\n\n\ncorrelations were not that impressive \n\n\n\n(correlation coefficient values were \n\n\n\nsmall). Diabetes is a progressive \n\n\n\ncondition in which \u03b2-cell function \n\n\n\ndeteriorates with increasing duration \n\n\n\nof diabetes. Stepwise therapy with \n\n\n\nmultiple pharmacological therapies, \n\n\n\ntherefore, is often needed over time \n\n\n\nto maintain target glucose control. \n\n\n\nIntermittent uncontrolled blood \n\n\n\nglucose level is not a definite \n\n\n\nindicator for poor diabetic control. It \n\n\n\nmight just reflect a further \n\n\n\nprogression of the disease and a \n\n\n\nmore aggressive treatment is needed. \n\n\n\nImproving patients\u2019 factors, of \n\n\n\ncourse, will slow down the disease \n\n\n\nprogression but persistent good \n\n\n\nglycaemic control requires a \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n266 \n\n\n\ncombination of many factors. In this \n\n\n\nstudy, the analysis only involved the \n\n\n\ncorrelation between each single \n\n\n\nvariable with blood glucose level. \n\n\n\n\n\n\n\nLimitation of the study \n\n\n\n\n\n\n\nThe study has several limitations \n\n\n\nsuch as small sample size (N=29) \n\n\n\nand the finding does not reflect the \n\n\n\noverall situation in the diabetes \n\n\n\npopulation. Secondly, most of the \n\n\n\ndata were gathered though verbal \n\n\n\ncommunications with patients \n\n\n\n(compliance, alternative \n\n\n\nmedications, understanding about \n\n\n\nmedications given, previous \n\n\n\ncounseling history and \n\n\n\ncomplications). This technique is \n\n\n\nprone to possibility of incomplete or \n\n\n\nbias data. Thirdly, the study uses an \n\n\n\naverage of 2 readings of fasting \n\n\n\nblood glucose that were taken within \n\n\n\n3 months. Few readings within short \n\n\n\nperiod of time-frame might influence \n\n\n\nthe average of blood glucose value. \n\n\n\nFinally the study does not use \n\n\n\nHbA1c level although HbA1c is a \n\n\n\nbetter indicator of glycaemic control.  \n\n\n\nHbA1c is not routinely done at the \n\n\n\nstudied hospital.  \n\n\n\n\n\n\n\nRecommendation \n\n\n\n\n\n\n\nEducation and counseling on \n\n\n\nmedications and lifestyle \n\n\n\nmodifications should be initiated at \n\n\n\ndiagnosis stage and reinforced \n\n\n\nregularly.  Group counseling can be \n\n\n\nconducted from time to time and \n\n\n\npatients are highly encouraged to \n\n\n\nparticipate in group counseling. \n\n\n\nThrough group counseling, patients \n\n\n\ncan share their problems in daily \n\n\n\ndiabetes management, understand \n\n\n\nmore about the disease and be able \n\n\n\nto manage the disease better.  \n\n\n\n\n\n\n\nFurther study using larger population \n\n\n\ncan be conducted to survey the effect \n\n\n\nof a combination of multiple factors \n\n\n\nin diabetic control. Future study is \n\n\n\nrecommended to use HbA1c level as \n\n\n\nefficacy parameter for a more \n\n\n\nreliable result.  \n\n\n\n\n\n\n\nReferences. \n\n\n\n\n\n\n\n1. Wild S, Roglic G, Green A, \n\n\n\nSicree R, King H. Global \n\n\n\nprevalence of diabetes: estimates \n\n\n\nfor the year 2000 and projections \n\n\n\nfor 2030. Diabetes Care \n\n\n\n2004;27:1047-53. \n\n\n\n2. National Health & Morbidity \n\n\n\nSurvey 2, 1996. \n\n\n\n3. American Diabetes Association. \n\n\n\nStandards of medical care in \n\n\n\ndiabetes. Diabetes Care \n\n\n\n2006;29:S4-42 \n\n\n\n4. Mary Anne Koda-Kimble, Lloyd \n\n\n\nYee Young, Wayne A.Kradjan & \n\n\n\nB.Joseph, Applied Therapeutics: \n\n\n\nThe Clinical Use of Drugs, 7\nth\n\n\n\n\n\n\n\nEdition, 2001, Lippincott \n\n\n\nWilliams & Wilkins. \n\n\n\n5. Ministry of Health Malaysia, \n\n\n\nPersatuan Diabetes Malaysia, \n\n\n\nAcademy of Medicine. Clinical \n\n\n\nPractice Guidelines \u2013 \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n267 \n\n\n\nManagement of Type 2 Diabetes \n\n\n\nMellitus, Third edition, 2004.  \n\n\n\n6. Duff EM; O'Connor A; \n\n\n\nMcFarlane-Anderson N; \n\n\n\nWint YB; Bailey EY; Wright-\n\n\n\nPascoe RA, The University of \n\n\n\nthe West Indies School of \n\n\n\nNursing, Mona, Kingston 7, \n\n\n\nJamaica, Self-care, compliance \n\n\n\nand glycaemic control in \n\n\n\nJamaican adults with diabetes \n\n\n\nmellitus, 2006. \n\n\n\n7. Sone H; Katagiri A; Ishibashi S; \n\n\n\nAbe R; Saito Y; Murase T; Yam\n\n\n\nashita H; YajimaY; Ito H; Ohash\n\n\n\ni Y; Akanuma Y; Yamada N;  Ef\n\n\n\nfects of lifestyle modifications \n\n\n\non patients with type 2 diabetes: \n\n\n\nthe Japan Diabetes \n\n\n\nComplications Study (JDCS) \n\n\n\nstudy design, baseline analysis \n\n\n\nand three year-interim report, \n\n\n\n2002 \n\n\n\n8. Kirk A ; Mutrie N ; MacIntyre P \n\n\n\n; Fisher M, Centre for Exercise \n\n\n\nScience and Medicine, \n\n\n\nUniversity of Glasgow, Scotland. \n\n\n\nEffects of a 12-month physical \n\n\n\nactivity counselling intervention \n\n\n\non glycaemic control and on the \n\n\n\nstatus of cardiovascular risk \n\n\n\nfactors in people with Type 2 \n\n\n\ndiabetes, 2004 \n\n\n\n \n\n\n\n\n\n"
"\n\nMalaysian Journal of Pharmacy Volume 6 Issue 1 December 2020 \n \n\n\n\n21 \n\n\n\n\n\n\n\n*Corresponding author:  \n\n\n\nJaasminerjit Kaur \n\n\n\nEmail: ucn.jaasminerjit@kpjuc.edu.my \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n1School of Pharmacy, KPJ Healthcare University College, Nilai, Negeri \n\n\n\nSembilan, Malaysia \n2Faculty of Pharmacy, University of Cyberjaya, Cyberjaya, Selangor, \nMalaysia \n3Faculty of Pharmacy, Universiti Teknologi MARA, Puncak Alam, \n\n\n\nSelangor, Malaysia \n4KPJ Seremban Specialist Hospital, Seremban 70200, Negeri Sembilan, \n\n\n\nMalaysia \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nOriginal Research Article \n\n\n\n\n\n\n\nUtilization Pattern of Lipid Modifying Agents in An \n\n\n\nOutpatient Pharmacy Department of a Private Hospital in \n\n\n\nMalaysia \n \n\n\n\nXin Xuan Cha1, Ching Siang Tan1, Shashidharan Menon1, H. Jaasminerjiit Kaur1*, Kah Seng Lee2, Mohamed \n\n\n\nMansor Manan3, Shafeeq Mohd Faizal4 \n \n\n\n\n\n\n\n\nArticle Info  \n\n\n\n \nReceived date: 16 Dec 2020 \n\n\n\nAccepted date: 30 Dec 2020 \n\n\n\nPublished date: 31 Dec 2020  \n\n\n\n\n\n\n\nKeywords:  \n\n\n\nPharmacoepidemiology, Statin, \n\n\n\ncardiovascular diseases, \n\n\n\nprescribing pattern, Defined \n\n\n\nDaily Dose  \n\n\n\n\n\n\n\nABSTRACT  \n\n\n\n\n\n\n\nIntroduction: Lipid-modifying drugs have been used to treat dyslipidemia as well as for the primary \n\n\n\nand secondary prevention of CVDs and stroke. Objectives: This study aims to describe the drug \n\n\n\nutilization pattern of lipid-modifying drugs in a private hospital. Method: A retrospective study was \n\n\n\ncarried out in outpatient of the selected hospital. Patients were selected based on inclusion and \n\n\n\nexclusion criteria by using convenience sampling. Data were collected through KCIS by retrieving \n\n\n\npatients\u2019 registration number. Defined daily dose (DDD) was calculated and compared to World \n\n\n\nHealth Organization DDD. Medicine prices were also analysed. Results: A total of 180 patients\u2019 \n\n\n\nrecord were analysed, 70% of them were male; 40.6% of the patients were from the age range of 50 \n\n\n\nto 59 years old; ethnicity breakdown was Malay (69.4%), Indian (18.3%) and Chinese (12.2%). \n\n\n\nAmong all lipid-modifying drugs, utilization of statins was the highest as statins are the preferred \n\n\n\nline in the treatment of dyslipidemia. Innovator brands were more preferred where most of the lipid-\n\n\n\nmodifying drugs used in the selected hospital are innovator brand drugs. In terms of cost, lipid-\n\n\n\nmodifying drugs contributes to about 27% of the total cost of prescription in average. Conclusion: \n\n\n\nThe utilization of all lipid-modifying drugs in the selected hospital was lower as compared to WHO \n\n\n\nDDD. As compared to combination therapy, monotherapy with atorvastatin was generally preferred \n\n\n\nin the selected hospital. The utilization of atorvastatin was found to be the highest in the OPD of the \n\n\n\nselected hospital.  \n\n\n\n\n\n\n\n\n\n\n\nINTRODUCTION  \n\n\n\n\n\n\n\nDyslipidemia is a medical condition referring to an abnormal \n\n\n\nlipid level in the blood. Elevated levels of LDL cholesterol in \n\n\n\nblood are associated with Cardiovascular Diseases (CVDs), \n\n\n\ncerebral stroke and renal failure or even death [1]. CVDs are \n\n\n\nprincipal cause of death globally as well as in Malaysia [10].  \n\n\n\nAccording to National Health & Morbidity Survey 2015, \n\n\n\nMalaysian has a high risk of CVDs, an estimation of 73% of \n\n\n\ntotal death is due to non-communicable diseases (NCDs). \n\n\n\nThese NCDs include overweight or obesity, diabetes mellitus, \n\n\n\nhypertension as well as hypercholesterolemia. The prevalence \n\n\n\nof hypercholesterolemia in Malaysia has increased from 32.6% \n\n\n\nin the year 2011 to 47.7% in the year 2015 indicating poor \n\n\n\ndyslipidemia management [2]. \n\n\n\nLipid-modifying Agents (LMAs) are used for primary & \n\n\n\nsecondary prevention of CVDs [13]. The total expenditure of \n\n\n\nLMAs has been increased by 56.6% from RM 210 million in \n\n\n\nthe year 2009 to RM 329 million in the year 2010. This \n\n\n\ninflation was greatly contributed by the private sector (64.8%) \n\n\n\n[12]. \n\n\n\nIncrement of cost per year in LMAs is directly proportional to \n\n\n\nprevalence of CVS patient. This is a clear implication on the \n\n\n\nneed of drug utilization review (DUR) to identify the \n\n\n\nappropriateness in the usage of LMAs. DUR is defined as an \n\n\n\nauthorized, structured, ongoing review of prescribing, \n\n\n\n\nmailto:ucn.jaasminerjit@kpjuc.edu.my\n\n\n\n\n\n\nX.X Cha et al. Malaysian Journal of Pharmacy 6 (1) 2020 \n\n\n\n\n\n\n\n\n\n\n\n22 \n\n\n\n\n\n\n\ndispensing and use of medication with the goals of promoting \n\n\n\noptimal medication therapy and ensuring drug therapy meets \n\n\n\nstandard [3]. \n\n\n\nIn this research, drug utilization of LMAs in a private \n\n\n\nhealthcare centre was conducted in a private hospital in Negeri \n\n\n\nSembilan, with the intention to describe if the Defined Daily \n\n\n\nDoses (DDDs) of LMAs are prescribed and utilized \n\n\n\naccordingly based on the WHO DDD criteria in private \n\n\n\nhospitals. DDD is defined as an assumed average maintenance \n\n\n\ndose/day for a drug used for its main indication in adults [10]. \n\n\n\nThis study will be able to provide information on the \n\n\n\ncompliance of WHO DDD in the private hospital and cost of \n\n\n\nlipid-modifying drugs can be calculated in order to reduce the \n\n\n\nusage of high-end drug. This may eventually facilitates the \n\n\n\ndevelopment of hospital drug formularies.   \n\n\n\nThe objectives of this study include to describe the drug \n\n\n\nutilization pattern and analyse by comparing WHO DDD \n\n\n\ncriteria of LMAs prescribed in the OPD of private healthcare \n\n\n\ncentre. Secondly, to identify the highly utilized LMA \n\n\n\nprescribed in the OPD of private healthcare centre and to \n\n\n\ncalculate the cost of LMA per prescription. \n\n\n\n\n\n\n\nMETHODOLOGY \n\n\n\n\n\n\n\nA retrospective, observational, quantitative study on the \n\n\n\nutilization of lipid-modifying agents was conducted in the \n\n\n\noutpatient department of private hospital, Malaysia. A list of \n\n\n\nitem movement for each lipid-modifying drug in the selected \n\n\n\nprivate hospital with the transaction date between 1st January \n\n\n\n2017 till 31st December 2017 was first generated together with \n\n\n\npatients\u2019 name, Medical Record Number (MRN), transaction \n\n\n\ndate, quantity dispensed as well as prescriber\u2019s name by using \n\n\n\nthe Hospital Information Technology System (HITS).  \n\n\n\nThe prescription was chosen using convenience sampling \n\n\n\nmethod. List of MRN generated were used to retrieve patient's \n\n\n\nprescription via KPJ Clinical Information System (KCIS). \n\n\n\nSelection of patient according to eligibility criteria. The \n\n\n\ninclusion criteria include newly registered (in year 2017) and \n\n\n\nexisting patients (follow up from past years) prescribed LMAs, \n\n\n\npatients of either sex age 18 years old and above while \n\n\n\nprescription with incomplete data were excluded from studies. \n\n\n\nPatient\u2019s medical data was not collected as it was not \n\n\n\naccessible in the private hospital. \n\n\n\n\n\n\n\nData retrieved were collected using data collection form \n\n\n\nthrough KCIS include patient's demographic, like age, gender \n\n\n\nand race as well as prescription details such as name and brand \n\n\n\nof prescribed medicine, frequency, dose and duration of the \n\n\n\nmedicine prescribed as well as prescriber details like \n\n\n\nprescriber category and education background for each patient \n\n\n\nwere recorded. Costs of lipid-modifying drugs and total cost \n\n\n\nper prescription were calculated based on the price reference \n\n\n\nlist provided by the pharmacist.  \n\n\n\n\n\n\n\nDemographic information and prescribing record of each \n\n\n\npatient were analysed descriptively and statistically by using \n\n\n\nthe Statistical Package for Social Science (SPSS) program \n\n\n\nversion 22.0 which were expressed in mean and standard \n\n\n\ndeviation. The DDD was computed based formula derived \n\n\n\nfrom Manitoba Centre for Health Policy. The ethical issues \n\n\n\nand informed consent have been approved by Research Ethics \n\n\n\nCommittee of KPJ University College, Nilai, Malaysia. This \n\n\n\napproval has been obtained before conducting the study. \n\n\n\n\n\n\n\n\n\n\n\nTable 1: Demographic profiles of selected patients \n\n\n\n\n\n\n\nCategory Frequency (n=180) Percent (%) \n\n\n\nGender \n\n\n\nMale 126 70.0 \n\n\n\nFemale 54 30.0 \n\n\n\nAge (years) \n\n\n\nBelow 20 0 0.0 \n\n\n\n20 \u2013 29 1 0.6 \n\n\n\n30 \u2013 39  4 2.2 \n\n\n\n40 \u2013 49  36 20.0 \n\n\n\n50 \u2013 59  73 40.6 \n\n\n\n60 and above 66 36.7 \n\n\n\nEthnicity \n\n\n\nMalay 125 69.4 \n\n\n\nChinese 22 12.2 \n\n\n\nIndian 33 18.3 \n\n\n\n \n\n\n\n\n\n\n\n\nX.X Cha et al. Malaysian Journal of Pharmacy 6 (1) 2020 \n\n\n\n\n\n\n\n\n\n\n\n23 \n\n\n\n\n\n\n\nRESULT AND DISCUSSION \n\n\n\n\n\n\n\nIn this study, demographic characteristic, dyslipidemia can be \n\n\n\nseen higher in men (70%) than in women (30%). This result is \n\n\n\nconsistent with several findings from China and American-\n\n\n\nbased studies [4,5]. This could be attributed to the unhealthy \n\n\n\nlifestyle such as alcohol drinking and cigarette smoking in \n\n\n\nmen, while on the other hand, women are generally more \n\n\n\nhealth conscious [11]. \n\n\n\n\n\n\n\nDyslipidemia can be seen increasing by age, peaking in the age \n\n\n\ngroup of 50 to 59 years (40.6%), but slightly reducing in age \n\n\n\ngroup of more than 60 years (36.7%). Similarly, in other \n\n\n\nstudies from China, America and Africa, the prevalence of \n\n\n\ndyslipidemia increases with age [4, 5, 6, 14]. In terms of \n\n\n\nethcinity, dyslipidemia is most prevalent in Malay (69.4%), \n\n\n\nfollowed by Indian (18.3%) and Chinese (12.2%). \n\n\n\n\n\n\n\nThe average number of drugs per prescription was 5.54 drugs \n\n\n\nper prescription. Previous study reported by WHO suggested \n\n\n\nthat for a patient without chronic diseases such as \n\n\n\nhyperlipidemia, hypertension, about two to three drugs per \n\n\n\nprescription is ideal to ensure proper adherence [10]. However, \n\n\n\nthis study reported higher number of drugs per prescription. \n\n\n\nThis may increase risk of drug interaction. Other study \n\n\n\nsuggested that personal patients\u2019 request or demand could lead \n\n\n\nto over-prescribing of multi-vitamins or medications for minor \n\n\n\nailments [15]. Medication counselling and bedside counselling \n\n\n\nare also implemented to ensure patients have proper \n\n\n\nunderstanding of each medication prescribed in order to \n\n\n\nenhance medication adherence. \n\n\n\n\n\n\n\nIn terms of drug utilization of statin, this study revealed that \n\n\n\nthe most frequently prescribed statin was atorvastatin (64.7%) \n\n\n\nand the least was simvastatin (11.8%), remaining was \n\n\n\nrosuvastatin (23.5%). A study supported that atorvastatin was \n\n\n\nthe safest statin in association with renal function [7] while \n\n\n\nanother study also reported that atorvastatin is more cost- \n\n\n\neffective as compared to rosuvastatin as the additional efficacy \n\n\n\nof rosuvastatin does not support the extra cost [8]. \n\n\n\n\n\n\n\nThe utilization rates per residents per day and the rates per user \n\n\n\nper day were lower compared to the WHO DDD. This low \n\n\n\ndrug utilization rate is due to the low sample size obtained, \n\n\n\nwhich ultimately affects the result of utilization rates. This low \n\n\n\nlevel of utilization obtained cannot be used to reflect the \n\n\n\noverall usage of lipid-modifying drugs in OPD of the selected \n\n\n\nhospital. \n\n\n\n\n\n\n\nThe average cost of lipid-modifying drugs per prescription \n\n\n\ncontributes to about 27% of the total cost of prescription. The \n\n\n\nLMA used are mostly innovator brand drugs with a high price \n\n\n\nper unit. Generic brands of atorvastatin at a cheaper price were \n\n\n\nleast preferred. The high cost of lipid-modifying drugs directly \n\n\n\ncontributes to the rise in total cost of prescription, which may \n\n\n\nburden the patients financially especially those with low or \n\n\n\nmoderate income will eventually leads to poorer medication \n\n\n\nadherence. Majority of the patients with dyslipidemia also has \n\n\n\nat least one comorbidity of either CVDs such as hypertension, \n\n\n\nmyocardial infarction, coronary artery disease and/or diabetes. \n\n\n\nThe higher the number of comorbidities, the higher the \n\n\n\nnumber of prescription drugs, which in turn increases the cost \n\n\n\nof prescription [9]. With a significant increase in cost, patients \n\n\n\nespecially those with low or moderate income will eventually \n\n\n\nleads to poorer medication adherence where they either stop \n\n\n\n\n\n\n\nTable 2: Drug utilization based on DDD \n\n\n\n\n\n\n\nLipid-modifying Drug WHO DDD  \n\n\n\n(DDD) \n\n\n\nTotal DDD \n\n\n\n(DDD) \n\n\n\nRates per residents per day  \n\n\n\n(DDD per 1,000 residents per \n\n\n\nday) \n\n\n\nRates per user per \n\n\n\nday \n\n\n\n(DDD per user per \n\n\n\nday) \n\n\n\nSimvastatin 20mg 30 820 0.07 1.71 \n\n\n\nAtorvastatin 20mg 20 2,655 0.24 1.84 \n\n\n\nAtorvastatin 40mg 20 820 0.07 2.10 \n\n\n\nAtorvastatin 80mg 20 4,360 0.39 5.38 \n\n\n\nRosuvastatin 10mg 10 1,030 0.09 2.27 \n\n\n\nRosuvastatin 20mg 10 1,940 0.17 4.04 \n\n\n\nFenofibrate 145mg 200 837.38 0.07 1.34 \n\n\n\nEzetimibe/Simvastatin 10/20mg - 1,065 0.10 1.87 \n\n\n\nEzetimibe/Simvastatin 10/40mg - 930 0.08 1.82 \n\n\n\n \n\n\n\n\n\n\n\n\nX.X Cha et al. Malaysian Journal of Pharmacy 6 (1) 2020 \n\n\n\n\n\n\n\n\n\n\n\n24 \n\n\n\n\n\n\n\nfilling their prescription or reduce the frequency of taking the \n\n\n\nmedication, which ultimately worsen health outcomes. \n\n\n\n\n\n\n\nStudy Limitation and Further Study \n\n\n\n\n\n\n\nOne limitation in this study is convenience sampling method \n\n\n\nused with a low sample size, which affects the utilization rate \n\n\n\nmeasured and that the result obtained shall not be used to \n\n\n\ngeneralize or represent the overall utilization. However this \n\n\n\nstudy serves as a pilot study to aid in further studies on drug \n\n\n\nutilization. Another limitation is the restricted access to \n\n\n\npatients\u2019 medical to obtain important information such as \n\n\n\ndiagnosis, comorbidity, laboratory results like lipid profile, \n\n\n\nlifestyle and family histories which could be an aid in \n\n\n\ncalculating Framingham Point Scores in order to identify the \n\n\n\nappropriateness of lipid-modifying drug prescribing.  Further \n\n\n\nstudies can be done using all patients\u2019 data to reflect on the \n\n\n\nactual utilization of lipid-modifying drugs. The \n\n\n\nappropriateness on prescribing of lipid-modifying drugs can \n\n\n\nbe identified if complete access to patients\u2019 medical notes is \n\n\n\npermitted. Since the average number of drugs per prescription \n\n\n\nin the selected hospital is close to 6 drugs, medication \n\n\n\nadherence can be evaluated to ensure patients are taking \n\n\n\nmedication correctly. \n\n\n\n\n\n\n\nCONCLUSIONS  \n\n\n\n\n\n\n\nThe drug utilization of LMAs in OPD of private healthcare \n\n\n\ncentre is lower as compared to WHO DDD which may be due \n\n\n\nto low number of samples collected and may not be used to \n\n\n\nreflect the overall utilization. Monotherapy with Atorvastatin \n\n\n\nis generally preferred in private healthcare centre. Innovator \n\n\n\nbrands were more preferred where most of the LMAs using in \n\n\n\nprivate healthcare centre are innovator drugs. The higher price \n\n\n\nper unit of innovator drugs increases the cost of LMA where \n\n\n\nphysician may consider switching from innovator brands to \n\n\n\ngeneric drugs for a more cost-saving approach.  The average \n\n\n\nnumber of drugs per prescription was found to be high at 5.54, \n\n\n\nthis increases the risk of drug-drug interactions and in turn \n\n\n\nincreases patients\u2019 health risks. Pharmacists are recommended \n\n\n\nto actively participate in prevention of drug-drug interactions \n\n\n\nby involving in medication reconciliation to reduce \n\n\n\ninappropriate and unnecessary drug prescribing. \n\n\n\n\n\n\n\nCONFLICT OF INTEREST \n\n\n\n\n\n\n\nThe authors declare no conflict of interest. \n\n\n\n\n\n\n\nREFERENCES  \n \n\n\n\n1. Williams, G. H., & Young, W. F. 2013. Dyslipidemia. Retrieved from \n\n\n\nHormone Health Network website: (online). \n\n\n\nhttps://www.hormone.org/diseases-and-conditions/heart-health-and-\nmetabolism/dyslipidemia (last accessed 30th September 2018).  \n\n\n\n2. Ministry of Health Malaysia. National Health & Morbidity Survey \n\n\n\n2015. Kuala Lumpur, Malaysia: Institue for Public Health, Ministry \nof Health, Malaysia. 2015. \n\n\n\n3. Academy of Managed Care Pharmacy. 2009. Drug Utilization Review. \n\n\n\n(online). \n\n\n\nhttp://www.amcp.org/WorkArea/DownloadAsset.aspx?id=9296 (last \n\n\n\naccessed 17th December 2017). \n4. Goff, D. C., et al. 2006. Dyslipidemia Prevalence, Treatment, and \n\n\n\nControl in the Multi-Ethnic Study of Atherosclerosis (MESA). \n\n\n\nCirculation, 113(5), 647-656. \ndoi:10.1161/CIRCULATIONAHA.105.552737 \n\n\n\n5. Taylor, H. A. et al. 2009. Dyslipidemia and the Treatment of Lipid \n\n\n\nDisorders in African Americans. The American Journal of Medicine, \n122(5), 454-463. doi:10.1016/j.amjmed.2008.09.049 \n\n\n\n6. Cai, L., et al. 2012. Prevalence, Awareness, Treatment, and Control of \n\n\n\nDyslipidemia among Adults in Beijing, China. Journal of \nAtherosclerosis and Thrombosis, 19(2), 159-168.  \n\n\n\n7. Barakat, L., et al. 2013. Comparison of Efficacy and Safety of \n\n\n\nRosuvastatin, Atorvastatin and Pravastatin among Dyslipidemic \nDiabetic Patients. International Scholarly Research Notices (ISRN) \n\n\n\nPharmacology, 2013, 7. doi:http://dx.doi.org/10.1155/2013/146579 \n\n\n\n8. Mould-Quevedo, J. n. F., et al. 2014. Cost-Effectiveness Analysis of \n\n\n\nAtorvastatin versus Rosuvastatin in Primary and Secondary \n\n\n\nCardiovascular Prevention Populations in Brazil and Columbia. Value \n\n\n\nin Health Regional Issues, 5(2), 48-57. \ndoi:http://dx.doi.org/10.1016/j.vhri.2014.07.007 \n\n\n\n9. The National Institute for Health and Care Exellence Guideline \n\n\n\n(NICE). 2018. Multimorbidity and polypharmacy. (online). \nhttps://www.nice.org.uk/advice/ktt18/chapter/evidence-context (last \n\n\n\naccessed 29th September 2017). \n\n\n\n10. World Health Organization. 2017. Definition and General \nConsiderations. (online). \n\n\n\nhttps://www.whocc.no/ddd/definition_and_general_considera/ (last \n\n\n\naccessed 16th November 2017). \n11. Kwon, Y. J., et al. (2016). High-risk drinking is associated with \n\n\n\ndyslipidemia in a different way, based on the 2010\u20132012 KNHANES. \n\n\n\nClinica Chimica Acta, 456, 170-175. \n12. Ministry of Health Malaysia. 2014. Malaysian Statistics On \n\n\n\nMedicines 2009 & 2010. Petaling Jaya: Ministry of Health Malaysia. \n\n\n\n13. Clark, M. A. et al. 2012. Lippincott\u2019s Illustrated Reviews: \n\n\n\nPharmacology (Vol. 5). Philadelphia: Lippincott Williams & \n\n\n\nWilkins. \n \n\n\n\n \n\n\n\n\n\n"
"\n\nMalaysian Journal of Pharmacy Volume 6 Issue 1 December 2020 \n \n\n\n\ni \n\n\n\n\n\n\n\n \n1School of Pharmaceutical Sciences Universiti Sains Malaysia  \n2PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nMessage to the readers \n \n\n\n\nWelcome Letter for Malaysian Journal of Pharmacy new \n\n\n\nEditorial Board  \n \n\n\n\nChan Siok Yee1 and Long Chiau Ming2 \n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy (MJP) since its launch in 2001, upholds the essence of knowledge and experience \n\n\n\ndissemination of regional pharmaceutical related research and sciences. With Dr Yew Su Fong as the founding Editor \n\n\n\nin Chief, a few journal issues were published and in year 2008 the torch was passed on to the successor, Professor Dr \n\n\n\nMohd Baidi Bahari. Under the helm of Prof Baidi, valuable research findings by respective hospitals in Malaysia were \n\n\n\npublished, some disseminated in the form of conference proceeding and abstract. Gradually, MJP has become a \n\n\n\nkeystone to showcase the research findings of fellow pharmacists especially in the hospital setting which provide \n\n\n\npublications that are both informative and impactful, highlighting matters that of high value to the profession. In recent \n\n\n\nyears, the journal\u2019s management and structure grow and improve, along with its appointment of the journal\u2019s immediate \n\n\n\npast Editor in Chief, Associate Professor Dr Asrul Asrul Akmal Shafie that strengthened the workflow of the journal. \n\n\n\nIn term of operation, the way forward for MJP is to keep abreast with the latest trend and technology advancement.  \n\n\n\nWeb-based automated submission system, digital object identifier (DOI), citation tracking are the crucial features to be \n\n\n\nimplemented to encourage article submission to MJP. Given a chance to lead MJP, we would like to take a moment to \n\n\n\nintroduce the revamped structure of our editorial board. The newly assembled board comprises of registered pharmacist \n\n\n\nfrom different disciplines of pharmacy whom either a well cited researcher or highly experienced practising pharmacist. \n\n\n\nTo name a few, Professor Habibah A Wahab, Dean of School of Pharmaceutical Sciences of Universiti Sains Malaysia \n\n\n\n(USM), Professor Mohd Cairul Iqbal Mohd Amin, Deputy Director of Ministry of Higher of Education, Professor \n\n\n\nWong Ting Wui and Associate Professor Dr Asrul Asrul Akmal Shafie who are among the high cited researchers in \n\n\n\ntheir research field. Advisors are included in the structure of our editorial board who are entrusted to advise the Board \n\n\n\non strategic planning and progress of the journal. Advisors include Emeritus Professor Yuen Kah Hay and Emeritus, \n\n\n\nProfessor Dr Paraidathathu Thomas, former Editor in Chief Professor Dr Mohd Baidi Bahari, international renown \n\n\n\nresearcher Dr Sheng Qi and Associate Professor Alberto Berardi. This local and international advisory team is in the \n\n\n\ninterest of transparency, good governance and render the decision-making process to independent scrutiny. Besides, \n\n\n\nthe Board serves on the principle of autonomy and impartiality, to ensure the article published in this MJP is of high \n\n\n\nquality and non-bias. As far as the journal is concerned, the editorial board of MJP have the right to reject manuscript \n\n\n\nthat is deemed not appropriate or unqualified without influence, fear, or favour.  \n\n\n\nMJP is a peer-reviewed publication with an aim to publish content covers all aspects of pharmacist in Malaysia and \n\n\n\nbeyond. It solicits manuscripts across different areas as long as it brings benefit to the growth of pharmacy profession \n\n\n\nas a whole. The scope of the journal includes research performed clinically, community, lab-based, social \n\n\n\nadministrative based, Pharmacy Education as well as industrial related. Relevant contents from academicians, \n\n\n\npharmacy student (final year projects), pharmaceutical industrial research, as well as the mandatory research by \n\n\n\nprovisionally registered pharmacy (PRP) are also welcome. Special Issue may also be considered for current hot topic. \n\n\n\nWe envisage that MJP will serve as a platform to educate, motivate and help the author as well as readers to better \n\n\n\nserve as a pharmacist.\n\n\n\n \n\n\n\n\n\n"
"\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n336 \n \n\n\n\nCalculated 10 Years Risk of CHD: Primary Preventive Measures in Medical Ward PPUKM \n\n\n\n(University Kebangsaan Malaysia Medical Centre) \n\n\n\nSemira Abdi Beshir \n1\n, Rosnani Hashim\n\n\n\n1 \n\n\n\n\n\n\n\nDepartment of Clinical Pharmacy, Faculty of Pharmacy, Cyberjaya University College of Medical Sciences. \n\n\n\n\n\n\n\nCorresponding Author: Mrs.Semira Abdi, email semiraabdi@gmail.com \n\n\n\n\n\n\n\nABSTRACT \n\n\n\nCoronary heart disease (CHD) is the leading cause of morbidity and mortality globally. Identification of \n\n\n\ncommon risk factors and risk stratification helps to prioritize primary preventive measures and hence can \n\n\n\nreduce this epidemic. This retrospective cross sectional study was carried out to assess the primary preventive \n\n\n\nmeasures according to 10 years CHD risk stratification. One hundred thirty (67 female and 63 female) middle \n\n\n\naged (40-65 years) patients admitted to PPUKM\u2019s medical ward with no prior diagnosis of CHD were \n\n\n\nselected. Patient diagnosed with diabetes or hypertension related to pregnancy was excluded. The patients\u2019 \n\n\n\nmedical record and order management system (OMS) were screened to obtain relevant demographic \n\n\n\ninformation, medical and medication history and related laboratory results. The Joint British Societies CHD \n\n\n\nrisk prediction chart was used to calculate the 10 years CHD risk. Gender specific differences of 10 years \n\n\n\ncalculated CHD risk, baseline measure of BP, cholesterol, weight, BMI, HbA1C level and number of patients \n\n\n\nwho received primary preventive measures were used as outcome measures. Results showed that male patients \n\n\n\nhad a significantly higher 10 years CHD risk than female (P < 0.05). Hypertension was the most prevalent risk \n\n\n\nfactor followed by diabetes and dyslipidemia. About10% (n=6) of hypertensive patients with SBP\u2265160 mmHg \n\n\n\nand 32 (37%) diabetic patients did not receive antihypertensive therapy and lipid lowering therapy \n\n\n\nrespectively. Hence, there is a need for further improvement in primary preventive measures for CHD. \n\n\n\n\n\n\n\nKey words: Coronary heart disease, risk factors, primary prevention, Joint British Risk prediction chart, 10 \n\n\n\nyears CHD risk  \n\n\n\n Malaysian Journal of Pharmacy  Vol. 1 issue 9, 2011, pg 336 - 344 \n\n\n\n\n\n\n\n\n\n\n\nINTRODUCTION \n\n\n\n\n\n\n\nCHD is the principal cause of morbidity and \n\n\n\nmortality in many countries world-wide. WHO \n\n\n\n(2001) estimated that by the year 2020, it will be \n\n\n\nthe single largest cause of disease burden globally. \n\n\n\nAccording to department of statistics of Malaysia, \n\n\n\nCHD is among the three leading cause of \n\n\n\nmedically certified death in Malaysia. National \n\n\n\nheart association of Malaysia (2009) estimated that \n\n\n\nCHD afflicted 141 persons/100,000 populations \n\n\n\neach year.  \n\n\n\n\n\n\n\nRisk factors for CHD which are defined and \n\n\n\nconfirmed by the Framingham study conducted by \n\n\n\nGordon et al. (1977) and other interventional trials \n\n\n\ninclude, male gender, advanced age, family history \n\n\n\nof early heart disease, cigarette smoking, high \n\n\n\nblood pressure, high blood cholesterol, being \n\n\n\noverweight, physical inactivity, and diabetes. \n\n\n\nHowever, these studies were conducted \n\n\n\npredominantly on Caucasian and migrant Asian \n\n\n\npopulations. Recently there is a growing interest to \n\n\n\nexamine the impact and role of established risk \n\n\n\nfactors of CHD on Asian population in times of \n\n\n\neconomic advancement and modernization in Asia \n\n\n\n(Jeannette et al 2001).\n \n\n\n\nGlobal risk assessment is an approach to CHD \n\n\n\nprevention that estimates the absolute risk based \n\n\n\non the summation of risks contributed by each risk \n\n\n\nfactor. The risk factors do not add their effects in a \n\n\n\nsimple way. Rather, they multiply each other's \n\n\n\neffects. Although not all risk factors are \n\n\n\nmodifiable, all can contribute to the risk \n\n\n\nassessment, and the intensity of risk factor \n\n\n\nmanagement can be adjusted according to the \n\n\n\nseverity of the overall risk. \n\n\n\n\n\n\n\nPrimary prevention of CHD requires modification \n\n\n\nof risk factors or prevention of their development \n\n\n\nwith the aim of delaying or preventing new-onset \n\n\n\nCHD.  The National Cholesterol Education Program \n\n\n\n\nmailto:semiraabdi@gmail.com\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n337 \n \n\n\n\nAdult Treatment Panel guidelines (NCEP ATP III) \n\n\n\nprovide recommendations for CHD prevention, \n\n\n\nfocusing on lipid lowering by adjusting the\n \nintensity \n\n\n\nof cholesterol lowering therapy with absolute risk. \n\n\n\nAs indicated in the report by joint national \n\n\n\ncommittee (1993), the National High Blood \n\n\n\nPressure Education Program (NHBPEP) has set \n\n\n\nforth a parallel approach for blood pressure control. \n\n\n\nIn contrast to the NCEP, however, earlier NHBPEP \n\n\n\nreports did not match the intensity of therapy to \n\n\n\nabsolute risk for CHD. \"Normalization\" of blood \n\n\n\npressure is the essential goal of therapy regardless \n\n\n\nof risk status. \n\n\n\n\n\n\n\nThis study was set to determine the occurrence of \n\n\n\ncommon risk factors and global assessment of \n\n\n\nthese risk factors to examine the extent of primary \n\n\n\npreventive measures based on the risk stratification \n\n\n\nand furthermore, it looked into the trends of \n\n\n\nprescribing for antihypertensive and lipid lowering \n\n\n\nagents for primary prevention of CHD. \n\n\n\n\n\n\n\nMETHODS \n\n\n\n\n\n\n\nThis is a retrospective, cross-sectional survey that \n\n\n\nincluded conveniently sampled participants \n\n\n\nadmitted to medical ward of PPUKM between the \n\n\n\nyear 2007 and 2008.  Patients\u2019 information about \n\n\n\ntheir age, sex, race, medical condition, medication \n\n\n\nhistory and related laboratory results were \n\n\n\nobtained from patients\u2019 medical record and the \n\n\n\norder management system (OMS). \n\n\n\n\n\n\n\nThe study utilized the Joint British Societies (JBS) \n\n\n\nCHD risk prediction charts to calculate the 10 \n\n\n\nyears CHD risk. The British risk prediction chart is \n\n\n\nsuperior to other risk assessment methods because \n\n\n\nit directly plots the Framingham function for a \n\n\n\ngiven level of absolute CHD risk resulting in more \n\n\n\naccurate value. Furthermore, this method \n\n\n\nrepresents the Framingham data more \n\n\n\nappropriately than other charts since it stratifies the \n\n\n\nCHD risk into three categories (<15% (green \n\n\n\nband), 15-30% (orange band) and >30% (red \n\n\n\nband)). \n\n\n\n\n\n\n\nThe study included patients between 40 and 65 \n\n\n\nyears of age without a prior diagnosis of CHD. \n\n\n\nThe patients < 40 years of age are not recruited for \n\n\n\nthe study since JBS cannot be used to accurately \n\n\n\npredict the CHD risk in this age group. Patients \n\n\n\nwith diabetes or hypertension related to pregnancy \n\n\n\nare excluded. Missing values were considered as \n\n\n\nabsent (zero). Subjects were considered smokers if \n\n\n\nthey were reported as smokers regardless of the \n\n\n\nnumber of cigarettes they smoke daily and they are \n\n\n\nconsidered as previous smokers if they stopped \n\n\n\nsmoking for at least 6 months (Larabie 2005). \n\n\n\n\n\n\n\nHypercholesterolemia is defined according to the \n\n\n\ncategories indicated on the NCEP ATPIII \n\n\n\nguidelines. Patients having \u2265 30 kg/m\n2\n body mass\n\n\n\n\n\n\n\nindex (BMI) were considered obese. Respondents \n\n\n\nwere considered to have diabetes if they were \n\n\n\nreported to be diagnosed with diabetes in past year, \n\n\n\nor have a blood sugar level greater than or equal to \n\n\n\n126 mg/dL or if were prescribed with oral \n\n\n\nhypoglycaemic agent or insulin. Hypertension was \n\n\n\nconsidered present if respondents had a reported \n\n\n\nhigh blood pressure (SBP \u2265 140 mm Hg and DBP \n\n\n\n\u226590 mm Hg) on two or more occasions or if they \n\n\n\nwere ever prescribed medication to lower their \n\n\n\nblood pressure. Family history was considered \n\n\n\npresent if the record indicated diagnosis of CHD or \n\n\n\nstroke (TIA) in first degree relatives regardless of \n\n\n\nage of onset.  \n\n\n\n\n\n\n\nOUTCOME MEASURES \n\n\n\n\n\n\n\nThe outcome measures include baseline measure \n\n\n\nof BP, cholesterol, weight, BMI, HbA1C level, 10 \n\n\n\nyears calculated risk of CHD, and proportion of \n\n\n\npatients who received primary preventive \n\n\n\nmeasures, trends of prescribing for primary \n\n\n\nprevention. \n\n\n\n\n\n\n\nSTATISTICAL ANALYSES \n\n\n\n\n\n\n\nAnalyses were performed using SPSS version 15.0 \n\n\n\nfor window. Descriptive statistics was used to \n\n\n\ncharacterize respondents, chi-square tests to assess \n\n\n\ndifferences in proportions, and the student t test to \n\n\n\nassess differences in means. The difference is \n\n\n\nconsidered significant for a statistical P value of P \n\n\n\n< 0.05. \n\n\n\n\n\n\n\nRESULTS \n\n\n\n\n\n\n\nA total of 200 patients medical records were \n\n\n\nscreened for this study and 130 (67 female and 63 \n\n\n\nmale) patients were included based on the \n\n\n\ninclusion criteria. Malays accounted for 53% \n\n\n\n(n=69) of the population studied (n=130) while the \n\n\n\nremaining 47% were Chinese (n=47, 36%), \n\n\n\nIndians (n=13, 10%) and other races (n=1, 1%). \n\n\n\n\n\n\n\nThe (mean \u00b1 SD) age and weight of the study \n\n\n\npopulation was 55.54 \u00b1 6.764 years and 66.0 \u00b1 \n\n\n\n13.08kg. The BMI was calculated for 105 patients, \n\n\n\n17% (n=18) were found to obese (BMI \u2265 \n\n\n\n30kg/m2) and 27% (n=28) were overweight (BMI \n\n\n\nbetween 25-30 kg / m\n2\n). \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n338 \n \n\n\n\n\n\n\n\nA total of 23.8% (n=31) of the subjects were \n\n\n\ncurrent smokers and 27 (20.7%) subjects had \n\n\n\nstopped smoking in the previous 6 months to 3 \n\n\n\nyears. \n\n\n\nThe difference for measured baseline TC, HDL-C, \n\n\n\nLDL-C and SBP between male and female was not \n\n\n\nsignificant (P > 0.05). Similarly there was no \n\n\n\nsignificant difference between different races with \n\n\n\nregard to calculated 10 years CHD risk. The  \n\n\n\ncalculated 10 years CHD risk differed significantly \n\n\n\nbetween male and female subjects at  level of \n\n\n\nt(128) =2.106, P < 0.05 (Table 1).  \n\n\n\n\n\n\n\nFamily history record was not found for 23 % of \n\n\n\nthe study population. For those with family history \n\n\n\nrecords, 63.85% did not have any history of CHD, \n\n\n\nwhile 13.08% were indicated to have family \n\n\n\nhistory of CHD.  \n\n\n\n\n\n\n\nHypertension is the most common risk factor in \n\n\n\nthis study population and  25.6% (32) of the \n\n\n\npatients were treated with monotherapy while dual \n\n\n\ntherapy and multiple drug therapy (\u22653drugs) was \n\n\n\ngiven to 35% (42) and 24% (29) of the patients \n\n\n\ncorrespondingly. Conversly, 15% (n=13) of \n\n\n\npatients did not receive any drug for the \n\n\n\nmanagement of their high blood pressure. \n\n\n\n\n\n\n\n\n\n\n\nTable 1.  Gender Specific Differences in Weight, BP, Cholesterol and Calculated 10 Years CHD Risk. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nParameters Mean \u00b1 SD P value \n\n\n\nMale Female \n\n\n\n\n\n\n\n\n\n\n\nWeight \n\n\n\n\n\n\n\n\n\n\n\n68.58kg \u00b1 12.89 \n\n\n\n\n\n\n\n63.58 kg \u00b1 12.89 \n\n\n\n\n\n\n\nHDL-C \n\n\n\n\n\n\n\n55.33 mg/dL \u00b1 30.37 49.90mg/dL \u00b1 27.29 0.5 \n\n\n\nTC \n\n\n\n\n\n\n\n192.2 mg/dL \u00b1 53.34 197.69mg/dL \u00b1 65.57 0.59 \n\n\n\nLDL-C \n\n\n\n\n\n\n\n109.68mg/dL \u00b1 42.66 120.50mg/dL \u00b1 50.43 0.19 \n\n\n\nSystolic blood pressure \n\n\n\n\n\n\n\n155.20mmHg \u00b1 31.2 162.5mmHg \u00b1 26.47 0.16 \n\n\n\n10 years calculated risk of CHD \n\n\n\n\n\n\n\n18.8%  \u00b1 10.87 15.22% \u00b1 8.56 0.037* \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n339 \n \n\n\n\nFigure 1. Distribution of CHD risk factors among the population \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nTable 2. Demographic Characteristics of Respondents According to Risk Stratification \n\n\n\n\n\n\n\nDemographic \n\n\n\ncharacteristics \n\n\n\n\n\n\n\n Risk stratification \n\n\n\n<15% 15-30% >30% \n\n\n\nMale \n\n\n\nFemale \n\n\n\n25 \n\n\n\n37 \n\n\n\n26 \n\n\n\n27 \n\n\n\n12 \n\n\n\n3 \n\n\n\nMalay \n\n\n\nChinese \n\n\n\nIndian \n\n\n\nOthers \n\n\n\n31 \n\n\n\n23 \n\n\n\n7 \n\n\n\n1 \n\n\n\n30 \n\n\n\n19 \n\n\n\n4 \n\n\n\n0 \n\n\n\n8 \n\n\n\n5 \n\n\n\n2 \n\n\n\n0 \n\n\n\n\n\n\n\n\n\n\n\nDISCUSSION \n\n\n\n\n\n\n\n\n\n\n\nThe findings of the study showed that 52 % (n=68) \n\n\n\nof the population have a 10 years CHD risk greater \n\n\n\nthan or equal to 15% according to the JBS CHD \n\n\n\nprediction chart risk category. \n\n\n\n\n\n\n\nThe 10-year risk stratification for CHD provide \n\n\n\nguidance for prioritizing primary prevention \n\n\n\nmeasures of CHD.  The remaining 48 % (n=62) \n\n\n\nwere found to have low absolute risk (10 years \n\n\n\nCHD risk < 15%). Low absolute risk particularly \n\n\n\namong young adults does not ensure a lifetime of \n\n\n\nlow risk because the number and severity of \n\n\n\nmetabolic risk factors worsen with aging. Hence \n\n\n\nperiodic monitoring is needed to assess the \n\n\n\nchanges in risk status over time. \n\n\n\n\n\n\n\nAlthough JBS risk prediction chart is a valuable \n\n\n\ntool in predicting CHD risk, it has some \n\n\n\nlimitations. This arises from the fact that the \n\n\n\nscoring system is derived from Framingham heart \n\n\n\nstudy participants which differ from the subjects \n\n\n\nconsidered in this study by their geographical \n\n\n\nlocation and ethnic group. However, an advantage \n\n\n\nof using JBS is that it suggests priorities for \n\n\n\ninstituting primary prevention strategies. \n\n\n\n\n\n\n\nThis study comprises of patients between 40-65 \n\n\n\nyears of age which could benefit greatly from the \n\n\n\nprimary preventive measures.  \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n340 \n \n\n\n\n\n\n\n\n\n\n\n\nFigure 2. Number of Patients Who Received Anti Hypertensive Therapy Versus The Systolic Blood \n\n\n\nPressure \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nFigure 3. Use of Lipid Lowering Therapy According to Risk Stratification \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n31 \n\n\n\n28 \n\n\n\n13 \n\n\n\n31 \n\n\n\n25 \n\n\n\n2 \n\n\n\n0\n\n\n\n5\n\n\n\n10\n\n\n\n15\n\n\n\n20\n\n\n\n25\n\n\n\n30\n\n\n\n35\n\n\n\n<15% 15-30% >30%\n\n\n\nN\nu\n\n\n\nm\nb\n\n\n\ner\n o\n\n\n\nf \n p\n\n\n\nat\nie\n\n\n\nn\nts\n\n\n\n\n\n\n\n10 years CHD risk \n\n\n\nReceived lipid\nlowering therapy\n\n\n\nReceived no lipid\nlowering therapy\n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n341 \n \n\n\n\nTable 4. Total Cholesterol Range-Diabetes-Lipid Lowering Therapy Cross Tabulation \n\n\n\nLipid lowering \n\n\n\ntherapy \n\n\n\n\n\n\n\nTotal cholesterol \n\n\n\nrange \n\n\n\nDiabetes Total \n\n\n\n\n\n\n\nGiven  \n\n\n\n  Diabetes No Diabetes  \n\n\n\nTC Range  < 200 23 7 30 \n\n\n\n200-239 16 6 22 \n\n\n\n\u2265 240 15 5 20 \n\n\n\n  Total 54 18 72 \n\n\n\nNot given  TC Range  < 200 24 16 40 \n\n\n\n200-239 7 9 16 \n\n\n\n\u2265 240 1 1 2 \n\n\n\n  Total 32 26 58 \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nFigure 4. Use of Aspirin According to Risk Stratification \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nThe number of female subjects in the study is \n\n\n\nhigher than male subjects, because male subjects \n\n\n\nhave higher chance of being diagnosed with CHD \n\n\n\nthan females in this age group. As reported by \n\n\n\nParanjape et al. (2005) women in the age group of \n\n\n\n20\u201350 are shown to have much less susceptibility \n\n\n\nto coronary heart disease and other atherosclerotic \n\n\n\ndiseases as compared to men. The findings of this \n\n\n\nstudy  \n\n\n\n\n\n\n\nalso showed significantly higher calculated 10 \n\n\n\nyears risk of CHD for male than female         (P < \n\n\n\n0.05).  There is no statistical difference between \n\n\n\nthe different sexes and races with regard to risk \n\n\n\nstratification (Table 2).  \n\n\n\nAccording to the Framingham Heart Study, obesity \n\n\n\nincreases an individual's risk of CHD by 104 \n\n\n\npercent. This is because obesity raises blood \n\n\n\ncholesterol and triglyceride levels, and reduces \n\n\n\nHDL levels which lead to more plaque build up in \n\n\n\nthe arteries. Obesity increases blood pressure and \n\n\n\ncan lead to diabetes. A total 17% of the subjects \n\n\n\n(n=18) were found obese and n=28 (27%) were \n\n\n\noverweight.  As reported by Gotto (2002) and \n\n\n\nNHLBI (2005) patients who are under high risk for \n\n\n\nCHD but had BMI > 25kg/m\n2\n would require total \n\n\n\nlife style changes (TLC). \n\n\n\n0\n\n\n\n5\n\n\n\n10\n\n\n\n15\n\n\n\n20\n\n\n\n25\n\n\n\n30\n\n\n\n35\n\n\n\n40\n\n\n\n<15% 15-30% >30%\n\n\n\n22 \n\n\n\n27 \n\n\n\n12 \n\n\n\n40 \n\n\n\n26 \n\n\n\n3 \n\n\n\nN\nu\n\n\n\nm\nb\n\n\n\ne\nr \n\n\n\no\nf \n\n\n\np\nat\n\n\n\nie\nn\n\n\n\nts\n \n\n\n\n10 years CHD risk \n\n\n\nReceived aspirin\n\n\n\nReceive no\naspirin\n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n342 \n \n\n\n\nEzzati et al. (2005) reported that smoking \n\n\n\ncontributes to high prevalence rate in CHD \n\n\n\nmortality and is mostly related to men in all \n\n\n\nregions and it. Similarly in this study, 92.5% \n\n\n\n(n=25) of the smokers in the study were male \n\n\n\n(Figure 1). Rapid reversal of CHD mortality is \n\n\n\nobserved epidemiologically after smoking \n\n\n\ncessation, even in patients with established CHD. \n\n\n\nThomson & Rigotti (2003) recommended to give \n\n\n\ndue emphasis to efforts to reduce smoking \n\n\n\nprevalence. \n\n\n\nIn this study, 90% subjects were having \n\n\n\nhypertension (Figure 1) and according to the study \n\n\n\ndone by Lee et al. (2000) in Singapore to compare \n\n\n\nthe relatively different contributions of risk factors \n\n\n\nto the risk of CHD between Asians and Caucasians \n\n\n\nshowed that hypertension is the most important \n\n\n\nrisk factor for CHD in Asians. \n\n\n\nOut of 117 hypertensive patients in this study, 88% \n\n\n\n(n=100) received antihypertensive therapy. \n\n\n\nAccording to the Joint British recommendations on \n\n\n\nprevention of CHD, life style advice and drug \n\n\n\ntreatment should be given for a patient with SBP is \n\n\n\n\u2265 160 mmHg or DBP \u2265 100 mmHg, regardless of \n\n\n\nabsolute CHD risk. In this study 10% (n=6) of the \n\n\n\nsubjects with SBP \u2265 160 were not on any \n\n\n\nmedication (Figure 2). \n\n\n\nAs indicated by Benner et al. (2001), large \n\n\n\nprospective randomized trials have confirmed the \n\n\n\nimportance of blood pressure control in reduction \n\n\n\nof cardiovascular mortality and morbidity, \n\n\n\nirrespective of the class drugs used.  \n\n\n\nDiabetes too increases the risk of developing \n\n\n\nCHD. ATP III indicated that most patients with \n\n\n\ndiabetes are at high risk even in the absence of \n\n\n\nestablished CHD. For effective CHD prevention it \n\n\n\nis recommended that optimal glycaemic control \n\n\n\nshould be reached (HbA1c< 7%). Results from this \n\n\n\nstudy showed that subjects had a significantly \n\n\n\ndifferent HbA1c level (t (87) =3.387, P< 0.05) \n\n\n\nfrom the target level and the majority of subjects \n\n\n\nwere having HbA1c level greater than 7 %.  \n\n\n\nA study by Hu et al. (2001) shows that type II \n\n\n\ndiabetics have the same cardiovascular risk as non-\n\n\n\ndiabetics post myocardial infarction, suggesting a \n\n\n\nstrong case for all patients with type II diabetes to \n\n\n\nreceive cholesterol lowering therapy. \n\n\n\nThe findings of this study showed a significant \n\n\n\nassociation between diabetes and lipid lowering \n\n\n\ntherapy use (P < 0.05). Among diabetic patients, \n\n\n\n62%, (n=54) received lipid lowering agent. On the \n\n\n\ncontrary, 37% (n=32) of the diabetic subjects did \n\n\n\nnot obtain any lipid lowering agent. Only 3% \n\n\n\n(n=1) of these patients had TC \u2265 240mg/dL while \n\n\n\n22% (n=7) and 75% (n=24) had a borderline TC \n\n\n\n(200-239 mg/dL) and desirable TC (< 200mg/dL) \n\n\n\nrespectively (Table 4).  \n\n\n\nDyslipidemia is the third prevalent risk factor after \n\n\n\nhypertension and diabetes occurring in 46.2% (60) \n\n\n\nof the subjects. Lipid lowering therapy was given \n\n\n\nto 87%, 53% and 50% of subjects with 10 years \n\n\n\nrisk of CHD > 30%, 15-30 % and < 15% \n\n\n\nrespectively. The Joint British guideline \n\n\n\nrecommended all patients with 10 years CHD risk \n\n\n\n\u226515% should receive lipid lowering therapy. \n\n\n\n\n\n\n\nLaw et al. (2003) reported that lipid lowering \n\n\n\ntherapy (statin) is effective in decreasing coronary \n\n\n\nheart disease (CHD) and stroke risk, both in \n\n\n\nprimary and in secondary prevention. \n\n\n\nThe benefit of treatment with a statin is observed \n\n\n\namong people with annual levels of risk as low as \n\n\n\n1%. Heart Protection Study Collaborative Group \n\n\n\n(2005) suggest that even at this level of risk statin \n\n\n\ntreatment is cost effective within the terms of \n\n\n\nreference applied to other medical treatment.  \n\n\n\nAspirin uses for primary prevention have been \n\n\n\nevaluated in three major meta-analysis conducted \n\n\n\nby Hyden et al (2005), Sanmuganathan et al. \n\n\n\n(2001) and Ridker et al (2005). The use of aspirin \n\n\n\nfor the primary prevention of CHD was reported to \n\n\n\nbe beneficial among patients with high \n\n\n\ncardiovascular risk. Furthermore De Backer et al. \n\n\n\n(2003) recommends aspirin for primary prevention \n\n\n\nin adults with diabetes or well-controlled \n\n\n\nhypertension and in men at high risk > 20%. \n\n\n\nHowever the benefits of aspirin in patients with \n\n\n\nlower risk remains controversial. \n\n\n\nIn this study, aspirin use increased with increase in \n\n\n\n10-year CHD risk level (Table 6). The association \n\n\n\nof the risk level with use of aspirin was statistically \n\n\n\nsignificant; (X\n2\n=10.19, df= 2, P < 0.05).  \n\n\n\nMoreover, use of aspirin is strongly associated \n\n\n\nwith presence of diabetes (X\n2\n=4.397, df= 1, P < \n\n\n\n0.05) and dyslipidemia.  \n\n\n\nCONCLUSION \n\n\n\nRisk factor modification is crucial to reduce the \n\n\n\nmorbidity and mortality related to CHD. This \n\n\n\nstudy reveals that the most prevalent risk factor for \n\n\n\nCHD was hypertension and this may be attributed \n\n\n\nto healthcare factors including under diagnosis or \n\n\n\ninadequate control of previously diagnosed \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n343 \n \n\n\n\nhypertension. Primary prevention measures are \n\n\n\nhighly recommended for those with higher risk \n\n\n\ngroups for each risk factors modulated. However, \n\n\n\nnot all treatment eligible patients received primary \n\n\n\npreventive measures as observed in this study. \n\n\n\nTherefore, future evaluation into the reason for \n\n\n\nsuboptimal primary prevention practice is required \n\n\n\nto improve the management practice.  \n\n\n\n\n\n\n\nACKNOWLEDGMENT \n\n\n\n\n\n\n\nThe authors would like to acknowledge the \n\n\n\nmedical ward staff of HUKM and record room \n\n\n\npersonnel for their invaluable assistance\n\n\n\n. \n\n\n\n\n\n\n\n\n\n\n\nREFERENCES  \n\n\n\n1. World Health Organization. The World Health Report 2001: Making a Difference. Geneva: WHO.  \n\n\n\n2. National Heart Association of Malaysia (NHAM).2009.Heart Disease Top Killer in Government \n\n\n\nHospitals.www.malaysianheart.org/article.php?aid=42. \n\n\n\n3. Gordon T, Castelli WP, Hjortland MC, Kannel WB, Dawber TR. Predicting coronary heart disease in \n\n\n\nmiddle-aged and older persons: the Framingham study. JAMA. 1977;238: 497-499. \n\n\n\n4. Ho JE, Paultre F. & Lori M. 2005. The gender gap in Coronary Heart Disease Mortality: Is there a \n\n\n\ndifference between Blacks and Whites? Journal of Womens Health 2(14):117-127. \n\n\n\n5. Jeannette L, Derrick H, Kee SC, Suok KC, Bee YT & Kenneth H. 2001. Risk factors and incident \n\n\n\ncoronary heart disease in Chinese, Malay and Asian Indian males: the Singapore Cardiovascular Cohort \n\n\n\nStudy. Int J Epidemiol 30:983-988. \n\n\n\n6. NCEP. 2001. Executive Summary of the Third Report of the National Cholesterol Education Program \n\n\n\nExpert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult \n\n\n\nTreatment Panel III). JAMA 285:2486\u20132497. \n\n\n\n7. Joint National Committee. The Fifth Report of the Joint National Committee on Detection, Evaluation, \n\n\n\nand Treatment of High Blood Pressure. Bethesda, Md: National Heart, Lung, and Blood Institute; \n\n\n\n1993:49. NIH publication. 93\u20131088. \n\n\n\n8. 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Estrogen protection against coronary \n\n\n\nheart disease: Are the relevant effects of estrogen mediated through its effects on uterus \u2013 such as the \n\n\n\ninduction of menstruation, increased bleeding, and the facilitation of pregnancy? Medical Hypotheses \n\n\n\n65(4): 725-727. \n\n\n\n13. Ezzati, M., Henley, S.J., Thun MJ. & Lopez AD. 2005. Role of smoking in global and regional \n\n\n\ncardiovascular mortality. Circulation 112(4):489-497. \n\n\n\n14. Thomson CC & Rigotti NA 2003. Hospital and Clinic Based Smoking Cessation Interventions for \n\n\n\nSmokers with Cardiovascular Disease. Progress in Cardiov Dis 45(6):459-479. \n\n\n\n15. Lee WL, Chepung  AM, Cape D, & Zinman B. 2000. Impact of diabetes on coronary artery disease in \n\n\n\nwomen and men: a meta analysis of prospective studies. Diabetes Care 23:962-968. \n\n\n\n16. Brenner BM, Cooper ME, de Zeeuw D, Keane WF, Mitch, WE, Parving, H.H., Remuzzi G, Snapinn SM, \n\n\n\nZhang Z. & Shahinfar S. 2001. Effects of losartan on renal and cardiovascular outcomes in patients with \n\n\n\ntype 2 diabetes and nephropathy. RENAAL Study Investigators. N Engl J Med 345(12):861-869.  \n\n\n\n17. Nayaran P & Man AJ. 1998. Clinical pharmacology of modern antihypertensive agents and their \n\n\n\ninteraction with alpha-adrenoceptor antagonists. Br J Urol 81(1):6-16. \n\n\n\n\njavascript:AL_get(this,%20'jour',%20'Circulation.');\n\n\n\n\n\n\nMalaysian Journal of Pharmacy  Vol. 1 issue 9, 2011                                                                        Research article \n \n\n\n\n344 \n \n\n\n\n18. Verdecchia P, Reboldi G, Angeli F, Gattobigio R, Bentivoglio M, Thijs L, Staessen JA & Porcellati C. \n\n\n\n2005. Angiotensin-converting enzyme inhibitors and calcium channel blockers for coronary heart disease \n\n\n\nand stroke prevention. Hypertension. 46(2):386-92.  \n\n\n\n19. Hu FB, Stampfer MJ, Solomon, CG, Liu S, Willett WC, Speizer FE, Nathan DM & Manson JE 2001. The \n\n\n\nimpact of diabetes mellitus on mortality from all causes and coronary heart disease in women: 20 years of \n\n\n\nfollow-up. Arch Intern Med 161(14):1717-23. \n\n\n\n20. Sowers JR. 2003. Effect of statins on vascularature: implication for aggressive lipid management in \n\n\n\ncardiovascular metabolic syndro-me.  Am J Cardiol 91:14B-22B. \n\n\n\n21. Law MR, Wald NJ, Rudnicka A  R. 2003.Quantifying effect of statins on low density lipoprotein \n\n\n\ncholesterol, ischaemic heart disease, and stroke: systematic review and meta-analysis.   BMJ .326.1423\u2013\n\n\n\n1427.  \n\n\n\n22. Heart Protection Study Collaborative Group. 2005. Cost effectiveness of simvastatin in people at different \n\n\n\nlevels of vascular disease risk: economic analysis of a randomised trial in 20536 individuals. Lancet \n\n\n\n365.1779\u20131785.  \n\n\n\n23. Hayden M, Pignone M, Phillips C & Mulrow C. 2002. Aspirin for the primary prevention of \n\n\n\ncardiovascular events: a summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern \n\n\n\nMed 136:161-172. \n\n\n\n24. Sanmuganathan PS, Ghahramani, P, Jackson PR, Wallis EJ & Ramsay LE 2001. Aspirin for primary \n\n\n\nprevention of coronary heart disease: safety and absolute benefit related to coronary risk derived from \n\n\n\nmeta-analysis of randomised trials. Heart 85:265\u2013271. \n\n\n\n25. Ridker PM, Cook NR, Lee IM, Gordon D, Gaziano, JM, Manson, JAE, Hennekens CH & Buring, JE \n\n\n\n2005. A randomized trial of low-dose aspirin in the primary prevention of cardiovascular disease in \n\n\n\nwomen. N Engl J Med 352:1293\u20131304. \n\n\n\n26. De Backer, G., Ambrosioni, E., Borch-Johnsen, K., Brotons, C., Cifkova, R., Dallongeville, J., Ebrahim, \n\n\n\nS., Faergeman, O., Graham, I., Mancia, G., Cats, V.M., Orth-Gom\u00e9r, K., Perk, J., Py\u00f6r\u00e4l\u00e4, K., Rodicio, \n\n\n\nJ.L., Sans, S., Sansoy, V., Sechtem, U., Silber, S., Thomsen, T. & Wood, D. 2004. European guidelines on \n\n\n\ncardiovascular disease prevention in clinical practice. Third Joint Task Force of European and other \n\n\n\nSocieties on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of \n\n\n\neight societies and by invited experts). European Society of Cardiology. American Heart Association. \n\n\n\nAmerican College of Cardiology. Atherosclerosis 173(2):381-91. \n\n\n\n\n\n\n\n \n\n\n\n\n\n"
"\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 38 \n\n\n\nSelf-medication practices among Malaysian consumer: A questionnaire-\n\n\n\nbased study \n\n\n\nGuat See Ooi\n1\n, Chee Ping Chong*\n\n\n\n2\n, Mohd Baidi Bahari\n\n\n\n3 \n\n\n\n\n\n\n\n1\nDiscipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains \n\n\n\nMalaysia, 11800 Minden, Penang, Malaysia \n2\nLecturer, Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, \n\n\n\nUniversiti Sains Malaysia, 11800 Minden, Penang, Malaysia \n3\nProfessor, Faculty of Pharmacy, AIMST University, 08100 Bedong, Kedah, Malaysia \n\n\n\n\n\n\n\n*Corresponding author: \n\n\n\nMalaysian Journal of Pharmacy, Vol 1 Issue 10, 2012, 38 - 47                                                \n\n\n\n\n\n\n\nAbstract \n\n\n\n\n\n\n\nThis study was carried out to assess the prevalence of self-medication practice among \n\n\n\nMalaysian consumers who visit to community pharmacies. The data was collected using \n\n\n\nstructured questionnaires which were randomly distributed to 500 consumers who visited \n\n\n\nto 10 conveniently selected community pharmacies in Sungai Petani, Kedah between \n\n\n\nAugust to October 2007.  Out of the 500 questionnaire distributed, 105 responses were \n\n\n\nreceived for a response rate of 21.0%. Approximately 45% of the respondents have \n\n\n\npracticed self-medication in the preceding six months. The respondents mainly practiced \n\n\n\nself-medication for fever (35.2%), colds and flu (35.2%) and cough (31.4%). The most \n\n\n\npopular classes of medicines used by the consumers were analgesic/NSAIDs (32.4%), \n\n\n\ncold and flu medicines (23.8%) and antacids (18.1%). Only 27.6% of respondents were \n\n\n\nconfident in self-managing medications or dietary supplements.  The consumers mostly \n\n\n\nagreed that more advice on medications should be given by pharmacist (75.2%) and \n\n\n\npharmacist has high level of professionalism on medication (65.7%). The study \n\n\n\nconcluded that the practice of self-medication mostly involved management of minor \n\n\n\nailments using non-prescription and over-the-counter medicines.  \n\n\n\n\n\n\n\nKeywords: self-medication, consumer, community pharmacy, pharmacist, minor ailment \n\n\n\n\n\n\n\nIntroduction: \n\n\n\nSelf-medication is a common practice \n\n\n\namong the consumers, particularly for \n\n\n\nthose in developing countries (1). It can \n\n\n\nbe considered as the most common form \n\n\n\nof self-care in health. It is defined as the \n\n\n\nuse of a drug product for the treatment of \n\n\n\na disease or symptom or for the disease \n\n\n\nprevention or promotion of health, \n\n\n\nwithout a professional prescription (2) or \n\n\n\nobtaining and consuming medicines \n\n\n\nwithout the advice of a physician or \n\n\n\npharmacist either for diagnosis, \n\n\n\nprescription or surveillance of a \n\n\n\ntreatment (1).\n  \n\n\n\nOver the last decade, the economical, \n\n\n\npolitical, and cultural factors have \n\n\n\ncontributed to a constant increase in self-\n\n\n\nmedication worldwide, leading this \n\n\n\npractice into a major public health \n\n\n\nconcern. The huge amount of medicines \n\n\n\ncurrently available in the market does \n\n\n\nnot equate with an improvement in \n\n\n\nquality of life (2). The main concerns \n\n\n\nregarding self-medication are the risk of \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 39 \n\n\n\ninadequate use of drugs and the \n\n\n\noccurrence of side-effects and accidents \n\n\n\nrelated to this practice (2). For instance, \n\n\n\nthe use of non-prescription medications \n\n\n\nand dietary supplements by elderly \n\n\n\npatients in USA has causes concern (3). \n\n\n\nThis geriatric population uses more \n\n\n\nprescription medications and have higher \n\n\n\npotential risk of developing harmful \n\n\n\nmedication-related problems than the \n\n\n\nyounger adults. Various reports have \n\n\n\nshown that 40% to 87% of community-\n\n\n\ndwelling adults older than 65 years were \n\n\n\nusing at least one OTC product regularly \n\n\n\nand 5.7% were taking five or more non-\n\n\n\nprescription medications and/or dietary \n\n\n\nsupplements daily (3).  \n\n\n\n\n\n\n\nPatients turn to purchase medicines \n\n\n\nfrequently through drugstore sales \n\n\n\npersonnel, in an attempt to save time and \n\n\n\nmoney on a medical appointment that \n\n\n\nfails to meet their expectations (2). \n\n\n\nSeveral studies have documented that \n\n\n\ncommunity pharmacies are not the only \n\n\n\nsites where medicines are bought and \n\n\n\nsold, they are also places where \n\n\n\ninformation and advice on health \n\n\n\nproblems and treatment is sought (4). \n\n\n\nSome studies have found that it is fairly \n\n\n\nroutine for the patient to seek the advice \n\n\n\nof pharmacists and medicine shop \n\n\n\nattendants for common ailments. Such \n\n\n\nconsultations are convenient; they save \n\n\n\ntime, money and the opportunity cost of \n\n\n\nwaiting to be seen by a doctor (4).\n  \n\n\n\nSince medicines are widely used in the \n\n\n\npopulation to reduce morbidity and \n\n\n\nmortality (3), it is important to ensure \n\n\n\nthat the non-prescription medicines and \n\n\n\nOTC are used appropriately during self-\n\n\n\nmedication. The patient\u201fs self-\n\n\n\nmedication practice must be evaluated to \n\n\n\nprovide the information which enables \n\n\n\nhealth care providers to educate the \n\n\n\npatients on issues around self-\n\n\n\nmedication. In order to maximize the \n\n\n\ntherapeutic outcome and provide safe \n\n\n\nand quality medical care, a better \n\n\n\nunderstanding of the patient demand and \n\n\n\nfactors affecting patient\u201fs self-\n\n\n\nmedication practices is required. \n\n\n\nNevertheless, currently there is lack of \n\n\n\nstudy on self-medication and factors \n\n\n\ncontributing to consumer\u201fs practice of \n\n\n\nself-medication with community \n\n\n\npharmacies services in Malaysia. Thus, a \n\n\n\nstudy is warranted to investigate the \n\n\n\npractices of self-medication with \n\n\n\ncommunity pharmacies in Malaysia. \n\n\n\nConsequently, strategies and action plans \n\n\n\ncan be developed to improve the \n\n\n\ncommunity pharmacy services on the \n\n\n\nissue around consumer self-medication. \n\n\n\nTherefore, this study was carried out to \n\n\n\nobtain baseline data on self-medication \n\n\n\npractices among the Malaysian \n\n\n\nconsumers and factors influencing self-\n\n\n\nmedication. \n\n\n\n\n\n\n\nMethod \n\n\n\nThis is a cross-sectional descriptive \n\n\n\nstudy using a structured questionnaire. \n\n\n\nThe questionnaire was adapted and \n\n\n\nmodified from a survey instrument \n\n\n\nformulated by Shankar et al. (1). The \n\n\n\nquestionnaire was designed in three \n\n\n\ndifferent languages (English, Malay and \n\n\n\nMandarin) to cater for the language \n\n\n\nproficiency differences among the \n\n\n\nMalaysian consumers. The questionnaire \n\n\n\nwas initially examined by an expert for \n\n\n\nits face and content validity. \n\n\n\nSubsequently, internal consistency and \n\n\n\nreliability were tested by assigning 20 \n\n\n\ncustomers to answer the questionnaire. \n\n\n\nThe consumers consisted of Malay, \n\n\n\nChinese and Indian who visited a \n\n\n\ncommunity pharmacy in the state of \n\n\n\nPenang, Malaysia.  A Cronbach\u201fs alpha \n\n\n\nof 0.73 was obtained (value of > 0.70 is \n\n\n\nconsidered acceptable reliability).  \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 40 \n\n\n\nThis final questionnaire comprised of 5 \n\n\n\nsections. The first section contained \n\n\n\nquestions on demographic and \n\n\n\nsocioeconomic background of \n\n\n\nrespondents. The second section \n\n\n\ncontained questions on distance from \n\n\n\nresidency to nearest pharmacy, type of \n\n\n\npharmacy the respondents used to visit \n\n\n\nand frequency of visit. The third section \n\n\n\nassesses the consumer self-medication \n\n\n\npractice for the past 6 months, reason for \n\n\n\nnot consulting doctor, main use of the \n\n\n\nmedicines and main symptoms that \n\n\n\nbeing experienced. The forth section was \n\n\n\nthe details of medicine taken and \n\n\n\nmedical conditions that had been \n\n\n\nsuffered. The last section was to assess \n\n\n\nthe consumer's opinion towards self-\n\n\n\nmedication. Respondents were requested \n\n\n\nto describe the level of agreement on \n\n\n\nself-medication based on 10 statements \n\n\n\nwhich formulated in a 5-point Likert \n\n\n\nscale (1 = Strongly disagree; 2 = \n\n\n\nDisagree; 3 = Not sure; 4 = Agree; 5 = \n\n\n\nStrongly agree).  \n\n\n\n\n\n\n\nA convenient sample of 10 community \n\n\n\npharmacies in Sungai Petani city, state of \n\n\n\nKedah, Malaysia was chosen as the \n\n\n\nstudy stations. The study population \n\n\n\nconsisted of consumers who visited to \n\n\n\nthe selected pharmacies. The consumers \n\n\n\nmust be aged over 18 years and literate. \n\n\n\nA total of 500 questionnaires were sent \n\n\n\nby personal visit by the researcher (Ooi \n\n\n\nGS) to the selected pharmacies and detail \n\n\n\nexplanation had been given to the \n\n\n\npharmacists-in-charged. The \n\n\n\nquestionnaires were then randomly \n\n\n\ndistributed to the consumers who visited \n\n\n\nto the selected pharmacies by the \n\n\n\npharmacists-in-charged. The respondents \n\n\n\nwere requested to complete the \n\n\n\nquestionnaire and returned it to the \n\n\n\npharmacists before they leave the \n\n\n\npharmacy. Participation in this study was \n\n\n\nstrictly voluntary and written informed \n\n\n\nconsent was obtained from the \n\n\n\nrespondents. Once the completed \n\n\n\nquestionnaire was received, all \n\n\n\nidentifying information had been \n\n\n\nremoved to protect anonymity.  \n\n\n\n\n\n\n\nData analysis  \n\n\n\n\n\n\n\nData analysis was performed by using \n\n\n\nSPSS version 15.0. Chi-square statistic \n\n\n\nwas used to investigate differences in the \n\n\n\nconsumers' tendency to practice self-\n\n\n\nmedication between different groups of \n\n\n\nconsumers (age, gender, race, martial \n\n\n\nstatus, educational level, monthly \n\n\n\nincome and insurance coverage), based \n\n\n\non their responses to question 3A: \u201cHave \n\n\n\nyou purchased medicines of your own \n\n\n\nwithout consulting either a doctor or a \n\n\n\npharmacist in the preceding six \n\n\n\nmonths?\u201d. The sub-groups with less than \n\n\n\nten respondents were excluded from the \n\n\n\nanalysis. Odds ratio were calculated for \n\n\n\nvariables which showed significant \n\n\n\ndifferences based on Chi-square \n\n\n\nanalysis. Student t-test was used to \n\n\n\ninvestigate differences between \n\n\n\nconsumers' monthly health care \n\n\n\nexpenditure between those who practiced \n\n\n\nself-medication and those who did not \n\n\n\npractice in this way. A significant level \n\n\n\nof less than 0.05 was used for all \n\n\n\nanalytical statistic analysis.  \n\n\n\n\n\n\n\nResults \n\n\n\nDemographic characteristics \n\n\n\n Of the 500 questionnaire \n\n\n\ndistributed, 105 responses were received \n\n\n\nfor a response rate of 21.0%. The \n\n\n\nrespondents were mostly female (57.1%) \n\n\n\nand aged between 20-29 years old \n\n\n\n(31.4%). In terms of ethnicity, the \n\n\n\nmajority of the respondents were \n\n\n\nChinese (57.1%). Approximately two-\n\n\n\nthird (64.8%) of the respondents were \n\n\n\nmarried and around half (51.5%) were \n\n\n\neither graduated from primary or \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 41 \n\n\n\nsecondary school. Most of the \n\n\n\nrespondents were employed (86.7%) \n\n\n\nwith a monthly income within RM1,500-\n\n\n\nRM5,000 (47.6%). Around six out of ten \n\n\n\n(57.0%) of the respondents spent RM0-\n\n\n\nRM99 per month on health care and only \n\n\n\n7.7% spent RM300 and above (Table 1). \n\n\n\n\n\n\n\nTable 1: Demographic characteristics of the responding consumers \n\n\n\n\n\n\n\nCharacteristic n % Characteristic n % \n\n\n\nAge group   Educational level   \n\n\n\n20-29 33 31.4 Primary or secondary 54 51.5 \n\n\n\n30-39 24 22.9 Collage/Technical school 20 19.0 \n\n\n\n40-49 20 19.0 University 30 28.6 \n\n\n\n\u2265 50 28 26.6 No formal education 1 1.0 \n\n\n\n\n\n\n\nGender   Monthly income (RM)   \n\n\n\nMale 45 42.9 < 800 16 15.2 \n\n\n\nFemale 60 57.1 800-1500 20 19.0 \n\n\n\n   1500-3000 25 23.8 \n\n\n\nRace   3000-5000 25 23.8 \n\n\n\nMalay 26 24.8 > 5000 5 4.8 \n\n\n\nChinese 60 57.1 Unemployed 4 3.8 \n\n\n\nIndian 18 17.1 Retired 10 9.5 \n\n\n\nOthers 1 1.0    \n\n\n\n   Monthly health care expenditure (RM)   \n\n\n\nMarital status   0-99 60 57.0 \n\n\n\nSingle 36 34.3 100-199 24 22.9 \n\n\n\nMarried 68 64.8 200-299 13 12.4 \n\n\n\nWidowed 1 1.0 \u2265300 8 7.7 \n\n\n\n\n\n\n\n\n\n\n\nDetails of pharmacy visit \n\n\n\n Majority of the respondents \n\n\n\n(81.0%) were able to assess the nearest \n\n\n\npharmacy from residency within 15 \n\n\n\nminutes (Table 2). The respondents \n\n\n\nvisited independent pharmacy (63.8%) \n\n\n\nmore frequently than chain pharmacy \n\n\n\n(36.2%).  Most of the respondents \n\n\n\n(51.4%) visit to pharmacies once or \n\n\n\ntwice a month.  \n\n\n\n\n\n\n\nSelf-medication for the preceding six \n\n\n\nmonths \n\n\n\n Approximately 45% of the \n\n\n\nrespondents have practiced self-\n\n\n\nmedication in the preceding six months \n\n\n\n(Table 3). The purchased medicines were \n\n\n\nmainly for their own used (84.8%), \n\n\n\nfollowed by for their parents (25.7%) \n\n\n\nand children (24.8%). The respondents \n\n\n\nmainly experience fever (35.2%), colds \n\n\n\nand flu (35.2%) and cough (31.4%). \n\n\n\nAllopathic medicines (73.3%) and \n\n\n\nsupplements (67.6%) were \n\n\n\npredominantly used by the respondents. \n\n\n\nRespondents' main reasons for not \n\n\n\nconsulting a doctor including do not \n\n\n\nthink it is necessary to do so (52.4%) and \n\n\n\nfeel expensive (34.3%). Majority \n\n\n\n(95.2%) of the respondents purchased \n\n\n\ntheir medicines from pharmacy. When \n\n\n\nspecifically looking at the main use of \n\n\n\nthe purchased medicines, the \n\n\n\nrespondents mostly used it for treatment \n\n\n\n(69.5%) and health maintenance \n\n\n\n(36.2%).  \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 42 \n\n\n\nTable 2: Details of pharmacy visit among the responding consumers \n\n\n\n\n\n\n\nSurvey question n % \n\n\n\n2A. Distance from residency to nearest pharmacy   \n\n\n\n< 5 min 32 30.5 \n\n\n\n5-15 min 53 50.5 \n\n\n\n15-30 min 15 14.3 \n\n\n\n> 30 min 5 4.8 \n\n\n\n\n\n\n\n2B. Which types of pharmacy do you visit most?   \n\n\n\nChain (has 4 or more stores under common ownership) 38 36.2 \n\n\n\nIndependent (has 3 or fewer stores under common ownership) 67 63.8 \n\n\n\n\n\n\n\n2C. How frequent do you visit pharmacy?   \n\n\n\nMore than once a week 6 5.7 \n\n\n\nOnce a week 8 7.6 \n\n\n\nTwice a month 23 21.9 \n\n\n\nOnce a month 31 29.5 \n\n\n\nOnce every 2-3 months 16 15.2 \n\n\n\nOnce every 6 months 13 12.4 \n\n\n\nOnce a year 8 7.6 \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nDifferences in the tendency of self-\n\n\n\nmedication between different \n\n\n\ndemographic groups \n\n\n\n\n\n\n\n Chi-square analysis showed no \n\n\n\nsignificant differences (p > 0.05) in the \n\n\n\ntendency of self-medication between \n\n\n\nconsumers with different age, gender, \n\n\n\nrace, martial status, educational level and \n\n\n\nmonthly income.  However, consumers \n\n\n\nwith insurance coverage were 3.45 times \n\n\n\n(Odds ratio) more tend to practice self-\n\n\n\nmedication than those without insurance \n\n\n\ncoverage (chi-square value X\n2 \n\n\n\n(1) = 8.20, \n\n\n\np = 0.004).  \n\n\n\n\n\n\n\nThe mean monthly health care \n\n\n\nexpenditure among consumers who \n\n\n\npracticed self-medication (RM127.02 \u00b1 \n\n\n\n140.45) was slightly higher than those \n\n\n\nwho consulted with doctor or pharmacist \n\n\n\nwhen purchasing medicines (RM91.29 \u00b1 \n\n\n\n115.23). However, t-test analysis showed \n\n\n\nthat the different was not significant (p = \n\n\n\n0.122).  \n\n\n\n\n\n\n\n Medical condition of the respondents \n\n\n\n\n\n\n\n Around 58% of the responding \n\n\n\nconsumers do not have underlying \n\n\n\nmedical condition (Table 4). For those \n\n\n\nwho have one underlying disease \n\n\n\n(34.3%),   the main conditions were \n\n\n\nallergy (9.5%), hypertension (5.7%) and \n\n\n\ndiabetes (4.8%). About 8% of the \n\n\n\nrespondents have two underlying \n\n\n\nmedical conditions, which \n\n\n\npredominantly were hypertension and \n\n\n\ndiabetes (2.9%).  \n\n\n\n\n\n\n\nDetails of medicines taken during self-\n\n\n\nmedication \n\n\n\n\n\n\n\n The three most popular classes of \n\n\n\nallophatic drugs used by the respondents \n\n\n\nduring self-medication were \n\n\n\nanalgesic/NSAIDs (32.4%), cold & flu \n\n\n\nmedicines (23.8%) and gastrointestinal \n\n\n\nmedications/antacids (18.1%). When \n\n\n\nassessing the type of supplements \n\n\n\nnormally used during self-medication, \n\n\n\nvitamin C (30.5%), multivitamin \n\n\n\n(25.7%) and fish oil/Omega 3 (10.5%) \n\n\n\nwere the most popular supplements \n\n\n\n(Table4).                                               \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 43 \n\n\n\n\n\n\n\nTable 3: Self-medication for the preceding six months among the responding consumers \n \n\n\n\nSurvey question n % \n\n\n\n3A. Have you purchased medicines of your own without consulting either a \n\n\n\ndoctor or a pharmacist in the preceding six months? \n\n\n\n\n\n\n\nYes 47 44.8 \n\n\n\nNo 58 55.2 \n\n\n\n\n\n\n\n3B. To whom is the medicine meant for?*   \n\n\n\nSelf 89 84.8 \n\n\n\nParents 27 25.7 \n\n\n\nChildren 26 24.8 \n\n\n\nSpouse 13 12.4 \n\n\n\nOthers 6 5.7 \n\n\n\nMissing data 1 1.0 \n\n\n\n\n\n\n\n3C. What was the main symptoms did you experience?*   \n\n\n\nFever 37 35.2 \n\n\n\nColds and flu 37 35.2 \n\n\n\nCough 33 31.4 \n\n\n\nHeadache/migraine 30 28.6 \n\n\n\nGastric pain 27 25.7 \n\n\n\nMuscle pain 23 21.9 \n\n\n\nSore throat 21 20.0 \n\n\n\nStomach discomfort 19 18.1 \n\n\n\nAllergic 11 10.5 \n\n\n\nOthers 13 12.4 \n\n\n\n\n\n\n\n3D. What type of medicine(s) did you use?*   \n\n\n\nAllopathic (modern) medicines 77 73.3 \n\n\n\nSupplements 71 67.6 \n\n\n\nCosmetics 48 45.7 \n\n\n\nHerbal medicines 36 34.3 \n\n\n\nNutritional products 8 7.5 \n\n\n\nMissing data 1 1.0 \n\n\n\n\n\n\n\n3E. What was your main reason for not consulting a doctor?*   \n\n\n\nNot necessary 55 52.4 \n\n\n\nExpensive 36 34.3 \n\n\n\nInconvenience 14 13.3 \n\n\n\nFar 7 6.7 \n\n\n\nNot effective 4 3.8 \n\n\n\nOthers 10 9.5 \n\n\n\n\n\n\n\n3F. Which type of premises does you usually go to purchase your \n\n\n\nmedication?* \n\n\n\n\n\n\n\nPharmacy 100 95.2 \n\n\n\nChinese medical hall 11 10.5 \n\n\n\nMedical hall 4 3.8 \n\n\n\nMalay traditional clinic 3 2.9 \n\n\n\nOthers 3 2.9 \n\n\n\n\n\n\n\n3G. State the main use of the medicines that you purchased on your own:*   \n\n\n\nTreatment 73 69.5 \n\n\n\nHealth maintenance 38 36.2 \n\n\n\nPrevention 19 18.1 \n\n\n\nOthers 2 1.9 \n\n\n\nMissing data 2 1.9 \n\n\n\nNote: *The respondent (n = 105) can answer more than one answer \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 44 \n\n\n\n \nTable 4: Medical condition of the respondents and details of medicines taken during self-\n\n\n\nmedication \n\n\n\n\n\n\n\nSurvey item n % \n\n\n\n4A. Medical condition of the responding consumers   \n\n\n\nConsumer without underlying medical condition 61 58.1 \n\n\n\nConsumer with one underlying  medical condition 36 34.3 \n\n\n\nAllergy 10 9.5 \n\n\n\nHypertension 6 5.7 \n\n\n\nDiabetes 5 4.8 \n\n\n\nGastric 3 2.9 \n\n\n\nCardiovascular disease 3 2.9 \n\n\n\nMigraine/headache 2 1.9 \n\n\n\nDysmenorrhoea / Period pain 2 1.9 \n\n\n\nHyperlipidemia 1 1.0 \n\n\n\nOthers 4 3.8 \n\n\n\nConsumer with two underlying medical conditions 8 7.6 \n\n\n\nHypertension & Diabetes 3 2.9 \n\n\n\nHypertension & hyperlipidemia  2 1.9 \n\n\n\nAllergy & Gastric 1 1.0 \n\n\n\nDiabetes & cardiovascular disease 1 1.0 \n\n\n\nGastric & others 1 1.0 \n\n\n\n\n\n\n\n4B. Class of allophatic / modern drug(s)  normally used  \n\n\n\nby the responding consumers during self-medication* \n\n\n\n\n\n\n\nAnalgesics or NSAIDs 34 32.4 \n\n\n\nCold & flu 25 23.8 \n\n\n\nGastrointestinal medications / antacids 19 18.1 \n\n\n\nCardiovascular medications 17 16.2 \n\n\n\nAllergy medications 16 15.2 \n\n\n\nDiabetes medications 10 9.5 \n\n\n\nAntibiotics 6 5.7 \n\n\n\nOthers 1 1.0 \n\n\n\n\n\n\n\n4C. Class of herbal medicine(s) normally used by the  \n\n\n\nresponding consumers during self-medication* \n\n\n\n\n\n\n\nChinese herbal medicines 20 19.0 \n\n\n\nMalay herbal medicines 11 10.5 \n\n\n\nIndian herbal medicines 5 4.8 \n\n\n\n\n\n\n\n4D. Type of supplements normally used by the responding  \n\n\n\nconsumers during self-medication* \n\n\n\n\n\n\n\nVitamin C 32 30.5 \n\n\n\nMultivitamin 27 25.7 \n\n\n\nFish oil / Omega 3 11 10.5 \n\n\n\nVitamin B complex 8 7.6 \n\n\n\nCalcium 8 7.6 \n\n\n\nVitamin A, C & E 7 6.7 \n\n\n\nEvening primose oil 6 5.7 \n\n\n\nVitamin E 4 3.8 \n\n\n\nOthers 15 14.3 \n\n\n\nNotes: *The respondent (n = 105) can answer more than one answer \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 45 \n\n\n\nConsumers\u2019 opinion towards self-\n\n\n\nmedication \n\n\n\n\n\n\n\n The respondents\u201f responses \n\n\n\ntowards questions assessing their opinion \n\n\n\non self-medication were shown in Table \n\n\n\n5. Majority of the consumers (69.5%) \n\n\n\nwere either strongly disagreed or \n\n\n\ndisagreed that prescription medication \n\n\n\ncan be purchased without professional\u201fs \n\n\n\nassistance. Only 27.6% of respondents \n\n\n\nwere confident in self-managing \n\n\n\nmedications/dietary supplements. \n\n\n\nAdditionally, approximately one in every \n\n\n\nthree consumers were either strongly \n\n\n\nagreed or agreed that non-prescription \n\n\n\nmedications/dietary supplements can be \n\n\n\npurchased without assistance. Most of \n\n\n\nthe respondents (62.9%) held positive \n\n\n\nopinion that non-prescription \n\n\n\nmedications/dietary supplements help \n\n\n\nmaintain health. The consumers mostly \n\n\n\nagreed that more advice on \n\n\n\nmedications/dietary supplements should \n\n\n\nbe given by pharmacists (75.2%) and \n\n\n\npharmacist has high level of \n\n\n\nprofessionalism on medications (65.7%). \n\n\n\nHowever, the responding consumers \n\n\n\npredominantly held a neutral opinion \n\n\n\nabout whether more prescription \n\n\n\nmedicines should be switched to \n\n\n\npharmacy or over-the-counter status \n\n\n\n(45.7%). Around half of the respondents \n\n\n\n(53.4%) expressed disagreement upon \n\n\n\nthe sharing of medicines among family \n\n\n\nmembers as compared to 16.2% who in \n\n\n\nfavour with this practice. Majority of the \n\n\n\nconsumers disagreed that the leftover \n\n\n\nmedicines stored at home can be used \n\n\n\nwhen needed (78.1%). The consumers \n\n\n\ngenerally disagreed that originally \n\n\n\nprescribed dosage can be changed \n\n\n\naccording to their own judgment \n\n\n\n(80.0%).  \n \n\n\n\nTable 5: Responding consumers\u2019 opinion towards self-medication \n\n\n\n\n\n\n\nSurvey question/Statement Frequency (%) \n\n\n\n1 2 3 4 5 Missing \n\n\n\ndata \n\n\n\n1. Prescription medications can be purchased \n\n\n\nwithout professional\u201fs assistance. \n \n\n\n\n42 \n\n\n\n(40.0) \n\n\n\n31 \n\n\n\n(29.5) \n\n\n\n23 \n\n\n\n(21.9) \n\n\n\n8 \n\n\n\n(7.6) \n\n\n\n1 \n\n\n\n(1.0) \n\n\n\n0 \n\n\n\n(0.0) \n\n\n\n2. I am confident in self-managing \n\n\n\nmedications/dietary supplements. \n \n\n\n\n7 \n\n\n\n(6.7) \n\n\n\n16 \n\n\n\n(15.2) \n\n\n\n53 \n\n\n\n(50.5) \n\n\n\n19 \n\n\n\n(18.1) \n\n\n\n10 \n\n\n\n(9.5) \n\n\n\n0 \n\n\n\n(0.0) \n\n\n\n\n\n\n\n3. Non-prescription medications/dietary \n\n\n\nsupplements can be purchased without assistance. \n \n\n\n\n13 \n\n\n\n(12.4) \n\n\n\n24 \n\n\n\n(22.9) \n\n\n\n33 \n\n\n\n(31.4) \n\n\n\n24 \n\n\n\n(22.9) \n\n\n\n11 \n\n\n\n(10.5) \n\n\n\n0 \n\n\n\n(0.0) \n\n\n\n4. More advice on medications/dietary supplements \n\n\n\nshould be given by pharmacist. \n \n\n\n\n2 \n\n\n\n(1.9) \n\n\n\n3 \n\n\n\n(2.9) \n\n\n\n20 \n\n\n\n(19.0) \n\n\n\n40 \n\n\n\n(38.1) \n\n\n\n39 \n\n\n\n(37.1) \n\n\n\n1 \n\n\n\n(1.0) \n\n\n\n5. I think non-prescription medications/dietary \n\n\n\nsupplements help maintain health. \n \n\n\n\n5 \n\n\n\n(4.8) \n\n\n\n8 \n\n\n\n(7.6) \n\n\n\n26 \n\n\n\n(24.8) \n\n\n\n40 \n\n\n\n(38.1) \n\n\n\n26 \n\n\n\n(24.8) \n\n\n\n0 \n\n\n\n(0.0) \n\n\n\n6. I think pharmacist has high level of \n\n\n\nprofessionalism on medications. \n \n\n\n\n2 \n\n\n\n(1.9) \n\n\n\n11 \n\n\n\n(10.5) \n\n\n\n23 \n\n\n\n(21.9) \n\n\n\n32 \n\n\n\n(30.5) \n\n\n\n37 \n\n\n\n(35.2) \n\n\n\n0 \n\n\n\n(0.0) \n\n\n\n7. Medicines can be shared among family members \n \n\n\n\n32 \n\n\n\n(30.5) \n\n\n\n24 \n\n\n\n(22.9) \n\n\n\n32 \n\n\n\n(30.5) \n\n\n\n15 \n\n\n\n(14.3) \n\n\n\n2 \n\n\n\n(1.9) \n\n\n\n0 \n\n\n\n(0.0) \n \n\n\n\n8. The leftover medicines stored at home can be \n\n\n\nused anytime when needed. \n \n\n\n\n47 \n\n\n\n(44.8) \n\n\n\n35 \n\n\n\n(33.3) \n\n\n\n16 \n\n\n\n(15.2) \n\n\n\n6 \n\n\n\n(5.7) \n\n\n\n1 \n\n\n\n(1.0) \n\n\n\n0 \n\n\n\n(0.0) \n\n\n\n9. Originally prescribed dosage can be changed \n\n\n\naccording to my own judgement. \n \n\n\n\n47 \n\n\n\n(44.8) \n\n\n\n37 \n\n\n\n(35.2) \n\n\n\n15 \n\n\n\n(14.3) \n\n\n\n5 \n\n\n\n(4.8) \n\n\n\n1 \n\n\n\n(1.0) \n\n\n\n0 \n\n\n\n(0.0) \n\n\n\n10. More prescription (doctor) medications should \n\n\n\nbe switched to pharmacy or over-the-counter status. \n \n\n\n\n6 \n\n\n\n(5.7) \n\n\n\n21 \n\n\n\n(20.0) \n\n\n\n48 \n\n\n\n(45.7) \n\n\n\n13 \n\n\n\n(12.4) \n\n\n\n17 \n\n\n\n(16.2) \n\n\n\n0 \n\n\n\n(0.0) \n\n\n\nNote: 1 = Strongly disagree; 2 = Disagree; 3 = Not sure; 4 = Agree; 5 = Strongly agree \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 46 \n\n\n\nDiscussion \n\n\n\n\n\n\n\nThis study revealed that self-medication \n\n\n\npractices were prevalent among the \n\n\n\nMalaysian consumers who visited \n\n\n\ncommunity pharmacy. About 45% of the \n\n\n\nsurveyed respondents had purchased \n\n\n\nmedicines without consulting either a \n\n\n\ndoctor or pharmacist in the previous six \n\n\n\nmonths. This percentage was lower \n\n\n\ncompared with a recent study undertaken \n\n\n\namong consumers in Kuala Lumpur, the \n\n\n\ncapital city of Malaysia where 62.7% \n\n\n\nhad practiced self-medication in the \n\n\n\npreceding week (5). However, the \n\n\n\nprevalence of self-medication in the \n\n\n\npresent study was slightly higher than \n\n\n\nstudy findings from Jordan (42.5%) (6) \n\n\n\nand Southwest Ethiopia (39.2%)(7).  \n\n\n\n\n\n\n\nConsumers from different demographic \n\n\n\nbackground found to have no significant \n\n\n\ndifferences in their tendency of self-\n\n\n\nmedication. The only factor which \n\n\n\nindicated higher probability for \n\n\n\npractising self-medication among the \n\n\n\nconsumers was insurance coverage. \n\n\n\nHowever, the present study did not \n\n\n\nevaluate the reasons behind this \n\n\n\nobservation. Around half of the \n\n\n\nresponding consumers expressed \u201cnot \n\n\n\nnecessary\u201d as their main reason for not \n\n\n\nconsulting a doctor. This finding may be \n\n\n\ndue to the fact that the respondents \n\n\n\nmostly performed self-treatment for \n\n\n\nminor ailments like fever, cold and flu \n\n\n\nand cough which can be managed by \n\n\n\nnon-prescription medicines. Study from \n\n\n\nother countries also found similar trend \n\n\n\nwhere consumers were confident with \n\n\n\nself-medication for minor ailments. For \n\n\n\ninstance, a recent study in Canada found \n\n\n\nadolescents\u201f self-administration of \n\n\n\nacetaminophen for pain is common with \n\n\n\n50% to 75% of junior high students \n\n\n\nreporting that they use acetaminophen \n\n\n\nfor pain relief without first checking with \n\n\n\nany healthcare provider (8). \n\n\n\nNevertheless, self-treatment practice \n\n\n\nwithout proper information given may \n\n\n\nincrease risk of misuse or over-\n\n\n\nconsumption of non-prescription \n\n\n\nmedicines. The Malaysian consumers \n\n\n\nshould be educated on the dangers of \n\n\n\nself-medication and advised doing it \n\n\n\nonly for minor ailments and to seek \n\n\n\nmedical treatment if unsure (5).  \n\n\n\n\n\n\n\nThe present study highlighted the \n\n\n\nimportant role of community pharmacist \n\n\n\nin providing advice and professional \n\n\n\nconsultation to the consumers who \n\n\n\npractice self-medication. Majority of the \n\n\n\nsurveyed consumers viewed that more \n\n\n\nadvice on medications should be \n\n\n\nprovided by pharmacists. Further, the \n\n\n\nrespondents generally viewed \n\n\n\npharmacists as having high level of \n\n\n\nprofessionalism on medication. \n\n\n\nTherefore, community pharmacists must \n\n\n\nbe equipped themselves with the skills of \n\n\n\neducating the consumers on the \n\n\n\nappropriate and quality use of non-\n\n\n\nprescription and over-the-counter \n\n\n\nmedicinal products. Indeed, educational \n\n\n\nintervention by pharmacist is needed to \n\n\n\ncorrect the inappropriate practices \n\n\n\nobserved among some consumers in the \n\n\n\npresent study,  for instance, the sharing \n\n\n\nof medicines among family members \n\n\n\nand the keeping of leftover medications. \n\n\n\nThe development of professional \n\n\n\nstandards of practice among the \n\n\n\ncommunity pharmacists is needed in the \n\n\n\narea of self-medication (5). This could \n\n\n\nbe achieved via structured training and \n\n\n\nestablishment of guidelines to assist the \n\n\n\ncommunity pharmacists in providing \n\n\n\nprofessional consultation to the \n\n\n\nconsumers with regards to self-\n\n\n\nmedication.  \n\n\n\n\n\n\n\nStudy limitation \n\n\n\n\n\n\n\nThe selection bias cannot be ruled out \n\n\n\ndue to the convenience sampling and \n\n\n\nself-reported information obtained in the \n\n\n\npresent study. The small sample size and \n\n\n\nlow response rate further reduced the \n\n\n\ngeneralisability of the study findings. \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 47 \n\n\n\nFuture study should include a larger \n\n\n\nrepresentative sample size of the \n\n\n\nMalaysian consumers who visit to \n\n\n\ncommunity pharmacies.  \n\n\n\n\n\n\n\nConclusion \n\n\n\n\n\n\n\nSelf-medication is prevalent in Sungai \n\n\n\nPetani with approximately 45% of \n\n\n\nsurveyed consumers using some form of \n\n\n\nself-medication in the past 6 months of \n\n\n\nthe study. The practice of self-\n\n\n\nmedication mostly involved management \n\n\n\nof minor ailments using non-prescription \n\n\n\nand over-the-counter medicinal products. \n\n\n\nPharmacist is responsible to limit the \n\n\n\npotential risks involved in self-\n\n\n\nmedication by educating the consumers \n\n\n\nregarding the medicines and its \n\n\n\nappropriate use, and instructions to \n\n\n\nreceived medical treatment if they are \n\n\n\nunsure. \n\n\n\n\n\n\n\n\n\n\n\nReferences \n\n\n\n1. Shankar PR, Partha P, Shenoy N. Self-medication and non-doctor prescription \n\n\n\npractices in Pkhara valley, Western Nepal: a questionnaire-based study. BMC Fam Pract \n\n\n\n2002;3:17. \n\n\n\n\n\n\n\n2. Filho AIdL, Lima-Costa MF, Uch\u00f4a E. Bambui Project: a qualitative approach to \n\n\n\nself-medication. Cad Sa\u00fade P\u00fablica, Rio de Janeiro. 2004;20(6):1661-1669. \n\n\n\n\n\n\n\n3. Langford BJ, Jorgenson D, Kwan D, Papoushek C. Implementation of a self-\n\n\n\nadministered questionnaire to identify patients at risk for medication-related problems in \n\n\n\na family health center. Pharmacotherapy. 2006;26(2):260-268. \n\n\n\n\n\n\n\n4. Kamat VR, Nichter M. Pharmacies, self-medication and pharmaceutical \n\n\n\nmarketing in Bombay, India. Soc Sci Med 1998;47(6):779-794. \n\n\n\n\n\n\n\n5. Hassali MA, Shafie AA, Al-Qazaz H, Tambyappa J, Palaian S, Hariraj V. Self-\n\n\n\nmedication practices among adult population attending community pharmacies in \n\n\n\nMalaysia: an exploratory study. Int J Clin Pharm 2011;33:794-799. \n\n\n\n\n\n\n\n6. Yousef AM, Al-Bakri AG, Bustanji Y, Wazaify M. Self-medication patterns in \n\n\n\nAmman, Jordan. Pharm World Sci 2008;30:24-30. \n\n\n\n\n\n\n\n7. Suleman S, Katsela A, Mekonnen Z. Assessment of self-medication practices in \n\n\n\nAssendabo town, Jimma zone, southwestern Ethiopia. Res Social Adm Pharm 2009;5:76-\n\n\n\n81. \n\n\n\n\n\n\n\n8. Laura PS, Jennifer PK, Cindy D, Karen MW, Michael SW. Misunderstanding and \n\n\n\npotential unintended misuse of acetaminophen among adolescents and young adults. J \n\n\n\nHealth Commun 2011;16(Suppl 3):256-267. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n"
"\n\nMalaysian Journal of Pharmacy Volume 7 Issue 2 (2021) \n \n\n\n\n\n\n\n\n32 \n\n\n\n\n\n\n\n*Correspondence: jihandiyana@moh.gov.my Department of Pharmacy, Hospital Tuanku Fauziah, Ministry of Health \n\n\n\nMalaysia, Jalan Tun Abdul Razak, 01000 Kangar, Perlis, Malaysia.  \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n Original Article  \n\n\n\n\n\n\n\nPublic Knowledge and Attitudes Towards Antibiotics Usage in \n\n\n\nPerlis: A Cross-Sectional Study \n \n\n\n\nJihan Diyana Maidin*, Mumtaz Mohamad Ghausillah, Ahmad Syahmi Ahmad Zaini, Norhaffizawati \n\n\n\nOthman \n\n\n\n\n\n\n\n \nArticle Info  \n\n\n\n \nReceived date: 23 March 2021  \n\n\n\nAccepted date: 24 Aug 2021 \n\n\n\nPublished date: 31 Dec 2021 \n\n\n\n\n\n\n\nKeywords: Anti-bacterial \n\n\n\nagents, knowledge, attitude, \n\n\n\nMalaysia, surveys and \n\n\n\nquestionnaires \n\n\n\nABSTRACT  \n\n\n\n\n\n\n\nIntroduction: Antibiotic resistance is increasing worldwide. The prevalence of bacterial resistance \n\n\n\nvaries in different geographical areas, and it was correlated with the utilisation of antibiotics in the \n\n\n\ngeneral population. Objective: This study was conducted to assess public knowledge and attitudes \n\n\n\ntowards antibiotic usage in Perlis, Malaysia. Method: A validated self-administered questionnaire \n\n\n\nsurvey was distributed among the public in three main parliament areas of Perlis using the quota \n\n\n\nsampling method from August to October 2017. The questionnaire from a previous study by Lim et \n\n\n\nal. was used and the data were analysed using SPSS version 20.0. Result: About half of the \n\n\n\nrespondents (51%) were found to have good knowledge (score \u2265 6 out of 12), and 45.1% have a good \n\n\n\nattitude (score \u2265 6 out of 8). The mean knowledge score was 5.0 \u00b1 2.19 and the mean attitude score \n\n\n\nwas 5.6 \u00b1 3.00. As for knowledge, most respondents still perceived those antibiotics would work on \n\n\n\nviral infections in the common cold and cough. In terms of attitude, almost three-quarters of the study \n\n\n\npopulation (74%) expected antibiotics to treat cough and cold while two-thirds of the respondents \n\n\n\n(65.1%) expected that taking antibiotics would improve recovery. Half of the respondents (53.6%) \n\n\n\nwill stop taking antibiotics when they start feeling better. Age, education level, and employment \n\n\n\nsector were found to be significantly associated with knowledge and attitude. There was a positive \n\n\n\ncorrelation (r = 0.581) between knowledge and attitude scores. Conclusion: This study has identified \n\n\n\npeople with better knowledge would have an appropriate attitude regarding the use of antibiotics. \n\n\n\nHence, educational programmes targeting the young generation and public who do not work in the \n\n\n\nhealthcare field are significant to promote the appropriate utilisation of antibiotics among the public \n\n\n\nin Perlis.   \n\n\n\n\n\n\n\nINTRODUCTION  \n  \n\n\n\nAntibiotics are medicines that destroy or inhibit the growth \n\n\n\nof microorganisms. Whenever a patient has been identified \n\n\n\nwith bacterial infections, doctors will prescribe specific \n\n\n\nantibiotics to treat them. If the infection is suspected, but the \n\n\n\npathogen responsible for the illness has not been identified, \n\n\n\nan empirical antibiotic therapy will be given. For empirical \n\n\n\ntreatment using antibiotic, it involves the administration of \n\n\n\nbroad-spectrum antibiotics that covers a wide range of \n\n\n\nmicroorganisms. \n\n\n\nAntibiotic resistance has become a significant issue in the \n\n\n\n20th century and persists until now [1]. The accumulation \n\n\n\nand spread of antibiotic resistance threats to limit the \n\n\n\neffectiveness of antibiotics [2]. There are a lot of factors that \n\n\n\nlead to antibiotic resistance. Lack of information about the \n\n\n\nknowledge of the complete course of antibiotics, their side \n\n\n\neffects, standard acceptable dosage limits is the potential \n\n\n\nreason that leads to microbial resistance issues and increased \n\n\n\nmorbidity [3]. For example, patients may not know that the \n\n\n\nantibiotic regime must be completed even though the patient \n\n\n\nmight feel healthy before the course is completed. Patients \n\n\n\n\n\n\n\n\n\n\n\n\nJihan D.M. et al. Mal J Pharm 7 (2) 2021, 32-38 \n\n\n\n\n\n\n\n33 \n\n\n\n\n\n\n\nwho did not complete the antibiotic regime might lead to an \n\n\n\nincrease in antibiotic resistance. Thus, it is crucial to ensure \n\n\n\npatient\u2019s compliance in finishing their antibiotic regime at all \n\n\n\ncosts. The lack of newly approved antibiotics in recent times \n\n\n\nmay pose more problems as previous antibiotics have reduced \n\n\n\nefficacy to treat infection [4].   \n\n\n\n\n\n\n\nThe prevalence of bacterial resistance varies in different \n\n\n\ngeographic areas, and it is correlated with the consumption of \n\n\n\nantibiotics in the general population [5]. Thus, it is essential to \n\n\n\nassess public knowledge and attitude towards antibiotics \n\n\n\naccording to their respective geographic areas. This study aims \n\n\n\nto assess the understanding and attitude towards antibiotic \n\n\n\nusage among the general population in Perlis.  \n\n\n\n\n\n\n\nMETHOD  \n \n\n\n\nA cross-sectional survey involving a community that lived in \n\n\n\nPerlis was conducted from September to November 2017 using \n\n\n\na validated questionnaire [6]. The sample size was determined \n\n\n\nusing the Raosoft sample size calculator for the estimated \n\n\n\n253,600 people in Perlis [7]. The minimum sample size of 384 \n\n\n\nis required to provide a confidence level of 95% with an \n\n\n\nassumption of 50% response distribution and a 5% margin of \n\n\n\nerror. A quota sampling method was used according to three \n\n\n\nparliamentary constituencies in Perlis which are Kangar (156 \n\n\n\nrespondents), Arau (151 respondents) and Padang Besar (97 \n\n\n\nrespondents). Each of the samples was determined by using a \n\n\n\nratio from the total population number of each constituency. \n\n\n\nThe subjects from each constituency were selected using a \n\n\n\nconvenient sampling method. The inclusion criteria for the \n\n\n\nsubjects were: (i) Aged 18 years old and above; (ii) understood \n\n\n\nEnglish or Malay language and; (iii) aware of the term \n\n\n\n\u2018antibiotics\u2019.  The self-administered questionnaire used in the \n\n\n\nstudy was adopted from a study done by Lim & Teh [6].  \n\n\n\n\n\n\n\nData were analyzed using SPSS\u00ae 20.0. Demographic \n\n\n\ncharacteristics, recent use of antibiotics, knowledge and \n\n\n\nattitude scores will be summarized using descriptive statistics. \n\n\n\nThe difference between mean scores was examined by using a \n\n\n\nt-test or ANOVA, where appropriate. Demographic \n\n\n\ncharacteristics which contributed significantly to knowledge \n\n\n\nand attitude were identified using multivariable logistic \n\n\n\nregression. Pearson\u2019s correlation was used to examine the \n\n\n\nrelationship between antibiotic knowledge and attitude score. \n\n\n\nAssociation between knowledge score and appropriateness of \n\n\n\nattitude of antibiotics use were determined using the chi-square \n\n\n\ntest. In all statistical analyses, a p-value of < 0.05 will be \n\n\n\nconsidered to be statistically significant.  \n\n\n\n\n\n\n\nThe study was registered with the National Medical Research \n\n\n\nRegister (NMRR) and approved by the Medical Research \n\n\n\nEthics Committee (MREC), Ministry of Health Malaysia \n\n\n\n(NMRR-17-2853-38768).  \n\n\n\n\n\n\n\nRESULT  \n \n\n\n\nA total of 404 questionnaires were distributed during this study. \n\n\n\nThe respondents were enrolled at three main parliamentary \n\n\n\nconstituencies: Kangar, Padang Besar and Arau. However, only \n\n\n\n384 questionnaires were being analysed, as 20 incomplete \n\n\n\nquestionnaires were excluded (95.1% usable response). Table I \n\n\n\nshows the summary of respondents\u2019 demographic \n\n\n\ncharacteristics. The majority of the respondents fall within the \n\n\n\nage of 18 to 30 years old (37.0%), Malay (93.2%), female \n\n\n\n(65.9%), undertaken tertiary education (53.1%) and wage-\n\n\n\nearners (62.5%). Most of the respondents (72.4%) went to \n\n\n\ngovernment healthcare facilities to seek treatment. \n\n\n\n\n\n\n\nThe mean knowledge score obtained was 5.0 \u00b1 2.19, and the \n\n\n\nmean attitude score was 5.6 \u00b1 3.00. This study showed 51% of \n\n\n\nthe total respondents had good knowledge, while less than half \n\n\n\nof the respondents (45.1%) had a good attitude towards \n\n\n\nantibiotics usage.   \n\n\n\n\n\n\n\nTable I shows that gender, education level, employment status, \n\n\n\nand health -related occupation significantly contribute to mean \n\n\n\nknowledge and attitude scores (p < 0.05). Additionally, family \n\n\n\nmembers\u2019 occupations related to healthcare had a significant \n\n\n\nassociation with the mean knowledge score, while age was \n\n\n\nfound to contribute significantly to the mean attitude. \n\n\n\n\n\n\n\nRespondents considered as having good knowledge of \n\n\n\nantibiotics were more likely to have a positive attitude towards \n\n\n\nthe use of antibiotics. A significant positive correlation was \n\n\n\nnoted between respondents\u2019 antibiotics knowledge score and \n\n\n\ntheir attitude score (r = 0.581, p < 0.001). \n\n\n\n\n\n\n\nBased on the statements given to assess antibiotics knowledge, \n\n\n\n75.8% of respondents knew that antibiotics are medicines to \n\n\n\nkill bacteria. However, 81.5% and 78.6% of respondents still \n\n\n\nperceived that antibiotics could treat viral infections and work \n\n\n\non most colds and coughs respectively. 54.7% of respondents \n\n\n\nperceived wrongly that antibiotics use could be discontinued \n\n\n\nwhen symptoms are improving. However, 56.5% of \n\n\n\nrespondents knew overuse of antibiotics could lead to \n\n\n\nantibiotics resistance. \n\n\n\n\n\n\n\nIn terms of attitude, 74% of the study population presumed the \n\n\n\nuse antibiotics to treat cough and cold, while 65.1% of the \n\n\n\nrespondents expected that taking antibiotics would improve \n\n\n\n\n\n\n\n\n\n\n\n\nJihan D.M. et al. Mal J Pharm 7 (2) 2021, 32-38 \n\n\n\n\n\n\n\n34 \n\n\n\n\n\n\n\nTable I. Respondents\u2019 demographic characteristics \n\n\n\n\n\n\n\nCharacteristic \nn (%) \n\n\n\n(n = 384) \n\n\n\nKnowledge \n\n\n\nMean (SD) p-value \np-value \n\n\n\nAttitudes \n\n\n\nMean (SD) \np-value \n\n\n\nAge \n\n\n\n   18-30 142 (37.0) 5.2 (0.277) 0.132 4.30 (0.195) < 0.001 \n\n\n\n   31-45 122 (31.8) 5.8 (0.253) 5.48 (0.180) \n\n\n\n   46+ 120 (31.3) 5.9 (0.257) 5.36 (0.183) \n\n\n\nGender \n\n\n\n   Male  131 (34.1) 4.9 (0.261) < 0.001 4.25 (0.190) < 0.001 \n\n\n\n   Female 253 (65.9) 6.0 (0.186) 5.4 (0.132) \n\n\n\nRaces \n\n\n\n   Malay 358 (93.2) 5.6 (0.157) 0.363 5.02 (0.115) 0.57 \n\n\n\n   Non-malay 26 (6.8) 6.2 (0.670) 4.77 (0.455) \n\n\n\nEducation level \n\n\n\n   No formal education 12 (3.1) 5.9 (0.981) < 0.001 4.42 (0.570) < 0.001 \n\n\n\n   Primary school 15 (3.9) 4.5 (0.524) 4.13 (0.456) \n\n\n\n   Secondary school 153 (39.8) 4.6 (0.220) 4.31 (0.167) \n\n\n\n   College/University 204 (53.1) 6.4 (0.210) 5.62 (0.150) \n\n\n\nEmployment status \n\n\n\n   Employed for wages 240 (62.5) 6.1 (0.196) < 0.001 5.53 (0.132) < 0.001 \n\n\n\n   Self Employed 54 (14.1) 4.5 (0.365) 3.80 (0.258) \n\n\n\n   Student 34 (8.9) 4.7 (0.467) 3.71 (0.381) \n\n\n\n   Housewives 39 (10.2) 4.9 (0.479) 4.51 (0.376) \n\n\n\n   Retired 17 (4.4) 6.1 (0.661) 5.24 (0.466) \n\n\n\nHealthcare related occupation \n\n\n\n   Yes  82 (21.4) 7.6 (0.362) < 0.001 6.02 (0.235) < 0.001 \n\n\n\n   No 302 (78.6) 5.1 (0.156) 4.72 (0.123) \n\n\n\nFamily member\u2019s occupation related to healthcare \n\n\n\n   Yes  85 (22.1) 7.1 (0.303) < 0.001 5.32 (0.245) 0.136 \n\n\n\n   No 299 (77.9) 5.2 (0.169) 4.92 (0.125) \n\n\n\nCommon location seeking healthcare \n\n\n\n   Government 278 (72.4) 5.6 (0.184) 0.922 4.98 (0.132) 0.737 \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n   Non-Government 133 (27.6) 5.6 (0.279) 5.07 (0.210) \n\n\n\n \nTable II. Association between the appropriateness of antibiotic use and knowledge level \n\n\n\n\n\n\n\nAttitude Inappropriateness \nKnowledge score n (%) \n\n\n\nX2(p) \nPoor (n = 188) Good (n = 196) \n\n\n\nWhen I get a cold, I will take antibiotics to help me get better \n\n\n\nmore quickly. \n\n\n\nInappropriate 156 ( 82.9 ) 94 ( 47.9 ) 51.79 \n\n\n\nAppropriate 32 ( 17.1) 102 ( 51.1 ) < 0.001 \n\n\n\nI expect antibiotics to be prescribed by my doctor if I suffer \n\n\n\nfrom common cold symptoms. \n\n\n\nInappropriate 167 ( 88.8) 117 ( 59.7 ) 42.29 \n\n\n\nAppropriate 21 ( 11.2 ) 79 ( 40.3 ) < 0.001 \n\n\n\nI usually stop taking an antibiotic when I start feeling better. \nInappropriate 146 ( 77.6 ) 60 ( 30.6 ) 85.41 \n\n\n\nAppropriate 42 ( 22.4 ) 136 ( 69.4 ) < 0.001 \n\n\n\nIf my family member is sick, I usually will give my antibiotic to \n\n\n\nthem. \n\n\n\nInappropriate 86 ( 45.7 ) 38 ( 19.4 ) 30.48 \n\n\n\nAppropriate 102 ( 54.3 ) 158 ( 80.6 ) < 0.001 \n\n\n\nI usually keep antibiotic stock at home in case of emergency. \nInappropriate 63 ( 33.5 ) 33 ( 16.8 ) 14.22 \n\n\n\nAppropriate 125 ( 66.5 ) 163 ( 83.2 ) < 0.001 \n\n\n\nI will use leftover antibiotics for a respiratory illness (runny \n\n\n\nnose/ sore throat / flu). \n\n\n\nInappropriate 66 ( 35.1 ) 23 ( 11.7 ) 29.43 \n\n\n\nAppropriate 122 ( 64.9 ) 173 ( 88.3 ) < 0.001 \n\n\n\nI will take antibiotics according to the instruction on the label. \nInappropriate 32 ( 17.0 ) 14 ( 7.1 ) 8.88 \n\n\n\nAppropriate 156 ( 83.0 ) 182 ( 92.9 ) 0.004 \n\n\n\nI usually will look at the expiry date of the antibiotic before \n\n\n\ntaking it. \n\n\n\n\n\n\n\nInappropriate 37 ( 19.7 ) 18 ( 9.2 ) 8.61 \n\n\n\nAppropriate \n\n\n\n\n\n\n\n151 ( 80.3 ) 178 ( 90.8 ) 0.004 \n\n\n\n\n\n\n\nChi-square; significant when p < 0.05 \n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\nJihan D.M. et al. Mal J Pharm 7 (2) 2021, 32-38 \n\n\n\n\n\n\n\n35 \n\n\n\n\n\n\n\nrecovery. 53.6% of the respondents would stop taking \n\n\n\nantibiotics when they start feeling better.  \n\n\n\n\n\n\n\nTable II shows the association between the appropriateness of \n\n\n\nantibiotics use and knowledge level. The majority of the \n\n\n\nrespondents with poor knowledge tend to think antibiotics help \n\n\n\nthem to get better (82.0%) and stop taking antibiotics when \n\n\n\nthey feel better (77.6%). Even though most of the respondents \n\n\n\nwith poor and good knowledge scores responded \n\n\n\ninappropriately to the attitude statement \u2018I expect antibiotic to \n\n\n\nbe prescribed by my doctor if I suffer from common cold \n\n\n\nsymptoms\u2019, the number of the poor knowledge score \n\n\n\nrespondents outstand the number of respondents of good \n\n\n\nknowledge which was 167 (88.8%) compared to 117 (59.7%) \n\n\n\nrespectively.  Interestingly, most of the Perlis respondents \n\n\n\nrealised antibiotics should not be kept for an emergency; \n\n\n\nleftover antibiotics are not supposed to be used, antibiotics \n\n\n\nshould be taken with instructions and expiration date must be \n\n\n\nobserved before taking them.  \n\n\n\nThe demographic variables were initially analysed using \n\n\n\nsimple logistic regression. Based on Table III, three variables \n\n\n\nshowed a significant association with the respondents\u2019 \n\n\n\nknowledge regarding antibiotics use which was age (p < 0.047), \n\n\n\nhealthcare-related workers (p < 0.001) and having family \n\n\n\nmembers\u2019 occupations related to healthcare (p < 0.001). These \n\n\n\nthree variables were shown to be significant predictors for good \n\n\n\nknowledge of antibiotics when further analysed using forward, \n\n\n\nbackward and stepwise multiple logistic regression.  \n\n\n\n\n\n\n\nRespondents in the older age group, aged 31 to 45 years old \n\n\n\nwith an adjusted odds ratio of 2.15; 95% CI : 1.26 - 3.65) and \n\n\n\naged 46 years old and above (adjusted OR 1.80; 95% CI: 1.50 \n\n\n\n- 4.47) were found to have higher odds of better knowledge in \n\n\n\nantibiotics when compared to respondents aged 18 to 30 years \n\n\n\nold. \n\n\n\n\n\n\n\nRespondents who had career-related to healthcare were 4.28 \n\n\n\nhigher odds (95% CI : 2.38 - 7.71) more likely of having a \n\n\n\nbetter knowledge of antibiotics compared to non-healthcare \n\n\n\nworkers.  \n\n\n\n\n\n\n\nTable III. Demographic factors associated with public knowledge of antibiotic use \n\n\n\n\n\n\n\nFactors \nSimple Logistic Regression Multiple Logistic Regression \n\n\n\nCrude OR 95% CI p-value Adj. OR 95% CI p-value \n\n\n\nGender   \n\n\n\n0.14 \n\n\n\n\n\n\n\n    Male 1 (ref.)   \n\n\n\n   Female 2.395 ( 0.90 , 2.10 )   \n\n\n\nAge   \n\n\n\n0.047 \n\n\n\n\n\n\n\n0.001 \n   18-30 1 (ref.) 1 (ref.) \n\n\n\n   31-45 1.565 ( 0.96 , 2.55 ) 2.146 ( 1.26 , 3.65 ) \n\n\n\n   46+ 1.797 ( 1.09 , 2.94 ) 1.797 ( 1.50 , 4.47 ) \n\n\n\nRace   \n\n\n\n0.767 \n\n\n\n\n\n\n\n    Malay 1 (ref.)   \n\n\n\n   Non-malay 1.128 ( 0.51 , 2.51 )   \n\n\n\nHighest Education Level   \n\n\n\n< 0.001 \n\n\n\n\n\n\n\n\n\n\n\n   No formal education 1 (ref.)   \n\n\n\n   Primary School  0.5 ( 0.11 , 2.38 )   \n\n\n\n   Secondary School 0.628 ( 0.19 , 2.04 )   \n\n\n\n   College/ University 0.615 ( 0.50 , 5.19 )   \n\n\n\nEmployment Status   \n\n\n\n0.029 \n\n\n\n\n\n\n\n\n\n\n\n   Employed for wages 1 (ref.)   \n\n\n\n   Self-employed 0.458 ( 0.25 , 0.84 )   \n\n\n\n   Student 0.544 ( 0.26 , 1.13 )   \n\n\n\n   Housewife/Househusband 0.541 ( 0.27 , 1.08 )   \n\n\n\n   Retired/ Unemployed 1.426 ( 0.51 , 3.98 )   \n\n\n\nHealthcare related worker   \n\n\n\n< 0.001 \n\n\n\n\n\n\n\n< 0.001    No 1 (ref.) 1 (ref.) \n\n\n\n   Yes 3.62 ( 2.09 , 6.25 ) 4.28 ( 2.38 , 7.71 ) \n\n\n\nFamily member\u2019s occupation related to healthcare   \n\n\n\n< 0.001 \n\n\n\n\n\n\n\n< 0.001    No 1 (ref.) 1 (ref.) \n\n\n\n   Yes 2.876 ( 1.71 , 4.83 ) 2.738 ( 1.59 , 4.72 ) \n\n\n\nCommon location seeking healthcare   \n\n\n\n0.981 \n\n\n\n\n\n\n\n   Private 1 (ref.)   \n\n\n\n   Government 1.005 ( 0.64 , 1.57 )   \n\n\n\n\n\n\n\nNote: aMultiple logistic regression analysis using the Forward Stepwise (Likelihood Ratio) method; OR = odds ratio; 95% CI = 95% confidence interval \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\nJihan D.M. et al. Mal J Pharm 7 (2) 2021, 32-38 \n\n\n\n\n\n\n\n36 \n\n\n\n\n\n\n\nRespondents who had family members who have healthcare-\n\n\n\nrelated work have 2.74-fold (95% CI : 1.59 - 4.72) more likely \n\n\n\nto have adequate knowledge in antibiotics than respondents \n\n\n\nwho had not. Respondents in the older age group, having a \n\n\n\ncareer or family members related to healthcare, were found to \n\n\n\nhave higher odds of better knowledge in antibiotics. \n\n\n\n\n\n\n\n\n\n\n\nIn Table IV, for attitude, female, older age class respondents \n\n\n\nand respondents with occupation related to healthcare were \n\n\n\nfound to have a significant association with the respondents\u2019 \n\n\n\nattitude towards antibiotics use using forward stepwise \n\n\n\nmultiple logistic regression. Female (adjusted OR 2.11; 95% \n\n\n\nCI : 1.32 - 3.37) and healthcare-related workers (adjusted OR \n\n\n\n4.63; 95% CI : 2.57 - 8.31) were independently associated with \n\n\n\ngood attitudes. Respondents in the older age group, those aged \n\n\n\n31 to 45 years old (adjusted OR 3.394; 95% CI : 1.94 - 5.95) \n\n\n\nand aged 46 years old and above (adjusted OR 3.228; 95% CI : \n\n\n\n1.83 - 5.68), were found to have higher odds of better attitude \n\n\n\nin antibiotics when compared to respondents aged 18 to 30 \n\n\n\nyears old. For attitude, female, older age class respondents and \n\n\n\nrespondents with occupations related to healthcare were found \n\n\n\nto have a better attitude than male, younger class respondents \n\n\n\nand non-related health occupation respondents. Age and the \n\n\n\nemployment sector were found to be significantly associated \n\n\n\nwith both knowledge and attitude.   \n\n\n\n\n\n\n\nDISCUSSION \n \n\n\n\nThis study was done among the public in one of the states with \n\n\n\nthe lowest urbanisation level in Malaysia, which is Perlis [7]. \n\n\n\nThe previous studies in Malaysia were all done in states with a \n\n\n\nhigh level of urbanisation which was Penang, Putrajaya and \n\n\n\nSelangor. The findings in this study may give a better \n\n\n\nunderstanding of public knowledge and attitudes towards \n\n\n\nantibiotics usage among the community in a rural state, in \n\n\n\naddition to findings from the studies done before in urban states. \n\n\n\nThe compilation of these findings could give clearer insight for \n\n\n\nthe authorities to manage issues of inappropriate antibiotics use \n\n\n\nin Malaysia.\n\n\n\nTable IV. Demographic factors associated with the public attitude toward antibiotic use \n\n\n\n\n\n\n\nFactors \nSimple Logistic Regression Multiple Logistic Regression \n\n\n\nCrude OR 95% CI p-value Adj. OR 95% CI p-value \n\n\n\nGender   \n\n\n\n< 0.001 \n\n\n\n\n\n\n\n0.002    Male 1 (ref.) 1 (ref.) \n\n\n\n   Female 1.375 ( 1.54 , 3.73 ) 2.105 ( 1.32 , 3.37 ) \n\n\n\nAge    \n\n\n\n0.001 \n\n\n\n\n\n\n\n< 0.001 \n   18-30 1 (ref.) 1 (ref.) \n\n\n\n   31-45 2.460 ( 1.49 , 4.06 ) 3.394 ( 1.94 , 5.95 ) \n\n\n\n   46+ 2.158 ( 1.31 , 3.56 ) 3.228 ( 1.83 , 5.68 ) \n\n\n\nRace    \n\n\n\n0.485 \n\n\n\n\n\n\n\n    Malay 1 (ref.)   \n\n\n\n   Non-malay 0.748 ( 0.33 , 1.69 )   \n\n\n\nHighest Education Level    \n\n\n\n< 0.001 \n\n\n\n\n\n\n\n\n\n\n\n   No formal education 1 (ref.)   \n\n\n\n   Primary School  0.350 ( 0.06 , 1.93 )   \n\n\n\n   Secondary School 0.513 ( 0.15 , 1.71 )   \n\n\n\n   College/ University 2.170 ( 0.67 , 7.07 )   \n\n\n\nEmployment Status    \n\n\n\n< 0.001 \n\n\n\n\n\n\n\n\n\n\n\n   Employed for wages 1 (ref.)   \n\n\n\n   Self-employed 1.688 ( 0.62 , 4.58 )   \n\n\n\n   Student 0.408 ( 0.13 , 1.30 )   \n\n\n\n   Housewife/Househusband 0.514 ( 0.15 , 1.76 )   \n\n\n\n   Retired/ Unemployed 0.893 ( 0.28 , 2.85 )   \n\n\n\nHealthcare related worker    \n\n\n\n< 0.001 \n\n\n\n\n\n\n\n< 0.001    No 1 (ref.) 1 (ref.) \n\n\n\n   Yes 3.406 ( 2.03 , 5.73 ) 4.626 ( 2.57 , 8.31 ) \n\n\n\nFamily member\u2019s occupation related to healthcare   \n\n\n\n0.16 \n\n\n\n\n\n\n\n    No 1 (ref.)   \n\n\n\n   Yes 1.414 ( 0.87 , 2.29 )   \n\n\n\nCommon location seeking healthcare   \n\n\n\n0.457 \n\n\n\n\n\n\n\n   Private 1 (ref.)   \n\n\n\n   Government 0.843 ( 0.54 , 1.32 )   \n\n\n\n\n\n\n\nNote: aMultiple logistic regression analysis using the Forward Stepwise (Likelihood Ratio) method; OR = odds ratio; 95% CI = 95% confidence interval \n\n\n\n\n\n\n\n\n\n\n\n\nJihan D.M. et al. Mal J Pharm 7 (2) 2021, 32-38 \n\n\n\n\n\n\n\n37 \n\n\n\n\n\n\n\nThe overall results have shown that half of the study population \n\n\n\nin Perlis obtained scores more than the mean knowledge score, \n\n\n\nwhile a slightly lower percentage of them obtained scores more \n\n\n\nthan the mean attitude score. A significant positive correlation \n\n\n\nwas noted between respondents\u2019 antibiotic knowledge score \n\n\n\nand their attitude score. Our result was consistent with the study \n\n\n\nin Putrajaya [6], where adequate knowledge of antibiotics was \n\n\n\nshown to be a predictor for appropriate attitudes. On the other \n\n\n\nhand, the study in Penang [8] showed contrast results regarding \n\n\n\nour findings.  The study in Penang suggested that better \n\n\n\nknowledge does not necessarily imply an appropriate attitude \n\n\n\nconcerning antibiotics use. The findings, however, were limited \n\n\n\nto the respondents who attended the hospital. In our view, these \n\n\n\nresults offer compelling evidence that the different strategies to \n\n\n\nincrease the public\u2019s awareness of antibiotic-related issues \n\n\n\nshould be tailored according to different settings. Through our \n\n\n\nfindings, healthcare professionals and authorities in Perlis need \n\n\n\nto give attention to antibiotics-related-educational programmes \n\n\n\nto ensure proper antibiotics-taking behaviors among the local \n\n\n\ncommunity.  \n\n\n\n\n\n\n\nAbout 60% of the respondents answered incorrectly to identify \n\n\n\npenicillin as an antibiotic in this study and Putrajaya [6]. The \n\n\n\nprevious studies were done among the general public in \n\n\n\nMalaysia and found out that the population are more familiar \n\n\n\nwith the brand name instead of the generic name [9,10,11,12]. \n\n\n\nBesides that, the medications in Malaysia are sometimes not \n\n\n\nlabelled with their name especially by private clinics and retail \n\n\n\npharmacies [13], which might be the reason behind this finding. \n\n\n\nIn contrast, our study shows most of the respondents were able \n\n\n\nto differentiate antibiotics from other common drugs such as \n\n\n\nparacetamol and aspirin. Both medications are also over the \n\n\n\ncounter (OTC) medications [14] and more easily acquired than \n\n\n\nantibiotics which need prescription by a doctor. \n\n\n\n\n\n\n\nThe majority of the respondents in Perlis were unable to \n\n\n\nidentify the role of antibiotics accurately. More than the third \n\n\n\nquarter of respondents still perceived that those antibiotics \n\n\n\nwould work on viral infections in common cold and cough \n\n\n\nwhich is comparable to previous local studies in Putrajaya \n\n\n\n(83.0%) and Penang (86.6%).  The same issue happened \n\n\n\nworldwide [15]. This series of findings show where a vast \n\n\n\nmajority of respondents throughout Malaysia still have the \n\n\n\nsame misconception; hence healthcare providers must put extra \n\n\n\neffort into this issue. The information should outreach the \n\n\n\ncommunity as various community education programmes are \n\n\n\navailable in Malaysia such as Know Your Medicine and \n\n\n\nantibiotics awareness campaigns, for instance, World \n\n\n\nAntibiotic Awareness Week (WAAW). \n\n\n\n\n\n\n\nFurthermore, it was found that most of the respondents would \n\n\n\ntake antibiotics for cold, where the same findings were also \n\n\n\npresent in Putrajaya\u2019s case study [6]. A possible explanation for \n\n\n\nthe high rate of this inappropriate behavior corresponds to the \n\n\n\nfindings that most of our respondents did not know antibiotics \n\n\n\nineffective against viral infection and cold and cough. However, \n\n\n\nthe proportion in our study was found higher than other studies \n\n\n\ndone in Penang [8]and Shah Alam [16], where less than half of \n\n\n\ntheir respondent population would do the same. The \n\n\n\nmisconception also may lead to the findings where three over \n\n\n\nfour of the respondents anticipate antibiotics to be prescribed \n\n\n\nby the physician if they had a cold for faster recovery. Misuse \n\n\n\nof antibiotics can cause side effects and lead to antibiotic \n\n\n\nresistance [17]. \n\n\n\n\n\n\n\nIn addition, more than half of respondents in Perlis thought that \n\n\n\nthe consumption of antibiotics could be stopped when \n\n\n\nsymptoms are improving. Similarly, in terms of attitude, they \n\n\n\nalso usually stop taking antibiotics when they start feeling \n\n\n\nbetter, which was higher compared to previous studies in \n\n\n\nPenang [8], Putrajaya [6] and Shah Alam [16]. Above all, it \n\n\n\nwould be expected to obtain such outcomes of inappropriate \n\n\n\nattitudes regarding antibiotics usage as the inadequate \n\n\n\nknowledge of antibiotics was shown to be a predictor for poor \n\n\n\nattitudes in this study. Hence, each part of healthcare providers \n\n\n\nfrom doctors, medical assistants, nurses, pharmacists and \n\n\n\nothers are responsible for reminding patients repetitively to \n\n\n\nfinish their antibiotic course in order for patients to realize the \n\n\n\nimportance of antibiotic compliance. \n\n\n\n\n\n\n\nRespondents in the older age group, having a career or family \n\n\n\nmember working in healthcare, were found to have a higher \n\n\n\nprobability of better knowledge and antibiotic usage attitude. \n\n\n\nThe study in Putrajaya also identified the same finding \n\n\n\nregarding better knowledge of antibiotics among the older age \n\n\n\ngroup [6]. Respondents with careers or having family members \n\n\n\nworking in the healthcare field has better knowledge as it may \n\n\n\nbe easier for them to seek medical advice regarding health and \n\n\n\nmedication compared to those who do not. The same \n\n\n\ndemographic factors also scored better in attitude as our study \n\n\n\nfound a significant positive correlation between respondents\u2019 \n\n\n\nantibiotic knowledge score and their attitude score. \n\n\n\n\n\n\n\nFrom these findings, the health care teams can identify the \n\n\n\ntarget groups that should be given more attention to improving \n\n\n\npublic knowledge and attitude regarding antibiotic usage. \n\n\n\nThese groups include the younger age group and the public who \n\n\n\ndo not work in the healthcare field. The educational \n\n\n\nprogrammes should be held at strategic places that are easily \n\n\n\naccessible and can reach them such as schools, universities or \n\n\n\nmalls, rather than at a hospital or other healthcare facilities.  \n\n\n\n\n\n\n\nOur study was done using a convenience sampling method to \n\n\n\nselect the respondents at public places in three main \n\n\n\n\n\n\n\n\n\n\n\n\nJihan D.M. et al. Mal J Pharm 7 (2) 2021, 32-38 \n\n\n\n\n\n\n\n38 \n\n\n\n\n\n\n\nparliaments areas in Perlis; thus, the results are subject to bias \n\n\n\nand may not be generalised to other populations. Moreover, as \n\n\n\nthe data for this study was collected through a self-administered \n\n\n\nquestionnaire, the accuracy of the results was solely dependent \n\n\n\non the honesty and understanding of the respondents. We are \n\n\n\nalso unable to assess respondents who are illiterate (cannot \n\n\n\nunderstand Malay or the English language).  \n\n\n\n\n\n\n\nCONCLUSION   \n \n\n\n\nThis study has identified people with better knowledge would \n\n\n\nhave an appropriate attitude regarding antibiotics usage.  Hence, \n\n\n\neducational programmes such as antibiotic awareness \n\n\n\ncampaigns and patient counseling are very critical in promoting \n\n\n\nthe appropriate utilisation of antibiotics among the public in \n\n\n\nPerlis. However, such programmes should be tailored to gain \n\n\n\ninterest from the targeted groups which are the younger age \n\n\n\ngroup and the public who does not work in the healthcare field \n\n\n\nat Perlis \n\n\n\n\n\n\n\nACKNOWLEDGEMENT  \n \n\n\n\nThe authors would like to thank the Director-General of Health, \n\n\n\nMalaysia, for his permission to publish this research. We would \n\n\n\nalso like to extend our appreciation to Puan A\u2019tia Hashim \n\n\n\n(Pharmaceutical Services Programme, Ministry of Health M \n\n\n\nalaysia), Puan Nor Azlina Bakar (Perlis State Health \n\n\n\nDepartment), Dr Othman Warijo (Hospital Director, Hospital \n\n\n\nTuanku Fauziah (HTF)), Puan Nik Mah Nik Mat (Department \n\n\n\nof Pharmacy, HTF) and also Mr Ang Wei Chern (Clinical \n\n\n\nResearch Centre, HTF) for the continuous support in this study.   \n\n\n\n\n\n\n\nCONFLICT OF INTEREST   \n \n\n\n\nThe authors declare no conflict of interest. \n\n\n\n\n\n\n\nREFERENCE \n \n\n\n\n[1] Dodds, D. 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Antimicrobial Resistance and Infection Control, \n\n\n\n6(1), 1\u20138. https://doi.org/10.1186/s13756-017-0208-x \n\n\n\n \n\n\n\n\nhttps://doi.org/10.1016/j.bcp.2016.12.005\n\n\nhttps://doi.org/10.1016/j.tig.2017.05.003\n\n\nhttps://doi.org/10.3389/fpubh.2014.00145\n\n\nhttps://doi.org/10.1007/82_2015_490\n\n\nhttps://www.dosm.gov.my/v1/index.php?r=column/ctheme&menu_id=L0pheU43NWJwRWVSZklWdzQ4TlhUUT09&bul_id=MDMxdHZjWTk1SjFzTzNkRXYzcVZjdz09\n\n\nhttps://www.dosm.gov.my/v1/index.php?r=column/ctheme&menu_id=L0pheU43NWJwRWVSZklWdzQ4TlhUUT09&bul_id=MDMxdHZjWTk1SjFzTzNkRXYzcVZjdz09\n\n\nhttps://www.dosm.gov.my/v1/index.php?r=column/ctheme&menu_id=L0pheU43NWJwRWVSZklWdzQ4TlhUUT09&bul_id=MDMxdHZjWTk1SjFzTzNkRXYzcVZjdz09\n\n\nhttps://doi.org/10.3855/jidc.1502\n\n\nhttps://doi.org/10.1111/jphs.12167\n\n\nhttps://doi.org/10.1111/j.2042-7174.2012.00219.x\n\n\nhttps://doi.org/10.4321/s1886-36552014000400006\n\n\nhttps://doi.org/10.2174/157488609789006921\n\n\nhttps://www.mims.com/malaysia/drug/info/paracetamol\n\n\nhttps://doi.org/10.4040/jkan.2011.41.6.742\n\n\nhttps://doi.org/10.20510/ukjpb/2/i6/91175\n\n\nhttps://doi.org/10.1186/s13756-017-0208-x\n\n\n\n"
"\n\nMalaysian Journal of Pharmacy Volume 8 Issue 1 (2022) \n \n\n\n\n\n\n\n\n7 \n \n\n\n\n*Correspondence: karniza.khalid@moh.gov.my 1 Clinical Research Centre, Hospital Tuanku Fauziah, Jalan Tun Abdul \nRazak, 01000 Kangar, Perlis, Malaysia \n2 Department of Pharmacy, Hospital Tuanku Fauziah, Jalan Tun Abdul \nRazak, 01000 Kangar, Perlis, Malaysia \n\n\n\n\n\n\n\nMALAYSI\nAN \n\n\n\nJournal of \nPharmacy \n\n\n\n \nOriginal Article \n \n\n\n\nQualitative Analysis on Interprofessional Collaboration in the \nManagement of Paediatric Bronchial Asthma: Challenges and \nSuggestions for Improvement  \n \nKarniza Khalid1*, Nurul Azima Mazlan2, Wan Nor Amalina Zainun2, Amalina Anuar1, Nuqman \nMursyid Ramli2, Wei Chern Ang1,2  \n \n\n\n\n \nArticle Info  \n \nReceived date: 30 Sept 2021  \nAccepted date: 21 Mar 2022 \nPublished date: 30 Jun 2022 \n \nKeywords: Pharmacists, \nMTAC, decision making, \nasthma, patient care, \nmedication adherence. \n\n\n\nABSTRACT  \n  \nIntroduction: Multi-disciplinary healthcare providers need to move beyond task-based \nresponsibility towards a more collaborative approach. Chronic childhood diseases such as bronchial \nasthma demands effective multidisciplinary team collaboration to improve patient care. Objective: \nWe aimed to examine the interprofessional collaboration between physicians and pharmacists in the \nmanagement of paediatric bronchial asthm, to explore the views and experiences of both \npharmacists and physicians on the important aspects of Paediatric Respiratory Medication Therapy \nAdherence Clinic (PRMTAC) and patient-centeredness, and to identify barriers against \ninterprofessional shared decision-making in the management of paediatrics bronchial asthma. \nMethod: The study involved a face-to-face interview involving paediatric medical officers and \npharmacists involved with PRMTAC. The semi-structured interview included four pharmacists and \nthree paediatric resident physicians from Hospital Tuanku Fauziah, Perlis, Malaysia. A full audio \nrecording was used for detailed data retrieval and verbatim transcription. The session was deemed \ncompleted once all the probed questions had reached a thematic conclusion. Result and \nDiscussion: Three main themes emerged: (I) The relevance and necessity of PRMTAC service to \ncomplement paediatric outpatient bronchial asthma management, (II) the lack of communication \nbetween pharmacist-physician in outpatient bronchial asthma management, and (III) \nrecommendations for a combined clinic in the management of outpatient paediatric bronchial \nasthma. PRMTAC services were rated as highly relevant in the management of outpatient bronchial \nasthma among all study respondents, irrespective of profession. The detailed assessment of \nmedication compliance and technical demonstration provided by PRMTAC services were deemed \nfundamental in holistic patient care. The current clinical scenario demonstrates that the pharmacist \nand paediatric medical team work independently and in parallel, rather than collaboratively. Such \nworkflow challenges in-tandem decision-making with regards to patient-focused medication. The \nlack of interaction also impedes sharing of ideas and new knowledge that could benefit both parties \nin relation to the management of outpatient bronchial asthma. A combined clinic was unanimously \nsuggested to remedy this.  Conclusion: Proper planning with regard to allocation of support \nsystems and mobilisation of human resources needs to be instituted to realise the implementation of \na nationwide combined clinic in the management of paediatric bronchial asthma.  \n \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nKhalid K.et al. Mal J Pharm 8 (1) 2022, 7-12 \n \n\n\n\n8 \n \n\n\n\nINTRODUCTION  \n \nMulti-disciplinary healthcare providers need to move beyond \ntask-based responsibility towards a more collaborative \napproach [1]. In the hospital setting, pharmacists and \nphysicians typically work in tandem with each other [2] and \nthe efficiency of interprofessional collaboration at the ground \nlevel will translate into better patient care and management.   \n \nChronic childhood diseases such as bronchial asthma demand \neffective multidisciplinary team management to improve \npatient care [3,4]. The medical paediatric team is naturally \nexpected to provide a holistic outpatient management for \nchildren with bronchial asthma, including detailed assessment \nof interval symptoms and revision of the asthma action plan \nwhenever necessary. However, in view of the growing clinical \nburden and patient load, the quality of medical review and \nconsultation is likely to be adversely affected to some degree \n[5]. \n \nTherefore, the Paediatric Respiratory Medication Therapy \nAdherence Clinic (PRMTAC) was established under the \ndiscretion of Pharmacy Department circa 2015 in Malaysia to \ncomplement the management of outpatient paediatric \nbronchial asthma patients. PRMTAC was primarily chartered \nto provide support in terms of clinical assessment of inhaler \ntechnique, review of medication, chamber care and providing \nclinical recommendation. Other key assessment points include \nthe assessment of the peak expiratory flow rate for older \nchildren, assessment of medication adherence, and confirming \nthe presence or absence of interval symptoms. \n \nDespite the fact that PRMTAC services essentially cover the \ncore clinical assessment in the management of outpatient \nbronchial asthma, physicians remain as the prescriber and the \ndecision-maker in clinical management. Thorough assessment \nfrom PRMTAC in turn provides insight [6] and assists the \nclinician in making a comprehensive decision with regards to \nmedical care [2]. However, the PRMTAC service was \nprovided separately, and communication with the prescriber \nwas maintained only through a feedback document. Such a \nwork process may open room for inadvertant interprofessional \nmiscommunication. \n \nTherefore, our study aimed to examine the interprofessional \ncollaboration between physicians and pharmacists in the \nmanagement of paediatric bronchial asthma, to explore the \nviews and experiences of both pharmacists and physicians on \nthe important aspects of PRMTAC and patient-centeredness, \nand to identify barriers to shared decision-making in the \nmanagement of paediatric bronchial asthma. \n \n \n\n\n\nMETHOD  \n \nThe study involved one-to-one, face-to-face interviews \ninvolving the paediatric medical team, and the pharmacists \nwho were directly involved with PRMTAC in Hospital \nTuanku Fauziah, Perlis, Malaysia. Individual session (Figure \nI) was conducted to encourage sharing of personal ideas that \nmay otherwise be deterred in a group interview. \n \n\n\n\nPotential participants were approached by the investigator and \nthe purpose of the study as well as how it would be conducted \nwere explained. Potential participants were given ample time \nto read through the participant information sheet and ask \nquestions. Upon agreement to participate, a different date, \ntime, and place for a meetup that was convenient for both the \ninvestigator and participant was scheduled. The consent form \nwas signed in the presence of the investigator before \nproceeding with the interview session.  \n \nThe semi-structured interview was guided by a list of \nquestions relevant to each profession with regards to the \nmanagement of outpatient paediatric bronchial asthma. Probes \nincluded, but were not limited to the performance of standard \nassessment of bronchial asthma, including the assessment of \ninhaler technique, peak expiratory flow rate, asthma control \nand interval symptoms, and medical advice and \nrecommendation. Participants were also encouraged to share \npersonal reflections related to their experiences in managing \npaediatric bronchial asthma patients. The session was \nconducted in either English or Malay, according to the \nparticipant\u2019s preference. Each session took an average of 45 \nminutes. A full audio recording  \n \n \n\n\n\n \n \nFigure I. Individual face-to-face interview setting \n\n\n\n\n\n\n\n\nKhalid K.et al. Mal J Pharm 8 (1) 2022, 7-12 \n \n\n\n\n9 \n \n\n\n\nwas used during the entire session for detailed data retrieval \nand verbatim transcription. \n \nThe session was deemed completed once all the probed \nquestions had reached the thematic conclusion. The \ntranscribed interview answer dialogues were then coded into \nspecific themes and were analysed to reach the research \nobjectives. \n \nRESULT  \n \nThree main themes emerged from the study:- (I) The \nrelevance and necessity of PRMTAC service to complement \npaediatric outpatient bronchial asthma management, (II) the \nlack of communication between pharmacist and physician in \noutpatient bronchial asthma management, and (III) the \nrecommendation for a combined clinic in the management of \noutpatient paediatric bronchial asthma.  \n \nOverall, this study included a total of seven participants, four \nof which were pharmacists who were actively involved in \nPRMTAC services, while the remaining three participants \nwere senior paediatric residents who had served at least five \nyears in the clinical department (Table I). \n \n\n\n\nTheme I: The relevance and necessity of PRMTAC service \nto complement paediatric outpatient bronchial asthma \nmanagement \n \nPRMTAC service was deemed as necessary for a holistic \npatient management, with services such as counselling, \nassessment of prophylactic adherence, asthma control, and \nassessment of inhaler technique being examples of services \noffered. Furthermore, it is exclaimed by participants that prior \nassessments from PRMTAC service saved time for the \npaediatric team during follow-up assessments without \ncompromising patient care. This is further illustrated in the \nfollowing responses: \n\n\n\n \n\u201c(PRMTAC service) is quite important. We assess the \ntechnique and explore compliance issues. Doctors may not \nhave enough time to monitor and assess the uses and the \ntechniques, overall causing patients to end up not receiving \nbenefits from it..\u201d [sic] (Subject 01, Pharmacist) \n \n\u201cIf patient are not using MDIs (Metered Dose Inhaler) with \nthe correct techniques, the disease will not get any better, and \nthe doctor may end up increasing the dose. I\u2019ve experienced \nhandling one patient who was prescribed seven puffs \nSalbutamol, but the techniques displayed were wrong. In \nreality, the patient merely needed four puffs.\u201d [sic] (Subject \n02, Pharmacist) \n \n\u201cOn a normal clinic day, I would see four to five patients per \nsession, I would spend 20 to 30 minutes per patient. Even \nthen, it was still not enough time to assess the patients \nthoroughly.\u201d [sic] (Subject 06, Paediatric resident) \n \nIt is also important to note that pharmacists are deemed better \nat probing and getting more information than doctors during \nconsultation. Patients are believed to be more open towards \npharmacists than doctors, as suggested by the following \nquotes:  \n \n\u201cPRMTAC is necessary. Sometimes, doctors would not have \nenough time to assess every patient. Sometimes when we \nassess patients in the clinic, we think that there is compliance \nissue, symptoms did not improve, so we want a second opinion \nfrom a pharmacist to re-assess the situation. Sometimes, \npatients do not openly discuss their problems with the doctors, \nbut they disclosed them to pharmacists. There were times \nwhen pharmacists were able to get more history than \ndoctors.\u201d [sic] (Subject 05, Paediatric resident) \n \nThere were also instances the pharmacists noted that the \nmedical team not been teaching the right techniques to the \npatients. Such incidents were typically encountered during in-\nward rounds with the paediatric medical team. \n \n\u201cSometimes the coordination of breath is wrong. You should \nempty your lung first. But sometimes, the doctor just ask \npatient to blow only without realizing patient is inhaling.\u201d \n[sic] (Subject 01, Pharmacist) \n \n\u201cMost of the time, the housemen will be instructed to teach \nthe MDI technique to the patient. It depends on the medical \nofficer whether he/she will supervise the housemen. Normally, \nif the housemen were senior enough, and since we trust their \ncapability, we would just freely let them do it. There had been \nno formal workshops or CMEs. We also learned from seniors, \nor during times when the in-ward pharmacists were teaching \n\n\n\nTable I. Study respondents \n \n\n\n\nSubject Profession Age \n(years) Gender Total number \n\n\n\nyears of service \n01 Pharmacist 35 M 11 \n02 Pharmacist 28 F 4 \n03 Pharmacist 32 F 7 \n04 Pharmacist 30 F 5 \n\n\n\n05 Paediatric \nresident 44 F 19 \n\n\n\n06 Paediatric \nresident 31 F 5 \n\n\n\n07 Paediatric \nresident 35 M 6 \n\n\n\n \n\n\n\n\n\n\n\n\nKhalid K.et al. Mal J Pharm 8 (1) 2022, 7-12 \n \n\n\n\n10 \n \n\n\n\nthe patients who were newly diagnosed.\u201d [sic] (Subject 07, \nPaediatric resident) \n \nTheme II: The lack of communication between pharmacist-\nphysician in outpatient bronchial asthma management \n \nBoth pharmacists and physicians unanimously agreed that the \nawareness of the availability of PRMTAC service could be \nimproved: \n \n\u201cThere were times when the number of referrals to PRMTAC \nwas very low, affecting our KPI.\u201d [sic] (Subject 04, \nPharmacist) \n \n\u201cOnly the same medical officers are referring patients to us.\u201d \n[sic] (Subject 02, Pharmacist) \n \n\u201cI would refer patients to PRMTAC when I suspect that the \ntechnique is wrong or compliance is an issue. On average I \nwould refer around 2-3 patients per month. But I don\u2019t think \nthe junior MOs are aware of PRMTAC\u201d [sic] (Subject 06, \nPaediatric resident) \n \nPharmacists were also in doubt whether the feedback form \nreturned to their paediatrics counterparts added any value to \nthe paediatrics\u2019 assessment. There had been an absence of \ndirect, physical interactions between pharmacist and \npaediatric team in the management of patients with bronchial \nasthma, and everything was done sequentially rather than \nsimultaneously. \n \n\u201cWe don\u2019t know whether or not our written feedbacks and \nsuggestion were read or even considered by the Paeds Team.\u201d \n[sic] (Subject 02, Pharmacist) \n \nAdditionally, there was one response from one of the \npharmacist respondents in this study regarding an aspect of \nthe paediatric medical team that could be improved upon:- \n \n\u201cSometimes patients\u2019 diagnoses were written as \n\u2018hypersensitive airway\u2019, I think they may need to be more \nspecific\u2026 such as by including other underlying diseases\u201d \n[sic] (Subject 01, Pharmacist) \n \nTheme 3: Recommendation for a combined clinic in the \nmanagement of outpatient paediatric bronchial asthma \n \nBoth pharmacists and paediatric teams on suggestions for a \ncombined clinic towards a more comprehensive medical care \nfor patients with bronchial asthma. Simultaneous assessment \nby both professionals will allow a more definitive approach \nand sharing of ideas between healthcare providers with a more \nefficient workflow. However, participants of this study \npointed out how ensuring the feasibility of a combined clinic \n\n\n\nwould require proper planning, especially in limited-resource \nfacilities. \n \n\u201cI would prefer a combined clinic. But the average number of \npatients would be more, so there would be a need to assign \nmore dedicated MO (medical officers), and more pharmacists \nwill need to be present also.\u201d [sic] (Subject 01, Pharmacist) \n\u201cIf the pharmacists can be present during medical \nconsultation, it would be better. We would also like to know \nabout the information that had been counselled and assessed \non. I think that the delivery of services would be more efficient \nthat way. As of now, the patient would go there first to see \npharmacist, before coming to us. So we can only refer to the \npharmacy notes provided.\u201d [sic] (Subject 05, Paediatric \nresident) \n \n\u201cSince we are seeing patients separately from the Paeds, \ncommunication is difficult. The establishment of a combined \nclinic would ease this, we would be closer to the prescribers \nto discuss any relevant issues. But pharmacists needed in \ngreater number, and they need to be allocated on specific \ndays for such asthma patients. Now, our PRMTAC is run \nduring the afternoon session, one day per week. It would be \nbetter for us to offer such services during the morning session. \n[sic] (Subject 04, Pharmacist) \n \n\u201cDuring the pandemic, a virtual counselling session may be \nconsidered. There is a recently published guideline from \nMOH since last January. However, we would still need to \naddress the available resources and find ways to link up with \nthe Paeds team.\u201d [sic] (Subject 03, Pharmacist) \n \nFurther recommendations with regards to outpatient \nassessment of paediatric bronchial asthma patients were \nsuggested:  \n \n\u201cI agree that, most of the time, assessments by the Paeds were \ninadequate due to the sheer patient load at any given clinic \nsession. But, it should be the responsibility of the doctors to at \nleast assess the PEF and techniques during consultation. \nThere should be a formal guideline, specifying \u2018this is what \nyou should do in clinic\u2019, or \u2018this is what should be written in \nreport\u2019. We can probably come up with a specific guideline, \nlike a checklist to be used in the clinic, something simple to \noptimise the time efficiency.\u201d [sic] (Subject 05, Paediatric \nresident) \n \n\u201cPRMTAC review follow-up should be more stringent. We \nkept losing patients. There had also been no guidelines on \nwhich areas to comment or emphasize on when counselling. \nThere had also been no credentialing and privileging \nprogram for PRMTAC officers.\u201d [sic] (Subject 02, \nPharmacist) \n \n\n\n\n\n\n\n\n\nKhalid K.et al. Mal J Pharm 8 (1) 2022, 7-12 \n \n\n\n\n11 \n \n\n\n\n \n \n \nDISCUSSION \n \nPRMTAC services were rated as highly relevant in the \nmanagement of outpatient bronchial asthma among all study \nrespondents, irrespective of profession. The detailed \nassessment of medication compliance, which may be affected \nby complex regimens or inadequate instructions [2,3] and the \ntechnical demonstration provided by PRMTAC services were \ndeemed fundamental in holistic patient care [7], particularly in \ncases of poorly controlled and partially controlled asthma.  \n \nPRMTAC session typically oversees fewer patients as \ncompared to the medical follow-up, hence were able to \nengage better with patients and establish better \ncommunication and rapport, which is fundamental in patient \ncare [8]. PRMTAC service acts as an extra safety check in the \nsystem [7,9] as it also assesses inhaler technique and \nmedication compliance, improves disease control, identifies \ntriggering factors, and assesses peak expiratory flow rates in \nolder children.  \n \nPharmacists in-charge of PRMTAC service should be \ncredentialed and accredited. Certain sets of requirements and \nworkshops need to be instituted to credential them as part of \nthe PRMTAC team as it requires skills to perform PRMTAC \nservices [10]. PRMTAC service should be considered as a \nspecialized form of MTAC. The first reason is that the process \nof dealing with paediatric patients requires certain soft skills \nto enable mutual interaction. Secondly, besides assessing \nmedication adherence and disease control through interval \nsystem scores and peak expiratory flow rates, pharmacists \nshould also be well-versed with the use of different types of \ninhalers and choice of medications, as well as the proper \ntechnique and care of different chamber brands. Indeed, it has \nbeen suggested based on the literature that such specialized \nskills need to be acquired by pharmacists delivering \nPRMTAC services [3]. \n \nThe current clinical scenario demonstrates that the pharmacist \nand paediatric medical team works independently and in \nparallel [2], rather than collaboratively. Such workflow \nchallenges shared decision-making with regards to patient-\nfocused medication. The lack of physical interaction between \npharmacist and physician also impedes sharing of ideas and \nnew knowledge [2,6] that could benefit both parties in relation \nto the current and updated management of outpatient \nbronchial asthma. A combined clinic was unanimously \nsuggested to remedy this. \n \nA combined clinic would suggest the simultaneous presence \nof multiple subspecialties or related professions providing \n\n\n\ninformed and comprehensive medical decisions regarding \npatient care [1,4]. Indeed, a combined clinic is routine in the \nmedical setting in patients with complex medical illness \nrequiring multiple views from each managing team. \nTherefore, in the setting of the outpatient management of \npaediatric bronchial asthma, the establishment of a combined \nclinic may resolve certain issues related to interprofessional \nmiscommunication, an issue that was highlighted in our study. \nHowever, allocation of resources whilst considering \nfeasibility, manpower, and logistics, should be carefully \nconsidered to minimize inefficiency and instances of poor \nexecution. \n \nCONCLUSION  \n \nProper planning regarding allocation of support system and \nmobilisation of human resources needs to be instituted to \nrealise the implementation of a nationwide combined clinic in \nthe management of paediatric bronchial asthma.  \n \nRegular continuous medical education (CME) sessions are \nrecommended for healthcare workers involved in the \nmanagement of outpatient bronchial asthma to inform them of \ncurrent updates with regards to any breakthroughs in clinical \nmanagement. \n \nACKNOWLEDGEMENT \n  \nThe authors would like to thank the Director General of \nHealth Malaysia for his permission to publish the paper. 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J Eval Clin Pract \n[Internet]. 2020 Dec 1 [cited 2021 May 31];26(6):1638\u201347. \nAvailable from: https://doi.org/10.1111/jep.13346 \n\n\n\n[9] Mehuys E, Van Bortel L, De Bolle L, Van Tongelen I, Annemans L, \nRemon JP, et al. Effectiveness of pharmacist intervention for asthma \ncontrol improvement. Eur Respir J [Internet]. 2008 Apr 1 [cited 2021 \nMay 31];31(4):790\u20139. Available from: \nhttps://doi.org/10.1183/09031936.00112007 \n\n\n\n[10] Elaro A, Bosnic-Anticevich S, Kraus K, Farris KB, Shah S, Armour \nC, et al. Pharmacists\u2019 perspectives of the current status of pediatric \nasthma management in the U.S. community pharmacy setting. Int J \nClin Pharm [Internet]. 2017 Aug 1 [cited 2021 May 31];39(4):935\u2013\n44. Available from: https://doi.org/10.1007/s11096-017-0471-1 \n \n\n\n\n\n\n"
"\n\n\n\n\n\ni \n\n\n\n\n\n\n\n \n \nMALAYSIAN \n\n\n\nJOURNAL of PHARMACY \n\n\n\n \nSupplement: \n\n\n\nProceedings of the 9th National Pharmacy R&D \n\n\n\nConference 2016 \n\n\n\n\n\n\n\n\n\n\n\n \n \n \n \nA Publication of the Malaysian Pharmaceutical Society \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nVol. 2 Issue 2. August 2016 \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n                      PP12684/8/2008 \n\n\n\nVol.3 Issue 1. November 2017 \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n  MALAYSIAN \n\n\n\n  JOURNAL of PHARMACY \n\n\n\n\n\n\n\n \n       In this issue: \n\n\n\n\n\n\n\n\n\n\n\n        Exploration of EQ-5D-5L Bolt-On Items among    \n\n\n\n                                                                                                Malaysian Population \n               \n\n\n\n              Supplement \n\n\n\n\n\n\n\nProceedings of the 13th MPS Pharmacy Scientific \n\n\n\nConference \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nA Publication of the Malaysian Pharmaceutical Society \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\nii \n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\ni \n\n\n\nEDITORIAL BOARD \n \nMalaysian Journal of Pharmacy \n\n\n\nVol.3 Issue 1, November 2017 \n\n\n\n___________________________________________________________________ \n\n\n\n\n\n\n\nThe Official Journal of the Malaysian Pharmaceutical Society \n\n\n\n\n\n\n\nEditor-in-Chief:   Assoc Prof Dr Asrul Akmal Shafie \n\n\n\n\n\n\n\nManaging Editor:  Mr Ho Rhu Yann \n\n\n\n\n\n\n\nInternational Advisory Board: Assoc Prof Dr Chua Siew Siang \n\n\n\n    Prof Dr Mohd Baidi Bahari    \n\n\n\n\n\n\n\nAssociate Editors:  Mr Lam Kai Kun \n\n\n\n                                                   Prof Dr Mohamed Azmi Ahmad Hassali \n\n\n\n                                                   Assoc Prof Dr Mohamad Haniki Nik Mohamed \n\n\n\n                                                  Ms Syireen Alwi \n\n\n\n                                                     Prof P T Thomas \n\n\n\n                                                    Dr Wong Tin Wui \n\n\n\n                                               Assoc Prof Dr Vikneswaran a/l Murugaiyah \n\n\n\n                                                    Prof Dr Yuen Kah Hay \n\n\n\n\n\n\n\n\n\n\n\nPublisher: \n\n\n\n\n\n\n\nMalaysian Pharmaceutical Society   \n16-2 Jalan OP 1/5, 1-Puchong Business Park \n\n\n\nOff Jalan Puchong \n\n\n\n47160 Puchong \n\n\n\nMalaysia \n\n\n\nTel: 6-03-80791861 \n\n\n\nFax: 6-03-80700388 \n\n\n\nHomepage: www.mps.org.my \n\n\n\nEmail: mps.online@gmail.com \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nThe Malaysian Journal of Pharmacy is a publication of the Malaysian Pharmaceutical Society. Enquiries \n\n\n\nare to be directed to the publisher at the above address. The Publisher reserves copyright and renewal \n\n\n\non all published materials, and such material may not be reproduced in any form without the written \n\n\n\npermission of the Publisher. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n9  \n \n\n\n\n\n\n\n\n\n\n\n\n\nii \n\n\n\nTable of Contents \n\n\n\n \nAcknowledgement iii \n\n\n\nReviewers of abstract iii \n\n\n\nEditorial iv-v \n\n\n\nResearch Paper: Exploration of EQ-5D-5L Bolt-On Items among Malaysian Population 1-13 \n\n\n\nList of oral presentations 14-15 \n\n\n\nAbstracts of oral presentation 16-40 \n\n\n\nList of poster presentations 41-44 \n\n\n\nAbstracts of poster presentation 45-79 \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\niii \n\n\n\nABSTRACTS OF THE 13th MPS PHARMACY SCIENTIFIC CONFERENCE 2017 \n \n\n\n\nAcknowledgement \n \n\n\n\nThe editorial board would like to thank the Director General of Health, Malaysia for permission to \n\n\n\npublish the abstracts in this journal. \n\n\n\n\n\n\n\n\n\n\n\n50 & Fabulous: Looking back on the journey, embracing the future \nDate: 3-5th November 2017 \n\n\n\n\n\n\n\n\n\n\n\nReviewers of Abstract \n \n\n\n\nDr. Baharudin Ibrahim  \n\n\n\nDr. Lim Ching Jou  \n\n\n\nDr. Lee Chong Yew  \n\n\n\nDr. Nur Hidayah Kaz Abdul Aziz  \n\n\n\nDr. Chong Chee Ping  \n\n\n\nMr Abubakar Sha'aban \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\niv \n\n\n\nEditorial  \n\n\n\n50 & Fabulous: Looking back on the journey, embracing the future \n\n\n\nTye Sok Cin1, Tangiisuran B1,2* \n1 School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 USM, Penang, Malaysia \n2 Pusat Racun Negara, Universiti Sains Malaysia, 11800 USM, Penang, Malaysia \n\n\n\n*Contact for correspondence, please email: bala@usm.my \n\n\n\n\n\n\n\n\u201cWhat is past is prologue.\u201d The famous quote by Shakespeare reminds that, one should study the past \n\n\n\nin order to best anticipate and be prepared for the future. As a frontline pharmacist, we should constantly \n\n\n\nask ourselves a few questions: What are the characteristics of the past we should honor? What can we \n\n\n\nlearn from the present? What parts of the future should we embrace? By embarking on a career in \n\n\n\npharmacy, each of us has joined an ancient and honourable profession that deals with the latest, up-to-\n\n\n\ndate technological advances for the benefit of mankind. \n\n\n\nFirst, let\u2019s examine the past. Pharmacy service was officially established  in Malaysia since 1951 with \n\n\n\nimplementation of the Registration of Pharmacist Act 1951, Poisons Act 1952 and Dangerous Drugs \n\n\n\nAct 1952.1 Malaysian Pharmaceutical Society was subsequently formed and registered with the \n\n\n\nRegistrar of Societies on 6th Nov 1967.2 Due to the shortage of pharmacist in the country, compulsory \n\n\n\nservice was introduced in the public sector  in 2003 which was later enforced in 2nd September 2004 \n\n\n\nthrough the amendment to the regulations of the Registration of Pharmacists Act 1951.3 Pharmacy \u2013 the \n\n\n\nscience and technique of preparing and dispensing drugs and medicines, has undergone transformation \n\n\n\nover the years, evolving itself from a product-oriented to a patient-oriented profession by the mid 1960s. \n\n\n\nIn the 1990\u2019s, the concept of Pharmaceutical Care was introduced by Helper and Strand. The touchstone \n\n\n\nof this approach was that, pharmacist should accept responsibility in assisting patients to obtain the very \n\n\n\nbest outcomes from their use of medications. This marked the beginning of a period of rapid transition \n\n\n\nonto clinical pharmacy services that was characterized by an expansion and integration of professional \n\n\n\nfunctions, as well as increased professional diversity and closer interaction with physicians and other \n\n\n\nhealth care professionals.  \n\n\n\nThe present - On the brink of another major milestone, the streamlining and integration of modern \n\n\n\ntechnology allows improved workflow for pharmacists practicing in various settings including \n\n\n\ncommunity, hospital, industry, academia and others. Regardless of the site of practice, taking a patient \n\n\n\ncentred approach to optimise medication should be priority. For examples, in industrial \n\n\n\npharmacy, the manufacture, regulation, and promotion of medicines is targeted on improving \n\n\n\npatient safety. The introduction of new pharmacy services, including the initiation of smoking \n\n\n\ncessation services and various Medication Therapy Adherence Clinics (MTAC) by the Pharmaceutical \n\n\n\nServices Division, Ministry of Health Malaysia across nationwide ambulatory settings is a proof that \n\n\n\npharmacists are able to work in collaboration with other healthcare professionals. These services are \n\n\n\nbeneficial in preventing and managing ill-health among general population and also among special \n\n\n\npopulations such as older person and patients with complex needs through the optimisation of the \n\n\n\nmedication management.  \n\n\n\nNext, the future. In view of the rising trends of non-communicable diseases, antibiotic resistance and \n\n\n\ngrowing baby boomers across the globe, there is a need for astute strategic planning for pharmacist to \n\n\n\nwork in collaboration across settings. In addition, we should recognize our strength as a group and \n\n\n\nprovide services valued by the public and other healthcare professionals. Contemporary and future \n\n\n\npharmacists must possess specific knowledge, attitudes, skills, and behaviours in support of their roles \n\n\n\nthrough continuous education. Pharmacist certification could be implemented through a coordinated \n\n\n\nnational certification board. We should prepare ourselves to transform and maximize technological \n\n\n\n\nmailto:bala@usm.my\n\n\n\n\n\n\n\n\n\n\nv \n\n\n\nadvances and progress toward digital pharma, telepharmacy, gene based therapy and individualized \n\n\n\nmedicine.  \n\n\n\nIn summation, transformation in the pharmacy workforce over the coming years should focus on \n\n\n\npatients as the center of all the pharmacists do, by promoting proactive, compassionate pharmaceutical \n\n\n\ncare and encouraging professionals, services and organizations to work together.  \n\n\n\n\n\n\n\nReferences \n\n\n\n1. Our History. Pharmaceutical Services Divisions. https://www.pharmacy.gov.my/v2/en/content/our-\n\n\n\nhistory.html. Accessed October 20, 2017. \n\n\n\n2. Malaysian Pharmaceutical Society. \n\n\n\nhttp://www.mps.org.my/newsmaster.cfm?&menuid=37&action=view&retrieveid=3177. Accessed \n\n\n\nMay 6, 2017. \n\n\n\n3. Registration of Pharmacists Act 1951 and Regulations. Pharmaceutical Services Divisions. \n\n\n\nhttps://www.pharmacy.gov.my/v2/en/documents/registration-pharmacists-act-1951-and-\n\n\n\nregulations.html. Accessed October 21, 2017. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n1 \n\n\n\nEXPLORATION OF EQ-5D-5L BOLT-ON ITEMS AMONG MALAYSIAN POPULATION \n\n\n\n\n\n\n\nThakumar AV1, Shafie AA1*, Lim CJ1 \n1Discipline of Social & Administrative Pharmacy, Universiti Sains Malaysia, Penang, Malaysia. \n* Contact for correspondence, please email: aakmal@usm.my \n\n\n\nABSTRACT \n\n\n\nThis study aimed to assess the adequacy of EQ-5D-5L in defining health as perceived by Malaysians \n\n\n\nusing a mixed methodology approach. Potential additional dimensions (i.e. bolt-on items) to supplement \n\n\n\nthe current instrument were also explored. This study was carried out in two phases. In phase one, focus \n\n\n\ngroup discussions (N = 6-8 in each group) were employed to gauge the perception of Malaysians on the \n\n\n\ndimensions deemed important additions to the EQ-5D-5L instrument. Phase two involved further \n\n\n\nvalidation of bolt-ons to the EQ-5D-5L using a cross-sectional survey of 100 general public in Penang, \n\n\n\nMalaysia. A total of 11 bolt-ons were identified from phase 1. These bolt-ons were sleep, vitality, \n\n\n\nhappiness, close relationships, stress, mental abilities, social support, religion, vision, hearing, and \n\n\n\nspeaking.  In phase 2, the bolt-ons of \u2018vitality\u2019 and \u2018stress\u2019 stood out with 70% (n=70) and 64% (n=64) \n\n\n\nparticipants reported facing most problems with, respectively. Both phases of study suggest that \n\n\n\nadditional dimensions for the existing EQ-5D-5L instrument may be useful to better capture the HRQoL \n\n\n\namong Malaysians. Larger scale study is warranted to further validate the bolt-ons identified in this \n\n\n\nstudy.  \n\n\n\nKeywords: Health-related quality of life, EQ-5D-5L, bolt-on, health dimensions \n\n\n\nINTRODUCTION \n\n\n\nHealth-related quality of life (HRQoL) instruments offer a way to measure patient-reported outcomes \n\n\n\nin addition to existing clinical indicators for a more wholesome assessment of a person\u2019s well-being \n\n\n\n(1). Currently, these instruments are widely applied in economic valuations, besides quantifying the \n\n\n\neffectiveness of medical treatments, and monitoring patients\u2019 medical progress (2).  \n\n\n\nOne of the most commonly used generic HRQoL measures is the EuroQol five-dimensional \n\n\n\nquestionnaire (EQ-5D). The EQ-5D instrument comprises five dimensions, namely mobility, self-care, \n\n\n\nusual activities, pain/ discomfort and anxiety/depression (3). The EQ visual analogue scale (EQ-VAS) \n\n\n\nusually accompanies the 5 earlier questions and measures general health on a thermometer-like scale \n\n\n\nfrom 0 (worst possible health imaginable) to 100 (best possible health imaginable) (4). Designed with \n\n\n\nsimplicity in mind, the original EQ-5D has three levels (known as EQ-5D-3L) of severity ranging from \n\n\n\n\u2018no problem\u2019 to \u2018unable to\u2019 perform a specific task. However, having suffered from ceiling effects (5, \n\n\n\n6), a newer version with five levels of severity (EQ-5D-5L) has been introduced since 2009 (7).  \n\n\n\nIn tandem with the growth of health technology assessment in Malaysia, the application of the EQ-5D-\n\n\n\n5L instrument has been increasingly utilised in the country (8). Importantly, the concept and application \n\n\n\nof HRQoL, being subjective in nature, has shown to be influenced by both culture and socioeconomic \n\n\n\nstatus (9, 10), and these differences may extend between the context of Malaysia and the European \n\n\n\ncountries in which the instrument was originally developed. A recent study (11) conducted on the data \n\n\n\nof 51 countries of the World Values Survey indicated that self-reported health is indeed associated with \n\n\n\ncultural values that differ between countries. Therefore, the dimensions included in the EQ-5D-5L \n\n\n\ninstrument, which was developed and catered to the European population, may not truly reflect how \n\n\n\nAsians choose to define health. \n\n\n\nHaving a HRQoL tool that fits the need of the local population would mean that the scope of dimensions \n\n\n\nchosen reflects the definition of health as a population. HRQoL tools that functions alternatively as \n\n\n\npreference-based measures, such as the EQ-5D-5L can be used to generate health utilities. These health \n\n\n\nutilities sum up the values of the dimensions to quantify the value of health. Consequently, patient-\n\n\n\nreported outcome measures (PROM), including the EQ-5D-5L must quantify health with only a selected \n\n\n\nnumber of health dimensions before becoming too burdensome on respondents. The choice of HRQoL \n\n\n\ndimensions to include in an instrument has far reaching implications, especially when used in economic \n\n\n\nevaluations. Health utilities that fail to reflect the true health concerns of a population will not be \n\n\n\neffective as outcome variables in quantifying or comparing benefits of different treatment approaches. \n\n\n\nIn the initial stages of development, the interpretation and perception of the five health dimensions of \n\n\n\nEQ-5D-5L instrument were tested qualitatively in focus groups in different European populations (12), \n\n\n\n\n\n\n\n\n\n\n\n\n2 \n\n\n\nsignifying that the dimensions chosen are suitable for the European populations. To date, there is no \n\n\n\nqualitative study done to determine how Asian populations (including Malaysians), perceive the \n\n\n\ndimensions of the EQ-5D-5L instrument and whether the scope of HRQoL fits the need of the local \n\n\n\npopulation.  \n\n\n\nTherefore, assessing the perception of Malaysians about the use of EQ-5D-5L will be timely to guide \n\n\n\nthe application of this instrument. Furthermore, exploring additional dimensions  (commonly known as \n\n\n\nbolt-ons) (13) that can supplement the EQ-5D-5L instrument will be useful to  better capture the HRQoL \n\n\n\nneeds of the Malaysian population. This study aimed to assess the adequacy of the EQ-5D-5L in \n\n\n\ndefining health as perceived by Malaysians using a mixed methodology approach. Specifically, a \n\n\n\nqualitative approach was applied to study the perception of Malaysians on the EQ-5D-5L and EQ-VAS \n\n\n\nin describing the HRQoL and to explore potential bolt-ons to complement the existing EQ-5D-5L \n\n\n\ninstrument and subsequently, a quantitative approach was used to explore the suitability of the bolt-ons.  \n\n\n\nMETHODS \n\n\n\nThis study was divided into two phases. Focus group discussions were held in the first phase with the \n\n\n\naims to gauge the perception and understanding of Malaysian population on the original EQ-5D-5L \n\n\n\ninstrument and subsequently, to explore additional dimension(s) (if any) to strengthen the instrument. \n\n\n\nIn the second phase, the effects of bolt-ons (based on findings in phase 1) to the EQ-5D-5L descriptive \n\n\n\ninstrument were further studied. Ethics approval has been granted by the Malaysia Medical Research \n\n\n\n& Ethics Committee (ID NMRR-13-1377-18574). \n\n\n\nStudy Population and Setting \n\n\n\nIn phase 1, focus groups comprised of 6 to 8 participants each, were conducted. The inclusion criteria \n\n\n\nfor participant recruitment were Malaysians aged between 30 and 50 years who were able to converse \n\n\n\nin Malay or English. Participants were recruited via purposive sampling to ensure that the final cohort \n\n\n\nhad a healthy mix of different gender, ethnicity and age, whilst adhering to the inclusion criteria and \n\n\n\nwritten consents were also obtained. The focus groups were held in Universiti Sains Malaysia, Penang. \n\n\n\nA semi-structured interview guide was used in the discussion and the number of focus groups conducted \n\n\n\nwas determined by data saturation. Topics of discussion included understanding of the five dimensions \n\n\n\nin the EQ-5D-5L, factors influencing the EQ-VAS scores, and any other aspects perceived to affect \n\n\n\ntheir definition of health and HRQoL. Both sessions were conducted in a mix of the Malay and English \n\n\n\nlanguages to facilitate delivery of ideas where participants were informed that they could speak their \n\n\n\npreferred language and each session was audio recorded.  \n\n\n\nPhase 2 of the study was a cross-sectional survey that involved 100 conveniently sampled general \n\n\n\npublic. Malaysians aged 18 years and above, and were able to speak or write in Malay or English were \n\n\n\nrecruited. The questionnaire was self-completed by the respondents and assistance was provided when \n\n\n\nclarification was required. The questionnaire consisted of five parts, namely socio-demographic \n\n\n\ninformation, self-reported health using EQ-5D-5L descriptive instrument, bolt-ons structured in the \n\n\n\nsame manner as the EQ-5D-5L descriptive instrument (identified from Phase 1) (APPENDIX 1), EQ \n\n\n\nvisual analogue scale (EQ-VAS), and the ease of understanding of the EQ-5D-5L and bolt-ons using a \n\n\n\n5-point Likert type scale (1= very easy to understand, 5= very difficult to understand) (as shown in \n\n\n\nAppendix). The questionnaire was available in both Malay and English languages. \n\n\n\nData Analysis \n\n\n\nThe focus group audio recordings were independently transcribed verbatim by two researchers and \n\n\n\ncrosschecked for inconsistency. The finalized transcriptions were analysed for emergent themes using \n\n\n\nthe framework approach, as described elsewhere (14). Basically, the framework approach involves \n\n\n\nsystematically summarizing the data of the transcript into a framework matrix to facilitate clear \n\n\n\ninterpretation of underlying themes or concepts. All co-investigators were involved in discussing to \n\n\n\nreach a consensus on themes, codes, and representative quotes.  \n\n\n\nDescriptive analysis was applied in phase 2. The frequencies and percentages of all variables, together \n\n\n\nwith mean and standard deviation of continuous variables were presented in table forms.  Chi-square \n\n\n\ntest was used to test the relationship between various categorical socio-demographic variables and the \n\n\n\nease of understanding of each dimension, Fisher\u2019s Exact Probability Test for 2 x 2 tables with \n\n\n\nfrequencies less than 10, while Mann-Whitney test was applied for continuous variables. The ease of \n\n\n\nunderstanding responses of each dimension was grouped into two, those who answered \u201cvery easy\u201d or \n\n\n\n\n\n\n\n\n\n\n\n\n3 \n\n\n\n\u201ceasy\u201d and those who answered \u201cmoderate\u201d or higher. Data were analysed using SPSS Statistics version \n\n\n\n22 (IBM, Illinois) and p-value of < 0.05 was considered statistically significant. \n\n\n\nRESULTS  \n\n\n\nPhase 1: Focus Group Discussions \n\n\n\nData saturation was reached after two intensive discussion sessions. The recruited participants \n\n\n\ncomprised a mix of the major races in the Malaysian population i.e. Malay, Chinese, and Indian (Table \n\n\n\n1). Each focus group lasted for about one and a half hour. Opinions expressed in Malay were later \n\n\n\ntranslated to English and face validated by a native speaker investigator prior to data analysis. \n\n\n\nThree themes were identified in phase 1: \n\n\n\ni) Understanding about EQ-5D-5L  \n\n\n\nGenerally, the participants found all five dimensions in EQ-5D-5L were easy to comprehend. The \n\n\n\nmobility dimension was generally interpreted as only walking abilities as stated in the severity \n\n\n\ndescriptions of the dimension in the instrument,  \n\n\n\n\u201cLooking from the statements, it is already written here problems with walking, so I presume that \n\n\n\nmobility (dimension) refers to walking. So, I am answering the question based on the word \u2018walking\u2019 \n\n\n\n(abilities) and not the general word of mobility.\u201d (Female, 31, Chinese)  \n\n\n\n\n\n\n\nTable 1: Phase 1 study sample characteristics (n=14) \n\n\n\nVariables                                                                            n % \n\n\n\nAge (years), mean (SD), range   39.1 (7.4), (30-49) \n\n\n\nNumber of participants   \n\n\n\n Focus group One 8 57.1 \n\n\n\nFocus group Two 6 42.9 \n\n\n\nGender \n \n\n\n\n\n\n\n\nMale 7 50.0 \n\n\n\nFemale 7 50.0 \n\n\n\nEthnicity \n \n\n\n\n\n\n\n\nMalay 5 35.7 \n\n\n\nChinese 5 35.7 \n\n\n\nIndian 4 28.6 \n\n\n\nReligion   \n\n\n\nMuslim 6 42.9 \n\n\n\nBuddhist 2 14.3 \n\n\n\nHindu 3 21.4 \n\n\n\nNone/ did not disclose 3 21.4 \n\n\n\nEducation Level \n \n\n\n\n\n\n\n\nSecondary school 5 35.7 \n\n\n\nMatriculation/ STPM/ Diploma 1 7.1 \n\n\n\nCollege/ University 8 57.1 \n\n\n\nEmployment Status   \n\n\n\nEmployed 10 71.4 \n\n\n\nHouse caretaker 2 14.3 \n\n\n\nRetired 2 14.3 \n\n\n\nMarital Status \n \n\n\n\n\n\n\n\nMarried 13 92.9 \n\n\n\nWidowed 1 7.1 \n\n\n\nHousehold Income \n \n\n\n\n\n\n\n\nLess or equal to RM 1,500 4 28.5 \n\n\n\nRM 1,501 - RM 3,000 5 35.7 \n\n\n\nRM 3,001 - RM 4,500 1 7.1 \n\n\n\nRM 4,501 - RM 6,000 1 7.1 \n\n\n\nRM 6,001 - RM 7,500 3 21.4 \n\n\n\n\n\n\n\n\n\n\n\n\n4 \n\n\n\nThe self-care dimension was interpreted by most respondents as the ability to carry out one\u2019s basic and \n\n\n\ndaily activities,  \n\n\n\n\u201cTo me, the second dimension (self-care) describes the ability of a person to care for himself. That is \n\n\n\nwhat I understand. Whether a person is able to perform his daily activities independently or whether \n\n\n\nhe needs assistance or not in terms of bathing, wearing clothes, cleaning\u2026\u201d (Male, 33, Malay) \n\n\n\nParticipants perceived the usual activities dimension as their daily routines,  \n\n\n\n\u201cUsual activities are things such as going to and coming back from work. Seems like that. Activities \n\n\n\nthat we usually perform daily.\u201d (Male, 32, Malay) \n\n\n\nComparatively, more respondents were facing problems themselves in the dimension of pain/discomfort \n\n\n\nand anxiety/depression and therefore were explaining their own experiences in facing those health \n\n\n\nissues. The pain/ discomfort dimension was perceived to encompass either physical discomforts or \n\n\n\npains,  \n\n\n\n\u201cThe (dimension) that is having pain, a slight pain. I just twisted my back because of hiking or \n\n\n\nsomething else. I\u2019m not too sure. Yeah, so I have got some slight discomfort.\u201d (Male, 48, Chinese) \n\n\n\nNearly all participants associated anxiety/depression dimension as having the feeling of worry due to \n\n\n\nstressful life events, \n\n\n\n\u201c\u2026my son just coming home from hospital (after a dengue infection). He is going to sit for an exam \n\n\n\ntomorrow. So, I am worried about his health. He is not fit yet. So I am just worried and then Deepavali \n\n\n\nis around the corner. So with all this, I am a housewife and I am also working, so the (whole thing) is \n\n\n\nstressful.\u201d (Female, 48, Indian) \n\n\n\nii) Factors influencing the score of EQ-VAS \n\n\n\nOne of the key factors affecting the rating of EQ-VAS was the existing environmental problem, \n\n\n\n\u201cI score 50 for today because of the haze and cough. As for the kids, they will also be having the cough \n\n\n\ncausing their health to become worse.\u201d (Male, 33, Indian) \n\n\n\n\u201cI scored 70 because of the terrible haze last week. Everything is related to haze. For example, when I \n\n\n\nwanted to do some outdoor activities, like playing ball in the open air, the breathing is badly affected. \n\n\n\nIt\u2019s bad.\u201d (Male, 32, Malay) \n\n\n\nWhilst some of the participants rated their EQ-VAS score based on measurable HRQoL factors such as \n\n\n\nobtaining sufficient sleep or having physical pains after vigorous sports, others chose to rate their health \n\n\n\nbased on being able complete unfinished business or spend quality time with family, \n\n\n\n\u201cI rate my scale as 85 because we had Eid holidays and I was able to spend a lot of quality time with \n\n\n\nmy child and wife.\u201d (Male, 32, Malay) \n\n\n\niii) The concept and dimensions of \u2018health\u2019  \n\n\n\nThe participants were asked to define \u201chealth\u201d and discuss about various aspects affecting their health. \n\n\n\nInterestingly, the majority of the participants emphasized on the importance of the mental and social \n\n\n\naspects in defining good health, \n\n\n\n\u201cIf you\u2019re mentally not healthy, then you will easily commit suicide, and you will still not be in a \n\n\n\ncomplete health state. In terms of social, we need to interact with people. Only we interact with people \n\n\n\nthen we share our problems, (receive) encouragement from peers. That definitely will help to build the \n\n\n\nmore complete health state. So I think both elements (mental and social) are important.\u201d (Female, 33, \n\n\n\nChinese) \n\n\n\nBesides, there were others who stressed upon the spiritual aspect in affecting people\u2019s health,  \n\n\n\n\u201cOkay, to me, an individual has to be healthy from the inside, spiritually. Viewing from a Muslim \n\n\n\nperspective, when we pray or read the Quran, so, the inner self will reflect our outer self. Being loyal \n\n\n\nto God will allow us to be healthier and calmer.\u201d (Male, 33, Malay) \n\n\n\n\u2018Sleep\u2019 was also commonly deemed as an important dimension to influence health, with participants \n\n\n\nsharing their experience of developing chronic diseases and nervous breakdowns as a result of lacking \n\n\n\nsleep,  \n\n\n\n\u201cI put sleep as number one because if you don't get enough sleep, the disease will just break in. \n\n\n\nHypertension, heart attack... And all this start from the sleep, don't have enough rest and even with a \n\n\n\nlittle bit of tension you cannot handle because the brain is too tired.\u201d (Female, 48, Indian) \n\n\n\n\n\n\n\n\n\n\n\n\n5 \n\n\n\nThe feeling of stress, especially due to the workload and uncompleted tasks was prevalent among some \n\n\n\nparticipants. The stress often affects health in a negative way, \n\n\n\n\u201cFeeling unhealthy because of stressing up with work...Or anything else that you have unfinished \n\n\n\nbusiness. Then you feel unhappy with the thing until you complete it or at least attempt to complete it.\u201d \n\n\n\n(Male, 36, Indian) \n\n\n\nSocial support was perceived by a number of participants as another influential factor affecting health \n\n\n\nas it helps people overcome the stresses of daily living, \n\n\n\n\u201c... and social support has to be there to support everybody to take through their daily living so if you \n\n\n\ncan\u2019t do daily living properly, then you are going to get stressed and back to the same circle certainly.\u201d \n\n\n\n(Male, 36, Indian) \n\n\n\nFactors that have been deemed important to influence HRQoL by two or more participants were then \n\n\n\nconsidered as bolt-ons. In total, 11 bolt-ons were identified include sleeping, social support, vitality, \n\n\n\nhappiness, close relationships, stress, mental abilities, religion, vision, hearing, and speaking. These \n\n\n\nwere further tested in phase 2. \n\n\n\n\n\n\n\nPhase 2: Bolt-On Survey  \n\n\n\nThe demographics of the 100 participants are shown in Table 2. 95% of the survey participants claimed \n\n\n\nthat their comprehension level of the EQ-5D-5L descriptive instrument with bolt-ons ranged between \n\n\n\n1 (very easy to understand) to 2 (easy) of the 5-point Likert scale, and no one reported a comprehension \n\n\n\nlevel of higher than 3 (moderate).  \n\n\n\nIn general, responses of moderate on the bolt-on descriptive instrument tended to come from those \n\n\n\nwhose highest educational qualification was pre-university level (matriculation/STPM/diploma), male \n\n\n\ngender. No obvious trend was observed for age, marital status, income, and household number. \n\n\n\nHowever, no statistical significance was reached on the test of associations on all the bolt-on \n\n\n\ndimensions. In the original EQ-5D-5L dimensions, similar trends were observed, and none of the \n\n\n\nsociodemographic variables were statistically associated to the responses, except gender where only \n\n\n\nmales reported moderate ease of comprehension. \n\n\n\n\n\n\n\n\n\n\n\n\n6 \n\n\n\n\n\n\n\nTable 2: Phase 2 study sample characteristics (n=100)  \n\n\n\nVariables  n \n\n\n\nLanguage   \n\n\n\nMalay 70  \n\n\n\nEnglish 30  \n\n\n\nGender   \n\n\n\nMale 41  \n\n\n\nFemale 59  \n\n\n\nEthnicity   \n\n\n\nMalay 59  \n\n\n\nChinese 19  \n\n\n\nIndian 17  \n\n\n\nOthers 5  \n\n\n\nAge (years), mean (SD), range  30.4 (11.4), (19-80) \n\n\n\nCurrent health status   \n\n\n\n       Excellent 8  \n\n\n\nVery Good 22  \n\n\n\nGood 55  \n\n\n\nFair 15  \n\n\n\nPoor  0  \n\n\n\nEducation Level   \n\n\n\nNo formal education 1  \n\n\n\nSecondary school 7  \n\n\n\nMatriculation/ STPM/ Diploma 66  \n\n\n\nBachelor's degree 19 \n\n\n\nPostgraduate's degree 7  \n\n\n\nEmployment Status  \n\n\n\nEmployed 63 \n\n\n\nHouse caretaker 2 \n\n\n\nStudent 27 \n\n\n\nUnemployed 7 \n\n\n\nMarital Status   \n\n\n\nNever married 59  \n\n\n\nMarried 40  \n\n\n\nDivorced/Separated 0 \n\n\n\nWidowed 1  \n\n\n\nHousehold Number, mean (SD) 4.2 \n\n\n\nHousehold Income   \n\n\n\nLess than RM 1,500 14  \n\n\n\nRM 1,500 - RM 3,000 29  \n\n\n\nRM 3,001 - RM 4,500 24  \n\n\n\nRM 4,501 - RM 6,000 14  \n\n\n\nRM 6,001 - RM 7,500 6  \n\n\n\nAbove 7,500 13  \n\n\n\nTime to complete survey (min), mean (SD)  6.9 (2.8) \n\n\n\nEQVAS Score (1-100), mean (SD), range 84.0 (11.2), (40-100) \n\n\n\n\n\n\n\n\n\n\n\n\n7 \n\n\n\nNote: The figures (n) also reflect the percentage, % as there are a total of 100 participants. \n\n\n\nIn assessing their self-reported on the pain/discomfort dimension health problem on the EQ-5D-5L \n\n\n\ndescriptive instrument, the majority of participants reported facing no problems in the five original \n\n\n\nhealth dimensions (Figure 1). Of the 5 dimensions, the highest self-reported problems (ranging from \n\n\n\nslight problems to extreme problems) were associated with anxiety/depression (39%) and \n\n\n\npain/discomfort (34%). Comparatively, of the bolt-ons, two particular dimensions, i.e. vitality (70%) \n\n\n\nand stress (61%) denoted most significant amount of self-reported problems among the 100 participants. \n\n\n\n\n\n\n\n\n\n\n\nDISCUSSION  \n\n\n\nOverall, all participants showed good understanding of the individual 5 dimensions in EQ-5D-5L in \n\n\n\nboth phase 1 and 2. The simple way the original EQ-5D-5L dimensions were worded was used as a \n\n\n\nbasis to which the bolt-ons were constructed. This factor could have contributed to at least 95% of the \n\n\n\nrespondents stating the EQ-5D-5L descriptive instrument with bolt-ons questions were either very easy \n\n\n\nor easy to understand and subsequently ease of understanding of the bolt-ons was also not associated \n\n\n\nwith any socioeconomic factors. Comprehension level for the bolt-ons was not affected by age, gender, \n\n\n\neducation level, employment status, marital status, income and household number.  \n\n\n\nThis is in line with the intentions of the developers of the EQ-5D-5L instrument for easy administration \n\n\n\nof this HRQoL assessment tool. Past qualitative studies conducted in the early stages of development \n\n\n\nof the EQ-5D instrument showed that even among health researchers, the meaning of terms used to \n\n\n\ndescribe dimensions may be interpreted variably (12). This led to the EuroQol Group initiating an \n\n\n\noutline to define key concepts of the instrument with primary uses in translating the EQ-5D into \n\n\n\ndifferent languages. Having proper understanding of the dimensions is important to ensure \n\n\n\ncomparability and validity among studies conducted in different setting and countries.  \n\n\n\n\n\n\n\n\n\n\n\n\n8 \n\n\n\nThe EQ-VAS, being part of the measure of general health in EQ-5D-5L, captured a wider range of \n\n\n\nissues that might influence individual perception of own health, from the usual physical illness to \n\n\n\nsubjective matters such as spending enough time with one\u2019s loved ones. Observing the wide spectrum \n\n\n\nof reasons for the EQ-VAS responses of participants, the visual analogue scale may be better used as a \n\n\n\ncomplementary HRQoL tool, rather than a stand-alone tool considering that perception and rating of \n\n\n\n\u2018health\u2019 may vary significantly among individuals. However, the existence of a global health question \n\n\n\nsuch as the EQ-VAS allow perceptions of health that may not be collectively be shared by the majority \n\n\n\nof the population, be captured by a number ranging from zero to 100. \n\n\n\nThe concept of health or HRQoL is generally accepted to encompass physical, mental, and social \n\n\n\nwellbeing. Focus group discussions revealed that personal definitions of health may vary slightly but \n\n\n\nthere are recurring concepts of health that are shared by many. Of the 11 bolt-on suggested, 5 can be \n\n\n\nclassified as physical abilities (speaking, hearing, vision, vitality, sleep), 3 under mental concepts \n\n\n\n(mental abilities, happiness, stress), and the remaining 3 under social concepts (close relationships, \n\n\n\nsocial support, religion).  \n\n\n\nIn structuring the concepts for the bolt-ons, similar wordings were used to describe the Likert scale with \n\n\n\nno problems being the first option and extreme problems being the last option. Only the religion bolt-\n\n\n\non, being a more abstract concept, was worded differently with emphasis of religious belief to one\u2019s \n\n\n\napproach in life (from entire dependence on religion to none at all on the Likert scale). \n\n\n\nThe dimension of vitality, of which respondents collectively reported having most problems with (70% \n\n\n\nin this study), showed similar trend as in another large-scale EQ-5D-3L bolt-on study in Switzerland. \n\n\n\nThe dimension was defined as \u2018energy/fatigue (15) in that study, and the description was quite similar \n\n\n\nto our description for vitality, despite a different term was used. Although the Swiss study involved \n\n\n\nrandomly selected general population aged 20 and above, no information on how representative the \n\n\n\nsample were. Therefore, it cannot be said for certain that vitality is a culturally prevailing dimension \n\n\n\nfor the Swiss population, only that adding this dimension to the original EQ-5D dimensions help to \n\n\n\nexplain the variance (R2) when regressed onto the EQ-VAS. \n\n\n\nStress is another dimension in this study with a higher percentage of respondents reporting having \n\n\n\nproblem with. Surprisingly, stress has never been suggested in any previous EQ-5D-3L bolt-on studies. \n\n\n\nThis could be because most of the past studies were conducted to address instrument limitations in \n\n\n\ncondition-specific cases. The dimension of stress may be perceived as too general to test for in condition \n\n\n\nspecific studies. Also, the factor of culture may come into play. The dimension was included in the \n\n\n\nphase 2 of our study as it was frequently highlighted in the focus group discussions (phase 1) as an \n\n\n\nimportant factor associated with feeling unhealthy. This feeling of un-healthiness was usually triggered \n\n\n\nby a variety of personal or work-related stressors and indeed, stress is often linked to poorer well-being \n\n\n\nand increased health issues (16). \n\n\n\nPast bolt-on studies have been conducted in Southern Yorkshire, UK or the Netherlands where five \n\n\n\nadditional dimensions including tiredness, vision, hearing (17), cognition (18) and sleep (19) have been \n\n\n\ntested. The former four dimensions were shown to significantly impact health state values in their utility \n\n\n\nindex while only the sleep dimension was deemed less significant. Contrarily, a recent bolt-on study on \n\n\n\nthe EQ-5D-3L instrument in Cape Town, South Africa (20) added sleep and concentration as bolt-ons \n\n\n\nas means to explain the variance of health in community based-populations. The bolt-ons did increase \n\n\n\nthe explanatory power of the original instrument when the EQ visual analogue scale (EQ-VAS) was \n\n\n\nused as the dependent variable. Additionally, a vision bolt-on study conducted in Singapore (21) \n\n\n\ndemonstrated that adding vision bolt-on to the existing EQ-5D-3L instrument better discriminated those \n\n\n\nwith different levels of vision problems. The study suggested the index score of EQ-5D-3L with vision \n\n\n\nbolt-on was significantly more sensitive than the standard EQ-5D-3L index score in detecting changes \n\n\n\nof people with varying levels of visual impairment. However, it is to be noted that the study focused on \n\n\n\ndiscriminating different levels of visual impairment using the bolt-on index, and not deriving new bolt-\n\n\n\nons based on differences in cultural values. \n\n\n\nDepending on the populations and methods of testing used, the results of bolt-on studies generally vary \n\n\n\nin various countries with different cultures. A standardisation of methodology in bolt-on studies carried \n\n\n\nout in different populations may assist in revealing the true usefulness of particular bolt-on(s). \n\n\n\nThere are a few limitations in this study. Our study was conducted in the state of Penang, thus may not \n\n\n\nbe generalizable to the whole of Malaysia. Also, phase 2 of the study only captured the self-reported \n\n\n\nhealth problems as reflected by the EQ-5D-5L descriptive instrument together with bolt-ons. No \n\n\n\n\n\n\n\n\n\n\n\n\n9 \n\n\n\npreference-based valuation method was employed to quantify the explicit value of additional \n\n\n\ndimensions to better scope the need of such bolt-ons. Being an exploratory study, the sample size \n\n\n\nemployed was small and the methodology was simple. Possible bias in the study might arise from the \n\n\n\nconvenience sampling design of phase 2. The over-sampling of those who have employment may have \n\n\n\nskewed the results to favour vitality and stress as the two dimensions with highest reported problems. \n\n\n\nHowever, to the best of our knowledge, our study was the first in Malaysia and Southeast Asia to explore \n\n\n\npotential bolt-ons based on local culture and social-economic status. Observing that bolt-ons vitality \n\n\n\nand stress have more than half of the respondents reporting problem in them, these could be two \n\n\n\nadditional dimensions worthy of more emphasis in future HRQoL studies. Therefore, it is hoped that \n\n\n\nthe preliminary results of this study will provide insights into guiding the selection of bolt-ons for larger \n\n\n\nscale validation studies in the near future. \n\n\n\nCONCLUSION \n\n\n\nIn our study, the HRQoL concept was seen to encompass a wider scope than currently covered by the \n\n\n\nEQ-5D-5L instrument, with the vitality and stress having most potential for bolt-ons in future valuation \n\n\n\nstudies.  This study suggested that the prospect of adding bolt-ons to complement the EQ-5D-5L \n\n\n\ninstrument would better suit the HRQoL needs of the Malaysian population.  \n\n\n\nACKNOWLEDGEMENTS \n\n\n\nWe would like to extend our gratification to the following undergraduate pharmacy students for their \n\n\n\nassistance in the study- Chiew YK, Teoh AXY, Jayakumar T, Tan RS, Wong XM, Koh Y, Mohd \n\n\n\nNazdmi MAN, Thum CS, Kamarul Zaman MA, and Mohd Ali NA. 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Epub 2010/11/19. doi: \n\n\n\n10.1093/intqhc/mzq068. PubMed PMID: 21084324. \n\n\n\n16. Schneiderman N, Ironson G, Siegel SD. STRESS AND HEALTH: Psychological, Behavioral, and \n\n\n\nBiological Determinants. Annu Rev Clin Psychol. 2005;1:607-28. doi: \n\n\n\n10.1146/annurev.clinpsy.1.102803.144141. PubMed PMID: PMC2568977. \n\n\n\n17. Yang Y, Rowen D, Brazier J, Tsuchiya A, Young T, Longworth L. An exploratory study to test the \n\n\n\nimpact on three \"bolt-on\" items to the EQ-5D. Value Health. 2015;18(1):52-60. doi: \n\n\n\n10.1016/j.jval.2014.09.004. PubMed PMID: 25595234. \n\n\n\n18. Krabbe PF, Stouthard ME, Essink-Bot ML, Bonsel GJ. The effect of adding a cognitive dimension \n\n\n\nto the EuroQol multiattribute health-status classification system. J Clin Epidemiol. 1999;52(4):293-\n\n\n\n301. PubMed PMID: 10235169. \n\n\n\n19. Yang Y, Brazier J, Tsuchiya A. Effect of adding a sleep dimension to the EQ-5D descriptive system: \n\n\n\nA \"bolt-on\" experiment. Med Decis Making. 2014;34(1):42-53. doi: 10.1177/0272989X13480428. \n\n\n\nPubMed PMID: edselc.2-52.0-84890605215. \n\n\n\n20. Jelsma J, Maart S. Should additional domains be added to the EQ-5D health-related quality of life \n\n\n\ninstrument for community-based studies? An analytical descriptive study. Population Health \n\n\n\nMetrics. 2015;13(1):13. PubMed PMID: doi:10.1186/s12963-015-0046-0. \n\n\n\n21. Luo N, Wang X, Ang M, Finkelstein EA, Aung T, Wong T-Y, et al. A Vision \u201cBolt-On\u201d Item Could \n\n\n\nIncrease the Discriminatory Power of the EQ-5D Index Score. Value Health. 2015;18(8):1037-42. \n\n\n\ndoi: http://dx.doi.org/10.1016/j.jval.2015.08.002. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n11 \n\n\n\nAPPENDIX 1 \n\n\n\nEQ-5D-5L with bolt-ons self-reported questionnaire \n\n\n\n\n\n\n\n8. Under each heading, please tick the ONE box that best describes your health TODAY \n\n\n\n\n\n\n\n8.1. MOBILITY \n\n\n\n\u25a1 1. I have no problems in walking about  \n\n\n\n\u25a1 2. I have slight problems in walking about \n\n\n\n\u25a1 3. I have moderate problems in walking about \n\n\n\n\u25a1 4. I have severe problems in walking about \n\n\n\n\u25a1 5. I am unable to walk about \n\n\n\n\n\n\n\n8.2. SELF-CARE \n\u25a1 1. I have no problems washing or dressing myself \n\n\n\n\u25a1 2. I have slight problems washing or dressing myself \n\n\n\n\u25a1 3. I have moderate problems washing or dressing myself \n\n\n\n\u25a1 4. I have severe problems washing or dressing myself \n\n\n\n\u25a1 5. I am unable to wash or dress myself \n\n\n\n\n\n\n\n8.3. USUAL ACTIVITIES (e.g. work, study, housework, family or leisure activities) \n\n\n\n\u25a1 1. I have no problems doing my usual activities \n\n\n\n\u25a1 2. I have slight problems doing my usual activities \n\n\n\n\u25a1 3. I have moderate problems doing my usual activities  \n\n\n\n\u25a1 4. I have severe problems doing my usual activities \n\n\n\n\u25a1 5. I am unable to do my usual activities \n\n\n\n\n\n\n\n8.4. PAIN / DISCOMFORT \n\n\n\n\u25a1 1. I have no pain or discomfort \n\n\n\n\u25a1 2. I have slight pain or discomfort \n\n\n\n\u25a1 3. I have moderate pain or discomfort \n\n\n\n\u25a1 4. I have severe pain or discomfort \n\n\n\n\u25a1 5. I have extreme pain or discomfort \n\n\n\n\n\n\n\n8.5. ANXIETY / DEPRESSION \n\n\n\n\u25a1 1. I am not anxious or depressed \n\n\n\n\u25a1 2. I am slightly anxious or depressed \n\n\n\n\u25a1 3. I am moderately anxious or depressed \n\n\n\n\u25a1 4. I am severely anxious or depressed \n\n\n\n\u25a1 5. I am extremely anxious or depressed \n\n\n\n\n\n\n\n8.6. SLEEP \n\u25a1 1. I have no problems in getting enough sleep \n\n\n\n\u25a1 2. I have slight problems in getting enough sleep \n\n\n\n\u25a1 3. I have moderate problems in getting enough sleep \n\n\n\n\u25a1 4. I have severe problems in getting enough sleep \n\n\n\n\u25a1 5. I am unable to get enough sleep \n\n\n\n\n\n\n\n8.7. VITALITY \n\u25a1 1. I am not tired at all  \n\n\n\n\u25a1 2. I am slightly tired or lacking in energy \n\n\n\n\u25a1 3. I am moderately tired or lacking in energy \n\n\n\n\u25a1 4. I am severely tired or lacking in energy \n\n\n\n\u25a1 5. I am extremely tired or lacking in energy \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n12 \n\n\n\n\n\n\n\n8.8. HAPPINESS \n\n\n\n\u25a1 1. I am happy  \n\n\n\n\u25a1 2. I am slightly unhappy \n\n\n\n\u25a1 3. I am moderately unhappy \n\n\n\n\u25a1 4. I am severely unhappy \n\n\n\n\u25a1 5. I am extremely unhappy \n\n\n\n8.9. CLOSE RELATIONSHIPS \n\n\n\n\u25a1 1. I have no problems in keeping relationships with people close to me  \n\n\n\n\u25a1 2. I have slight problems in keeping relationships with people close to me \n\n\n\n\u25a1 3. I have moderate problems in keeping relationships with people close to me \n\n\n\n\u25a1 4. I have severe problems in keeping relationships with people close to me \n\n\n\n\u25a1 5. I am unable to keep relationships with people close to me \n\n\n\n\n\n\n\n8.10. STRESS \n\n\n\n\u25a1 1. I am not feeling stressful  \n\n\n\n\u25a1 2. I am feeling slightly stressful \n\n\n\n\u25a1 3. I am feeling moderately stressful \n\n\n\n\u25a1 4. I am feeling severely stressful \n\n\n\n\u25a1 5. I am feeling extremely stressful \n\n\n\n\n\n\n\n8.11. MENTAL ABILITIES \n\n\n\n\u25a1 1. I have no problems with memory \n\n\n\n\u25a1 2. I have slight problems with memory \n\n\n\n\u25a1 3. I have moderate problems with memory \n\n\n\n\u25a1 4. I have severe problems with memory \n\n\n\n\u25a1 5. I am unable to memorize \n\n\n\n\n\n\n\n8.12. SOCIAL SUPPORT (e.g. family, friends, peers, society) \n\n\n\n\u25a1 1. I have no problems in getting enough social support \n\n\n\n\u25a1 2. I have slight problems in getting enough social support \n\n\n\n\u25a1 3. I have moderate problems in getting enough social support \n\n\n\n\u25a1 4. I have severe problems in getting enough social support \n\n\n\n\u25a1 5. I am unable to get enough social support \n\n\n\n\n\n\n\n8.13. RELIGION \n\n\n\n\u25a1 1. My approach to life relies entirely on my religious belief \n\n\n\n\u25a1 2. My approach to life relies strongly on my religious belief \n\n\n\n\u25a1 3. My approach to life relies moderately on my religious belief \n\n\n\n\u25a1 4. My approach to life relies slightly on my religious belief \n\n\n\n\u25a1 5. My approach to life does not rely on my religious belief \n\n\n\n\n\n\n\n8.14. VISION \n\u25a1 1. I have no problems in seeing  \n\n\n\n\u25a1 2. I have slight problems in seeing \n\n\n\n\u25a1 3. I have moderate problems in seeing \n\n\n\n\u25a1 4. I have severe problems in seeing \n\n\n\n\u25a1 5. I am unable to see \n\n\n\n\n\n\n\n8.15. HEARING \n\u25a1 1. I have no problems in hearing \n\n\n\n\u25a1 2. I have slight problems in hearing \n\n\n\n\u25a1 3. I have moderate problems in hearing \n\n\n\n\u25a1 4. I have severe problems in hearing \n\n\n\n\u25a1 5. I am unable to hear \n\n\n\n\n\n\n\n\n\n\n\n\n13 \n\n\n\n\n\n\n\n8.16. SPEAKING \n\u25a1 1. I have no problems in speaking \n\n\n\n\u25a1 2. I have slight problems in speaking  \n\n\n\n\u25a1 3. I have moderate problems in speaking \n\n\n\n\u25a1 4. I have severe problems in speaking \n\n\n\n\u25a1 5. I am unable to speak \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n14 \n\n\n\nLIST OF ORAL PRESENTATIONS \n\n\n\n\n\n\n\nNo Presenting \n\n\n\nAuthor \n\n\n\nTitle \n\n\n\n001 Lee LK Prevalence of Polypharmacy and Its Associated Factors among Elderly in \n\n\n\nOld Folks Homes, Taiping \n\n\n\n002 Cheong WL The Effectiveness of Oral Methylcobalamin for the Treatment of Mild-\n\n\n\nModerate Peripheral Neuropathy \n\n\n\n003 Wadi NMA Investigation of Healing Effect of In Situ-Forming Mucoadhesive \n\n\n\nHydrogel on Ligature-Induced Periodontitis in Rats \n\n\n\n004 Loo JSE An Assessment of G Protein-Coupled Receptor Homology Models \n\n\n\nConstructed from Templates of Various Transmembrane Sequence \n\n\n\nIdentities \n\n\n\n005 Cheen AL Assessment of the Impact of Automated Dispensing Cabinet \n\n\n\nImplementation in a Tertiary Hospital in Malaysia \n\n\n\n006 Wong EYL Stability Indicating HPLC-UV Method for Determination of Montelukast \n\n\n\nin Development of Chewable Tablet \n\n\n\n007 Abu Arrah EM Formulation of Omeprazole Nanosuspension Using High-Pressure \n\n\n\nHomogenization Method \n\n\n\n008 Aizat Z Scheduled Substances as a Cause Leading to Dangerous Drug Abuse \n\n\n\n009 Wadi NMA Development and Evaluation of In Situ-Forming Syringeable \n\n\n\nMucoadhesive Gel Formulation for Periodontitis \n\n\n\n010 Bacayo MFD Job Satisfaction, Continuing Professional Development and \n\n\n\nPharmaceutical Care Practices of Hospital Pharmacists in The Philippines \n\n\n\nand Malaysia: Basis for Pharmacy Professional Development Plan \n\n\n\n012 Chua SS Continuing Professional Development Activities Preferred by Community \n\n\n\nPharmacists \n\n\n\n013 Neivashini M Survey on General Perception of Smoking Cessation among Patients \n\n\n\nVisiting Cardiology Clinic Hospital Serdang \n\n\n\n016 Baharudin MSF The Novel Finding of Perceived Stress Scale Between Type 2 Diabetes \n\n\n\nMellitus Patients & Healthy adults \n\n\n\n017 Abdul Rahman \n\n\n\nMN \n\n\n\nRheological Characterisation of Baccaurea angulata Dental Gels, and \n\n\n\ntheir Release Profiles \n\n\n\n022 Zamery MI Extraction of Protocatechuic Acid Enriched Fraction from Clinacanthus \n\n\n\nNutans Leaves \n\n\n\n024 Mohd GA Stability Evaluation of Folic Acid and Photosensitizer-Folic Acid (PS-FA) \n\n\n\nConjugate Through Design of Experiment Approach \n\n\n\n028 Mohd HN Subcritical Water Extraction as a Modern Green Extraction Technique of \n\n\n\nHydroxychavicol from Piper betle Linn. Leaves \n\n\n\n029 Bacayo MFD Correlation of Target International Normalised Ratio (INR) and Patient\u2019s \n\n\n\nUnderstanding on Warfarin Therapy at Medication Therapy Adherence \n\n\n\nClinic in Klang Valley \n\n\n\n030 Abd Jalil MA The Evaluation of Physicochemical and Antimicrobial Properties of \n\n\n\nHoney Based Hydrogel \n\n\n\n032 Syed OSS Effect of Cosmetic Cream containing Piper betle Linn. Extract on Skin: A \n\n\n\nPilot Study \n\n\n\n036 Lee AY Downregulation of Semaphorin 5A in Human Glioblastomas by \n\n\n\nAlternative Splicing Causes a Loss of Its Tumour Suppressor Function \n\n\n\n037 Mohamad NZ Knowledge, Attitude and Perception of Muslim Consumers Towards Halal \n\n\n\nCosmetic Products \n\n\n\n038 Voo JYH Perceptions of Medical Doctors Towards Clinical Pharmacists in Duchess \n\n\n\nof Kent Hospital (DOKH), Sandakan \n\n\n\n\n\n\n\n\n\n\n\n\n15 \n\n\n\n\n\n\n\n042 Che Pa MF Tuberculosis Incidence after Completion of Isoniazid Prophylaxis Therapy \n\n\n\nin Retroviral Disease Patients \n\n\n\n043 Hammad MA Statins Effects on Cataract among Patients With Type 2 Diabetes Mellitus \n\n\n\n045 Hammad MA The Equivalence between the Malay and UK English Versions of Mini-\n\n\n\nAddenbrooke\u2019s Cognitive Examination \n\n\n\n048 Buang A Halal Guide on the Use of  Pharmaceutical Intoxicants in Medicines \n\n\n\n049 Abubakar U Single Dose Versus Multiple Doses of Antibiotic Prophylaxis in Caesarean \n\n\n\nSection: Protocol For a Systematic Review and Meta-analysis of African \n\n\n\nStudies \n\n\n\n050 Ghadzi SMS Pharmacometrics Modelling of the Natural Diabetes Disease Progression \n\n\n\nand Lifestyle Intervention Effects on Weight, Beta Cell Function and \n\n\n\nInsulin Sensitivity in Individuals with Impaired Glucose Tolerance \n\n\n\n051 Sha'aban A Personalisation of Aspirin Therapy: A Focus on Gastric Toxicity \n\n\n\n056 Al-Sammarraie HJ Design and Evaluation of Self Emulsifying Solid Dispersion of Ethanol \n\n\n\nExtract of Moringa Leaves and Assessment of Anti-inflammatory, Anti-\n\n\n\nNociceptive and Anti-Rheumatoid Arthritis Activity \n\n\n\n060 Aminu N Compatibility Studies of Triclosan and Flurbiprofen with Formulation \n\n\n\nExcipients: A Systematic Drug-Drug and Drugs-Excipients Compatibility \n\n\n\nScreening \n\n\n\n065 Ismail Z Bone Mineral Density among Postmenopausal Malay Women \n\n\n\n066 Nizaruddin MA A Qualitative Study Investigating Medication Safety Issues Experienced \n\n\n\nby Community Pharmacists \n\n\n\n067 Faller EM Emerging Roles of Pharmacists in Global Health: Perspectives from the \n\n\n\nAsia Pacific Region \n\n\n\n069 Samsudin S Participation of Private and Government Healthcare Providers in Smoking \n\n\n\nCessation Services (M-quit Services) \n\n\n\n070 Pathmapiriyaa M Effect of 'Educational Pamphlet' in Prevention of Human Papilloma Virus \n\n\n\nRelated Infections among Young Adult Population \n\n\n\n072 Mosleh RS Relationship of Patient Characteristics and Organizational Factors with \n\n\n\nHealth Care Collaboration among Type 2 Diabetes Patients in Palestine \n\n\n\n074 Sim XY The Effect of High Fat Diet Intake on Blood Glucose Level of Prediabetic \n\n\n\nand Type 2 Diabetic Rats. \n\n\n\n078 Ali AN Effect of Educational Pamphlet Regarding Human Papilloma Virus (HPV) \n\n\n\nInfections and HPV Vaccination: A KAP Study among Parents with Age \n\n\n\nEligible Children for HPV Vaccination \n\n\n\n083 Chiang XY Research and Development of Self-Emulsifying Drug Delivery System for \n\n\n\nEnhanced Bioavailability of Curcumin \n\n\n\n084 Stephanie S Gynura Crepioides Leaves Extract : An Antibacterial Study \n\n\n\n085 Idris B Pharmacological Evidence for the Blood Pressure Lowering Effect of \n\n\n\nTapinanthus globiferus \n\n\n\n092 Gaurav A Shared-Feature Pharmacophore Model of Phosphodiesterase10A \n\n\n\nInhibitors \n\n\n\n099 Qamar M Knowledge and Attitude Towards Antibiotic Usage among General Public \n\n\n\nin Kuala Lumpur, Malaysia \n\n\n\n100 Khan NH Moisture Sorption Analysis of Hibiscus sabdariffa L. Spray Dried Extract \n\n\n\n102 Nagojappa NBS Computer Assisted Design, Synthesis and Acetylcholinesterase Inhibitory \n\n\n\nActivity of Some Indole Derivatives Targeting Alzheimer\u2019s Disease \n\n\n\n103 Haseeb A Evaluation of Antimicrobial Stewardship Programs Implementation and \n\n\n\nOutcomes Using Interrupted Time Series Analysis, in a Selected Hospital \n\n\n\nat Makkah, Kingdom of Saudi Arabia \n\n\n\n104 Balasubramaniam \n\n\n\nS \n\n\n\nEvaluation of Illness Perceptions and Their Associations with Glycaemic \n\n\n\nControl in Type 2 Diabetes Mellitus Patients at Hospital Pulau Pinang \n\n\n\n\n\n\n\n\n\n\n\n\n16 \n\n\n\n\n\n\n\nMPSPSC2017000001 (Oral) \n\n\n\nPREVALENCE OF POLYPHARMACY AND ITS ASSOCIATED FACTORS AMONG ELDERLY IN \n\n\n\nOLD FOLKS HOMES, TAIPING \n\n\n\n\n\n\n\nLee LK1, Maideen SFK2, Khan AR2 \n\n\n\n1Department of Public Health, Royal College of Surgeon Ireland  \n2Department of Public Health, Penang Medical College      \n\n\n\n\n\n\n\nINTRODUCTION: Polypharmacy is a major health problem among the elderly and is responsible for drug \n\n\n\nrelated problems including adverse drug reactions, drug-drug interactions and non-adherence.  \n\n\n\nOBJECTIVES: The aim of this study is to determine the prevalence of polypharmacy and its associated factors \n\n\n\namong the elderly in old folk\u2019s homes of Taiping.  \n\n\n\nMETHODS: An analytical cross sectional study was conducted in four old folks homes in Taiping, Perak. Four \n\n\n\nhomes were chosen using purposive sampling followed by simple random sampling to choose 200 participants. \n\n\n\nThe inclusion and exclusion criteria were aged 60 years and above and ability to participate in an interview. The \n\n\n\nquestionnaires were divided into four parts, which were sociodemographic, health status, health seeking and \n\n\n\npolypharmacy. Charlson's comorbidity index was used to determine the extent of comorbidities and Morisky \n\n\n\nMedical Adherence Scale (MMAS-4) were used to determine medical non-adherence.  \n\n\n\nRESULTS: The prevalence of polypharmacy in this study was 36.2%. The predictors were alternative medicine \n\n\n\nusage, pharmacy visits, usage of vitamins and minerals, hospitalisation and co-morbidities. Among the \n\n\n\npolypharmacy group, the prevalence of adverse drug reaction was 53%, drug-drug interactions 8.2%, and non-\n\n\n\nadherence 5.4%. \n\n\n\nCONCLUSIONS: The results in this study are consistent with numerous studies around the world on \n\n\n\npolypharmacy. This study can be generalised to the elderly population living in old folks homes in Perak as it \n\n\n\nincluded both the government and privately run old folks homes. Mandatory medical review by clinical \n\n\n\npharmacists to reduce polypharmacy and drug related problems is recommended to overcome the negative effects \n\n\n\nof polypharmacy. \n\n\n\n\n\n\n\n\n\n\n\nMPSPSC2017000002 (Oral) \n\n\n\nTHE EFFECTIVENESS OF ORAL METHYLCOBALAMIN FOR THE TREATMENT OF MILD-\n\n\n\nMODERATE PERIPHERAL NEUROPATHY \n \n\n\n\nCheong WL1 \n1School of Pharmacy, Monash University Malaysia, Malaysia \n\n\n\n\n\n\n\nINTRODUCTION: Methylcobalamin is often prescribed for the symptomatic treatment of peripheral \n\n\n\nneuropathy. Current evidence indicates potential efficacy with intrathecally or intramuscularly administered \n\n\n\nmethylcobalamin. The efficacy of oral methylcobalamin taken alone for the treatment of peripheral neuropathy \n\n\n\nhas not been well-established. \n\n\n\nOBJECTIVE: The objective of this study is to evaluate the effectiveness of oral methylcobalamin therapy in \n\n\n\ntreating the symptoms of peripheral neuropathy. \n\n\n\nMETHOD: Patients with peripheral neuropathy at an outpatient clinic were asked to identify the severity of their \n\n\n\nsymptoms on a ten-point scale (0 = symptom-free, 10 = most severe) prior to starting therapy with oral \n\n\n\nmethycobalamin (500mg three times daily). After 8 weeks of treatment with oral methylcobalamin patients were \n\n\n\nasked to score their symptom severity again as well as any adverse reaction experienced. \n\n\n\nRESULTS: 50 patients were enrolled in the study. The median and mean symptom severity score at baseline was \n\n\n\n3 and 2.44 out of 10, respectively. 21 patients (42%) reported improvements in the severity of symptoms \n\n\n\nexperienced. There was no worsening of symptoms reported. Mean and median post-treatment symptom severity \n\n\n\nscore was 2 and 1.76 (p <0.01) respectively. 8 patients (16%) experienced adverse reactions.  \n\n\n\nCONCLUSION: Patients with peripheral neuropathy receiving oral methylcobalamin reported modest \n\n\n\nimprovements in symptom severity. The clinical significance and economic benefit of prescribing oral \n\n\n\nmethylcobalamin for the treatment of peripheral neuropathy remains uncertain. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n17 \n\n\n\n\n\n\n\nMPSPSC2017000003(Oral) \n\n\n\nINVESTIGATION OF HEALING EFFECT OF IN SITU-FORMING MUCOADHESSIVE HYDROGEL \n\n\n\nON LIGATURE-INDUCED PERIODONTITIS IN RATS \n\n\n\n\n\n\n\nWadi NMA1, Al Zarzour RH1, Kaur G 3 , Ahuja A.2, Peh KK1  \n1School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 USM, Penang, Malaysia. \n2Departments of Pharmacy, Oman Medical College, Muscat, Oman. \n3Institute for Research in Molecular Medicine (INFORMM), USM, Penang, Malaysia. \n\n\n\n\n\n\n\nINTRODUCTION: Periodontitis is a serious gum inflammation that damages the soft tissue in response to \n\n\n\nbacterial infections.  \n\n\n\nOBJECTIVE: The aim of the study was to investigate the healing effect of in situ-forming mucoadhesive \n\n\n\nhydrogel containing metronidazole (antibacterial) and diclofenac sodium (anti-inflammatory) on ligature-induced \n\n\n\nperiodontal disease (EIPD) in rats using histological evaluation. \n\n\n\nMETHODS: 30 Sprague-Dawley (SD) rats were used. EIPD was induced in using silk thread ligatures around \n\n\n\nthe lower frontal teeth of the animal. Five  groups  with six animals in each group namely, (i) Naive group (neither \n\n\n\nsubjected to EIPD nor treated); (ii) Non-treated (NT) group (subjected to EIPD but not treated), (iii)Group treated \n\n\n\nwith metronidazole after subjected to EIPD, (iv) Group treated with diclofenac potassium after subjected to \n\n\n\nEIPD; (v) Group treated with both drugs after subjected to EIPD. After 6 days, the effect of the treatments was \n\n\n\nevaluated based on clinical appearance and histopathology using hematoxylin - eosin staining of the gingival \n\n\n\ntissue. \n\n\n\nRESULTS: A statistically significant difference (p< 0.05) was noted in the inflammatory and repair parameters \n\n\n\nof the healing process between the treated groups and the control. Moreover, treatment with both drugs accelerated \n\n\n\nthe healing significantly (p< 0.0001) compared to drugs given alone. \n\n\n\nCONCLUSION: The combination of antibacterial and anti-inflammatory agent demonstrated a significantly \n\n\n\nfaster healing than each agent alone. Local delivery plays a potentially advantageous role in the clinical therapy \n\n\n\nof periodontal disease. \n\n\n\n\n\n\n\n\n\n\n\nMPSPSC2017000004 (Oral) \n\n\n\nAN ASSESSMENT OF G PROTEIN-COUPLED RECEPTOR HOMOLOGY MODELS \n\n\n\nCONSTRUCTED FROM TEMPLATES OF VARIOUS TRANSMEMBRANE SEQUENCE IDENTITIES \n\n\n\n\n\n\n\nLoo JSE1, Emtage AL2, Ng KW1, Yong ASJ1, Doughty SW3 \n1School of Pharmacy, Taylor\u2019s University, Subang Jaya, Selangor, Malaysia. \n2School of Pharmacy, The University of Nottingham Malaysia Campus, Semenyih, Selangor, Malaysia. \n3Penang Medical College, George Town, Penang, Malaysia.   \n\n\n\n\n\n\n\nINTRODUCTION: G protein-coupled receptor (GPCR) crystal structures have recently become more readily \n\n\n\navailable. However, homology modelling still represents a crucial method for structure-based drug design \n\n\n\ninvolving GPCRs. The new crystal structures therefore provide the opportunity to assess the relative performance \n\n\n\nof GPCR homology models.  \n\n\n\nOBJECTIVES: This study aimed to assess the performance of GPCR homology models relative to their crystal \n\n\n\nstructures in two common structure-based drug design applications: ligand binding pose prediction and \n\n\n\nenrichment in virtual screening.  \n\n\n\nMETHODS: Homology models for eight class A GPCR targets were constructed from three templates with \n\n\n\nvarying transmembrane sequence identities each using Modeller. Ligand binding pose prediction was assessed \n\n\n\nvia Root Mean Square Deviation (RMSD) following re-docking of the cognate ligand using Glide with the \n\n\n\nInduced Fit Docking (IFD) protocol. Virtual screening enrichment was assessed via the LogAUC of Receiver \n\n\n\nOperating Characteristic curves following screening of a ligand set containing 50 high binding affinity ligands \n\n\n\n(pKi > 7.5) with matched decoys. Both the initial homology models and models optimized through IFD were \n\n\n\nstudied for enrichment.  \n\n\n\nRESULTS: Crystal structures performed better than their corresponding homology models in both assessments. \n\n\n\nAccurate ligand binding pose prediction was possible but was generally difficult to achieve using homology \n\n\n\nmodels. In virtual screening using homology models still conferred significant enrichment compared to random \n\n\n\nselection, with clear benefit also observed in using models optimized through IFD.  \n\n\n\nCONCLUSION: Homology models of GPCRs that are reasonably accurate structurally can be constructed, but \n\n\n\nthe performance of these models remain significantly inferior to crystal structures. \n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n18 \n\n\n\n\n\n\n\nMPSPSC2017000005(Oral) \n\n\n\nASSESSMENT OF THE IMPACT OF AUTOMATED DISPENSING CABINET IMPLEMENTATION \n\n\n\nIN A TERTIARY HOSPITAL IN MALAYSIA \n\n\n\n\n\n\n\n Chow HS1, Ng VCW1 and Cheen AL 1 \n1Dept of Pharmacy, Sunway Medical Centre Sdn. Bhd., Bandar Sunway, Selangor, Malaysia \n\n\n\n\n\n\n\nINTRODUCTION: Automated Dispensing Cabinets (ADCs) are often core components of closed loop \n\n\n\nmedication management systems. ADCs were implemented since 2006 in 12 wards of a tertiary hospital. \n\n\n\nOBJECTIVE: To assess the impact of implementing ADCs on medicines management in inpatient wards. \n\n\n\nMETHODS: Data were collected on the impact of implementing ADCs, including medication supply time from \n\n\n\npharmacy, time savings for pharmacy and nursing on manual processes, medication stock discrepancies, and \n\n\n\nmedication errors. The hospital\u2019s practice of using ADCs was benchmarked against the Institute for Safe \n\n\n\nMedication Practices\u2019 (ISMP\u2019s) Medication Safety Self Assessment for ADCs. \n\n\n\nRESULTS: 70% of inpatient medications prescribed is available in the ADC, reducing turnaround time for \n\n\n\nmedication supply by 45% compared to wards with no ADC. Pharmacy staff saved 7 hours per day on processing \n\n\n\nmanual resupply of medications, while nursing staff spent 10 hours less per week on managing manual ward \n\n\n\nstocks. There was 93% reduction in stock discrepancies in wards with ADCs compared to those with none. The \n\n\n\nuse of profiling feature in ADCs, where medication orders are reviewed by pharmacy prior to medication removal, \n\n\n\nhas reduced errors related to ADC usage in critical care wards by 71%. Results from the benchmark against ISMP \n\n\n\nguidelines showed that the hospital\u2019s score on safe use of ADCs (82%) is comparable to hospitals in the USA \n\n\n\n(79%). \n\n\n\nCONCLUSION: Implementation of ADCs has automated the distribution and management of medications in \n\n\n\nthis hospital. This augurs well as the hospital embarks towards achieving a closed loop medication management \n\n\n\nsystem. \n\n\n\n\n\n\n\n\n\n\n\nMPSPSC2017000006 (Oral) \n\n\n\nSTABILITY INDICATING HPLC-UV METHOD FOR DETERMINATION OF MONTELUKAST IN \n\n\n\nDEVELOPMENT OF CHEWABLE TABLET  \n\n\n\n\n\n\n\nWong EYL1, Loh GOK1, Tan YTF1, Peh KK1 \n\n\n\n1School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 USM, Penang, Malaysia. \n\n\n\n\n\n\n\nINTRODUCTION: Montelukast, a leukotriene receptor antagonist used in the treatment of chronic asthma, is \n\n\n\nsusceptible to photodegradation and oxidation degradation. HPLC-UV method is commonly used for \n\n\n\nidentification of possible impurities or degradants arisen during stability studies.  \n\n\n\nOBJECTIVE: The objective of this study was to develop and validate a simple, sensitive and stability-indicating \n\n\n\nHPLC-UV method for the determination of montelukast and its impurities in the development of chewable tablet \n\n\n\nformulation.  \n\n\n\nMETHODS: Chromatographic separation was achieved using Atlantis\u00ae T3 3\u00b5m C18 (4.6mmID X 10cm) \n\n\n\nanalytical column. The mobile phase consisted potassium dihydrogen phosphate (0.05mM)-acetonitrile-\n\n\n\ntriethylamine (450:550:1.33, v/v/v) adjusted to pH 2.0 with orthophosphoric acid. The analysis was run at a flow \n\n\n\nrate of 1.5 mL/min with detection wavelength at 255nm. Method validation was performed in accordance to ICH \n\n\n\nguidelines. Stress degradation studies, comprising of acid and alkali hydrolysis, oxidative hydrogen peroxide \n\n\n\ndegradation, photodegradation in solution and solid state as well as heat degradation, were performed.  \n\n\n\nRESULTS: The standard calibration curve was linear from 0.0025 - 0.375mg/mL. Montelukast sodium was \n\n\n\nsensitive to photodegradation, oxidation and acid hydrolysis. Oxidative degradation kinetic study showed that \n\n\n\nmontelukast sodium followed first order reaction. The detection limit and quantification limit were 0.01\u00b5g/mL \n\n\n\nand 0.04\u00b5g/mL. System suitability evaluation and relative standard deviation (%RSD) of below 2.0% indicated \n\n\n\nthat the analytical method was robust.  \n\n\n\nCONCLUSION: The stability indicating HPLC-UV method was successfully developed and validated for \n\n\n\ndetermination of montelukast and its impurities in the development of chewable tablet formulation. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n19 \n\n\n\n\n\n\n\nMPSPSC2017000007 (Oral) \n\n\n\nFORMULATION OF OMEPRAZOLE NANOSUSPENSION USING HIGH-PRESSURE \n\n\n\nHOMOGENIZATION METHOD \n\n\n\n\n\n\n\nAbu Arrah EM1, Toh SM1   \n1School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 USM, Penang, Malaysia. \n\n\n\n\n\n\n\nINTRODUCTION: The oral route is the dominant and most convenient drug delivery route for patients. Most \n\n\n\nof the available active pharmaceutical active ingredients are hydrophobic drugs with the major limitation in oral \n\n\n\nbioavailability. Omeprazole is a good example of this type of active ingredient. \n\n\n\nOBJECTIVES: The study objective was to optimize an omeprazole nanosuspension using a high-pressure \n\n\n\nhomogenization method to improve the bioavailability of omeprazole. \n\n\n\nMETHODS: Omeprazole nanosuspensions were developed using a high-pressure homogenization method. \n\n\n\nVarious surfactants were screened. Poloxamer 188 (2% w/v) was chosen for optimization studies. Then, a Box-\n\n\n\nBehnken design was utilized to optimize designated formulation and process parameters. Omeprazole \n\n\n\nnanosuspensions were characterized for particle size, polydispersity index and zeta potential. \n\n\n\nRESULTS: From our study,10 mg omeprazole for initial drug weight, 1500 bar for homogenization pressure and \n\n\n\n30 cycles of homogenization provided a nanosuspension of mean particle size of 85 nm with polydispersity index \n\n\n\nof 0.23 and zeta potential of -46.9 mV. \n\n\n\nCONCLUSION: The high-pressure homogenization method is an effective way to prepare a successful \n\n\n\nomeprazole nanosuspension.  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nMPSPSC2017000008 (Oral) \n\n\n\nSCHEDULED SUBSTANCES AS A CAUSE LEADING TO DANGEROUS DRUG ABUSE. \n\n\n\n\n\n\n\nAizat Z1, Hanif M1, Ameerul A1, Zamrul HN1, Chan YM1, Vighnaraja M1, Terence Lim JJ1, Syaza FCH1.   \n1Pharmacy Enforcement Branch, Division of Pharmaceutical Services, Pulau Pinang.  \n\n\n\n\n\n\n\nINTRODUCTION: Products containing scheduled substances such as psychotropic pills, cough medicines and \n\n\n\nMitragyna Speciosa (ketum) had been frequently abused, mainly due to their addictive potential. The widespread \n\n\n\nabuse of products containing scheduled substances often perceived as less threatening compared to the pandemic \n\n\n\nissue of illicit dangerous drugs use. \n\n\n\nOBJECTIVES: This study aims to qualitatively investigate the issues surrounding the abuse of products \n\n\n\ncontaining scheduled substances and the relationship between the abuse of these products and the illicit use of \n\n\n\ndangerous drugs among the clients in Cure & Care Clinic Karangan, Kedah. \n\n\n\nMETHODS: Direct interview sessions were simultaneously held by four interviewers, involving a total of thirty \n\n\n\nclients at the Cure & Care Clinic Karangan, Kedah. Convenience sampling method was used. Interviewers were \n\n\n\ngiven a set of questions as reference points. Interviews were done until the data saturation point was achieved. \n\n\n\nInterviews were audio-recorded, transcribed verbatim, and the data was analysed into themes.   \n\n\n\nRESULTS: The thematic analysis grouped the data into five themes, namely the factors triggering scheduled \n\n\n\nsubstance abuse, accessibility and affordability of the abuse scheduled substances, the types of scheduled \n\n\n\nsubstances abused and illicit use of dangerous drugs, dependence or habit-forming effects, and the ramification \n\n\n\nof substance addiction. Two main products containing scheduled substances; cough preparations and ketum had \n\n\n\nbeen identified as the popular choice for abuse among the clients. The thematic analysis of the data showed that \n\n\n\nthe abuse of these products were driven by several socioeconomic factors and catalysed by the ubiquity of these \n\n\n\nproducts. The abuse of products containing scheduled substances has been shown to eventually lead to the use of \n\n\n\ndangerous drugs among the clients.  \n\n\n\nCONCLUSIONS: Current approach on enforcement activities and regulations on abuse-prone scheduled \n\n\n\nsubstances need to be revamped as an effort in tackling the issue of illicit dangerous drug use.   \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n20 \n\n\n\n\n\n\n\nMPSPSC2017000009 (Oral) \n\n\n\nDEVELOPMENT AND EVALUATION OF IN SITU-FORMING SYRINGEABLE MUCOADHESIVE \n\n\n\nGEL FORMULATION FOR PERIODONTITIS \n\n\n\n\n\n\n\nWadi NMA1, Mohammed F1, Ahuja A2, Peh KK1 \n1School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 USM, Penang, Malaysia. \n2Departments of Pharmacy, Oman Medical College, Muscat, Oman. \n\n\n\n\n\n\n\nINTRODUCTION: Periodontitis is an inflammatory dental disease caused by pathogenic microorganisms. Local \n\n\n\ndelivery of in situ-forming syringeable mucoadheisve gel formulation containing anti-inflammatory and \n\n\n\nantibacterial drugs is a treatment of choice for periodontitis. \n\n\n\nOBJECTIVE: To develop poloxamer based in situ-forming syringeable mucoadhesive gel formulations \n\n\n\ncontaining metronidazole and diclofenac potassium and evaluate the in-vitro drug release, syringeability, \n\n\n\nantibacterial property and anti-inflammatory effect. \n\n\n\nMETHODS: Gel formulations incorporated with metronidazole and diclofenac potassium, comprising of \n\n\n\ndifferent ratio of mixture of Poloxamer 407 and Poloxamer 188, Carbopol 934 and xanthan gum were prepared. \n\n\n\nThe gel formulations were evaluated for syringeability and in vitro drug release. The antibacterial study was \n\n\n\nconducted using agar diffusion method against four types of bacteria, P. gingivalis, Strep. mutans, Staph. aureous \n\n\n\nand E.coli. Anti-inflammatory activity was evaluated using carrageenan-induced paw edema in rat.  \n\n\n\nRESULTS: Mixture of Poloxmer 407 (20%) and Poloxamer 188(10%) gelled at 35.7 \u00b10.6 \uf0b0C. All the gel \n\n\n\nformulations were syringeable. A statistically significant difference (p < 0.05) was observed in drug release among \n\n\n\nthe gel formulations. The optimized gel formulation showed slow release of both drugs up to 120 hours. The gel \n\n\n\nformulation inhibited the growth of microorganisms and decreased the carrageenan-induced paw edema in rat for \n\n\n\nfour hours when compared with the control. \n\n\n\nCONCLUSION:  In situ-forming syringeable mucoadheisve gel formulation containing antibacterial and anti-\n\n\n\ninflammatory drugs, metronidazole and diclofenac potassium, was successfully developed and exhibited sustained \n\n\n\ndrug release. The gel formulation demonstrated antibacterial and anti-inflammatory effects.   \n\n\n\n\n\n\n\n\n\n\n\nMPSPSC2017000010(Oral) \n\n\n\nJOB SATISFACTION, CONTINUING PROFESSIONAL DEVELOPMENT AND PHARMACEUTICAL \n\n\n\nCARE PRACTICES OF HOSPITAL PHARMACISTS IN THE PHILIPPINES AND MALAYSIA: BASIS \n\n\n\nFOR PHARMACY PROFESSIONAL DEVELOPMENT PLAN \n\n\n\n\n\n\n\nBacayo MFD1, Badong VP2, Sagarino VEV2, Hernandez MTL3, Falle EM1, Asman MF1        ,  \n1 School of Pharmacy, Management and Science University, Selangor Malaysia, \n 2 School of Graduate Studies, University of the Immaculate Conception, Davao City Philippines,  \n3 Clinical Pharmacist, Manila Philippines \n\n\n\n\n\n\n\nINTRODUCTION: Pharmacist should be at higher concern about their job performance, efficiency at work and \n\n\n\njob satisfaction which is a contributing factor for a person's productivity that will influence job performance. It is \n\n\n\nthe pharmacy practitioners\u2019 responsibility to enhance and upgrade their knowledge, skills, and capabilities to \n\n\n\nremain effective and compliant. The transition of pharmacy practice is pharmaceutical care practices, the era of \n\n\n\ntaking responsibility in the performance of clinical functions.  \n\n\n\nOBJECTIVES: This study aimed to determine the level of job satisfaction, level of awareness and engagement \n\n\n\nin continuing professional development and effectiveness in carrying out pharmaceutical care practices of hospital \n\n\n\npharmacist. \n\n\n\nMETHODS: This quantitative study used the descriptive survey method using a validated self-made \n\n\n\nquestionnaire administered among 200 pharmacists from hospitals in Davao City and Selangor. The data obtained \n\n\n\nfrom both locations were analysed using descriptive and inferential statistics. \n\n\n\nRESULTS: The findings showed that hospital pharmacists were satisfied with their jobs. Their awareness to \n\n\n\ncontinuing professional development is high but their participation in research is very low. The level of \n\n\n\npharmaceutical care practices is of great extent.  \n\n\n\nCONCLUSION: There is no significant difference on the pharmaceutical care practices of the pharmacists. There \n\n\n\nis a significant low correlation between job satisfaction and pharmaceutical care practices. A significant \n\n\n\nassociation exist between continuing professional development and pharmaceutical care practices.  \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n21 \n\n\n\n\n\n\n\nMPSPSC2017000012(Oral) \n\n\n\nCONTINUING PROFESSIONAL DEVELOPMENT ACTIVITIES PREFERRED BY COMMUNITY \n\n\n\nPHARMACISTS \n\n\n\n\n\n\n\nLatip NNA1, Chua SS1,2, Pinkney CT3, Balashanker S3 \n1Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia \n2School of Pharmacy, Faculty of Health and Medical Sciences, Taylor\u2019s University , Lakeside Campus, Selangor, \n\n\n\nMalaysia \n3School of Pharmacy, University of Nottingham, Semenyih, Malaysia \n\n\n\n\n\n\n\nINTRODUCTION: Continuing professional development (CPD) is an approach to ensure that healthcare \n\n\n\nprofessionals such as the pharmacists are kept up-to-date in their knowledge and skills throughout their \n\n\n\nprofessional careers. \n\n\n\nOBJECTIVES: To determine the types of CPD activities preferred by community pharmacists in Malaysia and \n\n\n\nto identify the barriers in achieving the required CPD points. \n\n\n\nMETHODS: A cross-sectional study on community pharmacists in Malaysia was conducted. An online \n\n\n\nquestionnaire was distributed to all community pharmacists in Malaysia using survey monkey. To maximize the \n\n\n\nresponse rate, a reminder was sent to all the community pharmacists two weeks after the first email. \n\n\n\nRESULTS: A total of 513 community pharmacists completed the questionnaire. Most of the respondents \n\n\n\nparticipated in CPD activities to improve their professional skills and performance, and to comply with the CPD \n\n\n\nrequirements (95% and above). The most preferred CPD activities were Continuing Medical Education (CME) \n\n\n\n[66.3%] which consisted of seminars, lectures, and forum; and workshops or courses (64.9%). The main barrier \n\n\n\nto participation in CPD activities were job constraints and accessibility to the activities. Most of the respondents \n\n\n\nwere interested in topics related to nutrition and diet, pain management, paediatric, infectious disease and adverse \n\n\n\ndrug reactions. \n\n\n\nCONCLUSION: Community pharmacists preferred taught CPD activities but job constraint was the main barrier. \n\n\n\nTherefore, CPD providers should organize more of such activities and not during working hours. \n\n\n\n\n\n\n\n\n\n\n\nMPSPSC2017000013(Oral) \n\n\n\nSURVEY ON GENERAL PERCEPTION OF SMOKING CESSATION AMONG PATIENTS VISITING \n\n\n\nCARDIOLOGY CLINIC HOSPITAL SERDANG    \n\n\n\n\n\n\n\nNeivashini M1, Goo TH1, Muhammad AL Qasim MN1, Nur Ainnaja A1     \n1Department of Pharmacy, Hospital Serdang, Malaysia    \n\n\n\n\n\n\n\nINTRODUCTION: Tobacco smoking is one of the risk factors for cardiovascular disease .Quit Smoking \n\n\n\nClinic Hospital Serdang was established to assist patients to successfully quit smoking. This study aims to identify \n\n\n\nthe general perception of smoking cessation among patients who smoked visiting Cardiology Clinic, Hospital \n\n\n\nSerdang.  \n\n\n\nMETHOD: This study was done from December 2016 until March 2017. A validated questionnaire was \n\n\n\ndeveloped and tested to assess this study objective. The self-administered questionnaire was then distributed to \n\n\n\nthe target group.  \n\n\n\nRESULTS: A total of 330 tobacco smoking patients were recruited. 93% (n=307) are male and 65% \n\n\n\n(n=214) age ranging 45 to64 years old. 37% (n=122) respondents have smoked cigarette for 11-20 years, followed \n\n\n\nby30% (n = 99) for 1-10 years. Most of the respondent aware that smoking can deteriorate heart disease (83%, \n\n\n\nn=273). 45% (n=150) of respondents have planning or have made an attempt to quit smoking. The most common \n\n\n\nreasons to quit smoking are, concern with current (56%, n= 184) and future health (59%, n=192). The most \n\n\n\nfrequent reasons given by respondents for not quitting smoking were due to withdrawal symptoms (18%, n=60) \n\n\n\nand fear of failure (17%, n=55). \n\n\n\nCONCLUSION: This study, demonstrated that respondents have a positive awareness and willingness towards \n\n\n\nquitting smoking. Therefore, continuous and comprehensive guidance of health care professionals will increase \n\n\n\nthe patients\u2019 willingness to quit smoking. Thus, a referral to QSC should be made to maintain and promote \n\n\n\ncardiovascular disease patients\u2019 motivation to quit smoking. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n22 \n\n\n\n\n\n\n\nMPSPSC2017000016 (Oral) \n\n\n\nTHE NOVEL FINDING OF PERCEIVED STRESS SCALE BETWEEN TYPE 2 DIABETES MELLITUS \n\n\n\nPATIENTS & HEALTHY ADULTS  \n\n\n\n\n\n\n\nBaharudin MSF1, Soe MK1,  Jamsheed S2, Abdul Rahim R1, Andylim N3, Yaakob N3 and Mansor A3  \n1Department of Basic Medical Sciences, Kulliyyah of Pharmacy, International Islamic University Malaysia, \n\n\n\nKuantan, Pahang, Malaysia. \n2 Department of Pharmacy Practice, Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan, \n\n\n\nPahang, Malaysia. \n3Department of Medical, Hospital Pekan, Pekan, Pahang, Malaysia. \n\n\n\n\n\n\n\nINTRODUCTION: Stress is unpleasant, but one of the most common psycho-social life experiences among \n\n\n\npeople worldwide. Stress is believed to affect eating behaviour, blood glucose level, cholesterol level and obesity. \n\n\n\nThese impaired physiological systems can leads to the catastrophic phenomenology on metabolic activity. \n\n\n\nOBJECTIVES: This study aimed to compare the Perceived Stress Scale (PSS) between Type 2 Diabetes Mellitus \n\n\n\n(T2DM) patients with healthy adults in Hospital Pekan, Pahang. \n\n\n\nMETHODS: A case-control study was conducted among 208 subjects (104 T2DM and 104 healthy) of Hospital \n\n\n\nPekan, Pahang. Sample size comprised of 208 respondents after fulfilling all inclusion and exclusion criteria. A \n\n\n\nvalidated Malay version of PSS questionnaire was used to collect the data in order to assess their stress level. The \n\n\n\nresult then was analysed descriptively and inferentially. \n\n\n\nRESULTS: The mean value for both groups\u2019 PSS score was found (38.72 \u00b1 10.87). T2DM patients\u2019 PSS was \n\n\n\nhigher (48.93 \u00b1 2.92) with minimum and maximum PSS score of 36.00 and 56.00 respectively compared to \n\n\n\nhealthy adults (28.51 \u00b1 4.28) by minimum and maximum PSS score of 16.00 and 41.00 correspondingly \n\n\n\n(P=0.000). \n\n\n\nCONCLUSION: Findings of this research suggested that patients with T2DM have poorer psychological well-\n\n\n\nbeing (high PSS) contrasting with normal healthy persons. \n\n\n\n\n\n\n\n\n\n\n\nMPSPSC2017000017 (Oral) \n\n\n\nRHEOLOGICAL CHARACTERISATION OF BACCAUREA ANGULATA DENTAL GELS, AND \n\n\n\nTHEIR RELEASE PROFILES \n\n\n\n\n\n\n\nAbdul Rahman MN1, Abdul Qader OAJ2, Sukmasari S3, Doolaanea AA1 \n1Department of Pharmaceutical Technology, Kulliyyah of Pharmacy \n2Department of Oral Medicine and Oral Pathology, Kulliyyah of Dentistry \n3Department of Paediatric Dentistry, Kulliyyah of Dentistry International Islamic University Malaysia, Bandar \n\n\n\nIndera Mahkota , 25200 Kuantan, Pahang, Malaysia \n\n\n\n\n\n\n\nINTRODUCTION: Bacaurea angulata has potential wound healing effect on the dental wound due to its hight \n\n\n\nantioxidant contents. Plant extract is expected to affect the polymer networks that form the gel and lead to several \n\n\n\nchanges including rheological and release profiles.  \n\n\n\nOBJECTIVES: To characterize the rheological and release profiles of Baccaurea angulata dental gels.  \n\n\n\nMETHOD: Three different gel polymers which are Carbopol 940, Guar Gum and Konjac Gum, were being \n\n\n\ncharacterised rheologically before and after the incorporation of the 3% w/w Baccaurea angulata extract. Later, \n\n\n\nthese gels will be tested their release profiles using Franz Diffusion Cell. \n\n\n\nRESULTS: It was found that apparent viscosity of the gels at 3 different shear rate as well as shear stress needed \n\n\n\nto produce shear rate of 100s-1, decrease after incorporation of extracts in all gel polymers. The Franz Cell \n\n\n\nDiffusion result has shown significant difference in term of released content, where Carbopol 940 was identified \n\n\n\nas the gels that release the highest percentage (75.75 \u00b1 1.18%), followed by Guar Gum and Konjac Gum which \n\n\n\nare 36.71\u00b1 0.44%, and 32.33 \u00b1 0.31% respectively. Regarding the mean flux, Carbopol 940 and Konjac Gum have \n\n\n\nthe highest value within the first hour of application compared to Guar Gum which takes 7 hours to release most \n\n\n\nof its content. Carbopol 940 was found to releasing the maximum amount of content with the fastest rates. \n\n\n\nCONCLUSION: It is concluded that carbopol 940 is the best polymer candidates for Baccaurea angulata dental \n\n\n\ngel formulation, since it has the best release and rheological profiles. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n23 \n\n\n\n\n\n\n\nMPSPSC2017000022 (Oral) \n\n\n\nEXTRACTION OF PROTOCATECHUIC ACID ENRICHED FRACTION FROM CLINACANTHUS \n\n\n\nNUTANS LEAVES \n \n\n\n\nZamery MI1, Hadi H1, Hassan NA2.  \n1Department of Pharmaceutical Technology, Kulliyyah of Pharmacy, International Islamic University Malaysia \n2Department of Pharmaceutical Chemistry, Kulliyyah of Pharmacy, International Islamic University Malaysia \n\n\n\n\n\n\n\nINTRODUCTION: Clinacanthus nutans is abundant in Malaysia. It contains bioactive compounds such as \n\n\n\nphenolics. PCA is a phenolic acid, naturally existed in plant species including C. nutans. It has beneficial effects \n\n\n\nespecially for the treatment and prevention for diseases pertinent to oxidative stress.  \n\n\n\nOBJECTIVES: To extract PCA enriched fraction from C. nutans leaves, analyse it with validated high-\n\n\n\nperformance liquid chromatography (HPLC) method, assess its anti-oxidant capacity.  \n\n\n\nMETHODS: The leaves were macerated in n-hexane followed by dichloromethane and methanol. Methanol \n\n\n\nextract was fractionated by vacuum liquid chromatography (VLC) and the fractions were screened by thin layer \n\n\n\nchromatography (TLC). The fraction was analysed by validated HPLC method. Anti-oxidant activity assay was \n\n\n\nperformed by 1,1-diphenyl-2-picrylhydrazyl (DPPH) radical scavenging assay.  \n\n\n\nRESULTS: 32 fractions were obtained with VLC. Four fractions (F1 \u2013 F4) were acquired after pooling similar \n\n\n\nTLC pattern. As compared to F3, F2 had been observed to possess more intense spot of PCA while F1 and F4 \n\n\n\nhave no PCA spot. All parameters for HPLC method validation were within the specifications. HPLC of F2 \n\n\n\nshowed PCA at 8.124 minutes retention time with the highest peak area among other compounds at 260 nm. Anti-\n\n\n\noxidant assay showed anti-oxidant activity for F2 (IC50=898.51\u00b110.93mg/mL) is the highest as compared to \n\n\n\nunfractionated methanol extract (IC50=1148.20\u00b119.25mg/mL) (p=0.001) and other extracts (p<0.001).  \n\n\n\nCONCLUSION: PCA enriched fraction (F2) was obtained from C. nutans leaves. F2 possesses the highest anti-\n\n\n\noxidant among others, thus, it can be utilized in future research focuses on anti-oxidant applications.  Clinacanthus \n\n\n\nnutans, DPPH, fractionation, protocatechuic acid, VLC. \n\n\n\n\n\n\n\nMPSPSC2017000024 (Oral) \n\n\n\nSTABILITY EVALUATION OF FOLIC ACID AND PHOTOSENSITIZER-FOLIC ACID (PS-FA) \n\n\n\nCONJUGATE THROUGH DESIGN OF EXPERIMENT APPROACH \n\n\n\n\n\n\n\nMohd Gazzali A1,2, Lobry M3, Colombeau L3,  Acherar S2, Vanderesse R2,  Bastogne T4, Frochot C3 \n1School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 USM, Penang, Malaysia. \n2Laboratoire de Chimie Physique Macromol\u00e9culaire, UMR-CNRS 7375, Universit\u00e9 de Lorraine, 1, Rue \n\n\n\nGrandville, BP451, 54001 Nancy Cedex, France \n3Laboratoire R\u00e9actions et G\u00e9nie des Proc\u00e9d\u00e9s, UMR-CNRS 7274, Universit\u00e9 de Lorraine, 1, Rue Grandville, \n\n\n\nBP451, 54001 Nancy Cedex, France \n4Centre de Recherche en Automatique de Nancy, UMR-CNRS 7039, Universit\u00e9 de Lorraine, Campus Science, \n\n\n\nBP 70239, 54506, Vandoeuvre-les-Nancy Cedex, France \n\n\n\n\n\n\n\nINTRODUCTION: Folic acid is a small molecule that has shown great potential as a targeting agent in a number \n\n\n\nof diseases. In certain type of cancers such as the ovarian cancer, due to the upregulation of folate receptor, folic \n\n\n\nacid can be used as a targeting agent to specifically deliver therapeutic molecules. However, in our endeavour to \n\n\n\nutilize folic acid in the delivery of photosensitizer (PS) for photodynamic therapy (PDT), we found that the \n\n\n\nconjugate of PS-folic acid has a problem of stability \u2013 the conjugate was inactivated due to the degradation of \n\n\n\nfolic acid molecule. \n\n\n\nOBJECTIVE: Hence, in order to understand this issue and to decide the suitable measures to overcome the \n\n\n\ndegradation problem, a stability study was conducted on folic acid and a model of PS-folic acid conjugate.  \n\n\n\nMETHOD: The molecules were exposed to five factors \u2013 light, different temperatures, different medium, and \n\n\n\npresence of oxygen and time length. The Design of Experiment (DOE) approach was taken to evaluate the \n\n\n\ndifferent factors. Overall, 26 experiments were conducted (three replicates) and the results were analysed by \n\n\n\nstatistical analysis.  \n\n\n\nRESULTS: From the result obtained, light was shown to be the most important factor in causing the degradation \n\n\n\nof folic acid and PS-folic acid conjugate. The other factors have less significant influence on the stability of the \n\n\n\nmolecules.  \n\n\n\nCONCLUSION: It is important to protect or minimize the exposure of the molecules to light during manipulation \n\n\n\nand analysis. This will ensure the delivery of active molecules during therapy. \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n24 \n\n\n\n\n\n\n\nMPSPSC2017000028 (Oral) \n\n\n\nSUBCRITICAL WATER EXTRACTION AS A MODERN GREEN EXTRACTION TECHNIQUE OF \n\n\n\nHYDROXYCHAVICOL FROM PIPER BETLE LINN. LEAVES \n\n\n\n\n\n\n\nMohd Hanif N1, Sarker MZI1, Abd Had H1 \n\n\n\n1Department of Pharmaceutical Technology, Kulliyyah of Pharmacy, International Islamic University Malaysia, \n\n\n\nJalan Sultan Ahmad Shah, Bandar Indera Mahkota, 25200 Kuantan, Pahang Darul Makmur, Malaysia \n\n\n\n\n\n\n\nINTRODUCTION: Hydroxychavicol is commonly extracted from Piper betle leaves using conventional solvent \n\n\n\nextraction. However, there is a modern green extraction technique using subcritical water to extract \n\n\n\nhydroxychavicol at a high temperature between 100 and 374 and a high pressure. It is used due to cost-\n\n\n\neffectiveness, time-saving, greater extraction yields and environmental friendly. \n\n\n\nOBJECTIVES: To determine optimum conditions for subcritical water extraction of hydroxychavicol and to \n\n\n\ncompare hydroxychavicol yield between conventional solvent extraction and subcritical water extraction \n\n\n\ntechniques. \n\n\n\nMETHODS: Subcritical water extraction of hydroxychavicol was carried out at different temperatures ranging \n\n\n\nfrom 80 to 180? Then, it was conducted at different static extraction time interval of 10, 30, 60 and 90 minutes \n\n\n\nwith total extraction time of 180 minutes. The hydroxychavicol content was analyzed by using a validated high \n\n\n\nperformance liquid chromatography (HPLC) method. The HPLC method was validated for linearity, specificity, \n\n\n\naccuracy, precision, limit of detection (LOD) and limit of quantification (LOQ). \n\n\n\nRESULTS: The highest amount of hydroxychavicol (11.05%) was extracted from Piper betle leaves using \n\n\n\nsubcritical water extraction at 100? with static extraction time interval of 60 minutes. Subcritical water extraction \n\n\n\nshowed significantly greater hydroxychavicol yield of 11.05% compared to solvent extraction of 7.78% (P=0.04). \n\n\n\nThe HPLC method showed a good linearity (r2>0.999), satisfactory accuracy (percentage difference 0.1 to 1.33%), \n\n\n\nprecision (RSD 0.11 to 1.44%) with low LOD (0.13\u00b5g/mL) and LOQ (0.43\u00b5g/mL). \n\n\n\nCONCLUSION: Subcritical water extraction has potential to be an alternative extraction technique of \n\n\n\nhydroxychavicol from Piper betle leaves. \n\n\n\n\n\n\n\nMPSPSC2017000029 (Oral) \n\n\n\nCORRELATION OF TARGET INTERNATIONAL NORMALISED RATIO (INR) AND PATIENT\u2019S \n\n\n\nUNDERSTANDING ON WARFARIN THERAPY AT MEDICATION THERAPY ADHERENCE \n\n\n\nCLINIC IN KLANG VALLEY \n\n\n\n\n\n\n\n Abdullah AF1, Bacayo MFD1, Abdullah NA2, Faller EM1                                                                                                                                        \n 1School of Pharmacy, Management & Science University, Shah Alam, Malaysia \n 2Clinical Pharmacist, Hospital Tuanku Ampuan Rahimah, Klang, Malaysia                                                             \n\n\n\n\n\n\n\nINTRODUCTION: Warfarin has been prescribed as an oral anticoagulant that needs consistent monitoring of \n\n\n\nthe international normalised ratio (INR). Patients' concurrent compliance and education of therapy plays an \n\n\n\nimportant role in avoidance of the adverse drug events as well as controlling INR level. \n\n\n\nOBJECTIVES:  To evaluate the patient's understanding on warfarin therapy and target INR goal and to establish \n\n\n\nits correlation. \n\n\n\nMETHOD: A prospective study design was used in warfarin Medication Therapy Adherence Clinic (MTAC) \n\n\n\nfrom April 2016 until July 2016. 243 patients prescribed with warfarin were identified. Patients were interveiwed \n\n\n\nusing Perception of Anticoagulant Therapy Questionnaires (PACTQ). Medical data were reviewed for INR levels. \n\n\n\nData were investigated using Spearman correlation analysis (p<0.05). \n\n\n\nRESULTS: A total of 97 were eligible and accepted to complete the questionnaires. One third of subjects had a \n\n\n\nsecondary level of education, 50% were employed. Half who participated were Malay, aging from 45 to 64 years \n\n\n\nold. Most of the patients used warfarin for more than 5 years. Mean score PACTQ test among participants was \n\n\n\n66.2+ 5.4, while for INR control, poor understanding of patients dominates the most 78+ 17.3, which account \n\n\n\nhighest among the three groups. Significant differences were found among the level of understanding among \n\n\n\ndifferent gender. There was a significant correlation between patient's warfarin therapy perception and the time \n\n\n\nspent with the therapeutic range (TTR %) (r=0.036; p=0.727). \n\n\n\nCONCLUSION: The study found no significant relationship exists between patient's understanding on warfain \n\n\n\ntherapy and target INR goal.  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n25 \n\n\n\n\n\n\n\nMPSPSC2017000030 (Oral) \n\n\n\nTHE EVALUATION OF PHYSICOCHEMICAL AND ANTI-MICROBIAL PROPERTIES OF HONEY \n\n\n\nBASED HYDROGEL  \n\n\n\n\n\n\n\nAbd Jalil MA1,3, Kasmuri AR2, Ab Hadi H1 \n1Department of Pharmaceutical Technology, Kulliyyah of Pharmacy, IIUM, Malaysia   \n2Department of Basic Medical Sciences, Kulliyyah of Pharmacy, IIUM, Malaysia \n3Deprtment of Basic Medical Sciences for Nursing, Kulliyyah of Pharmacy, IIUM, Malaysia \n\n\n\n\n\n\n\nINTRODUCTION: Hydrogel possess three-dimensional cross linked networks of hydrophilic polymers. Honey \n\n\n\ncontains anti-microbial properties due to its peroxide and non-peroxide components. \n\n\n\nOBJECTIVES: To develop and characterize honey based hydrogel formulation and to evaluate its anti-microbial \n\n\n\nproperties.  \n\n\n\nMETHODS: The hydrogel were developed by combining polyvinyl alcohol (PVA) and polyethylene glycol \n\n\n\n(PEG). 1% protein-free agar was added to the combination as well as honey according to their respective \n\n\n\nformulations. Then, the characterization tests consist of gel fraction; swelling ratio and water vapour transmission \n\n\n\n(WVTR) were conducted. For the antimicrobial evaluation, microbial limit test and agar diffusion test were \n\n\n\nconducted against Staphylococcus aureus and Pseudomonas aeruginosa.  \n\n\n\nRESULTS: For the gel fraction test, the control formulation was significantly (p<0.05) highest among the others; \n\n\n\nindicates that the PVA in this formulation was almost completely cross-linked. For the swelling ratio test, \n\n\n\nformulation 2 that contain 20% (w/v) honey was significantly (p<0.05) higher than the control and agar groups; \n\n\n\nindicates a higher water uptake occurred. The WVTR of formulation 2 was within the recommended range which \n\n\n\nis in between 80\u2013105gm -2day -1. Formulation 5 with 40% (w/v) honey has shown anti-microbial effect towards \n\n\n\nStaphylococcus aureus. For microbial limit tests, all formulations showed the absence of bacteria in their \n\n\n\nrespective surfaces. \n\n\n\nCONCLUSIONS: Formulation 2 demonstrated significantly better physicochemical properties but displaying no \n\n\n\nanti-microbial properties. However, formulation 5 showed an acceptable physicochemical properties but able to \n\n\n\ndisplay a good anti-microbial properties. Therefore, formulation 5 will be selected for further studies.  \n\n\n\n\n\n\n\n\n\n\n\nMPSPSC2017000032 (Oral) \n\n\n\nEFFECT OF COSMETIC CREAM CONTAINING PIPER BETLE LINN. EXTRACT ON SKIN: A \n\n\n\nPILOT STUDY \n\n\n\n\n\n\n\nSyed Omar SS1, Ab Hadi1 \n1Pharmaceutical Technology Department, Kulliyyah of Pharmacy, International Islamic University Malaysia \n\n\n\n\n\n\n\nINTRODUCTION: Piper betle L. a local Malaysian plant from piperaceae family or also known as sireh has \n\n\n\nbeen found to possess many therapeutic benefits. Although this plant has been widely studied, there are minimal \n\n\n\ndata on the benefits of this plant on the skin. Hence, the extract of this plant was formulated into a cosmetic cream \n\n\n\nfor skin application with natural based ingredients.  \n\n\n\nOBJECTIVES: This study aims to evaluate effects of the cream incorporating Piper betle L. extract on human \n\n\n\nskin such as skin-lightening, hydration and elasticity.  \n\n\n\nMETHODS: To study the effect of this formulation on the skin a pilot study was done on 6 subjects, both male \n\n\n\nand female, in order to see the effects of this cream on the melanin content, hydration and elasticity of the skin. \n\n\n\nThe skin parameters were measured during baseline and weekly for 4 weeks using several probes from Dermalab \n\n\n\nCombo\u00ae.  \n\n\n\nRESULTS: The overall results for melanin content showed that the melanin content of the skin is significantly \n\n\n\nreduced (p=0.000). This maybe contributed by the anti-tyrosinase activity of hydroxychavicol. Elasticity \n\n\n\nparameters also showed significant reduction in the mean values (p=0.007) which may be due to anti-oxidant \n\n\n\nactivity contributed by high total phenolic content. However, hydration parameter showed no significant \n\n\n\nimprovement. This is most likely due to multiple factors that may affect the skin\u2019s hydration such as time of skin \n\n\n\ntest, water intake and environmental factors. \n\n\n\nCONCLUSION: Piper betle L. may be able to exert beneficial effects on the skin with consistent use. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n26 \n\n\n\n\n\n\n\nMPSPSC2017000036 (Oral) \n\n\n\nDOWNREGULATION OF SEMAPHORIN 5A IN HUMAN GLIOBLASTOMAS BY ALTERNATIVE \n\n\n\nSPLICING CAUSES A LOSS OF ITS TUMOR SUPPRESSOR FUNCTION \n\n\n\n\n\n\n\nShah Jahan FR1, Law JW1 and Lee AY1 \n\n\n\n1School of Pharmacy, Monash University Malaysia. \n\n\n\n\n\n\n\nINTRODUCTION: Semaphorins and their receptors plexins are families of axon guidance molecules involved \n\n\n\nin diverse biological functions. We have recently demonstrated the effects of semaphorin 5A (Sema5A) in \n\n\n\ninhibiting migration and invasion in human glioblastoma cells. Notably, Sema5A protein level is markedly \n\n\n\ndownregulated in astrocytoma specimens from low to high grade. We therefore hypothesized that Sema5A \n\n\n\nsubserves tumor suppressor function in glioblastomas, which is compromised due to a dysregulation of its \n\n\n\nexpression, hence contributing to brain cancer development. \n\n\n\nOBJECTIVES: To examine the mechanism underlying downregulation of Sema5A protein expression in high-\n\n\n\ngrade glioblastomas. Its anti-tumorigenic function was validated by reconstitution of expression in glioblastoma \n\n\n\ncells. \n\n\n\nMETHODS: Sema5A mRNA transcripts in human astrocytoma of different grades were subjected to quantitative \n\n\n\nreal-time PCR and sequence analysis to determine its expression level and identify genetic aberrations. Wild-type \n\n\n\nSema5A and splice variants were ectopically expressed and assayed for anti-tumorigenic function. \n\n\n\nRESULTS: While neither mutation nor significant change in mRNA levels was observed in Sema5A across \n\n\n\ndifferent grades of astrocytoma, a number of alternatively spliced variants of Sema5A transcript were found to be \n\n\n\nexpressed at comparable level as the wild-type counterpart. Ectopic expression of these variants in HEK293 cells \n\n\n\nresults in premature truncation isoforms of Sema5A protein, which are unstable and targeted for proteasomal \n\n\n\ndegradation. Reconstitution of Sema5A expression in glioblastoma cells is sufficient to suppress anchorage-\n\n\n\nindependent growth. \n\n\n\nCONCLUSION: Sema5A is downregulated in glioblastomas by alternatively splicing, which causes a loss of its \n\n\n\nanti-tumorigenic function. Sema5A therefore represents a promising therapeutic agent for brain cancers. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nMPSPSC2017000037 (Oral) \n\n\n\nKNOWLEDGE, ATTITUDE AND PERCEPTION OF MUSLIM CONSUMERS TOWARDS HALAL \n\n\n\nCOSMETIC PRODUCTS  \n\n\n\n\n\n\n\nMohamad Noor Z1,2, Zulkifli NA1, Mohamed Ismail R3,4 \n\n\n\n1Kulliyyah of Pharmacy, International Islamic University Malaysia, Pahang. \n2Faculty of Pharmacy and Health Sciences, University Kuala Lumpur Royal College of Medicine Perak, Perak. \n3Asian Halal Laboratory (AHAL), Universiti Utara Malaysia, Kedah. \n4School of Technology Management and Logistics, Universiti Utara Malaysia, Kedah. \n\n\n\n\n\n\n\nINTRODUCTION: \u2018Halal\u2019 is not restricted to only food and beverages, but also cosmetics. In Malaysia, cosmetic \n\n\n\nproducts are not yet subjected to obtain halal certification to be marketed. Thus, Muslims are responsible to \n\n\n\nascertain the halal status of cosmetic products to avoid \u2018prohibited ingredients\u2019 according to Islam.  \n\n\n\nOBJECTIVES: This study aimed to investigate the knowledge, attitude and perception of Muslim consumers \n\n\n\ntowards halal cosmetic products.  \n\n\n\nMETHODS: A cross-sectional study was conducted by distributing a self-administered questionnaire via online \n\n\n\nand paper-form hardcopies. Questionnaire was divided into four parts: socio-demographic, and knowledge, \n\n\n\nattitude and perception, of the consumers, related to halal cosmetic products. Prior to the full-scale study, a \n\n\n\nfeasibility study was conducted using snowball sampling to run a reliability analysis for the questionnaire. Data \n\n\n\nwere analysed using SPSS version 19.0. RESULTS: In the feasibility study (N=40), Cronbach\u2019s Alpha indicated \n\n\n\nwithin good and acceptable range; knowledge (0.837), perception (0.834) and attitude (0.732). The full-scale study \n\n\n\nreceived 363 responses from Muslim consumers all over Malaysia (female, 75.5%; male, 24.5%). Malays were \n\n\n\n97.8%, and 72.5% were within 21-25 years old. Data found that 51% and 48% of respondents have good and \n\n\n\nmoderate knowledge respectively. For attitude, 44% and 22% of respondents agreed and strongly agreed to switch \n\n\n\nto halal-certified products, and respectively, 25% and 57% agreed and strongly agreed that cosmetic products \n\n\n\nshould obtained halal certification before being marketed.  \n\n\n\nCONCLUSION: In general, it was found that more than half of the Muslim consumers have good knowledge, \n\n\n\nattitude and perception towards halal cosmetic products. \n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n27 \n\n\n\n\n\n\n\nMPSPSC2017000038 (Oral) \n\n\n\nPERCEPTIONS OF MEDICAL DOCTORS TOWARDS CLINICAL PHARMACISTS IN DUCHESS OF \n\n\n\nKENT HOSPITAL (DOKH), SANDAKAN \n\n\n\n\n\n\n\nVoo JYH1, Teo CC1, Kwan HHS1, Adil HG1, Rosmadi NAD1  \n1Department of Pharmacy, Duchess Of Kent Hospital, Sandakan, Malaysia \n\n\n\n\n\n\n\nBACKGROUND: Clinical pharmacists are recognised as major provider of valid evidence-based information on \n\n\n\nthe suitability, cost-effectiveness and safety of medications. Study regarding perceptions of medical doctors \n\n\n\n(medical officers and physician) towards clinical pharmacists has not been previously conducted in DOKH.  \n\n\n\nOBJECTIVES: This study aimed to assess the perceptions of medical doctors towards clinical pharmacists in \n\n\n\nDOKH and to identify the obstacles which hinder the integration of clinical pharmacists into the primary \n\n\n\nhealthcare team.  \n\n\n\nMETHODS: A cross-sectional validated questionnaires was carried out on all consented medical doctors in \n\n\n\nDOKH (n=120) from February to April 2017. All collected data was tabulated and presented using descriptive \n\n\n\nanalyses.  \n\n\n\nRESULTS: Most of the medical doctors in DOKH expressed willingness to cooperate with clinical pharmacists \n\n\n\n(93.3%). Almost all respondents agreed that the clinical pharmacist has a role in patient medication education \n\n\n\n(98.3%).  A huge majority agreed that clinical pharmacist is an important integral role part of the clinical ward \n\n\n\nteam (96.7%) by minimising medication errors, maximising cost-effectiveness and hence improving patient \n\n\n\ntherapy outcome (97.5%). Nevertheless, only 65% of medical doctors believed that the clinical pharmacist have \n\n\n\nfulfilled his/her role.  One-third of respondents identified poor communication skills and lack of clinical \n\n\n\nknowledge, confidence and training as barriers to clinical pharmacists integrating into the primary healthcare \n\n\n\nteam. \n\n\n\nCONCLUSION: A large proportion of medical doctors had positive perceptions towards clinical pharmacists in \n\n\n\nDOKH. Lack of clinical knowledge, confidence and training and poor communication skills are the major \n\n\n\nobstacles for integration of clinical pharmacists into the primary healthcare team. \n\n\n\n\n\n\n\n\n\n\n\nMPSPSC2017000042 (Oral) \n\n\n\nTUBERCULOSIS INCIDENCE AFTER COMPLETION OF ISONIAZID PROPHYLAXIS THERAPY \n\n\n\nIN RETROVIRAL DISEASE PATIENTS \n\n\n\n\n\n\n\nChe Pa MF1, Aminurrahman UH1, Cheah HM1, Koh KC2 \n1Department of Pharmacy, Hospital Tuanku Ja\u2019afar, Seremban  \n2Department of Internal Medicine, International Medical University (IMU) \n\n\n\n\n\n\n\nINTRODUCTION: Isoniazid prophylaxis therapy (IPT) is a proven intervention to prevent tuberculosis (TB) \n\n\n\namong retroviral disease (RVD) patients. The implementation of IPT is recommended by the Ministry of Health \n\n\n\nMalaysia since 2012. However, there are few data in local setting regarding this implementation and its \n\n\n\neffectiveness. \n\n\n\nOBJECTIVE: To measure the level of uptake of IPT and TB incidence after the completion of IPT. \n\n\n\nMETHODS: A retrospective observational study was conducted in Infectious Disease Clinic, Hospital Tuanku \n\n\n\nJa\u2019afar, Seremban, Negeri Sembilan. All 289 patients were screened through medical documents between \n\n\n\nNovember 2011 and May 2015. 123 patients who received oral isoniazid 5mg/kg daily as isoniazid prophylaxis \n\n\n\ntherapy (IPT) were selected. TB incidence was calculated in person-years using Cox regression analysis.   \n\n\n\nRESULTS: A total of 123 patients (42.6%) received IPT out of 289 RVD patients between November 2011 and \n\n\n\nMay 2015. 78% reported completion of 6-months IPT. The overall TB incidence was 2.2 per 100 person-years \n\n\n\n(95%CI: 2.05-2.35). Patients who initiated IPT before antiretroviral therapy had TB incidence of 14 per 100 \n\n\n\nperson-years while those who initiated IPT after antiretroviral therapy was 1.6 per 100 person-years (p=0.0251).  \n\n\n\nCONCLUSION: IPT may be beneficial among RVD patients in preventing incidence of TB especially after or \n\n\n\nduring antiretroviral therapy has been started. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n28 \n\n\n\n\n\n\n\nMPSPSC2017000043 (Oral) \n\n\n\nSTATINS EFFECTS ON CATARACT AMONG PATIENTS WITH TYPE 2 DIABETES MELLITUS \n\n\n\n\n\n\n\nHammad MA1, Mohamed Noor DZ1, Syed Sulaiman SA1, Sha'aban A1, Aziz NA2 \n1School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 USM, Penang, Malaysia. \n2Endocrinology Clinics, Penang General Hospital, Penang, Malaysia  \n\n\n\n\n\n\n\nINTRODUCTION:  Cataract is the leading cause of poor vision and blindness worldwide. The effects of statin \n\n\n\nadministration on cataract remain unclear.  \n\n\n\nOBJECTIVES:  To evaluate the prevalence of cataract and to determine whether statin use affects the risk of \n\n\n\ncataract development among outpatients with Type 2 diabetes mellitus in Hospital Pulau Pinang, Malaysia. \n\n\n\nMETHODS:  This is a retrospective cohort study of 717 diabetic outpatients (559 statins user with age (58\u00b111.9) \n\n\n\nand 158 statins non-users with age (45.2\u00b118.1). Clinical data, demographic criteria, medications and confirmed \n\n\n\ndiagnosis of cataract were collected.  \n\n\n\nRESULTS:  The age of 717 subjects was (55.2\u00b114.9) years and females 367(51.2%). Malay was 268(37.4%), \n\n\n\nChinese 255(35.6%) and Indian 194(27.1%). Cataract was diagnosed in 303(42.3%) patients with age (60.5\u00b113.8) \n\n\n\nyears. Cataract distribution among treatment and control group was 255(45.6%) and 48(30.4%) cases respectively. \n\n\n\nAbout 172(46.9%) of female and 131(37.4%) of the male had a cataract. While, 112(41.8%) Malay, 117(45.9%) \n\n\n\nChinese, and 74(38.1%) Indian subjects developed a cataract. The relative risk (RR) for cataract due to statin \n\n\n\nusage is 1.5, and excessive relative risk (ERR) is 50%. The absolute risk (AR) is 15.2% and number need to harm \n\n\n\n(NNH) is 7. Chi-square, Spearman's correlation test (P-value: 0.001), and multinomial logistic regression test \n\n\n\nindicated a significant statistical association of statins use and cataract incidence (P-value: 0.002). \n\n\n\nCONCLUSION: More than one-third of cases had a cataract. Statin users\u2019 cohort had a higher risk of cataract \n\n\n\nincidence than statin non-user group. Female and Chinese had increased risk of cataract than male, Indian and \n\n\n\nMalay. \n\n\n\n\n\n\n\n\n\n\n\n \nMPSPSC2017000045 (Oral) \n\n\n\nTHE EQUIVALENCE BETWEEN THE MALAY AND UK ENGLISH VERSIONS OF MINI-\n\n\n\nADDENBROOKE'S COGNITIVE EXAMINATION \n\n\n\n\n\n\n\nHammad MA1, Mohamed Noor DZ1, Syed Sulaiman SA1, Sha'aban A1 \n1School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 USM, Penang, Malaysia. \n\n\n\n\n\n\n\nINTRODUCTION: The UK Version C (2014) of Mini-Addenbrooke\u2019s Cognitive Examination (M-ACE) is a \n\n\n\nvery sensitive and specific tool for the detection of cognition impairment. It is particularly useful in differentiating \n\n\n\nmild cognitive impairment from dementia. \n\n\n\nOBJECTIVES: To validate the reliability of the Malay (2016) version of M-ACE for detecting cognition \n\n\n\nimpairment and measure its equivalence with the UK Version C (2014) English. \n\n\n\nMETHODS: A cross-sectional study design was conducted. M-ACE was done for 104, bilingual (Malay and \n\n\n\nEnglish speakers) Malaysian outpatients with Type 2 diabetes mellitus at Hospital Pulau Pinang, Penang, \n\n\n\nMalaysia. Both the Malay Version (2016) and UK Version C (2014) instruments were administered to Reliability, \n\n\n\ntest-retest, and equivalent forms. Reliability tests were done for the five domains of each of the two versions. To \n\n\n\nfurther assess of equivalence, the mean scores of five scales of the two versions were calculated and compared.  \n\n\n\nRESULTS: From 104 consenting participants, 63(60.6%) were males. The mean age of participants was \n\n\n\n58.9\u00b110.8 years. The majority of contributors were Indian 38(36.5%), followed by Malay 37(35.6%) and Chinese \n\n\n\n29(27.9%). The reliability of M-ACE Malay version was very good (Cronbach\u2019s \u03b1-coefficient =0.839). Student \n\n\n\nt-tests showed non-significant differences between the mean scores obtained from the two versions for each of its \n\n\n\nfive domains.  \n\n\n\nCONCLUSIONS: The UK English and Malay-language versions of the M-ACE indicated equivalence in \n\n\n\nbilingual Malaysian diabetic outpatients. The findings recommended that the Malay and UK English versions can \n\n\n\nbe used interchangeably in further studies for patients who speak either English or Malay languages. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n29 \n\n\n\n\n\n\n\nMPSPSC2017000048 (Oral) \n\n\n\nHALAL GUIDE ON THE USE OF PHARMACEUTICAL INTOXICANTS IN MEDICINES \n\n\n\n\n\n\n\nBuang A1 \n\n\n\n1Malaysian Pharmaceutical Society \n\n\n\n\n\n\n\nINTRODUCTION: Currently, there is no halal guide on the use of pharmaceutical intoxicants in medicines. The \n\n\n\nNational Fatwa committee of Malaysia has a halal guide on the use of alcohol in food based on the input from \n\n\n\nUniversiti Putra Malaysia\u2019s food expert and was published in 2011. This guide was also extended to include \n\n\n\nmedicines and perfumes. As such, it is important for pharmacists as guardians of medicines to be in the fore-front \n\n\n\nto formulate a guide for this purpose.  \n\n\n\nOBJECTIVE: To formulate halal guide on the use of pharmaceutical intoxicants in medicines. \n\n\n\nMETHODS: On 22nd May 2017, Inhart and MPS co-organised a half-day stakeholders meeting to discuss and \n\n\n\nformulate the guide. The stakeholders consist of the Ministry of Health, Jakim, Ministry of Defence, HDC, IIUM, \n\n\n\nUSM, UM, UPM, CUCMS and industry.  \n\n\n\nRESULTS: Based on one of the Pillars of Syariah (Maqasid Shariah) concerning preservation of life, medicines \n\n\n\nthat have al-khamr or intoxicating properties are permissible (halal) to be used for Muslim patients. These \n\n\n\nmedicines also known as pharmaceutical intoxicants can be used based on their approved prescribed dosage upon \n\n\n\nregistration with the National Pharmaceutical Regulatory Agency (NPRA), Ministry of Health Malaysia for \n\n\n\nquality, safety and efficacy. Pharmaceutical intoxicants such as ethanol, anesthetics, analgesics, anticonvulsants, \n\n\n\nanti-parkinson, anti-depressions, anxiolytics, antipsychotics and hypnotics are psycho-active drugs for various \n\n\n\ntypes of treatment.  \n\n\n\nCONCLUSION: Drug companies as far as possible should avoid the use of ethanol in their oral products such as \n\n\n\ncough mixtures. The prescribed dose for these products shall be approved by NPRA. The guide will include food-\n\n\n\ndrug interphase products and will be forwarded to Jakim for further action. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nMPSPSC2017000049 (Oral) \n\n\n\nSINGLE DOSE VERSUS MULTIPLE DOSES OF ANTIBIOTIC PROPHYLAXIS IN CAESAREAN \n\n\n\nSECTION: PROTOCOL FOR A SYSTEMATIC REVIEW AND META-ANALYSIS OF AFRICAN \n\n\n\nSTUDIES  \n \n\n\n\nAbubakar U1 and Sulaiman SAS1   \n1School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 USM, Penang, Malaysia. \n\n\n\n\n\n\n\nINTRODUCTION: Caesarean section is associated with 5 \u2013 20 fold increase risk of postpartum infections \n\n\n\ncompared to vaginal delivery and antibiotic prophylaxis reduced such infections. Evidence from meta-analyses \n\n\n\ndemonstrates that single dose of antibiotic prophylaxis is not inferior to multiple doses in reducing infectious \n\n\n\nmorbidity in caesarean section. However, African studies are underrepresented in these meta-analyses. In addition, \n\n\n\nObstetrician argued that African Hospitals are different, in terms of microbial contamination, from hospitals in \n\n\n\nother parts of the world. Furthermore, African studies comparing single dose to multiple dose of antibiotic \n\n\n\nprophylaxis have reported conflicting results. \n\n\n\nOBJECTIVES: To determine the optimal duration of antibiotic prophylaxis in caesarean section by comparing \n\n\n\nsingle dose and multiple doses interventions. \n\n\n\nMETHODS: Electronic search of Pubmed and Scopus databases with World Health Organization and Pan \n\n\n\nAfrican Clinical trial registry would be conducted to identify eligible studies. Only Randomized Control Trials \n\n\n\nconducted in Africa that compared single dose and multiple doses of antibiotic prophylaxis in caesarean section \n\n\n\n(elective and emergency) would be included. A standardized data collection sheet would be used for data \n\n\n\nextraction. Risk of bias of the included studies would be assessed using Cochrane risk of bias tool. The primary \n\n\n\noutcome is composite infectious morbidity of the secondary outcomes; endometriosis, wound infection and \n\n\n\nurinary tract infection.  \n\n\n\nDATA ANALYSIS: Statistical analysis will be performed using REVIEW MANAGER (RevMan) version 5.3. \n\n\n\nPooled studies will be analysed using random-effect model and binary outcomes will be presented as summary \n\n\n\nrisk ratio with 95% confidence interval.   \n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n30 \n\n\n\n\n\n\n\nMPSPSC2017000050 (Oral) \n\n\n\nPHARMACOMETRICS MODELLING OF THE NATURAL DIABETES DISEASE PROGRESSION \n\n\n\nAND LIFESTYLE INTERVENTION EFFECTS ON WEIGHT, BETA CELL FUNCTION AND \n\n\n\nINSULIN SENSITIVITY IN INDIVIDUALS WITH IMPAIRED GLUCOSE TOLERANCE \n\n\n\n\n\n\n\nGhadzi SMS1,2, Karlsson MO1, de Mello VD3, Uusitupa M3, Kjellsson MC1; Finnish Diabetes Prevention Study \n\n\n\nGroup \n1Department of Pharmaceutical Biosciences, Uppsala University, Sweden \n2School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 USM, Penang, Malaysia. \n3Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio Campus, Kuopio, Finland \n\n\n\n\n\n\n\nINTRODUCTION: Pharmacometrics modelling is an interesting method used in quantifying diabetes disease \n\n\n\nprogression.  \n\n\n\nOBJECTIVES: The objective of this study was to characterise and quantify the effect of natural disease \n\n\n\nprogression in comparison to lifestyle intervention on body weight, insulin sensitivity and beta cell function \n\n\n\namong individuals with impaired glucose tolerance (IGT), applying the weight-HbA1c-insulin-glucose (WHIG) \n\n\n\nmodel.  \n\n\n\nMETHODS: The data from Finnish Diabetes Prevention Study with yearly weight, fasting plasma glucose, \n\n\n\nfasting serum insulin, and glycated haemoglobin values for six years, were used in the study. A total of 522 \n\n\n\nsubjects with IGT were randomized into control and intervention groups. The WHIG model was used to fit the \n\n\n\ndata from baseline until the sixth year, using NONMEM.  \n\n\n\nRESULTS: At the end of the study, 0.9% and 4.1% reduction of weight were recorded in the control and \n\n\n\nintervention groups, respectively. Insulin sensitivity increased on average from 63.2% of normal to 69.0% in the \n\n\n\ncontrol group and from 63.7% of normal to 77.9% in the intervention, mainly due to weight change. For beta cell \n\n\n\nfunction, the baseline value was 50.1% and 51.7% of normal for the control and intervention groups, respectively, \n\n\n\nand decreased to 41.1% and 40.1% of normal. A fundamental disturbance in the beta cell function among \n\n\n\nprediabetics may cause the reduction of beta cell function. A 0.4% decrease of postprandial glucose input was \n\n\n\nrecorded with the total effects of natural disease progression and lifestyle intervention.  \n\n\n\nCONCLUSION: In conclusion, effective weight reduction and insulin sensitivity improvement were achieved \n\n\n\nwith lifestyle intervention. \n\n\n\n\n\n\n\nMPSPSC2017000051 (Oral) \n\n\n\nPERSONALISATION OF ASPIRIN THERAPY: A FOCUS ON GASTRIC TOXICITY \n\n\n\n\n\n\n\nSha\u2019aban A1, Zainal H1, Khalil NA2 and Ibrahim B1 \n1School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 USM, Penang, Malaysia. \n2Animal Research Centre, Advanced Medical and Dental Institute Universiti Sains Malaysia, Bertam, 13200, \n\n\n\nKepala Batas, Penang, Malaysia. \n\n\n\n\n\n\n\nINTRODUCTION: The use of aspirin (75-325mg) has become the cornerstone of secondary prevention in \n\n\n\ncoronary heart disease. It has been proven to reduce the risk of new atherothrombotic events by 25\u201330% through \n\n\n\nplatelet inhibition. Despite its demonstrated beneficial effects, it is also well documented that it causes damage to \n\n\n\nthe gastrointestinal (GI) tract. However, the reasons why some people develop serious lesions, whereas most only \n\n\n\nhave minor but clinically important lesions are poorly understood. Therefore, concern about development of GI \n\n\n\ntoxicity, especially bleeding remains a major factor limiting the widespread use of aspirin. GI symptoms also \n\n\n\nserve as a major cause of discontinuation or non-adherence to therapy in some patients, thereby leading to \n\n\n\ntreatment failure and presumed aspirin resistance. \n\n\n\nOBJECTIVES: This study aims to illustrate and classify aspirin-induced GI toxicity in rats, which serves as a \n\n\n\nprelude to the discovery of new biomarkers for aspirin-induced GI toxicity. \n\n\n\nMETHOD: Thirty-two (32) Sprague-Dawley rats were given 10.41mg/kg aspirin for 4 weeks, sacrificed and their \n\n\n\nstomachs examined macroscopically for GI toxicity using stereomicroscope. \n\n\n\nRESULTS: Twenty (62.5%) of the rats developed a gastric toxicity. The toxicities were neither regular in shape \n\n\n\nnor frequency. They presented as either red streaks, petechiae, haemorrhagic/non- haemorrhagic erosions or \n\n\n\nulcerations. They were all confined to the acid-producing glandular mucosa and were mostly small in nature. \n\n\n\nCONCLUSION: Our study clearly depicts gastric toxicity to aspirin. The task ahead is the NMR-based \n\n\n\npharmacometabonomic analysis of the biofluids to identify biomarkers that may be linked to the gastric toxicity. \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n31 \n\n\n\nMPSPSC2017000056 (Oral) \n\n\n\nDESIGN AND EVALUATION OF SELF EMULSIFYING SOLID DISPERSION OF ETHANOL \n\n\n\nEXTRACT OF MORINGA LEAVES AND ASSESSMENT OF ANTI-INFLAMMATORY, ANTI-\n\n\n\nNOCICEPTIVE AND ANTI-RHEUMATOID ARTHRITIS ACTIVITY \n\n\n\n\n\n\n\nAl-Sammarraie HJ1, Karim Khan NA1, Mahmud R2, Asmawi MZ3, Murugaiyah V3 \n\n\n\n1Discipline of Pharmaceutical Technology, School of Pharmaceutical Sciences, Universiti Sains Malaysia \n2Discipline of Pharmaceutical Chemistry, School of Pharmaceutical Sciences, Universiti Sains Malaysia. \n3Discipline of Pharmacology, School of Pharmaceutical Sciences, Universiti Sains Malaysia. \n\n\n\n\n\n\n\nINTRODUCTION: Rheumatoid arthritis (RA) is a chronic systemic inflammatory disorder affecting 0.5 to 2% \n\n\n\nof the population. Available RA medications associated with serious adverse effects, low rate of response and/or \n\n\n\nhigh cost. Traditional medicine using botanical natural products, like Moringa oleifera Lam, provide an attractive \n\n\n\nalternative. Unfortunately, many traditional medicinal uses of plants lacks for scientific evidences supporting the \n\n\n\nclaimed use and available commercial products are non-standardised. \n\n\n\nOBJECTIVES: To evaluate the anti-inflammatory, anti-nociceptive and anti-arthritic activities of ethanol extract \n\n\n\nMoringa leaf and formulated dosage form. In addition to that, this study aimed to formulate and evaluate a \n\n\n\nstandardised oral dosage form. \n\n\n\nMETHODS: Carrageenan-induced paw oedema and complete Freund\u2019s adjuvant (CFA)-induced rheumatoid \n\n\n\narthritis in Sprague-Dawley male rats was used as disease model. The anti-nociceptive activity was evaluated in \n\n\n\nboth normal and arthritic animals using Eddy\u2019s hot plate and tail-flick method. A self emulsifying solid dispersion \n\n\n\nwas designed. For evaluation of the dosage form, a HPLC-UV method was developed.  \n\n\n\nRESULTS: A significant analgesic activity and reduction in inflammatory oedema were detected for both crude \n\n\n\nextract and formulated dosage form.  Data obtained give potential evidence of effectiveness in prevention of RA. \n\n\n\nGelucire 50/13 and HPMC were successfully used in formulation of standardised dosage form.  \n\n\n\nCONCLUSION: Ethanol extract of Moringa leaves showed a promising bio-efficacy against RA. The evaluation \n\n\n\nof the formulated dosage form identified that gelucire 50/13 and HPMC solid dispersion was an effective approach \n\n\n\nfor production of standardised oral dosage.  \n\n\n\n\n\n\n\n\n\n\n\nMPSPSC2017000060(Oral) \n\n\n\nCOMPATIBILITY STUDIES OF TRICLOSAN AND FLURBIPROFEN WITH FORMULATION \n\n\n\nEXCIPIENTS: A SYSTEMATIC DRUG-DRUG AND DRUGS-EXCIPIENTS COMPATIBILITY \n\n\n\nSCREENING \n\n\n\nAminu N1,2,  Chan SY1 and Toh SM1 \n\n\n\n1Discipline of Pharmaceutical Technology, School of Pharmaceutical Sciences, Universiti Sains Malaysia, \n\n\n\n11800 USM, Penang, Malaysia. \n2Department of Pharmaceutics & Pharmaceutical Microbiology, Faculty of Pharmaceutical Sciences, Usmanu \n\n\n\nDanfodiyo University, P.M.B. 2346, Sokoto, Nigeria. \n\n\n\n\n\n\n\nINTRODUCTION: Triclosan (TCS) is a broad spectrum antimicrobial agent that has been found effective in the \n\n\n\ntreatment of periodontitis. Flurbiprofen (FLB) is an analgesic that has been found efficacious when used as a \n\n\n\ntopical or systemic medication for dental pains. The clinical effectiveness of these drugs in the treatment of \n\n\n\nperiodontitis are limited by their poor aqueous solubility. As a solution, a novel nanogelformulation of these drugs \n\n\n\nusing a poly-\u03b5-caprolactone (PCL) and chitosan (CS) polymers is proposed herein. However, a combination of \n\n\n\nincompatible chemical components may result in interactions, hence the need for compatibility screening. \n\n\n\nOBJECTIVES: To assess the compatibility of triclosan-flurbiprofen, and the drug duo against selected excipients \n\n\n\nused in the fabrication of nanogel formulation. \n\n\n\nMETHODS: The compatibility studies were conducted by isothermal stress testing followed by evaluations of \n\n\n\norganoleptic parameters, HPLC, Fourier\u2013transform infrared (FT-IR) spectroscopy, differential scanning \n\n\n\ncalorimetry (DSC) and X-ray powder diffraction (XRPD). \n\n\n\nRESULTS: No notable changes were observed after organoleptic evaluations. The results of FT-IR, DSC and \n\n\n\nXRPD showed lack of interactions between the selected drugs and excipients. Following the HPLC analysis, \n\n\n\nretention times of FLB and TCS were found to be 10.1 min and 12.5 min and that of CS and PCL was 7.8 min \n\n\n\nand 9.2 min, respectively. All the peaks were distinct and no interference was observed in the chromatograms. \n\n\n\nCONCLUSION: The study showed that TCS and FLB are compatible with each other and with the selected \n\n\n\nexcipients for nanogel formulation.  \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n32 \n\n\n\n\n\n\n\nMPSPSC2017000065 (Oral) \n\n\n\nBONE MINERAL DENSITY AMONG POSTMENOPAUSAL MALAY WOMEN \n\n\n\n\n\n\n\nIsmail Z1, Mamat KA1, Basri AM1, Haikal MAN1, Adam A1 \n1Pharmacy Faculty, Mahsa University, Bandar Saujana Putra Selangor, Malaysia. \n\n\n\n\n\n\n\nINTRODUCTION: In Malaysia, there is lack of information regarding bone mineral density (BMD) among \n\n\n\nMalays especially for postmenopausal women. Poor BMD leads to weaker bones and are more likely to break \n\n\n\n(fractures). As a person age, further bone loss can lead to osteoporosis.   \n\n\n\nOBJECTIVES: This research was carried out to identify the BMD among postmenopausal Malays women, its \n\n\n\nrelationship to lifestyle and other determinants that cause low bone density.  BMD was determined by using \n\n\n\nquantitative ultrasound (QUS) at the calcaneal part of the feet.  Anthropometry, lifestyle behaviour and family \n\n\n\nhistory were also determined by using questionnaires adopted from many sources including International \n\n\n\nOsteoporosis Foundation.   \n\n\n\nRESULTS: From the study, 67 Universiti Teknologi MARA (UiTM) staffs were recruited with a mean age 53.24 \n\n\n\n\u00b1 0.77 years.  Subjects were all Malays, females and post menopause.  Majority of the subjects studied reside in \n\n\n\nrural areas and fall in the lower income groups.  Detail results showed that 37.3% have normal bone densities, \n\n\n\nfollowed by 47.8% had osteopenia and 14.9% had osteoporosis.  There were no significant difference of BMD to \n\n\n\nvariables such as body mass index (BMI), total body fat, exposure to sunlight, breakfast frequency, calcium \n\n\n\nsupplement intake, milk intolerance, and caffeine intake and exercise frequency.  The study found that family \n\n\n\nhistory has a significant influence on BMD.  \n\n\n\nCONCLUSIONS: The study cohort revealed that most of the postmenopausal women were from low income \n\n\n\nbackground families, but practise active and healthy lifestyles.  This group did not take any commercial \n\n\n\nsupplements every day. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nMPSPSC2017000066 (Oral) \n\n\n\nA QUALITATIVE STUDY INVESTIGATING MEDICATION SAFETY ISSUES EXPERIENCED BY \n\n\n\nCOMMUNITY PHARMACISTS  \n  \n\n\n\nNizaruddin MA1, Patel JR 2, Wong KT 2 \n1School of Pharmacy, University of Nottingham Semenyih, Malaysia. \n2Faculty of Pharmacy, Cyberjaya University College of Medical Sciences, Cyberjaya, Malaysia. \n\n\n\n\n\n\n\nINTRODUCTION: Medication safety issues (MSIs) are widespread and rather understudied in the primary care \n\n\n\nsetting of Malaysia. Malaysia has experienced a 20% increase in adverse drug reactions reporting in the past three \n\n\n\nyears with many resulting from MSIs. This illustrates the importance of investigating how MSIs occur. \n\n\n\nOBJECTIVES: The study aims to investigate the MSIs present in the primary care setting of Malaysia from the \n\n\n\nperspective of the community pharmacists and their causative factors. \n\n\n\nMETHODS: A qualitative phenomenological approach was used involving face-to-face, semi-structured \n\n\n\ninterviews with 19 community pharmacists (CP) in Klang Valley, Malaysia. By utilising purposive sampling the \n\n\n\nparticipants were recruited by telephone. Interviews were audio recorded, transcribed verbatim and thematically \n\n\n\nanalysed. \n\n\n\nRESULTS: The main themes were medication safety issues caused by the present healthcare system, community \n\n\n\npharmacists and patients. Existence of strong competition between GPs and CPs due to a lack of dispensing \n\n\n\nseparation creates inadequate communication and coordination within the healthcare system. CPs contribution to \n\n\n\nMSIs includes dispensing prescription medicines without prescription. CPs experienced a language barrier with \n\n\n\npatients that affect their counselling with them and the understanding of their patients on medication labels and \n\n\n\nadherence. \n\n\n\nCONCLUSIONS: The CPs provided an important insight into the causative factors of MSI. Combining this with \n\n\n\nthe perspectives of other stakeholders of healthcare will assist in developing future regulatory changes that aim to \n\n\n\nalert contributors of the MSIs, importance of preventing them and modify the conditions which facilitate their \n\n\n\nexistence.  \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n33 \n\n\n\n\n\n\n\nMPSPSC2017000067 (Oral) \n\n\n\nEMERGING ROLES OF PHARMACISTS IN GLOBAL HEALTH: PERSPECTIVES FROM THE ASIA \n\n\n\nPACIFIC REGION \n\n\n\n\n\n\n\nFaller EM1, Hernandez MT2, Hernandez AM3, Bacayo MFD, Labao HC4 \n\n\n\n1School of Pharmacy, Management and Science University, University Drive, Seksyen 13, 40100, Shah Alam, \n\n\n\nSelangor Malaysia \n2 Independent Clinical Pharmacy Practitioner, Critical Care Pharmacist, Philippines \n3Patient Safety Department, The Medical City, Philippines \n4Global Health Pharmacy Network, University Drive, Seksyen 13, 40100, Shah Alam, Selangor, Malaysia \n\n\n\n\n\n\n\nINTRODUCTION: There are rapid changes in the roles of Pharmacists in the global health arena imperative for \n\n\n\nthe realization of sustainable development goals. As one of the most accessible healthcare providers in a \n\n\n\ncommunity, it is evident in multiple facets of global health practices, research, regulatory health policies etc. \n\n\n\nOBJECTIVE: The study aims to explore the awareness on contemporary roles of pharmacists in different \n\n\n\npractice settings responding to their emerging roles in the global health arena. \n\n\n\nMETHODS: A descriptive cross-sectional study using validated questionnaire encompassing domains related \n\n\n\nwith skills assessment on the role of Pharmacists in global health were used. Respondents were chosen from the \n\n\n\n1st and 2nd Global Health Pharmacy Certificate Courses held in Malaysia and the Philippines, respectively. \n\n\n\nParticipants were Pharmacists whose practice pattern range in diversity and settings from countries in the Asia-\n\n\n\nPacific Region. A total of 398 survey questionnaires were analysed out of 500 who attended the course, yielding \n\n\n\na return rate of 80%. \n\n\n\nRESULTS: Results revealed that respondents are working as community pharmacists (53.5%), hospital \n\n\n\npharmacists (32.2%), academe (4.5%) and others (9.8%). Respondents agreed that their emerging roles as \n\n\n\npharmacists include skills on cultural sensitivity (57%), patient care (45.2%), healthcare accessibility (56.8%), \n\n\n\nclinical competency (51.3%), goal settings (53%), life-long learning (51%) and intra-disciplinary participation \n\n\n\n(38.9%). \n\n\n\nCONCLUSION: Majority of the respondents agree of the crucial skills in the emerging roles of Pharmacists in \n\n\n\nthe global health. Hence, more comprehensive efforts and sustainable programs such as Certificate Course and \n\n\n\nGlobal Health Pharmacy Network that respond to the emerging needs of the global society.  \n\n\n\n\n\n\n\n\n\n\n\nMPSPSC2017000069(Oral) \n\n\n\nPARTICIPATION OF PRIVATE AND GOVERNMENT HEALTHCARE PROVIDERS IN SMOKING \n\n\n\nCESSATION SERVICES (MQUIT SERVICES) \n\n\n\n\n\n\n\nSamsudin S1, Misnan A1, Tangiisuran B2, Hassan N3, Omar M1, Hamdan Z4, Hashim H1, Awang R1   \n1Clearinghouse for Tobacco Control, the National Poison Centre, Universiti Sains Malaysia \n2School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 USM, Penang, Malaysia. \n3Tobacco Control Section and FCTC Secretariat, Ministry of Health Malaysia \n4Centre for Knowledge, Communication and Technology, Universiti Sains Malaysia \n\n\n\n\n\n\n\nINTRODUCTION: In accordance to Framework Convention on Tobacco Control, Ministry of Health Malaysia \n\n\n\nhas established the mQuit Services. This program aimed to increase access and quality of smoking cessation \n\n\n\nservices provided by the healthcare providers (HCP) by integrating with the USM Tobacco Quitline (USMTQ).  \n\n\n\nOBJECTIVE: To describe the profile of HCP participated in the quitline services. \n\n\n\nMETHODS: The accredited HCP were given access to USMTQ system and clients\u2019 demographic and smoking \n\n\n\nhistory were documented into the system and referred to USMTQ into a series of customised and personalised \n\n\n\ntelephone based consultation.  \n\n\n\nRESULTS: Within a year of inception, a total number of 369 HCP have been using mQuit Services of which 161 \n\n\n\n(43.3%) were from private HCP and the remaining (56.7%) were from government quit clinics.  Selangor recorded \n\n\n\nthe highest number of registered HCPs (n=106) with highest came from private sectors (66) and 40 from the \n\n\n\ngovernment sector. The participation of HCPs in the mQuit services have resulted with a total number of 682 \n\n\n\nclients registered into its program and half of them (54.2%) were referred to USMTQ service for telephone \n\n\n\nconsultation. Results also shown that government HCP referred more clients to USMTQ services compared to \n\n\n\nHCPs from private sector (57.4% vs 42.6% respectively).  \n\n\n\nCONCLUSION: HCP from both sectors supported and participated in the mQuit services. Hence, it is important \n\n\n\nfor mQuit Services to increase participation of accredited HCP across the country in order to heighten the chances \n\n\n\nof smokers getting assistance through USMTQ. \n\n\n\n\n\n\n\n\n\n\n\n\n34 \n\n\n\n\n\n\n\nMPSPSC2017000070 (Oral) \n\n\n\nEFFECT OF 'EDUCATIONAL PAMPHLET' IN PREVENTION OF HUMAN PAPILLOMA VIRUS \n\n\n\nRELATED INFECTIONS AMONG YOUNG ADULT POPULATION \n  \n\n\n\nAli AN1,3,  Pathmapiriyaa M1, Ng YP1, Prajapati Sunil K1, Ahmed NZ2, Sarriff A3 \n1Faculty of Pharmacy, AIMST University, Semeling, Bedong, Kedah Darul Aman, Malaysia. \n2Pfizer, Hospira Health Care India Pvt Ltd, Plot No. 117, Jawaharlal Nehru Pharma City, (SEZ), Parawada \n\n\n\nMandal, Visakhapatnam, Andhra Pradesh 531019, India. \n3School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Gelugor, Penang, Malaysia.  \n\n\n\n\n\n\n\nINTRODUCTION: Knowledge on Human Papilloma Virus (HPV) infection is crucial to prevention of HPV \n\n\n\nrelated cancers. The intervention tool (Pamphlet) was developed, validated and translated to local Bahasa \n\n\n\nMalaysia language before use. Main Outcome Measures: Pre- and post-test at three time points to estimate \n\n\n\nknowledge gained and knowledge retained regarding HPV infection and vaccination was measured using 16 item \n\n\n\nknowledge assessment tool.  \n\n\n\nOBJECTIVE: The aim of this study was to estimate the effectiveness of educational pamphlet in HPV prevention \n\n\n\namong young adult students and general public.  \n\n\n\nMETHOD: A prospective, longitudinal study was done using pre-validated questionnaire and convenience \n\n\n\nsampling. Percentage, frequency, median and IQR used for descriptive statistics whereas McNemar\u2019s and \n\n\n\nWilcoxon test for inferential statistics using SPSS version 23.  \n\n\n\nRESULTS: The research findings showed a significant increase in knowledge gain (N = 942) with a knowledge \n\n\n\nscore for pre- and post test were Mdn = 10 (IQR = 6) and Mdn = 14 (IQR = 2), p < 0.001) respectively, with a \n\n\n\nsignificant improvement of 4 points (Z = 24.9; p < .001). This reveals a poor knowledge among participants. At \n\n\n\nthe three to six months post-test, Mdn = 14, (IQR= 2), with a significant improvement in knowledge score (Z=24.7; \n\n\n\np <.001) from base line.  \n\n\n\nCONCLUSION: The educational protocol significantly increased knowledge about HPV infection and HPV \n\n\n\nvaccination, regardless of sociodemographic characteristics and risk behaviours. There was no significant change \n\n\n\nin knowledge observed after intervention between time lines.  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nMPSPSC2017000072(Oral) \n\n\n\nRELATIONSHIP OF PATIENT CHARACTERISTICS AND ORGANIZATIONAL FACTORS WITH \n\n\n\nHEALTH CARE COLLABORATION AMONG TYPE II DIABETES PATIENTS IN PALESTINE \n\n\n\n\n\n\n\nMosleh RS\u00b9, Abd Aziz N\u00b9, Ali SM\u00b2, Manan MM\u00b3, Zyoud SH4 \n\n\n\n\u00b9Faculty of Pharmacy, Department of Pharmacy Practice, Universiti Teknologi MARA (UiTM), Malaysia. \n\n\n\n\u00b2Faculty of Pharmacy, Department of Pharmacy Practice, Asia Metropolitan University, Malaysia. \n\n\n\n\u00b3School of Pharmacy, KPJ University College, Malaysia. \n4School of Medicine and Health Sciences, Department of Pharmacy, An-Najah National University, Palestine. \n\n\n\n  \nINTRODUCTION: Comprehensive diabetes health care relies on health care collaboration that provides the \n\n\n\nopportunity for health care professionals and health care organizations to share information relevant to a diabetes \n\n\n\nmanagement evaluation and progress toward appropriate health care service measures.  \n\n\n\nOBJECTIVES: The objectives of this study were to assess the health care collaboration and its relationship with \n\n\n\npatient characteristics and organizational factors in type II diabetes patients.  \n\n\n\nMETHODS: A cross-sectional study was conducted. The health care collaboration scale was used to assess health \n\n\n\ncare collaboration that included physician\u2019s referral to another facility specializing in advanced diabetes \n\n\n\nexamination and/or treatment, referral to other different health care professionals for diabetes education and/or \n\n\n\nassistance, and diabetes health care home visits or phone consultations by health care professionals. All analyses \n\n\n\nwere performed using SPSS v 16.0.  \n\n\n\nRESULTS: Three hundred thirty type II diabetes patients were enrolled. The mean age of participants was 60 \u00b1 \n\n\n\n9.7 years; 51.2% were male. The mean \u00b1 SD total health care collaboration score was 1.6 \u00b1 0.9, which was lower \n\n\n\nthan average score (i.e. cumulative percentage=26.7%). After adjusting covariates using multiple linear \n\n\n\nregressions, residency place, body mass index, diabetes education from health care professionals, quality of \n\n\n\nfollow\u2013up and patient\u2013health care professionals relationship are the variables that significantly and independently \n\n\n\nrelated to health care collaboration (P <0.05).  \n\n\n\nCONCLUSION: Health care collaboration were inappropriate, and the study is a preliminary indication that \n\n\n\nhealth care collaboration in Palestine leaves a great deal of room for research and improvement. \n\n\n\n\n\n\n\n\n\n\n\n\n35 \n\n\n\n\n\n\n\nMPSPSC2017000074 (Oral) \n\n\n\nTHE EFFECT OF HIGH FAT DIET INTAKE ON BLOOD GLUCOSE LEVEL OF PREDIABETIC AND \n\n\n\nTYPE 2 DIABETIC RATS. \n\n\n\n\n\n\n\nSim XY1, Ibrahim B1, Murugaiyah V1, Greimel P2, Gam LH1  \n1School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 USM, Penang, Malaysia. \n2Laboratory for Cell Function Dynamics, RIKEN Brain Science Institute, Wako, Japan \n\n\n\n\n\n\n\nINTRODUCTION: Type 2 diabetes mellitus (T2DM) is a metabolic disease where the body blood glucose is \n\n\n\nhigh due to insulin resistance. T2DM is primarily caused by unhealthy lifestyle. Diabetic patients are advised to \n\n\n\nchange their diet. However, most patients in Malaysia were unable to abide since many of Malaysian delicacies \n\n\n\nwere prepared with high fat content.  \n\n\n\nOBJECTIVES: This study aims to evaluate the effect of high fat diet intake on blood glucose level of prediabetic \n\n\n\nand type 2 diabetic rats as compared to normal rats.  \n\n\n\nMETHOD: Rats were induced to prediabetes and diabetes states. They were separated into various groups. GA \n\n\n\nis normal rats fed with normal diet (ND) while GB is normal rats fed with high fat diet (HFD). GC is diabetic rats \n\n\n\nfed with ND, GD is diabetic rats fed with ND and treated with metformin, whereas GE is diabetic rats fed with \n\n\n\nHFD and GF is diabetic rat fed with HFD and treated with metformin. GG is prediabetic rats fed with ND while \n\n\n\nGH is prediabetic rats fed with HFD. The fasting blood glucose was monitored twice weekly for 6 weeks.  \n\n\n\nRESULTS: Blood glucose of GA and GB was low whereas high blood glucose was seen in GC and GE \n\n\n\nthroughout the study. GD and GF, the blood glucose level was high initially but it dropped after the rats were \n\n\n\ntreated with metformin.  \n\n\n\nCONCLUSION: There is no effect on blood glucose level after the rats were fed on high fat diet for six weeks. \n\n\n\n\n\n\n\n\n\n\n\nMPSPSC2017000078 (Oral) \n\n\n\nEFFECT OF EDUCATIONAL PAMPHLET REGARDING HUMAN PAPILLOMA VIRUS (HPV) \n\n\n\nINFECTIONS AND HPV VACCINATION: A KAP STUDY AMONG PARENTS WITH AGE ELIGIBLE \n\n\n\nCHILDREN FOR HPV VACCINATION \n \n\n\n\nAli AN1, 3, Pathmapriya M1, Ng YP1, Prajapati SK1, Ahmed NZ2, Sarriff A3 \n1Faculty of Pharmacy, AIMST University, Semeling, Bedong, Kedah Darul Aman, Malaysia. \n2Pfizer, Hospira Health Care India Pvt Ltd,Plot No#117, Jawaharlal Nehru Pharma City, Visakhapatnam, Andhra \n\n\n\nPradesh 531019, India. \n3School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 USM, Penang, Malaysia. \n\n\n\n\n\n\n\nINTRODUCTION: Parents play the vital role in vaccination decisions for their children. Globally, adolescents \n\n\n\nand young adults are at high risks for contacting HPV related diseases.  \n\n\n\nOBJECTIVES: To evaluate the effect of educational pamphlet in influencing Knowledge, Attitude and Practice \n\n\n\n(KAP) among parents.  \n\n\n\nMETHODS: A prospective, longitudinal study using convenience sampling. The study was carried out by \n\n\n\nrepeated measures of KAP at three time points. Descriptive and inferential statistics were done.  \n\n\n\nRESULTS: The overall response rate was 57%. The research findings showed significant differences (p < .001) \n\n\n\nbetween all sociodemographic variables and KAP scores except location. The Friedman test reported difference \n\n\n\nin median among the three phases, is significant X2 (2, N=858) = 602, p < .001 and the Kendall\u2019s coefficient of \n\n\n\nconcordance, (W = .32) indicating fairly strong differences among the three phases. Friedman\u2019s mean rank of \n\n\n\nKAP score was 1.37, 2.41 and 2.22 (p < .001) respectively. The median KAP score difference at intervention was \n\n\n\nsignificantly greater than base line, Z = 10.8, p < .001. The post intervention was significantly greater than the \n\n\n\nmedian KAP score at base line, Z = 18, p < .001. Whereas, the median score difference at post intervention and \n\n\n\nintervention was not significant, Z = .35, p = .73.  \n\n\n\nCONCLUSION: The educational protocol significantly increased KAP scores about HPV infection and HPV \n\n\n\nvaccination, regardless of sociodemographic characteristics. Appropriate, well-structured educational materials \n\n\n\ncan promote the understanding and acceptability of HPV vaccination.  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n36 \n\n\n\n\n\n\n\nMPSPSC2017000083 (Oral) \n\n\n\nRESEARCH AND DEVELOPMENT OF SELF-EMULSIFYING DRUG DELIVERY SYSTEM FOR \n\n\n\nENHANCED BIOAVAILABILITY OF CURCUMIN \n\n\n\n\n\n\n\nChiang XY1, Lim SC1, Yuen KH1, Chan SY1 \n\n\n\n1School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 USM, Penang, Malaysia. \n\n\n\n\n\n\n\nINTRODUCTION: Curcumin has been extensively investigated due to its positive efficacy in various disease \n\n\n\nconditions. However, the low clinical therapeutic efficiency of this compound is usually limited by its lipophilic \n\n\n\nnature which leads to poor solubility, limited intestinal absorption and eventually low bioavailability. Recently, \n\n\n\ncurcumin has emerged to be a future nanomedicine for cancer. A study cited that antitumor activity of curcumin \n\n\n\nentails prolong exposure of the cancer cells to curcumin. Oftentimes, the desirable antitumor effect of curcumin \n\n\n\nis not obtained due to the short half-life of this compound. \n\n\n\nOBJECTIVE: This study aimed to develop an efficient oral drug delivery formulation for the enhancement of \n\n\n\noral absorption of curcumon. \n\n\n\nMETHODS: Firstly, an effective self-emulsifying drug delivery system will be designed. Emulsification system \n\n\n\nthat has been developed in our lab. The optimised formulation will be characterised for its mean droplet size, \n\n\n\nphysical and chemical stability. An in vivo study will be conducted using a rat model. \n\n\n\nRESULTS: An optimised self-emulsifying formulation comprising of 3:2:5 w/w mixture of soya oil, PEG-400 \n\n\n\nand Cremophor EL loaded with 100 mg/g curcuma extract (which contains approximately 50 mg/g curcumin \n\n\n\nactive) was found to have the most satisfactory in vitro performance with an average droplet size of 273.7 nm. \n\n\n\nThe optimised self-emulsifying formulation is stable up to 6 months upon various storage conditions. \n\n\n\nCONCLUSION: An in vivo study conducted using Sprague-Dawley rats shown that the oral bioavailability of \n\n\n\ncurcumin was successfully enhanced by our optimised self-emulsifying formulation. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nMPSPSC2017000084 (Oral) \n\n\n\nGYNURA CREPIOIDES LEAVES EXTRACT: AN ANTIBACTERIAL STUDY \n\n\n\n\n\n\n\nStephanie S1, Naveen Kumar HS1, Philip K2, Wayah SB2, Panda BP1, Low BS3 \n1School of Pharmacy, Faculty of Health and Medical Sciences, Taylor's University, Lakeside Campus, Subang \n\n\n\nJaya, Malaysia. \n2Division of Microbiology, Institute of Biological Sciences, Faculty of Science, University of Malaya, Kuala \n\n\n\nLumpur, Malaysia. \n3School of Medicine, Faculty of Health and Medical Sciences, Taylor's University, Lakeside Campus, Subang \n\n\n\nJaya, Malaysia. \n\n\n\n\n\n\n\nINTRODUCTION: Gynura crepioides (G. crepioides) is a spinach which is native to South-east Asia, \n\n\n\nspecifically Indonesia. There are claims that many Gynura species has valuable medicinal potential such as \n\n\n\nantiviral, anti-inflammatory, anti-hyperglycaemic, anti-hypertensive, anti-hyperlipidemic, anti-carcinogenic, anti-\n\n\n\noxidative, and anti-ulcerogenic activities. Although the G.crepioides species has claims suggesting its medicinal \n\n\n\nvalue, to date there is no report on the antibacterial efficacy of the plant. \n\n\n\nOBJECTIVES: This study aimed to evaluate the in-vitro antibacterial potential of ethanolic (70%) extract of \n\n\n\nG.crepioides on selected bacterial strains. \n\n\n\nMETHODS: The extraction of phytochemicals was carried out by using ultrasound-assisted extraction (UAE) \n\n\n\nmethod for 60 minutes at 75 \u00b0C by using ethanol (70 %) as a solvent. The in-vitro antibacterial sensitivity assay \n\n\n\nfor extract was conducted by well diffusion technique against Escherichia coli, Pseudomonas aeruginosa, \n\n\n\nStaphylococcus aureus, Bacillus cereus, and Micrococcus luteus and results were recorded by measuring the Zone \n\n\n\nof Inhibition (ZOI). Additionally, the antibacterial potency assay was conducted on the sensitive bacterial strain \n\n\n\nto determine the Minimum Inhibitory Concentration (MIC) by using tetracycline as a positive control. \n\n\n\nRESULTS: The results from antibacterial sensitivity test of the extract indicated that only Micrococcus \n\n\n\nluteus showed ZOI at 33.12 compared to Tetracycline (ZOI-56).  The results from the antibacterial potency assay \n\n\n\nrevealed the MIC at 6.25x10-3 g/ml.  \n\n\n\nCONCLUSION: The result obtained from this study demonstrates that Gynura crepioides has the potential to be \n\n\n\nexplored as an antibacterial agent. \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n37 \n\n\n\n\n\n\n\nMPSPSC2017000085(Oral) \n\n\n\nPHARMACOLOGICAL EVIDENCE FOR THE BLOOD PRESSURE LOWERING EFFECT OF \n\n\n\nTAPINANTHUS GLOBIFERUS \n\n\n\n\n\n\n\nIdris B 1, Asmawi MZ1, Mahmud R2, \n1Department of Pharmacology, School of Pharmaceutical Sciences, University Sains Malaysia (USM), 11800, \n\n\n\nPenang, Malaysia \n2School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 USM, Penang, Malaysia. \n\n\n\n\n\n\n\nINTRODUCTION: Tapinanthus globiferus (TG), known as mistletoe, is a parasitic medicinal plant with a \n\n\n\ndocumented folkloric use in treatment of cardiovascular related diseases like hypertension and atherosclerosis. \n\n\n\nOBJECTIVE: The objective of this research is to provide in-depth pharmacological assessment on its \n\n\n\nantihypertensive efficacy and the putative mechanisms of actions involved. \n\n\n\nMETHODS: Six groups of male spontaneously hypertensive rats (SHRs) were orally administered with water, \n\n\n\nethanolic, chloroform and petroleum ether extract (500 mg/kg/day) of T. globiferus while the positive control \n\n\n\ngroups received Verapamil (15mg/kg) for 2 weeks. Vasorelaxant effect of extracts and fractions were evaluated \n\n\n\non rat aortic ring preparations. Mechanism studies were conducted on aortic rings preparations pre-incubated with \n\n\n\nvarious antagonists like 1H-[1,2,4] oxadiazolo-[4,3-a]quinoxalin-1-one  (ODQ 10 \u03bcM), sCG  inhibitors; N\u03c9-\n\n\n\nNitro-L-arginine methyl ester hydrochloride (L-NAME 10 \u03bcM) a nitric oxide synthase (NOS) inhibitor; Atropine \n\n\n\n(10 \u03bcM), a cholinergic receptor blocker; indomethacin (1\u03bcM), a cyclooxygenase inhibitor and various  k+ channel \n\n\n\nblockers such as Tetraethyl ammonium (TEA 10 \u03bcM). \n\n\n\nRESULTS: Invasive intravenous and non-invasive oral administration of the extracts exhibited a dose-dependent \n\n\n\nsignificant decrease in the blood pressure with the ethanol extract being more potent. All extracts and fractions \n\n\n\n(0.125 - 4mg/ml) also gave a concentration-dependent vasorelaxation (p<0.05) on pre-contracted aortic rings. \n\n\n\nCONCLUSION: The mechanism studies from this study suggests that T. globiferus exerts an endothelium-\n\n\n\nindependent vasodilation via calcium channels blockade, direct activation of soluble Guanylate Cyclase and \n\n\n\npossibly by also inhibiting the formation of inositol 1, 4, 5-triphosphate.  \n\n\n\n\n\n\n\n\n\n\n\nMPSPSC2017000092 (Oral) \n\n\n\nSHARED-FEATURE PHARMACOPHORE MODEL OF PHOSPHODIESTERASE10A INHIBITORS \n\n\n\n\n\n\n\n Gaurav A1, Akowuah GA1, Al-Nema M1 \n1Faculty of Pharmaceutical Sciences, UCSI University, Kuala Lumpur, Malaysia; \n\n\n\n\n\n\n\nINTRODUCTION: Phosphodiesterase10A (PDE10A) is a dual-substrate enzyme that catalyses the inactivation \n\n\n\nof cAMP and cGMP and is expressed most prominently in the striatum. The inhibition of PDE10A results in the \n\n\n\nelevation of cAMP and cGMP, activating the direct and indirect pathways in striatum. Activation of these \n\n\n\npathways provides significant improvement of positive, negative and cognitive symptoms of schizophrenia. The \n\n\n\navailable drugs provide relief from the positive symptoms of schizophrenia but they do not improve the negative \n\n\n\nor cognitive symptoms. The existing drugs have serious side effects that impacts the patient adherence to the \n\n\n\ntreatment. Thus, the understanding of the structural features of PDE10A inhibitors is important for further \n\n\n\ndiscovery efforts. \n\n\n\nOBJECTIVES: The objective of the study was to develop a shared feature pharmacophore model for PDE10A \n\n\n\ninhibitors and validate the developed pharmacophore. \n\n\n\nMETHODS: LigandScout 4.1 was used to generate structure-based pharmacophore using PDE10A structure \n\n\n\n(PDB ID: 5C1W) and pharmacophore-features for 8 known PDE10A inhibitors. Structure-based pharmacophore \n\n\n\nmodels obtained for the PDE10A structure and the pharmacophore-features of known PDE10A inhibitors were \n\n\n\nthen used to obtain a shared-feature pharmacophore model. \n\n\n\nRESULTS: The best shared-feature pharmacophore consists of three features: hydrophobic unit, aromatic ring \n\n\n\nand hydrogen-bond acceptor. The generated pharmacophore successfully identified the active compounds in the \n\n\n\ndecoy set. \n\n\n\nCONCLUSION: Shared-feature pharmacophore was generated using a structure-based pharmacophore and \n\n\n\npharmacophore features obtained from known PDE10A inhibitors. The validation was performed by decoy set \n\n\n\nscreening. The validated pharmacophores will be used for screening of small-molecule databases in further \n\n\n\nstudies.  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n38 \n\n\n\n\n\n\n\nMPSPSC2017000099 (Oral) \n\n\n\nKNOWLEDGE AND ATTITUDE TOWARDS ANTIBIOTIC USAGE AMONG GENERAL PUBLIC IN \n\n\n\nKUALA LUMPUR, MALAYSIA \n\n\n\n\n\n\n\nQamar M1, Hammad MA2, Shaikh FA1, Ahmad S1  \n1Faculty of Pharmacy, MAHSA University, Jalan SP2, Bandar Saujana Putra Jenjarom, Kuala Langat, Selangor, \n\n\n\nMalaysia \n2School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 USM, Penang, Malaysia. \n\n\n\n\n\n\n\nINTRODUCTION: The emergence of superbugs and bacterial resistance to antibiotics is a growing problem \n\n\n\nworldwide. This circumstance is an alarming to public health globally in the 21st Century. Thus, public knowledge \n\n\n\nand attitude towards antibiotic usage play an important role in the success of treatment process and prevent from \n\n\n\nantibiotic resistance.  \n\n\n\nOBJECTIVES: This study aimed to evaluate public knowledge and attitude towards antibiotic utilization and \n\n\n\nthe association of knowledge across various socio-demographic variables. \n\n\n\nMETHODS: A cross-sectional study with self-administered questionnaire was distributed in a convenience \n\n\n\nsample of 380 respondents from Kuala Lumpur.  \n\n\n\nRESULTS: Majority (60.8%) of respondents possessed moderate level of knowledge of antibiotic usage. Most \n\n\n\n(73.7%) of the respondents knew antibiotic is used for bacterial infection. However, 19.2% of respondents \n\n\n\nmisunderstood that antibiotics is indicated for viral infection. About 53.4% of the respondents were aware of \n\n\n\nantibiotic ineffectiveness in relation to overuse of antibiotics. With regard to attitude, 51.1% believed that taking \n\n\n\nantibiotics when having cold symptoms could help to get better more quickly, while 21.9% expected antibiotic to \n\n\n\nbe prescribed for common cold symptoms. More than 50% stated that they keep stock of antibiotics at home in \n\n\n\ncase of emergency. Surprisingly, 65.3% agreed that they will use leftover antibiotics for respiratory illness \n\n\n\n(running nose, sore throat, flu). No significant association were observed between socio-demographic \n\n\n\ncharacteristics with knowledge of antibiotic usage.  \n\n\n\nCONCLUSION: Educational campaigns are needed to stress out the importance of correct usage of antibiotics \n\n\n\namong general public. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nMPSPSC2017000100 (Oral) \n\n\n\nMOISTURE SORPTION ANALYSIS OF HIBISCUS SABDARIFFA L. SPRAY DRIED EXTRACT \n\n\n\n\n\n\n\nKhan NH1, Darwis Y1 and Chan SY1 \n\n\n\n1School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 USM, Penang, Malaysia. \n\n\n\n\n\n\n\nINTRODUCTION: Solid pharmaceutical ingredients can sorb moisture during processing and can cause adverse \n\n\n\neffects on their stability. These unwanted effects could be physical implications such as variation in dissolution \n\n\n\nrate and water content, crystallization of components and powder caking. Chemical reactions, like hydrolysis and \n\n\n\noxidation, could also be accelerated by water uptake. Therefore, identifying the moisture affinity of the \n\n\n\ningredient(s) is mandatory.  \n\n\n\nOBJECTIVES: To assess moisture sorption properties of spray dried extract of the Hibiscus sabdariffa to know \n\n\n\nthe degree of its hygroscopicity.  \n\n\n\nMETHODS: Desiccator method was employed with saturated salt solutions to provide a range of relative \n\n\n\nhumidities from 33% to 75%. An excessive amount of each salt namely, Magnesium Chloride (33%), Potassium \n\n\n\nChloride (43%), Magnesium Nitrate (53%) and Sodium Chloride (75%) dissolved in distilled water, and the \n\n\n\nsaturated salt solution positioned in the well of the desiccator. Accurately weighed samples of the extract placed \n\n\n\nin the desiccators, and the samples were periodically withdrawn and reweighed until an equilibrium weight \n\n\n\nattained.  \n\n\n\nRESULTS: The extract showed excessive moisture sorption in all cases except 33% RH. The extract sorbed \n\n\n\n9.24\u00b10.40% and 9.96\u00b10.72% moisture at 43% and 53% RH respectively and deliquesced at 75% RH after 24 hrs. \n\n\n\nConversely, at 33% RH the moisture sorbed was <1% which is considered safe for processing and storage.  \n\n\n\nCONCLUSION: This study found that the tested extract is highly hygroscopic, 75% RH identified as critical \n\n\n\nrelative humidity (RH0) and the extract can safely be processed in relative humidity of <33%. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n39 \n\n\n\n\n\n\n\nMPSPSC2017000102 (Oral) \n\n\n\nCOMPUTER ASSISTED DESIGN, SYNTHESIS AND ACETYLCHOLINESTERASE INHIBITORY \n\n\n\nACTIVITY OF SOME INDOLE DERIVATIVES TARGETING ALZHEIMER\u2019S DISEASE \n\n\n\n\n\n\n\nDoreen OXJ1, Nagojappa NBS 1 \n\n\n\n1School of Pharmacy, Faculty of Health and Medical Sciences, Taylor\u2019s University Lakeside Campus, Jalan \n\n\n\nTaylor\u2019s, Subang Jaya, Selangor Darul Ehsan, 47500, Malaysia. \n\n\n\n\n\n\n\nINTRODUCTION: Alzheimer\u2019s disease is the most common form of dementia in elderly population. \n\n\n\nAlzheimer\u2019s disease has been characterized as chronic neurodegenerative disorder that slowly destroys human \n\n\n\nbrain cells. The classic signs found in the Alzheimer\u2019s disease includes progressive loss of the neurons function \n\n\n\nand decrease level of neurotransmitters, mainly acetylcholine which lead to memory loss and impaired \n\n\n\ncognition. According to existing guidelines, acetylcholinesterase inhibitors are the first-line agents for the \n\n\n\ntreatment of mild and moderate Alzheimer\u2019s disease. Extensive literature review revealed that, indole-based \n\n\n\nheterocyclic compounds were found to be effective acetylcholinesterase enzyme inhibitors. Some studies also \n\n\n\nconcluded that indole amide compounds possess good acetylcholinesterase enzyme inhibitory activity.  \n\n\n\nOBJECTIVES: In this context the present study involves the design of 42 novel indole-based amide compounds \n\n\n\nas potential acetylcholinesterase inhibitors.  \n\n\n\nMETHODS: Molecular docking study was performed to determine the interactions that formed between the \n\n\n\nproposed compounds with 3D X-ray crystal structure of acetylcholinesterase enzyme. Physiochemical features of \n\n\n\ndesigned compounds were determined by using OSIRIS calculation. Based on these two results eleven compounds \n\n\n\nwhich predicted good acetylcholinesterase enzyme inhibition were selected. Selected indole-based amide \n\n\n\ncompounds were synthesized by following standard acid amine coupling method, using HATU as coupling \n\n\n\nreagent. The compounds synthesized were characterized using standard physical and analytical techniques. The \n\n\n\nsynthesized compounds were evaluated for their acetylcholinesterase inhibitory activity by using modified \n\n\n\nEllman\u2019s method.  \n\n\n\nRESULTS: Among the eleven synthesized compounds, four compounds exhibited around 50% of \n\n\n\nacetylcholinesterase enzymes inhibitory activity at the concentration .of 0.11\u03bcM, 0.16\u03bcM, 0.14\u03bcM and 0.13\u03bcM. \n\n\n\nCONCLUSION: Indole-based amide compounds are have the potential to be used for Alzheimer\u2019s disease based \n\n\n\non their displayed acetylcholinesterase inhibitory activity. \n\n\n\n\n\n\n\nMPSPSC2017000103 (Oral) \n\n\n\nEVALUATION OF ANTIMICROBIAL STEWARDSHIP PROGRAMS IMPLEMENTATION AND \n\n\n\nOUTCOMES USING INTERRUPTED TIME SERIES ANALYSIS, IN A SELECTED HOSPITAL AT \n\n\n\nMAKKAH, KINGDOM OF SAUDI ARABIA \n  \n\n\n\nHaseeb A1, 2, Verma A1, Hassali MAA1 \n1School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang \n2Department of Clinical Pharmacy, College of Pharmacy, Umm Al Qura University, Makkah, Saudi Arabia \n\n\n\n\n\n\n\nINTRODUCTION: Antimicrobial therapy for management of severe infections among critically ill patients is \n\n\n\nchallenging due to unstable hemodynamic status of patients. Antimicrobial stewardship program is a collaborative \n\n\n\neffort to optimize antimicrobial use in health care institutions through evidence based quality improvement \n\n\n\nstrategies.  \n\n\n\nOBJECTIVE: The aim of this research was to evaluate the impact of Antimicrobial Stewardship Programs (ASP) \n\n\n\nimplementation in a critical care setting for improving antimicrobial use, cost and clinical outcomes at selected \n\n\n\nhospital at Makkah region, Kingdom of Saudi Arabia.  \n\n\n\nMETHODS: A controlled interrupted time series analysis was used to compare outcomes in the 9 months before \n\n\n\nand after ASP implementation.  \n\n\n\nRESULTS: Mean total monthly antimicrobial consumption measured as defined daily dose (DDD) per 100 bed \n\n\n\ndays was reduced by 25 % (742.86 vs. 555; P=0.) as compared to control group by 7 % (35 vs 38; P=0.735). Total \n\n\n\nantimicrobials cost measured as total mean cost per 100 bed days was increased by 55% (38723 Vs 87552; P=067). \n\n\n\nThe use of IV Ceftriaxone measured as defined daily dose per100 bed days was decreased by 82 % (94 vs 17; P= \n\n\n\n0.008).,  \n\n\n\nCONCLUSION: Overall, based on the present study findings, involvement of higher administration in \n\n\n\nmultidisciplinary ASP committees, daily audit & feedback by clinical pharmacist and physicians with infectious \n\n\n\ndiseases training and support from intensive care team are key sets of recommendations that can be made to \n\n\n\nenhance quality use of antibiotics in Saudi healthcare institutions.  \n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n40 \n\n\n\n\n\n\n\nMPSPSC2017000104 (Oral) \n\n\n\nEVALUATION OF ILLNESS PERCEPTIONS AND THEIR ASSOCIATIONS WITH GLYCAEMIC \n\n\n\nCONTROL IN TYPE 2 DIABETES MELLITUS PATIENTS AT HOSPITAL PULAU PINANG \n\n\n\n\n\n\n\nBalasubramananiam S1, Lim SL2, Goh LH3, Subramaniam S3, Tangiisuran B1 \n\n\n\n1Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia  \n2Endocrinology Department, Hospital Pulau Pinang, Malaysia  \n3Clinical Research Centre, Hospital Pulau Pinang, Pulau Pinang, Malaysia \n\n\n\n\n\n\n\nINTRODUCTION: Malaysia has a high prevalence of diabetes at 16.6% and suboptimal glycaemic control with \n\n\n\nonly 22% meeting HbA1C target of < 7%. Illness perceptions involve coping strategies and behavioural responses \n\n\n\nthat could affect glycaemic control. \n\n\n\nOBJECTIVE: Evaluation of illness perceptions and their associations with glycaemic control. \n\n\n\nMETHODS: A cross-sectional study was conducted in a purposive sample of 384 patients using Revised Illness \n\n\n\nPerception Questionnaire and 8-Item Morisky Medication Adherence Scale.  \n\n\n\nRESULTS: The patients\u2019 median age was 58.1 years and median duration of diabetes was 13 years. 44.3% were \n\n\n\nmales, whereas 55.2% were females. The study consisted of 38.8% Malays, 31.0% Chinese, 28.9% Indians and \n\n\n\n1.3% other ethnic groups. 75.5% of patients had poor diabetes control and 44% of patients had low adherence to \n\n\n\ndiabetes medication. The median score of illness perception dimensions for timeline (acute/chronic), \n\n\n\nconsequences, personal control, treatment control, illness coherence, timeline cyclical and emotional \n\n\n\nrepresentations was 23, 18, 22, 18, 19, 12 and 14, respectively. The higher scores on timeline indicate strongly \n\n\n\nheld beliefs about the chronicity of the disease, whereas high personal control indicates positive beliefs about the \n\n\n\ncontrollability of diabetes. Timeline cyclical and emotional representations were significantly associated with \n\n\n\nglycaemic control with p values of 0.041and 0.032, respectively. \n\n\n\nCONCLUSION: Timeline cyclical and emotional representations dimensions of illness perceptions have \n\n\n\nsignificant associations with glycaemic control; therefore further studies should be conducted to establish exact \n\n\n\nrelationships for concrete recommendations to improve psychosocial management of diabetes. \n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n41 \n\n\n\nLIST OF POSTER PRESENTATIONS \n\n\n\n\n\n\n\nNo Presenting Author Title \n\n\n\n014 Hadi H Skin Lightening Effect of Seaweed Gel Formulation: An In vivo Study \n\n\n\n018 Yow HY The Effects of Curcumin in Neurotransmitter Signalling in Kainate Model of \n\n\n\nEpileptic Rats \n\n\n\n019 Rajavel V Design, Optimization, Formulation and Evaluation of Edaravone Nanoparticles \n\n\n\nUsing Box-Behnken Design Surface Response Methodology \n\n\n\n020 Lim KC Initiatives Improving Documentation and Communication of Patient\u2019s Drug \n\n\n\nAllergy in a Private Hospital Setting \n\n\n\n021 Zamery MI Fabrication of Face Cream Containing Enriched Fraction of Protocatechuic Acid \n\n\n\nfrom Clinacanthus nutans (C. nutans) Leaves \n\n\n\n023 Tey MN The Evolution and Expansion of Clinical Pharmacy Service and Its Impact in a \n\n\n\nPrivate Hospital Setting \n\n\n\n025 Hassan IH Drug-Excipient Compatibility Testing for a Fixed-Dose Gabapentin-\n\n\n\nCarbamazepine Capsule \n\n\n\n026 Wong YY Clinical Audit  on Inhaler Technique among Hospital Serdang Adult Patients \n\n\n\n027 Mohd HN Formulation and Characterization of Cosmetic Cream Incorporating Piper betle \n\n\n\nLinn. Extract \n\n\n\n031 Thong LM Effect of Combination of Superdisintegrants on the Physical Properties of Orally \n\n\n\nDisintegrating Tablets \n\n\n\n033 Syed OSS Pre-Scale Up Formulation of Halal Skin-Lightening Cream Containing Piper betle \n\n\n\nL. Extract \n\n\n\n035 Sellappans R Pilot Testing of the Physician-Pharmacist Partnership for Patient Safety \n\n\n\nIntervention \n\n\n\n040 Naeem HK Screening of Punica granatum Seeds for Antibacterial and Antioxidant Activity \n\n\n\nAgainst Various Extracts \n\n\n\n041 Ngadimon IW Development of Shared Decision Making Aid Tool for the Use of Pharmacists in \n\n\n\nCases of Antibiotic Treatment in Respiratory Tract Infection among Adolescents \n\n\n\n044 Al-Nema M Ligand-Based Pharmacophore Modelling of Phosphodiesterase 10A Inhibitors \n\n\n\n046 Farhan AB The Dissolution Performances of Flurbiprofen Solid Dispersion Systems \n\n\n\n047 Al-Shami AKM Knowledge, Attitude and Practice of Medical and Health Sciences Students at \n\n\n\nIIUM Towards Zika Virus \n\n\n\n\n\n\n\n\n\n\n\n\n42 \n\n\n\n052 Iqbal MZ Knowledge, Attitude and Practice of Mental Health Disorder among Healthcare \n\n\n\nStudents of Medicine, Pharmacy and Dentistry in a Private University in Kedah, \n\n\n\nMalaysia \n\n\n\n053 Iqbal MZ Knowledge and Perception of Health Care Students of a Malaysian Private \n\n\n\nUniversity about Ebola Virus Disease (EVD) \n\n\n\n054 Razali MF Trend of Pharmaceutical Products Poisoning Cases Reported to the National Poison \n\n\n\nCentre of Malaysia from 2006 To 2015 \n\n\n\n055 Fatokun O Factors Associated With Consumer Spending on Herbal Products among the \n\n\n\nGeneral Public in Kuala Lumpur, Malaysia \n\n\n\n057 Sha'aban A Drug Utilisation and Associated Adverse Drug Events in Hypertensive Patients at \n\n\n\na Tertiary Healthcare Facility in South-West Nigeria \n\n\n\n058 Prajapati SK Measurement of Effect of Spironolactone  Patients with Rheumatoid Arthritis \n\n\n\n059 Jimam NS Uncomplicated Malaria Diagnostic and Treatment Practices in Primary Health \n\n\n\nCare Facilities of Plateau State, Nigeria: A Retrospective Study \n\n\n\n061 Tan CS Vasorelaxation Effect of Glycyrrhizae uralensis Through the Endothelium \n\n\n\nDependent Pathway \n\n\n\n063 Ch'ng YS Vasorelaxant Properties of Vernonia amygdalina Ethanol Extract and Its Possible \n\n\n\nMechanism of Action \n\n\n\n064 Ng CH Overview of Signalling Mechanism Pathways Employed by BPaid in Vasodilatory \n\n\n\nActivity \n\n\n\n068 Iqbal Z Vasorelaxant Activities and Underlying Pharmacological Mechanisms of Gynura \n\n\n\nprocumbens Merr. Leaf Extracts in Isolated Rat Thoracic Aorta \n\n\n\n071 Pathmapiriyaa M Quality of 'Educational Intervention Tool' in Prevention of Human Papilloma Virus \n\n\n\nInfection among Parents \n\n\n\n073 Teh YH Isolation and Purification of Bioactive Protein(S) with Anti-Breast Cancer Property \n\n\n\nfrom Gynura procumbens (Lour.) Merr. Extract \n\n\n\n075 Ng SY Paediatric Pharmacist: Our Journey and Milestone \n\n\n\n076 Che Yaacob NL A Preliminary Study: Consumer Satisfaction Towards Accessibility and \n\n\n\nPharmaceutical Care in Malaysia Community Pharmacies \n\n\n\n077 Che Yaacob NL Knowledge and Attitude Towards Antibiotic Use among Public in Alor Setar, \n\n\n\nKedah \n\n\n\n079 Ali AN Development, Translation and Validation of Adults KAP Survey Questionnaire \n\n\n\nRegarding Prevention of Human Papilloma Virus Infection and HPV Vaccination \n\n\n\n081 Raman W An Assessment of Knowledge of Smoking Cessation among Final Year Pharmacy \n\n\n\nStudents in Malaysia \n\n\n\n082 Jimam NS Adjunct Medications in Uncomplicated Malaria Management and Their Direct \n\n\n\nCost Implications on Patients: A Case Study of Primary Health Care Facilities in \n\n\n\nPlateau State, Nigeria \n\n\n\n086 Siddalingam R Self-Nanoemulsifying Drug Delivery Systems of Dutasteride: Development and In \n\n\n\nvitro Characterization \n\n\n\n087 Bangash NSA Impact of Platinum Based Therapy and Non-Platinum Based Therapy on Survival \n\n\n\nin Malaysian Patients with Advanced Non-Small Cell Lung Cancer  \n\n\n\n088 Bangash NSA Does EGFR Mutation Influence Survival Outcomes Following First-Line Gefitinib \n\n\n\nTherapy in Malaysian Patients with Advanced Non-Small Cell Lung Cancer \n\n\n\nPatients? \n\n\n\n\n\n\n\n\n\n\n\n\n43 \n\n\n\n089 Raman W Adherence to Topical Corticosteroid Use among the Public in the Community \n\n\n\nPharmacy Setting in Seberang Perai Selatan, Penang \n\n\n\n091 Bangash NSA Incidence of Treatment-Related Side Effects in Non-Small Cell Lung Cancer \n\n\n\nPatients Receiving Platinum Therapy at a Public Tertiary Care Hospital \n\n\n\n093 Kool N High Performance Liquid Chromatography of Newly Synthesized Prodrugs of \n\n\n\nAceclofenac \n\n\n\n094 Tey KK Knowledge and Use of Antibiotics among the Public in the Klang Valley \n\n\n\n095 Al-Samarrai EM Cholinesterase Inhibitory-Guided Fractionation and Isolation of Bioactive \n\n\n\nCompounds from Tinospora crispa and Melastoma malabathricum \n\n\n\n096 Tey KK Disposal Practices of Medication in Community Pharmacies in Malaysia \n\n\n\n097 Negi JS A Novel Controlled Ionic Gelation Method for Development of Chitosan \n\n\n\nNanoparticles \n\n\n\n098 Tey KK Utilisation of Community Pharmacy Services by the Public in Klang Valley \n\n\n\n101 Hussin SN Awareness Level on Mental Illness among Students in Institutions of Higher \n\n\n\nLearning in Ipoh \n\n\n\n105 Dahlan AFM Contribution of Carbohydrate Intake to HbA1c in Type 2 Diabetes Patients Using \n\n\n\nPharmacometrics Modelling \n\n\n\n106 Othman MF Health Professional Awareness of Drug Cost : A Systematic Review \n\n\n\n107 Misnan A Prevalence and Factors Associated with Drop Out among the USM Tobacco \n\n\n\nQuitline Service Clients in Malaysia \n\n\n\n108 Puspha RN Drug Utilization Review: Analgesics among Patients with Acute, Nociceptive Non-\n\n\n\nCancerous Pain \n\n\n\n109 Cheann LL Psychological Distress and Emotional Burnout of Health Professionals in Hospital \n\n\n\nSetting: A Comparison Between Doctors and Pharmacists \n\n\n\n110 Hashim N Effects of Ethanolic Orthosiphon stamineus Extract on the Behaviour of Gestated \n\n\n\nand Non-Gestated Female Rats Subjected to Chronic Mild Stress \n\n\n\n111 Jafari SF In vitro and In vivo Anticancer Activities of Potassium Koetjape: A Solubility \n\n\n\nEnhanced Formulation of Koetjapic Acid Isolated from Sandoricum koetjape \n\n\n\n112 Iskandar TS Comparison of Protein Profile for Chicken, Pork and Beef Using Proteomic \n\n\n\nApproach \n\n\n\n113 Shaukat AR The Use of Traditional and Complementary Medicine to Conceive, During \n\n\n\nPregnancy and the Postpartum Period in Kuala Muda District, Kedah, Malaysia \n\n\n\n114 Salim MR Characterization of Plastics from Original and Falsified Panadol Actifast Blister \n\n\n\nPack Using Differential Scanning Calorimetry \n\n\n\n115 Sharma D Drug Content and In vitro Dissolution of Ciprofloxacin Tablets \n\n\n\n116 Thuraisingam M A Comparative Study of Attention and Mental Alertness Level Between Coffee \n\n\n\nand Green Tea Users in KPJ Healthcare University College \n\n\n\n117 Kumari AVAG Antimicrobial Activity of Moringa oleifera Leaves Extracts Against Isolated \n\n\n\nHuman Dental Pathogens \n\n\n\n118 Anandarajagopal K Antipyretic activity of Hibiscus rosa-sinensis Stem Extract \n\n\n\n119 Khan A Development of Polymeric Films for the Effective Delivery of Timolol Maleate in \n\n\n\nthe Management of Glaucoma \n\n\n\n\n\n\n\n\n\n\n\n\n44 \n\n\n\n120 Hanish Singh JC Doxycycline Attenuates Cognitive Dysfunction on Cerebral Ischemic Stroke in \n\n\n\nWistar Rats \n\n\n\n121 Menon BVV The Prescribing Pattern of Antidiabetics and Utilization of Clinical Practice \n\n\n\nGuidelines in Managing T2DM Patients in a Private Hospital \n\n\n\n122 Beshir SA Evaluation of the Predictive Performance of Bleeding Risk Scores in Patients with \n\n\n\nNonvalvular Atrial Fibrillation  on Oral Anticoagulants \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n45 \n\n\n\n\n\n\n\nMPSPSC2017000014 (Poster) \n\n\n\nSKIN LIGHTENING EFFECT OF SEAWEED GEL FORMULATION: AN IN VIVO STUDY \n\n\n\n\n\n\n\nHadi H1 and Mohd NN1 \n1Kulliyyah of Pharmacy, International Islamic University Malaysia, Bandar Indera Mahkota \n\n\n\n\n\n\n\nINTRODUCTION: There are numerous skin lightening products out there that use harmful substances such as \n\n\n\nmercury and hydroquinone. Therefore, seaweed gel formulation was formulated by using seaweed as the main \n\n\n\ningredient to provide skin lightening effect to the skin as well as to provide moisture and improve skin conditions \n\n\n\nwithout greasy feels to the skin.  \n\n\n\nOBJECTIVE: This study is to assess the skin lightening effect of seaweed gel formulation besides the safety of \n\n\n\nthe formulation to the consumers.  \n\n\n\nMETHODS: A total of 15 healthy female subjects (19-24 years old) were selected according to skin condition, \n\n\n\nage and sun behavior. Melanin content, skin hydration, collagen intensity and skin elasticity were assessed using \n\n\n\nDermaLab Combo, Cortex Technology. All of the aforementioned assessments were done at mid volar area of the \n\n\n\nright forearm after applying the formulation at the respected area every day for 28 days. The assessment was done \n\n\n\nonce a week for 4 weeks. \n\n\n\nRESULTS: The seaweed gel formulation has significantly reduced the melanin content of the subjects, provides \n\n\n\nextra hydration to the stratum corneum as well as improving its collagen intensity. However, it does not \n\n\n\nsignificantly improve the skin elasticity. The reducing of melanin content shows significant difference after \n\n\n\napplying the formulation for 3 weeks. The hydration of stratum corneum improves after 1 week of applying the \n\n\n\nformulation, while collagen intensity increases after 3 weeks of applying the formulation.  \n\n\n\nCONCLUSION: Seaweed gel formulation provides skin lightening effect as well as improves hydration and \n\n\n\ncollagen intensity of the skin. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nMPSPSC2017000018 (Poster) \n\n\n\nTHE EFFECTS OF CURCUMIN IN NEUROTRANSMITTER SIGNALING IN KAINATE MODEL OF \n\n\n\nEPILEPTIC RATS \n\n\n\n\n\n\n\nYow HY1, Ahmad N2, Azmi N2, Makmor-Bakry M2 \n1School of Pharmacy, Faculty of Health and Medical Sciences, Taylor\u2019s University Lakeside Campus, Subang \n\n\n\nJaya, Malaysia. \n2Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia. \n\n\n\n\n\n\n\nINTRODUCTION:  Temporal lobe epilepsy is the most common and difficult-to-treat type of partial epilepsy. \n\n\n\nBy understanding the molecular mechanism of epileptogenesis, it is likely to discover new therapies with \n\n\n\nantiepileptogenic effect. Curcumin has been shown to have potential antiepileptogenic effect in preclinical studies. \n\n\n\nHowever, its molecular pathways in modulating epileptogenesis remain unclear. \n\n\n\nOBJECTIVES: Current study investigated the antiepileptogenic pathways associated with curcumin therapy on \n\n\n\ngene expression hippocampal brain tissues of kainic acid (KA)-induced post-status epilepticus rats. \n\n\n\nMETHODS: A single dose of kainic acid 10 mg/kg was used to induce a convulsive status epilepticus in female \n\n\n\nWistar rats. After one week of curcumin treatment, gene expression profiling by using microarray was conducted \n\n\n\non hippocampal tissues. A set of differential expression changes was determined based on criteria of dual fold \n\n\n\nchange in either direction and p < 0.05, whereas gene annotation and pathway analysis had been performed using \n\n\n\nDatabase for Annotation, Visualization and integrated Discovery software. \n\n\n\nRESULTS: Multiple biological processes were involved in KA-induced epileptogenesis, including \n\n\n\nneurotransmitters signalling.  KA demonstrated to be involved in downregulating GABA\u03c1 receptor (GABRR1) \n\n\n\nand glutamate related receptors (GRIN2C, GRID1).  Curcumin had been shown to be involved in increasing the \n\n\n\nGABAergic transmission via upregulation of GABAA receptor-associated protein (GABARAP) and decreasing \n\n\n\nthe glutamatergic transmission by upregulating glutamate transporter (SLC1A3). \n\n\n\nCONCLUSION: This study provides novel insights into the mechanisms of curcumin in modulating \n\n\n\nneurotransmission in epileptic brain, which forms the fundamental for future studies in its molecular pathways as \n\n\n\nan anti-epileptogenic agent. \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n46 \n\n\n\n\n\n\n\nMPSPSC2017000019 (Poster) \n\n\n\nDESIGN, OPTIMIZATION, FORMULATION AND EVALUATION OF EDARAVONE \n\n\n\nNANOPARTICLES BY USING BOX-BEHNKEN DESIGN SURFACE RESPONSE METHODOLOGY \n\n\n\n\n\n\n\nRajavel V1 ,  Kalaimani JRK1 , Venugopal V1 , Muralidharan S1 , Ching JYS1 , Maniam K1 , Tiong KKK1  \n1Faculty of Pharmacy, AIMST University, Semeling, Bedong, 08100, Kedah, Malaysia \n\n\n\n\n\n\n\nOBJECTIVE: To optimize, prepare and evaluate edaravone nanoparticles by 3 levels factorial design using Box-\n\n\n\nBehnken surface response method. \n\n\n\nMETHOD: The edaravone nanoparticle formula was optimized by 3 levels factorials design using design expect \n\n\n\nsoftware. The nanoparticles were prepared by using emulsification method ethyl cellulose (EC) as a biodegradable \n\n\n\npolymer. The prepared nanoparticles were subjected to morphology, particle size, entrapment efficiency and in-\n\n\n\nvitro drug release studies. \n\n\n\nRESULTS: The software produced 17 formulations with varying concentration of EC, PVA and Tween-80 with \n\n\n\na fixed dose of edaravone (5 mg). The drug and polymer compatibility study was done by FTIR spectroscopy. All \n\n\n\nthe 17 formulations morphology was spherical in shape and the zeta potential rage is -12.7 mV to -28.5 mV. The \n\n\n\nparticle size and entrapment efficiency (EE) was main independent variable in the formula optimization. The in-\n\n\n\nvitro dissolution of all the formulations were followed initial burst release followed by sustained release more \n\n\n\nthan 12 hours. Based on the factorial design studies, the optimized formulation of edaravone nanoparticle was \n\n\n\nfounded. The optimized formulation was observed particle size and EE i.e. 589.2nm and 77.24% respectively. \n\n\n\nFrom the observed results, the values were subjected to factorial design of 17 formulations. The observed values \n\n\n\nare very closely matches with formulation 7.   \n\n\n\nCONCLUSION: The edaravone nanoparticle formula was optimized by 3 levels factorial design and the 5 mg of \n\n\n\nedaravone, 450 mg EC, 2000 PVA and 300 mg tween-80 is the best formulation to easy scale up the production \n\n\n\nof edaravone nanoparticle.   \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nMPSPSC2017000020 (Poster) \n\n\n\nINITIATIVES IMPROVING DOCUMENTATION AND COMMUNICATION OF PATIENT\u2019S DRUG \n\n\n\nALLERGY IN A PRIVATE HOSPITAL SETTING \n \n\n\n\nLim KC1, Gan HP1, Tan SK 1 \n1Department of Pharmacy, Sunway Medical Centre, Bandar Sunway, Selangor, Malaysia. \n\n\n\n\n\n\n\nINTRODUCTION: Inconsistent documentation and communication of drug allergy (DA) among healthcare \n\n\n\nprofessionals resulted in medication errors. It is pivotal to establish a mechanism to prevent DA related adverse \n\n\n\nevents. \n\n\n\nOBJECTIVE: To describe initiatives taken by Sunway Medical Centre to improve documentation and \n\n\n\ncommunication of DA. \n\n\n\nMETHODS: Several improvement initiatives were undertaken. 1) Hospital-wide policy related to handling DA \n\n\n\ninformation was developed and executed. 2) Alert features were added into Hospital information System for staff \n\n\n\nto enter patient\u2019s DA. 3) Pharmacy staffs stamp \u201cAllergy\u201d on the prescription when alerted, and screen the \n\n\n\nprescription against allergy at each step of prescription processing. 4)  Referral to pharmacist can be made to \n\n\n\nprovide education and issue \u201cDrug Allergy Card\u201d. 5) Education sessions to nurses were conducted throughout the \n\n\n\nyears. 6) Monthly audit was conducted to obtain compliance rate of documentation of DA. \n\n\n\nRESULTS: Series of initiatives led to increased awareness among healthcare professionals. Numbers of reported \n\n\n\nmedication error related to DA reduced (3 in year 2013, 2 in year 2014, 1 in year 2015, and zero in year 2016), \n\n\n\nand numbers of referral to pharmacist and \u201cDrug Allergy Card\u201d issued to patient increased (7 in year 2014, 31 in \n\n\n\nyear 2015, 44 in year 2016). Compliance rate of allergy documentation was 99% in 2015 and 2016.  \n\n\n\nCONCLUSION: Comprehensive documentation and communication of DA is indispensable to reduce \n\n\n\nmedication errors related to DA. Introduction of Computerized Physician Order Entry (CPOE) in the near future \n\n\n\nwill further close these gaps and improve quality of care. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n47 \n\n\n\n\n\n\n\nMPSPSC2017000021 (Poster) \n\n\n\nFABRICATION OF FACE CREAM CONTAINING ENRICHED FRACTION OF PROTOCATECHUIC \n\n\n\nACID FROM CLINACANTHUS NUTANS (C. NUTANS) LEAVES \n\n\n\n\n\n\n\nZamery MI1, Hadi H1 \n\n\n\n1Department of Pharmaceutical Technology, Kulliyyah of Pharmacy, International Islamic University Malaysia  \n\n\n\n\n\n\n\nINTRODUCTION: C. nutans is predominantly native to Malaysia and contains variety of bioactive constituents \n\n\n\nincluding protocatechuic acid (PCA). PCA was found to have cosmeceutical value which protects skin from \n\n\n\noxidative stress. Emulsion is a dispersion of a liquid in other immiscible liquid with surfactant as stabilizer. Most \n\n\n\ncosmetics developed as oil-in-water emulsion and required to have certain criteria such as homogenous, mild-to-\n\n\n\nskin and stable.  \n\n\n\nOBJECTIVES: To formulate and characterise a face cream containing PCA enriched fraction.  \n\n\n\nMETHODS: Cream formulation involves 82.7% aqueous and 15% oil and 2.3% cooling phases. It was \n\n\n\nformulated via double boiling, agitation and homogenization techniques. Formulated cream was characterised by \n\n\n\nevaluating physical (phase separation before and after centrifugation), organoleptic (visual, colour, odour and \n\n\n\ntexture), particle size, zeta potential, rheology, pH and microbial contamination and PCA quantification by high-\n\n\n\nperformance liquid chromatography (HPLC) analyses.  \n\n\n\nRESULTS: A homogenous cream was formulated having light yellow colour, smooth texture and chamomile \n\n\n\nscent. Centrifugation test showed no phase separation. Particle size of the cream was 4.27\u00b10.05\u00b5m with the span \n\n\n\nvalue of 0.55\u00b10.02. Zeta potential of the cream was -68.3\u00b10.8mV. The rheological analysis of the cream showed \n\n\n\nflow behaviour of pseudoplastic non-Newtonian. Then, pH of the cream was 5.14\u00b10.02. All microbial limit test \n\n\n\nshowed absent of microbial growth. HPLC analysis showed the PCA peak clearly at 8.122 minutes retention time.  \n\n\n\nCONCLUSION: Face cream containing PCA enriched fraction from C. nutans leaves was formulated. The \n\n\n\nparameters for cream characterization were within the specification.  Face cream, particle size, pH, rheology, zeta \n\n\n\npotential. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nMPSPSC2017000023 (Poster) \n\n\n\nTHE EVOLUTION AND EXPANSION OF CLINICAL PHARMACY SERVICE AND ITS IMPACT IN \n\n\n\nA PRIVATE HOSPITAL SETTING  \n\n\n\n\n\n\n\nTey MN1, Gan HP1, Tan SK1 \n1Department of Pharmacy, Sunway Medical Centre Sdn. Bhd., Malaysia. \n\n\n\n\n\n\n\nINTRODUCTION: The pharmacy practice in Sunway Medical Centre has evolved from a profession that \n\n\n\ndispenses medications in pharmacy to optimize the use of medications at ward level. \n\n\n\nOBJECTIVE: To describe expansion of clinical pharmacy service and its impact in SunMed - a tertiary private \n\n\n\nhospital in Malaysia.  \n\n\n\nMETHODS: Clinical pharmacy service began with coverage of 2 medical wards in year 2012 was then expanded \n\n\n\nextensively in year 2015, to cover 9 wards/units with support by recommendation from healthcare accreditation \n\n\n\nbodies. Referral to clinical pharmacist can also be made via the Pharmacy Referral Form for wards with no clinical \n\n\n\npharmacist coverage. Provision of service are prioritised to patients who are identified \u201cat risk\u201d of medicines-\n\n\n\nrelated problems.  \n\n\n\nRESULTS: The increase of full-time clinical pharmacists from 2 pharmacists in year 2014 to 5 pharmacists in \n\n\n\nyear 2015 leading to increased numbers of patients being reviewed (6915 in year 2014, 9483 in year 2015, 19480 \n\n\n\nin year 2016) and numbers of clinical interventions (635 in year 2014, 1845 in year 2015, 3855 in year 2016). The \n\n\n\ninterventions were predominantly adverse events prevented (26%), patient education (19%) and medication \n\n\n\nreconciliation (17%), with the average acceptance rate of 85.6% by doctors. Clinical pharmacists also actively \n\n\n\ninvolved in medication-related quality improvement initiatives, such as antimicrobial stewardship, training to \n\n\n\nnurses and development of educational material for patients. \n\n\n\nCONCLUSION: Expansion of clinical pharmacy service improved patient care and contributed to effective \n\n\n\nmedication management within the hospital. Assessment of interventions\u2019 clinical significance will be \n\n\n\ninstrumental for future study. \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n48 \n\n\n\n\n\n\n\nMPSPSC2017000025 (Poster) \n\n\n\nDRUG-EXCIPIENT COMPATIBILITY TESTING FOR A FIXED-DOSE GABAPENTIN-\n\n\n\nCARBAMAZEPINE CAPSULE \n\n\n\n\n\n\n\n Hassan IH1, Chatterjee B1, Doolaanea AA1, Mohamed F1, AL-Mahmood SMA2  \n 1Kulliyyah of Pharmacy, International Islamic University Malaysia \n\n\n\n 2Kulliyyah of Nursing, International Islamic University Malaysia \n\n\n\n\n\n\n\nINTRODUCTION: Carbamazepine and gabapentin have been concomitantly prescribed for neuropathic pain. in \n\n\n\norder to increase patient\u2019s compliance, a fixed-dose carbamazepine-gabapentin combination is recommended.  \n\n\n\nOBJECTIVE: This study aims to test compatibility between gabapentin and carbamazepine with several \n\n\n\nexcipients.  \n\n\n\nMETHODS: Two compatibility assessment methods which are DSC and FTIR were used to assess the potential \n\n\n\nincompatibility. The thermograms of DSC and FTIR spectra were furthered compared between the drug-\n\n\n\ndrug/excipient mixtures against individual drug or excipients. The examples of tested excipients are \n\n\n\nlactosemonohydrate, magnesiumstearate, talc, HPMC, corn starch and microcrystalline cellulose.  \n\n\n\nRESULTS: DSC results suggested that, all tested excipients were physically compatible with carbamazepine. \n\n\n\nHowever, the melting peak of gabapentin showed significant shifted peak which indicate possible physical \n\n\n\ninteractions with lactosemonohydrate, magnesiumstearate and talc. Nevertheless, the interactions were only \n\n\n\noccurred when the temperature was higher than room temperature and without any evidence at ambient \n\n\n\ntemperature, hence, physically compatible. The significant pattern of shifted peak was also seen in the physical \n\n\n\nmixture of carbamazepine and gabapentin. In order to protect one of the drugs, carbamazepine was chosen to be \n\n\n\ngranulated with 2% and 5% of HPMC solutions which act as granulating liquid. The result of peak melting point \n\n\n\nof gabapentin was greatly improved for both solutions as if there is no interaction with carbamazepine. FTIR \n\n\n\nresults illustrated that, the selected excipients such as lactosemonohydrate, magnesiumstearate, Talc and HPMC \n\n\n\nin the prototype formula were chemically compatible with gabapentin and carbamazepine.  \n\n\n\nCONCLUSION: To conclude, the granulation of carbamazepine had successfully rendered it to be compatible \n\n\n\nwith gabapentin and all excipients. \n\n\n\n\n\n\n\n\n\n\n\nMPSPSC2017000026 (Poster) \n\n\n\nCLINICAL AUDIT ON INHALER TECHNIQUE AMONG HOSPITAL SERDANG ADULT PATIENTS \n\n\n\n\n\n\n\nSuhaimi SZ1, Wong YY1, Hoo YY1, Kepli WM1, Koo JH1, Mohamed Shukor FZ1 \n\n\n\n1Department of Pharmacy, Hospital Serdang, Kajang, Selangor, Malaysia \n\n\n\n\n\n\n\nINTRODUCTION: Correct inhaler technique is essential to maximize the benefits of the medications, and \n\n\n\npharmacists play an important role to identify patients who failed to use their inhaler correctly. \n\n\n\nOBJECTIVES:  To determine the proportion of patients who able to use their inhaler correctly. \n\n\n\nMETHOD: The audit was carried out from August 2016 to May 2017. Patients on regular inhaler aged 18 years \n\n\n\nand above who came for prescription refill and those who were admitted to the hospital during the specified audit \n\n\n\ntime were recruited. Patients\u2019 inhaler technique was audited using Malaysia Respiratory Medication Therapy \n\n\n\nAdherence Clinic (RMTAC) checklist. Patients may attempt the audit thrice. If they fail the first attempt, verbal \n\n\n\ncounseling and patient information leaflet were given. If they fail the second attempt, a video was shown. After \n\n\n\nthe third attempt, patients who failed were referred to RMTAC clinic. \n\n\n\nRESULT: A total of 256 patients were recruited. Among these patients 70.7% were above 50 years old. At first \n\n\n\nattempt, 174 (68.0%) patients passed the audit. Those who failed the first attempt, 71 (86.6%) patients passed \n\n\n\nafter the second attempt. Only 1 patient failed after the third attempt. \n\n\n\nCONCLUSION: This audit showed face-to-face training session(s) and video improved patients\u2019 inhaler \n\n\n\ntechnique. However, continuous patient education with repeated assessment is very important to retained optimal \n\n\n\ninhaler technique especially in elderly patients. Regular audit on patients\u2019 inhaler technique is recommended. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n49 \n\n\n\n\n\n\n\nMPSPSC2017000027 (Poster) \n\n\n\nFORMULATION AND CHARACTERIZATION OF COSMETIC CREAM INCORPORATING PIPER \n\n\n\nBETLE LINN. EXTRACT  \n\n\n\n\n\n\n\nMohd Hanif N1, Doolaanea AA1, Abd Hadi H1  \n1Department of Pharmaceutical Technology, Kulliyyah of Pharmacy, International Islamic University Malaysia, \n\n\n\nBandar Indera Mahkota, Pahang Darul Makmur, Malaysia \n\n\n\n\n\n\n\nINTRODUCTION: Piper betle Linn. is an evergreen and perennial plant with glossy heart-shaped leaves which \n\n\n\ncontains various biologically active compounds. Hydroxychavicol is a phenolic compound found in Piper betle \n\n\n\nleaves which exhibits many potential biological activities such as antimicrobial, antioxidant, anti-inflammatory \n\n\n\nand anti-tyrosinase. \n\n\n\nOBJECTIVES: The study aimed to formulate cosmetic cream incorporating Piper betle extract and to \n\n\n\ncharacterize the developed cream. \n\n\n\nMETHODS: The cosmetic cream containing 0.02% Piper betle extract was developed by incorporating three \n\n\n\nphase ingredients include aqueous phase (75.2%), oil phase (20.8%) and cooling phase (4.0%). O/W emulsion \n\n\n\nwas prepared by adding aqueous phase into oil phase through a combination process of heating up to 75\u00baC and \n\n\n\nhomogenization at 3500 rpm. The cream formulation was characterized for organoleptic properties, pH, particle \n\n\n\nsize, zeta potential, rheological behaviour and microbial limit test. \n\n\n\nRESULTS: For organoleptic properties, the cream has an off white color, pleasant odour, smooth texture and no \n\n\n\nphase separation. The cream formulation has a pH value of 5.39 \u00b1 0.03 which was near to skin pH (4.5-5.5), \n\n\n\nsmaller particle size of 3.73 \u00b1 0.01 \u00b5m and polydispersity index of 0.56 \u00b1 0.11, negatively zeta potential of -57.53 \n\n\n\n\u00b1 1.47 mV and exhibited non-Newtonian behavior in which viscosity decreases when shear rate increases. The \n\n\n\ncream has no growth of viable microorganisms, yeasts and fungi. \n\n\n\nCONCLUSION: Based on physical characterization, the cream containing 0.02% Piper betle extract is regarded \n\n\n\nas a stable formulation with acceptable organoleptic properties.  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nMPSPSC2017000031 (Poster) \n\n\n\nEFFECT OF COMBINATION OF SUPERDISINTEGRANTS ON THE PHYSICAL PROPERTIES OF \n\n\n\nORALLY DISINTEGRATING TABLETS \n\n\n\n\n\n\n\nWong JTC1, Thong LM1  \n1Faculty of Pharmacy, SEGi University, Kota Damansara, Selangor, Malaysia. \n\n\n\n\n\n\n\nINTRODUCTION: The oral route is considered to be the most acceptable drug delivery route. However, it is \n\n\n\nnot favourable amongst geriatric patients and for those suffering from dysphagia. Thus, orally disintegrating \n\n\n\ntablets (ODTs) have been developed to address such compliance issues, as ODTs are able to dissolve or \n\n\n\ndisintegrate in the oral cavity without any addition of water. Presence of superdisintegrants in the formulation is \n\n\n\naimed to achieve rapid tablet disintegration by facilitating the swelling and breaking up of the tablet into smaller \n\n\n\nfragments. The choice of superdisintegrants can influence the disintegration rate of ODTs. Use of a combination \n\n\n\nof superdisintegrants in the formulation can enhance the performance of the ODTs. \n\n\n\nOBJECTIVES: in this study, the effect of combination of two different types of superdisintegrants, namely \n\n\n\ncroscarmellose (CCS) and crospovidone (CP), at varying ratios (total of 6 %w/w) on the physical properties of \n\n\n\nthe ODTs was evaluated. \n\n\n\nMETHODS: ODTs were prepared by direct compression method and were characterised for the uniformity of \n\n\n\nweight, tablet hardness, disintegration time and wetting time of the ODTs. \n\n\n\nRESULTS: The ODTs containing the combination of superdisintegrants at a ratio of 2:4 (CCS: CP) was found \n\n\n\nto be the most optimal formulation with the shortest disintegration time (8.53 \u00b1 0.69 seconds), as compared to the \n\n\n\nother formulations studied.  \n\n\n\nCONCLUSION: In this preliminary study, the formulation which has demonstrated the most optimal \n\n\n\nperformance can be further explored with the incorporation of active drugs. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n50 \n\n\n\n\n\n\n\nMPSPSC2017000033 (Poster) \n\n\n\nPRE-SCALE UP FORMULATION OF HALAL SKIN-LIGHTENING CREAM CONTAINING PIPER \n\n\n\nBETLE L. EXTRACT \n\n\n\n\n\n\n\nSyed OSS1, Ab Hadi H1 \n\n\n\n1Pharmaceutical Technology Department, Kulliyyah of Pharmacy, International Islamic University Malaysia \n\n\n\n\n\n\n\nINTRODUCTION: Piper betle L. extract was found to give skin-lightening effect due to the presence of \n\n\n\nphytochemical, hydroxychavicol.  As hyperpigmentation is a common skin issue, developing this cream in a larger \n\n\n\nscale allows identification and solutions to problems that usually occur in pilots scale development. The \n\n\n\nprocedures involved before scaling up will also highly affect the actual process later. Hence, meticulous \n\n\n\npreparation before scaling up is required. \n\n\n\nOBJECTIVES: The objectives of this study is to prepare for scaling up a halal cosmetic cream containing Piper \n\n\n\nbetle L. extract to pilot scale \n\n\n\nMETHODS:  The Quality Target Product Profile (QTPP) was decided based on previous research. From the \n\n\n\nQTTP, prior knowledge and equipment\u2019s specification, the Critical Quality Attributes (CQA) is extracted and the \n\n\n\nCritical Process Parameters (CPP) to be monitored was identified.  On top of that, in depth research was done in \n\n\n\norder to buy raw materials that fulfil halal requirements. \n\n\n\nRESULTS: CQA identification was used in deciding critical characteristics of the cream to be analysed such as \n\n\n\norganoleptic properties, pH, particle size, zeta potential, rheology, microbial count and HPLC analysis. Batch \n\n\n\nManufacturing Record (BMR) and Batch Packaging Record (BPR) for the scale up were able to be completed and \n\n\n\nall the raw materials were also endorsed by a Halal committee hence confirming the product to be produce will \n\n\n\nbe of halal quality. \n\n\n\nCONCLUSION: The identification of parameters affecting the cream, elaborate research on equipment and \n\n\n\nmaterials involved in scale up process is important in planning a scale up formulation. \n\n\n\n\n\n\n\n\n\n\n\nMPSPSC2017000035 (Poster) \n\n\n\nPILOT TESTING OF THE PHYSICIAN-PHARMACIST PARTNERSHIP FOR PATIENT SAFETY \n\n\n\nINTERVENTION  \n\n\n\n\n\n\n\nSellappans R1,2, Ng CJ2, Lai PSM2 \n1School of Pharmacy, Faculty of Health and Medical Sciences, Taylor\u2019s University, 47500 Subang Jaya, \n\n\n\nSelangor, Malaysia. \n2Department of Primary Care Medicine, University Malaya Primary Care Research Group (UMPCRG), Faculty \n\n\n\nof Medicine, University of Malaya, Malaysia. \n\n\n\n\n\n\n\nINTRODUCTION: The Physician-Pharmacist Partnership for Patient Safety (4Ps) is an intervention that was \n\n\n\ndeveloped based on a needs assessment, literature and a conceptual framework. It involves both doctors and \n\n\n\npharmacists discussing how to optimise patients\u2019 medications to improve safety. \n\n\n\nOBJECTIVES: To pilot test the 4Ps intervention in improving doctor-pharmacist collaborative working \n\n\n\nrelationship. \n\n\n\nMETHODS: This pilot test was conducted with doctor-pharmacist dyads in a primary care clinic in Kuala \n\n\n\nLumpur. Four doctor-pharmacist dyads delivered the 4Ps intervention to patients with chronic diseases once a \n\n\n\nweek over three weeks in December 2014. The impact of 4Ps on the collaborative working relationships between \n\n\n\ndoctors and pharmacists were assessed using a validated Physician-Pharmacist Collaborative index (PPCI) at \n\n\n\nweek 1, 2 and 3. The findings were further explored by interviewing doctors and pharmacists individually using \n\n\n\na topic guide at week 1 and 3. The interviews were audio-recorded, transcribed verbatim and analysed \n\n\n\nthematically.  \n\n\n\nRESULTS: The PPCI scores of doctors and pharmacists increased gradually over time (doctors=86.0, 92.3, 94.0, \n\n\n\npharmacists=83.0, 87.0, 89.3). The interviews revealed that the 4Ps helped to build trust between doctors and \n\n\n\npharmacists, and provided a platform for them to communicate. The 4Ps also facilitated knowledge exchange \n\n\n\nbetween the doctors and pharmacists. In addition, 77 drug-related problems were identified by the dyads.  \n\n\n\nCONCLUSION: This preliminary study found an increase in professional exchanges and collaboration between \n\n\n\nthe doctors and pharmacists, and improves patient safety.  The 4Ps should be evaluated in a randomised controlled \n\n\n\ntrial to establish its effectiveness definitively.   \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n51 \n\n\n\n\n\n\n\nMPSPSC2017000040 (Poster) \n\n\n\nSCREENING OF PUNICA GRANATUM SEEDS FOR ANTIBACTERIAL AND ANTIOXIDANT \n\n\n\nACTIVITY AGAINST VARIOUS EXTRACTS \n\n\n\n\n\n\n\nNaeem HK1, Adriana TY Lee1, Candy ZT Goo1, Ooi WY1  \n1Faculty of Pharmacy, AIMST University, 08100 Bedong, Kedah, Malaysia.                                                   \n\n\n\n\n\n\n\nINTRODUCTION: Punica granatum plant fruits best in areas with long, hot and dry summers (90\u00b0 F) and cooler \n\n\n\nwinters. Genus name comes from the Latin name contracted from Punicum malum. The different extracts \n\n\n\n(maceration with ethanol and hexane separately and soxhlet with ethanol) were investigated for their antimicrobial \n\n\n\nand antioxidant activity.  \n\n\n\nOBJECTIVES: The literary evidences over therapeutic agent\u2019s research over development of antioxidants and \n\n\n\nantibiotic activity from medicinal plants inspired the investigators to aim over screening of Punica granatum seeds \n\n\n\nfor antibacterial and antioxidant activity with various extracts. \n\n\n\nMETHODS: Penicillin and ampicillin were used as positive control using agar well diffusion method. For the \n\n\n\nantioxidant activity, DPPH radical scavenging assay was performed. IC50, the half maximal (50%) inhibitory \n\n\n\nconcentration was measured in this study.  \n\n\n\nRESULTS: Ethanol soxhlet extracts showed good inhibitory effect over growth of all the seven strains of bacteria. \n\n\n\nEthanol maceration extract only possessed antimicrobial activity against Neisseria gonorrhoeae, Pseudomonas \n\n\n\naeruginosa and Staphylococcus aureus whereas hexane extract showed no antimicrobial activity. For the \n\n\n\nantioxidant activity, DPPH radical scavenging assay was performed. I5, the half maximal (50%) inhibitory \n\n\n\nconcentration for extracts WERE calculated. Ethanol soxhlet (ES) extract showed the lowest IC50 value (1350.27 \n\n\n\n\u03bcg/mL); hexane extract (HM) showed IC50 value of 3005.66 \u03bcg/mL and ethanol maceration extract (EM) showed \n\n\n\nhighest IC50 value (4852.26 \u03bcg/mL).  \n\n\n\nCONCLUSION: The seeds of punica granatumhas shown substantial antibacterial and antioxidant activity.  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nMPSPSC2017000041 (Poster) \n\n\n\nDEVELOPMENT OF SHARED DECISION MAKING AID TOOL FOR THE USE OF PHARMACISTS \n\n\n\nIN CASES OF ANTIOBIOTIC TREATMENT IN RESPIRATORY TRACT INFECTION AMONG \n\n\n\nADOLESCENTS \n\n\n\n\n\n\n\nNgadimon IW1, Islahudin F2, Makmor-Bakry M2, Mohamed Shah N2, Md. Hatah E2 \n1Faculty of Pharmacy, MAHSA University, Jenjarom, Selangor \n2Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur. \n\n\n\n\n\n\n\nINTRODUCTION: The use of shared decision-making aid tool among medical practitioners showed a \n\n\n\nsignificant reduction in irrelevant antibiotic prescription, especially respiratory infections. in this study, a tool is \n\n\n\nespecially designed for guiding antibiotic use in respiratory infections among adolescents. \n\n\n\nOBJECTIVE: This study aims to apply the shared decision-making model in pharmacy practice by developing \n\n\n\na tool that can be used by pharmacists in antibiotics treatment among adolescents. \n\n\n\nMETHOD: A purposive sampling is used that involved pharmacists in Malaysia. The respondents will choose \n\n\n\nthe statements that they think most suitable to be incorporated into the tool.  To evaluate the designed tools, pilot \n\n\n\nstudy was conducted among 20 pharmacists and their respective adolescent patients. \n\n\n\nRESULTS: in the evaluation study, respondents showed very good acceptance toward the aid tool. All \n\n\n\nrespondents (n = 20, 100%) agreed that information delivered in this tool is sufficient to help them make decisions. \n\n\n\nRespondents also felt that the decision-making process with pharmacists was useful for them (n=20, 100%).  \n\n\n\nCONCLUSION: The designed tool seems to have a positive impact in the decision-making process and received \n\n\n\ngood acceptance from users. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n52 \n\n\n\n \nMPSPSC2017000044 (Poster) \n\n\n\nLIGAND-BASED PHARMACOPHORE MODELLING OF PHOSPHODIESTERASE 10A INHIBITORS \n\n\n\n\n\n\n\n Al-Nema M1, Akowuah G1, Gaurav A1        \n1Department of Pharmaceutical Sciences, UCSI University, Kuala Lumpur, Malaysia. \n\n\n\n\n\n\n\nINTRODUCTION: Phosphodiesterase 10A (PDE10A) is a dual substrate enzyme that catalyses the inactivation \n\n\n\nof both cAMP and cGMP in to AMP and GMP respectively. This enzyme is expressed mainly in striatum. Thus \n\n\n\ninhibition of PDE10A results in elevation of cAMP and cGMP which activate the direct and indirect pathways in \n\n\n\nstriaum. Activation of these two pathways provides effective improvement of positive, negative, and cognitive \n\n\n\nsymptoms of schizophrenia. All the available antipsychotic drugs provide relief for the positive symptoms of \n\n\n\nschizophrenia but they do not improve the negative or cognitive symptoms of the disease. Besides that, the existing \n\n\n\ntherapies produce serious side effects that impact the patient's adherence to the treatment. \n\n\n\nOBJECTIVES: The present study was designed to develop ligand-based pharmacophore models for PDE10A \n\n\n\ninhibitors and validates the generated pharmacophores. \n\n\n\nMETHOD: in this study LigandScout was used to generate ligand-based pharmacophore by clustering a series \n\n\n\nof well-known inhibitors in to nine clusters according to their pharmacophore characteristics, followed by \n\n\n\nvalidation of the generated pharmacophores by using test and decoy sets. \n\n\n\nRESULTS: The pharmacophores of the compounds contain three features: aromatic ring, hydrophobic unit, and \n\n\n\nhydrogen bond acceptor except three pharmacophores which contain only two features. All generated \n\n\n\npharmacophores were able to recognize most of the active compounds in test set.   \n\n\n\nCONCLUSION: Nine pharmacophores were generated and validated by using LigandScout software. The \n\n\n\nvalidated pharmacophores will be used for screening of Universal Natural Products Database in future study. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nMPSPSC2017000046 (Poster) \n\n\n\nTHE DISSOLUTION PERFORMANCES OF FLURBIPROFEN SOLID DISPERSION SYSTEMS \n\n\n\n\n\n\n\nFarhan AB1, Chan SY2  \n1School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 USM, Penang, Malaysia. \n\n\n\n\n\n\n\nINTRODUCTION: inconsistent dissolution performances of solid dispersion-(SD) are reported in recent years. \n\n\n\nA review reported that 18% of the studies revealed deterioration of dissolution performance or similar \n\n\n\nbioavailabilities of SD to their corresponding physical mixed (PM).  \n\n\n\nOBJECTIVES: The goal of this study is to investigate the relation of dissolution performances of SD to their \n\n\n\namorphicity which is generally believed to be crucial for dissolution enhancement. \n\n\n\nMETHODS:   SD was prepared by spray drying Flurbiprofen (FBP) by using PVPVA, Cabopol (CP) and HPMC \n\n\n\nas carriers. PM was prepared by simple mixing using a mortar and pestle. Physicochemical properties of the \n\n\n\nsamples were tested using XRPD, DSC and ATR-FTIR. Dissolution performances of the prepared SD and their \n\n\n\ncorresponding PM. \n\n\n\nRESULTS: SD 30% FBP-HPMC revealed halo pattern in XR diffractogram which indicating fully amorphous \n\n\n\nnature. This result is in concurrence with its DSC thermograms where no apparent melting point was detected. In \n\n\n\ncontrast, DSC thermograms of both SD FBP-PVA and SD FBP-CP systems revealed melting of FBP at 150oC \n\n\n\nwhich indicate the present of crystalline traces. This could be further supported by the characteristic FBP diffracted \n\n\n\npeaks noted in XRPD of SD FBP-PVA and SD FBP-CP. interestingly, partially crystalline dispersion of SD-FBP-\n\n\n\nPVA recorded higher dissolution rate as compared to a fully amorphous dispersion of SD FBP-HPMC. \n\n\n\nCONCLUSIONS: Partially crystalline dispersion is sufficient in dissolution enhancement of poorly soluble FBP. \n\n\n\nPerformance-effective SD entails a suitable carrier in order to maintain its amorphous solubility and not hurdle its \n\n\n\nrelease.  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n53 \n\n\n\n\n\n\n\nMPSPSC2017000047 (Poster) \n\n\n\nKNOWLEDGE, ATTITUDE AND PRACTICE OF MEDICAL AND HEALTH SCIENCES STUDENTS \n\n\n\nAT IIUM TOWARDS ZIKA VIRUS \n\n\n\n\n\n\n\nAl-Shami AK1, Jamshed S1, Elsayed T1, Elkalmi R2 \n1Kulliyyah of Pharmacy, international Islamic University Malaysia, 25200 Kuantan, Pahang, Malaysia \n2Faculty of Pharmacy, UiTM, Puncak Alam Campus, 42300 Bandar Puncak Alam, Selangor, Malaysia \n\n\n\n\n\n\n\nINTRIDUCTION: Zika virus is a mosquito-borne flavivirus that was first identified in Uganda in 1947. The \n\n\n\nmost common complications of this virus are congenital brain abnormalities to the foetus and Guillain-Barr\u00e9 \n\n\n\nsyndrome in the infected person. Knowledge about Zika is the most crucial part for prevention as zero knowledge \n\n\n\nabout Zika could contribute to poor attitude and practice towards the disease itself.  \n\n\n\nOBJECTIVES: This study aims to assess knowledge, attitude and practice towards Zika virus among \n\n\n\nundergraduate medical and health sciences students at international Islamic University Malaysia (IIUM). The \n\n\n\nstudy is a cross-sectional and involved 180 final year students from Kulliyyah of Pharmacy and Kulliyyah of \n\n\n\nAllied Health Sciences and third and fourth year students from Kulliyyah of Dentistry and Kulliyyah of Medicine. \n\n\n\nA self-administered questionnaire was used for data collection.  \n\n\n\nRESULTS: The response rate was 85.5% (171/200), with 57 (33.33%) males and 114 (66.67%) females. Their \n\n\n\nknowledge of the cause, signs and symptoms of Zika virus infection was quite good, but moderate regarding its \n\n\n\ncomplications. The majority of respondents had a common perspective that baby will be the most affected from \n\n\n\nthis infection which indicates a good knowledge. Approximately, half of them were considering taking preventive \n\n\n\nmeasures against Zika virus which indicates a good attitude towards it.  \n\n\n\nCONCLUSION: Further exposure of the students in the future providing them more details about harmful effects \n\n\n\nof Zika on humans is recommended. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nMPSPSC2017000052 (Poster) \n\n\n\nKNOWLEDGE, ATTITUDE AND PRACTICE OF MENTAL HEALTH DISORDER AMONG \n\n\n\nHEALTHCARE STUDENTS OF MEDICINE, PHARMACY AND DENTISTRY IN A PRIVATE \n\n\n\nUNIVERSITY IN KEDAH, MALAYSIA \n\n\n\n\n\n\n\nIqbal MZ1,2, Teh SP 2, Mavis ZQS2, Prajapati SK2  \n1School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 USM, Penang, Malaysia. \n2Departmentt of Clinical Pharmacy, Faculty of Pharmacy, AIMST University Malaysia. \n\n\n\n\n\n\n\nINTRODUCTION: The university years of an individual are emotionally and intellectually more demanding \n\n\n\nthan almost any other stage of education. Mental health problem will not only affect the mental of university \n\n\n\nstudents but also affect their physical, biochemical and physiological health which will ultimately affect their \n\n\n\nhealthy status. \n\n\n\nOBJECTIVES: The objective of the study is to evaluate and compare knowledge, attitude and practice of \n\n\n\nmedical, pharmacy and dental student in AIMST University on the progress of Mental Health.  \n\n\n\nMETHOD: A cross sectional observational study on a convenient random sample of 284 students from University \n\n\n\nwas conducted by using validated questionnaires to gather data on the attitude, knowledge and practice of students. \n\n\n\nRESULTS: From 284 respondents in university, 104 of the respondents were males (36.6%) and 180 of were \n\n\n\nfemales (63.4%). For knowledge and perception, males (Mean rank = 11.12\u00b12.01) were having less adequate \n\n\n\nknowledge than females (Mean rank=11.75\u00b11.74). Among the Faculties, students from Medical were having the \n\n\n\nmost adequate knowledge than other faculties (Mean rank=12.02\u00b11.58). The result showed that those in the age \n\n\n\ngroup of 25-30 were having more adequate knowledge on mental health disorder (Mean rank=11.86\u00b10.90). Pre-\n\n\n\nfinal and final year respondents were having almost same percentage of adequate knowledge (Mean \n\n\n\nrank=11.52\u00b11.77) and (Mean rank=11.51\u00b11.96) respectively.  \n\n\n\nCONCLUSION: The medical students were having most adequate knowledge as compared to other faculties in \n\n\n\nthe university.  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n54 \n\n\n\n\n\n\n\nMPSPSC2017000053 (Poster) \n\n\n\nKNOWLEDGE AND PERCEPTION OF HEALTH CARE STUDENTS OF A MALAYSIAN PRIVATE \n\n\n\nUNIVERSITY ABOUT EBOLA VIRUS DISEASE (EVD) \n\n\n\n\n\n\n\nIqbal MZ1, Balu D1, Prajapati SK1 \n\n\n\n1Faculty of Pharmacy, AIMST University, 08100 Kedah Malaysia \n\n\n\n\n\n\n\nINTRODUCTION: Ebola Virus Disease (EVD) also known as Ebola haemorrhagic fever is a deadly disease \n\n\n\nwith current outbreak in West Africa. EVD outbreak was notified as a Public Health Emergency of international \n\n\n\nimportance on 8th August, 2014 by WHO. Malaysia, being one of the major countries with tourist attractions, is \n\n\n\nat high risk for the spread of EVD through tourists, international students and some immigrants. \n\n\n\nOBJECTIVES: This study is to assess the Knowledge and Perception of Medicine, Dentistry and Pharmacy \n\n\n\nstudents in AIMST University regarding Ebola virus disease (EVD). Objectives of the study to evaluate the gaps \n\n\n\nin knowledge & attitude among Medicine, Dentistry and Pharmacy students regarding EVD and how to improve \n\n\n\nthe knowledge of the disease to the students as a preparations to face the disease in future.  \n\n\n\nMETHODS: Cross sectional observational study was conducted. It was conduct on 84 medicine students, 90 \n\n\n\ndentistry students and 99 pharmacy students from AIMST University, Kedah, Malaysia.  \n\n\n\nRESULTS: Student\u2019s knowledge and attitude were correlated with the students\u2019 Faculty, Year of study, Age, \n\n\n\nGender, Race, Education background and Residency. Mann Whitney and Kruskal Wallis test were performed to \n\n\n\nobserve the statistical difference among the variables. Pharmacy students (38.4%) are having more adequate \n\n\n\nknowledge than Dentistry (28.9%) and Medicine students (27.4%).  \n\n\n\nCONCLUSION: Gaps between knowledge and practices were seen in all categories which is alarming. These \n\n\n\ngaps were mainly due to lack of knowledge, poor motivation, education system and students psychology. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nMPSPSC2017000054(Poster) \n\n\n\nTREND OF PHARMACEUTICAL PRODUCTS POISONING CASES REPORTED TO THE \n\n\n\nNATIONAL POISON CENTRE OF MALAYSIA FROM 2006 TO 2015 \n\n\n\n\n\n\n\nRazali MF1, Awang R1, Abdul Majid I1, Hashim H1, Mohamad Khan HR1, Mohamed Ariff 1, Samsudin S1, \n\n\n\nMisnan A1, Amir A1, Md. Rashid S1 \n1National Poison Centre, Universiti Sains Malaysia, 11800 USM, Malaysia \n\n\n\n\n\n\n\nINTRODUCTION:  The Malaysian National Poison Centre (NPC) provides nationwide telephone information \n\n\n\nservice on the management of various poisonings to health professionals and general public. Enquiries related to \n\n\n\npharmaceutical products poisoning is the most common enquiries received by the centre. \n\n\n\nOBJECTIVE:  This study aimed to review and report the trend of pharmaceuticals poisoning cases handled by \n\n\n\nNPC for a period of 10 years (2006\u20132015). \n\n\n\nMETHODS:  The poisoning case reports documented by the centre during the ten year period were retrieved and \n\n\n\nstudied retrospectively. \n\n\n\nRESULTS:  During the study period, a total of 39,088 poisoning calls were received and around 36% (N=14,081) \n\n\n\nwere pharmaceutical poisoning cases. Majority of the pharmaceutical poisoning cases were intentional (60.5%), \n\n\n\nin females (53%), in Malays (32.3%) and in the age group of 20-74 years-old (56.3%).  Of all the cases, majority \n\n\n\nwere acute poisoning (90.4%) and oral exposure was about 98.6%. Analysis of the sub-classes of the common \n\n\n\npharmaceutical products showed that psychiatric medicines (21%), topical agents (18.1%) and analgesics (14.4%) \n\n\n\nwere the most common products implicated. One alarming feature of the study was the high incidence of \n\n\n\npoisoning in children less than 18 years-old which is about 33.9%. Overall, pharmaceuticals poisoning cases \n\n\n\nreferred for enquiry to NPC showed an increasing numbers each year.    \n\n\n\nCONCLUSION:  This study showed an increasing trend of pharmaceuticals poisoning in Malaysia. Statistics \n\n\n\npresented may not represent the actual burden of pharmaceuticals poisoning in Malaysia, but may serve as a \n\n\n\nbaseline towards better preventive measures in planning related drug policies in the country. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n55 \n\n\n\n\n\n\n\nMPSPSC2017000055 (Poster) \n\n\n\nFACTORS ASSOCIATED WITH CONSUMER SPENDING ON HERBAL PRODUCTS AMONG THE \n\n\n\nGENERAL PUBLIC IN KUALA LUMPUR, MALAYSIA  \n\n\n\n\n\n\n\nFatokun O1, Palani N1, Karunanithy J1, Mohamad HM1, Ping FL1, Khoo MJ1, Umathavan RD1 \n\n\n\n1Department of Clinical Pharmacy, UCSI University, Cheras 56000 Kuala Lumpur, Malaysia  \n\n\n\n\n\n\n\nINTRODUCTION: An estimated US$ 500 million is spent annually in Malaysia on traditional and \n\n\n\ncomplementary medicines, including herbal products. Yet, little is known about the factors influencing such \n\n\n\nspending. \n\n\n\nOBJECTIVES: To examine the factors influencing consumers\u2019 spending on herbal products in Malaysia. \n\n\n\nMETHODS: This study was a cross-sectional interviewer-administered questionnaire survey, using a \n\n\n\nconvenience sample of study participants aged 18 years and older. The independent variables were herbal \n\n\n\ntherapies adoption model variables, comprising consumer characteristics, social systems, communication \n\n\n\nchannels, and herbal characteristics. The amount of spending on herbal products was the dependent variable, with \n\n\n\nparticipants\u2019 responses dichotomise into low spender and high spender, based on the median split of monthly \n\n\n\nspending on herbal products. \n\n\n\nRESULTS: A total of 400 individuals were included in this study. The mean and median monthly spending were \n\n\n\nRM 97.86 (SD = 92.73) and RM 60 (IQR = 90) respectively. Significant associations were observed between \n\n\n\nspending on herbals and gender (P < 0.001), age (P = 0.001), marital status (P = 0.01), occupation (P = 0.03), \n\n\n\nfrequency of use of herbal products (P < 0.001), place of purchase (P = 0.01) and beliefs about safety (P = 0.03) \n\n\n\nand effectiveness (P = 0.03) of herbal products.  \n\n\n\nCONCLUSION: An adoption model of herbal therapies is useful in explaining consumers spending on herbal \n\n\n\nproducts. The identified factors could be helpful in informing policy and practice decisions relevant to the \n\n\n\npromotion and utilization of herbal products in Malaysia. \n\n\n\n\n\n\n\nMPSPSC2017000057 (Poster) \n\n\n\nDRUG UTILISATION PATTERN AND ASSOCIATED ADVERSE DRUG EVENTS IN \n\n\n\nHYPERTENSIVE PATIENTS AT A TERTIARY HEALTHCARE FACILITY IN SOUTH-WEST \n\n\n\nNIGERIA \n\n\n\n\n\n\n\nSha\u2019aban A1, 2, AI Jatau3, Aly A1, Hammad MA1, Casmir EA4, Olubukola OO5 \n1School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 USM, Penang, Malaysia. \n2Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmaceutical Sciences, Ahmadu Bello \n\n\n\nUniversity, Zaria, Nigeria. \n3Pharmacy, School of Medicine, University of Tasmania, 7005 Hobart, Tasmania, Australia  \n4Department of Medicine, College of Medicine, University of Lagos, Lagos, Nigeria \n5Department of Clinical Pharmacy and Biopharmacy, Faculty of Pharmacy, University of Lagos, Nigeria,  \n\n\n\n\n\n\n\nINTRODUCTION: Hypertension is one of the most common chronic diseases and an important public health \n\n\n\nproblem worldwide. Hypertensive patients are subject to multiple and life-long therapies, which make them at \n\n\n\nhigh risk of adverse drug events. Few data are available on adverse drug events (ADEs) among hypertensive \n\n\n\noutpatients. \n\n\n\nOBJECTIVES: The objectives of this study were to determine the pattern of drug utilization and the associated \n\n\n\nadverse drug events in a cohort of hypertensive patients. \n\n\n\nMETHOD: This was a cross-sectional study using interviewer guided, self-administered questionnaires. Using \n\n\n\npurposive sampling technique, the questionnaires were distributed to 400 consented patients. Complete \n\n\n\nmedication profile was ascertained from respective case notes of the patients at the end of each clinic. \n\n\n\nRESULTS: 370 valid questionnaires were retrieved (response rate = 92.5%). Overall, diuretics had the highest \n\n\n\nfrequency of usage (64.1%), followed by antiplatelets (46.5%) then angiotensin converting enzyme inhibitors \n\n\n\n(44.9%). Only 3.5% of the study patients were on monotherapy. ADEs were experienced in about 64.6% of the \n\n\n\nstudy patients. The top 5 frequently experienced ADEs in this study were Dizziness, 76 (20.5%); Headache, 75 \n\n\n\n(20.3%); Tiredness, 67 (18.1%); Cough, 64 (17.3%); Peripheral oedema, 33 (8.9%) and Faintness upon rising, 26 \n\n\n\n(7.0%). \n\n\n\nCONCLUSION: The antihypertensive drug use at the tertiary healthcare facility was, to a large extent, rational \n\n\n\nand consistent with the Guidelines for the Management of hypertension in Nigeria and the World Health \n\n\n\nOrganization/ international Society of Hypertension (WHO/ISH). However, high frequency of ADEs has been \n\n\n\nreported by the patients, thus, the need for preventive intervention measures in the outpatient setting to reduce the \n\n\n\nburden of ADEs. \n\n\n\n\n\n\n\n\n\n\n\n\n56 \n\n\n\n\n\n\n\nMPSPSC2017000058 (Poster) \n\n\n\nMEASUREMENT OF EFFECT OF SPIRONOLACTONE ON PATIENTS WITH RHEUMATOID \n\n\n\nARTHRITIS \n\n\n\n\n\n\n\n Prajapati SK1, Ali AN1, Iqbal MZ1 \n1AIMST University, Bedong, Kedah, Malaysia \n\n\n\n\n\n\n\nINTRODUCTION: The aim of the study is to investigate whether addition of spironolactone (add-on therapy) \n\n\n\nwould provide additional clinical and functional benefits to patients who have active Rheumatoid Arthritis (RA) \n\n\n\nand have an incomplete response.  \n\n\n\nOBJECTIVE: To measure the effect of spironolactone on na\u00efve RA patients via Health Assessment \n\n\n\nQuestionnaire\u2013Disability index (HAQ-DI).  \n\n\n\nMETHOD: A prospective, open label study under defined inclusion criteria. 32 patients continued their previous \n\n\n\nDMARD(s) regimen as such and Spironolactone 2mg/kg OD was added. 28 patient was completed the study and \n\n\n\nassessed at baseline & 12th week visit. The patient, physician assessment and pain score were calculated using \n\n\n\nWilcoxon rank sum test by software SPSS-20.  \n\n\n\nRESULTS: All three scales of assessment found significant results after 12 weeks of add-on therapy. There was \n\n\n\nan improvement in Patient assessment of general health on VAS scale from 6.8 \u00b1 0.24 to 3.76 \u00b1 0.34 (p<0.01 vs \n\n\n\nbaseline). An improvement of health score or decrease in disease activity from 7.03 \u00b1 0.22 to 4.11 \u00b1 2.61 in 0-12 \n\n\n\nweeks (p< 0.01 vs baseline) was exhibited on the Physician assessment score of general health on VAS. Pain \n\n\n\nintensity assessment improved from 7.0 \u00b1 0.29 to 2.88 \u00b1 0.37 (p<0.01 vs baseline). There were decreases in pain \n\n\n\nin majority joint count for many of patients.  \n\n\n\nCONCLUSION: The add-on therapy of spironolactone improved the physical function and health related quality \n\n\n\nof life in patient with RA, who had an incomplete response since long time.  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nMPSPSC2017000059 (Poster) \n\n\n\nUNCOMPLICATED MALARIA DIAGNOSTIC AND TREATMENT PRACTICES IN PRIMARY \n\n\n\nHEALTH CARE FACILITIES OF PLATEAU STATE, NIGERIA: A RETROSPECTIVE STUDY \n\n\n\n\n\n\n\nIsmail NE1, Jimam NS1,2, Dapar MP2  \n1Department of Clinical Pharmacy, Faculty of Pharmacy, MAHSA University, Selangor, Malaysia;  \n2Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmaceutical Sciences, University of Jos, \n\n\n\nPlateau State, Nigeria \n\n\n\n\n\n\n\nINTRODUCTION: Malaria is one of major public health problems, especially in the sub-saharan Africa, and \n\n\n\nremains as one of the leading causes of morbidity and mortality worldwide, with pregnant women and children \n\n\n\nbeing more vulnerable. Inappropriate health workers' diagnostic and treatment practices have been reported to be \n\n\n\none of the factors responsible for the high prevalence of the disease. \n\n\n\nOBJECTIVES: The study evaluated health workers' adherence to malaria diagnostic and treatment guideline \n\n\n\nacross selected Primary Health Care (PHC) facilities in Plateau state, Nigeria. \n\n\n\nMETHODS: The study involved retrospective extraction of diagnostic and treatment information of 1200 patients \n\n\n\ntreated for uncomplicated malaria in PHC facilities using Patients' Medication Review Form (PMRF). Statistical \n\n\n\nanalysis was conducted using Statistical Package for Social Sciences (SPSS) version 23. \n\n\n\nRESULTS: Malaria cases accounted for 63.1%, followed by 'malaria and typhoid' (19.2%). More females \n\n\n\n(59.7%) patronized the facilities for malaria treatment compared to their male counterparts (40.3%). Most of the \n\n\n\ndiagnoses (81.9%) were done via rapid diagnostic test (RDT) approach (42.0%) and microscopy (39.9%), with \n\n\n\nsymptomatic method (18.1%) been the least. The use of artemisinin-based combination therapy (ACT) was high \n\n\n\n(45.3%), followed by artemether (14.8%) and quinine (14.2%) across the facilities and age groups. Only 45.3% \n\n\n\nof the health workers prescribed antimalarial drugs in accordance to guideline. \n\n\n\nCONCLUSION: The health workers adhered to guideline in diagnostic practices, but not in their prescribing \n\n\n\npractices of antimalarial medications. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n57 \n\n\n\n\n\n\n\nMPSPSC2017000061 (Poster) \n\n\n\nVASORELAXATION EFFECT OF GLYCYRRHIZAE URALENSIS THROUGH THE ENDOTHELIUM \n\n\n\nDEPENDENT PATHWAY \n\n\n\n\n\n\n\nTan CS1, Ch\u2019ng YS1, Loh YC1, Asmawi MZ1, Ahmad 1, Yam MF1 \n\n\n\n1School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 USM, Penang, Malaysia. \n\n\n\n\n\n\n\nINTRODUCTION: Glycyrrhiza uralensis (G. uralensis) is one of the herbs used in traditional Chinese medicine \n\n\n\nand plays a major role as an anti-hypertensive agent. \n\n\n\nOBJECTIVES: This study is designed to investigate the vasorelaxation effect of G. uralensis from various \n\n\n\nextracts and to study its pharmacological effect. \n\n\n\nMETHODS: The vasorelaxation effect of G. uralensis extracts were evaluated on thoracic aortic rings isolated \n\n\n\nfrom Sprague Dawley rats. Three extracts of G. uralensis were tested: 95% ethanolic extract (ENG), 50% \n\n\n\nethanolic extract (EFG) and water extract (WG). \n\n\n\nRESULTS: EFG showed the strongest vasorelaxation activity. EFG caused the relaxation of the aortic rings pre-\n\n\n\ncontracted with phenylephrine either in the presence or absence of endothelium and pre-contracted with potassium \n\n\n\nchloride in endothelium-intact aortic ring. N\u03c9-nitro-L-arginine methyl ester, methylene blue, or 1H-\n\n\n\n[1,2,4]Oxadiazolo[4,3-a]quinoxalin-1-one inhibit the vasorelaxation effect of EFG in the presence of \n\n\n\nendothelium. On the other hand, in the presence of the potassium channel blockers (tetraethylammonium and \n\n\n\nbarium chloride), the vasorelaxation effect of EFG was not affected, but glibenclamide and 4-aminopyridine did \n\n\n\ninhibit the vasorelaxation effect of EFG. With indomethacin, atropine and propranolol, the vasorelaxation effect \n\n\n\nby EFG was significantly reduced. EFG was also found to be effective in reducing Ca2+ release from sarcoplasmic \n\n\n\nreticulum and the blocking of calcium channels. \n\n\n\nCONCLUSION: The results obtained suggest that EFG is involved in the NO/sGC/cGMP pathway. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nMPSPSC2017000063 (Poster) \n\n\n\nVASORELAXANT PROPERTIES OF VERNONIA AMYGDALINA ETHANOL EXTRACT AND ITS \n\n\n\nPOSSIBLE MECHANISM OF ACTION \n\n\n\n\n\n\n\nCh\u2019ng YS1, Loh YC1, Ng CH1, Tan CS1, Ahmad M1, Asmawi MZ1, Yam MF1 \n\n\n\n1School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 USM, Penang, Malaysia. \n\n\n\n\n\n\n\nINTRODUCTION: Vernonia amygdalina Del. (VA) (Asteraceae) is commonly used to treat hypertension in \n\n\n\nMalaysia. \n\n\n\nOBJECTIVES: This study aims to investigate the vasorelaxant mechanism of VA ethanol extract (VAE) and \n\n\n\nanalyzes its tri-step FTIR spectroscopy fingerprint. \n\n\n\nMETHODS: Dried VA leaves were extracted with ethanol through maceration and concentrated using rotary \n\n\n\nevaporator before freeze-dried. The vasorelaxant activity and the underlying mechanisms of VAE using the \n\n\n\ncumulative concentration (0.01\u20132.55 mg/mL at 20-min intervals) were evaluated on aortic rings isolated from \n\n\n\nSprague Dawley rats in the presence of antagonists. \n\n\n\nRESULTS: The tri-step FTIR spectroscopy showed that VAE contains alkaloids, flavonoids, and saponins. VAE \n\n\n\ncaused the relaxation of pre-contracted aortic rings in the presence and absence of endothelium with EC50 of \n\n\n\n0.057 \u00b1 0.006 and 0.430 \u00b1 0.196 mg/mL, respectively. In the presence of Nx-nitro-L-arginine methylester (EC50 \n\n\n\n0.971 \u00b1 0.459 mg/mL), methylene blue (EC50 1.203 \u00b1 0.426 mg/mL), indomethacin (EC50 2.128 \u00b1 1.218 \n\n\n\nmg/mL), atropine (EC50 0.470 \u00b1 0.325 mg/mL), and propranolol (EC50 0.314 \u00b1 0.032 mg/mL), relaxation \n\n\n\nstimulated by VAE was significantly reduced. VAE acted on potassium channels, with its vasorelaxation effects \n\n\n\nsignificantly reduced by tetraethylammonium, 4-aminopyridine, barium chloride, and glibenclamide (EC50 0.548 \n\n\n\n\u00b1 0.184, 0.158 \u00b1 0.012, 0.847 \u00b1 0.342, and 0.304 \u00b1 0.075 mg/mL, respectively). VAE was also found to be active \n\n\n\nin reducing Ca2\u00fe released from the sarcoplasmic reticulum and blocking calcium channels. \n\n\n\nCONCLUSION: The vasorelaxation effect of VAE involves upregulation of NO/cGMP and PGI2 signalling \n\n\n\npathways, and modulation of calcium/potassium channels, and muscarinic and b2-adrenergic receptor levels. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n58 \n\n\n\n\n\n\n\nMPSPSC2017000064 (Poster) \n\n\n\nOVERVIEW OF SIGNALING MECHANISM PATHWAYS EMPLOYED BY BPAID IN \n\n\n\nVASODILATORY ACTIVITY \n\n\n\n\n\n\n\nNg CH 1, Loh YC 1, Tan CS1,Ch\u2019ng YS1, Ahmad M1, Yam  MF1.  \n1School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 USM, Penang, Malaysia. \n\n\n\n\n\n\n\nINTRODUCTION: Hypertension, one of the famous \u201csilent killers\u201d that can attack people at any age, is a current \n\n\n\nhot topic among scientists due to multiple syndromic behaviour and concomitant diseases. The new scientific-\n\n\n\nbased TCM formulation approach was used in a previous study by combining five TCM herbs including Gastrodia \n\n\n\nelata Bl., Uncariarhynchophylla (Miq.) Miq. ex Havil., Pueraria thomsonii Benth., Panax notoginseng (Burk.) \n\n\n\nF. H. Chen, and Alisma orientalis (Sam.) Juzep in optimized ratio (named BPAid). \n\n\n\nOBJECTIVE: The objective of present study was to evaluate the mechanism pathways employed by BPAid for \n\n\n\nvasodilatory effect with the use of an in vitro isolated aortic rings assay. \n\n\n\nMETHODS: The fingerprints and chemical properties of BPAid was identified by using tri-step FTIR \n\n\n\nspectroscopy and compared with its derivatives. \n\n\n\nRESULTS: All the mechanisms investigated were involved in the BPAid\u2019s vasodilation activity in which the \n\n\n\nmajority contributed via the NO/sGC/cGMP pathways, followed by PGI2, \u03b22-adrenergic, and M3-receptors \n\n\n\npathways. Furthermore, the BPAid appeared to manage vascular tone by regulating action potential via potassium \n\n\n\nand both VOCC and IP3R pathways.  \n\n\n\nCONCLUSION: The results obtained has confirmed the expected outcome that the benefits of TCM herbs in \n\n\n\nBPAid can meet the criteria of counteracting multiple signalling mechanism pathways involved in the aetiology \n\n\n\nof hypertension.  It is also suggested that the majority of the vasodilatory effects exerted by BPAid were attributed \n\n\n\nto the presence of saponins and aromatic ring-containing vasoactive compounds.  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nMPSPSC2017000068 (Poster) \n\n\n\nVASORELAXANT ACTIVITIES AND UNDERLYING PHARMACOLOGICAL MECHANISMS OF \n\n\n\nGYNURA PROCUMBENS MERR. LEAF EXTRACTS IN ISOLATED RAT THORACIC AORTA \n  \n\n\n\nZ Iqbal1, MF Yam1, MZ Asmawi1 \n\n\n\n1School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 USM, Penang, Malaysia. \n\n\n\n\n\n\n\nINTRODUCTION: Previous studies have investigated the cardiovascular activity of Gynura Procumbens single-\n\n\n\nsolvent extracts.  \n\n\n\nOBJECTIVE: The objective of this study was to evaluate the in vitro vasorelaxant properties and the underlying \n\n\n\npharmacological mechanisms of serial extracts and fractions of Gynura procumbens Merr (GP).  \n\n\n\nMETHODS: The leaves of GP were serially extracted with petroleum ether, chloroform, methanol and water \n\n\n\nusing maceration method. Suspended aorta preparations were pre-contracted with phenylephrine (PE 1 \u00b5M) or \n\n\n\npotassium chloride (K+ 80 mM) followed by cumulative addition of GP extracts (0.25 - 3 mg/ml).  \n\n\n\nRESULTS: The petroleum ether extract (GPPE) was the most potent among the four extracts. Pre-incubation of \n\n\n\nendothelium-intact aorta with atropine (1 \u00b5M), indomethacin (10 \u00b5M), methylene blue (10 \u00b5M) and prazosin \n\n\n\n(1\u00b5M) have no effect on GPPE induced vasorelaxation. The vasorelaxant effect of GPPE was also not completely \n\n\n\nblocked in endothelium denuded aorta. In contrast, pre-treatment of aorta rings preparations with L-NAME (10 \n\n\n\n\u00b5M), glibenclamide (10 \u00b5M), and propranolol (1\u00b5M) attenuate the vasorelaxation effect of GPPE. The calcium-\n\n\n\ninduced vasocontractions were antagonized significantly with GPPE in calcium free and high potassium medium.  \n\n\n\nCONCLUSION: These results illustrate that Ca2+ antagonizing actions of GPPE in rat isolated aorta are \n\n\n\ncomparable to that of verapamil and may be mainly responsible for vasodilation. The GC-MS, and antioxidant \n\n\n\nstudies also support our results. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n59 \n\n\n\n\n\n\n\nMPSPSC2017000071 (Poster) \n\n\n\nQUALITY OF 'EDUCATIONAL INTERVENTION TOOL' IN PREVENTION OF HUMAN \n\n\n\nPAPILLOMA VIRUS INFECTION AMONG PARENTS \n\n\n\n\n\n\n\nAli AN1,3,  Pathmapiriyaa M1, Ng YP1, Prajapati Sunil K1, Ahmed NZ2, Sarriff A3 \n1Faculty of Pharmacy, AIMST University, Semeling, Bedong, Kedah Darul Aman, Malaysia. \n2Pfizer, Hospira Health Care india Pvt Ltd, Plot No. 117, Jawaharlal Nehru Pharma City, (SEZ), Parawada \n\n\n\nMandal, Visakhapatnam, Andhra Pradesh 531019,  \n\n\n\nIndia. \n3School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 USM, Penang, Malaysia. \n\n\n\n\n\n\n\nINTRODUCTION: Human papillomavirus (HPV) is one of the most common sexually transmitted infections. \n\n\n\nSexually active adolescents and young adults are at high risk for HPV infection. The knowledge of parents \n\n\n\nregarding HPV is vital who are decision makers for their age eligible children for HPV vaccination.  \n\n\n\nOBJECTIVES: This study aimed to develop informative educational pamphlet and evaluate its effectiveness \n\n\n\namong parents.  \n\n\n\nMETHODS: A prospective longitudinal study using pre-validated questionnaire with convenience sampling \n\n\n\nmethod. Percentage, frequency, median and IQR used for descriptive statistics McNemar\u2019s test and Wilcoxon \n\n\n\nsigned rank test for inferential statistics using SPSS version 23. \n\n\n\nRESULTS: The research findings showed a significant increase in knowledge gain (N = 858) with a median \n\n\n\nknowledge score (maximum 10) for pre-test (Mdn = 3 and IQR= 9, p < 0.001) and post intervention test were \n\n\n\n(Mdn = 10 and IQR=2, p < 0.001) respectively, with a significant improvement of 7 points (Z = 18.8; p < .001). \n\n\n\nThis reveals a very poor knowledge and benchmark information was present among the participants before \n\n\n\nintervention. At the three to six months post intervention follow-up (N = 858), a statistically significant increase \n\n\n\nin correct responses was observed (Mdn = 10, IQR= 1, p < .001) with a significant improvement in knowledge \n\n\n\nscore (Z=18.8; p <.001) from base line score.  \n\n\n\nCONCLUSION: The educational protocol significantly increased knowledge about HPV infection and HPV \n\n\n\nvaccination, regardless of socio-demographic characteristics and risk behaviours.  \n\n\n\n\n\n\n\n\n\n\n\nMPSPSC2017000073 (Poster) \n\n\n\nISOLATION AND PURIFICATION OF BIOACTIVE PROTEIN(S) WITH ANTI-BREAST CANCER \n\n\n\nPROPERTY FROM GYNURA PROCUMBENS (LOUR.) MERR. EXTRACT  \n \n\n\n\nYH Teh1, CS Hew1, Vikneswaran M1, LH Gam1 \n\n\n\n1School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 USM, Penang, Malaysia. \n\n\n\n\n\n\n\nINTRODUCTION: Gynura Pocumbens (Lour.) Merr, is a traditional medical plants that can be found in Asia \n\n\n\ncountries. It is used to treat kidney discomfort, rheumatism, diabetes mellitus, and hypertension. The previous \n\n\n\nstudies show that small molecular compounds from the leaves extract possess anti-hyperglycemic, anti-\n\n\n\nhyperlipidaemic, anti-cancer and anti-inflammatory activities.  In our recent study, we have shown the raw \n\n\n\nproteins extract of the plant leaves with anti-cancer properties. \n\n\n\nOBJECTIVES: This study is aimed to identify and isolate the bioactive protein(s) that exerts anti-cancer activity \n\n\n\nin the leaves of G. Procumbens. \n\n\n\nMETHODS: The proteins were extracted by using mild phosphate buffer. Then, proteins were purified by \n\n\n\nammonium sulphate precipitation and gel filtration. The gel-filtration fractions were taken to treat human breast \n\n\n\ncancer cell line MDA-MB-231. SDS-PAGE was used to analyse the active fraction. Protein bands were excised \n\n\n\nfor in-gel digestion and the tryptic-digested peptides were analysed using LCMS/MS. \n\n\n\nRESULTS: Cell morphologies showed that active fraction SN-F11/12 inhibits the growth of MDA-MB-231 cell \n\n\n\nline. There were 15 protein bands detected on the SDS-PAGE analysis of fraction SN-F11/12. Out of 15 protein \n\n\n\nbands of the fraction SN-F11/12, two protein bands were found no hit. \n\n\n\nCONCLUSION: fraction SN-F11/12 of G.Procumbens inhibits the growth of MDA-MB-231 cell line. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n60 \n\n\n\n\n\n\n\nMPSPSC2017000075 (Poster) \n\n\n\nPAEDIATRIC PHARMACIST: OUR JOURNEY AND MILESTONE \n\n\n\n\n\n\n\nOthman NH1, Sivasupramaniam S1, Khoo SN1, Ng BY1, Ng SY1, Chuo SH1, Toh CC1, Won ZY1, Wong PM1, \n\n\n\nSalleh NH1, Wong SW1, Sha\u2019ari S1, Chhabra IK1, Tang CJ1, Loo JH1, Cheng YX1 and Tan MW2 \n1Committee of Clinical Pharmacy (Paediatric Pharmacy), Malaysia  \n2Pharmaceutical Service Division, Ministry of Health Malaysia \n\n\n\n\n\n\n\nINTRODUCTION: Paediatric pharmacy service is formed to assist medical team in providing optimum \n\n\n\npharmacotherapy in paediatric population. in 2016, there were 252 paediatric wards available in MOH hospitals \n\n\n\nwith 55% of the paediatric wards have designated paediatric pharmacists (45% full time and 10% part time ward \n\n\n\npharmacists) \n\n\n\nOBJECTIVES This study is aimed to provide an overview of paediatric pharmacy service in MOH hospitals and \n\n\n\nto review the types of interventions and information provided by paediatric pharmacists. \n\n\n\nMETHODS: All types of intervention and information provided by paediatric ward pharmacists during office \n\n\n\nhour in MOH hospitals with paediatric pharmacy services from January 2016 to December 2016 were \n\n\n\nretrospectively collected.  \n\n\n\nRESULTS: A total of 47,878 clinical interventions were done by paediatric ward pharmacists. Among the 16 \n\n\n\ntypes of the clinical interventions done, the three most common interventions were regimen with inappropriate \n\n\n\ndose (25.25%), inappropriate drug (16.70%) and recommendation regarding therapeutic drug monitoring (TDM) \n\n\n\n(13.48%). It was followed by the intervention on the inappropriate frequency (9.30%), inappropriate duration \n\n\n\n(6.24%) and recommendations regarding total parenteral nutrition (TPN) (6.77%). Absence of the prescribers \n\n\n\nsignatures or stamps (44.4%, n=2768) and incomplete patient data (43.6%, n=2720) were the highest interventions \n\n\n\nmade for non-clinical interventions. Drug doses and method of drug administration were the highest drug \n\n\n\ninformation provided amongst all the categories (38.2%, n =10586).  \n\n\n\nCONCLUSION: Appearance of paediatric pharmacy service in paediatric ward did assist medical team in \n\n\n\noptimizing patient pharmacotherapy and delivering drug information which is specialized in paediatric population. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nMPSPSC2017000076 (Poster) \n\n\n\nA PRELIMINARY STUDY: CONSUMER SATISFACTION TOWARDS ACCESSIBILITY AND \n\n\n\nPHARMACEUTICAL CARE IN MALAYSIA COMMUNITY PHARMACIES \n\n\n\n\n\n\n\nChe Yaacob NL1, Hassan Y2, Karuppannan M2 \n1Faculty of Pharmacy, Mahsa University, Selangor, Malaysia \n2Faculty of Pharmacy, University Technology Mara, Puncak Alam, Selangor, Malaysia \n\n\n\n\n\n\n\nINTRODUCTION: Pharmacists are one of the most accessible health care professionals in terms of location and \n\n\n\nplay an increasing role in maintaining patient health as well as driving quality. Pharmaceutical care is an extended \n\n\n\nrole of pharmacist to ensure better quality services in healthcare delivery. Efforts should not only be made to track \n\n\n\nconsumer satisfaction with pharmacy services but also to improve it where needed.   \n\n\n\nOBJECTIVES: To investigate consumer satisfaction towards accessibility and pharmaceutical care in Malaysia \n\n\n\ncommunity pharmacies. \n\n\n\nMETHODS: A cross-sectional survey of 400 pharmacy consumers at 4 randomly selected community \n\n\n\npharmacies was conducted. Data were gathered on consumer demographics and their satisfaction with the \n\n\n\ncommunity pharmacies using a 32-item rated instrument items. Descriptive statistics was computed on sample \n\n\n\ncharacteristics and the questionnaire items. Inferential statistics used Student\u2019s t test and one-way ANOVA. \n\n\n\nRESULTS: The response rate for the survey was 79.3% (317/400). The study found that 61% of the respondents \n\n\n\nhave excellent level of satisfaction towards access to community pharmacy, 37% was satisfied at good level and \n\n\n\n2% poor. Meanwhile, 54.7% of the respondents was satisfied at excellent level to performance of pharmaceutical \n\n\n\ncare, 44.7% was at the good level and 0.7% was at the poor level. This study also found that marital status, job \n\n\n\nstatus and income have significant influence on satisfaction level. \n\n\n\nCONCLUSION: Malaysian consumers have high satisfaction towards accessibility and pharmaceutical care in \n\n\n\nMalaysia community pharmacies. Thus, there is an opportunity for the community pharmacies to enhance their \n\n\n\nconsumer loyalty by improving the services.  \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n61 \n\n\n\n\n\n\n\nMPSPSC2017000077 (Poster) \n\n\n\nKNOWLEDGE AND ATTITUDE TOWARDS ANTIBIOTIC USE AMONG PUBLIC IN ALOR SETAR, \n\n\n\nKEDAH \n  \n\n\n\nChe Yaacob NL1, En LY1 \n 1Faculty of Pharmacy, Mahsa University, Selangor, Malaysia \n\n\n\n\n\n\n\nINTRODUCTION: Antibiotic resistance has been a serious concern worldwide. Decreasing in the development \n\n\n\nof new antibiotic to counter with the menace of antibiotic resistance causes less antibiotic effective for the \n\n\n\ntreatment. Increasing knowledge and positive attitude towards antibiotic use will be helpful to prevent antibiotic \n\n\n\nresistant.  \n\n\n\nOBJECTIVES: The study aims to evaluate the level of knowledge and attitude towards antibiotic use as well as \n\n\n\nthe usage of antibiotic among public.  \n\n\n\nMETHODS: This cross-sectional study was carried out in Alor Setar, Kedah. The data were extracted for \n\n\n\ndescriptive analysis. Chi-Square test was used to assess association between variables.  \n\n\n\nRESULTS: 57.8% of the respondents had a good knowledge of antibiotic, 40.1% had a moderate level and 2.1% \n\n\n\nhad poor knowledge of antibiotic. However 84.4% of respondents had positive attitude towards antibiotics and \n\n\n\n15.6% of respondents had a negative attitude towards antibiotics. There was a statistically significant difference \n\n\n\nin knowledge level across gender (p<0.011), age group (p<0.000), race (p<0.000), education background \n\n\n\n(p<0.000), household income per month (p<0.000) and occupation related to healthcare (p<0.000). Level of \n\n\n\nattitude found to be statistically significant difference between age group (p<0.000), race (p<0.000), education \n\n\n\nbackground (p<0.000), household income per month (p<0.013), occupation related to healthcare (p<0.002) and \n\n\n\nfamily member\u2019s occupation related to healthcare (p<0.186). \n\n\n\nCONCLUSION: The knowledge and attitude of using antibiotic in Alor Setar still considering not in satisfying \n\n\n\nlevel. Thus, future antibiotic awareness should be carried out to improve knowledge among public. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nMPSPSC2017000079 (Poster) \n\n\n\nDEVELOPMENT, TRANSLATION AND VALIDATION OF ADULTS KAP SURVEY \n\n\n\nQUESTIONNAIRE REGARDING PREVENTION OF HUMAN PAPILLOMA VIRUS INFECTION \n\n\n\nAND HPV VACCINATION \n\n\n\n\n\n\n\nAli AN1, 3, Pathmapriya M1, Ng YP1, Prajapati Sunil K1, Ahmed NZ2, Sarriff A3 \n1Faculty of Pharmacy, AIMST University, Semeling, Bedong, Kedah Darul Aman, Malaysia. \n2Pfizer, Hospira Health Care India Pvt Ltd, Plot No#117, Jawaharlal Nehru Pharma City, Visakhapatnam, Andhra \n\n\n\nPradesh 531019, India. \n3School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 USM, Penang, Malaysia. \n\n\n\n\n\n\n\nINTRODUCTION: Knowledge, attitude and perception (KAP) play major roles in Knowledge-Attitude-\n\n\n\nBehaviour (KAB) model, which proposes knowledge initiates changes in attitude that results in behaviour change.  \n\n\n\nOBJECTIVES: The aim was to develop and determine validity and reliability of the KAP - HPV questionnaire \n\n\n\n(KAP-HPV) among young adults aged 18-25 years.  \n\n\n\nMETHODS: A prospective, cohort study is performed using convenience sampling. The questions were adapted \n\n\n\nand slightly modified. Content and face validated, text readability consensus done to assess difficulty level, \n\n\n\nForward-backward translated to local Bahasa Malaysia by linguistic lecturers and KAP scores among Known-\n\n\n\nGroup\u2019s, test-retest using Spearman\u2019s rho correlation and Mann-Whitney test to identify score differences and \n\n\n\nCronbach\u2019s-alpha test for internal consistency.  \n\n\n\nRESULTS: The readability consensus used Flesch Reading Ease score (50.4) and Flesch-Kincaid grade level \n\n\n\n(9.7). Known-Group\u2019s validity using Mann-Whitney U test at pre- and post-test, (U (24) = 15.5, p <.001) and (U \n\n\n\n(24) = 12, p <.001). Cohen kappa statistic (\u03ba = .69, 95% CI, p < .001) measured the agreement between \n\n\n\ntranslations. For test reliability, Mann-Whitney test indicated knowledge score higher for post-test, (U (24) = 6, p \n\n\n\n< .001) than pre-test, (U (24) = 2, p < .001). The Cronbach\u2019s alpha test for internal consistency was (.862, p < \n\n\n\n.001, Mdn = 51 IQR = 7).  \n\n\n\nCONCLUSION: The people, who are convinced when they obtain specific knowledge, will change their attitude \n\n\n\nand start practicing behaviour change. Repeated measure of KAP using the same instrument significantly \n\n\n\nincreases KAP score.  \n\n\n\n\n\n\n\n\n\n\n\n\n62 \n\n\n\n\n\n\n\nMPSPSC2017000081 (Poster) \n\n\n\nAN ASSESSMENT OF KNOWLEDGE OF SMOKING CESSATION AMONG FINAL YEAR \n\n\n\nPHARMACY STUDENTS IN MALAYSIA \n\n\n\n\n\n\n\nRaman W1, 2, Aziz NA2, Ahmad S2 \n1Department of Pharmacy Practice, Faculty of Pharmacy, University Teknologi MARA (UiTM), Puncak Alam \n\n\n\nCampus, Selangor, Malaysia; \n2Department of Clinical Pharmacy, Faculty of Pharmacy, MAHSA University, Saujana Putra Campus, Selangor, \n\n\n\nMalaysia; \n\n\n\n\n\n\n\nINTRODUCTION: Pharmacists can play a fundamental role in assisting smokers to quit. Preparing the pharmacy \n\n\n\nstudents with comprehensive training is crucial to ensure the delivery of effective smoking cessation services. \n\n\n\nOBJECTIVES: The primary objectives of this study were to determine the current knowledge of smoking \n\n\n\ncessation and uncover the clinical 'gaps' in pharmacy-based smoking cessation practice among final year \n\n\n\npharmacy students. \n\n\n\nMETHODS: in this cross-sectional study, a total of 302 final year undergraduate pharmacy students were \n\n\n\nrecruited using two stage cluster sampling technique. Post signed consent, a self-administered and validated \n\n\n\nSmoking Cessation in Pharmacy (SCIP) questionnaire was distributed among the final year pharmacy students \n\n\n\nfrom six Malaysian universities. Data from the completed questionnaires were extracted and analysed.  \n\n\n\nRESULTS: Responses of 173 (57.3%) and 129 (42.7%) students were recorded from public and private sector \n\n\n\nuniversities, respectively. The majority of the respondents (n=256, 84.8%) possessed moderate level of knowledge \n\n\n\nregarding general aspects of smoking cessation. On the contrary, only two students (0.7%) possessed good level \n\n\n\nof knowledge; whereas, the majority of the students (98%) either showed moderate or poor level of knowledge \n\n\n\nregarding questions specific to pharmacologic or pharmacotherapeutic aspects of smoking cessation.  \n\n\n\nCONCLUSION: The study findings provide a valid indication of 'gaps' in clinical knowledge of respondents \n\n\n\nregarding evidence-based smoking cessation intervention. Thus, a curriculum related to pharmacologic and \n\n\n\npharmacotherapeutic aspects should be incorporated in the undergraduate pharmacy curricula. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nMPSPSC2017000082 (Poster) \n\n\n\nADJUNCT MEDICATIONS IN UNCOMPLICATED MALARIA MANAGEMENT AND THEIR \n\n\n\nDIRECT COST IMPLICATIONS ON PATIENTS: A CASE STUDY OF PRIMARY HEALTH CARE \n\n\n\nFACILITIES IN PLATEAU STATE, NIGERIA \n\n\n\n\n\n\n\nJimam NS1, 2, Ismail NE1, Dapar MLP2 \n1Department of Clinical Pharmacy, Faculty of Pharmacy, MAHSA University, Selangor, Malaysia; \n2Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmaceutical Sciences, University of Jos, \n\n\n\nPlateau state, Nigeria \n\n\n\n\n\n\n\nINTRODUCTION: Rampant use of adjunct medications in Primary Health Care (PHC) facilities have been \n\n\n\ndocumented, and this is attributable to inappropriate treatment of diseases in country.  \n\n\n\nOBJECTIVES: The study examines the prescribing trend and its direct cost for the treatment of uncomplicated \n\n\n\nmalaria treatment in PHC facilities at Plateau state, Nigeria.  \n\n\n\nMETHODS: The study involved retrospective extraction of all non-antimalarial drugs that were used in treating \n\n\n\n1200 patients for uncomplicated malaria in PHC facilities using patients' medication review forms (PMRF). \n\n\n\nStatistical analysis was conducted using IBM Statistical Package for Social Sciences (SPSSR) version 23. \n\n\n\nRESULTS: Analgesics were mostly prescribed (86.1%) followed by antibiotics (79.8%), and haematinics \n\n\n\n(65.7%), and the prescribing patterns cut across age groups. Details of the various classes of the adjunct \n\n\n\nmedications showed oral paracetamol been the most prescribed analgesic (69.2%), while 55.1% of the prescribed \n\n\n\nhaematinics were oral vitamin B-complex. Amoxicillin was the most patronized antibiotics (24.2%) by the \n\n\n\nprescribers. The average number of drugs per prescription was 4.67. The mean direct cost of adjunct medications \n\n\n\n(450.49 naira (Nigeria currency) / 1.27 USD / RM 5.40) per malaria case was higher than the mean direct cost of \n\n\n\nantimalarial drug (307.88 naira (Nigeria currency) / 0.87 USD / RM 3.69) per case.  \n\n\n\nCONCLUSION: The result showed that most of the adjunct drugs prescribed to patients for uncomplicated \n\n\n\nmalaria treatment across the PHC facilities were not necessary, and incurred more cost to the patients.  \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n63 \n\n\n\n\n\n\n\nMPSPSC2017000086 (Poster) \n\n\n\nSELF-NANOEMULSIFYING DRUG DELIVERY SYSTEMS OF DUTASTERIDE: DEVELOPMENT \n\n\n\nAND IN-VITRO CHARACTERIZATION  \n \n\n\n\nR Siddalingam1, Ng SH1, S Poonguzhali1 \n1School of Pharmacy, Taylor\u2019s University Lakeside Campus, Subang Jaya, Selangor, Malaysia. \n\n\n\n\n\n\n\nOBJECTIVES: The present study aims to prepare and evaluate the self-nanoemulsifying drug delivery \n\n\n\n(SNEDDS) system to enhance dissolution rate of a poorly soluble drug dutasteride.  \n\n\n\nMETHODS: The formulation was prepared using capryol 90, Transcutol HP and Cremophor EL as  oil, co-\n\n\n\nsurfactant and surfactant, respectively. The pseudo-ternary phase diagrams with presence and absence of drug \n\n\n\nwere plotted to find out the nanoemulsification range and also to evaluate the effect of dutasteride on the \n\n\n\nemulsification behaviour of the phases. Prepared SNEDDS formulations were evaluated for its particle size \n\n\n\ndistribution, Zeta potential, nanoemulsifying properties, robustness to dilution, self-emulsification time, turbidity \n\n\n\nmeasurement, drug content and in-vitro dissolution. The optimized formulations are further evaluated for heating \n\n\n\ncooling cycle, centrifugation studies, freeze thaw cycling, particle size distribution and zeta potential were carried \n\n\n\nout to confirm the stability of the formed SNEDDS formulations.  \n\n\n\nRESULTS: The particle size, zeta potential and polydispersity index of the optimized formulation found to be \n\n\n\n90.21\u00b15.67 nm, -5.15\u00b1 1.28 and 0.29 \u00b1 0.021, respectively. All the formulations show 60-88% drug release at \n\n\n\n15th minute in in-vitro dissolution study. The in vitro results are revealed that the prepared formulation enhanced \n\n\n\nthe dissolution rate of dutasteride significantly as compared with pure drug.   \n\n\n\nCONCLUSION: Based the results, it was concluded that the dutasteride-loaded SNEDDS shows potential to \n\n\n\nenhance the dissolution of dutasteride, thus improving the bioavailability and therapeutic effects. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nMPSPSC2017000087 (Poster) \n\n\n\nIMPACT OF PLATINUM BASED THERAPY AND NON-PLATINUM BASED THERAPY ON \n\n\n\nSURVIVAL IN MALAYSIAN PATIENTS WITH ADVANCED NON-SMALL CELL LUNG CANCER \n\n\n\n\n\n\n\nBangash NSA1,2, Hashim N3, Ismail NE2 \n1Clinical BioPharmaceutics Research Group (CBRG), Faculty of Pharmacy, Universiti Teknologi MARA, Puncak \n\n\n\nAlam Campus, Selangor, Malaysia. \n2Department of Clinical Pharmacy, Faculty of Pharmacy, MAHSA University, Selangor, Malaysia. \n3Department of Oncology and Radiotherapy, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia. \n\n\n\n\n\n\n\nINTRODUCTION: The management of non-small cell lung cancer (NSCLC) is becoming difficult with the \n\n\n\npassage of time due to its increased prevalence and progressive nature of the disease. Determining survival \n\n\n\nprognosis and defining the appropriate therapy in patients with lung cancer is challenging, as the majority of \n\n\n\npatients are diagnosed at a later cancer stage. \n\n\n\nOBJECTIVE: This study aimed to investigate the effect of platinum based therapy (PBT) and non-platinum \n\n\n\nbased (NPB) therapy on survival in advanced NSCLC. \n\n\n\nMETHODS: This study was a retrospective cohort of 163 adult patients diagnosed with locally advanced or \n\n\n\nmetastatic NSCLC at Hospital Kuala Lumpur, Malaysia. Survival was estimated using Kaplan-Meier test. Log-\n\n\n\nrank test was used to evaluate differences in survival curves and Cox proportional hazard model to calculate \n\n\n\nhazard ratio. \n\n\n\nRESULTS: Majority of the patients received PBT (n = 134; 82.2%) as compared to NPB therapy (n = 29; 17.7%). \n\n\n\nThe median survival time for PBT was 377 days. The survival curves of PBT and NPB therapy were significantly \n\n\n\ndifferent (\u03c72 = 5.355, p = 0.021). The hazard ratio of PBT was 2.080 (95% C.I (1.110 - 3.898) p = 0.022) times \n\n\n\nhigher than NPB therapy. \n\n\n\nCONCLUSION: Survival is significantly better with NPB therapies among advanced NSCLC patients. \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n64 \n\n\n\n\n\n\n\nMPSPSC2017000088 (Poster) \n\n\n\nDOES EGFR MUTATION INFLUENCE SURVIVAL OUTCOMES FOLLOWING FIRST-LINE \n\n\n\nGEFITINIB THERAPY IN MALAYSIAN PATIENTS WITH ADVANCED NON-SMALL CELL LUNG \n\n\n\nCANCER? \n\n\n\n\n\n\n\n Bangash NSA1,2, Hashim N3, Ismail NE2 \n1Clinical BioPharmaceutics Research Group (CBRG), Faculty of Pharmacy, Universiti Teknologi MARA, Puncak \n\n\n\nAlam Campus, Selangor, Malaysia; \n2Department of Clinical Pharmacy, Faculty of Pharmacy, MAHSA University, Selangor, Malaysia; \n3Department of Oncology and Radiotherapy, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia; \n\n\n\n\n\n\n\nINTRODUCTION: Advanced non-small cell lung cancer (NSCLC) patients with active mutations in epidermal \n\n\n\ngrowth factor receptor (EGFR) gene have been shown to confer sensitivity to EGFR tyrosine kinase inhibitor \n\n\n\n(TKI) gefitinib. However, wide interpatient variability in treatment outcomes in these patients remains \n\n\n\nunaccounted for response to EGFR TKIs. \n\n\n\nOBJECTIVES: This study aimed to evaluate the influence of EGFR mutation on survival outcomes among \n\n\n\nMalaysian patients with advanced NSCLC receiving first-line gefitinib therapy in the Department of Oncology \n\n\n\nand Radiotherapy, Hospital Kuala Lumpur, Malaysia.  \n\n\n\nMETHODS: Locally advanced or metastatic (stage III or IV) NSCLC adult patients (\u2265 18 years old) harbouring \n\n\n\nEGFR mutations, receiving first-line gefitinib treatment (N = 93) were evaluated in this retrospective study. \n\n\n\nOverall survival (OS) was estimated using Kaplan-Meier analysis. Log-rank test and Cox proportional hazard \n\n\n\nmodel was implemented to evaluate the differences in OS. \n\n\n\nRESULTS: The OS for 19 adult first- line gefitinib treated NSCLC patients was 802.498 days (95% C.I, 621.679 \n\n\n\n- 983.316 days). The median survival time for patients with positive EGFR status was 834.863 days (95% C.I, \n\n\n\n656.494 - 1013.232) whereas 246 days (95% C.I 76.917 - 415.083) for patients with negative EGFR status. No \n\n\n\nsignificant difference in survival curves was observed among patients having positive EGFR gene mutation status \n\n\n\nand negative EGFR gene mutation status (overall p = 0.091).  \n\n\n\nCONCLUSION: EGFR mutation is an independent prognostic factor for adult Malaysian patients with advanced \n\n\n\nNSCLC receiving first-line gefitinib treatment. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nMPSPSC2017000089 (Poster) \n\n\n\nADHERENCE TO TOPICAL CORTICOSTEROID USE AMONG THE PUBLIC IN THE \n\n\n\nCOMMUNITY PHARMACY SETTING IN SEBERANG PERAI SELATAN, PENANG \n\n\n\n\n\n\n\nRaman W1, Zaidi MA1, Bangash NSA1 \n1Department of Clinical Pharmacy, Faculty of Pharmacy, MAHSA University, Saujana Putra Campus, Selangor, \n\n\n\nMalaysia \n\n\n\n\n\n\n\nINTRODUCTION: Topical Corticosteroids (TCS) have been a mainstay in the treatment of various skin ailments \n\n\n\nwith ample evidence that support their long-term efficacy and safety. Despite that, the adherence to TCS treatment \n\n\n\ntends to be suboptimal in dermatological patients. \n\n\n\nOBJECTIVES: This study aimed to assess the level of adherence of TCS use among public in community \n\n\n\npharmacy setting. \n\n\n\nMETHODS: This study is a cross-sectional community based survey conducted in Seberang Perai Selatan, \n\n\n\nPenang. The questionnaires were distributed to the walk in customers who purchased any TCS for themselves or \n\n\n\ntheir child. However, customers who purchased TCS for friends or relatives were excluded from this study. The \n\n\n\nMedication Adherence Rating Scale, (MARS) was used as the study instrument. \n\n\n\nRESULTS: A total of 317 completed surveys were collected between January to March 2017. Majority of the \n\n\n\nrespondents (n = 181, 57.1%) bought TCS for their children and another 42.9% (n = 136) bought it for themselves. \n\n\n\nMajority of the respondents were supplied TCS by pharmacist 61.2% (n = 194). The most prevalent indications \n\n\n\nof TCS use were to treat rash (22.1%), eczema (20.2%), dermatitis (18.0%) and psoriasis (17.7%). The MARS \n\n\n\nresponse, showed that 47.0% (n = 193) and 53.0% (n = 168) of respondents showed good and poor level of \n\n\n\nadherence respectively toward TCS usage. \n\n\n\nCONCLUSION: Adherence to TCS usage is poor. It indicates a need for re-education of pharmacists and patients \n\n\n\non the safety of TCS use and the potential impact of their counselling on treatment adherence. \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n65 \n\n\n\n\n\n\n\nMPSPSC2017000091 (Poster) \n\n\n\nINCIDENCE OF TREATMENT-RELATED SIDE EFFECTS IN NON-SMALL CELL LUNG CANCER \n\n\n\nPATIENTS RECEIVING PLATINUM THERAPY AT A PUBLIC TERTIARY CARE HOSPITAL  \n\n\n\n\n\n\n\nBangash NSA1,2, Hashim N3, Ismail NE2 \n1Clinical BioPharmaceutics Research Group (CBRG), Faculty of Pharmacy, Universiti Teknologi MARA, Puncak \n\n\n\nAlam Campus, Selangor, Malaysia. \n2Department of Clinical Pharmacy, Faculty of Pharmacy, MAHSA University, Selangor, Malaysia. \n3Department of Oncology and Radiotherapy, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia. \n\n\n\n\n\n\n\nINTRODUCTION: The occurrence of side effects in cancer patients undergo platinum therapy (PT) is found to \n\n\n\nbe grave concern. \n\n\n\nOBJECTIVES: The study determined the incidence of side effects experienced by non-small cell lung cancer \n\n\n\n(NSCLC) patients receiving PT. \n\n\n\nMETHODS: A retrospective observational study reviewed 163 adult NSCLC patients (\u226518 years old) at \n\n\n\nDepartment of Oncology and Radiotherapy, Hospital Kuala Lumpur, Malaysia. Descriptive analysis was \n\n\n\nperformed using IBM SPSS 21.0.  \n\n\n\nRESULTS: Amongst 163 patients, 68.7% were male and 31.3% were female. There were 134 patients (82.2%) \n\n\n\ntreated with PT and 29 (17.8%) with non-platinum therapy. Commonly used platinum agents (PAs) were cisplatin \n\n\n\n90 out of 134 patients (67.2%), carboplatin 44 out of 134 patients (32.8%). Side effects observed after PT were \n\n\n\ngastro-intestinal (G.I) related (nausea, vomiting, diarrhoea) (n = 129; 95.5%), shortness of breath (n = 13; 9.6%), \n\n\n\nfever (n = 7; 5.1%), headache (n = 13; 9.6%), neuropathy (n = 15; 11.1%) and constipation (n = 2; 1.4%). The \n\n\n\noccurrence of anaemia was found to be higher among patients who received cisplatin (n = 69; 82.1%) as compared \n\n\n\nto carboplatin (n = 36; 66.6%). The other common side effects were myelosuppression characterised by \n\n\n\nneutropenia (n = 14; 17.2%) and thrombocytopenia (n = 8; 9.8%) for cisplatin therapy whereas it occurred in 9 \n\n\n\n(21.4%) patients of each for carboplatin therapy. \n\n\n\nCONCLUSION: GI related side effects were highly reported due to PT. PAs-induced anaemia and \n\n\n\nmyelosuppression appeared to be notably high in this study.  \n\n\n\n\n\n\n\n\n\n\n\nMPSPSC2017000093 (Poster) \n\n\n\nHIGH PERFORMANCE LIQUID CHROMATOGRAPHY OF NEWLY SYNTHESIZED PRODRUGS \n\n\n\nOF ACECLOFENAC \n\n\n\n\n\n\n\nKool N1 \n\n\n\n1R.V.N.I College of Pharmacy, AKTU, Greater Noida, U.P, India \n\n\n\n\n\n\n\nINTRODUCTION: The research work is focussed on the synthesis and method development and validation of \n\n\n\nnewly synthesized prodrugs of aceclofenac. Previously various papers have been published for the synthetic \n\n\n\nprocedures followed for the study. The method development and validation of the two newly synthesized prodrugs \n\n\n\nby UV-spectroscopy have been reported. \n\n\n\nOBJECTIVES: The objective of the study focusses on the method development and validation of these prodrugs \n\n\n\nby HPLC technique. The analysis of these prodrugs is necessary as these prodrugs of aceclofenac, which an \n\n\n\nimportant NSAID used in rheumatoid arthritis, showed relatively less side effects as compared to the original \n\n\n\ndrug. The further analysis of these prodrugs will give us the purity of the drug and authenticate that the method \n\n\n\nfollowed was accurate and precise. \n\n\n\nMETHODS: The samples were sent to JawaharLal Nehru University, New-Delhi, India for the testing and the \n\n\n\nsolvents used were ethanol and DMSO. The C-18 reverse phase column was used for the method development \n\n\n\nand validation.  \n\n\n\nRESULTS: The results obtained after HPLC were accurate and precise. A single independent peak of each \n\n\n\nprodrug has been obtained by high intensity. The peak was sharp and clear.  \n\n\n\nCONCLUSIONS: The entire study suggests that the method followed for the analysis by HPLC was accurate, \n\n\n\nprecise and rapid. The clear peak obtained for both the prodrugs were of high intensity and was clear. With this \n\n\n\nstudy we introduce the new method of development and validation of newly synthesized prodrugs by HPLC \n\n\n\ntechnique.   \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n66 \n\n\n\n\n\n\n\nMPSPSC2017000094 (Poster) \n\n\n\nKNOWLEDGE AND USE OF ANTIBIOTICS AMONG THE PUBLIC IN THE KLANG VALLEY \n\n\n\n\n\n\n\nWong SH1, Tey KK1 \n\n\n\n1Faculty of Pharmacy, SEGi University, Kota Damansara, Malaysia \n\n\n\n\n\n\n\nINTRODUCTION: Antibacterial resistance (ABR) is an alarming global public health threat in effective \n\n\n\ntreatment and prevention against common bacterial infections. It has a significant economic impact as a result of \n\n\n\nprolonged illness, morbidity and mortality. The Ministry of Health has initiated various strategies to promote \n\n\n\njudicious use of antibiotics, including National Antibiotic Guidelines and the Antimicrobial Stewardship Protocol \n\n\n\nin all government healthcare facilities. Inappropriate prescribing, overuse and misuse of antibiotics are key factors \n\n\n\ncontribute towards ABR.  \n\n\n\nOBJECTIVES:  This study aimed to evaluate the knowledge and use of antibiotics by the public in Klang Valley. \n\n\n\nMethods: Cross sectional quantitative survey using validated self-administered questionnaire involving 548 \n\n\n\nrespondents in Klang Valley.  \n\n\n\nRESULTS:  Out of 543 respondents, 80.1% agreed that antibiotics are effective against bacterial infection. \n\n\n\nHowever, they also had the wrong idea that antibiotics can be used for viral (63%), fungal (76.2%) and parasitic \n\n\n\n(74.6%) infections; and for cough and cold (55.2%). Antibiotics were mostly obtained from private clinics and \n\n\n\nhospitals (91.2%), with 42.7% and 25% of the respondents received counselling from doctors and community \n\n\n\npharmacists. Only 65.7% of the respondent complete their course of antibiotics with 30.8% kept left over \n\n\n\nantibiotics for future use; and 36.2% actually shared their antibiotics with friends and family members. \n\n\n\nCONCLUSION: Public needs to be educated on the cause and implication of AMR. Doctors and pharmacists \n\n\n\noften being the first contact for patients are in the best position to influence the appropriate use of antibiotics, \n\n\n\nalongside policy makers to combat ABR.  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nMPSPSC2017000095 (Poster) \n\n\n\nCHOLINESTERASE INHIBITORY-GUIDED FRACTIONATION AND ISOLATION OF BIOACTIVE \n\n\n\nCOMPOUNDS FROM TINOSPORA CRISPA AND MELASTOMA MALABATHRICUM \n\n\n\n\n\n\n\n Al-Samarrai EM1, Mahmud R1, MurugaiyahV1 and Ismail S2 \n1School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 USM, Penang, Malaysia. \n2Centre for Drug Research, Universiti Sains Malaysia (USM), Minden, Pulau Pinang, Malaysia. \n\n\n\n\n\n\n\nINTRODUCTION: Tinospora crispa Miers or akar patawali and Melastoma malabathricum Linn, or senduduk \n\n\n\nare medicinal plants used traditionally in Malaysia. \n\n\n\nOBJECTIVES: The present study was undertaken to isolate bioactive compounds of methanol extracts of both \n\n\n\nplants using cholinesterase enzymes inhibitory-guided approach. \n\n\n\nMETHODS: Tinospora crispa had shown the potent cholinesterase inhibitory activity. Further purification of it \n\n\n\nresulted in isolation of one compound, apigenin. Melastoma malabathricum of chloroform fraction and n-butanol \n\n\n\nfraction had shown potent cholinesterase inhibitory activity. Further purification of both fractions yielded a total \n\n\n\nfive compounds: ursolic acid, corosolic acid, quercetin, betulinic acid.  \n\n\n\nRESULTS:  Apigenin had shown a good cholinesterase inhibitory activity in-vitro against acetylcholinesterase \n\n\n\nand butrylcholinesterase (IC50 of 38.73 \u00b5g/mL) and (IC50 of 48.93 \u00b5g/mL). The cholinesterase inhibitory activity \n\n\n\nof both, ursolic and corosolic acid had the highest cholinesterase inhibitory activity against acetylcholinesterase \n\n\n\nand butrylcholinesterase with IC50 values ranging from 7.02 - 22.36 \u00b5g/mL and   8.61 - 11.55 \u00b5g/mL. Betulinic \n\n\n\nacid was the most potent among all the isolated compounds with (IC50 values 2.42 \u00b5g/mL and 0.21 \u00b5g/mL) against \n\n\n\nacetylcholinesterase and butrylchoilesterase. \n\n\n\nCONCLUSION: Lineweaver-Burk plots suggested the mixed-mode of inhibition. Most of the isolated \n\n\n\ncompounds considered as drugs candidatures.  Molecular docking analysis showed that all compounds were \n\n\n\nsuccessfully docked into the active binding site of cholinesterase.IC50 values for cholinesterase enzymes inhibitory \n\n\n\nactivities of isolated compounds were found to be well correlated with their free energy of bindings, with particular \n\n\n\nbinding orientation.  \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n67 \n\n\n\n\n\n\n\nMPSPSC2017000096 (Poster) \n\n\n\nDISPOSAL PRACTICES OF MEDICATION IN COMMUNITY PHARMACIES IN MALAYSIA \n\n\n\n\n\n\n\nLiew J1, Soong K1, Tey KK1 \n\n\n\n1Faculty of Pharmacy, SEGi University \n\n\n\n\n\n\n\nINTRODUCTION: Safe disposal of medications is becoming a global concern as it has a huge impact on the \n\n\n\nenvironment and ultimately the health of the public. In many countries, households are advised to return their \n\n\n\nunused medications to community pharmacies as one of the methods of disposal. Community pharmacists play a \n\n\n\nmajor role in ensuring proper disposal of medications.  \n\n\n\nOBJECTIVES: This study reports the outcomes of a survey on community pharmacists on their disposal \n\n\n\npractices of medications and factors affecting their disposal practice; as well as their role in providing medication \n\n\n\ndisposal advice to the public.  \n\n\n\nMETHODS: A validated and self-administered questionnaire was distributed to 250 randomly selected \n\n\n\ncommunity pharmacists.  \n\n\n\nRESULTS: Solid and aerosol medications were disposed mainly through rubbish bin whilst semi-solid and liquid \n\n\n\nmedications were returned to the distributors. Out of the 193 respondents, 66.84% and 64.77% felt that lack of \n\n\n\ndisposal guidelines and inconvenience were two main factors affecting their disposal practices, and 58.03% cited \n\n\n\ncosts being another factor. Only 57.51% of the respondents felt that it is important to provide counselling to the \n\n\n\npublic on safe disposal of medications, and 41.45% of the respondents actually carried out the counselling. \n\n\n\nCONCLUSION: Improper and unsafe disposal of medications need to be addressed and there is a pressing need \n\n\n\nto create awareness on the issue of proper disposal and its impact on the environment. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nMPSPSC2017000097 (Poster) \n\n\n\nA NOVEL CONTROLLED IONIC GELATION METHOD FOR DEVELOPMENT OF CHITOSAN \n\n\n\nNANOPARTICLES \n\n\n\n\n\n\n\nNegi JS1, Pant A2 \n1Department of Pharmaceutical Technology, Faculty of Pharmaceutical Sciences, UCSI University, Cheras, Kuala \n\n\n\nLumpur, Malaysia. \n2Department of Pharmaceutical Sciences, S Bhagwan Singh PG institute of Bio-Medical Sciences and research, \n\n\n\nBalawala, Dehradun-248161, Uttarakhand, India. \n\n\n\n\n\n\n\nINTRODUCTION: Chitosan is a natural polysaccharide having various biomedical applications in drug delivery \n\n\n\nand tissue engineering. Chitosan have been extensively used as a biocompatible polymer for developing \n\n\n\nnanocarriers. The chitosan based nanoparticles can be prepared by various methods such as ionic gelation, micro-\n\n\n\nemulsion technique, coacervation method. Ionic gelation has been used widely be several authors. However, tri \n\n\n\npoly phosphate based ionic gelation method also associated with problem of particle aggregation and poor \n\n\n\nphysical stability. This study proposed design of a novel controlled ionic gelation strategy for chitosan \n\n\n\nnanoparticles formation. \n\n\n\nOBJECTIVE: To develop and characterize a novel controlled ionic gelation method of chitosan nanoparticles \n\n\n\nformation.  \n\n\n\nMETHODS: Chitosan nanoparticles prepared with help of inclusion complex of beta cyclodextrin and tri poly \n\n\n\nphosphate. Further nanoparticles were characterized for particle size and surface morphology using differential \n\n\n\nlight scattering and transmission electron microscopy. \n\n\n\nRESULTS: The particle size for controlled ionic gelation method was found 104.2 nm \u00b10.608 with good PDI \n\n\n\nvalue of 0.346 \u00b10.016. They found smaller and more uniform than normal ionic gelation method. \n\n\n\nCONCLUSION: Chitosan nanoparticles can be successfully prepared by a novel controlled ionic gelation method \n\n\n\nusing cyclodextrin and tri poly phosphate complex. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n68 \n\n\n\n\\ \n\n\n\nMPSPSC2017000098 (Poster) \n\n\n\nUTILISATION OF COMMUNITY PHARMACY SERVICES BY THE PUBLIC IN KLANG VALLEY \n\n\n\n\n\n\n\nTang BWC1, Tey KK1  \n1Faculty of Pharmacy, SEGi University, Malaysia \n\n\n\n\n\n\n\nINTRODUCTION:  A wide range of community pharmacy services are currently available in Malaysia. Apart \n\n\n\nfrom management of minor ailments, prescription screening and filling, community pharmacists are also actively \n\n\n\ninvolved in providing health screening, monitoring tests and advisory services. However, public may not be aware \n\n\n\nof these services which ultimately lead to underutilisation. \n\n\n\nOBJECTIVES: This study was conducted to assess the reasons of visiting community pharmacy and utilisation \n\n\n\nof community pharmacy services by the public in Klang Valley. \n\n\n\nMETHODS: A cross-sectional random sampling study involving 577 public using validated self-administered \n\n\n\nstructured questionnaire. \n\n\n\nRESULTS: Of the 414 respondents, 12.8% has never visited a community pharmacy, and 36.5% visited once or \n\n\n\ntwice a year and 33.6% visited once a month. Reasons for visits were to purchase medications (60.9%), health \n\n\n\nsupplements (44.9%) and toiletries (31.9%); and 56.3% for management of minor ailments. Only 19.8% sought \n\n\n\nadvice from pharmacists and 9.2% used the monitoring services. For management of minor ailments, 66.6% of \n\n\n\nolder adults were aware of this service as compared to young adults (82.3%) and middle-aged adults (91.8%); \n\n\n\nwhich correspond to their usage of this service at 44.4%, 56.6% and 57.7% respectively. \n\n\n\nCONCLUSIONS: Community pharmacy services are underutilised and there is a need to increase awareness \n\n\n\namong the public on the services so that role extension of pharmacists can be a fulfilled. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nMPSPSC2017000101 (Poster) \n\n\n\nAWARENESS LEVEL ON MENTAL ILLNESS AMONG STUDENTS IN INSTITUTIONS OF HIGHER \n\n\n\nLEARNING IN IPOH \n\n\n\n\n\n\n\nMusa HI1, Hussin SN1, Puspitasari RM1  \n1Faculty of Pharmacy and Health Sciences, Universiti Kuala Lumpur, Royal College of Medicine Perak (UniKL \n\n\n\nRCMP), Perak, Malaysia. \n\n\n\n\n\n\n\nINTRODUCTION: Mental disorders onset prior to the age of 25, if left untreated, can affect emotional well-\n\n\n\nbeing and social development. The university years are emotionally and intellectually more demanding where \n\n\n\npressures and challenges will pose a variety of physical, social and emotional difficulties. As a result, university \n\n\n\nstudents become more vulnerable for developing mental health problems such as depression and anxiety disorder.  \n\n\n\nOBJECTIVES: This study was aimed to find out the levels of awareness on mental illness among students of \n\n\n\nhigh institutions in Ipoh through their knowledge on general and causes of mental illness and evaluate perceptions \n\n\n\non attitudes towards mentally ill person.  \n\n\n\nMETHODS: Questionnaires were administered randomly to high institutions students in Ipoh and stratified into \n\n\n\nhealth sciences and non-health sciences background.  \n\n\n\nRESULTS: Most of the respondents showed average in general knowledge on mental illness (59.2%), high \n\n\n\nknowledge on causes of mental illness (71.89%) and neutral attitude towards mental illness person (78.86%). \n\n\n\nFrom the results, students with health sciences background showed high general knowledge (45.23%) and \n\n\n\nknowledge on causes of mental illness (76.38%) compared to non-health sciences students, (28.08%) and \n\n\n\n(67.49%) respectively; (p>0.05). Students with positive attitude towards mental illness person was also higher \n\n\n\n(29.15%) among health sciences compared to non-health sciences students (11.33%); (p>0.05).  \n\n\n\nCONCLUSION: Students with health science background showed better levels of awareness on mental illness \n\n\n\ncompared to non-health science students. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n69 \n\n\n\n\n\n\n\nMPSPSC2017000105 (Poster) \n\n\n\nCONTRIBUTION OF CARBOHYDRATE INTAKE TO HBA1C IN TYPE 2 DIABETES PATIENTS \n\n\n\nUSING PHARMACOMETRICS MODELLING \n\n\n\n\n\n\n\nDahlan AFM1,2, Wellhagen GJ1, Karlsson MO1, Kjellsson MC1 \n1Pharmacometrics Research Group, Department of Pharmaceutical Biosciences, Uppsala University, Sweden \n2Kelantan State Pharmacy Enforcement Branch, Ministry of Health Malaysia, Malaysia \n\n\n\n\n\n\n\nINTRODUCTION: Lifestyle changes with diet adjustment are one of the standard treatments in type 2 diabetes. \n\n\n\nOBJECTIVE: in this study, we investigate the effect of different size and frequency of carbohydrate intake on \n\n\n\nglycosylated haemoglobin (HbA1c). \n\n\n\nMETHODS: The investigation was done with cross-over trial simulation using two published pharmacometric \n\n\n\nmodels, the integrated Glucose insulin (IGI) model, and the integrated Glucose RBC Haemoglobin (IGRH) model. \n\n\n\nTwo populations of diabetic patients were generated, with one population having a higher fasting plasma glucose \n\n\n\n(FPG) of 127 mg/dl to 324 mg/dl represent a poorly-controlled diabetes (PC) patient and the other a well-\n\n\n\ncontrolled diabetes (WC) population with FPG of 72 mg/dl to 126.9 mg/dl. Both populations simulated with a \n\n\n\nstandard diabetic meal intake and then compared against with three different meal intake scenarios of high and \n\n\n\nlow carbohydrate intakes as well as a low frequency standard meal intake. \n\n\n\nRESULTS: In WC population, high carbohydrate, low carbohydrate and low frequency intake produced 0.85%, \n\n\n\n-0.73% and -0.38% changes in HbA1c prediction respectively. In the PC population, HbA1c prediction were \n\n\n\n+0.30, -0.25 and -0.15. This study also found the occurrence of non-physiological profiles (NP) among the \n\n\n\nsimulated individuals. Uses of correlation blocks (CR) and inter individual variability (IIV) on insulin dependent \n\n\n\nglucose clearance, fasting serum insulin and incretin slope produced simulations with least fraction of NP. \n\n\n\nCONCLUSION: in this simulation study, we show that well-controlled type 2 diabetic patient were predicted to \n\n\n\nbenefit more from changes in carbohydrate intake compared to poorly controlled patients. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nMPSPSC2017000106 (Poster) \n\n\n\nHEALTH PROFESSIONAL AWARENESS OF DRUG COST: A SYSTEMATIC REVIEW \n \n\n\n\nOthman MF1, Asat N1, Lee KS2, Long CM3  \n1Department of Pharmacy Practice, Faculty of Pharmacy, Universiti Teknologi MARA \n2Pharmacy Practice and Development Division, Pharmaceutical Service Division, Malaysian Ministry of Health. \n3School of Pharmacy, KPJ Healthcare University College, Malaysia  \n\n\n\n\n\n\n\nINTRODUCTION: The health professional are often associated with medication in managing patient's illness. \n\n\n\nTheir awareness on medicine cost therefore is vital in alleviating patient\u2019s financial burden and ensuring patients \n\n\n\nare properly managed.   \n\n\n\nOBJECTIVES: This aim of this study was to review health professionals (pharmacist, nurse, and physician) level \n\n\n\nof awareness regarding cost of prescription drug products and identifying factors influencing awareness of the \n\n\n\ndrug cost.  \n\n\n\nMETHODS: Our search strategy included Pubmed, MEDLINE, Scopus and Science Direct. Articles for inclusion \n\n\n\nincluded; those that described the awareness, understanding, concerns, perceptions or knowledge of the health \n\n\n\nprofessional towards the drug cost or medication prices; results should be described quantitatively; have a \n\n\n\ndescription of how \u201cTrue\u201d costs determined and must have minimum of 10 participants of respondent either health \n\n\n\nprofessionals or physicians or nurses or pharmacists. Two authors reviewed each article for eligibility and \n\n\n\nextracted data independently. \n\n\n\nRESULTS: initial search yield 2342 articles and following screening, 18 articles included with 13 done on \n\n\n\nphysicians, 1 nurse, and 4 mixed of nurses and physicians with none done on pharmacist. Studies quality and \n\n\n\nmethodological were poor due to unclear sampling, low response rate and unclear quantification calculation. Cost \n\n\n\nunderestimation tended to be more frequent than overestimation. Qualitative information was provided in all \n\n\n\nstudies.   \n\n\n\nCONCLUSION: Health professionals frequently underestimate and overestimate drug prices which reflect poor \n\n\n\nknowledge of accurate actual drug cost. It was also found that accessibility to the medication cost information and \n\n\n\nrelationship between prescribers and patients are among the factors that influence medication cost awareness \n\n\n\namong health professionals.  \n\n\n\n\n\n\n\n\n\n\n\n\n70 \n\n\n\n\n\n\n\nMPSPSC2017000107 (Poster) \n\n\n\nPREVALENCE AND FACTORS ASSOCIATED WITH DROP OUT AMONG THE USM TOBACCO \n\n\n\nQUITLINE SERVICE CLIENTS IN MALAYSIA. \n\n\n\n\n\n\n\nMisnan A1, Samsudin S1,  Tangiisuran B2, Omar M1, Hassan N3, Hashim H1, Hamdan Z4, Awang R1 \n1Clearinghouse for Tobacco Control, National Poison Centre, Universiti Sains Malaysia \n2School of Pharmaceutical Sciences, Universiti Sains Malaysia  \n3Tobacco Control Section and FCTC Secretariat, Ministry of Health Malaysia  \n4Centre for Knowledge, Communication and Technology, Universiti Sains Malaysia \n\n\n\n\n\n\n\nINTRODUCTION: mQuit USM Tobacco Quitline (USMTQ) Services has been officially established to aid \n\n\n\nMalaysian smokers who have intention to quit with a series of consultations to ensure successful smoking \n\n\n\ncessation and prevent relapse. Under the mQuit services, Healthcare Providers (HCP) works in collaboration with \n\n\n\nthe USMTQ by referring their clients for smoking cessation program. However, there is risk for inadequate \n\n\n\nadherence to smoking cessation program and little is known about what leads to treatment discontinuation. \n\n\n\nOBJECTIVE: To identify the prevalence and factors associated with drop out among Quitline Service clients at \n\n\n\npoint of referral. \n\n\n\nMETHODS: Clients from referral Healthcare Providers (HCP) of government and private sectors and self-\n\n\n\nregistered were followed-up through phone interview using a systematic and advice based protocol. Those who \n\n\n\nsuccessfully confirmed their registration and completed 1 month consultation sessions were included in this study. \n\n\n\nFactors associated with drop out among Quitline Service clients were analysed using multivariate analysis. \n\n\n\nRESULT: In total, 533 clients were referred to Quitline Service since its inception in September 2016. Out of \n\n\n\nthese, 238 clients were registered while only 96 (40.4%) completed the one month consultations. From this \n\n\n\nnumber, 11 clients (11.5%) had completely dropped out from the program, 38 (39.6%) clients quit at six months \n\n\n\nfollow up and the remaining 47 (48.9%) were still undergoing the consultation sessions. This paper examines the \n\n\n\nfactors that might be associated with the reasons for the drop out cases based on 3 classifications: 1) referred and \n\n\n\ndrop out, 2) did not complete one month consultation, 3) went through at least one month consultation and drop \n\n\n\nout. \n\n\n\nCONCLUSION: There are number of reasons that can be associated with the cause for the drop out in the quitline \n\n\n\nprogram. Understanding of these reasons will help improve the quitline service that has been offered in the mQuit \n\n\n\nprogram. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n71 \n\n\n\n\n\n\n\nMPSPSC2017000108 (Poster) \n\n\n\nDRUG UTILIZATION REVIEW: ANALGESICS AMONG PATIENTS WITH ACUTE, NOCICEPTIVE \n\n\n\nNON-CANCEROUS PAIN \n\n\n\n\n\n\n\nPuspha Rajah N4,  Chen TS1, Won CL1, Kwong KS2,  Choo YW2, Yap LQ3, Lee SH3, Tungahser NF3, Fong YY4, \n\n\n\nDzulkifli NH4, Ahmad Shukri SS5, Wong WC5,Huang MG5, Afiqah Othman NF5, Sivaperumal V6, Salleh MI7, \n\n\n\nAw MC7, Baskaran N7, Hamid NA8, Abd Aziz NW8 and Mohd Wahiza MF8 \n1Department of Pharmacy, Hospital Raub, Pahang, Malaysia     \n2Department of Pharmacy, Hospital Kuala Lipis, Pahang, Malaysia     \n3Department of Pharmacy, Hospital Bentong, Pahang, Malaysia     \n4Department of Pharmacy Hospital Sultanah Hajjah Kalsom, Cameron Highlands, Pahang, Malaysia     \n5Pejabat Kesihatan Daerah Raub, Pahang, Malaysia                      \n6Pejabat Kesihatan Daerah Cameron Highlands, Pahang, Malaysia     \n7Pejabat Kesihatan Daerah Lipis, Pahang, Malaysia                       \n8Pejabat Kesihatan Daerah Bentong, Pahang, Malaysia     \n\n\n\n\n\n\n\nINTRODUCTION: Pain is the commonest reason for patients who seek treatment at Emergency or Outpatient \n\n\n\nDepartment. The usage of pain medications are more likely depend on accessibility and availability of the drug at \n\n\n\nthe local health setting. Currently, there is lacking of study to describe the usage of analgesic at Malaysian \n\n\n\nhealthcare facilities.  \n\n\n\nOBJECTIVES: This study is aim to review the usage of analgesics prescribed among patients with acute, \n\n\n\nnociceptive non-cancerous pain in hospitals and health clinics in West Pahang. \n\n\n\nMETHODS: A multicentre, cohort, cross sectional, descriptive study was conducted at hospitals and health \n\n\n\nclinics in District of Bentong, Raub, Lipis and Cameron Highlands. All outpatients and emergency prescriptions \n\n\n\nwere studied, with exclusion of hospitalized and discharged patients, diagnosis of chronic pain or patients with \n\n\n\nlong term analgesics. Define daily dose (DDD) per 1,000 inhabitants per day was calculated and was compared. \n\n\n\nThe expenditure of analgesics was calculated and was compared among the studied hospital and health clinics. \n\n\n\nRESULTS: Paracetamol, Diclofenac and Mefenamic Acid are the three commonest analgesics used in most of \n\n\n\nthe studied centers. Total expenditure of analgesics is recorded at RM 70,815.27, contributed the most by Hospital \n\n\n\nKuala Lipis (40.0%), followed by Hospital Raub (25.9%), and Hospital Bentong (15.6%). \n\n\n\nCONCLUSION: The study shows varied drug utilization pattern in studied hospitals and health clinics. The \n\n\n\nresult provides preliminary start to further review the drug utilization of analgesics in local health settings. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n72 \n\n\n\n\n\n\n\nMPSPSC2017000109 (Poster) \n\n\n\nPSYCHOLOGICAL DISTRESS AND EMOTIONAL BURNOUT OF HEALTH PROFESSIONALS IN \n\n\n\nHOSPITAL SETTING: A COMPARISON BETWEEN DOCTORS AND PHARMACISTS \n\n\n\n\n\n\n\nLL Cheann1, N Jagan2, Tangiisuran B1 \n\n\n\n1School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 USM, Pulau Pinang, Malaysia \n2 Department of Pharmacy, Hospital Kuala Lumpur, Malaysia \n\n\n\n\n\n\n\nINTRODUCTION: Psychological distress and burnout among healthcare professionals in hospital setting has \n\n\n\nbeen a topical issue. As healthcare professionals, devoid of psychological distress may avoid medical errors that \n\n\n\ncould be costly.  \n\n\n\nOBJECTIVES: To compare the occurrence of psychological distress and emotional burnout between the doctors \n\n\n\nand pharmacists.  \n\n\n\nMETHODS: A cross-sectional survey was conducted using self-administered questionnaire in a tertiary care \n\n\n\nhospital in Kuala Lumpur. Information about socio-demographic and interpersonal work-related were collected. \n\n\n\nThe psychological distress were assessed using the validated Malay version of Beck Depression inventory (BDI) \n\n\n\nand Beck Anxiety inventory (BAI) while emotional burnout was assessed using the validated Malay version of \n\n\n\nMaslach Burnout inventory Human Service Survey (MBI-HSS).  \n\n\n\nRESULTS: A total of 119 doctors and 158 pharmacists were recruited. Respondents were predominantly female \n\n\n\n(76.2%), with a mean age of 29.7\u00b13.5 years and 4.96\u00b13.17 years of practice. Doctors reported higher mean score \n\n\n\nof emotional burnout (21.3\u00b115.00) as compared to pharmacists (19.8\u00b112.39). For psychological distress, doctors\u2019 \n\n\n\nmean score of depression (8.6\u00b18.05) were similar to pharmacists (8.6\u00b16.70), while the mean score of anxiety for \n\n\n\ndoctors (7.7\u00b19.64) was slightly higher than pharmacists (7.1\u00b17.12). However, there was no significant differences \n\n\n\nobserved between the doctors and pharmacists in their psychological distress and emotional burnout score.  \n\n\n\nCONCLUSION: The occurrence of emotional burnout was higher among doctors. Psychological distress among \n\n\n\ndoctors and pharmacists were similar. Addressing psychological needs of the healthcare professionals and \n\n\n\nintervention were necessary to reduce burnout and psychological distress.  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nMPSPSC2017000110 (Poster) \n\n\n\nEFFECTS OF ETHANOLIC ORTHOSIPHON STAMINEUS EXTRACT ON THE BEHAVIOR OF \n\n\n\nGESTATED AND NON-GESTATED FEMALE RATS SUBJECTED TO CHRONIC MILD STRESS \n\n\n\n\n\n\n\nHashim N1, Hassan Z2 and Abdul Aziz NH1 \n1School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Pulau Pinang, Malaysia \n2Center for Drug Research, Universiti Sains Malaysia (USM), Minden, Pulau Pinang. \n\n\n\n\n\n\n\nINTRODUCTION: Women are twice more vulnerable to depression compared to men. Additionally, mothers \n\n\n\nare also at risk of suffering from postpartum depression. Many are afraid to seek treatment due to social stigma. \n\n\n\nResearch on potential herbal plant that may alleviate depression might be useful. \n\n\n\nOBJECTIVE: This study aimed to assess the effects of ethanolic Orthosiphon stamineus (OS) extract \n\n\n\nadministration on the behaviour of non-gestating and dam rats subjected to stress. \n\n\n\nMETHOD: Gestating (P) and non-gestating (NP) Sprague Dawley rats were subjected to four treatments: non-\n\n\n\nstressed (NS, negative control), stressed (S), stressed and treated with fluoxetine (FLX, positive control), and \n\n\n\nstressed and treated with OS extract (OS). All stressed rats were submitted to chronic unpredictable mild stressors \n\n\n\nthroughout the gestation period (same duration for NP rats). Treatment with drugs/extract started from 24H \n\n\n\npostpartum. Open Field Test (OFT), Novel Object Recognition (NOR) test and Forced Swim Test (FST) were \n\n\n\ncarried out within two weeks post-weaning of offspring. \n\n\n\nRESULT: OFT finding showed NPOS has significantly lower locomotor activity than NPFLX rats (p=0.04). \n\n\n\nWhereas the locomotor activity for POS rats is significantly higher than the PNT and NPOS rats (p=0.03 and \n\n\n\np=0.05, respectively). in NOR test, all NP rat groups and PFLX rats could significantly recognized novel object \n\n\n\nfrom familiar object, but not POS rats. in FST, POS rats performed significantly higher immobility versus PFLX \n\n\n\n(p<0.05) but no different than other dams. \n\n\n\nCONCLUSION: The effect of OS extract varies according to the parity status and the type of behaviour tests \n\n\n\napplied. \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n73 \n\n\n\n\n\n\n\nMPSPSC2017000111(Poster) \n\n\n\nIN VITRO AND IN VIVO ANTICANCER ACTIVITIES OF POTASSIUM KOETJAPE: A SOLUBILITY \n\n\n\nENHANCED FORMULATION OF KOETJAPIC ACID ISOLATED FROM SANDORICUM KOETJAPE  \n\n\n\n\n\n\n\nJafari SF1, Asif M1, Abdul Majid AMS1  \n1EMAN Research and Testing Laboratory, Department of Pharmacology, School of Pharmaceutical Sciences, \n\n\n\nUniversiti Sains Malaysia, 11800 USM, Penang, Malaysia. \n\n\n\n\n\n\n\n\n\n\n\nINTRODUCTION: Colorectal cancer is a multistep disease that occurs as a consequence of a series of pathologic \n\n\n\nchanges leading to the transformation of normal epithelial cells of the colon to invasive carcinoma. This type of \n\n\n\ncancer stands at third position in the world as a lethal and metastatic carcinoma. Plant\u2019s secondary metabolites \n\n\n\nhave potential to induce selective cytotoxicity against cancer cells and/or modulate multiple tumour development \n\n\n\nprocess, thus can serve as anticancer drugs. Sandoricum koetjape Merr. is a traditional medicinal plant, native to \n\n\n\nMalaysia, Cambodia and Southern Laos and has recently been introduced in Australia and America.  \n\n\n\nOBJECTIVES: In the present study an attempt was made to increase the aqueous solubility of Koetjapic Acid \n\n\n\n(KA) in order enhance its clinical application and to study its anti-colon cancer efficacy using in vitro and in vivo \n\n\n\nmethods. \n\n\n\nMETHODS: Potassium koetjapate (PK) was prepared by semi-synthetic method. Anticancer activities of PK \n\n\n\nwere compared with the native compound i.e., KA. MTT cell viability assay was used to obtain and compare the \n\n\n\nIC50 values of both the compounds. Pro-apoptotic effects of PK were assessed using caspases (3/7, 8 and 9), \n\n\n\nFurthermore, in vitro antitumor effects of PK were studied using hanging drop assay. Three doses of PK (25, 50, \n\n\n\nand 100 mg/kg body weight) were tested in athymic nude mice models to study the in vivo anti-tumorigenic \n\n\n\nefficacy of PK  \n\n\n\nRESULTS: In this study, various formulations of KA were prepared. Solubility studies revealed that resultant \n\n\n\nKA derivative i.e., PK had better aqueous solubility than the solid dispersions of KA. In vitro anticancer studies \n\n\n\nrevealed that PK has better cytotoxic activity than KA and its solid dispersion complex towards HCT 116 cell \n\n\n\nline. Apoptosis antibody array study that PK modulated the activity of multiple proteins. It down-regulated the \n\n\n\nexpression of HSP60, HSP70 and Bcl-2 proteins with concomitant up-regulation of TRAILR-1, TRAILR-2, p27 \n\n\n\nand p53 proteins respectively. Findings of hanging drop assay pointed that PK has dose-dependent antitumor \n\n\n\npotential and are well-correlated with outcomes of in vivo nude mice study. PK showed potent inhibition of tumor \n\n\n\ngrowth at 50 and 100 mg/kg, respectively \n\n\n\nCONCLUSION: All together, outcome of present study shows that PK has anti-colon cancer activity which gives \n\n\n\na hint about its potential anticancer application.  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n74 \n\n\n\n\n\n\n\nMPSPSC2017000112(Poster) \n\n\n\nCOMPARISON OF PROTEIN PROFILE FOR CHICKEN, PORK AND BEEF USING PROTEOMIC \n\n\n\nAPPROACH \n\n\n\n\n\n\n\nIskandar TS1and Gam LH1 \n1School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 USM, Penang, Malaysia. \n\n\n\n\n\n\n\nINTRODUCTION: Adulteration is a cunning danger that cannot be seen by the naked eye unless it is tested and \n\n\n\ninvestigated thoroughly. In the market, people are buying processed pre-cooked meat for consuming it but they \n\n\n\ndo not know the content and the sources roughly. Proteins are very unique in its own kind where pre-cooked meat \n\n\n\nprotein profile can be tested by using 1D PAGE approach. This is due to pre-cooked meat is daily purchased item \n\n\n\nin the market in Malaysia. \n\n\n\nOBJECTIVES: The study is to do this is by examine the protein profile of pre-cooked meat by using SDS-PAGE \n\n\n\nmethod that can illustrate the distinction of protein profile of three types of meat source that are chicken, pork and \n\n\n\nbeef \n\n\n\nMETHODS: There are three types of extraction were done that is Tris(40 mM Tris) buffer extraction, TSE \n\n\n\nbuffer(40 mM Tris, 1% ampholyte, 10%SDS  and 100mM EDTA) extraction and sodium chloride extraction. \n\n\n\nRESULTS: Tris extraction and also TSE extraction extracted a large amount of protein; results show that it is \n\n\n\nvery hard to distinguish the protein profile or to find the biomarker for each of the sample by using sodium chloride \n\n\n\nextraction, shows that lesser amount of protein is extracted due to the selectivity of protein extraction With that, \n\n\n\nthe protein profile can be compared due to the highest consistency percentage and less time and less step \n\n\n\nconsuming. The enhancement of the Tris extraction and TSE extraction is by precipitating the protein by using \n\n\n\nChloroform and methanol precipitation and ammonium sulfate precipitation.  \n\n\n\nCONCLUSION: The highest consistency for extraction methods are sodium chloride method and by comparing \n\n\n\nthese two types of precipitation method, ammonium sulfate precipitation shows better results due to the \n\n\n\nconsistency and reproducibility of the results as compared to chloroform and methanol precipitation.  \n\n\n\n\n\n\n\n\n\n\n\nMPSPSC2017000113(Poster) \n\n\n\nTHE USE OF TRADITIONAL AND COMPLEMENTARY MEDICINE TO CONCEIVE, DURING \n\n\n\nPREGNANCY AND THE POSTPARTUM PERIOD IN KUALA MUDA DISTRICT, KEDAH, \n\n\n\nMALAYSIA \n\n\n\n\n\n\n\nShaukat AR1,2, Hoh CML1, Farooqui M3, Gnanasan S2 \n1Department of Pharmacy, Hospital Sultan Abdul Halim, Kedah, Malaysia \n2Department of Pharmacy Practice, Faculty of Pharmacy, Universiti Teknologi MARA, Selangor, Malaysia \n3Department of Pharmacy Practice, Unaizah College of Pharmacy, Qassim University, Saudi Arabia \n\n\n\n\n\n\n\nINTRODUCTION: Traditional and complementary medicine (T&CM) has grown its roots in the Malaysian \n\n\n\nhealthcare system. Though T&CM is established worldwide, the regulations on its practices are varied with \n\n\n\nlimited reliable information sources.  \n\n\n\nOBJECTIVES: This study aimed to determine the use of T&CM to conceive, during pregnancy and the \n\n\n\npostpartum period by exploring the prevalence, pattern and disclosure of T&CM use.  \n\n\n\nMETHODS: in-depth qualitative interviews were carried out on 14 participants. Concurrently, quantitative \n\n\n\nsurveys were done on 374 participants by using self-administered questionnaires. Qualitative data were analysed \n\n\n\nthematically while quantitative data were represented via descriptive statistics.  \n\n\n\nRESULTS: Evidence presented show that the prevalence of T&CM use is high, which has been identified in the \n\n\n\nquantitative study (n=285, 76.2%). Majority of the participants used T&CM during the postpartum period (n=237, \n\n\n\n83.2%) and the most popular reason for use was to aid postpartum recovery (n=226, 79.3%). Although the most \n\n\n\nfrequent T&CM modality used was traditional Malay massage (n=170, 59.6%), biological based therapies (n=272, \n\n\n\n95.4%) was the highest among all five categories of T&CM. T&CM disclosure rate was 42.8% (n=122). The lack \n\n\n\nof concern by healthcare providers on T&CM use, the perception that T&CM will not disrupt conventional \n\n\n\nmedicines and the assumption that T&CM is safe were the most popular reasons for non-disclosure of T&CM \n\n\n\nuse.  \n\n\n\nCONCLUSION: This study reveals that women are interested in T&CM use. Hence, healthcare professionals \n\n\n\nshould realise their roles in aiding the integration of T&CM as part of the mainstream healthcare system in order \n\n\n\nto optimise patient care and prevent harm. \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n75 \n\n\n\n\n\n\n\nMPSPSC2017000114(Poster) \n\n\n\nCHARACTERIZATION OF PLASTICS FROM ORIGINAL AND FALSIFIED PANADOL ACTIFAST \n\n\n\nBLISTER PACK USING DIFFERENTIAL SCANNING CALORIMETRY (DSC) \n\n\n\n\n\n\n\nSalim MR1, 2, Widodo RT2 and Nordin MI2 \n\n\n\n1Pharmacy Enforcement Division, Ministry of Health Malaysia, Petaling Jaya, Selangor; \n2Pharmacy Department, Faculty of Medicine, University Malaya (UM), Kuala Lumpur; \n\n\n\n\n\n\n\nINTRODUCTION: Substandard and falsified (SF) medicine is a global problem and need serious action upon \n\n\n\ndetection. Early detection of SF medicine in a country will reduce the fatal risk to the consumer. Fast laboratory \n\n\n\ntesting is needed for effective surveillance and monitoring system of SF medicines.  \n\n\n\nOBJECTIVES: The study aim to characterize the plastics used as blister pack on primary packaging of falsified \n\n\n\nand original Panadol Actifast using Differential Scanning Calorimetry (DSC). \n\n\n\nMETHODS: Five different batches of original Panadol Actifast were purchased from the market. Each batch was \n\n\n\nanalyzed using DSC. The falsified Panadol Actifast was obtained from the Pharmacy Enforcement Division and \n\n\n\nalso been send for analysis. \n\n\n\nRESULTS: The DSC thermogram for falsified and original Panadol Actifast plastics consist of two peaks with \n\n\n\nsimilar pattern. The original Panadol Actifast plastic exhibits two peaks at 254.92\u00b11.13\u00b0C and at 294.5\u00b10.89\u00b0C \n\n\n\nThe DSC thermogram for the falsified Panadol Actifast consisted of two peaks at 268.98\u00b11.17\u00b0C and at \n\n\n\n306.84\u00b10.90\u00b0C. The differences in melting points shows that the plastics used in original and falsified Panadol \n\n\n\nActifast are different.  \n\n\n\nCONCLUSION: Fast and prompt decision can be made by comparing original and falsified Panadol Actifast \n\n\n\nDSC thermograms together. Falsified medicine can be detected through packaging material based on their melting \n\n\n\npoint using DSC.  \n\n\n\n\n\n\n\n\n\n\n\nMPSPSC2017000115(Poster) \n\n\n\nDRUG CONTENT AND IN VITRO DISSOLUTION OF CIPROFLOXACIN TABLETS \n\n\n\n\n\n\n\nSharma D1, Ming LC1,2, Patel RP1, Zaidi STR1. Al-Worafi YM3 \n1Pharmacy, School of Medicine, University of Tasmania, Hobart, TAS, Australia. \n2School of Pharmacy, KPJ Healthcare University College, Nilai, Negeri Sembilan \n3College of Pharmacy, Ajman University, Sharjah, United Arab Emirates \n\n\n\n\n\n\n\nINTRODUCTION: Counterfeit and falsified drugs are easily available worldwide and the use of these medicines \n\n\n\ncould lead to treatment failure and antibiotic resistance. Quality evaluation of drug products in the market could \n\n\n\nminimise the unwanted healthcare risk and adverse effect. \n\n\n\nOBJECTIVES: To evaluate the in vitro dissolution and quality of different brands of ciprofloxacin tablets that \n\n\n\nare available in the local market of India, Iran and Pakistan.  \n\n\n\nMETHODS: innovator and generic brands of immediate release ciprofloxacin 500mg tablets were purchased \n\n\n\nfrom the authorized medicine suppliers located at India, Iran and Pakistan as well as from a local pharmacy in \n\n\n\nHobart, Australia (reference product).  A total of 15 brands were tested for content uniformity and dissolution. \n\n\n\nFor content uniformity analysis, ciprofloxacin tablets were dissolved in sufficient amount of 10% acetic acid \n\n\n\nwhich later was diluted prior to HPLC analysis. For dissolution, the tablets was added to Simulated Gastric Fluid \n\n\n\nprepared according to United State Pharmacopeia (USP) and sample was taken at 5,10,15,20,30,45 and 60 \n\n\n\nminutes. Triplicate were used and each sample was tested twice. Dissolution profile comparison was performed \n\n\n\nusing similarity factor (f2) with f2\u226550 indicate similarity. \n\n\n\nRESULTS: Content uniformity analysis indicated that all the tablets were within the limits of USP (within the \n\n\n\nrange of 90-110%). Dissolution testing demonstrated that all tested brands, except one brand from Iran, followed \n\n\n\nthe USP requirement of not less than 80% dissolved in 30 minutes. Out of the 14 brands, four have similar \n\n\n\ndissolution profile in comparison to the reference brand. \n\n\n\nCONCLUSIONS: Drug products purchased from authorized drug suppliers tend to have lower risk of \n\n\n\ncounterfeiting. Complied drug content in 14 out of 15 brands tested, however, are not in congruent with the results \n\n\n\nof drug dissolution. Different dissolution profile could affect the in vivo ciprofloxacin absorption because \n\n\n\nphysiological-based pharmacokinetics modelling confirmed that ciprofloxacin exhibited apparent \u201cabsorption \n\n\n\nwindow\u201d in gastrointestinal tract. The inadvertent failure in drug release or dissolution compared to the reference \n\n\n\nproduct would yield lower bioavailability that eventually affects the desired minimum inhibitory concentration. \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n76 \n\n\n\n\n\n\n\nMPSPSC2017000116(Poster) \n\n\n\nA COMPARATIVE STUDY OF ATTENTION AND MENTAL ALERTNESS LEVEL BETWEEN \n\n\n\nCOFFEE AND GREEN TEA USERS IN KPJ HEALTHCARE UNIVERSITY COLLEGE \n\n\n\n\n\n\n\nThuraisingam M1, Md Noor NN 1, Manan MM 1 \n\n\n\n1 School of Pharmacy, KPJ Healthcare University College, Nilai, Negeri Sembilan, Malaysia     \n\n\n\n\n\n\n\nINTRODUCTION:  College students in today\u2019s society have become dependent on coffee due to the presence \n\n\n\nof caffeine for their daily activities. This paper focuses on the effect of two beverages which are green tea and \n\n\n\ncoffee that have different phytochemical ingredients that responsible for attention and mental alertness.  \n\n\n\nOBJECTIVES: The aim of this research was to compare the attention and mental alertness level between coffee \n\n\n\nand green tea consumption among students of KPJ Healthcare University College on human biological and \n\n\n\npsychological functioning of the students.  \n\n\n\nMETHODS: The study was conducted by by using a pre-post-test study design, in which forty-five (45) subjects \n\n\n\nwere recruited upon obtaining their consent. The study was then carried out in two sessions, in which green tea \n\n\n\nand coffee was supplied to the participants once per week, following a seven days of wash-out period. The \n\n\n\nparticipants were abstained from any intake of either food or beverages that contained caffeine or L-theanine \n\n\n\nduring this period. The attention and mental alertness of each subject was measured by the differences of \n\n\n\nmeasurement during pre-sampling and post-sampling upon consumption, in the context of blood pressure, heart \n\n\n\nrate, human benchmark tests, average aptitude test, Toronto Hospital Alertness Test (THAT) and ZOGIM-A \n\n\n\nquestionnaires (i.e. at baseline).   \n\n\n\nRESULTS: From this study, it was found that coffee and green tea both have significant improvement in the test \n\n\n\nsubject and it can be observed by way of testing their alertness before and after consumption. Both beverages \n\n\n\nshowed a positive outcome in attention and mental alertness within 30 minutes following the intake in term of \n\n\n\nincrease systolic blood pressure, shorter reaction time tests and responds through Toronto Alertness Hospital Test \n\n\n\n(THAT). However, the outcomes did not completely meet the objectives drawn out since the comparison between \n\n\n\nthe two beverages cannot be determined in a significant manner. None the less, green tea did show a potentially \n\n\n\nfavourable effect to the test subject\u2019s attention and mental alertness.  \n\n\n\nCONCLUSION: The present results suggest that green tea and coffee consumption is essential for focus attention \n\n\n\nand mental alertness, and a larger study is to be completed in the near future. \n\n\n\n\n\n\n\n\n\n\n\nMPSPSC2017000117(Poster) \n\n\n\nANTIMICROBIAL ACTIVITY OF MORINGA OLEIFERA LEAVES EXTRACTS AGAINST \n\n\n\nISOLATED HUMAN DENTAL PATHOGENS \n\n\n\n\n\n\n\nKumari AVAG1, Kevina Y1 \n\n\n\n1School of Pharmacy, KPJ Health Care University College, Nilai, Malaysia; \n\n\n\n\n\n\n\nINTRODUCTION: Dental caries are considered as one of the key role in oral health issues. Antibiotic resistance \n\n\n\nhas increased in the recent years against dental pathogens. Moringa oleifera is a plant with enormous \n\n\n\npharmaceutical properties. Therefore, the developments of naturally obtained antimicrobial agents from the M. \n\n\n\noleifera for dental pathogens are of interest.   \n\n\n\nOBJECTIVES: The present study was aimed to evaluate the antimicrobial activity of M. oleifera leaves against \n\n\n\nthe isolated human dental pathogens.  \n\n\n\nMETHODS: The powdered M. oleifera leaves were extracted by cold maceration technique. The dental \n\n\n\npathogens were isolated from the patients with dental caries and identified using staining techniques and \n\n\n\nbiochemical tests. Cup plate method was used to evaluate the antimicrobial activity of water and ethanolic extracts \n\n\n\nof M. oleifera against the isolated dental pathogens. MIC and MBC of both extracts were also determined. \n\n\n\nRESULTS: The isolated dental pathogens were Streptococcus mutans, Lactobacillus acidophilus, Klebsiella \n\n\n\npneumoniae and Candida albicans. Water and ethanolic extracts of M. oleifera leaves had high inhibitory effect \n\n\n\non S. mutans with diameter of inhibition zones 25.7 mm and 22.3 mm respectively. The MIC and MBC values of \n\n\n\nwater and ethanolic extracts of M. oleifera against S. mutans were found to be 25 mg/ml and 50 mg/ml \n\n\n\nrespectively. The results were compared with Amoxicillin which showed moderate sensitivity against S. mutans. \n\n\n\nCONCLUSION: The findings showed that M. oleifera leaves are a potential source of antimicrobial agent against \n\n\n\ndental pathogens. Further studies are required to evaluate the safety and therapeutic efficacy of M. oleifera leaves. \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n77 \n\n\n\n\n\n\n\nMPSPSC2017000118(Poster) \n\n\n\nANTIPYRETIC ACTIVITY OF HIBISCUS ROSA-SINENSIS STEM EXTRACT \n\n\n\n\n\n\n\nKhairi M1, Anandarajagopal K1 \n\n\n\n1School of Pharmacy, KPJ Healthcare University College, Persiaran Seriemas, Kota Seriemas, Nilai 71800, \n\n\n\nNegeri Sembilan, Malaysia \n\n\n\n\n\n\n\nINTRODUCTION: Natural products are chemical composite that typically have benefits of biological activity \n\n\n\nin the discovery and design of pharmaceutical drugs. Hibiscus rosa-sinensis (family: Malvaceae) is an evergreen \n\n\n\nherbaceous plant in tropical countries. The plant is utilized in treating various human diseases.  \n\n\n\nOBJECTIVE: The present study was intended to evaluate the antipyretic activity of H. rosa-sinensis stem extract \n\n\n\nin experimental rats.  \n\n\n\nMETHODS: The water and ethanol extracts of H. rosa-sinensis stem were prepared using cold maceration \n\n\n\nmethod and subjected to preliminary phytochemical screening to identify the presence of plant secondary \n\n\n\nmetabolites. The antipyretic activity was evaluated by yeast-induced pyrexia model in rats. Water and ethanol \n\n\n\nextracts of H. rosa-sinensis stem (200 mg/kg) was orally administered to the pyrexia-induced rats. Antipyretic \n\n\n\nactivity was assessed by measuring the rectal temperature of rats using a digital thermometer. The rectal \n\n\n\ntemperature was recorded before and after induction of yeast and after oral administration of extracts and standard \n\n\n\ndrug. \n\n\n\nRESULTS: The phytochemical analysis exhibited the presence of alkaloids, carbohydrates, glycosides, saponins, \n\n\n\nterpenoids, flavonoids, phenols and tannins in the stem extracts. Both extracts showed significant (p<0.001) \n\n\n\nreduction in elevated rectal temperature at 4th hour. However, water extract of H. rosa-sinensis stem exhibited \n\n\n\nhigh significant (p<0.001) antipyretic activity than ethanol extract which might due to the presence of flavonoids \n\n\n\nas well as terpenoids.  \n\n\n\nCONCLUSION: The findings suggest that H. rosa-sinensis stem might be useful in reducing fever and is a good \n\n\n\nresource for the development of new natural antipyretic agent. \n\n\n\n\n\n\n\nMPSPSC2017000119(Poster) \n\n\n\nDEVELOPMENT OF POLYMERIC FILMS FOR THE EFFECTIVE DELIVERY OF TIMOLOL \n\n\n\nMALEATE IN THE MANAGEMENT OF GLAUCOMA \n\n\n\n\n\n\n\nKhan A1, Anandarajagopal K1  \n1School of Pharmacy, KPJ Healthcare University College, Nilai, Negeri, Sembilan Malaysia \n\n\n\n\n\n\n\nINTRODUCTION: Effective delivery of therapeutic agents via the ocular route particularly for the systemic \n\n\n\neffects such as the management of glaucoma remains as a challenge for the formulation scientists and several \n\n\n\napproaches have been made to improve the local and systemic delivery of drugs to/via the eye. Timolol maleate \n\n\n\nis a \u03b2 adrenergic blocker used in the treatment of glaucoma.   \n\n\n\nOBJECTIVE: To develop ocular films for the effective delivery of Timolol maleate in the management of \n\n\n\nglaucoma. \n\n\n\nMETHODS: Films were prepared using Chitosan in combination with other polymers such as hydroxypropyl \n\n\n\ncellulose (HPC), hydroxyethyl cellulose, polyvinyl alcohol (PVA), and polyvinyl pyrrolidone (PVP), using \n\n\n\npropylene glycol as plasticizer. The prepared films were evaluated for physical/mechanical properties such as \n\n\n\nthickness, clarity, uniformity of appearance, swelling index, moisture uptake tensile strength in, folding endurance \n\n\n\nand percent, pH, bio-adhesive properties, drug content uniformity, in-vitro drug release and drug polymer \n\n\n\ninteraction studies.  \n\n\n\nRESULTS: Films prepared using a plasticizer concentration of 50% w/w of polymer concentration was found \n\n\n\nhave good physical appearance. Increase in the percentage of hydrophilic polymers resulted in significant increase \n\n\n\nin the thickness, percent moisture uptake & percentage swelling. Increase in the hydrophilic polymer \n\n\n\nconcentration also resulted in an increase of tensile strength and elongation at break. Maximum thickness was \n\n\n\nobserved for the formulation containing Chitosan \u2013 HEC (1:2). Likewise, highest swelling index with maximum \n\n\n\nmoisture uptake and highest endurance and tensile strength. A significant correlation was observed between the \n\n\n\nswelling index and the bio-adhesive strength of the polymer composites used. In-vitro drug release studies suggest \n\n\n\nthat increase in the hydrogel forming polymers resulted in more controlled release of drug compared to hydrophilic \n\n\n\npolymers. Stability studies indicated that there was no influence of relative humidity and storage at 45\u00baC. Timolol \n\n\n\nmaleate was completely entrapped in the polymer carrier which was evident from the IR spectra.  \n\n\n\nCONCLUSION: It can be concluded that ocular films prepared using hydrogels as film forming agents is a viable \n\n\n\noption for the effective delivery of Timolol maleate in management of glaucoma  \n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n78 \n\n\n\n\n\n\n\nMPSPSC2017000120 (Poster) \n\n\n\nDOXYCYCLINE ATTENUATES COGNITIVE DYSFUNCTION ON CEREBRAL ISCHEMIC \n\n\n\nSTROKE IN WISTAR RATS \n\n\n\nHanish Singh JC1, Sumanth YVH2, Manan MM1 \n1School of Pharmacy, KPJ Healthcare University College, Nilai, Negeri Sembilan, Malaysia-71800. \n2School of Pharmacy, Anurag Group of institutions, Ghatkesar, Hyderabad-501301 \n\n\n\n\n\n\n\nINTRODUCTION: Cerebral ischemic stroke (CIS) is a condition where there is a decrease in blood supply to \n\n\n\nthe brain, which may be due to thrombosis, systemic hypo perfusion, embolism or hypertension. The lack of blood \n\n\n\nsupply leads to abnormalities in the cognition and behaviour. There is an increase in the inflammatory mediator \n\n\n\nTNF-\u03b1, leukocytes and increase in acetylcholinesterase (ACHE), glutamate are found during cerebral ischemia. \n\n\n\nDoxycycline is a second-generation tetracycline antibiotic. Doxycycline also inhibits MMP-9 which have a vital \n\n\n\nrole in ischemic injury. \n\n\n\nOBJECTIVES: This investigation aimed to evaluate the effect of Doxycycline through reduction in inflammation \n\n\n\nand cognitive impairment in cerebral ischemic stroke model. \n\n\n\nMETHODS: The animals were randomly divided in to four groups of 6 rats per group as following, Group I:  \n\n\n\nVehicle (distilled water) treated orally, Group II:  ischemia produced, Group III and IV:  animals treated with \n\n\n\nDoxycycline 15 and 30mg/kg (p.o), induced with ischemia respectively. The middle carotid artery is ligated to \n\n\n\ninduce cerebral ischemia. Doxycycline is administered for 7 days and on 7th day ischemia was induced and \n\n\n\ntreatment continued till 14th day. After evaluation of behavioural parameters, the animals were sacrificed on 15th \n\n\n\nday and biochemical parameters like leukocyte count, lactate dehydrogenase (LDH), ACHE, glutamate are \n\n\n\nmeasured.  \n\n\n\nRESULTS: The biochemical evaluation revealed that the Doxycycline significantly reduced (P<0.05 and \n\n\n\nP<0.001) the elevated levels of AChE enzyme, glutamate and LDH, which exerted the neuroprotective effect in \n\n\n\nischemic conditions. Behavioural parameters were also improved.  \n\n\n\nCONCLUSION: In conclusion, our investigation with Doxycycline on CIS induced rats indicated \n\n\n\nneuroprotection. \n\n\n\n\n\n\n\n\n\n\n\nMPSPSC2017000121 (Poster) \n\n\n\nTHE PRESCRIBING PATTERN OF ANTIDIABETICS AND UTILIZATION OF CLINICAL \n\n\n\nPRACTICE GUIDELINES IN MANAGING T2DM PATIENTS IN A PRIVATE HOSPITAL \n\n\n\n\n\n\n\nMenon BVV1, Manan MM1 \n1School of Pharmacy, KPJ Healthcare University College, Malaysia     \n\n\n\n\n\n\n\nINTRODUCTION: The advent of novel antidiabetic agents had provided a new challenge to the management of \n\n\n\nType 2 Diabetes Mellitus in terms of the right choice of pharmacotherapy as per available guidelines. \n\n\n\nOBJECTIVES: The purpose of this study was to probe into the pattern of prescribing of antidiabetics in a private \n\n\n\nhospital setting and document the extent of utilization of the Malaysian CPG for Management of T2DM 2015 in \n\n\n\nmanaging these patients. \n\n\n\nMETHOD: The retrospective study used the convenient sampling method to select 115 T2DM patients using an \n\n\n\ninternally designed data collection form. The inclusion criteria were adult patients who were on antidiabetics for \n\n\n\nat least 3 months prior to sampling with or without comorbidities. The HbA1c values were used as an indicator \n\n\n\nfor glycaemic control. Values 8% and below were classified as good glycaemic control. \n\n\n\nRESULTS: The most prescribed class of antidiabetics were biguanides (Metformin) (87%) followed by DPP4 \n\n\n\ninhibitor (Sitagliptin) (61.7%) and Sulfonylureas (Gliclazide) (56.5%). The most commonly prescribed dual \n\n\n\ntherapy was Metformin plus Gliclazide (47.6%) followed by Metformin plus Sitagliptin (40.5%) while the most \n\n\n\nprescribed triple therapy was the combination of Metformin plus Gliclazide plus Sitagliptin (65.8%). Poor \n\n\n\nglycaemic control was observed in majority of the patients, with a mean HbA1c of 9.329 (\u00b1 2.201). The extent of \n\n\n\nutilization of guidelines were seen in 48% of patients. 55.7% was seen in the prescribing of sulfonylurea followed \n\n\n\nby metformin (24.6%). \n\n\n\nCONCLUSION: The utilization of CPG for the Management of T2DM 2015 in managing patients with T2DM \n\n\n\nwas found to be low and this was reflected in the glycaemic control of the sampled patients.  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n79 \n\n\n\n\n\n\n\nMPSPSC2017000122 (Poster) \n\n\n\nEVALUATION OF THE PREDICTIVE PERFORMANCE OF BLEEDING RISK SCORES IN \n\n\n\nPATIENTS WITH NONVALVULAR ATRIAL FIBRILLATION ON ORAL ANTICOAGULANTS \n\n\n\n\n\n\n\nBeshir SA1, Aziz Z 1, Yap LB 2, Chee KH 3, and Lo YL, 1,4*   \n1 Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia \n2 National Heart institute, Kuala Lumpur, Malaysia \n3 Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia \n4 School of Pharmacy, International Medical University, Kuala Lumpur, Malaysia \n\n\n\n\n\n\n\nINTRODUCTION: Bleeding risk scores (BRSs) aid in the assessment of oral anticoagulant-related bleeding risk \n\n\n\nin patients with atrial fibrillation. Ideally, the applicability of a BRS needs to be assessed, prior to its routine use \n\n\n\nin a population other than the original derivation cohort.  \n\n\n\nOBJECTIVE: To evaluate the performance of 6 established BRSs (mOBRI, CBRM, HEMORR2HAGES, HAS-\n\n\n\nBLED, ATRIA and ORBIT) to predict major or clinically relevant bleeding (CRB) events associated with the use \n\n\n\nof oral anticoagulant (OAC) among Malaysian patients.  \n\n\n\nMETHODS: This is a retrospective cohort study involving patients with nonvalvular atrial fibrillation (NVAF) \n\n\n\nreceiving warfarin, dabigatran or rivaroxaban at the University of Malaya Medical Centre (UMMC) and institut \n\n\n\nJantung Negara (IJN). Patients who experienced an OAC-associated major or CRB event within 12 months of \n\n\n\nfollow-up, or who have received OAC therapy for at least one year were identified. The BRSs were fitted \n\n\n\nseparately into patient data. The discrimination and the calibration of these BRSs were assessed.  \n\n\n\nRESULTS: A total of 1,017 patients with at least 1-year follow-up period, or those who developed a bleeding \n\n\n\nevent within one year of OAC use were recruited. Of which, 23 patients experienced a first major bleeding event; \n\n\n\nwhile 76 patients, a first CRB event. All the BRSs show a satisfactory calibration for major and CRB events. \n\n\n\nAmong these BRSs, only HEMORR2HAGES (C-statistic = 0.71, 95%CI 0.60-0.82, p < 0.001), and ATRIA score \n\n\n\n(C-statistic = 0.70, 95%CI 0.58-0.82, p < 0.001) show acceptable discrimination performance for major bleeding \n\n\n\nevents. All the 6 BRSs, however, lack acceptable predictive performance for CRB events.  \n\n\n\nCONCLUSION: These BRSs show poor to acceptable predictive performance on OAC-induced major or CRB \n\n\n\nevents. An improvement in the existing BRSs for OAC users is warranted. \n \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n80 \n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n81 \n\n\n\n \n\n\n\n\n\n"
"\n\nMalaysian Journal of Pharmacy Volume 7 Issue 1 (2021) \n \n\n\n\n\n\n\n\n11 \n\n\n\n\n\n\n\n*Correspondence: ivan@ssm.gov.mo; \n\n\n\nmicmicvongchon@gmail.com \n\n\n\n\n\n\n\n\n\n\n\n1 Department of Administration, Centro Hospitalar Conde de S\u00e3o Janu\u00e1rio, \n\n\n\nHealth Bureau, Macao SAR Government, China \n2 Division of Pharmacy, Centro Hospitalar Conde de S\u00e3o Janu\u00e1rio, Health \n\n\n\nBureau, Macao SAR Government, China \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n Case Studies \n\n\n\n\n\n\n\nMonotherapy with Lopinavir/Ritonavir or in Combination \n\n\n\nwith Interferon Beta-1b in Patients with Non-severe COVID-19 \n\n\n\nDisease: A Clinical Case Series \n \nKuok Leong Ng1*, Weng Chio2, Io Chon Vong2*, Chan Chan Si2, Veng Va Chau2, Si Man Wong2, Tou \n\n\n\nChan Cheong2, Iok Tong Wong2 \n\n\n\n\n\n\n\n  \nArticle Info  \n\n\n\n \nReceived date: 19 April 2021 \n\n\n\nAccepted date: 1 June 2021 \n\n\n\nPublished date: 30 June 2021 \n\n\n\n\n\n\n\nKeywords:  \n\n\n\nLopinavir/ritonavir, Interferon \n\n\n\nbeta-1b, COVID-19, PCR, \n\n\n\nLength of hospitalization, \n\n\n\nMacau \n\n\n\nABSTRACT  \n\n\n\n\n\n\n\nThe outbreak of Coronavirus Disease 2019 (COVID-19), caused by severe acute respiratory \n\n\n\nsyndrome (SARS) coronavirus (SARS-CoV-2), has infected and killed millions of people worldwide. \n\n\n\nIt has substantially increased the burden on healthcare system. However, the optimal approach to \n\n\n\ntreatment of COVID-19 is uncertain. \u201cOff-label\u201d use of lopinavir/ritonavir (LPV/r) and interferons, \n\n\n\nparticularly interferon beta (IFN-\u03b2), were the most suggested at the early stage. Although the United \n\n\n\nStates National Institutes of Health\u2019s (NIH) COVID-19 guidelines do not recommend the use of both \n\n\n\nmedications for the treatment of COVID-19 in hospitalized patients, their roles in patients with non-\n\n\n\nsevere disease are still unclear. Macau, a famous city for tourism, had 46 COVID-19 confirmed cases \n\n\n\nas of 2020. In this retrospective review, we summarized clinical and laboratory features of 39 \n\n\n\nCOVID-19 patients admitted in the Centro Hospitalar Conde de S\u00e3o Janu\u00e1rio (CHCSJ), of whom all \n\n\n\ndid not receive oxygen therapy or ventilatory support during hospitalization. Of note, 12 (30.8%) of \n\n\n\nthem were asymptomatic. The most common symptoms were fever and cough upon admission. They \n\n\n\nwere all treated with LPV/r \u00b1 IFN-\u03b2-1b plus supportive care. The mean length of hospitalization was \n\n\n\n26.6 (SD \u00b1 12.6) days with LPV/r monotherapy, whereas 27.8 (SD \u00b1 10.1) days with LPV/r/IFN-\u03b2-\n\n\n\n1b combination therapy (p=0.65). The percentage of 28-day negative results for polymerase chain \n\n\n\nreaction (PCR) test were 67.9% (19 of 28) with monotherapy and 63.6% (7 of 11) with combination \n\n\n\ntherapy (p=0.80). No fatal case was reported and all patients discharged successfully. No beneficial \n\n\n\nclinical outcome was observed with the addition of IFN-\u03b2-1b to LPV/r-based therapy. Further studies \n\n\n\nare warranted to confirm these findings. \n\n\n\n\n\n\n\nINTRODUCTION  \n  \n\n\n\nAt the end of 2019, a novel coronavirus was identified as the \n\n\n\ncause of atypical pneumonia in Wuhan, a city in the Hubei \n\n\n\nProvince of China and quickly spread in a number of countries. \n\n\n\nIn February 2020, the World Health Organization (WHO) \n\n\n\nnamed the disease COVID-19, which stands for coronavirus \n\n\n\ndisease 2019 [1]. The virus that causes COVID-19 is called \n\n\n\nsevere acute respiratory syndrome coronavirus 2 (SARS-CoV-\n\n\n\n2). As of Dec, 2020, it has infected more than 79 million \n\n\n\npatients with over 1.7 million deaths globally [2]. Moreover, \n\n\n\nhealthcare professionals are now facing a big challenge, in \n\n\n\nparticular on the treatment and the burden on the health care \n\n\n\nsystem. However, the optimal approach to treatment of \n\n\n\nCOVID-19 remains uncertain. Lopinavir/ritonavir (LPV/r) and \n\n\n\ninterferon beta (IFN-\u03b2), in particular interferon beta-1b were \n\n\n\nthe most proposed treatment options in off-label use at the early \n\n\n\nstage of pandemic due to modest activity in vitro against \n\n\n\nSARS-CoV and Middle East respiratory syndrome (MERS)-\n\n\n\nCoV. Although the United States National Institutes of \n\n\n\nHealth\u2019s (NIH) COVID-19 guidelines in Oct, 2020 [3] did not \n\n\n\nrecommend the use of both medications for treating COVID-\n\n\n\n19 in hospitalized patients, their roles in patients with non-\n\n\n\nsevere disease are still unclear. Macau, a Special \n\n\n\n\nmailto:ivan@ssm.gov.mo\n\n\nmailto:micmicvongchon@gmail.com\n\n\n\n\n\n\nNg, K.L. et al. Mal J Pharm 7 (1) 2021,11-15 \n\n\n\n\n\n\n\n12 \n\n\n\n\n\n\n\nAdministrative Region of the People\u2019s Republic of China \n\n\n\nreported a total of 46 COVID-19 cases in 2020. Among them, \n\n\n\nover 80 % were non-severe meaning that they did not need \n\n\n\noxygenation or mechanical ventilatory support during \n\n\n\nhospitalization. In this retrospective study, we collected data \n\n\n\nfrom 39 patients with COVID-19 admitted to the Centro \n\n\n\nHospitalar Conde de S\u00e3o Janu\u00e1rio (CHCSJ), which is the \n\n\n\ndesignated hospital for managing all COVID-19 patients in \n\n\n\nMacau SAR, China. All patients were treated with LPV/r \n\n\n\nmonotherapy or in combination with IFN-\u03b2-1b plus supportive \n\n\n\ncare. This study was to observe whether any clinical benefit \n\n\n\nexists by adding IFN-\u03b2-1b to LPV/r-based therapy compared \n\n\n\nwith LPV/r monotherapy.  \n\n\n\n\n\n\n\nMETHOD  \n  \n\n\n\nStudy design and participants \n\n\n\n\n\n\n\nEthical approval (document no. 0067/DAH/N/2020) was \n\n\n\nobtained from the ethical committee of Centro Hospitalar \n\n\n\nConde de S\u00e3o Janu\u00e1rio, Macau Health Bureau, Macau SAR, \n\n\n\nChina. Eligibility criteria for this study were patients with \n\n\n\nconfirmed COVID-19 disease and hospitalized at CHCSJ, \n\n\n\nwhile fulfilled the below clinical classification of non-severe \n\n\n\ndisease, and received LPV/r for a median of 21 days \u00b1 IFN-\u03b2-\n\n\n\n1b for a median of 14 days plus supportive care (i.e. \n\n\n\nsymptomatic drug treatment as well as general inpatient care \n\n\n\nincluding daily vital signs monitoring and regular biochemistry \n\n\n\ntests). We reviewed the details from medical records including \n\n\n\ndemographics, past medical history, laboratory results, \n\n\n\nradiological findings, clinical management, length of \n\n\n\nhospitalization and time to completed negative result for \n\n\n\npolymerase chain reaction (PCR) test.   \n\n\n\n\n\n\n\nPCR assay for SARS-CoV-2 \n\n\n\n\n\n\n\nSamples were mainly taken from nasopharyngeal swabs (NPS) \n\n\n\nin all patients. The extraction of nucleic acid from samples was \n\n\n\nperformed using EasyMag in accordance with the \n\n\n\nmanufacturer's instructions (bioMerieux, France). Extracted \n\n\n\nnucleic acid samples were tested for SARS-CoV-2 with qRT-\n\n\n\nPCR using a commercial SARS-CoV-2 (previously known as \n\n\n\n2019- nCoV) ORF1ab/N Gene Nucleic acid detection kit \n\n\n\n(BioGerm, China) and the LightCycler 480 real-time PCR \n\n\n\nsystem (Roche, Switzerland) in accordance with \n\n\n\nmanufacturer's instructions.  \n\n\n\n\n\n\n\nDefinitions for clinical classification \n\n\n\n\n\n\n\nAccording to the United States National Institutes of Health\u2019s \n\n\n\n(NIH) COVID-19 guidelines [3], severe illness is defined as \n\n\n\nindividuals who have SpO2 <94% on room air at sea level, a \n\n\n\nratio of arterial partial pressure of oxygen to fraction of inspired \n\n\n\noxygen (PaO2/FiO2) <300 mm Hg, respiratory frequency >30 \n\n\n\nbreaths/min, or lung infiltrates >50%. Whereas critical illness \n\n\n\nrefers to individuals who have respiratory failure, septic shock, \n\n\n\nand/or multiple organ dysfunction. In this study, we defined \n\n\n\nnon-severe COVID-19 disease patients as those who were \n\n\n\nasymptomatic or presymptomatic, mild illness with signs and \n\n\n\nsymptoms compatible with upper respiratory tract infection \n\n\n\n(e.g. isolated low-grade fever, cough, rhinorrhea or myalgia), \n\n\n\nmoderate illness that exhibited lower respiratory tract infection \n\n\n\n(e.g. pneumonia or bronchitis) but did not present with hypoxia \n\n\n\n(oxygen saturation \u2264 94 percent on room air) or need for \n\n\n\noxygenation or mechanical ventilatory support during \n\n\n\nhospitalization. \n\n\n\n\n\n\n\nCOVID treatments \n\n\n\n\n\n\n\nAll included patients with no contraindications received LPV/r \n\n\n\n(400 mg/100 mg) twice daily for a median of 21 days. Besides, \n\n\n\nthey were given either azithromycin 500mg daily or \n\n\n\nlevofloxacin 500-750mg daily as prophylactic agent for \n\n\n\nsecondary bacterial infection. Patients with an early onset of \n\n\n\nillness (within 7 days) were given interferon beta-1b 250mcg \n\n\n\n(8 million IU) subcutaneously every other day for a median of \n\n\n\n14 days when the drug was available in Macau.  Symptomatic \n\n\n\ntreatments (e.g. antipyretics, antihistamines and expectorants, \n\n\n\netc.) were given when required. The standard biochemistry, \n\n\n\nimaging tests were systematically performed upon admission. \n\n\n\n\n\n\n\nCriteria for discharge  \n\n\n\n\n\n\n\nPatients with completed negative result for PCR assay (i.e. two \n\n\n\nconsecutive negative nasopharyngeal samples) were \n\n\n\ntransferred to other units for medical observation then \n\n\n\ndischarged in the absence of relapse.  \n\n\n\n\n\n\n\nMeasured Outcomes \n\n\n\n\n\n\n\nWe interpreted the collected data including the length of \n\n\n\nhospitalization and the percentage of 28-day negative result for \n\n\n\nPCR test via nasopharyngeal swabs. \n\n\n\n\n\n\n\nData and statistical analyses \n\n\n\n\n\n\n\nPatients\u2019 data are presented as absolute value, percentage, mean \n\n\n\n\u00b1 SD or median ((interquartile rage (IQR)). Continuous \n\n\n\nvariables and categorical variables were compared using the \n\n\n\nMann-Whitney U test and \u03c7\u00b2 test, respectively; P value of less \n\n\n\nthan 0.05 was considered statistically significant. All tables \n\n\n\nwere generated by JASP 0.14.1. \n\n\n\n \n\n\n\n\n\n\n\n\nNg, K.L. et al. Mal J Pharm 7 (1) 2021,11-15 \n\n\n\n\n\n\n\n13 \n\n\n\n\n\n\n\n Table I Demographic and clinical characteristics of the patients at admission \n\n\n\n\n\n\n\nCharacteristics  Lopinavir + ritonavir \n\n\n\n(n=28) \n\n\n\nLopinavir + ritonavir + interferon beta-\n\n\n\n1b (n=11) \n\n\n\nAge, median (IQR) \u2014 yr 24.5 (18.5) 44.0 (20.0) \n\n\n\n<18y \u2014 no. (%) 6 (21.4) 0 (0.0) \n\n\n\n18 to 59 y \u2014 no. (%) 21 (75.0) 11 (100.0) \n\n\n\n\u226560 y \u2014 no. (%) 1 (3.6) 0 (0.0) \n\n\n\nMale \u2014 no. (%) 16 (57.1) 8 (72.7) \n\n\n\nComorbidity \u2014 no. (%)  \n\n\n\nDiabetes mellitus  0 (0.0) 2 (18.2) \n\n\n\nHypertension 2 (7.1) 4 (36.4) \n\n\n\nCardiovascular disease  1 (3.6) 0 (0.0) \n\n\n\nCurrent smoker \u2014 no. (%) 2 (7.1) 2 (18.2) \n\n\n\nEx-smoker \u2014 no. (%) 4 (14.3) 3 (27.3) \n\n\n\nTime between onset of symptoms and hospitalization, median (IQR) \u2014 \n\n\n\ndays \n\n\n\n1.5 (8.0) 1.0 (5.5) \n\n\n\nSigns and symptoms \u2014 no. (%)  \n\n\n\nFever,    \n\n\n\nBody temperature \u226537.5\u2103 (%) 10 (35.7) 3 (27.3) \n\n\n\nBody temperature, median (IQR) \u2014\u2103 37.0 (0.9) 37.3 (1.2) \n\n\n\nCough  8 (28.6) 4 (36.4) \n\n\n\nSore throat 3 (10.7) 6 (54.5) \n\n\n\nMyalgia  3 (10.7) 1 (9.1) \n\n\n\nDiarrhea, \u22653 times/day  3 (10.7) 0 (0.0) \n\n\n\nHeadache  3 (10.7) 0 (0.0) \n\n\n\nRhinorrhea  3 (10.7) 1 (9.1) \n\n\n\nDizziness 2 (7.1) 1 (9.1) \n\n\n\nAbdominal pain 0 (0.0) 1 (9.1) \n\n\n\nLoss of smell  1 (3.6) 0 (0.0) \n\n\n\nRespiratory rate \u2265 24/min (%) 0 (0.0) 0 (0.0) \n\n\n\nSerum creatinine, median (IQR) \u2014 umol/L 67.5 (22.3) 77.0 (14.0) \n\n\n\nWhite cell count, median (IQR) \u2014 x109/L 5.4 (3.6) 5.2 (3.8) \n\n\n\nLymphocyte count, median (IQR) \u2014 x109/L 1.6 (0.9) 1.3 (0.6) \n\n\n\nAspartate transaminase, median (IQR) \u2014 U/L 20.0 (6.0) 33.0 (11.5) \n\n\n\nAlanine transaminase, median (IQR) \u2014 U/L 15.0 (25.0) 26.0 (38.0) \n\n\n\nLactate dehydrogenase, median (IQR) \u2014 U/L 166.5 (53.3) 176.0 (88.0) \n\n\n\nC-reactive protein, median (IQR) \u2014 mg/dL 0.1 (0.3) 0.3 (0.5) \n\n\n\n\n\n\n\nTable II Treatment and outcome \n\n\n\n\n\n\n\nOutcomes Lopinavir + ritonavir \n\n\n\n(n=28) \n\n\n\nLopinavir + ritonavir + interferon \n\n\n\nbeta-1b (n=11) \n\n\n\nDeath, no. (%) 0 (0.0) 0 (0.0) \n\n\n\nDischarged, no. (%) 28 (100.0) 11 (100.0) \n\n\n\n28-day negative result for PCR assay, no. (%) 19 (67.9) 7 (63.6) \n\n\n\nTime for completed negative PCR result, days   \n\n\n\nMean \u00b1 SD 25.7 \u00b1 14.5 25.5 \u00b1 5.4 \n\n\n\nMin \u2013 Max 6 - 63 18 - 33 \n\n\n\nLength of stay in hospital, days   \n\n\n\n        Mean \u00b1 SD 26.6 \u00b1 12.6 27.8 \u00b1 10.1 \n\n\n\n        Min - Max 6 - 61 12 - 47 \n\n\n\nPossible adverse events, no. (%)   \n\n\n\n     Dermatologic  2 (7.1) 4 (36.4) \n\n\n\n     Gastrointestinal  19 (67.9) 8 (72.7) \n\n\n\n     Endocrine and metabolic 3 (10.7) 2 (18.2) \n\n\n\n     Hepatic 1 (3.6) 0 (0.0) \n\n\n\n     Central nervous system 4 (14.3) 0 (0.0) \n\n\n\n     Neuromuscular and skeletal  0 (0.0) 1 (9.1) \n\n\n\n\n\n\n\n \n\n\n\n\nhttps://en.wikipedia.org/wiki/Aspartate_transaminase\n\n\nhttps://en.wikipedia.org/wiki/Alanine_transaminase\n\n\n\n\n\n\nNg, K.L. et al. Mal J Pharm 7 (1) 2021,11-15 \n\n\n\n\n\n\n\n14 \n\n\n\n\n\n\n\nRESULT \n \n\n\n\nA total of 46 patients were reviewed, seven patients did not \n\n\n\nfulfil the inclusion criteria. Therefore, 39 patients were lastly \n\n\n\nrecruited which accounted for 85% of the confirmed COVID-\n\n\n\n19 cases in Macau in 2020. Of note, 12 (30.8%) of them were \n\n\n\nasymptomatic. 28 patients were treated with LPV/r \n\n\n\nmonotherapy and 11 patients were treated with LPV/r/IFN-\u03b2-\n\n\n\n1b combination therapy. All patients received treatment on the \n\n\n\nday of admission, and successfully discharged in the end. The \n\n\n\nmedian age of patients was 24.5 years old (IQR 18.5) for the \n\n\n\nLPV/r monotherapy group; 44 years old (IQR 20.0) for the \n\n\n\nLPV/r/IFN-\u03b2-1b combination group. The most common \n\n\n\nsymptoms were fever and cough (with the exception of sore \n\n\n\nthroat in the combination group) in both groups at admission. \n\n\n\nThe median time between onset of symptoms and \n\n\n\nhospitalization was 1.5 day (IQR 8.0) for the monotherapy \n\n\n\ngroup and 1.0 day (IQR 5.5) for the combination group (Table \n\n\n\nI). The mean length of hospitalization was 26.6 (SD \u00b1 12.6) \n\n\n\ndays with LPV/r monotherapy whereas 27.8 (SD \u00b1 10.1) days \n\n\n\nwith LPV/r/IFN-\u03b2-1b combination therapy (p=0.65). The \n\n\n\npercentage of 28-day negative results for PCR test were 67.9% \n\n\n\n(19 of 28) with monotherapy and 63.6% (7 of 11) with \n\n\n\ncombination therapy (p=0.80). The most common adverse \n\n\n\nevents   possibly related to medications include diarrhea and \n\n\n\nskin rash. Those were minor and treated accordingly (Table II). \n\n\n\nThere was a potential risk of interaction with the disease and \n\n\n\nother drugs.  \n\n\n\n\n\n\n\nDISCUSSION  \n  \n\n\n\nIn this retrospective review, no beneficial clinical effect was \n\n\n\nobserved in hospitalized patients with COVID-19 with the \n\n\n\naddition of injectable IFN-\u03b2-1b (given within 7 days of \n\n\n\nsymptom onset) to oral protease inhibitor (LPV/r)-based \n\n\n\ntherapy. On the contrary, a multicenter, open-label, \n\n\n\nrandomized, phase 2 trial conducted in Hong Kong, over 80% \n\n\n\nincluded patients with mild to moderate disease, compared 14 \n\n\n\ndays of triple antiviral therapy (n = 86) (LPV/r [400 mg/100 mg \n\n\n\nq12h], ribavirin [400 mg q12h], IFN-\u03b2-1b [8 million IU x 3 \n\n\n\ndoses q48h]) with LPV/r alone (n = 41). Results showed that \n\n\n\ntriple therapy significantly shortened the duration of viral \n\n\n\nshedding and hospital stay in patients with mild-to-moderate \n\n\n\nCOVID-19, the median time of combination therapy from the \n\n\n\nbeginning of study treatment to negative nasopharyngeal swab \n\n\n\n(7 days [IQR 5\u201311]) than the control group (12 days [IQR 8\u2013\n\n\n\n15]; hazard ratio 4.37 [95% CI 1.86\u201310.24], p=0.0010) [4]. \n\n\n\nAnother retrospective cohort study demonstrated that ribavirin \n\n\n\ntherapy compared with supportive therapy in severe COVID-\n\n\n\n19, was not associated with improved negative conversion time \n\n\n\nfor SARS-CoV-2 test and was not associated with an improved \n\n\n\nmortality rate5. Compared with our findings without ribavirin, \n\n\n\nthe mean time to negative result was approximately 25 days \n\n\n\nbetween the two groups. Owing to small sample size and lack \n\n\n\nof control group, the results of our study could not draw a \n\n\n\nconclusion on how effective is LPV/r in non-severe COVID-19 \n\n\n\npatients. It is worth noting that the patients\u2019 age in the \n\n\n\ncombination group ranged from 18-59 years old. We postulated \n\n\n\nthat these patients may have better immune response so that the \n\n\n\nresults may be affected. In addition, most cases were imported \n\n\n\nfrom different parts of the world, the genotype or phenotype of \n\n\n\ndifferent viral variants they carried might interfere with the \n\n\n\nfindings.  \n\n\n\n\n\n\n\nAt present, the COVID-19 pandemic has caused a huge burden \n\n\n\nto the economy and healthcare system around the world. \n\n\n\nHealthcare professionals work under stress every day. In \n\n\n\nMacau, CHCSJ, the designated hospital for treating COVID-19 \n\n\n\noffered adequate resources for in-hospital care and isolation \n\n\n\nwards throughout the outbreak even for asymptomatic patients. \n\n\n\nAs a matter of fact, there are no clear criteria for hospital \n\n\n\nadmission with COVID-19. The criteria may vary with the \n\n\n\navailability of hospital resources. Nonetheless, according to the \n\n\n\nUS National Institutes of Health (NIH) COVID-19 Treatment \n\n\n\nGuidelines Panel3, most patients with mild illness can be \n\n\n\nmanaged in an ambulatory care setting or at home. Therefore, \n\n\n\nwe believed that some of our non-severe cases may be treated \n\n\n\nin the outpatient setting in principle. Although several \n\n\n\ninternational guidelines against the use of LPV/r in hospitalized \n\n\n\npatient based on the results from multiple clinical trials [6-8], \n\n\n\nits role in the outpatient setting is being investigated. Therefore, \n\n\n\nour findings may provide an important reference for future \n\n\n\ninvestigation in such situation.  \n\n\n\n\n\n\n\nCONCLUSION \n\n\n\n\n\n\n\nThis series illustrated that no clinical benefit was observed with \n\n\n\nthe addition of IFN-\u03b2-1b to LPV/r-based therapy plus general \n\n\n\nsupportive care in hospitalized COVID-19 patient. In addition, \n\n\n\nit may also provide important information for the use of LPV/r \n\n\n\nin outpatient settings. In fact, more powerful evidences are \n\n\n\nwarranted to confirm these findings. \n\n\n\n\n\n\n\nCONFLICT OF INTEREST \n \n\n\n\nThe author declares no conflict of interest. This research did \n\n\n\nnot receive any specific grant from funding agencies in the \n\n\n\npublic, commercial or not-for-profit sectors. \n\n\n\n\n\n\n\nACKNOWLEDGEMENT \n \n\n\n\nWe appreciate all the clinical, technical and paramedical staffs \n\n\n\nin Macau for their support in this big challenge. \n\n\n\n\n\n\n\nREFERENCE \n \n\n\n\n[1] World Health Organization. Director-General's remarks at the media \n\n\n\nbriefing on 2019-nCoV on 11 February 2020. Available from: \n\n\n\n\n\n\n\n\nNg, K.L. et al. Mal J Pharm 7 (1) 2021,11-15 \n\n\n\n\n\n\n\n15 \n\n\n\n\n\n\n\nhttp://www.who.int/dg/speeches/detail/who-director-general-s-\n\n\n\nremarks-at-the-media-briefing-on-2019-ncov-on-11-february-2020/. \n\n\n\n[2] World Health Organization. Coronavirus disease 2019 (COVID-19) \n\n\n\nsituation report. Dec 29, 2020. Available from: \n\n\n\nhttps://www.who.int/publications/m/item/weekly-epidemiological-\n\n\n\nupdate---29-december-2020/. \n\n\n\n[3] US Department of Health and Human Services (HHS) Panel on \n\n\n\nCOVID-19 Treatment Guidelines. Coronavirus disease 2019 \n\n\n\n(COVID-19) treatment guidelines. Available from: \n\n\n\nhttps://www.covid19treatmentguidelines.nih.gov/. \n\n\n\n[4] Hung IFN, Lung KC, Keung EY, Liu R, Chung TWH, Chu MY, et al. \n\n\n\nTriple combination of interferon beta-1b, lopinavir\u2013ritonavir, and \n\n\n\nribavirin in the treatment of patients admitted to hospital with COVID-\n\n\n\n19: an open-label, randomised, phase 2 trial, Lancet. 2020 May 8;395: \n\n\n\n1695\u2013704.  \n\n\n\n[5] Tong S, Su Y, Yu Y, Wu C, Chen JL, Wang SH, et al. Ribavirin \n\n\n\ntherapy for severe COVID-19: a retrospective cohort study. \n\n\n\nInternational Journal of Antimicrobial Agents. 2020;106114.  \n\n\n\n[6] RECOVERY Collaborative Group. Lopinavir-ritonavir in patients \n\n\n\nadmitted to hospital with COVID-19 (RECOVERY): a randomised, \n\n\n\ncontrolled, open-label, platform trial. Lancet. 2020 Oct 24; 396: 1345\u2013\n\n\n\n52. \n\n\n\n[7] World Health Organization. Solidarity Trial Consotium. Repurposed \n\n\n\nAntiviral drugs for COVID-19-Interim WHO Solidarity Trial Results. \n\n\n\nN Engl J Med. 2021 Feb 11; 384:497-511.  \n\n\n\n[8] Cao B, Wang YM, Wen DN, Liu W, Wang JL, Fan GH, et al. A Trial \n\n\n\nof Lopinavir\u2013Ritonavir in Adults Hospitalized with Severe Covid-19. \n\n\n\nEngl J Med. 2020 May 7; 382:1787-1799. \n\n\n\n\n\n"
"\n\nMalaysian Journal of Pharmacy Volume 8 Issue 1 (2022) \n \n\n\n\n\n\n\n\n13 \n\n\n\n\n\n\n\n*Correspondence: anitharamadas @moh.gov.my \n\n\n\nramadas.anitha@gmait.com \n\n\n\n1 Department of Pharmacy, Hospital Kuala Lumpur,50586 Kuala Lumpur, \n\n\n\nMalaysia \n2 Consultant Infectious Disease Physician, Department of Medicine, \n\n\n\nHospital Kuala Lumpur, 50586 Kuala Lumpur, Malaysia \n3 Faculty of Pharmacy, Universiti Kebangsaan Malaysia, 50300 Kuala \nLumpur, Federal Territory of Kuala Lumpur, Malaysia  \n \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n Original Article \n\n\n\n\n\n\n\nImpact of an Antibiotic Stewardship Program on the Use of \n\n\n\nCarbapenem in a Malaysian Tertiary Hospital (ACTION)  \n \n\n\n\nAnitha Ramadas1*, Hwei Lin Teh1, Rahela Ambaras Khan1, Shan Lii Ching1, Rohana Hassan1, Chee \n\n\n\nLoon Leong2, Khairil Erwan Khalid2, Farida Hanim Islahudin3  \n\n\n\n\n\n\n\n \nArticle Info  \n\n\n\n \nReceived date: 31 Oct 2021  \n\n\n\nAccepted date: 03 Mar 2022 \n\n\n\nPublished date: 30 Jun 2022 \n\n\n\n\n\n\n\nKeywords: Antimicrobial \n\n\n\nstewardships, carbapenem. \n\n\n\nABSTRACT  \n\n\n\n\n\n\n\nIntroduction:  The Antimicrobial Stewardship (AMS) program had been advocated to promote the \n\n\n\nrational use of antibiotic prescribing. However, the outcome of AMS in promoting the judicious use \n\n\n\nof carbapenem, and thus, minimising resistance, has not been widely studied in Malaysia. Objective: \n\n\n\nTo investigate the types of interventions made by the AMS team, their acceptance, and the impact of \n\n\n\nsuch interventions on carbapenem consumption as well as the resistance pattern of carbapenem-\n\n\n\nresistant Enterobacterales (CRE). Method: This was a retrospective study conducted in adult medical \n\n\n\nwards of the Kuala Lumpur General Hospital (HKL), whereby data was extracted from the AMS \n\n\n\nforms of patients and subsequently reviewed by the AMS team from January to December 2016. \n\n\n\nResult and Discussion: The mean (SD) age of 169 patients included in this study was 59.2 (10.6) \n\n\n\nyears. Ertapenem was the most prescribed carbapenem (44.4%), followed by meropenem (34.3%) \n\n\n\nand imipenem/cilastatin (21.3%). The study demonstrated that only 32% of carbapenem therapy had \n\n\n\nbeen empirically initiated, while, 68 cases (40.2%) were classified as unjustified use. Out of these \n\n\n\ncases, 39 cases (57%) were recommended to be discontinued, 25 cases (37%) were to be de-escalated \n\n\n\nand 4 cases (6%) were set for changing/escalation. The acceptance rate was reported to be around \n\n\n\n73.5% (50 out of 68 cases). After one year of AMS implementation, carbapenem consumption (as \n\n\n\nshown by the defined daily dose/1000 inpatient bed-days) reduced by 33.7%. Similarly, a notable \n\n\n\ndecrease in CRE cases (33.3%) was observed following a year of AMS initiation. Conclusion: AMS-\n\n\n\nguided interventions were able to demonstrate a reduction in carbapenem consumption as well as \n\n\n\nCRE rates in the medical wards. \n\n\n\n\n\n\n\n\n\n\n\nINTRODUCTION  \n\n\n\n\n\n\n\nAntibiotic resistance is a major global health threat, which \n\n\n\nrequires prompt attention [1]. The rapid emergence of \n\n\n\nantibiotic resistance is attributed both to the overuse or misuse \n\n\n\nof antibiotics as well as the lack of innovation in the \n\n\n\ndevelopment of new antibiotics in recent years. The intensity \n\n\n\nof antibiotic consumptions per year is worrying, as previous \n\n\n\nstudies have shown the direct relationship between antibiotic \n\n\n\nconsumption and the emergence of resistance [1]. Therefore, \n\n\n\nthere is a need to monitor the appropriate use of antibiotics, as \n\n\n\nwell as to reduce inappropriate antibiotic prescribing [2].  \n\n\n\n\n\n\n\nIn Malaysia, healthcare-associated infections caused by \n\n\n\nmultidrug-resistant organisms (MDRO) particularly \n\n\n\ncarbapenem-resistant Enterobacterales (CRE) is on the rise, \n\n\n\nwith a two-fold increase in CRE isolates reported between the \n\n\n\nyears 2013 and 2016 (0.02 to 0.05 / 100 hospital admission) \n\n\n\n[3]. A similar finding was shown in a report by the Kuala \n\n\n\nLumpur General Hospital (HKL), the largest tertiary hospital \n\n\n\n\n\n\n\n\nRamadas.A.et al. Mal J Pharm 8 (1) 2022, 13-18 \n\n\n\n\n\n\n\n14 \n\n\n\n\n\n\n\nin the country; with an increasing trend in the number of CRE \n\n\n\ncases reported in 2015 [4]. The severity of the impact brought \n\n\n\nby these reports should be taken seriously, as infection due to \n\n\n\nthese organisms are associated with significant morbidity, \n\n\n\nmortality, and increased healthcare cost [2]. \n\n\n\n\n\n\n\nIn view of this, the World Health Organisation (WHO) reported \n\n\n\nin 2014 that there is an urgent need to address the global threat \n\n\n\nof antibiotic resistance through Antimicrobial Stewardship \n\n\n\n(AMS) program [1,2].  The first World Antibiotic Awareness \n\n\n\nWeek in 2015 had been launched to increase the awareness of \n\n\n\nantibiotic resistance and encourage appropriate use through an \n\n\n\nAMS. As a result, AMS programs had been introduced \n\n\n\nworldwide as one of the key strategies to rationalise antibiotic \n\n\n\nprescribing, conserve remaining antibiotics, and most \n\n\n\nimportantly, ensure optimal clinical outcomes for patients \n\n\n\n[1,2]. In line with global efforts, the Ministry of Health \n\n\n\nMalaysia (MOH) formulated a local AMS protocol to \n\n\n\nencourage stewardship activities in all healthcare facilities in \n\n\n\nthe country. The protocol emphasised on ten core strategies for \n\n\n\nAMS activities, one of which is to formalize regular \n\n\n\nmultidisciplinary stewardships rounds [5]. \n\n\n\n\n\n\n\nAs a concerted effort with MOH\u2019s AMS initiatives, a \n\n\n\nmultidisciplinary AMS team was formed in 2014 with the \n\n\n\nintention of commencing stewardship activities in HKL. In \n\n\n\n2016, the team consolidated its AMS efforts through the \n\n\n\ninitiation of stewardship rounds focusing on carbapenem cases. \n\n\n\nCarbapenem had been chosen as the antibiotics of concern \n\n\n\nsince the increasing CRE rate was hypothesized to be attributed \n\n\n\nto the increased in the imprudent use of carbapenem. In \n\n\n\nMalaysia, there is limited evidence on AMS in terms of its \n\n\n\nacceptance and impact. Therefore, it is important to investigate \n\n\n\nthe local acceptance of AMS recommendations as well as the \n\n\n\nimpact of stewardship strategies. The results would prove to be \n\n\n\nof great significance as it not only provides a view on the \n\n\n\neffectiveness of the program but would also highlight areas \n\n\n\nrequiring improvement for a more successful and effective \n\n\n\nstewardship program. Thus, the objectives of this study include \n\n\n\nthe following; to investigate the types of interventions made by \n\n\n\nthe multidisciplinary AMS team, the acceptance rate of \n\n\n\ninterventions and the impact on carbapenem consumption and \n\n\n\nCRE rate. \n\n\n\n\n\n\n\nMETHOD  \n\n\n\n\n\n\n\nStudy Design and Setting \n\n\n\n\n\n\n\nThe study was a retrospective study performed in adult medical \n\n\n\nwards in HKL. A retrospective review of patient data from the \n\n\n\nmedical records and recommendations made in the AMS \n\n\n\ntracking sheet was conducted in HKL from January 2016 to \n\n\n\nDecember 2016. The HKL AMS team consisted of infectious \n\n\n\ndisease physicians, clinical pharmacists, microbiologists and \n\n\n\ninfection control nurses who provide clinical expertise on a \n\n\n\npatient-by-patient basis for carbapenem therapy. Patients \n\n\n\ninitiated on carbapenem were routinely reviewed by the AMS \n\n\n\nteam and the use of carbapenem were classified as either \n\n\n\n\u201cjustified\u201d or \u201cnon-justified\u201d.  Appropriate recommendations \n\n\n\nwere suggested for the cases reviewed, which were recorded \n\n\n\ninto AMS tracking sheets.  \n\n\n\n\n\n\n\nInclusion and Exclusion Criteria \n\n\n\n\n\n\n\nDuring the one-year study period, the medical records of all \n\n\n\nhospitalised adult patients in the medical ward with a \n\n\n\ncarbapenem prescription that had been initiated by a physician \n\n\n\nand reviewed by the AMS team were included in the study. \n\n\n\nCases in which carbapenem was initiated by other wards or \n\n\n\nfacilities were excluded. \n\n\n\n\n\n\n\nData Collection \n\n\n\n\n\n\n\nData collection was performed using a standardised data \n\n\n\ncollection form. The baseline characteristics collected by the \n\n\n\nstudy investigators included demographic profile and details of \n\n\n\ninfection, whereby demographic data collected include age, \n\n\n\ngender, and ethnicity, while clinical data collected include the \n\n\n\ntype of carbapenem, indication for initiation, source of \n\n\n\ninfection, types of culture and sensitivity sample as well as the \n\n\n\nmicroorganisms isolated. The types of recommendations \n\n\n\nreported in the AMS tracking sheet were also collected. The \n\n\n\nimpact of AMS was determined by comparing the carbapenem \n\n\n\nconsumption and number of CRE cases a year after the AMS \n\n\n\nwas consolidated as compared to when it had first been \n\n\n\ninitiated; 2015 versus 2016. Carbapenem consumption was \n\n\n\nrecorded based on the antibiotic consumption surveillance \n\n\n\nreport [6,7], and expressed as WHO defined daily doses \n\n\n\n(DDDs) per 1000 patient-day [8]. The number of CRE cases \n\n\n\nwere obtained from the reports published by the pathology \n\n\n\ndepartment of the hospital [4,9]. Justified use of carbapenem \n\n\n\nrefers to use of carbapenem when it is indicated, whilst \n\n\n\nproviding appropriate and adequate coverage (optimal dose and \n\n\n\nduration) for the diagnosis or suspected infection based on \n\n\n\nprevious work, meanwhile non-justified use refers to the \n\n\n\nopposite [10].  \n\n\n\n\n\n\n\nSample Size and Data Analysis \n\n\n\n\n\n\n\nThe minimum sample size to achieve 80% study power and \n\n\n\n95% confidence interval was 114. The universal sampling \n\n\n\nmethod was applied, whereby all cases that fulfilled the \n\n\n\neligibility criteria were included in the study analysis. Data \n\n\n\nanalysis was conducted using IBM\u00ae SPSS Statistics for \n\n\n\nWindows, version 24. For continuous variables, the differences \n\n\n\nin mean between two groups were compared using the \n\n\n\nindependent sample t-test and reported as means (standard \n\n\n\ndeviation, SD). For categorical variables, either the Chi-\n\n\n\n\n\n\n\n\nRamadas.A.et al. Mal J Pharm 8 (1) 2022, 13-18 \n\n\n\n\n\n\n\n15 \n\n\n\n\n\n\n\nsquared or the Fisher\u2019s exact test was used, whereby result are \n\n\n\nreported as proportions (percentage, %). The CRE rates and \n\n\n\ncarbapenem consumption were analysed using the Chi-squared \n\n\n\ntest and t-test respectively. Statistical significance was denoted \n\n\n\nby p value < 0.05. \n\n\n\n\n\n\n\nEthics Approval \n\n\n\nEthical approval was obtained Medical Research and Ethic \n\n\n\nCommittee, Ministry of Health Malaysia (NMRR:17-577-\n\n\n\n34878). \n\n\n\n\n\n\n\nRESULT  \n\n\n\n\n\n\n\nDemographic and Clinical Characteristics \n\n\n\n\n\n\n\nFrom January to December 2016, 172 AMS cases reviewed by \n\n\n\nthe team. However, only 169 were included in this study based \n\n\n\non the inclusion and exclusion criteria. The demographic \n\n\n\nprofile and clinical characteristics of these patients are as \n\n\n\ndescribed in Table I. The mean (SD) age of patients included \n\n\n\nin this study was 59.2 (10.6) years, where almost half of them \n\n\n\nwere more than 60 years old. An equal proportion of male and \n\n\n\nfemale patients were included in the study. Ertapenem was the \n\n\n\nmost prescribed carbapenem (44.4%), followed by meropenem \n\n\n\n(34.3%) and imipenem/cilastatin (21.3%).  Carbapenems were \n\n\n\ninitiated empirically in 54 out of the 169 cases (32%), where \n\n\n\n80% of empirical prescriptions were for meropenem. About \n\n\n\n70% (n = 111) of the cultures obtained were sourced from \n\n\n\neither the blood (n=50), the urinary tract (n = 31), or the \n\n\n\nrespiratory tract (n = 31). Of the 115 microbiologically \n\n\n\nconfirmed cultures, extended-spectrum beta-lactamases \n\n\n\n(ESBL) producing microorganisms were isolated in 102 \n\n\n\n(88.7%) of the cases. There were 54 cases (32%), where there \n\n\n\nwere no positive cultures isolated.  \n\n\n\n\n\n\n\nTypes of AMS Recommendations and Acceptance Rate \n\n\n\n\n\n\n\nUpon review by the AMS team, it was found that only 101 \n\n\n\n(59.8%) cases of carbapenem use were justified. Meropenem \n\n\n\nwas the most common carbapenem that was used injudiciously \n\n\n\n(37 cases, 54.4 %). The types of recommendations given by the \n\n\n\nAMS team to rectify the non-justified use of antibiotics (68 \n\n\n\ncases) include discontinuation of therapy (39 cases), de-\n\n\n\nescalation of therapy (25 cases) and changing/escalation of \n\n\n\ntherapy (4 cases), as shown in Table II. The acceptance rate by \n\n\n\nthe primary team towards these recommendations was 73.5% \n\n\n\n(n = 50). There was a significant association between the types \n\n\n\nof recommendations given and its acceptance (p = 0.01). De-\n\n\n\nescalation was the most accepted recommendation (23 out of \n\n\n\n25 cases, 92%), followed by discontinuation of therapy (25 out \n\n\n\nof 39 cases, 64.1%) and change/escalation of therapy (2 out of \n\n\n\n4 cases, 50%).  The two cases accepted for escalation of therapy \n\n\n\ninvolved skin and soft tissue infection caused by MDRO \n\n\n\nAcinetobacter baumanii and Enterococcus sp. bacteraemia, \n\n\n\nwhereby colistin and vancomycin had been suggested \n\n\n\nrespectively.  The reasons of non-acceptance (n = 18, 40.2%) \n\n\n\nidentified from this study included (I) patients were responding \n\n\n\nclinically (n = 5, 27.8%), (II) severely ill patients (n = 6, \n\n\n\n33.3%), (III) immunocompromised patients (n = 3, 16.7%) and \n\n\n\n(IV) intention for short duration of carbapenem prescription \n\n\n\n(one week) (n = 4, 22.2%).  \n\n\n\n\n\n\n\nImpact of AMS on Carbapenem Consumption and CRE \n\n\n\nCases \n\n\n\n\n\n\n\nThe impact on carbapenem consumption after a year of AMS \n\n\n\nimplementation is as shown in Figure I, expressed as \n\n\n\nDDD/1000 inpatient bed-days for year 2015 and 2016 [6,7]. \n\n\n\nOverall, there was a 33.7% reduction in carbapenem \n\n\n\nconsumption (p < 0.001) from 26.3 DDD / 1000 inpatient bed-\n\n\n\ndays in the year 2015 to 17.4 DDD / 1000 inpatient bed-days in \n\n\n\nthe year 2016. There was a 55.7% decline in meropenem use \n\n\n\nfrom 2015 to 2016; 19.20 DDD / 1000 inpatient bed-days to \n\n\n\n8.51 DDD/1000 inpatient bed-days, respectively. However, the \n\n\n\nconsumption for ertapenem and imipenem / cilastatin escalated  \n\n\n\nTable II: Types of recommendations made for not-justified use of \n\n\n\ncarbapenem \n\n\n\n\n\n\n\nTypes of \n\n\n\nrecommendations \nn (%) Accepted \n\n\n\nNot \n\n\n\naccepted \np-value \n\n\n\nDiscontinue current \n\n\n\nantibiotic \n39 25 14 0.010a* \n\n\n\nDe-escalate to \nnarrow spectrum \n\n\n\nantibiotic \n\n\n\n25 23 2  \n\n\n\nChanging/escalation \nof antibiotic  \n\n\n\n4 2 2  \n\n\n\nTotal 68 50 18  \naFisher exact test was done as 4 cells (50%) have expected count < 5.  \n\n\n\n*p < 0.05 denotes statistical significance. FET value= 9.723. \n\n\n\n \nFigure I. Carbapenem DDD/1000 inpatient bed-days for the year 2015 \n\n\n\nand 2016. \n\n\n\n\n\n\n\n\n\n\n\n0\n\n\n\n5\n\n\n\n10\n\n\n\n15\n\n\n\n20\n\n\n\n25\n\n\n\n30\n\n\n\n2015 2016\n\n\n\nD\nD\n\n\n\nD\n/1\n\n\n\n0\n0\n\n\n\n0\n i\nn\n\n\n\np\na\nti\n\n\n\ne\nn\n\n\n\nt \nb\n\n\n\ne\nd\n\n\n\n d\na\ny\ns\n\n\n\nYear\n\n\n\nImipenem / Cilastatin Meropenem Ertapenem Total\n\n\n\n\n\n\n\n\nRamadas.A.et al. Mal J Pharm 8 (1) 2022, 13-18 \n\n\n\n\n\n\n\n16 \n\n\n\n\n\n\n\n\n\n\n\nbetween 2015 and 2016 with a 2-fold increase for imipenem / \n\n\n\ncilastatin (1.20 to 2.43 DDD / 1000 inpatient bed-days, \n\n\n\nrespectively) and a 10.2% increase for ertapenem (5.90 to 6.50 \n\n\n\nDDD / 1000 inpatient bed-days, respectively). CRE cases were \n\n\n\nalso noted to have significantly been reduced by 33.3% in the \n\n\n\nmedical department post a year after AMS initiation (p < \n\n\n\n0.001); with 24 cases reported in 2015 and 16 cases in 2016 \n\n\n\n[4,9]. \n\n\n\nDISCUSSION \n\n\n\n\n\n\n\nThis study demonstrated that the most common carbapenem \n\n\n\nused were ertapenem, meropenem and imipenem/cilastatin. \n\n\n\nUltimately, approximately of all instances of carbapenem use \n\n\n\nrecorded were considered as non-justified use. Fortunately, \n\n\n\nhowever, the AMS-guided intervention performed in the \n\n\n\nhospital on use of carbapenem prescriptions were generally \n\n\n\n\n\n\n\nTable I: Patient demographic and clinical characteristics, N = 169 \n\n\n\n\n\n\n\nVariables  n Justified Not justified p-value \n\n\n\nAge \n\n\n\n(years old) \n\n\n\nMean (SD) \n\n\n\n< 60 years old \n\n\n\n\uf0b3 60 years old \n\n\n\n59.2(10.6) \n\n\n\n80 \n\n\n\n89 \n\n\n\n59.2(16.7) \n\n\n\n46 \n\n\n\n55 \n\n\n\n58.5(17.6) \n\n\n\n34 \n\n\n\n34 \n\n\n\n0.802a \n\n\n\n0.638 \n\n\n\nGender Male \n\n\n\nFemale  \n\n\n\n88 \n\n\n\n81 \n\n\n\n57 \n\n\n\n44 \n\n\n\n31 \n\n\n\n37 \n\n\n\n0.166 \n\n\n\nEthnicity Malay \n\n\n\nChinese \n\n\n\nIndian \n\n\n\nOthers \n\n\n\n85 \n\n\n\n33 \n\n\n\n47 \n\n\n\n4 \n\n\n\n45 \n\n\n\n24 \n\n\n\n18 \n\n\n\n3 \n\n\n\n40 \n\n\n\n9 \n\n\n\n18 \n\n\n\n1 \n\n\n\n0.216 \n\n\n\nTypes of carbapenem prescribed Ertapenem \n\n\n\nMeropenem \n\n\n\nImipenem /cilastatin \n\n\n\n75 \n\n\n\n58 \n\n\n\n36 \n\n\n\n54 \n\n\n\n21 \n\n\n\n26 \n\n\n\n21 \n\n\n\n37 \n\n\n\n10 \n\n\n\n< 0.0001* \n\n\n\nIndication for initiation by primary \n\n\n\nteam \n\n\n\nEmpirical  \n\n\n\nMicrobiologically \nconfirmed  \n\n\n\n54 \n\n\n\n115 \n\n\n\n7 \n\n\n\n94 \n\n\n\n47 \n\n\n\n21 \n\n\n\n< 0.0001* \n\n\n\nSource of infection suspected Blood stream \n\n\n\nUrinary tract \n\n\n\nRespiratory  \n\n\n\nSkin and soft tissue \n\n\n\nIntra-abdominal \n\n\n\nBrain \n\n\n\nBone  \n\n\n\nMultiple foci \n\n\n\nUnknown source \n\n\n\n50 \n\n\n\n31 \n\n\n\n31 \n\n\n\n26 \n\n\n\n9 \n\n\n\n1 \n\n\n\n1 \n\n\n\n4 \n\n\n\n16 \n\n\n\n42 \n\n\n\n23 \n\n\n\n12 \n\n\n\n14 \n\n\n\n4 \n\n\n\n0 \n\n\n\n0 \n\n\n\n3 \n\n\n\n3 \n\n\n\n8 \n\n\n\n8 \n\n\n\n9 \n\n\n\n12 \n\n\n\n5 \n\n\n\n1 \n\n\n\n1 \n\n\n\n1 \n\n\n\n13 \n\n\n\n< 0.0001* \n\n\n\nType of samples sent for culture and \n\n\n\nsensitivity \n\n\n\nBlood \n\n\n\nUrine \n\n\n\nTracheal aspirate / \n\n\n\nsputum \n\n\n\nTissue \n\n\n\nPus/Swab \n\n\n\nNot taken \n\n\n\n113 \n\n\n\n24 \n\n\n\n20 \n\n\n\n7 \n\n\n\n3 \n\n\n\n2 \n\n\n\n74 \n\n\n\n15 \n\n\n\n7 \n\n\n\n5 \n\n\n\n0 \n\n\n\n0 \n\n\n\n39 \n\n\n\n9 \n\n\n\n13 \n\n\n\n2 \n\n\n\n3 \n\n\n\n2 \n\n\n\n0.009* \n\n\n\nTypes of organisms isolated No organism isolated \n\n\n\n  ESBL: \n\n\n\n     K. pneumoniae \n\n\n\n     E. coli  \n\n\n\n     Proteus sp.  \n\n\n\n     Enterobacter sp. \n\n\n\n     Citrobacter sp. \n\n\n\n  Sensitive strains: \n\n\n\n     K. pneumoniae \n\n\n\n  Others:  \n\n\n\n     A.baumanii \n\n\n\n(MDRO) \n\n\n\n     Burkholderia sp.  \n\n\n\n     S.aureus \n\n\n\n     Enterococcus sp. \n\n\n\n     Rhodococcus equi \n\n\n\n54 \n\n\n\n\n\n\n\n42 \n\n\n\n49 \n\n\n\n7 \n\n\n\n3 \n\n\n\n1 \n\n\n\n\n\n\n\n3 \n\n\n\n\n\n\n\n3 \n\n\n\n1 \n\n\n\n1 \n\n\n\n1 \n\n\n\n4 \n\n\n\n7 \n\n\n\n\n\n\n\n35 \n\n\n\n43 \n\n\n\n6 \n\n\n\n3 \n\n\n\n1 \n\n\n\n\n\n\n\n0 \n\n\n\n\n\n\n\n2 \n\n\n\n1 \n\n\n\n0 \n\n\n\n0 \n\n\n\n4 \n\n\n\n57 \n\n\n\n\n\n\n\n7 \n\n\n\n6 \n\n\n\n1 \n\n\n\n0 \n\n\n\n0 \n\n\n\n\n\n\n\n3 \n\n\n\n\n\n\n\n1 \n\n\n\n0 \n\n\n\n1 \n\n\n\n1 \n\n\n\n0 \n\n\n\n< 0.0001* \n\n\n\nChi-square test was performed unless otherwise stated.  \naIndependent-samples T-test.  \n\n\n\n*p < 0.05 denotes statistical significance. \n\n\n\n\n\n\n\n\nRamadas.A.et al. Mal J Pharm 8 (1) 2022, 13-18 \n\n\n\n\n\n\n\n17 \n\n\n\n\n\n\n\nencouraging, with the most common intervention involving the \n\n\n\ndiscontinuation of antibiotic. These findings are congruent to \n\n\n\nfindings from a previous work in a local study conducted at a \n\n\n\ndistrict hospital [11]. Our results were in contrast, however, to \n\n\n\na study conducted in Singapore where the most common \n\n\n\nintervention involved de-escalation of the therapy towards the \n\n\n\nuse of narrow spectrum antibiotics [12]. In terms of acceptance, \n\n\n\nthe current work demonstrated that de-escalation of antibiotics \n\n\n\nwas the more readily accepted recommendation by the primary \n\n\n\nteam as compared to other recommendations, namely the \n\n\n\ndiscontinuation of therapy and changing/escalation of \n\n\n\nantibiotic. Overall acceptance of recommendations in this study \n\n\n\nwas encouraging and comparable to other similar studies, \n\n\n\nwhich also reported an acceptance rate between 70-80% \n\n\n\n[13,14].  \n\n\n\n\n\n\n\nThe overall carbapenem consumption was significantly \n\n\n\nreduced after the introduction of carbapenem stewardship \n\n\n\nrounds in 2016. This can be attributed to the recommendations \n\n\n\nunder the AMS to discontinue carbapenem or to switch to \n\n\n\nnarrower spectrum antibiotics under appropriate conditionss. \n\n\n\nThese findings were consistent with other similar facilities, \n\n\n\nwhere a reduction in broad spectrum antibiotic usage was \n\n\n\nobserved after the initiation of stewardship programs [12,15]. \n\n\n\nThe results of this research depict that in this setting, although \n\n\n\nthere was overall reduction in carbapenem use, an increase in \n\n\n\nthe use of imipenem / cilastatin and ertapenem respectively was \n\n\n\nobserved. The rise in imipenem / cilastatin DDD / 1000 \n\n\n\ninpatient bed-days in 2016 was mainly attributed to the shift in \n\n\n\nprescribing pattern by the infectious disease physician in order \n\n\n\nto either promote antibiotic cycling or balance between \n\n\n\nmeropenem and imipenem / cilastatin use. Meanwhile, the \n\n\n\nincrease in DDD per 1000 inpatient bed-days for ertapenem \n\n\n\nwas also noted to increase in 2016, an occurrence which was \n\n\n\nattributed to streamlining of meropenem to ertapenem, a \n\n\n\ncarbapenem of a narrower-spectrum, in order to assuage the \n\n\n\nlikelihood of the emergence of MDRO Pseudomonas sp. \n\n\n\n\n\n\n\nIn addition to the reduction in carbapenem use, the number of \n\n\n\nCRE cases was significantly reduced upon initiation of AMS.  \n\n\n\nIn support of this finding, a systemic review reported that 11 \n\n\n\nout of 22 studies on the impact of AMS found significant \n\n\n\nreductions in antimicrobial resistance upon implementation of \n\n\n\nAMS [16]. Furthermore, previous work on AMS in a \n\n\n\ncommunity hospital in United States of America (USA) \n\n\n\nresulted in a reduction in the use of broad-spectrum antibiotics \n\n\n\nand a subsequently improved antimicrobial susceptibilities of \n\n\n\nPseudomonas sp [17]. However, evidences against these \n\n\n\nfindings exist, another study conducted in a tertiary teaching \n\n\n\nhospital concluded that although AMS does reduce antibiotics \n\n\n\nconsumption, it does not have any significant improvement on  \n\n\n\n\n\n\n\n\n\n\n\nantimicrobial susceptibilities. Despite that, it is important to \n\n\n\nnote that in the aforementioned study, antimicrobial resistance \n\n\n\nwas found to have not increased either [18]. These conflicting \n\n\n\noutcomes may be influenced by the different AMS strategies \n\n\n\nused, type of healthcare facility and number of intensive care \n\n\n\nbeds involved. Furthermore, it may be that the positive \n\n\n\nimplications of the AMS services implemented on \n\n\n\nantimicrobial resistance may also take time to be presented \n\n\n\nmore overtly [19], in which case, further work is required to \n\n\n\nmonitor outcomes of AMS in the long term. \n\n\n\n\n\n\n\nOur findings have contributed to the data on the impact of AMS \n\n\n\nin a tertiary care centre. However, several aspects of our \n\n\n\nmethodology may limit the generalisation of these findings. \n\n\n\nFirstly, the observational nature of this study renders it \n\n\n\nvulnerable to influences by confounding factors. In addition, \n\n\n\nthe involvement of a small cohort that includes, only medical \n\n\n\nwards, would mean the possible existence of type II errors. \n\n\n\nThirdly, recommendations on dosage adjustments were not \n\n\n\nrecorded as part of data collection even though it is a routine \n\n\n\nrecommendation during AMS rounds.  Finally, carbapenem \n\n\n\nconsumption and CRE cases were analysed through a direct \n\n\n\ncomparison between the data, presented in percentages, of pre-\n\n\n\nand post-interventions, though it would perhaps be more \n\n\n\nsuitable if an Interrupted Time Series analysis is to be \n\n\n\nconducted instead with the intention of confirming with greater \n\n\n\nclarity that the reduction was indeed due to the interventions \n\n\n\nmade. We were unable to carry out this analysis considering the \n\n\n\nfact that we did not have access to a series of data, in addition \n\n\n\nto the fact that the intervention only took place during the study \n\n\n\nperiod. \n\n\n\n\n\n\n\nCONCLUSION  \n\n\n\n\n\n\n\nAMS-guided interventions of carbapenems appeared to be a \n\n\n\nuseful strategy to reduce non-judicious use of carbapenem in a \n\n\n\ntertiary hospital and was able to demonstrate a reduction in \n\n\n\ncarbapenem consumption as well as CRE rates in the medical \n\n\n\nwards. Future long-term studies on the clinical outcomes are \n\n\n\nrequired to further investigate the overall impact of the AMS \n\n\n\nprogram. Development of a hospital-level AMS policy and \n\n\n\npromotion of AMS activities via seminars may improve \n\n\n\nacceptance of AMS interventions in local hospitals. \n\n\n\n\n\n\n\nACKNOWLEDGEMENT \n\n\n\n\n\n\n\nThe authors wish to thank the Director-General of Health, \n\n\n\nMalaysia for the permission to publish this paper. We are \n\n\n\ngrateful to the Hospital Director, Department of Pharmacy and \n\n\n\nDepartment of Pathology (Microbiology Unit), Kuala Lumpur \n\n\n\nGeneral Hospital for their support and contribution towards this \n\n\n\nresearch project. \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nRamadas.A.et al. Mal J Pharm 8 (1) 2022, 13-18 \n\n\n\n\n\n\n\n18 \n\n\n\n\n\n\n\nCONFLICT OF INTEREST \n\n\n\n\n\n\n\nThis study has no conflict of interest. This research did not \n\n\n\nreceive any specific grant from funding agencies in public, \n\n\n\ncommercial or not-for-profit sectors. \n\n\n\n\n\n\n\nREFERENCE \n \n\n\n\n[1] World Health Organisation. Global Report on Surveillance of \n\n\n\nAntimicrobial Resistance. World Health Organisation. 2014. \n\n\n\nhttps://apps.who.int/iris/handle/10665/112642  \n\n\n\n[2] Shlaes DM, Gerding DN, John JF, Craig WA, Bornstein DL, Duncan \n\n\n\nRA, Eckman MR, Farrer WE, Greene WH, Lorian V, Levy S, \n\n\n\nMcgowan JE, Paul SM, Ruskin J, Tenover FC, Watanakunakorn C. \n\n\n\nSociety for Healthcare Epidemiology of America and Infectious \n\n\n\nDiseases Society of America Joint Committee on the Prevention of \n\n\n\nAntimicrobial Resistance: Guidelines for the Prevention of \n\n\n\nAntimicrobial Resistance in Hospitals. Clin Infect Dis. 1997 Sep; \n\n\n\n25(3):584-99. https://doi.org/10.1086/513766 \n\n\n\n[3] Institute for Medical Research. 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Hospital Kuala Lumpur Antibiotic Resistance \n\n\n\nSurveillance Report. 2016.  \n\n\n\n[10] Gaur AH, English BK. The judicious use of antibiotics - An \n\n\n\ninvestment towards optimized health care. Indian J Pediatr. \n\n\n\n2006;73(4):343\u201350. https://doi.org/10.1007/BF02825829 \n\n\n\n[11] Sing DYF, Boo YL, Mukhlis R, Chin PW, Hoo FK. Antimicrobial \n\n\n\nstewardship program in a Malaysian district hospital: First year \n\n\n\nexperience. Pakistan J Med Sci. 2016;32(4):999\u20131004. \n\n\n\nhttps://doi.org/10.12669/pjms.324.9855 \n\n\n\n[12] Teo J, Kwa ALH, Loh J, Chlebicki MP, Lee W. The effect of a whole-\n\n\n\nsystem approach in an antimicrobial stewardship programme at the \n\n\n\nSingapore General Hospital. Eur J Clin Microbiol Infect Dis. \n\n\n\n2012;31(6):947\u201355. https://doi.org/10.1007/s10096-011-1391-y \n\n\n\n[13] Teng CB, Ng TM, Tan MW, Tan SH, Tay M, Lim SF, et al. Safety \n\n\n\nand effectiveness of improving carbapenem use via prospective \n\n\n\nreview and  feedback in a multidisciplinary antimicrobial stewardship \n\n\n\nprogramme. Ann Acad Med Singap. 2015;44(1): 19\u201325. PMID: \n\n\n\n25703493.  \n\n\n\n[14] Lew KY, Ng TM, Tan M, Tan SH, Lew EL, Ling LM, Ang B, Lye D, \n\n\n\nTeng CB. Safety and clinical outcomes of carbapenem de-escalation \n\n\n\nas part of an antimicrobial stewardship programme in an ESBL-\n\n\n\nendemic setting. J Antimicrob Chemother. 2014;70(4):1219\u201325. \n\n\n\nhttps://doi.org/10.1093/jac/dku479 \n\n\n\n[15] Okumura LM, da Silva MMG, Veroneze I. Effects of a bundled \n\n\n\nAntimicrobial Stewardship Program on mortality: A cohort study. \n\n\n\nBrazilian J Infect Dis. 2015;19(3):246\u201352.  \n\n\n\nhttps://doi.org/10.1016/j.bjid.2015.02.005 \n\n\n\n[16] Nathwani D, Varghese D, Stephens J, Ansari W, Martin S, \n\n\n\nCharbonneau C. Value of hospital antimicrobial stewardship \n\n\n\nprograms [ASPs]: A systematic review. Antimicrob Resist Infect \n\n\n\nControl. 2019;8(1):1\u201313 https://doi.org/10.1186/s13756-019-0471-0 \n\n\n\n[17] Day S, Smith D, Harris K, Cox H, Mather A. An Infectious Diseases \n\n\n\nPhysician-Led Antimicrobial Stewardship Program at a Small \n\n\n\nCommunity Hospital Associated With Improved Susceptibility \n\n\n\nPatterns and Cost-Savings After the First Year. Open Forum Infect \n\n\n\nDis. 2015;2(2):ofv064.  https://doi.org/10.1093/ofid/ofv064 \n\n\n\n[18] Cook PP, Catrou PG, Christie JD, Young PD, Polk RE. Reduction in \n\n\n\nbroad-spectrum antimicrobial use associated with no improvement in \n\n\n\nhospital antibiogram. J Antimicrob Chemother. 2004;53(5):853\u20139. \n\n\n\nhttps://doi.org/10.1093/jac/dkh163 \n\n\n\n[19] Jenkins T, Knepper B, Shihadeh K, Haas M, Sabel A, Steele A, \n\n\n\nWilson M, Price C, Burman W, Mehler P. Long-term outcomes of an \n\n\n\nantimicrobial stewardship program implemented in a hospital with \n\n\n\nlow baseline antibiotic use. Infect Control Hosp Epidemiol. \n\n\n\n2015;36(6):664\u201372. https://doi.org/10.1017/ice.2015.41 \n\n\n\n\nhttps://apps.who.int/iris/handle/10665/112642\n\n\nhttps://doi.org/10.1086/513766\n\n\nhttps://www.imr.gov.my/images/uploads/NSAR/NSAR_2016/NSAR_report_2016.pdf\n\n\nhttps://www.imr.gov.my/images/uploads/NSAR/NSAR_2016/NSAR_report_2016.pdf\n\n\nhttps://www.pharmacy.gov.my/v2/sites/default/files/document-upload/protocol-antimicrobial-stewardship.pdf\n\n\nhttps://www.pharmacy.gov.my/v2/sites/default/files/document-upload/protocol-antimicrobial-stewardship.pdf\n\n\nhttps://www.whocc.no/atc_ddd_index_and_guidelines/guidelines/\n\n\nhttps://doi.org/10.1007/BF02825829\n\n\nhttps://doi.org/10.12669/pjms.324.9855\n\n\nhttps://doi.org/10.1007/s10096-011-1391-y\n\n\nhttps://doi.org/10.1093/jac/dku479\n\n\nhttps://doi.org/10.1016/j.bjid.2015.02.005\n\n\nhttps://doi.org/10.1186/s13756-019-0471-0\n\n\nhttps://doi.org/10.1093/ofid/ofv064\n\n\nhttps://doi.org/10.1093/jac/dkh163\n\n\nhttps://doi.org/10.1017/ice.2015.41\n\n\n\n"
"\n\nMalaysian Journal of Pharmacy Volume 7 Issue 1 (2021) \n \n\n\n\n\n\n\n\n\n\n\n\n28 \n\n\n\n\n\n\n\n*Correspondence: hueymiin@moh.gov.my \n\n\n\n\n\n\n\n1 Pharmacy Department, Hospital Kuala Lipis, Kuala Lipis, Pahang, Malaysia  \n2 Pharmacy Department, Hospital Sultan Haji Ahmad Shah, Temerloh, Pahang \n\n\n\nMalaysia.   \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n Original Research Article \n\n\n\n\n\n\n\nAnalgesic Dosing Behaviours in Patients with Chronic, Non-\n\n\n\nCancer Pain: Does it Affect the Pain Control? \n \n\n\n\nMohamad Akmal Bin Harun1, Nurul Fateeha Binti Ahmad1, Cheah Huey Miin2* \n\n\n\n\n\n\n\n  \nArticle Info  \n\n\n\n \nReceived date: 30 Dec 2020 \n\n\n\nAccepted date:   3 Feb 2021 \n\n\n\nPublished date: 30 June 2021 \n\n\n\n\n\n\n\nKeywords: Chronic pain, pain \n\n\n\ncontrol, pain management \n\n\n\nindex, brief pain inventory, \n\n\n\nanalgesic, Malaysia  \n\n\n\nABSTRACT  \n\n\n\n\n\n\n\nChronic pain has a significant impact on sufferers\u2019 quality of life. Furthermore, treatment \n\n\n\ninadequacies are often reported in the literatures. This study aims to investigate the prevalence of the \n\n\n\ndifferent dosing behaviors in analgesics use in chronic, non-cancer pain and their correlation to pain \n\n\n\ncontrol. This is a cross-sectional study and a convenience sampling method was applied. Brief Pain \n\n\n\nInventory- Short Form and Pain Management Index was computed to assess pain control. Statistical \n\n\n\nanalysis was performed with Pearson chi-square test and alpha value was set at 0.05. A total of 127 \n\n\n\npatients were analyzed. 70.9% of the patients reported inadequate pain control with their prescribed \n\n\n\nanalgesic(s). 88.2% patients only took oral analgesics whenever they felt the pain while 11.8% \n\n\n\npatients took around-the-clock despite the absence of pain. Among them, 11.8-34.7% of patients did \n\n\n\nnot follow their prescriber\u2019s instruction for oral and topical analgesic use respectively. However, no \n\n\n\nstatistically significant result was found between the dosing behaviors and pain control (p>0.95). It \n\n\n\nwas also reported that 98% of patients were not aware of the maximum daily dose of their prescribed \n\n\n\nanalgesic(s). The prevalence of \u2018as needed\u2019 dosing is higher than around-the-clock dosing in the \n\n\n\nmanagement of chronic, non-cancer pain, with deviation from the prescribed instructions between \n\n\n\n11.8-34.7%. However, those differences were not significantly associated with the pain control.  \n\n\n\n\n\n\n\nINTRODUCTION  \n  \n\n\n\nPain is often a symptom reported by patients suffering from \n\n\n\nvarious clinical conditions. The International Association for \n\n\n\nthe Study of Pain (IASP) defines pain as an 'unpleasant sensory \n\n\n\nand emotional experience associated with actual or potential \n\n\n\ntissue damage' [1]. Pain should not be viewed as merely a \n\n\n\nsymptom, as pain can persist for a long period of time even after \n\n\n\nan underlying injury or disease has resolved. When the pain \n\n\n\npersists for at least three months, it is categorized as chronic \n\n\n\npain, and the cause can be cancerous or non-cancerous origins.  \n\n\n\n\n\n\n\nAmong Asian adults, Malaysia has one of the lowest \n\n\n\nprevalence of chronic pain at 7.1%, in comparison to Northern \n\n\n\nIraq (72%), Cambodia (48%) and Singapore (8.7%). However, \n\n\n\nthe pain prevalence is notably higher among the geriatric \n\n\n\npopulation (42 to 90.8%) [2].  \n\n\n\n\n\n\n\nPain should not be overlooked. This is because people with \n\n\n\nchronic pain were often reported to have a poor quality of life \n\n\n\ndue to immobility, disability, disturbed sleep, isolation, \n\n\n\nanxiety, frustration, depression, poor appetite and nutrition, \n\n\n\nincreased susceptibility to disease, dependence on medication, \n\n\n\nand long-term medical care [3-6]. Specifically, for chronic non-\n\n\n\ncancer pain (CNCP), it was found that as much as 80.8% of \n\n\n\npatients whose activities of daily living were affected by pain \n\n\n\n[7], further highlighting the inadequacy of pain management in \n\n\n\nthis patient cohort. \n\n\n\n\n\n\n\nPain management starts with pain assessment since the choice \n\n\n\nof analgesic will be different based on the pain score. Pain \n\n\n\nassessment can be performed with Numerical Rating Scale \n\n\n\n(NRS), which uses an 11-point scale. Pain can range from none \n\n\n\n(score zero) to the worst pain ever possible (score ten).[8] After \n\n\n\nthe determination of a pain score, the next step in pain \n\n\n\nmanagement is analgesic selection. To guide analgesic \n\n\n\nselection, National Health Service (NHS) United Kingdom \n\n\n\n\n\n\n\n\nHarun, M.A. et al. Mal J Pharm 7 (1) 2021, 28-33 \n\n\n\n\n\n\n\n29 \n\n\n\n\n\n\n\n(UK) devised a treatment guideline for CNCP. In the guideline, \n\n\n\nit was recommended that every treatment should start with \n\n\n\nparacetamol, and this medication should be added to a \n\n\n\nsubsequent regimen for its synergistic effect. If the pain \n\n\n\npersists, or not properly controlled, non-steroidal anti-\n\n\n\ninflammatory drugs (NSAIDs) or weak opioids can be \n\n\n\nprescribed. If the NSAIDs or weak opioids are still ineffective, \n\n\n\na more powerful opioid like morphine or fentanyl should be \n\n\n\ngiven to the patient [9].  \n\n\n\n\n\n\n\nCNCP treatment is mostly based on the principles behind the \n\n\n\nWorld Health Organization (WHO) analgesic ladder [10], \n\n\n\nwhich was originally developed for cancer pain management. \n\n\n\nBecause of this origin, the majority of institutional guidelines, \n\n\n\nreviews, and training manuals advocate the effectiveness of \n\n\n\nregular analgesic in both cancerous and non-cancerous chronic \n\n\n\npain [9,11-14]. Unfortunately, in Malaysia, it was found that \n\n\n\nonly 4.2 to 4.4% of the population take their analgesic regularly \n\n\n\nin chronic pain [15-16], which is lower than a chronic pain \n\n\n\nprevalence of 7.1% in the country. Therefore, this study was \n\n\n\ninitiated to investigate the prevalence of the different dosing \n\n\n\nbehaviors in analgesics use in CNCP outpatients and their \n\n\n\ncorrelation to pain control.  \n\n\n\n\n\n\n\nMETHOD  \n  \n\n\n\nStudy design \n \n\n\n\nThis was a single-center, cross-sectional study conducted in the \n\n\n\noutpatient pharmacy department of Kuala Lipis Hospital in \n\n\n\nMalaysia. Convenience sampling was used to recruit study \n\n\n\nparticipants. Possible sampling bias was minimized by \n\n\n\nconsistently recruiting patients during their clinic \n\n\n\nappointments, which are 8 a.m. to 1 p.m. from Mondays to \n\n\n\nFridays, excluding public holidays. \n\n\n\n\n\n\n\nSample Size Estimation \n \n\n\n\nWith an estimated prevalence of chronic pain at 7.1% [2], a \n\n\n\nconfidence level of 95%, and a confidence limit of 5%, a \n\n\n\nminimum sample size of 101 was calculated to provide \u226580% \n\n\n\npower [17]. After considering a possible 15% dropout rate, the \n\n\n\nfinal calculated sample size was 117 subjects. \n\n\n\n\n\n\n\nStudy Subjects \n\n\n\n\n\n\n\nAll patients who presented to the outpatient pharmacy with a \n\n\n\nvalid prescription were screened for eligibility. Patients who \n\n\n\ntook at least one analgesic for a minimum of three months, as \n\n\n\nverified by the pharmacy dispensing record, were invited for \n\n\n\nstudy participation. We excluded patients who were less than \n\n\n\neighteen years old, pregnant women, and those with a diagnosis \n\n\n\nof cancer-related pain. \n\n\n\n\n\n\n\nMeasurement of Outcomes \n \n\n\n\nAll study subjects were assisted by researchers to fill in a \n\n\n\nquestionnaire. The questionnaire consisted of three sections. \n\n\n\nThe first section consisted of baseline demographic \n\n\n\ncharacteristics of study subjects such as gender, age, race, \n\n\n\noccupational status, and pain diagnosis. The second section was \n\n\n\nabout study subjects' pain management details such as the \n\n\n\nprescribed analgesic(s) (name and dosage form), dose, actual \n\n\n\ndose taken for each analgesic, and whether they used over-the-\n\n\n\ncounter (OTC) analgesic and complementary medicines. If the \n\n\n\nprescribed instruction of the analgesics was \u2018as needed\u2019, we \n\n\n\nfurther investigated if the respondents can correctly identify the \n\n\n\nmaximum allowable daily dose. Information for the second \n\n\n\nsection was first extracted from medical records and pharmacy \n\n\n\ndispensing record, before verbally verified with the patients. \n\n\n\nThe third part was the Brief Pain Inventory- Short Form (BPI-\n\n\n\nsf) to assess pain among study subjects. BPI-sf is a 9-item self-\n\n\n\nadministered questionnaire and is chosen for this study due to \n\n\n\nits ability to assess the totality of pain experience (minimum, \n\n\n\nmaximum, average and current pain score) [18]. The patient is \n\n\n\nasked to rate their worst, least, average, and current pain \n\n\n\nintensity, list current treatments and their perceived \n\n\n\neffectiveness. The Malay version of the BPI previously \n\n\n\nvalidated in local population [19] was used in this study. A pilot \n\n\n\ntest of fourteen patients gave a Cronbach\u2019s alpha value of \n\n\n\n0.677. \n\n\n\n\n\n\n\nWe used the pain management index (PMI) to assess the \n\n\n\nadequacy of pain control. The index is constructed upon the \n\n\n\npatient's worst pain level in the last twenty-four hours \n\n\n\nrecategorized as zero (no pain), one (pain score one to three, \n\n\n\nmild pain), two (pain score four to seven, moderate pain), or \n\n\n\nthree (pain score eight to ten, severe pain). To compute the \n\n\n\nindex, the new pain level was then subtracted from the most \n\n\n\npotent level of their prescribed analgesic categorized as zero \n\n\n\n(no analgesic drug), one (non-opioid), two (a weak opioid), or \n\n\n\nthree (a strong opioid). Ranging from -3 (a patient with severe \n\n\n\npain receiving no analgesic) to +3 (a patient receiving \n\n\n\nmorphine or an equivalent and reporting no pain), a score of \n\n\n\nzero and higher (positive value) indicated acceptable pain \n\n\n\ncontrol with analgesic while a negative value suggested \n\n\n\nsuboptimal pain control [20-21]. The index was computed with \n\n\n\nMicrosoft Excel function and the accuracy of calculation was \n\n\n\nthen manually cross-checked by the researchers. \n\n\n\n\n\n\n\nTwo dosing categories, regular or as needed, were used to \n\n\n\ninvestigate the prevalence of dosing deviation. The dosing \n\n\n\nbehavior was classified as regular if the patient took analgesics \n\n\n\nat a fixed interval (once daily or several times a week) despite \n\n\n\nthe absence of pain. On the other hand, if analgesics were used \n\n\n\nonly in the presence of pain sensation, the dosing behavior was \n\n\n\nclassified as \u2018as needed\u2019. \n\n\n\n \n\n\n\n\n\n\n\n\nHarun, M.A. et al. Mal J Pharm 7 (1) 2021, 28-33 \n\n\n\n\n\n\n\n30 \n\n\n\n\n\n\n\nStatistical Analysis \n \n\n\n\nData was analyzed using IBM SPSS Statistics for Windows, \n\n\n\nVersion 21 (IBM Corp. Released 2012. IBM SPSS Statistics \n\n\n\nfor Windows, Version 21.0. Armonk, NY: IBM Corp.). \n\n\n\nDescriptive statistic was used to summarize the demographic \n\n\n\ndata in mean, standard deviation (SD), and proportion. Pain \n\n\n\nscore was presented in median and interquartile range (IQR). \n\n\n\nPearson chi-square and fisher's exact test were used to study the \n\n\n\nrelationship between the dosing deviation and PMI. All the p-\n\n\n\nvalues were two-tailed and statistical significance was defined \n\n\n\nas p < 0.05. \n\n\n\n\n\n\n\nEthics Approval  \n \n\n\n\nThe study was registered under Malaysia National Medical \n\n\n\nResearch Registry (NMRR-16-1880-32144) and approved by \n\n\n\nthe Medical Research and Ethics Committee Malaysia \n\n\n\n((6)KKM/NIHSEC/P16-1549). All participants provided \n\n\n\nwritten informed consent before enrolment, and the study was \n\n\n\nconducted in accordance with the Declaration of Helsinki.  \n\n\n\n\n\n\n\nRESULT \n \n\n\n\nStudy Subjects \n\n\n\n\n\n\n\nWe approached a total of 130 patients. Three patients refused \n\n\n\nto participate in the survey due to time constraints. One hundred \n\n\n\nand twenty-seven (97.7%) outpatients with CNCP participated \n\n\n\nin the study and were included in the final data analysis. Of \n\n\n\nthese patients, forty-eight (37.8%) were male, and seventy-nine \n\n\n\n(62.2%) were female. The mean (\u00b1 SD) age was 55 (\u00b112.8) \n\n\n\nyears. Majority of the patients were Malay (58.3%), followed \n\n\n\nby Indian (33.1%), Chinese (7.9%) and Siamese (0.8%). Most \n\n\n\nof them were in full-time employment (68.5%), while 30.7% \n\n\n\nwere unemployed at the time of the interview. As shown in \n\n\n\nTable I, the most frequent pain diagnosis was osteoarthritis \n\n\n\n(31.5%), followed by cervical or lumbar degenerative disease \n\n\n\n(28.3%) and pelvic inflammatory disease (11.8%). Pain \n\n\n\ndiagnoses such as fibromyalgia, bone fracture, spinal stenosis, \n\n\n\nand anterior cruciate ligament injury were collectively grouped \n\n\n\nunder the category of 'others' due to the relatively low \n\n\n\nfrequency in our study subjects. \n\n\n\n\n\n\n\nFor pain management, most of the patients had been prescribed \n\n\n\na combination of oral and topical analgesic (74.8%). Of note, a \n\n\n\ntremendous 80.3% of the patients needed at least two \n\n\n\nanalgesics for pain control, and only 19.7% of them were \n\n\n\ntreated with just an analgesic. NSAIDs, especially celecoxib \n\n\n\nand weak opioid tramadol, were the most frequent oral \n\n\n\nanalgesics prescribed by our doctors, with a total combined \n\n\n\nfrequency of 73.2%. On the other hand, topical NSAIDs \n\n\n\n(diclofenac and ketoprofen) were also the most frequently \n\n\n\nprescribed topical analgesic in our study subjects. \n\n\n\nTable I: Baseline characteristics of study patients (N=127) (a) \n\n\n\ndemographic data and (b) Analgesic regimen \n\n\n\n\n\n\n\n(a) (a) Demographic characteristics \n\n\n\n\n\n\n\nVariable Mean (\u00b1SD) \n\n\n\nAge  \n\n\n\n 54 (\u00b112.8) \n\n\n\n\n\n\n\nVariable Number (%) \n\n\n\nGender  \n\n\n\nFemale  79 (62.2%) \n\n\n\nMale 48 (37.8%) \n\n\n\n\n\n\n\nRace  \n\n\n\nMalay  74 (58.3 %) \n\n\n\nIndian  42 (33.1%) \n\n\n\nChinese 10 (7.9%) \n\n\n\nSiamese 1 (0.8%) \n\n\n\n\n\n\n\nOccupational status  \n\n\n\nEmployed  88 (69.3%) \n\n\n\nUnemployed/Retired  39 (30.7%) \n\n\n\n\n\n\n\nDiagnosis of Chronic Pain  \n\n\n\nOsteoarthritis 40 (31.5%) \n\n\n\nCervical/Lumbar degenerative disease 36 (28.3%) \n\n\n\nPelvic inflammatory disease 15 (11.8%) \n\n\n\nLower back pain 7 (5.5%) \n\n\n\nMusculoskeletal injury 3 (2.4%) \n\n\n\nRheumatoid arthritis 3 (2.4%) \n\n\n\nCervical/Lumbar radiculopathy 3 (2.4%) \n\n\n\nCarpal tunnel syndrome 3 (2.4%) \n\n\n\nSupraspinatus inflammation 3 (2.4%) \n\n\n\nOthers 14 (11.2%) \n\n\n\n\n\n\n\n(b) (b) Analgesic regimens  \n\n\n\n\n\n\n\nVariable Number (%) \n\n\n\nDosage form of analgesic  \n\n\n\nOral only 32 (25.2%) \n\n\n\nTopical only 0 (0%) \n\n\n\nCombination (Oral +Topical) 95 (74.8%) \n\n\n\n\n\n\n\nNumber of analgesics  \n\n\n\n1 25 (19.7%) \n\n\n\n2 77 (60.6%) \n\n\n\n3 22 (17.3%) \n\n\n\nMore than 3 3 (2.4%) \n\n\n\n\n\n\n\nType of ORAL analgesic  \n\n\n\nNSAIDs 47 (37%) \n\n\n\nTramadol 46 (36.2%) \n\n\n\nGabapentin 1 (0.8%) \n\n\n\nParacetamol  1 (0.8%) \n\n\n\nCombination  32 (25.2%) \n\n\n\n\n\n\n\nType of TOPICAL analgesic  \n\n\n\nNSAIDs 66 (52%) \n\n\n\nMethyl salicylate ointment 28 (22%) \n\n\n\nCombination 1 (0.8%) \n\n\n\n\n\n\n\nAdditional OTC analgesic from community pharmacy \n\n\n\nYes  16 (12.6%) \n\n\n\nNo 111 (87.4%) \n\n\n\n\n\n\n\nComplementary medicines  \n\n\n\nYes  19 (15%) \n\n\n\nNo 108 (85%) \n\n\n\nNSAIDs: Non-steroidal anti-inflammatory drugs; OTC: over the counter \n\n\n\n\n\n\n\n\n\n\n\n\n\nHarun, M.A. et al. Mal J Pharm 7 (1) 2021, 28-33 \n\n\n\n\n\n\n\n31 \n\n\n\n\n\n\n\nIn addition to medication supply from the hospital, 12.6% of \n\n\n\npatients bought OTC analgesics from a community pharmacy \n\n\n\nto supplement their prescription medicines, and nineteen (15%) \n\n\n\npatients practiced traditional and complementary medicines \n\n\n\nsuch as massage, acupuncture, meditation, and cupping as part \n\n\n\nof their pain management. \n\n\n\n\n\n\n\nPain Assessment  \n\n\n\n\n\n\n\nOn average, patients reported their worst pain score at eight out \n\n\n\nof ten, while the least pain score was one out of ten (Fig. 1). \n\n\n\nThe median percentage of pain relief from the prescribed \n\n\n\nanalgesic(s) was seventy percent. With regards to the location \n\n\n\nof pain, 33.9% of patients experienced pain at more than one \n\n\n\nbody part, 31.5% at trunk regions, 29.9% at lower limb(s), and \n\n\n\nonly 4.7% at upper limb(s). \n\n\n\n\n\n\n\nPrevalence of Different Analgesic Dosing Behaviors      \n\n\n\n\n\n\n\nAn analysis of the prescribing pattern for oral analgesics \n\n\n\nshowed that 95.3% of prescribers annotated \u2018as needed\u2019 dosing. \n\n\n\nMeanwhile, 88.2% of patients took their oral analgesic(s) 'as \n\n\n\nneeded'. (Table II) The study showed cases of discrepancy \n\n\n\nbetween the prescribed dose and the actual dose taken, but the \n\n\n\nfrequency was minimal. For oral analgesics, only fifteen \n\n\n\n(11.8%) patients did not take their analgesic according to the \n\n\n\nprescribed instruction. Meanwhile, about one-third (34.7%) of \n\n\n\npatients applied topical analgesics regularly despite being \n\n\n\ninstructed to apply only 'as needed' (Table II). We also \n\n\n\ndiscovered an alarming 98.4% of patients did not know the \n\n\n\nmaximum allowable daily dose of the analgesic(s) prescribed \n\n\n\nto them when instructed to take as needed.   \n\n\n\n\n\n\n\nPMI and Pain Control \n\n\n\n\n\n\n\nOur study demonstrated that as high as 70.9% of patients were \n\n\n\nunder-treated for their chronic pain, represented by negative \n\n\n\nPMI as shown in Table III. No significant relationship was \n\n\n\nfound between the dosing deviation with PMI; whether taking \n\n\n\nit via oral analgesics (p=0.534), topical analgesics (p=0.767), \n\n\n\nor the combination routes (p>0.95) (Table III).  \n\n\n\n\n\n\n\nDISCUSSION  \n  \n\n\n\nFrom this study, we observed a discrepancy in analgesic use \n\n\n\nbetween the prescribed dose and the actual dose taken by \n\n\n\npatients. There were 11.8% and 34.7% of patients who did not \n\n\n\nfollow their prescriber's instruction when using oral and topical \n\n\n\nanalgesics. Earlier results of a qualitative study in 2006 also \n\n\n\nproved the existence of self-dosing behavior in analgesic use \n\n\n\n[22]. \n\n\n\n\n\n\n\nRegardless, the self-dosing behavior especially in the \n\n\n\nconsumption of oral analgesics was not apparent in our study. \n\n\n\n88.2% of patients took oral analgesic(s) 'as needed', which \n\n\n\naligned with 95.3% of the 'as needed' prescribed instruction. \n\n\n\nHowever, the matching preference of both prescribers and the \n\n\n\npatients in our study subjects was far from good news. Current \n\n\n\nrecommendations advocated regular administration of \n\n\n\nanalgesics in chronic pain management [9,11-14], but only \n\n\n\n4.7% of the prescriptions were written for 'regular dosing', \n\n\n\n \nFig. I: Pain scores reported by 127 study patients as collected from Brief \n\n\n\nPain Inventory-Short Form (BPI-sf) \n\n\n\nTable III: Percentage of patients with negative and positive PMI scores \n\n\n\nbased on deviation of oral and topical analgesic dosing   \n\n\n\n\n\n\n\nDosing Deviation Pain Management Index (PMI) \n\n\n\nPositive Negative Total p-value \n\n\n\nOral only \n\n\n\nYes \n\n\n\nNo \n\n\n\n\n\n\n\n1  \n\n\n\n9  \n\n\n\n\n\n\n\n1  \n\n\n\n21  \n\n\n\n\n\n\n\n2  \n\n\n\n30  \n\n\n\n\n\n\n\n0.534a \n\n\n\nTotal 10  22  32   \n\n\n\nTopical only \n\n\n\nYes \n\n\n\nNo \n\n\n\n\n\n\n\n10  \n\n\n\n 17  \n\n\n\n\n\n\n\n23 \n\n\n\n45  \n\n\n\n\n\n\n\n33 \n\n\n\n62 \n\n\n\n\n\n\n\n0.767b \n\n\n\nTotal 27  68  95   \n\n\n\nOverall \n\n\n\nYes \n\n\n\nNo \n\n\n\n\n\n\n\n4  \n\n\n\n33  \n\n\n\n\n\n\n\n11  \n\n\n\n79  \n\n\n\n\n\n\n\n15  \n\n\n\n112  \n\n\n\n\n\n\n\n>0.95a \n\n\n\nTotal 37 \n\n\n\n(29.1%) \n\n\n\n90 \n\n\n\n(70.9%) \n\n\n\n127 \n\n\n\n(100%) \n\n\n\n\n\n\n\naFisher's exact test bPearson chi-square test \n\n\n\n\n\n\n\nTable II: Analgesic dosing behaviors among patients (N=127) \n\n\n\n\n\n\n\nType of \n\n\n\nAnalgesics \n\n\n\nPrescriber Instruction, \n\n\n\nN (%) \n\n\n\nPatient Dosing, N (%) Total \n\n\n\nAs \n\n\n\nNeeded \n\n\n\nRegular As \n\n\n\nNeeded \n\n\n\nRegular  \n\n\n\nOral 121 (95.3) 6 (4.7) 112 (88.2) 15 \n\n\n\n(11.8) \n\n\n\n127 \n\n\n\nTopical 94 (98.9) 1 (1.1) 61 (64.2) 34 \n\n\n\n(35.8) \n\n\n\n95 \n\n\n\n \n\n\n\n\n\n\n\n\nHarun, M.A. et al. Mal J Pharm 7 (1) 2021, 28-33 \n\n\n\n\n\n\n\n32 \n\n\n\n\n\n\n\nhighlighting a guideline non-adherence in chronic pain \n\n\n\nmanagement among our healthcare professionals. \n\n\n\n\n\n\n\nPain control was not found to be significantly associated with \n\n\n\ndosing deviation (p>0.95). Negative PMI, an indication of poor \n\n\n\npain control with analgesics, was the major observation in our \n\n\n\npatients, regardless of whether they followed or deviated from \n\n\n\nthe prescribed dose. Hence, additional analgesic should be \n\n\n\nadded to the existing regimen for better pain control. In the \n\n\n\nstudy, none of the patients was prescribed a strong opioid, \n\n\n\ndespite the fact that a few patients reported their worst pain \n\n\n\nscore at 10, the highest pain score. In Kuala Lipis Hospital, \n\n\n\nstrong opioids are reserved for cancer patients. Thus, the \n\n\n\nstrongest analgesic available for CNCP patients in our setting \n\n\n\nis weak opioids. The prescribing practice will need to be \n\n\n\nreviewed following the results of the study, as the majority of \n\n\n\nCNCP patients in our study subjects were inadequately treated. \n\n\n\nStrong opioids should be used to manage severe pain, based on \n\n\n\nthe WHO analgesic ladder [10] and local guidelines [23].  \n\n\n\n\n\n\n\nThe most frequently prescribed oral analgesics in our setting \n\n\n\nwere celecoxib and tramadol. Other oral analgesics that were \n\n\n\nprescribed to our patients were paracetamol and diclofenac. \n\n\n\nGabapentin and pregabalin were also used as adjuvants in \n\n\n\nneuropathic pain. There were no prescribing records found for \n\n\n\nstrong opioids in the management of CNCP. Celecoxib, a \n\n\n\nselective cyclooxygenase-2 inhibitor, was the most commonly \n\n\n\nprescribed analgesic within the family of NSAIDs due to its \n\n\n\nbetter gastrointestinal safety profile. It was also well-accepted \n\n\n\namong doctors in Malaysia due to the general belief that \n\n\n\ncelecoxib is more efficacious than conventional NSAIDs in \n\n\n\nreducing pain and inflammation [24]. On the other hand, the \n\n\n\nonly weak opioids in our hospital formulary are tramadol and \n\n\n\ndihydrocodeine. Since dihydrocodeine is classified as a \n\n\n\ndangerous drug and hence more stringent prescribing criteria, \n\n\n\nthe cheap and easily accessible tramadol is a popular add-on \n\n\n\noption for CNCP patients whose pain is uncontrolled with \n\n\n\nNSAIDs and paracetamol.  \n\n\n\n\n\n\n\nIt was shown in our study that 98% of CNCP patients did not \n\n\n\nknow the maximum allowable daily dose of analgesic(s) which \n\n\n\nthey were taking. They claimed to take their analgesic(s) as \n\n\n\nneeded without knowing the maximum allowable quantity per \n\n\n\nday. This situation is alarming as it can increase the risk of \n\n\n\nmedication misuse and accidental overdose. In fact, an \n\n\n\nAustralian report on injury research and statistics revealed that \n\n\n\nparacetamol, a type of analgesic, was accountable for the 2nd \n\n\n\nhighest pharmaceutical poisoning cases (11%, n=718) [25]. \n\n\n\nNot only that, but the deficiency in patient knowledge about \n\n\n\nparacetamol use was also highlighted in a few descriptive and \n\n\n\ncross-sectional studies [26-28]. Therefore, the knowledge gap \n\n\n\namong patients on the safe use of analgesics could be an \n\n\n\nopportunity for pharmacists to play a bigger role in preventing \n\n\n\ncases of pharmaceutical poisoning. However, a hospital survey \n\n\n\non the counseling practice of pharmacists showed \n\n\n\ndisappointing results. The survey confirmed that less than half \n\n\n\nof the pharmacists provided counseling and precautionary \n\n\n\nwarnings when dispensing paracetamol [29].  Therefore, \n\n\n\npharmacists need to do more in educating patients about the \n\n\n\nsafe use of not just paracetamol but of all analgesics in pain \n\n\n\nmanagement.  \n\n\n\n\n\n\n\nBesides the conventional analgesics, traditional and \n\n\n\ncomplementary medicines are gaining popularity and have \n\n\n\nbecome one of the popular alternatives in chronic pain \n\n\n\nmanagement. It was found that 69.4% of the Malaysian \n\n\n\npopulation used traditional and complementary medicines \n\n\n\nthroughout their life, and 55.6% of them used them annually \n\n\n\n[30]. In our study, nineteen (15%) patients sourced traditional \n\n\n\nand complementary medicines such as massage, acupuncture, \n\n\n\nmeditation, and cupping; and reported efficacy from these \n\n\n\nalternatives. The positive experience with traditional and \n\n\n\ncomplementary medicines is also demonstrated overseas. In \n\n\n\nfact, a patient survey in Singapore found that as much as 72% \n\n\n\nof patients reported better pain relief with complementary \n\n\n\nmedicines [31]. Gathering from the current evidence, \n\n\n\ntraditional and complementary medicines can become an \n\n\n\neffective alternative approach in chronic pain management, \n\n\n\nespecially among those patients who found limited pain relief \n\n\n\nfrom their current analgesics. However, they should be guided \n\n\n\nby informed healthcare professionals during the selection \n\n\n\nprocess so as not to fall victims to unscrupulous dealers, which \n\n\n\neventually may give rise to other health complications. \n\n\n\n\n\n\n\nCONCLUSION  \n \n\n\n\nThe prevalence of \u2018as needed\u2019 dosing is higher than around-the-\n\n\n\nclock dosing in the management of chronic, non-cancer pain, \n\n\n\nwith deviation from the prescribed instructions between 11.8-\n\n\n\n34.7%. However, those differences were not significantly \n\n\n\nassociated with the pain control. Our study highlighted that \n\n\n\npoor pain control in CNCP patients was due to fundamental \n\n\n\nerror at the prescribing stage, starting from inappropriate \n\n\n\nanalgesic choice and description of dosage frequency. Poor \n\n\n\npain control was impacted less by patients deviating from \n\n\n\nprescribing instructions. \n\n\n\n\n\n\n\nACKNOWLEDGMENT \n  \n\n\n\nWe would like to thank the Director-General of Health \n\n\n\nMalaysia for his permission to publish this article. We would \n\n\n\nalso like to express our gratitude to Georgia Bolden-Strestik, \n\n\n\nTan Jee Aik and Yap Pei Qi for helping to proofread the \n\n\n\nmanuscript. \n\n\n\n\n\n\n\nCONFLICT OF INTEREST \n  \n\n\n\nNone declared. \n\n\n\n\n\n\n\n\nHarun, M.A. et al. Mal J Pharm 7 (1) 2021, 28-33 \n\n\n\n\n\n\n\n33 \n\n\n\n\n\n\n\nREFERENCE \n \n[1] Merskey H, Bogduk N. 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Validation of the Malay Brief \n\n\n\nPain Inventory questionnaire to measure cancer pain. J Pain Symptom \n\n\n\nManage. 2006 Jan;31(1):13-21. \n\n\n\n[20] Harminder S, Raja PSB, Baltej S. Assessment of adequacy of pain \n\n\n\nmanagement and analgesic use in patients with advanced cancer using \n\n\n\nthe brief pain inventory and pain management index calculation. J \n\n\n\nGlob Oncol. 2017;3(3): 235 \u2013 41. \n\n\n\n[21] Apolone G. Corli O, Caraceni A, et al. Pattern and quality of care of \n\n\n\ncancer pain management. Results from the Cancer Pain Outcome \n\n\n\nResearch Study Group. Br J Cancer. 2009;100(10): 1566 \u2013 74. \n\n\n\n[22] Sale JEM, Gignac M, Hawker G. How \"bad\" does the pain have to be? \n\n\n\nA qualitative study examining adherence to pain medication in older \n\n\n\nadults with osteoarthritis. Arthritis Care Res. 2006;55(2):272\u20138. \n\n\n\n[23] Malaysian Association for the Study of Pain. A guide to the use of \n\n\n\nstrong opioids in chronic non-cancer pain. 2015 [cited 26th November \n\n\n\n2019]. Available online from: \n\n\n\nhttp://www.masp.org.my/index.cfm?menuid=33 \n\n\n\n[24] Chan HK, Bakri E, Tan SY, et al. Prescribing patterns of celecoxib \n\n\n\nand prescribers' perceptions among three general hospitals in Northern \n\n\n\nMalaysia. Arch Pharma Pract. 2014;5(1): 28-34. \n\n\n\n[25] Tovell A, McKenna K, Bradley C & Pointer S. Hospital separations \n\n\n\ndue to injury and poisoning, Australia 2009\u201310. Injury research and \n\n\n\nstatistics series no. 69. Cat. no. INJCAT 145. Canberra: AIHW. \n\n\n\n[26] Hornsby LB, Whitley HP, Hester EK, et al. Survey of patient \n\n\n\nknowledge related to acetaminophen recognition, dosing, and toxicity. \n\n\n\nJ Am Pharm Assoc. 2010;50(4):485-9. \n\n\n\n \n[27] Shone LP, King JP, Doane C, et al. Misunderstanding and potential \n\n\n\nunintended misuse of acetaminophen among adolescents and young \n\n\n\nadults. J Health Commun. 2011;16(Suppl 3): 256\u201367. \n\n\n\n[28] Wolf MS, King J, Jacobson K, et al. Risk of unintentional overdose \n\n\n\nwith non-prescription acetaminophen products. J Gen Intern Med. \n\n\n\n2012;27(12): 1587\u201393. \n\n\n\n[29] Ali I, Khan AU, Khan J, et al. Survey of hospital pharmacists' \n\n\n\nknowledge regarding acetaminophen dosing, toxicity, product \n\n\n\nrecognition and counselling practices. J Pharm Health Serv Res. \n\n\n\n2017;8(1):39\u201343.  \n\n\n\n[30] Siti ZM, Tahir A, Farah Al, et al. Use of traditional and \n\n\n\ncomplementary medicine in Malaysia: a baseline study. Complement \n\n\n\nTherapies in Med. 2009;17(5-6):292-9. \n\n\n\n[31] Tan MG, Win MT, Khan SA. The use of complementary and \n\n\n\nalternative medicine in chronic pain patients in Singapore: a single-\n\n\n\ncentre study. Ann Acad Med Singapore. 2013;42(3):133-7. \n\n\n\n \n\n\n\n\nhttp://www.wales.nhs.uk/sites3/Documents/814/PainLadder-ABHBNov2012.pdf\n\n\nhttp://www.wales.nhs.uk/sites3/Documents/814/PainLadder-ABHBNov2012.pdf\n\n\nhttp://www.masp.org.my/index.cfm?menuid=33\n\n\n\n"
"\n\nMalaysian Journal of Pharmacy Volume 7 Issue 2 (2021) \n \n\n\n\n\n\n\n\n64 \n\n\n\n\n\n\n\n*Correspondence: weithing@gmail.com \n1Bpharm. Faculty of Pharmacy, SEGi University Kota Damansara, Jalan \n\n\n\nTeknologi 47810 Petaling Jaya, Selangor Darul Ehsan, Malaysia. \n2Bpharm, MSc. Faculty of Pharmacy, SEGi University Kota Damansara, \n\n\n\nJalan Teknologi 47810 Petaling Jaya, Selangor Darul Ehsan, Malaysia. \n \n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n Original Article \n\n\n\n\n\n\n\nKnowledge, Attitude and Practice of Malaysian Private \n\n\n\nHospital Pharmacists on Medication Review  \n \n\n\n\nSze Ling Wong1, Wei Thing Sze2* \n\n\n\n\n\n\n\n \nArticle Info  \n\n\n\n \nReceived date: 17 Aug 2021  \n\n\n\nAccepted date: 06 Dec 2021 \n\n\n\nPublished date: 31 Dec 2021 \n\n\n\n\n\n\n\nKeywords: Medication Review \n\n\n\nPrivate Hospital \n\n\n\nHospital Pharmacist. \n\n\n\nABSTRACT  \n\n\n\n\n\n\n\nBackground: Medication review is emerging as one of the vital components of medication \n\n\n\nmanagement to prevent medicine-related problems. Study demonstrated a high prevalence of \n\n\n\npotentially inappropriate medication use in private aged care facilities. There is a strong need for \n\n\n\nmedication review in the private healthcare system in Malaysia to ensure pharmaceutical safety and \n\n\n\neffectiveness. This study aimed to determine the knowledge, attitude and practice of private hospital \n\n\n\npharmacists on medication review service in Malaysia. Method: This cross-sectional study was \n\n\n\ncarried out from October to November 2020 using an online questionnaire. Private hospital \n\n\n\npharmacists in Malaysia were invited to participate in a validated 36-items questionnaire. Descriptive \n\n\n\nstatistics, Mann-Whitney U test and Kruskal-Wallis H test were performed to analyse the data. \n\n\n\nResults: Survey questionnaires were completed by 104 private hospital pharmacists. 80 pharmacists \n\n\n\n(76.9%) presented with a high level of knowledge of medication review, while 92 pharmacists \n\n\n\n(88.5%) had a positive attitude. Approximately two-third (n = 68, 65.4%) was providing medication \n\n\n\nreview in the pharmacy, whereas 45 of them (43.3%) did not obtain patient\u2019s medication history at \n\n\n\nthe time of admission or as early as possible. Besides, only 69 of the participants (66.3%) reconciled \n\n\n\npatient\u2019s own medication with the prescribed medicines. Factors associated significantly with \n\n\n\npractice of medication review include age (p = 0.010) and years of experience as a private hospital \n\n\n\npharmacist (p = 0.016).  Three major perceived challenges of implementing medication review were \n\n\n\nlack of time (82.7%), insufficient training (79.8%) and lack of manpower (60.6%). Conclusion: In \n\n\n\nconclusion, private hospital pharmacists in Malaysia have high level of knowledge, a positive attitude \n\n\n\nand a fair practice regarding medication review service. Several challenges such as lack of time, \n\n\n\ninsufficient training and lack of manpower might obstruct the practice of medication review service \n\n\n\nin the private hospitals.  \n\n\n\n\n\n\n\n\n\n\n\nINTRODUCTION  \n  \n\n\n\nMedicines are the primary intervention for the prevention and \n\n\n\ntreatment of illnesses and diseases. Medicines must be \n\n\n\nprescribed and administered appropriately to achieve the best \n\n\n\npharmaceutical outcomes. Therefore, reviewing medicines and \n\n\n\nmedicine-taking behaviour is critical in patient care plans and \n\n\n\nhealthcare [1].  \n\n\n\n\n\n\n\nAccording to the guideline \"A Guide to Medication Review \n\n\n\n2008\", medication review was defined as \"a structured, critical \n\n\n\nexamination of a patient's medicines to reach an agreement \n\n\n\nwith the patient about treatment, optimising the impact of \n\n\n\nmedicines, minimising the number of medication-related \n\n\n\nproblems and reducing waste\". Medication review is emerging \n\n\n\nas one of the vital components in medication management to \n\n\n\nimprove the quality, safety and appropriate use of medicines, \n\n\n\nthus preventing drug-related problems [2]. As drug experts in \n\n\n\nhealthcare, pharmacists play an essential role in medication \n\n\n\nreview service beyond regular pharmacy practices such as drug \n\n\n\ndispensing and patient counselling. In particular, clinical \n\n\n\npharmacists work frequently and regularly interact with \n\n\n\nphysicians, other healthcare professionals, and patients to \n\n\n\n\n\n\n\n\nSze W.T. et al. Mal J Pharm 7 (2) 2021, 64-73 \n\n\n\n\n\n\n\n65 \n\n\n\n\n\n\n\nensure prescribed medicines contribute to the best possible \n\n\n\noutcomes [3].  \n\n\n\n\n\n\n\nHome Care Pharmacy Services (HCPS), or in Malaysia, known \n\n\n\nas Home Medication Review (HMR), provides home care \n\n\n\nfacilities for patients treated at Ministry of Health (MOH) \n\n\n\nfacilities to enhance patient's care after returning home from \n\n\n\nhealth facilities. The whole process of HCPS involves a \n\n\n\ncomprehensive and systematic workflow, including drug \n\n\n\nreconciliation and medication review for quality use of \n\n\n\nmedications and to resolve pharmaceutical care issues, such as \n\n\n\nadverse drug reactions, patient's adherence and medication \n\n\n\nstorage. It has focused on patients from neurology, psychiatry \n\n\n\nand geriatric disciplines and those with chronic diseases and \n\n\n\npolypharmacy [4].  \n\n\n\n\n\n\n\nMedication review has proven to provide positive impacts for \n\n\n\nthe patients. First of all, this service could reduce the number \n\n\n\nof prescribed medicines, improve medication appropriateness, \n\n\n\npromote proper polypharmacy, and determine potential and \n\n\n\nactual drug-related problems, thus reducing the frequency of \n\n\n\nhospitalisation and the number of deaths in geriatric. Moreover, \n\n\n\nit may assist in medication adherence and identification and \n\n\n\nresolution of challenging drug issues faced by nursing staff and \n\n\n\ncaregivers [5]. HMR program has demonstrated to be \n\n\n\nbeneficial in patients with chronic diseases, especially stroke, \n\n\n\nschizophrenia and type 2 diabetes mellitus (T2DM). Benefits \n\n\n\nof HMR include significantly reduced blood pressure, glucose \n\n\n\nlevel and cholesterol level in post-stroke patients, improved \n\n\n\nmedication adherence, knowledge on medications and quality \n\n\n\nof life among schizophrenic patients and patients with T2DM \n\n\n\n[6\u20139].  \n\n\n\n\n\n\n\nIn Malaysia, pharmacy practice has evolved from a product-\n\n\n\noriented to a more patient-oriented service. Doctors in the \n\n\n\ngovernment hospitals prescribe according to the drug \n\n\n\nformulary of the hospital, and prioritise the use of generic \n\n\n\ndrugs. Medicines dispensed to the patients are supervised by \n\n\n\npharmacists [10]. In contrast, doctors in the private practice \n\n\n\npossess the legal right to prescribe and dispense medicines, and \n\n\n\nbrand prescribing is the norm. The low generic prescription rate \n\n\n\nis due to their negative perceptions about safety, quality and \n\n\n\nefficacy of generic medicines [11]. The absence of prescribing \n\n\n\nand dispensing separation in the private sector could lead to \n\n\n\npossible profit-oriented medical and pharmacy practices. \n\n\n\nDispensing doctors was found to prescribe seven times more \n\n\n\nmedicines than non-dispensing doctors. Nevertheless, out of \n\n\n\nconvenience and the interest of cost-savings, many patients \n\n\n\nchoose to purchase medications for chronic diseases from \n\n\n\ncommunity pharmacies without medical consultation and \n\n\n\nfollow-ups with doctors from the hospital, which ultimately \n\n\n\ncompromise patient safety and hinder cost-effective medication \n\n\n\nuse [12,13]. A cross-sectional study demonstrated that \n\n\n\nresidents of aged care facilities were highly vulnerable to \n\n\n\npotentially inappropriate medication use, indicating a need for \n\n\n\na periodic medication review to minimise morbidity [14].  \n\n\n\n\n\n\n\nThe emergence of medical tourism and private healthcare \n\n\n\ninsurance have resulted in the fast development of private \n\n\n\nhospitals, which in turn lead to the role expansion of private \n\n\n\nhospital pharmacists [15]. Aside from the conventional role as \n\n\n\nan inpatient and outpatient pharmacist, private hospital \n\n\n\npharmacists have the opportunity to involve in clinical services \n\n\n\nin the wards, therapeutic drug monitoring, clinical oncology \n\n\n\npharmacy, medication adherence clinic as well as parenteral \n\n\n\nnutrition services and so on [16]. However, there are no reports \n\n\n\non the extend of the provision of medication review service in \n\n\n\nthe private hospitals. A few studies had reported the medication \n\n\n\nreview service which was primarily carried out by pharmacists \n\n\n\nin the public hospitals [6-9,17]. Impacts of medication review \n\n\n\nand its challenges were emphasised in these studies [6-9], while \n\n\n\none study discussed the KAP among pharmacists on \n\n\n\nmedication therapy management in public hospital [17].  \n\n\n\n\n\n\n\nTo the best of our knowledge, there is no study that has assessed \n\n\n\nthe knowledge, attitude and practice of private hospital \n\n\n\npharmacists on medication review in Malaysia. Ultimately, the \n\n\n\nmain objective of this research was to determine the \n\n\n\nknowledge, attitude and practice (KAP) of private hospital \n\n\n\npharmacists on medication review services in Malaysia. It also \n\n\n\naimed to identify the perceived challenges and barriers of \n\n\n\nimplementing medication reviews by private hospital \n\n\n\npharmacists in Malaysia. \n\n\n\n\n\n\n\nMETHOD  \n \n\n\n\nStudy Design and Setting \n\n\n\n\n\n\n\nWe conducted a cross-sectional survey on knowledge, attitude \n\n\n\nand practice on medication review among private hospital \n\n\n\npharmacists in Malaysia. Self-administered questionnaires \n\n\n\nwere distributed online through emails from October 2020 to \n\n\n\nNovember 2020. We utilised online resources such as private \n\n\n\nhospital official websites, the Official Portal of Pharmaceutical \n\n\n\nServices Programme, and Yellow Pages Malaysia to identify \n\n\n\nall private hospitals located in Malaysia and their contact \n\n\n\nnumbers. We also obtained the email addresses of pharmacy \n\n\n\ndepartment or the pharmacists for questionnaire distribution.  \n\n\n\n\n\n\n\nSample Size Calculation \n\n\n\n\n\n\n\nThe total population size of registered pharmacists in private \n\n\n\nhospitals and clinics in Malaysia was estimated at 417 [18]. \n\n\n\nHowever, the number of pharmacists involved in the \n\n\n\nmedication management of inpatients and outpatients were \n\n\n\nunclear. Therefore, all private hospital pharmacists were \n\n\n\ninvited to participate in the study through email.  \n\n\n\n \n\n\n\n\n\n\n\n\nSze W.T. et al. Mal J Pharm 7 (2) 2021, 64-73 \n\n\n\n\n\n\n\n66 \n\n\n\n\n\n\n\nInclusion Criteria \n\n\n\n\n\n\n\nParticipants who are eligible to participate in this study include: \n\n\n\n(I) a fully registered pharmacist (FRP) under the Pharmacy \n\n\n\nBoard, (II) currently works in private hospitals, (III) works in \n\n\n\nprivate hospitals for at least one year, (IV) able to understand \n\n\n\nEnglish and (V) agrees with the informed consents to \n\n\n\nparticipate in the study voluntarily.   \n\n\n\n\n\n\n\nExclusion Criteria \n\n\n\n\n\n\n\nThe exclusion criteria include: (I) a pharmacist assistant or \n\n\n\nprovisionally registered pharmacist (PRP), (II) works in \n\n\n\ngovernment hospitals or government clinics, or private clinics, \n\n\n\n(III) works in private hospitals for less than one year, and (IV) \n\n\n\nunable to understand English.  \n\n\n\n\n\n\n\nSubject Recruitment and Data Collection \n\n\n\n\n\n\n\nUniversal sampling was carried out because the number of \n\n\n\npharmacists working in private hospitals was unknown, while \n\n\n\ncompensating for any refusal to respond. Data were obtained \n\n\n\nby compiling responses from questionnaires distributed \n\n\n\nthrough email invitations to the respective pharmacy \n\n\n\ndepartment of the private hospitals. The participants were \n\n\n\nrequired to complete the questionnaires sent via Google Forms. \n\n\n\nParticipants were given options to provide their departmental \n\n\n\nor personal email addresses, or they could choose to complete \n\n\n\nthe survey as anonymous. Three follow-up reminders were \n\n\n\nconducted by email after each three consecutive days, and \n\n\n\nalong the follow-up process we excluded the email addresses \n\n\n\nthat were provided by participants in the completed survey. \n\n\n\nPhone calls were also made to the pharmacy departments to \n\n\n\ncheck if the online survey has been well received, as well as to \n\n\n\nserve as a final reminder on the survey.  \n\n\n\n\n\n\n\nEthical Consideration \n\n\n\n\n\n\n\nThe SEGI University Research Ethics Committee approved the \n\n\n\nstudy. Informed consent was obtained by clicking the \u2018agree\u2019 \n\n\n\noption in the questionnaire. Participants' names were excluded \n\n\n\nto ensure anonymity. They were informed that their \n\n\n\nparticipation was entirely voluntary, and their answers in this \n\n\n\nstudy will remain confidential.  \n\n\n\n\n\n\n\nQuestionnaire  \n\n\n\n\n\n\n\nA 36 item-questionnaire was constructed with reference to \n\n\n\nofficial practice guidelines and a validated questionnaire on \n\n\n\nmedication review [2,17,19-20] (Refer Appendix on \n\n\n\ndescriptions of sections in the questionnaire). Four pharmacists \n\n\n\nwith experiences in clinical pharmacy and medication review \n\n\n\nreviewed the questionnaire's content to ensure its content is \n\n\n\nrelevant to the local practice setting. Face validation of the \n\n\n\nquestionnaire was established with a pre-test on nine private \n\n\n\nhospital pharmacists before the actual study. The questionnaire \n\n\n\nwas amended and refined based on the comments and feedback \n\n\n\nfrom respondents, such as sentence restructuring. \n\n\n\n\n\n\n\nThe participants' summated score of each KAP domain was \n\n\n\ndivided into three levels based on Bloom's cut-off point [21]. \n\n\n\nRespondents who scored 80% and above were categorised as \n\n\n\nhaving a high level of knowledge, positive attitude or good \n\n\n\npractice. Respondents that acquired 60% to 79% were on a \n\n\n\nmoderate level, whereas respondents with less than 60% had a \n\n\n\nlow level, negative attitude and poor practice on medication \n\n\n\nreview.  \n\n\n\n\n\n\n\nStatistical Analysis  \n\n\n\n\n\n\n\nStatistical Package for the Social Sciences (IBM SPSS\u00ae) \n\n\n\nsoftware, version 26, was used to analyse data gathered from \n\n\n\nall respondents. Data were presented in descriptive statistics, as \n\n\n\nfrequency and percentage (%) for categorical data, whereas \n\n\n\nmedian (interquartile range) for continuous data. Correlation \n\n\n\nbetween levels of KAP on medication review was analysed by \n\n\n\nSpearman's Rank Order Correlation test because they were \n\n\n\nordinal data. Mann-Whitney U and Kruskal-Wallis H statistical \n\n\n\ntests were performed to assess the association between \n\n\n\nsociodemographic characteristics and each KAP total score. \n\n\n\nThe data obtained were not normally distributed. A level of p-\n\n\n\nvalue \u2264 0.05 was considered to be statistically significant. \n\n\n\n\n\n\n\nRESULT  \n \n\n\n\nSociodemographic Characteristics  \n\n\n\n\n\n\n\nOne hundred and four respondents completed the survey \n\n\n\nquestionnaires. Table I below summarises the \n\n\n\nsociodemographic characteristics of the respondents. They \n\n\n\nwere predominantly female (n = 76, 73.1%), Chinese (n = 69, \n\n\n\n66.3%), had Bachelor\u2019s degree as their highest education level \n\n\n\n(n = 83, 79.8%), graduated in Malaysia (n = 67, 64.4%) and \n\n\n\nhave one to five years of experience as a private hospital \n\n\n\npharmacist (n = 53, 51.0%). The same number of respondents \n\n\n\n(n = 44, 42.3%) come from the same age group of between 21 \n\n\n\nand 30 and between 31 and 40.  \n\n\n\n\n\n\n\nKnowledge on Medication Review  \n\n\n\n\n\n\n\nKnowledge of private hospital pharmacists on medication \n\n\n\nreview was categorised as high. The median score was 9.0 (IQR \n\n\n\n1.0), with a minimum of 5 points and a maximum of 9 points \n\n\n\nobtained by the respondents. The majority of the participants (n \n\n\n\n= 80, 76.9%) had a high level of knowledge regarding \n\n\n\nmedication review, while 20.2% (n = 21) and 2.9% (n = 3) had \n\n\n\na moderate and low level, respectively.  \n\n\n\n \n\n\n\n\n\n\n\n\nSze W.T. et al. Mal J Pharm 7 (2) 2021, 64-73 \n\n\n\n\n\n\n\n67 \n\n\n\n\n\n\n\nNine statements were used to assess the knowledge of \n\n\n\npharmacists on medication review (Table II). Approximately \n\n\n\nall of the pharmacists (n = 100, 96.2%) knew the definition of \n\n\n\nmedication review. They were also aware that this service aims \n\n\n\nto optimise the impact of treatment for an individual patient (n \n\n\n\n= 101, 97.1%), to improve the quality of life, safety and \n\n\n\nappropriate use of medicines (n = 104, 100%), to identify \n\n\n\nproblems for action by the prescriber, patient or both but can \n\n\n\nalso be regarded as an educational intervention to support \n\n\n\npatient knowledge and adherence (n = 91, 87.5%). However, \n\n\n\n37.5% of the participants (n = 39) were unsure of the three types \n\n\n\nof medication review service, namely prescription review, \n\n\n\ncompliance and concordance review and clinical medication \n\n\n\nreview. All respondents were aware that patients should have \n\n\n\nthe chance to raise questions and highlight problems related to \n\n\n\ntheir medicines. In addition, 96.2% (n = 100), 98.1% (n = 102) \n\n\n\nand 81.7% (n = 85) of the respondents correctly opined that \n\n\n\n\"medication review conducted with the patient should include \n\n\n\nprescribed medicines, over-the-counter medicines and \n\n\n\ncomplementary medicines\", \"medication review should be \n\n\n\nundertaken systematically by a competent person\" and \n\n\n\n\"medication review should be documented in the patient's \n\n\n\nnotes\", respectively. There was a significant association \n\n\n\nbetween gender with knowledge score on medication review (p \n\n\n\n= 0.030) among all pharmacists participating in this study \n\n\n\n(Table III). \n\n\n\n\n\n\n\nAttitude on Medication Review \n\n\n\n\n\n\n\nGenerally, private hospital pharmacists in Malaysia exhibited a \n\n\n\npositive attitude towards medication review service as the \n\n\n\nmedian score of attitudes was equal to 27.0 (IQR 5.0) (Table \n\n\n\nIV). The minimum and maximum scores were 6 and 30, \n\n\n\nrespectively. A large proportion of the participants (n = 92, \n\n\n\n88.5%) had a positive attitude, 10.6% (n = 11) were neutral and \n\n\n\n\n\n\n\nTable I. Sociodemographic characteristics of the respondents  \n\n\n\n(n = 104) \n\n\n\n\n\n\n\nCharacteristics Frequency Percentage (%) \n\n\n\nGender \n\n\n\n   Male  28 26.9 \n\n\n\n   Female 76 73.1 \n\n\n\nAge \n\n\n\n   21-30 44 42.3 \n\n\n\n   31-40 44 42.3 \n\n\n\n   41 and above 16 15.4 \n\n\n\nRace \n\n\n\n   Malay 24 23.1 \n\n\n\n   Chinese 69 66.3 \n\n\n\n   Indian 9 8.7 \n\n\n\n   Others a 2 1.9 \n\n\n\nHighest education level \n\n\n\n   Bachelor\u2019s 83 79.8 \n\n\n\n   Master\u2019s 21 20.2 \n\n\n\nCountry where the undergraduate degree is taken \n\n\n\n   Malaysia 67 64.4 \n\n\n\n   United Kingdom 27 26.0 \n\n\n\n   Others b 10 9.6 \n\n\n\nPharmacy practice rolesc \n\n\n\n   Outpatient 63 60.6 \n\n\n\n   Inpatient 57 54.8 \n\n\n\n   Store 31 29.8 \n\n\n\n   Clinical 21 20.2 \n\n\n\n   Drug information centre 20 19.2 \n\n\n\n   Management 15 14.4 \n\n\n\n   Others d 13 12.5 \n\n\n\nYears of experience  \n\n\n\n   1-5 53 51.0 \n\n\n\n   6-10 30 28.8 \n\n\n\n   11-15 13 12.5 \n\n\n\n   16 and above 8 7.7 \n\n\n\n\n\n\n\n a Punjabi and Iban \nb Australia and Taiwan \nc Pharmacists practising more than one role (n = 220) \nd Medication Therapy Adherence Clinic (MTAC), Total Parenteral \n\n\n\nNutrition (TPN), Cytotoxic Drug Reconstitution (CDR) and Nuclear\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nTable II. Knowledge on medication review among private hospital \n\n\n\npharmacists in Malaysia \n\n\n\n\n\n\n\nStatements \n\n\n\nFrequency (%) \n\n\n\nTrue False \nNot \n\n\n\nsure \n\n\n\nMedication review is defined as a \n\n\n\nstructured, critical examination of a \n\n\n\npatient's medicines to reach a treatment \n\n\n\nagreement, optimising the impact of \n\n\n\nmedicines, minimising the number of \n\n\n\nmedication-related problems and reducing \n\n\n\nwaste. \n\n\n\n\n\n\n\n100 \n\n\n\n(96.2) \n\n\n\n0 \n\n\n\n(0) \n\n\n\n4 \n\n\n\n(3.8) \n\n\n\nMedication review aims to improve or \n\n\n\noptimise the impact of treatment for an \n\n\n\nindividual patient.  \n\n\n\n101 \n\n\n\n(97.1) \n\n\n\n0  \n\n\n\n(0) \n\n\n\n3  \n\n\n\n(2.9) \n\n\n\n\n\n\n\nMedication review aims to improve the \n\n\n\nquality, safety and appropriate use of \n\n\n\nmedicines. \n\n\n\n\n\n\n\n\n\n\n\n104 \n\n\n\n(100) \n\n\n\n\n\n\n\n0  \n\n\n\n(0) \n\n\n\n\n\n\n\n0  \n\n\n\n(0) \n\n\n\nMedication review aims to identify the \n\n\n\nprescriber, patient, or both problems for \n\n\n\naction but can also be regarded as an \n\n\n\neducational intervention to support patient \n\n\n\nknowledge and adherence. \n\n\n\n\n\n\n\n91 \n\n\n\n(87.5) \n\n\n\n0  \n\n\n\n(0) \n\n\n\n13 \n\n\n\n(12.5) \n\n\n\nThere are three types of medication \n\n\n\nreview:  Prescription review, Compliance \n\n\n\nand concordance review and Clinical \n\n\n\nmedication review.  \n\n\n\n\n\n\n\n64 \n\n\n\n(61.5) \n\n\n\n1  \n\n\n\n(1.1) \n\n\n\n39 \n\n\n\n(37.5) \n\n\n\nMedication reviews conducted with the \n\n\n\npatient should include prescribed \n\n\n\nmedicines, over-the-counter medicines \n\n\n\nand complementary medicines.  \n\n\n\n\n\n\n\n100 \n\n\n\n(96.2) \n\n\n\n1  \n\n\n\n(1.1) \n\n\n\n3  \n\n\n\n(2.9) \n\n\n\nAll patients should have the chance to \n\n\n\nraise questions and highlight problems \n\n\n\nabout their medicines.  \n\n\n\n104 \n\n\n\n(100) \n\n\n\n0  \n\n\n\n(0) \n\n\n\n0  \n\n\n\n(0) \n\n\n\n\n\n\n\nMedication review should be undertaken \n\n\n\nsystematically by a competent person.  \n\n\n\n\n\n\n\n\n\n\n\n102 \n\n\n\n(98.1) \n\n\n\n\n\n\n\n1  \n\n\n\n(1.1) \n\n\n\n\n\n\n\n1  \n\n\n\n(1.1) \n\n\n\nMedication review should be documented \n\n\n\nin the patient's notes. \n\n\n\n\n\n\n\n85 \n\n\n\n(81.7) \n\n\n\n5  \n\n\n\n(4.8) \n\n\n\n14 \n\n\n\n(13.5) \n\n\n\n \n\n\n\n\n\n\n\n\nSze W.T. et al. Mal J Pharm 7 (2) 2021, 64-73 \n\n\n\n\n\n\n\n68 \n\n\n\n\n\n\n\nonly 1.0% (n = 1) were negative towards medication review \n\n\n\nservice.  \n\n\n\n\n\n\n\nAlmost all of the respondents (n = 98, 94.2%) agreed that \n\n\n\nreviewing a patient's medication profile and providing \n\n\n\ninterventions to prevent adverse effects were important roles of \n\n\n\npharmacists besides the process of normal dispensing \n\n\n\nfunctions. Similarly, 95.2% (n = 99) believed that patients \n\n\n\nwould receive adequate and beneficial information regarding \n\n\n\ntheir chronic diseases and medicines with medication review \n\n\n\nservice. Ninety-eight pharmacists (94.2%) also agreed that \n\n\n\nmedication review service is valuable by considering the three \n\n\n\ntypes of medication review. Nevertheless, only more than \n\n\n\nthree-quarters of the participants (n = 82, 78.8%) supported that \n\n\n\npatients' health outcomes improved when a pharmacist \n\n\n\nmonitors medications compared to other healthcare \n\n\n\nprofessionals. There was a high expression of agreement with \n\n\n\nthe statements saying that applying medication review service \n\n\n\nrequires more knowledge than basic information of pharmacy \n\n\n\npractice (n = 97, 93.3%) and providing medication review \n\n\n\nservice allows pharmacists to participate in patient care at a \n\n\n\nborder spectrum (n = 99, 95.2%).  A significant association was \n\n\n\nobserved in different races on attitude scores pertaining to \n\n\n\nmedication review (p = 0.001), as shown in Table V below.  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nPractice on Medication Review  \n\n\n\n\n\n\n\nPractice on medication review was regarded as fair with a \n\n\n\nmedian score of 4.0 (IQR 2.0), a minimum score of 0 and a \n\n\n\nmaximum score of 6. 41.3% (n = 43) and 40.4% (n = 42) of the \n\n\n\nparticipants had a good and poor practice on medication \n\n\n\nreview, respectively.  \n\n\n\n\n\n\n\nPharmacists' practice on medication review was determined by \n\n\n\nsix questions (Table VI). Among all pharmacists, \n\n\n\napproximately two-thirds (n = 68, 65.4%) provided medication \n\n\n\nreview service in the pharmacy, whereas 45 (43.3%) did not \n\n\n\nobtain patient's medication history at the time of admission or \n\n\n\nas early as possible. Besides, only 69 participants (66.3%) \n\n\n\nreconciled patient's medication with the prescribed medicines \n\n\n\non admission and discharge, and less than half of the \n\n\n\nrespondents (n = 47, 45.2%) performed medication chart \n\n\n\nreview throughout patient's admission. There was a higher \n\n\n\nexpression that pharmacists provided medication education to \n\n\n\npatients during hospitalisation and on discharge (n = 82, \n\n\n\n78.8%), and they usually refer to updated treatment guidelines \n\n\n\nfor diseases or drug information resources (n = 83, 79.8%). \n\n\n\nTable VII below shows that sociodemographic characteristics \n\n\n\nassociated significantly with practice score on medication \n\n\n\nreview include age (p = 0.010) and years of experience as a \n\n\n\nprivate hospital pharmacist (p = 0.016).  \n\n\n\n\n\n\n\nCorrelation between Knowledge, Attitude and Practice on \n\n\n\nMedication Review  \n\n\n\n\n\n\n\nThe correlation between KAP was analysed by Spearman's \n\n\n\nRank Order Correlation test to explore their relationships. \n\n\n\nBased on the result, knowledge had a moderate positive \n\n\n\ncorrelation with attitude regarding medication review, which is \n\n\n\nstatistically significant (r = 0.467, p < 0.001). However, no \n\n\n\ncorrelation was observed between knowledge and practice, as \n\n\n\nwell as between attitude and practice. \n\n\n\n\n\n\n\nPerceived Challenges and Barriers of Implementing \n\n\n\nMedication Review  \n\n\n\n\n\n\n\nThe top three major challenges perceived were lack of time (n \n\n\n\n= 86, 82.7%), insufficient training (n = 83, 79.8%) and lack of \n\n\n\nmanpower (n = 63, 60.6%). More than half of the participants \n\n\n\n(n = 61, 58.7%) did not have adequate information technology \n\n\n\n(IT) support to provide medication review. Half of them \n\n\n\nindicated that the availability of space or private counselling \n\n\n\narea was a challenge and believed that a high budget is required \n\n\n\nto implement medication review service. Other barriers \n\n\n\nreported include lack of experience (n = 27, 26%), \n\n\n\ninterprofessional collaboration (n = 22, 21.2%), patients' \n\n\n\ncooperation (n = 18, 17.3%), pharmacists' proactivity (n = 7, \n\n\n\n6.7%) and limited resources (n = 3, 2.9%).  \n\n\n\nTable III. Factors associated with knowledge score of private hospital \n\n\n\npharmacists on medication review in Malaysia \n\n\n\n\n\n\n\nCharacteristics Median \n\n\n\n(IQR) \nZa X2(df)b \n\n\n\np-\n\n\n\nvalue \n\n\n\nGender \n\n\n\n   Male  8.0 (2.0) -2.165 - 0.030 \n\n\n\n   Female 9.0 (1.0)    \n\n\n\nAge \n\n\n\n   21-30 8.5 (1.0) - 0.152 (2) 0.927 \n\n\n\n   31-40 9.0 (1.0)    \n\n\n\n   41 and above 9.0 (1.8)    \n\n\n\nRace \n\n\n\n   Malay 8.5 (1.0) - 4.499 (3) 0.212 \n\n\n\n   Chinese 9.0 (1.0)    \n\n\n\n   Indian 7.0 (3.0)    \n\n\n\n   Others  7.5 (0.0)    \n\n\n\nHighest education level \n\n\n\n   Bachelor\u2019s 8.0 (1.0) -1.369 - 0.171 \n\n\n\n   Master\u2019s 9.0 (1.0)    \n\n\n\nCountry where the undergraduate degree is taken \n\n\n\n   Malaysia 8.0 (2.0) - 1.719 (2) 0.423 \n\n\n\n   United Kingdom 9.0 (1.0)    \n\n\n\n   Others b 9.0 (1.0)     \n\n\n\nYears of experience  \n\n\n\n   1-5 8.0 (2.0) - 3.823 (3) 0.281 \n\n\n\n   6-10 9.0 (1.3)    \n\n\n\n   11-15 9.0 (1.5)    \n\n\n\n   16 and above 9.0 (0.8)    \n \n\n\n\na Mann-Whitney U test \nb Kruskal-Wallis H test \n\n\n\n\n\n\n\n\nSze W.T. et al. Mal J Pharm 7 (2) 2021, 64-73 \n\n\n\n\n\n\n\n69 \n\n\n\n\n\n\n\nDISCUSSION  \n \n\n\n\nKnowledge on Medication Review \n\n\n\n\n\n\n\nThe respondents' knowledge on medication review was at a \n\n\n\nhigh level, indicating that private hospital pharmacists are \n\n\n\naware and familiar with the concept of medication review. This \n\n\n\nresult is comparable to a local study, in which a large \n\n\n\nproportion of the respondents (92.5%) had a high level of \n\n\n\nknowledge on medication therapy management (MTM) [17]. \n\n\n\nLikewise, studies had found that community pharmacists in the \n\n\n\nUSA, Qatar and Lebanon had adequate knowledge about \n\n\n\nmedication use review and medication therapy management \n\n\n\n[19,22-23]. Consequently, our findings prove that pharmacists' \n\n\n\nknowledge is not a barrier to performing this extended service. \n\n\n\nTable IV. Attitude on medication review among private hospital pharmacists in Malaysia \n\n\n\n\n\n\n\nStatements Frequency (%) \n\n\n\n SA A N D SD \n\n\n\nBesides the processes of normal dispensing functions, reviewing patients' medication \n\n\n\nprofiles and providing interventions are essential as pharmacist roles to prevent adverse \n\n\n\neffects. \n\n\n\n\n\n\n\n64  \n\n\n\n(61.5) \n\n\n\n34  \n\n\n\n(32.7) \n\n\n\n5  \n\n\n\n(4.8) \n\n\n\n0  \n\n\n\n(0) \n\n\n\n1  \n\n\n\n(1.0) \n\n\n\nPatients would receive adequate and beneficial information about their chronic \n\n\n\ndiseases and medication therapies from their providers by applying medication review \n\n\n\nservice.  \n\n\n\n\n\n\n\n64  \n\n\n\n(61.5) \n\n\n\n35  \n\n\n\n(33.7) \n\n\n\n3  \n\n\n\n(2.9) \n\n\n\n1  \n\n\n\n(1.0) \n\n\n\n1  \n\n\n\n(1.0) \n\n\n\nBy considering the three types of medication review:  Prescription review, Compliance \n\n\n\nand concordance review and Clinical medication review, do you agree that medication \n\n\n\nreview service is valuable?  \n\n\n\n\n\n\n\n62  \n\n\n\n(59.6) \n\n\n\n36 \n\n\n\n(34.6) \n\n\n\n4  \n\n\n\n(3.8) \n\n\n\n1 \n\n\n\n(1.0) \n\n\n\n1  \n\n\n\n(1.0) \n\n\n\nA patient's health outcomes would be improved when a pharmacist monitors \n\n\n\nmedications compared to other healthcare providers.  \n\n\n\n\n\n\n\n44  \n\n\n\n(42.3) \n\n\n\n38  \n\n\n\n(36.5) \n\n\n\n20 \n\n\n\n(19.2) \n\n\n\n1 \n\n\n\n(1.0) \n\n\n\n1  \n\n\n\n(1.0) \n\n\n\nApplying medication review service requires more knowledge than basic information \n\n\n\nof pharmacy practice.  \n\n\n\n\n\n\n\n62  \n\n\n\n(59.6) \n\n\n\n35  \n\n\n\n(33.7) \n\n\n\n6  \n\n\n\n(5.8) \n\n\n\n0 \n\n\n\n(0) \n\n\n\n1  \n\n\n\n(1.0) \n\n\n\nProviding medication review service is a unique opportunity for pharmacists to \n\n\n\nparticipate in patient care at a broader spectrum.  \n\n\n\n\n\n\n\n66  \n\n\n\n(63.5) \n\n\n\n33  \n\n\n\n(31.7) \n\n\n\n4  \n\n\n\n(3.8) \n\n\n\n0  \n\n\n\n(0) \n\n\n\n1  \n\n\n\n(1.0) \n\n\n\n\n\n\n\nSA - Strongly Agree; A \u2013 Agree; N \u2013 Neutral; D - Disagree; SD - Strongly Disagree \n\n\n\n\n\n\n\nTable V: Factors associated with attitude score of private hospital pharmacists on medication review in Malaysia \n\n\n\n\n\n\n\nCharacteristics Median (IQR) Za X2(df)b p-value \n\n\n\nGender \n\n\n\n   Male  27.0 (4.8) -0.295 - 0.768 \n\n\n\n   Female 27.5 (5.0)    \n\n\n\nAge \n\n\n\n   21-30 27.0 (5.8) - 0.250 (2) 0.882 \n\n\n\n   31-40 27.5 (5.8)    \n\n\n\n   41 and above 27.0 (2.0)    \n\n\n\nRace \n\n\n\n   Malay 30.0 (2.5) - 16.455 (3) 0.001 \n\n\n\n   Chinese 27.0 (5.0)    \n\n\n\n   Indian 25.0 (3.5)    \n\n\n\n   Others  27.5 (0.0)    \n\n\n\nHighest education level \n\n\n\n   Bachelor\u2019s 27.0 (5.0) -0.181 - 0.856 \n\n\n\n   Master\u2019s 27.0 (6.0)    \n\n\n\nCountry where the undergraduate degree is taken \n\n\n\n   Malaysia 27.0 (5.0) - 2.474 (2) 0.290 \n\n\n\n   United Kingdom 26.0 (5.0)    \n\n\n\n   Others  29.0 (3.5)    \n\n\n\nYears of experience  \n\n\n\n   1-5 27.0 (6.0) - 4.162 (3) 0.244 \n\n\n\n   6-10 28.5 (4.0)    \n\n\n\n   11-15 27.0 (4.5)    \n\n\n\n   16 and above 29.0 (2.5)    \n\n\n\n\n\n\n\na Mann-Whitney U test \nb Kruskal-Wallis H test \n\n\n\n \n\n\n\n\n\n\n\n\nSze W.T. et al. Mal J Pharm 7 (2) 2021, 64-73 \n\n\n\n\n\n\n\n70 \n\n\n\n\n\n\n\nThis study shows that female pharmacists had a higher level of \n\n\n\nknowledge in medication review than their male counterparts \n\n\n\n(p = 0.030). Similar to the study executed by Al-Tameemi and \n\n\n\nSarrriff, where better knowledge in medication therapy \n\n\n\nmanagement existed in females [17]. It was also reported that \n\n\n\nthe topic of pharmaceutical care was more appealing to female \n\n\n\npharmacists compared to male pharmacists [24].   \n\n\n\n\n\n\n\nFigure I. Perceived Challenges and Barriers of Implementing Medication \n\n\n\nReview  \n\n\n\n\n\n\n\nAttitude on Medication Review  \n\n\n\n\n\n\n\nMoreover, pharmacists participating in this study exhibited a \n\n\n\npositive attitude towards medication review, where a majority \n\n\n\nof the respondents agreed or strongly agreed with most of the \n\n\n\nstatements. The result is in line with articles published locally \n\n\n\nand internationally which indicated positive attitudes of \n\n\n\npharmacists toward MTM implementation [17,19,22,25\u201328]. \n\n\n\nAl-Tameeni and Sarriff revealed that pharmacists were \n\n\n\ninterested and willing to provide MTM service for patients in \n\n\n\nthe future, in which they agreed that this extended service \n\n\n\nwould improve the quality of health service [17]. Similarly, \n\n\n\nstudies show that pharmacists perceived medication review as \n\n\n\na unique opportunity for them as an extended role to participate \n\n\n\nin a broader range of patient care [19,26].  \n\n\n\n\n\n\n\nAmong all the six statements given in the questionnaire, the \n\n\n\nproportion of participants who agreed that \"Patient's health \n\n\n\noutcomes would be improved when a pharmacist monitors \n\n\n\nmedications compared to other healthcare providers\" is slightly \n\n\n\nlower (78.8%). The reason is that medication management does \n\n\n\nnot solely depend on pharmacists. Interprofessional \n\n\n\ncollaboration, especially between general practitioners and \n\n\n\npharmacists, is crucial as it has successfully resolved many \n\n\n\ndrug-related problems and has proven to enhance health \n\n\n\noutcomes [29]. The positive attitude was significantly \n\n\n\nassociated with race, where Malay ethnicity scored the highest \n\n\n\n(p = 0.001), while other sociodemographic characteristics did \n\n\n\nnot influence the scoring on attitude regarding medication \n\n\n\nreview. A study conducted in Malaysia has reported the \n\n\n\ninfluence of ethnicity on pharmacists\u2019 attitude in proving minor \n\n\n\nailment service [30]. As Malaysia is a multi-ethnic nation, \n\n\n\nfurther in-depth qualitative study will be useful to explore how \n\n\n\nethnicity affects pharmacists\u2019 attitude on medication review \n\n\n\nservice.  \n\n\n\n\n\n\n\nTable VI. Practice on medication review among private hospital \n\n\n\npharmacists in Malaysia \n\n\n\n\n\n\n\nQuestions \nFrequency (%) \n\n\n\nYes No \n\n\n\nAre you providing medication review service in \n\n\n\nthe pharmacy?  \n\n\n\n\n\n\n\n68 \n\n\n\n(65.4) \n\n\n\n36 \n\n\n\n(34.6) \n\n\n\nDo you obtain patient's medication history at the \n\n\n\ntime of admission or as early as possible? \n\n\n\n\n\n\n\n59 \n\n\n\n(56.7) \n\n\n\n45 \n\n\n\n(43.3) \n\n\n\nDo you reconcile patient's medication with the \n\n\n\nprescribed medicines on admission and \n\n\n\ndischarge? \n\n\n\n\n\n\n\n69 \n\n\n\n(66.3) \n\n\n\n35 \n\n\n\n(33.7) \n\n\n\nDo you perform medication chart review \n\n\n\nthroughout the patient's admission?  \n\n\n\n\n\n\n\n47 \n\n\n\n(45.2) \n\n\n\n57 \n\n\n\n(54.8) \n\n\n\nDo you provide medication education to the \n\n\n\npatient during hospitalisation and on discharge? \n\n\n\n\n\n\n\n82 \n\n\n\n(78.8) \n\n\n\n22 \n\n\n\n(21.2) \n\n\n\nDo you usually refer to updated treatment \n\n\n\nguidelines for diseases or drug information \n\n\n\nresources?  \n\n\n\n\n\n\n\n83 \n\n\n\n(79.8) \n\n\n\n21 \n\n\n\n(20.2) \n\n\n\n\n\n\n\n\n\n\n\nTable VII: Factors associated with practice score of private hospital \n\n\n\npharmacists on medication review in Malaysia \n\n\n\n\n\n\n\nCharacteristics Median \n\n\n\n(IQR) \nZa X2(df)b \n\n\n\np-\n\n\n\nvalue \n\n\n\nGender \n\n\n\n   Male  4.0 (2.0) -0.269 - 0.788 \n\n\n\n   Female 4.0 (2.0)    \n\n\n\nAge \n\n\n\n   21-30 3.0 (3.0) - 9.291 (2) 0.010 \n\n\n\n   31-40 4.0 (2.8)    \n\n\n\n   41 and above 5.0 (1.8)    \n\n\n\nRace \n\n\n\n   Malay 4.0 (2.8) - 2.812 (3) 0.422 \n\n\n\n   Chinese 4.0 (2.5)    \n\n\n\n   Indian 5.0 (1.0)    \n\n\n\n   Others  3.0 (0.0)    \n\n\n\nHighest education level \n\n\n\n   Bachelor\u2019s 4.0 (2.0) -0.375 - 0.708 \n\n\n\n   Master\u2019s 4.0 (3.0)    \n\n\n\nCountry where the undergraduate degree is taken \n\n\n\n   Malaysia 4.0 (2.0) - 0.033 (2) 0.984 \n\n\n\n   United Kingdom 4.0 (2.0)    \n\n\n\n   Others b 4.0 (2.8)    \n\n\n\nYears of experience  \n\n\n\n   1-5 3.0 (3.0) - 10.268 (3) 0.016 \n\n\n\n   6-10 4.0 (3.0)    \n\n\n\n   11-15 5.0 (2.0)    \n\n\n\n   16 and above 5.0 (2.5)    \n \n\n\n\na Mann-Whitney U test \nb Kruskal-Wallis H test \n\n\n\n\n\n\n\n\n\n\n\n0 20 40 60 80 100\n\n\n\nResources limitation\n\n\n\nPharmacists' proactivity\n\n\n\nPatients' cooperation\n\n\n\nInterprofessional collaboration\n\n\n\nLack of experience\n\n\n\nHigh budget\n\n\n\nAvailabity of space\n\n\n\nLack of IT support\n\n\n\nLack of manpower\n\n\n\nInsufficient training\n\n\n\nLack of time\n\n\n\nPercentage of participants (%)\n\n\n\nPerceived Challenges and Barriers of Implementing \n\n\n\nMedication Review \n\n\n\n\n\n\n\n\nSze W.T. et al. Mal J Pharm 7 (2) 2021, 64-73 \n\n\n\n\n\n\n\n71 \n\n\n\n\n\n\n\nPractice on Medication Review \n\n\n\n\n\n\n\nBased on our study, practice on medication review among \n\n\n\nprivate hospital pharmacists was regarded as fair. More than \n\n\n\nhalf of the respondents (65.7%) were providing medication \n\n\n\nreview service in their pharmacy. In the USA, it was also \n\n\n\nreported that nearly half of the pharmacists were practising \n\n\n\ntargeted and comprehensive medication review with follow-up \n\n\n\ncare [23,28]. Although more than half of the respondents \n\n\n\nprovide medication review service, 43.3% of the respondents \n\n\n\ndid not obtain patient's medication history at the time of \n\n\n\nadmission or as early as possible, and 54.8% did not perform \n\n\n\nmedication chart review throughout the patient's admission. \n\n\n\nThe practice and process of medication review seems to be \n\n\n\ninconsistent across different hospitals. This could be due to the \n\n\n\nabsence of a standardised protocol on medication review in \n\n\n\nMalaysia for hospital pharmacists.  \n\n\n\n\n\n\n\nDespite the low frequency in providing medication review \n\n\n\nservice, most of the respondents in this study provided \n\n\n\nmedication education to patients during hospitalisation and on \n\n\n\ndischarge, which is also one of the critical principles for a \n\n\n\nmedication review.  \n\n\n\n\n\n\n\nStatistical analysis revealed that age and years of experience \n\n\n\nwere associated with practice on medication review. \n\n\n\nRespondents aged 41 years and above had the highest score \n\n\n\ncompared to younger pharmacists (p = 0.010), and the median \n\n\n\nscore increased as the age increase. Besides, participants with \n\n\n\n11 to 15 years of experience scored the highest (p = 0.016). \n\n\n\nThese findings might be due to older pharmacists have more \n\n\n\nexperience and have been in contact with patients for a longer \n\n\n\ntime, hence are more familiar with daily pharmacy practices to \n\n\n\npractice medication review than younger pharmacists. Apart \n\n\n\nfrom these, gender, race, education level, and country where \n\n\n\nundergraduate degree was taken did not significantly affect \n\n\n\nmedication review practice. \n\n\n\n\n\n\n\nCorrelation between Knowledge, Attitude and Practice on \n\n\n\nMedication Review \n\n\n\n\n\n\n\nThere was a statistically significant but moderate positive \n\n\n\ncorrelation between knowledge and attitude levels, suggesting \n\n\n\nprivate hospital pharmacists with higher knowledge have better \n\n\n\nattitudes toward medication review implementation in \n\n\n\nMalaysia. In other words, the positive attitudes could be \n\n\n\nexplained by their better understanding and awareness of \n\n\n\nmedication review. Supported by a study relevant to MTM, \n\n\n\nwhere 95.0% of the respondents were very aware of MTM, \n\n\n\nmost of them believed that pharmacists are willing and should \n\n\n\nbe involved in MTM services [23]. Nevertheless, no correlation \n\n\n\nwas found between knowledge and practice and between \n\n\n\nattitude and practice, which reveals that the frequency of \n\n\n\npractising medication review would not be increased even if the \n\n\n\npharmacists had better knowledge and attitude. Although \n\n\n\npharmacists generally have good knowledge on medication \n\n\n\nreview, the practice can be hindered by the barriers in the \n\n\n\nimplementation of medication review service, such as lack of \n\n\n\nresources and compatibility of the service with local hospital \n\n\n\npractice [31]. \n\n\n\n\n\n\n\nPerceived Challenges and Barriers of Implementing \n\n\n\nMedication Review \n\n\n\n\n\n\n\nChallenges and barriers to the provision of medication review \n\n\n\nhad been pointed out in several studies [17,19,22,23,25,28,32-\n\n\n\n33]. This study identifies the top three challenges perceived by \n\n\n\nprivate hospital pharmacists, which were lack of time, \n\n\n\ninsufficient training and lack of human resources to implement \n\n\n\nmedication review service. Time deficiency was often reported \n\n\n\nwith a workforce shortage, especially by pharmacists working \n\n\n\nin small private hospitals. The reason is that 60% of the \n\n\n\npharmacists in Malaysia are serving in the public sector, which \n\n\n\nmeans there is limited staff available to perform pharmacy-\n\n\n\nrelated activities in private hospital settings. Thus, private \n\n\n\nhospital pharmacists have inadequate time to apply medication \n\n\n\nreview [34]. Nonetheless, applying MTM will allow \n\n\n\npharmacists to spend more time and become more involved in \n\n\n\na patient's care plan, thus enhancing patient medication \n\n\n\nadherence and minimising hospitalisation [17].  \n\n\n\n\n\n\n\nTraining and education programs are importantly needed to \n\n\n\nequip pharmacists with competent skills to identify medication-\n\n\n\nrelated problems [33]. It was reported that while pharmacy \n\n\n\ngraduates develop expertise in therapeutics of medicines, \n\n\n\nundergraduate training generally lacks significant patient \n\n\n\ncontact. This provides limited training opportunities for the \n\n\n\ndevelopment of clinical and communication skills, which is \n\n\n\nimportant for medication review practice [35]. A supervised \n\n\n\npharmacy student-led medication review had been proven as a \n\n\n\npotential experiential learning opportunity for pharmacy \n\n\n\nstudents [36]. The use of medication review tools should be \n\n\n\nemphasised in the undergraduate study to encourage and \n\n\n\nsupport the future pharmacy graduates to participate in this \n\n\n\nextended service.  \n\n\n\n\n\n\n\nOn the contrary, more than half of the respondents do not think \n\n\n\nmedication review implementation requires a high budget. \n\n\n\nHowever, it is different from a local study carried out in \n\n\n\nHospital Pulau Pinang that showed cost as one of the most \n\n\n\ncommon obstacles [17]. The disparity could be due to limited \n\n\n\nhealth budget support for medication review services in the \n\n\n\ngovernment public hospitals.  \n\n\n\n\n\n\n\nCollaboration between healthcare professionals, including \n\n\n\nprescribers and nurses, was reported as an additional challenge. \n\n\n\nIt is explained by the absence of prescribing and dispensing \n\n\n\nseparation in private practices. A formal patient referral \n\n\n\n\n\n\n\n\nSze W.T. et al. Mal J Pharm 7 (2) 2021, 64-73 \n\n\n\n\n\n\n\n72 \n\n\n\n\n\n\n\nmechanism for pharmacist medication review service by other \n\n\n\nhealth care providers can be useful, and there should be a \n\n\n\nmechanism to allow pharmacists and prescribers to discuss or \n\n\n\nreceive feedback on the issues and outcome of the medication \n\n\n\nreviews [37]. Interprofessional education should also be \n\n\n\nimplemented in all medical and pharmacy schools so that \n\n\n\nstudents have an understanding and agreement on role \n\n\n\nspecifications between different health professionals [29].  \n\n\n\nInterprofessional training of structured medication review can \n\n\n\nbe organised for pharmacists together with other health \n\n\n\nprofessionals to allow all parties to understand the role and \n\n\n\nprocess of medication review. This can also increase the \n\n\n\npharmacist\u2019s confidence level in cooperating with other health \n\n\n\nprofessionals through medication review [38].  \n\n\n\n\n\n\n\nThe results from the current study are subjected to a few \n\n\n\nlimitations. Firstly, this was a cross-sectional study limited to a \n\n\n\nparticular time point, and the study period was short for only a \n\n\n\ntwo-month time. Therefore, it is unable to predict any changes \n\n\n\nin the KAP of participants in the future. Secondly, only 103 \n\n\n\nprivate hospital pharmacists participated in this study, out of an \n\n\n\nestimate of 417 pharmacists working in private hospitals or \n\n\n\nclinics [18]. Therefore, the results may not generalise well. \n\n\n\nThirdly, this survey was vulnerable to non-response bias from \n\n\n\nthose unwilling or unable to respond because the questionnaire \n\n\n\nwas distributed primarily by email address, and there was a \n\n\n\nhigh possibility that the email invitation went to spam. Apart \n\n\n\nfrom that, the use of close-ended questionnaire might have \n\n\n\ncaused a high level of knowledge, because all the questions are \n\n\n\npositively phrased and straightforward to answer. Lastly, \n\n\n\nfactors associated with KAP might be affected by the \n\n\n\nimbalance sociodemographic characteristic of the respondents \n\n\n\nin this study. \n\n\n\n\n\n\n\nCONCLUSION  \n \n\n\n\nOverall, this study provided some insights that the private \n\n\n\nhospital pharmacists in Malaysia had a high level of \n\n\n\nknowledge, a positive attitude and a fair practice regarding \n\n\n\nmedication review service. There was also a significant \n\n\n\npositive correlation observed between knowledge and attitude \n\n\n\non medication review. This study highlighted several \n\n\n\nchallenges and barriers that might obstruct the practice of \n\n\n\nmedication review service in the hospitals, with lack of time \n\n\n\nand insufficient training being the most agreed challenges. The \n\n\n\nhigh knowledge level and positive attitude toward medication \n\n\n\nreview bode well for the profession, however its challenges \n\n\n\nneed to be acknowledged and tackled in order to enhance its \n\n\n\nprovision. Some of the strategies may include training on \n\n\n\nmedication review for pharmacists, interprofessional education \n\n\n\non medication review within the hospital, and having more \n\n\n\ntrained private hospital pharmacists who conduct medication \n\n\n\nreview service. \n\n\n\nIn this digital age, medication review process can be integrated \n\n\n\ninto the electronic hospital information system which allows \n\n\n\nthe hospital pharmacists to analyse, store, and share patients\u2019 \n\n\n\nmedical and treatment information with the prescribers, which \n\n\n\ncan improve the prescribers\u2019 and pharmacists\u2019 decision-making \n\n\n\nduring the medication review process [39]. Nevertheless, views \n\n\n\nof the pharmacists as well as other stakeholders of private \n\n\n\nhealthcare providers on the enablers, barriers as well as the \n\n\n\nstrategies to overcome the barriers of medication review \n\n\n\nimplementation in private healthcare institutions should be \n\n\n\nfurther explored through an in-depth qualitative study. \n\n\n\n\n\n\n\nACKNOWLEDGEMENT  \n \n\n\n\nNo funding is received for this research.  \n\n\n\n\n\n\n\nCONFLICT OF INTEREST   \n \n\n\n\nThe authors declare no conflict of interest.  \n\n\n\n\n\n\n\nREFERENCE   \n \n\n\n\n[1] Care (UK) NCC for P. Reviewing medicines [Internet]. Medicines \n\n\n\nAdherence: Involving Patients in Decisions About Prescribed \n\n\n\nMedicines and Supporting Adherence [Internet]. Royal College of \n\n\n\nGeneral Practitioners (UK); 2009 [cited 2020 Jul 28]. \n\n\n\nhttps://www.ncbi.nlm.nih.gov/books/NBK55429/ \n\n\n\n[2] Clyne W, Blenkinsopp A, Seal R. 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Community pharmacists\u2019 attitudes towards \n\n\n\nmedicines use reviews and factors affecting the numbers performed. \n\n\n\nPharm World Sci PWS. 2008 Oct;30(5):536\u201343. \n\n\n\nhttps://doi.org/10.1007/s11096-008-9203-x \n\n\n\n[27] MacIntosh C, Weiser C, Wassimi A, Reddick J, Scovis N, Guy M, et \n\n\n\nal. Attitudes toward and factors affecting implementation of \n\n\n\nmedication therapy management services by community pharmacists. \n\n\n\nJ Am Pharm Assoc JAPhA. 2009 Feb;49(1):26\u201330. \n\n\n\nhttps://doi.org/10.1331/JAPhA.2009.07122 \n\n\n\n[28] Shah B, Chawla S. A needs assessment for development and provision \n\n\n\nof medication therapy management services in New York City. J \n\n\n\nPharm Pract. 2011 Jun;24(3):339\u201344. \n\n\n\nhttps://doi.org/10.1177/0897190010396584 \n\n\n\n[29] Mubarak N, Hatah E, Aris MAM, Shafie AA, Zin CS. 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Integr Pharm Res Pract. 2020 Apr \n\n\n\n2;9:71\u201381. https://doi.org/10.2147/IPRP.S179628 \n\n\n\n[33] Mekonnen AB, McLachlan AJ, Brien JE, Mekonnen D, Abay Z. \n\n\n\nBarriers and facilitators to hospital pharmacists\u2019 engagement in \n\n\n\nmedication safety activities: a qualitative study using the theoretical \n\n\n\ndomains framework. J Pharm Policy Pract. 2018 Jan 23;11(1):2. \n\n\n\nhttps://doi.org/10.1186/s40545-018-0129-y \n\n\n\n[34] CodeBlue. Malaysia Meets WHO Target Of Doctors, Nurses For \n\n\n\nUniversal Health Coverage: Minister [Internet]. CodeBlue. 2020 \n\n\n\n[cited 2020 Nov 17] \n\n\n\nhttps://codeblue.galencentre.org/2020/08/04/malaysia-has-enough-\n\n\n\ndoctors-and-nurses-exceeding-who-target-minister/ \n\n\n\n[35] Wright D, Loftus D, Christou M, et al. 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Drugs Aging. 2015;32(6):495\u2013503. \n\n\n\nhttps://doi.org/10.1007/s40266-015-0270-0 \n\n\n\n\nhttps://doi.org/10.1186/s40545-015-0031-9\n\n\nhttps://doi.org/10.1016/j.sapharm.2011.06.002\n\n\nhttps://doi.org/10.1111/ijpp.12244\n\n\nhttps://doi.org/10.1097/MD.0000000000007929\n\n\nhttps://doi.org/10.1080/10548408.2016.1250697\n\n\nhttps://doi.org/10.5530/jyp.2019.11.67\n\n\nhttps://doi.org/10.1186/s40780-019-0131-9\n\n\nhttps://doi.org/10.1007/s11096-014-0025-8\n\n\nhttps://ww2.health.wa.gov.au/~/media/Files/Corporate/Policy%20Frameworks/Clinical%20Governance%20Safety%20and%20Quality/Policy/Medication%20Review%20Policy/Supporting/Best-Practice-Principles-for-Medication-Review.pdf\n\n\nhttps://ww2.health.wa.gov.au/~/media/Files/Corporate/Policy%20Frameworks/Clinical%20Governance%20Safety%20and%20Quality/Policy/Medication%20Review%20Policy/Supporting/Best-Practice-Principles-for-Medication-Review.pdf\n\n\nhttps://ww2.health.wa.gov.au/~/media/Files/Corporate/Policy%20Frameworks/Clinical%20Governance%20Safety%20and%20Quality/Policy/Medication%20Review%20Policy/Supporting/Best-Practice-Principles-for-Medication-Review.pdf\n\n\nhttps://ww2.health.wa.gov.au/~/media/Files/Corporate/Policy%20Frameworks/Clinical%20Governance%20Safety%20and%20Quality/Policy/Medication%20Review%20Policy/Supporting/Best-Practice-Principles-for-Medication-Review.pdf\n\n\nhttps://www.uky.edu/~rsand1/china2018/texts/Bloom%20et%20al%20-Taxonomy%20of%20Educational%20Objectives.pdf\n\n\nhttps://www.uky.edu/~rsand1/china2018/texts/Bloom%20et%20al%20-Taxonomy%20of%20Educational%20Objectives.pdf\n\n\nhttps://doi.org/10.1007/s11096-018-0666-0\n\n\nhttps://doi.org/10.1016/j.sapharm.2009.01.001\n\n\nhttp://fip.org/files/fip/publications/2009_FIP_Global_Pharmacy_Workforce_Report.pdf\n\n\nhttp://fip.org/files/fip/publications/2009_FIP_Global_Pharmacy_Workforce_Report.pdf\n\n\nhttps://doi.org/10.1016/j.sapharm.2006.02.008\n\n\nhttps://doi.org/10.1007/s11096-008-9203-x\n\n\nhttps://doi.org/10.1331/JAPhA.2009.07122\n\n\nhttps://doi.org/10.1177/0897190010396584\n\n\nhttps://doi.org/10.1371/journal.pone.0216563\n\n\nhttps://doi.org/10.1007/s11096-020-00973-x\n\n\nhttps://doi.org/10.1007/s00228-020-02846-8\n\n\nhttps://doi.org/10.1007/s00228-020-02846-8\n\n\nhttps://doi.org/10.2147/IPRP.S179628\n\n\nhttps://doi.org/10.1186/s40545-018-0129-y\n\n\nhttps://codeblue.galencentre.org/2020/08/04/malaysia-has-enough-doctors-and-nurses-exceeding-who-target-minister/\n\n\nhttps://codeblue.galencentre.org/2020/08/04/malaysia-has-enough-doctors-and-nurses-exceeding-who-target-minister/\n\n\nhttp://dx.doi.org/10.1136/bmjopen-2015-009246\n\n\nhttps://doi.org/10.1186/1471-2296-14-57\n\n\nhttps://doi.org/10.1186/s12877-019-1263-3\n\n\nhttps://doi.org/10.1007/s40266-015-0270-0\n\n\n\n"
"\n\n\n\n\n\n8 \n \n\n\n\nThe impact of implementing WMTAC towards anticoagulation treatment in \nDungun Hospital \n\n\n\nAN Alias*, SF Ali, W Yusoff, NAS Yahaya, NH Abdul Karim, SA Fadzillah \n\n\n\nPharmacy Unit, Dungun Hospital, 23000, Dungun, Terengganu, Malaysia. \n \n* Contact for correspondence, please email: farmasidungun@gmail.com \n\n\n\nABSTRACT \n\n\n\nObjective:   The   main   objective   of   this   study   is   to   compare   patients\u2019   outcome   in \nanticoagulation treatment before and after Warfarin Medication Therapy Adherence Clinic \n(WMTAC).  The study compares the cost of INR test between usual care (UC) and WMTAC. \nThe study also determines factors affecting International Normalized Ratio (INR) level among \nWMTAC patients. \n\n\n\nMethods:  A retrospective study involving WMTAC patients was conducted by trained \npharmacists at Dungun Hospital. Patients were reviewed by UC for 4 months and continuously \nfollowed up by WMTAC for another 4 months were included in this study. Patients who passed \naway, transferred out and defaulted were excluded from the study. The data were derived from \nPatient Medical Record and recorded in Warfarin Data Collection Form for analyze. \n\n\n\nResults: The time in therapeutic range (TTR) was 73.46% for WMTAC and 45.58% for UC \n(p<0.001). The expanded TTR for WMTAC was 90.37% and 61.88% for UC (p<0.001).  The \npercentage of time INR level <1.5 were 0.57% for WMTAC patients and 7.92% for UC patients, \nwhile 5.28% UC patients had INR level > 5. The total reagent costs of INR test were MYR \n341.04 for WMTAC and MYR 519.40 for UC. The known factors affecting INR level in \nWMTAC patients were diet (55%), missed dose (36%) and drug interaction (9%). \n\n\n\nConclusion: According to this study, the WMTAC implementation significantly improved \nanticoagulation treatment. Besides that, it also beneficial for our reagent cost expenses.  \n\n\n\nKeywords: Cost, Expanded TTR, INR, TTR, WMTAC \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n9 \n \n\n\n\nINTRODUCTION \n\n\n\nOral anticoagulant (OAC) is commonly used despite its narrow therapeutic index, thus it is vital \nto maintain INR within targeted range [1\u20133]. It is such a successful agent for the medical \nmanagement  commonly  used  in  the  management, for the prevention of stroke and systemic \nembolism in adults, involving patients who are having either atrial fibrillation (AF), deep vein \nthrombosis (DVT), pulmonary embolism (PE), prevention of recurrent DVT or recurrent PE \n[1,2,4,5] . Hence pharmacist-managed Warfarin Medication Therapy Adherence Clinic \n(WMTAC) being established in most countries. Implementation of the pharmacist-managed \nanticoagulation clinic (ACC) had positive impact on patient care [6\u20138]. In Malaysia, Warfarin \nMTAC was introduced in 2004 as part of the clinical pharmacy services in the Ambulatory \nClinic System which emphasizes on medication management to improve on quality, safety and \ncost effectiveness of patient care [9]. \n\n\n\nWarfarin Medication Therapy Adherence Clinic (WMTAC) was implemented at Dungun \nHospital since 18 February 2013. Pharmacist-managed WMTAC is collaborating with  Medical  \nOfficer  in  the management  of  patients  with  anticoagulation  therapy  by  providing  \nmedication  counseling services. The aim of WMTAC was to provide service continuity and \nenhance patient care for patients on anticoagulation therapy through education, frequent \nmonitoring, and close follow-up. The continuity of patient care will maximize the benefits of \nanticoagulation therapy and minimize the adverse effect and complications resulting from OAC \ntherapy. WMTAC also provides Consultative services to healthcare providers on anticoagulant \ndrug management and related issues [9]. \n\n\n\nMany studies have demonstrated good INR level in WMTAC patients. Another study stated \nthat WMTAC patients were found to have better International Normalized Ratio (INR) control \ncompared to patients who received intervention by usual care (UC). Patients who were receiving \ntreatment by UC, their INR result were reviewed by the doctors then received any adjustment \nthat will be made based on the result. There is no specific dosing nomogram was utilized but \nbased on doctors\u2019 management and practices. Nevertheless, it is still important that joint \ncooperation between physicians, pharmacists, and nurses should exist in order to achieve \ndesired therapeutic outcomes. [10]. \n\n\n\nEvidence has shown that there is an improvement in Time in Therapeutic Range (TTR) and \nclinical outcomes in patients managed by trained staff using standardized procedures and dosing \ndecision support tools. Study by Van De Ham et al conclude that INR patterns of patients can \npredict the clinical outcomes over TTR, and this also can help us to identify patients who need \nadditional OAC monitoring [11]. \n\n\n\nMany similar studies were conducted in Malaysia and found that WMTAC had achieved better \nINR level compared to UC. Since WMTAC has been established at Dungun Hospital from \n2013, we decided to carry out the study to measure the importance and needs of WMTAC \nservice among our population. The objective of this study is to compare anticoagulation control \nbefore and after WMTAC care. In addition, from this study we were able to determine the \neffectiveness of WMTAC service in Dungun Hospital.  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n10 \n \n\n\n\nMETHODOLOGY \n\n\n\nSelection and description of participants \n\n\n\nA retrospective study was conducted from June to July 2016 in WMTAC and Outpatient \nDepartment (OPD) at Dungun Hospital, Terengganu. All data for 81 patients in WMTAC were \nderived from patient medical record from 2013 to 2015. The patients who has met the inclusion \ncriteria were included in the study as participants. Those participants who were selected has \nbeen reviewed by UC for 4 months and followed by WMTAC for another 4 months. We chose \na total of 8 months because that is the longest and most complete data that we can retrieved \nfrom the patient medical record. During the treatment under UC, the participants received \nstandard care from medical officers and no algorithm or protocol used. In the followed-up \nsession by WMTAC, the same standard care with some additional services such as medication \ncounselling and close drug therapy monitoring were given to the participants by trained \npharmacist. On the other hand, participants who had at least two INR values not more than 6 \nweeks apart were also included in the study. Patients with incomplete data, passed way and \ntransferred out were excluded from this study. Flow of the study was shown in.\n\n\n\n \nFigure 1: Flow of the study \n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n11 \n \n\n\n\nTechnical information \n\n\n\nThe primary outcome of this study is to measure the percentage of time patients\u2019 INR  within  \nthe  recommended  TTR,  to  determine  the  percentage  of  TTR  within  \u00b10.2  units  of  the \nrecommended therapeutic range (\u2018expanded therapeutic range\u2019) and to measure the percentage \nof time the INR was above 5.0 or below 1.5. TTR is a percent of days where INR is between \ntargeted therapeutic range. TTR of INR between targeted range is very important not only for \nsafety but also for effectiveness of warfarin anticoagulation in patients [13]. Expanded TTR is \nthe percentage of TTR of INR within \u00b10.2 units of the recommended therapeutic range [9]. \n\n\n\nThe secondary outcome was to compare the INR cost test between WMTAC and UC. The cost \ninvolved was only the reagent used per patient. The tertiary outcome was to determine factors \naffecting INR level among patients under WMTAC care. \n\n\n\nThe data were derived from Patient Medical Record, including patient\u2019s demographic, \nindication for warfarin, INR target, duration of therapy and risk factor (bleeding or \nthromboembolic events). INR results and weekly dose recommended also were taken into \naccount. All the data that have been collected will be recorded in Warfarin Data Collection \nForm .This study was approved by Medical Review and Ethical Committee of Ministry of \nHealth (MOH) and registered with National Medical Research Registry (NMMR) NMRR-16-\n2089-30772.  \n\n\n\n\n\n\n\nStatistical Analysis \n\n\n\nStatistical analyses were done by using IBM Statistical Package for Social Science (SPSS) \nVersion 21.0. Means and standard deviations were calculated for continuous data whilst \nfrequency and percentage were tabulated for categorical data. TTR was calculated using a \nmodification of the Rosendaal linear interpolation method [12]. This method of calculating TTR \nexamines the amount of time between INR results to determine how long the patient may have \nbeen within therapeutic range.  Paired t-test was used to compare adequacy of anticoagulation \nbefore and after WMTAC care. All statistical assessments were conducted at 5% significance \nlevel with its\u2019 95% confident interval. \n\n\n\n\n\n\n\nRESULT \n\n\n\nA total of 41 participants were included in this study. The median age is 48 years old and 63.4% \nof patients are female. The most common indications for warfarin were atrial fibrillation and \nmechanical heart valves which are 51% and 44% respectively.  \n\n\n\n\n\n\n\n\n\n\n\n\n12 \n \n\n\n\n\n\n\n\na PE: Pulmonary embolism; b CVA: cardiovascular accident; c MI: myocardial infarction; d ACS: Acute coronary syndrome \n\n\n\n\n\n\n\nThe number of INR test per patient within 4 months in the WMTAC and UC group was 4 and \n6, respectively. The number of INR tests per patient greater than 4 weeks apart in WMTAC and \nUC group was 1 and 0 respectively. \n\n\n\n\n\n\n\nTable 2: Frequency of INR testing among warfarin patient (n=41) \n\n\n\nVariables Warfarin MTAC Usual Care \nTotal number of INR test 174 265 \nNumber of INR test per patient 4 6 \nINR tests >4 weeks apart, n 58 14 \nNumber of INR test>4 weeks apart per patient 1 0 \nNumber of withhold session 8 23 \nNumber of withhold session per patient 0 1 \nNumber of adjustment dose 39 108 \nNumber of adjustment dose per patient 1 3 \n\n\n\nThe WMTAC group spent significantly more time than the UC group in the therapeutic range \nTTR: 73.46% versus 45.58%; p<0.001, as well as in the expanded TTR: 90.37% versus 61.88%; \np<0.001. \n\n\n\nThe percentage of time that the patients INR <1.5 and >5.0 in WMTAC group is less than the \nUC group (0.57% versus 7.92% & 0.00% versus 5.28%) respectively. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nTable 1: Sociodemographic characteristic of WMTAC patients at Hospital Dungun (n=41) \nVariables n (%) \nAge in years, median  \n  Male 63 \n  Female 48 \nGender  \n  Male 15 (36.6) \n  Female 26 (63.4) \nIndication for anticoagulation  \n  Atrial Fibrillation 21 (51.2) \n  Mechanical Heart Valve 18 (43.9) \n  PEa 1 (2.4) \n  CVAb 1 (2.4) \n  MIc/ACSd 1 (2.4) \nTarget INR range (Based on individualized target)  \n  2.0-3.0 27 (65.9) \n  2.0-2.5 1 (2.4) \n  2.5-3.0 3 (7.3) \n  2.5-3.5 10 (24.4) \nRisk Factor for thromboembolism or bleeding  \n  Hypertension 19 (46.3) \n  Stroke history 6 (14.6) \n  Diabetes 2 (4.9) \n  Age > 65 6 (14.6) \n  Renal disease 1 (2.4) \n  Antiplatelet 7 (17.1) \n\n\n\n\n\n\n\n\n\n\n\n\n13 \n \n\n\n\nTable 3: Anticoagulation control among warfarin patients \n\n\n\nVariables WMTAC UC p-valuea \n\n\n\nPercentage of Time INR in Range    \nTherapeutic range (TTR)b 73.46 45.58 p<0.001 \nExpanded range (Expanded TTR)c 90.37 61.88 p<0.001 \n   <1.5                                                          0.57 7.92  \n   >5.0                                                              0.00 5.28  \na Paired t-test; b Therapeutic range: 2.0-3.0, 2.0-2.5, 2.5-3.0 or 2.5-3.5; c expanded therapeutic range \u00b10.26,12,1 \n\n\n\n\n\n\n\nThere is a significant association between number of INR test, number of adjustment dose and \nnumber of withhold session with TTR in UC group (p<0.001, p=0.002 and p=0.001) \nrespectively. While there is no significant association between number of INR test, number of \nadjustment dose and number of withhold session with TTR in WMTAC group (p=0.376, \np=0.641and p=0.976) respectively. \n\n\n\n\n\n\n\nTable 4: Relation between Interventions and TTR \n\n\n\nGroup Interventions TTRa p-valueb \nWMTAC      No. of INR test number of adjustment dose 73.46 p=0.376 \n No. of adjustment dose          73.46 p=0.641 \n No. of withhold session 73.46 p=0.976 \nUC No. of INR test 45.58 p<0.001 \n No. of adjustment dose 45.58 p=0.002 \n No. of withhold session 45.58 p<0.001 \na Therapeutic range: 2.0-3.0, 2.0-2.5, 2.5-3.0 or 2.5-3.5; bSimple Linear Regression test \n\n\n\n\n\n\n\nThe total number of INR test in UC group was 265 which totaled to MYR 519.40. While the \ntotal cost of INR test under WMTAC was MYR 341 which involved 174 INR test. Thus, there \nis 34% of cost reduction when referred to WMTAC.  \n\n\n\n\n\n\n\nTable 5: Total reagent cost of INR test under UC and WMTAC \n\n\n\nVariables Usual care (UC) \n(4 months) \n\n\n\nWarfarin MTAC \n(4 months) \n\n\n\nTotal number of INR test 265 174 \nTotal cost of INR test (MYR) 519.40 341.04 \nAverage number of INR test per patient 6.5 4.2 \nAverage cost of INR test (MYR) per patient 12.74 8.23 \nNote: Cost per INR test is MYR 1.96 \n\n\n\nThe largest contributing factors affecting INR among WMTAC patients was diet which 55% \nfollowed by missed dose, 36% and drug interaction, 9%. From 55% of diet, the type of diet that \ninvolves was fruit (about 50%) then followed by green leafy and nuts. \n\n\n\n\n\n\n\n\n\n\n\n\n14 \n \n\n\n\n \nFigure 2: Factors affecting INR level under Warfarin MTAC \n\n\n\n\n\n\n\nDISCUSSION \n\n\n\nThe result demonstrated that participants in the WMTAC group spent more time in both the \nTTR and the expanded TTR compared to the UC group and these differences were statistically \nsignificant. This result was well supported by a study conducted by You J.H.S.  et al., where \npatients in the pharmacist-managed group spent a higher percentage of time in both the \ntherapeutic INR range and expanded therapeutic range than those in the physician-managed \ngroup [64% (n=112) versus 59% (n=109),  p<0.001] and [78% versus 76% p<0.001] \nrespectively [14]. The study conducted in Canada showed patients managed by the \nanticoagulation clinics were within the TTR and expanded therapeutic range more than patients \nmanaged by family physicians (73% versus 65%, p<0.0001) and 91% versus 85%, p<0.0001) \nas in accordingly [12]. This finding also supported by other study done by Hassan SS. et al, \nSaokaew S. et al and Thanimalai S. et al [10, 15, 16] \n\n\n\nThe percentage of time patients\u2019 INR was <1.5 and >5 is lower in WMTAC group compared to \nUC group respectively. This finding was supported by one of the studies conducted by Wilson \nS.J. et al. presented high risk INR values (<1.5 or >5.0) were more often observed in patients \nmanaged by family physicians (40%) than in patients managed by anticoagulation clinics (30%, \np = 0.001) [17].  The other study conducted by Young S. et al. found the percentage of time \nINR values was <1.5 and >5 were lower for both pharmacist care (PC) compared to usual care \n(UC) [ 0.7% (n=112) versus 1.9% (n=81) p<0.0001] and [0.3% versus 0.1% p< 0.0001] \nrespectively [12]. \n\n\n\nOur study only indicates a significant difference in UC group when comparing TTR with \nnumber of INR test, number of adjustment dose and number of withhold session. While TTR \nof WMTAC group did not has any influence in those third variables. This finding reflected on \nhow each group intervene the patients in each their INR visits. The WMTAC group used \nwarfarin dosage adjustment algorithms, assessed patients for factors that would affect the result \nand/or the subsequent recommendation for examples changes in medications or diet, sign and \nsymptoms of hemorrhagic or thromboembolic events, missed dose and illnesses and provide \neducation/counselling [11, 13]. \n\n\n\nThe total cost of INR test was lower in WMTAC group compared to UC group. Chan et al found \nthat the cost per patient per months was lower in the pharmacist-managed group (76 +/- US \ndollar) (43 +/- 53 British pound) compare to physician-managed group (98 +/- 158 US dollar) \n(55 +/- 89 British pound) [18]. Another study found that the direct anticoagulation care cost \n\n\n\n55\n\n\n\n36\n\n\n\n9\n\n\n\n0\n\n\n\n10\n\n\n\n20\n\n\n\n30\n\n\n\n40\n\n\n\n50\n\n\n\n60\n\n\n\nDiet Missed dose Drug interaction\n\n\n\nPe\nrc\n\n\n\nen\nta\n\n\n\nge\n %\n\n\n\n\n\n\n\n\n\n\n\n\n15 \n \n\n\n\nwas 35,465 US dollar versus 111,586 US dollar and the overall medical care cost was 754,191 \nUS dollar versus 1,480,661 US dollar for the anticoagulation service group versus the usual \ncare group [19]. \n\n\n\nThe limitation of this study was inconsistent WMTAC follow up, which may affect the \ncontinuity management of INR control. Thus, data from patient medical record will be missing. \nPatient with incomplete data would only produce limited data and they were excluded from the \nstudy. As the result we managed to get small sample size. \n\n\n\n\n\n\n\nCONCLUSIONS \n\n\n\nWMTAC resulted in a significantly better anticoagulation control. The WMTAC compared to \nusual care achieved significantly better INR control as measured by the percentage of time \npatient\u2019s INR values were kept in both therapeutic and expanded range. Besides that it also \nshowed benefit in our reagent cost expenses. \n\n\n\n\n\n\n\nACKNOWLEDGEMENT \n\n\n\nWe would like to thank the Director of Health Malaysia for permission to publish this paper. \nWe thank our patients and colleagues for the helpfulness throughout the research period. We \nalso thank Chief of Dungun Hospital, Dr Farah Najwa for giving permission to conduct this \nresearch. We are really grateful because we managed to complete our research. This research \ncannot be completed without the effort and co-operation from our group members. Last but not \nleast, we would also want to extend our appreciation to those who could not be mentioned here \nbut here played their role throughout our research journey. \n\n\n\n\n\n\n\nCONFLICT OF INTEREST \nThe author has none to declare. \n  \n\n\n\nREFERENCES \n\n\n\n1. Yahaya HM, Hassali MA, Awaisu A, Shafie AA.  Factors Associated with Warfarin \nTherapy Knowledge and Anticoagulation Control among Patients Attending a Warfarin \nClinic in Malaysia. Journal of Clinical and Diagnostic Research 2009 Aug 3:1663 - 1670. \n\n\n\n2. Kuruvilla M. A review of Warfarin dosing and monitoring. Bayl Univ Med Cent. 2001 Jul \n14:305-306. \n\n\n\n3. Pirmohamed M. Warfarin: Almost 60 years old and still causing problem. Br J Clin \nPharmacol.2006 Nov 62(5):1365-2125 \n\n\n\n4. Ciurus T, Radwan AC, Lelonek M. Factors affecting the quality of anticoagulation with \nwarfarin: experience of one cardiac centre. Kardiochir Torakochirurgia Pol. 2015 Dec \n12(4):334\u2013340. \n\n\n\n5. Keeling D, Baglin T, Tait C, Watson H, Perry D, Baglin C, et al. Guideline on oral-\nanticoagulation with warfarin. Br J Haematol.2011 Aug 154(3): 311-24 \n\n\n\n6. David LD & Robert WB. Development and Implementation of a Pharmacist- managed \ninpatient Warfarin Protocol. Bayl Univ Med Cent.2005 Oct 18(4):397-400 \n\n\n\n7. Yamada K & Nabeshima T. Pharmacist-managed clinics for patient education and \ncounselling in Japan: current status and future perspective. J Pharm Health Care Sci. 2015 \nJan 1:2 \n\n\n\n\n\n\n\n\n\n\n\n\n16 \n \n\n\n\n8. Dib JG, Mohammed K, Momattin H & Aishehri AM. Implementation of Pharmacist- \nmanaged Anticoagulation Clinic in Saudi Arabian Health Centre. Hosp Pharm. 2014 Mar \n49(3):260-268 \n\n\n\n9. Ahmad KM, Naina B, Mohamed S, Rajik MA, Badarudin NZ, et al. Protocol Medication \nTherapy Adherence Clinic: Warfarin. 1st ed. Haq AHSM, Rahman SSA, Othman NA, et al. \neditors. Malaysia Pharmaceutical Services Division Ministry of Health Malaysia; 2010 \n\n\n\n10. Hasan SS, Syed IA, Basariah N, Chong DW, Mei TK, Chin OH. Factors affecting warfarin-\nrelated knowledge and INR control of patients attending physician- and pharmacist-\nmanaged anticoagulation clinics. J Pharm Pract 2011 Oct 24(5):485-93 \n\n\n\n11. Van De Ham HA, Klungel OH, Leufkens HG, Van Staa TP. The patterns of anticoagulation \ncontrol and the risk of stroke, bleeding and mortality patients with non-valvular atrial \nfibrillation. Journal Thromb Haemost 2013 Jan 11(1): 107-115   \n\n\n\n12. Young S, Bishop L, Twells L, Dillon C,Hawboldt J, O'shea P. Comprison of Pharmacist \nManaged Anticoagulation with Usual Medical Care in a Family Medicine Clinic. BMC Fam \nPractic. 2011 12(88):1471-2296. \n\n\n\n13. Caldeira D, Cruz I, Morgado G, Stuart B, Gomes C, Martins C, Jo\u00e3o I, and Pereira H, \nEvaluation of time in therapeutic range in anticoagulated patients: a single-center, \nretrospective, observational study. BMC Res Notes.2014 Dec 9(7): 891 \n\n\n\n14. You J.H.S, Cheng G & Chan T.Y.K, Comparison of a clinical pharmacist-managed \nanticoagulation service with routine medical care: Impact on clinical outcomes & health \ncare costs. Hong Kong Med J. 2008 14(Suppl 3):s23-7 \n\n\n\n15. Saokaew S, Sapoo U, Nathisuman S, Chaiyakunapruk N and Permsuwan U, \nAnticoagulation control of pharmacist-managed collaborative care versus usual care in \nThailand. Int J Clin Pharm. 2012 Feb 34(1):105-12 \n\n\n\n16. Thanimalai S, Shafie AA, Hassali MA, Sinnadurai J, Comparing effectiveness of two \nanticoagulation management models in a Malaysian tertiary hospital. Int. J. Clin. Pharm. \n2013 35(5) 736-43 \n\n\n\n17. Wilson SJ, Wells PS, Geoffrey ML, Martin J, Burton E & Anderson DR. Comparing the \nquality of oral anticoagulant management by anticoagulant management by anticoagulation \nclinics & by family physician: A randomized controlled trial.  Canadian Medical Assciation \nJ. 2003 169(4):293-8 \n\n\n\n18. Chan FW, Wong RS, Lau WH, Chan TY, Cheng G & You JH. Management of Chinese \npatients on Warfarin therapy in two models of anticoagulation service \u2013 a prospective \nrandomized trial. British Journal of Clinical Pharmacology.2006 Nov 62(5):601-9     \n\n\n\n19. Hall D, Buchanan J, Helms B, Eberts M, Mark S, Manolis C, Peele P & Docimo A. Health \ncare expenditures and therapeutic outcomes of a pharmacist-managed anticoagulation \nservice versus usual medical care. Pharmacotherapy J. 2011 Jul 31(7):686-94            \n\n\n\n\n\n\n \n* Contact for correspondence, please email: farmasidungun@gmail.com\n\n\n \nThe percentage of time patients\u2019 INR was <1.5 and >5 is lower in WMTAC group compared to UC group respectively. This finding was supported by one of the studies conducted by Wilson S.J. et al. presented high risk INR values (<1.5 or >5.0) were more of...\n\n\n\n\n\n"
"\n\nMalaysian Journal of Pharmacy Volume 6 Issue 1 December 2020 \n \n\n\n\n1 \n\n\n\n*Corresponding author:  \n\n\n\nChing Siang Tan \n\n\n\nEmail: chingsiang9@hotmail.com \n\n\n\n\n\n\n\nSchool of Pharmacy, KPJ Healthcare University College, Malaysia \n\n\n\n\n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n\n\n\n\nShort communication \n\n\n\n\n\n\n\nThe Need of Patient Education to Improve Medication \n\n\n\nAdherence Among Hypertensive Patients \n \n\n\n\nChing Siang Tan \n \n\n\n\n\n\n\n\nArticle Info  \n\n\n\n \nReceived date: 16 Dec 2020 \n\n\n\nAccepted date: 27 Dec 2020 \n\n\n\nPublished date: 31 Dec 2020  \n\n\n\n\n\n\n\nKeywords:  \n\n\n\npatient education, medication \n\n\n\nadherence, hypertensive \n\n\n\npatient \n\n\n\n\n\n\n\n\n\n\n\nABSTRACT  \n\n\n\n\n\n\n\nEssential medicines have become indispensable to maintain and to improve our lives and health. \n\n\n\nLatest literature again reiterated that inappropriate use of medicine is a global phenomenon in both \n\n\n\ndeveloped and developing countries still prevail. Poor adherence is associated with negative clinical \n\n\n\noutcome of the disease. It is important to note that about 50% of treatment failures are due to poor \n\n\n\nmedication adherence and this results in substantial morbidity and mortality. Patient\u2019s belief and \n\n\n\nperception have been reported to influence medication adherence. Low rate of adherence was found \n\n\n\nstrongly associated with patient\u2019s belief across the studies with chronic diseases with hypertension, \n\n\n\ncoronary heart disease, diabetes, asthma and renal disease. Exploring the health beliefs of patients is \n\n\n\nvital to improve adherence and thereby blood pressure among the patients with hypertension. Lack \n\n\n\nof knowledge about usage of medication and various misleading perceptions of hypertension \n\n\n\nmanagement have resulted inappropriate use of medication especially medication adherence among \n\n\n\ncommunity-dwelling patients with hypertension. Literatures classified non-adherence into primary \n\n\n\nand secondary. Primary non-adherence refers to medication is purposefully never filled or taken; \n\n\n\nSecondary non-adherence is defined as medication is not taken properly or continued as prescribed \n\n\n\nand further classified into intentionally and unintentionally. Patient education aims to train patient in \n\n\n\nthe skill and self-management of their chronic disease by adapting to the treatment or lifestyle \n\n\n\nchanges. Despite improving in patients\u2019 skill and self-care by providing information about the \n\n\n\ntreatment, patient education could enhance their empowerment and medication adherence. Patient \n\n\n\neducation is a basic right of the patients and healthcare members have responsible to provide such \n\n\n\ninformation. However, the authenticity of the available information is yet to be verified. Therefore, \n\n\n\nhealthcare professional could play a vital role here to educate their patients about the appropriate \n\n\n\ninformation.  \n\n\n\n\n\n\n\n\n\n\n\nINTRODUCTION  \n\n\n\n\n\n\n\nEssential medicines are defined as those medicines that satisfy \n\n\n\nthe priority health care needs of the population in a country [1]. \n\n\n\nEssential medicines have become indispensable to maintain \n\n\n\nand to improve our lives and health [2]. Additionally, essential \n\n\n\nmedicines play a significant role in therapeutic assets of \n\n\n\nmedical treatment options. Yet, medicines still are unaffordable, \n\n\n\nunavailable, unsafe and inappropriate used among many people \n\n\n\naround the globe [3, 4]. World Health organisation (WHO) has \n\n\n\ndefined Quality Use of Medicine (QUM) as \u201cPatients receive \n\n\n\nmedications appropriate to their clinical needs, in doses that \n\n\n\nmeet their own individual requirement, for an adequate period \n\n\n\nof time, and at the lowest cost to them and their community\u201d[5]. \n\n\n\nAustralian National Medicines Policies has defined QUM as \n\n\n\n\u201cselecting management and suitable medicine wisely, and \n\n\n\nusing medicines safely and effectively\u201d[6].  \n\n\n\n\n\n\n\nWHO has estimated that more than half of all medicines are \n\n\n\nprescribed, dispensed or sold inappropriately in worldwide [7]. \n\n\n\nMoreover, 50% of the patients did not take medicine in \n\n\n\nappropriate manner [7] and this leads to the various \n\n\n\ncomplications of not well-managed chronic diseases. Latest \n\n\n\nliterature again reiterated that inappropriate use of medicine is \n\n\n\na global phenomenon in both developed and developing \n\n\n\ncountries still prevail [8]. Common problems of inappropriate \n\n\n\nuse of medicine have emerged, including the use of too many \n\n\n\nmedicines per patient with the similar function (polypharmacy), \n\n\n\ninappropriate use of antibiotic, inappropriate self-medication \n\n\n\nespecially prescription-only medicine, inappropriate use of \n\n\n\ninjection when the regime can be substituted with oral \n\n\n\n\nmailto:chingsiang9@hotmail.com\n\n\n\n\n\n\nC.S. Tan Malaysian Journal of Pharmacy 6 (1) 2020 \n\n\n\n\n\n\n\n\n\n\n\n2 \n\n\n\n\n\n\n\nformulation and failure to prescribe according to guidelines [9].  \n\n\n\nIn addition, people tend to forget the details given by doctor \n\n\n\nand pharmacist, not able to buy prescribed medicine at \n\n\n\npharmacy due to financial problem, take initiative to stop \n\n\n\nconsuming prescribed medicine, or taken the wrong dosage \n\n\n\n[10]. Patients were found to have greater tendency to store large \n\n\n\nquantities of medications in urban households with large \n\n\n\npercentages of the medication was being wasted [11]. \n\n\n\n\n\n\n\nMedicine Adherence Underpinned by Patient\u2019s Perception \n\n\n\n\n\n\n\nWHO defines adherence as \u201cthe extent to which a person\u2019s \n\n\n\nbehaviour \u2013 taking medications, following a diet and/ or \n\n\n\nexecuting lifestyle changes, corresponds with agreed \n\n\n\nrecommendations from a health care provider\u201d[12]. \n\n\n\nWorldwide, approximately $177 billion was spent in direct and \n\n\n\nindirect health care cost annual due to poor adherence [13]. \n\n\n\nMedication adherence is one of the important aspects of the \n\n\n\nQUM. Poor adherence is associated with negative clinical \n\n\n\noutcome of the disease [14]. It is important to note that about \n\n\n\n50% of treatment failures are due to poor medication adherence \n\n\n\nand this results in substantial morbidity and mortality [15, 16].   \n\n\n\nPatient\u2019s belief and perception have been reported to influence \n\n\n\nmedication adherence [17-19]. Low rate of adherence was \n\n\n\nfound strongly associated with patient\u2019s belief across the \n\n\n\nstudies with chronic diseases with hypertension [20], coronary \n\n\n\nheart disease [21], diabetes [22], asthma [23] and renal disease \n\n\n\n[24]. Exploring the health beliefs of patients is vital to improve \n\n\n\nadherence and thereby blood pressure (BP) among the patients \n\n\n\nwith hypertension [20]. Literature demonstrated that patient\u2019s \n\n\n\nbeliefs about medicines yielded a significant predictor to \n\n\n\nmedication adherence compare to social demographic factors \n\n\n\n[21]. To maximise treatment outcomes, a number of rigorous \n\n\n\nreviews were focused on the modifying factors, such as \n\n\n\npatient\u2019s beliefs, rather than non-modifying demographic \n\n\n\nvariables [21, 25]. Many patients with hypertension did not \n\n\n\nadhere to antihypertensive medication because they had \n\n\n\nmisperception towards hypertension or they were unconfident \n\n\n\nwith their antihypertensive medication such as concern of \n\n\n\npotential adverse effects [26-28]. In overseas, lack of \n\n\n\nknowledge about usage of medication and various misleading \n\n\n\nperceptions of hypertension management have resulted \n\n\n\ninappropriate use of medication especially medication \n\n\n\nadherence among community-dwelling patients with \n\n\n\nhypertension [28-30]. \n\n\n\n\n\n\n\nPossible reasons of non-adherence includes perceptual factors \n\n\n\nsuch as beliefs, attitudes and preference [21, 31]. Studies have \n\n\n\nshown that medication adherence was greatly influenced by \n\n\n\npatients\u2019 health belief towards hypertension [14]. Patient\u2019s \n\n\n\nbeliefs play an important role in predicting medication \n\n\n\nadherence [22, 32]. Patient\u2019s judgement in the need of \n\n\n\nmedication (necessity belief) relatively to their concern of \n\n\n\nadverse effect influences their motivation to start and continue \n\n\n\nwith medication [33].  \n\n\n\nIt must be noted that literature demonstrated that low \n\n\n\nmedication adherence was observed among patients with \n\n\n\nchronic diseases [34]. A wide variation of non-adherence rate \n\n\n\n(i.e. 7%-67%) has been reported among the patients with \n\n\n\ncardiovascular diseases [35]. Medication adherence among \n\n\n\npatients with hypertension was reported ranged from 50% to \n\n\n\n70% [36]. It is evident that many patients with hypertension \n\n\n\nhave obstacles to adhere to their medication regimens [4]. \n\n\n\nApproximately half of them were found to be non-adherent and \n\n\n\nleading to suboptimal clinical benefits [16, 37]. In Malaysia, \n\n\n\nonly 35% of patients with hypertension have controlled BP \n\n\n\nlevel with antihypertensive medications [38]. A recent local \n\n\n\nstudy revealed that the reasons of poor medication adherence \n\n\n\namong patients with hypertension were due to misconception \n\n\n\nabout side effect of antihypertensive medication and lack of \n\n\n\nknowledge towards hypertension management [31].   \n\n\n\nDifferentiating the Type of Medication Non-adherence \n\n\n\n\n\n\n\nLiteratures classified non-adherence into primary and \n\n\n\nsecondary. Of note, when medication is purposefully never \n\n\n\nfilled or taken; or a new prescription is not filled by patient, it \n\n\n\nis called as primary non-adherence [36, 39]. While, secondary \n\n\n\nnon-adherence is defined as medication is not taken properly or \n\n\n\ncontinued as prescribed [36]. Secondary non-adherence is \n\n\n\nclassified into intentionally and unintentionally. Intentional \n\n\n\nnon-adherence refers to patient\u2019s decision to stop medication \n\n\n\non their own, either insufficient information about benefits or \n\n\n\nside effect of medication [40]. On the other hand, unintentional \n\n\n\nnon-adherence occurs when patient is prevented from taking \n\n\n\nmedication under unplanned circumstances, for instances, \n\n\n\nforgetfulness, does not understand instruction of use for the \n\n\n\nmedication, language barriers or physical barrier to comply \n\n\n\nmedication [41]. Taking a scrutiny into the medication \n\n\n\nadherence break down components; 12% of cardiovascular \n\n\n\npatients did not fill up prescription (primary non-adherence); \n\n\n\n12% of the primary non-adherence was found by not started \n\n\n\nmedication; while 29% of cardiovascular patients did not take \n\n\n\nprescribed medication for long term (secondary non-\n\n\n\nadherence), and only 47% of cardiovascular patients adhered to \n\n\n\nprescribed medication [42]. Another study revealed that the \n\n\n\nadherence rate was dropped to only 35% during the first year \n\n\n\nof treatment among the patients with hypertension [43].  \n\n\n\n\n\n\n\nWay Forward: The Need for Continued Patient Education \n\n\n\nto Mitigate Medication Non-Adherence and Wastage \n\n\n\n\n\n\n\nPatient education is defined as \u201cA systematic experience in \n\n\n\nwhich a combination or a variety of methods are used. These \n\n\n\nmight include the provision of information and advice and \n\n\n\nbehaviour modification techniques, which influence the way the \n\n\n\npatient experiences his illness and/or his knowledge and health \n\n\n\nbehaviour, aimed at improving or maintaining or learning to \n\n\n\ncope with a condition, usually a chronic one\u201d[44]. The concept \n\n\n\nof patient education is to train patient in the skill and self-\n\n\n\nmanagement of their chronic disease by adapting to the \n\n\n\ntreatment or lifestyle changes [45]. Despite improving in \n\n\n\npatients\u2019 skill and self-care by providing information about the \n\n\n\ntreatment, patient education could enhance their empowerment \n\n\n\n\n\n\n\n\nC.S. Tan Malaysian Journal of Pharmacy 6 (1) 2020 \n\n\n\n\n\n\n\n\n\n\n\n3 \n\n\n\n\n\n\n\nand medication adherence [46]. In addition, patient education \n\n\n\ncould reduce the medical expenses in terms of long term care \n\n\n\nfor both patients and society [45]. Patient education plays an \n\n\n\nimportant role in therapeutic plan by improving patients\u2019 self-\n\n\n\nmanagement skills [47] and to enhance patient-centred \n\n\n\nperspective [48].   \n\n\n\nPatient education can be divided into clinical patient education \n\n\n\n(learning and teaching process are carried out at clinical setting) \n\n\n\nand community health education (education program \n\n\n\nemphasises on prevention, wellness and healthcare awareness \n\n\n\namong the community level)[49]. With the expert knowledge \n\n\n\nand proper training, health promoters generally have credibility \n\n\n\nto conduct patient education program. However, expertise \n\n\n\nalone does not make a good health educator. Three principles \n\n\n\nmust be adopted in patient educational programme: (i) patients\u2019 \n\n\n\nbelief and understanding of the aims of education program must \n\n\n\nbe delivered and evaluated through some learning tools [50-52], \n\n\n\n(ii) established relationship between patients and healthcare \n\n\n\nproviders [53, 54], and (iii) attention must be given to low self-\n\n\n\nesteem and non-vocal patients to change their health-related \n\n\n\nbehaviors [55].  \n\n\n\nPreparation of patient education is important. Health educator \n\n\n\nneeds to think through the objectives of the session, the way of \n\n\n\nconducting and the involvement of participants [56]. Jensen \n\n\n\nand Simvska reported that the optimal learning outcome could \n\n\n\nbe achieved throughout active participation during learning \n\n\n\nprocess [57]. Whilst Ewles and Simnett added that learning \n\n\n\nmethods should be variated in different ways i.e. books, leaflets, \n\n\n\nhandout, poster, flip-chart, PowerPoint slides and others [56]. \n\n\n\nHealth care provider could play an important role to educate \n\n\n\npatients in order to enable them to further understand their \n\n\n\nconditions and the given therapy [58]. Evidence demonstrated \n\n\n\nthat patients want health information but some of them have \n\n\n\ndifficulty in understanding and remember the information \n\n\n\ndelivered by the health educator [59].  \n\n\n\nA recent local study revealed that a total of 20,799 excessive \n\n\n\npills were returned by patients with hypertension at a single \n\n\n\nMalaysian government hospital, with a total cost of (Malaysian \n\n\n\nRinggit) MYR 4,362.28 (equal to USD 1037) was wasted \n\n\n\nduring the 8 months of study period with an average wastage \n\n\n\nof MYR 42.35 (equal to USD 10) per patient; changing \n\n\n\nmedication by the doctor and death of patients were the most \n\n\n\ncommon reasons accounted for the wastage [60]. Lack of \n\n\n\nknowledge about usage of medication and various misleading \n\n\n\nperceptions of hypertension management have resulted \n\n\n\ninappropriate use of medication especially medication \n\n\n\nadherence among community-dwelling patients with \n\n\n\nhypertension [29, 30]. Within this context, a pharmacist whom \n\n\n\ntraditional roles focus on medication dispensing and \n\n\n\nprocurement have been serving well as a healthcare educator. \n\n\n\nBeing an expert of medicines, a pharmacist is dedicated to \n\n\n\nprovide medicine counselling to patients, taking into \n\n\n\nconsideration their prescription, non-prescription, self-\n\n\n\nprescribed, herbal medications as well as the drug \n\n\n\ninteraction[61].  \n\n\n\nCONCLUSIONS  \n\n\n\n\n\n\n\nPatient education is a basic right of the patients and healthcare \n\n\n\nmembers have responsible to provide such information. \n\n\n\nHealthcare providers could provide pertinent yet enough \n\n\n\ninformation to the patients and thus avoiding the development \n\n\n\nof confusion. Patients might obtain information from other \n\n\n\nsources, such as social media, friends, neighbour and family \n\n\n\nmembers. However, the authenticity of the available \n\n\n\ninformation is yet to be verified. Therefore, healthcare \n\n\n\nprofessional could play a vital role here to educate their patients \n\n\n\nabout the appropriate information [62].  \n\n\n\n\n\n\n\nThe evolving of patient education and the emerging of the new \n\n\n\ndevelopments are expected from the healthcare professional. \n\n\n\nCurrently healthcare professional have more access and \n\n\n\ntraining opportunity in patient education technique, such as \n\n\n\ncounselling and motivational interview [63]. However, many \n\n\n\nhealthcare professionals confronted challenging when \n\n\n\neducating patient because of limited time was allocated to cover \n\n\n\nall health topics [64]. Therefore, the development of patient \n\n\n\neducation interventions is impeding with the direction of \n\n\n\nreplacing a part of consultation time with providing tools for \n\n\n\nself-monitoring by patient themselves at outside of healthcare \n\n\n\nsetting.  \n\n\n\n\n\n\n\nCONFLICT OF INTEREST \n\n\n\n\n\n\n\nThe authors declare no conflict of interest. This research did \n\n\n\nnot receive any specific grant from funding agencies in the \n\n\n\npublic, commercial or not-for-profit sectors. \n\n\n\n\n\n\n\nREFERENCES  \n \n\n\n\n1. World Health Organization. Essential Medicines and Health Products. \n\n\n\n2020  [cited 2020 21th December]; Available from: \nhttps://www.who.int/medicines/services/essmedicines_def/en/. \n\n\n\n2. Organization, W.H., Towards access 2030: WHO essential medicines \n\n\n\nand health products strategic framework 2016-2030. 2017, World \nHealth Organization. \n\n\n\n3. Tan Ching, S., M.A. Hassali, and F. 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"\n\n\n\n\n\nMalaysian Journal of Pharmacy\nVolume 1 Number 1 May 2001\n\n\n\nThe Official Journal of the Malaysian Pharmaceutical Society\n\n\n\nEditor-in-Chief: Dr. Yew Su Fong\n\n\n\nAssociate Editors: Assoc. Prof. Dr. Abas bin Hj Hussin\n\n\n\nDr. Ab Fatah bin Haji Ab Rahman\n\n\n\nDr. Abu Bakar Abdul Majeed\n\n\n\nAssoc. Prof. Dr. Aishah bte Adam\n\n\n\nAssoc. Prof. Dr. Chung Lip Yong\n\n\n\nAssoc. Prof. Dr. Hadida bte Hashim\n\n\n\nProf. Dr. Mohd. Isa bin Abdul Majid\n\n\n\nMr. John Chang\n\n\n\nDr. Mohamed Izham bin Mohamed Ibrahim\n\n\n\nAssoc. Prof. Dr. Mustafa Ali Mohd.\n\n\n\nAssoc. Prof. Dr. Paraidathathu Thomas a/l P.G. Thomas\n\n\n\nMr. Wong Kok Thong\n\n\n\nMr. Wong Sie Sing\n\n\n\nProf. Yuen Kah Hay\n\n\n\nPublisher: Malaysian Pharmaceutical Society\n\n\n\nP.O. Box 158 Jalan Sultan\n\n\n\n46710 Petaling Jaya\n\n\n\nSelangor\n\n\n\nMalaysia\n\n\n\nTel: 03-77291409\n\n\n\nFax: 03-77263749\n\n\n\nHomepage: www.mps.org.my\n\n\n\nEmail:mspharm@po.jaring.my\n\n\n\nThe Malaysian Journal of Pharmacy is a bi-annual publication of the Malaysian Pharmaceutical Society.\nEnquiries are to be directed to the Publisher at the above address or the Editor-in-Chief at the Pharmacy\nDepartment, Faculty of Allied Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul\nAziz, 53100 Kuala Lumpur. The Publisher reserves copyright and renewal on all published materials, and\nsuch material may not be reproduced in any form without the written permission of the Publisher.\n\n\n\n\nhttp://www.mps.org.my/\n\n\n\n\n\n\nEditorial\n\n\n\n1\n\n\n\nTable of Contents\n\n\n\nEditorial\nPublish and disseminate\nSF Yew\n\n\n\n2\n\n\n\nGeneral Article\nPharmacy practice in Malaysia\nSS Wong\n\n\n\n3\n\n\n\nContinuing Pharmacy Education\nBioethics\nA B A Majeed\n\n\n\n10\n\n\n\nResearch Papers\nCareer choice of Malaysian pharmacy\nstudents: A preliminary study\nAR Ab Fatah, MI Mohamed Izham, MY Zuraidah, B\nMohd Baidi & I Rusli\n\n\n\n16\n\n\n\nPublic awareness of community pharmacy\nand pharmacists\nH Hadida, M Ahmad, WH Lim, PY Lum, MY\nNatasha, YB Tang\n\n\n\n23\n\n\n\nDevelopment of a high-performance liquid\nchromatographic method for analysis of\nglibenclamide from dissolution studies\nWI Wan Azman, N Mohamed Ibrahim, H Hadida, A\nKumar\n\n\n\n30\n\n\n\nBook Review\nFarmakologi Perubatan Sekali Imbas: M.J.\nNeal, Edisi Ketiga.  Terjemahan\ndikendalikan oleh Unit Terjemahan Melalui\nKomputer.  Penyunting Terjemahan: Abas\nHj. Hussin.\nA Adam\n\n\n\n35\n\n\n\nInstructions to Authors 37\n\n\n\n\n\n\n\n\nEditorial\n\n\n\n2\n\n\n\nEditorial\n\n\n\nPublish and disseminate\nResearch in pharmacy-related areas within this country is growing.  If not for anything\n\n\n\nelse, the job promotion tied to research publications should serve as a carrot to\n\n\n\nacademicians, and yet many useful local research findings have ended up as\n\n\n\ndissertations kept in the darkest corners of the library. While research is normally\n\n\n\nassociated with academicians, it is not confined to that group. Practising pharmacists\n\n\n\nalso play an important role. For example, the Malaysian Pharmaceutical Society has\n\n\n\nsupported studies such as \u201cSurvey on Diabetic Care Management\u201d, that was presented\n\n\n\nby the Pharmacy Practice Chapter at the Society\u2019s Project 2003 Workshop II held at\n\n\n\nKuala Lumpur in 1999. The findings however were only shared among the group of\n\n\n\npharmacists who were able to attend.  Many hospital pharmacists also do carry out\n\n\n\nsmall research projects, but presentation of the results is often limited to members of\n\n\n\nthat department.  All these highlight the need for proper documentation, where\n\n\n\nvaluable findings can be widely disseminated and discussed, and help reduce\n\n\n\nrepetitions in research.\n\n\n\nSo, for a long time now, it has been the aim of the Malaysian Pharmaceutical Society\n\n\n\nto publish its own journal. As well as to encourage research and publication, this\n\n\n\njournal intends to keep local pharmacists, academicians and others in the related areas\n\n\n\nin touch with the profession.  This bi-annual nationally peer-reviewed journal covers\n\n\n\nareas related to Pharmacy in the form of General Articles, Invited Reviews, Research\n\n\n\nPapers and Book Reviews. In addition, the Continuing Pharmacy Education section\n\n\n\nallows members to earn CPE points. The editors would like to invite you to submit\n\n\n\nmanuscripts for the areas above, which will be reviewed year round. Please refer to\n\n\n\nthe Instructions for Authors on page 36 for more information. Feedback on articles in\n\n\n\neach issue is welcomed, and these will be published in the Letters to the Editor section\n\n\n\nin the following issue.\n\n\n\nIn order for the widest readership possible, this journal will be distributed to members\n\n\n\nof the Society throughout the country, and later on, to allied health professional\n\n\n\norganizations, universities and relevant government agencies.  We hope that for now,\n\n\n\nthis journal will be the avenue for pharmacy publications within the country, and that\n\n\n\nour boundaries will expand regionally in the future.\n\n\n\nYew Su Fong\n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy 2001 1:2-8  General article\n\n\n\n3\n\n\n\nPharmacy Practice in Malaysia\nWong Sie Sing\n\n\n\n8 Jalan Court House, 93000 Kuching, Sarawak, Malaysia\n\n\n\nABSTRACT\n\n\n\nPharmacists in Malaysia practise their profession in rugged terrains which demand\nboth professional skills and pioneering spirits. Many of the current pharmaceutical\nstandards, practices, and legislations need overhauling in order to meet the\naspiration of the nation in this new millennium. The Malaysian Pharmaceutical\nSociety has a vital role to play. The profession requires the greatest understanding\nof the Malaysian Medical Association and the Government in this transition period.\n\n\n\nKeywords: pharmacy practice, pharmacy standards, legislations, healthcare, Malaysia\n\n\n\nINTRODUCTION\n\n\n\nPharmacy is a learned profession. It is a well-\nestablished science-based profession which\npossesses all the essential characteristics of a\nprofessional group. Four main characteristics\nreflect the profession\u2019s distinctiveness: the special\nsphere of knowledge and intellectual discipline,\nwell defined functions, professional ethics and\nconduct, and practitioners representative body.\nPersons who desire to partake in the profession\nneed to master the pharmaceutical sciences.\n\n\n\nThe first distinctive characteristic concerns the\nspecial sphere of knowledge and intellectual\ndiscipline. Knowledge in the pharmaceutical\nsciences may be acquired through undergraduate\npharmacy degree courses presently available\nlocally in Universiti Sains Malaysia, Universiti\nMalaya, Universiti Kebangsaan Malaysia,\nInternational Medical University, Sepang Institute\nof Technology and Sedaya College. In addition to\nthese six institutions of higher education,\nUniversiti Teknologi Mara and International\nIslamic University are expected to offer pharmacy\ndegree course soon. Pharmacy graduates from 56\nother overseas universities, in 13 countries, are also\nrecognized by the Pharmacy Board (1). Only pharmacy\nstudents who have satisfactorily completed the\nprescribed  course  are  permitted  to  embark upon\n\n\n\nthe compulsory twelve months  of  pre-registration\ntraining in an establishment recognized by the\nPharmacy Board. Currently a pre-registration\npharmacy graduate has a choice to receive training\nin either hospital pharmacy, community pharmacy,\nmanufacturing pharmacy or wholesale trading\npharmacy.\n\n\n\nThe second feature is the presence of a national\nbody representing all the pharmacy practitioners.\nMalaysian Pharmaceutical Society (MPS) was\nformed and incorporated under the Society Act in\n1965. It promotes pharmaceutical practice, protects\nthe interests of the practitioners and end-users, and\nencourages the advancement of the pharmaceutical\nsciences. It is interesting to add here that another\ntwo pharmaceutical societies, namely Sabah\nPharmaceutical Society and Sarawak\nPharmaceutical Society also co-exist to champion\nthe pharmacy profession in the states of Sabah and\nSarawak, respectively.\n\n\n\nThe third feature relates to the professional ethics\nand conduct which guide all members. The\nCouncil of MPS had issued a guideline on the\nmatter. Uniquely the Pharmacy Board had also\nissued the \u201cCode of Conduct For Pharmacists and\nBody Corporates\u201d. By virtue of the power given to\n\n\n\n\n\n\n\n\nGeneral article: Pharmacy practice in Malaysia\n\n\n\n4\n\n\n\nthe Pharmacy Board under Section 22(1)(e) and (j)\nof the Registration of Pharmacists Act 1951, this\ndocument may be legally binding upon the\npharmacists.\n\n\n\nThe fourth feature of a learned profession is the\nprovision by its practitioners of uniform\nprofessional services and advice to the public. This\nrefers to the supply of medicines to the public,\naccompanied by appropriate advice (that is, patient\nmedication counseling) during the dispensing\nprocess.\n\n\n\nPharmacy, as a learned profession, was rarely\nchallenged since time immemorial. The inherent\ndynamism has brought it through several rounds of\nprofessional metamorphosis. As a result, the\npractice of pharmacy has been described in a\nvariety of ways.\n\n\n\nWHAT IS PHARMACY PRACTICE?\n\n\n\nDiffering views have been presented on this\nmatter. Some consider it a profession, others look\nat it as a trade \u2013 albeit a professional one. There is\nno concise and precise description on what\npharmacy practice should be. Perhaps the\ndifficulty is due to the co-existence of both\nspecialized and generalized professional services\nwhich the profession offers.\n\n\n\nNonetheless, pharmacy practitioners all agree that\npharmacists ought to know the properties (which\ninclude pharmacodynamics, pharmacokinetics,\nmechanisms of drug action, side-effects, adverse\ndrug-drug reactions, adverse drug-food reactions,\nand drug toxicity) of all the medicines, their\nformulation processes, proper storage conditions,\nand appropriate usage. Such knowledge should be\napplied primarily towards public interests during\nthe course of our profession activities. These\nprofessional activities pertain to the supply of\nmedicines for humans, supply of veterinary\nmedicines, infant and enriched formulas for adults,\nsick-room appliances, agricultural, horticultural\nand industrial chemicals, scientific apparatus (such\nas stethoscopes and clinical thermometers),\nsurgical appliances and instruments, electro-\nmedical therapeutic apparatus (such as blood\npressure meters and blood glucose or cholesterol\nmonitors). But many pharmacies also offer non-\nprofessional activities which are often closely\nassociated with pharmacy, such as the supply of\nperfumes, cosmetics, toilet requisites and\nphotographic materials.\n\n\n\nPharmacy practice in Malaysia varies from one\npharmacy to another. Chain-store pharmacies\nusually offer a significant proportion of non-\nprofessional services and activities alongside the\ntraditional professional services. Smaller\nindependent pharmacies normally focus on\nprofessional pharmacy services. Both types are\nrepresentative of private pharmacy practice in\nMalaysia. On the other hand, pharmacy practice in\nthe government sector is quite different.\nGovernment pharmacists enjoy a more favourable\nlegal environment which permits them complete\ncontrol over the supply of medicines. Government\ndoctors do not provide pharmacy services to\npatients, unlike their counterparts in private\npractice. Consequently, private pharmacies operate\nunder very harsh and unfavourable conditions\nimposed by legal and historical limits. Many\ncommunity pharmacies do not even receive one\nprescription chit a day! This unhealthy scenario\nshould be rectified by the government, with the\nfull understanding of the Malaysian medical\nprofession. It is hoped that the pharmacy\nprofession will be granted a new lease of life in\nthis new millennium.\n\n\n\nPHARMACY PRACTICE IN THE NEW\nMILLENNIUM\n\n\n\nMalaysia is one of the front-runners amonst\ndeveloping countries in this high technology\ninformation era through the creation and\nimplementation of the world renowned Multimedia\nSuper Corridor. Our nation ranks 16th as a world\ntrading nation, and we are a signatory to almost all\ninternational treaties including global trade\nliberalization related to the World Trade\nOrganization. Global trade liberation will\ninevitably be accompanied by a free flow of\nprofessionals (such as lawyers, accountants,\npharmacists and doctors). With a relatively lower\npharmacist to population ratio coupled with a\ncomparatively higher salary in our country,\nneighbouring foreign pharmacists will flow into\nMalaysia to fill up any shortage. We may not be\nprepared sufficiently to handle the situation to the\nnational advantage. The interests of local\npractitioners may be damaged. In this context, the\npharmacy profession in Malaysia needs to work\ndoubly hard so as not to be caught unprepared.\n\n\n\nAgainst such a background, MPS has risen to the\noccasion by examining the various professional\nissues and putting in place necessary strategies to\nenhance professionalism in every aspect of the\n\n\n\n\n\n\n\n\nGeneral article: Pharmacy practice in Malaysia\n\n\n\n5\n\n\n\npharmacy practice. The undersigned feels strongly\nthat Malaysian pharmacists need to address the\nfollowing matters in order to be able to contribute\nmore meaningfully, as an important primary\nhealthcare team member, to the overall health of\nthe nation:\n\n\n\n(a) Control over the supply of medicines\n\n\n\nAs mentioned earlier, private medical doctors\ncontrol a large percentage of medicines supplied to\npatients. It is high time that this control be\nexclusively given to pharmacists who, after all, are\nthe only professionals properly trained for the job.\nIn 1984, the Malaysian Medical Association\n(MMA) had agreed, in principle, that the present\nsystem should change for the better. Physicians\nshould focus on diagnosis and prescribing. The\ndispensing of medicines had been mutually agreed\nto be the professional role of pharmacists and\nshould, therefore, be implemented for both the\npublic, as well as the private sector.\n\n\n\nMany brainstorming sessions have been held on\nthis matter. Finally, MPS launched in 1998 Project\n2003 to spearhead this professional activity. Seven\nsub-committees (namely Pharmacy Practice\nStandards Committee, Professional Competence\nCommittee, Professional Image and Public\nEducation Committee, Telepharmacy Committee,\nPharmacy Legislation Committee, Manpower\nProjection Committee, and National Drug Policy\nand National Healthcare System Committee) were\nestablished to examine and prepare reports on\nvarious important aspects of the profession. It is\nhoped that a formal official recommendation will\nbe ready for submission to the Government by the\nmiddle of 2001.\n\n\n\n(b) National Healthcare Fund\n\n\n\nNational healthcare bills have risen sharply in\nrecent years. Health expenses in 1999 were\nreported at about four and a half billion ringgit.\nThere is a need to cap and control the bill and to\ninvolve citizens in this important matter. As a\ncaring and well-planned nation, it seems an\nexcellent idea to introduce a National Healthcare\nFund to finance all future needs of the people in\nour medication-treatment. It should be by and for\nthe people. The government also needs to budget\nfor it because about one-third of the population\nwill require subsidy.\n\n\n\nIndeed, Malaysia cannot afford not to plan ahead\nfor a National Healthcare Fund or a similar scheme\n\n\n\nbecause in about 10 years\u2019 time, a fifth of our\npopulation would have aged beyond 65 years. The\ngeriatric population requires a bigger budget for\nhealth matters. And it will not get cheaper as the\nyears go by.\n\n\n\nThe National Healthcare Fund should finance all\nmedicines supplied. Pharmacists should be paid a\nprofessional fee for services rendered to the public.\nThis will enhance the professional image of\npharmacists, and place us at par with other\nprofessionals in Malaysia. MPS needs to\ncontribute proactively, through seminars and\npublic talks, singularly as well as collectively, with\nother stakeholders (namely MMA, allied health\nbodies, consumer groups, Insurance and Managed\nCare Organizations) to work out a win-win\nformula for all the health service providers and\nusers.\n\n\n\n(c) Even distribution of pharmacy services\n\n\n\nThe present 3000-plus registered pharmacists is\nexpected to increase to about 5000 by the year\n2004. MPS needs to ensure an even distribution of\npharmacies throughout the country. Some sort of\npharmacy zoning system may be necessary. The\npopulace should be entitled to receive similar\nstandards of pharmacy services to that in the big\ncities. A duty roster will ensure round-the clock\navailability of medicines to needy patients.\n\n\n\nIn cities such as Kuala Lumpur, Kota Kinabalu,\nKuching, Johore Bahru and Penang, there are\nprobably too many private community pharmacies\ncatering to the needs of city dwellers. Perhaps\nnewcomers should be given incentives or\nlegislated to set up pharmacies in small towns and\nrural areas. In rural places where there are no\nprivate clinics, private community pharmacies can\nstill complement the services provided by the\ngovernment's rural clinics. A town of 30,000\npeople requires about three private community\npharmacies to work side by side with the\npublic/hospital pharmacies. Distribution of\npharmacies should be worked out on a district\nbasis.\n\n\n\nIt was reported that there are about 350\npharmacists working in government hospitals,\nclinics, laboratories and stores (MMA press\nrelease, 24th August 2000). This represents about\n13% of all practising pharmacists. However, 45%\nof the medical practitioners work in the public\nsector. Obviously the national pharmacist shortage\nlies in the public sector. Urgent action needs to be\n\n\n\n\n\n\n\n\nGeneral article: Pharmacy practice in Malaysia\n\n\n\n6\n\n\n\ntaken by the government to rectify this problem.\n\n\n\nThe Health Minister announced, on 9th December\n2000, the requirement for a compulsory three-year\ngovernment service for all newly qualified\ndentists, effective from 1st January 2001. It is time\nthat pharmacists join the doctors and dentists in\ncompulsory national government service. This is in\nline with the present global paradigm shift in\nhealthcare delivery.\n\n\n\n(d) Self-regulation in pharmacy standards and\npractice\n\n\n\nThere is a need for a paradigm shift in allowing the\nlearned profession to be self-regulated in matters\npertaining to pharmacy standards and practice.\nThese refer to ethics and conduct of pharmacists,\nthe continuing competence of members to practise,\nand assessment of new entrants into the profession.\n\n\n\nSome other professional groups in Malaysia (such\nas the MMA and Malaysian Advocates Society)\nhave been self-regulating in these matters. It is a\nstep forward which will inevitably bring much\nbenefit to the people.\n\n\n\nContinuing Pharmacy Education (CPE) for the\npractising pharmacists is a universal trend carried\nout by most advanced nations. The United States\nof America and the United Kingdom adopt\ndifferent CPE systems. Perhaps the MPS-CPE\npioneering project can form the basic framework\nto build upon. Seminars, conferences and certain\nwrite-ups can be a basis for assessment. To capture\nall CPE efforts, it may be reasonable and feasible\nto adopt the American Log-Book system where the\nonus to maintain records lies with the practitioners.\nThe Royal Pharmaceutical Society of Great Britain\n(RPSGB) had introduced the Continuing\nEducation Logbook in 1995 (2). The RPSGB are\nin the process of consulting its 40,000 members in\nworking out a new framework for professional\nregulation with measures to ensure professional\ncompetence and lifelong learning (3).\n\n\n\nOur present pre-registration training programme\nhas its form but lacks mechanisms for monitoring\nthe actual progress of students. Visual assessment\nmay not be sufficient and objective enough.\nRegular intervals of written assessments are\npreferable. The pharmacist-supervisors\u2019 input will\ndepend on his/her experience and knowledge. A\nsystematic write-up on what to impart and a\nstandard list of reference books/materials should\nstandardize the supervision. Wholesale trading\n\n\n\npharmacy and manufacturing pharmacy do not\nexpose the pre-registration students to adequate\npatient counseling. Many students are left to \u2018learn\non their own\u2019. It is vital for the profession to\nacertain whether it is important for all students to\nattain the same breath and depth of\nprofessionalism in the different disciplines.\n\n\n\nThe undersigned recommends the New Zealand\nsystem that was recently implemented. Since 1997,\nall newly qualified pharmacy graduates in New\nZealand undergo a twelve-month pharmacy pre-\nregistration training program which defines seven\nprofessional competency standards expected of a\nregistered pharmacist. A combination of on-the-job\nassessment, submission of assignments,\nperformance at training days, completion of a\nlearning record, and attendance at a final\nassessment centre determines the standards\nachieved (4). Australia is likely to follow a similar\ncompetence-based accreditation for pharmacists\n(5).\n\n\n\n(e) Education and research\n\n\n\nPharmacy has been designated as one of the\npriority development areas in our knowledge \u2013\nbased new economy which our government is very\ndetermined to nurture. Pharmacy educationists\nneed to ensure that our profession is well\npositioned to derive optimal growth. The choice of\nsubjects in undergraduate pharmacy degree\nprogrammes ought to provide wide coverage and\nsufficient depth in all the pharmaceutical sciences.\nPostgraduate studies should produce specialists in\nvarious disciplines such as pharmaceutics,\npharmacognosy, synthetic-medicinal chemistry,\nclinical pharmacy and pharmaceutical\nbiotechnology. Our educational system needs to\nproduce both generalists as well as specialists who\nwill contribute to the further advancement of the\nprofession.\n\n\n\nThe local pharmaceutical industry may form a\nsymbiotic partnership with academicians. The\nlatter can generate the much needed input in basic\npharmaceutical science research. The former can\ncommercialize useful products or applications for\nmutual benefit. This modulus of operation is a\nnorm in many advanced countries.\n\n\n\nA sound pharmacy education system with\nemphasis and smart partnership in research and\ndevelopment will surely bring forth tremendous\nprogress to the pharmacy profession in Malaysia.\nGreater and closer co-operation between\n\n\n\n\n\n\n\n\nGeneral article: Pharmacy practice in Malaysia\n\n\n\n7\n\n\n\npharmaceutical scientists in universities and the\npharmaceutical industry in areas such as\nproduction of raw material for pharmaceuticals,\nsynthesis of new and useful chemical entities,\nbiotechnology in manufacturing, design of new\nand better methods in extraction of active\ningredients from local medicinal plants,\nformulation, and general transfer of technology\nfrom the academic scientists to the pharmaceutical\nindustry should be encouraged.\n\n\n\n(f) National Formulary and Pharmacopoeia:\n\n\n\nA hallmark of a learned profession is a systematic\naccumulation and compilation of new knowledge\ninto reference standards or specifications which\nposterity can build upon for greater advancement.\nThe legal profession has unmatched achievement\nin this matter. All advanced western nations have\nbuilt up their own wealth of knowledge and\ntechnology over a long period of time. After being\nindependent for four and a half decades, Malaysia\nshould begin to build its own Pharmacopoeia and\nNational Formulary.\n\n\n\nIt is a matter of grave concern that many locally\nconcocted medicinal preparations are not properly\ndocumented. Many rural folks (\"village doctors\")\nhave been using selected plants as medicines for\ngenerations. This knowledge of traditional\nmedicine needs to be preserved in writing (into\nFormulary or Pharmacopoeia) before these old\nfolks leave us for good.\n\n\n\nEven worse still is the fact that we may lose a large\nrange of indigenous plants during our rapid\neconomic development. Malaysia is blessed with\nabout 12,500 species of medicinal plants (6) which\ncan be a valuable source of new drugs. As much as\n50% of modern medicines have been derived from\nplants, the majority of them from the tropical\nforest (7). The Malaysian forest represents one of\nthe richest of the region's tropical forest but is also\nin serious danger of over-exploitation.\n\n\n\nMuch research has been initiated by local scientists\nin the fields of natural product chemistry but the\nscientific impact these efforts has generated is\nminimal. Much of the activities are confined to\ndetecting and identifying the chemical constituents\nthat possess biological activity and are often\ndiscontinued at the juncture where critical animal\nor human testing is required further (8).\n\n\n\nThe Malaysian Herbal Products Blueprint was\nlaunched in September 2000 by the Malaysian\n\n\n\nIndustry-Government Group for High Technology\n(MIGHT). It is hoped that MIGHT will give equal\nemphasis to research and development and\nproduce monographs on Malaysian herbs, in\naddition to developing and promoting the local\nherbal industry (9).\n\n\n\nPerhaps it is the right time for all the six local\ninstitutions of higher learning where pharmacy is\ntaught to jointly initiate and spearhead a national\nproject in establishing an Institute of\nPharmaceutical Research, parallel to the Institute\nof Medical Research.\n\n\n\nIt is also high time for MPS to work side by side\nwith MMA in recommending to the government of\na permanent committee, comprising of experts\nfrom various medical and pharmaceutical\nspecialities, to bring into being a National\nPharmacopoeia and Formulary.\n\n\n\n(g) Pharmacy legislation:\n\n\n\nThe Poisons Act 1952 (Revised 1989) and\nRegistration of Pharmacists Act 1951 (Revised\n1989) are the two main pillars of pharmacy law in\nMalaysia. Other pieces of legislation such as the\nDangerous Drugs Act 1952 (Revised 1980), Sale\nof Drugs Act 1952 (Revised 1989), and Medicines\n(Advertisement and Sale) Act 1956 (Revised\n1983) are built upon these two laws. It is quite\napparent that these acts were first formulated with\nstrong British Colonial characteristics. Although\nthese laws have been reviewed during the last\ndecade, much of the reviews were piecemeal in\nnature without much forward vision and strategy in\ndeveloping the pharmacy profession. With the\nadvent of the Information Technology Era, our\npresent pharmacy legislations are obviously not\nequipped to deal with matters such as electronic\nprescribing, digital signature, Telemedicine and\nTelepharmacy. Significant overhauls are the order\nof the day.\n\n\n\nIt is imperative that Telepharmacy and Internet\npharmacy should also comply completely with all\npharmacy legislations. Professional ethics and high\nstandards should be maintained. Medicines should\nonly be delivered to patients in person. Systems\nand mechanisms to detect and to verify the\nprescriber\u2019s signature that come with electronic\nprescribing should be in place. Malaysian\ncyberspace legislations for pharmacy practice need\nto be incorporated.\n\n\n\nA paradigm shift and legislation overhaul are\n\n\n\n\n\n\n\n\nGeneral article: Pharmacy practice in Malaysia\n\n\n\n8\n\n\n\nsuggested for the following areas of pharmacy\npractice:\n(i) exclusive control over the supply of\n\n\n\nmedicines by the pharmacists;\n(ii) re-classification Group D Poisons as Group\n\n\n\nC Poisons;\n(iii) pharmacists\u2019 control over the supply of\n\n\n\nherbal and traditional medicines/products;\n(iv) introduction of an annual practising\n\n\n\ncertificate to replace the present annual\nretention certificate and Type A Licence;\n\n\n\n(v) self-regulation in professional matters such\nas ethics and conduct, practice standards,\nand continuing education;\n\n\n\n(vi) introduction of a compulsory three-year\nnational service for all new pharmacists;\nand\n\n\n\n(vii) introduction of pharmacy cyberspace\nlegislation to deal with Telepharmacy and\nInternet-Pharmacy.\n\n\n\nCONCLUSION\n\n\n\nPharmacists in Malaysia practise under two\ndifferent sets of legal-historical framework.\nGovernment employed pharmacists enjoy\ncomplete control over the supply of medicines.\nThey are even exempted from many pharmacy\nregulation provisions. On the other hand, private\npharmacists do not have full control over the\nsupply of medicines. Medical doctors, in the\nprivate clinics and private hospitals, still dispense\nmedicines to their own patients. This doctor-\ndispensing practice has been allowed since the\nColonial era when Malaysia suffered from acute\nshortage of all professionals. This outdated and\nunhealthy situation must change in the near future.\nThe government needs to legislate such a change.\nAs a developing country, Malaysia has already\nbeen served with a reasonable ratio of pharmacists\n\n\n\nto doctors per given population. The national ratio\nof private pharmacists to private doctors is 1 to\n2.4. There are 5400 private practising doctors and\n2300 private practising pharmacists. We have\nalready achieved the optimal ratio of one doctor to\nthree pharmacists in the urban places. With the\nannual increase of about 450 new pharmacists\nfrom now on, there is a serious threat of\nunemployment for the pharmacists in a few years'\ntime.\n\n\n\nOn the other hand, there are insufficient numbers\nof pharmacists working in the public sector.\nUrgent measures must be worked out to rectify the\nsituation. The acute shortage of pharmacists in the\npublic sector may be overcome with the new\nentrants. The government's 118 hospitals, 772\nhealth clinics and 1992 rural clinics (Statistics\nDept. Bulletin-1999) certainly need to employ\nmany more pharmacists in order to render quality\nservices to the people.\n\n\n\nMPS needs to work hand-in-hand with the\nGovernment Planning Unit to map out a thorough\nmanpower projection for pharmacists and the\nsupporting staff over the next decade.\n\n\n\nThe pharmacy profession needs the greatest\nunderstanding of the medical profession and the\nconsumer groups in working out the most\nappropriate healthcare delivery system in the\ninterests of the people in this country. MPS has a\nvital role in leading pharmacists through this\ntransition period into a new type of pharmacy\npractice. This new kind of pharmacy profession\nenvisaged will be more fitting for a fast developing\ncountry like Malaysia. Vision 2020 will certainly\nbe incomplete if pharmacists fail to rise to the\noccasion in building a professional and caring\npharmacy practice for the nation.\n\n\n\n*****\nREFERENCES\n\n\n\n1. Kelayakan Farmasi Dari Institusi Pengajian\nTinggi. Malaysian Pharmaceutical Society.\nhttp://www.mps.org.my/html/universiti_yang_\ndiiktiraf.htm (5 Apr. 2001).\n\n\n\n2. Continuing education logbook for 1999. Pharm J\n1999;262:15.\n\n\n\n3. Society starts consultation on a new framework\nfor   professional   regulation.   Pharm  J    2000;\n\n\n\n264: 4000.\n4. Shaw JP, Drumm D. Prescription for registration:\n\n\n\nThe New Zealand pharmacy pre-registration\ntraining programme. Pharm J.1999;263:98-101.\n\n\n\n5. Caldwell J. NZ Society introduces practice\ncertificate based on competence. Pharm J\n2000;265:320.\n\n\n\n6. Latiff A. Traditional use, potential for\n\n\n\n\nhttp://www.mps.org.my/html/universiti_yang_\n\n\n\n\n\n\nGeneral article: Pharmacy practice in Malaysia\n\n\n\n9\n\n\n\nexploitation and conservation of medicinal plants\nin Malaysia. In: Proceedings of the Seminar on\nTraditional Herbs and Medicinal Plants in\nSarawak; 2000 Oct. 10; Kuching : Sarawak\nDevelopment Institute, 2000.\n\n\n\n7. Chai PPK. Global perspectives on the herbs and\nmedicinal plants industry. In: Proceedings of the\nSeminar  on  Traditional   Herbs   and   Medicinal\n\n\n\nPlants in Sarawak; 2000 Oct 10; Kuching:\nSarawak Development Institute, 2000.\n\n\n\n8. Ghazally I, Murtedza M, Laily BD. Chemical\nProspecting in the Malaysian forest 1st ed.\nMalaysia: Pelanduk Publications;1995.\n\n\n\n9. Malaysian Industry-Government Group for High\nTechnology. October 2000.\nhttp://www.might.org.my (5 Apr. 2001).\n\n\n\nFrom page 14\n\n\n\nContinuing Pharmacy Education question:\nStudy this case and give your response (100-200 words) based on the bioethical principles outlined in the\nCPE article on page 9. You may earn 2 CPE points if you submit a credible response to the MPS-CPE\nSecretariat at the Malaysian Pharmaceutical Society, P.O. Box 158, Jalan Sultan, 46710 Petaling Jaya,\nSelangor.\n\n\n\nAs a pharmacist at a regional transplant centre, you are in the team that allocates organs for transplantation.\nYour committee is at a deadlock as to which option to choose. The first is to allocate according to need (the\nsickest person gets the organ). The second option is to allocate according to an ordered pair. In the ordered\npair formula, people who have abused their bodies (a heavy smoker) will be considered only after others\nwho have not abused their bodies have received their transplants. The third proposal suggests that those\nwho have agreed to be organ donors (usually by a pledger card that they carry) should be put at the top of\nthe list. Your vote is key for the majority. Who will you vote for? Why?\n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy 2001;1:9-14 CPE Article\n\n\n\n10\n\n\n\nContinuing Pharmacy Education\n\n\n\nBioethics\nAbu Bakar Abdul Majeed\n\n\n\nContinuing Pharmacy Education Chairman, Malaysian Pharmaceutical Society, c/o Institut\nKefahaman Islam Malaysia, No 2, Langgak Tunku off Jalan Duta, 50480 Kuala Lumpur\n\n\n\nABSTRACT\n\n\n\nBioethics was originally proposed in the early 1970s to denote \u2018the incorporation of\nbiological knowledge and human values\u2019. It is becoming more relevant in the\nbiological age. This paper looks at some of the biological issues that require an\nethical input. These include the Human Genome Project, human cloning and\nassisted reproductive technologies, contraception and abortion, organ donation and\ntransplantation, euthanasia, brain death, human embryonic cells and AIDS.\nExamples of issues that have been raised in this area: Who owns our genes? Can we\n\u2018design\u2019 our babies? Should humans be cloned? Can pregnancy be terminated? Is\nmercy killing all right? Is brain death equivalent to death? Can embryonic cells be\nused in experiments? While some have been settled, others still persist till today.\nThe numerous ethical questions pertaining to biology beg serious efforts on the part\nof ethical theorists to dig deep into their established principles. Similarly those\nworking within applied ethics cannot operate effectively without referring to\ntheoretical ethics. Hence thus far, many of the bioethical issues have been tackled. It\nis proposed that as a member of the health team, pharmacists too need to be well\nversed in issues pertaining to bioethics.\n\n\n\nKeywords: ethics, biotechnology, cloning, euthanasia, brain death\n\n\n\nINTRODUCTION\n\n\n\nA new revolution in the making\n\n\n\nThe 20th century was an auspicious century indeed.\nIt showcased numerous achievements in science\nand technology. This is especially true of research\nin the field of biology and its related discipline,\nbiotechnology. It is not an exaggeration to state\nthat so soon after the information revolution of the\nlast few decades, the dawn of the 21st century\nmarks the start of yet another revolution, the\nbiological revolution.\n\n\n\nAlthough advances in the various fields of  biology\n\n\n\nhave thus far resulted in major achievements, they\nalso pose an inventory of real and potential\nhazards, as well as create new ethical conundrums.\nAccording to Lemkow (1993), an American study\non \u201cPublic Perceptions of Biotechnology\u201d reveals\nthat the public accepts science and technology in\ngeneral (1). However, attitudes to biological\nresearch indicate certain ambivalence. Sixty-six\npercent felt that genetic engineering would\nimprove life compared with 92 percent for solar\nenergy and 51 percent for nuclear energy.\n\n\n\n\n\n\n\n\nCPE Article: Bioethics\n\n\n\n11\n\n\n\nHowever, 42 percent of the respondents said that it\nwas \u201cmorally wrong\u201d to change the genetic\nmakeup of human cells.\n\n\n\nIn a similar European study, the main ethical\nissues in science and technology centre on human\ngenetics (1). Apprehension and anxiety were\nexpressed about the manipulation of human\ngenetic material even when diagnostic benefits\ncould be demonstrated. While therapeutic and\ndiagnostic applications found much support, there\nwas concern about the use of genetic information,\nsuch as the social pressure to have an abortion in\nthe face of negative prenatal diagnostic\ninformation, although this does not necessarily\nrequire genetic engineering techniques. Concern\nwas also expressed about the requirement of\ngenetic information at work in relation to the right\nto privacy.\n\n\n\nA TIME/CNN telephone poll of 1,1015 adult\nAmericans conducted in early 2001 on the issue of\nhuman cloning, found that 90 percent of\nrespondents thought that human cloning is a bad\nidea (2). The reasons for opposing cloning are:\nreligious belief (34 percent), interference of human\ndistinctiveness and individuality (22 percent), fear\nof it being used to breed a superior race (22\npercent) and that the technology is dangerous (14\npercent). Further, 93 percent of respondents would\nnot want to have themselves cloned if they had the\nchance to do it.\n\n\n\nThe aim of this article is to look at several\ncontemporary biological issues that beg an ethical\ninput and to consider bioethical principles thus far\napplied to cope with some of these issues.\n\n\n\nHuman Genome Project\n\n\n\nThe Human Genome Project is aimed at figuring\nout what protein each gene produces and for what\npurpose. This human encyclopaedia may be used\nto identify diseased genes and design methods to\nsubstitute them with healthy ones. Hopefully, this\ntype of disease prevention envisaged by\nproponents of gene therapy will be able to deal\nwith many debilitating disorders such as\nAlzheimer\u2019s Disease, Parkinson\u2019s Disease and\nHuntington\u2019s Disease, problems that have been\nattributed to genetic malfunctions.\n\n\n\nOther spin-offs from the Human Genome Project\ninclude the ability to predetermine the baby\u2019s\nattributes, grow new tissues and organs for\ntransplantations, slow aging body parts and\n\n\n\nprepare more effective vaccines. However all these\nprocedures are not about to happen soon. In fact,\nnot only do several technical posers appear to be\ndaunting, the moral implications of the project are\nequally mind-boggling. First and foremost is of\ncourse the question of ownership. Who owns our\ngenes?\n\n\n\nThus, scientists have begun to patent whichever\nsections of the genome that they can lay their\nhands on (3). Patenting proponents insist on the\nneed to have such protection to ensure returns on\ntheir investment. Naturally ethicists have different\nopinions. Were the early anatomists granted\nentitlements to the various bodily organs they\ndiscovered? Galen could have staked claims to\nsome of our veins and arteries. Ibn Sina too should\nhave been granted rights to certain parts of the\nbrain.\n\n\n\nThe other question is whether the benefits of\ngenetic science research like the Human Genome\nProject could be distributed to the world\u2019s\npopulation in a just manner. While some\nresearchers prefer the human genome data to be\nfreely available, others want a premium be put for\nusing it. Therefore those who have had no part in\nthe venture at all will have to wait and see if they\ncan afford to pay for the information on human\ngenes, should they need it for research and\ndevelopment.\n\n\n\nSimilarly, on the application side of this type of\nresearch, since gene therapy involves a high cost,\nonly the minority already well supplied with\nmedical goods and services will be able to afford\nit. This will only widen the existing differentials in\nhealth status between different social classes, and\nfurther broaden the North-South divide in terms of\naccessibility to modern medical treatment.\n\n\n\nGenetic engineering and eugenics\n\n\n\nGenetic engineering may help doctors develop\nways to correct or compensate for some genetic\ndefects, perhaps even during conception. This will\nsurely give rise to ethical questions. Although at\nthis stage we are talking about preventing or\nprotecting our children from genetic diseases,\nartificial improvement of other traits of the\ndeveloping embryo would surely be sought not too\nlong in the future. This opens a whole new\npossibility of designing babies. Many agree that\ngenetic engineering must not be adopted as a\nmeans for changing the human genetic\nconstitution, in what is called the improvement of\n\n\n\n\n\n\n\n\nCPE Article: Bioethics\n\n\n\n12\n\n\n\nthe human breed, or in genetically tampering with\nthe human personality or interfering in human\ncompetence or individual responsibility.\n\n\n\nCloning, assisted reproductive technologies and\nsurrogacy\n\n\n\nIn 1997, there was a focus on the success of an\nanimal cloning procedure using matured, rather\nthan the usual embryonic cells (4). As this\nexperiment involved a large mammal, the\npossibility of cloning a human becomes real\nindeed. The greatest motivation of cloning\nexperiments described above is in finding ways of\nproviding infertile couples with the opportunity to\nsecure an offspring. But is human cloning\ndesirable? Should parents be allowed to clone a\nchild they lost? Should they clone to have twins at\ndifferent times? Should cloning be allowed to\nproduce vital organs for use to help others?\n\n\n\nThe birth of the first \u2018test tube baby\u2019 in 1978 marked\nyet another milestone in the history of reproductive\ntechnologies. In vitro fertilization became well\naccepted as a relatively-risk-free technique and by\n1990, there were more than 25,000 \u2018test-tube babies\u2019\nin the world. Related to artificial reproductive\ntechnologies are the issues of sperm banks and\nsurrogate motherhood. There are men who are not\nable to produce viable sperms for fertilization to\nhappen. The wife in this case, probably would need\nto request sperms from donors. In order to facilitate\nthis procedure, sperm banks have been established as\na resource centre to provide sperms on demand.\nThen there are women who are physiologically\nunable to conceive and nourish foetuses. Conception\nof embryos prepared in laboratories will have to be\ndone in a third party\u2019s womb, thus the term surrogate\nmotherhood. Surrogacy is considered a legal\nprocedure in some developed countries. Artificial\nreproductive technologies, though implemented\npreviously, still attract public attention as moral\nquestions with regard to these procedures keep\ncropping up.\n\n\n\nContraception and abortion\n\n\n\nThese are two biological issues that simply refuse\nto go away. Contraception is vital for family\nplanning. Various types of contraception are\navailable, either natural or artificial, and ethical\nissues that are still being debated today pertain to\nthe suitability and permissibility of these methods.\nAbortion in particular generates moral questions of\nenormous magnitude. At what stage of the embryo\ndoes life begin? Does it start with the very first\n\n\n\nbeat of the developing heart? And when this\nhappens, how does one justify terminating the\npregnancy?\n\n\n\nOrgan donation and transplantation\n\n\n\nNumerous ethical questions have been raised\nregarding tissue and organ transplantation\nprocedures. They include whether human beings\nhave the right to give away a part of their body\nsuch as the kidney or a portion of their liver,\nwhether it is all right to harvest body parts of a\ncadaver, and how available parts are assigned to\nthose who are in need of them. Although these\nissues may appear to be rather straightforward in\nsome of today\u2019s societies, there are still those who\nare unsure of how to deal with them.\n\n\n\nThen there is always the question of\nxenotransplantation, or transplantation using parts\nfrom animals. There may well be a lot of\nreservations among certain communities around\nthe world regarding the suitability and\npermissibility of this method. In any case, there are\ncontemporary ethical issues regarding \u201coffspring\ndonor\u201d where for reasons of genetic compatibility,\na couple decides to conceive a second child in the\nhope that he or she would become a donor for the\nfirst child who is in need of certain bodily parts,\nfor example, the bone marrow. And with the\ncoming of therapeutic cloning and new procedures\nlike organogenesis (where specific organs rather\nthan a whole human may be grown from\nembryonic stem cells), tougher ethical issues are\nbound to crop up.\n\n\n\nEuthanasia\n\n\n\nEuthanasia or mercy killing may be active or\npassive. Active euthanasia means patients are\ndeliberately killed, for example by injecting an\noverdose of sedatives. Active euthanasia is\nnormally voluntary, where a patient with a rational\nframe of mind requests and is granted death.\nPassive euthanasia happens when a patient is\ndeliberately allowed to die from whatever illness\nhe is suffering from, by refusing to perform\nsurgery, initiate heart resuscitation procedure, or\nadminister medication. Passive euthanasia may be\nvoluntary, when the patient consents to it, or non-\nvoluntary, when he does not express the desire to\ndie.\n\n\n\nEuthanasia has always been a prime issue in the\ndebate on the right to die. It, however, is legally\npermitted in at least one western nation, that is,\n\n\n\n\n\n\n\n\nCPE Article: Bioethics\n\n\n\n13\n\n\n\nHolland. In 1973, the Royal Dutch Medical\nAssociation approved guidelines for physician-\nassisted suicide (PAS), a form of euthanasia. These\nguidelines are: euthanasia must be done by a\nphysician; a second physician must concur with\nthe decision; death must be requested by the\npatient while competent; the request must be free\nof doubt, well-documented and repeated; the\nrequest must not have been coerced; the patient\u2019s\ncondition must be intolerable; and that, there must\nbe no way to improve the patient\u2019s lot.\n\n\n\nThe American Medical Association takes a very\ndifferent approach on PAS. Although active\neuthanasia is forbidden, passive euthanasia appears\nto be allowed. The practice of allowing patients to\ndie by not treating them, endorsed by thinkers as\nearly as Socrates, is an inescapable part of modern\nmedicine. Today more than 80% of people die in\nhospitals, and advances in medical technology\nhave made it possible to keep almost anyone alive\nindefinitely, even after they have no thought or\nfeeling or hope of recovery. The maintenance of\nlife by artificial means in such cases is deemed\npointless, as the hospitals would quickly be filled\nwith living corpses, leaving more deserving\npatients no beds. Thus, many would agree that it is\nethically acceptable to cease treatment and let such\npatients die (5).\n\n\n\nBrain death\n\n\n\nThe traditional criteria for determining death, until\nrecently, was the permanent cessation of heart and\nlung function. When a person stopped breathing\nand the heart stopped beating for more than a few\nminutes, that person was declared dead. The loss\nof oxygen to the brain would almost instantly\nproduce irreversible brain damage and loss of all\ncognitive function (6).\n\n\n\nHowever, the introduction of new medical\ntechnology, and most importantly of respirators,\nhas enabled modern medicine to continue\nartificially maintaining patients\u2019 heart and lung\nfunction. This can often save lives that previously\nwould have been lost. Sometimes, it may even\npermit the patient to recover a normal level of\nfunction.\n\n\n\nIn other cases, however, heart and lung function\ncan be restored or continued by these artificial\nmeans after brain function has been partially or\ncompletely destroyed, for example, from\nprolonged loss of oxygen or severe trauma of the\nbrain. Such possibilities have forced a rethinking\n\n\n\nof the traditional criteria for the determination of\ndeath. There is now an additional criterion for\ndeath, that is, the complete and irreversible loss of\nall brain function, or so-called brain death. The\nconcept of \u2018brain death\u2019 was first proposed in 1959\nby a team of French doctors. The criteria adopted\nfor brain death were coma, cessation of breathing,\nthe absence of brainstem and tendon reflexes, and\nthe absence of electroencephalographic (EEG)\nwaves. If these conditions persisted in the patient\nfor more than 24 hours, then he or she would be\npronounced dead, and the ventilator switched off,\neven though the heart might still be beating.\n\n\n\nFurther discussions led to the announcement at the\n22nd World Medical Assembly in Sydney in 1968,\nwhich in a nutshell stated that death had occurred\nif there were no means of saving the patient,\nregardless of whether some of his organs were still\nfunctioning. In the same year, the \u2018Harvard criteria\nto determine death\u2019 was introduced. In addition to\nthe original French criteria, the Harvard criteria\nstipulates that there must also be an absence of\npupil and spinal reflexes, no movement of the\npatient for an hour, and that breathing should cease\nthree minutes after switching off the ventilator (7).\n\n\n\nHuman embryonic cells\n\n\n\nMost recently in several countries, scientists and\npolicy-makers are revisiting the issue on the use of\nhuman stem cells and embryos for research. Stem\ncells have the capability of developing into any\ntype of tissue, as well as growing into human\nbeings. Thus, in the United States, current laws\nforbid the use of public funds to obtain stem cells\nfrom human embryos (8). In Germany, a human\nembryo is protected under the law from the\nfertilization to the implantation stage. Any\nresearch on or with human embryos is prohibited\nunless the embryo can be ascertained of an\nimmediate and direct benefit to it (9). But efforts\nare underway to reverse this situation (10). For\nexample, the American National Institute of Health\n(NIH) recently issued guidelines on funding of\nmedical research that makes use of human\nembryos (11). Similarly the British government\nhas allowed cloning of stem cells for scientific\nstudy of transplants. This study would help bolster\nthe prospect of therapeutic cloning that could\ndevelop new treatments for diseases such as\nAlzheimer\u2019s Disease and Parkinson\u2019s Disease.\n\n\n\nAcquired Immunodeficiency Syndrome (AIDS)\n\n\n\nThe human immunodeficiency virus (HIV) that\n\n\n\n\n\n\n\n\nCPE Article: Bioethics\n\n\n\n14\n\n\n\ncauses AIDS continues to be a major threat to the\nhealth of millions of people worldwide. Sadly\nthough, there is little sign that the disease is\nabating. Today it has been established that apart\nfrom the sharing of infected needles and blood\ntransfusion, indiscriminate sexual practices are the\nmain modes of HIV transmission. In view of the\ngravity of the situation, whatever means that can\nhelp to wipe out the scourge are strongly\nrecommended, regardless of whether they are of\npreventive, curative or palliative in nature.\n\n\n\nPrevention must be the primary strategy adopted to\nminimize the risk of HIV transmission. However,\nin relation to the compulsory HIV antigen or\nantibody screening that has been proposed for\nmembers of the high-risk groups, many ethical\nissues have to be surmounted. Is it morally correct\nto simply focus on the high-risk HIV-carriers, such\nas drug addicts, prostitutes, transsexuals and\nconvicts? In order to avoid transfusion of\ncontaminated blood, should donors, rather than the\nblood per se, be tested for HIV antibody or\nantigen? Should compulsory screening be imposed\non brides and bridegrooms to ensure that they are\nfree from HIV, thus preventing them from passing\non the virus to their potential spouses or later even\nto their offspring? These are no doubt difficult and\nchallenging questions. They must be dealt with\nextreme care and heartfelt concern for the parties\ninvolved. When it comes to ethics, there is always\nthe dilemma of choosing between the interests of\nthe community and those of the individual.\n\n\n\nEthics\n\n\n\nLet\u2019s turn now to the issue of ethics and how\nhumans have developed a system to tackle it.\nBertrand Russel elegantly describes ethics as \u201cin\norigin the art of recommending to others the\nsacrifices required for cooperation with oneself\u201d.\nEthics, or the study of morality, makes up one of\nthe four main divisions of philosophy. Here it is\nfurther subdivided into categories of meta-ethics or\ntheoretical ethics, that is the study of meanings of\nethical terms and the forms of ethical argument;\ndescriptive ethics, that deals with the study of\nmoral and ethical beliefs and customs of different\ncultures; normative ethics, which is the study of\nethical principles that have been accepted as norms\nor right behaviour; and applied ethics, that relates\nto the application of moral standards used in\ndecision-making to concrete rather than abstract\nconditions (12).\n\n\n\nThe various ethical questions pertaining to\n\n\n\nbiological sciences in the contemporary world are\nclear indications that the time has come when\nethical theorists can no longer ignore the problems\nof application. Similarly, those working within\napplied ethics can no longer operate effectively\nwithout taking theoretical considerations into\naccount. This is especially true where principles\nand codes appear to make conflicting claims on the\ncondition or situation under examination. When\nsuch conflicting claims occur it is referred to as an\nethical dilemma. When this occurs, we will have to\nresort to ethical reasoning that is, the process of\nanalysis in determining what is right or wrong, and\nwhat is the correct or more responsible choice in a\ngiven situation. It is also an examination of our\nmoral judgements, and an attempt to determine the\ngrounds on which these judgements are based.\n\n\n\nThe literature is filled with the various\nclassifications of ethical theories. For example,\nthey can be classified as, one, principle-based\ntheories (normative ethics), and two, virtue-based\ntheories (12). Principle-based theories are of either\nthe deontological or consequentialist\n(utilitarianism) types. The former relates to the\ntheory of obligation or duties, or rules and rights,\nwhile the latter links the rightness of an act to the\ngoodness of the state of affairs it brings about.\nJudgements made may be general or specific. They\nare all normative, they affirm or apply norms or\nstandards to making decisions. They must be\nuniversal, applicable to all relevant cases, impartial\nand objective. The procedure to implement\nprinciple-based ethical theory are, (i) identify\nethical principles, and (ii) evaluate ethical choices\nin terms of how well they fit with those principles.\n\n\n\nVirtue-based theories include communitarinism\nthat applies the Aristotelian approach where\npractical wisdom is employed in the reasoning\nprocess, the focus is on the uniqueness of each\nethical situation, and is based on shared\ncommunity values. It also includes relationalism\nthat emphasizes the values of love, family and\nfriendship inherent to the situation at hand. The\nprocedure to do this is by identifying the ethically\nvirtuous person, and evaluating ethical choices in\nterms of how well they exemplify the deliberations\nof the ethically virtuous person. This theory is very\nmuch situation-based.\n\n\n\nBioethics\n\n\n\nBioethics can be defined as the study of the\nrightness and wrongness of acts performed within\nthe life sciences, through the application of both\n\n\n\n\n\n\n\n\nCPE Article: Bioethics\n\n\n\n15\n\n\n\nethical theory and casuistry (case-study method) to\nthe complexity of development in the biological\nsciences. The bioethics practiced today mostly\nderives its rulings from the normative and\nsituational ethical principles. The word \u2018bioethics\u2019\nwas first coined by the oncologist Professor Van\nRensselaer Potter II in 1970 in an article entitled\n\u201cBioethics: The Science of Survival\u201d (13). After\ndoing much work in the field of cancer research\nwhere he managed to establish links between\ncertain types of cancer and environmental\npollutants, Potter argued that a science of survival\nmust be more than science alone. It should\nincorporate two ingredients, namely, biological\nknowledge and human values. Later, Potter (1975)\nrefined the definition of bioethics as a product of\ncross-fertilization between the two branches,\n\u201cmedical bioethics\u201d and \u201cecological\nbioethics\u201d(14). However, medical practitioners did\nnot generally accept these concepts. They\npreferred to redefine bioethics to mean clinical\nethics.\n\n\n\nAnd thus, from then on bioethics conjured a much\nnarrower meaning than its original scope and\nbreadth. And it is in this context that many of the\nrecent and contemporary discussions on issues\nrelated to health, life and death are being looked at.\nThis was particularly true during the era of\nheightened debates on reproductive sciences like\ncontraception and abortion in the 1950s and 1960s.\nAt  the  time,  the  founder-director of the Kennedy\n\n\n\nCenter of Ethics at Georgetown University,\nProfessor Andr\u00e9 Hellegers seized the opportunity\nto turn bioethics into an academic discipline that\nreflected the needs of the time. This was rather\neasily acceptable as bioethics can readily be\nidentified with the established field of medical\nethics. In essence medical ethics began with the\nadvent of medicine itself, that is, the \u2018Hippocrates\nOath\u2019. And then there was the anti-vivesectionist\nmovement (15) that was already influential in the\n19th century that helped to keep researchers who\nuse animals as subjects for experiments, on their\ntoes.\n\n\n\nCONCLUSION\n\n\n\nToday, bioethics is a full-fledged subject matter\nwith a number of international professional\nsocieties, and courses offered in universities\nthroughout the world. It will become even more\nimportant in the future. As a member of the\nprofessional healthcare team, pharmacists too need\nto be aware of the controversial issues pertaining\nto medical practice and how to deal with them.\nOne way in which this can be done is to refer to\nlong-established ethical guidelines. With this,\npharmacists can play an important role in\nalleviating patients\u2019 and their relatives\u2019 anxiety, as\nwell as clear their conscience on morally-\nchallenging issues.\n\n\n\nSee page 8 for the CPE question\n\n\n\n*****\nREFERENCES\n\n\n\n1. Lemkow L. Public attitudes to genetic engineering:\nSome European perspectives. Luxembourg: Office\nof Official Publications of the European\nCommunities; 1993.\n\n\n\n2. TIME/CNN Poll. TIME 2001 Feb. 26. p. 45.\n3. Thiele. Moral problems in the patenting of human\n\n\n\ngenes. Europ\u00e4ische Akadamie Newsletter 2000; 21:\n1-3.\n\n\n\n4. Campbell KHS, McWhir J, Ritchie WA, Wilmut I.\nSheep cloned by nuclear transfer from a cultured\ncell line. Nature 1997; 385:810-813.\n\n\n\n5. Beauchamp TL. Suicide. In: Regan T, editor.\nMatters of Life and Death. USA:McGraw-Hill Inc.\n\n\n\n6. Brock DW. Life and Death - philosophical essays\nin biomedical ethics. Cambridge: Cambridge\nUniversity Press; 1993.\n\n\n\n7. Jusoh MR. Mati otak - Perspektif doktor Islam\n(Brain-death - A Muslim Doctor\u2019s perspective). In:\nIbrahim I, editor. Islam dan Pemindahan Organ\n(Islam and organ transplantation). Kuala Lumpur:\n\n\n\nInstitute of Islamic Understanding Malaysia\n(IKIM); 1998.\n\n\n\n8. Shapiro HT. Ethical dilemmas and stem cell\nresearch. Science 1999;285:2065.\n\n\n\n9. Kaiser J. Stem cells as potential nerve therapy.\nScience 1999; 285:649-650.\n\n\n\n10. Abbot A. German researchers seek legal backing\nfor stem cell work. Nature 2000;404: 424.\n\n\n\n11. Zitner A. Embryo stem cell work could get public\nfunding, Los Angeles Times; 2000 Aug. 13.\n\n\n\n12. Beach R. The responsible conduct of research.\nWeinheim:VCH; 1996.\n\n\n\n13. Potter VR. Bioethics: the science of survival.\nPerspectives in Biology and Medicine 1970;14:127-\n153.\n\n\n\n14. Potter VR. Global Bioethics: Building on the\nLeopold Legacy. East Lansing:Michigan State\nUniversity Press; 1988.\n\n\n\n15. Koenig R. European researchers grapple with\nanimal rights. Science 1999;284:1604-1606.\n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy 2001;1:15-21 Research Article\n\n\n\n16\n\n\n\nCareer Choice of Malaysian Pharmacy\nStudents: A Preliminary Analysis\nAb Fatah Ab Rahman1, Mohamed Izham Mohamed Ibrahim1*, Zuraidah Mohd\nYusoff1, Mohd Baidi Bahari1 & Rusli Ismail2\n\n\n\n1School of Pharmaceutical Sciences, 11800 Universiti Sains Malaysia, Penang, Malaysia.\n2Department of Pharmacology, School of Medical Sciences, Universiti Sains Malaysia, 16150\nKelantan, Malaysia.\n\n\n\n*Author for correspondence\n\n\n\nABSTRACT\n\n\n\nA cross-sectional study was conducted among pharmacy students to determine\nfactors influencing their choice of work place and to evaluate whether a one-year\nhospital pre-registration training programme had any effect on these choices.\nQuestionnaires were distributed to graduating students at the School of\nPharmaceutical Sciences, Universiti Sains Malaysia.  The questionnaires were again\nsent to the same group of students by post at the end of their pre-registration\ntraining year. The response rate during the follow-up stage was 46%.  Results\nindicated that students in the survey were more interested in independent and chain\ncommunity pharmacies compared to other practice settings.  Students\u2019 choices of\nfirst place of practice appeared to be influenced by both intrinsic and extrinsic job\nfactors.  Our findings did not show major changes in students\u2019 preferences for\npractice sites before and after the hospital pre-registration period.  This information\nis expected to be useful for pharmacy employers.\n\n\n\nKey words: pharmacy, career choice, job factor, workplace, Malaysia\n\n\n\nINTRODUCTION\n\n\n\nChanges within the pharmacy profession over the\npast 15 \u2013 20 years have been inspiring. Pharmacy\nis expected to continue to be an exciting and\ninnovative field in the coming new systems of\nhealth care. It will provide new roles and\nopportunities for pharmacists to serve the health\ncare needs of the society. Therefore, future\npharmacists need to make wise decisions regarding\neducational and professional preparedness,\nkeeping in mind the mobility and flexibility of\ncareer positions.\n\n\n\nUntil 1995, there was only one pharmacy school in\n\n\n\nMalaysia. Pharmacy students at Universiti Sains\nMalaysia (USM) undergo a 4-year academic\nprogramme towards a Bachelor of Pharmacy\ndegree. The curriculum for the first three years\nconsists of basic pharmaceutical science subjects\nunder the general categories of pharmaceutical\nchemistry, pharmaceutical technology, physiology\nand pharmacology. Students are exposed to\nclinical pharmacy curriculum during their fourth\nacademic year (1). They  spend an average of 20\nhours per week at a university hospital for their\nclinical attachments. They rotate through various\nclinical pharmacy services, medical and surgical-\n\n\n\n\n\n\n\n\nResearch article: Career choice of Malaysian pharmacy students\n\n\n\nbased attachments, including attachments at\nvarious community pharmacy outlets. After\ngraduating, they undergo a one-year training\nprogramme at a recognized pharmacy institution\nbefore they are registered with the Malaysian\nPharmacy Board.  This training is also known as\npre-registration training, similar to that practised in\nthe United Kingdom.\n\n\n\nAs a preliminary study, we decided to evaluate\npharmacy students\u2019 choices of practice sites upon\ngraduation and the factors influencing these\nchoices. Since this coincided with the compulsory\none-year pre-registration training programme, we\nwere also interested to see whether this training\nhad any influence on the students\u2019 choices. We\nbelieve that this information will be useful to\npotential employers when recruiting newly\nregistered pharmacists.\n\n\n\nMETHODS\n\n\n\nSurvey questionnaires were distributed to 71\ngraduating pharmacy students at USM after their\nfinal examinations. The questionnaires asked for\ndemographic data, preference of practice sites,\nprevious experience or work, and whether any of\ntheir immediate family members were health\nprofessionals. Students were also asked to rate the\nimportance of identified factors (2), which they\nthought would affect their preference of practice\nsites. These were rated on the Likert scale of 1 to 5\n(1 =  extremely   important,   5  =  extremely\nunimportant). These questionnaires were designed\n\n\n\nin the national language (i.e., Malay). To\ndetermine its clarity, the questionnaire was pre-\ntested on hospital pharmacists and Master of\nClinical Pharmacy students at the university.  For\nsome questions, students were allowed to check\nmore than one answer. Towards the end of the one-\nyear pre-registration training, another\nquestionnaire was mailed to the same batch of\nstudents to their respective home addresses.\n\n\n\nData were analysed using the Statistical Package\nfor Social Sciences (SPSS) Version 7.5 (SPSS Inc.,\nIll).  Descriptive data are presented as percentages.\nDiscrete data were analysed by chi-square or\nFisher\u2019s Exact tests. Significance level chosen for\nstatistical testing was 0.05.\n\n\n\nRESULTS\n\n\n\nAll 71 final year students (100%) took part in the\nfirst evaluation (before pre-registration). Thirty-\nthree responded after pre-registration training\ngiving a response rate of 46%. All students\nunderwent a one-year period of pre-registration\ntraining at government hospitals.\n\n\n\nDemographic data\n\n\n\nThe mean age of students at the time of graduation\nwas 24.3 years old and nearly two-thirds were\nfemales. Malay students constituted approximately\nhalf of the graduating class. The number of\nrespondents before and after pre-registration\ntraining based on gender and race were not\nstatistically significant (Table 1).\n\n\nTable 1.  Demographic data of students who responded to both surveys.\n\n\n\nBefore pre-registration\n(n=71)\n\n\n\nAfter pre-registration\n(n=33)\n\n\n\nChi-Square Test/Fisher\u2019s\nExact Test\n\n\n\nGender\n   Male\n   Female\n\n\n\n24 (34%)\n46 (65%)\n\n\n\n12 (36%)\n19 (58%)\n\n\n\nP=0.661 (NS)\n\n\n\nRace\n   Malay\n   Chinese\n   Indian\n   Other\n\n\n\n37 (52%)\n23 (32%)\n7 (10%)\n2 (3%)\n\n\n\n15 (45%)\n12 (36%)\n2 (6%)\n2 (6%)\n\n\n\nP=0.839 (NS)\n\n\n\nNote:  The total percentages are not equal to 100 due to missing values\n           NS=not significant\n\n\n17\n\n\n\n\n\n\n\n\nResearch article: Career choice of Malaysian pharmacy students\n\n\n\nMajority of students did not have a family member\n(defined as parents or siblings) as a health\nprofessional.  Five however, had a pharmacist,\nthree had doctors, one had a dentist, four had\nnurses, one had a pharmacy technician and one had\na medical assistant among their family members.\n\n\n\nRelationship between gender and race with\ndesired place of work\n\n\n\nThe most common preferred place of work in\ndecreasing order was, independent community\npharmacy, chain community pharmacy,\ngovernment hospital, private hospital, and\npharmaceutical industry (Table 2).\n\n\n\nWhen grouped according to three major places of\nwork (i.e. hospital pharmacy, community\npharmacy, industry), over 60% of female students\nplanned on going into community pharmacy, and\njust under 30% planned on pursuing hospital work.\nAmong male students, about 50% preferred\ncommunity pharmacy, and about 30% planned to\nenter hospital pharmacy practice. The differences\nbetween gender preferences were not statistically\nsignificant (p>0.05).\n\n\n\n Community pharmacy was the first choice among\n87% Chinese students and 58.3% of the Malay\nstudents (Table 3).  On the other hand, about 36%\nof the Malay students chose hospital pharmacy as\ncompared to about 4 % of the Chinese students.\nIndian students were relatively equally divided in\ntheir choice of desired places of work. The\ndifferences between races in terms of their desired\nplaces of work were not statistically significant\n(p>0.05).\n\n\n\nRelationships between previous working\nexperiences with the desired place of work\n\n\n\nTable 4 shows that 60.6% students had experience\nworking at pharmacies or drug stores; 43.7% at\nhospital pharmacies and 5.6% at pharmaceutical\nindustries. When results for independent and chain\ncommunity pharmacies were combined to give an\noverall picture of the choice for community\npharmacy practice, a total of 43 students (61%)\npreferred to work at this site. Of these, 29 (67%)\nhad worked at a pharmacy or drug store\npreviously, 20 (46%) at a hospital pharmacy, and 2\n(5%) in the pharmaceutical industry.\n\n\nTable 2.  Relationship between gender and desired place of work (first survey).\n\n\n\nMale\nN (%)\n\n\n\nFemale\nN (%)\n\n\n\nTotal\nN (%)\n\n\n\nFisher\u2019s Exact Test\n\n\n\nGovernment hospital 1 (4.3) 11 (23.9) 12 (17.4) 0.06 (NS)\n\n\n\nPrivate hospital 6 (26.1) 2 (4.3) 8 (11.6)\n\n\n\nIndependent community\npharmacy\n\n\n\n7 (30.4) 17 (37.0) 24 (34.8)\n\n\n\nChain community\npharmacy\n\n\n\n5 (21.7) 14 (30.4) 19 (27.5)\n\n\n\nPharmaceutical industry 2 (8.7) 2 (4.3) 4 (5.8)\n\n\n\nPostgraduate studies 1 (4.3) 0 1 (1.4)\n\n\n\nOthers 1 (4.3) 0 1 (1.4)\n\n\n\nTotal 23 (100) 46 (100) 69 (100)\n\n\n\nNote: The total number of students are not equal to 71 due to missing values.\nThe percentages are based on the number of students responded on the items\nNS=not significant\n\n\n18\n\n\n\n\n\n\n\n\nResearch article: Career choice of Malaysian pharmacy students\n\n\nTable 3.  Relationship between race and desired place of work (first survey).\n\n\n\nMalay\nN (%)\n\n\n\nChinese\nN (%)\n\n\n\nIndian\nN (%)\n\n\n\nOther\nN (%)\n\n\n\nTotal\nN (%)\n\n\n\nFisher\u2019s\nExact Test\n\n\n\nGovernment hospital 9 (25.0) 1 (4.3) 1 (14.3) 1 (33.3) 12 (17.4) 0.06 (NS)\n\n\n\nPrivate hospital 4 (11.1) 0 (0) 2 (28.6) 2 (66.6) 8 (11.6)\n\n\n\nIndependent community\npharmacy\n\n\n\n11 (30.5) 12 (52.2) 1 (14.3) 0 24 (34.8)\n\n\n\nChain community\npharmacy\n\n\n\n10 (27.8) 8 (34.8) 1 (14.3) 0 19 (27.5)\n\n\n\nPharmaceutical industry 2 (5.6) 1 (4.3) 1 (14.3) 0 4 (5.8)\n\n\n\nPostgraduate studies 0 0 1 (14.3) 0 1 (1.4)\n\n\n\nOther 0 1 (4.3) 0 0 1 (1.4)\n\n\n\nTotal 36 (100) 23 (100) 7 (100) 3 (100) 69 (100)\n\n\n\nNote: The total number of students are not equal to 71 due to missing values\nThe percentages are based on the number of students responded on the items\n NS=not significant\n\n\n19\n\n\n\nTable 4.  Relationship between previous working experiences with the desired place of work (first\nsurvey).\n\n\n\nDesired place of workaPrevious\nworking\n\n\n\nexperience\nb\n\n\n\nGovernment\nhospital\n\n\n\nN (%)\n\n\n\nPrivate\nhospital\n\n\n\nN (%)\n\n\n\nIndependent\ncommunity\npharmacy\nN (%)\n\n\n\nChain\ncommunity\npharmacy\nN (%)\n\n\n\nPharmaceu\n-tical\nindustry\nN (%)\n\n\n\nPost\ngraduate\nstudies\nN (%)\n\n\n\nOther\n\n\n\nN(%)\n\n\n\nTotal\n\n\n\nN(%)\nPharmacy/\ndrug store\n     Yes\n      No\n\n\n\n7 (16.3)\n6 (21.4)\n\n\n\n6 (14.0)\n3 (10.7)\n\n\n\n16 (37.2)\n8 (28.6)\n\n\n\n13 (30.2)\n6 (21.4)\n\n\n\n1 (2.3)\n3 (10.7)\n\n\n\n0\n13 (3.6)\n\n\n\n0\n1 (3.6)\n\n\n\n43 (100)\n28 (100)\n\n\n\nHospital\npharmacy\n     Yes\n     No\n\n\n\n4 (12.9)\n9 (22.5)\n\n\n\n5 (16.1)\n4 (10.0)\n\n\n\n8 (25.8)\n16 (40.0)\n\n\n\n12 (38.7)\n7 (17.5)\n\n\n\n2 (6.5)\n2 (5.0)\n\n\n\n0\n1 (0.03)\n\n\n\n0\n1 (0.03)\n\n\n\n31 (100)\n40 (100)\n\n\n\nPharmaceu-\ntical\nindustry\n     Yes\n     No\n\n\n\n1 (25.0)\n12 (17.9)\n\n\n\n1 (25.0)\n8 (11.9)\n\n\n\n1 (25.0)\n23 (34.3)\n\n\n\n1 (25.0)\n18 (26.9)\n\n\n\n0\n4 (6.0)\n\n\n\n0\n1 (1.5)\n\n\n\n0\n1 (1.5)\n\n\n\n4 (100)\n67 (100)\n\n\n\na\n only one practice choice was allowed\n\n\n\nb\n each student may choose more than one answer\n\n\n\n\n\n\n\n\nResearch article: Career choice of Malaysian pharmacy students\n\n\n\nSimilarly, when results for government and private\nhospitals were combined as hospital pharmacy\npractice, a total of 22 students (31%) preferred to\nwork at this site. Of these, 13 (59%) had\npreviously worked at pharmacies or drug-stores, 9\n(41%) at hospital pharmacies and 2 (9%) at\nindustry-based pharmacies.\n\n\n\nThus, the majority of those who preferred\ncommunity pharmacy had previous experience at\npharmacies or drug-stores. On the other hand,\namong those who preferred hospital pharmacy as\ntheir future place of work, only 41% had previous\nexperience with hospital work.\n\n\n\nOf the four  students who preferred industry-based\npharmacies, one had worked at a pharmacy or a\ndrug-store and two at hospital pharmacies. None\nworked at industry-based pharmacies before.\n\n\n\nDesired place of work/practice before and after\npre-registration training\n\n\n\nTable 5 demonstrates the students\u2019 desired places\nof work before and after pre-registration training.\nThe majority showed interest in community\npharmacy (i.e., independent and chain) both before\nand after the training (61% and 57%, respectively).\nThe percentages of students who chose hospital\nsetting (combined both government and private\nsettings) before and after pre-registration period\nwere 31% and 24%, respectively. Only a small\npercentage chose pharmaceutical industry. Overall,\nthe results did not show major changes in students\u2019\n\n\n\npreferences for practice sites before and after the\npre-registration training. However, overall results\nshowed a drop in percentages for most practice\nsites.\n\n\n\nFactors affecting practice choices\n\n\n\nThe top ten factors that students believed affected\ntheir choices of future practice sites before pre-\nregistration training were desire for a satisfying\nand self-fulfilling position, job security,\nopportunity for advancement, salary, sense of\naccomplishment, opportunity to use one\u2019s abilities\nand education, opportunity to serve the\ncommunity, geographic location, nature of work\nand employer\u2019s policies (Table 6).  Except for\nemployer\u2019s policies, these remained in the top ten\ncategories of factors even after the pre-registration\ntraining period. None of the changes in ratings\nwhich occurred after the pre-registration period\nwere statistically significant.\n\n\n\nDISCUSSION\n\n\n\nThere was not much difference between the\nproportion of female and male students in our\nstudent population as compared to recent\nenrollments in the US schools of pharmacy (3).\nThe majority of our students did not have any\nfamily member working as a health professional.\n\n\n\nParents might exert significant influence on\nstudents\u2019 decision to choose pharmacy as a career\n\n\nTable 5.  Respondents desired place of work before and after pre-registration training\n\n\n\nDesired place of work Before pre-registration\n(n=71)\n\n\n\nAfter pre-registration\n(n=33)\n\n\n\nIndependent community Pharmacy 24 (34%) 7 (21%)\n\n\n\nChain community Pharmacy 19 (27%) 12 (36%)\n\n\n\nGovernment hospital 13 (18%) 4 (12%)\n\n\n\nPrivate hospital 9 (13%) 4 (12%)\n\n\n\nPharmaceutical industry 4 (6%) 1 (3%)\n\n\n\nPostgraduate studies 1 (1%) 1 (3%)\n\n\n\nOthers 1 (1%) 3 (9%)\n\n\n\nNote:  The total percentages are not equal to 100 due to missing values\n\n\n20\n\n\n\n\n\n\n\n\nResearch article: Career choice of Malaysian pharmacy students\n\n\n\n(\na\nin\np\n\n\n\nI\nh\nc\np\nr\np\nf\nh\nH\n5\ng\nT\ny\n(\n\n\n\nS\np\nO\nto\nin\nin\nd\n\n\nTable 6.  Top ten rating of respondents\u2019 perception of factors affecting choice of future workplace\n\n\n\nFactors\nBefore pre-registration\nmean (SD)\n\n\n\nAfter pre-\nregistration\nmean (SD)\n\n\n\nStudent\u2019s\nt-test\n\n\n\n1 Desire for a satisfying and self-\nfulfilling position\n\n\n\n1.6 (0.6) 1.7 (0.9) NSa\n\n\n\n2 Job security 1.6 (0.8) 1.9 (1.0) NSa\n\n\n\n3 Opportunity for advancement 1.6 (0.7) 1.6 (0.9) NSa\n\n\n\n4 Salary 1.7 (0.7) 1.8 (0.7) NSa\n\n\n\n5 Sense of accomplishment 1.8 (0.8) 1.7 (0.7) NSa\n\n\n\n6 Opportunity to use one\u2019s abilities\nand education\n\n\n\n1.8 (0.8) 1.5 (0.8) NSa\n\n\n\n7 Opportunity to serve community 1.8 (0.7) 1.8 (0.7) NSa\n\n\n\n8 Geographic location 1.8 (0.8) 1.8 (0.8) NSa\n\n\n\n9 Nature of work 1.9 (0.8) 1.8 (0.8) NSa\n\n\n\n10 Employer\u2019s policies 1.9 (0.8) 2.1 (0.9) NSa\n\n\n\na  All comparisons were not significantly different at alpha level of 0.05\n\n\n21\n\n\n\n4), but our results showed that this factor was not\nmong the ten most important factors (Table 6) in\nfluencing their choice of field work as a\n\n\n\nharmacist.\n\n\n\nt is interesting to see that government and private\nospital practices were less favoured by students\nompared to independent or chain community\nharmacies. These choices were similar to those\neported by others (2,4). The findings may\nartially explain the consistently low  \u201cfilling rate\u201d\nor the positions of pharmacist in government\nospitals. In 1995, the Malaysian Ministry of\nealth (MOH) annual report showed that of the\n70 positions for staff pharmacists available at\novernment hospitals, only 341 were filled (5).\nhis trend has been consistent for the last few\nears where the \u201cfilling rate\u201d was only around 60%\n6,7).\n\n\n\ntudies on gender difference in preference for\nractice sites have shown conflicting results (4,8).\nur results showed that only about one-third of the\ntal number of female students would like to go\nto hospital pharmacy practice. However,\ntended  and  actual practice settings tend to\n\n\n\niffer.   In   fact,  among   pharmacy   practitioners,\n\n\n\ninvestigators have shown a growing trend of\nsimilarity in gender distributions of practice\nsettings (9, 10).  It is interesting to see from our\nfindings that community pharmacy practice\nseemed to be more favourable among Chinese\nstudents whereas hospital pharmacy practice\nseemed to be more favourable among Malay\nstudents. This tendency for a difference in racial\npreference of practice sites needs to be further\nexplored.\n\n\n\nApproximately half of our students had previous\nexperiences either at hospital pharmacies,\ncommunity pharmacies or drug stores.  Previous\nexperience at a hospital pharmacy did not have\nmuch effect on students\u2019 preference to practise at\nhospitals (29%).  On the other hand, previous\nexperience at a pharmacy or drug-store might have\ninfluenced many students (67%) on their\npreference to practise at a community pharmacy.\nIn general, regardless of whether students had\nprevious working experience or not, the\ncommunity pharmacy setting was the most desired\nplace of work.\n\n\n\nFactors known as intrinsic factors are associated\nwith good feelings about a job, and that bad\n\n\n\n\n\n\n\n\nResearch article: Career choice of Malaysian pharmacy students\n\n\n\n22\n\n\n\nfeelings are associated with extrinsic factors.\nIntrinsic factors include the nature of work, desire\nfor a satisfying and self-fulfilling position,\nopportunity for advancement, sense of\naccomplishment, opportunity to use one\u2019s abilities\nand education, and opportunity to serve the\ncommunity.  Extrinsic factors include job security,\nsalary, geographic location, availability of\nposition, working conditions, influence of family,\nfriends or professors, and employer\u2019s policies.  As\nreported by others (1,11), the results from our\nsurvey showed that a combination of these job\nfactors were involved in students\u2019 selection of\npractice sites. Although six out of ten were\nintrinsic factors, this may change once in the\nprofession. Other factors may also affect\npharmacists\u2019 choice of current practice sites (12)\nand most of them can be considered as extrinsic\nfactors (e.g. income potential, and influence of\nspouse).\n\n\n\nOur findings showed that hospital pre-registration\nexperience did not have a major effect on the\nchoice of practice sites.  In one study, it was found\nthat although the percentage of students who\nparticipated in a hospital internship programme\nwas high, there was a lower percentage of students\nwho selected a career in hospital pharmacies when\ncompared to community pharmacies (11). The\nauthors  suggested  that  the  activities students  did\n\n\n\nduring their internship might not be viewed as\npersonally rewarding by many of them. This might\nhave influenced their lack of preference for\nhospital pharmacy practice. Hospital pre-\nregistration in our setting may not be similar to\nhospital internship programme practised in the US\nbut suggestions to improve students\u2019 experience in\nhospital setting (11) may be applicable to ours.\nThis includes providing a more structured\nprogramme which provides emphasis in the\noperations, administration and patient - oriented\npharmaceutical services to enable students to\nexperience hospital pharmacy practice in greater\ndepth.\n\n\n\nCONCLUSION\n\n\n\nThis survey provides some insights into the\nreasons why pharmacy graduates choose their first\nsite of practice.  An understanding of the factors\nthat influence graduates\u2019 practice-site choices is\nimportant if employers wish to design effective\nstrategies to employ future pharmacists. Our\nfindings did not show major changes in students\u2019\npreferences for practice sites before and after the\nhospital pre-registration period.  Speculation that\nstudents would be more inclined toward hospital\npractice because of additional clinical education in\ntheir final year is not supported by our data.\n\n\n\n*****\nREFERENCES\n\n\n\n1. Hassan Y. Challenge to clinical pharmacy practice\nin Malaysia. Ann Pharmacother 1993;27:1134-8.\n\n\n\n2. Besier JL, Jang R. Factors affecting practice-area\nchoices by pharmacy students in the Midwest. Am\nJ Hosp Pharm 1992;49:598-602.\n\n\n\n3. Meyer SM. The pharmacy student population:\napplications received 1995-96, degrees conferred\n1995-96, fall 1996 enrollments. Am J Pharm Educ\n1997;61:63s - 74s.\n\n\n\n4. Rascati KL. Career choice, plans, and commitment\nof pharmacy students. Am J Pharm Educ\n1989;53:228 - 234.\n\n\n\n5. Malaysian Ministry of Health. Pharmaceutical\nservices resources. In: Annual Report. Kuala\nLumpur: Ministry of Health; 1995. p 155.\n\n\n\n6. Malaysian Ministry of Health. Hospital pharmacy.\nIn:  Annual Report. Kuala Lumpur: Ministry of\nHealth; 1993. p 7.\n\n\n\n7. Malaysian Ministry of Health. Health manpower.\n\n\n\nIn: Annual Report. Kuala Lumpur: Ministry of\nHealth; 1994. p 10.\n\n\n\n8. Ferguson JA, Roller L. Career aspirations\ncompared by gender and generation status:\npreliminary analysis of pharmacy students. Am J\nPharm Educ 1986;50:39-43.\n\n\n\n9. Lurvey P. Pharmacist career patterns:  a\nlongitudinal study of practice settings. Am J\nPharm Educ 1992;56:114 - 123.\n\n\n\n10. Lee M, Fjortoft N. Gender differences in attitudes\nand practice patterns of pharmacists. Am J Pharm\nEduc 1993; 57:313 - 319.\n\n\n\n11. Carter EA, Segal R. Factors influencing\npharmacists\u2019 selection of their first practice\nsetting. Am J Hosp Pharm 1989;46:2294-2300.\n\n\n\n12. Scott DM, Neary TJ, Thilliander T, et al.  Factors\naffecting pharmacists\u2019 selection of rural or urban\npractice sites in Nebraska. Am J Hosp Pharm\n1992;49:1941-1945.\n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy 2001;1:22-28 Research article\n\n\n\n23\n\n\n\nPublic Awareness of Community Pharmacy\nand Pharmacists\nHadida Hashim1*, Ahmad Mahmud2, Lim Wai Hing1, Lum Peck Yoong3,\nNatasha Mohd. Yusof1 & Tang Yoke Bun1\n\n\n\n1Department of Pharmacy, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur,\nMalaysia.\n2Pharmaceutical Services Division, Selangor State Health Department, 15th Floor, Wisma MPSA,\nPersiaran Perbandaran, 40000 Shah Alam, Malaysia.\n3Farmasi Wu, No.4, Jalan SS2/63, 47300 Petaling Jaya, Selangor, Malaysia.\n\n\n\n*Author for correspondence\n\n\n\nABSTRACT\n\n\n\nAn exploratory study to ascertain the public\u2019s awareness of community pharmacy\nand pharmacists in a selected subset of the Malaysian population was undertaken,\nutilising an interviewer-administered structured questionnaire approach. A total\nscore was computed for each respondent, ranging from a possible minimum of 0 and\na maximum of 24. The scores achieved were arbitrarily categorised into poor (<11),\nfair (11 \u2013 14), good (15 \u2013 19) and excellent (>19) levels of general knowledge\nregarding community pharmacy and pharmacists. The scores achieved ranged from\n3 to 21, with an average \u201cfair\u201d score of 13.7. The results showed that 93.6% of the\nrespondents (n = 561) interviewed had heard of the term \u201cpharmacist\u201d before.\nInterestingly, 17.5% of the respondents were of the opinion that pharmacists\nworked on farms. A significant 77.4% perceived that a pharmacist served in a\ndoctor\u2019s clinic. It was noted that 84.1% of those surveyed would go to doctors for\nadvice on medicine, while only 49.4% would seek a pharmacist. A majority (76.7%)\nof the respondents interviewed chose to go to a doctor\u2019s clinic for a screening test.\nThe study amplifies the need for a more aggressive projection of the pharmacist\u2019s\nimage in the community in order to be recognized and accepted by the public as an\nintegral partner in the health care profession.\n\n\n\nKeywords: pharmacy, pharmacists, survey, perception, awareness\n\n\n\nINTRODUCTION\n\n\n\nIn this day and age, pharmacists play an\nessential role in educating patients regarding\ndrug therapy as patients become increasingly\nresponsible for their own health care.\nCommunity    pharmacists  are  the  health  care\n\n\n\nprofessionals most accessible to the public (1).\nThe community setting is a platform for the\npharmacist to project himself beyond the\ntraditional image of being simply a \u201cdrug\nsupplier\u201d    in    that    he    is   able  to  provide\n\n\n\n\n\n\n\n\nResearch article: Public awareness of community pharmacy\n\n\n\n24\n\n\n\n pharmacotherapeutic counselling to patients,\napart from general health care information to\nthe public. This is in line with Hepler and\nStrand\u2019s concept of pharmaceutical care (2).\n\n\n\nHowever, this professional expertise will only\nbe fully utilised if the public is aware of and\nunderstands the role played by the pharmacist\nin the community. Hence, this exploratory\nstudy was conducted to ascertain the public\u2019s\nawareness regarding the community pharmacy\nprofession and pharmacists.\n\n\n\nAIM\n\n\n\nThe aim of this study is to examine the public\u2019s\nawareness about community pharmacy and\npharmacists, in a selected subset of the\nMalaysian population.\n\n\n\nMETHOD\n\n\n\nStudy design\n\n\n\nThis public opinion survey was conducted\nusing a structured interview technique, in\nwhich the respondents were asked questions by\ntrained researchers (25 undergraduate students\nand 1 pharmacist).  It took place over a 4-day\nperiod in August 1997, during the University of\nMalaya Convocation Festival. Visitors to the\nPharmacy booth who appeared to be over 18\nyears of age were approached about\nparticipation in the survey. The sampling\nmethod used was that of convenience sampling.\nOnly those who agreed (97.9%) participated in\nthe study, with each interview taking\napproximately 8 to 10 minutes to complete.\n\n\n\nQuestionnaire\n\n\n\nA structured questionnaire was used. Apart\nfrom the portion relating to the demographic\nprofile of the respondents, there were\naltogether 10 questions focussed on the\nfollowing aspects:\na) the respondents\u2019 general awareness of\n\n\n\npharmacists and their places of work\nb) the purchasing pattern of respondents in\n\n\n\nrelation to pharmacies, sinseh\n(traditional Chinese medicine\npractitioner) shops and other places\n\n\n\nc) the awareness of services offered by\ncommunity pharmacies such as treatment\n\n\n\nof minor ailments, screening tests and\nadvice on medications.\n\n\n\nEach question had pre-formulated responses.\nThe questionnaire designed by the research\nteam was piloted with a sample of 25 staff\nmembers of the Faculty of Medicine,\nUniversity of Malaya.\n\n\n\nData analysis\n\n\n\nThe data was entered into a worksheet and\nanalysed using Microsoft Excel\u00ae. A scoring\nsystem was practised as follows:\n\n\n\na) For any question requiring either a \u201cYes\u201d or\n\u201cNo\u201d or \u201cUnsure\u201d response, only the positive\nresponse was given a score of 1, whilst any of the\nother two responses was awarded a score of 0\neach. As an example, for the question \u201cHave you\nheard of the term \u2018Pharmacist\u2019?\u201d a \u201cYes\u201d response\nwas scored as 1.\n\n\n\nb) For any question requiring the choice of one or\nmore than one answer, only the answers deemed\nappropriate was given a score of 1 each and a\ndeduction of 1 was made for each inappropriate\nanswer, with the lowest possible final score of 0\nfor any question. As an example, for the question\n\u201cTo whom would you go for advice on\nmedicines?\u201d where more than one answer may be\ngiven, a respondent who chose \u201cPharmacist\u201d,\n\u201cDoctor\u201d and/or \u201cNurse\u201d was given a score of 1\nfor each of the answers with a deduction of 1 if\n\u201cSinseh\u201d was also selected along with any of the\nappropriate answers.  If \u201cSinseh\u201d was the only\nanswer selected, the respondent received a final\nscore of 0 for that question.\n\n\n\nA total score was computed for each respondent,\nranging from a possible minimum of 0 and a\nmaximum of 24. The scores achieved were\narbitrarily categorised into poor (<11), fair (11 \u2013\n14), good (15 \u2013 19) and excellent (>19) levels of\ngeneral knowledge regarding community\npharmacy and pharmacists.\n\n\n\nRESULTS AND DISCUSSION\n\n\n\nGeneral\n\n\n\nThere were 561 respondents, who were mainly\nMalaysians (97.5%). The ethnic representation\nwas 59% Malays, 29% Chinese and 9%\nIndians. The majority (61.5%) of the\nrespondents were between 18 \u2013 25 years old\nwith 18.2% and 17.1% aged between 26 \u2013 35\n\n\n\n\n\n\n\n\nResearch article: Public awareness of community pharmacy\n\n\n\nyears and 36 \u2013 50 years respectively. In terms\nof gender distribution, 41% of the respondents\nwere male.  The composition of the\nrespondents include undergraduates (55.1%),\nprofessionals (16.6%), non-professionals\n(20.3%), school-going students (3.7%),\npostgraduate students (2.3%), housewives\n(1.1%) and pensioners (0.9%). The majority\n(75%) of respondents lived in urban areas.\n\n\n\nThe respondents\u2019 scores ranged between 3 to 21\nout of a possible maximum of 24. The majority of\nthe respondents obtained scores in the \u201cfair\u201d (48%)\nand \u201cgood\u201d (39.6%) categories.  The mean score\nwas 13.7 and the mode was 14 (both in the \u201cfair\u201d\ncategory). Figure 1 reflects an almost normal\ndistribution. The generally fair scores achieved by\nthe respondents were not unexpected with almost\nthree-quarters (74%) of them either undertaking or\nhad attained a tertiary level of education. There\nwere only four respondents who obtained excellent\nscores: two were undergraduates, one was a\nhousewife while the other was a sales\nexecutive. Surprisingly, no professional\nachieved an \u201cexcellent\u201d score. The scores for\nthe different occupations, genders and ethnic\ngroups were not significantly different based\non the student\u2019s t-test (p>0.05).\n\n\n\nPublic image of pharmacists\n\n\n\nThe  respondents  were  assessed  on  their  level of\n\n\n\nawareness of the term \u201cPharmacist\u201d as well as the\nnature of work and workplace of a pharmacist.\nMost respondents (93.6%) had heard of the term\n\u201cpharmacist\u201d while 89.7% and 88.2% respectively,\nthought they knew what the pharmacist did and\nwhere the pharmacist worked. However, the\nfollowing question, which required the\nrespondents to choose the workplace of the\npharmacist, disproved the above notion. While\nmost respondents associated the pharmacist with\nthe retail sector, hospitals, academia and factories,\na shocking 77.4% associated pharmacists with\ndoctors\u2019 clinics and 17.5% with farms! [Figure 2].\nObviously, the respondents had heard of the term\n\u201cpharmacist\u201d; however, their awareness of a\npharmacist\u2019s role in the community was not\ncompletely accurate. The association with\nworking in a doctor\u2019s clinic suggested a\nconfusion between the roles of dispensers and\npharmacists. Farms were also associated with\npharmacists, possibly due to the perceived\nsimilarity between the words \u201cpharmacy\u201d and\n\u201cfarm\u201d. Most of the study population (91.1%)\nassociated pharmacists with the community or\nretail pharmacies and less with hospitals,\nfactories and pharmaceutical trading houses.\nThis confirms that community pharmacists\nhave a higher visibility and hence would be in\na better position to disseminate information and\ninfluence public opinion on pharmacy.\n\n\n\nIn this survey, quite a large proportion of the\n\n\n0 0 1 1 3 4 4\n9\n\n\n\n15\n\n\n\n29\n\n\n\n47\n\n\n\n62\n69\n\n\n\n91\n\n\n\n79\n\n\n\n60\n\n\n\n50\n\n\n\n25\n\n\n\n8\n3 1 0 0 0\n\n\n\n0\n\n\n\n10\n\n\n\n20\n\n\n\n30\n\n\n\n40\n\n\n\n50\n\n\n\n60\n\n\n\n70\n\n\n\n80\n\n\n\n90\n\n\n\n100\n\n\n\n1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24\n\n\n\nScore\n\n\n\nN\num\n\n\n\nbe\nr o\n\n\n\nf R\nes\n\n\n\npo\nnd\n\n\n\nen\nts\n\n\n\nFigure 1. Distribution of the respondents\u2019 scores based on the\nappropriateness of the responses given to the questions administered.\n\n\n25\n\n\n\n\n\n\n\n\nResearch article: Public awareness of community pharmacy\n\n\n\npeople in\nuniversity a\nwas not su\non univers\nfestival.  \nexpected to\nin the gene\n\n\n\nSale item\npharmacie\n\n\n\nThe famil\npharmacy \nbefore the\ntheir purch\nwas found\nvisited a \nsinseh sho\n\n\n\nThe respo\npreferred \ntoiletries, h\ncrude herb\nand presc\nresponse pe\nthat a pha\nmultivitam\n(83.2%) a\ndisplayed \nrespondent\nmedicines \n\n\n6.4\n\n\n\n77.2\n\n\n\n91.1\n\n\n\n60.1\n\n\n\n74.5\n\n\n\n17.5\n\n\n\n77.4\n\n\n\n41.9\n\n\n\n1.1\n0\n\n\n\n10\n\n\n\n20\n\n\n\n30\n\n\n\n40\n50\n\n\n\n60\n\n\n\n70\n\n\n\n80\n\n\n\n90\n\n\n\n100\n\n\n\nSch\noo\n\n\n\nl \n\n\n\nUniv\ners\n\n\n\nity\nReta\n\n\n\nil\n\n\n\nFac\ntor\n\n\n\ny\n\n\n\nHos\npit\n\n\n\nal\nFarm\n\n\n\nDoc\ntor\n\n\n\n's C\nlin\n\n\n\nic\n\n\n\nTrad\ning\n\n\n\n H\nou\n\n\n\nse\n\n\n\nUns\nure\n\n\n\nWorkplace\n\n\n\nPe\nrc\n\n\n\nen\nta\n\n\n\nge\n o\n\n\n\nf r\nes\n\n\n\npo\nnd\n\n\n\nen\nts\n\n\n\n (%\n) \n\n\n\nFigure 2: Public\u2019s perception of pharmacists\u2019 workplaces.\n\n\n26\n\n\n\nterviewed (77.2%) identified the\ns a place of work for pharmacists. This\n\n\n\nrprising since this study was conducted\nity grounds during the convocation\nThis percentage would, however, be\n be smaller if the study was conducted\n\n\n\nral population.\n\n\n\ns associated with community/retail\ns\n\n\n\niarity of the respondents with the\nand sinseh shop was established\n\n\n\n respondents were asked questions on\nasing patterns at these two places. It\n that 88.4% of the respondents had\npharmacy before as compared to a\np (67.4%).\n\n\n\nndents were interviewed on their\nplaces for purchasing groceries,\n\n\n\nealth supplements, woundcare products,\ns, over-the-counter (OTC) medicines\n\n\n\nription drugs, with more than one\nrmitted for these questions. It was seen\nrmacy was generally associated with\nins (89.9%), woundcare products\nnd prescription drugs (79.7%), as\nin Figure 3. The majority of the\ns (55.4%) preferred to buy OTC\nfrom places other than the pharmacy\n\n\n\nand the sinseh shop. Could price and accessibility\nbe a contributing factor?  In comparison, a public\nopinion survey of community pharmaceutical\nservices in Malta (3) revealed that almost 31% of\ntheir study population visited a pharmacy\nprimarily to purchase prescribed medication while\nonly 23.3% did so mainly to obtain OTC products.\n\n\n\nIt was interesting to note that almost 40% of the\nrespondents would also purchase prescription\nmedicines from another doctor\u2019s clinic having\nacquired the prescription from a clinic or hospital.\nThis is certainly an alarming situation as it\nindicates an evident lack of awareness of the\nfunction of a community pharmacy.\n\n\n\nCommunity pharmacies are also often associated\nwith the sale and supply of products other than\ndrugs and medical supplies. Fortunately, although\na pharmacy was not the favoured place the\nrespondents would go for the purchase of groceries\nand toiletries, a certain percentage of the\nrespondents do associate a pharmacy with these\nitems (23% and 43% respectively).  There is\ncertainly justification for the diversification of\nsales range for these community pharmacies.\nProfitability, competition and service are probably\nthe motivation for these premises to offer items\nother than drugs and medical supplies. Hence, a\nsignificant proportion of the respondents inevitably\nperceived the pharmacies that they frequent as a\n\n\n\n\n\n\n\n\nResearch article: Public awareness of community pharmacy\n\n\n\n\u201cconvenience store\u201d.\n\n\n\nServices offered by community/retail\npharmacies\n\n\n\nThe  final  section  surveyed  the   respondents\u2019\n\n\n\npreferences in sourcing treatment for minor\nailments and screening tests [Figure 4] and\nadvice on medications [Figure 5]. The respondents\nwere given a choice of a pharmacy, clinic, sinseh\nshop and hospital for the treatment of minor\nailments   such  as  cough, cold or minor aches and\n\n\n89.9\n\n\n\n79.7\n\n\n\n8.7\n\n\n\n36.9\n\n\n\n83.2\n\n\n\n43.0 40.7\n\n\n\n23.4\n23.0\n\n\n\n3.4\n\n\n\n66.0\n\n\n\n20\n12.313.0\n\n\n\n12.3\n\n\n\n55.4\n\n\n\n86.1\n\n\n\n24.1\n\n\n\n91.3\n\n\n\n31.225.9\n\n\n\n0\n10\n20\n30\n40\n50\n60\n70\n80\n90\n\n\n\n100\n\n\n\nGroc\neri\n\n\n\nes\n\n\n\nToil\netr\n\n\n\nies\n\n\n\nMult\nivit\n\n\n\nam\nins\n\n\n\nWou\nnd\n\n\n\nca\nre \n\n\n\nProd\nuc\n\n\n\nts\n\n\n\nCrud\ne H\n\n\n\nerb\ns\n\n\n\nOTC M\ned\n\n\n\nicin\nes\n\n\n\nPres\ncri\n\n\n\npti\non\n\n\n\n D\nrug\n\n\n\ns\n\n\n\nItems purchased\n\n\n\nPe\nrc\n\n\n\nen\nta\n\n\n\nge\n o\n\n\n\nf r\nes\n\n\n\npo\nnd\n\n\n\nen\nts\n\n\n\n (%\n)\n\n\n\nPharmacy Sinseh Others Another Doctor's Clinic\n\n\n\nFigure 3: Sale items associated with community pharmacies, sinseh shops and others.\n\n\n41.7\n\n\n\n11.210.3\n\n\n\n0.2\n\n\n\n73.6\n76.7\n\n\n\n24.6\n\n\n\n59.0\n\n\n\n0\n\n\n\n10\n\n\n\n20\n\n\n\n30\n\n\n\n40\n\n\n\n50\n\n\n\n60\n\n\n\n70\n\n\n\n80\n\n\n\n90\n\n\n\nMinor ailments Screening tests\n\n\n\nServices required\n\n\n\nPe\nrc\n\n\n\nen\nta\n\n\n\nge\n o\n\n\n\nf r\nes\n\n\n\npo\nnd\n\n\n\nen\nts\n\n\n\n (%\n)\n\n\n\nPharmacy Sinseh Clinic Hospital\n\n\n\nFigure 4: Utilisation of services.\n\n\n27\n\n\n\n\n\n\n\n\nResearch article: Public awareness of community pharmacy\n\n\n\n28\n\n\n\npains, where more than one answer may be given.\nAlthough treatment for minor ailments can be\nobtained at the community pharmacies after\nconsultation with the pharmacists, the majority of\nthe respondents (73.6%) preferred the doctor\u2019s\nclinic, with only 41.7% selecting the pharmacy.\nShould we be surprised? This phenomenon was\nalso reflected in a survey conducted in Malta\n(3), where respondents were reported to more\nlikely consult their doctor or self-medicate for\nthe treatment of minor ailments rather seek\nadvice from the pharmacist. Similarly, Hargie\net al (1992) also reported that in Northern\nIreland, general practitioners were the first\npreference for the majority of the patients with\nregards to the treatment of minor conditions\n(4).\n\n\n\nCorrespondingly, when the respondents were\nquestioned on the places associated with offering\nscreening tests, the popular choices were the clinic\n(76.7%) and the hospital (59%). Only 11.2% of\nrespondents would go to a pharmacy for screening\ntests. Some community pharmacies do offer\nservices such as screening tests to the public. This\nstudy indicates that perhaps a majority of the\npublic is unaware of such services being available\nin the community pharmacies and thus would\nprefer to go to general practitioners and hospitals\nfor the treatment of minor ailments as well as for\nscreening tests.\n\n\n\nThe next question quizzed the respondents on\nwhom they would go to for advice on\nmedications, where more than one answer was\npermitted. It was disappointing to note that\nonly 49.4% of the respondents would go to a\npharmacist for information concerning\nmedicines, compared to 84.1% of the\nrespondents who would choose a doctor.\n[Figure 5]\n\n\n\nThus, although pharmacists are deemed to be\nexperts on drugs (1), it is unfortunately not\nperceived as such in the eyes of the majority of\nthe respondents interviewed. This result is in\nconcurrence with the findings of a recent\nsurvey conducted in Northern Ireland by Bell et\nal (2000).  The latter revealed that although the\nmajority of those interviewed (87.8%)\nconsidered pharmacists as experts in the field\nof medicines, however, only 64.6% reported\nthat they would talk initially to a pharmacist\nregarding information or advice concerning\nmedicines (5). One possible reason for this\nsituation may be the lack of rapport between\nthe patients/public and the pharmacists as\ncompared to doctors or nurses. Another reason\nmay be the fact that pharmacists are often\nviewed by the public as business people\nconcerned with making money rather than\nhealth-oriented care-driven professionals. Two\nsurveys conducted in Northern Ireland (4,5) found\nthat about one-third of their study populations\n\n\n\n49.4\n\n\n\n5.9\n\n\n\n84.1\n\n\n\n13.6\n\n\n\n0\n\n\n\n10\n\n\n\n20\n\n\n\n30\n\n\n\n40\n\n\n\n50\n\n\n\n60\n\n\n\n70\n\n\n\n80\n\n\n\n90\n\n\n\nPharmacist Sinseh Doctor Nurse\n\n\n\nHealthcare professionals\n\n\n\nPe\nrc\n\n\n\nen\nta\n\n\n\nge\n o\n\n\n\nf r\nes\n\n\n\npo\nnd\n\n\n\nen\nts\n\n\n\n (%\n)\n\n\n\nFigure 5: Health care professionals whom the respondents would\napproach for advice on medications.\n\n\n\n\n\n\n\n\nResearch article: Public awareness of community pharmacy\n\n\n\n29\n\n\n\nharboured that perception.\n\n\n\nIn examining the situation in other countries, it\nwas found that in India, community pharmacies\nwere not perceived to be respectable (6). In Great\nBritain, on the other hand, two national\nrepresentative surveys had demonstrated that the\npublic interviewed do perceive pharmacists as\nappropriate advisers for common ailments but not\nfor more general health matters (7).  In the United\nStates of America, the 1998 Schering Report XXI\nshowed strong gains in terms of the patients\u2019\nperception of community pharmacists, compared\nto a similar 1978 survey (8).  It is imperative that\nthe Malaysian public should be made aware of and\nunderstand the role of pharmacists in the\ncommunity, in order for the profession to realise\nits full potential and the public to benefit from the\nexpertise available. Improved social interactions\nbetween the public and the pharmacists, in\nparticular personal attention in relation to advice\non the treatment of minor ailments, self-care and\ndispensed medications, is probably the key to\nincreasing the level of public awareness.\n\n\n\nLimitations of the study\n\n\n\nAdmittedly, the study population used in this\nsurvey was biased towards the more educated and\nurban portion of the Malaysian public, specifically\nthose who visited the Pharmacy booth during the\nUniversity of Malaya Convocation Festival. This\nstudy was, however, designed for a quick snap-\nshot of this subset\u2019s perception of community\npharmacies and pharmacists with the thought in\nmind that if this subset demonstrates a lack of\nawareness, then it is most unlikely that the less\neducated and rural subsets of the Malaysian public\nwill be any better.  Another limitation of this study\n\n\n\nwas its setting that did not permit a more extensive\nline of questioning.\n\n\n\nCONCLUSION\n\n\n\nAlthough this study was conducted in a selected\nsubset of the population, it does offer a baseline\nrelating to the public perception of community\npharmacy and the pharmacy profession in 1997, at\nleast in relation to the more educated and urban\nsection of the public. Of late, with increasing\nattention in the mass media on the issue of\ndispensing separation and the role of the\npharmacists, particularly in the community, the\npublic\u2019s perception towards the pharmacists may\nhave since improved.  Its significance or the lack\nof it can only be demonstrated through the conduct\nof a second survey, preferably using a bigger study\npopulation and a stratified random selection of the\ninterview sites representing the various\nstates/territories in Malaysia. Nonetheless, the\nfindings of this survey have clearly impressed the\nurgent need for the pharmacy profession,\nparticularly the community pharmacy sector, to\nproject itself in the eyes of the public as uniquely\nqualified professionals on drugs, and a reliable\nsource of unbiased information as well as advice\non medications and general health care.\n\n\n\nACKNOWLEDGMENTS\n\n\n\nThe authors wish to thank all the 25 undergraduate\nstudents, who conducted the interviews for this\nstudy after undergoing the training provided, and\nMr. Mohamed Azmi bin Ahmad Hassali for his\nassistance in the procurement of the literature.\n\n\n\n*****\nREFERENCES\n\n\n\n1. World Health Organisation. The scope of pharmacy\nand the functions of pharmacists. In: The role of the\npharmacist in the health care system. Report of a\nWHO Consultative Group; 1988 Dec. 13-16; New\nDelhi.\n\n\n\n2. Hepler CD, Strand LM. Opportunities and\nresponsibilities in pharmaceutical care. Am J Hosp\nPharm 1990; 47: 533-43.\n\n\n\n3. Cordina M, McElnay JC, Hughes CM. Societal\nperceptions of community pharmaceutical services\nin Malta. J Clin Pharm Ther 1998; 23: 115-26.\n\n\n\n4. Hargie O,   Morrow N,    Woodman C.    Consumer\n\n\n\nperceptions and attitudes to community pharmacy\nservices. Pharm J 1992; 249:688-91.\n\n\n\n5. Bell HM, McElnay JC, Hughes CM. Societal\nperspectives on the role of the community\npharmacist and community-based pharmaceutical\nservices. J Soc Admin Pharm 2000; 17: 119-28.\n\n\n\n6. Singh H. India: Retail pharmacy not respectable.\nPharm J 1982; 228:145.\n\n\n\n7. Anon. Public faith in pharmacist\u2019s advisory role.\nPharm J 1985; 235:177.\n\n\n\n8. Anon. Pharmacists gain in public esteem. Am Drug\n1999; 216:29.\n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy 2001;1:29-34 Research article\n\n\n\n30\n\n\n\nDevelopment of a High-Performance Liquid\nChromatographic Method for Analysis of\nGlibenclamide from Dissolution Studies\n\n\n\nWan Azman Wan Ismail, Mohamed Ibrahim Noordin, Hadida Hashim*,\nAshok Kumar Narayana\n\n\n\nDepartment of Pharmacy, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur,\nMalaysia.\n\n\n\n*Author for correspondence\n\n\n\nABSTRACT\n\n\n\nA HPLC method for the detection and quantification of glibenclamide, from\ndissolution studies of glibenclamide tablets (5 mg), was developed. The dissolution\ntest employed was the basket method, operating at 100 rpm, using 1000ml\nphosphate buffer pH 7.4 as the dissolution medium. Elution was performed on LC-\n18 reverse phase, SupelcosilTM ODS column (4.6mm x 25cm, 5\u00b5\u00b5\u00b5\u00b5m) using a mobile\nphase consisting of 0.02M monobasic ammonium phosphate in 60%v/v acetonitrile\nin water at a flow rate of 2ml/min, using phenacetin as the internal standard. The\neluent was monitored at 254nm with an UV detector. Retention times of the\nglibenclamide and phenacetin peaks were 3.61 minutes and 1.8 minutes respectively.\n\n\n\nKey words: glibenclamide, dissolution studies, in vitro, HPLC analysis\n\n\n\nINTRODUCTION\n\n\n\nGlibenclamide is the most extensively used\nsulphonylurea in many parts of the world for the\nmanagement of non-insulin-dependent diabetes\nmellitus (NIDDM) (1). A search of the registry of\ndrugs approved for marketing in Malaysia, kept at\nthe Drug Evaluation and Safety Division of the\nNational Pharmaceutical Control Bureau, revealed\na total of 32 glibenclamide preparations registered\nas at July 1999. These included the innovator\nproducts, namely Daonil\uf6da  and Euglucon\uf6da , as well\nas 30 generic preparations, of which 14 were\nimported.\n\n\n\nGlibenclamide is documented to possess low\naqueous solubility (2). Large inter- and intra-\nindividual  responses  following  administration  of\n\n\n\nglibenclamide preparations have also been\nreported (3-5). Such variations are undesirable and\nmay expose susceptible patients to the danger of\nhypoglycaemia or other hazards when changing a\npatient\u2019s therapy from one preparation to another.\n\n\n\nSince 1970, dissolution requirements have been\nadded to tablet and capsule monographs, in\ngeneral, in response to concerns for bioavailability.\nOf equal significance is the recognition of the\nimmense value of dissolution testing as a tool for\nquality control. Thus, equivalence in dissolution\nbehaviour was sought in light of both\nbioavailability and quality control considerations\n(2). The United States Pharmacopoeia (USP) 1995,\nhowever, does not require glibenclamide tablets to\n\n\n\n\n\n\n\n\nResearch article: Analysis of glibenclamide by HPLC\n\n\n\n31\n\n\n\ncomply to the dissolution test (2). Nonetheless,\ndissolution profiles are often used by the industry\nto ascertain the release rates of glibenclamide from\ntablet formulations as a quality assurance tool.\n\n\n\nSignoretti et al (1983) and El-Sayed et al (1989)\nconducted studies to evaluate the physico-chemical\ncharacteristics, including the dissolution profiles,\nof various glibenclamide preparations which might\ncontribute to the unpredictable behaviour of the\ndrug products (6,4). In their studies, Signoretti et\nal (1983) used a method based on ultraviolet\nspectrophotometry to analyze glibenclamide from\ndissolution samples.\n\n\n\nHowever, in terms of sensitivity, precision and\nspecificity, a high-performance liquid\nchromatographic (HPLC) method may offer\nadditional advantages (5,7-9). The USP (1995)\ndocuments a HPLC method for the assay of\nglibenclamide tablets using progesterone as the\ninternal standard (2). The use of an internal\nstandard is required for evaluating system\nsuitability and is not necessary for assays, which\nhave been proven to be accurate, precise, sensitive\nand specific. However, the authors felt that the\nincorporation of a suitable internal standard\nprovides an added value to a HPLC technique, as\nan additional calibration tool, to accommodate any\nchanges in the system and to improve retention\nreproducibility throughout the analytical period\n(10).\n\n\n\nAIM\n\n\n\nThis study aims to develop a HPLC method, with\nthe incorporation of an internal standard, for the\ndetection and quantification of glibenclamide from\ndissolution studies.\n\n\n\nMATERIALS AND METHODS\n\n\n\nMaterials\n\n\n\nTwo of the 5mg glibenclamide tablet preparations\navailable in the Malaysian market namely, Brand\nA (expiry date: August 2002) and Brand B (expiry\ndate: April 2002) were used in the dissolution\nstudies. Glibenclamide RS, progesterone RS and\nphenacetin RS were obtained from the Reference\nStandard Unit, National Pharmaceutical Control\nBureau (NPCB). HPLC-grade acetonitrile and\nmethanol as well as AR-grade monobasic\n\n\n\nammonium phosphate and phosphoric acid were\nused in preparing the mobile phase.\n\n\n\nApparatus\n\n\n\nIn vitro dissolution studies were carried out in a\nErweka\uf6da  DT 70 dissolution apparatus using the\nbasket method, operated at 100 rpm. The HPLC\nsystem consisted of a dual-pump Waters\uf6da  solvent\ndelivery system (Model 600E) a Rheodyne\uf6da  (7725\ni) variable-volume, syringe-loading sample\ninjector, a Waters\uf6da  UV detector (Model 486) set at\n254 nm and Millennium\uf6da  2010 chromatography\nManager, version 2.1 data system as the integrator.\nA stainless steel SupelcosilTM LC-18 ODS (4.6\nmm x 25 cm, 5 \u00b5m) column was used as the\nstationary phase.\n\n\n\nAssay procedures and validation\n\n\n\nStock solutions of 0.05%w/v of glibenclamide RS\nin methanol:phosphate buffer pH7.4 (2:98%v/v),\n0.001%w/v progesterone RS in acetonitrile and\n0.001%w/v of phenacetin RS in phosphate buffer\nwere prepared separately. Standard solutions of\nvarying concentrations of glibenclamide (0.05, 0.1,\n0.2, 0.5, 0.75, 0.8, 1, 1.5, 2 and 5\u00b5g/ml) were\nprepared. This range was selected based on 5\u00b5g/ml\nbeing the maximum concentration of\nglibenclamide in the dissolution medium, upon\ncomplete dissolution of the tablet.\n\n\n\nTo each 1ml aliquot of the standard solutions,\n0.5ml of the internal standard solution (0.001%w/v\nprogesterone or 0.001%w/v phenacetin) was\nadded. 10\u00b5l aliquots of the mixture were then\ninjected into the HPLC (minimum of n=5 for each\nmixture). For the mixtures incorporating\nprogesterone as the internal standard, the following\nmobile phases were used:\na) 0.02M monobasic ammonium phosphate in\n\n\n\nacetonitrile:water (55:45%v/v)\nb) 0.02M monobasic ammonium phosphate in\n\n\n\nacetonitrile:water (60:40%v/v)\nFor each of the mobile phases, the pH was\nadjusted to 5.25 \u00b1 0.10, using phosphoric acid, and\nit was delivered isocratically at 2ml/min. Mobile\nphase (b) was also used for aliquots of mixtures\ncontaining phenacetin as the internal standard.\n\n\n\nFor the assessment of intra-day precision, 10\u00b5l\naliquots of the complete set of glibenclamide\nstandard and the internal standard (phenacetin)\nmixtures were injected (n=3) at 4 different times\nover an 18-hour period, namely in the early\n\n\n\n\n\n\n\n\nResearch article: Analysis of glibenclamide by HPLC\n\n\n\n32\n\n\n\nmorning, noon, mid-evening and night. This was\nrepeated over 3 days to measure inter-day\nprecision.\n\n\n\nTo further validate the accuracy of the assay\ntechnique, the phosphate buffer pH 7.4 used in the\ndissolution experiments was spiked with 3\ndifferent known concentrations of the\nglibenclamide standard (0.65, 1.30 and 1.95\n\u00b5g/ml) and assayed. Phenacetin was used as the\ninternal standard for the assay of the spiked\nsamples.\n\n\n\nApart from measuring the retention times of the\nanalyte peaks, calibration curves of peak area\nratios (PAR) of glibenclamide:internal standard\nversus the known glibenclamide concentrations\nwere also constructed.\n\n\n\nDissolution experiments\n\n\n\n1000 ml of phosphate buffer pH 7.4 @ 37oC was\nused as the dissolution medium. Dissolution of the\ntablets was carried simultaneously in 6 vessels,\nusing the basket method, operating at 100 rpm.\n2ml samples were drawn at 5, 10, 15, 30, 60, 90\nand 120 minutes from the onset of the dissolution\nstudies. Equal volumes of phosphate buffer pH 7.4\npreheated to 37oC, was added into each vessel to\nreplace the withdrawn volumes. The samples were\nfiltered through a 0.45\u00b5m (millipore) membrane\nfilter . To each 1ml aliquot of the samples, 0.5ml\n\n\n\nof 0.01mg/ml phenacetin in phosphate buffer\npH7.4 was added as the internal standard. 10\u00b5l\naliquots of the sample and internal standard\nmixture were then analysed by HPLC (n=3).\n\n\n\nRESULTS AND DISCUSSION\n\n\n\nA mobile phase composing of 0.02M monobasic\nammonium phosphate in 55%v/v acetonitrile in\nwater was initially used, with progesterone as the\ninternal standard, as recommended by the United\nStates Pharmacopoeia (1995). The retention times\nfor the glibenclamide and progesterone peaks were\n4.5 minutes and 7.9 minutes respectively. The\nprolonged retention time of progesterone coupled\nwith its extremely poor aqueous solubility\nrendered it unsuitable as an internal standard for\nthis assay. It was subsequently substituted with\nphenacetin. To reduce the retention time of the\nglibenclamide peak, the composition of the\nacetonitrile in the mobile phase was increased to\n60%v/v. The retention time of phenacetin was\nfound to be 1.8 minutes (Figure 1) while the mean\nretention time for the glibenclamide peaks was\n3.61 minutes with Relative Standard Deviation\n(RSD) values between 0.08% and 1.6% (n=12).\nThe maximum RSD at 1.6% showed that the\nprecision of this method was acceptable.\n\n\n\nThe calibration curve for glibenclamide was linear\nin the concentration range 0.05 to 5 \u00b5g/ml (R2 =\n0.997;  y = 0.1384x + 0.0138).  The  intercept  was\n\n\n\nFigure 1. Retention times for glibenclamide and phenacetin peaks (mobile phase:0.02M\nmonobasic ammonium phosphate in acetonitrile:water, 60:40%v/v)\n\n\n\nphenacetin glibenclamide\n\n\n\nAU\n\n\n\n\n\n\n\n\nResearch article: Analysis of glibenclamide by HPLC\n\n\n\n33\n\n\n\nnot significantly different from zero. However, for\nthe dissolution experiments, preliminary studies\nrevealed that there was incomplete dissolution of\nthe glibenclamide tablets from both Brands A and\nB. Less than 2\u00b5g/ml of glibenclamide was detected\nin the dissolution medium at 120 minutes from the\nonset of the dissolution studies. As such, the\nconcentration range for the calibration curve\nutilized for the dissolution studies was narrowed\ndown to 0.05-2 \u00b5g/ml. The linearity (R2 = 0.9908)\nwas found to be acceptable for this range as\ndisplayed in Figure 2.\n\n\n\nUsing peak area ratios of glibenclamide:phenacetin\n(internal standard), the coefficients of variation for\nboth intra- and inter-day analyses were shown to\nrange from 0.91% to 5.91% and 0.39% to 6.26%\nrespectively for the complete range of\nglibenclamide standards.  As such the intra- and\ninter- day precision of the assay were found to be\nacceptable.\n\n\n\nTable 1 compares the results of the assayed\nconcentrations    (   calculated   from   the  standard\n\n\n\ncurve) of the spiked samples of phosphate buffer\npH 7.4 to the known concentrations of\nglibenclamide added. The differences between the\nknown concentration values and the values\nquantitated from the assay method were not\nsignificant as reflected by the very low values\n(<2%) of the percentage of the [difference \u00f7\nknown concentration].  This further validated the\naccuracy of the assay method.\n\n\n\nFigures 3 and 4 display the dissolution profiles\nfrom the studies conducted on the two commercial\nglibenclamide preparations, Brands A and B, using\nthe HPLC method developed. It was found that the\nHPLC method developed was suitable to measure\nthe low levels of glibenclamide released into the\ndissolution medium.\n\n\n\nFor both brands, dissolution of the tablets were not\ncomplete, even at 120 minutes.  USP (1995)\ngenerally requires that, for an immediate release\ntablet, at least 75% of its active ingredient is\ndissolved within 45 minutes (2).  However, the\npharmacopoeia does not specify dissolution testing\n\n\n\ny = 0.2597x - 0.0038\nR2 = 0.9908\n\n\n\n-0.1\n0\n\n\n\n0.1\n0.2\n0.3\n0.4\n0.5\n0.6\n\n\n\n0.00 0.50 1.00 1.50 2.00 2.50\n\n\n\nConcentrations (ug/ml)\n\n\n\nPe\nak\n\n\n\n A\nre\n\n\n\na \nR\n\n\n\nat\nio\n\n\n\nFigure 2. Calibration curve of glibenclamide for dissolution studies.\n\n\n\nMean \u00b1 SD; n=5\n\n\n\nTable 1. Analysis data of phosphate buffer pH 7.4 spiked with known concentrations of\nglibenclamide.\n\n\n\nKnown concentration\nof glibenclamide\nadded to buffer\n\n\n\nsolutions (\u00b5g/ml)\n[a]\n\n\n\nQuantitated mean\nconcentration of\n\n\n\nglibenclamide from\nHPLC assay (\u00b5g/ml)\n\n\n\n[b]\n\n\n\nDifference between\nknown concentration\nand detected mean\n\n\n\nconcentration (\u00b5g/ml)\n[a]-[b]\n\n\n\nPercentage of difference\nfrom known concentration\n\n\n\n(%)\n[a]-[b] x 100\n\n\n\n               [a]\n\n\n\n0.65 0.65 0 0\n1.30 1.28 0.02 1.54\n1.95 1.93 0.02 1.03\n\n\n\n\n\n\n\n\nResearch article: Analysis of glibenclamide by HPLC\n\n\n\nin the glibenclamide table\nthese tablets need not \nrequirement. Nonetheless,\nsolubility, glibenclamide \npotentially face bioavail\ndissolution profile is foun\nThus, the industry does u\nas a quality assurance tool\n\n\n\nCONCLUSION\n\n\n\nA HPLC method fo\nquantification of glibenc\nstudies had been succe\n\n\n\nMean \u00b1 SD; n=6\n\n\n\n\n\n\n\n0.00 \n\n\n\n0.50 \n\n\n\n1.00 \n\n\n\n1.50 \n\n\n\n2.00 \n\n\n\n0 \n\n\n\nC\non\n\n\n\nce\nnt\n\n\n\nra\ntio\n\n\n\nn \n(u\n\n\n\ng/\nm\n\n\n\nl) \n\n\n\nFigu\n\n\n\n\n\n\n\n0.00 \n\n\n\n0.50 \n\n\n\n1.00 \n\n\n\n1.50 \n\n\n\n2.00 \n\n\n\n0 20 40 60 80 100 120 140 \n\n\n\nTime (minutes) \n\n\n\nC\non\n\n\n\nce\nnt\n\n\n\nra\ntio\n\n\n\nn \n(u\n\n\n\ng/\nm\n\n\n\nl) \n\n\n\nFigure 3. Dissolution profile of glibenclamide from Brand A\n\n\n\nMean \u00b1 SD; n=6\n\n\nMean \u00b1 SD; n=6\n\n\n34\n\n\n\nt monograph and as such\ncomply to the general\n due to its poor aqueous\ntablet formulations may\nability problems if its\nd to be relatively poor.\ntilize dissolution studies\n.\n\n\n\nr the detection and\nlamide from dissolution\nssfully developed, with\n\n\n\nacceptable retention times of the drug and internal\nstandard peaks, of less than 4 minutes per assay.\nThe HPLC method is able to detect glibenclamide\nconcentrations as low as 0.05\u00b5g/ml with a Relative\nStandard Deviation ranging between 0.08% and\n1.6%.  Apart from the greater precision and\nsensitivity attained using this HPLC method, the\nspecificity offered is undoubtedly another\nadvantage compared to the UV method of analysis.\n\n\n\nACKNOWLEDGEMENTS\n\n\n\nThe authors wish to thank University of Malaya\nR&D Unit for its financial support and Mr. Mohd\nNasir of the Reference Standard Unit, National\n\n\n\n20 40 60 80 100 120 140 \n\n\n\nTime (minutes) \n\n\n\nre 4. Dissolution profile of glibenclamide from Brand B\n\n\n\n\n\n\n\n\nResearch article: Analysis of glibenclamide by HPLC\n\n\n\n35\n\n\n\nPharmaceutical Control Bureau, Ministry of\nHealth Malaysia for his prompt supply of the\n\n\n\nreference standards.\n\n\n\n*****\nREFERENCES\n\n\n\n1. Lebovitz HE, Melander A. Sulfonylureas: Basic\naspects and clinical uses. In: Alberti KGMM,\nDeFronzo RA, Keen H, Zimmet P, editors..\nInternational textbook of diabetes mellitus.\nEngland: John Wiley & Sons; 1992.\n\n\n\n2. The United States Pharmacopoeia/The National\nFormulary (USP XXIII/ NF XVIII). United States\nPharmacopoeial Convention Inc: USA; 1995.\n\n\n\n3. Coppack SW, Lant AF, McIntosh CS, et al.\nPharmacokinetic and pharmacodynamic studies of\nglibenclamide in non-insulin-dependent diabetes\nmellitus. Br J Clin Pharmac 1990; 29:673-84.\n\n\n\n4. El-Sayed YM, Suleiman MS, Hasan MM, et al.\nComparison of the pharmacokinetics and\npharmacodynamics of two commercial products\ncontaining glibenclamide. Int J Clin Pharmacol\nTher Toxicol 1989; 27: 551-7.\n\n\n\n5. Marchetti P, Navalesi R. Pharmacokinetic-\npharmacodynamic relationships of oral\nhypoglycaemic   agents.  Clin     Pharmacokinetics\n\n\n\n1989; 16: 100-28.\n6. Signoretti EC, Dell\u2019utri A, Cingolani E.\n\n\n\nBioavailability of glibenclamide tablets. Farmaco\n(Prat) 1983; 40: 141-5.\n\n\n\n7. Charles BG, Ravenscroft PJ. Measurement of\ngliclazide in plasma by radial compression\nreversed-phase liquid chromatography. Clin Chem\n1984; 30: 1789-91.\n\n\n\n8. Emilsson H. High-performance liquid\nchromatographic determination of glipizide in\nhuman plasma and urine. J Chromatog 1987; 421:\n319-26.\n\n\n\n9. Raghow G, Meyer MC. High-performance liquid\nchromatographic assay of tolbutamide and\ncarboxytolbutamide in human plasma. J Pharm Sci\n1981; 70: 1166-7.\n\n\n\n10. Smith RM. Retention index scales used in high-\nperformance liquid chromatography.  J Chrom Lib:\nRetention and selectivity in liquid chromatography\n1995; 57:93-144.\n\n\n\n\n\n\n\n\nBook Review\n\n\n\n36\n\n\n\nBook review\n\n\n\nFarmakologi Perubatan Sekali Imbas\nEdisi Ketiga\nM J Neal\nTerjemahan dikendalikan oleh Unit Terjemahan Melalui Komputer.\nPenyunting Terjemahan: Abas Hj. Hussin\n\n\n\nPenerbit Universiti Sains Malaysia Pulau Pinang 1999 ISBN 983-861-182-4\n\n\n\nOne of the first things that we do upon being given\na new book is to quickly flick through the pages to\nsee if the book is of any interest or of any value to\nus. This was my first action upon receiving the\ntranslated version of Medical Pharmacology at a\nGlance, third edition, by Michael J. Neal. This\nbook was translated by Universiti Sains Malaysia\u2019s\nTranslation Unit, with Abas Hj. Hussin as the\neditor. At first glance, \u201cMedical Pharmacology at a\nGlance\u201d appeared to be a simply written\npharmacology book which is illustrated with well-\ndrawn, yet simple diagrams packed with\ninformation. The Malay translation is easy to read\nand understand. All major topics in pharmacology\nare covered and these are arranged in chapters\nbeginning with basic topics in pharmacology and\nconcluding with poisoning and adverse effects.\nDrugs are grouped according to their indications,\nfor example, drugs for treatment of hypertension,\ndrugs for gout and so on.\n\n\n\nUpon further examination, I find this book to be\nuseful as an additional reference material. It should\nideally be used together with other textbooks in\npharmacology. The strength of \u201cMedical\nPharmacology at a Glance\u201d lies in its well-drawn\nout and informative diagrams. It should ideally be\nused as a quick reference by students and teachers\nof pharmacology. It would also be very beneficial\nfor use in tutorials or as revision. The text in this\nbook is simple and concise and must be read with\nreference to the diagrams. This book is suitable not\n\n\n\nonly for pharmacy or medical students, but also\nstudents of dentistry, nursing or other courses that\nincorporate pharmacology in the curriculum.\n\n\n\nThe reviewer would like to draw attention to the\nuse of drug names written in the Malay form.  For\nexample, chloroquine is written as \u201cklorokuina\u201d,\ntheophylline as \u201cteofilina\u201d and so on. The\nreviewer\u2019s personal opinion is that the names of\ndrugs should be maintained in their original form.\nThis will make it easier for the student and newly\npractising professional to identify these drugs. It is\nvery rare indeed for the student or professional to\nencounter Malay versions of drug names in\npractice. What should be translated to the Malay\nlanguage should be drug class or chemical names\nof drugs. Another reason to maintain original drug\nnames is to avoid confusion between the different\ndrugs. As it is, with the enormous numbers of\ndrugs in the market, confusion pertaining to drugs\nof almost similar names already exists. In addition\nmost references and new literature refer to a drug\nby its internationally recognized name. It is\nperhaps timely for teachers of pharmacology in\nMalaysia to come to an agreement with regards to\nthis matter.\n\n\n\nIn summary, \u201cFarmakologi Perubatan Sekali\nImbas Edisi Ketiga\u201d is excellent material for quick\nreferencing.\n\n\n\nAishah Adam\n\n\n\n*****\nThis book costs RM26.00 and it can be ordered from Kooperasi Kedai Buku USM Bhd, 11800 Pulau Pinang (Fax : 04-\n6575688) or for bulk orders where up to 30% discount is given, contact: Penerbit USM, Perpustakaan Utama 2, 11800\nPulau Pinang (Fax : 04-6575714, email : penerbitusm@notes.usm.my).\n\n\n\n\n\n\n\n\n37\n\n\n\nMalaysian Journal of Pharmacy\nInstructions to Authors\nInstructions to Authors\nAuthors will greatly assist the editors if the instructions below are followed.\n\n\n\n1. Preparation of manuscripts\n\ufffd Articles in English will be given priority over those in Bahasa Malaysia.\n\ufffd Type papers double spaced, using Times New Roman font size 12 throughout the text, legends, tables\n\n\n\nand references, on A4 sized paper.\n\ufffd Number all pages. 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Submission of books for review\n\n\n\nAuthors are invited to send one copy of the book for review to the Editor in Chief at the address stated\nabove. Books accepted for review will not be returned.\nDirect enquiries to the Editor-in-Chief at (tel) 03-40405661/26923066ext5661, (fax) 03-26983271, (email)\nsufong@medic.ukm.my\n\n\n\n\n\n\n \nMalaysian Journal of Pharmacy\n\n\nTable of Contents\n\n\n \n\n\n \n\n\n \n\n\n \n\n\n \n\n\n \n\n\n \n\n\n \nWong Sie Sing\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nINTRODUCTION\n\n\n\n\nWHAT IS PHARMACY PRACTICE?\n\n\nPHARMACY PRACTICE IN THE NEW MILLENNIUM\n\n\n \n\n\n \nContraception and abortion\n\n\nBrain death\n\n\n\n\n\n\nAnd thus, from then on bioethics conjured a much narrower meaning than its original scope and breadth. And it is in this context that many of the recent and contemporary discussions on issues related to health, life and death are being looked at. This wa\n\n\nCenter of Ethics at Georgetown University, Professor Andr\u00e9 Hellegers seized the opportunity to turn bioethics into an academic discipline that reflected the needs of the time. This was rather easily acceptable as bioethics can readily be identified with\n\n\n \nABSTRACT\n\n\nKey words: pharmacy, career choice, job factor, workplace, Malaysia\n\n\n \n\n\n \n\n\n \nINTRODUCTION\n\n\nMETHODS\n\n\nRESULTS\n\n\n\n\n\n\nDISCUSSION\n\n\nINTRODUCTION\n\n\nAIM\n\n\nMETHOD\n\n\n \nStudy design\n\n\nQuestionnaire\n\n\nData analysis\n\n\n\n\nRESULTS AND DISCUSSION\n\n\n \nGeneral\n\n\nPublic image of pharmacists\n\n\n \nperceived the pharmacies that they frequent as a \u201cconvenience store\u201d.\n\n\nCorrespondingly, when the respondents were questioned on the places associated with offering screening tests, the popular choices were the clinic (76.7%) and the hospital (59%). Only 11.2% of respondents would go to a pharmacy for screening tests. Some c\n\n\nCONCLUSION\n\n\nACKNOWLEDGMENTS\n\n\nREFERENCES\n\n\n\n\n\n\n\n\nABSTRACT\n\n\n\n\n\n\nINTRODUCTION\n\n\nAIM\n\n\nMATERIALS AND METHODS\n\n\n \n\n\n \n\n\n \nMaterials\n\n\nApparatus\n\n\n\n\nAssay procedures and validation\n\n\nDissolution experiments\n\n\n\n\n\n\nRESULTS AND DISCUSSION\n\n\nThe calibration curve for glibenclamide was linear in the concentration range 0.05 to 5 (g/ml (R2 = 0.997;  y = 0.1384x + 0.0138).  The  intercept  was\n\n\nnot significantly different from zero. However, for the dissolution experiments, preliminary studies revealed that there was incomplete dissolution of the glibenclamide tablets from both Brands A and B. Less than 2(g/ml of glibenclamide was detected in t\n\n\nCONCLUSION\n\n\nACKNOWLEDGEMENTS\n\n\n \n\n\n \n\n\n \n\n\n \n\n\n \nREFERENCES\n\n\n \n\n\n \nMalaysian Journal of Pharmacy\n\n\n\n\nInstructions to Authors\n\n\n\n\n\n\nAuthor page\n\n\n \nJournal/Magazine article\n\n\nBooks\n\n\nConference papers\n\n\n\n\n\n\n\n\n\n\n\n\n\n"
"\n\nMalaysian Journal of Pharmacy Volume 8 Issue 1 (2022)  \n \n\n\n\n\n\n\n\n\n\n\n\n*Correspondence: tahir.khan@uvas.edu.pk \n1Institute of Pharmaceutical Science, University of Veterinary and Animal \n\n\n\nScience UVAS, Lahore Pakistan \n2Faculty of Pharmacy, University of Cyberjaya, Cyberjaya, Selangor, \n\n\n\nMalaysia. \n3Faculty of Data Science and Information Technology, INTI International \n\n\n\nUniversity, Nilai, Negeri Sembilan, Malaysia. \n4Department of Physiology, Faculty of Biosciences, University of \n\n\n\nVeterinary and Animal Science UVAS, Lahore Pakistan \n5College of Pharmacy, Faculty of Medicine, University of Almaarefa, \n\n\n\nRiyadh, Kingdom of Saudi Arabia \n\n\n\n\n\n\n\n42 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n Original Article \n\n\n\n\n\n\n\nPrice Variation Among Registered Brands of Anti-Cancer \n\n\n\nMedicines Available in Pakistan \n \n\n\n\nFiza Ayub1, Kah Seng Lee2, Khang Wen Goh3, Muhammad Faisal Nadeem1, Imtiaz Rabbani4, Amal \n\n\n\nK Sulaiman5, Tahir Mehmood Khan1  \n\n\n\n\n\n\n\n \nArticle Info  \n\n\n\n \nReceived date: 07 Dec 2021  \n\n\n\nAccepted date: 15 Dec 2021 \n\n\n\nPublished date: 30 Jun 2022 \n\n\n\n\n\n\n\nKeywords: Anti-cancer \n\n\n\nmedicines, price variation, \n\n\n\nAvailability of drugs, Pakistan  \n\n\n\nABSTRACT  \n\n\n\n\n\n\n\nThe current study aims to explore the number of registered anticancer medicine in Pakistan and the \n\n\n\nprice variation of these single-ingredient medicines. A data-based study was conducted between \n\n\n\nMarch 2021 and May 2021. Pharmaguide (Mobile Version 2020 \u2013 2021), Druginfosys.com and \n\n\n\nMedicialstore.com.pk were used to derive the price of anticancer medications sold in Pakistan. The \n\n\n\ndifference in minimum and maximum costs of each formulation was calculated, and the price \n\n\n\nvariations in 81 anticancer medicines belonging to 14 different categories were analysed.  There were \n\n\n\n115 formulations registered for these 81 anticancer medications. Estimations in price difference \n\n\n\nrevealed that topotecan (4mg / ml) had the highest price variation, while the lowest price variation of \n\n\n\n4.01% was observed for abiraterone acetate (250mg). Price variations among different anti-cancer \n\n\n\nbrands marketed in Pakistan are noticeable and substantial, therefore necessitating action from the \n\n\n\ndrug regulatory authority of Pakistan, not only to gain awareness on this issue, but also to set pricing \n\n\n\nthresholds to make the prices of anti-cancer medications more affordable. In addition, external \n\n\n\nreference pricing and reimbursement programs partially sponsored by the government or insurance \n\n\n\ncompanies can be a possible way to control the price variation of anti-cancer drugs. \n\n\n\n\n\n\n\n\n\n\n\nINTRODUCTION  \n\n\n\n\n\n\n\nCancer is the leading cause of mortality and morbidity. Overall, \n\n\n\ncarcinoma of the breast (11.7%), lung (11.4%), prostate (7.3%), \n\n\n\nstomach (5.6%) and other types of cancer (53.9%) are observed \n\n\n\namong the majority of cancer patients in both developed and \n\n\n\ndeveloping countries [1]. Meanwhile, haematological cancers \n\n\n\n(leukaemia, lymphoma, lymphoma and multiple myeloma) \n\n\n\ncontributed 10% to the cancer burden [2] and according to \n\n\n\nrecently published statistics, leukaemia was found to be the \n\n\n\n15th most commonly diagnosed cancer [3].  \n\n\n\n\n\n\n\nIn the year 2020, there had been about 38 million deaths \n\n\n\nworldwide attributed to non-communicable diseases (NCDs), \n\n\n\nof which, about 10.0 million deaths occurred due to cancer. It \n\n\n\nis estimated that by 2040, approximately 28.4 million new \n\n\n\ncases of cancer will be diagnosed, with an estimated 47.0% \n\n\n\nincrease in cases as compared to 2020 [4].  Delayed diagnosis \n\n\n\nas well as impeded access and affordability to healthcare \n\n\n\nfacilities substantially contribute to mortality among the cancer \n\n\n\npatients. Moreover, genetic factors and lifestyle habits could be \n\n\n\npotential contributing factors towards new cases of cancer [5].  \n\n\n\nFurthermore, another important issue that cannot be ignored is \n\n\n\nthe increasing treatment costs, leading to a consequent increase \n\n\n\n\n\n\n\n\nAyub F. et al. Mal J Pharm 8 (1) 2022, 42-56 \n\n\n\n\n\n\n\n43 \n\n\n\n\n\n\n\nin spending by the governments in order to acquire newly \n\n\n\ndeveloped treatments for the affected population [6].  \n\n\n\n\n\n\n\nIn Pakistan, the 5th most populated nation globally [7], cancer \n\n\n\nhas resulted in 10.0 million deaths in 2020 [4]. In addition, it \n\n\n\nhas been reported by GLOBOCAN that in 2020, about 2million \n\n\n\ncases of cancer were diagnosed in Pakistan (90373females and \n\n\n\n88015males), with breast cancer (14.5%) being the most \n\n\n\nprevalent cancer in Pakistan followed by lip and oral cavity \n\n\n\ncancer (9.5%), lung cancer (5.9%), cancer of the oesophagus \n\n\n\n(5.7%), and colorectal cancer (4.8%), with other types of \n\n\n\ncancer making up about 59.6% of cancer cases [8]. However, \n\n\n\nthe actual number of cases could be more than these as-reported \n\n\n\nfigures due to early mortalities and negligence in diagnosis of \n\n\n\npatients by health care providers [9]. Moreover, there is also \n\n\n\nlack of a national registry to date in order to timely document \n\n\n\nand report newly diagnosed cancer cases as well as the \n\n\n\nmortalities associated with them. \n\n\n\n\n\n\n\nThe recent development of new anticancer medicines, despite \n\n\n\ncontributing to an increase in range of available medicines, \n\n\n\ncauses an increase in the average cost of cancer medicines per \n\n\n\nmonth by approximately USD 100,000 from about USD 45,00 \n\n\n\nin 2014    to as much as USD300,000in 2015 (whereby 1USD \n\n\n\nis equivalent to 152.50PKR as of 20th April 2021) [10,11]. In \n\n\n\nthe context of the Pakistani healthcare setting, the availability \n\n\n\nof new drugs might put an additional burden on the health \n\n\n\nspending of the government, which could translate to an \n\n\n\nincrease in expenses paid by patients. These issues, of drugs, \n\n\n\nwould cause sufficient problems, not only by aggravating the \n\n\n\ndisease condition of patients, but also by being detrimental to \n\n\n\nthe affordability of these treatments among patients [12]. The \n\n\n\nprice of anticancer medicines is a great cause of worry for \n\n\n\nPakistani patients. In fact, it is believed that the income of an \n\n\n\naverage family would not be able to afford treatment \n\n\n\nconsidering the fact that 45.5% of the population live below the \n\n\n\npoverty line [13], an issue that persists despite constant \n\n\n\nendeavours by the National Health Ministry Services. In \n\n\n\naddition, most of these newly developed anticancer \n\n\n\nmedications would remain under patent protection for a \n\n\n\nspecific duration, potentially limiting the availability of their \n\n\n\nprospective lower-costing generic counterparts which could \n\n\n\nmitigate cost issues. In public and private sectors, the \n\n\n\navailability of generic medicines is found to be as low as 15% \n\n\n\nand 31% respectively [14]. In fact, such figures depicting \n\n\n\nmedication availability can be extrapolated even beyond \n\n\n\nPakistan, as evident from a study conducted in 49 European \n\n\n\ncountries [15].  \n\n\n\n\n\n\n\nThe current study aims to compare the prices of registered \n\n\n\nanticancer medicine brands in Pakistan and the price variation \n\n\n\nin their respective single-ingredient medicines. A large number \n\n\n\nof anticancer medicines, including those manufactured in \n\n\n\nPakistan as well as those that are imported, are sold under \n\n\n\ndifferent brand names by their respective national or \n\n\n\nmultinational pharmaceutical firms [16]. Therefore, a \n\n\n\ncomparison on the prices and price variations of various brands \n\n\n\nis necessary, particularly so for anticancer medicines. It is \n\n\n\nbelieved that data from this study would prove to be useful to \n\n\n\nprescribers, customers, and regulatory authorities in order to \n\n\n\nformulate and enforce more stringent policies aimed towards \n\n\n\nimproving the availability and accessibility to anticancer \n\n\n\nmedicines.   \n\n\n\n\n\n\n\nMETHODS  \n\n\n\n\n\n\n\nA data-based study was conducted from 1st March 2021 to 31st \n\n\n\nMay 2021. In situations where a comparison has to be made \n\n\n\nbetween two dosage forms (with the same active component) \n\n\n\nproduced by two different manufacturers, comparisons are \n\n\n\nmade on the basis of their active ingredients, specifically as \n\n\n\nthey appear in their respective salt forms(whereby each salt of \n\n\n\nan active alkylating agents, anti-metabolites, vincaalkoids, \n\n\n\ntaxanes, topoisomerase 1 inhibitor, miscellaneous agents, \n\n\n\nhormonal agents, biological agents, anti-cancer antibiotics, \n\n\n\ncytotoxic agents, aromatase inhibitor, anti-androgen, 5-\u03b1-\n\n\n\nreductase and histone deacetylase inhibitor are considered \n\n\n\nseparately) . \n\n\n\n\n\n\n\nStudy Design \n\n\n\n\n\n\n\nPharmaguide (Mobile Version 2020 \u2013 2021), Druginfosys.com \n\n\n\nand Medicialstore.com.pk and other relevant sources of pricing \n\n\n\nnotifications from the drug regulatory authority of Pakistan \n\n\n\nwere used to derive the prices of anticancer medications sold \n\n\n\nlocally in Pakistan. Pharmaguide is a reliable source of \n\n\n\ninformation related to the cost and availability of medications, \n\n\n\nserving as such for the past thirty years with consistent updates \n\n\n\nevery three months. Costs in Pharmaguide are presented as \n\n\n\nactual retail (consumer) costs as it is depicted on packs.  Dosage \n\n\n\nforms containing a combination of active ingredients (either \n\n\n\ndrug or drug salts) of different strengths, as they are \n\n\n\nmanufactured by one or multiple different manufactures, were \n\n\n\nexcluded from the study. \n\n\n\n\n\n\n\nPrice Estimation \n\n\n\n\n\n\n\nInformation concerning the quantity of registered brands, \n\n\n\nformulations, and manufacturer were collected, and \n\n\n\ninformation regarding the price of all enclosed medicine \n\n\n\nmanufactured by completely different manufacturers, with \n\n\n\nrespect to the varying strengths of medications, were identified \n\n\n\nand gathered into an MS excel sheet. In situations where \n\n\n\ncomparisons are made between items of different pack sizes, \n\n\n\nthe number of pills in each pack is used to compare their costs. \n\n\n\nThe difference in minimum and maximum costs of each \n\n\n\nformulation was calculated, whereby the value does not take \n\n\n\ninto account the manufacturer (that is, whether it was local or \n\n\n\n\n\n\n\n\nAyub F. et al. Mal J Pharm 8 (1) 2022, 42-56 \n\n\n\n\n\n\n\n44 \n\n\n\n\n\n\n\nmultinational) of the more costly brands [17]. Furthermore, the \n\n\n\ncost of medicines with only a single brand is calculated by \n\n\n\nobtaining the difference between the maximum price of per unit \n\n\n\ntablet and the minimum cost of the per unit tablet, with 15% \n\n\n\nprofit compared to the actual price [18]. To elaborate further on \n\n\n\nthat point, the medicines had been sold by retail pharmacies \n\n\n\nwith 15% profit to their customers. Therefore, the retail price \n\n\n\nwas considered to be the maximum price and the trade price \n\n\n\n(which is 15% less than the retail price) is considered to be the \n\n\n\nminimum price. Medicines were classified based on their \n\n\n\npharmacological categories; alkylating agents, anti-\n\n\n\nmetabolites, vincaalkolides, taxanes, topoisomerase 1 inhibitor, \n\n\n\nhormonal agents, targeted therapy/biological agents, anti-\n\n\n\ncancer antibiotics, cytotoxic agents, aromatase inhibitor agents, \n\n\n\nanti-androgen agents, 5-\u03b1 \u2013reductase agents, miscellaneous \n\n\n\nagents, and histone deacetylase inhibitor agents. \n\n\n\n\n\n\n\nData Analysis \n\n\n\n\n\n\n\n All brands of the varying salts of anticancer medicines \n\n\n\nregistered in the country were noted in conjunction with the \n\n\n\nretail value per unit pill. Then, the specific details pertaining to \n\n\n\nthe type of drug (with specification of its salt species) are \n\n\n\ntabulated, while including a number of important factors such \n\n\n\nas the number of brands associated with the drug, the \n\n\n\ncorresponding doses of the drug and their contribution, by \n\n\n\npercentage, within their drug class as well as with respect to \n\n\n\ntheir brands. The brands of each drug with the least and most \n\n\n\nvalue for their price were identified. Finally, with the \n\n\n\nconsideration of all the prices of anticancer drugs (inclusive of \n\n\n\nall brands) that had been gathered in the datasheet, the \n\n\n\ndifference between the highest and lowest value was \n\n\n\ncalculated, from which, the value of price variation was \n\n\n\ncalculated as follows [19]: \n\n\n\nRESULT \n\n\n\n\n\n\n\nA total of 81 drugs were registered with 115 different strengths \n\n\n\n(mg). In total 560 brands for 14 different classes of anticancer \n\n\n\nmedications were identified. Of the many classes of anticancer \n\n\n\nmedications studied in this research, the highest contribution is \n\n\n\nseen in hormonal agents with a total contribution of 20.53% \n\n\n\n(115 / 560), while anti-metabolites were found to be second, \n\n\n\naccount for 15.35% (86 / 560). The details are described in \n\n\n\nTable I. \n\n\n\n\n\n\n\nThe results show that the letrozole (2.5mg) tablets is ranked top \n\n\n\namong the retailed medications across 19 registered brands, \n\n\n\nmaking up 3.39% (19 / 560) of the total registered brands of \n\n\n\nanticancer drugs, followed by ibandronic acid (150mg) tablets \n\n\n\nat 2.85% (16 / 560) and p Prednisolone(5mg) tablets at 2.32% \n\n\n\n(13/560). Tamoxifen (10mg) tablets follow suit with a share of \n\n\n\n2.14% (12 / 560) among total registered brands of anticancer \n\n\n\nmedication. The percentage contribution of all the anticancer \n\n\n\nmedications within their classes, with respect to their registered \n\n\n\nanti-cancer brands, are presented in Table II. \n\n\n\nWith relation to the price variations within the alkylating agents \n\n\n\ngroup, the maximum cost variation was 159.61%  (with price \n\n\n\nper tablet ranging from PKR 1363 to PKR 525), as seen in \n\n\n\nifosfamide (1g), while the minimum cost variation was 8.0% \n\n\n\n(with a price per tablet of PKR 540 to PKR 500), as seen in \n\n\n\ndecarbazine 200mg. However, among the anti-metabolites, 5-\n\n\n\nfluurouracil (250mg / mL) injections demonstrated the highest \n\n\n\nprice variation, that is, 1520% (with a price per tablet of PKR \n\n\n\n810 to PKR 50), and the minimum cost variation was 17.71% \n\n\n\nas seen in 6-mercaptopurine (50mg) tablets. Among Vinca \n\n\n\nalkaloids, the highest price variation was noted in vinblastine \n\n\n\n(10mg / ml) injections, that is, 48.75% (price per tablet of PKR \n\n\n\n595 to PKR 400), while vinorelbine 10mg/ml demonstrated the \n\n\n\nminimum price variation of the group at 17.64%.   \n\n\n\n\n\n\n\nIn the cytotoxic agents\u2019 group, the maximum price variation is \n\n\n\n658.82%, as shown by etoposide (5mg) tablets, while the \n\n\n\nminimum price variation within in the group was 20%, as seen \n\n\n\nfor etoposide (20mg) tablets. Finasteride was the only drug of \n\n\n\nthe 5-\u03b1-reductase inhibitors that was available in three different \n\n\n\nstrengths, the maximum and minimum price variation was \n\n\n\n47.61% and 37.71% for its 1mg and 5mg strengths \n\n\n\nrespectively. Meanwhile, flutamide (250mg) and (calutamide) \n\n\n\n50mg, two drugs among the anti-androgen agents, the \n\n\n\nmaximum and minimum price variations was noted to be \n\n\n\n40.84% and 547.69% respectively. Letrozole and anastrazole \n\n\n\nPrice of most expensive brand- Price of least expensive brand) X 100 \n\n\n\n                        (Price of least expensive brand) \n\n\n\nTable I. Contribution of anticancer in total registered brands \n\n\n\n\n\n\n\nDrug Class \n\n\n\nNo. of \n\n\n\nMolecules in \n\n\n\nEach Class \n\n\n\nTotal \n\n\n\nBrands of \n\n\n\nall Strength \n\n\n\n% Age in \n\n\n\nTotal \n\n\n\n\n\n\n\nAlkylating Agents \n8 37 6.6 \n\n\n\nAnti-metabolites 8 86 15.35 \n\n\n\nVincaalkolids 3 24 4.28 \n\n\n\nTaxanes 2 52 9.28 \n\n\n\nTopoisomerase1 \n\n\n\ninhibitor \n2 15 2.67 \n\n\n\nMiscellanous 2 45 8.03 \n\n\n\nHormonal Agents 13 115 20.53 \n\n\n\nBiological agents/ \n\n\n\nTargeted therapy \n26 59 10.53 \n\n\n\nAnti-cancer \n\n\n\nantibiotics \n8 64 11.6 \n\n\n\nCytotoxic 3 18 3.21 \n\n\n\nAromatase inhibitor 2 23 4.1 \n\n\n\nAnti-androgen 2 9 1.6 \n\n\n\n5-\u03b1-reductase 1 10 1.78 \n\n\n\nHistone deacetylase \n\n\n\ninhibitor \n1 2 0.35 \n\n\n\nTOTAL 81 559 99.91 \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nAyub F. et al. Mal J Pharm 8 (1) 2022, 42-56 \n\n\n\n\n\n\n\n45 \n\n\n\n\n\n\n\nwere the two drugs of the aromatase inhibitor class, with \n\n\n\nmaximum and minimum price variations of 700 % and 39.18% \n\n\n\nfor the 2.5mg and 1mg strengths of different drugs respectively. \n\n\n\nOf the hormonal agents, the maximum price variation is \n\n\n\n1674.54% (price per tablet of PKR 6832 to PKR 385) as seen \n\n\n\nfor ibandronic acid 150mg, while the minimum price variation \n\n\n\nis 4.01%, as shown by abiraterone acetate (250mg). As for \n\n\n\ntaxanes, docetaxel 20mg / ml showed a maximum price \n\n\n\nvariation of 386.66%, while the minimum price variation is \n\n\n\n4.66% as seen for paclitaxel (300mg / mL)\n\n\n\n\n\n\n\nClass Num. of Brands Strength Contribution within class Contribution on in Total Brands (%) \n\n\n\nAlkylating agents \n\n\n\n  Cyclophosphamide 3 1000mg 8.10 0.53 \n\n\n\n  Cyclophosphamide 2 500mg 5.40 0.35 \n\n\n\n  Cyclophosphamide 1 200mg 2.70 0.17 \n\n\n\n  Ifosfamide 2 2g 5.40 0.35 \n\n\n\n  Ifosfamide 3 1000mg 8.10 0.53 \n\n\n\n  Decarbazine 3 200mg 8.10 0.53 \n\n\n\n  Oxaliplatin 8 100mg 21.6 1.42 \n\n\n\n  Oxaliplatin 8 50mg 21.6 1.42 \n\n\n\n  Oxaliplatin 1 150mg 2.70 0.17 \n\n\n\n  Melphalan 1 2mg 2.70 0.17 \n\n\n\n  Chlorambucil 1 2mg 2.70 0.17 \n\n\n\n  Chlorambucil 1 5mg 2.70 0.17 \n\n\n\n  Lomustine 1 40mg 2.70 0.17 \n\n\n\n  Dibromodulcitol 1 250mg 2.70 0.17 \n\n\n\n  Dibromodulcitol 1 50mg 2.70 0.17 \n\n\n\nAnti-metabolites \n\n\n\n  Methotreaxte 10 2.5mg 11.62 1.78 \n\n\n\n  Methotreaxte 7 10mg 8.13 1.25 \n\n\n\n  Methotreaxte 4 50mg / vial 4.65 0.71 \n\n\n\n  Methotreaxte 1 25mg / vial 1.16 0.17 \n\n\n\n  Methotreaxte 2 5mg / vial 2.32 0.35 \n\n\n\n  Methotreaxte 1 550mg / vial 1.16 0.17 \n\n\n\n  Methotreaxte 1 1000mg / vial 1.16 0.17 \n\n\n\n  Methotreaxte 1 1000mg / 10ml 1.16 0.17 \n\n\n\n  Methotreaxte 1 50mg / 2ml 1.16 0.17 \n\n\n\n  Methotreaxte 1 50mg / 10ml 1.16 0.17 \n\n\n\n  Methotreaxte 1 500mg / 20ml 1.16 0.17 \n\n\n\n  Methotreaxte 1 500mg / vial 1.16 0.17 \n\n\n\n  5-fluurouracil 1 200mg 1.16 0.17 \n\n\n\n  5-fluurouracil 4 50mg / ml 4.65 0.71 \n\n\n\n  5-fluurouracil 3 50mg / 5ml 3.48 0.53 \n\n\n\n  5-fluurouracil 1 50mg / 10ml 1.16 0.17 \n\n\n\n  5-fluurouracil 3 500mg / ml 3.48 0.53 \n\n\n\n  5-fluurouracil 2 250mg / ml 2.32 0.35 \n\n\n\n  5-fluurouracil 1 25mg / 10ml 1.16 0.17 \n\n\n\n  5-fluurouracil 1 25mg / 20ml 1.16 0.17 \n\n\n\n  5-fluurouracil 1 100mg 1.16 0.17 \n\n\n\n  5-fluurouracil 1 100mg / ml 1.16 0.17 \n\n\n\n  Cytarabine 7 100mg / vial 8.13 1.25 \n\n\n\n  Cytarabine 4 500mg / vial 4.65 0.71 \n\n\n\n  Cytarabine 1 1000mg / vial 1.16 0.17 \n\n\n\n  6-mercaptopurine 2 50mg 2.32 0.35 \n\n\n\n  6-thioguanine 1 40mg 1.16 0.17 \n\n\n\n  Pemetrexed injection 1 100mg / vial 1.16 0.17 \n\n\n\n  Pemetrexed injection 1 500mg / vial 1.16 0.17 \n\n\n\nTable II. Contribution of registered brands in different classes and individual anticancer \n\n\n\n\n\n\n\n\nAyub F. et al. Mal J Pharm 8 (1) 2022, 42-56 \n\n\n\n\n\n\n\n46 \n\n\n\n\n\n\n\nClass Num. of Brands Strength Contribution within class Contribution on in Total Brands (%) \n\n\n\n\n\n\n\n  Trifluridine/tipiricil 1 15mg 1.16 0.17 \n\n\n\n  Trifluridine/tipiricil 1 20mg 1.16 0.17 \n\n\n\n  Bendamustine Hydochloride 1 100mg / ml 1.16 0.17 \n\n\n\n  Gemcitabine 8 1000mg / vial 9.3 1.42 \n\n\n\n  Gemcitabine 1 1000mg / 50ml 1.16 0.17 \n\n\n\n  Gemcitabine 8 200mg / vial 9.3 1.42 \n\n\n\n  Gemcitabine 1 200mg / 10ml 1.16 0.17 \n\n\n\nVinca Alkakoids \n\n\n\n  Vincristine 10 1mg / ml 41.66 1.78 \n\n\n\n  Vincristine 3 2mg / ml 12.5 0.53 \n\n\n\n  Vinblastine 2 10mg / vial 8.33 0.35 \n\n\n\n  Vinorelbine 4 10mg / ml 16.66 0.71 \n\n\n\n  Vinorelbine 5 50mg / ml 20.83 0.89 \n\n\n\nHistone Deacetylase Inhibitor \n\n\n\n  Farydak 1 20mg 50 0.17 \n\n\n\n  Farydak 1 15mg 50 0.17 \n\n\n\n5-\u03b1-reductase \n\n\n\n  Finasteride 3 1mg 30 0.53 \n\n\n\n  Finasteride 6 5mg 60 1.07 \n\n\n\n  Finasteride 1 300mcg / vial 10 0.17 \n\n\n\nAnti-androgen \n\n\n\n  Flutamide 4 250mg 44.44 0.71 \n\n\n\n  Calutamide 5 50mg 55.55 0.89 \n\n\n\nAromatase inhibitor \n\n\n\n  Letrozole 19 2.5mg 82.60 3.39 \n\n\n\n  Anastrazole 1 1mg / vial 4.34 0.17 \n\n\n\n  Anastrazole 3 1mg 13.04 0.53 \n\n\n\nCytotoxic Agents \n\n\n\n  Capecitabine 3 500mg 16.66 0.53 \n\n\n\n  Pixantrone Dimaleate 1 29mg / ml 5.55 0.17 \n\n\n\n  Etoposide 2 50mg 11.11 0.35 \n\n\n\n  Etoposide 6 20mg / 5ml 33.33 1.07 \n\n\n\n  Etoposide 4 20mg / ml 22.22 0.71 \n\n\n\n  Etoposide 1 100mg / 5ml 5.55 0.17 \n\n\n\n  Etoposide 1 100mg / ml 5.55 0.17 \n\n\n\nTaxanes \n\n\n\n  Paclitaxel 5 6mg / ml 9.61 0.89 \n\n\n\n  Paclitaxel 8 30mg / ml 15.38 1.42 \n\n\n\n  Paclitaxel 5 150mg / ml 9.61 0.89 \n\n\n\n  Paclitaxel 1 100mg / 16.7ml 1.92 0.17 \n\n\n\n  Paclitaxel 3 100mg / ml 5.76 0.53 \n\n\n\n  Paclitaxel 2 260mg / ml 3.84 0.35 \n\n\n\n  Paclitaxel 4 300mg / ml 7.69 0.71 \n\n\n\n  Paclitaxel 1 210mg / ml 1.92 0.17 \n\n\n\n  Paclitaxel 3 6mg / 5ml 5.76 0.53 \n\n\n\n  Paclitaxel 1 6mg / 16.7ml 1.92 0.17 \n\n\n\n  Docetaxel 9 20mg / ml 17.30 1.60 \n\n\n\n  Docetaxel 4 80mg / ml 7.69 0.71 \n\n\n\n  Docetaxel 3 20mg / 0.5ml 5.76 0.53 \n\n\n\n  Docetaxel 3 80mg / 0.5ml 5.76 0.53 \n\n\n\nTopoisomerase 1 inhibitor     \n\n\n\n  Irinotecan 2 40mg / vial 14.28 0.35 \n\n\n\n  Irinotecan 5 100mg / vial 35.71 0.89 \n\n\n\n  Irinotecan 2 100mg / 5ml 14.28 0.35 \n\n\n\n  Irinotecan 2 40mg / 2ml 14.28 0.35 \n\n\n\n\n\n\n\n\nAyub F. et al. Mal J Pharm 8 (1) 2022, 42-56 \n\n\n\n\n\n\n\n47 \n\n\n\n\n\n\n\nClass Num. of Brands Strength Contribution within class Contribution on in Total Brands (%) \n\n\n\n\n\n\n\n  Irinotecan 1 40mg / 5ml 7.14 0.17 \n\n\n\n  Topotecan 3 4mg / ml 21.42 0.53 \n\n\n\nMiscellaneous Agents \n\n\n\n  Cisplatin 7 50mg / ml 15.55 1.25 \n\n\n\n  Cisplatin 5 10mg / ml 11.11 0.89 \n\n\n\n  Cisplatin 4 10mg / 20mg 8.88 0.71 \n\n\n\n  Cisplatin 1 50mg / 50ml 2.22 0.17 \n\n\n\n  Cisplatin 1 1mg / 100ml 2.22 0.17 \n\n\n\n  Cisplatin 4 50mg / 100ml 8.88 0.71 \n\n\n\n  Cisplatin 2 25mg / ml 4.44 0.35 \n\n\n\n  Cisplatin 1 100mg / ml 2.22 0.17 \n\n\n\n  Carboplatin 2 200mg / 20ml 4.44 0.35 \n\n\n\n  Carboplatin 6 150mg / 15ml 13.33 1.07 \n\n\n\n  Carboplatin 6 450mg / 45ml 13.33 1.07 \n\n\n\n  Carboplatin 4 50mg / 5ml 8.88 0.71 \n\n\n\n  Carboplatin 1 150mg / vial 2.22 0.17 \n\n\n\n  Carboplatin 1 450mg / vial 2.22 0.17 \n\n\n\nAnti-cancer antibiotics \n\n\n\n  Doxorubicin 10 10mg / vial 15.38 1.78 \n\n\n\n  Doxorubicin 9 50mg / vial 13.84 1.60 \n\n\n\n  Doxorubicin 3 10mg / 5ml 4.61 0.53 \n\n\n\n  Doxorubicin 3 50mg / 25ml 4.61 0.53 \n\n\n\n  Doxorubicin 2 20mg / vial 3.07 0.35 \n\n\n\n  Doxorubicin 1 10mg / 10ml 1.53 0.17 \n\n\n\n  Doxorubicin 1 50mg / 50ml 1.53 0.17 \n\n\n\n  Daunorubicin 5 20mg / vial 7.69 0.89 \n\n\n\n  Bleomycin 4 15mg 6.15 0.71 \n\n\n\n  Mitomycin C 3 10mg / vial 4.61 0.53 \n\n\n\n  Mitomycin C 2 2mg / vial 3.07 0.35 \n\n\n\n  Epirubicin HCL 3 10mg / 5ml 4.61 0.53 \n\n\n\n  Epirubicin HCL 3 50mg / 25ml 4.61 0.53 \n\n\n\n  Epirubicin HCL 1 10mg / vial 1.53 0.17 \n\n\n\n  Epirubicin HCL 2 50mg / vial 3.07 0.35 \n\n\n\n  Epirubicin HCL 1 2mg / ml 1.53 0.17 \n\n\n\n  Idarubicin Hydrochloride 1 5mg / vial 1.53 0.17 \n\n\n\n  Idarubicin Hydrochloride 2 10mg / vial 3.07 0.35 \n\n\n\n  Idarubicin Hydrochloride 1 20mg / 20ml 1.51 0.17 \n\n\n\n  Dactinomycin. 2 0.5mg / 3ml 3.07 0.35 \n\n\n\n  Trastuzumab 1 160mg / vial 1.51 0.17 \n\n\n\n  Trastuzumab 1 100mg / vial 1.51 0.17 \n\n\n\n  Trastuzumab 1 600mg / 5ml 1.51 0.17 \n\n\n\n  Trastuzumab 1 440mg / 20ml 1.51 0.17 \n\n\n\n  Trastuzumab 1 150mg / vial 1.51 0.17 \n\n\n\nBiological Agents/Targated therapy \n\n\n\n  Bevacizumab 1 100mg / 4ml 1.69 0.17 \n\n\n\n  Bevacizumab 1 400mg / 16ml 1.69 0.17 \n\n\n\n  Erlotinib 2 150mg 3.38 0.35 \n\n\n\n  Erlotinib 1 25mg 1.69 0.17 \n\n\n\n  Erlotinib 2 100mg 3.38 0.35 \n\n\n\n  Everolimus 1 0.5mg 1.69 0.17 \n\n\n\n  Everolimus 1 5mg 1.69 0.17 \n\n\n\n  Everolimus 1 10mg 1.69 0.17 \n\n\n\n  Everolimus 1 0.5mg 1.69 0.17 \n\n\n\n  Everolimus 1 0.75mg 1.69 0.17 \n\n\n\n  Everolimus 1 0.25mg 1.69 0.17 \n\n\n\n\n\n\n\n\nAyub F. et al. Mal J Pharm 8 (1) 2022, 42-56 \n\n\n\n\n\n\n\n48 \n\n\n\n\n\n\n\nClass Num. of Brands Strength Contribution within class Contribution on in Total Brands (%) \n\n\n\n\n\n\n\n  Gefitnib 1 250mg 1.69 0.17 \n\n\n\n  Imatinib 2 400mg 3.38 0.35 \n\n\n\n  Imatinib 2 100mg 3.38 0.35 \n\n\n\n  Lapatinib 1 250mg 1.69 0.17 \n\n\n\n  Nilotinib 1 150mg 1.69 0.17 \n\n\n\n  Nilotinib 1 200mg 1.69 0.17 \n\n\n\n  Pazopanib 1 200mg 1.69 0.17 \n\n\n\n  Pazopanib 1 400mg 1.69 0.17 \n\n\n\n  Ruxolitinib 1 5mg 1.69 0.17 \n\n\n\n  Ruxolitinib 1 15mg 1.69 0.17 \n\n\n\n  Ruxolitinib 1 20mg 1.69 0.17 \n\n\n\n  Sorafenib 3 200mg 5.08 0.53 \n\n\n\n  Sunitinib 1 12.5mg 1.69 0.17 \n\n\n\n  Sunitinib 1 25mg 1.69 0.17 \n\n\n\n  Sunitinib 1 50mg 1.69 0.17 \n\n\n\n  Ocrelizumab 1 300mg / 10ml 1.69 0.17 \n\n\n\n  Ramucirumab 1 10mg / ml 1.69 0.17 \n\n\n\n  Olaratumab 1 500mg / 50ml 1.69 0.17 \n\n\n\n  Halaven 1 0.88mg / 2ml 1.69 0.17 \n\n\n\n  Atezolizumab 1 1200mg / 20ml 1.69 0.17 \n\n\n\n  Palbociclib 1 75mg 1.69 0.17 \n\n\n\n  Palbociclib 1 100mg 1.69 0.17 \n\n\n\n  Palbociclib 1 125mg 1.69 0.17 \n\n\n\n  Ceritinib 1 150mg 1.69 0.17 \n\n\n\n  Lenalidomide 1 5mg 1.69 0.17 \n\n\n\n  Lenalidomide 2 10mg 3.38 0.35 \n\n\n\n  Lenalidomide 1 15mg 1.69 0.17 \n\n\n\n  Lenalidomide 1 25mg 1.69 0.17 \n\n\n\n  Bortezomib 1 2mg / vial 1.69 0.17 \n\n\n\n  Bortezomib 1 3.5mg / vial 1.69 0.17 \n\n\n\n  Trametinib 1 0.5mg 1.69 0.17 \n\n\n\n  Trametinib 1 2mg 1.69 0.17 \n\n\n\n  Dabrafenib 1 50mg 1.69 0.17 \n\n\n\n  Dabrafenib 1 75mg 1.69 0.17 \n\n\n\n  Ribociclib 1 200mg 1.69 0.17 \n\n\n\n  Ribociclib 1 600mg 1.69 0.17 \n\n\n\n  Cetuximab 1 5mg / ml 1.69 0.17 \n\n\n\n  Rituximab 1 100mg / 10ml 1.69 0.17 \n\n\n\n  Rituximab 1 500mg / 50ml 1.69 0.17 \n\n\n\n  Rituximab 1 10mg / 10ml 1.69 0.17 \n\n\n\n  Rituximab 1 10mg / 50ml 1.69 0.17 \n\n\n\nHormonal Agents \n\n\n\n  Estradiol (Valerate) 2 5mg / ml 1.73 0.35 \n\n\n\n  Estradiol (Valerate) 1 10mg / 3ml 0.86 0.17 \n\n\n\n  Estradiol (Valerate) 3 2mg 2.60 0.53 \n\n\n\n  Ethinylestradiol 2 5mg / ml 1.73 0.35 \n\n\n\n  Ethinylestradiol 7 0.02mg 6.08 1.25 \n\n\n\n  Ethinylestradiol 1 0.05mg 0.86 0.17 \n\n\n\n  Ethinylestradiol 1 2mg 0.86 0.17 \n\n\n\n  Ethinylestradiol 1 35mcg 0.86 0.17 \n\n\n\n  Ethinylestradiol 10 0.03mg 8.69 1.78 \n\n\n\n  Ethinylestradiol 1 0.035mg 0.86 0.17 \n\n\n\n  Ethinylestradiol 1 0.035mcg 0.86 0.17 \n\n\n\n  Ethinylestradiol 1 35mg 0.86 0.17 \n\n\n\n  Ethinylestradiol 1 0.02mg / ml 0.86 0.17 \n\n\n\n\n\n\n\n\nAyub F. et al. Mal J Pharm 8 (1) 2022, 42-56 \n\n\n\n\n\n\n\n49 \n\n\n\n\n\n\n\nClass Num. of Brands Strength Contribution within class Contribution on in Total Brands (%) \n\n\n\n\n\n\n\n  Prednisilone 13 5mg 11.3 2.32 \n\n\n\n  Methylprednisilone 2 1000mg / vial 1.73 0.35 \n\n\n\n  Methylprednisilone 4 40mg / ml 3.47 0.71 \n\n\n\n  Methylprednisilone 2 40mg / 2ml 1.73 0.35 \n\n\n\n  Methylprednisilone 1 80mg / 2ml 0.86 0.17 \n\n\n\n  Methylprednisilone 1 125mg / 2ml 0.86 0.17 \n\n\n\n  Methylprednisilone 2 500mg / vial 1.73 0.35 \n\n\n\n  Tamoxifen 12 10mg 10.43 2.14 \n\n\n\n  Tamoxifen 8 20mg 6.95 1.42 \n\n\n\n  Exemestane 1 25mg 0.86 0.17 \n\n\n\n  Megestrol 3 40mg 2.60 0.53 \n\n\n\n  Megestrol 3 160mg 2.60 0.53 \n\n\n\n  Abiraterone acetate 1 250mg 0.86 0.17 \n\n\n\n  Ibandronic acid 16 150mg 13.91 2.85 \n\n\n\n  Ibandronic acid 3 3mg / 3ml 2.60 0.53 \n\n\n\n  Ibandronic acid 1 6mg / 6ml 0.86 0.17 \n\n\n\n  Ibandronic acid 1 2mg / 2ml 0.86 0.17 \n\n\n\n  Ibandronic acid 1 168.75mg 0.86 0.17 \n\n\n\n  Ibandronic acid 1 2.5mg 0.86 0.17 \n\n\n\n  Ibandronic acid 1 1mg / ml 0.86 0.17 \n\n\n\n  Stilboesterol 1 0.5mg 0.86 0.17 \n\n\n\n  Stilboesterol 1 120mg 0.86 0.17 \n\n\n\n  Fulvestrant 1 50mg / ml 0.86 0.17 \n\n\n\n  Lenvatinib (As Mesilate) 1 4mg 0.86 0.17 \n\n\n\n  Lenvatinib (As Mesilate) 1 10mg 0.86 0.17 \n\n\n\n  L-asparaginase 1 1000IU 0.86 0.17 \n\n\n\n\n\n\n\n\n\n\n\nAmong miscellaneous agents, different doses of cisplatin \n\n\n\nconsisted of the most expensive and cheap brands, specifically, \n\n\n\nthe 50mg / ml and 10mg / 20ml variations demonstrated price \n\n\n\ndifference of 646.7% and 8 % price respectively. Among anti-\n\n\n\ncancer antibiotics, highest price difference was found in \n\n\n\ndoxorubicin (20mg / vial) injections (7092.98%), while the \n\n\n\nsmallest price difference was 5.36% as seen in epirubicin HCl \n\n\n\n50mg/vials. In the group of biological agents, erlotinib 150mg \n\n\n\nshowed the maximum price variation of 13418.29%, while the \n\n\n\nminimum price variation was 5.32% as seen in imatinib 100mg. \n\n\n\nAmong topoisomerase 1 inhibitors, the highest price variation \n\n\n\nof 19912.25% was found in Topotecan 4mg / ml, while the \n\n\n\nsmallest variation was 5.26% as seen in irinotecan 100mg / \n\n\n\n5m.l Panobinostat was the only histone deacetylase inhibitor \n\n\n\ndrug available in two different strengths (20mg and 15mg). The \n\n\n\ndata on the percentage of price variation among different \n\n\n\nbrands is summarized in Table III. \n\n\n\n\n\n\n\nDRUG \nDosage \n\n\n\nform \nDOSE (mg) \n\n\n\nNo. of Manuf. \n\n\n\nCompanies \n\n\n\nMaximum price per \n\n\n\ntablet (PKR) \n\n\n\nMinimum price per \n\n\n\ntablet (PKR) \n\n\n\nPercentage \n\n\n\nvariation (%) \n\n\n\nAlkylating agents \n\n\n\nCyclophosphamide Injection 1000mg 3 358 220 62.72 \n\n\n\n  500mg 2 120 110 9.09 \n\n\n\nIfosfamide Injection 2000mg 2 2272 2000 13.6 \n\n\n\n  1000mg 3 1363 525 159.61 \n\n\n\nDecarbazine Injection 200mg 3 540 500 8 \n\n\n\nOxaliplatin Injection 100mg 8 21554 16000 34.17 \n\n\n\n  50mg 8 10777.36 8900 21.09 \n\n\n\nAnti-metabolites \n\n\n\nMethotreaxte Tablet 2.5mg 10 8 3.82 109.42 \n\n\n\n  10mg 7 29.2 14.66 99.18 \n\n\n\n Injection 50mg / vial 4 237.6 194.5 22.15 \n\n\n\n  5mg / vial 2 180 84 114.2 \n\n\n\n5-fluurouracil Injection 50mg / ml 4 130 61.7 110.69 \n\n\n\n  50mg / 5ml 3 84 40 110 \n\n\n\nTable III. Percentage Variations among different brands \n\n\n\n\n\n\n\n\nAyub F. et al. Mal J Pharm 8 (1) 2022, 42-56 \n\n\n\n\n\n\n\n50 \n\n\n\n\n\n\n\nDRUG \nDosage \n\n\n\nform \nDOSE (mg) \n\n\n\nNo. of Manuf. \n\n\n\nCompanies \n\n\n\nMaximum price per \n\n\n\ntablet (PKR) \n\n\n\nMinimum price per \n\n\n\ntablet (PKR) \n\n\n\nPercentage \n\n\n\nvariation (%) \n\n\n\n\n\n\n\n  500mg / ml 3 162 80 102.5 \n\n\n\n  250mg / ml 2 810 50 1520 \n\n\n\nCytarabine Injection 100mg / ml 7 180   \n\n\n\n  500mg / vial 4 867 500 73.4 \n\n\n\n6-mercaptopurine Tablet 50mg 2 8.24 7 17.71 \n\n\n\nGemcitabine  Injection 1000mg / vial 8 10100 8330 21.24 \n\n\n\n  200mg / vial 8 2050 1675 22.38 \n\n\n\nVinca Alkakoids       \n\n\n\nVincristine Injection 1mg / ml 10 450 142 216.9 \n\n\n\n  2mg / ml 3 319 231 38.09 \n\n\n\nVinblastine Injection 10mg / vial 2 595 400 48.75 \n\n\n\nVinorelbine   Injection 50mg / ml 5 9856 8370 17.75 \n\n\n\n  10mg / ml 4 2200 1870 17.64 \n\n\n\n5-\u03b1-reductase       \n\n\n\nFinasteride Tablet 1mg 3 9.3 6.3 47.61 \n\n\n\n  5mg 5 48.2 35 37.71 \n\n\n\nAnti-androgen Agents      \n\n\n\nFlutamide Tablet 250mg 4 50 35.5 40.84 \n\n\n\nCalutamide Tablet 50mg 5 421 65 547.69 \n\n\n\nAromatase inhibitor      \n\n\n\nLetrozole Tablet 2.5mg 19 600 75 700 \n\n\n\nAnastrazole Tablet 1mg 3 238 171 39.18 \nCytotoxic Agents      \n\n\n\nCapecitabine Tablet 500mg 3 208.33 140 48.8 \n\n\n\nEtoposide Capsule 50mg 2 258 34 658.82 \n\n\n\n Injection 20mg / 5ml 6 846 376 125 \n\n\n\n  20mg / ml 4 660 550 20 \n\n\n\nHormonal Agents      \n\n\n\nEstradiol (Valerate) Injection 5mg / ml 2 21.6 15 44 \n\n\n\n Tablet 2mg 3 9 6.5 38.46 \n\n\n\nPrednisilone Tablet 5mg 13 2.78 0.34 717.64 \n\n\n\nMethylprednisilone  Injection 40mg / ml 4 140 103 35.92 \n\n\n\n  40mg / 2ml 2 235 160 46.87 \n\n\n\n  500mg / vial 2 1205 889 35.54 \n\n\n\n  1000mg / vial 2 2285 1680 36.01 \n\n\n\nEthinylestradiol Injection 5mg / ml 2 21 7 200 \n\n\n\n Tablet 0.02mg 7 15.23 5 204.6 \n\n\n\n  0.03mg 10 2 0.23 769.56 \n\n\n\nIbandronic acid  Tablet 150mg 16 6832 385 1674.54 \n\n\n\n Injection 3mg / 3ml 3 7138 1540 363.5 \n\n\n\nTamoxifen Tablet 10mg 12 22.75 8.6 164.53 \n\n\n\n  20mg 8 29.7 8 271.25 \n\n\n\nMegestrol Tablet 40mg 3 50 11 354.54 \n\n\n\n  160mg 3 53.4 43.33 23.24 \n\n\n\nAbiraterone acetate Tablet 250mg 2 1167 1122 4.01 \n\n\n\nTaxanes       \n\n\n\nPaclitaxel Injection 6mg / ml 5 5936 2500 137.44 \n\n\n\n  30mg / ml 8 6000 3500 71.42 \n\n\n\n  150mg / ml 5 22500 12200 84.42 \n\n\n\n  100mg / ml 3 9000 7650 17.64 \n\n\n\n  260mg / ml 2 17300 14705 17.64 \n\n\n\n  300mg / ml 4 20325 19420 4.66 \n\n\n\nDocetaxel Injection 20mg / ml 9 36500 7500 386.66 \n\n\n\n  80mg / ml 4 24000 20000 20 \n\n\n\n  20mg / 0.5ml 3 8000 7200 11.11 \n\n\n\n  80mg / 0.5ml 3 20000 17000 17.64 \n\n\n\nMiscellaneous Agents       \n\n\n\nCisplatin Injection 50mg / ml 7 1247 167 646.7 \n\n\n\n  10mg / ml 5 200 122 63.93 \n\n\n\n  10mg / 20ml 4 216 200 8 \n\n\n\n  50mg / 100ml 4 778 523 48.75 \n  25mg / ml 2 494 289 70.93 \n\n\n\nCarboplatin Injection 200mg / 20ml 2 3888 958 305.84 \n\n\n\n  150mg / 15ml 6 4102 1300 215.53 \n\n\n\n  450mg / 45ml 6 4450 1463 204.16 \n\n\n\n  50mg / 5ml 4 1131 700 61.57 \n\n\n\n\n\n\n\n\nAyub F. et al. Mal J Pharm 8 (1) 2022, 42-56 \n\n\n\n\n\n\n\n51 \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nDRUG \nDosage \n\n\n\nform \nDOSE (mg) \n\n\n\nNo. of Manuf. \nCompanies \n\n\n\nMaximum price per \ntablet (PKR) \n\n\n\nMinimum price per \ntablet (PKR) \n\n\n\nPercentage \nvariation (%) \n\n\n\n\n\n\n\nAnti-cancer antibiotics      \n\n\n\nDoxorubicin Injection 10mg / vial 10 701 257 172.76 \n\n\n\n  50mg / vial 9 2394 1000 139.4 \n\n\n\n  10mg / 5ml 3 470 430 9.3 \n\n\n\n  50mg / 25ml 3 2090 1000 109 \n\n\n\n  20mg / vial 2 41000 570 7092.98 \n\n\n\nDaunorubicin Injection 20mg / vial 5 728 570 27.71 \n\n\n\nBleomycin Tablet 15mg 4 1100 1000 10 \n\n\n\nMitomycin C Injection 10mg / vial 3 627 62.7 900 \n\n\n\n  2mg / vial 2 180 18 900 \n\n\n\nEpirubicin HCL  Injection 10mg / 5ml 3 788 670 17.61 \n\n\n\n  50mg / 25ml 3 3635 2500 45.4 \n\n\n\n  50mg / vial 2 3635 3450 5.36 \n\n\n\nIdarubicin \n\n\n\nhydrochloride \n\n\n\nInjection 10mg / vial 2 9355 6400 46.17 \n\n\n\nDactinomycin. Injection 0.5mg / vial 2 292 240  \n\n\n\nBiological Agents / Targated therapy                    \n\n\n\nErlotinib Tablet 150mg 2 6866.67 847 13418.29 \n\n\n\n  100mg 2 5571.06 677  \n\n\n\nImatinib Tablet 400mg 2 4666.67 1666.7 179.99 \n\n\n\n  100mg 2 1167 1108 5.32 \n\n\n\nSorafenib Tablet 200mg 3 3880 350 1008.57 \n\n\n\nLenalidomide Tablet 10mg 2 950 150.53 87.37 \n\n\n\nTopoisomerase 1 inhibitor      \n\n\n\nIrinotecan Injection 40mg / vial 2 5562 3000 85.4 \n\n\n\n  100mg / vial 5 13349 7125 87.35 \n\n\n\n  100mg / 5ml 2 7500 7125 5.26 \n\n\n\n  40mg / 2ml 2 3000 2550 17.64 \n\n\n\nTopotecan Injection 4mg / ml 3 23427 10000 134.27 \n\n\n\n\n\n\n\n\n\n\n\nSince panobinostatwas available in single brand, the price \n\n\n\nvariation was calculated using the retail price as the maximum \n\n\n\nprice per tablet and the trade price (which was 15% less than \n\n\n\nthe actual retail price) as the minimum price per tablet. This \n\n\n\ngives a price variation of 17.64%. Similarly, all the drugs of \n\n\n\ndifferent classes of anti-cancer which were available in single \n\n\n\nbrands had the same price difference of 17.64% [10]. The data \n\n\n\non the percentage price variation among different brands with \n\n\n\n15% profit is summarized in Table IV.\n\n\n\n\n\n\n\nDRUG \nDosage \n\n\n\nform \nDOSE (mg) \n\n\n\nNo. of Manuf. \n\n\n\nCompanies \n\n\n\nMaximum price per \n\n\n\ntablet (PKR) \n\n\n\nMinimum price per \n\n\n\ntablet (PKR)with \n\n\n\n15% profit \n\n\n\nPercentage \n\n\n\nvariation with \n\n\n\n15% profit \n\n\n\nAlkylating agents       \n\n\n\nCyclophosphamide Injection 200mg 1 55 46.75 17.64 \n\n\n\nOxaliplatin Injection 150mg 1 28500 24255 17.64 \n\n\n\nMelphalan Tablet 2mg 1 36 30.6 17.64 \n\n\n\nChlorambucil Tablet 2mg 1 160 136 17.64 \n\n\n\n  5mg 1 326 277.1 17.64 \n\n\n\nLomustine Capsule 40mg 1 74 62.9 17.64 \n\n\n\nDibromodulcitol Tablet 250mg 1 59 50.15 17.64 \n\n\n\n  50mg 1 17 14.45 17.64 \n\n\n\nAnti-metabolites       \n\n\n\nMethotreaxte Injection 25mg / vial 1 166 141.1 17.64 \n\n\n\n  550mg / vial 1 1260 1071 17.64 \n\n\n\n  1000mg / vial 1 2558.52 2174.75 17.64 \n\n\n\n  1000mg / 10ml 1 2754 2340.9 17.64 \n\n\n\n  50mg / 2ml 1 90 76.5 17.64 \n\n\n\n  50mg / 10ml 1 220 187 17.64 \n\n\n\n  500mg / 20ml 1 145.8 123.93 17.64 \n\n\n\n  500mg / vial 1 1830 1555.5 17.64 \n\n\n\n5-fluurouracil Capsule 200mg 1 63 53.55 17.64 \n\n\n\n Injection 50mg / 10ml 1 162 137.7 17.64 \n\n\n\nTable IV. Percentage Variations among different brands with 15% Profit \n\n\n\n\n\n\n\n\nAyub F. et al. Mal J Pharm 8 (1) 2022, 42-56 \n\n\n\n\n\n\n\n52 \n\n\n\n\n\n\n\nDRUG \nDosage \n\n\n\nform \nDOSE (mg) \n\n\n\nNo. of Manuf. \n\n\n\nCompanies \n\n\n\nMaximum price per \n\n\n\ntablet (PKR) \n\n\n\nMinimum price per \n\n\n\ntablet (PKR)with \n\n\n\n15% profit \n\n\n\nPercentage \n\n\n\nvariation with \n\n\n\n15% profit \n\n\n\n\n\n\n\n  25mg / 10ml 1 42 35.7 17.64 \n\n\n\n  25mg / 20ml 1 79 67.15 17.64 \n\n\n\n  100mg / ml 1 172 146.2 17.64 \n\n\n\n  100mg 1 6 5.1 17.64 \n\n\n\nCytarabine Injection 1000mg / vial 1 1000 850 17.64 \n\n\n\n6-thioguanine Tablet 40mg 1 54 45.9 17.64 \n\n\n\nPemetrexed \n\n\n\ninjection \n\n\n\nInjection 100mg / vial 1 18900 16065 17.64 \n\n\n\n  500mg / vial 1 70000 59500 17.64 \n\n\n\nTrifluridine/tipiricil Tablet 15mg 1 5422 4608.7 17.64 \n\n\n\n  20mg 1 6773 5757.05 17.64 \n\n\n\nBendamustine \n\n\n\nHydochloride \n\n\n\nInjection 100mg / ml 1 7890 6706.5 17.64 \n\n\n\nGemcitabine  Injection 1000mg / 50ml 1 12804 10883.4 17.64 \n\n\n\nHistone Deacetylase Inhibitor     \n\n\n\nFarydak Tablet 20mg 1 760090 646076.5 17.64 \n\n\n\n  15mg 1 760090 646076.5 17.64 \n\n\n\nCytotoxic Agents      \n\n\n\nEtoposide Injection 100mg / ml 1 550 467.5 17.64 \n\n\n\n  100mg / 5ml 1 550 467.5 17.64 \n\n\n\nHormonal Agents      \n\n\n\nEstradiol (Valerate) Injection 10mg / 3ml 1 62 52.7 17.64 \n\n\n\nL-asparaginase Injection 10000IU 1 2066 1756.1 17.64 \n\n\n\nMethylprednisilone  Injection 80mg / 2ml 1 235 199.75 17.64 \n\n\n\n  125mg / 2ml 1 297 252.45 17.64 \n\n\n\nEthinylestradiol  Capsule 0.05mg 1 31 26.35 17.64 \n\n\n\n Tablet 35mg 1 9.5 8.075 17.64 \n\n\n\n  35mcg 1 14.76 12.54 17.64 \n\n\n\n  2mg 1 10.23 8.69 17.64 \n\n\n\n  0.035mg 1 9.52 8.09 17.64 \n\n\n\n  0.035mcg 1 9.52 8.09 17.64 \n\n\n\n  0.02mg / ml 1 14 11.9 17.64 \n\n\n\nIbandronic acid  Injection 6mg / 6ml 1 25464 21644.4 17.64 \n\n\n\n  2mg / 2ml 1 10200 8670 17.64 \n\n\n\n  168.75mg 1 385 327.25 17.64 \n\n\n\n  2.5mg 1 18 15.3 17.64 \n\n\n\n  1mg / ml 1 1500 1275 17.64 \n\n\n\nExemestane Tablet 25mg 1 190 161.5 17.64 \n\n\n\nStilboesterol Tablet 0.5mg 1 45 38.25 17.64 \n\n\n\n  120mg 1 636 540.6 17.64 \n\n\n\nFulvestrant Injection 50mg / ml 1 30000 25500 17.64 \n\n\n\nLenvatinib (As \nMesilate) \n\n\n\nTablet 4mg 1 1973 1677.05 1764 \n\n\n\n  10mg 1 4932 4192.2 17.64 \n\n\n\nTaxanes       \n\n\n\nPaclitaxel Injection 100mg / 16.7ml 1 9000 7650 17.64 \n\n\n\n  210mg / ml 1 2032 1727.2 17.64 \n\n\n\nMiscellanous Agents      \n\n\n\nCisplatin Injection 50mg / 50ml 1 648 550.8 17.64 \n\n\n\n  1mg / 100ml 1 885 752.25 17.64 \n\n\n\n  100mg / ml 1 1400 1190 17.64 \n\n\n\nCarboplatin Injection 150mg / vial 1 1500 1275 17.64 \n\n\n\n  450mg / vial 1 3000 2550 17.64 \n\n\n\nAnti-cancer antibiotics      \n\n\n\nDoxorubicin Injection 10mg / 10ml 1 440 374 17.64 \n\n\n\n  50mg / 50ml 1 1950 1657.5 17.64 \n\n\n\nEpirubicin HCL  Injection 10mg / vial 1 788 669.8 17.64 \n\n\n\n  2mg / ml 1 8908 7571.8 17.64 \n\n\n\nIdarubicin \n\n\n\nhydrochloride \n\n\n\nInjection 5mg / vial 1 5034 4278.9 17.64 \n\n\n\n  20mg / 20ml 1 14166 12041.1 17.64 \n\n\n\nTrastuzumab  Injection 160mg / vial 1 354535 301354.75 17.64 \n\n\n\n  100mg / vial 1 221583 188345.55 17.64 \n\n\n\n\n\n\n\n\n\n\n\n 600mg / 5ml 1 130000 110500 17.64 \n\n\n\n\n\n\n\n\nAyub F. et al. Mal J Pharm 8 (1) 2022, 42-56 \n\n\n\n\n\n\n\n53 \n\n\n\n\n\n\n\nDRUG \nDosage \n\n\n\nform \nDOSE (mg) \n\n\n\nNo. of Manuf. \n\n\n\nCompanies \n\n\n\nMaximum price per \n\n\n\ntablet (PKR) \n\n\n\nMinimum price per \n\n\n\ntablet (PKR)with \n\n\n\n15% profit \n\n\n\nPercentage \n\n\n\nvariation with \n\n\n\n15% profit \n\n\n\n\n\n\n\n  440mg / 20ml 1 130000 110500 17.64 \n\n\n\n  150mg / vial 1 32349 27496.65 17.64 \n\n\n\nBiological Agents/Targated therapy                    \n\n\n\nBevacizumab Injection 100mg / 4ml 1 28800 24480 17.64 \n\n\n\n  400mg / 16ml 1 114500 97325 17.64 \n\n\n\nErlotinib Tablet 25mg 1 1900 1615 17.64 \n\n\n\nEverolimus Tablet 0.5mg 1 193.45 164.43 17.64 \n\n\n\n  5mg 1 10500 8925 17.64 \n\n\n\n  10mg 1 15000 12750 17.64 \n\n\n\n  0.75mg 1 399.33 339.43 17.64 \n\n\n\n  0.25mg 1 143.75 122.15 17.64 \n\n\n\nGefitnib Tablet 250mg 1 544.23 462.59 17.64 \n\n\n\nLapatinib Tablet 250mg 1 1344.33 1142.68 17.64 \n\n\n\nNilotinib Tablet 150mg 1 10640 9044 17.64 \n\n\n\n  200mg 1 3800 3230 17.64 \n\n\n\nPazopanib Tablet 200mg 1 1766.67 1501.66 17.64 \n\n\n\n  400mg 1 2944.43 2502.76 17.64 \n\n\n\nRuxolitinib Tablet 5mg 1 2637.66 2242.01 17.64 \n\n\n\n  15mg 1 7912.96 6726.01 17.64 \n\n\n\n  20mg 1 10380 8823 17.64 \n\n\n\nSunitinib Tablet 12.5mg 1 3377 2870.45 17.64 \n\n\n\n  25mg 1 6685 5682.25 17.64 \n\n\n\n  50mg 1 13088 11125 17.64 \n\n\n\nOcrelizumab Injection 300mg / 10ml 1 750018 637515.3 17.64 \n\n\n\nRamucirumab Injection 10mg / ml 1 78107 66390.95 17.64 \n\n\n\nOlaratumab Injection 500mg / 50ml 1 142820 121397 17.64 \n\n\n\nHalaven Injection 0.88mg / 2ml 1 50685 43082.25 17.64 \n\n\n\nAtezolizumab Injection 1200mg / 20ml 1 561951 477658.35 17.64 \n\n\n\nPalbociclib Injection 75mg 1 2254.4 1916.24 17.64 \n\n\n\n Tablet 100mg 1 2254.4 1916.24 17.64 \n\n\n\n  125mg 1 22784.3 19366.65 17.64 \n\n\n\nCeritinib  Tablet 150mg 1 3757 3193.45 17.64 \n\n\n\nLenalidomide Tablet 5mg 1 288 244.8 17.64 \n\n\n\n  15mg 1 760 646 17.64 \n\n\n\n  25mg 1 1116 948.6 17.64 \n\n\n\nBortezomib Injection 2mg / vial 1 8000 6800 17.64 \n\n\n\n  3.5mg / vial 1 28175 23948.75 17.64 \n\n\n\nTrametinib Tablet 0.5mg 1 7645 6498.25 17.64 \n\n\n\n  2mg 1 23555 20021.75 17.64 \n\n\n\nDabrafenib Tablet 50mg 1 4865 4135.25 17.64 \n\n\n\n  75mg 1 7271 6180.35 17.64 \n\n\n\nRibociclib Tablet 200mg 1 7540 6409 17.64 \n\n\n\n  600mg 1 24201.4 20571.19 17.64 \n\n\n\nRituximab   100mg / 10ml 1 34500 29325 17.64 \n\n\n\n Injection 500mg / 50ml 1 85500 72675 17.64 \n\n\n\n  10mg / 10ml 1 23000 19550 17.64 \n\n\n\n  10mg / 50ml 1 114000 16550 17.64 \n\n\n\nCetuximab Injection 5mg / ml 1 28500 96900 17.64 \n\n\n\nTopoisomerase 1 inhibitor      \n\n\n\nIrinotecan Injection 40mg / 5ml 1 3000 2550 17.64 \n\n\n\nAromatase inhibitor      \n\n\n\nAnastrazole Injection 1mg / vial 1 5600 4760 17.64 \n\n\n\n\n\n\n\n\n\n\n\nDISCUSSION \n\n\n\n\n\n\n\nTo date, this is perhaps the first study aimed towards evaluating \n\n\n\nthe price variation of anticancer drugs in Pakistan. The present \n\n\n\nstudy aims to compare the cost of different brands of anticancer \n\n\n\ndrugs registered in Pakistan. Our findings have shown that \n\n\n\nthere is large variation in the cost of different brands; price \n\n\n\nvariations of 4.01% to 19,912.25% have been observed across \n\n\n\n115 different formulations of anticancer drugs. In fact, nine \n\n\n\nformulations demonstrated prices that varied from 4.01% to \n\n\n\n20%, while seven formulations showed price variations that \n\n\n\nexceed 30%. Furthermore, the price of nine formulations varied \n\n\n\nfrom 500% to as high as 10,000%. Topotecan 4mg / ml had the \n\n\n\nhighest price variation 19,912.25% and the lowest price \n\n\n\nvariation 4.01% was observed for abiraterone acetate (250mg).  \n\n\n\n \n\n\n\n\n\n\n\n\nAyub F. et al. Mal J Pharm 8 (1) 2022, 42-56 \n\n\n\n\n\n\n\n54 \n\n\n\n\n\n\n\nThe result of this research seems to strongly suggest that, in \n\n\n\nPakistan, drugs are registered in different brands and \n\n\n\nformulations with a huge variations in price. The pricing of \n\n\n\ndrugs in Pakistan is regulated under the Drug Regulatory \n\n\n\nAuthority of Pakistan (DRAP) which works under the Federal \n\n\n\nGovernment. As of yet, there exists no clear price calculation \n\n\n\nformula in the Drug Act, 1976 [20].   \n\n\n\n\n\n\n\nThe price of cancer drugs and care can be improved through the \n\n\n\nestablishment of policies and intervention aimed towards \n\n\n\nlowering the prices of the drugs [11]. It should be noted that \n\n\n\navailability and affordability are considered to be key \n\n\n\nrequirements for the ubiquitous access of medicines, even more \n\n\n\nso as far as the availability and affordability of anticancer drugs \n\n\n\nare concerned, which are drugs essential for saving lives. \n\n\n\n\n\n\n\nOne of the most important, yet difficult, challenges faced \n\n\n\ntowards equity in healthcare is the price of medicine. The health \n\n\n\nbudget of smaller developing countries such as Pakistan is \n\n\n\ngreatly affected by their buying power for such medications. \n\n\n\nNumerically, it is expected that drug and drug-related \n\n\n\nexpenditures can be anywhere between 50 - 90% of the total, \n\n\n\nnon-personnel costs. Due to lack of knowledge on the cost of \n\n\n\ndrug as well as drug quality and non-availability, it is difficult \n\n\n\nfor physicians to decide on and to prescribe the most \n\n\n\neconomical treatment [21]. Manufacturing companies instate a \n\n\n\nhigh cost of anti-cancer medications which are presented by \n\n\n\nsales representatives [22].  \n\n\n\n\n\n\n\nA study conducted by Volger S et al. showed that the costs of \n\n\n\nthe anti-cancer drugs in higher income countries (namely, 16 \n\n\n\nEuropean countries as well as Australia and New Zealand) vary \n\n\n\nwidely from 28 to 388%. Meanwhile, the cost of the different \n\n\n\nanti-cancer medicines was found to be low in Greece and high \n\n\n\nin Sweden, Switzerland and Germany [23].  In a separate study \n\n\n\nby S. Salmasi., whereby the price of cancer drugs in high-, \n\n\n\nmiddle- and low-income countries are surveyed (including 10 \n\n\n\nAsian countries, South-East Asian countries, as well as \n\n\n\ncountries in Western Pacific and Eastern Mediterranean \n\n\n\nregions), it is found that the costs of the anti-cancer medicines \n\n\n\nwere low in Taiwan, while highest prices was found in Oman \n\n\n\n[6]. Furthermore, a study by Tadesse and Fang found that in the \n\n\n\npublic and private sectors of Ethiopia, the lowest price of \n\n\n\ngeneric anti-cancer drugs were sold at prices between 1.29 and \n\n\n\n2.62 times the international reference price [24]. As for our \n\n\n\ncurrent study, a large price variation in between different \n\n\n\nanticancer drugs can be attributed to many factors, such as \n\n\n\ndifferences in the cost of production, prescribing of patented \n\n\n\nbrands instead of generic brands, and the lack of subsidy \n\n\n\nschemes.  \n\n\n\n\n\n\n\nIn the developed countries like Australia, the cost of the anti- \n\n\n\ncancer treatment is funded through different Health  \n\n\n\nTechnology Assessment (HTA) reimbursement programmes \n\n\n\nsuch as the Pharmaceutical Benefit Scheme (PBS), the National \n\n\n\nImmunization Program (NIP) and the Medicare Benefit \n\n\n\nSchedule (MBS), as well as through several other means \n\n\n\ninvolving the public and private sectors [25]. The aim of these \n\n\n\nprogrammes is to improve the health care interventions through \n\n\n\nuse of money from taxpayers, thus and lowering the cost of, \n\n\n\nand increase the quality and efficacy of, treatment with \n\n\n\nanticancer drugs [26]. In addition to all the government is \n\n\n\nspendings is an extra 6.7 million dollars to assist all Australian \n\n\n\ncancer patients to support and improve the results of cancer \n\n\n\ntreatments [27]. In contrast, the government of Pakistan \n\n\n\nprovides a limited amount free medications exclusively for the \n\n\n\npublic health sector. Furthermore, limited funding for serious \n\n\n\nhealth issues like cardiac surgery, dialysis, renal transplant, and \n\n\n\ncancer is a prominent issue. The Punjab CML Project, for \n\n\n\nexample, used to provided PKR 13 billion (approximately \n\n\n\n$85,274,371) for the free cancer treatment until 2017, before it \n\n\n\nwas forced to close down due to lack of funding from the \n\n\n\ngovernment, subsequently causing pharmaceutical companies \n\n\n\nto discontinue the provision of free medicines. Although the \n\n\n\nproject had been re-initiated on June 2020, the provision of free \n\n\n\nmedicines were again halted as of the 28th of February,2021 \n\n\n\ndue to the delay in the signing process of the memorandum of \n\n\n\nunderstanding (MOU) [28].  \n\n\n\n\n\n\n\nTo ascertain the availability and affordability of medicines, \n\n\n\nproper policies, external reference pricing, promotion of \n\n\n\ngenerics and reimbursement programmes must be developed \n\n\n\nfor medicine pricing [29]. The first step in pursuit of that goal \n\n\n\nwould involve quantitatively measuring and properly \n\n\n\nunderstanding the cost of medicines and the rationale behind \n\n\n\ntheir use. Therefore, considering the direness of the situation, \n\n\n\nthe government, health care providers, and the general public \n\n\n\nshould make strenuous efforts towards convincing the \n\n\n\npharmaceutical manufacturing companies to ensure that \n\n\n\nmedications are affordable to the general public. \n\n\n\n\n\n\n\nCONCLUSION \n\n\n\n\n\n\n\nOur study shows that there is a huge price variation among \n\n\n\ndifferent brands of anticancer drugs marketed in Pakistan.  The \n\n\n\nhighest price variation was observed for topotecan (4mg / ml). \n\n\n\nIn light of such issues, there is deemed necessary for the \n\n\n\ngovernment to set appropriate pricing systems in order to \n\n\n\nmitigate cancer-related mortality. External reference pricing, \n\n\n\nreimbursement programmes, effective strategies to implement \n\n\n\npolicies, and creating monopoly rules for the exemption of tax \n\n\n\nwould stabilise the price variations of anticancer drugs, whilst \n\n\n\nproviding low budget medicines and treatment options for the \n\n\n\nrelief of patients. \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nAyub F. et al. Mal J Pharm 8 (1) 2022, 42-56 \n\n\n\n\n\n\n\n55 \n\n\n\n\n\n\n\nCONFLICT OF INTEREST \n\n\n\n\n\n\n\nThe authors have no conflicts of interest to declare. This \n\n\n\nresearch did not receive any specific grant from funding \n\n\n\nagencies in public, commercial or not-for-profit sectors. \n\n\n\n\n\n\n\nREFERENCE \n \n\n\n\n[1] WHO. World fact sheets cancers. Globocan 2020 [Internet]. \n\n\n\n2020;419:1\u20132. \n\n\n\nhttps://gco.iarc.fr/today/data/factsheets/populations/900-world-fact-\n\n\n\nsheets.pdf \n\n\n\n[2] Offidani M, Petrucci MT. 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"\n\nMalaysian Journal of Pharmacy Volume 7 Issue 1 (2021) \n \n\n\n\n\n\n\n\n\n\n\n\n43 \n\n\n\n\n\n\n\n*Correspondence: fongcwei@gmail.com \n1Department of Pharmacy, Hospital Sultanah Nur Zahirah, Jalan Sultan \n\n\n\nMahmud, 20400 Kuala Terengganu, Terengganu, Malaysia. \n2Department of Nephrology, Hospital Sultanah Nur Zahirah, Jalan Sultan \n\n\n\nMahmud, 20400 Kuala Terengganu, Terengganu, Malaysia.   \n \n\n\n\nMALAYSIAN \n\n\n\nJournal of \n\n\n\nPharmacy \n\n\n\n Original Research Article \n\n\n\n\n\n\n\nThe Effect of Pharmacist's Interventions on Anaemia \n\n\n\nManagement among Continuous Ambulatory Peritoneal \n\n\n\nDialysis Patients in Terengganu Tertiary Hospital \n \n\n\n\nChui Wei Fong1*, Wan Najiah Wan Mokhtar1, Norlaila Kartina Malini Mamat1, Muhammad Zaidi \n\n\n\nSattar1, Zaiha Harun2, Tengku Nur Izzati Tengku Abd Kadir1 \n\n\n\n\n\n\n\n \nArticle Info  \n\n\n\n \nReceived date:   3 May 2021 \n\n\n\nAccepted date: 24 June 2021 \n\n\n\nPublished date: 30 June 2021 \n\n\n\n\n\n\n\nKeywords: Anaemia, peritoneal \n\n\n\ndialysis, erythropoietin, \n\n\n\npharmacist, haemoglobin \n\n\n\n\n\n\n\nABSTRACT  \n\n\n\n\n\n\n\nPharmacist\u2019s interventions in anaemia management have been shown to improve clinical and \n\n\n\neconomic outcomes. To determine the outcome of hemoglobin (Hb) level after the implementation \n\n\n\nof ESA monitoring card and counselling, a prospective, single-blinded randomised controlled study \n\n\n\ninvolved patients attending the CAPD clinic in Terengganu tertiary hospital, Malaysia was carried \n\n\n\nout. Intervention group received ESA injection counselling based on a validated checklist and ESA \n\n\n\nmonitoring card, while the standard care group only received standard care. Result showed a total of \n\n\n\n118 eligible patients with 68 of them in the standard care group and 50 patients in the intervention \n\n\n\ngroup with an average age of 50.8 (\u00b114.57) and 49.4 (\u00b113.69) years, respectively. Mean Hb showed \n\n\n\nsignificant improvement in both standard care and interventional groups with p<0.001. Intervention \n\n\n\ngroup had a higher percentage increment in mean Hb 6.7% compared to standard care group 5.9%. \n\n\n\nHowever, mean difference Hb between standard care and interventional group after at least 1 month \n\n\n\nof interventions was not significant with 0.59 (\u00b11.78) and 0.692 (\u00b11.68) respectively (p=0.764). In \n\n\n\nconclusion, pharmacist\u2019s interventions, including counselling and ESA monitoring card may help in \n\n\n\nimproving Hb level in CAPD patients. \n\n\n\n\n\n\n\nINTRODUCTION  \n  \n\n\n\nAnaemia is a common complication among chronic kidney \n\n\n\ndisease (CKD) patients and, its prevalence rises with \n\n\n\ndecreasing estimated glomerular filtration [1]. Anaemia in \n\n\n\nCKD presents as normochromic, normocytic and associated \n\n\n\nwith symptoms such as fatigue, shortness of breath, insomnia, \n\n\n\nand headache [2]. Inadequate erythropoietin production is the \n\n\n\nmost common cause of anaemia [1\u20133]. It contributes to reduced \n\n\n\nquality of life and is associated with cardiovascular disease, \n\n\n\nhospitalisation, cognitive impairment, and mortality [4]. \n\n\n\n\n\n\n\nErythropoietin stimulating agent (ESA) and iron \n\n\n\nsupplementation are the standard treatment for anaemia among \n\n\n\nend stage renal failure (ESRF) patients in Malaysia. Each \n\n\n\npatient is treated according to the haemoglobin (Hb) target with \n\n\n\nthe lowest effective ESA dose while avoiding large fluctuations \n\n\n\nin Hb levels or prolonged periods out of target Hb [5]. Studies \n\n\n\nhave shown the beneficial effects of anaemia treatment, such as \n\n\n\nimproved quality of life protection against cardiovascular \n\n\n\ndisease, morbidity, mortality, and hospitalisation rates \n\n\n\nreduction [6]. However, anaemia management in ESRF \n\n\n\npatients is complex, and there are barriers to effective anaemia \n\n\n\ntreatment, including patient non-adherence to the treatment \n\n\n\nregimen, lack of familiarity with clinical practice guidelines for \n\n\n\nanaemia treatment, and complexity of patients with CKD [7]. \n\n\n\nIn addition, managing renal anaemia with ESA and iron \n\n\n\nreplacement poses clinical challenges, including maintaining \n\n\n\nstable Hb levels within narrow target ranges, balancing iron and \n\n\n\nESA dosages, and optimising the erythropoietin response with \n\n\n\nthe lowest possible effective ESA dose [8]. Therefore, a \n\n\n\nmultidisciplinary approach is necessary to overcome the \n\n\n\nchallenges and barriers in anaemia treatment. Pharmacist \n\n\n\nclinical activities in anaemia management, including providing \n\n\n\n\n\n\n\n\nFong C.W. et al. Mal J Pharm 7 (1) 2021, 43-48 \n\n\n\n\n\n\n\n44 \n\n\n\n\n\n\n\ndrug information to the physician, compiling guidelines for \n\n\n\nproper use of ESA and iron, dosing and monitoring ESA \n\n\n\ntherapy, patient education had effectively improved Hb level, \n\n\n\nand compliance with ESA use criteria [8\u201310].  \n\n\n\n\n\n\n\nThe effectiveness of a treatment depends on patient adherence \n\n\n\nand proper ESA injection technique. Inadequate knowledge on \n\n\n\nESA injection can influence patient medication adherence. \n\n\n\nHowever, we have limited data on patient medication \n\n\n\nknowledge and ESA injection technique. Besides, one of the \n\n\n\nkey performance indicators (KPI) in our nephrology \n\n\n\ndepartment is that at least 70% of continuous ambulatory \n\n\n\nperitoneal dialysis (CAPD) patients achieved the target Hb \n\n\n\nlevel (10g/dl), but we did not meet the KPI to date. Despite \n\n\n\nrenal pharmacists have been part of renal team and participate \n\n\n\nin the treatment of CKD, there is no relevant study on the \n\n\n\neffectiveness of renal pharmacy service in Malaysia. Therefore, \n\n\n\nwe would like to investigate the effectiveness of interventions \n\n\n\nby pharmacists in optimising anaemia management in CAPD \n\n\n\npatients. The main objective of this study was to investigate the \n\n\n\neffect of pharmacist interventions on Hb outcome in CAPD \n\n\n\npatients receiving subcutaneous (SC) ESA.  \n\n\n\n\n\n\n\nMETHOD  \n  \n\n\n\nStudy Design and Setting \n\n\n\n\n\n\n\nThis is a prospective, single-blinded randomised controlled \n\n\n\nstudy. The study was conducted for 6 months in the CAPD \n\n\n\nclinic of Terengganu tertiary hospital, Malaysia. The \n\n\n\nrecruitment and data collection was performed from March to \n\n\n\nAugust 2017. The setting for pharmacist educational \n\n\n\nintervention consisted of a private counselling room in the \n\n\n\nCAPD clinic. The study was approved by Medical Research \n\n\n\nand Ethics Committee, Ministry of Health Malaysia (MOH) \n\n\n\nMalaysia (KKM.NIHSEC.P17-1202). Informed consent was \n\n\n\nobtained from all individual participants included in the study. \n\n\n\n\n\n\n\nParticipants and randomisation  \n\n\n\n\n\n\n\nBased on the study done by Wei Yang et al., the sample size \n\n\n\nrequired for detecting difference of mean Hb is 0.5g/dl with \n\n\n\npower of study =80%, and type 1 error at 0.05 was 48 subjects \n\n\n\nfor both intervention group and standard care subjects [11].  A \n\n\n\ntotal of 55 subjects for each arm were included in this study by \n\n\n\nconsidering a dropout rate of 10%. Participants randomised \n\n\n\ninto the interventional group and standard care with a 1:2 ratio \n\n\n\nusing simple randomisation technique. For the allocation of the \n\n\n\nparticipants, a list of all CAPD patients was created in the \n\n\n\nsoftware of SPSS Version 22 by one pharmacist and then a \n\n\n\nrandomisation sequence was created using this computer-\n\n\n\ngenerated list of numbers into both interventional and control \n\n\n\ngroups. Three pharmacists involved in patient enrollment. \n\n\n\nPatient did not know which group they are in as this is a single-\n\n\n\nblinded study.  \n\n\n\n\n\n\n\nResearch tool \n\n\n\n\n\n\n\n\u2022 ESA monitoring card initiative from the MOH Malaysia \n\n\n\nto properly monitor Hb level in dialysis patients with \n\n\n\nESA therapy. Physician updated the latest Hb level and \n\n\n\nESA dose on the ESA card for each appointment. ESA \n\n\n\ncard consists of ESA dose titration and monitoring \n\n\n\nparameter guidelines developed based on KDIGO \n\n\n\nclinical practice guideline for anaemia in CKD 2012 to \n\n\n\nassist the physician in adjusting ESA dose and \n\n\n\nmonitoring. Adjustment of ESA dose was based on \n\n\n\npatient current Hb level, rate of change in Hb \n\n\n\nconcentration, current ESA dose and clinical \n\n\n\ncircumstances [12]. ESA monitoring card is attached as \n\n\n\nAppendix 1. \n\n\n\n\u2022 Counselling checklist for ESA injection initiative from \n\n\n\nMOH Malaysia is intended as a reference document for \n\n\n\npharmacist or nursing staff to counsel patients \n\n\n\nprescribed with ESA. Counselling checklist is attached \n\n\n\nas Appendix 2. \n\n\n\n\u2022 Data collection form was used to collect information \n\n\n\nregarding the patient's social demographic data, medical \n\n\n\nhistory, current ESA dose, current medications, \n\n\n\nlaboratory parameters, and medication adherence.We \n\n\n\nincluded CAPD patients above 18 years old who \n\n\n\nattended CAPD clinic, received SC erythropoietin beta \n\n\n\ninjection and been taught on ESA injection technique by \n\n\n\nCAPD nurse. Excluded patients including who received \n\n\n\nblood transfusion two weeks before recruitment and \n\n\n\nwithin the study period; pregnant patient and cancer \n\n\n\npatient. \n\n\n\n\n\n\n\nStandard care \n\n\n\n\n\n\n\nThe standard care of patients consisted of physician-patient \n\n\n\nmeetings in the CAPD clinic. Patients who are newly \n\n\n\nprescribed ESA injection referred to CAPD nurse for ESA \n\n\n\ninjection technique related education. Patients collected their \n\n\n\nmonthly ESA injection from the hemodialysis unit and self-\n\n\n\ninjected ESA at home. Patients in the standard care group did \n\n\n\nnot receive intervention from pharmacists. \n\n\n\n\n\n\n\nIntervention  \n\n\n\n\n\n\n\nPatients in the intervention group received standard care of \n\n\n\nphysician-patient meetings and pharmacist interventions. \n\n\n\nIntervention group patients were required to attend hospital at \n\n\n\nthe baseline, three months, and six months during the \n\n\n\nintervention. Patients' follow-up visits were arranged according \n\n\n\nto patient-physician appointment to reduce dropout. At the \n\n\n\nbaseline visit, demographic data; current medication; current \n\n\n\n\n\n\n\n\nFong C.W. et al. Mal J Pharm 7 (1) 2021, 43-48 \n\n\n\n\n\n\n\n45 \n\n\n\n\n\n\n\nESA dose; laboratory parameters such as Hb level, iron status, \n\n\n\nserum ferritin, TSAT, and TIBC level were collected. On each \n\n\n\nfollow-up visit, patients were assessed on ESA injection \n\n\n\nknowledge based on ESA counselling checklist, including its \n\n\n\nfunction, dose of injection, side effects, storage, and  ESA \n\n\n\ntransport from hospital to home, injection technique and \n\n\n\nadherence. Patients were required to answer all questions in \n\n\n\nESA checklist correctly; any wrong answer given was \n\n\n\nconsidered inadequate knowledge. Pharmacists provided \n\n\n\ncounselling and education for patients with inadequate \n\n\n\nknowledge or wrong injection techniques to improve their \n\n\n\nknowledge or injection technique. Monitoring of laboratory \n\n\n\nparameter and ESA dose were performed, and any intervention \n\n\n\nwas spoken to the nephrology physician. \n\n\n\n\n\n\n\nOutcome measures \n\n\n\n\n\n\n\nPrimary outcome of the study was Hb level. The target Hb in \n\n\n\nour setting is 10-12g/dl. Monitoring of Hb level, iron status, \n\n\n\nserum ferritin, TSAT, TIBC level was performed every 3 \n\n\n\nmonths as recommended by Kidney Disease Improving Global \n\n\n\nOutcome (KDIGO) anaemia guideline for CKD 2012. \n\n\n\n\n\n\n\nSecondary outcome of the study was the adherence to ESA \n\n\n\ninjection post-intervention. Adherence to ESA injection was \n\n\n\nassessed based on the ESA sticker. The patient was required to \n\n\n\ndetach the sticker from the ESA injection syringe before use \n\n\n\nand paste it on the CAPD booklet as evidence of use. \n\n\n\nPharmacists calculated the number of ESA injections dispensed \n\n\n\nfor the patient last month and the total number of stickers found \n\n\n\non the CAPD booklet. The total doses missed was inferred from \n\n\n\nthe sticker count observed from the CAPD booklet. A patient \n\n\n\nis defined as adhering to ESA injection if the adherence score \n\n\n\n(Eq.1) is \u226590% [13]. \n\n\n\n \n\ud835\udc34\ud835\udc51\u210e\ud835\udc52\ud835\udc5f\ud835\udc52\ud835\udc5b\ud835\udc50\ud835\udc52 \ud835\udc60\ud835\udc50\ud835\udc5c\ud835\udc5f\ud835\udc52 \n\n\n\n=\n\ud835\udc47\ud835\udc5c\ud835\udc61\ud835\udc4e\ud835\udc59 \ud835\udc51\ud835\udc5c\ud835\udc60\ud835\udc52\ud835\udc60 \ud835\udc51\ud835\udc56\ud835\udc60\ud835\udc5d\ud835\udc52\ud835\udc5b\ud835\udc60\ud835\udc52\ud835\udc51 \u2212  \ud835\udc47\ud835\udc5c\ud835\udc61\ud835\udc4e\ud835\udc59 \ud835\udc51\ud835\udc5c\ud835\udc60\ud835\udc52 \ud835\udc5a\ud835\udc56\ud835\udc60\ud835\udc60\ud835\udc52\ud835\udc51\n\n\n\n\ud835\udc47\ud835\udc5c\ud835\udc61\ud835\udc4e\ud835\udc59 \ud835\udc51\ud835\udc5c\ud835\udc60\ud835\udc52 \ud835\udc51\ud835\udc56\ud835\udc60\ud835\udc5d\ud835\udc52\ud835\udc5b\ud835\udc60\ud835\udc52\ud835\udc51 \n (\ud835\udc38\ud835\udc5e. 1) \n\n\n\n\n\n\n\nData analyses \n\n\n\n\n\n\n\nAll data were analysed using IBM\u00ae Statistical Package for \n\n\n\nSocial Sciences version 22.0 (IBM corp. 2013).  Baseline \n\n\n\ncharacteristics of both groups were compared using \n\n\n\nIndependent t-test for continuous variables, Person chi-square, \n\n\n\nand Fisher-exact for categorical variable. Comparison of mean \n\n\n\ndifference in Hb was performed using Independent t-test and \n\n\n\nPaired t-test. All statistical tests with p-values of <0.05 denote \n\n\n\nstatistical significance. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nRESULT \n \n\n\n\nDemographic and Clinical Characteristics \n\n\n\n\n\n\n\nOf the 146 eligible patients, 50 patients were randomised to the \n\n\n\nintervention group, and 70 patients were randomised into the \n\n\n\nstandard care group. 2 patients dropped out of the study due to \n\n\n\ndeceased. A total of 118 patients completed the study. Figure I. \n\n\n\nshows the trial flow diagram prepared according to CONSORT \n\n\n\nguidelines. The average ages were 50.8 (\u00b114.57) and 49.4 \n\n\n\n(\u00b113.69) years in the standard care and interventional groups. \n\n\n\nGender was found to be approximately equal, and subjects were \n\n\n\npredominantly Malay in both groups. Details of patient \n\n\n\ncharacteristics are shown in Table I. There was no significant \n\n\n\ndifference in the baseline demographic and clinical \n\n\n\ncharacteristics of participants.  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nFigure I. Trial flow diagram in accordance with CONSORT guidelines \n\n\n\n(CONSORT, Consolidated Standards of Reporting Trials) \n\n\n\n Eligible patients (n=146) \n\n\n\nExcluded (n=26) \n\n\n\n\u27a2 Not meeting inclusion \n\n\n\ncriteria \n\n\n\n\n\n\n\n Randomized (n=120)  \n\n\n\nStandard care group (n=70) Intervention group (n=50) \n\n\n\nDeceased (n=2)  \n\n\n\n\n\n\n\nCompleted study (n=50) \n\n\n\nCompleted study (n=68) \n\n\n\nTable I: Demographic data and clinical characteristics (N=118) \n\n\n\n\n\n\n\nCharacteristics \n\n\n\nStandard \n\n\n\nCare Group \n\n\n\n(n = 68) \n\n\n\nInterventional \n\n\n\nGroup \n\n\n\n(n=50) \n\n\n\nP-\n\n\n\nValue* \n\n\n\nAge, mean (SD), year 50.8 (14.5) 49.4 (13.6) 0.593 \n\n\n\nGender, n (%)    \n\n\n\nMale  34 (28.8) 23 (19.6) \n0.404a \n\n\n\nFemale 34 (28.8) 27 (22.8) \n\n\n\nEthnicity, n (%)    \n\n\n\nMalay 68 (57.6) 49 (41.6) \n0.347b \n\n\n\nChinese 0 1 (0.8) \n\n\n\nBody weight, mean \n\n\n\n(SD), kg \n60.9 (13.8) 60.7 (12.5) 0.957 \n\n\n\nTransferrin \n\n\n\nsaturation, mean \n\n\n\n(SD), % \n\n\n\n30.7 (13.4) 29.3 (10.3) 0.541 \n\n\n\n\n\n\n\n*Independent t-test, a Pearson chi-square, b Fisher-exact tests were used \n\n\n\n \n\n\n\n\n\n\n\n\nFong C.W. et al. Mal J Pharm 7 (1) 2021, 43-48 \n\n\n\n\n\n\n\n46 \n\n\n\n\n\n\n\nHb level in pre-and post-intervention for standard care and \n\n\n\ninterventional groups \n\n\n\n\n\n\n\nMean Hb showed significant improvement in both standard \n\n\n\ncare and interventional groups with p<0.001 (Table II). The \n\n\n\nintervention group had a higher increment in mean Hb (6.7%) \n\n\n\nthan the standard care group (5.9%). However, the mean \n\n\n\ndifference Hb between standard care and interventional group \n\n\n\nafter at least one month of interventions was found to be not \n\n\n\nsignificant with 0.59 (\u00b11.78) and 0.692 (\u00b11.68) respectively \n\n\n\n(p=0.764) using Independent T-test (Table III).  \n\n\n\n\n\n\n\nAdherence to ESA administration post-intervention for \n\n\n\nstandard care and interventional groups \n\n\n\n\n\n\n\nThe intervention group had higher adherence to ESA \n\n\n\nadministration (76%) than the standard care group (66.1%) \n\n\n\npost-intervention. No significant difference was found between \n\n\n\nthe standard care and intervention group (p=0.309) using Chi-\n\n\n\nsquare test (Table IV).   \n\n\n\n\n\n\n\nDISCUSSION  \n  \n\n\n\nSevere anaemia (Hb< 9.0g/dl) is associated with increased risks \n\n\n\nof cardiac complications, such as left ventricular hypertrophy \n\n\n\nand cardiovascular disease, and low quality of life [14]. \n\n\n\nCorrection of anaemia has been associated with improved \n\n\n\nhealth-related quality of life, including physical functioning \n\n\n\nand fatigue [15]. With the increasing health care cost over the \n\n\n\npast several years, pharmacists have a critical role in providing \n\n\n\nthe most cost-effective and beneficial pharmaceutical care in \n\n\n\nanaemia treatment. Available studies reported the benefits and \n\n\n\nimpact of pharmacy services in anaemia management. A study \n\n\n\nconducted showed that active participation of pharmacists in \n\n\n\nanaemia management significantly improved mean Hb level \n\n\n\n[8,16]. Other studies reported that pharmacist education \n\n\n\nprogram led to significant Hb improvement. [17,18].  \n\n\n\n\n\n\n\nOur study demonstrated that intervention group showed \n\n\n\nsignificant improvement in mean Hb, but the mean difference \n\n\n\nHb was statistically non-significance against the standard care \n\n\n\ngroup. Likewise, previous studies also did not show significant \n\n\n\ndifferences in haemoglobin outcome between standard care and \n\n\n\npharmacist intervention group [10,18]. The lack of significance \n\n\n\nwas explained by achievement of haemoglobin target was very \n\n\n\nhigh in standard group compared with other studies [10]. Study \n\n\n\nby Mateti et al. reported that the insignificant result was due to \n\n\n\nboth control and intervention group had achieved the optimal \n\n\n\nHb level of 10g/dl, and increasing the target Hb above the target \n\n\n\nrange had no benefit [18]. In our study, the insignificant result \n\n\n\ncould be due to lack of blinding in pharmacist activities such as \n\n\n\ncounselling and ESA card, which may increase overall patient \n\n\n\ncare by healthcare providers. Besides, similar physicians who \n\n\n\nattended patient\u2019s follow-up visits in both control and \n\n\n\ninterventional groups may lead to bias. Deficiency of vitamin \n\n\n\nB12, folic acid, and iron are associated with anaemia [12]. \n\n\n\nAdherence to oral iron and different dietary intake could be \n\n\n\nfactors affecting haemoglobin level. However, our study lacks \n\n\n\ndata on patient adherence to oral iron and dietary pattern, so a \n\n\n\ndefinite conclusion cannot be draw.  \n\n\n\n\n\n\n\nESA injection adherence compliance was a common problem \n\n\n\nin peritoneal dialysis patients.  Peritoneal dialysis patients are \n\n\n\ngenerally taught to self-administered SC ESA at home. Two \n\n\n\nstudies showed that adherence rates with self-administered \n\n\n\nESA ranged between 45% and 65% (non - adherence defined \n\n\n\nas less than 90% use of prescribed dose) [13,19].  This low \n\n\n\npercentage revealed the difficulty of PD patients to adherence \n\n\n\nwith this treatment. In our study, we assessed patient adherence \n\n\n\nto ESA administration post-intervention. The result showed \n\n\n\nthat the intervention group had a higher percentage of \n\n\n\nadherence to ESA administration than the standard group; \n\n\n\nhowever, there was no significant difference between the \n\n\n\ngroups. Medication teaching emphasising patient adherence is \n\n\n\nan area in which pharmacists can positively affect patient care. \n\n\n\nTable II. Mean Hb of pre and post-intervention for standard care and \n\n\n\ninterventional group \n\n\n\n\n\n\n\nCharacteristic \n\n\n\nPre \n\n\n\nintervention \n\n\n\nmean Hb \n\n\n\n(SD), g/dL \n\n\n\nPost \n\n\n\ninterventions \n\n\n\nmean Hb \n\n\n\n(SD), g/dL \n\n\n\nCI P-\n\n\n\nValue* \n\n\n\nStandard Care \n\n\n\nGroup  \n\n\n\n(n = 68) \n\n\n\n9.84 (\u00b11.89) 10.44 (\u00b11.91) -1.02, -\n\n\n\n0.16 \n\n\n\n<0.001 \n\n\n\nInterventional \n\n\n\nGroup (n=50) \n\n\n\n9.74 (\u00b11.68) 10.43 (\u00b11.90) -1.17, -\n\n\n\n0.21 \n\n\n\n<0.001 \n\n\n\n\n\n\n\n*Paired t-test was used \n\n\n\n\n\n\n\nTable III. Mean difference Hb for standard care and interventional \n\n\n\ngroup \n\n\n\n\n\n\n\nCharacteristic \nMean difference \n\n\n\nHb (SD), g/dL \nCI P-Value* \n\n\n\nStandard Care \n\n\n\nGroup  \n\n\n\n(n = 68) \n\n\n\n0.594 (\u00b11.78) -0.74, \n\n\n\n0.54 0.764 \n\n\n\nInterventional \n\n\n\nGroup (n=50) \n\n\n\n0.69 (\u00b11.68) -0.73, \n\n\n\n0.54 \n \n\n\n\n\n\n\n\n*Independent t-test was used \n\n\n\n\n\n\n\nTable IV. Adherence to ESA administration between both groups \n\n\n\n\n\n\n\nCharacteristic Yes (n, %) No (n,%) P-Value* \n\n\n\nStandard Care \n\n\n\nGroup  \n\n\n\n(n = 68) \n\n\n\n45 (66.1) 23 (33.9) 0.309 \n\n\n\nInterventional \n\n\n\nGroup (n=50) \n\n\n\n38 (76) 12 (24)  \n\n\n\n\n\n\n\n*Chi-square test \n \n\n\n\n \n\n\n\n\n\n\n\n\nFong C.W. et al. Mal J Pharm 7 (1) 2021, 43-48 \n\n\n\n\n\n\n\n47 \n\n\n\n\n\n\n\nEducational interventions by pharmacists had significantly \n\n\n\nimproved hemodialysis patients medication knowledge and \n\n\n\nmedication adherence [20,21]. One study reported that \n\n\n\npharmacist educational programme consisting of medical and \n\n\n\ntherapeutic information, information on injection device, \n\n\n\ntraining of pen, self-injection of the first dose in front of \n\n\n\npharmacists resulted in a higher level of adherence and leading \n\n\n\nto optimal Hb level within 2 months [17]. These strengthen the \n\n\n\nimportance of patient education and medication teaching by \n\n\n\npharmacists to improve adherence, achieve patient self-care, \n\n\n\nand attain therapeutic goals. However, this study has \n\n\n\nlimitations. First, a short duration of the study was a limitation \n\n\n\nto draw a conclusion about the service's long-term \n\n\n\neffectiveness or to assess the clinical impact of the service. \n\n\n\nBesides, this was a single institutional study, and the result may \n\n\n\nnot be generalisable to other practice settings. Future studies \n\n\n\nwith similar design can be conducted at multiple centres to \n\n\n\nproduce more reliable and generalisable results. \n\n\n\n\n\n\n\nCONCLUSION  \n  \n\n\n\nPharmacist's interventions, including ESA injection \n\n\n\ncounselling and ESA monitoring card may help in improving \n\n\n\nHb level of CAPD patients. \n\n\n\n\n\n\n\nACKNOWLEDGMENT \n  \n\n\n\nWe want to thank the Director-General of Health Malaysia for \n\n\n\nhis permission to publish this article and the Head of Pharmacy \n\n\n\nDepartment and CAPD nurses in Hospital Sultanah Nur \n\n\n\nZahirah, Kuala Terengganu, Malaysia, for their contribution \n\n\n\nand support throughout this study. \n\n\n\n\n\n\n\nCONFLICT OF INTEREST \n  \n\n\n\nAuthors declared no conflict of interest.  \n\n\n\n\n\n\n\nREFERENCE \n \n\n\n\n[1] Fishbane S, Spinowitz B. Update on Anemia in ESRD and Earlier \n\n\n\nStages of CKD: Core Curriculum 2018. Am J Kidney Dis. 2018 Mar \n\n\n\n1;71(3):423\u201335.  \n\n\n\n[2] Hazin MAA. Anemia in chronic kidney disease. Vol. 66Suppl 1, \n\n\n\nRevista da Associacao Medica Brasileira (1992). NLM (Medline); \n\n\n\n2020. p. s55\u20138.  \n\n\n\n[3] Cases A, Egocheaga MI, Tranche S, Pallar\u00e9s V, Ojeda R, G\u00f3rriz JL, \n\n\n\nPortol\u00e9s JM. Anemia of chronic kidney disease: Protocol of study, \n\n\n\nmanagement and referral to Nephrology. Nefrol (English Ed. 2018 Jan \n\n\n\n1;38(1):8\u201312.  \n\n\n\n[4] KDOQI Clinical Practice Guidelines and Clinical Practice \n\n\n\nRecommendations for Anemia in Chronic Kidney Disease. Am J \n\n\n\nKidney Dis. 2006;47(5 Suppl 3).  \n\n\n\n[5] Pantelias K, Graps E. Management of Anemia on Hemodialysis. In: \n\n\n\nHemodialysis. InTech; 2013.  \n\n\n\n[6] Parfrey PS, Foley RN, Wittreich BH, Sullivan DJ, Zagari MJ, Frei D. \n\n\n\nDouble-Blind Comparison of Full and Partial Anemia Correction in \n\n\n\nIncident Hemodialysis Patients without Symptomatic Heart Disease. \n\n\n\nJ Am Soc Nephrol. 2005;16:2180\u20139.  \n\n\n\n[7] Gilmartin C. Pharmacist\u2019s role in managing anemia in patients with \n\n\n\nchronic kidney disease: Potential clinical and economic benefits. Am \n\n\n\nJ Heal Pharm. 2007;64(13 SUPPL.):15\u201322.  \n\n\n\n[8] Ohnishi J, Miyake A, Kuwatsuka K, Onoue Y, Lee M, Koyama T, \n\n\n\nSendo T, Kawasaki H, Kitamura Y. Effect of pharmacist management \n\n\n\non serum hemoglobin levels with renal anemia in hemodialysis \n\n\n\noutpatients. Biol Pharm Bull. 2011;34(10):1609\u201312.  \n\n\n\n[9] Aspinall SL, Cunningham FE, Zhao X, Boresi JS, Tonnu-Mihara IQ, \n\n\n\nSmith KJ, Stone RA, Good CB. Impact of pharmacist-managed \n\n\n\nerythropoiesis-stimulating agents clinics for patients with non-\n\n\n\ndialysis-dependent CKD. Am J Kidney Dis. 2012 Sep;60(3):371\u20139.  \n\n\n\n[10] Debenito JM, Billups S, Tran T, Price L. Impact of a Clinical \n\n\n\nPharmacy Anemia Management. J Manag Care Spec Pharm JMCP \n\n\n\nJuly. 2014;20(7):715\u201320.  \n\n\n\n[11] Yang W, Israni RK, Brunelli SM, Joffe MM, Fishbane S, Feldman HI. \n\n\n\nHemoglobin variability and mortality in ESRD. J Am Soc Nephrol. \n\n\n\n2007 Dec;18(12):3164\u201370.  \n\n\n\n[12] Kidney Disease: Improving Global Outcomes (KDIGO) Anemia \n\n\n\nWork Group. KDIGO Clinical Practice Guideline for Anemia in \n\n\n\nChronic Kidney Disease. Kidney Int Suppl. 2012;2(4):279\u2013335.  \n\n\n\n[13] Nicoletta P, Bernardini J, Dacko C, Terry C, Fried L. Compliance with \n\n\n\nsubcutaneous erythropoietin in peritoneal dialysis patients. Adv Perit \n\n\n\nDial. 2000;16:90\u20132.  \n\n\n\n[14] H\u00f6rl WH. Anaemia management and mortality risk in chronic kidney \n\n\n\ndisease. Nat Rev Nephrol. 2013;9(5):291\u2013301.  \n\n\n\n[15] Alexander M, Kewalramani R, Agodoa I, Globe D. Association of \n\n\n\nanemia correction with health related quality of life in patients not on \n\n\n\ndialysis. Curr Med Res Opin. 2007;23(12):2997\u20133008.  \n\n\n\n[16] Marouf BH. Role of Pharmacist Intervention in the Management of \n\n\n\nAnemia Associated with Chronic Kidney Diseases at the \n\n\n\nHemodialysis Setting Pharmacology View project. J Young Pharm. \n\n\n\n2020;12(2):162\u20138.  \n\n\n\n[17] Allenet B, Chen C, Romanet T, Vialtel P, Calop J. Assessing a \n\n\n\npharmacist-run anaemia educational programme for patients with \n\n\n\nchronic renal insufficiency. Pharm World Sci. 2007;29(1):7\u201311.  \n\n\n\n[18] Mateti UV, Nagappa AN, Attur RP, Nagaraju SP, Rangaswamy D. \n\n\n\nImpact of pharmaceutical care on clinical outcomes among \n\n\n\nhemodialysis patients: A multicenter randomized controlled study. \n\n\n\nSaudi J Kidney Dis Transpl. 2018 Jul 1;29(4):801\u20138.  \n\n\n\n[19] Wazny LD, Stojimirovic BB, Heidenheim P, Blake PG. Factors \n\n\n\ninfluencing erythropoietin compliance in peritoneal dialysis patients. \n\n\n\nAm J Kidney Dis. 2002;40(3):623\u20138.  \n\n\n\n[20] Sathvik BS, Narahari MG, Gurudev KC, Parthasarathi G. Impact of \n\n\n\nClinical Pharmacist-Provided Education on Medication Adherence \n\n\n\nBehaviour in ESRD Patients on Haemodialysis. Iran J Pharm Sci \n\n\n\nWinter. 2009;5(1):21\u201330.  \n\n\n\n[21] Rani NV, Soundararajan P, Lakshmi Samyuktha CH, Kannan G, \n\n\n\nThennarasu P. Impact of clinical pharmacist provided education on \n\n\n\nmedication knowledge and adherence of hemodialysis patients in a \n\n\n\nSouth Indian university hospital. Asian J Pharm Clin Res. \n\n\n\n2013;6(SUPPL.4):24\u20137.  \n\n\n\n \n\n\n\n\n\n\n\n\nFong C.W. et al. Mal J Pharm 7 (1) 2021, 43-48 \n\n\n\n\n\n\n\n48 \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n"
"\n\n\n\n\n\nPP12684/8/2008 \n\n\n\nVol. 1 Issue 6. December 2008 \n\n\n\n\n\n\n\nMALAYSIAN \n\n\n\nJOURNAL of PHARMACY \n \n\n\n\nIn this issue: \n\n\n\n\n\n\n\n\uf0b7 Adherence To Antihypertensives \n\n\n\n\n\n\n\n\uf0b7 The Study of Alfuzosin and Finasteride \n\n\n\n\n\n\n\n\uf0b7 Serum Trace Elements and Immunoglobulin \n\n\n\nProfile \n\n\n\n\n\n\n\n\uf0b7 Influences of Patient-Related Factors in \n\n\n\nDiabetes \n\n\n\n\n\n\n\n\uf0b7 Proceedings of the MPS Pharmacy Scientific \n\n\n\nConference 2006 \n\n\n\n\n\n\n\nA Publication of the Malaysian Pharmaceutical Society \n\n\n\n\n\n\n\n\n i \n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy \nVol.1 Issue 6, December 2008     \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nThe Official Journal of the Malaysian Pharmaceutical Society       \n\n\n\n \n Editor-in-Chief: Assoc. Prof. Dr. Mohd Baidi bin Bahari \n\n\n\n\n\n\n\n Associate Editors: Assoc. Prof. Dr. Abas bin Hj Hussin \n\n\n\n  Assoc. Prof. Dr. Ab. Fatah bin Hj Ab Rahman \n\n\n\n  Prof. Dr. Abu Bakar bin Abdul Majeed \n\n\n\n  Prof. Dr. Aishah bte Adam \n\n\n\n  Assoc. Prof. Dr. Chung Lip Yong \n\n\n\n  Prof. Dr. Mohd. Isa bin Abdul Majid \n\n\n\n  Mr. John Chang \n\n\n\n  Assoc. Prof. Dr. Mohamed Izham bin Mohamed Ibrahim \n\n\n\n  Assoc. Prof. Dr. Mustafa Ali Mohd. \n\n\n\n  Prof. Dr. Paraidathathu Thomas a/l P.G. Thomas \n\n\n\n  Mr. Wong Sie Sing \n\n\n\n  Prof. Dr. Yuen Kah Hay \n\n\n\n\n\n\n\n Publisher: Malaysian Pharmaceutical Society \n\n\n\n5-B Lorong Rahim Kajai 13 \n\n\n\nTaman Tun Dr Ismail \n\n\n\n60000 Kuala Lumpur \n\n\n\n  Tel: 6-03-77291409 \n\n\n\nFax: 6-03-77263749 \n\n\n\n  Homepage: www.mps.org.my \n\n\n\nEmail: mspharm@po.jaring.my \n\n\n\n\n\n\n\n\n\n\n\n \nThe Malaysian Journal of Pharmacy is a publication of the Malaysian Pharmaceutical \n\n\n\nSociety.  Enquiries are to be directed to the publisher at the above address.  The Publisher \n\n\n\nreserves copyright and renewal on all published materials, and such material may not be \n\n\n\nreproduced in any form without the written permission of the Publisher.     \n\n\n\n\n\n\n\n \n\n\n\n\nhttp://www.mps.org.my/\n\n\nmailto:mspharm@po.jaring.my\n\n\n\n\n\n\n ii \n\n\n\nTable of contents \n \n\n\n\nEditorial  \n\n\n\n Mohd Baidi Bahari  iii \n\n\n\nResearch Papers  \n\n\n\n Adherence To Antihypertensives Among Haemodialysis \n\n\n\nPatients At Five Non-Governmental Organisation Centres In \n\n\n\nMalaysia \n\n\n\nHui-Lin Saw, Yoke-Lin Lo, Chae-Miang. Cher, Sean-Hau \n\n\n\nChang  \n\n\n\n\n\n\n\n220 \n\n\n\n The Study of Alfuzosin and Finasteride in the Treatment of \n\n\n\nBenign Prostatic Hyperplasia \n\n\n\nLee Sau Yong, Tan Meng Wah and Wan Noor Hayati \n\n\n\n\n\n\n\n234 \n\n\n\n Serum Trace Elements and Immunoglobulin Profile in Lung \n\n\n\nCancer Patients \n\n\n\nA F M Nazmus Sadat, Md. Iqbal Hossain, Md.  Khalid \n\n\n\nHossain, Md. Selim Reza, Zabun Nahar, Md. Nazrul Islam \n\n\n\nKhan, SK. Nazrul Islam, and Abul Hasnat\n \n\n\n\n\n\n\n\n246 \n\n\n\n Influences of Patient-Related Factors in Diabetes \n\n\n\nManagement Among Non-Insulin-Treated Type 2 Diabetics \n\n\n\nYap Li Swan  \n\n\n\n256 \n\n\n\nSupplement   \n\n\n\n Proceedings of the MPS Pharmacy Scientific Conference \n\n\n\n2006 \n\n\n\n\n\n\n\nS95 \n\n\n\nInstructions to Authors  \n\n\n\n Please refer to webpage www.mps.org.my for the latest \n\n\n\nupdate \n\n\n\n\n\n\n\n \n\n\n\n\nhttp://www.mps.org.my/\n\n\n\n\n\n\n iii \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nEditorial     \n \n \n\n\n\nThis issue of the Malaysian Journal of Pharmacy, the official journal for the Malaysian \n\n\n\nPharmaceutical Society contains several research articles that were submitted to the \n\n\n\neditor in the past few years since the last issue of the journal in 2006.  The issue also \n\n\n\npublishes the proceeding of the Malaysian Pharmaceutical Society Scientific Conference \n\n\n\n2006. \n\n\n\n\n\n\n\nThe shortage of contribution from the researchers to the locally published journals has \n\n\n\ncontributed to the delay or even discontinuation of most local journals.  Higher reward \n\n\n\ngiven by the research institutions or universities to the researchers who published their \n\n\n\nfinding in high impact factor journals has contributed to this scenario.  The researchers \n\n\n\nare willing to wait for the long list to publish their research finding in more prestigious \n\n\n\njournals with highest impact factor. Local journals are left to published research finding \n\n\n\nthat do not meet the merit of prestigious journals. \n\n\n\n\n\n\n\nThe editor of the Malaysian Journal of Pharmacy is inviting all authors to publish their \n\n\n\narticle in this journal.  Contribution could be in the form of original article, review article, \n\n\n\ncontinuous pharmacy development (CPD), short communication, letter to editor and other \n\n\n\ntype of manuscripts.  The editor also welcome contribution in the from of important news \n\n\n\nrelated to pharmacy such as news on adverse drug reaction, list of drug discontinued from \n\n\n\nthe market, new list of registered drugs, and other related information.  Malaysian \n\n\n\nPharmaceutical Society Area Committees are also invited to publish the report of their \n\n\n\nactivities in the Malaysian Journal of Pharmacy. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nMohd Baidi Bahari \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n220 \n\n\n\nAdherence To Antihypertensives Among Haemodialysis Patients \n\n\n\nAt Five Non-Governmental Organisation Centres In Malaysia \n\n\n\n\n\n\n\nHui-Lin Saw\n1\n, Yoke-Lin Lo\n\n\n\n1*\n, Chae-Miang. Cher\n\n\n\n1\n, Sean-Hau Chang\n\n\n\n2\n  \n\n\n\n1\nDepartment of Pharmacy, \n\n\n\n2\nDepartment of Medicine, Faculty of Medicine, \n\n\n\nUniversity of Malaya, 50603 Kuala Lumpur \n\n\n\n\n\n\n\n* Corresponding author \nMalaysian Journal of Pharmacy 2008: 1( 6): 220 -233                                               \n\n\n\n\n\n\n\nAbstract \n\n\n\nBackground: Uncontrolled hypertension is associated with increased \n\n\n\ncardiovascular mortality among haemodialysis (HD) patients. Poor adherence to \n\n\n\nantihypertensive regimens was found to contribute to inadequate control of blood \n\n\n\npressure. The study is aimed to investigate the adherence to antihypertensives and \n\n\n\nfactors affecting adherence among HD patients at non-governmental organisation \n\n\n\n(NGO) dialysis centres at the vicinity around Kuala Lumpur  \n\n\n\nMethods: Cross-sectional surveys using questionnaires were conducted in five \n\n\n\nNGO dialysis centres and Statistical Package for the Social Sciences (SPSS) was \n\n\n\nemployed to conduct all statistical analyses. Patients who took at least 80% of the \n\n\n\nprescribed antihypertensives were considered as adherent.  \n\n\n\nResults: Two hundred and thirty-one respondents were interviewed; of which, \n\n\n\n68% of patients were adherent. Patients\u2019 socio-demographic characteristics did \n\n\n\nnot show any correlation to their adherence (p>0.05). On the other hand, the \n\n\n\nsetting of dialysis centres did influence drug adherence significantly (p=0.033). \n\n\n\nMedication cost influenced adherence in a way that those who received \n\n\n\nmedication for free and who had no difficulty paying for their medications were \n\n\n\nmore adherent when compared to their counterparts (p=0.004 and p=0.016, \n\n\n\nrespectively). The number of prescribed medications also showed significant \n\n\n\nrelationship with adherence (p=0.032). Furthermore, patients who did not \n\n\n\nexperience major side effects from antihypertensives revealed better adherence \n\n\n\n(p=0.019). Conclusions: Adherence to antihypertensives was suboptimal among \n\n\n\nHD patients at the NGO dialysis centres studied. Thus, all potential barriers to \n\n\n\nadherence should be taken into consideration in the treatment of hypertension \n\n\n\namong these patients.  \n\n\n\n\n\n\n\nKeywords: haemodialysis; drug adherence; antihypertensives \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n221 \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nIntroduction \n\n\n\n\n\n\n\nCardiovascular disease is the main \n\n\n\ncause of death in haemodialysis \n\n\n\n(HD) patients. In Malaysia, it \n\n\n\naccounted for 26% of death in \n\n\n\ndialysis population in year 2004 \n1\n. \n\n\n\nHypertension is one of the risk \n\n\n\nfactors to increased cardiovascular \n\n\n\nmortality \n2,3\n\n\n\n while antihypertensive \n\n\n\ntherapy was found to decrease the \n\n\n\nrisk \n3\n.  \n\n\n\nPrevalence of hypertension in HD \n\n\n\npatients is very high and in the \n\n\n\nUnited States it was found to be 86% \n4\n. Tozawa and colleagues \n\n\n\n5\n reported \n\n\n\nthat antihypertensives were the \n\n\n\nsecond most commonly prescribed \n\n\n\ngroup of drugs in HD patients with \n\n\n\n71% of patients were prescribed at \n\n\n\nleast one antihypertensive agent.   \n\n\n\nDespite advanced development of \n\n\n\neffective antihypertensive drugs and \n\n\n\ntreatment guidelines, \n\n\n\npharmacological treatment of \n\n\n\nhypertension in HD patients \n\n\n\ncontinue to be a great challenge to \n\n\n\nhealthcare providers partly because \n\n\n\nHD patients are known to be poor \n\n\n\ncompliers to their medications \n5-7\n\n\n\n. \n\n\n\nDrug adherence is now recognised \n\n\n\nglobally as the foundation to the \n\n\n\nsuccess of medical therapy, because \n\n\n\npatients will only obtain the full \n\n\n\nbenefit of the medications provided \n\n\n\nthey follow the prescribed regimens \n\n\n\nreasonably closely. More than one \n\n\n\nstudies found that poor adherence to \n\n\n\nantihypertensives was one of the \n\n\n\nmajor factors to uncontrolled \n\n\n\nhypertension \n8,9\n\n\n\n. \n\n\n\nVery few studies, if any, regarding \n\n\n\ndrug adherence among HD patients \n\n\n\nhave been carried out in Malaysia. In \n\n\n\nview of the importance of adherence \n\n\n\nto antihypertensives on blood \n\n\n\npressure (BP) control, the need for a \n\n\n\nresearch to study adherence to \n\n\n\nantihypertensives and factors \n\n\n\naffecting adherence among HD \n\n\n\npatients in Malaysia either as a \n\n\n\nwhole population or in subgroups of \n\n\n\npopulation is clear and warranted. \n\n\n\nNon-governmental organisation \n\n\n\n(NGO) dialysis centres became the \n\n\n\nfocus of this study because over the \n\n\n\nyears, the NGOs have been playing \n\n\n\nan increasing role in dialysis \n\n\n\nprovision in this country. A recent \n\n\n\nreport showed that 34% of dialysis \n\n\n\npatients in Malaysia were receiving \n\n\n\ntheir HD treatment in NGO dialysis \n\n\n\ncentres in year 2004 \n1\n. These centres \n\n\n\nare mostly non-profit, charitable \n\n\n\norganisations which provide \n\n\n\nsubsidized treatment to patients from \n\n\n\nlow-income groups.    \n\n\n\nThe aims of this study are to assess \n\n\n\nthe degree of adherence to \n\n\n\nantihypertensive regimens among \n\n\n\nHD patients at various NGO dialysis \n\n\n\ncentres, to examine adherence \n\n\n\naccording to socio-demographic \n\n\n\ncharacteristic and to identify various \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n222 \n\n\n\nfactors affecting adherence to \n\n\n\nantihypertensive(s).  \n\n\n\n\n\n\n\nMethods  \n\n\n\n\n\n\n\nStudy population  \n\n\n\nNGO dialysis centres located in the \n\n\n\nvicinity of the University of Malaya \n\n\n\nwere identified. Subsequently, \n\n\n\nethical approval to interview \n\n\n\nconsenting patients and to review \n\n\n\ntheir medical records was obtained \n\n\n\nfrom the respective authorities. All \n\n\n\nadult HD patients who were \n\n\n\nprescribed at least one \n\n\n\nantihypertensive agent were eligible \n\n\n\nto participate in this study. Subjects \n\n\n\nwere recruited by convenience \n\n\n\nsampling. \n\n\n\nPatients who had received \n\n\n\nhaemodialysis therapy for less than \n\n\n\nthree months were excluded from \n\n\n\nthe study because their clinical \n\n\n\nconditions and their drug regimens \n\n\n\nwere yet to be stabilised \n10\n\n\n\n. Patients \n\n\n\nwho could not be interviewed \n\n\n\nbecause they were too ill, had \n\n\n\ndifficulties with communication or \n\n\n\nhad severe physical or mental \n\n\n\ndisabilities were excluded. Those \n\n\n\nwho could not recall their drug \n\n\n\nregimens were also excluded.  \n\n\n\nData collection  \n\n\n\nA pilot study was conducted to \n\n\n\ncheck the clarity and reliability of \n\n\n\nthe questionnaire.  Amendments \n\n\n\nwere made to the questionnaire \n\n\n\nbefore the actual study was carried \n\n\n\nout. Interviews were conducted from \n\n\n\nOctober, 2005 to February, 2006. \n\n\n\nPatients were interviewed using \n\n\n\nstructured questionnaires while they \n\n\n\nwere receiving their dialysis \n\n\n\ntreatment. The questionnaire \n\n\n\nincluded questions on socio-\n\n\n\ndemographic characteristics, the \n\n\n\npatient\u2019s renal disease and drug \n\n\n\ntreatment. Information obtained was \n\n\n\ncorroborated with their medical \n\n\n\nrecords. Four questions used to \n\n\n\nassess adherence to \n\n\n\nantihypertensives were adopted from \n\n\n\nthe Brief Medication Questionnaire \n\n\n\ndeveloped by Svarstad and \n\n\n\ncolleagues \n11\n\n\n\n. These questions \n\n\n\nfocused in the past one week to \n\n\n\nminimise recall bias.  \n\n\n\n\n\n\n\nPercentage of adherence in the past \n\n\n\nseven days was calculated as \n\n\n\nfollows: \n\n\n\n\n\n\n\nPercentage of adherence \n\n\n\n= \n  weekpast the in consumed be to  wasthat pills ensiveantihypert of number Total\n\n\n\n weekpast the in patient theby  consumed pills ensiveantihypert of number Total\nX 100% \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n223 \n\n\n\nData analysis  \n\n\n\n\n\n\n\nFor the purpose of statistical \n\n\n\nanalysis, adherence was defined as \n\n\n\ntaking at least 80% of the prescribed \n\n\n\nantihypertensives dose within the \n\n\n\npast seven days \n12,13\n\n\n\n. All statistical \n\n\n\nanalyses were performed using \n\n\n\nStatistical Package for the Social \n\n\n\nSciences (SPSS Inc., Chicago IL, \n\n\n\nUSA.). Chi-square tests were used to \n\n\n\nanalyse the relationships between \n\n\n\nadherence to antihypertensive(s) and \n\n\n\n(i) patients\u2019 socio-demographic \n\n\n\ncharacteristics and (ii) patients\u2019 \n\n\n\nclinical characteristics. The variables \n\n\n\nwere considered to be significantly \n\n\n\nrelated to adherence to \n\n\n\nantihypertensives if p values were \n\n\n\nless than 0.05. \n\n\n\n\n\n\n\nResults \n\n\n\n\n\n\n\nPatient characteristics  \n\n\n\n\n\n\n\nOf 252 eligible patients approached \n\n\n\nby the investigators, 21 refused to \n\n\n\nparticipate (response rate of 92%), \n\n\n\nresulting in a total of 231 patients \n\n\n\nfrom five NGO dialysis centres \n\n\n\nparticipated in this study. These five \n\n\n\ncentres were labelled as Centre A, B, \n\n\n\nC, D and E for the purpose of \n\n\n\nconfidentiality. The age of HD \n\n\n\npatients in this study population \n\n\n\nranged from 26 to 82 years (mean = \n\n\n\n52.82 years; SD = 12.54 years). \n\n\n\nMale patients accounted for 57.6% \n\n\n\nand 42.4% female. More than half of \n\n\n\nthe patients were Chinese (61%), \n\n\n\n21.4% of Malay, 17% of Indian and \n\n\n\none Portuguese. These patients had \n\n\n\nbeen dialysed from a minimum of 3 \n\n\n\nmonths up to a maximum of 15 \n\n\n\nyears (mean = 3.49; SD = 3.00). The \n\n\n\nnumber of concurrent diseases (other \n\n\n\nthan end stage renal failure) ranged \n\n\n\nfrom one to five (mean = 2.36; SD = \n\n\n\n0.91); whereas the number of \n\n\n\nprescribed medications taken by \n\n\n\nthem ranged from three to eleven \n\n\n\n(mean = 6.44; SD = 2.06).    \n\n\n\n\n\n\n\nDegree of adherence  \n\n\n\n\n\n\n\nThere were 57% of patients admitted \n\n\n\n100% adherence to their \n\n\n\nantihypertensives, 11% achieved \n\n\n\nadherence rate at least 80% (but not \n\n\n\nto 100%) and 32 % showed an \n\n\n\nadherence rate less than 80%.  \n\n\n\n\n\n\n\nPatient socio-demographic \n\n\n\ncharacteristics and non-adherence  \n\n\n\n\n\n\n\nAs seen in Table 1, socio-\n\n\n\ndemographic characteristics did not \n\n\n\nshow significant relationships with \n\n\n\nadherence to antihypertensive(s).  \n\n\n\n\n\n\n\nClinical characteristics of non-\n\n\n\nadherent patients  \n\n\n\n\n\n\n\nTable 2 summarises the correlations \n\n\n\nbetween adherence to \n\n\n\nantihypertensives and patient clinical \n\n\n\ncharacteristics. A few significant \n\n\n\nrelationships were observed between \n\n\n\npatients\u2019 clinical characteristics and \n\n\n\nnon-adherence to antihypertensives.\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n224 \n\n\n\nTable 1: Socio-demographic characteristics and non-adherence to \n\n\n\nantihypertensive(s) \n\n\n\n\n\n\n\nCharacteristics Number of patients \n\n\n\ninterviewed \n\n\n\nNumber of non-\n\n\n\nadherent patients (%) \n\n\n\n\n\n\n\n\n\n\n\n(p) \n\n\n\nTotal 231 74  \n\n\n\nGender \n\n\n\n   Male \n\n\n\n   Female \n\n\n\n\n\n\n\n\n\n\n\n133 \n\n\n\n98 \n\n\n\n\n\n\n\n45 (33.8) \n\n\n\n29 (29.6) \n\n\n\n(0.495) \n\n\n\n\n\n\n\nAge (in years) \n\n\n\n   26-45 \n\n\n\n   46-65 \n\n\n\n   66-85 \n\n\n\n\n\n\n\n\n\n\n\n65 \n\n\n\n136 \n\n\n\n30 \n\n\n\n\n\n\n\n22 (33.8) \n\n\n\n41 (30.1) \n\n\n\n11 (36.7) \n\n\n\n(0.735) \n\n\n\nRace \n\n\n\n   Chinese \n\n\n\n   Indian \n\n\n\n   Malay \n\n\n\n   Portuguese \n\n\n\n\n\n\n\n\n\n\n\n144 \n\n\n\n46 \n\n\n\n40 \n\n\n\n1 \n\n\n\n\n\n\n\n43 (29.9) \n\n\n\n14 (30.4) \n\n\n\n16 (40.0) \n\n\n\n1  \n\n\n\n(0.301) \n\n\n\nMarital status \n\n\n\n   Married \n\n\n\n   Never married \n\n\n\n   Divorced/ separated \n\n\n\n   Spouse deceased \n\n\n\n\n\n\n\n\n\n\n\n171 \n\n\n\n42 \n\n\n\n10 \n\n\n\n8 \n\n\n\n\n\n\n\n52 (30.4) \n\n\n\n14 (33.3) \n\n\n\n5 (50.0) \n\n\n\n3 (37.5) \n\n\n\n(0.608) \n\n\n\nEducation \n\n\n\n   Illiterate \n\n\n\n   Primary school \n\n\n\n   Secondary school \n\n\n\n   Tertiary education \n\n\n\n\n\n\n\n\n\n\n\n27 \n\n\n\n79 \n\n\n\n105 \n\n\n\n20 \n\n\n\n\n\n\n\n\n\n\n\n9 (33.3) \n\n\n\n29 (36.7) \n\n\n\n31 (29.5) \n\n\n\n5 (25.0) \n\n\n\n(0.666) \n\n\n\nEmployment \n\n\n\n   Unemployed \n\n\n\n   Employed/self-employed \n\n\n\n\n\n\n\n\n\n\n\n184 \n\n\n\n47 \n\n\n\n\n\n\n\n57 (31.0) \n\n\n\n17 (36.2) \n\n\n\n(0.496) \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n225 \n\n\n\nTable 2: Clinical characteristics and non-adherence to antihypertensives \n\n\n\n\n\n\n\nCharacteristics Number of patients \n\n\n\ninterviewed \n\n\n\nNumber of non-\n\n\n\nadherent patients (%) \n\n\n\np value \n\n\n\nTotal 231 74  \n\n\n\nDialysis centres  \n\n\n\n   Centre A \n\n\n\n   Centre B \n\n\n\n   Centre C \n\n\n\n   Centre D \n\n\n\n   Centre E \n\n\n\n\n\n\n\n\n\n\n\n96 \n\n\n\n70 \n\n\n\n35 \n\n\n\n21 \n\n\n\n9 \n\n\n\n\n\n\n\n25 (26.0%) \n\n\n\n32 (45.7%) \n\n\n\n9 (25.7%) \n\n\n\n4 (19.0%) \n\n\n\n4 (44.4%) \n\n\n\n(0.033*) \n\n\n\nLength of time on dialysis  \n\n\n\n   \u2264 2 years \n\n\n\n   > 2-5 years \n\n\n\n   > 5 years  \n\n\n\n\n\n\n\n109 \n\n\n\n74 \n\n\n\n48 \n\n\n\n\n\n\n\n\n\n\n\n33 (30.3%) \n\n\n\n26 (35.1%) \n\n\n\n15 (31.3%) \n\n\n\n(0.781) \n\n\n\nCause of renal failure  \n\n\n\n   Diabetes  \n\n\n\n   Hypertension  \n\n\n\n   Others  \n\n\n\n\n\n\n\n109  \n\n\n\n35 \n\n\n\n87 \n\n\n\n\n\n\n\n\n\n\n\n37 (33.9%) \n\n\n\n10 (28.6%) \n\n\n\n27 (31.0%) \n\n\n\n(0.812) \n\n\n\nNumber of co-morbidities  \n\n\n\n   1 \n\n\n\n   2 \n\n\n\n   \u2265 3 \n\n\n\n\n\n\n\n40 \n\n\n\n96 \n\n\n\n95 \n\n\n\n\n\n\n\n\n\n\n\n13 (32.5%) \n\n\n\n31 (32.3%) \n\n\n\n30 (31.6%) \n\n\n\n(0.992) \n\n\n\nNumber of prescribed \n\n\n\nmedications \n\n\n\n   3-5 \n\n\n\n   6-8 \n\n\n\n   9-11 \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n79 \n\n\n\n110 \n\n\n\n42 \n\n\n\n\n\n\n\n\n\n\n\n32 (40.5%) \n\n\n\n26 (23.6%) \n\n\n\n16 (38.1%) \n\n\n\n(0.032*) \n\n\n\nNumber of \n\n\n\nantihypertensives \n\n\n\n   1 \n\n\n\n   2 \n\n\n\n   3-5  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n106 \n\n\n\n79 \n\n\n\n46 \n\n\n\n\n\n\n\n\n\n\n\n35 (33.0%) \n\n\n\n27 (34.2%) \n\n\n\n12 (26.1%) \n\n\n\n(0.618) \n\n\n\n\n\n\n\nMonthly medication \n\n\n\nexpenses \n\n\n\n   Free (Government \n\n\n\nsubsidized) \n\n\n\n   RM 1-RM 50 \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n122 \n\n\n\n27 \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n29 (23.8%) \n\n\n\n13 (48.1%) \n\n\n\n(0.021*) \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n226 \n\n\n\n   RM 51-RM 100 \n\n\n\n   > RM 100    \n\n\n\n\n\n\n\n49 \n\n\n\n33 \n\n\n\n21 (42.9%) \n\n\n\n11 (33.3%) \n\n\n\nDifficulty paying for \n\n\n\nmedications \n\n\n\n   Had difficulty  \n\n\n\n   No difficulty  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n58 \n\n\n\n173 \n\n\n\n\n\n\n\n\n\n\n\n26 (44.8%) \n\n\n\n48 (27.7%) \n\n\n\n(0.016*) \n\n\n\nSide effects \n\n\n\n   Experienced side effects \n\n\n\n   No side effect \n\n\n\n\n\n\n\n27 \n\n\n\n204 \n\n\n\n\n\n\n\n\n\n\n\n14 (51.9%) \n\n\n\n60 (29.4%) \n\n\n\n(0.019*) \n\n\n\n\n\n\n\n\n\n\n\n* Significant difference \n \n\n\n\n\n\n\n\nThe locations of dialysis centres \n\n\n\ninfluenced adherence to \n\n\n\nantihypertensives significantly (p = \n\n\n\n0.033). Patients from Centre B were \n\n\n\nmore likely to be nonadherent \n\n\n\ncompared to those from Centre A \n\n\n\n(p=0.008), C (p=0.048) and D (p = \n\n\n\n0.028).  No significant difference \n\n\n\nwas found among Centre A, C and \n\n\n\nD. Centre E was not included in the \n\n\n\ncomparison because its sample size \n\n\n\nwas too small. The number of \n\n\n\nprescribed medications, rather than \n\n\n\nthe number of prescribed \n\n\n\nantihypertensives was found to \n\n\n\ninfluence non-adherence to \n\n\n\nantihypertensives. Those patients \n\n\n\nwho took six to eight medications \n\n\n\ndaily were significantly more \n\n\n\nadherent than those taking three to \n\n\n\nfive medications (p = 0.013). In \n\n\n\ngeneral, patients whose medications \n\n\n\nwere fully subsidised showed \n\n\n\nsignificantly better adherence than \n\n\n\nthose paying for their medications (p \n\n\n\n= 0.004).  \n\n\n\n\n\n\n\nContradictorily, when a medicine \n\n\n\nwith a higher cost was prescribed, \n\n\n\nthe adherence rate was also higher \n\n\n\n(Figure 1). Finally, patients who had \n\n\n\ndifficulty paying for their \n\n\n\nmedications and those who \n\n\n\nexperienced side effects from their \n\n\n\nantihypertensives were significantly \n\n\n\nless adherent than their counterparts\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n227 \n\n\n\nFigure 1: Comparison of adherence to antihypertensives according to monthly \n\n\n\nmedication expenses \n\n\n\n\n\n\n\n0\n\n\n\n10\n\n\n\n20\n\n\n\n30\n\n\n\n40\n\n\n\n50\n\n\n\n60\n\n\n\n70\n\n\n\n80\n\n\n\n90\n\n\n\n100\n\n\n\nFree RM1-\n\n\n\nRM50\n\n\n\nRM51-\n\n\n\nRM100\n\n\n\nMore\n\n\n\nthan RM\n\n\n\n100\n\n\n\nMonthly medication expenses\n\n\n\n%\n o\n\n\n\nf \np\n\n\n\na\nti\n\n\n\ne\nn\n\n\n\nts\n\n\n\nCompliant\n\n\n\nNon-compliant\n\n\n\n\n\n\n\nDiscussion \n\n\n\n\n\n\n\nAs has been found in previous \n\n\n\nresearch, an adherence rate of at \n\n\n\nleast 80% is required to achieve a \n\n\n\ndesired reduction in BP \n12,13\n\n\n\n. With \n\n\n\nthis cut-off point, 68% of patients \n\n\n\nwere found to have adequately \n\n\n\ncomplied with their antihypertensive \n\n\n\nregimens.   The degree of adherence \n\n\n\nto antihypertensive medications in \n\n\n\nthis study was found to be higher \n\n\n\ncompared to a study by Curtin and \n\n\n\ncolleagues \n14\n\n\n\n, where only 52% to \n\n\n\n57% of patients acquired at least \n\n\n\n80% of adherence. This difference \n\n\n\ncould be due to the variation in \n\n\n\nmethods that were employed in \n\n\n\ncarrying out the research \n15\n\n\n\n. In their \n\n\n\nstudy, Medication Event Monitoring \n\n\n\nSystem (MEMS\nTM\n\n\n\n) was used to \n\n\n\nmonitor patients\u2019 adherence over a \n\n\n\nperiod of six weeks. Furthermore, \n\n\n\ninterview method is known to \n\n\n\noverestimate adherence rate because \n\n\n\npatients tend to underreport their \n\n\n\nnon-adherent behaviour and some \n\n\n\nmay be unwilling to disclose this \n\n\n\nmedically unacceptable behaviour \n11\n\n\n\n.     \n\n\n\n\n\n\n\nSocio-demographic characteristics \n\n\n\nwere not found to be associated with \n\n\n\nadherence to antihypertensives. \n\n\n\nMultiple studies have been \n\n\n\nconducted to study the relationship \n\n\n\nbetween drug adherence and \n\n\n\ndemographic characteristics. So far \n\n\n\nthe results are inconclusive \n6,14,16\n\n\n\n. \n\n\n\nThis study was unable to assess the \n\n\n\nrelationship between household \n\n\n\nincome and adherence to  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n228 \n\n\n\nantihypertensives as about 10% of \n\n\n\npatients did not know or were \n\n\n\nunwilling to disclose their household \n\n\n\nincome and some admitted \n\n\n\nunderreporting their household \n\n\n\nincome. Enrolment for most NGO \n\n\n\ndialysis centres in Malaysia gives \n\n\n\npriority to those from a lower \n\n\n\nincome group. Hence, it is \n\n\n\nunderstandable why patients refused \n\n\n\nto disclose their actual household \n\n\n\nincome.  \n\n\n\n\n\n\n\nThe setting of dialysis centres was \n\n\n\nfound to significantly influence \n\n\n\npatients\u2019 adherence to \n\n\n\nantihypertensives. This observation \n\n\n\nis probably closely related to the \n\n\n\nnature of healthcare provider-patient \n\n\n\nrelationship. Centre A is the only \n\n\n\ncentre in this study which has an in-\n\n\n\nhouse nephrologist and doctors. \n\n\n\nMedical consultation is readily \n\n\n\naccessible whenever patients \n\n\n\nexperience any doubt or problems \n\n\n\nregarding their antihypertensive \n\n\n\nregimens. Constant availability of \n\n\n\ndoctors to patients provides a sense \n\n\n\nof security and nurtures a trusting \n\n\n\ndoctor-patient relationship and \n\n\n\nsubsequently promotes patient \n\n\n\nadherence \n17,18\n\n\n\n. On the other hand, \n\n\n\nthe other dialysis centres are \n\n\n\naffiliated to nearby hospitals and \n\n\n\npatients are followed-up by visiting \n\n\n\ndoctors. In these centres, the ratio of \n\n\n\nstaff nurse to patients seemed to \n\n\n\ninfluence patient adherence. The \n\n\n\nratio of staff nurse to patients in \n\n\n\nCentre B, C and D were 1:10, 1:5 to \n\n\n\n7 and 1:5, respectively. It is evident \n\n\n\nthat the lower the ratio of staff nurse \n\n\n\nto patients, the higher the adherence \n\n\n\nrate was observed. This could be due \n\n\n\nto a better quality and quantity of \n\n\n\ntime spent between nurses and \n\n\n\npatients facilitating drug adherence.  \n\n\n\n\n\n\n\nThe impact of healthcare provider-\n\n\n\npatient interaction on patient care is \n\n\n\nalways a topic of interest among \n\n\n\nresearchers \n19-21\n\n\n\n. In the management \n\n\n\nof patients with chronic diseases, in \n\n\n\nthis case, HD patients, a \n\n\n\nmultidisciplinary involvement of \n\n\n\nhealthcare team is essential (Joy et \n\n\n\nal. 2005). Pharmacists in Malaysia \n\n\n\ndo not yet have rapport with HD \n\n\n\npatients as compared to rapport of \n\n\n\ndoctors and nurses to HD patients. \n\n\n\nPharmacists can provide counselling \n\n\n\nto HD patients regarding their \n\n\n\nmedications and benefits of being \n\n\n\nadherent to prescribed regimens. \n\n\n\nThey can also help in addressing \n\n\n\npatients\u2019 feedbacks about their \n\n\n\nmedications. Throughout the years, \n\n\n\nmany studies have successfully \n\n\n\nproven the positive impact of \n\n\n\npharmacist\u2019s involvement in the care \n\n\n\nof HD patients \n22-25\n\n\n\n.  \n\n\n\n\n\n\n\nA linear relationship between the \n\n\n\nnumber of prescribed medications \n\n\n\nand adherence to antihypertensives \n\n\n\nwas not found. The exact reason \n\n\n\nbehind this observation is unclear. \n\n\n\nNevertheless, it is worth noting that \n\n\n\nthe use of pillbox was found to be \n\n\n\nbeneficial in facilitating drug \n\n\n\nadherence especially for patients \n\n\n\nwith polypharmacy. \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n229 \n\n\n\nHigh medication cost adversely \n\n\n\naffects drug adherence \n26,27\n\n\n\n. Drug \n\n\n\naffordability is always a concern \n\n\n\namong HD patients because other \n\n\n\nthan monthly medication expenses, \n\n\n\nthey have to pay for their HD \n\n\n\ntreatment and other medications \n\n\n\nsuch as erythropoietin and calcitriol. \n\n\n\nIn this study, it was found that \n\n\n\npatients received their subsidized \n\n\n\nmedication were more likely to be \n\n\n\nadherent to antihypertensives than \n\n\n\nthose who have to pay the full cost \n\n\n\nfor their medications. This could \n\n\n\nmean that if HD patients received \n\n\n\ntheir medications partially \n\n\n\nsubsidized, their adherence may be \n\n\n\nimproved.  \n\n\n\n\n\n\n\nPatients who admitted having \n\n\n\ndifficulty paying for their \n\n\n\nmedications appeared to be less \n\n\n\nadherent than their counterparts. \n\n\n\nThis was possible that financial \n\n\n\ntension forced them to adopt \n\n\n\nstrategies such as reducing or \n\n\n\nskipping doses of their \n\n\n\nanytihypertensives in order to make \n\n\n\nthe medications last longer \n26\n\n\n\n. There \n\n\n\nwere patients in this study who \n\n\n\nadmitted being unable to refill their \n\n\n\nprescriptions in time due to financial \n\n\n\nconstraint.  \n\n\n\nPiette and colleagues \n28\n\n\n\n concluded in \n\n\n\ntheir study that problems associated \n\n\n\nwith cost of medication are rather \n\n\n\ncomplex. Patients can react to cost \n\n\n\nof medication differently. Some \n\n\n\nwould continue taking their \n\n\n\nmedication despite the cost, but \n\n\n\nsome would forgo treatment even \n\n\n\nthough they could afford it. In order \n\n\n\nto have a better view about the effect \n\n\n\nof medication cost on individual \n\n\n\npatients, Heisler and colleagues \n29\n\n\n\n\n\n\n\nsuggested that healthcare providers \n\n\n\nshould discuss about this issue with \n\n\n\ntheir patients as part of the \n\n\n\nassessment of drug adherence. \n\n\n\nIdentifying patients with financial \n\n\n\ndifficulty and subsequently \n\n\n\nappropriate actions such as \n\n\n\nrecruiting financial aid from welfare \n\n\n\nbodies or prescribing less expensive \n\n\n\nalternatives would probably be \n\n\n\nhelpful in promoting drug \n\n\n\nadherence.  \n\n\n\nSide effects associated with \n\n\n\nantihypertensives such as dizziness, \n\n\n\ngeneral weakness, a \u2018weak heart\u2019 \n\n\n\nand a slow heart rate were identified \n\n\n\nby patients. In this study, less than \n\n\n\nhalf of the patients told their doctors \n\n\n\nabout their drug problems. This \n\n\n\nphenomenon agreed with the finding \n\n\n\nby Kjellgren and colleagues \n17\n\n\n\n that \n\n\n\npatients are usually reluctant to tell \n\n\n\ntheir doctors about the side effects \n\n\n\nthey experienced if these side effects \n\n\n\ncan be alleviated by altering the \n\n\n\ndosage themselves. Furthermore, \n\n\n\npatients did not have ready access to \n\n\n\ndoctors in most dialysis centres in \n\n\n\nthis study. Failure of patients to tell \n\n\n\ntheir doctors about the side effects of \n\n\n\ndrugs they experienced may actually \n\n\n\nendanger their wellbeing especially \n\n\n\nif these side effects occur frequently \n18\n\n\n\n. In view of this, healthcare \n\n\n\nproviders have the responsibility to \n\n\n\nconstantly seek feedbacks from \n\n\n\npatients on whether they experience \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n230 \n\n\n\nany side effects from their current \n\n\n\ntherapy \n17\n\n\n\n. These feedbacks help \n\n\n\nreveal their non-adherent behaviour.  \n\n\n\nAs reported by Horne and Weinman \n30\n\n\n\n, there were patients who did not \n\n\n\nexperience side effects from the \n\n\n\ncurrent antihypertensive regimens, \n\n\n\nyet due to previous hypotensive \n\n\n\nepisodes, they pre-empted by \n\n\n\nintentionally reduce the doses of \n\n\n\ntheir medications.  In the present \n\n\n\nstudy, many patients withheld their \n\n\n\nantihypertensive doses on own \n\n\n\naccord before dialysis due to the \n\n\n\nconcern of intradialytic hypotension. \n\n\n\nThis action has been identified in \n\n\n\nprevious studies as one of the major \n\n\n\nfactors contributing to inadequate \n\n\n\ncontrol of blood pressure among HD \n\n\n\npatients \n8,9\n\n\n\n. It was suggested that re-\n\n\n\nevaluation of blood pressure profiles \n\n\n\nand antihypertensive regimens of \n\n\n\nthese patients is warranted.  \n\n\n\nThe interpretation of results in the \n\n\n\npresent study should take into \n\n\n\naccount the limitations. This study \n\n\n\nwas conducted in only 5 out of 93 \n\n\n\nNGO dialysis centres in Malaysia \n1\n. \n\n\n\nIn addition, the degree of adherence \n\n\n\nto antihypertensives might be \n\n\n\noverestimated because patients who \n\n\n\nwere at risk of non-adherence, for \n\n\n\nexample those who were confused \n\n\n\nwith their drug regimens, cognitively \n\n\n\nimpaired, unable to recall their drug \n\n\n\nregimens and those who were too \n\n\n\nsick to be interviewed, were \n\n\n\nexcluded from this study. \n\n\n\n\n\n\n\nConclusion  \n\n\n\n\n\n\n\nAdherence to antihypertensives \n\n\n\namong HD patients at NGO dialysis \n\n\n\ncentres appeared to be suboptimal. \n\n\n\nSocio-demographic characteristics \n\n\n\ndid not predict adherence. Other \n\n\n\nfactors such as healthcare provider-\n\n\n\npatient relationship, medication cost, \n\n\n\ndrug affordability and side effects of \n\n\n\nmedications seemed to be the \n\n\n\nstronger determinants of adherence. \n\n\n\n\n\n\n\nThe understanding regarding drug \n\n\n\nadherence among HD patients in \n\n\n\nMalaysia is still lacking. It is hope  \n\n\n\nthat this study will serve as a \n\n\n\nstimulus to further studies in drug \n\n\n\nadherence among HD patients. By \n\n\n\nunderstanding the factors that \n\n\n\npredispose to non-adherence, \n\n\n\nspecific interventions can be \n\n\n\ndeveloped to enable patients to gain \n\n\n\noptimal benefits from their \n\n\n\nmedications.  \n\n\n\nThe inherent limitation of interview \n\n\n\nmethod to accurately measure drug \n\n\n\nadherence can be overcome by \n\n\n\nassessing the laboratory test results \n\n\n\nand examining the clinical features \n\n\n\nof the patients.  \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n231 \n\n\n\nReferences \n\n\n\n\n\n\n\n1.  Lim YN, Lim TO. Twelfth \n\n\n\nReport of the Malaysian Dialysis \n\n\n\nand Transplant  Registry 2004. \n\n\n\nKuala Lumpur: National Renal \n\n\n\nRegistry, 2005. \n\n\n\n\n\n\n\n2. 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Archives of Internal \n\n\n\nMedicine 1990;150(4):841-5. \n\n\n\n\n\n\n\n17. Kjellgren KI, Svensson S, \n\n\n\nAhlner J, Saljo R. \n\n\n\nAntihypertensive treatment and \n\n\n\npatient autonomy--the follow-up \n\n\n\nappointment as a resource for \n\n\n\ncare. Patient Education & \n\n\n\nCounseling 2000;40(1):39-49. \n\n\n\n\n\n\n\n18. Svensson S, Kjellgren KI, \n\n\n\nAhlner J, Saljo R. Reasons for \n\n\n\nadherence with antihypertensive \n\n\n\nmedication. International \n\n\n\nJournal of Cardiology \n\n\n\n2000;76(2-3):157-63. \n\n\n\n\n\n\n\n19. Caris-Verhallen WM, Kerkstra \n\n\n\nA, Bensing JM, Grypdonck MH. \n\n\n\nEffects of video interaction \n\n\n\nanalysis training on nurse-patient \n\n\n\ncommunication in the care of the \n\n\n\nelderly. Patient Education & \n\n\n\nCounseling 2000;39(1):91-103. \n\n\n\n\n\n\n\n20. Franks P, Jerant AF, Fiscella K, \n\n\n\nShields CG, Tancredi DJ, \n\n\n\nEpstein RM. Studying physician \n\n\n\neffects on patient outcomes: \n\n\n\nphysician interactional style and \n\n\n\nperformance on quality of care \n\n\n\nindicators. Social Science & \n\n\n\nMedicine 2006;62(2):422-32. \n\n\n\n\n\n\n\n21. Pilnick A. \"Patient counselling\" \n\n\n\nby pharmacists: four approaches \n\n\n\nto the delivery of counselling \n\n\n\nsequences and their interactional \n\n\n\nreception. Social Science & \n\n\n\nMedicine 2003;56(4):835-49. \n\n\n\n22. Skoutakis VA, Acchiardo SR, \n\n\n\nMartinez DR, Lorisch D, Wood \n\n\n\nGC. Role-effectiveness of the \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n233 \n\n\n\npharmacist in the treatment of \n\n\n\nhemodialysis patients. American \n\n\n\nJournal of Hospital Pharmacy \n\n\n\n1978;35(1):62-5. \n\n\n\n\n\n\n\n23.Grabe DW, Low CL, Bailie GR, \n\n\n\nEisele G. Evaluation of drug-\n\n\n\nrelated problems in an outpatient \n\n\n\nhemodialysis unit and the impact \n\n\n\nof a clinical pharmacist. Clinical \n\n\n\nNephrology 1997;47(2):117-21. \n\n\n\n\n\n\n\n24. Manley HJ, Carroll CA. The \n\n\n\nclinical and economic impact of \n\n\n\npharmaceutical care in end-stage \n\n\n\nrenal disease patients. Seminars \n\n\n\nin Dialysis 2002;15(1):45-9. \n\n\n\n\n\n\n\n25. Manley HJ, McClaran ML, \n\n\n\nOverbay DK, et al. Factors \n\n\n\nassociated with medication-\n\n\n\nrelated problems in ambulatory \n\n\n\nhemodialysis patients. American \n\n\n\nJournal of Kidney Diseases \n\n\n\n2003;41(2):386-93. \n\n\n\n\n\n\n\n26. Kennedy J, Coyne J, Sclar D. \n\n\n\nDrug affordability and \n\n\n\nprescription noncompliance in \n\n\n\nthe United States: 1997-2002. \n\n\n\nClinical Therapeutics \n\n\n\n2004;26(4):607-14. \n\n\n\n\n\n\n\n27. Ponnusankar S, Surulivelrajan \n\n\n\nM, Anandamoorthy N, Suresh B. \n\n\n\nAssessment of impact of \n\n\n\nmedication counseling on \n\n\n\npatients' medication knowledge \n\n\n\nand compliance in an outpatient \n\n\n\nclinic in South India. Patient \n\n\n\nEducation & Counseling \n\n\n\n2004;54(1):55-60. \n\n\n\n\n\n\n\n28. Piette JD, Heisler M, Horne R, \n\n\n\nAlexander GC. A conceptually \n\n\n\nbased approach to understanding \n\n\n\nchronically ill patients' responses \n\n\n\nto medication cost pressures. \n\n\n\nSocial Science & Medicine \n\n\n\n2006;62(4):846-857. \n\n\n\n\n\n\n\n29. Heisler M, Wagner TH, Piette \n\n\n\nJD. Clinician identification of \n\n\n\nchronically ill patients who have \n\n\n\nproblems paying for prescription \n\n\n\nmedications. American Journal \n\n\n\nof Medicine 2004;116(11):753-8. \n\n\n\n\n\n\n\n30. Horne R, Weinman J. Patients' \n\n\n\nbeliefs about prescribed \n\n\n\nmedicines and their role in \n\n\n\nadherence to treatment in chronic \n\n\n\nphysical illness. Journal of \n\n\n\nPsychosomatic Research \n\n\n\n1999;47(6):555-67. \n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n234 \n\n\n\nThe Study of Alfuzosin and Finasteride in the Treatment of Benign Prostatic \n\n\n\nHyperplasia \n\n\n\n\n\n\n\nLee Sau Yong*, Tan Meng Wah and Wan Noor Hayati \n\n\n\n\n\n\n\nDeaprtment of Pharmacy, Hospital Tuanku Jaafar, Seremban, Negeri Sembilan \n\n\n\n\n\n\n\n* Corresponding Author \nMalaysian Journal of Pharmacy 2008: 1( 6): 234 - 245                                               \n\n\n\n\n\n\n\n\n\n\n\nAbstract \n\n\n\n\n\n\n\nBenign Prostatic Hyperplasia (BPH) is a hyperplasia process where there are an \n\n\n\nincreased number of cells from the transition zone of the gland. The goals of the \n\n\n\nstudy were: (1) to compare the effectiveness of finasteride 5mg (Proscar) versus \n\n\n\nalfuzosin 10mg (Xatral XL) for the treatment of BPH; (2) to compare the \n\n\n\ntreatment costs of both drug; (3) to compare the side-effect profile of both drug.  \n\n\n\nAll patients who have been diagnosed with BPH and have been receiving the \n\n\n\ntreatment in SOPD Hospital Tuanku Ja\u2019afar were reviewed.  The inclusion \n\n\n\ncriteria were: (1) male more than 45 year old; (2) patients who are not suffering \n\n\n\nfrom recurrent or rebound BPH.  Subjects were evaluated using the International \n\n\n\nProstate Symptom Score (IPSS) questionnaire The score and side effects \n\n\n\noccurrence were analysis by SPSS.  Only 66 men were analyzed in the study as 6 \n\n\n\nmen (8.3%) were excluded. 36 of them (55%) are taking Finasteride 5mg once \n\n\n\ndaily whereas the other 30 men (45%) are taking the extended released form of \n\n\n\nAlfuzosin 10mg once daily. The distribution of subject\u2019s age is even. Subjects \n\n\n\nwith Finasteride 5mg have higher score (mean = 22.18) than Alfuzosin 10mg \n\n\n\n(mean = 18.87) (p<0.05). However, the total side effect score of both drug \n\n\n\nshowed no significant different (p>0.05). Finasteride group (mean = 0.52 case) \n\n\n\nhas experienced a slightly more side effect than the Alfuzosin group (mean = \n\n\n\n0.50 case). This study concluded that both Alfuzosin and Finasteride provide \n\n\n\nsymptomatic relief to BPH patients.  Alfuzosin with its faster onset of action \n\n\n\ncould be very useful for patients who were diagnosed with BPH and carry \n\n\n\nmoderate IPSS scores. \n\n\n\n\n\n\n\nKeyword:  Benign Prostate Hyperplasia, Alfuzosin, outcome \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n235 \n\n\n\nIntroduction \n\n\n\n\n\n\n\nBenign Prostatic Hyperplasia (BPH) \n\n\n\nis a hyperplasia process where there \n\n\n\nare an increased number of cells \n\n\n\nfrom the transition zone of the \n\n\n\nprostate gland.  The prevalence of \n\n\n\nthis condition increases with age and \n\n\n\nrequires the presence of testicular  \n\n\n\nandrogens.  About half of men\u2019s \n\n\n\npopulation will develop BPH by the \n\n\n\naverage of 50 years old, due to the \n\n\n\ncomplex stromal-epithelial \n\n\n\ninteractions\n1\n.  The disease can be \n\n\n\nprogressive, showing symptoms \n\n\n\nwhich can be classified into two \n\n\n\ncategories: irritative (frequency, \n\n\n\nnocturia, burning, urgency or urge \n\n\n\nincontinence) and obstructive \n\n\n\n(hesitancy, weak stream, dribbling, \n\n\n\nincomplete voiding or retention).  \n\n\n\nBesides these bothersome lower \n\n\n\nurinary tract symptoms (LUTS), \n\n\n\nthere could also be associated \n\n\n\nanatomic enlargement of the prostate \n\n\n\nleading to the compression of the \n\n\n\nurethra, resulting in compromised \n\n\n\nurinary flow and bladder outlet \n\n\n\nobstruction (BOD). \n\n\n\n\n\n\n\nBPH symptoms manifested could \n\n\n\ninterfere with patient\u2019s daily living \n\n\n\nactivities, causing significant \n\n\n\nimpairment in the quality of life and \n\n\n\nin some cases compromised sexual \n\n\n\nfunctioning.  Serious cases could \n\n\n\nalso subsequently lead to secondary \n\n\n\nchanges of the bladder anatomy and \n\n\n\nfunction, urinary tract infections, \n\n\n\nformation of bladder stones, and \n\n\n\neventually causing the deterioration \n\n\n\nof the upper urinary tract \n\n\n\naccompanied with renal failure. \n\n\n\n\n\n\n\nPatients manifesting with different \n\n\n\nsymptoms should be treated using \n\n\n\ndifferent approaches.   Most patients \n\n\n\nare first assessed by a quantitative \n\n\n\nsymptom score, such as the \n\n\n\nInternational Prostate Symptom \n\n\n\nScore (IPSS) which was further \n\n\n\napplied in the present study.  \n\n\n\nAccording to a study\n2\n, an estimated \n\n\n\n35 percent of elderly males need \n\n\n\neither surgical or medical \n\n\n\nintervention or both for BPH in their \n\n\n\nlifetime.  However, surgical \n\n\n\nintervention was rather radical from \n\n\n\nmost of the patient\u2019 perspective and \n\n\n\nmany of them were reluctant to \n\n\n\nundergo surgery and prefer a less \n\n\n\ninvasive treatment.  Patients are \n\n\n\naware of the availability of effective \n\n\n\npharmacotherapy and also have the \n\n\n\nawareness of the complications of \n\n\n\nsurgery which can include \n\n\n\nsignificant morbidity such as \n\n\n\nirreversible incontinence and loss of \n\n\n\nsexual function.  It is therefore not \n\n\n\nastounding that besides surgery and \n\n\n\nwatchful waiting, medical \n\n\n\nmanagement is generally the first \n\n\n\nrecommendation for patients \n\n\n\nshowing bothersome symptoms, \n\n\n\nalthough many do make it better \n\n\n\nwithout any intervention.   \n\n\n\n\n\n\n\nWhen treating BPH, drug therapy \n\n\n\ncould always be an option to control \n\n\n\nsymptoms and delay the need for \n\n\n\nsurgical intervention. To decide the \n\n\n\nmost appropriate medication to treat \n\n\n\nmoderate to severe BPH, it is often \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n236 \n\n\n\ncrucial that the choice of drug \n\n\n\ndepends on the actual or patient-\n\n\n\nperceived effectiveness of therapy, \n\n\n\nonset of action, adverse effects, \n\n\n\ndosing regimen, potential drug-drug \n\n\n\ninteraction and cost.  The goals of \n\n\n\ndrug therapy are to provide \n\n\n\nsymptomatic relief and to prevent \n\n\n\nany further complications.  Drug \n\n\n\ntherapy for BPH normally begins \n\n\n\nwith a single therapeutic agent, \n\n\n\nusually an alpha-adrenergic \n\n\n\nantagonist.  BPH medication \n\n\n\ntreatment is always indicated for \n\n\n\nlong period.  Therefore, patient \n\n\n\nshould always be advised that \n\n\n\nsymptoms improvement could be \n\n\n\nobserved only when treatment is \n\n\n\ncontinued and good adherence is \n\n\n\nobserved.    \n\n\n\n\n\n\n\nDrug therapy for BPH can be \n\n\n\nclassified into 2 different categories: \n\n\n\nagents that act directly on the \n\n\n\nprostatic smooth muscles and those \n\n\n\nthat interfere with the stimulatory \n\n\n\neffects of testosterone on prostate \n\n\n\nenlargement.  Of the agents, \u03b11 \n\n\n\nadrenergic antagonists such as \n\n\n\nalfuzosin, doxazosin, terazosin relax \n\n\n\nprostatic smooth muscles, whereas \n\n\n\n5-\u03b1 reductase inhibitors such as \n\n\n\nfinastride, selectively inhibit the \n\n\n\nconversion of testosterone to \n\n\n\ndihydrotestosterone.  Both these \n\n\n\nagents are accepted for treatment of \n\n\n\nBPH.  However, the difference in \n\n\n\ntheir mechanisms of action has \n\n\n\nrendered these agents in treating \n\n\n\ndifferent clinical symptoms.  \n\n\n\nFinasteride was found to work best \n\n\n\nwith patients who have a significant \n\n\n\nprostate enlargement of more than \n\n\n\n40g in size.  On the other hand, \n\n\n\n\u03b11adrenergic antagonists are more \n\n\n\neffective in treating patients who \n\n\n\nmanifest with BPH symptoms \n\n\n\ncaused by excessive adrenergic tone \n\n\n\nin the prostatic stroma.  Therefore, \n\n\n\nthese antagonists are often \n\n\n\ncommonly being considered to be an \n\n\n\nappropriate treatment for all patients \n\n\n\nregardless of prostate size. \n\n\n\n\n\n\n\nFDA has currently approved four \u03b1 \n\n\n\nadrenergic antagonists (doxazosin, \n\n\n\nterazosin, tamsulosin and alfuzosin) \n\n\n\nfor lower urinary tract symptoms \n\n\n\nassociated with BPH. These agents \n\n\n\nhowever showed equal benefits and \n\n\n\nall provide modest symptoms relief.  \n\n\n\nThe first generation of \u03b1 blockers \n\n\n\nsuch as doxazosin, terazosin and \n\n\n\nprazosin are associated with \n\n\n\nsignificant vasodilatory actions.  \n\n\n\nThese \u03b1 blockers are always \n\n\n\nassociated with certain degrees of \n\n\n\nvasodilatory side-effects such as \n\n\n\ndizziness and postural hypotension \n\n\n\nand subsequently cause poor \n\n\n\ncompliance to treatment.  \n\n\n\n\n\n\n\nNewer generations of \u03b1 blockers, \n\n\n\nnamely alfuzosin and tamsulosin, \n\n\n\nbind more prominently to the lower \n\n\n\nurinary tract tissues compared to \n\n\n\nvascular tissues.  Reflecting this \n\n\n\ndifferential pattern of tissue binding, \n\n\n\nthese agents have been found to be \n\n\n\nassociated with a lower risk of \n\n\n\nsignificant vascular side-effects \n\n\n\ncompared with the non-uroselective \n\n\n\n\u03b1 inhibitors, despite having a \n\n\n\nsignificant effect in reducing BPH \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n237 \n\n\n\nsymptoms\n3\n.  However, literature has \n\n\n\nrevealed that tamsulosin appears to \n\n\n\nhave a lower probability of causing \n\n\n\npostural hypotension, but higher \n\n\n\nchances of ejaculatory dysfunction \n\n\n\nthan other \u03b1 blockers.   \n\n\n\n\n\n\n\nThe extended release (ER) form of \n\n\n\nalfuzosin (10mg once a day) has \n\n\n\nbeen used and approved by the \n\n\n\nUnited States Food and Drug \n\n\n\nAdministration in 2003 for treating \n\n\n\nsigns and symptoms of BPH based \n\n\n\non clinical improvements of the \n\n\n\nirritative and obstructive urinary \n\n\n\nsymptoms of the disease.  A study \n\n\n\nmentioned in the literature\n3\n had \n\n\n\ndiscussed a meta-analysis of 3 \n\n\n\nclinical trials studying the \n\n\n\nvasodilatory effects of the ER \n\n\n\nalfuzosin compared to placebo.  In \n\n\n\nthese studies, results had shown that \n\n\n\nthe effects were similar to placebo \n\n\n\nand no significant changes in blood \n\n\n\npressure were observed.   \n\n\n\n\n\n\n\nOn the other hand, finasteride, a \n\n\n\nselective 5-\u03b1 reductase inhibitor, acts \n\n\n\nthrogh a different mechanism \n\n\n\ncompared to \u03b1-blockers.  It decreases \n\n\n\nthe conversion of testosterone to \n\n\n\ndihydrotestosterone, a hormone \n\n\n\nprimarily found in the prostate \n\n\n\ngland, testes, hair follicles and \n\n\n\nadrenal glands.  Dihydrotestosterone \n\n\n\nis the primary contributing factor in \n\n\n\nthe development or exacerbation of \n\n\n\nBPH and prostate cancer.  Therefore, \n\n\n\nfinasteride, by selectively inhibiting \n\n\n\ntype II 5-\u03b1 reductase, could \n\n\n\nprogressively delay the development \n\n\n\nof BPH.  Many studies have shown \n\n\n\nthat finasteride, when compared to \n\n\n\nplacebo, has effectively reduced the \n\n\n\nvolume of the prostate and enlarged \n\n\n\nprostate glands in men \n4,5\n\n\n\n. \n\n\n\n\n\n\n\nMethodology \n\n\n\n\n\n\n\nWe conducted a study to compare \n\n\n\ntwo BPH drugs with different \n\n\n\nmechanisms of action.  The aims of \n\n\n\nthe study were: (1) to compare the \n\n\n\neffectiveness of finasteride 5mg \n\n\n\n(Proscar) versus alfuzosin 10mg \n\n\n\n(Xatral XL) for the treatment of \n\n\n\nBPH; (2) to compare the treatment \n\n\n\ncosts of both drug; (3) to compare \n\n\n\nthe side-effect profile of both drug \n\n\n\nSubjects were patients who have \n\n\n\nbeen diagnosed with BPH and have \n\n\n\nbeen receiving the treatment in \n\n\n\nSOPD Hospital Tuanku Ja\u2019afar.  The \n\n\n\ninclusion criteria were: (1) male \n\n\n\nmore than 45 year old; (2) patients \n\n\n\nwho are not suffering from recurrent \n\n\n\nor rebound BPH. On the other hand, \n\n\n\nthe exclusion criteria include: (1) \n\n\n\npatient who has multi-disease prior \n\n\n\nto the study; (2) patient who has \n\n\n\nundergone surgical intervention \n\n\n\nprior to the study; (3) patient who \n\n\n\nwas taking any other traditional or \n\n\n\ncomplementary medicines. \n\n\n\n\n\n\n\nSubjects were evaluated using the \n\n\n\nInternational Prostate Symptom \n\n\n\nScore (IPSS) questionnaire \n\n\n\n(Appendix I).  This instrument \n\n\n\nevaluates the lower urinary tract \n\n\n\nsymptoms for the past one month. \n\n\n\nSubjects were asked seven questions \n\n\n\nassociated with the following \n\n\n\nsymptoms: (1) incomplete emptying \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n238 \n\n\n\nof bladder during urination; (2) \n\n\n\nfrequency of urine in less than 2 \n\n\n\nhours; (3) intermittency that stopped \n\n\n\nand started again when urinated; (4) \n\n\n\nurgency (difficulty to postpone \n\n\n\nurination); (5) weak stream; (6) \n\n\n\nstraining which push to begin \n\n\n\nurination; and (7) nocturia (the \n\n\n\nnumber of times the subject has to \n\n\n\nget up from bed to urinate at night).  \n\n\n\nThe rating ranged from 0 to 5 which \n\n\n\nrepresent the frequency of the above \n\n\n\nsymptoms in the past one month.  \n\n\n\nThe total score of IPSS is calculated \n\n\n\nby sum up the individual scores.  \n\n\n\nBased on the total score of IPSS, 0-7 \n\n\n\nmeans mildly symptoms; 8-19 \n\n\n\nmeans moderately symptoms and \n\n\n\n20-35 means severely symptomatic.  \n\n\n\n\n\n\n\nSubjects were also asked about side-\n\n\n\neffects of the drugs based on the \n\n\n\nestablished side-effects profiles of \n\n\n\nthe drugs.  This was to help the \n\n\n\nresearcher to evaluate the patient\u2019s \n\n\n\nacceptance of the drug therapy.  \n\n\n\nThere was a total score of 10 for this \n\n\n\nquestion.  \n\n\n\n\n\n\n\nThe data were analyzed using SPSS.  \n\n\n\nThe two treatment groups were \n\n\n\ncompared using Student\u2019s t-test.  P-\n\n\n\nvalue less than 0.05 was considered \n\n\n\nstatistically significant.  \n\n\n\n\n\n\n\nResults \n\n\n\n\n\n\n\nA total of 72 men diagnosed with \n\n\n\nBPH were involved in the study.  \n\n\n\nHowever, only 66 men were \n\n\n\nincluded in the analysis.  Of the 72 \n\n\n\npatients, three were taking the \n\n\n\ncombination treatment of finasteride \n\n\n\n5mg and alfuzosin 10mg, 2 other \n\n\n\npatients had just started the \n\n\n\ntreatment for less than 1 week, \n\n\n\nwhereas 1 patient was known to \n\n\n\nhave underlying disease (stroke).  \n\n\n\nTherefore, 8.3% of the total patients \n\n\n\nwere excluded from this study as \n\n\n\nthey did not meet the inclusion \n\n\n\ncriteria. \n \n\n\n\n36 of the subjects (55%) received \n\n\n\nfinasteride 5mg once daily, whereas \n\n\n\nthe rest took the ER alfuzosin 10mg \n\n\n\nonce daily.  The distribution of \n\n\n\npatients included was fairly equal to \n\n\n\nhelp minimize any bias in patient \n\n\n\nselections.  This is the true \n\n\n\ndistribution of patients encountered \n\n\n\nby our hospital out-patient \n\n\n\ndepartment as the stock movements \n\n\n\nof our integrated store were found to \n\n\n\nbe collaborated with our patient \n\n\n\nnumbers. \n\n\n\n\n\n\n\nTable 1 column 2 presents the \n\n\n\ndistribution of the subjects by age \n\n\n\ngroup. Twenty men (30%) were \n\n\n\nfrom 50 to 59 years, 18 men (27%) \n\n\n\nwere from 60-69 years, and 22 men \n\n\n\n(34%) were from 70-79 years. Only \n\n\n\na small proportion of the study \n\n\n\npopulation (9%) was more than 80 \n\n\n\nyears old.   \n \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n239 \n\n\n\nTable 1 Age distribution of patients who received two different therapies for BPH \n\n\n\n\n\n\n\nAge Group N (%) \nName of Drugs \n\n\n\nFinasteride 5mg Alfuzosin 10mg \n\n\n\n50-59 20 (30) 2 (5.56%) 18 (60%) \n\n\n\n60-69 18 (27) 12 (33.3%) 6 (20%) \n\n\n\n70-79 22 (34) 20 (55.6%) 2 (6.67%) \n\n\n\n80-89 4 (6) 2 (5.56%) 2 (6.67%) \n\n\n\n90-99 2 (3) 0 (0%) 2 (6.67%) \n\n\n\n\n\n\n\n\n\n\n\nTable 1 Columns 2 and 3 shows the \n\n\n\ndistribution of patients who received \n\n\n\ntwo different therapies for BPH, by age \n\n\n\ncategories. In the finasteride group, \n\n\n\nabout 33% of the patients were in \n\n\n\nthe range of 60-69 years old, and \n\n\n\nmore than half of the patients were \n\n\n\naged 70-79 years.  Conversely, in the \n\n\n\nalfuzosin group, the majority of the \n\n\n\npatients (80%) were between 50-69 \n\n\n\nyears old.  This shows the trend of \n\n\n\ndrug prescribing in our hospital, \n\n\n\nwhere the younger patients were \n\n\n\nmost probably prescribed with \n\n\n\nalfuzosin and the older patients were \n\n\n\ntreated with finasteride.   \n\n\n\n\n\n\n\nSubjects who received finasteride \n\n\n\n5mg had a significantly higher IPSS \n\n\n\nthan those who received alfuzosin \n\n\n\n10mg (mean IPSS of 22.18\u00b18.06 \n\n\n\nvs.18.87\u00b17.34, respectively; \n\n\n\np=0.001).  This indicates that \n\n\n\npatients who were treated with \n\n\n\nfinasteride were severely \n\n\n\nsymptomatic whereas those who \n\n\n\nreceived alfuzosin were moderately \n\n\n\nsymptomatic (Table 2). \n\n\n\n\n\n\n\n\n\n\n\nTable 2      Statistical results of mean IPSS score for patients on Alfuzosin and \n\n\n\nFinasteride \n  \n\n\n\nDrugs N Mean Std. Deviation P value \n\n\n\n \nFinasteride 5mg \n\n\n\n \n598 \n\n\n\n \n22.18 \n\n\n\n \n8.060 \n\n\n\n0.001 \n \nAlfuzosin 10mg \n\n\n\n \n448 \n\n\n\n \n18.87 \n\n\n\n \n7.337 \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n240 \n\n\n\nTable 3    Mean IPSS scores for patients in different age groups \n\n\n\n\n\n\n\nAge group Mean Total IPSS Score \n\n\n\nFinasteride 5mg Alfuzosin 10mg \n\n\n\n50-59 27 16 \n\n\n\n60-69 21 25 \n\n\n\n70-79 19 3 \n\n\n\n80-89 32 4 \n\n\n\n90-99 n/a 22 \n\n\n\n\n\n\n\n\n\n\n\nThis study compared the mean IPSS \n\n\n\nof different age groups in the two \n\n\n\ntreatment arms.  Student\u2019s t-test \n\n\n\nshows that there was no significant \n\n\n\ndifference in IPSS between the two \n\n\n\ntreatment arms across all age groups. \n\n\n\nMost of the groups obtained a mean \n\n\n\nIPSS of 20 and above, which \n\n\n\nindicates severely symptomatic \n\n\n\npatients (refer to Table 3).   \n\n\n\n\n\n\n\nThe distribution of mean score based \n\n\n\non duration of treatment of both drug \n\n\n\nis shown in the Table 4.  The mean \n\n\n\nscore of finasteride 5mg for less than \n\n\n\nhalf a year was 25; half a year to one \n\n\n\nyear was 11; one year to 1.5 years \n\n\n\nwas 30; and more than 1.5 years was \n\n\n\n20. On the other hand, the mean \n\n\n\nscore of alfuzosin 10mg for less than \n\n\n\nhalf a year was 20; half a year to one \n\n\n\nyear was 21; one year to 1.5 years \n\n\n\nwas 7; and more than 1.5 years was \n\n\n\n10. \n\n\n\n \nTable 4     Mean IPSS scores for patients according to duration of drug therapy \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nMean Total IPSS Scores  \n\n\n\n\n\n\n\nP values \n\n\n\n< 1/2 yr \n\n\n\n0.5 yr to \n\n\n\n1 yr \n\n\n\n1yr to 1.5 \n\n\n\nyr > 1.5 yr \n\n\n\nFinasteride 5mg 25 11 30 20 \n\n\n\n>0.05 \nAlfuzosin 10mg 20 21 7 10 \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n241 \n\n\n\nTable 5: Mean score for the number of adverse events occurred among patients \n\n\n\n\n\n\n\n Incidence of Side-effects  \n\n\n\nDrugs N Mean Std. Deviation p \n\n\n\n\n\n\n\nFinasteride 5mg \n\n\n\n\n\n\n\n598 \n\n\n\n\n\n\n\n0.52 \n\n\n\n\n\n\n\n0.738 \n \n\n\n\n0.639 \nAlfuzosin 10mg 448 0.50 0.745 \n\n\n\n\n\n\n\nTable 5 shows no significant \n\n\n\ndifference in the total side-effects \n\n\n\nscores between the two intervention \n\n\n\ngroups (p=0.693).  Overall, the \n\n\n\nfinasteride group had experienced a \n\n\n\nslightly higher incidence of side-\n\n\n\neffects than the alfuzosin group \n\n\n\n(mean = 0.52 cases vs. 0.50 cases, \n\n\n\nrespectively)  \n\n\n\n\n\n\n\nFigure 1 presents the frequencies of \n\n\n\nindividual side-effects among the \n\n\n\ntreatment groups.  about 16.7% \n\n\n\nsubjects on finasteride complained \n\n\n\nof fatigue and decreased sexual \n\n\n\ndesires 5.6% experienced problems \n\n\n\nrelated to erectile dysfunction.  \n\n\n\nHeadache and dizziness contributed \n\n\n\nto 33.3%of side effects experienced \n\n\n\nby Alfuzosin arm.   \n \n\n\n\nFigure 1: Side effects experienced by patients on finasteride and alfuzosin group \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n242 \n\n\n\nIn comparison of treatment costs \n\n\n\nbetween the two treatments, \n\n\n\nfinasteride 5mg tablet (Proscar) was \n\n\n\nRM 123.00 per pack of 30\u2019s while \n\n\n\nalfuzosin 10mg tablet (Xatral XL) \n\n\n\nwas RM 41.31 per pack of 30\u2019s.  \n\n\n\nTreatment of BPH is often life long \n\n\n\nand effect will only be seen when \n\n\n\nthe treatment is continued.  \n\n\n\nTherefore, to consider a one-month \n\n\n\ntreatment, alfuzosin can reduce cost \n\n\n\nby RM81.969 per month, \n\n\n\ncontributing to RM980.28 every \n\n\n\nyear. \n\n\n\n\n\n\n\nDiscussion \n\n\n\n\n\n\n\nThe most important finding of this \n\n\n\nstudy is that patients taking ER \n\n\n\nalfuzosin 10mg had a significantly \n\n\n\nlower International Prostate \n\n\n\nSymptom Score (IPSS) when \n\n\n\ncompared to patients taking \n\n\n\nfinasteride 5mg.  BPH and its \n\n\n\nconsequent bothersome lower \n\n\n\nurinary tract symptoms can severely \n\n\n\naffect quality of life in older men.  \n\n\n\nOn the basis of this study, we could \n\n\n\ndeduce from the mean IPSS that \n\n\n\nalfuzosin provided a better \n\n\n\nimprovement in the quality of life of \n\n\n\nthese patients. \n\n\n\n\n\n\n\nThe study did not collect patients\u2019 \n\n\n\nbaseline values of the IPSS, \n\n\n\ntherefore it is impossible for us to \n\n\n\ncompare the effect before and after \n\n\n\ntreatment.  However, the finding \n\n\n\nshowed that patients with higher \n\n\n\nIPSS scores (more severe) were \n\n\n\nnormally prescribed finasteride 5mg.  \n\n\n\nThis observation could be seen as \n\n\n\nrational, since BPH is a progressive \n\n\n\nillness and significant prostate \n\n\n\nenlargement of more than 40g is \n\n\n\nnormally a manifestation of the later \n\n\n\nstages of BPH.  Progressive growth \n\n\n\nof the prostate would eventually \n\n\n\novercome the reduction in prostatic \n\n\n\nurethral obstruction achieved by the \n\n\n\nrelaxation of prostatic smooth \n\n\n\nmuscle tone caused by alpha \n\n\n\nblockers even in patients on \n\n\n\ntherapy\n5\n. \n\n\n\n\n\n\n\nOne study which compared \n\n\n\nfinastride with placebo showed \n\n\n\nsymptomatic improvements in men \n\n\n\nwith prostatic enlargement and \n\n\n\nmoderate to severe symptoms\n4\n.  \n\n\n\nTherefore, it would be logical to \n\n\n\nprescribe finasteride to patients who \n\n\n\ndo not respond well with to alfuzosin \n\n\n\nand to minimize the need of surgical \n\n\n\nintervention as it is always an \n\n\n\nattribution to severe enlargement of \n\n\n\nprostate size.  Patients treated with \n\n\n\nfinasteride can eventually have a \n\n\n\nfour-year risk reduction for surgical \n\n\n\nintervention and acute urinary \n\n\n\nretention\n4\n.  The benefit of finasteride \n\n\n\nis slow, which can only be observed \n\n\n\nconservatively at about 4 months \n\n\n\nafter initiation of therapy.  \n\n\n\nConversely, the effects of alfuzosin \n\n\n\ncan be seen within first few days of \n\n\n\ntreatment.  The promptness of action \n\n\n\nof alfuzosin provides benefits of \n\n\n\nquick evaluation without delay and \n\n\n\nminimizes the costly long-term \n\n\n\ntreatment where patients can only be \n\n\n\nre-evaluated after few months of \n\n\n\ninappropriate treatment. \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n243 \n\n\n\nThe overall side effects between \n\n\n\nalfuzosin and finasteride shows no \n\n\n\nsignificant difference, with p>0.05.  \n\n\n\nPatients from both arms shows \n\n\n\ndifferent side-effects profiles, about \n\n\n\n16.7% of patients treated with \n\n\n\nfinastride had experienced fatigue \n\n\n\nand decreased sexual desires. 5.6% \n\n\n\nof them had encountered problems \n\n\n\nrelated to erectile dysfunction.  \n\n\n\nThese side-effects were mostly \n\n\n\nobserved in patients receiving \n\n\n\nfinastride for less than 1 year.  On \n\n\n\nthe other hand the most prominent \n\n\n\nside-effects experienced by patients \n\n\n\ntaking alfuzosin were dizziness and \n\n\n\nheadache.  However, alfuzosin is \n\n\n\ngenerally reported to have only little \n\n\n\neffect on blood pressure when \n\n\n\ncompared to other \u03b1 blockers.  Meta \n\n\n\nanalyses of placebo and randomized \n\n\n\ncontrolled trials have demonstrated \n\n\n\nan extra 5%-20% of dizziness \n\n\n\nincidences reported by normotensive \n\n\n\npatients who underwent treatment \n\n\n\nwith terazosin or doxazosin.  \n\n\n\nHowever, with alfuzosin, the event \n\n\n\nof dizziness reported was \n\n\n\napproximately 5%\n6\n.  In addition, one \n\n\n\nrandomized controlled study found \n\n\n\nthat the occurrence of postural \n\n\n\nhypotension with alfuzosin was at \n\n\n\nplacebo level (estimated at 1%)\n7\n.  \n\n\n\nThis phenomenon is seen as \n\n\n\nalfuzosin is more selective to \n\n\n\nprostatic smooth muscle than \n\n\n\nvascular smooth muscles. \n\n\n\n\n\n\n\nAnother study estimated that about \n\n\n\n30-50% of BPH patients would \n\n\n\ndevelop essential hypertension\n8\n.  \n\n\n\nPatients who are originally on \u03b1-\n\n\n\nblocker as anti-hypertensive \n\n\n\nmedications are more likely to \n\n\n\nexperience cardiovascular adverse \n\n\n\neffects.  Therefore, the second \n\n\n\ngeneration \u03b1-blockers such as \n\n\n\nalfuzosin are more suitable to this \n\n\n\ngroup of patients as they are more \n\n\n\nselective and could minimize the \n\n\n\noccurrence of cardiovascular side \n\n\n\neffects. \n\n\n\n\n\n\n\nConclusion: \n\n\n\n\n\n\n\nFrom the study, it is clear that both \n\n\n\nalfuzosin and finasteride provide \n\n\n\nsymptomatic relief to BPH patients.  \n\n\n\nHowever, the differences in \n\n\n\nmechanisms of actions of the two \n\n\n\ndrugs made them useful to patients \n\n\n\nwith different underlying problems.  \n\n\n\nAlfuzosin with its faster onset of \n\n\n\naction could be very useful for \n\n\n\npatients who are diagnosed with \n\n\n\nBPH and carry moderate IPSS \n\n\n\nscores.  Further studies need to be \n\n\n\nconducted in order to obtain a \n\n\n\nclearer picture of the efficacy and \n\n\n\ntolerability of both drugs. \n\n\n\nReference: \n\n\n\n\n\n\n\n1. E. Darracott Vaughan, Jr., M. D. Medical Management of benign \n\n\n\nProstatic Hyperplasia-Are two Drugs Better Than One N Eng J Med. \n\n\n\n2003 Dec 18; Volume 349:2449-2451 \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n244 \n\n\n\n2. Oesterling JE. Benign prostatic hyperplasia: a review of its histogenesis \n\n\n\nand natural history. Prostate Suppl 1996;6:67-73 \n\n\n\n\n\n\n\n3. Kevin T. McVary. Alfuzoxin for Symptomatic Benign Protatic \n\n\n\nhyperplasia: Long- Term Experience. Available online 12 December 2005 \n\n\n\n\n\n\n\n4. John D. McConnell et al. The Effect of Finasteride on the Risk of Acute \n\n\n\nUrinary Retention and the Need for Surgical Treatment among Men with \n\n\n\nBenign Prostatic Hyperplasia. N Eng J Med. 1998 Feb 26;338(9):612-3 \n\n\n\n\n\n\n\n5. John D. McConnell et al. The Long Term Effect of Doxazosin, \n\n\n\nFinasteride and Combination Therapy on the Clinical Progression of \n\n\n\nbenign Prostatic Hyperplasia. The New England Journal of Medicine \n\n\n\n2003 Dec 18;349(25):2387-98 \n\n\n\n\n\n\n\n6. McKiernan JM, Lowe FC. Side effects of terazosin in the treatment of \n\n\n\nsymptomatic benign prostatic hyperplasia. South Med J. 1997;90:509\u2013\n\n\n\n513. \n\n\n\n\n\n\n\n7. Christopher R. Chapple. A Comparison of Varying \u03b1-Blokers and Other \n\n\n\nPharmacotherapy options for Lower Urinary Tract Symptoms. RevUrol. \n\n\n\n2005; 7(Suppl 4):S22-S30 \n\n\n\n\n\n\n\n8. Alfuzosin Hydrochloride for the Treatment of Benign Prostatic from \n\n\n\nAmerican Journal of Health-System Pharmacy.  Available online: \n\n\n\nwww.medscape,com/viewarticle/458899_13 \n\n\n\n\n\n\n\n9. A. Tejani et al; Clinical practice: Benign Prostatic Hypertrohpy. Available \n\n\n\nonline : www.cfpc.ca/cfp/2006/Sep/vol52-sep-clinical-therapeutics.asp \n\n\n\nAppendix I \n\n\n\nInternational prostate symptom score (IPSS) \n\n\n\n \nName:       Date: \n\n\n\n\n\n\n\nN\no\n\n\n\nt \nat\n\n\n\n a\nll\n\n\n\n\n\n\n\nL\nes\n\n\n\ns \nth\n\n\n\nan\n \n\n\n\n1\n t\n\n\n\nim\ne \n\n\n\nin\n 5\n\n\n\n\n\n\n\nL\nes\n\n\n\ns \nth\n\n\n\nan\n \n\n\n\nh\nal\n\n\n\nf \nth\n\n\n\ne \n\n\n\nti\nm\n\n\n\ne \nA\n\n\n\nb\no\n\n\n\nu\nt \n\n\n\nh\nal\n\n\n\nf \n\n\n\nth\ne \n\n\n\nti\nm\n\n\n\ne \n\n\n\nM\no\n\n\n\nre\n t\n\n\n\nh\nan\n\n\n\n\n\n\n\nh\nal\n\n\n\nf \nth\n\n\n\ne \n\n\n\nti\nm\n\n\n\ne \nA\n\n\n\nlm\no\n\n\n\nst\n \n\n\n\nal\nw\n\n\n\nay\ns \n\n\n\nY\no\n\n\n\nu\nr \n\n\n\nsc\no\n\n\n\nre\n \n\n\n\nIncomplete emptying \nOver the past month, how often have you had a \n\n\n\nsensation of not emptying your bladder completely \n\n\n\nafter you finish urinating? \n\n\n\n0 1 2 3 4 5 \n\n\n\n \n\n\n\n\nhttp://www.medscape,com/viewarticle/458899_13\n\n\nhttp://www.cfpc.ca/cfp/2006/Sep/vol52-sep-clinical-therapeutics.asp\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n245 \n\n\n\nFrequency \nOver the past month, how often have you had to \n\n\n\nurinate again less than two hours after you finished \n\n\n\nurinating? \n\n\n\n0 1 2 3 4 5 \n\n\n\n\n\n\n\nIntermittency \nOver the past month, how often have you found \n\n\n\nyou stopped and started again several times when \n\n\n\nyou urinated? \n\n\n\n0 1 2 3 4 5 \n\n\n\n\n\n\n\nUrgency \nOver the last month, how difficult have you found \n\n\n\nit to postpone urination? \n0 1 2 3 4 5 \n\n\n\n\n\n\n\nWeak stream \nOver the past month, how often have you had a \n\n\n\nweak urinary stream? \n0 1 2 3 4 5 \n\n\n\n\n\n\n\nStraining \nOver the past month, how often have you had to \n\n\n\npush or strain to begin urination? \n0 1 2 3 4 5 \n\n\n\n\n\n\n\n\n\n\n\nN\no\n\n\n\nn\ne \n\n\n\n1\n t\n\n\n\nim\ne \n\n\n\n2\n t\n\n\n\nim\nes\n\n\n\n\n\n\n\n3\n t\n\n\n\nim\nes\n\n\n\n\n\n\n\n4\n t\n\n\n\nim\nes\n\n\n\n\n\n\n\n5\n t\n\n\n\nim\nes\n\n\n\n o\nr \n\n\n\nm\no\n\n\n\nre\n \n\n\n\nY\no\n\n\n\nu\nr \n\n\n\nsc\no\n\n\n\nre\n \n\n\n\nNocturia \nOver the past month, many times did you most \n\n\n\ntypically get up to urinate from the time you went \n\n\n\nto bed until the time you got up in the morning? \n\n\n\n0 1 2 3 4 5 \n\n\n\n\n\n\n\n\n\n\n\nTotal IPSS score \n\n\n\n\n\n\n\n\n\n\n\n \nQuality of life due to urinary symptoms \n \n \n \n D\n\n\n\nel\nig\n\n\n\nh\nte\n\n\n\nd\n \n\n\n\nP\nle\n\n\n\nas\ned\n\n\n\n\n\n\n\nM\no\n\n\n\nst\nly\n\n\n\n\n\n\n\nsa\nti\n\n\n\nsf\nie\n\n\n\nd\n \n\n\n\nM\nix\n\n\n\ned\n \u2013\n\n\n\n\n\n\n\nab\no\n\n\n\nu\nt \n\n\n\neq\nu\n\n\n\nal\nly\n\n\n\n\n\n\n\nsa\nti\n\n\n\nsf\nie\n\n\n\nd\n \n\n\n\nan\nd\n\n\n\n\n\n\n\nd\nis\n\n\n\nsa\nti\n\n\n\nsf\nie\n\n\n\nd\n \n\n\n\nM\no\n\n\n\nst\nly\n\n\n\n\n\n\n\nd\nis\n\n\n\nsa\nti\n\n\n\nsf\nie\n\n\n\nd\n \n\n\n\nU\nn\n\n\n\nh\nap\n\n\n\np\ny\n \n\n\n\nT\ner\n\n\n\nri\nb\n\n\n\nle\n \n\n\n\nIf you were to spend the rest of your life with your \n\n\n\nurinary condition the way it is now, how would \n\n\n\nyou feel about that? \n0 1 2 3 4 5 6 \n\n\n\n \nTotal score: 0-7 Mildly symptomatic; 8-19 moderately symptomatic; 20-35 severely \n\n\n\nsymptomatic. \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n246 \n\n\n\nSerum Trace Elements and Immunoglobulin Profile in Lung \n\n\n\nCancer Patients \n\n\n\n \nA F M Nazmus Sadat\n\n\n\n1\n, Md. Iqbal Hossain\n\n\n\n2\n, Md.  Khalid Hossain\n\n\n\n3\n, Md. Selim \n\n\n\nReza\n4\n, Zabun Nahar\n\n\n\n2\n, Md. Nazrul Islam Khan\n\n\n\n5\n, SK. Nazrul Islam\n\n\n\n5\n, and \n\n\n\nAbul Hasnat\n2* \n\n\n\n \n1\nDepartment of Pharmacy, The University of Asia Pacific, Dhaka-1000, \n\n\n\nBangladesh. \n2\nDepartment of Clinical Pharmacy and Pharmacology, Faculty of \n\n\n\nPharmacy, University of Dhaka. Dhaka-1000, Bangladesh. \n3\nDepartment of \n\n\n\nPharmaceutical Chemistry, Faculty of Pharmacy, University of Dhaka. Dhaka-\n\n\n\n1000, Bangladesh. \n4\nAhsania Mission Cancer Hospital, Dhaka, Bangladesh. \n\n\n\n5\nInstitute of Nutrition and Food Science, University of Dhaka. Dhaka-1000, \n\n\n\nBangladesh. \n\n\n\n*Corresponding author \n\n\n\nMalaysian Journal of Pharmacy 2008: 1( 6): 246 -255                                               \n\n\n\n\n\n\n\nAbstract \n\n\n\nThe aim of this study was to determine the serum concentrations of trace \n\n\n\nelements (Zn, Cu, Mn, Pb) and immunoglobulins (IgG, IgA & IgM) in lung \n\n\n\ncancer patients. The study was conducted among 45 lung cancer patients and 50 \n\n\n\nage and gender-matched healthy volunteers. Flame atomic absorption \n\n\n\nspectroscopy method was employed to analyze the serum trace element \n\n\n\nconcentrations, and turbidimetry method using immunoglobulin kit was used for \n\n\n\nthe estimation of serum immunoglobulin levels. Results showed that the majority \n\n\n\nof the patients were literate and older married patients were smokers.  Compared \n\n\n\nto the control volunteers, they had significantly (P<0.05) lower BMI.  Serum \n\n\n\nconcentrations of trace elements and IgG were found to be significantly (p<0.05) \n\n\n\nlower in the lung cancer patients.  In the cancer patients, the concentration of \n\n\n\nzinc, copper, manganese and lead were 0.028\u00b10.007 mg/L, 0.029\u00b10.027 mg/L, \n\n\n\n0.011\u00b10.15 mg/L and 0.053\u00b10.049 mg/L respectively, while these were \n\n\n\n1.14\u00b10.27 mg/L, 1.15\u00b11.09 mg/L, 0.44\u00b10.59 mg/L and 2.209\u00b11.885 mg/L, \n\n\n\nrespectively in the healthy controls. IgG concentration was found to be \n\n\n\n14.96\u00b13.92 g/L in lung cancer patients and 20.56\u00b18.02 g/L in healthy volunteers. \n\n\n\nThe concentrations of serum IgA and IgM were found to be unchanged. \n\n\n\nCorrelative analysis suggested that serum lead value had a significant correlation \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n247 \n\n\n\nwith age in the lung cancer patient (r \u2550 \u20130.369, p \u2550 0.013). The decreased \n\n\n\nconcentration of trace elements and IgG may have a prognostic significance for \n\n\n\nthe detection of lung cancer. \n\n\n\n\n\n\n\nKey words: lung cancer, trace elements, immunoglobulin  \n\n\n\n\n\n\n\nIntroduction \n\n\n\n\n\n\n\nLung cancer is the most common \n\n\n\nmalignancy in the world. Its overall \n\n\n\n5-year survival rate is only 14% (1), \n\n\n\nand it has not changed substantially \n\n\n\nover the past two decades (2) The \n\n\n\nglobal incidence of lung cancer is \n\n\n\nincreasing with time. When \n\n\n\nadvanced, these tumors are difficult \n\n\n\nto treat, and existing therapies often \n\n\n\ndo not offer long-term disease \n\n\n\ncontrol. The poor prognosis is \n\n\n\nlargely due to lack of sufficient \n\n\n\nscreening and early diagnostic tools \n\n\n\nto physicians. Currently the \n\n\n\nscreening and early diagnosis of \n\n\n\nlung cancer relies mainly on chest \n\n\n\nX-ray, low-dose computed \n\n\n\ntomography, bronchoscopy, sputum \n\n\n\ncytology, and tumor markers \n\n\n\nincluding carcinoembryonic antigen \n\n\n\n(CEA), cytokeratin-19 fragments \n\n\n\n(Cyfra21-1), carbohydrate antigen \n\n\n\n19-9 (CA19-9), squamous cell \n\n\n\ncarcinoma antigen (SCCAg) and \n\n\n\nneuron-specific enolase (NSE), etc. \n\n\n\n(3). All these methods, however, \n\n\n\nlack adequate sensitivity and/or \n\n\n\nspecificity (4-7). Thus, there is an \n\n\n\nurgent need to search for more \n\n\n\nspecific methods that would provide \n\n\n\nmore specific information for \n\n\n\nscreening and early diagnosis of \n\n\n\nlung cancer. Because of the marked \n\n\n\nheterogeneity of lung cancer (7), a \n\n\n\npanel of biomarkers for screening \n\n\n\nand diagnosis would be most \n\n\n\nappropriate.  Kinetic turbidimetric \n\n\n\nmethod for the immunochemical \n\n\n\nquantification of immunoglobulins, \n\n\n\nan innovative turbidimetry  \n\n\n\n\n\n\n\ntechnology introduced by Skoug JW \n\n\n\n& Pardue HL in 1988 (8) has a new \n\n\n\nway to overcome many of the \n\n\n\nlimitations of the above procedures \n\n\n\n(9-10).  \n\n\n\n\n\n\n\nSince it is recognized that patients \n\n\n\nwith lung cancer have defective \n\n\n\nimmune responses       (11-12), \n\n\n\ndifferent factors may contribute for \n\n\n\nthe development of lung cancer. \n\n\n\nHowever, three-dimensional active \n\n\n\nconformation of some proteins \n\n\n\nnamely thymidylate synthetase, \n\n\n\ndihydrofolate reductase, p53, p16, \n\n\n\nK-ras etc. are very important. Some \n\n\n\nmetal ions act as a vital role to form \n\n\n\nthe three dimensional protein \n\n\n\nstructure (13). So conversion of \n\n\n\nactive to inactive or inactive to \n\n\n\nactive conformation of proteins may \n\n\n\ndepend on some particular trace \n\n\n\nelements. Trace elements at \n\n\n\noptimum levels are required for \n\n\n\nnumerous metabolic and \n\n\n\nphysiological processes in the \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n248 \n\n\n\nhuman body (14). They play a part \n\n\n\nin the synthesis and structural \n\n\n\nstabilization of both proteins and \n\n\n\nnucleic acids. Therefore, imbalances \n\n\n\nin the optimum levels of these trace \n\n\n\nelements may adversely affect \n\n\n\nbiological processes, and are \n\n\n\nassociated with many diseases, such \n\n\n\nas cancer (15). Lacking or imbalance \n\n\n\nof these trace elements may cause \n\n\n\nlung cancer.  In view of these above \n\n\n\ninvestigations, the present study was \n\n\n\ndesigned to investigate the \n\n\n\napplication of serum \n\n\n\nimmunoglobulin profiling to \n\n\n\ndistinguish lung cancer patients from \n\n\n\na healthy population, and to \n\n\n\ndetermine the relationship of trace \n\n\n\nelements and immunoglobulins \n\n\n\nlevels in lung cancer patients with \n\n\n\ntheir nutritional status and socio-\n\n\n\neconomic factors.  \n \n\n\n\nMaterials and methods \n\n\n\n\n\n\n\nStudy subjects  \n\n\n\nForty-five lung cancer patients \n\n\n\ncomprising 25 males and 20 females \n\n\n\nwere randomly recruited from \n\n\n\nAhsania Mission Cancer Hospital, \n\n\n\nDhaka Medical College Hospital, \n\n\n\nHoly Family Red Cresent Hospital \n\n\n\nand Bangabandu Sheikh Mujib \n\n\n\nMedical University, Dhaka. Fifty \n\n\n\nhealthy volunteers comprising 25 \n\n\n\nmales and 25 females were recruited \n\n\n\npurposively as control. Regarding \n\n\n\npatients, both small cell lung cancer \n\n\n\n(SCLC) and non-small cell lung \n\n\n\ncancer patients were identified as \n\n\n\nlung cancer patients. The study \n\n\n\nsubjects were briefed about the \n\n\n\npurpose of the study and written \n\n\n\nconsent was taken from each of \n\n\n\nthem. Ethical approval was obtained \n\n\n\nfrom the Bangladesh Medical \n\n\n\nResearch Council (BMRC).  \n\n\n\n\n\n\n\nSocio-economic and smoking \n\n\n\ninformation were collected in a \n\n\n\nquestionnaire. A routine physical \n\n\n\ncheck up such as organ activity, \n\n\n\nweight, nutritional condition, blood \n\n\n\npressure was given to all of the \n\n\n\npatients by an oncologist. Socio-\n\n\n\neconomic information was recorded \n\n\n\nat the time of admission into the \n\n\n\nhospital. Anthropometric data \n\n\n\n(height and weight) and information \n\n\n\non smoking habit were collected \n\n\n\nduring hospitalization under the \n\n\n\ndirect supervision of a lung cancer \n\n\n\nspecialist.  \n\n\n\n\n\n\n\nBlood analysis \n\n\n\nA 5ml venous blood sample was \n\n\n\ncollected from the antecubital vein \n\n\n\nof each of the lung cancer patients \n\n\n\nand healthy volunteers in a sterile \n\n\n\ntube.  The blood was then allowed to \n\n\n\nclot and centrifuged for 15 min at \n\n\n\n3000 rpm to extract the serum. The \n\n\n\nserum was aliquoted   into eppendorf \n\n\n\ntubes and stored at \uf02d80\u00b0 C for \n\n\n\nanalysis of trace elements and \n\n\n\nimmunoglobulins. \n\n\n\n\n\n\n\nAnalysis of trace elements  \n\n\n\nThe trace elements (Zn, Cu, Mn, Pb) \n\n\n\nlevels in both patients and controls \n\n\n\nwere determined by using flame \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n249 \n\n\n\natomic absorption spectrometry \n\n\n\n(Varian SpectraAA 220) according \n\n\n\nto the method of Falchuk Kh et. al. \n\n\n\n1990 (16). Samples were diluted by \n\n\n\ndeionized water by a factor of 40.  \n\n\n\n\n\n\n\nImmunoglobulin profiling \n\n\n\nThe serum immunoglobulin (IgG, \n\n\n\nIgA and IgM) levels in both patients \n\n\n\nand controls were determined by \n\n\n\nturbidimetry method using \n\n\n\nimmunoglobulin kit (Chronolab, \n\n\n\nSwitzerland). In this method anti-\n\n\n\nhuman antibodies were mixed with \n\n\n\nsamples containing IgG, IgA and \n\n\n\nIgM that formed insoluble antigen-\n\n\n\nantibody complexes. These \n\n\n\ncomplexes caused an absorbance \n\n\n\nchange depending upon the \n\n\n\nimmunoglobulin concentration that \n\n\n\nwas quantified by a calibrator. The \n\n\n\nserum was diluted with saline (1:4), \n\n\n\nand 10 \u00b5l of the diluted serum was \n\n\n\npipetted into microtitre plate. \n\n\n\nSeparate microtitre plate was used \n\n\n\nfor each of the immunoglobulins \n\n\n\n(IgG, IgM and IgA). Five (5) \u00b5l, 10 \n\n\n\n\u00b5l, 25 \u00b5l, 50 \u00b5l and 75 \u00b5l calibrator \n\n\n\nprotein were pipetted into marked \n\n\n\nwells of each of the microtitre plate \n\n\n\nfor calibration. 230 \u00b5l of tris-buffer \n\n\n\nwas then added into each serum-\n\n\n\ncontaining well of the three plates. \n\n\n\nTen (10) \u00b5l of tris-buffer was added \n\n\n\nto calibrator containing wells to \n\n\n\nmake total volume 240 \u00b5l. The plate \n\n\n\ncontent was mixed well with the \n\n\n\nhelp of a vortex mixer. The diluted \n\n\n\nrespective anti-human IgG, IgM and \n\n\n\nIgA (1:1 diluted with saline) were \n\n\n\nadded to the wells of respective \n\n\n\nmicrotitre plates. The plates were \n\n\n\nincubated for 2 minutes (as specified \n\n\n\nin the kit procedure) to allow \n\n\n\ncomplete reaction of anti-human \n\n\n\nimmunoglobulin with the test serum \n\n\n\nand calibrator protein. After proper \n\n\n\nmixing, absorbance was taken at 550 \n\n\n\nnm for IgG and IgA and at 405 nm \n\n\n\nfor IgM.  \n\n\n\nStatistical Analysis  \n\n\n\nSPSS software package (Version \n\n\n\n11.5, SPSS Inc. Chicago, USA) was \n\n\n\nused to analyze the data. Descriptive \n\n\n\nstatistics were used for all variables.  \n\n\n\nValues were expressed as \n\n\n\npercentage, mean and standard \n\n\n\ndeviation. Comparison of trace \n\n\n\nelements and immunoglobulins of \n\n\n\nlung cancer patients and controls \n\n\n\nwere performed by cross-table \n\n\n\nvariables and independent sample t-\n\n\n\ntest. Correlative analysis was \n\n\n\nperformed to find correlation of BMI \n\n\n\nand socio-economic factors on the \n\n\n\nserum trace element and \n\n\n\nimmunoglobulin concentrations. \n\n\n\n\n\n\n\nResults \n\n\n\nTable 1 shows the socio-economic \n\n\n\ninformation of the lung cancer \n\n\n\npatients and control subjects. It was \n\n\n\nshown that the majority of lung \n\n\n\ncancer patients were literate (56%) \n\n\n\nwith various professions having \n\n\n\nmonthly income 109.53\u00b170.44 US$, \n\n\n\naverage age 52.33\uf0b112.03 years and \n\n\n\n78% were found to be married. The \n\n\n\nmean BMI of patients was \n\n\n\n19.79\uf0b12.58, which was significantly \n\n\n\n(p<0.05) lower than that of the \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n250 \n\n\n\ncontrol subjects (25.53\uf0b14.54).  The \n\n\n\nvast majority (84%) of the patients \n\n\n\nwere smokers. \n\n\n\n\n\n\n\nTable 1: Socio-demographic status and chronic energy deficiency data \n\n\n\n(CED) of Lung cancer controls (n=50) and patients (n=45) \n\n\n\n\n\n\n\n Patients Controls \n\n\n\nParameter n % Mean\u00b1SD n % Mean\u00b1SD \n\n\n\n   Education       \n\n\n\n           Illiterate 20 44.44 \n\n\n\n\n\n\n\n18 36 \n\n\n\n \n           Secondary (vi-x class) 12 26.67 9 18 \n\n\n\n           Higher secondary 8 17.78 15 30 \n\n\n\nGraduate and above 5 11.11 8 16 \n\n\n\n   Occupation       \n\n\n\n            Service 15 33.33 \n\n\n\n\n\n\n\n16 32 \n\n\n\n             Small business 18 40 22 44 \n\n\n\n            House wife 12 26.67 12 24 \n\n\n\n  Monthly income in US $       \n\n\n\n            0-50 14 31.11 \n\n\n\n109.53\u00b170.44 \n\n\n\n12 24 \n\n\n\n97.53\u00b160.62 \n\n\n\n            51-100 16 35.56 14 28 \n\n\n\n            101-150 6 13.33 9 18 \n\n\n\n            151-200 6 13.33 8 16 \n\n\n\n            201-300 3 6.67 7 14 \n\n\n\n   Age in years       \n\n\n\n            25-40 13 28.89 \n\n\n\n52.33\u00b112.03 \n\n\n\n15 30 \n\n\n\n52.86\u00b113.21 \n            41-50 12 26.67 12 24 \n\n\n\n            51-60 14 31.11 15 30 \n\n\n\n            61-80 6 13.33 8 16 \n\n\n\nSmoking Behavior        \n\n\n\n            Non Smoker 5 11.11 \n\n\n\n\n\n\n\n8 16 \n\n\n\n            Partial Smoker 22 48.89 24 48 \n\n\n\n           Habituate  18 40 18 36 \n\n\n\n  Marital status   \n\n\n\n\n\n\n\n\n\n\n\n             Married 35 77.78 35 70 \n\n\n\n           Unmarried 10 22.22 15 30 \n\n\n\n   BMI       \n\n\n\n          15.5-18.4 (CED) 13 28.89 \n\n\n\n19.79\u00b12.58 \n\n\n\n4 8  \n\n\n\n25.53\u00b14.54 \n\n\n\n\n\n\n\n          18.5-25.0 (Normal) 30 66.67 19 38 \n\n\n\n         > 25.0 (Obese) 2 4.44 27 54 \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n251 \n\n\n\nSerum trace element levels are \n\n\n\npresented in the table 2.  It was \n\n\n\nshown that compared to the control \n\n\n\nsubjects, serum concentrations of \n\n\n\ntrace elements were found to be \n\n\n\nsignificantly (p<0.05) lower in the \n\n\n\nlung cancer patients.  The \n\n\n\nconcentration of zinc, copper, \n\n\n\nmanganese and lead were \n\n\n\n0.028\u00b10.007 mg/L, 0.029\u00b10.027 \n\n\n\nmg/L, 0.011\u00b10.15 mg/L and \n\n\n\n0.053\u00b10.049 mg/L in the lung cancer \n\n\n\npatients respectively, while these \n\n\n\nvalues were 1.14\u00b10.27 mg/L, \n\n\n\n1.15\u00b11.09 mg/L, 0.44\u00b10.59 mg/L \n\n\n\nand 2.209\u00b11.885 mg/L, respectively \n\n\n\nin the healthy controls. Serum IgG, \n\n\n\nIgA and IgM concentrations of lung \n\n\n\ncancer patients were 14.96\u00b13.92 g/L, \n\n\n\n5.06\u00b11.88 g/L and 5.33\u00b12.24 g/L, \n\n\n\nwhich were 20.56\u00b18.02 g/L, \n\n\n\n4.50\u00b11.40 g/L and 4.49\u00b12.44 g/L in \n\n\n\ncontrol subjects respectively (table \n\n\n\n3).  It was indicated that there was a \n\n\n\ngeneral trend of lowering of serum \n\n\n\nimmunoglobulin IgG level in lung \n\n\n\ncancer patients. Serum IgG \n\n\n\nconcentration was decreased \n\n\n\nsignificantly (p=0.021) in lung \n\n\n\ncancer patients.  The concentration \n\n\n\nof IgA and IgM were not changed \n\n\n\nsignificantly (P>0.05).  \n\n\n\n\n\n\n\nTable 2: Serum trace elements levels of lung cancer patients (n=45) and \n\n\n\nhealthy controls (n=50). \n\n\n\n\n\n\n\n\n\n\n\nTrace elements \n\n\n\n(mg/L) \n\n\n\nPatients Controls \n\n\n\np- value \nn % Mean \u00b1SD n % Mean \u00b1SD \n\n\n\nZn \n\n\n\n\n\n\n\n<0.03 \n\n\n\n0.03-1 \n\n\n\n> 1 \n\n\n\n32 \n\n\n\n13 \n\n\n\n\n\n\n\n71 \n\n\n\n29 \n\n\n\n\n\n\n\n0.028\u00b10.007 \n\n\n\n\n\n\n\n18 \n\n\n\n32 \n\n\n\n\n\n\n\n36 \n\n\n\n64 \n\n\n\n1.14\u00b10.27 \nP= \n\n\n\n0.000 \n\n\n\nCu \n\n\n\n\n\n\n\n<0.03 l \n\n\n\n0.03-1 \n\n\n\n> 1 \n\n\n\n\n\n\n\n27 \n\n\n\n18 \n\n\n\n\n\n\n\n\n\n\n\n60 \n\n\n\n40 \n\n\n\n\n\n\n\n\n\n\n\n0.029\u00b10.027 \n\n\n\n\n\n\n\n13 \n\n\n\n11 \n\n\n\n26 \n\n\n\n\n\n\n\n26 \n\n\n\n22 \n\n\n\n52 \n\n\n\n\n\n\n\n1.15\u00b11.09 \n\n\n\n\n\n\n\nP= \n\n\n\n0.000 \n\n\n\nMn \n\n\n\n\n\n\n\n<0.03 \n\n\n\n0.03-1 \n\n\n\n> 1 \n\n\n\n39 \n\n\n\n6 \n\n\n\n86.67 \n\n\n\n13.33 \n\n\n\n\n\n\n\n0.011\u00b10.15 \n\n\n\n\n\n\n\n24 \n\n\n\n13 \n\n\n\n13 \n\n\n\n\n\n\n\n48 \n\n\n\n26 \n\n\n\n26 \n\n\n\n\n\n\n\n0.44\u00b10.59 \n\n\n\n\n\n\n\nP= \n\n\n\n0.000 \n\n\n\n\n\n\n\nPb \n\n\n\n\n\n\n\n\n\n\n\n< 0.1 \n\n\n\n0.1-3 \n\n\n\n> 3 \n\n\n\n\n\n\n\n42 \n\n\n\n3 \n\n\n\n\n\n\n\n93.33 \n\n\n\n6.67 \n\n\n\n\n\n\n\n\n\n\n\n0.053\u00b10.049 \n\n\n\n\n\n\n\n10 \n\n\n\n23 \n\n\n\n17 \n\n\n\n20 \n\n\n\n46 \n\n\n\n34 \n\n\n\n\n\n\n\n2.209\u00b11.885 \n\n\n\n\n\n\n\n\n\n\n\nP= \n\n\n\n0.000 \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n252 \n\n\n\nTable 3: Serum immunoglobulins levels of lung cancer patients (n=45) and \n\n\n\nhealthy controls (n=50). \n\n\n\n\n\n\n\n\n\n\n\nImmunoglobulins \n\n\n\n(g/L) \n\n\n\nPatients Controls \np-value \n\n\n\n n % Mean \u00b1SD n % Mean \u00b1SD \n\n\n\n\n\n\n\nIgG \n\n\n\n\n\n\n\n<15  \n\n\n\n16-20  \n\n\n\n> 20  \n\n\n\n\n\n\n\n8 \n\n\n\n17 \n\n\n\n20 \n\n\n\n\n\n\n\n18 \n\n\n\n38 \n\n\n\n44 \n\n\n\n\n\n\n\n\n\n\n\n14.96\u00b13.92 \n\n\n\n\n\n\n\n11 \n\n\n\n18 \n\n\n\n21 \n\n\n\n\n\n\n\n22 \n\n\n\n36 \n\n\n\n42 \n\n\n\n\n\n\n\n\n\n\n\n20.56\u00b18.02 \n\n\n\n\n\n\n\n\n\n\n\nP= 0.021 \n\n\n\n\n\n\n\nIgA \n\n\n\n\n\n\n\n2-4  \n\n\n\n5-6  \n\n\n\n>6  \n\n\n\n\n\n\n\n6 \n\n\n\n30 \n\n\n\n9 \n\n\n\n\n\n\n\n13 \n\n\n\n67 \n\n\n\n20 \n\n\n\n\n\n\n\n\n\n\n\n5.06\u00b11.88 \n\n\n\n\n\n\n\n8 \n\n\n\n31 \n\n\n\n11 \n\n\n\n\n\n\n\n16 \n\n\n\n62 \n\n\n\n22 \n\n\n\n\n\n\n\n\n\n\n\n4.50\u00b11.40 \n\n\n\n\n\n\n\n\n\n\n\nP= 0.265 \n\n\n\n\n\n\n\nIgM \n\n\n\n\n\n\n\n<3  \n\n\n\n3-5  \n\n\n\n> 5  \n\n\n\n\n\n\n\n14 \n\n\n\n23 \n\n\n\n8 \n\n\n\n\n\n\n\n\n\n\n\n31 \n\n\n\n51 \n\n\n\n18 \n\n\n\n\n\n\n\n\n\n\n\n5.33\u00b12.24 \n\n\n\n\n\n\n\n19 \n\n\n\n22 \n\n\n\n9 \n\n\n\n\n\n\n\n38 \n\n\n\n44 \n\n\n\n18 \n\n\n\n\n\n\n\n\n\n\n\n4.49\u00b12.44 \n\n\n\n\n\n\n\n\n\n\n\nP= 0.762 \n\n\n\n\n\n\n\n\n\n\n\nCorrelation of serum trace elements \n\n\n\nand immunoglobulins in lung cancer \n\n\n\npatients with their socio-economic \n\n\n\nfactors are presented in table 4. Only \n\n\n\nserum lead concentration of the \n\n\n\npatients was found to be influenced \n\n\n\nwith the age of patients; in fact \n\n\n\nconcentration of lead is negatively \n\n\n\ncorrelated with the age of cancer \n\n\n\npatients. There was no correlation \n\n\n\nbetween other parameters.   \n\n\n\n\n\n\n\nTable 4. Correlation between different parameters in lung cancer patients (n \n\n\n\n= 45). \n \n\n\n\n  Pb Zn Mn Cu IgG IgM IgA \n\n\n\nBMI \n\n\n\n(kg/m\n2\n) \n\n\n\nr 0.013 0.019 0.048 0.106 0.024 0.055 -0.032 \n\n\n\n p 0.931 0.900 .752 0.490 0.877 0.720 0.836 \n\n\n\nIncome r 0.021 -0.009 -0.023 -0.156 -0.073 -0.247 -0.082 \n\n\n\n p 0.892 0.955 0.881 0.308 0.635 0.102 0.594 \n\n\n\nAge r -0.369 0.134 0.203 -0.166 0.261 0.192 0.045 \n\n\n\n p 0.013 0.380 0.181 0.275 0.083 0.207 0.767 \n \nr= Pearson Correlation \np= Significance (2-tailed) \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n253 \n\n\n\nDiscussion \n\n\n\n\n\n\n\nSerum trace elements level is used as \n\n\n\ndiagnostic tool in cancer (17). \n\n\n\nAnalysis of serum trace elements \n\n\n\nindicated a significant decrease in \n\n\n\nconcentration of zinc, copper, \n\n\n\nmanganese and lead.  Previous \n\n\n\nreports also found a decreased serum \n\n\n\nZn level in lung cancer patients \n\n\n\ncompared to controls, which is \n\n\n\nconsistent with our present findings \n\n\n\nbut some other reports also \n\n\n\nsuggested a significant increase in \n\n\n\nserum Cu level in lung cancer \n\n\n\npatients which is contradictory with \n\n\n\nour findings. (18-20). Trace \n\n\n\nelements play an important role in \n\n\n\nmaintaining three dimensional \n\n\n\nstructure of some proteins such as \n\n\n\nthymidylate synthetase, \n\n\n\ndihydrofolate reductase, p53, p16, \n\n\n\nK-ras etc. (13). So it may be \n\n\n\nsuggested that the decreased trace \n\n\n\nelements in the cancer patients may \n\n\n\nbe because of the deformed protein \n\n\n\nstructure. It is further noted that the \n\n\n\ndeficiency of trace elements like \n\n\n\nzinc, selenium might be risk factors \n\n\n\nfor the development of some cancers \n\n\n\n(21).  \n\n\n\nCirculating immune complexes are \n\n\n\ndetectable in the patients with \n\n\n\ncarcinomas of the head and neck, \n\n\n\nstomach, rectum, external genitals, \n\n\n\nlungs, with Hodgkin's disease, and \n\n\n\nmelanomas (22). Immunoglobulin \n\n\n\nlevels are abnormal in all the \n\n\n\naforementioned conditions. In \n\n\n\npulmonary carcinoma, cancer of the \n\n\n\nhead and neck, and Hodgkin's  \n\n\n\n\n\n\n\n\n\n\n\ndisease the concentrations of \n\n\n\nimmune complexes and IgG \n\n\n\ncorrelate (22). Serum \n\n\n\nimmunoglobulin analysis indicated \n\n\n\nthat the concentration of IgG was \n\n\n\ndecreased significantly in the lung \n\n\n\ncancer patients. Viramontes L, et. al. \n\n\n\n1989 (23) found decreased IgA \n\n\n\nconcentration in lung cancer \n\n\n\npatients, which is contradictory with \n\n\n\nour findings. Previous study also \n\n\n\nsuggested defective immune activity \n\n\n\nin cancer patients (11-12). Some \n\n\n\ninvestigators reported a positive \n\n\n\ncorrelation between the extent of \n\n\n\nmetastatic breast cancer and the \n\n\n\nserum level of various \n\n\n\nimmunoglobulins (24), particularly \n\n\n\nIgA.   \n\n\n\n\n\n\n\nConclusion. \n\n\n\nFrom socio-demographic data it was \n\n\n\nfound that the mean BMI of lung \n\n\n\ncancer patients was significantly \n\n\n\n(p<0.000) lower than that of the \n\n\n\ncontrol subjects, which is well \n\n\n\npredicted. Correlative analysis \n\n\n\nsuggested a significant correlation \n\n\n\nbetween serum lead value and age of \n\n\n\nthe patients. \n\n\n\n\n\n\n\n\n\n\n\nReferences: \n\n\n\n1. Spira A & Ettinger DS. \n\n\n\nMultidisciplinary management of \n\n\n\nlung cancer. N Engl J Med 2004. \n\n\n\n350:379\u2013392. \n\n\n\n2. Mitchell H & Megraud F. \n\n\n\nEpidemiology and diagnosis of \n\n\n\n\nhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&itool=pubmed_Abstract&term=%22Viramontes+L%22%5BAuthor%5D\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n254 \n\n\n\nHelicobacter pylori infection. \n\n\n\nHelicobacter  2002. 7(Suppl 1): \n\n\n\n8-16. \n\n\n\n3. Stieber P, Aronsson AC & Bialk \n\n\n\nP. Tumor markers in lung \n\n\n\ncancer: EGTM \n\n\n\nrecommendations. Anticancer \n\n\n\nRes 1999. 19:2817\u20132819. \n\n\n\n4. Lam S, Kennedy T, Unger M, \n\n\n\nMiller YE, Gelmont D, Rusch V, \n\n\n\nGipe B, Howard D, LeRiche JC, \n\n\n\nColdman A & Gazdar AF. \n\n\n\nLocalization of bronchial \n\n\n\nintraepithelial neoplastic lesions \n\n\n\nby fluorescence bronchoscopy. \n\n\n\nChest  1998. 113:696\u2013702. \n\n\n\n5. Kulpa J, Wojcik E, Reinfuss M \n\n\n\n& Kolodziejski L. \n\n\n\nCarcinoembryonic antigen, \n\n\n\nsquamous cell carcinoma \n\n\n\nantigen, CYFRA21-1, and \n\n\n\nneuro-specific enolase in \n\n\n\nsquamous cell lung cancer \n\n\n\npatients. Clin Chem 2002. \n\n\n\n48:1931\u20131937. \n\n\n\n6. Swensen SJ, Jett JR, Hartman \n\n\n\nTE, Midthun DE, Sloan JA, \n\n\n\nSykes AM, Aughenbaugh GL & \n\n\n\nClemens MA. Lung cancer \n\n\n\nscreening with CT: Mayo clinic \n\n\n\nexperience. Radiology 2003. \n\n\n\n226:756\u2013761.  \n\n\n\n7. Zhong L, Peng X, Hidalgo GE, \n\n\n\nDoherty DE, Stromberg AJ & \n\n\n\nHirschowitz EA. Identification \n\n\n\nof circulating antibodies to \n\n\n\ntumor-associated proteins for \n\n\n\ncombined use as markers of non-\n\n\n\nsmall cell lung cancer. \n\n\n\nProteomics 2004. 4:1216\u20131225. \n\n\n\n8. Skoug JW & Pardue HL. Kinetic \n\n\n\nturbidimetric method for the \n\n\n\nimmunochemical quantification \n\n\n\nof immunoglobulins, including \n\n\n\nsamples with excess antigen. \n\n\n\nClin Chem 1988. 34(2): 309-15. \n\n\n\n9. Rosty C, Christa L, Kuzdzal S, \n\n\n\nBaldwin WM, Zahurak ML, \n\n\n\nCarnot F, Chan DW, Canto M, \n\n\n\nLillemoe KD, Cameron JL, Yeo \n\n\n\nCJ, Hruban RH & Goggins M. \n\n\n\nIdentification of \n\n\n\nhepatocarcinoma-intestine-\n\n\n\npancreas/pancreatitis \u2013 \n\n\n\nassociated protein I as a \n\n\n\nbiomarker for pancreatic ductal \n\n\n\nadenocarcinoma by protein \n\n\n\nbiochip technology. Cancer Res \n\n\n\n2002. 62:1868\u20131875. \n\n\n\n10. Wadsworth JT, Somers KD, \n\n\n\nCazares LH, Malik G, Adam BL, \n\n\n\nStack BC Jr, Wright GL Jr, & \n\n\n\nSemmes OJ. Serum protein \n\n\n\nprofiles to identify head and \n\n\n\nneck cancer. Clin Cancer Res. \n\n\n\n2004. 10:1625\u20131632. \n\n\n\n11. Cohen H. Peptic ulcer and \n\n\n\nHelicobacter pylori. \n\n\n\nGastroenterol Clin North Am \n\n\n\n2000. 29: 775-789. \n\n\n\n12. Cave DR. Chronic gastritis and \n\n\n\nHelicobacter pylori. Semin \n\n\n\nGastrointestinal Dis 2001. 12: \n\n\n\n196-202. \n\n\n\n13. Martz E. Protein Explorer: Easy \n\n\n\nYet Powerful Macromolecular \n\n\n\nVisualization, Trends in \n\n\n\nBiochemical Sciences 2002. 107-\n\n\n\n109. \n\n\n\n14. Mertz W. The essential trace \n\n\n\nelements, Science 1981. 213: \n\n\n\n1332-1338. \n\n\n\n15. Muralidhar LH et al. Serum trace \n\n\n\nelement levels and the \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n255 \n\n\n\ncomplexity of inter-element \n\n\n\nrelations in patients with \n\n\n\nParkinson disease. J Trace Elem \n\n\n\nin Med  Biol 2004. 18:163-171. \n\n\n\n16. Falchuk Kh et al. Aqueous \n\n\n\nhoumour and serum zinc and \n\n\n\ncopper concentrations of patients \n\n\n\nwith flaucoma and cataract. Br J \n\n\n\nOphthalmol 1990. 74: 661-662.  \n\n\n\n17. Kuo HW, Chen SF, Wu CC, \n\n\n\nChen DR & Lee JH. Serum and \n\n\n\ntissue trace elements in patients \n\n\n\nwith breast cancer in Taiwan. \n\n\n\nBiol Trace Elem Res 2002. \n\n\n\n89(1):1-11. \n\n\n\n18. Altavilla G, Adamo V, Alafaci \n\n\n\nE, Buemi B, Chillemi S, La \n\n\n\nScala R, Marabello G & Palmara \n\n\n\nD. Serum levels of copper and \n\n\n\nzinc in patients with lung cancer. \n\n\n\nMinerva Med 1985. 76(44): \n\n\n\n2117-20. \n\n\n\n19. Diez M, Arroyo M, Cerdan FJ, \n\n\n\nMunoz M, Martin MA & \n\n\n\nBalibrea JL. Serum and tissue \n\n\n\ntrace metal levels in lung cancer \n\n\n\npatients. Oncology 1989. 46(4): \n\n\n\n230-4. \n\n\n\n20. Zhao X, Han C & Jing J. \n\n\n\nRelationship of serum trace \n\n\n\nelements to lung cancer and its \n\n\n\nclinical application.  Zhonghua \n\n\n\nLiu Xing Bing Xue Za Zhi 1998. \n\n\n\n19(5): 286-9  \n\n\n\n21. Cunzhi H, Jiexian J, Xianwen Z, \n\n\n\nJingang G, Shumin Z & Lili D. \n\n\n\nSerum and tissue levels of six \n\n\n\ntrace elements and copper/zinc \n\n\n\nratio in patients with cervical \n\n\n\ncancer and uterine myoma.  Biol \n\n\n\nTrace Elem Res  2003. \n\n\n\n94(2):113-22. \n\n\n\n22. Savina NP. Circulating immune \n\n\n\ncomplexes in malignant tumors. \n\n\n\nSov Med 1989. (8):8-10. \n\n\n\n23. Viramontes L, Cicero R, Acosta \n\n\n\nG, Barragan L, Orozco R, Torres \n\n\n\nS. Determination of secretory \n\n\n\nimmunoglobulin A, IgG and IgM \n\n\n\nin bronchial lavage from patients \n\n\n\nwith primary and metastatic lung \n\n\n\nneoplasms.Arch Invest Med \n\n\n\n(Mex) 1989. 20(2): 175-81. \n\n\n\n24. Pettingale KW, Merrett TG & \n\n\n\nTee DE. Prognostic value of \n\n\n\nserum levels of \n\n\n\nimmunoglobulins (IgG, IgA, \n\n\n\nIgM and IgE) in breast cancer: a \n\n\n\npreliminary study.   Br J Cancer \n\n\n\n1977. 36(5):550-7. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n256 \n\n\n\nInfluences of Patient-Related Factors in Diabetes Management Among Non-\n\n\n\nInsulin-Treated Type 2 Diabetics \n\n\n\n\n\n\n\nYap Li Swan*  \n\n\n\n2383, Taman L.G.L., Jalan Merbuk, 24000 Kemaman, Terengganu. \n\n\n\n*Corresponding Author \n\n\n\nMalaysian Journal of Pharmacy 2008: 1( 6): 256- 267                                               \n\n\n\n\n\n\n\n\n\n\n\nAbstract \n\n\n\n\n\n\n\nStudy was conducted to investigate the influences of patient-related factors in \n\n\n\ndiabetic management among non-insulin-treated type 2 diabetics in Outpatient \n\n\n\nDepartment, Hospital Kemaman. Convenience interview has been conducted, \n\n\n\nfollowed by further review of outpatient cards. Data collected from 29 subjects \n\n\n\nwas analyzed by using SPSS Version 11. The inclusive criteria were patients \n\n\n\ndiagnosed with diabetes for at least one year and on oral hypoglycemic agent. \n\n\n\nPatients on insulin treatment were excluded. The efficacy parameter was the \n\n\n\nfasting blood glucose level. 86.2% of study population were non-smokers. 41.4% \n\n\n\nconsumed alternative medicines concurrently with antidiabetic medications. \n\n\n\nMajority of the subjects practiced lifestyle modifications, 62.1% in the form of \n\n\n\nroutine exercise and 79.3% dietary modifications. 24.1% and 20.7% received \n\n\n\ncounseling before being put on diabetic medications and on lifestyle \n\n\n\nmodifications respectively. Many diabetics have poor understanding on their \n\n\n\nmedications. Only 27.6% have their fasting blood glucose level \u2264 7mmol/L \n\n\n\nduring the study duration. 72.4% patients claimed to have good compliance to the \n\n\n\nmedications prescribed. Study revealed that patients had better glycaemic control \n\n\n\nif they had better understanding/knowledge about the medications, had better \n\n\n\ncompliance, practice lifestyle modifications and had been counseled before. \n\n\n\nOther variables (age, smoking and concurrent use of alternative medicines) failed \n\n\n\nto demonstrate significant effect on glycaemic control. This study revealed \n\n\n\nproblems such as non-optimal glycaemic control, insufficient patients\u2019 \n\n\n\nknowledge about the disease and medications, and inadequate compliance in \n\n\n\ndiabetic population. Pharmacists can help the community to manage diabetes \n\n\n\nbetter. This information is expected to be useful for pharmacists in improving \n\n\n\ntheir roles.  \n\n\n\n\n\n\n\nKey Words: Type 2 diabetes, blood glucose level, lifestyle modifications, \n\n\n\ncounseling, compliance  \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n257 \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nIntroduction \n\n\n\n\n\n\n\nDiabetes is a worldwide common \n\n\n\nchronic disorder. In ASEAN region, \n\n\n\nit is estimated that 7 million people \n\n\n\nare affected by diabetes mellitus (1). \n\n\n\nIn Malaysia, diabetes is one of the \n\n\n\nmost prevalent chronic illnesses \n\n\n\nwhich contribute to ill health and \n\n\n\npremature mortality.  The prevalence \n\n\n\nis about 8% (2). Diabetes occurs \n\n\n\nwhen the pancreas fails to produce \n\n\n\nadequate insulin or when the body \n\n\n\ncannot utilize the insulin effectively \n\n\n\n(insulin resistance). It is a syndrome \n\n\n\ncharacterized by hyperglycaemia \n\n\n\ntogether with other metabolic \n\n\n\nabnormalities (e.g. disturbance in \n\n\n\nlipid and protein metabolism).  \n\n\n\n\n\n\n\nEssentially, diabetes mellitus is \n\n\n\ncategorized into 2 groups: type 1 \n\n\n\ndiabetes and type 2 diabetes. \n\n\n\nAccording to American Diabetes \n\n\n\nAssociation (ADA), 90-95% of \n\n\n\npatients diagnosed with diabetes are \n\n\n\ntype 2 (3).  \n\n\n\n\n\n\n\nType 2 Diabetes Mellitus \n\n\n\n\n\n\n\nType 2 diabetes is also known as \n\n\n\nadult-onset diabetes due to its \n\n\n\nrelatively late onset compare with \n\n\n\ntype 1 diabetes. The disorder occurs \n\n\n\nas a result of impaired insulin \n\n\n\nsecretion; tissue resistance to insulin \n\n\n\nor due to increase hepatic glucose \n\n\n\noutput. The long-term consequences \n\n\n\nof diabetes account for the majority \n\n\n\nof morbidity and mortality. Chronic \n\n\n\nsequelaes of diabetes always link \n\n\n\nwith poor diabetes control. Glucose \n\n\n\ntoxicity as a result of uncontrolled \n\n\n\nhyperglycemia appears to contribute \n\n\n\nto the development and progression \n\n\n\nof microvascular complications \n\n\n\n(retinopathy, nephropathy and \n\n\n\nneuropathy). Diabetes is also the risk \n\n\n\nfactor for macrovascular \n\n\n\nimplications (e.g. cardiovascular, \n\n\n\ncerebral vascular and peripheral \n\n\n\nvascular systems). (4) \n\n\n\n\n\n\n\nCurrently there is no known cure for \n\n\n\ndiabetes but the disease can be \n\n\n\ncontrolled enabling the patient to \n\n\n\nlead a healthy and productive life. \n\n\n\nThe primary goal of diabetes \n\n\n\nmanagement is to bring the glucose \n\n\n\nlevel as close to normal value as \n\n\n\npossible. There are five major \n\n\n\ncomponents in the management of \n\n\n\ndiabetes mellitus: diet, exercise, \n\n\n\neducation, oral hypoglycemic agents \n\n\n\nand insulin. In addition, monitoring \n\n\n\nof glycaemic control and \n\n\n\nmanagement of complications \n\n\n\nshould also be emphasized. Good \n\n\n\nglycaemic control prevents/delays \n\n\n\nshort term as well as the long term \n\n\n\ndiabetic complications.  \n\n\n\n\n\n\n\nObjectives \n\n\n\n\n\n\n\nGeneral objectives \n\n\n\n\n\n\n\n\uf0b7 To investigate the influence of \n\n\n\npatient-related factors in diabetes \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n258 \n\n\n\nmanagement in non-insulin-\n\n\n\ntreated type 2 diabetics (in \n\n\n\noutpatient department of the \n\n\n\nHospital Kemaman).  \n\n\n\n\uf0b7 To analyze and determine factors \n\n\n\nwhich might affect the glycaemic \n\n\n\ncontrol. \n\n\n\n\n\n\n\nSpecific objectives \n\n\n\n\n\n\n\n\uf0b7 To determine patients\u2019 \n\n\n\nunderstanding/ knowledge \n\n\n\ntowards oral hypoglycaemic \n\n\n\nagents in non-insulin treated type \n\n\n\n2 diabetics.  \n\n\n\n\uf0b7 To investigate the patients\u2019 \n\n\n\ncompliance to the diabetes \n\n\n\ncontrol. \n\n\n\n\uf0b7 To analyze the roles of lifestyle \n\n\n\nmodifications on diabetes \n\n\n\nmanagement. \n\n\n\n\uf0b7 To investigate the roles of \n\n\n\ncounseling on diabetes \n\n\n\nmanagement. \n\n\n\n\uf0b7 To identify the barriers towards \n\n\n\neffective glycaemic control and \n\n\n\nsteps to overcome the barriers.  \n\n\n\n\uf0b7 To recognize pharmacists roles \n\n\n\nin improving glucose \n\n\n\nmanagement in diabetic patients.  \n\n\n\n\n\n\n\nDefinitions \n\n\n\n\n\n\n\na) Diabetes mellitus \n\n\n\n\n\n\n\n In practice, diagnosis of \n\n\n\ndiabetes mellitus must be confirmed \n\n\n\nby the measurement of venous \n\n\n\nplasma glucose. Malaysian Clinical \n\n\n\nPractice Guidelines stated that the \n\n\n\ndiagnosis value of diabetes is as \n\n\n\nfollow: \n\n\n\n\n\n\n\nFasting Plasma Venous Glucose Random Plasma Venous Glucose \n\n\n\n\u2265 7.0 mmol/L \u2265 11.1 mmol/L \n\n\n\n\n\n\n\n\n\n\n\nIn asymptomatic patient, 2 abnormal \n\n\n\nglucose values are required to \n\n\n\nconfirm the diagnosis of diabetes \n\n\n\nwhereas for patient presents with \n\n\n\nsymptom(s), only one abnormal \n\n\n\nglucose value is diagnostic.[5] \n\n\n\n\n\n\n\nb) Efficacy Parameter of \n\n\n\nGlycaemic Control \n\n\n\nMany quality indicators have been \n\n\n\nproposed to measure different \n\n\n\naspects \n\n\n\nof diabetes management. In this \n\n\n\nstudy, the efficacy parameter used is \n\n\n\nthe fasting blood glucose level.  \n\n\n\n\n\n\n\nEfficacy Parameter Indicators \n\n\n\nTarget Glycaemic Control \nFasting  \n\n\n\n\n\n\n\n4.4 \u2013 6.1 mmol/L \n\n\n\n\n\n\n\n*The glycaemic control is considered not achieved if the fasting plasma glucose \n\n\n\nis > 7.0 mmol/L.  \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n259 \n\n\n\nc) Understanding / Knowledge of \n\n\n\nMedications Taken \n\n\n\n\n\n\n\nPatients\u2019 knowledge of the \n\n\n\nmedications taken (oral \n\n\n\nhypoglycemic agents, OHA) is \n\n\n\nexpected to be one of the factors \n\n\n\naffecting glycaemic control. In this \n\n\n\nstudy, several questions regarding \n\n\n\nmedications taken had been \n\n\n\nforwarded to the patients to assess \n\n\n\ntheir understanding about the oral \n\n\n\nhypoglycaemic agents consumed. \n\n\n\n\n\n\n\nBelow are some of the questions asked: \n\n\n\n\n\n\n\nUnderstanding / Knowledge of \n\n\n\nMedication Name \n\uf0b7 Do you know the name (Brand Name / \n\n\n\nGeneric Name) of the medications taken? \n\n\n\n\uf0b7 How do you recognize your medications? \n\n\n\nUnderstanding / Knowledge of \n\n\n\nMedication Indications \n\uf0b7 What this particular medication is \n\n\n\nindicated for? \n\n\n\n\uf0b7 How this OHA agent acts on the blood \n\n\n\nglucose level? \n\n\n\nUnderstanding / Knowledge of \n\n\n\nMedication Dosage & \n\n\n\nAdministration \n\n\n\n\uf0b7 How is the medication(s) taken? Dose & \n\n\n\nfrequency \n\n\n\n\uf0b7 Pre or post prandial? \n\n\n\n\uf0b7 What do you do when you miss a dose? \n\n\n\nUnderstanding / Knowledge of \n\n\n\nMedications Storage \n\uf0b7 Where do you keep your medicines? \n\n\n\n\uf0b7 What storage condition do you think might \n\n\n\naffect the medication\u2019s efficacy? \n\n\n\n\n\n\n\nEach section counted for 1 mark: \n\n\n\n\n\n\n\nLevel of understanding/ knowledge Marks \n\n\n\nPoor 0-1 \n\n\n\nModerate 2-3 \n\n\n\nGood 4 \n\n\n\n\n\n\n\nd) Compliance \n\n\n\n\n\n\n\nType 2 diabetic patients usually \n\n\n\nwere on oral hypoglycaemic agent(s) \n\n\n\neither on mono- or poly- therapy. \n\n\n\nPatients have to take their \n\n\n\nmedication(s) in multiple daily \n\n\n\ndosing in order to achieve good \n\n\n\nglycaemic control. Compliance to \n\n\n\nmedications, therefore, plays an \n\n\n\nessential role to ensure blood \n\n\n\nglucose level is well-controlled. In \n\n\n\nthis study, 6 following questions \n\n\n\nwere asked to evaluate the \n\n\n\ncompliance. Each question counted \n\n\n\nfor 1 mark. \n\n\n\n\n\n\n\n\uf0b7 How are the medications taken? \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n260 \n\n\n\n\uf0b7 Have you ever forgotten to take \n\n\n\nyour medications? How often?  \n\n\n\n\uf0b7 How frequent are you delayed in \n\n\n\ntaking daily medications? \n\n\n\n\uf0b7 What do you do when you miss a \n\n\n\ndose? \n\n\n\n\uf0b7 When do you come for follow up \n\n\n\n/ refill? \n\n\n\n\uf0b7 Do you share the medications \n\n\n\nwith some one else? \n\n\n\n\n\n\n\nThe interviewer would then \n\n\n\ncategorize patients into poor, \n\n\n\nmoderate or good compliance based \n\n\n\non the patient\u2019s score. \n\n\n\n\n\n\n\nLevel of compliance Marks \n\n\n\nPoor 0-2 \n\n\n\nModerate 3-4 \n\n\n\nGood 5-6 \n\n\n\n\n\n\n\nMethodology \n\n\n\n\n\n\n\nA descriptive study has been carried \n\n\n\nout between Jan \u2013 March 2007. \n\n\n\nSample was selected via \n\n\n\nconvenience sampling among \n\n\n\npatients who were on oral \n\n\n\nhypoglycemic agent(s). The data \n\n\n\ncollection was performed in two \n\n\n\nstages. In the first stage, patients \n\n\n\nwere interviewed and data were \n\n\n\nrecorded in a data collection form \n\n\n\nspecially designed for this study \n\n\n\n(Appendix).  Subsequently, \n\n\n\noutpatient cards of the same patients \n\n\n\nwere reviewed to complete \n\n\n\ninformation.  \n\n\n\n\n\n\n\nThe data was subsequently analyzed \n\n\n\nby using SPSS Version 11.  \n\n\n\nDescriptive data were presented in \n\n\n\npercentage and Pearson Correlation \n\n\n\ntest was used to evaluate the \n\n\n\nrelationship between the fasting \n\n\n\nplasma glucose and patient\u2019s factors.  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nInclusion criteria \n\n\n\n\n\n\n\n\uf0b7 Patient is on at least one type \n\n\n\nof oral hypoglycemic agent.  \n\n\n\n\n\n\n\nExclusion criteria \n\n\n\n\n\n\n\n\uf0b7 Patient newly diagnosed with \n\n\n\ndiabetes mellitus (less than 1 \n\n\n\nyear). \n\n\n\n\uf0b7 Patient on insulin treatment \n\n\n\n\n\n\n\nResult and discussion \n\n\n\n\n\n\n\nIn this study, an overall of 29 \n\n\n\npatients with type 2 diabetes in \n\n\n\noutpatient department had been \n\n\n\napproached to assess the effect of \n\n\n\nseveral patient-related factors (which \n\n\n\nare expected to affect the body \n\n\n\nglycaemic control) on body blood \n\n\n\nglucose level. The study population \n\n\n\nconsists of 27 (93.1%) Malays and 2 \n\n\n\n(6.9%) Chinese with 8 (27.6%) of \n\n\n\nthe population were male and 21 \n\n\n\n(72.4%) were female. The \n\n\n\npopulation has the mean age of \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n261 \n\n\n\n54.93 \u00b110 and the mean of 7.38 \n\n\n\nyears diagnosed with diabetes \n\n\n\nmellitus. [Table 1] \n\n\n\n\n\n\n\nTable 1. Patient Demographics Data \n \n\n\n\n\n\n\n\nParameters N \n\n\n\n\n\n\n\nNumber of patients \n\n\n\nNumber of OHA prescribed per patient \n\n\n\n     Mean \n\n\n\nYears diagnosed with diabetes mellitus \n\n\n\n     Mean \n\n\n\n29 \n\n\n\n\n\n\n\n1.85 \n\n\n\n\n\n\n\n7.38 \n\n\n\nSex \n\n\n\n     Male (%) \n\n\n\n     Female (%) \n\n\n\n\n\n\n\n8 (27.6%) \n\n\n\n21 (72.4%) \n\n\n\nAge, (years) \n\n\n\n     Mean (SD) \n\n\n\n     Median (range) \n\n\n\n\n\n\n\n54.93 (\u00b110.392) \n\n\n\n53 (31-75) \n\n\n\nRace \n\n\n\n     Malay (%) \n\n\n\n     Chinese (%) \n\n\n\n\n\n\n\n27 (93.1%) \n\n\n\n2 (6.9%) \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nMost of the patients were non-\n\n\n\nsmokers (86.2%). 41.4% of the \n\n\n\npopulation consumed alternative \n\n\n\nmedications concurrently with \n\n\n\nantidiabetic medications. Lifestyle \n\n\n\nmodifications, as part of diabetes \n\n\n\nmanagement, practiced by majority \n\n\n\nof the population, with 62.1% \n\n\n\npatients claimed exercise routinely \n\n\n\nand 79.3% patients controlled their \n\n\n\ndaily dietary intake. \n\n\n\n\n\n\n\nApproximately one quarter of the \n\n\n\npopulation received counseling on \n\n\n\ndiabetes prior to the study (24.1% \n\n\n\nand 20.7% patients received \n\n\n\ncounseling before being put on \n\n\n\ndiabetic medications and lifestyle \n\n\n\nmodifications respectively). There \n\n\n\nare many patients out there who still \n\n\n\ndo not completely understand about \n\n\n\nthe medications prescribed to them. \n\n\n\nGood glycaemic control is the \n\n\n\nprimary goal in diabetes \n\n\n\nmanagement. The results, \n\n\n\nnevertheless, demonstrated a non-\n\n\n\noptimal control of blood glucose \n\n\n\nlevel. Only 27.6% have their fasting \n\n\n\nblood glucose level \u22647mmol/L \n\n\n\nduring the study duration. More than \n\n\n\n70% (72.4%) patients claimed to \n\n\n\nhave good compliance to the \n\n\n\nmedications prescribed. Some \n\n\n\npatients acknowledge moderate-poor \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n262 \n\n\n\ncompliance due to personal \n\n\n\ndisability, old age, multiple drug \n\n\n\nregimen and other problems. Table 2 \n\n\n\nlisted the variables that might affect \n\n\n\nthe glycaemic control. \n\n\n\n\n\n\n\nTable 2 : Variables Which Might Affect Glycaemic Control \n \n\n\n\n\n\n\n\nVariables N (%) \n\n\n\n\n\n\n\nSmoking \n\n\n\n     Not smoking (%) \n\n\n\n     Smoking (%) \n\n\n\n\n\n\n\n25 (86.2%) \n\n\n\n4 (13.8%) \n\n\n\nAlternative medications \n\n\n\n     Not take alternative medications (%) \n\n\n\n     Take alternative medications (%) \n\n\n\n\n\n\n\n17 (58.6%) \n\n\n\n12 (41.4%) \n\n\n\nLifestyle modifications \n\n\n\n     No routine exercise (%) \n\n\n\n     Routine exercise (%) \n\n\n\n\n\n\n\n     No dietary control (%) \n\n\n\n     Dietary control (%) \n\n\n\n\n\n\n\n11 (37.9%) \n\n\n\n18 (62.1%) \n\n\n\n\n\n\n\n6 (20.7%) \n\n\n\n23 (79.3%) \n\n\n\nCounseling on medications \n\n\n\n     No counseling given before (%) \n\n\n\n     Counseling given before (%) \n\n\n\n\n\n\n\n22 (75.9%) \n\n\n\n7 (24.1%) \n\n\n\nCounseling on lifestyle modifications \n\n\n\n     No counseling given before (%) \n\n\n\n     Counseling given before (%) \n\n\n\n\n\n\n\n23 (79.3%) \n\n\n\n6 (20.7%) \n\n\n\nUnderstanding / Knowledge of the medications taken  \n\n\n\n\n\n\n\nUnderstanding / Knowledge of medications name \n\n\n\n     No (%) \n\n\n\n     Yes (%) \n\n\n\nUnderstanding / Knowledge of medications indications \n\n\n\n     No (%) \n\n\n\n     Yes (%) \n\n\n\nUnderstanding / Knowledge of medications dosage & \n\n\n\nadministration \n\n\n\n     No (%) \n\n\n\n     Yes (%) \n\n\n\nUnderstanding / Knowledge of medications storage \n\n\n\n     No (%) \n\n\n\n     Yes (%) \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n18 (62.1%) \n\n\n\n11 (37.9%) \n\n\n\n\n\n\n\n4 (13.8%) \n\n\n\n25 (86.2%) \n\n\n\n\n\n\n\n\n\n\n\n7 (24.1%) \n\n\n\n22 (75.9%) \n\n\n\n\n\n\n\n9 (31.0%) \n\n\n\n20 (69.0%) \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n263 \n\n\n\nCompliance \n\n\n\n     Poor (%) \n\n\n\n     Moderate (%) \n\n\n\n     Good (%) \n\n\n\n\n\n\n\n3 (10.3%) \n\n\n\n5 (17.2%) \n\n\n\n21 (72.4%) \n\n\n\nGlycaemic control -Fasting blood glucose level \n\n\n\n     Not-controlled (FBG > 7mmol/L) (%) \n\n\n\n     Well-controlled (FBG \u2264 7mmol/L) (%) \n\n\n\n\n\n\n\n21 (72.4%) \n\n\n\n8 (27.6%) \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nPatient-related factors have always \n\n\n\nbeen identified as the determining \n\n\n\nfactors towards good glycaemic \n\n\n\ncontrol. Gycaemic control, therefore, \n\n\n\nis expected to be improved if these \n\n\n\ndetermining factors are improved.  It \n\n\n\nis expected that blood glucose level \n\n\n\nmight achieve well-controlled level \n\n\n\nif the following criteria are met: \n\n\n\n\n\n\n\n\uf0b7 younger age (expected to be \n\n\n\nmore aware of the importance of \n\n\n\nself-care and have better \n\n\n\nunderstanding about the \n\n\n\nmedications taken) \n\n\n\n\uf0b7 non-smoker \n\n\n\n\uf0b7 has better understanding about \n\n\n\nthe medications taken \n\n\n\n\uf0b7 has good compliance to the \n\n\n\nmedications taken \n\n\n\n\uf0b7 counseling on medications and \n\n\n\nlifestyle modifications given \n\n\n\nbefore being put on diabetic \n\n\n\nmedication(s) \n\n\n\n\uf0b7 practices lifestyle modifications, \n\n\n\ninvolving dietary control and \n\n\n\nroutine involvement in physical \n\n\n\nexercise \n\n\n\n\n\n\n\nConcurrent use of alternative \n\n\n\nmedicine is also expected to \n\n\n\ninfluence the diabetic control. \n\n\n\n\n\n\n\nTable 3 showed the correlation \n\n\n\nbetween the patient\u2019s factors and the \n\n\n\nfasting plasma glucose.  The results \n\n\n\nrevealed that fasting blood glucose \n\n\n\nlevel had no significant correlation \n\n\n\nwith patients\u2019 age.  Positive \n\n\n\ncorrelations found to be established \n\n\n\nbetween fasting blood glucose level \n\n\n\nand patients\u2019 understanding / \n\n\n\nknowledge towards oral \n\n\n\nhypoglycaemic agents. Patients had \n\n\n\ntheir blood glucose level better \n\n\n\ncontrolled when they had higher \n\n\n\nknowledge of the indications, dosage \n\n\n\n& administration and storage of the \n\n\n\nmedications. Patients\u2019 knowledge \n\n\n\nabout the name of the medications, \n\n\n\nhowever, did not improve the \n\n\n\nglycaemic control significantly.  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n264 \n\n\n\nTable 3. Correlation Between Fasting Blood Glucose & Patient\u2019s Factors \n \n\n\n\n Correlation \n\n\n\ncoefficient \n\n\n\nP-value \n\n\n\nAge 0.323 NS \n\n\n\nUnderstanding / Knowledge of \n\n\n\nmedications name \n\n\n\n-0.005 NS \n\n\n\nUnderstanding / Knowledge of \n\n\n\nmedications indications \n\n\n\n0.023 <0.05 \n\n\n\nUnderstanding / Knowledge of \n\n\n\nmedications dosage & administration \n\n\n\n0.348 <0.05 \n\n\n\nUnderstanding / Knowledge of \n\n\n\nmedications storage \n\n\n\n0.247 <0.05 \n\n\n\nCompliance 0.223 <0.05 \n\n\n\nCounseling on medication before 0.193 <0.05 \n\n\n\nCounseling on lifestyle modification \n\n\n\nbefore \n\n\n\n0.066 <0.05 \n\n\n\nExercise 0.050 <0.05 \n\n\n\nDietary Control 0.125 <0.05 \n\n\n\nSmoking -0.247 NS \n\n\n\nAlternative medications -0.049 NS \n\n\n\n\n\n\n\nP<0.05 \u2013 Significant \n\n\n\nNS \u2013 Non-significant  \n\n\n\n\n\n\n\nStudy also showed that better \n\n\n\nmedication compliance produced \n\n\n\nbetter glycaemic control. This result \n\n\n\nwas parallel with the findings from \n\n\n\nDuff EM; O'Connor A and friends \n\n\n\nstating that there was an inverse \n\n\n\nrelationship between self-care scores \n\n\n\nand HbA1c% (6).  In Duff\u2019s study, \n\n\n\nself-care practices included weight \n\n\n\ncontrol, exercise and medication \n\n\n\ncompliance.  \n\n\n\n\n\n\n\nLifestyle modifications including \n\n\n\nroutine exercise and dietary control \n\n\n\nappeared to influence the fasting \n\n\n\nblood glucose level positively. \n\n\n\nPatients who practiced lifestyle \n\n\n\nmodifications were found to have \n\n\n\nbetter glycaemic control. The \n\n\n\nparallel results was demonstrated by \n\n\n\nSone H ; Katagiri A and friends who \n\n\n\nconcluded that lifestyle modification \n\n\n\nhad a small but significant \n\n\n\nimproving effect on glycaemic \n\n\n\ncontrol (7). \n\n\n\n\n\n\n\nIn addition, this study found that the \n\n\n\nrelationship between counseling \n\n\n\ngiven before and the extent of \n\n\n\nglycaemic control. It was found that \n\n\n\npatients who had been counseled \n\n\n\nbefore whether on lifestyle \n\n\n\nmodifications or medications or both \n\n\n\npresented with better blood glucose \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n265 \n\n\n\ncontrol. This finding was \n\n\n\ncorresponded to the finding by \n\n\n\nKirk A and friends.(8) The \n\n\n\nresearchers concluded that physical \n\n\n\nactivity counseling was effective in \n\n\n\npromoting physical activity in \n\n\n\npeople with Type 2 diabetes. The \n\n\n\ncounseling improved glycaemic \n\n\n\ncontrol in these patients. One of the \n\n\n\nproblems highlighted here is that \n\n\n\nonly a minority of the population has \n\n\n\nbeen counseled before and has \n\n\n\nsufficient knowledge about the \n\n\n\ndisease and medications taken. \n\n\n\nCounseling will help patients \n\n\n\nunderstand the management of \n\n\n\ndiabetes better and therefore, \n\n\n\nimprove the compliance and \n\n\n\nglycemic control.  \n\n\n\n\n\n\n\nIt was found that no significant \n\n\n\ncorrelation between smoking and \n\n\n\nfasting blood glucose levels. In other \n\n\n\nwords, there was no significant \n\n\n\ndifference in glycaemic control \n\n\n\nbetween smoker and non-smoker. \n\n\n\nHowever the expectation that non-\n\n\n\nsmokers would have better blood \n\n\n\nglucose control, can not be \n\n\n\nconfirmed in this study due to the \n\n\n\nlimitation in sample size. Only 4 out \n\n\n\nof 29 in the study population were \n\n\n\nsmokers.  \n\n\n\n\n\n\n\nThe study also failed to demonstrate \n\n\n\nany correlation between the \n\n\n\nconsumption of alternative \n\n\n\nmedications and the fasting blood \n\n\n\nglucose level. About half of the \n\n\n\nstudy populations (41.4%) were \n\n\n\ntaking alternative medicines \n\n\n\nconcurrently with oral \n\n\n\nhypoglycaemic agents with the \n\n\n\nbeliefs that the alternative \n\n\n\napproaches will aid in their \n\n\n\nglycaemic control. Akar kayu, \n\n\n\npegaga and traditional medicines \n\n\n\nwere among those taken by these \n\n\n\npatients. The beliefs that the \n\n\n\nconsumption of alternative \n\n\n\nmedication helps in the management \n\n\n\nof glycaemic control, however, was \n\n\n\nnot confirmed in this study. The role \n\n\n\nof alternative medicines in diabetes \n\n\n\ncontrol is still under investigation. \n\n\n\nNot much established clinical data is \n\n\n\navailable for alternative medicines \n\n\n\nuse. Larger-scale and more \n\n\n\ncomprehensive study on the use of \n\n\n\nalternative medicines in diabetes \n\n\n\nmanagement should be carried out in \n\n\n\nthe future.  \n\n\n\n\n\n\n\nThis study managed to demonstrate \n\n\n\nsome significant results but the \n\n\n\ncorrelations were not that impressive \n\n\n\n(correlation coefficient values were \n\n\n\nsmall). Diabetes is a progressive \n\n\n\ncondition in which \u03b2-cell function \n\n\n\ndeteriorates with increasing duration \n\n\n\nof diabetes. Stepwise therapy with \n\n\n\nmultiple pharmacological therapies, \n\n\n\ntherefore, is often needed over time \n\n\n\nto maintain target glucose control. \n\n\n\nIntermittent uncontrolled blood \n\n\n\nglucose level is not a definite \n\n\n\nindicator for poor diabetic control. It \n\n\n\nmight just reflect a further \n\n\n\nprogression of the disease and a \n\n\n\nmore aggressive treatment is needed. \n\n\n\nImproving patients\u2019 factors, of \n\n\n\ncourse, will slow down the disease \n\n\n\nprogression but persistent good \n\n\n\nglycaemic control requires a \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n266 \n\n\n\ncombination of many factors. In this \n\n\n\nstudy, the analysis only involved the \n\n\n\ncorrelation between each single \n\n\n\nvariable with blood glucose level. \n\n\n\n\n\n\n\nLimitation of the study \n\n\n\n\n\n\n\nThe study has several limitations \n\n\n\nsuch as small sample size (N=29) \n\n\n\nand the finding does not reflect the \n\n\n\noverall situation in the diabetes \n\n\n\npopulation. Secondly, most of the \n\n\n\ndata were gathered though verbal \n\n\n\ncommunications with patients \n\n\n\n(compliance, alternative \n\n\n\nmedications, understanding about \n\n\n\nmedications given, previous \n\n\n\ncounseling history and \n\n\n\ncomplications). This technique is \n\n\n\nprone to possibility of incomplete or \n\n\n\nbias data. Thirdly, the study uses an \n\n\n\naverage of 2 readings of fasting \n\n\n\nblood glucose that were taken within \n\n\n\n3 months. Few readings within short \n\n\n\nperiod of time-frame might influence \n\n\n\nthe average of blood glucose value. \n\n\n\nFinally the study does not use \n\n\n\nHbA1c level although HbA1c is a \n\n\n\nbetter indicator of glycaemic control.  \n\n\n\nHbA1c is not routinely done at the \n\n\n\nstudied hospital.  \n\n\n\n\n\n\n\nRecommendation \n\n\n\n\n\n\n\nEducation and counseling on \n\n\n\nmedications and lifestyle \n\n\n\nmodifications should be initiated at \n\n\n\ndiagnosis stage and reinforced \n\n\n\nregularly.  Group counseling can be \n\n\n\nconducted from time to time and \n\n\n\npatients are highly encouraged to \n\n\n\nparticipate in group counseling. \n\n\n\nThrough group counseling, patients \n\n\n\ncan share their problems in daily \n\n\n\ndiabetes management, understand \n\n\n\nmore about the disease and be able \n\n\n\nto manage the disease better.  \n\n\n\n\n\n\n\nFurther study using larger population \n\n\n\ncan be conducted to survey the effect \n\n\n\nof a combination of multiple factors \n\n\n\nin diabetic control. Future study is \n\n\n\nrecommended to use HbA1c level as \n\n\n\nefficacy parameter for a more \n\n\n\nreliable result.  \n\n\n\n\n\n\n\nReferences. \n\n\n\n\n\n\n\n1. Wild S, Roglic G, Green A, \n\n\n\nSicree R, King H. Global \n\n\n\nprevalence of diabetes: estimates \n\n\n\nfor the year 2000 and projections \n\n\n\nfor 2030. Diabetes Care \n\n\n\n2004;27:1047-53. \n\n\n\n2. National Health & Morbidity \n\n\n\nSurvey 2, 1996. \n\n\n\n3. American Diabetes Association. \n\n\n\nStandards of medical care in \n\n\n\ndiabetes. Diabetes Care \n\n\n\n2006;29:S4-42 \n\n\n\n4. Mary Anne Koda-Kimble, Lloyd \n\n\n\nYee Young, Wayne A.Kradjan & \n\n\n\nB.Joseph, Applied Therapeutics: \n\n\n\nThe Clinical Use of Drugs, 7\nth\n\n\n\n\n\n\n\nEdition, 2001, Lippincott \n\n\n\nWilliams & Wilkins. \n\n\n\n5. Ministry of Health Malaysia, \n\n\n\nPersatuan Diabetes Malaysia, \n\n\n\nAcademy of Medicine. Clinical \n\n\n\nPractice Guidelines \u2013 \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol.1 Issue 6, 2008                                              Research Article \n\n\n\n267 \n\n\n\nManagement of Type 2 Diabetes \n\n\n\nMellitus, Third edition, 2004.  \n\n\n\n6. Duff EM; O'Connor A; \n\n\n\nMcFarlane-Anderson N; \n\n\n\nWint YB; Bailey EY; Wright-\n\n\n\nPascoe RA, The University of \n\n\n\nthe West Indies School of \n\n\n\nNursing, Mona, Kingston 7, \n\n\n\nJamaica, Self-care, compliance \n\n\n\nand glycaemic control in \n\n\n\nJamaican adults with diabetes \n\n\n\nmellitus, 2006. \n\n\n\n7. Sone H; Katagiri A; Ishibashi S; \n\n\n\nAbe R; Saito Y; Murase T; Yam\n\n\n\nashita H; YajimaY; Ito H; Ohash\n\n\n\ni Y; Akanuma Y; Yamada N;  Ef\n\n\n\nfects of lifestyle modifications \n\n\n\non patients with type 2 diabetes: \n\n\n\nthe Japan Diabetes \n\n\n\nComplications Study (JDCS) \n\n\n\nstudy design, baseline analysis \n\n\n\nand three year-interim report, \n\n\n\n2002 \n\n\n\n8. Kirk A ; Mutrie N ; MacIntyre P \n\n\n\n; Fisher M, Centre for Exercise \n\n\n\nScience and Medicine, \n\n\n\nUniversity of Glasgow, Scotland. \n\n\n\nEffects of a 12-month physical \n\n\n\nactivity counselling intervention \n\n\n\non glycaemic control and on the \n\n\n\nstatus of cardiovascular risk \n\n\n\nfactors in people with Type 2 \n\n\n\ndiabetes, 2004 \n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nSUPPLEMENT \n \n\n\n\n \nProceedings Of The  \nMPS-Pharmacy Scientific Conference 2006 \n\n\n\n\n\n\n\nLifelong Learning in Pharmacy \n \n\n\n\n8-10 September 2006 \n\n\n\nCrown Princess Hotel, Kuala Lumpur \n\n\n\n\n\n\n\nJointly organised by the Malaysian Pharmaceutical Society (MPS), Department of \n\n\n\nPharmacy University Malaya and the Pharmaceutical Services Division of the \n\n\n\nMinistry of Health, Malaysia \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nTable of Contents \n\n\n\n\n\n\n\n\n\n\n\nNumber Presenter Title \n\n\n\nS95 Andrew P Morris Community Pharmacy & Clinical Governance: A \n\n\n\nSnapshot From The UK  \n\n\n\nS95 Lim Yik Ming Public Knowledge And Opinion Of The Role Of \n\n\n\nPharmacist And Source Of Drug Information  \n\n\n\nS96 Wan Sazrina Wan \n\n\n\nZaid  \n\n\n\nThe Effects Of Length Of Practice And Job Position On \n\n\n\nEthical Compliance Among Community Pharmacists In \n\n\n\nMalaysia \n\n\n\nS96 N A Mohd Said A Cross-Sectional Survey Of Herbal Medicines Use By \n\n\n\nResidents Of Puchong, Selangor \n\n\n\nS97 Ruwaida Nur \n\n\n\nZainol Abidin \n\n\n\nFluoxetine Versus Tricyclic Antidepressants For \n\n\n\nDepressive Disorders: A Systematic Review \n\n\n\nS97 Chua Siew Siang Public\u2019s Perception On The Implementation Of \n\n\n\nDispensing Separation In Malaysia \n\n\n\nS98 Che Zuraini \n\n\n\nSulaiman \n\n\n\nPrescribing Errors Detected In The Inpatient Pharmacy Of  \n\n\n\nA Teaching Hospital \n\n\n\nS98 Faizah Safina \n\n\n\nBakrin \n\n\n\nA Preliminary Report On Public Quit Smoking Clinic In \n\n\n\nMalaysia \n\n\n\nS99 Yip Wai Man Malaysian Pharmacists\u2019 Attitude Towards Dispensing \n\n\n\nSeparation (SPD) \n\n\n\nS99 Hong Chee Meng The Opinion And Knowledge Of Malaysian Public \n\n\n\nTowards Dispensing Separation \n\n\n\nS100 Rommel Irwan \n\n\n\nRomlee \n\n\n\nConsultation Of Community Pharmacists on Minor Health \n\n\n\nProblems. \n\n\n\nS100 Riyadh Al Batani Evaluation Of The Total Parenteral Nutrition Services At \n\n\n\nUniversiti Sains Malaysia Hospital \n\n\n\nS101 Siti Hadijah Bt \n\n\n\nShamsudin \n\n\n\nVulnerability To Corruption At Critical Decision Points \n\n\n\nOf The Pharmaceutical System in Malaysia. \n\n\n\n\n\n\n\nS101 Ng Yean Joo Review Of The Use Or Misuse Of Drug Therapy In \n\n\n\nPaediatric Patients Prior TO Admission For Acute \n\n\n\nGastroenteritis TO University Malaya Medical Centre \n\n\n\n\n\n\n\nS102 Kong Sing Teang Attainment Of Target LDL-C Levels By Patients \n\n\n\nReceiving HMG Co-A Reductase Inhibitors. \n\n\n\n\n\n\n\n\n\n\n\n\nS102 Low Jen Sen Use Of Surgical Antimicrobial Prophylaxis In A Tertiary \n\n\n\nCare Hospital \n\n\n\nS103 Abdulwahab \n\n\n\nAtfah  \n\n\n\nA Case Report On A Patient with disseminated \n\n\n\nIntravascular Coagulant And Profused Bleeding \n\n\n\nFollowing Septic Abortion \n\n\n\nS103 Chan Sook Wan Acute Paracetamol Overdose In Hospital Kulim: \n\n\n\nPresentation, Management And Outcome \n\n\n\nS104 Chew Shiu Wei Therapeutic INR Control Of Patients On Warfarin In \n\n\n\nKulim Hospital \n\n\n\nS104 Nur Hidayah Kaz \n\n\n\nBt Abdul Aziz \n\n\n\nAssessment On Effect Of Hypoalbuminemia On \n\n\n\nPhenytoin Serum Concentration In Intensive Care And \n\n\n\nMedical Patients Of Penang General Hospital \n\n\n\nS105 Chew Lan Sim Patients\u2019 Knowledge On Warfarin Therapy At The \n\n\n\nWarfarin Clinic, Hospital Teluk Intan \n\n\n\nS105 Chow Su Wen   A Comparison Between Beta-Blockers Only & Beta-\n\n\n\nBlockers +Diuterics as First-Line Antihypertensives In \n\n\n\nHospital Alor Star \n\n\n\nS106 Erwany Md Dewa Review And Assesment Of Therapeutic Drug Monitoring \n\n\n\nOf Digoxin among Inpatients In Hospital Melaka \n\n\n\nS106 Mardhiah \n\n\n\nAmiruddin \n\n\n\nOnce-Daily Dosing Of Aminoglycosides: Review and \n\n\n\nRecommendations For Clinical Practice \n\n\n\nS107 Abul Hasnat  A Bioavailability And Pharmacokinetic Study Of Two \n\n\n\nOral Formulations Of Ciprofloxacin 250 MG Tablets In \n\n\n\nHealthy Male Volunteers. \n\n\n\nS107 Fathihah Bt Basri Effect Of Losartan On Renal Haemodynamics Of Rats \n\n\n\nWith Hypertension \n\n\n\nS108 Fathihah Bt Basri Effect Of Losartan On Renal Haemodynamics Of \n\n\n\nSpontaneously Hypertensive Rats With Nephrotoxic \n\n\n\nRenal Failure \n\n\n\nS108 Raisa Nazir \n\n\n\nAhmad \n\n\n\nEffect of High Salt Load in the Normotensive WKY Rats \n\n\n\nS109 Tan Bee Ling The Attitude of Malaysian Pharmacists Towards \n\n\n\nContinuing Professional Development (CPD) \n\n\n\nS109 Kuan Wai Hong  The Knowledge & Attitude Of UKM Pharmacy Students \n\n\n\nOn Pharmacy Profession \n\n\n\nS110 Subashini G  Perceptions Of Pharmacy Students On Pharmaceutical \n\n\n\nCare \n\n\n\nS110 Nashiru Billa Effects Of Granulating Fluids And Hardness On \n\n\n\nDiclofenac Release From Colon-Targeted Polymer \n\n\n\nMatrices \n\n\n\n\n\n\n\n\n\n\n\n\nS111 Leong Kok \n\n\n\nHoong \n\n\n\nOptimizing Excipient Mixtures By Mathematical \n\n\n\nModelling In Formulating A Sustained-Release \n\n\n\nTheophylline Tablet \n\n\n\nS111 Ahmed Mohamed \n\n\n\nOthman \n\n\n\nDevelopment And Evaluation Of Controlled Release \n\n\n\nFloating Dosage Forms Of Famotidine \n\n\n\nS112 NurJannah Bt \n\n\n\nMohamad \n\n\n\nHussain \n\n\n\nCytoprotective Effects Of Honey Alone Or In \n\n\n\nCombination With Aqueous And Ethanol Extracts From \n\n\n\nChromolaena odorata L. In Reducing Gastric Lesions \n\n\n\nS112 Aidiahmad Dewa Intrarenal Haemodynamic Regulation In Diabetes: Role \n\n\n\nOf Sympathetic And Renin-Angiotensin Systems \n\n\n\nS113 Zaheer Ud Din \n\n\n\nBabar \n\n\n\nEvaluating Medicine Prices, Availability, Affordability \n\n\n\nAnd Price Components In Malaysia \n\n\n\nS113 Faridah Aryani \n\n\n\nMd.Yusof \n\n\n\nCost Utility Analysis Of The Ministry Of Health Dialysis \n\n\n\nProgramme \n\n\n\nS114 Hassan Pyar Ali Evaluation Of The Cultivation Condition For Enhancing \n\n\n\nThe Growth Of Lactobacillus acidophilus \n\n\n\nS114 Mohamed Haniki \n\n\n\nNik Mohamed \n\n\n\nCost-Effectiveness Of Medications For Smoking \n\n\n\nCessation \n\n\n\nS115 R Malini Causes of Drug Administration Errors In Medical Wards \n\n\n\nS115 S A Mortazavi A Consumption Pattern Survey Of Antibiotics In A Large \n\n\n\nTeaching Hospital In Tehran \n\n\n\nS116 N A Ramli  Assessment Of Undergraduate Community Pharmacy \n\n\n\nAttachment Programme \n\n\n\nS116 R Wati OTC-Steroids In Community Pharmacy \n\n\n\nS117 D C M Kong Knowledge And Perceptions Of Recent Pharmacy \n\n\n\nGraduates About Generic Medicines \n\n\n\nS117 P Lai A Retrospective Study Of Adverse Drug Reactions \n\n\n\nAttributed To The Use Of Simvastatin In A Tertiary \n\n\n\nHospital \n\n\n\nS118 I Abdul Wahab Assessment On Pre-Degree Pharmacy Students\u2019 Interest \n\n\n\nIn Pharmacy \n\n\n\nS118 S W Yeong Basic Health Knowledge Of A Sample Of The Malaysian \n\n\n\nUrban Population \n\n\n\nS119 Mahmathi \n\n\n\nKaruppannan \n\n\n\nRational Use Of Antibiotics Among Pharmacy Students \n\n\n\nS119 Samsinah H Asthma Care Before And After Hospitalization: Potential \n\n\n\nRole For Pharmacists Intervention \n\n\n\nS120 H Mehrgan Antimicrobial Susceptibility Pattern Of The Uncommonly \n\n\n\nIsolated Burkholderia cepacia Strains \n\n\n\n\n\n\n\n\n\n\n\n\nS120 P L Lua Vital To Monitor Prescribing Practices: A Case Report On \n\n\n\nPrescribing Error In A Malaysian Community Clinic \n\n\n\nS121 H G Lee Evaluation Study On Patients Taking Antiretroviral \n\n\n\nDrugs: Efficacy, Side Effects And Compliance Issues \n\n\n\nS121 Feras Jassim \n\n\n\nJirjees \n\n\n\nIs Diuretic Therapy Inappropriate In Ascites Patients With \n\n\n\nIneffective Intravascular Volume? A Case Report \n\n\n\nS122 M Anwar Khan Group Of Antibiotics Most Frequently Prescribed For \n\n\n\nUpper Respiratory Tract Infection In Pediatrics \n\n\n\nS122 D C M Kong Differential Protein Binding Of HIV Protease Inhibitors In \n\n\n\nMatched Umbilical Cord And Maternal Plasma \n\n\n\nS123 J S Low Cost Of Adherence And Non-Adherence To Antibiotic \n\n\n\nGuideline For Surgical Antimicrobial Prophylaxis In A \n\n\n\nTertiary Care Hospital \n\n\n\nS123 Thanimalai S An Assessment Of Empiric Antibiotic Therapy Of \n\n\n\nHospitalized Patients With Community-Acquired \n\n\n\nPneumonia \n\n\n\nS124 Mansour Adam Factors Influencing The Quality Of Life In Kidney Failure \n\n\n\nPatients \n\n\n\nS124 C L Yoong Evaluation Of Comparative Efficacy Between Generic \n\n\n\nAnd Innovator Products Of Simvastatin And Pravastatin \n\n\n\nS125 Buniyamin I Optimization Of The Dimerisation Of Stilbenes By HPLC \n\n\n\nTechnique \n\n\n\nS125 M I Noordin Determination Of Ethanol At Various Fermentation \n\n\n\nIntervals Of Traditionally Fermented Glutinous Rice And \n\n\n\nTapioca (Tapai) Using Fourier Transform Infrared \n\n\n\nSpectroscopy (FTIR) \n\n\n\nS126 M I Noordin Crystallization Kinetics Of Theobroma And A Palm \n\n\n\nKernel Oil Blend \n\n\n\nS126 C T Tee Cytotoxicity Of Some Plant Species In Sabah Rainforest \n\n\n\nS127 N Shamsuddin Use Of Complementary And Alternative Medicine (CAM) \n\n\n\nAmong Cancer Patients In The Clinical Oncology Unit Of \n\n\n\nUniversity Of Malaya Medical Centre \n\n\n\nS127 R Kalavathy Cholesterol-Reducing Activity Of Probiotics \n\n\n\nS128 R Kalavathy Acid and Bile Tolerance Of Lactic Acid Bacteria As \n\n\n\nProbiotics For Humans \n\n\n\nS128 S M Lim Antitumour Activity Of SRJ13, A New Semisynthetic \n\n\n\nDerivative Of Andrographolide In Breast Cancer Cell \n\n\n\nLines  \n\n\n\n\n\n\n\n\n\n\n\n\nS129 R Kalavathy Antitumor Activity Of Malaysian Endophytes  \n\n\n\nS129 V T G Chuang Recombinant Human Serum Albumin Dimer Has High \n\n\n\nBlood Circulation Activity And Low Vascular \n\n\n\nPermeability In Comparison With Native Human Serum \n\n\n\nAlbumin \n\n\n\nS130 N Bolourtchian The Effect Of Citric And Tartaric Acids On The Release \n\n\n\nPerformance Of A Weakly Basic Drug From Matrix \n\n\n\nTablets \n\n\n\nS130 Bohari Yaacob Characterization Of Sago Starch Derivatives (CMSS) For \n\n\n\nAqueous Pharmaceutical Film Coating Application \n\n\n\nS131 Nadia Halib Study Of Physicochemical Properties Of Gamma \n\n\n\nIrradiated Bacterial Cellulose \n\n\n\nS131 L V Kiew Attenuation Of The Degradation Of Gemcitabine In \n\n\n\nPlasma Via Polymeric Drug Conjugation \n\n\n\nS132 L V Kiew Improved Antitumour Efficiency Of Gemcitabine Via \n\n\n\nPolymeric Drug Conjugation \n\n\n\nS132 A M Othman In Vitro Evaluation Of Salbutamol Sulphate Transdermal \n\n\n\nDelivery Systems \n\n\n\nS133 Tanveer Ahmad \n\n\n\nKhan \n\n\n\nA Preliminary Investigation On The Preparation And \n\n\n\nPhysical Properties Of Chitosan Lotions \n\n\n\n \n\n\n\n\n\n\n\n\nS95 \n\n\n\nOral Presentation OPP1 (000004)  \n\n\n\n\n\n\n\n\n\n\n\nCommunity Pharmacy & Clinical Governance: A Snapshot From The UK  \n \n\n\n\nA P Morris \n\n\n\nSchool of Pharmacy, Faculty of Health and Biological Sciences, University of Nottingham Malaysia Campus, \n\n\n\nSemenyih, Selangor Darul Ehsan. \n\n\n\n\n\n\n\nClinical governance has been described as a \u2018means of delivering high quality services to patients\u2019. Although \n\n\n\na relatively new term, the processes which are described under the umbrella of clinical governance are \n\n\n\ngenerally well-established. Clinical governance is often depicted as comprising of seven \u2018pillars\u2019: risk \n\n\n\nmanagement, clinical audit, staffing and staff management, clinical effectiveness, patient and public \n\n\n\ninvolvement, use of information and continuing education and training. Community pharmacists must be \n\n\n\nfully versed with the concept of clinical governance since The Royal Pharmaceutical Society of Great Britain \n\n\n\nnow expects all pharmacists to engage in clinical governance when providing any professional service. \n\n\n\nFurthermore, UK community pharmacies, which hold a contract with the National Health Service (NHS) to \n\n\n\ndispense prescriptions have, since April 2005, been contractually required to meet minimum clinical \n\n\n\ngovernance standards. NHS organisations will visit pharmacies on an annual basis to monitor all aspects of \n\n\n\nthis new Community Pharmacy contract, including clinical governance. Local Health Boards, which are the \n\n\n\nNHS bodies responsible for local health administration in Wales, have been proactive in supporting \n\n\n\ncommunity pharmacists in this area. To date, 4 Local Health Boards have commenced using a new clinical \n\n\n\ngovernance toolkit, the Maturity MatrixTM Pharmacy, to help evaluate clinical governance within the \n\n\n\ncommunity pharmacy setting. A further 10 LHBs are committed to using this tool. The establishment of \n\n\n\nappropriate clinical governance systems will help community pharmacists build a good working \n\n\n\nenvironment for their staff, whilst simultaneously facilitating the provision of high quality services that will \n\n\n\nbenefit their patients and contribute to business growth. \n\n\n\n\n\n\n\n\n\n\n\nOral Presentation OPP2 (000019) \n\n\n\n\n\n\n\nPublic Knowledge And Opinion Of The Role Of Pharmacist And Source Of Drug Information  \n \n\n\n\nY M Lim1, V T G Chuang1,2  \n1Department of Pharmacy, Faculty of Allied Health Sciences, Universiti Kebangsaan Malaysia, Kuala \n\n\n\nLumpur, Malaysia; 2The School of Pharmacy, Faculty of Medical & Health Sciences, The University of \n\n\n\nAuckland, Auckland, New Zealand \n\n\n\n\n\n\n\nThis study was carried out to study public\u2019s preference sources of medication information, their awareness of \n\n\n\nthe importance of medical information with regards to medical safety and their perception on the role of \n\n\n\npharmacists. An interviewer-administered structured questionnaire was used to interview 459 members of \n\n\n\nthe public (45.3% male, 54.7% female). 79.7% of the respondents indicated that health care professional was \n\n\n\nthe main source of medical information, followed by internet (32.0%). People aged 40 and below was more \n\n\n\nlikely to obtain information from internet (P=0.013). The public relies more on doctors than pharmacists in \n\n\n\ngetting information about medicines in prescriptions, alternative drugs and counseling on drug \n\n\n\nadministration. In contrast, pharmacist was an important source of information about drug prices and herbal \n\n\n\nproducts. The public is concerned with the indication of medicine (95.4%), how (94.1%) and when (92.2%) \n\n\n\nto take the medicine. The main barrier in getting medicine information was due to the lack of awareness of \n\n\n\none\u2019s right in doing so. Majority of the respondents (55.6%) visited a pharmacy less than once a month with \n\n\n\nthe purpose to buy toiletries, cosmetics and supplements (58.4%). Generally, pharmacist is a profession that \n\n\n\nis highly recognised but underutilised by the public. Although the respondents are aware of the role of \n\n\n\npharmacists as a drug expert, they tend to go to doctors to seek medication advice. The public has vague \n\n\n\nperception on the extended role of pharmacist and distinction between pharmacist and pharmacist assistant. \n\n\n\nThis highlighted the need of public education on pharmacy profession. \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nS96 \n\n\n\nOral Presentation OPP3 (000043) \n\n\n\n\n\n\n\nThe Effects Of Length Of Practice And Job Position On Ethical Compliance Among Community \n\n\n\nPharmacists In Malaysia \n\n\n\n\n\n\n\nW Z W Sazrina, A B A Majeed and P L Lua  \nFaculty of Pharmacy, Universiti Teknologi MARA, Shah Alam, Selangor \n\n\n\n\n\n\n\nBeing both a professional and a businessperson simultaneously may place community pharmacists in a \n\n\n\ndifficult situation as the priority between professionalism and business profit need to be delicately balanced. \n\n\n\nThis study aims to compare the level of ethical compliance in community pharmacists possessing different \n\n\n\nlengths of practice and job positions. A specific pharmacoethics instrument was sent to all 1,493 registered \n\n\n\ncommunity pharmacists in Malaysia. The ethical dimensions investigated include: Business Practice, Ethical \n\n\n\nPractice, Professional Practice and Personal Attitude. Data was analysed using SPSS whereby one-way \n\n\n\nANOVA with post-hoc comparisons was employed. A total of 210 respondents completed the instrument \n\n\n\n(majority age-range = 31-40 years; male = 86; length of practice: 1-5years = 76, 6-10years = 67, 11-15years \n\n\n\n= 46, 16-20years = 12, >20years = 9; positions held: Pharmacist Only = 53, Pharmacist-cum-Manager = 29, \n\n\n\nPharmacist-cum-Owner = 128). In terms of length-of-practice, no significant difference was demonstrated \n\n\n\nin all the pharmacoethics dimensions (p>0.05). However, Pharmacist-cum-Owner exhibited significantly \n\n\n\nlower mean scores for Ethical Practice (p=0.040) and Personal Attitude (p=0.023) compared to Pharmacist-\n\n\n\ncum-Manager. In all dimensions, Pharmacist-cum-Owner consistently showed the lowest mean scores \n\n\n\ncompared to the rest. These findings seemed to suggest that job positions do affect pharmacists\u2019 ethical \n\n\n\ncompliance particularly in their Ethical Practice and Personal Attitude aspects. Consequently, future \n\n\n\ncompulsory and structured ethical reinforcement trainings/programmes must be introduced especially for \n\n\n\npharmacists involved in their own pharmacy management. This serves to improve the level of ethical \n\n\n\ncompliance and to ensure that professionalism is never compromised in place of business priorities. \n\n\n\n\n\n\n\n\n\n\n\nOral Presentation OPP4 (000063) \n\n\n\n\n\n\n\n\n\n\n\nA Cross-Sectional Survey Of Herbal Medicines Use By Residents Of Puchong, Selangor \n \n\n\n\nN A Mohd Said, Z Aziz \n\n\n\nDepartment of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur \n\n\n\n\n\n\n\nDespite substantial growth in the use of traditional medicine which includes herbal medicines (HM) in \n\n\n\nMalaysia, there is still limited data on its use. This study aimed to examine the prevalence and types of HM \n\n\n\nused and the reasons for their use. Face-to-face interview of convenient sample of 400 residents in Puchong, \n\n\n\nSelangor using a structured questionnaire was conducted. The questionnaire identified whether respondents \n\n\n\nhad taken HM during the previous year, the identity of the products taken if any, their reasons for taking HM, \n\n\n\ntheir opinions on the safety and quality of HM and general demographic information. Approximately 20% of \n\n\n\nrespondents reported taking a HM of some kind within the previous year. Chinese HM was the most \n\n\n\nfrequently reported HM used at 36%, followed by Malay HM at 30%. The most frequently reported reason \n\n\n\nfor HM intake was for general health, followed by hypertension, diabetes and arthritis. Most respondents \n\n\n\n(70%) who used HM did not inform their doctors about their HM use and about 40% of the users obtained \n\n\n\ntheir information on HM from traditional practitioners. HM users were significantly more likely than non-\n\n\n\nusers to agree that HM were adequately tested for safety (\u03c72 = 8.65, p = 0.003) and quality (\u03c72 = 11.89, p = \n\n\n\n0.001). In conclusion, this survey provides insight into the nature of HM usage in an urban Malaysian \n\n\n\npopulation. As this study revealed high prevalence of HM usage, healthcare providers should consider this \n\n\n\nissue in discussions with patients. \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nS97 \n\n\n\nOral Presentation OPP5 (000064) \n\n\n\n\n\n\n\nFluoxetine Versus Tricyclic Antidepressants For Depressive Disorders: A Systematic Review  \n \n\n\n\nR N Zainol Abidin, Z Aziz \n\n\n\nDepartment of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur \n\n\n\n\n\n\n\nThe selective serotonin reuptake inhibitors (SSRI) antidepressants have been reported to be better tolerated \n\n\n\nthan the older tricyclic antidepressants. This review compares the efficacy of fluoxetine with tricyclic \n\n\n\nantidepressant namely imipramine and amitriptyline. The search strategy included a search of (a) Electronic \n\n\n\nbibliographic databases (MEDLINE, EMBASE); (b) reference lists of related reviews (c) reference lists of \n\n\n\nall located studies (d) the Cochrane Group register of controlled trials. Randomised controlled trials \n\n\n\ncomparing fluoxetine with either imipramine or amitriptyline in the treatment of patients with depressive \n\n\n\ndisorders were selected. The outcome measure assessed was improvement in Hamilton Depression Rating \n\n\n\nscores. Effect size from seven trials which compared fluoxetine with amitriptyline was extracted and pooled. \n\n\n\nSimilarly, effect size was pooled from nine trials which compared fluoxetine with imipramine. Since there \n\n\n\nwas evidence of heterogeneity of treatment effects,  random effects model was  used  for  data  pooling. The \n\n\n\npooled effect size was 0.141 (95% CI -0.119 to 0.401) for studies comparing fluoxetine with amitriptyline \n\n\n\nand 0.068 (95% CI -0.224 to 0.361) for studies comparing fluoxetine with imipramine. There was no \n\n\n\nsignificant difference in effectiveness between fluoxetine and amitriptyline or between fluoxetine and \n\n\n\nimipramine. As such, treatment decisions on these agents need to be based on considerations of their cost \n\n\n\nand relative patient acceptability. \n\n\n\n\n\n\n\n\n\n\n\nOral Presentation OPP6 (000070) \n\n\n\n\n\n\n\n\n\n\n\nPublic\u2019s Perception On The Implementation Of Dispensing Separation In Malaysia  \n  \n\n\n\nS S Chua, S H Chuo, P C Foo  \n\n\n\nDepartment of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur \n\n\n\n\n\n\n\nThe main beneficiary in the implementation of dispensing separation in Malaysia should be the general \n\n\n\npublic. Therefore, the study was conducted to assess the general public\u2018s perception of dispensing separation \n\n\n\nin Malaysia. A descriptive cross sectional study was conducted via personal interview using a structured \n\n\n\nquestionnaire in the Klang Valley and in Sibu. The general public\u2019s perception of dispensing separation was \n\n\n\nassessed using 10 items with a 5-point Likert scale and this was validated in two pilot studies. The Cronbach \n\n\n\nalpha values improved from 0.592 to 0.943 between the first and second pilot studies. Of the 525 \n\n\n\nrespondents in the Klang Valley, 43% felt that dispensing separation would be a good practice in Malaysia \n\n\n\nwhile 32.6% disagreed and 24.4% were not sure. Similarly, of the 400 respondents in Sibu, 43.3% were \n\n\n\nsupportive, 41.5% disagreed and 15.2% were not sure. The median scores obtained in the Klang Valley and \n\n\n\nin Sibu were 31 and 30, respectively. This implies that generally the respondents were neutral towards \n\n\n\ndispensing separation. Respondents felt that since two professionals would be involved, less mistakes would \n\n\n\noccur and doctors would be more careful as the pharmacist would be checking the medicines given. \n\n\n\nHowever, the main concerns were difficulty in finding a pharmacist at night and inconvenience. Respondents \n\n\n\nwith higher education, professional jobs, higher household incomes and greater familiarity with the work of \n\n\n\ncommunity pharmacists, were more likely to favour dispensing separation. More exposure of the general \n\n\n\npublic to the roles of community pharmacists and the consequences of dispensing separation would better \n\n\n\nprepare Malaysians for its implementation. \n\n\n\n\n\n\n\n\nS98 \n\n\n\nOral Presentation OPP7 (000073) \n\n\n\n\n\n\n\n\n\n\n\nPrescribing Errors Detected In The Inpatient Pharmacy Of A Teaching Hospital \n  \n\n\n\nL F Lau1, S S Chua1, C Z Sulaiman2 \n1Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur; 2Inpatient Pharmacy \n\n\n\nUnit, University Malaya Medical Centre, Kuala Lumpur \n\n\n\n\n\n\n\nPrescribing errors are the most common type of medication errors and cause of preventable adverse drug \n\n\n\nevents. A prospective direct observational study was conducted to determine the extent and types of \n\n\n\nprescribing errors detected in an inpatient pharmacy. The study was conducted over 20 consecutive \n\n\n\nweekdays and the types of prescribing errors, interventions to resolve the problematic prescriptions and \n\n\n\noutcome of the interventions were documented in a data collection form. Convenience sampling was used to \n\n\n\nselect prescriptions received by the pharmacy during the study period. From a total of 2086 prescriptions \n\n\n\nsampled, 1723 prescribing errors (83 errors per 100 prescriptions) were recorded. These included 1396 \n\n\n\n(81.0%) errors of omission and 327 (19.0%) errors of commission. The most common errors were absence of \n\n\n\ndate on the prescription (51.1%), double prescriptions (10.2%) and missing patient data (8.0%). Drugs \n\n\n\ncommonly associated with prescribing errors were ciprofloxacin, pantoprazole and ranitidine. Most of the \n\n\n\nerrors detected were classified as probably clinically insignificant (70.3%) while 0.2% was considered as \n\n\n\npotentially life-threatening. A total of 26.6 hours were spent to resolve 499 prescriptions (23.9%) with \n\n\n\nproblems. The main outcome of the interventions was the prescription was clarified, dispensed or not \n\n\n\ndispensed. The results of this study demonstrate that prescribing errors are common and although a small \n\n\n\nproportion may be of clinical significance, these are preventable and hence, measures should be taken to \n\n\n\nprevent the occurrence of such errors. \n\n\n\n\n\n\n\n\n\n\n\nOral Presentation OPP8 (000076) \n\n\n\n\n\n\n\n\n\n\n\nA Preliminary Report On Public Quit Smoking Clinic In Malaysia \n\n\n\n\n\n\n\nFaizah Safina Bakrin1, Rahmat Awang2, Sallehudin Abu Bakar3, Mohamad Haniki Nik Mohamed4 \n1Department of Pharmacy, Faculty of Medicine, Universiti Malaya, Kuala Lumpur; 2National Poison Centre, \n\n\n\nUniversiti Sains Malaysia, Minden, Penang; 3Kuala Lumpur Federal Territory Health Department, Jalan \n\n\n\nCenderasari, Kuala Lumpur; 4Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan, \n\n\n\nPahang Darul Makmur \n\n\n\n\n\n\n\nAccording to the statistics from the Malaysia Health Ministry for the year 2000, 54.6% of adult men and 5% \n\n\n\nof adult women were smokers. A few of these smokers had tried or were willing to quit smoking. Since 1998, \n\n\n\nthe smoking cessation program (SCP) was initiated at more than 200 Quit Smoking Clinics (QSC) \n\n\n\nthroughout the country.  The aim of this study was to examine the activities and facilities in these clinics. \n\n\n\nThe study was carried out in two phases. In the first phase, a natural observational study was conducted at \n\n\n\nthe Respiratory Medical Institute Kuala Lumpur. In the second phase, a brief cross sectional telephone \n\n\n\nsurvey was conducted using convenience sampling with one representative of QSC from every district in \n\n\n\nMalaysia. Out of the 294 QSC identified, 173 was still actively practicing SCP while 106 was no longer \n\n\n\npracticing SCP. Another 15 SCP was not contactable. Out of 173 active QSC, 78 was chosen for the \n\n\n\ntelephone survey. A total of 200 counselors were identified in these QSC and the majority of these \n\n\n\ncounselors were Medical Officers. Only two were pharmacists. The majority (90%) of these QSC were \n\n\n\nsupplying their clients\u2019 nicotine replacement therapy. Further work will be carried out to evaluate the success \n\n\n\nof the smoking cessation program. \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nS99 \n\n\n\nOral Presentation OPP9 (000022) \n\n\n\n\n\n\n\n\n\n\n\nMalaysian Pharmacists\u2019 Attitude Towards Dispensing Separation (SPD) \n \n\n\n\nW M Yip1, V T G Chuang1,2 \n\n\n\n \n1Department of Pharmacy, Faculty of Allied Health Sciences, Universiti Kebangsaan Malaysia, Kuala \n\n\n\nLumpur, Malaysia; 2The School of Pharmacy, Faculty of Medical & Health Sciences, The University of \n\n\n\nAuckland, Auckland, New Zealand \n\n\n\n\n\n\n\nThis descriptive study was conducted by sending self-administered questionnaires to pharmacists from all \n\n\n\nstates in Malaysia which were selected randomly. The survey aims to assess the level of support from \n\n\n\npharmacists on SPD, and to find out and compare the community pharmacies\u2019 preparation for SPD. 85% of \n\n\n\nthe respondents supported or strongly supported the implementation of SPD in Malaysia, compared with \n\n\n\nonly 2% who opposed. 75% of those who opposed gave the reason that there are not enough pharmacists. \n\n\n\nThe pharmacists felt that the main advantage of SPD was that patients would get more information about \n\n\n\ntheir medicines but the main problem would be opposition by medical doctors. 58% of the respondents felt \n\n\n\nthat dispensing fees should be charged. The majority of the respondents (44%) thought that it would \n\n\n\nrequired  2 to 5 years of preparation before SPD can be implemented in Malaysia. The level of individual-\n\n\n\nowned pharmacies\u2019 and chain pharmacies\u2019 preparation for SPD were evaluated in 5 aspects. The community \n\n\n\npharmacies were well prepared in terms of pharmacists\u2019 confidence. However, the level of preparation in the \n\n\n\nother 4 aspects which include basic facilities for dispensing, changes in pharmacy practice, quality of \n\n\n\nservices and the estimated time needed by community pharmacies to get prepared before implementation of \n\n\n\nSPD, were not satisfactory. Individual-owned pharmacies were better prepared for SPD than chain \n\n\n\npharmacies. Overall, pharmacists support the implementation of SPD in this country but the level of \n\n\n\npreparation of community pharmacies were not satisfactory for the implementation of SPD in the near \n\n\n\nfuture. \n\n\n\n\n\n\n\n\n\n\n\nOral Presentation OPP10 (000023) \n\n\n\n\n\n\n\n\n\n\n\nThe Opinion And Knowledge Of Malaysian Public Towards Dispensing Separation \n \n\n\n\nC M Hong1, V T G Chuang1,2 \n1Department of Pharmacy, Faculty of Allied Health Sciences, Universiti Kebangsaan Malaysia, Kuala \n\n\n\nLumpur, Malaysia; 2 The School of Pharmacy, Faculty of Medical & Health Sciences, The University of \n\n\n\nAuckland, Auckland, New Zealand \n\n\n\n\n\n\n\nA national workshop was held in Kuala Lumpur in October 2001 to discuss the future National Medicines \n\n\n\nPolicy, where a consensus on including separation of prescribing and dispensing in the National Medicine \n\n\n\nPolicy was taken. The main objective of this questionnaire-survey was to find out the level of knowledge and \n\n\n\nopinion of the Malaysian public towards dispensing separation, and how their knowledge may affect their \n\n\n\nattitude toward this new healthcare policy. A side-assisted questionnaire survey of 410 members of the \n\n\n\ngeneral public (age >16 years old) at various places in Kuala Lumpur was conducted. The results show that \n\n\n\noverall 78 respondents (19%) strongly agree, 256 respondents (62.4%) agree, 68 respondents (16.6%) \n\n\n\ndisagree and 8 respondents (2%) very disagree that our country should implement the policy of dispensing \n\n\n\nseparation. From the correlation analysis, significant correlation was found (p<0.01) between the knowledge \n\n\n\nscore and the agreement score of the general public towards dispensing separation, but the R value was low \n\n\n\n(R2=0.059), signifying a weak correlation. The majority thought that medicine safety was the main factor \n\n\n\nand confidence in pharmacists as the second factor that drove them to support this policy. Convenience was \n\n\n\nthe main concern for those respondents. Most of them suggested relocating the pharmacy, to make it more \n\n\n\naccessible by the patients especially for those who are very sick, handicapped or elderly. As a conclusion, \n\n\n\nthe level of public\u2019s knowledge was one of the factors that affects their agreement. Public education like \n\n\n\ncampaigns and seminars are essential to increase the public awareness on this issue. \n\n\n\n\n\n\n\n\nS100 \n\n\n\n\n\n\n\nOral Presentation OPP11 (000078) \n\n\n\n\n\n\n\n\n\n\n\nConsultation Of Community Pharmacists On Minor Health Problems  \n \n\n\n\nRommel I R, S S Chua, Junaidah A \n\n\n\nDepartment of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur \n\n\n\n\n\n\n\nCommunity pharmacists play a major role in providing primary healthcare. Their roles in providing \n\n\n\nconsultations on minor ailments were assessed in this study. The study was conducted at 20 randomly \n\n\n\nselected pharmacies in the Klang Valley. Of the 813 customers who visited a pharmacy, 44% (358 \n\n\n\ncustomers) of the visits were for the purpose of buying some non-prescription medications or seeking the \n\n\n\nadvice of the pharmacist on minor health problems. These 358 respondents were interviewed using a \n\n\n\nstructured questionnaire. Respiratory tract ailments (31.0%), CNS ailments (21.3%) and skin problems \n\n\n\n(14.7%) were the most common minor ailments presented. The most common type of medication purchased \n\n\n\nwas non-steroidal anti-inflammatory drugs (17.9%), followed by products with antihistamines (15.2%) and \n\n\n\ncough preparations (7.8%). The cost of treatment ranged from RM1.80 to RM79.00 with a median at \n\n\n\nRM9.90 but a majority of the respondents (81.8%) spent less than RM20.00. More than half of the \n\n\n\nrespondents (59.5%) said that they did not receive any advice on the medication(s) purchased but 83.6% of \n\n\n\nthem claimed they already knew how to use the medications. However, 11.5% rated the pharmacy service as \n\n\n\nexcellent while another 41.9% rated it as good. In addition, 93% of the respondents said that they would seek \n\n\n\nthe advice of the pharmacist again if they had the same minor ailment. The main reasons for choosing to see \n\n\n\na pharmacist for health problems was convenience and accessibility. This study demonstrates that the general \n\n\n\npublic is gradually accepting community pharmacists as consultants for minor health problems but \n\n\n\npharmacists should play a more active role in providing adequate counselling. \n\n\n\n\n\n\n\n\n\n\n\nOral Presentation OPP12 (000069) \n\n\n\n\n\n\n\n\n\n\n\nEvaluation Of The Total Parenteral Nutrition Services At Universiti Sains Malaysia Hospital \n \n\n\n\nR A Batani, D C Abdullah, M B Bahari \n\n\n\nSchool of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia \n\n\n\n\n\n\n\nTotal Parenteral Nutrition (TPN) has been used in Universiti Sains Malaysia Hospital (USMH), Malaysia \n\n\n\nsince 1986. Unfortunately there is no published data on the cost, complications and outcome of patient \n\n\n\nreceiving TPN in USMH. The study was carried out to evaluate the cost, complications and outcome of TPN. \n\n\n\nThe data were obtained from patient medical records and was analyzed using SPSS version 11. 215 TPN \n\n\n\ncases from 2003 to 2005 were evaluated. The demographic of the TPN cases were neonates 22.8%, pediatric \n\n\n\n11.0%, adult 64.6%, male 52.6%, female 46.1%. Malay comprises of 87.4%, Chinese 6.0% and Indian 1.9%. \n\n\n\nThe average cost for TPN in neonate is RM 98 \u00b1 46, pediatric RM 210 \u00b1 121 and adult RM 398 \u00b1 103. The \n\n\n\nTPN associated complications were electrolyte complication (56.5%), metabolic complication (5.5%), renal \n\n\n\ncomplication (14.5%), liver complication (12.4%), hyperglycemia (9%), hyperlipidemia (0.7%), \n\n\n\nhypoglycemia (0.7%). 71.2% cases tolerated oral nutrition after TPN was stopped, however 1.8% of the \n\n\n\npatients in the study expired. The study showed a significant difference in the cost of TPN in each group of \n\n\n\npatients. The TPN services in Universiti Sains Malaysia hospital were associated with high TPN related \n\n\n\ncomplications and has acceptable outcome.  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nS101 \n\n\n\nOral Presentation OPP13 (000034) \n\n\n\n\n\n\n\n\n\n\n\nVulnerability To Corruption At Critical Decision Points Of The Pharmaceutical System In Malaysia \n\n\n\n\n\n\n\nS Hadijah, Majeed A B A \n\n\n\nFaculty of Pharmacy, Universiti Teknologi Mara (Uitm), Shah Alam, Selangor \n \n\n\n\nPharmaceutical system involves many different steps such as registration of drugs, selection of essential \n\n\n\ndrugs, procurement, distribution, and control of drug promotion. Studies show that certain characteristics in \n\n\n\nthe system make the systems\u2019 vulnerable to corruption. The aim of the study was to identify points in the \n\n\n\nsystems that were vulnerable to corruption and to evaluate perception of vulnerability to corruption. Face-to-\n\n\n\nface interview was conducted among both public and private sector pharmacists. Information collected was \n\n\n\nbased on 56 indicators from diagnostic tools framework of Cohen (2002) in Costa Rica (revised version). A \n\n\n\nconvenient sample of six pharmacists from each of the public and private sectors were selected. The \n\n\n\nindicators were rated according to specified criteria. An average rating was calculated for each of the \n\n\n\nquestions addressing a given decision point. Average rating had a possible range from zero to one. Sum of \n\n\n\nall the ratings of one was divided by the number of questions in a given decision point to obtain the \n\n\n\npercentage indicators. The resulting percentage was converted to a zero-to-ten scale by multiplying the \n\n\n\nresulting percentage by ten. System with an overall rating of 6.3 suggests that it is only marginally \n\n\n\nvulnerable to corruption. The findings showed that there were differences in perceptions between \n\n\n\nrespondents from the public and private sector, 7.29 and 5.81 respectively towards vulnerability to \n\n\n\ncorruption.  Selection and drug promotion were moderately vulnerable to corruption, with a relatively low \n\n\n\nrating of about 4.23 for both sectors. The registration and procurement processes received 8.11 (public) and \n\n\n\n8.53 (private), indicating that they were minimally vulnerable to corruption. \n\n\n\n\n\n\n\n\n\n\n\nOral Presentation OCP1 (000013) \n\n\n\n\n\n\n\n\n\n\n\nReview Of The Use Or Misuse Of Drug Therapy In Paediatric Patients Prior To Admission For Acute \n\n\n\nGastroenteritis To University Malaya Medical Centre \n\n\n\n\n\n\n\nY J Ng1, Y L Lo1, W S Lee2  \n1Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur; 2Department of \n\n\n\nPaediatrics, Faculty of Medicine, University of Malaya, Kuala Lumpur \n\n\n\n\n\n\n\nAcute gastroenteritis (AGE) is a common illness among children and accounts for a significant number of \n\n\n\npaediatric outpatient visits as well as hospitalisation. As such, appropriate treatment received prior to \n\n\n\nhospital admission is of utmost importance. This study was to determine the commonly used classes of drugs \n\n\n\nto treat AGE prior to hospital admission, to correlate the pre-admission treatment received with the length of \n\n\n\nstay in hospital, and to demonstrate the influence of demographic factors on pre-admission treatment. This \n\n\n\nretrospective observational study reviewed 222 AGE patients admitted to the paediatric infectious diseases \n\n\n\nward, P4 in University Malaya Medical Centre for a period of one year. One hundred and fifty four patients \n\n\n\nreceived medications prior to admission of which 143 (92.9%) patients received known classes of \n\n\n\nmedications. Antipyretic agents were the most commonly prescribed drugs in 69.2% of the cases; followed \n\n\n\nby antibiotics (38.5%), antiemetics (35.7%), oral rehydration salts (29.4%) and antidiarrhoeals (28.0%). The \n\n\n\nmean duration of stay in hospital was slightly shorter in patients who received prior medications than those \n\n\n\nwho did not (2.22 versus 2.32 days respectively). Sex and age had no influence on the type of pre-admission \n\n\n\ntreatment. This study disclosed that 70% of children admitted for AGE were treated suboptimally prior to \n\n\n\nhospital admission. Oral rehydration salts was largely under-utilised despite their proven efficacy and safety \n\n\n\nand the practice of inappropriate drug therapy remained rampant in the studied subjects. Greater effort \n\n\n\nshould be made to educate the general public in the appropriate treatment of AGE. \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nS102 \n\n\n\n\n\n\n\nOral Presentation OCP2 (000014) \n\n\n\n\n\n\n\n\n\n\n\nAttainment Of Target LDL-C Levels By Patients Receiving HMG Co-A Reductase Inhibitors \n\n\n\n\n\n\n\nS T Kong1, Y L Lo2, C T Chua3, W H Lim1, S P Wong4 \n1Pharmacy Unit, University of Malaya Medical Centre, Kuala Lumpur; 2Department of Pharmacy, Faculty of \n\n\n\nMedicine, University of Malaya, Kuala Lumpur; 3Department of Medicine, Faculty of Medicine, University \n\n\n\nof Malaya, Kuala Lumpur; 4Pharmacy Unit, Hospital Ampang, Selangor \n\n\n\n\n\n\n\nElevated low density lipoprotein cholesterol (LDL-C) level is one of the key risk factor for coronary heart \n\n\n\ndisease (CHD). Despite the proven benefits of low LDL-C levels, studies have shown that many patients \n\n\n\nwere treated sub-optimally. The objectives of this study are to determine the percentage of treated patients \n\n\n\nattaining the LDL-C target levels and the factors which might influence the attainment at a tertiary hospital. \n\n\n\nA cohort of 383 patients, with CHD or CHD risk equivalent, receiving subsidised statins was enrolled. The \n\n\n\nLDL-C target was determined following the Malaysian Clinical Practice Guidelines on Management of \n\n\n\nDyslipidaemia 2002. Data acquired were patient characteristics, lipid profiles, and the type and dosage of \n\n\n\nstatins used. Analyses were carried out using SPSS v12.0 and p values of < 0.05 were considered statistically \n\n\n\nsignificant. Eight subjects without documented post-treatment LDL-C levels were excluded. Of the 375 \n\n\n\nsubjects analysed, only 36% attained the target LDL-C of < 2.6 mmol/L. Indication of statin use has a strong \n\n\n\ninfluence on the attainment, while sex did not. In the secondary prevention group, patients of 65 years of age \n\n\n\nor above, or Chinese race were more likely to attain the target LDL-C levels. We found that the use of statins \n\n\n\nin reducing LDL-C was not optimised in UMMC. Factors such as geneticity and compliance are worth to be \n\n\n\nassessed in future research. Full implementation of the guidelines and the development of an integrated CHD \n\n\n\nprevention strategy, involving all healthcare professionals may be considered to improve the management of \n\n\n\nhypercholesterolemia. \n\n\n\n\n\n\n\nOral Presentation OCP3 (000037) \n\n\n\n\n\n\n\n\n\n\n\nUse Of Surgical Antimicrobial Prophylaxis In A Tertiary Care Hospital \n \n\n\n\nJ S Low1, R Rajasuriar1, S Hussain1, D Poopaladurai2, A C Roslani3  \n1Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur; 2Pharmacy Unit, \n\n\n\nUniversity of Malaya Medical Centre, Kuala Lumpur; 3Department of Surgery, Faculty of Medicine, \n\n\n\nUniversity of Malaya, Kuala Lumpur \n\n\n\n\n\n\n\nSurgical antimicrobial prophylaxis (SAP) has been shown to be effective in reducing postoperative surgical \n\n\n\nsite infections (SSIs). Despite well-established principles of SAP, many studies have reported inappropriate \n\n\n\nutilization of antimicrobials prior to surgery. The objectives of this study were (i) to assess the practice of \n\n\n\nSAP and its adherence to University Malaya Medical Centre (UMMC) guidelines, (ii) to assess the rates of \n\n\n\nSSIs among these patients. A retrospective review of randomly selected patients who underwent elective \n\n\n\nsurgeries (orthopaedic, general and ENT) from January to June 2005 was conducted. Data extracted from \n\n\n\nmedical records included patient demographics, co-morbidities, type of surgery and data on prophylactic \n\n\n\nantibiotic administration. The main outcomes (measured in proportions) were correct indications for SAP, \n\n\n\ncorrect choice and dose of antibiotic, appropriate timing, dosing interval and duration of SAP. These \n\n\n\nparameters were assessed based on hospital guideline recommendations. Rates of SSIs were assessed based \n\n\n\non the CDC\u2019s National Nosocomial Infections Surveillance system. Of the 304 medical records assessed, \n\n\n\nSAP was indicated in 199 (65.5%) however only 52.8% of this received prophylaxis. Adherence to \n\n\n\nparameters of antibiotic choice, dose, timing, dosing interval and duration of prophylaxis were 29.5%, \n\n\n\n95.2%, 80.2%, 76.5% and 44.1% respectively. The overall adherence rate to hospital guidelines was 32.2%. \n\n\n\nPostoperative SSIs were documented in 8.0% of patients who underwent procedures where prophylaxis was \n\n\n\nindicated. This study revealed that there is still considerable room for improvement in the overall delivery of \n\n\n\nSAP in UMMC. Efforts should be focused on streamlining the selection of antimicrobials and limiting the \n\n\n\nduration of prophylaxis postoperatively. \n\n\n\n\n\n\n\n\nS103 \n\n\n\n\n\n\n\nOral Presentation OCP4 (000038) \n\n\n\n\n\n\n\nA Case Report On A Patient with Disseminated Intravascular Coagulation And Profused Bleeding \n\n\n\nFollowing Septic Abortion \n\n\n\n\n\n\n\nAbdulwahab Atfah1, Noorizan A A1, Yahaya Hassan1, Jahizah Hassan2  \n1School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia; 2Department of \n\n\n\nAnesthesiology, Penang General Hospital, Penang, Malaysia \n\n\n\n\n\n\n\nDisseminated Intravascular Coagulation (DIC) is characterized by the widespread activation of coagulation, \n\n\n\nwhich results in the intravascular formation of fibrin and ultimately thrombotic occlusion of small and \n\n\n\nmidsize vessels. DIC lead to micro vascular and macrovascular thrombosis while consuming platelets by \n\n\n\ntrapping them in the clot. DIC may induce severe bleeding. The objective of this presentation is to discuss a \n\n\n\ncase of DIC following septic abortion. A 20-year-old Indonesian female of 5-month gestation was admitted \n\n\n\nto a general hospital following septic abortion. Subsequently she developed DIC, septicemic shock, acute \n\n\n\nrenal failure, hypoxemia and metabolic acidosis. During her hospitalization, she was given antibiotics such \n\n\n\nas IV Tazocin , IV amikacin, IV vancomycin, IV fluconazole and IV metronidazole. Other medications \n\n\n\nadministered included IV hydrocortisone, IV ranitidine and IV human albumin. She also had fever, unstable \n\n\n\nblood pressure and heart rate and profused bleeding from various sites. Her hematologic profile included \n\n\n\nINR of 1.1, APTT 29.5 seconds and platelets 79X109 per L. Her bleeding could not be controlled by \n\n\n\nconventional management and her condition deteriorated. The cornerstone in treating DIC is based on the \n\n\n\netiology. A meta-analysis study has found that antithrombin III would stop thrombosis, improve platelet \n\n\n\ncounts and multiorgan functions in DIC patients. Hence antithrombin III can be recommended to this patient \n\n\n\nto stop her bleeding and prevent multiple organ failure. \n\n\n\n\n\n\n\n\n\n\n\nOral Presentation OCP5 (000057) \n\n\n\n\n\n\n\nAcute Paracetamol Overdose In Hospital Kulim: Presentation, Management And Outcome \n\n\n\n\n\n\n\nH M Teh, S W Chan, M S Salbiah, A N Nurzita \n\n\n\nJabatan Farmasi, Hospital Kulim, Kulim, Kedah \n\n\n\n\n\n\n\nThis is a two-year retrospective study designed to evaluate the clinical presentations, management and \n\n\n\noutcome of treatment in acute paracetamol (PCM) overdose patients admitted to Hospital Kulim using 47 \n\n\n\nbed head tickets from Jan 2004 to Dec 2005 where 11 were excluded. The result showed out of these 36 \n\n\n\nsubjects, 10 subjects (27.8%) developed potential hepatotoxicity according to the Rumack & Matthew \n\n\n\nnomogram. This potential toxic group had reported significantly earlier symptoms (vomiting p=0.007, \n\n\n\nabdominal pain and giddiness p=NS) with a mean peak paracetamol level of 128.42\uf0b134.51 (p<0.005). The \n\n\n\npeak serum total bilirubin(\u00b5mol/L), AST(IU/L), ALT(IU/L) and PT(seconds) were significantly higher in the \n\n\n\ntoxic group compared to the non-toxic group (19.17\uf0b112.17 vs 11.01\uf0b14.12, p=0.03; 105.67\u00b1111.08 vs \n\n\n\n23.5\u00b15.43, p=0.04; 112.7\u00b193.40 vs 24.31\uf0b16.80, p=0.05; 18.00\uf0b17.10 vs 12.38\uf0b11.98, p=0.02). Patients were \n\n\n\ngiven N-acetylcysteine (NAC) treatment based mostly on the Therapeutic Drug Monitoring result (74%), \n\n\n\nfollowed by amount of ingestion (16%), and severity of presenting symptoms (10%). Time to NAC \n\n\n\ntreatment for the toxic group was 9.40 hours after acute PCM ingestion. The liver function profile, including \n\n\n\ntotal bilirubin (\u00b5mol/L), AST (IU/L), ALT (IU/L) and PT (seconds) improved significantly (p<0.05) after \n\n\n\nNAC treatment in the toxic group (19.17 vs 11.66; 105.67 vs 28.58; 112.75 vs 32; 18 vs 11.44). However, \n\n\n\nthe limitations of this study are small sample size and no definite time range of liver function test (LFT) after \n\n\n\nNAC treatment. Improvement of LFT values was assumed to be due to NAC treatment. In conclusion, NAC \n\n\n\ngives a hepato-protective effect, as NAC effectively improves the liver function profile of PCM poisoning \n\n\n\npatients. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nS104 \n\n\n\nOral Presentation OCP6 (000058) \n\n\n\n\n\n\n\nTherapeutic INR Control Of Patients On Warfarin In Kulim Hospital \n\n\n\n\n\n\n\nS W Chew, M S Salbiah, A J Norhanita \n\n\n\nJabatan Farmasi, Hospital Kulim, Kulim, Kedah \n\n\n\n\n\n\n\nThe aim of this research was to evaluate the control of warfarin therapy of patients in Kulim Hospital. \n\n\n\nControl of warfarin therapy was measured by the percentage of time within the therapeutic range, the \n\n\n\nproportion of tests in range, the mean dose and also the mean INR. 33 patients were included in this \n\n\n\nretrospective study. The INR and the corresponding dose of warfarin of these patients were recorded and \n\n\n\nanalysed. A simple survey was also performed. 2 patients were excluded because these patients were on \n\n\n\ntherapy for less than 6 months. The average percentage of time spent within the therapeutic range (INR 2-3), \n\n\n\nof all patients, was 52.4% (95% confidence interval [CI], 46.5-58.4%). The percentage of time spent below \n\n\n\nand above the therapeutic range was 33.1% (95% CI, 27.1-39%) and 14.5% (95% CI, 10.2-18.8%) \n\n\n\nrespectively. The average dose was 3.81 mg (95% CI, 3.22-4.41 mg) and the mean INR was 2.38 (95% CI, \n\n\n\n2.27-2.49). The proportion of tests within range is 0.51 (95% CI, 0.45-0.57). From the survey, no correlation \n\n\n\nwas found between the way of administration and alcohol use with INR level. It was also found that most of \n\n\n\nthe patients (n=29) on warfarin did not know that taking over-the-counter (OTC) medication can affect their \n\n\n\nINR level. Therefore the benefit that patients would get from medication counseling is evident and all \n\n\n\npatients on warfarin should be counseled on the use of warfarin. \n\n\n\n\n\n\n\n\n\n\n\nOral Presentation OCP7 (000060) \n\n\n\n\n\n\n\n\n\n\n\nAssessment On Effect Of Hypoalbuminemia On Phenytoin Serum Concentration In Intensive Care \n\n\n\nAnd Medical Patients Of Penang General Hospital \n \n\n\n\nNur Hidayah Kaz Abdul Aziz, Noorizan Abdul Aziz, Jahizah Hassan, Zubaidah Che Embee \n\n\n\nSchool of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang; Department of Anesthesiology and \n\n\n\nIntensive Care, Penang General Hospital, Penang; Department of Pharmacy, Penang General Hospital, \n\n\n\nPenang \n\n\n\n\n\n\n\nIntroduction: Hypoalbuminemia commonly occurs in hospitalized patients, especially those critically ill \n\n\n\nand is the most common clinical condition to cause alteration in phenytoin protein binding. The objective of \n\n\n\nthis study is to assess the effect of hypoalbuminemia on phenytoin serum concentration in critically ill and \n\n\n\nmedical patients in Penang General Hospital, Malaysia. Method: Phenytoin serum levels and albumin levels \n\n\n\nwere obtained retrospectively from the TDM Pharmacy and Record Office. Purposive sampling was used to \n\n\n\nobtain the samples. Samples were divided into two groups according to albumin level. Corrected phenytoin \n\n\n\nserum concentration was calculated for group of samples with albumin level lower than 30g/dL using \n\n\n\nWinter-Tozer Equation. Exact Fisher's test was used to find the association between phenytoin serum \n\n\n\nconcentration and albumin level. Results: 17 pairs of samples were obtained. There was no significant \n\n\n\nassociation between hypoalbuminemia and measured phenytoin serum level. Concurrent medications that \n\n\n\nwere known to influence the protein-binding of phenytoin were also not found to be significantly affecting \n\n\n\nthe phenytoin concentration. Conclusion: Although a significant association between serum albumin level or \n\n\n\nconcurrent drugs and phenytoin serum concentration could not be found in this study, the samples with \n\n\n\nhigher phenytoin level from the albumin <30g/dL group outnumbered the others. \n\n\n\n \n\n\n\n\n\n\n\n\nS105 \n\n\n\n\n\n\n\nOral Presentation OCP8 (000065) \n\n\n\n\n\n\n\n\n\n\n\nPatients\u2019 Knowledge On Warfarin Therapy At The Warfarin Clinic, Hospital Teluk Intan \n\n\n\n\n\n\n\nI Rokiah, M Y Abdul Haniff, S Amutha, S Irmawath, G Y Lim, L S Chew  \n\n\n\nDepartment of Pharmacy, Hospital Teluk Intan, Teluk Intan, Perak \n\n\n\n\n\n\n\nThe aim of this study was to determine the various factors contributing to patients\u2019 knowledge of warfarin \n\n\n\ntherapy including demographic and socioeconomic factors. The correlations between patientis\u2019 knowledge of \n\n\n\nwarfarin therapy and the awareness and compliance towards their medication were also accessed. A \n\n\n\nretrospective and cross-sectional study was held at the warfarin clinic, Hospital Teluk Intan. Randomized \n\n\n\nsampling with questionnaires was used and patients\u2019 medical records were reviewed. A total of 52 \n\n\n\npatients were enrolled, of which 25 were males (48.1%) and 27 were females (51.9%). The age range \n\n\n\nwas from 36 \u2013 77 years old with a mean of 58.73 \uf0b1 9.55 and mode of 52-years-old. A large number of \n\n\n\nrespondents (63.5%) received primary schooling and 71.2% had a low income (< RM 500/ month). 69.2% of \n\n\n\nthe respondents were literate with 53.8% able to understand Malay. About 94.2% received verbal education \n\n\n\nfrom either the medical officers or staff nurses, and 98.1% through a warfarin book. The awareness \n\n\n\nof patients towards their medications was low (44.2%). Compliance to medication was fairly good at 76.1%. \n\n\n\nThe study showed that patients\u2019 age, socioeconomic level, education level and literacy had a significant \n\n\n\nrelationship on patients\u2019 knowledge on warfarin therapy (p < 0.05). There was a significant correlation \n\n\n\nbetween patients\u2019 knowledge on warfarin therapy and the awareness towards their medications (p = 0.002). \n\n\n\nIn conclusion, patient education plays an important role in the success of warfarin therapy and ultimately \n\n\n\nreducing disease complications, potential toxicity and drug interactions. Thus, pharmacists should provide \n\n\n\nadequate counseling along with the use of conventional warfarin books. \n\n\n\n\n\n\n\n\n\n\n\nOral Presentation OCP9 (000098) \n\n\n\n\n\n\n\n\n\n\n\nA Comparison Between Beta-Blockers Only & Beta-Blockers + Diuretics As First-Line \n\n\n\nAntihypertensives In Hospital Alor Star \n\n\n\n\n\n\n\nSW Chow, Atia H, Saripah S \n\n\n\nDepartment Of Pharmacy, Hospital Alor Star, Kedah \n\n\n\n\n\n\n\nBeta-blockers have been used to treat primary hypertension for more than 30 years with an impressive safety \n\n\n\nrecord. However, the effectiveness of using only beta-blockers as initial therapy for primary hypertension \n\n\n\nhas not been clearly documented.  Studies have suggested that using diuretics instead (either alone or in \n\n\n\ncombination with beta-blockers) may be more effective in reducing blood pressure. This study compares the \n\n\n\neffectiveness of using either beta-blockers alone or in combination with diuretics in reducing blood pressure. \n\n\n\nIn this retrospective study, medical cards of hypertensive patients were screened and 60 cards of patients \n\n\n\nwho were started on either beta-blockers alone (either metoprolol, atenolol or bisoprolol) (Group 1) or on \n\n\n\nbeta-blockers (as mentioned above) + diuretics (either chlorothiazide, frusemide or modiuretic) (Group 2) as \n\n\n\ninitial therapy were selected. Both groups consist of 30 patients each, with ages ranging from 40-82 years old. \n\n\n\nGroup 1 consists of 20 males and 10 females, while Group 2 consists of 22 males and 8 females. Blood \n\n\n\npressure measurements before (on the day of appointment before being prescribed the antihypertensives) and \n\n\n\nafter starting medications (on the following medical appointment in 1-3 months time) were recorded. \n\n\n\nSystolic blood pressure reductions were 7.09% (Group 1) compared to 11.05% (Group 2) (p<0.05).Diastolic \n\n\n\nblood pressure reductions were 6.21% (Group 1) and 6.31% (Group 2) respectively, p>0.05.  Meanwhile, \n\n\n\ntargeted blood pressure achievement of 140/90mmHg was found to be 60% (Group 2) vs 53% (Group 1) \n\n\n\n(p<0.05).  In conclusion, using beta-blockers in combination with diuretics may be more effective than using \n\n\n\nit alone in reducing blood pressure and consequently reducing cardiovascular-related morbidity and \n\n\n\nmortality. \n\n\n\n \n\n\n\n\n\n\n\n\nS106 \n\n\n\nOral Presentation OCP10 (000101) \n\n\n\n\n\n\n\n\n\n\n\nReview And Assessment Of Therapeutic Drug Monitoring Of Digoxin Among Inpatients In Hospital \n\n\n\nMelaka \n\n\n\n\n\n\n\nM D Erwany, L Y Ong, L B Khong, K Halisah, M S Nursahjohana, M T Nor Mazni, A A Abdol Malek  \n\n\n\nDepartment of Pharmacy, Hospital Melaka, Malacca \n\n\n\n\n\n\n\nDigoxin has a narrow therapeutic index and therapeutic drug monitoring (TDM) is used to target the dose \n\n\n\ngiven to be within the desired therapeutic range, while minimising the risk of toxicity. The objectives of the \n\n\n\nstudy are i) to review all cases of digoxin in-patients, ii) to assess the appropriateness of TDM requests, and \n\n\n\niii) to determine the common drug-drug interactions during digoxin treatment. The study design was a \n\n\n\nretrospective, descriptive study. All forms registered in the TDM record book from January 2004 till March \n\n\n\n2006 was included.  Relevant data was recovered from the Medical Records Unit to retrieve patients biodata, \n\n\n\ndrug administered in the ward, laboratory results and doctor\u2019s notes. Results were analysed using Microsoft \n\n\n\nExcel version 2002 and characterised by descriptive statistics. Fifty-nine patients with 64 requests for serum \n\n\n\ndigoxin concentrations were enrolled. Sampling time was appropriate in 37.5% of the cases whereas 31.3% \n\n\n\nwere inappropriate.  38 patients (64%) were new patients on digoxin, of which 23 of them were given \n\n\n\nloading doses. 50 % of the requests were within therapeutic range, 42.2% sub-therapeutic and 7.8 % in the \n\n\n\ntoxic range. The common drug-drug interactions identified were beta-blockers, diuretics, and amiodarone \n\n\n\nand 10 cases (17%) had dose alterations due to suspected toxicity. Inadequacies in the TDM must be \n\n\n\naddressed for patients to achieve optimal benefits of these services. \n\n\n\n\n\n\n\n\n\n\n\nOral Presentation OCP11 (000100) \n\n\n\n\n\n\n\n\n\n\n\nOnce-Daily Dosing Of Aminoglycosides: Review And Recommendations For Clinical Practice \n\n\n\n\n\n\n\nA Mardhiah, S S E Debbie, S Norsahjohana, A Suhadah \n\n\n\nDepartment of Pharmacy, Malacca General Hospital, Malacca \n\n\n\n\n\n\n\nThe use of aminoglycosides such as amikacin and gentamicin has seen an increase in trend in recent years. \n\n\n\nMany of these antibiotics are used in the treatment of Gram-negative infections, peritonitis, intra-abdominal \n\n\n\ninfections and pneumonia. Today, we are concerned over the advantages and disadvantages of once-daily \n\n\n\ndosing regimens as compared to the conventional multi-dosing regimens. With the help of therapeutic drug \n\n\n\nmonitoring (TDM), we can ascertain the clinical efficacy and risk of toxicity of the drug when administered \n\n\n\nas either a once-daily or multiple dosing regimens. This study is a retrospective study, which involved the \n\n\n\nuse of data gathered from 164 aminoglycosides TDM records for the year 2005. From our study, 35.7% \n\n\n\n(N=71) were male subjects and 34.3%(N=37) were females. In the whole year of 2005, there were a total of \n\n\n\n108 cases of amikacin and 56 cases of gentamicin TDM. For amikacin, 26.9% (N=29) cases for once-daily \n\n\n\nadministration and 73.2% (N=79) cases for multiple dosing administration. For gentamicin, 39.3% (N=22) \n\n\n\ncases for once-daily administration and 60.7%(N=34) cases for multiple dosing administration. Amikacin \n\n\n\nlevels that fell within therapeutic range was 32.4% (N=35) while the remaining 67.6% (N=73) were out of \n\n\n\nrange. For gentamicin, 41.1% (N=23) gentamicin levels were found to be within therapeutic range while \n\n\n\n58.9% (N=33) gentamicin levels were out of range. Due to the limitations of this study, we found no \n\n\n\nsignificant correlation between the type of administration and the therapeutic levels obtained for both \n\n\n\namikacin and gentamicin. However, many literatures have quoted the advantage of a once-daily \n\n\n\nadministration over multiple-daily dosing regimens. Based on some studies done in Australia and USA, it \n\n\n\nappears that once-daily administration regimen is found to be clinically effective, reduces the incidence of \n\n\n\nnephrotoxicity and provides a cost-effective method for administration of aminoglycosides by reducing \n\n\n\nancillary service time and serum aminoglycoside determinations. \n\n\n\n\n\n\n\n\nS107 \n\n\n\nOral Presentation OPG1 (000030) \n\n\n\n\n\n\n\n\n\n\n\nA Bioavailability And Pharmacokinetic Study Of Two Oral Formulations Of Ciprofloxacin 250 MG \n\n\n\nTablets In Healthy Male Volunteers \n  \n\n\n\nAbul Hasnat, Mohammad Abul Kalam Azad \n\n\n\nDepartment of Clinical Pharmacy and Pharmacology, Dhaka University, Dhaka, Bangladesh \n\n\n\n\n\n\n\nA bioavailability and pharmacokinetic study of a local and a generic ciprofloxacin 250 mg film coated \n\n\n\ntablets was carried out in 24 healthy human volunteers. The products were administered orally after \n\n\n\novernight fasting, using a two-way crossover design. Serial blood samples were collected for a period of 12 \n\n\n\nhours and were analyzed using a HPLC with ultraviolet detection. Various pharmacokinetic parameters, \n\n\n\nincluding AUC0-t, AUC0-\uf02c\uf0a5 Cmax, tmax, t1/2, kel, AUMC0-12, AUMC0-\uf0a5, and MRT were determined. The mean \n\n\n\nCmax values of the generic and the local product were found to be 1.46 \u00b1 0.032 \uf06dg/ml and 1.49 \u00b1 0.0845 \n\n\n\n\uf06dg/ml and the mean AUC0-12 was found to be 5.79 \u00b1 0.67 \uf06dg-h/ml and 5.82 \u00b1 0.38 \uf06dg-h/ml respectively. The \n\n\n\nmean AUC0-\uf0a5 values of the generic and the local product were found to be 6.92 \u00b1 0.92 \uf06dg-h/ml and 6.858 \u00b1 \n\n\n\n0.932 \uf06dg-h/ml respectively. Both the generic and the local products produced a same mean tmax value (1.2 \u00b1 \n\n\n\n0.273 h); while the mean t1/2 values were 4.52 \u00b1 0.66 h and 4.961 \u00b1 1.19 h respectively. The mean kel values \n\n\n\nof the generic and the local products were found to be 0.156 \u00b1 0.022 h-1 and 0.147 \u00b1 0.033 h-1 and the mean \n\n\n\nMRT values were found to be 6.378 \u00b1 0.79 h and 6.878 \u00b1 1.53 h respectively. The relative bioavailability of \n\n\n\nthe local drug was 100.55% at 12 hours and 99.08% at infinity. All the differences in pharmacokinetic \n\n\n\nparameters between the two products were within acceptable range (p > 0.1). Therefore, it can be concluded \n\n\n\nthat the local product tested is unequivocally bioequivalent to the generic product. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nOral Presentation OPG2 (000052) \n\n\n\n\n\n\n\n\n\n\n\nEffect Of Losartan On Renal Haemodynamics Of Rats With Hypertension  \n  \n\n\n\nB Fathihah1, A S Munavvar1, N A Abdullah2, D Aidiahmad, A H Khan1, H A Rathore1, N A Raisa1, M \n\n\n\nH NurJannah1, E J Johns3 \n\n\n\n1School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia; 2Department of \n\n\n\nPharmacology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; 3Department of \n\n\n\nPhysiology, Aras Windle, University College Cork, College Road, Cork, Ireland \n\n\n\n\n\n\n\nLosartan, an orally active selective non-peptide blocker of the angiotensin subtype 1 receptor is an \n\n\n\nestablished drug in hypertension. This study explored the role of renin-angiotensin (RAS) and sympathetic \n\n\n\nnervous (SNS) systems in the control of renal haemodynamics in hypertension. To achieve this, we \n\n\n\ncompared non-treated (SHR) and losartan-treated spontaneously hypentensive rats (LSHR). Losartan (10 \n\n\n\nmg/kg) was given orally for 7 days prior to the acute study. The animals were anesthetized and their mean \n\n\n\narterial pressure (MAP) and renal blood flow (RBF) were measured using a pressure transducer and \n\n\n\nelectromagnetic flowmeter respectively. Reductions in RBF when subjected to renal nerve electrical \n\n\n\nstimulation and intrarenal noradrenaline (NA), phenylephrine (PE), methoxamine (ME) and angiotensin II \n\n\n\n(Ang II) were determined. Data, expressed as mean \u00b1 s.e.m, were recorded using a computerized data \n\n\n\nacquisition system and were compared by 2-way ANOVA followed by Bonferronni post-hoc test with a \n\n\n\nsignificance level at 5%. A significant decrease (p<0.05) in percentage drop of RBF was observed in LSHR \n\n\n\nas compared to SHR when subjected to RNS, NA, PE and ME. There was a significant drop (p<0.05) of \n\n\n\nRBF after administration of Ang II in LSHR. These showed that presynaptic NA release was enhanced by \n\n\n\nbinding of Ang II to presynaptic AT1 receptors. Furthermore, the functions of the postsynaptic \uf0611-\n\n\n\nadrenoceptor subtypes were influenced by binding of Ang II to postsynaptic AT1 receptors, the predominant \n\n\n\ntype in mediating vasoconstriction. Hence, the interaction between RAS and SNS gives a big impact in \n\n\n\nmodulating the renal haemodynamic in hypertension. \n\n\n\n \n\n\n\n\n\n\n\n\nS108 \n\n\n\nOral Presentation OPG3 (000053) \n\n\n\n\n\n\n\n\n\n\n\nEffect Of Losartan On Renal Haemodynamics Of Spontaneously Hypertensive Rats With Nephrotoxic \n\n\n\nRenal Failure  \n\n\n\n\n\n\n\nB Fathihah1,  A S Munavvar1, N A Abdullah 2, D Aidiahmad, A H Khan1, H A Rathore1,  N A Raisa1, \n\n\n\nM H NurJannah1, E J Johns3 \n\n\n\n1School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia; 2Department of \n\n\n\nPharmacology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; 3Department of \n\n\n\nPhysiology, Aras Windle, University College Cork, College Road, Cork, Ireland \n\n\n\n\n\n\n\nThis study was designed to explore the role of losartan in modulating the renal haemodynamics in \n\n\n\nhypertension with nephrotoxic renal failure. Normal spontaneously hypertensive rats (SHR) and cisplatin-\n\n\n\ninduced hypertensive rats (RFSHR) were treated with losartan orally for 7 days. The animals were \n\n\n\nanesthetized and their mean arterial pressure (MAP) and renal blood flow (RBF) were measured using a \n\n\n\npressure transducer and electromagnetic flowmeter respectively. Reductions in RBF when subjected to renal \n\n\n\nnerve electrical stimulation and intrarenal noradrenaline (NA), phenylephrine (PE), methoxamine (ME) and \n\n\n\nangiotensin II (Ang II) were determined. Data, expressed as mean \u00b1 s.e.m, were recorded using a \n\n\n\ncomputerized data acquisition system and were compared by 2-way ANOVA followed by Bonferronni post-\n\n\n\nhoc test with a significance level at 5%. The responses to RNS, showed a significant decrease in percentage \n\n\n\ndrop of RBF (p<0.05) in RFSHR as compared to SHR. However RFSHR showed a significant increase \n\n\n\n(p<0.05) in percentage drop of RBF when subjected to NA, PE and Ang II. Administration of ME gave no \n\n\n\nsignificant (p>0.05) change in percentage drop of RBF. The results suggested that, in renal failure state, the \n\n\n\npostsynaptic AT1 receptors are upregulated and the presynaptic AT1 receptors are downregulated. \n\n\n\nOccurrence of increase of sensitivity of the renal vasculature to \uf0611-adrenoceptor-mediated activation is seen \n\n\n\nwith minimal contribution of \uf0611A and \uf0611D-adrenoceptors. \n\n\n\n\n\n\n\n\n\n\n\nOral Presentation OPG4 (000055) \n\n\n\n\n\n\n\n\n\n\n\nEffect Of High Salt Load In The Normotensive WKY Rats \n \n\n\n\nN A Raisa1, A S Munavvar1, N A Abdullah2, D Aidiahmad1, A H Khan1, H A Rathore1, B Fathihah1, \n\n\n\nM H NurJannah1, E J Johns3 \n1School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia; 2Department of \n\n\n\nPharmacology, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia; 3Department of \n\n\n\nPhysiology, Aras Windle, University College Cork, College Road, Cork, Ireland \n\n\n\n\n\n\n\nThe present study investigated the effect of high salt load in normotensive WKY rats. Adult WKY rats were \n\n\n\nfed with 0.9% isotonic saline (150mmol) and normal rat chow for six weeks. Metabolic data were collected \n\n\n\nevery week, which included the bodyweight (BW) water intake (WI), urine output (UO) and conscious \n\n\n\nrecording of BP by using the tail cuff method. Urine and plasma were collected for electrolyte assay. All \n\n\n\ndata were expressed as mean \u00b1 s.e.m and analyzed using one way ANOVA followed by bonferoni post hoc \n\n\n\ntest with the significance level of 5%. The metabolic data collected were compared before and after the salt \n\n\n\nload. WI, UO, and urinary sodium showed significant (p<0.05) increase, while no significant (P>0.05) \n\n\n\nchange was observed in the BP, BW, and plasma sodium level. The result showed the body\u2019s physiological \n\n\n\nresponse to high salt loads, such that, in normal conditions, the body rapidly adapts to diets high in salt \n\n\n\ncontent with enhanced thirst; increased natriuretic and diuretic responses. Diuresis and natriuresis serve a \n\n\n\ncritical role to maintain sodium balance. The natriuretic and antinatriuretic mechanism work over a period of \n\n\n\ntime to oppose the expression of diuresis and natriuresis if the intake of sodium is less and allow diuresis and \n\n\n\nnatriuresis to be detected with high sodium intake without affecting the BP. \n\n\n\n \n\n\n\n\n\n\n\n\nS109 \n\n\n\n\n\n\n\nOral Presentation OPE1 (000026) \n\n\n\n\n\n\n\n\n\n\n\nThe Attitude Of Malaysian Pharmacists Towards Continuing Professional Development (CPD)  \n\n\n\n\n\n\n\nB L Tan1, V T G Chuang1,2  \n1Department of Pharmacy, Faculty of Allied Health Sciences, Universiti Kebangsaan Malaysia, Kuala \n\n\n\nLumpur, Malaysia; 2The School of Pharmacy, Faculty of Medical & Health Sciences, The University of \n\n\n\nAuckland, Auckland, New Zealand \n\n\n\n\n\n\n\nThe aim of the study was to investigate pharmacists\u2019 attitudes and approaches to continuing professional \n\n\n\ndevelopment (CPD) in Malaysia. Survey forms developed based on study objectives were posted to 480 \n\n\n\npharmacists in Malaysia and also uploaded in i-bulletin of Malaysian Pharmaceutical Society. 337 \n\n\n\nrespondents from hospital, industry, community pharmacy and academic participated in this study. It was \n\n\n\nfound that in the year 2005, the majority of pharmacists (85.2%) were involved in formal CPD activities \n\n\n\nsuch as seminars, workshops, conferences or postgraduate courses. A third of these respondents was female \n\n\n\nand employed in the hospital. They had completed more than 30 hours of CPD activities. Other informal \n\n\n\nactivities of CPD undertaken included reading professional journals (86.1%), reading manufacturer \n\n\n\nliteratures (84.6%), internet-based learning (73%) and professional discussion with colleagues (68.2%)  \n\n\n\nHowever, only 11% of the respondents had undertaken postgraduate courses. The main barrier given for the \n\n\n\nnon-participation in CPD activities was lack of time (60%). Almost all respondents agreed that pharmacists \n\n\n\nshould be engaged in CPD activities to maintain their professional competency. Most pharmacists (73%) \n\n\n\nagreed that CPD should be compulsory and that 30 hours per year of CPD activities was a realistic figure. \n\n\n\nThe involvement of pharmacists in CPD activities in year 2005 can be considered high. \n\n\n\n\n\n\n\n\n\n\n\nOral Presentation OPE2 (000029) \n\n\n\n\n\n\n\n\n\n\n\nThe Knowledge & Attitude Of UKM Pharmacy Students On Pharmacy Profession \n \n\n\n\nW H Kuan1, V T G Chuang2 \n1Department of Pharmacy, Faculty of Allied Health Sciences, Universiti Kebangsaan Malaysia, Kuala \n\n\n\nLumpur, Malaysia; 2The School of Pharmacy, Faculty of Medical & Health Sciences, The University of \n\n\n\nAuckland, Auckland, New Zealand \n\n\n\n\n\n\n\nThe study was carried out to access the knowledge and attitude of UKM pharmacy students towards \n\n\n\npharmacy profession. Questionnaires were distributed to randomly selected pharmacy students in UKM. The \n\n\n\nresults showed that 35.3% of the respondents chose pharmacy course because of its bright future after \n\n\n\ngraduated whereas another 33.3% due to their interest on this course. 27.5% of the respondents got to know \n\n\n\npharmacy profession through the mass media while 22.7% through their previous visits to pharmacies. When \n\n\n\nask on their choice of field after graduated, 51.6% of the respondents choose hospital as the first choice \n\n\n\nwhile 24.8% choose community pharmacy as first choice. 16.5% of them haven\u2019t decided their fields with \n\n\n\n29% of them in their final year. 69.7% of the respondents are willing to stay on-call on weekends or holiday. \n\n\n\nBesides, 66.8% of the respondents consider 3-year compulsory service as a chance to train themselves, \n\n\n\n17.0% consider it as a time to contribute for patient care, while 4.3% consider it as a waste of time. When the \n\n\n\nrespondents were asked about their primary objective when they serve as pharmacists, 69.2% of the \n\n\n\nrespondents chose patient care as their main concern, 23.4% chose reputation and only 7.5% chose business. \n\n\n\nBased on the responses from final year students, 88.4% of them believe their intervention in patient care \n\n\n\ncould bring at least 60% of changes on patient outcome. Generally, majority of the pharmacy students in \n\n\n\nUKM have gained a satisfactory attitude on pharmacy profession, though there are rooms for further \n\n\n\nimprovement. \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nS110 \n\n\n\nOral Presentation OPE3 (000092) \n\n\n\n\n\n\n\n\n\n\n\nPerceptions Of Pharmacy Students Towards Pharmaceutical Care \n \n\n\n\nShubashini G, Yogheswaran G, Mahmathi K, Noor Rodhiah A R \n\n\n\nFaculty of Pharmacy, Universiti Teknologi MARA, Shah Alam, Selangor \n\n\n\n\n\n\n\nEarly pharmacy practice exposure in the pharmacy curriculum enables students to visualize the evolving \n\n\n\nphilosophy of pharmaceutical care. The objectives of this study were to discover and describe the \n\n\n\nperceptions of pharmacy students from Universiti Teknologi MARA (UiTM) towards pharmaceutical care. \n\n\n\nA cross-sectional study was conducted among pharmacy students from Year 1 till Year 4 (n = 325). The \n\n\n\nquestionnaire was designed to assess Perceptions of Pharmacy Students towards Pharmaceutical Care (13 \n\n\n\nitems) based on Likert scores from 1 (strongly disagree) to 5 (strongly agree). Descriptive statistics on the \n\n\n\nsample characteristics and questionnaire items were computed. Student\u2019s t-test and a one\u2013way analysis of \n\n\n\nvariance (ANOVA) were utilized for inferential statistics. The Cronbach\u2019s alpha reliability coefficient for the \n\n\n\nsurvey instrument was found to be 0.874. Students were 98.4% single, Muslim Malays from Peninsular \n\n\n\nMalaysia (mean age = 20.5 \u00b11.46; range = 18-29).78.7% of students were female. 23.5% of students had \n\n\n\nexperience working in a pharmacy. Generally, the mean scores for Perception of Pharmaceutical Care was \n\n\n\n4.09 \u00b1 0.49 (range = 1.46-5.00). 93% of students agreed that all pharmacists should perform pharmaceutical \n\n\n\ncare. 42.8% of students, especially those from Year 3 and Year 4 (p = 0.008) indicated that providing \n\n\n\npharmaceutical care takes too much time and effort. Positive perceptions towards certain items were \n\n\n\nassociated with age and working experience in a pharmacy (p < 0.05). However, positive perceptions were \n\n\n\nnot associated with gender. In conclusion, UiTM pharmacy students indicated positive perceptions on \n\n\n\npharmaceutical care.  \n\n\n\n\n\n\n\n\n\n\n\nOral Presentation OPT1 (000009) \n\n\n\n\n\n\n\n\n\n\n\nEffects Of Granulating Fluids And Hardness On Diclofenac Release From Colon-Targeted Polymer \n\n\n\nMatrices \n  \n\n\n\nN Billa1, K H Yuen2, T Julianto3 \n1The University of Nottingham Malaysia Campus, Semenyih, Selangor, Malaysia; 2University of Science \n\n\n\nMalaysia, Penang, Malaysia, Malaysia; 3Universiti Teknologi Mara, Shah Alam, Selangor, Malaysia \n\n\n\n\n\n\n\nThe effects of granulating fluids and polymer matrix hardness on diclofenac release from colon-targeted \n\n\n\npolymer matrices (xanthan gum, guar gum, pectin and chitosan) were studied in phosphate buffer (pH 6.8) \n\n\n\nand in simulated colonic conditions using rat caecal contents.  Each of the polymers was prepared using \n\n\n\nisopropyl alcohol as well as water as granulating fluid and then compressed into tablets at two levels of \n\n\n\nhardness. Water produced harder matrices compared to those prepared using isopropyl alcohol. Diclofenac \n\n\n\nrelease from chitosan and pectin matrices in phosphate buffer was not sustained beyond 5 min irrespective of \n\n\n\ntype of granulating fluid used and level of matrix hardness. On the other hand, diclofenac release from \n\n\n\nxanthan gum matrices and guar gum matrices was more sustained and not affected by the level of hardness \n\n\n\nof the polymer matrix prepared using either of the granulating fluids, although release rates were generally \n\n\n\nhigher from guar gum matrices. Under simulated colonic conditions, diclofenac release was slower from \n\n\n\nmatrices prepared at higher levels of hardness compared to those at lower levels of hardness for all the \n\n\n\ndifferently granulated matrices except for pectin, from which rate of diclofenac release remained rapid. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nS111 \n\n\n\n\n\n\n\nOral Presentation OPT2 (000047) \n\n\n\n\n\n\n\n\n\n\n\nOptimizing Excipient Mixtures By Mathematical Modelling In Formulating A Sustained-Release \n\n\n\nTheophylline Tablet \n \n\n\n\nK H Leong, L Y Chung, M J C Buckle  \n\n\n\nDepartment of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur \n\n\n\n\n\n\n\nPharmaceutical formulations are usually developed by trial and error. This approach is time consuming, \n\n\n\ncostly and may give misleading conclusions for complex formulation without the realization of the \n\n\n\nformulator. This study explores the application of mathematical modelling for pharmaceutical formulation \n\n\n\nwith the aim of expediting formulation processes and minimizing errors. The evaluation was performed on a \n\n\n\nsustained-release theophylline formulation using a simplex lattice experimental design consisting mixtures of \n\n\n\npolymers including iota-carrageenan as the gel forming agent, lambda-carrageenan as the viscosity modifier \n\n\n\nand acacia gum as the retardant. Tablets produced from these formulations were tested for drug release by \n\n\n\ndissolution in simulated gastric fluid (SGF) and simulated intestinal fluid (SIF) using spectrophotometric \n\n\n\nmeasurements of theophylline at 272nm. Modelling on the drug release data obtained was carried out using \n\n\n\nmodel dependent polynomial functions. Constraints were placed on the model independent variables to give \n\n\n\nthe ideal release characteristics. The model was validated by profiling the theophylline release rate using the \n\n\n\noptimal formulation predicted by the model. The observed drug release rate of the optimal formulation was \n\n\n\nshown to be not significantly different to the release pattern predicted by the model [one-way ANOVA; \n\n\n\n(p>0.05)]. The dissolution profile of the optimal formula fitted into the Power Law Model indicating zero-\n\n\n\norder release kinetics. The results of this study demonstrate the suitability of the mathematical model in \n\n\n\nobtaining an optimized sustained-release theophylline formulation with a predictable drug release profile. \n\n\n\n\n\n\n\n\n\n\n\nOral Presentation OPT3 (000089) \n\n\n\n\n\n\n\n\n\n\n\nDevelopment And Evaluation Of Controlled Release Floating Dosage Forms Of Famotidine \n\n\n\n\n\n\n\nA M Othman, A M Sabati \n\n\n\nDepartment of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Sana'a University, Yemen \n\n\n\n\n\n\n\nThe purpose of this research was an attempt to develop a floating delivery system for famotidine. Several \n\n\n\ndosage forms including granules, capsules and tablets, were prepared. Different types of hydrophilic \n\n\n\npolymers and gas floating agents were tried. The floating behavior, the dissolution profiles, density, drug \n\n\n\ncontent, weight uniformity, and hardness test were studied. Capsules filled with mixtures of famotidine, \n\n\n\nhydroxypropylmethylcellulose (HPMC-4000), carbopol-971P, and gas producing agents (citric acids and \n\n\n\nsodium bicarbonate) and microcrystalline cellulose (MCC), exhibited floating for 24 hrs in dissolution \n\n\n\nmedium, HCl buffer pH 2.2 at 37\u02daC rotating at 50 rpm, and provided controlled release over 7 hrs. The \n\n\n\noptimal floating and controlled release were observed from capsules containing a higher ratio of HPMC-\n\n\n\n4000 and from these containing a higher ratio of gas floating agents as 58 and 52 percent of drug releases \n\n\n\nafter 7 hrs. On the other hand capsules containing different concentrations of MCC, as a filler, showed \n\n\n\nhigher drug release with increasing MCC concentration. Finally, all famotidine tablets prepared by direct \n\n\n\ncompression of powdered mixtures exhibited more controlled drug release compared to conventional tablets \n\n\n\n(obtained from the market) but less floating time compared to that obtained from famotidine floating \n\n\n\ncapsules.  \n\n\n\n\n\n\n\n\nS112 \n\n\n\nOral Presentation OTC1 (000051) \n\n\n\n\n\n\n\n\n\n\n\nCytoprotective Effects Of Honey Alone Or In Combination With Aqueous And Ethanol Extracts \n\n\n\nFrom Chromolaena odorata L. In Reducing Gastric Lesions \n \n\n\n\nM H NurJannah2, A A Mahmood1, K Sidek1, A S Munavvar2, S Ismail1 \n1Department of Molecular Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; \n2School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia \n\n\n\n\n\n\n\nCytoprotective effects are important in keeping the integrity of gastric mucosa from strong irritants which \n\n\n\nmay induce gastric ulcers. Chromolaena odorata L. plant extracts, honey and cimetidine were used to \n\n\n\nevaluate their cytoprotective effects against gastric lesions. Aqueous and ethanol extracts of the plant were \n\n\n\nevaluated to determine which extracts are better in protecting gastric mucosa. Sprague-Dawley rats were pre-\n\n\n\ntreated via oral administration with either honey alone, aqueous or ethanol extracts of C. odorata, or \n\n\n\ncimetidine for 30 minutes. The plant extracts and cimetidine were also administered in combination with \n\n\n\nhoney. The rats were then fed with absolute ethanol combined with HCl, which served as irritants to induce \n\n\n\ngastric lesions. Thirty minutes later, the rats were sacrificed and their stomachs were removed for further \n\n\n\ngross and histological examination to evaluate gastric lesions progression. The treatment groups were \n\n\n\ncompared to the ulcer control group, which were administered with absolute ethanol combined with HCl \n\n\n\nonly. Data were expressed as ulcer index (mean \u00b1 S.E.M.) and inhibition percentage. The results showed that \n\n\n\nabsolute ethanol combined with HCl causes necrosis, hemorrhages and edema to the gastric mucosa. All \n\n\n\ntreatment groups showed a significantly (P<0.05) lower ulcer index and a higher inhibition percentage as \n\n\n\ncompared to the ulcer control group. The data suggest that honey contains factors that promote gastric \n\n\n\nmucosa cytoprotective effects and that C. odorata enhances the effects of honey. However the mechanism \n\n\n\nfor this enhancement is still unclear. \n\n\n\n\n\n\n\nOral Presentation OPG5 (000081) \n\n\n\n\n\n\n\n\n\n\n\nIntrarenal Haemodynamic Regulation In Diabetes: Role Of Sympathetic And Renin-Angiotensin \n\n\n\nSystems \n \n\n\n\nD Aidiahmad1, A S Munavvar1, N A Abdullah2, E J Johns3 \n1School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia; 2Department of \n\n\n\nPharmacology, Faculty of Medicine, University of Malaya, Kuala Lumpur; 3Department of Physiology, \n\n\n\nUniversity College Cork, College Road Cork, Ireland \n\n\n\n\n\n\n\nThis study was designed to investigate the interaction of the sympathetic and local renin-angiotensin systems \n\n\n\nat the level of renal haemodynamics in diabetes. Streptozotocin-induced diabetic WKY rats were \n\n\n\nanaesthetized with pentobarbitone sodium (60 mg/kg IP). The left kidney was exposed and an \n\n\n\nelectromagnetic flow probe was placed on the renal artery for renal blood flow (RBF) measurement. Bipolar \n\n\n\nelectrodes were used to stimulate the renal nerve. Reductions in RBF when subjected to electrical \n\n\n\nstimulation, bolus doses of phenylephrine, methoxamine and angiotensin II were determined in the presence \n\n\n\nof 5-methylurapidil, chloroethylclonidine, BMY7378, amlodipine, perindopril and losartan, and mean \n\n\n\narterial pressure (MAP) were monitored. The renal vasoconstrictor effects were significantly attenuated by 5-\n\n\n\nmethylurapidil and amlodipine in both non- and diabetic WKY, but by chloroethylclonidine and BMY 7378 \n\n\n\nin only non-diabetic WKY. The perindopril-treated group yielded significant attenuated responses to all \n\n\n\nadrenergic agonists but not Ang II in non-diabetic WKY, and in diabetic WKY only to RNS. Pressor \n\n\n\nresponses by Ang II in both groups were significantly reduced by losartan. RBF remained unchanged but \n\n\n\nMAP dropped significantly in certain groups throughout the study. Collectively, these data suggest that, in \n\n\n\ndiabetes, the angiotensin type 1 (AT1) receptors and the \uf0611A-adrenergic subtype continue to predominate in \n\n\n\nvasoconstriction at the expense of \uf0611B- and \uf0611D-subtypes, which have been down-regulated and become less \n\n\n\nfunctional. Intrarenal interaction at the renal vasculature level is greatly influenced by hyperglycaemic \n\n\n\nconditions possibly due to activation of local renal renin-angiotensin system. \n\n\n\n \n\n\n\n\n\n\n\n\nS113 \n\n\n\n\n\n\n\nOral Presentation OOO1 (000017) \n\n\n\n\n\n\n\nEvaluating Medicine Prices, Availability, Affordability And Price Components In Malaysia \n \n\n\n\n\n\n\n\nBabar Z U1, Izham M Ibrahim M2, Singh H1, Bukahri N I3  \n1School of Pharmacy, University College Sedaya International, Kuala Lumpur, Malaysia; 2School of \n\n\n\nPharmaceutical Sciences, University Sains Malaysia, Penang, Malaysia; 3School of Pharmacy, International \n\n\n\nMedical University, Kuala Lumpur, Malaysia \n\n\n\n\n\n\n\nMalaysia\u2019s stable healthcare system is facing challenges with increasing medicine costs. To investigate these \n\n\n\nissues a survey was carried out to evaluate medicine prices, availability, affordability and the structure of \n\n\n\nprice components. The methodology developed by the World Health Organization (WHO) and Health \n\n\n\nAction International (HAI) was used. Price and availability data for 48 medicines was collected from 20 \n\n\n\npublic sector facilities, 32 private sector retail pharmacies and 20 dispensing doctors in four geographical \n\n\n\nregions of West Malaysia. Medicine prices were compared with international reference prices to obtain a \n\n\n\nmedian price ratio. Price components\u2019 data were collected throughout the supply chain and mark-ups, taxes, \n\n\n\nand other distribution costs were identified. In private pharmacies, innovator brand prices were 16 times \n\n\n\nhigher than the reference prices, while generics were 6.6 times higher. In dispensing doctor clinics, the \n\n\n\nfigures were 15 times higher for innovator brands and 7.5 for generics. Dispensing doctors applied high \n\n\n\nmark-ups of 50-76% for innovator brands, and up to 316% for generics. Retail pharmacy mark-ups were also \n\n\n\nhigh - between 25-38% and 100-140% for innovator brands and generics, respectively. In the public sector, \n\n\n\nwhere medicines are free, availability was low even for medicines on the National Essential Drugs List. In \n\n\n\nconclusion, the free market by definition does not control medicine prices, necessitating price monitoring \n\n\n\nand control mechanisms. To increase access and affordability, promotion of generic medicines and improved \n\n\n\navailability of medicines in the public sector are required. \n\n\n\n\n\n\n\nOral Presentation OOO2 (000033)  \n\n\n\n\n\n\n\n\n\n\n\nCost Utility Analysis Of The Ministry Of Health Dialysis Programme \n \n\n\n\nFaridah Aryani MY1, Adrian G1, Lim T O1, Ghazali A2, Zaki Morad M Z3, Mohamed Izham M I4 \n1Clinical Research Centre, Hospital Kuala Lumpur, Kuala Lumpur; 2Nephrology Department, Hospital \n\n\n\nSelayang; Kuala Lumpur; 3Nephrology Department, Hospital Kuala Lumpur, Kuala Lumpur; 4School of \n\n\n\nPharmaceutical Sciences, Universiti Sains Malaysia, Penang \n\n\n\n\n\n\n\nIntroduction: End-stage renal disease is on the rise in Malaysia. Dialysis prevalence has grown from 138 \n\n\n\np.m.p. in 1996 to 497 p.m.p. (12,974 patients) at the end of 2005. In tandem with this increase, the Ministry \n\n\n\nof Health (MOH) has expanded its dialysis programme, which comprised 137 dialysis centres nationwide in \n\n\n\n2005. Objectives: To determine (1) the cost effectiveness of MOH dialysis program, measured as cost per \n\n\n\nquality-adjusted life year (QALY) saved. (2) utility and QALY  and (3) life expectancy of dialysis patients. \n\n\n\nMethods: This is a multi-centre observational study for MOH dialysis patients. The quality of life \n\n\n\ninstruments used was the EQ-5D and Spitzer\u2019s index QOL. Health utility was determined by time trade-off \n\n\n\nand transformed visual analogue scale methods. Costs were valued in terms of year 2004 RM from the \n\n\n\nperspective of the MOH. All costs incurred by the MOH in the provision of dialysis, including patient care \n\n\n\nand hospitalisation costs, were included in the study. Results and Discussion: Quality of life of continuous \n\n\n\nambulatory peritoneal dialysis (CAPD) patients was higher among the dialysis patients (0.79 to 0.93 of \n\n\n\nperfect health equivalent) compared to haemodialysis patients (0.79 to 0.89 of perfect health equivalent). \n\n\n\nOverall life expectancy on dialysis was 10.13 years with superior life expectancy for haemodialysis (11.37 \n\n\n\nyears) compared to CAPD (7.94 years). Age at commencement of dialysis, diabetic status, haemoglobin \n\n\n\nlevel, albumin level and dialysis modality were significant predictors of life expectancy. The cost per patient \n\n\n\nyear on dialysis was RM33,958 for haemodialysis and RM33,243 for CAPD. The cost per QALY was \n\n\n\nRM43,000 for haemodialysis and RM41,000 for CAPD. Conclusion: Haemodialysis and CAPD were \n\n\n\nequally cost effective given the current of utilisation of EPO therapy. \n\n\n\n\n\n\n\n\nS114 \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nOral Presentation OOO3 (000091) \n\n\n\n\n\n\n\nEvaluation Of The Cultivation Condition For Enhancing The Growth Of Lactobacillus acidophilus \n  \n\n\n\nHassan Pyar Ali, Peh K K, Pazilah I, Darah I \n\n\n\nSchool of Pharmaceutical Sciences, Universiti Sains Malaysia, Minden, Penang  \n\n\n\n\n\n\n\nGrowth is defined as the logical increase in all the chemical constituents of the cell which leads to an \n\n\n\nincrease in the number of the population. The growth of Lactobacillus acidophilus was optimized and the \n\n\n\nparameters investigated consisted of different selective culture media (Rogosa agar, LAMVAB agar, MRS \n\n\n\nagar and edible agar media), inoculation methods (pour plate and spread plate) and cultivation conditions \n\n\n\n(aerobic and anaerobic environment). In addition, two colony quantification methods; colony counting \n\n\n\nmethod and counting using the McFarland standard, were compared by estimating the number of \n\n\n\nLactobacillus acidophilus grown in MRS agar. The morphology and characteristics of Lactobacillus \n\n\n\nacidophilus were similar in MRS, Rogosa, LAMVAB and edible agar media, except that the colour of the \n\n\n\ncolony was green in LAMVAB agar medium while white in the other three media. The pour plate method \n\n\n\nprovided a relatively higher number of counts than the spread plate method. No significant difference was \n\n\n\nfound in viable counts between aerobic and anaerobic conditions, suggesting that Lactobacillus acidophilus \n\n\n\ncould be cultivated under both environments. The results of colonies determined using the two different \n\n\n\ncounting methods were different. The McFarland standard method might be less accurate when compared \n\n\n\nwith the colony counting method. \n\n\n\n\n\n\n\n\n\n\n\nOral Presentation OOO4 (000085) \n\n\n\n\n\n\n\n\n\n\n\nCost-Effectiveness Of Medications For Smoking Cessation \n\n\n\n\n\n\n\nM Haniki N M1, M Izham M I2, Nagmeldien A M M3, Nurulain A B4, Norlela A M4 \n1Department of Pharmacy Practice, Kulliyyah of Pharmacy, International Islamic University Malaysia, \n\n\n\nKuantan, Pahang; 2Department of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, \n\n\n\nUniversiti Sains Malaysia, Penang; 3School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang; \n4Health Centre, Universiti Sains Malaysia, Penang. \n\n\n\n\n\n\n\nTreating tobacco dependence is economically significant since it can prevent a variety of costly chronic \n\n\n\ndiseases, including cancer, heart and pulmonary diseases. Studies have shown that smoking cessation \n\n\n\ntreatments ranging from clinician advice to pharmacotherapy to specialist-delivered intensive programs are \n\n\n\ncost-effective relative to other commonly used disease prevention interventions and medical treatments. \n\n\n\nHowever, local data on cost-effectiveness of medications for smoking cessation interventions is lacking. \n\n\n\nThus, we conducted a cost-effectiveness analysis (CEA) of medications used at a quit smoking clinic in \n\n\n\nMalaysia. Methods: Cost-effectiveness analysis of data from a local quit smoking clinic, involving cost of \n\n\n\ninputs (health personnel, medications in the form of nicotine gum and/or patch, disposables, printed \n\n\n\nmaterials, assets, space) and outcomes, i.e., quit rates (%) by types of treatment (counselling \u00b1 medications). \n\n\n\nResults: Data from 129 male smokers during a period of 34.5 months. Average duration of time spent per \n\n\n\nclient = 15 minutes. Average cost of health personnel per client visit = RM11.25. Total cost of medications = \n\n\n\nRM15,916.10. Total cost of the program =RM38,634.66. Quit rate for nicotine gum = 24% vs. 30% for both \n\n\n\ngum and patch. No clients quit using nicotine patch. CE ratio for gum = 1067 vs. 842 for gum + patch. \n\n\n\nAverage cost of cigarettes spent by each client/month = RM 131.25. Conclusions: Smoking cessation \n\n\n\nmedications are cost-effective. The higher success rate with combined gum and patch use suggests a need of \n\n\n\nhigher nicotine dosing than using gum or patch alone. \n\n\n\n \n\n\n\n\n\n\n\n\nS115 \n\n\n\nPoster Presentation PPP1 (000006) \n\n\n\n\n\n\n\n\n\n\n\nCauses of Drug Administration Errors In Medical Wards \n \n\n\n\nR Malini, T Shantini \n\n\n\nDepartment of Pharmacy, Hospital Kajang, Kajang, Selangor Darul Ehsan \n\n\n\n\n\n\n\nDrug administration errors largely involve errors of omission where administration is omitted due to various \n\n\n\nfactors such as wrong patient and lack of stock. The objective of this study is to identify the causes of drug \n\n\n\nadministration errors and to reduce it. This is a prospective study conducted for a month in medical wards. \n\n\n\nFrom this study, it was observed that there were a number of factors that caused drug administration errors in \n\n\n\nthe medical wards. These errors commonly occurred in the wards and therefore an intervention was \n\n\n\nintroduced to reduce such errors. It was found that the common causes of drug administration errors were \n\n\n\n\u2018using other patient\u2019s medication\u2019, \u2018using incorrect measuring cups\u2019, \u2018using the after office hours\u2019 stock\u2019, \n\n\n\n\u2018patient's medication not in the trolley bin or in the wrong bin\u2019, \u2018more than one patients' medications in the \n\n\n\nsame bin\u2019 and \u2018discharged patients' medications still in the trolley bins\u2019. An intervention to label the trolley \n\n\n\nbin with patient's name, registration number and the existing bed number was introduced. It was found \n\n\n\nthat the numbers of causes of drug administration errors was significantly higher in the pre-study than in the \n\n\n\npost-study. This demonstrates that labelling the trolley bins with patients\u2019 name and registration numbers can \n\n\n\nreduce the causes of drug administration errors.  \n\n\n\n\n\n\n\nPoster Presentation PPP2 (000007) \n\n\n\n\n\n\n\n\n\n\n\nA Consumption Pattern Survey Of Antibiotics In A Large Teaching Hospital In Tehran \n \n\n\n\nS A Mortazavi, G Hajebi \n\n\n\nSchool of Pharmacy, Shaheed Beheshti University of Medical Sciences, Vali-e-asr Avenue, Tehran, Iran \n\n\n\n\n\n\n\nIrrational and uncontrolled consumption of antibiotics could increase the number of resistant bacterial \n\n\n\nspecies, particularly in hospital infections, and cause hazardous adverse effects albeit avoidable. This study \n\n\n\ninvestigated the consumption pattern of antibiotics in different wards of Taleqani teaching hospital, a large \n\n\n\nand well-known medical centre in Iran, using the ATC/DDD (defined daily dose) system within the \n\n\n\nframework of DUE (drug use evaluation) retrospective studies. Among 2137 filed patient records, 57% \n\n\n\nreceived antibiotics, accounting for 19.42% of the overall hospitalization drug expenses. Over 68% of \n\n\n\npatients underwent surgery received antibiotics. The overall amount of antibiotics consumed was found to be \n\n\n\n99.82 DDD/100 bed days. 79.34% of the antibiotics used were parenteral. Orthopedics and repair surgeries \n\n\n\naccounted for the greatest (23%) amount of antibiotic consumption, followed by infectious (19%), GI (17%), \n\n\n\nand gynecology and obstetrics (15%) diseases. Over 75% of the total amount of antibiotics used was due to \n\n\n\ncephalosporins (49%) and penicillins (27%). Aminoglycosides (6%), imidazole derivatives (5%), \n\n\n\nfluoroquonolones (4%) and other groups (9%) made up the rest. The consumption rate of antibiotics in \n\n\n\nTaleqani teaching hospital, and possibly throughout Iran, appears to be greatly higher than similar European \n\n\n\nstudies. Furthermore, based on the present study, antibiotic prophylaxis in different categories of surgery \n\n\n\n(especially in elective surgeries) on a few days basis seems to be irrational and costly. Hence, the physicians \n\n\n\nhabits in prescribing antibiotics should be revised in Iran. National drug policies, holding regular continuous \n\n\n\neducational meetings for the prescribers and preparing standard treatment guidelines by the governmental \n\n\n\ndrug authorities are suggested. \n\n\n\n\n\n\n\n\nS116 \n\n\n\n\n\n\n\nPoster Presentation PPP3 (000010) \n\n\n\n\n\n\n\n\n\n\n\nAssessment Of Undergraduate Community Pharmacy Attachment Programme \n \n\n\n\nI Abdul Wahab, P L Lua, N A Ramli  \n\n\n\nFaculty of Pharmacy, Universiti Teknologi MARA (UiTM), Shah Alam, Selangor \n\n\n\n\n\n\n\nA three-week Community Pharmacy Attachment Program for sixth semester, Bachelor of Pharmacy (Hons.) \n\n\n\nundergraduates was designed to provide students with an early exposure of technical and relevant pharmacy \n\n\n\nskills. The aim of this study was to evaluate students\u2019 overall performance in this special training. Fifty-two \n\n\n\npharmacy outlets in Peninsular Malaysia, including one in East Malaysia, were chosen as training locations \n\n\n\nfor 61 students (male = 14; female = 47; mean age = 21 years; range = 21 \u2013 25 years). Fifteen major criteria \n\n\n\nwere created by the Community Pharmacy Secretariat for students to be assessed by pharmacist in-charge in \n\n\n\ntheir respective locations. The responses were scored from 1 to 5 (1 = poor, 2 = fair, 3 = good, 4 = very \n\n\n\ngood, 5 = excellent). On average, students obtained the highest score in terms of Punctuality (4.46 \u00b1 0.62), \n\n\n\nwhile lowest scores were given for aspects of Problem-Solving Ability (3.64 \u00b1 0.78) and Creativity (3.64 \u00b1 \n\n\n\n0.95). The positive outcome on punctuality was most likely due to their attendance being part of the \n\n\n\nevaluation. Their relatively lower scores for Problem-Solving Ability and Creativity were due to the \n\n\n\nattachment being scheduled before their theory classes. Nevertheless, students were overall considered to be \n\n\n\nvery good (4.00 \u00b1 0.11) in majority of the criteria assessed. These outcomes indicated that the students need \n\n\n\nto be further polished on their problem-solving ability and creativity via future restructuring of the \n\n\n\nprogramme. This will serve to ensure that the desired quality and professionalism are embedded in \n\n\n\npharmacist-to-be. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nPoster Presentation PPP4 (000027) \n\n\n\n\n\n\n\nOTC-Steroids In Community Pharmacy \n \n\n\n\nR Wati, A B A Majeed, P L Lua \n\n\n\nFaculty of Pharmacy, Universiti Teknologi MARA, Shah Alam, Selangor \n\n\n\n\n\n\n\nA large percentage of primary care pharmacy visits are dermatological related complaints. Individuals \n\n\n\nfrequently present with skin, hair or nail problems to community pharmacists due to their ease of \n\n\n\naccessibility. Therefore, this study was carried out to determine the type and frequency of purchases of skin-\n\n\n\nrelated products by the pharmacy\u2019s customers. Data collected for the research project was derived from the \n\n\n\ncommunity pharmacy\u2019s computer system called the PHARMAPOS system. Meanwhile customers were also \n\n\n\ninterviewed by the research assistants to assess whether their dermatological ailments were treated by any \n\n\n\nmedical practitioners prior to visiting the pharmacy. A total of 794 skin related preparations purchased were \n\n\n\nrecorded from June - December 2005. This gave an average of 132 items per month and 4 items per day. \n\n\n\nApproximately 82% of the products sold were already available over-the counter (OTC). These included \n\n\n\ntopical preparations for antifungal, antibacterial or anti-acne use, corticosteroids and combination \n\n\n\npreparations. Topical corticosteroids (plain/combinations) represented 75% (597/794) of the total products \n\n\n\npurchased. Among these, 25% of the buyers obtained advice/treatment from their medical practitioners at \n\n\n\nsome stage. Based on the large numbers of OTC topical steroids purchased, it is obvious that community \n\n\n\npharmacists are playing an important role in the management of dermatological related problems and should \n\n\n\nbe a reliable information provider for customers seeking advice. In conclusion, ongoing continuing \n\n\n\nprofessional development programmes for the pharmacists related to the management of dermatological \n\n\n\nconditions are highly recommended. \n\n\n\n\n\n\n\n\nS117 \n\n\n\n\n\n\n\n\n\n\n\nPoster Presentation PPP5 (000074) \n\n\n\n\n\n\n\n\n\n\n\nKnowledge And Perceptions of Recent Pharmacy Graduates About Generic Medicines \n \n\n\n\nM A Hassali, D C M Kong, K Stewart \n\n\n\nVictorian College of Pharmacy, Monash University, Parkville, Victoria, Australia \n\n\n\n\n\n\n\nThe ever-rising price of prescription medicines is a phenomenon that affects nearly every developed country. \n\n\n\nAn effective strategy to contain the escalating costs is to use generic medicines. Within this context, most \n\n\n\npolicy makers are encouraging healthcare professionals to prescribe or substitute with generic medicines \n\n\n\nwhenever possible. Whichever strategy that is adopted, that is generic prescribing or generic substitution, the \n\n\n\nmain challenge is how to instil and maintain confidence of patients and carers in using generic medicines. \n\n\n\nThis is where pharmacists have a pivotal role. The objectives of this study were to evaluate pharmacy pre-\n\n\n\nregistrants\u2019 perceptions of and knowledge about generic medicines and generic substitution, and to explore \n\n\n\nfactors influencing pharmacy pre-registrants\u2019 future generic substitution practices. A web-based survey was \n\n\n\ndeveloped and used to gather data. The sampling frame was pharmacy graduates from Australian universities \n\n\n\nwho were undertaking pre-registration training prior to being eligible to register to practise as a pharmacist. \n\n\n\nThe total number of Australian pharmacy graduates reported as being enrolled in pre-registration courses at \n\n\n\n31st January 2005 was 948. By the end of the three-month study period, 289 pre-registrants responded to the \n\n\n\nsurvey (response rate = 30.5%). More than 80% of the study participants thought that generic medicines are \n\n\n\ninferior, less effective and produce more side effects compared to brand name medicines. These findings \n\n\n\nhighlight the need for pharmacy pre-registrants to better understand the principles and concepts of \n\n\n\nbioavailability and bioequivalence if they are to contribute appropriately to generic medicine use. \n\n\n\n\n\n\n\n\n\n\n\nPoster Presentation PPP6 (000086) \n\n\n\n\n\n\n\n\n\n\n\nA Retrospective Study Of Adverse Drug Reactions Attributed To The Use Of Simvastatin In A \n\n\n\nTertiary Hospital  \n  \n\n\n\nS S Chua1, Abida H2,  Noorulhuda S1, Zamrul N H1, P Lai1,3 \n1Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur; 2National \n\n\n\nPharmaceutical Control Bureau, Ministry of Health, Petaling Jaya, Selangor; 3Pharmacy Unit, University \n\n\n\nMalaya Medical Centre, Kuala Lumpur \n\n\n\n\n\n\n\nStatins have been proven to be both safe and well tolerated in millions of patients but are still not free from \n\n\n\nadverse drug reactions (ADRs). Therefore, this study was conducted to determine the types of ADRs \n\n\n\nassociated with the use of statins, in particular simvastatin.  A retrospective study was conducted at the \n\n\n\nUniversity of Malaya Medical Centre (UMMC). A total of 680 patients who were just started on simvastatin \n\n\n\nin 2003 were identified using the Pharmacy Information System (PIS). The medical records of these patients \n\n\n\nwere reviewed for any recorded ADRs. Eight cases of ADRs (1.2% of the patients) were identified and these \n\n\n\nincluded 2 cases of diarrhoea, 2 cases of rashes, 1 case of muscle ache, 1 case of insomnia, 1 case of irritable \n\n\n\nmood and 1 case of elevated transaminase level more than three times the upper limit. In the same year, 8 \n\n\n\ncases of ADRs associated with the use of simvastatin were reported to the Malaysian Adverse Drug Reaction \n\n\n\nAdvisory Committee (MADRAC). However, none of the cases identified in UMMC were reported to \n\n\n\nMADRAC. This study demonstrates the under-reporting of ADRs to MADRAC and hence the review of \n\n\n\npatients\u2019 medical records could be used as a mean of supplementing such a database. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nS118 \n\n\n\nPoster Presentation PPE1 (000011) \n\n\n\n\n\n\n\n\n\n\n\nAssessment On Pre-Degree Pharmacy Students\u2019 Interest In Pharmacy \n  \n\n\n\nI Abdul Wahab, P L Lua , N A Ramli \n\n\n\nFaculty of Pharmacy, Universiti Teknologi MARA (UiTM), Shah Alam, Selangor \n\n\n\n\n\n\n\nThe Pre-Degree Pharmacy programme (PI010) is the latest introduced by Universiti Teknologi MARA \n\n\n\n(UiTM). It acts as a basis to select excellent candidates with relevant academic qualification to pursue the \n\n\n\npharmacy degree programme. Thirty-nine students registered in May 2006 for their third/last semester. This \n\n\n\nsemester was uniquely brief (5 weeks) and highly-focused on pharmacy-related subjects. A survey was \n\n\n\nadministered in their final week of study 1) to investigate their early interest in pharmacy as a career and 2) \n\n\n\nto evaluate the Introduction to Bioorganic Chemistry course (PHM032). The instrument assessed Course, \n\n\n\nStudent Expectations and Grades, based on Likert scores 1 (strongly disagree) to 5 (strongly agree). A 100% \n\n\n\nresponse was received (male = 15; female = 24; mean age = 19 years; range = 18 \u2013 21 years). Majority \n\n\n\ndecided to pursue pharmacy after secondary school (n = 17; 44%), during Pre-Degree Pharmacy experience \n\n\n\n(n = 12; 31%), during secondary school (n = 9; 23%) and before secondary school (n = 1; 3%). The mean \n\n\n\nscores for PHM032 course were 3.50 \u00b1 0.80 (Course), 3.63 \u00b1 0.64 (Grading) and 3.72 \u00b1 0.76 (Student \n\n\n\nExpectations). The findings indicated that interest towards pharmacy had already been present in many \n\n\n\nstudents after secondary school, probably due to the increased popularity of pharmacy programs in the \n\n\n\ncurrent Malaysian education scenario. Students also responded positively with regard to the PHM032 course \n\n\n\nwhich forms an important pharmacy foundation subject. These collective outcomes are highly encouraging \n\n\n\nsignals for the future of pharmaceutical education in this country. \n\n\n\n\n\n\n\n\n\n\n\nPoster Presentation PPE2 (000018) \n\n\n\n\n\n\n\n\n\n\n\nBasic Health Knowledge Of A Sample Of The Malaysian Urban Population \n \n\n\n\nS W Yeong \n\n\n\nUniversity College Sedaya International, Cheras, Kuala Lumpur \n\n\n\n\n\n\n\nThe movement towards patient directed care could be seen with the recent emphasis on clinical pharmacy. It \n\n\n\nremains unsure whether the general public (patients) is ready for the intended pharmaceutical care. Their \n\n\n\nlevel of health literacy is an important factor in the success of drug therapies. With the above in mind, a \n\n\n\nquestionnaire was set-up to understand the basic health knowledge of the general public during a public \n\n\n\nhealth campaign organized by University College Sedaya International in Sunway Pyramid, Kuala Lumpur. \n\n\n\nThe questionnaire that consisted of 20 multiple-choice-questions on health knowledge were distributed to the \n\n\n\nshoppers near the site of the campaign. A total of 118 questionnaires were completed from the three-day \n\n\n\ncampaign. It was found that 84% of the subjects knew that the normal blood pressure was 120/80 mm Hg \n\n\n\nand HDL was the \"good\" cholesterol. Only about half of the subjects were correct in naming 5 mmol/L as \n\n\n\nthe normal cholesterol reading. As for the meaning of LDL to HDL ratio, 45% answered that it is an \n\n\n\nindicator of the risk of getting diabetes mellitus but the correct response should be indicator of the risk of \n\n\n\nstroke. 50% answered that another name for stroke is artherosclerosis, while only 41% knew the correct \n\n\n\nanswer of \"brain attack\". 54% thought that urine tests were used to diagnose diabetes mellitus instead \n\n\n\nof blood tests. Various studies have concluded that insufficient health knowledge was a major barrier in \n\n\n\neducating patients. Therefore, similar studies should be done on our multicultural Malaysian population for \n\n\n\nbetter management of drug therapy. \n\n\n\n\n\n\n\n\nS119 \n\n\n\n\n\n\n\n\n\n\n\nPoster Presentation PPE3 (000093) \n\n\n\n\n\n\n\n\n\n\n\nRational Use Of Antibiotics Among Pharmacy Students \n \n\n\n\nMahmathi Karuppannan, Shubashini Gnanasan, Elya Noor Seikh Omar \n\n\n\nFaculty of Pharmacy, Universiti Teknologi MARA, 40450 Shah Alam, Selangor \n\n\n\n\n\n\n\nAntibiotic resistance is a rapidly increasing phenomenon. Irrational use of antibiotics is one of the major \n\n\n\ndeterminants in the development of resistance. This cross-sectional study was conducted to determine the \n\n\n\nknowledge, attitude and behavior of pharmacy students of a University towards antibiotic use. A \n\n\n\nquestionnaire consisting of 13 items was designed and given to all the pharmacy students in Universiti \n\n\n\nTeknologi MARA (n = 300). The mean age was 20.6 \u00b1 1.4 (range = 18 - 29) and 74% were females. The \n\n\n\nmean antibiotic knowledge score was 9.02 \u00b1 1.4 (total score = 12, score range = 4 - 12) with mean score for \n\n\n\n4th year students, 9.96 \u00b1 1.2 and 1st year students, 8.82 \u00b1 1.42. Out of 300 students, 57.7% believed that \n\n\n\nantibiotics could be used for common cold and 78.7% agreed that antibiotics could be started with a \n\n\n\npharmacist\u2019s advice. Self-medication with antibiotics was admitted by 15% of the students and 12.1% of the \n\n\n\nrespondents used antibiotics until their symptoms disappeared. More than half of the students (66.8%) \n\n\n\ncompleted the antibiotic course during their last infection and 67.8% did not know the name of the \n\n\n\nantibiotics they used. These findings show that the knowledge of pharmacy students on antibiotics is \n\n\n\nmoderate. It is rather surprising to know that pharmacy students approve antibiotics against common cold \n\n\n\nand most of the pharmacy students agree that antibiotics could be started with pharmacist\u2019s advice, in a \n\n\n\ncountry where a prescription is needed for antibiotics. Specific education regarding antibiotics for pharmacy \n\n\n\nstudents can improve the knowledge and rational use of antibiotics. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nPoster Presentation POO1 (000068) \n\n\n\n\n\n\n\n\n\n\n\nAsthma Care Before And After Hospitalization: Potential Role For Pharmacists Intervention \n \n\n\n\nSamsinah H1, Ramli Z2, Mohamed Izham M I2, Wan Jazilah W I3 \n1Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur; 2School of \n\n\n\nPharmaceutical Sciences, Universiti Sains Malaysia, Penang; 3Department of Paediatrics, Hospital Selayang, \n\n\n\nKuala Lumpur \n\n\n\n\n\n\n\nAccording to the national guideline, effective asthma management encompasses the following components; \n\n\n\nassessment and monitoring, identifying and controlling of triggers, appropriate pharmacotherapy, and \n\n\n\neducation for partnership in care. Evidence suggests that unscheduled clinic and emergency department (ED) \n\n\n\nvisits reflect failure of long term care. Interventions by pharmacists have been shown to improve outcome of \n\n\n\ncare. Objective: To describe the management of asthma six months before and four months after \n\n\n\nhospitalization in Selayang Hospital. Methods: Electronic medical records of children aged 5-14 years \n\n\n\nhospitalized for asthma were reviewed in retrospective based on the management components. Results: 72 \n\n\n\n(37% female) children met the inclusion criteria. Prior to index admission, three children had previous \n\n\n\nhospitalization. 83% had at least one visit of which more than half experienced multiple visits (2 to 8; \n\n\n\nmedian=3). Medications upon admission included combination therapy (inhaled corticosteroid (ICS) and \n\n\n\nshort acting beta-2 agonist (SABA) and/or long acting beta-2 agonist (LABA)), SABA only or oral anti-\n\n\n\nasthmatics.  40% were not on any medication. It was also found that 43% of those on combination therapy \n\n\n\nwere non-compliant. Inhaler technique was assessed in 15% and trigger factors were identified in 70% of the \n\n\n\npatients during hospitalization. Assessment of severity was documented in 25% of the patients and 68% \n\n\n\nwere discharged with ICS. Within four months after hospitalization, 28% of the children re-attended ED, 6% \n\n\n\nwere re-admitted and 25% defaulted with follow-up appointments. Conclusion: The management of asthma \n\n\n\nfell short of that recommended by the guideline. Pharmacists can assist in the management of asthma. \n\n\n\n\n\n\n\n\nS120 \n\n\n\nPoster Presentation PCP1 (000003) \n\n\n\n\n\n\n\n\n\n\n\nAntimicrobial Susceptibility Pattern Of The Uncommonly Isolated Burkholderia cepacia Strains \n \n\n\n\nH Mehrgan1, M Rahbar2  \n1Department of Pharmaceutics, School of Pharmacy, Shaheed Beheshti University of Medical Sciences, \n\n\n\nTehran, Iran; 2Reference Laboratory, Ministry of Health, Tehran, Iran \n\n\n\n\n\n\n\nAntimicrobial susceptibility pattern of Burkholderia cepacia (B. cepacia), a rare but life-threatening \n\n\n\npathogen causing fatal infections especially among immunocompromised or cystic fibrosis patients, was \n\n\n\nevaluated in this study. During May 2005 to March 2006, 12 strains of B. cepacia were isolated from various \n\n\n\nspecimens of patients admitted to Milad Hospital (Tehran, Iran) and their susceptibility to antibiotics was \n\n\n\nassessed by the disk diffusion technique (NCCLS 2004). Demographic data and medical history of the \n\n\n\npatients were also gathered using a questionnaire. Of 12 cases studied, 7 (58.3%) were female and 5 (41.7%) \n\n\n\nmale. Specimens from which the strains were isolated included blood (7, 58.3%), respiratory tube (2, \n\n\n\n16.7%), urine, wound and femur bone (1 each, 8.3% each). These isolates were frequently from medical \n\n\n\nwards (66.7%) than ICU (25.0%) or surgical wards (8.3%). Blood samples were mostly (71.4%) from \n\n\n\nchildren particularly infants (<2 years) and other samples from adult patients especially those >55 years of \n\n\n\nage. The respiratory tube isolates were from patients on mechanical ventilation. The susceptibility pattern (% \n\n\n\nsusceptible) of the isolates against the tested antimicrobials were as follows: ceftazidime, 50.0; cefotaxime, \n\n\n\n0.0; ceftriaxone, 0.0; cefepime, 50.0; aztreonam, 0.0; imipenem, 100; piperacillin, 50.0; piperacillin-\n\n\n\ntazobactam, 50.0; ticarcillin-clavulanic acid, 50.0; ciprofloxacin, 58.3; amikacin, 58.3; gentamicin, 8.3; \n\n\n\ntobramycin, 8.3; sulfamethoxazole-trimethoprim, 83.3; tetracycline, 66.7. Our findings suggest imipenem as \n\n\n\nthe sole antimicrobial agent absolutely active against this bacterium. Nevertheless, sulfamethoxazole-\n\n\n\ntrimethoprim that is the historical drug of choice for treatment of infections caused by B. cepacia remains \n\n\n\nuseful in our hospital. \n\n\n\n\n\n\n\n\n\n\n\nPoster Presentation PCP2 (000016) \n\n\n\n\n\n\n\n\n\n\n\nVital To Monitor Prescribing Practices: A Case Report On Prescribing Error In A Malaysian \n\n\n\nCommunity Clinic \n \n\n\n\nP L Lua \n\n\n\nFaculty of Pharmacy, Universiti Teknologi MARA, Shah Alam, Selangor \n\n\n\n\n\n\n\nDespite increases in the number of community pharmacies, the Malaysian society is still dependent on drug \n\n\n\nprescribing and dispensing by general practitioners (GPs). This case aims to highlight the importance of \n\n\n\nmonitoring GP prescribing practices in the absence of pharmacist dispensing rights. All information was \n\n\n\nobtained from patient interview and by counter-checking with the GP\u2019s medication records. A 62-year old \n\n\n\nman with penicillin, aspirin and sulphur allergies complained of common chills and sore throat. He was also \n\n\n\non regular KCl Tablet 600mg 3 tablets qds and KCl Solution 15ml bd for hypokalaemia. Prednisolone Tablet \n\n\n\n5mg bd, Erythromycin Tablet 400mg qds, Cimetidine Tablet 400mg bd and Diphenhydramine Syrup 15ml \n\n\n\ntds were prescribed by the GP. Several hours post-consumption, uncontrolled hiccups appeared - his \n\n\n\nprevious diagnostic hypokalaemic symptom. All medications were stopped but the hiccups failed to subside. \n\n\n\nBlood test clearly showed elevated K+ level and decreased Na+ level plus abnormal ECG change. Upon \n\n\n\nhospitalisation, the electrolyte imbalance was corrected via intravenous infusion of dextrose and insulin (to \n\n\n\npromote shift of K+ into intracellular space), leading to ECG normalisation. This case illustrates the \n\n\n\nunwarranted outcomes of prescribing error which had led to classical drug interactions. Cimetidine could \n\n\n\nincrease plasma erythromycin level, increasing the risk of toxicity while erythromycin can inhibit the \n\n\n\nmetabolism of corticosteroids. Corticosteroids could potentially cause fluid and electrolyte disturbances, \n\n\n\nhence its administration to a hypokalaemic patient was highly questionable. In the absence of dispensing \n\n\n\nseparation for pharmacists, patient-initiated spontaneous reporting system on suspicious prescribing-related \n\n\n\nadverse events should be introduced through enhanced public health education/awareness programmes. \n\n\n\n\n\n\n\n\nS121 \n\n\n\n\n\n\n\n\n\n\n\nPoster Presentation PCP3 (000041) \n\n\n\n\n\n\n\n\n\n\n\nEvaluation Study On Patients Taking Antiretroviral Drugs: Efficacy, Side Effects And Compliance \n\n\n\nIssues \n\n\n\n\n\n\n\nH G Lee1,2, S A S Sulaiman1 \n1Department of Pharmacy, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia; 2School of \n\n\n\nPharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia. \n\n\n\n\n\n\n\nThe objective of treating Human Immunodeficiency Virus (HIV) patients with antiretroviral therapy (ART) \n\n\n\nis to improve the patients\u2019 quality of life while keeping adverse effects to a minimum. We performed this \n\n\n\nstudy to describe the types of combination therapy prescribed and to evaluate ART efficacy, side effects and \n\n\n\nmedication compliance among HIV patients. The study was a cross-sectional survey conducted in a public \n\n\n\nhospital in December 2003. Patients were interviewed based on a structured questionnaire after their follow-\n\n\n\nup appointment in the outpatient HIV clinic. A total of 43 patients were selected in the study based on \n\n\n\nconvenience sampling and their ages ranged from 25 -55 years old (mean\uf0b1SD= 37.91\uf0b17.69 years). 18.6% of \n\n\n\nthem were unemployed while the remaining had a monthly income of around RM1000. Interviewed patients \n\n\n\nhad been on ART for an average of 2.34\uf0b11.79 years. Triple therapy was the most popular combination \n\n\n\ntherapy prescribed (n=37, 86%) and as high as 55.8% had their treatment plan changed during their course of \n\n\n\ntreatment. Although 58.1% (n=25) of subjects obtained positive trends in CD4 counts from the medication \n\n\n\nprescribed, medication non-compliance however was observed to be high, at 44.2 %. Financial constrains \n\n\n\nand adverse drug reactions were identified as the main problems that led to non-compliance.  Medication \n\n\n\ncompliance is a crucial issue that needs to be addressed in this study population. Missing even 5% of \n\n\n\nantiretroviral medications during the course of treatment may impair the HIV patients\u2019 chances of \n\n\n\nsuppressing viral replication. By identifying issues related to drug treatment in HIV patients, health \n\n\n\nprofessionals may help them cope with their illness better. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nPoster Presentation PCP4 (000044) \n\n\n\n\n\n\n\n\n\n\n\nIs Diuretic Therapy Inappropriate In Ascites Patients With Ineffective Intravascular Volume? A Case \n\n\n\nReport \n\n\n\n\n\n\n\nFeras Jassim Jirjees1, Noorizan Abd Aziz1, Yahaya Hassan1, Rozina G 2 \n1School of Pharmaceutical Science, University Sains Malaysia, Pulau Pinang; 2Deparment of Medicine, \n\n\n\nHospital Pulau Pinang, Pulau Pinang \n\n\n\n\n\n\n\n The objective of this study is to present a case of a patient with ascites and how he was managed without \n\n\n\ndiuretic therapy. A 53-year-old Indian man was admitted to the medical ward in Penang general hospital on \n\n\n\n2/5/2006 with problems of fever, hypotension (due to ineffective intravascular volume), encephalopathy, \n\n\n\nascites, dehydration, and leg edema leading to the inability to walk, and in an uncomfortable and confused \n\n\n\nstate. He was treated with antibiotics, potassium chloride, normal saline, dextrose 5%, ranitidine, and \n\n\n\nthiamine. Some of his problems were resolved during his admission, including dehydration, hypotension, \n\n\n\nand encephalopathy. However his ascites and leg edema persisted, which contributed to him persistently \n\n\n\nfeeling uncomfortable. He was discharged and had to obey fluid and sodium restrictions. Proper use of \n\n\n\ndiuretics would have helped to improve his fluid distribution with minimal effects on intravascular volume \n\n\n\nand electrolytes. In conclusion, diuretic therapy (spironolactone and/or furosemide) should have been given \n\n\n\nto this patient after his BP had normalized to achieve optimum outcomes. \n\n\n\n\n\n\n\n\nS122 \n\n\n\nPoster Presentation PCP5 (000066) \n\n\n\n\n\n\n\n\n\n\n\nGroup Of Antibiotics Most Frequently Prescribed For Upper Respiratory Tract Infection In \n\n\n\nPediatrics \n\n\n\n\n\n\n\nM Anwar Khan, Moh Baidi, Revathy Nellusamy \n\n\n\nSchool of Pharmacy, University Sains Malaysia, 11800 Pulau Pinang, Malaysia; Department of Pediatric, \n\n\n\nHospital Pulau Pinang Malaysia (HPPM), Penang \n\n\n\n\n\n\n\nAntibiotics are commonly used for the therapy of upper respiratory tract infections (URTI) in pediatrics. The \n\n\n\nuse of antibiotics for the management of URTI may vary depending on the type of infecting organism.  This \n\n\n\nstudy was carried out to determine the pattern of antibiotic usage in pediatric URTIs in Penang Hospital. The \n\n\n\ndata from January to December 2003 were collected retrospectively from the record office and transferred \n\n\n\ninto study form and analyzed using SPSS version 12.01. The results were that 36 male and 46 female \n\n\n\npediatrics were confirmed to have URTIs. 29 of them were less than 3 years old, 15 were between 3 to 6 \n\n\n\nyears and 38 were more than 6 years old.  The most frequent type of URTI were rhinitis and cold (13.41% \n\n\n\neach) followed by bronchitis and otitis media (12.9% respectively), viral URTI (8.53%), sinusitis (7.31%) \n\n\n\nand others. Penicillins were the most commonly prescribed antibiotics.  It was also the most frequently \n\n\n\nprescribed antibiotics for bronchiolitis and sinusitis, while cephalosphorins were frequently used for otitis \n\n\n\nmedia and macrolides for sinusitis, bronchopneumonia and phyringotonsilitis.  The data show that the \n\n\n\nselection of antibiotics was made based on the type of URTIs. \n\n\n\n\n\n\n\n\n\n\n\nPoster Presentation PCP6 (000075) \n\n\n\n\n\n\n\nDifferential Protein Binding Of HIV Protease Inhibitors In Matched Umbilical Cord And Maternal \n\n\n\nPlasma \n  \n\n\n\nS Sudhakaran, C R Rayner, J Li, D C M Kong, N M Gude, R L Nation \n\n\n\nVictorian College of Pharmacy, Monash University, Parkville, Victoria, Australia \n\n\n\n\n\n\n\nThe pharmacokinetics of the anti-HIV agents, Protease Inhibitors (PIs) in the fetus is not well explored. This \n\n\n\nproject aims to determine whether lower umbilical cord (C) than maternal (M) binding of indinavir and \n\n\n\nsaquinavir contributed to the low cord:maternal (C/M) total plasma concentration ratios reported previously. \n\n\n\nThe unbound fraction (fu) of indinavir and saquinavir was determined using equilibrium dialysis. Binding to \n\n\n\npurified human serum albumin (HSA) and \uf0611-acid glycoprotein (AAG) in buffer solutions was examined. \n\n\n\nMatched C and M plasma was spiked with 1.00 mg/L indinavir (n = 12) or 0.15 mg/L saquinavir (n = 20). \n\n\n\nHSA and AAG concentrations in C and M plasma were measured using radial immunodiffusion. Indinavir \n\n\n\nand saquinavir demonstrated protein concentration-dependent binding in buffer solutions of HSA and AAG. \n\n\n\nThe fu of indinavir was significantly higher (p = 0.001) in C (0.53 \uf0b1 0.12) compared with M (0.36 \uf0b1 0.11) \n\n\n\nplasma. The fu of saquinavir was different (p < 0.001) between C (0.0090 \uf0b1 0.0046) and M (0.0066 \uf0b1 0.0039) \n\n\n\nplasma. HSA and AAG concentrations differed (p < 0.030) in C versus M plasma. The transplacental AAG \n\n\n\nconcentration gradient contributed significantly to the binding differential of both PIs. The fu of indinavir and \n\n\n\nsaquinavir was significantly higher in C than M plasma, thus contributing to the low C/M total plasma \n\n\n\nconcentration ratios observed previously for PIs. The unbound concentrations of indinavir and saquinavir are \n\n\n\nlikely to be substantially lower in C than M plasma, and this is relevant for prophylaxis of perinatal \n\n\n\ntransmission of HIV. \n\n\n\n \n\n\n\n\n\n\n\n\nS123 \n\n\n\nPoster Presentation PCP7 (000079) \n\n\n\n\n\n\n\nCost Of Adherence And Non-Adherence To Antibiotic Guideline For Surgical Antimicrobial \n\n\n\nProphylaxis In A Tertiary Care Hospital \n \n\n\n\nJ S Low1, S Hussain1, R Rajasuriar1, D Poopaladurai2, A C Roslani3 \n1Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur; 2Pharmacy Unit, \n\n\n\nUniversity of Malaya Medical Centre, Kuala Lumpur; 3Department of Surgery, Faculty of Medicine, \n\n\n\nUniversity of Malaya, Kuala Lumpur \n\n\n\n\n\n\n\nSuboptimal use of surgical antimicrobial prophylaxis (SAP) has been shown to increase health care costs \n\n\n\nthrough extended hospitalization, treatment of infections and antibiotic resistance. This study was conducted \n\n\n\nto determine and to compare the direct costs of SAP between adherent and non-adherent use according to \n\n\n\nUniversity of Malaya Medical Centre (UMMC) SAP guidelines in patients undergoing specific surgeries. \n\n\n\nMedical records of 130 patients who underwent elective surgeries (orthopaedic, general and ENT) from \n\n\n\nJanuary to June 2005 were randomly selected from each category of surgery and reviewed in retrospective. \n\n\n\nDirect medical costs of SAP, from the hospital's perspective, were calculated with respect to (i) cost of \n\n\n\nadherent and non-adherent use of SAP, (ii) cost of postoperative antibiotic use (associated with prophylaxis \n\n\n\nor treatment of surgical site infections). Data on SAP administrations were obtained from the adherence \n\n\n\nstudy. Cost of antibiotics was calculated with reference to the Pharmacy Information System. Among the \n\n\n\n304 cases assessed, 40.8% were given SAP. RM9236.46 was spent on SAP in 90.2% (N=122) non-adherent \n\n\n\ncases with potential savings of RM7260.45 if the SAP guidelines were followed. The average cost of \n\n\n\npostoperative antibiotic use for non-adherent cases (67.8%) was RM44.65 as compared to adherent cases \n\n\n\n(32.2%) at RM4.14 (N=304). The study suggests that non-adherence to SAP guidelines led to increased drug \n\n\n\ncosts. Knowledge of the direct costs of SAP can be utilized to evaluate the impact of SAP use on the overall \n\n\n\nhospital expenditure. \n\n\n\n\n\n\n\nPoster Presentation PCP8 (000087) \n\n\n\n\n\n\n\nAn Assessment Of Empiric Antibiotic Therapy Of Hospitalized Patients With Community-Acquired \n\n\n\nPneumonia \n \n\n\n\nThanimalai S1, Rajasuriar R2, Abdullah F1, Ali S F1, Hashim A1, Ahmad M1, Mohd Kassim K N B1, \n\n\n\nMd. Saman K1, Saari N1 \n1Pharmacy Division, Ministry of Health, Malaysia; 2Pharmacy Department, Faculty of Medicine, University \n\n\n\nof Malaya, Kuala Lumpur \n\n\n\n\n\n\n\nBackground: Decisions on appropriate empiric antibiotic therapy for community-acquired pneumonia (CAP) \n\n\n\nis a challenge in Malaysia due to the lack of national guidelines and reliable prevalence data on microbial \n\n\n\nresistance patterns for pathogens causing CAP. The utilization of antibiotics without clear and specific \n\n\n\nguiding principles carries the risk of causing widespread microbial resistance and unnecessary treatment \n\n\n\ncosts. Objectives: (1) To describe the pattern of empiric antibiotic therapy prescribed to hospitalized CAP \n\n\n\npatients and its adherence to international guidelines (2) To assess the extent of sequencing therapy utilized \n\n\n\namong these patients. Method: A prospective, observational study was conducted from 1 July-30 September \n\n\n\n2003. Adult patients admitted to 11 government-funded hospitals in Malaysia with a working diagnosis of \n\n\n\nCAP were randomly recruited. Data on patient demographics, antibiotic utilization and treatment courses \n\n\n\nwere noted. Data were analyzed using SPSS 9.0 and p<0.05 was considered to be significant. Results: There \n\n\n\nwere 287 patients recruited with a mean(\uf0b1SD) age of 50.8(\uf0b120.5) years. The majority were Malay (48.8%) \n\n\n\nmales (57.5%). 473 courses of empiric antibiotic therapy was initiated; 39.5% monotherapy, 56.4% dual-\n\n\n\ntherapy and 4.2% triple-therapy. The most common empiric regimen prescribed was the \uf062-lactam/\uf062-\n\n\n\nlactamase inhibitor and macrolide combination (35.2%) followed by \uf062-lactam/\uf062-lactamase inhibitor as \n\n\n\nmonotherapy (20.9%). While choice of agent was concordant in 86.1% of cases with international guideline \n\n\n\nrecommendations, only 36.4% of patients with confirmed CAP underwent sequencing therapy. Patients with \n\n\n\nsequencing therapy had a significantly shorter duration of hospital stay compared to those without. (mean 4.9 \n\n\n\nvs 7.7 days, t(127)=4.04, p<0.001). Conclusion: Greater efforts should be placed on programs that promote \n\n\n\nIV-to-oral switch in therapy to further improve the management of CAP. \n\n\n\n\n\n\n\n\nS124 \n\n\n\nPoster Presentation PCP9 (000059) \n\n\n\n\n\n\n\nFactors Influencing The Quality Of Life In Kidney Failure Patients \n\n\n\n\n\n\n\nMansour Adam1, Yahaya Hassan1, Noorizan Abdulaziz1, Rozina Gazali2, Zalila Ali3 \n\n\n\n1School of Pharmaceutical Science, Universiti Science Malaysia, Pulau Pinang; 2Department of Medicine, \n\n\n\nHospital Pulau Pinang, Pulau Pinang; 3School of Mathematics, Universiti Science Malaysia, Pulau Pinang \n\n\n\n\n\n\n\nKidney failure patients on maintenance haemodialysis and peritoneal dialysis experience decreased quality \n\n\n\nof life and increased mortality compared to the normal population. The purpose of this study was to \n\n\n\ninvestigate factors that influence the quality of life in patients with kidney failure. A total of 308 patients \n\n\n\nwere studied prospectively. Twelve cases were excluded from the study due to death (3), patient absconded \n\n\n\nfrom the medical ward (2) and patients discharged on self risk (7). Patients with GFR of <15 ml/minute/1.73 \n\n\n\nm2 were recruited as cases, and those with GFR>15 ml/minute/1.73m2 were considered as controls. The \n\n\n\nSF36 (Short Form with 36 questions) for quality of life is a self administered and well documented \n\n\n\nquestionnaire which contains eight domains (general health, vitality, mental health, physical functioning, \n\n\n\nrole physical, bodily pain, social functioning, and role emotional). The mean age of patients was \n\n\n\n51.17\u00b116.76 years. The ethnic group distribution was Malays (40.5%), Chinese (45.6%), and Indians or \n\n\n\nothers (13.9%). There were 50.7% male and 49.3% female patients. 37.2% of patients were on hemodialysis, \n\n\n\n12.5% on peritoneal dialysis and 50.3% were not on any dialysis. The mean score of SF36 for quality of life \n\n\n\nmeasure for the eight domains was persistently higher in the kidney failure group than the control group. The \n\n\n\nStudent t-tests showed significant difference (P<0.001) between the two groups in terms of their general \n\n\n\nhealth, vitality and mental health. Mann-Whitney test shows a significance difference (P<0.001) between the \n\n\n\ntwo groups in term of physical functioning, role physical, bodily pain, social functioning and role emotional. \n\n\n\nBased on the general linear model test, it was found that increased age, lower creatinine clearance, \n\n\n\ncalcium/phosphorus balance agents, longer duration of chronic kidney disease (CKD), antihypertensive \n\n\n\ndrugs (excluding diuretics), primary education,  cardiovascular drugs (such as nitrates, digoxin, lipid \n\n\n\nlowering agents, diuretics) were found to be associated with  a lower quality of life. Higher education was \n\n\n\nfound to be associated with a better quality of life. Therefore, the study demonstrates that the SF36 quality of \n\n\n\nlife measure can be used to determine factors that influenced the quality of life in patients with kidney failure. \n\n\n\n\n\n\n\n\n\n\n\nPoster Presentation PCP10 (000050) \n\n\n\n\n\n\n\n\n\n\n\nEvaluation Of Comparative Efficacy Between Generic And Innovator Products Of Simvastatin And \n\n\n\nPravastatin \n\n\n\n\n\n\n\nC L Yoong, C E Lim, A Lee, M I Hashim, M Kathirgamanathan, L M Yap, N Mohd Nazri, C D \n\n\n\nRamachandran \n\n\n\nDepartment of Pharmacy, National Heart Institute Malaysia, Kuala Lumpur \n\n\n\n\n\n\n\nWith the availability of generic brands of simvastatin and pravastatin in Malaysia due to the patent expiry of \n\n\n\nZocor and Pravachol, the P&T Committee of the National Heart Institute (IJN) recently decided to evaluate \n\n\n\nthe possibility of substituting these agents with their generic equivalents; simvastatin 10mg and pravastatin \n\n\n\n20mg tablets. An open label, observational study was undertaken to evaluate the efficacy of these generic \n\n\n\nsubstitutions by comparing the cholesterol levels of patients after switching over from the innovator products. \n\n\n\nA total of 304 patients (simvastatin-228; pravastatin-76) who met the study inclusion criteria were enrolled \n\n\n\nin the study and their cholesterol levels monitored. In the simvastatin arm, the results showed no significant \n\n\n\ndifference in LDL, HDL and total cholesterol levels after the switch-over compared to when the patients \n\n\n\nwere on the innovator products. The exception was for the triglycerides level with a significant drop of 7.1%. \n\n\n\nSimilar results were also observed with the generic pravastatin 20mg except for LDL levels with a \n\n\n\nsignificant drop of 4.7%. Overall, the study shows a very positive result toward the generic equivalence of \n\n\n\nthe drugs, suggesting that both innovator and generic simvastatin and pravastatin have similar efficacy in \n\n\n\ntheir lipid-lowering effect. In conclusion, the generic simvastatin and pravastatin is as efficacious as its \n\n\n\ninnovator products, thus suggesting brand substitution as a possibility. \n\n\n\n\n\n\n\n\nS125 \n\n\n\n\n\n\n\n\n\n\n\nPoster Presentation PPC1 (000005) \n\n\n\n\n\n\n\n\n\n\n\nOptimization Of The Dimerisation Of Stilbenes By HPLC Technique \n \n\n\n\nBuniyamin I, S A Illah, Velu S S, Abdul Wahab I, Weber J F F, Thomas, N F \n\n\n\nFaculty of Pharmacy, UiTM, Shah Alam, Selangor \n\n\n\n\n\n\n\nSixteen different solvent systems were evaluated for the dimerisation of 3,4-dimethoxy-12-\n\n\n\nbenzyloxystilbene 1: water, acetonitrile, methanol, ethanol, acetone, 2-propanol, methyl ethyl ketone, ethyl \n\n\n\nacetate, dichloromethane, chloroform, dimethylformamide, tetrahydrofuran,  xylene, toluene, hexane  and \n\n\n\ndiethyl ether. Starting material 1 was introduced to the above mentioned solvents with 15 equivalent of ferric \n\n\n\nchloride (FeCl3) 60% w/v for 12 hours. After removal of the ferric chloride reagent by filtration on silica, \n\n\n\nthe reaction mixture was diluted to make it 1 mg/mL, with 4-acetoxystyrene added as internal standard. The \n\n\n\n16 samples were injected into an analytical High Performance Liquid Chromatography (HPLC) column. A \n\n\n\nstandard chromatogram gave the following retention time, tR (\u00b10.1 min); internal standard = 2.7, 1 = 4.4. \n\n\n\nMeanwhile, the dimers, 2 and 3, were eluted in tR (\u00b10.1 min) = 12.5 and 19.8, respectively. The dimerisation \n\n\n\nof 1 could be significantly optimized by using dichloromethane as the solvent, where 2 and 3 arose as major \n\n\n\nproducts. In the case of chloroform, the formation of 2 and 3 were suppressed and two unknown products \n\n\n\nwere formed. For the rest of the mentioned solvents, the HPLC chromatograms did not show significant \n\n\n\npeaks of 2 and 3 and some of them do not show any noticeable product peaks. \n\n\n\n\n\n\n\n\n\n\n\nPoster Presentation PPC2 (000048) \n\n\n\n\n\n\n\n\n\n\n\nDetermination Of Ethanol At Various Fermentation Intervals Of Traditionally Fermented Glutinous \n\n\n\nRice And Tapioca (Tapai) Using Fourier Transform Infrared Spectroscopy (FTIR) \n \n\n\n\nS K Hong, M I Noordin \n\n\n\nDepartment of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur \n\n\n\n\n\n\n\nTapai is a traditional fermented food available in Malaysia. The ethanol content in fermented tapai is the \n\n\n\nmajor concern of this study. The fermentation duration required for ethanol to be formed in both fermented \n\n\n\ntapai pulut and tapai ubi was determined. Ethanol contained in tapai was detected by using Attenuated Total \n\n\n\nReflectance (ATR) accessory of Fourier Transform Infrared Spectroscopy (FTIR). The applicability of ATR-\n\n\n\nFTIR in detecting ethanol formation in tapai was also evaluated in this study. The prepared tapai pulut and \n\n\n\ntapai ubi were sampled at one-hour intervals during the fermentation process and analysed for the presence \n\n\n\nof ethanol. Ethanol was detected in tapai pulut that had been fermented for six hours and in tapai ubi after \n\n\n\neight hours fermentation. As shown by the results obtained in this study, ATR-FTIR coupled with distillation \n\n\n\nis applicable in detecting the presence of ethanol in fermented tapai. \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nS126 \n\n\n\nPoster Presentation PPC3 (000049) \n\n\n\n\n\n\n\n\n\n\n\nCrystallization Kinetics Of Theobroma And A Palm Kernel Oil Blend \n \n\n\n\nS M Yusof, M I Noordin \n\n\n\nDepartment of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur \n\n\n\n\n\n\n\nCrystallization is an exothermic process that occurs when a compound goes through a phase transition from \n\n\n\nliquid to solid form. Heat is released in the process, enabling the molecules of the compound to bind together \n\n\n\nand form a solid structure. In this study, the non-isothermal crystallization kinetics of theobroma and palm \n\n\n\nkernel oil blend was investigated by using Differential Scanning Calorimetry (DSC). Samples of \n\n\n\nboth substances were scanned non-isothermally with DSC. During the process, each of the samples was \n\n\n\nmelted at 80\u00b0C and cooled from 80\u00b0C to 0\u00b0C at different cooling rates. The Avrami equation was used to \n\n\n\ndescribe the overall crystallization kinetics process that occurs in both substances. Even though the rate of \n\n\n\nscanning is different, the Avrami exponent n for both of the substances was approximately 2 which means \n\n\n\nthat both substances undergo one dimensional crystal growth. The activation energy, Ea for \n\n\n\nboth substances was evaluated using the Arrhenius equation. The Ea for theobroma oil was found to be -\n\n\n\n4046.76 kJ/mol while the Ea for palm kernel oil blend was found to be -399.94 kJ/mol. We can conclude \n\n\n\nthat our palm kernel oil blend can form a crystal structure faster and releases less energy compared to \n\n\n\ntheobroma oil. \n\n\n\n\n\n\n\n\n\n\n\nPoster Presentation PTC1 (000046) \n\n\n\n\n\n\n\n\n\n\n\nCytotoxicity Of Some Plant Species In Sabah Rainforest \n\n\n\n\n\n\n\nC T Tee1, L Y Chung1, S H Goh2 \n \n1Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur; 2Forest Research \n\n\n\nInstitute of Malaysia, Kuala Lumpur \n\n\n\n\n\n\n\nThe high species diversity in the rainforests of Sabah provide a rich chemodiversity and opportunities for \n\n\n\ndiscovery of new biologically active chemical leads. A preliminary cytotoxicity screening was carried out. \n\n\n\nPlant samples were collected and the voucher specimens were deposited at the Forest Research Center, \n\n\n\nSabah. The dried plant materials were ground and extracted using methanol. The methanol extracts were \n\n\n\nthen evaporated in vacuo and freeze dried. The extracts were dissolved in ethanol and co-cultured with the \n\n\n\ncancer cell lines, MDA and MCF-7 cells and Chang liver cells, for 72 hours at concentrations of 10, 30 and \n\n\n\n60 \uf06dg/ml. Cell proliferation was evaluated using MTT proliferation assay. The liquid handling and washing \n\n\n\nsteps in the assay were automated to expedite the process and reduce operator error. A total of 210 samples \n\n\n\nfrom 110 plant species representing 39 plant families were screened against the above mentioned cell lines. \n\n\n\nThe results showed that 24 extracts at concentration of 60 \uf06dg/ml caused 50-75% growth inhibition to the cell \n\n\n\nlines, and another 24 extracts with inhibition rate above 75%. Overall, the extracts from the Aglaia shawiana \n\n\n\n(bark), Ficus septica (leaves), Clausena excavate (leaves), Walsura pinnata (bark) and Dendrocnide elliptica \n\n\n\n(bark) showed IC50 below 10 \uf06dg/ml against the cancer cell lines tested and have been selected for further \n\n\n\ninvestigation. \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nS127 \n\n\n\nPoster Presentation PTC2 (000072) \n\n\n\n\n\n\n\n\n\n\n\nUse Of Complementary And Alternative Medicine (CAM) Among Cancer Patients In The Clinical \n\n\n\nOncology Unit Of University Of Malaya Medical Centre \n \n\n\n\nJ N Wong1, N Shamsuddin1, A Z Bustam2 \n1Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur; 2Clinical Oncology \n\n\n\nUnit, University of Malaya Medical Centre, Kuala Lumpur \n\n\n\n\n\n\n\nUse of CAM therapies is gaining importance worldwide especially in chronic diseases such as cancer. CAM \n\n\n\nuse is of great concern since it may interfere with conventional treatments. This study was conducted to \n\n\n\nassess the pattern of CAM use among Malaysian cancer patients, the reasons that prompted their use and the \n\n\n\ndisclosure rate of CAM use to the oncologists. This was a descriptive cross-sectional survey of 321 patients \n\n\n\nwho were interviewed face to face. A majority of the patients were females, Chinese and aged between 41 to \n\n\n\n64. Herbal therapies was the most common CAM used in this study sample (68.8%), followed by vitamin \n\n\n\nand mineral supplements (62.3%). Most of the patients used these two types of CAM. The most common \n\n\n\nreason cited for using CAM was to increase the body's ability to fight cancer while the most common \n\n\n\nperceived benefit was an improvement in physical well being. Of the patients interviewed, 90.3% mentioned \n\n\n\nthat they were satisfied with the effects of CAM. Friends (55.5%) and family (27.4%) served as the major \n\n\n\nsources of CAM information. The monthly expenditure on CAM mainly ranged between RM100 to RM499. \n\n\n\nThe disclosure of CAM use to their oncologists was rather low accounting for only 45.5% of \n\n\n\ncases. Therefore, oncologists should be well equipped with knowledge pertaining to CAM use as well as \n\n\n\npromoting disclosure of CAM use among their patients to avoid any drug-drug interactions while the patients \n\n\n\nare on chemotherapy. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nPoster Presentation PTC3 (000084) \n\n\n\n\n\n\n\n\n\n\n\nCholesterol-Reducing Activity Of Probiotics   \n\n\n\n\n\n\n\nR Kalavathy1, N Abdullah2, Y W Ho2   \n1Faculty of Pharmacy, Universiti  Teknologi MARA, Shah Alam, Selangor; 2Institute of Bioscience, \n\n\n\nUniversiti Putra Malaysia, Serdang, Selangor  \n\n\n\n\n\n\n\nIn recent years, there has been considerable interest and research on the beneficial effects of probiotics on \n\n\n\ncholesterol metabolism. This is based on several studies where there appears to be a relationship between \n\n\n\nconsumption of cultured dairy products and reduction of serum cholesterol levels in humans. However, the \n\n\n\nexact mechanism(s) of action of probiotic bacteria on cholesterol reduction remains unclear. The objective of \n\n\n\nthis study was to determine the cholesterol-reducing ability of Lactobacillus acidophilus I 26 in vitro. The L. \n\n\n\nacidophilus I 26 probiotic strain was inoculated into MRS (Man Rogosa Sharpe) broth containing cholesterol \n\n\n\n(162.8 \u00b5g/ml) and was incubated at 39 \uf0b0C for 20 h, after which the broth was fractionated to yield \n\n\n\nsupernatant fluid and cell pellet by centrifugation. The cholesterol in the supernatant and bacterial cell pellet \n\n\n\nwas extracted using the o-pthalaldehyde method. A qualitative fluorescence technique was also used to \n\n\n\ndetect the presence of cholesterol in the cell pellets. Lactobacillus acidophilus I 26 reduced the amount \n\n\n\nof cholesterol in the supernatant by 63.37 % and a large amount of cholesterol that was removed from the \n\n\n\ngrowth medium was found in the cell pellet (60.66 %) of the probiotic bacteria. Results from the \n\n\n\nfluorescence analysis confirmed that the Lactobacillus cells were able to assimilate cholesterol as the cell \n\n\n\npellets fluoresced yellow gold when stained with Nile Red. Furthermore, the fact that several washings did \n\n\n\nnot detach the assimilated cholesterol suggests incorporation of the cholesterol within the cellular membrane.  \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nS128 \n\n\n\nPoster Presentation PTC4 (000094) \n\n\n\n\n\n\n\n\n\n\n\nAcid and Bile Tolerance Of Lactic Acid Bacteria As Probiotics For Humans \n \n\n\n\nR Kalavathy1, N Z Abdul Rahman1, C C Sieo2, N Abdullah2, Y W Ho2 \n1Faculty of Pharmacy, Universiti Teknologi MARA, Shah Alam, Selangor; 2Institute of Bioscience, \n\n\n\nUniversiti Putra Malaysia, Serdang, Selangor \n\n\n\n\n\n\n\nThere is increasing evidence of the potential of lactic acid bacteria (LAB) as a probiotic to enhance intestinal \n\n\n\nhealth. However, to provide health benefits, a probiotic must be able to tolerate physical and chemical \n\n\n\nbarriers such as acid and bile in the gastrointestinal tract. The small intestine and colon of humans contain \n\n\n\nrelatively high concentrations of bile acids, which can inhibit growth or kill bacteria. Therefore it is essential \n\n\n\nfor  probiotic bacteria to be able to grow in a medium containing about 0.15 to 0.30 % of bile salt. The aim \n\n\n\nof this study was to investigate the ability of 12 LAB strains to tolerate acid and bile. The 12 LAB strains \n\n\n\nused in the present study were selected from 125 LAB strains based on their inhibitory activity against \n\n\n\npathogens (E. coli and S. aureus). MRS broth was supplemented with bile salt for the bile tolerance test or \n\n\n\nadjusted to pH 1 to 3 with hydrochloric acid (HCl) for the acid tolerance test. Out of 125 strains studied, P2, \n\n\n\nP5, P9, and P12 were able to resist up to 0.3 % bile salt while strains P1, P3, P4, P6, P7, P8, P10, and P11 \n\n\n\nwere slightly inhibited after 12 h of incubation. On the other hand, strains P1, P5, P7, P10 and P12 exhibited \n\n\n\ngood acid tolerance and survived even at a low pH (pH 1). The results showed that strains P5 and P12 will \n\n\n\nbe able to survive the low pH of the stomach and tolerate and grow in the high bile environment of the \n\n\n\nintestine, suggesting these strains as potential probiotic candidates. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nPoster Presentation PPG1 (000082) \n\n\n\n\n\n\n\n\n\n\n\nAntitumour Activity Of SRJ13, A New Semisynthetic Derivative Of Andrographolide In Breast \n\n\n\nCancer Cell Lines  \n \n\n\n\nN H Hassan1, S M Lim1, J Stanslas2, S H Lim2 \n1Faculty of Pharmacy, Universiti Teknologi MARA, Shah Alam, Selangor Darul Ehsan; 2Cancer Research \n\n\n\nand Drug Discovery Group, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), \n\n\n\nSerdang, Selangor Darul Ehsan  \n\n\n\n\n\n\n\nSRJ13, a semisynthetic compound derived from andrographolide, has been found to have strong selectivity \n\n\n\ntowards breast cancers by the National Cancer Institute (NCI) of the USA in vitro anticancer screen. The \n\n\n\nNCI anticancer map indicated that the mechanism of SRJ13 falls under the unknown category. This study \n\n\n\ninvestigated the antitumour activity of SRJ13, as single agent and in combination with tamoxifen, against \n\n\n\nMCF-7 (hormone-dependent) and MDA-MB-468 (hormone-independent) breast cancer cell lines. Cells were \n\n\n\ncultured in RPMI 1640 medium supplemented with 10% FBS and 1% penicillin-streptomycin. The breast \n\n\n\ncancer cells were then treated with SRJ13 at concentrations ranging from 0.1\u00b5M to 100\u00b5M. The cells were \n\n\n\nincubated for 96 hours after which viability of the cells was determined using MTT assay. Data generated \n\n\n\nfrom the microplate reader was used to determine 50% growth inhibitory concentrations (GI50). Both cell \n\n\n\nlines were also treated with SRJ13 and tamoxifen, singly and in combination. GI50 values for SRJ13 against \n\n\n\nMCF-7 and MDA-MB-468 were 4.9\u00b5M and 2.1\u00b5M, respectively. This indicates that SRJ13 is relatively \n\n\n\nmore selective against the hormone-independent breast cancer cell line. Greater inhibition of MDA-MB-468 \n\n\n\ncell growth was observed for combined treatment with SRJ13 and tamoxifen at concentrations of twice their \n\n\n\nrespective GI50 values compared to the inhibition observed for treatment with the single agents at the same \n\n\n\nconcentrations. However the combined treatment against the MCF-7 cell line showed no significant \n\n\n\ndifference in the cell growth inhibition. \n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nS129 \n\n\n\nPoster Presentation PPG2 (000083) \n\n\n\n\n\n\n\n\n\n\n\nAntitumor Activity Of Malaysian Endophytes  \n \n\n\n\nH Abu Bakar1, R Kalavathy1, G Ellis2, J W Blunt2, M H Munro2, A L Cole3, S A Illah1, J F F Weber1  \n1Faculty of Pharmacy, Universiti Teknologi MARA, Shah Alam, Selangor, Malaysia; 2Department of \n\n\n\nChemistry, University of Canterbury, Christchurch, New Zealand; 3School of Biological Sciences, \n\n\n\nUniversity of Canterbury, Christchurch, New Zealand \n\n\n\n\n\n\n\nCancer is one of the leading causes of death worldwide, contributing to about 5 million deaths per year. \n\n\n\nDespite the sophisticated design for cancer chemotherapy, there is no cancer treatment that is 100% effective \n\n\n\nagainst disseminated cancer. Furthermore, acquired resistance is also becoming common. Therefore, there is \n\n\n\na growing demand for new effective and safe anticancer drugs. Intensive research for anticancer agents from \n\n\n\nvarious sources has led to the exploration of natural products from unusual sources, which include \n\n\n\nendophytes. Endophytes, are microorganisms that reside within plants and represents a huge source of \n\n\n\nbioactive compounds. However, in Malaysia research into the use of endophytes in drug discovery is still in \n\n\n\nits infancy. In the present study, 350 endophytes from 25 Malaysian plants from UiTM\u2019s forest at Kuala \n\n\n\nPilah were extracted and examined for their antitumor properties. The extracts (two fold dilution series) were \n\n\n\ntreated with P388 cells (Murine Leukaemic) followed by the MTT assay. A total of 102 from the 350 \n\n\n\nendophytes showed remarkable antitumor activity against P388 cell with an IC50 in the range of 0.098 \u00b5g/mL \n\n\n\nto 12.50 \u00b5g/mL. Six strains [HAB 2 (R1), HAB 21 (R22), HAB 10 (R12), HAB 14 (R3), HAB 21 (R22) and \n\n\n\nHAB 21 (F7)] were found to be extremely active (IC50 < 0.1\u00b5g/mL). Further activity-monitored fractionation \n\n\n\nshould be conducted to determine the potential of these six strains for the development of anticancer drugs. \n\n\n\n\n\n\n\nPoster Presentation PPT1 (000002) \n\n\n\n\n\n\n\nRecombinant Human Serum Albumin Dimer Has High Blood Circulation Activity And Low Vascular \n\n\n\nPermeability In Comparison With Native Human Serum Albumin \n  \n\n\n\nS Matsushita1, V T G Chuang1,2, M Kanazawa1, S Tanase3, K Kawai4, T Maruyama1, A Suenaga1, M \n\n\n\nOtagiri1  \n1Department of Biopharmaceutics, Graduate School of Pharmaceutical Sciences, Kumamoto University, Oe-\n\n\n\nhonmachi, Kumamoto, Japan; 2The School of Pharmacy, Faculty of Medical and Health Sciences, The \n\n\n\nUniversity of Auckland, Auckland, New Zealand; 3Department of Analytical Biochemistry, School of Health \n\n\n\nSciences, Kumamoto University, Kuhonji, Kumamoto, Japan; 4School of Health Sciences, Faculty of \n\n\n\nMedicine, Kanazawa University, Kodatsuno, Kanazawa, Japan \n\n\n\n\n\n\n\nPURPOSE: Human serum albumin (HSA) is used clinically as an important plasma expander. Albumin \n\n\n\ninfusion is not recommended for critically ill patients with hypovolemia, burns, or hypoalbuminemia because \n\n\n\nof the increased leakage of albumin into the extravascular spaces, thereby worsening edema. In the present \n\n\n\nstudy, we attempted to overcome this problem by producing a recombinant HSA (rHSA) dimer with \n\n\n\ndecreased vascular permeability and an increased half-life. METHODS: Two molecules of rHSA were \n\n\n\ngenetically fused to produce a recombinant albumin dimer molecule. The pharmacokinetics and \n\n\n\nbiodistribution of the recombinant proteins were evaluated in normal rats and carrageenan-induced paw \n\n\n\nedema mouse model. RESULTS: The conformational properties of this rHSA dimer were similar to those for \n\n\n\nthe native HSA (the HSA monomer), as evidenced by the Western blot and spectroscopic studies. The \n\n\n\nbiological half-life and area under the plasma concentration-time curve of the rHSA dimer were \n\n\n\napproximately 1.5 times greater than those of the monomer. Dimerization also caused a significant decrease \n\n\n\nin the total body clearance and distribution volume at the steady state of the native HSA. rHSA dimer \n\n\n\naccumulated to a lesser extent in the liver, skin, muscle, and fat, as compared with the native HSA. Up to 96 \n\n\n\nh, the vascular permeability of the rHSA dimer was less than that of the native HSA in paw edema mouse \n\n\n\nmodels. A prolonged plasma half-life of the rHSA dimer was also observed in the edema model rats. \n\n\n\nCONCLUSIONS: rHSA dimer has a higher retention rate in circulating blood and a lower vascular \n\n\n\npermeability than that of the native HSA. \n\n\n\n \n\n\n\n\n\n\n\n\nS130 \n\n\n\n\n\n\n\nPoster Presentation PPT2 (000008) \n\n\n\n\n\n\n\n\n\n\n\nThe Effect Of Citric And Tartaric Acids On The Release Performance Of A Weakly Basic Drug From \n\n\n\nMatrix Tablets \n \n\n\n\nN Bolourtchian, S Dadashzadeh \n\n\n\nDepartment of Pharmaceutics, School of Pharmacy, Shaheed Beheshti University of Medical Sciences, \n\n\n\nTehran, Iran \n\n\n\n\n\n\n\nWith controlled release oral dosage forms, possible pH-dependent release often results in vivo variability and \n\n\n\nbioavailability problems. This is especially important for weak basic drugs, which often demonstrate a pH \n\n\n\ndependent solubility in the pH range of gastrointestinal tract. The aim of this study was to achieve a pH-\n\n\n\nindependent release of propranolol HCl, a weak basic drug, from HPMC based matrices using organic acids \n\n\n\nas an approach to overcome this problem. Tablets containing propranolol HCl, HPMC K4M, dicalcium \n\n\n\nphosphate and different percentages of citric or tartaric acids were prepared by the direct compression \n\n\n\nmethod. The dissolution tests were performed in acid and phosphate buffer media (pH=1.2 and pH=6.8, \n\n\n\nrespectively). The collected data were compared by using the mean dissolution time (MDT, n=3) and \n\n\n\nsimilarity factor (f2). Based on the results, the similarity factors obtained for tablets containing 5 and 10% \n\n\n\ntartaric acid (f2=89.1 and 87.6 respectively) were significantly higher compared to tablets prepared with no \n\n\n\nacid (F2=58, P<0.05). The MDT values calculated for the acid containing matrices in acid and buffer \n\n\n\ndissolution media were also similar. Further increasing of tartaric acid percentage in tablet formulation, \n\n\n\nresulted in a decrease in similarity factor. The results also showed that employing citric acid in matrix \n\n\n\npreparation was not as suitable as tartaric acid in providing a pH-independent release pattern (f2=51.4-60.3 \n\n\n\nfor various formulations). In addition, the polymer concentration had a major impact on the obtained results. \n\n\n\nUsing HPMC at percentages lower than 30%, did not show the desirable pH-independent release profiles. \n\n\n\n\n\n\n\nPoster Presentation PPT3 (000025) \n\n\n\n\n\n\n\n\n\n\n\nCharacterization Of Sago Starch Derivatives (CMSS) For Aqueous Pharmaceutical Film Coating \n\n\n\nApplication \n \n\n\n\nBohari Yaacob1, Mohd Cairul Iqbal2, Kamaruddin Hashim1, Norzita Yacob1, Norhashidah Talip1 \n1Malaysian Institute for Nuclear Technology Research ( MINT), 4300 Bangi, Kajang, Selangor; \n2Pharmaceutical Research Laboratory, Department of Pharmacy, Faculty of Allied Health Sciences, \n\n\n\nUniversiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur \n\n\n\n\n\n\n\nAqueous coating process and natural polymers have become an active area of research nowadays. Sago \n\n\n\nstarch is one of them and so far has been used as filler, binder and disintegrating agent in oral solid dosage \n\n\n\nforms but not as a coating agents. Therefore the objectives of this experiment are to synthesise sago starch \n\n\n\ninto a carboxymethyl starch (CMSS) and to characterize it in order to suit the aqueous pharmaceutical film \n\n\n\ncoating process. CMSS is prepared by an etherification process using sodium monochloroacetate (NaMCA) \n\n\n\nas the etherifying agent and degree of substitution value (DS) analysis is carried out to find out the amount of \n\n\n\nhydroxyl groups (O-H) being replaced by carboxymethyl groups (COOH). Solubility tests, Fourier transform \n\n\n\ninfrared analysis (FTIR) and viscosity tests were used to characterize the CMSS. The etherification process \n\n\n\nat molar ratio of anhydro glucose unit (AGU) of sago starch to NaMCA, 1.5 : 1.0 will produce CMSS with \n\n\n\nDS values of 0.63 and viscosity of 212.0 cps. The CMSS dissolves completely within 15 min in water at \n\n\n\nroom temperature whereas sago starch is insoluble and forms a high viscosity solution. From FTIR analysis, \n\n\n\nthe O-H peak intensity of CMSS is less than the sago starch whereby new peak at 1587 cm-1 indicates the \n\n\n\npresence of a carboxymethyl group in the CMSS which does not appear in FTIR spectrum of sago starch. \n\n\n\nThis study shows that CMSS has the potential to be use as coating solution in an aqueous pharmaceutical \n\n\n\nfilm coating application.  \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nS131 \n\n\n\nPoster Presentation PPT4 (000036) \n\n\n\n\n\n\n\n\n\n\n\nStudy Of Physicochemical Properties Of Gamma Irradiated Bacterial Cellulose \n  \n\n\n\nNadia Halib1, Mohd Cairul Iqbal Mohd Amin2, Zulkifli Mohamed Hashim1, Farahatun Unir @ \n\n\n\nHashim2 \n1Medical Technology Division, Malaysian Institute for Nuclear Technology Research (MINT), Bangi, \n\n\n\nKajang, Selangor; 2Department of Pharmacy, Faculty of Allied Health Sciences, Universiti Kebangsaan \n\n\n\nMalaysia, Kuala Lumpur \n\n\n\n\n\n\n\nFilm forming polymers are widely used in formulation of solid dosage form. These materials are mainly used \n\n\n\nas coating substances and binder agents for granulation. The solubility, digestibility and mechanical behavior \n\n\n\nof the film formed must be adequate for the objective of the application. Mainly aqueous solutions are used \n\n\n\nfor the dispersion of polymer because they are environmentally more suitable and cheaper. Bacterial \n\n\n\ncellulose produced by Acetobacter xylinum is one of the biopolymer that has several practical implications in \n\n\n\nbiotechnology and other fields of biomedical sciences. Although the chemical nature of bacterial cellulose is \n\n\n\nsimilar to plant cellulose, bacterial cellulose possesses highly crystalline structure and purity precluding the \n\n\n\nuse of organic solvents or processing steps necessary in the manufacturing of plant-derived cellulose. \n\n\n\nFurthermore the physiochemical properties of the membrane can be chemically modified to obtain desired \n\n\n\nfunctionality. Most importantly they feature biocompatibility characteristics ideally suited for encapsulation \n\n\n\nsystems. Therefore the objectives of the study are to investigate and evaluate the properties of the bacterial \n\n\n\ncellulose, which has been exposed to gamma radiation as a potential aqueous coating material. In this study, \n\n\n\n3% of bacterial cellulose aqueous dispersion was prepared and radiated with 25 kGy gamma rays. The \n\n\n\nviscosity study was conducted using viscometer run at 25\u00baC while morphological study was done using SEM \n\n\n\nwith 50000X magnification. To determine chemical bonding present in the polymer chain, bacterial cellulose \n\n\n\npowder with particle size of 200\u00b5m was analyzed using FTIR within the range of wave number from 500 - \n\n\n\n4000 cm-1. As for the tensile strength analysis, bacterial cellulose was prepared as free film with thickness \n\n\n\nbetween 100-120\u00b5m and cut into size of 4mm x 20mm. From the study, the viscosity of the dispersion was \n\n\n\nfound to be 289.9 \u00b1 8.7 cp, while tensile strength of the free film was 744.356 MPa. In conclusion, this study \n\n\n\nshows that bacterial cellulose radiated with gamma rays has good rheological and tensile characteristics as a \n\n\n\ncoating material for pharmaceutical applications. \n\n\n\n\n\n\n\n\n\n\n\nPoster Presentation PPT5 (000061) \n\n\n\n\n\n\n\n\n\n\n\nAttenuation Of The Degradation Of Gemcitabine In Plasma Via Polymeric Drug Conjugation \n\n\n\n\n\n\n\nL V Kiew1, L Y Chung2, K Sidik1 \n1Department of Molecular Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur; \n2Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur \n\n\n\n\n\n\n\nThe anticancer drug, gemcitabine is one of the standard regimens for non-small cell lung cancer (NSCLC). \n\n\n\nHowever, it can be rapidly deaminated by cytidine deaminase in plasma to the inactive metabolite 2\u2019,2\u2019-\n\n\n\ndifluorodeoxyuridine. To improve its plasma stability, we synthesized a polymeric derivative of gemcitabine \n\n\n\n(GD200401) and studied its stability in storage and in plasma. The gemcitabine derivative (GD200401) and \n\n\n\ngemcitabine were incubated with human plasma at 37\u02daC over 8 days respectively. Aliquots of the mixtures \n\n\n\nwere removed at time intervals, ultrafiltered and analysed using reverse phase High Performance Liquid \n\n\n\nChromatography (HPLC) to quantify gemcitabine and its degradation product. The results clearly showed \n\n\n\nGD200401 was more stable compared to gemcitabine (two-way ANOVA; p < 0.05), with t1/2 >192 hours and \n\n\n\n24 hours respectively. In summary, polymeric conjugation of gemcitabine protected the drug from \n\n\n\ndegradation in plasma and improved the plasma half-life by 8 folds. \n\n\n\n \n\n\n\n\n\n\n\n\nS132 \n\n\n\n\n\n\n\nPoster Presentation PPT6 (000062) \n\n\n\n\n\n\n\n\n\n\n\nImproved Antitumour Efficiency Of Gemcitabine Via Polymeric Drug Conjugation \n \n\n\n\nL V Kiew1, L Y Chung2, K Sidik1 \n1Department of Molecular Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur; \n2Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur \n\n\n\n\n\n\n\nConjugation of an anticancer drug to biocompatible polymers is an attractive approach to improve its tumour \n\n\n\ntargeting properties and therapeutic index. In this study, we sought to improve the antitumour efficiency of \n\n\n\ngemcitabine by synthesizing a polymeric derivative (GD200401) and studied its in vivo antitumour activity. \n\n\n\nThe gemcitabine derivative (GD200401) and gemcitabine in single (20 - 80 mg of gemcitabine \n\n\n\nequivalent/kg) or multiple doses (4 doses at 7 days intervals; 20 - 40 mg gemcitabine equivalent/kg), were \n\n\n\ninjected via the tail vein into 9 weeks old Balb-c mice bearing 4T1 mouse breast tumour (200 mm3). \n\n\n\nChanges in mouse tumour size were monitored for 12 days (for single dose study) and 28 days (for multiple \n\n\n\ndose study). The results were expressed as tumour size reduction (TSR) i.e. % change relative to initial \n\n\n\ntumour size (mean (n=10) \u00b1 SEM) and tumour growth delay (TGD) (mean (n=10); days), and analysed using \n\n\n\n2-way ANOVA. In the single dose study, GD200401 showed significantly higher TSR and TGD compared \n\n\n\nto gemcitabine at all the concentrations tested (2-way ANOVA; p < 0.05). At 80 mg of gemcitabine \n\n\n\nequivalent/kg, GD200401 gave TSR, -51.0 \u00b1 7.1% and TGD, 9 days whilst gemcitabine gave TSR, -18.2 \u00b1 \n\n\n\n7.1% and TGD, 3 days. In the multiple dose study, similar trends were observed; GD200401 showed \n\n\n\nsignificantly higher potency compared to gemcitabine (2-way ANOVA; p < 0.05). At 40 mg of gemcitabine \n\n\n\nequivalent/kg, GD200401 gave TSR, -56.4 \u00b1 4.9% and TGD, 27 days whilst gemcitabine gave TSR, -17.3 \u00b1 \n\n\n\n7.2% and TGD, 3 days. The results clearly showed GD200401 possessed superior in vivo anti-tumour \n\n\n\nefficiency as compared to its parent drug, gemcitabine. \n\n\n\n\n\n\n\n\n\n\n\nPoster Presentation PPT7 (000088) \n\n\n\n\n\n\n\n\n\n\n\nIn Vitro Evaluation Of Salbutamol Sulphate Transdermal Delivery Systems \n\n\n\n\n\n\n\nA M Othman, A M Sabati \n\n\n\nDepartment of Pharmaceutics & Industrial Pharmacy, Faculty of Pharmacy, Sana'a University, Yemen \n\n\n\n\n\n\n\nThe transdermal delivery systems for salbutamol sulphate (SS) were designed using a hydrophilic polymer, \n\n\n\nhydroxypropyl methylcellulose (HPMC) with different concentrations of plasticizers such as polyethylene \n\n\n\nglycol (PEG), propylene glycol (PG), glycerin (GL), and Tween-80 as enhancer. The prepared transdermal \n\n\n\nfilms were evaluated in-vitro for drug release using phosphate buffer pH5.8 and cellophane membrane as a \n\n\n\nbarrier. Transdermal films prepared with 10% PEG and 4% HPMC produced flexible and smooth films \n\n\n\nwhich can be easily removed from the glass mould and released the highest amount of SS (66.1%) after 6 \n\n\n\nhours. Incorporation of different concentrations of plasticizers such as PEG, PG, and GL, and Tween 80 as \n\n\n\nenhancer revealed that films containing PEG and PG exhibited an optimal controlled drug release within 6 \n\n\n\nhours where more retardation of drug release was obtained from those containing GL and Tween-80. \n\n\n\nTransdermal films containing PEG and PG of 10 and 15% w/w of polymer represented the proper controlled \n\n\n\ndrug release within the period time of experiment. Further in vitro investigation of SS from HPMC films \n\n\n\ncontaining PEG of 10 and 20% w/w of polymer using rat skin as a biological membrane was evaluated \n\n\n\nwhere 44.76 and 69.43 percentages of SS were permeated after 6 hours respectively. \n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\nS133 \n\n\n\nPoster Presentation PPT8 (000090) \n\n\n\n\n\n\n\n\n\n\n\nA Preliminary Investigation On The Preparation And Physical Properties Of Chitosan Lotions \n \n\n\n\nTanveer Ahmad Khan1, Kok Khiang Peh2, Rahman bin Baco1 \n1Faculty of Pharmacy, International Islamic University Malaysia, Kuantan; 2School of Pharmaceutical \n\n\n\nSciences, Universiti Sains Malaysia. Pulau Pinang \n\n\n\n\n\n\n\nChitosan is a polysaccharide made up of \u00df-glucosamine and N-acetyl-D-glucosamine units. Due to its \n\n\n\ncharacteristic features, chitosan can be used to improve skin cell metabolism, repair scar tissues, and balance \n\n\n\noil secretion. The aim of this preliminary study was to formulate and evaluate chitosan loaded lotions (o/w \n\n\n\nemulsion). The aqueous phase contained chitosan (1% w/v in 1% acetic acid) and glycerin, while the oil \n\n\n\nphase consisted of liquid paraffin and theobroma oil. Sorbitant Monopalmitate (SMP) and sodium lauryl \n\n\n\nsulfate (SLS) were selected as emulsifiers. Various types of chitosan loaded lotions were prepared, having \n\n\n\ndifferent ratios of SMP to SLS (and combinations of SMP and SLS). The mixtures were homogenized using \n\n\n\nan Ultra Turrax Homogenizer at 11,000 rpm. The lotions were investigated in terms of physical appearance, \n\n\n\nodour and skin feel. Phase separation of the sample was observed visually while the extent of coalescence \n\n\n\nwas observed using a light microscope. The rheological properties were examined using a rotational \n\n\n\nviscometer using spindle 40. Almost all the lotions were white in colour and had the smell of cocoa butter. \n\n\n\nThe lotion was slightly oily when applied to the skin. The phase separation studies showed that lotions \n\n\n\nprepared with SMP were more stable than those prepared with SLS. Nevertheless, the use of combination of \n\n\n\nSMP and SLS showed greater stability than the use of individual emulsifiers. Decrease in the concentration \n\n\n\nof emulsifying agents decreased the stability of the lotion. Coalescence did not occur in all the samples \n\n\n\nevaluated. All the lotions exhibited non-Newtonian pseudoplastic flow behaviour.  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n"
"\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 1 \n\n\n\nAssessment of Malaysian Clinical Practice Guidelines  \n\n\n\nB. Rugayah M.P.H. \n1\n. M.D. Noormah M.Sc\n\n\n\n1\n, M.M. Mohamed Ph.D*\n\n\n\n2\n, S.F.K. \n\n\n\nShahnaz \n3 \n\n\n\n1\nMalaysian Health Technology Assessment Section, Ministry of Health Malaysia. \n\n\n\n2\nUniversity Teknologi Mara, Puncak Alam Campus, Selangor. \n\n\n\n3\nHospital Tengku Ampuan Rahimah \n\n\n\n* Corresponding author \nMalaysian Journal of Pharmacy, Vol 1 Issue 10, 2012, 1-14                                               \n\n\n\n\n\n\n\nAbstract \n\n\n\n\n\n\n\nThe Ministry of Health Malaysia (MOH) coordinates the development of Clinical \n\n\n\nPractice Guidelines (CPGs) in Malaysia, in collaboration with the Academy of Medicine \n\n\n\nof Malaysia (AMM). This study assessed the methodological quality of 29 Malaysian \n\n\n\nnational CPGs which were developed since 2000 to 2003 using Appraisal of Guidelines \n\n\n\nfor Research & Evaluation (AGREE) Instrument. The study showed high score for only \n\n\n\ndomains on Scope & Purpose as well as Clarity & Presentation (68%, 75% respectively). \n\n\n\n\n\n\n\nKeywords: clinical practice guidelines, AGREE instrument, appraisal of guidelines, \n\n\n\nMalaysian CPGs. \n\n\n\n\n\n\n\nIntroduction \n\n\n\n\n\n\n\nAssessment of the national Malaysian \n\n\n\nClinical Practice Guidelines (AMCPG) \n\n\n\nusing Appraisal of Guidelines for \n\n\n\nResearch & Evaluation (AGREE) \n\n\n\nInstrument was proposed to study the \n\n\n\nmethodological quality in the \n\n\n\ndevelopment of Clinical Practice \n\n\n\nGuidelines (CPGs) in Malaysia.  \n\n\n\n\n\n\n\nThe Ministry of Health (MOH) \n\n\n\ncoordinates the development of \n\n\n\nevidence-based CPGs in Malaysia. This \n\n\n\nwas a collaborative effort between \n\n\n\nMinistry of Health Malaysia (MOH) and \n\n\n\nAcademy of Medicine Malaysia (AMM). \n\n\n\nThe goal of the CPG development was to \n\n\n\nincrease quality in the delivery of health \n\n\n\ncare services based on clinical evidence \n\n\n\nwith scientific rigor.  \n\n\n\n\n\n\n\nThis (AMCPG) Project was found to be  \n\n\n\nworthy to be conducted in Malaysia, in \n\n\n\nview of the fact that Malaysia had \n\n\n\ndeveloped several CPGs. An evaluation \n\n\n\nof these developed CPGs could provide \n\n\n\nmore information in improving the \n\n\n\ndevelopment of evidence-based CPGs in \n\n\n\nMalaysia. It is believed that evidence-\n\n\n\nbased CPGs can help improve the \n\n\n\ndelivery of health care, although proof to \n\n\n\nsuch claim has not been consistently \n\n\n\ndemonstrated. \n\n\n\n\n\n\n\nEvaluation of the CPG can be \n\n\n\ncategorized into three levels\n3, 4, 5 \n\n\n\nnamely: \n\n\n\n1) Examination of the process of \n\n\n\nguideline development, dissemination \n\n\n\nand implementation; 2) Measurement of \n\n\n\nthe extent of implementation of the \n\n\n\nguideline and 3) Assessment of \n\n\n\nguidelines effect on patient outcomes \n\n\n\nand health care utilization.  Another way \n\n\n\nof evaluation was to classify into two \n\n\n\nlevels, namely quality of the CPG and \n\n\n\nlater its effectiveness. Good \n\n\n\ndevelopment methodology using current \n\n\n\nbest evidence will determine the quality \n\n\n\nof the CPG. A \u201cgood quality guideline\u201d \n\n\n\nis the one that ultimately leads to \n\n\n\nimprove patient outcome. However, the \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 2 \n\n\n\nquality of a guideline is indirectly \n\n\n\nmeasured by assessing in whatever \n\n\n\ndegree guideline producers minimized \n\n\n\npotential biases that could occur in the \n\n\n\ndevelopment process and affect validity \n\n\n\nof its recommendations \n6, 7, and 8\n\n\n\n. Wrong \n\n\n\nrecommendations affect the health \n\n\n\nprofessionals\u201f credibility on guidelines, \n\n\n\nand consequently, limit their adoption. \n\n\n\n\n\n\n\nIn 1999, Shaneyfelt et al. assessed \n\n\n\nquality of CPG published in Medline \n\n\n\nbetween 1985 and 1997 by using \n\n\n\nsystematically developed instrument. \n\n\n\nThe majority of 279 assessed guidelines \n\n\n\ndid not meet the pre-established \n\n\n\nmethodological standards, being rigour \n\n\n\nof recommendations as one of the most \n\n\n\ndeficiently reported \n6, 9\n\n\n\n. Similar results \n\n\n\nwere reported by Cluzeau et al. \n6, 10\n\n\n\n, \n\n\n\nGrilli et al. \n6,11\n\n\n\n and Graham et al. \n6,12 \n\n\n\nin \n\n\n\n1999, 2000 and 2001 respectively. In \n\n\n\n2003 the AGREE collaboration \n\n\n\n(currently the AGREE Research Trust) \n\n\n\npublished the results of the first \n\n\n\ninternational project aimed at developing \n\n\n\nand validating a generic instrument for \n\n\n\nguidelines assessment\n7,8\n\n\n\n. This instrument \n\n\n\nhas been translated to different \n\n\n\nlanguages and extending its use \n\n\n\nthroughout the world. In recent years, \n\n\n\nseveral studies showed methodological \n\n\n\ndeficiencies of using the AGREE \n\n\n\ninstrument in guideline development\n6,13-\n\n\n\n15\n \n\n\n\n\n\n\n\nIn Malaysia, although many different \n\n\n\ninstitutions are interested in CPG \n\n\n\ndevelopment, there is no information \n\n\n\nabout the quality of the guidelines \n\n\n\nproduced. The purpose of this research \n\n\n\nwas to describe trends in guidelines \n\n\n\nproduction in Malaysia and to assess \n\n\n\ntheir quality by using the AGREE \n\n\n\ninstrument. \n\n\n\n\n\n\n\nMaterials and methods \n\n\n\n\n\n\n\nA cross-sectional study was undertaken \n\n\n\nin 2004 to describe guidelines \n\n\n\nproduction in Malaysia between years \n\n\n\n2000-2003. Documents were considered \n\n\n\nas CPG if: 1) they included explicit \n\n\n\nrecommendations targeted to health \n\n\n\nprofessional or health providers \n\n\n\ndecision-making in managing diseases or \n\n\n\ncondition, 2) the scope included related \n\n\n\nto screening and primary prevention, \n\n\n\nand/or diagnosis, and/or treatment and/or \n\n\n\nsecondary prevention and/or \n\n\n\nrehabilitation; 3) they contained \n\n\n\ndescription of participants or responsible \n\n\n\ninstitutions and bibliographic references; \n\n\n\n4) they were produced and diffused in \n\n\n\nthe period of study (January 2000 to \n\n\n\nDecember 2003) and could be freely \n\n\n\naccessed. The exclusion criteria were: 1) \n\n\n\nguidelines targeted to patients (patients \n\n\n\n\u201eguidelines) and/or exclusively oriented \n\n\n\nto health services organization and not to \n\n\n\nclinical decision-making for managing \n\n\n\ndiseases or conditions; 2) guidelines for \n\n\n\nwhich it was not possible to determine if \n\n\n\na systematic process was applied in their \n\n\n\ndevelopment such as documents that \n\n\n\nlacked an explanation of the guideline \n\n\n\ndevelopment methodology that had been \n\n\n\nused or documents diffused as brief \n\n\n\nreports which only contained a set of \n\n\n\nrecommendations or documents referred \n\n\n\nto as guidelines, but were undertaken by \n\n\n\nonly one author without any reference to \n\n\n\nthe methodology applied); 3) guidelines \n\n\n\nwhose year of development could not be \n\n\n\nestablished as it was not stated and last \n\n\n\nbut not least 4) guidelines that were not \n\n\n\nproduced by a Malaysian institution \n\n\n\n(adapted guidelines were included only \n\n\n\nwhen the adaptation process was \n\n\n\nexplicitly explained). \n\n\n\n\n\n\n\nAll guidelines registered by the Health \n\n\n\nTechnology Assessment units (HTA) in \n\n\n\nMOH and AMM between January 2000 \n\n\n\nand December 2003 were selected for \n\n\n\nthis study. The original published CPGs \n\n\n\nor a photocopy of the original CPGs \n\n\n\nwere retrieved from the HTA unit, the \n\n\n\nchairman of the guideline developers \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 3 \n\n\n\ngroup/or downloaded from the Ministry \n\n\n\nof Health Malaysia website. \n\n\n\n\n\n\n\nQuality guideline assessment was \n\n\n\nperformed using the AGREE instrument. \n\n\n\nThis instrument was the instrument of \n\n\n\nchoice as it covers practically all the \n\n\n\nrelevant dimensions of the evidence-\n\n\n\nbased guideline development process. In \n\n\n\naddition, it has been internationally \n\n\n\nvalidated. The AGREE has fewer items \n\n\n\nand uses a numerical scale that facilitates \n\n\n\nthe analysis \n8, 16,17\n\n\n\n.  \n\n\n\n\n\n\n\nA total of four appraisers were invited to \n\n\n\nparticipate voluntarily in the assessment \n\n\n\nphase. To be considered eligible, \n\n\n\nprofessionals should have had at least \n\n\n\none of the following criteria: a) previous \n\n\n\nclinical epidemiology background; and \n\n\n\nb) knowledge on guidelines \n\n\n\ndevelopment. The professionals who \n\n\n\naccepted the invitation and fulfilled the \n\n\n\neligibility criteria were trained in the use \n\n\n\nof the AGREE instrument. A learning \n\n\n\nprogram was developed in two stages: I. \n\n\n\nSelf-reading of the tool-kit: all \n\n\n\nparticipants were provided with the \n\n\n\nEnglish version of the AGREE \n\n\n\ninstrument, the English version of the \n\n\n\nTraining Manual. II. Pilot assessment - \n\n\n\none CPG was assessed independently by \n\n\n\nall professionals.  \n\n\n\n\n\n\n\nAll of the 29 copies of the CPGs \n\n\n\nretrieved were given to each appraiser to \n\n\n\nbe appraised within one month. A data \n\n\n\ncollection form designed on an Excel \n\n\n\nsheet, accompanied by a user-guide on \n\n\n\nthe AGREE instrument were given to \n\n\n\neach appraiser. Results of assessments \n\n\n\nwere returned to the researcher team by \n\n\n\nmail. No assessor received any \n\n\n\nhonorarium. \n\n\n\n\n\n\n\nAGREE consists of 23 key items \n\n\n\norganized in six domains. Each domain \n\n\n\nis intended to capture a separate \n\n\n\ndimension of guideline quality. Domain \n\n\n\n1: Scope and purpose (items 1-3) is \n\n\n\nconcerned with the overall aim of the \n\n\n\nguideline, the specific clinical questions \n\n\n\nand the target patient population. \n\n\n\nDomain 2: Stakeholder involvement \n\n\n\n(items 4-7) focuses on the extent to \n\n\n\nwhich the guideline represents the views \n\n\n\nof its intended users. Domain 3: Rigor of \n\n\n\ndevelopment (items 8-14) relates to the \n\n\n\nprocess used to gather and synthesize the \n\n\n\nevidence, the methods to formulate the \n\n\n\nrecommendations and to update them. \n\n\n\nDomain 4: Clarity and presentation \n\n\n\n(items 15-18) deals with the language \n\n\n\nand format of the guideline. Domain 5: \n\n\n\nApplicability (items 19-21) pertains to \n\n\n\nthe likely organizational, behavioral and \n\n\n\ncost implications of applying the \n\n\n\nguideline. Domain 6: Editorial \n\n\n\nindependence (items 22-23) is concerned \n\n\n\nwith the independence of the \n\n\n\nrecommendations and acknowledgement \n\n\n\nof possible conflict of interest from the \n\n\n\nguideline development group. \n\n\n\n\n\n\n\nEach item is rated on a 4-point scale \n\n\n\nranging from 4 \u201eStrongly Agree\u201f to 1 \n\n\n\n\u201estrongly Disagree\u201f, with two mid points: \n\n\n\n3 \u201eAgree\u201f and 2 \u201eDisagree\u201f. The scale \n\n\n\nmeasures the extent to which a criterion \n\n\n\n(item) has been fulfilled. \u201eStrongly \n\n\n\nAgree\u201f means that  the appraiser was \n\n\n\nconfident that the criterion has been fully \n\n\n\nmet, and if the appraiser was  confident \n\n\n\nthat the criterion has not been fulfilled at \n\n\n\nall or if there is no information available \n\n\n\nthen he/she should answer \u201eStrongly \n\n\n\nDisagree\u201f.  If the appraiser was unsure \n\n\n\nthat a criterion had been fulfilled, for \n\n\n\nexample because the information was \n\n\n\nunclear or because only some of the \n\n\n\nrecommendations fulfill the criterion, \n\n\n\nthen he/she should answer \u201eAgree\u201f or \n\n\n\n\u201eDisagree\u201f, depending on the extent to \n\n\n\nwhich he/she thought the issue had been \n\n\n\naddressed. \n\n\n\n\n\n\n\nAccording to the AGREE Collaboration  \n\n\n\nthe domain scores of each CPG were \n\n\n\nindividually considered. Scores of \n\n\n\nindividual items in each domain were \n\n\n\n\nhttp://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2572637#B16\n\n\nhttp://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2572637#B17\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 4 \n\n\n\nsummed and standardized as a \n\n\n\npercentage of the maximum possible \n\n\n\nscore for that domain, taking into \n\n\n\naccount the number of appraisers. \n\n\n\nDomain scores can be calculated by \n\n\n\nsumming up all the scores of the \n\n\n\nindividual items in a domain and by \n\n\n\nstandardizing the total as a percentage of \n\n\n\nthe maximum possible score for that \n\n\n\ndomain \n6\n. \n\n\n\n\n\n\n\nThe internal consistency of each domain \n\n\n\nwas evaluated using Cronbach's alpha. \n\n\n\nThe Reliability between appraisers was \n\n\n\ndetermined for each question and each \n\n\n\ndomain of the AGREE. Intraclass \n\n\n\ncorrelation coefficients (ICC) were \n\n\n\ncalculated within each pair of appraisers \n\n\n\nand across the pool of appraisers. ICCs \n\n\n\nand Cronbach's alpha values above 0.75 \n\n\n\nwere considered to represent good \n\n\n\nreliability while values at 0.40\u20130.75 \n\n\n\nwere considered moderate and value of \n\n\n\n<0.40 was of poor reliability. \n\n\n\n\n\n\n\n\n\n\n\nResults \n\n\n\n\n\n\n\nA total of 29 documents were retrieved \n\n\n\neither from HTA unit or chairman of the \n\n\n\nguideline developers group or from the \n\n\n\nMOH or AMM websites. All the 29 \n\n\n\nCPGs were published locally. The \n\n\n\nfinancial sponsor for all these CPGs was \n\n\n\nmainly MOH.  There were no \n\n\n\npharmaceutical drug companies \n\n\n\ninfluencing our researches. Those \n\n\n\ndeveloping the CPGs consist of a \n\n\n\nmixture of professionals mainly from the \n\n\n\nuniversities and private professional \n\n\n\nbodies like the AMM. The development \n\n\n\nprocess usually took about 1 to 2 years. \n\n\n\n\n\n\n\nAll the 29 documents fulfilled the \n\n\n\ninclusion criteria. All the 29 CPGs were \n\n\n\nassessed by 4 assessors. On the item \n\n\n\nScope and purpose, only thirteen \n\n\n\nguidelines (13/29) covered diagnosis, \n\n\n\nnine guidelines (9/29) covered \n\n\n\nmanagement, four guidelines (4/29) \n\n\n\ncovered treatment, one guideline (1/29) \n\n\n\ncovered prevention and one (1/29) \n\n\n\nguideline covered screening. \n\n\n\n\n\n\n\nCPG production was found to increase \n\n\n\nfrom year 2001 to year 2003 (Figure 1). \n\n\n\nMinistry of Health was the principal \n\n\n\nCPG producer during this period of time. \n\n\n\nA CPG should be strongly recommended \n\n\n\nif it was rated high (3 or 4) on the \n\n\n\nmajority of items and most domain \n\n\n\nscores were above 60% indicating the \n\n\n\nCPG had a high overall quality.  A CPG \n\n\n\nshould be recommended with provisos or \n\n\n\nalterations if it was rated high (3 or 4) or \n\n\n\nlow (1 or 2) on a similar of items  and \n\n\n\nmost domain scores were between 30% \n\n\n\nand 60% indicating the CPG had a \n\n\n\nmoderate overall quality. A CPG should \n\n\n\nnot be recommended if it was rated low \n\n\n\n(1 or 2) on the majority of items and \n\n\n\nmost domain scores were below 30% \n\n\n\nindicating the CPG had a low overall \n\n\n\nquality. \n\n\n\n\n\n\n\nDomains corresponding to Clarity and \n\n\n\nPresentation (overall score was 75%) \n\n\n\nand Scope and Purpose (overall score \n\n\n\nwas 68%) (Figure 2) were high. The \n\n\n\nmajority of the CPG assessed received \n\n\n\nmoderate scores in nearly all domains \n\n\n\nsuch as Editorial Independence (the \n\n\n\noverall score was 56%), Stakeholder \n\n\n\nInvolvement (the overall score was 50%) \n\n\n\nand for Rigor of Development (the \n\n\n\noverall score was 48%). However for \n\n\n\nApplicability (the overall score was \n\n\n\n26%) the score was low. In comparison \n\n\n\nto the results of the other domains, \n\n\n\nClarity and Presentation was the best \n\n\n\nscored and applicability was the worst \n\n\n\nscored aspect of the 29 CPGs. \n\n\n\n\n\n\n\nThere was no statistically significant \n\n\n\ndifference observed in the standardized \n\n\n\ndomain scores corresponding to \n\n\n\nApplicability and Editorial \n\n\n\nIndependence. Statistically significant  \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 5 \n\n\n\nFigure 1: Total number of CPG produced per year \n\n\n\n\n\n\n\n\n\n\n\ndifferences were observed among scores \n\n\n\ncorresponding to the Scope and Purpose, \n\n\n\nClarity and Presentation, Stakeholder \n\n\n\nInvolvement and Rigor of Development \n\n\n\n(Figure 3 and table 2). \n\n\n\n\n\n\n\nSince the distribution of the items scored \n\n\n\nwere skewed, the median value was used \n\n\n\nwhich can be a good way to determine \n\n\n\nan approximate average. Analysis by \n\n\n\nitem showed median values lower than 3 \n\n\n\nin 13 of the 23 items of the AGREE \n\n\n\ninstrument: 2 items received the lowest \n\n\n\npossible score (1) (table 1). \n\n\n\n\n\n\n\n\n\n\n\nThe Malaysian CPGs did show \n\n\n\nsignificant improvement from 2000 to \n\n\n\n2003 for Scope & Purpose; Rigor & \n\n\n\nDevelopment, Stakeholder involvement \n\n\n\nand Applicability using AGREE (Fig. 4 ) \n\n\n\nHowever Clarity and presentation and \n\n\n\nEditorial independence showed lowering \n\n\n\nin values from 2002 to 2003. \n\n\n\n\n\n\n\nInter-rater reliability is an estimation \n\n\n\nbased on the correlation of scores \n\n\n\nbetween/among two or more raters who  \n\n\n\n\n\n\n\nrate the same item, scale, or instrument \n\n\n\nand Intraclass correlation coefficient \n\n\n\n(ICC) was used to measure the inter-rater \n\n\n\nreliability of the four appraisers. It may \n\n\n\nalso be used to assess test-retest \n\n\n\nreliability. ICC may be conceptualized as \n\n\n\nthe ratio of between-groups variance to \n\n\n\ntotal variance. ICC measured the extent \n\n\n\nto which there was agreement \n\n\n\nconsistency among the appraisers. When \n\n\n\ninterpreting ICC <0.4 represents poor \n\n\n\nreliability, 0.40 -0.75 represents fair to \n\n\n\ngood reliability and >0.75 represents \n\n\n\nexcellent reliability. For the domain, \n\n\n\nRigor of Development (ICC=0.67`) and \n\n\n\nScope & Purpose (ICC= 0.60) the score \n\n\n\nwas moderate (Table 3). The ICC for the \n\n\n\nother domains in the Malaysian CPGs \n\n\n\nwas low (ICC \u2264 0.40). \n\n\n\n\n\n\n\nCronbach\u201fs alpha being the most \n\n\n\ncommon form of internal consistency \n\n\n\nreliability coefficient, was used to \n\n\n\nmeasure the extent to which item \n\n\n\nresponses correlate with each other.  \n\n\n\nAlternatively, it can be interpreted as the \n\n\n\ncorrelation of the observed scale with all \n\n\n\n0\n\n\n\n2\n\n\n\n4\n\n\n\n6\n\n\n\n8\n\n\n\n10\n\n\n\n12\n\n\n\nYear2000 Year2001 Year2002 Year2003\n\n\n\nTotal number of CPG\n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 6 \n\n\n\npossible other scales measuring the same \n\n\n\nthing and using the same number of it. \n\n\n\n\n\n\n\nFor the domain, Rigor of Development \n\n\n\n(Cronbach\u201fs alpha = 0.68) and Scope & \n\n\n\nPurpose (Cronbach\u201fs alpha = 0.63), the \n\n\n\nscore was moderate (Table 3). \n\n\n\nCronbach\u201fs alpha for the other domains \n\n\n\nin the Malaysian CPGs were low \n\n\n\n(Cronbach\u201fs alpha \u2264 0.40). \n\n\n\n\n\n\n\nThere seems to be variability of \n\n\n\nindividual scores between the appraisers \n\n\n\non items of the AGREE instrument and \n\n\n\nsome of the variability may be due to \n\n\n\ndifferences in interpretation of several \n\n\n\nitems where the instructions were broad.  \n\n\n\n \nFigure 2: Results of analysis of the 29 CPGs on the six AGREE instrument domains \n\n\n\n                                   Scope           Participation          Rigour              Clarity               Applicability      Independence\n\n\n\n\n\n\n\ndifferences were observed among scores \n\n\n\ncorresponding to the Scope and Purpose, \n\n\n\nClarity and Presentation, Stakeholder \n\n\n\nInvolvement and Rigor of Development \n\n\n\n(Figure 3 and table 1). \n\n\n\n\n\n\n\nSince the distribution of the items scored \n\n\n\nwere skewed, the median value was used \n\n\n\nwhich can be a good way to determine \n\n\n\nan approximate average. Analysis by \n\n\n\nitem showed median values lower than 3 \n\n\n\nin 13 of the 23 items of the AGREE \n\n\n\ninstrument: 2 items received the lowest \n\n\n\npossible score (1) (table 2). \n\n\n\n\n\n\n\n\n\n\n\nThe Malaysian CPGs did show \n\n\n\nsignificant improvement from 2000 to \n\n\n\n2003 for Scope & Purpose; Rigor & \n\n\n\nDevelopment, Stakeholder involvement \n\n\n\nand Applicability using AGREE (Fig. 4 ) \n\n\n\nHowever Clarity and presentation and \n\n\n\nEditorial independence showed lowering \n\n\n\nin values from 2002 to 2003. \n\n\n\n\n\n\n\nInter-rater reliability is an estimation \n\n\n\nbased on the correlation of scores \n\n\n\nbetween/among two or more raters who \n\n\n\nrate the same item, scale, or instrument \n\n\n\nand Intraclass correlation coefficient \n\n\n\n(ICC) was used to measure the inter-rater \n\n\n\nreliability of the four appraisers. It may \n\n\n\nalso be used to assess test-retest \n\n\n\nreliability. ICC may be conceptualized as \n\n\n\nthe ratio of between-groups variance to \n\n\n\ntotal variance. ICC measured the extent \n\n\n\nto which there was agreement \n\n\n\nconsistency among the appraisers. When \n\n\n\nIndependenceApplicabilityClarityRigourparticipationScope\n\n\n\n100\n\n\n\n80\n\n\n\n60\n\n\n\n40\n\n\n\n20\n\n\n\n0\n\n\n\n3\n\n\n\n18\n\n\n\n16\n\n\n\nS\nta\n\n\n\nn\nd\n\n\n\na\nrd\n\n\n\niz\ne\n\n\n\nd\n d\n\n\n\no\nm\n\n\n\na\nin\n\n\n\n s\nco\n\n\n\nre\ns \n\n\n\n(%\n) \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 7 \n\n\n\ninterpreting ICC <0.4 represents poor \n\n\n\nreliability, 0.40 - 0.75 represents fair to \n\n\n\ngood reliability and >0.75 represents \n\n\n\nexcellent reliability. For the domain, \n\n\n\nRigor of Development (ICC=0.67`) and \n\n\n\nScope & Purpose (ICC= 0.60) the score  \n\n\n\nwas moderate (Table 3). The ICC for the \n\n\n\nother domains in the Malaysian CPGs \n\n\n\nwas low (ICC \u2264 0.40). \n\n\n\n\n\n\n\nCronbach\u201fs alpha was also used to test \n\n\n\nfor internal consistency\n\n\n\n \nFigure 3: Temporal evolution of the median standardized score for each AGREE \n\n\n\ninstrument domain \n\n\n\n\n\n\n\nTable 1: Comparison of the CPG quality according to independent variables \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n       Median [ Interquartile range] of standardized domain scores \n\n\n\nScope Participation Rigour Clarity Applicability independence \n\n\n\n2000-03 (n=29) 58% (49%) 52% (11%) 52% (33%) 79% (20%) 22% (13%) 50 (17%) \n\n\n\nYear 2000 (n=5) 47% (11%) 40% (20%) 27% (20%) 67% (29%) 19% (10%) 50% (19%) \n\n\n\nYear 2001 (n=10) 51% (8%) 46% (9%) 38% (16%) 67% (24%) 22% (15%) 50% (22%) \n\n\n\nYear 2002 ( N=4) 90% (40%) 54% (10%) 62% (13%) 92% (8%) 32% (29%) 56% (35%) \n\n\n\nYear 2003 (n=10) 99% (15%) 56% (7%) 66% (8%) 82% (8%) 25% (7%) 52% (11%) \n\n\n\nP value 0.000 0.000 0.000 0.002 0.413 0.904 \n\n\n\n \nreliability coefficient to measure the \n\n\n\nextent to which item responses correlate \n\n\n\nwith each other.  Alternatively, it can be \n\n\n\ninterpreted as the correlation of the \n\n\n\nobserved scale with all possible other \n\n\n\nscales measuring the same thing and \n\n\n\nusing the same number of it. When \n\n\n\ninterpreting Cronbach's alpha \n\n\n\nmagnitudes:  <0.4 represents poor \n\n\n\nreliability, 0.40 -0.75 represents fair to \n\n\n\ngood reliability and >0.75 represents \n\n\n\nexcellent reliability. For the domain, \n\n\n\nRigor of Development (Cronbach\u201fs alpha \n\n\n\n= 0.68) and Scope & Purpose \n\n\n\n(Cronbach\u201fs alpha = 0.63), the score was \n\n\n\nmoderate (Table 3). Cronbach\u201fs alpha \n\n\n\nfor the other domains in the Malaysian \n\n\n\nCPGs were low (Cronbach\u201fs alpha \u2264 \n\n\n\n0.40). \n\n\n\n\n\n\n\n0\n\n\n\n20\n\n\n\n40\n\n\n\n60\n\n\n\n80\n\n\n\n100\n\n\n\n120\n\n\n\nyear 2000 year 2001 year 2002 year 2003\n\n\n\nScope\n\n\n\nParticipation\n\n\n\nRigour\n\n\n\nClarity\n\n\n\nApplicability\n\n\n\nIndependence\n\n\n\nM\ne\n\n\n\nd\nia\n\n\n\nn\n o\n\n\n\nf \nth\n\n\n\ne \nst\n\n\n\na\nn\n\n\n\nd\na\n\n\n\nrd\niz\n\n\n\ned\n s\n\n\n\nco\nre\n\n\n\n f\no\n\n\n\nr \nea\n\n\n\nch\n d\n\n\n\no\nm\n\n\n\na\nin\n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 8 \n\n\n\nThere seems to be variability of \n\n\n\nindividual scores between the appraisers \n\n\n\non items of the AGREE instrument and  \n\n\n\n\n\n\n\n\n\n\n\nsome of the variability may be due to \n\n\n\ndifferences in interpretation of several \n\n\n\nitems where the instructions were broad. \n\n\n\n\n\n\n\n\n\n\n\nTable 2: Scores by Item of the AGREE instrument \n\n\n\nDomain and items of the AGREE instrument Median \n\n\n\nValue \n\n\n\nInterq\n\n\n\nuartile \n\n\n\nRange \n\n\n\nDomain 1: Scope and Purpose \n\n\n\n1. The overall objectives of the guideline is (are) specifically \n\n\n\ndescribed \n\n\n\n3 2 \n\n\n\n2. The clinical question(s) covered by the guideline is (are) \n\n\n\nspecifically described \n\n\n\n3 2 \n\n\n\n3. The patients to whom the guideline is meant to apply are \n\n\n\nspecifically described \n\n\n\n4 1 \n\n\n\nDomain 2: Stakeholder involvement \n\n\n\n4. The guideline development group includes individuals from \n\n\n\nall the relevant professional groups \n\n\n\n4 1 \n\n\n\n5. The patients\u201f views and preferences have been sought 1 1 \n\n\n\n6. The target users of the guideline are clearly defined 3 1 \n\n\n\n7. The guideline has been piloted among end uders 1 2 \n\n\n\nDomain 3: Rigour of Development \n\n\n\n8. The systematic methods were used to search for evidence 2 2 \n\n\n\n9. The criteria for selecting the evidence are clearly described 2 3 \n\n\n\n10. The methods used for formulating the recommendations are \n\n\n\nclearly described \n\n\n\n2 2 \n\n\n\n11. The health benefits, side effects and risks  have been \n\n\n\nconsidered in formulating the recommendations \n\n\n\n3 2 \n\n\n\n12. There is an explicit link between the recommendations and \n\n\n\nthe  supporting evidence \n\n\n\n3 2 \n\n\n\n13. The guideline has been externally reviewed by experts prior \n\n\n\nto its publication \n\n\n\n2 2 \n\n\n\n14. A procedure for updating the guideline is provided 2 2.25 \n\n\n\nDomain 4 : Clarity and Presentation \n\n\n\n15. The recommendations are specific and unambiguous 4 1 \n\n\n\n16. The different options for management of the condition are \n\n\n\nclearly presented \n\n\n\n4 1 \n\n\n\n17. Key recommendations are clearly identifiable 3 1 \n\n\n\n18. The guideline is supported with tools for application \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n3 2 \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 9 \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nFigure 4: Results of 4 Reviewers based on AGREE instrument \n\n\n\n\n\n\n\n\n\n\n\nDiscussion \n\n\n\n\n\n\n\nThe results of the study showed that \n\n\n\nthrough the years, development of \n\n\n\nguidelines in Malaysia had progressively \n\n\n\nincreased. The quality of guidelines in \n\n\n\nMalaysia was practically unknown. To \n\n\n\nour knowledge, this was the first \n\n\n\nguideline appraisal in Malaysia. From \n\n\n\nthis research, the quality of the 29 \n\n\n\nMalaysian guidelines was far from ideal: \n\n\n\nscores were moderate and low in all \n\n\n\ndomains.  \n\n\n\n\n\n\n\nVariability of individual scores between \n\n\n\nthe appraisers on items of the AGREE \n\n\n\ninstrument, was noted as evidenced by \n\n\n\nthe low Cronbach\u201fs alpha and ICC. On \n\n\n\nthe other hand, the Argentinean study, by \n\n\n\nMar\u00eda Eugenia Esandi and Zulma Ortiz \n\n\n\net al, ICC and Cronbach's alpha for each \n\n\n\ndomain were in all cases moderate or \n\n\n\nhigh (0.46\u20130.74), except for Editorial \n\n\n\nIndependence which showed very low \n\n\n\nvalues. \n\n\n\n\n\n\n\nFirst, low quality could have been the \n\n\n\nresult of the absence of an explicit policy  \n\n\n\n0%\n\n\n\n10%\n\n\n\n20%\n\n\n\n30%\n\n\n\n40%\n\n\n\n50%\n\n\n\n60%\n\n\n\n70%\n\n\n\n80%\n\n\n\n90%\n\n\n\n100%\n\n\n\n1 2 3 4 5 6\n\n\n\nAGREE DOMAIN\n\n\n\nPE\nR\n\n\n\nC\nEN\n\n\n\nTA\nG\n\n\n\nE\n\n\n\nYEAR 2000\n\n\n\nYEAR 2001\n\n\n\nYEAR 2002\n\n\n\nYEAR 2003\n\n\n\nDomain 5: Applicability \n\n\n\n19. The potential organizational barriers in applying the \n\n\n\nrecommendations have been discussed \n\n\n\n2 1 \n\n\n\n20. The potential cost implications of applying the \n\n\n\nrecommendations have been considered \n\n\n\n2 1 \n\n\n\n21. The guideline presents key review criteria for monitoring and \n\n\n\n/ or audit purposes \n\n\n\n2 1 \n\n\n\nDomain 6: Editorial Independence \n\n\n\n22. The guideline is editorially independent from the funding \n\n\n\nbody \n\n\n\n3 2 \n\n\n\n23. Conflicts of interest of guideline development members have \n\n\n\nbeen recorded \n\n\n\n2 2 \n\n\n\n1) Scope & Purpose   \n2) Stakeholder \nInvolvement  \n3) Rigor & Development  \n4) Clarity & Presentation  \n5) Applicability  \n6) Editorial \n\n\n\nIndependence  \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 10 \n\n\n\nTABLE 3: Reliability Scores of the AGREE instrument \n\n\n\n Single rater ICC \n\n\n\n(95% CI) \n\n\n\nReliability Measures \n\n\n\nAverage of raters ICC \n\n\n\n(95% CI) \n\n\n\nCronbach alpha P value \n\n\n\nScope 0.27  (0.17 to 0.38) 0.60 (0.44 to 0.71) 0.63 0.00 \n\n\n\nParticipation 0.05 (0.003 to 0.10) 0.19 (- 0.12 to 0.43) 0.34 0.00 \n\n\n\nRigour 0.20 (0.14 to 0.27) 0.67 (0.57 to 0.75) 0.68 0.00 \n\n\n\nClarity 0.1 (0.04 to 0.18) 0.36 (0.1 to 0.55) 0.43 0.00 \n\n\n\nApplicability 0.12 (0.04 to 0.21) 0.36 (0.13 to 0.53) 0.39 0.00 \n\n\n\nEditorial \n\n\n\nIndependence \n\n\n\n-0.80 (-0.16 to 0.01) - 0.3 (-1.3 to 0.2) - 0.33 0.96 \n\n\n\n \nfor guidelines production (especially \n\n\n\ndevelopment of evidence-based CPGs) \n\n\n\nand evaluation during the period under \n\n\n\nassessment. There was also no clear \n\n\n\nguidance on the integration of multiple \n\n\n\nstakeholders. Most of the guidelines did \n\n\n\nnot have enough multidisplinary \n\n\n\nrepresentatives in the development \n\n\n\nprocess. In order to balance the interests, \n\n\n\npreferences and knowledge of different \n\n\n\nstakeholders whose participation in the \n\n\n\nguideline development process is \n\n\n\nrequired, a more integrated approach is \n\n\n\nrequired. \n\n\n\n\n\n\n\nSecondly, low quality scores of the \n\n\n\nMalaysia guidelines could be explained \n\n\n\nby a slower penetration and \n\n\n\nconsolidation of the evidence-based \n\n\n\nmedicine concept in comparison to \n\n\n\ndeveloped countries. Before the year \n\n\n\n2002, the awareness of evidence-based \n\n\n\nmedicine concept amongst the healthcare \n\n\n\npractitioners was still low in Malaysia. \n\n\n\nIn the United States, the Consensus \n\n\n\nDevelopment Program at the National \n\n\n\nInstitute of Health developed its first \n\n\n\nguideline in 1977. In the last 30 years, all \n\n\n\nthese organizations have accumulated a \n\n\n\nvast experience in guideline \n\n\n\ndevelopment, dissemination and \n\n\n\nimplementation. Currently, principles of \n\n\n\nevidence-based-medicine dominate \n\n\n\nalmost all of these national guideline \n\n\n\nprograms. The creation of international  \n\n\n\n\n\n\n\nnetworks, like the Guidelines \n\n\n\nInternational Network (G-I-N), as well \n\n\n\nas the establishment of projects like the \n\n\n\nAGREE, have clearly contributed to the \n\n\n\nimprovement and standardization of \n\n\n\nthese processes in the participating \n\n\n\ncountries. Contrastingly, Malaysia, did \n\n\n\nnot take part in any of these activities \n\n\n\nexcept until recently. Diffusion and \n\n\n\ndissemination of appropriate methods for \n\n\n\nevidence-based guidelines development \n\n\n\nis limited in Malaysia. This study found \n\n\n\nthat until 2003, this process was not \n\n\n\nsystematized and the development of \n\n\n\nCPGs still relied heavily on the opinion \n\n\n\nof experts. The manual development of \n\n\n\nevidence-based CPGs was drafted in \n\n\n\n2003. \n\n\n\n\n\n\n\nThirdly, limited accessibility to updated \n\n\n\nbiomedical literature can negatively \n\n\n\nimpact on the use of relevant and \n\n\n\nimportant evidence to support guidelines \n\n\n\nrecommendations. Most of the \n\n\n\ngovernment facilities had very limited \n\n\n\naccessibility to current biomedical \n\n\n\nliterature due to the financial constrain. \n\n\n\nEven after the broad agreement on the \n\n\n\nneed for systematic reviews to inform \n\n\n\nrecommendations, this type of evidence \n\n\n\nwas rarely referred in Malaysian \n\n\n\nguidelines. Therefore, networking \n\n\n\nactivities between guideline producers \n\n\n\nshould also be promoted.  \n\n\n\n \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 11 \n\n\n\nAnother factor that could have \n\n\n\ninfluenced the quality of Malaysian \n\n\n\nguidelines is the lack of economical and \n\n\n\nhuman resources devoted to guideline \n\n\n\nproduction. Since the cost of producing \n\n\n\nevidence-based guidelines is relatively \n\n\n\nhigh, a systematic methodology to adapt \n\n\n\ninternational guidelines would be an \n\n\n\nefficient way of improving not only the \n\n\n\nquantity but also their quality \n18\n\n\n\n. \n\n\n\nInternationally developed guidelines can \n\n\n\nbe adapted to the local context, \n\n\n\nrepresenting a considerable saving of \n\n\n\nmoney. However, an explicit and \n\n\n\nsystematic adaptation process should be \n\n\n\nperformed as guidelines' applicability \n\n\n\nand transferability can be strongly \n\n\n\ninfluenced by different factors, such as \n\n\n\npopulation needs (prevalence of disease, \n\n\n\nbaseline risk status), setting (availability \n\n\n\nof resources) and other factors that \n\n\n\nmodify translation of recommendations \n\n\n\ninto practice \n19\n\n\n\n.  \n\n\n\n\n\n\n\nAlthough many of the Malaysian \n\n\n\nguidelines were classified as evidence-\n\n\n\nbased, a thorough review of their quality \n\n\n\nutilizing the AGREE instrument led to \n\n\n\nthe authors to recommend the guidelines \n\n\n\nonly with provisos or alterations. \n\n\n\nOverall, almost all the guidelines \n\n\n\nperformed poorly with respect to \n\n\n\napplicability. Most of the guidelines \n\n\n\nfailed to address issues of barriers to \n\n\n\nimplementation, monitoring criteria, and \n\n\n\nevidence of pilot testing.  \n\n\n\n\n\n\n\nOn the other hand, the study on the \n\n\n\nclinical practice guidelines in Argentina \n\n\n\n(1994\u20132004) \n7\n by Mar\u00eda Eugenia Esandi \n\n\n\nand Zulma Ortiz et al. scored lower in \n\n\n\nthe overall standardized scores.  Overall \n\n\n\nstandardized score for each domain \n\n\n\nwere: Scope & Purpose (overall score \n\n\n\nwas 39%); Stakeholder Involvement \n\n\n\n(overall score was 13%); Rigor & \n\n\n\nDevelopment (overall score was 10%); \n\n\n\nClarity and presentation (overall score \n\n\n\nwas 42%); Applicability (overall score \n\n\n\nwas 6%); Editorial Independence \n\n\n\n(overall score was 0%). \n\n\n\n\n\n\n\nOne of the key factors regarding the \n\n\n\nadequacy of the guidelines pertains to \n\n\n\nthe rigor of development. Many of the \n\n\n\nguidelines did not clearly delineate the \n\n\n\nliterature review methodology used or \n\n\n\nthe mechanism by which \n\n\n\nrecommendations were formulated. This \n\n\n\nstep is crucial in determining whether the \n\n\n\nrecommendations were truly based on \n\n\n\nevidence or in understanding how \n\n\n\nevidence was synthesized. \n\n\n\n\n\n\n\nAs in the evidence-based decision \n\n\n\nmaking, patient preferences and \n\n\n\nexperiences should be factored into \n\n\n\ndecisions regarding clinical care, \n\n\n\nespecially in diseases such as cancer in \n\n\n\nwhich treatments can have significant \n\n\n\nmorbidity and can impact on quality of \n\n\n\nlife. All guideline committees should \n\n\n\nhave patient representatives and all \n\n\n\nliterature reviews specifically addresses \n\n\n\nquality of life when available. \n\n\n\n\n\n\n\nFinally, findings of this assessment \n\n\n\nhighlighted the need of improving the \n\n\n\nreporting of the editorial independence \n\n\n\nof guideline producers. Practically none \n\n\n\nof the Malaysian guideline reported \n\n\n\nconflict of interests or funding sources. \n\n\n\nLack of transparency was also reported \n\n\n\nby Papanikolaou et al. in an evaluation \n\n\n\nof 191 published guidelines: only 7 \n\n\n\n(3.7%) disclosed potential conflicts of \n\n\n\ninterest \n20\n\n\n\n. In the case of the Malaysian \n\n\n\nguidelines, omission could have been \n\n\n\nunintentional or, on the contrary, \n\n\n\nintentional (financial ties might have \n\n\n\nexisted in some situations and \n\n\n\ndeliberately hidden by guideline \n\n\n\nauthors). However, regardless of the \n\n\n\nintent of guideline developers' actions, \n\n\n\nexplicit declaration of conflict of \n\n\n\ninterests at the beginning of the process \n\n\n\nis strongly recommended by most \n\n\n\ninternational organizations as a way of \n\n\n\nreducing the probability of biased \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 12 \n\n\n\nrecommendations and increasing \n\n\n\nguidelines' credibility \n21\n\n\n\n. \n\n\n\n\n\n\n\nThere were several limitations noted in \n\n\n\nour study.  It should be noted that in the \n\n\n\nAGREE instrument, the appraiser have \n\n\n\nto choose from four categories (1, 2, 3, \n\n\n\n4) for his /her evaluation.  Secondly, \n\n\n\nbecause we relied on materials reported \n\n\n\nin the published versions of the \n\n\n\nguidelines, our findings could be \n\n\n\naffected not only by the quality of the \n\n\n\nguidelines themselves but also by the \n\n\n\nquality of the reporting process. It was \n\n\n\npossible that in some cases, guideline \n\n\n\ndevelopers used appropriate techniques \n\n\n\nbut did not report them. We attempted to \n\n\n\nminimize this by including in our \n\n\n\nevaluation any background on \n\n\n\nsupporting articles if they were available. \n\n\n\nHowever we feel that just as in other \n\n\n\nmedical reports, documentation of \n\n\n\nmethods used is important, and if \n\n\n\nexplicitly stated can help determine the \n\n\n\nvalidity of recommendations. Thirdly, \n\n\n\nusing the AGREE instrument, the inter-\n\n\n\nrater reliability was only poor to \n\n\n\nmoderate. Some of the variability may \n\n\n\nbe due to differences in interpretation of \n\n\n\nseveral items where the instructions were \n\n\n\nbroad. Another potential limitation of the \n\n\n\nAGREE instrument concerns the validity \n\n\n\nof the responses to the question on the \n\n\n\noverall assessment of the guideline. \n\n\n\nAlthough the reviewers were instructed \n\n\n\nto consider the domain scores when \n\n\n\nmaking a decision about whether or not \n\n\n\nto recommend the guideline, no clear \n\n\n\nrules were established. \n\n\n\n\n\n\n\nIn Malaysia most practitioners, before \n\n\n\nthe year 2003, were not clear of \n\n\n\nprocesses involves in evidence-based \n\n\n\nmedicine approach. Most were still \n\n\n\ndoing with consensus-consulting and \n\n\n\nagreeing to expert opinions. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nTo our knowledge this is the first time a \n\n\n\nstudy of this kind has been undertaken in \n\n\n\nMalaysia. Its execution was the first step \n\n\n\nin the building a network of \n\n\n\nprofessionals interested in improving \n\n\n\nevidence-based CPG development, \n\n\n\ndissemination and implementation in the \n\n\n\ncountry. Its findings have been found to \n\n\n\nbe very useful in improving the \n\n\n\nmethodological quality of developing \n\n\n\nCPGs in Malaysia.           \n\n\n\n\n\n\n\nConclusion \n\n\n\n\n\n\n\nThis study was one of the firsts that \n\n\n\nsystematically employed the AGREE \n\n\n\ninstrument for the critical assessment of \n\n\n\nguidelines produced in Malaysia. The \n\n\n\nAGREE instrument can serve as a model \n\n\n\nto identify improvement opportunities in \n\n\n\nthe guidelines development process of \n\n\n\nMalaysia. In this sense, this research \n\n\n\nshows the low quality of guidelines \n\n\n\nproduced and points out areas to which \n\n\n\ntraining initiatives should be oriented. \n\n\n\n\n\n\n\nA review of the current Malaysian \n\n\n\nguidelines demonstrates that many of the \n\n\n\nclinical topics of interest have been \n\n\n\nconsidered by at least one guideline. \n\n\n\nNone covers all the necessary elements. \n\n\n\nFurthermore, although these guidelines \n\n\n\nmay accurately reflect clinical practice, \n\n\n\nfew adhere to the standards set forth by \n\n\n\nthe AGREE instrument. \n\n\n\n\n\n\n\nSeveral approaches could be used to \n\n\n\nimprove the quality of guidelines. The \n\n\n\nguideline producers could become \n\n\n\nfamiliar with guideline development \n\n\n\nstandards that have been established and \n\n\n\nmake greater efforts to incorporate them \n\n\n\ninto guidelines, strive to widely adopt \n\n\n\nand use them. \n\n\n\n\n\n\n\n\nMalaysian Journal of Pharmacy Vol. 1 Issue 10, 2012                   \n\n\n\n 13 \n\n\n\n\n\n\n\nAcknowledgement \n\n\n\n\n\n\n\nThis research project was sponsored by \n\n\n\nthe Small Research Grant, Government \n\n\n\nof Malaysia (Project Code: MRG-2004-\n\n\n\n5) \n\n\n\n\n\n\n\nWe would like to thank the following for \n\n\n\ncontributing their precious idea and \n\n\n\nadvice to lead us to the successful write \n\n\n\nup of this project: \n\n\n\n\n\n\n\n\uf0b7 Dato\u201fDr. Zaki Morad, Director of \n\n\n\nClinical Research Centre HKL \n\n\n\n\uf0b7 Dr Sivalal,  Unit Head of Health \n\n\n\nTechnology Assessment \n\n\n\n\uf0b7 Dr Jamaiyah Haniff, Principal \n\n\n\nAssisstant Diector, Clinical Research \n\n\n\nCentre \n\n\n\n\uf0b7 Dr Rusilawati  Jawdin, Principal \n\n\n\nAssisstant Diector, Health \n\n\n\nTechnology Assessment unit \n\n\n\n\uf0b7 Matron Jaya Devi, Health \n\n\n\nTechnology Assessment Unit \n\n\n\n\uf0b7 Dr Maizun Mohd Zain, Principal \n\n\n\nAssisstant Diector, Evidence-based \n\n\n\nmedicine Unit \n\n\n\n\n\n\n\nReferences \n\n\n\n\n\n\n\n1. 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